LEW 14 BOROUGH OF LEWISHAM. Annual Report on the Vital Statistics and Sanitary Condition of the BOROUGH OF LEWISHAM, For the Year 1926, 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 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. 1929-26. 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 1926-27. Chairman:— Councillor E. W. Hayes (ex-Mayor). Ex-Officio:— His Worship the Mayor (Councillor Albert E. Webb, 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 ,, G. W. Ilsley ,, A. E. McAdam „ A. E. Markham ,, Miss G. M. Mason „ J. D. Pain „ Mrs. G. Pinnell ,, Mrs. A. Wightwick C. W. Woolston MATERNITY AND CHILD WELFARE COMMITTEE. 1929-26. 1926-27. Chairman:- Chairman:- Councillor Mrs. E. Edwards. Councillor Mrs. G. Pinnell Ex-Officio:— Ex-Officio:— His Worship the Mayor His Worship the Mayor (Councillor Edwin W. Hayes, J.P.) (Councillor Albert E. Webb, J.P.) The Members of the Public Health Committee, together with the following ladies representing the Voluntary Infant Welfare Centres— Miss M. Barrett Miss J. Howes Miss M. Barrett Miss J. H. Howes Mrs. B. B. Beven Mrs. M. Kemp Miss A. Burrows Mrs. M. Kemp Miss A. C. E. Fuller Mrs. E. M.White Miss A. C. E. Fuller Mrs. E. M. White Mrs. H. M. Wigmore Mrs. H. M. Wigmore 4 Staff of the Public Health Department. MEDICAL: A. Wellesley Harris, M.R.C.S., D.P.H., &c., 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., B.S., B.Sc., 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 Sanitary Inspectors. B. A. Knappett W. S. Parsons S. P. Rayner Miss N. F. Jones Health Visiting Staff: Miss F. L. Burton Miss A. M. M. Edwards Health Visitors for Miss K. H. Kempster Miss G. Simpson Maternity and Miss C. H. Thompson child Welfare Miss E. M. Watson Miss E. Brocklehurst Health Visitors for Mrs. M. S. Wardle 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. Iles. „ ,, —Tuberculosis Dispensary—Miss M. Colquhuon. Secretary to Tuberculosis Care Committee—Miss O. Fergusson. Superintendent—Disinfection Station—H. T. Ibbett. Caretaker-Attendant—Coroner's Court and Mortuary—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-sixth Annual Report on the Vital Statistics and Sanitary Condition of the Borough for the year ended 31st December, 1926. Vital Statistics.—The statistical figures contained in this Report are calculated upon the estimated population supplied by the Registrar-General, amounting to 187,800. Death-rate.—The total number of deaths occurring among residents amounted to 1,890, equivalent to a death-rate of 10.0 per thousand of the population, the lowest recorded death-rate in London. In Table 3 the causes of death are set out in detail, showing that out of the total number of 1,890 deaths, 246 were attributed to Cancer, 204 to diseases of the Heart, 159 to Pneumonia in all its forms, and 135 to Pulmonary Tuberculosis. The infant mortality rate of 40 per thousand births constitutes a new record, being the lowest ever recorded in Lewisham, and also the lowest in all the Metropolitan Boroughs. It is gratifying to note that the work carried out by your Council in relation to Child Welfare has had a steady beneficial effect during the last 25 years. This is very graphically shown in the chart enclosed in the Report, from which you will sec that the infant mortality rate has fallen from 128 per thousand births in 1901 to 40 in 1926. Infectious Disease:-During the year 478 cases of Scarlet Fever were notified, compared with 383 cases in 1925. Of the total, 413 were removed to Hospital. The disease was of an exceedingly mild type, only two cases of the total proving fatal. 6 Three hundred and ninety-nine cases of Diphtheria were notified, compared with 256 in the previous year. Of this number, 377 were removed to Hospital for treatment. Enteric Fever—including Paratyphoid.—Fifteen cases were notified, ten of which were removed to Hospital. Only one case proved fatal. Puerperal Fever and Puerperal Pyrexia.— Six cases of Puerperal Fever were notified, five of which were treated in hospital. New regulations in regard to this disease came into force in October—The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. Your Council, as required by the regulations, made special arrangements with St. John's Hospital for the services of a specialist to consult with medical practitioners. These arrangements have up to the present worked exceedingly well, and it is an advantage that the specialist is also in charge of the Pathological Laboratory, so that he is able to make bacteriological examinations without any delay. Tuberculosis— During the year under review 378 primary notifications were registered in the Borough, compared with 344 cases in the previous year. The deaths notified as due to Tuberculosis amounted to 135, giving a death-rate for this disease of .71 per thousand inhabitants, compared with .63 in 1925. Maternity Home.—During the year 315 confinements took place in the Home, particulars of the cases being fully set out in Dr. Miller's report appended hereto. It is satisfactory to note that the popularity of the Maternity Home increases every year. The accommodation was increased from 12 to 17 beds in 1924, and every year shows the necessity for further increase in this direction. In conclusion, I wish to express my appreciation of the kind consideration afforded me by your Council and Committees. 7 and to thank my colleagues and staff for their loyal support and assistance. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, awellisley Harris July, 1927. Medical Officer of Health. 9 Summary of Vital Statistics for the year 1926. Number of Births:— Legitimate 2,798 Total 2,885 Illegitimate 87 Birth-rate 15.36 Number of Deaths 1,890 Death-rate 10.0 Maternal Mortality:—Number of From Sepsis Nil. women dying in, or in Total 6 consequence of child-birth ,, other causes 6 Deaths of Infants under One year of age: — Legitimate 105 Illegitimate 11 Total 116 Infantile Mortality Rate, per 1000 births: — Legitimate 37 Illegitimate 126 Total 40 Deaths from Measles (all ages) 15 „ „ Whooping Cough (all ages) 6 ,, ,, Diarrhoea (under 2 years of age) 11 Deaths from Pulmonary Tuberculosis, 135. Death-rate, 0.71. 11 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 1926 is 187,800. This estimate is supplied for use in calculating the vital statistics, and has been derived from the Census population in 1921, after allowance for the births, deaths and migration which occurred between the Census date and the 30th June last. It is explained that in the absence of definite information regarding migration between localities, the allowance made for this element of the movement is necessarily an approximate one. The method adopted has been applied impartially to all areas of the country, and the Registrar-General believes that for the majority of areas the resulting population may be accepted as sufficiently accurate for the purposes they are intended to serve. As I pointed out in my last Annual Report, there is every reason to believe, when local circumstances are taken into consideration, that the population of this Borough is considerably larger than the Registrar-General estimates, but as we have no reliable factor on which to base an estimate, we shall have to await the Census of 1931 in order to see whether this surmise is correct. 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. 12 Rateable Value.—The rateable value of the Borough at 30th September, 1926, was £1,330,882, and the estimated product of a penny rate £5,400. Births. The number of births registered in 1926 was 2,885, of which number 1,493 were males and 1,392 females. This number represents a birth-rate of 15.36, which is, with the exception of the years 1917-18, the lowest ever recorded in this Borough. [ The following Table gives the number of births and the birth-rate during the last ten years: — Table 1, Births. Birth-rate. 1917 2,686 14.9 1918 2,362 13.8 1919 2,910 16.6 1920 3,984 22.8 1921 3,433 19.4 1922 3,208 18.2 1923 3,297 18.1 1924 3,066 16.3 1925 2,907 15.6 1926 2,885 15.3 Illegitimacy.