pop 33 Metropolitan Borough of Poplar. Annual Report FOR THE YEAR 1927 ON The Sanitary Condition and Vital Statistics of the Metropolitan Borough of Poplar, comprising the Registration Sub-districts of POPLAR and BOW and BROMLEY. W. ALLAN YOUNG, Medical Officer of Health. 3 PUBLIC HEALTH AND HOUSING COMMITTEE. Alderman T. J. Goodway, J.P., Mayor (ex-officio). Councillor J. A. Ashley (Chairman). Councillor G. J. Cressall, J. P. (Vice-Chairman). Councillor J. A. Ashley ,, T. J. Blacketer, L.C.C. ,, Mrs. N. F. Cressall. ,, G. J. Cressall, J. P. ,, A. E. Easteal. ,, B. Fleming. ,, Mrs. A. L. Harris. Councillor J. H. Jones. Alderman Mrs. J. A. March. Councillor G. A. Newton. ,, R. Palfreman. ,, W. T. Sell. ,, Mrs. E. Stavers. ,, C. A. Tanner. MATERNITY AND CHILD WELFARE COMMITTEE. Alderman T. J. Goodway, J.P., Mayor (ex-officio). Councillor Mrs. E. Stavers (Chairman). Alderman Mrs. J. A. March (Vice-Chairman). Councillor T. J. Blacketer, L.C.C. „ G. J. Cressall, J. P. „ Mrs. N. F. Cressall. „ Mrs. A. L. Harris. „ Mrs. E. M. Lambert. „ Mrs. J. Mackay. Alderman Mrs. J. A. March. Councillor Mrs. E. Mudge. ,, A. R. Sargent. ,, Mrs. E. Stavers. Co-opted Members: Miss E. Herbert. Mrs. M. Power. 4 Public Health Office, Bow Road, E.3. 19th July, 1928. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar. Mr. Mayor, Ladies and Gentlemen, I beg to submit my first Annual Report upon the Vital Statistics and Sanitary Condition of the Borough. The publication of this report has been delayed owing to the amount of extra work which has devolved upon the department as a result of the flooding caused by the overflowing of the Thames, early in January, and an outbreak of Smallpox which occurred in March, April, May and June of this year. A full report of the flooding will be included in the next annual report; meanwhile, the following facts may be of interest:— (i) Number of houses flooded 1,141 (ii) Number of houses from which damaged household goods were removed 93 (iii) Number of houses disinfected 1,131 (iv) No outbreak of infectious disease followed as a result of the flooding. In preparing this report, whilst following the arrangement prescribed by the Ministry of Health in Circular No. 834, I have endeavoured to retain some of the features of the reports which have been presented to you in former years. Population.—The Registrar-General's estimate of the population is the lowest since 1923, being 2,000 less than his estimate for 1926. This adversely affects the death rate for 1927 when compared with the corresponding rates for the years 1924-1926. Births.—The corrected births were fewer than those of preceding years and the birth rate per 1,000 of the population, 19.8, is the lowest recorded in the Borough. 5 Deaths.—The death rate, 11.8, is below the average for the preceding five years (12.2). Infantile Mortality.—The infantile mortality rate is the second lowest recorded, despite the fact that the number of births (upon which the rate is calculated) is the smallest recorded, with the exception of that for the year 1918. Infectious Disease.—Notifications of infectious disease were fewer in 1927 than in 1926. The outstanding feature is the reduction in the number of cases of Zymotic Enteritis, mainly accounted for by the unusually large number notified in 1926, as a result of the outbreak of Gastro-enteritis reported in that year. In October, a report upon the Schick Test and the method of immunising susceptibles against Diphtheria was submitted to the Public Health and Housing Committee. On its acceptance by the Council the Minister of Health sanctioned the scheme, but the first clinic was not held until 5th June, 1928. A copy of the report, as submitted, is printed as an appendix. Smallpox.—One case of Smallpox occurred in the Borough during the year. tuberculosis.—The report of the Tuberculosis Officer is quoted in extenso. The number of new cases coming to the knowledge of the department shows a slight decrease. Five tuberculosis patients who died were not notified (2.6 per cent. of total deaths from tuberculosis) and seven other cases were notified only after death. Maternity and Child Welfare.—This section of the work oontinues to increase, the attendances at the ordinary infant consultations as well as at the special clinics being higher than those of the year 1926. During the year, the new Maternity and Child Welfare Centre, in Wellington Road, was opened. In this building are the Observation 6 Wards with cote for 12 babies suffering from disorders of digestion, etc., the artificial sunlight clinic for the northern portion of the Borough and the Dental Clinic. Approval was obtained during the year for the transfer of the Christchurch Clinic, where accommodation was very poor, to other premises, and the removal was effected in the early part of 1928. These changes afford better accommodation for mothers and greatly facilitate the work of the staff. In the latter part of the year, it was reported to the Maternity and Child Welfare Committee that on account of the increasing number of clinics it was impossible for the existing staff of Health Visitors to devote sufficient time to "home visiting," which still remains a most important part of their work. The Committee therefore recommended the Council to make representations to the Minister of Health for the appointment of two additional Health Visitors. In February, of this year, approval to appoint one additional Health Visitor was received from the Minister of Health. Proposed Maternity Beds.—The negotiations with the Poplar Board of Guardians, for the provision in St. Andrew's Hospital of lying-in accommodation for expectant mothers who are not in receipt of relief and who are willing to contribute towards the cost according to their means, which were commenced in 1926, continued during the year. At the same time arose the question of extending the Council's ante natal work to include the cases which were being dealt with by the Guardians in connection with their Maternity Wards, at 86, High Street, Poplar. Both of these questions were discussed at a joint meeting of members of the Maternity and Child Welfare Committee and representatives of the Poplar Board of Guardians; and later the Town Clerk, the Medical Officer of Health, the Medical Superintendent of St. Andrew's Hospital, and the Deputy Clerk to the Guardians had a conference and discussed the details. Extracts from a report upon the proposed lying-in accommodation, including a suggested agreement to be entered into with the Guardians, which I submitted to the Maternity and Child Welfare Committee in November, is given in appendix "B." This report was adopted by the Council and submitted to the Minister of Health and the Board of Guardians. .7 In the early part of 1928, a letter was received from the Minister of Health, giving general approval for one year to the scheme submitted, subject to certain modifications in the agreement. It is hoped that an agreement will soon be entered into between the Borough Council and the Board of Guardians, and that the Maternity Wards will be opened before the end of 1928. Free Milk Scheme.—The Council, at their meeting in May, considered a report of the Maternity and Child Welfare Committee and agreed that on and after 30th September, 1927, the general distribution of Grade "A" (Tuberculin Tested) Milk be discontinued and in its place reputable brands of dried milk be supplied, but that Grade "A" (Tuberculin Tested) Milk be supplied in special cases (infants) where the Medical Officers in charge of the Council's Child Welfare Clinics considered its use specially advisable. Health Education.—Appreciating the importance of disseminating information relating to health and disease, and in order to inculcate the desire for self-help in everyday matters affecting the health of the individual as well as that of the community, the question of organising lectures on general public health subjects was discussed with the Public Health and Housing Committee. Owing, however, to other important matters claiming prior attention, this question of health education was deferred for consideration until the present year and will be referred to fully in the next annual report. Nevertheless, it may be mentioned here that a series of lectures has been arranged for the coming winter. Staff.—On May 26th, 1927, the Council resolved that in the absence of the Medical Officer of Health, the Tuberculosis Officer, Dr. W. C. P. Smith be authorised to act as Medical Officer of Health for the Borough. During the year, the following changes have taken place in the personnel of the department:— Mr. W. D. Quested (Chief Disinfector) retired in July, after 43 years' service. He was succeeded by Mr. W. Hodge. Mr. H. C. Rodford, a member of the clerical staff, retired on 31st Deoember, on account of ill-health, after 27 years' service, and was succeeded by Mr. D. Evans. Mr. D. Flynn was appointed office boy, in September. 8 Sickness.—In January, 1928, a report was submitted to the Public Health and Housing Committee to the effect that the Houses-letin-Lodgings Inspector had not done more than six weeks' work on houses-let-in-lodgings, because his time had been devoted practically entirely to district work, owing to sickness of one or other of the District Inspectors, or because of holiday duty. The sickness rate among the Inspectorial staff in 1927 was abnormally high, no less than 318 working days being lost on that account; that is equivalent to the absence of one Inspector for rather more than a year. It was found necessary to transfer the Houses-letin-Lodgings Inspector to district work, resulting in a reduction of routine work generally. As a result of the report, the Council asked the Minister of Health to sanction the appointment of an additional Sanitary Inspector. The sanction was granted. Housing.-—The shortage of housing accommodation in the Borough still remains a very serious problem. Practically all the houses in the Borough are occupied by members of more than one family, and a very large number by members of more than two families. As the houses were originally built to accommodate one family, the sanitary arrangements, water supply, facilities for cleansing and washing and cooking are inadequate to meet the needs of three families. Under such conditions it is not surprising to find that the standard of cleanliness in many houses is low. As time goes on the overcrowding becomes worse and the proper separation of the sexes is a problem which at present many families find it almost impossible to solve. The average income of the majority of the overcrowded families is small, rendering it impossible for them to pay economic rents for the accommodation which they require, or to live at any great distance from their work. It would appear that, for the present at any rate, large modern tenements five or six stories high with ample open space at front and back and erected on suitable Sites in the Borough, are required if the families who cannot afford to move out to the London County Council estates are to be accommodated. Whatever type of dwelling is provided I cannot see how the present position can be met unless it is realised 9 that for some time to come it will be impossible to let many houses at anything approaching an economic rent. I must record here my appreciation of the support and consideration which I have received from the members of the Public Health and Housing Committee, the Maternity and Child Welfare Committee, and the Council as a whole. Further, I am indebted to the Chief Officers of other departments for their help and co-operation. In conclusion, I wish to thank the members of the staff of the Public Health Department for the whole-hearted support which I have received during the past year. I am, Ladies and Gentlemen, Your obedient Servant, W. ALLAN YOUNG, Medical Officer of Health. 10 Section I. NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. Area of Borough (excluding water) 2,136 acres Population (Census, 1921) 162,618 Population, estimated to middle of 1927 167,000 Number of Inhabited Houses (Census, 1921) 23,064 Number of families or separate occupiers (Census, 1921) 37,288 Rateable Value (April, 1927) £996,400 Sum represented by a Penny Rate (April, 1927) £3,840 Social Conditions, including the chief occupations of the inhabitants, and the influence of any particular occupation on public health. Poplar is an industrial district with a number of large factories and several docks. There are also many wharves along the river which bounds the Borough on the south. The Census of 1921 shows the largest proportion of the inhabitants are employed in various forms of transport, nearly one-twelfth of the total population being transport workers, or more than one-fourth of the males in employment at the time of the Census. Among other occupations are metal workers, woodworkers and furniture makers, builders and bricklayers, etc., makers of food, confectionery, matches and tobacco. The Borough is densely populated (78 persons per acre). SUMMARY OF VITAL STATISTICS. Total M. F. Births Legitimate 3,245 1,683 1,562 Birth Rate 19.8 Illegitimate 64 35 29 Totals 3,309 1,718 1,591 11  Total M. F. Deaths 1,978 1,056 922 Death Rate 11.8 Number of women dying in, or in consequence of childbirth from sepsis 2 from other causes 7 Infantile Mortality rate 66. (Legitimate, 63. Illegitimate, 187.) Deaths from Measles (all ages) 8 „ Whooping Cough (all ages)34 ,, Diarrhoea (under 2 years of age) 37 VITAL STATISTICS. 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 167,000. This estimated population is 2,000 less than the figure supplied by him for the year 1926 and, to a slight extent, adversely affects the death rates which are calculated upon the reduced estimate. The population of 167,000 gives a density figure of 78 persons per acre. BIRTHS. Early in the year 1928, the Registrar-General supplied the following information relating to the year under review:— Registered Inward Transfers. Outward Transfers. Nett. Total Births Males 1,505 235 22 1,718 3,309 Females 1,396 218 23 1,591 Illegitimate Males 31 5 1 35 64 Females 28 5 4 2 12 The corrected birth-rate per 1,000 population was 19.8, as against 26.6, 25.6, 22.9, 22.7 and 21.6 for the years 1922-1926. During the year, 3,008 notifications were received under the Notification of Births Act, 1907. MARRIAGES. During the year, the marriages of 2,916 persons were registered, giving a rate of 17.5, as against 15.0, 16.1, 15.3, 16.2 and 15.8 in the five years, 1922-1926. DEATHS. 1,918 deaths were registered as having occurred in the Borough. 258 deaths of non-residents must be deducted, and 318 deaths of Poplar residents which occurred outside the Borough must be added, giving a nett total of 1,978 and a rate of 11.8 per 1,000 of the estimated population. The natural increase of population represented by excess of births over deaths was 1,331. 13 Deaths during 1927 in the Metropolitan Borough of Poplar, classified according to certain localities. (Old Table.) 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 163 71 84 106 424 Bow and Bromley Sub-District 118 65 62 85 330 St. Andrew's Hospital 254 143 150 157 704 Poplar Institution 51 28 22 36 137 Bow Institution 47 34 37 35 153 Bromley House Institution — — 1 1 2 Poplar Hospital 26 26 24 26 102 Adelaide Buildings — — 1 — 1 Baffin „ — — — — — Council „ — — — — — Grosvenor „ 5 — 1 4 10 Hanbury „ — — — — — Hudson „ — — — — — Melbourne „ — — — — — Montreal „ — — — 1 1 Ontario „ Ottawa „ — — — — — Prestage „ 1 1 1 — 3 Quebec „ — — — — — Sydney „ — — 1 — 1 Toronto „ — — — — — Wellington „ — — — — — Winnipeg „ — — 1 — 1 River Thames 1 4 5 3 13 „ Lee — 1 2 — 3 Limehouse Cut — 1 — 1 2 Bow Creek 1 — — — 1 Regents Canal — — 1 — 1 East India Docks — — 1 — 1 West India Docks — — — — South-West India Docks — — 1 1 2 Millwall Docks — — 2 1 3 L.M.S. Ry. Station 1 — — — 1 Casual Wards — — — 1 1 Highways 3 2 12 2 19 Victoria Park — — — 1 1 L.C.C. Tramway Depot 1 — — — 1 672 376 409 461 1918 Deaths occurring outside the Borough of persons belonging thereto (add) 93 74 64 87 318 Deaths occurring within the Borough of persons not belonging thereto (deduct) 71 57 69 61 258 Deaths at all ages—nett 694 393 404 487 1978 14 TABLE I. Vital Statistics during 1927 and Previous Years. (Old Table.) 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 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 3412 3831 22.9 2122 12.7 442 343 277 72 2023 12.1 1925 168,500 3387 3831 22.7 1973 11.7 311 308 288 75 1970 11.7 1926 169,000 3274 3658 21.6 1879 11.1 238 288 258 70 1929 11.4 1927 167,000 2901 3309 19.8 1918 11.5 258 318 218 66 1978 11.8 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 (6) 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; (6) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known; and (d) failing this, to the district where the body was found. Area of District in acres (land and inland water) 2327.7 Total population at all ages 162,6181 Number of inhabited houses 23,064 Average number of persons per house 7.05 At Census of 1921 . Total families or separate occupiers 37,288 TABLE II. The Borough. Causes of. and Ages at, Death during the Year 1927. 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. Total under 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 15 All causes Certified 1977 1977 218 65 33 18 23 357 25 22 38 163 133 535 704 1052 925 130 702 5 .. 32 24 318 1211 Uncertified 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 1 1 1 Enteric Fever .. M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Smallpox .. M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Measles 8 M 6 .. 4 .. 1 1 6 .. .. .. .. .. .. .. 7 1 .. 1 .. .. .. .. 5 6 F 2 1 1 .. .. .. 2 .. .. .. .. .. .. .. 4 Scarlet Fever 3 M 2 .. .. .. .. .. .. 1 .. .. 1 .. .. .. 1 2 .. .. .. .. .. .. 3 3 F 1 .. .. 1 .. .. 1 .. .. .. .. .. .. .. 5 Whooping Cough 34 M 16 .. 5 2 .. 1 14 2 .. .. .. .. .. .. 17 17 .. 4 .. .. .. .. 17 21 F 18 .. 9 5 .. .. 17 1 .. .. .. .. .. .. 9 Diphtheria 17 M 12 .. 4 .. 1 2 7 3 2 .. .. .. .. .. 12 5 .. 2 .. .. .. .. 14 16 F 5 .. .. 1 .. 1 2 1 .. .. .. 1 1 .. 7 Influenza 36 M 16 .. .. .. 1 .. 2 1 .. .. 4 3 2 4 20 16 .. 7 .. .. .. .. 4 12 F 20 .. 2 1 .. .. 3 .. .. 1 .. .. 5 11 8 Encephalitis lethargica 4 M 2 .. .. .. .. .. .. .. .. 1 1 .. .. .. 2 2 .. .. .. .. .. .. 3 3 F 2 .. .. .. .. .. .. .. .. 1 1 .. .. .. 9 Meningococcal Meningitis 3 M 2 .. .. l .. .. 2 .. .. .. .. .. .. .. 2 1 .. .. .. .. .. .. 2 2 F 1 .. 1 .. .. .. 1 .. .. .. .. .. .. .. 10 Tuberculosis of respiratory system 162 M 94 .. 1 .. .. .. 1 .. 1 5 31 21 29 6 85 77 .. 70 .. .. .. .. 29 99 F 68 .. .. .. .. .. .. .. .. 8 36 12 10 2 11 Other Tuberculous Diseases 28 M 19 4 2 1 2 4 13 .. 3 .. 2 .. .. 1 15 13 .. 8 .. .. .. .. 17 25 F 9 1 3 .. 2 .. 6 1 .. .. 1 .. .. 1 12 Cancer, Malignant disease 240 M 120 .. .. .. .. .. .. .. .. .. 2 3 61 54 129 111 11 104 .. .. .. .. 23 138 F 120 .. .. .. .. .. .. .. .. 1 2 11 53 53 13 Rheumatic Fever 10 M 6 .. .. .. .. .. .. .. .. 2 1 .. 2 1 3 7 .. 5 .. .. .. .. .. 5 F 4 .. .. .. .. .. .. .. .. .. 2 .. 1 1 14 Diabetes 14 M 6 .. .. .. .. .. .. .. .. .. .. .. 3 3 8 6 .. 6 .. .. .. .. 1 7 F 8 .. .. .. .. .. .. .. .. .. .. .. 7 1 15 Cerebral haemorrhage, etc. 74 M 31 .. .. .. .. .. .. .. .. .. 1 1 11 18 33 41 2 30 .. .. .. .. 2 34 F 43 .. .. .. .. .. .. .. .. .. .. 1 19 23 16 Heart Disease 350 M 163 .. .. .. .. .. .. 2 1 1 11 8 50 90 175 175 42 130 2 .. 2 1 (a) 26 203 F 187 .. .. .. .. .. .. 1 4 5 7 10 46 114 17 Arterio-sclerosis 99 M 53 .. .. .. .. .. .. .. .. .. .. 1 8 44 68 31 28 28 1 .. .. .. 9 66 F 46 .. .. .. .. .. .. .. .. .. .. .. 9 37 18 Bronchitis 144 M 82 1 1 3 .. .. 1 15 .. .. .. 1 4 22 40 80 64 10 53 .. .. 1 .. 5 69 F 62 6 2 l .. 1 10 .. .. .. .. 1 15 36 19 Pneumonia (all forms) 188 M 103 37 8 6 5 3 59 .. .. 2 4 5 23 10 108 80 4 72 .. .. 8 1 (b) 19 104 F 85 12 10 9 5 2 98 1 1 2 6 5 18 14 20 Other Respiratory Diseases 9 m 7 .. .. .. .. .. .. .. .. 1 2 .. 3 1 7 2 2 5 .. .. .. .. .. 7 F 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 21 Ulcer of Stomach or Duodenum 17 M 12 .. .. .. .. .. .. .. .. .. .. 4 5 3 8 9 2 7 .. .. 1 .. 6 16 F 5 .. .. .. .. .. .. .. .. .. .. 1 3 1 22 Diarrhœa, etc. 39 M 16 15 1 .. .. .. 16 .. .. .. .. .. .. .. 19 20 .. 24 .. .. 2 .. 7 33 F 23 19 2 .. .. .. 21 .. .. .. 1 1 .. .. 23 Appendicitis and Typhlitis 15 M 9 .. .. 1 .. .. 1 1 1 .. 1 .. 5 .. 8 7 .. 5 .. .. 2 .. 8 15 F 6 .. .. .. .. .. .. .. .. .. 3 .. .. 3 24 Cirrhosis of Liver 14 M 8 .. .. .. .. .. .. .. .. .. 1 1 5 1 6 8 .. 4 .. .. .. .. 4 8 F 6 .. .. .. .. .. .. .. .. .. .. 1 3 2 25 Acute and Chronic Nephritis 65 M 36 .. .. .. .. .. .. 1 1 2 3 13 13 33 32 .. 29 1 .. .. 1 (e) 8 39 F 29 .. .. .. .. .. .. .. .. 2 3 l 12 11 26 Puerperal Sepsis 2 M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 .. .. .. .. 1 2 F 2 .. .. .. .. .. .. .. .. .. 2 .. .. .. 27 Other accidents and diseases of 7 M .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 3 1 2 .. .. .. .. .. 8 F 7 .. .. .. .. .. .. .. .. .. 3 4 .. .. 28 Congenital Debility and formation, premature birth 78 M 48 48 .. .. .. .. 48 .. .. .. .. .. .. .. 34 44 8 13 .. .. .. .. 16 37 F 30 30 .. .. .. .. 30 .. .. .. .. .. .. .. 29 Suicide 13 M 9 .. .. .. .. .. .. .. .. .. .. 2 5 2 8 5 .. 1 .. .. 2 1 (d) 1 5 F 4 .. .. .. .. .. .. .. .. .. 2 1 1 .. 30 Other Deaths from Violence 87 M 61 1 2 2 1 1 7 4 3 2 12 11 14 8 49 38 .. 27 .. .. 9 16 (e) 25 77 F 26 2 1 1 .. 1 5 1 .. .. .. 1 10 9 31 Other Defined Diseases 216 M 116 12 2 .. .. 1 14 1 4 2 11 10 34 39 112 104 18 64 1 .. 5 3 (f) 64 155 F 100 7 2 1 .. 4 14 3 1 .. 5 27 45 32 Causes ill-defined or unknown 2 m 1 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. 2 1 .. .. .. .. 1 (g) .. 2 F 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Deaths from All Causes M 1056 137 32 13 11 14 207 16 16 18 89 77 295 338 F 022 81 33 20 7 9 150 9 6 20 74 56 240 367 Totals 1978 .. 1978 218 65 33 18 23 357 25 22 38 163 133 535 705 1053 025 130 702 5 32 24 319 1212 (a) Highway, 1. (b) East India Docks, 1. (c) Highway, 1. (d) Limehouse Cut, 1. (e) Highways, 3; River Thames, 6; Millwall Docks, 2: South-West India Docks, 2: River Lee, 2: and Limehouse Cut, 1. (f) Highways, 2: River Thames, 1. (g) In railway carriage, L.M.S. Rly., 1. The following table, compiled and furnished by the Registrar-General, is inserted at the request of the Ministry of Health (vide Circular 834 (England) ). Causes of Death. Sex. All Ages 0— 1 — 2— 5— 15— 25— 45— 65— 75— All Causes M 1054 137 32 38 31 42 143 294 194 143 F 922 81 33 36 17 50 100 239 164 202 1 Enteric fever M — — — — — — — — — — F — — — — — — — — — — 2 Smallpox M — — — — — — — — — — F — — — — — — — — — — 3 Measles M 6 — 4 2 — — — — — — F 3 2 1 — — — — — — — 4 Scarlet fever M 1 — — — 1 — — — — — F 1 — — 1 — — — — — — 5 Whooping cough M 15 6 5 3 1 — — — — — F 18 2 9 5 2 — — — — — 6 Diphtheria M 12 — 4 3 5 — — — — — F 5 — — 2 1 — 1 1 — — 7 Influenza M 15 1 — 1 1 1 6 1 2 2 F 20 — 2 1 — 1 — 5 5 6 8 Encephalitis gica M 2 — — — — 1 1 — — — F 2 — — — — 2 — — — — 9 Meningococcal meningitis M 2 1 — 1 — — — — — — F 1 — 1 — — — — — — — 10 Tuberculosis of respiratory system M 94 — 1 — 1 15 42 30 4 1 F 68 1 — — — 24 32 9 1 1 11 Other tuberculous diseases M 18 4 2 6 3 1 — 1 1 — F 9 — 3 2 1 — 1 1 — 1 12 Cancer, malignant disease M 121 — — — — 1 5 61 42 12 F 121 — — — — 1 13 54 37 16 13 Rheumatic fever M 3 — — — — 2 — 1 — — F 1 — — — — 1 — — — — 14 Diabetes M 6 — — — — — — 3 3 — F 8 — — — — — — 7 1 — 15 Cerebral haemorrhage, etc. M 32 — — — — 1 1 10 12 8 F 48 — — — — — 1 21 19 7 16 Heart disease M 161 — — — 3 3 16 42 52 45 F 181 — — — 5 8 15 45 39 69 17 Arterio-sclerosis M 55 — — — — — 2 11 14 28 F 50 — — — — — — 10 13 27 18 Bronchitis M 77 9 2 1 — — 5 26 18 16 F 54 4 1 2 — — 1 14 12 20 19 Pneumonia (all forms) M 108 39 9 13 — 5 9 25 7 1 F 94 16 12 15 2 4 11 18 9 7 20 Other respiratory diseases M 10 1 — — — — 1 5 2 1 F 6 — — — — — — 2 2 2 21 Ulcer of stomach or duodenum M 14 — — — — — 5 4 4 1 F 5 — — — — — 1 3 — 1 22 Diarrhœa, etc. M 16 14 1 — — — — 1 — — F 21 18 2 — — 1 — — — — 23 Appendicitis and typhlitis M 9 — — 1 2 — 1 5 — — F 7 — — — — — 3 1 1 2 24 Cirrhosis of liver M 9 — — — — — 2 6 1 — F 6 — — — — — 1 3 1 1 25 Acute and chronic nephritis M 30 — — — 1 3 5 10 8 3 F 25 — — — — 4 1 12 6 2 26 Puerperal sepsis M — — — — — — — — — — F 2 — — — — — 2 — — — 27 Other accidents and diseases of pregnancy & parturition M — — — — — — — — — — F 7 — — — — 1 6 — — — 28 Congenital debility and malformation, premature birth M 49 49 — — — — — — — — F 32 31 — 1 — — — — — — 29 Suicide M 9 — — — — — 2 5 1 1 F 4 — — — — 1 2 1 — — 30 Other deaths from violence M 56 1 2 4 7 4 19 13 3 3 F 24 2 1 1 — — 1 10 4 5 31 Other defined diseases M 123 11 2 3 6 5 21 34 20 21 F 98 5 1 6 6 2 8 22 13 35 32 Causes ill-defined or unknown M 1 1 — — — — — — — — F 1 — — — — — — — 1 — Legit. Illegit. Deaths under 1 year M 129 8 F. 76 5 Totals 205 13 15 TABLE III. Infantile Mortality during the Year 1927. 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 57 11 13 5 86 36 44 29 23 101 117 218 Uneertified — — — — — — — — — — — — Small pox — — — — — — — — — — — — Chickenpox — — — — — — — — — — — — Measles — — — — — — — — 1 1 — 1 Scarlet Fever — — — — — — — — — — — — Whooping Cough — — — — — 1 4 2 2 3 6 9 Diphtheria and Croup — — — — — — — — — — — — Erysipelas — — — — — — — — 1 1 — 1 Tuberculous Meningitis — — — — — — — 1 3 3 1 4 Abdominal losis — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — 1 — 1 1 Meningitis (not Tuberculous) — — — — — — 1 1 — — — 2 Convulsions — — 2 — 2 1 1 — — — 4 4 Laryngitis — — — — — — — — — — — — Bronchitis — — — 1 1 5 4 5 2 10 7 17 Pneumonia (all forms) — 1 2 1 4 11 15 9 10 24 25 49 Diarrhœa — — — — — 2 11 5 1 7 12 19 Enteritis 1 — — — 1 7 6 1 — 8 7 15 Gastritis — — — — — — — 1 — 1 — 1 Syphilis — — 1 — 1 1 — — — — 2 2 Rickets — — — — — — — — — — — — Suffocation, overlying — — — — — 1 — — — 1 — 1 Injury at birth — 1 — — 1 — — — — — 1 1 Atelectasis 1 — — — 1 — — — — 1 — 1 Congenital Malformations 4 5 3 1 13 1 1 1 1 6 11 17 Premature birth 43 4 2 1 50 3 — — — 22 31 53 Atrophy, Debility and Marasmus 1 — 2 1 4 3 1 — — 6 9 8 Other Causes 7 — 1 — 8 — — 3 1 5 7 12 Total Deaths 57 11 13 5 86 36 44 29 23 101 117 218 Nett Births in the year Legitimate 3,245* Illegitimate 64* Nett Deaths in the year Legitimate 205* Illegitimate 13* *Registrar-General's figures. 16 INFANT MORTALITY. There were 218 deaths of children under one year of age, the deathrate per 1,000 births for the past 20 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 (39) 64 1927 66 59 Note.—The figures in brackets are the mortality rates amongst infante visited by the Health Visitors. These rates are calculated upon births occurring in any particular year, and deaths in that and the following year. 17 TABLE IV. Birth-rate, Death-rate, and Analysis of Mortality During the Year 1927. Bibthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population . Rate per 1,000 Births. Percentage or Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhœa and Enteritis (under 2 years). Total Deaths under One Year. Causes of Death Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.m. No Inquest. Uncertified Causes of Death. England and Wales† 16.7 12.3 0.01 0.00 0.09 0.01 0.09 0.07 0.57 0.51 6.3 69 91.7 6.6 0.7* 1.0 107 County Boroughs and Great Towns, including London† 17.1 12.2 0.01 0.00 0.12 0.01 0.10 0.08 0.49 0.46 8.3 71 91.9 6.6 0.9* 0.6 155 Smaller Towns (adjusted Populations 20,000-50,000)† 16.4 11.3 0.01 0.00 0.07 0.01 0.08 0.05 0.58 0.41 5.0 68 92.7 6.8 0.3* 1.2 London 16.1 11.9 0.01 0.00 0.04 0.01 0.12 0.09 0.39 0.51 7.5 59 90.3 7.9 1.8* 0.0 Poplar Borough 19.8 11.8 — — 0.05 0.02 0.21 0.10 0.21 0.59 11.2 66 88.7 10.7 0.5* 0.1 † Provisional figures The rates have been calculated on a population estimated to the middle of 1926. The mortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London, the groups of towns and Poplar. * These percentages relate to 8 months of the year only (1st May to 31st December). 18 TABLE V. (1927). 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 fants under one year to 1,000 births. *LONDON 4,541,000 16.1 — 11.9 59 West Districts. Paddington 142,700 15.5 0.5 13.5 79 Kensington 176,700 15.0 0.36 13.8 66 Hammersmith 132,800 15.6 0.3 13.0 61 Fulham 161,900 15.1 0.2 11.3 66 Chelsea 63,690 13.4 0.4 14.1 76 City of Westminster 136,500 10.0 0.5 12.3 68.6 North Districts. St. Marylebone 103,500 13.2 0.4 11.3 59 Hampstead 86,160 11.9 0.2 12.2 51 St. Pancras 213,200 15.5 0.4 12.3 62 Islington 334,300 18.3 0.38 12.3 53 Stoke Newington 52,130 14.0 0.27 12.2 66 Hackney 224,700 15.7 0.46 11.6 64 Central Districts. Holborn 42,209 11.96 0.14 12.5 38 Finsbury 75,500 19.2 0.5 13.4 50 City of London 13,010 8.7 0.23 11.5 105 East Districts. Shoreditch 105,700 20.6 0.7 12.6 74 Bethnal Green 117,900 19.9 0.6 11.3 57.7 Stepney 251,580 18.1 0.5 11.6 68 Poplar 167,000 19. 8 0. 