pop 34 Metropolitan Borough of Poplar. Annual Report FOR THE YEAR 1928 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, D.S.O., M.D., Ch.B., D.P.H. Medical Officer of Health. 3 PUBLIC HEALTH AND HOUSING COMMITTEE. Alderman: J. T. Wooster, J.P., Mayor (ex-officio). Chairman: Cr. J. H. Jones. Vice-Chairman: Cr. Mrs. E. Stavers. Ashley, J. A. Jones, J. H. (Ch.) Palfreman, R. Blacketer, T. J., J.P. Lambert, Mrs. E. M. Sell, W. T. (L.C.C.) Cressall, G. J., J.P. Lyons, W. Sloman, H. W. Cressall, Mrs. N. F. Newton, G. A. Stavers, Mrs. E. (V.Ch.) Harris, Mrs. A. L. Overland, A. Tanner, C. A. MATERNITY AND CHILD WELFARE COMMITTEE. Alderman: J. T. Wooster, J.P., Mayor (ex-officio). Chairman: Cr. Mrs. J. Mackay. Vice-Chairman: Cr. A. R. Sargent. Blacketer, T. J., J.P. Lambert, Mrs. E. M. Sargent, A. R. (V.Ch.) (L.C.C.) Cressall, G. J., J.P. Mackay, Mrs. J. (Ch.) Stavers, Mrs. E. Cressall, Mrs. N. F. Mudge, Mrs. E. Tanner, C. A. Harris, Mrs. A. L. Co-opted. Members: Miss E. Herbert (Roy. Coll. of St. Katharine); Mrs. J. A. March; Mrs. M. Power; Mrs. Sumner. 5 Public Health Office, Bow Road, E.3. June, 1929. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar. Mr. Mayor, Ladies and Gentlemen, I beg to submit my second Annual Report upon the Vital Statistics and Sanitary Condition of the Borough. Population.—The Registrar-General's estimate of 162,000 is actually less than the population enumerated at the Census of 1921, despite a natural increase from 1921 to 1928 of 11,000. Means of gauging accurately the extent of migration and immigration are not available, but even allowing that migration is in excess of immigration the estimated population for this year appears to be unduly low. This adversely affects the death rate for 1928 compared with corresponding rates for previous years. Births.—The corrected births were fewer than those of the preceding year and the birth rate per 1,000 of the population (19.9) would have been the lowest recorded in the Borough but for the reduction in the estimated population. Deaths.—Although there were 1,909 deaths in 1928, compared with 1,978 in 1927, the death rate is the same (11.8) owing to the altered estimated population. Infantile Mortality.—Infantile deaths from Measles numbered 14, compared with only 1 in 1927, and this fact, taken in conjunction with the decrease in the number of births registered during 1928, accounts for the slightly higher rate (71). Infectious Disease.—There has been a decided rise in the notifications of infectious disease during 1928, mainly as the result of making Chickenpox notifiable. Fewer cases of Scarlet Fever occurred, but this was more 6 than balanced by an increase of 133 cases of Diphtheria. The cases of Diphtheria occurred generally throughout the Borough, no district being specially affected. Smallpox broke out in the Borough in March and cases continued throughout the year. In all 68 cases were notified up to the end of the year. In May ,Chickenpox was made notifiable and 442 cases were notified. The extra work entailed in dealing with Smallpox and visiting cases of Chickenpox has taken up a very considerable amount of time of both the clerical staff and the inspectorate, with the result that a certain amount of routine work has necessarily suffered. A detailed statement on Smallpox will be found on page 90. As stated in last year's report the Ministry of Health sanctioned the establishment of a Diphtheria Immunisation Clinic. This Clinic was opened on 5th June, 1928. The Medical Officer in charge is Dr. F. Porter-Smith, M.R.C.S. (Eng.), L.R.C.P. (London), who is also in charge of the Clinic established by the Hackney Borough Council. His report is given on page 88. Tuberculosis.—The report of the Tuberculosis Officer is quoted in extenso. The number of new cases coming to the knowledge of the Department again shows a slight decrease. Maternity and Child Welfare.—This section of the work continues to increase, the attendances at the ordinary infant consultations as well as at the special clinics being considerably higher than those of the year 1927. The amount of home visiting by the Health Visitors has also increased. This has been made possible by the appointment of an additional Health Visitor and, in my opinion, is one of the most satisfactory features of this year's work. The report of the Consulting physician in charge of the Observation Wards is very satisfactory and encouraging, especially when it is seen that the improvement in the condition of the great majority of the children is maintained after their returning home. Good work is also being done at the weekly clinic held in connection with the Wards, and 7 the figures relating to the re-establishment of breast feeding indicate the value of the work which is being done by the staff, and, what is also important, shows that the mothers themselves in spite of considerable inconvenience persevere in their attendances for test feeds and advice. Proposed Maternity Beds.—The terms of the agreement between the Borough Council and the Board of Guardians for the provision of maternity beds in St. Andrew's Hospital have now been settled, and together with the list of staff will be forwarded to the Minister of Health for approval within the next few weeks. It is hoped to open the Council's Maternity Ward about the beginning of September, 1929. The Ward will provide accommodation for 12 maternity cases with Labour Ward and Night Nursery. Compensation to Midwives.—During the year my attention was drawn to one or two instances where midwives lost their cases as a result of patients being recommended by Clinic Medical Officers to enter Hospital for confinement on account of abnormal conditions. In order that such action on the part of Clinic Medical Officers should not deter midwives from referring patients to the Council's Ante-Natal Clinics the Council agreed to the payment of compensation up to an amount not exceeding ten shillings to a midwife in such circumstances, subject to the following conditions:— (1) That the Medical Officer of the Clinic certified that he or she has advised the patient to be confined in a Maternity Home or Hospital; (2) That the Midwife submits the Ante-Natal Clinic Medical Officer's Report; (3) That the patient confirms the fact that she has engaged a midwife to attend her in her confinement and had been referred by the Midwife to the Clinic; (4) That the birth takes place in Hospital; (5) That if a booking fee has already been paid to the Midwife this fee must be returned to the patient before compensation is paid to the Midwife. The scheme was approved by the Minister of Health early in 1929. 8 Maternal Mortality.—During the year the Minister of Health appointed a Committee to consider the investigation of maternal deaths, and issued an investigation and enquiry form for use in cases of maternal deaths. The Council agreed that the clinical part of such investigations should be conducted by the Council's Consulting Obstetric Specialist, Dr. Malcolm Donaldson. A copy of the Investigation Report, together with the accompanying note prepared by Sir George Newman was sent to all medical practitioners practising in the Borough. Dental Clinics.—The arrangements for dental treatment of mothers and children attending the Maternity and Child Welfare Clinics were revised during the year in order to meet the needs of increasing numbers and the revised scheme came into operation early in 1929. Public Education in Health .—The experiment undertaken last winter of offering lectures on health subjects to social and political organisations in the Borough has proved an undoubted success,as is evidenced by the fact that we have had repeated requests for more lectures, more in fact than our financial estimates would permit. This section of the work will, I am sure, exercise a far-reaching influence on the health and well-being of the Borough and justifies the Council in developing and extending the educational side of public health work during the coming years. This subject is referred to in detail on page 46. Temporary Office Accommodation.—On account of the overcrowded conditions existing at the Public Health Office and also in view of the fact that the Health Visitors were accommodated in another building,a temporary structure was erected to accommodate certain sections of the Department. Staff.—During the year the following changes have taken place in the personnel of the Department:— Mr. H. W. Leonard commenced duty as Sanitary Inspector (additional) on 23rd April. Mr. J. J. Jackson (Caretaker and Messenger at Public Health Office) retired in March after 24 years' service. He was succeeded by Mr. C. E. Richardson. 9 Mr. D. Boyce (Assistant Disinfector) retired on 30th June and was succeeded by Mr. A. Barrows (previously a Sanitary Inspector's Assistant). Messrs. E. Willson and W. Cue were appointed as Sanitary Inspectors' Assistants vice Mr. A. Barrows (promoted) and Mr. F. E. Quested (retired). Mr. F. Renwick was appointed Disinfecting Apparatus Attendant vice Mr. W. Quested (retired). Miss E. M. Craigie commenced duty as Additional Health Visitor, 7th May, 1928. Miss K. D. Evans was appointed Clerk in the Maternity and Child Welfare Section, vice Miss G. Hood (resigned). As in the past I am indebted to the Chief Officers of other Departments for their help and co-operation, and gratefully acknowledge the help which I have received from the members of the staff, not only in the general work of the Department, but also in connection with the extra work involved in dealing with Smallpox. May I also express my appreciation of the support 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. 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 1928 162,000 Number of Inhabited Houses (Census, 1921) 23,064 Number of families or separate occupiers (Census, 1921) 37,288 Rateable Value (April, 1928) £917,141 Sum represented by a Penny Rate (April, 1928) £3.582 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 showed the largest proportion of the inhabitants were 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 that time. 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 (76 persons per acre). SUMMARY OF VITAL STATISTICS. Total F. Births Legitimate 3.137 1,579 1558 Birth Rate 19.9 Illegitimate 91 43 48 Totals 3,228 1,622 1,606 11  Total M. F. Deaths 1909 1,091 818 Death Rate 11.8 Number of women dying in, or in consequence of, | from sepsis — childbirth |from other causes 8 Maternal Death Rate 2.5 Infantile Mortality Rate, 71. (Legitimate, 66. Illegitimate, 253.) Deaths from Measles (all ages) 56 ,, Whooping Cough (all ages) 19 ,, Diarrhoea (under 2 years of age) 43 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 162,000. This estimated population is 5,000 less than the figure supplied by him for the year 1927 and adversely affects the death rates which are calculated upon the reduced estimate. The population of 162,000 gives a density figure of 76 persons per acre. BIRTHS. Early in the year 1929, the Registrar-General supplied the following information relating to Births registered in the year 1928:— Registered Inward Transfers. Outward Transfers. Nett. 3,228 Total Births Males 1,371 266 15 1,622 Females 1.356 270 20 1,606 Illegitimate Males 33 11 1 43 91 Females 40 11 3 48 12 The corrected birth rate per 1,000 population was 19.9, as against 25.6, 22.9, 22.7, 21.6 and 19.8 for the years 1923-1927. During the year, 2,768 notifications were received under the Notification of Births Act, 1907. MARRIAGES. During the year, the marriages of 2,890 persons were registered, giving a rate of 17.8, as against 16.1, 15.3, 16.2, 15.8 and 17.5 in the five years 1923-1927. DEATHS. 1,838 deaths were registered as having occurred in the Borough. 260 deaths of non-residents must be deducted, and 331 deaths of Poplar residents which occurred outside the Borough must be added, giving a nett total of 1,909 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 1,319. 13 Deaths during 1928 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 127 82 65 109 383 Bow and Bromley Sub-District 97 68 58 87 310 St. Andrew's Hospital 226 136 139 170 671 Poplar Institution 39 49 22 45 155 Bow Institution 34 33 32 33 132 Bromley House Institution 1 1 — — 2 Poplar Hospital 40 29 25 36 130 Adelaide Buildings 1 — — — 1 Baffin ,, — — — — — Council ,, — — — — — Grosvenor ,, 6 2 1 — 9 Hanbury ,, - - - - - Hudson ,, - - - - - Melbourne ,, - - - - - Montreal ,, — 1 — — 1 Ontario ,, - - - - - Ottawa ,, - - - - - Prestage ,, 1 — — — 1 Quebec ,, - - - - - Sydney „ 1 — — — 1 Toronto ,, — — — — — Wellington ,, - — — - -- Winnipeg ,, — — — — — River Thames 5 2 2 — 9 ,, Lee — 1 — 2 3 Limehouse Cut — 1 — — 1 Bow Creek — 1 — — 1 Regents Canal - - - - - East India Docks - - - - - West India Docks — 1 1 — 2 South-West India Docks - - - - - Millwall Docks — — 1 — 1 L.M.S. Rly. Station - - - - - Casual Wards - - - - - Highways 8 — 6 10 24 Blackwall Tunnel — 1 — — 1 L.C.C. Tramway Depot - - - - - 586 408 352 492 1838 Deaths occurring outside the Borough of persons belonging thereto (add) 86 90 70 85 331 Deaths occurring within the Borough of persons not belonging thereto (deduct) 77 67 57 59 260 Deaths at all ages—nett 595 43i 365 518 1909 14 TABLE I. Vital Statistics during 1928 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 Ajje. At all Ages. Number. Rate. Number.* Rate, Number.* Rate per 1000 Nett Births. Number. *  1 2 3 4 5 6 7 8 9 10 11 12 13 1923 166,400 3842 4256 25 6 1928 11-6 418 370 255 60 1880 11.3 1924 167,300 3112 3831 22.9 2122 12.7 442 343 277 72 2023 121 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 111 238 288 258 70 1929 11.4 1927 167,000 2901 3309 19.8 1918 11.5 258 318 218 66 1978 11.8 1928 162,000 2727 3228 19.9 1838 11.3 260 331 230 71 1909 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 occuired, if known ; and (d) failing this, to the district where the bodr was found. Area of District in Total population at all ages .. 162,618 At acres (land and 2327.7 Number of inhabited houses .. 23,064 - Censui inland water) Average number of personB per house 7.05 of 1921. Total families or separate occupiers .. .. 37,288 TABLE II. The Borough. Cavses of, and Ages at, Death during the Year 1928. 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 titutions, etc. Ail Ages. Under 1 year. j 1 to 2 years. 2 to 5 years. Total under 5 years. 5 to 9 years. 10 to 14 years. 15 to 19 years. 20 to 24 years. 25 to 34 years. 35 to 44 years. 45 to 54 years. 55 to 64 years. 65 to 74 vears. 75 years and over. Poplar. Bow and Bromley. Poplar Institution. St. Andrew's 1 Hospital. Bow Institution. Bromley House Institution. Poplar Hospital. See Footnotes. Outlying Institutions,etc. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 all causes Certified l909 1909 230 74 67 371 48 20 42 56 86 109 206 297 334 340 1061 848 148 655 5 1 48 21 332 1210 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Enteric Fever 3 m 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 2 .. .. .. .. .. .. 1 1 F 2 .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 2 Smallpox .. m .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. f .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Measles 56 m 38 10 15 9 34 4 .. .. .. .. .. .. .. .. .. 26 30 .. 10 .. .. .. .. 22 .. f 18 4 7 5 16 2 .. .. .. .. .. .. .. .. .. 4 Scarlet Fever 2 m 2 .. .. 2 2 .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. 2 .. f .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ft Whooping Cough 19 m 9 3 5 1 9 .. .. .. .. .. .. .. .. .. .. 14 5 .. 2 .. .. .. .. 6 8 f 10 3 4 3 10 .. .. .. .. .. .. .. .. .. .. 0 Diphtheria 26 m 14 2 2 7 11 2 .. 1 .. .. .. .. .. .. .. 18 8 .. .. .. .. 2 .. 23 25 f 12 1 4 2 7 5 .. .. .. .. .. .. .. .. .. 7 Influenza 24 m 15 1 1 .. 2 .. .. 2 .. .. 2 2 6 1 .. 16 8 1 9 .. .. .. .. 2 .. f 9 3 1 1 5 .. .. .. .. .. .. .. 3 1 .. 8 Encephalitis lethargica 1 m .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. f 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 9 Meningococcal Meningitis 1 M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 f 1 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. 10 Tuberculosis of respiratory system 153 m 91 .. .. 1 1 .. 1 6 10 13 22 21 8 2 1 79 74 17 42 .. .. .. .. 35 95 f 62 .. 1 1 2 .. 5 14 11 17 6 5 2 .. .. 11 Other Tuberculous Diseases 25 m 15 .. 2 2 4 6 .. .. 2 1 1 .. 1 .. .. 13 12 1 8 .. .. 1 .. 11 21 f 10 2 .. 3 5 1 1 1 .. .. 1 .. 1 .. .. 12 Cancer, Malignant disease 204 m 115 .. 1 .. 1 .. .. 1 .. 1 1 20 28 43 20 114 90 9 90 .. .. 1 .. 20 120 f 89 .. .. .. .. 1 .. .. 1 .. 6 16 27 25 13 18 Rheumatic Fever 13 m 9 .. .. 1 1 i 2 .. .. 1 3 .. .. 1 .. 10 3 .. 3 .. .. 2 .. 2 7 f 4 .. .. .. .. .. .. 1 .. .. .. 1 .. 1 1 14 Diabetes 11 m 5 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 6 5 .. 6 .. .. .. .. 1 7 * 6 .. .. .. .. .. .. .. .. .. 2 2 2 .. .. 15 Cerebral haemorrhage, etc. 61 m 23 .. .. .. .. .. .. .. .. .. 1 3 6 9 4 32 29 4 19 1 .. .. .. 5 29 f 38 .. .. .. .. .. .. .. .. 1 .. 6 6 14 11 16 Heart Disease 302 m 158 .. .. .. .. .. .. .. 1 2 2 21 41 46 45 161 141 31 107 1 .. 2 .. 29 172 f 144 .. .. .. .. 1 1 1 2 6 3 13 34 29 54 17 Arterio-sclerosis 140 m 85 .. .. .. .. .. .. .. .. .. 4 5 13 27 36 89 57 35 37 .. .. 1 (a) 9 87 f 61 .. .. .. .. .. .. .. .. .. .. 2 6 14 39 5 18 Bronchitis 111 m 71 10 1 .. 11 .. .. .. .. 2 4 12 9 18 15 54 57 11 25 1 .. .. (b) . 43 f 40 10 1 .. 11 .. .. .. .. .. 1 5 5 5 13 1 19 Pneumonia (all forms) 177 m 105 31 8 4 43 .. 3 2 1 3 11 12 12 13 5 102 75 5 70 1 .. 4 (c) 23 103 f 72 19 7 5 31 1 .. .. 2 .. 4 8 9 7 10 20 Other Respiratory Diseases 22 m 15 .. .. 2 2 1 .. .. .. 3 .. 4 4 1 .. 16 6 .. 9 .. .. 1 .. 6 16 f 7 1 .. 1 2 1 .. 1 .. .. .. .. 1 1 1 21 Ulcer of Stomach or Duodenum 18 m 15 .. .. .. .. .. .. .. .. 1 2 5 7 .. .. 11 7 .. 9 .. .. 2 .. 4 15 f 3 .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 22 Diarrhoea, etc. 47 m 22 16 4 .. 20 .. .. .. .. 1 .. .. .. 1 .. 19 28 1 27 .. .. 2 .. 11 41 f 25 19 4 .. 23 .. .. .. .. 1 .. .. .. 1 .. 23 Appendicitis and Typhlitis 8 m .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 5 .. 3 .. .. 2 .. 3 8 f 8 .. .. 1 1 4 1 .. .. 1 1 .. .. .. .. 24 Cirrhosis of Liver 7 m 6 .. .. .. .. .. .. .. .. .. 1 1 2 2 .. 5 2 .. 3 .. .. .. .. .. 3 f 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 25 Acute and Chronic Nephritis 71| m 39 .. .. 2 2 .. .. 1 1 2 2 7 10 7 7 37 34 8 38 .. .. 1 .. 11 58 F 32 .. .. .. .. 2 .. .. .. 2 1 6 8 .. 6 20 Puerperal Sepsis .. m .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• f .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 27 Other accidents and diseases of pregnancy and parturition 8 m .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 5 1 6 .. .. .. .. 1 8 f 8 .. .. .. .. .. .. .. 2 5 1 .. .. .. .. 28 Congenital Debility and malformation, premature birth 71 m 41 40 1 .. 41 .. .. .. .. .. .. .. .. .. .. 41 32 5 10 .. .. .. .. 21 36 f 32 31 .. 1 32 .. .. .. .. .. .. .. .. .. .. 29 Suicide 14 m 9 .. .. .. .. .. .. .. .. 1 2 2 4 .. .. 7 7 4 .. .. .. 1 3 8 f 5 .. .. .. .. .. .. .. .. 2 1 .. 1 1 .. 30 Other Deaths from Violence 81 m 61 1 .. 5 6 6 2 6 6 4 9 4 5 6 7 49 32 5 26 .. .. 15 (b) 22 77 f 20 5 1 2 8 2 .. .. .. 1 .. .. 1 4 4 9 31 Other Defined Diseases 221 m 125 12 3 4 19 4 4 2 6 6 7 15 18 24 20 131 90 11 86 .. .. 12 (c) ft3 166 f 90 5 1 2 8 3 .. 1 4 8 9 6 16 15 26 3 32 Causes iil-deflned or unknown 4 m 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 2 2 3 .. .. .. .. if) .. 3 f 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. Deaths from All Causbb 1909 m 1091 126 43 40 209 25 12 21 33 42 73 135 175 206 160 1061 848 148 655 5 1 48 21 32 1210 f 818 124 31 27 162 23 8 21 23 44 36 71 122 297 128 180 340 Totals 1909 230 74 67 371 48 20 42 56 86 109 206 334 (a) Highways, 2. (b) Highways, 4; On barge, River Lee, 1. (c) Highway, 1. {d: River Lee, i. (e) Highways, 4; River Thames, 2; Limehouse Cut, 1; West India Docks, 2. if) Highways, 2; River Thames, 1, The following table, compiled and furnished by the Registrar-General, is inserted at the request of the Ministry of Health (vide Circular 939 (England) ). Causes of Death. Sex. All Ages 0— 1— 2— 5— 15— 25 45— 65- 75- All Causes M 1090 127 41 40 38 54 115 310 218 147 F 818 101 32 27 31 43 79 194 141 167 1 Enteric fever M 1 — — — — — — — 1 F 2 - - - - 2 - - - - 2 Smallpox M - - - - - - - - - - F - - - - - - - - - - 3 Measles M 38 10 14 9 5 F 18 4 7 5 2 - - - - - 4 Scarlet fever M 2 - - 2 - - - - - - F - - - - - - - - - - 5 Whooping cough M 9 3 5 1 - - - - - - F 10 3 4 3 - - - - - - 6 Diphtheria M 13 1 2 7 2 1 — — — — F 12 1 4 2 5 - - - - - 7 Influenza M 15 1 1 — — 2 2 8 1 — F 9 3 1 1 — — 3 1 _ 8 Encephalitis lethargica M 1 - - - - - - - 1 — F 1 - - - - - - - 1 — 9 Meningococcal meningitis M - - - - - - - - - - F 1 1 - - - - - - - - 10 Tuberculosis of respiratory system M 90 — 1 1 1 21 34 29 2 1 F 63 1 1 1 5 25 23 7 — — 11 Other tuberculous diseases M 16 — 1 2 6 3 3 1 — — F 10 1 — 3 2 1 2 1 — — 12 Cancer, malignant disease M 117 — 1 — — 1 2 49 46 18 F 91 — — — 1 1 7 43 28 11 13 Rheumatic fever M 9 — — 1 3 — 4 — 1 — F 3 — — — — 1 — 1 1 — 14 Diabetes M 5 — — — 1 — 1 1 2 — F 6 1 5 — — 15 Cerebral haemorrhage, etc. M 22 - - - - - 1 9 9 3 F 39 - - - - - 1 13 15 10 16 Heart disease M 168 — — — — 1 7 67 50 43 F 138 — — — 2 3 8 42 34 49 17 Arterio-sclerosis M 70 - - - - - 2 13 24 31 F 53 - - - - - - 7 9 37 18 Bronchitis M 71 12 1 — — — 5 24 17 12 F 40 9 1 1 — — 11 6 12 19 Pneumonia (all forms) M 111 33 8 5 2 3 15 28 15 2 F 76 24 8 6 1 1 4 18 9 5 20 Other respiratory diseases M 14 — — 1 — — 5 4 2 2 F 16 — — — 1 1 1 1 3 9 21 Ulcer of stomach or duodenum M 15 - - - - - 3 12 — — F 3 - - - - - - 1 1 1 22 Diarrhoea, etc. M 21 16 4 - - - - - 1 — F 24 18 4 — — 1 — 1 — 23 Appendicitis and typhlitis M — — — — — — — — — — F 0 — — 1 5 — 2 — 1 — 24 Cirrhosis of liver M 5 - - - - - 1 2 2 — F 1 — 1 25 Acute and chronic nephritis M 34 — — 2 2 3 14 7 6 F 31 — — — 2 1 3 14 8 3 26 Puerperal sepsis M - - - - - - - - - — F - - - - - - - - - — 27 Other accidents and diseases of pregnancy & parturition M - - - - - - - - - — F 8 — — — — 2 6 — — — 28 Congenital debility and malformation, premature birth M 39 39 - - - - - - - — F 30 31 - - - - - - — — 29 Suicide M 9 - - - - - 3 6 — — F 5 - - - - - 3 1 1 - 30 Other deaths from violence M 60 1 5 7 12 13 8 7 7 F 19 5 1 2 2 — 1 2 3 3 31 Other defined diseases M 135 11 3 4 11 8 11 35 30 22 F 100 4 1 2 3 5 16 24 19 26 32 Causes ill-defined or unknown M — — — — — — — — — — F — — — — — — — — - - Legit. Illegit. Deaths under 1 year M 118 9 F. 98 6 Totals 216 15 15 TABLE III. Infantile Mortality during the Year 1928. 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 49 15 6 6 76 43 45 38 28 115 115 230 Uncertified — — — — — — — — — — — — Smallpox - - - - - - - - - - - - Chicken pox - - - - - - - - - - - - Measles - — - - - 3 — 5 6 6 8 14 Scarlet Fever — — — — — — — — — — — — Whooping Cough - — - - - 2 1 2 — 4 1 5 Diphtheria and Croup - - - - - - - - 3 2 1 3 Erysipelas - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - 1 - - 1 1 Abdominal Tuberculosis - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - 1 - 1 1 Meningitis (not Tuberculous) - - - - - - - 1 1 - 2 2 Convulsions 2 — - — 2 - — 1 — 2 1 3 - - - Bronchitis 2 2 12 2 1 3 8 12 20 Pneumonia (all forms) — — 1 2 3 11 14 12 10 21 29 50 Diarrhoea - - - - - 6 7 6 3 7 15 22 Enteritis — — 1 1 2 4 6 1 — 6 7 13 Gastritis - - - - - - - - - - - - Syphilis — 1 1 1 — 1 1 2 Rickets - - - - - - - - - - - - Suffocation, overlying — 2 — — 2 — 1 — — 3 — 3 Injury at birth i — — — I — — — — 1 — I Atelectasis 1 - - - 1 - - - - - 1 1 Congenital Malformations .. 7 3 - 1 11 - 3 2 - 10 6 16 Premature birth 31 6 1 2 40 3 2 — — 25 20 45 Atrophy, Debility and Marasmus 5 1 1 - 7 - 2 2 - 7 4 11 Other Causes 2 1 1 — 4 1 7 4 1 12 5 17 Total Deaths 49 15 6 6 76 43 45 3S 28 115 115 230 Jiett Births | Legitimate .. 3,137* in the year \ Illegitimate .. 91* Nett Deaths / Legitimate .. .. 207 in the year \lllegitimate .. .. 23 •Registrar-General's figures. 16 INFANT MORTALITY. There were 230 deaths of children under one year of age, the death rate per 1,000 births for the past 21 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 I9I3 113 (83) 105 1914 117 (117) 104 *9*5 134 (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 i925 75 (50) 67 1926 70 (39) 64 1927 66 (42) 59 1928 71 67 Note.—The figures in brackets are the mortality rates amongst infants 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 1928. ---- Birthrate 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. Diarrh<ea and Enteritis (under 2 years). Total Deaths under One Year. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. live Births Stillbirths. England and Walest 16.7 0.70 11.7 0.01 0.00 0.11 0.01 0.07 0.06 0.19 0.53 7.0 65 90.9 6.7 1.4 1.0 107 County Boroughs and Great Towns, including Londonf .. 16.9 0.70 11.6 001 0.00 015 0.02 009 0 09 0.17 0.48 9.6 70 91.J 6 5 1.9 0.6 156 Smaller Town3 (adjusted Populations 20,000.50,000) t 16 6 0.73 10.6 0 01 0.00 0.08 0.01 0.06 0.08 0.21 0.41 4.8 60 92.6 5.7 0.5 1.2 Londonf 15.9 0.53 11.6 0.01 0.00 0.30 0.02 0.09 0.09 0.13 0.55 10.2 67 88.7 7.6 3.7 0.0 Poplar Borough.. 19 9 0.63 11.8 0.02 0.00 0.34 0.01 0.12 0.16 0.15 0.59 13.3 71 85.5 12.2 2.3 0.0 †Note by Registrar.General. Provisional Figure*. The rates for England and Wales have been calculated on a population estimated to the middle of 1928, but those for the towns have been calculated on populations estimated to the middle of 1927. (The mortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London and the groups of towns). 