LEW 17 METROPOLITAN BOROUGH OF LEWISHAM. REPORT OF THE Medical Officer of Health For the Year 1929 John W. Miller, M B., Ch.B., D.P.H. Lewisham Printed by Freame, Manning & Co., Ltd., 12a, Lee High Road LEW 17 METROPOLITAN BOROUGH OF LEWISHAM REPORT of the Medical Officer of Health For the Year 1929. John W. Miller, M B., Ch.B., D.P.H. Lewisham: Printed by Freame, Manning & Co., Ltd., 12a, Lee High Road 2 PUBLIC HEALTH COMMITTEE, appointed 9th November, 1929. His Worship the Mayor (Councillor C. G. Bryant, J.P.) Councillor J. T. Hallinan (Ex-Mayor), (Chairman) Aldermen:— H. Chiesman, M.B.E., J.P. E. W. Hayes A. W. Hiscox Councillors:— Miss A. Ball Mrs. E. E. Goldthorpe A. O. Bentley Miss G. M. Mason H. E. Brown Mrs. G. Pinnell D. C. Cummings W. J. Purvis W. J. Easterbrook W. G. C. Roberts Mrs. E. Edwards R. Steeden Mrs. M. H. Edwards T. Steeden Mrs. C. M. Wadham MATERNITY AND CHILD WELFARE COMMITTEE, appointed 9th November, 1929 His Worship the Mayor (Councillor C. G. Bryant, J.P.) Councillor Miss A. Ball (Chairman) Aldermen:— H. Chiesman, M.B.E.. J.P. E. W. Hayes A. W. Hiscox Councillors:— A. O. Bentley W. McCubbin H. E. Brown H. W. Mitchenall D. C. Cummings Mrs. G. Pinnell Mrs. E. Edwards W. J. Purvis Mrs. M. H. Edwards W. G. C. Roberts Mrs. E. E. Goldthorpe R. Steeden Miss G. M. Mason Mrs. C. M. Wadham A. J. Wakelin together with Miss A. Burrows Miss J. H. Howes Mrs. E. N. S. Creed Mrs. L. M. Sibley Miss A. C. E. Fuller Mrs. E. M. Smith Mrs. E. M. White 3 CONTENTS. Page Public Health Committee 2 Maternity and Child Welfare Committee 2 Section I.—Statistics and Social Conditions 5 „ II.—General Provision of Health Services 12 „ III.—Sanitary Circumstances 18 „ IV.—Housing 28 „ V.—Inspection and Supervision of Food 32 „ VI.—Infectious Diseases 42 „ VII.—Maternity and Child Welfare 66 4 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report for the year 1929 on the Health and Sanitary State of the Borough of Lewisham, this being the twenty-ninth of the series. The Vital Statistics contained therein show that Lewisham still remains one of the healthiest of the London Boroughs. The corrected death-rate for the year was 11.5 per thousand of the population, as against 10.0 per thousand in 1928. This rate compares favourably with the death-rate of 13.8 for the County of London. The birth-rate was 15.7 per thousand of the population, and is a very slight increase on the year 1928, when the birthrate was 15.2 per thousand. The infant mortality, a most valuable index of the health of the Borough, was 44 per thousand births, as against 52 per thousand in 1928. This rate is the lowest ever recorded in the Borough, and the lowest of any of the London Boroughs. It is considerably below the average for the County of London, which amounted to 70 per thousand births. In the autumn an outbreak of Enteric Fever occurred in the Sydenham district of the Borough, and adjoining portions of Beckenham and Penge. There were 104 Lewisham cases, with 15 deaths. It is a pleasure to be able to record my appreciation of the kind consideration and support accorded me by the Chairman and members of the Public Health Committee and the Maternity and Child Welfare Committee, and to thank my colleagues, the Chief Officers of Departments, and the staff of the Public Health Department, for their loyal support and assistance. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, John W. Miller. Public Health Department, Lewisham Town Hall, Catford, S.E. 6. June, 1930. 5 SECTION I.—STATISTICS AND SOCIAL CONDITIONS. A summary of the Statistics for the year 1929 is set out herewith in the form specified by the Ministry of Health: — Area, in acres 7,015 Population:—Census, 1921 174,194 Estimated, 1929 207,900 Number of Inhabited Houses in 1921 34,420 Number of Families or Separate Occupiers in 1921 43,685 Rateable Value (as per County of London Valuation, 6th April. 1929) £1,394,755 Produce of a 1d. rate (estimated) £5,659 Births—Legitimate 3,156 Illegitimate 105 Birth-rate 15.7 Deaths 2,409 Death-rate 11.5 Number of women dying in, or in consequence of childbirth: — From Sepsis 9 From other causes 8 Deaths of Infants under 1 year of age per 1,000 births: Legitimate 41 Illegitimate 133 Total 44 Deaths from Measles (all ages) 6 „ „ Whooping Cough (all ages) 20 „ „ Diarrhœa (under 2 years of age) 15 Social Conditions. Lewisham may be described as a residential suburb of London. There are a few factories in the Borough, but these employ only a very small proportion of the residents, the great majority of whom are employed elsewhere. 6 Population. The population of the Borough at the Census in 1921 was 174,194. The Registrar-General's estimate of the population in 1929 is 207,900. This figure has been employed in calculating the various mortality and other rates which appear in this Report. Births. The number of births in 1929, after correction for inward and outward transfers, was 3,267, compared with 3,036 in 1928. This number is equivalent to a birth-rate of 15.7 per thousand of the population, and is a very slight increase on the year 1928, when the birth-rate was 15.2 per thousand. The number of illegitimate infants born was 105 equivalent to 3.2 per cent. of the total. Marriages. The number of marriages registered in the Borough during the year was 1,443. Of this number, 689 were solemnized in the Established Church, 204 at Nonconformist Places of Worship, and 550 at the Register Office. Deaths. The number of deaths of Lewisham Residents registered during 1929 was 2,409. The death-rate was 11.5 per thousand of the population, compared with 10.0 per thousand in 1928. The principal causes of death are summarised in the following list:— 4 Cause of Death. Number of Deaths. Principal Zymotic Diseases 61 Influenza 121 Pulmonary Tuberculosis 153 Other Tuberculous Diseases 31 Cancer 300 Cerebral Haemorrhage 83 Heart Disease 447 Arterio Sclerosis 99 Bronchitis 171 Pneumonia 154 Nephritis and Bright's Disease 68 Puerperal Fever 9 Other Diseases and Accidents of Parturition 8 Premature Birth and Congenital Debility 65 Suicide 27 Accidents 98 All other causes 514 Total 2,409 Infant Mortality. The number of infants who died before reaching the age of one year was 144, and the infant mortality rate was 44 per thousand births. The corresponding figure for the County of London was 70. Maternal Mortality. The number of deaths recorded in the Borough resulting from child-birth was 17, of which number 9 were due to Puerperal Sepsis, and 8 to other accidents and diseases of child-birth. This mortality is higher than in any of the previous ten years, as will be seen from the following figures: — Deaths from Year. 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 1927 4 2 6 1928 4 3 7 The problem of maternal mortality is receiving the serious consideration of the responsible authorities, and a Committee of experts has been formed under the auspices of the Ministry of Health, with Sir George Newman, the Chief Medical Officer of the Ministry, as Chairman. 8 An investigation was made into each of the maternal deaths which occurred in this Borough, and forwarded to the Maternal Mortality Committee. The Council were fortunate in securing the services of Mr. G. F. Gibberd, F.R.C.S., to conduct these investigations. It is hoped that in the near future a scheme will be in operation for the provision of the services of two Consulting Obstetricians to assist medical practitioners in complicated cases of pregnancy or labour. The services of the Consultants would only be available where the financial circumstances of the patient are such that the necessary expert advice could not otherwise be obtained. The Council would be responsible for the Consultant's fee, but would reserve the right to recover all or part of the fee from the patient or her husband. The provision of Home Helps and sterile maternity outfits for necessitous cases will also be included in the scheme. The following table shows the Maternal Deaths classified according to the certified causes of death:— Diseases and Accidents of Pregnancy. Complications of Labour and the Puerperium. Other Causes. (1) Ruptured tubal pregnancy. (!) Puerperal Sepsis. (1) Asthma, causing heart failure 8 hours after parturition. (2) Puerperal Sepsis. (2) Accidental haemorrhage and hydramnios. (3) Puerperal Peritonitis. (4) Post partum haemorrhage and Puerperal Peritonitis (3) Miscarriage, followed by septic endometritis. (5) Retained placenta and Puerperal Sepsis. (6) Delayed labour and Puerperal Septicaemia. (4) Miscarriage, followed by general peritonitis. (7) Difficult labour and Acute Yellow Atrophy of Liver. (8) Obstructed labour and Puerperal Sepsis. (9) Retained placenta and Post partum haemorrhage. (10) Post-partum Eclampsia. (11) Post-partum Eclampsia. (12) Haemorrhage into the left suprarenal gland during labour. It will be seen that Puerperal Sepsis is responsible directly, or indirectly, for the majority of these deaths. It is only by careful medical supervision during the ante-natal period, and by conducting all confinements with the aseptic precautions of a major operation, by an experienced obstetrician, that maternal mortality will be reduced to the unavoidable minimum. 9 Causes of Death at Different Periods of Life during the Year 1929. 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 7 — — — 2 — 3 2 — — F 9 — — — 1 3 4 1 — — 2. Small Pox M — — — — . — — — — — — F — — — — — — — — — — 3. Measles M 3 2 1 — — — — — — — F 2 — — 1 1 — — — — — 4. Scarlet Fever M 3 — — 1 1 1 — — — — F 2 — — 1 1 — — — — — 5. Whooping Cough M 7 3 3 1 — — — — — — F 13 7 6 — — — — — — — 6. Diphtheria M 7 — — 4 3 — — — — — F 8 2 — 2 4 — — — — — 7. Influenza M 58 2 3 2 2 4 13 18 7 7 F 63 — 1 1 — 4 4 14 16 23 8. Encephalitis Lethargica M — — — — — — — — — — F 1 — — — — — — — 1 — 9. Meningococcal Meningitis M 1 — — — — — 1 — — — F — — — — — — — — — — 10. Tuberculosis of Respiratory System M 83 — — J 1 13 32 30 5 1 F 70 — — — 2 18 40 7 3 — 11. Other Tuberculous Diseases M 19 — 1 4 7 3 3 1 — — F 12 1 — 1 3 3 3 1 — — 12. Cancer, Malignant Disease M 128 — — — 2 — 4 62 29 31 F 172 — — — — — 12 70 49 41 13. Rheumatic Fever M 1 — — — — — — 1 — — F 3 — — — 1 — 1 1 — — 14. Diabetes M 7 — — — — — 1 4 2 — F 15 — — — 1 — 2 2 9 1 15. Cerebral Hæmorrhage. &c. M 26 — — — — — 1 9 5 11 F 57 — — — — — — 16 17 24 16. Heart Disease M 182 — — — 6 2 16 51 64 43 F 265 — — — 1 8 22 54 65 115 17. Arterio Sclerosis M 46 — — — — — — 11 15 20 F 53 — — — — — — 7 15 31 18. Bronchitis M 90 4 2 — — 1 4 22 26 31 F 81 3 — — 2 — 1 9 12 54 Continued on next Page. 10 Causes of Death at Different Periods of Life during the Year 1929—continued. Causes of Death. Sex. All Ages Under 1 year. 1 and under 2 years. 