—The number of births registered of infants born out of wedlock was 87, equivalent to 3.0 per cent. of the total. Deaths. The total number of deaths of residents of the Borough was 1,890, compared with 1,927 in the previous year. This number represents a death-rate of 10.0 per thousand of the population, and is the lowest recorded in this Borough since 1909. According to statistics published by the Registrar-General, this death-rate was the lowest recorded in any of the Metropolitan Boroughs. Causes of Death. In Table No. 3, the causes of death are set out in detail, and only the following items call for comment: — Cancer.—The deaths from cancer and malignant diseases 13 numbered 246, compared with 267 in the previous year, and equal to 13.0 per cent. of the total deaths. Zymotic Diseases.—The deaths from the diseases grouped under this heading during the year 1926 and previous years are set out in Table 2. The death-rate from these diseases (excluding Diarrhoea and Enteritis) was 0.18, compared with 0.37 in 1925. Table 2. 1922. 1923. 1924. 1925. 1926. Enteric Fever 1 2 2 1 1 Measles 17 2 17 3 15 Scarlet Fever 12 7 5 2 2 Whooping Cough 13 8 11 18 6 Diphtheria 32 27 10 17 10 Diarrhoea and Enteritis 18 30 12 17 11 Violence and Suicide.—The deaths from violence numbered 75, and from Suicide, 13. Twenty-four 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 116, compared with 160 in the previous year, and the infant mortality rate was 40 per thousand births, which is the lowest rate ever recorded in the Borough, and, for the year under review, the lowest recorded in any of the Metropolitan Boroughs. Marriages. The number of marriages registered in the Borough during the year was 1,340, of which number 730 were solemnized in the Established Church, 154 at Non-Conformist places of worship, and 456 at the Register Offices. This number is equivalent to a marriage rate of 14.2 per thousand of the population. In 1925, 1,414 marriages were registered, and the marriage rate was 12.0. 14 Table 3. Causes of Death during the Year 1926. Causes of Death. Nett Deaths at subjoined ages of Residents occurring within and without the District. Total Deaths at all Ages. 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 5 6 3 1 - - - - 6 9 15 4. Scarlet Fever - - 2 - - - - - - 2 2 5. Whooping Cough 3 1 2 - - - - - 2 4 6 6. Diphtheria - 1 4 4 - - 1 - 6 4 10 7. Influenza - - - 1 1 2 8 12 11 13 24 8. Erysipelas — 1 — 1 - 2 - - 2 2 4 9. Pulmonary Tuberculosis — — — 2 36 63 34 - 77 58 135 10. Tuberculous Meningitis — 1 3 9 2 - - - 10 5 15 11. Other Tuberculous Diseases — — 2 2 1 2 3 2 5 7 12 12. Cancer — — — 1 2 14 112 117 124 122 246 13. Rheumatic Fever - - - 5 2 2 - 1 5 5 10 14. Meningitis 1 — 1 2 - - 1 - 2 3 5 15. Organic Heart Disease — — — 2 7 15 63 117 81 123 204 16. Bronchitis 7 2 1 1 1 1 18 105 60 76 136 17. Pneumonia (all forms) 21 13 8 8 2 23 34 50 74 85 159 18. Other Respiratory Diseases — — 1 - — 5 9 14 13 16 29 19. Diarrhœa and Enteritis 10 1 — - — - - - 6 5 11 20. Appendicitis & Typhlitis — - - 1 2 1 8 1 8 5 13 21. Cirrhosis of Liver — — - - - - 6 3 6 3 9 21a. Alcoholism - - - - - 1 1 1 2 1 3 22. Nephritis & Bright's Disease — — — 1 7 13 17 23 30 31 61 23. Puerperal Fever — — — - - - - - - - - 24. Other accidents and diseases of Pregnancy & Parturition - - - - - 6 - - - 6 6 25 Congenital Debility, Pre mature Birth 48 1 1 1 - - - - 36 15 51 26. Violent Deaths, excluding Suicide 1 1 3 7 9 9 14 31 45 30 75 27. Suicide — — — — 1 7 4 1 7 6 13 28. Other Defined Diseases 20 6 5 10 11 54 142 387 289 346 635 29. Diseases ill-defined or unknown — - - - - - - - - - - Totals 116 34 36 59 84 220 476 865 908 982 1890 SubEntries. 14(a). Cerebro-spinal Meningitis - - - 1 - - - - 1 - 1 28(a). Polio-Myelitis — — - - - - - - - - - 28(b). Encephalitis Lethargica - - - 1 - - 1 - 2 - 2 included in above figures. 17 (a). Lobar-pneumonia 2 1 1 2 1 11 23 10 29 22 51 17(b). Pneumonia (type not stated) 1 - - 2 - 3 1 8 7 8 15 BOROUGH OF LEWISHAM. CHART SHOWING THE INFANT MORTALITY RATE DURING THE YEARS 1901 to 1926. 15 Table 4 Infant Mortality, 1926. 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 under4 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 1 One Year Smallpox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - 1 1 3 5 Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - 1 1 1 3 Diphtheria - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - — — — — - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - 1 - - 1 Convulsions - 1 1 - 2 1 1 - - 4 Laryngitis - - — — — — - — — - Bronchitis - — — — — 3 3 - 1 7 Pneumonia (all forms) 1 - - 1 2 6 1 4 8 21 Diarrhœa - - - - - - - - - - Enteritis - 2 — — 2 5 - 1 2 10 Gastritis — — — — — — — — — - Syphilis - - - — — - - - - - Rickets — — — - - - - - - - Suffocation, overlying 1 — — — 1 — — — — 1 Injury at birth 3 — — — 3 — — — — 3 Atelectasis 2 - — — 2 - - - - 2 Congenital Malformations 4 — — 1 5 2 - - 1 8 Premature birth 24 — — — 24 1 — - — 25 Atrophy, Debility & Marasmus 3 1 1 — 5 5 3 1 1 15 Other Causes 4 3 — — 7 1 — 1 2 11 Totals 42 7 2 2 53 24 11 9 19 116 Mortality Rate per 1000 Births. Deaths of Illegitimate Children under 1 year of age 11 37 „ Legitimate „ „ „ 105 126 16 Table 5. Comparative Statistics of Metropolitan Cities, and Boroughs for the Year 1926. Boroughs. Estimated Population Mid-year, 1925. Death Rate. Birth Rate. Infant Mortality. Rate per 1000 Births. County of London 4,602,000 11.4 17.1 64 West. Paddington 147,100 12.3 15.4 84 Kensington 179,400 12.4 15.1 61 Hammersmith 134,500 11.3 16.3 67 Fulham 163,700 10.7 16.3 65 Chelsea 61,800 12.4 13.3 65 City of Westminster 139,600 11.2 11.3 62 North. St. Marylebone 106,100 12.6 12.8 82 Hampstead 88,040 10.1 12.2 58 St. Pancras 215,900 12.2 16.8 76 Islington 339,200 12.0 18.5 67 Stoke Newington 53,190 11.0 15.6 49 Hackney 228,300 10.6 17.3 60 Central. Holborn 43,315 11.7 12.4 90 Finsbury 77,560 12.8 20.6 67 City of London 13,340 10.9 7.9 66 East. Shoreditch 107,300 11.9 23.3 66 Bethnal Green 119,800 11.6 20.9 72 Stepney 255,370 11.7 19.7 65 Poplar 168,500 11.3 21.7 70 South. Southwark 189,000 12.7 20.2 70 Bermondsey 123 000 11.9 20.8 56 Lambeth 311,100 11.5 17.2 54 Battersea 172,100 11.2 17.3 61 Wandsworth 340,900 10.4 14.3 64 Camberwell 275,400 11.0 16.6 64 Deptford 115,900 11.1 18.2 56 Greenwich 102,936 10.9 17.8 63 Lewisham 187.800* 10.0 15.3 40 Woolwich 140,740 10.1 16.9 42 *1920 Population. 17 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. (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-Pox.—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 situated1 a short distance from the Borough boundary, and the London General Hospitals, are also largely used by the inhabitants. 18 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, and 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) Voluntary. 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 1926, 191 bodies were received into the Mortuary, and 190 inquests held. Post-mortem examinations numbered 94. 19 Public Health Officers of the Council. The names and qualifications of those members of the Staff of the Public Health Department for whom a salary grant is received, 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.Ii. and Maternity and Child Welfare Medical Officer. †Jordan, Rose F. M.D.,B.S.,B.Sc., D.P.H. Tuberculosis Officer (part-time). †Ruddy, Mary K. M.R.C.S., L.R.C.P. Infant Welfare Medical 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 *HolifieId,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 20 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) files, 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 are available for nursing cases 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. 