METROPOLITAN BOROUGH OF LEWISHAM. REPORT OF THE Medical Officer of Health For the Year 1937. John W. Miller, M.B., Ch.B., D.P.H. London: Printed by E. G. Berryman & Sons, Ltd., Blackheath Road, S.E.10. LEW 25 METROPOLITAN BOROUGH OF LEWISHAM. REPORT of the Medical Officer of Health For the Year 1937. 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 1937 on the health and sanitary condition of the Borough, this being the thirty-seventh of the series. The good health of the Borough is reflected in the vital statistics which appear in the report. The general death rate was the lowest of all the Metropolitan Boroughs, and the infantile mortality rate and the death rate from pulmonary tuberculosis showed a decrease on the previous year. The incidence of infectious disease calls for very little comment. There was less Scarlet Fever than in the previous year, but more Diphtheria. Sonne Dysentery became prevalent in the latter part of the year, 97 cases being notified, but this disease was common to many other parts of the Metropolis and the Home Counties. The Diphtheria Immunisation Scheme was revised during the year, and the Council now supply the immunising material, and pay a fee to the medical practitioner for administering the injections. The Maternity and Child Welfare services were extended during the year by the appointment of three more health visitors, by holding additional sessions at Bellingham, Forest Hill and Brockley, and by establishing Toddlers' Clinics at the Lewisham Health Centre and at Downham. The provision of additional Clinics, one on the Honor Oak Estate and another on the Downham Estate Extension, has also been under consideration. A scheme for the treatment of Minor Ailments in pre-school children at the St. John's Hospital, the South Eastern Hospital for Children, and the Downham Health Centre was commenced during the year. The Council participated in the National Campaign for the wider use of the Health Services which was promoted by the Central Council for Health Education in conjunction with the Ministry of Health. Publicity was given to the campaign by means of posters and leaflets. 4 Progress was made with the clearance of unfit houses, and representations were made to the Council in regard to ten Clearance Areas. Subsequent to the holding of Public Enquiries at the Town Hall, the Order was confirmed by the Ministry of Health, one house in a Catford Area being excluded from the Order in view of the offer of works submitted by the owner. In conclusion, I desire to express my appreciation of the kind consideration accorded me by the Chairman and members of the Public Health and Maternity and Child Welfare Committees, and to thank my colleagues, the Chief Officers of Departments and the staff of the Public Health Department for their loyal support and assistance. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JOHN W. MILLER, Medical Officer of Health. Town Hall, Catford, S.E.6. July, 1938. STAFF OF THE PUBLIC HEALTH DEPARTMENT, at the end of 1937. 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) Manley, C. W. J. (a) (b) Blaylock, E. T. (a) (b) Phillips, A. J. (a) (b) Brittain, R. C. (a) (b) Rayner, S. P. (a) (b) Craven, J. R. (a) (b) Thomas, A. G. (a) (b) Crowther, J. (a) (b) Walker, E. (a) (b) Holifield, C. E. (a) (b) Sanitary Inspector—Female. Miss D. M. Parnell (a) Sampling Officer and Food Inspector. H. Tolson (a) 6 Health Visitors. Miss F. L. Burton (c) (d) (e) Miss W. Eve (c) (d) (e) (f) Miss M. Chappell (d) (c) (e) Miss M. Middleton (d) (c) (e) Miss D. M. Charles (d) (e) Miss M. Reid (c) (d) (e) (f) Miss W. Cresswell (c) (d) (e) (f) Miss G. Simpson (a) (d) (e) (f) Miss G. M. Cromwell (c) (d) (e) Miss C. H. Thompson (a) (d) (e) Miss A. M. Edwards (c) (e) Miss E. M. Watson (a) (d) (e) Miss G. M. Wheeler (d) (e) (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) W. G. Coker C. C. Summers Miss E. Dewdney W. D. Back 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, Health Centre Miss B. C. Aylett 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, Health Centre S. Ambrose (a) Sanitary Inspector's Certificate. (d) Health Visitor's Certificate. (b) Food Inspector's Certificate. (e) Certificate of Central Midwives Board. (c) Trained Nurse. (f) Light Certificate. 7 STATISTICS. General Statistics, 1937. Area of the Borough 7,015 acres. Population:— Census, 1931 219,953 Estimated, Mid-year, 1937 226,000 Number of inhabited houses (end of 1937) according to Rate Books 56,000 (appx.). Rateable Value (at April, 1937) £1,788,803 Sum represented by a penny rate £7,117 Extracts from Vital Statistics, 1937. Total. Males. Females. Live Births:—Legitimate 2,923 1,511 1,412 Illegitimate 96 52 44 Total 3,019 1,563 1,456 Birth Rate per 1,000 of the estimated population 13.4 Total. Males. Females. Still-Births 119 66 53 Rate per 1,000 births (live and still-births) 39.4 — — Total. Males. Females. Deaths 2,455 1,185 1,270 Death Rate per 1,000 of the estimated papulation:— (crude) 10.8; (corrected) 10.9 Deaths from Puerperal Causes:— Deaths. Rate per 1,000 (live and still) Births. No. 29 Puerperal Sepsis l 0.32 No. 30 Other Puerperal Causes 3 0.96 Total 4 1.27 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 47 Legitimate infants per 1,000 legitimate live births 45 Illegitimate infants per 1,000 illegitimate live births 83 Deaths from Measles (all ages) — „ „ Whooping Cough (all ages) 11 „ „ Diarrhœa (under 2 years of age) 28 8 Population. The Registrar-General's estimate of the population of the Borough at mid-year, 1937, is 226,000, 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 1937 was supplied by the Registrar-General:— Total Registered Inward Transfers Outward Transfers Births allocated to Borough Legitimate Males 1,471 179 139 1,511 Legitimate Females 1,384 172 144 1,412 Illegitimate Males 71 4 23 52 Illegitimate Females 47 13 16 44 Totals 2,973 368 322 3,019 It will be seen that the corrected number of births is 3,019, which is equivalent to a birth rate of 13.4 per 1,000. The births and birth rates in the last ten years are shown herewith:— Year. No. of Births. Birth Rate. 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 1937 3,019 13.4 9 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 2,992 live births. Still-Births. Total number notified 101 Borough Cases born outside the Borough 6 Number of Borough Cases enquired into 97 Borough Cases in which no enquiry could be made 4 Causes of still-birth in the 97 investigated:— 1. Maternal Causes:— (a) Toxaemia 14 (b) Instrumental Labours 10 (c) Delayed Labours 10 (d) Ante-partum Hæmorrhage:— Placenta Praevia 4 7 Accidental Hæmorrhage 3 (e) Ill Health of Mother 4 (f) Hydramnios 2 2. Fœtal Causes:— (a) Breech Presentation 15 (b) Hydrocephalus 4 (c) Spina Bifida 2 (d) Anencephalus 2 (e) Foot Presentation 1 (f) Cord Prolapse 1 (g) Cord round neck 1 3. Causes not known 24 Marriages. The number of marriages registered in the Borough during the year was 1,766, compared with 1,951 in 1936. Of this number, 891 were solemnised in the Established Church, 239 in Non-conformist Places of Worship, and 636 at the Register Office. 10 Deaths. The number of deaths of Lewisham residents registered in 1937 was 2,455, 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. 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 1937 2,455 10.9 Deaths in Public Institutions. The deaths occurring in Hospitals and other Public Institutions in the Borough numbered 1,473, of which 953 were residents, and 476 residents died in Institutions outside the Borough. Infant Mortality. The number of infants who died before reaching one year of age was 141, equivalent to an infant mortality rate of 47 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. 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 1936 163 55 66 1937 141 47 60 11 Neo-natal Deaths. The number of infants who died in the first 4 weeks of life was 58, and the causes of death were as follows:— Prematurity 28 Atelectasis 6 Bronchitis 4 Gastro-enteritis 4 Congenital Deformity 3 Broncho-pneumonia 3 Umbilical Hæmorrhage 2 Meningitis 1 Icterus Neonatorum 1 Suprarenal Hæmorrhage 1 Pulmonary „ 1 Cerebral ,, 1 Congenital Heart Disease 1 Asphyxia 1 Toxaemia 1 Investigations were made into the circumstances of the 97 stillbirths and 58 Neo-natal deaths. It was found that:— 11 mothers received no ante-natal care. 22 mothers received some ante-natal care from their own doctor. 22 mothers received some ante-natal care from their own midwives. 85 mothers attended a Hospital Clinic. 15 mothers attended one of the Borough Ante-natal Clinics. The total number of still-births and Neo-natal deaths for 1937 is 159, and though this figure is lower than last year's it should be possible to lower it considerably, as a large proportion of the causes of death are preventable. 12 Table showing Causes of Death at Different Periods of Life during the Year 1937. 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 1 — — — — — — 1 — — — — F — — — — — — — — — — — — 2. Measles M — — — — — — — — — — — — F — — — — — — — — — — — — 3. Scarlet Fever M 2 — 1 — — — — — 1 — — — F — — — — — — — — — — — — 4. Whooping Cough M 6 4 1 — 1 — — — — — — — F 5 5 — — — — — — — — — — 5. Diphtheria M 4 — — 1 3 — — — — — — — F 7 — — 3 3 1 — — — — — — 6. Influenza M 41 — 2 — — 2 — 3 7 8 10 9 F 53 2 — — — 1 2 2 5 9 11 21 7. Encephalitis Lethargica M — — — — — — 1 — — — — — F 1 — — — — — — — — — — 8. Cerebro-Spinal Fever M 3 3 — — — — — — — — — — F 2 2 — — — — — — — — — — 9. Tuberculosis of Respiratory System M 78 — — — — 10 15 9 26 10 7 1 F 56 — — — — 15 18 11 7 3 2 — 10. Other Tuberculous Diseases M 5 — — 1 3 1 — — — — — — F 8 — — 1 4 — — 1 2 — — — 11. Syphilis M 4 — — — — — — 1 — 2 1 — F 1 — — — — — — — 1 — — — 12. General Paralysis of the Insane. Tabes Dorsalis.. M 5 — — — — — — 1 — 1 3 — F 1 — — — — — — 1 — — — — 13. Cancer, Malignant Disease M 178 — — 1 — — 3 9 18 62 54 31 F 201 — — — — — 2 17 37 47 57 41 14. Diabetes M 10 — — — — — 2 — 1 1 4 2 F 28 — — — — — 1 — 5 5 8 9 15. Cerebral Hæmorrhage, etc. M 37 — — — — — — 2 2 1 15 17 F 61 — — — — — — 1 6 7 13 34 1G. Heart Disease M 266 — — — — 4 4 7 26 55 87 83 F 343 — — — 2 3 5 10 14 34 103 172 17. Aneurysm M 8 — — — — — — — 2 4 1 1 F 3 — — — — — — — 1 1 — 1 18. Other Circulatory Diseases M 84 — — — — — — — 2 10 35 31 F 76 — — — — — — 2 3 10 29 32 19. Bronchitis M 47 2 — 1 — — — 1 4 7 10 22 F 43 3 — — — — 2 1 2 5 6 42 13 Table showing Causes of Death at Different Periods of Life during the Year 1937—continued. Causes of Death. Sex. A11 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 56 6 4 — — 2 1 3 10 13 10 7 F 51 9 