2 and under 5 years. nd 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 79 8 5 3 — 3 11 21 17 11 F 75 8 4 2 2 1 7 10 13 22 20. Other Respiratory Diseases M 21 — — — — 1 4 4 7 5 F 20 — — 1 — 1 2 3 7 6 21. Ulcer of Stomach and Duodenum M 12 — — — — — 4 8 — — F 9 — — — — 2 5 1 1 22. Diarrhœa, &c. M 14 12 — 1 — — — 1 — — F 8 6 — — — — 2 — — — 23. Appendicitis & Typhlitis M 4 — — 1 — — — 2 — 1 F 2 — — — — — — 2 — — 24. Cirrhosis of Liver M 8 — — — •— — — 5 2 1 F 4 — — — — — — 3 1 — 25. Acute & Chronic Nephritis M 34 — — — — 1 3 14 9 7 F 34 — — — — 1 2 18 8 5 26. Puerperal Sepsis M — — — — — — — — — — F 9 — — — — — 9 — — — 27. Other accidents and diseases of Pregnancy & Parturition M — — — — — — — — — — F 8 — — — — 1 7 — — — 28 Congenital Debility, Pre mature Birth M 33 31 — 1 — — 1 — — — F 32 20 1 — 1 — — — — — 29. Suicide M 18 — — — — 1 4 9 2 2 F 9 — — — — — 4 5 — — 30. Other Deaths from Violence M 47 — 1 — 2 6 13 14 5 6 F 51 3 — 1 2 2 10 6 9 18 31. Other Defined Diseases M 184 13 2 3 6 6 15 44 32 63 F 203 9 2 6 5 3 15 49 22 89 32. Causes ill-defined or unknown M — — — — — — — — — — F — — — — — — — — — — All Causes M 1122 75 18 22 32 42 133 333 227 240 F 1287 6'J 14 16 27 45 149 289 248 430 Totals — 2409 144 32 38 59 87 282 622 475 670 11 Table showing the Birth Rates, Death Rates and Infant Mortality Rates in the 29 Metropolitan Cities and Boroughs in 1929. Births per 1000 population. Deaths per 1000 population. Infantile Deaths, per 1000 births. County of London 15.7 County of London 13.8 County of London 70 City of London 7.0 Lewisham 11.5 Lewisham 44 Holborn 10.0 Woolwich 12.5 Stoke Newington 47 Westminster 10.3 City of London 12.6 Hampstead 53 Hampstead 11.3 Hampstead 12.8 Hackney 58 Chelsea 11.6 Deptford 12.9 Hammersmith 61 St. Marylebone 11.9 Stoke Newington 13.0 Wandsworth 61 Wandsworth 13.3 Wandsworth 13.0 Woolwich 61 Kensington 14.3 Camberwell 13.2 Battersea 63 Paddington 14.7 Bethnal Green 13.3 City of London 63 Camberwell 15.1 Fulham 13.4 Bethnal Green 64 Fulham 15.2 Hackney 13.5 Camberwell 66 Lambeth 15.5 Hammersmith 13.5 Lambeth 67 St. Pancras 15.5 St. Marylebone 13.5 Chelsea 69 Lewisham 15.7 Stepney 13.6 Bermondsey 71 Hackney 15.8 Battersea 13.8 Holborn 71 Woolwich 15.8 Greenwich 13.8 Islington 71 Hammersmith 15.9 Poplar 13.8 Fulham 72 Stoke Newington 15.9 Westminster 13.8 Greenwich 72 Battersea 16.0 Bermondsey 14.1 Deptford 75 Greenwich 16.1 Lambeth 14.4 Poplar 75 Deptford 16.5 Islington 14.6 St. Marylebone 75 Stepney 17.2 Holborn 14.7 Westminster 75 Islington 17.4 Kensington 14.7 Finsbury 79 Southwark 17.8 Paddington 14.9 St. Pancras 81 Bethnal Green 18.4 St. Pancras 15.0 Southwark 81 Finsbury 18.8 Chelsea 15.2 Shoreditch 82 Poplar 18.9 Southwark 15.4 Kensington 84 Bermondsey 19.5 Shoreditch 15.5 Stepney 89 Shoreditch 19.8 Finsbury 15.6 Paddington 99 Note.—The Birth and Death Rates for Lewisham are calculated on the Estimated Population for 1929, while those from other districts are extracted from the Registrar General's Report, and are based on the 1928 population. 12 SECTION II—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Hospitals Provided or Subsidized by the Local Authority or by the County Council. Fever and Small-pox.— Hospitals for the treatment of infectious diseases in the Metropolis are under the control of the Metropolitan Asylums Board. One of these Institutions, the Park Hospital, is situated in the Borough, and most of the Lewisham cases are sent either to this Hospital, the Brook Hospital at Shooters Hill, or the South-Eastern Hospital at New Cross. Small-pox cases are received for observation at South Wharf, Rotherhithe, and sent for treatment to Joyce Green Hospital, near Dartford. Tuberculosis.—Institutional treatment for tuberculosis is arranged by the London County Council. Maternity.—The Lewisham Borough Council's Maternity Home is situated at 41, Rushey Green, Catford. It was opened in 1918 with twelve beds, which number was subsequently increased to seventeen. The Maternity Wards of Lewisham Hospital also provide accommodation for Lewisham residents. Accommodation for the treatment of infants suffering from marasmus and ophthalmia neonatorum is provided at St. Margaret's, Kentish Town, by the Metropolitan Asylums Board. Other Hospitals.-—The only Voluntary General Hospital in the Borough is the St. John's Hospital, Morden Hill, and this 13 Institution, and the Lewisham Hospital, which is maintained by the Lewisham Guardians, constitute the main provision for the sick of Lewisham. The Miller Hospital, King's College Hospital, and the London General Hospitals, are largely used by inhabitants of the Borough. Children.—-The South-Eastern Hospital for Children is situated at Sydenham, within the Borough. The Hostel forming part of the Sydenham Infant Welfare Centre in Adamsrill Road, provides twelve beds for wasting and premature babies. Institutional Provision for Unmarried Mothers, Illegitimate Infants, and Homeless Children. The Borough Council does not provide accommodation of this nature. The Lewisham and Lee Shelter for Girls, situated in Ladywell Park, provides accommodation for unmarried mothers, as also does the Southwark Diocesan Maternity Home, Stretton House, Grove Park. Ambulance Facilities. (a) For infectious cases.—The Metropolitan Asylums Board ambulance service is available for the removal of infectious cases to Hospital. (b) For non-infectious cases.— The Metropolitan Asylums Board's ambulance service is available, on payment, for the transport of non-infectious patients. For accidents, or illness in streets or public places, and, in certain circumstances, for maternity cases, the London County Council Ambulance Service is available. 14 Clinics and Treatment Centres. A list of the Clinics and Treatment Centres is set out below in tabular form:— Situation. Nature of Accommodation. By Whom Provided. No. of sessions weekly. Ante-Natal. Maternity Home, 41, Rushey Green, S E.6 Waiting Room Consultation Room Lewisham Borough Council 2 5-7, Adamsrill Road, S.E.26 Examination Room Do. Sydenham Infant Welfare Centre 1 Maternity and Child Welfare. Wesleyan Hall, Rushey Green, S.E.6 Consultation Room Weighing Room Lewisham Borough Coucil 4 Congregational Church Hall. Bellingham Green, S.E.6 Waiting Rooms Do. Voluntary Organization 1 Wesleyan Hall, Rushey Green, S.E.6 Do. Do. 2 St. Barnabas Hall, Downham Way. Bromley Do. Do. 1 Wesleyan Church Hall, Brockley Rise, S.E.23 Do. Do. 1 Wesleyan Hall, Burnt Ash Hill, Grove Park, S.E.12 Do. Do. 1 Wesleyan Hall, Hither Green Lane, S.E.13 Do. Do. 1 St. Margaret's Hall, Old Road, Lee, S.E.13 Do. Do. 1 St. Mary's Parish Hall, Ladywell Road, S.E.13 Do. Do. 1 6-7, Adamsrill Road, S.E.26 Do. Do. 2 Tuberculosis Dispensary. 47, Catford Hill. S.E.6 Waiting Rooms Consultation Room Dressing Rooms Dispensary, etc. Lewisham Borough Council 4 Venereal Diseases. St. John's Hospital. Lewisham, S.E 13 — — — 15 Public Health Officers of the Council. In tabular form is shown below the names, qualifications, service and duties of the members of the Public Health Staff. Several changes took place during the year. Dr. J. G. Wilson resigned his appointment as Assistant Medical Officer on being appointed to a similar position under the Lancashire County Council, and was succeeded by Dr. J. T. C. Roberts. Dr. Mary Ruddy (part-time Infant Welfare Medical Officer), was appointed as an Assistant Medical Officer of Health under the Middlesex County Council, and was succeeded by Dr. Evelyn Davies. Mr. A. G. Thomas was appointed Sanitary Inspector in succession to Mr. H. King, who died in November, 1928, and Mr. S. Bradley was appointed Sanitary Inspector to fill the vacancy caused by the resignation of Mr. W. S. Parsons. Year Appointed Name. Qualifications. Appointment. |1928 Miller, John W. M.B., Ch.B., D.P.H. Medical Officer of Health. §1929 Roberts, J. T. C. M.B., Ch.B., M.R.C.S., L.R.C.P., D.P.H. Assistant M.O.H. and Maternity and Child Welfare Medical Officer. §1916 Jordan, Rose M.D., B.S., B.Sc., D.P.H. Tuberculosis Officer (part-time). §1929 Davies, Evelyn M.R.C.S., L.R.C.P. Infant Welfare Medical Officer (part-time). §1896 Knappett, B. A. Cert., Roy. San. Inst. Sanitary Inspector. Cert.. Meat and other Foods §1897 Gray, A. H. Cert., Roy. San. Inst. Ditto Cert., Meat and other Foods ||1902 Cooper, J. A. K. Cert., Roy. San. Inst. Ditto Cert., Meat and other Foods ||1910 Crowther, J. Cert., Roy. San. Inst. Ditto Cert., San. Insp. Exam. Bd. Cert., Meat and other Foods ||1912 Berry, J. H. Cert.. San. Insp. Exam. Bd. Ditto ||1914 Holifield, C. E. Cert., Roy. San. Ins:. Ditto Cert., San. Insp. Exam. Bd. Cert., Meat and other Foods ||1920 Rayner, S. P. Cert.. Roy. San. Inst. Ditto Cert.. San. Insp. Exam. Bd. Cert., Meat and other Foods ||1927 Walker, E. Cert.. San. Insp. Exam. Bd. Ditto Cert., Meat and other Foods 16 Public Health Officers of the Council—continued. Year Appointed Name. Qualifications. Appointment. ||1929 Thomas, A. G. Cert., R.S.1, and San. Insp. Sanitary Inspector. Exam. Joint Board. Cert., Meat and other Foods. ||1929 Bradley, S. Cert., R.S.1, and San. Insp. Exam. Joint Board. Ditto Cert., Meat and other Foods. ||1905 Jones, Miss N. F. Cert., Roy. San. Inst. Ditto Cert., San. Insp. Exam. Bd. §1915 Watson, Mi's E. M. Cert., C.M.B. Health Visitor. Cert., Roy. San. Inst. (Hlth. Vistrs. & Insp. Nuis.). §1916 Burton, Miss F. L. Cert., Gen. Hosp. Training. Ditto Cert., C.M.B. Cert , Roy., San. Inst. (Health Visitors) §1917 Thompson, Miss C. H. Cert., C.M.B. Ditto Cert., Roy. San. Inst. (Health Visitors) §1920 Edwards, Miss A. M. M. Cert., Gen. Hosp. Training. Ditto Cert., C.M.B. §1924 Simpson, Miss G. Cert., C.M.B. Ditto Cert., San. Insp. Exam. Bd. Health Visitors' Diploma §1927 Cresswell, Miss W. Cert., Gen. Hosp. Training. Ditto Cert., C.M.B. §1928 Eve, Miss W. Cert., Gen. Hosp. Training Ditto Cert., C.M.B. Health Visitors Certificate §1917 Wardle, Mrs. M. Cert., Gen. Hosp. Training. Tuberculosis Visitor Cert., L.G.B. for Scotland. §1921 Brocklehurst, Miss N. Cert., Roy. San. Inst. Ditto Cert., San. Insp. Exam. Bd. Cert., C.M.B. CLERKS: F. E. Seckerson (Chief Clerk). C. C. Summers. §Miss B. C. Aylett. R. E. Stephan. J. Barry. A. J. Phillips. OTHER STAFF. Matron, Municipal Maternity Home Clerk Dispenser, Maternity and Child Welfare „ „ Tuberculosis Dispensary Secretary, Tuberculosis Care Committee Superintendent, Disinfecting Station Caretaker-Attendant, Coroner's Court and Mortuary Caretaker, Tuberculosis Dispensary §Mrs. D. Fynn. §Mrs. M. Iles. §Miss M. Colquhuon. §Miss O. Fergusson. H. T. Ibbett. H. J. L. Bailey. §S. J. Ambrose. || Salary contribution received under Public Health Acts. § „ „ „ by Exchequer grants. 17 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 Infectious Diseases (London) Regulations. 1927. agreements have been e ntered into whereby the services of these nurses are available for nursing cases of whooping cough, measles, pneumonia, puerperal fever, and ophthalmia neonatorum, a fee of 1s. 3d. per visit being paid by the Council. Miduives.—No midwives are employed or subsidized by the Council for outside work. Legislation in Force. There are no local Acts of Parliament. The Bye-laws of the London County Council, and such provisions of the London County Council (General Powers) Acts as relate to sanitary matters, are enforced, as also are various local bye-laws and regulations. Bacteriological W ork. Increasing use is made of the facilities afforded by the Council for bacteriological work at the St. John's Hospital, and darning the year 3,621 specimens were examined, compared with 3,191 in the previous year, the details being as follows:— Material from cases of suspected Diphtheria:— Diphtheria bacillus isolated 200 Negative 1,998 2,198 Sputa from cases of suspected Tuberculosis:— Tubercle bacillus found 102 „ „ not found 698 800 Blood from cases of suspected Enteric Fever:— Positive result 97 Negative result 421 518 Pathological specimens for enteric organisms:— Positive result — Negative result 96 96 Other specimens 9 18 SECTION III.—SANITARY CIRCUMSTANCES OF THE AREA. 