LEW 22 METROPOLITAN BOROUGH OF LEWISHAM. REPORT of the Medical Officer of Health For the Year 1934. John W. Miller, M.B., Ch.B., D.P.H. London: Printed by E. G. Berryman & Sons, Ltd., Blackheath Road, S.E.10. PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewis ham. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report for the year 1934 on the health and sanitary condition of the Borough, this being the thirty-fourth of the series. An examination of the statistical figures contained therein shows that the health of the Borough is satisfactory. The corrected death rate from all causes amounted to 10.1 per thousand of the population compared with 10.2 in the previous year. The Infant Mortality rate was 43 per thousand births, compared with 39 in 1933. The rate for the County of London was 67 per thousand births. The birth rate was 12.2 per thousand, the same as in 1933. The death rate from Pulmonary Tuberculosis was 0.58 per thousand compared with 0.64 in the previous year. There was an increase in the incidence of Scarlet Fever and Diphtheria, 1,277 cases of Scarlet Fever being notified, compared with 1,129 in 1933, and 473 cases of Diphtheria, as against 354 in the previous year. The increase in the prevalence of these diseases was general throughout the country. During the year certain structural alterations and additions were carried out to the Maternity Home, and plans for the erection of a new Maternity and Child Welfare Clinic and Tuberculosis Dispensary on the Priory Site were approved by the Ministry of Health. The Council also decided to arrange for an extension of the Maternity and Child Welfare services by providing an additional session at the Downham Health Centre and by establishing an Infant Welfare Centre in Brockley to relieve the congestion in the neighbouring centres, and for the benefit of residents of the new blocks of flats provided in that district by the London County Council for the housing of families evacuated from slum areas. Two additional Health Visitors, one for Maternity and Child Welfare, the other for Tuberculosis, were appointed during the year together with a junior clerk to assist in the work of the Care Committee. 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 1934. Medical Officer of Health & Administrative Tuberculosis Officer. John W. Miller, m.b., ch.b., d.p.h. Assistant Medical Officer of Health and Maternity and 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 Gynaecologists and Obstetricians. G. F. Gibberd, m.s., m.b., f.r.c.s. Arnold Walker, m.a., m.b., b.ch., f.r.c.s. J. B. Blaikley, m.b., b.s., f.r.c.s. Public Vaccinators. Lewisham District .. F. S. Barnett, m.r.c.s., l.r.f.p.s. & l.m., l.s.a. Catford District .. F. S. Hogg, l.r.c.p., l.r.c.s., l.r.f.p.s., l.s.a. Sydenham District .. W. Rhys Davies, m.b., ch.b. Forest Hill District .. R. Morley Greenop, m.r.c.s., l.r.c.p. Public Analyst. A. J. Lickorish, f.i.c. Sanitary Inspectors—Male. Berry, J. H. (a) Phillips, A. J. (a) (b) Cooper, J. A. K. (a) (b) Rayner, S. P. (a) (b) Craven, J. R. (a) (6) Thomas, A. G. (a) (b) Crowther, J. (a) (6) Walker, E. (a) (b) Holifield, C. E. (a) (b) Sanitary Inspector—Female. Mrs. N. F. Selfe (a) (retired September, 1934) Sampling Officer and Workshops Inspector. H. Tolson (a) 5 Health Visitors. Miss F. L. Burton (c) (d) (e) Miss A. M. Edwards (c) (e) Miss D. M. Charles (d) (e) Miss C. H. Thompson (a) (d) (e) Miss W. Cresswell (c) (d) (e) Miss G. Simpson (a) (d) (e) Miss W. Eve (c) (d) (e) Miss E. M. Watson (a) (d) (e) Tuberculosis Visitors. Miss I. C. Atkins (c) (d) (e) Miss N. Brocklehurst (a) (e) Mrs. M. Wardle (c) (d) Infant Life Protection Visitor. Miss A. J. Watts Clerks. F. E. Seckerson (a) (Chief Clerk) G. Ockenden C. C. Summers W. D. Back Miss B. C. Aylett W. G. Coker Other Staff. Vaccination Officer C. W. Knottley Assistant Vaccination Officer R. F.. Stephan Matron of Maternity Home Mrs. D. Fynn Clerk-Dispenser, Maternity Home and Clinics Mrs. M. lies Clerk-Dispenser, Tuberculosis Dispensary Miss M. Colquhoun Secretary, Tuberculosis Care Committee Miss O. Fergusson Disinfecting Superintendent H. T. Ibbett Caretaker-Attendant, Coroner's Court and Mortuary H. L. Bailey Caretaker, Tuberculosis Dispensary S. Ambrose (a) Sanitary Inspector's Certificate. (d) Health Visitor's Certificate. (b) Food Inspector's Certificate. (e) Certificate of Central Midwives Board, (c) Trained Nurse. 6 STATISTICS. General Statistics, 1934. Area of the Borough 7,015 acres. Population:— Census, 1931 219,953 Estimated, Mid-year, 1934 222,180 Number of inhabited houses (end of 1934) according to Rate Books 49,200 Rateable Value (at 6th April, 1934) £1,665,385 Sum represented by a penny rate £6,662 Extracts from Vital Statistics, 1934. Total. Males. Females. Live Births:—Legitimate 2,621 1,323 1,298 Illegitimate 94 51 43 Birth Rate per 1,000 of the estimated population 12.2 Total. Males. Females. Still-Births 100 50 50 Rate per 1,000 births (live and still-births) 36 Total. Males. Females. Deaths 2,225 1,048 1,177 Death Rate per 1,000 of the estimated population:— (crude) 10.0 ; (corrected) 10.1 Deaths from Puerperal Causes:— Rate per 1,000 Deaths. (live and still) Births. No. 29 Puerperal Sepsis 2 0.73 No. 30 Other Puerperal Causes 2 0.73 Total 4 1.47 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 43 Legitimate infants per 1,000 legitimate live births 41 Illegitimate infants per 1,000 illegitimate live births 95 Deaths from Measles (all ages) 19 „ „ Whooping Cough (all ages) 13 „ „ Diarrhoea (under 2 years of age) 9 7 Population. The Registrar-General's estimate of the population of the Borough at mid-year, 1934, is 222,180, 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 1934 was supplied by the Registrar-General:— Total Registered Inward Transfers Outward Transfers Births allocated to Borough Legitimate Males 1,268 150 95 1,323 Legitimate Females 1,251 144 97 1,298 Illegitimate Males 57 10 16 51 Illegitimate Females 48 10 15 43 Total 2,624 314 223 2,715 It will be seen that the corrected number of births is 2,715, 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. 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 1934 2,715 12.2 8 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 2,637 births. Still-Births. Notifications of 94 still-births were received, and details of these are as follows:— Total number notified 94 Out-of-Borough cases born in the Borough, and not investigated 0 Borough Cases born outside the Borough 5 Number of Borough cases 85 Borough cases in which no enquiry could be made 10 The causes of still-birth in the 75 cases which were investigated were as follows:— Maternal Causes: Toxaemia 18 Ante-partum Haemorrhage:— Placenta Praevia 3 Accidental Haemorrhage 2 Delayed Labour 2 Difficult Instrumeutal Labour 16 111 Health of Mother.. 3 Hydramnios 2 Fall 2 Shock 1 Fœtal Causes: * Breech Presentation 6 Foot Presentation 1 Transverse Presentation 3 Monstrosity Inattention at Birth 2 1 Causes not known 13 Marriages. The number of marriages registered in the Borough during the year was 1,726, compared with 1,580 in 1933. Of this number, 957 were solemnised in the Established Church, 200 in Non-conformist Places of Worship, and 569 at the Register Office. Deaths. The number of deaths of Lewisham residents registered in 1934 was 2,225, and the corrected death rate was 10.1 per 1,000 persons. The deaths and death rates recorded in the last ten years are shown hereunder:- Year. No. of Deaths. Death Rate. 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 1934 2,225 10.1 Deaths in Public Institutions. The deaths occurring in Hospitals and other Public Institutions in the Borough numbered 1,205, of which 748 were residents, and 359 residents died in Institutions outside the Borough. Infant Mortalitv. The number of infants who died before reaching one year of age was 118, equivalent to an infant mortality rate of 43 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. 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 1934 118 43 67 9 Neo-natal Deaths. The number of infants who died in the first four weeks of life was 60, and the causes of death were as follows:— Prematurity 20 Atelectasis 6 Broncho-pneumonia 5 Bronchitis 2 Difficult Delivery 5 Inanition 1 Congenital Heart Disease 4 Malformation 3 Spina Bifida 4 Convulsions 2 Marasmus 1 Pyloric Stenosis 3 Icterus Gravis 1 Enteritis 1 Pertussis 1 Hydrocephalus 1 Investigations were made into the circumstances of the 75 stillbirths and 60 neo-natal deaths, and it was found that 34 mothers received no ante-natal care whatsoever, 26 paid an occasional visit to their own doctors, 13 were supervised by a midwife, 45 attended a Hospital clinic, and 17 had attended one of the four Ante-natal clinics provided by the Borough Council. 10 11 Table showing Causes of Death at Different Periods of Life during the Year 1934. 