POP 32 Metropolitan Borough of Poplar. Annual Report FOR THE YEAR 1926 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 J. A. Hammond, J.P., Mayor (ex-officio). Councillor Mrs. N. F. Cressall (Chairman). Councillor J. Ashley (Vice-Chairman). Councillor A. Baker. Alderman Mrs. J. A. March. „ T. J. Blacketer. Councillor J. Mudge. „ T. J. Goodway. „ J. T. O'Callaghan. „ Mrs. A. L. Harris. „ R. Palfreman. „ J.H.Jones. „ W. T. Sell. „ Mrs. J. Mackay. „ Mrs. E. Stavers. Councillor C. A. Tanner. MATERNITY AND CHILD WELFARE COMMITTEE. Councillor J. A. Hammond, J.P., Mayor (ex-officio). Alderman Mrs. J. A. March (Chairman). Councillor T.J. Blacketer. Councillor A. R. Sargent. „ G. J. Cressall, J.P. „ Mrs. E. Stavers. „ Mrs. N. F. Cressall. „ Mrs. A. L. Harris. „ Mrs. E. M. Lambert. Co-opted Members'. „ Mrs. J. Mackay. Miss E. Herbert. „ G. A. Newton. Mrs. M. 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. Gbabham.*‡ (a) J. Johnson.*§ (a) A. J. Field.† (b) H. A. peaboe.*†§‡ (a) C. h. BBOWN.*†‡§ (a) W. Boyce.† (c) f. A. Smith.*‡ (Retired July, 1926.) (a) H. J. Langley.* Miss M. E. davies.*†¶|| (d) S. Kelly (a) District Inspectors. (b) Food Inspectors. (c) Houses-let-in-Lodgings Inspector to June, 1926. District Inspector from July (d) Inspector for Houses divided into separate tenements from July. Clerks: F. J. White.* H. C. Rodfobd. H. A. Pubdy. W. F. Robebts. Miss S. Fells. Miss E. Hamilton. A. Hamilton. S. Duggin (Office Boy). Offices—Caretaker and Messenger: J. J. Jaokson. 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. Brows. *Cert. S.I.E. Board. † Cert R.S.I. ‡Cert. Meat and Food Inspector. § R.P.C. ¶ C.M.B. || 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 Inspectors, the Maternity and Child Welfare and the Tuberculosis Dispensary Staffs. vii MATERNITY AND CHILD WELFARE. Chief Health Visitor: Miss J. M. CABD0z0.*¶†† Health Visitors: Miss E. A. Foskett.*¶ Mrs. M. J. Edgell.§¶ Miss M. Mallett.* Mrs. E. K. Haythornthwaite.*¶| Miss G. E. Paice.*†† Miss E. A. Sheppard (Resigned), Miss A. Eaton*¶ (from 12th July), Sister-inCharge Artificial Light Treatment. (a)Miss D. A. E. LANDRAY.*¶† (a)Miss E. A. H. Williams*¶† (from 4th August). Clerk: Miss G. Hood. There are three Doctors, one Dental Surgeon and an Anæsthetist attending the Council's Clinics. Free Milk Scheme. Temporary Clerks: Miss R. Williams (Resigned). Miss M. L. Thompson (Resigned). Miss I. Collen (from 10th September). Miss K. Phelan (from 29th May). Investigation and Enquiry Officer (part time): C. A. Webster. 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. Cullen, M.R.C.S., L.R.C.P., D.P.H, Health Visitors: Miss H. Messem. Miss D. Wood.‡ Miss N. Roberts.** Dispenser: Mrs. A.M. Smith. Clerks: Miss E. S. Jones (Resigned). Miss A. D. Frost (from 12th July). 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. ‡ San. Insp. Cert. R.S.I. ** H.V.Cert.R.S.I. ¶ Three Years' General Nursing Certificate, †† Fully Trained at Children's Hospital. (a) H- V. Cert. Board of Education. viii SUMMARY OF STATISTICS FOR 1926. Area of Borough (excluding water) 2,136 acres Population (Census, 1921) 162,618 Population, estimated to middle of 1926 169,000 Density 79 Number of Marriages 1340 Number of Inhabited Houses (Census, 1921) 23,064 Number of families or separate occupiers (Census, 1921) 37 ,288 Rateable Value £994,518 Sum represented by a penny rate (April, 1926) £3,833 Total M. F. Births—Legitimate 3,576 1,820 1,7561 Birth Rate 21.6 —Illegitimate 82 41 41 Deaths 1,929 1,071 858 Death Rate 11.4 Number of women dying in, or in consequence of from sepsis 4 childbirth from other causes 9 Deaths of Infants under one year of age, per 1,000 births:— *Legitimate, 67. Illegitimate, 3. Total, 70. Deaths from Measles (all ages) 39 „ Whooping Cough (all ages) 9 „ Diarrhoea (under 2 years of age) 61 * Legitimate (per 1,000 legitimate births) 68 Illegitimate (per 1,000 illegitimate births) 158 Chart Showing Birth, Death and Infantile Mortality Rates for the Years 1901—1926. 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, 1926," I have pleasure in submitting my 34th Annual Report. It refers to the year 1926. Births.—The birth-rate further declined to the low figure of 21.6. Mortality.—The rate of mortality at all ages was 11.4 per 1,000 population and the infant mortality rate 70 per 1,000 nett births. These are the second lowest rates recorded for the Borough. Deaths from cancer numbered 215 (122 male, 93 female), as against 191 (104 male, 87 female) in 1925. Deaths from tuberculosis and from diseases of the respiratory system were fewer than in the previous year. Deaths from whooping-cough numbered 9 as compared with 60 in 1925. Infectious Diseases.—Notifications of infectious diseases were in excess of the number for 1925. 2 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 slight increase. 13 tuberculosis patients who died were not notified (8.0 per cent. of the total deaths from tuberculosis), and thirteen other cases were notified only after death. Verminous Articles for Sale.—By section 44 of the London County Council (General Powers) Act, 1926, the provisions of Part III of the London County Council (General Powers) Act, 1922, are extended and applied to any articles offered or exposed for sale or stored or deposited for sale upon any stall, etc., and to any covers or wrappers of such articles. Maternity and Child Welfare.-—The Borough Council has two Artificial Sunlight Treatment Centres in operation (a) at the Parish Hall, Avenue Road, Bow, and (b) at Simpson's Road Clinic, Poplar. The work of these Centres is dealt with in the body of my report. The new and commodious clinic for North Poplar (erected at the rear of Nos. 134 and 136, High Street, Poplar) was officially opened on 12th January, 1926. The clinic was described in my last Report, but copies of the plans are reproduced in this Report. The total cost of erecting and equipping this clinic was about £3,000, of which furnishing cost approximately £100. On account of the changing conditions in the Borough, through the housing shortage, it became imperative that more health visiting be carried out in the Bow area. In April the Ministry of Health approved of the proposal to appoint an additional health visitor for this district and Miss E. A. H. Williams was appointed, commencing duty on 4th August. Proposed Maternity Home.—Consideration has been given to the question of the establishment, with the Poplar Board of Guardians, of a joint maternity home. The accommodation provided by the Guardians at All Saints' Hospital, High Street, Poplar, is inadequate and many of the patients admitted are stated to be non-pauper. The provision of increased accommodation is being considered by the Guardians, and a Joint Committee consisting of representatives of the Borough Council and Guardians has been appointed to discuss the matter. At the end of the year no definite scheme had been submitted. 3 Free Milk Scheme.— The Council resolved in 1925, that on and after 1st January, 1926, all milk supplied to mothers and children under Circular 185 should be Grade "A" (Tuberculin Tested). Staff.—During the year the following changes have taken place in the personnel of the staff:— Mr. W. Boyce, Sanitary Inspector, retired on reaching the age limit after 36 years of service. Mr. F. A. Smith, Houses-let-in-Lodgings Inspector, was appointed District Sanitary Inspector, in place of Mr. Boyce, and Mr. S. Kelly, Sanitary Inspector's Assistant, appointed in place of Mr. Smith. Miss A. E. Eaton, took the place of Miss E. A. Sheppard, as Nurse-in-Charge of the Artificial Sunlight Clinics. Miss M. L. Thompson and Miss R. Williams, temporary Clerks under the Maternity and Child Welfare Free Milk Scheme, resigned on account of marriage, and Miss K. Phelan and Miss I. Collen, appointed in their places. Miss E. Jones, Clerk at the Dispensary, resigned on account of marriage, and was succeeded by Miss A. D. Frost. Miss E. A. H. Williams was appointed as an additional Health Visitor. Mr. S. Duggin, office boy, appointed in place of Mr. A. Hamilton, promoted to Clerk, Meat and Food Inspectors and Houses-let-in-Lodgings Inspector. Special Reports.—During the year I submitted the following special reports:— (a) "Prevention of Diphtheria—Schick Test and Immunisation (not liable to Infection)." (b) "Puerperal Fever and Puerperal Pyrexia." stitutional Treatment: Transfusion of Blood and Injection of N.A.B. (Novarsenobillon) )." Public Analyst.—The Public Analyst's Report in connection with the Sale of Foods and Drugs Acts, etc., is given in full. Conferences.—During the year the Public Health and Housing Committee appointed delegates to the following conferences:— Royal Sanitary Institute. Sanitary Inspectors' Association. National Milk Conference. Drainage Bye-laws.—During the year the London County Council submitted draft revised drainage bye-laws, under section 202 of the 4 Metropolis Local Management Act, 1855, and the Metropolis Management Acts (Amendment) Bye-laws Act, 1899. Certain suggestions were submitted to the London County Council upon these draft Bye-laws. Regulations as to Underground Sleeping Rooms.—To conform with the requirements of the Housing Act, 1925, the Council's Regulations as to underground rooms, habitually used as sleeping places, approved on 26th April, 1911, have been amended and submitted to the Minister of Health for his sanction. Bacteriological Examinations.—The arrangements with the Seamen's Hospital, Greenwich, for carrying out bacteriological examinations (other than Tubercle) continue to be satisfactory. In this my final report I am glad to have an opportunity to express my thanks to the officers, labourers and members of the Public Health Department for their constant, loyal and wholehearted support, without which it would have been impossible to have worked the Department smoothly and to the public benefit. I also must thank the Chiefs and members of the Council's various Departments for their co-operation in the work of my Department. I cannot conclude without mentioning the kindness, consideration and courtesy I have always received from the officials of the Ministry of Health. I express my gratitude, as many a knotty point has been solved at an unofficial interview. In relinquishing my official duties in Poplar I wish the Borough may have the highest birth rate and the lowest death rate in the Kingdom, and an infantile mortality so negligible that there will be no necessity for a heading in future Annual Reports. I am, Sir, Ladies and Gentlemen, Your obedient Servant, Fredr hm dlegandez. Medical Officer of Health. Public Health Offices, Bow Road, E.3, February, 1927. PART I. Vital Statistics. 6 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 169,000, 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 4,605,600. BIRTHS. Early in the year 1927, the Registrar-General supplied the following information relating to the year under review:— Registered Inward Transfers. Outward Transfers. Nett. Total Births—Males 1,668 220 27 1,861 3,658 (Legitimate and Females Illegitimate) 1,606 218 27 1,797 Illegitimate—Males 31 11 1 41 82 Females 31 11 1 41 The birth-rate per 1,000 population was 21.6 as against 27.2, 26.6, 25.6, 22.9 and 22.7 for the years 1921-1925. During the year, 3,293 notifications were received under the Notification of Births Act, 1907. MARRIAGES. During the year the marriages of 2680 persons were registered, giving a rate of 15.8 as against 16.2, 15.0, 16.1, 15.3 and 16.2 in the five years 1921-1925. DEATHS. 1,879 deaths were registered as having occurred in the Borough. 238 deaths of non-residents must be deducted and 288 deaths of Poplar residents which occurred outside the Borough must be added, giving a nett total of 1,929 and a rate of 11.4 per 1,000 of the estimated population. 7 It should be borne in mind, when studying death rates, that comparisons should be made with those of districts the inhabitants of which live under similar conditions. See Table III, East Districts. 1921. 1922. 1923. 1924. 1925. 1926. Deaths from all causes, rate per 1,000 population 12.7 14.3 11.3 12.1 11.7 11.4 Deaths under 1 year of age, rate per 1,000 nett births 83 79 60 72 75 70 Deaths over 65 years of age, rate per 1,000 total population 6.8 8.1 3.6 3.9 4.1 3.9 Zymotic diseases:— Death rate per 1,000 population 1.5 1.5 0.6 0.8 0.9 0.9 Proportion of 1,000 deaths 125.3 110.9 58.5 65.7 75.6 75.2 Tuberculosis, all forms:— Death rate per 1,000 population 1.3 1.3 1.2 1.2 1.1 1.0 Proportion of 1,000 deaths 105.7 94.4 103.7 97.9 96.9 84.0 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 2.6 3.6 2.4 3.2 2.9 2.4 Proportion of 1,000 deaths 208.6 254.6 212.7 265.4 246.2 207.9 Deaths from Various Diseases. Disease. 1921. 1922. 1923. 1924. 1925. 1926. Measles 39 62 22 37 27 39 Whooping-Cough 29 88 7 39 60 9 Influenza 16 86 22 48 20 23 Pneumonia, all forms 193 260 163 230 185 154 Diarrhœa and Enteritis (all ages) 112 28 41 30 54 69 *Smallpox, Measles, Scarlet Fever, Whooping-Cough, Diphtheria and Mem. Croup, Typhoid Fever and Diarrlœal Diseases. 8 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." 1926. 28th Feb. St. Andrew's Hospital, no fixed abode. Male, 54. Acute bronchitis; cardiac failure. 17th Mar. S.S. "Umlazi," East India Dock, of Calcutta . Male, 36. Embolism of coronary artery. P.M. Inquest. 19th „ 31, Orchard Place, of Jersey, Channel Islands. Male, 73. Cancer of prostate gland Asthenia. 4th May On way to Poplar Hospital Male, 50. (unknown). Atheroma of coronary arteries. Myocardial degeneration. P.M. Inquest. 28th Dec., 1925. (Body recovered 13th May, 1926). River Thames, of Hamburg. Male, 36. Fell into river while boarding ship. Asphyxia due to drowning. Accidental cause. P.M. Inquest. 21st May. River Thames, off Storers Wharf. Male, newly-born (unknown). Want of attention at birth. Open verdict. Inquest. 2nd June. River Thames, off Bullivant's Wharf. Female newlyborn (unknown). Want of attention at birth. Open verdict. Inquest. 10th „ Poplar Hospital, of Pietermaritzburg, South Africa. Female, 67. Cerebral haemorrhage. 23rd „ River Thames, off Lancaster's Wharf. Female, newlyborn (unknown). Want of attention at birth. Open verdict. Inquest. 2nd July St. Andrew's Hospital, no fixed abode. Male, 49. Pulmonary tuberculosis. 9 DEATHS OF PERSONS OF UNKNOWN ADDRESSES, Etc. , INCLUDED IN THE MORTALITY STATISTICS—(Continued). 1st Aug. St. Andrew's Hospital, no fixed abode. Male, 52. Pulmonary tuberculosis. 10th „ S.S. "Patricia," Millwall Dock, of Gothenburg, Sweden. Female, 42. Aortic valvular disease. P.M. Inquest. 5th Sept. River Thames, off Bullivant's Wharf, of Rotterdam. Male, 19. Fell into Thames. Asphyxia due to drowning. Accidental cause. Inquest. 9th Sept. West India Docks, of Flisby, Sweden. Male, 26. Fell from a ship into dock. Asphyxia due to drowning. Accidental cause. P.M. Inquest. 21st „ Near Stewarts Dry Dock, Cubitt Town. Male, newly-born, (unknown). Prematurity. Want of attention at birth. Open verdict. P.M. Inquest. 16th Oct. S.S. "Shelley," East India Docks (address not known). Male, 56. Enlarged prostate. Cystitis, Nephritis. 8th Dec. S.S. "Intaba,'' South West India Docks, of Kutty, India. Male, 50. Fatty degeneration of heart. Pneumonia. P.M. Inquest. 9th „ S.S. "Ingoma," West India Docks, of Calcutta. Male, 36. Lobar pneumonia, P.M. Inquest. 21st „ River Thames, off Lenanton's Wharf. Male, 55. (unknown). Asphyxia due to drowning. Open verdict P.M. Inquest. 10 INQUESTS AND DEATHS FROM VIOLENCE. The number of inquests held in the Borough was 297. From this total must be deducted 64 non-residents, and 35 added of residents who died outside the Borough, the nett total being 268. Verdict of Violence:— Railways 1 Vehicles and horses 23 Ships, boats and docks 4 Building operations — Conflagrations — Burns, scalds and explosions 7 Drowning (excluding suicides) 8 Suffocations in bed 1 Poisons and poisonous vapours 1 Other causes 28 Suicides 19 Total 92 Verdict of Natural Causes (including deaths from disease accelerated by accident, etc.) 176 Total 268 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 297. All were inquest cases. Residents. Non-Residents.* No age stated 6 — Stillborn 1 — Under 1 year 15 1 1 to 5 years 20 — 5 to 15 years 19 — 15 to 25 years 12 — 25 to 65 years 130 1 65 years and upwards 89 3 Totals 292 5 * Brought from outside the Borough for the convenience of the Coroner. Included under "Residents" are Institution cases irrespective of usual place of residence. 11 Deaths during 1926 in the Metropolitan Borough of Poplar, classified according to certain 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 109 106 67 99 381 Bow and Bromley Sub-District 103 78 66 100 347 St. Andrew's Hospital 222 171 158 172 723 Poplar Institution 27 30 26 34 117 Bow Institution 50 36 22 36 144 Bromley House Institution — — — 1 1 Poplar Hospital 19 29 18 22 88 Adelaide Buildings — 1 — — 1 Baffin „ — — — 1 1 Council „ 2 1 — — 3 Grosvenor „ 1 — 2 4 7 Hanbury „ — — — — — Hudson „ — — — — — Melbourne „ — — — 1 1 Montreal „ — — — — — Ontario „ 1 — — — 1 Ottawa „ — — 1 — 1 Prestage „ — — 1 1 2 Quebec „ — — — — — Sydney „ — — 1 — 1 Toronto „ 1 — — — 1 Wellington „ 1 — — — 1 Winnipeg „ — — — — — River Thames 2 6 3 3 14 „ Lee — — — — — Limehouse Cut 1 — — 1 2 Bow Creek — 1 — — 1 Ducketts Canal 1 — — — 1 East India Docks 1 — — 1 2 West India Docks — — 1 1 2 South-West India Docks — 1 1 1 3 Millwall Docks — 1 1 — 2 Hackney Cut — 1 — — 1 Guardians' Offices — — — 1 1 Highways 11 5 6 6 28 Victoria Park 1 — — — 1 553 467 374 485 1879 Deaths occurring outside the Borough of persons belonging thereto add 79 61 81 67 288 Deaths occurring within the Borough of persons not belonging thereto deduct 76 63 39 60 238 Deaths at all ages—nett 556 465 416 492 1929 12 TABLE I. Vital Statistics during 1926 and Previous Years. Poplar (Whole Borough). Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the Borough. Transferable Deaths.† Nett Deaths belonging to the Borough. Uncorrected Number. Nett. Of Non-residents registered in the Borough. Of Residents not registered in the Borough. Under 1 Year 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 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 3112 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 28 75 1970 11.7 1926 169,000 3274 3658 21.6 1879 11.1 238 288 258 70 1929 11.4 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) must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first institution. (2) The deaths of infants born and dying within a year of birth at any temporary address to which the mother went for her confinement should be referred to the district of fixed or usual residence of the mother. (3) Deaths from violence are referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the hccident occurred, if known; (c) failing this, to the district where death occuired, if known; and (d) failing this, to the district where the body was found. Area of District in Total population at all ages 162,618 At acres (land and)-2327.7 Number of inhabited houses 23,064 Census inland water) Average number of persons per house 7.05 of 1921 . Total families or separate occupiers 37,288 13 TABLE II. The Borough. Causes of, and Ages at, Death during the Year 1926. Causes of Death Total Deaths. Sex. Nett Deaths at Subjoined Ages. Nett Deaths in SubDistricts. Nett Deaths in Public Institutions and certain localities within and outside Borough (at all ages) belonging thereto. Nett Deaths in Public Institu tions, etc. All Ages. Under 1 year. 1 to 2 years. 