LIBRARY LEW 26 METROPOLITAN BOROUGH OF LEWISHAM. REPORT OF THE Medical Officer of Health For the Year 1938. John W. Miller, M.B., Ch.B., D.P.H. London : Printed by E. G. Berryman & Sons, Ltd., Blackheath Road, S.E.10. - LEW 26 METROPOLITAN BOROUGH OF LEWISHAM. REPORT of the Medical Officer of Health For the Year 1938. 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 Report for the year 1938 on the health and sanitary conditions of the Borough, this being the thirty-eighth of the series. The Borough retained its position as one of the healthiest in the Metropolis. The death rate was slightly lower than last year, while the infant mortality remained at the same low figure. The incidence of infectious disease calls for little comment. Scarlet Fever again showed a decrease on the previous year, and Diphtheria an increase. The aggregate of the two diseases was very little higher than in the previous year. The expected biennial epidemic of Measles arrived in the early part of the year, but was not unduly severe. Further progress in maternity and child welfare was made by the completion of arrangements to rent premises on two new London County Council estates, viz. : Honor Oak and Whitefoot Lane, for the provision of clinics for mothers and infants. The Council also approved, in principle, the policy of providing municipal clinics for parts of the Borough which are not too well served at present, and, as a commencement, authorised negotiations for the acquisition of land upon which to erect a clinic to serve the population residing in Bellingham and Lower Sydenham. The maternity and child welfare medical staff was augmented by the appointment of an additional whole-time Medical Officer, and an obstetric consultant for the ante-natal clinics. 4 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 :hank 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. August, 1939. STAFF OF THE PUBLIC HEALTH DEPARTMENT, at the end of 1938. 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.a., m.b., ch.b., l.m., d.p.h. Tuberculosis Officer. Rose Jordan, b.sc., m.d., m.b., b.s., d.p.h. Infant Welfare Medical Officers. Evelyn Davies, m.r.c.s., l.r.c.p., d.p.h. Beatrice H. Bakewell, m.b., ch.b., d.p.h., d.c.o.g. Mary Stoker Murdy, m.b., b.s., m.r.c.s., l.r.c.p. (part-time). Consultant at Ante-Natal Clinic. J. B. Blaikley, m.b., b.s., f.r.c.s. Consulting Gynaecologists and Obstetricians. G. F. Gibberd, m s., m.b., b.s., f.r.c.s. Arnold Walker, m.a., m.b., b.ch., f.r.c.s., m.c.o.g. J. B. Blaikley, m.b., b.s., f.r.c.s., m.c.o.g. Public Vaccinators. Lewisham District . . F. S. Barnett, m.r.c.s., l.r.f.p.s. & l.m., i .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, F.. T. (a) (b) Phillips, A. J. (a) (b) Brittain, R. C. (a) (b) Pinches, W. T. (a) (b) Craven, J. R. (a) (6) Thomas, A. G. (a) (b) Crowther, J. (a) (6) Walker, E. (a) (fc) Holifield, C. E. (n) (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) (c) 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) (c) (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) Chief Clerk and Asst. Administrative Officer. F. E. Seckerson (a) Clerks. C. C. Summers K. G. Sandford W. D. Back N. A. I. French W. G. Coker (a) (b) Miss E. Dewdney C. F. Costello Miss Q. E. Ralph 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 Clerk. Tuberculosis Dispensary Miss D. Wright 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 (а) 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, 1938. Area of the Borough 7,015 acres. Population:— Census, 1931 219,953 Estimated, Mid-year, 1938 229,000 Number of inhabited houses (end of 1938) according to Rate Books 56,000 (appx.). Rateable Value (at April, 1938) £1,827,931 Sum represented by a penny rate £7,273 Extracts from Vital Statistics, 1938. Total. Males. Females. Live Births:—Legitimate 3,073 1,571 1,502 Illegitimate 115 59 56 Total 3,188 1,630 1,558 Birth Rate per 1,000 of the estimated population 13.9 Total. Males. Females. Still-Births 87 41 46 Rate per 1,000 births (live and still-births) 26.5 Total. Males. Females. Deaths 2,403 1,160 1,243 Death Rate per 1,000 of the estimated population:— (crude) 10.49 ; (corrected) 10.5 Deaths from Puerperal Causes:— Rate per 1,000 Deaths. (live and still) Births. No. 29 Puerperal Sepsis 5 1.52 No. 30 Other Puerperal Causes 2 0.61 Total 7 2.13 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 104 Deaths from Measles (all ages) 14 „ „ Whooping Cough (all ages) 3 „ „ Diarrhoea (under 2 years of age) 16 8 Population. The Registrar-General's estimate of the population of the Borough at mid-year, 1938, is 229,000, 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 1938 was supplied by the Registrar-General. The figures are adjusted for inward and outward transfers. Legitimate Males 1571 Legitimate Females 1502 Illegitimate Males 59 Illegitimate Females 56 Total 3188 The number of births is equivalent to a birth rate of 13.9 per 1,000. The births and birth rates in the last ten years are shown herewith : — Year. No. of Births. Birth Rate. 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 1938 3,188 13.9 Still-Births. 87 still-births were registered. 9 Notified Births. Under an Act of 1907, a birth must he 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 3,163 live births. Marriages. The number of marriages registered in the Borough during the year was 2,036, compared with 1,766 in 1937. Of this number, 1,113 were solemnised in the Established Church, 258 in Non-conformist Places of Worship, and 665 at the Register Office. Deaths. The number of deaths of Lewisham residents registered in 1938 was 2,403, and the corrected death rate was 10.5 per 1,000 persons. The deaths and death rates recorded in the last ten years are shown hereunder:— Year. No. of Deaths. Death Rate. 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 1938 2,403 10.5 Deaths in Public Institutions. The deaths occurring in Hospitals and other Public Institutions in the Borough numbered 1,359, of which 964 were residents, and 466 residents died in Institutions outside the Borough. 10 Infant Mortality. The number of infants who died before reaching one year of age was 151, 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. 