LEW 24 METROPOLITAN BOROUGH OF LEWISHAM. REPORT OF THE Medical Officer of Health For the Year 1936. 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 Lewisham. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report for the year 1936 on the health and sanitary condition of the Borough, this being the thirty-sixth of the series. A summary of the vital statistics is given on page 6, and it will be seen that the corrected death-rate, 10.9 per 1,000 of the population, is slightly higher than last year. The birth-rate also showed a slight increase, being 13.0 per 1,000, as against 12.5 last year. An increase in the number of deaths of infants under 1 year of age from 119 in 1935 to 163 in 1936 resulted in a corresponding rise in the infant mortality rate, from 43 per 1,000 births to 55 per 1,000. An exceptional number of infantile deaths from respiratory diseases was the principal cause of this increase. The incidence of infectious disease again remained at a rather low level. The Maternity and Child Welfare scheme has continued to work satisfactorily. The new Health Centre in High Street, Lewisham, which contains both the Tuberculosis Dispensary and the Maternity and Child Welfare Centre, was opened by H.R.H. the Duchess of Kent on May 7th, 1936. In the last-named building there are now held every week four Clinics for mothers and infants, four for expectant mothers, two sessions for the Sunlight Clinic, the diphtheria Immunisation Clinic at frequent intervals, while the Catford Voluntary Infant Welfare Centre occupies the building on two afternoons each week. Prominence has been given in my report to the Ministry of Health Circular relating to the medical inspection and care of children under school age. It will be obvious that the steps taken by the Council to give effect to the Minister's suggestions will throw a considerable amount of additional work on the Department. I again desire to express my appreciation of the consideration shown to 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 1936. 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. 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) Blaylock, E. T. (a) (b) Brittain, R. C. (a) (b) Craven, J. R. (a) (b) Crowther, J. (a) (b) Holifield, C. E. (a) (b) Manley, C. W. J. (a) (b) Phillips, A. J. (a) (b) Rayner, S. P. (a) (b) Thomas, A. G. (a) (b) Walker, E. (a) (b) 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 D. M. Charles (d) (e) Miss W. Cresswell (c) (d) (c) Miss G. M. Cromwell (c) (d) (e) Miss W. Eve (c) (d) (e) Miss A. M. Edwards (c) (e) Miss M. Reid (c) (d) (e) Miss C. H. Thompson (a) (d) (e) Miss G. Simpson (a) (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 (c) (d) (e) Clerks. F. E. Seckerson (a) (Chief Clerk) C. C. Summers Miss B. C. Avlett W. D. Back W. G. Coker Miss E. Dewdney K. G. Sandford 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. 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. (b) Food Inspector's Certificate. (c) Trained Nurse. (d) Health Visitor's Certificate. (e) Certificate of Central Midwives Board. 6 STATISTICS. General Statistics, 1936. Area of the Borough 7,015 acres. Population:— Census, 1931 219,953 Estimated, Mid-year, 1936 224,000 Number of inhabited houses (end of 1936) according to Rate Books 55,000 (appx.). Rateable Value (at April, 1936) £1,758,642 Sum represented by a penny rate £6,997.18.6 Extracts from Vital Statistics, 1936. Total. Males. Females. Live Births:—Legitimate 2,813 1,435 1,378 Illegitimate 119 57 62 Total 2,932 1,492 1,440 Birth Rate per 1,000 of the estimated population 13.0 Total. Males. Females. Still-Births 110 62 48 Rate per 1,000 births (live and still-births) 37.5 Total. Males. Females. Deaths 2,431 1,207 1,224 Death Rate per 1,000 of the estimated population:— (crude) 10.8; (corrected) 10.9 Deaths from Puerneral Causes:— Deaths. Rate per 1,000 (live and still) Births. No. 29 Puerperal Sepsis 1 0.32 No. 30 Other Puerperal Causes 5 1.64 Total 6 1.97 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 55 Legitimate infants per 1,000 legitimate live births 49 Illegitimate infants per 1,000 illegitimate live births 200 Deaths from Measles (all ages) 22 „ „ Whooping Cough (all ages) 15 „ ,, Diarrhœa (under 2 years of age) 22 7 Population. The Registrar-General's estimate of the population of the Borough at mid-year, 1936, is 224,000, 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 1936 was supplied by the Registrar-General:- Total Registered Inward Transfers Outward Transfers Births allocated to Borough Legitimate Males 1,396 152 113 1,435 Legitimate Females 1,358 132 112 1,378 Illegitimate Males 70 7 20 57 Illegitimate Females 73 5 16 62 Total 2,897 296 261 2,932 It will be seen that the corrected number of births is 2,932, which is equivalent to a birth rate of 13.0 per 1,000. The births and birth rates in the last ten years are shown herewith:— Year. No. of Births. Birth Rate. 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 1936 2,932 13.0 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 2,813 births. Still-Births. Notifications of 91 still-births were received, and details of these are as follows : — Total number notified 91 Out-of-Borough Cases born in the Borough, and not investigated 5 Borough Cases born outside the Borough 2 Number of Borough Cases 86 Borough Cases in which no enquiry could be made 10 The causes of still-birth in the 76 cases which were investigated were as follows:— Maternal Causes:— Toxaemia 9 Ante-partum Hæmorrhage:— Placenta Prævia 3 Accidental Hæmorrhage 4 Delayed Labour 6 Difficult Instrumental Labour 13 Syphilis 1 Fall 4 Shock 3 Blow in the abdomen 1 Fœtal Causes:— Breech Presentation 8 Cord Presentation 2 Transverse Presentation 1 Face Presentation 1 Cord round neck 1 Monstrosity 2 Causes not known 10 Marriages. The number of marriages registered in the Borough during the year was 1,951, compared with 1,860 in 1935. Of this number, 1,039 were solemnised in the Established Church, 278 in Non-conformist Places of Worship, and 634 at the Register Office. 9 Deaths. The number of deaths of Lewisham residents registered in 1936 was 2,432, and the corrected death rate was 10.9 per 1,000 persons. The deaths and death rates recorded in the last ten years are shown hereunder:— Year. No. of Deaths. Death Rate. 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 1936 2,432 10.9 Deaths in Public Institutions. The deaths occurring in Hospitals and other Public Institutions in the Borough numbererd 1,430, of which 964 were residents, and 466 residents died in Institutions outside the Borough. Infant Mortality. The number of infants who died before reaching one year of age was 163, equivalent to an infant mortality rate of 55 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. 1927 131 40 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 1930 103 55 66 10 Neo-natal Deaths. The number of Infants who died in the first four weeks of life was 72, and the causes of death were as follows:- Prematurity 25 Atelectasis 3 Broncho-pneumonia 12 Intra-cranial Haemorrhage 9 Gastro-enteritis 2 Congenital Heart Disease 3 Spina Bifida 3 Pyloric Stenosis 1 Imperforate Anus 2 Perirenal Haemorrhage 3 Asphyxia 2 Congenital Malformation 1 Oedema of Lungs 1 Malæna Neonatorum 1 Hæmatemesis Neonatorum 1 Inanition 1 Toxœmia of Mother 1 Overlaying 2 Investigations were made into the circumstances of the 76 stillbirths and 72 neo-natal deaths, and it was found that 18 mothers received no ante-natal care whatsoever, 24 were supervised by their own doctors, 32 were supervised by a midwife, 60 attended a Hospital clinic, 11 had attended one of the Ante-natal clinics provided by the Borough Council, and 3 had attended Ante-natal clinics in other Boroughs. 11 Table showing Causes of Death at Different Periods of Life during the Year 1936. 