18 TABLE V. (1928). Cities and Boroughs. Estimated population to the middle of year. Births. Annual rate per 1,000 persons living Zymotic Deaths. Annual rate per 1,000 persons living. Deathrate per 1,000 living. Deaths of Infants under one year to 1,000 births. *LONDON 4,458,200 15.9 — 11.6 67 Weal Districts. Paddington 145,200 14.99 0.87 13.03 85 Kensington 178,400 14.3 0.64 13 0 83 Hammersmith 136,300 16.6 0.5 11.4 69 Fulham 155,300 15.4 0.6 11.5 77 Chelsea 63,630 12.6 0.2 13.5 48 City of Westminster 129,700 10.3 0.21 11.5 58 North Districts. St. Marylebone 104,000 12.6 0.74 111 79 Hampstead 85,800 11.6 0.27 11.6 54 St. Pancras 205,600 15.9 1.06 12.7 80 Islington 324,700 17.8 0.73 12.8 64 Stoke Newington 50,690 15. 0.29 12.5 61 Hackney 217,200 16 0 0.54 11 .7 67 Central Districts. Hoi born 39,280 12.0 0.35 13.5 57 Finsbury 72,010 20.4 1.36 15.1 85 City of London 11,430 7.2 0.17 12.2 60 East Districts. Shoreditch 101,200 20.1 1.08 13.8 80 Bethnal Green 112,200 19 0 11.7 73.9 Stepney 244,000 18.7 0.90 11.7 71 Poplar 162,000 19. 9 0 .65 11. 8 71 South Districts. Southwark 181,300 19.2 0.98 12.7 70 Bermondsey 115,200 18.1 1.19 13.2 85 Lam beth 298,100 16.82 0.56 12.30 61.1 Battersea 164,100 16.7 0.67 11.9 64.2 Wandsworth 354,948 13 0 0.27 10.58 49 Camberwell 260,400 15.8 0.76 11.9 61 Deptford 112,400 16.3 0.7 12.0 76 Greenwich 100,200 16.42 0.59 11.13 55 Lewisham 199,300 15.2 0.47 10.0 52 Woolwich 141,100 16.1 0.39 11.0 50 *The provisional figures relating to London were supplied by the Registrar. General. Other figures supplied by Medical Officers of Health. 19 (These summaries are inserted for comparison with those shown in \previous reports.) 1923. 1024. 1925. 1926. 1927. 1928. Deaths from all causes, rate per 1,000 population 11.3 12.1 11.7 11.4 11. 8 11.8 Death? under 1 year of age, rate per 1,000 nett births 60 72 75 70 66 71 Deaths over 65 years of age, rate per 1,000 total population .. 3.6 3.9 4.1 3.9 4.2 4.2 *Zymotic diseases:— Death rate per 1,000 population 0.6 0.8 0.9 0.9 0.6 0.6 Proportion of 1,000 deaths 58.5 65.7 75.6 75.2 51.6 55.5 Tuberculosis, all forms:— Death rate per 1,000 population 1.2 1.2 1.1 1.0 1.1 1.1 Proportion of 1,000 deaths 103.7 97.9 96 9 84.0 96.0 93.2 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 2.4 3.2 2.9 2.4 2.0 1.9 Proportion of 1,000 deaths 212.7 265.4 246.2 207.9 172.4 162.4 Deaths from Various Diseases. Disease. 1923. 1924. 1925. 1926. 1927. 1928. Measles 22 37 27 39 8 56 Whooping.Cough 7 39 60 9 34 19 Influenza 22 48 20 23 36 24 Pneumonia, all forms 163 230 185 154 138 177 Diarrhoea and Enteritis (all ages) 41 30 54 69 39 47 *Smallpox, Measles, Scarlet Fever, Whooping.Cough, Diphtheria and Mem. Croup, Typhoid Fever and Diarrhœal Diseases. 20 TABLE VI. Total Deaths (at all ages) in I'ublic 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 155 671 132 2 130 1090 Uncertified — — ~ — — — 1. Enteric Fever — 1 — 1 1. Smallpox — — — — — — 3. Measles — 16 — — 1 17 4. Scmlet Fever — — — — 5. Whooping Cough — 2 — — 2 6. Diphtheria — 2 2 7. Influenza 1 9 10 8. Encephalitis Lethargica.. — — 2 — 1 3 9 Meningococcal Meningitis — — — — 1 1 10. Tuberculosis of respiratory system 17 42 5 1 3 68 11. Other Tuberculous Diseases ] 8 2 - 3 14 12. Cancer, malignant disease 9 92 6 10 117 13. Rheumatic Fever — 4 — — 4 14 Diabetes — 6 1 — - 7 15. Cerebral hæmerrhage, etc 4 19 2 — 2 27 16. Heart Disease 32 109 51 — 4 196 17. Arterio-sclerosis 37 40 24 — 2 103 18. Bronchitis 12 25 2 — 1 40 19. Pneumonia (all forms) 5 71 2 — 9 87 20. Other Respiratory Diseases - 9 - - 1 10 21. Ulcer of Stomach or Duodenum - 9 - - 4 13 22. Diarrhœa, etc. i 27 — — 3 31 23. Appendicitis and Typhlitis i 3 5 9 24. Cirrhosis of Liver — 3 - — 1 4 25. Acute and Chronic Nephritis 8 38 18 - 3 67 26. Puerperal Sepsis — — — 27. Other accidents and diseases of pregnancy and parturition 1 6 - - - 7 28 Congenital Deh:,ity and malformation, premature birth 6 10 1 - 3 20 29. Suicide — 4 — 1 5 30. Other Deaths from Violence 5 32 - - 47 84 31. Other Defined Diseases 11 86 16 1 23 137 32. Causes ill-defined or unknown 4 4 All Causes Males 103 388 101 1 92 685 Females 52 283 31 1 38 405 Totals 155 671 132 2 130 1090 21 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.'' 1928. Jan. 30. 50a, St. Leonards St., of no fixed abode. Male, 75. Haemorrhage from aneurysm in right lung. Chronic tuberculosis of lungs. P.M. Inquest. Feb. 22. Foreshore of River Thames. Male, 7 days (unknown) . Asphyxia from drowning. P.M. Open verdict. Inquest. Feb. 28. River Thames, entrance of South-West India Dock. Male, newly-born (unknown). Haemorrhage from umbilical cord. Lack of attention at birth, but nothing known as to other circumstances. P.M. Open verdict. Inquest. Mar. 22. In ambulance, High St., Poplar. Ship's Donkeyman of Sweden Male, 68. Rupture of aortic aneurysm. P.M. Inquest. Feb. 14. Poplar Hospital. Seaman of Scotland. Male, 36. Fracture of skull. Fell down hold of ship in dock. P.M. Inquest. Aug. 22. River Thames, off Trinity Wharf. Male, 50 (unknown) . Found drowned. P.M. Inquest. Aug. 11. West India Docks. Seaman of unknown address. Male, 25. Asphyxia due to drowning. P.M. Open verdict. Inquest. Nov. 6. 2a, Bow Road. Female, 60 (unknown) . Lobar pneumonia. Exposure and self-neglect. P.M. Nov. 11. St. Andrew's Hospital. Labourer, of unknown address. Male, 28. Bronchiectasis. Pulmonary abscess. Pneumothorax . INQUESTS AND DEATHS FROM VIOLENCE. The number of inquests registered was 280. From this total must be deducted 76 of non-residents, and 29 added of residents who died outside the Borough, the nett total being 233. Analysis of the 95 deaths classified to Suicide and other deaths from Violence (International Short List Headings Nos. 29 and 30):— 22 Suicide 14 Food poisoning — Poisoning by venomous animals — Other acute accidental poisonings (not by gas) 1 Conflagration 1 Accidental burns (conflagrations excepted) 8 Accidental mechanical suffocation 4 Accidental absorption of irrespirable or poisonous gas — Accidental drowning 10 Accidental injury: By firearms — By cutting or piercing instruments I By fall 29 In mining and quarrying — By machinery 2 By other forms of crushing: Road vehicles 23 Railways 1 Other crushing accidents 1 Injury by animals (poisoning by venomous animals excepted) — Wounds of war — Execution of civilians by belligerent armies — Hunger or thirst — Excessive cold — Excessive heat — Lightning — Electricity (lightning excepted) — Homicide: By firearms — By cutting or piercing instruments — By other means — Infanticide — Fracture (cause not specified) — Other and unstated forms of accidental violence — Violent deaths of unstated nature (i.e., accidental, suicidal, etc.) and cause — 95 For death rates from violence, and the percentage of inquest cases to total deaths, see Table IV. 23 MORTUARY. The number of bodies deposited in the Mortuary, Cottage Street, Poplar, during the year was 343:— Residents. Non-Residents.* No age stated — — Stillborn 3 — Under 1 year 20 — 1 to 5 years 23 — 5 to 15 years 24 — 15 to 25 years 22 1 25 to 65 years 135 4 65 years and upwards 105 6 Totals 332 11 *Brought from outside the Borough for the convenience of the Coroner. Inquests were held on 299, and 41 post-mortems were made by order of the Coroner. The total number of post-mortems made was 140. Three bodies were brought to the Mortuary for custody only, pending burial. 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. 24 Maternity. Nil. (See reference to the provision of maternity beds in St. Andrew's Hospital on page 7). 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 124). 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. 25 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. 1928 1,055,885 £425.954 5. 11d. 1,838 26 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, 1928, the total days maintenance for the year amounted to 171,432 days, giving an average daily number of 468. 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, 1928, are as follows:— Sick Wards, Poplar Institution 179 Maternity Wards, All Saints' Annexe 36 The number of entries in the District Medical Officers' Registers of cases for medical treatment for the year ended 31st December, 1928, are as follows:— Poplar Districts. District Number of Medical Officer. Medical District. Entries. Dr. H.J. O'Brien West 1.704 Dr. M. J. Byrne East 2,224 Dr. C. F. White Middle 1,682 St. Andrew's Hospital Part Bromley 378 (from 1st Oct., 1928) Dr. W. C. Millea South 1,508 Dr. M. J. Hallissey S. Central 2,217 Bow Districts. Dr. C.Phelps Old Ford West 2,487 Dr. D. G. McRae Bow 2,888 St. Andrew's Hospital Old Ford East and part Bromley 4.944 27 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.*† (a) H. W. Leonard.*‡ From 23rd April, 1928. (a) J. Johnson.*§ (a) C. H. Brown.*†‡§ (a) H. J. Langley.* (a) Distriot Inspectors. (a) A. J. Field.t (a) F. A. Smith.*‡ (b) C. A. Urabham.*‡ (b) H. A. pearce.*†§‡ Miss M. E. Davis.*†¶|| (c) S. Kelly* (b) Food Inspectors. into separate tenements (c) Inspector for Houses divided A. Barrows (promoted), J. Chapman, A. Collyer, W. Cue, C. F. Gregory, G. A. Hale, F. E. Quested (retired). E. Willson (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.* W. F. Roberts. A. Hamilton.†† H. A. Purdy D. Evans. Miss S. Fells. Mrs. E. Long. D. Flynn (Office Boy). Caretaker and Messenger: J. J. Jackson (retired). C. E. Richardson (from 1st March, 1928). 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). 28 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: Mrs. E. Tomlins (temporary). Caretaker: J. Tyler. DISINFECTING STATION, YEO STREET. Disinfectors: W. Hodge† (Chief). D. Boyce (Retired). A. Barrows (from 2nd July, 1928). 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). † Cert. R.S.I. 29 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, R.R.C.*¶†† Health Visitors: Miss E. A. Foskett.*¶ Mrs. M. J. Edoell.§¶ 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.*¶† (c)Miss E. A. H. Williams*¶ (c) Miss E. M. Craioie.*¶ (from 7th May, 1928). Clerk: Miss G. Hood (resigned). Miss K. D. Evans (from 27th August 1928). 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 (resigned). Miss L. Green'IT (from 10th December, 1928). Two Staff Nurses, three Probationers, one Cook, one Maid and a Porter. Free Milk Scheme. Temporary Clerks: Miss I. Collen. Miss K. Phelan. Miss C. Rudd (from 9th January, 1928). 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. K.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. (c) New H.V. Certificate. NOTE.—Contributions under the Public Health Acts or by Exchequer Grants are made towards the salaries of the Medical Officer of Health, Chief Clerk, Sanitary Inspectors, the Maternity and Child Welfare and the Tuberculosis Dispensary Staffs. 30 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 71. 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. Date of Section. Adoption. 16 (1) Prevention of nuisances arising from matter 20th Oct., 1893. thrown in any street; offensive matter running into an uncovered place; keeping of animals; paving of yards and open spaces 39 (2) Keeping water closets supplied with sufficient 20th Oct., 1893. water 50 Securing cleanliness and freedom from pollu- 20th Oct., 1893. tion of tanks, cisterns and other receptacles used for storing water 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 1st April, 1927. sleeping places 31 Bye-laws made by the London County Council. Public Health (London) Act, 1891. Date of Section. Adoption. 16 (2) Closing of cesspools and privies; removal 28th June, 1893. and disposal of refuse 16 (2) Removal of faecal and offensive matter 26th Nov., 1901. 39(1) Construction of closets, privies, ashpits, 28th June, 1893. cesspools and dung receptacles 14th June, 1901. 3rd Jan., 1905. 19 Bone boiler, manure manufacturer or tallow 25th Nov., 1907. melter 19 Gut scraper and catgut maker or catgut 25th Nov., 1907. manufacturer 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 Soapboiler 25th Nov., 1907. 19 Tripe boiler 25th Nov., 1907. J9 Slaughterhouses (conduct of business) 27th April, 1923 and 21st July, 1925. 32 London County Council (General Powers) Act, 1908. Date of Section. Adoption 9 Rag and bone dealer 18th Sept., 1928 9 Fish curer 28th Feb., 1911 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, re- 20th Aug., 1903, construction, 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) Act, 1891, has been applied to:— 33 (1) Zymotic Enteritis (from 1st June to 30th September in each year). (2) Chicken-pox (from 5th May, 1928 to 4th May, 1930). New Legislation. During the year the following Acts of Parliament, etc., have come into operation:— Acts, Regulations, Orders, etc. Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Amendment Regulations, 1928. Public Health (Ophthalmia Neonatorum) Amendment Regulations, 1928. Infectious Diseases (London) Regulations, 1927. Acts. Agricultural Produce (Grading and Marking) Act, 1928. Food and Drugs (Adulteration) Act, 1928. London County Council (General Powers) Act, 1928. Bye-laws. (Amendment). For regulating the business of a rag and bone dealer. 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 Northumberland 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 1928. House refuse collected 31,797 tons. Trade refuse collected 167 ,, Slop and sweepings 10,981 ,, Refuse from street markets 2,629 ,, SANITARY INSPECTORS WORK, Etc. Tubulated Statement of Inspections, Insanitary Conditions found existing, and lie-inspections during the year 1928. East Combined West Combined Poplar South Bromley North Bromley Central Bow East Bow West Totals 1928 Totals 1927. Total Inspections: 1513 1422 1426 1247 896 943 1148 8595 8694 On complaints of nuisances, etc. 488 745 620 633 320 490 582 3878 3718 On notification of infectious diseases 387 520 459 279 2,6 186 258 2365 2586 House-to-House 63 25 — 2 61 26 35 212 653 Workshops, workplaces, etc. 284 47 97 88 59 44 198 817 797 Miscellaneous 291 85 250 245 180 197 75 1323 940 Premises found in fair condition 759 630 771 554 242 314 482 3752 3561 Do. requiring amendment 754 792 655 693 654 629 666 4843 5133 Details of Insanitary Conditions, etc. Walls and ceilings dirty 210 292 237 362 263 210 371 1945 2419 Yards, forecourts and areas insufficiently paved or drained 108 54 66 62 98 35 116 539 638 Inlets to drains not properly trapped — 8 — — — — 1 9 7 Number of drains tested 306 191 372 169 233 158 507 1936 1944 Do. do. defective 73 90 36 37 15 37 80 368 386 Do. do. obstructed 76 128 79 97 50 78 39 547 456 Sink waste pipes not trapped or otherwise defective 84 21 36 18 69 26 101 355 316 Do. do. directly connected to drains 1 2 — — — 6 — 9 10 Soil pans of w.c.'s without suitable water supply 65 29 30 51 45 17 38 275 277 Do. do. broken or unsuitable 37 15 13 24 27 35 13 164 143 Do. do. in foul condition 18 17 13 13 11 24 96 145 Do. do. untrapped 1 3 — — 1 1 6 6 Roofs, guttering, and rainwater pipes defective 236 323 338 349 251 173 269 1939 2121 Water supplies to premises cut off (notified by Metropolitan Water Board) — 2 1 1 — — — 4 14 Water service fittings defective, causing waste of water 53 23 28 27 8 21 16 176 164 Drinking water improperly stored — 3 1 1 1 — 6 1 Dampness 204 62 79 65 92 114 79 695 843 Inundations 135 12 1005 — * 12 40 1204 43 Overcrowding 22 7 4 10 11 2 — 56 26 No proper receptacle for house refuse 65 62 80 64 64 101 81 517 403 Accumulations of dung or refuse 78 18 16 10 8 23 12 165 153 Insanitary P.H. urinals 11 4 1 3 8 7 1 35 24 Other nuisances, dilapidations, want of ventilation, etc. 311 411 491 486 186 492 306 2683 3211 Breaches of London County Council's By-laws 82 12 27 1 — 59 2 183 268 Breaches of Council's By-laws 75 7 81 15 98 39 1 319 543 Intimations served 537 713 647 693 588 629 659 4466 4966 Notices served 136 256 207 331 206 153 261 1580 1779 Final Notices served 44 64 64 167 45 61 86 531 326 Summonses applied for — 2 — 17 2 1 — 27 26 Passengers from Continental Ports:— Visited — — — — — — — — 12 Undiscovered — — — — — — — — 2 Intimations served in respect of verminous rooms 18 26 20 29 43 10 — 146 213 Verminous rooms cleansed by owners, etc. 31) 15 20 46 38 2 — 151 200 Re-inspections.. 2500 3381 2231 2744 1819 2589 2626 17890 19930 Visits to Smallpox contacts 3863 1036 2919 378 670 176 163 9205 — Do. school absentees, etc. 52 — — — 158 — — 210 — House-to-house visits re smallpox 176 131 — 164 — — 471 — Visits re typhoid fever contacts — — — — — — 160 160 — *59 visits made, but no inundations found. 35 Work of Lady Sanitary Inspector. Tabulated statement of Inspections, of Insanitary Conditions found existing, and of Reinspections, etc., during the year 1928. Poplar. Bow and Bromley. Totalas. Workshops, Workplaces, Laundries, &c., Number of, on the Register 69 100 169 Workshops. Number of Workrooms therein 72 129 201 ,, Number of Inspections of 70 106 176 ,, Number of Reinspections of 36 88 124 Workrooms, Number of Inspections of 76 148 224 ,, found to be overcrowded 7 3 10 ,, found to be insufficiently ventilated 2 2 4 ,, found to be in dirty condition 6 20 26 Workshops, etc., newly discovered and registered 1 9 10 ,, Workrooms therein measured 1 9 10 ,, Reported to H.M. Inspector on discovery 1 9 10 Factories, Number visited 83 180 263 ,, W.C.'s dirty, insufficient, &c. 72 54 126 Outworkers' premises visited 293 866 1,159 Written Intimations served and instances reported 68 18 86 Statutory Notices served 6 12 18 Final Notices served — — — Works carried out under supervision:— (a) Additional means of ventilation provided 2 2 4 (6) Rooms cleansed and whitewashed 6 20 26 (c) Yards, floors, roofs, &c., repaired — — — (d) Sanitary conveniences constructed, cleansed or repaired 72 54 126 (e) Dampness remedied — — — (f) Sink waste pipes renewed, etc — — — (g) Miscellaneous 1 13 14 Overcrowding of Workrooms, Cases abated 7 3 10 Miscellaneous Visits (including visits to Council Houses) 581 131 712 Visits re Verminous Children 65 80 145 ,, Scabies 63 18 81 ,, Outworkers' Lists 36 30 66 ,, Suspected Infectious Disease 468 217 685 ,, Eye Infections 63 9 72 Visits to Schools 57 31 88 ,, cases of chickenpox 112 51 163 ,, workshops re smallpox contacts — 37 37 Factory and workshop inspections, 439; fair condition, 250; removed or discontinued 9; required cleansing, 26; sanitary conveniences defective or insufficient, 126; overcrowded, 10; want of ventilation, 4; other nuisances, 14. 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 1928. Houses registered 95 Notices sent out, re above 130 House-to-House visits for registration purposes 253 Rooms measured, etc. 551 Declarations, for information, sent out 128 ,, with information, returned 101 Inspections of registered houses 152 Re-inspections 296 Number of Intimations served 57 ,, Notices served 16 ,, Final Notices served — ,, drains repaired or reconstructed — Notices under L.C.C. Bye-laws served 6 ,, ,, ,, ,, complied with 2 Number of rooms cleansed 40 ,, ,, freed from vermin 7 Overcrowding, cases discovered 5 37 STABLES. During the summer months of 1928 weekly inspections of stable premises were resumed, and the frequent and complete removal of horse manure insisted upon. 187 stables were inspected and reported upon, the total number of inspections being 950. The following infringements of the Bye-laws were dealt with Accumulations of manure, or premises otherwise not clean 75 Lack of ventilation 1 Floors not properly drained 5 Dung receptacles:— (a) Not provided 16 (b) Defective 18 (c) Not covered 9 Other defects 27 134 Intimations were served, followed by 19 Notices and 6 Final Notices. The works required were completed before the end of the year. Lighting of Staircases in Tenement Buildings. The provisions of the London County Council (General Powers) Act, 1927, Section 61, came into operation on the 1st August, 1928. The action taken with regard to Section 61 of the London County Council (General Powers) Act, 1927, was given in extenso in last year's annual report. In all cases the lighting of staircases has been improved and the requirements of the Act complied with. 38 FACTORY AND WORKSHOPS ACTS. Table A. Table giving number 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 1928. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male. Female. Total. Bakehouses (Factories) 44 - 44 148 92 1 - - Bakehouses (Workshops) 26 — 26 101 58 - - - Bakehouses (Domestic Workshops) 6 - 6 16 14 - - - Factories (Laundries and Miscellaneous Factories) 24 125 149 279 64 3 - - Laundries (Workshops) — 6 6 6 2 2 - — Laundries (Domestic Workshops) - 2 2 2 - - - - Workshops 160 159 319 401 155 17 1 - Workshops (Domestic) 14 2 16 13 1 - - — Workplaces — 361 361 1207 161 26 7 — Workplaces (Domestic) 30 — 30 61 5 — — — Places where food is sold or prepared 313* - 313* 1354 341 15 2 - Milk Premises 111 - 111 265 5 — - - Cowsheds 4 — 4 18 1 2 — — Slaughterhouses 7 — 7 8 — — — — Other offensive trade premises 8† - 8† 43 3 - - - Ice Cream premises 128‡ — 128‡ 197 19 — — — Homeworkers' premises 27 1152 1179 1203 66 24 1 - 39 Table B. Workshops on Register (Male), 1928. 2 Acetylene gas making. 3 Metal works. 18 Bootmaking. 2 Oil stores. 1 Barge building. 4 Paint making. 1 Bedding making. 2 Plumbing. 1 Bitumen making. 1 Poultry food mixing. 1 Blind making. 2 Printing. 1 Boiler coverer. 3 Rag sorting. 2 Boat Building. 2 Rope making. 2 Brash making. 1 Sack making. 1 Building, etc. 1 Sawyer. 11 Cabinet making. 1 Shellac bleaching. 2 Carpenters. 1 Show case making. 1 Chemical works. 1 Stonemasonry. 1 Cigar making. 1 Stove making. 1 Clay pipe making. 19 Tailoring. 2 Cork cutting. 1 Tank making. 4 Cooperages. 4 Tarpaulin works. 1 Dental workshop. 2 Tin toy making. 1 Electrical engineering. 1 Transfer making. 4 Engineering. 1 Trunk making. 9 Farriers. 4 Upholstering. 1 French polishing. 3 Undertaking. 1 Frilling making. 2 Van building, etc. 2 Furniture making. 1 Waterproof working. 4 Furriers. 2 Welding. 1 Garden Ticket making. 1 Wheelwright. 1 Glass works. 3 Wire working. 1 Horsehair working. 1 Wood Tar products. 4 Harness making. 1 Zinc working. 7 Motor garage works. As per List, Table A Workshops on Register, page 38. Domestic Workshops on Register (where Men are Employed.)* 2 Blacksmiths. 2 Tailoring. 4 Boot repairing. 1 Tailor's Presser. 1 Decorative earthenware making. 1 Wire working. 1 Mat making. 1 Zinc working. 1 Printing. 40 Home Workers on Register (Male). 26 Bootmaking. 1 Tailoring. Workshops and Domestic Workshops on Register (Females).* 1 Badger hair sorting. 1 Paper and rag sorting. 1 Bedding making. 1 Pickle and sauce making. 2 Boot factors. 3 Pressers and cleaners. 1 Cabinet making. 2 Shirt and pvjama making. 1 Cap making. 1 Seal stamp making. 1 Confectionery making. 1 Table jelly making. 2 Cork cutting. 66 Tailoring. 11 Costume making. 1 Tarpaulin works. 18 Dressmaking. 2 Tiemaking. 2 Embroidering. 1 Tin goods labelling and sorting. 1 French polishing. 3 Toymaking. 4 Furriers. 3 Trimming making. 3 Infants' shoes making. 3 Upholstering. 8 Laundries. 1 Waterproof garment making. 18 Milliners. 1 Whalebone dressing. 4 Packing. 1 Wood chopping. * It is very difficult to separate Workshops and Domestic Workshops, as these premises are sometimes one and sometimes the other, according to the pressure of work. See Table A, page 38. Factories on Register (Where Females are Employed) 2 Bedding manufacturing. 1 Perambulator builder. 3 Blouse making. 1 Pianoforte manufacturer. 2 Boot making. 3 Preserved food. 5 Box making. 2 Ragwork. 1 Brush making. 1 Rice starch making. 1 Bunting and flag making. 3 Rope works. 1 Butter mixing factory. 3 Rubber goods making. 1 Buttons and buckles. 1 Rug making. 1 Cabinet making. 4 Sack making. 2 Chip basket making. 2 Sausage factory. 1 Christmas cracker making. 4 Shirt making. 1 Cigarette paper making. 1 Shroud making. 1 Clay fuel and pipes. 25 Tailoring. 3 Cleaners and dyers. 3 Tarpaulin works. 1 Condiment packing. 1 Ticket printing. 41 Factories on Register (where Females are Employed).—contd. 3 Confectionery making. 2 Timber works and wicker furniture making. 1 Cork cutting. 1 Corset making. 1 Tortoiseshell goods making. 4 Costume making. 1 Toy balloon making. I Dog biscuit manufacturer. 2 Toy making. 4 Dressmaking. 2 Trimming making. 1 Fibre, hemp and jute making. 1 Type founder. 2 Glass works. 2 Varnish and paint works. I Gum works. 1 Wallpaper manufacturer. 1 Kapok works. 3 Waterproof making. 2 Laundries. 1 Whalebone works. 1 Match making. i Wine bottling. i Mineral water manufacturer. 2 Woollen garment making. 2 Overall making. Table C. See note, page 40. Factories, Workshops, Laundries, Workplaces and Homeworkers. 1.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecuti ons. Intima- ' Statution. tory. Final. Factories (Including Factory Laundries.) 427 156 4 — Workshops! •• (Including Workshop Laundries.) 508 215 19 1 — Domestic Workshops! 31 15 — Workplaces .. 1207 161 26 7 Domestic Workplaces Places where food is sold or pre- 61 5 — — pared§ 1354 341 15 2 Homeworkers' Premises 1203 66 24 1 — Total 4900 959 88 11 — t Including Workshop Bakehouses. See Table A, page 38. ‡ Including Domestic Bakehouses and Laundries. See Table A, page 38. The inspections of all factories where food is prepared are included. Power is used in 42 of the premises. 42 2.—DEFECTS FOUND* (Corresponding figures for 1927 are shown in italics). Particulars. Number of Defects. Number of Found. Remedied. Referred to H.M. Inspector. Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Act: Want of cleanliness 606 (744) 606 (744) .. .. Want of ventilation 6 (5) 5 (5) .. .. Overcrowding .. 10 (13^ 10 (13) .. .. Want of drainage of floors (6) .. (6) .. .... Other nuisances 186 (329) 185 (329) .. .. Sanitary accommodation 'insufficient 5 (2) 5 (2) .. .. unsuitable or defective 146 (108) 146 (108) .. .. not separate for sexes 5 (4) 5 (4) .. .. 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.) 6 6 Total 970(1211) 962 (1211) 8 * These defects refer to premises as mentioned above under table of Inspection. St Nature of Work. Outworkers' List (Section 107) wholesome premises. (Section 108). (Seotions™C»,"llO». Table D.