4 — 1 2 1 3 3 6 9 13 21. Other Respiratory Diseases M 17 — — — — 1 — 1 1 6 2 6 F 20 — 1 — 1 — — 2 — 1 3 12 22. Peptic Ulcer M 25 — — — — — — 3 6 10 3 3 F 6 — — — — — — — 2 3 — 1 23. Diarrhoea, etc. M 18 14 1 — — 1 — — — 1 — 1 F 16 13 — — — — 1 1 — — — 1 24. Appendicitis M 4 — — — — 1 1 1 1 — 1 1 — F 5 — — — — — — — — 25. Cirrhosis of Liver M 4 — — — — — — 1 — 1 2 — F 2 — — — — — — — — — 2 — 26. Other Diseases of Liver, etc. M 3 — — — — — — — 2 — 1 — F 4 — — — — — — — — 1 — 3 27. Other Digestive Diseases M 25 1 1 2 — 1 — — 3 7 7 3 F 18 1 — — 2 1 — 1 1 3 3 6 28. Acute & Chronic Nephritis M 24 — — — 1 2 — 3 3 5 3 7 F 43 — — — 1 — 1 5 2 9 11 14 29. Puerperal Sepsis F 1 — — — — — 1 — — — — — 30. Other Puerperal Causes F 3 — — — — 1 — 2 — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. M 41 39 1 1 — — — — — — — — F 23 23 — — — — — — — — — — 32. Senility M 27 — — — — — — — — 2 25 F 55 — — — — — — — — — 2 53 33. Suicide M 15 — — — — 1 5 4 1 1 3 — F 7 — — — — — — 2 1 — 4 — 34. Other Violence M 48 3 — 1 2 9 6 4 8 7 3 5 F 34 2 1 — 4 2 — 2 4 4 3 12 35. Other Defined Diseases M 98 6 2 1 9 2 7 4 5 21 17 24 F 92 3 — 2 5 5 7 7 11 19 17 16 36. Causes ill—defined or unknown M 1 — — — — — — — — — 1 — F 1 — — — — — — — — — — 1 Totals M 1185 78 13 9 19 37 44 58 128 240 281 278 F 1270 63 6 6 23 31 42 72 107 170 284 466 14 Table showing the Population, Birth, Death and Infantile mortality rates during 1937 in the Metropolitan Cities and Boroughs. Borough Estd. Res. Population (mid-1937) Live Births rate per 1,000 popn. Death Rate per 1,000 popn. Infantile Mortality rate per 1,000 live births West Districts. Paddington 138,300 13.7 13.1 66 Kensington 175,600 12.1 13.4 83 Hammersmith 126,500 15.1 12.16 68 Fulham 138,900 13.9 13.1 56 Chelsea 56,510 10.8 14.1 59 Westminster 124,300 8.3 11.6 56 North Districts St. Marylebone 92,110 9.3 13.0 73 Hampstead 90,690 11.2 11.7 54 St. Pancras 181,900 13.1 12.8 65 Islington 295,400 15.3 13.1 67 Stoke Newington 50,250 14.9 12.6 37 Hackney 206,700 13.8 11.2 43 Central Districts. Holborn 34,600 8.1 11.8 79 Finsbury 58,700 13.8 14.6 71 City of London 8,980 5.5 11.2 41 East Districts. Shoreditch 82,240 14.9 12.5 54 Bethnal Green 94,560 13.3 12.6 54 Stepney 203,100 13.6 12.2 60 Poplar 136,800 15.5 12.6 61 South Districts. Southwark 147,400 14.7 14.1 65 Bermondsey 98,790 14.4 12.3 59 Lambeth 273,800 14.1 13.2 69 Battersea 143,500 14.9 12.9 70 Wandsworth 341,700 11.5 12.4 64 Camberwell 224,800 14.1 12.8 58 Deptford 96,580 15.1 11.8 45 Greenwich 95,990 13.8 12.0 50 LEWISHAM 226,000 13.4 10.9 47 Woolwich 149,400 14.2 11.1 40 15 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:— I. The Municipal Maternity Home. II. Clinics for Expectant Mothers. III. Post-natal Clinics. IV. Clinics for Mothers and Infants. V. Artificial Sunlight Clinics. VI. Toddler's Clinics. VII. Dental Treatment. VIII. Treatment for minor ailments including operative treatment for Tonsils and Adenoids and Orthopaedic treatment. IX. The provision of milk and drugs for necessitous mothers and their infants. X. The supply of Maternity Outfits. XI. The provision of Home Helps for confinement cases. XII. The services of a Consultant in cases of Puerperal Fever and Pyrexia as well as difficult or complicated obstetric cases. XIII. Convalescent Home Treatment for Mothers and Children. XIV. Home Visiting by Health Visitors. XV. Nursing in the Home. XVI. Infant Life Protection. These services are closely linked up with the Voluntary Organisations engaged in Infant Welfare work in the Borough. The staff employed is as follows:— A. Medical. One whole-time Medical Officer in charge of the Municipal Maternity Home as well as Clinics for Infants, Toddlers, Ante-natal cases and Artificial Sunlight Treatment. One whole-time Medical Officer in charge of Ante-natal, Infants' and Toddlers' Clinics. One part-time Medical Officer in charge of Clinics for Mothers and Infants. Three Consultants for Puerperal Fever and Pyrexia cases as well as difficult and complicated obstetric cases. 16 B. Nursing. Maternity Home Staff (vide under 1). Thirteen Health Visitors. One Infant Life Protection Officer. Temporary Health Visitors during the epidemics of measles. I.—The Municipal Maternity Home. The Maternity Home is situated at 41, Rushey Green, Catford. It contains three wards with accommodation for 17 patients and an isolation ward with one bed. An endeavour is made to secure an average admission of 28 patients each month and the minimum stay required per patient is 14 days. As far as possible only cases likely to follow a normal course are admitted. In cases already booked, where any abnormality develops, the patient is referred to one of the Council's Consultants who admits the case to Guy's Hospital if hospital treatment is indicated. The Consultant Service provided for practitioners in the district is also available for patients already admitted to the Maternity Home who may require it. Intending applicants for the Home fill in a form stating their incomes, expenditure and the number of persons in the family, etc. The members of the Maternity and Child Welfare Sub-Committee consider each application and fix the fee to be paid. All fees are required to be paid in full a month before admission. All mothers booked for admission to the Home are required to attend one of the three Ante-natal Clinics held weekly, exclusively for Maternity Home cases, at the Health Centre, 410, High Street, Lewisham. Table No. 1 shows the details regarding the Maternity Home cases that attended these clinics during the year. Patients who live outside the Borough are not eligible for admission to the Maternity Home but cases already booked that subsequently remove outside the Borough are not excluded provided the removal takes place within 3 months of the date of confinement. While in the Home every encouragement is given the Mothers to breast-feed their babies. Very many people look upon breast feeding as a natural process, which it should be, and that therefore 17 mothers should know by instinct how to make it successful. In point of fact there are innumerable little difficulties which, if not dealt with expertly in the early days of lactation, lead to early weaning of the baby and all its unpleasant sequela; both to mother and child. To help in this effort to promote natural feeding the Maternity and Child Welfare Committee sanctioned the purchase of an electric breast pump during the year. The machine has proved to be invaluable in cases of engorged, painful breasts, cracked nipples and scanty milk secretion, the three primary causes of early weaning of the baby from the breast. From the fifth day after confinement onwards, mothers are encouraged to carry out postural exercises with a view to restoring the musculature to normal as soon as possible. Before discharge from the Home every mother and baby receives a complete medical examination and a definite appointment is given each mother for her post-natal examination. She is also urged to take her baby without delay to the nearest welfare centre. The particulars of the cases admitted to the Home during the year are as follows:— Number of Patients delivered 281 Number of Primiparæ 143 Number of Multiparæ 138 Number of Infants born (6 sets of twins) 287 Presentations: Vertex 272 Pelvic 13 Footling 1 Born before arrival 1 Obstetric Operations: Forceps 1 Minor Operations 114 Manual Removal of Placenta 3 Puerperal Morbidity 4 (All Recovered) 18 Still-Births 6 Maternal Deaths Nil The sex incidence of the Infants was as follows:— Males, 153 Females, 134 Progress of Infants while in the Home:— Number born alive 281 Died within 3 days (premature twin) 1 Over birth weight on discharge 150 Equal to birth weight on discharge 24 Under birth weight on discharge 102 Transferred with Mother to another Institution 4 Number of Infants entirely breast fed 274 Number of Infants in which breast feeding was supplemented 7 The nursing staff consists of a Matron, 1 Sister, 4 Midwives and 2 assistant nurses who are resident in the Maternity Home. The domestic staff of 1 Cook, 1 Laundrywoman and 5 maids is mostly non-resident. In May, Miss Crowe, who had been sister in the Home for 16 years, left to open a nursing home of her own in Manchester. Her faithful and loyal service, given in a quiet and unobtrusive manner over many years, was much appreciated by staff and patients alike. II.—Clinics for Expectant Mothers. One fortnightly and five weekly ante-natal clinics are held in the Borough. The fortnightly one is held at the Sydenham Welfare Centre, Adamsrill Road, on alternate Monday mornings. Four of the weekly sessions are held at the Health Centre, 410, High Street, Lewisham, on Monday, Tuesday and Thursday mornings and Thursday afternoons and one at the Downham Centre on Thursday mornings. During the year an arrangement was made with the L.C.C. whereby expectant mothers living on the Downham Estate who were booked with the Lewisham Hospital for their confinements received their ante-natal supervision at the Downham Ante-natal 19 Clinic. Fifty-eight such patients attended during the year. The arrangement has worked satisfactorily and the mothers have appreciated coming to the Clinic which is nearer their homes than the Hospital. Particulars of the Ante-natal Clinics for the year are as follows:— Table No. 1. Sydenham Maternity Home Health Centre Downham Number of Sessions held 27 148 52 52 Number of Patients examined 86 429 701 160 Number of attendances made by patients 316 3261 1592 523 Average number of attendances per session 11.7 22 30.6 10 Number of Primigravidæ examined 14 224 186 17 Number of Multigravidæ examined 72 205 246 125 Number not pregnant — — 31 6 Number of normal labours 63 262 211 111 Number of abnormal labours 5 20 65 13 Number undelivered at the end of 1937 16 147 134 36 Number who left the Borough 2 — 22 — Number of Post-natal examinations made — — *259 18 Number sent by Midwives — — 111 6 Number sent by the Health Visitors — — 109 19 Number who came on their own initiative — 429 57 28 Number sent by others — — 155 49 Number sent by Lewisham Hospital — — — 58 The Labours that ended abnormally are classified as follows:— 1 Forceps 1 1 19 Still-born 1 6 14 8 Breech 1 10 4 — Miscarriage — 1 4 3 Adherent Placenta — †3 — — Ante-partum Hæmorrhage 1 — — 1 Caesarian Section — — 3 — Premature Birth 1 — 2 — Induction — — 18 — Version for Placenta Prævia — — 1 — *248 of these were of patients delivered in the Municipal Maternity Home. †This number includes one still-birth. 