PoP 31 Metropolitan Borough of Poplar. Annual Report for the YEAR 1925 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. Councillor E. I. Lansbury, J.P., Mayor (ex-officio). Councillor T. J. Good way (Chairman). Councillor Mrs. J. Mackay (Vice-Chairman). Councillor J. Ashley. Councillor G. A. Newton. ,, T.J. Blacketer. ,, J. T. O'Callaghan. ,, J.A.Hammond. ,, C. Petherick. ,, Mrs. E. M. Lambert. ,, J. Rogers. Alderman Miss M. Lester. ,, Mrs. J. Scurr, J.P. Councillor Mrs. J. A. March. Alderman C. A. Tanner. Councillor W. J. Whitelock. MATERNITY AND CHILD WELFARE COMMITTEE. Councillor E. I. Lansbury, J.P., Mayor (ex-oflicio). Councillor Mrs. E. M. Lambert (Chairman). Councillor G. A. Newton (Vice-Chairman). Councillor D. M. Adams. Councillor Mrs. J. Scurr, J.P. ,, T.J. Blacketer. ,, W.J. Whitelock. ,, Mrs. N. F. Cressall. Alderman Miss M. Lester. Go-opted Members: Councillor Mrs. J. A. March. Miss E. Herbert. ,, J. Rogers. 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. PARKES, F.I.C., F.C.S. Chief Clerk: HAROLD DYER.† Sanitary Inspectors: (a) H. A. Tibbatts.* (a) Wm. Johnson.*‡ (b) C. A. Grabham.*‡ (a) J. Johnson.*§ (a) A. J. Field.† (b) H. A. Pearce.*†§‡ (a) C. H. Brown.*†‡§ (a) W. BOYCE.† (b) F. A. Smith.*‡ (a) H. J. Lanoley.* Miss M. E. davies.*†! (a) Inspector under the Food and Drugs Acts (to 1st June) and the Canal Boats Acts. (b) Housing Inspector (to 1st June) and Food Inspector (from 2nd June, 1925). Clerks: F. J. White.* H. C. Rodford. H. A. Purdy. W. F. Roberts. Miss S. Fells. Miss E. Hamilton. A. Hamilton. Offices—Caretaker and Messenger: J. J. Jackson. 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. *Cert. S.I.E. Board. † Cert R.S.I. ‡ Cert. Meat and Food Inspector. § R.P.C. ! C.M.B. II H.V. Cert. (Board of Education). NOTE.—Contributions under the Public Health Acts or by Exchequer Grants are made towards the salaries of the Medical Officer of Health, Sanitary Inspector?, the Maternity and Child Welfare and the Tuberculosis Dispensary Staff's. vii MATERNITY AND CHILD WELFARE. Chief Health Visitor: Miss J. M. CARDozo.*!†† Health Visitors: Miss E. A. FosKErr.*! Mrs. M. J. Edoell.§! Miss M. Mallett.* Mrs. E. K. Haythornthwaite.*! Miss G. E. PAicE.*†† MlSS D. A. E. landray.*!† Clerk: Miss G. Hood. There are three Doctors, one Dental Surgeon and an Amæsthetist attending the Council's Clinics. Free Milk Scheme. Temporary Clerks: Miss R. Williams. Miss M. L. Thompson. Investigation and Enquiry Officer: C. A. Webster (temporary). TUBERCULOSIS DISPENSARY, 1, WELLINGTON ROAD. Tuberculosis Officer: W. C. P. Smith, B.A. (Camb.), M.R.C.S., L.R.C.P., D.P.H. (Camb.). Assistant Tuberculosis Officer: C. K. Ccllen, M.R.C.S., L.R.C.P. Health Visitors: Miss H. Messem. Miss D. Wood.} Miss N. Roberts.** Dispenser: Clerks: Mrs. A. M. Smith. Miss E. S. Jones. Miss A. Rogers. Secretary to Care Committee: Miss l. Nugent. Nurse-Helper: Caretaker: Mrs. E. Tomlins (temporary). J. Tyler. *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 1925. Area of Borough (excluding water) 2,136 acres Population (Census, 1921) 162,618 Population, estimated to middle of 1925 168,500 Density 79 Number of Marriages 1362 Number of Inhabited Houses (Census, 1921) 23,064 Number of families or separate occupiers (Census, 1921) 37,288 Rateable Value £947,552 Sum represented by a penny rate (April, 1926) £3,833 Total M. F. Births—Legitimate 3,765 1,930 1,8351 Birth Rate 22.7 —Illegitimate 66 34 32 Deaths 1,970 1,049 921 Death Rate 11.7 Number of women dying in, or in consequence of, { from sepsis 5 childbirth { from other causes 7 Deaths of Infants under one year of age, per 1,000 births:— *Legitimate, 71. Illegitimate, 4. Total, 75. Deaths from Measles (all ages) 27 ,, Whooping.Cough (all ages) 60 ,, Diarrhoea (under 2 years of age) 51 *Legitimate (per 1,000 legitimate births) 72 Illegitimate (per 1,000 illegitimate births) 227 Metropolitan Borough of Poplar Comprising the Registration Sub-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 33rd Annual Report. It refers to the year 1925. Births.—The birth-rate has declined continuously since 1920, and last year reached the low figure of 22.7. Mortality.—The rate of mortality at all ages was 11.7 per 1,000 population; this is the second lowest rate recorded for the Borough. The infant mortality rate was 75 per 1,000 nett births, an increase on the figure for the preceding year (72). Deaths from cancer numbered 191 (104 male, 87 female), as against 211 (115 male, 96 female) in 1924. Deaths from tuberculosis and from diseases of the respiratory system were fewer than in the previous year. Whooping-cough deaths increased to 60. Infectious Diseases.—Notifications of infectious diseases were in excess of the number for 1924, the increase in the number of cases of erysipelas, pneumonia and zymotic enteritis more than balancing the reduction in scarlet fever and diphtheria. Tuberculosis.—The report of the Tuberculosis Officer is quoted in extenso. The number of new cases coming to the knowledge of this department shows a decrease. 2 Two tuberculosis patients who died were not notified (1.0 per cent. of the total deaths from tuberculosis), and thirteen other cases were notified only after death. X-Ray Apparatus.—In the early part of the year the Dispensary X-ray apparatus was overhauled and made to comply with the requirements of the National Physical Laboratory, Teddington, at a cost of a little over £100. Motor Vehicles.—The horse-driven disinfecting vans have been superseded by two motors (Morris Standard Vans). Previously a horse was hired daily. The old vans had been in use for over 30 years, and were nearing the end of their tether. A one-ton (Morris) lorry has also been purchased for delivering electrolytic disinfectant from the Dep6t to the distributing centres. This replaces the arrangement of hiring a horse and van. Removal of human bodies from foreshore.—During the year, the arrangements as to removal of human bodies cast ashore from any of the tidal waters belonging to the Borough were reviewed and, after advertising, the tender of a local undertaker to remove any such body at any time, and also if necessary to remove bodies of persons dying in their homes from an infectious disease, to the Council's Mortuary, for a flat rate of £2 per body was accepted. Verminous Second-hand. Bedding.—On account of complaints as to the sale from stalls of dirty and filthy second-hand bedding, the Council suggested to the London County Council that powers be obtained to deal with such nuisances. Education and Propaganda.—Two film displays upon public health matters (arranged by the British Social Hygiene Council) were given during March—one each at the Town Hall, Poplar and Bow Baths. During the evenings of September 28th and 29th, four outdoor film displays were given through the kindness of the Bermondsey Borough Council. These were followed by a three-days' Health Exhibition and series of lectures and film displays in the Poplar Town Hall. During the three days, talks were given to approximately 1,200 senior schoolchildren. The speakers at the open public meetings included Lady Barrett ("Ante-Natal Care"), Dr. C. W. Saleeby ("Sunlight and Health"), Dr. 3 Stenhouse Williams ("Clean Milk"), and Sir William Collins ("Public Health"). The Exhibition included :— (a) The Travelling Exhibition of The Central Council for Infant and Child Welfare. (b) An exhibit upon milk provided by the National Milk Publicity Council. (c) A milk exhibit provided by the National Institute for search in Dairying, Reading. (d) Display of garments made in the Council's Maternity and Child Welfare Clinics. (e) Exhibit by the British Social Hygiene Council. (f) An information bureau. In addition, the public were invited to view the Council's Artificial Sunlight Centre, and through the kindness of the Principals, the Royal College of St. Katharine, and the Children's House, Eagling Road. In connection with the Campaign, a handbook of general public health information was compiled, and a copy distributed to every house in the Borough. In co-operation with the Libraries Committee, 5,000 bookmarks, showing the health facilities available in the Borough and giving some "health hints," were distributed through the Public Libraries, and a page in the Library "Quarterly Record" was reserved for public health information. Maternity and Child Welfare.—An Artificial Sunlight Treatment Centre was opened on 20th March, 1925, at the Parish Hall, Avenue Road, Bow. The work of this Centre is dealt with in the body of my report. A new and commodious clinic for North Poplar has been erected at the rear of Nos. 134 and 136, High Street (this was officially opened on 12th January, 1926), and sanction has been obtained from the Ministry of Health for the establishment of a second artificial sunlight clinic. The clinic is described in my report. 4 Plans for the proposed Observation Wards to be erected in the grounds of No. 1, Wellington Road have been approved, and estimates as to the cost of furnishing and maintenance have been submitted to the Ministry of Health. Estimates for the building are now being obtained by the Borough Surveyor. The Council has resolved that on and after 1st January, 1926, all milk supplied to mothers and children under Circular 185 shall be Grade "A" (Tuberculin Tested). Electrolytic Disinfectant Depot.—The old wooden structure has been demolished and replaced by a more extensive solid building, and additional plant installed. Staff.—No change has taken place in the personnel of the Staff during the year. Miss E. A. Sheppard was appointed temporarily as Nurse-inCharge of the Artificial Sunlight Clinic. Mr. C. A. Grabham and Mr. H. A. Pearce, who were originally appointed as "Housing" Inspectors, were appointed as "Meat and Food" Inspectors, and relieved the District Sanitary Inspectors of all duties relating to the Sale of Food and Drugs Acts, meats and foods, with the exception of those duties they are bound by statute to carry out. Special Reports.—During the year I have issued the following special reports :— 1. "Salt and Bread—Lack of Iodine." 2. "Practical Artificial Light Treatment—Quantity and Quality of Ultra-Violet Rays." 3. "A Simple Portable Photometer for Gauging Intensity of Ultra-Violet Rays"—"U-V. Scope." 4. "Twenty Years' Working of the Electrolytic Disinfecting Plant of Poplar." Public Analyst.—The Public Analyst's Report in connection with the Sale of Foods and Drugs Acts, etc., is given in full. 6 Bacteriological Examinations.—The arrangements with the Seamen's Hospital, Greenwich, for carrying out bacteriological examinations (other than Tubercle) continue to be satisfactory. I'am, Sir, Ladies and Gentlemen, Your obedient Servant, Medical Officer 0f Health. Public Health Offices, Bow Road, E 3, March, 1926 PART I. Vital Statistics. 8 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 168,500, giving a density of 79 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 4,602,000. BIRTHS. Early in the year 1926 the Registrar-General supplied the following information relating to the year under review : — Registered Inward Transfers. Outward Transfers. Mett.  Total Births—Males 1,728 247 11 1,914) 3,831 Females 1,659 221 13 1,867) Illegitimate —Males 27 7 — 34) 66 Females 28 7 3 32 The birth-rate per 1,000 population was 22.7 as against 34.1, 27.2, 26.6, 25.6 and 22.9 for the years 1920-1924. During the year 3,505 notifications were received under the Notification of Births Act, 1907. MARRIAGES. During the year the marriages of 2,724 persons were registered, giving a rate of 16.2, as against 18.7, 16.2, 15.0, 16.1 and 15.3 in the five years 1920-1924. DEATHS. 1,973 deaths were registered as having occurred in the Borough. 311 deaths of non-residents must be deducted and 308 deaths of Poplar residents which occurred outside the Borough must be added, giving a nett total of 1,970 and a rate of 11.7 per 1,000 of the estimated population. 9 It should be borne in mind. when studying death rates, that comparisons should be made with those ot districts the inhabitants of which live under similar conditions. See Table III, East Districts. 1920. 1921. 1922. 1923. 1924. 1925.  Deaths from all causes, rate per 1,000 population 14.7 12.7 14.3 11.3 121 11.7 Deaths under 1 year of age, rate per 1,000 net births 82 83 79 60 72 75 Deaths over 65 years of age, rate per 1,000 total population 8.3 6.8 81 3.6 3 9 41 Zymotic diseases:— Death rate per 1,000 population 1.3 1.5 1.5 0.6 0.8 0 9 Proportion of 1,000 deaths 92.7 125.3 110.9 58.5 65.7 75.6 Tuberculosis, all forms:— Death rate per 1,000 population 1.6 1.3 1.3 1.2 1.2 11 Proportion of 1,000 deaths 112.2 105.7 94.4 103.7 97.9 96.9 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 3.6 2.6 3.6 2.4 3.2 2.9 Proportion of 1,000 deaths 250.8 208.6 254.6 212 7 265.4 246.2 Deaths from Various Diseases. Disease. 1920. 1921. 1922. 1923. 1924. 1925.  Measles 33 39 62 22 37 27 Whooping.Cough 50 29 88 7 39 60 Influenza 53 16 86 22 48 20 Pneumonia, all forms 235 193 260 163 230 185 Diarrhoea and Enteritis (all ages) 55 112 28 41 30 54 *Smallpox, Measles, Scarlet Fever, Whooping.Cough, Diphtheria and Mem. Croup, Typhoid Fever and Diarrhœal Diseases. 10 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." 1925. 17th Jan. St. Andrew's Hospit- Female, 28. Gall stones and suppura- al, of barge "Trent." tion in gall bladder. Pneumonia. P.M. Inquest. 8th July. River Thames, off Male, newly-born Haemorrhage from cord. Morton's Wharf. (unknown Want of attention at parentage). birth. P.M. Inquest. 26th Sept. In street, at Oban Male, 7 days. Suffocation. Murder by Street. some person unknown, P.M. Inquest. 15th Oct. Scandinavian Male, 28. Acute lobar pneumonia. Sailors' Home, of Chronic tuberculosis. Norway. P.M. Inquest. 7th Nov. St. Andrew's Hospit- Male, 65. Diabetes. Diabetic co al, of no fixed abode. ma. Pneumonia. 11 INQUESTS AND DEATHS FROM VIOLENCE. The number of inquests held in the Borough was 280. From this total must be deducted 95 non-residents, and 31 added of residents who died outside the Borough, the nett total being 216. Verdict of Violence :— Railways 2 Vehicles and horses 25 Ships, boats and docks 0 Building operations 2 Conflagrations 0 Burns, scalds and explosions 5 Drowning (excluding suicides) 9 Suffocations in bed 1 Poisons and poisonous vapours 2 Other causes 29 Suicides 10 Murder 4 Manslaughter 1 Total 90 Verdict of Natural Causes (including deaths from disease accelerated by accident, etc) 126 Total 216 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 281. All were inquest cases. Residents. Non-Residents.*  No age stated 0 0 Stillborn 1 0 Under 1 year 22 1 1 to 5 years 20 0 5 to 15 years 22 1 15 to 25 years 18 0 25 to 65 years 124 2 65 years and upwards 65 5 Totals 272 9 *Brought from outside the Borough for the convenience of the Coroner. 12 Deaths during 1925 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 Quarter 2nd Quarter 3rd Quarter 4th Quarter Total.  Poplar Sub-District 140 88 75 117 420 Bow and Bromley Sub-District 121 67 77 120 385 St. Andrew's Hospital 242 141 135 214 732 Poplar Institution 33 23 26 28 110 Bow Institution 45 41 33 39 158 Bromley House Institution — — — — — Poplar Hospital 27 28 27 28 110 Adelaide Buildings - - - - - Baffin ,, - - - - - Council ,, — — — 1 1 Grosvenor ,, 3 3 1 — 7 Hanbury ,, 2 — — — 2 Hudson ,, - - - - - Melbourne ,, - - - - - Montreal ,, — — 1 — 1 Ontario ,, — — — 1 1 Ottawa ,, — 1 — — 1 Prestage ,, — — — 1 1 Quebec ,, — — — 1 1 Sydney ,, — — 1 — 1 Toronto ,, - - - - - Wellington ,, - - - - - Winnipeg ,, - - - - - River Thames — 3 5 2 10 „ Lee — 1 — — 1 Limehouse Cut 1 — — — 1 Bow Creek - - - - - Ducketts Canal 1 2 — — 3 East India Docks - - - - - West India Docks — 1 4 — 5 Mill wall Docks 1 — — — 1 L. M- & S. Railway 1 1 — — 2 L. & N. E. Railway — I — — 1 Highways 8 3 3 3 17 Poplar Baths — 1 — — 1 625 405 388 555 1973 Deaths occurring outside the Borough of persons belonging thereto .. add 75 74 69 90 308 Deaths occurring within the Borough of persons not belonging thereto deduct 117 67 64 63 311 Deaths at all ages—nett 583 412 393 582 1970 13 TABLE I. Vital Statistics during 1925 anil Previous Fears. Poplar (Whole Borough). Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the Borough. Transferable Deaths.+ Nett Deaths belong, ing to the Borough. Uncorrected Number. Nett. Of Non-residents registered in the Borough. Of Residents not registered in the Borough. Under 1 Year of Age. At all Ages. Number. Rate. Number.* Rate. Number.* Rate per 1000 Nett Births. Number.* Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13  1920 (159,766 (159,941 5107 5457 341 2318 14.5 410 444 447 81 2352 14.7 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 166,400 3842 4256 25 6 1928 11.6 418 370 255 60 1880 11.3 1924 167,300 3 412 3831 22.9 2122 12.7 442 343 277 72 2023 12.1 1925 168,500 3387 3831 22.7 1973 11.7 311 308 288 75 1970 11.7 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. † "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 dictrict 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 fixed or usual residence of the parent. (3) Deaths from violence are referred (a) to the district of residence, under the genernl 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 occui red, if known ; and (d) failing this, to the district where the body was found irea of District in acres (land and inland water) 2327.7 Total population at all ages 162,618 Number of inhabited houses 23,064 Average number of persons per house 7.05 At Census of 1921. Total families or separate occupiers 37,288 14 15 TABLE II. METROPOLITAN BOROUGH OF POPLAR The Borough. 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 b years. 5 to 10 vears. * 10 to lb years. l5 to 20 years. 20 to 3b years. 3b to 4b years. 4b to 65 years. 65 years and over Poplar. Bow and Bromley. Poplar Institution. St. Andrew's Hospital. Bow Institution. Bromley House Institution. Poplar Hospital. See Footnotes. Outlying Institutions. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 All causes Certified 1968 1968 288 88 41 26 9 29 30 37 140 122 469 689 .. .. 104 684 2 .. 43 14 306 1153 Uncertified 2 2 .. .. .. .. .. .. .. .. .. 1 .. 1 2 .. .. .. .. 2 2 1 Enteric Fever .. M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. f .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Small-pox .. M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Measles 27 M 13 5 5 1 2 .. .. .. .. .. .. .. .. 9 18 .. 16 .. .. .. .. .. 16 f 14 2 6 3 2 .. 1 .. .. .. .. .. .. 4 Scarlet Fever .. M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Whooping Cough 60 M 20 5 8 6 .. 1 .. .. .. .. .. .. .. 38 22 .. 22 .. .. .. .. 8 30 F 40 16 16 4 2 1 1 .. .. .. .. .. .. 6 Diphtheria 8 M 1 .. .. 1 .. .. .. .. .. .. .. .. .. 5 3 .. 1 .. .. .. .. 7 8 F 7 .. 1 1 1 3 1 .. .. .. .. .. 7 Influenza 20 M 13 .. .. .. .. .. .. 1 .. 1 .. 5 4 12 8 2 3 .. .. .. .. 1 6 F 7 .. .. .. .. .. .. .. .. .. .. .. 4 8 Encephalitis lethargic 3 M 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. 2 .. .. .. .. .. 2 F 1 .. .. .. .. .. .. .. .. .. .. .. .. 9 Meningococcal Meningitis 5 M 1 .. .. .. .. .. .. 1 .. .. .. .. .. 3 2 .. 2 .. .. .. .. 3 5 F 4 1 1 .. .. .. .. .. 1 .. • • .. .. 10 Tuberculosis of respiratory sys 157 M 84 2 2 .. 3 76 81 2 50 .. .. 1 .. 39 92 f 73 1 1 1 1 i 11 24 16 .. 2 11 Other Tuberculous Diseases 31 m 19 3 4 *• 3 .. 2 3 .. .. .. .. .. 19 15 .. 15 .. .. .. .. 14 29 F 15 I 5 b 2 .. .. .. .. .. • • • • .. 12 Cancer, Malignant disease 101 m 104 .. .. .. .. .. .. .. .. .. .. .. 48 100 91 5 81 .. .. 4 .. 24 114 F 87 .. .. .. .. .. .. .. .. .. .. .. 41 13 Rheumatic Fever 12 M 2 .. .. .. .. .. .. 1 .. .. .. 1 .. 6 6 .. 5 .. .. 1 .. 3 9 F 10 .. .. .. .. .. .. .. .. 1 1 1 14 Diabetes 10 M 3 .. .. .. .. .. .. .. .. .. .. .. .. F 7 .. .. .. .. .. .. .. .. 1 .. 1 1 15 Cerebral haemorrhage, etc. 60 M 26 .. .. .. .. .. .. .. .. .. .. 3 4 8 2 .. 5 .. .. .. .. 2 7 F 34 .. .. .. .. .. .. .. .. .. .. 11 15 16 Heart Disease 203 m 98 .. .. .. .. .. .. .. .. 1 1 9 23 36 24 7 18 .. .. 2 .. 4 31 F 105 .. .. .. .. .. .. 1 .. 3 7 29 58 17 Arterio-selerosis 105 M 61 .. .. .. .. .. 1 2 1 10 11 31 49 105 98 32 25 1 .. 2 2 (a 26 88 F 44 .. .. .. .. .. .. • • .. .. 1 6 54 18 Bronchitis 286 m 153 17 4 2 1 .. .. .. .. .. .. 6 38 63 42 21 55 .. .. 1 1 (b 10 88 f 133 12 2 1 2 .. .. .. 1 3 8 40 77 10 Pneumonia (all forms) 185 m 106 30 11 6 2 .. .. 1 .. .. 2 36 77 140 146 16 142 1 .. .. .. 5 164 F 79 22 13 3 1 .. 1 1 3 2 2 31 17 20 Other Respiratory Diseases 14 M 11 .. .. .. .. .. 2 2 2 7 2 13 11 94 91 5 74 .. .. 4 .. 17 100 V 3 .. .. .. 1 1 1 .. .. 2 .. 8 .. 21 Ulcer of Stomach or Duodenum 14 m 10 .. .. .. .. .. .. .. • • .. .. 1 1 9 5 1 2 .. .. .. .. 