Pop 29 Metropolitan Borough of Poplar. Annual Report for the YEAR 1923. on The Sanitary Condition and Vital Statistics of the Metropolitan Borough of Poplar, comprising the Registration Sub-districts of POPLAR, and BOW and BROMLEY BY FREDK. WM. ALEXANDER, Medical Officer of Health. V PUBLIC HEALTH AND HOUSING COMMITTEE. Alderman J. Scurr, J.P., Mayor (ex-officio) Councillor T. J. Blacketer (Chairman). Councillor Mrs. J. A. March (Vice-Chairman). Councillor A. Baker Councillor J. T. O’Callaghan ,, H. E. Butler ,, C. Petherick ,, T. J. Goodway ,, W. Reigleuth ,, C. W. Key ,, J. Russell Alderman Miss M. Lester Mrs. J. Scurr, J.P. Councillor Mrs. J. Mackay ,, W. J. Whitelock Councillor C. E. Williams. MATERNITY AND CHILD WELFARE COMMITTEE. Alderman J. Scurr. J.P., Mayor {ex-officio). Alderman Miss M. Lester (Chairman). Councillor W. J. Whitelock (Vice-Chairman). Councillor T. J. Blacketer Councillor G. A. Newton ,, G. J. Cressall ,, Mrs. J. Scurr, J.P. ,, Mrs. N. F. Cressall Co-opted Members: ,, Mrs. J. A. March Miss E. Herbert Mrs. Power vi STAFF. Medical Officer of Health: FREDERICK WILLIAM ALEXANDER, M.R.C.S., L.R.C.P. (Edin.), D.P.H. (ENG.). Public Analyst: ALBERT E. PA.RKES, F.I.C., F.C.S. Chief Clerk: HAROLD DYER.f Sanitary Inspectors; Inspectors under the Food and Drugs and Canal Boats Acts: H. A. Tibbatts.* J. Johnson. *§ C.H. Brown.*†‡§ II. J. Langley.* Miss A. Wm. Johnson.*‡ A. J. Field.† W. boyce.† C. A. Gbabham.*‡ H. A. Pearce.*†§‡ F. A. Smith.*† Tattersall† (resigned Jan., 1924). Clerks: F. J. White. H. C. Rodford. H. A. Purdy. W. F. Roberts. Miss S. Feli.s. Miss E. Hamilton. A. Hamilton. Mrss G Hood (transferred to M. and C. W. Staff). Offices—Caretaker and Messenger : J. J. Jackson. * Cert. S.I.E. Board. † Cert R.S.I. ‡ Cert. Meat and Food Inspector. § R.P.C. vii MATERNITY AND CHILD WELFARE. Chief Health Visitor : Miss A. E. Hall*† (Resigned). Miss J. M. Cardozo*¶ (from 1st Sept., 1923). Health Visitors : Miss E. A. Foskett.*¶ Mrs. M. J. Edgell.§ Miss M. Mallett.* Mrs. E. K. Haythornthwaite*¶ (from 22/2/23). Miss G. E. Paice*†† (from 24/9/23). Clerk : Miss V. F. Wood (resigned). Miss G. Hood (from 18/8/23). There are four Doctors, one Dental Surgeon and an Anaesthetist attending the Council's Clinics. FREE MILK SCHEME. Temporary Clerks: Mrs. R. Burwood (to Nth August only). Miss R. Williams. Miss M. L. Thompson. Investigation and Enquiry Officer: C. A. Webster (temporary). TUBERCULOSIS DISPENSARY, 135, BOW ROAD. (Removed to 1, Wellington Road, 1st January, 1924.) Tuberculosis Officer: W. C. P. Smith, B.A. (Camb.), M.R.C.S., L.R.C.P., D.P.H. (Camb.). Assistant Tuberculosis Officer : D. H. Geffen, M.D. (Lond.), B.S., D.P.H. Health Visitors: Miss H. Messem. Miss D. Wood.‡ Miss N. Roberts.** Dispenser: Clerks: Mrs. A. M. Smith. Miss E. S. Jones. Miss A. Rogers. Nurse-Helper: Caretaker: Mrs. E. Tomlins (temporary). J. Tyler. DISINFECTING STATION, YEO STREET. Disinfectors: W. D. Quested (Chief). D. Boyce. Shelter and Cleansing Station Attendant : Mrs. A. Howe. MORTUARY. Mortuary Keeper and Caretaker of Coroner's Court: J. Brown. * C.M.B. † Cert. S.I.E.B. § Cert. Mid. Colonial Medical Association. ‡ H.V. Cert. R.S.I, and San. Insp. Cert. R.S.I. ** H.V.Cert.R.S.I. ¶ Three Years' General Nursing Certificate. †† Fully Trained at Children’s Hospital. viii SUMMARY OF STATISTICS FOR 1923. Area of Borough (excluding water) 2,136 acres Population (Census, 1921) 162,618 Population, estimated to middle of 1923 166,400 Density 77.9 Number of Marriages 1,339 Number of Inhabited Houses (Census, 1921) 23,064 Number of families or separate occupiers 37,288 Rateable Value £932,704 Sum represented by a penny rate £3,755 Total M. F. Births—Legitimate 4,161 2,150 2,011 Birth Rate 25.6 —Illegitimate 95 54 41 Deaths 1,880 1,049 831 Death Rate 11.3 Number of women dying in, or in consequence of, childbirth from sepsis 7 from other causes 7 Deaths of Infants under one year of age, per 1,000 births:— Legitimate, 58. Illegitimate, 2. Total, 60. Deaths from Measles (all ages) 22 ,, Whooping Cough (all ages) 7 ,, Diarrhoea (under 2 years of age) 32 Metropolitan Borough of Poplar Comprising the Registration Sib-Districts of Poplar, and Bow and Bromley. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar. Sir, Ladies and Gentlemen, In accordance with the "Sanitary Officers' Order, 1922," I have pleasure in submitting my thirty-first Annual Report. This deals with the year 1923, and differs slightly in arrangement from the reports of previous years. Sub-Districts.—The Registration Sub-Districts were revised as from 1st February. Part of the Bromley Sub-District was amalgamated with that of Poplar, and the whole of Bow absorbed into the Bromley Sub-District, the enlarged areas being named "Poplar Sub-District" and "Bow and Bromley Sub-District." Mortality.—The rate of mortality at all ages is the lowest recorded for the Borough, while the infantile mortality rate, calculated per 1,000 nett births, is 60, also a record. Deaths from violence reached the high figure of 106, owing to a large increase in the number of cases of accidental drowning. Deaths from cancer numbered 203, compared with 190 in the previous year. There were decreases in the numbers of deaths from tuberculosis and other diseases of the respiratory system. Infectious Diseases.—Notifications of infectious diseases were fewer tuan in 1922, notwithstanding a four-fold increase in the number of cases of Zymotic Enteritis. Tuberculosis.—The report of the Tuberculosis Officer is quoted in extenso. The number of new cases notified from all sources during the year was fewer than in the previous year. Six Tuberculous patients who died were not notified (3 per cent. of the total deaths from Tuberculosis), but 20 other cases were notified only after death. Public Analyst.—The Public Analyst submits a report in connection with the Sale of Food and Drugs Acts, ctc. 2 Maternity and Child Welfare.—The report of the Chief Health Visitor (which, for convenience, has been compiled to 12th January, 1924), and also a very instructive and interesting report by the Senior Medical Officer of the Royal College of St. Katharine, are appended. The mortality rate amongst infants visited was the exceedingly low one of 38.4. The Dental Surgeon at the Council's Clinic has submitted statements of the work in connection with the Maternity and Child Welfare and Tuberculosis Dental Clinics. Changes of Staff.—During the year Miss A. E. Hall resigned owing to ill health, after nearly sixteen years' service. Miss J. M. Cardozo was promoted to Chief Health Visitor, and Miss G. E. Paice was appointed to replace Miss Cardozo. Mrs. E. K. Haythornthwaite was appointed early in 1923 in place of Miss E. G. Littlewood. who had resigned. Miss V. F. Wood, clerk in the Maternity and Child Welfare Department, resigned on the occasion of her marriage, and Miss G. Hood was transferred from the Public Health Staff to the Maternity Department. The services of one of the temporary clerks employed in connection with the Free Milk Scheme were dispensed with owing to the reduction in the work. Bacteriological Examinations.—In April, 1923, the bacteriological work (other than Tubercle) was undertaken by the Seamen's Hospital, Greenwich, and the new arrangement, which was made at the request of local practitioners for convenience, has proved very satisfactory. I am, Sir, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. Public Health Offices, Bow Road, E. 3. March, 1924,. 3 AREA AND POPULATION. The area of the Borough is 2,136 acres, and the population, estimated to the middle of the year by the Registrar-General, is 166,400, giving a density of 77.9 persons per acre. The estimated population given above has been used for calculating the various rates in the present report. The population of London is estimated at 4,564,109. BIRTHS. Early in the year 1924 the Registrar General supplied the following information, relating to the year under review :— Registered. Inward Transfers. Outward Transfers. Nett. Total Births—Males 1,990 235 21 2,204 Females 1,852 228 28 2,052 Illegitimate—Males 48 13 7 54 Females 44 7 10 41 The birth-rate per 1,000 population was 25.6 as against 20.4, 24.6, 34.1, 27.2 and 26.6 for the years 1918-1922. During the year 3,821 I'otifications were received under the Notification of Births Act, 1907. MARRIAGES. During the year the marriages of 2,678 persons were registered, giving a rate of 16.1, as against 16.7, 20.8, 18.7, 16.2 and 15.0 in the preceding five years. DEATHS. 1,928 deaths were registered as having occurred in the Borough. 418 deaths of non-residents must be deducted and 370 deaths of Poplar residents which occurred outside the Borough must be added, giving a nett total of 1,880 and a rate of 11.3 per 1,000 of the estimated population . 4 It should be borne iu mind, when studying death rates, that comparisons should be made with those of districts the inhabitants of which live under similar conditions. See Table IV., East Districts. 1918. 1919. 1920. 1921. 1922. 1923. Deaths from all causes, rate per 1,000 population 22.7 14.4 14.7 12.7 14.3 11.3 Deaths under 1 year of age, rate per 1,000 nett births 107 83 82 83 79 60 Deaths over 05 years of age, rate per 1,000 total population 14.7 8.0 8.3 6.8 8.1 3.6 Zymotic diseases:— Death rate per 1,000 population 2.1 1.0 1.3 1.5 1.5 0.6 Proportion of 1,000 deaths 95.9 72.7 92.7 125.3 110.9 58.5 Tuberculosis, all forms:— Death rate per 1,000 population 2.5 1.4 1.6 1.3 1.3 1.2 Proportion of 1,000 deaths 112.0 100.3 112.2 105.7 94.4 103.7 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 4.8 3.0 3.6 2.6 3.6 2'4 Proportion of 1,000 deaths 212.0 208.8 250.8 208.6 254.6 212.7 Deaths from Various Diseases. Disease. 1918. 1919. 1920. 1921. 1922. 1923. Measles 151 7 33 39 62 22 Whooping Cough 61 24 50 29 88 7 Influenza 524 139 53 16 86 22 Pneumonia, all forms 377 215 235 193 260 163 Diarrhoea and Enteritis (all ages) 58 82 55 112 28 41 5 DEATHS OF PERSONS OF UNKNOWN ADDRESSES, ETC., INCLUDED IN THE MORTALITY STATISTICS. The following deaths have been included in the mortality statistics of the Borough in accordance with the Registrar-General's rules relating to "Transferable Deaths." 1923. 4th May. In Randall's Market. Unknown. Male, newlyborn. Heart failure due to lack of attention at birth. Found dead wrapt in parcel in street. P.M. Inquest. 1st June. St. Andrew's Hospital. Lighterman, address unknown. Male, 61. Epithelioma of tongue. Bronchitis. P.M. Natural cause. Inquest. 29th June. s.s. "Songster," West India Docks. Ship's fireman. Male, 38. Ruptured aneurysm of aorta. P.M. Natural cause. Inquest. 7th Aug. Millwall Docks. Seaman of s.s. "Star." Male, 21. Found drowned. Open verdict. Inquest. 29th Aug. R. Thames, off Fletcher's Dock Unknown. Male, about 30. Found drowned in River Thames (tidal water). Open verdict. Inquest. 25th Oct. On board s.s. "Star," in Millwall Docks Ship's coal trimmer, of . Germany. Male, 45. Cerebral hæmorrhage. P.M. Inquest. 25th Oct. Poplar Hospital. Engine Fitter, of Kilmarnock, Scotland . Male, 34. Crushed between piston of engine and side of ship. Fractured ribs and internal hæmorrhage. P.M. Accidental. Inquest. 6 INFANT MORTALITY. There were 255 deaths of children under one year of age, the deathrate per 1,000 births for the past 16 years being:— Borough of Poplar. County of London. 1908 124 (104) 113 1909 130 (99) 108 1910 119 (106) 103 1911 158 (116) 129 1912 108 (90) 90 1913 113 (83) 105 1914 117 (117) 104 1915 134 (98) 112 1916 104 (78) 89 1917 95 (79) 103 1918 107 (68) 107 1919 83 (69) 85 1920 81 (48) 75 1921 83 (66) 80 1922 79 (38) 74 1923 60 60 Note.—The figures in brackets are the mortality rates amongst infants visited by the Health Visitors. The infants visited are, for the most part, resident in the poorest portions of the Borough. These rates are calculated upon births occurring in any particular year, and deaths in that and the following year. The causes of death of infants under one year of age are shown in Table III., page 12. 7 INQUESTS AND DEATHS FROM VIOLENCE. The number of inquests held in the Borough was 284. From this total must be deducted 84 of non-residents, and 42 added of residents who died outside the Borough, the nett total being 242. Verdict of Violence:— Railways 1 Vehicles and horses 16 Ships, boats and docks 3 Building operations 2 Conflagrations 0 Burns, scalds and explosions 10 Drowning (excluding suicides) 20 Suffocations in bed 4 Poisons and poisonous vapours 2 Other causes 27 Anthrax 1 Suicides 17 Murder 1 Manslaughter 1 Fish poisoning 1 Total 106 Verdict of Natural Causes 136 Total 242 For death rates from violence, and the percentage of inquest cases to total deaths, see Table V. MORTUARY. The number of bodies deposited in the Mortuary, Cottage Street, Poplar, during the year was 275— Residents. Non-Residents.* No age stated 1 0 Stillborn 0 1 Under 1 year 17 6 1 to 5 years 16 0 5 to 15 years 18 2 15 to 25 years 19 1 25 to 65 years 102 14 65 years and upward 68 10 Totals 241 34 * Brought from outside the Borough for the convenience of the Coroner. 8 Deaths during 192.3 in the Metropolitan borough of Poplar, classified according to localities. Names of localities adopted for the purpose of these statistics ; public institutions being shown as separate localities. 1st Quartei 2nd Quarter 3rd Quartei 4th Quartei Total. Poplar Sub-District 123 99 84 129 435 Bow and Bromley Sub-District 109 77 86 104 376 St. Andrew's Hospital 195 191 180 201 767 Poplar Institution 12 14 13 17 56 Bow Institution 26 32 23 30 111 Bromley House Institution 2 8 7 2 19 Poplar Hospital 28 24 30 22 104 Adelaide Buildings.. — — — — — Baffin ,, — — — — — Council ,, 1 — — 1 2 Grosvenor ,, 2 3 — 3 8 Hanburv ,, — — — 1 1 Hudson ., — — — — Melbourne — — — 1 1 Montreal ,, — — — — — Ontario ,, 1 1 — — 2 Ottawa ,, — — — — — Prestage ,, — — — — — Quebec ,, — 1 — — 1 Sydney ,, — 1 1 — 2 Toronto ,, — — — — — Wellington ,, — — — — — Winnipeg ,, — — — — — River Thames — 3 1 3 7 ,, Lee 1 3 — — 4 Limehousc Cut — — 3 — 3 Bow Creek 1 — — — 1 Ducketts Canal — — — — — East India Docks — — — — — West India Docks 1 — 2 — 3 Millwall Docks 1 — 1 1 3 Regents Canal — — 1 — 1 Highways 1 10 4 6 21 504 467 436 521 1928 Deaths occurring outside the Borough of persons bslonging thereto 106 78 88 98 370 Deaths occurring within the Borough of persons not belonging thereto 96 113 100 109 418 Deaths at all ages—nett 514 432 424 510 1880 9 TABLE I. Vital Statistics during 1923 and Previous Years. Poplar (Whole Borough). Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the Borough. Transferable Deaths.+ Nett Deaths belonging to the Borough. Uncorrected Number. Nett. Of Non-residents registered in the Borough. Of Residents not registered in the Borough. Under 1 Year cf Age. At all Ages. Number. Kate. Number.* Rate. Number.* Rate per 1000 Nett Births. Number. * Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1918 139,530 2901 3203 20.4 3526 25.2 896 548 344 107 3178 22.7 156,338 1919 153,644 3671 3949 24.6 2337 15.2 549 425 328 83 2213 14.4 160,051 1920 159,766 5107 5457 341 2318 14.5 410 444 447 81 2352 14.7 159,941 1921 164,100 4117 4478 27.2 2107 12.8 431 414 374 83 2090 12.7 1922 165,700 3990 4417 26.6 2396 14.4 480 456 349 79 2372 14.3 1923 166,40) 3842 4256 25 6 |l928 11.6 418 370 255 60 1880 11.3 Notes.