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 Fevers M — — — — — — — — — — — — F — — — — — — — — — — — — 2. Measles M 13 2 7 1 — — — — — — — — F 9 3 2 — — — — — — — — — 3. Scarlet Fever M 1 — — — — 1 — — — — — — F 1 — — 1 — — — — — — — — 4. Whooping Cough M 7 2 1 3 1 — — — — — — — F 8 5 2 1 — — — — — — — — 5. Diphtheria M 2 — — — 2 — — — — — — — F 2 — — — 2 — — — — — — — 6. Influenza M 17 2 1 — — — 1 1 3 4 3 2 F 21 — 1 — — — 1 1 5 — 2 10 7. Encephalitis Lethargica M — — — — — — — — — — — — F 2 — — — — — — — — 1 1 — 8. Cerebro-Spinal Fever M 2 — 1 — — — — 1 — — — — F — — — — — — — — — — — — 9. Tuberculosis of Respiratory System M 76 — — — — 13 17 15 18 10 3 — F 65 — 1 — 1 20 19 14 7 3 — — 10. Other Tuberculous Diseases M 7 — 1 — 3 — — — 1 1 1 — F 10 — — 2 3 3 — 1 — — 1 — 11. Syphilis M — — — — — — — 1 1 2 1 — F 1 1 — — — — — — — — — — 12. General Paralysis of the Insane. Tabes Dorsalis M 6 — — — — — — — 2 4 — — F 3 — — — — — — — 1 1 1 — 13. Cancer, Malignant Disease M 162 1 — — 2 3 — 8 23 47 47 31 F 200 1 — — — — 4 13 29 46 56 51 14. Diabetes M 14 — — — — — — — 2 3 6 3 F 19 — — — — — — — — 5 9 5 15. Cerebral Haemorrhage, etc. M 31 — — — — — 1 1 3 5 7 14 F 67 — — — — — 1 2 5 9 22 28 16. Heart Disease M 270 — — — — 5 3 8 21 58 85 90 F 319 — — — 4 3 6 13 10 27 90 166 17. Aneurysm M 14 — — — — — 1 1 2 2 5 3 F 6 — — — — — — — 1 1 1 3 18. Other Circulatory Diseases M 59 — — — — — — 1 5 8 23 22 F 57 — — — — — — — 3 10 18 26 19. Bronchitis M 56 3 1 — — 1 — 1 1 16 17 16 F 38 2 1 — — — 1 1 1 4 6 22 12 Table showing Causes of Death at Different Periods of Life during the Year 1936—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 87 25 5 3 — — 3 4 10 26 5 6 F 62 8 3 1 — 1 5 5 5 6 8 20 21. Other Respiratory Diseases M 14 — — 1 — — 1 1 2 2 5 2 F 20 1 1 — — — 1 1 1 5 4 6 22. Peptic Ulcer M 28 — — — — — — 2 7 11 5 3 F 10 1 — — — — — 1 — 3 1 4 23. Diarrhœa, etc. M 16 13 — — — — 1 — — 1 1 — F 11 9 — 1 — — — — — — — 1 24. Appendicitis M 12 — — 2 3 — 1 1 1 2 2 — F 3 — — — 2 — — — — 1 — — 26. Cirrhosis of Liver M 3 — — — — — — 1 — — 1 1 F 4 — — — — — — — 4 — — — 26. Other Diseases of Liver, etc. M 4 — — — — — — 1 — — 2 1 F 6 — — — — — — — 1 2 1 2 27. Other Digestive Diseases M 19 3 — 1 2 2 — 2 3 2 2 2 F 19 1 — 1 1 1 — 1 3 4 3 4 28. Acute & Chronic Nephritis M 45 — — — 1 — 5 2 4 14 5 14 F 42 — — — — 2 — 4 5 10 8 13 29. Puerperal Sepsis F 1 — — — — — — 1 — — — — 30. Other Puerperal Causes F 5 — — — — — 2 3 — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. M 48 46 — — 1 1 — — — — — — F 22 22 — — — — — — — — — — 32. Senility M 36 — — — — — — — — — 2 34 F 59 — — — — — — — — — 4 55 33. Suicide M 19 — — — — — 3 2 7 4 3 — F 6 — — — — 1 — 1 1 2 1 — 34. Other Violence M 41 1 — 3 4 5 3 9 4 3 4 5 F 40 4 — — — 3 1 1 1 2 4 24 35. Other Defined Diseases M 93 5 — 1 3 7 2 7 11 13 20 24 F 87 2 — 2 3 6 2 6 10 13 27 16 36. Causes ill-defined or unknown M — — — — — — — — — — — — F — — — — — — — — — — — — Totals M 1207 103 13 21 23 38 42 70 131 238 255 273 F 1225 60 13 12 16 40 43 69 93 155 268 456 13 Table showing the Population, Birth. Death and Infantile Mortality rates during 1936 in the Metropolitan Cities and Boroughs. Borough Estd. Res. Population (mid-1936) Live Births rate per 1,000 popn. Death Rate per 1,000 popn. Infantile Mortality rate per 1,000 live births crude adjusted West Districts Paddington 139,200 13.8 12.98 12.81 72 Kensington 176,100 12.7 12.5 11.7 73 Hammersmith 127,700 15.1 12.5 12.9 60 Fulham 141,300 14.9 12.6 12.7 64 Chelsea 56,500 11.3 13.7 11.6 53 Westminster 124,100 8.5 11.1 11.4 65.8 North Districts St. Marylebone 92,400 9.8 12.6 12.5 75 Hampstead 90,700 10.4 10.2 9.6 65.8 St. Pancras 183,900 13.0 13.5 13.8 79 Islington 304,100 15.24 12.44 12.56 61 Stoke Newington 50,350 13.7 11.4 10.9 44.6 Hackney 209,100 14.4 12.0 12.6 62.9 Central Districts. Holborn 34,850 8.29 11.99 12.83 62 Finsbury 60,800 13.8 14.0 15.3 81 City of London 9,100 7.5 11.4 12.65 147 East Districts. Shoreditch 85,400 14.9 12.8 14.1 75 Bethnel Green 96,900 13.5 12.7 14.3 98 Stepney 207,800 14.7 12.6 14.7 100.09 Poplar 140,300 15.0 12.5 13.8 72 South Districts. Southwark 152,200 14.8 13.1 — 59 Bermondsev 100,400 15.4 12.8 14.6 60 Lambeth 277,500 13.9 12.5 12.4 59 Battersea 145,500 14.63 13.06 12.93 59.21 Wandsworth 343,000 11.40 11.79 10.96 58 Camberwell 229,300 13.93 12.64 12.64 58.86 Deptford 98,900 15.7 12.2 12.6 50 Greenwich 95,900 13.82 11.36 11.58 49 LEWISHAM 224,000 13.0 10.8 10.9 55 Woolwich 146,500 13.8 11.2 11.8 59 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 VoluntaryOrganisations 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. It was necessary to close the Home for several weeks in August and September for interior and exterior decoration, the installation of central heating, and the replacement of defective electric wiring. The particulars of the cases admitted to the Home during the year are as follows:— Number of Patients delivered 245 Number of Primiparæ 134 Number of Multipræ 111 Number of Infants born (2 sets of Twins) 247 15 Presentations: Vertex 238 Pelvic 7 Face 1 Born before arrival 1 Obstetric Operations: Forceps 3 Minor Operations 96 Manual Removal of Placenta 5 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 Nil The sex incidence of the Infants was as follows:— Males, 128; Females, 119 Total, 247 The average length and weight of the full-term infants were as follows:— Males, Length, 22.15 ins. Weight, 71bs. 11.37 ozs. Females, Length, 21.51 ins. Weight, 71bs. 3.79 ozs. Progress of Infants while in the Home:— Number born alive 247 Died within 3 days (Premature Twins) 2 Over birth weight on discharge 169 Equal to birth weight on discharge 16 Under birth weight on discharge 59 Transferred with Mother to another Institution 1 Number of Infants entirely breast fed 243 Number of Infants in which breast feeding was supplemented 4 16 Clinics for Expectant Mothers. The Central Clinic is held at the Maternity Home on Monday, Tuesday, and Thursday mornings and Thursday afternoons in each week. Particulars of the Clinics for the year 1936 are as follows:— Number of Sessions held l62 Number of Patients examined 645 Number of Attendances made by all Patients 3,437 Number of Primigravidæ examined 327 Number of Multigravidæ examined 294 Number who were found to be not pregnant 24 Number of normal labours 338 Number of abnormal labours 58 Number undelivered at the end of 1936 190 Number removed from the district 35 Number sent by the Maternity Home 457 Number sent by Midwives 91 Number sent by Doctors and Institutions 4 Number who came on their own initiative 81 Number who came at the suggestion of the Health Visitor 12 Number who attended for Post-natal examination 228 The labours that ended abnormally are classified as follows:— Breech 4 Ante-Partum Hæmorrhage 1 Breech (premature) 4 Post-Partum Hæmorrhage 1 Face + Forceps 1 Premature Birth 2 Forceps 12 Premature + Ante-Partum Hæmorrhage 1 Forceps (macerated foetus) 1 Still-birth 4 Induction 5 Miscarriage 10 Induction + Forceps 2 Abortion 1 Adherent Placenta 6 Cæsarean 1 Placenta Prævia 1 Puerperal Pyrexia 1 17 The Complications found are classified as follows:— Complication. Primiparae Multiparae Not Pregnant Total Diseases and Disorders of the Reproductive System Threatened Miscarriage — 1 — 1 Prolapse — 1 — 1 Retroversion — 2 — 2 Sterility 2 3 — 5 Cystocele — 9 — 9 Rectocele — 2 — 2 Leucorrhœa — 1 — 1 Purulent Vaginal Discharge 3 5 — 8 Diseases and Disorders of the Digestive System: Dental Caries 85 68 — 153 Pyorrhœa 3 4 — 7 Heartburn 36 31 — 67 Hyperemesis 11 9 — 20 Indigestion 38 21 — 59 Constipation 107 86 1 194 Diseases of Respiratory System: Laryngitis — 2 — 2 Nasal Catarrh 8 7 — 15 Bronchitis 17 18 — 35 Disorders of the Circulatory System: Valvular Disease of the Heart 8 5 — 13 High Blood Pressure 134 93 — 227 Varicose Veins of Lower Limbs 50 74 — 124 Hæmorrhoids 6 11 — 17 Epistaxis 5 1 — 6 Disorders of the Nervous System: Insomnia of Pregnancy 15 24 — 39 Diseases of the Urinary System: Albuminuria of Pregnancy 24 11 — 35 Glycosuria of Pregnancy 12 11 — 23 Pyelitis 1 — — 1 Affections of the Skin : Seborrhœa — 1 — 1 Urticaria 2 — — 2 Psoriasis — 1 — 1 Herpes 1 — — 1 Pruritus 1 3 — 4 Lupus of Leg 1 — — 1 Diseases of the Eye : Conjunctivitis — 1 — 1 Diseases of the Ear. Otorrhœa — 1 — 1 General Diseases: Anaemia of Pregnancy 7 8 — 15 Malpresentations 3 1 — 4 Rheumatism 1 2 — 3 Cramp 4 4 — 8 No Complications found 21 15 — 36 18 Post-Natal Clinic.—This Clinic has been held throughout the year on Tuesday mornings, and 228 mothers attended for a postnatal examination. Downham Ante-natal Clinic.