4 7 f 4 .. .. .. .. .. .. .. 1 .. 1 7 1 22 Diarrhoea, etc. 54 m 28 23 4 1 .. .. .. .. .. 2 .. .. 2 3 11 .. 5 .. .. .. .. 4 9 F 26 22 2 .. 1 .. .. .. .. .. .. .. .. 23 Appendicitis and Typhlitis 11 m 6 .. .. .. .. .. .. .. .. .. .. .. 1 23 31 .. 32 .. .. 4 .. 14 50 f 5 .. .. .. .. .. 1 3 1 .. .. 1 .. 24 Cirrhosis of Liver 3 M 1 .. .. .. .. .. .. .. 1 1 1 2 .. 4 7 .. 9 .. .. .. .. 2 11 F 2 .. .. .. .. .. .. .. .. .. .. 1 .. 25 Acute and Chronic Nephritis 43 m 25 .. .. .. .. .. .. .. .. .. .. 1 1 1 2 .. .. .. .. .. .. .. .. F 18 .. .. .. .. .. 1 1 2 .. 2 9 10 26 Puerperal Sepsis 5 m .. .. .. .. .. .. .. .. .. 2 3 7 6 25 18 1 16 .. .. 2 •• 7 26 F 5 .. .. .. .. .. .. .. .. .. .. .. .. 27 Other accidents and diseases of pregnancy and parturition . 7 M .. .. .. .. .. .. .. .. .. 5 .. .. .. 3 2 .. 2 .. .. •• .. 2 4 F 7 .. .. .. .. .. .. .. .. .. .. .. .. 28 Congenital Debility and malformation, premature birth 90 m 63 62 .. 1 .. .. .. .. .. 3 4 .. .. .. .. .. .. .. .. .. .. .. .. f 33 31 1 .. .. .. .. 1 .. .. .. .. .. 2 5 .. 2 .. .. .. .. 2 4 29 Suicide 10 m 9 .. .. .. .. .. .. .. .. .. .. .. .. 44 52 6 22 .. .. .. .. 21 49 F 1 .. .. .. .. .. .. .. .. 2 1 6 .. 7 3 1 .. .. .. 1 3 3 8 30 Other Deaths from Violence 77 M 56 4 1 .. 2 1 5 1 1 .. .. .. .. F 21 3 1 3 2 .. 2 1 2 9 5 15 11 42 35 1 21 .. .. 12 (c) 6 (d) 2 (e) 20 60 31 Other Defined Diseases 269 5 m 133 16 2 1 1 .. 4 4 .. 1 2 .. 6 F 136 10 1 1 1 1 1 3 2 8 12 30 53 137 132 4 57 .. .. 8 66 137 32 Causes ill-defined or unknown 1 M 1 .. .. .. .. .. .. .. 3 9 8 27 71 F .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 .. 1 Deaths from all Causes M 1049 167 39 19 11 2 17 18 15 65 65 279 352 .. F 921 121 49 22 15 7 12 12 22 75 58 190 338 Totals .. 1970 288 88 41 26 9 29 30 37 140 123 469 690 1017 953 104 684 2 .. 43 14 308 1155 (a) Highway, 1; Recreation Ground, Bow and Bromley s.D., 1. (b) Highway. (c) Duckett's Canal,1; River Thames,2. (d) Highway,3. River Thames, 1; River Lee,l: West India Docks,1 (e) Highway,2. 16 The following death rates for the year 1925 are interesting when compared with one another:— Annual Rate per 1,000 persons living. Deaths of Children under one year of age to 1,000 Births.  Poplar Borough 11.7 75 * England and Wales 12.2 75 *105 Great Towns ‡ 12.2 79 *157 Smaller Towns 11.2 74 *London 11.7 67 *Liverpool 13.7 98 *Manchester 14.1 92 *Edinburgh 14.5 96 *Glasgow 14.8 102 *Dublin 15.4 111 *Belfast 14.0 104 *Provisional figures furnished by the Registrar-General. ‡ Including London 17 TABLE III. (1925). Cities and Boroughs. Estimated population to the middle of year. 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 4,602,000 18.0* ? 11.7* 67* West Districts. Paddington 147,100 15.9 0.4 12.1 72 Kensington 179,600 15.8 0.5 13.2 78 Hammersmith 134,500 17.5 0.7 11.9 65 Fulham 163,700 16.9 0.5 10.7 76 Chelsea 64,820 14.4 0.4 13.6 69 City of Westminster 139,600 10.7 0.37 12.3 69 North Districts. St. Marylebone 106,100 14.1 0.5 11.6 63 Hampstead 88,040 12.0 0.19 10.2 55 St. Pancras 215,900 17.9 0.8 12.7 72 Islington 339,200 19.4 0.39 12.26 63 Stoke Newington 53,190 15.8 0.34 11.2 61 Hackney 228,300 17.9 0.49 10.9 65 Central Districts. Hoi born 43,315 12.16 0.43 12.51 63 Finsbury 77,560 22.6 0.8 13.6 59.8 Oity of London 13,340 7.5 0.53 11.8 60 East Districts. Shoreditch 107,300 24.6 1.2 13.3 88 Bethnal Green 119,800 21.9 1.3 12.0 80.6 Stepney 255,370 21.2 0.94 11.9 73 Poplar 168,500 22.7 0.9 117 75 South Districts. Southwark 189,000 21.2 0.9 13.1 77 Bermondsey 123,000 23.4 ? 12.6 78 Lambeth 311,100 24.6 0.5 12.1 44.8 Battersea 172,100 18.5 0.4 10.5 58.1 Wandsworth 340,900 14.31 0.33 10.43 52 Camberwell 275,400 17.7 0.5 11.1 64.7 Deptford 115,900 18.8 0.8 12.1 63 Greenwich 103,936 18.8 0.57 11.23 70 Lewisham 185,600 15.6 0.3 10.3 55 Woolwich 140,740 18.3 0.4 10.8 55 *These provisional figures are taken from a table furnished by the Registrar. General. Other figures supplied by Medical Officers of Health. 18 TABLE IV. Birth-rate, Death-rate, and Analysis of Mortality During the Year 1925. Birthrate per 1,000 Total Population. Annual Death-rate per 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. Diarrhoea and Enteritis (under 2 years). Total Deaths under One Year. Causes of Death Certified by Registered Med ical Practitioners. Inquest Cases. Uncertified Causes of Death.  England and Walesf 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 0.32 0.47 8.4 75 92.1 6.9 1.0 105 County Boroughs and Great Towns, including London † 18.8 12.2 0.01 0.00 0.17 0.03 0.18 0.09 0.30 0.43 10.8 79 92.1 7.3 0.6 157 Smaller Towns (adjusted Populations 20,000.50,000) † 18.3 11.2 0.01 0.00 0.15 0.02 0.14 0.06 0.31 0.38 7.6 74 93.0 5.9 1.1 London † 18.0 11.7 0.01 0.00 0.08 0.02 0.19 0.11 0.23 0.46 10.6 67 91.1 8.9 0.0 Poplar Borough 22.7 11.7 — — 0.16 — 0.36 0.05 0.12 0.52 138 75 88.9 11.0 0.1 * 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 1925, while those for the towns have been calculated on populations estimated to the middle of 1924. 19 TABLE V. METROPOLITAN BOROUGH OF POPLAR. Total Deaths (at all ages) in Public 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 72 390 131 81 674 F 38 342 27 29 436 Uncertified M - — — — F — — — — — 1. Enteric Fever M — CLOSED. —- — F — — — — 2. Small-pox M — — — F - — — 3. Measles M - 9 — 9 F 7 — 7 4. Scarlet Fever M — — — F - - - — — 5. Whooping Cough M - 11 — 11 F - 18 — 18 6. Diphtheria M - 1 — 1 F - — — — 7. Influenza M 1 2 — 1 4 F 1 1 — 1 3 8. Encephalitis Lethargica M - 1 — — 1 F 1 — — 1 9. Meningococcal Meningitis M - 1 — 1 F - 1 — 1 10. Tuberculosis of respiratory system M 2 25 1 1 29 F — 26 — — 26 11. Other Tuberculous Diseases M 9 — — 9 F 6 — 4 10 12. Cancer, malignant disease M 2 49 6 7 64 F 3 39 2 1 45 13. Rheumatic Fever M - 1 — — 1 F - 4 1 5 14. Diabetes M 1 1 — 2 F 4 — — 4 15. Cerebral haemorrhage, etc. M 6 9 — 4 19 F 2 10 — 1 13 16. Heart Disease M 20 16 60 1 97 F 14 12 15 2 43 20 TABLE V. (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. Poplar Institution. St. Andrew's Hospital. Bow Institution. Bromley House Institution. Poplar Hospital. Total deaths in Public Institutions within the Borough.  17. Arterio-sclerosis M 16 29 7 CLOSED. 1 53 F 16 27 1 — 44 18. Bronchitis M 15 80 19 2 116 F 3 82 2 — 87 19. Pneumonia (all forms) M 3 48 5 9 65 F 2 25 — — 27 20. Other Respiratory Diseases M 1 3 1 — 5 F — — 21. Ulcer of Stomaoh or Duodenum M — 3 _ 3 6 F — 2 — 2 22. Diarrhoea, etc. M — 18 1 3 22 F — 14 1 2 17 23. Appendicitis and Typh- 1 litis M — 5 1 6 F — 4 1 5 24. Cirrhosis of Liver M — — — — — F 25. Acute and Chronic Nephritis M — 9 7 2 18 F 1 7 2 1 11 26. Puerperal Sepsis M - F 3 3 27. Other accidents and diseases of pregnancy and parturition M __ F — 2 1 — 3 28. Congenital Debility and malformation, promature birth M 4 14 18 F 2 9 — — 11 29. Suicide M 1 1 1 3 F - 30. Other Deaths from Violence M 15 3 38 56 F 1 6 10 17 31. Other Defined Diseases M 1 30 20 6 57 F 3 32 3 5 43 32. Causes ill-defined or unknown M — 1 1 F — — — — — All causes M 72 390 131 81 674 F 38 342 27 29 430 Totals .. 110 732 158 110 1110 PART II. Infectious Diseases, etc. 22 TABLE VI. METROPOLITAN BOROUGH OF POPLAR. The Borough. Cases of Infectious Disease notified during the Year 1925. Notifiable Disease. Cases Notified in Whole Borough. Total cases notified in each Sub-District. No. of Cases removed to Hospital from each Sub-District. At all Ages. 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. Smallpox — — — — — — — — — — — — — — — — — — Cholera (C), Plague (P) — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 329 4 17 31 40 32 110 57 17 18 2 1 — 199 130 194 125 319 Erysipelas 77 1 2 — 2 — 4 3 3 10 15 28 9 40 37 16 19 35 Scarlet Fever 453 4 22 24 51 64 178 71 17 19 2 I — 247 206 246 205 451 Typhus Fever — — — — — — — — — — — — — — — — — — Enteric Fever 1 — — — — — — — — 1 — — — — 1 — 1 1 Relapsing Fever — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — Puerperal Fever 14 — — — — — — — — 13 1 — — 7 7 7 4 11 Cerebro-Spinal Meningitis 6 2 — 1 — — — 1 1 — — 1 — 3 3 3 2 5 (a)Acute Poliomyelitis & (b) Acute Polioencephalitis 2 1(b) — 1(a) — — — — — — — — — 1(b) 1(a) — — — Acute Encephalitis Lethargica 6 — — — — — — — 1 2 3 — — 4 2 — 1 1 Ophthalmia Neonatorum *43 43 — — — — — — — — — — — 34 9 2 2 4* Zymotic Enteritis 134 57 36 11 10 7 5 4 1 2 — 1 — 80 54 12 8 20 Anthrax 1 — — — — — — — — — — 1 — 1 — 1 — 1 Trench Fever — — — — — — — — — — — — — — — — — — Pneumonia (all forms) 637 86 91 44 43 39 71 34 28 64 29 72 36 398 239 133 144 277 Malaria 2 — — — — — — — — — 2 — — — 2 — 1 1 Dysentery — — — — — — — — — — — — — — — — — — Totals 1705 198 168 112 146 142 368 170 68 129 54 105 45 1014 691 614 512 1126 Pulmonary Tuberculosis 262 4 1 — 1 3 9 12 29 96 50 53 4 Other forms of Tuberculosis 84 4 12 12 6 7 11 19 3 4 3 2 1 191 155 — — — Totals 2051 206 181 124 153 152 388 201 100 229 107 160 50 1205 846 — — — Note:- Cases reported "not suffering," etc., are excluded from the above table * One case whicb occurred in a. lying-income outside the Borough not included here. 23 INFECTIOUS DISEASES. Notifications. There were 1,705 notifications of cases of infectious diseases, excluding 72 second notifications and 57 cases in which diagnosis was not confirmed. The notification rate was 10.1, as against 13.8, 12.9, 6.6, 9.2, and 9.8 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. Puerperal Fever. Zymotic Enteritis. Pneumonia (all forms). Poplar Institution 9 .. 1 .. .. .. .. 1 7 .. 1* .. .. .. 1* 3* St. Andrew's Hospital 7 1† 1 5† .. .. .. .. .. 1** .. 5** .. .. .. .. Bow Institution 3 .. 1 .. .. .. .. .. 2 .. .. .. .. .. .. .. Bromley House Institution Closed .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Langley House, 54, East India Dock Road 7 .. .. 7 .. .. .. .. .. .. .. 7** .. .. .. .. Poplar Hospital 2 1† .. 1† .. .. .. .. .. 1** .. 1** .. .. .. .. Admitted intoSt. Andrew's Hospital. ** Removed to M.A.B. Hospitals. † Staff. Infectious Diseases in Milkshops and Homeworkers' Premises. Five cases of infectious disease (3 scarlet fever, I diphtheria and 1 erysipelas) were connected with milk shops. One case of diphtheria was associated with an itinerant vendor of milk. 24 25 premises with outworkers were connected with infectious cases: 10 diphtheria, 12 scarlet fever, 2 erysipelas, and 1 measles. 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. Removal of Cases of Notifiable Diseases to Hospital. Disease. M.A.B. Hospitals Poor Law Institutions General Hospitals etc. Total Removals Percentage of cases notified. Diphtheria 317 1 1 319 97.0 Erysipelas 1* 33 1 35 45.4 Scarlet Fever 450 — 1 451 99.5 Enteric fever — 1 — 1 100. Puerperal Fever 5 4 2 11 78.6 Cerebro-spinal Fever — 2 3 5 83.3 Encephalitis Lethargica 1 — — 1 16.7 Ophthalmia Neonatorum 3 1 — 4 9.3 Pneumonia 1 271 5 277 43.5 Malaria — 1 — 1 50. Anthrax — — 1 1 100. Acute Poliomyelitis, etc. — — — — — Zymotic Enteritis — 18 2 20 14.9 Totals 778 332 16 1126 65.9 N.B.—Cases reported to bs "not suffering" have been exclulel from above table. * Admitted with scarlet fever. 26 Comparative Mortality. Diphtheria Scarlet fever Enteric fever Cases notified 698 1,400 17 1920 Deaths 59 14 4 Mortality rate per cent 8.4 1.0 23.5 Cases notified 648 1,423 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 Cases notified 348 460 8 1924 Deaths 2 6 1 Mortality rate per cent. 5.7 1.3 12.5 Cases notified 329 453 1 1925 Deaths 8 0 0 Mortality rate per cent. 2.4 0.0 0.0 BACTERIOLOGICAL EXAMINATIONS. 1,312 swabbings from doubtful cases of diphtheria were examined. Of these 151 gave positive results (11.5 prr cent). No blood specimens from doubtful cases of enteric fever were examined. DIPHTHERIA ANTI-TOXIN. 172,000 units of diphtheria anti-toxin were issued to medical practitioners during the year. 26 SMALLPOX. No cases of smallpox were notified during the year under review. VACCINATION. The Vaccination Officer, Mr. P. Ryan, has kindly furnished me with the following:— Total number of medical certificates of successful primary vaccinations in respect of persons of all ages received was 762. 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 was treated 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. 77 cases of erysipelas were notified during the year. Seven deaths occurred. 27 PUERPERAL FEVER. Number of Cases. Fourteen cases of puerperal fever were notified. Five patients died. . CONTINUED AND TYPHUS FEVERS. No cases of continued fever occurred. No case of typhus fever occurred. SPOTTED FEVER. EPIDEMIC CEREBRO-SPINAL MENINGITIS .* Six cases occurred. Five patients died from the disease, and the other patient died from croupous pneumonia and pneumococcal meningitis. ACUTE POLIO -MYELITIS, OR ACUTE POLIO -ENCEPHALITIS AND ACUTE ENCEPHALITIS LETHARGICA. One case of acute polio-myelitis and one of polio-encephalitis were notified. Six cases of encephalitis lethargica occurred. Three of the cases died from the disease. Two other patients died :—One, carcinoma of lung nnd brain and one from meningococcal meningitis. (This latter was notified as cerebro spinal meningitis, and is included under that heading.) These are not included in the six cases. MEASLES. 772 cases of measles were reported to the Medical Officer of Health from various sources (principally from L.C.C. schools). 27 deaths were attributed to measles. * Posterior basal meningitis is included in the term " cerebral-spinal fever," which does not include meningitis due to tuberculosis, syphilis, middle ear disease, or injury. 28 DISINFECTING DEPARTMENT. Rooms and Articles (Infectious and Verminous) Disinfected. The following figures give the number of rooms and articles disinfected:— Rooms. Beds. 1 Mattresses and Palliasses. Pillows. Bolsters. Various. Totals. Infectious Disease 911 884 402 2616 932 10711 15545 Miscellaneous 95 458 130 871 188 3567 5214 Totals 1006 1342 532 3487 1120 14278 20759 Pulmonary Tuberculosis 381 43 6 111 40 462 662 Totals 1387 1385 538 3598 1160 14740 21421 Other articles also passed through the Council's apparatus, from the Shelter, Glaucus Street : Disinfectors' clothing, overalls, drop-sheets, etc., to the number of 8,850, and 25,830 articles of clothing from verminous persons were disinfected, making a total of 56,101 articles. 313 articles were destroyed at the Council's apparatus at the request of Relieving Officers. At the request of the London County Council, the Council undertook to disinfect old tramway uniforms from the Poplar and Bow Tramway Depots, at a charge of 2d. per overcoat and Id. for other garments. ELECTROLYTIC DISINFECTANT FLUID. At the seven depots the electrolytic fluid was still in great demand by the public. On account of the increasing demands for the fluid, the wooden structure which was erected in 1912 has been demolished and replaced by a larger building of reinforced concrete with a lighted roof, and the site has been purchased. The building is 60 feet long, 30 feet wide, and 12 feet to the eaves. It contains a lobby for employees' garments, messroom and lavatory accommodation. An additional plant consisting of five 30-amp. graphode electrolysers has been purchased from Messrs. Mather & Piatt, Manchester. At the end of the year I presented to the Public Health and Housing Committee a special report upon "Twenty Years' Working of the Electrolytic Disinfectant Plant of Poplar" in which the work of the old and new plants is fully described. During the year 1925, 72,165 gallons were manufactured and broken down to 144,330 gallons for distribution. 29 Distribution of Fluid. The fluid was distributed as follows:— galls. Violet Road Depot 75,817 Biekmore Street Depot 14,025 Old Ford Road Depot 10,341 Ford Road Depot 5,538 Trego Road Depot 6,000 Stebondale Street Depot 5,325 Millwal Depot 924 Public Health Offices 105 Poplar Baths 4,241 Bow Baths 3,919 Island Baths 2,295 Violet Road Baths 180 Wick Lane Baths 239 Empson Street Baths 672 Open Air Bath, Bromley 996 ,, ,, Millwall 100 Poplar Town Hall 147 Bromley Public Hall 165 Works Department 144 Guardians' Offices 378 Poplar Institution 5,458 Langley House 350 Poplar Training School, Hutton 111 Public Libraries 4 ???4 Used at Council's Shelter in baths of verminous persons 652 London County Council Schools 3,310 Mortuary, High Street, Poplar 424 Borough of Poplar Tuberculosis Dispensary 16 Royal College of St. Katharine 264 Private Firms in Borough 856 C uncil Offices, Poplar 264 Finance Department Offices 75 Kingsley Hall 63 Bow War Pensions Office 36 North Poplar Clinic 102 Artificial Sunlight Clinic 9 Howrah House Convent 200 Bow Relief Offices 103 Children's House 9 144,330 30 Cost of Material and Electricity. The cost of materials and electricity for manufacturing the electro lytic fluid was as follows:— £ s. d. Electricity, 15,057 units at l½d. per unit (with 40-50 per cent. advance) 133 13 9 Chloride of Magnesium, 10 tons 3 cwts. 1 qr. 10 lbs. 55 15 10 Salt, 15 tons, 0 cwt. 0 qrs. 57 7 6 Caustic Soda, 17 cwt. 0 qrs. 16 lbs. 28 9 1 Water (72,165 gallons) 3 18 0 Total cost of materials and electricity to produce 72,165 gallons (strong); broken down to 144,330 gallons 279 4 2 Electric motor for stirring ; 415 units 3 12 8 Bottles, Corks and Labels. Bottles 22 14 3 Corks 12 10 0 Labels 6 0 0 £41 4 3 Total quantity of water used for all purposes, 218,000 gallons, cost £11 16s. 2d. 31 Total Quantity Manufactured since Installation of Plant. Since the installation of the plant, a period of 20 years, 891,864 gallons of fluid have been manufactured (see footnote) at a cost for electricity of £1,417 3s. 2£d., and materials of £1720, 10s. 8d. Year. Output, gallons. Materials, Chloride of Magnesium, Salt, Caustic Soda and Water Cost. Electricity. Total. £ 8. d. £ 8. 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 21 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 0 101 133 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 6½ 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 1924 70,350† 132 7 2 136 2 5 268 9 7 1925 72,165† 145 10 5 133 13 9 279 4 2 Totals 891,864 £1,720 10 8 £1,417 3 2½ £3,137 13 101 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 male 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 ,, 1924 140,700 ,, 1925 144,330 ,, 32 Electrolytic Disinfectant. Estimate for year ended 31st March, 1925. Expenditure for year ended 31st March, 1925. Average Expenditure for 3 years ended 31st March, 1925. Estimate for year ending 31st March, 192l. Estimate for year ending 31st March, 1927. No. £ £ £ £ £ £ £ £ £ £ 1 Wages (Manufacturing, bottling and delivery to Depots, Guardians' Institutions and Sick Asylum) 890 954 932 900 879 1 2 Rent, Hates and Insurance—Main Depot 85 113 105 90 82 2 3 Supervision of Plant 15 15 15 15 15 3 4 Electricity and Water 140 165 157 140 250 4 5 Materials (Chemicals) 150 140 122 • 150 250 5 6 Hottles, Corks, Wax, Labels and Paste 50 63 55 50 55 6 7 Sundries (including Testing Apparatus"and Carboys) 60 67 82 60 70 7 8 Repairs—Depot 100 94 86 20 80 8 9 Repairs—Plant 20 10 3 20 10 9 1510 1621 l557 1445 1691 10 Issuing—Wages—(Old Ford Road, Trego Road, Ford Road, Bickmore Street, West Ferry Road, and Stebondale Street Depots) 648 635 645 654 606 10 11 Issuing—Cartage 112 154 140 120 — 11 12 Rent—Issuing Depots (Ford Road, Trego Road and Stebondale Street) 32 36 35 32 36 12 13 Sundries and Petty Expenses 20 1 6 20 5 13 14 Repairs—Issuing Depots — 202 75 — 100 14 812 1028 901 826 747 2322 2649 2458 2271 2438 15 Less—Sale of Fluid 30 37 35 30 35 15 2292 2612 2423 2241 2403 33 Spraying and Cleansing Floors of London County Council Schools with Electrolytic Disinfecting Fluid. 3,310 gallons were supplied to eight London County Council Public Elementary Schools for spraying and cleansing floors of classrooms. 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. 4,241 gallons were supplied to the Poplar Baths, 3,919 gallons to the Bow Baths, 2,295 gallons to the Island Baths, and 1,096 gallons to the open-air swimming baths, making a total of 11,551 gallons. Mill wall Open-Air Swimming Bath An open-air swimming bath was opened at Millwall on 26th June, 1925. On account of complaints as to the serious condition of the water, the District Sanitary Inspector and myself made many visits, and on the 13th July, 1925, I communicated with the London County Council, pointing out that the water was exceedingly dirty and that the bathers complained of the slimy condition of the sides and bottom of the bath and steps. I also submitted to the London County Council a report by Mr. A. E. Parkes, the Public Analyst, upon some samples of the water. There is no doubt that the state of affairs which was existing was a menace to the public health. 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. Number of Children Cleansed. Total number of C leans ings. Amount. 