—This Table is arranged to show the gross births and deaths in the borough and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1000 of the estimated gross population. * In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the borough, but excluding the deaths of soldiers and sailors that have occurred in hospitals and institutions in the district. In Column 12 are entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. t "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence—e.g., casuals— are not included in Columns 8 or 9, except in certain instances under 3 (b) below. The following special cases arise as to Transferable Deaths— (1) Persons dying in institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses and nursing homes (but not almshouses) are regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first institution. (2) The deaths of infants born and dying within a year of birth in an institution to which the mother was admitted for her confinement are referred to the district of nxed or usual residence of the parent. (3) Deaths from violence are referred (a) to the district of residence, under the penorn) rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known; and (d) failing this, to the district where the body was found. Area of District in Total population at all ages 162,618 At aeres (land and 2327.7 Number of inhabited houses 23,064 Census inland water) Average number of persons per house 7.05 of 1921. Total families or separate occupiers 37,288 10 11 TABLE II. METROPOLITAN BOROUGH OF POPLAR The Borough. Causes of and Ages at. Death during the Year 1923. Causes of Death Total Deaths. Sex. Nett Deaths at Subjoined Ages. Nett Deaths in SubDistricts . Nett. Deaths in Public Institutions and certain localities within and outside Borough (at all ages) belonging thereto. Nett Deaths in Public Institu tions, etc. All Ages Under 1 year. 1 to 2 years. 2 to 3 years. 3 to 4 years. 4 to 5 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. 20 to 35 years. 35 to 45 years. 45 to 65 years. 65 years and over Poplar. Bow and Bromley. Poplar Institution. St. Andrew's Hospital Bow Institution. Bromley House Institution. Poplar Hospital. Sec Footnotes. Outlying institutions. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 All causes Certified 1870 M 1048 155 49 19 11 5 27 14 22 77 88 287 234 1020 859 52 351 2 .. 55 22 360 1051 F 831 100 29 10 8 2 21 13 30 70 60 186 302 Uncertified 1 M 1 .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 1 1 F .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Enteric Fever 3 M 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 2 .. 1 .. .. .. .. .. 1 F 2 .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Small-pox .. M .. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. 10 12 .. 7 .. .. .. .. 2 9 3 Measles 22 M 16 3 9 3 1 .. .. .. .. .. .. .. F 6 2 2 1 .. .. 1 .. .. .. .. .. .. 4 1 .. .. .. .. .. .. 5 5 4 Scarlet Fever 5 M 1 .. .. 1 .. .. .. .. .. .. .. .. .. F 4 1 2 1 .. .. .. .. .. .. .. .. .. 3 4 .. 3 .. .. .. .. 1 4 5 Whooping Cough 7 M 2 1 .. 1 .. .. .. .. .. .. .. .. .. F 5 2 3 .. 1.. .. .. .. .. .. .. .. .. 21 11 .. 1 .. .. 1 .. 26 28 8 Diphtheria 32 M 18 2 3 2 3 2 5 1 .. .. .. .. .. F 14 .. 1 1 3 .. 8 1 .. .. .. .. .. 12 10 .. .. .. .. .. .. 4 4 7 Influenza 22 M 9 1 .. .. .. .. .. .. 1 1 .. 3 3 F 13 .. .. .. .. .. .. .. 1 1 2 4 5 1 1 .. 1 .. .. .. .. 1 2 8 Encephalitis lothargica.. 2 M 2 .. .. .. 1 .. .. 1 .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 1 9 Meningococcal Meningitis 1 M 1 .. 1 .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. 102 67 1 16 .. .. 2 .. 36 95 10 Tuberculosis of respiratory sys 16 M 100 2 1 .. .. 1 1 1 3 29 31 27 4 F 69 1 2 .. 1 .. 1 3 15 23 11 6 1 17 9 .. 10 .. .. 2 .. 11 23 11 Other Tuberculous Diseases 26 M 15 1 5 3 3 .. 1 .. 1 .. .. 1 .. F 11 1 2 1 .. .. 2 1 1 1 1 1 .. 112 91 3 79 1 .. .. .. 30 113 12 Cancer, Malignant disease 203 M 113 .. .. .. .. .. 1 2 .. 2 2 62 44 F 90 .. .. .. .. .. .. .. .. 2 11 41 36 5 10 .. 1 .. .. .. .. 5 6 13 Ithsumatic Fever 15 M 8 .. .. .. .. .. .. 2 3 1 .. 1 1 F 7 .. .. .. .. .. 1 1 2 2 1 .. .. .. 14 Diabetes 9 M 4 .. .. .. .. .. .. .. .. .. .. 3 1 5 4 .. 1 .. .. .. .. 2 3 F 5 .. .. .. .. .. .. 1 .. .. .. 2 2 15 Cerebral haemorrhage, etc. 44 M 20 .. .. .. .. .. .. .. .. 1 .. 8 11 27 17 2 11 .. .. .. 1 (a) 4 18 F 24 .. .. .. .. .. .. .. .. 2 .. 9 13 16 Heart Disease 198 M 93 1 .. .. .. .. .. .. 4 5 4 31 48 87 111 20 46 .. .. 3 1 (b) 17 87 F 105 .. .. .. .. .. .. 2 4 5 10 35 49 17 Arterio-sclerosis 79 M 32 .. .. .. .. .. .. .. .. .. .. 11 21 42 37 2 53 .. .. .. .. 10 65 F 47 .. .. .. .. .. .. .. .. .. .. 8 39 18 Bronchitis 217 M 111 4 2 1 .. .. 1 .. .. 3 7 39 54 114 103 7 86 .. .. .. .. 6 99 F 106 7 3 .. .. 1 .. .. .. 2 5 20 59 19 Pneumonia (all forms) 163 M 110 26 16 7 1 .. 4 .. 1 4 15 22 14 88 75 6 59 .. .. 12 1 (c) 16 94 F 53 13 6 4 2 .. 2 .. .. 4 7 4 11 20 Other Respiratory Diseases 20 M 14 1 1 .. .. .. .. .. 2 .. .. 6 4 14 6 2 5 .. .. .. .. 5 12 F 6 1 1 .. .. .. .. .. 1 .. .. 2 1 21 Ulcer of Stomach or Duodenum 13 M 12 .. .. .. .. .. .. .. .. 2 2 5 3 8 5 .. 4 .. .. 1 .. 5 10 F 1 .. .. .. .. .. .. .. .. 1 .. .. .. 22 Diarrhoea, etc., 41 M 27 21 2 .. .. .. .. .. .. .. 2 2 .. 20 21 2 12 .. .. 1 .. 10 25 F 14 8 1 .. .. .. .. .. .. .. 1 1 2 23 Appendicitis and Typhlitis 13 M 8 .. .. .. .. .. 1 2 .. 3 .. .. 1 10 3 .. 1 .. .. 4 .. 7 12 F 5 .. .. .. .. 1 2 1 1 1 .. 1 .. 24 Cirrhosis of Liver 8 M 6 .. .. .. .. .. .. .. .. .. 1 4 1 4 4 .. 1 .. .. .. .. 1 2 F 2 .. .. .. .. .. .. .. .. .. .. 2 .. 25 Acute and Chronic Nephritis 43 M 17 .. .. .. .. .. .. 1 .. 2 1 7 7 31 14 5 10 1 .. 2 .. 10 28 F 28 .. .. .. .. .. .. .. .. 4 .. 12 11 26 Puerperal Sepsis 7 M .. .. .. .. .. .. .. .. .. .. .. .. .. 4 3 .. 5 .. .. .. .. 2 7 F 7 .. .. .. .. .. .. .. 1 4 2 .. .. 27 Other accidents and diseases 01 pregnancy and parturition 7 M .. .. .. .. .. .. .. .. .. .. .. .. .. 3 4 .. 3 .. .. .. .. 3 6 F 7 .. .. .. .. .. .. .. .. 4 3 .. .. 23 Congenital Debility and malformation, premature birth,. 123 M 75 .. 1 .. .. .. .. .. .. .. .. .. .. 66 62 2 10 .. .. 1 .. 23 36 F 53 52 1 .. .. .. .. .. .. .. .. 7 .. 29 Suicide 17 M 11 .. .. .. .. .. .. .. .. .. 2 3 2 9 8 .. 2 .. .. .. 3 (d) 5 10 F 6 .. .. .. .. .. .. .. .. .. 1 3 2 30 Other Deaths from Violence 89 M 65 4 4 1 .. 1 .. 2 4 12 5 16 7 57 32 .. 21 .. .. 19 10 (e) 29 79 F 24 3 1 1 2 .. 9 .. 1 .. 1 4 8 31 Other Defined Diseases 2.3 M 157 14 4 .. 2 1 3 3 3 11 16 32 68 143 130 .. 72 .. .. 7 6 (f) 92 177 F 116 9 4 1 .. .. 3 2 3 8 4 22 62 32 Causes ill-defined or unknown 2 M 1 .. .. .. .. .. 1 .. .. .. .. .. 1 2 .. .. .. .. .. .. 1 1 F 1 .. .. .. .. .. .. .. .. .. .. .. 1 All causes M 1049 155 49 19 11 5 27 14 22 77 88 287 295 F 831 100 29 10 8 2 21 13 30 70 60 186 302 Totals 1880 1880 255 78 29 19 7 48 27 52 147 148 473 597 1021 859 52 551 2 .. 55 22 370 1052 (a) s.s. "Star," Millwall Docks, Poplar S.D. 1. (b) Highway, Bow and BromleyS.D. 1. (c) Highway, Poplar S.D. 1. (d) Lee Cut, Bow and Bromley S.D. 1; Lee Cut, Poplar S.D.I; and Highway, Poplar S.D. 1. (e) River Lee, Bow an 1 Bromley S.D. 1; Bow Creek, Poplar S.D. 1: Millwall Docks, Poplar S.D. I; Limehou.se Cut, Poplar S.D. 1; Regents Canal, Bow and Bromley S.D. 1; River Thames. Poplar S.D. 3; and Highway, Poplar S.D. 2. (/) Highway, Poplar S.D. 3; Highway, Bow and Bromley S.D . 2; and s.s. "Songster," West India Docks, Poplar S.D. 1. 12 TABLE III. METROPOLITAN BOROUGH OF POPLAR. The Borough. Infantile Mortality daring the Year 1923. Nett Deaths from stated Causes in Weeks and Months under One Year of Age. Causes of Death Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Nett total Deaths under 1 year. Poplar. Bow and Bromley Whole Borough All causes Certified 81 20 11 5 117 37 38 38 25 124 131 255 Uncertified — — — — — — — — — — — — Small Pox — — — — — — — — — — — — Chicken Pox — — — — — — — — — — — — Measles — — — — — — — 2 3 2 3 5 Scarlet Fever — — — — — — — 1 — 1 — 1 Whooping Cough — — — — — 2 — — 1 2 1 3 Diphtheria and Croup — — — — — 1 — 1 — 1 1 — Erysipelas — — — — — 1 — — — — 1 1 Tuberculous Meningitis — — — — — — 1 — 1 1 1 — Abdominal Tuberculosis — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — 1 1 1 1 2 3 Meningitis (not Tuberculous) — — — — — — 1 1 — — 2 2 Convulsions 1 — — — 1 2 1 1 — 2 3 5 Laryngitis — — — — — — — — — — — — Bronchitis — — — — — 1 4 4 2 7 4 11 Pneumonia (all forms) 1 1 1 1 4 4 10 10 11 16 23 39 Diarrlxœa — 1 — — 1 1 3 4 1 6 4 10 Enteritis — 2 — — 2 4 7 4 2 8 11 19 Gastritis — — — — — — — — — — 1 1 Syphilis — — — 1 1 1 — — — 1 1 2 Rickets — — — — — — — — — — — — Suffocation, overlying 2 — — — 2 1 — 1 — 2 2 4 Injury at birth 1 — — — 1 — — — — — 1 1 Atelectasis 4 — — — 4 — 1 — — 3 2 5 Coneenital Malformations 11 1 3 _ 15 6 1 1 1 9 15 24 Premature birth 52 9 3 2 66 4 1 2 — 38 35 /3 Atrophy, Debility and Marasmus 6 5 4 1 16 6 5 2 _ 17 12 29 Other Causes 3 1 — — 4 2 2 3 2 7 6 13 Total Deaths 81 20 11 5 117 37 38 38 25 124 131 255 Nett Births Legitimate 4,161* Nett Deaths Legitimatemn infants 246 in the year Illegitimate 95* in the year of Illegitimate infants 9 Medical Officer of Health's figures— Legitimate, 4,152 ; Illegitimate, 95; total, 4,247. * Registrar-General. 13 TABLE IV. (1923). Cities and Boroughs. Estimated population to the middle of 1923. Notifications. Annual rate per 1,000 persons living. Births. Annual rate per 1,000 persons living. Zymotic Deaths. Annual rate per 1,000 persons living. Deathrate per 1,000 living. Deaths of Infants under one year to 1,000 births. LONDON 4,564,109 .. 20.2* ? 11.2* 60* West Districts. Paddington 146,200 .. 17.9 0.4 11.7 69 Kensington 178,500 .. 17.5 0.69 12.3 70 Hammersmith 133,600 .. 20.2 0.5 11.0 64 Fulham 161,600 .. 18.4 0.5 10.5 64 Chelsea 64,480 .. 15.1 0.4 12.2 58 City of Westminster 140,430 .. 12.5 0.09 10.6 46.6 North Districts. St. Marylebone 105,400 .. 15.8 0.48 11.7 66 Hampstead 87,410 .. 14.3 0.4 10.3 42 St. Pancras 214,400 .. 20.3 0.6 12.1 63 Islington 336,600 .. 21.1 0.38 11.6 66 Stoke Newington 52,820 .. 18.2 0.23 10.2 46 Hackney 226,400 .. 19.6 0.23 10.6 58 Central Districts. Holborn 43,376 .. 13.67 0.53 12.1 79 Finsbury 77,230 .. 23.9 0.76 13.03 60.7 City of London 13,480 .. 8.2 0.22 11.2 60 East Districts. Shoreditch 106,200 .. 26.9 0.8 13.0 82 Bethnal Green 118,700 .. 24.2 0.88 11.3 68.7 Stepney 253,850 .. 22.8 0.7 11.0 62 Poplar 166,400 .. 25 .6 0.6 11.3 60 South Districts. Southwark 187,464 .. 24.3 0.8 12.8 68 Bermondsey 121,700 .. 24.0 12.2 76 Lambeth 308,500 .. 27.04 0.4 11.2 42.7 Battersea 170,600 .. 20.1 0.67 10.8 49.5 Wandsworth 336,100 .. 16.28 0.39 10.14 52.5 Camberwell 272,300 .. 20.7 0.7 11.0 56.7 Deptford 114,900 .. 21.1 0.65 11.1 59 Greenwich 102,777 .. 20.51 0.46 10.95 60 Lewisham 182,400 .. 18.07 0.4 10.14 43 Woolwich 140,000 .. 20.5 0.2 9.9 43 * These provisional figures are taken from a table furnished by the Registrar. General. Other figures supplied by Medical Officer of Health of borough concerned. 14 The following death rates for the year 1923 are interesting when compared with one another:— Annual Rate per 1,0C0 persons living. Deaths of Children under one year of age to 1,000 Births. Poplar Borough 11.3 60† *England and Wales 11.6 69 *105 Great Towns‡ 11.6 72 *157 Smaller Towns 10.6 69 *London 11.2 60 Liverpool 13.7 99 Manchester 13.4 88 Edinburgh 13.8 82 Glasgow 14.2 90 *Dublin (City) 14.4 111 Belfast 13.8 101 * Provisional figures furnished by the Registrar-General. ‡ Including London. 15 TABLE V. BlRTHRATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAK 1923. Birthrate per 1,000 Total Population. Annual Death-rate ter 1,000 Civilian Population. Rate per 1,000 Births. Percentage of Total Deaths.* All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhœa and Enteritis (under 2 years). Total Deaths under One Year. Causes of Death certified by Registered medical Practitioners. Inquest Cases. Uncertified Causes of Death. England and Wales† 19.7 11.6 0.01 0.00 0.14 0.03 0.10 0.07 0.22 0.44 7.7 69 92.0 6.9 1.1 105 County Boroughs and Great Towns, including London† 20.4 11.6 0.01 0. 00 0.15 0.03 0.12 0 .09 0.22 0.40 9.9 72 92.2 7.2 0.6 157 Smaller Towns (adjusted Populations 20,000.50,000)† 19.8 10.6 0.01 – 0.19 0.02 0.10 0.06 0.21 0.38 6.4 69 92.6 6.1 1.3 London† 20.2 11.2 0.01 0.00 0.08 0.02 0.09 0.13 0.17 0.45 10.2 60 90.8 9.1 0.1 Poplar Borough 25.0 11. 3 0. 02 0.00 0 .13 0. 03 0. 04 0.19 0.13 0.64 7.5 60 8.71 12.8 0.05 * Non.civilians are included in these figures for England and Wales, but not for other areas. †Provisional figures for England and Wales, 105 Great Towns, 157 Smaller Towns and London. The rates for England and Wales and for Poplar have been calculated on a population estimated to the middle of 1923, while those for the towns have been calculated on populations estimated to the middle of 1922. 16 TABLE VI. METROPOLITAN BOROUGH OF POPLAR. Total Deaths (it all ages) in Put/lie Institutions within the Borough. (Residents and Non-Residents included.) Causes of Death. Sex. Poplar Institution. St. Andrew's Hospital. Bow Institution. Bromley House Institution. Poplar Hospital. Total deaths in Public Institutions within the Borough. All causes Certified M 40 442 87 14 66 049 F 16 325 24 5 38 408 Uncertified M — — — — F — — — — — — 1. Enteric Fever M — 1 — — — 1 F 2. Small-pox M — — — — — — F — — — — — — 3. Measles M — 5 — — — 5 F — 2 — — — 2 4. Scarlet Fever M — — — — — — F — — — — — 5. Whooping Cough M — 1 — — — 1 F — 3 — — — 3 6. Diphtheria M — 1 — — 1 2 F — — — — — — 7. Influenza M — — — — — — F — — — — — — 8. Encephalitis Lethargica M 1 1 F 9. Meningococcal Meningitis M — 1 — — — 1 F — — — — — — 10. Tuberculosis of respiratory system M 1 42 1 — 1 45 F — 29 1 — 1 31 11. Other Tuberculous Diseases M — 10 — — 3 13 F — 5 — — 2 7 12. Cancer, malignant disease M 1 78 5 — 3 87 F 2 38 3 — — 43 13. Rheumatic Fever SI — — — — — F — 2 — — — 2 14. Diabetes M 1 — — — 1 F — 2 1 — — 3 15. Cerebral hemorrhage, etc. M ] 9 4 1 1 10 F 1 5 — — 1 7 10. Heart Disease M 15 28 34 2 1 80 F 7 35 11 1 3 57 17 TABLE VI. (continued). METROPOLITAN BOROUGH OF POPLAR. Total Deaths (at all ages) in Public Institutions within the Borough. (Residents and Non-Residents included.) Causes of Death. Sex. Poplarlnstitution. St. Andrew's Hospital. Bow Institution. Bromley Houpe Institution. Poplar Hospital. Total deaths in Public Institutions within the Borough. 17. Arterio-sclerosis M 1 38 14 — — 53 F 1 38 1 — — 40 18. Bronchitis M 6 62 7 — — 75 F 2 60 2 — — 64 19. Pneumonia (all forms) M 5 50 1 10 66 F — 20 — — 6 26 20. Other Respiratory Diseases SI 2 7 — — — 9 F — — — — — — 21. Ulrer of Stomach or Duodenum M 6 — — 4 10 F — 1 — — — I 22. Diarrhoea, etc. 51 — 9 — — 3 12 F 2 6 — — — 8 23. Appendicitis and Typhlitis M — 1 — — 2 3 F — — — — 3 3 24. Cirrhosis of Liver M 2 — — — 2 F — — 25. Acute and Chronic Nephritis M 4 6 6 1 2 19 F 1 10 3 2 16 2G. Puerperal Sepsis M — — — F 5 5 27. Other accidents and diseases of pregnancy and parturition 11 F — 4 — — 1 5 28. Congenital Debility and malformation, premature birth M 3 6 — — 1 10 F — 7 — — — 7 29. Suicide M — 1 1 — — 2 F — 3 — — — 3 30. Other Deaths from Violence M — 18 2 — 25 45 F — 12 — — 11 23 31. Other Defined Diseases M 1 58 12 10 9 90 F 38 2 4 8 52 32. Causes ill-defined or unknown M — — — — — — F — — — — — — All causes M 40 442 87 14 66 649 F 16 325 24 5 38 408 Totals .. 56 767 111 19 104 1057 18 TABLE VII. METROPOLITAN BOROUGH OF POPLAR. The Borough. Cases of Infectious Disease notified during the Year 1923. Notifiable Disease. At all Ages. Cases Notified in Whole Borocgh. Total cases notified in each Sub-District. No. of Tases truovM to Hospital from each Sub-District. At Ages—Years. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards. Poplar. Bow and Bromley. Poplar. Bow and Bromley. Total Cases Removed. Small-pox — — — — — — — — — — — — — — — — — — Cholera (C), Plague (P) — — — — — — — — — — — — — — — Diphtheria (inclading Membranous Croup) — 8 21 24 43 26 115 35 13 12 4 2 — 179 124 172 123 295 Erysipelas 79 3 – 2 2 – 1 6 3 11 18 21 12 41 38 13 16 29 Scarlet Fever 263 6 19 27 36 24 86 46 10 0 2 1 – 154 109 149 104 253 Typhus Fever — — — — — — – — — — — — — — — Enteric Fever 8 — – – — – 1 1 — 6 — — — 4 4 3 3 6 Relapsing Fever – – – – – – – – – – – – – – – – – – Contnued Fever – – – – – – – – – – – – – – – – – – Puerperal Fever 16 – – – – – – – 2 10 4 — 9 7 8 6 14 Cerebro-Spina Meningit is 2 – 2 – – – – 2 1 1 Acute Poliomyelitis and Acute Polioencephalitis 1 1 — — — — — — — 1 — 1 — ] Acute Encephalit is Lethargica 7 – – 1 2 2 – 2 4 3 3 3 6 Ophthalmia Neonatorum 38 38 – – 19 19 4 4 8 Pulmonary Tuberculosis 248 2 2 1 4 12 12 30 109 57 51 4 153 131 ? ? ? Other forms of Tuberculosis 121 3 13 12 12 5 29 12 10 17 4 4 — 60 61 ? ? ? Zymotic Enteritis 350 93 119 40 19 10 22 12 4 12 5 11 3 171 179 – – – Anthrax 1 — — — — — — 1 — — – — 1 — 1 1 Trench Fever — — — — — — — — — — — — — — Pneumonia (all forms) 400 52 58 36 28 16 31 22 23 48 43 66 37 257 203 153 120 273 Malaria 1 — — — — — — — — — 1 – – 1 — 1 1 Dysentery – – – – – – – – – – – – – – – – – – Totals 1934 205 235 141 142 85 297 148 I95 234 I137 159 56 1054 880 507 381 888 19 INFECTIOUS DISEASES. Notifications. There were 1,529 notifications of cases of infectious diseases, excluding 58 second notifications and 89 cases in which diagnosis was not confirmed. The notification rate was 9.2 as against 4.7, 5.7, 13.8, 12.9 and 6.6 for the preceding five years Number of Cases Occurring in Institutions. Notifications of parishioners from Institutions (excluding cases which had been notified before admission) within the Borough were as follows:— Total Cases. Notifications. Removals. Diphtheria. Erysipelas. Scarlet Fever. Smallpox. Puerperal Fever. Ophthalmia Neonatorum. Zymotic Enteritis. Pneumonia (all forms). Diphtheria. Erysipelas. Scarlet Fever. Smallpox. Puerpera Fever. Zymotic Enteritis. Pneumonia (all forms). Poplar Institution 12 1 1 .. .. .. .. 5 5 1** 1* .. .. .. 1* 2* St. Andrew's Hospital 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1* Bow Institution 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Bromley House Institution 1 1 .. .. .. .. .. .. .. 1* .. .. .. .. .. Langley House, 54, East India Dock Road 9 .. .. 1 .. .. .. .. 1 .. .. 1** .. .. .. 1* Poplar Hospital .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Admitted into St. Andrew's Hospital. ** Removed to M.A.B. Hospitals. Infectious Diseases in Milkshops and Home workers' Premises. One ease of infectious disease (measles) was connected with a milk- shop. 20 Six premises with outworkers were connected with infectious cases notified : 5 diphtheria and 1 erysipelas. No notices were served under the Factory and Workshop Act, 1901, Sections 108 and 110, but, where there was any risk of infection the work was discontinued, and any work found on the premises was disinfected before being returned. No cases of measles were connected with outworkers' premises. Removal of Cases of Notifiable Diseases to Hospital. Disease. M.A.B. Hospitals Poor Law Institutions General Hospitals Total Removals Percentage of cases notified. Diphtheria 290 2 3 295 97.4 Erysipelas 1 26 2 29 36.7 Scarlet Fever 252 — 1 253 96.2 Enteric fever 1 2 3 6 75.0 Puerperal Fever 3 9 2 14 87.5 Cerebro-spinal Fever — — 1 1 50.0 Encephalitis Lethargica 3 3 6 85.7 Ophthalmia Neonatorum 6 1 1 8 21.0 Pneumonia — 273 — 273 59.3 Malaria — 1 — 1 100. Anthrax — — 1 1 100. Poliomyelitis — — 1 1 100. N.B.—Cases reported to be "not suffering" have been excluded from above table. 21 Comparative Mortality. Diphtheria Scarlet fever Enteric fever Cases notified 305 231 12 1918 Deaths 31 2 1 Mortality rate per cent. 10.2 0.9 8.3 Cases notified 320 370 23 1919 Deaths 38 4 6 Mortality rate per cent. 11.9 1.1 26.1 Cases notified 698 1,400 17 1920 Deaths 59 14 4 Mortality rate per cent 8.4 1.0 23.5 Cases notified 648 1423 16 1921 Deaths 64 13 5 Mortality rate per cent. 9.9 0.9 31.2 Cases notified 626 415 10 1922 Deaths 62 7 0 Mortality rate per cent. 9.9 1.7 0.0 Cases notified 303 263 8* 1923 Deaths 32 5 3 Mortality rate per cent. 10.6 1.9 37.5 * The lowest number of cases recorded. BACTERIOLOGICAL EXAMINATIONS. 681 swabbings from doubtful cases of Diphtheria were examined. Of these 100 gave positive results (14.7 per cent). 4 blood specimens from doubtful cases of Enteric Fever were examined, positive results being obtained in one case (25 per cent). DIPHTHERIA ANTI-TOXIN. 16,000 units of Diphtheria anti-toxin were issued to medical practitioners during the year. 22 TUBERCULOSIS. Report of Dr. W. C. P. Smith, Tuberculosis Officer and Assistant Medical Officer of Health for Tuberculosis Purposes. Information required by Ministry of Health. (i.) A list of dispensaries, specifying also branch dispensaries and visiting stations; a list of the Tuberculosis Officers employed; a statement of the numbers of other officers employed in dispensary work; a list of residential institutions, specifying for each the number of beds normally available for patients from the area of the Local Authority, and the type of case for which these beds are used. In the case of residential institutions belonging to the Local Authority, the names of Medical Officers and the number of other officers should be given. (1) (a) Tuberculosis Dispensary.—Alexandra House, 135, Bow Road, E. These premises were vacated during the latter part of December, and a move was made to 1, Wellington Road. The new premises are in every way an improvement on the old. Careful planning of the necessary alterations has resulted in an arrangement of the various rooms, which promises to facilitate the work and to prove more convenient and comfortable both for the patients and the staff. (b) Proposed Branch Dispensary.—No further action has been taken with regard to the proposed branch dispensary at 134, High Street, Poplar. In the meantime the fares to and from the Bow Road Dispensary are refunded to necessitous patients living south of the East India Dock Road. Tuberculosis Officer: W. C. P. Smith. Assistant Tuberculosis Officer: D. H. Geffen. Other Officers:— .'1 Health Visitors. 1 Dispenser. 1 Clerk I Assistant Clerk. 1 Part-time helper (female"). 1 Caretaker. The approval of the Minister of Health of the proposed appointment of a paid officer, to act as Secretary to the Care Committee, and Organiser of care work generally, has been received. Owing to the lack of accommodation at 135, Bow Road, it was decided to leave this matter 23 in abevance until the new dispensary was ready for occupation. The appointment is to be made early in the new year. Residential Institutions: — (a) Sanatoria—hospitals and homes available under the L.C.O. scheme (which now includes all classes of patients, whether insured, uninsured, or ex-Service men). (b) The Poor Law Infirmary. (c) A few In-patient letters for Victoria Park or other hospitals when obtainable. (ii.) In the case of administrative counties, precise particulars of arrangements for co-operation with Sanitary Authorities and their officers. Nil. (iii.) The nature and extent of co-operation with general and special hospitals, school clinics, and, other institutions. General Hospitals.—Under an agreement between the Council and the London Hospital, cases of surgical tuberculosis and certain other cases are referred to this hospital for opinion or treatment. Also under the L.C.C. scheme, the dispensary is "linked" to the London Hospital for purposes of consultation in special cases. Cases of lupus are treated by the Finsen Light at the London Hospital on the recommendation of the Tuberculosis Officer. A charge of us. is made for each application of the treatment, and if more than twelve applications are requiied for any case a further recommendation from the Tuberculosis Officer is necessary. Four new cases have been recommended during the year. Thirteen cases in all have been attending, and have received a total of 233 applications of this treatment. Special Hospitals.—No special arrangements exist, except that cases in which an artificial pneumothorax has been produced may be referred to Brompton Hospital for the necessary refills at a charge of 10s. for each refill. Non-tuberculous pulmonary cases are referred generally to Victoria Park Hospital either by cards or out-patient letters. Similar cases in children are sent to one or other of the Children's Hospitals—at Shadwel! and Hackney Road School Clinics.—As intimated in the last report, an extension of the scheme of co-operation with the school medical service has been in 24 operation during the year. Children in three categories, viz., (a) "unsatisfactory children," (b) apparently healthy contact, and (c) unexamined contacts, are referred to the Divisional School Medical Officer, who arranges to have them kept under observation and periodically examined—usually for six months—and to report the result to the Tuberculosis Officer. During the Year 297 children have been dealt with in this way. In addition to the above, a number of children having defects— aural, nasal, dental, etc.—have been brought to the notice of the Divisional School Medical Officer with a view to treatment. (iv.) Any special arrangements made to secure the co-operation of medical practitioners and the working of the arrangements for periodical reports on insured patients under domiciliary treatment. The Tuberculosis Officer communicates with every local practitioner who notifies a case of tuberculosis, offering to confer as to the best means of dealing with the case. The practitioner is also invited to avail himself of the services of the care committee for any case occurring in his private practice in which he thinks they will prove helpful. A number of cases have been sent to the dispensary by local practitioners for investigation. In each case—usually after a short period of observation—a report has been sent to the practitioner by the Tuberculosis Officer. 523 such reports have been sent during the year. A revised scheme for the co-ordination of the work of Tuberculosis Officers and Insurance Practitioners (Memo. 286) was received from the Ministry of Health, December 27th. This is to come into operation on January 1st, 1924. It provides for the interchange of information concerning definite or suspected cases of tuberculosis occurring in insured persons, and for the closer co-operation of the Tuberculosis Officer ami the Panel Practitioner in the treatment and care of such cases. (v.) The arrangements for following up patients in cases where the diagnosis is doubtful. Cases of doubtful diagnosis are kept under observation at the dispensary. If a decision as to diagnosis cannot be come to after a short period, they are either referred to the London Hospital for an opinion, or recommended under the L.C.C. scheme for admission to hospital for further observation. (vi.) The arrangements for securing the examination and systematic supervision of "home contacts." 25 Home contacts are examined at the dispensary—as a rule by special appointment. The arrangements for their attendance and their subsequent supervision are in the hands of the Health Visitors. A special effort is made to keep under observation the contacts of sputum positive cases, and to re-examine them at short intervals. 1,020 contacts have boon examined during the year. (vii.) Information as to special methods of diagnosis and treatment in use and the number of persons to whom these special methods have been applied. The X-ray apparatus is constantly in use for screen examinations. A small number of selected cases were given nasal insufflations of B.E. with the object of testing the efficacy of this treatment. The insufflations were given three times a week, and very careful records were kept over a period of from three to four months. As none of the cases showed improvement in any direction, it was felt that the results were not sufficiently encouraging to warrant a continuance or extension of this form of treatment. (viii.) The results of local experience as to the relative value of each form of treatment. See (vii.) above. (ix.) The nature and extent of any dental treatment provided by the Council for tuberculous patients. A dental clinic has been held weekly at the Old Ford Wesleyan Mission Hall since October, 1922, to which all cases needing dental treatment, and for whom no provision is otherwise made, are referred by the Tuberculosis Officer. Cases requiring new dentures are referred to the Care Committee tor assessment of the amount of contributions payable by the patient, and for any assistance the Committee may be able to furnish towards the cost. Details of the work done are given in the Dental Surgeon's Report. (See p. 41.) (x.) Any arrangements for the provision of nursing or of extra nourishment for patients living at home. Nursing where necessary for children up to 10 years of age can be provided by the Council. No special provision is made for the nursing older children or of adults, but the services of a district nurse or help from a local nursing association can be obtained through the Care Committee. 26 Extra nourishment in the form of dried milk and eggs has been provided for a number of cases on the terms laid down by the Minister of Health. In other cases extra nourishment has been obtained from the Guardians or the Red Cross Society. (x1-) The arrangements for treating non-pulmonary tuberculosis, especially tuberculosis of bones and, joints in adults and in children, and for the provision of surgical apparatus, etc. Non-pulmonary cases requiring residential treatment are referred to the L.C.C. for sanatorium or hospital treatment. Cases that can suitably be dealt with as out-patients are referred to the London Hospital according to the terms of the agreement referred to, as are also cases of lupus for Finsen Light treatment. Surgical apparatus is obtained through hospital almoners, Invalid Children's Aid Association, Charity Organisation Society, or other charitable bodies. (xii.) The arrangements for "care" and "after care" and their working. The Care Committee meets fortnightly at the dispensary. Most of the public or voluntary organisations connected with social work are represented, as well as the London Insurance Committee and the Panel Practitioners. The services of the Committee are available for any case of tuberculosis in the borough, but the sanction of the patient is obtained before his case is brought before it. A special Secretary for care work is to be appointed shortly. (xiii.) Particulars as to any local arrangements for finding employment for patients. No arrangements exist for finding employment for patients except the Labour Bureaux, which are of little or no value to the tuberculous patient, who usually requires light occupation. (xiv.) Statement as to the supply and supervision of shelters at the homes of patients. One shelter has been purchased and loaned. (xv.) Any special points noted locally as to the incidence of tuberculosis (i.e., occupation). Nothing of special note. 27 (xvi.) Any special methods adopted or proposed for the prevention of tuberculosis. No special measures have been in use. The provision of spit cups or flasks and of disinfectant, the arrangement, where possible, of separate sleeping accommodation, advice on general hygiene, the removal of infectious cases or of contacts from close association with them, the reference of ailing and delicate children to other agencies for treatment or convalescence, and where possible the improvement of housing conditions are all of them routine measures of a preventive kind. (xvii.) Special difficulties encountered. The difficulty of finding light employment or light hours of employment for patients who return from sanatorium fit for something short of full time work. The difficulty of improving adverse home conditions consequent upon the shortage of houses. Attendances at Dispensary 7,325 New patients examined 1,966 Contacts examined for first time 761 Total contacts examined 1,020 Notifications by Tuberculosis Officer: — Pulmonary 174 Non-pulmonary 34 Health Visitors' visits 9,074 Doctors' visits 329 'Sputum examinations: — For Dispensary 1,665 For Public Health Department 159 Reports to Practitioners 523 Other reports 1,616 * This at 3/6 an examination, the fee usually charged by research laboratories, represents an expenditure of approximately £SS0—exclusive of cost of postage. W. C. P. SMITH, Tuberculosis Officer. 