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 1938 151 47 57 11 Table showing Causes of Death at Different Periods of Life during the Year 1938. Causes of Death. Sex All Ages Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 and upwards 1. Typhoid and Paratyphoid Fevers M - - - - - - - - - - - - F — — — — — -2. Measles M 7 2 3 2 - - - - - - - - F 7 — 2 5 - - - - - - - - 3. Scarlet Fever M 1 - - - - - - - - - - - F - - - - - - - - - - - - 4. Whooping Cough M 2 1 — 1 - - - - - - - - F 1 — 1 - - - - - - - - - 5. Diphtheria M 11 — — 1 10 - - — — — F 12 1 — 6 5 - - - - - - - 6. Influenza M 11 - - - - - - - 2 2 5 2 F 3 1 - 1 1 - - 7. Encephalitis Lethargica M - - - - - - - - - - - - F - - - - - - - - - - - - 8. Cerebro-Spinal Fever M 1 - - - - - - - - - - - F 1 1 - - - - - - - - - 9. Tuberculosis of Respiratory System M 76 — — — — 15 12 12 16 17 4 F 77 — 1 — — 12 30 15 9 6 4 - 10. Other Tuberculous Diseases M 10 — 1 — 1 1 — 2 3 2 - F 12 1 1 1 3 2 2 2 - - - - 11. Syphilis M — — — — — — — F 3 — — 2 1 - 12. General Paralysis of the Insane. Tabes Dorsalis M 6 - - - - - - - 2 2 1 1 F 1 — — — — — — 1 — - 13. Cancer, Malignant Disease M 182 — — — 2 1 3 10 25 47 69 25 F 206 — — — 1 — 3 16 31 45 57 53 14. Diabetes M 10 — — — — — — 1 6 3 F 23 - - - - - - - 1 9 5 8 15. Cerebral Haemorrhage, etc. M 28 — — — 1 — — — — 10 8 9 F 57 — — — — 1 — 2 6 6 16 26 16. Heart Disease M 300 — — — 2 5 4 11 27 54 93 104 F 346 — — — 2 1 5 12 13 43 85 185 17. Aneurysm M 10 — — — 1 — — 2 4 2 1 F 3 — — — — — 1 1 - 1 18. Other Circulatory Diseases M 66 - - - - - - - 3 18 28 17 F 73 - - - - - - - - 13 26 34 19. Bronchitis M 29 4 1 2 9 6 7 F 32 2 — — — - 1 1 1 1 5 21 12 Table showing Causes of Death at Different Periods of Life during the Year 1938—continued. Causes of Death. Sex. All Ages. Under 1 year. 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 and upwards 20. Pneumonia (all forms) M 72 17 4 1 2 - 3 6 8 12 11 8 F 65 10 2 1 1 2 1 5 8 I 12 22 21. Other Respiratory Diseases M 16 — — 2 — — — 3 3 — 1 7 F 13 — — — — 2 — 1 1 3 — 6 22. Peptic Ulcer M 12 - - - - - 1 — 3 3 .4 1 F 7 1 _ 4 1 1 23. Diarrhoea, etc. M 12 11 1 - - - - - - - — - F 4 4 - - - - - - - - - - 24. Appendicitis M 14 — - - 2 3 — — 3 3 2 1 F 6 - 4 1 — 1 25. Cirrhosis of Liver M 4 — 1 3 — F 2 - - - 1 1 26. Other Diseases of Liver, etc. M 3 1 — — 1 - 1 — F 16 - - - - - - 3 — 2 4 7 27. Other Digestive Diseases . . M 23 2 1 1 — 1 2 2 2 6 6 F 21 2 — — 2 2 1 1 2 11 28. Acute & Chronic Nephritis M 36 — 2 1 5 3 4 10 7 4 F 32 — — 2 1 1 4 9 7 8 29. Puerperal Sepsis F 5 — — 2 1 2 — — — — 30. Other Puerperal Causes F 2 — — — 1 1 — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. M 49 48 - - - - - - - 1 - - F 29 27 1 1 - - - - - - - 32. Senility M 11 - - - - - - - - - - 11 F 42 - - - - - - - - - 3 39 33. Suicide M 16 - - - - - 1 2 3 6 4 — F 6 — 1 1 1 2 1 — — 34. Other Violence M 37 3 2 3 4 10 1 3 2 4 2 3 F 35 3 — — 2 3 — 2 2 2 5 16 35. Other Defined Diseases M 103 6 5 2 5 — 4 9 17 11 23 21 F 98 5 3 2 5 4 2 9 12 11 25 20 36. Causes ill-defined or unknown M 2 — — — — — — — 2 — F 3 — - — - - 1 — 1 - 1 - Xotals M 1160 95 17 13 32 37 30 65 128 221 285 231 F 1243 56 12 15 20 32 52 79 104 157 258 458 13 Table showing the Population, Birth, Death and Infantile mortality rates during 1938 in the Metropolitan Cities and Boroughs. Borough Estd. Res. Population (mid-1938) Live Births rate per 1,000 popn. Death Rate per 1,000 popn. Infantile Mortality rate per 1,000 live births West Districts. Paddington 137,400 13.7 11.3 66 Kensington 174,100 12.8 11.8 78 Hammersmith 125,100 15.0 11.3 62 Fulham 137,700 14.2 11.6 51 Chelsea 50,050 10.2 13.5 80 Westminster 124,400 8.4 10.5 57 North Districts. St. Marylebone 90,680 8.8 11.1 60 Hampstead 90,480 11.7 11.4 57 St. Pancras 179,400 13.6 11.5 64 Islington 292,300 15.4 11.9 65 Stoke Newington 50,480 13.8 11.0 43 Hackney 205,200 13.4 10.7 56 Central Districts. Holborn 34,350 7.3 10.5 84 Finsbury 56,960 13.0 12.9 73 City of London 8,780 6.6 10.7 52 East Districts. Shoreditch 80,300 14.7 11.4 64 Bethnal Green 92,910 14.2 11.3 59 Stepney 200,500 13.1 11.1 63 Poplar 134,400 14.9 11.4 60 South Districts. Southwark 145,300 14.0 12.5 57 Bermondsey 97,420 14.8 11.1 45 Lambeth 272,800 14.1 11.9 51 Battersea 141,700 14.9 11.8 53 Wandsworth 340,100 11.9 11.2 46 Camberwell 222,400 14.0 12.3 61 Deptford 95,460 14.4 11.8 54 Greenwich 95,770 13.6 10.9 42 LEWISHAM 229,000 13.9 10.5 47 Woolwich 150,900 13.6 10.4 50 14 (GENERAL PROVISION OF HEALTH SERVICES. Maternity and Child Welfare. A very lull report on the Council's Maternity and Child Welfare Services, compiled by Dr. Mackenzie, was included in my report for the year 1937, and thins section of the present report consists mainly of statistical information relating to the various aervices, Provision has been made during the year for extending the maternity and child welfare services of the Borough by an agreement to rent a portion of the Goldsmiths' Community Centre, Boundfield Road, on the Whitefoot Lane Estate, where it is propoaed to hold ante-natal and infant clinics. It has also been decided to lease accommodation to be provided by the London County Council in a combined Medical Centre on the Honor Oak Housing Estate, which will the utilised for a similar purpose. The Council have also agreed to the principle of providing additional municipal clinics for such parts of the Borough as are at present inadequately served, and, as an initial measure, have decided that the necessary steps be taken to provide a municipal clinic to meet the demands of the Bellingham and I.ower Sydenham districts. An additional whole-time Maternity and Child Welfare Medical Officer was appointed, in the person of Or. Beatrice Helen Bakewell, and she commenced duty on July 25th, 1938. The medical staff now consists of one part-time, and three whole-time Medical Officers. The greath increased demand for Home Helps, principally due to the inauguration of the London County Council's Domiciliary Midwifery Service, necessitated a complete reorganisation of the Schemes. A scale of contributions to be paid towards the cost of the service was adopted, anil the working of the Scheme was placed in the hands of one of the Health Visitors, under the supervision of the Senior Maternity and Child Welfare Medical Officer. The problems of the prevention of maternal mortality again came under review consequent upon