20 The Complications found arc classified as follows:— Sydenham Centre Maternity Home Health Centre Downham Diseases and Disorders of the Reproductive System: Ante-partum Hæmorrhage — — 9 — Threatened Miscarriage — — 4 4 Purulent Vaginal Discharge — 1 2 — Diseases and Disorders of the Alimentary System: Dental Caries 10 116 138 — Heartburn and Indigestion — 96 69 — Hyperemesis — 15 145 3 Gastric Ulcer — — 1 — Constipation 14 144 148 — Diarrhœa — — 1 — Right Inguinal Hernia — 1 5 — Diseases of the Respiratory System: Nasal Catarrh — 14 — — Bronchitis — 29 32 — Tuberculosis — — 1 — Diseases and Disorders of the Circulatory System: Anaemia — 10 17 — Valvular Disease of the Heart — 1 14 12 High Blood Pressure — 164 56 — Varicose Veins of Lower Limbs 16 82 94 — Oedema of Lower Limbs — — 5 — Hæmorrhoids — 12 8 1 Epistaxis — 9 — — Cramp — — 16 — Diseases and Disorders of the Nervous System: Insomnia of Pregnancy — 49 24 — Headaches — — 25 — Neurasthenia — — 4 — Spastic Paralysis — — 1 — Fits — — 1 — Diseases of the Urinary System: Albuminuria of Pregnancy — 13 39 — Glycosuria of Pregnancy — 13 2 — Affections of the Skin: Psoriasis — 1 — — Ichthyosis — — 1 — Carbuncle — — 1 — Pruritus — 4 — — Erythema Nodosum — — 1 — 21  Sydenham Centre Maternity Home Health Centre Downham General Conditions: Malpresentations — 5 5 1 Contracted Pelvis — — 37 — Disproportion — — 3 — Goitre — — 2 — Otorrhœa — — 1 — Venereal Disease — — 2 — Sterility — — 2 — The outstandingly improved figure in the foregoing table is that of the number of ante-natal cases sent to the Clinics by the Health Visitors. As the accommodation at the Health Centre for ante-natal work is so satisfactory, a special effort was made during the year by the Health Visitors to encourage expectant mothers to make use of the Council's ante-natal clinics. The results have been most satisfactory as the number sent this year was 128 as compared with 12 last year. The increase in the Health Visiting Staff has also been a factor in this improvement. The number sent by midwives has also increased this year from 91 last year to 117 and it is hoped that this improvement will continue now that the domiciliary midwifery service is in operation. A written report of every case, after the first examination, is sent to the midwife engaged for the confinement by the Medical Officer of the Ante-natal Clinic. If abnormalities arise the midwife is informed and advised to encourage her patient to consult her own doctor or go to hospital. If the patient fails to keep her subsequent appointments at the clinic the midwife is informed and every effort made by her and the Health Visitor of the district to persuade the mother to return to the clinic for supervision. The amount of dental caries amongst our expectant mothers is still considerable. 270 cases showed dental caries severe enough to require treatment. The Borough Council has provided facilities for this treatment and an increasing number of mothers are being persuaded to make use of them. Unfortunately, the popular impression is that dental treatment, especially the extraction of teeth, 22 is harmful during pregnancy and some mothers are genuinely nervous of having anything done before confinement. As a matter of fact if carious teeth are extracted a few at a time and before the last 6 weeks of pregnancy the chances of untoward results are remote. III.—Post-Natal Clinics. Post-natal cases have been seen throughout the year on Thursday mornings at the Central Clinic, 410, High Street, Lewisham, 238 mothers made 259 attendances at the clinic during 1937. The majority were mothers who had been confined at 41, Rushey Green. Mothers confined in their own homes do not at present seem to realise the importance and necessity of a post-natal examination six weeks after confinement as a factor in the future well-being of their physical condition. Under the new scheme of domiciliary midwifery the Municipal Midwives are being instructed to encourage their patients to attend a post-natal clinic, so that improvement in such attendances may be looked for next year. In addition to the post-natal examinations made at the Central Clinic 18 such examinations were made at the Downham Clinic during 1937. Post-natal cases requiring treatment have been referred to one of the Council's obstetric consultants at St. John's Hospital. It is hoped that next year a consultant's clinic will be established at the Central Clinic to which such cases can be sent instead of directly to hospital. IV.—Clinics for Mothers and Infants. (a) Municipal. These clinics are held at the Lewisham Health Centre on 4 mornings each week and at the Downham Health Centre on 2 mornings each week. One of the Maternity and Child Welfare Medical Officers and 2 Health Visitors attend each clinic. Every baby must be weighed and seen by the Doctor. Necessitous mothers can obtain cod liver oil and other similar preparations for themselves and their children for as little as 1d. per week. All who can, are expected to pay cost price for the preparations recommended to them by the clinic doctor. 23 At the Lewisham Centre 2,325 attendances were made by mothers and 8,162 by children, while at the Downham Centre mothers made 1,211 attendances and children 4,361 attendances. The cases treated during the year were classified as follows : — Health Centre. Downham. Mothers' Clinic. Diseases and Disorders of the Reproductive System 136 88 Diseases and Disorders of the Alimentary System 80 36 Diseases and Disorders of the Respiratory System 9 14 Diseases and Disorders of the Nervous System — 3 Diseases of the Urinary System 6 1 Affections of the Skin 10 6 Diseases of the Eye — 4 Diseases of the Ear 2 — Diseases of the Circulatory System 2 10 Other Diseases 106 30 Consultations 1574 693 Health Centre. Downham. Infants' Clinic. Diseases and Disorders of the Alimentary System 275 123 Diseases and Disorders of the Respiratory System 393 200 Diseases and Disorders of the Circulatory System 2 2 Diseases of the Urinary System 8 4 Diseases and Disorders of the Nervous System 25 4 Affections of the Skin 132 100 Diseases of the Ear 19 7 Diseases of the Eye 28 14 Wounds or Bruises 2 5 Scalds and Burns 5 6 Congenital Defects 2 3 Rickets 60 19 Other Diseases 79 54 Consultations on Feeding and Management (under 1 year) 2.485 1,279 Consultations on Feeding and Management (1-5 years) 3,149 1,427 (b) Voluntary Infant Welfare Centres. There are 11 Voluntary Infant Welfare Centres in the Borough, each conducted by a committee of voluntary workers with a Superintendent, who is a co-opted member of the Maternity and Child Welfare Sub-Committee of the Council. A Medical Officer and Health Visitor belonging to the Staff of the Borough Council attend all but three sessions held by the Voluntary Committees. At these three sessions, which are held in the mornings at Forest Hill, Brockley and Bellingham, no doctor at present holds consultations 24 but a Health Visitor attends. They were primarily instituted as weighing sessions only, to relieve the pressure of the increasing numbers attending the afternoon centres. In the near future these sessions will be provided with a doctor. The ladies on these voluntary committees render the Borough an invaluable service which is much appreciated by the Council. All the expenses other than the rent of premises are undertaken by the voluntary committees, including the stocking of the stands with dried milk, cod liver oil, etc. A considerable amount of organisation and effort is needed to run these centres as successfully as they are and the increasing number of attendances made by the mothers with their children is a striking tribute to the popularity of the Centres and the excellence of the service rendered to the public by all concerned. The attendances at the Voluntary Infant Welfare Centres during 1937 are summarised below:— Name of Centre. No. of Sessions Doctor's Consultations Attendances under 1 year 1—5 years Bellingham Infant Welfare Centre 50 2068 2518 3772 Brockley Infant Welfare Centre 48 2053 2656 1537 Catford School for Mothers 99 3452 6625 4082 Downham Infant Welfare Centre 47 1395 3225 3115 Forest Hill School for Mothers 102 1528 6418 6112 Grove Park Infant Welfare Centre 49 1352 2199 2879 Hither Green Infant Welfare Centre 48 1457 3637 3859 Lee and Blackheath School for Mothers 51 1568 4547 4419 St. Mary's School for Mothers 50 1283 3527 2678 Sydenham Infant Welfare Centre 102 1163 5555 2180 Upper Sydenham Infant Welfare Centre 48 991 1876 874 V.—Artificial Sunlight Clinics. In January, 1937, two Clinics a week on Monday and Thursdaywere started at the Health Centre, Lewisham, for the administration of Artificial Sunlight treatment, chiefly to children. Two carbon Arc Lamps and one Mercury Vapour Lamp have been used. Two Health Visitors holding the necessary Light Certificate have carried out the treatments under the general supervision of the Assistant 25 Medical Officer of Health. Patients attend twice a week by appointment and receive treatment free of charge. All cases are examined by the Doctor before treatment is commenced and patients are encouraged to attend regularly for 6 weeks after which a rest of 4 weeks is given. Before a second or third course of treatment is given, patients are again seen by the Doctor and their condition noted. 254 patients were treated during the year, of which 250 were children and 4 were mothers. 