LEW 21 METROPOLITAN BOROUGH OF LEWISHAM. REPORT of the Medical Officer of Health For the Year 1933. John W. Miller, M.B., Ch.B., D.P.H. Greenwich : Printed by E. G. Berryman & Sons, Ltd., Blackheath Road, S.E.10. 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 1933 on the health and sanitary condition of the Borough, this being the thirty-third of the series. A summary of the Vital Statistics is given on page five, from which it will be seen that the corrected death-rate was 10.2 per thousand of the population, exactly the same as in the past two years, and again the lowest in all the Metropolitan Boroughs. 1 he death-rate for the County of London was 12.5 per thousand. The Infant Mortality rate was 39 per thousand live births, compared with 54 per thousand in 1932. This is the lowest infant mortality rate ever recorded in the Borough, and, with one exception, the lowest among the Metropolitan Boroughs. The declinc in the Birth-rate continues, and in the year under review was 12.2 per thousand, compared with 12.7 in 1932. The Death-rate from pulmonary tuberculosis was 0'64 per thousand, compared with 0.59 in the previous year. There was an increase in the incidence of Scarlet Fever and Diphtheria, 1,129 cases of scarlet fever being notified, compared with 513 in 1932, and 354 cases of diphtheria, as against 228 in the previous year. The increase in the prevalence of this disease was general throughout the Metropolis. During the year a survey of the Health Services of the Borough was carried out by officials of the Ministry of Health. The Minister's observations on this survey are set out in the Appendix to this Report. It is a pleasure to again record my appreciation of the kind consideration accorded me by the Chairman and Members of the Public Health and Maternity and Child Welfare Committees, 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, Town Hall, Medical Officer of Health. Catford, S.E.6. STAFF OF THE PUBLIC HEALTH DEPARTMENT, at the end of 1933. Medical. Medical Officer of Health John W. Miller, m.b., ch.b., d.p.h. Assistant Medical Officer of Health & Maternity & Child Welfare Medical Officer .. Ella G. F. Mackenzie, m.d., m.b., ch.b., d.p.h. Tuberculosis Officer .. Rose Jordan, m.d., b.s., b.sc., d.p.h. Infant Welfare Medical Officer (part-time) Evelyn Davies, m.r.c.s., l.r.c.p., d.p.h. Consulting Obstetricians . G. F. Gibberd, m.s., m.b., f.r.c.s. Arnold Walker, m.a., m.b., b.ch., f.r.c.s., l.r.c.p. J. B. Blaiklev, m.b., b.s., f.r.c.s. l.r.c.p. Public Vaccinators F. S. Barnett, m.r.c.s., l.r.f.p.s. & l.m., l.s.a. F. S. Hogg, l.r.c.p., l.r.c.s., l.r.f.p.s., l.s.a. W. Rhys Davies, m.b., ch.b. R. Morley Greenop, m.r.c.s., l.r.c.p. Sanitary Inspectors. Berry, J. H. (a) Cooper, J. A. K. (a) (b) Craven, J. R. (a) (b) Crowther, J. (a) (b) Gray, A. H. (a) (b) Hohfield, C. E. (a) (b) Rayner, S. P. (a) (b) Thomas, A. G. (a) (b) Tolson, H. (a) Walker, E. (a) (b) Woman Sanitary Inspector, Selfe, Mrs. N. F. (a) Health Visitors. Maternity and Child Welfare. Miss F. L. Burton (c) (a) (e) Miss W. Cresswell (c) (d) (e) Miss W. Eve (c) (d) (e) Miss A. M. Edwards (c) (e) Miss C. H. Thompson (a) (d) (e) Miss G. Simpson (a) (d) (e) Miss E. M. Watson (a) (d) (e) Tuberculosis. Miss N. Brocklehurst (a) (e) Mrs. M. Wardle (c) (d) Clerks. F. E. Seckerson (a) C. C. Summers Miss B. C. Aylett a. j. Phillips (a) (b) G. Ockenden W. D. Back Other Staff. Public Analyst A. J. Lickorish, f.i.c. Matron, Maternity Home Mrs. D. Fynn Clerk-Dispenser, Maternity Home and Clinics Mrs. M. Iles Clerk-Dispenser, Tuberculosis Dispensary Miss M. Colquhoun Secretary, Tuberculosis Care Committee Miss O. Fergusson Vaccination Officer C. W. Knottley Assistant Vaccination Officer (temporary) R. E. Stephan Disinfection Superintendent H. T. Ibbett Caretaker-Attendant, Coroner's Court and Mortuary H. L. Bailey Caretaker, Tuberculosis Dispensary S. Ambrose (a) Sanitary Inspector's Certificate. (b) Food Inspector's Certificate. (c) Trained Nurse. (d) Health Visitor's Certificate. (e) Certificate of Central Midwives Board. 5 STATISTICS. General Statistics, 1933. Area of the Borough 7,015 acres. Population: — Census, 1931 219,953 Estimated, Mid-year, 1933 221,100 Number of inhabited houses (end of 1933) according to Rate Books 48,500 Rateable Value (at 6th April, 1933) £1,641,731 Sum represented by a penny rate £6,567 Extracts from Vital Statistics, 1933. Total. Males. Females. Live Births: —Legitimate 2,607 1,365 1,242 Illegitimate 95 44 51 Birth Rate per 1,000 of the estimated population 12.2 Total. Males. Females. Still-Births 86 43 43 Rate per 1,000 births (live and still-births) 31 Total. Males. Females. Deaths 2,271 1,091 1,180 Death Rate per 1,000 of the estimated population 10.2 Deaths from Puerperal Causes: — Deaths. Rate per 1,000 (live and still) Births. No. 29 Puerperal Sepsis 3 1.11 No. 30 Other Puerperal Causes 4 1.48 Total 7 2.59 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 39 Legitimate infants per 1,000 legitimate live births 37 Illegitimate infants per 1,000 illegitimate live births 84 Deaths from Measles (all ages) 1 „ „ Whooping Cough (all ages) 8 „ „ Diarrhoea (under 2 years of age) 14 6 Population. The Registrar-General's estimate of the population of the Borough at mid-year, 1933, is 221,100, which figure has been employed in calculating the various mortality and other rates appearing in this Report. Births. Registered Births. The following information in regard to the registration of live births in the Borough during the year 1933 was supplied by the Registrar-General:— Total Registered Inward Transfers Outward Transfers Births allocated to Borough Legitimate Males 1,335 129 99 1,365 Legitimate Females 1,233 108 98 1,242 Illegitimate Males 64 2 22 44 Illegitimate Females 57 9 15 51 Total 2,689 248 235 2,702 It will be seen that the corrected number of births is 2,702, which is equivalent to a birth rate of 12.2 per 1.000. The births and birth rates in the last ten years are shown herewith:— Year. No. of Births. Birth Rate. 1924 3,066 16.3 1925 2,907 15.6 1926 2,885 15.3 1927 2,755 15.1 1928 3,036 15.2 1929 3,261 15.7 1930 3,147 15.1 1931 3,115 14.1 1932 2,817 12.7 1933 2,702 12.2 7 Notified Births. Under an Act of 1907, a birth must be notified to the Medical Officer of Health within 36 hours. The information obtained in this manner enables the Health Visitor to exercise supervision of the mother and infant in the early days succeeding the confinement. During the year notifications were received of 2,591 births. Still-Births. Notifications of 82 still-births were received, and details of these are as follows:— Total number notified 82 Out-of-Borough cases born in the Borough, and not investigated 3 Borough Cases born outside the Borough 15 Number of Borough cases 79 Borough cases in which no enquiry could be made 21 The causes of still-birth in the 58 cases which were investigated were as follows:— Maternal Causes: Albuminuria 7 Ante-partum Haemorrhage:— Placenta Praevia 1 Accidental Haemorrhage 4 Delayed Labour 4 Influenza 3 Difficult Instrumental Labours 10 Fall 3 Ill Health of Mother 1 Fcetal Causes: Breech Presentation 2 Transverse Presentation 1 Monstrosity 2 Prolapsed Cord 3 Post Maturity and Induction 2 Causes not known 15 Marriages. The number of marriages registered in the Borough during the year was 1,580, compared with 1,500 in 1932. Of this number. 843 were solemnised in the Established Church, 197 in Non-conformist Places of Worship, and 540 at the Register Office. 8 Deaths. The number of deaths of Lewisham residents registered in 1933 was 2,271, and the death rate was 10.2 per 1,000 persons. The deaths and death rates recorded in the last ten years are shown hereunder:— Year. No. of Deaths. Death Rate. 1924 1,934 10.4 1925 1,927 10.3 1926 1,890 10.0 1927 2,083 11.0 1928 1,993 10.0 1929 2,409 11.5 1930 2,041 9.7 1931 2,254 10.2 1932 2,263 10.2 1933 2,271 10.2 Deaths in Public Institutions. The deaths occurring in Hospitals and other Public Institutions in the Borough numbered 1,160, of which 769 were residents, and 307 residents died in Institutions outside the Borough. Infant Mortality. The number of infants who died before reaching one year of age was 107, and the infant mortality is therefore 39 per 1,000 births. The following table shows the infant mortality for the last ten years, and a comparison with the County of London:— Year. No. of Deaths. Infant Mortality Rate. Lewisham. County of London. 1924 146 47 69 1925 160 55 67 1926 116 40 64 1927 131 46 59 1928 158 52 67 1929 144 44 70 1930 134 42 59 1931 155 49 65 1932 154 54 66 1933 107 39 59 9 The number of infants who died in the first four weeks of life was 58, and the causes of death were as follows:- Prematurity 24 Atelectasis 4 Broncho-pneumonia 2 Bronchitis 2 Difficult Delivery 7 Inanition 1 Congenital Heart Disease 4 Suffocation in bed with mother I Malformation 2 Spina Bifida 3 Toxaemia of Mother 1 Ante-Partum Haemorrhage in Mother 3 Convulsions 1 Marasmus 3 Maternal Mortality. The number of deaths resulting from child birth was seven, of which three were due to Puerperal Sepsis. From a perusal of the statistics relating to still-births, and infant and maternal mortality, it will be noted that seven mothers lost their lives in child-birth, or its sequelae, fifty-eight infants died before they were a month old, and eighty-two children were born dead. On investigation it was found that a considerable number of these deaths were from causes preventable, or probably preventable, had the mothers received efficient, and sufficient, ante-natal supervision throughout the period of pregnancy. It is an unfortunate fact that many prospective mothers receive no ante-natal care whatsoever, while others attend a Clinic only occasionally or rarely in the last few weeks of pregnancy, when the chance of preventing a still-birth, a neo-natal death, or even a maternal death, are reduced to a minimum. In support of the conclusions drawn in the preceding paragraphs, 1 may say that as a result of the investigations made into the circumstances of fifty-eight still-births and the same number of neo-natal deaths, it was found that forty-four mothers received no ante-natal care whatsoever; fourteen paid an occasional visit to their own doctor; fifteen were supervised by a midwife ; thirty-four attended a Hospital Clinic, and nine had attended one of the three Ante-Natal Clinics provided by the Borough Council, 10 Table showing Causes of Death at Different Periods of Life during the Year 1933. 