21 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 1926 were as follows: — Van Loads 13,499 Cart Loads 10,828 Motor Loads 5,452 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 1926:— Dust Destructors 33,785 tons Trained away 1,551 ,, Shoots 118 ,, Total 35,454 tons Sanitary Inspection of the Borough. The work carried out by the Sanitary Inspectors, and the nuisances discovered, are shewn in the following Tables: — Table 6. Work of Male Sanitary Inspectors. Nature of Inspection. No. Complaints investigated 1,177 Enquiries re Infectious Diseases 955 Milkshops 360 Cowhouses 60 Slaughterhouses 534 Food - stalls 410 Stable-yards and Motor Garages 8 Houses let in Lodgings 29 Smoke Observations 12 House-to-House Inspections 1,287 Miscellaneous Inspections 901 22 Woman Sanitary Inspector. — This Officer is 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 7. Nature of Work. No. of Inspections. Factories and Workshops 393 Outworkers 372 Complaints 229 Infectious Diseases 1,021 Miscellaneous 90 Return Visits 684 Table 8. Nuisances discovered and dealt with by the Public Health Department. Dirty and Dilapidated Premises 1200 Defective Soil and Ventilating Pipes— Defective Roofs 591 Defective Rain-water Pipes and Gutters 472 (a) necessitating replacement 111 (b) „ repair 89 Damp Premises 665 Dust-bins requiring replacement 372 Defective Drains— Foul or Uncovered DrinkingWater Cisterns 100 (a) necessitating struction 139 (b) „ repair 249 Defective or Unpaved Yards 224 Defective Water-Closets— Offensive Accumulations 95 (a) necessitating replacement 261 Improperly Kept Animals 19 (b) „ repair 278 Houses without proper supply of water 76 Defective Waste Pipes 248 Notices.—"Intimation" notices were served to the number of 2,172, and "Statutory" notices, 425. Legal Proceedings. — Details of proceedings instituted under the Public Health and kindred statutes are summarised in the following Table: — 24 Table 10. Workshops on Register (other than Domestic Workshops'). Trade or Business. Workshops. Workrooms No. of Employees. Male. Female. Blacksmith 15 16 31 Boot Repairers 90 91 120 — Builders 59 88 215 — Cabinet-making and Joinery 23 34 65 — Carriage Builders 7 14 21 — Cycle Repairers 25 30 41 — Dentists 47 48 68 9 Dressmakers 68 76 1 382 Ironmongers 7 8 14 — Jewellery, Watch, etc., Repairs 42 44 64 2 Laundries 22 59 7 67 Millinery 25 26 — 84 Motor Repairers 50 58 102 Photographers 21 38 27 25 Picture Framers 13 16 15 3 Tailors 55 68 83 41 Umbrella Makers and Repairers 20 47 21 16 Undertakers 9 11 10 Upholsterers 35 47 60 20 Miscellaneous 132 172 312 191 Totals 665 991 1277 840 Table 11. Factories on Register. Trade or Business. No. Trade or Business. No. Boot-making & Repairing 48 Motor Manufacturers and Repairers 35 Builders 13 Carriage Builders 10 Printers 25 Electrical and other Engineering 32 Timber Merchants 17 Miscellaneous 61 Laundries 17 Totals 263 25 Table 12. Domestic Workshops on Register (excluding Outworkers). Trade or Business. No. Employees. Male. Female. Boot Repairers 70 72 Cabinet-making and Joinery 4 5 — Cycle Repairers 2 2 — Dressmakers 35 — 42 Jewellery and Watch Repairs 15 17 — Laundry 13 — 18 Millinery 6 — 6 Picture Framers 3 3 — Tailors 19 19 1 Umbrella Makers 4 4 2 Wig-makers 2 2 - Miscellaneous 38 40 6 Totals 211 164 75 Homework. — Outworkers on Register. Lists of Outworkers received from Employers 83 Addresses of Outworkers:— Received from other Authorities 240 Forwarded to „ „ 159 Visits made to Outworkers 1139 26 Table 13. Inspections. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 603 34 — Workshops (including Workshop Laundries) 1560 57 — Workplaces (other than Outworkers' premises) 152 23 — Total 2315 114 — Table 14. Defects Found. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (1) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 21 21 — — Want of ventilation - — - — Overcrowding 4 4 — — Want of drainage of floors 1 1 — — Other nuisances 16 16 - — Sanitary accommodation insufficient 1 1 - - unsuitable or defective 52 52 - - not separate for sexes 1 1 — — Offences under the Factory and Workshop Acts :— Illegal occupaion 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 96 96 — — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 27 SECTION IV.-HOUSING. Ministry of Health Summary of Housing Statistics, 1926. Number of new houses erected during the year: — (a) Total (including numbers given separately under (b)) 1326 (b) With State assistance under the Housing Acts:— (1) By the Local Authority None, (ii) By other bodies or persoas 739 1. Unfit dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2706 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 1296 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 1734 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 972 3. Action under Statutory Powers. A.—Proceedings under section 3 of the Housing Act, 1925 Nil. 28 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 350 (2) Number of dwelling-houses in which defeats were remedied after service of formal notices: — (a) By owners 350 (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 1 (3) Number of dwelling-houses in respect of which Closing Orders were determined Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made 1 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 House-to House Inspection. A routine inspection of the houses comprised in the roads set out below was carried out during the year by the Sanitary Inspectors delegated to this particular duty:— Name of Road. No. of houses inspected. Name of Road. No. of houses inspected. Acacia Road 39 Laurel Grove 19 Burford Road 60 Leahurst Road (part) 167 Conington Road 26 Lethbridge Road 49 Doggett Road 87 Mill Road 86 Elswick Road 77 Mount Pleasant Cottages 6 Ewart Road 123 Myrtle Grove 28 Fambridge Road 18 Orchard Cottages 11 Fransficld Grove 29 Rubens Street 28 Halifax Street 37 Rutland Road 31 Haseltiine Road 31 Stanton Road 8 Herschell Road 21 Stanton Square 40 Holmshaw Road 63 Tugela Street 51 Kangley Bridge Road 31 Watlington Grove 42 Kelvin Grove 16 29 The total number of houses inspected was 1,224, and in 866 houses defects were found, necessitating the service of Notices under the Public Health (London) Act, 1891. Statistics relating to Occupancy:— 1 house contained 5 families. 6 houses ,, 4 ,, 66 ,, „ 3 „ 467 ,, ,, 2 „ 687 ,, „ 1 family. One-roomed Tenements.—109. 3 were occupied by 6 persons. 11 ,, ,, ,, 5 ,, 13 ,, ,, ,, 4 ,, 17 ,, ,, ,, 3 ,, 15 ,, ,, ,, 2 ,, 50 ,, ,, „ 1 person. Two-roomed Tenements.—304. 4 were occupied by 7 persons. 1 1 ,, ,, ,, 6 ,, 24 ,, ,, ,, 5 ,, 52 ,, ,, ,, 4 ,, 70 ,, ,, ,, 3 ,, 110 ,, ,, ,, 2 ,, 33 „ „ „ 1 person. Three-roomed Tenements.—441. 1 was occupied by 10 persons. 3 were ,, ,, 9 ,, 6 ,, ,, ,, 8 ,, 15 ,, ,, ,, 7 ,, ,, 32 ,, ,, ,, 6 ,, 45 ,, ,, ,, 5 ,, 90 ,, ,, ,, 4 ,, 131 ,, ,, ,, 3 ,, 102 „ „ „ 2 „ 16 ,, „ „ 1 person. 30 SECTION V. INSPECTION AND SUPERVISION OF FOOD Milk Supply.—The bulk of the milk consumed by the inhabitants of the Borough is produced outside London, and we have only six licensed cowsheds in the Borough. Samples are frequently taken from retailers, both in shops and on the rounds, and submitted to analysis. Milk and Dairies Order, 1926.—This Order, made by the Ministry of Health under the provisions of the Milk and Dairies (Consolidation) Act, 1926, came into force on October 1st, 1926. This Order is designed to afford the milk supply of the country complete protection from contamination and infection during the whole process of production and distribution, and its numerous clauses provide for the inspection of the cattle, the hygiene of the farm, the cleanliness of the vessels in which it is conveyed to the distributor, and the condition of the dairies in which it is handled prior to distribution. In this Borough a comprehensive review of all premises on the register of dairies was carried out in the light of the more stringent regulations contained in the Order, and a newRegister compiled. The suitability of the premises for registration was judged from fche condition as to cleanliness, etc., of the room from which the milk was sold, and the nature of any other article sold, and in regard to the premises in which the milk was stored, the ventilation and lighting, the composition and construction of the floor, and the water supply and drainage were taken into consideration, together with the method of cleansing the utensils. In a few cases suggestions as to minor alterations were made, with a view to bringing the premises up to the necessary standard. In the case of eight retail shops it was necessary to recommend that the registration be revoked, in view of the unsuitability of the premises for the sale of milk from open vessels. 