1925. £ s. d. March 376 500 43 5 0 June 342 400 37 5 0 September 301 320 31 8 0 December 367 428 40 3 0 Totals 1,386 1,648 £152 1 0 31 In 1,412 of the cleansings a special comb was used. (143 boys, 1,26i> girls.) Miss Davies made 116 visits in connection with verminous school children—65 Poplar and 51 Bow and Bromley. For cleansing of verminous rooms, see pages 51 and 64. Itch Cases. Miss Davies made 72 visits in connection with children suffering from itch—45 Poplar, and 27 Bow and Bromley. CLEANSING OF PERSONS ACT, 1897. During the year, 48 persons—including 47 (8 men and 39 women) from common lodging houses—see below) had applied for baths and for their clothes to be disinfected. 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 was:— Common Lodging House, etc. Male. Female. Total. 215, Bow Road — — — St. James's Chambers, 217, High Street, Poplar 2 — 2 65, Bow Lane — — — 378, Old Ford Road — — — 2 — 2 From Common Lodging Houses without the Borough of Poplar— Whitechapel 6 39 45 6 39 45 SHELTER AND CLEANSING STATION. During the year no persons were accommodated at the shelter. 35 TUBERCULOSIS. Report of Dr. W. G. 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 ana visiting stations; a list of the Tuberculosis Officers employed; a statement of the number 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.—1, Wellington Road, Bow. (2) Staff. Tuberculosis Officer: W. C. P. Smith. Assistant Tubeiculotis Office)': C. K. Cullen. 3 Health Visitors. 1 Dispenser. 1 Care Secretary. 1 Clerk. 1 Assistant Clerk. 1 Part-time helper (female). 1 Caretaker. (3) Residential Institutions: (a) Sanatoria —hospitals and homes available under the L.C.C. scheme for both pulmonary and non-pulmonary cases. (b) The Poor Law Infirmary (St. Andrew's Hospital). (c) Occasional In-patient letters for hospitals or homes, obtained from charitable sources. (ii.) In the case of administrative counties, precise particulars of arrangements for co-operation with Sanitary Authorities and their officers. The L.C.C. is the County Administrative authority. (iii.) The nature and extent of co-operation with general and special hospitals, school clinics, and other institutions. 36 (a) General Hospitals.—Under the London County Council scheme, the dispensary is "linked" to the London Hospital for consultative purposes, and cases presenting special difficulty or requiring special methods of investigation are referred there for opinion. Also under an old agreement between the Borough Council and the London Hospital, surgical cases and certain others can be sent to the Hospital for investigation and necessary treatment. Cases of lupus are, by special arrangement, treated at the London Hospital at the expense of the Borough Council on the Tuberculosis Officer's recommendation. A fee of 5s. per application of the Finsen Light is charged, and continuance of the treatment beyond 12 applications requires a further authorisation from the Tuberculosis Officer. Recently, it has been found! advantageous in some cases to combine general light treatment, by lamps other than the Finsen lamp, with the local application of the Finsen Light, and a charge of Is. for each application of such treatment has been authorised. This combination is said to shorten the duration of the whole treatment and is therefore not likely to lead to any increase in the cost. During 1925, one new case of lupus was recommended for treatment, while eight old cases were carried over from the previous year. A total of 302 applications of light were given. (b) Special Hospitals.—The Tuberculosis Officer is visiting physician to the tuberculosis wards of St. Andrew's Hospital. Patients who are being treated by the artificial pneumothorax method, attend either Brompton or Victoria Park hospitals for refills. A charge of 10s. is made for each refill. Cases of non-tuberculous pulmonary disease are, when necessary, referred by card or Out-patient letter to Victoria Park Hospital, or, in the case of children, to one or other of the Children's hospitals, but not under any special arrangement. (c) School Clinics.—Arrangements for the treatment of minor ailments and defects, e.g., tonsils and adenoids, otorrhoea, etc., among school children, are in the hands of the Divisional School Medical Officer and the School Care Committees. Cases requiring such treatment are brought to the notice of the Divisional Medical Officer, who deals with them. 37 The scheme of co-operation between the dispensary and the School Medical Service explained in last year's report, has continued to work well. 177 children, either of the unsatisfactory type, or children who are living in contact with a definite case of tuberculosis, have been referred to the Divisional Medical Officer to lie kept under observation, and useful reports have been received from time to time on their progress. By these means the Tuberculosis Officer obtains information concerning the condition of child contacts whom he has not been able to examine himself, and is also informed as to subsequent progress of those contacts who were apparenty healthy when examined at the dispensary, while reports on the progress of the "unsatisfactory" children help him to decide whether further investigation of their cases at the dispensary is required or not. (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 with him 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 may prove useful. In all cases, whether insured or uninsured, referred to the dispensary for investigation, a report is sent by the Tuberculosis Officer to the patient's doctor, giving the result of the investigation. 761 such reports to private practitioners were sent during the year. Co-operation with insurance practitioners in respect of their panel patients has been continued under the scheme outlined last year. By means of the appropriate form the panel doctor is notified whether his patient is (1) Under observation at the dispensary, (2) being sent to sanatorium or hospital, (3) being placed under Domiciliary (viz., panel doctor) Treatment, (4) given Dispensary Treatment, or (5) placed under "general supervision" by the Tuberculosis Officer, no active treatment being required. As soon as possible after a patient's return from sanatorium a copy of the sanatorium report on his case is sent to the panel doctor, with a statement as to what further treatment is considered necessary. 38 In all oases on "Domiciliary Treatment," the panel doctor is asked to furnish periodical reports on the patients' progress and the need for continued or altered treatment. In addition, these patients are examined periodically by the Tuberculosis Officer. On December 31st, 1925, 250 patients were receiving " Domiciliary Treatment." (v.) The arrangements for following up patients in cases where the diagnosis is doubtful. Arrangements for following up cases in which the diagnosis is doubtful vary according to circumstances. Generally speaking, an effort is made by means of frequent physical and sputum examinations, to come to an early decision, but this is not always possible, especially with children. If this method is not successtul and the case is an urgent one. a recommendation to the London County Council for admission to hospital for observation for diagnosis is made, or the case, especially if surgical tuberculosis is suspected, is referred as an out-patient to the London Hospital for a further opinion. In cases where there is no urgency and where the lack of a definite diagnosis does not imply a corresponding lack of proper treatment, the patient is discharged from further attendance but is kept under general observation in conjunction with his own doctor, if he has one. He is advised to return for further examination after a suitable lapse of time—3 or 6 months—when, if he does not come, it is generally found possible to get him to do so by means of a letter or visit. Cases of this kind among school children are referred, as described above, to the Divisional School Medical Officer to be kept under observation by the School Medical Officers, generally for a period of six months, after which they are returned to the Tuberculosis Officer unless circumstances render an earlier return advisable. (vi.) The arrangements for securing the examination and systematic supervision of " home contacts Contacts are examined at the Dispensary as soon as possible after a case is notified. Arrangements for their attendance are made by the Health Visitor when visiting the home or by letter, and the convenience of the patients themselves is studied as far as possible with regard to the time of attendance. Child contacts of school age, whether already examined by the Tuberculosis Officer and found to be apparently healthy, or unexamined, are passed on to the Divisional School Medical Officer for observation, to be reported on in due course. 441 contacts were 39 examined at the dispensary during the year, 18*2 being adults and the remainder children. In addition, a number of unexamined contacts were referred to the Divisional School Medical Officer. (vii.) Information as to special methods of diagnosis and treatment in use and the number of persons to whom these special methods hare been applied. The X-Rav installation has continued in use for diagnostic purposes. No other special methods have been employed. (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. Definite cases of tuberculosis requiring dental treatment are referred to the Council's Dental Clinic, a special session for tuberculous patients being held each week. As soon as possible after diagnosis, patients who need it are sent for dental treatment in order to get done what is essential to put the mouth in order before their possible admission to sanatorium. The provision of new dentures is a matter for later consideration, which can, as a rule, be left until the patient's return home. The arrangements for defraying the cost of dentures are in the hands of the Care Committee. (x.) Any arrangements for the provision of nursing or of extra nourishment for patients living at home. The Council provides nursing in certain cases of children up to 10 years of age. For older children and adults, no special provision exists and the services of a district nurse must be relied on. Extra nourishment has been provided for a number of cases for varying periods. Dried milk (Ambrosia), eggs, red bone marrow and glycolecithin have all been given, but it is found that the two latter preparations quickly pall on the patients who almost without exception ask to have them changed for eggs after a short time. The amount of expenditure sanctioned by the Ministry of Health, viz.: £2 per 1,000 of the population has hitherto been found to be adequate. This is largely owing to the number of patients who are in receipt of relief 40 from the Guardians, who make them an additional allowance for extra nourishment. The number of patients to whom nourishment has been furnished from the Dispensary during the year is 54, and 12 of these were still receiving it on December 31st. (xi.) The arrangements for treating noil-pulmonary tuberculosis especially tuberculosis of bones and joints in adults and in children, ana for the prorision of surgical apparatus, etc. Xon-pulmonary cases which can suitably be treated as out~patient6 are referred for treatment to the London Hospital under the arrangement already referred to. Cases requiring residential treatment are dealt with under the London County Council's scheme. Cases of tuberculosis of the skin, as stated above, are sent to the London Hospital for Finsen or other light treatment. No special arrangements exist for the provision of surgical apparatus. Generally speaking, what is required is provided through the almoner's office of the hospital where the patient has been under surgical treatment. In the event of any difficulty, the matter would be referred to the Care Committee for them to deal with. (xii.) The arrangements for "care" and "after care" and their working. Care and after care are in the hands of the Tuberculosis Care Committee, which meets fortnightly at the dispensary and considers all cases in which assistance of any sort is required. The Committee is appointed annually by the Borough Council and is composed of representatives from the Council, together with one or more representatives from each of the public bodies or voluntary organisations interested in social work in the district. The London Insurance Committee and the local panel practitioners are also represented. The services of the Committee are available for all; cases of tuber culosis occurring in the borough, provided the patients themselves are willing to accept them. Twenty-one meetings were held during the year, at which 449 cases were considered. 195 recommendations regarding assessment for residential treatment were submitted to the London County Council. 41 Assistance through the Committee has been obtained for 30 patients requiring dentures. The cost has been paid by the Guardians in 17 cases, by the Borough Council in two cases, and by the Red Cross Society in four cases. In other cases, grants have been obtained from the approved societies, the Hospital Sunday Fund, the Hospital Savings Association, the Society for the Relief of Distress, etc., etc. The Council has supplied on loan, beds and bedding to patients who have been advised to sleep separately, but who have not the means of arranging this for themselves. Sixteen patients have been assisted in this way during the year and, in addition, two shelters have been obtained and erected by the Council in the patients' own yards or gardens on the Committee's recommendation. The Committee have found very helpful the scheme recently inaugurated by the London County Council for boarding out in the country children living in infected homes, and children due to be discharged from sanatoria whose homes are temporarily unsuitable for their return. The scheme has only been in operation since April, but during the period April 1st to December 31st, 26 children were accepted for boarding out. Arrangements for placing the children are in the hands of the Invalid Children's Aid Association. (xiii.) Particulars as to any local arrangements for finding employment for -patients. No local arrangements exist for finding employment, for patients, apart from the Labour Exchanges, which hitherto have not been of much service to the tuberculous patient. In accordance with suggestions emanating from the Ministry of Health, patients returning from sanatoria fit for non-laborious occupations, have been sent to the Exchange with a special letter from the Tuberculosis Officer, stating the type of work for which they are suitable, accompanied, where possible, by a certificate of freedom from infection. None of them has, so far as I know, obtained work by this means. When, as now, there is a great scarcity of work for the physically fit, it is hardly to be expected that, apart from philanthropic schemes, special jobs should be forthcoming for the tuberculous. It has been possible, thanks to the Poplar Guardians, to arrange the admission of several patients to the Papworth Colony, in the hope that they may find suitable work there under specially favourable conditions. While some of these are unable to settle down, or are found unsuitable and return home, several others, notably women, appear to 42 have settled contentedly with such prospect of permanency as fully justifies the policy of sending them. Five women patients are at present at Papworth. One has been there over two years and another over one year. Two Poplar patients have for some time been successfully employed at the Spero Leather Workshop, under the management of the Central Fund for the Industrial Welfare of Tuberculous Persons. (xiv.) Statement as to the supply and supervision of shelters at the homes of patients. Shelters are provided by the Borough Council for suitable cases where there is a garden or yard in which they can be placed. Two new shelters have been supplied on loan during the past year and four altogether were out on loan on December 31st. The Health Visitors in whose districts the homes are situate, have the general supervision of these shelters, and see that they are properly used. (xv.) Any special points noted locally as to the incidence of tuberculosis (i.e., occupation) No special incidence in relation to occupation has been noted. (xvi.) Any special methods adopted or proposed for the prevention of tuberculosis. The methods used for the prevention of tuberculosis have as their objects (a) the prevention of infection; (b) the improvement of general health and raising of the resistance to the disease of those exposed to infection. The provision of spit-cups or Masks and of disinfectant, the arrangement of separate sleeping accommodation with the provision of beds and bedding where necessary, the removal of infectious cases to hospital, or of contacts from the infected home, the disinfection of rooms, bedding, etc., the reference of weakly and ailing children to suitable agencies for treatment or convalescence, advice on general hygiene, and where possible, the improvement in housing conditions, all help towards the accomplishment of one or both of these objects. (xvii.) Special difficulties encountered. The most pressing difficulties are still those concerned with the finding of suitable employment for the tuberculous worker, and of finding adequate housing and sleeping accommodation for affected 43 families, in many of which the members are so crowded together as to give the sick ones small chance of recovery, while condemning the healthy to an unfair risk of infection. In reviewing the work of the past five years, a definite improvement both in method and results is to be seen. The number of new notifications has shown a steady and fairly rapid decline since the abnormal war years and those immediately following. So far as the Dispensary is concerned, the number of definite cases discovered in 1925 is the smallest in any year since it opened in 1912. This may fairly be taken to mean that there is less tuberculosis in the borough. That it is not due to any lessened activity on the part of the dispensary service is apparent in the records, where the figures relating to investigation and supervision, e.g., physical and bacteriological examinations, visits of Doctors and Health Visitors, correspondence with practitioners, etc., are larger, indicating that more time and attention have been given to individual cases. This has been facilitated by getting rid of a large number of chronic chest cases, not definitely tuberculous, from the dispensary books. There has been an improvement in regard to the number of contacts examined, while the scheme of co-operation with the School Medical Service has brought about better supervision of child contacts already examined at the dispensary, and makes use of the specially favourable position of the School Medical Officer to secure the examination of those whom the Tuberculosis Officer has not been able to get hold of. There has been a marked increase recently in the proportion of insured to uninsured cases, both in attendances and in new cases coming for examination. This would seem to imply that insured persons are being given more careful consideration in relation to tuberculosis, and that co-operation between panel doctors and the dispensary is closer— due perhaps to the recent elaboration of the scheme. The provision of dental treatment at the Council's Clinic has been a decided step in advance, and there is no reason now, outside his or her predilection, why any tuberculous patient should suffer the additional handicap of septic teeth. The adoption by the Council of the Ministry of Health's proposals with regard to the provision of extra, nourishment has been the means of giving valuable help to special cases, where the patients have remained at, or returned to work, and are consequently not in receipt of any grant from the Guardians. 