LEW 23 METROPOLITAN BOROUGH OF LEWISHAM. REPORT of the Medical Officer of Health For the Year 1935. 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 1935, on the Health and Sanitary condition of the Borough, this being the thirty-fifth of the series. An examination of the statistical figures contained therein shows that the health of the Borough remains satisfactory. The corrected death rate from all causes amounted to 10 per thousand of the population compared with 10.1 in the previous year. The Infant Mortality rate was 43 per thousand births, the same as in 1934. The rate for the County of London was 58 per thousand births. The birth rate was 12.5 per thousand, a slight increase on 1934, when it was 12.2 per thousand- The death rate from Pulmonary Tuberculosis was 0.58 per thousand, the same as in 1934. There was a decrease in the incidence of Scarlet Fever and Diphtheria, 830 cases of Scarlet Fever being notified, compared with 1,277 for 1934, and 314 cases of Diphtheria, as against 473 in the previous year. A scheme for immunisation of children against diphtheria came into operation in June. The Maternity and Child Welfare services were extended during the year by the provision of an additional session at the Downham Infant Welfare Centre and the establishment of an Infant Welfare Centre in Brockley. These additional services necessitated the appointment of Dr. Evelyn Davies on a full time basis. Building operations in connection with the erection of the New Maternity and Child Welfare Clinic and Tuberculosis Dispensary, on the Priory site, were also commenced. Slum clearance proceeded during the year, and a survey of certain areas of the Borough was commenced in connection with sections 1 and 2 of the Housing Act, 1935, to ascertain the extent of overcrowding. It is a pleasure to again record my appreciation of the kind consideration accorded me by the Chairmen 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 1935. 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 Officers. Evelyn Davies, m.r.c.s., l.r.c.p., d.p.h. Mary Stoker Murdy, m.b., b.s., m.r.c.s , l.r.c.p. (part-time). 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. Morlev Greenop, m.r.c.s., l.r.c.p. Public Analyst. A. J. Lickorish, f.i.c. Sanitary Inspectors—Male. Berry, J. H. (a) Brittain, R. C. (a) (6) Craven, J. R. (a) (b) Crowther, J. (a) (b) Holifield, C. E. (a) (b) Phillips, A. J. (a) (6) Rayner, S. P. (a) (b) Thomas, A. G. (a) (b) Walker, E. (a) (6) Sanitary Inspector—Female. Miss D. M. Parnell (a) Sampling Officer and Food 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) (c) Miss C. H. Thompson (a) (d) (e) Miss W. Crcsswell (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. VVardle (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. E. Stephan Matron of Maternity Home. Mrs. D. Fynn Clerk-Dispenser, Maternity Home and Clinics Mrs. M. lles 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. I 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. (e) Trained Nurse. 6 STATISTICS. General Statistics, 1935. Area of the Borough 7,015 acres. Population : — Census, 1931 219,953 Estimated, Mid-year, 1935 223,000 Number of inhabited houses (end of 1935) according to Rate Books 50,000 Rateable Value (at April, 1935) £1,703,333 Sum represented by a penny rate £6,777.16.11. Extracts from Vital Statistics, 1935. Total. Males. Females. Live Births:—Legitimate 2,690 1,354 1,336 Illegitimate 102 53 49 Birth Rate per 1,000 of the estimated population 12.5 Total. Males. Females. Still-Births 98 51 47 Rate per 1,000 births (live and still-births) 35 Total. Males. Females. Deaths 2,214 1,070 1,144 Death Rate per 1,000 of the estimated population : — (crude) 9.9 ; (corrected) 10.0 Deaths from Puerperal Causes : — Rate per 1,000 Deaths. (live and still) Births. No. 29 Puerperal Sepsis 3 1.07 No. 30 Other Puerperal Causes 9 3.22 Total 12 4.29 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 39 Illegitimate infants per 1,000 illegitimate live births 127 Deaths from Measles (all ages) 3 „ „ Whooping Cough (all ages) 3 „ „ Diarrhœa (under 2 years of age) 18 7 Population. The Registrar-General's estimate of the population of the Borough at mid-year, 1935, is 223,000, 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 1935 was supplied by the Registrar-General : — Total Registered Inward Transfers Outward Transfers Births allocated to Borough Legitimate Males 1,351 123 120 1,354 Legitimate Females 1,324 110 98 1,336 Illegitimate Males 58 17 22 53 Illegitimate Females 60 8 19 49 Total 2,793 258 259 2,792 It will be seen that the corrected number of births is 2,792, which is equivalent to a birth rate of 12.5 per 1,000. The births and birth rates in the last ten years are shown herewith : — Year. No. of Births. Birth Rate. 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 1935 2,792 12.5 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 2,699 births. Still-Births. Notifications of 89 still-births were received, and details of these are as follows : — Total number notified 89 Out-of-Borough cases born in the Borough, and not investigated 5 Borough Cases born outside the Borough 12 Number of Borough cases 84 Borough cases in which no enquiry could be made 15 The causes of still-birth in the 69 cases which were investigated were as follows : — Maternal Causes : Toxaemia 23 Eclampsia 1 Ante-partum Hæmorrhage :— Placenta Prævia 1 Accidental Hæmorrhage 5 Delayed Labour 1 Difficult Instrumental Labours 12 Syphilis 1 Hydramnios 1 Fall 1 Shock 2 Fatal Causes: Breech Presentation 8 Cord Presentation 1 Monstrosity 1 Causes not known 11 Marriages. The number of marriages registered in the Borough during the year was 1,860, compared with 1,726 in 1934. Of this number, 1,034 were solemnised in the Established Church, 218 in Non-conformist Places of Worship, and 608 at the Register Office. 9 Deaths. The number of deaths of Lewisham residents registered in 1935 was 2.214, and the corrected death rate was 100 per 1,000 persons. The deaths and death rates recorded in the last ten years are shown hereunder : — Year. No. of Deaths. Death Rate. 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 1935 2.214 10.0 Deaths in Public Institutions. The deaths occurring in Hospitals and other Public Institutions in the Borough numbered 1,192, of which 854 were residents, and 312 residents died in Institutions outside the Borough. Infant Mortality. The number of infants who died before reaching one year of age was 119, 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. 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 1935 119 43 58 10 Neo-natal Deaths. The number of infants who died in the first four weeks of life was 70, and the causes of death were as follows : — Prematurity 34 Atelectasis 7 Broncho-pneumonia 4 Inter-cranial Hæmorrhage 4 Breech Delivery 2 Gastro-enteritis 3 Congenital Heart Disease 7 Spina Bifida 2 Marasmus 2 Pyloric Stenosis 3 Imperforate Anus 1 Want of attention at Birth 1 Investigations were made into the circumstances of the 69 stillbirths and 70 neo-natal deaths, and it was found that 30 mothers received no ante-natal care whatsoever, 16 paid an occasional visit to their own doctors, 10 were supervised by a midwife, 60 attended a Hospital clinic, and 23 had attended one of the Ante-natal clinics provided by the Borough Council. 11 Table showing Causes of Death at Different Periods of Life during the Year 1935. 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 — — — — — — — — — — — — F — — — — — — — — — — — — 2. Measles — — — — — — — — — — — — F 3 — 1 — 2 — — — — — — — 3. Scarlet Fever M — — — — — — — — — — — — F 1 — — — 1 — — — — — — — 4. Whooping Cough M 3 3 — — — — — — — — — — F — — — — — — — — — — — — 5. Diphtheria M 9 — — — 9 — — — — — — — F 5 — — 3 2 — — — — — — — 6. Influenza M 10 1 1 — — — 1 1 1 1 1 3 F 16 — — — — — — 1 — 1 6 8 7. Encephalitis Lethargica M — — — — — — — — — — — — — — — — — — — — — — — — 8. Cerebro-Spinal Fever M 2 1 — — — — —1— — — — — — F 1 — — 1 — — — — — — — — 9. Tuberculosis of Respiratory System M 70 — 2 — 2 9 14 19 13 7 4 — F 61 — — — 2 20 19 12 3 3 1 1 10. Other Tuberculous Diseases M 10 1 — 1 2 2 1 1 2 — — — F 6 — 1 — 1 1 2 1 — — — — 11. Syphilis M 6 — — — — — — 2 3 1 — — F — — — — — — — — — — — — 12. General Paralysis of the Insane. Tabes Dorsalis M 3 — — — — — — 1 — 2 — — F 1 — — — — — — — — — 1 13. Cancer, Malignant Disease M 164 — — — 1 2 3 9 22 44 58 25 F 180 — 1 1 — 8 13 28 41 42 46 14. Diabetes M 11 — — — — — 1 — — 5 4 1 F 13 — — — — — — — 1 2 3 7 15. Cerebral Haemorrhage, etc. M 38 — — — — — — — 7 6 6 19 F 62 — — — — — 1 1 3 8 21 28 16. Heart Disease M 238 — — — 2 4 6 10 19 51 70 76 F 306 — — — 2 — 7 5 17 35 97 143 17. Aneurysm M 9 — — — — — 1 — 1 3 4 F 1 — — — — — — — — — 1 18. Other Circulatory Diseases M 69 — — — — — — — 2 17 27 13 F 68 — — — — — — 1 4 6 16 41 19 Bronchitis M 31 — — — — 1 — 1 — 6 8 15 F 21 1 — — — — — 2 1 — 4 13 12 Table showing Causes of Death at Different Periods of Life during the Year 1935—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 36 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 