—Home Work. Lists received from Employers. Notice served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the year. | Once in the year. Failing to keep or permit inspection of list Failing to send lists. Lists. Outworkers. Lists. Outworkers Contractors. Workmen . Contractors . Workmen. (1) (2) (3) (4) (5) (6) (7) (S) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— 31* Making, etc. 102 10 788 — — - Cleaning and Washing 2 20 2 — 11 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 4 - 107 Brush Making Pea Picking Feather Sorting Carding,etc.,of buttons, etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas ers, Christmas Stockings, etc. 2 — 5 — — Textile Weaving Totals 110 10 920 2 — 11 - --- 31" .. .. * For Infectious Diseases see page 85. 44 LIST OF OUTWORKERS, FACTORY AND WORKSHOP ACT, 1901 {S. 107). 1928 Number of Lists received. Number of Addresses of Outworkers. Class of Homework. Due Feb. 1st. Due Aug. 1st. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Due Feb. 1. Due Aug. 1. Due Feb.1. Due Aug. 1. Total 49 462 46 468 248 289 385 374 Tailoring 39 307 36 306 1 I 248 289 385 374 Shirtmaking.. 1 10 1 12 Miscellaneous 4 30 4 36 Shoemakers 1 26 1 23 Boxes .. 2 54 2 56 Overalls 2 35 2 35 Table E. Registered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at tvhe end of the year. Number. (1) (2) Bakehouse Workshops .. 26 Bakehouse Domestic Workshops 6 Important classes Laundries Workshops 6 of workshops, such as Laundries Domestic Workshops 2 workshop bakehouses Workshops 319 may be enumerated Domestic Workshops 16 here. Workplaces 75 Workplaces Domestic 30 Places where food is sold or preparedcccccccc 313† Total number of workshops and workplaces, etc., on Register 793‡ † Power is used in 42 of these premises. ‡ See Tables A and B, pages 38 and 39. Table F. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133).. 8 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 51 Reports (of action taken) sent to H.M. Inspector 51 Other (Communications) .. 3 Underground Bakehouses (s. 101):— Certificates granted during the year .. In use at the end of the year 23 45 SMOKE NUISANCES. 39 observations were made and 9 nuisances recorded. 18 complaints were received from the London County Council. 19 intimations were served and were followed by a notice in 1 instance. 2 summonses were issued and 1 conviction obtained. 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. 181 rooms in 86 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. 1,708 orders for fluid were issued. 108¼ gallons of insecticide were distributed during the year. LICENSED PREMISES' URINALS. 35 urinals on licensed premises were found to be in insanitary condition and were subsequently cleansed. WATER CERTIFICATES. Six certificates were granted under Section 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. 46 STREET TRADING. A record is kept in the Public Health Office of street traders who have been licensed to deal in foodstuffs. All storage premises are kept under supervision and periodically inspected. Further, all new applications are reported upon prior to licences being granted. 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. Where rats are still persistent after the use of poison and where there are reasons for suspecting drainage defects, the ground is opened and the drain examined as a matter of routine. Rats and Mice (Destruction) Act, 1919. No notices were served under the above Act during the year. 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. PUBLIC EDUCATION IN HEALTH. With the assistance of Mr. T. Wigley, M.A., who has had considerable experience in lecturing upon health subjects, a scheme for offering lectures to various social and political organisations in the Borough was prepared, and a report was submitted to the Public Health Committee in March, 1928. The scheme was approved, and early in May circular letters were sent out to the various bodies offering lectures on the following subjects:— 47 Syllabus of Lectures. (1) The Development of the Child. (2) The Fears of the Child. (3) "Peculiar" Children. (4) What to tell our Children about Sex. (5) The Care of the Child. (6) Environment and the Child. (7) Adolescence and its Problems. (8) Sex-hygiene for boys. (9) Sex-hygiene for girls. (10) Recreation and Health. (11) Education through Habit. (12) Instinct and Instincts. (13) Our Bodies and how we live. (14) The Workers' Health. (15) Venereal Diseases. (16) Tuberculosis—a scourge of to-day. (17) Microbes, Friends and Foes. (18) Food and Drink—their use and abuse. (19) Social Hygiene. (20) Sunlight and Health. (21) The Romance of Medical Science. (22) Recent advances of Medical Research (23) The Story of Preventive Medicine. (24) Mental Hygiene. (25) The Problem of Sex Education. 48 The following lectures for women's meetings were added to the syllabus later in the year "Helping your Children to grow up." '"The Care of the Unborn Baby.'' "The Change of Life.'' "Common Diseases and Home Remedies.'' Arrangements were made with three lecturers:— Dr. Gladys Ward.—To address female audiences on subjects mainly concerning the health of women and girls. Dr. F. Porter-Smith and Mr. T. Wigley, M.A.—To lecture to other audiences on a wide range of subjects covered by the syllabus. The general arrangements were left to Mr. F. J. White, a member of the clerical staff. As the majority of lectures are given during the autumn and winter months the following report, submitted by Mr. T. Wigley, upon this branch of the work relates to the financial year, ending 31st March, 1929:- Report by Mr. T. Wigley, M.A. The effective administration of the Public Health services depends not only upon the special knowledge and experience of a Medical Officer and the sympathetic help of a Committee, but upon the progressive enlightenment of the general public with regard to the ways of health and disease. Without the intelligent co-operation of the citizen the further progress of applied medical science will be rendered difficult, if not impossible. As Sir George Newman pointed out in a recent report, "Nothing is more certain than the fact that the physical advancement and health of mankind is dependent not upon a 'doctor's stunt' here or a 'sanitary institution' there, but upon the whole social evolution of the people." Probably the most important factor in social evolution is 49 education and, while we cannot be too grateful for the great names in Preventive Medicine, we cannot shut our eyes to the fact that much disease and disorder is preventable, if the knowledge of the experts were made accessible to, and welcomed by, the public at large. The knowledge of the few must be made the possession of the many, if public assent is to be won to such measures as are necessary for the control of disease and the attainment of health. Recognising the truth of these facts, the Public Health Committee, last year, sanctioned the expenditure of £110 Public Education in Health. This took the form of an offer of lectures on various aspects of health and disease, as they affect the community, the Adult and the Child. Organisations, social, political and religious, were approached, and the response was immediate and whole-hearted. Many organisations desired to have more lectures than at that time could be allowed. Considerable interest has been awakened, and it is significant that the animated discussion and questions, which have followed each lecture, sometimes lasted over an hour. It would appear that in some cases a series of lectures would be appreciated and helpful, thus enabling the lecturer to deal with a subject in more detail and related to a larger background. In all, 48 lectures have been given, and it is estimated that nearly 3,800 people have been reached. Again and again, members of audiences have expressed their appreciation of the opportunity of learning more about these vital matters, which has been provided by our Health Authority, and wished that such knowledge had been theirs years ago. Summary. Number of Centres at which lectures were given 17 Number of lectures given 48 To men and boys 10 23 ,, women and girls ,, mixed audiences 15 48 50 Expenditure. Grant to Central Council for Health Education . £10 0 0 Fees to Lecturers £107 2 0 Total £117 2 0 RAG FLOCK ACT, 1911. No samples of rag flock were produced during the year 1928, there being no premises in the Borough where rag flock is stored. HAIRDRESSERS' PREMISES. The hairdressers' premises, numbering 99, were inspected during the year. The number of inspections was 148. Cleansing was necessary at 5 of the premises, and other nuisances found numbered 19. 13 intimations and 5 statutory notices were served, also one final notice. The requirements of these documents were complied with. OVERCROWDING. On account of the existing conditions regarding shortage of houses and the fact that statutory notices might be used in Court to obtain ejectment orders, the Public Health Committee resolved that Statutory Notices for overcrowding should not be served unless authority was specially asked for by the Medical Officer of Health. Overcrowding, unless very gross or accompanied by mixing of sexes, has not been dealt with officially. Of 61 cases reported, 15 were abated, housing accommodation being provided by the Borough Council in I case and by the L .C .C. in 14 instances. (Since the end of 1928 a number of other cases have been abated.) Ten cases of overcrowding in workshops were abated. 51 CANAL BOATS ACTS. For the year ended 31st December, 1928, 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 3 I Mr. A. J. Field, Bow East Division — — Mr. F. A. Smith, Bow West Division — — Totals 3 I *There is no canal in either of these Divisions ; the Inspectors deputise, when necessary, for other Inspectors. Mr. J. Johnson reported: "No registered canal boats have been seen in West Combined Division section of canal during 1928." Mr. H. J. Langley reported: "No canal boats have been observed to stop in the Bromley North section of the canal during 1928." Mr. Wm. Johnson reported: "Two boats belonging to the same firm were in generally neglected condition. In one the cooking stove was defective and the cabin woodwork dirty. In the other, the cabin was very dirty and woodwork charred and burnt. Roof of cabin leaky. Cooking stove defective and broken and without funnel to flue. Letters were sent to the owners and to the Registration Authority. One boat since overhauled and the other proceeded to Brentford for overhaul." Mr. A. J. Field reported: "Canal boats which frequently discharged cargoes in the Bow East Division have ceased to call, owing to changed business conditions. Frequent visits have been, and are being, paid to this section of the canal but no registered or residential boats have been seen." Mr. F.A. Smith reported:" No canal boats have been seen during 1928." LEGAL PROCEEDINGS. (Public Health (London) Act, 1891, Metropolis Management Acts, etc.) Address. Nature of Complaint. Date of Decision. Result. Inspector. 1928. 372, Old Ford Road Failed to amend the drains 14th Feb. Work done; Summons withdrawn; £2 4s. costs Kelly, S. 62, Swaton Road Various defects 13th Feb. 10 days' order; £2 8s. costs.. Langley, H. J. 30, Tibbatts Road Kitchen stove and parting wall defective 13th Feb. 10 days'order; £2 8s. costs.. Langley, H.J. 22, Sophia Street .. Roof, fireplace and stove defective 6th Mar. 14 days'order; £2 8s. costs.. Langley, H.J. 16, Tibbatts Road Various defects 3rd Apr. 7 days' order; £2 8s. costs Langley, H.J. 14, Tibbatts Road Ditto 3rd Apr. 7 days' order; £2 8s. costs Langley, H.J. 41, Wyke Road Ditto 3rd Apr. 7 days'order; £2 6s. costs Field, A.J. 317, St. Leonard's Road. Drains defective 19th Apr. 28 days'order; £2 8s. costs.. Johnson, W. 35, Blackthorn Street Various defects 30th May Work done; £2 4s. costs Langley, H.J. 135, Abbott Road VV.C. cistern and kitchen flue defective 7th June £5 penalty; £3 3s. costs Johnson, W. "Crown" Chemical Works, Three Mill Lane Smoke nuisance 11th July Dismissed Langley, H.J. 14, Otis Street Manhole chamber cover defective 20th July Work done; 10s. costs Langley, H.J. 13, Franklin Street Various defects 20th July 7 days' order; £2 8s. costs Langley, H.J. LEGAL PROCEEDINGS—(continued..) (Public Health (London) Act, 1891, Metropolis Management Acts, Etc.) Address. Nature of Complaint. Date of Decision. Result. Inspector. 1928. 14, Franklin Street Various defects 20th July Work done; 10s. costs Langley, H.J. 24, Franklin Street Ditto 20th July 7 days' order; £2 costs Langley, H.J. 27, Franklin Street Manhole cover and W.C. cone defective 20th July 7 days' order; £2 costs Langley, H.J. 56, Bygrove Street Various defects 31st July 7 days' order; £2 8s. costs Johnson, J. 2, Claude Street Ditto 13th Aug 14 days' order; £2 8s. costs.. Leonard, H. W. L.M. & S. Railway Works, Bow Smoke nuisance 4th Oct. £10 penalty; £2 4s. costs Langley, H.J. 30, Tibbatts Road Roof defective, and other defects 4th Dec. 7 days' order; £2 8s. costs Langley, H.J. 3, Glaucus Street Roof and window frames defective 11th Dec. 10s. penalty; £2 2s. costs Langley, H.J. 14, Ship Street Roof and window sashes defective 19th Nov Work done; £4 10s. costs Kelly, S. 4, Barque Street Roof defective, and rainwater pipe obstructed 19th Nov Work done; (costs included in above) Kelly, S. 30, Tibbatts Road Failed to comply with Magistrate's Order (made 4th Dec., 1928) 2nd Jan., 1929 £5 penalty; £2 2s. costs Langley, H. London County Council (General Powers) Act, 1907, Sec. 78. 40, Pennyfields No proper and sufficient water supply on first 15th Nov... 10 days' order; £2 8s. costs .. Kelly, S. and second storeys of tenement house 54 Section IV. HOUSING CONDITIONS. Housing Accommodation provided during 1928. The number of families re-housed during the past year was as follow: Families accommodated . Number of persons (approx. (a) By the Poplar Borough Council:— (1) in newly-erected houses - - (2) In adapted buildings 2 13 (b) By the London County Council 138 690 Totals 140 703 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, 1928. 1.—General . (1) Estimated population 162,000 (2) General death rate 118 (3) Death rate from tuberculosis (all forms) 11 (4) Infantile mortality 71 (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 1928:— (a) Total (including numbers given separately under (b) ) 1 house & 9 flats 55 (b) With State assistance under the Housing Acts:— (i) By the Local Authority Nil. (ii) By other bodies or persons — 2.—Unfit Dwelling-houses. I.—Inspection of Dwelling-houses during the year. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or other Acts) *6,485 (2) Number of dwelling-houses (included under sub-head(i) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 *212 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation .. 4,520 * The number of inspections of dwelling-houses during 1928 has fallen considerably, owing to the inspectors' time being fully occupied with duties in connection with Smallpox. 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 2,941 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. 56 (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 1,579 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 1,l578 (6) By Local Authority in default of owners (317, St. Leonard's Road). 1 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 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (4) Number of dwelling-houses in respect of which tion Orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 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. 57 Increase of Rent and Mortgage Interest (Restrictions) Acts. No certificates were issued under the above Acts. Unhealthy Area. The West Ferry Road and Orchard Place areas were represented to the London County Council in 1919. On account of the Thames flooding in January, the London County Council were pressed to consider dealing with these areas. In November, intimation was received from the London County Council that the Housing Committee were prepared to recommend the Council to make a scheme under Part II of the Housing Act, 1925, in respect of the portion of the West Ferry Road area on the north-eastern side of that road (including Ingleheim Cottages). This excluded the portion of the West Ferry Road area on the south-western side of that road which the London County Council considered could be reconditioned. The Housing Committee however did not see their way under existing conditions to recommend the Council to deal with the Orchard Place area by way of a clearance scheme under Part II of the Act. The area on the north-eastern side of the West Ferry Road was therefore represented to the London County Council and a copy of the representation sent to the Ministry of Health. The London County Council at their meeting on 22nd January, 1929, agreed to the making of an improvement scheme for this area. Iundations caused by the Overflowing of the River Thames. The areas particularly affected in the exceptional flooding caused by the overflowing of the River Thames on 7th January, 1928, were:—The Isle of Dogs and Orchard House area and a few houses in Dace Road in the northern part of the Borough. There were in all 1,141 houses affected. Four of the Sanitary Inspectors were taken from their ordinary duties, and inspections were made of all flooded premises. The amount of damage caused to personal effects and property varied according to the level reached by the flood waters, and was most serious in (a) part of Orchard Place, where the water rose to a height of 7 feet, and (b) part of West Ferry Road, where heavy mineral oil was added to the flood water and increased the damage. 58 As the flood waters receded, sludge of a more or less offensive character was left behind. In some cases a layer of this offensive material was left on the floor coverings and furniture and in all instances deposits of sludge were left under the floor boards of houses affected, to a depth of two to three inches. TABLE I. The following classification has been used to show the extent of the flooding:— Number of houses. A. Serious flooding. Bedding damaged or where water in living rooms was more than 2 ft. deep, or where less than 2 ft. the water was mixed with oil.) 255 B. Less serious flooding. (Water in living rooms or in basements with boarded floors, to a height of under 2 ft. over floor boards.) 636 C. Slight flooding (Water up to, but not over, floor boards, i.e., under floor boards in living rooms or in concrete basements not used as living rooms.) 250 TABLE II. Area. Number of Houses. Bedding damaged. Affected. Disinfected. Relimed. A. B. C. Total. No. 1 5 2 7 7 No. 2 54 23 2 79 79 8 22 No. 3 7 36 4 47 47 1 No. 4 39 128 77 244 243 17 9 No. 5 — 149 18 167 168 — 6 No. 6 92 84 72 248 241 18 39 No. 7 63 211 75 349 346 — 16 255 636 250 1,141 1,131 43 93 Note: In 22 cases premises were cleansed by tenants or owners (included in total above). In 8 cases lime was supplied (not included in Table above). In all cases enquiries were made as to the beds and bedding which had been damaged and arrangements were made for all the wet bedding to be removed to the Council's Baths either at East India Dock Road or Glengall Road for drying and subsequent re-issue, or destruction. In order to carry out the work of cleansing, the Works Department very soon had a hundred men organised in gangs working in conjunction with the Medical Officer of Health. 59 The following methods were adopted in dealing with the affected houses:— A. Cleansing and disinfection of houses. (1) Walls were stripped and cleansed from the high water mark to the ground, floor boards were cleansed, and the whole treated with a strong mixture of chloride of lime solution. (2) Floor boards were lifted, and where necessary water pumped out, and the under-floors surface treated with ground lime and chloride of lime. (3) Where oil was mixed with the flood water, walls were washed with soap and soda before treatment with chloride of lime. B. Supply of Coal in order to assist in the Drying of Floors and Walls. Coal was supplied for use in the ground floor rooms in the affected houses, and windows and doors were kept open to hasten the drying of floors and walls. In this work the following quantities of materials were used:— Supplied by Works' Department. Ordinary grey lime, 29 bushels. Ground grey lime, 18 tons 16 cwts. Bleaching powder (chloride of lime) 3 tons 6 cwt. 1 qtr. 20 lbs. Supplied by Public Health Department. Soap—1 case Sunlight, ½ case Lifebuoy. Soda, 1 cwt. Floor cloths (1 doz.). In addition to the above, occupiers of affected houses were encouraged to obtain liberal quantities of strong electrolytic fluid (hypochlorite solution) at the various depots, for the general cleansing of the homes. In special cases it was found necessary to repeat the liming process and to increase the quantity of chloride of lime used. 60 The total number of houses cleansed by the Works Department was 1,109; 22 houses were cleansed by tenants or owners under the supervision of the Sanitary Inspectors. Lime was supplied to occupiers of eight houses. When the report of this flooding was submitted to the Public Health Committee the Medical Officer of Health expressed his appreciation of the way in which those of the Works Department who were actually involved in the work carried out their duties. He also referred to the willing co-operation and great assistance rendered by the Superintendents and Staff of the Baths Department in drying, and in some cases actually washing, damaged bedding and clothing. Flooding In North Bow Caused by the Blocking of a Main Sewer, July, 1928. In the early morning of 28th July, 1928, certain premises in Tredegar Road, Bow, were flooded with sewage as a result of a blockage of the London County Council sewer. Following rain on the night of 31st July to 1st August the cellars and basements of 14 houses in Tredegar Road and four houses in Coborn Road were flooded with sewage to depths varying from a few inches to 4ft. 6in. The following action was taken:— (A) LONDON COUNTY COUNCIL. The London County Council Engineer's Department immediately installed temporary pumps which were got working as soon as possible. We were informed by the London County Council Engineers that when the temporary arrangements made were in full working order it would be possible to deal with the dry weather flow of sewage, but if thunder-storms or heavy rain occurred there was every likelihood of a recurrence of the floodings. This state of affairs continued until the new by-pass constructed to convey the contents of the sewer round the blocked portion was completed. (B) POPLAR BOROUGH COUNCIL. Arrangements were made by the Borough Surveyor's Department for the pumping out of the sewage from the various basements and cellars. 61 In co-operation with the Borough Surveyor's Department the following procedure was adopted in the affected houses:— (1) Floor boards raised. All offensive matter removed and the ground covered with chloride of lime and lime. (2) Cellars cleared of offensive matter and sprinkled with chloride of lime and ordinary lime. (3) Walls and floors washed down with disinfectant. (4) Areas and yards cleared and sprinkled with chloride of lime and lime. A temporary depot for the issue of electrolytic disinfectant was opened and fluid was liberally distributed. Following the heavy rain on 3rd-4th August all these premises were again flooded and in addition 5 other houses in Tredegar Road. Arrangements were immediately made by the Borough Surveyor for the provision of additional pumping assistance, and when the premises had been cleared the cleansing and disinfection of each house was again carried out. The London County Council Housing Department was approached with a view to obtaining from them alternative accommodation for those families who were unable to find accommodation in the upper stories of the houses in which they were living. On the 4th August the London County Council Housing Department put at the disposal of the Works Department of the Borough Council alternative accommodation for 4 or 5 families should they be required. In one instance only did a family (consisting of husband, wife and 2 children, who were living in a basement at Tredegar Road) accept accommodation. A considerable amount of damage was caused to furniture, goods, etc., but all persons were informed that this Authority could not accept any claims for damage, although a record of the damage was kept. 62 With the exception of one house all the premises were relimed on 1oth August. On 27th August we received intimation from a London County Council Official that the work on the new by-pass which had been under construction had been completed and that our permanent work on the affected premises could be commenced. The owners (or their representatives) of premises where basements and cellar floors were of wood were interviewed on the property by the Medical Officer of Health, Deputy Borough Surveyor and the District Sanitary Inspector and in nearly every instance the owners agreed to remove all offensive material and concrete the sites. Section V. INSPECTION AND SUPERVISION OF FOOD. PREMISES WHERE FOOD IS SOLD OR PREPARED. Premises where food is sold, stored or prepared, have been inspected during the year and, where necessary, action has been taken to ensure that all foodstuffs were handled with care and protected from contamination . COWHOUSES. There are 4 cowhouses licensed by the London County Council. The cowhouses have been inspected and the necessary action taken under the Milk and Dailies 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 115 registered premises (including 4 cowhouses) where milk is sold. These milk shops were kept under observation. 63 The standard of cleanliness in cowhouses, milk shops, and other premises where milk is dealt with has been maintained. 