6 11.8 66 South Districts. South wark 184,250 19.0 0.8 13.4 61 Bermondsey 121,000 18.5 0.37 12.9 67 Lambeth 307,700 16.2 0.39 12.4 50.5 Battersea 169,000 16.6 0.3 12.2 53.5 Wandsworth 342,700 13.53 0.25 11.3 51 Camberwell 271,100 15.6 — 11.4 52 Deptford 113,800 16.8 0.3 11.5 58 Greenwich 101,920 16.2 0.3 10.8 53 Lewisham 188,600 15.1 0.15 11.0 46 Woolwich 140,770 15.9 0.2 10.6 42 *The provisional figures relating to London were supplied by the RegistrarGeneral. Other figures supplied by Medical Officers of Health. 19 (These summaries are inserted for comparison with those shown in previous reports.) 1922. 1923. 1924. 1925. 1926. 1927. Deaths from all causes, rate per 1,000 population 14.3 11.3 12.1 11.7 11.4 11.8 Deaths under 1 year of age, rate per 1,000 nett births 79 60 72 75 70 66 Deaths over 65 years of age, rate per 1,000 total population 8.1 3.6 3.9 4.1 3.9 4.2 *Zymotic diseases:— Death rate per 1,000 population 1.5 0.6 0.8 0.9 0.9 0.6 Proportion of 1,000 deaths 110.9 58.5 65.7 75.6 75.2 51.6 Tuberculosis, all forms:— Death rate per 1,000 population 1.3 1.2 1.2 1.1 1.0 1.1 Proportion of 1,000 deaths 94.4 103.7 97.9 96.9 84.0 96.0 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 3.6 2.4 3.2 2.9 2.4 2.0 Proportion of 1,000 deaths 254.6 212 7 265.4 246.2 207.9 172.4 Deaths from Various Diseases. Disease. 1922. 1923. 1924. 1925. 1926. 1927. Measles 62 22 37 27 39 8 Whooping-Cough 88 7 39 60 9 34 Influenza 86 22 48 20 23 36 Pneumonia, all forms 260 163 230 185 154 188 Diarrhoea and Enteritis (all ages) 28 41 30 54 69 39 *Smallpox, Measles, Scarlet Fever, Whooping-Cough, Diphtheria and Mem. Croup, Typhoid Fever and Diarrhœal Diseases. 20 Deaths from Tuberculosis. It will be seen on reference to Table II. that the deaths from Tuberculosis were 162, from tuberculosis of the respiratory system (lungs, larynx and throat) and 28 to other forms of tuberculosis. (lungs, larynx and throat) and 28 to other forms of tuberculosis. The following table gives the classification of these latter, according to organ or part affected (vide International Manual of Causes of Death). Heading in International Manual. Part affected. Number of Deaths. 32 Central Nervous System 19 33 Intestines and peritoneum 2 34 Vertebral column — 35 Joints 1 36 Other organs:— (a) Skin and subcutaneous tissues — (b) Bones (vertebral column excepted) .. — (c) Lymphatic glands (abdominal glands excepted) (d) Genito-urinary system 2 (e) Other sites — 37 Disseminated tuberculosis:— (a) Acute 2 (b) Chronic or unstated 2 28 21 TABLE VI. 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 137 704 153 1 102 1097 Uncertified — — — — — — 1. Enteric Fever — — — — — — 2. Smallpox — — — — — — 3. Measles — 1 — — — 1 4. Scarlet Fever — — — — — — 6. Whooping Cough — 4 — — — 4 6. Diphtheria — 2 — — — 2 7. Influenza 1 8 — — 1 10 8. Encephalitis Lethargica — — 1 — — 1 9. Meningococcal Meningitis — — — — — — 10. Tuberculosis of respiratory system — 70 — — — 70 11. Other Tuberculous Diseases — 8 1 — — 9 12. Cancer, malignant disease 11 103 7 — 4 125 13. Rheumatic Fever 1 5 — — — 6 14. Diabetes — 6 — — — 6 15. Cerebral hemorrhage, etc. 3 30 2 — 1 36 16. Heart Disease 44 133 88 — 4 269 17. Arterio-sclerosis 29 29 16 1 3 78 18. Bronchitis 10 53 — — 1 64 19. Pneumonia (all forms) 4 72 3 — 10 89 20. Other Respiratory Diseases 2 4 1 — 7 21. Ulcer of Stomach or Duodenum 2 8 — — . 4 14 22. Diarrhœa, etc. — 24 — — 7 31 23. Appendicitis and Typhlitis — 5 — — 6 11 24. Cirrhosis of Liver — 4 2 — 1 7 25. Acute and Chronic Nephritis 1 28 16 3 48 26, Puerperal Sepsis — 1 — — — 1 27. Other accidents and diseases of pregnancy and parturition 1 2 — — — 3 28. Congenital Debility and malformation, premature birth 8 13 — — — 21 29. Suicide — 1 — — 3 4 30. Other Deaths from Violence — 29 4 — 39 72 31. Other Defined Diseases 19 61 12 — 15 107 32. Causes ill-defined or unknown 1 — — — — 1 All Causes Males 81 396 121 1 68 667 Females 56 308 32 — 34 430 totals 137 704 153 1 102 1097 22 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." 1927. 28th Jan. Poplar Hospital, of Copenhagen. Male, 38. Fell down ship's hold. Fractured spine. P.M. Accident. Inquest. 26th Mar. In railway carriage, L.M.8. Railway Station, South Bromley. Male, newly-born (unknown). Unascertained on account of advanced decomposition. P.M. Natural cause. Inquest. 5th Mar. River Thames, of Sweden. Male, 25. Jumped into river to save a girl. Asphyxia due to drowning. P.M. Inquest. 26th April. River Thames. Male, 65. (unknown). Found drowned. Open verdict. Inquest. 28th May. Poplar Pavilion, East India Dock Road. Male, 5 days. (unknown). Asphyxia in circumstances unknown. P.M. Open verdict. Inquest. 6th July. River Lee. Male, 45. (unknown). Found drowned. P.M. Inquest. 20th July. River Thames. Female, 1 day. (unknown). Want of attention at birth. P.M. Open verdict. Inquest. 14th Aug. River Thames. Male, 30. (unknown). Found drowned. P.M. Open verdict. Inquest. 11th Oct. River Thames. Female, 45. (unknown). Found drowned. P.M. Open verdict. Inquest. INQUESTS AND DEATHS FROM VIOLENCE. The number of inquests registered was 246. From this total must be deducted 72 of non-residents, and 37 added of residents who died outside the Borough, the nett total being 211. Analysis of the 100 deaths classified to Suicide and other deaths from Violence (International Short List headings Nos. 29 and 30):— 23 Suicide 13 Food poisoning — Poisoning by venomous animals — Other acute accidental poisonings (not by gas) 1 Conflagration — Accidental burns (conflagrations excepted) 7 Accidental mechanical suffocation 3 Accidental absorption of irrespirable or poisonous gas 1 Accidental drowning 9 Accidental injury: By firearms — By cutting or piercing instruments — By fall 27 In mining and quarrying — By machinery — By other forms of crushing: Road vehicles 19 Railways 2 Other crushing accidents 2 Injury by animals (poisoning by venomous animals excepted) — Wounds of war 2 Execution of civilians by belligerent armies — Hunger or thirst — Excessive cold — Excessive heat — Lightning — Electricity (lightning excepted) 1 Homicide: By firearms — By cutting or piercing instruments — By other means 3 Infanticide — Fracture (cause not specified) 1 Other and unstated forms of accidental violence 3 Violent deaths of unstated nature (i.e., accidental, suicidal, etc.) and cause 6 100 For death rates from violence, and the percentage of inquest cases to total deaths, see Table IV. 24 MORTUARY. The number of bodies deposited in the Mortuary, Cottage Street, Poplar, during the year was 255. Residents. Non-Residents.* No age stated 1 — Stillborn 3 — Under 1 year 14 1 1 to 5 years 19 — 5 to 15 years 14 — 15 to 25 years 18 — 25 to 65 years 114 2 65 years and upwards 69 — Totals 252 3 *Brought from outside the Borough for the convenience of the Coroner. Inquests were held on 248, and 7 post-mortems were made by order of the Coroner. The total post-mortems made was 115. Section II. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Hospitals Provided or Subsidised by the Local Authority or by the London County Council:— Fever and Smallpox. Hospitals for patients suffering from these diseases are provided by the Metropolitan Asylums Board. Tuberculosis. Residential Institutional Treatment for tuberculous patients is provided by the London County Council. 25 Maternity. Nil. (See reference to the provision of maternity beds in St. Andrew's Hospital in Appendix B.) Children. At the Observation Wards two five-cot wards and an isolation ward are provided for children suffering from malnutrition, etc. (See report of Consulting Physician, page 125.) Other Hospitals. There are no hospitals in the Borough provided or subsidised by the Council. There is one General Hospital, Poplar Hospital, supported voluntarily, and St. Andrew's Hospital (maintained by the Board of Guardians). Other Institutions in the Borough are:— Poplar Institution (Poplar Union); Bow Institution (City of London Union); Bromley House Institution (Stepney Union); all of which are maintained by Boards of Guardians. Institution for unmarried mothers, etc. There is one such Institution in the Borough but it is not in any way connected officially with the Council. Ambulance facilities. (a) For infectious cases: This service is provided by the Metropolitan Asylums Board. (b) For non-infectious and accident cases: The ambulance service of the Metropolitan Asylums Board is available for non-infectious cases. The ambulance service of the London County Council deals with accident cases, and also is available for removal of parturient women to hospital in cases of emergency. 26 The Board of Guardians provide an ambulance for removal of the sick poor. Clinics and Treatment Centres. A full list of the Maternity and Child Welfare Clinics in the Borough is given in the Maternity and Child Welfare Section of this report. There are several school treatment centres in the Borough maintained by the London County Council. Venereal Diseases. There is no treatment centre in the Borough. Posters published by the London County Council giving addresses of the nearest clinics are displayed in the public urinals throughout the Borough. These posters also state that a complete list of Hospitals where treatment is available can be had on application at the office of the Public Health Department. General Remarks. There are a number of general hospitals within easy reach of the Borough. Patients from the northern part of the Borough attend the Queen's Hospital, Hackney Road (Children), or the London Hospital which is attended also by inhabitants of other parts of the Borough. For patients living in the southern portion of the Borough the Miller Hospital, Greenwich, is not far distant. Among other hospitals which serve the locality are the Dreadnought Hospital, Greenwich (for Seamen), the East London Hospital for Children, Shadwell, and the City of London Chest Hospital, Victoria Park. POOR LAW RELIEF, ETC. Mr. G. Butler, Clerk to the Guardians, has kindly supplied the following information:— Outdoor Relief. Medical Relief Only. No. of persons. Cost. No. of persons. 1927 1,360,902 £581,671 6s. 1d. 2,072. 27 The figures for the total number of persons are arrived at by adding together the total numbers relieved each week for the 52 weeks. ''Medical Relief only" implies that no relief other than the services of a District Medical Officer was given to these persons. With regard to the cases in receipt of medical treatment at St. Andrew's Hospital during the period ended 31st December, 1927, the total days' maintenance for the year amounted to 188,865, giving an average daily number of 517. Sick cases are also treated in the Poplar Institution in the Sick Wards, and maternity cases in the All Saints Maternity Annexe. The average daily numbers for the year ended 31st December, 1927, are as follows:— Sick Wards, Poplar Institution 178 Maternity Wards, All Saints Annexe 41 The number of entries in the District Medical Officers' registers of cases for medical treatment for the year ended 31st December, 1927, are as follows:— Poplar Districts. Dr. H. J. O'Brien 1,704 Dr. C. F. White 1,737 Dr. M. J. Byrne 2,337 Dr. W. C. Millea 1,684 Dr. M. J. Hallissey 3,610 Bow Districts. Dr. G. Haddick 4,964 Dr. J. Hirschmann 1,376 Dr. D. G. MacRae 3,103 Dr. C. Phelps 3,068 28 STAFF. Medical Officer of Health: W. ALLAN YOUNG, D.S.O., M.D. (Edin.), D.P.H. (Camb.) 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 Public Analyst: ALBERT E. PARKES, F.I.C., F.C.S. GENERAL PUBLIC HEALTH SECTION, PUBLIC HEALTH OFFICE. Chief Clerk and Administrative Assistant: HAROLD DYER.† Sanitary Inspectors: (a) H. A. Tibbatts.* (a) Wm. Johnson.*‡ (b) C. A. Grabham.*‡ (a) J. Johnson.*§ (a) A. J. Field.† (b) H. A. pearce.*†§‡ (a) C. H. Brown.*†‡§ (a) F. A. Smith.*‡ (a) H. J. Langley.* Miss M. E. Davies.*†‡ (c) S. Kelly* (a) District Inspectors. (b) Food Inspectors. (c) Inspector for Houses divided into separate tenements. A. Barrows, J. Chapman, A. Collyer, C. F. Gregory, G. A. Hale, F. E. Quested (unqualified Assistants to assist the District Inspectors). C. A. Webster (part-time unqualified Assistant to assist the Food Inspectors). H. Harbott (Chauffeur). Clerks: F. J. White.* H. C. Rodford. H. A. Purdy. W. F. Roberts. Miss S. Fells. Miss E. Hamilton. A. Hamilton‡‡. S. Duggin (Office Boy). D. Flynn (Office Boy). To September. From September. Caretaker and Messenger: J. J. Jaokson. *Cert. S.I.E. Board. † Cert R.S.I. †† Cert. R.S.I. & S.I.E.J.B. † Cert. Meat and Food Inspector. § R.P.C. ¶C.M.B. ׀‌‌׀ ‌ H.V. Cert. (Board of Education). 29 TUBERCULOSIS SECTION. Tuberculosis Officer: Dr. W. C. P. Smith. Asst. Tuberculosis Officer: Dr. C. K. Cullen. Dental Surgeon (part-time): Mr. C. Hammond Williams. Health Visitors: Miss H. Messem. Miss D. Wood.‡ Miss N. Roberts.** Dispenser: Mrs .A.M. Smith . Clerks: Miss A. D. Frost. Miss A. Rogers. Secretary to Care Committee: Miss L. Nugent. Nurse-Helper: Caretaker: Mrs. E. Tomlins (temporary). J. Tyler. DISINFECTING STATION, YEO STREET. Disinfectors: W. D. Quested (Chief) Resigned. W. Hodge (Chief) from 22nd June, 1927. D. Boyce. There are also two Apparatus Attendants and one Motor Driver. Manufacture and Distribution of Electrolytic Disinfecting Fluid. Manufacturing: C. Hagon and T. Kelleher. Distributing at Depots: C. Shaw, W. Hagon and D. Hogan. Lorry Driver: F. Farrow. Shelter and Cleansing Station. Attendants: Mrs. A. Howe and Mrs. A. Stollery. MORTUARY. Mortuary Keeper and Caretaker of Coroner's Court: J. Brown. Asst. Mortuary Keeper: D. Hogan (part-time). 30 MATERNITY AND CHILD WELFARE SECTION. (Part-time Medical and Dental Staff). Clinic Medical Officers: Mrs. H. M. Gordon Clark, M.D., Ch.B. (Glasgow). *Miss E. Marian Layman, M.B., B.S. (London). Miss Gladys Ward, M.D., Ch.B., D.P.H. (Edin.). *Also Medical Officer-in-charge Artificial Light Treatment. Dental Surgeon: C. Hammond Williams, L.D.S., R.C.S. (Eng.). Anaesthetist: S. Hutchinson, M.R.C.S. (Eng.), L.R.C.P. (Lond.). Chief Health Visitor: Miss J. M. Cardozo.*¶†† Health Visitors: Miss E. A. Foskett.*¶ Mrs. M. J. Edgell.§¶ Miss M. Mallett.* Mrs. E. K. Haythornthwaite.*¶ Miss G. E. paice.*†† Miss A. Eaton*¶ Sister-in-Charge Artificial Light Treatment. (a) Miss D.A.E. LANDRAY.*¶† (a)Miss E. A. H. Williams*¶† Clerk: Miss G. Hood. Observation Wards. Wellington Road, Bow, E.3. (Opened 11th November, 1927.) Consulting Physician: H. St. H. Vertue, M.A., M.D., Ch.B. (Oxford.) Emergency Medical Officer: D.G. Macrae, M.R.C.S. (Eng.), L.R.C.P. (Lond.). Matron-in-Charge: Miss A. C. Andrews. Sister: Miss M. Morgans. Two Staff Nurses, two Probationers, one Cook, one Maid and a Porter. Free Milk Scheme. Temporary Clerks: Miss I. Collen. Miss K. Phelan (from 29th May). Investigation and Enquiry Officer (part-time): C. A. Webster. *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. 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. 31 Professional Nursing in the Home—General and for Certain Infectious Diseases.—Agreements with local nursing associations are in operation, the fees payable being at the rate of 1s. 3d. per visit. For number of cases visited and total visits paid, see Table in the Maternity and Child Welfare Section of this Report. Chemical Work.—The Public Analyst's laboratory is situate at 139, St. Leonard's Road, Poplar. The Report of the Public Analyst will be found on page 69. ADOPTIVE ACTS, BYE-LAWS AND REGULATIONS RELATING TO PUBLIC HEALTH IN FORCE IN THE DISTRICT. Bye-laws made by Poplar Borough Council. Public Health (London) Act, 1891. Section. Date of Adoption. 16 (1) Prevention of nuisances arising from matter thrown in any street; offensive matter running into an uncovered place; keeping of animals; paving of yards and open spaces 20th Oct., 1893. 39 (2) Keeping water closets supplied with sufficient water 20th Oct., 1893. 50 Securing cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water 20th Oct., 1893. Regulations made by Poplar Borough Council. 88 Management of Mortuaries 15th Sept., 1910. Factory and Workshop Act and Public Health (London) Act. — Underground Bakehouses 12th Mar., 1903. Housing Act, 1925. 18 Underground rooms habitually used as sleeping places 1st April, 1927. 32 Bye-laws made by the London County Council. Public Health (London) Act, 1891 Section. Date of Adoption. 16 (2) Closing of cesspools and privies; removal and disposal of refuse 28th June, 1893. 16 (2) Removal of faecal and offensive matter 26th Nov., 1901. 39 (1) Construction of closets, privies, ashpits, cesspools and dung receptacles 28th June, 1893. 14th June, 1901. 3rd Jan., 1905. 19 Bone boiler, manure manufacturer or tallow melter 25th Nov., 1907. 19 Gut scraper and catgut maker or catgut manufacturer 25th Nov., 1907. 19 Fat melter or fat extractor 25th Nov., 1907. 19 Fellmonger 25th Nov., 1907. 19 Dresser of fish skins 25th Nov., 1907. 19 Dresser of fur skins 22nd Mar., 1922. 19 Glue and size manufacturer 25th Nov., 1907. 19 Knacker 25th Nov., 1907. 19 Slaughterer of Poultry 22nd Dec., 1923. 19 Soap boiler 25th Nov., 1907. 19 Tripe boiler 25th Nov., 1907. 19 Slaughterhouses (conduct of business) 27th April, 1923 and 21st July, 1925. 33 London County Council (General Powers) Act, 1908. Section. Date of Adoption. 9 Rag and bone dealer 18th Sept., 1923. 9 Fish curer 28th Feb., 1914. 9 Vendor of fried fish 28th Feb., 1914. London County Council (General Powers) Act, 1903. 54 Conveyance of carcases of dead horses through 21st Feb., 1905. public streets Metropolis Management Act, 1855. 202 Drains, regulating dimensions of, keeping, 14th June, 1901. cleansing and repairing of 9th Nov., 1923. Metropolis Management Act, 1855 (Section 202), and Metropolis Acts (Amendment Bye-laws) Act, 1899. Plans to be deposited.—Construction, 20th Aug., 1903, reconstruction, or alteration of pipes, and drains, traps and other apparatus 4th Aug., 1911. Slaughterhouse, etc. (Metropolis) Act, 1874, and the Local Government Act, 1888. Slaughterer of cattle 27th Oct., 1891. Regulations made by the London County Council. Public Health Act, 1891, and Housing Act, 1925-26. Houses-let-in-Lodgings or occupied by mem-5th Mar., 1926. bers of more than one family Section 55 of the Public Health (London) 1st June to 30th Act, 1891, has been applied to Zymotic Sept. Enteritis 34 Section III. SANITARY CIRCUMSTANCES OF THE BOROUGH. Scavenging.—The collection of refuse and cleansing of streets, etc., are carried out by the Works Department. I am indebted to Mr. Harley Heckford, M.Inst.C.E., the Borough Engineer and Surveyor, for the following particulars:— House Refuse.—Collected twice weekly by the pail system, the pails being placed on the kerb by the householder. Two-thirds of the house refuse is incinerated at the Council's Refuse Destructor, when it is tipped into tubs and hoisted by cranes and shot into the furnaces, all handling of the refuse itself being thus avoided. The other third is barged from a riverside wharf. Trade Refuse.—This is collected only when specially requested, and its method of disposal depends entirely on its composition, it being sent to the Destructor or Barge as circumstances warrant. Street Cleansing.—The system for street cleansing includes hand sweeping by gangs, orderly men, horse-drawn machine broom and motor sweepers. The main and other important roads are swept daily and nightly; other roads mostly three times weekly. The sweepings and/or slop are picked up and put into Barge at the above wharf, or sent by rail by contractors to a shoot. Street Watering.—This service embraces the use of modern up-to-date motor water vans, supplemented by horse-drawn water vans. The extent of the watering depends almost entirely on weather conditions. Summary for the Year 1927. House refuse collected 30,294 tons. Trade refuse collected 219 ,, Slop and sweepings 11,749 „ Refuse from street markets 2,510 ,, SANITARY INSPECTORS' WORK, Etc. Tabulated Statement of Inspections, Insanitary Conditions found existing, and Re-inspectious during the year 1927. East Combined West Combined Poplar South Bromley North Bromley Central Bow East Bow West Totals 1927 Totals 1926. Total Inspections: 1251 1598 1301 1308 1200 972 1064 8694 8496 On complaints of nuisances, etc. 405 682 562 653 356 452 608 3718 4217 On notification of infectious diseases 409 548 331 448 446 131 273 2586 2083 House-to-House 107 150 58 50 111 148 29 653 418 Workshops, workplaces, etc. 206 91 130 74 149 58 89 797 537 Miscellaneous 124 127 220 83 138 183 65 940 513 Premises found in fair condition 610 691 649 570 415 275 351 3561 3474 Do. requiring amendment 641 907 652 738 785 697 713 5133 5007 Details of Insanitary Conditions, etc. Walls and ceilings dirty 355 328 454 323 322 250 387 2419 2748 Yards, forecourts and areas insufficiently paved or drained 170 79 61 52 108 79 89 638 640 Inlets to drains not properly trapped — 7 — — — — 7 6 Number of drains tested 273 167 410 173 220 276 425 1944 1983 Do. do. defective 57 96 62 51 16 30 74 386 465 Do. do. obstructed 62 84 73 104 52 55 26 456 526 Sink waste pipes not trapped or otherwise defective 67 36 33 — 98 19 63 316 372 Do. do. directly connected to drains — 7 — — — 2 1 10 15 Soil pans of w.c.'s without suitable water supply 60 35 59 51 48 3 21 277 309 Do. do. broken or unsuitable 48 27 14 12 17 15 10 143 165 Do. do. in foul condition 40 14 22 3 8 49 9 145 119 Do. do. untrapped 2 1 — — 2 — 1 6 10 Roofs, guttering, and rainwater pipes defective 284 367 391 300 310 211 258 2121 2450 Water supplies to premises cut off (notified by Metropolitan Water Board 2 2 5 1 4 14 9 Water service fittings defective, causing waste of water 51 25 24 21 11 19 13 164 188 Drinking water improperly stored — — — — — 1 — 1 5 Dampness 265 91 131 40 1ll 135 70 843 752 Inundations — 22 — 12 9 — — 43 97 Overcrowding 8 — — 8 8 1 1 26 19 No proper receptacle for house refuse 76 57 62 55 73 22 58 403 378 Accumulations of dung or refuse 31 29 19 43 9 15 7 153 87 Insanitary P.H. urinals 2 1 2 6 9 — 4 24 35 Other nuisances, dilapidations, want of ventilation, etc. 389 455 938 324 260 646 199 3211 3439 Breaches of London County Council's By-laws 113 43 — 7 7 94 4 268 195 Breaches of Council's By-laws 154 9 132 9 129 81 29 543 429 Intimations served 614 916 650 738 699 657 692 4966 4865 Notices served 200 337 109 350 265 225 293 1779 2375 Final Notices served 55 66 8 67 53 43 34 326 456 Summonses applied for 3 10 — 6 1 — 6 26 30 Passengers from Continental Ports:— Visited 10 2 — — — — 12 5 Undiscovered 2 — — — — — — 2 1 Intimations served in respect of verminous rooms 27 19 46 48 48 18 7 213 353 Verminous rooms cleansed 54 19 26 48 42 9 2 200 236 Re-inspections 3294 2952 2900 2528 2815 2745 2696 19930 18189 35 Work of Lady Sanitary Inspector. Tabulated statement of Inspections of Insanitary Conditions found existing, and of Reinspections, etc., during the year 1927. Poplar Bow and Bromley. Totals. Workshops, Workplaces, Laundries, &c., Number of, on the Register 55 71 126 Workshops. Number of Workrooms therein 69 126 195 ,, Number of Inspections of 87 137 124 ,, Number of Reinspections of 29 78 107 Workrooms, Number of Inspections of 108 174 282 ,, found to be overcrowded — 13 13 ,, found to be insufficiently ventilated — 3 3 ,, found to be in dirty condition 11 32 43 Workshops, etc., newly discovered and registered 1 5 6 ,, Workrooms therein measured 1 5 6 ,, Reported to H.M. Inspector on discovery 1 5 6 Factories, Number visited 38 105 143 ,, W.C.'s dirty, insufficient, &c. 20 64 84 Outworkers' premises visited 273 801 1,074 Written Intimations served 67 98 165 Statutory Notices served 23 21 44 Final Notices served — — — Works carried out under supervision:— (a) Additional means of ventilation provided — 3 3 (b) Rooms cleansed and whitewashed 50 76 126 (c) Yards, floors, roofs, &c., repaired 13 16 29 (d) Sanitary conveniences constructed, cleansed or repaired 20 63 83 (e) Dampness remedied — — — (f) Sink waste pipes renewed, etc. — — — (g) Miscellaneous 6 3 9 Overcrowding of Workrooms, Cases abated — 13 13 Miscellaneous Visits (including visits to Council Houses) 444 165 609 Visits re Verminous Children 123 179 302 ,, Scabies 67 31 98 ,, Outworkers' Lists 18 18 36 ,, Suspected Infectious Disease 465 326 791 ,, Eye Infections 128 24 152 Visits to Schools 26 18 44 Factory and workshop inspections, 365; fair condition, 221; removed or discontinued 53; required cleansing, 43; sanitary conveniences defective or insufficient, 84. 36 Council Houses. At the request of the Special Housing Committee, the Lady Sanitary Inspector visits twice a year the houses and flats owned by the Borough Council, and a report of the conditions found is submitted for the information of the Housing Committee. HOUSES DIVIDED INTO SEPARATE TENEMENTS, ETC. Report of Inspector—Year 1927. Houses registered Nil Notices sent out, re above — House-to-House visits for registration purposes 69 Rooms measured, etc. 111 Declarations, for information, sent out 13 ,, with information, returned 10 House-to-House inspections (general) 26 Re-inspection 42 Number of Intimations served 27 ,, Notices served 3 „ Final Notices served 2 Number of drains repaired or reconstructed — A summons was issued in one case for failure to furnish particulars on declaration form (Bye-law No. 10). Defendant was fined £1 and ordered to pay £2 4s. costs. During the year, owing to sickness and absence on holiday of other members of the staff, the Inspector who is responsible for Houses-let-inLodgings work devoted a great part of his time deputising for District Sanitary Inspectors. Consequently, little time has been given to the Houses-let-in-Lodgings section of the work. STABLES. As flies are a common means of spreading the infection of diarrhoeal diseases, and as horse manure is their main breeding ground, the following circular letter was issued:— 37 (Enclos.) To Occupier of stables, Situate at Dear Sir, I would draw your attention to the By-laws made by the London County Council and Poplar Borough Council referring to Stables, Horse Manure, etc., extracts of which are enclosed. Horse manure being the chief breeding ground of the ordinary house-fly in this country, and as flies play such an important part in the spread of many diseases, particularly infantile diarrhoea, it is important that strict attention be paid to the regular and complete removal of manure if the health of the community is to be safeguarded. The manure must be removed completely at least once in every seven days, and it cannot be stated that manure has been completely removed until the receptacle has been cleaned or swept out, leaving no remains on the floor or walls. Yours faithfully, W. ALLAN YOUNG, Medical Officer of Health. 177 stables were inspected and reported upon. The following infringements of the Bye-laws were dealt with:— Accumulations of manure, or premises otherwise not clean 58 Lack of ventilation 1 Floors not properly drained 6 Dung receptacles:— (a) Not provided 42 (b) Defective 24 (c) Not covered 15 Other defects 49 137 Intimations were served, followed by 42 Notices and 16 Final Notices. The works required were completed before the end of the year. During the summer months of 1928 weekly inspections of stable premises will be resumed, and the frequent and complete removal of horse manure insisted upon. 38 New Legislation. During the year, the following Acts of Parliament, etc., have come into operation:— Sale of Food and Drugs Act, 1927. London County Council (General Powers) Act. 1927. Public Health (Infectious Diseases) Regulations, 1927. Public Health (Condensed Milk) Amendment Regulations, 1927. Public Health (Dried Milk) Amendment Regulations, 1927. Bye-laws. Consideration was given to the London County Council Draft Revised Water Closet Bye-laws, and certain suggestions were submitted to the London County Council upon these Bye-laws. Regulations as to Underground Sleeping Rooms. The Council's Revised Regulations for underground rooms habitually used as sleeping places have been approved by the Minister of Health. Lighting of Staircases in Tenement Buildings. The provisions of the London County Council (General Powers) Act, 1927, Section 61, come into operation on the 1st August, 1928. The Section applies to a tenement building only, i.e., a building constructed or reconstructed by way of conversion so as to comprise two or more separate or self-contained flats or tenements intended or used for occupation by the working classes; but does not include a house to which Sections 6 and 7 of the Housing Act, 1925, apply, i.e., let in lodgings or occupied by members of more than one family (for which Bye-laws have been made). The owner of every tenement building is required (a) Wherever practicable, to provide every common staircase with adequate means of lighting by natural light, including (in the case of a building constructed or reconstructed after the commencement of the Act) a window or windows or opening or openings on the staircase at each storey, opening directly into the external air; and (b) to provide adequate means for the artificial lighting of every common staircase, and to keep such means efficient and lighted daily from one hour after sunset until 11 o'clock 39 in the afternoon. In the case of a common staircase leading to not more than two separate or self-contained flats or tenements in a twostorey tenement building, the owner is not required to make provision for artificial lighting. When the Bill was under consideration by the Local Legislation Committee of the House of Commons, the London County Council gave an undertaking to the Committee that the initiative in securing uniform arrangements would be taken by the Standing Joint Committee in conjunction with the County Council. A communication was received from the Metropolitan Boroughs Standing Joint Committee suggesting the following procedure, which had been recommended by the Association of Metropolitan Town Clerks:— (а) That each Metropolitan Borough Council should prepare a schedule of the common staircases of tenement buildings within its area and cause a survey of the same to be made with a view to ascertaining which of the staircases do not already contain the adequate lighting by day and/or by night contemplated by the section. (b) That in any case in which it appears to the Borough Council as the result of this survey that any staircase is not so lit and that it is practicable so to light it either by day or by night or both a letter be sent in the first place to the owner drawing his attention to the section and asking him what steps he proposes to take in order to make such provision by the 1st August, 1928. (c) That in the event of his proposals being regarded as reasonably sufficient they be accepted, and that if not, he be invited to amend his proposals in such direction as the Borough Council may think necessary or desirable. (d) That if the owner still dissents he be afforded an opportunity of placing his views personally before the appropriate Committee of the Borough Council. (e) That the Borough Council, by inspection through a Committee or a sub-committee, should satisfy itself that the owner is in default before taking proceedings. 