28 of the children were under 1 year and 222 between the ages of 1 and 5 years. Of those under 1 year, 7 were treated with the Carbon Arc Lamp and 21 with the Mercury Vapour. Of those over 1 year 193 were treated with the Carbon Arc Lamp and 29 with the Mercury Vapour. The 4 mothers received treatment with the Mercury Vapour Lamp. The total number of treatments given was 4,174, and as the number of sessions held was 94, the average number of treatments per session was 44.4. The number of Doctor's consultations was 361. The chief conditions treated were Rickets, Malnutrition, Anaemia, Catarrhal conditions and debility after illnesses, chiefly of infectious diseases. The following table shows the numbers and conditions treated and the results of treatment at the end of the year : — Light Cases treated in 1937. Number. Cured. Improved Unchanged. Ceased Attending. Still Under Treatment. Rickets 185 25 24 9 47 80 Malnutrition 36 3 17 – 8 8 Anæmia 9 1 2 – 2 4 Catarrhal Conditions 7 – 1 – 3 3 Debility after Infectious Disease 4 2 – 1 1 Adenitis 1 1 – – – – Psoriasis 1 1 – – – – Mental Deficiency 2 – 2 – – – Achondroplasia 1 — — 1 – – 26 It will be noted that the largest number is that under the heading of Rickets. Of these only 30, however, could be classed as gross rickets. The rest manifested only the milder forms of this disease such as flabby muscles, delayed dentition, late closing of the anterior fontanelle, etc. Great enthusiasm was shown by the mothers for Light treatment when the clinic was first opened and it was difficult to persuade some mothers that their children did not require Light treatment, but as the novelty has worn off many have ceased attending. Of the total 250 children treated, 61 ceased attending before treatment was completed. The 3 main causes of this dropping off were:— (a) Lack of effort on the part of the mother to persevere with treatment; (b) the children being spoilt and refusing to wear the shades and generally being out of the control of the mother; and (c) the home duties of the mothers being of so exacting a nature that time could not be spared to bring one member of the family for treatment twice a week. Generally speaking, however, the majority of the mothers have persevered with treatment and the increasing number of patients will necessitate the duplication of sessions in the near future. The children under 1 year seemed to respond most readily to Light treatment and progressed so favourably that they could be discharged quite well after 1 or 2 courses of treatment, the thin "nervy" children between 1 and 5 years have been most difficult to treat successfully; and in many cases because of increased restlessness and sleeplessness treatment has either had to be suspended or given in much smaller doses than usual. VI.—Toddlers' Clinics. In accordance with the provision made by the Council following on the Ministry of Health Circular 1550, two Toddlers' Clinics were established in the Borough in September, 1937. The one at the Health Centre, Lewisham, has been held every Monday 27 afternoon since September 6th, 1937, and the one at Downham Centre has been held every Wednesday afternoon since September 29th, 1937. Each Clinic is conducted by one of the Maternity and Child Welfare Medical Officers and 2 Health Visitors. All children born in 1934 and 1935 who were not already on a school register were sent invitations to attend one or other of these clinics on a definite date. Each district has been done in turn so that the Health Visitor of the district concerned could have an opportunity of visiting the Toddlers to be invited and encouraging the mothers to make use of the invitations when they came. For the examinations, cards similar to those used by the School Medical Service have been used with a few modifications. Considering that the holding of separate clinics for Toddlers is new to the mothers of Lewisham the response to the invitations has been fairly good. One point of interest that has emerged is that mothers who have never consented to attend the usual Welfare Centres with their children have accepted the invitation to the Toddlers' Clinics. A record is kept of all the defects found in each child as well as of the recommendations regarding observation or treatment made by the doctor. The Health Visitors have access to this record for the purpose of following up their cases until observation is no longer necessary or treatment has been carried out. From the record Health Visitors can also ascertain the children who did not accept the invitation and at subsequent home visits can again urge attendance. It is proposed to issue an annual invitation to each child, not on a school register, between the ages of 2 and 5 years of age. During the 4 months in which the two Toddlers' Clinics were working in 1937, 16 sessions were held at the Health Centre, Lewisham, and 14 at the Downham Centre. 137 children, of which 67 were girls and 70 were boys, attended the Lewisham Centre and 103 children, 52 girls and 51 boys, attended the Downham Centre, making a total of 240 children that were examined. The average attendance per session at Lewisham was 8.5 and at Downham 7.3. The following table gives a synopsis of the conditions and defects found:— 28 Condition, Disease or Defect Girls Boys Total 2—3 3—4 4—5 2—3 3—4 4—5 L. D. L. D. L. D. L. D. L. D. L. D. L. D. Clothing and Footgear (a) Good 12 5 39 47 2 — 8 — 41 51 3 — 105 103 (b) Fair 5 – 6 – 1 – 3 — 11 — 1 — 27 — (c) Bad 5 — Cleanliness (a) Good 13 5 25 47 3 — 7 — 31 51 3 — 82 103 (b) Fair 3 — 19 — — — 1 — 21 — 1 — 45 — (c) Dirty 1 — 3 — — — 3 — 3 — — — 10 — Nutrition (a) Good 8 2 23 30 1 — 0 — 21 30 3 — 02 62 (b) Fair 2 2 9 13 — — 2 — 13 21 — — 20 30 (c) Poor 7 1 15 4 2 — 3 — 21 — 1 — 49 5 Circulatory System (a) Heart Disease – – – – – – – – – – – – 3 — (b) Anaemia 1 1 6 12 1 — 1 — 1 8 — — 10 21 Respiratory System (a) Bronchitis 4 — 11 3 2 — 4 — 19 5 — — 40 8 (b) Asthma — — — — — — — — 1 — — — 1 — (c) Tonsils and Adenoids 9 — 14 9 2 — 3 — 13 12 1 — 42 21 Alimentary System (a) Constipation 2 — 1 3 6 – (b) Anorexia 6 — 15 — — — 4 — 9 — 2 — 30 – (c) Worms — — 2 — 1 — — — 1 — — — 4 — (d) Teeth Carious 3 1 16 14 2 – 3 – 10 11 3 – 43 26 29 Condition, Disease or Defect Girls Boys 2—3 3—4 4—5 2—3 3—4 4—5 Total L. D. L. D. L. D. L. D. L. D. L. D. L. D. Nervous System (a) Backward — — 1 — — —• — — 4 1 — — 5 1 (b) Behaviour Symptoms 5 — Genito-Urinary Symptoms (a) Enuresis 2 — 8 — 1 — 4 — 15 — — — 30 — Skin Conditions (a) Eczema – – 1 – – – – – 3 – – – 4 — Eye Defects (a) Squint 1 — 1 — – — 1 — 1 — — — 4 – (6) Stye – – – – – – – – – 1 – – – 1 (c) Myopia – – – 1 – – – – – – – – – 1 Ear Defects (a) Otorrhœa 2 – – – – – – – 4 – – – 6 — Rickets 9 1 21 5 1 — 5 — 27 8 — — 63 14 Enlarged Glands 11 — 15 — 1 — 6 — 24 — 2 — 59 — Other diseases and defects 7 — 24 — 3 — 9 — 30 4 2 — 75 4 Not vaccinated 7 — 20 — 1 — 1 — 26 – 3 — 58 — No previous attendances at a Clinic 1 — 4 12 — — — — 3 8 — — 8 20 In the above table the figures are entered separately for the Lewisham Health Centre (L) and the Downham Centre (D). 30 As regards clothing only 5 could be classified as bad or unsuitable at Lewisham and none at Downham. One feels that this, perhaps, is not quite a true picture of the standard of clothing in the whole Borough as it was noted that the really careless mothers did not accept the invitations to attend. The same remarks apply to the numbers under the heading of cleanliness. Even among many of those who did attend one could see that the mothers had taken some extra trouble to clean up the faces and hands of the children for the examination but had forgotten the feet. Many times some hesitation occurred when mothers were asked to remove the shoes and stockings of their children and in these cases invariably the feet were found to be dirty. The figures regarding nutrition are fairly satisfactory as 51.6 per cent, were graded as good and 25.8 per cent, as fair. Most of the 22.5 per cent, of children with poor nutrition were seen at the Lewisham Clinic, to which all toddlers, except those living at Grove Park, Downham and Bellingham were invited. Rickets takes the highest place in the diseases and defects found. 32 per cent, of the children showed some signs of this disease such as knock knees, bow legs, etc. None of the deformities, however, were gross enough to call for elaborate orthopaedic treatment. 28 per cent, of the children showed dental caries of a degree that required treatment and 26 per cent, were found with enlarged Tonsils and Adenoids which required operative treatment. 24 per cent, showed enlarged cervical glands which were due to the carious teeth or enlarged and unhealthy tonsils and adenoids. Only 20 per cent, were associated with symptoms of bronchitis and' 1 per cent, suffered from heart disease but 12 per cent, showed some degree of anaemia as judged by the colour of the conjunctivae, lips and general appearance. 15 per cent, suffered from anorexia and most of the only children figured in this category, but apart from anorexia, diseases and defects of the alimentary system were markedly few. Enuresis was complained of in 11 girls and 19 boys, making a percentage of 12. Otorrhoea was the only ear defect found and this occurred only in 6 cases. Eye defects also were few, 4 squints and 1 myopia. 58 of the children or 24 per cent, were unvaccinated, an unsatisfactory figure as regards safeguarding the population against small pox infection. 31 It is hoped that next year the number of attendances at these clinics will be proportionately increased as the mothers get familiar with their aims and objects and realise that it is better to have defects rectified as soon as possible instead of waiting for the school clinics to deal with them at a later date. VII.—Dental Treatment. The Council's scheme for dental treatment has been extended during 1937. Previously, all dental treatment for nursing and expectant mothers and children under 5 years was carried out by St. John's Hospital, Lewisham. According to the financial circumstances of patients the Council paid in part or whole the cost of extractions, fillings and dentures. Since September, 1937, the South Eastern Hospital for Children and the London County Council at their Downham Clinic have carried out dental treatment for children referred to there from the Welfare Centre and Clinics in addition to the dental work done by St. John's Hospital. The number so treated was 46. As regards the mothers, 97 received dental treatment and 48 partial or complete dentures. VIII.—Treatment of Minor Ailments. Since September, 1937, provision has also been made with St. John's Hospital, Lewisham, The South Eastern Hospital for Children, Sydenham, and the L.C.C. at their Downham Clinic,, for the treatment of minor ailments including the operative treatment of tonsils and adenoids as well as Orthopaedic treatment for children under 5 years who were found at the Welfare Centre and Clinics to require it. A special voucher is given to each mother to the nearest treatment centre. The following table gives the numbers and the conditions for which vouchers were issued and the results:— Condition. No. Vouchers used. Vouchers not used. Tonsils and Adenoids 42 35 7 Skin Conditions 14 13 1 Orthopaedic Conditions 10 14 2 Otorrhoea 9 8 1 Eye Conditions 8 8 0 Cyst 1 1 0 Phimosis 1 1 0 Nasal Catarrh 1 0 1 32 Every quarter, a list is compiled of those who have not used their vouchers and the Health Visitors pay a round of special visits to persuade the mothers to see that their children receive necessary treatment. IX.