2 to 3 years. 3 to 4 years. 4 to 5 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. 20 to 35 years. 35 to 45 years. 45 to 65 years. 65 years and over. Poplar. Bow and Bromley. Poplar Institution. St. Andrew's Hospital. Bow Institution. Bromley House Institution. Poplar Hospital. See Footnotes. Outlying Institutions. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 All causes Certified 1928 1928 257 70 34 29 13 33 32 34 138 133 499 656 1047 881 108 710 2 .. 39 40 288 1187 Uncertified 1 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 Enteric Fever 3 M 1 .. .. .. .. .. .. .. 1 .. .. .. .. 2 1 .. .. .. .. .. .. 2 2 F 2 .. .. .. .. .. .. .. .. 1 .. 1 .. 2 Smallpox .. M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Measles 39 M 28 10 9 3 6 .. .. .. .. .. .. .. .. 25 14 .. 27 .. .. .. .. 2 29 F 11 4 4 2 .. 1 .. .. .. .. .. .. .. 4 Scarlet Fever 3 M 2 .. 1 1 .. .. .. .. .. .. .. .. .. 2 1 .. .. .. .. .. .. 3 3 F 1 .. .. .. 1 .. .. .. .. .. .. .. .. 5 Whooping Cough 9 M 3 1 2 2 7 .. 5 .. .. .. .. 2 7 F 6 3 1 1 1 .. .. .. .. .. .. .. .. 8 Diphtheria 22 M 12 .. 2 4 1 2 3 .. .. .. .. .. .. 10 12 .. 3 .. .. .. .. 18 21 F 10 .. 2 1 2 1 2 2 .. .. .. .. .. 7 Influenza 23 M 11 .. .. .. .. .. .. .. .. 1 2 4 4 12 11 6 3 .. .. .. .. 1 19 F 12 1 .. 1 .. .. .. .. .. .. .. 5 5 8 Encephalitis lethargica 3 M 2 .. .. 1 .. .. .. .. .. 1 .. .. .. 2 1 .. .. .. .. .. .. 1 1 F 1 .. .. .. .. .. .. .. .. .. .. 1 .. 9 Meningococcal Meningitis 3 M 2 .. .. 1 .. .. 1 .. .. .. .. .. .. 1 2 .. 1 .. .. .. .. 2 3 F 1 .. .. .. .. .. .. .. .. 1 .. .. .. 10 Tuberculosis of respiratory system 135 M 83 2 .. 1 .. .. .. .. 6 26 12 33 3 70 65 2 56 .. .. 1 1 (a) 31 91 F 52 .. .. .. .. .. .. 4 6 20 10 11 1 11 Other Tuberculous Diseases 27 M 14 1 1 .. 4 2 1 2 .. 2 .. 1 .. 21 6 .. 11 .. .. .. .. 11 22 F 13 3 .. 3 .. .. 1 1 2 2 .. .. 1 12 Cancer, Malignant disease 215 M 122 .. .. 1 .. .. .. 1 1 2 8 60 49 128 87 12 95 .. .. .. .. 29 136 F 93 .. .. .. .. .. .. .. .. 4 14 43 32 13 Rheumatic Fever 12 M 6 .. .. .. .. .. 2 1 .. .. 1 .. 2 4 8 .. 7 .. .. .. .. 1 8 F 6 .. .. .. .. .. .. 3 2 1 .. .. .. 14 14 Diabetes 21 M 10 .. .. .. .. .. .. .. .. .. .. 6 4 9 12 .. 13 .. .. .. .. 3 16 F 11 .. .. .. .. .. .. .. .. .. 1 5 4 15 Cerebral haemorrhage, etc. 69 M 27 .. .. .. .. .. .. .. .. .. 1 7 19 37 32 5 24 .. .. 4 .. 2 35 F 42 .. .. .. .. .. .. .. .. .. .. 18 24 16 Heart Disease 227 M 118 .. .. .. .. .. .. .. .. 3 7 38 69 109 118 17 66 1 .. .. 10 (b) 21 115 F 109 .. .. .. .. .. .. .. 1 6 7 29 66 17 Arterio-sclerosis 89 M 49 .. .. .. .. .. .. .. .. .. .. 15 34 53 36 18 37 .. .. .. 2 (c) 5 62 F 40 .. .. .. .. .. .. .. .. .. .. 11 29 18 Bronchitis 234 M 131 16 1 1 .. 2 .. .. .. 1 5 36 69 115 119 17 89 1 .. 1 .. 14 122 F 103 7 10 .. .. .. 1 .. .. 2 4 22 57 19 Pneumonia (all forms) 154 M 85 21 9 2 3 .. 1 1 .. 7 8 17 16 85 69 2 55 .. .. 4 3(d) 16 80 F 69 14 12 3 3 1 2 1 .. 5 6 10 12 20 Other Respiratory Diseases 13 M 7 .. 1 .. .. .. .. .. 1 .. 1 3 1 8 5 .. 5 .. .. .. .. 1 6 F 6 .. .. 1 .. .. .. .. .. .. 1 1 3 21 Ulcer of Stomach or Duodenum 14 M 12 .. .. .. .. .. .. .. .. 1 6 5 .. 8 6 .. 6 .. .. 2 .. 5 13 F 2 .. .. .. .. .. .. .. .. .. .. 2 .. 22 Diarrhoea, etc. 69 M 40 30 5 .. .. .. 1 1 .. .. 1 1 1 39 30 .. 42 .. .. .. 1(e) 6 49 F 29 25 3 1 .. .. .. .. .. .. .. .. .. 23 Appendicitis and Typhlitis 19 M 10 .. .. .. 1 1 1 .. .. 1 1 2 3 8 11 .. 10 .. .. 3 .. 5 18 F 9 .. .. .. .. 2 1 3 .. 2 .. .. 1 24 Cirrhosis of Liver 15 M 11 .. .. .. .. .. .. .. .. 1 2 8 .. 3 12 .. 9 .. .. .. .. 1 10 F 4 .. .. .. .. .. .. .. .. .. 1 .. 3 25 Acute and Chronic Nephritis 58 M 30 .. .. .. .. .. .. .. .. 2 3 15 10 29 29 3 25 .. .. 1 1(f) 11 41 F 28 .. 2 .. .. .. .. 1 .. 2 3 11 9 26 Puerperal Sepsis 4 M .. .. .. .. .. .. .. .. .. .. ...... .. .. 3 1 .. 3 .. .. .. .. 1 4 F .. .. .. .. .. .. .. .. .. 3 1 .. .. 27 Other accidents and diseases of pregnancy and parturition 9 m .. .. .. .. .. .. .. .. .. .. .. .. .. 5 4 3 4 .. .. .. .. .. 7 F 9 .. .. .. .. .. .. .. 1 4 4 .. .. 28 Congenital Debility and mal- formation, premature birth 82 M 46 46 .. .. .. .. .. .. .. .. .. .. .. 47 35 6 11 .. .. 1 1(g) 17 36 F 36 36 .. .. .. .. .. .. .. .. .. .. .. 29 Suicide 19 M 16 .. .. .. .. .. .. .. .. 3 4 6 3 11 8 .. .. .. .. 2 6(h) 2 10 F 3 .. .. .. .. .. .. .. .. .. .. 2 1 30 Other Deaths from Violence 73 M 57 2 2 .. 2 .. 7 3 4 13 4 8 12 44 29 .. 24 .. .. 12 11(i) 17 64 F 16 2 .. .. 2 .. 2 .. .. .. .. 2 8 31 Other Defined Diseases 264 M 135 19 2 2 1 .. 3 4 2 12 13 37 40 155 109 17 79 .. .. 8 4 (j) 57 165 F 129 15 1 4 2 1 4 4 6 9 2 20 61 32 Causes ill-defined or unknown 2 M 1 .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 .. .. .. .. .. .. 1 1 F 1 .. .. .. .. .. .. .. .. .. .. 1 .. Deaths from all Causes M 1071 148 35 17 18 7 20 13 16 76 79 303 339 F 858 110 35 17 11 6 13 19 18 62 54 196 317 Totals .. .. 1929 258 70 34 29 13 33 32 34 138 133 499 656 1048 881 108 710 2 .. 39 40 288 1187 (a) Highways, 1. (b) Highways,6; Millwall Dock, 1; South-West India Dock, 1; Poplar Borough Council Yard, 1; Guardians' Offices, 1. (c) Highways, 2. (d) Highways, 1; West India Docks, 1; South-West India Dock,1. (e) Highways, 1 (f) Highways, 1. (g) Highways, 1. (h) Highways, 2 ; Limehouse Cut, 2 ; Millwall Dock, 1; South-West India Dock,1. (i)Highways, 5, River Thames, 5; West India Dock, 1. (i) River Thames, 3; East India Docks. 1. 15 TABLE III. (1926). 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 4,605,600 17.1* ? 11.6* 64* West Districts. Paddington 146,700 15.3 0.8 12.6 86 Kensington 180,000 15.1 0.6 12.8 60 Hammersmith 134,400 16.3 0.6 11.4 66 Fulham 164,300 16.2 0.6 10.8 64 Chelsea 64,820 13.3 0.7 12.5 64 City of Westminster 138,400 11.3 0.44 11.6 59.7 North Districts. St. Marylebone 105,800 12.7 0.5 11.9 81 Hampstead 87,530 12.3 0.23 10.6 60 St. Pancras 216,800 16.7 0.8 12.4 76 Islington 339,200 19.0 0.5 12.0 66 Stoke Newington 53,080 16.0 0.8 10.7 48 Hackney 228,500 17.2 0.46 10.8 59 Central Districts. Holborn 43,200 12.38 0.5 12.1 90 Finsbury 77,550 21.4 0.67 12.9 66 City of London 13,230 7.1 0.07 10.4 66 East Districts. Shoreditch 106,400 23.5 0.6 12.2 66 Bethnal Green 119,600 20.9 ? 11.6 70 Stepney 256,100 19.4 0.79 11.5 65 Poplar 169,000 21.6 0.9 11.4 70 South Districts. Southwark 188,600 20.2 0.9 12.7 70 Bermondsey 123,100 19.6 0.76 12.1 60 Lambeth 311,000 17.9 0.5 11.5 38.4 Battersea 171,900 17.3 0.7 11.4 61.6 Wandsworth 342,100 14.1 0.6 10.37 64 Camberwell 275,400 16.6 ? 11.0 70 Deptford 115,700 18.2 0.7 11.3 56 Greenwich 104,300 17.7 0.4 10.8 61 Lewisham 187,800 15.3 0.2 10.0 40 Woolwich 141,900 17.4 0.3 10.2 48 * These provisional figures are taken from a table furnished by the RegistrarGeneral. Other figures supplied by Medical Officers of Health. 16 TABLE IV. Birth.rate, Death.rate, and Analysis of Mortality During the Year 1926. Birthrate per 1,000 Total Population. Annual Death.rate per 1,000 Population . Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrh(ca and Enteritis (under 2 years). Total Deaths under One Year. Causes of Deat h Certified by Registered Med ical Practitioners Inquest Cases. Uncertified Causes of Death. England and Walesf 17.8 11.6 0.01 0.00 0.09 0.02 010 0.07 0.22 0.47 8.7 70 91.8 7.2 1.0 105 County Boroughs and Great Towns, including Londonf 18.2 11.6 0.01 0.00 0.12 0.02 0.10 0.10 0.22 0.43 11.8 73 92.0 7.5 0.5 158 Smaller Towns (adjusted Populations 20,000.50,000) † 17.6 10.6 0. 01 0.00 0.07 0.02 0.11 006 0.23 0.40 6.6 67 92.6 6.3 1.1 London† 17.1 11.6 0.01 0.00 0.20 002 0.05 0.12 0.17 0.48 11.8 64 90.6 9.4 0.0 Poplar Borough 21.6 11 .4 0 02 — 0.23 0. 02 0. 05 0.13 0.14 0.54 17. 2 70 86.0 13.9 01 The rates for England and Wales and for Poplar have been calculated on a population estimated to the middle of 1926, while those for the towns have been calculated on populations estimated to the middle of 1925. The mortality rates refer to the whole population as regards England and Wale3, but only to civilians as regards London, the groups of towns and Poplar. The following rates for certain specified towns may be of interest : Death Kate:—Liverpool 13.7 ; Manchester 13.17 ; Edinburgh 13.5 : Glasgow 14.2; Dublin 14.! ; Belfast 15.4.f Infantile Mortality Kate:—Liverpool 104: Manchester 86.6 : Edinburgh 80 ; Glasgow 103: Dublin 106: Belfast 112.t †Provisional figures. 17 TABLE V. Total Deaths (at all ages) in Public Institutions within the Borough. (Residents and Non-Residents included.) Causes of Death. _ Poplar Institution. St. Andrew's Hospital. Bow Institution. Bromley House Institution. Poplar Hospital. Total deaths in Public Institutions within the Borough. All causes Certified 117 723 144 1 88 1073 Uncertified - - - - - - 1. Enteric Fever - - - - - 2. Smallpox - — — - — — 3. Measles - 27 — - — 27 4. Scarlet Fever - — — - — — 6. Whooping Cough - 6 — - — 6 6. Diphtheria - 3 — - — 3 7. Influenza 6 3 — - — 9 8. Encephalitis Lethargica — — — - — — 9. Meningococcal Meningitis — 1 — - — 1 10. Tuberculosis of respiratory system 3 56 5 - 2 66 11. Other Tuberculous Diseases — 11 — - - 11 12. Cancer, malignant disease 12 96 10 - 3 121 13. Rheumatic Fever — 7 — - — 7 14. Diabetes — 13 — - — 13 15. Cerebral haemorrhage, etc. 5 27 2 - 5 39 16. Heart Disease 20 66 77 - — 163 17. Arterio-sclerosis 19 36 5 1 1 62 18. Bronchitis.. 18 93 13 - 1 125 19. Pneumonia (all forms) 2 55 2 - 9 68 20. Other Respiratory Diseases - 5 - - 2 7 21. Ulcer of Stomach or Duodenum - 6 - - 3 9 22. Diarrhoea, etc. — 41 — - 1 42 23. Appendicitis and Typhlitis - 10 - - 5 15 24. Cirrhosis of Liver — 9 — - 1 10 25. Acute and Chronic Nephritis 3 26 18 _ 1 48 26. Puerperal Sepsis — 3 — - — 3 27. Other accidents and diseases of pregnancy and parturition 3 4 - - 1 8 28. Congenital Debility and malformation, premature birth 6 12 - - 1 19 29. Suicide — — — - 5 5 30. Other Deaths from Violence - 26 3 _ 32 61 31. Other Defined Diseases 20 81 9 - 15 125 32. Causes ill-defined or unknown _ All Causes Males 78 415 121 1 61 677 Females 39 308 23 - 27 396 totals 117 728 144 1 88 1073 PART II. Infectious Diseases, etc. 20 TABLE VI. The Borough. Cases of Infectious Disease notified during the Year 1926. 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) 411 9 17 31 47 54 173 41 16 20 3 271 140 ?69 138 407 Erysipelas 71 4 2 1 2 6 1 3 11 4 32 5 45 26 22 17 39 Scarlet Fever 610 5 21 50 43 69 277 100 18 24 3 - - 411 199 404 196 600 Typhus Fever - - -— — — — - - - - - Enteric Fever 4 — — - - - - - 1 2 1 - -__ 3 1 1 1 2 Relapsing Fever - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - Puerperal Fever 13 — — — — — — — 1 10 2 5 8 4 7 11 Puerperal Pyrexia 8 - - - - - - - - 7 1 4 4 2 1 3 Cerebro-Spinal Meningitis 3 __ - 1 1 __ __ 1 - - - 1 2 1 2 3 (a)Acute Poliomyelitis & (b) Acute Polioencephalitis 2(a) 1(a) — — — — 1(a) — - - 2(a) - 1(a) 1(a) Acute Encephalitis Lethargica 5 — 1 — — — 1 2 1 2 3 - 3 3 Ophthalmia Neonatorum 43 43 — — - — — — - - 27 16 3 2 5 *Zymotic Enteritis 623 93 103 50 33 29 62 36 37 69 37 59 15 405 218 20 9 29 Anthrax — — — — — — — — — — — - _ Trench Fever — — — — — — — — — — - - - - Pneumonia (all forms) 533 67 53 50 41 29 70 21 19 55 35 55 38 379 154 90 70 160 Malaria — — — — — — — — — — - - - - - -- - Dysentery — — — — — — — — — — — — — — — — Totals 2326 222 196 184 166 181 590 199 96 201 86 146 59 1555 771 817 446 1263 Pulmonary Tuberculosis 256 2 5 1 1 7 10 29 1 14 40 44 3 213 152 — — - Other forms of Tuberculosis 109 5 5 2 7 10 27 18 10 15 3 6 1 Totals 2691 229 206 186 174 192 624 227 135 330 129 196 63 1768 923 — — Note.—154 Cases reported "not suffering," etc., are excluded from the above table, ♦ Notifiable from 1st June to 30th September. 21 INFECTIOUS DISEASES. Notifications. There were 2,326 notifications of cases of infectious diseases, excluding 96 second notifications and 154 cases in which diagnosis was not confirmed. The notification rate was 13.8 as against 13.8,12.9, 6.6, 9.2, 9.8 and 10.1 for the five years 1921-5. Number op Cases Occurring in Institutions. Notifications of inmates of Institutions (excluding cases admitted with the disease) 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 8 .. 1 .. .. .. .. 1 6 .. 1* .. .. .. 1* 1* St. Andrew's Hospital 6 2† 1 1† .. .. .. .. 2§ 2** •• 1** .. •• •• .. Bow Institution .. .. .. .. Nil .. .. .. .. .. .. .. .. .. .. Bromley House Institution .. .. .. .. Nil .. .. .. .. .. .. .. .. .. .. Langley House, 54, East India Dock Road 2 .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1* Poplar Hospital 1 .. .. 1† .. .. .. .. .. .. 1** .. .. .. •• * Admitted into St. Andrew's Hospital. ** Removed to M.A.B. Hospitals. †Staff. §1 Staff. Infectious Diseases in Milkshops and Home workers' Premises. Six cases of infectious disease (2 scarlet fever and 4 measles) were connected with milk shops. 22 33 premises with outworkers were connected with infectious cases: 14 diphtheria, 18 scarlet fever, and 1 measles. One notice was served under the Factory and Workshop Act, 1901T Sections 108 and 110. 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 405 2 — 407 990 Erysipelas — 34 5 39 54.9 Scarlet Fever 600 — — 600 98.4 Enteric fever 1 — 1 2 50.0 Puerperal Fever 6 5 — 11 84.6 Puerperal Pyrexia 2 — 1 3 37.5 Cerebro.spinal Fever — 1 2 3 100. Encephalitis Lethargica 2 1 3 60.0 Ophthalmia Neonatorum 5 - - 5 11.6 Pneumonia — 159 1 160 30.0 Acute Poliomyelitis, etc. - - 1 1 50.0 Zymotic Enteritis - 28 1 29 4.6 Totals 1019 231 13 1263 54.3 N.B.—Cases reported to be “not suffering" have been excluded from above table. 23 Comparative Mortality. Diphtheria Scarlet fever Enteiic fever 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 Cases notified 411 610 4 1926 Deaths 22 3 3 Mortality rate per cent. 5.3 0.5 75.0 BACTERIOLOGICAL EXAMINATIONS. 1,264 swabbings from doubtful cases of diphtheria were examined. Of these 187 gave positive results (14.8 per cent.). 3 blood specimens from doubtful cases of enteric fever were examined, all negative results. DIPHTHERIA ANTI -TOXIN. 56,500 units of diphtheria anti-toxin were issued to medical practitioners during the year. 24 SMALLPOX. No cases of smallpox were notified during the year. 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 771. PLAGUE. No case of this disease was notified during the year. ANTHRAX, GLANDERS, AND HYDROPHOBIA IN MAN. No cases of these diseases occurred. 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. ERYSIPELAS. 71 cases of erysipelas were notified during the year. Two deaths occurred. PUERPERAL FEVER ETC. Public Health (Puerperal Fever and Puerperal Pvrexia) Regulations, 1926. These Regulations came into operation on 1st October, 1926. The Minister of Health has sanctioned the appointment of Dr. Malcolm Donaldson as Obstetric Specialist (with Dr. C. S. Lane-Roberts as Deputy) at a fee of £5 5s. in cases where a medical practitioner requires assistance, and also of arrangements for bacteriological examination of 25 blood and lochia at the Seamen's Hospital, Greenwich, at a fee of 10s. 6d. for each examination. In cases where the bacteriologist is required to obtain samples an additional charge of £1 Is. per visit has also been sanctioned. The following is a summary of the notifications, etc., during the year:— Puerperal Puerperal Fever. Pyrexia. Notifications 13 8 Removed to M.A.B. Hospitals 6 2 Removed to other Hospitals 5 1 Specialist called in — 2 Deaths 4 - — CONTINUED AND TYPHUS FEVERS. No cases of continued fever occurred. No case of typhus fever occurred. SPOTTED FEVER. EPIDEMIC CEREBRO-SPINAL MENINGITIS * Three cases occurred. All terminated fatally. ACUTE POLIO-MYELITIS, OR ACUTE POLIO ENCEPHALITIS AND ACUTE ENCEPHALITIS LETHARGICA. Two cases of acute polio-myelitis were notified, one patient died. Five cases of encephalitis lethargica occurred. Three of the cases died from the disease. One notified case which died from cerebral tumour is not included. MEASLES. 1,161 cases of measles were reported to the Medical Officer of Health from various sources (principally from L.C.C. schools). 39 deaths were attributed to measles. * Posterior basal menineitis is included in the term "cerebral-spinal fever," which does not include meningitis due to tuberculosis, syphilis, middle ear disease, or injury. 26 GASTRO-ENTERITIS OUTBREAK. Zymotic Enteritis is a notifiable disease in this Borough, from 1st June to 30th September, each year. During the five weeks ended 31st July, 238 cases were notified. The majority of these cases occurred during the two weeks ended 17th and 24th July, and were confined to a small area in the Bromley South and Bromley Central Wards. As there was apparently something unusual in the outbreak, the Ministry of Health was communicated with at once, and house-to-house visits in the area carried out. Particular attention was directed to the food and water supplies. Samples of food, discharges from several patients, and blood specimens were sent to the Pathological Laboratory of the Ministry of Health. So far as the germ of food poisoning was concerned, all the samples gave negative results. Numerous samples of water were examined by the bacteriologist of the Metropolitan Water Board. A Medical Officer of the Ministry of Health investigated the outbreak, and was afforded all available information and assistance. He was accompanied by Officers of this Department when conducting his enquiries into the possible cause of the outbreak. His official report has not yet been published. FISH POISONING. On receipt of information from a medical practitioner that he had two cases of Zymotic Enteritis which he thought might be due to fish poisoning, enquiries were made at two houses and it was ascertained that eight persons were suffering with similar symptoms, evidently due to fish poisoning. Five cases were admitted into St. Andrew's Hospital. Samples of faecal matter from the patients were immediately forwarded to the Ministry of Health Pathological Laboratory, and the Government bacteriologist reported that he had isolated the aertrycke bacillus, the commonest salmonella in cases of food poisoning. The outbreak was traced to fish from a common source of supply. All the patients recovered. 27 DISINFECTING DEPARTMENT. Rooms and Articles (Infectious and Verminous) Disinfected. The following figures give the number of rooms and articles disinfected:— Rooms. Beds. Mattresses and Palliasses. Pillows. Bolsters. Various. Totals. Infectious Disease 1185 1144 524 3403 1225 14185 20481 Verminous & Miscellaneous 87 103 40 204 63 1221 1631 Totals 1272 1247 564 3607 1288 15406 22112 Pulmonary Tuberculosis 282 44 13 118 42 663 880 Totals 1554 1291 577 3725 1330 16069 22992 Other articles also passed through the Council's apparatus, from the Shelter, Glaucus Street:—Disinfectors' clothing, overalls, towels, clothing of verminous children, etc., to the number of 14,880, and 8,298 articles of clothing from verminous persons were disinfected, making a total of 46,170 articles. 99 articles were destroyed at the Council's apparatus on request. 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 his 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 1925, 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 1926, 65,317 1/2 gallons were manufactured and broken down to 130,635 gallons for distribution. 