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 M - - - - - - - - - - - - F i - - 1 - - - - - - - - 2. Measles M 10 2 3 3 2 - - - - - - - F 9 - 2 3 3 - - 1 - - - - 3. Scarlet Fever M 3 - - - 2 1 1 - - - - - F 2 - - - 1 - - 1 - - - - 4. Whooping Cough M 6 2 1 2 1 - - - - - - - F 7 2 3 1 1 - - - - - - - 5. Diphtheria M 9 1 1 2 5 - - - - - - - F 17 - 1 3 10 1 - - 1 1 - - 6. Influenza M 16 - - - - 1 1 - 4 1 8 1 F 14 - 1 - - - - 1 1 3 4 4 7. Encephalitis Lethargica M 2 - - - - - 1 - 1 - - - F 1 - - - - - 1 - - - - - 8. Cerebro-Spinal Fever M 3 - - 1 - - 2 - - - - - F 1 - - 1 - - - - - - - - 9. Tuberculosis of Respiratory M 62 - - - 1 8 16 11 16 7 2 1 F 67 - - - 4 14 22 1 1 9 4 3 - 10. Other Tuberculous Diseases M 9 - 3 - 2 2 2 - - - - - F 4 - - 1 - 3 - - - - - - 11. Syphilis M 2 - - - - - - - - - 2 - F 1 - - - - - - 1 - - - - 12. General Paralysis of the Insane. Tabes Dorsalis M 5 - - - - - - - 2 2 1 - F 2 - - - - - - - - 1 1 - 13. Cancer, Malignant Disease M 157 - - - - 1 2 16 19 45 49 25 F 190 - - - 1 - 2 14 34 52 55 32 14. Diabetes M 16 - - - 2 - 1 1 4 8 - F 20 - - - - 1 1 1 3 9 5 15. Cerebral Haemorrhage, etc. M 26 - - - - 1 - - 1 5 9 10 F 69 - - - 1 - - 3 4 10 29 22 16. Heart Disease M 217 - - - 2 2 4 9 24 42 74 60 F 279 - - - 4 1 3 6 21 38 74 132 17. Aneurysm M 8 - - - - - - 1 - 5 2 - F 4 - 1 - - - 1 - - 1 1 - 18. Other Circulatory Diseases M 54 - - - - - - 1 3 6 26 18 F 53 - - - - - - - 2 7 15 29 19. Bronchitis M 36 2 - - - - 1 - 4 - 10 19 F 41 2 - - - - - - 1 5 7 26 12 Table showing Causes of Death at Different Periods of Life during the Year 1934—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 77 16 7 2 1 1 4 5 7 10 13 11 F 73 4 1 5 3 1 3 5 10 11 14 16 21. Other Respiratory Diseases M 17 - - - - 1 - 3 6 2 3 2 F 15 - - - - - 1 - - 3 4 7 22. Peptic Ulcer M 16 - - - - - - 1 4 7 2 2 F 5 - - - - - - - 1 - 3 1 23. Diarrhoea, etc. M 9 7 - - - - - - - - 1 1 F 5 2 - - - 1 1 - - - - 1 24. Appendicitis M 7 - - - 1 - 2 - 2 - 2 - F 8 - - 2 - - - 1 1 1 1 2 26. Cirrhosis of Liver M 3 - - - - - - - - 2 1 - F 1 - - - - - - - - 1 - - 26. Other Diseases of Liver, etc. M 5 - - - - - - - 2 - 2 1 F 12 - - - - - - - 3 1 3 4 27. Other Digestive Diseases M 20 3 - 1 - 1 1 1 4 5 2 2 F 21 3 - - - 1 - 1 2 4 4 6 28. Acute & Chronic Nephritis M 32 1 - - - 2 - 2 4 9 10 3 F 38 - - - - 2 - 5 4 9 8 8 29. Puerperal Sepsis F 2 - - - - - 1 1 - - - - 30. Other Puerperal Causes F 2 - - - - - 1 1 - - - - 31. Congenital Debility, Premature Birth, Malformations, etc. M 37 37 - - - - - - - - - - F 25 24 - - - 1 - - - - - - 32. Senility M 30 - - - - - - - - - 7 23 F 58 - - - - - - - - - 6 52 33. Suicide M 17 - - - - 1 - 3 7 4 1 1 F 8 - - - - - - 3 2 3 - - 34. Other Violence M 47 2 1 - 2 8 4 2 5 7 6 10 F 30 - 1 - 3 1 2 4 - 1 7 11 35. Other Defined Diseases M 89 4 1 1 5 1 7 6 15 14 20 15 F 92 4 - 1 7 4 4 6 17 20 12 17 36. Causes ill-defined or unknown M 1 - - - - - - - 1 - - - F - - - - - - - - - - - - Totals M 1048 77 17 12 24 33 48 62 132 177 261 205 F 1177 41 10 18 38 30 46 66 114 179 260 375 13 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. 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. 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 206 Number of Primiparæ 110 Number of Multipara 96 Number of Infants born (1 set of Twins) 207 14 Presentations : Vertex 202 Pelvic 4 Transverse 1 Obstetric Operations: Forceps 1 Minor Operations 52 Ante-Partum Hmœorrhage1 Maternal Death 1 Puerperal Morbidity Nil (Note : The standard of morbidity is taken as : " The rising of the temperature to 100 F. on at least two occasions between the second and the eighth days.") Still-Births 3 Details of the Still-Births are as follows:— Still-Births. Maturity Cause of Death Remarks 2 Premature Unknown Macerated 1 Full term Difficult Labour — The sex incidence of the Infants was as follows:— Males, 110; Females, 97 Total, 207 The average length and weight of the full-term infants were as follows:— Males, Length, 22.02 ins. Weight, 71bs. 10 ozs. Females, Length, 21.48 ins. Weight, 71bs. 4 ozs. Progress of Infants while in the Home:— Number born alive 204 Died on 10th day (Spina Bifida) 1 Over birth weight on discharge 126 Equal to birth weight on discharge 63 Under birth weight on discharge 14 Number of Infants entirely breast fed 202 Number of Infants in which breast feeding was supplemented 1 Number of Infants entirely artificially fed 1 15 Extension of Premises. During the year certain necessary improvements were carried out at the Maternity Home. The ward facing Rosenthal Road was converted into an isolation room with bathroom and water-closet, and in addition to this there was room for a lavatory containing three wash basins. To accommodate the four beds displaced by these alterations two of the existing wards were extended in the rear to take three additional beds on the first floor and one on the ground floor. A sterilizing room leading off the labour room and an admission bathroom on the ground floor were provided. Additional sleeping accommodation for the nursing staff was also provided at the Maternity Home in lieu of the premises rented by the Council at No. 1, Honley Road. It was necessary to suspend bookings at the Home for three months to enable the alterations to be carried out, and there was a consequent decrease in the number of cases admitted during the year. 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 1934 are as follows:— Number of Sessions held 150 Number of Patients examined 630 Number of Attendances made by all Patients 3,172 Number of Primigravidæexamined 310 Number of Multigravidæ examined 295 Number who were found to be not pregnant 25 Number of normal labours 325 Number of abnormal labours 42 Number undelivered at the end of 1934 207 Number removed from the district 31 Number sent by the Maternity Home 402 Number sent by Midwives 121 Number sent by Doctors and Institutions 7 Number who came on their own initiative 93 Number who came at the suggestion of the Health Visitor 7 Number who attended for Post-natal examination 191 16 The 42 labours that ended abnormally are classified as follows:— Breech 8 Induction 4 Transverse 1 Caesarean Section 2 Forceps 13 Ante-Partum Haemorrhage 2 Miscarriage 6 Post „ „ 1 Premature Birth 1 Surgical Abortion 1 Still-births 3 The number of ante-natal cases sent by the Midwives to the Central Clinic during the year was 121, as compared with 97 in 1933, and the number of pregnant women who attended on their own initiative was 93 as compared with 37 in 1933. These figures are encouraging as they show that not only the midwives but also the mothers themselves are making increasing use of the service provided. 17 The Complications found are classified as follows:— Complication. Primiparae Multipara Not Pregnant Total Diseases and Disorders of the Reproductive System Threatened Abortion - 2 - 2 ,, Miscarriage - 1 - 1 Prolapse - 2 - 2 Cystocele - - 6 6 Rectocele - 2 - 2 Retroversion - - 12 12 Subinvolution - - 2 2 Leucorrhœa - 1 - 1 Purulent Vaginal Discharge 1 7 1 9 Diseases and Disorders of the Digestive System: Dental Caries 82 94 - 176 Alveolar Abscess 2 - - 2 Pyorrhoea 2 2 - 4 Heartburn 25 37 - 62 Hyperemesis 25 20 - 45 Indigestion 32 24 - 56 Enteritis 1 - - 1 Constipation 96 79 4 179 Inguinal Hernia 1 1 - 2 Diseases of Respiratory System: Hay Fever 1 - - 1 Nasal Catarrh 10 18 4 32 Bronchitis 13 23 1 37 Disorders of the Circulatory System: Valvular Disease of the Heart 9 11 - 20 High Blood Pressure 116 108 - 224 Varicose Veins of Lower Limbs 53 74 - 127 Varicose Ulcer 1 - - 1 Haemorrhoids 9 9 2 20 Epistaxis 3 7 - 10 Diseases and Disorders of the Nervous System: Insomnia of Pregnancy 20 39 - 59 Diseases of the Urinary System: Albuminuria of Pregnancy 35 19 - 54 Glycosuria of Pregnancy 9 13 - 22 Prolapse of Bladder - 1 - 1 Affections of the Skin: Urticaria 1 1 - 2 Psoriasis 1 - - 1 Herpes - 1 - 1 Pruritus 2 2 - 4 Furunculosis 2 1 - 3 Diseases of the Eye: Hordeolum - 1 - 1 General Diseases: Anaemia of Pregnancy 4 11 - 15 Enlarged Thyroid 1 - - 1 Rheumatism 1 1 - 2 Rheumatoid Arthritis 1 - - 1 Malpresentations 8 5 - 13 No Complications found 33 26 9 68 18 Downham Ante-natal Clinic. This Clinic is held at the Downham Health Centre on one morning each week. During the year 123 women attended, the total attendances amounting to 326. Post-Natal Clinic.—This Clinic has been held throughout the year on Tuesday mornings. Of the 206 mothers delivered in the Municipal Maternity Home, 191 attended for post-natal examination. X-Ray Examinations.—Durng the year six X-Ray examinations of pregnant women were carried out at St. John's Hospital. 