26 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications received during the period from the 31st December, 1922, to the 29th December, 1923. The Borough. Age Periods. Notifications on Form A. Notifications on Form B. Number of Notifications on Forms C and D. Number of Primary Notifications. Total Notifications Number of Primary Notifications. Total Notifications on Form B. Form C. Form D. 0 to 1 1 to 5 5 to 10 10 to 15 15 20 25 35 to to to to 20 25 35 45 45 to 55 55 to "55 65 and upwards. Total Primary Notificntionn. on Form A. Under 5 5 to 10 10 to 15 Total Primary Notifications. PoorLaw Institutions. Sanatoria. PoorLaw Institutions. Sanatoria. Pulmonary— Males 1 3 6 5 12 19 53 33 22 13 4 151 268 2 2 3 18 171 16 144 Females 1 4 4 5 18 29 28 24 13 3 — 129 222 — 2 — 2 2 11 82 17 70 Non-Pulmonary— Males 2 20 17 6 6 4 2 3 o 2 64 82 1 1 2 8 8 4 7 Females 1 21 11 5 4 9 2 1 — — — 54 79 — 1 1 2 7 11 15 11 14 Totals 5 48 38 21 40 31 65 61 37 18 4 398 651 1 3 3 7 14 48 276 48 235 29 New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, during the period 31st December, 1922, to the 29th December, 1923, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912. Age Periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total cases. Pulmonary— Males 1 1 1* 1 1+ 5 Females 1 – – – – 1 – – – – – 2 Non-pulmonary— Males – – – – – – – – – – – – Females .. — – — — — — – 1 — — — 1 * Royal Navy. t Ministry of Pensions. Remainder from Registrars' Returns of Deaths. 30 Actual Number of Cases on Register. Number of cases on Register at beginning of year 1923 4,438 Add new cases during year 407 Cases returned to Register 18 4,863 Deduct: — Died (notified cases only) 185 Removed, etc. 626 Arrested or cured Removed from Register—cases not notified since 1914 413 1,224 Number of cases on Register beginning of 1924 3,639 SMALLPOX. No cases of smallpox were notified during the year under review. VACCINATION. The Vaccination Officer, Mr. Ryan, has kindly furnished me with the following:— Total number of certificates of primary vaccinations in respect of persons of all ages received was 1,102. PLAGUE. No case of this disease was notified during the year. ANTHRAX, GLANDERS, AND HYDROPHOBIA IN MAN. Anthrax. One case of this disease occurred. Patient died in the London Hospital. London Notification of Glanders Order, 1907. No notice was received from the Veterinary Inspector of the London County Council of the existence of Glanders at premises in the Borough. Hydrophobia. No case of this disease was notified during the year. ERYSIPELAS. 79 cases of erysipelas were notified during the year. Two deaths occurred. 31 PUERPERAL FEVER. Number of Cases. Sixteen cases of puerperal fever were notified. Seven patients died. CONTINUED AND TYPHUS FEVERS. No cases of continued fever occurred. No case of typhus fever occurred. SPOTTED FEVER. EPIDEMIC CEREBRO-SPINAL MENINGITIS.* Two cases occurred. One patient died. ACUTE POLIO -MYELITIS, OR ACUTE POLIO -ENCEPHALITIS, AND ACUTE ENCEPHALITIS LETHARGICA. No cases of Acute Polio-myelitis, nor of Polio-encephalitis were notified. Seven cases of Encephalitis Lethargica occurred. Two patients died. * Posterior basjl meningitis is included in theterm " cerebro spinal fever," which does not include meningitis due to tuberculosis, syphilis, middle ear disease, or injury. OPHTHALMIA NEONATORUM. Notifications of Ophthalmia Neonatorum. Thirty-eight cases of Ophthalmia Neonatorum were notified during the year:—30 notified by doctors only, 3 by midwives only, and 5 by both doctors and midwives. The total notifications received numbered 51. Year. Cases Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated At home. In hospital. 1914 75 70 5 73 2 1915 64 62 2 62 1 1 1916 60 60 60 1917 39** 37 1 36 1 1 1918 40 38 2 39 1 — 1919 61 51 10 60 1 — — 1920 61 51 10 59 — 2 1921 47 41 6 42 2 1 2 1922 36 33 3 34 1 1 1923 38 30 8 35 — — 3 Totals 521 473 47 500 7 1 12 ** 1 born in Institution—not visited, no information available. Erratum: Page 31. One case of Acute,Poliomyelitis was notified but none of Polioencephalitis. Erratum: Page 31. One case of Acute,Poliomyelitis was notified but none of Polioencephalitis. 32 MATERNITY AND CHILD WELFARE. Report to Medical Officer of Health of Miss J. M. Cardozo, Chief Health Visitor. Public Health Offices, Bow Road, E. 3. January, 192 If. Sir, I submit herewith my first Annual Report, as Chief Health Visitor, upon the work of the Maternity and Child Welfare Department relating to the year 1923. Removal.—On the expiration of lease, March 31st, 1923, the Allanmouth Road Clinic was transferred to Old Ford, as the attendances did not justify the expenses incurred. Infant Consultations.—The nine weekly sessions all shew an increased average attendance, Bow Clinic being the highest, with 56.7 per session. • Dental Clinic.—This branch of the work has shewn a marked improvement, as will be seen by the Dentist's report. Infantile Mortality.—The rates, 60 per 1,000 births, and 38.4 per 1,000 children visited, are the lowest ever recorded in the Borough. The Mortality rate amongst the "Toddlers" has been considerably reduced. London County Council.—Two thousand and fifty-five case sheets relating to children who have reached the age of 5 years, were forwarded to the Education Department. New Year's Party.—The Staff and their friends entertained 1,200 Mothers and Children, who attend the Infant Welfare Clinics, to a Tea and Concert on January 2nd, 1924, at Poplar, and on January 4th, 1924, at Bow. Our thanks are due to the many friends who, by their help and co-operation, made the Parties very enjoyable. Visiting Areas. The Royal College of St. Katharine. All the work between East India Dock Road—Bow Road. Poplar Borough Council.—All the work North of Bow Road and South of East India Dock Road. 33 Statistical Summary for 1923. Public Health Department. The Royal College of St. Katharine. Total. Ante-natal:— Visits 689 811 1,500 Re-Visits 544 1,443 1,987 Post-natal:— Visits 1,689 2,078 3,767 Removed before Visit 32 31 63 Died before Visit 43 48 91 Stillbirths 116 19 135 Re-visits:— Under 1 7,988 16,963 24,951 1—5 13,337 35,412 48,749 Removed 197 412 609 Died 94 129 223 Ophthalmia Neonatorum:—* Visits 38 nil. 38 Re-visits 148 nil. 148 Zymotic Enteritis:— Visits 102 157 259 Re-visits 95 223 318 Dead 4 6 10 Measles:— Visits 25 357 382 Re-visits 10 165 175 Dead — 6 6 Miscellaneous — 8,332 8,332 Total Visits Paid 25,151 66,592 91,743 * All infants with this disease are notified to the Medical Officer of Health, and are immediately visited by the Health Visitors of the Public Health Department. Stillbirths. Number of stillbirths 110 No information available 16 Premature births 32 First pregnancies 26 Mothers who had had previous stillbirths:— One. Two. Three. 7 2 3 34 Nursing. Ophth. Neon. Measles. Pneumonia. Cases. Visits. Cases. Visits. Cases. Visits. Under Under Under Under 5 5-10 5 5-10 5 5-10 5 5-10 Last London Nursing Society 10 186 3 1 35 19 8 1 150 21 St. John Divine 1 21 — — — — — — — — Total 11 207 3 1 35 19 8 1 150 21 ATTENDANCES AT CLINICS. Old Ford. Allanmouth Road (a). West Ferry Road. Christchurch. North Poplar. Royal College of St. Katharine. First attendances 861 28 134 205 290 — Infant consultations 10,897 357 1,921 4,258 5,637 10,458 Average per session 56.7 32.0 37.6 42.0 55.2 — Average attendances of each child 7.9 3.6 6.5 9.0 10.6 — Dental Clinic 445 — — — — 737 Expectant mothers 190 — 5 — 141 399 Sewing Class — — — — 207 124 (a) Closed 31st March, 1923. Total attendances at all Clinics:—Public Health Department, 24,058; Royal College of St. Katharine, 11,718. Money Taken. £ s. d. For Dried Milk (8,705lbs.) 652 17 6 ,, Medical sundries 114 7 11 ,, Dentures 38 14 0 ,, Spectacles 0 1 4 ,, Materials at Sewing Class 38 7 0 ,, Convalescent Treatment 2 8 6 Total money taken 846 16 3 Free issue.—2,5391bs. Dried Milk. 5,700 vouchers for cod liver oil, malt, etc., were also issued. 35 Grants in Aid. Convalescent Treatment (1 mother, 6 children) 7 cases. Attendance of midwife 16 ,, Loan of maternity bag 4 ,, Zymotic Enteritis. Died before notification received 7 Not traced 10 Visited 259 Under 1 year (seefeeding below) 78 (3 died). 1 to 2 years 113 2 to 3 years 42 3 to 4 years 18 4 to 5 years 8 Feeding. Age period. Breast. Mixed feeding. Hand fed. Not stated. Under 1 year 30 32 13 — Died 1 2 — — Ophthalmia Neonatorum. Number of notifications received 38 Died whilst under supervision 3 Sight of one eye damaged — Recovered 35 Occurred in Institutions 3 Occurred in the practice of medical practitioners 6 Occurred in the practice of midwives 29 Admitted to hospital as in-patients 8 Treated as hospital out-patients 10 Treated privately 20 Visited by nurse 11 Vital Statistics, 1922. All births, including those occurring in outlying districts, but belonging to the Borough 4,489 Attended by doctors 1,017 Attended by midwives 2,863 Delivered in institutions 598 Not stated 11 Stillborn 124 Died before visit 99 Not requiring or desiring visits 438 Visited 3,828 Removed and not traced 219 Died during visitation 147 36 Remaining under supervision end of first year 3,462 Stillbirths per 1,000 births 27.6 Mortality per 1,000 births, died before visit 22.0 Mortality per 1,000 visited 38.4 The feeding of infants during the first six months of life was aa follows :— 1. Those alive at end of completed year (December, 1923)— Breast-fed 76.3 Mixed feeding 21.5 Hand-fed 2.2 2. Those who died— Breast-fed 55.8 Mixed feeding 35.4 Hand-fed 8.8 3. Comparison of rates of mortality between infants— Breast-fed 3.0 Mixed feeding 6.5 Hand-fed 14.6 Year of Birth. 1918 1919 1920 1921 Remaining under supervision:- End of first year — — — 3,457 ,, ,, second ,, — — 3,909 — „ „ third ,, — 2,987 — — ,, ,, fourth ,, 2,112 — — — Found 11 35 104 84 Given up — 2 1 2 Removed and not traced 56 84 154 137 Died 12 21 44 64 Remaining under supervision:- End of second year — — — 3,338 ,, ,, third ,, — — 3,814 — ,, „ fourth ,, — 2,915 — — ,, ,, fifth ,, 2,055 — — — Mortality per 1,000 visited:- 18.5 (49.8) Second year — — — Third — — 11.2 (29.8) — Fourth — 7.3 (9.4) — — Fifth 5.6 (7.2) — — — The figures in brackets are the rates for the previous years. I am, Sir, Your obedient Servant, J. M. CARDOZO, Chief Health Visitor. 37 ROYAL COLLEGE OF ST. KATHARINE. Report from the Senior Medical Officer, Harold Waller, M.D. For the main part the work carried out in the district allotted to the Royal College of St. Katharine has followed, during the past year, the lines laid down at its inception in 1913. Experience has naturally shown certain directions in which its value could be strengthened, and the suggestion has been made that some account should be given in the Medical Officer of Health's Annual Report of one particular development which has been found useful. The Health Visitors and Medical Officers at the Clinics are daily concerned to promote the highest possible percentage of successful breast-nursing of the infants. Regular inspection shows us that this is easy to achieve in the majority; but there are many cases where, for one reason or another, the infant does not thrive at the breast, or is brought to be weighed because its mother fears it is not thriving. Some of these cases offer considerable difficulty of diagnosis, and it has been our experience that even the most careful instructions based on an examination of mother and child sometimes fail to effect improvement. The fact is that whereas a weekly inspection and weighing will show that the baby is not thriving, they cannot furnish the exact reasons in obscure cases. Some opportunity is needed to observe directly the infants behaviour, to estimate the amount of food it receives, and to gauge its mother's skill in management, and the effect also of its surroundings on its progress. To this end certain of the mothers are invited to bring their infants for a daily inspection to Brunswick Road, where the College has a small garden with a shelter and a room set aside for experimental feeding. The value of being able to watch the babies and estimate the daily yield of milk over a period of time has been so great that one almost ventures to think it will have to become part of the necessary equipment of every Infant Welfare Institution. A few examples of the discoveries made will explain best both the types of problem and the methods of investigation. A mother complains that her infant is no longer satisfied with its feeds, cries after nursing, and requires frequent meals. The nurse in charge of the observation department finds that the feeding had gradually become entirely one-sided; i.e., the baby had abandoned one breast and 38 involution had set in. A few day's systematic training and the yield of milk steadily improves in the disused gland, and increases also in the previously over-worked and partially exhausted breast. A woman complains that her child is not satisfied with the breastmilk, cries all day, and is vomiting profusely. She thinks the milk is failing. Weighing the child before and after a series of meals shows the "dissatisfaction" and vomiting to be due to the pain of over-feeding. The milk supply is over abundant, and the average yield is between 6 and 7 ozs. per feed. Inspection of the glands often gives no information which could lead one to expect a surplus of milk. By curtailing the feeds the infant's behaviour rapidly alters, and in a few days it is thriving and sleeping quietly. Again, an infant whose weight had been stationary for several weeks was recommended for daily observation. Profuse nasal catarrh was suspected as being responsible. The mother's statement that her child turned from the breast was confirmed, and the amount of milk taken at each feed was small. The effort to suckle with nasal breathing completely obstructed produced rapid exhaustion in the child. It was brought early in the morning and left until evening in a cot in the garden, where a simple toilet of the nose was carried out. The condition yielded in a few days and a rapid gain in weight followed, coinciding with a great increase in the amount of milk taken. A common type of case which we have treated here with conspicuous success, but which is particularly resistant to any other means, is the irritable nervous type of infant—very frequently a first-born—whose exacting behaviour troubles and fatigues the parents. Here we get almost uniformly a report from the nurse that the mother has no appreciation of the need of quiet handling, punctual routine, and strict discipline. Indeed, so worn out are the mothers of these screaming infants that we not uncommonly take charge of the babies from morning to night for several days, stop all attemps at breast-feeding for the time, and send the women home to rest and make up their shortage of sleep. The child is meanwhile hand fed and kept in the open air. After two or three days breast-nursing is restarted and the mother trained very carefully to avoid stimulating the child by jogging and jolting; often her methods of handling a newborn are of the crudest. Most make apt pupils; a few require weeks before they can nurse their babies without provoking a storm of nervous crying. The improvements which follow both in the yield of milk and in the infants' behaviour and nutrition