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 220 persons have been so registered. Cleansing of milkshop premises was necessary in 4 instances. 1 other nuisance was found. 6 intimations and 2 Statutory notices were served. For milkshops connected with infectious diseases, see page 85. 14 persons were, on account of change of ownership of premises, registered as retail purveyors of milk. Milk (Special Designations) Order, 1923. During the year, the following licences under the above Order were issued:— Grade "A" (Tuberculin Tested) Milk:— 8 bottling establishments. 20 dealers in sealed bottles only. 5 supplementary licences (principal licences issued by other Authorities). 1 licence for the sale of "Certified" Milk, and 2 supplementary licences. 2 supplementary licences for the sale of "Pasteurised" milk 1 licence for the sale of Grade "A " milk. 1 licence for a ' 'Pasteurising'' establishment. 1 licence for the sale of ' 'Pasteurised'' milk. 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 74. 64 Bacteriological Examination of Samples of Milk for Tuberculosis. In March, 1928, arrangements were made by the London County Council for their Milk Inspector to take samples of milk for examination for the presence of the tubercle bacillus. It was arranged that when the London County Council Milk Inspector took samples, we would receive information of the samples taken, on the following day or so. After an interval of five weeks we would receive a bacteriological report upon the samples, and the action taken by the London County Council. When the Poplar Food Inspectors took samples, a report form would be filled up and submitted forthwith to the London County Council, to be followed at the end of five weeks with a copy of the bacteriological report from the Lister Institute. In accordance with these arrangements, 106 samples of milk were taken on delivery at a railway station in the Borough, by the London County Council Milk Inspector. These samples were reported upon as follows:— (a) No evidence of tuberculosis 76 (b)Macro and microscopical evidence of tuberculosis 7 (c) Guinea pigs reported to have succumbed to an acute intercurrent infection by some organisms other than tubercle contained in the milk 23 106 In the case of (6) and (c) the Medical Officer of Health of the London County Council reported the facts to the County Medical Officers of Health concerned. Six samples of milk were also taken from three cowsheds in the Borough and these were reported upon as showing no evidence of tuberculosis. No samples were taken by officers of this Department. ICE CREAM. London County Council (General Powers) Act, 1902, Sec. 43- There are 128 premises in the Borough where ice cream is manufactured . 197 inspections were made during the year. 65 Cleansing of premises was necessary in 15 instances. 12 other nuisances existed. 19 intimations were served and the necessary cleansings were carried out, and other nuisances were abated. BAKEHOUSES. There are 76 bakehouses in use, of which 23 are underground. In 44 bakehouses machinery is used. See Table A, page 38, number made up to end of year. Inspections . The bakehouses in the Borough were inspected at least twice during the year, the total inspections numbering 265. Cleansing was found to be necessary on 158 occasions, and 7 other nuisances were found. The cleansings were carried out and the nuisances abated after service of 164 intimations, followed in 1 instance by a statutory notice. SLAUGHTERHOUSES. Two 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:— Goat slaughtered on premises G. Rewauchand, 94, Letter of not suitable and not licensed. High Street, Poplar, caution sent, ditto .. .. Mrs. Carr, 38, Cotton Letter of Street. caution sent. (In the latter case the facts were reported to the London County Council, and Mrs. Carr has stated she does not intend again to slaughter at the premises.) There are 7 slaughterhouses licensed by the London County Council. For number of inspections see Table A, page 38, and reports of Food Inspectors, pages 66 and 68. 66 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 38. 1,354 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 305 instances, and 50 other defects existed. 341 intimations were served, which in 15 cases were followed up by statutory notices, and 2 final notices. It was not necessary to take legal proceedings to secure compliance with the terms of the notices, as the necessary work was carried out. STATISTICAL REPORTS OF FOOD INSPECTORS. MR. C. A. GRABHAM. In submitting the following Mr. Grabham reported he had been engaged on Smallpox work also, and during the year had paid 36 visits and 273 re-visits to infected premises. (Inspections for 1927 in italics). Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. 1928 1927 Bakehouses 141 188 124 1 — Slaughterhouses 1 7 — — — — Cowhouses 2 6 — — — — Milkshops 94 192 1 — — — Eating-houses 56 95 8 1 — — Stalls 340 359 — — — — Other places where food is sold or prepared 221 507 9 — — - Ice cream premises 131 182 16 - — — Wharves where food is prepared or stored, etc 24 23 - - - - Fried Fish Vendors, etc 339 252 233 4 1 — 185 Market Inspections:—Morning, 83; Evening, 102. 67 Slaughterhouses: 418 visits. Number of Carcases inspected : — (a) Satisfactory 2976 (6) Unsatisfactory 14 (c) Condemned and destroyed or otherwise disposed of (included in (b) above) 2 and parts of 12 Number of Samples procured:— Formal. Informal. Total la) Under Sale of Food and Drugs Acts : (i) Number genuine 308 141 449 (ii) Number adulterated 36 27 63 (iii) Number poor quality, etc. (included in (i) genuine above) 24 — 24 (6) Under Special Orders and Regulations: (i) Number satisfactory 23 — 23 (ii) Number unsatisfactory 6 — 6 Aotion taken in respect of unsatisfactory samples:— (i) Summonses applied for 11 — 11 (ii) Letters of caution sent to vendors 21 — 21 (iii) Reported to Ministry of Agriculture, etc 6 — 6 Public Health (Foreign Meat) Regulations—Certificates issued by M.O.H. 243 (164 visits to factories). Foodstuffs Inspected for Export. Tons. cwt. qrs. lbs Beef, Forequarters, etc. (Origin—Argentina, Australia, Brazil, New Zealand, Uruguay) 4 1 1 3 Hams (Origin—English) — 15 0 12 (America) 20 12 3 13 Ox Tails (Origin—Uruguay) — — 2 24 Ox Tongues (Origin—Argentina, Brazil, Uruguay) 1 15 1 19 Kidneys (Origin—America, Brazil) — 5 2 19 Oxford Sausages (Origin—English) 34 10 0 0 Vienna Sausages (Origin—English) — 5 — — Cambridge Sausages (Origin—English) — 15 — — Pork Sausages (Origin—English) — 5 - — Beef Sausages (Origin—English) — 5 - — Bologna Sausages (Origin—English) 2 gross - - Bacon (Origin—English) — 5 - 22 „ (Origin—America, Danish, Latvia) 8 18 1 25 veal (Origin—-Argentina, Australia, Brazil, New Zealand, Uruguay) 1 9 3 5 Lamb (Origin—Australia) — 2 2 23 Chicken (Origin—English) — — 4 18 Sows (Origin—English) 1 7 — 6 Meat Extract (Origin—Australia) — 5 0 0 Mutton (Origin—New Zealand) 2 8 3 5 Bath Chaps (Origin—English) 200* •Weight not recorded. 68 (ii) Organs condemned and destroyed:— Bovine:—Lungs, 118; Livers, 53, and parts of, 29; Mesenteries, 41, and parts of, 25; Omenta, 13; Pancreas, 26; Spleens, 13; Tripes, 7; Udders, 33; Kidneys, 9; Intestines, 4; Hearts, 3. Sheep:—Lungs, 448; Livers, 79. Pigs:—Lungs, 147; Livers, 47; Mesenteries, 24; Omenta, 15; Spleens, 19; Kidneys, 4; Tripe, 1; Hearts, 6; Intestines, 1. Heads: Bovine, 54; Pigs, 31. Tongues: Bovine, 55; Pigs, 31. (b) Surrendered by owners as being unsound, or seized while exposed or deposited for sale:— 16 cases Dessicated Cokernut.—Surrendered. (Released for pig feeding.) 1,147 lbs. Mixed Sweets.—Surrendered. (Released for pig feeding.) 6,560 bags Butter Beans.—Surrendered. (Released for pig feeding.) 1,311 tins Condensed Milk.—Surrendered. (Releasedfor pig feeding.) 18 lbs. Lamb.—Surrendered. 3 tins Pineapples.—Surrendered. 5 boxes Pears.—Surrendered. 6 boxes Tomatoes.—Surrendered. 26 bags Potatoes, 1 ton 6 cwt.-—Surrendered. 2,354 tins Grape Fruit.—Surrendered. 16 stone Fish.—Surrendered. MR. H. A. PEARCE. (Inspections for 1927 in italics.) Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. 1927 1928 Bakehouses 148 124 40 — — — Slaughterhouses 10 7 — — — — Cowhouses 29 16 1 2 — — Milkshops 164 171 4 — — — F.ating-houses 92 92 16 5 1 — Stalls 707 877 — — — — Other places where food is sold or prepared 559 391 21 3 — — Ioe cream premises .. 90 66 3 — — — Wharves where food is prepared or stored, etc — — — — — — Fried Fish Vendors, etc. 248 231 139 2 — — 176 Market Inspections:—Morning, 118; Evening, 58. Foodstuffs Destroyed. (a) Condemned at Slaughterhouse Inspections:— cwt. qrs. lbs. (i) Beef 14 — 3 Pork 1 2 18 69 Slaughterhouses:—212 visits. Number of Carcases inspected:— (a) Satisfactory 1629 (6) Unsatisfactory 1 and parts of 10 (c) Condemned and destroyed or otherwise disposed of (included in (6) above) 1 and parts of 10 Formal. Informal. Total. Number of Samples procured :— (a) Under Sale of Food and Drugs Acts: (i) Number genuine 173 87 260 (ii) Number adulterated 21 7 28 (iii) Number poor quality, etc. (included in (i) genuine above) 7 — 7 (4) Under Special Orders and Regulations: (i) Number satisfactory *18 — *18 (ii) Number unsatisfactory 7 — 7 * 1 reported as suspicious. Action taken in respect of unsatisfactory samples: — (i) Summonses applied for 7 — 7 (ii) Letters of caution sent to vendors 15 — 15 (iii) Reported to Ministry of Agriculture, etc. .. 6 — 6 Public Health (Foreign Meat) Regulations—Certificates issued by M.O H. 14 (9 visits to factory). Foodstuffs Inspected for Export. Tons. cwt. qtrs. lbs. Real Oxford Sausages (England) 2 — — — 3 Bags of Ox Tongues (Argentina) — 3 2 2 3 Bags of Ox Tails (Argentina) — 1 1 9 4 Boxes Picnic Hams (U.S.A.) — 17 2 22 2 Boxes Long Cut Hams (U.S.A.) — 10 — 7 39 Bellies, Pieces, Bacon (England) — 4 — 10 80 Smoked Hams (England) — 7 2 21 4 Boxes Bacon (U.S.A.) — 21 — 12 1 Forequarter Beef (Argentina) — 1 1 21 12 Middles Bacon (England) — 2 2 22 70 Foodstuffs Destroyed. (а) Condemned at Slaughterhouse Inspections:— (i) Beef:— (7 briskets; 4 flanks; 1 middle rib; 7 back ribs; 3 skirts; 3 rumps; 2 fore-ribs; 4 loins; 1 forequarter; 1 whole carcase.) Pork (3 fore-ends; 1 leg; 1 loin). Total Weight .. 11 cwt. 0 qtr. 7 1b. (ii) Organs condemned and destroyed:— Bovine:—Lungs, 53; Livers, 44 and parts of 5; Mesenteries, 17 and parts of 6; Omenta, 8; Pancreas, 9; Spleens, 5; Tripes, 7; Udders, 22; Kidneys, 10; Intestines, 3; Hearts,2; Stomachs, 4. Sheep:—Lungs, 396; Livers, 100 and parts of 3. Pigs:—Lungs,78; Livers,22; Mesenteries, 14; Omenta,4; Kidneys,2; Heart. 1; Spleens, 3. Heads (including Tongues):—Bovine, 27; Pigs, 17. (b) Surrendered by owners as being unsound, or seized while exposed or deposited for sale:— 2 stone 8 lb. Spanish Potatoes—Surrendered. 121/2 Hams, 2 stone 20 lbs.—Surrendered. Beef and Mutton pieces, 2 stone 26 lbs.—Surrendered. 8 tins Loganberries—Surrendered. 1 tin Peaches—Surrendered. 5 Sheeps Livers—Surrendered. 1 tin Fruit—Surrendered. 3 pieces Bacon, 151/2 lbs.—Seized and condemned. 2 Sheeps Livers—Seized and condemned. 1 Head and Tongue (Bovine)—Seized and condemned. SLAUGHTERER OF POULTRY. The business of a slaughterer of poultry is carried on at one premises in the Borough under licence of the London County Council. The premises were constructed under the supervision of officers of this Department and the London County Council. 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. 71 Certificates were issued in connection with 257 consignments of foodstuffs: Canada (93), Australia (63), United States of America and Dependencies (48), Venezuela (36), other countries (17). 173 visits were paid to factories in connection with the above. For details of foodstuffs inspected for export, see pp. 67 and 70. PUBLIC ANALYST'S ANNUAL REPORT. During the year 1928, 807 samples were examined under the Sale of Food and Drugs Acts. Three of these samples were submitted by a neighbouring Borough, the remainder were taken by our own Inspectors. Of these, 266 samples were purchased informally. Eighty-nine samples or 11.03 per cent were found to be adulterated. In addition 35 samples were of inferior quality or doubtful purity. Of the informal samples, 34 were adulterated, and 2 were of doubtful or inferior quality. The adulteration for th e previous eight ye. irs was as follows:— Year. No. of samples examined. Percentage of adulteration. 1927 793 10.1 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 765 4.8 The average adulteration for the London Boroughs in 1927 was at the rate of 3.9 per cent., and for the whole of England and Wales 5.5 per cent. 72 The number of samples examined was in the ra???o of 4.8 per 1000 of the population, as compared with an average of 8.8 per 1,000 for the London Boroughs, and 3.3 per 1,000 for the whole of England and Wales during 1927. As mentioned in last year's report, the proportion of adulterated samples is steadily increasing and for some time past the percentage has been the highest in the London area. It would be a mistake to consider this an indication that there is more actual adulterated food in Poplar than in other London Boroughs. The most probable explanation is, that owing to the vigilance of the Inspectors and the increasing practice of concentrating attention on those articles of food found by experience to be below normal in quality, the proportion of adulterated samples found is relatively high. Preservatives . The following samples were found to contain preservatives:— Sample. Number examined. Percentage preserved. Butter 51 3.9 Pearl barley 26 46.2 Tapioca 2 100.0 Lemon squash 3 100.0 Lime juice cordial 2 100.0 Beer 8 75.0 Cider 2 100.0 Table jelly 8 75.o Sweets 26 34.5 Dried fruit 2 50.0 Meat 2 50.0 Sausage 10 30.0 Sauce 5 40.0 Total 147 34.7 73 In most cases the Regulations were complied with both as regards type of preservative and amounts permitted, but in the following cases there were infringements:— Two butters contained boracic acid, 11 pearl barleys were bleached with sulphur dioxide, 1 meat contained sulphur dioxide, and 2 sweets contained excess of sulphur dioxide. Condensed Milks. Seven samples were examined under the Condensed Milk Regulations, 5 full-cream and 2 evaporated. These were all satisfactory. Bacteriological Examination of Milks. Sixty samples of Grade "A" (Tuberculin Tested) milk were examined. 48 of these were taken by the Inspectors with the usual formalities, and 12 were submitted by the bottlers. Thirteen of the former and 3 of the latter were unsatisfactory. This is at the rate of 26.7 per cent., showing an increase on the previous year when the rate of unsatisfactory samples was 16.3 per cent. In all cases the unsatisfactory condition was due to the presence of bacillus coli. In only 2 cases was the total number of organisms in excess, in addition to the presence of bacillus coli. The presence of bacillus coli occurring with a normal number of total organisms is probably due to unclean methods of production. Seven samples were taken in course of delivery, from churns at the Railway Stations, followed in 6 cases by samples from same delivery at bottlers' premises, after bottling. This method of sampling followed up unsatisfactory samples which had previously been taken from bottlers. In 4 cases it was found that the milk as taken from the churn was in an unsatisfactory condition owing to the presence of bacillus coli. The samples taken from bottlers premises later in the day showed little difference from the original samples. 74 The total number of organisms varied from 500 to 400,000 per Cc. In 8 cases the number was below 1,000, and in 31 cases below 10,000. The chemical composition of the Grade "A" milks was very irregular. The fats varied from 2.4 to 7.1 per cent., and the total solids from 11.0 to 15.5 per cent. In 7 cases the fat content was below the legal limit of 3.0 per cent. The non-fatty solids in all cases were over the minimum limit. One sample of Pasteurised Milk and 1 sample of Certified milk were also examined. The Pasteurised Milk was satisfactoiy. The Certified Milk was unsatisfactory owing to the presence of bacillus coli. Other samples examined during the year were:— For the Public Health Department:— 1 Starch (bacteriological). 3 Minerals. 1 Lemonade powder. 2 Canned fruits. For the Surveyor's Department:— 2 Disinfectant powders. ALBERT E.PARKES, F.I.C., Public Analyst. 75 THE SALE OF FOOD AND DRUGS ACTS. The results of the analyses of 807 samples were reported to the Committee during the year:— Sample. Number examined, 1928. Adulterated . Action taken. Legal Proceedings.* Letters of caution sent. Milk 386 17 6 11 ,, Dried 1 - - - ,, Condensed 13 - - - Cream 1 - - - Batter 51 5 1 4 Margarine 48 5 - 3 Cheese 2 - - - Dripping 8 - - - Lard 6 - - - Shredded Suet 4 4 - 2 Mustard 5 - - - Pepper 6 - - - Malt Vinegar 6 5 1 1 Vinegar 22 2 1 - Sauce 5 1 - - Cocoa 2 - - - Coffee 4 1 - - Coffee and Chicory 1 - - - Coffee and Chicory Essence 2 - - - Cornflour 5 2 - 1 Rice 6 - - - Ground Rice 2 - - - Pearl Barley 26 14 1 3 Sago 5 3 - - Oatmeal 4 - - - Flour 3 - - - Self-raising Flour 3 - - - Ground Ginger 6 - - - Baking Powder 1 - - - Custard Powder 4 - - - Chocolate 1 - - - Cake 2 - - - Jam 7 2 1 - Tapioca 2 - - - Table Jelly 8 - - - Lemon Curd 2 - - - Golden Syrup 4 - - - Tea 1 - - - Carried forward 664 61 11 25 76 Sample. Number examined, 1928. Adulterated . Action taken Legal Proceedings.* Letters of caution sent. Brought forward 664 61 11 25 Sugar 4 - - - Sweets 26 10 1 - Dried Fruit 2 - - - Cyder 2 - - - Zinc Ointment 3 - - - Boracic Ointment 4 1 - 1 Sulphur Ointment 2 - - - Milk of Sulphur 2 - - - Lime Water 4 - - - Camphorated Oil 2 - - - Cream of Tartar 4 - - - Glycerine 2 - - - Lime Juice Cordial 2 - - - Lemon Squash 3 - - - Lemonade 2 - - - Lemonade Crystals 2 - - - Soda Water 2 - - - Ginger Wine 1 - - - Gin 3 2 - 2 Whisky 17 10 5 2 Rum 3 2 2 - Beer 8 - - - Mincemeat, Fruit 4 - - - Meat Pie 1 - - - Meat Paste 1 - - - Brawn 2 - - - Sausage 10 - - - Fresh Meat 6 1 - - Beans and Pork 1 - - - Bacon 2 - - - Fish Paste 2 - - - Cordials 4 - - - Olive Oil 2 - - - Table Salt 2 - - - Bread and Butter 6 2 - 1 Totals, 1928 807 89† 19 31 Totals, 1927 793 80‡ 20 31 * See pages 77.81. † Including 34 informal samples. ‡ Including 25 informal samples. Of the samples of milk, 32 were procured from itinerant vendors on Sundays and 180 from itinerant vendors on weekdays. All these samples were genuine. Samples of milk were taken on delivery as follows:—Poplar Institution, 2; Poplar Hospital, 4; St. Andrew's Hospital, 2; Bromley House Institution 3. All these samples were genuine. 77 Eight samples of milk were taken on delivery at Railway Stations. 7 were reported to be genuine, and one adulterated. A letter of caution was sent in respect of the adulterated sample. SALE OF FOOD (ADULTERATION) ACT. Administrative Action Taken Respecting Samples Reported to be Not Genuine. March Quarter, 1928. Sample No. Nature of Sample. Result of Analysis. Action taken. G. 1 Informal Whisky 37 degrees under proof Formal sample taken. G. 10. G. 10 Whisky 37.5 degrees under proof Summons; £3 3s. costs.* G. 17 Milk 3 per cent. deficient in fat Letter of caution. (Same vendor.) G. 18 Milk 3 per cent. deficient in fat G. 10 Informal Pearl barley Sulphur dioxide 98 parts per million Formal sample, G. 111. G. 11 Informal Pearl barley Sulphur dioxide 65 parts per million Formal sample, G. 112. G. 13 Informal Pearl barley Sulphur dioxide 43 parts per million Formal sample G. 109. G. 17 Informal Whisky 37 degrees under proof See G. 10 above.* G. 27 Margarine 16.9 per cent. water Letter of caution. G. 22 Informal Pearl barley Sulphur dioxide 40 parts per million No action. G. 23 Informal Pearl barley Sulphur dioxide 50 parts per million No action. G. 24 Informal Pearl barley Sulphur dioxide 40 parts per million No action. G. 25 Informal Pearl barley Sulphur dioxide 30 parts per million No action. G. 52 Boracic ointment 3 per cent. deficient in boracic acid Letter of caution. 189 Informa Mint rock Sulphur dioxide 15 parts per million No action. (Continued over.) 78 March Quarter, 1928 (Continued). Sample No. Nature of Sample. Result of Analysis. Action taken. G. 47 Margarine 16.3 per cent. water Letter of caution. G. 33 Informal Mint rock Sulphur dioxide 550 parts per million Formal sample G. 66. G. 66 Mint rock Sulphur dioxide 580 parts per million Summons; £5 5s. costs. G. 70 Milk 6.6 per cent. deficient in fat Letter of caution. G. 73 Butter 16.5 per cent. water Letter of caution. G. 105 Butter 16.5 per cent. water and 0.1 per cent. boracic acid Letter of caution. G. 109 Pearl barley Sulphur dioxide 15 parts per million Letter of caution. G. 110 Pearl barley Sulphur dioxide 60 parts per million Letter of caution. G. 111 Pearl barley Sulphur dioxide 60 parts per million Summons against wholesaler; £5 5s. costs. G. 128 Milk 5.8 per cent. added water Letter of caution. G. 134 Malt Vinegar Absence of malt extract Summons; 7s. 6d. costs. Informal Pearl barley Sulphur dioxide 50 parts per million No action. G. 31 Informal Sauce Sulphur dioxide 10 parts per million; Salicylic acid 50 parts per million Formal sample to be taken if obtainable. (Itinerant vendor.) G. 56 Informal Palmints 0.25 per cent. talc No action. G. 60 Informal Malt vinegar Absence of malt extract Formal sample taken, G. 134. G. 61 Informal Malt vinegar Absence of malt extract Formal sample taken (declared to be wood vinegar). G. 135 Butter 0.2 per cent. boracic acid Letter of caution. 79 June Quarter, 1928. Sample No. Nature of Sample. Result of Analysis. Action taken. G. 72 Informal Cornflour 2 per cent. mineral matter Formal sample, G. 158. G. 158 Cornflour 1.5 per cent. mineral matter Letter of caution. G. 86 Informal Bread and butter Bread and margarine Formal sample, G. 184. G. 184 Bread and butter Bread and margarine Letter of caution. G. 175 Milk 3.5 per cent. added water Letter of caution. G. 179 Milk 22.3 per cent. added water Summons; £1 penalty; £1 1s. costs. P. 16 Milk 10 per cent. deficient in fat Summons; £5 penalty; £3 3s. costs. G. 97 Informal Vinegar 7.5 per cent. deficient in acid Formal sample, G. 203. G. 203 Vinegar 10 per cent. deficient in acid Summons; warranty pleaded; Summons dismissed. (See Note below.) P. 46 Milk 3.3 per cent. deficient in fat Summons; £3 3s. costs. P. 47 Milk 3.3 per cent. deficient in fat Letter of caution. P. 49 Margarine 16.6 per cent. water Letter to vendor. P. 50 Butter Consisted entirely of margarine; not properly labelled Summons; 6s. penalty; 10s. 6d. costs. Note.—Summonses were applied for against the wholesalers who supplied the vendor in this case. A penalty of £10 was imposed and defendants were ordered to pay £6 6s. costs. September Quarter, 1928. Sample No. Nature of Sample. Result of Analysis. Action taken. G.237 Milk 29 per cent. added water Summons; £1 penalty; £2 2s. costs. P. 28 Informal Fresh meat Sulphur dioxide 43 parts per million Formal sample; genuine. P. 29 Informal Raspberry Jam 35 per cent. apple pulp Formal sample, P. 71. (Continued over). 80 September Quarter, 1928 (Continued). Sample No. Nature of Sample. Result of Analysis. Action taken. P. 71 Raspberry Jam 35 per cent. apple pulp Summons; £3 3s. costs. P. 76 Milk 2.3 per cent. added water Letter of caution. P. 81 Margarine 16.5 per cent. water Letter of caution. P. 94 Milk 3.3 per cent. deficient in fat Letter of caution. P. 37 Informal Sweets 0.8 per cent. talc Formal sample, P. 91. P. 91 Sweets 0.8 per cent. talc No action; business since sold. G. 248 Milk 10 per cent. added water Summons; £2 4s. costs. G. 125 Informal Malt Vinegar 100 per cent. wood vinegar.. Formal sample, G. 261. G. 261 Malt vinegar 100 per cent. wood vinegar.. Letter of caution. G. 128 Informal Pearl barley 0.2 per cent. talc Formal sample, G. 262. G. 262 Pearl barley 0.2 per cent. talc Letter of caution. P. 93 Milk 3.3 per cent. deficient in fat Letter of caution. G. 134 Informal Rum 36 degrees under proof Formal sample, G. 288. G. 288 Rum 38 degrees under proof Summons: £1 1s. costs. G. 135 Whisky 43 degrees under proof Formal sample, G. 287. P. 101 Whisky 37 degrees under proof Letter of caution. P. 102 Gin 36 degrees under proof Letter of caution. P. 103 Whisky 38 degrees under proof Summons; £2 costs. P. 104 Gin 36 degrees under proof Letter of caution. G. 300 Whisky 38 degrees under proof Summons; £5 5s. costs. P. 115 Whisky 37 degrees under proof Letter of caution. P. 116 Whisky 38 degrees under proof Summons; £5 5s. costs. G. 299 Margarine 16.3 per cent. water No action pending enquiries. P. 42 Informal Dripping. 2.3 per cent. free fatty acids Formal sample, P. 109. 81 September Quarter—(Continued). Sample No. Nature of Sample. Result of Analysis. Action taken. P. 109 Dripping 2.8 per cent. free fatty acids Letter to vendor. G. 133 Informal Dripping 2.9 per cent. free fatty acids, coloured Formal sample, G. 295. G. 295 Dripping.. 2.9 per cent. free fatty acids, coloured Letter to vendor. December Quarter, 1928. Sample No. Nature of Sample. Result of Analysis. Action taken. P. 52 Informal Shredded Suet No label; 14 per cent. starch Formal sample, P. 130. P. 130 Shredded Suet No label; 14 per cent. starch Letter of caution. G. 144 Informal Shredded Suet No label; 14 per cent. starch Formal sample, G. 318. G. 318 Shredded Suet No label; 16 per cent. starch Letter of caution. G. 146 Informal Sweets 0.6 per cent. talc Formal sample, G. 325. G. 325 Sweets 0.5 per cent. talc Letter of caution. P. 54 Informal Sweets 0.5 per cent. talc Formal sample, P. 136. P. 136 Sweets 0.5 per cent. talc Sample taken on delivery; genuine. G. 322 Butter 16.5 per cent. water Letter of caution. G. 150 Informal Coffee 25 per cent. chicory Formal sample, G. 330. G. 330 Coffee Declared to be coffee and chicory No action G. 326 Milk 5.8 per cent. added water Letter of caution. G. 333 Milk 10 per cent. deficient in fat Letter of caution. G. 167 Informal Sago Tapioca Formal sample, G. 366. G. 366 Sago Tapioca No action. P. 167 Milk 26.6 per cent. deficient in fat Summons; £1 1s. costs. P. 93 Informal Sago Tapioca Formal sample to be taken. 