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 1934:— Rushey Green Clinic. Downham Clinic. No. on Register Attendantces No. on Register Attendances Mothers - 694 2,294 Mothers - 201 619 Infants - 1,480 8,110 Infants - 476 1,769 The cases treated during the year were classified as follows:— Mothers' Clinic. Rushey Green. Downham. Diseases and Disorders of the Reproductive System 297 160 Diseases and Disorders of the Alimentary System 165 65 Diseases and Disorders of the Respiratory System 11 6 Diseases and Disorders of the Nervous System 6 3 Diseases of the Urinary System 7 - Affections of the Skin 16 10 Diseases of the Eye 6 8 Diseases of the Heart, Blood Vessels, etc. 8 5 General Diseases 210 60 Consultations 1102 236 19 Infants' Clinic. Rushey Green. Downham. Diseases and Disorders of the Reproductive System - - Diseases and Disorders of the Alimentary System 431 106 Diseases and Disorders of the Respiratory System 818 174 Diseases and Disorders of the Circulatory System 4 1 Diseases of the Urinary System 5 2 Affections of the Skin 123 91 Diseases of the Ear 48 12 Diseases of the Eye 32 22 Scalds and Burns 5 - Mental Defects 47 1 Injuries and Diseases of the New Born 37 8 Rickets 25 10 General Diseases 211 50 Consultations on Feeding and Management (under 1 year) 2,165 552 Consultations on Feeding and Management (1-5 years' 2,550 472 New Premises for Central Maternity and Child Welfare Clinic. Plans have been prepared and approved by the Ministry of Health for a Central Maternity and Child Welfare Clinic to be erected on a portion of the Priory Site. The Priory Site, previously the property of the late Lewisham Board of Guardians and transferred to the London County Council under the provisions of the Local Government Act, 1929, was purchased from the County Council in 1929 for £3,750, the intention being to build thereon a Central Maternity and Child Welfare Clinic and a Tuberculosis Dispensary. The Central Clinic is at present held at rooms belonging to and adjoining the Catford Wesleyan Church, Rushey Green, but having regard to the services to be provided and to the circumstances generally, this arrangement, which was only adopted as a temporary expedient, cannot be considered satisfactory. The new Maternity and Child Welfare Clinic is designed on the "Central Hall" principle, the hall being used as a place of waiting and assembly, and to afford access to the various Clinics. The main entrance and principal elevation will face the High Street, Lewisham ; additional entrances will be provided at the side and rear of the building, conveniently situated to the perambulator sheds. It will be seen from the plans that ample facilities are available for:— (1) An ante-natal clinic, comprising a doctor's consulting room. history room, test room and dressing cubicles; 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:- Total Attendances. Name of Centre. No. of Sessions held in the Year. Children under 1 year of age. Children aged 1-5 years. Bellingham Infant Welfare Centre 50 1,761 2,436 Catford School for Mothers 99 4,325 2,554 Downham Infant Welfare Centre 48 3,247 3,942 Forest Hill School for Mothers 49 4,340 3,767 Grove Park Infant Welfare Centre 49 2,108 2,082 Hither Green Mothers' & Babies' Welcome 48 2,898 3,035 Lee and Blackheath School for Mothers 50 3,228 3,116 St. Mary's School for Mothers 50 4,486 2,159 Sydenham Infant Welfare Centre 97 4,026 1,922 Upper Sydenham Infant Welfare Centre 49 1,922 866 20 (2) An infants' clinic, comprising a consulting room, small anteroom and a weighing room sufficiently large to contain two scales. (It will be noted that the provision of two consulting rooms will enable two separate clinics to be conducted at the same time, without inconvenience to either). (3) A dispensary, which will provide ample room for the medicines supplied either free or at a reduced price for necessitous persons, and for the dried milk which is at present issued from the Town Hall. This dispensary will take the place of the present one at the Maternity Home. (4) An artificial sunlight clinic. As it is proposed to conduct an artificial sunlight clinic, provision has been made for a dressing room and a room to contain the necessary apparatus. (5) A " Toddlers' " room. The remaining accommodation will consist of a staff room, staff lavatories, kitchen, patients' lavatories and store rooms. The caretaker's apartments will be on the first floor, and comprise a living room, kitchen, bathroom and three bedrooms. The heating will be by means of a low pressure hot water system, provision being made in the basement for a boiler and the storage of fuel. 21 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 children. 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 68 mothers and 17 children, and complete or partial dentures to 20 mothers were authorised by the Maternity and Child Welfare Committee. 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 1,879 grants of dried milk for four weeks free of charge, and 367 grants at the reduced price of 6d. per lb. Altogether, 11,066 lbs. of dried milk were issued at a cost to the Council of £782 3s. 5d. Maternity Outfits. There is an increasing demand for the sterilized maternity outfits which are supplied to expectant mothers on the recommendation of a doctor or midwife, and 314 outfits were supplied during the year, compared with 227 in the previous year. No charge was made for the outfit in 143 cases, 45 were issued at half-price, and 126 at cost price. Obstetric Consultants. The services of the Consultants whose services are retained by the Council were requisitioned by medical practitioners in six 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 n only 3 cases. 22 Health Visitors. There are eight 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 turing the first year of the infant's life, and afterwards, at longer tervals, 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 year is summarised below:— Infants under 1 year of age:— First visits 2,851 Subsequent visits 8,375 Infants between 1 and 5 years of age:— Total visits 11,307 Expectant mothers:— First visits 747 Subsequent visits 319 Infant death enquiries 82 Still-birth enquiries 77 Visits to Puerperal Fever cases 15 Visits to Ophthalmia Neonatorum cases 33 Visits to Measles cases6 17 Visits to other Infectious cases 311 Miscellaneous visits 932 Ineffectual calls 4,199 Council at the rate of 1s. 3d. per visit. The cases nursed during 1934 and the number of visits made, are shown in the following table:— Nature of Illness. No. of Cases. No. of Visits. Ophthalmia Neonatorum 2 87 Measles 92 836 Pneumonia 96 1,615 Whooping Cough 2 34 Totals 192 2,572 Midwives. The London County Council supplied the information that 42 midwives residing in the Borough gave notice of their intention to practice during 1934. Infant Life Protection. The number of foster-mothers on the Register at the end of the year was 136, and the children in their care numbered 175. The officer charged with supervising the welfare of these infants made 2,274 visits to their homes during the year. Four nurse-children died, an inquest being held in one case. Laboratory Facilities. Food and 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. 23 Attendances at Centres:— Municipal 656 Voluntary 558 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 24 Bacteriological Examinations.—Bacteriological examinations are 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 3,090 specimens were examined, the details being as follows: — Material from cases of suspected Diphtheria:— Diphtheria bacillus isolated 239 Negative 2,075 2,314 Sputa from cases of suspected Tuberculosis:— Tubercle bacillus found 102 Tubercle bacillus not found 614 716 Blood from cases of suspected Enteric Fever:— Positive result 2 Negative result 52 54 Pathological specimens for Enteric Organisms:— Positive result — Negative result 6 — 6 Total 3,090 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 359 bodies were received into the Mortuary, of which number, 105 were brought in from outside the Borough, and 165 from Public Institutions. The Inquests held numbered 225, and 182 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: — 25 Disinfecting Station. Premises Visited 2,114 Rooms Disinfected 5,095 Articles Disinfected:— Beds 1,161 Blankets 4,934 Bolsters 1,224 Mattresses 2,318 Pillows and Cushions 5,407 Quilts 2,058 Sheets 3,151 Miscellaneous Articles 11,060 Wearing Apparel 11,433 42,746 Articles Washed 20,711 Mattresses Re-tufted 1,425 Verminous Rooms Treated 300 Verminous Articles Treated 1,600 Cleansing Station. Children Treated for Vermin 1,023 Attendances at the Cleansing Station 1,775 Adults Treated for Vermin 6 Attendances at the Cleansing Station 6 Children Treated for Scabies 118 Baths Given 815 Adults Treated for Scabies 38 Baths Given 117 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 1934 is shown helnw Loads. Tons. Container System 21,490 36,931 Freighters 4,410 5,424 Other Vehicles 476 475 Totals 26.376 42,830 The main portion of the refuse is disposed of at the Destructors situated at Molesworth Street, Lewisham, and Home Park, 26 ham, the remainder being sent away by barges or deposited on shoots in the Borough. The following are the figures for 1934:— Tons. Home Park Destructor 18,442 Molesworth Street Destructor 16,639 Barged away 8,313 Shoots 140 Totals 43,534 The figures for disposal include 442 tons of trade refuse delivered by tradesmen to the Council's dust destructors, and 262 tons of market refuse. Sanitary Inspection of the Borough. The work of the male Sanitary Inspectors is summarised in the following statement:— Inspections: On complaint 1,424 After Infectious Disease 1,624 Notice from Builder 555 Other Inspections 2,794 Re-inspections 8,733 New Dwellings, for Water Certificates 1,262 Notices: Number of Intimation Notices Served 1,746 Number of Statutory Notices Served 495 Sanitary Improvements Effected. Premises Cleansed and Repaired 1,459 Drains Entirely Reconstructed 175 Drains Repaired 315 Water-closets Cleansed or Repaired 701 Soil-pipes Renewed or Repaired 210 Waste-pipes Renewed or Repaired 543 Rainwater Pipes Renewed or Repaired 198 Roof and Gutters Repaired 526 Dampness in Premises Remedied 610 Yards Drained or Paved 355 Dust-bins Provided 304 Water-cisterns Cleansed or Covered 34 Water Fittings Repaired 86 Additional water supplies provided to tenement houses 19 Defective Fire-places remedied 263 Offensive Accumulations Removed 83 Urinals Cleansed or Repaired 29 Animals Improperly Kept 19 Other Nuisances Remedied 1,084 27 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. 