are most satisfactory. Moreover, the experience is invaluable for any subsequent baby the woman may bear. 39 This type of case supplies a large proportion of infants whose mothers are apt to report their milk failed soon after they got up after their confinement; but bottle-feeding naturally produces no alteration in the child's behaviour and frequently adds dyspepsia to its troubles. Failures of lactation are sent to this department, and its records contain many instances of successful re-establishment of breast-feeding. The methods used are of the simplest. The child is coaxed and taught to restart suckling; massage of the breasts, as advocated by Truby King, and their alternate douching with hot and cold water are carried out, and the women encouraged to do it for themselves at home. The necessary hand-feeding is done with a spoon, and this encourages the infant to suckle. Dummies are prohibited. The regularity and patience which these women show is a remarkable tribute to their devotion. At first they are required to attend four times daily. Later alternate days may suffice, and as the feeding improves, their presence only on one or two days weekly is demanded to verify the amount of milk yielded. This work is proving itself steadily a most valuable clinical adjunct to the weekly consultations, and reduces the amount of guesswork prescription of bottle feeds to a minimum. Not the least part of its value is the object-lesson it provides of the benefit to the babies of sleep in the open air. Without a practical demonstration of its possibilities and safety, many of the mothers find it impossible to overcome a feeling of its riskiness. Having once had their fears allayed, they are willing and eager to carry out the same treatment at home, and are fortified to withstand the warnings and criticisms of their more timid neighbours. If a comparison were to be made of work in the clinics to-day compared with work ten years ago, one would say unhesitatingly that the most striking change is the early application by the mothers for advice. At the start of the work we were far too much occupied in trying to remedy unsuccessful experiments in artificial feeding. Help was asked when it was obvious that the child had failed on bottle food. Now we are asked why the breast-feeding is not satisfactory, and before bottlefeeding is embarked on. The difference appears to us to be both significant and encouraging. H. K. WALLER. 40 REPORT ON MATERNITY AND CHILD WELFARE DENTAL CLINIC FOR THE YEAR 1923. The Medical Officer of Health, Borough of Poplar. Sir, The figures for the year ending December 31st, 1923, show a considerable increase in the work done, number of attendances, etc. They are as follows:— Attendances New Patients Sessions Extractions Fillings Scalings 445 145 50 862 105 87 compared to the figures for previous year, 1922 : 158 58 41 326 66 — You will observe that we have:— Nearly trebled the number of attendances; More than doubled the number of new patients; Increased extractions by two and a half times; ,, fillings—nearly doubled; ,, Scalings (though the figures for 1922 are not known). We have held 9 more Sessions in 1923 than in 1922. The average number of attendances per session has increased from 4.0 in 1922 to 8.9 in 1923, and I think that an average of 8 per session represents a maximum number of patients which can be satisfactorily coped with at a time. The reasons for this considerable increase I consider are as follows:— (i) Closer co-operation in regard to dental work, amongst those concerned; (ii) Results shown by previous patients becoming apparent to a certain extent, thus helping to popularise the work; (iii) The aids at my disposal for performing the work in a satisfactory manner (e.g., good equipment, highly skilled anaesthetist, and really valuable attendant help). I see no reason why the Dental Clinic should not continue to show an upward tendency, as our efforts show certain signs of being appreciated. 41 I am of the opinion that we gain much by having the same staff constantly, as the patients do not feel such apprehension when they are sure of meeting people they know at the Clinic. Finally, may I take the opportunity of thanking all the members of your staff for their help and consideration, which has assisted me very greatly during the past year. I have the honour Sir, to remain, Your obedient Servant, C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. "Brooklands," Acton Hill, W.3. 10-1-24. REPORT ON THE TUBERCULOSIS DENTAL CLINIC (PERIOD 18-10-22—31-12-22 AND YEAR 1923.) The Medical Officer of Health, Borough of Poplar, Sir, The Tuberculosis Dental Clinic held its first session on October 18th, 1922, and I propose therefore, to deal with the period from then till the end of that year, before dealing with the year 1923. 1922: The figures for the period 18-10-22—31-12-22, are as follows:— Attendances New Patients Sessions Extractions Fillings Scalings 34 24 12 49 11 20 Though not too gratifying, these figures show a certain amount of work done for a beginning, and every hope was entertained of a rapid growth in the year following:— 1923: The figures for the year being as follows:— Attendances New Patients Sessions Extractions Fillings Scalings 80 62 49 300 81 60 42 It will be seen that our hope has not been realised to any great extent for, whereas we had an average attendance per session in 1922 of less than three, in 1923 it has fallen to lesS than two. I am not aware of anything happening at the Clinic that could account for old patients not continuing their treatment, and by the number ol extractions, fillings or scalings, as above, there can be no doubt as to the necessity for dental work. The patients are more difficult to treat than those in normal health undoubtedly, and possibly "funk" repeated visits on the same account. Whether the patients are "followed up" thoroughly I cannot say, but I think the supply of new patients might be increased if possible. The arrangements for help at the Tuberculosis Dental Clinic differ from those at the Maternity Dental Clinic. At the latter, the same Health Visitor is present at each Session. At the former these Health Visitors take turns. I cannot consider this arrangement good, the patient is met by a different Health Visitor each Session, and, though each Health Visitor is perfectly capable, and a great help to me, I consider the arrangement bad from the patients' point of view. With one constant attendant at each Session, I think we can gain the patient's confidence. I trust I am clear on this point, which presents certain difficulties in explanation, but which I think is of considerable importance.* Every precaution is taken in the work to prevent infection. All instruments are thoroughly sterilized after use, and the room disinfected with formalin at the close of each Session. A special set of gas masks is used for anaesthetic cases, as such articles are difficult to render surgically clean. The patients do appear to appreciate our efforts in the majority of cases. I have the honour to remain, Sir, Your obedient Servant, C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. "Brooklands," Acton Hill, W.3. 10-1-24. (Note by Medical Officer of Health. This matter is being considered.) 43 Free Milk Scheme. Mr. Dyer, Chief Cleric, reported :— During the 12 months ended 29th December, 1923, 15,537 applications for free milk were received, of which 14,086 were granted (compared with 18,082 applications and 16,215 grants for 1922). Orders for 512,610 pints of fresh, and 3,230 lbs. of dried milk were issued, the total commitments amounting to approximately £6,600. Personal enquiry was made into 2,974 cases by the Investigation and Enquiry Officer. In 34 cases it was found that applicants had commenced work and received an income which rendered them over scale, while receiving free milk, without notifying the fact. In 12 of these, letters of caution were sent, and the remaining 22 were instructed to refund the value of milk supplied to them. Proceedings in the County Court were taken regarding one case (the instructions for this were given in 1922). During the year the sum of £29 was repaid on account of milk supplied on incorrect information, making a total sum of £299 repaid to 29th December, 1923. By arrangement with the Dairymen's Association since April 1st, 1923, the Council has been paying 4d. per gallon below the ruling retail price. Previous to this the Association had only been allowing 2d. per gallon. The price of milk per pint to the Council varied during the year as follows:—1st January, 3¾d., 1st February, 3½d., 1st April, 2½d., 1st October, 3d., 2nd December, 3½d. 44 REPORT OF MISS A. TATTERSALL. To the Medical Officer of Health. Sir, I beg to present my twenty-third report of work clone in factories and workshops, among out-workers, inspection of homes of children attending school in a verminous condition and suffering from scabies, and investigation of complaints of various kinds. Many changes have taken place in the Borough since I took up the appointment of Woman Sanitary Inspector in 1900. During the last few years the number of workshops has tended to decrease, largely owing to small employers, some with under a dozen workers, having installed electric or gas power, much to the benefit of the employees. The majority of the workshops are good, a few being in basements, but none that could possibly be termed underground. The outworkers also have decreased. I think employers have realised it is more satisfactory to have their work, especially clothing, made under their supervision, rather than in homes, where it is sandwiched between domestic duties. In regard to the homes of verminous children, the improvement has been marvellous. I think of when investigating these complaints, the house door opened to emit an abominable odour, but I have not experienced that particular smell for a long time; it is unusual now to find no furniture and no bedding, which, in years gone by, was quite usual. The standard of living and comfort has risen immensely, in spite of the acute housing shortage, which leads to many nuisances. I regret to say farewell to my work and to you, sir, and all my fellow officers. I have had very happy years here and shall always be interested in the welfare of the Borough. I am, Sir, Yours faithfully, ALICE TATTERSALL. (See also Tabulated Statement on page 45.) 45 Tabulated statement of Inspections of Insanitary Conditions found existing, and of Re-inspections, &c, during the twelve months ended 29th December, 1923. (Miss Alice Tattersall, Lady Inspector). Poplar. Bow and Bromley. Totals. Workshops, Workplaces, Laundries, &c., Number of, on the Register 41 98 139 Workshops, Number of Workrooms therein 68 126 194 ,, Number of Inspections of 91 162 253 ,, Number of Re-inspections of 40 94 134 ,, Number overcrowded — 3 3 ,, &c., newly discovered and registered 6 11 17 ,, Workrooms therein measured 4 23 27 ,, Reported to H.M. Inspector on discovery 5 11 16 Houses visited for enquiry at which no female hands were employed 319 933 1,252 Written intimations issued 8 20 28 Statutory Notices 4 10 14 Final Notices — — — Works carried out under supervision (a) Rooms cleansed and whitewashed 9 19 28 (A) Yards, roofs, &c., repaired 1 1 2 Additional means of ventilation provided 1 — 1 Sanitary Conveniences Constructed — 4 4 Overcrowding of Workrooms, cases of, abated — — — Visits re Scabies 37 25 62 ,, Suspected infectious disease 17 25 42 ,, Outworkers'Lists 34 74 108 ,, Inspection of Schools — — — ,, Verminous School Children 44 27 71 Miscellaneous Inspections 33 61 94 Reports of Housing Inspectors. Summary, 1923. Poplar. Bromley Bow. Totals. House-to-house Inspections 241 217 324 782 Re-inspections 3,611 4,097 2,940 10,648 Number of Intimations served— Public Health (London) Act 513 529 478 1,520 P.B.C. By-laws 215 180 213 608 L.C.C. (General Powers) Act, re verminous rooms 32 56 28 116 Number of Notices served— Public Health (London) Act 99 219 109 427 P.B.C. By-laws 38 98 68 204 For cleansing 36 87 23 146 Number of Final Notices served—- For cleansing and other matters 34 69 35 138 Number of drains tested— Chemical test 215 193 318 726 Smoke test 31 24 19 74 Water test 55 177 50 282 Number of drains defective 15 24 15 54 ,, ,, obstructed 9 11 2 22 46 47 SANITARY INSPECTORS' WORK, Etc. (See also Tables on preceding page.) Tabulated Statement of Inspections, Insanitary Conditions found existing, and Re-inspections during the year 1923. East Combined Division. West Combined Division. Poplar South Division. Bromley North Division. Bromley Central Division. Bow East Division. Bow West Division. Totals Totals Inspections 1,093 1,405 1,215 1,464 1,171 1,232 1,389 8,969 On complaints of nuisances, etc 390 811 693 845 634 632 497 4,502 On notification of infectious diseases 398 407 281 466 226 214 256 2,248 House-to-House 14 — — 6 134 195 31 380 Bakehouses 28 39 15 25 19 9 42 177 Slaughterhouses 3 — — 5 — — 50 58 Cowhouses 9 5 — 6 — 8 18 46 Milkshops 67 66 16 21 27 58 142 397 Ice cream vendors' premises 21 20 35 7 23 18 26 150 Workshops, workplaces, etc. 163 57 175 83 108 98 327 1,011 Premises found in fair condition 402 710 689 1,007 383 506 764 4,461 Do. requiring amendment 691 695 526 457 788 726 625 4,508 Details of Insanitary Conditions, etc. Walls and ceilings dirty 303 246 307 181 318 27 1 342 1,968 Yards, forecourts and areas insufficiently paved or drained 92 33 63 67 99 81 54 489 Inlets to drains not properly trapped — 1 — — 7 5 2 15 Number of drains tested 150 88 158 102 187 130 113 928 Do. do. defective 39 60 28 38 10 43 37 255 Do. do. obstructed 24 77 34 109 48 78 80 450 Sink waste pipes not trapped or otherwise defective 46 1 11 5 94 24 8 189 Sink waste pipes directly connected to drains — 2 — 2 — — — 4 East Combined Division. West Combined Division Poplar South Division. Bromley North Division. Bromley Central Division. Bow East Division. Bow West Division. Totals Soil pans of w.c. s without suitable water supply 38 12 30 29 28 2 23 162 Do. do. broken or unsuitable 18 18 7 10 12 30 10 105 Do. do. in foul condition 42 11 21 1 5 42 17 139 Do. do. untrapped — — — 1 2 — — 3 Roofs, guttering and rainwater pipes defective 272 169 186 281 264 229 176 1,577 Water supplies to premises cut off (notified by Metropolitan Water Board) 3 — — — 1 4 4 12 Water service fittings defective, causing waste of water 11 7 16 5 2 12 6 59 Drinking Water improperly stored 2 — — — 1 — 3 Dampness 280 69 87 30 127 125 74 792 Inundations — 3 — 4 3 20 — 30 Overcrowding 4 — — 5 8 1 1 19 No proper receptacle for house refuse 59 7 75 62 95 58 89 445 Accumulations of dung or refuse 15 10 29 9 10 2 9 84 Foul P.H. urinals 5 3 3 — 6 — 4 21 Other nuisances, dilapidations, want of ventilation, etc. 191 222 492 245 378 669 542 2,739 Breaches of London County Council's By-laws 199 39 — — 98 73 21 430 Breaches of Council's By-laws 81 — 22 1 10 65 51 230 Intimations served 691 528 526 447 654 726 625 4,197 Notices served 239 405 125 262 421 202 420 2,074 Final Notices served 78 44 41 91 73 47 38 412 Summonses applied for (except Food and Drugs) — 1 — 4 6 2 1 13 Passengers from Continental Ports: — Visited 4 — 4 1 — — — 9 Undiscovered — — — — — — — — Intimations served in respect of verminous rooms 29 34 29 40 89 31 34 286 Verminous rooms cleansed 49 23 18 42 98 37 42 309 Re-inspections 2,525 3,023 2,434 2,080 1,548 2,284 1,629 15523 48 HOUSING ACTS, 1890-1923. Housing (Inspection op District) Regulations, 1910. Representations to Council under Housing, Town Planning, Etc., Act, 1909. No premises were inspected with a view to closing under Section 17 (1) of the Housing and Town Planning, Etc. Act, 1909. Increase of Rent and Mortgage Interest (Restrictions) Acts. Twelve certificates were issued under the above Acts. HOUSING CONDITIONS. Statistics. Year Ended December, 1923. 