31 The number of premises now on the Register is 142, and during the year under review 360 inspections were made. Milk (Special Designations) Order, 1923.—The following is a list of the premises in respect of which Licences were issued for the production or sale of milk under the designations provided by this Order : — To produce and bottle " Grade A " Milk:— Burnt Ash Farm, Lee Messrs. Edwards & Sons, Ltd. To Pasteurise:— Station Buildings, Forest Hill Messrs. Edwards & Sons, Ltd. To sell by Retail:— Premises. Licencee. Designation. (See Footnote.) 17, Sydenham Road Edwards & Sons, Ltd. A, B, C, D, E. 290, Sydenham Road ,, ,, 116, Bromley Road ,, ,, 18, Bellingham Terracc ,, ,, 3, Perry Vale ,, ,, 195, Stan stead Road ,, ,, 108, Catford Hill ,, ,, 389, Brockley Road ,, ,, 30, Burnt Ash Road ,, ,, 109, Manor Lane ,, ,, 96, Verdant Lane ,, ,, 242, Brownhill Road ,, ,, 138, Rushey Green ,, ,, 30, Loampit Hill ,, ,, 1, Manor Park Parade ,, ,, 25, Dermody Road ,, ,, 22, Montpelier Vale Express Dairy Co., Ltd. A, C. 300, High Street, Lewisham ,, ,, 8, Bellingham Terrace ,, ,, 155, Ardgowan Road ,, ,, 188, Burnt Ash Hill ,, ,, 112, Wood Vale Curtis Bros. & Dumbrill, T.td. A, C, D, E. 1, Kirkdale Thos. French &Co., Ltd. A. 5, Sandhurst Market H. Lewis B. A = Certified: B = Grade A; C = Grade A (Tuberculin Tested): D = Grade A (Pasteurised): E = Pasteurised. Bacteriological Examinations. — During the year, twenty samples of "Certified" Milk and nine samples of "Grade A" Milk, consigned to dealers in this Borough, were submitted to bacteriological examination. In each case the sample was found to comply with the standard provided by the Regulations. Meat and other Foods.—All premises upon which food is prepared and sold are inspected regularly, and the following visits were made during the year: — Slaughterhouses 534 Cowhouses 60 Bakehouses 206 Restaurants and Eating-houses 294 Meatshops and Stalls 885 Sale of Food and Drugs Act. Four hundred and sixty-seven samples were taken under the Sale of Food and Drugs Acts, and submitted to the Public Analyst during the year. Of this number 357 were purchased officially in conformity with the provisions of the Acts, and the remaining 110 were bought informally as "test" samples. Five or 1.1 per cent, of the official samples were certified by the Public Analyst as being adulterated, or below legal standard, compared with 2.05 per cent, in 1925. 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 355 350 5 Separated Milk 2 2 — Total Official Samples 357 352 5 Informal Samples. Butter 31 29 2 Cream 10 10 — Preserved Cream 8 8 — Cocoa 9 9 — Coffee 13 13 — Flour 6 6 — Lard 6 6 — Mustard 9 9 — Medicinal Prescriptions 2 2 — Pepper 6 6 — Vinegar 4 4 — Imported Apples 6 4 2 Total Informal Samples 1 106 4 Totals, all Samples 467 458 9 33 Milk. — 355 samples of milk were submitted for analysis and of this number five or 1.1 per cent, were certified as adulterated or below the standard fixed by the Board of Agriculture and Fisheries. The average composition of these milk samples is set out below:— Period. Average Composition of all Samples submitted, Genuine and 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 3.45 8.86 3.46 8.87 3.0 8.5 Second ,, 3.47 8.89 3.47 8.89 Third ,, 3.46 8.90 3.47 8.90 Fourth ,, 3.68 8.90 3.71 8.91 Average for the Year 3.51 8.88 3.52 8.89 Public Health (Milk and Cream) Regulations. None of the samples of milk were reported as containing any preservative or colouring matter. Eight 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. Percentage of Preservative. Remarks. 127 0.35 per cent. Boric Acid Sold as Preserved Cream and labelled in accordance with the Regulations. 164 0.30 „ „ „ 166 0.35 ,, ,, ,, 167 0.30 „ ,, ,, 324 0.30 „ „ „ 325 0.35 ,, ,, ,, 340 0.30 ,, ,, ,, 341 0.32 ,, ,, ,, 34 Adulterated Samples. Administrative action taken in regard to the nine samples certified as adulterated or below the legal standard :— Article. Sample marked No. Result of Analysis. Action Taken. Milk 7 6 per cent, deficient in milk fat Partially frozen at time of purchase ; Vendor cautioned ,, 24 2 per cent, added water Vendor cautioned Imported Apples 19 Arsenic contamination 21 equivalent to l/100th of a grain per pound Milk 309 10 per cent, deficient in milk fat Vendor cautioned by direction of the Public Health Committee ,, 369 16 per cent, deficient in milk fat Prosecution — Summons dismissed on payment of 21s. costs Test Samples— 414 10 per cent, deficient in milk fat Ditto Butter 430 Margarine Subsequent official samples proved genuine ,, 431 ,, Ditto 35 SECTION VI.—Infectious Diseases. The notifications of infectious disease received during the year are summarised in Tables 15 and 16. Those relating to Tuberculosis are shewn in a separate Table. Table 15. Cases of Infectious Disease notified during 1926. Diseases. Total Cases notified. Cases admitted to Hospital. Total Deaths. Male. Female. Total. Small Pox - - - - - Scarlet Fever 217 261 478 413 2 Diphtheria 180 219 399 377 10 Enteric Fever (including Paratyphoid) 9 6 15 10 1 Puerperal Fever and Puerperal Pyrexia — 11 11 9 — Erysipelas 21 36 57 22 4 Pneumonia, Acute and Influenzal 102 59 161 98 — Malaria 3 3 1 — Dysentery - - - - — Encephalitis Lethargica 7 5 12 9 2 Acute Polio-Myelitis 1 - 1 1 — Cerebro-Spinal Meningitis 1 - 1 1 1 Ophthalmia Neonatorum 7 3 10 1 — 30 Disease. Number of Cases Notified. Table 16. Infectious Diseases Notified, 1926—Age Groups. At Ages—Years Total at all Ages 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 years 20 and under 35 years 35 and under 45 years 45 and under 65 years 65 and over Scarlet Fever 2 10 26 31 41 223 75 33 31 4 2 - 478 Diphtheria 3 7 10 31 34 174 71 21 33 11 1 — 399 Enteric Fever (including Paratyphoid) — - 1 1 — 3 3 3 3 — 1 — 15 Puerperal Fever — - — — — — — 1 9 1 — — 11 Erysipelas 1 1 1 — 1 2 2 3 9 5 27 5 57 Pneumonia (Acute & Influenzal) 10 7 6 2 1 24 9 10 31 23 30 8 161 Malaria — — — — — — — — 2 1 — — 3 Dysentery — — — — — — — — — — — — — - — 1 1 — 2 1 1 4 — 2 — 12 Acute Polio-Myelitis - - - - - 1 - - - - — — 1 Cerebro-Spinal Meningitis - - - - - - - - - - - - 1 Ophthalmia Neonatorum 10 - - - - - - - - - - - 10 37 Diseases. Age Groups. At all ages. Table 17. Deaths from Infectious Diseases, 1926. 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 years 20 and under 35 years 35 and under 45 years 45 and under 65 years 65 and over. Measles 5 6 — 2 1 1 — — — - — 15 Scarlet Fever — — 1 — 1 — — — — — — — 2 Enteric Fever - - - - - - - - - — 1 — 1 Whooping Cough 3 1 — 2 — — — — — — — — 6 Diphtheria — 1 1 1 2 4 — — — — 1 — 10 Influenza — — — — — 1 — — 2 1 8 12 24 Pulmonary Tuberculosis - - - - - - 2 17 51 30 35 — 135 Erysipelas - 1 - - - - - 1 1 1 - - 4 38 Scarlet Fever.—The number of cases of Scarlet Fever notified was 478, compared with 383 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 18.—Scarlet Fever. Cases. Deaths. Mortality per 100 cases 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 1926 478 2 0.4 Diphtheria.—The cases notified numbered 377, compared with 256 in the previous year. Statistics for the past ten years are shewn in the following Table:— Table 19.—Diphtheria. Diphtheria Cases. Deaths. Mortality per 100 cases. 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 1926 377 10 2.6 Diphtheria Anti-toxin.—In accordance with our practice for many years past, supplies of anti-toxin are kept in the Public 39 Health Department, available at any hour for any medical practitioner who may require to administer the serum either as a prophylactic or for treatment. During the year 42 tubes were issued, 40 of these being for treatment, and 2 for prophylactic purposes. No charge is made when the practitioner certifies that the patient is. unable to afford the cost. Enteric Fever.