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 786, and during the year 2,187 inspections were made of these premises. The number of sanitary defects found was 25, all of which were remedied. Details of the above are given in tabular form. Factories and Workshops on the Register. Bakehouses 34 Factory Bakehouses 48 Dressmakers, Milliners, etc. 67 Laundries 37 Tailors 59 Dentists 39 Bootmakers and Repairers 87 Builders 45 Motor Manufacturers and Repairers 90 Jewellers and Watch Repairers 37 Upholsterers and Cabinet Makers 41 Miscellaneous 202 Total 786 Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 664 7 — Workshops (including Workshop Laundries) 1,451 11 — Workplaces (other than Outworkers' premises) 72 — — Total 2,187 18 — 28 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 8 8 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 8 8 — — Sanitary accommodation insufficient 3 2 — unsuitable or defective 2 2 — — not separate for sexes 2 2 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) 1 1 — — 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 25 25 — — 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. 29 Rats and Mice (Destruction) Act, 1919. During the year 250 investigations were made into complaints of alleged rat infestation. In 128 instances, defective drains were found to be responsible, and in 72 instances the contributory cause was found elsewhere. The complaint was unfounded in 50 cases. Smoke Abatement. During the year 50 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 12 instances. The institution of legal proceedings was not necessary in any case. Legal Proceedings. Details of proceedings instituted under the Public Health ant kindred statutes are stated in the following table:— Premises. Offence. Result. 47, West Hill, Sydenham, S.E.26 Acting contrary to Closing Order prohibiting the use of her dwelling for human habitation. Fined 40/- and Costs, 20/- Do. do. Do. do. do. Fined 20/- and Costs, 20/- 30 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) 3,278 (b) Number of Inspections made for the purpose 3,278 (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 554 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 37 (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 1,447 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 1,198 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 31 (B) Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 458 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : — (а) By owners 458 (б) 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 3 (2) Number of dwelling - houses demolished in pursuance of Demolition Orders 2 (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 Nil (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 32 (F) Proceedings under Sections 11, 14 and IS 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 Slum Clearance. A survey of the Borough was made with the object of preparing a list of properties which, by reason of the age of the structures and the unsatisfactory internal arrangements, do not conform to presentday housing standards, and which therefore require to be dealt with as clearance areas. A list of small areas, twenty-seven in number, has been compiled and the total number of houses involved in these areas is approximately 445; the total number of persons who will be displaced and for whom re-housing accommodation will have to be provided being estimated at 1,557. It must be pointed out that such a list is provisional, and the number of houses approximate only, the exact limits and number of unfit houses being unknown until the houses in the areas have been surveyed and considered for representation. Four areas were represented to the Council, viz., the Loampit Vale (Ward Cottages) Area, Lewisham (comprising Nos. 1 and 2, Ward Cottages ; the Loampit Vale (Pear Tree Cottages) Area, Lewisham (comprising Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11, Pear Tree Cottages and No. 31, Loampit Vale, Lewisham), the Vian Street Area (comprising Nos. 1, 2, 3, 4, 5, 6, 7, 8, 10, 12 and 14, Vian Street, Lewisham), and the Loampit Vale and Wilmore Place Area (comprising Nos. 4, 5 and 6, Wilmore Place, Loampit Vale, and Nos. 15, 17 and 19, Loampit Vale, Lewisham). Two areas—Loampit Vale (Ward Cottages) Area and Loampit Vale (Pear Tree Cottages) Area were considered by the Council, and 33 in each case it was decided to order the demolition of all the buildings in each area, and in pursuance of Part I of the Housing Act, 1930, and of the First Schedule thereto a clearance order was made in respect of such properties. A local public Inquiry in regard to the orders made by the Council in respect of the two areas was held at the Town Hall on the 26th November, 1934. The Inspector heard the evidence or statements submitted by, or on behalf of, ten objecting tenants, the objections in the majority of cases being on the ground that they were not in a position to pay any increased rent or travelling expenses. The Minister of Health subsequently confirmed the clearance orders. 34 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 138, and 252 inspections of these premises were made during the year. In addition, 145 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 1934, as follows: — Premises licensed to Pasteurise 2 Retail premises licensed to sell Certified Milk 9 „ ,, ,, ,, Grade A (Tuberculin Tested) Milk 10 ,, ,, ,, ,, Grade A Milk .. 6 ,, „ ,, ,, Pasteurised Milk .. 55 Bacteriological Examination of Milk. -The designations and numbers of the samples examined are shown in the following summary:— " Certified " Milk 6 " Grade A " (Tuberculin Tested) Milk 7 " Pasteurised " Milk 15 Undesignated Milk 37 Total 65 Certified Milk.—(Standard: —Not more than 30,000 bacteria in one c.c., and no Coliform Bacillus in 1/10 c.c.). Six samples of this grade of milk, consigned in bottles to retailers in the Borough, were taken and examined at the request of the Ministry of Health. All conformed to the required standard. 35 The reports on the samples are as follows: — No. of Sample. Month. Bacterial content per c.c. Bacillus Coli. 7 April 6,600 Absent. 24 June 1,740,000 Present 35 July 89,000 Absent. 41 August 4,733 do. 48 August 67,500 do. 51 September 7,433 do. 64 October 4,233 do. "Grade A" (Tuberculin Tested) Milk—Standard:—Not more than 200,000 bacteria per c.c., and no Coliform Bacillus 1/100 c.c.). Seven samples of this grade were examined and one of these failed to comply with the standard. Six of the samples were taken at the request of the Ministry of Health. "Pasteurised" Milk.—Standard:—(Not more than 100,000 bacteria per c.c.). Of the fifteen samples of this grade which were examined, twelve were taken on delivery at the various Institutions of the London County Council situated in this Borough, the remaining three being taken from local retailers. In only one of these samples was the bacterial count greater than that permitted, and the attention of the local authority responsible for the licensing of the pasteurising establishment was called to the matter. The reports on the samples are as appended herewith: — No. of Sample. Bacterial content per c.c. Bacillus Coli. 2 1,480 Absent 12 1,466 do. 34 3,666 do. 47 606 do. 50 1,426 do. 63 2,800 do. 36 The reports on the samples are as follows: — No. of Sample. Month. Bacterial content per c.c. Bacillus Coli. 1 January 8,000 Present in l/10th c.c. 3 February 2,400 Absent. 5 March 100,000 Present in l/100th c.c. 6 April 43,000 Absent. 8 April 31,333 Absent. 11 May 97,500 Absent. 22 June 8,833 Absent. 23 June 177,000 Present in l/100th c.c. 27 July 12,133 Present in l/100th c.c. 40 July 7,333 Absent. 40 August 0,033 Absent. 49 September 18,100 Absent. 52 October 09,000 Absent. 05 November 10,500 Present in l/10th c.c. 00 December 18,700 Absent. Undesignated Milk—Thirty-seven samples of undesignated milk, taken from local dairymen in the course of delivery to their customers, were submitted for examination. Three of the samples were of sufficiently high quality to comply with the standard laid down for "Certified" Milk, and 14 were within the standard for "Grade A" Milk. In every instance where the milk showed a bacterial count of over 200,000 per c.c., the retailer concerned was interviewed and efforts made to ascertain the cause of the high bacterial count. The result of this action was reflected in subsequent samples taken from the same retailers, which in most cases revealed counts of under 200,000 per c.c. The reports on the samples are as follows : — No. of Sample. Month. Bacterial content per c.c. Bacillus Coli. 4 February 270,000 Absent. 