—Milk Assistance Scheme. The Council's Scheme for the provision of free or half cost dried milk for infants and nursing and expectant mothers was continued during the year. The age of children eligible for assisted milk was raised from 2 to 3 years of age and expectant mothers received milk at any stage of pregnancy and not only in the last 3 months as previously. The scale of family incomes eligible for assisted milk has also been revised so as to include a larger number of families whose wage earners do not receive incomes sufficient to provide adequate supplies of milk for the mothers and children under 3 years. A satisfactory arrangement with the Public Assistance department is also working in the case of families in receipt of relief who require an extra milk allowance. With the growth of the L.C.C. housing estates in the Borough and the consequent increase in the number of applicants for assisted milk the Council decided to decentralise the distribution of this milk from the Health Centre, Lewisham. This has entailed the appointment of a milk clerk and the co-operation of some of the Voluntary Welfare Committees so that milk can be distributed to necessitous mothers at the ordinary welfare sessions and the milk depots. The scheme has so far worked well and the mothers much appreciate the convenience of collecting their weekly supplies of milk from the Centres or depots nearest their homes. All applications for milk have to be received monthly on the form provided and the applicant must be seen by the doctor or Health Visitor except in cases of illness. All applications are considered by the Maternity and Child Welfare Sub-Committee and during the year under review, this Sub-Committee authorised 5,871 grants of dried milk for 4 weeks free of charge, and 985 grants at half cost. Altogether 29,318 lbs. of dried milk were issued at a cost to the Council of £1,990. 33 At the four weekly Clinics held at the Health Centre, Lewisham, and the two weekly Clinics held at the Downham Centre, necessitous mothers can obtain supplies of Cod Liver Oil and Iron, Virol, etc., for themselves and their children for as little as 1d. per week. Mothers who can afford to pay more may be asked to pay as much as 6d. per week. This, however, is the maximum charge. No free supplies of these preparations are distributed. X.—Maternity Outfits. During the year, 430 sterilised maternity outfits were supplied to expectant mothers on the recommendation of a doctor or midwifp. No charge was made for the outfit in 145 cases, 86 were issued at half cost and 199 at cost price. The demand for these outfits will, in future, probably decrease as the district midwifery is absorbed by the municipal midwives, for the L.C.C. is providing a free outfit for each of their booked cases. XI.— Home Helps. This service, in cases of confinement only, has increased to a remarkable extent since it was first started in 1930. The need has chiefly occurred on the new housing estates where expectant mothers with one or more children find it impossible to leave their homes for the confinement, have no familiar friend that would come in and help at the time, nor sufficient money to pay for outside domestic help. During the year, Home Helps were provided in 27 cases of confinement and in only 5 instances were the applicants asked to make any contribution to the cost. The fee paid to Home Helps was £1 per week without food but at this rate suitable women have been so difficult to find that an increase in the weekly wage is under consideration. Applications for Home Helps have to be made on the prescribed forms and these are submitted to the Maternity and Child Welfare Sub-Committee which decides whether the applicant is to pay anything towards the cost. The Health Visitor of the district in which the mother lives then calls on her and suggests one of the Home Helps that is on the Council's rota. It is arranged for the mother 34 and the selected Home Help to meet at the patient's house. Home Helps are employed for two weeks on each case and their work in the home inspected each week by the Health Visitor of the district. XII. —Obstetric Consultants. The services of three consultants are retained by the Council for consultations in cases of Puerperal Fever and Pyrexia as well as cases of difficult or complicated labour. This service was requisitioned only once during the year. Next year a weekly ante-natal and postnatal Consultant's Clinic is to be established at the Health Centre, Lewisham. To such a Clinic could be referred any case of complicated or abnormal pregnancy as well as cases where recovery from labour have not been satisfactory and require further treatment. XIII.—Convalescent Homes and Treatment. A grant of £50 was made to the local Branch of the Invalid Children's Aid Association for the year 1937-38, in consideration of the convalescent treatment arranged by the Association for children recommended by the Medical Officers of the Council's Clinics. Six mothers and their babies were sent to the Zachary Merton Convalescent Home at Rustington for a period of two weeks, in accordance with the arrangement made by the Council with the Governing Body of that Institution. The Committees of the Voluntary Infants Welfare Centres have also taken their share in arranging convalescent treatment for mothers and children attending their Centres. XIV.—Home Visiting by the Health Visitor. There were 10 whole-time Health Visitors engaged in Maternity and Child Welfare work at the beginning of the year and three more were appointed in the summer so that, since August, 1937, 13 whole-time Health Visitors have been at work in the Borough. Each has a particular part of the Borough allotted to her for home visiting. 35 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. As a routine every child from birth to 2 years is visited quarterly and every child between 2 and 5 years at least half-yearly. Where a child between 2 and 5 years has a brother or sister under 2 years the toddler gets quarterly visits as well. Special extra visits are paid to children of any age where the circumstances appear to warrant it. The Health Visitors duties also comprise the following:— (a) Visits to expectant mothers who have made application for admission to the Municipal Maternity Home, Lewisham Hospital and other Hospitals, as well as to those whose confinements are to take place in their own homes. (b) Enquiries into cases of puerperal fever, ophthalmia neonatorum and certain other infectious diseases. (c) Enquiries into infant deaths including still-births. (d) Enquiries into applications for assisted milk. (e) Enquiries into applications for Home Helps. Each Health Visitor, in addition to her district visiting, attends 4 to 6 clinics a week either at Voluntary Infant Welfare Centres or at the Municipal Clinics. The work carried out by these officers during the year is summarised below:— First visits to Infants under 1 year of age 2,946 Subsequent visits 9,797 Infants between 1 and 5 years of age:— Total visits 19,327 Expectant mothers:— Total visits 1,945 36 Infant death enquiries 103 Still-birth enquiries 98 Visits to Puerperal Fever cases 42 Visits to Ophthalmia Neonatorum cases 41 Visits to other Infectious cases 552 Miscellaneous visits 1062 Ineffectual calls 5844 A ttendances at Centres:— Municipal 1143 Voluntary 706 Facilities were granted to one of the Health Visitors to attend a refresher course during the year, and £5 was paid by the Council towards her expenses. 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 arc available free for certain infectious cases. Payment is made by the Council at the rate of 1s. 3d. per visit. The cases nursed during 1937, and the number of visits made, are shown in the following table:— Nature of Illness. No. of Cases. No. of Visits. Measles l 28 Ophthalmia Neonatorum 2 26 Pneumonia 64 1,024 Whooping Cough 4 106 Infant Life Protection. The number of foster-mothers on the Register at the end of the year was 133, and the children in their care numbered 231. The officer charged with supervising the welfare of these infants made 2,170 visits to their homes during the year. National Health Campaign. The Council decided to participate in the National Health Campaign, promoted by the Central Council for Health Education, in conjunction with the Ministry of Health, to promote the wider use of the Health Services. 37 Publicity was given to the campaign by means of a series of large posters exhibited on hoardings in various parts of the Borough, by distribution to every home in the Borough of a series of leaflets describing the Health Services available, and by bookmarks placed in books issued from the Public Libraries. 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, 2,714 specimens were examined, the details being as follows:— Material from cases of suspected Diphtheria:— Diphtheria bacillus isolated 149 Negative 1,700 Sputa from cases of suspected Tuberculosis:— Tubercle bacillus found 168 Tubercle bacillus not found 553 Blood from cases of suspected Enteric Fever Positive result 4 Negative result 38 Pathological specimens for Enteric Organisms:— Positive result 17 Negative result 25 Total 2,714 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 woman who was found to be living in unsanitary conditions, and the necessary Order of the Court was obtained for her removal to a suitable institution. 38 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 422 bodies were received into the Mortuary, of which number, 143 were brought in from outside the Borough and 210 from Public Institutions. The Inquests held numbered 309, and 194 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 table:— Disinfecting Station. Premises Visited 1,246 Rooms Disinfected 2,683 Articles Disinfected:— Beds 679 Blankets 3,104 Bolsters 745 Mattresses 1,730 Pillows and Cushions 3,894 Quilts 1,293 Sheets 2,201 Miscellaneous Articles 5,827 Wearing Apparel 6,482 Articles Washed 14,689 Mattresses Re-tufted 766 Verminous Rooms Treated 277 Verminous Articles Treated 1,690 Cleansing Station. Children Treated for Vermin 1,222 Attendances at the Cleansing Station 2,386 Adults Treated for Vermin — Attendances at the Cleansing Station — Adults and Children Treated for Scabies 147 Baths Given 837 Eradication of Bed Bugs. During the year, 30 Council houses and 130 other houses were found to be bug infested, and were subsequently disinfested. The usual method of treatment is by fumigating with sulphur, or by spraying with insecticide, and, if necessary, the removal of the architraves and mouldings. The work of disinfestation is carried out entirely by the Council. Prospective tenants of Council houses are advised to have their effects disinfected before taking possession. 