—Six cases of Enteric Fever were notified, one of which proved fatal. Nine cases of Para-typhoid Fever were also notified. Puerperal Fever and Puerperal Pyrexia.—Six cases of Puerperal Fever were notified, five of which were treated in Hospital. None of the cases proved fatal. The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, came into force on the 1st October. Briefly, they require that, in addition to Puerperal Fever, a medical practitioner shall notify cases of Puerperal Pyrexia, the latter disease being defined as "any febrile condition occurring in a woman "within 21 days after child-birth or miscarriage in which a "temperature of 100-4° F. or more has been sustained during "a period of 24 hours, or has recurred during that period." The regulations also empower the Local Authority to make provision for the special treatment of women suffering from Puerperal Pyrexia, for consultation with an obstetric specialist, and for skilled nursing. Your Council accordingly came to an agreement with the Authorities of the St. John's Hospital, whereby the services of an obstetrical specialist should be at the disposal of any medical practitioner who should wish for the same, and for the collection and examination of pathological specimens if considered necessary. In regard to nursing, it has been arranged that the services of one of the Ranyard Nurses shall be available, if required. 40 The following extract from a communication which was circularised to all the medical practitioners in the Borough will explain more fully the object of the Regulations, and in this connection I may say that the Minister's assumption that the Regulations would result in a great increase in the number of notifications has not been borne out by the facts, as only five cases of Puerperal Pyrexia were notified between the commencement of the Regulations and the end of the year. In one case the assistance of the specialist was sought. The Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. In the Circular accompanying these Regulation, the Minister of Health states that Puerperal Fever has been notifiable throughout the country since the Infectious Disease (Notification) Extension Act, 1890, came into force. Experience has shown, however, that for a variety of reasons notification of this disease has been far from complete, with the result that not only are the statistics relating to the disease inaccurate and misleading (particularly as regards incidence and fatality rate), but measures for the prevention and effective treatment have been seriously hampered. The Circular goes on to state that the main reason for the comparative failure to notify is to be found in the fact that Puerperal Fever is ill-defined and is not a specific disease comparable with Scarlet Fever or Diphtheria. There is frequently, therefore, a genuine doubt as to the correct diagnosis. The term, moreover, bears a connotation which may be thought to imply some slur upon the patient or medical attendant, and this may possibly act as a deterrent to notification of a doubtful case. In any event, it is certain that many cases are not notified at all and that severe cases are often notified only when it is too late for effective action to be taken ; and it is therefore important to modify the existing arrangements for the notification of Puerperal Fever by requiring the prompt notification of this morbid process as soon as symptoms suggestive of septic infection become manifest, in order that adequate nursing and treatment can be ensured and the spread of infection to others prevented. The Minister is advised that it will ultimately be desirable to replace the term "Puerperal Fever" by the term "Puerperal Pyrexia," the latter being defined in terms which involve no theory as to causation, but without legislation amending the Infectious Disease (Notification) Acts it is not practicable to substitute "Puerperal Pyrexia" for "Puerperal Fever" as a disease notifiable under these Acts. The Regulations, therefore, while prescribing new forms for the notification of cases of Puerperal Fever, also require the notification of cases of Puerperal Pyrexia (as defined in the Regulations) in addition to the present notification of Puerperal Fever under the Infectious Diseases (Notification) Acts, thus placing an obligation upon medical practitioners to notify all cases of Pyrexia during the puer- 41 perium irrespective of the cause to which the fever may be attributed. It is recognised that this requirement will lead to a great increase in the number of notifications and that many cases so reported will be relatively trivial in degree, but the great importance of securing adequate treatment in the early stages of Puerperal infection is regarded as outweighing any objection to the notification of a certain amount of minor illness which gives no cause for anxiety. I enclose herewith books of forms for the notification of both Puerperal Fever and Puerperal Pyrexia, and have specially to call your attention to the definition of the latter disease which appears on the form, and to the fact that the notification forms enable a practitioner to indicate whether any assistance in dealing with the case is desired. The Minister suggests that I should remind you that the Metropolitan Asylums Managers have made special arrangements for the institutional treatment of Puerperal Fever in three of their Hospitals, viz., the Eastern, North Western, and South Western, where special wards are set aside, and special medical and nursing staffs provided. I am, yours faithfully, A. Wellesley Harris, Medical Officer of Health. Pneumonia.—The Public Health (Pneumonia, etc.) Regulations, 1918, require the notification of Acute Lobar and Influenzal Pneumonia, and during the year 161 cases were notified. Encephalitis Lethargica. — Twelve cases of this disease were notified, and particulars of each case are given in the following Table:— No. of Case. Age. Sex. Remarks as to further development of Case, etc. 1 34 M Partial paralysis resulted. Marked change in character and intelligence. 2 21 M Complete recovery. 3 14 F Diagnosis doubtful. Subsequently died from Tubercular Meningitis. 4 17 F Complete recovery. Diagnosis doubtful. 5 14 M Complete recovery. 6 5 M Diagnosis doubtful. Subsequently notified as Lobar Pneumonia. 7 8 F Complete recovery. 8 55 F Complete recovery. 9 53 M Died. 10 3½ M Died. 11 20 M Complete recovery. 12 21 F Still under treatment. 42 Ophthalmia Neonatorum.—Ten cases of this disease were notified during the year, and are shewn in tabular form herewith, as required by the Ministry of Health:— Cases. Results. Notified. Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Home. Hospital. 10 9 1 10 - — — Nursing in the Home.—The services of the Ranyard Nurses, and the nurses attached to local Nursing Associations are utilised for attending cases in respect of which the Council have power to provide nursing assistance, a fee of 1s. 3d. per visit being paid. During the year the number of visits made was as follows:— Pneumonia 994 visits. Ophthalmia Neonatorum 219 ,, Measles 178 ,, 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 the medical practitioners in the Borough. During the year, 2702 specimens were sent to the Laboratory for examination, compared with 2,164 in the previous year, the details being as follows:— Nature of Specimen. Number sent. Result of Examination. Positive. Negative. Material from suspected Diphtheria Cases 2033 212 1821 Sputa from suspected Tuberculosis Cases 621 102 519 Blood from suspected Enteric Cases 29 5 24 Pathological Specimens from 18 4 14 Cerebro-spinal Fluid 1 — 1 2702 323 2379 43 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 1150 16604 Diphtheria 888 11101 Tuberculosis 604 1247 Cancer 95 804 Measles 63 183 Enteric Fever 32 475 Erysipelas 21 93 Other Diseases 158 2312 Totals 3017 32819 Disinfestntion.—One hundred and seventy-five rooms and 315 articles infested with vermin were disinfected. TUBERCULOSIS. Notifications. Notifications.