1.—General. (1) Estimated population 166,400 (2) General death rate 11.3 (3) Death rate from tuberculosis (all forms) 1.2 (4) Infantile mortality 60 (5) Number of dwelling-houses of all classes (Census 1921) 23,248 (6) Number of working-class dwelling-houses Practically all (7) Number of new working-class houses erected houses, during 1923 tenements. (In course of erection, 61 tenements.) 2.—Unfit Dwelling-houses. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or other Acts) 7,823 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 49 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 5,022 II.—Remedy of defects without Service of Formal (Statutory) Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers. 2,123 III.—Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning, Etc., Act, 1919 — (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit— (a) by owners — (b) by Local Authority in default of owners — (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4,072 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 3,992 (b) by Local Authority in default of owners 1 (c) by Local Authority and owner jointly 1 C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, Etc., Act, 1909— (1) Number of representations made with a view to the making of Closing Orders 4* (2) Number of dwelling-houses in respect of which Closing Orders were made 4* * See footnote p. 50. 50 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — (4) Number of dwelling-houses in respect of which Demolition Orders were made — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — 3.—Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., or (b), Part II., of the Act of 1890 :— (1) Name of areas — (2) Acreage — (3) Number of woiking-class houses in area . — (4) Number of working-class people to he displaced — 4.—Number of houses not complying with the building byelaws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, Etc., Act, 1919 — 5.—Staff engaged on housing work with, briefly, the duties of each officer 10 (7 district sanitary inspectors and 3 doing house-to-house inspections.) * Nos. 39, 41, 43 and 45, Gale Street. Closing Orders were made on 22nd March, 1923, and became operative, but Demolition Orders were not made owing to inability to provide accommodation for displaced persons. Early in 1924 two-months' notices were served under the 1919 and 1923 Acts, Sections 28 and 10 respectively, upon the above premises, and also upon No. 157, St. Leonard's Street. A special report, dated 4th February, 1924, relating to Abandoned Property and the difficulty of enforcing Sections 28 and 10 of the Housing and Town Planning Etc., Act, 1919, and the Housing, Etc., Act, 1923, respectively, was submitted to the Public Health and Housing Committee. 51 WORKSHOPS, WORKPLACES, LAUNDRIES AND OUTWORKERS. TABLE A. Table giving number of, and inspections, etc., of Bakehouses, Laundries, Workshops, Workplaces, Places where food is prepared, Milk premises, Cowsheds, Slaughter-houses, Offensive Businesses, Ice Cream premises, and Homeworkers' premises. Premises. On Register during year 1923. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male. Female Total Bakehouses (Factories) 29 _ 29 119 27 3 — — Bakehouses (Workshops) 55 — 55 193 43 — — — Bakehouses (Domestic Workshops) 1 — 1 4 2 — — — Factories (Laundries and Miscellaneous Factories) + + + + + + 68 2 2 — — Laundries (Workshops) — 4 4 14 — — — Laundries (Domestic Workshops) 3 3 6 — — — — Workshops 91 1308 2218 445 48 17 — — Workshops (Domestic) 10 2 12 40 40 4 — — Workplaces 129 — 129 359 45 8 — — Workplaces (Domestic) 35 — 35 102 9 4 1 — Places where food is sold or prepared 25 lr — 251r 1004¶ 159 26 6 — Milk Premises 132 132 480 1 1 — — Cowsheds 10 9 10 38 1 Slaughterhouses 9 56 1 — — Other offensive trade premises 6rr — 6rr 23 2 — — — Ice Cream premises 101 — 101 184 17 1 — — Homeworkers' premises 50 504 554 1320 7 6 2 — + No Register is kept of Factories. Figures are from Journals and Card Index. 8 Including 24 workshops where both men and women are employed, r Power is used in 25 of these premises where sausages are made. ¶ Including inspections of all factories where food is prepared, rr 6 registered by the London County Council. 52 TABLE B. Workshops on Register (Male), 1923. 9 Bootmaking. 1 Barge breaking. 2 Boat building. 1 Brush making. 1 Building, etc. 6 Cabinet making. 1 Chemical Works. 1 Cigar making. 1 Cork cutting. 6 Confectionery making. 3 Cooperages. 1 Electrical Engineering and Winding. 3 Engineering. 12 Farriers. 2 French polishing. 1 Frilling making. 2 Harness making. 1 Joinery. 1 Motor garage works. 2 Metal works. 2 Oil stores. 1 Packing case making. 2 Paint making. 2 Plumbing. 1 Poultry food mixing. 1 Rag sorting. 8 Tailoring. 3 Tarpaulin works. 1 Skin dressing. 1 Stonemasonry. 1 Tin toy making. 2 Upholstering. 3 Undertaking. 1 Van building. 1 Waterproof working. 1 Welding. 1 Wheelwright. 1 Wood chopping. 1 Wire working. 1 Walking stick making. 1 Zinc working. As per List, Table A Workshops on Register, page 51. Workshops on Register (Men and Women Employed). 2 Cork cutting. 15 Tailoring. 3 Confectionery making. 1 Upholstering. 3 Bootmaking. Domestic Workshops on Register (where Men are Employed).* 1 Clay pipe making. 1 Tailoring. 1 Vinegar works. 3 Blacksmiths. 1 Boot repairing. 1 Picture frame making. 2 Cycle repairing. 1 Keg and drum repairing. 1 Decoratcd earthenware making. 53 Home Workers on Register (Male). 40 Bootmaking. 6 Tailoring. 1 Furrier. 1 Brush making. 1 Waterproof garment making. 1 Fancy leather goods making. Workshops and Domestic Workshops on Register (Females).* 54 Tailoring. 7 Laundries. 8 Boot upper making. 9 Dressmaking. 3 Upholstering. 2 Cork cutting. 2 Skirt and blouse making. 3 Waterproof garment making. 3 Sack and bag making. 1 Shirt and pyjama making 4 Furriers. 1 Seal stamping. 8 Milliners. 4 Tieniaking. 3 Knitted garment making. 8 Confectionery making. 1 Packing. 1 Glass blowing. 5 Mantle making. 1 Paper and rag sorting. 1 Wood chopping. 3 Trimming making. 1 Corset making. 1 Artificial flower making. 1 Horse hair sorting. 3 Toymaking. 1 Bedding making. * It is very difficult to separate Workshops and Domestic Workshops, as these premises are sometimes one and sometimes the other, according to the pressure of work. See Table A, page 51. 54 TABLE C.* See footnote, page 53. Factories, Workshops, Laundries, Workplaces and Homeworkers. 1 .—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Intimation. Statutory. Final. Factories (Including Factory Laundries.) 187 29 5 .. .. Workshops! .. (Including Workshop Laundries.) 652 91 17 .. .. Domestic Workshops^ 50 6 .. .. .. Workplaces (Males) .. 359 45 8 .. .. Domestic Workplaces (Males) 102 9 4 1 .. Places where food is sold or prepared!) 1004 159 26 6 .. Homeworkers'Premises 1320 7 6 2 .. Total 3674 346 66 9 •• * Tables ( C,D,E and are filled in at the request ot the secretary ot State, Including Workshop Bakehouses. See Table A, page 51. Including Domestic Bakehouses and Laundries. See Table A, page 51. The inspections of all factories where food is prepared are included. Power is used to chop meat for sausages, etc., in 25 of the premises. 2 .—DEFECTS FOUND * Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector (1) (2) (3) (4) (5) . Nuisances under the Public Health Act: Want of cleanliness 342 342 .. .. Want of ventilation 1 1 .. .. Overcrowding 3 3 .. .. Want of drainage of floors .. .. .. .. Other nuisances 296 296 .. .. Sanitary accommodation insufficient 2 2 .. .. unsuitable or defective 28 28 .. .. not separate for sexes .. .. .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse(s.101) .. Breach of special sanitary requirements for bakehouses (ss. 97 to 100) Other offences .. (Excluding offences relating to outwork which are included in Table D of this Report.) Total 672 672 .. .. These defects refer to premises as mentioned above under of Inspection 55 Nature of Work. Outworkers' List, (Section 107). Outwork in unwholesome premises. (Section 108). Outwork in infected premises, (Sections 139,110). Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of list. Failing to send lists. Outworkers. Lists. Outworkers. Lists. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— Making, etc. 76 134 621 7 7 18 6* TABLE D.—Home Work. Cleaning and Washing Household Linen Lace, lace curtains and nets Curtains and furniture hangings Furniture and Upholstery Electro-plate File Making Brass and Brass Articles Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, etc. Artificial Flowers Nets, other than wire nets Tents Sacks Racquet and Tennis Balls Paper, etc., Boxes, Paper Bags 2 ... 221 1 ... 17 Brush Making Pea Picking Feather Sorting Carding,etc.,of buttons, etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, etc. Textile Weaving Total 78 134 842 8 7 35 6* * For infectious Diseases see page 19. 56 LIST OF OUTWORKERS, FACTORY AND WORKSHOP ACT, 1901 (S. 107).* 1923 Number of Lists received. Number of Addresses of Outworkers. Class of Homework. Due Feb. 1st. Due Aug. 1st. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Due Feb. 1. Due Aug. 1. Due Feb. 1. Due Aug. 1. Total 41 547 45 571 268 309 403 207 Tailoring 30 259 33 255 Shirtmaking 1 7 1 6 Miscellaneous 5 116 5 153 Shoemakers 4 42† 4 42‡ Boxes 1 123 2 115 * See page 55. † 15 Males and 27 Females. ‡ 12 Males and 30 Females. TABLE E. Registered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses may be enumerated here. Bakehouse Workshops 55 Bakehouse Domestic Workshops 1 Laundries Workshops 4 Laundries Domestic Workshops 3 Workshops 221* Domestic Workshops 12 Workplaces 129 Workplaces Domestic 35 Places where food is sold or prepared 251† Total number of workshops and workplaces, etc., on Register 711† * 24 where men and women are employed. † Power is used in 25 of these premises. ‡ See Tables A and B, pages 51 and 52. TABLE F. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act(s. 133).. 17 Action taken in matters referred. Notified by H.M. Inspector 7 by H.M. Inspector as able under the Public Health Acts, but not under the Reports (of action taken) sent to H.M. Inspector 7 tory and Workshop Act (s. 5) Other (Communications) 10 Underground Bakehouses (s. 101):— Certificates granted during the year .. In use at the end of the year 26 57 COFFEE SHOPS, EATING HOUSES, FRIED-FISH SHOPS, HOTELS & RESTAURANTS, ETC.† London County Council (General Powers) Act, 1908.—Sanitary Regulations for Premises used for Sale, etc., of Food for Human Consumption. The number of premises in the Borough where food is sold or prepared for sale is 251. London County Council (General Powers) Act, 1908. 1,004 visits were paid to these premises during the year and the Sanitary Regulations under the London County Council (General Powers) Act, 1908, Section 8, were enforced. Want of cleanliness was found in 145 instances, and 125 other defects existed. 159 intimations were served, which in 26 cases were followed up by Statutory notices and six final notices were served. MILK SHOPS. At the end of the year there were in the Borough 142 registered premises (including 10 cow-houses) where milk is sold. These milk shops were kept under observation. Cleansing of premises was necessary in seven instances. Three other defects were found. Pour milkshops have been placed on the register during the year. Fifteen premises were on account of change of occupiers re-registered as milkshops. The sale of milk was discontinued on nine premises. l or rpilkshops connected with infectious diseases, see page 19. †See Tables A and C, pages 51 and 54. 58 The Milk (Special Designations), Order, 1924. The above Order revoked previous regulations and came into operation on the 1st July, 1923. No applications were made for certificates under this Order or under the previous Regulations. ICE CREAM. London County Council (General Powers) Act, 1902, Sec. 43. There are 101 premises where ice creams are manufactured within the Borough, on the register. 184 inspections were made during the year. Cleansing of premises was necessary in 17 instances. 15 other nuisances existed. HAIRDRESSERS' PREMISES. The hairdressers' premises were inspected during the year. RAG AND BONE DEALERS. The bye-laws made by the London County Council, respecting the business of a Rag and Bone Dealer were allowed by the Minister of Health on the 18th September, 1923, and confirmed by the Home Secretary, 26th September, 1923. The bye-laws relate to:— (a) the storage, manipulation, and removal of rags, bones, rabbit skins or other like articles; (b) the construction, lighting, ventilation and cleansing of rooms used in connection with the business; (c) the provision of sufficient properly constructed receptacles, (d) the paving and drainage of yards; (e) prohibit the use of sleeping rooms for storage, etc., and (f) prohibit the use of material from infected premises. 59 SMOKE NUISANCES. 36 smoke nuisances were dealt with during the year:—12 Bow East, 0 Bow West, 11 Bromley North, 6 Bromley Central, 1 East Combined, 5 West Combined, and 1 Poplar South. One summons was issued, see page 81. BAKEHOUSES. Inspections. The Bakehouses throughout the Borough were inspected at least twice during the year. There are 85 Bakehouses in use, of which 26 are underground. In 29 bakehouses machinery is used. See Table A, page 51, number made up to end of year. Cleansing was necessary in the various bakehouses on 88 occasions. Twenty other nuisances were found (including 2 defective or unsuitable w.c. accommodation). Three bakehouses were disused at time of visit. SLAUGHTERHOUSES. The bye-iaw made by the London County Council for regulating the conduct of a business of a slaughterer of cattle was allowed by the Minister of Health on 7th December, 1923. The bye-law, which comes into operation on 8th March, 1924, requires that animals to be slaughtered in a slaughterhouse shall be effectually stunned prior to slaughter, such stunning to be effected with a mechanically operated instrument. The bye-law does not apply to the slaughter of cattle according to the Jewish method of slaughtering, if no unnecessary suffering is inflicted. SLAUGHTERER OF POULTRY. The bye-laws made by the London County Council respecting the business of a slaughterer of poultry were allowed by the Minister of Health on the 22nd December, 1923. The bye-laws are made for regulating the conduct of the business of a slaughterer of poultry, the structure of the premises on which the business is being carried on, and the mode in which application is to be made for sanction to establish such business anew within the County of London exclusive of the City of London. 