39 SANITARY CIRCUMSTANCES OF THE AREA. Refuse Removal and Disposal. The collection of house and trade refuse is carried out by the Borough Engineer's Department, a weekly collection being the rule. The tonnage collected in 1937 is shown below. Loads. Tons. Container System 23,586 41,635 Freighters 4,095 4,685 Other Vehicles 320 207 Totals 28,001 46,527 The refuse is disposed of at the Council's Destructors situated at Molesworth Street, Lewisham, and Home Park, Sydenham, from a contractor's wharf by barge or deposited on shoots in the Borough. The following are the figures for 1937:— Tons. Home Park Destructor 17,865 Molesworth Street Destructor 15,720 Barged away 13,454 Shoots 499 Total 47,538 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 1,581 After Infectious Disease 1,024 Notice from Builder 551 Other Inspections 5,061 Re-inspections 7,232 New Dwellings, for Water Certificates 1,670 Notices: Number of Intimation Notices Served 1,212 Number of Statutory Notices Served 248 40 Sanitary Improvements Effected: Premises Cleansed and Repaired 1,020 Drains Entirely Reconstructed 96 Drains Repaired 254 Water-closets Cleansed or Repaired 394 Soil-pipes Renewed or Repaired 168 Waste-pipes Renewed or Repaired 264 Rainwater Pipes Renewed or Repaired 139 Roofs and Gutters Repaired 522 Dampness in Premises Remedied 553 Yards Drained or Paved 123 Dust-bins Provided 190 Water-cisterns Cleansed or Covered 22 Water Fittings Repaired 151 Additional water supplies provided to tenement houses 27 Defective Fire-places remedied 174 Offensive Accumulations Removed 69 Urinals Cleansed or Repaired 14 Other Nuisances Remedied 557 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. Nature of Business. Factories. Workshops. Workplaces. Dressmakers, Milliners 17 25 — Laundries 19 11 — Tailors 1 60 — Dentists — 38 — Bootmakers and Repairers 61 87 — Builders 18 58 — Motor Garages 43 51 13 Jewellers and Watch Repairers — 33 — Upholsterers and Cabinet Makers 1 25 — Miscellaneous 87 172 7 41 Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories 718 6 – (including Factory Laundries) Workshops 1,337 4 (including Workshop Laundries) Workplaces 34 (other than Outworkers' premises) Totals 2,089 10 — 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 8 8 – – Want of ventilation – – – – Overcrowding – – – – Want of drainage of floors – – – – Other nuisances – – – – Sanitary accommodation insufficient – – – – unsuitable or defective 2 2 – – 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) – – – – Totals 10 10 – – *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 42 Outworkers. No. of out-workers on the Register 353 Visits made 662 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, 256 investigations were made into complaints of alleged rat infestation. In 101 instances, defective drains were found to be responsible, and in 93 instances the contributory cause was found elsewhere. The complaint was unfounded in 62 cases. Smoke Abatement. During the year 248 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 18 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:— Offence. Result. Distributing toys for rags, contrary to L.C.C. Bye-laws. Fined 5/-. „ „ „ „ „ Fined 5/-. „ „ „ „ „ Fined 5/-. „ „ „ „ „ Fined 7/-. „ „ „ „ „ Summons dismissed under Probation of Offenders Act. 43 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) 2,717 (b) Number of Inspections made for the purpose 2,717 (2) (a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 384 (6) Number of Inspections made for the purpose 384 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,212 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 967 Action under Statutory Powers during the Year:— (A) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (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 44 (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 229 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 203 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (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 12 of the Housing Act, 1936: — (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 10 (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 Housing Act, 1936.—Overcrowding:— (a).— (i) Number of dwellings overcrowded at the end of the year 529 (ii) Number of families dwelling therein 529 (iii) Number of persons dwelling therein 3981 (b).—Number of new cases of overcrowding reported during the year 112 (c).—(i) Number of cases of overcrowding relieved during the year 434 (ii) Number of persons concerned in such cases 2708 Unfit Houses dealt with as Clearance Areas. During the year representations were made in connection with the following Clearance Areas:— Area. Premises. Romer Place, Nos. 1 to 21 (odd), 2 to 12 (even), Romer Lewisham Place, and Nos. 1 to 7 (consecutive), Fuller's Place. 45 Area. Premises. Avenue Square, Lewisham Nos. 1 to 12 (consecutive), Avenue Square, and 10 to 20 (even), Engate Street. Patrol Place, Catford Nos. 11 to 20 (consecutive), Patrol Place. Queen's Bench, Catford Nos. 1 to 4 (consecutive), Queen's Bench, Holbeach Road, Catford Nos. 10 to 16 (even), Holbeach Road. Willow Walk, Catford Nos. 15 to 33 (odd), Willow Walk. Blackshaw's Alley, Catford Nos. 1 to 8 (consecutive), Blackshaw's Alley. Bromley Road, Catford, No. 1 Nos. 280 to 288 (even), Bromley Road. Bromley Road, Catford, No. 2 Nos. 340 to 344 (even), Bromley Road. Bromley Road, Catford, No. 3 Nos. 370 to 374 (even), Bromley Road. After receiving notification that the London County Council did not themselves intend to deal with any of these areas, Orders were made by the Council and submitted to the Ministry of Health for confirmation. Subsequent to the holding of public inquiries at the Town Hall, the Orders were confirmed with the exception of the Willow Walk, Catford, Clearance Area, in which Area, No. 17 Willow Walk was excluded in view of the offer of works submitted by the owner. Ten houses were subject to the provisions of Section 42 of the Housing Act, 1936, which provides for compensation in respect of good maintenance. Towards the end of the year, the following areas were also represented:— Area. Premises. Chaplin Street, Forest Hill Nos. 1 to 30 (consecutive), Chaplin Street, and 8 to 22 (even), Hindsley's Place. Bath Place, Forest Hill Nos. 1, 2 and 2a Bath Place. 46 The orders were subsequently made by the Council but the Public Inquiry has not yet been held. Since the commencement of the Slum Clearance campaign up to the end of 1937, twenty-seven Orders have been made by the Council affecting 235 houses. Of this number, 120 houses have already been demolished while many of the remaining houses are vacant and in course of demolition. Action by the London County Council in this Borough. Orders were made by the London County Council in connection with the following Areas:— Area. Premises. Loampit Vale, Lewisham, No. 1 Nos. 1 and 2, Smith Cottages, 1 to 6 (consecutive), Dunsley Place, and 1 to 6 (consecutive), Mount Pleasant Cottages. Loampit Vale, Lewisham, No. 2 Nos. 1 to 9 (odd), 6 to 10 (even), Hurst Cottages, and 2, 6 and 7, Hope Cottages. A Public Inquiry was held at the Town Hall at which I was asked to corroborate the evidence of the London County Council. The Orders were subsequently confirmed and the houses demolished. Closing Orders Prohibiting the Use of Part of a Building for Human Habitation. The following is a list of premises which were represented under Section 12 of the Housing Act, 1936, in respect of underground rooms or part of the premises, and subsequently formed the subject of a Closing Order:— Nos. 5, 7, 9 and 11, High Street, Lewisham. Nos. 9 and 11, Blythe Vale. No. 7, Kent House Road. No. 21, Ladywell Park. Nos. 3 and 4, St. Germain's Villas. No. 49, Clarendon Rise. 47 The following premises were also represented, but were subsequently put into repair and rendered habitable:— No. 60, Limes Grove. Nos. 1, 2, 5 and 6, St. Germain's Villas. No. 104, Wiverton Road. No. 38, Campshill Road. No. 2, Thornford Road. 48 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 131, and in addition, 294 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 393. Cowhouses.—There is now only one licensed cowhouse in the Borough, and this was inspected four 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 1937, as follows: — Premises licensed to Pasteurise 1 Retail premises licensed to sell Pasteurised Milk 53 Retail premises licensed to sell Tuberculin Tested Milk 18 Supplementary Licences to sell Pasteurised Milk 2 Supplementary Licences to sell Tuberculin Tested Milk 1 Bacteriological Examination of Milk.—Samples of milk for bacteriological examination were taken as under:— Pasteurised Milk—24 samples, all of which complied with the standard laid down in the Milk (Special Designations) Order. Undesignated Milk—8 samples, 6 of which gave a positive reaction to the test for the coli-form bacillus ; and 11 samples submitted to the animal inoculation test for tubercle, all of which gave a negative result. One sample was specially examined for the presence of the Sonne dysentery bacillus, but gave a negative result. 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:— 49 Premises. Licensee. 291, High Street, Lewisham 324, High Road, Lee Havelock Street Mews, Forest Hill 12, Montpelier Vale 13, Rushey Green Weardale Road, Lee H. Calton (J. Balsdon & Co.) R. C. Hammett, Ltd. Chalk & Cox, Ltd. B. W. Parsons, Ltd. Chalk & Cox, Ltd. H. W. Hemmings Notice of intention to slaughter must be given to the Public Health Department, and all carcases are examined before being offered for sale. During the year, the Sanitary Inspectors made 335 attendances at the slaughter-houses for this purpose, and details of the animals killed and inspected are set out in the following table, on the form specified by the Ministry of Health:— Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 175 3 6 1,505 2,073 Number inspected 175 3 6 1,505 2,073 All diseases except Tuberculosis: Whole carcases condemned — — — — 1 Carcases of which some part or organ was condemned 34 — — 19 7 Percentage of the number inspected affected with disease other than Tuberculosis 19.4 — — 1.2 0.4 Tuberculosis only: Whole carcases condemned — — — — — Carcases of which some part or organ was condemned. 21 — — — 100 Percentage of the number inspected affected with Tuberculosis 12.0 — — — 4.8 Unsound Food.—The following quantities of meat, fish, etc., were surrendered as unfit for food, and destroyed:— 50 Bullocks' heads, liver, etc., 5¾ cwts.; Pigs' heads, livers, and offal, cwts.; Sheep's livers, etc., 25 lbs.; Horse-flesh, 1 cwt.; Cod, 4 boxes; Haddocks, 175 lbs.; Dabs, 4 boxes; Herrings, 1 box; Mackerel, 1 box; Pears, 3 cwts; Cucumbers, 1 box; Raspberries, 47 baskets ; Fruit, 31 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, 548 premises were on the Register, 364 of which were ice-cream premises. Bakehouses.