a report presented to Parliament by the Ministry of Health. To conform with the recommendations 15 contained in this Report, the Council decided to engage Mr. J, H. Blaikley, F,R.C.S., etc., to conduct a weekly consultative Clinic for antenatal and pout-natal cases, and to advise on request in clinical matters concerning the patients in the Maternity Home. An emergency obstetrical Service was instituted by the London County Council, This service provides for skilled medical and nursing attention at the patient's home in an emergency, when she cannot be removed to a Hospital without undue risk. Statistics relating to the various services provided by the Council arc act out hereunder : - Maternity Home, 41, Rushry (Green, Catford, S.E.6. Number of patients delivered 315 Number of Primiparæ 175 Number of Multipara) 140 Number of Infant* horn 316 Presentations: Vertex 309 Pelvic 6 Face 1 Obstetric Operations: Forceps 8 Minor operations 157 Manual removal of placenta 3 Puerperal Morbidity Nil Still-births 2 Maternal deaths Nil Sex incidence: Males, 160; Females, 156. Progress of infants while in the Home: Born alive 314 Died within 4 days 2 Over birth-weight on discharge 184 Equal to birth-weight on discharge 12 Under birth-weight on discharge 113 Transferred with mother to another Institution 3 Number of infants entirely breast-fed 305 Number of infants in which breast-feeding was supplemented 4 16 Clinics for Expectant Mothers. No. of Patients. No. of Attendances. Lewisham Health Centre 1383 5439 Downham Health Centre 175 729 Sydenham Infant Welfare Centre 114 389 Consultative Ante-Natal Clinic. The following is the report of the Consultant on the work at the above-named Clinic:— "Consultative ante-natal clinics were started at the beginning of April, 1938, and during the last nine months of the year, 79 patients were referred. In all, 114 attendances were made. Of these 79 patients, 54 were women expecting their first babies. All the mothers were delivered successfully of live babies. "When serious difficulty was anticipated, or interference was necessary, the patients were admitted to Guy's Hospital. Disproportion due to contracted pelvis was the commonest complication; in three cases Caesarean Section was found necessary after a trial of labour; in eight cases delivery was effected with forceps, varying difficulty being encountered; and three patients had labour induced prior to full term. "Twenty-two were referred for albuminuria of pregnancy, on nine occasions, induction of labour was performed. Other abnormalities encountered were breech presentations, toxic jaundice, chorea gravidarum, ante-partum haemorrhage and recto-vaginal fistula." J. B. BLAIKLEY, M.B., B.S., F.R.C.S., M.C.O.G. Clinics for Mothers and Infants. Attendances Mothers. Infants. Lewisham Health Centre 1866 9561 Downham Health Centre 1084 5586 17 Voluntary Infant Welfare Centres. Name of Centre. No. of Sessions Doctor's Consultations Attendances under 1 year 1—5 years Bellingham Infant Welfare Centre 95 2,982 3,441 5,795 Brockley Infant Welfare Centre 96 2,806 3,162 3,409 Catford School for Mothers 99 2,732 6,562 3,825 Downham Infant Welfare Centre 49 1,729 3,067 3,540 Forest Hill Infant Welfare Centre 104 1,962 7,450 8,084 Grove Park Infant Welfare Centre 50 1,348 2,869 3,030 Hither Green Infant Welfare Centre 47 1,402 3,609 3,253 Lee and Blackheath School for Mothers 51 1,562 4,499 5,318 St. Mary's School for Mothers 51 1,238 3,268 2,606 Sydenham Infant Welfare Centre 102 1,128 5,003 1,806 Upper Sydenham Infant Welfare Centre 48 1,094 2,358 1,019 Artificial Sunlight Clinic. Children Treated during, 1938. Number. Cured. Improved. Unchanged. Ceased Attending. Still Under Treatment. Rickets 394 50 110 20 108 100 Malnutrition 95 0 21 6 23 39 Debility 54 3 14 7 18 12 Anaemia 35 3 8 3 11 10 Bronchitis 34 0 0 — 12 10 Debility after Infectious ease 29 6 5 2 8 8 Other conditions 52 — 13 5 15 19 Totals 093 74 177 49 195 198 Number of Children treated 693 Number of attendances 10,974 Number of Sessions 201 Average attendance per session 54.6 Consultations with Doctor 1,714 18 Toddlers' Clinics. (L.—Lewisham Clinics. D.—Downham Clinics.) 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 35 130 188 73 31 2 42 157 160 49 20 3 476 414 (b) Fair 5 16 21 — — — 5 22 19 2 1 — 51 40 (c) Bad 4 — 11 — — — 1 — 12 — 1 — 29 — Cleanliness : (a) Good 40 125 203 71 27 2 42 152 156 49 19 3 487 402 (b) Fair 2 21 8 2 2 — 3 27 21 2 36 52 (c) Dirty 2 — 9 — 2 — 3 — 14 — 3 — 33 — Nutrition : (a) Good 31 83 153 36 24 2 29 103 118 30 16 3 371 257 (6) Fair 11 60 37 34 4 — 13 70 37 18 2 — 104 182 (c) Poor 2 3 30 3 3 — 6 6 36 3 4 — 81 15 Circulatory System : (a) Heart Disease 2 — — — 1 2 — 2 1 — — — 4 4 (6) Anaemia 1 — 2 2 1 — — 5 4 3 — — 8 10 Respiratory System : (a) Bronchitis 3 6 — 8 — — — — — 12 1 8 4 34 (b) Asthma — — — — (c) Tonsils and Adenoids 8 6 46 4 8 — 13 — 47 7 7 6 129 23 19 Condition, Disease or Defect Girls Boys Total 2—3 3—4 4—5 2—3 3—4 4—5 L. #] L. D. L. D. L. D. L. D. L. D. L. D. Alimentary System : (a) Constipation 3 1 5 1 1 3 2 15 2 19 4 (b) Anorexia 3 1 14 5 3 2 7 2 34 3 (c) Worms 1 2 3 3 1 1 - - - - 5 6 (d) Teeth Carious 9 6 60 11 24 — 6 11 56 16 12 2 167 46 Nervous System : • (a) Backward — 2 1 1 1 1 1 1 2 - - 4 6 (b) Behaviour Symptoms — — 5 2 1 — 1 1 2 1 3 — 12 4 Genito-Urinary Symptoms : (a) Enuresis 3 9 12 1 2 6 4 24 - - - 47 14 (b) Albuminuria 2 — 10 — 4 — 1 - 2 — — — 19 - Skin Conditions : (a) Eozema 2 — 3 1 1 — — — 1 — — — 7 1 Eye Defects : (a) Squint — 2 3 — — — — — — — — — — — (b) Stye — —- 1 — — — — — — 1 — (c) Myopia — — 2 — — — 1 — 1 — 1 — 5 — Ear Defects : (a) Otorrhoea 6 — 1 8 1 — 5 — — — 21 — Rickets 8 2 50 — 8 17 3 58 — 6 — 147 5 Enlarged Glands 13 3 45 10 18 3 67 — 8 — 161 6 Other diseases and defects 4 10 19 11 1 11 9 39 9 — — 74 39 Not vaccinated 24 51 115 10 19 22 50 96 4 11 — 287 115 No previous attendances at a Clinic 37 34 159 19 10 — 52 55 174 — 10 — 442 108 Immunised against Diphtheria 3 8 5 3 3 — 5 8 8 2 6 — 30 21 20 Dental Treatment. Number of mothers provided with dentures, 45. Number of mothers who received dental treatment, 158. Minor Ailments. Details of cases sent during the year 1938. L.C.C. St. John's South Eastern Treatment Hospital Hospital Centre Minor Ailments 74 26 88 Dental Treatment. 