61 8 1 4 2 1 2 7 4 10 11 11 F 48 7 2 1 — 2 3 3 3 6 7 14 21. Other Respiratory Diseases M 10 — — 1 — 1 — — 2 3 1 2 F 9 — 1 2 — — 1 — — — 3 2 22. Peptic Ulcer M 16 — — — — — — — 4 7 4 1 F 4 — — — — — — — — — 2 2 23- Diarrhœa, etc. M 13 9 1 1 1 — — — — — 1 — F 12 7 1 — — — — — 1 — 1 2 24. Appendicitis M 7 — — 1 1 1 — — — 3 — 1 F 9 — — 1 1 — 1 1 — 2 1 2 25. Cirrhosis of Liver M 5 — — — — — — 1 1 3 — F 5 — — — — 1 — — 1 1 2 — 26. Other Diseases of Liver, etc. M 3 — — — — — — — 1 — — 2 F 9 — — — — 1 2 1 5 27. Other Digestive Diseases M 23 3 — — 1 — 1 1 3 5 5 4 F 21 — — 1 — 2 1 2 1 2 4 8 28. Acute & Chronic Nephritis M 42 — — 1 1 — 1 3 12 6 14 4 F 50 — — — — — 1 2 5 11 17 14 29. Puerperal Sepsis F 3 — — — — — 2 — 1 — — — 30. Other Puerperal Causes F 9 — — — — — 6 3 — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. M 42 42 — — — — — — — — — — F 29 27 — 1 1 — — — — — — — 32. Senility M 25 — — — — — — — — — 1 24 F 72 — — — — — — — — — 9 63 33. Suicide M 14 — — — — — 3 1 4 3 2 1 F 7 — — — — — 2 3 — — 1 1 34. Other Violence M 50 2 1 1 3 5 5 8 2 6 6 11 F 27 1 — — 1 1 4 2 — 1 6 11 36. Other Defined Diseases M 95 4 2 3 2 6 2 7 12 10 26 21 F 85 2 1 1 5 2 8 4 15 15 11 21 36. Causes ill-defined or unknown M 1 — — — — — — — — 1 — — F — — — — — — — — — — — — Totals M 1070 74 8 13 27 32 42 71 115 198 256 234 F 1144 45 8 12 17 30 66 56 85 136 257 432 13 Table showing the Birth, Death and Infantile Mortality rates during 1935 in the Metropolitan Cities and Boroughs. Birth Rate. Adjusted Death Rate. Infant Mortality Rate. City of London 7.6 LEWISHAM 10.0 LEWISHAM 43 Holborn 7.6 Wandsworth 10.2 Woolwich 44 Westminster 8.3 Hampstead 10.5 Poplar 46 St. Marylebone 9.7 Stoke Newington 10.6 Hackney 47 Chelsea 10.2 Chelsea 10.7 Hampstead 49 Hampstead 11.0 Woolwich 10.8 Bethnal Green 51 Wandsworth 11.0 Islington 10.9 Fulham 51 Kensington 12.4 Greenwich 11.0 Stoke Newington 51 LEWISHAM 12.5 Hackney 11.1 Deptford 52 St. Pancras 13.3 Kensington 11.3 Islington 52 Camberwell 13.4 Deptford 11.5 Shoreditch 52 Lambeth 13.6 Bethnal Green 11.6 Wandsworth 55 Fulham 13.8 Fulham 11.7 St. Marylebone 56 Greenwich 13.8 St. Marylebone 11.7 Chelsea 59 Stoke Newington 13.9 Camberwell 11.8 Finsbury 59 Hackney 14.0 Westminster 11.8 Greenwich 59 Woolwich 14.0 Battersea 11.9 Lambeth 59 Paddington 14.1 Paddington 11.9 Camberwell 60 Battersea 14.2 Lambeth 12.0 St. Pancras 62 Stepney 14.3 City of London 12.2 Stepney 63 Bethnal Green 14.4 St. Pancras 12.2 Battersea 65 Deptford 14.4 Hammersmith 12.3 Southwark 66 Bermondsey 14.5 Poplar 12.3 Bermondsey 69 Shoreditch 14.6 Shoreditch 12.4 Hammersmith 70 Finsbury 14.7 Southwark 12.4 Paddington 71 Hammersmith 14.7 Holborn 12.7 Westminster 72 Islington 14.8 Stepney 12.8 Kensington 79 Southwark 14.8 Bermondsey 13.3 Holborn 89 Poplar 15.4 • Finsbury 13.7 City of London 113 14 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. 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 315 Number of Primiparae 179 Number of Multiparæ 136 Number of Infants born (3 sets of Twins) 318 15 Presentations: Vertex 307 Pelvic 9 Face 1 Born before arrival 1 Obstetric Operations: Forceps 2 Minor Operations 97 Post-Partum Hæmorrhage 1 Puerperal Morbidity 1 (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 6 Details of the Still-Births are as follows : — Still-Births. Maturity Cause of Death Remarks 3 Premature Unknown Two Macerated 1 ,, Anencephalic Macerated 1 Full term Partial Separation of — Placenta 1 ,, ,, Early Rupture of — Membranes The sex incidence of the Infants was as follows :— Males, 151; Females, 167 .. Total, 318 The average length and weight of the full-term infants were as follows : — Males, Length, 21.72 ins. Weight, 71bs. 8.06 ozs. Females. Length, 21.39 ins. Weight, 71bs. 3.05 ozs. Progress of Infants while in the Home :— Number born alive 312 Died within 3 days 4 Over birth weight on discharge 207 Equal to birth weight on discharge 10 Under birth weight on discharge 89 Transferred with Mother to another Institution 2 Number of Infants entirely breast fed 302 Number of Infants in which breast feeding was supplemented 6 16 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 1935 are as follows: — Number of Sessions held 148 Number of Patients examined 706 Number of Attendances made by all Patients 4,018 Number of Primigravidæ examined 314 Number of Multigravidæ examined 314 Number who were found to be not pregnant 23 Number of normal labours 400 Number of abnormal labours 52 Number undelivered at the end of 1935 199 Number removed from the district 32 Number sent by the Maternity Home 516 Number sent by Midwives 105 Number sent by Doctors and Institutions 5 Number who came on their own initiative 72 Number who came at the suggestion of the Health Visitor 8 Number who attended for Post-natal examination 215 The labours that ended abnormally are classified as follows : — Face 1 Ante-Partum Haemorrhage 1 Breech 11 Induction 6 Forceps 5 Induction + Forceps 1 Forceps and Breech 1 Caesarean 1 Forceps and Manual Premature Birth 5 Removal of Placenta 1 Still-births 8 Adherent Placenta 4 Miscarriage 6 Partial separation of Placenta 1 17 The Complications found are classified as follows : — Complication. Primiparæ Multipara Not Pregnant Total Diseases and Disorders of the Reproductive System Miscarriage — 3 — 3 Prolapse — 2 — 2 Cystocele — 12 — 12 Rectocele — 2 — 2 Leucorrhœa — 2 — 2 Purulent Vaginal Discharge 4 6 — 10 Diseases and Disorders oj the Digestive System : Dental Caries 100 91 1 198 Alveolar Abscess 1 — — 1 Pyorrhoea 2 3 — 5 Heartburn 47 30 — 77 Hyperemesis 12 17 — 29 Indigestion 38 34 — 72 Glossitis 1 — — 1 Constipation 138 104 — 242 Diseases of Respiratory System : Laryngitis 1 — — 1 Nasal Catarrh 21 17 — 38 Bronchitis 29 30 59 Disorders of the Circulatory System: Valvular Disease of the Heart 5 7 — 12 High Blood Pressure 149 85 — 234 Varicose Veins of Lower Limbs 67 92 — 159 Varicose Ulcer — 1 — 1 Haemorrhoids 9 18 1 28 Epistaxis 8 5 — 13 Diseases and Disorders of the Nervous System: Insomnia of Pregnancy 29 44 — 73 Diseases of the Urinary System : Albuminuria of Pregnancy 17 6 — 23 Glycosuria of Pregnancy 13 6 — 19 Prolapse of Bladder 1 1 — 2 Affections of the Skin : Urticaria 4 1 — 5 Psoriasis — 1 — 1 Herpes 1 — — 1 Pruritus — 1 — 1 Furunculosis 2 2 Intertrigo — 1 — 1 Papilloma 1 2 — 3 General Diseases : Anaemia of Pregnancy 5 5 — 10 Enlarged Thyroid — 1 — 1 Malpresentations 6 2 — 8 No Complications found 30 28 15 73 18 Post-Natal Clinic.—This Clinic has been held throughout the year on Tuesday mornings. It is gratifying to note that the number of mothers who attended for a post-natal examination shows an increase on last year. X-Ray Examinations.—During the year six X-Ray examinations of pregnant women were carried out at St. John's Hospital. Downham Ante-natal Clinic.—This Clinic is held at the Downham Health Centre on one morning each week. During the year 118 women attended, the total attendances amounting to 277. Seven women attended for a post-natal examination. 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 two mornings in each week at the Downham Health Centre. It was found necessary to hold an additional session at the Downham Centre to relieve the congestion which existed. The Clinics are attended by one of the Maternity and Child Welfare Medical Officers and two Health Visitors at each session. Attendances during 1935: — Rushey Green Clinic. Downham Clinic. No. on Register Attendances No. on Register Attendances Mothers - 726 2,770 Mothers - 256 1,178 Infants 1,675 8,906 Infants 580 2,883 The cases treated during the year were classified as follows : — Mothers' Clinic. Rushey Green Downham. Diseases and Disorders of the Reproductive System 294 185 Diseases and Disorders of the Alimentary System 205 105 Diseases and Disorders of the Respiratory System 20 42 Diseases and Disorders of the Nervous System 1 1 Diseases of the Urinary System 13 — Affections of the Skin 6 11 Diseases of the Eye 2 8 General Diseases 226 53 Consultations 1339 497 19 Infants' Clinic. Rushey Green. Down ham Diseases and Disorders of the Alimentary System 385 154 Diseases and Disorders of the Respiratory System 663 204 Diseases and Disorders of the Circulatory System 4 4 Diseases of the Urinary System 7 3 Affections of the Skin 161 111 Diseases of the Ear 35 3 Diseases of the Eye 34 15 Scalds and Burns 2 1 Rickets 21 7 General Diseases 144 62 Consultations on Feeding and Management (under 1 year) 2,660 932 Consultations on Feeding and Management (1-5 years) 2,665 973 Voluntary Infant Welfare Centres. There are eleven Voluntary Infant Welfare Centres in the Borough, and the attendances at these during the year are summarised helow :— „ . , ... , 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 50 1,985 3,278 Brockley Infant Welfare Centre 34 1,067 776 Catford School for Mothers 99 5,179 2,720 Downham Infant Welfare Centre 47 3,061 4,003 Forest Hill School for Mothers 49 5,103 3,200 Grove Park Infant Welfare Centre 49 2,626 2,307 Hither Green Mothers' & Babies' Welcome 48 2,814 3,602 Lee and Blackheath School for Mothers 47 3,626 3,017 St. Mary's School for Mothers 51 4,435 2,230 Sydenham Infant Welfare Centre 101 4,762 1,934 Upper Sydenham Infant Welfare Centre 48 1,540 1,200 A new voluntary Infant Welfare Centre was opened in April at St. Cyprian's Hall, Brockley. This Centre will provide for the needs of the families residing on the new London County Council Honor Oak Estate, the development of which is proceeding very rapidly, and also for those on a part of the adjoining Deptford Borough Council Estate. 