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 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 and upwards 1. Typhoid and Paratyphoid Fever M 1 — — — — — — — 1 — — — F 1 — — — — — — — — —— — — 2. Measles M 1 — — — 1 — — — — — — — F — — — — — — — — — — — — 3. Scarlet Fever M 2 — — — — — — — 1 1 — — F 3 — 1 — 1 1 — — — — — — 4. Whooping Cough M 5 2 1 2 — — — — — — — — F 3 1 1 1 — — — — — — — — 5. Diphtheria M 9 — 1 3 5 — — — — — — — F 11 — — 5 5 — 1 — — — — — 6. Influenza M 38 1 1 — — 1 3 5 7 9 6 5 F 55 — 1 — — 1 1 3 6 10 9 24 7. Encephalitis Lethargica M — — — — — — — — — — — — F — — — — — — — — — — 1 1 8. Cerebro-Spinal Fever M 2 — — — 1 — 1 — — — — — F — — — — — — — — — — — — 9. Tuberculosis of Respiratory System M 86 — — — — 10 12 18 23 19 4 — F 56 — — — 2 18 13 10 5 5 3 — 10. Other Tuberculous Diseases M 6 — — — 1 3 — 1 — — 1 — F 12 — — 2 3 3 — 1 — 2 1 — 11. Syphilis M 2 — — — — — — 1 1 — — — F 2 — — — — — — 1 1 — — — 12. General Paralysis of the Insane. Tabes Dorsalis. . M 5 — — — — — — — 3 1 1 — F — — — — — — — — — — — — 13. Cancer, Malignant Disease M 142 — — — 1 1 — 5 20 38 54 23 F 159 — — — 2 — 2 7 23 45 55 25 14. Diabetes M 13 — — — — 3 1 1 — 4 3 1 F 20 — — — — — — — 1 7 8 4 15. Cerebral Haemorrhage, etc. M 30 — — — — — 1 1 2 10 9 7 F 72 — — — — 1 — 2 5 11 24 29 16. Heart Disease M 213 — — — — 4 10 4 16 49 62 68 F 292 — — — 1 1 10 5 17 41 74 143 17. Aneurysm M 8 — — — — — — — 3 4 1 — F 3 — — — — — — — 2 — 1 — 18. Other Circulatory Diseases M 68 — — — — — — — 2 20 31 15 F 49 — — — — — — 1 2 6 14 26 19. Bronchitis M 34 4 — — — — 3 —_ — 7 3 17 F 42 1 — — — — — 2 1 6 7 25 11 Table showing Causes of Death at Different Periods of Life during the Year 1933—continued. Causes of Death. Sex. All Ages. Under 1 year. 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 and upwards 20. Pneumonia (all forms) M 67 10 3 4 2 4 1 5 6 11 8 13 F 50 9 1 — — — — 8 6 4 5 17 21. Other Respiratory Diseases M 10 — — — 1 — — — 3 1 2 3 F 20 1 — — — 1 1 1 3 1 3 9 22. Peptic Ulcer M 16 — — — — — 1 — 3 6 5 1 F 8 — — — — — — 2 3 1 1 1 23. Diarrhoea, etc. M 7 4 1 — — 1 — — 1 — — — F 11 9 — — — 1 — — — — — 1 24. Appendicitis M 3 — — — 1 — — — — 2 — — F 8 — — — 2 — — 1 1 2 1 1 25. Cirrhosis of Liver • — 3 — — — — — — — — 2 — 1 F 3 — — — — — — — — 2 — 1 26. Other Diseases of Liver, etc. M 6 — 1 — — — — — — 1 2 2 F 6 — — — — — — — 1 3 1 1 27. Other Digestive Diseases .. M 26 — 1 3 1 1 1 3 5 7 2 2 F 21 — 1 — 1 — — — 5 2 5 7 28. Acute & Chronic Nephritis M 44 — — 1 2 2 — 1 6 10 12 10 F 40 — — — 2 1 3 3 4 4 13 10 29. Puerperal Sepsis F 3 — — — — — 1 2 — — — — 30. Other Puerperal Causes F 4 — — — — 1 3 — — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. M 31 29 — 1 1 — — — — — — — F 33 31 — — 1 — 1 — — — — — 32. Senility M 39 — — — — — — — — — 1 35 F 69 — — — — — — — — — 8 61 33. Suicide M 23 — — — — 1 — 3 3 8 6 2 F 4 — 1 1 1 2 — — 1 — 1 — 34. Other Violence M 52 3 — 1 6 17 4 1 8 3 4 5 F 32 — — — — 1 1 2 4 6 3 15 35. Other Defined Diseases M 97 2 — 3 3 5 7 8 12 19 17 21 F 86 — 2 2 10 — 5 8 13 15 20 11 36. Causes ill-defined or unknown M 2 — — — — 1 — — — — 1 — F — — — — — — — — — — — — Totals M 1091 55 9 18 26 54 45 57 126 232 238 231 F 1180 52 7 10 30 32 42 60 104 173 258 412 12 GENERAL PROVISION OF HEALTH SERVICES. Maternity and Child Welfare. Of primary importance among the Health Services for which the Borough Council is responsible is that which is concerned with Maternity and Child Welfare. The Council's activities in this direction comprise the following : — The Municipal Maternity Home. Clinics for Expectant Mothers. Treatment Clinics for Mothers and Infants. Dental Treatment. Nursing in the Home. A Scheme for the provision of Milk for necessitous Mothers and their Infants. The supply of Maternity Outfits. The provision of Home Helps for confinement cases. Home Visiting by Health Visitors These services are closely linked up with the Voluntary Organisations engaged in Infant Welfare work in the Borough. The mothers of Lewisham, and the Borough Council, owe a debt of gratitude to the ladies who conduct these voluntary organisations, for their enthusiastic and efficient work in the cause of maternal and infant welfare. Municipal Maternity Home. The Maternity Home is situated at 41, Rushey Green, Catford. It contains accommodation for seventeen patients, and an endeavour is made to secure an average admission of 28 patients each month. The particulars of the cases admitted to the Home during the year are as follows:— Number of Patients delivered 328 Number of Primiparae 183 Number of Multipara 145 Number of Infants born (1 set of Twins) 329 13 Presentations: Vertex 318 Pelvic 8 Fall 2 Transverse 1 Obstetric Operations: Forceps 1 Manual Removal of Placenta 1 Minor Operations 49 Post-Partum Hemorrhage: 2 Puerperal Morbidity 2 (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 the eighth days.") Still-Births 2 Details of Still-Births are as follows : Still-Births. Maturity Cause of Death Remarks 1 Premature Unknown Macerated 1 Full term „ „ The sex incidence of the Infants was as follows:— Males, 174; Females, 155 .. Total, 329 The average length and weight of the full-term Infants were as follows:— Males, Length, 22.05 ins. Weight, 71bs. 8ozs. Females, Length, 21.8 ins. Weight, 71bs. 3ozs. Progress of Infants while in the Home:— Number born alive 327 Over birth weight on discharge 215 Equal to birth weight on discharge 19 Under birth weight on discharge 90 Number of Infants entirely breast fed 324 Number of Infants in which breast feeding was supplemented 2 Number of Infants artificially fed 1 14 Clinics for Expectant Mothers. The Central Clinic is held at the Maternity Home, on Monday Tuesday and Thursday mornings in each week. Particulars of the Clinics for the year 1933 are as follows:— Number of Sessions held 147 Number of Patients examined 640 Number of Attendances made by all Patients 3,708 Number of Primigravidæ examined 316 Number of Multigravidæ examined 307 Number who were found to be not pregnant 17 Number of normal labours 412 Number of abnormal labours 35 Number undelivered at the end of 1933 164 Number removed from the district 12 Number sent by the Maternity Home 480 N umber sent by Mid wives 97 Number sent by Doctors and Institutions 7 Number who came on their own initiative 37 Number who came at the suggestion of a Health Visitor 19 The 35 Labours that ended abnormally are classified as follows:— Transverse 1 Premature Birth 3 Face 3 Premature Birth (still-born) 1 Breech 9 Still-births 4 Forceps 6 Ante-Partum Hemorrhage 1 Induction and Sterilization 1 Post 2 Miscarriage 3 Manual Removal of Placenta 1 Downham Ante-Natal Clinic.—This branch Clinic is held at the Downham Health Centre on one morning each week. During the year 97 women attended, the total attendances amounting to 355. X-Ray Examinations.—During the year an arrangement was made with St. John's Hospital whereby abnormal and complicated cases of pregnancy attending the Ante-Natal Clinics can be X-rayed, with a view to suitable treatment being given in time. Post-Natal Clinic.—A Post-natal Clinic was commenced in the latter part of the year, so that women who had attended the Antenatal Clinic could attend for a medical examination about six weeks after the confinement. This Clinic has been remarkably well attended, a fact that is most gratifying as it leads one to believe that the mothers are alive to the importance of being sure that their recovery has been complete and satisfactory. 15 The Complications found are classified as follows:— Complication. Primiparæ Multipara Not Pregnant Total Diseases and Disorders of the Reproductive System Threatened Abortion 1 — — 1 „ Miscarriage 1 — — 1 Prolapse — 3 — 3 Cystocele — 2 8 10 I.eucorrhœa — — 1 1 Purulent Vaginal Discharge 6 13 1 20 Rectocele — — 2 2 Sterility — — 1 1 Diseases and Disorders of the Digestive System: Dental Caries 78 90 — 168 Constipation 137 100 2 239 Heartburn 41 33 — 74 Hyperemesis 37 25 — 62 Gastritis — 1 — 1 Enteritis — — 1 1 Stomatitis — 1 — 1 Gingivitis — — 1 1 Indigestion 31 27 — 58 Pyorrhœa 3 2 — 5 Septic Throat 1 — — 1 Mumps — 1 — 1 Diseases of the Respiratory System: Coryza — 1 — 1 Nasal Catarrh 24 16 — 40 Bronchitis 40 35 — 75 Diseases of the Circulatory System: Valvular Disease of the Heart 6 4 — 10 High Blood Pressure 166 140 — 306 Varicose Veins of Lower Limbs 53 77 1 131 Haemorrhoids 6 13 — 19 Epistaxis 4 2 — 6 Diseases and Disorders of the Nervous System : Insomnia of Pregnancy 34 31 — 65 Diseases of the Urinary System: Albuminuria of Pregnancy 42 33 — 75 Glycosuria of Pregnancy 20 14 — 34 Cystitis 1 — — 1 Pyelitis 1 — — 1 Affections of the Skin: Privitus 3 4 — 7 Caruncle 1 — ] 2 Septic Finger 1 — — 1 Diseases of the Ear: Otorrhœa 1 1 — 2 Diseases of the Eye: Hordeolum — — 1 1 General Diseases: Anaemia of Pregnancy 11 16 — 27 Exophthalmia — 1 — 1 Maxilliary — 1 — 1 Enlarged Thyroid 1 — — 1 Malpresentations — 2 — 2 No Complications found 34 32 10 76 16 Treatment Clinics for Mothers and Infants. These Clinics are held on four mornings in each week at the Wesleyan Hall, Rushey Green, Catford, which is rented by the Council for this purpose, and one morning in each week at the Downham Health Centre. The Clinics are attended by one of the Maternity and Child Welfare Medical Officers and two Health Visitors at each session. Attendances during 1933:— Rushey Green Clinic. Downham Clinic. No. on Register Attendances No. on Register Attendances Mothers 733 2,213 Mothers 186 498 Infants 1,537 8,323 Infants 410 1,626 The cases treated during the year were classified as follows:— Mothers' Clinic. Rushey Green. Downham. Diseases and Disorders of the Reproductive System 528 168 Diseases and Disorders of the Alimentary System 229 119 Diseases and Disorders of the Respiratory System 13 21 Diseases and Disorders of the Nervous System 19 5 Diseases of the Urinary System 11 — Affections of the Skin 18 6 Diseases of the Eye 3 4 Diseases of the Heart, Blood Vessels, etc. — 5 