—During the year 378 primary notifications of Tuberculosis were received, of which 297 were of Pulmonary Tuberculosis, and 81 of other forms of Tuberculosis. The deaths from Pulmonary Tuberculosis numbered 135 and of other forms of the disease 27. The death-rate from Pulmonary Tuberculosis was 0-71 per thousand inhabitants, compared with 0.63 in 1925 and 0.68 in 1924. The age and sex incidence of the cases notified during the year is summarised in the following Table:— 44 Table 20. Age Periods. Pulmonary Tuberculosis. Non-Pulmonary. Total all Forms. Males. Females. Total. Males. Females. Total. 0-1 — — — 1 1 2 2 1-5 — 1 1 6 - 6 7 5-10 3 3 6 16 9 25 31 10-15 4 7 11 5 8 13 24 15-20 13 20 33 6 6 12 45 20-25 21 33 54 2 4 6 60 25-35 45 42 87 6 1 7 94 35-45 27 18 45 4 3 7 52 45-55 32 16 48 — 1 1 49 55-65 8 1 9 — 2 2 11 65 and upwards 3 — 3 — — — 3 Totals 156 141 297 46 35 81 378 The following Table summarises the Tuberculosis Register, and shews the number of cases which exist in the Borough:— Table 21. Cases of Tuberculosis on the Register, 1926. Pulmonary. Non-Pulmonary. Males Females Total Males Females Total Cases on Register at end of 1925 672 523 1195 236 235 471 Cases added to Register in 1926 158 142 300 51 37 88 Cases removed from Register in 1926 Deaths and Removals from Borough 105 92 197 23 15 38 Cases on Register at end of 1926 725 573 1298 264 257 521 45 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 Apartmenls. 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 the following report by Dr. Rose Jordan, the Tuberculosis Officer:— During the year 1926 there were 378 primary notifications of tuberculosis in the Borough, of which 297 were of pulmonary and 81 of other forms of tuberculosis. During the year, 135 persons died from pulmonary tuberculosis and 27 from other forms of tuberculosis, the death-rate from pulmonary tuberculosis thus being 0.71 per 1,000 inhabitants, as compared with 0.63 in 1925, 0.68 in 1924 and 0.76 in 1923. The area of activity of the Dispensary organisation has been largely increased by the rapid development during the year of the London County Council Downham Estate, on which houses have been granted to many families containing tuberculous members, who had been living under unsuitable conditions in other districts. The notified cases of tuberculosis now living on this Estate number 60, while 8 others have died during the year. Several Lewisham families, among whom tuberculosis had made its appearance, and who were living under overcrowded conditions, have been granted accommodation on the Downham Estate, usually after 3—4 years of waiting. Others, badly in need of better accommodation, are pinning their hopes on the new Borough Council Estate to be opened shortly at Grove Park. It is pathetic how occasionally whole families are wiped out by tuberculosis, partly as a result of their being obliged to live in close contact with tuberculous members. Thus, in one family, father, mother, two girls and three boys, all adults, died within a few years of one another, while the remaining three children were removed to more healthy surroundings with the assistance of the Guardians and the London County Council, and have so far survived and remained healthy. Table A gives a summary of the work carried out by the two Health Visitors, whose activities among the patients at their homes is greatly appreciated. 40 TABLE A. Work of Tuberculosis Health Visitors. Visits. ex-Service Men. Civilians Total. Pulmonary Tuberculosis 55 216 353 2230 Other Forms 6 76 Subsequent Visits 182 1520 1702 Visits to Cases not Notified 24 151 175 No. of Patients occupying Separate Beds 27 138 165 353 ,, sharing bed with 1 other 27 142 169 ,, ,, ,, „ 2 others 7 10 17 ,, ,, ,, ,, 3 ,, - 2 2 No. of Patients occupying Separate Rooms 26 113 139 353 ,, sharing room with 1 other 23 102 125 ,, ,, „ ,, 2 others 8 52 60 ,, ,, ,, ,, 3 ,, 2 20 22 ,, ,, ,, ,, 4 „ 1 5 0 ,, ,, ,, ,, 5 ,, 1 — 1 Table B shows the condition on December 31st, 1926, of all patients diagnosed as suffering from pulmonary tuberculosis, who have attended the Dispensary since its establishment in June, 1916. Many of these patients attend the Dispensary at regular intervals for treatment or observation. Those who do not attend are visited in their homes, or their own doctors are asked for reports on their condition. 47 TABLE B. Condition on 31st December, 1926, of all cases of Pulmonary Tuberculosis who have attended the Dispensary since its foundation. Year 1916 (6 months) 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 Totals No. of Cases 74 157 200 185 200 159 165 181 166 165 204 1956 Dead 48 70 82 62 87 68 70 68 56 42 20 673 Left 14 50 56 54 44 36 42 37 29 17 12 391 Well — 6 12 15 18 18 29 44 33 51 43 269 Fair — 11 9 21 11 15 11 22 37 41 98 276 Unwell 4 2 — 4 3 3 9 7 9 14 31 86 Discharged as arrested, or agnosis not confirmed 8 18 41 29 37 19 4 3 2 — — 161 Totals 74 157 200 185 200 159 165 181 166 165 204 1856 48 It will be seen from the table that 1,856 patients suffering from pulmonary tuberculosis attended during these 10| years, and of these 673 are now dead, i.e., 36 2 per cent.; 391 have gone to live elsewhere, and some of these are also known to have died; 161 have been discharged either as "disease arrested" or "diagnosis not confirmed," and 631 are still on the Dispensary register. Of the latter, 269 are well and at work, 276 are in fair health, and 86 are unwell and unfit for work. The Tuberculosis Officer paid 335 visits at the homes of patients, and visited 9 patients in consultation with their medical attendants. The London County Council admitted 202 patients to residential institutions. The Lewisham Hospital admitted 50 patients recommended by the Tuberculosis Officer, these being either advanced cases living under unsuitable home conditions or acute cases requiring immediate treatment. Some of them were afterwards transferred to L.C.C. institutions. The Dispensary is affiliated to King's College Hospital and to the Miller General Hospital, and during the year four laryngeal cases were sent to King's College Hospital for reports and four cases to the Miller, one for light treatment and three for X-ray diagnosis. Three cases of lupus were treated by Finsen light at the London Hospital. Eleven selected cases were treated by artificial pneumo-thorax induction at Brompton Hospital, this treatment having been sanctioned by the Borough Council. The Borough Council has granted special diet allowance of milk, eggs, and butter to 15 necessitous patients. Thirty-two patients have, with the sanction of the Borough Council, received dental treatment at the British Dental Hospital, Lewisham, 4 of them also having been assisted in obtaining dentures. The two shelters previously supplied by the Borough Council were found to be so much in demand that two more were applied for. These arrived in November, 1926, and were immediately put into requisition. The four shelters are loaned to patients, who are obliged otherwise to share a room with other members of the family and who have suitable outdoor accommodation for their erection. Two beds have also been supplied for use in the shelters. The Secretary of the Care Committee reports that the Care Committee met 24 times during the year. Assessments were made for 231 patients in order to fix the amount of their contribution towards institutional treatment. Of this number, 69 were asked to contribute various sums from 1s. to 25s., the total amount collected during the year being £666 0s. 6d., for a total of 107 patients paying towards their institutional treatment during the year. 144 patients received entirely free treatment. The Care Comittee was also able to help patients with regard to their pensions and their insurance difficulties, to arrange convalescent treatment, to supply clothing and to help in various other ways. 49 The Care Committee organised an American Sale in the Dispensary garden, which added £58 17s. 11d. to the voluntary fund. The Lewisham branch of the Red Cross also contributed £10 to the fund, which was earmarked for ex-Service patients. Mr. Marshall, of the Lewisham Literary Institute, kindly organised an