—This Clinic is held at the Downham Health Centre on one morning each week. During the year 130 women attended, the total attendances amounting to 345. Eleven women attended for a post-natal examination. Clinics for Mothers and Infants. These Clinics are held at the Lewisham Health Centre on four mornings each week, and at the Downham Health Centre on two mornings each week. Each Clinic is attended by one of the Maternity and Child Welfare Officers, and by two Health Visitors. At the Lewisham Centre the attendances of infants numbered 8,790, there being 1,652 children on the Register, and at the Downham Centre there were 3,588 attendances, and 670 children on the Register. The cases treated during the year were classified as follows:— Mothers' Clinic. Rushey Green. Downham. Diseases and Disorders of the Reproductive System 159 74 Diseases and Disorders of the Alimentary System 165 52 Diseases and Disorders of the Respiratory System 7 6 Diseases and Disorders of the Nervous System 7 2 Diseases of the Urinary System 2 — Affections of the Skin 6 8 Diseases of the Eye 2 4 Diseases of the Veins 2 2 General Diseases 177 29 Consultations 1489 461 19 Infants' Clinic. Rushey Green. Downham. Diseases and Disorders of the Alimentary System 328 116 Diseases and Disorders of the Respiratory System 611 176 Diseases and Disorders of the Circulatory System — 4 Diseases of the Urinary System 14 4 Diseases and Disorders of the Nervous System 11 3 Affections of the Skin 138 137 Diseases of the Ear 26 7 Diseases of the Eye 23 31 Wounds and Bruises — 5 Scalds and Burns 10 — Congenital Defects 2 2 Rickets 28 15 General Diseases 99 34 Consultations on Feeding and Management (under 1 year) 2,625 1,088 Consultations on Feeding and Management (1-5 years) 3,396 1,105 Voluntary Infant Welfare Centres. There are eleven Voluntary Infant Welfare Centres in the Borough, and the attendances at these during the year are summarised below :- Name of Centre. No. of Sessions held in the Year. Total Attendances. Children under 1 year of age. Children aged 1-5 years. Bellingham Infant Welfare Centre 53 2,475 3,156 Brockley Infant Welfare Centre 48 1,781 1,491 Catford School for Mothers 98 6,031 3,427 Downham Infant Welfare Centre 47 3,010 3,257 Forest Hill School for Mothers 55 5,224 3,644 Grove Park Infant Welfare Centre 51 2,605 2,455 Hither Green Mothers' & Babies' Welcome 48 3,648 3,337 Lee and Blackheath School for Mothers 50 4,317 3,728 St. Mary's School for Mothers 51 3,724 2,130 Sydenham Infant Welfare Centre 100 4,060 1,918 Upper Sydenham Infant Welfare Centre 47 1,653 1,112 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 57 mothers and 24 infants, and complete or partial dentures for S3 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 3,006 grants of dried milk for four weeks free of charge, and 549 grants at the reduced price of 6d. per lb. Altogether, 17,037 lbs. of dried milk were issued at a cost to the Council of £1,188. 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 381 outfits were supplied during the year, compared with 359 in the previous year. No charge was made for the outfit in 132 cases, 65 were issued at half-price, and 184 at cost price. Obstetric Consultants. The services of the Consultants whose services are retained by the Council were requisitioned by a medical practitioner in one case of difficult confinement. Home Helps. The services of a Home Help were provided in 26 cases of confinement. In a few instances the applicants were asked to make a small contribution to the cost. Health Visitors. There are nine whole-time Health Visitors engaged in Maternity and Child Welfare work. One of these was appointed during the year and commenced duty in July. An additional Health Visitor was 21 also appointed during the year but did not take up her duties till January of the following year. Each Health Visitor has a particular part of the Borough allotted to her 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 2,836 Subsequent visits 6,989 Infants between 1 and 5 years of age:— Total visits 12,621 Expectant mothers:— First visits 934 Subsequent visits 363 Infant death enquiries 91 Still-birth enquiries 83 Visits to Puerperal Fever cases 20 Visits to Ophthalmia Neonatorum cases 57 Visits to Measles cases 585 Visits to other Infectious cases 483 Miscellaneous visits 970 Ineffectual calls 3,629 Attendances at Centres:— Municipal 695 Voluntary 786 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 1s. 3d. per visit. The cases nursed during 1936, and the number of visits made, are shown in the following table:— Nature of Illness. No. of Cases. No. of Visits. Measles 44 530 Pneumonia 69 1,431 Whooping Cough 2 28 Ophthalmia Neonatorum 2 88 Totals 117 2,077 Infant Life Protection. The number of foster-mothers on the Register at the end of the year was 131, and the children in their care numbered 199. The officer charged with supervising the welfare of these infants made 1,706 visits to their homes during the year. Eight nurse-children died. Children under School Age. Ministry of Health Circular 1550 (29th May, 1936). This Circular is on the subject of the arrangements made by local Authorities for the supervision of the health of children not in attendance at school. The Minister states that he is convinced that, in general, these arrangements are satisfactory in so far as they apply to children up to the age of 18 months or 2 years, and the striking fall in the infant mortality rate, which last year was the lowest on record, namely— 57 per 1,000 births, testifies to the value of the work performed under Maternity and Child Welfare Schemes for the benefit of children in the first year of life. 23 The Minister is, however, concerned to find in many areas insufficient attention is being given to the health of children between the ages of 18 months and five years. He understands that more than 16 per cent. of the children entering school are found to require treatment for some disease or defect, and it is clear that in many cases these conditions could have been prevented from developing or could have been quickly cured if adequate supervision of the health of the children had been exercised throughout the pre-school years. The Minister mentions the policy of the Government in regard to the provision of nursery schools and the admission of children under five years of age to the infant departments of elementary schools, but whatever provision is made on the lines there suggested, very considerable numbers of children under the age of five will remain at home, and in the interests of their health it is essential that in all areas there should be systematic visiting of these young children who are not in attendance at school. It is pointed out that it should be the duty of the Health Visitor to see these children at regular intervals to make enquiries as to their state of health and to be on the look-out for any symptoms or signs which suggest a departure from normal health. In all cases where there is ground for suspecting disease or defects, the mother should be advised to consult the family doctor, or to take the child to the appropriate clinic for medical examination. In some areas, special arrangements have been made for the holding of " toddlers' clinics " at the Infant Welfare Centres, and there is much to be said for these arrangements if the mothers can be persuaded to bring the toddlers periodically to the clinics for examination by the doctor, but the success of these clinics will depend to a great extent on the regular visiting of the homes by the Health Visitor and on the relations which she is able to establish with the mothers. The Minister further states that, in many areas, the school clinic is available for the treatment of minor ailments and of special defects in young children, and it is desirable that such arrangements should be more generally made. 24 It is mentioned that, in certain areas, Day Nurseries have been provided for the care of young children whose mothers go out to work, and it is suggested that Councils should consider the desirability of establishing these institutions. The Minister states that it is clear that the success of any efforts to secure adequate supervision of the health of young children will depend on the efficiency of the Health Visiting staff, and that in many areas it may be necessary to increase that staff. The Minister regrets to find that, in some areas, the salaries offered for these posts are inadequate. The