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 1929 were as follows:— Loads. Tons. Horsed Vans 14,180 17,965 Carts 7,769 6,221 "S.D." Freighters 7,256 12,109 Motor Lorries 1,546 3,262 Pagefield Containers 1,590 3,097 Totals 32,341 42,654 The refuse is mainly disposed of at the Council's Destructors situated at Molesworth Street, Lewisham, and Home Park, Lower Sydenham, whilst smaller quantities are sent away by train, or deposited on shoots in the Borough. The following are the figures for 1929:— Loads. Tons. Home Park Dust Destructor 11,864 18,464 Molesworth Street „ 13,736 15,880 Trained away 6,421 7,932 Shoots 320 378 32,341 42,654 Sanitary Inspection. The Sanitary Inspection of the Borough is carried out by a staff consisting of ten male Inspectors and one female Inspector. Seven of the male Inspectors are each responsible for a particular portion of the Borough, two are engaged in routine house-to-house inspection over the whole Borough, and the inspection of restaurants and eating-houses, and one Inspector 19 carries out the duties of inspecting factories, workshops, bakehouses, and dairies, and is the principal sampling officer under the Food and Drugs Acts. In the latter capacity he is assisted by the two house-to-house Inspectors. The female Inspector is responsible for the inspection of factories, workshops, laundries and outworkers' premises where female labour is employed. She also investigates cases of encephalitis lethargica, pneumonia, and infectious diseases reported from schools, and conducts special enquiries when required. Details of the Sanitary Inspectors' work are contained in the following statement:— Inspections. On complaint 1,780 House-to-house 459 Infectious diseases 2,377 Notice from builder 404 New houses for water certificates 1,494 Other Inspections 1,474 Re-inspections 10,479 Notices served. Intimation (Public Health (London) Act) 1,691 Statutory (Ditto) 477 Cleansing and Repairs. Premises cleansed 827 Ventilation improved 83 Roofs repaired 478 Dampness abated 384 Gutters and rain-water pipes provided or repaired 304 Yards and forecourts paved 106 Yard and forecourt paving repaired 143 Defective scullery sinks replaced 178 Untrapped sink waste pipes replaced 280 Other repairs and improvements 564 Water Sup-ply. Re-instated 92 Fittings repaired 119 Cisterns cleansed 41 ,, provided 30 „ covered 66 „ abolished 8 Additional facilities provided in tenement houses — Other improvements — Drainage. Drains reconstructed 166 Drains cleansed and repaired 206 Gully traps fixed 369 Soil and vent pipes fixed 208 „ „ repaired 81 New covers provided to inspection chambers 103 Waste and rain-water pipes disconnected from drain 59 Inspection chambers provided 117 Other repairs and improvements 84 Water Closets. Old water-closets abolished 42 New water-closets provided 230 New pans and traps provided 262 Defective flush remedied 239 Pans cleansed 129 Seats provided or repaired 162 Roofs repaired 147 Walls, etc., repaired or cleansed 228 Doors repaired or renewed 46 Ventilation improved 91 Floors repaired 106 Other repairs or improvements 143 Urinals. Cleansed 30 Repaired 11 Reconstructed 9 Abolished 3 Dung Receptacles. Provided 2 Repaired 5 Abolished 1 Nuisances from keeping of animals. Number abated 20 20 21 Offensive accumulations. Number removed 108 Dustbins. Number provided 277 Smoke nuisances. Observations 88 Nuisances 6 Intimation Notices 5 Statutory Notices 2 General. Other miscellaneous nuisances abated 323 Legal Proceedings. Details of proceedings instituted under the Public Health and kindred statutes are summarised in the following Table:— Premises. Offence. Result. 17 Summerfield St. Premises in such a state as to be a nuisance Ordered to abate nuisance within 7 days, and to pay £1 4s. 0d. costs. 90. Devonshire Road. Ditto. Ordered to abate nuisance within 21 days, and to pay £1 1s. 0d. costs. Smoke Abatement. During the year 88 observations were made by the Sanitary Inspectors for the detection of nuisances arising from the emission of smoke, and as a result notices were served in five instances. The institution of legal proceedings was not necessary in any case. Rats and Mice (Destruction) Act, 1919. This Act places upon the occupiers of premises the responsibility for rat destruction and prevention. Each of the Sanitary 22 Inspectors has been appointed to act as Rat Officer in accordance with the Act, and he advises occupiers as to the beat methods of destroying rats, or of rendering buildings rat-proof. During the year, 182 complaints of rat infestation were received in the Public Health Department. In 64 instances, defective drains were found to be the cause of the appearance of the rats, while in 70 instances the contributory cause was found elsewhere, generally the proximity of chicken-houses. The complaint was unfounded in 48 cases. Factory and Workshop Act. Details of the administration of this Act are contained in this report in accordance with the requirement of the Ministry of Health. The total number of factories, workshops and work-places on the Register was 973, and during the year 2,642 inspections were made of these premises. The number of sanitary defects found was 119, all of which were remedied. Details of the above are given in tabular form. Factories and Workshops on the Register. Bakehouses 31 Factory Bakehouses 42 Eating Houses and Restaurants 116 Dressmakers, Milliners, etc. 98 Laundries 16 Tailors 67 Dentists 45 Bootmakers and Repairers 117 Builders 59 Motor Manufacturers and Repairers 53 Jewellers and Watch Repairers 40 Upholsterers and Cabinet Makers 48 Miscellaneous 241 Total 973 23 Outworkers. No. of Lists received from Employers 97 Addresses of Outworkers received from other Councils 232 ,, „ „ forwarded to other Councils 115 No. of visits made to Outworkers 97 Inspection of Factories, Workshops and Workplaces. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions (4) Factories (including Factory Laundries) 797 7 — Workshops (including Workshop Laundries) 1699 12 — Workplaces (other than Outworkers' premises) 146 1 — Total 2642 20 — Delects found in Factories, Workshops and Workplaces. Particulars. (1) Number of Defects. No. of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:—* Want of cleanliness 31 31 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors 2 2 — — Other nuisances 43 43 — — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 40 40 — — not separate for sexes — — Offences under the Factory and IVorkshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921 — — Total 119 119 — — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 24 Rag Flock Acts, 1911 and 1928 These Acts prohibit the sale or use, for the purpose of making any article of upholstery, cushions or bedding, of unclean flock manufactured from rags. The expression " flock manufactured from rags" is defined as flock which has been produced wholly or partly by tearing up woven or knitted or felted materials, whether old or new, but does not include flock obtained wholly in the processes of the scouring and finishing of newly-woven or newly-knitted or newly-felted fabrics. There are no manufacturers or wholesale dealers of this material in the Borough, and it has not been necessary to take any action under the Acts. Offensive Trades. There are no offensive trades in the Borough. 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, Premises Disinfected. Rooms Disinfected. Articles Removed and Disinfected. Scarlct Fever 819 2072 19062 Diphtheria 405 1008 7938 Tuberculosis 168 402 786 Cancer 59 98 795 Enteric Fever 93 304 1961 Other Diseases 177 477 2960 Total 1721 4361 33502 Disinfestalion.—One hundred and eighty-five rooms and 295 articles infested with vermin were disinfected. 25 The present Disinfecting Station is quite inadequate for the need? of the Borough, and the Council have considered and approved plans for the erection of a new Disinfecting Station on a portion of the Council's Depot at Wearside Road, Lewisham, at an estimated cost of £9,000. Cleansing of Verminous Persons. This Council does not at present possess any establishment for dealing with school children and other persons who are found to be in need of cleansing treatment for scabies and vermin, but has recently considered and approved plans and estimates for the erection of a Cleansing Station in connection with the new Disinfecting Station. Coroner's Court and Mortuary. These premises are situated in Ladywell Road, Lewisham. and comprise a Court Room, Witnesses' and Jury Rooms, Caretaker's apartment, Mortuary and Infectious Mortuary. During the year, 136 bodies were received into the Mortuary. 61 post-mortem examinations made, and 125 inquests held Jby the Coroner. Health Education. The arrangements made in 1928 for the publication and distribution of " Better Health,'" the official organ of the Central Council for Health Education, were continued during 1929. Advantage has also been taken of the publicity matter provided gratis by the Health and Cleanliness Council, in the form of pictorial posters, leaflets, etc. Lectures on health subjects are given at intervals by professional lecturers at the Infant Welfare Centres in the Borough. Active propaganda is continuously carried out by the Health Visitors in the course of their work at the Centres and in the home.- of the people. 26 Removal of In-firm and Diseased Persotts in Certain Cases. Section 28 of the London County Council (General Powers) Act, 1928, provides for the removal of aged, infirm, or diseased persons, to a suitable institution, hospital, or other suitable place, on the certificate of the Medical Officer of Health. They may be detained, and maintained there for a period not exceeding three months, or such further period as may be determined by further orders. The penalty for obstructing such an order is not exceeding £10. The Medical Officer of Health certifies in writing that the person (a) Is aged, or infirm, or physically incapacitated, and resides in premises in the district which are insanitary owing to any neglect on the part of the occupier thereof, or under insanitary conditions; or (b) Is suffering from any grave chronic disease; and that such person is unable to devote to himself, or to receive trom persons with whom he resides, proper care and attention, and that thorough enquiry and consideration have shown the necessity in the interest of the health of such person, and for preventing injury to the health o£, or serious nuisance to, other persons, that he should be removed from the premises in which he is residing. The Medical Officer of Health gives to any person proposed to be removed under the provisions of this Section, or to some person being in charge of such person, three clear days' notice of his intention to make an application to a Petty Sessional Court. The Medical Officer of Health gives three clear days' notice to the Guardians before making any application under this subsection. The consent, in writing, of the Guardians fc necessary before the persons are received, or retained, in a Poor LawHospital, and the Guardians are entitled to appear before a Petty Sessional Court to be heard upon the application. The Medical Officer of Health makes application to a Petty Sessional Court and tenders oral proof of the allegation in his certificate. 27 After oral proof of the allegation in the Medical Officer's certificate, and subject to examination of such person by a Registered Medical Practitioner to be nominated by them, if they think fit the Court may make an order for the removal of such person to a suitable hospital, infirmary, poor law, or other institution, or otner suitable place, and for the detention and maintenance of such person therein for a period not exceeding three months in the first instance. The order may be renewed for further periods of three months each. The cost of the removal and maintenance in a suitable place shall be borne by the Sanitary Authority. The Sanitary Authoritymay be required to contribute towards the maintenance of any dependents of that person, as the Sanitary Authority may think fit, or as thev may be directed by the Court. The Guardians may assume such obligation as may be agreed upon between them and the Sanitary Authority. At any time after the expiration of six clear weeks from the making of the order, an application may be made to the Court by, or on behalf of, the person "in respect of whom the order was made for its rescission; three cLear days' notice must also be given to the Medical Officer of Health. In connection with this Section of the Act, one case was brought to my notice during the year—an aged and infirm woman of independent means, and who owned her house. She was miserly, lived alone under deplorable conditions, and refused to change her mode of living. While the circumstances of the case were under consideration, this woman had a fainting fit in the street and was removed to Lewisham Hospital. Application was made by me at Greenwich Police Court for an order for her detention i.i the Hospital. The Guardians were represented in Court by one of their Officials, who protested against an order being granted, as the woman had independent means. The magistrate refused to grant an order for her detention in Hospital, but would consider a fresh application for an order when the woman returned home to her insanitary surroundings. A relative ultimately persuaded the Ond woman to go direct to a Private Nursing Home after her discharge from Hospital. 