General Diseases 295 66 Consultations 692 149 Ante-natal Consultations 48 — Infants' Clinic. Rushey Green. Downham. Diseases and Disorders of the Reproductive System 147 72 Diseases and Disorders of the Alimentary System 600 163 Diseases and Disorders of the Respiratory System 832 228 Diseases and Disorders of the Nervous System 51 4 Diseases of the Urinary System 18 2 Affections of the Skin 175 74 Diseases of the Ear 58 — Diseases of the Eye 38 20 Wounds and Bruises — 2 Scalds and Burns 9 — Mental Defects 2 1 Congenital Defects 8 1 Injuries and Diseases of the New Born 49 25 Rickets 61 19 General Diseases 136 46 Consultations on Feeding and Management (under 1 year) 2,033 458 Consultations on Feeding and Management (1-5 years) 2,429 292 17 Sydenham Infant Welfare Centre. This Institution is situated in Adamsrill Road, Sydenham. It is administered by a Voluntary Committee on which the Borough Council is represented. Funds are obtained by donations and subscriptions, and the Centre is also in receipt of a grant from the Borough Council. The Centre comprises clinics for infants and expectant mothers, and for sunlight treatment. There are three wards, each containing six beds, for the accommodation of children under 2 years of age, who are suffering from malnutrition, and require special dietetic treatment. In addition to these activities, provision is made for district midwifery. The Centre is staffed by an Honorary Medical Officer, an Antenatal and Infant Welfare Medical Officer, a Superintendent, Midwife and House-Matron, two Staff Nurses, two Junior Nurses, and seven Probationers, the latter receiving training as children's nurses. During the year, 149 expectant mothers attended the Ante-natal Clinic, making in all 426 attendances. 115 of these patients were subsequently attended in their confinement by the Centre Midwife. Ninety-five children were admitted to the Hostel for in-patient treatment. The Upper Sydenham Infant Welfare Centre, which is held at the Park Hall, Sydenham Park, is a branch of the Sydenham Infant Welfare Centre, whose Committee is responsible for its management. 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. The work is now carried out by the Dental Department of the St. John's Hospital, Lewisham. During the year dental treatment was provided for 64 mothers and 11 infants, and complete or partial dentures to 23 mothers were authorised by the Maternity and Child Welfare Committee, 18 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 Sub-Committee charged with the duty of considering applications for assistance from necessitous persons, authorised 2,024 grants of dried milk for four weeks free of charge, and 203 grants at the reduced price of 6d. per lb. Altogether, 10,009 lbs. of dried milk were issued at a cost to the Council of £761 16s. 3d. Maternity Outfits. There is a steady demand for the sterilized maternity outfits which are supplied to expectant mothers on the recommendation of a doctor or midwife, and 227 outfits were supplied during the year, compared with 231 in the previous year. No charge was made for the outfit in 119 cases, 48 were issued at half-price, and 60 at cost price. Obstetric Consultants. The services of the Consultants whose services are retained by the Council were requisitioned by medical practitioners in three cases of difficult confinement. Home Helps. There was very little demand for this service during the year, and the services of a Home Help were provided in only five cases. Infant Life Protection. Under the Transfer of Powers (London) Order, 1933, which came into operation on 1st April, 1933, certain functions exercisable by the London County Council are transferred to Borough Councils and included in the Order are functions under Part I of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932, in relation to infant life protection. These duties, briefly, are the reception of notices given by persons who undertake for reward the nursing and maintenance of infants, and the inspection of premises by infant life protection visitors or other persons appointed by the Council for that purpose; fixing the number of infants to be kept in a dwelling in which any infant is received for reward, and applications to a court of justice 19 for an order directing the removal of an infant to a place of safety. In accordance with the powers granted by this Order, the officer who was carrying out the work under the London County Council was transferred to this Council as from 1st April, 1933. At the end of the year there were 179 nurse-children on the register, under the care of 127 foster-mothers. One nurse-child died during the year. Health Visitors. There are seven whole-time Health Visitors engaged in Maternity and Child Welfare work, to each of whom a particular part of the Borough is allotted for home visiting. Under the Notification of Births Acts, early information is received in the Health Department of births which have taken place, and when the doctor or midwife has ceased to attend, a call is made by the Health Visitor, who thus has an early opportunity of advising the mother in regard to the feeding, clothing and general management of the infant. Every encouragement is given the mother to attend an Infant Welfare Centre. Three or four visits are paid during the first year of the infant's life, and afterwards, at longer intervals, until the child reaches the age of five years. The Health Visitors' duties also comprise visits to expectant mothers, enquiries into cases of puerperal fever and ophthalmia neonatorum, infant deaths, and applications under the milk assistance scheme. Each Health Visitor attends the Voluntary Infant Welfare Centre in her district, and takes her turn in attending the Municipal Clinics. The work carried out by these officers during the years is summarised below:— Infants under 1 year of age:— First visits 2,548 Subsequent visits 6,911 Infants between 1 and 5 years of age:— Total visits 9,736 20 Expectant mothers :— First visits 755 Subsequent visits 285 Infant death enquiries 108 Still-birth enquiries 121 Visits to Puerperal Fever cases 20 Visits to Ophthalmia Neonatorum cases 59 Visits to Measles cases 460 Visits to other Infectious cases 244 Miscellaneous visits 634 Ineffectual calls 3,377 Attendances at Centres :— Municipal 592 Voluntary 616 Voluntary Infant Welfare Centres. There are ten Voluntary Infant Welfare Centres in the Borough, and the attendances at these during the year are summarised below:— Name of Centre. No. of Sessions held in the Year. Total Attendances. Children under 1 year of age. Children aged 1-5 years. Bellingham Infant Welfare Centre 47 1,780 2,177 Catford School for Mothers 96 4,920 3,188 Downham Infant Welfare Centre 48 3,588 2,860 Forest Hill School for Mothers 51 4,158 2,728 Grove Park Infant Welfare Centre 48 2,055 1,251 Hither Green Mothers' & Babies' Welcome 48 2,828 2,646 Lee and Blackheath School for Mothers 50 3,598 2,518 St. Mary's School for Mothers 51 4,002 1,765 Sydenham Infant Welfare Centre 97 4,446 1,511 Upper Sydenham Infant Welfare Center 50 1,298 854 Nursing in the Home. By arrangement with the Ranyard Nurses, who carry out general nursing in most parts of the Borough, the services of a nurse are available free for certain infectious cases. Payment is made by the Council at the rate of Is. 3d. per visit. The cases nursed during 1933 and the number of visits made, are shown in the following table : — 21 Nature of Illness. No. of Cases. No. of Visits. Ophthalmia Neonatorum 4 115 Measles 17 219 Pneumonia 73 1,515 Whooping Cough 4 81 Puerperal Fever 1 10 Totals 99 1,940 Midwives. The London County Council supplied the information that 46 midwives residing in the Borough gave notice of their intention to practice during 1933. Laboratory Facilities. Food atid Drugs.—The Public Analyst is Mr. A. J. Lickorish, F.I.C. Details of the analyses carried out during the year will be found in the section of the Report dealing with inspection and supervision of food. Bacteriological Examinations.-Bacteriological examinations arc carried out at the Pathological Department of the St. John's Hospital, Lewisham. Full use of this service is made by the medical practitioners in the Borough, and during the year 2,721 specimens were examined, the details being as follows :— Material from cases of suspected Diphtheria :— Diphtheria bacillus isolated Negative 159 1,808 1,967 Sputa from cases of suspected Tuberculosis :— Tubercle bacillus found .. 116 Tubercle bacillus not found 577 693 Blood from cases of suspected Enteric Fever :— Positive result 3 Negative result 48 51 Pathological specimens for Enteric Organisms :— Positive result Negative result 10 10 Total 2,721 22 Removal of Infirm or Diseased Persons. It was not necessary to take any action under Section 28 of the London County Council (General Powers) Act, 1928, relating to the above. Coroner's Court and Mortuary. These premises are situated in Ladywell Road and comprise a Court Room, Witness Room, Coroner's Office, Caretaker's Apartments and Mortuary. During the year 311 bodies were received into the Mortuary, of which number 49 were brought in from outside the Borough, and 134 from Public Institutions. The Inquests held numbered 215, and 155 post-mortem examinations were conducted. Disinfection and Personal Cleansing. The Disinfecting and Personal Cleansing Station is situated at Wearside Road, Lewisham. Details of the work carried out during the year are contained in the following Tables : — 23 Disinfection.—Return of Work for 1933. Articles Disinfected Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total Beds 66 88 97 62 81 65 54 60 103 126 129 139 1,070 Blankets 252 321 426 298 262 237 168 152 259 476 536 610 3,997 Bolsters 57 83 84 71 69 68 62 67 84 127 131 147 1,050 Mattresses 117 142 171 163 165 154 165 122 168 226 213 259 2,065 Pillows & Cushions 435 412 379 345 415 285 319 292 375 596 573 652 5,088 Quilts 112 131 180 132 133 123 115 73 142 220 233 280 1,874 Sheets 144 158 211 176 250 240 175 176 254 375 392 397 2,948 Miscellaneous 557 569 1,189 753 572 697 537 592 840 1,210 1,259 1,211 10,086 Wearing Apparel 519 573 882 635 755 892 386 474 906 1,284 1,122 1,566 9,984 Totals 2,259 2,477 3,619 2,635 2,802 2,761 1,981 2,008 3,131 4,640 4,588 5,271 38,172 Premises visited 29 110 151 107 150 129 110 151 166 189 252 226 1,833 Rooms disinfected 216 273 347 256 344 352 264 392 432 410 590 548 4,424 24 Cleansing Station Return of Work for 1933. Children treated for Vermin 907 Attendances at Cleansing Station 1,626 Adults treated for Vermin 3 Attendances at Cleansing Station 3 Children treated for Scabies 117 Baths given ... 