40 This letter was considered by the Public Health and Housing Committee in conjunction with a report from the Medical Officer of Health and the following resolutions were adopted:— (i) That this Committee ask the Council to delegate the powers under this section to the Public Health and Housing Committee. (ii) That the Committee follow the procedure suggested by the Association of Metropolitan Town Clerks. (iii) That the Medical Officer of Health be instructed to prepare a schedule of the common staircases in tenement buildings within the Borough, to cause a survey of the same to be made, and that where it is found necessary the procedure detailed in the letter be carried out. In accordance with these instructions an inspection has been made of all tenement buildings in the Borough and arrangements made to interview the owners of those premises which are not in conformity with the Act. The following is an extract from the report submitted to the Public Health and Housing Committee:— Number of tenement buildings inspected 67 Number satisfactorily lighted 58 Number not satisfactorily lighted:— (a) Natural lighting 7 (b) Artificial lighting 2 9 67 In the cases where natural lighting was not satisfactory steps have been, or are being taken, to improve the lighting. In both cases where artificial lighting was not satisfactory adequate means for lighting have been discussed and it is expected the necessary work will be put in hand without undue delay. 41 FACTORY AND WORKSHOP ACTS. 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 1927. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male Female. Total. Bakehouses (Factories) 44 — 44 179 90 — — — Bakehouses (Workshops) 32 — 32 123 67 — — Bakehouses (Domestic Workshops) 7 — 7 34 20 — — — Factories (Laundries and Miscellaneous Factories) 29 113 142 172 71 — — — Laundries (Workshops) — 4 4 4 1 — — Laundries (Domestic Workshops) — 2 2 2 — — — Workshops 146 145 291 613 128 19 — 1 Workshops (Domestic) 12 8 20 38 6 1 — — Workplaces 329 2 331 1605 182 57 6 — Workplaces (Domestic) 54 — 54 169 23 8 2 Places where food is sold or prepared 313* — 313* 1753 445 16 3 — Milk Premises 100 100 356 13 4 1 — Cowsheds 4 4 35 Slaughterhouses 8 8 17 —- Other offensive trade premises 7† — 7† 25 1 — — — IceCream premises 117‡ 117‡ 272 26 1 Homeworkers' premises 34 932 966 1098 26 — — — *Power is used in 42 of these premises. ‡ ,, ,, 21 ,, ,, †Registered by the London County Council. 8 offensive trades carried on; 1 premises used for two offensive trades—Fat Boiler and Tallow. Melter. 42 Table B. Workshops on Register (Male), 1927. 14 Bootmaking. 1 Barge building. 1 Bitumen making. 1 Blind making. 1 Boiler coverers. 2 Boat Building 1 Brush making. 2 Building, etc. 11 Cabinet making. 1 Carpenter. 1 Chemical works. 1 Cigar making. 1 Clay pipe making. 3 Cork cutting. 5 Cooperages. 4 Engineering. 13 Farriers. 3 French polishing. 1 Frilling making. 3 Furniture making. 1 Furrier. 1 Glass works. 1 Horsehair working. 4 Harness making. 3 Motor garage works. 3 Metal works. 2 Oil stores. 5 Paint making. 2 Paper sorting, etc. 2 Plumbing. 1 Poultry food mixing. 1 Printing. 1 Rag sorting. 2 Rope making. 1 Sack making. 1 Shellac bleaching. 1 Stonemasonry. 1 Stove making. 17 Tailoring. 3 Tank making. 4 Tarpaulin works. 1 Tinsmith. 2 Tin toy making. 1 Transfer making. 1 Trunk making. 2 Upholstering. 3 Undertaking. 2 Van building, etc. 1 Waterproof working. 1 Welding 1 Wheelwright. 2 Wire working. 1 Wood Tar products. 1 Zinc working. As per List, Table A Workshops on Register, page 41. Domestic Workshops on Register (where Men are Employed).* 2 Blacksmiths. 2 Boot repairing. 1 Decorative earthenware making. I Mat making. 1 Printing. 3 Tailoring. 1 Wire working. 1 Zinc working. Home Workers on Register (Male). 29 Bootmaking. 2 Clothing. 3 Tailoring. 43 Workshops and Domestic Workshops on Register (Females).* 1 Badger hair sorting. 1 Bedding making. 1 Boot factor. 1 Cabinet making. 1 Cap making. 6 Confectionery making. 2 Cork cutting. 10 Costume making. 9 Dressmaking. 1 Embroidering. 1 French polishing. 4 Furriers. 4 Infants' shoes making. 1 Knitted garment making. 6 Laundries. 1 Leather sorting. 14 Milliners. 3 Packing. 2 Paper and rag sorting. 1 Pickle and sauce making. 3 Pressers and cleaners. 2 Sack and bag making. 2 Shirt and pyjama making. 1 Seal stamp making. 1 Table jelly making. 61 Tailoring. 2 Tarpaulin works 1 Tiemaking. 1 Tin goods labelling and sorting. 3 Toymaking. 2 Trimming making. 1 Upholstering. 2 Waterproof garment making. 1 Whalebone dressing. *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 41. Factories on Register (where Females are Employed). 2 Bedding manufacturing. 1 Blouse making. 2 Boot making 6 Box making. 1 Brush making. 1 Bunting and flag making. 1 Butter mixing factory. 1 Cabinet making. 1 Chip basket making. 1 Christmas cracker making. 1 Cigarette paper making. 1 Clay fuel and pipes. 2 Cleaners and dyers. 1 Condiment packing. 1 Perambulator builder. 1 Pianoforte manufacturer. 3 Preserved food. 1 Ragwork. 1 Rice starch making. 3 Rope works. 2 Rubber goods making. 1 Rug making. 4 Sack making. 1 Sausage factory. 5 Shirt making. 1 Shroud making. 24 Tailoring. 1 Tarpaulin works. 44 Factories on Register (where Females are Employed).—conta. 3 Confectionery making. 1 Cork cutting. 1 Corset making. 4 Costume making. 1 Dog biscuit manufacturer. 4 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 Ticket printing. 2 Timber works and wicker furniture making. 1 Tortoiseshell goods making. 1 Toy balloon making. 1 Toy making. 2 Trimming making. 1 Type founder. 3 Varnish and paint works. 1 Wallpaper manufacturer. 2 Waterproof making. 1 Whalebone works. 1 Wine bottling. 2 Woollen garment making. Table C. See note, page 43. Factories, Workshops, Laundries, Workplaces and Homeworkeks. 1 .—INSPECTION. Premises. Inspections. Number of Written Notices. Prosecutions. Factories (Including Factory Laundries.) 351 Intimation. Statutory. Final. 161 — — — Workshops† (Including Workshop Laundries.) 740 195 20 — 1 Domestic Workshops} 74 26 1 Workplaces 1605 182 57 6 — Domestic Workplaces 169 23 8 2 — Places where food is sold or prepared§ 1753 445 16 3 — Homeworkers' Premises 1098 26 — — — Total 5790 1058 102 11 1 †Including Workshop Bakehouses. See Table A, page 41. ‡Including Domestic Bakehouses and Laundries. See Table A, page 41. § The inspections of all factories where food is prepared are included. Power is used in 42 of the premises. 45 2.—DEFECTS FOUND.* (Corresponding figures for 1926 are shown in italics). 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 744 (471) 744 (471) 2 .. Want of ventilation 5 (.5) 5 (5) .. .. Overcrowding 13 (2) 13 (2) .. .. Want of drainage of floors 6 (3) 6 (3) .. .. Other nuisances 329 (21) 329 (21) 1 .. Sanitary accommodation insufficient 2 (5) 2 (5) .. 1 unsuitable or defective 108 (83) 108 (83) .. .. not separate for sexes 4 (7) 4 (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 1211 (794) 1211 (794) 3 1 *These defects refer to premises as mentioned above under table of Inspection. 46 Nature of Work. Outworkers' List (Section 107). Prosecutions. Outwork in unwholesome premises. (Section 108). Outwork in infected premises, (Sections 199, 110). table d.—home work. Lists received from Employers. Notice served on Occupiers as to keeping or sending lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or per mit inspection of list. Failing to send lists. Lists. Outworkers. Lists. Outworkers Contractors. Workmen . Contractors . Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— 778 Making, etc. 87 12 6 — 27 36* Cleaning and Washing 2 28 — — — 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 — 95 Brush Making — — — Pea Picking Feather Sorting Carding.etc. ,of buttons,etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, Textile Weaving 2 — 4 — — 47 LIST OF OUTWORKERS, FACTORY AND WORKSHOP ACT, 1901 (S. 107). Class of Homework. 1927 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 46 428 48 477 195 213 352 365 Tailoring 39 309 41 341 195 213 352 365 Shirtmaking 1 10 1 14 Miscellaneous 2 11 2 21 Shoemakers 1 30 1 33 Boxes 1 50 1 45 Overalls 2 18 2 23 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 32 Bakehouse Domestic Workshops 7 Laundries Workshops 4 Laundries Domestic Workshops 2 Workshops 291 Domestic Workshops 20 Workplaces 331 Workplaces Domestic 54 Places where food is sold or prepared 313† Total number of workshops and workplaces, etc., on Register 1054‡ † Power is used in 42 of these premises. ‡ See Tables A and B, pages 41 and 42. Table F. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshon Act (s. 133) 10 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 9 Reports (of action taken) sent to H.M. Inspector 9 Other (Communications) 3 Underground Bakehouses (s. 101):— Certificates granted during the year .. In use at the end of the year 24 48 SMOKE NUISANCES. 57 smoke nuisances (38 complaints from the London County Council) were dealt with during the year:—7 Bow East, 0 Bow West, 13 Bromley North, 14 Bromley Central, 0 East Combined, 10 West Combined, and 13 Poplar South. 26 intimations were served and were followed by notices in 7 instances. No summonses were issued. RAG AND BONE DEALERS. No legal proceedings were taken for non-compliance with the L.C.C. Bye-laws. LONDON COUNTY COUNCIL (GENERAL POWERS) ACTS, 1904 AND 1922. *Verminous Rooms. Verminous rooms are brought to the notice of owners upon the "Intimations," which are followed, if necessary, by "Statutory Notices" as there are usually other nuisances or defects upon the premises. Notices are also served under section 10 of the London County Council (General Powers) Act, 1922. 200 rooms in 68 houses were cleansed by the Public Health Department. A fluid insecticide is issued at the Disinfectant Depots, and sprayers loaned to tenants in order to rid rooms and contents of bugs. 1,021 orders for fluid were issued. Approximately 250 gallons of insecticide were distributed during the year. PUBLIC SANITARY CONVENIENCES. At the request of the Public Health and Housing Committee all the public sanitary conveniences in the Borough were inspected and a report was submitted to the Committee and a copy sent to the Borough Surveyor. The attention of the London County Council was also drawn to one or two defects in conveniences under their control. The respective authorities placed in proper sanitary condition the conveniences to which special reference had been made in the report. * For the Cleansing of Verminous Rooms, see Tabulated Statement facing page 34. 49 LICENSED PREMISES' URINALS. Twenty-four urinals on licensed premises were found to be in insanitary condition, and were subsequently cleansed. WATER CERTIFICATES. 41 Certificates were 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. STREET TRADING. During the year, the Public Health and Housing Committee considered a Report of the Medical Officer of Health suggesting certain Bye-laws which should be incorporated in the Street Trading Bye-laws. The Committee, being of opinion that these suggestions would considerably strengthen the Bye-laws, submitted them to the Works Committee. The suggested alterations were incorporated in the model Bye-laws and were submitted to the Home Office but were not accepted, the Home Office pointing out that modifications of the model Bye-laws may only be made for the purpose of meeting special requirements. The Meat and Food Inspectors visited and reported upon the storage accommodation of all applicants for street trading licences who were dealing in foodstuffs. In the majority of instances the storage accommodation was satisfactory, and in the remainder suggestions were made for improving the storage accommodation. In these latter cases licences were issued, subject to the storage accommodation being made satisfactory. A record is kept in the Public Health Office of street traders who have been licensed to deal in foodstuffs. 50 RATS AND MICE DESTRUCTION. 481b. of barium carbonate paste and 301b. 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 and where there is ground for suspecting drainage defects, the ground is opened and the drain examined as a matter of routine. Accumulations of refuse are also directed to be removed. Rats and Mice (Destruction) Act, 1919. One notice was served under Section 5 of the above Act in consequence of complaints respecting a dump in Poplar South Division. A large amount of material was removed and the remainder was properly stacked. This had the effect of abating the nuisance and there have been no further complaints. SCHOOLS. Inspection of Schools. The public elementary schools were inspected during the year. A few minor defects were discovered and reported to the London County Council. RAG FLOCK ACT, 1911. No samples of rag flock were procured during the year 1927. HAIRDRESSERS' PREMISES. The hairdressers' premises, numbering 96, were inspected during the year. The number of inspections was 217. Cleansing was necessary at 15 of the premises, and other nuisances found numbered 22. 51 29 intimations and 10 statutory notices were served, also one final notice. The requirements of these documents were complied with. OVERCROWDING. Overcrowding, unless very gross or accompanied by mixing of sexes, has not been dealt with officially. Of 26 cases reported, 11 were abated, housing accommodation being provided by the Borough Council in 8 cases and by the L.C.C. in 3 instances. (See "Housing Conditions" page 56.) Thirteen cases of overcrowding in workshops were abated. CANAL BOATS ACTS. For the year ended 31st December, 1927, the inspections and reports of the Inspectors were as follows:— Registered boats. NonRegistered boats. *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 — 2 Mr. A. J. Field, Bow East Division 15 8 Mr. F. A. Smith, Bow West Division — — Totals 15 10 * There is no canal in either of these Divisions; the Inspectors deputise, when necessary, for other Inspectors. Mr. J. Johnson reported "Frequent visits to the section of canal in the West Combined Division have failed to find any registered canal boats during such visits—either stationary or on the move." Mr. H. J. Langley reported "None observed to stay in the Bromley North Reach during duration of visits." Mr. Wm. Johnson reported "Two boats were very dirty and neglected. In one the fresh water tank was badly dented and had a badly fitting lid, spots of oil on surface of drinking water. Letters sent to owners. The boats were overhauled, repainted, and made habitable, although not registered. One boat visited twice." Mr. A. J. Field reported "Two registered boats were visited twice. Condition of boats generally good. Two cases of leaky cabin tops. Letters sent to Owners and Registration Authority." 52 LEGAL PROCEEDINGS. (Public Health (London) Act, 1891; Metropolis Management Acts, etc.). Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 1927. 13, Mostyn Road Failed to amend the drains 1st Feb. 2s. penalty; £2 2s. costs Kelly, S. 50, Benledi Street Various defects Failed to provide ashpit 31st Jan. 21 days' order; £2 8s. costs Tibbatts, H. A. 31st Jan. 5s. penalty Tibbatts, H. A. 54, Benledi Street Various defects 31st Jan. 21 days' order; £2 8s. costs Tibbatts, H. A. 56, Benledi Street Ditto 31st Jan. 21 days' order; £2 8s. costs Tibbatts, H. A. 11, Gawthorne Street Failed to amend the drains 1st Mar. 8s. penalty; £2 2s. costs Kelly, S. 6, Stratfield Road Ditto ditto 21st Feb. £1 penalty; £2 2s. costs Kelly, S. 8, Stratfield Road Ditto ditto 21st Feb. £1 penalty; £2 2s. costs Kelly, S. 42, Stafford Road Roof defective 1st Mar. 28 days' order; £2 8s. costs Smith, F. A. 77, Fern Street Various defects 7th Mar. Nuisance abated; Summons withdrawn on payment of £2 4s. costs Davies, Miss M. E. 8, Grace Street Main roof defective 8th Mar. 14 days' order; £2 8s. costs Kelly, S. 23, Eagling Road Various defects 8th Mar. £1 penalty; £2 2s. costs Kelly, S. 53 Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 1927. 8, Grace Street Failed to comply with Magistrate's order to abate the nuisance 25th Apr. Work done; Costs allowed, £2 2s. Kelly, S. 70, Stewart Street Various defects; no proper ash receptacle 4th May Summons withdrawn on payment of £2 4s. costs Davies, Miss M. E. 17, Ruston Street Accumulation of rubbish in yard; wash-house roof defective 27th Apr. Work done; Costs allowed, £2 4s. Smith, F. A. 11, Gawthorne Street Drain defective 27th Apr. 28 days' order; £2 8s. costs Smith, F. A. 22, Vernon Road Ditto 10th May 14 days' order; £2 8s. costs Smith, F. A. 4, Ruston Street Various defects 24th May Work done; 10s. penalty; £1 1s. costs Smith, F. A. 19, Hawthorn Buildings Main roof defective; rainwater-pipe choked; no chimney-pot flue 3rd June 14 days' order; £2 penalty; £2 8s. costs Langley, H. J. 20, Hawthorn Buildings Main roof, W.C. ceiling and gutters defective 3rd June 14 days' order; £2 penalty; £2 8s. costs Langley, H. J. 84, Upper North Street Top front room in filthy state 17th June 7 days' order; £2 8s. costs Johnson, J. 14, Clifton Street No eaves gutters to back addition and wall damp 17th June Work done; £1 penalty; £2 2s. costs Johnson, J. 148, High Street (Workshop) Failed to provide sufficient and suitable sanitary conveniences for workpeople 22nd June Adjourned sine die-, later (3rd August) work done; Summons withdrawn; £2 4s. costs Johnson, J. 54 Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 1926. 147, Devons Road Main roof defective 20th July Work done; Summons with drawn on payment of £2 4s. costs Langley, H. J. 11, Gawthorne Street Obstructing an Officer in the execution of his duties 21st July £2 penalty; £3 3s. costs Defendant went to prison in default of payment Smith, F. A. 11, Gawthorne Street Failed to comply with Magistrate's order to abate the nuisance 3rd Aug. £10 penalty; £5 5s. costs Smith, F. A. 61, Marner Street Roof defective 21st Sept. Work done; Summons dismissed Johnson, W. 1, Payne Road Drains defective 17th Oct. Adjourned sine die Kelly, S. 2, Payne Road Ditto 17th Oct. Adjourned sine die Kelly, S. 3, Payne Road Ditto 17th Oct. Adjourned sine die Kelly, S. 11, Gawthorne Street Failed to comply with Magistrate's order to abate the nuisance 8th Nov. Adjourned sine die for Council to consider whether they should do the work Smith, F. A. 766, Old Ford Road Owner's application for revocation of Closing Order made by Magistrate 25th June, 1924 25th Oct. Closing Order cancelled Field, A. J. 82, High Street, Poplar (premises at rear) No proper and sufficient water supply, rendering premises unfit for human habitation 4th Nov. Closing Order made; £2 8s. costs Johnson, J. 6, Clifton Street Roof, wall and ceiling of top back room defective 4th Nov. 21 days' order; £2 8s. costs Johnson, J. 55 Address, etc. Nature of Complaint. Date of Decision. Result. Name of Officer. 1927. 25, Hillplace Street Wooden steps and landing staging in yard defective 4th Nov. 7 days' order; £2 8s. costs Johnson, J. 8, Hillplace Street Roof and eaves gutters at rear defective 14th Nov. 21 days' order; £2 8s. costs Johnson, J. 12, Hillplace Street Roof over landing and over top front and back rooms ceilings defective; walls and ceilings of passage staircase and landing defective 4th Nov. 21 days' order; £2 8s. costs Johnson, J. 24, Hillplace Street Roof, ceiling of back rooms, window of top back room and sashcords of ground floor front room defective 4th Nov. 21 days' order; £2 8s. costs Johnson, J. 4, Wendon Street Failed to amend the drains 20th Dec. System held to be a "drain" ; £1 penalty; £2 2s. costs Kelly, S. 35, Tredegar Road Defendant did unlawfully assault and beat Mr. F. A. Smith, Sanitary Inspector 26th May £2 penalty or 7 days imprisonment Smith, F. A. 56 Section IV. HOUSING CONDITIONS. It was found on examination of the records that overcrowding does not exist when judged by the standard adopted by the Registrar-General, namely two persons per room, yet when examined on the basis of overcrowding existing when more than two-and-a-half persons occupy a bedroom it was found that the average number of persons per bedroom was 2.74. The housing investigation sheets used in the Department until early in the current year did not afford all the particulars that are necessary for estimating overcrowding when the standard of two-and-a-half persons per bedroom is adopted. Therefore, the number of records used in the present enquiry only represent a proportion of the houses inspected during 1927. but can be taken as representative of the Borough as a whole. Number of houses to which the records relate 472 Number of houses overcrowded (Registrar-General's standard) 21 Number of houses overcrowded (two-and-a-half persons per bedroom) 96 In addition to the above in 19 houses social overcrowding (mixing of the sexes) was reported. Housing Accommodation provided during 1927. The number of families re-housed during the past year was as follows:— Families accommodated. Number of persons (approx.) (a) By the Poplar Borough Council:— (1) In newly-erected houses 103 478 (2) In adapted buildings 4 18 (b) By the London County Council 152 684 Totals 259 1,180 57 In order to prevent, as far as possible, a recurrence of overcrowding in premises vacated by families who have been re-housed by the Borough Council, or by the London County Council, letters are sent to tenants who are responsible for sub-letting, warning them that action will be taken if the vacated accommodation again becomes overcrowded. Statistics. Year Ended December, 1927. 1.—General. (1) Estimated population 167,000 (2) General death rate 11.8 (3) Death rate from tuberculosis (all forms) 1.1 (4) Infantile mortality 66 (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 1927:— (a) Total (including numbers given separately under (b) ) 147 (b) With State assistance under the Housing Acts:— (i) By the Local Authority 103 (ii) By other bodies or persons 40 2.—Unfit Dwelling-houses. 1.—Inspection of Dwelling-houses during the year. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or other Acts) 7,912 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 668 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1* * See Legal Proceedings, page 54. 58 (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 5,146 II.—Remedy of Defects during the year without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 3,492 III.—Action under Statutory Powers during the year. A. Proceedings under Section 3 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which notices were served requiring repair Nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil. (b) By Local Authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,654 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 1,652 (b) By Local Authority in default of owners (1 pending—No. 11, Gawthorne Street.) Nil. 59 A Closing Order was made by a Magistrate in respect of a workshop occupied as a dwelling-house (rear of 82, High Street, Poplar). A Closing Order, made by a Magistrate under the Public Health (London) Act, 1891, on 25th June, 1924, was cancelled 25th October on the application of the owner of the premises, 766, Old Ford Road. 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 1* (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. * On 22nd September the Council determined the Closing Order made on 31st March, 1921, in respect of 213a, Bow Road, as the house had been made reasonably fit for human habitation. Housing (Inspection of District) Regulations, 1925. Representations to Council under Housing Act, 1925. No premises were inspected with a view to closing under the Housing Act, 1925. Increase of Rent and Mortgage Interest (Restrictions) Acts. Twelve certificates were issued under the above Acts. 60 Section V. INSPECTION AND SUPERVISION OF FOOD. PREMISES WHERE FOOD IS SOLD OR PREPARED. During the year numerous inspections have been made of premises where food is sold, stored, or prepared, and in some cases plans and specifications were submitted and owners interviewed with a view to improving the conditions under which the businesses were carried on. The storage of raw and finished food products has received attention, and the storage and disposal of waste materials have been improved. In several instances accommodation for employes has been materially improved by the addition of lavatories and cloak rooms. A number of serious nuisances of a structural character were referred to, and dealt with by, the District Inspectors. COWHOUSES. There were 7 cowhouses licensed by the London County Council at the beginning of the year. Five applications for renewal of licences were made, but one was not granted in consequence of objections lodged by the Borough Council. There were 4 cowhouses at the end of the year. The cowhouses have been inspected and the necessary action taken under the Milk and Dairies Order, 1926, regarding lighting (natural and artificial) and cleansing; standings have been reconstructed to prevent fouling of the animals. MILK-SHOPS. At the end of the year there were in the Borough 104 registered premises (including 4 cow-houses) where milk is sold. These milk shops were kept under observation. The standard of cleanliness observed shows a considerable improvement, especially in cow-houses, milkshops, and other premises where milk is dealt with. The improvement is also noticeable in the persons engaged in the milk trade. 61 Sale of Milk in Bottles. The Committee agreed on the recommendation of the Medical Officer of Health and the Council's Solicitors that persons selling milk in bottles should be registered as purveyors of milk. During the year 168 persons have been so registered. Cleansing of milkshop premises was necessary in 7 instances. Seven other defects were found. For milk shops connected with infectious diseases, see page 85. Eleven persons were, on account of change of ownership of premises, registered as retail purveyors of milk. Milk and Dairies Order, 1926. 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." Notices under Article 14 (3) were served in 1926 upon 25 applicants to appear before the Committee to show cause why they should not be removed from the Register. Nineteen of the applicants appeared in person, but 6 did not appear. After considering all the circumstances, 21 were removed from the Register and 4 were allowed to remain on the Register subject to them conforming with the requirements of the Statutes. Five appeals were made against the Committee's decision to remove purveyors from the Register and 3 of these were dismissed. In the remaining 2 cases the appeals were allowed, the Magistrate being of the opinion that certain arrangements had since been made by the persons which overcame the reasons specified in the notices served upon them. Milk (Special Designations) Order, 1923. During the year, the following licences under the above order were issued:— Grade "A" (Tuberculin Tested) milk:— 10 bottling establishments. 19 dealers in sealed bottles only. 5 supplementary licences (principal licences issued by other Authorities). 62 1 licence was issued for the sale of "Certified" Milk, and 2 supplementary licences. 