28 Distribution of Fluid. The fluid was distributed as follows:— galls. Violet Road Depot 59,269 Biekmore Street Depot 15,310 Old Ford Road Depot 9,265 Ford Road Depot 7,200 Trego Road Depot 6,525 Stebondale Street Depot 6,220 Millwall Depot 1,435 Public Health Offices Ill Poplar Baths 4,458 Bow Baths 3,279 Island Baths 3,270 Violet Road Baths 150 Wick Lane Baths 489 Empson Street Baths 407 Open Air Bath, Bromley 1,100 Poplar Town Hall 105 Bromley Public Hall 174 Works Department 153 Guardians'Offices 325 Poplar Institution 4,770 Langley House 328 Poplar Training School, Hutton 187 Public Libraries 372 Used at Council's Shelter in baths of verminous persons 762 London County Council Schools 2,835 Mortuary, High Street, Poplar 300 Borough of Poplar Tuberculosis Dispensary 16 Royal College of St. Katharine 180 Private Firms in Borough 629 Council Offices, Poplar 216 Finance Department Offices 75 Kingsley Hall 75 Bow War Pensions Office 12 North Poplar Clinic 108 Artificial Sunlight Clinic, Avenue Road 12 Howrah House Convent 183 Bow Relief Offices 120 Heston and Isleworth U D.C. 180 130,635 29 Cost of Materials and Electricity. The cost of materials and electricity for manufacturing the electrolytic fluid was as follows: — £ s. d. Electricity, 18,228 unitsat ljd.per unit (with 40-65 per cent, advance) 168 3 2 Chloride of Magnesium, 7 tons, 6 cwts. 1 qr. 9 1b 45 12 3 Salt, 25 tons, 0 cwt. 0 qr. 102 14 0 Caustic Soda, 17 cwt. 1 qr. 16 lb. 26 1 8 Water (65,317.; gallons) 3 0 6 Total cost of materials and electricity to produce 65, 317 1/2 gallons (strong); broken down to 130,635 gallons 345 11 7 Electric motor for stirring ; 316 units 2 19 3 Bottles, Corks and Labels. Bottles 23 10 2 Corks 18 2 6 Labels 300 £44 12 8* Total quantity of water used for all purposes, 377,000 gallons, cost £15 7s. Id. 30 Total Quantity Manufactured since Installation of Plant. Since the installation of the plant, a period of 21 years, 957,181 gallons of fluid have been manufactured (see footnote) at a cost for electricity of £1,585 6s. 4|d., and materials of £1,897 19s. Id. Year. Output, gallons. Materials, Chloride of Magnesium, Salt, Caustic Soda and Water. Cost. Electricity. Total. 1906 17,000 £ s. d. £ s. d. £ s. d. 17 12 5 15 17 10 33 10 3 1907 15,586 14 16 9 14 13 2 29 9 11 1908 28,280 27 14 7 28 7 10 56 2 5 1909 27,216 23 4 7 29 17 7½ 53 2 2½ 1910 50,726 47 11 10 50 10 6 98 2 4 1911 53,063 50 17 9 56 16 7½ 107 14 4½ 1912 54,388 41 7 10 59 14 4½ 101 2 2½ 1913 66,740 62 7 3 71 0 10½ 133 8 1½ 1914 68,795† 59 16 11 75 0 3 134 17 2 1915 36,985† 35 19 3 48 12 0 84 11 3 1916 26,790† 74 4 0 40 3 1 114 7 1 1917 27,900† 75 10 4 44 11 6½ 120 1 10½ 1918 30,750t 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 56,520t 166 0 1 119 13 9 285 13 10 1923 64,740† 118 0 7 123 11 3 241 11 10 1924 70,3501† 132 7 2 136 2 5 268 9 7 1925 72,165† 145 10 5 133 13 9 279 4 2 1926 65,317 ½† 177 8 5 168 3 2 345 11 7 Totals 957,181½ £1,897 19 1 £1,585 6 4½ £3,483 5 5½ Not only are the Public Health Department and other buildings of the Council (the public baths,etc.) furnished with the disinfectant, but the institutions of the Managers of St. Andrew's Hospital and of the Board of Guardians (within and without the Borough) are supplied with an unlimited quantity free, as required. As applicants now usually bring their own receptacles to the depots, there is a very appreciable saving in the expense on bottles. † Since 1914 the fluid has been made of greater strength than originally, and afterwards broken down to half strength for distribution. Quantity distributed:— 1914 88,425 gallons. 1921 102,660 gallons. 1915 73,970 ,, 1922 113, 040 1916 53,580 ,, 1923 129, 480 1917 55,800 ,, 1924 140, 700 1918 61,500 ,, 1925 144. 330 1919 66,570 ,, 1926 130, 635 1920 78, 510 co Eleetrolytio Disinfectant. Estimate for year ended 31st March, Expenditure for year ended 31st March, Average Expenditure for 3 years ended 31st March, Estimate for year ending 3ist March, Estimate for year ending 31st March, No 1926. 1926 1926 1927. 1928. 1 Wages (Manufacturing, bottling and delivery to Depots, Guardians'Institutions and Sick Asylum) £ £ £ £ £ £ £ £ £ £ 900 876 916 872 868 1 2 Rent, Rates and Insurance—Main Depot 90 99 104 82 109 2 3 Supervision of Plant 15 15 15 15 15 3 4 Electricity and Water 140 131 147 250 200 4 5 Materials (Chemicals) 150 170 143 250 200 5 6 Bottles, Corks, Wax, Labels and Paste 50 39 55 55 50 6 7 Sundries (including Testing Apparatus (and Carboys) 60 76 65 70 70 7 8 Repairs—Depot 20 352 171 80 50 8 9 Repairs—Plant 20 76 29 10 10 9 9a Capital Account—Cost in excess of loan — 83 27 — — 9a 1445 1917 1672 1684 1572 10 Issuing—Wages—(Old Ford Road, Trego Road, Ford Road, Bickmore Street, West Ferry Road, and Stebondale Street Depots) 654 628 639 598 600 10 11 Issuing—Cartage 120 70 120 — — 11 12 Rent—Issuing Depots (Ford Road, Trego Road and dale Street) 32 31 34 36 36 12 13 Sundries and Petty Expenses 20 1 5 5 5 13 14 Repairs—Issuing Depots — 105 103 99 100 14 826 835 901 738 741 2271 2752 2573 2422 2313 16 Lett—Sale of Fluid 30 21 29 35 30 15 2241 2731 2544 2387 2283 32 Spraying and Cleansing Floors op London County Council Schools with Electrolytic Disinfecting Fluid. 2865 gallons were supplied to ten 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 proportions as mentioned in the Annual Report for the year 1909, viz.,1 part of Chlorine to 2,000,000 parts of water. 4,458 gallons were supplied to the Poplar Baths, 3,279 gallons to the Bow Baths, 3,270 gallons to the Island Baths, and 1 ,100 gallons to the open-air swimming baths, making a total of 12,107 gallons. SHELTER AND CLEANSING STATION. During the year no persons were accommodated at the shelter VERMINOUS CHILDREN ATTENDING SCHOOLS. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1907 CHILDREN ACT, 1908 Number of Verminous Children Bathed. Quarter. N umber of Children Cleansed. Total number of Cleansings. Amount. 1926. £ 8. d. March 374 440 40 4 0 June 313 377 34 13 0 September 258 296 27 14 0 December 388 415 39 17 0 Totals 1,333 1.528 £142 3 0 In 1,363 of the cleansings a special comb was used. (175 boys, 1,188 girls.) Miss Davies made 445 visits in connection with verminous schoolchildren—204 Poplar, and 241 Bow and Bromley. To enable the heads of children to be properly cleansed, a sink with a hot and cold water spray has been installed at the Cleansing Station. For cleansing of verminous rooms, see page 49. 33 Itch Cases. Miss Davies made 66 visits in connection with children suffering from itch—27 Poplar, and 39 Bow and Bromley. CLEANSING OF PERSONS ACT, 1897. During the year, 141 persons—including 65 (40 men and 25 women) from common lodging houses (see below)—had applied for baths and for their clothes to be disinfested. VERMINOUS PERSONS IN COMMON LODGING HOUSES, LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1907. Number of Persons Cleansed from Common Lodging Houses Within and Without the Borough. The number of persons from Common Lodging Houses within and without the Borough of Poplar, cleansed at the Council's Cleansing Station, Glaucus Street, during the year was:— Common Lodging House, etc. Male. Female. Total. 215, Bow Road — — St. James's Chambers, 217, High Street, Poplar - — — 65, Bow Lane - — — 378, Old Ford Road — — — - — From Common Lodging Houses without the Borough of Poplar— Whitechapel 40 25 65 Totals 40 25 65 34 TUBERCULOSIS. Report of Dr. W. C. P. Smith, Tuberculosis Officer and Assistant Medical Officer of Health for Tuberculosis Purposes. Information required by Ministry of Health. (i) A list of dispensaries, specifying also branch dispensaries and visiting stations: a list of the Tuberculosis Officers employed; a statement of the 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) Borough Tuberculosis Dispensary. — 1, Wellington Road, Bow, E.3. (2) Staff. Tuberculosis Officer: W. C. P. Smith. Assistant Tuberculosis Officer: C. K. Cullen. 3 Health Visitors. 1 Dispenser. 1 Care Committee Secretary. 1 Clerk. 1 Assistant Clerk. 1 Part-time helper (female). 1 Caretaker. (3) Residential Institutions. (a) Sanatoria, hospitals and homes available under the London County Council scheme for both jmlmonary 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 London County Council is the County Administrative Authority 35 (iii). The nature and extent of co-operation with general and special hospitals, school clinics, and other institutions. (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 treated at the London Hospital by Finsen and other forms of artificial light, on the Tuberculosis Officer's recommendation. A charge is made to the Borough Council of 5s. per application for Finsen Light, and Is. for other light treatment. During the past year, no new cases were recommended for the treatment, while nine old cases were carried over from 1925. They received a total of 150 applications of light. (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 Hospital for refills. A charge of 10s. is made for each refill. Eight patients have received this treatment, a total of 137 refills being given. Cases of non-tuberculous pulmonary disease are, when necessary, referred bv 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.—Children of school age found to be suffering from defects or ailments which can be dealt with at the School Treatment Centres arc referred to the Divisional School Medical Officer, who arranges for their treatment. Children who are considered to be suitable subjects for an Open-Air School are also referred to the Divisional School Medical Officer for consideration. Under a scheme for co-operation with the School Medical Service, contacts of tuberculous patients, if of school age, whether previously 36 examined at the dispensary or not, are referred to the Divisional Medical Officer, who arranges for them to be kept under observation and periodically examined. After a suitable interval these cases are sent back, with a report to the Tuberculosis Officer, who decides what further action, if any, is to be taken. Generally, delicate children—though not contacts—in whom there is a special likelihood of tuberculosis developing are dealt with in the same way. Under this scheme, 100 children have been dealt with in 1926. (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. 806 such reports to rivate 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" bv 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. In all cases on "Domiciliary Treatment," the panel doctor is asked to furnish periodical reports on the patient's progress and the need for continued or altered treatment. In addition, these patients are examined periodically by the Tuberculosis Officer. On December 31st, 1926, 242 patients were receiving "Domiciliary Treatment." 37 (v.) The arrangements for following up patients in cases where the diagnosis is doubtful. Arrangements for following up cases of doubtful diagnosis are the same as in previous years. If a diagnosis cannot be arrived at within a reasonable time at the dispensary, the patient, when pulmonary disease is suspected, is usually recommended for admission to hospital under the London County Council scheme for special observation and investigation, or, if the character of the case does not require this, is seen again at the dispensary after an interval of from three to six months. Doubtful cases of surgical tuberculosis are sent to the London Hospital for a further opinion, or admission to hospital is arranged for them in the same way as for doubtful pulmonary cases. Doubtful cases amongst school children in which there is no urgency, are kept under observation for a further period in conjunction with the School Medical Officers as already described. In all such cases, the co-operation of the patient's own doctor is, where possible, enlisted, and re-attendance at the dispensary after the prescribed interval is secured by reminders in the form of letters or visits to the patient's home. (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. 336 contacts were examined at the dispensary during the year, 142 being adults and the lemainder 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 cf persons to whom these special methods have been applied. The X-Ray installation has continued in use for diagnosis purposes. No other special methods have been employed. 38 (viii.) The results of local experience as to the relative value of cock, form of treatment. See above. (ix.) The nature arid extent of any dental treatment provided by the Council for tuberculous patients. A special session for tuberculous patients is held each week at the Council's Dental Clinic. All patients in need of dental treatment are sent there as soon after notification as the need is discovered. Many of these patients are awaiting sanatorium treatment, and their immediate requirement is the removal of any septic condition of the teeth which will prevent them from getting full benefit from this. Dental treatment is free, but in cases where dentures are needed, arrangements have to be made to defray the cost of these. The character of these arrangements and the number of patients supplied are indicated in the report on Care Committee work, while details of the work carried out at the Clinic will be found in the report of the Council's Dentist. (x ) Any arrangements for the prevision of nursing or of extra nourishment for patients living at home. The Council has power to provide nursing, if required, for children up to 10 years of age. For older children and adults no special provision is made, but the services of a District Nurse are generally forthcoming. Extra nourishment in the form of Ambrosia (dried milk) and eggs has been granted to suitable cases on the same lines as previously. The grant is made for a period of 12 weeks, after which the case is reconsidered. The amount of expenditure sanctioned by the Ministry of Health has been found to be sufficient up to the present. 56 patients have been in receipt of extra nourishment for varying periods during the year; of these, 26 were still receiving it on December 31st. For the convenience of patients living in the southern end of the Borough, the weekly allowance can be drawn at Simpsons Road, Poplar, instead of at the dispensary. (xi ) The arrangements for treating non-pulmonary tuberculosis, especially tuberculosis of bones and joints in adults and in children, and for the provision of surgical apparatus, etc. 39 Non-pulmonary cases which can suitably be treated as Outpatients 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 arraiigementsfor ' 'care'' and ' 'after-care'' and their working. Care and after-care of patients and their families who are in need of assistance is undertaken by the Care Committee. The Secretary reports as follows:— The Tuberculosis Care Committee, consisting of representatives of the Borough Council, the Guardians, and most of the public and charitable agencies of the District, continues to meet fortnightly. Twenty meetings were held during 1926, and 427 cases were considered. 187 recommendations regarding assessment were submitted to the London County Council. Twenty cases of patients who had been ordered dentures at the Borough Council's Dental Clinic were considered. Some of these were able to make weekly payments, and were assessed. Some were entitled to dental benefit through their approved societies under the National Health Insurance Act, or to benefits through the Hospital Saving Association. Assistance in other cases was obtained through the Guardians, the Hospital Sunday Fund, the Poplar Benevolent Fund, the Society for Relief of Distress, the Red Cross Society, the Churches, etc., and in one case the cost was paid by the Borough Council. In order to enable tubercular persons to sleep alone, bedsteads and bedding were supplied on loan by the Borough Council in 15 cases, and one shelter was provided. Perhaps the outstanding feature in the Care Committee's activities during 1926 was the inauguration of the Poplar Tuberculosis Fund for 40 the provision of Accessories to Institutional Treatment and After-Care. The Committee had long felt the need of a small fund at their disposal through which patients could be assisted, as occasion arose, in such ways as the provision of clothing, dentures and other appliances, convalescence, country holidays, domestic help for housewives, removal expenses, help in obtaining suitable work, etc., etc. The practice of referring patients to other agencies had proved unsatisfactory, and it had often been impossible to carry out suggested schemes. Particularly, the provision of clothing for sanatorium was often an urgent matter, and patients sometimes refused vacancies on account of not having been able to obtain the necessary outfit. In March, 1926, the Public Health Committee gave their sanction to the raising of a voluntary fund for these purposes. The approval of the London County Council was also obtained in order that the Fund might be eligible for participation in the profits of Sunday Cinematograph Exhibitions, but no assistance from this source has yet been obtained. The Care Committee, have, however, during the year, raised about £35 by means of holding dances and a sale and from a few subscriptions, and they hope to continue their efforts in this direction. The Committee still find the shortage of housing accommodation a great obstacle in the way of improvement of home conditions. A few patients have been able to move out to the London County Council's Housing Estate, Becontree, having been recommended for preferential consideration on account of tuberculosis; but this is only practicable where there is a certain family income, and locality of work often proves a difficulty to families who might otherwise be suitable. The housing shortage and the problem of finding light work for ex-sanatorium patients are the greatest of the difficulties with which the Tuberculosis Care Committee has to contend. (xiii.) Particulars as to any local arrangements for finding employment for patients. Apart from the Labour Exchanges, which can do little or nothing for the patient whose working capacity is impaired, no purely local arrangements exist for finding employment for patients. The Central Fund for the Industrial Welfare of Tuberculous Workers has been able to employ several patients either in their Spero Leather Workshop or their Firewood Factory. Some engaged at piece rates in this latter kind of work seem disappointed at the amount of their earnings after deducting fares and other necessary outgoings. A fairly high flatrate pension appears to be necessary in these cases. 