entertainment, which added £16 13s. Od. to the Care Committee fund. With the help of this voluntary fund it was possible in September to inaugurate a Handicrafts Class for 16 Dispensary patients, men and women considered by the Tuberculos s Officer suitable physically and mentally to join a class of this kind. The services of Miss Forth, an instructress on the L.C.C. panel, were obtained for two hours each Monday morning for 12 weeks, and it was decided to choose leather work as the subject for tuition. The pupils, under their very able and enthusiastic instructress, found the work absorbingly interesting, and it has contributed largely to their mental well-being. The London County Council gave the venture their cordial approval and agreed to pay for the services of the instructress. The success of the class has been largely due to the efforts of Miss Hone, a voluntary member of the Care Committee, who worked out the details and found the instructress, and who is herself a member of the class. The course is to be continued next year. The tuberculous ex-Service men living in the Borough are kept under supervision at the Dispensary, and reports upon their condition are sent at intervals to the Ministry of Pensions. The following tables give a summary of the work carried out at the Dispensary during the year :— Table C. Summary of First Attendances at the Dispensary, 1926. Applied on own initiative. Sent by Doctor. Sent by Min. of Pensions. Transferred from Hosp., Disp., etc. Sent by L.C.C. Contacts. Totals. Pulmonary 39 108 3 46 2 6 204 Non-Pulmonrry 19 6 1 10 6 3 45 No Tuberculous Disease 85 89 1 10 25 172 382 Suspects 5 9 1 1 3 1 20 148 212 6 67 36 182 651 50 Table D. Attendances of Patients at the Dispensary. 1926. First Attendances. Subsequent Attendances. Totals. January 65 213 278 February 59 213 272 March 66 253 319 April 53 173 226 May 45 169 214 June 44 211 255 July 54 192 246 August 40 195 235 September 50 226 276 October 53 215 268 November 71 191 262 December 51 171 222 651 2422 3073 Table E. Residence of Patients in Wards. Ward. Insured. Uninsured. Total. Church 10 13 23 Manor 13 5 18 South 1 8 9 Blackheath ... 8 21 29 Lewisham Village 18 43 61 Lewisham Park 21 34 55 Brockley 8 24 32 Catford 83 156 239 Forest Hill 27 50 77 Sydenham 50 58 108 239 412 651 Table F. Stages in Pulmonary Tuberculosis. Male. Female. Children under 16. Total. Stage I. 29 30 3 62 „ II. 56 56 3 115 „ III 13 12 2 27 98 98 8 204 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. 51 Table G. Cases of Non-Pulmonary Tuberculosis. Male. Female. Children under 16. Total. Glands 3 1 13 17 Bone 5 6 7 18 Other Regions 1 2 7 10 9 9 27 45 ROSE JORDAN, Tuberculosis Officer. 52 SECTION VII.—Maternity and Child Welfare. 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 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 2,612 Return „ „ 8,429 Visits to Children between 2 and 5 years 3,299 Infantile Death Enquiries 54 Stillbirth Enquiries 31 Ante-Natal Visits 614 Milk Assistance Scheme Enquiries 1,375 Visits to Enteritis Cases 40 Visits to Ophthalmia Cases 20 Return Visits to „ „ 71 Municipal Maternity Home. Medical Officer Dr. J. W. Miller. Matron Mrs. D. Fynn. The Maternity Home is situated at 41, Rushey Green, Catford, and has seventeen beds, permitting an average admission of 26 patients per month. The nursing stall comprises the Matron, five nurses and two probationers. The domestic staff includes a cook, two housemaids, a laundry-maid, and a daily cleaner. There is also a Clerk-Dispenser. 53 During the year 315 confinements took place in the Home, of which 161 were primiparæ and 154 multipara, and the nature of these cases is shewn in the following Table:— Total. Proportion to Total. Percentage. Total Number of Labours 315 - - Vertex Presentation 305 1 in 1.03 96.82 Face „ 1 1 in 315 .31 Pelvic „ 14 1 in 22.5 4.4 Twins 5 1 in 63 1.58 Accidental Haemorrhage 1 1 in 315 .31 Post-Partum Eclampsia 1 1 in 315 .31 Manual Removal of Placenta 1 1 in 315 .31 Forceps 10 1 in 31.5 3.17 Minor Operations (P.20 : M.8) 28 1 in 11.25 8.8 Prolapse of Cord 1 1 in 315 .31 Pyelonephritis 1 1 in 315 .13 Phlebitis 1 1 in 315 .31 Hydramnios 1 1 in 315 .31 Albuminuria of Pregnancy 1 1 in 315 .31 Puerperal Insanity 1 1 in 315 .31 „ Sepsis 1 1 in 315 .31 Morbidity 6 1 in 52.5 1.90 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. Of the 320 infants born, nine were still-born, and two 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 „ 7 Macerated 1 Total number born dead 9 Infants born alive who died in the Home 2 Total number born dead or died in the Home 11 54 Still- births. Maturity. Cause of Death. Remarks. 1. Premature Anencephalic Fœtus macerated 2. Full-term Unknown 3. „ „ - 4. „ „ - 5. „ „ - 6. „ Eclampsia in mother - 7. „ Hydrocephalus Fœtus macerated 8. „ Prolapse of Cord (Twin) - 9. „ Impacted Breech - Live Births. Maturity. Period of Survival. Cause of Death. 10. Premature 12½ hours Atelectasis 11. Full-term 31 „ Congenital Heart The sex incidence of the infants was as follows:— Males, 181. Females, 139. Total, 320. The average length and weight of the full-term infants were as follow:— Males Length, 21.5 inches. Weight, 7.5-lbs. Females „ 21.3 „ „ 7.3-lbs. All the infants were entirely breast-fed. One case of Ophthalmia Neonatorum occurred, in spite of the prophylactic measures taken. The case responded to treatment and was discharged well. One patient was admitted suffering from a mild attack of Influenza. On the second day after birth the infant developed a temperature of 104°, and was fed with difficulty. The temperature gradually subsided, but on the tenth day the infant had two convulsion fits. These were not repeated, and the infant made an uninterrupted recovery. The following Table shews the details of cases for the period from 1st June, 1918, to 31st December, 1926:— Number of Births 2,098 Total number born dead 62 Premature Deaths, recent 12 Infants born alive who died in the Home 36 Full-term Deaths v 36 Macerated 13 Total number born dead or died in the Home 98 Putrid 1 55 The following Table shews the number and classification of cases admitted to the Maternity Home during the period June 1st, 1918, to December 31st, 1926:— Total. Proportion to Total. Percentage. Total Number of Labours 2072 - - Vertex Presentation 1998 1 in 1.03 96.42 Face „ 4 1 in 518 .19 Pelvic „ 94 1 in 22.04 4.53 Transverse „ 2 1 in 1036 .09 Twins 26 1 in 79.69 1.25 Accidental Hæmorrhage 9 1 in 230.2 .43 Placenta Prævia 1 1 in 2072 .04 Acute Inversion of Uterus 1 1 in 2072 .04 Post-Partum Hæmorrhage 10 1 in 207.2 .48 Secondary „ „ 1 1 in 2072 .04 Eclampsia 1 1 in 2072 .04 Post-Partum Eclampsia 2 1 in 1036 .09 Fibroids of Uterus 3 1 in 690.6 .14 Dermoid Cyst in Pelvis 1 1 in 2072 .04 Manual Removal of Placenta 9 1 in 230.2 .43 Forceps 119 1 in 17.41 5.74 Minor Operations 312 1 in 6.64 15.05 Internal Version 1 1 in 2072 .04 Prolapse of Cord 8 1 in 259 .38 Rupture of Cord 1 1 in 2072 .04 Craniotomy (Hydrocephalus) 1 1 in 2072 .04 Hydramnios 1 1 in 2072 .04 Pyelonephritis 2 1 in 1036 .09 Albuminuria of Prcgnancy 6 1 in 345.3 .28 Parenchymatous Mastitis 2 1 in 1036 .09 Phlebitis 3 1 in 690.6 .14 Measles 1 1 in 2072 .04 Puerperal Insanity 3 1 in 690.6 .14 Puerperal Sepsis 5 1 in 414.4 .24 Morbidity 45 1 in 46.04 2.17 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 2,035. 56 An analysis of the cases is set out in the following Table:— Classification of Cases. No. Totals. Consultations 1676 1676 Disorders and Diseases of the Reproductory System— Threatened Abortion 1 Endocervicitis 6 Pruritis Vulvæ 7 Neuralgia of Nipple 1 Hydramnios 1 16 Disorders and Diseases of the Alimentary System— Dental Caries 19 Stomatitis 2 Dyspepsia 77 Constipation 42 Hæmorrhoids 5 145 Diseases of the Heart, Blood Vessels, Etc.