28 SECTION 1Y,—HOUSING. Summary of Housing Statistics, 1929. Number of new houses erected during the year :— (a) Total (including numbers given separately under (b)) 1,382 (b) With State assistance under the Housing Acts:— (i) By the Local Authority — (ii) By other bodies or persons 927 1. Inspection of duelling-houses during the year :— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,849 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations. 1925 459 (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 ... 1,453 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 976 29 3. Action under Statutory Poners. A.—Proceedings under section 3 of the Housing Act, 1925 Nil. B.—Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect oi which notices were served requiring defects to be remedied 477 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 477 (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 — 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 ko id- No. of houses inspected. No. in which defects were found. Brookbank Road 79 62 Ellerdale Street 79 51 Hindsley's Place 13 11 Hither Green Lane (part) 13 10 Loampit Vale (part) 29 25 The Retreat 21 18 Sparta Street (part) 30 22 Stanstead Road (part) 49 31 313 230 30 New Houses. The following newly-erected dwelling-houses were passed for occupation during the year:— Downham Estate (London County Council) 895 Bellingham Estate „ „ „ 32 Erected by private enterprise 455 Total 1,382 Rent Restriction Acts, 1920 and 1923. During the year 34 applications were made by occupiers for the certificate of the Sanitary Authority under the provisions of the above Acts, and in each case the Council authorised the issue of the certificate. A report cf 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 10 instances. Municipal Housing Schetne. Under the Housing Act, 1919, the Council provided 86 houses on Lewisham Park Estate and 119 flats by the conversion of 36 large houses. Under the Housing (Financial Provisions) Act, 1924, the Council have developed a site consisting of 43 acres at Chinbrook Road, Grove Park, where there have been provided:— 336 "A" type houses, containing living room, three bedrooms, scullery, bathroom, etc., let at inclusive rentals of 18s. Od. a week (Net weekly rental 13s. 6d.). 136 "B" type houses, containing living room, parlour, three bedrooms, scullery, bathroom, etc., let at inclusive rentals of 21s. Od. a week (Net weekly rental 15s. 10d.). 32 Flats, containing living room, two bedrooms, scullery, bathroom, etc., let at inclusive rentals of 14s. 4d. a week (Net weekly rental lis. Od.). In connection with this scheme, approximately 8 acres have been reserved for the purpose of Allotments and Children's Recreation Ground. 31 The Council are at present proceeding with a scheme under the Housing (Financial Provisions) Act, 1924, for the provision of 60 flats (20 flats containing 3 bedrooms and 40 containing 2 bedrooms) on a site already in the ownership of the Council at Winchfield Road, Lower Sydenham. The rents to be charged for these properties have not yet been definitely determined, but an eflort is being made in this scheme to meet the needs of some of the very poor people living in the immediate neighbourhood, and with this in view, it is hoped that it will be possible to fix inclusive rentals of 10s. per week for three bedroom flats and 8s. 6d. per week for two bedroom flats. 32 SECTION Y.—INSPECTION AND SUPERVISION OF FOOD During the year careful supervision has been kept over premises where food is prepared or sold, with the object of securing a proper standard of cleanliness, and the observance of such regulations as are applicable. Details of the inspections made are set out below. Bakehouses.—There are 73 bakehouses on the Register, and 204 inspections of these were made during the year. Dairies and Milkshops.—The number of premises registered under the provisions of the Milk and Dairies Order, 1926, is 126, and during the year 311 inspections were made. Cowhouses.—There is now only one licensed cowhouse in the Borough, and this was regularly inspected. Slaughterhouses.—A list of licensed slaughterhouses in the Borough is set out below. During the year 773 visits were made for the purpose of inspecting the condition of the premises and for the examination of slaughtered animals, which numbered 5,136. List of Slaughterhouses. Premises. Licensee. 291, High Street, Lewisham. Herbert Calton. 324, High Road, Lee. R. C. Hammett, Ltd. 434, High Road, Lee. J. T. Dennis. Havelock Street, Forest Hill. Chalk & Cox, Ltd. Myron Place, Lee. A. W. Medlycott. 12, Montpelier Vale, Blackheath. B. W. Parsons, Ltd. 13, Rushey Green, Catford. Chalk & Cox, Ltd. Restaurants and Eating-houses.—There are 116 establishments of this description on the register, and during the year 336 inspections were made. Food Shops and Stalls.—The number of inspections made of these premises was 1,873. Fried-fish Shops.—There are 34 fried-fish shops on the register, and 145 visits were made during the year. 33 Ice Cream Premises.—The London County Council (General Powers) Act. 1928. provides for the registration with the Sanitary Authority of any premises upon which ice cream is manufactured, stored or sold. Hotels, restaurants and clubs are exempt from registration. There are 169 premises of this description on the register, and these were visited regularly during the year. Milk (Special Designations) Order, 1923.—Licences for the production or storage of milk under the special designations provided by the above Order were issued for the year 1929 as follows:— Premises licensed to Pasteurise 3 Retail premises licensed to sell Certified Milk 21 „ „ „ Grade A (Tuberculin Tested) Milk 19 „ „ „ „ Grade A Milk 9 „ ,, „ ,, Pasteurised Milk 56 t'acteriological Examination of Designated. Milk. — Ihe following samples were taken, and submitted to the Clinical Research Association for bacteriological examination :— Certified Milk 12 samples. Grade A (Tuberculin Tested) Milk 1 sample. With the exception of one sample of Certified Milk, all were found to comply with the standard laid down by the Regulations. Unsound Food.—The following quantities of meat, fish, etc., were surrendered as unfit for food, and destroyed :— 2 carca-es of Beef. 1 box Rock Salmon. 1 box Catfish. 193 lbs. Skate. 1 „ Dabs. 2 boxes Soles. 70 lbs. Haddocks. 1 box Whiting. 2 boxes Herrings. 10 boxes Lettuce. The Food and Drugs (Adulteration) Act, 1928. During the year under review- 912 samples of food, drug-, etc., were obtained by the Council's Inspectors and submitted to the Public Analyst for examination. Of this number 412 were purchased formally in accordance with the provisions of the above-named Act and the remaining 503 were obtained informally as " test' samples. Thirty, or 7.2 per cent, of the formal samples were certified as adulterated or below standard by the Public Analyst, compared with 3.8 per cent, in 1928. 34 The following Table gives details of the samples analysed:— Arttcle. Number of Samples Examined. Number Adulterated, etc. Formal. Informal. Total. Formal. Informal. Total. Aniseed Essence - 4 4 - - - Arrowroot — 1 1 — — — Butter 2 90 92 — — — Baking Powder — 5 5 — — — Boracic Ointment 1 6 7 — 1 1 Coffee — 16 16 — — — Confectionery and Jam — 13 13 — — — Cream — 13 13 — — — Cocoa — 12 12 — — Camphorated Oil — 7 7 — — — Cod Liver Oil — 12 12 — — — Cheese — 6 6 — — — Cream of Tartar — 5 5 — — — Cornflour — 5 5 — — — Condensed Milk — 5 5 — - - Custard Powder — 7 7 — — — Dripping — 10 10 — — — Flour — 20 20 — 1 1 Fruit (Dried & Canned — 35 35 — — — Glycerine and Borax — 7 7 — — — Gregory Powder 1 6 7 — 1 1 Ground Ginger — 8 8 — — — Ice Cream — 4 4 — — — Honey — 3 3 — — — Lard — 5 5 — — — Lemon Squash... — 7 1 — — — Milk 975 — 275 12 — 12 Mustard — 5 5 — — — Meat (Bacon) — 4 4 — — — Margarine — 6 6 — - — Orange Wine — 5 5 — - — Olive Oil — 5 5 — - — Preserved Vegetables — 12 12 — - — Paregoric — 3 3 — - — Pepper — 5 5 — - — Quinine — 7 7 — — — Sulphur — 3 3 — — — Soda. Bicarbonate — 3 3 — — — Sausages 7 56 63 4 6 10 Sugar — 26 •26 — - — Sweet Spirit of Nitre 2 4 6 2 2 4 Seidlitz Powder — 5 5 — - — Sal Volatile — 3 3 — - — Stout — 1 1 — — — Spice, Mixed — 10 10 — — — Tincture of Iodine — 3 3 — — — Tartaric Acid — 1 1 — - — Tea — 10 10 — - - Tapioca — 5 5 — - - 35 Article. Number o: Samples Examined. Number Adulterated, etc. Formal. Informal. Total Formal. Informal Total. Spirits— Brandy 10 — 10 - - — Gin 33 — 33 2 — 2 Rum 19 — 19 4 — 4 Whisky 61 — 61 6 — 6 Vinegar 1 6 4 - - - Totals 412 500 912 30 11 41 The Sale of Food and Drugs (Adulteration) Act, 1928.— This Act, which came into operation on January 1st. 1929, repeals and consolidates the provisions of the Sale of Food and Drugs Acts, 1875 to 1927, together with a number of amending provisions contained in other Statutes, notably the Milk and Dairies (Consolidation) Act, 1915. The administering Authorities are for the first time referred to as " Food and Drugs Authorities,'" and the Officers who are empowered to take samples, as " Sampling Officers.'" Merchandise Marks Act, 1926.—In pursuance of the provisions of this Act, it is not lawful to sell, expose for sale, or by way of advertising foods of some other kind, distribute in the United Kingdom, any imported foods to which there is applied any name or trade mark being, or purporting to be, the name or trade mark of any manufacturer, dealer, or trader, or the name of anv place or district in the United Kingdom, unless the name or trade mark is accompanied by an indication of origin. Section 9 of this Act confers on Food and Drugs Authorities the power to execute any of the provisions of the Act (other than those relating to importation) in respect of foodstuffs which are the subject of an order in Council; and under this Act the following orders have so far been made in regard to foodstuffs: — 36 (Imported Goods), No. 3 Order, 1928, relating to Honey and Fresh Apples. (Imported Goods), No. 5 Order, 1928, relating to Currants, Sultanas and Raisins, Eggs in shell, Dried Eggs, and Oat Products. (Imported Goods),, No. 4 Order, 1929, relating to Raw Tomatoes. With regard to No. 4 Order, this does not come into operation until March, 1930. Artificial Cream Act, 1929.—This Act is designed to regulate the sale and manufacture of a cream substitute which has hitherto been commonly known as reconstituted cream, and is usually prepared by emulsifying butter, dried skimmed milk and water; but the definition in Section 6 of the Act is drawn in sufficiently wide terms to include any article of food resembling cream and containing nothing but the ingredients of cream. The Act also provides that where any substance purporting to be cream, or artificial cream, is artificial cream, it shall not be sold under a description or designation including the word " cream " unless that word is immediately preceded by the word " artificial." Section 2 of the Act requires that, with certain specified exceptions, premises where artificial cream is manufactured or sold must be registered with the Local Authority, namely, the Borough Council. These premises are open to inspection by a duly authorised officer of the Council. Agricultural Produce (Grading and Marketing) Art, 1928.