9 April 84,000 Absent. 13 June 7,300,000 Present. 14 do. 96,333 Absent. 15 do. 55,333 Present. 16 do. 4,900,000 Absent. 17 do. 86,333 Present. 18 do. 148,000 Absent. 19 do. 168,666 Absent 20 21 do. do. 186,666 80,000 Present. Absent. 37 No. of Sample. Month. Bacterial content per c.c. Bacillus Coli. 25 July 475,000 Present. 26 do. 785,000 do. 28 do. 1,315,000 do. 29 do. 86,666 Absent. 30 do. 37,333 Present. 31 do. 1,460,000 do. 32 do. 990,000 do. 33 do. 77,666 do. 36 do. 785,000 do. 37 do. 555,000 do. 38 do. 3,800,000 do. 39 do. 4,600,000 do. 42 August 2,200,000 do. 43 do. 9,166 Absent. 44 do. 1,350,000 Present. 45 do. 1,490,000 do. 53 October 117,333 Absent. 54 do. 6,333 do. 55 do. 17,666 do. 56 do. 23,666 Present. 57 do. 48,333 do. 58 do. 365,000 Absent. 59 do. 67,600 do. 60 do. 105,666 do. 61 do. 57,333 do. 62 do. 53,666 do. 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 510 attendances for the purpose of inspecting the carcases of animals slaughtered, which numbered 5,179. 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 license : — Premises. Licensee. 291, High Street, Lewisham 324, High Road, Lee Havelock Street Mews, Forest Hill 12, Montpelier Vale 13, Rushey Green Weardale Road, Lee H. Calton (J. Balsdon & Co.) R. C. Hammett, Ltd. Chalk & Cox, Ltd. B. W. Parsons, Ltd. Chalk & Cox, Ltd. H. W. Hemmings 38 The Slaughter of Animals Act, 1933, came into operation on the 1st January, 1934. The Act provides for the humane and scientific killing of animals and for purposes connected therewith, and also places on local authorities the new duty of licensing slaughtermen. With regard to the first provision, there is at the present time the undermentioned bye-law in operation, made by the London County Council in March, 1923, and which was based upon model bye-laws issued by the Ministry of Health: — "A person shall not in a slaughterhouse proceed to slaughter any animal until the same shall have been effectually stunned and such stunning shall, except as hereafter provided, be effected with a mechanically operated instrument, suitable and sufficient for the purpose." The local authorities for enforcing the provisions of the Act in the County of London are, as in the case of the London County Council Bye-law referred to, the Metropolitan Borough Councils. The Act requires that animals to be slaughtered in slaughterhouses or knackers' yards shall be instantaneously slaughtered or shall by stunning be instantaneously rendered insensible to pain until death supervenes, and such slaughtering or stunning shall be effected by means of a mechanically operated instrument in proper repair, which is defined to include an electrical instrument. The animals to which this Act applies or may apply are as follows: —horse, mare, gelding, pony, foal, colt, filly, stallion, ass, donkey, mule, bull, cow, bullock, heifer, calf, steer, ox, sheep, ewe, wether, ram, lamb, pig, boar, hog, sow, goat, kid. No person shall be liable for any contravention in respect of the slaughter of a pig, boar, hog or sow unless a supply of electrical energy is available or can reasonably be made available. Slaughter by a Jew or a Mohammedan for his co-religionists is exempt from these provisions of the Act, but as regards the former, only if he is licensed by a Commission which is to be established under the first Schedule of the Act. Every local authority is required within twelve months after the passing of the Act, i.e., before the 28th July, 1934, to consider 39 whether they will by resolution apply the Act to all or any of the following animals: —sheep, ewes, wethers, rams and lambs, the said animals being exempt in any area in which no such resolution is in force, and the local authority may by resolution exempt goats or kids or both from the Act. In view of the fact that the Ministry of Health have expressed the opinion that there is nothing in the present Act which renders the London County Council Bye-law inoperative, the Council did not consider it necessary that a specific resolution should be adopted for the purpose of including sheep in the provisions of the Act. In connection with the administration of the Act, the Council decided— (a) that the Medical Officer of Health and each of the Sanitary Inspectors be appointed officers for the purposes of the Slaughter of Animals Act, 1933; (b) that the licences to slaughtermen under the Act be granted for a period of one year, terminable on the 31st December, and (c) that a fee of 2s. be charged for the original licence, and Is. for each subsequent renewal thereof. Unsound. Food.—The following quantities of meat, fish, etc., were surrendered as unfit for food, and destroyed: — Bullocks' Heads, 5 stones; Pigs, Pigs' Heads, etc., 114 stones; Liver 43£ stones; Sheeps' Plucks, etc., 8 lbs.; Tinned Hams, 10 stones; Fish, various, 25 stones; Winkles, 2 boxes; Rabbits, 36 boxes; Tomatoes, 20 stones. 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 292 premises were on the register, including 153 ice-cream premises. 40 Bakehouses.—There are 82 bakehouses on the Register, and 265 inspections of these were made during the year. Restaurants and Eating-houses.—There are 120 establishments of this description on the Register, and during the year 125 inspections were made. Food Shops and Stalls.—Inspections of these premises during the year numbered 1,748. Agricultural Produce (Grading and Marking) Act, 1928.—This Act provides for the grading and marking of agricultural produce. The following orders were made by the Ministry of Agriculture during the year: — Date of Order, 1934. Article of Produce. January 23rd Cauliflowers and Broccoli. February 12th Asparagus. „ 19th Radishes. „ 19th Red Beet. „ 19th Cabbage Greens and Cabbages. ,, 19th Salad (Spring) Onions. ,, 20th Leeks. ,, 22nd Carrots. May 3rd Parsnips. ,, 3rd Ripe Onions and Shallots. „ 3rd Swedes. ,, 8th Watercress. „ 8th Horse Radishes. ,, lbth Kidney and Runner Beans. ,, 23rd Forced Rhubarb. June 2nd Mushrooms. „ 29th Canned Fruit. 29th Jam. J uly 9th Canned Vegetables. August 8th Bottled Fruits. December 3rd Natural Rhubarb. ,, 5th Stilton Cheese. Merchandise Marks Act, 1926.—Orders were made by the Ministry of Agriculture requiring an indication of origin to be applied to the following articles of imported food, viz., Bacon and Ham, Dead Poultry, Maize Starch, and Chilled and Frozen Meat, etc. Food Poisoning. I have to record an outbreak of food poisoning caused by the consumption of meat purchased from a local shop, whereby twentysix persons in this Borough were affected. The history of the outbreak is as follows: — 41 On Saturday morning, the 16th June, I received a telephone message from a local doctor informing me that he had been called to see two families who, in his opinion, were suffering from food poisoning, and that the particular article suspected was silverside of beef purchased, already cooked, at a local shop. A member of each family affected had purchased on the previous evening, the ISth June, silverside of beef at the same time, from the same tray, and from the same shop. That evening each family consisting of husband and wife had for supper silverside of beef, lettuce, cucumber and rice pudding. About two hours after partaking of supper, all four were seized with severe sickness, vomiting and diarrhoea. The doctor also informed me that his partner had been called to see a family, consisting of husband and wife, with similar symptoms. As the circumstances were suspicious, enquiries were made to find out whether, by chance, any of the suspected beef was left over from the previous evening's supper in any of the affected households. A portion was obtained from one house and sent to the Council's Bacteriologist for examination. At the same time, a visit was paid to the shop where the suspected meat was purchased. The shop is one of four branch shops, three of which were in other districts. It was ascertained that the supplies were obtained from a depot in Camberwell, and, in the case of silverside of beef, it was delivered at the Lewisham branch daily in slabs of approximately 10 lbs., each wrapped in grease-proof paper. It was supplied at the following times and in the following quantities on Friday and Saturday, the ISth and 16th June: — Time No. of Silversides Weight Friday, 8.30 a.m. 3 28½ lbs.) 57½lbs. ISth June 11.0 a.m. 2 20 „ 3.30 p.m. 1 9 7„ Saturday, 8.0 a.m. 2 21½ lbs. ] | 78½ lbs. 16th June 10.30 a.m. 4 45 „ 3.0 p.m. 1 12 „ 42 No silverside of beef was left in hand on Thursday, the 14th June, at dinner-time (early closing) or on Friday evening, the 15th June. The shop is of modern construction and well kept. The manager informed me that no member of the staff had recently been off duty suffering from illness of a suspicious nature. On Monday morning, the 18th June, I received further information that ten additional families were affected and in each case the victims had partaken of cooked silverside of beef purchased from the same shop as the previous cases and on the same date, Friday, the 