1 supplementary licence for the sale of "Pasteurised" milk was issued. 1 supplementary licence for the sale of Grade "A" milk was issued. The bottling establishments have been under constant supervision, and for the purpose of renewal of licences, plans of the premises were prepared and submitted for approval. For results of examination of samples see Public Analyst's report, pages 71 and 72. Grade "A" (Tuberculin Tested) Milk and Tubercle Test. At the suggestion of the Medical Officer of Health arrangements were made for two samples of Grade "A" (Tuberculin Tested) milk per quarter to be examined for tubercle at the Lister Institute. Four samples submitted during the year were reported upon "no evidence of tubercle.'' One sample of "Certified" milk was submitted for tubercle test, but the examination was incomplete; the inoculated animal died from some acute infection other than tubercle. ICE CREAM. London County Council (General Powers) Act, 1902, Sec. 43. There are 117 premises in the Borough where ice cream is manufactured. 272 inspections were made during the year. Cleansing of premises was necessary in 13 instances. 18 other nuisances existed. 13 intimations were served, followed by notices in 4 instances, and a final notice in one instance. The necessary cleansings were carried out, and other nuisances were abated. BAKEHOUSES. There are 83 bakehouses in use, of which 24 are underground. In 44 bakehouses machinery is used. See Table A, page 41, number made up to end of year. 63 Inspections. The bakehouses in the Borough were inspected at least twice during the year, the total inspections numbering 325. Cleansing was found to be necessary on 130 occasions, and one other nuisance was found. The cleansings were carried out and the nuisance abated after service of intimations. SLAUGHTERHOUSES. No contraventions of the bye-laws made by the London County Council for regulating the conduct of a business of a slaughterer of cattle were reported. There were 8 slaughterhouses licensed by the London County Council at the beginning of the year. In one case, renewal of the licence was refused as a result of the objections lodged by the Borough Council. One slaughterhouse was remodelled in consequence of drainage work being necessary. COFFEE SHOPS, EATING HOUSES, FRIED FISH SHOPS, HOTELS AND RESTAURANTS, ETC. London County Council (General Powers) Act, 1908.—Sanitary Provisions for Premises Used for Sale, etc., of Food for Human Consumption. The number of premises in the Borough where food is sold or prepared for sale is 313; see Table A, page 41. 1,753 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 402 instances, and 51 other defects existed. 445 intimations were served, which in 16 cases were followed up by statutory notices, and 3 final notices were served. It was not necessary to take legal proceedings to secure compliance with the terms of the notices, as the necessary work was carried out. 64 STATISTICAL REPORTS OF FOOD INSPECTORS. MR. C. A. GRABHAM. (Inspections for 1926 in italics.) Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. Bakehouses 188 115 94 — — — Slaughterhouses 7 2 — — — — Cowhouses 6 8 — — — — Milkshops 192 188 9 — — — Eating-houses 95 40 13 — — — Stalls 359 375 — — — — Other places where food is Bold or prepared 507 381 10 2 — — Ice cream premises 182 102 13 2 — Wharves where food is prepared or stored, etc 23 26 — — — Fried Fish Vendors, etc 252 120 201 4 1 — 224 Market Inspections:—Morning, 143; Evening, 81. Slaughterhouses: 321 visits. Number of Carcases inspected:— (a) Satisfactory 2282 (b) Unsatisfactory 8 (c) Condemned and destroyed or otherwise disposed of (included in (6) above) Parts of 8 Number of Samples procured:— Formal. Informal. Total (a) Under Sale of Food and Drugs Acts: (i) Number genuine 249 117 366 (ii) Number adulterated 30 12 42 (iii) Number poor quality, etc. (included in (i) genuine above) 21 — 21 (6) Under Special Orders and Regulations: (i) Number genuine 21 5 26 (ii) Number unsatisfactory 5 — 5 Action taken in respect of unsatisfactory samples:— (i) Summonses applied for 12 — 12 (ii) Letters of caution sent to vendors 21 — 21 (iii) Reported to Ministry of Agriculture, etc 3 — 3 Public Health (Foreign Meat) Regulations—Certificates issued by M.O.H. 232 (162 visits to factories). 65 Foodstuffs Inspected for Export. Tons. cwt. qrs. lbs. Bacon 7 7 2 12½ Beef 3 15 2 23 Dripping 2 10 — — Hams 12 10 3 24¼ Kidneys — 8 — 23 Lambs' Plucks — 1 1 2 Mutton 1 1 — 25 Pork 1 1 — 15 Sausages 34 — — — Sweetbreads — 1 2 12 Tongues 1 14 — 22 Turkeys — 2 1 26 Veal — 18 1 20 Bath Chaps 385 Weight not ascertained. Bologna Sausages 391 Partridges 220 Foodstuffs Destroyed. (a) Condemned at Slaughterhouse Inspections:— (i) Beef 12 cwt. 2 qr. 1lb. (ii) Organs condemned and destroyed:— Bovine:—Lungs, 116; Livers, 44, and parts of, 30; Mesenteries, 34, and parts of, 21; Omenta, 12; Pancreas, 23; Spleens, 14; Tripes, 22; Heads, 40; Tongues, 40; Udders, 22; Kidneys, 3; Intestines, 2. Sheep:—Lungs, 343; Livers, 24. Pigs:—Lungs, 15; Livers, 4; Mesenteries, 6; Omentum, 1; Spleens, 2; Heads, 8; Tongues, 8; Kidneys, 2. (b) Surrendered by owners as being unsound, or seized while exposed or deposited for sale:— 1 Pig's Liver—Surrendered. 8 cases Prunes—Surrendered. 60 lbs. Prunes—Surrendered. 11 tins Condensed Milk—Seized and condemned. 5 cwt. 14 lbs. Winkles—Surrendered. 4 stone Skate—Surrendered. 2 cases Condensed Milk—Surrendered. 120 tins M. & V. Rations—Surrendered. 146 cases and 10 tins Canadian Blueberries—Surrendered. 304 (2lb. tins) Pineapples—Surrendered. 84 (2½b. tins) Pineapples—Surrendered. 3 cases Pineapples—Surrendered. 1 Sheep's Liver—Seized and condemned. 2 targets of Mutton—Surrendered. 2 Ox Tails—Surrendered. 25 bags Potatoes—Surrendered. 18 cwt. 1 qtr. 14 lbs. Bacon—Surrendered. 1 case Rabbits—Surrendered. 1 box (5 stone) Haddocks—Surrendered. 29 tins Condensed Milk—Surrendered. 66 MR. H. A. PEARCE. (Inspections for 1926 in italics.) Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. Bakehouses 148 140 83 — — — Slaughterhouses 10 12 — — — — Cowhouses 29 27 — — — — Milkshops 164 226 4 4 1 — Eating-houses 92 88 20 3 — — Stalls 707 1080 — — — — Other places where food is sold or prepared 559 463 26 3 — — Ice cream premises 90 103 13 1 — Wharves where food is prepared or stored, etc. — 2 — — — — Fried Fish Vendors, etc. 248 104 175 4 2 — 225 Market Inspections:—Morning, 152; Evening, 73. Slaughterhouses:—275 visits. Number of Carcases inspected:— (a) Satisfactory 2123 (b) Unsatisfactory 16 (c) Condemned and destroyed or otherwise disposed of (included in (6) above) parts of 16 Number of Samples procured:— Formal. Informal. Total. (a) Under Sale of Food and Drugs Acts: (i) Number genuine 229 101 330 (ii) Number adulterated 20 13 33 (iii) Number poor quality, etc. (included in (i) genuine above) 27 — 27 (6) Under Special Orders and Regulations: (i) Number genuine 26 3 29 (ii) Number unsatisfactory 8 2 10 Action taken in respect of unsatisfactory samples:— (i) Summonses applied for 6 — 6 (ii) Letters of caution sent to vendors 16 — 16 (iii) Reported to Ministry of Agriculture, etc. 1 — 1 Public Health (Foreign Meat) Regulations—-Certificates issued by M.O.H. 12 (12 visits to factory). 67 Foodstuffs Destroyed. (a) Condemned at Slaughterhouse Inspections:— (i) Beef 12 cwt. 0 qr. 3lb. (13 briskets; 10 flanks; 5 middle ribs; 7 back ribs; 7 skirts; 3 rumps; 8 fore-ribs; 3 loins.) Pork (2 loins) 14 lbs. (ii) Organs condemned and destroyed:— Bovine:—Lungs, 87; Livers, 62, and parts of, 8; Mesenteries, 38, and parts of, 3; Omenta, 13; Pancreas, 28; Spleens, 9; Tripes, 7; Heads, 39; Tongues, 40; Udders, 21; Kidneys, 6; Intestines, 4; Heart, 1. Sheep:—Lungs, 616; Livers, 60, and parts of, 1. Pigs:—Lungs, 31; Livers, 20; Mesenteries, 9; Omenta, 5; Heads, 5; Tongues, 5. (b) Surrendered by owners as being unsound, or seized while exposed or deposited for sale:— 23 tins Salmon—Surrendered. 22 tins Pilchards—Surrendered. 1 tin Apricots—Surrendered. 4 jars Mustard Pickles—Surrendered. 1 jar Pickled Onions—Surrendered. 1 jar Pickled Cabbage—Surrendered. 84 tins Bloater Paste—Surrendered. 1 ton 18 cwt. 2 qrs. 10 lbs. Fat and Bones (Horse and Bovine)—Surrendered —see page 84. , 2 Ox Tails—Surrendered. 2½ Hearts (Bovine)—Surrendered. 1 Head and Tongue—Seized and condemned. 1 fore-end Bacon, 16½ lbs.—Surrendered. 1 Aitch bone; 1 buttock; 1 silverside; 1 thick flank; beef—weight, 1 cwt. 8 lbs.—Surrendered. 3 tons and 7 lbs. Butter scrapings released for soap-making—see p. 83. 68 Foodstuffs Inspected fob Export. Tons. cwt. qrs. lbs. Beef Sausages 1 10 — — Real Oxford Sausages — 10 — — Beef (1 forequarter) — — 5 24 Pork (99 bellies) — 10 2 7 Veal (1 side) — — 3 7 Bacon (1 fore-end) — — — 16 Hams (47) — 5 — 2 Premises Specially Inspected with a view to Improving Conditions under which food is being prepared (excluding bakehouses and Butchers' Shops). 1. Number of premises visited 18 2. ,, visits made 55 3. Nature of business:— Sausage, brawn and cooked meats 6 Butchers (cooked meats) 9 Butter-blending factory 1 Jelly factory 1 Wholesale grocers (ham boiling) 1 — 18 4. Number of premises in which specifications have been prepared 2 5. ,, premises in which work specified has been carried out 1 6. ,, premises in which work has been carried out, without specification, and equipment improved 10 7. Number of premises in which work has been completed 2 8. ,, premises in which work has not been completed 1 SLAUGHTERER OF POULTRY. There are no premises in the Borough where the business of a slaughterer of poultry is carried on. 69 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. Certificates were issued in connection with 244 consignments of foodstuffs: Canada (80), Australia (63), United States of America and Dependencies (59), Venezuela (25), other countries (17). 173 visits were paid to factories in connection with the above. For details of foodstuffs inspected for export, see pp. 65 and 68. PUBLIC ANALYST'S ANNUAL REPORT. During the year 1927, 793 samples were examined under the Sale of Food and Drugs Acts. Of these, 80 samples, or 10.1 per cent were found to be adulterated. In addition 46 samples were of inferior quality or doubtful purity, or 5.8 per cent. The adulteration figures for the previous 7 years are as follows:— Year. No. of samples examined. Percentage of adulteration. 1926 812 9.0 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 761 4.1 70 As observed in last year's report the amount of adulteration is increasing. The increase in the total adulteration does not apply to all samples, but only to some particular cases, or circumstances connected thereto. The Preservatives Regulations coming into force two years ago was one cause, resulting in many samples being returned as adulterated which previously had been allowed to pass as genuine. Previous to 1925, spirits had not been sampled for a few years. The first batch of samples taken after this interval resulted in over 37 per cent. being found adulterated. This naturally caused a big increase in the total figure. A third cause is the increasing practice of taking informal samples. This enables more particular attention to be paid to the foodstuffs which experience shows are liable to be tampered with, or are not up to standard quality. The average adulteration for the London Boroughs in 1926 was at the rate of 3.6 per cent., and for the whole of England and Wales 5.8 per cent. The number of samples examined was in the ratio of 4.75 per 1000 of the population as compared with 8.96 per 1000 for the London area, and 3.18 per 1000 for the whole of England and Wales. Of the 793 samples 248 were purchased informally and all were submitted by the Inspectors. Twenty-five of the informal samples were adulterated and 4 were of inferior quality. During the first quarter of the year, before the 1927 Act came into force, 2 Condensed Milks were examined under the Condensed Milk Regulations and found to be satisfactory, and 6 samples were examined under the Preservatives Regulations, of which 3 were found to contain preservatives. These 8 samples are not included in the above figures. 71 Preservatives. The following samples were found to contain preservatives:— Sample. Number examined. Percentage preserved. Butter 49 36.7 Cream 6 50.0 Lemon curd 5 40.0 Lime juice cordial 5 40.0 Malt vinegar 5 80.0 Fresh meat 34 17.7 Meat paste 1 100.0 Meat pies 2 100.0 Pearl barley 4 50.0 Total 111 36.3 In the majority of cases the amounts were within the limits allowed by the Regulations, and only in a few cases was it necessary to take further action. It was found that during the warm weather butchers were in the habit of spraying the fresh meat with a preservative solution. A circular was issued pointing out that the practice was illegal, after which further samples taken were found satisfactory. Condensed Milk. Twenty-one samples were examined. One sample was of poor quality, the others complied with the Regulations both as to composition and labelling. Bacteriological Examination of Milks. Forty-nine samples of Grade "A" (Tuberculin Tested) milk were examined, 40 taken by the Inspectors and 9 submitted by the bottlers. Six of the former and 2 of the latter, or 16.3 per cent., were unsatisfactory. In 5 cases bacillus coli only exceeded the limit, in the other 3 cases both bacillus coli and the total number of organisms were in excess. 72 In 43 cases the total number of organisms was below 100,000 per 1 Cc, and in 26 cases it was below 10,000 per 1 Cc. In 3 cases less than 1,000 were present. The chemical composition of these samples was as follows:— Fats varied from 2.8 to 4.7 per cent., with an average of 3.57 per cent. Total solids varied from 11.8 to 13.9 per cent., with an average of 12.44 per cent. Three samples contained less than 3 per cent. of fat. Twelve samples contained less than 12 per cent. of total solids. There was practically no difference between the average chemical composition of Grade "A" (Tuberculin Tested) milks and that of the general supply. One sample of Certified Milk was examined. This was satisfactory. Amongst the other samples examined were:— For the Public Health Department:— Food preservative. Electrolytic fluid. Pills. Wheat (bacteriologically). 3 Flours (bacteriologically). 9 Butters (bacteriologically). Carbon deposit. For the Engineer's Department:— Sewage Tar fluid. ALBERT E. PARKES, F.I.C., Public Analyst. 73 THE SALE OF FOOD AND DRUGS ACTS. The results of the analyses of 793 samples were reported to the Committee during the year:— Sample. Number examined. Adulterated . Action taken. Legal Proceedings.* Letters of caution sent. Milk 351 16 8 8 ,, Dried 1 — — — ,, Condensed 21 — — — Cream 6 3 1 2 Butter 49 7 — 2 Margarine 47 6 — 3 Cheese 6 — — — Dripping 10 — — — Lard 10 — — — Shredded Suet 8 4 1 1 Mustard 6 — — — Pepper 10 2 — 1 Vinegar 18 2 1 — Sauce 2 — — — Cocoa 6 2 — 1 Coffee 6 — — — Coffee and Chicory 4 — — — Cornflour 4 — — — Rice 2 — — — Ground Rice 4 — — — Pearl Barley 6 2 — 2 Sago 2 — — — Oatmeal 6 — — — Flour 1 — — — Self-raising Flour 5 — — — Ground Ginger 2 — — — Baking Powder 4 — — — Egg Powder 4 — — — Canned Peas 1 — — — Cake 6 — — — Jam 4 — — — Marmalade 4 — — — Table Jelly 2 — — — Lemon Curd 5 2 — 1 Golden Syrup 2 — — — Malt Vinegar 7 3 — 1 Borax 5 1 — — Cream of Tartar 2 — — — Tea Dust 4 — — — Carried forward 643 50 11 22 74 Sample. Number examined. 1927. Adulterated. Action taken Legal Proceedings.* Letters of caution sent. Brought forward 643 50 11 2«) Sweets 12 5 — 2 Dried Fruit 2 — — — Cyder 2 — — — Zinc Ointment 2 1 1 — Boracic Ointment 2 — — — Milk of Sulphur 2 — — — Lime Water 5 1 — — Camphorated Oil 2 — — — Lime Juice Cordial 5 2 — 1 Lemon Squash 4 — — — Lemonade 1 — — — Lemonade Powder 2 — — — Ginger Beer 2 — — — Gin 6 3 1 2 Whisky 23 7 5 1 Rum 11 3 2 1 Wines 6 — — — Mincemeat, Fruit 2 — — — Meat Pie 2 2 — 1 Meat Paste 1 — — — Brawn 2 — — — Sausage 17 — — — Fresh Meat 34 6 — 1 Ham 1 — — — Bacon 1 — — — Sausage Meat 1 — — — Totals, 1927 793 80 † 20 31 Totals, 1926 812 72 37 32 * See pages 75-79. † Including 25 informal samples. Of the 351 samples of milk, 23 were procured on Sundays from itinerant vendors and 142 from itinerant vendors on weekdays. All the samples were genuine. Samples were taken on delivery as follows:—Poplar Institution, 3; Poplar Hospital, 5; and St. Andrew's Hospital, 3. All these samples were genuine. Two samples taken on delivery at Railway Stations were reported to be genuine. These samples were taken at the request of an adjoining Local Authority. 75 Administrative Action Taken Respecting Samples Reported to be Not Genuine, Etc. March Quarter, 1927. Sample No. Article. Result of Analysis, etc. Action taken. 6. 1 Whisky 39 degrees under proof Summons; £6 6s. costs. G. 3 Whisky 40 Summons; £5 penalty; £1 1s. costs. G. 6 Rum 38 Summons; £5 penalty; £1 1s. costs. P. 3 Whisky 40 Summons; £5 penalty; £1 1s. costs. P. 1 Whisky P. 7 Rum 40 Summons;38 Summons; £5 penalty; £1 1s. costs. £5 penalty; £1 1s. costs. P. 12 Margarine 1.5 per cent. excess water Caution. G. 13 Cocoa 3 per cent. added alkali Caution. G. 17 Milk 6.6 per cent. deficient in fat Summons; £2 2s. costs. G. 27 Margarine 1.5 per cent. excess water Caution. P. 25 Butter 1 per cent. excess water Caution. G. 31 Milk 3 per cent. deficient in fat Caution. P. 58 Milk 30 per cent. added water Summons; £3 penalty; £1 1s. costs. G. 62 Milk 2.3 per cent. added water Caution. P. 64 Milk 2.3 per cent. added water; 14.6 per cent. deficient in fat Summons; £2 penalty; £1 1s. costs. G. 70 Milk 8.2 per cent. added water; 23.6 per cent. deficient in fat Summons; £3 penalty; £1 1s. costs. G. 73 Zinc Ointment 30 per cent. deficient in zinc oxide Summons; £5 penalty; £3 3s. costs. G. 79 Milk 10 per cent. deficient in fat.. Summons; 2s. costs. 76 March Quarter, 1927—Continued. Sample No. Article. Result of Analysis, etc. Action taken. G. 88 Milk 10 per cent. deficient in fat Caution. G. 36 Shredded Suet Contained starchy matter, 7.3 per cent. (not labelled) Caution. Informal Butter 2.7 per cent. free fatty acids No action. Informal Butter 2.2 per cent. free fatty acids No action. Informal Table Jelly Sulphur Dioxide, 160 parts per million No action. Informal Meat Paste Boracic acid 2 grains per 1b. Formal sample taken (Genuine) Informal Malt Vinegar Sulphur Dioxide 43 parts per million No action. June Quarter, 1927. Sample No. Article. Result of Analysis, etc. Action taken. G. 92 Milk 4.7 per cent, added water .. Letter of caution. P. 87 Milk 4.7 per cent, added water .. Letter of caution. G. 98 Pearl Barley 38 parts per million sulphur dioxide Letter of caution. P. 102 Gin 41 degrees under proof Summons; £5 5s. costs G. 106 Whisky 36 degrees under proof No action. P. 113 Lemon Curd 6 grains boracic acid per lb. Letter of caution. G. 118 Milk 3.5 per cent. added water Letter of caution. P. 17 Informal Malt Vinegar 45 parts per million sulphur dioxide Formal sample taken (P.125). 77 June Quarter—Continued. Sample No. Article. Result of Analysis, etc. Action taken. Informal Malt Vinegar 25 parts per million sulphur dioxide No action. P. 23 Informal Margarine 16.9 per cent. water No action. Informal Margarine 16.8 per cent. water Formal sample taken (G. 142) G. 142 Margarine 16.7 per cent. water Letter of caution. Informal Sweets 0.2 per cent. Talc Formal sample taken (G. 153) G. 153 Sweets 0.2 per cent. Talc Letter of caution. P. 35 Informal Sweets 0.2 per cent. Talc Formal Sample taken (P. 142) P. 142 Sweets 0.2 per cent. Talc Letter of caution. P. 36 Informal Butter 17.1 per cent. water Formal sample taken (P. 153) P. 41 Informal Butter 16.3 per cent. water Formal sample taken (P. 153) P. 153 "genuine." G. 157 Milk 3.5 per cent. added water Letter of caution. G. 161 Milk 5.8 per cent. added water Summons. £2 2s. costs. P. 97 Pearl Barley 93 parts per million sulphur dioxide Letter of caution. P. 14 Informal Lemon Curd 6 grains per lb. boracic acid Formal sample taken (P. 113) above. P. 125 Malt Vinegar 35 parts per million sulphur dioxide Letter of caution. G. 126 Butter 16.3 per cent. water Letter of caution. G. 130 Margarine Sold in unstamped wrapper Letter of caution. P. 133 Cream 0.4 per cent. boracic acid (not labelled) Letter of caution. G. 140 Cream 0.3 per cent. boracic acid (not labelled) Summons: £2 penalty; £1 1s. costs. 78 September Quarter, 1927. • Sample No. Article Result of Analysis, etc. Action taken. P. 158 Cream 0.35 per cent. boracic acid Letter of caution. P. 47 Informal Lime juice cordial Salicylic acid 0.2 grains per pint Formal sample taken (P. 163) P. 49 Informal Meat Pie Meat contained sulphur dioxide 40 parts per million Formal sample taken (P. 167 P. 163 Lime juice cordial Salicylic acid 0.2 grains per pint Letter of caution. P. 167 Meat Pie Meat contained sulphur dioxide 50 parts per million Letter of caution. P. 58 Informal Lime water 10 per cent. deficient in lime Formal sample taken (P. 183) Informal Butter 16.2 per cent. water No action. Informal Meat Sulphur dioxide 370 parts per million Formal sample taken (G. 197) Informal Meat Sulphur dioxide 80 parts per million Formal sample taken (Genuine) G. 197 Meat Sulphur dioxide 450 parts per million Letter of caution. P. 71 Cocoa 2.5 per cent, added alkali No action—"declared. Informal Sweets 0.2 per cent. Talc No action. P. 199 Borax Arsenic, 100 parts per million No action—domestic borax Informal Meat Sulphur dioxide 50 parts per million Formal sample taken (Genuine) P. 183 Lime water Not made with distilled water Letter of caution. 79 December Quarter. Sample No. Article. Result of Analysis, etc. Action taken. G. 224 Meat Sulphur dioxide, 15 parts per million Further sample taken. G. 235 Meat Sulphur dioxide, 5 parts per million Further sample taken. G. 252 Vinegar 15 per cent. deficient in acid Summons; £1 penalty; £2 2s. costs. Informal Vinegar 15 per cent. deficient in acid Formal sample, G. 252 above. P. 95 Informal Shredded suet 14 per cent. starch; no label Further sample taken. P. 235 Shredded suet 17 per cent. starch; no label Summons; £2 penalty; £1 1. costs. P. 107 Informal Pepper 2.5 per cent. chalk; 5 per cent. maize starch Formal sample taken (P. 247) P. 108 Informal Shredded suet 8 per cent. starch; no label Formal sample taken (P. 246) P. 246 Shredded suet 8 per cent. starch; no label Letter of caution. P. 247 Pepper 2.5 per cent. chalk; 5 per cent. maize starch Letter of caution. P. 250 Whisky 37 degrees under proof Letter of caution. P. 251 Rum 37 degrees under proof Letter of caution. P. 253 Gin 37 degrees under proof Letter of caution. G. 265 Whisky 40 degrees under proof Summons; £2 2s. costs. G. 269 Gin 36 degrees under proof Letter of caution. G. 279 Milk 16.4 per cent. added water Summons; £1 1s. costs. G. 280 Milk 4.7 per cent. added water Letter of caution. G. 285 Milk 8 per cent. added water Summons; £1 1s. costs. Informal Margarine 16.4 per cent. water Formal sample taken. Informal Butter 16.1 per cent. water Formal sample taken. Informal Butter 16.3 per cent. water Formal sample taken. 80 Milk and Dairies (Consolidation) Act, 1915, and Amendment Act, 1922. Milk and Dairies Acts and Order. Milk bottled in street Caution sent. Splitting and filling churns at Milk Depot Caution sent. Milk bottled in street (2nd offence) Summons; 16s. penalty; £2 4s. costs. Paraffin oil delivered through shop Caution sent. Paraffin oil sold in milkshop Caution sent. Milk sold in bottle bearing reference to Grade Letter of caution. "A" (Tuberculin Tested) Milk. Milk delivered in bottle which had been filled Summons. £5 penalty; £1 1s. in street costs. Filling bottle with milk in street Letter of caution. Milk sold from barrow, and receptacles not „ „ marked Filling bottle with milk in street „ „ „ „ „ (roundsman) „ „ „ „ „ (roundsman)„ „ „ „ „ (roundsman) „ „ Trading as a dairyman when not registered Summons; Defendant failed to appear; warrant issued by Magistrate. 81 Public Health (London) Act, 1891, Section 47. Seizures of Foodstuffs. Proceedings under the above Section were taken as follows:— Particulars. Date of Decision. Result. Name of Officer. Exposed for sale 11 tins of condensed milk which were unsound, etc. Jan. 29th Condemnation Order made. Letter of caution sent to vendor. Grabham, C. A. Exposed for sale a sheep's liver which was unsound, etc. April 12th. Condemnation Order made. Letter of caution sent to vendor. Grabham, C. A. Tuberculous Ox Head and tongue exposed for sale. July 30th. Aug. 25th. Condemnation Order made. Dismissed under Probation of Offenders Act, £1 1s. costs. Pearce, H. A. Public Health (Milk and Cream) Regulations. 1912 and 1917. 1 — MILK; AND CREAM NOT SOLD AS PRESERVED CREAM. (A) Number of Samples examined for the presence of preservative. (B) Number in which preservative was reported to be present, and percentage of preservative found in each case. Milk 351 Nil. Cream 6 3* In two cases letters of caution were sent. In one case legal proceedings taken. £2 penalty and £1 1s. costs imposed. 82 2.—CREAM SOLD AS PRESERVED CREAM. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. (i.) Correct statements made (ii.) Statements incorrect (iii.) Percentage of preservative found . in each sample Percentage stated on statutory label. No samples taken. (b) Determinations made of milk fat in cream sold as Preserved cream. (i.) Above 35 per cent. Nil. (ii.) Below 35 per cent. Nil. (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V. (2) of the Regulations have not been observed.—Nil. (d) Particulars of each case in which the Regulations have not been complied with, and action taken.—Nil. 3. Thickening Substances.—Any evidence of their addition to cream or preserved cream, action taken where found.—Nil. 4 Other Observations, if any.—The sale of cream in this Borough is of negligible quantity, and, owing to the impending operation of the Public Health (Preservatives in Food) Regulations, no preserved cream has been observed for sale. 83 Margarine Act, 1887, Sale of Food and Drugs Act, 1899, and the Butter and Margarine Act, 1907. No applications were made for registration of premises under the above Acts. 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, 1927, 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 — Damaged Butter. A consignment of New Zealand butter which had been damaged by water was released by the Medical Officer of Health for Bermondsey for treatment at a butter-blending factory in this Borough. The consignment consisted of 2,999 boxes, each containing 561b. Before any treatment of the butter was permitted, three samples were taken. The Public Analyst reported that one sample was mouldy, with growths of a variety of pencillium, and was rancid, containing 2.7 per cent. of free fatty acids. The other two samples were free from mould and were normal in composition. 84 The butter was then scraped to remove superficial mould or staining. Samples of the butter after scraping were taken, and were reported to be sound and of normal composition. In cases where mould had penetrated to any depth, the whole contents of the box were put aside with the butter scrapings. The butter which was undamaged was then blended with other butters and packed for sale. Three samples taken after blending were reported to be perfectly sound, normal in chemical composition, and free from rancidity. The damaged butter—bulk and scrapings, amounting to 3 tons and 71b.— was released for soapmaking. Suspected Case of Anthrax. In consequence of information received from Reigate, 1 ton 18 cwt. 2 qr. 101b. of fat and bones (horse and bovine), on the premises of a firm of soapmakers, were destroyed by burning because it was suspected that among them were the bones of an animal that had died from Anthrax. Public Health (Imported Food) Regulations, 1925. Notices were received from time to time from the Port of London Sanitary Authority respecting tallow which had been released under suitable guarantees for soapmaking, lubricating oils, etc. During the year, 73 visits were made to factories, wharves, etc., and 757 casks and several quantities of loose tallow were dealt with. Damaged Wheat. Quantities of damaged wheat were released by various Authorities to be used in this Eorough for poultry food. The total quantity dealt with during the year was 6 cwt. 21b. TABLE VII. Notifiable diseases during the Year 1927. Notifiable Disease. Cases Notified in Whole Borough. Total cases notified in each Sub-District. No. of Cases removed to Hospital from each Sub-District Total Deaths in Age-Periods. Total deaths in each Sub-District At all Ages. At Ages—Years. 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. 