20 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 carried out by the Dental Department of the St. John's Hospital, Lewisham. During the year dental treatment was provided for 102 mothers and 23 infants, and complete or partial dentures to 45 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 2,417 grants of dried milk for four weeks free of charge, and 510 grants at the reduced price of 6d. per lb. Altogether, 15,013 lbs. of dried milk were issued at a cost to the Council of £1,049. 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 359 outfits were supplied during the year, compared with 314 in the previous year. No charge was made for the outfit in 161 cases, 85 were issued at half-price, and 113 at cost price. Obstetric Consultants. The services of the Consultants whose services are retained by the Council were requisitioned by a medical practitioner in only one case of difficult confinement. Home Helps. The services of a home help were provided in fourteen cases of confinement. In a few instances the applicants were asked to make a small contribution to the cost. 21 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 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 year is summarised below : — Infants under 1 year of age :— First visits 2,637 Subsequent visits 7,861 Infants between 1 and 5 years of age :— Total visits 10,505 Expectant mothers :— First visits 858 Subsequent visits 342 Infant death enquiries 82 Still-birth enquiries 90 Visits to Puerperal Fever cases 14 Visits to Ophthalmia Neonatorum cases 22 Visits to Measles cases 214 Visits to other Infectious cases 319 Miscellaneous visits 930 Ineffectual calls 3,416 Attendances at Centres :— Municipal 608 Voluntary 648 22 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 1935 and the number of visits made, are shown in the following table : — Nature of Illness. No. of Cases. No. of Visits. Measles 21 247 Pneumonia 67 1,141 Whooping Cough 2 35 Totals 90 1,423 Midwives. The London County Council supplied the information that 49 midwives residing in the Borough gave notice of their intention to practice during 1935. Infant Life Protection. The number of foster-mothers on the Register at the end of the year was 132, and the children in their care numbered 176. The officer charged with supervising the welfare of these infants made 1906 visits to their homes during the year. 5 nurse-children died. 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 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 2,846 specimens were examined, the details being as follows : — Material from cases of suspected Diphtheria :— Diphtheria bacillus isolated 164 Negative 1,881 2,045 Sputa from cases of suspected Tuberculosis :— Tubercle bacillus found. 103 Tubercle bacillus not found 600 703 Blood from cases of suspected Enteric Fever :— Positive result 2 Negative result 75 77 Pathological specimens for Enteric Organisms :— 1 f Positive result Negative result 21 21 Total 2,846 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 376 bodies were received into the Mortuary, of which number, 111 were brought in from outside the Borough, and 155 from Public Institutions. The Inquests held numbered 260 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 : — 24 Disinfecting Station. Premises Visited 1,530 Rooms Disinfected 3,744 Articles Disinfected :— Beds 756 Blankets 3,248 Bolsters 846 Mattresses 1,718 Pillows and Cushions 3,700 Quilts 1,496 Sheets 2,280 Miscellaneous Articles 6,946 Wearing Apparel 7,152 28,142 Articles Washed. 12,642 Mattresses Re-tufted 954 Verminous Rooms Treated 335 Verminous Articles Treated 1,269 Cleansing Station. Children Treated for Vermin 1,034 Attendances at the Cleansing Station 1,723 Adults Treated for Vermin 2 Attendances at the Cleansing Station 2 Adults and Children Treated for Scabies 104 Baths Given 76 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. The tonnage collected in 1935 is shown below. Loads. Tons. Container System 22,442 37,922 Freighters 4,559 5,546 Other Vehicles 134 115 Totals 27,135 43,583 The main portion of the refuse is disposed of at the Destructors situated at Molesworth Street, Lewisham, and Home Park, Syden ham, the remainder being sent away by barges or deposited on shoots in the Borough. The following are the figures for 1935 : — 25 Tons. Home Park Destructor 17,816 Molesworth Street Destructor 17,288 Barged away 9,219 Shoots 122 Totals 44,440 The figures for disposal includes trade refuse delivered by tradesmen to the Council's dust destructors, and refuse collected from the open-air market and street traders. Sanitary Inspection of the Borough. The work of the male Sanitary Inspectors is summarised in the following statement : — Inspections . On complaint 1,565 After Infectious Disease 1,178 Notice from Builder 644 Other Inspections 3,007 Re-inspections 6,576 New Dwellings, for Water Certificates 842 Municipal Flats 192 Notices : Number of Intimation Notices Served 1,314 Number of Statutory Notices Served 315 Sanitary Improvements Effected. Premises Cleansed and Repaired 822 Drains Entirely Reconstructed 191 Drains Repaired 297 Water-closets Cleansed or Repaired 431 Soil-pipes Renewed or Repaired 182 Waste-pipes Renewed or Repaired 247 Rainwater Pipes Renewed or Repaired 204 Roof and Gutters Repaired 384 Dampness in Premises Remedied 383 Yards Drained or Paved 151 Dust-bins Provided 165 Water-cisterns Cleansed or Covered 23 Water Fittings Repaired 89 Additional water supplies provided to tenement houses 15 Defective Fire-places remedied 168 Offensive Accumulations Removed 65 Urinals Cleansed or Repaired 27 Animals Improperly Kept 19 Other Nuisances Remedied 335 26 Woman Sanitary Inspector. The woman inspector is responsible for the inspection of factories, workshops, and laundries. 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. Factories, Workshops and Workplaces. Name of Business. Factories. Workshops. Workplaces Dressmakers, Milliners, etc. 5 39 — Laundries 19 9 — Tailors 1 52 — Dentists — 35 — Bootmakers and Repairers 65 76 — Builders 18 54 — Motor Manufacturers & Repairers 40 51 12 Jewellers and Watch Repairers. — 33 — Upholsterers and Cabinet Makers — 31 — Miscellaneous 95 178 9 Totals 243 558 21 Inspection of Factories, Workshops and Workplaces. Premises, (1) Number Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory Laundries) 488 2 — Workshops (including Workshop Laundries) 1,255 3 — Workplaces (other than Outworkers' premises) 33 — — Total 1,770 5 — 27 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) (6) Nuisances under the Public Health Acts :—* Want of cleanliness 1 1 — — Want of ventilation — — — — Overcrowding 1 — 1 — Want of drainage of floors — — — Other nuisances 2 2 — — Sanitary accommodation insufficient — — — — unsuitable or defective 10 10 — — not separate for sexes 1 — — — Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse (s. 101) 2 2 _ — 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 17 15 1 — Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Shops Act, 1934. This Act received the Royal Assent on the 25th July, 1934, and came into operation on the 30th December, 1934. The Act contains important provisions for : — (a) Regulating the hours of employment of persons under the age of 18 years employed about the business of a shop or in retail trade elsewhere, and in particular for limiting the normal hours of employment of such young persons to a fortyeight hour week (fifty-two hours a week before the 27th December, 1936), and 28 (b) for securing improved arrangements for the health and comfort of all shop workers, adults and young persons alike. The provisions relating to hours of employment are administered by the London County Council. As regards the arrangements for the health and comfort of shop workers generally, while the enforcement of the provisions as to the lighting of shops, washing facilities and facilities for meals, rests with the London County Council, those regarding ventilation, temperature and sanitary conveniences are administered by the Metropolitan Borough Councils. 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. Rats and Mice (Destruction) Act, 1919. During the year 237 investigations were made into complaints of alleged rat infestation. In 127 instances, defective drains were found to be responsible, and in 80 instances the contributory cause was found elsewhere. The complaint was unfounded in 30 cases. Smoke Abatement. During the year 22 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 5 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. 