15th June, with the exception of one family in which case the beef was purchased on Saturday morning. In this particular family, though three persons partook of the beef, only one was affected. On Tuesday, the 19th June, three members of a family partook of sandwiches made from ham purchased on the 18th at the suspected shop. They were all seized with intense sickness and diarrhcea within 2\ hours of eating the sandwiches. At the commencement of the outbreak, I communicated with the Medical Officer of Health of the district where the premises in which the beef was prepared, cooked and wrapped, were situated. It was learned that complaints of alleged illness after eating meat purchased from two of the other branch shops had been received by the firm. The bacteriological report on the sample of meat previously mentioned was received on the 21st June, and was as follows: — " Bacteriological examination of the sample of meat gave a growth of Bacillus Coli, Bacillus Proteus and putrefactive organisms, but organisms of the Salmonella Group were not found." Agglutination Tests on blood from one of the patients were as follows: — Aertrycke Negative Gaertner ditto Salmonella Group ditto 43 Bacteriological examination of fa:ces of one patient gave a negative result. In the majority of the cases, the illness commenced within a few hours after eating the silverside of beef and in one case ham, and lasted about forty-eight hours. The principal symptoms were severe sickness, vomiting, diarrhoea and collapse and, so far as could be ascertained, were not associated with a rise of temperature. On the evidence available, it would appear that a portion or portions of 57£ lbs. of silverside of beef sold on Friday, the 15th June, had in some way become contaminated, and that Saturday's supply, the 16th June, had practically escaped such contamination. It would also seem that there was some contamination of the cooked ham sold on the afternoon of the 18th June. The contamination was probably bacterial in nature, the organisms producing the toxin having been destroyed in the process of cooking. It is of interest to note that later in the year two further cases of food poisoning occurred, one on the 8th September and the other on the 20th September ; in the first case after eating boiled ham, and in the second cooked brisket of beef. The ham and beef were purchased from the shop associated with the previous outbreak. The illness resulting from the consumption of the ham might be ascribed to a staphylococcus toxin since staphylococcus aureus was present in rather large numbers in the ham. No further cases occurred. Food and Drugs (Adulteration) Act, 1928.—During the year under review 998 samples of food, drugs, etc., were obtained by the Council's Inspectors and submitted to the Public Analyst for examination. Of this number 303 were purchased formally in accordance with the provisions of the above-named Act, and the remaining 695 were obtained informally as "test" samples. Eighteen, or 5.7 per cent, of the formal samples were certified as adulterated or below standard by the Public Analyst, compared with 4.8 per cent, in 1933. 44 The following table gives the details of the samples analysed: — Article. Mo. ot Samples Examined. No. of Samples Adulterated, etc. Formal Informal Total Formal Informal Total Butter — 83 83 — — — Cheese — 2 2 — — — Cocoa — 41 41 — — — Coffee — 13 13 — — — Cream — 28 28 — — — Coffee and Chicory — 2 2 — — — Coffee Mixtures — 2 2 — — — Jam & Marmalade — 1 1 — — — Flour, Self—raising — 10 10 — — — Flour, Plain — 2 2 — — — Lard — 17 17 — — — Margarine — 05 05 — — — Milk 279 — 279 12 — 12 Milk, Condensed 2 19 21 — 1 1 Mustard — 20 20 — — — Sugar — 19 19 — — — Tea — 41 41 — — — Ground Ginger — 10 10 — — — Brandy 3 3 — — — Gin 2 — 2 — — — Rum 3 — 3 — — — Whisky 4 — 4 — — — Beverages, etc. — 6 0 — — — Cornflour — 2 2 — — — Fish, Canned 1 10 17 1 1 2 Fish Paste — 9 9 — — — Fruit — 1 1 — — — Dried 1 20 27 1 1 2 Honey — 0 6 — — — Jellies — a 3 — — — Meat — 15 15 — 1 1 Meat Paste — 7 7 — — — Pepper 2 44 40 1 3 4 Pickles & Sauces — 7 7 — — — ' Powder, Custard — 7 7 — — — ,, Baking — 2 2 — — — Preserved — Vegetables — 2 2 — 1 1 Rice — 2 2 — — — Sago — 1 1 — — — Semolina — 1 1 — — — Sausages 2 34 30 — 4 4 Spices, etc. 1 30 31 1 2 3 Suet.. — 2 2 — 1 I Tapioca — 4 4 — — — Acid, Boric — 1 1 — — — ,, Citric — 5 5 — — — ,, Tartaric — 4 4 — — — Borax — 3 3 — — — 45 Article. No. of Samples Examined. No. of Samples Adulterated, etc. Formal Informal Total Formal Informal Total Camphorated Oil — 7 7 — — — Cream of Tartar — 4 4 — — — Lime Water 1 3 4 — 1 1 Liniment of Turpentine — 6 6 — — — Linseed, Crushed 1 6 7 1 1 2 Oil, Almond — 4 4 — — — ,, Castor — 5 5 — — — ,, Cod Liver — 1 1 — — — ,, Eucalyptus — 5 5 — — — Ointment, Boric — 2 2 — — — ,, Mercury — 5 5 — — — ,, Zinc — 5 5 — — — Paregoric — 3 3 — — — Powder, Gregory — 4 4 — — — ,, Seidlitz 1 6 7 1 1 2 Sal Volatile — 4 4 — — — Tincture, Iodine — 6 6 — — — ,, Quinine — 4 4 — — — Totals 303 695 998 18 18 36 Milk.—Two hundred and sixty-seven samples of milk were examined by the Public Analyst, and 10 of these, or 3.74 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 3.65 8.93 87.42 3.0 8.5 Second ,, 3.54 8.80 87.66 Third 3.71 8.68 87.61 Fourth ,, 3.80 8.88 87.32 Average for the Year 3.68 8.82 87.50 46 Adulterated Samples. Serial No. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. Administrative Action taken. 721 Sausages Informal Sulphur Dioxide 330 parts per million Declaration of preservative exhibited. 795 Pepper ,, Sulphur Dioxide 100 parts per million Formal sample No. 842 842 Pepper Formal Sulphur Dioxide 30 parts per million Vendor Cautioned 878 Beef Suet Informal Starch 4.5% Declaration on packing 885 Dried Mint „ Foreign leaves 35% Formal sample No. 928 890 Pepper ,, Sulphur Dioxide 155 parts per million 913 Dried Mint Foreign leaves 15% 928 Formal ,, 50% Vendor Cautioned 25 Pepper Informal Sulphur Dioxide 60 parts per million Subsequent formal sample genuine 77 Sultanas ,, Sulphur Dioxide 180 parts per million excess Formal sample No. 85 85 ,, Formal Sulphur Dioxide 160 parts per million excess Vendor Cautioned 91 Milk ,, Fat deficient 10% Summons against Retailer dismissed 115 ,, ,, ,, ,, 5% 116 ,, ,, ,, ,, 15% 117 ,, ,, ,, ,, 10% 125 ,, ,, ,, ,, 5% Summons against Farmer dismissed 126 ,, ,, ,, ,, 6% 127 ,, ,, ,, ,, 14% 128 ,, ,, ,, ,, 8% 129 ,, ,, ,, ,, 11% 211 ,, Informal Extraneous water 3% Retailer fined £2 239 Herring in Tomato ,, Tin 3 grains per lb. Subsequent formal sample No. 319 282 Sausages ,, Sulphur Dioxide 103 parts per million Subsequent formal sample genuine 47 Serial No. Articles. Formal or Informal. Nature of Adulteration or Irregularity. Observations. Administrative Action taken. 295 Sausages Informal Sulphur Dioxide 160 parts per million 319 Herrings, tinned Formal Tin 3.2 grains per lb. Vendor Cautioned 408 Minced Meat Informal Sulphur Dioxide 105 parts per million Subsequent formal sample genuine 427 Milk Formal Extraneous water 2.1% Subsequent samples taken on deliverv proved genuine 428 ,, , , „ 2.2% 494 Sausages Informal Sulphur Dioxide 110 parts per million Declaration of Preservative 577 Condensed Milk . . ,, Deficient in milk solids-not-fat equivalent to about ¼ pint machine skimmed milk Subsequent formal samples genuine 596 Seidlitz Powder ,, Tartaric Acid excess 58.4% Formal sample No. 691 609 Lime Water ,, Lime deficient 84% Subsequent formal sample genuine 645 Crushed Linseed ,, Oil deficient 59.4% Subsequent formal sample No. 690 690 ,, ,, Formal ,, ,, 65.9% Vendor Cautioned 691 Seidlitz Powder ,, Tartaric Acid 71.2% and Sodium bicarbonate and Rochclle Salt 54% excess Vendor Cautioned 737 Tomato Puree Informal 3.7 grains tin, .22 grains copper per lb. Vendor Cautioned Stocks withdrawn from sale. 48 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-Mvelitis 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, 2,243 cases were notified, compared with 1,975 in 1933. The figures for the last three years are given in detail in the following table:— Disease. Year. 1993 1933 1934 Smallpox 2 21 3 Scarlet Fever 513 1,129 1277 Diphtheria 228 354 473 Paratyphoid Fever 2 9 2 Typhoid Fever — 2 4 Puerperal Fever 10 8 12 Puerperal Pyrexia 28 32 31 Erysipelas 99 106 141 Acute Primary and Influenzal Pneumonia 293 281 273 Ophthalmia Neonatorum 11 13 17 Encephalitis Lethargica 4 — 1 Cerebro-spinal Meningitis 12 13 5 Polio-Myelitis 3 6 4 Anthrax — 1 — Totals 1,205 1,975 2,243 49 Scarlet Fever.—The incidence of this disease continued to be unduly high, 1,277 cases being notified, compared with 1,129 in the previous year. There were five fatal cases. Diphtheria.—This disease also showed an increase over the previous year, 473 cases being notified as against 354 in 1933. There were 26 deaths from this disease. Small-Pox—Three cases of small-pox were notified, all being members of the same household. The first case was that of a young man, unvaccinated, who probably contracted the disease outside the Borough. He died three days after admission to Hospital. Two further cases were notified and removed to Hospital, but in one of these the diagnosis was not confirmed. Typhoid Fever.