METROPOLITAN BOROUGH OF LEWI SHAM. Annual Report on the Vital and Sanitary Statistics Fop the Year 1927. A. WELLESLEY HARRIS, M.R.C.S., D.P.H., &c., Medical Officer of Health and Public Analyst; 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 IN D EX. Subject. Page Ante-natal Clinic 38 Bacteriological Work 50 Births and Birth Rate 7 Child Welfare Clinic 43 Coroner's Court and Mortuary 50 Deaths and Death Rate 7 Dental Treatment 46 Disinfection 50 Factories and Workshops 18 Food Inspection 20 Health Visitors' Work 35 House-to-House Inspection 16 House Refuse 51 Housing Statistics 48 Infantile Mortality 7 10 Infectious Diseases 24 Legal Proceedings 15 Marriages 7 Maternal Mortality 47 Maternity Clinic 40 Maternity Home 35 Milk Assistance Scheme 47 Population 7 Rent Restrictions Acts 49 Sanitary Inspectors' Work 14 Staff 4 Tuberculosis Officer's Report 28 Vital Statistics—Summary 6 Voluntary Infant Welfare Centres 46 Water Certificates 49 4 PUBLIC HEALTH COMMITTEE. 1926-27. Chairman :— Councillor E. W. Hayes (ex-Mayor). Ex-Officio :— His Worship the Mayor (Councillor Albert E. Webb, J.P.) Alderman H. Chicsman, J.P. „ A. W. Iiiscox ,, 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 1927-28. Chairman :— Councillor A. E. Markham. Ex-Officio :— His Worship the Mayor (Councillor H. J. Furneaux, J.P.). Alderman H. Chiesman, J.P. „ A. W. Hiscox T. R. Roberts, J.P. Councillor Mrs. R. Andrews „ A. O. Bentley ,, R. J. Cutler „ H. A. Dunkley „ Mrs. E. Edwards „ A. E. Goss „ E. W. Hayes „ Miss G. M. Mason „ A. E. McAdam „ J. D. Pain „ Mrs. G. Pinnell „ Mrs. A. Wightwick „ C. W. Woolston MATERNITY AND CHILD WELFARE COMMITTEE. 1926-27. Chairman :— Councillor Mrs. G. Pinnell Ex-Officio :— His Worship the Mayor (Councillor Albert E. Webb, J.P.) 1927-28. Chairman :— Councillor Mrs. E. Edwards. Ex-Officio :— His Worship the Mayor (Councillor H. J. Furneaux, 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. H. Howes Miss A. Burrows Mrs. M. Kemp Miss A. C. E. Fuller Mrs. E. M. White Mrs. H. M. Wigmore Miss M. Barrett Miss J. H. Howes Miss A. Burrows Mrs. M. Kemp Miss A. C. E. Fuller Mrs. L.K. Russell Mrs. E. M. White 5 Staff of the Public Health Department, 1927. 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-lime). 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. II. Gray C. E. Holifield H. King B. A. Knappett W. S. Parsons S. P. Rayner E. Walker (from 8th August. 1927) Miss N. F. Jones Sanitary Inspectors. Health Visiting Staff: Miss F. L. Burton Miss A. M. M. Edwards Miss K. H. Kempster Miss G. Simpson Miss C. H. Thompson Miss E. M. Watson Miss W. Cresswell (from 1st October, 1927) 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. 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. 6 NATURAL AND SOCIAL CONDITIONS. Estimated Population, 1927 188,600 Population, Census, 1921 174,194 Area, acres 7,015 Inhabited Houses, 1921 34,420 Number of Families or Separate Occupiers, 1921 43,685 Rateable Value (as per County of London Valuation, 6th April, 1927) £1,314,887 Estimated produce of a penny rate £5,334 The Borough of Lewisham is to a large extent a residential one, the majority of the householders being employed elsewhere. There are a few factories in the district. Summary of Vital Statistics. Births — Legitimate 2,755 „ Illegitimate 93 Total 2,848 Eirth-rate 15.1 Deaths 2,083 Death-rate 11.0 Number of women dying in, or in consequence of, childbirth: — From Sepsis 4 From other causes 2 Deaths of Infants under 1 year of age per 1,000 births: — Legitimate 43 Illegitimate 139 Total 46 Deaths from Measles (all ages) 2 „ „ Whooping Cough (all ages) 7 „ Diarrhœa under 2 years of age) 9 7 Population. The population of the Borough for the year 1927 is estimated by the Registrar-General to be 188,600, which figure is used for calculating the mortality and other rates which appear in this Report. Births. The number of births registered in 1927 was 2,848, of which number 1,430 were males and 1,418 females. This number represents a birth-rate of 15.1 per 1,000 of the population, which is, with the exception of two years during the War, the lowest birth-rate yet recorded in the Borough. Illegitimacy.—The number of infants born out of wedlock was 93. of 3.2 per cent. of the total. Marriages. The number of marriages registered in the Borough during the year was 1,502, of which number 818 were solemnized in the Established Church, 173 at Nonconformist Places of Worship, and 511 at the Register Offices. This number is equivalent to a marriage rate of 15.4 per thousand of the population. In 1926, 1,340 marriages were registered, and the marriage rate was 14.2. Deaths. The total number of deaths of residents of the Borough was 2.083, compared with 1,890 in 1926. This number represents a death-rate of 11.0 per 1,000 of the population, a higher rate than last year, which was 10.0 per thousand. The death-rate for the County of London was 11.9 per 1,000, and for England and Wales, 12.3 per 1,000. Infant Mortality.—The number of infants who died before reaching the age of one year was 131, compared with 116 in 1926, and the infant mortality rate was 46 per 1,000 births, compared with 40 in the previous year. The corresponding figure for the County of London was 59 per 1,000 births, and for England and Wales, 69. 8 Causes of Death at Different Periods of Life during the Year 1927. Causes of Death Sex. All Ages Under 1 year. 1 and under 2 years 2 and under 5 years. 5 and under 15 years. 15 and under 25 years 25 and under 45 years. 45 and under 65 years. 65 and under 75 years 75 and upwards. 