740 Adults treated for Scabies 26 Baths given ... 79 Rooms treated for Vermin, etc. 338 Articles of Clothing and Bedding treated 1,795 SANITARY CIRCUMSTANCES OF THE AREA. Refuse Removal and Disposal. The collection of house and trade refuse is carried out by the Borough Surveyor's Department, a weekly collection being the rule. Practically the whole of the refuse is now collected in lowloading line containers and motor vehicles. The tonnage collected in 1933 is shown below. Loads. Tons. Container System 20,469 37,093 Freighters 4,570 6,297 Other Vehicles 357 364 Totals 25,396 43,754 The main portion of the refuse is disposed of at the Destructors situated at Molesworth Street, Lewisham, and Home Park, Sydenham, the remainder being sent away by barges or deposited on shoots in the Borough. The following are the figures for 1933 : — Loads. Tons. Home Park Destructor 10,719 17,816 Molesworth Street Destructor 12,278 17,975 Barged away 4,571 8,549 Shoots 55 86 Totals 27,622 44,426 The figures for disposal include refuse from the Council's Openair Market, and also trade refuse delivered by tradesmen to the Council's dust destructors. 25 Sanitary Inspection of the Borough. The work of the male Sanitary Inspectors is summarised in the following statement:— Inspections : On complaint 1,355 House-to-house 566 Infectious diseases 1332 Notice from builder 543 New houses for water certificates 1,136 Other Inspections 1,411 Re-inspections 9,614 Notices Served : Intimation (Public Health (London) Act) 1,528 Statutory (Ditto) 458 Cleansing and Repairs : Premises cleansed 1,488 Ventilation improved 208 Roofs repaired 555 Dampness abated 621 Gutters and rain-water pipes provided or repaired 351 Yards and forecourts paved 111 Yard and forecourt paving repaired 322 Defective scullery sinks replaced 185 Untrapped sink waste pipes replaced 203 Other repairs and improvements 850 Water Supply : Re-instated 138 Fittings repaired 81 Cisterns cleansed 13 Cisterns provided 8 Cisterns covered 26 Cisterns abolished 18 Additional facilities provided in tenement houses 21 Other improvements 28 Drainage : Drains reconstructed 268 Drains cleansed and repaired 197 Gully traps fixed 454 Soil and vent pipes fixed 209 Soil and vent pipes repaired 55 New covers provided to inspection chambers 65 Waste and rain-water pipes disconnected from drain 33 Inspection chambers provided 183 Other repairs and improvements 230 26 Water Closets : Old water-closets abolished 51 New water-closets provided 234 New pans and traps provided 342 Defective flush remedied 219 Pans cleansed 39 Seats provided or repaired 111 Roofs repaired 105 Walls, etc., repaired or cleansed 145 Doors repaired or renewed 52 Ventilation improved 78 Floors repaired 87 Other repairs or improvements 58 Urinals : Cleansed 31 Repaired 7 Reconstructed 15 Abolished 2 Dung Receptacles : Provided 1 Repaired 3 Abolished 2 Nuisances from keeping animals : Number abated 27 Offensive accumulations : Number removed 62 Dustbins : Number provided 314 Smoke nuisances : Observations 166 Nuisances 5 Intimation Notices 3 Statutory Notices 1 General: Other miscellaneous nuisances abated 124 Woman Sanitary Inspector. The woman inspector is responsible for the inspection of factories, workshops, and laundries where female labour is employed. She also carries out investigations into cases of encephalitis lethargica, pneumonia and infectious diseases reported from schools. 27 The work of this officer is summarised below : — Inspections on complaint 167 Re-inspections 224 Visits : Outworkers' premises 348 Factories, workshops and laundries 227 Miscellaneous 51 Enquiries re infectious diseases : Chicken Pox, etc. 531 Various infectious diseases reported by School Teachers 292 Notices served : Intimation 90 Statutory — Premises and Occupations Controlled by Bye-Laws and Regulations. The following is a summary of the premises comprised under this heading:— Description. No. on Register at end of 1933. Inspections during 1933. Milk Premises 134 328 Cowsheds 1 2 Slaughterhouses 7 799 Ice Cream Premises 141 324 Restaurants and Eating Houses 118 290 Fried Fish Premises 55 194 Bakehouses 73 193 Houses let in Lodgings 15 56 Factories and Workshops. Details of the administration of the Factory and Workshop Act, 1901, are included in this report in accordance with the requirements of the Ministry of Health. The total number of factories and workshops on the register was 810, and during the year 2,348 inspections were made of these premises. The number of sanitary defects found was 73, all of which were remedied. 28 Details of the above are given in tabular form. Factories and Workshops on the Register. Bakehouses 27 Factory Bakehouses 46 Dressmakers, Milliners, etc. 64 Laundries 38 Tailors 61 Dentists 40 Bootmakers and Repairers 91 Builders 45 Motor Manufacturers and Repairers 87 Jewellers and Watch Repairers 37 Upholsterers and Cabinet Makers . . 46 Miscellaneous 228 Total 810 Outworkers. No. of Lists received from Employers 77 Addresses of Outworkers received from other Councils 221 „ „ „ forwarded to other Councils 120 No. of visits made to Outworkers 452 Inspection of Factories, Workshops and Workplaces. Number of Premises. Inspections. Written Notices. Prosecution. (1) (2) (3) (4) Factories 690 24 — (including Factory Laundries) Workshops (including Workshop Laundries) 1,543 32 — Workplaces (other than Outworkers' premises) 115 — — Total 2,348 56 — 29 Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :—* Want of cleanliness 5 5 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 32 32 — — Sanitary accommodation insufficient 1 1 — — unsuitable or defective 33 33 — — not separate for sexes 1 1 — — Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) — — — — Total 73 73 — — *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Rag Flock Acts, 1911 and 1918. There are no manufacturers of or wholesale dealers in rag flock in the Borough, and no action under the Acts has been necessary during the year. Offensive Trades. No offensive trades are established in the Borough. 30 Rats and Mice (Destruction) Act, 1919. During the year 238 investigations were made into complaints of alleged rat infestation. In 132 instances, defective drains were found to be responsible, and in 101 instances the contributory cause was found elsewhere. The complaint was unfounded in 21 cases. Smoke Abatement. During the year 166 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 three instances. The institution of legal proceedings was not necessary in any case. Legal Proceedings. Details of proceedings instituted under the Public Health and kindred statutes are stated in the following table: — Premises. Offence. Result. 47, West Hill, S.E.6 Occupying premises without water supply. Closing Order made. Do. do. Acting contrary to closing Order. Penalty of 40/- 31 HOUSING. The following summary of housing statistics is included in this report on the instructions of the Ministry of Health:— Inspection of Dwelling Houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,875 (b) Number of Inspections made for the purpose 3,787 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 554 (b) Number of Inspections made for the purpose 1,775 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those ferred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,002 Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers . 743 Action under Statutory Powers during the Year:— (A) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,056 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- 32 (a) By owners 892 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 19 and 21 of the Housing Act, 1930: — (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling - houses demolished in pursuance of Demolition Orders Nil (D) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (E) Proceedings under Section 3 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declaration by owners of intention to close Nil (F) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925: — (1) Number of dwelling-houses in respect of which Closing Orders were made Nil (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit Nil (3) Number of dwelling-houses in respect of which Demolition Orders were made Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 33 Municipal Housing Schemes. The activities of the Council under the various Housing enactments since the War may be summarised as follows:— Acts under which accommodation provided. Scheme. Accommodation provided. Housing, Town Planning, etc., Act, 1919. Converted properties. 119 Flats. Housing, Town Planning, etc., Act, 1919. Lewisham Park Estate. 86 houses, 30 "A" type, 48 "B" type, and 8 "B4" type. The Housing (Financial Provisions) Act, 1924, and Housing Act, 1925. Grove Park Estate. 472 houses, 386 "A" type, 136 "B" type, and 32 flats. Do. Kent House Buildings, Winchfield Road, Sydenham. 5 blocks containing 12 flats each—60 flats. Total 558 houses, 211 flats. 