110 66 71 Vision 9 17 — Tonsils and Adenoids 64 58 1 Orthopaedic Treatment 4 — — Milk Assistance Scheme. Number of Grants for Four Weeks :— For Mothers Free 2,081 Half-price 275 For Infants Free 8,880 Half-price 1,093 Total Quantity of Dried Milk issued 540 141bs. Maternity Outfits. Number of outfits issued free 81 Number of outfits issued at half-cost 61 Number of outfits issued at cost 105 Total 247 Obstetric Consultants. The services of one of the obstetric consultants retained by the Council were requisitioned by medical practitioners in seven cases. Convalescent Treatment. Four mothers with their babies were sent to the Zachary Merton Convalescent Home, Rustington. A grant of £50 was made to the Invalid Children's Aid Association in respect of convalescence arranged for children referred from the Infant Welfare Clinics. 21 Health Visitors. The following is a summary of the work carried out by the Health Visitors during the year : — First visits to Infants under 1 year of age 3,083 Subsequent visits 9,314 Infants between 1 and 5 years of age :— Total visits 19,311 Expectant mothers :— Total visits 2,544 Infant death enquiries 142 Still-birth enquiries 94 Visits to Puerperal Fever cases 10 Visits to Ophthalmia Neonatorum cases 40 Visits to other Infectious cases 2,780 Miscellaneous visits 1,334 Ineffectual calls 6,249 Attendances at Centres :— Municipal 1,871 Voluntary 797 Home Nursing. The following is a summary of the cases nursed by the Ranyard Nurses during the year : — Nature of Illness No. of Cases No. of Visits Measles 123 1,095 Pneumonia 84 1,258 Ophthalmia Neonatorum. 2 24 Whooping Cough 2 52 Threadworms 3 10 Otorrhoea 1 17 Polio-myelitis 1 3 Puerperal Fever 2 43 Infant Life Protection. The number of foster-mothers on the Register at the end of the year was 153, and the children in their care numbered 312. One child died during the year. 22 Laboratory Facilities. Food and Drugs.—The Public Analys.t 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, 3,426 specimens were examined, the details being as follows:— Material from cases of suspected Diphtheria :— Diphtheria bacillus isolated 154 Negative 2,347 Sputa from cases of suspected Tuberculosis :— Tubercle bacillus found 98 Tubercle bacillus not found 764 Blood from cases of suspected Enteric Fever :— Positive result 5 Negative result 13 Pathological specimens for Enteric Organisms :— Positive result 5 Negative result 40 Total 3,426 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 427 bodies were received into the Mortuary, of which number, 166 were brought in from outside the Borough and 219 from Public Institutions. The Inquests held numbered 311, and 178 post-mortem examinations were conducted. 23 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 1,368 Rooms Disinfected 2,933 Articles Disinfected :— Beds 649 Blankets 3,071 Bolsters 760 Mattresses 1,988 Pillows and Cushions 4,181 Quilts 1,375 Sheets 2,287 Miscellaneous Articles 5,676 Wearing Apparel 6,432 Articles Washed 15,446 Mattresses Re-tufted 737 Verminous Rooms Treated 295 Verminous Articles Treated 1,981 Cleansing Station. Children Treated for Vermin 1,225 Attendances at the Cleansing Station 2,182 Adults Treated for Vermin 4 Baths Given to Adults and Children for Scabies 1,388 Eradication of Bed Bugs. During the year, 18 Council houses and 143 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. 24 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 1938 is shown below Loads Tons Container System 24,115 42,191 Freighters 2,603 2,798 Other Vehicles 1,004 1,890 Totals 27,722 46,879 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 1938:— Tons Home Park Destructor 12,137 Molesworth Street Destructor 12,396 Barged away 22,870 Shoots 485 Total 47,888 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 1,664 After Infectious Disease 1,064 Notice from Builder 845 Other Inspections 5,684 Re-inspections 8,497 New Dwellings, for Water Certificates — Notices : Number of Intimation Notices Served 1,628 Number of Statutory Notices Served 328 25 Sanitary Improvements Effected : Premises Cleansed and Repaired 1,208 Drains Entirely Reconstructed 139 Drains Repaired 279 Water-closets Cleansed or Repaired 338 Soil-pipes Renewed or Repaired 187 Waste-pipes Renewed or Repaired 350 Rainwater Pipes Renewed or Repaired 148 Roofs and Gutters Repaired 49<i Dampness in Premises Remedied 503 Yards Drained or Paved 189 Dust-bins Provided 217 Water-cisterns Cleansed or Covered 18 Water Fittings Repaired 110 Additional water supplies provided to tenement houses 6 Defective Fire-places remedied 234 Offensive Accumulations Removed 62 Urinals Cleansed or Repaired 12 Other Nuisances Remedied 695 Factories and Workshops. The woman inspector is responsible for the inspection of factories, and details of the administration of the Factories Act, 1937, are included in this report in accordance with the requirements of the Ministry of Health. Factories. Nature of Business. With Mechanical Power Without Mechanical Power Other Premises Dressmakers, Milliners 18 26 — I.aundries 19 8 — Tailors 1 53 — Dentists — 37 — Bootmakers and Repairers 70 80 — Builders 19 56 — Motor Garages 35 60 10 Jewellers and Watch Repairers — 30 — Upholsterers and Cabinet Makers 1 28 — Miscellaneous 100 186 8 26 (a) Inspection for purposes of Provisions as to Health. Premises Number of Inspections. Written Notices. Prosecutions (1) (2) (3) (4) Factories with mechanical power 1,064 2 — Factories without mechanical power 755 3 — Other premises 13 - - Totals 1,832 5 - (b) Defects Found. Particulars. Number of Defects. Number of defects in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of cleanliness (S. 1) — — — — Overcrowding (S. 2) — — — — Unreasonable temperature (S. 3) — — Inadequate ventilation (S. 4) — — — — ineffective drainage of floors — — (S. 6) — — Sanitary Conveniences (S. 7) — — Insufficient — — Unsuitable or defective 5 5 — — Not separate for sexes — — — — Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) — — — — Total 5 5 — — 27 Outworkers. No. of out-workers on the Register 324 Visits made 706 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, 204 investigations were made into complaints of alleged rat infestation. In 73 instances, defective drains were found to be responsible, and in 75 instances the