Council were asked to review their arrangements for supervising the health of young children, and inform the Minister as soon as possible of the result of their consideration of this Circular. As the result of very serious consideration given to this Circular, and the report of the Medical Officer of Health thereon, the Council resolved upon the following action to meet the suggestions made by the Minister of Health : — To take the necessary steps with a view to the immediate appointment of one whole-time Health Visitor. To appoint three additional Health Visitors early in the next financial year. To establish " toddlers' clinics" at the Downham Centre, the new Central Clinic, Lewisham, and at the proposed new clinic in the Brockley district. To make arrangements with the South Eastern Hospital for Children, Sydenham, and at St. John's Hospital, Lewisham, for the provision for the pre-school child of orthopædic treatment, operative treatment for tonsils or adenoids, or both, dental treatment, treatment of diseases and defects of the eyes, and other minor defects. To make arrangements with the London County Council for the treatment of minor ailments of children not requiring hospital treatment. To make arrangements for the appointment of part-time medical officers or a part-time medical officer on a sessional basis 25 to attend at two infant welfare centres per week when the wholetime medical officers will be engaged in attending the proposed " toddlers' clinics." To restore the age limits for the purposes of the assisted milk scheme to those set out in the Ministry's Circular No. 185, dated 31st March, 1921. To make the necessary provision in the estimates for the next financial year for the additional services specified above. To forward a copy of the Medical Officer of Health's report to the Minister of Health and to inform him of the action to be taken by this Council with an assurance that the needs of " toddlers " in this Borough will receive continued attention. 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. 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, 2,786 specimens were examined, the details being as follows : — Material from cases of suspected Diphtheria :— Diphtheria bacillus isolated 104 Negative 1,841 Sputa from cases of suspected Tuberculosis Tubercle bacillus found 112 Tubercle bacillus not found 696 Blood from cases of suspected Enteric Fever :— Positive result 4 Negative result 26 Pathological specimens for Enteric Organisms :— Positive result — Negative result 3 Total 2,786 26 Removal of Infirm or Diseased Persons. It was necessary to employ the powers granted by Section 224 of the Public Health (London) Act, 1936, in respect of an elderly man who was found to be living in unsanitary conditions, and the necessary Order of the Court was obtained for his removal to a suitable institution. 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 387 bodies were received into the Mortuary, of which number, 98 were brought in from outside the Borough, and 184 from Public Institutions. The Inquests held numbered 269, and 153 post-mortem examinations were conducted. Disinfection and Personal Cleansing. The Disinfecting Station is situated at Wearside Road, Lewisham. Details of the work carried out during the year are contained in the following tables : — Disinfecting Station. Premises Visited 1,559 Rooms Disinfected 3,522 Articles Disinfected :— Beds 750 Blankets 2,995 Bolsters 837 Mattresses 1,733 Pillows and Cushions 4,002 Quilts 1,410 Sheets 2,137 Miscellaneous Articles 6,189 Wearing Apparel 6,796 Articles Washed 13,687 Mattresses Re-tufted 914 Verminous Rooms Treated 366 Verminous Articles Treated 1,609 Cleansing Station. Children Treated for Vermin 1,002 Attendances at the Cleansing Station 1,972 Adults Treated for Vermin 1 Attendances at the Cleansing Station 1 Adults and Children Treated for Scabies 171 Baths Given 836 A new motor disinfecting van was purchased during the year at a cost of £225. 27 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 1936 is shown below. Loads. Tons. Container System 24,037 42,195 Freighters 4,344 5,079 Other Vehicles 296 267 Totals 28,677 47,541 The main portion of the refuse is disposed of at the Destructors situated at Molesworth Street, Lewisham, and Home Park, Sydenham, the remainder being sent away by barges or deposited on shoots in the Borough. The following are the figures for 1936 : — Tons. Home Park Destructor .. 17,750 Molesworth Street Destructor 16,946 Barged away 13,793 Shoots 238 Totals 48,727 The figures for disposal include 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 Sanitary Inspectors is summarised in the following statement : — Inspections . On complaint 1,623 After Infectious Disease 1,075 Notice from Builder 641 Other Inspections 4,275 Re-inspections 8,985 New Dwellings, for Water Certificates 1,515 Notices : Number of Intimation Notices Served 1,474 Number of Statutory Notices Served 586 28 Sanitary Improvements Effected. Premises Cleansed and Repaired 1,099 Drains Entirely Reconstructed 152 Drains Repaired 308 Water-closets Cleansed or Repaired 451 Soil-pipes Renewed or Repaired 200 Waste-pipes Renewed or Repaired 313 Rainwater Pipes Renewed or Repaired 220 Roofs and Gutters Repaired 528 Dampness in Premises Remedied 570 Yards Drained or Paved 193 Dust-bins Provided 202 Water-cisterns Cleansed or Covered 33 Water Fittings Repaired 232 Additional water supplies provided to tenement houses 17 Defective Fire-places remedied 208 Offensive Accumulations Removed 94 Urinals Cleansed or Repaired 24 Animals Improperly Kept 20 Other Nuisances Remedied 642 Two additional Sanitary Inspectors were appointed during the year, and the staff of Inspectors now numbers twelve. Factories and Workshops. The woman inspector is responsible for the inspection of factories, workshops, and laundries, and 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. 13 31 — Laundries 19 11 — Tailors 1 58 — Dentists — 40 — Bootmakers and Repairers 60 87 — Builders 20 50 — Motor Garages and Repairers 44 51 11 Jewellers and Watch Repairers — 32 — Upholsterers and Cabinet Makers 1 33 — Miscellaneous 96 172 7 Totals 254 565 18 29 Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 415 1 — Workshops (including Workshop Laundries) 969 1 — Workplaces (other than Outworkers' premises) 26 — — Total 1,410 2 — 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 — — — — Want of ventilation — — — — Overcrowding 1 — 1 — Want of drainage of floors — — — — Other nuisances — — — — Sanitary accommodation insufficient — — — — unsuitable or defective 1 1 — — not separate for sexes — — — — Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) — — — — Total 2 1 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. 30 Outworkers. No. of out-workers on the Register 339 Visits made 427 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 277 investigations were made into complaints of alleged rat infestation. In 122 instances, defective drains were found to be responsible, and in 82 instances the contributory cause was found elsewhere. The complaint was unfounded in 73 cases. Smoke Abatement. During the year 91 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. 28, Stillness Road. Non-compliance with notices, requesting the abatement of nuisances. Notice complied with and summons withdrawn. New Legislation. The Public Health (London) Act, 1936, received the Royal Assent on July 31st, and came into operation on October 1st, 1936. The Act, in the main, is a consolidating measure, and therefore, does not call for comment. 31 HOUSING. The following summary of housing statistics is included in this report on the instructions of the Ministry of Health : — Inspection of Dwelling Houses during the Year : — (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,294 (b) Number of Inspections made for the purpose 7,504 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 622 (b) Number of Inspections made for the purpose 1,910 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation188 (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 1,474 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 888 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 32 (B) Proceedings under Public Health Acts : — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 586 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : — (a) By owners 562 (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 23 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 3 Housing Act, 1935.