—Four cases of this disease were notified, and three of them were removed to Hospital. In two of the cases the diagnosis was not confirmed. Of the two actual cases, one was known to have contracted the disease outside the Borough, and in other the source of infection was not traced. Para-typhoid Fever.—Two cases of this disease occurred. In one of them the source of infection was traced to a source outside the Borough, and in the other the source was not discovered. Ophthalmia Neonatorum.—During the year seventeen 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 17 13 4 17 — — 50 Table showing Cases of Infections Disease Notified, 1934. 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 1 1 — — 3 3 Scarlet Fever 3 22 57 79 103 569 274 56 87 20 7 — 1277 1059 Diphtheria 5 13 21 25 19 220 91 20 50 6 3 — 473 470 Typhoid Fever — — — — — — 1 1 — — — 4 3 Paratvphoid Fever — — — 1 — — — — — 1 — — 2 1 Puerperal Fever — — — — — — — — 8 4 — — 12 10 Puerperal Pyrexia — — — — — — — — 23 8 — — 31 20 Erysipelas — 1 — — 1 4 4 7 23 29 51 21 141 68 Acute Primary & Influenzal Pneumonia 6 8 13 9 12 39 10 15 42 32 59 28 273 103 Ophthalmia Neonatorum 17 — — — — — — — — — — — 17 4 Cerebro-Spinal Meningitis — — 2 — — — — 1 2 — — — 5 5 Acute Anterior Polio-Myelitis — — — — 1 2 — 1 — — — — 4 3 Encephalitis Lethargica — — — — — — — — — 1 — — 1 1 Totals 31 44 93 114 136 836 379 102 237 102 120 49 2243 1760 51 Table showing Number of Deaths from Infectious Diseases in 1934. 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 1 upwards | Typhoid and Paratyphoid Fevers — — 1 — — — — — — — — 1 Measles 2 5 6 5 — — 1 — — — — 19 Scarlet Fever — — — 3 1 — 1 — — — — 5 Whooping Cough 4 4 3 2 — — — — — — — 13 Diphtheria 1 2 5 15 1 — — 1 1 — — 26 Influenza — 1 — — 1 1 1 5 4 12 5 30 Encephalitis Lethargica — — — — — 2 — 1 — — — 3 Cerebro-Spinal Fever — — 2 — — 2 — — — — — 4 Puerperal Fever — — — — — 1 1 — — — — 2 52 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 69 phials of 8,000 units each (for treatment) and 11 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, 1933:— Number of Births registered from 1st January to 31st December, 1933 2,089 Number of these Births duly entered by 31st January, 1935, in the Vaccination Register :— Successfully Vaccinated 1,251 Insusceptible to Vaccination 8 Number in respect of whom Statutory Declarations of Conscientious Objection have been received 1,095 Died unvaccinated 89 Number of these Births which on 31st January, 1935, remained unentered in Vaccination Register on account of Postponement by Medical Certificate 33 Removal to districts, the Vaccination Officers of which have been duly appraised 57 Removal to places unknown 91 Number of these Births remaining on 31st January, 1935, neither duly entered in Vaccination Register not temporarily accounted for 05 Total number of Certificates and copies of Certificates of successful Primary Vaccination of Children under 14 received during the calendar year, 1934 1,421 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, 1934 1,085 Vaccination by Medical Officer of Health. No vaccination was performed by this officer under the Public Health (Smallpox Prevention) Regulations, 1917. 53 Tuberculosis. Notification.—During the year 287 new cases of pulmonary, and 60 new cases of non-pulmonary tuberculosis were received. The number of cases on the tuberculosis register at the commencement and end of the year is shown in the following table:— Pulmonary. Non-pulmonary. M F M F Number of Cases on Register at commencement of year 584 500 142 187 ,, ,, Notified during the year 153 134 27 33 ,, ,, removed from the register 113 132 25 27 ,, ,, remaining on the register at end of the year 624 502 144 193 Mortality.—During the year 129 persons died from pulmonary tuberculosis, and 13 died from other forms of this disease. The death rate from pulmonary tuberculosis was 0.58 per 1,000 inhabitants, as compared with 0.64 per thousand in 1933. Age Distribution—The following table shows the age distribution of the new cases and deaths 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 2 — 10 5 — — 3 1 5 3 — 3 5 1 4 2 — 10 3 9 3 7 — — — — 15 16 12 5 4 8 14 2 3 20 25 31 1 2 — — — — 25 44 42 2 2 16 22 2 — 35 31 25 — 4 11 11 — — 45 23 9 1 4 16 9 — — 55 2 4 2 — 7 4 — — 65 and upwards 4 2 — — 3 3 — — Totals 153 134 27 33 62 67 9 4 54 Efficiency of Notification.—The ratio of non - notified tuberculosis deaths to total tuberculosis deaths was one in nine. 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. Tuberculosis Dispensary.—The Council's Dispensary is situated at 47, Catford Hill, S.E.6. Particulars of the sessions held are shown in the following table: — Monday 2 p.m. to 4 p.m. Women, and Children not at school 4.30 p.m. to 5.30 p.m. Children attending school Tuesday 10 a.m. to 12 noon Men (not working) Thursday 4.30 p.m. to 5 p.m. Children attending school 5 p.m. to 7.30 p.m. Men and Women at work only Friday 10 a.m. to 12 noon Women, and Children not at school Plans have been prepared and approved by the Ministry of Health and the London County Council for the provision of a new Tuberculosis Dispensary to be erected on a portion of the Priory Site. The present dispensary was established in 1916 in a private dwelling house rented by the Council. Later, in 1920, the freehold was purchased. In 1925 the adjoining house, No. 45, Catford Hill, was purchased, but only a small part of these premises is available for use at the present time. Both these houses have become structurally dangerous and in a very bad state of repair, and temporary works have been carried out to render them safe for a short period. The new Tuberculosis Dispensary building will be built at the rear of the Maternity and Child Welfare Clinic, and will have a frontage to Blagdon Road, from which it will be entered, so that both the entrances and the buildings for the two services will be separate. The building will consist of two floors, the ground floor being allocated for the actual dispensary work, whilst the first floor Tuberculosis Dispensary Plan of Proposed New Tuberculosis Dispensary. 55 will be utilized for the activities of the Care Committee. On the ground floor the accommodation will comprise a patients' waiting room, a record room, a history and weighing room, dressing cubicles, a doctor's consulting room, an office dispensary, health visitors' offices and lavatories. On the first floor there will be a large committee room, a small waiting room, secretarial offices and store, clerk's office, members' and staff cloak room and lavatories. The heating will be by means of a low pressure hot water system. Report of the Tuberculosis Officer. Cases on Register.— The number of cases on the Town Hall Register on December 31st, 1934, was 1,463, comprising 1,126 cases of pulmonary tuberculosis and 337 cases of non-pulmonary tuberculosis. The number of cases on the Dispensary Register was 947, of which 780 were of pulmonary and 167 of nonpulmonary tuberculosis, showing that 64 per cent, of all tuberculous cases in the Borough have attended the Dispensary for examination. Every notified case of tuberculosis is visited at home by the Dispensary staff, whether or not they have attended the Dispensary. Attendance of Patients.—During the year the new cases who attended the Dispensary numbered 672 and the total attendances were 2,847. Of the new cases 200 were referred to the Dispensary by their own doctors, 132 applied on their own initiative, while 228 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 1934 of all patients diagnosed as suffering from pulmonary tuberculosis who have attended the dispensary since its foundation in June, 1916. All cases remaining in the Borough are followed up year by year and the records of those who leave the Borough are transferred to the district to which they remove. Home Visiting—The number of visits paid to the homes of the patients was considered insufficient by the Inspector of the Ministry of Health and for this reason a third Health Visitor was appointed in April and the Borough was divided into three districts, each Health Visitor taking charge of the homes of tuberculous patients in 56 her own district. Table B gives a summary of the work of the Health Visitors. The visits paid by them were 1,449 in excess of those paid in 1933. The Tuberculosis Officer paid 356 visits to the homes of patients and saw 14 patients in their own homes in consultation with their own doctors. Reports.—Written reports to the number of 1,040 were sent out from the Dispensary. Residential Treatment.—The London County Council admitted 133 insured and 60 uninsured patients to residential institutions. The Lewisham Hospital admitted 32 patients referred by the Dispensary, these being seriously ill cases in urgent need of treatment and having unsuitable home conditions. The appointment of the Tuberculosis Officer as Consultant in tuberculosis to the Lewisham Hospital has been continued and 45 visits have been paid during the year to the two wards containing 26 male and 26 female patients respectively. The Hospital is under the control of the London County Council and patients from other Boroughs than Lewisham are also admitted to its wards. Affiliated and Other Hospitals.