41 Several other eases have been admitted to the Papworth Colony, and those mentioned in last year's Report as having apparently settled there, still remain. (xiv.) Statement as to the supply and supervision of shelters at the homes of patients. Shelters are provided on loan by the Borough Council in cases where there is suitable accommodation and the patient appears likely to make proper use of them. One new shelter has been supplied during the year, and four were out on loan on December 31st. The Health Visitors have the general supervision of shelters in their own districts, report on their condition, and ensure as far as possible that they are put to proper use. (xv.) Any special points noted locally as to the incidence of tuberculosis (/.s.. occupation). No special occupational incidence has been noted. (xvi.) Any special methods adopted or proposed for the prevention of tuberculosis. No special methods of prevention have been in use. Routine measures are taken which have for their object:—(1) The prevention of infection, viz., the control of the tubercle bacillus; or (2) the improvement of the general health and the tubercle-resisting power of those exposed to infection; or (3) their removal from surroundings where infection is specially likely to occur. Such measures are:—the provision of sputum flasks or cups and of disinfectant; the arrangement of separate sleeping accommodation by means of shelters, bedsteads and bedding; the removal of infectious cases to hospital, or of other inmates out of the infected home; the disinfection of rooms, bedding, clothes, etc.; the reference of weakly and ailing children to suitable agencies for treatment or for convalescence; advice on general and special hygiene and the improvement of housing conditions. To these should be added the general prophylactic work of the Public Health Department. and especially measures to ensure a pure milk supply. (xvii.) Special difficulties encountered. As in previous years, shortage of adequate housing accommodation and almost complete lack of work for tuberculous patients 42 capable of being employed under special conditions, constitute the chief difficulties encountered. STATISTICS, 1926. Attendances at Dispensary (Insured, 2,129; Uninsured, 3,392) 5,521 New patients examined 1,103 Contacts examined 336 Notifications by Tuberculosis Officer:— Pulmonary, 154; Non-pulmonary, 35 189 Patients sent away for Sanatorium Treatment 215 Patients away in Institutions, 31st December 117 Patients receiving Domiciliary Treatment, 31st Dec. 242 Patients receiving Dispensary Treatment, 31st December 176 Under observation pending diagnosis, 31st December 190 In receipt of extra nourishment during the year 56 In receipt of extra nourishment, 31st December 26 Health Visitors' visits 8,597 Doctors'visits 184 Sputum examinations made :— Dispensary, 1,781; Public Health Department, 274. . 2,055 Reports sent to:— Practitioners, 806 ; Public Authorities, 1,274 2,080 W. C. P. SMITH The Council has taken advantage of the arrangements made by the London County Council with the Victoria Park Chest Hospital for certain patients to receive artificial sunlight treatment. With reference to the Public Health (Tuberculosis) Regulations, 1925, which state that:— "No person who is aware that he is suffering from Tuberculosis of the respiratory tract shall enter upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk, or the handling of vessels used for containing milk." the Public Health and Housing Committee authorised the circularising of all dairymen in the Borough, pointing out the advisability of examination of all persons engaged in the milk trade, and informing them that all facilities would be afforded them for examination by the Tuberculosis Officer at the Council's Dispensary. Advantage was taken of this by many of the men employed in the trade. 43 REPORT OF DENTAL SURGEON. To The Medical Officer of Health, The Borough of Poplar. Sir, I have the honour to submit my Annual Report of the work carried out at the Old Ford Tuberculosis Dental Clinic for the year 1926. The amount of work carried out is up to standard, though there have been fewer attendances. At the same time, there have been fewer sessions. Our figures are as follows:— 47 Sessions. 56 New Patients. 236 Attendances. 84 Fillings. 301 Extractions. 79 Scalings. Dentures, Dressings, etc., the actual figures not being available. We continue to find difficulties with some cases, owing to their sanatorium treatment holding up dental treatment. This only applies to those sanatoria where dental treatment is not available, of course. There can be no doubt of the advisability of combining the two forms of treatment. We do not experience any rapid growth in the numbers attending the Clinic, and I hope that this may be a sign that the disease is not making any progress in the Borough. The greatest care continues to be taken in the matter of sterilising the premises and instruments after each session. I should like to take this opportunity of thanking all those who have so kindly helped me in my work at the Clinic. I have the honour to be, Sir, Your obedient servant, C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. 44 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications received during the period 3rd January, 1926, to 1st January, 1927. The Borough. Age Periods. Notifications on Form A. Notifications on Form B. Number of Notifications on Forms C and D. Number of Primary Notifications. Total Notifications 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. PoorLaw Institutions. Sanatoria. PoorLaw Institutions. Sanatoria. Pulmonary— Males 2 5 5 3 9 19 38 22 21 10 2 136 263 — 1 — 1 1 24 145 45 111 Females — 2 1 6 20 24 33 18 9 4 1 118 199 — — 1 1 2 9 67 23 46 Non-Pulmonary— Males 2 11 16 6 4 3 3 3 1 1 — 50 68 — 1 1 2 4 21 17 17 12 Females 3 13 10 8 6 4 5 — 1 3 1 54 68 — — 3 3 5 11 18 8 11 Totals 7 31 32 23 39 50 79 43 32 18 4 358 598 — 2 5 7 12 65 247 93 180 45 New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, during the period 3rd January, 1926, to 1st January, 1927, 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 - - - - - - 2 — — 1 1 4 Females — — — 1 — 1 — 2 1 — — 5 Non-pulmonary— Males — 1 — — — — 1 — — — — 2 Females — 1 — 1 — — — — — — — 2 From Registrars' Returns of Deaths. 46 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. Summary of Quarterly Returns to the London County Council. Quarter ended March. June. September. December. Number of Cases on Register at commencement of quarter 3,840 3,778 3,789 3,794 Number of New Cases notified 89 89 86 85* Number of Cases removed from Register 151 78 81 53 Number of Cases on Register at end of quarter. Pulmonary 2,474 2,474 2,465 2.481 Non-Pulmonary 1,304 1,315 1,329 1,345 Totals 3,778 3,789 3,794 3,826* *Adjusted on March 1927 return—18 cases added. These cases were re-notified after having been removed from Register, etc. PART III. Work of Sanitary Inspectors. 48 SANITARY INSPECTORS' WORK, Etc. Tubulated Statement of Inspections, Insanitary Conditions found existing, and Re-inspections during the year 1926. East Combined West Combined Poplar South Bromley North Bromley Central Bow East Bow West Totals Total Inspections:— 1,217 1,514 1,162 1,339 1,079 1,070 1,115 8,490 On oomplaints of nuisances, etc. 423 829 610 806 285 596 668 4,217 On notification of infectious diseases 581 608 317 329 468 185 315 2,803 House-to-House 47 42 6 56 75 120 72 418 Workshops, workplaces, etc. 152 16 116 91 60 63 39 537 Miscellaneous 14 25 97 57 191 106 23 513 Premises found in fair condition 529 719 425 671 421 344 365 3,474 Do. requiring amendment 688 790 737 668 658 726 740 5,007 Details of Insanitary Conditions, etc. Walls and ceilings dirty 388 314 573 336 320 269 548 2,748 Yards, forecourts and areas insufficiently paved or drained 194 66 63 48 87 93 89 640 Inlets to drains not properly trapped 1 2 — — 1 2 — 6 Number of drains tested 328 242 393 157 278 226 359 1,983 Do. do. defective 102 125 74 48 12 28 76 465 Do. do. obstructed 47 95 83 113 40 86 62 526 Sink waste pipes not trapped or otherwise defective 111 29 37 2 89 37 67 372 Sink waste pipes directly connected to drains 8 1 — — — 6 — 15 Continued over. 49 (Continued from previous page.)  East Combined West Combined Poplar South Bromley North Bromley Central Bow East Bow West Totals Soil pans of w.c.'s without suitable water supply 65 39 75 31 54 7 38 309 Do. do. broken or unsuitable 59 13 14 12 16 28 23 165 Do. do. in foul condition 51 9 5 4 10 24 16 119 Do. do. untrapped 4 2 — — 3 1 — 10 Roofs, guttering and rainwater pipes defective 335 311 436 361 297 352 358 2,450 Water supplies to premises cut off (notified by Metropolitan Water Board) — — — 7 — 1 1 9 Water service fittings defective, causing waste of water 41 30 43 26 10 22 16 188 Drinking Water improperly stored 5 — — — — — — 5 Dampness 161 98 110 38 127 117 101 752 Inundations 5 30 6 33 1 21 1 97 Overcrowding 2 — — 9 — 7 1 19 No proper receptacle for house refuse 52 43 56 36 104 26 61 378 Accumulations of dung or refuse 25 22 9 9 8 5 9 87 Foul P.H. urinals 1 4 4 20 5 1 — 35 Other nuisances, dilapidations, want of ventilation, etc. 392 363 962 355 244 595 528 3,439 Breaches of London County Council's By-laws 68 2 — 2 7 59 57 195 Breaches of Council's By-laws 99 4 134 — 75 89 28 429 Intimations served 681 748 737 668 607 726 698 4,865 Notices served 220 522 164 362 368 321 418 2,375 Final Notices served 92 80 15 86 81 59 43 456 Summonses applied for — 4 — 12 8 2 4 30 Passengers from Continental Ports:— Visited 2 — — — — 2 1 5 Undiscovered — — — — — 1 — 1 Intimations served in respect of verminous rooms 30 29 105 49 61 33 46 353 Verminous rooms cleansed 81 29 4 41 56 24 1 236 Re-inspections 3,480 2,721 2,783 2,260 1,961 2,408 2,576 18,189 50 HOUSING ACTS, 1890-1925. Housing (Inspection of District) Regulations, 1925. Representations to Council under Housing Act, 1925. No premises were inspected with a view to closing under Housing Act, 1925. Increase of Rent and Mortgage Interest (Restrictions) Acts. One certificate was issued under the above Acts. Accommodation on London County Council Estates. Accommodation has been provided, on the nomination of the Council, for 127 families on the London County Council Estates, as follows:— Becontree. Downham. Total. 122 5 127 Approximate number of persons accommodated to date (October, 1926), 565. HOUSING CONDITIONS. Statistics . Year Ended December, 1926. 1.—General. (1) Estimated population 169,000 (2) General death rate 11.4 (3) Death rate from tuberculosis (all forms) 1.0 (4) Infantile mortality 70 (5) Number of dwelling-houses of all classes (Census 1921) 23,248 (6) Number of working-class dwelling-houses 23,000 (approx.) (7) Number of new working-class houses erected during 1926 (for the Council) 96 houses. (In course of erection for the Council, 103.) 31 2.—Unfit Dwelling-houses. 1.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or other Acts) 7 ,703 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 579 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 5,168 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 2,666 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 Nil. (2) Number of dwelling-houses which were rendered fit— (a) by owners Nil. (b) by Local Authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. 52 B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,502 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 2,502 (b) by Local Authority in default of owners Nil. (c) by Local Authority and owner jointly Nil. (d) Closing Orders made by Magistrates Nil. 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 Nil. (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. UNHEALTHY AREAS. Rebuilding is now proceeding in the St. Leonard's Street and Birchfield Street Areas, in the former by the Poplar Borough Council and in the latter by the London County Council. Work of Lady Sanitary Inspector. FACTORY and WORKSHOP ACT, 1901, Sec. 107. One employer was summoned for failing to send a list of outworkers employed by him. Summons was withdrawn on payment of £2 2s. costs. 53 Tabulated, statement of Inspections of Insanitary Conditions found existing, and of Reinspections, &c., during the year 1926. Poplar. Bow and Bromley. Totals. Workshops, Workplaces, Laundries, &c., Number of on the Register 55 124 179 Workshops, Number of Workrooms therein 85 165 250 ,, Number of Inspections of 53 115 168 „ Number of Reinspections of 26 66 92 Workrooms, Number of Inspections of .. 69 166 235 ,, found to be overcrowded 1 1 2 ,, found to be insufficiently ventilated 1 — 1 ,, found to be in dirty condition 16 29 45 Workshops, etc., newly discovered and registered 4 4 8 ,, Workrooms therein measured 4 4 8 ,, Reported to H.M. Inspector on discovery 4 4 8 Factories, Number visited 18 94 112 „ W.C.'s dirty, insufficient, &c. 22 43 65 Outworkers' premises visited 229 945 1,174 Written Intimations served 75 116 191 Statutory Notices served 17 36 53 Final Notices served 5 4 9 Works carried out under supervision:— (a) Additional means of ventilation provided — 2 2 (b) Rooms cleansed and whitewashed 50 103 153 (c) Yards, floors, roofs, &c., repaired 8 25 33 (d) Sanitary conveniences constructed, cleansed or repaired 29 35 64 Overcrowding of Workrooms, Cases abated 1 — 1 Miscellaneous Visits 521 108 629 Visits re Verminous Children 204 241 445 „ Scabies 27 39 66 ,, Outworkers' Lists 16 20 36 ,, Suspected Infectious Disease 160 120 280 „ Eye Infections 68 29 97 Visits to Schools 28 31 59 ‡Factory and workshop inspections, 372; fair condition, 262; removed or discontinued 70; required cleansing, 45; sanitary conveniences defective or insufficient, 65. Work of Houses-Let-in Lodgings Inspectors. (See also paqe 62) Mr. F. A. Smith, January to June, 1926. Mr. S. Kelly, July to December, 1926. Jan. to June. July to Dec. House-to-house Inspections 161 38 Re-inspections 845 147 Number of Intimations served— Public Health (London) Act 192 39 P.B.C. By-laws 67 — L.C.C. (General Powers) Act, re verminous rooms 3 — Number of Notices served— Public Health (London) Act 111 10 P.B.C. By-laws 36 — M.L.M. Act, 1855, Sec. 85, re drains 3 — Number of drains tested— 170 43 „ „ defective 8 2 „ „ obstructed 4 — (Note: Mr. S. Kelly also deputised for District Sanitary Inspectors.) 54 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 Homeworkers' premises. Premises. On Register during year 1926. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male Female Total Bakehouses (Factories) 44 — 44 148 96 6 — — Bakehouses (Workshops) 33 — 33 98 72 3 — — Bakehouses (Domestic Workshops) 3 — 3 9 6 — — — Factories (Laundries and Miscellaneous Factories) 37 119 156 192 49 23 1 — Laundries (Workshops) — 8 8 12 2 2 — — Laundries (Domestic Workshops) — 3 3 3 — — — — Workshops 147 111 258 518 103 42 1 — Workshops (Domestic) 10 3 13 13 1 1 — — Workplaces 186 — 186 391 50 7 3 — Workplaces (Domestic) 51 — 51 131 15 3 1 — Places where food is sold or prepared 410* — 410* 1196 420 23 1 — Milk Premises 120 — 120 414 36 4 1 — Cowsheds 9 — 9 35 — — — — Slaughterhouses 8 — 8 14 1 — — — Other offensive trade premises 8† — 8† 18 — — — — Ice Cream premises 124‡ — 124‡ 205 42 3 1 — Homeworkers' premises 32 944 976 1187 57 22 2 2 *Power is used in 33 of these premises. ‡,, „ 14 „ „ † Registered by the London County Council. 55 TABLE B Workshops on Register (Male), 1926. 1 Acetylene Works. 12 Bootmaking. 2 Barge building. 1 Bitumen making. 2 Boat building. 2 Brush making. 1 Building, etc. 7 Cabinet making. 1 Carpenter. 1 Chair-frame making. 1 Chemical works. 1 Cigar making. 1 Clay pipe making. 4 Cork cutting. 5 Confectionery making. 4 Cooperages. 1 Electrical Engineering and Winding 6 Engineering 14 Farriers 3 French polishing. 1 Frilling making 1 Flush tank works. 2 Furniture making. 1 Furrier. 1 Glass works. 1 Hair working. 4 Harness making. 1 Joinery. 3 Motor garage works. 1 Metal works. 2 Oil stores. 4 Paint making. 1 Paper sorting, etc, 2 Plumbing. 1 Poultry food mixing. 1 Rag sorting. 2 Rope making. 1 Sackmaking. 1 Shellac bleaching. 1 Stonemasonry. 18 Tailoring. 4 Tarpaulin work. 1 Tinsmith. 2 Tin toy making. 1 Trunk making. 5 Upholstering. 3 Undertaking. 2 Van building, etc. 2 Vinegar making. 1 Waterproof working. 1Wax refining. 1 Welding. 1 Wheelwright. 1 Wire working. 1 Walking stick making. 1 Zinc working. As per List, Table A Workshops on Register, page 54. Domestic Workshops on Register (where Men are Employed).* 1 Blacksmith. 1 Blind making. 2 Boot repairing. 1 Decorative earthenware making 1 Mat making. 1 Plumbing. 2 Tailoring. 1 Wire working. 56 Home Workers on Register (Male). 30 Bootmaking. 1 Tailoring. 1 Brushmaking. Workshops and Domestic Workshops on Register (Females).* 1 Badger hair sorting. 1 Bedding making. 3 Boot upper making. 5 Confectionery making. 2 Cork cutting. 5 Costume making. 8 Dressmaking. 1 Embroidering. 1 French polishing. 3 Furriers. 3 Infant shoe making. 1 Knitted garment making. 11 Laundries. 8 Milliners. 2 Pressers and cleaners. 1 Paper and rag sorting. 1 Sack and bag making. 2 Shirt and pyjama making. 1 Seal stamp making. 49 Tailoring. 1 Tarpaulin works. 2 Tiemaking. 1 Tinned goods labelling and sorting. 2 Toymaking. 2 Trimming making. 1 Trunk making. 1 Underwear making. 2 Upholstering. 2 Waterproof garment making. 1 Whalebone dressing. 1 Wood chopping. *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 54. Factories on Register (where Females are Employed). 2 Bedding manufacturing. 2 Biscuit manufacturing. 3 Blouse and dresses making. 2 Boot making. 6 Box making. 1 Brush making. 1 Bunting and flag making. 1 Butter mixing factory. 2 Chip basket making. 3 Christmas cracker making. 1 Cigarette paper making. 1 Clay fuel and pipes. 2 Cleaners and dyers. 1 Pianoforte manufacturer. 3 Preserved food. 1 Rag sorting. 1 Ragwork. 1 Rice starch making. 3 Rope works. 2 Rubber goods making. 1 Rug making. 3 Sack making. 1 Sausage factory. 4 Shirt making. 1 Shroud making. 1 Sugar refining. 26 Tailoring. 1 Tarpaulin works. (This Table is continued on next page.) 57 Factories on Register (where Females are Employed).—contd. 1 Condiment packing. 4 Confectionery making. 1 Cork cutting. 1 Corset making. 2 Costume making. 1 Dog biscuit manufacturer. 1 Dressmaking. 1 Fibre, hemp and jute making. 1 Flute making. 1 Glass works. 1 Kapok works. 1 Laundry. 1 Match making. 1 Mineral water manufacturer. 2 Overall making. 1 Packing for machinery. 1 Perambulator builder. 1 Ticket printing. 2 Timber works and wicker furniture making. 1 Tortoiseshell goods making. 1 Toy balloon making. 1 Toy making. 1 Trimming making. 1 Type founder. 4 Varnish and paint works. 1 Wallpaper manufacturer. 2 Waterproof making. 1 Whalebone works. 1 Wine bottling 2 Woollen garment making. 1 Wood chopping. TABLE C. See note, page 56. Factories, Workshops, Laundries, Workplaces and Homeworkers. 1.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Intimation. Statutory. Final. Factories 340 145 29 1 •• (Including Factory Laundries.) Workshops† 628 177 47 1 .. (Including Workshop Laundries.) Domestic Workshops‡ 25 7 1 .. .. Workplaces (Males) 391 50 7 3 .. Domestic Workplaces (Males) 131 15 3 1 .. Places where food is sold or prepared§ 1196 420 23 1 .. Homeworkers' Premises 1187 57 22 2 2 Total 3898 871 132 9 2 †Including Workshop Bakehouses. See Table A, page 54. ‡ Including Domestic Bakehouses and Laundries. See Table A, page 54. § The inspections of all factories where food is prepared are included. Power is used in 33 of the premises. 58 2.—DEFECTS FOUND.* Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Act: Want of cleanliness 471 471 .. 1 Want of ventilation 6 6 .. .. Overcrowding 2 2 .. .. Want of drainage of floors 3 3 .. .. Other nuisances 217 217 .. 1 Sanitary accommodation insufficient 5 5 .. .. unsuitable or defective 83 83 .. .. not separate for sexes 7 7 .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) Other offences (Excluding offences relating to outwork which are included in Table D of this Report.) Total 794 794 .. 2 *These defects refer to premises as mentioned above under table of Inspection. 59 Nature of Work. (1) Outworkers' List (Section 107). Outwork in un- wholesome premises, (Section 108). Outwork in infected premises, (Sections 109, 110). TABLE D.