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. Smallpox 1 — — — — — — — — 1 — — — — 1 — 1 1 — — — — — — — — — — — — — — — Cholera (C), Plague (P) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 362 7 22 35 29 43 137 45 13 23 4 4 — 221 141 218 139 357 17 — 4 1 1 3 4 2 — — 1 1 — 12 5 Erysipelas 95 3 5 — — 2 4 4 7 13 15 29 13 47 48 31 20 5 J — — — — — — — — — — — — — — — Scarlet Fever 715 2 17 42 54 76 346 115 32 27 3 1 — 417 298 411 293 704 3 — — 1 — — 1 — — 1 — — — 1 2 Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever 4 — — — 1 1 1 — 1 — — — — 2 2 1 1 2 — — — — — — — — — — — — — — — Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 7 — — — — — — — — 4 3 — — 1 6 1 5 6 2 — — — — — — — — 2 — — — — 2 Puerperal Pyrexia 15 — — — — — — — — 12 3 — — 9 6 4 3 7 — — — — — — — — — — — — — — — Cerebro-Spinal Fever 4 1 1 1 — 1 — — — — — — — 2 2 2 1 3 3 1 1 1 — — — — — — — — — 2 1 (a) Acute Poliomyelitis & (6) Acute Polioencephalitis 2 1(b) — — — — — — — 1(a) — — — 2 — 1(b) — 1(b) 1(b) 1(b) — — — — — — — — — — — 1(b) — Acute Encephalitis Lethargica 5 — — — — — 1 — 1 1 — 1 1 4 1 2 1 3 4 — — — — — — — 2 2 — — — 2 2 Ophthalmia Neonatorum 48 48 — — — — — — — — — — — 39 9 2 1 3 — — — — — — — — — — — — — — — *Zymotic Enteritis 94 33 19 9 3 5 6 1 2 7 3 4 2 32 62 6 9 15 39 34 3 — — — — — — 1 1 — — 19 20 Anthrax — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Trench Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia (Acute Primary and Acute Influenzal) 542 60 65 56 41 32 59 25 26 52 32 63 31 347 195 73 62 135 155 39 15 14 7 3 1 1 4 10 8 33 20 91 64 Malaria 1 — — — — — — — — 1 — — — — 1 — 1 1 — — — — — — — — — — — — — — — Dysentery — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Totals 1895 155 129 143 128 160 554 190 82 142 63 102 47 1123 772 752 537 1289 224 75 23 17 8 6 6 3 6 16 10 34 20 128 96 Note.—161 Cases reported "not suffering," etc., are excluded from the above table. * Notifiable from 1st June to 30th September. 85 Section VI. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. INFECTIOUS DISEASE. Notifications. 1,895 cases of Infectious Disease were notified during the year. In addition there were 161 cases notified as Infectious Diseases but in which the diagnosis was not confirmed. The notification rate was 11.3, compared with 13.8 in 1926, 10.1 in 1925, 9.8 in 1924, 9.2 in 1923, and 6.6 in 1922. Cases of Infectious Disease Occurring in Institutions. (This Table does not include cases admitted with the disease.) 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 10 .. 6 .. .. .. .. .. 4 .. 3* .. .. .. .. .. St. Andrew's Hospital 31 20 † 2 ‡ 3 .. .. .. 5 1 19** .. 2** .. .. .. .. Bow Institution 2 2§ .. .. .. .. .. .. .. 2** .. .. .. .. .. .. Bromley House Institution 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Langley House, 54, East India Dock Road 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1* Poplar Hospital .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Admitted intoSt. Andrew's Hospital. ** Removed to M.A.B. Hospitals. ‡2 Staff. †2 Staff. § 1 Staff. Infectious Diseases in Milkshops and Homeworkers' Premises. Two cases of infectious disease occurred in families connected with the sale of milk, and no dairy premises were associated with infectious disease during the year. 86 36 cases of infectious disease occurred in homeworkers' premises— 8 diphtheria, 26 scarlet fever, 1 erysipelas and 1 measles. No notice was served under the Factory and Workshop Act, 1901, 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. Smallpox 1 — — 1 100. Diphtheria 355 2 — 357 98.6 Erysipelas 1* 50 — 51 53.7 Scarlet Fever 704 — — 704 98.5 Enteric Fever 1 — 1 2 50.0 Puerperal Fever 5 1 — 6 85.7 Puerperal Pyrexia 1 3 3 7 46.7 Cerebro-spinal Fever 1 — 2 3 75.0 Encephalitis gica 1 — 2 3 60.0 Ophthalmia Neonatorum 3 — — 3 6.3 Pneumonia — 134 1 135 24.9 Acute Polio-encephalitis — — 1 1 100. Zymotic Enteritis — 15 — 15 15.9 Malaria — — 1 1 100. Totals 1073 205 11 1289 68.1 * Admitted with Scarlet Fever. N.B.—Cases reported to be "not suffering" have been excluded from above table. 87 Comparative Mortality. Diphtheria. Scarlet Fever. Enteric Fever. Cases 648 1423 16 1921 Deaths 64 13 5 Fatality Rate 9.9 0.9 31.2 Cases 626 415 10 1922 Deaths 62 7 0 Fatality Rate 9.9 1.7 0.0 Cases 303 263 8 1923 Deaths 32 5 3 Fatality Rate 10.6 1.9 37.5 Cases 348 460 8 1924 Deaths 20 6 1 Fatality Rate 5.7 1.3 12.5 Cases 329 453 1 1925 Deaths 8 0 0 Fatality Rate 2.4 0.0 0.0 Cases 411 610 4 1926 Deaths 22 3 3 Fatality Rate 5.3 0.5 75.0 Cases 362 715 4 1927 Deaths 17 3 0 Fatality Rate 4.7 0.4 0.0 SCARLET FEVER. The total notifications received numbered 809 and the total removals were 798. Of these, 94 cases were later certified to be not suffering from Scarlet Fever, leaving a total of 715 cases, the attack-rate being 4.28 per 1,000 of population. 3 deaths occurred, giving a fatality rate of 0.4 per cent. 88 DIPHTHERIA. The total notifications received numbered 427 and the total removals to hospital were 422. 65 patients were certified to be suffering from other diseases, leaving a total of 362 cases, the attack-rate being 2.17 per 1,000 of population. 17 deaths occurred, giving a fatality rate of 4.7 per cent. SCHICK TEST AND IMMUNISATION FROM DIPHTHERIA. A Special Report was submitted to the Public Health and Housing Committee in October and is included as an appendix to this Report. On the recommendation of the Committee, the Report was adopted by the Council and application made to the Minister of Health under Section 77 of the Public Health (London) Act, 1891, for sanction to the scheme as outlined in the Report. The sanction of the Minister of Health was received early in 1928 and the Clinic was opened in June, 1928. DIPHTHERIA ANTI-TOXIN. 97,500 units of diphtheria anti-toxin were issued to medical practitioners during the year. ENTERIC FEVER. Five notifications were received and 3 patients were removed to hospital. One patient was later certified to be not suffering from Enteric Fever, leaving a total of four cases for the year, the attack-rate being 0.02 per 1,000 of population. No deaths from Enteric Fever occurred during the year. BACTERIOLOGICAL EXAMINATIONS. 1,740 swabbings from doubtful cases of diphtheria were examined. Of these, 203 gave positive results (11.7 per cent.). 6 blood specimens from doubtful cases of Enteric Fever were examined. 89 5 gave negative results and one gave a weak positive (agglutination of Bacillus Typhosus and Bacillus Paratyphosus B in serum diluted 1/10 to 1/80, but not higher). The patient was notified and treated at home, and recovered. One specimen of faeces was examined for typhoid group of organisms and gave a negative result. One specimen of faeces was examined for the presence of the dysentery group of organisms and for amoebae or cysts, and was found to be negative. SMALLPOX. On the 10th May the Medical Officer of Health was asked by a medical practitioner to see one of his patients who had a rash on his body and who had been attending the surgery for a few days. The patient was found to be suffering from Smallpox and was immediately removed to a Metropolitan Asylums Board Hospital. All contacts in the Borough were kept under strict observation and the Medical Officers of Health of the respective districts were notified of contacts in their areas. The direct contacts in the house were vaccinated and were temporarily housed at the Smallpox Shelter while the premises were being disinfected. The Ministry of Health and the London County Council were informed of the details of the case. The Poor Law Authority and their Officers were likewise informed and circular letters sent to all Medical Practitioners in the Borough. Circulars advising vaccination or re-vaccination were sent to the heads of certain businesses, the staffs of which, because of the nature of their employment, were particularly liable to come into contact with infection, e.g., laundries, hairdressers, rag and bone dealers, and undertakers. Preliminary steps were taken to make Chickenpox notifiable should the disease spread, but fortunately this was not found necessary. 90 In spite of the fact that the patient had wandered about with the rash well out for three or four days, only one case of Smallpox occurred amongst the contacts, namely, a brother-in-law of the patient, who lived in an adjoining Borough. As a result of the close co-operation existing between the Board of Guardians and the Public Health Department, extra facilities for vaccination of contacts and the public generally were early made available, and were advertised by means of posters displayed throughout the Borough. From returns received from the Public Vaccinators it would appear that approximately 270 persons were vaccinated or re-vaccinated during this little outbreak. SHELTER AND CLEANSING STATION. During the year eight persons were accommodated in the Council's shelter. Seven were contacts of the Smallpox case reported above, and one was a casual who had been in contact with Smallpox and had refused re-vaccination. He could not be detained in the Casual Wards until the expiry of the quarantine period and was offered accommodation in the Council's Shelter, and was paid 1s. per day during his detention. VACCINATION. The Vaccination Officer, Mr. P. Ryan, has kindly furnished me with the following particulars regarding vaccination in the Borough:— 91 Extract from the Report of the Vaccination Officer, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1926, inclusive:— Registration Sub-Districts. Number of Births registered 1st Jan. to 31st Dec., 1926. Number of Births entered by 31st January, 1928, in "Vaccination Register." Number of Births which on 31st January, 1928, remained unentered in "Vaccination Register." Number of Births neither entered in the "Vaccination Register" nor accounted for in Columns 8, 9 and 10. Total number of Certificates of Successful Primary Vaccination of Children under 14 received during the calendar year 1927. Number of Statutory Declarations of Conscientious Objection actually received during the calendar year 1927. Col. I Successfully vaccinated . Col. II Col. IV Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V Died unvaccinated. Postponement by Medical Certificate. Removals to Districts the Vaccination Officers of which have been duly apprised. Removals to places unknown, cases not found, etc. Insusceptible of Vaccination. Had Smallpox. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Poplar 1927 301 — — 1211 101 9 15 60 230 877 1874 Bow and Bromley 1349 204 — — 836 73 6 16 30 184 Total 3276 505 — — 2047 174 15 31 90 414 877 1874 Note —(a) The total of the figures in Columns 3 to 11 should agree with the figure in Column 2. (b) The figures in Columns 2 to 11 should not include re-registered births. 92 The following analysis of the Vaccination Return reveals the fact that 83 per cent. of the children whose births were registered in 1926 were not protected by successful vaccination:— Births registered 3,276 Deduct:— Died unvaccinated 174 Removals to other districts 31 Removals to places unknown, etc. 90 295 Surviving residents 2,981 Successful vaccinations numbered 505 = 16.9 per cent. Conscientious Objections declared 2,047 Vaccinations postponed on Medical Certificates 15 Number not accounted for 414 Total unvaccinated children 2,476=83.1 per cent. 2,981 100 per cent. Public Health (Smallpox Prevention) Regulations, 1917. The number of vaccinations and re-vaccinations performed by the Medical Officer of Health were as follows:— Primary vaccination 1 Revaccinations 22 Total 23 Summary of results. 4 good scars 3 2 „ „ 1 Very slight 1 Doubtful 1 Abortive 17 Total 23 93 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. 95 cases of erysipelas were notified during the year. Three deaths occurred. PUERPERAL FEVER, ETC. Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. These Regulations came into operation on 1st October, 1926. As stated in the Annual Report for 1926, the Minister of Health has sanctioned the appointment of Dr. Malcolm Donaldson as Obstetric Specia'ist (with Dr. C. S. Lane-Roberts as deputy) in cases where a medical practitioner requires assistance, and has approved the arrangements for bacteriological examination of blood and lochia at the Seamen's Hospital, Greenwich. During 1927, the Specialist was called in to see two cases of Puerperal Pyrexia and arranged for the patients to be removed to St. Bartholomew's Hospital. The patients made a complete recovery. In a further case, a medical practitioner desired a blood test; but after consultation with Dr. Davies, of the Seamen's Hospital, a blood count only was undertaken. Arrangements have been completed with the local Nursing Societies for home nursing of cases of Puerperal Fever and Puerperal Pyrexia where this service is required. 94 The following is a summary of the notifications, etc., during the year:— Puerperal Fever. Puerperal Pyrexia. Cases notified 7 15 Removed to M. A. B. Hospitals 5 1 Removed to other hospitals 1 6 Treated at home 1 8 Specialist called in .. — 2 Deaths 2 — The deaths occurred in cases that had been removed to hospital from their own homes where the confinements had taken place. CONTINUED AND TYPHUS FEVERS. No cases of continued fever occurred. No case of typhus fever occurred. CEREBRO-SPINAL FEVER. Four cases of Cerebro-Spinal Fever occurred, three of which terminated fatally. The fourth case is reported to be recovering. ACUTE POLIOMYELITIS. One case of Acute Poliomyelitis occurred. The patient died early in 1928. Another patient who was notified as suffering from Acute Poliomyelitis was removed to a hospital of the Metropolitan Asylums Board. Patient died there, and it was found that the cause of death was Tubercular Meningitis and not Acute Poliomyelitis. ACUTE ENCEPHALITIS LETHARGICA. Five cases of Encephalitis Lethargica were notified during the year. Of these one patient died. A patient who was notified in 1924 also died. In addition there were two deaths from this disease in persons who were inmates of Institutions outside the Borough. Cases of Encephalitis Lethargica are kept under observation until the acute stage has passed. Subsequently, periodical visits are made and reports as to the condition of patients are forwarded to the London County Council. 95 Excluding the cases who died during the year, 21 cases were investigated. The following is a summary of the reports submitted Recovered or much improved and returned to work or school 4 In Institutions:— Mental Hospitals 3 Other Hospitals 2 Industrial Home 1 Convent 1 7 Attending hospitals or otherwise undergoing treatment 4 Suffering from after-effects but not receiving treatment 4 Left the District 2* 21 *1 since died. The 8 patients suffering from after-effects (excluding those in Institutions) were affected as follows:— Intelligence below normal, with loss of control over limbs, in one case paralysis 3 Sleep, poor or excessive, with slow movements in one case, and rolling of eyes in the other 2 Movements unsteady, no other ill-effects 1 Conduct abnormal (very spiteful, tendency to become hysterical) 1 Squint 1 8 ACUTE POLIO-ENCEPHALITIS. One case of Acute Polio-Encephalitis was notified. Death occurred in Poplar Hospital prior to notification. MEASLES. 963 cases of measles were reported to the Medical Officer of Health from various sources (principally from L.C.C. schools). 8 deaths were attributed to measles. 96 All cases of Measles are visited and where home conditions are unsatisfactory, parents are advised to have patients removed to hospital. In June, a letter was received from the Metropolitan Asylums Board which stated, inter alia:— that, after careful consideration and consultation with representatives of the Ministry of Health, the London County Council and the Metropolitan Branch of the Society of the Medical Officers of Health, it has been agreed that, in view of the much higher mortality of measles, and its far greater destructive effect on child life, the present practice of always admitting scarlet fever in preference to measles shall be abandoned: that in lieu thereof there shall be a definite allocation of beds for the two diseases; that the allocation shall be revised periodically in relation to the requirements of the moment and that in times of measles prevalence the larger proportion of accommodation shall be allocated to measles." " . . . the effect of this decision will be that, when the incidence of infectious disease is such that the Board can admit all cases they are asked to receive, so far as scarlet fever is concerned, no alteration of the present arrangement will be necessary. Any medical practitioner will be able, as at present, to secure the removal of a case by direct application to the Head Office of the Board or the nearest ambulance station, and, in the case of measles, the revised arrangement will enable the medical practitioner to secure the removal of a patient to hospital with the same facility as in the case of scarlet fever. When, however, the number of beds available becomes short and, say 75 per Cent. of the accommodation set apart for the two diseases is exhausted, any person desiring the admission of a case of either scarlet fever or measles will be referred to the Medical Officer of Health with a view to his selecting those cases which, in his opinion, should be received into hospital having regard to all the circumstances.'' This information was circulated to all medical practitioners in the Borough and it was pointed out to them that the following points were considered of importance in guiding the Medical Officer of Health in coming to a decision where, when there is a shortage of beds for either disease, the circumstances of a case warranted the removal to Hospital:— 97 (a) The selection of the cases should be based on the type of home, and home conditions, rather than type of case (whether or not patient can be reasonably isolated at home). (b) The age of patient. (c) Whether wearing apparel is made or homework done on the premises. (d) In cases of measles whether there are any facilities for home nursing. (e) Whether there are any members of the family employed in the handling of food or milk. During the year 135 cases of Measles were admitted to M.A.B. Hospitals from the Borough. PUBLIC HEALTH (PNEUMONIA, MALARIA DYSENTERY, AND TRENCH FEVER) REGULATIONS, 1919. Pneumonia. 542 cases of Acute Primary and Acute Influenzal Pneumonia were notified during the year, 135 of the patients being treated in hospitals. 155 deaths from these diseases occurred. Malaria. One case of Malaria was notified during the year. Patient was treated in Hackney Road Hospital. Dysentery. No cases of Dysentery were notified. Trench Fever. No cases of this disease occurred during the year. ALTERED DIAGNOSIS CASES. 161 patients who had been notified as suffering from infectious disease were later certified to be suffering from some condition other than that which was notified:— 98 94 Scarlet Fever; 65 Diphtheria; 1 Enteric Fever; and 1 Acute Poliomyelitis. The final diagnosis in the 94 Scarlet Fever cases was:— Tonsillitis 6 Erythema 15 Measles 7 Diphtheria 2 Nephritis 1 Appendicitis with Peritonitis 1 Urticaria and Rheumatism 1 Disease not specified 61* 94 *These were reported "Negative case," "Not notifiable," etc. The final diagnosis in the 65 Diphtheria cases was:— Tonsillitis 22 Laryngitis 14 Erythema multiforma 1 Measles 1 Scarlet Fever Encephalitis Lethargica 1 Vincent's Angina 1 Conjunctivitis 1 Catarrh 1 Broncho-pneumonia 1 Quinsy 1 Disease not specified 19* 65 *These were reported "Negative case," "Not notifiable." etc. The patient notified as suffering from Enteric Fever was later certified to be a "negative case." The patient notified as suffering from Acute Poliomyelitis was certified as suffering from "Tubercular Meningitis" and not Acute Poliomyelitis. 99 CANCER. The number of deaths from Cancer is increasing year by year, the figures for the last five years being:— Year. Males. Females. Total. 1923 113 90 203 1924 115 96 211 1925 104 87 191 1926 122 93 215 1927 120 120 240 Number of Heading in International Manual. Site of Primary Growth. Males. Females Totals 43 Buccal cavity 13 4 17 44 Pharynx, Oesophagus, Stomach, Liver and annexa 58 39 97 45 Peritoneum, Intestines and tum 18 24 42 46 Female Genitai Organs — 22 22 47 Breast — 17 17 48 Skin — — — 49 Other or unspecified organs 31 14 45 Totals 120 120 240 Note.—One Male death certified as "Scarlet Fever, Lobar Pneumonia, Sarcoma of muscle, " is not included above. In Table II, facing p. 14, the death has been assigned to Scarlet Fever. OPHTHALMIA NEONATORUM. Cases of this disease are visited immediately after notification. A complete summary of cases notified and visited is given in the Section of this report dealing with Maternity and Child Welfare. In cases of true Ophthalmia Neonatorum every endeavour is made to secure the removal to hospital of the patient and mother. 100 DISINFECTING DEPARTMENT. Wrappers for Infected Articles. The Public Health and Housing Committee approved of the provision of strong sheets as wrappers for conveying bedding, clothing, etc., from infected premises to the Disinfecting Station. These wrappers are disinfected at the same time as the articles, and the disinfected articles are placed in the same wrapper for return. Rooms and Articles (Infectious and Verminous) Disinfected. The following figures give the number of rooms and articles disinfected:— Premises. Rooms. Beds. Mattresses Pillows. Bolsters. Various. Totals. Infectious Disease 1276 1523 1197 268 2457 846 12697 17465 Verminous & Miscellaneous 68 200 135 84 254 91 1453 2017 Totals 1344 1723 1332 352 2711 937 14150 19482 Pulmonary Tuberculosis 269 288 45 21 122 43 437 668 Totals 1613 2011 1377 373 2833 980 14587 20150 Other articles also passed through the Council's apparatus:—Disinfectors' clothing, overalls, drop-sheets, etc., to the number of 3,707, and 7,515 articles of clothing from verminous persons were disinfected and 1,015 other articles; making a total of 32,387 articles. 164 articles were destroyed at the Council's apparatus on request. ELECTROLYTIC DISINFECTANT FLUID. The electrolytic disinfecting fluid as manufactured contains approximately 8—9 grammes per litre of free chlorine and is broken down to a etrength of approximately 4 grammes per litre for distribution. During the year 1927, 76,538£ gallons were manufactured. 148,635 gallons of the weaker solution were produced, of which 147,655 gallons were distributed. The production of the solution at a strength of 4 grammes of available chlorine per litre has averaged 141,200 gallons per annum for three years at an average annual cost of £2,921, the cost per gallon thus being approximately 5d. 101 Distribution of Fluid. The fluid was distributed as follows:— galls. Violet Road Depot 70,367 Bickmore Street Depot 15,735 Old Ford Road Depot 9,175 Ford Road Depot 7,125 Trego Road Depot 6,670 Stebondale Street Depot 7,070 Millwall Depot 1,515 Public Health Offices 105 Poplar Baths 5,683 Bow Baths 4,520 Island Baths 2,635 Violet Road Baths 48 Wick Lane Baths 602 Empson Street Baths 475 Open Air Bath, Bromley 1,200 Poplar Town Hall 77 Bromley Public Hall 117 Works Department 245 Guardians' Offices 239 Poplar Institution 7,026 Langley House 252 Poplar Training School, Hutton 82 Public Libraries 596 Used at Council's Cleansing Station in baths of verminous persons 308 London County Council Schools 2,793 Mortuary, High Street, Poplar 582 Tuberculosis Dispensary 24 Royal College of St. Katharine 144 Council Offices, Poplar 158 Finance Department Offices 78 Kingsley Hall 51 Simpsons Road Clinic 87 M. and C. W. Centre, Wellington Road 21 Artificial Sunlight Clinic, Avenue Road 3 Howrah House Convent 164 Bow Relief Offices 129 S. Mildred's House 21 Sold to Private Firms in Borough, etc. 1,533 147,655 102 Total quantity of water used for all purposes, 332,000 gallons, cost £11 19s. Id. Cost of Materials and Electricity. The cost of materials and electricity for manufacturing the electrolytic fluid was as follows:— £ b. d. Electricity, 20,717 units at 1½d. per unit (with 50-65 per cent, advance) 197 5 9 Chloride of Magnesium, 7 tons, 10 cwts. 1 qr. 25 lb 48 6 7 Salt, 27 tons 100 12 0 Caustic Soda, 20 cwt. 2 qr. 8 lb. 30 17 0 Water (76,538½ gallons) 2 15 3 Bottles, Corks and Labels. Bottles 20 14 0 Corks 12 10 0 Labels 3 0 0 £36 4 0 Total cost of materials and electricity to produce 76,538½ gallons (strong); broken down to 148,635 gallons 379 16 7 Electric motor for stirring; 466 units 4 8 6 103 Total Quantity Manufactured since Installation of Plant, Since the installation of the plant, a period of 22 years, 1,033,720 gallons of fluid have been manufactured (see footnote) at a cost for electricity of £1,782 12s. 1½d., and materials of £2,080 9s. lid. Year. Output, gallons. Materials, Chloride of Magnesium, Salt, Caustic Soda and Water Cost. Electrioity. Total. £ s. d. £ 8. d. £ s. d. 1906 17,000 17 12 5 15 17 10 33 10 3 1907 15,586 14 16 9 14 13 2 29 9 11 1908 28,280 27 14 7 28 7 10 56 2 5 1909 27,216 23 4 7 29 17 n 53 2 21 1910 50,726 47 11 10 50 10 6 98 2 4 1911 53,063 50 17 9 56 16 n 107 14 41 1912 54,388 41 7 10 59 14 H 101 2 21 1913 66,740 62 7 3 71 0 101 133 8 11 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 61 120 1 101 1918 30,750† 114 5 9 51 2 8 165 8 5 1919 33,285† 139 4 0 77 7 9 216 11 9 1920 39,255† 153 11 4 105 7 3 258 18 7 1921 51,330† 220 7 10 134 18 8 355 6 6 1922 56,520† 166 0 1 119 13 9 285 13 10 1923 64,740† 118 0 7 123 11 3 241 11 10 1924 70,350† 132 7 2 136 2 5 268 9 7 1925 72,165† 145 10 5 133 13 9 279 4 2 1926 65,317½† 177 8 5 168 3 2 345 11 7 1927 76,538½† 182 10 10 197 5 9' 379 16 7 Totals 1,033,720 £2,080 9 11 £1,782 12 1½ £3,863 2 0½ 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 ,, 1927 147,655 „ 104 Electrolytic Disinfecting Fluid. Estimate for Year ended 31st March, 1927. Expenditure for Year ended 31st March, 1927. Average Expenditure for 3 years ended 31st March, 1927. Estimate for Year ending 31st March, 1928. Estimate for Year ending 31st March, 1929. Wages Rates and Insurance—Main Depot Rent (Issuing Depots) Electricity and Water Chemicals Testing Apparatus Bottles, Carboys, Hampers, Corks, etc. Overalls and Clogs Issuing Conveyance Supervision of Plant Repairs and Renewal of Plant Repairs (Works Dept.) Main Depot ,, ,, Issuing Depots Petty Expenses and Sundries Capital Account—Cost in excess of Loan Leas Income £ 1470 82 36 250 250 125 - 15 10 80 99 5 - 2422 35 £ 2387 £ 1600 108 34 259 165 124 - 15 96 64 109 1 - 2575 26 £ 2549 £ 1565 107 34 185 158 122 75 15 61 170 138 1 28 2659 28 £ 2631 £ 1467 109 36 200 200 120 - 15 10 50 100 5 - 2312 30 £ 2282 £ 1291 108 39 220 204 5 75 9 - 15 50 22 11 3 - 2052 25 £ 2027 105 Spraying and Cleansing Floors of London County Council Schools with Electrolytic Disinfecting Fluid. 2,793 gallons were supplied to ten London County Council 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. 5,683 gallons were supplied to the Poplar Baths, 4,520 gallons to the Bow Baths, 2,635 gallons to the Island Baths, and 1,200 gallons to the open-air swimming baths, making a total of 14.038 gallons. VERMINOUS CHILDREN ATTENDING SCHOOLS, LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1907. CHILDREN ACT, 1908. Number of Verminous Children Bathed. Quarter. Number of Children Cleansed. Total number of Cleansings. Amount. 1927. £ s. d. March 396 477 42 15 0 June 262 321 29 8 0 September 298 327 31 1 0 December 346 376 36 0 0 Totals 1,302 1,501 £139 4 0 In 1,308 of the cleansings a special comb was used. (274 boys, 1,034 girls.) Cleansing Station. To enable the heads of children to be properly cleansed, a sink with a hot and cold water spray has been installed. Miss Davies made 302 visits in connection with verminous schoolchildren—123 Poplar, and 179 Bow and Bromley. For cleansing of verminous rooms, see table facing page 34. 106 Scabies. Miss Davies made 98 visits in connection with children suffering from Scabies—67 Poplar, and 31 Bow and Bromley. Arrangements were made for the children to be bathed, and for bedding and clothing to be disinfested. CLEANSING OF PERSONS ACT, 1927. During the year, 110 persons—including 82 (57 men and 25 women) from common lodging houses (see below)—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 and Seamen's Lodging Houses Within and Without the Borough. The number of persons from Common Lodging Houses and Seamen's Lodging Houses within and without the Borough of Poplar, cleansed at the Council's Cleansing Station, Glaucus Street, during the year was:— Lodging House. Male. Female. Total. 196, Bow Road 4 — 4 215, Bow Road — — — St. James's Chambers, 207, High Street, Poplar 5 — 5 65, Bow Lane — — — 378, Old Ford Road — — — 38, Pennyfields — 9 — 9 From Common Lodging Houses without the Borough of Poplar— Whitechapel 48 25 73 Totals 57 25 82 107 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. (а) Borough Tuberculosis Dispensary.—1, Wellington Road, Bow, E.3. (b) Staff— Tuberculosis Officer: W. C. P. Smith. Asst. Tuberculosis Officer: C. K. Cullen. 3 Health Visitors. 1 Dispenser. 1 Care Secretary. 1 Clerk. 1 Asst. Clerk. I Part-time Helper (female). I Caretaker. (c) Residential Institutions:— (a) Sanatoria, Hospitals and Homes available under the London County Council scheme for both pulmonary and non-pulmonary cases. 108 (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. (iii.) The nature and extent of co-operation with general and special hospitals, school clinics, and other institutions. (а) General Hospitals.