35, Wearside Road, Lewisham. Default in complying with notice requiring a proper and sufficient water supply. Closing Order within 21 days. Do. do. Acting contrary to Closing Order. Defendant referred for medical examination and later removed to Mental Hospital. 29 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) 2,882 (b) Number of Inspections made for the purpose 5,949 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 367 (b) Number of Inspections made for the purpose 1,050 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 67 (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 1,303 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 871 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 30 (B) Proceedings under Public Health Acts : — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 333 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : — (a) By owners 292 (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 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 Slum Clearance. During the year the following areas, comprising a total of 73 houses, were represented to the Council for clearance : Area. Premises. Dacre Street and Dacre Square Nos. 42, 44/46, 48, 50 and 52, Dacre Street, and Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12, Dacre Square. Boones place Nos. 1, 2, 3, 4, 5, 6, 7, 8 and 9, Boones Place. Wells Road, No. 1 Nos. 41, 43, 45, 47, 49 and 51, Wells Road. Wells Road, No. 2 Nos. 55, 57, 59, 61, 63, 65 and 67, Wells Road. Orchard Place, Castlands Road. Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11, Orchard Place- Russell Street, No. 1 Nos. 34, 36, 38, 40, 42, 44, 46 and 48, Russell Street. 31 Area. Premises Russell Street, No. 2 Nos. 7, 9, 11, 13, 15, 17, 19, 21, 23, 27, 29 and 31, Russell Street. Russell Street, No. 3 Nos. 2, 4 and 6, Russell Street. HOUSING ACT, 1935. The Housing Act, 1935, received the Royal Assent on August 2nd, and the passing of the Act opens the attack upon the evils of overcrowding. Sections 1 to 12 of the Act contain the specific provisions for the abatement and prevention of overcrowding. The general scheme is to provide a standard for measuring overcrowding, and, subject to suitable safeguards, to make it, as soon as practicable, a punishable offence to infringe that standard ; to provide for a survey by every housing authority to ascertain the extent of overcrowding in their area and the places where it exists ; and to secure that the new accommodation required to abate overcrowding is provided in the places where it is needed. Overcrowding Survey. Section 1 of the Act imposes on every local authority the duty of carrying out an inspection of their district in order to ascertain what houses are overcrowding according to the standard laid down in the Act. The overcrowding standard consists of two parts. Section 2 (1) (a) of the Act provides that there must be sufficient sleeping accommodation in a house to secure proper sex separation. Section 2 (1) (b) is a standard of capacity, and in conjunction with Schedule I, fixes in relation to the accommodation in any particular house the maximum number of persons, irrespective of sex, who may be permitted to sleep in that house at one time. The two Tables in Schedule I are as follows : — Table I. Where a house consists of— The permitted number of persons is— (a) One room 2 (b) Two rooms 3 (c) Three rooms 5 (d) Four rooms 7½ (e) Five rooms or more 10 with an additional 2 in respect of each room in excess of five (In using this lable, a room of less than 50 square feet is not counted as a room). 32 Table II. Where a room in a house has a floor area of- The permitted No of persons is— (a) 110 sq. ft. or more 2 (b) 90 „ ,, „ „ but less than 110. 1½ (c) 70 „ „ „ „ „ „ 90 l (d) 50 „ „ „ „ 70 ½ (e) Under 50 sq. ft. Nil. In the application of these tables account is only to be taken of rooms which are normally used in the locality either as a living room or as a bedroom. In applying Table II each room of the size mentioned is to be reckoned as capable of accommodating the number set out in the Table, and the aggregate for all the rooms in the house is ascertained in this manner. The "permitted number" for the house is the aggregate number so obtained or the number given by Table I, whichever is the smaller. In a Ministry of Health Memorandum it was pointed out that "this standard does not represent any ideal standard of housing, but the minimum which is in the view of Parliament tolerable whilst at the same time capable of immediate or early enforcement." The survey fell into two stages, the first being a preliminary enumeration to ascertain the number of persons in each family, the number of children under 10 years of age, and the number of rooms occupied. The enumeration, which was made in respect of 31,539 structurally separate houses occupied by 35,182 separate families, was begun in the autumn, and showed (i) the families which were overcrowded irrespective of the sizes of the rooms occupied (ii) the families which were not overcrowded, and (iii) doubtful cases of overcrowding, i.e., those in which families might be overcrowded when the sizes as well as the numbers of the rooms occupied were taken into consideration. The second stage of the survey consisted of the measurement of the floor area of all the rooms in the houses in which doubtful cases of overcrowding had been disclosed by the preliminary enumeration, with a view to determining definitely whether the families were or were not overcrowded on the standard laid down in the Act. In this second stage of the survey, the ages of children under 10 years of age were recorded and particulars of the numbers of lodgers living with families were obtained. The method adopted for selecting the doubtful cases of overcrowding was to fix, in respect of each size of dwelling, an arbitrary 33 number below the maximum permitted number in Table 1 and to assume that, if the "equivalent number" of persons (i.e., counting each child under 10 years of age as half a person) occupying the dwelling was less than this number, the dwelling would not be overcrowded on the standard of Table II in the Act. If the "equivalent number" of persons in a dwelling house was equal to or in excess of the reduced permitted number and the family was not definitely overcrowded on the standard of Table 1, the case was considered doubtful and detailed room measurements were obtained. Statistical summary of the survey. From the information obtained as a result of the survey, tables were prepared showing the distribution of the families concerned in relation to the size of the family and the size of the accommodation occupied, in terms of the maximum number of persons permitted to occupy the dwelling under the Act. The following inset gives the information relating to the whole Borough. The vertical columns of the table show the sizes of the rooms occupied in terms of the maximum "equivalent number" of persons who could be permitted to occupy the dwellings without causing them to be overcrowded. In cases in which the floor areas of the rooms in dwellings were ascertained it has been possible to determine accurately the permitted numbers of persons in respect of the dwellings. In other cases other calculations have been employed. The horizontal divisions represent the sizes of the families in terms of the "equivalent numbers" of persons occupying the dwellings. In cases in which the ages of children were not ascertained, a child under 10 years of age was counted as half a person. The table, therefore, gives a picture of the housing conditions (so far as density is concerned) of the families enumerated in Lewisham at the time the survey was taken. The thick black diagonal line in the table separates the overcrowded families from those not overcrowded. The families recorded on the left of the diagonal line are all overcrowded and the worst cases of overcrowding are those farthest from the line. The families recorded to the right of the line are families not overcrowded. As a result of the Survey it was found that there were 1,057 families living in overcrowded conditions in Lewisham. The extent to which the overcrowding is to be remedied by the provision of new housing accommodation is arrived at by a calculation 34 which makes allowance for the release of accommodation owing to the vacation of dwellings. A formula was suggested by the County Council for calculating the re-housing needs. It indicated a rehousing need of 32 three-roomed, 57 four-roomed, 83 five-roomed, 23 six-roomed, 19 seven-roomed, 4 eight-roomed and 1 nine-roomed dwellings: a total of 219. This formula assumes that 50 per cent, of one and two-roomed dwellings are capable of division so that rooms can be added to other dwellings to make the required size of dwelling in existing accommodation and that dwellings above that size will be wholly available. HOUSING ACT, 1935.