1. Enteric Fever M – — — — — — —-— — — — F 1 — — — — — 1 — — — 2. Small Pox M — — — — — — — — — — F — — — — — — — — — — 3. Measles M 2 — 1 — — — — 1 — — F — — — — — — — — — — 4. Scarlet Fever M 3 — — — 2 — 1 — — — F — — — — — — — — — — 5. Whooping Cough M 3 2 — 1 — — — — — — F 4 2 1 1 — — — — — — 6. Diphtheria M 9 — — 4 4 1 — — — — F 7 — — 1 5 1 — — — — 7. Influenza M 43 1 3 1 1 4 6 13 6 8 F 53 2 — — 4 1 3 15 15 13 8. Encephalitis Lethargica M 3 — — — — — — 2 1 — F 3 — — — — — 1 1 1 — 9. Meningococcal Meningitis M — — — — — — — — — — F — — — — — — — — — — 10. Tuberculosis of Respiratory System M 101 — 1 — — 23 51 23 2 1 F 74 — — — 3 28 29 12 1 1 11. Other Tuberculous Diseases M 11 — 2 2 4 1 — 2 — — F 9 — 2 1 1 2 2 — — 1 12. Cancer, Malignant Disease M 119 1 — — 1 2 5 56 38 16 F 171 — — — — 1 12 70 52 36 13. Rheumatic Fever M 1 — — — — 1 — — — — F 4 — — — 1 — 1 1 — 1 14. Diabetes M 11 — — — — — 1 5 3 2 F 11 — — — — — 1 3 7 — 15. Cerebral Haemorrhage, &c. M 57 — — — — — 1 17 23 16 F 64 — — — — — — 15 20 29 16. Heart Disease M 127 — — — 3 2 9 41 41 31 F 171 — — — — 1 10 45 49 66 17. Arterio Sclerosis M 45 — — — — — — 16 16 13 F 42 — — — — — — 12 9 21 18. Bronchitis M 74 3 1 — — — 2 15 17 36 F 86 3 — — — — 4 13 10 56 Continued on next Page. 9 Causes of Death at Different Periods of Life during the Year 1927—continued. Causes of Death. Sex. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. 19. Pneumonia (all forms) M 71 9 9 1 2 – 11 17 11 11 F 75 9 1 4 2 3 7 13 16 20 20. Other Respiratory Diseases M 17 1 — — — — 2 8 2 4 F 13 — — — — — 2 5 2 4 21. Ulcer of Stomach and Duodenum M 12 – – – – – 3 4 4 1 F 6 – – – – – – 5 — 1 22. Diarrhœa, &c. M 10 5 — — — — 2 1 1 1 F 10 3 1 2 — — — 2 – 2 23. Appendicitis & Typhlitis M 2 — — — — — – — 2 — F 2 — — — 1 — 1 — — – 24. Cirrhosis of Liver M 1 — — — — — – 1 — – F 6 – – – – – – 4 2 — 25. Acute & Chronic Nephritis M 23 — — 1 — — 3 12 5 2 F 30 — — — 1 2 6 11 6 4 26. Puerperal Sepsis M — — — — — — — — — — F 4 – – – – – 4 – – – 27. Otheraccidents and diseases of Pregnancy & Parturition M – – – – – – – – – – F 2 — — — — 1 1 — — – 28 Congenital Debility, Pre mature Birth M 43 41 1 — — — — 1 — — F 24 23 — — — 1 — – – – 29. Suicide M 13 — – — — — 6 5 2 – F 6 — — — — 2 — 3 1 – 30. Other Deaths from Violence M 49 4 1 2 6 8 8 7 5 8 F 17 — 1 — 1 3 1 — 3 8 31. Other Defined Diseases M 146 14 1 2 4 5 22 27 29 42 F 192 8 2 1 6 4 23 33 27 88 32. Causes ill-defined or unknown M – – – – – – – – – – F — — — – – — — – – – All Causes M 996 81 20 14 27 47 133 274 208 192 F 1087 50 8 10 '25 50 109 263 221 351 Totals 208 131 28 24 52 97 242 537 429 543 10 Table showing Causes of Infant Mortality in 1927. Cause of Death. Under I Week. 1 and under 2 Weeks. 2 and under 3 Weeks. 3 and under 4 Weeks. Total under 4 Weeks. 1 — 3 Months. 3 — 6 Months. 6 — 9 Months. 9 — 12 Months. Total under One Year Measles — — — — — — — — — — Whooping Cough — — — 1 1 1 1 — 1 4 Diphtheria — — — — — — — — — — Influenza — — — — — 1 — 1 1 3 Tuberculosis of Nervous System — — — — — — — — — — Tuberculosis of Intestines and Peritoneum — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Syphilis — — — — — — — — — — Meningitis — — — — — — — — — — Convulsions — 2 — 1 3 1 — — — 4 Bronchitis — — — 1 1 2 — 3 1 7 Pneumonia — — 1 1 2 4 4 6 2 18 Other Respiratory Diseases — — — — — — 1 1 — 2 Inflammation of the Stomach — — — — — — — — — — Diarrhoea and Enteritis — — — 1 1 3 1 1 — 6 Hernia: Intestinial Obstruction — — — — — — — 1 2 3 Congenital Malformations 3 1 — 1 5 4 4 — — 13 Congenital Debility & Sclerema 3 — — — 3 2 — 1 — 6 Icterus — — — — — — — — — — Premature births 32 — 1 1 34 — — 1 — 35 Injury at birth 2 — — — 2 — — — — 2 Diseases of Umbilicus — — — — — — — — — — Atelectasis 6 — — — 6 — 1 — — 7 Suffocation in bed 2 — — — 2 1 — — — 3 Other Causes 7 3 1 2 13 2 1 — 2 18 Totals 55 6 3 9 73 21 13 15 9 131 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. 11 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. (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 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, 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 and1 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. Downham.—St. Barnabas' Hall. Downham Wav. 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. 12 Public Health Officers of the Council. The names and qualifications of those members of the Staff of the Public Health Department in respect of 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 PublicAnalyst. †Miller, John Wilson M.B., Ch.B., D.P.H. Assistant M.O.H. 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. Ditto *Berry, J. H. Cert., Meat and other Foods 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 Walker, E. 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. Health Visitor (M.& C. W.) †Burton, Miss F. L. (Hlth. Vistrs. & Insp. Nuis.). Cert., Gen. Hosp. Training. Ditto Cert., C.M.B. Cert., Roy. San. Inst. (Health Visitors). 13 Public Health Officers of the Council—continued. Name. Qualifications. Appointment. †Thompson, Miss C. H. Cert., Roy. San. Inst. Ditto (Health Visitors). Cert., C.M.B. Health Visitor (M. & C. W.) †Edwards, Miss A. M. M. Cert., Gen. Hosp. Training. Cert., C.M.B. Ditto †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 †Cresswell, Miss W. Cert., Gen. Hosp. Training Cert., C.M.B. 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 are available for nursing cases of measles, pneumonia and ophthalmia neonatorum, a fee of 1s. 3d. per visit being paid by the Council. 14 Midwives.—No midwives are subsidized by the Council for outside work. Acts and Bye-laws—There are no local Acts of Parliament. The Bye-laws of the London County Council are enforced, as also are various local Bye-laws relating to sanitary matters. Sanitary Inspection of the Borough. The work carried out by the Sanitary Inspectors, and the nature of the nuisances discovered and remedied, is shown in detail in the following tables : — Male Sanitary Inspectors. Complaints 1,167 Infectious Diseases 1,052 House-to-house 1,377 Factories and Workshops 2,313 Bakehouses 212 Dairies 350 Cowhouses 24 Slaughterhouses 566 Food-stalls 925 Houses let in Lodginigs 42 Smoke Observations 24 New Houses, for Water Certificates 1,740 Miscellaneous 1,152 Re-inspections and re-visits 12,671 Woman Sanitary Inspector. Complaints 233 Infectious Diseases 892 Factories and Workshops 300 Outworkers 346 Miscellaneous 139 Re-visits 613 15 Nuisances discovered and remedied. Dirty and Dilapidated Premises 1124 Defective Roofs 570 Defective Rain-water Pipes and Gutters 447 Damp Premises 557 Defective Drains— (a) necessitating struction 131 (b) „ repair 236 Defective Water-Closets— (a) necessitating replacement 333 (b) „ repair 294 Defective Waste Pipes ... 