769 Slum Clearance, The Public Health Committee considered a Circular Letter from the Ministry of Health, stating that His Majesty's Government have given very careful consideration to a matter that deeply and urgently concerns social welfare, viz., the clearance of slums and the improvement of bad housing conditions. It was suggested that the Metropolitan Borough Councils should confer with, and submit their proposals to, the London County Council, whose duty it would be to co-ordinate such proposals and transit them to the Minister, as part of a general programme which they will themselves prepare for the County of London. Certain properties of the old cottage type, occurring in small groups of badly arranged houses, and so placed in many cases that re-housing on the sites is impracticable, were specially considered by 34 the sub-committee of the Public Health Committee. The subcommittee were in agreement with the views of the Council's Sanitary Inspectors that certain properties should be dealt with by clearance areas. It is not possible at the present time to determine a time-table for the initiation, progress, and completion of action in relation to these areas. This will be settled after consultation and collaboration with the London County Council. The Ministry of Health, in the circular under consideration, suggest that all areas requiring clearance should be dealt with not later than 1938, although they point out that the area and population of the County of London are large in comparison with those in any other urban aggregation, and the effort required by the Metropolitan Borough Councils and the London County Council will be greater, and the time needed to remedy the present deficiencies will be larger in proportion. 35 INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Dairies and Milkshops.—The number of premises registered under the provisions of the Milk and Dairies Order, 1926, is 134, and 328 inspections of these premises were made during the year. In addition, 104 retailers were registered for the sale of milk in bottles or cartons, it being a condition that the milk is not to be sold otherwise than in the closed and unopened receptacles in which it was delivered to the premises. Cowhouses.—There is now only one licensed cowhouse in the Borough. Milk (Special Designations) Order, 1923.—Licences for the production or sale of milk under the designations provided by the above-named Order were issued for the year 1933, as follows:— Premises licensed to Pasteurise 2 Retail premises licensed to sell Certified Milk 8 ,, ,, ,, ,, Grade A (Tuberculin Tested) Milk 9 ,, Grade A Milk 3 ,, ,, ,, Pasteurised Milk 14 Supplementary Licences to sell Pasteurised Milk 1 Bacteriological Examination of Milk.—Forty- one samples of milk were submitted to bacteriological examination: — Of this number, seven were taken from retailers in the Borough in the ordinary course of delivery to householders. Four of the samples were found to contain the coliform bacillus. Eleven samples were taken on delivery at the London County Council Institutions situated in the Borough, viz., Grove Park Hospital, Park Hospital, Ladywell Institution and Lewisham Hospital. Three of these samples contained the coliform bacillus. Twenty-three samples of milk sold under the designations, "Certified" and "Grade 'A' (Tuberculin Tested)," were taken from specified retailers at the request of the Ministry of Health, the authority which is responsible for the issue of licences to producers of milk. All these samples were found to comply with the standard laid down in the Milk (Special Designations) Order, 1923. 36 Meat and other Foods. The Public Health (Meat) Regulations, 1924.—These Regulations require that notice of intention to slaughter must be given to the Council. During the year the Sanitary Inspectors made 799 attendances for the purpose of inspecting the carcases of animals slaughtered, which numbered 7,528. Slaughterhouses.—Under the provisions of the London County Council (Transfer of Powers) Order, 1933, the Council is now responsible for the licensing of slaughterhouses, and the following premises have been licensed:— Premises. Licensee. 291, High Street, Lewisham H. Calton (J. Balsdon & Co.) 324, High Road, Lee R. C. Hammett, Ltd. 434, High Road, Lee J. T. Dennis Havelock Street Mews, Forest Hill Chalk & Cox, Ltd. 12, Montpelier Vale B. W. Parsons, Ltd. 13, Rushey Green Chalk & Cox, Ltd. Weardale Road, Lee H. W. Hemmings Unsound Food.—The following quantities of meat, fish, etc., were surrendered as unfit for food, and destroyed:— Liver, 990 lbs. ; Pigs' Heads, 108 lbs. ; Ox Heads, 48 lbs. ; Pork, 83 stones ; Sheep, 10½ stones ; Fish, 140 lbs. ; Stale Confectionery, 85 lbs. Registration of Food Premises—Section 5 of the London County Council (General Powers) Act, 1932, requires the registration with the Local Authority of all premises used for the preparation or manufacture of sausages, or for the potting, pressing, pickling, or preserving of meat, fish, or other food intended for sale, and for the manufacture or sale of ice-cream. At the end of the year 289 premises were on the register, including 151 ice-cream premises. Bakehouses—There are 73 bakehouses on the Register, and 193 inspections of these were made during the year. 37 Restaurants and Eating-houses—There are 118 establishments of this description on the Register, and during the year 290 inspections were made. Food Shops and Stalls.—Inspections of these premises during the year numbered 1,032. Fried-fish Premises.—There are 55 fried-fish premises, and inspections during the year numbered 194. Agricultural Produce (Grading and Marking) Acts.—The Ministry of Agriculture and Fisheries issued a booklet with reference to the Agricultural Produce (Grading and Marking) Acts, 1928 and 1931, showing the progress and present position of the National Mark Movement. The main object of these Acts is to encourage the standardisation of agricultural produce by enabling the Ministry to prescribe grade designations and grade designation marks, the use of which involves a civil liability on the seller if the article does not accord with the statutory definition indicated by the designation. The following articles have up to the present time been included in the National Mark Scheme, grade designations having been prescribed by the Ministry in respect of such articles:— Tomatoes and Cucumbers Cauliflower and Broccoli Poultry Strawberries Cabbage Lettuce Beef Cherries Cider Flour Plums Eggs Malt products Canned and Bottled Fruits and Vegetables and Honey. The Ministry intimate that a still wider range of home products will in time be brought under the National Mark Scheme until this movement covers most agricultural commodities of commercial significance. Grading schemes are also under consideration for mutton and lamb, butter, cheese, jam and grapes. 38 Food and Drugs (Adulteration) Act, 1928. During the year under review 838 samples of food, drugs, etc., were obtained by the Council's Inspectors and submitted to the Public Analyst for examination. Of this number 310 were purchased formally in accordance with the provisions of the above-named Act and the remaining 528 were obtained informally as " test " samples. Fifteen, or 4 8 per cent of the formal samples were certified as adulterated or below standard by the Public Analyst, compared with 3.6 per cent in 1931. The following table gives details of the samples analysed:— 39 The following table gives details of the samples analysed:— Article. No. of Samples Examined. No. of Samples Adulterated, etc. Formal Informal Total Formal Informal Total Baking Powder — 1 1 — — — Borax & Glycerine 3 8 11 2 3 5 „ & Honey 1 2 3 — 1 1 Brandy 13 — 13 — — — Butter — 34 34 — — — Camphorated Oil — 6 6 — — — Cocoa — 17 17 — — — Cod Liver Oil — 1 1 — — — Coffee — 17 17 — — — Cornflour — 7 7 — — — Cream — 12 12 — — — Cream of Tartar — 1 1 — — — Fish, Canned — 7 7 — 2 2 „ potted — 1 1 — — — Flour, Self-raising — 27 27 — — — Friar's Balsam 3 3 — — — Fruit, Canned — 3 3 — — — „ Crystalised 20 20 — — — „ Dried 1 57 58 1 1 2 Gin 27 — 27 — — — Ginger, Ground — 3 3 — — — Honey — 12 12 — — — Jam & Marmalade — 15 15 — — — Lard — 18 18 — — — Linseed, Crushed — 4 4 — — — Margarine — 22 22 — — — Meat 2 39 41 — — — Milk 210 1 211 9 — 9 Milk, Condensed — 3 3 — — — Mincemeat — 15 15 1 3 4 Mustard — 2 2 — — — Ointment, Boric — 5 5 — — — „ Carbolic — 1 1 — — — „ Zinc — 4 4 — — — Olive Oil — 2 2 — — — Paregoric — 6 6 — — — Pepper — 3 3 — — — Powder, Custard — 4 4 — — — Gregory — 3 3 — — — Rice — 4 4 — — — Rum 8 — 8 — — — Sal Volatile — 2 2 — — — Sausages 1 62 63 1 2 3 Spices — 9 9 — — — Sugar — 26 26 — — — Sweet Spirit of Nitre 1 5 6 1 1 2 40 Table of samples analysed—continued. Article. No. of Samples. Examined. No. of Samples Adulterated, etc. Formal Informal Formal Total Informal Total Tapioca — 10 10 — — — Tea — 9 9 — — — Tincture of Iodine — 6 6 — 1 1 Treacle and Syrup — 1 1 — — — Vaseline — 1 1 — — — Vegetables, Preserved — 3 3 — — — Vinegar 3 3 6 — — — Water, Distilled — 1 1 — — — Whisky 40 — 40 — — — Totals 310 528 838 15 14 29 41 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 or Irregularity. Administrative Action Taken. 768 Glycerine and Borax Informal Borax 16.5% deficient. Formal Sample 773. 769 Honey and Borax Informal Borax 100% deficient. Formal Sample genuine. 773 Glycerine and Borax Formal Borax 12.5% deficient. No Action. 811 Milk ,, Extraneous water 11.2% Dismissed, with £2 2s. 0d., costs. 842 Milk ,, Ditto. 10.2% 843 Milk ,, Ditto. 12% 845 Herring and Tomato Informal Tin 4.41 grains per lb. Vendor Cautioned. 852 Whisky Formal Proof Spirit 1 degree deficient. Vendor Cautioned. 22 Herring and Tomato Informal Tin 3.7 grains per lb. Vendor Cautioned. 82 Glycerine and Borax Informal Borax deficient 50.5% Formal Sample 107. 107 Glycerine and Borax Formal Borax deficient 14.6% Summons Withdrawn. 217 Milk Formal Extraneous water 7.7% Fined £5 and £3 3s. costs. 225 Minced Meat Informal Sulphur Dioxide 66 parts per million Formal Sample 240. 240 Minced Meat Formal Sulphur Dioxide 67 parts per million. Dismissed. £2 2s. costs. 243 Minced Meat Informal Sulphur Dioxide 55 parts per million Subsequent formal sample genuine. 277 Milk Formal Fat 13% deficient Dismissed, £3 3s. costs. 310 Pork Sausages Informal Sulphur Dioxide 150 parts per million Declaration of Preservation Exhibited 323 Beef Sausages Informal Sulphur Dioxide 240 parts per million Formal Sample 380. 380 Beef Sausages Formal Sulphur Dioxide 161 parts per million Vendor Cautioned. 396 Minced Meat Informal Sulphur Dioxide 65 parts per million. Subsequent formal sample genuine. 422 Milk Formal Extraneous water 2% Dismissed £2 2s. costs. 423 Milk Formal Extraneous water 2.1% Dismissed £2 costs. 476 Tincture of Iodine Informal 14.5 excess Iodine. Vendor Cautioned. 42 Serial No. Article. Formal or Informal Nature of Adulteration or Irregularity. Administrative Action Taken. 479 Sweet Spirit of Nitre Informal Ethyl Nitre deficient 89.6% Formal Sample 533. 