—The Dispensary is "linked" to the London Hospital under the London County Council scheme for consultative purposes. Cases of lupus are sent to the London Hospital for special treatment by means of the Finsen light and general phototherapy. These cases are treated on the authority of the Tuberculosis Officer, the cost of treatment being charged to the Borough Council. During the year 2 new cases and 4 old cases have been undergoing this treatment, a total of 109 applications of one or other form of light having been given. (b) Special Hospitals. —The Tuberculosis Officer is visiting physician to the tuberculosis wards of St. Andrew's Hospital. Patients requiring refills following upon the induction of artificial pneumothorax are by arrangement sent to either Brompton or Victoria Park Hospitals, a charge of 10s. being made for each refill. Four patients have attended for this purpose receiving altogether 61 refills. Non-pulmonary cases suitable for artificial sunlight treatment are by agreement sent to Victoria Park Hospital. This arrangement has not been found to work well, as owing to the frequent attendances required, the distance to be travelled and the somewhat inconvenient time of the sessions, patients and especially parents of child patients, have not been able to afford the necessary time. It is a matter for regret that the Council's own light installations should not be available for these cases. 109 (c) School Clinics.—Ailments or defects other than tuberculosis discovered in children of school age are brought to the notice of the Divisional School Medical Officer who arranges for the child's examination and necessary treatment. Co-operation with the School Medical Service as explained in previous reports continues to work satisfactorily. Some 110 children, either "unsatisfactory children" or contacts have been dealt with under this scheme. (iv.) Any special arrangements made to secure the co-operation of medical practiitoners and the working of the arrangements for periodical reports on insured patients under domiciliary treatment. On receipt of a notification the Tuberculosis Officer at once communicates with the notifying practitioner offering his assistance in dealing with the case and calling attention to the services the Care Committee may be able to render the patient and his family. In all cases where patients are referred to the Dispensary a report is sent to the practitioner, and where necessary arrangements are made for treatment. 695 reports of this kind have been sent during the year. Co-operation with insurance practitioners continues under the scheme which has been explained in previous reports and close touch with panel doctors had been maintained by means of the customary forms. 367 reports have been sent to, and 166 received from panel doctors in respect of patients having "domiciliary" treatment. 244 patients were on "domiciliary" treatment on December 31st. (v.) The arrangements for following up patients in cases where the diagnosis is doubtful. Cases in which a diagnosis cannot be arrived at after a reasonable period of dispensary observation are referred to the London County Council for admission to Brompton or Victoria Park Hospitals for further investigation. Cases of doubtful non-pulmonary tuberculosis are sent to the London Hospital. In other doubtful cases, where admission to hospital is not considered necessary arrangements are made for the patient to attend the dispensary after a lapse of a suitable period of time so that the case can be reconsidered. 110 (vi.) The arrangements for securing the examination and systematic supervision of ' 'home contacts.'' A list of all contacts is prepared by the Health Visitor of the district concerned, who arranges for their attendance at a convenient time for examination and where necessary re-examination. All contacts of school age are dealt with in co-operation with the School Medical Service. 297 contacts were examined, 107 being adults and the remainder children. In addition a number of unexamined contacts were reported to the Divisional School Medical Officer. (vii.) Information as to special methods of diagnosis and treatment in use and the number of persons to whom these special methods have been applied. The X-Ray apparatus has continued in use for diagnostic purposes. No special form of treatment has been in use. (viii.) The results of local experience as to the relative value of each form of treatment. See (vii.) (ix.) The nature and extent of any dental treatment provided by the Council for tuberculous patients. Patients requiring dental treatment are referred to the Council's Dental Clinic, a special session for tuberculous patients being held weekly, with a gas day once a month. Particulars of the number of patients dealt with and the work carried out will be found in the Dental Surgeon's return. Arrangements for defraying the cost of dentures are made by the Care Committee. (x.) Any arrangements for the provision 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. 111 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. 72 patients have been in receipt of extra nourishment for varying periods during the year, of these 28 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 diawn at Simpsons Road, Poplar, instead of at the Dispensary. (xi.) The arrangements for treating non-jpulmonary tuberculosis, especially tuberculosis of bones and joints in adults and in children, and for the provision of surgical apparatus, etc. Non-pulmonary cases which can suitably be treated as out-patients are referred for treatment to the London Hospital under the arrangement already refered 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; other cases for light treatment are referred to Victoria Park Hospital. One female patient was sent to Dr. Rolliers Clinic at Leysin, Switzerland, in February and is still under treatment there. No special arrangements exist for the provision of surgical apparatus. Generally speaking, what is required is provided through the Almoner's Office of the hospital where the patient has been under surgical treatment. In the event of any difficulty, the matter would be referred to the Care Committee for them to deal with. (xii.) The arrangements for "care" and "after-care" and their working. Care and after-care are in the hands of the Tuberculosis Care Committee. The Secretary reports as follows:— 112 " The Tuberculosis Care Committee, consisting of representatives of Public Authorities and charitable agencies, meets fortnightly at the Dispensary. During 1927, 22 meetings were held, and 372 cases were considered. " 186 recommendations regarding assessment for institutional treatment were submitted to the London County Council. 20 dental cases were considered, and 58 "special cases" dealt with. "The work of the Care Committee mainly consists in consideration of problems arising out of the social and economic aspect of tuberculosis. Of great assistance to the Committee during 1927 was the Poplar Tuberculosis Fund—the voluntary fund for helping persons suffering from tuberculosis, or their relatives—which was inaugurated in 1926, but not drawn upon until January, 1927. The Committee have had to go very carefully at first, the Fund being still in its infancy, but it was possible during the year to give direct assistance to 14 patients. Clothing was provided in 6 cases, assistance given towards cost of removal to houses outside London in 2 cases, and part-cost of dentures paid in 2 cases. A holiday was made possible for a mother after the death of a daughter who had been nursed at home with surgical tuberculosis for many months; a deck-chair was bought to enable a patient to sit out in his garden; fares to visit a relative were allowed in a case where it was specially necessary, and some general expenses were paid for a patient in Switzerland. Assistance is only given in those cases in which it is not possible to get help from any other agency. During the year, the Committee have made several efforts to increase the Fund, and were fortunate in August, 1927, in obtaining a weekly contribution from the Poplar Hippodrome in respect of Sunday Cinematograph Exhibitions. In November, a successful Household and Jumble Sale was held in aid of the Fund. "The Tuberculosis Care Committee are very grateful to the Poplar Board of Guardians for their continued assistance in helping patients known to them with clothing for sanatorium, with dentures, and in many other ways; and also for sending several patients to Papworth Colony, and providing sanatorium treatment for patients ineligible for further residential treatment through the London County Council. They are also grateful to the Council for the provision of beds, bedding and shelters, and for having taken up the case of one patient who was specially recommended for treatment in Switzerland, and was sent by the Council to Leysin in February, 1927. 113 "The Care Committee also wish to acknowledge the useful work of the Invalid Children's Aid Association in visiting and convalescing children, and to express their gratitude to the British Red Cross Society and the United Services Fund for assistance given to ex-Service men and their families. "Although a few tubercular patients have been fortunate during the year in moving into Council flats or houses and thereby improving their home conditions, the housing problem still remains a great difficulty. The London County Council have given special preference to people suffering from tuberculosis for houses on their Estates at Becontree and Downham; but the high rents and inaccessibility as regards work prove a difficulty in many cases, and many families who have made the move have, unfortunately, been in financial distress since, particularly Army pensioners who have had their pensions reduced. "The difficulty of assisting ex-sanatorium patients to find light work remains as great as ever. "The Poplar Tuberculosis Care Committee is represented on the Standing Conference of Metropolitan Borough Tuberculosis Care Committees, which has met twice during the year. " (xiii.) Particulars as to any local arrangements for finding employment for patients. No special arrangements exist for finding employment for patients. The Employment Exchanges have not proved of any service. For patients who are not capable of competing in the open market, some special organisation, such as the Spero workshops, appears to offer the best chance of employment under existing conditions. (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 4 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 (i.e., occupation). No special occupational incidence has been noted. 114 (xvi.) Any special methods adopted or proposed for the prevention of tuberculosis. No special methods have been adopted beyond those already mentioned in previous Reports. (xvii.) Special difficulties encountered. The lack of suitable employment for patients and of suitable accommodation for badly-housed patients and their families continue to be the chief difficulties encountered. STATISTICS FOR 1927. Attendances at Dispensary (Insured, 1,989; Uninsured, 3,633) 5,622 New patients examined 1,277 Contacts examined 297 Notifications by Tuberculosis Officer :— Pulmonary, 151; Non-pulmonary, 31 182 Patients sent away for Sanatorium Treatment 264 Patients away in Institutions 31st December 95 Patients receiving Domiciliary Treatment, 31st December 244 Patients receiving Dispensary Treatment, 31st December 146 Under observation, pending diagnosis, 31st December 49 In receipt of extra nourishment during the year 72 In receipt of extra nourishment, 31st December 28 Health Visitors' visits 7,997 Doctors' visits 189 Sputum examinations made (for Dispensary, 1,825; for Public Health Department, 348) 2,173 Reports sent (to Practitioners, 695; to Public Authorities, 1,195) 1,890 W. C. P. SMITH, Tuberculosis Officer. Tuberculosis: Treatment at Leysin. At the request of the General Purposes Committee of the Council, arrangements were made by the Public Health Committee to send a patient (suffering from tuberculous spine and hip) to Leysin. The patient proceeded to Leysin on the 14th February, accompanied by Dr. Smith, the Tuberculosis Officer, who, upon his return, submitted a report with his observations on Leysin. Medical reports on the progress of the patient have been received from time to time, and Dr. Smith believes there is a definite improvement in the patient. 115 TUBERCULOSIS DENTAL CLINIC. Report of Dental Surgeon. Mr. C. Hammond Williams, Dental Surgeon, submitted the following report:— I have the honour to submit my Annual Report of the work carried out at the Tuberculosis Dental Clinic for the year 1927. The following are the figures, showing the work done:— 51 Sessions have been held. 57 New Patients have attended. 192 Total Attendances. 63 Fillings. 317 Extractions. 66 Scalings. In addition dentures have been supplied and minor treatment performed. The old difficulty of the coincidence of sanatorium and dental treatment still exists; it seems that this cannot be overcome. Similar difficulties in relation to the change of premises as occurred in connection with the Maternity and Child Welfare Dental Clinic, arose in this instance, which tended towards a slowing up of the work for a time. But the advantages of the new premises are apparent now that we are properly installed. Great care continues to be exercised in disinfecting and ventilating the rooms after each Session. This applies also to the equipment and instruments. Again may I take the opportunity of thanking all those who have always assisted in the work at the Clinic. C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. 116 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications received during the period 2nd January, 1927, to 31st December, 1927. 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 - 3 2 1 10 18 26 30 28 7 5 130 234 - 1 - 1 1 15 134 21 117 Females — 1 7 4 16 22 24 12 6 4 2 98 177 — — — — — 10 92 19 81 Non-Pulmonary— Males 4 13 9 7 8 3 2 1 - - 47 84 - 1 2 3 9 3 12 5 9 Females 1 9 7 7 4 2 2 1 — — 1 34 48 — 1 — 1 1 4 20 4 20 Totals 5 26 25 18 38 45 54 44 34 11 8 309 523 — 3 2 5 11 32 258 49 227 New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, during the period 2nd January, 1927, to 31st December, 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 — 3 Females Non-pulmonary— Males 1 _ _ 1 2 Females - — — — — — — - - - - - Source of information—Death returns. 118 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. Summary of Quarterly Returns to the London County Council. Number of Cases on Register at commencement of quarter Quarter ended 1 March. June. September. December. 3,844 3,863 3,883 3,905 Number of New Cases notified 78 83 86 67 Number of Cases removed from Register 59 63 64 92 Number of Cases on Register at end of quarter. Pulmonary 2,500 2,609 2,528 2,604 Non-Pulmonary 1,363 1,374 1,377 1,376 Totals 3,863 3,883 3,905 3,880 119 Particulars of new cases of Tuberculosis and of all Deaths from the disease:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under X .. — — 5 1 — — 4 1 1 3 1 13 9 1 — 9 5 5 3 7 10 8 — — — 1 10 1 4 9 7 1 — 3 — 15 10 16 8 4 5 8 — — 20 18 22 3 2 [31 36 2 1 25 26 24 2 2 35 32 12 1 1 21 12 — — 45 28 6 1 — 129 10 — — 55 8 4 65 and upwards 5 2 — 1 6 2 1 1 Totals 134 98 52 35 94 68 19 9 Section VII. MATERNITY AND CHILD WELFARE. 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. 120 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 Wesleyan Mission, Old Ford Road Christ Church Schools, Manchester Road 54, West Ferry Road Avenue Road, Bow (Transferred to Wellington Road, Aug. 5th, 1927.) Maternity Child Welfare Centre, Wellington Road, Bow (b) Provided by the Royal College of St. Katharine— 228-230, Brunswick Road The Lighthouse Mission, Blackthorn St. Trinity Hall, Auguata Street Medical Officer's, Weighing and Waiting Rooms (Weighing room also used for Artificial Sunlight Treatment) Ditto and Dental Clinic (Weighing and Waiting Room combined) Medical Officer's, Weighing and Waiting Rooms Ditto Ditto Ditto Artificial Sunlight Clinic and Waiting Roon Medical Officer's, Weighing and Waiting Rooms, Dispensary Dentist's Room, Recovery Room, Artificial Light Room 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 Medical Officer's Room and Large Hall for weighing and waiting 1 Ditto Ditto Ditto Wednesdays, 10.30 to 12.30 and 2—4 p.m. 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. Tuesdays, Thursdays and Fridays, 2—4 p.m. Ante-natal—Fridays 10.30 to 12.30. Dental Clinic—Wednesdays 10—12 Tuesdays and Wednesdays, 2—4 p.m. Fridays, 2 to 4 p.m. Sewing Class, Mondays, 2—4 p.m. Light treatment, Mondays, Wednesdays and Fridays, 9.30 to 12.30 and 2.30 to 4.30. Dental Clinic, Wednesdays, 10—12. Transferred from Old Ford, Aug. 3rd. Artificial Light Clinic. Transferred from Avenue Road, Aug. 5th. Special Consultation, Friday, 2.30—4.30. Tuesdays, Thursdays and Fridays, 2 p.m. Sewing Class Wednesdays, 2 p.m. Dental Clinics—Mondays, 1.30 and 3 p.m. Antenatal Tuesdays, 10 a.m. Light Treatment— Mondays to Fridays, 9.30 to 12.30 and 2 to 4 .30 p m. Tonsil Clinic twice monthly. Wednesdays, 2 p.m. Wednesdays. 2 p.m. 121 The work of this section of the Department has increased immensely since 1920, as will be seen by the number of attendances at the Centres: — Borough Council. Royal College. 1920 14,490 13,147 1921 15,710 9,856 1922 17,404 8,992 1923 24,058 11,718 1924 27,137 13,598 1925 31,540 17,809 1926 35,084 20,473 1927 36,110 23,588 Oil page 120 will be found a list of the Maternity and Child Welfare Centres in the Borough, together with the days and hours of clinics and the accommodation available in each. The Clinic accommodation on the Island has been given further consideration during the year. As it was not possible to find a site for the erection of a new Centre (and the Ministry of Health had intimated they were not prepared to sanction further loans for this purpose, at the present time), enquiries were made to find suitable accommodation, which could be rented. The conditions at Christ Church were bad in the extreme. During the latter part of the year negotiations were entered into with the Church Authorities of the Cubitt Town Primitive Methodist Church, Manchester Road, and an Agreement for one year was drawn up for the use of the premises (except the Church) for one day per week (morning and afternoon sessions) at a rental of £80 per annum, with the additional payment of 2s. 6d. per session to the Caretaker. The sanction of the Ministry of Health was received on 31st December, and arrangements were made for the transfer of the Clinic held at Christ Church to the new premises early in 1928. The other clinic on the island, namely, that at 54, West Ferry Road, is rented by the Council. 122 MATERNITY AND CHILD WELFARE CENTRE AND OBSERVATION WARDS, WELLINGTON ROAD. This centre was officially opened by His Worship the Mayor (Alderman T. J. Goodway, J.P.) on the 8th November, 1927, and the first patients were admitted on the 11th November, 1927. Plans of these buildings were included in last year's annual report. The construction is of brickwork, the first floor and flat roofs being of steel and concrete covered with asbestic composition and asphalt. The front part, facing Wellington Road, is a two-storey building in red brickwork with patent stone dressings, and a feature is made of the Borough Arms in a circular panel in the centre of the front elevation. The one-storey buildings are finished in rough-cast with ornamental white cement surrounds to doors and windows. The flat roof, protected by iron railings and approached by a stone staircase from a central point near the children's wards, is intended to be used for open air treatment Observation accommodation for ten children is provided in two five-cot wards with nurses' duty room and milk laboratory adjoining, along with an isolation ward with separate sanitary arrangements. The ward windows are glazed with patent "Vita" glass. There are also wellequipped Dental and Artificial Sunlight clinics and a small detached establishment laundry. The administrative building comprises on the ground floor a large up-to-date kitchen with scullery, larders, stores, etc., adjoining, living rooms for nurses, and maids' and matron's rooms. On the upper floor are nine bedrooms and two bathrooms. An exit is provided to the flat promenade roof at rear. The furnishing and equipping of the building was left in the hands of the Medical Officer of Health. With the approval of the Ministry of Health Dr. H. St. H. Vertue of Guy's Hospital (who is also on the medical staff of the Royal College of St. Katharine) and Dr. D. G. Macrae, 1, Bow Road, were appointed consulting physician and emergency medical officer respectively. The resident staff comprises Matron, Sister, two Staff Nurses, two Probationers, a Cook and Housemaid. There are also a non-resident 123 porter and cleaners. The appointment of a third probationer may be necessary when all the beds in the wards are occupied. The Dental (Maternity and Child Welfare and Tuberculosis) and Bow Artificial Sunlight clinics were transferred to the new centre at the beginning of August and one of the Infant Welfare clinics was transferred from Old Ford early in 1928. From the 11th November to the end of the year 10 patients were admitted to the wards for treatment and 8 were remaining at the end of the year. The scheme for admission of cases to the wards is as follows:— Scheme for Admission to Wards. (1) Dr. Vertue, the Consulting Physician, will be in attendance at the Ward on Friday afternoons, from 2.30 p.m. till 4.30 p.m. (2) Admissions to the Wards are to be confined to infants suffering from marasmus, prematurity, debility at birth, atrophy, inanition, disorders of digestion and other like ailments. In special cases a mother and baby may be admitted for the purpose of the establishment of breast feeding. Cases may be recommended for admission by the Medical Officers of the Welfare Centres of the Borough. The final decision as to admission in any particular case will rest with the Consulting Physician in charge of the Wards. (3) The cases are to be selected by the Clinic Medical Officers, who will address a communication to Dr. Vertue (the Consulting Physician at the Wards, Wellington Road), giving their reasons for so referring the patient and stating whether it is a case for: (a) Possible admission to the Wards, or (6) Opinion only. The letter will be handed to the parent, or Guardian, with instructions to take it, together with the patient, to the Observation Wards, Wellington Road, Bow, on Friday afternoons, at 2 p.m. prompt. When it is suggested that a child should be admitted to the Ward?, the Clinic Medical Officer, or Health Visitor, must point out to the parent, 124 or guardian, that if the family income exceeds a certain scale they must be prepared to contribute (anything from Is. to 8s. per week according to income) towards the maintenance of the child while in the Wards. The parent, or guardian, is to be warned to be prepared to leave the child in the Wards if the Consulting Medical Officer so advises. (4) A history sheet is to be completed and forwarded to the Medical Officer of Health in sufficient time for transfer to the Consulting Physician before the child is seen by him. (5) Upon admitting a patient to the Wards, the Matron will obtain from the parent, or guardian, particulars as to past and present feeding, the present condition of the patient (marks on body, rashes, deformities, etc.) and illnesses. These particulars will be attached to the history sheet. The Matron will give to the parent, or guardian, a leaflet giving certain information as to visiting, removal of patients, etc. (6) The Matron will inform the Medical Officer of Health immediately of the name and address of all patients admitted. (7) The Medical Officer of Health will obtain particulars of income of family for the purpose of assessment, and will assess each case, so that payments may be commenced without delay. All assessments will be submitted to the Committee at the first available meeting for their confirmation. (8) After assessment the parent, or guardian, and Matron will be informed. (9) The Matron will notify the Medical Officer of Health of the probable day of discharge to enable the Health Visitor to resume touch with the case. In cases where it can be afforded, parents are required to pay towards the maintenance of their children and in this connection an income scale submitted by the Ministry of Health has been adopted as a general 125 standard. Care is, however, taken that the payment asked for does not act as a deterrent when admission to the wards is desirable on other grounds. The Maternity and Child Welfare Committee approved of rules for the nursing staff and for the general management of the centre. A visiting sub-committee, consisting of two members of the Maternity and Child Welfare Committee is appointed monthly to visit the Centre. REPORT OF CONSULTING PHYSICIAN. Report of Dr. H. St. H. Vertue, Consulting Physician at the Maternity and Child Welfare Observation Wards. The first clinic was held on the 11th of November, and subsequent clinics on every Friday afternoon, totalling eight. The cases in the Observation Ward were visited on each occasion; and in addition, extra visits were paid at least once weekly to observe the progress of the cases that had been admitted. Both Out-patient and In-patient cases were seen. Out-patients.—The number of separate cases seen was 9. Of these some were seen once only; others were referred for two or more visits, for the purpose of further observation. When the observations were complete, the cases were sent back to their clinic Medical Officers with a letter detailing the results, and making any suggestions that seemed suitable for further treatment. The 9 cases comprised the following:— Failure of Lactation 3 Rickets 2 Food Refusal 1 Nervous Child 1 Congenital Amyotonia 1 Mongolism 1 9 126 In-patients.—There were 10 admissions to the Ward, comprising 9 new admissions and 1 re-admission. The nature of the cases was as follows:— Primary Diagnosis. Contributory. Result. 1. Dyspepsia due to Mismanagement of Artificial Feeding. Malnutrition. Recovery. 2. Ditto ditto ditto. 3. (i) Ditto (i) Mikrokephaly. (i) Admitted Andrew's with Acute chitis. to St. Hospital Bron- 4. (ii) Ditto, re-admitted. (ii) ditto. (ii) Recovery. 5. Failure of Lactation. Dyspepsia on Artificial Feeding. Partial re-establishment Recovery. 6. Dyspepsia, due to Mismanagement of Artificial Feeding. Nervous Unrest. Recovery. 7. Ditto. — ditto. 8. Malnutrition from Mismanagement of Artificial Feeding. ditto. 9. Dyspepsia from Mismanagement of Artificial Feeding. ditto. 10. Ditto. — ditto. The disturbance of digestion was in several cases considerable and long-lasting. All of them, however, made a perfect recovery; and none was discharged until the digestive functions were restored and the child was able to take a diet which it was within the mother's capacity to obtain and prepare. All left in a good state of vigour and nutrition. I append a list of the numbers of each diagnosis:— (1) Dyspepsia due to mismanagement of artificial feeding 8 (2) Malnutrition from mismanagement of artificial feeding 1 (3) Failure of lactation 1 10 127 The Work of the Staff.—The Ward-staff has worked very well. A keen interest has been shown in the problems of Infant Welfare. Good nursing has been the rule. The infants admitted have not only been restored to normal functions, but also in the case of the feebler children, their whole appearance has been transformed. It is pleasant to note that those soothing and educative influences are at work on the children, which are quite as important for their future health as scientific accuracy in feeding and so forth. In addition to the treatment of the children, the parents have been invited to the Ward to learn the details of management and feeding from the staff. This is considered an important part of the work. Further Remarks.—The Observation Ward has been in existence such a short time, that it is premature to make any observations on the number and class of cases, or the results. H. St. H. VERTUE, M.D., Consulting Physician. Adjustment of Royal College of St. Katharine Area. The Wellington Road centre is situate just in that area of the Borough where maternity and child welfare work is carried out by the Royal College of St. Katharine. As it appeared that it was far more convenient for the mothers living in this vicinity to attend the Wellington Road centre than that of the Royal College of St. Katharine, negotiations were in progress at the end of the year for the adjustment of this area. This adjustment has now been made and has been approved by the Minister of Health. Children's Consultation Centre—London Hospital. Information was received from the London County Council that a Children's Consultation Centre had been established at the London Hospital under Dr. Maitland-Jones, a Physician on the staff of that Hospital. This Centre was established for the assistance of Medical Officers in charge of Maternity and Child Welfare Clinics in the East End of London. During the year 22 cases were referred by the Clinic Medical Officers to this Centre. 