—Home Work. Lists received from Employers. (8)Notice served on Occupiers as to keeping or sending lists. Prosecutions. (11)Instances. (12)Notices served. (13)Prosecutions. (14)Instances. (15) Orders made (S. 110). (16) Prosecutions (Sections 109, 110). Twice in the year. Once in the year. (9) Failing to keep or permit inspection of list. (10) Failing to send lists. Lists. (2) Outworkers. Lists. (5) Out workers Contractors. (3) Work- men. (4) Contractors. (6) Workmen. (7) Wearing Apparel— Making, etc. 88 24 807 7 .. 26 .. .. 1 1 .. 33 Cleaning and Washing 1 .. 26 Household Linen Lace, lace curtains and nets Curtains and furniture hangings Furniture and Upholstery Electro-plate File Making Brass and Brass Articles Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, etc. Artificial Flowers Nets, other than wire nets Tents Sacks Racquet and Tennis Balls Paper, etc., Boxes, Paper Bags 2 .. 113 1 .. 16 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. 4 .. 23 .. .. Textile Weaving Totals 95 24 944 9 .. 68 .. .. 1 1 1 .. 33* .. .. *For Infectious Diseases see page 22. 60 LIST OF OUTWORKERS, FACTORY AND WORKSHOP ACT, 1901 (S. 107).* Class of Homework. 1926 Number of Lists received. Number of Addresses of Outworkers. 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 51 505 53 507 248 199 324 457 Tailoring 45 362 47 354 Shirtmaking 1 10 1 10 Miscellaneous — — 1 26 Shoemakers 2 39 2 38 Boxes 2 76 1 53 Overalls 1 18 1 26 *See page 54. TABLE E. Registered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses may be enumerated here. Bakehouse Workshops 33 Bakehouse Domestic Workshops 3 Laundries Workshops 8 Laundries Domestic Workshops 3 Workshops 258 Domestic Workshops 13 Workplaces 186 Workplaces Domestic 51 Places where food is sold or prepared 410† Total number of workshops and workplaces, etc., on Register 965‡ † Power is used in: 3 of these premises. ‡ See Tables A and B, pages 54 and 55. TABLE F. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 7 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Notified by H.M. Inspector 17 Acts, but not under the Factory and Workshop Act (s. 5) Reports (of action taken) sent to H.M. Inspector 17 Other (Communications) 6 Underground Bakehouses (s. 101):— Certificate granted during the year .. In use at the end of the year 24 61 RAG AND BONE DEALERS. No legal proceedings were taken for non-compliance with the L.C.C. Bye-laws. SMOKE NUISANCES. 56 smoke nuisances (49 complaints from the London County Council) were dealt with during the year:—15 Bow East, 1 Bow West, 1 Bromley North, 10 Bromley Central, 3 East Combined, 13 West Combined, and 13 Poplar South. Two summonses were issued, see page 65. CANAL BOATS. For the year ended 31st December, 1926, the inspections and reports of the Inspectors respecting registered and non-registered canal boats were as follows:— Non- Registered. Registered. †Mr. H. A. Tibbatts, East Combined Division — — ‡ Mr. J. Johnson, West Combined Division — — †Mr. C. H. Brown, Poplar South Division — — ¶(Mr. H. J. Langley, Bromley North Division — — *Mr. Wm. Johnson, Bromley Central Division 4 — **Mr. A. J. Field, Bow East Division 18 12 Mr. W. Boyce, Bow West Division — — 22 12 †There is no canal in the East Combined and Poplar South Divisions; the Inspectors deputise, when necessary, for other Inspectors. ‡Mr. J. Johnson reported "There have been no registered canal boats in the Division during observations in 1926." ¶ Mr. H.J. Langley reported "No canal boats have been seen to stay long enough for an inspection. The locks are lower down canal.'' *Mr. W. Johnson reported ''Condition of boats generally fair. One boat not marked or numbered—letter sent to owners." **Mr. A. J. Field reported "One registered boat visited twice. Three cases of leaking cabin top and decking. Letters to owners and registration authority." 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. †For the Cleansing of Verminous Rooms, see Tabulated Statements, pages 49 and 53. 62 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. 1,916 orders for fluid were issued. Three hundred gallons were distributed during the year. LICENSED PREMISES' URINALS. Thirty-five p.h. urinals were found to be in foul condition, and were subsequently cleansed. HOUSES DIVIDED INTO SEPARATE TENEMENTS, ETC. Bye-laws made by the London County Council under section 6 of the Housing Act, 1925, were allowed by the Minister of Health on the 5th day of March, 1926. With the advent of these Bye-laws, the Bye-laws made by the Borough Council in 1912 ceased to operate. 107 house-to-house visits were made and 13 premises were registered. These are not included in the Table on page 53. WATER CERTIFICATES. One certificate was granted 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. 63 RATS AND MICE DESTRUCTION. Forty-eight lbs. of barium carbonate paste and 20 lbs. 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 ia 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 1926. 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. One case of overcrowding in a workshop was abated. 64 GENERAL. 2,766 Complaints (including 49 smoke) as to nuisances were made. 5,473 communications on general matters were dispatched, and 3,179 in connection with the supply of milk. During the year the following Orders, Regulations, Bye-laws, have come into operation:— Milk & Dairies Order, 1926. L.C.C. Bye-laws for Houses divided into separate tenements, etc. Public Health (Ophthalmia Neonatorum) Regulations, 1926. Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. POOR LAW RELIEF, Etc. Mr. G. Butler, Clerk to the Guardians, has kindly supplied me with the following information:— Outdoor Relief. Medical Relief Only. No. of persons. Cost. No. of persons. £ 1926 1,562,134 679,012 2,188 These figures are the sum of the total numbers relieved each week, the averages per week being 30,041 (outdoor relief) and 42 (medical relief). The average weekly cost of outdoor relief was £13.059. During the year 1926, the total days maintenance in St. Andrew's Hospital amounted to 210,858 (Poplar cases 210,577, Limehouse cases 281). giving an average daily number of 578. Sick cases are also treated in the Poplar Institution Sick Wards, and Maternity Cases in the All Saints' Maternity Annexe; the average weekly numbers for the year are as follows:— Sick Wards, Poplar Institution 189 Maternity Wards, All Saints' Annexe 20 65 LEGAL PROCEEDINGS. (Public Health (London) Act, 1891, Metropolis Management Acts, etc.). Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 1926. 162, Abbott Road Sink waste pipe unsuitable and not trapped 6th Jan. £1 penalty; £2 2s. costs Johnson, W. 164, Abbott Road Various defects 6th Jan. 7 days' order; £2 8s. costs Johnson, W. Wick Lane Works Smoke nuisance 12th Jan. £2 4s. costs Field, A. J. Stour Road Ditto 23rd Feb. £5 penalty; £2 2s. costs Field, A. J. 9, Hawthorn Buildings W.C. blocked 2nd Mar. £2 4s. costs Smith, F. A. 24, Hawthorn Buildings Roof defective 2nd Mar. 7 days' order; £2 8s. costs Smith, F. A. 63, Abbott Road Various defects 31st Mar. £2 penalty; £2 8s. costs Johnson, W. 19, Donald Street Ditto 16th Apr. £2 penalty; £2 2s. costs Johnson, W. 3, Stratfield Road. Water service pipe broken 10th May Abatement Order made; £2 8s. costs Langley, H. J. 17, Stratfield Road Various defects 10th May Work done. £2 4s. costs. Langley, H. J. 29, Stratfield Road Ditto 10th May Work done. £2 4s. costs Langley, H. J. 63, British Street Ditto 10th May 14 days' order; £2 8s. costs . . Langley, H. J. 40, Ford Street Ditto 15th June 7 days' order; £2 6s. costs Davies, Miss M. E. 66 Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 1926. 38la, Old Ford Road Various defects 27th July 14 days' order; £2 6s. costs Smith, F. A. 12, Donald Street Stair treads defective 28th July 14 days' order; £2 8s. costs Johnson, W. 14, Donald Street Various defects 28th July 14 days' order; £2 8s. costs Johnson, W. 16, Donald Street Back door sill and stair treads defective 28th July 14 days' order; £2 8s. costs Johnson, W. 22, Southill Street Failed to amend the drains 23rd July £2 penalty; £2 2s. costs Johnson, J. 238, Devons Road Failed to provide ashpit 26th July Ashpit provided. £2 2s. costs Pearce, H. A. 339, Old Ford Road Various defects 3rd Aug. 14 days' order; £2 6s. costs Davies, Miss M. E. 86, High Street, Bow Drain obstructed 31st Aug. Work done. Withdrawn on payment of £6 6s. costs Kelly, S. 88, High Street, Bow Ditto 31st Aug. 90, High Street, Bow Ditto 31st Aug. 381a, Old Ford Road Failed to comply with Magistrate's order 12th Oct. Adjourned for work to be done. £4 4s. costs Smith, F. A. 19, Park Street Various defects 21st Oct. 7 days' order. £2 8s. costs Davies, Miss M. E. 37, Gawthorne Street Main and back addition roofs and gutters defective 8th Dec. Work done; £2 4s. costs Kelly, S. 228, Devons Road Main roof and valley gutter defective 9th Dec. Work done; £2 4s. costs Langley, H. J. 67 Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 1926. 32, Eagling Road Roof defective 9th Dec. Work done; £2 4s. costs Langley, H. J. 19, Hawthorn Buildings Main roof and front ceiling defective 2nd Dec. 14 days' order; £2 8s. costs Langley, H. J. 1, Latham Street Various defects 7th Dec. 14 days' order; £1 penalty; £2 8s. costs Johnson, J. 17, Guildford Road Accumulation of builders' rubbish 3rd Dec. 7 days' order; £2 8s. costs Johnson, J. 19, Guildford Road Ditto 3rd Dec. 7 days' order; £2 8s. costs Johnson, J. 133, Abbott Road. . Roof and gutter to bay window defective 7th Dec. £5 penalty; £2 2s. costs Johnson, W. 1, Claude Street Various defects 29th Dec. 14 days' order; £2 8s. costs. Kelly, S. 30, Ranwell Street Ditto 29th Dec 7 days' order; £2 penalty; £2 6s. costs Kelly, S. 28, Ranwell Street Top front room roof and ceiling defective 29th Dec 7 days' order; £2 penalty; £2 6s. costs Smith, F. A. PART IV. FOOD. 70 STATISTICAL REPORTS OF FOOD INSPECTORS. MR. C. A. GRABHAM. Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. Bakehouses 115 96 8 - - Slaughterhouses 2 — — — — Cowhouses 8 — — — — Milkshops 188 15 — — — Eating-houses 40 1 1 — — Stalls 375 — — — — Other places where food is sold or prepared 381 79 - - - Ice cream premises 102 15 — — — Wharves where food is prepared or stored, etc. 26 - - - - Fried Fish Vendors, etc 120 101 (6 month only) 174 Market Inspections:- Morning, 106; Evening, 68. Slaughterhouses: 281 visits. Number of Carcases inspected:-(а) Satisfactory 1904 (b) Unsatisfactory 9 (c) Condemned and destroyed or otherwise disposed of (included in (b) above) Parts of 9 Number of Samples procured:— Formal. Informal. Total. (a) Under Sale of Food and Drugs Acts 369 31 400 (i) Number genuine 330 25 355 (ii) Number adulterated 39 6 45 (iii) Number poor quality, etc. (included in (i) genuine above) 17 - 17 (b) Under Special Orders and Regulations 31 2 33 (i) Number genuine 22 1 23 (ii) Number unsatisfactory 9 1 10 (iii) Number poor quality, etc. (included in (i) genuine above) 3 - 3 Action taken in respect of unsatisfactory samples:- (i) Summonses applied for 15 - 15 (ii) Letters of caution sent to vendors 30 - 30 (iii) Reported to Ministry of Agriculture, etc 3 - 3 Public Health (Foreign Meat) Regulations-Certificates issued by M.O.H 220 (117 visits to factories). 71 Foodstuffs Inspected for Export. Tons cwt. qrs. lbs. Bacon (American) — 6 2 11 Bacon. Wilts Middles — 1 1 20 Beef 4 5 1 16 Gammons, Danish 2 3 1 6 Hams (American) 1 3 0 0 Hams, York — — 2 6 Meat Extract — — 3 26 Mutton 1 9 1 22 Ox Tails — 6 2 18 Pork 1 7 2 24 Sausages 40 8 2 8 Saveloys — 1 0 8 Suet — 18 3 6 Sweetbreads — 3 2 12 Tongues 2 2 3 7 Veal — 19 2 23 Poultry:-Chickens, 238; Ducks. 82; Turkeys. 184. Weight not ascertained. Foodstuffs Destroyed. Total weight of foodstuffs destroyed 12 tons 10 cwt. 2 qrs. 18 lbs. Tons. cwt. qrs. lbs. Beef - 8 2 24 Fish, various - 1 2 8 Fruit and vegetables 1 19 1 21 Glace Cherries 10 — — — Margarine — — 3 21 Total 12 10 2 18 Weights of following were not ascertained:— Mutton 4 hindquarters. Oranges 816 cases. Apples 25 ,, Pineapple 15,, and 33 tins. Ham 3 £ ,, Potatoes 1 case. Tomatoes 4 boxes. Garlic 52 bags. Ice Cream 30 quarts. Tinned goods, various 126 tins. Soup Tablets 382. Loganberries 4 tins. Organs condemned and destroyed (Slaughter houses):- Lungs, 517 (Beasts, Sheep and Pigs). Mesenteries, 25 and parts of 22 (Beasts and Pigs). Livers, 84 and parts of 66 (Beasts, Sheep, Pigs and Goats). Heads and Tongues, 27 (Beasts and Pigs). Spleens, 5 (Beasts and Pigs). Kidneys, 8 (Beasts); Udders, 12 (Beasts); Tripes, 5 (Beasts); Omenta, 9 (Beasts); Pancreas, 7 (Beasts); Intestines, 1 (Beasts). 33 cases and 26 tins of Condensed Milk detained and released for Pig Feeding only. 72 MR. H. A. PEARCE. Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. Bakehouses 140 78 1 - - Slaughterhouses 12 1 — — — Cowhouses 27 — — — — Milkshops 226 21 4 1 — Eating-houses 88 17 4 1 — Stalls 1080 - — — — Other places where food is sold or prepared 463 133 18 4 - Ice cream premises 103 27 3 1 - Wharves where food is prepared or stored, etc 2 - - - - Fried Fish Vendors, etc 104 89 — 1 1 (6 months only) 207 Market Inspections:- Morning, 135; Evening, 72. Slaughterhouses:-267 visits. Number of Carcases inspected:- (а) Satisfactory 2031 (b) Unsatisfactory 21 (c) Condemned and destroyed or otherwise disposed of (included in (b) above) 1 and parts of 20.* Formal. Informal, Total Number of Samples procured:- (a) Under Sale of Food and Drugs Acts 390 33 423 (i) Number genuine 350 23 373 (ii) Number adulterated 40 10 50 (iii) Number poor quality, etc. (included in (i) genuine above) 25 1 26 (b) Under Special Orders and Regulations 38 - 38 (i) Number genuine 28 - 28 (ii) Number unsatisfactory 10 - 10 (iii) Number poor quality, etc. (included in (i) genuine above) - - - Action taken in respect of unsatisfactory samples:- (i) Summonses applied for 25 - 25 (ii) Letters of caution sent to vendors 18 - 18 (iii)Reported to Ministry of Agriculture, etc. 7 — 7 Public Health (Foreign Meat) Regulations—Certificates issued by M.O.H. 19 (8 visits to factory). Foodstuffs Inspected for Export:- Sausages, 1 ton; Hams (American), 2 tons 5 cwt. 3 qrs. 18 lbs. *Total weight of meat destroyed 1 ton 9 cwt. 2 qrs. 12 lbs. 1 Carcase; 7 Forequarters; 2 Hindquarters; 3 Short top pieces; 6 Sirloins; 3 Aitch bones; 1 Thick Hank; 8 Thin Hanks; 4 Clod and Stickings; 8 Briskets; 3 Mid ribs; 9 Fore ribs; 5 Rumps; 3 Thin skirts; 1 Top of ribs; 3 Breasts of Mutton; 3 Bruised meat. 73 Organs condemned and destroyed (Slaughterhouses):- Livers, 138 and 31 parts; Heads, 41; Tongues, 43; Stomachs, 6; Langs. 640; Omenta, 10; Mesenteries, 43 and 2 parts; Spleens, 15; Pancreas, 18; Hearts, 2; Udders, 18; Kidneys, 13; Intestines, 2. Total, 989. (Note.—Lungs, Livers, Spleens and Mesenteries, Bovine, Sheep and Pigs; Heads and Omenta, Bovine and Pigs; other organs, Bovine only.) Other foodstuffs condemned and destroyed:- 20 boxes Cape Pears; Strawberries, 168 lbs.; Mussels, £ bushel; Pineapple. 479 l1b. tins; Condensed Milk, 6 l1b. tins; Plaice, 64 lbs.; Pears (Bartlett), 840 lbs.; Periwinkles, £ bushel; Prunes, 28 lbs.; Salmon. 1 tin; Cherries, 1 tin; 1 Liver (seized); 14 Hocks of Bacon (seized. 9183 tins of Machine Skimmed Condensed Milk were detained and subsequently released for Pig Feeding. 28 lbs. Butter were released for commercial purposes. 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. 1,196 visits were paid to these premises during the year, and the Sanitary Regulations made under the London County Council (General Powers) Act, 1908, Section 8, were enforced. Want of cleanliness was found in 153 instances, and 59 other defects existed. 420 intimations were served, which in 23 cases were followed up by Statutory notices, and one final notice was served. MILK SHOPS. At the end of the year there were in the Borough 129 registered premises (including nine cow-houses) where milk is sold. These milk shops were kept under observation. †See Tables A and C, pages 54 and 57. 74 In addition. 141 premises where sterilised milk in bottles is sold were noted. Cleansing of premises was necessary in 27 instances. Twelve other defects were found. For milk shops connected with infectious diseases, see page 21. Eight premises were, on account of change of occupiers, re-registered as milk shops. The sale of milk was discontinued on 27 premises. Milk and Dairies Order, 1926. As by this order premises, as well as persons, are to be registered, the opportunity was taken to revise the whole of the Register. This had not been completed at the end of the year. Article 14 (3) of this Order states:- "No foul or noxious matter, or soiled bed or body clothing shall be conveyed through any part of a building used for the keeping or storage of milk." In a number of instances, milk premises had only one entrance for everything. The facts were laid before the Council's Solicitors for their interpretation of this article, and they stated that the Council would most certainly be justified in either refusing to register a retail purveyor of milk, or in removing a retail purveyor of milk, already registered, from the register, in cases where a dairy or shop has only one entrance and soiled clothes, coal, paraffin and ashpits are habitually carried through the shop where milk is stored, and in cases where the premises communicate by door, window or otherwise with a manure receptacle. The advice of the Legal Department of one of the Municipal Journals was also sought, and they replied that it seemed clear that when ashes, etc., could only be removed from premises by being conveyed through a dairy, that such premises were unsuitable for use as a dairy. 75 In view of these opinions, notices have been served upon a number of persons selling milk to appear early in 1927 before the Public Health and Housing Committee (to whom powers under the Milk and Dairies (Amendment) Act, 1922, have been delegated), to show cause why they should not be removed from the Register. Milk (Special Designations) Order, 1923. During the year, the following licences under the above order for Grade "A" (Tuberculin Tested) milk were issued:- Ten bottling establishments. 24* dealing in sealed bottles only. 5 supplementary licences (principal licences issued by other Authorities). One licence was issued for the sale of "Certified" Milk, and 2 supplementary licences. *Including 3 cancelled subsequently. The bottling establishments have been under constant supervision. For results of examination of samples see Public Analyst's report, page 81. Representations were made to the Ministry of Health that the Milk and Dairies Acts and Orders should be uniformly administered, and that all cows should be periodically submitted to a tubercle test. ICE CREAM. London County Council (General Powers) Act, 1902, Sec. 43. There are 124 premises where ice creams are manufactured within the Borough, on the Register. 205 inspections were made during the year. Cleansing of premises was necessary in 32 instances. 23 other nuisances existed. 76 BAKEHOUSES. Inspections. The bakehouses throughout the Borough were inspected at least twice during the year. There are 80 bakehouses in use, of which 24 are underground. In 44 bakehouses machinery is used. See Table A, page 54, number made up to end of year. Cleansing was necessary in the various bakehouses on 157 occasions. Eight other nuisances were found. SLAUGHTERHOUSES. No contraventions of the bye-laws made by the Loudon 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. 239 certificates were issued in connection with 195 consignments of foodstuffs: Canada: (67 certificates), Australia (80), United States of America and Dependencies (49), Venezuela (28), other countries (15). 