82 Milk and Dairies (Consolidation) Act, 1915, and Amendment Act, 1922. Milk and Dairies Acts and Order . Milk bottled in street (roundsman) Letter of caution (G.Q.). ,, ,, ,, (proprietor) Letter of caution (J.G.E.). ,, ,, ,, (roundsman) (F.R.). ,, ,, ,, (proprietor) (S.G.). ,, ,, ,, Letter of caution to roundsman and proprietor (S.G. and L.C.S.). ,, ,, ,, Letter of caution to roundsman and proprietor (C.T. and F.W.J,). ,, ,, ,, Letter of caution to roundsman and proprietor (A.A. and T.J.P.). ,, ,, ,, *Letter of caution to proprietor (G.G.). ,, ,, ,, *Summons: £2 2s. costs (P.G.). Milk sold from a barrow which was not Letter of caution (W.W.). marked as prescribed. Milk bottled in street Letter of caution to roundsman and proprietor (F.B. and D.J.). ,, ,, Letter of caution to proprietor (D.D.). ,, ,, Letter of caution to proprietor (C.J.H.). *Members of same firm. Public Health (Meat) Regulations, 1924. Action taken for infringements of the Regulations was as follows:— Meat exposed on stall which was not properly Letter of caution (J.W.). screened. ,, ,, ,, ,, ,, ,, (D.L.P.). ,, ,, ,, ,, ,, ,, (W.L.P.). Stall not properly screened ,, ,, *(G.S.). ,, ,, ,, ,, ,, (R.K.). Meat exposed to contamination *Summons: £3 penalty; £22s. costs (G.S.). *Same offender. 83 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. Unsound Bacon in possession of defendant. 30th July Condemnation Order made. Pearce, H. A. 11th Sept. £2 2s. costs. Pearce, H. A. Sold three picees of Bacon which were unsound. 11th Sept. (3summonses) £20 penalty; £5 5s. costs. Pearce, H. A. Bovine Head diseased. 20th Dec. Condemnation Order made. Pearce, H. A. Diseased Sheeps Livers exposed for sale. 19th Dec. Condemnation Order made. Pearce, H. A. 8th Jan.1929 £2 penalty; £2 2s. costs. Pearce, H. A. Public Health (Milk and Cream) Regulations, 1912 and 1917. 1 .—MILK; AND CREAM NOT SOLD AS PRESERVED CREAM. 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 386 Nil. Cream 1 Nil. 84 Margarine Act, 1887, Sale of Food and Drugs Act, 1899, and the Butter and Margarine Act, 1907. 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, 1928, viz.:— Sub-District. Margarine. Butter. Wholesale Dealer. Manufacturer. Factory. Wholesale Dealer in Milk-blended. Poplar 7 - 1 - Bow and Bromley 11 - 3 - Totals 18 - 4 - Agricultural Produce (Grading and Marking) Act, 1928. The Council appointed the Medical of Health and the two Meat and Food Inspectors as the officers for the enforcement of the provisions of the Agricultural Produce (Grading and Marking) Act, 1928. 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, 1,601 casks of tallow were dealt with at factories, wharves, etc. Damaged Wheat. Quantities of damaged wheat were released by various Authorities to be used in this Borough for poultry food. The total quantity dealt with during the year was 19 qtrs. and 281 lbs. Flour Sweepings. Twenty-one bags of flour sweepings were released for cattle and poultry food. TABLE VII. Notifiable diseases during the Year. (52 Weeks ended 29th December, 1928). Notifiable Disease. Casks 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 68 2 - 2 1 - 19 10 7 18 3 6 - 47 21 47 21 68 - - - - - - - - - - - - - - - Cholera (C), Plague (P) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 495 10 33 40 44 58 215 53 21 20 1 - - 320 175 316 174 490 26 3 6 4 2 3 7 - 1 - - - - 18 8 Erysipelas 90 2 1 1 - - 1 5 7 12 15 29 17 51 39 16 18 34 5 - - - - - - - - - 1 3 1 2 3 Scarlet Fever 633 5 14 38 45 61 313 91 37 28 2 1 - 404 231 403 223 626 2 - - 1 - 1 - - - - - - - 2 - Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric Fever 5 - - - - - - - 2 1 1 - 1 1 4 - 3 3 3 - - - - - - - 2 - - - 1 1 2 Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 5 - - - - - - - - 3 1 1 - 2 3 2 3 5 - - - - - - - - - - - - - - - Puerperal Pyrexia 10 - - - - - - - - 7 3 - - 6 4 5 4 9 - - - - - - - - - - - - - - - Cerebro-Spinal Fever 1 1 - - - - - - - - - - - - 1 - 1 1 1 1 - - - - - - - - - - - - 1 Acute Poliomyelitis 2 - 1 - - - - - 1 - - - - 2 - 2 - 2 1 - - - - - - - - 1 - - - 1 - Acute Encephalitis Lethargica 2 - - - - - - - - 1 - - 1 1 1 - - - 1 - - - - - - - - - - - 1 - 1 Ophthalmia Neonatorum 58 58 - - - - - - - - - - - 42 16 5 5 10 - - - - - - - - - - - - - - - *Zymotic Enteritis 234 75 69 27 12 5 14 3 8 7 5 7 2 138 96 16 17 33 47 35 8 - - - - - - 2 - - 2 19 28 Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia, Acute Primary 547 73 65 45 40 34 80 22 23 56 38 48 23 403 141 76 55 131 87 25 7 1 6 - 2 1 3 5 7 20 10 52 35 „ Acute Influenzal 15 1 - - 1 - - - - 4 2 4 3 12 3 1 2 3 7 1 - - - - - - - - 2 2 2 5 2 †Chickenpox 442 19 38 38 38 54 216 32 7 - - - - 228 214 12 8 20 - - - - - - - - - - - - - - - Acute Polioencephalitis 1 1 - - - - - - - - - - - 1 - 1 - 1 1 1 - - - - - - - - - - - 1 - Malaria 1 - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - Dysentery 1 - - - - - - - - - - 1 - 1 - 1 - 1 2 - - - - - - - - - 1 1 - 2 - Totals 2612 247 221 191 181 212 858 216 113 158 71 97 47 1660 952 903 534 1437 183 66 21 6 8 4 9 1 6 8 11 26 17 103 80 Note.—151 Cases reported "not suffering,'' etc., are excluded from the above table. * Notifiable from 1st June to 30th September. † Notifiable from 5th May, 1928 (see note on p. 92). N.B.—The deaths from Pneumonia are of notified patients only. 85 Section VI. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. INFECTIOUS DISEASE. Notifications . 2,612 cases of Infectious Disease were notified during the year. In addition there were 151 cases notified as Infectious Diseases but in which the diagnosis was not confirmed. The notification rate was 16.1, compared with 11.3 in 1927,13.8 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. Chickenpox Diphtheria. Erysipelas. Scarlet Fever. Smallpox. Puerperal Pyrexia. Acute Poliomyelitis Acute Polioencephalitis. Zymotic Enteritis. Pneumonia (all forms). Diphtheria. Erysipelas. Scarlet Fever. Smallpox. Puerperal Fever. Zymotic Enteritis. Pneumonia (all forms). Poplar Institution 10 .. .. 3 .. .. .. .. .. 3 4 .. 3* .. .. .. 3* 2* St. Andrew's Hospital 58 3 16† 4 2 1 1 .. .. 8 27 16** .. 2** 1* .. .. .. Bow Institution 2 .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Bromley House Institution .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Langley House, 54, East India Dock Road 4 1 1 .. 3 .. .. .. .. .. .. 1** .. 3** .. .. .. .. Poplar Hospital 8 .. .. .. 5§ .. .. 1 1 .. 1§ .. .. 5** .. .. .. .. * Admitted to St. Andrew's Hospital. ** Removed to M. A.B. Hospitals. † 1 Staff. §1 Staff. Infectious Diseases in Milkshops and Homeworkers' Premises. One case of infectious disease occurred in a family connected with the sale of bottled milk. The sale of milk was stopped until the premises were disinfected. 86 Three notices were served under Article 17 of the Milk and Dairies Order, 1926, where persons engaged in the milk trade had been contacts of cases of infectious disease. 31 cases of infectious disease occurred in homeworkers' premises— 2 smallpox, 10 diphtheria, 13 scarlet fever, 1 chickenpox, 1 puerperal fever and 4 measles. No notice was served under the Factory and Workshop Act, 1901, Sections 108 and no. 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 68 - - 68 100. Chickenpox - 18 2 20 - Diphtheria 487 - 3 490 99.0 Erysipelas 1* 32 1 34 37.8 Scarlet Fever 623 - 3 626 98.6 Enteric Fever 1 - 2 3 60.0 Puerperal Fever 4 1 - 5 100. Puerperal Pyrexia .. 5 4 - 9 90.0 Cerebro-spinal Fever 1** - - 1 100. Encephalitis Lethargica - - - - - Ophthalmia Neonatorum 9 - 1 10 17.2 Pneumonia - 128 6 134 23.8 Acute Polio-encephalitis - - 1 1 100. Acute Poliomyelitis - - 2 2 100. Zymotic Enteritis .. - 30 3 33 14.1 Malaria - - - - - Dysentery - - 1 1 100. Totals 1,199 213 25 1,437 55.0 * Admitted with Scarlet Fever. **Admitted with Measles. N.B.—Cases reported to be "not suffering" have been excluded from above table. 87 Comparative Mortality. Diphtheria. Scarlet Fever. Enteric Fever. 1921 Cases 648 1423 16 Deaths 64 13 5 Fatality Rate 9.9 0.9 31.2 1922 Cases 626 415 10 Deaths 62 7 0 Fatality Rate 9.9 1.7 0.0 1923 Cases 303 263 8 Deaths 32 5 3 Fatality Rate 10.6 1.9 37.5 1924 Cases 348 460 8 Deaths 20 6 1 Fatality Rate 5.7 1.3 12.5 1925 Cases 329 453 1 Deaths 8 0 0 Fatality Rate 2.4 0.0 0.0 1926 Cases 411 610 4 Deaths 22 3 3 Fatality Rate 5.3 0.5 75.o 1927 Cases 362 715 4 Deaths 17 3 0 Fatality Rate 4.7 0.4 0.0 1928 Cases 495 635 5 Deaths 26 2 3 Fatality Rate 5.2 0.3 60.0 SCARLET FEVER. The total notifications received numbered 718 and the total removals were 709. Of these, 83 cases were later certified to be not suffering from 88 Scarlet Fever, leaving a total of 635 cases, the attack-rate being 3.9 per 1,000 of population. 2 deaths occurred, giving a fatality rate of 0.3 per cent. DIPHTHERIA. The total notifications received numbered 559 and the total removals to hospital were 554. 64 patients were certified to be suffering from other diseases, leaving a total of 495 cases, the attack-rate being 3.0 per 1,000 of population. 26 deaths occured, giving a fatality rate of 5.2 per cent. SCHICK TEST AND IMMUNISATION FROM DIPHTHERIA. DIPHTHERIA IMMUNISATION CLINIC. The Clinic was opened on 5th June, 1928, and is held at the new Maternity and Child Welfare Centre, Wellington Road. The Medical Officer in charge is Dr. Porter-Smith, M .R .C .S. (Lond.), L .R .C .P. (Eng.). The number of children who have attended the clinic and their attendances up to 31st Dec. are shown below. 5th June, 1928—31st December, 1928. Number of Schick tests 69 Number of children immunised 29 Number of children with natural immunisation 13 Number of children receiving immunisation treatment 27 Number of attendances 305 The following steps have been taken to make the Clinic known to the inhabitants of the Borough:— (1) Leaflets, have been distributed:— (a) Through all the Maternity and Child Welfare Centres. (b) At every house where a case of Diphtheria has been notified. (c) With the permission of the London County Council, through the Elementary Schools in the Borough. 89 (2) Lectures and health talks have been given throughout tne Borough on various public health subjects, and four of these lectures were devoted to various aspects of preventive medicine and what it could do, and these included a full explanation of Schick testing and immunising against Diphtheria. The following is a statement submitted by the Medical Officer in charge of the Clinic:— "So far the attendance has been rather on the small side, but there are definite signs of improvement during the last few weeks and I am sure that when the presence of such a valuable service becomes generally known in the Borough, the parents will avail themselves of the protection afforded against Diphtheria which still takes a heavy toll of young children and is frequently attended with damaging results. The conditions at the Wellington Road Clinic are ideal for this work and I have been very ably assisted by the staff. There has been some difficulty in the past to get the London County Council school children to the Clinic, due, I believe, to the risk of losing their attendance marks; here again there are signs of improvement during the last few weeks. I regard this matter as important, as school children are naturally rather more exposed to Diphtheria than those under school age.'' Note by M.O.H.—It may be of interest to report that within the last few weeks the numbers attending for treatment have considerably increased. [May, 1928.) DIPHTHERIA ANTI-TOXIN. 294,000 units of diphtheria anti-toxin were issued to medical practitioners during the year. ENTERIC FEVER. Six notifications were received and 4 patients were removed to hospital. One patient was later certified to be not suffering from Enteric Fever, leaving a total of five cases for the year, the attack-rate being 0.03 per 1,000 of population. Three deaths from Enteric Fever occurred, the fatality rate being 60 per cent. 90 BACTERIOLOGICAL EXAMINATIONS. 2,249 swabbings from doubtful cases of diphtheria were examined. Of these, 247 gave positive results (11.0 per cent.). 5 blood specimens from doubtful cases of Enteric Fever were examined. 4 gave negative results and one gave a doubtful positive (agglutination of Bacillus Typhosus and Bacillus Paratyphosus B in serum diluted 1/20 to 1/40, but not higher). Para A Typhosus agglutinated by 1/20 serum. No agglutination of Para B Typhosus. A specimen of faeces from the same patient was negative for enteric group of organisms. These examinations were carried out at the Seamen's Hospital, Greenwich. SMALLPOX. Incidence and Type. Although cases of Smallpox had occurred in the metropolis earlier in the year, the first case of Smallpox in Poplar was reported on 26th March, 1928, and in all there have been 68 cases notified to the end of the year. The 68 cases included 44 males and 24 females, and the age grouping was as follows:— Under five years 5 cases. 5 and under 10 19 ,, 10 and under 15 10 ,, 15 and under 20 7 ,,1 20 and under 35 18 ,, 35 and under 45 3 45 and under 65 6 ,, All the cases were immediately removed to hospital. The disease being of a mild type there were no deaths and no serious complications. 32 families living in 29 houses were affected, and one case occurred in the Casual Wards. "Missed" Cases. There were 9 "missed" or unrecognised cases, of which 5 were subsequently notified. The other 4 were non-infectious when discovered and were not notified. 91 Vaccinal Condition of Patients. 63 of the 68 notified cases were unvaccinated. 4 patients over 50 years of age and 1 patient 37 years of age had not been vaccinated since infancy. SOURCE OF INFECTION. The mildness of the type of infection rendered the tracing of the source of infection very difficult. In several instances the primary case in a household has only been discovered when subsequent cases in the family with a more profuse or more marked rash have been reported, or have been discovered when examining and following up contacts. SOURCE OF INFECTION. "Missed" case in house (Not notified—noninfectious when discovered). 68 NOTIFIED CASES. Primary case in house. Subsequent cases associated with primary cases Not traced. Other cases in immediate neighbourhood. Imported. In same house. Elsewhere inBorough. 4 10 3 4* 29 22 * 1 each from Newcastle-on-Tyne, Portsmouth, Kent hopfields, and West Ham. ACTION TAKEN. (a) Contacts.—Between 26th March and 31st December no less than 1,285 contacts have been kept under observation; the total visits paid by the Sanitary Inspectors to those resident in the Borough numbered 9,242. This does not include contacts (Staff and Patients) in St. Andrews Hospital, of whom 732 were vaccinated. Of the 1,285 contacts visited only 343 were vaccinated or re-vaccinated. In addition to following up contacts house-to-house inspections have been carried out in several affected areas, and leaflets have been left at each house explaining the signs and symptoms of Smallpox, and urging the necessity for seeking medical advice should eruptions appear, and also urging vaccination or re-vaccination. (b) School Medical Inspections, Absentees, etc.—At the request of the Public Health Department medical inspection of school children was carried out by the London County Council staff at several schools. Arrangements were made for the immediate notification of absentees, in 92 addition to the usual intimation on Form 84, and all cases of suspicious illness were reported without delay by School Medical Inspectors and School Nurses. All these cases were kept under observation by the Public Health Department. This procedure led to the discovery of 9 cases of Smallpox. The number of visits paid by the Sanitary Inspectors to school absentees was 593. (c) Notification of Chickenpox.—Early in the outbreak it was deemed advisable to make Chickenpox notifiable as it was found that cases of Chickenpox and cases of Smallpox were occurring in the same neighbourhood. The Council made an Order applying Section 55 of the Public Health (London) Act, 1891, to Chickenpox for a period of three months, and the Order was approved by the Minister of Health. Subsequently an Order to cover a period of another nine months was made by the Council and duly approved by the Minister. The first of these Orders came into operation on 5th May, 1928, and from that date to the end of the year 544 cases of Chickenpox were reported:— 453 by medical practitioners; 63 by the school authority; 24 by parents; 4 by sanitary inspectors. As the first case of the outbreak of Smallpox had been mistaken for Chickenpox all cases notified as Chickenpox were visited by a member of the medical staff. This procedure resulted in the discovery of n cases of Smallpox. The following table shows the visits paid by the medical staff to cases • of doubtful Smallpox, Chickenpox, and Smallpox contacts. Several of these visits represent visits paid to workplaces in order to examine contacts of cases who had been at work in an infectious condition:— 93 Number of Visits by Medical Staff. Reason for Visit . Doubtful Smallpox cases. Cases of Chickenpox. Smallpox Contacts. School exclusions. Miscellaneous. Total visits by medical staff. Diagnosis S.P.+ Not S.P. orC.P. C.P.+ S.P.+ C.P.+ NotC.P. or S.P. Medical Officer of Health (a) 52 60 8 *4 363 16 †422 393 200 1,518 (b) 1 4 4 – – – – – – 9 (c) 1 – – – – – – – – 1 Tuberculosis Officer 1 2 2 – 48 2 12 48 1 116 Assistant Tuberculosis Officer 3 – – – 38 2 21 170 1 235 Total 1,879 Note, (a) Poplar residents. (b) Non-residents seen at Poplar Hospital. (c) Non-resident—contact of Poplar family. * In connection with these 4 cases, 3 further cases of Smallpox were discovered in the four houses, † 5 cases of Smallpox from Shelter. 94 [d) Other action.—Action has been taken on the lines suggested in Memo. 71a (Med.) of the Ministry of Health, dated November, 1922, in each case, and in addition to medical practitioners being circulated from time to time, circular letters have been sent to undertakers, hairdressers,, laundries, rag and bone dealers, and pawnbrokers. 29 houses have been disinfected. 213 persons ,, ,, 1,210 beds and bedding ,, 199 immediate contacts were removed to the Council's Shelter for disinfection and re-vaccination, while their homes were being disinfected. The closest co-operation has existed between the Board of Guardians and this Authority, and when found necessary additional facilities for vaccination and re-vaccination were granted. Posters advising vaccination or re-vaccination and full information as to the facilities available were displayed throughout the Borough. In addition, leaflets were prepared and distributed throughout the Borough through the agencies of the schools and the Maternity and Child Welfare Clinics, and by the Sanitary Inspectors and Health Visitors. VACCINATION. The Vaccination Officer, Mr. P. Ryan, has kindly furnished me with the following particulars regarding vaccination in the Borough:— 95 Extract from the Report of the Vaccination Officer, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1927, inclusive:— tration Sub-Districts. Number of Births registered 1st Jan. to 31st Dec., 1927. Number of Births entered by 31st January, 1929, in "Vaccination Register." Number of Births which on 31st January, 1929, 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 1928. Number of Statutory Declarations of Conscientious Objection actually received during the calendar year 1928. 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 1698 291 1 – 1045 71 10 11 52 217 1863 1737 Bow and Bromley 1203 175 1 – 765 66 10 9 26 151 Total 2901 466 2 – 1810 137 20 20 78 368 1863 1737 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. 96 The following analysis of the Vaccination Return reveals the fact that 82 per cent, of the children whose births were registered in 1927 were not protected by successful vaccination:— Births registered 2,901 Deduct:— Died unvaccinated 137 Removals to other districts 20 Removals to places unknown, etc. 78 235 Surviving residents 2,666 Successful vaccinations numbered 466 Insusceptible of vaccination 2 468=17.6 per cent. Conscientious Objections declared 1,810 Vaccinations postponed on Medical Certificates 20 Number not accounted for 368 Total unvaccinated children 2,198=82.4 per cent. 2,666= 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 vaccinations 4 Re-vaccinations 9 Total 13 Summary of results:— Four good scars 6 Very slight 1 Abortive 6 Total 13 97 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. 90 cases of erysipelas were notified during the year. Five deaths occurred. PUERPERAL FEVER, ETC. Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. The Consulting Obstetrician appointed under the above Regulations, Dr. Malcolm Donaldson, was not called upon to visit any case of Puerperal Fever or Puerperal Pyrexia during the year. The following is a summary of the notifications, etc., during the year:— Puerperal Fever. Puerperal Pyrexia. Cases notified 5 10 Removed to M A.B. Hospitals 4 5 Removed to other hospitals 1 4 Treated at home – 1 Specialist called in .. – – Deaths – – CONTINUED AND TYPHUS FEVERS. No cases of continued fever occurred. No case of typhus fever occurred. 98 CEREBRO-SPINAL FEVER. One case of Cerebro-Spinal Fever was notified. The patient had been admitted to a Metropolitan Asylums Board Hospital suffering from Measles and died there. The cause of death was Broncho-pneumonia, Measles, Meningococcal Meningitis. / ACUTE POLIOMYELITIS. Two cases of Acute Poliomyelitis occurred. One was an inmate of Poplar Hospital (home address in Barking). The other patient was treated in the East London Hospital. One patient who was notified in 1927 died in 1928. ACUTE ENCEPHALITIS LETHARGICA. Five notifications were received. In three cases diagnosis was not confirmed, leaving two true cases. Of these one patient died at home, and the other is now attending the Out-Patients' Department of the London Hospital. 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. Excluding the cases who died during the year, 32 cases were investigated. The following is a summary of the reports submitted:— Recovered or much improved and returned to work or school 15 In Institutions:— Mental Hospitals *2 Other Hospitals 2 Convent 1 5 Attending hospitals or otherwise undergoing treatment 7 Suffering from after-effects but not receiving treatment 2 Left the District 3 32 *1 since died. 99 The 9 patients suffering from after-effects (excluding those in Institutions) were affected as follows:— Intelligence below normal – Sleep, poor or excessive, with slow movements in one case, and rolling of eyes in the other 2 Movements unsteady, no other ill-effects 3 Conduct abnormal (very spiteful, tendency to become hysterical, bad tempered, etc.) 4 9 ACUTE POLIO-ENCEPHALITIS. One case of Acute Polio-Encephalitis was notified. Death occurred in Poplar Hospital prior to notification. MEASLES. 1,520 cases of measles were reported to the Medical Officer of Health from various sources (principally from L .C .C. schools). 56 deaths were attributed to measles. During the year 175 cases of measles were admitted to M.A.B. Hospitals from the Borough. PUBLIC HEALTH (PNEUMONIA, MALARIA, DYSENTERY, AND TRENCH FEVER) REGULATIONS, 1919. The above Regulations were revoked by the Public Health (Infectious Diseases) Regulations, 1927, which came into operation on 1st January, 1927. Under the new Regulations the notification of Trench Fever is no longer required, and certain modifications are made regarding notification °f cases of Malaria. 100 Pneumonia . 547 cases of Acute Primaiy Pneumonia and 15 cases of Acute Influenzal Pneumonia were notified during the year, 134 of the patients being treated in hospitals. 94 notified patients died—87 Acute Primary Pneumonia and 7 Acute Influenzal Pneumonia. Malaria . One case of Malaria was notified during the year. Patient was treated at home. Dysentery. One case of Dysentery was notified. Patient died in the London Hospital. A patient who died in another hospital outside the Borough was not notified. ALTERED DIAGNOSIS CASES. 151 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:— 83 Scarlet Fever; 64 Diphtheria; 1 Enteric Fever; and 3 Encephalitis Lethargica. The final diagnosis in the 83 Scarlet Fever cases was:— Tonsilitis 4 Mumps and Rhinitis 1 Erythema 11 Scarlatiniform Rash 1 Measles 7 German Measles 2 Diphtheria 1 Purpura 1 Stomatitis 1 Urticaria 2 Vincent's Angina 1 Chickenpox 1 Disease not specified *50 83 *These were reported "Negative case", "Not notifiable", etc. 101 The final diagnosis in the 64 Diphtheria cases was:— Tonsilitis 19 Tonsilitis with Whooping Cough 1 Tonsilitis with Scabies 1 Laryngitis 4 Measles 2 Measles and Impetigo 1 Scarlet Fever 1 Non-Membranous Croup 1 Retropharyngeal Abscess 1 Quinsy 1 Disease not specified *32 64 *These were reported "Negative case", "Not notifiable", etc. The patient notified as suffering from Enteric Fever was certified to be suffering from Enteritis. The final diagnosis in the 3 cases notified as Encephalitis Lethargica was (i) Cerebral Tumour, (ii) Senile Dementia, and (iii) Pyrexia due to Osteomyelitis, respectively. CANCER. The number of deaths from Cancer for the last five years is shown below:— Year. Males Females. Total. 1924 115 96 211 1925 104 87 191 1926 122 93 215 1927 120 120 240 1928 115 89 204 102 Number of Heading in International Manual. Site of Primary Growth. Males. Females, Totals. 