—There are 78 bakehouses on the Register, and 355 inspections of these were made during the year. Restaurants and Eating-houses.—There are 123 establishments of this description on the Register, and during the year, 254 inspections were made. Food Shops and Stalls.—Inspections of these premises during the year numbered 1,536. By-laws for the Protection of Food. The London County Council By-laws for the protection of food came into force on January 1st. They have, for their object, the promotion of sanitary and cleanly conditions in the manufacture, preparation, storage, transport or exposure for sale of any article intended to be sold for food. Food and Drugs /Adulteration) Act, 1928. During the year under review, 888 samples of food, drugs, etc., were obtained by the Council's Inspector and submitted to the Public Analyst for examination. Of this number, 117 were purchased formally in accordance with the provisions of the above-named Act, and the remaining 771 were obtained informally as "test" samples. Six formal samples and twenty-eight informal samples were certified by the Public Analyst as adulterated or below standard. 51 Milk.—One hundred and seventeen samples of milk were examined by the Public Analyst, and of these, only one was 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 8.75 87.61 3.0 8.5 Second „ 3.54 8.80 87.66 Third „ 3.68 8.71 87.61 Fourth ,, 3.79 8.80 87.41 Average for the Year 3.66 8.765 87.57 — — 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 – 7 7 — — — ,, Citric — 6 6 — — — ,, Tartaric — 6 6 — — — Arrowroot — 6 6 — — — Baking Powder — 5 5 — • — — Borax — 5 5 — — — Brandy — 7 7 — — — Butter — 35 35 — — — Cheese 26 26 — 1 1 Cocoa — 19 19 — — — Coffee 6 6 — — — Cream — 22 22 — — — Cream of Tartar — 5 5 — — — Dripping — 6 6 — — — Fish, Canned — 130 130 — 16 16 Paste 29 29 — — — Flour, Self-raising — 14 14 — — — 52 Article. No. of Samples Examined. No. of Samples Adulterated, etc. Formal Informal Total Formal Informal Total Fruit, Canned 1 1 „ Dried — 22 22 — — — Gin — 12 12 — — — Ginger, ground — 10 10 — — — Honey — 2 2 — — — Lard — 19 19 — — — Lime Water — 7 7 — 1 1 Liniment of Turpentine 1 5 6 1 2 3 Linseed, crushed — 9 9 — — — Margarine — 26 26 — — — Meat Paste — 21 21 — — — Milk 111 6 117 1 — 1 Condensed — 32 32 — — — Oil, Almond — 7 7 — — — ,, Camphorated — 7 7 — — — „ Castor — 6 6 — — — ,, Cod Liver — 7 7 — — — „ Eucalyptus — 6 6 — — — Ointment, Boric 1 7 8 1 1 2 „ Mercury — 1 1 — 1 1 „ Zinc — 6 6 — — — Paregoric — 6 6 — — — Powder, Gregory's — 2 2 — — — ,, Seidlitz — 7 7 — — — Rum 1 17 18 1 1 2 Sal Volatile — 6 6 — — — Sausages — 30 30 — — — Soups — 2 2 — — — Spices and — — — — Condiments — 52 52 — 2 2 Suet — 14 14 — — — Tea — 21 21 — — — Tincture of Iodine — 6 6 — — — Tincture of Quinine 6 6 — — — Vegetables, Canned — 12 12 — — — Vinegar — 13 13 — —. — Whisky 3 24 27 2 3 5 Totals 117 771 888 6 28 34 53 Adulterated Samples. No. Article. Formal or Informal. Adulteration or Irregularity. Action Taken. 716 Sild Informal Tin, 2.98 grains per lb. Stocks withdrawn from sale. 722 „ „ Tin, 2.15 grains per lb. Stocks exhausted. 742 Wrapped Cheese „ Tin, 5.85 grains per lb. Stocks destroyed. 5 Sild „ Tin, 3.2 grains per lb. Stocks withdrawn and Vendor cautioned. 85 „ „ Tin, 2.13 grains per lb. „ „ „ „ 89 Mercury Ointment „ Mercury excess, 22.6%. „ „ „ „ 106 Sild „ Tin, 2.8 grains per lb. „ „ „ „ 107 „ „ Tin, 3.7 grains per lb. „ „ „ „ 114 Lime Water „ Lime deficient, 96%. „ „ „ „ 157 Liniment of Turpentine „ Turpentine deficient, 38.46%. „ „ „ „ 174 Sild „ Tin, 2.2 grains per lb. „ „ „ „ 187 „ „ Tin, 2.41 grains per lb. Stocks exhausted. 234 „ „ Tin, 3.08 grains per lb. Stocks withdrawn from sale. 257 Curry Powder „ Lead, 21 parts per million. „ „ „ „ 330 Sild „ Tin, 2.41 grains per lb. Stocks exhausted. 343 Curry Powder „ Lead, 76 parts per million. Subsequent formal sample. 347 Sild „ Tin, 2.16 grains per lb. Stocks withdrawn from sale. 378 „ „ Tin, 2.46 grains per lb. „ „ „ „ 396 Brisling „ Tin, 2.5 grains per lb. „ „ „ „ 54 Adulterated Samples—contd. No. Article. Formal or Informal. Adulteration or Irregularity. Action Taken. 437 Milk Formal Extraneous water, 2%. Subsequent sample genuine. 468 Brisling Informal Tin, 3.9 grains per lb. Stock exhausted. 486 Sild „ Tin, 2.2 grains per lb. Stocks withdrawn from sale. 492 Anchovy Fillets . . „ Tin, 2.7 grains per lb. „ „ „ „ 567 Boracic Ointment „ Boric acid deficient, 15.9%. See sample No. 588. 572 Liniment of Turpentine „ Turpentine deficient, 58.4%. See sample No. 589. 588 Boracic Ointment Formal Boric acid deficient, 13.5%. Vendor cautioned. 589 Liniment of Turpentine „ Turpentine deficient, 61.5%. „ „ 605 Whisky Informal Proof spirit deficient, 8.2 degrees. Subsequent sample genuine. 631 „ „ Proof spirit deficient, 3.4 degrees. See subsequent sample No. 651. 640 „ „ Proof spirit deficient, 11.6 degrees. See subsequent sample No. 649. 641 Rum „ Proof spirit deficient, 11.9 degrees. See subsequent sample No. 650. 649 Whisky Formal Proof spirit deficient, 9 degrees. Summons dismissed on payment of £5 5s. 0d. costs. 650 Rum „ Proof spirit deficient, 15.2 degrees. „ „ „ „ 651 Whisky „ Proof spirit deficient, 3 degrees. Vendor cautioned. 55 INFECTIOUS DISEASES. The following table shows the incidence of notifiable infectious disease during the year, and in the two preceding years:— Disease. Year. 1935 1936 937 Scarlet Fever 830 868 634 Diphtheria 314 247 328 Typhoid Fever 5 6 13 Paratyphoid Fever 17 6 6 Puerperal Fever 3 2 6 Puerperal Pyrexia 32 35 42 Erysipelas 68 92 95 Pneumonia 184 200 240 Cerebro-spinal Meningitis 6 9 7 Polio Myelitis 1 2 11 Encephalitic Lethargica 1 2 2 Malaria – 2 3 Dysentery – – 97 Ophthalmia Neonatorum 4 18 15 It will be seen from the above that the incidence of Scarlet Fever was less than the preceding year, while Diphtheria showed a slight increase. In five of the thirteen cases of Typhoid Fever notified, the diagnosis was not confirmed at the hospital, and two of the six paratyphoid cases were also not diagnosed as such. During the latter part of the year, 97 cases of Sonne Dysentery were notified. There were no fatal cases. The disease was prevalent throughout the Metropolis and the Home Counties, and the cause of the prevalence in this Borough was not ascertained. Details of the age groups of patients, and of the fatal cases, are given in the two following tables:— 56 Table showing Cases of Infectious Disease Notified, 1937. Disease. Number of Cases Notified. At Ages—Years. Total at all Ages Number removed to Hospital. Under 1 year 1 and under 2 years 2 and under 3 years 3 and under 4 years 4 and under 5 years 5 and under 10 years 10 and under 15 years 15 and under 20 years 20 and under 35 years 35 and under 45 years 45 and under 65 years 65 and over Scarlet Fever 3 13 31 45 57 278 123 33 37 8 6 – 634 595 Diphtheria 4 9 7 22 16 163 43 26 29 6 3 — 328 317 Typhoid Fever — — — — — 1 1 5 6 — — — 13 11 Paratvphoid Fever — — — — 1 — — 1 3 — 1 — 6 6 Puerperal Fever — — — — — — — — 5 1 — — 6 6 Puerperal Pyrexia — — — — — — — 2 31 9 — — 42 38 Erysipelas 2 2 — — — — 6 7 12 14 42 10 95 58 Pneumonia 4 7 6 5 7 22 10 12 45 33 48 41 240 105 Cerebro-spinal Meningitis 4 — 1 — — 1 — — — — 1 — 7 7 Polio Myelitis — 2 2 — — 3 2 2 — — — — 11 11 Encephalitic Lethargica — — — — — 1 — — — 1 — — 2 2 Malaria — — — — — — — 1 2 — — — 3 3 Dysentry 8 12 8 3 9 8 6 4 21 3 12 3 97 52 Ophthalmia Neonatorum 15 — — — — — — — — — 15 4 Totals 40 45 55 75 90 477 191 93 191 75 113 54 1499 1215 57 Table showing Number of Deaths from Infectious Diseases in 1937. Diseases. Age Groups. All ages. Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 years and upwards Typhoid and Paratyphoid Fevers – – – – – – 1 – – – – 1 Scarlet Fever – 1 – – – – – 1 – – – 2 Whooping Cough 9 1 – 1 – – – – – – – 11 Diphtheria – – 4 6 1 – – – – – – 11 Influenza 2 2 — — 3 2 5 12 17 21 30 94 Encephalitic Lethargica – – – – – – – – – – – 1 Cerebro-spinal Fever 5 – – – – – – – – – – 5 Puerperal Fever – – – – – – – – – – – 1 58 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, 60 phials of 8,000 units each (for treatment) and 4 prophylactic doses of 500 units each, were issued. Diphtheria Immunisation. The scheme under which facilities are provided for the immunisation of children against diphtheria has undergone revision during the year. Under the original scheme, which commenced in 1935, medical practitioners received 10/- for each child treated, but had to provide the requisite immunising material. The revised scheme provides for a fee of 7/6 to the doctor for each case, the Council supplying the material. The new arrangement as to fees came into force in October of this year, and has given a considerable impetus to the scheme. During the year, 1,027 children received immunising injections. 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, 1936:— Number of Births registered from 1st January to 31st December, 1930 2,898 Number of these Births duly entered by 31st January, 1938, in the Vaccination Register:— Successfully Vaccinated 1,303 Insusceptible of Vaccination 4 Number in respect of whom Statutory Declarations of Conscientious Objection have been received 1,177 Died unvaccinated 121 Number of these Births which on 31st January, 1938, remained unentered in Vaccination Register on account of:— Postponement by Medical Certificate 33 Removal to districts, the Vaccination Officers of which have been duly apprised 73 Removal to places unknown 136 59 Number of these Births remaining on 31st January, 1938, neither duly entered in Vaccination Register nor temporarily accounted for 51 Total number of Certificates and copies of Certificates of successful Primary Vaccination of Children under 14 received during the calendar year, 1937 1,515 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, 1937 1,198 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, 353 new cases of pulmonary, and 60 new cases of non-pulmonary tuberculosis were received. 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 2 2 3 1 — — 1 1 5 8 3 6 6 — — 3 4 10 2 3 9 3 — — — — 15 14 33 2 3 10 15 1 — 20 33 38 4 2 — — – – 25 47 45 3 9 15 18 — — 35 27 24 1 2 9 11 — 1 45 29 12 2 1 26 7 — 2 55 17 4 — 3 10 3 — — 65 and upwards 7 2 – – 8 2 – – Totals 186 167 30 30 78 56 5 8 60 Efficiency of Notification.—The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was one in seven. It was not necessary to take any action in regard to the nonnotification of tuberculosis during the year. Public Health (Prevention of Tuberculosis) Regulations, 1925.