—Overcrowding : — (a).— (i) Number of dwellings overcrowded at the end of the year 844 (ii) Number of families dwelling therein 844 (iii) Number of persons dwelling therein 6066 (b).—Number of new cases of overcrowding reported during the year 261 (c).—(i) Number of cases of overcrowding relieved during the year 437 (ii) Number of persons concerned in such cases 2780 Unfit Houses dealt with as Clearance Areas. The work of dealing with unfit houses proceeded satisfactorily during the year, and, since the commencement of the campaign, 17 Clearance Orders, affecting 144 houses, have been made by the Council, and subsequently confirmed by the Minister of Health, in most cases after the holding of a Public Enquiry. Sixty-eight 33 of these houses have already been demolished, and most of the remainder have been vacated and are in process of demolition. Three hundred and sixty-two persons have so far been displaced by these Orders and in the majority of cases re-housed on the London County Council Estates at Bellingham, Downham, Honor Oak and Mottingham, the latter being popular owing to the low rents of the houses on this Estate. In some cases, however, tenants have preferred to find their own accommodation in order to remain near their place of work and save the additional expense of fares travelling to and from their homes. During 1936 the following Orders were made and subsequently confirmed : — Area. Premises. Orchard Place, Cast- Nos. 1 to 11 (consecutive), Orchard Place. lands Road, Catford Russell Street, Nos. 34 to 48 (even), Russell Street. Sydenham, No. 1 Russell Street, Nos. 7 to 31 (odd), Russell Street. Sydenham, No. 2 Russell Street, Nos. 2, 4 and 6, Russell Street. Sydenham, No. 3 Elmira Street, Nos. 11, 13, 15, 17, 19, 21, 23 and 25, Lewisham, No. 1 Elmira Street. Elmira Street, Nos. 31 and 33, Elmira Street. Lewisham, No. 2 Elmira Street, Nos. 39a, 41, 43, 45, 47, 49, 51, 53 and Lewisham, No. 3 55, Elmira Street ; 1, 2 and 3, Pettitt's Buildings ; 1 and 2, Eureka Place, and 40, 42, 44 and 46, Mill Road. Elmira Street, Nos. 59, 61, 63 and 65, Elmira Street. Lewisham, No. 4 Mill Road, Lewisham Nos. 2, 4, 6, 10, 12, 14 and 16, Mill Road. Two houses, viz :—1a and 2a, Paragon Place, Blackheath, which were included in the Council's Clearance Programme, were voluntarily demolished by the owners after the tenants had been re-housed by the London County Council. Two large areas were the subject of Clearance Orders made by the London County Council and, after a Public Inquiry at the Greenwich Town Hall, at which I was asked to corroborate the County Council's evidence, were confirmed by the Ministry of Health. These areas consisted of the following properties : — 34 Area. Premises. Sparta Street, No. 1 Nos. 1 , 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 and 26, Harwich Place ; 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 and 15, Carthage Street; 37, 39, 41, 43, 45, 47, 49, 51, 53, 55, 57, 59, 61, 63, 65, 67, 69, 71, 73 and 75, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72, 74, 76, 78, 80, 82, 84, 86, 88 and 90, Sparta Street ; 1 and 2, Vine Cottages, Sparta Street. Sparta Street, No. 2 Nos. 11, 12, 13, 14, 15 and 16, Merton Place; 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23 and 24, Regent Street ; 17, 19, 21, 23 and 25, Sparta Street. Certain other properties, which are in the Borough of Greenwich, namely : — Nos. 4a, 5, 6, 7 and 8, Merton Place ; Nos. 5, 9, 11 and 13, Sparta Street ; Nos. 1 and 2, Burling Place, were also included in No. 2 Area. It is proposed to utilise this site for re-building, and the London County Council, therefore, purchased compulsorily, certain other surrounding properties to join up these two areas and enlarge the site. The London County Council have also made Clearance Orders in respect of the following areas : — Area. Premises. Loampit Vale, No. 1 Nos. 1 and 2, Smith's Cottages ; 1,2, 3, 4, 5 and 6, Dunsley Place ; 1, 2. 3, 4, 5 and 6, Mount Pleasant Cottages. Loampit Vale, No. 2 Nos. 1, 3, 5, 7 and 9, 6, 8, and 10, Hurst Cottages ; 2, 6 and 7, Hope Cottages. Closing Orders Prohibiting the Use of Part of a Building for Human Habitation. The following is a list of premises which were represented for Closing Orders under Section 84 of the Housing Act, 1935, in respect of underground rooms or part of the premises: — 35 1, 2, 3, 4, 5, 6, Southbrook Mews. (Closed.) 15 to 22, The Retreat, Hither Green. (Closed.) 27a, Longton Grove. (Closed.) 243, High Street, Lewisham. (Closed.) 17, Hither Green Lane. (Closed.) 2, Ringstead Road. (Rendered fit.) 87, Courthill Road. (Rendered fit.) 58, Ladywell Park. (Rendered fit.) 21, Ladywell Park. (Closed.) HOUSING ACT, 1936. Overcrowding Provisions. The fixing of the " appointed days," in respect of the Housing Act, 1936, was the subject of a Ministry of Health Circular (No. 1539), dated 7th May, 1936, in which it was pointed out that the two most relevant considerations in fixing the appointed days were the extent of the overcrowding, and the time likely to elapse before a substantial amount of that overcrowding could be remedied. In view of the comparatively small amount of overcrowding in this Borough, revealed by the survey carried out in the previous year, and the fact that the London County Council would be in a position to provide most of the accommodation required for the abatement of the overcrowding, the Council made certain representations to the Minister of Health, as a result of which he made an Order, in respect of this Borough, fixing January 1st, 1937, as the appointed day under Sections 3, 4, 8 and 68 of the Act, which brings the overcrowding standard into operation, and July 1st, 1936, as the appointed day under Section 6 of the Act, under which it is compulsory for an entry to be made in all rent books within six months stating the number of persons permitted to occupy the house. As a consequence of this Order, it became necessary to carry out a further survey of the Borough and to take measurements of the rooms comprised in all working-class dwellings, in order to ascertain the number of persons allowed to occupy each dwelling, and to be in a position to furnish this information to the owner, as required by that Act. A temporary staff was engaged, and the work completed in December. In all, some 24,000 houses were measured, and a staff of temporary clerks was employed in calculating the permitted numbers and issuing the certificates to owners. 36 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 144, and, in addition, 149 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. The inspections of these premises during the year numbered 545. Cowhouses.—There is now only one licensed cowhouse in the Borough, and this was inspected eight times during the year. 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 1936 as follows : - Premises licensed to Pasteurise 1 Retail premises licensed to sell Certified Milk 9 ,, ,, ,, ,, Grade A (Tuberculin Tested) Milk 13 ,, ,, ,, ,, Grade A Milk 3 ,, ,, ,, ,, Grade A (Pasteurised) 4 „ „ ,, ,, Pasteurised Milk 53 Bacteriological Examination of Milk.—Samples of milk for bacteriological examination were taken as under : — Pasteurised—24 samples, of which number 2 were found to contain bacteria in excess of the 100,000 permitted by the Milk (Special Designations) Order. Certified—6 samples, all of which complied with the Order. Grade A (Tuberculin Tested)—1 sample, which complied with the Order. Grade A (Pasteurised)—1 sample, which contained bacteria in excess of the permitted number. Four samples of milk (not graded) were submitted to the animal innoculation test for tubercle and gave a negative result. The Milk (Special Designations) Order, 1936.—This Order came into force on June 1st, 1936. It revokes the Orders of 1923 and 1934, and abolishes the following designations : — 37 (1) Certified ; (2) Grade A (Tuberculin Tested) ; (3) Grade A. The new Order prescribes the following special designations : — (1) Tuberculin Tested Milk.