— Under the Agricultural Produce (Grading & Marking) Act, 1928, the Minister of Agriculture and Fisheries is empowered to prescribe grade designations to indicate the quality of any articles of agricultural produce, and where any person sells any article to which a grade designation is applied, it shall be deemed to be a term of the Contract of Sale that the quality of the article accords with the grade designation. Regulations made by the Minister may prescribe a trade designation mark to represent any trade designation, and may 37 make provision for authorising or enyxnvering any person or body of persons to authorise the marking with a trade designation mark of any article in respect of which such a mark has been prescribed or of anv covering containing or label attached to any such article. Special provisions are also included as to the marking of preserved eggs, to the effect that after the 28th February, 1929, no egg which has been subject to any process of preservation shall be sold or exposed for sale unless the egg is marked in the prescribed manner, viz.. the word "Preserved." This applies to eggs preserved in lime-water, water-glass, oil, and whether home-produced or imported. If and so long as any order in Council made under Section 2 of the Merchandise Marks Act, 1926. is in force prohibiting the sale or the exposure for sale in the United Kingdom of imported eggs, unless they bear an indication of origin, British e^gs which have been kept in cold storage or chemical storage in any premises must not be removed from such premises unless the e^gs have been marked in the prescribed manner, viz., with the word "Chilled" or the words "Cold Stored," and in the latter case with the word "Sterilised." The Borough Council is the Local Authority under this Act, and it is therefore their duty to enforce the provisions thereof; it is further provided that premises used for the purpose of cold storage or chemical storage of eggs may be registered by the Local Authority, and an Officer of the Local Authoritv may at any time during businesfc hours inspect such premises. The following Regulations have been made under this Act: — Agricultural Produce (Grading and Marking) (General) Regulations, 1928. Agricultural Produce (Grading and Marking) (Eggs) Regulations, 1928. Agricultural Produce (Grading and Marking) (Broccoli) Regulations, 1929. Agricultural Produce (Grading and Marking) (Tomatoes and Cucumbers) Regulations, 1929. 38 Agricultural Produce (Grading and Ma>rking) (Wheat Flour) Regulations, 1929. Agricultural Produce (Grading and Mairking) (Beef) Regulations, 1929. Agricultural Produce (Grading and Marking) (Potatoes) Regulations, 1929. Agricultural Produce (Grading and Marking) (Apples and Pears) Regulations, 1929. Agricultural Produce (Grading and Marking) (Malt Flour and Malt Extract) Regulations, 1929. Milk.—275 samples of Milk were examined by the Public Analyst, and of this number 12, or 4-3 per cent, were certified as adulterated or below standard. The average composition of the samples is set out in the following Table :— Period. Average Composition of Genuine Samples. Board of Agriculture Standard. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage oi Water. Percentage of Milk Fat. Percentage of Solids not Fat. First Quarter 3.63 8.79 87.58 3.0 8.5 Second ,, 3.44 8.75 87.81 Third ,, 3.53 8.65 87.82 Fourth ,, 3.81 8.78 87.41 Average for the Year 3.60 8.74 87.65 The Public Health (Preservative etc., in Food) Regulations. All the articles of food examined for the presence of preservatives were found to conform to the requirements of the Regulations with the exception of the ten samples of Sausages, details of which are set out in the table of Adulterated Samples. Proceedings were taken against the vendor of Sausage, Samples Nos. 469 and 470; who was convicted and fined £2 and £1 Is. costs. In another case (Official Sample No. 480) the declaratory label required by the regulations was not exhibited and the Public Health Committee directed that a written caution be given to the vendor. Similar warnings were issued in regard to the informal samples where this requirement of the regulations had been contravened. 39 Adulterated, Samples. The following Table shows the administrative action taken by the Council in regard to each sample not reported as genuine by the Public Analyst: — Serial No. Article. Formal or informal. Nature of Adulteration. Action Taken. 51 Whisky Formal. Diluted to 3 degrees of Proof Spirit below Standard. Prosecution. Fine, £5. 72 Rum ,, Do. 6.5 degrees. do. Prosecution. Fine. £5. 116 Whisky ,, Do. 2 decrees, do. Prosecution. Costs £3 3s. Od. 118 Whisky ,, Do. 3 degrees, do. Prosecution. Costs, £3 3s. Od. 11!) Rum ,, Do. 3 degrees, do. 132 Whisky ,, Do. 115 degrees, do. Prosecution. Fine, £5, Costs, £2 10s. Od. 133 Rum ,, Do. 12.5 degrees, do. Prosecution. Fine, £5; Costs, £2 10s. Od. 161 Whisky ,, Do. 9.6 degrees, do. Prosecution. Costs, £5 5s. Od. 188 Gin ,, Do. 8.5 degrees, do. Prosecution. Costs, £3 3s. Od. 195 Milk ,, 15% extraneous water. Prosecution. Costs, £3 3s. Od. 196 ,, ,, 16% fat deficiency. Prosecution. Costs, £3 3s. Od. 231 ,, ,, 2% extraneous water. Prosecution. Fine £2 ; Costs, £2 2s. Od. 281 Rum ,, 8.5 degrees Proof Spirit below Standard. Prosecution. Vendor fined £5 and £2 2 0 costs. 356 Self-raising Flour Informal. 100% Flour. Subsequent sample genuine. 366 Boracic Ointment " 3,3% deficient in Boric Acid. Subsequent sample genuine. 378 Gregory Powder •• 16,7 % Magnesium Carbonate. Subsequent samp.e genuine. 384 Whisky Formal. 2 degrees Proof Spirit below Standard. Vendor cautione 385 Gin " 2 degrees Proof Spirit below Standard. Vendor cautioned 40 Serial No. Article. Formal or Informal. Nature of Adulteration. n Taken. 404 Milk Formal. Extraneous Water 3%. FatDeficiency 6%. Prosecution. Summons dismissed. 406 ,, ,, Fat Deficiency 6%. Prosecution. Costs, £1 10s. Od. 433 ,, ,, ExtraneousW ater 2%. Prosecution. Costs, £3 3s. Od^ 436 ,, ,, Extraneous Water 3%. 455 Sausage Informal. Boric Acid 191, grains per lb. Official Samples Nos. 469 and 470. 457 ,, ,, Boric Acid 24.6 grains per lb. 1 469 ,, Formal. Boric Acid 16.29 grains per lb. Prosecution. Fine, £2 ; costs, £1 Is. 470 ,, ,, Boric Acid 19'96 grains per lb. Prosecution. Summons dismissed. 474 ,, Informal. Sulphur Dioxide 380 parts per million. Unlabelled. Vend or cautioned. 480 Sausages Formal. Sulphur Dioxide 310 parts per million. Vendor cautioned. 501 ,, Informal. Sulphur Dioxide 155 parts par million. Official Sample No. 584. 543 ,, " Boric Acid 4.3 grains per lb. Official Sample Genuine. 544 ,, " Sulphur Dioxide 210 parts per million. Notice exhibited in accordance with Regulations. 5$4 ,, Formal. Sulphur Dioxide 115 parts per million. Notice exhibited in accordance with Regulations. 587 Milk •• Extraneous Water 2%. Cautioned. 589 ,, •• Extraneous Water 2%. Cautioned. 597 " ,, Fat Deficient 11%. Prosecution. No fine. Costs, £5 5s. Od. 612 " •- Extraneous Water 3%. Prosecution. Fine £1; Costs, £2 2s. Od. 637 ,, ,, Extraneous Water 2%. Cautioned. 674 Sweet Spirit of Nitre Informal. 71.5% Ethyl Nitrite deficiency. Formal sample No. 686. 41 Serial No. Article. Formal or Informal. Nature of Adulteration. Action Taken. 682 Sweet Spirit of Nitre Informal. 44% Ethyl Nitrite deficiency. Formal sample No. 687. 686 ,, Formal. 40% ditto. Prosecutions. Summonses dismissed, the Magistrate being satisfied that no wilful act on vendor's part caused the deficiency. 687 ,, 40% ditto. 42 SECTION YI.—PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. The following diseases are notifiable in the Borough :— Cerebrospinal Meningitis Pneumonia—Acute Primary Cholera „ —Acute Influenzal Continued Fever Polio-myelitis Diphtheria Plague Dysentery Puerperal Fever Encephalitis Lethargica Puerperal Pyrexia Erysipelas Relapsing Fever Enteric (or Typhoid) Fever Scarlet Fever , Malaria Smallpox Membranous Croup Tuberculosis Ophthalmia Neonatorum Typhus Fever Small-pox. Small-pox was prevalent in London during 1929, but Lewisham was fortunate in having only eight cases notified, and one of these was found not to be suffering from Small-pox. Case No. 1, a male, 18 years, was notified and removed from a Doctor's Consulting Room outside the Borough. On investigation a missed case No. 2, a brother, 20 years, was discovered. Both cases were vaccinated in infancy. Vaccination was offered to the remaining five members of the family. This was accepted, and carried out by the Public Vaccinator. No further cases occurred in the family. Washing sent to a public laundry from the infected house was traced to a Collecting Depot, and removed for disinfection, together with all other washing with which this had come into contact—eleven bags and baskets in all. The laundry vans were disinfected. Arrangements were also made for the Public Vaccinator to attend at the Laundry to vaccinate the employees. Five of the staff were vaccinated for the first time, while eight were re-vaccinated. This response to the offer of free vaccination was rather disappointing, as there were 115 persons employed at the Laundry. Case No. 3, a female, 15 years, was removed from a Doctor's Consulting Room in the Borough. She had never been 43 ated. Her mother, Case No. 4, refused re-vaccination, and subsequently developed small-pox. Case No. 3 was probably infected outside the Borough. No further cases occurred in the family. Case No. 5, a female. 24 years, was vaccinated in infancy. The infection was probably contracted outside the Borough. The other members of the family were re-vaccinated, and no further cases occurred. Case No. 6, a female, 17 years, unvaccinated, contracted the disease in an institution outside the Borough. The other members of the familv were vaccinated, and no further cases occurred. Case No. 7, a female, 23 years, unvaccinated, was removed to Hospital from her place of business outside the Borough. The rest of the family refused vaccination, and her mother and a sister subsequently developed the disease. I am of the opinion that immediate vaccination of all persons who have been in contact with the case is essential, and it is to be regretted that this cannot be enforced. Scarlet Fever. During the year, 843 cases of Scarlet Fever were notified, compared with 522 in the previous year. The patients removed to Hospital numbered 740. There were 5 deaths from this disease. A comparison with previous years can be made from the following Table, which shows the number of cases notified in each of the past ten years :— Scarlet Fever. Cases. Deaths. Mortality per 100 cases. 1920 728 8 1.1 1921 1120 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 1928 522 4 0.7 1929 843 5 0.6 44 Diphtheria. The number of cases of this disease notified during the year was 416, compared with 334 in the previous year. With the exception of 12 cases, all the patients were removed to Hospital. There were 15 deaths from Diphtheria. The figures for the past ten years are shown below :— Diphtheria. Diphtheria Cases. Deaths. Mortality per ioo cases 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 1928 334 15 4.5 1929 416 15 3.6 Diphtheria Anii-toxin Serum. For the convenience of medical practitioners, anti-toxin can be obtained from the Public Health Department at any hour, and is supplied at cost price, or free in necessitous cases. During the year, 57 phials of 8,000 units each (for treatment purposes) were supplied free, and one at cost price. Twenty-two prophylactic doses of 500 units each were supplied free, and four at cost price. The cost of this service to the Council was approximately £24. Typhoid and Para-typhoid Fever.—One hundred and ten cases of Typhoid Fever were notified during the year, and two cases of Para-typhoid. 