44 On the social side also improvement may be recorded. The Care Committee has shown increasing keenness and efficiency since first appointed by the Council in 1920, and is now fully representative of the various agencies likely to be of service to patients and their families, so that whatever help is possible within the limits of its powers is forthcoming. The addition to the dispensary staff of a salaried officer especially for "care work" and to act as secretary to the Care Committee, has greatly facilitated the organisation and carrying out of the social side of the work. The recently increased facilities for the removal of children from infected homes through the medium of the Invalid Children's Aid Association should prove of considerable value from the point of view of prevention. A general increase in the efficiency of the dispensary service during the past five years may, I think, fairly be claimed. STATISTICS FOR 1925. Attendances at Dispensary (Insured, 2,043; Uninsured, 4,148 6,191 New patients examined 1,335 Contacts examined 441 Notifications by Tuberculosis Officer:— Pulmonary, 172; Non-pulmonary, 18 190 Patients sent away for Sanatorium Treatment 237 Patients away in institutions, 31st December 113 Patients receiving Domiciliary Treatment, 31st December 279 Patients receiving Dispensary Treatment, 31st December 162 Under observation pending diagnosis. 31st December 16 In receipt of extra nourishment during the year 54 In receipt of extra nourishment, 31st December 12 Health Visitors' Visits 9,178 Doctors' Visits 331 Sputum examinations made (Dispensary, 1,682; Public Health Department, 229) 1,911 Reports sent (to Practitioners, 767; to Public Authorities, 1,349) 2,116 W. C. P. SMITH, Tuberculosis Officer. 45 REPORT OF DENTAL SURGEON. Mr. C. Hammond Williams, in his Annual Report for the year 1925 on the work carried out at the Tuberculosis Dental Clinic at Old Ford states:— Our figures are as follows :— New Sessions Fillings Teeth Attendances. Patients. Held. Inserted. Extracted. Scalings. 262 54 50 113 271 93 Compared with 1924 an increase can be noted in some instances; for example, in attendances, fillings and scalings. Fewer Sessions have been held by two, and the number of new patients has dropped slightly. It will be seen that the ratio of work done to the number of attendances is good, at the same time the number of attendances is distinctly poor. The difficulty of sanatorium treatment and dental treatment overlapping still exists, and I am convinced that the only remedy is for dental treatment to be available at sanatoria. I note that this is possible in some cases, but not in many. We find great difficulty also in getting patients notified for gas extractions to turn up when sent for. The number of failures to attend on these ocpasions is too great, and though they are given two further opportunities to attend on the following gas days, they seldom put in an appearance. It seems a pity that these patients should not avail themselves of the free benefits offered, but we have no authority to make dental treatment compulsory, of oourse, and we can only persevere in the education and enlightenment of such cases, on the importance of oral hygiene in their physical condition. Dentures are supplied to patients attending the Tuberculosis Dental Clinic at the same low cost as for the Maternity and Child Welfare Dental Clinic. A difficulty has arisen in this respect. The scale of costs in force is very much lower than that allowed by the Insurance Societies and the Public Dental Service Association of Great Britain. Under the scale used by the latter bodies, certain stipulations are made on the subject of materials, etc. Our scale precludes the use of the same materials absolutely; it is necessary, therefore, to make estimates on the P.D.S.A. scale where patients apply for dental benefits through their Insurance Societies. Hence the big difference in estimates. In the case of such funds as the Hospital Saturday Fund being called on for assistance, every effort is made to explain this position to the authorities, lest any misunderstanding should arise. The matter of sterilisation in the Clinic is carefully attended to, and in the case of articles not easily sterilised, a separate set of appliances is reserved for the Tuberculosis Dental Clinic only. C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. 46 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications received during the period 4th January, 1925, to 2nd January, 1926. 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 Notification* on Form A. 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 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total Primary Notifications. Under 5 5 to 10 10 to 15 Total Primary Notifications. Poor Law Institutions. Sanatoria. Poor Law Institutions. Sanatoria. Pulmonary— Males 3 4 3 4 12 18 36 36 23 15 2 156 249 — — 1 1 1 15 152 24 125 Females 1 1 4 7 17 20 22 14 6 9 2 103 199 — 2 — 2 2 15 66 12 54 Non-Pulmonary— Males 3 15 5 7 2 1 1 1 — — — 35 51 — — 3 3 10 6 13 5 7 Females l 22 4 2 1 1 1 2 2 — 1 37 48 — 2 7 9 12 7 17 10 15 Totals 8 42 16 20 32 40 60 53 31 24 5 331 547 — 4 11 15 25 43 248 51 201 47 New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, during the period 4th January, 1925, to 2nd January, 1926, 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 Females — — — 1 — — — — — — — — Non-pulmonary— Males — 1 — — — — —_ — — — — 1 Females — — — — — — — — — — — — From Registrars' Returns of Deaths. 48 Actual Number of Cases on Register. Number of cases on Register at beginning of year 1925 4,171 4,517 Add new cases during year 346 Deduct:— Died (notified cases only) 174 Removed, etc. 1 503 677 Arrested or cured Removed from Register Number of cases on Register, beginning of 1926 3,840 PART III. 50 SANITARY INSPECTORS' WORK, Etc. Tabulated Statement of Inspections, Insanitary Conditions found existing, and Re-inspections during the year 1925. East Combined West Combined Poplar South Bromley North Bromley Central Bow East Bow West Totals Total Inspections: — 1,058 1,498 1,479 1,654 947 1,090 1,220 8,946 On complaints of nuisances, etc... 430 900 595 909 369 580 646 4,435 On notification of infectious diseases 297 433 267 464 276 185 277 2,199 House-to-House 22 — — 12 61 60 — 155 Bakehouses 14 20 8 14 9 7 19 91 Slaughterhouses 23 — 1 4 — — 45 73 Cowhouses 4 2 — — — 6 6 18 Milkshops 23 12 19 23 5 15 30 127 Ice cream vendors' premises 9 8 22 — 9 8 — 56 Workshops, workplaces, etc. 138 45 164 103 86 67 181 784 Miscellaneous 92 78 403 125 132 162 16 1,008 Premises found in fair condition 484 737 722 1139 330 457 548 4,417 Do. requiring amendment 574 761 757 515 617 633 672 4,529 Details of Insanitary Conditions, etc. 271 312 678 261 280 247 308 2,357 Walls and ceilings dirty 128 58 70 44 87 55 43 485 Yards, forecourts and areas insufficiently paved or drained 2 — — — — 1 — 3 Inlets to drains not properly trapped 178 126 322 129 161 195 144 1,255 Number of drains tested 69 76 69 24 1 37 46 322 Do. do. defective 55 68 86 129 31 50 57 476 Do. do. obstructed 53 19 45 4 103 12 12 248 Sink waste pipes not trapped or otherwise defective 2 — — — — — — 2 Sink waste pipes directly connected to drains 51  East Combined West Combined Poplar South Bromley North Bromley Centrai Bow East Bow West Totals Soil pans of w.c.'s without suitable water supply 83 29 76 33 35 7 30 293 Do. do. broken or unsuitable 42 18 17 16 21 21 8 143 Do. do. in foul condition .. 54 JO 13 8 4 21 24 134 Do. do. untrapped .. — — — — — 1 — 1 Roofs, guttering and rainwater pipes defective 284 253 410 233 224 167 227 1,798 Water supplies to premises cut off (notified by Metropolitan Water 14 Board) 1 — — 1 1 17 Water service fittings defective, causing waste of water 28 15 47 16 9 10 8 133 Drinking Water improperly stored 1 1 — — 1 — 3 Dampness 240 79 100 34 115 101 80 749 Inundations 7 — 7 9 — — — 23 Overcrowding 2 — 4 4 — — — 10 No proper receptacle for house refuse 48 36 38 31 61 23 38 275 Accumulations of dung or refuse 20 14 22 8 6 3 8 81 Foul P.H. urinals — 4 6 2 7 1 1 21 Other nuisances, dilapidations, want of ventilation, etc. 267 347 982 269 246 531 537 3,179 Breaches of London County Council's By-laws Breaches of Council's By laws 62 2 — — 35 44 32 175 39 2 124 3 52 53 40 313 Intimations served 550 719 757 515 571 633 672 4,417 Notices served 158 420 194 315 263 185 421 1,956 Final Notices served 76 54 21 76 41 40 49 357 Summonses applied for (except Food and Drugs) 2 — — 5 7 2 3 19 Passengers from Continental Ports: — Visited 4 3 — — — — 7 Undiscovered — 1 — — — — 1 Intimations served in respect of verminous rooms 30 35 91 51 21 38 266 Verminous rooms cleansed 65 35 67 46 101 20 38 372 Re-inspections 2,793 2,574 2,461 1,895 1,992 2,189 1,442 15,346 52 HOUSING ACTS, 1890-1925. Housing (Inspection of District) Regulations, 1925. Representations to Council under Housing Act, 1925. Ten premises were inspected with a view to closing under Housing Act, 1925. Increase of Rent and Mortgage Interest (Restrictions) Acts. Two certificates were issued under the above Acts. During the year, 50 families, comprising about 220 persons, were provided with housing accommodation by the London County Council. HOUSING CONDITIONS. Statistics. Year Ended December, 1925. 1.—General. (i) Estimated population 168,500 (2) General death rate 11.7 (3) Death rat© from tuberculosis (all forms) 1.1 W Infantile mortality 75 (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 during 1925 (for the Council) (In course of erection for the Council 56.) 81 houses. 2.—Unfit Dwelling-houses. 1.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or other Acts) ... 8,072 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1925 ... 406 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 18 (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 4,768 53 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 2,638 III.—Action under Statutory Powers. A. Proceedings under Section 3 of the Housing Act, 1925 (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit— (а) by owners — (б) by Local Authority in default of owners 1* (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 2,130 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 2,118 (b) by Local Authority in default of owners — (c) by Local Authority and owner jointly — (d) Closing Orders made by Magistrates 8 * Several defects were remedied by the Council in a house which had been previously rendered fit by them in 1920 and 1923, the costs being added to the outstanding debt. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders 10 (2) Number of dwelling-houses in respect of which Closing Orders were made 10 54 (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 4* (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 4* 8 houses (563, Old Ford Road, 37-45, Beale Road, and 21-23, Ranwell Street) were subjects of Closing orders made by Magistrates under the Public Health (London) Act, 1891. 6 of the Closing Orders made in 1924 were cancelled early in 1925. (8 to 12, Andrew Street and 21, Charles Street). Closing Orders were made in respect of 1 and 2, Elizabeth Cottages, 1, 2, 3 and Sophia Street, and 2, 4, 6 and 8, Ford Street. * 2, 4, 6 and 8, Ford Street. UNHEALTHY AREAS. (a) Under date 10th December, 1924, the Ministry of Health issued an order sanctioning the Improvement Scheme of the London County Council in respect of Baker's Alley, Bromley Cottages and Birohfield Street. (b) The Ministerial Inquiry relating to the Gale Street (39-45) and St. Leonards Street (137-159), areas was held at the Council Offices, Poplar, on 17th February, 1925, and on 23rd June, 1925, the Ministry of Health issued the " Poplar (Gale Street and St. Leonards Street Improvement Scheme) Order, 1925." Lady Sanitary Inspector. Miss Davies reported:— During the year 407 visits and revisits have been paid to tenants of the Council's property, in addition to routine Inspection of Workshops and Sanitary Accommodation in Factories where women are employed, outworkers' premises, etc. 55 The standard of cleanliness among the newest houses and flats is high; there are exceptions, but very few. Among those houses that have been occupied for some years are a number that need visiting. Where unsatisfactory conditions are found the occupier's attention is directed to them and a remedy suggested. In some cases it has been desirable to serve an intimation notice, and attempts are made to persuade the occupier to take more pride in her home. Allowances must be made for busy mothers with large families to care for, and the visit is always made in as sympathetic a manner as is possible. The hot-water supply to the sink and bath is a great boon and is really appreciated. Many mothers remarked that it is far easier to bath the children than to partially wash them at night. In no case has it been found that " the bath is used for coal " as is so often alleged. Not all gardens are cultivated, but the majority are. It was a joy in May to see gardens of houses that hail not been occupied six months, v/ell cultivated, with small fruit trees in bloom. Though visits at first are not always welcome, the occupiers in time become friendly. 56 Tabulated statement of Inspections, of Insanitary Conditions found existing and of Reinspections, Ji'c., during the year 1925. Poplar. Bow and Bromley. Totals. Workshops, Workplaces, Laundries, &c., Number of on the Register 55 107 162 Workshops, Number of Workrooms therein 85 154 239 ,, Number of Inspections of 81 171 252 ,, Number of Reinspections of 45 77 122 Workrooms, Number of Inspections of 110 222 332 ,, found to be overcrowded — 4 4 ,, found to be insufficiently ventilated 1 — 1 ,, found to be in dirty condition 16 38 54 Workshops, etc., newly discovered and registered 1 4 5 ,, Workrooms therein measured 1 4 5 ,, Reported to H.M. Inspector on discovery 1 4 5 Factories, Number visited 49 72 121 ,, W.C.'s dirty, &c. 19 34 53 Outworkers'premises visited 366 691 1,057 Written Intimations served 64 84 148 Statutory Notices served 15 24 39 Final Notices served — 4 4 Works carried out under supervision:— (a) Additional means of ventilation provided 1 — 1 (6) Rooms cleansed and whitewashed 53 84 137 (c) Yards, floors, roofs, &c., repaired 14 21 35 (d) Sanitary conveniences constructed, cleansed o repaired 29 31 60 Overcrowding of Workrooms, Cases abated — 4 4 Miscellaneous Visits 308 138 446 Visits re Verminous Children 65 51 116 ,, Scabies 45 27 72 ,, Outworkers ' Lists 25 19 44 ,, Suspected Infectious Disease 125 145 270 ,, Eye trouble 65 32 97 Visits to Schools 34 20 54 Factory and workshop inspections, 494 ; fair condition, 237 ; removed or discontinued 5; require cleansing, 54; sanitary conveniences defective or insufficient, 103. Reports of Housing Inspectors. January to May. 1925. Poplar. Bromley. Bow. Totals House-to-house Inspections 42 67 142 251 Re-inspections 1,773 2,198 2,123 6,094 Number of Intimations served— Public Health (London) Act .. 143 289 154 586 P.B.C. By-laws 35 42 104 181 L.C.C. (General Powers) Act, re verminous rooms 2 7 5 14 Number of Notices served— Public Health (London) Act 39 186 68 293 P.B.C. By-laws 22 38 44 104 For cleansing 11 33 — 44 M.L.M. Act, 1855, Sec. 85, re drains 5 6 18 29 Number of Final Notices served— For cleansing and other matters 13 67 5 85 Number of drains tested— Chemical test 54 72 147 273 Smoke test 1 6 4 11 Water test 50 93 68 211 Number of drains defeetive 5 8 12 25 ,, ,, obstructed 2 7 2 11 57 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, Slaughterhouses, Offensive Businesses, Ice Cream premises, and Homworkers' premises. Premises. On Register during year 1925. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male. Female. Total. Bakehouses (Factories) 37 37 194 21 Bakehouses (Workshops) 44 — 44 187 27 — — — Bakehouses (Domestic Workshops) 2 2 5 1 — — Factories (Laundries and Miscellaneous Factories) 35 116 151 177 61 11 — — Laundries (Workshops) — 4 4 8 1 1 — — Laundries (Domestic Workshops) .. 3 3 6 — — Workshops 135 148 283 506 88 19 4 4 Workshops (Domestic) 14 7 21 23 2 1 — — Workplaces 162 — 162 290 32 9 1 — Workplaces (Domestic) 44 — 44 101 8 1 — — Places where food is sold or prepared 29 7r — 297r 1656¶ 252 15 5 Milk Premises 128 — 128 544 16 3 1 — Cowsheds 10 — 10 34 1 — — — Slaughterhouses 8 — 8 58 — — — — Other offensive trade 6rr 6rr 3 — — premises Ice Cream premises 146 — 146 247 28 3 — — Homeworkers' premises 29 1141 1170 1109 80 25 — 58 TABLE B. Workshops on Register (Male), 1925. 10 Bootmakiug. 2 Oil stores. 2 Barge building. 3 Paint making. 1 Bitumen making. 1 Paper sorting, etc. 1 Boat building. 2 Plumbing. 1 Brush making. 1 Poultry food mixing. 1 Building, etc. 1 Rag sorting. 8 Cabinet making. 1 Rope making. 1 Chair-frame making. 1 Sackmaking. 1 Chemical works. 3 Skin dressing. 1 Cigar making. 1 Stonemasonry. 1 Clay pipe making. 18 Tailoring. 4 Cork cutting. 4 Tarpaulin works. 5 Confectionery making. 1 Tinsmith. 4 Cooperages. 1 Tin toy making. 1 Electrical Engineering and 1 Trunk making. Winding. 6 Upholstering. 5 Engineering. 3 Undertaking. 13 Farriers. 2 Van building, etc. 3 French polishing. 1 Vinegar making. 1 Frilling making. 1 Waterproof working. 1 Flush tank works. 1 Wax refining. 1 Gas works. 1 Welding. 4 Harness making. 1 Wheelwright. 1 Joinery. 1 Wire working. 2 Motor garage works. 1 Walking stick making. 2 Metal works. 1 Zinc working. As per List, Table A Workshops on Register, page 57. Domestic Workshops on Register (where Men are Employed).* 2 Blacksmiths. 1 Keg and drum repairing. 1 Blind making. 1 Picture frame making. 3 Boot repairing. 1 Plumbing. 2 Cycle repairing. 2 Tailoring. 1 Decorative earthenware making 59 Home Workers on Register (Male). 25 Bootmaking. 1 Shirt making. 1 Brush making. 2 Tailoring. Workshops and Domestic Workshops on Register (Females).* 1 Artificial flower making. 1 Race card stamping. 1 Badger hair sorting. 2 Sack and bag making. 1 Bedding making. 1 Shirt and pyjama making. 4 Boot upper making. 1 Seal stamping. 8 Confectionery making. 1 Table jelly making. 3 Cork cutting. 69 Tailoring. 1 Corset making. 2 Tarpaulin Works 6 Costume making. 2 Tiemaking. 14 Dressmaking. 1 Tinned goods labelling and 5 Furriers. sorting. 4 Infants' shoes making. 3 Toymaking. 1 Knitted garment making. 2 Trimming making. 1 Leather sorting. 3 Upholstering. 7 Laundries. 2 Waterproof garment 10 Milliners. making. 1 Packing. 1 Whalebone dressing. 1 Pressers and cleaners. 1 Wood chopping. 1 Paper and rag sorting. * 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 57. Factories on Register (Female). 3 Bedding manufacturing. 1 Pianoforte manufacturer. 1 Blouse making. 3 Preserved goods. 1 Boiler packing. 1 Ragwork. 2 Boot making. . 1 Rice starch making. 5 Box making. 3 Rope works. 3 Brush making. 2 Rubber goods making. 1 Bunting and flag making. 1 Rug making. 1 Butter mixing factory. 5 Sack making. 1 Chip basket making. 1 Sausage factory. 2 Christmas cracker making. 3 Shirt making. 1 Cigarette paper making. 1 Shroud making. 1 Clay fuel and pipes. 27 Tailoring. 2 Cleaners and dyers. 1 Tarpaulin works. 60 Factories on Register (Female)—contd. 1 Condiment packing. 1 Ticket printing. 4 Confectionery making. 2 Timber works and wicker 1 Cork cutting. furniture making. 1 Corset making. 1 Tortoiseshell goods making 4 Costume making. 1 Toy balloon making. 1 Dog biscuit manufacturer. 1 Toy making. 1 Dressmaking. 1 Trimming making. 1 Fibre, hemp and jute making. 1 Type founder. 1 Flute making. 4 Varnish and paint works. 1 Glass works. 1 Wallpaper manufacturer. 1 Kapok works. 2 Waterproof making. 1 Laundry. 1 Whalebone works. 1 Match making. 1 Wine bottling. 1 Mineral water manufacturers. 1 Woollen garment making. 2 Overall making. 1 Wood chopping. 1 Perambulator builders. TABLE C. See footnote, page 59. Factories, Workshops, Laundries, Workplaces and Homeworkers. 1 .—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Factories 371 Intimation. 82 Statutory. 11 Final. Workshops † (Including Workshop Laundries.) 701 116 20 4 4 Domestic Workshops ‡ 34 3 1 Workplaces (Males) 290 32 9 1 Domestic Workplaces (Males) 101 8 1 Places where food is sold or prepared§ 1656 252 15 5 Homeworkers' Premises 1109 80 25 Total 4262 573 82 10 4 † Including Workshop Bakehouses. See Table A, page 57. ‡ Including Domestic Bakehouses and Laundries. See Table A, page 57. § The inspections of all factories where food is prepared are included. Power is used in 35 of the premises. 61 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 344 344 2 Want of ventilation 1 1 Overcrowding 39 39 Want of drainage of floors 3 3 Other nuisances 135 135 2 Sanitary accommodation insufficient 2 2 unsuitable or defective 68 68 not separate for sexes 3 3 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 out work which are included in Table D of this Report.) Total 595 595 4 * These defects refer to premises as mentioned above under table of Inspection. 02 Nature of Work, Outworkers'List, (Section 107). Outwork in unwholesome premises. (Section 108). Outwork in infected premises, (Sections 109, 110). TABLE D.— Home Work. 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. t ailing to keep or permit inspection of list. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen . Contractors . | Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (8) (10) (11) (12) (13) (14) (15) (6) Wearing Apparel— Making, etc. 91 24 925 5 23 1 1 ** 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. 25* Artificial Flowers Nets, other than wire nets Tents Sacks Racquet and Tennis Balls Paper, etc., Boxes, Paper Bags 4 179 Brush Making 1 1 Pea Picking Feather Sorting Carding,etc. ,of buttons,etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, etc. 2 6 1 7 Textile Weaving 1 1 25* 63 LIST OF OUTWORKERS, FACTORY AND WORKSHOP ACT, 1901 (S. 107).* 1925 Number of Lists reoeived. 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 46 522 51 662 261 257 308 385 Tailoring 38 353 42 477 Shirtmaking.. 1 9 1 11 Miscellaneous 1 4 2 11 Shoemakers .. 3 54 3 63 Boxes 2 91 2 88 Overalls 1 11 1 12 * See page 62. TABLE E. Registered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses may be enumerated here. Bakehouse Workshops 44 Bakehouse Domestic Workshops 2 Laundries Workshops 4 Laundries Domestic Workshops 3 Workshops 283 Domestic Workshops 21 Workplaces 162 Workplaces Domestic 44 , Places where food is sold or prepared 297† Total number of workshops and workplaces, etc., on Register 86‡ †Power is used in 35 of these premises. ‡See Tables A and B, pages 57 and 58. TABLE F. Class. Number. (i) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factorv and Workshop Act (s. 133).. 6 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) I Notified by H.M. Inspector 9 1 1 Reports (of action taken) sent to H.M. Inspector 9 Other (Communications) .. 5 Underground Bakehouses (s. 101):— Certificates granted during the year iii use at the end of the year 24 64 RAG AND BONE DEALERS. No legal proceedings were taken for non-compliance with the L.C.C. Bye-laws. SMOKE NUISANCES. 109 smoke nuisances were dealt with during the year :—24 Bow East, 2 Bow West, 27 Bromley North, 22 Bromley Central, 9 East Combined, 13 West Combined, and 12 Poplar South. Two summonses were issued, see pages 69 and 70. CANAL BOATS. For the year ended 31st December, 1925, the inspections and reports of the Inspectors respecting registered and non-registered canal boats were as follows:— Registered. NonRegistered. t.Ur. H. A. Tibbatts, East Combined Division 1 — }Mr. J. Johnson, West Combined Division — — fMr. C. H. Brown, Poplar South Division — — UMr. H. J. Langley, Bromley North Division — — *Mr. Wm. Johnson, Bromley Centra! Division 4 1 **Mr. A. J. Field, Bow East Division 14 18 Mr. W. Boyce, Bow West Division 2 7 21 26 t There is no canal in the East Combined and Poplar South Divisions; the Inspectors deputise, when necessary, for other Inspectors. If Mr. H. J. Langley reported "Although there are many canal boats that sail through Bromley Reach, they do not stop until they arrive at Bromley Lock, therefore I have not paid a visit to any canal boat." * Mr. W. Johnson reported one boat was overcrowded through carrying an extra boy (during holidays). In another case, repainting of woodwork was necessary, and in a third the boat was not marked or numbered, and was unoccupied at time of visit. ** Mr. A. J. Field reported that one registered boat was visited twice. LONDON COUNTY COUNCIL (GENERAL POWERS) ACTS, 1904 AND 1922. †Verminous Rooms. Verminous rooms are still brought to the notice of owners upon the "Intimations," which are followed, if necessary, by "Statutory Notices." more especially as there are generally other defects upon the premises. 65 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 issued at the Disinfectant Depots and sprayers loaned to tenants in order to rid rooms and contents of bugs. 1944 orders for fluid were issued. Three hundred and thirty-five gallons were distributed during the year. Licensed Premises' Urinals. Twenty-one p.h. urinals were found to be in foul condition, and were subsequently cleansed. HOUSES LET IN LODGINGS OR OCCUPIED BY MEMBERS OF MORE THAN ONE FAMILY. During the year no houses were registered, the number on the register being 1,453, which includes a number of premises occupied by Chinese. BYE-LAWS—HOUSES DIVIDED INTO SEPARATE TENEMENTS, ETC. These Bye-laws were made by the London County Council on 17th November, and submitted to the Minister of Health for confirmation. The advent of these Bye-laws is long overdue. WATER CERTIFICATES. No certificates were applied for under sec. 48 of the Public Health (London) Act, 1891. CUSTOMS AND INLAND REVENUE ACTS, 1890-1891, AND REVENUE ACT, 1903. No applications for certificates for exemption under the Customs and Inland Revenue Acts, 1890-1891, and the Revenue Act, 1903, were made during the year. tFor the Cleansing of Verminous Rooms, see Tabulated Statements, pages 51 and 56. 66 RATS AND MICE DESTRUCTION. Thirty-two lbs. of barium carbonate paste and 201bs. of red squill baits were 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, by the use of barium carbonate paste, and the red squill preparation recommended by the Ministry of Agriculture, which are distributed to tenants of houses, where necessary, and 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 reported. RAG FLOCK ACT, 1911. No samples of rag flock were procured during the year 1925. HAIRDRESSERS' PREMISES. The hairdressers' premises were inspected during the year. OVERCROWDING. A number of cases of overcrowding were reported, but on account of lack of housing accommodation remained unabated. 4 cases of overcrowding which were found in workshops were abated. GENERAL. 2,941 Complaints (including 99 smoke) as to nuisances were made. 3,884 communications on general matters were dispatched, and 3.006 in connection with the supply of milk. POOR LAW RELIEF, Etc. Mr. Butler, Clerk to the Guardians (April, 1926), has kindly supplied me with the following information:— 67 The average weekly numbers of persons in receipt of outdoor relief, and the cost, and the average weekly numbers of persons receiving medical relief only (that is no relief other than the services of a District Medical Officer) during the years 1921-1923 were as follows:— Outdoor Relief. I Medical Relief Only. No. of persons. Average per Cost average per week. No. of persons average per Year. week. £. week. 1921 15,332 5,554 80 1922 27,024 10,569 83 1923 29,265 11,506 65 1924 26,901 10,469 47 1925 26,606 11,254 40 With reference to St. Andrew's Hospital this is certified to accommodate 787, and previous to the dissolution of the Poplar and Stepney Sick Asylums district on 31st March, 1925. the beds were apportioned as follows:— Poplar 562 Limehouse 225 During the period April 1st to December 31st, 1925, the total days maintenance amounted to 163,153, giving an average daily number of 593. A comparative statement for the preceding five years gives the following :— Days Average Maintenance : Daily number. Year ended 31/3/21 175,371 480 Poplar only. „ „ 31/3/22 192,561 527 „ „ 31/3/23 166,730 456 „ „ 31/3/24 178,962 489 „ „ 31/3/25 ... 185,586 508 April to December. 1925 163,153 593 Sick cases are also treated in the Poplar Institution, and the average weekly numbers for the past five years are as follows: — Year ended 31/3/22 28 „ „ 31/3/23 75 „ .. 31/3/24 85 „ „ 31/3/25 161 „ „ 31/3/26 178 68 LEGAL PROCEEDINGS. (Public Health (London) Act, 1891, Metropolis Management Acts, etc.). Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 21, Charles Street Main roof defective and premises unlit for human habitation 1925. 9th Jan Closing order made; £2 8s. costs. (Closing order cancelled 11th November, 1925) Grabham, C.A. 29, Fairfoot Road Roof defective and premises unfit for human habitation 9th Jan Work done. Summons withdrawn. No costs Langley, H.J. 114, Fern Street Roof defective, ceiling dilapidated 12th Jan Work done. Summons withdrawn . £2 4s. costs Ditto 11, Tapley Street Various defects 21st Jan 14 days' order; £3 3s. costs Johnson, W. 12, Tapley Street Ditto 21st Jan 14 days'order; £3 3s. costs Ditto 60, St. Stephen's Road Ditto 20th Jan 7 days' order; £2 penalty; £2 2s. costs Smith, F. A. 72, St. Stephen's Road Ditto 20th Jan 7 days' order; £2 2s. costs Ditto 76, St. Stephen's Road Ditto 10th Feb 14 days'order; £2 8s. costs Ditto 78, Qulckett Street Failed to comply with Magistrate's order 23rd Feb. £20 penalty; £5 5s. costs Pearce, H. A. 46, Merchant Street Various defects 20th Feb 21 days' order; £2 8s. costs Langley, H.J. 9, Beale Road Ditto 24th Feb 14 days'order; £2 6s. costs Smith, F. A. 11, Tapley Street Failed to comply with Magistrate's order 2nd Mar £2 penalty; £2 2s. costs or 9 days imprisonment Johnson, W. 69 Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 12, Tapley Street Failed to comply with Magistrate's order 1925. 2nd Mar. £1 penalty; £2 2s. costs or 9 days imprisonment Ditto 32 to 48, Tibbatts Road .. Reconstructed drains not in accordance with L.C.C. bye-laws 16th Mar. £3 3s. costs Pearce, H. A. 7, Beale Road Various defects 21st Apr. Work done. Summons withdrawn. £2 4s. costs Smith, F. A. 11, Tapley Street Failed to comply with Magistrate's order 23rd Mar. £3 penalty; £2 2s. costs Johnson, W. 12, Tapley Street Ditto 23rd Mar. £3 penalty; £1 Is. costs Ditto The Forge, "White Horse" Yard Roof defective 23rd Mar. Closing order made; £2 8s. costs Johnson, J. 34, Beale Road Various defects 24th Mar. 14 days'order; £2 6s. costs Smith, F. A. 23, Cantrell Road Kitchen chimney defective 22nd Apr. 21 days'order; £2 8s. costs Langley, H.J. 45, Norman Road Various defects 7th Apr. 14 days' order; £2 6s. costs Davies, Miss M. E. Russia Wharf, Bell Road Smoke nuisance 6th Apr. 30 days' abatement order made £5 penalty; £2 2s. costs Johnson, W. 43, Beale Road Various defects 28th Apr. 21 days'order; £2 6s. costs Smith, F. A. 45, Beale Road Ditto 28th Apr. 21 days'order; £2 6s. costs Ditto 32 to 48, Tibbatts Road Reconstructed drains not in accordance with London County Council bye-laws. (Three summonses) 4th Aug. £2 penalty; £1 Is. costs on each summons Pearce, H . A . 70 Address, etc. Nature ol complaint. Date of Decision. Result. Name of Offioer. 1925. 45, Norman Road Failed to comply with Magistrate's order 28th May £3 10s. penalty; £2 2s. costs Davies, Miss M. E. 05, Kerbey Street Walls and ceilings ground floor front room dirty 28th May 7 days' order; £2 6s. costs Ditto 21 , Ran well Street Drains defective 9th June 14 days' order; £1 5s. costs Smith, F. A. 23, Ranwell Street Ditto 9th June 14 days'order; £1 5s. costs Ditto 37, Beale Road Various defects 9th June 14 days'order; £1 5s. costs Ditto 39, Beale Road Ditto 9th June 14 days'order; £1 5s. costs Ditto 41, Beale Road Ditto 9th June 14 days'order; £1 5s. costs Ditto 482, Old Ford Road Drain defective 9th June Summons withdrawn. Nuisance abated Boyce, W. 22, Lamprell Street Various defects 30th June Summons withdrawn. Work done; £2 4s. costs Ditto 36, Lamprell Street Ditto 30th June Summons withdrawn. Work done; £2 4s. costs .. Ditto 45, Norman Road Failed to comply with Magistrate's order 16th July £5 penalty; £2 2s. costs Davies, Miss M. E. Crown Chemical Works, Three Mill Lane Smoke nuisance 24th July Summons dismissed; £15 15s. costs Langley, H. J. 71 Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 1925. 150, Fairfoot Road Various defects 30th July. 6 weeks'order; £2 8s. costs Pearce, H. A . 148, Fairfoot Road Ditto 30th July. 6 weeks'order; £2 8s. costs Ditto 37, Beale Road Various defects rendering premises unfit for human habitation 29th Sep. •Closing order made in each case. No costs Smith, F. A. 39, Beale Road Ditto 29th Sep. 41, Beale Road Ditto 29th Sep. 43, Beale Road Ditto 29th Sep. 45, Beale Road Ditto 29th Sep. 21, Ranwell Street Ditto 29th Sep. 23, Ranwell Street Ditto 29th Sep. 563, Old Ford Road Ditto 30th Sep. Closing order made; £2 8s. costs Field, A.J. 5, Prospect Place Various defects 2nd Oct. 14 days order; £2 8s. costs Johnson, W. 8, Prospect Place Ditto 2nd Oct. £3 penalty including costs Ditto PART IV. FOO D. 74 FOOD AND DRUGS. In February, 1925, I reported to the Public Health and Housing Committee that, after giving full consideration to the Public Health (Meat) Regulations, 1924, I was of opinion that the time had arrived when the duties appertaining to Meat and Food generally should be placed in the hands of particular inspectors. I suggested dividing the Borough into two areas and relieving the District Sanitary Inspectors of all work under the Sale of Food and Drugs Acts, and all orders and regulations regarding meat and foods. The Council on 23rd April, 1925, approved of this arrangement and appointed Messrs. C. A. Grabham and H. A. Pearce (who had previously been appointed as Housing Inspectors) to be Meat and Food Inspectors, also Mr. F. A. Smith to ast as deputy when required, for the time being. This new arrangement came into effect on 2nd June, 1925, and I am sure the administration of the Food and Drugs Acts has been more efficient, if only from the fact that as the work is in the hands of only two men it is possible to obtain a more intimate knowledge of what is actually going on and act accordingly. The Ministry of Health has authorised the use cf a mark for stamping carcases after examination by the Medical Officer of Health and the two Meat Inspectors. This marking is only carried out when desired by the butcher, and the Council has agreed to make a charge of a shilling for each carcass or part of a carcass marked. No carcases have been marked during the year. The amount of work done under the Public Health (Meat) Regulalations, 1924, has been very considerable, and the appointment of the Food Inspectors has been fully justified. Opposition to the screening of stalls was, at first, very great, but gradually the traders are becoming more and more amenable to the requirements of the regulations. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Defendant. Nature of Complaint. Date of Decision. Result. Name of Officer. Thos. A. .Jones, Duff's Fields, St. Leonard's Road Stall in Tetley Street not suitably screened 1925. 24th Nov. £5 penalty; £1 1s. costs Smith, F. A. F. Weiland, 61, Strone Road, Forest Gate Stall in Roman Road not marked with name and address 15th Dec. 10s. penalty.. Pearce, H. A. Ditto Stall in Roman Road not suitably scrned. 15th Dec. 9s. penalty; £1 1s. costs Ditto 75 STATISTICAL REPORTS OF FOOD INSPECTORS. MR. C. A. GRABHAM (2nd June to 31st December 1925). Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. Bakehouses 49 9 — — — Slaughterhouses 4 — — — — Cowhouses 1 — — — — Milkshops 126 3 1 1 — Eating-houses 159 25 — — — Stalls 43 — — — Other places where food is sold or prepared 293 48 — — — Ice cream premises 82 — — — — Wharves where food is prepared or stored, etc. 9 — — — — Slaughterhouses: 203 visits. Number of Carcases inspected :— (a) Satisfactory 434 (6) Unsatisfactory 1 (c) Condemned and destroyed or otherwise disposed of (included in (6) above) 1 Number of Samples procured:— Formal. Informal. Total. (a) Under Sale of Food and Drugs Acts 229 20 249 (i) Number genuine 207 17 224 (ii) Number adulterated 22 3 25 (iii) Number poor quality, etc. (included in (i) genuine above) 23 — 23 (6) Under Special Orders and Regulations 1 1 (i) Number genuine 1 — 1 (ii) Number adulterated — — — (iii) Number poor quality, etc. (included in (i) genuine above) — — — Action taken in respect of unsatisfactory samples:— (i) Summonses applied for 13 — 13 (ii) Letters of caution sent to vendors 21 2 23 (iii) Reported to Ministry of Agriculture, etc. 2 — 2 Public Health (Foreign Meat) Regulations—Certificates issued by M.O.H. 73 (60 visits to factories). Total weight of foodstuffs destroyed See list * at foot. Orgars condemned and destroyed:— Lungs (Sheep), 11 sets. ,, (Beasts), 37 ,, Livers (Sheep), 1 ,, (Beasts), 5 Tripe (Beasts), 1 Spleen ,, 1 Mesentery ,, 1 Heads ,, 5 76 Other foodstuffs condemned and destroyed :— *Onions, 4 tons. 5 cwt., 2 qrs.; Cauliflowers, 3 crates; 2 Forequarters Beef, 42 stone; Brisket of Beef, 5½ lb.; Eels, 50 1b.; Ostend Rabbits, 80 lb.; Bananas, 16 crates. Other matters;— Market Inspections, 25; 1 Butter Blending Factory registered (January, 1926). MR. H. A. PEARCE (2nd June to 31st December, 1925). Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. Bakehouses 82 12 — — — Slaughterhouses 7 — — — — Cowhouses 15 — — — — Milkshops 132 13 2 — — Eating-houses 48 12 4 2 — Stalls 437 — — — — Other places where food is sold or prepared 247 53 7 3 — Ice cream premises 66 11 2 — Wharves where food is prepared or stored, etc. 3 — — — — Market Inspections : Evening, 40; Morning, 40. Slaughterhouses: 263 visits. Number of Carcases inspected:— (a) Satisfactory 1920 (b) Unsatisfactory 10 (c) Condemned and destroyed or otherwise disposed of (included in (6) above) 10 (parts of) Number of Samples procured :— Formal. Informal. Total. (a) Under Sale of Food and Drugs Acts 234 18 252 (i) Number genuine 201 16 217 (ii) Number adulterated .. 33 2 35 (iii) Number poor quality, etc. (included in (i) genuine above) 12 — 12 (6) Under Special Orders and Regulations 3 — 3 (i) Number genuine 3 — 3 (ii) Number adulterated — — — (iii) Number poor quality, etc. (included in (i) genuine above) — — Action taken in respect of unsatisfactory samples:— (i) Summonses applied for 11 — 11 (ii) Letters of caution sent to vendors 19 — 19 (iii) Reported to Ministry of Agriculture, etc. — — — Public Health (Foreign Meat) Regulations—Certificates issued by M.O.H. — — 9 77 Total weight of foodstuffs destroyed See list * at foot. Organs condemned and destroyed:— Livers, 79; Heads, 36; Tongues, 30; Stomachs, 5; Lungs, 595; Omenta, 8; Mesenteries, 47; Spleens, 5; Pancreas, 9; Hearts, 4; Udders, 6; Kidneys, 5; Intestines, 1. Total, 830. (Note.—Livers and Lungs, Bovine and Sheep; other organs, Bovine.) Other foodstuffs condemned and destroyed:— Pears, 14 lbs.; Strawberries, 108 baskets (378 lbs. approximately); Bananas, 3 crates; Chickens, 6; Ducks, 4; Pulped Apricots, 30 lbs. * 2 Clod and Stickings; 6 Briskets; 5 Foreribs; 7 Loins; 6 Flanks; 4 Forequarters; 4 Rumps. MR. F. A. SMITH (2nd June to 31st December, 1925). Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. Bakehouses 119 19 — — — Slaughterhouses 4 — — — — Cowhouses 18 — — — — Milkshops 190 — — — — Eating-houses 295 12 — — — Stalls 111 — — — — Other places where food is sold or prepared 544 79 — — — Ice cream premises 49 4 — — — Wharves where food is prepared or stored, etc. — — — — — Slaughterhouses : Number of Carcases inspected:— (a) Satisfactory 31 (b) Unsatisfactory — (c) Condemned and destroyed or otherwise disposed of (included in (6) above) Formal. Informal. Total. Number of Samples procured:— (a) Under Sale of Food and Drugs Arts 14 1 15 (i) Number genuine 13 1 14 (ii) Number adulterated 1 — 1 (iii) Number poor quality, etc. (included in (i) genuine above) 2 — 2 (b) Under Special Orders and Regulations 2 — 2 (i) Number genuine 2 — 2 (ii) Number adulterated — — — (iii) Number poor quality, etc. (included in (i) genuine above) — — — 78 Action taken in respect of unsatisfactory samples:— Formal. Informal. Total. (i) Summonses applied for — — — (ii) Letters of caution sent to vendors — — — (iii) Reported to Ministry of Agriculture, etc. — — — Public Health (Foreign Meat) Regulations—Certificates issued by M.O.H. — — Nil. Total weight of foodstuffs destroyed Organs condemned and destroyed :— Beasts—1 Head, 1 Liver, 1 Mesentery, 3 sets of Lungs. Sheep—1 Pluck, 1 Liver, 2 sets of Lungs, 2 Breasts of Mutton. Other foodstuffs condemned and destroyed:— 2 boxes of Apples, 36 bags of Cocoanuts, 4 baskets of Raspberries, 3 boxes of Fish, 2 pecks of Peas. COFFEE SHOPS, EATING HOUSES, FRIED-FISH SHOPS, HOTELS & RESTAURANTS, ETC.t London County Council (General Powers) Act, 1908.—Sanitary Provisions for Premises Used for Sale, Etc., of Food for Human Consumption. London County Council (General Powers) Act, 1908. For number of premises in the Borough where food is sold or prepared for sale, see Table A, page 57. 1,386 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 68 instances, and 60 other defects existed. 233 intimations were served, which in 11 cases were followed up by Statutory notices, and five final notices were served. MILK SHOPS. At the end of the year there were in the Borough 138 registered premises (including 10 cow-houses where milk is sold) and 4 premises where sterilised milk also is sold. These milk shops were kept under observation. 