—OVERCROWDING SURVEY. Distribution of working-class families in relation to size of family and size of dwelling occupied. Metropolitan Borough of LEWISHAM. Size of family ("equivalent number" of persons) Size of dwelling occupied, in terms of the maximum "equivalent number" of persons permitted to occupy it without causing it to be overcrowded. Totals of Families. 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 & over. Overcrowded. Not Overcrowded, Total. 1 3 862 28 661 8 1 508 3 7 1 263 - - 2 119 1 - 66 - - 19 - - - 8 - 2,560 2,560 1½ — 1 3 28 1 - 15 - - - 7 - - - 2 - - 1 - - - - - - - - 58 58 2 — 7 56 1,439 58 - 2,569 4 29 - 1,675 1 1 7 1,095 - - 480 2 - 166 - - - 75 7 7,657 7,664 2½ 1 2 7 5 315 - 1,196 10 47 - 712 1 1 5 294 - - 90 - - 13 - 1 - 4 10 2,694 2,704 3 — 3 4 11 218 1 1,916 13 82 - 2,111 5 6 6 1,496 - - 695 1 1 270 - - - 84 18 6,905 6,923 3½ — - 2 56 16 1 666 4 80 2 717 3 2 7 341 - - 131 - - 37 - - - 7 74 1,998 2,072 4 — - 4 44 14 - 6 31 614 1 1,650 18 12 40 1,331 3 5 722 2 1 270 - 1 - 113 62 4,820 4,882 4½ — - - 11 2 2 3 10 298 - 574 3 3 12 345 1 - 127 - - 53 - - - 13 18 1,439 1,457 5 — - - 7 6 1 2 16 220 4 888 9 5 26 807 2 8 412 2 - 221 - - - 89 32 2,693 2,725 5½ — - - 3 - - 105 3 34 1 365 10 8 7 229 1 1 90 1 - 49 - - - 18 145 780 925 6 — - - 2 - - 98 4 28 5 129 67 49 63 440 19 5 234 5 - 114 1 - 1 56 137 1,183 1,320 6½ — - - 1 - 1 31 1 7 2 87 27 33 37 128 10 1 61 1 - 46 - - 1 15 130 360 490 7 — - - - 1 - 17 2 6 1 66 26 28 20 204 7 4 117 2 1 66 1 - - 38 119 488 607 7½ — - - 1 1 - 7 - - 1 33 15 13 15 94 10 7 27 1 - 20 - - - 9 71 183 254 8 — - - - - - 5 - - - 63 10 2 4 12 16 25 46 - 1 25 - - - 22 84 147 231 8½ — - - - - - 2 - 1 - 42 - - 4 6 8 15 20 - - 13 - - - 6 55 62 117 9 — - - - - - 1 1 1 - 11 - 1 1 6 13 17 18 2 2 14 - - - 5 35 58 93 9½ — - - - - - - - - - 9 1 - - 1 7 8 2 1 2 10 1 - - 1 26 17 43 10 — - - - - - - - - - 6 - - - 1 5 6 - 2 1 8 - 1 - 4 18 16 34 10½ — — - - - - - - - - 3 - - 1 1 - - - 1 - 2 - 1 - - 6 3 9 11 — _ _ - - - - - - - 1 - - - 2 - 2 1 - - 1 1 - - 1 6 3 9 11½ — — - - - - - - - - 1 - - - 1 - - - - 1 - - - - - 3 - 3 12 _ _ _ _ - _ - - - - 1 - - - - - - - - - - — - - 1 1 1 2 12½ — — - - - - - - - - - - - - - - - - - - - - - - - - - - 13 & over — — - - - - - - - - - - - - - - - - - - - - - - - - - - TOTALS OF DWELLINGS OVERCROWDED 1 12 17 136 40 4 271 27 77 9 323 52 16 10 18 25 16 1 1 1 - - - - - 1,057 NOT OVER CROWDED 3 863 87 2,133 600 3 6,876 75 1,377 9 9,091 144 148 247 6,937 78 88 3,339 22 9 1,417 4 4 2 569 34,125 TOTAL 4 875 104 2,269 640 7 7,147 102 1,454 18 9,414 196 164 257 6,955 103 104 3,340 23 10 1,417 4 4 2 569 35,182 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 152, and in addition, 142 retailers were registered for the sale of milk in oottles 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. The inspections of these premises during the year numbered 516. 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 1935 as follows : — Premises licensed to Pasteurise 2 Retail premises licensed to sell Certified Milk 9 ,, „ ,, ,, Grade A (Tuberculin Tested) Milk 11 ,, ,, ,, ,, Grade A Milk 7 Pasteurised Milk 19 Bacteriological Examination of Milk.—The designations and numbers of the samples examined are shown in the following summarY : — "Certified" Milk 5 "Grade A" (Tuberculin Tested) Milk 5 "Pasteurised '' Milk 22 Undesignated Milk 13 Total 45 Certified Milk.—(Standard: —Not more than 30,000 bacteria in one c.c., and no Coliform Bacillus in 1/10 c.c.). Five 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. "Grade A" (Tuberculin Tested) Milk.—(Standard:—Not more than 200,000 bacteria per c.c., and no Coliform Bacillus 1/100 c.c.). 36 Five samples of this grade were examined and three of these failed to comply with the standard. All 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 twenty-two samples of this grade which were examined, eleven were taken on delivery at the various Institutions of the London County Council situated in this Borough, eight at Elementary Schools, and the remainder from local retailers. In three of the samples taken at the Schools the bacterial count was greater than that permitted, and the attention of the London County Council was drawn to the matter- Undesignated Milk :— Thirteen samples of undesignated milk, taken from local dairymen in the course of delivery to their customers, were submitted to bacteriological examination, and in only two instances was the bacterial count considered to be unduly high. Six of the samples were specially tested for tubercle bacilli by animal inoculation, but gave a negative result. 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 397 attendances for the purpose of inspecting the carcases of animals slaughtered, which numbered 5,275. 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. Havelock Street Mews, Forest Hill Chalk & Cox, Ltd. 12, Montpelier Vale B. W. Parsons, Ltd. 13, Kushey Green Chalk & Cox, Ltd. Weardale Road, Lee H. W. Hemmings 37 Unsound Food.—The following quantities of meat, fish, etc., were surrendered as unfit for food, and destroyed : — Tinned Fruit, 69 tins; Bananas, 1 cwt.; Tomatoes, 21 boxes; Blackberries, 9 barrels; Asparagus, 27 tins; Sardines, 2,492 tins; Sild, 536 tins; Fresh fish, 9½ stones, and 25 boxes; Ham, 10 lbs.; Sheep, pig and bullock offal, 195 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 327 premises were on register, including 167 ice-cream premises. Bakehouses.—There are 82 bakehouses on the Register, and 375 inspections of these were made during the year. Restaurants and Eating-houses.—There are 135 establishments of this description on the Register, and during the year 239 inspections were made. Food Shops and Stalls.—Inspections of these premises during the year numbered 2,312. Merchandise Marks Act, 1925. The following orders came into force during the year : — Merchandise Marks (Imported Goods) No. 7 order, 1934, with the Merchandise Marks (Imported Goods) exemption directions (Nos. 3, 4, 6 and 7), 1934. Sale of Food (Revocation) order, 1935, with the Merchandise Marks (Imported Goods) Exemption Directions (No. 1), 1935. Merchandise Marks (Imported Goods) Exemption Directions (No. 4), 1935, which combines in one inclusive Direction, the Merchandise Marks (Imported Goods) Exemption Directions (No. 4), 1934, the Merchandise Marks (Imported Goods) Exemption Directions 38 (No. 7), 1934, and the Merchandise Marks (Imported Goods) Exemption Directions (No. 1), 1935. Public Health (Shell Fish) Regulations, 1934. These regulations which came into operation on 1st June, 1935, revoke the Public Health (Shell Fish) Regulations, 1915, and replace them by provisions which are generally similar but are modified in certain respects. Under the new regulations, the Medical Officer of Health is required to make an investigation with regard to any laying from which suspected shell fish have been derived and to make a report to the local authority. Food and Drugs (Adulteration) Act, 1928. During the year under review 803 samples of food, drugs, etc., were obtained by the Council's Inspector and submitted to the Public Analyst for examination. Of this number 171 were purchased formally in accordance with the provisions of the above-named Act, and the remaining 632 were obtained informally as "test" samples. One formal sample only was certified as adulterated or below standard by the Public Analyst. The following table gives the details of the samples analysed : — Article. No. of Samples Examined. No. of Samples Adulterated, etc. Formal Informal Total Formal Informal Total Acid, Boric 4 4 ,, Citric — 3 3 — — — ,, Tartaric — 3 3 — — — Baking Powder — 1 1 — — — Beverages — 1 1 — — — Borax — 3 3 — — — Brandy 1 — 1 — — — Butter — 54 54 — — — Butter on Bread — 1 1 — — — Cheese — 10 10 — — — Cocoa — 14 14 — — — Coffee — 7 7 — — — Cream — 16 16 — — — Cream of Tartar — 4 4 — — — Fish, Canned — 151 151 — 43 43 ,, Potted — 12 12 — — — 39 Article. No. of Samples Examined. No. of Samples Adulterated, etc. Formal Informal Total Formal Informal Total Flour, Self-raising 13 13 — — — Friar's Balsam 1 1 — Fruit, Canned 18 18 — ,, Dried 9 9 — Gin 3 3 — Gregory Powder — 3 3 — 1 1 Ground Ginger — 6 6 — Lard 30 30 Lime Water 8 8 1 1 Linseed, Crushed 5 5 — — Margarine — 28 28 Meat 12 12 1 1 ,, Canned ] 1 — — ,, Potted 4 4 __ Milk 163 5 168 1 1 2 ,, Condensed 1 1 ,, Preparations — 2 2 Oil, Almond 4 4 — ,, Camphorated — 5 5 — — ,, Castor 4 4 ,, Cod Liver 2 2 Ointment, Boric 5 5 ,, Mercury — 3 3 — — — ,, Zinc 3 3 — Paregoric — 3 3 — — Pepper — 19 19 — — Rice 2 2 Rum 1 1 Sal Volatile 4 4 Sauces and Pickles 7 7 Sausages — 19 19 — Sedlitz Powder 7 7 Soup 1 1 Spices _ 8 8 Suet 9 9 Sugar 20 20 — — Tapioca — 1 1 — — — Tea 40 40 — — Tincture of Iodine 5 5 ,, Quinine Turpentine, — 4 4 — — — Liniment of Vegetables, 4 4 — Preserved 16 16 — 1 1 Vinegar 3 3 — — Whisky 3 — 3 — — — Wine, Non-Alcoholic — 1 1 — — — Totals 171 632 803 1 48 49 40 Milk.—One hundred and sixty-six samples of milk were examined by the Public Analyst, and 2 of these, or 1.20 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 3.70 8.86 87.44 3.0 8.5 Second ,, 3.58 8.91 87.51 Third „ 3.74 8.78 87.48 Fourth ,, 3.88 8.89 87.23 Average for the Year 3.725 8.86 87.415 41 Adulterated Samples. Serial No. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. Administrative Action taken. 795 Milk Informal Extraneous Water, 66.5%. Fat deficient, 8%. Sample submitted by retailer —no action necessary. 808 Silds ,, Tin, 2.99 grains per pound. All Stocks surrendered and destroyed. 809 Sardines ,, Tin, 5.62 grains per pound. 816 ,, ,, Tin, 3.17 grains per pound. 817 ,, ,, Tin, 4.04 grains per pound. 818 ,, ,, Tin, 2.33 grains per pound. 819 ,, , Tin, 5.36 grains per pound. 820 ,, ,, Tin, 2.83 grains per pound. 821 ,, ,, Tin, 5.08 grains per pound. 822 ,, ,, Tin, 4.87 grains per pound. 823 ,, ,, Tin, 3.62 grains per pound. 824 ,, ,, Tin, 6.33 grains per pound. 825 ,, ,, Tin, 3.24 grains per pound. 826 ,, ,, Tin, 4.46 grains per pound. 827 Silds . ,, Tin, 3.42 grains per pound. 828 Sardines ,, Tin, 4.84 grains per pound. 829 ,, ,, Tin, 3.33 grains per pound. 830 ,, ,, Tin, 3.83 grains per pound. 831 ,, ,, Tin, 4.96 grains per pound. 832 ,, ,, Tin, 5.25 grains per pound. 42 Adulterated Samples.—contd. Serial No. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. Administrative Action taken. 833 Sardines Informal. Tin, 5.21 grains per pound. All Stocks surrendered and destroyed. 834 ,, ,, Tin, 6.29 grains per pound. 835 ,, ,, Tin, 3.42 grains per pound. 836 ,, ,, Tin, 7.00 grains per pound. 837 ,, ,, Tin, 4.46 grains per pound. 838 Silds ,, Tin, 2.58 grains per pound. 839 ,, ,, Tin, 2.42 grains per pound. 840 ,, ,, Tin, 2.08 grains per pound. 841 ,, ,, Tin, 2.58 grains per pound. 865 Condensed Tomato ,, Tin, 3.33 grains per pound. 860 Milk Formal. Fat Deficient 5%. Subsequent sample genuine. 126 Silds Informal. Tin, 6.4 grains per pound. All Stocks surrendered and destroyed. 134 ,, ,, Tin, 3.1 grains per pound. 158 160 ,, ,, Tin, 2.9 grains per pound. Tin, 4.1 grains per pound. 162 ,, ,, Tin, 2.1 grains per pound. 175 Minced Meat ,, Sulphur Dioxide 170 parts per million. Vendor Cautioned 294 Gregory Powder ,, Dispensed with Magnesium Oxide instead of Magnesium Carbonate. 313 Lime Water ,, Calcium Hydroxide deficient 26.7%. 345 Herrings-in- Tomato ,, Tin, 3.0 grains per pound. Stock withdrawn from sale. 43 Serial No. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. Administrative Action taken. 379 Silds Informal. Tin, 2.5 grains per pound. Stock surrendered and destroyed. 413 ,, ,, Tin, 3.1 grains per pound. 491 ,, ,, 4.1 grains of tin per pound. Wholesaler’s stock exported. 43 tins surrendered. M.O.H. of W holesaler’s district notified. 497 ,, ,, 5.1 grains of tin per pound. Vendor’s stock surrendered and destroyed. 505 ,, ,, 2.6 grains of tin per pound. Vendor’s stock returned by request to exporter for examination. 565 ,, ,, 2.7 grains of tin per pound. Vendor’s stock exhausted. 615 Sardines ,, 32 parts of lead per million. Vendor’s stock surrendered and destroyed. M.O.H. of Wholesaler’s district notified. 640 Silds ,, 2.6 grains of tin per pound. 648 ,, ,, 3.2 grains of tin per pound. 44 Tin and Tin Compounds in Tinned Foods. It will be seen from the list of adulterated samples that a considerable number of samples of Tinned Sardines and Silds were found to contain tin and tin compounds, and on this subject the following very instructive report was received from Mr. Adrian Lickorish, the Public Analyst:— " The presence of tin in canned goods must always be taken into consideration in the case of every article of food preserved in this way. Meat, fish, vegetables, and fruit are all liable to contamination. If, however, the canning processes are carried out with the proper knowledge and skill, modern research has shown that the proportion of tin in the freshly canned product need be very small and sometimes so small as to be practically negligible. Presuming that the canning has been properly carried out and that the article has left the cannery containing the minimum quantity of tin, this quantity may be gradually increased as time goes on, the increase varying somewhat according to the nature of the article and the way in which it has been stored, and after some years may become very excessive. If, for instance, the goods are kept at a low temperature, the rate of tin increase may be small. At the present time there is a considerable amount of work being done at the Ports in inspecting and examining canned goods on entry into the County, but this cannot, of course, deal with the question of age, and there is no guarantee what age the sample may reach before it is consumed. A report was submitted to the Local Government Board in 1908 by Dr. Buchanan, one of their expert advisers, in which it was pointed out that an advantage would be gained from an administrative point of view if there was some mark by which the firm by whom canned goods are prepared could determine the date and place of preparation, and, in my opinion, there would be many advantages in such a course. It would be a great help to the authorities in their necessary investigations ; in addition to the routine sampling, which is always being carried on, particular attention could be paid to the older canned goods. The retailer would know whether he were buying old or new goods. It seems doubtful whether he can always be aware of this now, since these may be kept in a warehouse possibly for 45 years before finally reaching his shop. Incidentally, quite a lot of information valuable from a scientific point of view would also be obtained. Moreover, there would be nothing new in such a course, since it is already done by some firms with respect to other articles. Although the ages of canned products is not the only factor which may lead to the presence of excessive amounts of tin, I do consider that, if the recommendation of Dr. Buchanan as to the marking of canned goods was carried out and the marking done in some simple way which could be easily interpreted, it would be of considerable value to Public Health Authorities in carrying out their duties. There may, of course, be technical difficulties, but these should not be insuperable." Representations were subsequently made to the Ministry of Health by the Council, suggesting that consideration should be given to the question of taking the necessary action in order to prohibit tinned foods for sale being kept in stock beyond a safe period, and a reply was received from the Ministry to the effect that they had taken a note of such representations but that it seemed that there would probably be considerable practical difficulties in giving effect to the suggestion. 46 INFECTIOUS DISEASES. The following diseases are compulsorily notifiable in the Borough:— Acute Encephalitis Lethargica Hydrophobia Acute Influenzal Pneumonia Glanders Acute Primary Pneumonia Malaria Acute Polio-Encephalitis Membranous Croup Acute Polio-Myelitis Ophthalmia Neonatorum Anthrax Plague Cerebro-Spinal Meningitis Puerperal Fever Cholera Puerperal Pyrexia Continued Fever Relapsing Fever Diphtheria Scarlet Fever Dysentery Smallpox Erysipelas Tuberculosis Enteric (or Typhoid) Fever Typhus Fever Notifications. There was a substantial decrease in the incidence of infectious disease, and, excluding tuberculosis, which is dealt with separately in another part of this Report, 1,465 cases were notified, compared with 2,243 in 1934. The figures for the last three years are given in detail in the following table:— Disease. Year. 1933 1934 1935 Smallpox 21 3 Scarlet Fever 1,129 1277 830 Diphtheria 354 473 314 Paratyphoid Fever 9 2 17 Typhoid Fever 2 4 5 Puerperal Fever 8 12 3 Puerperal Pyrexia 32 31 32 Erysipelas 106 141 68 Acute Primary and Influenzal Pneumonia 281 273 184 Ophthalmia Neonatorum 13 17 4 Encephalitis Lethargica — 1 1 Cerebro-spinal Meningitis .. 13 5 6 Polio-Myelitis 6 4 1 Anthrax 1 — — Totals 1,975 2,243 1,465 47 Scarlet Fever.—There was a gratifying decrease in the incidence of this disease, 830 cases being notified, compared with 1,277 in the previous year. There was one fatal case. Diphtheria.