contributory cause was found elsewhere. The complaint was unfounded in 56 cases. Smoke Abatement. During the year 64 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 3 instances. The institution of legal proceedings was not necessary in any case. 28 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) 4,385 (b) Number of Inspections made for the purpose 4,385 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,102 (b) Number of Inspections made for the purpose 1,102 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those ferred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,628 Remedy of Defects during the Year without Service of Formal Notices : — Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,147 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 29 (B) Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 454 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : — (a) By owners 296 (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 7 (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 343 (ii) Number of families dwelling therein 343 (iii) Number of persons dwelling therein 2,424 (b).—Number of new cases of overcrowding reported during the year 94 (c).—(i) Number of cases of overcrowding relieved during the year 277 (ii) Number of persons concerned in such cases 1,043 Unfit Houses dealt with as Clearance Areas. During the year seven Clearance Orders were made by the Council and submitted to the Ministry of Health for confirmation. After holding public inquiries all the Orders were confirmed without 30 variation except in the case of Paragon Place, Blackheath (No. 2) Area, where an outbuilding which was used as a lock-up garage was excluded. At the inquiry held in connection with the Orders made on property in Blackheath, in addition to evidence for the owners, the Blackheath Society made a plea for the retention of the properties on aesthetic grounds. The following is a list of properties concerned : — Area. Premises. 1. Chaplin Street, Nos. 1 to 30 (consecutive), Chaplin Street, Forest Hill and Nos. 8 to 22 (even), Hindsley's Place. 2. Bath Place, Nos. 1, 2 and 2a, Bath Place (now Beechen Forest Hill Place). 3. Bath Place, Nos. 1 to 6 (consecutive), Bath Place (now Blackheath Wemyss Place). 4. Eliot Place, Nos. 16 and 17, Eliot Place. Blackheath 5. Paragon Place, Nos.1 and 2 Paragon Place. Blackheath (No. 1 Area) 6. Paragon Place, Nos. 5, 6, 7, 8, 12 and 13 Paragon Place. Blackheath (No. 2 Area) 7. Paragon Place, Nos. 17 to 23 (consecutive), Paragon Blackheath Place. (No. 3 Area) The Ministry of Health directed that payments under Section 42 of the Housing Act, 1936, should be made in respect of 8 houses. Claims for compensation for disturbance of trade were made in respect of three shops and the Council agreed to make an allowance in each case. As a result of action taken by this Council 64 houses have been demolished and 207 persons displaced in the past year bringing the total since the commencement of the programme to 167 houses demolished and 569 persons displaced. 31 The London County Council have rehoused the tenants from the Sparta Street Areas and have cleared the site prior to the erection of several blocks of tenements. 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 : — 56, Campshill Road. Colonnade House Garage, Paragon Place. 45, Tranquil Vale. 1, 11 and 12, Rennell Street. The following premises were also represented, but were subsequently put into repair and rendered habitable : — 4, Thornford Road. 4, Ringstead Road. 48c, Mount Pleasant Road. 16, Wisteria Road. 32 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 127, and in addition, 312 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 529. 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 1938, as follows : — Premises licensed to Pasteurise 1 Retail premises licensed to sell Pasteurised Milk 51 Retail premises licensed to sell Tuberculin Tested Milk. 19 Supplementary Licences to sell Pasteurised Milk 4 Supplementary Licences to sell Tuberculin Tested Milk. 1 Bacteriological Examination of Milk.—Samples of milk for bacteriological examination were taken as under:— Pasteurised, Milk— 28 samples, all of which complied with the standard laid down in the Milk (Special Designations) Order. Undesignated Milk—12 samples, 6 of which gavea positive reaction to the test for the coli-form bacillus. Slaughterhouses.—Under the provisions of the London County Council (Transfer of Powers) Order, 1933, the Council is now responsible for the licensing of slaughterhouses, and the following premises have been licensed: — Premises. Licensee. 291, High Street, Lewisham H. Calton (J. Balsdon & Co.) 324, Lee High Road R. C. Hammett, Ltd. Havelock Street Mews, Forest Hill Chalk & Cox, Ltd. 12, Montpelier Vale B. W. Parsons, Ltd. Weardale Road, Lee H. W. Hemmings 33 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 268 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 199 — — 2,292 1,994 Number inspected 199 — — All diseases except Tuberculosis: Whole carcases condemned — — — 9 1 Carcases of which some part or organ was condemned Percentage of the number inspected affected with 45 — — 20 14 disease other than Tuberculosis 22.0 — — 1.3 0.7 Tuberculosis only: Whole carcases condemned — -— — — 1 Carcases of which some part or organ was condemned. 18 — — — 102 Percentage of the number inspected affected with Tuberculosis 9.0 — — — 5.1 Restaurants and Eating-houses.—There are 129 establishments of this description on the Register, and during the year, 489 inspections were made. Bakehouses.—There are 78 bakehouses on the Register, and 292 inspections of these were made during the year. Food Shops and Stalls.—Inspections of these premises during the year numbered 1,238. 34 Food and Drugs (Adulteration) Act, 1928. During the year under review, 1,018 samples of food, drugs, etc., were obtained by the Council's Inspector and submitted to the Public Analyst for examination. Of this number, 163 were purchased formally in accordance with the provisions of the above-named Act, and the remaining 855 were obtained informally as " test" samples. Seven formal samples and thirty informal samples were certified by the Public Analyst as adulterated or below standard. Milk.