45 Outbreak of Enteric Fever in the Sydenham. District. During the last quarter of the year an outbreak of Enteric Fever occurred in Sydenham and in portions of the adjoining1 Urban Districts of Beckenham and Penge. Altogether, 129 cases, with 17 deaths, were recorded. In the Sydenham district (population approximately 32,000) of the Borough, 104 cases were notified, but two of these cases were subsequently found not suffering from Enteric Fever. There were 15 deaths. Seventy-three houses and 45 roads were invaded. An epidemic of Enteric Fever in London is a very rare occurrence, and, having regard to the serious nature of the disease, I deemed it advisable, at the commencement of the outbreak, to inform the Ministry of Health, and one of their Medical Officers, Dr. E. L. Sturdee, collaborated with me in the investigation. History of Enteric Fever in the Infected District. The incidence of Enteric Fever in Sydenham and the rest of the Borough, and the deaths resulting therefrom, during the five years preceding 1929, is shown in the following Table I:— Year. Sydenham- Remainder of Borough. Notified cases of Enteric Fever. Deaths from Enteric Fever. Notified cases of Enteric Fever. Deaths from Enteric Fever. 1924 3 1 13* 2 1925 1 — 9 1 1920 l — 6 1 1927 1 — 6 1 1928 1 fi 4 * Includes Paratyphoid. From the figures in the foregoing Table it will be seen that in the 5 years 1924-28 the history of Sydenham was not unfavourable as regards Enteric Fever. 46 The Outbreak of Enteric Fever. Daring the greater part of 1929 no case of Enteric Fever was notified in Sydenham, which subsequently suffered in October from an outbreak of this disease. The subjoined table gives the notifications of Enteric Fever received in each of the months for 1929, from January to August, and in each week from September to December, and shows the sudden development of the outbreak. Table II. Showing the notifications received in each of the months for 1929, from January to August, and in each week from September to December, 1929. Period. Sydenham. Remainder of Borough. Notified Cases of Enteric Fever. Notified cases of Enteric Fever. Primary. Secondary. 1929 Jan. — — - Feb. — — 1* Mar. — — 1** April — — — May — — — June — — — July — — 1* August — — 1* Sep. 7 — — — ,, 14 — — 1 ,, 21 — — — ,, 28 — — — Oct. 5 12 — — ,, 12 11 — — ,, 19 23 5 — „ 26 25 4 — Nov. 2 6 5 — ,, 9 2 - — ,, 16 2 1 — ,, 23 — — 1 ,, 30 — 2 — Dec. 7 — — — ,, 14 - - — ,, 21 ,, 28 - - 2 2 - 1 * Final diagnosis not Enteric Fever. ** Final diagnosis Paratyphoid Fever. 47 The progress of the epidemic, week by week, from beginning to end, is shown in Table III. These figures show the explosive nature of the outbreak, rapidly reaching its height in the week ending 12th October, and its gradual fall. It can also be inferred, taking into consideration the period of incubation of the disease, that infection occurred some time in the weeks ending 7th and 14th September. Table IV gives the age and sex of each of the 102 notified cases. Table III. Showing the number of attacks, week by week, in Sydenham, together with the weekly number of houses and roads newly invaded. Week ending. Cases. Houses newly invaded. Roads newly invaded. 1929 September 7 — — — ,, 14 — — — ,, 21 — — — ,, 28 19 13 12 October 5 22 15 10 ,, 12 31 24 14 ,, 19 18 14 5 ,, 26 5 3 2 November 2 1 i — ,, 9 2 1 1 ,, 16 — — — ,, 23 2 1 — ,, 30 — — — December 7 — — — ,, 14 — — ,, 21 2 1 1 ,, 28 - - - Totals 102 73 45 48 Table IV. Showing age and sex incidence of the disease; and also the age and sex of the 15 fatal cases, together with the proportion of deaths to attacks in each age period. Age Periods. Cases. Deaths Number of deaths per cent, of attacks of Enteric Fever. Males. Females. Total. Males. Females. Total. Under 5 years 1 1 2 - - 5—10 6 7 13 - — 1 7.6 10—20 10 15 25 - 4 5 20.0 20—30 14 9 23 1 — 1 4.3 30—40 1 13 14 - 3 4 28.5 40—50 3 13 16 - — 1 6.2 50 and upwards 3 6 9 2 1 3 33.3 At all ages 38 64 102 7 8 15 14.7 It appears from this Table that the incidence of attack was heaviest at ages 10-30 years, and least under 5 years. More females were aSected than males. The case mortality rate among males was 18.40/0, and was high compared with that of females, 12.5%. The case mortality rate of both sexes together was 14.7 per cent. It is of interest to note that the case mortality rate on the whole number of 129 cases in Sydenham, Beckenham and Penge, was 13.7 %, that is to say, it is lower than the rate of the 102 Sydenham cases, and is a fairer indication of the severity of the outbreak. Incidence as Regards Social Condition. The incidence of the disease was in no way related to the social condition of the residents in the district, the well-to-do and the poorer classes being alike aSected. Cause of the Outbreak. The usual channels by which the disease is conveyed were explored, and early in our investigations we were able to exclude water. It appears that the Sydenham district receives 49 its water from three reservoirs, which serve an extensive area, and the supplies from these reservoirs are interchangeable. Laboratory examinations of water samples taken by officials of the Metropolitan Water Board revealed nothing abnormal, and samples subsequently taken by the Sanitary Inspector were also found satisfactory. Most of the samples were taken from houses in which cases of Typhoid Fever occurred. Milk was definitely excluded, also water-cress, fried-fish, ice cream and shell-fish. One outstanding feature of the outbreak, as shown by the spot map, was its limitation to practically one-and-a-half to two square miles, suggesting some local infection. An exhaustive enquiry was made into the various foodstuSs consumed by each patient, and the sources of supply, the patient's partiality to or recently acquired taste for any particular article of diet being carefully noted. It will be appreciated that such an investigation is difficult, the information of necessity being obtained, in the majority of cases, from the patient's relatives. Further, the scope of the inquiry, embracing all articles of food eaten any time from a fortnight to three weeks prior to the onset of the illness, imposes a very considerable tax on the memory of the person supplying the information; but as the cases accumulated and our investigations proceeded, it became evident that the name of a certain food shop, situated in the centre of the area affected and which we shall call " X," was recurring with remarkable frequency in our records of food consumed by the people affected. This shop, which is excellently conducted, had a great many customers in the district, but it is to be remembered not much more than about 12% of those exposed to infection develop the disease. Further investigations cast suspicion on certain articles of food which, because of their nature, were eaten without preliminary cooking in the home. 50 It is not suggested that these food-stuffs in themselves could cause Typhoid Fever, but it is conceivable that they could be contaminated before purchase by being handled by a person suffering from a mild unrecognised attack of Typhoid Fever, or by a " carrier." When it became apparent that circumstantial evidence was gradually strengthening against shop "X," Dr. Sturdee arranged an interview with a representative of " X" at the Ministry of Health on the 17th October. At this interview we informed the representative of our suspicions, and he gave us every facility for carrying out a systematic examination of all the employees. These examinations included blood tests, and the examination of urine and excreta, the object being the detection of a mild unrecognised case, or a possible carrier. At a certain stage in the bacteriological examinations, six employees were suspended because of suspicious reports; but further tests proved negative. I arranged for admission to St. John's Hospital for three of the suspects, to facilitate the collection of excreta for examination which, under ordinary conditions, presents some difficulties. A list of the home addresses of the employees was obtained, and inquiries were made at their homes, but no history of a recent suspicious illness could be elicited. Four employees who had left shop " X " during September, and one temporarily employed then, were followed up; but the usual tests proved negative. One employee, N.M... was found to have been off duty (through illness) from the 8th October. I visited him and obtained specimens for the necessary tests, but though he looked pale and debilitated, the results of the tests were negative. The subsequent history of this employee is of interest. He never 'returned to work and on the 4th November died from severe haemorrhage from the bowel. It is worthy of note that three days previous to his death he felt well enough to go out of doors for a walk. A post-mortem examination showed that death was due to Typhoid Fever. The 51 bacillus Typhosus was isolated from a specimen of blood-stained excreta taken just before death. From a survey of all the evidence available, we arrived at the following conclusions: — (1) Though the post-mortem findings point to N.M. being infected with Typhoid Fever subsequent to the first known cases, there is always the possibility of his having suffered from a mild primary attack of Typhoid Fever followed by a severe relapse, which proved fatal. (2) There might be an unrecognised intermittent carrier in shop "X." Measures Taken to Check the Outbreak. On the 7th October, 1929, a circular letter was sent to the medical practitioners in Sydenham warning them of the presence of Enteric Fever in the district, and reminding them of the facilities available for blood examination, etc. Later, a public statement was made by the Chairman of the Public Health Committee at a Council Meeting, advising the public in general terms of the precautions to be taken against the disease. Accompanied by Mr. S. P. Rayner, Sanitary Inspector, I visited the home of each case notified and inquired into all articles of food eaten by the patient any time from a fortnight to three weeks prior to the onset of the illness, and also where purchased. At the same time an inspection was made of the sanitary condition of the premises. Removal of the patient to Hospital was advised. Ninetyone cases were removed and 11 were nursed at home. In cases nursed at home, written instructions were sent to those attending the case, setting out the precautions to be taken to prevent the spread of the disease, and disinfectant was supplied free of charge. Disinfection of bedding and bedrooms was carried out immediately on the patient's removal to Hospital, or recovery 52 at home. In connection with those cases nursed at home the medical attendant was advised to submit for bacteriological examination at least two specimens of excreta before certifying the patient free from infection. Instructions were given with regard to the personal hygienic routine to be observed by all the staff of shop " X," and periodic visits were made to ensure that this routine was strictly followed. In conclusion, I would like to record my appreciation of the valuable help and support which I received from Dr. E. L. Sturdee, O.B.E., Ministry of Health, and also express my thanks to the members of the Staff of the Public Health Department for the willing and zealous manner in which they carried out the extra duties falling on them in consequence of the outbreak. Puerperal Fever and Puerperal Pyrexia. Twenty-one cases of Puerperal Fever were notified, and 25 cases of Puerperal Pyrexia. Of the former, 9 cases proved fatal. In notifying these diseases, the medical practitioner is given the opportunity of applying for :— (a) a second opinion of the case ; (b) a bacteriological examination of the lochia or blood ; (c) the removal of the patient to Hospital ; (d) the services of a trained nurse. In order to be in a position to comply with any requests that may be received under the above headings, the Council have arranged for the services of a gynaecologist and bacteriologist to be available when required, and have entered into an agreement with the Ranyard Nurses, whereby a trained nurse can be provided for attendance at the patient's home. Institutional treatment is available at the Hospitals of the Metropolitan Asylums Board. Pneumonia. Acute Primary Pneumonia and Acute Influenzal Pneumonia are notifiable under the Infectious Diseases (London) Regulations, 1928, and during the year 355 cases were notified. 