— Varicose Veins 12 Phlebitis 1 13 Diseases of the Respiratory System— Nasal Catarrh 12 Epistaxis 2 Bronchitis 28 Tuberculosis 1 43 Functional Disorders and Diseases of the Nervous System— Neuritis 9 Insomnia of Pregnancy 25 Sickness of Pregnancy 20 54 Diseases of the Urinary System— Albuminuria of Pregnancy 7 Cystitis 3 Pyelitis 1 11 Affections of the Skin— Furunculosis 1 Urticaria 1 2 General Diseases— Anaemia of Pregnancy 19 19 57 Maternity and Child Welfare Clinics. These are at present held at the Wesleyan Church Halt, Rushey Green, on four mornings in each week. The attendances during 1926 were as follows:— Maternity Clinic 1,620 Child Welfare Clinic 7,066 An analysis of the ailments treated, is set out in the following Tables : — Maternity Clinic. Classification of Cases. No. Totals. Consultations 866 866 Disorders and Diseases of the Keproductory System— Pruritis 1 Endocervicitis 7 Subinvolution of Uterus 60 Menorrhagia 3 Dysmenorrhœa 1 Sore Nipples 12 Neuralgia of Nipple 1 Breast Abscess 4 Flushed Breasts 2 Engorged Breasts 3 Scanty Secretion of Milk 49 143 Disorders and Diseases of the Alimentary System— Dental Caries 78 Pyorrhœa 6 Coryza 1 Pharyngeal Catarrh 1 Tonsillitis 8 Stomatitis 1 Dyspepsia 40 Gastric Ulcer 1 Gastro-Enteritis 3 Colitis 2 Constipation 52 Hæmorrhoids 17 Fissure of Anus 1 Thread Worms 1 Round Worms 1 213 58 Maternity Clinic—continued. Classification of Cases. No. Totals. Diseases of the Respiratorv System— Nasal Catarrh 6 Influenza 1 Laryngitis 3 Bronchitis 50 Pleurisy 1 61 Diseases of the Heart, Blood Vessels, Etc.— Double Phlegmasia Alba Dolens 1 Phlebitis 1 Varicose Veins 5 Varicose Ulcer 1 8 Functional Disorders and Diseases of the Nervous System— Facial Neuralgia 12 Neuritis 15 Epilepsy 3 Sciatica 1 Insomnia of Pregnancy 2 Sickness of Pregnancy 18 51 Diseases of the Lymphatic System, Thyroid, Etc.— Thyroid Inefficiency 1 Thyroid Enlargement 1 Exophthalmic Goitre 1 3 Diseases of the Urinary System— Cystitis 1 1 Affections of the Skin— Alopecia 1 Psoriasis 3 Eczema 4 Erythema Nodosum 1 Urticaria 1 Impetigo 1 Herpes 1 Furunculosis 4 17 Diseases of the Ear— Otitis Media 2 2 Diseases of the Eye— Hordeolum 1 Blepharitis Marginalis 1 Iritis 1 Hypermetropia 1 4 59 Maternity Clinic—continued. Classification of Cases, No. Totals. Diseases of the Muscles, Bones and Joints— Sprained Wrist 1 1 General Diseases— Anaemia of Pregnancy 5 Lactational Anæmia 198 Post-Partum Anæmia 28 Muscular Rheumatism 15 Acute Rheumatism 1 Sub-acute Rheumatism 2 Post-Influenzal Debility 1 250 60 Child Welfare Clinic. Classification of Cases. No. Totals. Consultations on Feeding and Management 5272 5272 Functional Disorders and Diseases of the Alimentary System— Tongue-tie 4 Dental Caries 85 Disorders of Dentition 83 Buccal Polypus 1 Enlarged Tonsils and Adenoids 19 Mumps 1 Thrush 17 Gingivitis 1 Tonsillitis 12 Stomatitis 12 Dyspepsia 227 Gastro-Enteritis 19 Gastro-Intestinal Catarrh 65 Ileo-Colitis 8 Catarrhal Jaundice 1 Constipation 189 Marasmus 2 Prolapse of Rectum 2 Fissure in Ano 1 Hernia (Inguinal—Single) 3 Hernia (Umbilical) 21 Thread Worms 25 Round Worms 3 801 Diseases of the Respiratory System— Nasal Catarrh 55 Pertussis 13 Influenza 2 Bronchitis 440 Broncho-Pneumonia 2 Asthma 4 516 Functional Disorders and Diseases of the Nervous System— Habit Spasm 3 Night Terrors 1 Backward Child 2 Paraplegia 1 Convulsions 4 Epilepsy 1 Acute Anterior Poliomyelitis 1 Angio-Neurotic Oedema 1 14 61 Child Welfare Clinic—continued. Classification of Cases. No. Totals. Diseases of the Lymphatic System— Cervical Adenitis 15 Sub-mental Adenitis 1 Occipital Adenitis 1 Axillary Adenitis 1 18 Diseases of the Urinary System— Eneuresis 8 Urethral Caruncle 1 Cystitis 1 10 Functional Disorders and Diseases of the Reproductive System— Phimosis 6 Preputial Adhesions 23 Mastitis 2 Vaginitis 3 Masturbation 1 35 Affections of the Skin— Nævus 10 Eczema 36 Eczema Capitis 11 Eczema (Face) 5 Seborrhœa Capitis 5 Ringworm 2 Furunculosis 7 Erythema Nodosum 3 Erythema Multiforme 2 Impetigo 28 Urticaria 113 Alopecia 1 Alopecia Ariata 1 Acne Vulgaris 3 Acne Rosacea 1 Lupus 1 Prurigo 1 Pruritis 1 Paronychia 4 Sore Buttocks 25 Pemphigus 2 Vaccinia 1 Warts 1 264 Diseases of the Ear— Otitis Media 37 Abscess in External Auditory Meatus 2 39 62 Child Welfare Clinic—continued. Classification of Cases. No. Totals Diseases of the Eye— Catarrhal Conjunctivitis 8 Phlyctenular Conjunctivitis 5 Ophthalmia Neonatorum 2 Blepharitis Marginalis 4 Strabismus 2 Meibomian Cyst 2 Hordeolum 11 Ecchymosis 1 35 Injuries and Diseases of the Muscles, Bones and Joints, Etc.— Ganglion l Fracture of Forearm l Genu Valgum 2 4 Wounds and Bruises 10 10 Scalds and Burns 5 5 Exanthemata— Measles 1 Chickenpox 2 3 Mental Defects 2 2 Congenital Defects— Undescended Testicle 2 Cleft Palate 1 Double Harelip and Cleft Palate 1 Webbed Toes 1 Imperforate Hymen 1 Hypospadius 1 Flat Foot 2 Club Foot 1 Pigeon Toe 1 11 Injuries and Diseases of the Newborn— Cephalhæmatoma 1 Hæmatoma of Sterno-Mastoid 3 Sepsis of Umbilicus 2 Umbilical Adenoma 5 Icterus Neonatorum 1 12 Rickets 5 5 General Diseases— Rheumatism 3 Debility from Measles 7 10 63 Dental Treatment.—By agreement with the British Dental Hospital, the following cases were treated during 1926:— Dental Treatment (Extractions, Fillings, etc.):— Expectant and Nursing Mothers 73 Infants 62' Dentures:— Expectant and Nursing Mothers 33 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 clothing1, etc., at cost price. The Borough Council provide the necessary medical consultant at each of these centres, with one exception, i.e., the Sydenham Centre, which has its own Medical Advisers. Particulars of these Centres are given in the following Table:— Voluntary Infant Welfare Centres. Title. Where Held. No. of sessions weekly. Total attendances, 1926. Catford School for Mothers Wesleyan Hall, Rushey Green 2 10935 Forest Hill Infant Welfare Centre Salvation Army Hall, Wastdale Rd. 1 2915 Hither Green Babies' Welcome Wesleyan Hall, Hither Green 1 3806 Bellirgham Infant Welfare Centre St. Dunstan's Hall. Bellingham 2 6348 Lee and Backheath School for Mothers St. Margaret's Hall. Old Road, Lee 1 4476 St. Mary's School for Mothers St. Mary's Mission Hall, Ladywell Pk. 1 3755 Sydenham Infant Welfare Centre 5-7, Adamsrill Rd., Sydenham 2 4891 64 Maternal Mortality. The number of deaths recorded in the Borough resulting from childbirth was exceedingly low, there being an entire absence of deaths due to puerperal sepsis, and only 6 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 1921 2 6 8 1922 1 7 8 1923 2 10 12 1924 2 9 11 1925 - 5 5 1926 - 6 6 Milk Assistance Scheme.—The Council's Scheme for the provision of milk to infants and expectant and nursing mothers was continued during the year. The number of families to whom grants were made was 521, compared with 446 in 1925. 1,005 orders were issued for fresh milk for periods of 4 weeks, the majority of grants being for one pint per day. 5,126 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 £730. During the year 9,577 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, and the cash taken in respect of these sales amounted to £776 3s. 1d. i. INDEX. page Ambulance Facilities 18 Analyst, Public, Report of 32 Area of Borough 11 Bacteriological Examinations 42 Births and Birth Rate 12 Cancer 12 Clinics—Ante-natal 55 Maternity 57 Infant 60 Deaths and Death Rate 12 Dental Treatment 63 Diphtheria 38 Diphtheria Anti-toxin 38 Disinfection 43 Encephalitis Lethargica 41 Factories and Workshops 23—26 Health Visitors Work 52 Hospitals 17 House Refuse Collection 21 House-to-House Inspection 28 Housing Statistics 27 Infantile Mortality 13 Infectious Diseases 35 Inhabited Houses 11 Legal Proceedings 22 Marriages 13 Maternal Mortality 64 Maternity Home 52 Meat Inspection 32 Milk Assistance Scheme 64 Milk and Dairies Order, 1926 30 Milk (Special Designations) Order, 31 Milk Supply 30 Mortuary 18 Nuisances 22 ii. page Nursing in the House 20, 42 Officers, Public Health 19 Ophthalmia Neonatorum 42 Outworkers 25 Population 11 Puerperal Fever 30 Rateable Value 12 Rent Restrictions Acts 23 Sanitary Inspectors' Work 21 Scarlet Fever 38 Smoke Abatement 23 Statistics, Summary of 9 Tuberculosis Dispensary 45 Tuberculosis, Notification of 43 Tuberculosis Officer, Report of 45 Voluntary Infant Welfare Centres 63 Water Certificates 23 Zymotic Diseases 13