295 Defective Soil and Ventilating Pipes— (a) necessitating replacement 218 (b) „ repair 70 Dust-bins requiring replacement 400 Foul or Uncovered Drinking- Water Cisterns 76 Defective or Unpaved Yards 359 Offensive Accumulations 80 Improperly Kept Animals 13 Houses without proper supply of water 90 Notices.—" Intimation " notices were served to the number of 2.005, and " Statutory" notices, 480. Legal Proceedings. — Details of proceedings instituted under the Public Health and kindred statutes are summarised in the following Table: — Premises. ffence. Result. 167, Lady well Rd. Premises in such a state as to be a nuisance Ordered to abate nuisance within 14 days, and to pay £1 1s. 0d. costs. 14 and 15, Watlington Grove Premises in such a state as to be a nuisance Ordered to abate nuisances within 21 days, and pay £2 2s. and £1 1s. costs respectively. 11, 12 and 13, Watlington Grove Premises in such a state as to be a nuisance Summons adjourned. 95, High Street, Sydenham Premises in such a state as to be a nuisance Ordered to abate nuisance within 21 days, and pay £1 1s. 0d. costs. 10, Glenwood Rd. Failure to comply with notice to cleanse, alter and amend drain Penalty of £4 4s. 0d. imposed. 95, High Street, Sydenham Failure to comply with Magistrate's Order Summons dismissed on payment of £5 5s. 0d. costs, the work having been carried out. 16 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. No.in which defects were found, Ardmere Road and Ardmere Cottages... 36 30 Beacon Road 40 26 Beadnell Road 75 35 Benin Street 28 27 Blashford Street ... 31 27 Braseley Grove 41 12 Bryden Grove 6 2 Clyde Place and Clyde Terrace 37 26 Creeland Grove 47 46 Dalmain Road 125 111 Darfield Road 89 47 Dartmouth Place Dartmouth Road 29 16 May's Flats Bird-in-hand Cottages Stifford Cottages J Davids Road 33 30 Etvino Road 15 4 Fairlawn Park ... .:. 48 26 Gillian Street 26 23 Hedgley Street 37 26 Hillmore Grove .,. 27 13 Horton Street 35 32 Jerrard Street 2G 19 KirUley Road 7 6 Merritt Road 93 47 Noel Terrace, Forest Hill 16 8 Perry Rise (part) 80 58 Prospect Place 5 4 Raglan Street 31 15 Railway Terrace ... 19 17 Siddons Road 62 33 Silvermere Road ... 97 45 High Street, Sydenham (part), and Suncroft Cottages 11 6 Thurston Road 81 44 Wemyss Road (part) 20 10 Woodlands Street 28 25 Totals 1,381 896 17 Statistics relating to Occupanoy. 11 houses contained 4 families. 81 ii i, 3 ., 592 „ „ 2 „ G78 „ 1 family. One-roomed, Tenements.—176. 2 were occupied by 6 persons. ^ ii II II 5 ,| 21 4 ft ii n * ii 16 II II II 3 II 32 2 ii II II 6 II 102 ,, „ ,, 1 person. Two-roomed Tenements.—311. 7 were occupied by 7 persons. 11 ii II II ^ II 28 „ „ „ 5 1^* II ii II 4 I, ii II II ^ I, 121 „ „ „ 2 25 „ „ I, 1 person. Three-roomed Tenements.—646. 3 were occupied by 10 persons. 12 9 16 11 11 11 U 11 11 11 11 ^ 11 22 7 " ii ii ii 1 ii 42 6 >> 91 11 u 11 11 11 11 & 11 19Q 4 A ^ 11 91 J1 * 11 189 „ „ „ 3 136 „ „ „ 2 25 „ „ „ 1 person. Smoke Abatement. During the year 24 observations were made for the detection of nuisances arising from the emission of black smoke, and as a result 3 notices were served. The institution of legal proceedings was not necessary in any case. 18 Factories and Workshops on the Register. Bakehouses 43 Factory Bakehouses 39 Eating Houses and places where food is prepared for sale 110 Dressmakers, Milliners, etc. 103 Laundries 47 Tailors 82 Dentists 50 Bootmakers and Repairers 182 Builders 68 Motor Manufacturers and Repairers 125 Jewellers and Watch Repairers 40 Upholsterers and Cabinet Makers 63 Miscellaneous 391 Total 1,343 Outworkers. No. of Lists received from Employers 88 Addresses of Outworkers received from other Councils 290 ,, ,, ,, forwarded to other Councils 136 No. of visits made to Outworkers 460 Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Prosecutions (1) (2) (3) (4) Factories (including Factory Laundries) 590 39 — Workshops (including Workshop Laundries) 1746 51 — Workplaces (other than Outworkers' premises) 277 20 — Total 2613 110 — 19 Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (') (3) (4) (5) Nuisances under the Public Health Acts :—* Want of cleanliness 27 27 — — Want of ventilation 3 3 — — Overcrowding 3 3 — – Want of drainage of floors — — — — Other nuisances 10 10 — — Sanitary accommodation insufficient 17 17 — — unsuitable or defective 50 50 — — not separate for sexes — — — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921 6 6 — — Total 116 116 — — *Including those specified in sections 2, 3, 7 and, 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 20 INSPECTION AND SUPERVISION OF FOOD. Dairies and Milkshops.—The number of premises registered under the provisions of the Milk and Dairies Order, 1926. is 137, and during the year 350 inspections were made of these premises. Cowhouses.— There are now only three licensed cowsheds in the Borough, and 24 visits were made to these during the year. Slaughterhouses.— There are eight slaughterhouses in the Borough, licensed by the London County Council, and during the year 566 visits were made to these to inspect the condition of the premises and to examine the carcasses of slaughtered animals. Bakehouses.— There are 82 bakehouses on our register, and 212 visits were made to these. Resaturants and Eating-houses.—The visits made to the 110 eating-houses in the Borough numbered 237. Food-stalls.—The number of visits made to food-stalls was 925. 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 in the Order :— To produce and bottle " Grade A " Milk :— Burnt Ash Farm, Lee... Messrs. Edwards & Sons, Ltd. (subsequently United Dairies (London), Ltd.). To Pasteurise :— Station Buildings, Forest Hill... Messrs. Edwards & Sons, Ltd. (Licence subsequently transferred to United Dairies (London), Ltd., at 57, Perry Vale, Forest Hill). 