53 It is the practice for an Officer of the Department to visit the home of the patient, and offer the services of a Ranyard Nurse, if, in the circumstances, such nursing appears to be necessary. During the year assistance in this direction was provided for 58 cases, the nurses making 1,272 visits. Ophthalmia Neonatorum. During the year 21 cases of this disease were notified, 10 of which were treated in Hospital. The result of the cases is set out in tabular form below:— Cases. Results. Notified. Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Home. Hospital. 21 11 10 21 — - — Measles.—The number of cases of Measles brought to our notice during the year was 609. Our information is derived from the returns supplied by the Head Teachers of the London County Council Schools. Five deaths from Measles occurred during the year. In London, epidemics of measles appear with regularity every two years. They usually commence in the latter part of the autumn, and continue for about six months. During the time of prevalence, the disease tends to become more virulent as the epidemic increases, and the result is reflected in the mortality figures, especially among children under 5 years of age. During the 1927-28 epidemic, 41,477 cases were reported as occurring among children attending the London County Council Schools. As measles is a disease specially of preschool age (2-5 years), it is probable, therefore, that a total of approximately 100,000 cases occurred in London during the epidemic period. 54 The epidemic of 1927-28 was more severe than its predecessor of 1925-26. The deaths during the six months ended 31st May, 1928, numbered 1,357, as compared with 1,034 during the six months (November to April) of 1925-26. Measles is responsible for more loss of life during the biennial epidemic than Scarlet Fever and Diphtheria combined. A prominent obstacle to preventative action is the difficulty of securing early knowledge of the first cases, and for some years past efforts have been made to speed up the machinery of voluntary school notification. A scheme of control was inaugurated in 1921 as a result of a Conference between the London County Council and the Metropolitan Boroughs. The object of the scheme may be briefly summarised as follows: — (1) The earliest possible notification of cases to the Medical Officers of Health of the Boroughs, through the school organisation and local Public Health and Voluntary Services. (2) Better understanding among parents of the fact that measles is a dangerous disease which, if neglected, may lead to death or serious physical results. Propaganda can best be accomplished through the medium of Health Visitors, talks to parents, leaflets, etc. (3) Improvement in the care and nursing of children suffering from measles, including a proper period of convalescence. (4) The provision of nursing, through District Nursing Associations, so that children can be properly treated in the home. (5) Immediate removal to M.A.B. Hospitals or Infirmaries of all children suffering from the disease if proper care and treatment cannot be provided at home. 55 (6) Removal of children suffering from complications to suitable Hospital, such as the Children's Hospital, Great Ormond Street, and Shadwell Children's Hospital, where special provision is made for such cases. The London County Council undertakes to ascertain, through its School Nursing Service, Teaching and School Attendance Staff, the earliest possible information of cases of measles. As soon as a district shows signs of becoming invaded, arrangements are made for the School Nurse to pay a daily visit to the schools affected with measles. She at once excludes all children suspected of developing the disease, and informs the. Divisional Officer (Education) of any suspicious absentees. Any cases of measles thus disclosed are reported at once to the Borough Medical Officer, and he arranges for home visiting, domiciliary nursing assistance, or removal to Hospital, as the circumstances dictate. At the end of the year the Council decided to carry out the scheme in this Borough, and authority was given for the engaging of two Temporary Assistant Health Visitors to visit the cases in their homes. 56 Disease. Number of Cases Notified. Notified Cases of Infectious Diseases, 1929. The cases of infectious disease notified during the year (with the exception of Tuberculosis, which is shown separately), are summarised in the following Table— At Ages—Years Total at all Ages Number removed to Hospital, Under 1 year 1and 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 4 5 and under 65 years 65 and over Small-Pox - - - - - - - 3 4 - 1 8 8 Scarlet Fever 2 18 33 47 65 418 117 64 42 27 10 — 843 740 Diphtheria 5 7 19 25 31 205 48 28 39 6 3 — 416 404 Enteric Fever — — 1 — 2 12 12 17 28 16 22 — 110 99 Paratyphoid Fever - — - 1 1 2 2 Puerperal Fever — — — 1 13 7 — 21 17 Pvrexia — — — — — — 1 19 5 — — 25 14 Erysipelas — 1 1 — 1 2 3 3 5 11 37 5 69 26 Pneumonia 11 11 15 9 16 38 13 24 61 48 66 43 355 169 Encephalitis Letbargica — — — — — 2 1 1 1 5 3 Acute Polio-Myelitis 1 2 1 - - 1 - - - - 5 2 Cerebro Spinal Meningitis — — 1 1 1 — 1 — — 4 4 Ophthalmia Neonatorum 21 — - — — — — — — — — — 21 10 40 39 71 82 115 677 193 144 211 123 140 49 1884 1498 57 Diseases. Age Groups. All ages. Table showing number of Deaths from Infectious Diseases during 1929— 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 Enteric Fever - - - 3 3 7 3 16 Measles 2 1 1 1 - - - 5 Scarlet Fever - - 2 2 1 — - — — 5 Whooping Cough 10 9 1 - - - - 20 Diphtheria 2 — 6 7 - - - 15 Influenza 2 4 3 2 8 17 32 23 30 121 Puerperal Fever — - — — — 9 — — — 9 58 Tuberculosis — New Cases and Mortality during 1929. Age Periods. Years. New Cases. Deaths. Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary. Males. Females. Males Females Males. Females. Males Females 0 1 — — 5 4 1 — 5 1 1 5 4 2 10 6 1 2 7 3 10 3 3 5 8 — — — — 15 12 16 5 9 13 18 3 3 20 12 29 3 3 — — — - 25 44 39 3 5 32 40 3 3 35 35 27 1 4 — — — — 45 29 12 3 2 30 7 1 1 55 18 6 — 3 5 3 65 and upwards 4 1 — — 1 — — — Totals 161 135 35 44 83 70 19 12 Efficiency of Notification. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was as follows :— Pulmonary = 1 : 17.0 Non-Pulmonary = 1 : 4.4 It was not necessary to take any action in regard to the non-notification of tuberculosis during the year. Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was taken under the above Regulations, which relate to tuberculous employees in the milk trade. 59 Report of the Tuberculosis Officer for 1929. The primary notifications of tuberculosis for 1929 numbered 375, of which 296 were of pulmonary tuberculosis and 79 of other forms of tuberculosis. During the year 153 persons died from pulmonary tuberculosis and 31 from non-pulmonary tuberculosis. The death rate from pulmonary tuberculosis was 0.73 per 1,000 inhabitants, compared with 0.77 per 1,000 inhabitants in 1928. There are at present living in the Borough 1,171 notified cases of tuberculosis, classified as follows:—Pulmonary males, 458; pulmonary females, 449; non-pulmonary males, 121; nonpulmonary females, 143. The estimated population is 207,900; there is, therefore, one case of tuberculosis for every 177 inhabitants. All these patients have been visited in their homes by the Health Visitors, and the great majority of them by the Tuberculosis Officer also, in order that advice may be given regarding the care of the patients in their homes. Of the tuberculous persons living in the Borough during 1929, 939 have at some time attended the Dispensarv, i.e., three-quarters of the total number. Table A shows the condition on December 31st, 1929, of the 2,500 patients diagnosed as suffering from pulmonary tuberculosis, who have attended the Dispensary since its foundation in June, 1916. Of these, 977 (39%) have died in the Borough, and 345 (13.8%) are well and at work. 209 (8.3%) have been discharged as cured, or with diagnosis unconfirmed. 60 TABLE A. Conditions on 31st December, 1929, 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 1928 1929 Totals No. of Cases 74 157 200 185 200 159 165 181 166 165 204 195 249 200 2500 Dead 49 72 88 63 91 76 82 80 77 75 81 61 54 28 977 Left 14 51 57 60 50 38 46 52 35 38 42 39 37 6 565 Well — 7 11 12 10 21 23 29 25 45 46 77 32 345 Fair 1 5 3 14 5 9 9 9 15 19 28 41 67 114 339 Unwell 2 1 1 1 — 1 1 6 3 3 5 7 14 20 65 Discharged as arrested or diagnosis not confirmed 8 21 44 36 42 25 6 11 7 5 3 1 — — 209 Totals 74 157 200 185 200 159 165 181 166 165 204 195 249 200 2500 61 Table B shows the work carried out by the two Health Visitors. The extent to which their visits are appreciated is shown by the constant applications from the patients for repeated visits in circumstances of difficulty, when help and advice are solicited. TABLE B. Health Visitors' Annual Report, 1929. Visits. ex-Service Men. Civilians. Total. Pulmonary Tuberculosis 58 219 277 353 Other Forms 2 74 76 Subsequent Visits 210 1649 1859 2061 Un-notified Cases 19 183 202 No. occupying Separate Room 13 111 353 ,, sharing with 1 other 24 130 „ ,, ,, 2others 20 40 ,, ,, ,, 3 ,, 1 10 ,, ,, ,, 4 ,, 1 2 ,, ,, ,, 5 „ 1 — No. having Separate Bed 13 153 353 ,, sharing with 1 other 43 127 ,, ,, ,,2 others 3 10 ,, ,, ,, 3 ,, 1 3 The Tuberculosis Officer paid 247 visits at the homes of patients, and visited 12 patients in consultation with their medical attendants. 62 The Dispensary works in close co-operation with the local practitioners who, during the year, sent 286 patients for opinion and advice or for treatment. 336 written reports were sent from the Dispensary, and 109 reports were received from Doctors concerning their panel patients. The London County Council admitted 222 patients to residential institutions. The Lewisham Hospital admitted 29 patients recommended by the Tuberculosis Officer, these being patients seriously ill and requiring urgent hospital treatment on account of unsuitable home conditions. Two men were sent by the London County Council to the Papworth Training Colony. Cambridge, thus increasing the number of Lewisham patients at this Colony to 7, all of whom are making excellent progress. Two of these patients have colonised with their families and have kept at regular work for many years; the other 5 are single youths and are learning useful trades. One of these had lost two older brothers from tuberculosis and seemed doomed to the same fate, he being the last child of his parents, but Papworth has saved his life. Another had lost two adult brothers, a baby brother and his mother from tuberculosis, and he also has a brighter future in prospect since he went to Papworth. The Dispensary is affiliated to King's College Hospital and to the Miller General Hospital, and patients are also sent to the London Hospital for Finsen Light treatment and to Brompton Hospital for artificial pneumothorax refills. During the year, 4 patients made 343 attendances at the London Hospital, and 20 patients received 264 refills at Brompton. The Pathological Department of St. John's Hospital, Lewisham. has examined 188 sputa of Dispensary patients, and has also examined the blood of 27 patients by Vernes' method, affording much help in the diagnosis and prognosis of tuberculous disease. Under the arrangement for dental treatment with the 63 British Dental Hospital, 39 patients received treatment and 9 were provided with dentures. The Borough Council granted diet allowance of milk and butter to 12 patients after their return from Sanatoria, in order to maintain their working capacity. The six shelters provided by the Borough Council were in constant use. The Secretary of the