43 Buccal cavity 14 — 14 44 Pharynx, Oesophagus, Stomach, Liver and annexa 44 33 77 45 Peritoneum, Intestines and tum 18 18 36 46 Female Genital Organs — 15 15 47 Breast — 16 16 48 Skin 1 — 1 49 Other or unspecified organs 38 7 j 45 Totals 115 89 204 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. ACUTE RHEUMATISM IN CHILDREN. During the year the Metropolitan Boroughs' Standing Joint Committee requested the observations of the Poplar Council upon the following resolution which had been submitted by one of the Metropolitan Borough Councils:— "That having regard to the prevalence of acute rheumatism in children and the severe consequences of the disease, the Metropolitan Boroughs' Standing Joint Committee be requested to consider the desirability of acute rheumatism in children under sixteen years of age being made a notifiable disease in the Administrative County of London, and of rheumatism supervisory centres being established in the Metropolitan City and Borough Councils.'' 103 When this resolution was submitted to the Public Health Committee they were informed that the making of acute rheumatism a notifiable disease would serve no useful purpose unless adequate provision was made for treatment. This would include not only hospital treatment for acute cases but prolonged medical supervision in a special institution, where educational facilities would also be provided. Any scheme for the control, treatment and supervision of these cases would require a special clinic, such as a rheumatism supervisory centre, and this should be established at a general or children's hospital with one of the Consulting Physicians of the hospital in charge of the scheme. In addition, the investigation of cases notified would involve extra duties and would necessitate special arrangements being made. It was suggested to the Committee that if a Rheumatism Supervisory Centre could be established at one of the larger general hospitals with a sufficient number of beds to supply the needs of several neighbouring boroughs, and in connection with which a body such as the London County Council or Metropolitan Asylums Board would establish a convalescent hospital with educational facilities, it might be possible to co-operate with adjoining boroughs in such a scheme. The Committee were reminded that rheumatism in children is mainly a disease of school age, namely, 5 to 12 years, and as the Education Authorities had made arrangements with the Metropolitan Asylums Board for affording facilities for treatment of these cases the Committee were assured that they were not being neglected. After consideration the Council, on the recommendation of the Public Health Committee, informed the Metropolitan Boroughs' Standing Joint Committee that present circumstances rendered the time inopportune for making Acute Rheumatism in children under 16 years of age a notifiable disease. If a Rheumatism Supervisory Centre could be established at one of the larger General Hospitals with a sufficient number of beds to supply the needs of several neighbouring Boroughs, and in connection with which a body such as the London County Council or Metropolitan Asylums Board would establish a convalescent Hospital with educational facilities it might be possible to co-operate with adjoining Boroughs in such a Scheme. 104 DISINFECTING DEPARTMENT. 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 1432 1887 1404 188 2630 699 18969 23890 Verminous & Miscellaneous 216 240 104 47 174 60 1254 1639 Totals 1648 2127 1508 235 2804 759 20223 25529 Pulmonary Tuberculosis 254 271 58 7 126 29 394 614 Totals 1902 2398 1566 242 2930 788 20617 26143 Other articles also passed through the Council's apparatus:— Disinfectors' clothing, overalls, drop-sheets, etc., to the number of 4,201, 3,570 articles of clothing from verminous persons were disinfected and 124 other articles; making a total of 34,038 articles. 232 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 strength of approximately 4 grammes per litre for distribution. During the year 1928, 84,712½ gallons were manufactured. 150,790 gallons of the weaker solution were produced, of which, with a balance of 980 gallons on hand at the beginning of the year, 151,590 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. 105 Distribution of Fluid. The fluid was distributed as follows:— galls. Violet Road Depot 64,395 Bickmore Street Depot 18,598 Old Ford Road Depot 9,975 Ford Road Depot 7,135 Trego Road Depot 6,525 Stebondale Street Depot 10,265 West Ferry Road Depot 2,715 Public Health Office 78 Poplar Baths 3,881 Bow Baths 3,627 Island Baths 2,422 Violet Road Baths 100 Wick Lane Baths 865 Empson Street Baths 517 Open Air Bath, Bromley 1,362 Poplar Town Hall 48 Bromley Public Hall 137 Works Department 191 Guardians' Offices 189 Poplar Institution 10,205 Lang ley House 212 Poplar Training School, Hutton 76 Public Libraries 517 Used at Council's Cleansing Station in baths of verminous persons 525 London County Council Schools 2,206 Mortuary, High Street, Poplar 510 Tuberculosis Dispensary 73 Royal College of St. Katharine 202 Council Offices, Poplar 128 Finance Department Offices 66 Kingsley Hall 36 Simpsons Road Clinic 96 M. and C. W. Centre, Wellington Road 30 Howrah House Convent 144 Bow Relief Offices 171 S. Mildred's House 33 Sold to Private Firms iH Borough, etc. 1,422 Used at premises where smallpox occurred 905 Used at premises in flooded areas 1,008 151,590 106 Cost of Materials and Electricity . The cost of materials and electricity for manufacturing the electrolytic fluid was as follows:— £ s. d. Electricity, 23,012 units at iid. per unit (with 50 per cent. advance) 215 14 9 Chloride of Magnesium, 6 tons, 17 cwts. 3 qtrs. 12 lb 46 7 9 Salt, 30 tons 14 cwt 113 0 2 Caustic Soda, 20 cwt. 2 qtrs. 8 lb 30 17 0 Water 84,712½ gals. 3 3 9 Total cost of materials and electricity to produce 84,712½ gallons (strong); broken down to 150,790 gallons 409 3 5 Electric motor for stirring; 392 units 3 13 6 Bottles, Corks and Labels. Bottles — — — Corks 16 4 0 Labels 5 15 0 £21 19 0 Total quantity of water used for all purposes, 370,000 gallons, cost £13 18s. 7d. 107 Total Quantity Manufactured since Installation of Plant. Since the installation of the plant, a period of 23 years, 1,118,432½ gallons of fluid have been manufactured (see footnote) at a cost for electricity of £1,998 6s. 10½d., and materials of £2,273 18s. yd.. The amount of fluid manufactured, and the cost of materials and electricity, in each of the last ten years is shown below:— Year. Output, gallons. Materials, Chloride of Magnesium, Salt, Caustic Soda and Water. Electricity. Total. £ s. d. £ s. d. £ s. d. 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 1928 84,712½† 193 8 8 215 14 9 409 3 5 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. † Since 1914 the fluid has been made of greater strength than originally, and afterwards broken down to half strength for distribution. Quantity distributed:— 1914 1915 1916 1917 1918 1919 1920 1921 88,425 gallons. 73,970 „ 53,580 „ 55,800 „ 61,500 „ 66,570 „ 78,510 „ 102,660 „ 1922 1923 1924 1925 1926 1927 1928 113,040 gallons. 129,480 „ 140,700 „ 144,330 „ 130,635 „ 147,655„ 151,590 „ 108 EXTRACT FROM ANNUAL ESTIMATES, Etc. Electrolytic Disinfecting Fluid. Estimate for Year ended 31st March, 1928. Expenditure for Year ended 31st March, 1928. Average Expenditure for 3 years ended 31st March, 1928. Estimate for Year ending 31st March, 1929. Estimate for Year ending 31st March, 1930. £ £ £ £ £ £ £ £ £ Wages 1467 1440 1515 1291 1277 Rates and Insurance—Main Depot 109 108 105 108 100 Rent (Issuing Depots) 36 38 34 39 46 Electricity and Water 200 186 192 220 220 Chemicals 200 169 168 204 200 Testing Apparatus 120 78 106 5 5 Bottles, Carboys, Hampers, Corks, etc. 75 70 Overalls and Clogs 9 9 Issuing-Conveyance – – 24 – – Supervision of Plant 15 15 15 15 15 Repairs and Renewal of Plant 10 41 71 50 50 Repairs (Works Dept.) Main Depot 50 14 143 22 100 ,, ,, Issuing Depots 100 117 110 11 150 Petty Expenses and Sundries 5 1 1 3 3 Capital Account—Cost in excess of Loan – 669 251 – – Lets Income 2312 2876 2735 2052 2245 30 2282 49 2827 32 2703 25 2027 25 2220 109 Spraying and Cleansing Floors of London County Council Schools with Electrolytic Disinfecting Fluid. 2,206 gallons were supplied to 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. 3,881 gallons were supplied to the Poplar Baths, 3,627 gallons to the Bow Baths, 2,422 gallons to the Island Baths, and 1,362 gallons to the open-air swimming baths, making a total of 11,292 gallons. VERMINOUS CHILDREN ATTENDING SCHOOLS, LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1907. CHILDREN ACT, 1908. Number of Verminous Children Bathed. Quaiter. Number of Children Cleansed. Total number of Cleansings. Amount. 1928. £ s. d. March 272 441 34 12 0 June (Cleansing Station closed) Nil Nil – September 170 213 18 19 0 December 127 143 13 9 0 Totals 569 797 £67 0 0 In 524 of the cleansings a special comb was used. (48 boys, 476 giiIs.) 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 145 visits in connection with verminous schoolchildren—65 Poplar, and 80 Bow and Bromley. For cleansing of verminous rooms, see table facing page 34. 110 Scabies . Miss Davies made 81 visits in connection with children suffering from Scabies—63 Poplar, and 18 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, 62 persons—including 31 (30 men and 1 woman) 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 – – – 215, Bow Road 1 – 1 St. James's Chambers, 207, High Street, Poplar 6 – 6 65, Bow Lane – – – 378, Old Ford Road – – – 38, Pennyfields – – – Salvation Army Home, Bow Road 2 – 2 9 – 9 From Common Lodging Houses without the Borough of Poplar 21 1 22 Totals 30 1 31 111 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. 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. (a) Borough Tuberculosis Dispensary.—I, 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. 1 Part-time Helper (female). 1 Caretaker. (c) Residential Institutions:— (а) Sanatoria, hospitals and homes available under the London County Council scheme for both pulmonary and nonpulmonary cases. (б) The Poor Law Infirmary (St. Andrew's Hospital). (c) Occasional In-Patient letters for hospitals or homes, obtained from charitable sources. (i.) 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. 112 . (ii.) The nature and extent of co-operation with general and special hospitals, school clinics, and other institutions. (a) 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 2 old cases have been undergoing this treatment, a total of 100 applications of one or other form of light having been given. (b) Special HospitalsThe 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, Victoria Park, or other approved hospitals, a charge of 10s. 6d. being made for each refill. Six patients have attended for this purpose,receiving altogether 83 refills. Non-pulmonary cases thought to be suitable for Artificial Sunlight treatment are by agreement sent for this to Victoria Park Hospital. This arrangement, originally sanctioned by the London County Council for an experimental period of 12 months ending the 31st March, 1928, was extended for a further year to 31st March, 1929. As mentioned in last year's report, little use has been made of this arrangement owing to the difficulty parents find in sparing the time necessary to take their children daily such a distance. Cases of "Surgical Tuberculosis'' on return from residential treatment are, as a rule, referred back to the Surgeon under whose care they were before being sent away. If for any reason this is not possible, the Metropolitan Asylums Board have a clinic at St. Margaret's Hospital, Kentish Town, for patients who have received treatment in their institutions, while patients who have been at Lord Mayor Treloar's Hospital, Alton, are seen at the Farringdon Dispensary by Sir Henry Gauvain. (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. 113 Co-operation with the School Medical service as explained in previous reports continues to work satisfactorily. Some 125 children, either "unsatisfactory children" or contacts, have been dealt with under this scheme. Suitable cases of definitely tuberculous children are attending the London County Council special school for tuberculous children at Geare House, Stepney Green, while other delicate children attend the Open Air School in Bow Road. (iii.) Any special arrangements made to secure the co-operation of medical practitioners and the working of the arrangements for periodical reports on insured patients under domiciliary treatment. 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. 693 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 has been maintained by means of the customary forms. 488 reports have been sent to, and 227 received from, panel doctors in respect of patients having "domiciliary" treatment. 198 patients were on "domiciliary" treatment on 31st December. (iv.) 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. (v.) The arrangements for securing the examination and systematic supervision of "home contacts." 114 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. 292 contacts were examined, 116 being adults and the remainder children. In addition a number of unexamined contacts were reported to the Divisional School Medical Officer. (vi.) Information as to special methods of diagnosis and treatment in us* 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. X-ray.—During the year, in order to facilitate early diagnosis, the London County Council relaxed the limitation of the period during which cases of tuberculosis could be referred to hospitals for X-ray examination. (vii.) The results of local experience as to the relative value of each form of treatment. See (vi.) (viii.) 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. (ix.) 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 ten years of age; for older children and adults no special provision is made, but the services of a district nurse are generally forthcoming. Extra nourishment in the form of Ambrosia (dried milk) and eggs has been granted to suitable cases on the same lines as previously. The grant 115 is made for a period of twelve 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, but owing to the fact that the Guardians have been obliged to reduce their scale of relief, a larger number of patients have received a grant from the dispensary service during the latter part of the year. 79 patients have been in receipt of extra nourishment for varying periods during the year. Of these, 35 were still receiving it on December 31st. For the convenience of patients living in the southern end of the borough the weekly allowance can be drawn at Simpsons Road, Poplar, instead of at the Dispensary. (x.) The arrangements for treating non -pulmonary tuberculosis, especially tuberculosis of bones and joints in adults and in children, and for the provision of surgical apparatus, etc. Non-pulmonary cases which can suitably be treated as outpatients are referred for treatment to the London Hospital under the arrangement already referred to. Cases requiring residential treatment are dealt with under the London County Council's scheme. Cases of tuberculosis of the skin, as stated above, are sent to the London Hospital for Finsen or other light treatment; other cases for light treatment are referred to Victoria Park Hospital. The patient who was sent to Leysin in 1927 has still remained under treatment there. According to the latest report received, she has made definite though slow progress towards arrest of the disease. 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. (xi.) 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:— The Tuberculosis Care Committee continues to meet fortnightly at the Dispensary and to deal with the treatment of tuberculosis from the social or economic point of view, and much interest is taken by the Committee in this aspect of the work. During 1928 there have been twenty 116 meetings of the Tuberculosis Care Committee and 336 individual cases have been considered. 147 recommendations regarding assessment have been submitted to the London County Council and 19 Dental cases have been dealt with. In addition 66 "special cases"—that is, cases in which some special form of advice or assistance is required—have been considered. The Poplar Tuberculosis Fund for assisting persons suffering from tuberculosis has been in full swing during 1928 and the Committee feel more and more the advantage of having their own small fund to turn to in urgent cases instead of having to apply to other sources. During the year it has been possible to give some sort of help in 43 cases. The Fund is particularly useful for assisting persons who cannot afford their own outfits for sanatorium and who, at the same time, are not entitled to help from the Guardians or from any other agency, and I think that we may say that, thanks to the Fund, many refusals of vacancies at sanatoria have been averted. Grants of clothes or boots have been made in 25 cases, and other forms of assistance provided during the year have included payment of part cost of dentures, provision of tools, payment of the cost of removal of a family to Papworth, provision of bedding (in cases ineligible for loan of bedding by the Council), payment of rent for period to enable a patient to go away to sanatorium and retain a home to come back to, purchase of an invalid chair to lend out etc. etc. The Poplar Tuberculosis Fund publishes its own Annual Report giving full details of its activities, together with the balance sheet, at the end of the financial year. Income during the year was derived from contributions received from the Managements of the Poplar Hippodrome and the Bow Electric Theatre, in respect of Sunday Cinematograph Entertainments, from the proceeds of a "Household and Jumble Sale" organised by the Committee in November, and a Dramatic Entertainment given by the 23rd North London Boy Scouts in March, and donations and contributions from kind friends. The Care Committee are very grateful to all those who have assisted the Fund. In September, 1928, the Tuberculosis Care Committee organised a Handicraft Class for ex-sanatorium men and women who, though fit for light work, have not been successful in obtaining employment on their discharge from treatment. The Class meets weekly at the Dispensary, under a teacher provided by the London County Council, and is at present learning fancy leather-work. The object is mainly occupational, but it is possible for the workers to earn a little pocket-money by the sale of goods, and we were successful in selling quite a number of articles just before Christmas. The Class is much appreciated by those who have joined. 117 The Tuberculosis Care Committee is very grateful to the Poplar Board of Guardians for their assistance to patients who are known to them, particularly the provision of clothing for sanatorium, and the provision of sanatorium treatment for those who have been refused further sanatorium treatment through the London County Council. They also wish to acknowledge the valuable help they receive from the Invalid Children's Aid Association in visiting and providing convalescence for children, and to thank all those who have interested themselves in the welfare of tuberculous persons in this borough. (xii.) Particulars as to any local arrangements for finding employment for patients. No further facilities for finding employment for patients exist beyond those mentioned in previous reports. Several of our patients have been employed during the year at the Spero Firewood Factory and two at the Spero Leather Factory. (xiii.) 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. Three shelters were on loan on 31st December. 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. (xiv.) Any special points noted locally as to the incidence of tuberculosis (i.e., occupation). No special occupational incidence has been noted. (xv.) Any special methods adopted or proposed for the prevention of tuberculosis. No special methods have been adopted beyond those already mentioned in previous reports. (xvi.) 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. Tuberculosis Officer and the Ministry of Pensions. A conference took place between the Medical Officer of Health, the Tuberculosis Officer and the Principal Medical Officer of the Ministry 118 of Pensions to discuss the question of treatment allowances for ex-Service men receiving pensions for tuberculosis. There were a number of cases of pensioners who had been receiving treatment allowances for over a year who were to be boarded by the Ministry of Pensions with a view to confirmation or adjustment of their assessments. As a result of the discussions, and at the request of the Ministry of Pensions, it was arranged that the Tuberculosis Officer should sit as a member of the Boards. The Minister of Health was of the opinion that there would be advantage in the attendance of the Tuberculosis Officer and the Public Health Committee agreed to Dr. Smith attending the Boards as a member. Post-Graduate Courses for Tuberculosis Officers. With the approval of the Ministry of Health and London County Council, Dr. Smith attended a Post-Graduate Course at the City of London Hospital, Victoria Park, from 26th November to 1st December, and Dr. Cullen attended a post-graduate course at Lord Mayor Treloar's Hospital, Alton, from 25th to 30th June. STATISTICS FOR 1928. Attendances at Dispensary (Insured, 1,613; Uninsured, 3,633) 4,726 New patients examined 945 Contacts examined 292 Notifications by Tuberculosis Officer (Pulmonary, 166; Nonpulmonary , 30) 196 Patients sent away for Sanatorium Treatment 196 Patients away in Institutions 31st December 104 Patients receiving Domiciliary Treatment, 31st December 198 Patients receiving Dispensary Treatment, 31st December 128 Under observation, pending diagnosis, 31st December 30 In receipt of extra nourishment during the year 79 In receipt of extra nourishment, 31st December 35 Health Visitors' visits 8,707 Doctors' visits 146 Sputum examinations made (for Dispensary, 1,495; for Public Health Department, 394) 1,889 Reports sent (to Practitioners, 693; to Public Authorities, 771) 1,464 W. C. P. SMITH, Tuberculosis Officer. 119 TUBERCULOSIS DENTAL CLINIC. Report of Dental Surgeon. Mr. C. Hammond Williams, Dental Surgeon, submitted the following report:— I beg to submit my Annual Report of the Dental Work carried out during the year 1928, in the Tuberculosis Dental Clinic. Our figures show a decrease in every instance. They are as follows:— 51 Sessions. 154 Attendances. 59 Fillings. 185 Extractions. 56 Scalings. The difficulty persists that patients are in Sanatoria before their dental treatment can be commenced. To reduce this, the arrangements for dental treatment have been revised. We now have two Tuberculosis Anaesthetic Sessions per month, instead of three Ordinary and one Anaesthetic Sessions, in the hope of getting the work done more quickly. It is impossible to say yet whether this will be satisfactory or not. C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. 120 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications received during the period 1st January, 1928, to 29th December, 1928. 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. Males — — 5 3 19 19 26 22 18 7 1 120 244 — — — — — 9 128 9 106 Females — — 1 8 21 15 19 14 4 3 2 87 182 — — 1 4 76 10 69 Non-Pulmonarv— Males — 9 13 5 1 2 1 2 1 — — 34 50 1 — — 1 1 3 14 1 12 Females 3 8 5 5 8 2 2 2 1 1 — 34 53 — 2 — 2 3 2 14 7 20 Totals 3 17 24 21 40 38 48 40 24 11 3 275 539 1 2 — 3 5 18 232 27 207 121 New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, during the period 1st January, 1928, to 29th December, 1928, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912. Age Periods 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total cases. Pulmonary— Males — — — — — 1 — — 2 — 1 4 Females — — — 1 — — 1 — — — — 2 Non-pulmonary— Males — — — — — — — — — — — — Females — — 1 — — — — — — — — 1 Source of information—Death returns. These 7 deaths of non-notified crises are equivalent to 3.9 per cent. of the total deaths from Tuberculosis. Number of cases notified only after death:—Nil 122 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1924. Summary of Quarterly Returns to the London County Council. Quarter ended March. June. September. December. Number of Cases on Register at commencement of quarter 3,880 3,882 3,796 3,113 Number of New Cases notified 89 72 68 50 Number of Cases removed from Register 87 158 751 950 Number of Cases on Register at end of quarter. Pulmonary 2,509 2,446 2,028 1,514 Non-Pulmonary 1,373 1,450 1,085 699 Totals 3,882 3,796 3.113 2,213 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 1 — — — 3 — — — 2 1 — — 9 8 1 2 4 3 5 5 1 14 8 — — 6 1 10 3 9 5 5 1 5 — 1 15 19 21 1 5 6 14 — I 20 20 15 2 2 16 11 2 — 25 26 20 1 2 13 17 1 — 35 22 14 2 2 22 6 1 1 45 20 4 1 1 21 5 55 7 3 — 1 8 2 1 1 65 and upwards 2 2 — — 3 — — — Totals 124 89 35 37 91 62 15 10 123 Deaths from Tuberculosis. It will be seen on reference to Table II. that the deaths from Tuberculosis were 153 from tuberculosis of the respiratory system (lungs, larynx and throat) and 25 from other forms of tuberculosis. The following table gives the classification of the 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 12 33 Intestines and peritoneum 3 34 Vertebral column 4 35 Joints 1 36 Other organs:— (a) Skin and subcutaneous tissues 1 (b) Bones (vertebral column excepted) — (c) Lymphatic glands (abdominal glands excepted) — (d) Genito-urinary system — (e) Other sites — 37 Disseminated tuberculosis:— (a) Acute 2 (b) Chronic or unstated 2 25 124 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; the Royal College of St. Katharine being responsible for the intermediate area, except for a small area in the vicinity of the Maternity and Child Welfare Centre in Wellington Road. 