60 CANAL BOATS. For the year ended 31st December, 1923, the inspections and reports of the Inspectors respecting registered canal boats and non-registered canal boats were as follows:— Registered NonRegistered. (Mr. H. A. Tibbatts, East Combined Division — — ‡ Mr. J. Johnson, West Combined Division — — †Mr. C. H. Brown, Poplar South Division — — Mr. H.J. Langley, Bromley North Division — — *Mr. Wm. Johnson, Bromley Central Division 1 — Mr. A. J. Field, Bow East Division 3 12 Mr. W. Boyce, Bow West Division 1 10 5 22 No infringements of the Acts and Regulations were reported. † No canal in Sub-division; deputises when necessary for other Inspectors. * Mr. W. Johnson reported "Several visits to Bromley Locks, but frequently only non-registered boats about." † Mr. J. Johnson reported that "There have been no canal boats up this past twelve months at time of visits." DISINFECTING DEPARTMENT. Rooms and Articles (Infectious and Verminous) Disinfected. The following figures give the number of rooms and articles disinfected:— Rooms. Beds. Mattresses and Palliasses. Pillows. Bolsters. Various. Totals. Infectious Disease 657 657 264 1964 776 8224 11885 Miscellaneous 71 222 47 348 104 1413 2134 Totals 728 879 311 2312 880 9637 14019 Pulmonary Tuberculosis 390 38 5 107 34 413 597 Totals 1118 917 316 2419 914 10050 14616 61 Other articles also passed through the Council's apparatus, from the Shelter, Glaucus Street, disinfectors' clothing, overalls, drop-sheets, etc., to the number of 8,977, and 25,300 articles of clothing from verminous persons were disinfected, making a total of 48,893 articles. Nineteen articles were destroyed at the Council's apparatus from premises where a case of cancer had occurred. ELECTROLYTIC DISINFECTANT FLUID. At the seven depots the electrolytic fluid was still in great demand by the public. During the year 1923, 64,740 gallons were manufactured and broken down to 129,480 gallons for distribution. Distribution of Fluid. The fluid was distributed as follows:— galls. Violet Road Depot 72,262 Bickmore Street Depot 12,065 Old Ford Road Depot 8,472 Ford Road Depot 5,292 Trego Road Depot 5,150 Stebondale Street Depot 4,170 Millwall Depot 792 Public Health Offices 144 Poplar Baths 4,457 Bow Baths 3,581 Island Baths 1,382 Violet Road Baths 200 Wick Lane Baths 153 Empson Street Baths 285 Poplar Town Hall 132 Bromley Public Hall 512 Works Department 468 Guardians' Offices 492 Poplar Union Workhouse 2,664 Langley House 221 Poplar Training School, Hutton 58 Public Libraries 312 62 Used at Council's Shelter in baths of verminous persons 641 London County Council Schools 2.972 Mortuary, High Street, Poplar 420 Borough of Poplar Dispensary 72 Royal College of St. Katharine 238 Private Firms in Borough 930 Council Offices, Poplar 329 Finance Department Offices 87 Kingsley Hall 45 Bow War Pensions Office 169 North Poplar Clinic 57 Howrah House Convent 232 Bow Relief Offices 24 Total 129,480 Cost of Materials and Electricity. The cost of materials and electricity for manufacturing the electrolytic fluid was as follows:— £ s. d. Electricity, 13,180 units at 1 id. per unit (with 50 per cent. advance) 123 11 3 Chloride of Magnesium, 7 tons, 18 cwts. 1 qr. 25 lbs. 37 14 8 Salt, 12 tons, 17 cwt., 2 qrs. 51 10 0 Caustic Soda, 13 cwt., 2 qrs., 24 lbs. 25 1 9 Water (64,740 gallons) 3 14 2 Total cost of materials and electricity to produce 64,740 gallons (strong); broken down to 129,480 gallons 241 11 10 Electric motor for stirring: 326 units 3 1 2 Bottles, Corks and Labf.ls. Bottles 24 10 8 Corks 15 0 0 Labels •• £39 10 8 Total quantity of water used for all purposes, 287.000 gallons, cost £16 7s. 3d. 63 Total Quantity Manufactured since Installation of Plant. Since the installation of the plant, a period of 18 years, 749,349 gallons of fluid have been manufactured (see footnote) at a cost for electricity of £1,147 7s. 0½d., and materials of £1,442 13s. 1d. Year. Output, gallons. Material, Chloride of Magnesium, Salt, Caustic Soda and Water Cost. Electricity. Total. £ 8. d. £ s. d. £ s. d. 1906 17,000 17 12 5 15 17 10 33 10 3 1907 15,586 14 16 9 14 13 2 29 9 11 1908 28,280 27 14 7 28 7 10 56 2 5 1909 27,216 23 4 7 29 17 7½ 53 2 2½ 1910 50,726 47 11 10 50 10 6 98 2 4 1911 53,063 50 17 9 56 16 7½ 107 14 4½ 1912 54,388 41 7 10 59 14 4½ 101 2 2½ 1913 66,740 62 7 3 71 0 10½ 133 8 1½ 1914 68,795† 59 16 11 75 0 3 134 17 2 1915 36,985† 35 19 3 48 12 0 84 11 3 1916 26,790† 74 4 0 40 3 1 114 7 1 1917 27,900† 75 10 4 44 11 120 1 10½ 1918 30,750† 114 5 9 51 2 8 165 8 5 1919 33,285† 139 4 0 77 7 9 216 11 9 1920 39,255† 153 11 4 105 7 3 258 18 7 1921 51,330† 220 7 10 134 18 8 355 6 6 1922 56,520† 166 0 1 119 13 9 285 13 10 1923 64,740† 118 0 7 123 11 3 241 11 10 Total 749,349 . £l ,442 13 .1 £1,147 7 0½ £2,590 0 1½ Not only are the Public Health Department and other buildings of the Council (the public baths, etc.) furnished with the disinfectant, but the institutions of the Managers of St. Andrew's Hospital and of the Board of Guardians (within and without the Borough) are supplied with an unlimited quantity free, as required. As applicants now usually bring their own receptacles to the depots, there is a very appreciable saving in the expense on bottles. † Since 1914 the fluid has been made of greater strength than originally, and afterwards broken down to half strength for distribution. Quantity distributed:— 1914 88,425 gallons. 1915 73,970 ,, 1916 53,580 ,, 1917 55,800 1918 61,500 ,, 1919 66,570 ,, 1920 78,510 ,, 1921 102,660 ,, 1922 113,040 ,, 1923 129,480 ,, 64 Electrolytic Disinfectant. Estimate for year ended 31st March, 1923. Expenditure for year ended 31st March, 1923. Average Expenditure for 3 years ended 31st March, 1923. Estimate for year ending 31st March, 1924. Estimate for year ending 31st March, 1925. No. £ £ £ £ £ £ £ £ £ £ 1 Wages (Manufacturing, bottling and delivery to Depots, Guardians'Institutions and Sick Asylums) 940 923 909 888 890 1 2 Kent. Rates and Insurance—Main Depot 189 102 125 85 85 2 3 Supervision of Plant 15 15 15 15 15 3 4 Electricity and Water 135 159 143 130 140 4 5 Materials (Chemicals) 190 108 176 200 150 5 6 Bottles, Corks, Wax, Labels and Paste 80 39 62 50 50 6 7 Sundries (including Testing Apparatus and Carboys) 60 128 87 60 60 7 8 Repairs—Depot 100 98 145 150 100 8 9 Repairs—Plant — — — 20 20 9 — 1709 — 1572 — 1662 — 1598 — 1510 10 Issuing—Wagss—(Old Ford Road, Trego Road, Ford Road, Bickmore Street, West Ferry Road, and Stebondale Street Depots) 678 654 671 644 648 10 11 Issuing—Cartage 120 129 119 112 112 11 12 Rent —Issuing Depots (Ford Road, Trego Road and Stebondale Street) 31 34 30 32 32 12 13 Sundries and Petty Expenses 22 19 17 22 20 13 — 851 — 836 — 837 — 810 — 812 2560 2108 2499 2408 2322 14 Less—Sale of Fluid 30 41 33 30 30 14 2530 2367 2466 2378 2292 65 Spraying and Cleansing Floors of London County Council Schools with Electrolytic Disinfecting Fluid. 2,972 gallons were supplied to nine London County Council Public Elementary Schools for spraying and cleansing floors of class rooms. Swimming Baths, the use therein of the Electrolytic Fluid. The fluid continues to be added to the water in the swimming baths in the same quantity and strength as mentioned in the Annual Report for the year 1909, viz., 1 part of Chlorine to 2,000,000 parts of water. 4,457 gallons were supplied to the Poplar Baths, 3,581 gallons to the Bow Baths, and 1,382 gallons to the Island Baths, making a total of 9,420 gallons. VERMINOUS CHILDREN ATTENDING SCHOOLS. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT 1907. CHILDREN ACT 1908. Number of Verminous Children Bathed; Itch Cases. Number of Verminous Children Bathed. Quarter. Total number of Cleansings. Amount. 1923. £ s. d. March .. 503 42 4 0 June 410 37 3 0 September 344 32 10 0 December 405 37 16 0 Totals 1,662 £149 13 0 66 1,076 verminous school children (54 boys and 1,022 girls) belonging to the Borough, and 267 school children (12 boys and 255 girls) residing outside the Borough were bathed and their clothes were disinfested. 286 children (176 boys and 110 girls) and 24 adults (11 male and 13 female) suffering from scabies were similarly dealt with. Miss Tattersall made 71 visits in connection with verminous school children—44 Poplar and 27 Bow and Bromley. Cleansing of Verminous Booms, see pages 45 and 16. Itch Cases. Miss Tattersall made 62 visits in connection with children suffering from itch—37 Poplar and 25 Bow and Bromley. CLEANSING OF PERSONS ACT, 1897. During the year 61 persons (26 men and 35 women—including 24 (7 men and 17 women) from Common Lodging Houses—see below) had applied for baths and for their clothes to be disinfested VERMINOUS PERSONS IN COMMON LODGING HOUSES LONDON COUNTY COUNCIL (GENERAL POWERS) ACT 1907. Number of Persons Cleansed from Common Lodging Houses Within and Without the Borough. The number of persons from Common Lodging Houses within and without the Borough of Poplar, cleansed at the Council's Cleansing Station, Glaucus Street, during the year ended 31st December, 1923 was: Common Lodging House, etc. Male. Female. Total. 215, Bow Road 5 — 5 St. James' Chambers, 217, High Street, Poplar — — — 65, Bow Lane — — — 378, Old Ford Road 2 2 7 — 7 From Common Lodging Houses without the Borough of Poplar — Whitechapel — 17 17 — 17 17 67 LONDON COUNTY COUNCIL (GENERAL POWERS) ACTS 1904 AND 1922.* † Verminous Rooms. Licensed Premises' Urinals. Verminous Rooms. Verminous rooms are still brought to the notice of owners upon the "Intimations" which arc followed, if necessary, by "Statutory Notices," more especially as there are generally other defects upon the premises, and certainly verminous premises are "in such a state as to be a nuisance to health." and owners, if they do not already know, are informed when defects are being dealt with under the Public Health (London) Act, 1891, that the vermin must be got rid of, otherwise the London County Council (General Powers) Acts, will be brought into operation. A fluid insecticide is given and sprayers loaned to tenants in order to rid rooms and contents of bugs. One hundred and forty gallops were distributed during the year. HOUSES LET IN LODGINGS OR OCCUPIED BY MEMBERS OF MORE THAN ONE FAMILY. At the end of the year there were 1,450 houses on the register, including a number of premises occupied by Chinese. The latter premises have been under constant supervision. WATER CERTIFICATES. One certificate was issued under sec. 48 of the Public Health (London) Act, 1891 CUSTOMS AND INLAND REVENUE ACTS, 1890-1891, AND REVENUE ACT 1903. One application for certificates for exemption under the Customs and Inland Revenue Act 1890-1891, and the Revenue Act 1903 was refused during the year. † For the Cleansing of Verminous Rooms, see Tabulated Statements, pages 49 & 47. 68 RATS AND MICE DESTRUCTION. During the organised "Rat Weeks" a large quantity of barium carbonate paste was distributed to applicants, the results being highly satisfactory. Lithographic varnish traps were also used with success. The number of complaints of the presence of rats and mice has greatly diminished. It must be added that every week is a "rat week" in Poplar, and the work of destruction proceeds, principally by the use of barium carbonate paste, which is still being distributed to tenants of houses, where necessary, and is recommended for use in factories, etc. Where rats are still persistent after the use of poison, the ground is opened and the drain examined as a matter of routine. Accumulations of refuse are also directed to be removed. SCHOOLS. Inspection of Schools. The public elementary schools were inspected during the year. A few minor defects were discovered and remedied. RAG FLOCK ACT 1911. No samples of rag flock were procured during the year 1923. OVERCROWDING. A number of cases of overcrowding were reported, but on account of lack of housing accommodation remained unabated. Three cases of overcrowding were found in workshops. GENERAL. 2.143 complaints (including 29 smoke) as to nuisances were made. 3,457 communications on general matters were despatched, and 4,457 in connection with the supply of milk. EXPORT OF MEAT PRODUCTS. Fifty certificates were issued in connection with 44 consignments of foodstuffs: Canada (30 certificates), Philippine Islands (11), Porto Rico (2), Hawaii (1) and Venezuela (6). 69 SUGAR SWEEPINGS. The question of the disposal of sugar sweepings from the holds of ships was raised during the year. The food factories in the Borough were specially visited, and it was ascertained that at one factory damage to bags containing sugar was prevented by the use of slings instead of hooks. At the other factory supplies of sugar came by road and any sweepings were sent away to be destroyed. No information as to the quantity destroyed in 1923 is available. PUBLIC ANALYST'S ANNUAL REPORT, 1923. During the year 762 samples were examined, of which 28 or 3.7 per cent were found to be adulterated. This figure is an increase on recent years, the average for the previous 5 years being 2.1 per cent. It compares favourably with the figures obtained in other Districts, the average in 1922 for the whole of London being 5.3 per cent., and for the whole of England, Scotland and Wales, 6.2 per cent. Seven out of the 762 samples were informally purchased, the others being submitted by the Inspectors in the usual manner. The number of samples examined is in the ratio of 4.7 per 1,000 of the population, as compared with 8.4 per 1,000 for the whole of London, and 3.0 per 1,000 for the whole of England, Scotland and Wales. It is of interest to note that the grosser forms of adulteration are not so prevalent as they were formerly. The decrease is due partly to the increased supervision now exercised by Local Authorities, and partly also to the increasing tendency for the manufacture and purveying of foodstuffs to pass into the hands of large business firms of repute, the goods being frequently sold by the retailer in the original sealed packages distributed by the wholesaler. Preservatives. The use of preservatives in certain articles of food is still very prevalent. From the remarks made at the end of the previous paragraph, it is obvious that the distribution of food from the manufacturer to the consumer now occupies time and necessitates a considerable amount of handling. In the absence of facilities for refrigeration for perishable goods, recourse is frequently had to the use of chemical preservatives. 70 In many instances, undoubtedly, their use is unnecessary, and at times excessive, but for want of authoritative standards, the Analyst in reporting must express opinions based on his own knowledge and experience. One sample of milk only out of the 437 examined was found to contain a preservative, and all were free from artificial colouring matters. Other samples found to contain preservatives are set out in the following table:— Food. Examined. Preserved. Percentage Preserved. Butter 43 22 51.2 Margarine 47 44 93.6 Cake 6 3 50.0 Lemon curd 2 2 100.0 Lemon squash 3 3 100.0 Lime juice cordial 1 1 100.0 Cordials 2 1 50.0 Coffee essence 1 1 100.0 Sausage 13 4 30.3 Fish paste 1 1 100.0 Total 119 82 68.9 Cocoa. Fourteen samples of cocoa powder were examined, all of which contained some form of added alkali. In some cases the cocoa powder was sold as "pure cocoa," and consequently the vendors were cautioned. In one case this called for a protest from the manufacturer, who objected to his product being considered impure. The attitude adopted has always been that when cocoa powder is sold as pure cocoa without any qualifying description of brand or name, it should be the pure product of the cocoa-bean without the addition of any other substance. 71 A small amount of alkali is added to some cocoa powders, and there is a mistaken idea that it renders the powder more soluble in water, the chief result however is to give the liquor a darker colour which looks stronger. These cocoa powders are frequently sold as "soluble" or "Dutch" cocoas, and with such a description, are accepted without complaint. In the United States of America objection is raised to the term "soluble," and the cocoas have to be described as "alkalized" cocoas. Condensed Milk. On 1st November the regulations for the standardization of condensed milk came into force. Under these regulations the various grades of condensed milk must reach definite standards of milk constituents, and it must be stated on the label the amount of fresh milk the contents of the tin are equivalent to. It is to be regretted that no provision is made to compel manufacturers to stamp the tin with the date of manufacture. A. E. PARKES, F.I.C., F.C.S. Public Analyst. 28th February, 1924. 