Care Committee reports that the Committee met 25 times during the year. 227 cases were considered for assessment in order to judge whether they were able to contribute towards their institutional treatment. Of these, 138 were passed as free cases, 24 were pensioners and therefore nonassessable, while 65 were asked to pay sums varying from 2/6 to 25/- a week. One patient was able to pay the full amount of £2 10s. Od. a week. The total sum collected and forwarded to the London County Council was £554 3s. Od. Apart from the work of assessment, the Care Committee was able to assist patients in a variety of ways:—12 families of children were boarded out while their mother was receiving institutional treatment; 113 patients were provided with clothing; maintenance grants were obtained from army funds for 37 pensioners; 2 patients were sent to training centres, one to a farm and one to be instructed in splint-making; in 6 cases an ambulance was provided to remove patients to homes for the dying; in 16 cases convalescence was arranged for relatives of patients, in order to help them to recuperate after the fatigue of nursing the invalid; and in addition to these examples of specified help, patients attend the Dispensary at all hours of the day to seek advice and sympathetic assistance from the Care Committee. The Handicrafts Class, now in its fourth year, is as popular as ever, and has a most beneficial influence on the health of the pupils. There are more candidates for admission to the class than can be accommodated and it is hoped that, before long, a more spacious class-room can be provided. The Ministry of Pensions is in constant communication 64 with the Dispensary concerning tuberculous pensioners; these receive preferential consideration when in need of institutional treatment. By means of the Care Committee they are put in touch with organisations such as the Red Cross and the United Services Fund for assistance with financial and other difficulties. The following Tables give a summary of the work carried out at the Dispensary during the year :— Table C. Attendances of Patients at the Dispensary. 1929. First Attendances. Subsequent Attendances. Totals. January 68 202 270 February 52 155 207 March 83 198 281 April 72 164 236 May 79 182 261 June 64 190 254 July 68 188 256 August 35 138 173 September 53 183 236 October 51 184 235 November 57 168 225 December 38 144 182 720 2096 2816 Table D. Summary of First Attendances at the Dispensary, 1929. Applled on own initiative. Sent by Doctor. Sent by Min. of Pensions. Transferred from Hosp., Disp., etc. Sent by L.C.C. Sent by Care Committee. Contacts. Totals. Pulmonary 42 110 1 42 5 200 Non-Pulmonary 21 3 — 11 1 2 — 38 Non-Tuberculous 105 170 — 15 15 — 174 479 Suspects - 3 - — — — - 3 168 286 1 68 16 2 179 720 65 Table E. Stages in Pulmonary Tuberculosis. Male. Female. Children under 15. Total. Stage I. 16 19 2 37 ,, II. 73 65 1 139 ,, III. 13 9 2 24 102 93 5 200 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 F. Cases of Non-Pulmonary Tuberculosis. Male. Female. Children under 15. Total. Glands 2 4 6 12 Bone 4 5 5 14 Other Regions 5 4 3 12 11 13 14 38 66 SECTION VII.—MATERNITY AND CHILD WELFARE. The Council's activities in relation to Maternity and Child Welfare include a Municipal Maternity Home, Ante-Natal, Maternity, and Infant Clinics, Dental Treatment, Nursing Assistance, a Scheme for the provision of milk for necessitous mothers and their infants, and an organised system of visiting by trained Health Visitors. These services are closely linked up with the various voluntary organisations engaged in infant welfare work in the Borough. Maternity and Child Welfare Centres. Ante-Natal Clinic.—This Clinic is housed at the Maternity Home, and is held on Monday and Thursday mornings and Monday afternoon in each week. Most of the patients who attend have been accepted for admis-sion to the Maternity Home, but an increasing number is sent by midwives for examination and advice. Some of the patients attend on the recommendation of neighbours, and others because they have learned the habit of seeking ante-natal advice whilst residing in other Boroughs. The number of attendances during the year was 2,211, and of these, 2,038 were made by patients booked for admission to the Maternity Home, and 173 by women who had made arrangements for their confinement elsewhere. The cases treated were classified as follows : — Disorders and Diseases of the Reproductive System 28 Disorders and Diseases of the Alimentary System 101 Diseases of the Heart, Blood Vessels, etc. 20 Diseases of the Respiratory System 15 Disorders and Diseases of the Nervous System 36 Diseases of the Urinary System 11 Affections of the Skin 8 Diseases of the Muscles, Bones and Joints 5 Diseases of the Lymphatic System, Ductless Glands, Thyroid, etc. 1 General Diseases 16 Consultations 1,970 67 infant and Maternity Clinics.—The Clinic for Mothers and Infants is held on four mornings in each week, at the Wesleyan Hall, Rushey Green, Catford, which is rented by the Council for this purpose. The Clinic is attended by the Maternity and Child Welfare Medical Officer, two of the Health Visitors also being in attendance. The attendances during 1929 were as follows:— Maternity Clinic 1,788 Infant Clinic 6,749 The cases treated during the year were classified as follows: Maternity Clinic. Disorders and Diseases of the Reproductive System 124 Disorders and Diseases of the Alimentary System 160 Diseases of the Respiratory System 32 Diseases of the Heart, Blood Vessels, etc. 11 Disorders and Diseases of the Nervous System 14 Diseases of the Lymphatic System, Thyroid, etc. 2 Diseases of the Urinary System 5 Affections of the Skin 10 . Diseases of the Ear 1 Diseases of the Muscles, Bones and Joints 12 General Diseases 115 Consultations 1,302 Infant Clinic. Disorders and Diseases of the Alimentary System 502 Diseases of the Respiratory System 426 Disorders and Diseases of the Circulatory System 2 Disorders and Diseases of the Nervous System 18 Diseases of the Urinary System 17 Disorders and Diseases of the Reproductive System 92 Affections of the Skin 201 Diseases of the Ear 65 Diseases of the Eye 38 Wounds and Bruises 10 Scalds and Burns 3 Exanthemata 7 Mental Defects 7 Congenital Defects 3 Orthopoedics 15 Injuries and Diseases of the Newborn 12 Rickets 20 General Diseases 19 Consultations on Infant Feeding and Management 5,292 68 Voluntary Infant Welfare Centres. The Voluntary Infant Welfare Centres in the Borough are set out below. The services of a doctor is provided by the Council at each of these Centres (with the exception of the Sydenham Centre), and the Health Visitor for the district is also in attendance. In the case of the Sydenham Centre a contribution is made by the Council in respect of the services of the medical consultant. No. of Sessions Name of Centre and where held. Weekly. Bellingham Infant Welfare Centre, Congregational Hall, Bellingham Green 1 Catford School for Mothers, Wesleyan Hall, Rushey Green 2 Downham Infant Welfare Centre, St. Barnabas' Hall, Downham Way 1 Forest Hill School for Mothers, Wesleyan Hall, Brockley Rise 1 Grove Park Infant Welfare Centre, Wesleyan Hall, Grove Park 1 Hither Green Mothers' and Babies' Welcome, Wesleyan Hall, Hither Green 1 Blackheath and Lee School for Mothers, St. Margaret's Hall, Old Road, Lee 1 St. Mary's School for Mothers, Parish Hall, Ladywell Road 1 Sydenham Infant Welfare Centre, 5 7, Adamsrill Road 2 Municipal Maternity Home. The Council's Maternity Home is situated at 41, Rushey Green, Catford, and was opened in June, 1918. It contains accommodation for 17 patients, which permits an average admission of 26 patients each month. 69 During 1929, 304 confinements took place in the Home, of which 178 were primiparae, and the nature of these cases is shown in the following Table: — Total number of Labours 304 Vertex Presentation 296 Pelvic „ 12 Face „ 1 Twins 5 Forceps 4 Manual Removal of Placenta 1 Prolapse of Cord 1 Minor Operations (P. 28, M. 3) 31 Thrombosis 1 Eclampsia 2 Ante-partum Haemorrhage 1 Post-partum „ 3 Albuminuria 2 Morbidity 6 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." There was one maternal death due to post-partum fulminating eclampsia. One infant was born in the ambulance before arrival at the Home. Of the 309 infants born, 7 were stillborn, and 5 died shortly after birth. Details of these cases are set out in the following Table: — Number of births 309 Full-term deaths, recent 3 Premature deaths, recent 2 Macerated 2 Total number born dead 7 Infants born alive who died in the Home 5 Total number born dead or died in the Home 12 Still-births. Maturity. Cause of Death Remarks. 1. Premature Atelectasis 2. ,, Unknown Macerated 3. ,, 4 Full Term Cord round neck Macerated 5. ,, Face Presentation (Prolonged Labour) - 6 ,, Unknown 7. „ .. - 70 Live Births. Maturity. Period of Survival. Cause of Death. 1. Premature 7 hours Prematurity 2. ,, 9 ,, Atelectasis. Prematurity 3. ,, 15 minutes Asphyxia Pallida. 4. ,, 3 days Prematurity. 5. Full-term 10 ,, (1) Congenital Aplastic Anaemia. (2) Acute Oedema of Lungs. The sex incidence of the infants was as follows:— Males, 159 ; Females, 150 ... Total, 309. The average length and weight of the full-term infants were as follow :— Males Length, 22.5 inches. Weight, 7 lbs. 4ozs. Females 21.4 „ „ 7 lbs. 2ozs. All the infants were entirely breast-fed, with the exception of eleven; of these, five required complementary and six supplementary feeds. One case of Eclampsia made an uninterrupted recovery. One case developed Pelvic Peritonitis after confinement, and was removed to the North Western Hospital, Hampstead, from which she was discharged well. Three of the infants had congenital defects, viz: — 1. Hypospadius. 2. Congenital Heart. 3. Congenital Talipes Equino-varus. Nurses' Quarters.—During the year the Council acquired the premises No. 1, Honley Road, Catford, for the purpose of providing sleeping quarters for some of the members of the stafi. The accommodation consists of four nurses' bedrooms, two maids' bedrooms, and two rooms for the woman caretaker. This arrangement has been found to work quite satisfactorily, and has been much appreciated by the Nursing Staff. 71 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 First visits to Infants 3,047 Subsequent ditto 9,588 Visits to Infants 1-5 years of age 4,727 First visits to Ante-natal Cases 264 Subsequent ditto 176 Enquiries into Infant Deaths 87 „ ,, Still-births 30 Visits to Puerperal Fever Cases 34 „ Ophthalmia Neonatorum Cases 116 „ Other Infectious Cases 592 Miscellaneous Visits 383 Dental Treatment. The Council's Scheme for Dental Treatment provides for financial assistance to enable nursing and expectant mothers to obtain artificial dentures, and for extractions and fillings required by mothers and infants. Arrangements have been made with the local branch of the British Dental Hospital, and the St. John's Hospital, to provide the treatment. During the year free dental treatment was provided for 100 mothers and 64 infants, and assistance in obtaining dentures was authorised for 61 nursing mothers. 72 Milk Assistance Scheme. — The Council's Scheme for the provision of dried milk for infants and nursing and expectant mothers was continued during the year. The extent of the assistance granted is indicated by the following figures: — 345 cases were granted 263 „ ,, 409 „ ,, 24 „ ,, 45 ,, ,, 5 „ ,, 37 „ ,, 11 ,, ,, 33 „ ,, 11 „ ,, 1 lb. per week for 4 weeks, free of charge. 1¼ lbs. ,, ,, ,, 1½ ,, ,, ,, 2 ,, ,, ,, ,, 2½ 3 ,, ,, ,, ,, 11b ,, „ @ 6d. per lb. 1¼ lbs. ,, ,, ,, 1½ ,, ,, ,, ,, 2 ,, ,, ,, ,, The total amount of dried milk issued at less than cost price was 6,293 lbs. Sale of Dried Milk.—During the year 5,390 lbs. of Dried Milk were sold at cost price to families to whom, in the opinion of the Health Visitors, the ordinary retail price was prohibitive.