—Greater use has been made of the out-patients' department of St. John's Hospital during 1934. To carry out the wishes of the Ministry of Health and of the London County Council an arrangement was made whereby Dispensary patients could be sent to the Hospital for X-ray examination as an aid to diagnosis. During 1934 ninety-one X-ray examinations were made at a cost of £68 5s. Od. In two cases pulmonary tuberculosis was found by X-ray examination where it had not been suspected clinically and in both cases tubercle bacilli were subsequently found in the sputum. Treatment by artificial pneumothorax has been found to be most beneficial and the majority of the refills are carried out in the Outpatients' Department of St. John's Hospital. During the year 46 patients made 587 attendances at a cost of £308 3s. 6d. A few 57 of these refills are carried out at other Hospitals, such as St. Thomas', Charing Cross, Margaret Street, Grove Park and the Colindale, to suit the convenience of individual patients. For laryngeal examination and surgical diagnosis some patients have been sent to King's College Hospital and the Miller Hospital ; and for Light treatment to the London Hospital and St. Thomas'. Five patients made 172 attendances for Light treatment at a cost of £19 2s. 0d. Sputum Tests.—The sputum of 277 patients was examined and reported upon by the Pathological Department of St. John's Hospital. Dental Treatment.—During the year 20 patients attended St. John's Hospital for dental treatment and 4 patients were assisted in the provision of dentures. Extra Diet.—This was granted to 6 patients to enable them to maintain their working capacity after Sanatorium treatment. Shelters.—The six shelters loaned by the Borough Council to tuberculous patients having insufficient sleeping accommodation, were in constant use. Care Committee.—The Secretary of the Care Committee reports that the Committee met 26 times during the year. From January 1st to August 8th the number of cases considered for assessment for residential treatment was 211, of whom 141 were passed as free cases, 5 were ex-service pensioners, whose payment is dealt with by the Pensions Committee, 57 were asked to pay amounts varying from 2s. 6d. to 50s. per week, and 8 cases were cancelled for various reasons. The total amount collected and forwarded to the London County Council was £304 6s. 9d. The London County Council decided that after August 8th, 1934, institutional treatment should be free of charge, although patients wishing to contribute towards the cost of their treatment were permitted to do so. Of 115 cases recommended for Sanatorium treatment during this period, 5 contributed in all £26 6s. 0d. 58 The cases considered for various kinds of help from the Care Committee, numbered 264, while 157 cases were provided with clothing. The Care Committee is dependant on voluntary help for its finances and has, during last year received a grant from the Sunday performances of the Gaumont Cinema. The Chairman organised whist drives and other entertainments to swell the fund. Direct financial assistance amounting to £268 5s. 8d., was given to patients and their dependants. At the end of the year the voluntary fund stood at £177 8s. 7d. Handicraft Class.—This class has now been taught by the same Instructress for 9 years; it helps greatly in keeping idle hands employed and depressed minds cheerful. The pupils are those unfit for regular work and well enough to attend once a week. The articles they make are sold either privately or at organised sales and the pocket money earned is an incentive to further effort. The Borough Council gives an annual grant of £10 for this class. Tables A—F give in statistical form a summary of the work carried out at the Dispensary. Appended is the Table required annually by the Ministry of Health. 59 TABLE A. Condition on 31st December, 1934, 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 1930 1931 1932 1933 1934 Totals No. of Cases 74 157 200 185 200 159 165 181 166 165 204 195 249 200 228 219 191 182 215 3535 Dead 49 75 90 66 93 80 83 87 85 83 92 91 105 95 88 75 57 39 15 1448 Left 14 52 59 62 52 39 52 55 41 41 53 56 79 45 62 52 36 23 12 885 Well — 2 — 7 3 2 5 9 3 8 19 14 31 23 46 57 60 59 53 401 Fair 1 1 — 1 3 7 2 4 10 10 6 10 7 20 20 27 27 49 117 322 Unwell 1 — — — — — 2 1 1 1 1 — — — 4 6 8 10 18 53 Discharged as arrested or diagnosis not confirmed 9 27 51 49 49 31 21 25 26 22 33 24 27 17 8 2 3 2 — 426 Totals 74 157 200 185 200 159 165 181 166 165 204 195 249 200 228 219 191 182 215 3535 60 Table B. Summary of Tuberculosis Health Visitors' Work, 1934. ex-Service Patients. Civilian Patients. Total. Visits to Pulmonary Tuberculous Patients 45 224 269 ,, Non-pulmonary ,, ,, 2 64 66 Subsequent Visits 337 2902 3239 Visits to Un-notified Patients 29 369 398 No of patients occupying Separate Room 14 124 138 ,, sharing with 1 other 29 124 153 ,, ,, ,,2 others 3 27 30 ,, ,, ,, 3 ,, 1 9 10 ,, ,, ,, 4 ,, — 3 3 ,, ,, ,, 5 ,, — 1 1 No. of Patients occupying Separate Bed 15 154 169 „ ,, sharing with 1 other 32 127 159 ,, ,, ,, 2 others — 5 5 ,, ,, ,, 3 others 2 2 Table C. Attendances of Patients at the Dispensary. 1934 First Attendances. Subsequent Attendances. Totals. January 54 211 265 February 31 182 213 March 50 180 230 April 56 161 217 May 57 169 226 June 59 157 216 July 79 214 293 August 72 187 259 September 54 174 228 October 62 199 261 November 55 173 228 December 43 168 211 672 2,175 2,847 61 Table D. Summary of First Attendances at the Dispensary, 1934. Applied on own initiative Sent by Doctor . Transferred from Hospitals, etc. Sent by L.C.C. Sent by Care Committee Contacts. Totals. Pulmonary 38 86 89 1 1 215 Non-Pulmonary 14 2 14 — — — 30 Non-Tuberculous 79 110 5 2 1 227 424 Suspects 1 2 — — — — 3 Total 132 200 108 3 1 228 672 Table E. Stages in Pulmonary Tuberculosis. Male. Female. Children under 15. Total. Stage I. 28 16 7 51 ,, II 76 65 3 144 ,, III 10 8 2 20 114 89 12 215 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 4 1 6 Bone 5 4 5 14 Other Regions 3 5 2 10 9 13 8 30 62 Return showing the work of the Dispensary during 1934. (Form T.145 of Memorandum 37/T (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 83 50 1 4 8 10 9 5 91 66 3 9 169 Diagnosis not completed — — — — — — — — 12 9 1 1 23 (c) Non-tuberculous — — — — — — — — 53 85 20 15 179 B.—Contacts examined during the year:— (a)Definitely tuberculous — — — 1 — — — — — — — 1 1 (b) Diagnosis not completed — — — — — — — — 1 1 — — 2 (c) Non-tuberculous — — — — — — — — 23 64 60 78 225 C.—Cases written off the Dispensary Register as:— (a) Recovered 27 35 — 3 3 6 6 4 30 41 6 7 84 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 88 158 86 94 426 D.—Number of Cases on Dispensary Register on 31st December :— (a) Definitely tuberculous 428 318 15 19 35 55 35 42 463 373 50 61 947 (b) Diagnosis not completed — — — — — — — — 1 2 — — 3 1. Number of cases on Dispensary Register on 1st January 967 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 356 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 73 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3638 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases" lost sight of" 87 10. Number of:— (a) Specimens of sputum, etc., examined 277 (b) X-ray examinations made in connection with Dispensary work 91 4. Cases written off during the year as Dead (all causes) 92 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 5. Number of attendances at the Dispensary (including Contacts) 2847 12. Number of "T.B.plus"cases on Dispensary Register on 31st December 521 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 159 13. Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 1 7. Number of consultations with medical practitioners:— (a) Personal 14 (b) Other 432 Provided by Voluntary Bodies — 33 INDEX TO CONTENTS. Subject Page Agricultural Produce (Grading and Marking) 40 Ante-natal Clinics 15 Bacteriological Examination of Milk 34 Bacteriological Examinations 24 Bakehouses 40 Births 7 Cleansing Station 25 Coroner's Court and Mortuary 24 Deaths 9 Dental Treatment 21 Diphtheria Anti-Toxin 52 Disinfection 25 Downham Ante-natal Clinic 18 Factories and Workshops 27 Food and Drugs, Analysis of 43 Food Poisoning 40 Food Shops and Stalls 40 Health Visitors 22 Home Helps 21 Home Nursing 23 Housing Statistics 30 Infant Clinics 18 Infant Life Protection 23 Infant Mortality 9 Infectious Diseases 48 Legal Proceedings 29 Marriages 8 Maternity and Child Welfare Clinic, New Premises 19 Maternity Home 13 Maternity Outfits 21 Merchandise Marks Act 40 Midwives 23 Milk Assistance Scheme 21 Milk Supply 34 34 Subjcct Page Neo-natal Deaths 10 Obstetric Consultants 21 Population 7 Post-natal Clinic 18 Rats and Mice (Destruction) Act 29 Refuse Removal and Disposal 25 Restaurants and Eating Houses 40 Sanitary Inspection 20 Slaughterhouses 37 Slum Clearance 32 Smoke Abatement 29 Statistics 5 Tuberculosis Dispensary 54 Tuberculosis, Notifications, etc. 53 Tuberculosis Officer's Report 55 Vaccination 52 Voluntary Infant Welfare Centres 20