79 In addition 125 premises where sterilised milk only is sold were noted. Cleansing of premises was necessary in 19 instances. Five other defects were found. For milkshops connected with infectious diseases, .see page 20. Ten premises were, on account of change of occupiers, re-registered as milkshops. The sale of milk was discontinued on three premises. For milkshops connected with infectious diseases, see page 23. † See Tables A and C, pages 57 and 59. The Milk (Special Designations), Order, 1923. The above Order revoked previous regulations and came into operation on the 1st July, 1923. Fourteen applications were made for dealers' licences for Grade A (Tuberculin Tested) milk (five bottlers). ICE CREAM. London County Council (General Powers) Act, 1902, Sec. 43. There are 146 premises where ice creams are manufactured within the Borough, on the register. 247 inspections were made during the year. Cleansing of premises was necessary in 32 instances. 29 other nuisances existed In one case ice cream making was stopped until unsatisfactory arrangements for stabling a horse had been altered. BAKEHOUSES. Inspections. The Bakehouses throughout the Borough were inspected at least twice during the year. There are 83 bakehouses in use, of which 24 are underground. In 37 bakehouses machinery is used. See Table A, page 5 7, number made up to end of year. Cleansing was necessary in the various bakehouses on 103 occasions. Three other nuisances were found (including 2 defective or unsuitable w.c. accommodation). 80 SLAUGHTERHOUSES. No contraventions of the bye-laws made by the London County Council for regulating the conduct of a business of a slaughterer of cattle were reported. SLAUGHTERER OF POULTRY. No contraventions of the bye-laws made by the London County Council respecting the business of a slaughterer of poultry were reported. CERTIFICATION OF CERTAIN FOOD PRODUCTS FOR EXPORT TO THE DOMINIONS AND FOREIGN COUNTRIES. In view of the requirements of the Food Laws in operation in the Dominions and elsewhere, the system of certification for food products which are derived from the flesh of cattle, sheep, swine or goats, or from game or poultry, and are prepared or packed in England and Wales for export, has been continued. By the Ministry of Health Memo. 32 (Foods), the Certifying Officer— usually the Medical Officer of Health—is required to keep himself informed, by personal inquiry and in other available ways, as to: — (1) The sanitary condition, structure and character of premises on which the food products are prepared, stored or packed, with special regard to the possibility of contamination of the food products at any stage. (2) The cleanliness and wholesomeness of the methods employed in preparing, storing or packing the food products. (3) The precautions taken to avoid the utilisation for food purposes of diseased, unsound or unwholesome material in any portion of the premises; and arrangements for the safe disposal of any material which, on account of disease, unsoundness, unwholesomeness, or for any other reason, is unfit for human food. In the case of products derived from cattle, sheep, swine, or goats, the Certifying Officer must also satisfy himself that the animals from which the products are prepared have been subjected to an ante-mortem and postmortem veterinary inspection and found free from disease and suitable for human food. Where the products are prepared from animals slaughtered in the United Kingdom, the Certifying Officer before certifying as to Veterinary examination must be satisfied : — (а) That the animals were subjected to veterinary examination, antemortem and post-mortem, by an Officer of the Local Authority for which he nimself acts; or (b) That the animals were slaughtered in a public abattoir under official veterinary inspection; 81 or he must be furnished by the applicant with a declaration signed by a qualified veterinary surgeon, appointed by the firm with the approval of the Certifying Officer, to the effect that an ante-mortem and post-mortem examination was made by him, and that the animals so examined were found free from disease. Where the products are prepared from material imported into the United Kingdom from overseas, the Certifying Officer must satisfy himself that the material was accompanied by a certificate as to ante-mortem and post-mortem veterinary inspection signed by an Official of the National Government of the country of origin, being a country whose certificates the Authorities are prepared to accept. If the information obtained by the Certifying Officer is not, in his view, satisfactory, certification is to be withheld and the Certifying Officer must inform the Ministry forthwith. The Certifying Officer will supply the Ministry of Health with such information as may be required in regard to the methods of inquiry, inspection and certification which have been adopted. During the year, special arrangements were made with the Officers of the Corporation of London regarding the certification for export of sausages which had been prepared under the supervision of officers of that authority. 167 certificates were issued in connection with 129 consignments of foodstuffs: Canada: (54 certificates), Australia (67), Philippine Islands (13), Venezuela (25), others (8). 102 visits were paid to factories in connection with the above. PUBLIC ANALYST'S ANNUAL REPORT. During the year 1925, 811 samples were examined under the Sale of Food and Drugs Acts, of which 65 or 8.0 per cent. were found to be adulterated. In addition, 104 samples or 12.8 per cent, were found to be of inferior quality. The figures for the previous 5 years are as follows: — Year. Samples Examined. Percentage of Adulteration. 1924 764 3.7 1923 762 3.7 1922 738 2.2 1921 710 0.8 1920 730 1.2 Average 741 2.3 82 The average adulteration for the whole of London in 1924 was 4.2 per cent. and for the whole of England and Wales 5.9 per cent. The number of samples examined was in the ratio of 4.8 per 1,000 of the population as compared with 8.7 per 1,000 for the whole of London and 3.1 per 1,000 for the whole of England and Wales. Thirty-five of the 811 samples were purchased informally and 2 samples were submitted by the public. Six of the informal samples and 1 submitted by the public were adulterated. Grade "A" Milk. Nine samples of Grade "A" Tuberculin Tested Milk were examined. Seven samples were submitted by the Inspectors, and 2 samples by the bottlers. These samples were all satisfactory. The number of micro-organisms found varied from 1,900 to 72,000 per 1 Cc, the latter being found during a spell of hot weather in July. The average chemical composition of these milks was: — Fat, 3.95 per cent. Non-fatty solids, 8.70 per cent. One sample was of poor quality, being only just within the legal limits. The average composition of the milk samples submitted under the Sale of Food and Drugs Acts during the year was: — Fat, 3.95 per cent. Non-fatty solids, 8.85 per cent. Condensed Milk Regulations. Eleven samples of condensed milk were examined, 10 of them being examined under the Condensed Milk Regulations. One sample was 3.5 per cent. deficient in milk solids and 3.3 per cent. deficient in fat. Another sample was 8.5 per cent. deficient in milk solids. 83 Preservatives. The following samples were found to contain preservatives: — Food. Number Examined. Preserved. Percentage Preserved. Butter 49 15 30.6 Margarine 56 34 60.7 Cake 4 2 50.0 Meat Pie 3 2 66.6 Sausage 9 2 22.2 Lime juice cordial 2 2 100.0 Cordials 2 2 100.0 Bacon 1 1 100.0 Mince-meat, fruit 2 1 50.0 Totals 128 61 47.6 Milk and Dairies (Consolidation) Act, 1915. This act came into force on September 1st, 1925. The provisions contained therein prohibit the sale of milk to which colouring matter, condensed milk, or dried milk has been added. They also give the vendor the privilege of demanding a sample to be taken in the course of delivery, if he wishes to rely upon the "warranty" defence. The owner of the cows can also demand a sample of the milk to be taken at the dairy where the cows are kept. Glass in Food. Twelve samples of food in glass containers were examined for the presence of particles of glass, at the request of the Ministry of Health. These consisted of:—4 beverages, 4 jams, 2 meat pastes and 2 fish pastes. The beverages were found to contain microscopical particles similar to ground glass but in amounts too small to estimate. 84 Two of the jams and 1 sample of the fish paste contained weighable amounts of siliceous matter, but as in each case sand was present it was impossible to state if they were contaminated with the glass particles. The following samples connected with the work of the various Departments were also examined. For the Electricity Department, 1 sample of Condenser Deposit. For the Public Health Department, 2 samples of water and 1 sample of deposit from open air swimming bath. One sample of fruit pulp. One sample of Electrolyser Deposit. ALBERT E. PARKES, F.I.C., F.C.S., Public Analyst. Milk. Early in the year, the Public Analyst reported that in eight months, of 222 samples of milk submitted to him as fresh milk he had found 140 were fresh and 82 heated. From investigations I made I gathered that most of the milk conveyed into London is over 24 hours and possibly two days old. This necessitated preservation by heating and then running over a brine bath. I am strongly of opinion that the public should not be under any misapprehension when purchasing milk, and while appreciating the difficulty of supplying London with fresh or unheated milk, this difficulty may be overcome by the proper cooling of milk at the farms and transportation in refrigerating waggons. The Council concurred in this view and directed that the attention of the Ministry of Health should be called to the reports of the Public Analyst, and the heated milk supplied in the Metropolis. Tea and Tea-Dust. On account of complaints received from a neighbouring Borough as to tea-dust being found on analysis to contain particles of metal, etc., many samples of tea and tea-dust were purchased in this Borough. The Public Analyst reported that some of these contained extraneous matters and were on the borderline of purity. As there was no standard for tea and I was advised that there would be certain difficulties in instituting legal proceedings, letters of caution were sent to the vendors. 85 Dripping. In November, a vendor was summoned at the Thames Police Court, and fined .£5 with 2 guineas costs, for selling dripping containing 1.1 per cent. excess of fatty acids and being coloured with an organic dye. Enquiries made by the Food Inspectors revealed the fact that fat not sold as "edible" was purchased from fat melters, manipulated, sophisticated, and then supplied to shopkeepers as dripping. Consequent upon this disclosure the Council resolved that the Ministry of Health be urged to promote legislation to the following effect:— (1) Dripping should be defined as the fat which drops from meat in roasting. (2) The standard for fatty acids in edible fats and dripping should be specified. (3) An officer of a local authority who is authorised to procure samples under the Sale of Food and Drugs Acts, shall, if specially authorised in that behalf by the local authority, have powers of entry, inspection and sampling as regards any premises where dripping or edible fats are prepared or manipulated or stored. (4) If any person wilfully neglects or refuses to obey or carry out, or obstructs, he shall be liable to a penalty not exceeding £100, and, in the case of a continuing offence, to a further penalty not exceeding £50 for every day during which the offence continues. 86 FOOD AND DRUGS ACTS. The results of the analyses of 811 samples were reported to the Committee during the year:— Sample. Number examined. Doubtful purity and inferior quality. Adulterated. Legal Proceedings. Milk 382 52 15 7 ,, Separated — — — — ,, Sterilized 1 — — — ,, Condensed 11 — 1 — Butter 49 6 — — Margarine 56 8 8 3 Cheese 4 — 2 2* Dripping 12 1 3 1 Lard 6 — — — Shredded Suet 4 1 2 — Mustard 7 1 — — Pepper 11 — — — Vinegar 18 — — — Sauce 2 — — — Cocoa 10 9 — — Coffee 8 — 1 — Coffee Mixture 2 — — — Cornflour 5 — — — Rice 4 — — — Ground Rice 4 — — — Arrowroot 4 — — — Pearl Barley 4 — — — Sago 4 — — — Oatmeal 2 — — — Flour 8 — — — Self-raising Flour 10 — — — Ground Ginger 5 — 1 — Baking Powder 6 — — — Egg Powder 6 — — — Custard Powder 4 — — — Curry Powder 2 — — — Bread 2 — — — Cake 4 2 — — Cake Mixture 2 — — — Jam 11 — — — Marmalade 2 — — — Table Jelly 2 — — — Golden Syrup 4 — — — Lemon Curd 2 — — — Borax 3 — — — Cream of Tartar 5 — — — Ground Cinnamon 3 — 1 — Alum 1 — — — Tea 10 — — — ,, Dust 4 — 1 — Sweets 11 1 6 — Bacon 1 — — — Glycerine 2 — — Carried forward 720 81 41 13 * One summons against a salesman not included. 87 Sample. Number examined. Doubtful purity and inferior quality. Adulterated. Legal Proceedings. Brought forward 720 81 41 13 Epsom Salts 1 — — — Cordials 2 2 — — Lime Water 3 2 — — Prescriptions (N.H.I.) 6 — 1 — Camphorated Oil 5 — 1 — Lime Juice Cordial 2 2 — — Lemon Squash 4 — 4 — Lemonade Crystals 2 — — — Spirits 48 12 18 14 Mincemeat, Fruit 2 1 — — Meat Pie 3 2 — — Meat Paste 2 — — — Brawn 2 — — — Sausage 9 2 — — Totals 811 104 65 27 Of the 383 samples of milk, 45 were procured on Sundays from itinerant vendors and 144 from itinerant vendors on weekdays. Seven samples purchased from itinerant vendors were not in accordance with the legal standard and proceedings were instituted in three cases and letters of caution sent in two. In one case an "appeal to cow" sample was taken subsequently. Samples were taken on delivery as follows :—Poplar Institution, 5 ; Poplar Hospital, 4; and St. Andrew's Hospital, 4. All these samples were genuine. 88 THE SALE OF FOOD AND DRUGS ACTS. Administrative Action taken in Respect of Samples reported to be not genuine, etc. March Quarter, 1925. Sample. No. Result of Analysis, etc. Result of Legal Proceedings, or action taken. Milk 3 Vehicle from which milk was served not marked with vendor's name and address Letter to vendor. Condensed Milk Informal Deficient in fat 3.3 per cent., and in milk solids 3.5 per cent. Formal sample taken. Milk 9 Deficient in fat 10 per cent. (Magistrate held that the milk had not been stirred in the receptacle from which it was delivered) £2 2s. costs; first offence. Margarine 620 Contained excess of water 1.5 per cent. Reported to Ministry of Agriculture. Margarine 622 Contained excess of water 2 per cent. Reported to Ministry of Agriculture. Milk 19 Contained added water 16.5 percent. (Magistrate would not convict on account of defendant's good record) £4 4s. costs. Camphorated Oil 22 Deficient in camphor 7.5 per cent. £2 2s. costs. Milk 350 Contained added water 2.3 per cent. Letter of caution. Margarine 24 Contained excess of water 2 per cent. Dismissed. Warranty proved. Butter 4 Contained 16.1 per cent. water Reported to Ministry of Agriculture. Margarine 10 Contained 16.6 per cent. water Reported to Ministry of Agriculture. Butter 335 Contained 16.1 per cent. water Reported to Ministry of Agriculture. Margarine 61a Served in plain wrapper Letter of caution. Pure Cocoa 345 Contained added alkali 2 per cent. Letter of caution. Pure Cocoa 20 Contained added alkali 2 per cent. Letter of caution. 89 June Quarter, 1925. Sample. No. Result of Analysis, etc. Result of Legal Proceedings, or action taken. Milk 350 Contained 2.3 per cent. added water Letter of caution. Milk 351 Contained 10.5 per cent. added water £1 penalty; £1 1s. costs. Prescription 28 Deficient in carbolic acid 11 per cent. Summons dismissed; £5 5s. costs against Council. Milk 49 Contained 2.3 per cent. added water Letter of caution. Milk 644 Contained 4.7 per cent. added water Letter of caution. Lemon Squash P. 11 Deficient in lemon juice 90 per cent. No action under Food and Drugs Acts. Unable to obtain evidence in support of proceedings under Merchandise Marks Acts. Lemon Squash G. 12 Deficient in lemon juice 90 per cent. No action under Food and Drugs Acts. Unable to obtain evidence in support of proceedings under Merchandise Marks Acts. Lemon Squash P. 22 Deficient in lemon juice 90 per cent. No action under Food and Drugs Acts. Unable to obtain evidence in support of proceedings under Merchandise Marks Acts. Lemon Squash G. 22 Deficient in lemon juice 90 per cent. No action under Food and Drugs Acts. Unable to obtain evidence in support of proceedings under Merchandise Marks Act. Ground Ginger P. 35 Contained excess of chalk 2 per cent. Letter of caution. Milk G. 16 Contained 3.5 per cent. added water £1 1s. costs. Butter 357 Contained 16.2 per cent. water Reported to Ministry of Agriculture. 90 June Quarter, 1925.—Continued. Sample. No. Result of Analysis, etc. Result of Legal Proceedings, or action taken. Cake 635 Contained 8.5 grains of boracic acid per lb. Letter to vendor. Margarine 37 Contained 16.8 per cent. water Reported to Ministry of Agriculture. Margarine G. 29 Contained 16.5 per cent. water Reported to Ministry of Agriculture. Meat Pic 39 Contained 3 grains boracicacid per lb. Letter to vendor. Meat Pie 43 Contained 2 grains boracicacid per lb. Letter to vendor. Butter P. 13 Contained 16.1 per cent. water No action. Cocoa G. 20 Contained 2 per cent. added alkali Letter to vendor. Cocoa P. 20 Contained 2.5 per cent. added alkali Letter to vendor. Sausage P. 25 Contained 3 grains boracicacid per lb. Letter of caution. Margarine 38 Contained 16.4 per cent. water Reported to Ministry of Agriculture. Sausage 37 Contained 1.5 grains sulphur dioxide per lb. No action. Lime juice cordial 41 Contained 2.5 grains sulphur dioxide per lb. No action. Lime juice cordial 42 Contained 2 grains sulphur dioxide per lb. No action. Margarine P. 29 Served in plain wrapper Letter of caution. Margarine G. 29 Served in plain wrapper Letter of caution. 91 September Quarter, 1925. Sample. No. Result of Analysis, etc. Result of Legal Proceedings, or other action taken. Milk G. 43 Contained 18.8 per cent. added water £5 penalty; £2 2s. costs. Margarine — Not properly labelled Vendor cautioned. Shredded suet G. 65 Contained 14 per cent. starch Letter to vendor. Shredded suet P. 65 Contained 14 per cent. starch Letter to vendor. Margarine G. 52 Not properly labelled Vendor cautioned. Sweets G. 74 Contained French chalk 10 grains per lb. Letters to vendor and manufacturers. Lime water S. 5 Not made with distilled water Vendor cautioned. Pure cocoa S. 13 Contained 2.5 per cent. added alkali Letter to vendor. Margarine P. 73 Contained 4.1 per cent. excess of water £2 2s. costs. Lime water G. 83 Not made with distilled water Vendor cautioned. Whisky P. 79 51.5 degrees under proof Summons dismissed under Probation Act. £6 6s. costs. Margarine G. 90 Contained 17.7 per cent. water and mineral oil 10 per cent. Further samples taken. Margarine Informal Contained 10 per cent. mineral oil Formal sample (G. 127) taken. Margarine G. 111 Contained 16.5 per cent. water Letter to vendor. Tea dust P. 114 Contained 5 per cent. excess mineral matter Vendor cautioned. Milk G. 117 Contained 20 per cent. added water £25 penalty; £5 costs. Sweets P. 75 Contained French chalk 34 grains per lb. Letters to vendor and manufacturers. Dripping P. 103 2.4 per cent. excess of free fatty acids Further samples taken (December quarter). Four samples of Tea Dust were badly cleaned and on the border-line of purity. Letters were sent to the vendors.' 92 December Quarter, 1925. Sample. No. Result of Analysis, etc. Result of Legal Proceedings, or other action taken. Margarine G. 127 Contained 12 per cent. mineral oil £3 3s. costs. Dripping P. 132 Contained 3.1 per cent. free fatty acids £5 penalty; £2 2s. costs. Milk G. 134 Contained 2.3 percent. added water Letter of caution. Milk G. 149 Contained 7 per cent. added water £5 penalty; £1 1s. costs. Milk G. 155 Deficient in fat 13.3 per cent. No action (see G. 162). Coffee G. 160 Contained 30 per cent. chicory Letter of caution. Milk G. 162 Deficient in fat 3.3 per cent. ' 'Appeal to cow'' sample. Sweets G. 168 Contained French chalk 24 grains per lb. Letter of caution. Sweets P. 168 Contained French chalk 14 grains per lb. Letter of caution. Sweets P. 169 Contained French chalk 14 grains per lb. Letter of caution. Dripping P. 177 Contained 3.2 per cent. free fatty acids Sample taken on delivery. Margarine G. 174 Contained 15 per cent. mineral oil Reported to Ministry of Agriculture and Fisheries. Rum Informal 43 degrees under proof Formal sample taken. Rum Informal 42 degrees under proof Formal sample taken. Whisky Informal 41 degrees under proof Formal sample taken. Cheese (full cream) P. 195 Deficient fat 48 per cent. (Proprietor) £2 2s. costs. Cheese (full cream) P. 195 Deficient in fat 48 per cent. (Salesman) 10s. 6d. costs. Cheese (full cream) G. 191 Deficient in fat 53 per cent. Letter of caution. Rum P. 204 43 degrees under proof. £5 penalty; £2 2s. cost. Gin G. 193 48 degrees under proof. £7 penalty; £3 3s. costs. 