—Milk from cows which have passed a veterinary examination and a Tuberculin test. The milk may be bottled on the farm or elsewhere, and it must satisfy a prescribed methylene blue reduction test for cleanliness. It must not contain at any time Coliform Bacilli in l/100th millilitre. (2) Tuberculin Tested Milk (Pasteurised).—Milk from Tuberculin tested cows which has been pasteurised. It must not contain more than 30,000 bacteria per millilitre. (3) Tuberculin Tested Milk (Certified).—Milk from Tuberculin tested cows which has been bottled on the farm. (4) Accredited Milk.—Milk from cows which have passed a veterinary examination, but which are not Tuberculin tested. It may be bottled on the farm or elsewhere. The same bacteriological standards are required as for Tuberculin tested milk. (5) Pasteurised Milk.- -This designation includes both accredited and ungraded milk when pasteurised. The milk must not contain more than 100,000 bacteria per millilitre. 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, Higli Road, Lee R. C. Hammett, Ltd. Havelock Street Mews, Forest Hill Chalk & Cox, Ltd. 12, Montpelier Vale B. W. Parsons, Ltd. 13, Rushey Green Chalk & Cox, Ltd. Weardale Road, Lee H. W. Hemmings Notice of intention to slaughter must be given to the Public Health Department, and all carcases are examined before being offered for sale. 38 During the year the Sanitary Inspectors made 410 attendances for this purpose, and 3,882 animals were slaughtered. Unsound Food.—The following quantities of meat, fish, etc., were surrendered as unfit for food, and destroyed : — Bullocks' heads, fats, livers, etc., 6 cwt. S stones ; Sheeps' liver, 12 lbs. ; Pigs' offal, etc., 5 cwt. 6½ stones ; Ham, 10½ lbs. ; Fish, various, 2 cwt. ; Tomatoes, 7 cwts. ; Peaches, 153 tins. 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, 357 premises were on register, including 182 ice-cream premises. During the year, 691 inspections of these premises were made. Bakehouses.—There are 78 bakehouses on the Register, and 521 inspections of these were made during the year. Restaurants and Eating-houses.—There are 121 establishments of this description on the Register, and during the year, 285 inspections were made. Food Shops and Stalls.—Inspections of these premises during the year numbered 1,221. Merchandise Marks Act, 1926. An Order amending the provisions of Order No. 7 of 1934, came into force during the year, relating to the manner in which the indication of origin may be applied to chilled beef, and skinned loins and shoulder cuts of frozen pork. Food and Drugs (Adulteration) Act, 1928. During the year under review, 905 samples of food, drugs, etc., were obtained by the Council's Inspector and submitted to the Public Analyst for examination. Of this number, 104 were purchased formally in accordance with the provisions of the above-named Act, and the remaining 801 were obtained informally as " test" samples. Four formal samples and thirty-one informal samples were certified by the Public Analyst as adulterated or below standard. 39 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 — 4 4 — — — Tartaric — 3 3 — — — Beverages — 1 1 — — — Baking Powder — 2 2 — — — Borax — 3 3 — — — Brandy — 3 3 — — — Butter — 32 32 — — — Butter on Bread 1 28 29 — 1 1 Cheese — 37 37 — 1 1 Cocoa — 32 32 — — — Chocolate Powder — 1 1 — — — Coffee — 8 8 — — — Coffee Mixtures — 3 3 — — — Confectionery — 2 2 — — — Cream — 31 31 — — — Cream of Tartar — 4 4 — — — Custard Powder — 1 1 — — — Dripping — 7 7 — — — Fish. Canned — 128 128 — 19 19 ,, Paste — 48 48 — — — Flour, Self-raising — 11 11 — — — Fruit, Canned — 18 18 — — — Dried 1 42 43 1 1 2 Gin 1 6 7 — 1 1 Ground ginger — 3 3 — — — Ice-cream — 1 1 — l 1 Lard — 29 29 — — — Lemonade Powder — 3 3 — — — Lime Water — 1 1 — — — Liniment of Turpentine — 1 1 — — — Linseed, crushed — 3 3 — — — Margarine — 35 35 — — — Meat — 3 3 — — — ,, Paste — 11 11 — — — ,, Pies — 1 1 — — — ,, Rolls — 2 2 — — — Milk 99 16 115 2 — 2 Condensed — 24 24 — — — Oil, Almond — 2 2 — — — ,, Camphorated — 3 3 — — — ,, Castor — 3 3 — — — ,, Cod Liver — 2 2 — — — ,, Eucalyptus — 2 2 — — — 40 Article. No. of Samples Examined. No. of Samples Adulterated, etc. Formal Informal Total Formal Informal Total Ointment, Boric . . — 2 2 — — — ,, Mercury — 2 2 — 1 1 ,, Zinc — 4 4 — — — Paregoric — 2 2 — — — Pickles — 1 1 — — — Powder, -Gregory . . 1 3 4 1 2 3 ,, Seidlitz . . — 3 3 — 1 1 Rum — 7 7 — 1 1 Sal Volatile. . — 2 2 — — — Sausages — 5 5 — — — Soup — 3 3 — — — Spices and Condiments — 61 61 — — — Suet — 6 6 — .— — Sugar — 10 10 — — Tea — 42 42 — — Tincture of Iodine. . — 2 2 — — Tincture of Quinine — 3 3 — — — Vegetables, Preserved — 6 6 — — — Vinegar 1 19 20 — 2 2 Whisky — 14 14 — — — Totals 104 801 905 4 31 35 Milk.—One hundred and fifteen samples of milk were examined by the Public Analyst, and 2 of these, or 1.7 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 3.64 8.84 87.52 3.0 8.5 Second ,, 3.40 8.78 87.82 Third ,, 3.59 8.79 87.62 Fourth ,, 4.01 8.97 87.02 Average for the Year 3.66 8.845 87.495 41 Adulterated Samples. No. Article. Formal or Informal. Adulteration or Irregularity. Action Taken. 711 Malt Vinegar Informal Artificial Vinegar, 100% Subsequent formal sample genuine. 828 Butter on Bread „ Margarine, 60%. „ „ „ „ 858 Gregory Powder „ Magnesium Carbonate deficient, 92.3%. Vendor Cautioned. 860 Mercury Ointment „ Mercury deficient, 10.4%. „ „ 862 Tincture of Iodine „ Iodine deficient, 9%. „ „ 868 Seidlitz Powder „ Rochelle Salt deficient, 24%. „ „ 17 Gregory Powder Formal Magnesium Carbonate deficient, 93.8%. „ „ 30 „ „ Informal „ „ „54.6%. „ „ 129 Ice-cream „ Copper Alloy, .086%. „ „ 174 Cheese and Celery „ Tin, 3.63 grains per lb. Stock surrendered and destroyed. 187 Sild „ Tin, 3.5 grains per lb. 234 Sardines „ Lead, 59 parts per million. Stocks returned to Wholesaler. 258 Sild „ Tin. 2.7 grains per lb. Subsequent samples genuine 311 „ „ Tin, 5.08 grains per lb. Only tin in stock. 323 „ „ Tin, 3.0 grains per lb. Stocks returned to Wholesaler. 332 „ „ Tin, 3.38 grains per lb. Stocks destroyed. 346 „ „ Lead, 32 parts per million. Sales stopped. 42 Adulterated Samples—contd. No. Article. Formal or Informal. Adulteration or Irregularity. Action Taken. 387 Glace Cherries Informal Copper, 28 parts per million. See Sample No. 450. 442 Sild „ Tin, 3.8 grains per lb. Stocks destroyed. 444 Milk Formal Extraneous water, 6%. Presecution—Case dismissed on payment of £3 3s. 0d. costs. 450 Glace Cherries „ Copper, 32 parts per million. Stock withdrawn from sale. 458 Sild in Oil. Informal Tin, 3.42 grains per lb. Stocks Surrendered 516 „ „ „ Tin, 2.2 grains per lb. „ „ 572 Silver Sild in Oil „ Tin, 2.6 grains per lb. „ „ 588 Sild in Oil „ Tin, 2.4 grains per lb. „ „ 611 Sild „ Tin, 4.1 grains per lb. „ „ 612 Malt Vinegar „ Vinegar other than Malt and Acetic Acid, 9.2% deficient. Subsequent formal sample genuine. 626 Milk Formal Extraneous water, 5.5%. Summons withdrawn. 43 Bye-laws for the Protection of Food.—New Bye-laws made by the London County Council came into force during the year and are intended to promote sanitary and cleanly conditions in the manufacture, preparation, storage, transport, or exposure for sale of any article intended for food. Pharmacy and Poisons, Act, 1933. On the 1st May, the provisions of Part II of the Act, in so far as they relate to the sale and distribution, etc., of poisons and poisonous substances, came into operation, and the names of tradesmen suitable for registration have been entered on the Council's list of persons entitled to sell poisons included in Part II of the Poisons List, which includes such articles as Spirits of Salts, Ammonia, Sulphuric Acid, Nitric Acid, Salts of Lemon, Arsenical and Mercurial Poisons, etc. 44 INFECTIOUS DISEASES. The following diseases are compulsorily notifiable in the Borough : — Acute Encephalitis Lethargica Acute Influenzal Pneumonia Acute Primary Pneumonia Acute Polio-Encephalitis Acute Polio-Myelitis Anthrax Cerebro-Spinal Meningitis Cholera Continued Fever Diphtheria Dysentery Erysipelas Enteric (or Typhoid) Fever Hydrophobia Glanders Malaria Membranous Croup Ophthalmia Neonatorum Plague Puerperal Fever Puerperal Pyrexia Relapsing Fever Scarlet Fever Smallpox Tuberculosis Typhus Fever Notifications. The following table shows the incidence of infectious disease during the year, and in the two preceding years : — Disease. Year. 1934 1935 1936 Smallpox 3 — — Scarlet Fever 1,277 830 868 Diphtheria 473 314 247 Paratyphoid Fever 2 17 6 Typhoid Fever 4 5 6 Puerperal Fever 12 3 2 Puerperal Pyrexia 31 32 35 Erysipelas 141 68 92 Acute Primary and Influenzal Pneumonia 273 184 200 Ophthalmia Neonatorum 17 4 18 Encephalitis Lethargica 1 1 2 Cerebro-spinal Meningitis 5 6 9 Polio-Myelitis 4 1 2 Malaria — — 2 Totals 2,243 1,465 1,489 45 Scarlet Fever.