21 To sell by Retail :— Premises. Licencee. Designation. (See Footnote.) 17, Sydenham Road Edwards & Sons, Ltd. (subsequently United Dairies (London) Ltd.). A, B, C, D, E. 290, Sydenham Road ,, ,, 110, Bromley Road ,, , 18, Bellingham Terrace ,, ,, 3, Perry Vale ,, ,, 195, Stanstead Road ,, ,, 108, Catford Hill ,, ,, 389, Brockley Road ,, ,, 30, Burnt Ash Road ,, ,, 109, Manor Lane ,, ,, 90, 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 ,, ,, 310, High Road, Lee R. Bowyer & Son A. 195, Perry Vale R. S. Flew A, C. 112, Wood Vale Curtis Bros. & Dumbrill, Ltd. A, C, D, E. 1, Kirkdale Thos. French & Co. A. 14, High Street, Sydenham Symons Bros. A, C. 133, Catford Hill W. Lloyd A. Park Farm, Beckenham A. Goodeve & Son A. Note.—a = Certified: B = Grade A; C = Grade A (Tuberculin Tested); D = Grade A (Pasteurised) : E = Pasteurised. Bacteriological Examinations. " Certified'' Milk.—Fourteen samples were taken for submission to bacteriological examination, and six of these were found not to comply with the standard laid down in. the Order, in that they gave a positive reaction to the test for bacillus coli. These results were communicated to the Ministry of Health, who are the licensing authority for the farms on which the milk was produced. " Grade A. (Tuberculin Tested) " Milk.—Five samples were examined, all of which were up to standard. " Grade A." Milk.—Thirteen samples were taken, three of which were not up to standard. The results were communicated to the licensing authority for the district in which the producing farm was situated. 22 Sale of Food and Drugs Acts. Four hundred and seventy-three samples were taken under the Sale of Food and Drugs Acts, and submitted to the Public Analyst during the year. Of this number 368 were purchased officially in conformity with the provisions of the Acts, and the remaining 105 were bought informally as " test" samples. Twelve or 3.2 per cent. of the official samples were certified by the Public Analyst as being adulterated, or below legal standard, compared with 1.1 per cent. in 1926 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 364 352 12 Separated Milk 4 4 — Total Official Samples 368 356 12 Informal Samples. Butter 20 20 — Cream 15 15 — Cocoa 10 10 — Coffee 19 19 — Camphorated Oil 3 3 — Flour 10 10 — Lard 12 12 — Mustard 9 9 — Medicinal Prescriptions 3 3 — Salmon and Shrimp Paste 1 1 — Tincture of Bark 3 3 — Total Informal Samples 105 105 Totals, all Samples 473 461 Milk. — 364 samples of milk were submitted for analysis and of this number twelve or 3.2 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:— 23 Period. Average Composition of all Samples submitted, Genuine and Adulterated. Average Composition of Genuine Samples. Board of Agriculture Standard. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat. First Quarter 3.44 8.94 3.46 8.97 3.0 8.5 Second ,, 3.36 8.86 3.37 8.86 Third ,, 3.44 8.85 3.46 8.86 Fourth ,, 3.44 8.88 3.47 8.88 Average for the Year 342 8.88 3.44 8.89 Public Health (Milk and Cream) Regulations. None of the samples of milk were reported as containing any preservative or colouring matter. Seven 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. 287 0.30 per cent. Boric Acid 288 0.25 ,, ,, ,, 291 0.35 „ „ ,, Sold as Preserved Cream and labelled in accordance with the Regulations. 293 0.30 „ „ ,, 447 0.30 „ ,, ,, 449 0.35 ,, ,, ,, 452 0.30 „ „ ,, 24 Disease. Number of Cases Notified. INFECTIOUS DISEASES The cases of infectious disease notified during the year (with the exception of Tuberculosis, which is shown separately), are summarised in the following Table— Notified Cases of Infections Diseases, 1927 At Ages—Years Total at all Ages Number removed to Hospital, 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 1 5 22 31 43 313 137 28 44 7 2 — 633 539 Diphtheria 5 9 16 29 19 132 64 26 33 7 5 — 345 311 Enteric Fever — — — — — 1 — — 4 — 1 — 6 4 Paratyphoid Fever — — — 1 1 2 — 1 1 2 — — 8 7 Puerperal Fever — — — — — — — — 4 1 — — 5 3 Pyrexia — — — — — — — 1 12 8 — — 21 8 Erysipelas 1 — 1 — 1 — 1 1 8 14 23 4 54 14 Pneumonia 5 12 3 11 4 26 13 10 40 33 42 22 221 126 Malaria — — — — — — — 1 1 — — — 2 2 Encephalitis Lethargica — — — — — — — — 1 2 1 1 5 1 Acute Polio-Myelitis 1 — — 3 — 1 1 — 2 — — — 8 5 Cerebro-Spinal Meningitis — — — — — — — — 1 — — — 1 — Ophthalmia Neonatorum 8 — — — — — — — — — — — 8 2 25 Diseases. Age Groups. Table showing number of Deaths from Infectious Diseases during 1927— Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 years and upwards All ages. Enteric Fever — — — — — 1 — — — 1 Measles — 1 — — — — 1 — — 2 Scarlet Fever — — — 2 — 1 — — — 3 Whooping Cough 4 1 2 — — — — — — 7 Diphtheria — — 5 9 2 — — — — 16 Influenza 3 3 1 5 5 9 28 21 21 96 Encephalitis Legarthica — — — — — 1 3 2 — 6 Puerperal Fever — — — — — 4 — — — 4 26 Scarlet Fever.—The number of cases of Scarlet Fever notified was 539, compared with 478 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 : — Scarlet Fever. Cases. Deaths. Mortality per 100 cases. 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 1927 539 3 0.5 Diphtheria.—The cases notified numbered 311, compared with 377 in the previous year. Statistics for the past ten years are shewn in the following Table: — Diphtheria. Diphtheria Cases. Deaths. Mortality per 100 cases. 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 1927 311 16 5.1 Ophthalmia Neonatorum. Cases. Results. Notified. Treated. Vision Unimpaired Vision Impaired. Total Blindness. Deaths. Home. Hospital. 8 6 2 7 – — 1* •Certified cause of death —Pneumonia 27 TUBERCULOSIS New Cases and Mortality during 1927 Age Periods. Years New Cases. Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary. Males. Females. Males Females Males. Females. Males Females 0 — — — — 1 1 — 5 7 1 — 4 3 5 2 2 11 7 — 3 4 1 10 3 1 5 2 — — — — 15 13 19 6 6 23 28 1 2 20 23 35 1 7 — — — — 25 40 46 4 5 51 29 — 2 35 27 21 3 5 — — — — 45 28 15 2 1 23 12 2 — 55 8 7 1 — — — — 65 and upwards 3 3 — — 3 2 — 1 Totals 148 149 38 40 101 74 11 9 Cases of Tuberculosis on the Register, 1927. Pulmonary. Non-Pulmonary. Males Females Total Males Females Total Cases on Register at end of 1926 ... 