125 visits were paid to factories in connection with the above. For details of foodstuffs inspected for export, see p. 71. 77 PUBLIC ANALYST'S ANNUAL REPORT. During the year 1926, 812 samples were examined under the Sale of Food and Drugs Acts. Of these 73 samples or 9.0 per cent. were found to be adulterated. In addition, 75 samples, or 9.2 per cent. were of doubtful purity or inferior quality. The figures for the previous 6 years are as follows:- Year. Samples examined. Percentage of Adulteration. 1925 811 8.0 1924 764 3.7 1923 762 3.7 1922 738 2.2 1921 710 0.8 1920 730 1.2 Average 752 3.3 It will be observed that the adulteration after being at a low figure for some years is on the increase. The average adulteration for the whole of London in 1925 was at the rate of 3.9 per cent., and for the whole of England and Wales 6.5 per cent. The number of samples examined was in the ratio of 4.8 per 1,000 of the population as compared with 5.3 per 1,000 for the whole of London, and 3.1 per 1,000 for the whole of England and Wales. Whilst this method of expressing the numbers of samples examined may be of interest for purposes of comparison, it is doubtful if it is the best one for determining the number to be examined. In a District like Poplar, where there are a multitude of small shops selling articles of food and drink, the samples taken do not average one sample per shop per annum. Fifty-one of the 812 samples were purchased informally, and all samples were submitted by the Inspectors. Nine of the informal samples were adulterated and 8 were of inferior quality. 78 Preservatives. The following samples were found to contain preservatives:- Sample. Number examined. Preserved. Percentage preserved. Butter 54 15 27.8 Margarine 59 49 83.0 Cream 3 2 66.7 Cake 5 3 60.0 Sausage 9 3 33.3 Lemon squash 2 2 100.0 Lime juice cordial 2 2 100.0 Sauce 4 1 25.0 Totals 138 77 55.9 Margarine. Four samples contained mineral oil varying in amount from 10 to 15 per cent. This is an objectionable form of adulteration. Mineral oil may be useful for medicinal purposes, but being indigestible it. has no food value. American Apples. In the early part of the year special attention was called to the sale of American apples which had been treated with arsenical spray for insecticidal purposes. Thirteen samples were examined and in 4 cases arsenic was found to be present to the extent of 1/25 to 1/50 grain per lb. Cocoa. The question of cocoa was commented upon in the 1923 Report. In spite of cautions many vendors still continue to sell an article as "pure" cocoa which is a compound containing added alkali. Pure cocoa should be a powder produced by grinding the cacao bean after removal of a portion of its fat by pressure, without the addition of any foreign ingredient. 79 Cocoa powder to which alkali has been added should have some special designation to indicate that it is a compound article. Seidlitz Powders. During 1926 and the previous year, samples of Seidlitz powders were examined and found to be deficient in weight. Seidlitz powders are put up in two packets, which must be mixed before use, and to obtain the desired effect the respective weights should be those specified by the British Pharmacopoeia. If one packet is deficient in weight the resulting mixture is unsatisfactory. There appears to be some difficulty in dealing with short weight under the Sale of Food and Drugs Acts, so unfortunately no action was taken in these cases. The powders were purchased from general shops and were sold as received from the wholesalers. Condensed Milk Regulations. Four samples of full-cream condensed milk and 4 samples of machineseparated condensed milk were examined. These were all satisfactory. Dried Milk Regulations. Two samples of full-cream dried milk were examined and found to be satisfactory. Bacteriological Examination of Milks. One sample of "Certified" Milk and 79 samples of Grade "A" (T.T.) milk were examined bacteriologically. 80 Fifty-seven of the Grade "A" milks and the "Certified" milk were submitted by the Inspectors. Twenty-two Grade "A" milks were submitted by the Bottlers. Four of the Inspectors' samples were taken on delivery at the Railway Station and 2 of them on delivery at the Bottlers' premises. Seventeen of the 79Grade "A" samples failed to reach the required standards of bacterial purity. Two of these were samples taken at Railway Stations. In 8 cases both Bacillus coli and the total organisms exceeded the numbers allowed. In 9 cases Bacillus coli only was in excess. Bacillus coli was present in 9 cases in 1/1000 Cc, in 1 case in 1/200 Cc. and in 7 cases in 1/100 Cc. The total numbers of organisms present varied from 500 per 1 Cc to 3,000,000 per 1 Cc.. In general the numbers were well below 100,000 per 1 Cc and in 45 cases the numbers were below 10,000. It is only fair to state that most of the unsatisfactory samples were taken in the spell of hot weather during the late summer. From an examination of the figures obtained there does not appear to be any ratio between the presence of Bacillus coli, the typical intestinal organism, and the total numbers of organisms. In one case with a total of 5,000 organisms per 1 Cc, Bacillus coli was found in 1/1000 Cc. At the other extreme, with a total of 200,000 organisms per 1 Cc, Bacillus coli was present in 1/100 Cc only. The first case evidently indicated dirt contamination on the premises of the Producer. In chemical composition these milks were as follows:- Fat varied from 2.7 to 7.9 per cent., with an average of 3.90 per cent. Total solids varied from 11.2 to 16.0 per cent. with an average of 12.46 per cent. 81 Three samples fell below the legal standard of 3.0 per cent. of fat. Ten samples contained less than 12.0 per cent. of total solids. One only, and this an abnormal sample contained less than 8.5 per cent. of nonfatty solids. Eight samples of bottled Sterilised Milk were bacteriologically examined. In every case Bacillus coli was absent from 1 Cc. The total numbers of organisms present varied from 5 to 8,000 per 1 Cc. The average chemical composition of these samples was:-Fat, 3.45 per cent.; and total solids 12.25 per cent. All samples were above the legal limits. Three samples of full-cream Dried Milk were bacteriologically examined. In 2 cases Bacillus coli was present in 1/10 grm. The total numbers of organisms present varied from 2,000 to 180,000 per 1 grm. Other samples examined for the Public Health Department were:- 6 Canned Fruits. 1 Glace Fruit. 3 Dried Fruits. 1 Sterilised Milk. 4 Waters. 1 Liniment. 3 Cod-liver Oil and Malt Extracts. ALBERT E. PARKES, F.I.C., Public Analyst. 82 FOOD AND DRUGS ACTS. The results of the analyses of 812 samples were reported to the Committee during the year:- Sample. Number examined. Doubtful purity and inferior quality. Adulterated . Legal Proceedings.* Milk 372 43 20 9 ,, Sterilized 2 1 — — ,, Condensed 1 — 1 1 Cream 2 — 1 — ,, preserved 1 — - — Butter 54 10 - — Margarine 59 5 12 7 Cheese 4 — - — Dripping 8 1 - — Lard 9 — - — Shredded Suet 2 — - — Mustard 9 1 — — Pepper 10 — — — Vinegar 22 — 1 — Sauce 2 1 — — Chutney 1 — — — Anchovy Sauce 2 — — — Cocoa 8 4 — — Coffee 10 — — — Coffee Essence 2 — — — Cornflour 8 — — — Rice 6 — — — Ground Rice 2 — — — Arrowroot 1 — — — Pearl Barley 6 — — — Sago 4 — — — Oatmeal 6 — 1 — Flour 6 — — — Self-raising Flour 6 — — — Ground Ginger 4 — 1 — Baking Powder 6 — — — Egg Powder 4 — — — Custard Powder 4 — — — Seasoning 2 — — — Pickles 4 — — — Cake 5 1 — — Pea Flour 2 — — — Jam 4 — — — Marmalade 2 — — — Table Jelly 1 — — — Jelly Crystal 1 — — — Golden Syrup 6 — 1 1 Rum and Coffee Essence 1 - - - Carried forward 671 67 38 18 *See pages 84-88. 83 Sample. Number examined. Doubtful purity and inferior quality. Adulterated. Legal Proceedings. Brought forward 671 67 38 18 Borax 2 - - - Cream of Tartar 4 - — — Tea 4 - — — ,, Dust 2 — 1 1 Sweets 11 1 — — Sherbet 2 - — — Apples 13 - 4 3 Citrate of Magnesia 2 - — — Liniment of Turpentine and Acetic Acid 2 - 1 1 Glauber Salts 2 - — — Seidlitz Powders 6 - 3 - Lime Water 4 - 3 2 Camphorated Oil 2 - — — Lime Juice Cordial 2 - — — Lemon Squ sh 2 - — - Lemonade 2 - — — Lemonade Crystals 2 - — - Gin 16 - 3 1 Whisky 32 4 15* 9 Rum 14 2 4* 2 Mincemeat, Fruit 2 - - - Meat Pie 2 - - - Brawn 2 - - - Sausage 9 1 — — Totals 812 75 72 37 *Including informal samples: Whisky, 5; Rum, 1. Of the 372 samples of milk, 49 were procured on Sundays from itinerant vendors and 166 from itinerant vendors on weekdays. Fifteen samples purchased from itinerant vendors were not in accordance with the legal standard and proceedings were instituted in seven cases. Samples were taken on delivery as follows:-Poplar Institution, 3; Poplar Hospital, 4; and St. Andrew's Hospital, 5. All these samples were genuine. Eight samples were taken on delivery at Railway Stations. Two samples were adulterated and two samples of Grade A (Tuberculin-Tested) milk were unsatisfactory. 84 THE SALE OF FOOD AND DRUGS ACTS. Administrative Action Taken Respecting Samples Reported to be Not Genuine, Etc. March Quarter, 1926. Sample No. Article. Result of Analysis. Action taken. G.7 Vinegar 2.5 per cent. deficient in acid Letter of caution. P.4 Milk 6.5 per cent. deficient in fat "Appeal to cow" samples taken (P.8 and P.11). P.8 Milk 10 per cent. deficient in fat.. Taken at time of milking; no action. P.11 Milk 6.6 per cent. deficient in fat Taken at time of milking; no action. P.16 Margarine 1.5 per cent. excess of water Reported to Ministry of Agriculture, etc. P.27 Apples Contained Arsenic 1/25 grain per lb. Summons; £1 3s. costs P.30 Apples Contained Arsenic 1/25 grain per lb. Summons; £3 penalty; £1 1s. costs. G.26 Apples Contained Arsenic 1/25 grain per lb. Summons; £3 penalty; £1 1s. costs. P.32 Milk 3.5 per cent. added water Letter of caution. Informal Apples Contained Arsenic 1/50 grain per lb. Formal samples taken. G.47 Milk 4.7 per cent. added water Letter of caution. P.74 Milk 5 per cent. deficient in fat Summons; £2 2s. costs. P.96 Condensed Milk.. 3.3 per cent. deficient in fat Summons; £24s. costs P.110 Seidlitz Powders 60 per cent. deficient in Tartaric Acid Letter of caution. Informal Seidlitz Powders 12.5 per cent. deficient in Tartaric Acid Formal samples taken. G.70 Sweets French Chalk 10 grains per lb. No action. G.43 Sausage Contained Boracic Acid 6.5 grains per lb. Letter to vendor. P.59 Butter 16.5 per cent. of water Letter to vendor. G.75 Butter 16.4 per cent. of water Letter to vendor. Informal Cake Contained Boracic Acid 6.5 grains per lb. No action. P.6 Informal Sauce Contained Salicylic Acid 1.5 grains per pint No action. 85 June Quarter. Sample No. Article. Result of Analysis. Action taken. P.112 Milk 15 per cent. added water Summons dismissed on warranty. P.115 Milk 5 per cent. added water Summons dismissed on warranty. G.119 Milk 2.3 per cent. added water Letter of caution. P.118 Seidlitz Powders 56 per cent. deficient in Tartaric Acid Letter of caution. G.127 Margarine Contained 15 per cent. mineral oil Sample (G. 148) taken on delivery. G.148 Margarine Contained 15 per cent. mineral oil Reported to Ministry of Agriculture. G.134 Milk 3.3 per cent. deficient in fat Letter of caution. P.202 Milk 86 per cent. deficient in fat.. Summons: see Note at foot. G.195 Milk 73 per cent. deficient in fat.. No action; sold as ''separated'' G.200 Milk 3.5 per cent. added water Letter of caution. G.206 Margarine 10 per cent. Mineral oil Letter of caution, and reported to Ministry of Agriculture. P .209 Milk 3.3 per cent. deficient in fat Taken on delivery at railway station; letter to producers. P.210 Milk 3.3 per cent. deficient in fat Taken on delivery at railway station; letter to producers. G.185 Oatmeal Biscuit meal Letter of caution. G.181 Milk 3.3 per cent. deficient in fat Letter of caution. G.- Milk Refusal to sell for analysis £2 fine; £1 Is. costs. P.- Milk Refusal to sell for analysis £3 fine; £1 1s. costs. Note.—Sample P. 202, defendant failed to appear; summons adjourned pending arrest. (See aUo foot of page 88.) 3 Samples of Cocoa contained added Alkali 2 per cent.; letters of caution sent. 1 Sample of Butter and 2 of Margarine contained excess water 0.5 per cent.; ''ported to Ministry of Agriculture. 86 September quarter. Sample No. Article. Result of Analysis. Action taken. P.223 Margarine 1.5 per cent. excess of water Letter to vendor, and to Ministry of Agriculture. P.230 Lime Water 65 per cent. deficient in lime Summons; £3 3s. costs. G.232 Lime Water 5 per cent. deficient in lime Letter of caution. G.246 Margarine 12 per cent. Mineral oil Summons; £2 penalty; £1 1s. costs. G.247 Margarine 2.4 per cent. excess of water Summons; £3 3s. costs. G.253 Lime Water 22 per cent. deficient in lime Summons; £1 penalty; £1 Is. costs. G.279 Cream Contained 0.4 per cent. Boracic Acid-not labelled Letter of caution. G.291 Whisky 40 degrees under proof (Informal) Formal sample G.294. G.294 Whisky 40 degrees under proof Summons; £3 3s. costs. P.14 Whisky 41 degrees under proof (Informal) Formal sample P.284. P.15 Whisky 38 degrees under proof (Informal) No action. P.284 Whisky 40 degrees under proof Summons; £3 3s. costs. P.276 Margarine 12 per cent. mineral oil Letter to vendor and to Ministry of Agriculture. P.293 Milk 20 per cent. deficient in fat.. Summons; £2 penalty; £2 2s. costs. P.307 Margarine 12 per cent. mineral oil Summons; £1 Is. costs. G.271 Butter Rancid (Informal) Butter seized and condemned by Magistrate. P.A.875 Butter Rancid (Informal) Butter seized and condemned by Magistrate. P.20 Butter Rancid (Informal) Formal sample P.306. P.306 Butter Rancid Sale stopped except for commercial purposes. P.314 Cocoa 2 per cent. added alkali No action; "Pure"cocos not demanded. P.18 Whisky 36 degrees under proof (Informal) No action. P.307 Margarine Sold in unstamped wrapper £1 penalty; £1 1s. costs. G.263 Cake 2.5 grains boracic acid per lb. Letter of caution. P.281 Sausage 6.5 grains boracic acid per lb. Letter to vendor. 87 December Quarter. Sample No. Article. Result of Analysis. Action taken. G.320 Margarine Contained unsaponifiable matter 10 per cent. Wholesalers cautioned. G.838 Margarine Contained excess water 2.2 per cent. Summons; £3 3s. costs. G.348 Whisky 40 degrees under proof Informal sample, see G. 349. G.356 Whisky 39 degrees under proof Informal sample, see G. 349 G. 349 Whisky 38 degrees under proof Summons; £5 5s. costs. P. 352 Tea Dust Contained excess mineral matter 8 per cent. Summons; £5 penalty; £2 2s. costs. P. 354 Lin. of Turpentine and Acetic Acid Deficient in glacial acetic acid 15.4 per cent., deficient in liniment of camphor, and contained extraneous water 36.7 per cent. Summons; £2 2s. costs. G.377 Milk Deficient in fat 23 per cent. Summons; £1 Is. costs. P.372 Milk Contained added water 3.5 per cent. Summons; £1 Is. costs. — Milk Refusal to sell for analysis.. Summons; £2 penalty; £1 Is. costs . P.360 Ground Ginger Contained excess mineral matter 2 per cent. Letter to vendor. G.384 Milk Contained added water 3.5 per cent. Summons; £25 penalty; £5 5s. costs. P.368 Margarine Served in unstamped wrapper Summons; 7s. 6d. costs. G.391 Milk Deficient in fat 8 per cent. Summons ; £2 4s . costs. G.393 Golden Syrup Contained glucose syrup 90 per cent. Summons; £5 penalty; £3 3s. costs. P.392 Whisky Contained excess of water 3 per cent. (3rd portion to Somerset House) Summons withdrawn on suggestion of Magistrate. £2 2s. costs. G.404 Margarine Contained 4 per cent. excess of water Summons; 7s. 6d. costs. G.403 Butter Contained 2.8 per cent. free fatty acids Letter of caution. G.420 Rum 48 degrees under proof Summons; £5 penalty; £1 1s. costs. 88 December Quarter—Continued. Sample No. Article. Result of Analysis. Action taken. P.397 Whisky 40 degrees under proof Summons; £3 penalty; £2 2s. costs. P.399 Whisky 44 degrees under proof Summons; £5 penalty; £1 1s. costs. P.412 Rum 38 degrees under proof Summons; £5 penalty; £1 1s. costs. G.426 Whisky 40 degrees under proof Summons; £5 penalty; £1 1s. costs. G.427 Whisky 43 degrees under proof Summons; £5 penalty; £1 1s. costs. P.418 Whisky 43 degrees under proof Summons; £5 penalty; £1 1s. costs. P.426 Gin 49 degrees under proof Summons; £5 penalty; £1 1s. costs. G.416 Whisky 36 degrees under proof Letter of caution. G.421 Rum 36 degrees under proof Letter of caution. P.415 Gin 37 degrees under proof Letter of caution. P.417 Gin 37 degrees under proof Letter of caution. G. 424 Rum 37 degrees under proof Letter of caution. P.419 Whisky 36 degrees under proof Letter of caution. P.420 Whisky 36 degrees under proof Letter of caution. Milk and Dairies (Consolidation) Act, 1915, and Dairies, Cowsheds and Milk Shops Order, 1855. Sample. No. Result of Analysis, etc. Result of Legal Proceedings or other action taken Name of Officer. Milk P.X. Vehicle and cans not marked with name and address Letter of caution. Pearce,H.A Milk G.195 Sold without being registered 17th Sept. £50 penalty or 3 months' hard labour. Grabham, C.A. Milk G.195 Sold from a can not marked with name and address ditto *Milk P.202 Sold from a can not marked with name and address. Pearce, H. A *(See also report for June Quarter, page 85.) 89 SEIZURES OF FOODSTUFFS. Public Health (London) Act, 1891, Section 47. Proceedings under the above section were taken as follows:- Particulars. Date of Decision. 1926. Result. Name of Officer. Exposed for sale 7 lbs liver unfit for food of man. (Condemnation Order 29th January.) 18th Feb. £30 penalty, £12 i2s. costs (or 2 months' imprisonment.) Pearce, H. A . Exposed for sale 17 eases of Apples which were unsound, etc. (Condemnation Order, 12th June.) 22nd June £2 2s. costs or 7 days' imprisonment. Grabham, C. A. Exposed for sale plums which were unsound, etc. — Letter of caution. Johnson, W- Exposed for sale 7 lbs. Butter, which was unsound, etc. 13th Aug. Condemnation Order made. Grabham, C. A. Exposed for sale 3 hocks of Bacon which were unsound. (14 hocks seized and condemned 9th October). 2nd Nov. £25 penalty; £5 5s. costs, or 3 months' imprisonment. Pearce, H. A. Exposed for sale 126 tins various foodstuffs. (Condemnation Order, 22nd October.) 10th Nov. £10 penalty, or 2 months' imprisonment. Grabham, C. A. Aiding and abetting above. 10th Nov. £40 penalty; £10 10s. costs or 3 months' imprisonment. Grabham, C. A. 90 Public Health (Milk and Cream) Regulations, 1912 and 1917. l.-MILK; AND CREAM NOT SOLD AS PRESERVED CREAM. (a) (b) Number of Samples examined for the presence of preservative. Number in which preservative was reported to be present, and percentage of preservative found in each case. Milk 374* Nil. Cream Two One *Including two 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 One sample (iii.) Percentage of preservative found of Preserved in each sample Cream was Percentage stated on statutory taken. label. (b) Determinations made of milk fat in cream sold as preserved cream. (i.) Above 35 per cent One (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.-One. (d) Particulars of each case in which the Regulations have not been complied with, and action taken. Not properly labelled. Letter of caution sent to vendor. 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. 91 Margarine Act, 1887, Sale of Food and Drugs Act, 1899, and the Butter and Margarine Act, 1907. Two applications were made for registration of premises for carrying on the business of wholesale dealer in margarine, and one for a butter blending factory. 