— No action was taken under the above Regulations, which relate to tuberculosis employees in the milk trade. Notification Register. Number of cases of Tuberculosis remaining at the 31st December, 1937 in the Register of Notifications Pulmonary Non-Pulmonary Total Cases Males Females Total Males Females Total 567 456 1,023 128 147 275 1,298 Number of cases removed from the Register during the year by reason of:— Removals 31 40 71 5 13 18 89 Recovery from the disease 18 16 34 4 10 14 48 Death 76 57 133 4 5 9 142 Periodical Revision of Register 175 155 330 73 67 140 470 61 REPORT OF THE TUBERCULOSIS OFFICER FOR 1937. The primary notifications of tuberculosis for 1937 numbered 413, of which 353 were of pulmonary tuberculosis and 60 of other forms of tuberculosis. During the year, 134 persons died from pulmonary tuberculosis and 13 died from other forms of the disease. The death-rate from pulmonary tuberculosis was 0.59 per 1,000 inhabitants, as compared with 0.62 for 1936. Ca9.es on Register.—A thorough revision of the register was carried out, with the result that the cases on the Town Hall Register number 1,298 (pulmonary 1,023, other forms, 275), while those on the Dispensary Register number 1,054 (pulmonary 875, other forms 179). Taking the population of Lewisham as 224,000, it appears that one person out of every 219 suffers from pulmonary tuberculosis. Attendances of Patients.—During the year 864 new patients attended the Dispensary and the total attendances numbered 3,439. Of the new cases, 255 were referred to the Dispensary by their medical attendants, 197 were referred from hospitals or from other areas, 315 were contacts of tuberculous patients and 78 applied on their own initiative. A summary of first attendances is shown in Table C. Home Visiting.—The three Health Visitors paid 5,156 visits to the homes of patients. Every newly notified case is visited as a routine and subsequent visits are paid as often as is necessary to give assistance in home difficulties. The Tuberculosis Officer visited 295 patients in their homes and also saw 12 patients there in consultation with their medical attendants. Reports.—Written reports to the number of 1,045 were sent out from the Dispensary. Residential Treatment.—The London County Council admitted 192 insured and 116 uninsured patients to residential institutions, while 43 patients were referred direct to the Lewisham Hospital by the Tuberculosis Officer, these being patients in urgent need of institutional treatment and living under unsuitable home conditions. 62 The Tuberculosis Officer visited the tuberculosis wards of the Lewisham Hospital 45 times in the capacity of Consultant in Tuberculosis to the Hospital. There is a small class of patients for whom no adequate provision is made—namely, the homeless individual, who is not in present need of institutional treatment, but is unfit for lucrative employment. These patients wander in and out of common lodginghouses leaving their infection behind them. Hostels for these patients, where they could be comfortably housed and suitably employed under sympathetic supervision, are urgently needed. As an example of this class, I would mention a young man aged 22, suffering from active pulmonary tuberculosis and unfit for work. His mother died from pulmonary tuberculosis and his father married again; then his father died from pulmonary tuberculosis and his step-mother married another tuberculous man; so that he now has both a step-father and a step-mother, upon neither of whom he has a real claim. He has been kept in institutions since July, 1935, and is now ready for discharge. A Borough Council shelter is to be erected for him in the garden of his step-parents, but this is more or less a temporary measure and he will probably remain a source of infection as long as he lives. Affiliated, and other Hospitals.—During the year, 121 patients were sent to St. John's Hospital, Lewisham, for X-Ray examination and report. Many patients are now treated by artificial pneumothorax and, on return from Sanatorium, require to keep up their refills for several years. During 1937, 112 patients received this form of treatment, of whom 71 attended St. John's Hospital for the purpose and 41 attended various other Hospitals. The cost of this treatment is borne by the Borough Council. Light treatment for lupus is given principally at the London Hospital, also at the cost of the Borough Council. 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 412 patients was examined and reported upon by the Pathological Department of St. John's Hospital. 63 Dental Treatment.—During the year, 14 patients attended St. John's Hospital for dental treatment and 5 patients were assisted in obtaining dentures. Extra Diet.—The Borough Council granted an allowance of milk, butter and eggs to 12 tuberculous patients to enable them to maintain their working capacity after return from Sanatorium. Those in receipt of Public Assistance are recommended for extra diet to the Public Assistance Committee. Shelters.—The Borough Council possesses 6 shelters to loan to tuberculous patients having inadequate sleeping accommodation. Care Committee.—The Care Committee meets at the Dispensary on alternate Thursday afternoons throughout the year to discuss methods of helping tuberculous patients and their families through difficult times. Money is raised by various voluntary means to defray the expenses incurred thereby. Handicrafts Class.—The Borough Council makes a grant of £10 a year to this class, which is now in its 12th year under the same London County Council instructress. The pupils are keenly interested in their work and the class is a great asset in affording occupational therapy. Tables A—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. 64 Table A. Summary of Tuberculosis Health Visitors' Work, 1937. ex-Service Patients. Civilian Patients. Totals. Visits to Pulmonary Tuberculous Patients 31 305 336 ,, Non-pulmonary ,, ,, – 62 62 Subsequent Visits 403 3860 4263 Visits to Un-notified Cases. . 35 460 495 No. of patients occupying Separate Room 11 185 196 ,, sharing with 1 other .. 17 146 163 „ „ „ 2 others .. 2 32 34 „ „ „ 3 „ – 2 2 „ „ „ 4 „ – 2 2 ,, 5 „ – 1 1 No. of Patients occupying Separate Bed 10 219 229 ,, ,, sharing with 1 other 18 145 163 ,, 2 others 1 5 6 Table B. Attendance of Patients at the Dispensary- 1937 First Attendances. Subsequent Attendances. Totals. January 65 219 284 February 88 204 292 March 73 171 244 April 88 267 355 May 50 172 222 June 71 202 273 July 75 220 295 August 66 209 275 September 69 241 310 October 76 240 316 November 86 237 323 December 57 193 250 Totals 864 2,575 3,439 65 Table C. Summary of First Attendances at the Dispensary, 1937. Applied on own initiative Sent by Doctor Transferred from Hospitals, etc. Sent by L.C.C. Sent by Ministry of Pensions Contacts Care Committee Totals. Pulmonary 2 107 145 2 11 267 Non-Pulmonary 3 3 36 1 – – – 43 Non-tuberculous 73 144 16 14 1 304 1 553 Suspects – 1 – – – – – 1 Totals 78 255 197 17 1 315 1 864 Table D. Stages in Pulmonary Tuberculosis. Male. Female. Children under 15. Totals. Stage I. 38 40 9 87 „ II 86 75 3 164 „ III 11 5 – 16 Totals 135 120 12 267 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. Totals. Glands 1 3 8 12 Bone 3 10 10 23 Other Regions 1 6 1 8 Totals 5 19 19 43 66 Return showing the work of the Dispensary during 1937. (Form T.145 of Memorandum 37/T (Revised) of the Ministry of Health.) Diagnosis. Pulmonary. Non-Pulmonary Totals. Grand Totals 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 (a) Definitely tuberculous 92 71 9 3 9 12 7 4 94 83 9 7 193 (b) Diagnosis not completed — — — — — — — — 4 2 — — 6 (c) Non-tuberculous 81 109 31 24 245 B.—Contacts examined during the year (a) Definitely tuberculous 1 8 1 1 — — — — 1 8 1 1 11 (b) Diagnosis not completed — — — — — — — — — — — — (c) Non-tuberculous 46 77 94 87 304 C.—Cases written off the Dispensary Register as:— (a) Recovered 17 16 1 1 9 5 2 4 19 21 3 5 48 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 130 188 125 111 554 D.—Number of Cases on Dispensary Register on 31st December:— (a) Definitely tuberculous 461 370 23 21 34 61 49 35 495 431 72 56 1054 (b) Diagnosis not completed — — — — — — — — 1 — — — 1 1. Number of cases on Dispensary Register on 1st January 990 2. Number of cases transferred from other areas and cases returned after discharge 105 under Head 3 in previous years 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases 120 “ lost sight of” 4. Cases written off during the year as Dead (all causes) 77 5. Number of attendances at the Dispensary (including Contacts) 3439 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 205 7. Number of consultations with medical practitioners :— (a) Personal 12 (b) Other 373 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 307 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4758 10. Number of :— (a) Specimens of sputum, etc., examined 412 (b) X-ray examinations made in connection with Dispensary work 121 11. Number of “Recovered” cases restored to Dispensary Register, and included in A(a) and A(b) above 2 12. Number of “ T.B. plus” cases on Dispensary Register on 31st December 611 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 — 67 INDEX TO CONTENTS. Subject Page Bed Bugs 38 Births 8 Clearance Areas 44 Convalescent Treatment 34 Coroner's Court and Mortuary 38 Cowhouses 48 Deaths10 ,, in Metropolitan Boroughs 14 ,, Table of Causes 12 Dental Treatment 31 Diphtheria Anti-Toxin 58 Diphtheria Immunisation 58 Disinfection 38 Expectant Mothers, Clinics for 18 Factories and Workshops 40 Food Premises Registration 50 Food Sampling 50 Health Campaign 36 Health Visitors 34 Home Helps 33 Home Nursing 36 Housing 43 Infant Life Protection 36 Infant Mortality 10 Infectious Diseases 55 Infirm or Diseased Persons 37 Laboratory Facilities 37 Legal Proceedings 42 Marriages 9 Maternity and Child Welfare 15 Maternity Home16 Maternity Outfits 33 Milk Assistance Scheme 32 68 Subject Page Milk, Bacteriological Examination 48 Minor Ailments Treatment 31 Neo-natal Deaths 11 Obstetric Consultants 34 Offensive Trades 42 Outworkers 42 Population 8 Post-natal Clinics 22 Rag Flock Acts 42 Rats and Mice 42 Refuse Removal 39 Sanitary Inspection 39 Slaughter-houses 48 Smoke Abatement 42 Staff 5 Statistics 7 Still-births 9 Sunlight Clinics 24 Toddlers' Clinics 26 Tuberculosis 59 Tuberculosis Officer's Report 61 Underground Rooms 46 Unsound Food 49 Vaccination 58 Voluntary Infant Welfare Centres 23 Frequency of exposure in individual cases:- (a) receiving local treatment: (b) receiving general light baths: Nature of any ancillary treatment given:-