—One hundred and sixty samples of milk were examined by the Public Analyst, and of these, none were certified as adulterated or below standard. The average composition of the samples is set out in the following table:— Period. Average Composition of Genuine Samples. Standard. Percentage of Milk Fat. Percentage of Solids, not Fat. Percentage of Water. Percentage of Milk Fat. Percentage of Solids, not Fat. First Quarter 3.63 8.80 87.57 3.0 8.5 Second ,, 3.52 8.86 87.62 Third 3.55 8.77 87.68 Fourth ,, 3.89 8.88 87.23 Average for the Year. 3.65 8.83 87.52 - - The following table gives the details of samples analysed :— Article. No. of Samples Examined. No. of Samples Adulterated. Formal Informal Total Formal Informal Total Acid, Boric 4 4 ,, Citric — 3 3 — — — ,, Tartaric — 4 4 — — — Arrowroot — 9 9 — — — Beverages — 3 3 — — — Borax — 4 4 — — — Brandy — 2 2 — — — Bread and Butter. 9 24 33 6 9 15 Butter 1 78 79 — 1 1 Cheese — 36 36 — — — Cocoa — 11 11 — — — Coffee — 15 15 — — — 35  Articles. No. of Samples Examined. No. of Samples Adulterated. Formal Informal Total Formal Informal Total  Confectionery - 21 21 - - - Cream — 17 17 — — — ,, of Tartar — 5 5 — — — Dripping — 13 13 — — — Fish, canned — 146 146 — 12 12 ,, paste — 28 28 — — — Flour, Self-raising — 5 5 — — — Fruit, canned — 3 3 — — — ,, dried — 18 18 — — — Gin — 7 7 — — — Ground Ginger — 4 4 — — — Honey — 1 1 — — — Lard — 19 19 — — — Lime Water — 4 4 — — — Linseed, crushed — 6 6 — — — Margarine — 37 37 — — — Meat Paste — 17 17 — — — ,, Pie — 1 1 — — — Milk 148 12 160 — — — ,, condensed — 44 44 - — — Oil, Aljnond — 4 4 - — - ,, Camphorated — 3 3 - - - „ Castor — 4 4 — — — ,, Cod Liver - 4 4 - - — ,, Eucalyptus — 4 4 — — — Ointment, Boric 1 4 5 1 1 2 ,, Mercury — 1 1 — — — ,, Zinc — 3 3 — — — Paregoric — 4 4 — — — Pepper — 29 29 — — — Powder, Baking — 6 6 — — — ,, Gregory's — 1 1 — — — ,, Sedlitz — 4 4 — — — Preserved tables — 4 4 — — — Rum — 13 13 — 2 2 Sal Volatile — 4 4 - — — Sausages 2 40 42 — 2 2 Soup — 1 1 — — — Spice 1 44 45 — — — Suet — 15 15 — — — Tea — 23 23 — — — Tincture of Iodine — 4 4 — — — ,, ,, Quinine — 4 4 — — — Treacle — 1 1 - — — Turpentine, ment of — 1 1 — — — Vinegar — 4 4 — — — Whisky 1 25 26 — 3 3 Totals 103 855 1,018 7 30 37 36 Adulterated Samples. No. Article. Formal or Informal. Adulteration or Irregularity. Action Taken. (564 Sild Informal Tin, 3.9 grains per lb. Vendor cautioned, stocks withdrawn from sale. 701 Sardines ” Lead, 20 parts per million ,, ,, ,, ,, 704 ” ” Lead, 16 parts per million ii ii ii ii 812 Brisling ” Tin, 2.4 grains per lb. ,, ,, ,, ,, 834 ,, ,, Tin, 2.1 grains per lb. ii ii i, ii 18 Sild ,, Tin, 2.1 grains per lb. ,, ,, ,, ,, 41 ” ” Tin, 2.1 grains per lb ii ii % ii ll 111 Sardines ” Lead, 34 parts per million Stocks exhausted. 121 Sild ” Tin, 6.1 grains per lb. Stocks surrendered. 295 Sausages ” Sulphur dioxide, 225 parts per million. Subsequent formal sample genuine. 299 Sild ” Tin, 2.7 grains per lb. Stocks surrendered. 304 Sausages ” Sulphur dioxide, 170 parts per million. Subsequent formal sample genuine. 365 Butter ” Margarine, 30%. ” ” ” ” 423 Sild ” Tin, 5.5 grains per lb. Stocks withdrawn from sale. 538 Boracic Ointment Boric acid deficient, 37.7%. Subsequent formal sample 612. 612 ” Formal Boric acid deficient, 26.4%. Vendor cautioned. 625 Sardines Informal Lead, 46 parts per million. Stocks surrendered. 641 Bread and Butter ” Margarine, 100%. Subsequent sample 710 genuine. 642 ” ” ” 100%. ,, ,, , , ,, 643 ” ” 100%. ” ” ” ” 37 Adulterated Samples—contd. No. Article. Formal or Informal. Adulteration or Irregularity. Action Taken. 665 Whisky Informal Proof spirit deficient, 1 degree. Vendor cautioned. 676 Bread and Butter ,, Margarine, 100%. Subsequent sample 713. 678 ,, ,, ,, ,, 100%. Subsequent sample 715. 680 ,, ,, ,, ,, 100%. Subsequent sample 714. 698 Whisky ,, Proof spirit deficient, 1.7 degrees. Vendor cautioned. 699 Rum ,, Proof spirit deficient, 1.3 degrees. ,, ,, 710 Bread and Butter Formal Margarine, 100%. Fined 20/- and Costs 10/-. 713 ,, ,, ,, ,, 100%. Vendor died. 714 ,, ,, ,, ,, 100%. Fined 20/- and Costs 21/-. 715 ,, ,, ,, ,, 100%. Fined 40/- and Costs, 20/-. 723 Rum Informal Proof spirit deficient, 1.1 degrees. Vendor cautioned. 733 Bread and Butter ,, Margarine, 100%. Subsequent sample 763. 736 ,, ,, ,, ,, 100%. Subsequent sample 764. 738 ,, ,, ,, ,, 100%. Subsequent sample genuine. 758 Whisky ,, Proof spirit deficient, 1.9 degrees. Vendor cautioned. 763 Bread and Butter Formal Margarine, 100%. Fined 20/- and Costs, 21/-. 764 ,, ,, ,, ,, 50%. Fined 20/- and Costs, 21/-. 38 INFECTIOUS DISEASES. The following table shows the incidence of notifiable infectious disease during the year, and in the two preceding years:— Disease. Year. 1936 1937 1938 Anthrax 1 Cerebro-spinal Fever 9 7 5 Diphtheria 247 328 469 Dysentery - 97 20 Erysipelas 92 95 82 *Measles — — 11 Ophthalmia Neonatorum 18 15 27 Pneumonia 200 240 258 Polio Myelitis 2 11 19 Puerperal Fever 2 6 2 Puerperal Pyrexia 35 42 45 Scarlet Fever 868 634 533 Typhoid Fever 6 13 2 Para-typhoid Fever 6 6 3 *Whooping Cough - — 76 *Notifiable from 1st October, 1938. 39 Table showing Cases of Infectious Disease Notified, 1938. 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 Anthrax - - - - - - - - - - 1 - 1 1 Cerebro-spinal Fever 1 - — — - — 1 2 1 — — - 5 5 Diphtheria 10 10 21 34 34 209 74 27 31 9 4 — 469 442 Dysentery — — 2 1 — 7 - — 5 2 1 2 20 16 Erysipelas 3 — 1 — — 5 2 5 12 12 27 15 82 54 *Measles 1 2 1 1 2 1 1 1 1 - — — 11 4 Ophthalmia Neonatorum 27 - - - - - - - - - - - 27 12 Pneumonia 4 14 8 16 4 39 13 10 41 36 54 19 258 150 Polio-Myelitis 1 1 4 1 — 9 2 1 - — - - 19 17 Puerperal Fever — — — — — — - 1 1 — — — 2 - Puerperal Pyrexia — — — — — — - 3 32 9 1 — 45 43 Scarlet Fever 2 16 43 35 44 231 88 35 20 9 3 1 533 460 Typhoid Fever — — — — — — — — — — 2 — 2 2 Para-tvphoid Fever — — — — — 1 — — 1 — 1 — 3 3 *Whooping Cough 10 11 13 13 5 23 — — 1 — — — 76 17 Totals 59 60 93 101 89 525 181 85 152 77 94 37 1553 1226 *Notifiable from 1st October, 1938. 40 Table showing Number of Deaths from Infectious Diseases in 1938. 