93 December Quarter, 1925—Continued. Sample. No. Result of Analysis, etc. Result of Legal Proceedings, or other action taken. Rum G. 196 41 degrees under proof £10 10s. costs. Rum G. 199 45 degrees under proof £10 10s. costs. Whisky G. 201 45 degrees under proof £8 8s. costs. Rum G. 206 42 degrees under proof £2 2s. costs. Whisky P. 207 48 degrees under proof £5 penalty; £5 costs. Rum P. 208 39 degrees under proof £2 2s. costs. Rum P. 220 50 degrees under proof £10 10s. costs. Whisky G. 210 40 degrees under proof £8 8s. costs. Rum G. 213 51 degrees under proof £12 12s. costs. Rum G. 214 45 degrees under proof £10 10s. costs. Sweets P. 215 Contained French chalk 15 grains per lb. Letter of caution. Ground cinnamon G. 224 Contained 2 per cent. sand Letter of caution. Whisky P. 197 43 degrees under proof £10 10s. costs. Cocoa P. 161 Contained 2.5 per cent added alkali Letter of caution. Cocoa G. 159 Contained 2.5 per cent. added alkali Letter of caution. Mustard P. 150 Contained 1 per cent. wheat starch Letter of caution. Cordial G. 152 Contained 2 grains salicylic acid per pint Letter of caution. Cake P. 139 Contained 2.5 grains boracicacid per lb. Letter of caution. Cocoa G. 207 Contained 2 per cent. added alkali Letter of caution. Cocoa P. 217 Contained 2.5 per cent added alkali Letter of caution. Shredded suet P. 214 Contained 14 per cent. starch (unlabelled) Letter of caution. Sweets G. 218 Contained French chalk 5 grains per lb. Letter of caution. 94 December Quarter, 1925—Continued. Sample. No. Result of Analysis, etc. Result of Legal Proceedings, or other action taken. Dripping P. 179 Contained 1.4 per cent. free fatty acids No action; taken on delivery Margarine P. 194 Contained 16.5 per cent. water Letter of caution. Butter G. 131 Contained 16.6 per cent. water Letter of caution. Mincemeat (fruit) Informal Contained salicylic acid 1.5 grains per lb. Letter of caution. Cordial P. 152 Contained salicylic acid 2 grains per pint Letter of caution. A number of informal samples of spirits were unsatisfactory, and formal samples were purchased later. In formal cases where the excess of water was only slight, letters of caution were sent (4 cases). Milk - Unlawfully refused to sell milk for analysis £3 penalty; £2 2s. costs. Milk and Dairies (Consolidation Act). Milk P. 146 Name and address not on vehicle and receptacles Letter of caution. Public Health (Condensed Milk) Regulations. Three letters of caution were sent to vendors who were retailing condensed milk in loose quantities. An informal sample of condensed milk was found to be deficient in weight. A formal sample was taken early in 1926. 95 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 383* Nil. Cream Nil. Nil. Including one sterilized. 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 as 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 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. 96 Margarine Act, 1887, Sale of Food and Drugs Act, 1899, and the Butter and Margarine Act, 1907. No applications were made for registration of premises for carrying on the business of wholesale dealer in margarine, or of butter blending. The proprietor of an unregistered butter-blending factory was cautioned. Application for a certificate of registration was subsequently made and the premises were registered early in 1926. 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, 1925, viz.:— Sub-District. Margarine. Butter. Wholesale Dealer. Manufacturer. Factory. Wholesale Dealer in Milk-blended. Poplar 6 — — — Bow and Bromley 9 — 2 — Totals 15 — 2 — PART V. MATERNITY AND CHILD WELFARE. 98 The Maternity and Child Welfare work is divided between the Borough Council and the Royal College of St. Katharine, the Borough Council taking the areas north of Bow Road and south of East India Dock Road and the Royal College of St. Katharine being responsible for the intermediate area (practically the whole of Bromley). The Royal College with a staff of medical officers, dentist, health visitors and nurses, is centred at 242, Brunswick Road, and in addition to maternity and child welfare, and dental clinics, its activities include observation wards, artificial sunlight treatment centre and tonsil clinic. The scheme of co-operation with the Royal College is as follows: — Birth enquiry forms are sent for all notified births. These are returned for registration on the anniversary of each birthday up to 5 years or before in the case of removal or death. Lists of notified cases of infectious diseases are sent. The Royal College supplies a monthly return to this office of visits paid by Health Visitors and total attendances at Clinics. In addition there is also at 132, High Street, Poplar, a Maternity and Child Welfare Centre, conducted under the auspices of the Settlement of the Holy Child (Roman Catholic). The case papers of all children under supervision are forwarded to the Education Department of the London County Council as the children attain the age of 5 years. The Maternity and Child Welfare work has increased immensely since 1920. Larger attendances are being recorded at the Clinics, the total attendances during 1925, and the preceding years being as follows: — Borough Council Royal College 1925 31,540 17,809 1924 27,137 13,598 1923 24,058 11,718 1922 17,404 8,992 1921 15,710 9,856 1920 14,490 13,147 The development of the work in Poplar has culminated with the erection of a permanent modernly-equipped clinic on the gardens at the rear of Nos. 134 and 136, High Street, Poplar. The original North 99 Poplar Clinic was opened on 1st December, 1920 (after the Royal College of St. Katharine had intimated that they would be unable to continue work south of East India Dock Road), at Shirbutt Street, with one session weekly. During 1921, it was found necessary to open a second session for infant consultations, and at the expiration of the lease of these premises in 1922, the clinic was transferred to 134, High Street, Poplar, which premises had been acquired by the Council. In 1924, a continued increase of work necessitated a re-arrangement of the health visiting districts and the appointment of a further health visitor. At the same time, as the clinic premises were overcrowded, a proposal to erect a modern building at the rear of 134 and 136, High Street, Poplar, was approved by the Borough Council and the Ministry of Health. The clinic comprises a large hall 45ft. by 35ft. from which are entered the weighing and consulting rooms. Separate dressing boxes are provided in the weighing room; there is sanitary accommodation for the staff and patients. The building is constructed of reinforced concrete, with a large lantern light, roof, covered with slates and supported by steel trusses. The floors are of concrete, covered with jointless asbestic composition. The Ministry of Health has sanctioned the establishment of a second artificial light centre here. In the plans of the proposed observation wards to be erected at Wellington Road, provision has been made for infant consultations to relieve the work at Old Ford. Artificial sunlight treatment was first carried out in my own office during the latter part of 1924. On account of the very encouraging results the Ministry sanctioned the establishment of an artificial sunlight clinic, and pending the erection of the observation wards temporary accommodation (comprising treatment and weighing rooms) has been rented at the Parish Hall, Avenue Road, Bow. After making thorough investigations I was convinced that the best results were to be obtained from a type "K," K.B.B. Artificial Sun lamp, and the Council purchased a lamp of this type. The original lamp is used as a standby in case of breakdown. Later in the year a "Murray Levick" lamp (for throwing red rays on the body) was purchased and this is used in conjunction with the sunlight lamp. The Maternity and Child Welfare Committee appointed Dr. E. M. Layman, one of the clinic doctors who was becoming au fait with the treatment, medical officer-in-charge of the Centre and Miss E. A. Sheppard, nurse-in-charge. The Clinic opened on 20th March, and 100 during the year 4,523 applications of light were given to 268 children. Improvement in the children has been general, but the results in some cases have been little short of marvellous. A Light Centre has also been established by the Royal College of St. Katharine, and with the opening of the Poplar Clinic early in 1926. where another Light Centre has been sanctioned, Poplar will be almost, if not quite, the best equipped Borough for the application of artificial sunlight. The bringing into use of artificial sunlight treatment is, in my opinion, the greatest advance in public health work of the century. During the past year or so, efforts have been particularly concentrated on ante-natal work, and the department works in close touch with the midwives of the district. An ante-natal clinic, opened in Poplar in 1924, is now well established and greatly increased attendances are recorded at Old Ford. Enquiries are made into all cases of maternal mortality and the deafhs from these cases during the years 1920 to 1925, were as follows:— 1920 1921 1922 1923 1924 1925 Sepsis 7 6 3 7 1 5 Other causes 12 10 9 7 4 7 There is no municipal maternity home, but the Guardians have a lying-in ward in their Institution, and several of the midwives in the Borough conduct private lying-in homes. Mothers in the Borough also avail themselves of the East End Mothers' Lying-in Hospital and other institutions. The Maternity and Child Welfare Committee make contributions toward the fees of midwives attending necessitous women. The scale adopted is as follows : — From the average weekly income, for the 4 weeks preceding the birth, is deducted the rent and 5s. for each child under the age of 14 years. If the nett weekly income is under 30s., the sum of 13s. 6d. is contributed towards the fee of the midwife, and if the income is between 30s. and 40s., 6s. is contributed. No grant is made if the income is over 40s. per week, or if maternity benefit is received. All stillbirths are investigated and a summary of the information obtained appears on page 108. 101 A private institution for dealing with unmarried mothers and babies has been opened at 83, Bow Road. It is under the Poplar Deanery and works independently of the Borough Council. A complete list of clinics in the Borough is given as an appendix, page 118. Milk is supplied to expectant and nursing mothers, and children under 3 years of age (in special circumstances, 5 years) under the Ministry of Health Circular 185. Liquid and dried milk are supplied, the latter only on the recommendation of the Clinic Medical officers. A full report of the free milk scheme appears on page 116. The following table shows the number of cases of Puerperal Fever, Ophthalmia Neonatorum, Epidemic Diarrhoea and Poliomyelitis, which have been notified since 1920:— Years. Puerperal Fever. O.N. Z.E. Poliomyelitis. 1920 24 61 128 — 1921 16 47 267 1 1922 16 36 85 3 1923 16 38 350 1 1924 . 8 46 67 4 1925 14 43 134 2 Nursing.—On the certificate of local medical practitioners a district nurse is sent in by the Borough Council to nurse children up to 10 years of age suffering from Ophthalmia Neonatorum, Measles, Whooping Cough, Epidemic Diarrhoea, etc., and a fee of Is. 3d. per visit is paid. Convalescent Treatment.—During the year, an agreement has been made with the local branch of the Invalid Children's Aid Association for dealing with children under 5 years of age who have been referred tii that Association by hospitals, etc., for convalescent treatment. The underlying principle is that the provision of convalescent treatment should 1 e under the control of the Borough Council. Children recommended to the Invalid Children's Aid Association are sent to one of the Council's Clinics for examination by one of the Medical Officers and particulars then submitted to the Maternity and Child Welfare Committee. If convalescent treatment is approved,, the I.C.A.A. make arrangements for sending the children away and obtaining grants from Societies, collection of monies from parents (if they are able to afford it^ and the Borough Council pays the balance. 102 Training of Health Visitors.—Under Circular 557 and with the approval of the Ministry of Health, a course of 6 lectures was arranged during October and November at the Royar College of St. Katharine. Three lectures were given by Dr. H. K. Waller and three by Dr. A. E. Hamilton. In addition to the Health Visitors, invitations were sent to all the midwives in the Borough, District Nurses and to the various Institutions. The lectures had an average attendance of 33, and were much appreciated. INFANT MORTALITY. There were 288 deaths of children under one year of age, the death-rate per 1,000 births for the past 18 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 (44) 60 1924 72 (38) 69 1925 75 67 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 the Table on page 107. 103 OPHTHALMIA NEONATORUM. Notifications of Ophthalmia Neonatorum. Forty-thiee cases of Ophthalmia Neonatorum were notified during the year:—35 notified by doctors only, 4 by midwives only, and 4 by both doctors and midwives The total notifications received numbered 54. In addition to the foregoing, one case occurred in a neighbouring borough, making a total of 44 cases. 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 31 1 — 1 1923 38 30 8 35 — — 3 1924 46 38 8 46 — — — 1925 44 39 5 42 — — 2 Total 611 550 60 588 7 1 14 ** 1 born in Institution—not visited, no information available. Miss J. M. Cardozo, chief health visitor, reported as follows Artificial Light Clinic.—The result of the Artificial Light Clinic, opened in Avenue Road last March, has proved a great asset to the work at the Infant Welfares. Children, who for various reasons could not be sent away for convalescent treatment, have attended and received great benefit. It is most encouraging to see the change in a fretful and ailing child who, after a few exposures, becomes happy and contented, improved both physically and temperamentally. Infant Consultations.—The attendances at the Clinics have been well maintained; Old Ford, with an average attendance of 60.4, and Poplar, 60. The prevalence of Measles and Whooping Cough has kept many babies away. 104 With the exception of the Island Clinics, the sessions are veryovercrowded. It is impossible to deal effectually with 80 to 100 children in one afternoon. This number is reached frequently at Old Ford, which is the only centre for a large area. The attendance at Christ Church would be much larger if the premises were more suitable. We badly need better accommodation on the Island. Ante-Natal Clinics.—At Old Ford, this Clinio has been well developed. The mothers are realising the advantage of medical supervision during pregnancy. The attendances at Poplar have also improved, but there is still a great deal to be done in this branch of the work throughout the Borough. Dental Clinic.—The Dental Clinic is now quite popular. Instead of an attendance of 4 or 5 per session, we now have a long waiting list, and it was found necessary to provide 4 extra sessions last year. The prejudice against dental treatment during pregnancy is not so marked. Several mothers have been referred from the Ante-Natal Clinics and' have received necessary treatment. infantile Mortality.—The rate for the Borough was 75. Out of 288 deaths, 93 were caused by Premature Birth, Malformations and Debility, and 61 of them occurred during the first four weeks of life. Respiratory diseases caused 102 deaths. The overcrowded condition of the homes is largely responsible for this high number. Zymotic Enteritis.—Out of the 18 deaths which occurred during the notifiable period, 10 died before visit, 3 notifications were not received, 3 only were visited. More deaths occurred before and after the notifiable period—35. The Health Campaign. This proved very useful in showing the various activities which are carried out by the Public Health Department. The Travelling Exhibition of the Central Council for Infant and Child Welfare, and the display of garments made by our own mothers at the Clinic sewing classes, were of great interest to both mothers and fathers. The most important visitors, from an educational point of view, were the school children, who were very keen on the short talks which were given. 105 The Health Visitors from the Royal College of St. Katharine assisted us during the three days. Lectures for Health Visitors, Mid-wives and Welfare Workers. —These lectures, given by Dr. H. K. Waller and Dr. A. E. Hamilton at the lioyal College of St. Katharine, were a great help to us all. Lady Barrett's lecture on October 1st on Ante-Natal Care, showed how clearly she understood the mothers' difficulties, and spurred us on to further efforts in Ante-Natal work. The mothers' Christmas parties took place again this year, thanks to the kindness of the Clinic staff and the many friends who remember us regularly each year. The new Clinic at Simpson's Road was not opened until January, 1926. but I cannot close this report without mentioning an event which has given such entire satisfaction to all concerned. After the dull quarters at Shiibutt Street and the overcrowded condition at 134, Hiirh Street, we fully appreciate the comfort of working under such ideal conditions and; needless to say, the mothers and children are equally appreciative. I wish to thank everyone for the care and trouble that has been taken in the planning and erection of this building. Our thanks are also due to the voluntary workers who so kindly assist at the Clinics. 106 Statistical Summary for 1925 Public Health Department. The Royal College of St. Katharine. Total. Ante-natal:— Visits 622 695 1,317 Re-Visits 887 1498 2,3S5 Post-natal:— Visits 1,497 1,888 3,385 Removed before Visit 21 35 56 Died before Visit 26 57 83 Stillbirths 52 43 95 Re-visits:— Under 1 7,913 16,338 24,247 1—5 17,216 28,944 46,160 Removed 226 448 674 Died 125 148 273 Ophthalmia Neonatorum:—* Visits 44 nil. 44 Re-visits 195 nil. 195 Zymotic Enteritis:— Visits 37 68 105 Re-visits 50 59 109 Dead 3 5 8 Measles:— Visits 57 366 423 Re-visits 34 118 152 Dead 2 11 13 Miscellaneous 213 2,421 2,634 Total Visits Paid 29,220 53,138 82,358 * 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. 107 METROPOLITAN BOROUGH OF POPLAR. The Borough. Infantile Mortality during the Year 1925. Net 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. Net total Deaths under 1 year. Poplar. Bow and Bromley Whole Borough All causes Certified 61 12 19 9 101 50 59 37 41 132 156 288 Uncertified — — — — — — — — — — — — Small Pox — — — — — — — — — — — — Chicken Pox — — — — — — — — — — — — Measles — — — — — 1 — 2 4 2 5 7 Scarlet Fever — — — — — — — — — — — — Whooping Cough — — — — — 2 6 4 9 12 9 21 Diphtheria and Croup.. — — — — — — — — — — — — Erysipelas — — — — — — — — — — — — Tuberculous Meningitis — — — — — — 1 — 2 1 2 3 Abdominal Tuberculosis — — — — — — — 1 — 1 — 1 Other Tuberculous Diseases — — — — — — 1 2 3 3 Meningitis (not Tuberculous) — — 1 1 2 — — — 2 2 2 4 Convulsions 2 — — 1 3 1 — — — 1 3 4 Laryngitis — — — — — — — — — — — — Bronchitis — 1 3 3 7 6 7 4 5 16 13 29 Pneumonia (all forms) — 2 5 — 7 11 12 11 11 26 26 52 Diarrhoea — — 1 — 1 5 7 7 1 8 13 21 Enteritis — 1 1 — 2 3 15 2 2 12 12 24 Gastritis — — — — — — — — — — — — Syphilis — 1 — 1 2 — — — — 2 — 2 Rickets — — — — — — — — — — — — Suffocation, overlying 1 — — 1 2 — — — — — 2 2 Injury at birth — 1 — — 1 — — — — — 1 1 Atelectasis 7 — — — 7 — — — — 3 4 7 Congenital Malformations 6 3 — — 9 2 2 — — 9 4 13 Premature birth 36 1 5 1 43 6 3 — — 17 35 52 Atrophy, Debility and Marasmus 5 1 2 1 9 11 2 3 3 14 14 28 Other Causes 4 1 1 — 6 2 3 3 — 6 8 14 Total Deaths 61 12 19 9 101 50 59 37 41 132 156 288 Net Births in the year Legitimate 3,765 Illegitimate 66 Net Deaths in the year of Legitimate infants 273 Illegitimate infanta 15 108 Stillbirths. Number of stillbirths 95 Delivered by Doctors 17 ,, by Midwives 36 ,, in Institutions 35 B.B.A. 7 No information available — Premature births 19 First pregnancies 17 Mothers who had had previous stillbirths:— One. Two. Three. Four. 9 5 1 4 Nursing. Ophth. Neon. Measles. Pneumonia. Cases. Visits. Cases. Visits. Cases. r Visits. Under 5 5-10 Under 5 5-10 Under 5 5-10 Under 5 5-10 East London Nursing Society 5 148 — — — — 1 3 7 15 St. John Divine 3 69 — — — — — — — — St. M ildred's D istr ict Nurse 2 93 — — — — — — — — Totals 10 310 — — — — 1 3 7 15 ATTENDANCES AT CLINICS. Bow. West Ferry Road. Christchurch. North Poplar. Royal College of St. Katharine. First attendances 623 129 180 335 927 Infant consultations 12,089 2,061 4,794 5,866 12,347 Average per session 60.4 41.0 46.5 60 — Average attendances of each child 9.0 7.3 10.8 11 — Dental Clinic 779 — — — 842 Expectant mothers 547 — — 208 410 Sewing Class — 298 — 375 376 Light Centre 4,523 — — 2,907 109 Total attendances at all Clinics:—Public Health Department, 31,540; Royal College of St. Katharine, 17,809. Monet Taken. £ s. d. For Dried Milk (9,6631b.) 724 14 6 ,, Medical sundries 40 6 4 ,, Dentures 31 13 6 ,, Materials at Sewing Class 34 16 8 ,, Convalescent Treatment 3 12 6 „ Virol 19 5 4 ,, Oil and Malt 99 4 8 Total money taken £953 13 6 Free issue.