725 573 1298 264 257 521 Cases added to Register in 1927 148 149 297 38 40 78 Cases removed from Register in 1927 Deaths and Removals from Borough 111 98 209 15 19 34 Cases on Register at end of 1927 762 624 1386 287 278 565 28 Report of Dr. Rose Jordan, Tuberculosis Officer. During the year 1927 the primary notifications of tuberculosis numbered 375, of which 297 were of pulmonary tuberculosis and 78 of other forms of tuberculosis. During the same period, 175 persons died from pulmonary tuberculosis, and 20 from non-pulmonary tuberculosis, the death-rate from pulmonary tuberculosis being 0.92 per 1,000 inhabitants. This is, unfortunately, the highest number of deaths from pulmonary tuberculosis recorded in the Borough during the present century, with the exception of the war year 1917. In may possibly in part be accounted for by the wet inclement summer. Table A. Statistics re Pulmonary Tuberculosis. Year. Borough of Lewisham. England and Wales. Deaths. Death Rate per 1000. Death Rate per 1000. 1901 120 0.93 0.896 1.26 1.214 1902 142 1.06 1.23 1903 107 0.78 1.20 1904 118 0.84 1.24 1905 126 0 87 1.14 1906 119 0.80 0.770 1.15 1.102 1907 138 0.90 1.14 1908 135 0.85 1.12 1909 125 0.75 1.09 1910 90 0 .55 1.01 1911 104 0.64 0.744 l.06 1.044 1912 112 0.68 1.02 1913 126 0.73 0.99 1914 128 0.77 1.02 1915 155 0.90 1.13 1916 167 — — 1.15 1.104 1917 182 — 1.21 1918 161 — 1.30 1919 139 0.86 0.99 1920 128 0.73 0.87 1921 143 o.81 0.724 0.88 0.812 1922 132 0.74 0.88 1923 139 0.76 0.83 1924 127 0.68 0.84 1925 117 0.63 0.83 1926 135 0.71 0.77 1927 175 0.92 29 An analysis of the deaths from pulmonary tuberculosis in the Borough since 1900 is shown in the accompanying Table A, in which the figures for Lewisham are compared with those for the whole of England and Wales, the average for each period of five years being added. It will be seen that, with the exception of the war years, there has been a steady decline in the death-rate throughout the country. Some criticisms have been offered with regard to the late notification of cases of tuberculosis in the country generally. This is not really so in the Borough of Lewisham, when the notifications are analysed. For, during 1927, there were 195 deaths from tuberculosis in the Borough, 175 from pulmonary tuberculosis and 20 from other forms of tuberculosis. Of this number, 57 (37 pulmonary and 20 other forms) were either un-notified or notified within three months of death, a total of 29 per cent. of late notifications. But, on investigation, it is found that only seven of the cases could have been notified at an earlier date, an actual percentage of 3.5. The inhabited area of the Borough has steadily grown during the year, owing to extension of the Downham Estate and the opening of the new Grove Park Estate. It has been possible to find accommodation on these Estates for a number of families containing tuberculous members, who were living under unsuitable conditions. It is hoped that the improved housing and sanitation will assist materially in protecting the contacts from infection. The notified cases of tuberculosis living on the Downham Estate now number 69 pulmonary and 18 other forms, while 8 died during the year. The four open-air shelters supplied by the Borough Council were so much appreciated by tuberculous patients having insufficient sleeping accommodation, that two additional shelters were ordered in November from Papworth Industries. Owing to inclement weather and continuous rainfall, they could not be utilised before the end of the year. 30 TABLE B. Visits. ex-Service Men. Civilians Total. Pulmonary Tuberculosis 62 216 278 Other Forms ... 3 71 74 Subsequent Visits 197 1475 1672 Un-notified Cases 20 145 165 No. occupying Separate Room 20 128 148 ,, sharing with 1 other 26 90 116 ,, ,, 2 others 14 45 59 „ „ „ 3 „ 3 19 22 „ „ „ 4 „ 1 2 3 „ „ „ 5 „ — 3 3 „ „ „ 6 „ 1 — 1 No. having Separate Bed 25 168 193 ,, sharing with 1 other 35 106 141 ,, ,, ,, 2 others 5 12 17 „ „ „ 3 „ — 1 1 „ „ „ 4 „ — — — Table B gives a summary of the work carried out by the two Health Visitors, whose visits are welcomed in the homes of the patients, where advice and help are asked and gladly given. 31 TABLE C. Condition on 315/ December, 1927, 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 1927 Totals No. of Cases 74 157 200 185 200 159 165 181 166 165 204 195 2051 Dead 48 72 86 62 89 75 79 73 62 57 58 20 781 Left 14 50 55 57 46 36 46 41 34 29 21 6 435 Well —- 5 12 17 16 16 18 37 30 39 55 34 279 Fair 1 10 6 17 8 13 14 23 32 31 60 106 321 Unwell 3 1 3 4 — 4 4 4 9 10 29 71 Discharged as arrested, or diagnosis not confirmed 8 20 40 29 37 19 4 3 4 - - -— 164 Totals 74 157 200 185 200 159 165 181 166 165 204 195 2051 Table C shows the condition on December 31st, 1927, of all patients diagnosed as suffering from pulmonary tuberculosis, who have attended the Dispensary since its inception in June, 1916. Of the 2,051 here classified, 781 are known to be dead, i.e., 38 per cent., 435 have left the Borough, 164 have been removed from the register, while 671 are still living in the Borough. Of the latter. 