482 Glycerine of Borax Informal Borax deficient 12.7% Subsequent formal sample genuine. 533 Sweet Spirit of Nitre Formal Ethyl Nitre 77.6% deficient. Vendor Cautioned. 548 Milk Formal Extraneous water 4.1% Summons Dismissed. 640 Raisins Informal Sulphur Dioxide excess 430 parts per million. Formal Sample 652. 649 Milk Formal Fat 49% deficient. Fined £10, and £3 costs. 652 Raisins Formal Sulphur Dioxide 650 parts per million Summons withdrawn. 43 Milk.—Two hundred and ten samples of milk were examined by the Public Analyst, and 9 of these, or 4.2 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. Standard. Percentage of Milk Fat. Percentage of Solids, not Fat. Percentage of Water. Percentage of Milk Fat. Percentage of Solids, not Fat. First Quarter 3.63 8.78 87.59 13.0 8.5 Second „ 3.51 8.84 87.65 Third „ 3.56 8.71 87.73 Fourth „ 3.9 8.8 87.3 Average for the Year 3.65 8.78 87.57 44 INFECTIOUS DISEASES. The following diseases are compulsorily notifiable in the Borough:— Acute Encephalitis Lethargica Acute Influenzal Pneumonia Acute Primary Pneumonia Acute Polio-Encephalitis Acute Polio-Myelitis Anthrax Cerebro-Spinal Meningitis Cholera Continued Fever Diphtheria Dysentery Erysipelas Enteric (or Typhoid) Fever Hydrophobia Glanders Malaria Membranous Croup Ophthalmia Neonatorum Plague Puerperal Fever Puerperal Pyrexia Relapsing Fever Scarlet Fever Smallpox Tuberculosis Typhus Fever Notifications. There was an increase in the incidence of infectious disease, and, excluding tuberculosis, which is dealt with separately in another part of this Report, 1,975 cases were notified, compared with 1,205 in 1932. in 1932. The figures for the last three years are given in detail in the following table:— Disease. 1931 Year. 1932 1933 Smallpox 7 2 21 Scarlet Fever 670 513 1,129 Diphtheria 376 228 354 Paratyphoid Fever 6 2 9 Typhoid Fever 6 — 2 Puerperal Fever 22 10 8 Puerperal Pyrexia 30 28 32 Erysipelas 66 99 106 Acute Primary and Influenzal Pneumonia 240 293 281 Ophthalmia Neonatorum 14 11 13 Encephalitis Lethargica 2 4 — Cerebro-spinal Meningitis 4 12 13 Polio-Myelitis 1 3 6 Anthrax — — 1 Totals 1,443 1,205 1,975 45 Table showing Cases of Infectious Disease Notified,1933. Disease. Number of Cases Notified. At Ages—Years. Total at all Ages Number removed to Hospital Under 1 year 1 and under 2 years 2 and under 3 years 3 and under 4 years 4 and under 5 years 5 and under 10 years 10 and under 15 years 15 and under 20 years 20 and under 35 years 35 and under 45 years 45 and under 65 years 65 and over Smallpox — 1 — — — 9 7 — 1 2 1 — 21 21 Scarlet Fever 3 17 50 77 101 491 229 54 75 23 9 — 1129 1031 Diphtheria 3 7 25 20 24 103 52 17 31 9 2 1 354 347 Typhoid Fever — — — — — — — 1 1 — — — 2 2 Paratyphoid Fever — — — — — 1 1 1 5 1 — — 9 7 Puerperal Fever — — — — — — — — 5 3 — — 8 7 Puerperal Pyrexia — — — — — — — 3 26 3 — — 32 29 Erysipelas 2 1 1 — — 3 3 2 13 21 48 12 106 47 Acute Primary & Influenzal Pneumonia 4 3 8 11 9 32 12 17 48 45 66 26 281 158 Ophthalmia Neonatorum 13 — — — — — — — — — — — 13 3 Cerebro-Spinal Meningitis 1 1 1 — — 3 3 1 3 — — — 13 11 Acute Anterior Polio-Myelitis — — — 1 — 2 2 — 1 — — — 6 5 Anthrax — — — — — — — — — 1 — — 1 1 Totals 26 30 85 109 134 704 309 96 209 108 126 39 1975 1669 46 Table showing Number of Deaths from Infectious Diseases in 1933. Diseases. Age Groups. 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 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 years and upwards Typhoid and Paratyphoid Fevers — — — — — — 1 1 — — — 2 Measles — — — 1 — — — — — — — 1 Scarlet Fever — 1 — 1 1 — — 1 1 — — 5 Whooping Cough 3 2 3 — — — — — — — — 8 Diphtheria — 1 8 10 — 1 — — — — — 20 Influenza 1 2 — — 2 4 8 13 19 15 29 93 Encephalitis Lethargica — — — — — — — — — 1 1 2 Cerebro-Spinal Fever — — — 1 — 1 — — — — — 2 Puerperal Fever — — — — — 1 2 — — — — 3 47 Scarlet Fever.—The incidence of this disease was unusually high, 1,129 cases being notified during the year, compared with 513 in the preceding year. Five of the cases proved fatal. Diphtheria.—This disease also showed an increase over the preceding year, 354 cases being notified, as against 228 in 1932. There were 20 deaths from this disease. Small-pox.—Twenty-one cases of small-pox were notified. With one exception, all the cases were located in a particular area in the southern part of the Borough. The exception was an elderly woman living in another part of the Borough, and, although she developed the disease during the occurrence of the main outbreak, no association between her and the other patients could be traced. Ten families were involved in the outbreak, which resulted in twenty cases. Sixteen of the patients were school children, one was an infant 11 years of age, and three were women who contracted the disease from their children. None of the patients had been vaccinated. The outbreak was mild in character, and the source of the infection was not traced. Typhoid Fever.—Two cases of this disease were notified. In neither case was the source of the infection traced. Paratyphoid Fever.—Nine cases were notified during the year. The diagnosis in two of the cases was not confirmed at the Hospital. The cases occurred in different parts of the Borough, and in no instance was the source of infection traced. There were two deaths. Anthrax.—A case anthrax was notified from Lewisham Hospital. The patient was employed by the Port of London Authority, and had recently been handling bales of dry cow hides imported from Indo-China. The characteristic lesions were situated on the face, The patient responded to treatment, and made a good recovery. 48 Ophthalmia Neonatorum. During the year thirteen cases of this disease were notified. Particulars of the cases are set out in the form specified by the Ministry of Health:— Cases. Results. Notified. Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Home. Hospital 13 10 3 12 1 — Diphtheria Anti-toxin. For the convenience of medical practitioners, anti-toxin serum is kept in the Public Health Department, and supplied at cost price, or, in necessitous cases, free. During the year 52 phials of 8,000 units each (for treatment) and 14 prophylactic doses of 500 units each, were issued. Vaccination. The following is an abstract of the Return submitted to the Registrar General by the Vaccination Officer, respecting the vaccination of children whose births were registered from 1st January to 31st December, 1932:— Number of Births registered from 1st January to 31st December, 1932 2,743 Number of these Births duly entered by 31st January, 1933, in the Vaccination Register:— Successfully Vaccinated 1,257 Insusceptible to Vaccination 15 Number in respect of whom Statutory Declarations of Conscientious Objection have been received 1,040 Died unvaccinated 110 49 Number of these Births which on 31st January, 1934, remained unentered in Vaccination Register on account of:— Postponement by Medical Certificate 44 Removal to districts, the Vaccination Officers of which have been duly appraised 52 Removal to places unknown 83 Number of these Births remaining on 31st January, 1934, neither duly entered in Vaccination Register nor temporarily accounted for 142 Total number of Certificates and copies of Certificates of successful Primary Vaccination of Children under 14 received during the calendar year, 1933 1,406 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer, irrespective of the dates of birth of the children to which they relate, during the calendar year, 1933 1,114 Vaccination by Medical Officer of Health. No vaccination was performed by this officer under the Public Health (Smallpox Prevention) Regulations, 1917. 50 Tuberculosis. The following table shows the number of new cases notified, and the mortality from tuberculosis, during the year:— Age Periods. Years. New Cases. Deaths. Pulmonary. Non-Pulmonary Pulmonary Non-Pulmonary Males Females Males Females Males Females Males Females 0 — — — — — — — — 1 — — — 1 — — — 2 5 1 — 4 4 — 2 1 3 10 2 6 6 7 — — — — 15 10 23 4 6 10 18 3 3 20 21 21 2 6 — — — — 25 36 45 1 2 12 13 — — 35 26 23 1 5 18 10 1 1 45 31 8 2 5 23 5 — — 55 12 4 1 1 10 5 — 2 65 and upwards 3 4 1 1 4 3 1 1 Totals 142 134 22 38 86 56 6 12 Efficiency of Notification.—The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was one in seven. It was not necessary to take any action in regard to the nonnotification 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. 51 Returns rendered under the Public Health (Tuberculosis) Regulations, 1930. First Quarter, 1933. Respiratory System Other Forms M F M F Number of Cases on Register at commencement of Quarter 579 471 140 187 „ „ Notified during Quarter.. 50 37 7 7 „ „ Removed from the Register 32 31 5 8 „ „ Remaining on Register 597 477 142 186 Second Quarter, 1933 Number of Cases on Register at commencement of Quarter 597 477 142 186 „ „ Notified during Quarter 28 32 5 11 „ „ Removed from the Register 27 13 3 7 „ „ Remaining on Register 598 496 144 190 Third Quarter, 1933 Number of Cases on Register at commencement of Quarter 598 496 144 190 „ „ Notified during Quarter 28 35 8 12 „ „ Removed from the Register 20 16 6 12 „ „ Remaining on Register 606 515 146 190 Fourth Quarter, 1933 Number of Cases on Register at commencement of Quarter 606 515 146 190 „ „ Notified during Quarter 36 31 2 8 „ „ Removed from the Register 58 46 6 11 „ „ Remaining on Register 584 500 142 187 52 Report of the Tuberculosis Officer for 1933. The primary notifications of tuberculosis for 1933 numbered 396, of which 333 were of pulmonary tuberculosis and 63 of other forms of tuberculosis. During the year 142 persons died from pulmonary tuberculosis and 18 died from other forms of tuberculosis. The death-rate from pulmonary tuberculosis was 0.68 per 1,000 inhabitants, which is slightly higher than that for the previous year. Cases on Register. The number of cases on the Town Hall register on December 31st, 1933, was 1,413, comprising 1,084 cases of pulmonary tuberculosis, and 329 cases of non-pulmonary tuberculosis. The number of cases on the Dispensary register was 965, of which 787 were of pulmonary tuberculosis and 178 of non-pulmonary tuberculosis. Thus 68 per cent of all tuberculosis cases in the Borough have attended the Dispensary. All notified cases of tuberculosis are visited at home by the Dispensary staff, whether or not they attend the Dispensary. Attendances of Patients. During 1933 the new cases attending the Dispensary numbered 572 and the total attendances were 2,675. Of the new cases 193 were referred to the Dispensary by their medical advisers, 146 applied on their own initiative, and 172 of the patients seen were contacts of tuberculous cases. A summary of first attendances is shown in Table D. Table A shows the condition at the end of the year 1933 of all patients diagnosed as suffering from pulmonary tuberculosis who have attended the Dispensary since its foundation in June, 1916. All these cases are followed up year by year and the only ones lost sight of are those which are transferred to other districts. Home Visiting.