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, 1926, viz.:- Sub-District. Margarine. Butter. Wholesale Dealer. Manufacturer. Factory. Wholesale Dealer in Milk-blended. Poplar 7 — 1 — Bow and Bromley 9 — 2 — Totals 16 — 3 — One premises of a wholesale dealer in Margarine which were registered on 18th January, 1926, were subsequently de-registered by order of the Public Health and Housing Committee held 11th October, 1926. These premises are not included in the above table. PART V. MATERNITY AND CHILD WELFARE. 94 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. The Maternity and Child Welfare work has increased immensely since 1920. Larger attendances are being recorded at the Clinics, the total attendances during 1926, and the preceding years being as follows:- Borough Council. Royal College. 1926 35,084 20,473 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 Proposed Clinic-Isle of Dogs. During the year consideration has been given to the clinic accommodation on the Isle of Dogs. The two present clinics are both situate in unsatisfactory premises. At Christchurch the conditions are bad in the extreme. The clinic has to be entered via a flight of about two dozen stone steps which, in Winter, are exceedingly dangerous. The clinic premises cannot be satisfactorily heated and part of the building is in an unsafe condition. The perambulators of the mothers have to remain in the yard below where they cannot be adequately protected. At West Ferry Road the Doctor's and weighing rooms are reached by a steep and narrow staircase and the accommodation is extremely limited. Efforts have been made to obtain other suitable accommodation and alternatively to obtain a piece of land where a central and up-to-date clinic could be erected. At the end of the year efforts to obtain other accommodation have been unsuccessful and the Minister of Health has stated that he was not 95 prepared to sanction further loans for this purpose at the present time although he realised that the accommodation in the Christchurch schools was not ideal for the purposes of a Clinic. Ante-natal. Efforts have been particularly concentrated on antenatal 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 deaths from these cases during the years 1920 to 1926, were as follows:- 1920 1921 1922 1923 1924 1925 1926 Sepsis 7 6 3 7 1 5 4 Other causes 12 10 9 7 4 7 9 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 102. 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. 96 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. Puerperal Pyrexia. 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 1926 13 8 43 623 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 1s. 3d. per visit is paid. Convalescent Treatment.-During the year 1925, an agreement was 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 to that Association by hospitals, etc., for convalescent treatment. The underlying principle is that the provision of convalescent treatment should be 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 payments from parents (if they are able to afford it) and the Borough Council contributes the balance. This arrangement is working satisfactorily. ARTIFICIAL SUNLIGHT TREATMENT. Dr. E. M. Layman, the Medical Officer in charge of Artificial Sunlight Treatment, has submitted the following interesting report:- "At the close of our second year's work at Sunshine Treatment in Poplar Borough, I write with great satisfaction of the marked benefit to health enjoyed by our children who attended. A A Previous History. Girl-, 3rd child. Fed on cow's milk and barley water. Walked at 1-5/12 year. Rickets noted at Welfare Centre by Clinic Doctor at age 2-3/12. Mother discontinued attendance, so no treatment given. 1/12/25. Seen again by Doctor, and started artificial sunlight Age 3-3/12. treatment. Weight, 341b. 50z. General Rickets and malnutrition. Both femora much curved; head shows old cranial Rickets. Chest shows ricketty curves and poor expansion. Mental development backward. Circulation poor. 18/12/25. Child shows distinct improvement. 26/1/26. After seven treatments, child was walking better, and reported better at home; gaining weight. 27/4/26. Has had 37 treatments, extending 5 months. Great improvement all round; very satisfactory; suspended, to report in 6 weeks. 15/6/26 Discharged; very satisfactory. 26/11/26. Was seen by Clinic Doctor after an interval of 5 months; Age 4-2/12. so greatly improved as to be almost unrecognised, and normal mentally. B Previous History. Boy; 10th child. Dried milk and orange juice. Feed- ing satisfactory. Weight, 101b. 3oz. Sent by Clinic Doctor for thinness. Age 5 months. Child normally formed; fontanelle about a crown piece; 17/11/25. very thin all over; behaviour normal. Child showed steady improvement from 1st exposure; was very happy, cheerful and contented. 25 treatments were given, extending November 17th, 1925, to February 4th, 1926 ; during this period the child had gained 41b. l0oz. 4/2/26. Child very satisfactory; suspended to report 6 weeks later. 15/3/26. Child very well; gained 21b. 60z. during the 6 weeks away. Discharged. c c Previous History. Boy; 1st child. Dried milk and mixed feeding. Had convulsion and diarrhœa with 1st tooth. Appetite poor; no special illnesses; crawls about. 10/8/26. Child examined.—Rickets, pale, adenoidal, fat,flabby; Age 11 months. chest poorly developed; lethargic; bad colour: bowing Weight. 221b. lloz . legs; 9 teeth. Commenced U.V. treatment, 10/8/26. After 6 treat nients child was reported "very much improved" by parents. Less lethargic; muscles firmer; appetite improved ; and much brighter generally. 30/10/26. Commenced treating legs with red rays; 10 minutes' exposure to red—previous to U. Violet exposure. Very rapid improvement of legs was noted, both at home and at the Clinic. 16/11/26. Child walking alone quite confidently. 21/12/26. Treatment was given from August 10th, 1926 to Decem- ber 21st (45 sessions); improved rapidly throughout the whole course. Was discharged very well. Walking well; muscles firm; good shape; 14 teeth; good appetite. Marked mental improvement. Had gained 51b. 8oz. D Previous History. Boy; 2nd child. Feeding cow's milk; now cow's milk and groats. 16/6/26. Examined; ricketty; unable to sit up alone; 1 tooth; fat Age 10 months. and flabby. After 3rd treatment, child made attempts to pull him self up. Treatment was given from June 16th to October 29th (38 sessions); during this period steady improvement Aug. 10th 1926. had taken place. Walking well; muscles firm ; 10 teeth, cut without trouble. Child very bright and contented. 29/10/26. Treatment suspended for one month during home diffi- 25/11/26. culties. Weight. 241b. One more tooth, very satisfactory ; to resume treatment, E E Previous History. First child; feeding dried milk and cream; mixed feed- ing. Teething satisfactory. Walked at 1-6/12 year; occasional incontinence night and day. 1/12/25. Examined.—Pale and anæmic; Femora incurved; Age 1-11/12. epiph +and chest walls ricketty. Abdomen tumid and Weight, 291b. 2oz child adopts lordotic posture. Normal mentally. Mother of child reported, "Child walks so 'pigeon toed,' she falls over her toes." Artificial sunlight treatment commenced Dec. 1st, 1925 ; 46 treatments were given—last one, April 30th. Rapid improvement was noted after four treatments, both at home and clinic. April 30th, treatment suspended; child very well; Weight, 301b. 14oz. muscles firm; legs straight; walking well. Anaemia bet- ter; child very bright. 11/6/26. Discharged ; very well. F Previous History. Girl; 7th child. Sent by own Clinic Doctor for rickets. Has been attending Great Ormond St.; has had splints for marked deformity of Tibiæ; but has recently been allowed to leave these off. 27/5/26. Very marked thickening and curve; but child contented. Age 1-10/12. Marked improvement in legs. Weight, 291b. 2oz. Child has had 35 treatments, and is very much better 17/8/26. generally; brighter; has gained weight, and legs much better. October 30th to December 14th, away with measles; is now continuing treatment to legs. Gain in weight, 31b. 12oz, G G Previous History. Boy; 6th child. Breast led to 10 months; mixed feed- ing; bronchitis with teething. Sent by Clinic Doctor for ricketty legs. 21/5/26. Examined.—Plump, flabby muscles; ricketty tibiæ; not Age 1 year walking; 6 teeth. Commenced artificial sunlight treat- Weight, 201b. 8oz. ment, 21/5/26 (not able to stand). A course of treatment extending from May 21st to Nov. 15th was given (53 sessions). 15/11/20. The child showed steady improvement from the com- mencement. Muscles much firmer; child brighter; talks very plainly; is walking well, and has now 13 teeth; gained in weight 41b. Tibiæ satisfactory. 17/12/26 Mother had been unable to bring child (owing to home affairs); general improvement maintained; child walking well; to resume for short period; more teeth erupting 97 Bow Road Clinic has served the northern half, and Simpsons Road Clinic, opened on January 14th, the southern, thus quite doubling our usefulness, as is evident from the numbers quoted, of cases treated and "baths" given. Children under five years are eligible, except cases of tuberculosis, this being the rule of the Ministry of Health. The large majority sent to me, or chosen by myself, from our Welfare Clinics suffered from rickets, not only the obvious deformities of bones, but delayed dentition, the catarrhal state with repeated bronchitis, muscular weakness, delay in walking, lethargy and occasional convulsions. A few of the older ones had anaemia and debility—usually produced bv overcrowding, lack of fresh air and poor feeding. All except very small, frail babies are given four minutes (two facing back, two facing front) at a distance of 28 inches from the lamp, as a first exposure. This is repeated on alternate days for four to six sessions and increased by one minute every four to six sessions, till a maximum exposure of eight minutes is reached. Each child is considered individually and his response to treatment enquired into before he is promoted to a longer exposure, and no rigid rule can safely be observed. Any unfavourable sign (like restlessness at home) that may occasionally be reported is a signal for cutting down the period of exposure, or at least delaying promotion to longer exposure; but with our present system, cutting down is very rarely necessary. I do not find with these young children that eight minutes need usually be exceeded with the K.B.B. lamp in use, as this has a high ultra-violet activity. Pigmentation is so slight as to be negligible, and seems to have no relation to the clinical effects. A few cases (of rickety legs) are now on a course of red-with-infra-red rays for 10 minutes, followed immediately by the ultra-violet bath. This is in accordance with some recent experience recorded in this and other countries, and as it is eminently satisfactory in our own Clinics, I propose to extend the use of the red lamps in picked cases. The advantage I have noted is a more rapid improvement in the rickets than I have found in similar cases with ultra-violet only. Seven cases have been reported in detail as of special interest. Many others, less dramatic, have been remarkably encouraging to the Sister and myself, as well as to their parents—especially perhaps fretful, 98 weak and languid children, who have brightened from the onset of treatment into enterprising, happy children. Most cases need at least 30 sessions, some 60, before I decide to give them a month's "rest" from treatment. All are asked to report after the absence, and if relapsed they begin again as fresh cases at fourminute exposures. I am more than ever convinced of the importance of the Sunshine Treatment to the children of Poplar, and am deeply interested in our work and its encouraging results." There are two Artificial Sunlight Centres administered by the Borough Council. The Centre at Avenue Road, Bow, has been open since March 30th, 1925; and the Centre at Simpsons Road, Poplar, opened on January 14th, 1926. Treatment is carried out at Bow on Mondays, Wednesdays and Fridays, and Poplar on Tuesdays, Thursdays and Saturdays. During 1926, 349 patients were treated, to whom 7,721 applications of light were given (Bow, 161 children and 3,812 baths; Poplar, 188 children and 3,909 baths). Of the patients admitted, 87 made under 10 attendances—various reasons were given—some on account of home difficulties and unable to spare time to attend, others as the patients had improved so much to the satisfaction of the parent. All the children receiving treatment take Cod Liver Oil in some form, either in an emulsion or in tabloid form. A Light Centre has also been established by the Royal College of St. Katharine, and Poplar is now almost, if not quite, the best equipped Borough for the application of artificial sunlight. Observation Wards. Prints of the plans of the Observation Wards are included in this report. The Minister of Health has approved of a contract for the erection of these Wards at a cost of £12,128, and also an estimate of £1,000 for the furnishing and equipment. Approval has also been given for the acceptance of a tender of £135 for electrical installation. -7JUN27 I 99 The proposed staff for these Wards is as follows:—Matron, Sister, two charge nurses, two assistant nurses or probationers, cook, maid, porter and necessary cleaners. It is estimated that the annual cost of maintenance will be approximately £4,000. Building operations were well in hand at the end of the year, and it is expected that the Wards will be ready for occupation about July. A complete list of clinics in the Borough is given as an appendix, page 115. INFANT MORTALITY. There were 258 deaths of children under one year of age, the deathrate per 1,000 births for the past 19 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 (50) 67 1926 70 64 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. 100 The causes of death of infants under one year of age are shown in the Table on page 108. OPHTHALMIA NEONATORUM. Notifications of Ophthalmia Neonatorum. Forty-three cases of Ophthalmia Neonatorum were notified during the year:—39 notified by doctors only, 1 by midwife only, and 3 by both doctors and midwives. The total notifications received numbered 50. Year. Cases. Vision unimpaired . Vision impaired . Total ness. Deaths Notified. Treated. At home. In hospital. 1914 75 70 5 73 - - 2 1915 64 62 2 62 1 — 1 1916 60 60 — 60 - — — 1917 39 ** 37 1 36 1 — 1 1918 40 38 2 39 1 — — 1919 61 51 10 60 1 — — 1920 61 51 10 59 - — 2 1921 47 41 6 42 2 1 2 1922 36 33 3 34 1 — 1 1923 38 30 8 35 — — 3 1924 46 38 8 46 — — — 1925 44 39 5 42 — — 2 1926 43 35 8* 42 — - 1 Total 654 585 68 630 7 1 15 **1 born in Institution—not visited, no information available. *Including 3 which occurred in institutions The Public Health (Ophthalmia Neonatorum) Regulations, 1926, came into operation on 1st October, 1926. They revoke previous Regulations and require medical practitioners only to notify cases of ophthalmia neonatorum. Miss J. M. Cardozo, Chief Health Visitor, reported as follows:— Infant Consultations.—The total attendances at all Centres Public Health Department and at the Royal College of St. Katharine, 55,557, give an average attendance of over 1,000 per week, a large increase on previous years. The New Building in Simpsons Road has been fully appreciated. The Mothers look upon it as their own and enjoy the large waiting room, which is such a change after their overcrowded homes. 101 The Old Ford Clinic is very overcrowded, but when the Observation Wards in Wellington Road open, the rooms available for Clinics should relieve this. Christ Church.—In spite of the unsuitable quarters and deplorable conditions this Clinic has done very well and the greatest credit is due to all concerned that the average attendance is 50.8. Ante-Natal.—There is still great need for further development in thie Branch of the work. More mothers are being delivered in Institutions each year:— 1924 783 1925 916 1926 990 These Mothers attend the Ante-Natal Clinic belonging to the Institution. There were 13 Maternal Deaths and 10 of the Mothers did not attend an Ante-Natal Clinic or attend a Doctor, although in some cases they were advised to do so. Dental Clinic.—The number of Mothers and Children applying for dental treatment is now much too large to be dealt with promptly at Old Ford Clinic. This should be relieved when the Wellington Road Clinic is opened. Light Centre.-—The assistance of Health Visitors at the Centre is a great improvement as they know the children and are able to follow up the cases. Increase of Staff.—-By the appointment of an additional Health Visitor, the only unvisited area in the Borough is now visited and trained help is available at the Light Centre. Convalescent Treatment.—A larger number of Mothers and Children were sent away for Convalescent Treatment. Our thanks are due to the United Service Fund who gave us grants amounting to £24 11s. l0d. towards the expenses. Infantile Mortality.—The rate for the Borough is 70, as against 75 for 1925. 102 Zymotic Enteritis.—The visiting of these cases is most unsatisfactory owing to the uncertainty of the Notifications. 15 died before Notifications were received. There were 31 deaths prior and subsequent to the notification period. I wish to thank the Voluntary Workers who have attended so regularly. They have been of great assistance at the Clinics. The Christmas Parties were larger this year. 1,300 guests were entertained. Our thanks are again due to the Clinic Staff and many friends for their support. Stillbirths. Number of stillbirths 110 Delivered by Doctors 10 ,, by Midwives 44 ,, in Institutions 53 B.B.A 2 No information available 1 Premature births 21 First pregnancies 20 Mothers who had had previous stillbirths:— One. Two. Three. 11 3 1 Nursing. Ophth. Neon. Measles. Pneumonia. Cases. Visits. Cases. Visits. Cases. Visits. Under 5 5-10 Under 5 5-10 Under 5 5-10 Under 5 5-10 East London Nursing Society 7 114 6 - 67 - 4 5 54 73 St. John Divine 2 28 — — — - 15 4 232 59 St. Mildred's District Nurse 1 10 - — — — 1 — 18 - Totals 10 152 6 — 67 — 20 9 304 132 103 Attendances at Clinics. Bow. West Ferry Road. Christ Church. Simpsons Road. Royal College of St. Katharine. First attendances 600 116 243 336 1,374 Infant consultations 10,645 2,299 5,234 6,770 13,911 Average per session 70.4 45.0 50.8 65.0 60.0 Average attendances of each child 9.6 13.0 12.8 10.3 — Dental Clinic 751 — - - 1 053 Ante-natal Clinic 542 — - 198 801 Sewing Class — 398 — 526 212 Light Centre 3,812 — — 3909 3,469 Garden attendances — — - - 1,027 Total attendances at all Clinics:—Public Health Department, 35,084; Royal College of St. Katharine, 20,473. Total, 55,557. Money Taken. £ s. d. For Dried Milk (9,6631b.) 604 10 0 ,, Medical sundries 22 12 8 ,, Dentures 58 5 0 ,, Materials at Sewing Class 24 3 1 ,, Convalescent Treatment 6 13 6 ,, Virol 22 6 8 ,, Oil and Malt 113 17 4 ,, Concentrated Food 13 11 10 Total money taken £866 0 1 4,006 vouchers for cod liver oil, malt, etc., were issued. Free issue.—2,7371b. Dried Milk. Grants in Aid. Convalescent Treatment (mothers and babies) 20 cases. Children 44 (12 in conjunction with I.C.A.A.) Attendance of Midwife 20 cases. Loan of maternity bag 9 ,, 104 Zymotic Enteritis. Notifications received 317 Died before notification received 15 Not traced and duplicates 18 Visited 284 Under 1 year (see feeding below) 81 (14 deaths). 