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 1928 41,420 27,653 In table facing this page 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 at each centre. During the year the Ante-Natal Clinics were increased by 3 per month, making a total of 8 Ante-Natal Clinics per month, held at the Council's Centres. In addition, the Royal College of St. Katharine hold a double Ante-Natal Session once a week. There have been no further increases to the Clinics held during the year. OBSERVATION WARDS. Report of Dr. H. St. H. Vertue, Consulting Physician at the Maternity and Child Welfare Observation Wards. Consultations were held every Friday afternoon (except Good Friday) at the Observation Wards, and in addition numerous visits were paid, to MATERNITY AND CHILD WELFARE CLINICS. Situation. Nature of Accommodation. Clinics. (a) Provided by the Borough Council:— Simpsons Road, Poplar Medical Officer's, Weighing and Waiting Rooms (Weighing Room also used for Artificial Sunlight Treatment) Infant Consultations: Wednesdays, 10.30a.m. to 12.30 p.m. and 2 to 4 p.m. Ante-Natal: First and third Mondays in each month, 2 to 4 p.m. Serving Class: Mondays, 2 to 4 p.m. Artificial Light Treatment: (By appointment only) Tuesdays and Thursdays, 9.30 a.m. to 12.30 p.m. and 2.30 to 4.30 p.m.; Saturdays, 9.30 a.m. to 12.30 p.m. Wesleyan Mission, Old Ford Road Medical Officer's Room and Weighing and Waiting Room combined Infant Consultations: Tuesdays and Fridays, 2 to 4 p.m. Methodist Chapel, Manchester Road Medical Officer's, Weighing and Waiting Rooms Ante-Natal: Fridays, 10.30 a.m. to 12.30 p.m. Infant Consultations: Wednesdays, 10.30 a.m. to 12.30 p.m., and 2 to 4 p.m. 54, West Ferry Road Ditto Ditto Ditto Infant Consultations: Fridays, 2 to 4 p.m. Sewing Class: Mondays, 2 to 4 p.m. Wellington Road Medical Officer's, Weighing and Waiting Rooms, Dispensary Dentist's Room, Recovery Room, Artificial Light Room Infant Consultations: Thursdays, 2 to 4 p.m. Ante-Natal: Second and fourth Wednesdays in each month, 2 to 4 p.m. Artificial Light Treatment: (By appointment only) Mondays, Wednesdays and Fridays, 9.30 a.m. to 12.30 p.m., and 2.30 to 4.30 p.m. Dental: (By appointment only) Wednesdays, 10 a.m. to 12 noon. Special Clinic: (By appointment only) Fridays, 2 to 4 p.m. (h) Provided by the Royal College of St. Katharine:— 228-230, Brunswick Road Two Medical Officers' Rooms; 1 Weighing and 2 Waiting Rooms; 1 Dental Clinic; 1 Artificial Light Room and Waiting Room; 2 Observation Wards, with Kitchen, Bathroom and Out-Patient Room for mothers Infant Consultations: Tuesdays, Thursdays and Fridays, 2 p.m. Sewing Class: Wednesdays, 2 p.m. Dental: (By appointment only) Mondays, 1.30 and 3p.m. Artificial Light Treatment: (By appointment only) Mondays to Fridays, 9.30 a.m. to 12.30 p.m., and 2 to 4.30 p.m. Ante-Natal: Tuesdays, 9.30 a.m. Tonsil Clinic: (By appointment only) Twice monthly. Remedial Exercise: (By appointment only) Mondays, 2.30 p.m., and Thursdays, 10 a.m. The Lighthouse Mission, Blackthorn Street Trinity Hall, Augusta Street Medical Officer's Room and Large Hall for weighing and waiting Ditto Ditto Ditto Infant Consultations: Wednesdays, 2 p.m. Infant Consultations: Wednesdays, 2 p.m. 125 observe the progress of the cases in the Wards. The patients sent by the Medical Officers of the clinics were dealt with in three ways. Some came for an opinion only and were dealt with at a single consultation. Others were admitted to the Observation Ward as In-patients. A numerous group attended as Out-patients for varying lengths of time. The last generally attended not only at the regular consultations but also in the intervening period, while a watch was kept on their progress by the Ward Staff, who were ready to report any matter of difficulty. In-patientsThe number of admissions to the Ward during the year was 30. The nature of the cases admitted was variable, but the greater number comprised a class of infant in whom artificial feeding had proved a difficulty, generally as a result of some mistake in the method of feeding. The next largest group was composed of children in whom the fault was constitutional, and showed itself in the form of a great difficulty in getting them to thrive on any fare, no matter how carefully prescribed. Such are the cases under the names of Marasmus and Cows' Milk Atrophy. In a third group the mother's power of managing her child had broken down, and in an atmosphere of over-anxiety the child refused to thrive. We called these cases Nervous Unrest or Food Refusal: the names sufficiently describe the nature of the condition. In the fourth group faulty hygiene at home had produced the state of malnutrition known as Rickets. These children were admitted to give them a start. Once under good conditions they made astoundingly good progress. The following is a list of different kinds of cases admitted (i) Dyspepsia and Malnutrition due to Mismanagement of Artificial Feeding 14 (ii) Marasmus 4 (iii) Cows' Milk Atrophy 2 (iv) Nervous Unrest 2 (v) Food Refusal 1 (vi) Rickets 4 (vii) Malnutrition from Previous Illness 1 (viii) Malnutrition from Failure of Breast-Feeding 2 30 When the children had been admitted, four objects were left in view— (i) To retone the damaged digestive powers: (ii) To get the child into a thoroughly good state of nutrition: (iii) To see it become a happy and 126 contented child: (iv) To have it on a diet which the mother could procure and prepare herself at home. The simpler the diet, the better. Fresh cow's milk suitably modified commends itself as the food best suited to the most delicate infants. But in one of the two cases of Cow's Milk Atrophy no form of milk, dried, fresh or treated in any way, would agree, and the child had to be sent home on a proprietary food. The objects aimed at were attained in all but six cases. I append a list of the results in the thirty cases. (i) Recovered 20 (ii) Improved 4 (iii) Transferred to Hospital with Infectious Disease 3 (iv) Removed by Parents with improvement 1 (v) Removed by Parents without improvement 1 (vi) Died (Feb. 1929) 1 30 The death that occurred was attributed to Influenza attacking a very debilitated marasmic child. Infectious disease is unfortunately likely now and again to break out in children who have been admitted, the infection not having been known until the disease appears. None of the infections actually spread in the ward. At a subsequent date as many as possible of the children who had been In-patients were inspected, in order that the permanence of the good results which had been obtained in them might be estimated. Nineteen were inspected, and the following is the result. In Very Robust Health 5 In Very Good Health 9 In Good Health 4 In Poor Health 1 19 It is cause for congratulation to the mothers that in all but one case they were able, once they had been given a fair start, to keep up good progress on the lines laid down. 127 Out-patients.—The number of children attending as Out-patients was sixty-nine. The number of actual attendances made by them was five hundred and thirty-five. The nature of the cases was as follows:— (i) Difficulties in Breast-feeding 34 (ii) Difficulties in Artificial-feeding 7 (iii) Nervous Unrest 1 (iv) Malnutrition of obscure origin 1 (v) Single Consultations 26 69 Difficulties in Breast-feeding were the main part of the Out-patient work. The mothers were desired if possible to bring their infants up at frequent intervals, in order that the secretion of milk could be watched and the feeding correctly adjusted. Many of the difficulties, such as poor suction, are difficult to overcome and need a lot of patience. Naturally the ideal aimed at was to restore perfectly normal feeding in each case. This was done in a fair proportion of cases; in most of the others that attended properly the feeding was satisfactorily adjusted on a scientific basis, with a fair certainty that partial breast-feeding would be maintained afterwards. A few were prevented from coming by some outside cause, and there were some who grew tired of giving the time and labour necessary. These are the results obtained:— Complete Re-establishment of Normal Breast-feeding 12 Partial Re-establishment with Correct Supplementary feeding 10 No Re-establishment 5 Failed to complete attendances 7 34 A more detailed account of the single consultations may be of interest. Most of them came up simply for an opinion. In some others a more prolonged course of observation was considered at the outset, but it was soon discovered on examination that simple treatment would put them 128 right, and that no special observation would thereafter be necessary. Breast-feeding cases again head the list. (i) Mismanagement of Breast-feeding without Loss of Breast-milk 12 (ii) Mismanagement of Artificial Feeding 3 (iii) Errors in Diet 3 (iv) Nervous Children 3 (v) Rickets 1 (vi) Congenital Defects 4 26 Work of the Staff.—Throughout the year the staff worked admirably. The keenest interest was shewn not only in those branches of the work which yield such rapid and spectacular results, such as for instance the dramatic successes obtained in certain of the In-patients, but also in the more laborious and less showy but in the end equally valuable work in the Out-patient babies suffering from failure of breast-feeding. It is a great pleasure to be able to note that there is a spirit in the Ward promoting a healthy, happy atmosphere, which has a very beneficial effect on the children. H. ST. H. VERTUE, M.A., M.D., Consulting Physician. 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 16 cases were referred by the Clinic Medical Officers to this Centre. 129 Below is a table giving the attendances at each of the Clinics during the year 1928:— Bow West Ferry Road. Manchester Road. Simpsons Road. Wellington Road. P.H. Dept. Total. Royal College of St. Katharine Total. Infant Consultations:— First attendances 384 169 236 317 555 1,661 1,015 Total attendances 8,433 2,869 6,125 7,039 4,018 28,484 17,769 Average per session 82.6 56.2 60 69 77.2 69.6 76.1 Average attendance of each child 14 10.4 13.3 11.9 7.2 11.5 — Dental Clinics:— Attendances — — — — 791 791 1,157 Average per session — — — — 15.5 15.55 11.1 Ante-Natal Clinics:— Attendances 538 — — 305 184 1,027 836 Average per session 10.5 — — 12.2 8 10.3 17.5 Light Clinics:— Attendances — — — 4,684 5,444 10,128 4,775 Average per session — — — 19.2 18.7 19.1 14.4 Sewing Class — 337 — 653 — 990 516 Garden attendances — — — — — — 1,637 Mothers' Clinic — — — — — — 91 Remedial Clinic — — — — — — 872 Total attendances at all Clinics:— 1928. 1927. P .H. Department 41,420 36,110 Royal College of St. Katharine 27,653 23,588 Total 69,073 59,698 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.—The Ante-Natal work is steadily increasing, in spite of the fact that there have been fewer births, and more mothers are confined in Institutions where Ante-Natal Clinics are held. The additional clinic at Wellington Road is well established. During the year a special effort was made to further the co-operation between the Council's Ante-Natal Clinics and the local midwives and Institutions. A supply of forms was sent to all midwives practising in 130 the Borough for use when patients were referred to the Ante-Natal Clinics. The Clinic Medical Officers' notes regarding the patient are entered on these forms, which are then returned to the midwives with requests for the forms to be completed after the confinements are over, giving short clinical notes of the confinements and after-history of the patients. There is still much work to be done before we can say that the majority of mothers realise the importance of medical supervision during pregnancy, and it is only by visiting and propaganda that this will be accomplished. Infant Consultations.—The total attendance at all clinics has increased during the year. Old Ford heads the list with an average of 82.6 per session. This is much too high, especially when the accommodation available is taken into consideration. These premises are now the least satisfactory of all our centres. The absence of a separate weighing room is a great disadvantage at such a busy clinic, where the attendance is at times over 100. The shelter for perambulators is also inadequate. The increased attendances at Manchester Road Clinic show how much more suitable are these premises compared with the former premises at Christchurch. They are well appreciated by mothers and staff. Artificial Light Clinics.—The attendances at the Artificial Light Clinics during the year numbered 10,128, an increase of 3,678 over last year's figure. These clinics are very popular with mothers, who go to a good deal of trouble to bring their children to the clinics when they see the improved condition of the children. The average number of exposures per child was approximately 17, although many of the children only received five or six. The prevalence of Measles and Whooping Cough during the year mainly account for the broken attendances. The increase in the total attendances is in a measure due to the consideration shown by the Sister-in-Charge, who, when making appointments for treatment with mothers, realising their home difficulties, makes arrangements to suit the mothers' convenience. Dental Clinic.—The Dental Clinic continues to do very useful work. Mothers are now realising the value of dental hygiene for themselves 131 and also for their children. There are still many who will not come for treatment before actual pain is experienced, but it is only by education that this can be overcome. Sewing Classes.—Here also the attendances have improved. The mothers have discovered that the time is well spent on Monday afternoons, as the clothes that are cut out and fixed for them are so much more satisfactory in shape and quality than ready-made garments. The Sewing Classes afford excellent opportunities for Health Talks, and advantage has been taken of this. The mothers also enjoy the social side of these classes. Home Visiting.—The visits paid by the Health Visitors show an increase of 6,433. This is partly due to the work of the extra Health Visitor who commenced her duties on 7th May, 1928, and was given the district tiansferred from the Royal College of St. Katharine, and partly to the regular and systematic visiting of the Staff. Home visiting is very exacting and at times monotonous, but it is by far the most important duty of the Health Visitors. This is the ' 'spade work "on which depends the success of their work in the district, and the amount and value of the work at the clinics. Maternal Deaths.—During 1928 there were 8 maternal deaths, as compared with 9 in 1927. 5 of these were first pregnancies, and only 2 of the 8 cases attended an Ante-Natal Clinic. For the first time on record, no deaths from Puerperal Sepsis occurred. Each maternal death is personally investigated. The registered cause of death in the 8 cases was as follows:— (a) From Sepsis.—Nil. (b) From other causes:— (1) Uremia, Acute Glomerular Nephritis, causing miscarriage. P.M. (2) Pelvic Peritonitis, Caesarean Section, obstructed labour. (3) Child Birth, Acute Inversion of Uterus, Post Partum Haemorrhage, Shock. P.M. 132 (4) Syncope, following child birth. (5) Acute Parotitis, Puerperal Eclampsia. (6) Pulmonary Embolism, Caesarean Section, following Eclampsia . P.M. (7) Cardiac Failure, shock following operation, Placenta Praevia, Caesarean Section. (8) Oedema of Lungs, Albuminuria of Pregnancy, obstructed labour. Infantile Mortality (71 per 1,000).—The higher infantile mortality rate is due to the increase of deaths from Measles. During 1928, 1,320 cases were visited, and there were 14 deaths under 1 year, compared with 476 cases visited and 1 death under 1 year in 1927. Unfortunately, there are still many mothers who will not regard Measles as a serious disease. The unsatisfactory housing conditions are also largely responsible for the spread of Measles, as any attempt at isolation is impossible in the small, overcrowded rooms. For this reason, every endeavour is made to get the parents' consent for removal to hospital. Zymotic Enteritis.—During the notifiable period, June—September, 188 cases were notified. 22 died, and these deaths occurred before the notifications were received. There was only 1 request for nursing assistance. This is the 21st Annual Report of the Maternity and Child Welfare Section of the Public Health Department. The following table which refers to the whole Borough, shows how the work has developed during this period:— Year. No. of Centres. No. of sessions held per week. Total attendances for the year. Total visits paid during the year. Infantile Mortality. 1908 6 2 1,200 3,495 124 (104 visited) 1928 8 46 69,073 78,181 71 (42 visited) I should like to thank the Voluntary Workers, who give such valuable assistance at the Infant Consultations and Sewing Classes, and those who 133 so kindly contributed to the Mothers' Christmas Tea Fund. The teas were given at each Centre, and were much enjoyed. Our thanks are also due for the co-operation we have received from all in the Borough who are working for the same object, the welfare of the mothers and babies. Stillbirths . 100 Stillbirths were investigated during the year 1928. (This refers to the whole Borough.) Number of Stillbirths 100 Doctors in attendance 23 Midwives in attendance 24 Delivered in Institutions 53 B.B.A 4 Premature Births 38 First Pregnancies 22 Mothers who had had previous Stillbirths:— One. Two. Three. Four. 13 3 1 1 Notifications of Ophthalmia Neonatorum . Fifty-nine cases of Ophthalmia Neonatorum were notified during the year:— (This table refers to the whole Borough.) Year. Notified. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths- 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 I — 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 — — — 1928 59 26 11 58 — — 1 Total 761 655 83 736 7 1 15 ** 1 born in Institution—not visited, no information available. * Including 3 which occurred in Institution. 134 Cases of Ophthalmia Neonatorum Notified and Visited (Whole Borough.) Number of notifications received 59 Very slight cases 14 Died in Institutions (intercurrent disease) 1 Sight of one eye damaged — Recovered 58 Occurred in Institutions 2 Occurred in the practice of medical practitioners 7 Occurred in the practice of midwives 50 Admitted to hospital as in-patients 11 Treated as hospital out-patients 9 Treated privately 39 Visited by nurse 10 Zymotic Enteritis, 1928. (Whole Borough). Notifications received 188 Died before notification received, under 1 year 15 ,, 1—2 years 7 Not traced — Visited 166 Under 1 year (see feeding below) 59 1 to 2 years 65 2 to 3 years 27 3 to 4 years 10 4 to 5 years 5 Admitted to or occurred in Hospital 33 135 Feeding. Age period. Breast. Mixed feeding. Hand-fed. Not stated. Under 1 year 25 6 28 — Died before Notification received 15 Under 1 year 1 — 14 — Home Nursing. By arrangement with the Nursing Associations nursing is provided (with the consent of the practitioner attending a patient) and paid for by 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 1928:— (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 7 — 3 10 — Visits 65 — 50 — 115 Measles Cases Under 5 14 2 4 20 — 5-10 4 — — 4 — Visits Under 5 147 20 64 — 231 5-10 29 — — — 29 Pneumonia Cases Under 5 15 34 1 50 — 5-10 4 — — 4 — Visits Under 5 260 704 26 — 990 5-10 85 — — — 85 Zymotic Cases — 1 — 1 — Enteritis Visits — 18 — — 18 Puer. Pyrexia Cases 1 — — 1 — Visits 16 — — — 16 Totals Cases 45 37 8 90 — Visits 602 742 140 — 1484 136 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, 9,609 lbs. 720 13 6 ,, ,, Humanized, 52 lbs. 5 4 0 Aberdeen Cream 9 4 4 Dusting Powder 1 11 0 Medicinal Paraffin 5 8 0 Medical Sundries 9 8 11 Dentures 62 11 6 Materials at Sewing Class 21 12 2 Convalescent Treatment 2 11 6 Virol 27 0 9 Oil and Malt 120 5 7 Concentrated Food 25 7 9 Payments for Gas (Dental Clinic) 2 6 6 Total 1,013 5 6 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. 4,223 such vouchers were issued during the year. Grants in Aid. Convalescent Treatment (mothers with babies) 6 cases. ,, ,, (mothers alone) 2 ,, ,, (children under 5 years) 21 Payment of Midwives' fees 10 Loan of maternity bag containing clothing, etc. 18 (The following tables refer to the whole Borough.) Statistics Respecting Infants Born in 1927. All births, including those occurring in outlying districts, but belonging to the Borough 3,489 Doctors in attendance 624 Midwives in attendance 1,716 Delivered in institutions 1,101 Not stated 48 Moved into Borough 64 3,553 137 Stillborn (Stillbirths per 1,000 births, 25) 7 Died before visit 71 Not requiring or desiring visits 120 278 Visited 3,275 Removed within the year 351 Died during visitation 138 489 Remaining under supervision end of first year 2,786 Mortality per 1,000 visited 42 The 2,786 children visited during 1928 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 76.6 per cent. Mixed feeding I9.2 „ Hand-fed 4.2 „ The 138 children who died during the first year of life, were fed during the first six months of life as follows:- Breast-fed 36. per cent. Mixed feeding 42. „ Hand-fed 22. „ Below is a statement comparing the mortality rates of children fed by the various methods:— (a) Babies breast-fed 23 (b) ,, who received mixed food (breast and hand) 98 (c) ,, hand-fed 205 138 STATISTICAL SUMMARY OF HOME VISITING FOR 1928. Public Health Department. The Royal College of St. Katharine. Total 1928. Total 1927. Cases. Visits. Cases. Visits. Cases. Visits. Cases Visits. Ante-Natal:— No. of Cases 612 — 618 — 1,230 — 1,171 Primary visits — 612 — 618 — 1,230 — 1,171 Re-visits — 716 — 1,697 — 2,413 — 2,569 Infant Child Welfare visits:— Primary visits (Infants) — 1,433 — 1,604 — 3,037 — 3,282 Removed before visit — 37 — 37 — 74 — 75 Died before visit — 40 — 35 — 75 — 75 Stillbirths — 46 — 54 — 100 — 87 Re-visits— Under 1 — 7,807 — 12,425 — 20.232 — 20,248 1—5 — 20,428 — ' 24,351 — 44,779 — 44,889 Removed — 480 — 690 — 1,170 — 1,168 Died — 90 — 106 — 196 — 208 {Ophthalmia Neonatorum:— No. of Cases notified 43 — 16 — 59 — 48 — Primary visits — 59 — — — 59 — 48 Re-visits — 132 — — — 132 — 120 Removed to Hospital 11 — — — 11 — 3 — •Enteritis:— (o) No. of Cases reported.. 3 — 14 — 17 — — — (6) No. of Cases notified (Z.E.) 52 — 136 — 188 — 69 — (o) Primary visits — 3 — 14 — 17 — —— Re-visits — 3 — — — 3 — — Removed to Hospital — — — — — — — Died — 6 — 5 — 11 — 22 (6) Primary visits — 52 — 136 188 — 69 Re-visits — 60 — 226 286 — 73 Removed to Hospital 33 — — — 33 — 15 — Died — 8 — 14 — 22 — 15 Measles:— No. of Cases 674 — 646 — 1,320 — 476 — Primary visits — 674 — 646 — 1,320 — 476 Re-visits — 267 — 201 — 468 — 228 Removed to Hospital 175 — — — 175 — 80 — Died — 24 — 24 — 48 — 8 Whooping Cough:— No. of Cases 277 — 269 — 546 — 542 — Primary visits — 277 — 269 — 546 — 642 Re-visits — 135 — 118 — 253 — 444 Removed to Hospital 26 — — — 26 — 49 — Died — 6 — 11 — 17 — 31 tPuerperal Fever:— No. of Cases notified 2 — 3 — 5 — 7 — Primary visits — 5 — — — 5 — 7 Re-visits — 5 — — — 5 — 16 Removed to Hospital 5 — — — 5 — 6 — Died — — — — — — — 2 †Puerperal Pyrexia:— No. of Cases notified 6 — 5 — 11 — 15 — Primary visits — 11 — — — 11 — 11 Re-visits — 11 — — — 11 — 41 Removed to Hospital 9 — — — 9 — 7 — Died — — — — — — — — Maternal Deaths (enquiries) 8 — — — — — — — Maternal Deaths:— 1 — 7 — 8 — 9 — Primary Visits — 8 — — — 8 — — Re-visits — 20 — — — 20 — —— Miscellaneous Visits — 222 — 1,224 — 1,446 — 1,489 Total Visits: — Primary — 3,134 — 3,287 — 6,420 — — Re-visits — 30,543 — 41,218 — 71,761 — — Total Visits paid, 1928 — 33,677 — 44,505 — 78,182 — — Total Visits paid, 1927 — 27.243 — 50,178 — — — 77,421 * Zymotic Enteritis is notifiable from 1st June to 30th September. † All cases are visited by Health Visitors of the Public Health Department. Enquiries re Maternal Deaths are made by the Public Health Department. 139 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. 1923. 1924. 1925. 1926. Remaining under supervision: End of first year — — — 2,971 ,, second year — — 2,905 — ,, third year — 2,742 — — ,, fourth year 2,939 — — — Inward Transfers 70 56 81 77 Visits discontinued 4 2 6 3 Outward Transfers 160 186 221 237 Died 17 17 22 67 Remaining under supervision: End of second year — — — 2,741 ,, third year — — 2,737 — ,, fourth year — 2,593 — — ,, fifth year 2,828 — — — Mortality per 1,000 visited: Second year — — — 22.(20.6) Third year — — 7.4 (10.8) — Fourth year — 6.1(5.7) — — Fifth year 5.6(4.2) — — — The figures in parentheses are the rates for the previous years. ARTIFICIAL SUNLIGHT TREATMENT. Dr. E. M. Layman, the Medical Officer in charge of Artificial Sunlight Treatment, has submitted the following interesting report:— In presenting my report on the work of the Light Department for 1928 I propose to give a few figures, thus affording some precise information as to results. 140 I have classified the diseases, or disordered state of health, of the children attending, as is seen in the Statistical Summary on page 145. I will deal first with the largest and perhaps most striking group, namely, Rickets, which I have subdivided into:— (a) Severe Rickets 44 cases; (b) Slight Rickets, 27 cases; (c) Muscular Rickets, 25 cases. (a) Severe Rickets, 44 cases. Of these: 31 were successful. 8 ,, moderately successful. 5 failed to improve (one only attended regularly, and he derived no benefit). Examples of success:— (i) G. C., age 18 months, breast-fed to 1 year, not walking, very poor condition, 16 teeth, chest rickety deformity. Weight, 22lbs. After 6 exposures, 18 teeth. After 8 exposures increasing from 4 to 5 and 6 minutes child walked, and weight had increased to 231b. 70Z. General improvement continued till discharged after 20 exposures. (ii) E. Y., age 19 months, breast-fed to 9 months, walked late, 12 teeth; head, chest, and whole body very rickety. Weight 2ilb. 70Z. After 4 exposures (preceded by red light throughout the course), 16 teeth, but loss in weight. Continued exposures, increasing from 4 to 6 and 7 minutes. Marked improvement in skeleton and muscles. Steady rise in weight. Discharged after 17 exposures. Weight 22lb. 70Z. All the successes attended regularly and most had an average of 25 exposures; the number of exposures varied with the patient's need and response and ranged from 16 to 30 up to 40 or more. (b) Slight Rickets, 27:— Of these: 20 were successful. 