279 are well and able to work. The Tuberculosis Officer paid 306 visits at the homes of patients, and visited 23 patients in consultation with their medical attendants. The London County Council admitted 192 patients to residential institutions. The Lewisham Hospital admitted 28 patients recommended by the Tuberculosis Officer. Two patients were admitted through the Guardians to the Papworth Training Colony, where they are making good progress. The Dispensary is affiliated to King's College Hospital and to the Miller General Hospital; and patients also attend the London Hospital for special light treatment, and Brampton. Hospital for Artificial Pneumothorax refills. During the year, 3 patients made 31 attendances for treatment for lupus, 5 patients were sent for X-Ray examination, 7 were referred to King's College Hospital for surgical and laryngeal complications, while 11 patients made 105 attendances for Artificial Pneumothorax refills. Under the special arrangements for dental treatment with the British Dental Hospital, 22 patients received dental treatment and two were provided with dentures. The Borough Council granted diet allowances of milk, eggs and butter to 15 patients to aid them in keeping fit for work after returning from Sanatorium. The Secretary of the Care Committee reports that 26 meetings were held during the year to discuss the financial and social circumstances of the patients and to assess their contributions towards institutional treatment. Ninety-six patients were asked to pay weekly contributions, varying from 1s. to 30s., while 106 were recommended for free treatment. Nearly £600 33 was thus collected from the patients and forwarded to the London County Council. Help was given with regard to the supply of clothing and other necessities and also for the boarding-out of children and for seeking employment. The voluntary fund was well maintained and proved a most useful adjunct in providing assistance. The Handicrafts Class has had three successful terms, each of 12 sessions. It consists of 16 male and female patients selected as suitable by the Tuberculosis Officer. A most efficient instructress is provided by the London County Council, and the leather, raffia and cane work accomplished has been of a surprisingly high order for beginners. The therapeutic benefit to the patients is most gratifying. During the year, 100 tuberculous ex-service men living in the Borough have been seen in connection with the Dispensary. They are given preferential consideration with regard to any necessary institutional treatment. The following tables give a summary of the work carried out at the Dispensary during the year: — Table D. Attendances of Patients at the Dispensary. 1926. First Attendances. Subsequent Attendances. Totals. January 76 246 322 February 57 170 227 March 78 198 276 April 55 182 237 May 78 202 280 June 28 170 198 July 59 170 229 August 36 122 158 September 61 214 275 October 62 197 259 November 7'2 187 259 December 42 127 169 704 2185 2889 34 Table E. Summary of First Attendances at the Dispensary, 1927. 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 46 96 5 39 1 8 195 Non-Pulmonrry 14 4 — 8 11 2 39 No Tuberculous Disease 121 124 1 C 38 177 407 Suspects 2 1 — — — — 3 183 225 6 53 50 187 704 Table F. Stages in Pulmonary Tuberculosis. Male. Female. Children under 16. Total. Stage I. 24 21 3 48 „ II. 52 53 2 107 „ III. 20 20 — 40 96 94 5 195 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 3 9 13 Bone 5 6 7 18 . Other Regions 1 3 4 8 7 12 20 39 85 MATERNITY AND CHILD WELFARE. Work of Health Visitors. Seven whole-time Health Visitors are engaged in Maternity and Child Welfare work, each being allotted a particular portion of the Borough. Infants are visited by them as soon as information of a birth is received, and at intervals, three or four times during the first year of life. Further visits are made subsequently, but at longer intervals, until the child reaches the age of five years. The duties of the Health Visitors also comprise visits to expectant mothers, to cases of Puerperal Fever, and Ophthalmia, to applicants under the Milk Assistance Scheme, and enquiries into infant deaths. Each Health Visitor attends the Voluntary Infant Welfare Centre which is held in her district, and also takes her turn in attending the Council's Infant Welfare Clinic. The work of these officers is summarised in the following table:— Primary Visits to Infants under 1 year 2,771 Subsequent „ „ „ 10,017 Children between 1 and 5 years of age 6,600 Still Births 30 Infant Deaths 60 Ante-Natal Cases—Primary Visits 237 „ ,, Subsequent Visits 141 Applications for Milk 1,393 Puerperal Fever and Pyrexia Cases 10 Ophthalmia Neonatorum Cases 9 Other Infectious Cases 193 Miscellaneous Visits 312 Municipal Maternity Home. Medical Officer Dr. J. W. Mii.i.er. 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. 36 The nursing stafl 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. During the year 310 confinements took place in the Home, of which 176 were priniparæ and 134 multipara, and the nature of these cases is shown in the following Table:— Total. Proportion to Total. Percentage. Total Number of Labours 310 - - Vertex Presentation 305 1 in 1.01 98.38 Pelvic „ 8 1 in 38..7 2.5 Twins 3 1 in 103.3 .96 Fibroid of Uterus 1 1 in 310 .32 Manual Removal of Placenta 1 1 in 310 .32 Forceps 8 1 in 38.7 2.5 Minor Operations (P.42, M.8) 50 1 in 6.2 16.12 Thrombosis 1 1 in 310 .32 Phlebitis 1 1 in 310 .32 Morbidity 4 1 in 77.5 1.29 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 313 infants born, six were still-born, and five died shortly after birth. Details of these cases are set out in the following Table: — Number of Births 313 Full-term Deaths 4 Macerated 2 Total number born dead 6 Infants born alive who died in the Home 5 Total number born dead or died in the Home 11 37 Still-births. Maturity. Cause of Death. Remarks. 1. Premature Unknown Foetus macerated 2. Full-term Asphyxia Pallida - 3. „ Prolonged Labour - 4. „ Unknown - 5. „ „ - 6. „ „ Foetus maceratcd Live Births. Maturity. Period of Survival. Cause of Death. 