—This disease also showed a decrease on the previous year, 314 cases being notified as against 473 in 1934. There were 14 deaths from this disease. Diphtheria Immunisation. A Scheme for the immunisation of children against Diphtheria was commenced in July. This Scheme provides for a payment of ten shillings to medical practitioners for each child immunised, the practitioner providing the necessary material. Dr. H. M. M. Woodward, of St. John's Hospital, was engaged by the Council to carry out the Schick testing, the object of which is to determine the child's susceptibility, or otherwise, to the disease. The following are details of the work carried out in 1935:— Number of children to whom a preliminary Schick Test was applied 108 „ found to be immune 36 „ found to be susceptible 72 „ immunised 43 „ Schick tested and found to be immune 1 „ awaiting Schick Test 42 „ awaiting immunisation 29 Number of children immunised without a preliminary Schick Test 193 „ subsequently Schick tested 47 „ found to be immune 46 „ found to be susceptible 1 „ awaiting Schick Test 146 Publicity was given to the Scheme by the distribution of the leaflet reproduced below:— 48 Metropolitan Borough of Lewisham. Protection against Diphtheria. One of the most serious diseases which attack children is diphtheria, both in the severity of the illness and in the after effects which it leaves with the sufferer. Not every child, of course, is attacked by diphtheria, but the risk is always present, especially young children and school children. The fact that anyone can be protected against the disease has been abundantly proved. Owing to the nature of their work, fever hospital nurses are greatly exposed to the infection of diphtheria, but when protected by immunisation, they do not contract the disease. Children in large numbers in Great Britain have been similarly treated and protected against the disease. The Council of the Metropolitan Borough of Lewisham have now made arrangements with medical practitioners to pay the doctor's fee for the protection of children between the ages of one and twelve years. The treatment involves three injections, which usually cause no disturbance to the child ; there is no sore at the point of injection and no scar or mark is left. The protection does not develop fully until about three or four months after the three injections. After this time, it will generally last over that period of the child's life when it is most likely to contract diphtheria, and may indeed last throughout life. If any parent or guardian wishes to have his children protected against diphtheria, or to have any further advice on the matter, he should consult his own doctor, or, if he has no family doctor, he should enquire at the Public Health Department at the Town Hall, Catford, S.E.6. JOHN W. MILLER, Medical Officer of Health. P.S.—Although your child, if protected, is extremely unlikely to contract diphtheria, it must not be assumed that such a thing is impossible. A very few cases of diphtheria have occurred amongst immunised children, but it must be pointed out that such attacks are nearly always slight. 49 Typhoid Fever. Five cases of this disease were notified, and all were removed to Hospital. In one of the cases the diagnosis was not confirmed. Of the four actual cases one contracted the disease outside the Borough and in the other three the source of infection was not traced. There were no fatal cases. Para-typhoid Fever.—Seventeen cases of this disease occurred, and fifteen of them were removed to Hospital. In one of the cases the diagnosis was not confirmed. Two of the cases each gave rise to a secondary case. In one case the disease was contracted outside the Borough and in the other cases, with the exception of the two secondary cases, the source of infection was not traced. There were no fatal cases. Small-Pox.—No cases of Small-Fox were notified. Ophthalmia Neonatorum.—During the year four cases of this disease were notified. Particulars of the cases are set out in the forms prescribed by the Ministry of Health:— Cases. Results. Notified. Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Home. Hospital 4 — 4 4 — — — 50 Measles Epidemic. In view of the anticipated biennial epidemic of measles, the Council agreed to co-operate with the London County Council School Medical Service in a scheme drawn up with the object of reducing the mortality and mitigating the complications associated with measles epidemics, by the prompt removal of cases to hospital, or by providing nursing assistance in the home, according to circumstances. The scheme may be briefly summarised as follows:— The efforts of the school authorities are concentrated on obtaining the earliest possible information of cases of measles or suspected measles and suspicious absentees. This information is immediately transmitted to the Public Health Department of the Council and the homes are visited by health visitors who arrange for removal to hospital or domiciliary nursing assistance as circumstances dictate. A similar scheme was put into operation during the epidemic which occurred in the winters of 1929-30, 1931-32, 1933-34 and proved of great assistance. 51 Table shozving Cases of Infectious Disease Notified, 1935. Disease. Number of Cases Notified. Total at all Ages Number removed to Hospital At Ages—Years. Under 1 year 1 and under 2 years 2 and under 3 years 3 and under 4 years 4 and under i 5 years 5 and under 10 years 10 and under 15 years 15 and under 20 years 20 and under 35 years 35 and under 45 years 45 and under 65 years 65 and over Scarlet Fever 3 17 39 47 69 376 152 50 57 16 4 — 830 758 Diphtheria 2 8 20 24 19 129 50 6 41 10 4 1 314 299 Typhoid Fever — — — — — — 1 — 1 — 3 — 5 4 Paratvphoid Fever — — — — — 5 1 2 5 3 1 — 17 15 Puerperal Fever — — — — — — — — 3 — — — 3 3 Puerperal Pyrexia — — — — — — — 2 27 3 — — 32 27 Erysipelas — 1 — — — 2 5 — 11 10 27 12 68 30 Acute Primary & Influenzal Pneumonia 12 6 1 6 6 16 1 12 33 28 48 15 184 77 Ophthalmia Neonatorum 4 — — — — — — — — — — — 4 4 Cerebro-Spinal Meningitis 1 1 2 — — — — — 2 — — — 6 6 Acute Anterior Polio-Mvelitis — — — — — 1 — — — — — — 1 1 Encephalitis Lethargica — — — — — — 1 — — — — — 1 1 Totals 22 33 62 77 94 529 211 72 180 70 87 28 1465 1225 52 Table showing Number of Deaths from Infectious Diseases in 1935. Diseases. Age Groups. All ages Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 16 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 — — — — — — — — — — — — Measles — 1 — 2 — — — — — — — 3 Scarlet Fever — — — — 1 — — — — — — 1 Whooping Cough 3 — — — — — — — — — — 3 Diphtheria — — 3 11 — — — — — — 14 Influenza 1 1 — — — 1 2 1 2 7 11 26 Encephalitis Lethargica — — — — — — — — — — — — Cerebro-Spinal Fever 1 — 1 — — 1 — — — — — 3 Puerperal Fever — — — — — 2 — 1 — — — 3 53 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 71 phials of 8,000 units each (for treatment) and 61 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, 1934:— Number of Births registered from 1st January to 31st December, 1934 2,624 Number of these Births duly entered by 31st January, 1936, in the Vaccination Register :— Successfully Vaccinated 1,183 Insusceptible to Vaccination — Number in respect of whom Statutory Declarations of Conscientious Objection have been received 1,108 Died unvaccinated 98 Number of these Births which on 31st January, 1936, remained unentered in Vaccination Register on account of:— Postponement by Medical Certificate 17 Removal to districts, the Vaccination Officers of which have been duly appraised 52 Removal to places unknown 112 Number of these Births remaining on 31st January, 1936, neither duly entered in Vaccination Register not temporarily accounted for 54 Total number of Certificates and copies of Certificates of successful Primary Vaccination of Children under 14 received during the calendar year, 1935 1,456 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, 1935 1,186 Vaccination by Medical Officer of Health. No vaccination was performed by this officer under the Public Health (Smallpox Prevention) Regulations, 1917. 54 Tuberculosis. Notification.—During the year 281 new cases of pulmonary, and 66 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 N umber of Cases on Register at commencement of year 624 502 144 193 ,, ,, Notified during the year 142 139 35 31 ,, ,, removed from the register 112 110 27 23 ,, ,, remaining on the register at end of the year 654| 531 152 201 Mortality.—During the year 131 persons died from pulmonary tuberculosis, and 16 died from other forms of this disease. The death rate from pulmonary tuberculosis was 0.58 per 1,000 inhabitants, and an exactly similar rate was recorded in the previous year. 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 — 1 1 — 3 3 2 — 1 1 5 5 3 8 5 2 2 2 1 10 — 4 7 5 15 12 18 2 2 9 20 2 1 20 25 31 4 3 25 28 49 6 5 14 19 1 2 35 32 23 2 7 19 12 1 1 45 22 6 2 — 13 3 2 — 55 15 2 1 1 7 3 — — 65 and upwards 2 3 — — 4 2 Totals 142 139 35 31 70 61 10 6 55 Efficiency of Notification.—The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was one in eleven. 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 tuberculosis employees in the milk trade. Tuberculosis Dispensary.—During the year under review the Council's Dispensary was 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 REPORT OF THE TUBERCULOSIS OFFICER FOR 1935. The primary notifications of tuberculosis for 1935 numbered 347, of which 281 were of pulmonary tuberculosis and 66 of other forms of tuberculosis. During the year 131 persons died from pulmonary tuberculosis and 16 died from other forms of tuberculosis. The death rate from pulmonary tuberculosis was 0.58 per 1,000 inhabitants. An exactly similar rate was recorded in 1934. Cases on Register.—The number of cases on the Town Hall register on December 31st, 1935, was 1,538, comprising 1,185 cases of pulmonary tuberculosis and 353 cases of non-pulmonary tuberculosis. The number of cases on the Dispensary register was 975, of which 805 were of pulmonary and 170 of non-pulmonary tuberculosis. Attendance of Patients.—During the year the new patients who attended the Dispensary numbered 659 and the total attendances were 3,040. Of the new cases 187 were referred to the Dispensary by 56 their own doctors. 