6 ,, moderately successful. 1 failed to improve. 141 Example of success:— E. D., 16 months, breast-fed to i year, 6th child, walked at 15 months, rickety and in poor condition. 8 teeth, weight, 171b. 70Z. Began to cut 4 teeth at once, with loss of weight, but from 6th exposure did extremely well in every way. Discharged after 32 exposures, weight, 191b. 70Z. Example of failure:— D. H., age 2 years 2 months. Poor condition. Rickety bowing of R. leg, 16 teeth. Weight 271b. 100z. After gaining 6oz. in 4 exposures, child steadily lost weight and condition remained poor. Exposures were diminished from 6 to 4 minutes, and red light ordered, but child ceased to attend after 18 exposures. Weight 271b. 40Z. This case, like the one under (a) appears to be a case constitutionally unfitted for this treatment. (c) Muscular Rickets, 25 cases. Of these: 15 were successful. 7 ,, moderately successful. 3 failed to improve. Example of success:— G. F., 14 months, breast-fed to 1 year. Teething. Weight 21lb. Has never walked, muscles very flabby, condition poor. Exposures twice interrupted by illness, but attended altogether for 20 treatments with marked improvement all round, till discharged. Weight 231b. (The failures attended irregularly.) Delayed Dentition, 24 cases. Of these: 14 were successful. 6 ,, moderately successful. 4 failed to improve (these failed to attend properly). 142 Example of success: D. M., aged 12 months, 2 teeth (dried milk). Weight 191b. 40Z. Not walking. Did not gain weight till after 6 exposures, but began cutting teeth slowly. Improved all round, walking after 13 exposures. 8 teeth and weight 20½lb. after 33 exposures. Disturbed Dentition, 38 cases: Of these: 23 were successful. 11 ,, moderately successful. 4 failed to improve. Example of success:— G. S., 13 months. 8 teeth, beginning to walk, recent diarrhoea, cough and loss of weight 2ilb. 2oz. Child excitable. Short exposures given at first (3 minutes). Uninterrupted improvement for 17 exposures, weight 22lb. 70Z. (The failures failed to attend). Bronchitis, 14 cases. Of these: 7 were successful. 5 ,, moderately successful. 2 failed to improve. Enlarged Glands, 10 cases. Of these: 5 were successful. 2 ,, moderately successful. 3 failed to improve. I consulted the T.B. department about a few cases in the last two groups: these were observed over a period of time and pronounced nontuberculous. The most persistent chronic bronchitis (with asthma developing) I succeeded in getting away to Carshalton after failing to improve her condition here. 143 For recovery after illness, 46 cases. Of these: 27 were successful. 11 ,, moderately successful. 8 failed to improve. Example of success:— C. F., aged 13 months. Measles when being weaned a month ago, debilitated ever since, no attempt to walk. 5 teeth. Steady improvement in every way. Discharged after 15 exposures. 16 teeth, walking, gain in weight 41b. 6oz. in 2 months. Three of the 8 failures attended well. One was suffering from fear of neighbouring child and improved after a long time when this ceased to disturb her. (During 1929 this case has markedly improved during a fresh course). Two were disappointments to us. The 5 others failed to attend properly. Restlessness, 9 cases. Of these: 3 were successful. 3 ,, moderately successful. 3 failed to improve. Frelfulness, 4 cases: Of these: 1 was moderately successful. 3 failed to improve. Nervousness, 6 cases. Of these: 4 were successful. 1 was moderately successful. 1 failed to improve. (Mongol, 1 case. Advised no improvement could be expected.) Mental Deficients, 2 cases. Both improved in general health,and one was reported by mother to be more controlled and intelligent, but improvement could not be observed at the clinic. 144 Asthma, i case aged i\ years. Did well, 25 exposures and gained weight well. No attacks while attending. Malnutrition, 73 cases. Of these: 44 were successful. 15 ,, moderately successful. 14 failed to improve. This large group contained both very young infants, failing to assimilate their feeds, and a good many elder children of 4 and upwards. Of the elders, a fair number were found to have worms. This condition had brought them often to a very low state, sometimes even suggesting tuberculosis , but when adequately treated, as I urged on the mothers, these cases at once improved. At least 6 failures were persevering attendants but derived no benefit, and after a good trial I had to discharge them. The rest were irregular attendants. Debility, 70 cases. Of these: 34 were successful. 13 ,, moderately successful. 23 failed to improve. Mothers. 24 mothers could be classed as 'successes' the rest were unable to attend regularly. A few came for deficient lactation, one for depression in pregnancy (a marked success), one for persistent rheumatism with fibrositis (a moderate success), and most for general debility, exhaustion and overwork. In future I hope to have under treatment at an earlier stage more cases of deficient lactation and especially expectant mothers who have failed in lactation with previous babies. I cannot at present give any useful figures for these. The difficulty mothers experience in attending regularly is unavoidable , particularly in the cases of mothers with large or ailing families. "SUNSHINE" CHILDREN AT PLAY.-Simpsons road clinic. 145 Statistical Summary. January ist to December 31 st, 1928. Bow. Poplar. Totals. Number of attendances 5.444 4,684 10,128 ,, ,, sessions 290 244 534 ,, ,, patients 306 302 608 The cases have been grouped as follows:— Group I. —Rachitic:— (a) Severe 44 96 (b) Slight skeletal 27 (c) Muscular 25 — 9 J 2. —Delayed dentition 24 9 t 3- —Disturbances with dentition 38 9 9 4 —Bronchitis and Bronchial catarrh 14 9 9 5 —Enlarged glands 10 9 9 6 —Recovery after illness 46 9 f 7 —Restlessness 9 9 9 8 —Fretfulness 4 9 9 9 —Nervousness 6 9 9 10 —Mongol 1 9 > 11 —Mentally deficient 2 9 9 12 —Asthma 1 9 9 13 —Malnutritution 73 9 9 14 —Debility 70 9 9 15 —Mothers 50 9 9 16 .—Miscellaneous cases (not reported). Less than 5 attendances 86 Current cases 75 Staff 3 • 164 608 146 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:— I beg to submit my Annual Report of the Dental Work carried out during the year 1928, in the Maternity and Child Welfare Dental Clinic. The figures are as follows:— 51 Sessions were held. 268 New patients. 791 Attendances were made. 95 Fillings were inserted. 113 Scalings. 1,807 Temporary and permanent teeth were extracted. In addition the usual routine work in the way of dressings, dentures etc., was carried out. It will be observed that in every case our figures are increased over the previous year, though the number of sessions is the same. This is very gratifying. The number of children attending last year seemed to be greater than previously, in fact some difficulty was experienced in coping with them at times. By the addition of extra anaesthetic sessions the accumulation of cases was reduced by the end of the year. Our new premises are giving great satisfaction, and it is usual for visitors to remark on these and our equipment. Our figures are proof of our popularity—if one may use the word. May I again thank you and all your staff for their very valuable assistance. C. HAMMOND WILLIAMS, L.D.S., R.C.S. (Eng.). 147 REPORT OF SENIOR MEDICAL OFFICER, ROYAL COLLEGE OF ST. KATHARINE. Changes in Upbringing. The struggle for relief to the young from the tyranny of over-clothing is one that infant welfare workers have carried on bravely for years. But their reward seems to have come more slowly here than in almost any other branch of their work. The tradition that most illness reaches the young child through the influence of bodily chill has ruled the mind for so long, that it has to many of us seemed almost unalterable. Without doubt the medical profession has been reluctant to question the tradition and put its truth or error to critical tests; and here, perhaps, as in other respects the healthy have often had to suffer precautions necessarily imposed on the weakly. No one doubts the value of warmly wrapping a thin, premature infant in cotton wool. But the robust .well-conditioned baby seems earlier and more easily capable of dealing with alterations of temperature than it is given credit for. And once it is able to take exercise on its own behalf, a healthy child can accommodate itself to cold temperatures in a remarkable way. Resistance, however, is rapidly lowered by any infectious process, and it is probably the frequency with which infections, in such regions as the throat, escape detection, that has given rise to the view that young children are especially vulnerable to climatic changes. In a crowded household where time for systematic outings is hard to come by, and the child is often indoors for days at a stretch, infections become almost the rule and erratic outings may very easily accentuate the symptoms and consolidate the tradition. The discovery that light plays a really important part in the maintenance of health as well as in the cure of disease sounded a thrilling challenge to this ancient timidity. It is entirely antagonistic to the view that infancy and childhood must be spent enveloped in many layers of suffocating clothing. We seem, indeed, just now to be watching a collapse of customs as dramatic as that which befell the walls of Jericho. It is some twenty years since Rollier showed achievements which were staggering, but it was thought impossible for a long while to apply his methods in this climate, especially in our cities. Artificial light clinics began to familiarise parents with the fact that the child's skin has important positive functions, and acts as a medium through which health can be directly influenced. The illustrated papers served a most useful purpose in shewing how rapidly the adult population can change its 148 attitude in a matter of this sort, and pictures of sun-bathing became a common-place. The artificiality of the mercury vapour lamp has been insisted on by the medical officer in charge of the light department at St. Katharine's ever since he started work there. And it has been his constant policy to close down the lamp room each summer and to persuade the parents to bring their children instead to the little garden we possess. There, with the department's specially trained nurse exercising supervision an increasingly large attendance has grown. Clothing has been gradually shed until babies got accustomed to complete exposure for increasing stretches of time, and toddlers learnt to play with toys, clad only in shoes and shorts. (See illustrations.) Six years ago the numbers weie small. But the benefits were remarked and discussed until for the past three years progress has been rapid. The garden is filled morning and afternoon. Those attending the ordinary welfare clinics have copied the rules enjoined for ailing children, and have caught the pioneers' enthusiasm. Sixty or more mothers may be seen in the garden waiting their turn to have their children weighed or inspected, the babies on their knees completely uncovered, the toddlers playing equally unclothed. Some of these children now actually rival the examples set by Rollier, for they are tanned a deep mahogany brown all over. The parents are using their own yards and gardens, and even accede to the children's request to play stripped in the streets. Others have carried the practice into the public parks and have stood up courageously to accusations of indecency or lunacy; have even borne without retaliation the suggestion that the pigment was derived fioni a daik ancestry. But it is among the quite young, almost new-born that perhaps the most astonishing results have been obtained when the old ideas of protection are remembered. There is a quite considerable group attending the consultations of under six months of age, some of them only three months old, the skin of whose trunks and limbs is deeply bronzed by steady and repeated exposure. The mothers of some of them have adopted the recommendation to give the daily bath in the backyard. The exposure has been skilfully and systematically conducted and the well-being of the children has impressed and silenced ciitics. Less often than formerly we see the unhappy results of an exhausting whole day excursion to the seaside planned and undertaken in the baby's interest. The common outcome was a scorched face and blistered limbs, fatigue, fretfulness, fever and food refusal for perhaps several days. The mothers have learnt better methods, and an entirely changing attitude towards theii children's requirements is steadily spreading. The benefit extends far beyond the actual weeks during which the treatment is carried out. For the child accustomed to being practically clotheless throughout the summer registers the most vehement protests 149 if overclothing is started in the autumn; and, fuither, having once tasted the comfort of outdoor existence, demands indomitably that it shall not be imprisoned, however severe the winter weather may be. HAROLD WALLER. 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 reported in the Annual Report for 1927, dried milk is supplied under the scheme with the exception that Grade 'A' (Tuberculin Tested) milk is supplied in special cases (infants) where the Medical Officers in charge of the Council's Child Welfare Clinics consider its use specially desirable. In April a letter was received from the Ministry of Health stating that the estimate for provision of milk and milk administration had been reduced by £3,233. This left a total sum of £2,800 for this service. The letter further stated that ' 'the Council should reconsider the procedure adopted in dealing with applications for milk with a view to securing strict observance of the following conditions:—(1) Milk should be supplied by the Council at less than cost price solely on medical grounds, and should not be supplied to applicants who are already in receipt of Poor Law Relief. Applicants whose circumstances are such that they can only be dealt with adequately through the machinery of the Poor Law should be referred to the Guardians. (2) Every applicant for milk should be seen in the first instance by the Medical Officer of Health or the Medical Officer of a Centre, and no application for milk should be considered by the Council, or the appropriate Committee of the Council, unless the Medical Officer furnishes a certificate that a supply is essential on grounds of health. Such certificate should be given only in those cases in which the Medical Officer is satisfied that the health of the mother or child will suffer unless a supply of milk is provided by the Council. (3) The scale of income adopted by the Council for the supply of milk at less than cost price should be revised in order to bring it into accord with the fall in the index figure of the cost of living since the scale was framed. (4) The Council should satisfy themselves that they are obtaining their supplies of milk, whether liquid or dried, at prices which bear adequate relation to the quantities of milk distributed by them.'' 150 A similar letter was received by other Boroughs and the Shoreditch Borough Council convened a conference of Local Authorities with a view to making joint representations to the Ministry. This Council sent representatives to the Conference. At this Conference it was pointed out that the suggestion of the Minister that milk should "not be supplied to applicants who are already in receipt of Poor Law Relief" would have the effect of transferring a considerable proportion of the families to the Guardians with a consequential additional burden on the local rates, and further that the Guardians had no power or organisation to carry out this duty. Resolutions were adopted by the Conference: (a) Pointing out that the estimates were based on experience gained over a number of years in carrying out the directions of the Minister of Health as laid down in Circular 185, and offering a strong objection to the action in reducing the estimates as such reduction would, in the opinion of the Conference, have a most detrimental effect upon the health of expectant and nursing mothers and of children in the respective Boroughs. (b) Asking the Minister of Health to give further consideration to the estimates. (c) Asking the Minister to receive a deputation from the Conference. (d) If necessary M.P.'sfor the Boroughs represented to be asked to raise the matter in the House of Commons. The resolutions were also adopted by the Borough Council and forwarded to the Ministry of Health. In acknowledging these resolutions the Ministry stated that it was for the Council to decide whether they will adopt the suggestions as to procedure contained in the Minister's previous letter "so long as it was understood that the net expenditure during the present financial year on which grant will be payable will not exceed £2,800." A similar letter was received by the Conference with an additional paragraph pointing out ' 'that in cases in which relief is being given by a 151 Board of Guardians, it is for the Guardians, on the advice of their Medical Officer, to decide whether any special need is present, and, if so, to take account of that need in determining the amount and form of relief to be given.'' A deputation from the Conference interviewed the Minister of Health on 24th July, when he intimated that he was not prepared to withdraw the Circular in dispute or to increase the amount of the grant in question. As the local scale had been in operation since November, 1922, when the cost of living figure was 85, the Maternity and Child Welfare Committee and General Purposes Committee considered an adjustment of the scale. After consideration, the Council resolved that the scale be revised on the basis of a cost of living figure of 65 with the proviso "that any cases hitherto supplied with milk in which milk would be discontinued under the new scale, be individually considered by the Maternity and Child Welfare Committee, with power to grant milk in cases of particular hardship.'' Upon the suggestion of the Medical Officer of Health the Maternity and Child Welfare Committee agreed that these special cases should be reported upon by the Health Visitors, and the Maternity and Child Welfare Committee in November appointed a Sub-Committee, with power to grant milk, subject to confirmation by the full Committee. The Committee agreed that reports upon the cases by the Clinic Medical Officers would be of great assistance in helping them in their decisions. This Sub-Committee first met on 26th November, and up to the end of the year had considered 44 applications respecting 63 individuals. Milk was granted to 49 individuals of whom 27 were recommended by Clinic Medical Officers. West Ferry Road Distributing Centre.—In September the Maternity and Child Welfare Committee agreed to discontinue the special distributing session at West Ferry Road. The greatest number of applicants dealt with was 8 and the Committee agreed that the recipients should attend the Centre when the Maternity and Child Welfare Clinic was in session. 152 During the 12 months ended 29th December, 1928, 8,449 applications for free milk were received, of which 7,772 were granted. Orders were issued for 11,639 pints of Grade "A" (Tuberculin Tested) Milk, and 40,909 pounds of dried milk, the total commitments amounting to approximately £3,090. 343 cases were investigated by the Enquiry Officer. 2 cases were reported to the Maternity and Child Welfare Committee as unsatisfactory; in one case the value of the milk supplied when the applicant was over scale was refunded, but in the second case the applicant was still under scale, but the fact that he had rendered false wages certificates was reported to his employer. Dried Milk distributed at Clinics (including the Royal College of St. Katharine) 23,191 lbs. Distributed by Office Staff 15.584 lbs. Total 38.775 lbs. The following table shows in comparative form the applications, etc. during the years 1920-28:— Year. Applications. Applications granted. Cost (approx) £ Orders issued. Cases investigated by l.O. (6). Unsatisfactory cases. Fresh. (Pints). Dried. (Lbs.). 1920 (a) V 17,095 j 873,585 3,454 1921 (e) 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 1928 8,449 7,772 3,090 11,639 40,909 343 2 NOTES.—(a) In 1920, 49 tins of condensed milk were also issued; (6) 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. 153 Nursing Homes Registration Act, 1927.—-In April, 1928, a report was submitted to the Maternity and Child Welfare Committee upon the provisions of this Act which came into operation on 1st July, 1928. Upon the recommendation of the Maternity and Child Welfare Committee the Council resolved that— "A communication be addressed to the Minister of Health, the London County Council and the Metropolitan Boroughs' Standing Joint Committee, urging on the grounds of efficiency, economy and the avoidance of overlapping, that all powers under the Act, other than the power to make by-laws, should, in London, be delegated to the Metropolitan Borough Councils, and that formal application be made to the London County Council for the delegation of powers under the Act, so far as Nursing Homes in the Borough of Poplar are concerned, to this Council.'' A reply was received from the Clerk of the London County Council stating that the London County Council had considered whether it should delegate any or all of its powers other than the power to make by-laws and the Council had come to the conclusion that "in order to secure a uniform standard throughout the County, all the powers should be exercised by the Central Authority during the initial period of the operation of the Act, and on 31st January, 1928, the Council decided not to delegate any of its powers. " A survey of the registrable nursing homes is now in progress and the Council proposes after 1st July next, when complete information as to the homes will be available, to review the whole matter." Later in the year a letter was received from the London County Council stating that as the question of delegation of various powers to the metropolitan boroughs must inevitably arise for reconsideration in the near future it was considered inadvisable now to delegate a particular portion of the public health service. 164 INDEX. Page Age Mortality 19 Altered Diagnosis Cases 100 Analyst's Report 71 Anthrax 97 Antitoxin, quantity issued 89 Area and Population 11 Artificial Sunlight Treatment 139 Bacteriological Examinations 90 Bakehouses 65 Births 11 Bye laws, etc. in force 30 Canal Boats 51 Cancer 101 Cerebro-spinal Fever 98 Cleansing of Verminous Persons, etc. 110 Clinics. M. & C.W 124 Committees Continued and Typhus Fevers 97 Cowhouses 62 Customs and Inland Revenue Acts, Certificates Death Rate amongst Infants Visited Deaths and Death Rates 12 Deaths, Classified Causes, Table 20 ,, Infantile, Table 15 Dentist's Reports 118, 146 Diarrhoea and Enteritis, Deaths Diphtheria Disinfectant, Electrolytic 104 Disinfecting Department 104 Electrolytic Disinfecting Fluid 104 Encephalitis Lethargica 98 Enteric Fever 89 Erysipelas 97 Export of Meat Poods 70 Floodings 57,60 Food, Supervision of 62 Food and Drugs Acts, etc. 75 Food Inspectors'Reports 60-08 Free Milk Scheme 149 Glanders 97 Hairdressers' Premises 50 Health, Public Education in 46 Health Visitor, Chief, Report of 129 Home Nursing 135 Houses Let in Lodgings 36 Housing Acts 97 Hydrophobia Ice Cream 64 Infantile Mortality15,16 Infectious Diseases, Table of Notifications 85 Inquests and Deaths from Violence 21 155 INDEX—(continued). Page Lady Sanitary Inspector, Report 35 Lectures on Health Subjects 46 Legal Proceedings, etc 52 Marriages 12 Maternity and Child Welfare 124 Measles 99 Meat Food Products, Certification 70 Milk (Special Designations) Order, 1923 63 Milkshops, etc. 62 Mortuary 23 Notification of Births Act 12 Notifications of Infectious Diseases, Table 85 Observation Wards 124 Offensive Trades 38 Ophthalmia Neonatorum 102, 133 Overcrowding 50 Plague 97 Pneumonia 99 Poliomyelitis, etc. 98 Poor Law Relief, etc. 25 Population 11 Public Education in Health 46 Puerperal Fever and Puerperal Pyrexia 97 Rag and Bone Dealer, Byelaws 45 Rag Flock Act 50 Rats and Mice' Destruction Act 46 Reports:— Artificial Sunlight Clinics, Medical Offioer 139 Chief Health Visitor 129 Dental Surgeon (M. & C.W.) 146 Dental Surgeon (Tuberculosis) 118 Lecturer on Health Subjects 46,89 Observation Wards, Consulting Physioian 124 Public Analyst 71 Schick Clinic, Medical Officer 88 Senior Medical Officer, Royal College of St. Katharine 147 Tuberculosis Officer 111 Rheumatism in Children 102 8anitary Inspectors'Work, Summary 34-36 Scarlet Fever 87 Schick Test 88 Schools, Inspection of 46 ,, Use of Electrolytic Fluid in 109 Slaughterer of Poultry 70 Slaughterhouses 65 Smallpox 90 Smoke Nuisances 45 Stables 37 Staff 27 Street Trading 46 Swimming Baths, Use of Electrolytic Fluid in 109 156 INDEX—(continued). Page Tables A to F (Workshops, eto.) 38-44 ,, of Deaths 13-21 ,, of Infectious Diseases 85 Tenement Buildings, Lighting of Staircases 37 Tubereulosis, Death Rate 10 „ Deaths 19, 123 ,, Officer's Report Ill ,, Regulations, Notifications, etc. 120 Typhoid Fever 89 Urinals on Licensed Premises 45 Vaccination 94 Verminous Children and Persons 109 ,, Rooms 45 Violence, Deaths from 22 Vital Statistics, Summary 10 ,, ,. Tables 13-21 Water Certificates 45 Workshops, Workplaces, etc. (Tables) 38-44 Zymotio Diseases, Death Rate 19 ,, Enteritis 134