7. Premature 4 hours Prematurity 8. „ (Twin) 24 „ 9. ,, ,, 50 „ 10. Full-term 4 days Intracranial Haemorrhage 11. „ 24 hours Atelectasis The sex incidence of the infants was as follows:— Males, 151. Females, 162. Total, 313. The average length and weight of the full-term infants were as follow: — Males Length, 21.9 inches. Weight, 7.6-lbs. Females ,, 21.3 ,, ,, 7.1-lbs. All the infants were entirely breast-fed with the exception of "three. In one case the mother was suffering from Pulmonary Tuberculosis and the infant was entirely bottle-fed. The other two required complementary feeds. Four of the infants had congenital defects, viz., 1, Talipes; 1, Undescended testicle; 1, Supernumerary linger; and 1, Partial cleft palate. One infant developed a Cephalhematoma. One case of Ophthalmia Neonatorum occurred, in spite of the prophylactic measures taken. The case responded to treatment and was discharged well. The following table shows the details of infants stillborn (or who died shortly after birth) for the period, 1st June, 1918, to 31st December, 1927:- Number of Births 2,411 Premature Deaths, recent 12 Full-term Deaths 40 Macerated 15 Putrid 1 Total number born dead 68 Infants born alive who died in the Home 41 Total number born dead or died in the Home 109 38 The following Table shews the number and classification of cases admitted to the Maternity Home during the period June 1st, 1918, to December 31st, 1927: — Total. Proportion to Total. Percentage. Total Number of Labours 2,382 - - Vertex Presentation 2,303 1 in 1.03 96.68 Face „ 4 1 in 595.5 .16 Pelvic „ 102 1 in 23.35 4.28 Transverse „ 2 1 in 1191 .08 Twins 29 1 in 82.13 1.21 Accidental Haemorrhage 9 1 in 264.6 .37 Placenta Previa 1 1 in 2382 .04 Acute Inversion of Uterus 1 1 in 2382 .04 Post-Partum Hemorrhage 10 1 in 238.2 .41 Secondary „ ,, 1 1 in 2382 .01 Eclampsia 1 1 in 2382 .04 Post-Partum Eclampsia 2 1 in 1191 .08 Fibroids of Uterus 1 1 in 595.5 .16 Dermoid Cyst in Pelvis 1 1 in 2382 .04 Manual Removal of Placenta 30 1 in 238.2 .41 Forceps 127 1 in 18.75 5.30 Minor Operations 3G2 1 in 6.58 15.19 Internal Version 1 1 in 2382 .04 Prolapse of Cord 8 1 in 297.75 .33 Rupture of Cord 1 1 in 2382 .04 Craniotomy (Hydrocephalus) 1 1 in 2382 .04 Hydramnios 1 1 in 2382 .04 Pyelonephritis 2 1 in 1191 .08 Albuminuria of Pregnancy G 1 in 397 .25 Parenchymatous Mastitis 2 1 in 1191 .08 Phlebitis 4 1 in 595.5 .16 Thrombosis 1 1 in 2382 .04 Measles 1 1 in 2382 .04 Puerperal Insanity 3 1 in 794 .12 Puerperal Sepsis 5 1 in 476.4 .20 Morbidity 49 1 in 48 61 2.05 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 2,203. 39 An analysis of the cases is set out in the following Table:— Classification of Cases. No. Totals. Consultations 1814 1814 Disorders and Diseases of the Reprodictory System— Endocervicitis 14 Pruritis Vulvae 4 Neuralgia of Nipple 1 19 Disorders and Diseases of the Alimentary System— Dental Caries 26 Stomatitis 1 Dyspepsia 100 Constipation 75 Haemorrhoids 5 Hernia 1 208 Diseases of the Heart, Blood Vessels, Etc.— Varicose Veins 14 Thyroid Enlargement 9 23 Diseases of the Respiratory System— Nasal Catarrh 4 Epistaxis 4 Bronchitis 29 Laryngitis 1 Tuberculosis 1 39 Functional Disorders and Diseases of the Nervous System— Neuralgia 3 Neuritis 2 Insomnia of Pregnancy 18 Sickness of Pregnancy 17 40 Diseases of the Urinary System— Albuminuria of Pregnancy 2 Cystitis 2 Pyelitis 1 5 Affections of the Skin— Chloasma Gravidarum 1 Furunculosis 1 Rosacea 1 Urticaria 3 Intertrigo 1 Paronychia 1 8 General Diseases— Anaemia of Pregnancy 44 Muscular Rheumatism 3 47 40 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 1927 were as follows: — Maternity Clinic 1,977 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 1051 1054 Disorders and Diseases op the Reproductory System— Abortion 1 Endocervicitis 8 Subinvolution of Uterus 65 Menorrhagia 6 Metrorrhagia 2 Amenorrhcea 3 Leucorrhcea 4 Sore Nipples 5 Mastitis 1 llreast Abscess 3 Flushed Breasts ,.. 3 Engorged Breasts 4 Scanty Secretion of Milk 77 182 Disorders and Diseases of the Alimentary System— Dental Caries 128 Pyorrhoea 1 Coryza 3 Pharyngeal Catarrh 1 Mumps 3 Tonsillitis 6 Stomatitis 3 Dyspepsia 33 Gastric Ulcer 2 Colitis 1 Constipation 87 Haemorrhoids 26 294 41 Maternity Clinic—continued. Classification of Cases. No. Totals. Diseases of the Respiratory System— Nasal Catarrh 8 Influenza 6 Laryngitis 8 Bronchitis 54 Asthma 1 Pulmonary Tuberculosis 1 77 Diseases of the Heart, Blood Vessels, Etc.— Valvular Disease of the Heart 2 Varicose Veins 2 Varicose Ulcer 2 6 Functional Disorders and Diseases of the Nervous System— Facial Neuralgia 9 Neuritis 2 Neurasthenia 2 Epilepsy 1 Insomnia of Pregnancy 1 Sickness of Pregnancy 10 25 Diseases of the Lymphatic System, Thyroid, Etc.— Thyroid Inefficiency 2 Thyroid Enlargement 3 5 Diseases of the Urinary System— Chronic Brieht's Disease 1 Cystitis 5 6 Affections of the Skin— Alopecia Areata 2 Eczema 4 Scabies 1 Rosacea 2 Urticaria 3 Impetigo 1 Furunculosis 4 Paronychia 1 18 Diseases of the Ear— Otitis Media 1 Diseases of the Eye— 1 Blepharitis Marginalis 2 Conjunctivitis 1 Meibomian Cyst 1 4 42 Maternity Clinic—continued. Classification of Cases. No. Totals. Diseases of the Muscles, Bones and Joints— Ganglion 1 Rheumatoid Arthritis 2 Muscular Rheumatism 32 35 Burns and Scalds 1 1 General Diseases— Anaemia of Pregnancy 7 Lactational Anaemia 230 Post-Partum Anaemia 32 269 43 Child Welfare Clinic. Classification of Cases. No. Totals. Consultations on Feeding and Management 5230 5230 Functional Disorders and Diseases of the Alimentary System— Tongue-tie 5 Dental Caries 78 Disorders of Dentition 66 Alveolar Abscess 2 Enlarged Tonsils and Adenoids 41 Mumps 1 Thrush 22 Gingivitis 2 Tonsillitis 6 Gastritis 1 Stomatitis 6 Dyspepsia 208 Gastro-Enteritis 8 Gastro-Intestinal Catarrh 74 Catarrhal Jaundice 2 Constipation 242 Intusuception 1 Prolapse of Rectum 1 Haemorrhoids 1 Hernia (Inguinal—Single) 2 Hernia (Inguinal—Double) 2 Hernia (Umbilical) 20 Thread Worms 27 Round Worms 2 820 Diseases of the Respiratory System— Nasal Catarrh 46 Pertussis 21 Laryngitis 2 Influenza 3 Bronchitis 434 Bronchial Catarrh 8 Broncho-Pneumonia 2 Asthma 3 519 Functional Disorders and Diseases of the Circulatory System— Valvular Disease of the Heart 1 Congenital Heart Disease 2 3 44 Child Welfare Clinic—continued. Classification of Cases. No. Totals. Functional Disorders and Diseases of the Nervous System— Convulsions 3 Epilepsy 1 Backward Speech 1 Angio-Neurotic Oedema 2 7 Diseases of the Lymphatic System— Cervical Adenitis 7 Post-Cervical