—This disease showed only a slight increase on the previous year, 868 cases being notified, as against 830 in 1935. There were two fatal cases. Diphtheria.—There was a gratifying decrease in the incidence of this disease, 247 cases being notified, compared with 314 in 1935. The deaths numbered 4 only, as against 14 in the previous year. Typhoid Fever.—Six cases of this disease were notified, and all received Institutional treatment. In two cases the diagnosis was not confirmed, one of these being subsequently found to be paratyphoid. In all the cases except one, in which the source of infection was not traced, the disease was contracted outside the Borough. There were no fatal cases. Para-Typhoid Fever.—Six cases of this disease occurred, and four of these were treated in Hospital. In one case the disease was found to have been contracted outside the Borough, and in the remainder the source of infection was not traced. Diphtheria Immunisation. The following are details of the work carried out in 1936 : — Number of children to whom a preliminary Schick Test was applied 277 „ found to be immune 64 „ found to be susceptible 213 „ immunised 156 „ awaiting immunisation 57 „ Schick tested and found to be immune 82 „ Schick tested and found not to be immune 1 „ awaiting Schick Test 73 Number of children immunised without a preliminary Schick Test 292 „ subsequently Schick tested 173 „ found to be immune 171 „ found to be susceptible 2 „ awaiting Schick Test 120 46 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, 67 phials of 8,000 units each (for treatment) and 2 prophylactic doses of 500 units each, were used. 47 Table showing Cases of Infectious Disease Notified, 1936. Number of Cases Notified. Disease. 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 j 20 years 20 and under 35 years 35 and under 45 years 45 and under 65 years 65 and over Scarlet Fever 2 12 39 75 74 358 151 59 71 20 6 1 868 803 Diphtheria 5 2 9 13 16 91 39 24 38 8 2 — 247 239 Typhoid Fever — — — — — 1 1 3 — — — 1 6 5 Paratvphoid Fever — — — 1 — — — — — — 2 1 6 5 Puerperal Fever — — — — — — — — 2 — — — 2 1 Puerperal Pyrexia — — — — — — — 2 30 3 — — 35 33 Erysipelas 4 1 — 1 — 2 5 3 13 13 35 15 92 43 Acute Primary & Influenzal Pneumonia 6 4 6 8 5 21 12 11 35 19 47 26 200 83 Ophthalmia Neonatorum 18 — — — — — — — — — — — 18 6 Cerebro-Spinal Meningitis 1 1 2 — — 1 1 — 2 1 — — 9 8 Acute Anterior Polio-Mvelitis — — — — — 1 — — — 1 — — 2 1 Encephalitic Lethargica — — — — — 1 — 1 — — — — 2 1 Malaria — — — — — — — 1 — 1 — — 2 1 Totals 36 20 56 98 95 476 209 106 191 66 92 44 1489 1230 48 Table showing Number of Deaths from Infectious Diseases in 1936. Diseases. Age Groups. Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 years and upwards All ages Typhoid and Paratyphoid Fevers — — — — — — — — — — — — Measles 5 7 9 1 — — — — — — — 22 Scarlet Fever — — 1 — — — — — — — — 2 Whooping Cough 7 3 4 1 — — — — — — — 15 Diphtheria — — — 4 — — — — — — — 4 Influenza 2 2 1 — — 2 2 8 4 5 12 38 Encephalitis Lethargica — — — — — — — — 1 1 — 2 Cerebro-Spinal Fever — 1 — — — — 1 — — — — 2 Puerperal Fever — — — — — — — — — — — 1 49 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, 1935 :— Number of Births registered from 1st January to 31st December, 1935 2,792 Number of these Births duly entered by 31st January, 1937, in the Vaccination Register Successfully Vaccinated 1,266 Insusceptible to Vaccination 9 Number in respect of whom Statutory Declarations of Conscientious Objection have been received .. 1,171 Died unvaccinated 99 Number of these Births which on 31st January, 1937, remained unentered in Vaccination Register on account of Postponement by Medical Certificate 24 Removal to districts, the Vaccination Officers of which have been duly appraised 49 Removal to places unknown 114 Number of these Births remaining on 31st January, 1937, neither duly entered in Vaccination Register not temporarily accounted for 60 Total number of Certificates and copies of Certificates of successful Primary Vaccination of Children under 14 received during the calendar year, 1936 1,432 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, 1936 1,174 Vaccination by Medical Officer of Health. No vaccination was performed by this officer under the Public Health (Smallpox Prevention) Regulations, 1917. Tuberculosis. Notification.—During the year, 294 new cases of pulmonary, and 85 new cases of non-pulmonary tuberculosis were received. 50 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 654 531 152 201 Notified during the year 161 133 49 36 ,, removed from the register 134 107 17 25 „ „ remaining on the register at end of the year 681 557 184 212 Mortality.—During the year, 141 persons died from pulmonary tuberculosis, and 16 died from other forms of this disease. The death rate from pulmonary tuberculosis was 0.62 per 1,000 inhabitants, compared with 0.58 per 1,000 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 — 6 4 — 1 1 2 5 2 2 8 3 — 1 3 3 10 1 6 8 3 — — — — 15 21 13 4 3 13 20 — 3 20 25 32 8 6 — — — — 25 31 35 4 12 17 19 — — 35 30 27 3 2 15 14 — — 45 27 12 3 2 18 7 1 — 55 19 5 4 — 10 3 1 — 65 and upwards 4 1 1 1 3 — 1 1 Totals 161 133 49 36 76 65 7 9 51 Efficiency of Notification.—The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was one in twelve. 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. REPORT OF THE TUBERCULOSIS OFFICER FOR 1936. On May 7th, 1936, the new Tuberculosis Dispensary at 1, Blagdon Road, was formally opened by H.R.H. the Duchess of Kent. It has taken the place of the old inconvenient temporary building at 47, Catford Hill, which had housed the Dispensary since its inception in 1916. The new building consists of the ground floor for all the medical work and the first floor for the Care work, including the Handicrafts Class. The whole building is well lighted and heated and has a constant supply of hot water. It is more centrally situated in the Borough than was the former Dispensary and more convenient for the large new housing estates at Downham and Honor Oak, to which so many families containing tuberculous members are transferred. The Dispensary Staff is unchanged and consists of one Tuberculosis Medical Officer, one Clerk Dispenser, three Health Visitors, one Care Committee Secretary with a Clerk ; there is also a voluntary worker, who gives her whole time to care work, to the great benefit of the patients. The primary notifications of tuberculosis for 1936 numbered 379, of which 294 were of pulmonary tuberculosis and 85 of other forms of tuberculosis. During the year, 141 persons died from pulmonary tuberculosis and 16 died from other forms of tuberculosis. The death rate from pulmonary tuberculosis was 0.62 per 1,000 inhabitants, a slight increase on the rate for 1935. Cases on Register.—The number of cases on the Town Hall register on December 31st, 1936, was 1,634, comprising 1,238 cases of pulmonary tuberculosis and 396 cases of non-pulmonary tuberculosis. The number of cases on the Dispensary register was 987, of which 808 were of pulmonary tuberculosis and 179 of nonpulmonary tuberculosis. 52 Attendances of Patients- During the year, the new patients who attended the Dispensary numbered 717, and the total attendances were 3,405. Of the new cases, 214 were referred to the Dispensary by their medical attendants, 174 were referred from Hospitals or from other areas, 261 were contacts of tuberculosis patients. A summary of first attendances is shown in Table C. Home Visiting.—The three Health Visitors paid over 4,870 visits to the homes of patients ; they gave advice as to the arrangement of the home for the benefit of the patient and the protection of the contacts and also arranged for the disinfection of rooms, bedding, etc., when necessary. No uniform is worn, so that the visits may be as unobtrusive as possible. Many instances of the appreciation of these visits by the patients and their families are recorded. The Tuberculosis Officer visited 267 patients in their homes and also saw 11 patients in their homes in consultation with their medical attendants. Reports.