—Table B shows the work carried out by the two Health Visitors, who paid 2,523 visits during the year and gave help and advice when required. When the homes are found unsuitable for tuberculous patients, an effort is made to find them more hygienic accommodation and some families have been granted houses on the London County Council's and the Borough Council's Estates, 53 The Tuberculosis Officer paid 343 visits to the homes of patients and saw 26 patients in their homes in consultation with their medical attendants. Reports.—Written reports to the number of 854 were sent out from the Dispensary. Residential Treatment.—The London County Council admitted 154 insured and 68 uninsured patients to residential institutions. The Lewisham Hospital admitted 41 patients referred by the Dispensary, these being seriously ill cases in urgent need of treatment and having unsuitable home conditions. In July, 1933, the Tuberculosis Officer was officially appointed Consultant in tuberculosis to the Lewisham Hospital and since July 12th the Hospital has been visited 22 times, every patient in the two wards for male and female patients suffering from pulmonary tuberculosis being seen each week. These visits have proved very helpful and it has been made possible to keep in constant touch with the patients. Affiliated and other Hospitals.—The Dispensary is affiliated to King's College Hospital and the Miller General Hospital and patients are sent to the Out-patient departments of these Hospitals for special diagnostic purposes, chiefly surgical, laryngeal and radiological. Treatment by artificial pneumothorax is induced in suitable cases while patients are undergoing institutional treatment and, on discharge, they attend as out-patients at various hospitals for their refills. During the year 32 patients made 506 attendances at a cost to the Borough Council of £265 13s. Od. Surgery of the thorax is being undertaken to an ever-increasing degree, but has of necessity to be carried out while the patient is in an institution and the cost of this treatment does not fall upon the Borough Council. The London Hospital receives out-patients for Finsen light treatment for tuberculous skin affections and during the year 2 patients made 94 attendances at a cost of £23 10s. Od. Sputum Tests.—The sputum of 224 patients was examined and reported upon by the Pathological Department of St. John's Hospital 54 Dental Treatment.—During the year 19 patients attended St. John's Hospital for dental treatment and 10 cases were assisted in the provision of dentures. Extra Diet.—The Borough Council granted an allowance of milk and butter to 6 patients to enable them to maintain their working capacity after Sanatorium treatment. Shelters.—The 6 shelters loaned by the Borough Council to tuberculous patients having limited sleeping accommodation were in constant demand and were greatly appreciated. Conjugal Pulmonary Tuberculosis.—It is a well-known fact that the children of tuberculous parents are very frequently affected by the disease and that it only too often proves fatal, more than one child of a family succumbing to the infection. But it has often been denied that adults infect one another in the same way. On surveying the Dispensary records of past years, 40 definite cases have been found, in which the infection has passed from husband to wife, or vice versa. In 25 of these instances both husband and wife have died from tuberculosis; in 3 cases both are still alive; in 6 the husband only is alive, and in 6 the wife only survives. The Health Visitors, in their daily rounds seek to amend the sleeping arrangements in order to eliminate this danger. Care Committee.—The Secretary of the Care Committee reports that the Committee met 26 times during the year. The number of cases considered for assessment for residential treatment numbered 329, of whom 228 were sent as free cases, 83 were asked to pay sums varying from 2/6 to 50/- per week, 9 were ex-service men and were referred for payment to the Pensions Committee, and 9 cases were cancelled for various reasons. Since April 1st, 1933, the Care Committee has been required to consider for assessment the patients admitted to the London County Council General Hospitals—a duty which would otherwise fall upon the Public Assistance Committee. The total amount collected and forwarded to the London County Council was £555 19s. 3d. Many patients are in need of clothing and a store is kept by the Care 55 Committee (to which contributions of clothing are solicited) ; it was possible to help 131 patients in this way. Financial help was given from the voluntary fund and by grants obtained from other sources to the amount of £245 10s. Od. The Care Committee has no official fund at its disposal to meet its many needs. The money was obtained from various sources, e.g., a donation from Queen Alexandra Rose-Day Fund, a monthly grant from the Gaumont Palace Cinema, proceeds of a whist-drive, from side-shows at a Handicrafts Exhibition arranged in conjunction with the Deptford, Camberwell and Lambeth Tuberculosis Care Committees. The balance of the voluntary fund at the end of 1933 amounted to £146 18s. 9d. The help given was: (1) Maintenance grants for dependents and boarding out of children chiefly received from exservice funds and the Charity Organisation Society, when not dependent on Public Assistance relief; (2) pocket money to destitute patients in institutions; (3) purchase of clothing not available from gifts of clothing received; (4) payment of fares, chiefly for relatives to visit patients at distant Sanatoria; (5) surgical appliances, beds and bedding; (6) grants of extra nourishment for advanced cases when not obtainable from other cources; (7) payment of National Health Insurance arrears, generally as loans. Handicrafts Class.—The Handicraft Class is now in its eighth year and has not lost in popularity. It is possible to accommodate 24 patients at a time, using both the waiting-room and the hut erected in the grounds. During 1933, 16 men and 19 women have received instruction and many of their goods have been disposed of, either privately or at exhibitions. The grant of £10 from the Borough Council covers practically all expenses connected with the class. Tables A—F give in statistical form a summary of the work carried out at the Dispensary. Appended is a copy of the Table required annually by the Ministry of Health. 56 TABLE A. Condition on 31st December, 1933. of all cases of Pulmonary Tuberculosis who have attended the Dispensary since its foundation. Year 1916 (6 mths.) 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Totals No. of Cases 74 157 200 185 200 159 165 181 166 165 204 195 249 200 228 219 191 182 3320 Dead 49 72 90 66 93 80 83 87 85 82 90 88 98 91 84 64 41 17 1360 Left 14 52 59 62 52 39 51 55 41 40 53 54 73 41 55 46 24 8 819 Well — 2 1 6 2 3 9 8 7 10 24 22 49 41 51 66 58 45 404 Fair 1 2 — 3 4 7 1 6 9 12 8 13 16 22 34 34 54 90 316 Unwell 1 2 — 1 — — 1 1 — 1 — 2 3 2 1 8 13 22 58 Discharged as arrested or diagnosis not confirmed 9 27 50 47 49 30 20 24 24 20 29 16 10 3 3 1 1 — 363 Totals 74 157 200 185 200 159 165 181 166 165 204 195 249 200 228 219 191 182 3320 57 Table B. Summary of Tuberculosis Health Visitors' Work, 1933. ex-Service Patients. Civilian Patients. Total. Visits to Pulmonary Tuberculous Patients 42 215 257 ,, Non-pulmonary „ „ 1 59 60 Subsequent Visits 298 1691 1989 Visits to Un-notified Patients 13 204 217 No of patients occupying Separate Room 16 140 156 „sharing with 1 other 23 107 130 „ „ „ 2 others 4 24 28 „ „ „ 3 — 2 2 „ „ „ 4 — 1 1 No. of Patients occupying Separate Bed 16 157 173 „ „ sharing with 1 other 27 116 143 „ „ „ 2 others — 1 1 Table C. Attendances of Patients at the Dispensary. 1933 First Attendances. Subsequent Attendances. Totals. January 50 185 235 February 56 190 246 March 59 208 267 April 35 132 167 May 48 195 243 June 38 160 198 July 50 197 247 August 43 149 192 September 42 181 223 October 56 204 260 November 52 179 231 December 43 123 166 572 2,103 2,675 58 Table D. Summary of First Attendances at the Dispensary, 1)33. Applied on own initiative Sent by Doctor. Transferred from Hospitals, etc. Sent by L.C.C. Contacts Totals. Pulmonary 48 86 42 1 5 182 Non-Pulmonary 24 3 9 2 — 38 Non-Tuberculous 74 104 5 2 165 350 Suspects — — — — 2 2 Total 146 193 56 5 172 572 Table E. Stages in Pulmonary Tuberculosis. Male. Female. Children under 15. Total. Stage I. 22 21 4 47 „ II 52 51 — 103 „ III 13 18 1 32 87 90 5 182 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 1 2 7 10 Bone 6 7 9 22 Other Regions 2 3 1 6 9 12 17 38 59 Return showing the work of the Dispensary during 1933. (Tables A and B of Memorandum 37/7 (Revised) of the Ministry of Health). Diagnosis. Pulmonary. Non-Pulmonary Total. Grand Total Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 74 63 2 1 9 9 4 8 83 72 6 9 170 (b) Diagnosis not completed — — — — — — — — 6 10 2 4 22 (c) Non-tuberculous — — — — — — — — 39 78 28 24 169 B.—Contacts examined during the year:— (a) Definitely tuberculous 3 1 1 — — — — — 3 1 1 5 (b) Diagnosis not completed — — — — — — — — 1 3 — 1 5 (c) Non-tuberculous — — — — — — — — 20 44 47 51 162 C.—Cases written off the Dispensary Register as:— (a) Recovered 11 17 — 5 1 6 6 9 12 23 6 14 55 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 64 136 77 77 354 D.