128 Below is a table giving the attendances at each of the Clinics during the year 1927 :— Bow. West Ferry Road. Christ Church. Simpson Road. p.h. Dept. Total. Royal College of St. Katharine Total. First attendances 666 121 196 310 1,293 974 Infant consultations 10,714 2,453 5,849 6,732 25,748 15,717 Average per session 70.0 48.09 57.3 64.7 62.8 67.1 Average attendance of each child 11.4 11.1 14.3 12.6 12.2 — Dental Clinic 741 — — — 741 833 Average per Session 14.5 — — — 14.5 11.5 Ante-natal Clinic .. 743 — — 199 942 634 Average per session 14.5 — — 16.6 15.0 13.7 Sewing Class — 397 — 539 936 444 Light Centre 2,846 — — 3,604 6,450 2,975 Average attendance 10.2 — — 15.0 12.6 9.0 Garden attendances — — — — — 1,942 Mothers'Clinic — — — — — 69 Total attendances at all Clinics:— P. H. Department 36,110 Royal College of St. Katharine 23,588 Total 59,698 The Maternity and Child Welfare Dental Clinic, the Tuberculosis Dental Clinic, and the Bow Artificial Sunlight Clinic were transferred to the new centre in Wellington Road during 1927. Early in 1928 one of the Infant Consultation Clinics was transferred from Old Ford to Wellington Road. Miss J. M. Cardozo, Chief Health Visitor, reports as follows upon the Maternity and Child Welfare work carried out by the Staff of the Public Health Department:— Ante-Natal Clinics.—A special eSort was made during the past year in this branch of the work. The attendances at the ante-natal clinics have increased from 740 in 1926 to 942 in 1927. There is still much to be done. One of our difficulties is to get into touch with the young mother expecting 129 her first baby, but in this many of our older mothers have helped considerably by recommending and actually bringing some of these mothers to the ante-natal clinics. By means of Health Visiting and Health Talks we are gradually finding the Ante-Natal Clinics fully justified and hope soon that it will be the exception for any mother to be confined who has not previously been medically examined. Maternal Deaths.—During 1927 there were 9 maternal deaths, compared with 13 in the previous year. Only 1 of the mothers attended an Ante-Natal Clinic. Each case is personally investigated. The registered cause of death in the 9 cases was as follows:— (а) From sepsis:— 1. "Puerperal peritonitis. Abdominal operation." 2. "Puerperal septicaemia following confinement." (б) From other causes:— 1. ' 'Post partum eclampsia.'' 2. "Acute nephritis following pregnancy." 3. ' 'Pulmonary embolism following parturition.'' 4. "Shock and haemorrhage from rupture of extra-uterine pregnancy.'' 5. "Syncope. Antepartum haemorrhage, accidental type." 6. "Pulmonary embolism after operation. Placenta praevia." 7. " Shock and haemorrhage during childbirth." 130 Infantile Mortality.—The infantile mortality rate of 66 is the second lowest recorded in the Borough. Infant Consultations.—-The average attendances at these clinics have increased in spite of a very wet summer and autumn, the weather having a marked influence on the attendances at clinics. Old Ford heads the list with an average of 70 attendances per clinic. The Maternity and Child Welfare Centre, Wellington Road.—The opening of this Centre in November, 1927, proved a great asset to our work. The Infant Consultation, Ante-Natal, Dental and Light Clinics are now being held there under ideal conditions and although only a few children have as yet been admitted to the Observation Wards it is most encouraging to see the enthusiastic way in which the mothers endeavour to carry out the methods which have proved so successful in the Wards. The transfer from Christ Church, Cubitt Town, to the Methodist Chapel, Manchester Road, only took place early this year, 1928, but I feel I must mention it in this report as the new premises are so entirely satisfactory. They are warm, spacious and convenient. A complete contrast to the old quarters and they are fully appreciated. Old Ford Wesleyan Mission.—The attendances here are still very high. When the numbers reach 80—120 for one session the work is not satisfactory. The Light Clinics.—The Clinics have been well attended and good results obtained. It is due to this that the number of children needing Convalescent Treatment was considerably lower than last year. In 1926, 44 children were sent away. In 1927 only 25. ♦ The Dental Clinic is still very popular. We have always a waiting list and I am glad to say that more expectant mothers were willing to attend for treatment. 131 Zymotic Enteritis.—-During last summer only 69 cases were notified. Of these 10 were dead before the notifications were received. Of the 59 who were visited, 3 died, all under 1 year and hand-fed babies. Our thanks are again due to the Voluntary Workers who render such valuable assistance at the Clinics. I should like to mention especially some of our older mothers who come regularly to the Clinics and take charge of the arrangements for tea. Without this help it would be impossible to have this very popular addition to the Infant Consultation Sessions. Christmas Parties.—The number of mothers and children on our books is now so large that it is impossible to accommodate them at two big parties. This year we held a Tea Party at each Clinic, seven in all. This proved to be very successful especially for the Island mothers, who were saved the journey to Poplar. I should like to thank all who so kindly helped and contributed to the Party Fund. The success of our work depends entirely on the co-operation of everyone concerned—Medical Practitioners, Midwives, District Nurses, Social Workers and, most important of all, that of the parents themselves. It requires a great effort on the part of a mother who, in addition to all her household duties, finds time to bring her children to different Clinics two or three times a week. Many of the mothers who have attended regularly at Clinics for 5 years and more are now not only benefitting themselves by the teaching they have received, but are in their turn teaching others. The result of this influence is frequently met with in our work, mothers who have moved into the district being brought with their children to the Infant Consultations and young expectant mothers being advised to attend the Ante-Natal Clinics. These older mothers are our best ambassadors. The Births and Deaths Registration Act, 1926, which came into operation on 1st July, 1927, requires the registration of stillbirths in addition to live births. 132 87 Stillbirths were investigated during the year 1927. (This refers to the whole Borough.) Number of Stillbirths 87 Doctors in attendance 30 Midwives in attendance 23 Delivered in Institutions 34 B.B.A 6 Premature Births 32 First pregnancies 29 Mothers who had had previous Stillbirths:— One. Two. Three. Four. 5 1 Nil. 2 Notifications of Ophthalmia Neonatorum. Forty-eight cases of Ophthalmia Neonatorum were notified during the year:— (This table refers to the whole Borough.) Year. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths Notified. Treated. At home. In hospital. 1914 75 70 5 73 — — 2 1915 64 62 2 62 1 — 1 1916 60 60 — 60 — — — 1917 39 ** 37 1 36 1 — 1 1918 40 38 2 39 1 — — 1919 61 51 10 60 1 — — 1920 61 51 10 59 — — 2 1921 47 41 6 42 2 1 2 1922 36 33 3 34 1 — 1 1923 38 30 8 35 — — 3 1924 46 38 8 46 — — — 1925 44 39 5 42 — — 2 1926 43 35 8* 42 — 1 1927 48 44 4 48 — — — Total 702 629 72 678 7 1 15 ** 1 born in Institution—not visited, no information available. * Including 3 which occurred in Institution. 133 Cases or Ophthalmia Neonatorum Notified and Visited. (Whole Borough.) Number of notifications received 48 Died in Institutions — Sight of one eye damaged — Recovered 48 Occurred in Institutions 1 Occurred in the practice of medical practitioners 6 Occurred in the practice of midwives 41 Admitted to hospital as in-patients 3 Treated as hospital out-patients 3 Treated privately 41 Visited by nurse 9 Zymotic Enteritis, 1927. (Whole Borough.) Notifications received 69 Died before notification received 10 Not traced — Visited 59 Under 1 year (seefeeding below) 24 (3 deaths) 1 to 2 years 19 2 to 3 years 10 3 to 4 years 3 4 to 5 years 3 Admitted to or occurred in Hospital 15 Feeding. Age period. Breast. Mixed feeding. Hand-fed. Not stated Under 1 year 7 7 7 — Died — — 3 — Died before Notification received 10 Home Nursing. By arrangement with the Nursing Associations, with the consent of the practitioner attending a patient, nursing is provided and paid for by 134 the Council at the rate of Is. 3d. per visit, in cases of Ophthalmia Neonatorum, Measles, Whooping Cough, Pneumonia, Zymotic Enteritis, Pemphigus, Puerperal Fever and Puerperal Pyrexia. The following is a summary of visits paid by Nurses during 1927:— (This table refers to the whole Borough.) E.L.N.S. St. John Divine. St. Mildred's District Nurse. Totals. Cases. Visits. Oph. Neon. Cases 6 1 2 9 — Visits 40 22 33 — 95 Measles Cases Under 5 1 5 — 6 — 5-10 1 — 1 — Visits Under 5 5 76 — — 81 5-10 — 9 — — 9 Pneumonia.. Cases Under 5 13 38 — 51 — 5-10 1 12 — 13 — Visits Under 5 194 810 — — 1004 5-10 11 203 — — 214 Pemphigus Cases 3 — — 3 — Visits 47 — — — 47 Puer. Pyrexia Cases 2 — 1 3 — Visits 29 — 13 — 42 Totals Cases 26 57 3 86 1492 Visits 326 1120 46 The undermentioned table shows the sales of food accessories, simple remedies, and materials for making clothing, which are sold at cost price to mothers attending the clinics:— £ s. d. Dried Milk, 8,482 lbs. 636 3 0 ,, ,, Humanized, 14 lbs. 1 14 0 Marylebone Cream 2 0 6 Dusting Powder 0 15 0 Medicinal Paraffin 4 15 0 Medical Sundries 11 19 6 Dentures 55 2 0 Materials at Sewing Class 31 13 3 Convalescent Treatment 15 17 6 Virol 23 12 8 Oil and Malt 119 12 5 Concentrated Food 19 5 7 Total £922 10 5 135 In addition to the foregoing, by arrangement with local chemists, vouchers are issued for certain food accessories, etc., to be supplied by the chemists at cost price. 4,003 such vouchers were issued during the year. 2,636 lbs. of Dried Milk, supplied under the Free Milk Scheme, were issued at the Clinics from 1st January to 19th October. From that date the revised scheme of distribution of free milk at the clinics came into operation. Grants in Aid. Convalescent Treatment (mothers with babies) 22 cases. „ ,, (children under 5 years) 25* „ Payment of Midwives' fees 20 „ Loan of maternity bag containing clothing, etc. .. 16 „ *1 case arranged by the I.C.A. A., the Council paying part of the cost. (The following Tables refer to the whole Borough). Statistics Respecting Infants Born in 1926. All births, including those occurring in outlying districts, but belonging to the Borough 3825 Doctors in attendance 708 Midwives in attendance 1955 Delivered in institutions 1069 Not stated 93 Stillborn (Stillbirths per 1,000 births, 28.7) 110 389 Died before visit 82 Not requiring or desiring visits 197 Visited 3436 Removed within the year 329 465 Died during visitation 136 Remaining under supervision end of first year 2971 Mortality per 1,000 visited 39 136 The 2,971 children visited during 1927 and remaining under supervision at the end of their first year of life, were fed during the first six months of life as follows:— Breast-fed 75.0 per cent. Mixed feeding 21.0 „ Hand-fed 3.9 „ The 136 children who died during the first year of life, were fed during the first six months of life as follows:— Breast-fed 53.7 per cent. Mixed feeding 30.9 Hand-fed 15.4 „ Below is a statement comparing the mortality rates of children fed by the various methods:— (a) Babies breast-fed 32 (6) ,, who received mixed food (breast and hand) 63 (c) /, hand—fed 151 137 The following table relates to visited children of ages 1 to 5 years. On reaching the age of 5 years the completed Case Papers are forwarded to the Education Authority:— Year of Birth. 1922. 1923. 1924. 1925. Remaining under supervision: End of first year .. — — — 3,057 ,, second year — - 2,894 — ,, third year — 3,087 — — ,, fourth year 3,092 — — — Inward Transfers 21 87 66 145 Visits discontinued 2 6 — 4 Outward Transfers 137 211 186 227 Died 13 18 32 66 Remaining under supervision: End of second year — — — 2,905 ,, third year — — 2,742 — ,, fourth year — 2,939 — — ,, fifth year 2,961 — — — Mortality per 1,000 visited: Second year — — — 20.6(21.3) Third year — — 10.8 (9.7) — Fourth year — 5.7 (5.5) — — Fifth year.. 4.2 (3.8) The figures in parentheses are the rates for the previous years. 138 Statistical Summary for 1927. Public Health Department. The Royal College of St. Katharine Total, 1927. Total, 1926.[.###] Ante-natal:— Visits 516 655 1,171 1,134 Re-visits.. 492 2,077 2,569 1,957 Post-natal:— Visits 1,591 1,691 3,282 3,498 Removed before visit 37 38 75 61 Died before visit 26 49 75 59 Stillbirths 35 52 87 100 Re-visits:— Under 1 6,930 13,318 20,248 20,938 1—5 15,640 29,249 44,889 42,373 Removed 481 687 1,168 848 Died 94 114 208 228 Ophthalmia Neonatorum*:- — Visits 48 — 48 43 Re-visits.. 120 — 120 165 Removed to Hospital (3) — (3) (5) Zymotic Enteritis—(notified ca-es)— Visits 19 50 69 284 Re-visits.. 11 62 73 228 Removed to Hospital (15) — (15) (29) Dead (a) Notified 7 8 15 29 (b) Other cases 15 7 22 Measles:— Visits 144 332 476 567 Re-visits.. 120 108 228 194 Removed to Hospital (80) — (80) — Dead 4 4 8 13 Whooping Cough:— Visits 191 351 542 262 Re-visits 84 360 444 89 Removed to Hospital (49) — (49) — Dead 13 18 31 3 Puerperal Fever*— Visits (7 cases) 7 — 7 Re-visits.. 16 — 16 Removed to Hospital (6) — (6) Dead 2 (2) 2 Puerperal Pyrexia*— Visits (15 cases) 15 — 15 Re-visits 44 — 44 Removed to Hospital (7) — (7) Dead Nil. — Nil. Maternal Deaths (see note, page 129.) Nil. (9) (9) Miscellaneous 541 948 1,489 742 Total Visits paid 27,243 50,178 77,421 73,842 • All patients with these diseases are notified to the Medical Officer of Health, and are immediately visited by the Health Visitors of the Public Health DepartmentFigures in brackets, not included in totals. 139 ARTIFICIAL SUNLIGHT TREATMENT. Dr. E. M. Layman, the Medical Officer in charge of Artificial Sunlight Treatment, has submitted the following interesting report:— "The work at our two Clinics, Wellington Road, Bow, and Simpson's Road, Poplar, has gone on steadily and satisfactorily during 1927. The change from Avenue Road to the new and fine quarters in Wellington Road, in August, has meant a great improvement in hygiene and comfort for mothers and babies. The lamps run well and smoothly. We have grouped our ordinary patients (children under 5) as seems most informative, for the report. 'Miscellaneous' includes mental backwardness and nervous depression as well as a few 'only children' with nervous excitability. (See summary on next page.) Rickets in one of its many forms is still the chief complaint. Skeletal rickets we now treat always with red light preceding the ultra-violet, having proved its added efficiency in this class. Difficulties in dentition, between 8 and 18 months, sometimes producing serious ill-health, have responded in a striking way to ultraviolet exposures. A few mothers, when pressed by their welfare doctors, have ventured on giving us a trial themselves. They have all done extremely well and have expressed their pleasure at the increased sense of well-being. I should like many more mothers, when offered sunlight treatment by their welfare doctors, to accept this. There must be numbers, debilitated by frequent child-bearing, lactation and heavy home duties who could avail themselves of the Light Clinics and the very real difficulty W finding time 'for themselves' is met in every case by individual arrangements with the Sister. Often short courses, 6, 8 or 15 exposures, will do great good." 140 Statistical Summary. January 1st to December 31st, 1927. Number of patients treated:— Bow 153 Poplar 218 Total 371 Number of Baths given:— Bow 2,846 Poplar 3,604 Total 6,450 Number of Sessions:— Bow 278 Poplar 235 Total 513 The cases have been grouped as follows:— Group 1.—Rachitic 77 ,, 2.—Catarrhal 20 ,, 3.—Under-development (Mental and Physical) cluding—Delay in growth, Malnutrition, Tonelessness 157 ,, 4.—Insufficient sleep 7 ,, 5.—Miscellaneous 19 ,, 6.—Mothers 6 Current Cases 85 371 In order to protect the Staff, reflectors have been fitted to the 2 K. B. B. artificial sunlight lamps and have been much appreciated. During the year the Hewittic Cooper Lamp, which is used in cases of emergency, was overhauled and the burner replaced. 141 MATERNITY AND CHILD WELFARE DENTAL CLINIC. Mr. C. Hammond Williams, L.D.S., R.C.S. (Eng.), the Dentist in charge of the Dental Clinic, has submitted the following report:— "The following figures show details of the work carried out:— Sessions. New patients. Total attendances. Fillings. Teeth extracted (temporary and permanent). Scalings. Dentures. Supplied. Repaired.[/##] 51 214 741 82 1591 108 32 5 Minor treatments, such as dressings, easings, etc., are not included in these figures. The slight decrease in the figures compared with the previous year is due, I think, to the change from the old premises to the new. The Wesleyan premises in Old Ford were the centre of Bow Clinics and were oil a bus route from Poplar. The new Centre, although just off Bow Road, is not on the direct bus route from Poplar. In such a change there is always some difficulty in keeping up the continuity of the work. The advantages of the change are enormous, however, and our new premises are a very great improvement on the old ones. In spite of a rather small surgery, we find the work runs smoothly and our recovery rooms provide a means whereby the Surgery can be cleared quickly and the next case seen with the minimum of delay. It would appear that the number of children requiring treatment is on the increase, and in most cases treatment by extraction is indicated. As it was considered that the extraction of eight or perhaps ten teeth in a child's mouth produced a considerable degree of shock, and the rather confined space of the recovery rooms rendered it hardly possible to keep these cases under observation for a reasonable time after general anaesthetics, arrangements were made for the provision of several stretchers in another room. The children are now encouraged to remain on the premises as long as possible, thereby ensuring a better recovery. 142 The number of old cases returning for further treatment is marked. This shows an appreciation of the treatment received, I think, and is very gratifying. A great difficulty now is keeping up with the waiting list. With only two hours per week at our disposal, a delay is bound to occur between the time a patient's name is placed on the list, and the time she can be attended to. In some cases this delay is over long. The Clinic, however, is working to capacity, and it is found that twenty cases, for instance, are as much as can be dealt with in an anaesthetic session. The time has come, I think, to regard the possibility of an extra session periodically. This might be a children's anaesthetic session, perhaps, reserving the usual anaesthetic session for adults only. Our equipment continues to give every satisfaction and is in excellent repair. Every consideration and help has been given in the fitting up of the premises, and I have no hesitation in saying that the Clinic now is one of the most up to date establishments for general dental treatment to be found. Again I must thank everyone I come in contact with for their very great help and co-operation in its efficient working." Dental Clinic—Extractions by Gas. During the year the Maternity and Child Welfare Committee considered the report of the Dentist (published in last year's Annual Report), in which he stated that 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. It was pointed out to the Committee that the introduction of a small fee, in cases where it could be afforded, would no doubt reduce the number of patients insisting upon extractions under gas, which extractions could in many instances be carried out quite well under a local anaesthetic and often with advantage to the patient. A scale of charges was already in operation at the Royal College of St. Katharine. Upon the recommendation of the Maternity and Child Welfare Committee the Council approved of a fee of 6d. being charged for cases requiring gas where it could be afforded. 143 ROYAL COLLEGE OF ST. KATHARINE, POPLAR. Report of the Medical Officer. March, 1928. Work at an Infant Welfare Centre is mainly a matter of watching and safeguarding the progress of healthy babies. The chief problems which surround such progress are those of feeding, management and family circumstances. At any point one or all of these may exert enough influence to deflect the baby from the path of normal health. As a rule, the combination of careful observation and examination at the Clinics, with the Health Visitor's knowledge of the mother's skill and the home conditions, is enough to control the average case. For one reason or another, however, not every child does manifest that immediate and satisfactory progress that one would like to record from the start of its attendance. Where there is evidence to believe the food supply is ample, a few weeks delay to allow the necessary adjustments to be made is of no great consequence. But there may be doubt on this point. And if the physician allows his doubt to be felt, the mother is likely to be much alarmed. Her anxiety may be well founded, for the condition of the child may suggest a failure to thrive. Time then becomes an important consideration, especially where the maintenance or reinforcement of lactation is an integral point of the problem. A mistake in the advice or in its interpretation involves a week's loss of time. The next visit reveals an accentuation of the symptoms, and a decline in the baby's weight may well decide the mother to seek advice elsewhere. It is especially likely to occur in the instances where only a few simple directions can be grasped at a time; yet the physician knows that multiple faults of feeding, management and housing are present and all need correction. In another group all clues to the cause of the child's failure may be of the faintest kind, with little to show which should be followed. A week or two on the wrong trail can then be disastrous. An ailing child has already changed to one seriously sick. The mother has to be told her baby is not suitable to attend a "Welfare Centre'' ; that it needs instead medical supervision at home or transference to a hospital. Review of the early years' work shows far too many case sheets where attendance ceased after one or two visits to the Clinics, suggesting 144 only too clearly that there was a failure to supply what was needed. We have learnt now to recognise a number of cases where the cause of failure is clear. The remedy is no less apparent, yet neither at home nor at the hospital is it possible to see how the necessary treatment can be applied. It is my belief that "Welfare Centres" can, for the first time, organise the means with very little alteration or extension of their scope and personnel. "Treatment" is not properly part of their function. But what follows will explain that the word is applied almost solely to intensive investigation and education, coupled with the application of certain necessary hygienic measures, which the mothers are taught by demonstration and practice. Guesswork is thus reduced to a minimum. To this end we have had at St. Katharine's for several years, a special department, which started in a small way but which has grown statistically to large dimensions. Its personnel now consists of a sister and two nurses. The sister was formerly a Health Visitor in the neighbourhood; an invaluable qualification enabling her, in a way that nothing else could, to fit the advice to the individual, even to the street in which she lives. A room has been set aside, furnished with scales, cots, screens, a basin with hot and cold water and the apparatus for preparing bottle feeds. Further, there is a strip of garden with a tiled shelter at the north end. This department is used for infants from all the Clinics in the neighbourhood, whose lack of progress is obscure; or, if clear, not amenable to the other methods at our disposal. The mothers are asked to bring the babies early in the morning and when, as is usual, breast feeding is in progress, to attend for the purpose of nursing at the approximate feeding hours. The staff carries out test weighing at each feed. If a deficiency of milk has been suspected by the physician, he will have ordered a suitable supplement to be added, should his suspicions be confirmed. The baby s habits are observed; its sleep timed; any tendency to vomit and its time with reference to feeds noted; the character of the vomiting, the amount lost; the type, reaction, and the frequency of stools are all considered. Records of temperature are made. A child's behaviour can thus be intensively studied, and, what is of no less importance, the mother's skill in handling it. For example, her reaction to its crying, shown by her impulse to seize it and carry it about, replace it at the breast or proffer a comforter, are suggestive of what is customary at home. An experienced nurse can soon show the value of more gentle handling for a few minutes in a position of comfort, and the right moment to replace the child in a cot behind a screen or in the open. Sympathetic enquiry not seldom draws out stories of stress and difficulty at home, trials at first sight not strictly germane to the question of infant welfare and 145 quite unlikely to be divulged at a Clinic consultation. They may nevertheless have a profoundly important bearing on the chance of successful lactation, and the experienced worker can often give help in their solution. Where anxiety has reduced a mother to a state verging on breakdown, we have often found it wise to bid her leave the baby in our charge for the day and call for it at night. Breast-feeding can be suspended with advantage for the time being. The mere rest from responsibility, and freedom from contact with a screaming infant for a few days, will sometimes restore a failing milk supply better than anything else. Observations thus made are recorded, some in detail and some as brief summaries, and sent on a special note-sheet to the physician who presides at the baby's weekly Clinic. He is then able to institute any orders which are revealed as desirable, reinforce advice or modify instructions, and judge whether further tuition requires the woman's attendance at the department, or whether the needs of the case will be met by visits from the Health Visitor to the home. Three days' attendance will sometimes show all that is necessary and much that was unsuspected. Three months is not always enough. There is sometimes no other way, or none with which I am familiar, to remove the obstacle of a spate of confusing advice from relatives or neighbours; advice which is all the more disastrous because it pours in at a time when a woman's fears impel her to turn for help to any kind of wild experiment. The opportunity which the special department affords, for applying measures to reinforce failing lactation, is demonstrated many times a year. The success of the training given is seen in the faithful way the teaching is carried out at home; in the women's willingness to make three, four and even five journeys a day from considerable distances, and in their requests to reattend if they detect or suspect a relapse. A great deal has been achieved here in getting a rational amount of clothing and clothing of a rational type. There is no way to compare with it for demonstrating the value to a baby of open air and light. Many a backyard, filled for years with lumber or given over to sickly poultry, has been cleared, cleaned and adapted as an open air nursery. Moreover, this has come about several times by a father calling at the building to fetch his wife, and seeing the peace and safety which the outdoor sleep has brought his baby. 146 Details of a few cases are given:— L. G.—A first-born male child. First attendance at four weeks of age. "Not getting on." Said to scream violently. Much discomfort L.G. and flatulence after feeds and frequent vomiting. Feeds greedily—milk supply copious. A wasted fretful infant with blue extremities. Referred to the department. Feeds found to average over 3 ozs. Suction vigorous. Discomfort apparent after the meals. Violent projectile vomiting observed at which most of the milk was returned soon after a feed of 5 ozs. This became fairly habitual but was controlled by allowing half the feed to be taken 147 naturally, half expressed by hand and given by a spoon. Gastric peristalsis was seen and a diagnosis of pyloric spasm made. Rccoveiy was gradual, but complete, and for a long period any carelessness in feeding or handling produced a return of the vomiting and restlessness. Attendance—9 weeks. A. M.