1 to 2 years 98 2 to 3 years 45 3 to 4 years 31 4 to 5 years 29 Feeding. Age period. Breast. Mixed feeding. Hand-fed. Not stated. Under 1 year 19 27 21 - Died — 6 8 Ophthalmia Neonatorum. Number of notifications received 43 Died in Institutions 1 Sight of one eye damaged — Recovered 42 Occurred in Institutions 3 Occurred in the practice of medical practitioners 5 Occurred in the practice of midwives 35 Admitted to hospital as in-patients 5 Treated as hospital out-patients 4 Treated privately 31 Visited by nurse 10 Vital Statistics, 1925. All births, including those occurring in outlying districts, but belonging to the Borough 4030 Attended by doctors 796 Attended by midwives 2218 Delivered in institutions 916 Not stated 100 Stillborn 95 Died before visit 86 105 Not requiring or desiring visits 358 Visited 3491 Removed and not traced 260 Died during visitation 174 Remaining under supervision end of first year 3057 Stillbirths per 1,000 births 23.5 Mortality per 1,000 births, died before visit 21.3 Mortality per 1,000 visited 49.8 The feeding of infants during the first six months of life was as follows:— 1. Those alive at end of completed year (December, 1926):— Breast-fed 78 Mixed feeding 18.5 Hand-fed 3.5 2. Those who died:— Breast-fed 44.8 Mixed feeding 28.7 Hand-fed 26.5 3. Comparison of rates of mortality between infants:— Breast-fed 3.1 Mixed feeding 8.1 Hand-fed 30.2 Year of Birth. 1921 1922 1923 1924 Remaining under supervision:— End of first year — — — 3067 ,, second — — 3207 - ,, third ,, — 3199 — - fourth ,, 3136 — — — 106 Year of Birth. 1921 1922 1923 1924 Found 6 51 61 64 Given up 1 5 2 5 Removed and not traced 1l1 135 147 165 Died 12 18 32 67 Remaining under supervision:— End of second year — — — 2894 ,, third — — 3087 — ,, fourth ,, — 3092 — — ,, fifth ,, 3018 — — — Mortality per 1,000 visited:— Second Year — — — 21.3(22.6) Third — —9.7(10.6) - Fourth — 5.5(6.0) - - Fifth 3.8(3.7) — — - The figures in parentheses are the rates for the previous years. 107 Statistical Summary for 1926. Public Health Department. The Royal College of St Katharine. Total. Ante-natal:— Visits 514 620 1,134 Re-Visits 622 1335 1,957 Post-natal:— Visits 1,707 1,791 3,498 Removed before Visit 32 29 61 Died before Visit 17 42 59 Stillbirths 58 42 100 Re-visits:— Under 1 6,955 13,983 20,938 1—5 15,531 26,842 42,373 Removed 306 542 848 Died 100 128 228 Ophthalmia Neonatorum:—* Visits 43 nil. 43 Re-visits 165 nil. 165 Zymotic Enteritis:— Visits 122 162 284 Re-visits 112 116 228 Dead 19 10 29 Measles:— Visits 205 362 567 Re-visits 64 130 194 Dead 2 11 13 Whooping Cough— Visits 53 209 262 Re-visists — 89 89 Dead — 3 3 Puerperal Fever 27 — 27 Miscellaneous 22 720 742 Total Visits Paid 26,676 47,166 73,842 * 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. 108 The Borough. Infantile Mortality during the Fear 1926. Nett Deaths from stated Causes in Weeks and Months under One Year of Age. Causes of Death Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Nett total Deaths under 1 year. Poplar. Bow and Bromley Whole Borough All causes Certified 61 13 6 9 89 56 37 45 30 145 112 257 Uncertified - — — — 1 — — — — 1 — 1 Smallpox - - - - - - - - - - - - Chickenpox - - - - - - - - - - - - Measles - - - - - - - 6 8 9 5 14 Scarlet Fever - - - - - - - - - - - - Whooping Cough - — — - — 2 — 2 — 1 3 4 Diphtheria and Croup - — - - - - - - - - - - Erysipelas - - — - — — — 1 — 1 — 1 Tuberculous Meningitis - - - - - - - 1 1 4 — 4 Abdominal Tuberculosis - - - - - - - - - - - - Other Tuberculous Diseases - - - - - 1 - - 1 1 1 2 Meningitis (not Tuberculous) - - - - - - 1 1 - 1 1 2 Convulsions 1 — — - 1 1 — — — 1 1 2 Laryngitis - — — - — — — — — — — — Bronchitis - 1 — 3 4 6 4 6 3 9 14 23 Pneumonia (all forms) 1 2 — 1 4 13 6 4 8 21 14 35 Diarrhoea - — 1 — 1 4 4 2 1 6 6 12 Enteritis - — — 1 1 10 11 16 5 23 20 43 Gastritis - - - - - 1 - - - 1 — 1 Syphilis - — 1 — 1 1 — — — 1 1 2 Rickets - - - - - - - - - - - - Suffocation, overlying 1 — — — 1 — — — — 1 — 1 Injury at birth - 1 — — 1 — — — — 1 - 1 Atelectasis 7 — — — 7 — — — — 4 3 7 Congenital Malformations 4 2 - - 6 2 1 - 1 6 4 10 Premature birth 36 5 4 2 47 6 2 — — 33 22 55 Atrophy, Debility and Marasmus 2 1 - 1 4 6 3 3 1 8 9 17 Other Causes 10 1 — 1 12 3 3 3 1 14 8 22 Total Deaths 62 13 6 9 90 56 37 45 30 146 112 258 Nett Births Legitimate 3,576 in the year Illegitimate 82 Nett Deaths Legitimate infants 245 in the year Illegitimate infants 13 109 ROYAL COLLEGE OF ST. KATHARINE, POPLAR. Report of the Medical Officer. March, 1927. Dr. A. G. Hamilton, who has had charge of the Light Clinic since it started in April, 1925, has recently summarised his impressions of the first year's work.* At the outset he emphasises the difficulty in assessing the exact, value of this form of therapeutics, for with the exception of Rickets controlled by serial X-ray photographs, there is no easy standard means of measuring or recording effects. Allowance must be made for "the enthusiasm engendered by a new and appealing form of treatment" and "the natural tendency to recovery in early life must not be forgotten.'' His report deals in detail with 116 children, between the ages of three months and five years of age, and four mothers. They are divided into eight groups:— 1. Pre-rachitic and bottle-fed (prophylaxis) 17 case* 2. Rachitic 54 ,, 3. Catarrhal 11 ,, 4. Under-developed; malnutrition; debility 20 ,, 5. Marasmus 4 ,, 6. Skin diseases 8 ,, 7. Miscellaneous 2 ,, 8. Mothers 4 ,, This is an arbitrary grouping, but it will be seen at once that it includes the majority of the common and important ailments affecting children dealt with by Welfare organisations. It is pointed out that the accurate diagnosis of early Rickets without X-Rays is a task of some difficulty, and Dr. Hamilton states the combination of pallor, head-sweating, muscular weakness, and enlargement of the abdomen, forms a syndrome which should always arouse suspicion. If in addition there can be noted one of the stigmata (frontal-bossing, beading of the ribs, joint laxity, etc.) then the disease must be taken as definitely established. 5 much improved. Tn the Pre-rachitic group he gives 11 improved. 1 no change. *"Light Treatment at an Infant Welfare Centre." A. G. Hamilton, M.D., M.B., Ch.B., F.R.C.S. Edin. Public Health. Feb. 1927. 110 17 much improved. In the Rachitic group 32 improved. 5 no change. The first and most striking change in these children was an increase in muscular strength and activity. In early Rickets head sweating ceases after a few treatments. This is the clinical sign most easy to record. To questions whether they noticed any change in the children produced by the treatment, the mothers made various statements. 43 stated the children were "more lively" or words to that effect. "Better appetite," 11. "Better tempered," 9. "Brighter," 6. "Fewer colds," 3. The question of "colds" leads, in the report, to a discussion on the close association between Rickets and the liability to contract catarrhal infections. The author finds the Rachitic and Catarrhal groups overlap a good deal. His conclusion that clinically ultra-violet radiation does not benefit rachitic infants, who suffer from unhealthy tonsils and adenoids, is disappointing. At best, progress is slow. One obvious reason is that repeated catarrhs interfere with systematic attendance for treatment. Better results are obtained if light is used after the tonsils and adenoids have been removed, but the exact value to be attributed to the operation and to the light must be difficult to assess. In the Catarrhal group (without Rickets) a number was noted to be suffering from the same handicap, and some had to submit to surgical removal. There are no figures to prove the catarrhs were lessened by light treatment. The improvement, when noted, was in the child's general condition. 3 much improved. 7 improved. 1 no change. In the fourth and fifth groups interesting and encouraging results are recorded. 1ll Contrary to some observers Dr. Hamilton records he has witnessed no striking increase in the rate of gain in weight, resulting from exposure to light. This is probably because accurate records of weight for months before and after treatment were available in the great majority of his patients. It is known, of course, that Rickets commonly occurs in infants who are rapidly putting on weight, and he mentions specially the type that has recently passed through a marasmic phase, and is receiving a diet rich in carbohydrates. This rate of gain is not accentuated by ultraviolet radiation, nor is it desirable that it should be. Many show marked amyotonia, and the earliest and most constant result is an improvement in muscle power and activity. "It is not surprising that this is accompanied by a diminished rate of gain, or even a fall in weight." He notes that an increase in physical energy and mental alertness often coincide. It is suggested that for general exposures of young children, the carbon arc has certain advantages over the Mercury Vapour lamp. Further, while the report shows that ultra-violet radiation has a field of great usefulness in work of this kind during the Winter months in a city, its author admits candidly that he obtained better results in the Summer, by exposing children to direct sunlight out of doors. He pictures the artificial sunlight room of the future as a "large, well ventilated, well warmed room, Hooded with light from multiple sources, where the children can play in safety, with nothing but their eyes shielded from the rays. The present method of short exposures, with children sitting or lying inert, has its obvious disadvantages." HAROLD WALLER, Medical Officer. REPORT OF DENTAL SURGEON. To The Medical Officer of Health, The Borough of Poplar. Sir, I have the honour to submit my Annual Report of the work carried out at the Old Ford Maternity and Child Welfare Dental Clinic for the year 1926. 112 Our figures, as below, compare very favourably with those for 1925, in some cases showing an increase. 49 Sessions held. 242 New Patients. 751 Attendances. 120 Fillings. 1,658 Teeth extracted (temporary and permanent). 146 Scalings. Other treatment, such as Dressings, Artificial Dentures, etc., of which I have not the accurate figures, has been carried out. The popularity of the Dental Clinic seems to have increased, and there is a big waiting list of patients. There is hardly time, working one session per week, to get through the work, as is shown by the waiting list. A considerable number of patients insist on having gas for extractions where a local anaesthetic would be suitable. These tend to choke the gas sessions, sometimes causing urgent gas cases to be held over. I am of the opinion that a small charge for gas would have a good effect in these cases, as mentioned in my last report. The number of children requiring treatment is very marked, and seems to increase. As they are so young, it is seldom possible to do anything but extractions, and in the majority of cases, the teeth are so badly decayed that no other line of treatment is thinkable. This condition may be due to errors of diet, but I think the primary cause is the pre-natal condition of the mother. It is manifest that an increasing number of mothers is realising the advantages of a sound mouth and teeth, both for themselves and their children. Our equipment continues to give entire satisfaction, and is in excellent repair. The premises, on the other hand, are not good. This will be remedied, of course, when our rooms in the new building are ready, and I venture to think we shall have a Dental Clinic then which will be second to none in every respect. May I conclude by thanking all those with whom I come in contact for their very valuable assistance in the efficient running of the Clinic. I have the honour to be, Sir, Your obedient servant, C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. 113 FREE MILK SCHEME. 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. Since 1st January, 1926, all milk supplied to mothers and children except where Clinic Medical Officers have prescribed dried milk, has been Grade "A" (Tuberculin Tested) milk. The Minister of Health has only approved of the expenditure of £6,500 in respect of this service, which sum includes administration. In September I reported to the Maternity and Child Welfare Committee that of 43 samples of Grade "A" (T.T.) milk bacteriologically examined. since January 1st, 15 had given unsatisfactory results and one was suspicious or doubtful. The 15 unsatisfactory samples each contained bacillus coli and the bacteria counts in many instances were far and away in excess of the limit of 200,000 laid down by the Milk (Special Designations) Order. A resolution by the Maternity and Child Welfare Committee that notice, be given to all dairymen that after 31st December, 1926, Grade A (Tuberculin Tested) milk would not be required under the Free Milk Scheme was referred back by the Council and at a subsequent meeting the Maternity and Child Welfare Committee resolved that the supply ot Grade "'A" (Tuberculin Tested) milk be continued and that the position be reconsidered in April, 1927. In the early part of the year. Mr. C. A. Webster, who since 1921, had been the Enquiry and Investigation Officer, Free Milk Scheme, was permanently appointed by the Public Health and Housing Committee and Maternity and Child Welfare Committees as Meat and Food Inspectors' Labourer and Enquiry and Investigation Officer, Free Milk Scheme. During the 12 months ended 2nd January, 1927, 12,928 applications for free milk were received, of which 11,905 were granted. Orders for 426,762 pints of fresh, and 2,9171b. of dried milk were issued, the total commitments amounting to approximately £7,249. Personal inquiry was made in 593 cases by the Inquiry and Investigation Officer. Six cases were reported to the Maternity and Child Welfare 114 Committee as unsatisfactory. In 3 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 child's age was understated; 1 case milk not cancelled on death of child; and 1 case milk received after wife and children had gone hopping. In four cases the Committee sent letters of caution, and in the two others repayment of value of milk supplied was accepted. During the year 15s. was repaid on account of milk supplied upon incorrect information, making a total sum of about £309 repaid to the end of December, 1926. The following table shows in comparative form the applications, etc., during the years 1920-26:— Year. Applications. Applications granted. Cost (approx) £ Orders issued. Cases investigated by 1.0. (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 14,080 6,600 512,614 3,230 2,974 34 1924 1 4,828 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 1926 12,928 11,905 7,249 426,762 2,917 593 6 Notes.—(a) In 1920, 49 tins of condensed milk were also issued; (b) the Enquiry' and Investigation Officer commenced duty in March, 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. By arrangement with the local Dairymen's Association the price of milk to the Council has been 7½ per cent, below the ruling retail price. The retail prices per pint during the year were:— 1st January, 4½d.; 1st April, 4d.; 5th September, 4½d. 115 MATERNITY AND CHILD WELFARE CLINICS. Situation. Nature of Accommodation. Clinics . (Infant Consultations unless otherwise stated.) (a) Provided by the Borough Council— Simpson's Road, Poplar Medical Officer's, Weighing and Waiting Rooms (Weighing room also used for Artificial Sunlight Treatment Wednesdays, 10.30 to 12.30 and 2—4 p.n.. Ante-natal First Monday in each month, 2—4 p.m. Sewing class Mondays, 2— 4 p.m. Artificial Light Treatment, Tuesdays and Thursdays, 9.30—12.30 and 2.30—4 30. Saturdays, 9.30—12.30. Wesleyan Mission, Old Ford Road Ditto and Dental Clinic (Weighing and Waiting Room combined). 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. Sewing Class, Mondays, 2—4 p.m. Avenue Road, Bow Artificial Sunlight Clinic and Waiting Room Light treatment, Mondays, Wednesdays and Fridays, 9.30 to 12.30 and 2.30 to 4.30. (b) Provided by the Royal College of St. Katharine— 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. Thursdays and Fridays, 2 p.m. Sewing Class Wednesdays, 2 p.m. Dental Clinics—Mondays, 1.30 and 3 p.m. Antenatal Tuesdays. 10a.m. Light Treatment Mondays to Fridays, 9.30 to 12.30 and 2 to 4.30 p.m . Tonsil Clinic twice monthly . The Light house M ission . Blackt horn St. Medical Officer's Room and Large Hall for weighing and waiting Wednesdays, 2 p.m. Trinity Hall, Augusta Street Ditto Ditto Ditto Wednesdays, 2 p.m. 116 INDEX. Page Age Mortality 7 Analyst's Report 77 Anthrax 24 Antitoxin, quantity issued 23 Area and Population 6 Artificial Sunlight Treatment 96-98 Bacteriological Examinations 23 Bakehouses 76 Births 6 Canal Boats 61 Cerebro-spinal Meningitis 25 Cleansing of Verminous Persons, etc. 33 Clinics, M. & C.W. 115 Clinic, Proposed 94 Committees Continued and Typhus Fevers 25 Customs and Inland Revenue Acts, Certificates 62 Death Rate amongst Infants Visited 99 Deaths and Death Rates 6,7 Deaths, Classified Causes, Table 13, 14 ,, Infantile, Table ix Dentist's Reports 43,111 Diarrhœa and Enteritis, Deaths 7 Diphtheria 23 Disinfectant, Electrolytic 27 Disinfecting Department 27 Electrolytic Disinfecting Fluid 27 32 Encephalitis Lethargica 25 Enteric Fever 23 Erysipelas 24 Export of Meat Foods 76 Fish Poisoning, Outbreak 26 Food and Drugs Acts, etc 82-88 Food Inspectors' Reports 70-72 Free Milk Scheme 113 Gastro-Enteritis, Outbreak 26 Glanders 24 Hairdressers' Premises 63 Health Visitor, Chief, Report of Houses Let in Lodgings Housing Acts 50-52 Hydrophobia 24 Ice Cream 75 Infantile Mortality 99 Infectious Diseases, Table of Notifications 20 Inquests and Deaths from Violence 10 Lady Sanitary Inspector, Report 52 Legal Proceedings, etc. 66 Marriages 6 Maternity and Child Welfare 94 Measles 26 Meat Food Products, Certification 76 117 INDEX-(continued) PAGE Milk (Special Designations) Order, 1923 75 Milks hops, etc. 73 Mortuary 10 Notification of Births Act 6 Notifications of Infections Diseases, Table 20 Observation Wards 98 Ophthalmia Neonatorum 100, 104 Outbreaks of Gastro enteritis and Fish poisoning 26 Overcrowding 63 Plague 24 Poliomyelitis, etc. Poor Law Relief, etc. 64 Population 6 Puerperal Fever and Puerperal Pyrexia 24 Hag and Bone Dealer, Byelaws 61 Hag Flock Act 63 Rats and Mice Destruction Act 63 Reports:— Chief Health Visitor 100 Dental Surgeon (M. & C.W.) 111 Dental Surgeon (Tuberculosis) 43 Public Analyst 77 Senior Medical Officer, Royal College of St. Katharine 109 Tuberculosis Officer 34 Sanitary Inspectors' Work, Summary 48,49,53 Scarlet Fever 23 Schools, Inspection of 63 Shelter 32 Simpsons Road Clinic, Plans, etc facing 115 Schools, Use of Electrolytic Fluid in 32 Slaughterer of Poultry, Byelaws 73 Slaughterhouses, Byelaws 76 Smallpox 24 Smoke Nuisances 61 "Spotted Fever" 25 Staff vi Swimming Baths, Use of Electrolytic Fluid in 32 Tables A to F (Workshops, etc.) 54-60 Tables of Deaths 11-17,108 ,, Infectious Diseases 20 Tuberculosis Officer's Report 34-41 ,, Regulations, Notifications, etc. 44 4(5 Typhoid Fever 23 Unhealthy Areas 52 Urinals on Licensed Premises 62 Vaccination 24 Verminous Children and Persons 32,33 Verminous Rooms 61 Vital Statistics, Summary viii ,, ,, Tables 12-14, 17 Water Certificates 62 Workshops, Workplaces, etc. (Tables) 54-60 Zymotic Diseases, Notifications, etc. 20 Zymotic Enteritis 104