—Number of Cases on Dispensary Register on 31st December:— (a) Definitely tuberculous 414 341 13 19 36 54 40 48 450 395 53 67 965 (b) Diagnosis not completed — — — — — — — — 1 1 — — 2 1. Number of cases on Dispensary Register on 1st January 984 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 39 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 82 4. Cases written off during the year as Dead (all causes) 98 6. Number of attendances at the Dispensary (including Contacts) 2675 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 148 7. Number of consultations with medical practitioners:— (a) Personal 26 (b) Other 299 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 369 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2070 10. Number of:— (a) Specimens of sputum, etc., examined 224 (b) X-ray examinations made in connection with Dispensary work 11 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A(b) above 2 12. Number of "T.B. plus" cases on Dispensary Register on 31st December 483 13. Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 1 Provided by Voluntary Bodies — 60 APPENDIX. MINISTRY OF HEALTH SURVEY. Early in the year a survey of the Public Health Services of the Borough was carried out by Sir Weldon Dalrymple-Champneys and Dr. I. D. Cameron at the request of the Minister of Health. In October, the following letter was received by the Council from the Minister of Health in connection with the survey, containing criticisms and suggestions in relation to particular services. The letter is as follows : -— Ministry of Health, Whitehall, S.W.I. 19 th October, 1933. Sir, I am directed by the Minister of Health to state that he has had under consideration the report made by Medical Officers of the Department after their recent survey of the public health services of the Borough. So far as can be judged from a general survey, it appears that the Council are maintaining a reasonable standard of efficiency in the discharge of their functions relating to public health, but the Council will readily appreciate that there remain, in relation to particular services, opportunities for improvement in a number of respects. Maternity and Child Welfare. (а) There is a need for more frequent visits to the homes of children between the ages of 1 and 5 and for additional infant welfare sessions. The time of the existing officers appears to be already fully occupied, and some increase in the staff of heath visitors would appear to be required for this expansion of service as and when circumstances permit. (b) At the same time the Council will appreciate that the conditions of service for the staff of health visitors employed on this work are an important factor in its success. The Minister is glad to learn from the report of the attention and interest devoted to Maternity and Child Welfare work both by the Borough Council's staff and by the voluntary workers concerned with the service, and it appears to him that having regard to the salaries paid generally in London to health visitors, the question of making some revision of the salaries paid to their health visitors at the present time merits consideration by the Council. (c) The Minister notes the record of work done at the municipal Maternity Home. He regards it, however, as essential for the continual safe working of the Institution that an isolation room should be provided and he trusts that early consideration will be be given to this matter. 61 (d) The Minister recognises the extent and value of the work undertaken by the Committee of the Sydenham centre but he is advised that the ward at present in use for the older children in residence is not entirely suitable or well placed, and he suggests that the Committee of the centre should be asked to consider whether alternative accommodation could be arranged. Tuberculosis. (a) The number of visits paid by the Tuberculosis Visitors to the homes of tuberculous patients is much below the average obtaining in London, and the Minister is advised that to remedy this defect additional clerical assistance at the Dispensary is required, in order to set free a portion of the time which it is at present necessary for the Visitors to spend upon clerical duties. (b) The Minister notes the very limited use made of X-ray examinations in the tuberculosis work of the Council, and he suggests that it should be considered whether this aid to diagnosis might not with advantage be more freely employed. Public Cleansing. (a) The Minister, whilst recognising the good work done by the Council's Surveyor in the matter of Public Cleansing, is of the opinion that the entrusting of this work to a special Cleansing Officer would tend to the greater efficiency of the Council's cleansing services and leave the Surveyor free to devote himself to other duties more properly belonging to his sphere of work. (b) The Council should also consider the extension, as opportunity arises, of the system of bi-weekly collection of house refuse in those parts of the Borough which appear specially to require such provision. (c) The Minister is advised that the conditions at the Council's shoot for road-sweepings at Southend Lane, Lower Sydenham, are not altogether satisfactory and the Council should instruct their officers to pay special attention to this matter. The Minister will be glad in due course to learn the result of the Council's consideration of the observations made above. In conclusion, I am to express the Minister's appreciation of the assistance afforded to his officers in the course of the survey. I am, Sir, Your obedient Servant, (Sgd.) DUDLEY WARD. These observations have had the careful consideration of this Council, and by their directions, the Minister of Health has been informed of the results, as follows:— 62 Maternity and Child Welfare. (a) In order to provide for more frequent visits to the homes of children between the ages of one and five, the Borough has been divided into eight units instead of seven as at present, and the Council have decided to appoint an additonal Health Visitor. The question of additional infant welfare sessions has been considered, but the Council have not come to any definite decision on this point at the moment, and the consideration of the subject has been deferred. (b) Following consideration of a return relating to the salaries paid to the Health Visitors in each of the Metropolitan Boroughs, the Council have raised the Scale hitherto in operation in this Borough. (c) The question of the provision of an isolation room at the Council's Maternity Home has had consideration, and the Council have decided to make this provision, and particulars of this proposal are being submitted to the Ministry under a separate communication. (d) The Committee of the Sydenham Infant Welfare Centre are proposing to effect a re-arrangement of the existing accommodation, and it is understood that plans of the proposed alterations have been submitted to and approved by the Ministry. Tuberculosis. (a) This Council concur with the views of the Ministry that more visits should be paid to tuberculous patients, but they do not agree that the provision of additional clerical assistance would solve the problem, as the clerical work carried out by the Health Visitors occupies only a small proportion of their time. The only alternative, therefore, appeared to be the appointment of an additional Health Visitor, and this the Council have resolved upon. They have also decided to appoint an additional female clerk in connection with the Care Committee work of the Dispensary. (b) With regard to the observations as to the limited use made of X-ray examinations the Council have resolved that for the future a more extended use of X-ray examinations should be made in 63 nection with the work, and they are proposing to enter into an agreement with the Committee of St. John's Hospital, Lewisham, for this purpose. Public Cleansing. (a) The Council have given careful consideration to the suggestion that a public cleansing officer should be appointed with a view to securing greater efficiency in the cleansing service, but after full deliberation of all the circumstances obtaining in this Borough, have arrived at the conclusion that the appointment of such as officer is unnecessary. (b) With regard to the suggested bi-weekly collection of house refuse, whenever attention is called to the need for such bi-weekly collection, if the Council are satisfied for such need, instructions are given to the Borough Surveyor to arrange accordingly. (c) The Council's Works and Highways Committee, having considered the Minister's observations, with regard to the Council's shoot for road sweepings at Southend Lane, took the opportunity of visiting this shoot. At the time of their visit, they considered that, although it was unsightly, there were no grounds or cause for complaint upon sanitary grounds. They have, however, instructed the Borough Surveyor to keep the shoot under observation with a view to taking such steps as may render complaints under any grounds unnecessary for the future. 64 INDEX TO CONTENTS. Subject Page Ante-natal Clinics 14 Anthrax 47 Bacteriological Examinations 21 Bakehouses 36 Births 6 Clinics for Mothers and Infants 14 Coroner's Court and Mortuary 22 Deaths 8 Dental Treatment 17 Diphtheria Anti-toxin 48 Disinfection and Personal Cleansing 23 Factories and Workshops 27 Food and Drugs (Adulteration) Act 1928—Statement of work under 38 Food Premises, Registration of 36 Food Shops and Stalls 37 Fried Fish Premises 37 Health Visitors' Work 19 Home Helps 18 Home Nursing 20 Housing Schemes 33 Housing Statistics 31 Ice-Cream Premises 36 Infant Mortality 8 Infectious Diseases 44 Legal Proceedings 30 Marriages 7 Maternal Mortality 9 Maternity Home 12 Maternity Outfits 18 Meat Inspection 36 Milk Assistance Scheme 18 Milk Supply 35 Ministry of Health Survey 60 Obstetric Consultants 18 65 Subject Page Ophthalmia Neonatorum 48 Population 6 Rats and Mice (Destruction) Act 30 Refuse Removal and Disposal 24 Sanitary Inspection 25 Slaughterhouses 36 Slum Clearance 33 Smallpox 47 Smoke Abatement 30 Statistics 5 Sydenham Infant Welfare Centre 17 Tuberculosis 50 Tuberculosis Officer, Report of 52 Typhoid and Paratyphoid Fever 47 Unsound Food 36 Vaccination 48 Voluntary Infant Welfare Centres 20 Woman Sanitary Inspector 26