—A first-born male child. First attendance at 10 weeks. Brought for wasting and infrequent stools. Breast fed. Seriously wasted —marked pallor and feebleness. 148 Referred to special department with recommendation to supplement feeds with a cow's milk mixture, if breast milk not sufficient. Test weighing showed 1J ozs. only obtained in the first three feeds. The child was feverish and able to digest extremely little. Improvement was slow. Average feed rose to 2 ozs. in one week, 3 ozs. in another fortnight and 4 ozs. three weeks later. Thereafter progress was rapid W.B. on a diet of breast milk only. This was one of the cases where the failure of breast nursing was due to the infant's difficulty in extracting the milk- Attendance—10 weeks. W. B.—Third-born male child. First attendance at 9 weeks. Weight 8 lbs. 1 oz. Birth weight thought to have been 9 lbs. Breastfeeding irregular and frequent. Instructions produced no improvement- 149 The child developed profuse nasal discharge and was referred to the special department for open air management and information about the feeds. These were found to be scanty—3 to 3½ ozs. No progress made until the respiratory condition improved. Strong suction then became possible and the yield soon rose, reaching an average of nearly 6 ozs. per feed. Progress uninterrupted. Attendance—9 weeks. E. B.—First-born male child. Brought at 2 weeks of age weighing 5½ lbs. Anxiety about lack of progress. Breast fed. No crying. Stools infrequent and urine scanty. Known to have weighed 7 lbs. at birth. The infant showed extreme emaciation. This had occurred so rapidly that the skin was cracked wherever it fell in folds. The abdomen was scaphoid and coils of bowel showed. The baby was lethargic and failed with exhaustion to suck for more than a few seconds. Referred to special department. Test weighing showed nothing was being obtained from the breasts, which were tense and the nipples partly inverted. Human milk from volunteers was given with a mixture 150 of diluted and fully peptonised cow's milk. Massage and the use of the breast pump improved the mother's capacity to yield and in a week about ½ oz. per feed was averaged. Five weeks from the first visit the child obtained 3½ ozs. per feed and was thereafter completely breast fed. Attendance—9 weeks. 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. As stated in the Annual Report for 1926, the Maternity and Child Welfare Committee had during that year considered terminating the general distribution of Grade "A" (Tuberculin Tested) milk under this scheme and had resolved that the position should be reconsidered in April, 1927. At their meeting held in April a report was submitted upon Grade "A" (Tuberculin Tested) and dried milks, recommending that the general distribution of Grade "A" (Tuberculin Tested) milk be discontinued and in its place reputable brands of dried milk be supplied, but that Grade "A" (Tuberculin Tested) milk be supplied in special cases (infants) where the Medical Officers in charge of the Council's Child Welfare Clinics considered its use specially advisable. It was pointed out that the only difficulty which would arise by the adoption of dried milk for general use would be that of distribution and it was suggested that this should take place at four points in the Borough, viz.:—Public Health Offices, the Maternity and Child Welfare Centre, Wellington Road, Simpson's Road Clinic, and West Ferry Road Clinic. The Maternity and Child Welfare Committee recommended, and the Council approved, of this scheme and the general distribution of Grade "A" (Tuberculin Tested) milk was terminated on the 30th September. These proposals met with the general approval of the Ministry of Health. Since 1st October, 1927, there have been available three classes of milk: a dried milk, brand "A," for general distribution, and a dried milk, brand "B" and Grade "A" (Tuberculin Tested) milk for special cases recommended by the Clinic Medical Officers. 151 When suggesting the change-over from Grade "A" (Tuberculin Tested) to dried milk, the Committee were reminded that this would probably entail the necessity of having further clerical assistance to help in the distribution. This was found necessary at the end of the year and, with the Council's and Ministry of Health's approval, an additional clerk commenced duty in the early part of 1928. During the 12 months ended 31st December, 1927, 11,702 applications for free milk were received, of which 11,117 were granted. Orders for 294,515 pints of fresh, and 16,896 lbs. of dried milk were issued, the total commitments amounting to approximately £5,961. Personal inquiry was made in 598 cases by the Inquiry and Investigation Officer. Ten cases were reported to the Maternity and Child Welfare Committee as unsatisfactory. The Committee sent letters of caution in eight cases, and ordered prosecutions in the other two. Case 1.—Husband fined 20s. and costs 9s. 4d., or 21 days imprisonment, and wife bound over in the sum of 40s. to come up for judgment. Case 2.—Fined 30s. and costs 9s. 4d. or 21 days imprisonment. The following table shows in comparative form the applications, etc., during the years 1920-27:— Year. Applications. Applications granted. Cost (approx) £ Orders issued. Cases investigated by I.O. (b). Unsatisfactory cases. Fresh. (Pints). Dried. (Lbs.). 1920 (a) ? 17,095 ? 873,585 3,454 — — 1921 (c) 23,799 18,270 14,500 782,012 1,236 1,611 107 1922 18,082 16,215 8,500 621,796 1,664 2,969 15 1923 15,537 14,086 6,600 512,614 3,230 2,974 34 1924 14,828 13,597 6,150 487,070 4,902 2,922 14 1925 12,475 11,358 4,994 410,587 3,727 1,633 9 1926 12,928 11,905 7,249 426,762 2,917 593 6 1927 11,702 11,117 5,961 294,515 16,896 598 10 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 per cent, below the ruling retail price. The retail prices per pint during the year were:— 1s: April. 4d.; 1st October, 4½d. 152 Appendix A. The following report was submitted to the Public Health and Housing Committee by the Medical Officer of Health on "Schick Test and Immunisation from Diphtheria":— Sir, Ladies and Gentlemen, In placing before you a letter from the Metropolitan Boroughs Standing Joint Committee in which this Council is asked to give their views on the prevention of Diphtheria by means of the Schick test and active immunisation, your Medical Officer of Health submits the following report on the subject. In doing so he would remind the Committee of the Special Report by Dr. F. W. Alexander on this subject, submitted to the Committee in October, 1926. DIPHTHERIA IMMUNISATION. It is now well-known that the timely use of antitoxin has gone far in reducing the mortality of Diphtheria, but has not led to a diminution in the number of cases. Small doses of diphtheria antitoxin have also been used successfully, to prevent contacts from developing the disease. By this means the security from attack only lasts for about three weeks. In recent years research work has been carried out for the purpose of discovering a method of determining whether a given person is susceptible (liable to contract the disease) or immune (freedom from disease), and also for procuring immunisation of the populace against diphtheria infection. By means of the Schick test we are able to determine whether or not a given person's blood contains sufficient antitoxin to protect him from an attack of diphtheria. As a result of testing a large number of persons of different ages it would appear from published figures that 80 per cent, of infants at birth have a natural immunity, and that this fades during the first month or two after birth, the immunity gradually decreasing until at three years of age only 28 per cent, of the children are immune. 153 Further, it has been established that by the injection of a mixture of toxoid and antitoxin a much more enduring protection can be achieved. This protection lasts at least seven years, and there is reason to believe that it remains for life. Even if the protection does not last for ever it should be remembered that a young child immunised is protected during a period of years when it is susceptible to diphtheria and when it is most likely to die from this disease. The following table shows that in spite of the measures to control the disease, namely, hospital isolation, antitoxin treatment and disinfection, there are still many cases of this disease occurring each year in the Borough, resulting in much sickness and subsequent illhealth, and a considerable proportion of the cases die, especially the younger children. In particular it should be noted that the mortality rate for children under 5 years of age is practically three times greater than that for persons over 5 years of age. Year. ATTACK RATE ALL AGES per 1,000 Population. CASES NOTIFIED. DEATHS. FATALITY RATE per 100 cases notified. Under 5 years. 5 years and over. All Ages Under 5 years. 5 years and over. All Ages Under 5 years. 5 years and over. All Ages Year. 1917 2.55 159 207 366 18 5 23 11.3 2.4 6.3 1917 1918 2.18 158 147 305 22 9 31 13.9 6.1 10.2 1918 1919 2.08 117 203 320 26 12 38 22.1 5.9 11.9 1919 1920 4.36 247 451 698 39 20 59 1 5.8 4.4 8.4 1920 1921 3.94 255 393 648 44 20 64 1 7.2 5.1 9.9 1 921 1922 3.77 268 358 626 41 21 62 15.3 5.8 9.9 1922 1923 1.82 122 181 303 17 15 32 1 3.9 8.3 10.6 1923 1924 2.08 144 204 348 14 6 20 9.7 2.9 5.7 1924 1925 1.95 124 205 329 7 1 8 5.6 0.5 2.4 1925 1926 2.43 158 253 411 15 7 22 9.5 2.8 5.3 1926 Aver. 19171926 2.72 175 260 435 24 12 36 13.8 4.5 8.2 Active immunisation against diphtheria has been practised for some time now in Edinburgh, Birmingham, Manchester, Bristol, Aberdeen, and in at least four of the Metropolitan Boroughs, with results which tend to show that this method—with the active cooperation of the general public—will considerably reduce the number of cases of diphtheria. Medical men who are best qualified to offer an opinion on the results, are very enthusiastic concerning the future 154 of this method of protecting the public. Sir George Newman, Chief Medical Officer of the Ministry of Health, in his Annual Report, for the year, 1925, states: "As a result of improvement in material and technique this method of prevention has now passed beyond the experimental stage, and is widely regarded as the best way of protecting against this disease." Further, he states: "As Antitoxin has proved itself the best method of treatment, so immunisation appears to be our best prophylactic." The application of the Schick test is carried out by injecting a minute quantity of testing fluid (toxin) into the skin. The test is quickly made, with little or no pain either at the time or afterwards. By examining the skin at the point of injection a week later a doctor experienced in this work can tell whether a person is protected or not. The mark on the skin soon fades and no scar is left. If it is found that the person is not protected and is thus liable to contract the disease, immunisation can be secured by inoculation with a small quantity of toxoid-antitoxin mixture. This inoculation is performed on three separate occasions at weekly intervals. After a lapse of three to six months the individual is again tested. The protection is not fully developed until three to six months after the inoculations. As, however, most children between the ages of six months and five years give a positive reaction to the Schick test, there is no necessity for carrying out such test in their case before inoculation unless it is specially requested. Should the Committee consider it advisable to offer facilities for the immunisation against diphtheria to children and adolescents in this Borough, the following scheme of procedure has been drawn up for your consideration and submission to the Ministry of Health for their approval. SCHEME FOR THE PROVISION OF SCHICK TEST AND IMMUNISATION AGAINST DIPHTHERIA. 1. Notifying Public of Facilities Offered. It will be necessary to issue an educational leaflet to all mothers attending the Infant Welfare Centres, and if possible have the same 155 leaflet distributed through the elementary schools in the Borough, and also through other channels should occasion arise, as, for example, after a case of diphtheria has occurred in a household, etc. The leaflet should explain the purpose of the Clinic and the value of toxoid-antitoxin inoculation. This is considered necessary as there is a considerable amount of prejudice existing to-day against any form of protective measure which involves inoculation. The following is a draft of the suggested leaflet:— METROPOLITAN BOROUGH OF POPLAR. DIPHTHERIA PREVENTION. To Parents and Guardians. Diphtheria is a dangerous disease, causing great loss of life. In England and Wales 80 of every 100 deaths from this disease are of young children under 10 years of age, and most are under 5 years. Some children, and grown up people, do not catch diphtheria because they are protected by nature against it—they are immune. Other children who are not immune may contract the disease, but they can be made immune, that is to say they can be protected against the infection of diphtheria. How Can This Protection be Secured? By a simple and painless test it is possible to find out whether your child is susceptible to diphtheria infection. The test is quickly made, with no pain, beyond a needle prick, either at the time or afterwards. If the test shows that your child is not protected owing to the absence of protective substances in the blood, it can be inoculated and rendered immune by the injection of a small quantity of protecting fluid once a week for (usually) three weeks. Nearly all children are protected by these three injections, but to make sure, the child should be tested again at the end of three months, and, if necessary, one or two further injections made. 156 It is unwise to have the protective treatment without the final test; all good work is tested before being passed as fit. Will the Protecting Injections Upset the Child? Not one of 100 children is unwell after the injection: only occasionally is a child slightly unwell for a time. There is no sore at the point of injection and no scar left. Where and When Protection Can be Obtained. The Poplar Borough Council has provided the means of protection against diphtheria for children in this Borough. It is for parents and guardians to use the means, for success depends on the co-operation of the parents. TAKE YOUR CHILD TO THE CENTRE. Wellington Road, Bow, on afternoon at 2.30. GIVE YOUR CHILD ALL THE ADVANTAGES YOU CAN. PROTECT YOUR CHILD FROM DIPHTHERIA. Treatment is not compulsory, but in the interest of your child it is strongly recommended. Public Health Offices, Bow Road, E.3. Medical Officer of Health. Note.—The Council have received the sanction of the Ministry of Health under Section 77 of the Public Health (London) Act, 1891, for the facilities above-mentioned. 2. Establishment of Clinics. The opening of a Clinic at Wellington Road for one afternoon per week (subject to the approval of the Maternity and Child Welfare Committee.) 3. Medical Officer. The services of a specially trained Doctor for about two hours on one day each week, at £1 11s. 6d. per session. 157 4. Nursing Attendance. As a temporary measure, and until it is seen how this work is likely to develop, it is suggested that the Maternity and Child Welfare Committee be requested to sanction the attendance of one of the resident nurses to assist the doctor at this clinic. 5. Equipment and Material. The purchase of:— (i.) Certain equipment, say £6. (ii.) Schick and inoculation material, say £100 for the first year. (It is estimated that for material alone it will cost for testing and immunising each patient approximately five shillings.) 6. Estimated Cost. The total cost of the service for one year would be approximately £188. 7. Consent of Parent or Guardian. Before any injection is made it is necessary to obtain the consent of the parent or guardian, preferably in writing. A form will be drawn up for this purpose which only requires the signature of parent or guardian. 8. Records. A card index will be kept of each child immunised and tested with a record of previous and subsequent infectious disease, etc. I am, Sir, Ladies and Gentlemen, Your Obedient Servant, W. ALLAN YOUNG, Medical Officer of Health. Public Health Offices, Bow Road, E.3. 6th October, 1927. 158 The Council recommended— That the Metropolitan Boroughs Standing Joint Committee be informed that, the Council is in favour of offering facilities for the carrying out of the Schick Test and for active immunisation against Diphtheria, but are in agreement with the opinion of the Fulham Borough Council that its effectiveness would be minimised unless similar schemes were put into operation by Metropolitan Borough Councils generally. (Adopted.) And further recommended— That application be made to the Minister of Health for his approval under Section 77 Public Health (London) Act, 1891, to a scheme for Schick Testing and Immunising against Diphtheria, as outlined in the report of the Medical Officer of Health, subject to approval of estimate by Finance Committee. (Adopted.) 159 Appendix B. LYING-IN ACCOMMODATION:— (Provision of Maternity Beds at St. Andrew's Hospital, by the Board of Guardians, for Expectant Mothers who are not in Receipt of Relief and who are Willing to Contribute Towards the Cost according to their Income). The following were the points upon which agreement was arrived at between the Council's and the Guardians' representatives:— (1) On behalf of the Board of Guardians, Dr. Bray stated the following accommodation would be reserved for the use of expectant mothers:— A Ward of 12 beds: a Labour Room; Separate Kitchen and Duty Room. (To all intents a self-contained suite, with practically a separate entrance). (It was pointed out that the original proposal was for the Borough Council to have 8 beds, but 12 was the number suggested by the Board's representatives, in order to save structural alterations. The Medical Officer of Health pointed out that it was questionable whether 12 beds could be kept fully occupied by the Council). (2) Payments by the Council to be at the rate of £2 15s. to £3 per week for each bed occupied, and a retaining fee of 10s. for each bed unoccupied. (3) The patients to be admitted by the Medical Superintendent of St. Andrew's Hospital, on the instructions of the Maternity and Child Welfare Committee, without the intervention of the Relieving Officer. (4) The nursing staff of the Ward to be drawn from nurses with special qualifications or training in maternity work; the medical officer responsible for the confinement, or his deputy, to have had special experience in midwifery, the Medical Officer of the Hospital being ultimately responsible for the treatment and care of the patients. 160 (5) Any agreement reached by the Council and the Board of Guardians to be for one year only so that at the end of that time it could be modified if this was found necessary. (6) A further report and more details and draft, agreement to be submitted later. In the meantime the Ministry to be informed of suggested scheme so that general sanction may be given thereto. On November 4th the Town Clerk was informed by the Clerk to the Guardians that the Board had approved of the foregoing memorandum subject to the Council contributing not less than £3 per week for each bed occupied and a retaining fee of 10s. per week for each bed unoccupied. The following is the draft agreement which is is proposed should be signed by the Council and Guardians:— (1) The Ward to consist of 12 beds, and to be reserved for the use of maternity patients sent into the Hospital by the Borough Council, the Council making a payment of £3 per week for each bed occupied (or a proportionate charge per day), and 10s. per week retaining fee for each bed unoccupied. (2) The patients to be admitted by the Medical Superintendent of the Hospital, on the order of the Medical Officer of Health, without the intervention of the Relieving Officer. (3) The nursing staff of the ward should be drawn from nurses with special qualifications or training in maternity work; and the Medical Officer responsible for the confinement of the patient, or his deputy, shall have had special experience and training in midwifery, the Medical Superintendent being ultimately responsible for the treatment and care of the patients. (4) The Medical Officer of Health to have right of access to the Ward at reasonable hours. (5) The garments supplied to patients in the Council's beds are to be differentiated in some way from the garments worn by other patients in the Hospital in receipt of poor law relief. MATERNITY WARDS. Scale op Charges suggested by Medical Officer of Health and Borough Accountant. Family Income (after deducting Rent and Insurance). Charges to Patients per Week. (d) (a) (b) (c) Eligible for Single Maternity Benefit and not more than one child. Eligible for Double Maternity Benefit. Not eligible for any Maternity Benefit or eligible for Single Maternity Benefit and more than one child. Daily Charge for periods extended beyond usual period of 14 days. £ s. d. £ s. d. £ s. d. Add 10s. in each case. Deduct 10s. in each case. s. d. Exceeding 2 5 0 and not exceeding 2 6 0 1 10 0 3s. minimum. „ 2 6 0 „ 2 7 0 1 10 6 „ 2 7 0 „ 2 8 0 1 11 0 „ 2 8 0 „ 2 9 0 1 11 6 „ 2 9 0 „ 2 10 0 1 12 0 „ 2 10 0 „ 2 11 0 1 13 0 „ 2 11 0 „ 2 12 0 1 14 0 3 1 „ 2 12 0 „ 2 13 0 1 15 0 3 2 „ 2 13 0 „ 2 14 0 1 16 0 3 3 „ 2 14 0 „ 2 15 0 1 17 0 3 4 „ 2 15 0 „ 2 16 0 1 18 0 3 5 „ 2 16 0 „ 2 17 0 1 19 0 3 6 „ 2 17 0 „ 2 18 0 2 0 0 3 7 „ 2 18 0 „ 2 19 0 2 1 0 3 8 „ 2 19 0 „ 3 0 0 2 2 0 3 9 „ 3 0 0 „ 3 1 0 2 3 0 3 10 „ 3 l 0 „ 3 2 0 2 4 0 3 11 „ 3 2 0 „ 3 3 0 2 5 0 4 0 „ 3 3 0 „ 3 4 0 2 6 0 4 1 „ 3 4 0 „ 3 5 0 2 7 0 4 2 „ 3 5 0 „ 3 6 0 2 8 0 4 3 „ 3 6 0 „ 3 7 0 2 9 0 4 4 „ 3 7 0 „ 3 8 0 2 10 0 4 5 „ 3 8 0 „ 3 9 0 2 11 0 4 6 „ 3 9 0 „ 3 10 0 2 12 0 4 7 „ 3 10 0 „ 3 11 0 3 13 0 4 8 „ 3 11 0 „ 3 12 0 2 14 0 4 9 „ 3 12 0 „ 3 13 0 2 15 0 4 10 „ 3 13 0 „ 3 14 0 2 16 0 4 11 „ 3 14 0 „ 3 15 0 2 17 0 5 0 „ 3 15 0 „ 3 16 0 2 18 0 5 1 „ 3 16 0 „ 3 17 0 2 19 0 5 2 „ 3 17 0 ,, 3 18 0 3 0 0 5 3 „ 3 18 0 „ 3 19 0 3 1 0 5 4 „ 3 19 0 „ 4 0 0 3 2 0 5 5 „ 4 0 0 .. .. Max 3 3 0 5 6 Max. Note.—In cases of family incomes below £2 5s., the charge to be decreased by 6d. per week for each 1s. of deficiency of income, subject to the minimum charge of £1 per week. 161 In addition to the foregoing the following are the suggestions for admitting patients to the beds:— Mothers seeking admission to the Wards will have to contribute according to the fixed income scale submitted herewith:— The arrangements for admission to the beds should be made through the Maternity and Child Welfare Committee, on the following lines:— (1) Expectant mothers attending Poplar Infant Welfare Centres must make application for admission to the Maternity Ward to the Health Visitor at the Infant. Welfare Centre they attend. (2) Expectant mothers not in attendance at Infant Welfare Centres must make application at a Centre or apply to the Medical Officer of Health, Public Health Offices, Bow Road, E.3. The application to be made during the third month of pregnancy and the payments completed before admission to the Ward. (3) After the printed application form has been filled in, the patient will be referred to the ante-natal doctor at the Infant Welfare Centre of the area in which she resides for report and recommendation. The doctor in charge of the ante-natal Clinic, after examining the applicant, will make observations in the space provided on the application form, and, after such further enquiries as may be indicated, the form will be sent to the Medical Officer of Health. Any patient who does not desire to attend a Welfare Centre may have the ante-natal report filled in by her own physician. (4) After review by the Medical Officer of Health, the applications will be placed before the Maternity and Child Welfare Committee, who will recommend admission to the Ward in suitable cases. (5) The clinical reports of the Medical Officers of the Maternity and Child Welfare Centres, or Private Physicians, and containing the medical facts of the case, will be made out in duplicate, and one copy will be sent to the Medical Officer in Charge of the Maternity beds, who will return the report to the Medical Officer of Health with his notes after the confinement has taken place. 162 (6) When the application is accepted by the Committee and provisional arrangement made with the Medical Officer in Charge of the maternity beds, the patient will be notified by letter that a bed will be available for her at or about the time of her expected confinement. Other particulars in regard to admission will be forwarded to her at the same time. The Health Visitor will be informed and instructed to assist the mother in making preparations for entering the Ward. (7) The various forms required to carry out such a scheme have been considered and approved by the Medical Superintendent of the Guardians. Finance.—With reference to the financial part of this scheme, if the charge of £3 per week, per bed occupied, is accepted and all the beds were occupied throughout the year, the gross expenditure would be approximately £1,872. From this sum would have to be deducted the contributions received from the patients, which, of course, will vary according to their income, but assuming it to be the minimum of £1 per week per bed, suggested in scheme, the net expenditure for a year would be £1,248, but it is extremely unlikely the 12 beds will be in constant use and, therefore, the sum of £1,050 may be a reasonable estimate of the cost for a year. In addition, there will be the cost of stationery and printing and other administrative expenses, estimated at £50, making a net total expenditure of £1,100. 163 INDEX. Page Age Mortality 19 Altered Diagnosis Cases 97 Analyst's Report 69 Anthrax 93 Antitoxin, quantity issued 88 Area and Population 11 Artificial Sunlight Treatment 139 Bacteriological Examinations 88 Bakehouses 62 Births 11 Byelaws, etc. in force 31 Canal Boats 51 Cancer 99 Cerebro-spinal Fever 94 Cleansing of Verminous Persons, etc. 105,106 Clinics, M. & C.W 120 Committees 3 Continued and Typhus Fevers 94 Cowhouses 60 Customs and Inland Revenue Acts, Certificates 49 Death Rate amongst Infants Visited 16 Deaths and Death Rates 12 Deaths, Classified Causes, Table 15,21 „ Infantile, Table 15 Dentist's Reports 115,141 Diarrhoea and Enteritis, Deaths 19 Diphtheria 88 Disinfectant, Electrolytic 100 Disinfecting Department 100 Electrolytic Disinfecting Fluid 100 Encephalitis Lethargica 94 Enteric Fever 88 Erysipelas 93 Export of Meat Foods 89 Food, Supervision of 60 Food and Drugs Acts, etc. 73 Food Inspectors' Reports 64-68 Free Milk Scheme 150 Glanders 93 Hairdressers' Premises 50 Health Visitor, Chief, Report of 128 Home Nursing 133 Houses Let in Lodgings 36 Housing Acts 56 Hydrophobia 93 Ice Cream 62 Infantile Mortality 15,16 Infectious Diseases, Table of Notifications 85 Inquests and Deaths from Violence 22 164 INDEX—(continued). Page Lady Sanitary Inspector, Report 35 Legal Proceedings, etc. 52 Marriages 12 Maternity and Child Welfare 119 Measles 95 Meat Food Products, Certification 69 Milk (Special Designations) Order, 1923 61 Milkshops, etc. 60 Mortuary 24 Notification of Births Act 12 Notifications of Infectious Diseases, Table 85 Observation Wards 122 Ophthalmia Neonatorum 99,132 Overcrowding 51,56 Plague 93 Pneumonia 97 Poliomyelitis, etc. 94 Poor Law Relief, etc. 26 Population 11 Public Sanitary Conveniences 48 Puerperal Fever and Puerperal Pyrexia 93 Rag and Bone Dealer, Byelaws 48 Rag Flock Act 50 Rats and Mice Destruction Act 50 Reports:— Artificial Sunlight Clinics, Medical Officer 139 Chief Health Visitor 128 Dental Surgeon (M. & C.W.) 141 Dental Surgeon (Tuberculosis) 115 Observation Wards, Consulting Physician 125 Public Analyst 69 Senior Medical Officer, Royal College of St. Katharine 143 Tuberculosis Officer 107 Sanitary Inspectors' Work, Summary 34-36 Scarlet Fever 87 Schick Test 88 and appendix A Schools, Inspection of 50 „ Use of Electrolytic Fluid in 105 Shelter 90 Slaughterer of Poultry 68 Slaughterhouses 63 Smallpox 89 Smoke Nuisances 48 Stables 35 Staff 28 Street Trading 49 Swimming Baths, Use of Electrolytic Fluid in 105 Tables A to F (Workshops, etc.) 41-47 „ of Deaths 13-21 „ Infectious Diseases 85 Tenement Buildings, Lighting of Staircases 38 Tuberculosis, Death Rate 19 165 INDEX—(continued). Page Tuberculosis, Deaths 20,119 „ Officer's Report 107 „ Regulations, Notifications, etc. 116 Typhoid Fever 88 Urinals on Licensed Premises 49 Vaccination 90 Verminous Children and Persons 105,106 „ Rooms 48 Violence, Deaths from 23 Vital Statistics, Summary 10 Tables 13-21 Water Certificates 49 Workshops, Workplaces, etc. (Tables) 41-47 Zymotic Diseases, Death Rate 19 „ Enteritis 133