84 applied on their own initiative while 208 of the patients seen were contacts of the tuberculosis cases. A summary of first attendances is shown in Table C. Table A shows the condition at the end of 1935 of all patients diagnosed as suffering from pulmonary tuberculosis who have attended the Dispensary since its foundation in June, 1916- Home Visiting.—The three Health Visitors paid 5,132 visits to the homes of patients, while the tuberculosis officer visited 373 patients in their homes and also saw 11 patients at their homes in consultation with their own doctors. Reports.—Written reports to the number of 1,175 were sent out from the Dispensary. Residential Treatment.—The London County Council admitted 131 insured and 73 uninsured patients to residential institutions. The Lewisham Hospital admitted 34 patients referred by the Dispensary, these being seriously ill cases in urgent need of treatment and having unsuitable home conditions. The tuberculosis officer paid 45 visits to the two tuberculosis wards of the Lewisham Hospital containing respectively 26 male and 26 female patients. Affiliated and other Hospitals.—During the year 119 patients were sent to St. John's Hospital, Lewisham, for X-Ray examination at a cost to the Borough Council of £89 5s. Od. Most of the artificial pneumothorax refills are also carried out at St. John's Hospital. During the year 62 patients made 985 attendances at a cost to the Borough Council of £517 2s. 6d. Some of the refills are carried out at other hospitals such as StThomas', Charing Cross, Margaret St., Grove Park, and Colindale, to suit the convenience of individual patients. Light treatment is provided at the London Hospital and at St. Thomas' Hospital. Four patients made 188 attendances for Light treatment at a cost to the Borough Council of £15 12s. Od. For Laryngeal examination and surgical diagnosis some patients have been referred to King's College Hospital and to the Miller General Hospital. Sputum Tests.—The sputum of 347 patients was examined and reported upon by the pathological department of St. John's Hospital. 57 Dented Treatment.—During the year 26 patients attended St. John's Hospital for dental treatment while 6 patients were assisted in the provision of dentures. Extra Diet.—The Borough Council granted an allowance of milk, eggs and butter to 7 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 insufficient sleeping accommodation have been in constant use. Care Committee.—The Secretary of the Care Committee reports that the Committee met 26 times during the year. The cases reviewed, who had been recommended for institutional treatment, numbered 345, and 18 of these made a voluntary contribution towards the cost of treatment, totalling a sum of £164 Is. 4d. Reports were made on 311 cases requiring help and 185 patients received clothing. Financial assistance to the amount of £290 was given to various families. At the end of the year the balance remaining in the Voluntary Fund was £170. 20 patients were assessed for the provision of dentures through St. John's Hospital. The London County Council sent 119 progress reports concerning children receiving institutional treatment and these reports were communicated to the relatives of the children. Handicrafts Class.—This has been the tenth year in which the handicrafts class has met for its weekly instruction and it has proved as popular as ever and as useful in providing occupational therapy for those patients well enough to attend, but unfit for work under ordinary conditions. Tables A to 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- Signed : ROSE JORDAN, Tuberculosis Officer. 58 TABLE A. Condition on 31st December, 1935, of all cases of Pulmonary Tuberculosis who have attended the Dispensary since its foundation. Year 1916 (6mths.) 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 Totals No. of Cases 74 157 200 185 200 159 165 181 166 165 204 195 249 200 228 219 191 182 215 215 3750 Dead 49 75 90 66 94 81 83 87 87 84 93 93 106 'J8 93 85 65 48 39 13 1529 Left 14 53 59 63 52 39 52 56 41 41 54 58 83 46 65 64 39 37 31 10 957 Well — 1 — 4 2 1 4 6 3 6 15 10 17 23 32 45 51 51 75 71 417 Fair 1 — — 1 2 7 4 4 9 10 4 6 7 10 16 20 28 37 59 113 338 Unwell 1 — — — — — 1 1 — — 1 1 — 1 6 3 5 7 11 7 45 Discharged as arrested or diagnosis not confirmed 9 28 51 51 50 31 21 27 26 24 37 27 36 22 16 2 3 2 — 1 464 Totals 74 157 200 185 200 159 165 181 166 165 204 195 249 200 228 219 191 182 215 215 3750 59 Table B. Summary of Tuberculosis Health Visitors’ Work, 1935. ex-Service Patients. Civilian Patients. Total. Visits to Pulmonary Tuberculous Patients 45 216 261 ,, Non-pulmonary ,, 1 61 62 Subsequent Visits 529 3738 4267 Visits to Un-notilied Cases. 55 487 542 No of patients occupying Separate Room 14 136 150 sharing with 1 other 28 99 127 ,, ,, ,, 2 others 2 36 38 ,, ,, ,,3 ,, 2 6 8 No. of Patients occupying Separate Bed 16 167 183 ,, ,, sharing with 1 other 30 108 138 ,, ,, ,, 2 others — 2 2 Table C. Attendance of Patients at the Dispensary. 1935 First Attendances. Subsequent Attendances. Totals. January 49 194 243 February 51 178 229 March 79 226 305 April 48 169 217 May 54 230 284 June 46 139 185 July 73 233 306 August 51 177 228 September 50 196 246 October 50 246 296 November 58 222 280 December 50 171 221 672 2,175 2,847 60 Table D. Summary of First Attendances at the Dispensary, 1935. Applied on own initiative Sent by Doctor. Transferred from Hospitals, etc. Sent by L.C.C. Contacts. Totals. Pulmonary 12 73 120 3 2 216 Non-Pulmonary 4 6 31 1 42 Non-Tuberculous 67 107 11 7 205 397 Suspects 1 2 — — 1 4 Total 84 188 168 11 208 659 Table E. Stages in Pulmonary Tuberculosis. Male. Female. Children under 15. Total. Stage I. 20 34 9 63 ,, II. 80 58 2 140 ,, III. 6 7 - 13 106 99 11 216 Stage I.—-Slight disease of one lobe. Stage II.—Disease of two lobes or part of three lobes. Stage III.—Severe disease of three or more lobes. Table F. Cases of Non-Pulmonary Tuberculosis. Male. Female. Children under 15. Total. Glands 2 2 12 16 Bone 3 8 10 21 Other Regions - 4 1 5 5 14 23 42 61 Return showing the work of the Dispensary during 1935. (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 70 66 3 3 4 8 6 8 74 74 9 11 108 (b) Diagnosis not completed — — — — — — — — 1 2 — — 3 (c) Non-tuberculous — — — — — — — — 61 96 18 17 192 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 — — 1 — — — — 1 — — 1 2 (b) Diagnosis not completed — — — — — — — — 1 — — — 1 (c) Non-tuberculous — — — — — — — — 25 54 67 59 205 C.—Cases written off the Dispensary Register as :— (a) Recovered 13 14 1 2 2 4 8 15 18 3 10 40 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 86 153 86 76 401 D.—Number of Cases on Dispensary Regis ter on 31st December :— (a) Definitely tuberculous 444 322 18 21 30 00 40 40 474 382 58 61 975 (b) Diagnosis not completed — — — — — — — — 2 2 — — 4 1. Number of cases on Dispensary Register on 1st January 950 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 384 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 88 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4813 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases “lost sight of ” 99 (a) Specimens of sputum, etc., examined 347 (b) X-ray examinations made in connection with Dispensary work 119 4. Cases written off during the year as Dead (all causes) 84 11. Number of “Recovered” cases restored to Dispensary Register, and included in A (a) and A (b) above 1 5. Number of attendances at the Dispensary (including Contacts) 3040 12. Number of “T.B. plus” cases on Dispensary Register on 31st December 565 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 143 13. Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— 7. Number of consultations with medical practitioners:— (a) Personal 11 Provided by the Council 1 (b) Other 456 Provided by Voluntary Bodies — 62 INDEX TO CONTENTS. Subject Page Agricultural Produce (Grading and Marking) 37 Ante-natal Clinics 16 Bacteriological Examination of Milk 35 Bacteriological Examinations 23 Bakehouses 37 Births 7 Cleansing Station 24 Coroner's Court and Mortuary 23 Deaths 9 Dental Treatment 20 Diphtheria Anti-Toxin 53 Diphtheria Immunisation 47 Disinfection 23 Downham Ante-natal Clinic 18 Factories and Workshops 26 Food and Drugs, Analysis of 38 Food Shops and Stalls 37 Health Visitors 21 Home Helps 20 Home Nursing 22 Housing Statistics 29 Infant Clinics 19 Infant Life Protection 22 Infant Mortality 9 Infant Welfare Centre, New Premises 19 Infectious Diseases 46 Legal Proceedings 28 Marriages 8 Maternity Home 14 Maternity Outfits 20 Merchandise Marks Act 37 Midwives 22 Milk Assistance Scheme 20 Milk Supply 35 63 Subject Page Neo-natal Deaths 10 Obstetric Consultants 20 Population 7 Post-natal Clinic 18 Rats and Mice (Destruction) Act 28 Refuse Removal and Disposal 24 Restaurants and Eating Houses 37 Sanitary Inspection 25 Slaughterhouses 36 Slum Clearance 30 Smoke Abatement 28 Statistics 6 Tuberculosis Dispensary 55 Tuberculosis, Notifications, etc. 54 Tuberculosis Officer's Report 55 Vaccination 53 Voluntary Infant Welfare Centres 19