—3,5391b. Dried Milk. 4,770 vouchers for cod liver oil, malt, etc.. were also issued. Grants in Aid. Convalescent Treatment (mothers and babies) 16 cases. Children 21 ,, Attendance of Midwife 28 ,, Loan of maternity bag 6 ,, Zymotic Enteritis. Died before notification received 10 Not traced 2 Visited 109 Under 1 year (see feeding below) 49 (5 deaths). 1 to 2 years 34 2 to 3 years 11 3 to 4 years 8 4 to 5 years 7 Feeding. Age period. Breast. Mixed feeding. Hand-fed. Not stated Under 1 year 19 7 18 — Died. — 1 4 — 110 Ophthalmia Neonatorum. Number of notifications received 44 Died in Institutions 2 Sight of one eye damaged - Recovered 42 Occurred in Institutions 2 Occurred in the practice of medical practitioners 8 Occurred in the practice of midwives 34 Admitted to hospital as in-patients 3 Treated as hospital out-patients 5 Treated privately 34 Visited by nurse 10 Vital Statistics, 1924. Alii births, including those occurring in outlying districts, but belonging to the Borough 3910 Attended by doctors 869 Attended by midwives 2214 Delivered in institutions 783 Not stated 44 Stillborn 72 Died before visit 86 Not requiring or desiring visits 346 Visited 3406 Removed and not traoed 211 Died during visitation 128 Remaining under supervision end of first year 3067 Stillbirths per 1,000 births 18.4 Mortality per 1,000' births, died before visit 22.0 Mortality per 1,000 visited 37.6 The feeding of infants during the first six months of life was as follows:— 1. Those alive at end of completed year (December, 1925)— Breast-fed 74.7 Mixed feeding 20.6 Hand-fed 4.7 Ill 2. Those who died— Breast-fed 51.6 Mixed Feeding 31.2 Hand-fed 17.2 3. Comparison of rates of mortality between infants— Breast-fed 2.8 Mixed feeding 6.0 Hand-fed 13.0 Year of Birth. 1920 1921 1922 1923 Remaining under supervision :— End of first year — — — 3337 ,, ,, second ,, — — 3327 — ,, „ third ,, — 3250 — — ,, fourth ,, 3697 — — — Found 5 22 41 105 Given up — — 4 5 Removed and not traced 116 116 129 152 Died 14 20 36 78 Remaining under supervision:— End of second year — — — 3207 ,, ,, third ,, — — 3199 — „ „ fourth ,, — 3136 — — „ ,, fifth ,, 3572 — — — 112 ROYAL COLLEGE OF ST. KATHARINE, POPLAR. Report of the Senior Medical Officer for the year ended 31st December, 1925. The opportunities for conference between those engaged in infant welfare work, the increasing literature and numerous official reports on the subject are steadily helping to define both the scope of the work and the problems it presents. Some of the less obvious clinical features are only beginning to crystallise out from the mass of routine work which is concerned largely with the feeding, clothing and general management of the early days of life. One such feature, for example, is special liability of the infant to catarrhal infections; another, the recognition of the baby who from birth is the prey to nervous unrest; a third, the detection of the earliest signs of incipient rickets. A group of cases which cause us no little anxiety and some dissatisfaction can be singled out in a review of each year's work. It consists of children who, after making good progress for about the first eight months of life, tend to drop below the normal standard of growth and at 18 months or 2 years of age do not by any means fulfil their early promise. The decline starts, it will be noticed, at or about the start of the weaning period, and one suspects therefore that the substitution of a mixed diet for some of the milk is not accurately adapted to the child's physical needs. Undoubtedly there are great opportunities for error here. A good mixed diet is more difficult to prescribe accurately than a milk diet. The ingredients are difficult to measure while their preparation is dependent on the mother's judgment and skill in cookery. Infants will often establish a perverse and troublesome preference for some particular foodstuff, notably farinaceous foods, and they are sometimes indulged rather than carefully trained to take balanced diet. The appearance of headsweating during sleep in a child about 10 months old often coincides with the habit of eating freely of bread, potato, biscuits, rice and chocolate. It can be observed, at the same time, the child's vitality is declining. Whereas, at six or seven months of age, when milk fed, he was actively clambering over his mother reaching for anything that attracted his attention at the clinic, essentially full of life and obviously enjoying it, he has become lethargic, sits stilt instead of standing up and is said to be getting fretful and wants to be nursed. Dietetic instruction at this stage should be careful and explicit as regards total amount of food, number of meals, balance of foodstuffs 113 and vitamin content. Breast milk should in some cases be replaced by cows' milk for in a number of instances the child refuses to take adequately its new food until it has ceased to be suckled. The poverty of muscle tone which is largely responsible for the lethargy, improves if the proper food is obtained. It has frequently been noticed that in infants' treatment by a combination of dietetics and exposure to a mercury vapour or carbon arc lamp, this atonia is abolished rapidly and the headsweating ceases coincidentally. The growth begins to improve and progress is again satisfactory. Nevertheless, there remains a group of children who, despite the application of these measures, do not respond. Their weight charts, after recording a steady curve for eight or nine months, begin to show sharp depressions and slow recoveries. The notes contain frequent mention of naso-pharyngeal infection and disordered digestion and loose stools. Their attendance perhaps begins to be irregular and the explanation is commonly an attack of bronchitis and that the weather was not suitable for a visit to the clinic. Otorrhcea, pneumonia following or complicating measles or whooping cough, are other reasons for prolonged absences and there is dismay, when on its return, the infant's weight is found to have shown no advance or an actual retrogression in three or four months. Dietetics and ultra-violet radiation fail disappointingly to control the infective catarrhs; the general condition remains definitely subnormal; headsweating c'uring sleep may be a prominent and constant feature and pallor, lack of muscle tone and abdominal prominence are evident; the child is labelled constitutionally delicate by parents and neighbours, its frequent attacks of feverishness giving rise to the suspicion tkat tuberculosis is the underlying cause. It becomes a great question whether these children should continue to attend clinics for the welfaring, and in London, at any rate, the mothers, with or without the doctor's recommendation, frequently transfer them to the hospital out-patient departments. In these children, great hypertrophy of adenoid tissue and repeated infection of the tonsils, with enlargement of cervical glands, is an outstanding feature, and it does not seem possible to dissociate their general debility from the tendency to recurrent infection in this region. It is commonly held that two years of age is unduly early to remove tonsils and adenoids. Welfare Centres are not equipped or staffed for the undertaking, and operations on out-patients at a hospital situated far from the infant's home involve considerable risk. Moreover, the anresthetic and surgical technique in the very young present somewhat 114 special features. Yet there can be little doubt that surgical treatment is what a large number are in need of, that nothing can replace it, and that its delay is often actually disastrous, judging by the frequency with which thoracic, aural and glandular complications supervene. Infant Welfare Clinics present an unrivalled field for observations on the early manifestations of ill-health and its causation. It seems possible that they may demonstrate a common need for the early prophylactic surgical treatment of adenoids and tonsils in the interests of general development. Our own case-records show most satisfying results in a number of selected instances where the surgical difficulties have been overcome. For the operation has been followed not only by a greatly increased freedom from catarrhal illnesses of any severity, but also by a most satisfactory improvement in metabolism. HAROLD WALLER. Medical Officer. REPORT OF DENTAL SURGEON. The following is Mr. C. Hammond Williams' Annual Report of the work carried out in the Maternity an3 Child Welfare Dental Clinic, at Old Ford, for the year 1925, and a survey of the five years the Dental Clinic has been in existence. (a) Annual Report for the Year, 1925. Our figures for the year are as follows:— Attendances New Patients Sessions Teeth Extracted Teeth Filled Scalings 779 251 55 1321 163 134 In addition, a considerable number of dentures has been fitted (the exact number is not available) and innumerable dressings and minor work pertaining to the teeth and mouth carried out. This shows a very considerable increase over last year's work. For instance, there has been an increase of 152 attendances (though only three extra sessions have been held). There has been an increase of 56 new patients. (Owing to a clerical error in our books, the number of new patients for 1924 was given as 255. This should have been 195). There has been an increase of 252 teeth extracted. The same applies to other work, particularly the fitting of dentures. 115 As will be observed, some extra sessions were held. This was on account of a formidable waiting list, and is an obvious sign that dental treatment is being appreciated in the Borough. (B) Survey of the Five Years, April, 1920, to December, 1925. Since the dental clinic was inaugurated, on April 7th, 1920, there has never been any doubt as to its success. The following figures of the work carried out relate only to such essential and fundamental items in treatment as extractions and fillings, together with the number of attendances and sessions held. It has not been possible to deal with other branches of the work such as the fitting of dentures, scalings, dressings, etc. During the period April, 1920 to December, 1925, 304 Sessions have been held; 2,699 attendances have been made; 4,492 teeth have been extracted; 680 teeth have been filled. Though I have no figures relating to other Maternity and Child Welfare Dental Clinics available, I have no doubt at all that our figures will bear favourable comparison with any others. In the same way, our Clinio will bear favourable comparison in every respect, except that of premises. The latter will be bettered in the near future, I understand. Our equipment, being the best procurable, has given every satisfaction and is in the best working condition still. We have found very little need for replacements in our equipment and instruments, only such perishable articles as rubber gas bags, and such commodities as drugs, impression compound, gas, etc., needing replenishment from time to time. The number of old patients who return periodically for further treatment or overhaul is steadily increasing, and it is very gratifying to observe these cases. Not only does it show a desire in the individual to have and maintain a healthy mouth, but it is a sign of a mental change in the community generally, whereby they are beginning to realise the importance and advantages of dental treatment. I think I am right in saying that the old horror of the dentist's chair is being overcome slowly but surely; and that the anticipation of dental treatment is even worse than the actual ordeal of the treatment is realised now more than ever. The number of young children requiring treatment 116 is very marked, and it is very sad to find numbers of children ranging from 18 months upwards with badly decayed and septic teeth in their mouths. Unfortunately these cases are rarely treatable except by extraction. One often wonders what condition these mouths will present later in life on account of numerous extractions in infancy. The remedy for this state of affairs, I am convinced, lies in the treatment and education of the mother, not only as far as her teeth and those of her children are concerned, but in diet and general condition. I have noticed a number of patients insist on having extractions under gas, even when one or two simple extractions, which could be done quite painlessly at the time with a local anaesthetic, are indicated. In these cases the administration of gas is a luxury and tends to hold up other cases where gas is a necessity. The establishment of a small fee, say 3d. or 6d. for each gas administration would tend to overcome this source of waste time, and expense, and I would commend this proposal to your notice. I believe such a course has been adopted in other clinics with success. I realise how very fortunate I have been in the help and co-operation I have received of everyone interested in the Clinic, since its commencement, and I am sure that, with such support, we can anticipate continued and even greater success in the future. C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. FREE MILK SCHEME. During the 12 months ended 26th December, 1925, 12,475 applica tions for free milk were received), of which 11,358 were granted. Orders for 410,587 pints of fresh, and 3,7271b. of dried milk were issued, the total commitments amounting to approximately £4,994. Personal inquiry was made in 1,633 cases by the the Inquiry and Investigation Officer. Nine cases were reported to the Maternity and Child Welfare Committee as unsatisfactory. In 6 cases applicants, or a member of their family, had commenced work and were then in receipt of an income which rendered them overscale, without notifying the change of income; 1 case Poor-Law relief was understated; 1 case unemployment benefit of a member of the family not stated and 1 case notification not given that child had been sent away. In each case the Committee sent a letter of caution. 117 During the year just over £2 was repaid on account of milk supplied upon incorrect information, making a total sum of about £308 repaid to the end of December, 1925. The Maternity and Child Welfare Committee have had under constant consideration the financial and other circumstances of each of the debtors and during the year several of the outstanding debts have been cancelled. Since 1st April, 1923, by arrangement with the Dairymen's Association, the Council has been paying 4d. per gallon below the ruling retail price. The price of milk per pint to the Council varied during the year as follows:—1st January, 3d.; 1st April, 2Ad.; 1st October, 3d. The following table shows in comparative form the applications, etc., during the years 1920-25: Year. Applications. Applications, granted. Cost (approx) £ Orders issued. Cases investigated by I.O.(b). Unsatisfactory cases. Fresh. (Pints). Dried. (Lbs.). 1920 (a) ? 17 095 ? 873,585 3,454 — 1921 (c) 23,799 18,270 14,500 782,012 1,236 1,611 107 1922 18,082 16,215 8,500 621,796 1,664 2,969 15 1923 15,537 14.086 6,600 512,614 3,230 2,974 34 1924 14,828 13,597 6,150 487,070 4,902 2,922 14 1925 12,475 11,358 4,994 410,587 3,727 1,633 9 Notes.—(a) In 1920, 49 tins of condensed milk were also issued; (6) the Inquiry and Investigation Officer commenced duty in Maich, 1921; (c) by Circular 185, dated 31st March, 1921, children between the ages of 3 and 5 years are only allowed milk upon a special medical certificate. During the year the question of a pure and clean milk supply has been under the serious consideration of the Maternity and Child Welfare Committee. Their deliberations culminated in the Council, on 25th June, resolving to give notice to all dairymen that on and after 1st January, 1926, the Council would require Grade "A" (Tuberculin Tested) milk to be delivered on all orders issued under the Maternity and Child Welfare Milk Scheme. 118 MATERNITY AND CHILD WELFARE CLINICS. Situation . Nature of Accommodation. Clinics. (Infant Consultations unless otherwise stated.) (a) Provided by the Borough Council— 134, High Street, Poplar Medical Officer's, Weighing and Waiting Rooms Wednesdays, 10.30 to 12.30 and 2—4 p.m. Ante-natal First Monday in each month, 2—4 p.m. Sewing class alternate Mondays, 2.30 to 4.30. Wesleyan Mission, Old Ford Road Ditto and Dental Clinic Tuesdays, Thursdays and Fridays, 2—4 p.m. Ante-natal—Fridays 10.30 to 12.30. Dental Clinic—Wednesdays 10—12 Christ Church Schools, Manchester Road Medical Officer's, Weighing and Waiting Rooms Tuesdays and Wednesdays, 2—4 p.m. 54, West Ferry Road Ditto Ditto Ditto Fridays, 2 to 4 p.m. Avenue Road, Bow Artificial Sunlight Clinic and Waiting Room Light treatment Monday to Friday, 9.30 to 12.30 and 2.30 to 4.30, and Saturdays 9.30 to 12.30 (Medical Officer attends Tuesday and Friday (b) Provided by the Boyal College of St. Katharine— mornings). 228-230, Brunswick Road Two Medical Officer's Rooms; 1 Weighing and 2 Waiting Rooms; 1 Dental Clinic; 1 Artificial Light Room and Waiting Room. Two Observation Wards, with Kitchen, Bath Room and Out-patient Room for mothers.. Tuesdays, Thursday and Fridays, 2 p.m. Sewing Class Wednesdays, 2 p.m. Dental Clinics—Mondays, 3 p.m., every 2 weeks. Ante-natal Tuesdays, 10 a.m. Light Treatment—Mondays to Fridays, 9.30 to 12.30 and 2 to 5 p.m. (Clinic, Medical Officer attending, Mondays, 2 p.m.). "Tonsil" Clinic held once monthly in Dental Clinic. (Monday, 9 am.). The Lighthouse Mission, Blackthorn St. Medical Officer's Room and Large Hall for weighing and waiting Wednesdays, 2 p.m. Shaftesbury Hall, Kerbey Street Ditto Ditto Ditto Wednesdays, 2 p.m. Kingsley Hall, Botolph Road Ditto Ditto Ditto Thursdays, 2p.m. (Sincediscontinued). 119 INDEX. Faok Age Mortality 9 Analyst's Report 81 Anthrax 26 Antitoxin, quantity issued 22 Area and Population 8 Bacteriological Examinations 25 Bakehouses 79 Births 8 Canal Boats 64 Cerebro-spinal Meningitis 27 Cleansing of Verminous Persons, etc. 34 Committees v. Continued and Typhus Fevers 27 Customs and Inland Revenue Acts 65 Death Rate amongst infants visited 102 Deaths and Death Rates 8 & 9 Deaths, Classified Causes, Table 14 ,, Infantile, Table 107 Dentist's Reports 45 & 112 Diarrhoea and Enteritis, Deaths 9 Diphtheria 25 Disinfectant, Electrolytic 28 Disinfecting Department 28 Electrolytic Disinfecting Fluid 28 Encephalitis Lethargica 27 Erysipelas 26 Export of Meat Foods 80 Food and Drugs Acts, etc. 86 Food Inspectors'Reports 74—78 Fond, Preparation for Sale, etc. 78 Free Milk Scheme 116 Glanders 26 Hairdressers'Premises 66 Health Visitor, Chief, Report of 103 Houses Let in Lodgings 65 Housing Acts 52 Housing Inspectors' Reports 56 Hydrophobia 26 IceCream 79 Infantile Mortality 102 & 107 Infectious Diseases, Table of Notifications 22 Inquests and Deaths from Violence 11 Lady Sanitary Inspector, Report 54 & 55 Legal Proceedings 68 Marriages 8 Maternity and Child Welfare 98—118 Measles 27 Milkshops, etc. 78 Mortuary 11 ko-o ~ 120 IN D EX—(continued) Page Notification of Births Act 8 Notifications of Infectious Diseases, Table 22 Ophthalmia Neonatorum 103 & 110 Overcrowding 66 Plague 26 Poliomyelitis, etc. 27 Poor Law Relief, etc. 66 Population 66 Puerperal Fever 27 Rag and Bone Dealer, Byelaws 64 Rag Flock Act 66 Rats and Mice Destruction Act 66 Reports:— Chief Health Visitor 103 Dental Surgeon (M.&C.W.) 114 Dental Surgeon (Tuberculosis) 45 Public Analyst 81 Senior Medical Officer, Royal College of St. Katharine 112 Tuberculosis Officer 35 Sanitary Inspectors'Work, Summary 50 & 51 Scarlet Fever 25 Schools, Inspection of 66 ,, Use of Electrolytic Fluid in 33 Slaughterer of Poultry, Byelaws 80 Slaughterhouses, Byelaws 80 Smallpox 26 Smoke Nuisances 64 "Spotted Fever" 27 Staff vi. Swimming Baths, Use of Electrolytic Fluid in 33 Tables A to F (Workshops, etc.) 57—63 Tables of Deaths 12—20 & 107 ,, Infectious Diseases 22 Tuberculosis Officer's Report 35 ,, Regulations, Notifications, etc. 46 & 47 Typhoid Fever 25 Unhealthy Areas 54 Vaccination 26 Verminous Children and Persons 33 & 34 Verminous Rooms 64 Vital Statistics, Summary viii. Tables 12-20 Water Certificates 65 Workshops, Workplaces, etc. (Tables) 51—63 Zymotic Diseases, Notifications, etc. 22