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 Scarlet Fever - - 1 - - - - - - - - 1 Whooping Cough 1 1 1 - - - - - - - - 3 Diphtheria 1 — 7 15 - - - - - - - 23 Influenza — 1 — — — — 1 2 3 5 2 14 Cerebro-spinal Fever — 1 — - - 1 - - - - - 2 Puerperal Fever — — - — 2 1 2 - — — — 5 41 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, 58 phials of 8,000 units each (for treatment) and 34 prophylactic doses of 500 units each, were issued. Diphtheria Immunisation. Number of children immunised during the year 1,406 Number of children immunised since the commencement of the scheme in 1935 3,117 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, 1937:— Number of Births registered from 1st January to 31st December, 1937 2,970 Number of these Births duly entered by 31st January, 1939, in the Vaccination Register:— Successfully Vaccinated 1,291 Insusceptible of Vaccination 17 Number in respect of whom Statutory Declarations of Conscientious Objection have been received 1,218 Died unvaccinated 95 Number of these Births which on 31st January, 1939, remained unentered in Vaccination Register on account of:— Postponement by Medical Certificate 38 Removal to districts, the Vaccination Officers of which have been duly apprised 79 Removal to places unknown 147 Number of these Births remaining on 31st January, 1939, neither duly entered in Vaccination Register nor temporarily accounted for 85 Total number of Certificates and copies of Certificates of successful Primary Vaccination of Children under 14 received during the calendar year, 1938 1,638 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, 1938 1,231 42 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, 264 new cases of pulmonary, and 66 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 1 - 1 2 3 - 1 1 2 5 6 - 6 1 — — 1 3 10 4 5 5 7 — — — — 15 21 22 3 4 15 12 1 2 20 17 16 5 5 - — — — 25 39 35 4 4 12 30 — 2 35 27 17 3 6 12 15 2 2 45 25 5 1 3 16 9 3 — 55 16 5 — 1 17 6 2 — 65 and upwards 2 1 — 2 4 4 — — Totals 157 107 29 37 76 77 10 12 Efficiency of Notification.— The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was one in 8.75. It was not necessary to take any action in regard to the nonnotification of tuberculosis during the year. 43 Public Health (Prevention of Tuberculosis) Regulations, 1925.— No action was taken under the above Regulations, which relate to tuberculous employees in the milk trade. Notification Register. Pulmonary Non-Pulmonary Total Cases Number of cases of Tuberculosis remaining at the 31st December, 1938 in the Register of Notifications Males Females Total Males Females Total 592 419 1,011 137 161 298 1,309 Number of cases removed from the Register during the year by reason of:— Removals 39 47 86 5 8 13 99 Recovery from the disease 18 19 37 7 5 12 49 Death 75 78 153 8 10 18 171 44 REPORT OF THE TUBERCULOSIS OFFICER FOR 1938. The primary notifications of tuberculosis for 1938 numbered 330, of which 264 were of pulmonary tuberculosis and 66 of other forms of tuberculosis. During the year 153 persons died from pulmonary tuberculosis and 22 died from other forms of the disease. The death-rate from pulmonary tuberculosis was 0.61 per 1,000 inhabitants, as compared with 0.59 for 1937 and 0.62 for 1936. Cases on Register.- The cases of tuberculosis on the Town Hall register number 1,309 (pulmonary 1,011, other forms 298); while those on the Dispensary register number 1,162 (pulmonary 944, other forms 218). Thus 88.7 per cent. of all the tuberculous cases in the Borough have either attended the Dispensary or have been seen by the Tuberculosis Officer. Attendances of Patients.- During the year, 999new patients attended the Dispensary, while the total attendances numbered 3,859. This compares with 864 new patients and a total attendance of 3,439 in 1937. Of the new cases 291 were referred to the Dispensary by their Medical Attendants, 291 were referred from hospitals or from other areas, 273 were contacts of tuberculous patients and 127 applied on their own initiative. A summary of first attendance is shown in Table C. Home Visiting.- The three Health Visitors paid 5,406 visits to the homes of patients, every newly-notified case being visited as soon as possible after notification and subsequent visits being paid as often as required. The Tuberculosis Officer visited 265 patients in their homes and also saw 10 patients there in consultation with their Medical Attendants. A record is kept at the Dispensary of the condition of every tuberculous patient in the Borough. Those who have kept entirely free from symptoms for a period of 5 years (pulmonary tuberculosis) or 3 years (non-pulmonary tuberculosis) after completion of their treatment are marked off the register as "disease arrested" and are asked to report again should symptoms recur. It is quite exceptional for any cases thus removed from the register to return at a later date on account of a break-down, 45 An investigation has been made into the number of tuberculous patients resident in the new Estates, with the following results:- Pulmonary T uberculosis. Non-Pulmonary Tuberculosis. Bellingham 66 24 Downham and District 297 77 Grove Park 14 10 Mottingham 5 4 Honor Oak 32 21 414 136 This great extension of the inhabited area of the Borough has enormously increased the work of visiting. Reports.- Written reports to the number of 1,278 were sent out from the Dispensary. Residential Treatment.— The London County Council admitted 243 insured and 117 uninsured patients to residential institutions, while 34 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. The Tuberculosis Officer visited the tuberculosis wards of the Lewisham Hospital 45 times in the capacity of Consultant in Tuberculosis to the Hospital. Affiliated and other Hospitals.— For X-Ray examination 84 patients were sent to St. John's Hospital, Lewisham, and 108 patients to the Lewisham Hospital. Films and reports of these cases were received at the Dispensary and formed an additional aid in the diagnosis of tuberculous disease. During the last few years an increasing number of patients have been treated, while at Sanatorium, by the induction of artificial pneumo-thorax and on their return home the patients attend at regular intervals of one to four weeks for refills. The majority of the refills are given at St. John's Hospital, 92 during 1938. Where more convenient for the patient, they are allowed to attend at other Hospitals for the purpose. The total number of patients receiving this form of treatment is 139. Light treatment for lupus is given 46 principally at the London Hospital. For laryngeal examination and for surgical diagnosis some patients have been referred to King's College Hospital or to the Miller General Hospital. Sputum Tests.