—Written reports to the number of 1,204 were sent out from the Dispensary. Residential Treatment.—The London County Council admitted 134 insured and 73 uninsured patients to residential institutions ; while 54 patients were referred direct to the Lewisham Hospital by the Tuberculosis Officer, these being patients in urgent need of treatment and having unsuitable home conditions. The Tuberculosis Officer visited the tuberculosis wards of the Lewisham Hospital 36 times in the capacity of consultant in tuberculosis to the Hospital. Affiliated and other Hospitals.—During the year, 140 patients were sent to St. John's Hospital, Lewisham, for X-Ray examination and report. Treatment by artificial pneumothorax is becoming ever more utilised and, during the year, 95 patients received this form of treatment as out-patients at various hospitals, 55 of them attending St. John's for the purpose. The cost of this treatment is born by the Borough Council. Light treatment for cases of lupus is given principally at the London Hospital. For laryngeal examination and for surgical diagnosis some patients have been referred to King's College Hospital or to the Miller General Hospital. Sputum Tests.—The sputum of 395 patients was examined and reported upon by the pathological department of St. John's Hospital. Dental Treatment.—During the year, 26 patients attended St. John's Hospital for dental treatment and 5 patients were assisted in obtaining dentures. 53 Extra Diet.—The Borough Council granted an allowance of milk, butter and eggs to 15 tuberculous patients to enable them to maintain their working capacity after return from Sanatorium. Shelters.—The six shelters provided by the Borough Council have been loaned to tuberculous patients having insufficient sleeping accommodation and sufficient garden space for their erection. Care Committee.--The Secretary of the Care Committee reports that the Committee met 27 times during the year. The cases considered for institutional treatment numbered 409. No assessment is made, as all necessary institutional treatment is given free by the London County Council, but 14 patients elected to contribute towards the cost of their treatment and a sum of £52 7s. 4d. was received from them and handed over to the London County Council. Many necessitous patients and their families were helped in various ways, such as provision of clothing and bedding, removal to better accommodation, boarding out of child contacts, fares to visit relatives undergoing treatment in a distant institution. Thus, 341 cases were considered for help, of whom, 171 received gifts of clothing. The London County Council sent reports concerning 114 children undergoing institutional treatment and these reports were communicated by the Care Committee to the parents. The Care. Committee, in all, distributed help to the value of £340, and at the end of the year the balance in hand of the voluntary fund amounted to £272. Handicrafts Class.—The large new room, where the Care Committee holds its fortnightly meetings, makes an admirable workroom for the handicrafts class, now in its eleventh year under the same instructress. The value of this occupational therapy is very considerable. Tables A to E 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. ROSE JORDAN, Tuberculosis Officer. 54 Table A. Summary of Tuberculosis Health Visitors' Work, 1936. ex-Service Patients. Civilian Patients. Total. Visits to Pulmonary Tuberculous Patients 33 255 288 ,, Non-pulmonary ,, ,, — 76 76 Subsequent Visits 427 3604 4031 Visits to Un-notified Cases. 53 525 578 No of patients occupying Separate Room 19 168 187 ,, sharing with 1 other 17 129 146 ,, ,, ,, 2 others 1 24 25 „ „ „ 3 „ — 5 5 „ „ „ 4 „ — 1 1 No. of Patients occupying Separate Bed 20 203 223 ,, ,, sharing with 1 other 16 120 136 ,. 2 others 1 4 5 Table B. Attendance of Patients at the Dispensary. 1936 First Attendances. Subsequent Attendances. Totals. January 63 226 289 February 71 193 264 March 84 278 362 April 44 188 232 May 65 171 236 June 49 217 266 July 59 253 312 August 37 197 234 September 66 243 309 October 74 273 347 November 58 228 286 December 47 221 268 717 2,688 3,405 55 Table C. Summary of First Attendances at the Dispensary, 1936. Applied on own initiative Sent by Doctor. Transferred from Hospitals, etc. Sent by L.C.C. Sent by Ministry of Pensions Contacts. Total. 9 88 121 — — 2 220 Non-Pulmonary 3 — 39 — 2 44 Non-tuberculous 52 123 14 2 o 257 450 Suspects — 3 — — — — 3 Total 04 214 174 2 2 261 717 Table D. Stages in Pulmonary Tuberculosis. Male. Female. Children under 15. Total. Stage I. 37 24 5 60 „ II 73 71 1 145 „ III. 6 9 — 15 110 104 6 220 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 E. Cases of Non-Pulmonary Tuberculosis. Male. Female. Children under 15. Total. Glands — 3 4 7 Bone 5 6 15 26 Other Regions 6 3 2 11 11 12 21 44 56 Return showing the work of the Dispensary during 1936. (Form T. 145 of Memorandum 37/T (Revised) of the Ministry of Health). Pulmonary. Non-Pulmonary Total. Grand Total Diagnosis. 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 81 66 1 1 5 _ 6 4 86 73 7 5 171 (b)Diagnosis not completed — — — — — — — — — — — — 6 (c) Non-tuberculous — — — — — — — — 71 78 24 17 190 B.—Contacts examined during the year :— (a) Definitely tuberculous — 1 1 — — — 2 — — — — — 4 (b) Diagnosis not completed — — — — — — — — — — — — — (c)Non-tuberculous — — — — — — — — 43 11 65 72 257 C.—Cases written off the Dispensary Register as :— (a) Recovered 16 10 1 1 — 5 3 3 16 15 4 4 39 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — 117 156 89 89 451 D.—Number of Cases on Dispensary Register on 31st December :— (a) Definitely tuberculous 433 338 19 18 37 60 44 38 470 398 63 56 987 (6) Diagnosis not completed — — — — — — — — 2 1 — — 3 1. Number of cases on Dispensary Register on 1st January 979 2. Number of cases transferred from other areas and cases returned after discharge 89 under Head 3 in previous years 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight 121 of " .. 4. Cases written off during the year as Dead (all causes) 95 5. Number of attendances at the Dispensary (including Contacts) 3405 C. Number of Insured Persons under Domiciliary Treatment on the 31st December 174 7. Number of consultations with medical practitioners :— (a) Personal 11 (b) Other 386 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 267 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4610 110. Number of :— (a) Specimens of sputum, etc., examined 395 (b) X-ray examinations made in connection with Dispensary work 140 11. Number of "Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above — 12. Number of " T.B. plus " cases on Dispensary Register on 31st December 555 13. Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) :— Provided by the Council 1 Provided by Voluntary Bodies 57 INDEX TO CONTENTS. Subject Page Bacteriological Examination of Milk 36 Births 7 Children under School Age 22 Cleansing Station 26 Clearance Areas 32 Clinics 16, 18 Coroner's Court and Mortuary 26 Deaths 9 Dental Treatment 20 Diphtheria Anti-Toxin 46 Diphtheria Immunisation 45 Disinfection 26 Downham Ante-natal Clinic 18 Factories and Workshops 28 Food and Drugs, Analysis of 38 Health Visitors 20 Home Helps 20 Home Nursing 22 Housing Statistics 31 Infant Clinics 19 Infant Life Protection 22 Infant Mortality 9 Infectious Diseases 44 Inspection and Supervision of Food 36 Laboratory Facilities 25 Legal Proceedings 30 Marriages 8 Maternity and Child Welfare 14 Maternity Home 14 Maternity Outfits 20 Merchandise Marks Act 38 Milk Assistance Scheme 20 Milk Supply 36 Neo-natal Deaths 10 58 Subject Page New Legislation 30 Obstetric Consultants 20 Overcrowding 35 Pharmacy and Poisons Act 43 Population 7 Rats and Mice (Destruction) Act 30 Refuse Removal and Disposal 27 Sanitary Inspection 27 Slaughterhouses 37 Smoke Abatement 30 Statistics 6 Tuberculosis Dispensary 54 Tuberculosis, Notifications, etc. 40 Tuberculosis Officer's Report 51 Vaccination 49 Voluntary Infant Welfare Centres 19 / $.