Adenitis 2 Sub-mental Adenitis 1 10 Diseases of the Urinary System— Eneuresis 6 6 Functional Disorders and Diseases of the Reproductive System— Phimosis 3 Preputial Adhesions 17 Preputial Inflammation 5 Mastitis 2 Breast Abscess 1 28 Affections of the Skin— Nævus 8 Eczema 73 Eczema Capitis 3 Seborrhœic Eczema 3 Seborrhœa Capitis 8 Pediculosis Capitis 1 Ringworm 1 Furunculosis 11 Erythema Multiforme 1 Impetigo 48 Urticaria 82 Alopecia 1 Sudamina 1 Scabies Herpes 1 Pemphigus 11 Dermatitis (Napkin) 3 Sore Buttocks 13 Ichthyosis 1 Paronychia 5 278 Diseases of the Ear— Otitis Media 35 Abscess in External Auditory Meatus 2 37 45 Child Welfare Clinic—continued. Classification of Cases. No. Totals Diseases of the Eye— Catarrhal Conjunctivitis 21 Phlyctenular Conjunctivitis 1 Ophthalmia Neonatorum 4 Blepharitis Marginalis 5 Strabismus 3 Meibomian Cyst 1 Keratitis 1 Cataract (Congenital) 1 Hordeolum 3 40 Injuries and Diseases of the Muscles, Bones and Joints, Etc.— Arthritis 1 Fracture of Clavicle 1 2 Wounds and Bruises 8 8 Scalds and Burns 3 3 Exanthemata— Chickenpox 6 6 Mental Defects 3 3 Congenital Defects— Cleft Palate 3 Double Harelip and Cleft Palate 1 Webbed Fingers 1 Supernumerary Finger 1 Imperforate Anus 1 Talipes 3 Flat Foot 3 Metatarsal Varus 4 17 Injuries and Diseases of the Newborn— Polypus of Umbilicus 12 Hematoma of Sterno-Mastoid 1 13 Rickets 18 General Diseases— 18 Anaemia 10 Rheumatism 7 17 . 46 Dental Treatment.—By agreement with the British Dental Hospital, the following cases were treated daring 1927: — Dental Treatment (Extractions, Fillings, etc.):— Expectant and Nursing Mothers 166 Infants 66 The supply of artificial dentures was authorised by the Council for 57 expectant and nursing mothers. Voluntary Infant Welfare Centres.— There are eight 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, 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, 1927. Catford School for Mothers Wesleyan Hall, Rushey Green 2 10786 Forest Hill Infant Welfare Centre Salvation Army Hall, Wastdale Road 1 2946 Hither Green Babies' Welcome Wesleyan Hall, Hither Green 1422 Bellingham Infant Welfare Centre St. Dunstan's Hall. Bellingham 1 4279 Lee and Blackheath School for Mothers St. Margaret's Hall. Old Road, Lee 4876 St. Mary's School for Mothers St. Mary's Mission Hall, Ladywell Pk. 1 4943 Sydenham Infant Welfare Centre 5-7, Adamsrill Rd., Sydenham 4784 Downham Infant Welfare Centre (opened May, 1927) St. Barnabas' Church Hall. Downham Way 1 1526 48 MISCELLANEOUS. Summary of Housing Statistics, 1927. Number of new houses erected during the year: — (a) Total (including numbers given separately under (£) ) 2012 (b) With State assistance under the Housing Acts :— (i) By the Local Authority 272 (ii) By other bodies or persons 1256 1. Inspection of dwelling-houses during the year: — (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 37622 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 1377 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation— (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2133 2. Remedy of defects without Service of formal Notices. Number of defective dwelling-houses rendered lit in consequence of informal action by the Local Authority or their officers 333 3. Action under Statutory Powers. A.—Proceedings under section 3 of the Housing Act, 1925 Nil. 49 B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1900 (2) Number of dwelling houses in winch defects were remedied after service of formal notices:— (a) By owners 1900 (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 — (2) Number of dwelling-houses in respect of which Closing Orders were made — (3) Number of dwelling-houses in respect of which Closing Orders were determined — (4) Number of dwelling-houses in respect of which Demolition Orders were made — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — Water Certificates. The following newly-erected dwelling-houses were passed for occupation during the year Downham Estate (London County Council) 1256 Grove Park Estate (Lewisham Borough Council) 272 Erected by private enterprise 484 Total 2012 Rent Restriction Acts, 1920 and 1923. During the year 23 applications were made by occupiers for the certificate of the Sanitary Authority under the provisions of the above Acs, and in each case the Council authorised the issue of the certificate. A report of the Sanitary Authority to the effect that the necessary work had been carried out and the premises placed in a reasonable state of repair, was issued to the owner in 5 instances. 50 Coroner's Court and Mortuary No. of bodies received into the Mortuary 183 No. of Inquests held 184 No. of Post-mortem Examinations made 92 Bacteriological Work. Increasing use is made of the facilities afforded by the Council for bacteriological work at the St. John's Hospital, and during the year 2834 specimens were examined, compared with 2702 in the previous year, the details being as follows: — Material from cases of suspected Diphtheria:— Diphtheria bacillus isolated 164 Negative 1839 2003 Sputa from cases of suspected Tuberculosis: — Tubercle bacillus found 119 „ ,, not found 621 740 Blood from cases of suspected Enteric Fever:— Positive result 6 Negative result 73 79 Pathological specimens for enteric organisms: — Positive result 2 Negative result 10 12 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:— 51 Disease Premises Disinfected. Rooms Disinfected. Articles Removed and Disinfected. Scarlet Fever 611 1465 18967 Diphtheria 313 788 9739 Tuberculosis 317 670 1538 Cancer G4 79 608 Enteric Fever 6 11 179 Erysipelas 6 8 24 Other Diseases 108 157 1647 Totals 1425 3178 32702 Disinfestation.—Seventy-eight rooms and 437 articles infested with vermin were disinfected. 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 1927 were as follows: — Van Loads 13,302 Cart Loads 8,503 Motor Loads 7,342 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 1927:— Dust Destructors 32,823 tons Trained away 3,655 ,, Shoots 145 „ Total 36,623 tons