— The sputum of 432 patients was examined and reported upon by the Pathological Department of St. John's Hospital. Dental Treatment.— During the year 19 patients attended at St. John's Hospital for dental treatment and 11 patients were assisted in obtaining dentures. Extra Diet.— The Borough Council granted an allowance of milk, butter and eggs to 19 tuberculous patients to enable them to maintain their working capacity after return from Sanatorium. Those in receipt of Public Assistance were recommended for extra diet to the Public Assistance Committee. These numbered 115. Shelters.-- The Borough Council loans six shelters to patients having insufficient sleeping accommodation. Care Committee.— The members of the Care Committee met at the Dispensary on alternate Thursdays throughout the year to discuss the difficulties of tuberculous patients and their families and to devise the best methods of assisting them. Many of the families need help in the way of clothing, beds and bedding, fares to visit their relatives in Sanatoria and many other contingencies ; the money to defray the expenses involved is collected by voluntary means, such as the organisation of whist-drives, concerts, etc., and by the sale of Christmas seals. Handicrafts and Book-binding Classes.— These classes are held at the Dispensary every week during term-time under the tuition of Instructors provided by the London County Council, while the Borough Council makes a grant to defray incidental expenses. The patients attending the classes are those unfit for regular employment, but sufficiently well to benefit by the instruction; they show a keen interest in their work, which helps to take their minds off their grave disabilities. Tables A to E give in statistical form a summary of the work carried out at the Dispensary. Appended is the Table required annually by the Ministry of Health. ROSE JORDAN. 47 Table A. Summary of Tuberculosis Health Visitors' Work, 1938. Visits to Pulmonary Tuberculous Patients 338 ,, Non-pulmonary „ ,, 80 Subsequent Visits 4,614 Visits to Un-notified Cases 415 No. of patients occupying Separate Room 216 „ sharing with 1 other 162 ,, ,, ,, 2 others 28 ,, ,, ,, 3 ,, 5 ,, ,, ,, 4 ,, 5 ,, ,, ,, 5 ,, 2 No. of Patients occupying Separate Bed 243 ,, ,, sharing with 1 other 168 „ ,, 2 others 6 Table B. Attendance of Patients at the Dispensary. 1938 First Attendances. Subsequent Attendances. Totals. January 103 265 368 February 95 231 326 March 120 262 382 April 84 227 311 May 110 261 371 June 67 220 287 July 63 223 286 August 67 222 289 September 65 237 302 October 84 258 342 November 72 239 311 December 69 215 284 Totals 999 2,860 3,859 48 Table C. Summary of First Attendances at the Dispensary, 1938. Applied on own initative Sent by Doctor Transferred from Hospitals, etc. Sent by L.C.C. Contacts Totals. Pulmonary 9 104 217 1 12 343 Non-Pulmonary 2 3 59 6 1 71 Non-tuberculous 116 184 15 10 260 585 Totals 127 291 291 17 273 999 Table D. Stages in Pulmonary Tuberculosis. Male. Female. Children under 15. Totals. Stage I. 45 42 21 108 ,, II 128 85 3 210 „ III 9 10 - 19 Totals 182 137 24 343 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 3 5 12 20 Bone 10 13 7 30 Other Regions 8 9 4 21 Totals 21 27 23 71 49 Return showing the work of the Dispensary during 1938. (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 (excluding contacts):— (a) Definitely tuberculous 114 98 12 4 13 22 8 a 127 120 20 9 276 (b) Diagnosis not completed - — — — — — — — — — — — - (c) Non-tuberculous - - - - - - - - 124 136 37 28 325 B.- Contacts examined during the year:— (a) Definitely tuberculous 4 5 2 1 — — — 1 4 5 2 2 13 (b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 44 77 70 69 260 C.— Cases written off the Dispensary Register as:— (a) Recovered 13 12 2 — — 4 6 2 13 16 8 2 39 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 169 214 110 97 590 D.— Number of Cases on Dispensary Register on 31st December:— (a) Definitely tuberculous 515 373 32 24 47 80 53 38 562 453 85 62 1162 (b) Diagnosis not completed - - - - - - - - - - - - - Number of cases on Dispensary Register on 1st January 1055 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 265 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 124 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 5270 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases "lost sight of " 134 10. Number of:— 432 (a) Specimens of sputum, etc., examined (b) X-ray examinations made in connection with Dispensary work 222 4. Cases written off during the year as Dead (all causes) 128 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 3 5. Number of attendances at the Dispensary 3859 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 208 12. Number of "T.B. plus" cases on Dispensary Register on 31st December 603 7. Number of consultations with medical 13. Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— (a) Personal 10 Provided by the Council 1 (b) Other 426 Provided by Voluntary Bodies 50 INDEX TO CONTENTS. Subject Page Ante-natal Consultation Clinic 16 Artificial Sunlight Clinic 17 Bakehouses 33 Bacteriological Examinations 22 Births 8 Birth Notifications 9 Clearance Areas 29 Closing Orders 31 Convalescent Treatment 20 Coroner's Court and Mortuary 22 Cowhouses 32 Deaths 9 „ Table of Causes 11 „ in Metropolitan Boroughs 13 Dental Treatment 20 Diphtheria Anti-Toxin 41 „ Immunisation 41 Disinfection 23 Factories and Workshops 25 Food Sampling 34 Health Visitors 21 Home Nursing 21 Housing Statistics 28 Infant Clinics 16 Infant Life Protection 21 Infant Mortality 10 Infectious Diseases 38 Marriages 9 Maternity and Child Welfare 14 Maternity Home 15 Maternity Outfits 20 Meat Inspection 33 Milk Assistance Scheme 20 Milk Supply 32 Minor Ailments 20 51 Subject Page Obstetric Consultants 20 Outworkers 27 Overcrowding 29 Population 8 Rats and Mice 27 Refuse Removal 24 Restaurants 33 Sanitary Inspection 24 Slaughterhouses 32 Smoke Abatement 27 Staff 5 Still-births 8 Toddlers' Clinics 18 Tuberculosis 42 Tuberculosis Officer's Report 44 Vaccination 41 Voluntary Infant Welfare Centres 17