72 FOOD AND DRUGS ACTS. The results of the analyses of 762 samples were reported to the Committee during the year, the samples being as follows:— Sample. Number examined. Doubtful purity and inferior quality. Adulterated. Legal Proceedings. Milk 437 65 15 6 ,, Separated 1 — — — Sterilized 1 — — — ,, Condensed 5 2 — — Cream 1 — — Butter 43 4 1 1 Margarine 47 4 3 1 Cheese 3 — — — Cream Cheese 2 — — — Dripping 3 — 1 — Lard 5 — — — Suet 1 — — — Shredded Suet 2 1 — — Mustard 9 — — — Pepper 9 — — — Cayenne Pepper 1 — — — Vinegar 25 1 3 1 Sauce 2 1 — — Table Salt 1 — — — Cocoa 14 7 — — Coffee 10 — — — Coffee Essence 1 1 — — Cornflour 2 — — — Rice 3 — — — Ground Rice 2 — — — Arrowroot 1 — — — Pearl Barley 5 — — — Tapioca 3 — — — Sago 3 — — — Oatmeal 3 — — — Self—raising Flour 6 — — — Ground Ginger 5 — — — Baking Powder 5 — — — Egg Powder 4 — — — Custard Powder 3 — — — Desiccated Coconut 1 — — — Cake 6 — — — Jam 9 — — — Table Jelly 4 — — — Jelly Crystals 1 — — — Lemon Curd 2 — — — Golden Syrup 6 — 1 — Honey 4 — — — Glycerine 1 — — — Borax 3 — 2 — Citric Acid 1 — — — Milk of Sulphur 1 — — — Carbonate of Soda 2 — — — Cream of Tartar 2 — — — Carried forward 711 87 26 9 73 Sample. Number examined. Doubtful purity and inferior quality. Adulterated. Legal Proceedings. Brought forward 711 87 26 9 Acid Phosphate of Lime 1 — — — Epsom Salts 1 1 — — Goulard's Lotion I — — — Liquorice Powder 1 1 — — Sal Volatile 1 — — — Boracic Ointment 1 — — — Carbolic Ointment 1 — 1 — Sulphur Ointment 1 — — — Zinc Ointment 0 — — — Soap Liniment 1 — — — Lime Water 3 1 — — Prescriptions 3 — — — Camphorated Oil 2 — — — Olive Oil 1 — 1 — Salad Oil 1 — — — Lime Juice 1 — — — Lemon Squash 3 — — — Lemonade Powder 3 — — — Hot Drink Essence 1 — — — Cordial 2 — — — Whisky 1 — — — Mincemeat 2 — — — Chocolates 1 — — — Meat Paste 1 — — — Fish Paste 1 — — — Canned Fish 1 — — — Fresh Sausage 13 1 — — Totals 762 91 28 9 Of the 437 samples of milk, 75 were procured on Sundays from itinerant vendors and 110 from itinerant vendors on weekdays. Five samples purchased from itinerant vendors were not in accordance with the legal standard and proceedings were instituted in two cases, letters of caution being sent in the remaining three. Samples were taken on delivery as follows:—Poplar Institution, 5; St. Andrew's Hospital, 5; Railway Stations, 12; and at canteens of firms in the Borough, 2. In addition two samples were taken on delivery at a dairy by request. All the samples were genuine. 74 Administrative Action taken with regard to Samples reported to be not genuine, etc. March Quarter. No. of Sample. Nature of Sample. Result of Analysis. Result of Legal Proceedings, etc. 160 Cake Contained Boric Acid 0.15 per cent. Letter of caution. — Butter Contained 2.2 per cent. excess of water £5 5s. costs. Summons withdrawn. — Margarine Contained 2.1 per cent. excess of water £2 2s. costs. 390 Olive Oil Contained 1.1 per cent. of water Letter of caution. — Milk Cans not properly labelled Letter of caution. 16 Vinegar Deficient in Acetic Acid 0.3 per cent. Letter of caution. 819 Cocoa Contained 2.5 per cent. added alkali Letter of caution. — Margarine Not properly labelled Letter of caution. 23 Milk Deficient in non-fatty-solids 0.7 per cent. £8 penalty; £3 3s. costs. — Margarine Not properly labelled Letter of caution. 75 June Quarter. No. of Sample. Nature of Sample. Result of Analysis. Result of Legal Proceedings, etc. 851 Borax Contained Arsenic 200 parts per million. Vendors and Ministry of Health informed. - Coffee and Chicory Essence Contained Salicylic Acid 3.5 grains per pint. Wholesalers informed and stock of vendor exchanged for fresh. 152 Margarine Contained Mineral Oil 0.3 per cent. Reported to Ministry of Agriculture. 642 Milk Deficient in non-fatty-solids 0.2 per cent. Letter of caution. 34 Dripping Contained 3.4 per cent. of water Letter of caution. 419 Milk Deficient in non-fatty-solids 0.2 per cent. Letter of caution. 633 Milk Deficient in non-fatty-solids 0.2 per cent. Letter of caution. 637 Milk Deficient in fat 3.3 per cent. Letter of caution. 421 Milk Below average quality and contained formalin 5 parts per million Wholesalers informed. 638 Margarine Contained 16.9 per cent. of water. Letter of caution. Ministry of Health and Ministry of Agriculture informed. 193 Milk Deficient in non-fatty-solids 0.3 per cent. Summons withdrawn; £2 2s. costs. - Cocoa Contained 2.4 per cent. added alkali. Letter of caution. 76 September Quarter. No. of Sample. Nature of Sample. Result of Analysis. Result of Legal Proceedings, etc. 153 Milk Deficient in fat 6.6 per cent. Summons dismissed. Milk sold as given by cow. 199 Margarine Contained about 0.4 per cent. Paraffin Reported to Ministry of Agriculture. No further action. 444 Lime Water Not of B.P. purity Letter of caution. 159 Milk Deficient in fat 5 per cent. Further samples taken on delivery satisfactory. No action. 862 Vinegar Deficient in Acetic Acid 7.5 per cent. Letter of caution. 68 Butter Contained 16.5 per cent. water Letter of caution. 189 Milk Deficient in non-fatty-solids 0.2 per cent. Letter of caution. 190 Soap Liniment Bottle not properly labelled.. Letter to vendor. 676 Butter Contained 16.3 percent. water Letter of caution. 77 December Quarter. No. of Sample. Nature of Sample. Result of Analysis. Result of Legal Proceedings, etc. 187 Milk Deficient in non-fatty-solids 0.7 per cent. Summons withdrawn; £2 2s. costs. 189 Milk Deficient in non-fatty-solids 0.2 per cent. Letter of caution. 488 Liquorice Powder 5 per cent. excess of Sugar. Deficient in liquorice. (Probably due to bad mixing.) Letter of caution. 192 Sulphur Ointment Badly mixed Letter of caution. 79 Carbolic Ointment Deficient in Phenol Letter of caution. 239 Borax Contained 200 parts per million of Arsenic Letter to vendor. 78 Milk Deficient in non-fatty-solids 0-3 per cent. Letter of caution. 80 Self-raising Flour Contained Arsenic 5 parts per million. (See also acid phosphate below.) Letters to vendor and Ministry of Health. (Informal) Acid Phosphate of lime Contained Arsenic 20 parts per million. Letters to vendor and Ministry of Health. 85 Cocoa Contained 2.5 per cent. added alkali. Letter to vendor. 100 Vinegar Deficient in acetic acid 5 per cent. £1 penalty. 485 Milk Deficient in fat 16.6 per cent. 5s. penalty; £2 2s. costs. 486 Margarine Contained 16.9 per cent. water Letter of caution. 210 Milk Deficient in non-fatty-solids 0.3 per cent. Letter of caution. 213 Milk Deficient in milk fat 0.5 per cent. Letter of caution. 709 Cocoa Contained 2.5 per cent. added alkali Letter to vendor. 94 Shredded Suet Contained 26 per cent. dry starch Letter to vendors. (Informal) Condensed Milk Below guaranteed weight; deficient in fat; not properly labelled Letter to vendor. 706 Fresh Pork Sausages Contained sulphur dioxide in the proportion of 4 grains per lb. Letters to vendor, wholesalers. and Ministry of Health. 905 Golden Syrup Contained at least 90 per cent. glucose. No action. (Further sample to be taken.) 78 Public Health (Milk and Cream) Regulations, 1912 and 1917. 1.—MILK; AND CREAM NOT SOLD AS PRESERVED CREAM. * (A) Number of Samples examined for the presence of preservative. (B) Number in which preservative was reported to be present, and percentage of preservative found in each case. Milk 439* One sample contained Formalin 5 parts per million. Letter to wholesale dealers. Cream 1 Nil. * Including 1 separated milk and 1 sterilised. 2 —CREAM SOLD AS PRESERVED CREAM. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i.) Correct statements made (ii.) Statements incorrect (iii.) Percentage of preservative found in each sample Percentage stated on statutory label. No samples of Preserved Cream were taken. (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent. Nil. (ii.) Below 35 per cent. Nil. (c) Instances where (apart from analysis) the requirements us to labelling or declaration of preserved cream in Article V. (2) of the Regulations have not been observed.—Nil. (d) Particulars of each case in which the Regulations have not been complied with, and action taken.—Nil. 3. Thickening Substances.—Any evidence of their addition to cream or preserved cream, action taken where found.—Nil. 79 4. Other Observations, if any.—There is very little demand for cream or preserved cream in this Borough and shopkeepers do not, as a rule, stock these articles. Margarine Act, 1887, Sale of Food and Drugs Act, 1899, and the Butter and Margarine Act, 1907. One application was received to register premises for the carrying on of business of wholesale dealer in margarine. The following is the number of premises in each Sub-District of the Borough registered under the above-mentioned Acts, up to and including 31st December, 1923, viz.:— Sub-District. Margarine. Butter. Wholesale Dealer. Manufacturer. Factory. Wholesale Dealer in Milk-blended. Poplar 6 .. .. .. Bow and Bromley 8 .. 2* 2* Totals 14 .. 2 2 * One not in use at present. 80 legal proceedings. No. of Street, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 70, Broomfield Street Various defects 1923. 12th Jan £1 penalty; £1 1s. costs Grabham, C. A. 74, ditto Ditto 12th Jan £1 penalty; £1 1s. costs Ditto 78, ditto Ditto 12th Jan £1 penalty; £1 1s. cost3 Ditto 22, Eastward Street Ditto 20th Feb 21 days' order; £2 8s. costs Pearce, H. A. 30, ditto Ditto 20th Feb 21 days' order; £2 83. costs Ditto 9, Weston Street Ditto 20th Feb 21 days' order; £2 8s. costs Ditto 23, Yattan Street Ditto 21st Mar Work done; £2 4s. costs Johnson, W. 25, ditto Ditto 21st Mar Work done; £2 4s. costs Ditto 37, Whitethorn Street Ditto 27th Mar 21 days' order; £2 8s. costs Pearce, H. A. 18, Perring Street Failed to provide proper ashpit 27th Mar 10s. penalty; £2 2s. costs Ditto 19, ditto Ditto 27th Mar 10s. penalty; £2 2s. costs Ditto 22, Sherwood Street Various defects 27th Mar 28 days' order; £2 8s. costs Ditto 29, Whitethorn Street Ditto 10th April £2 2s. costs Ditto 29, ditto Clearing eye and iron cover defective 10th April £5 penalty; £2 2s. costs Ditto 21, Portree Street Drain obstructed 17th April £2 2s. costs Johnson, W. 30, Ford Road Various defects 8th May 14 days' order; £2 7s. costs Smith, F. A. 81 No. of Street, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 32, Ford Road Various defects 1923. 8th May 14 days' order; £2 7s. costs Ditto 22, Sherwood Street Failed to comply with Magistrate's order 15th May £5 penalty; £2 2s. costs Grabham, C. A. 170, Devons Road Various defects 23rd May 14 days' order; £2 8s. costs Langley, H. J. 29, Fern Street Ditto 23rd May Work done; summons withdrawn Ditto 37, Blackthorn Street Ditto 4th June 14 days' order; £2 8s. costs Grabham, C. A. 39, ditto Ditto 4th June 14 days' order; £2 8s. costs Ditto 30, Ford Road Failed to comply with Magistrate's order 17th July Work done; £1 1s. costs Smith, F. A. 32, ditto Ditto 17th July Work done; £1 1s. costs Ditto 11, Perring Street Various defects 19th July 7 days' order; £2 8s. costs Pearce, H. A. 12, ditto Ditto 19th July 14 days' order; £2 penalty; £2 8s. costs Ditto 19, ditto Ditto 19th July 21 days' order; £5 penalty; £2 8s. costs Ditto 22, Sherwood Street Failed to comply with Magistrate's order 19th July £25 penalty; £2 2s. costs Pearce, H. A. Smithfields Animal Products Co., Marshgate Lane, West Ham Smoke nuisance 2nd Aug Abatement and Prohibition orders; £2 penalty; £3 10s. costs Field, A. J. 6, Bartlett Street Various defects 20th Aug 7 days' order; £2 8s. costs Johnson, W. 82 No. of Street, etc. Nature of complaint. Date of Decision. Result. Name of Officer. 9, Broomfield Street (1st floor front and back Various defects. (Application for Closing order) 1923. 23rd Aug Closing order made Smith, F. A. 6, Tibbatts Road Main roof and landing ceiling defective 11th Sept 7 days' order; £2 8s. costs Lanyley, H. J. 21, Hawthorn Buildings Various defects 15th Oct 14 days' order; £2 8s. costs Pearce, H. A. 23, ditto Ditto 15th Oct 14 days' order; £2 8s. costs Ditto 17, Cordelia Street Ditto 15th Oct 14 days' order; £2 8s. costs Grabham, C. A. 18, ditto Ditto 15th Oct 14 days' order; £2 8s. costs Ditto 19, ditto Ditto 15th Oct 14 days' order; £2 8s. costs Ditto 43, Market Street Ditto 24th Oct 14 days' order; £2 8s. costs Johnson, J. 8, Harley Street Ditto 22nd Nov 7 days' order; £2 8s costs Field, A. J. 36, Hewlett Road Ditto 11th Dec 14 days' order; £2 7s. costs Smith, F. A, 38, ditto Ditto 11 th Dec 14 days' order; £2 7s. costs Ditto 17, Eagling Road Drains defective 19th Dec Dismissed; system held to be a "sewer"; £5 5s. costs against Council Langley, H. J. 83 HOUSING, TOWN PLANNING, ETC., ACT, 1919, STATEMENT OF RATES ACT,1919. No. of Street, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 45, Portree Street Collected rent, name and address of M.O.H. not on rent book. 1923. 4th July 10s. penalty; 10s. costs Johnson, W. 23, Perring Street Demanded rent, name and address of M.O.H. not on rent book 30th July 10s. penalty; 10s. costs Pearce, H.A. 23, Perring Street (two rooms on first floor) Demanded rent, amount of rates not stated on rent book 30th July 10s. penalty; 10s. costs Ditto 23, Perring Street (three rooms on first floor) Ditto ditto ditto 30th July 10s. penalty; 10s. costs Ditto 12, Perring Street Ditto ditto ditto 19th July £1 penalty; £1 1s. costs Ditto 45, Portree Street Collected rent, name and address of M.O.H. not on rent book 9th Aug £2 penalty; £2 10s. costs Johnson, W. 84 INDEX. Page Age Mortality 5 Analyst's Report 69 Anthrax 30 Antitoxin, quantity issued 21 Bacteriological Examinations 21 Bakehouses 59 Births 3 & 4 Canal Boats 60 Cerebro-spinal Meningitis 31 Cleansing of Verminous Persons, etc. 65 Committees v. Continued and Typhus Fevers 31 Customs and Inland Revenue Acts 67 Dairies, Cowsheds, and Milkshops 57 Death Rate amongst infants visited 6 Deaths and Death Rates 3 Deaths, Classified Causes, Tables 10 ,, Infantile, Tables 12 Dentist's Reports 40 Diarrhoea and Enteritis, Deaths 5 Diphtheria 20 & 21 Disinfectant, Electrolytic 61 Disinfecting Department 60 Electrolytic Disinfecting Fluid 61 Encephalitis Lethargica 31 Erysipelas 30 Export of Meat Foods 68 Food and Drugs Acts, etc. 72 Food, Preparation or Sale, etc. 57 Free Milk Scheme 43 Glanders 30 Hairdressers' Premises 58 Health Visitor, Chief, Report of 32 Houses Let in Lodgings 67 Housing Acts 48 Housing Inspectors' Reports 42 Hydrophobia 30 Ice Cream 58 Infantile Mortality 6 Infectious Diseases, Tables of Notifications 18 Inquests and Deaths from Violence 7 Legal Proceedings 80 Marriages 3 Maternity and Child Welfare 32 Milkshops, etc. 57 Mortuary 7 Notification of Births Act 3 Notifications of Infectious Diseases, Tables 18 Ophthalmia Neonatorum 31 Overcrowding 68 85 Page Plague 30 Poliomyelitis, etc. 31 Population 3 Puerperal Fever 31 Rag and Bone Dealer, Byelaws 58 Rag Flock Act 68 Rats and Mice Destruction Act 68 Reports:— Chief Health Visitor 32 Clinic Dental Surgeon 40 Public Analyst 69 Senior Medical Officer, Royal College of St. Katharine 37 Tattersall, Miss A. 44 Tuberculosis Officer 21 Sanitary Inspectors' Work, Summary 45—47 Scarlet Fever 20 & 21 Schools, Inspection of 68 ,, Use of Electrolytic Fluid in 65 Slaughterer of Poultry, Byelaws 59 Slaughterhouses, Byelaws 59 Small-pox 30 Smoke Nuisances 59 "Spotted Fever" 31 Staff vi. & vii. Sugar Sweepings 6??? Swimming Baths, Use of Electrolytic Fluid in 65 Tables A to F (Workshops, etc.) 51—53 Tables of Deaths 9—17 ,, Infectious Diseases 18 Tuberculosis Dispensary 27 ,, Officer's Report 21 ,, Regulations, Notifications, etc. 28 Typhoid Fever 20 & 21 Vaccination 30 Verminous Children and Persons 65 Verminous Rooms 67 Vital Statistics, Summary viii. Tables 8—17 Water Certificates 67 Workshops, Workplaces, etc. (Tables A to F) 51—56 Zymotic Diseases, Notifications, etc. 18