Pop 35 Metropolitan Borough of Poplar. Annual Report FOR THE YEAR 1929 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. Councillor: C. W. Key, J.P., Mayor (ex-officio). Chairman: Cr. T. J. Blacketer, J.P., L.C.C. Vice-Chairman: Cr. J. A. Hammond. Adams, F. Harris, Mrs. A. L. Petherick, C. Ashley, J. A. Jones, J. H. Shepherd, Mrs .A.I. Blacketer, T. J., J .P. Mackay, Mrs. J. Simons, A. (L.C.C.) (Ch.) Newton, G. A. Sloman.H.W. Cressall, Mrs. N. F. Palfreman, R. Stavers, Mrs. E. Hammond, J. A. (V.Ch.) MATERNITY AND CHILD WELFARE COMMITTEE. Councillor: C. W. Key, J.P., Mayor (ex-officio). Chairman: Cr. A. R. Sargent. Vice-Chairman: Cr. Mrs. A. L. Harris. Cressall, G. J., J.P. Lambert, Mrs. E. M. Sargent, A. R. (Ch.) Cressall, Mrs. N. F. Mackay, Mrs. J. Shepherd, Mrs .A.I. Harris, Mrs. A. L. Mudge, Mrs. E. Stavers, Mrs. E. (V£h-) Tanner, C. A. Co-opted Members'. Miss E. Herbert (Roy. Coll. of St. Katharine); Mrs. J. A. March; Mrs. M. Power; Mrs. A. M. Sumner. 5 Public Health Office, Bow Road, E.3. July, 1930. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar. Mr. Mayor, Ladies and Gentlemen, I beg to submit my third Annual Report upon the Vital Statistics and Sanitary Condition of the Borough. Population.—The Registrar-General's estimate of 160,000 shows a still further reduction on the estimates of previous years. Births.—The corrected births were fewer than in 1928 and the birth rate has fallen from 19.9 in that year to 19.1 in 1929. This is the lowest birth rate recorded in the Borough. Deaths.—The death rate rose from 11.3 in 1928 to 14.0 in 1929. As the Registrar-General has noted in his quarterly report No. 321 the higher death rate "was due in a large measure to influenza and also to the high mortality from respiratory and circulatory diseases occurring during the spell of abnormally cold weather experienced throughout the country in February and early March.'' Infantile Mortality.—The infantile deaths numbered 230, giving a mortality rate of 75, as compared with 71 in 1928. The higher rate was in part due to the prevalence of respiratory diseases in the first quarter of the year, when 104 of the total of 230 deaths occurred. A table showing the deaths classified under diseases and age groups is printed on page 13. As indicated in the report of the Chief Medical Officer of the Ministry of Health the large proportion of deaths occurring in the first month of life would appear to indicate that the principal cause of neo-natal The numbers of deaths of Poplar residents in the first quarters of 1929 and preceding five years are shown below 1929. 1928. 1927. 1926. 1925. 1924. 1,024 595 694 556 583 701 6 deaths is prematurity. It would seem that the causes which give rise to premature birth are closely associated with the causes of a number of maternal deaths, and the most hopeful line of attacking these problems is by close supervision at Ante-Natal Clinics and by attending to abnormal conditions found. Maternal Mortality.—The number of women dying in, or as a consequence of, childbirth was 10, as against 8 last year, and as the number of births was less than in 1928 the maternal death rate rose to 3.3, as compared with 2.5. Infectious Disease.—Apart from Smallpox and Chickenpox, infectious disease during the year remained much the same as last year, there being, however, an increase in the number of Scarlet Fever cases. The 157 cases of Smallpox which occurred are referred to on pages 92-100. They wereallof a mild type and only 1 death occurred. Thiswas of a premature child whose mother was suffering from Smallpox. I should like to mention the measures we adopted were fairly successful in holding the disease in check until the end of the year when "missed" cases who attended social gatherings at Christmas time were the cause of a large increase in the number of cases during the early days of 1930. There were 1,084 cases of Chickenpox reported during the year, some of them being much more severe than many of the cases of mild Smallpox which occurred. It was with very great regret that we heard of the death of Dr. W. McConnell Wanklyn, the Smallpox Consultant of the London County Council, who died at his office at the County Hall on 30th April, 1929. Dr. Wanklyn was ever ready to visit Poplar at any time, and his assistance was greatly appreciated by all members of the staff who came in contact with him. During the year Measles was less prevalent than in 1928, but the number of cases of Whooping Cough increased and the death rate from this disease rose from 0.12 per thousand of the population in 1928 to 0.27. Of the 43 deaths from Whooping Cough 42 were of children under the age of 5 years. 7 Maternity and, Child Welfare.—The work of the Maternity and Child Welfare Section of the Department is dealt with fully in Section VI of this report. There, is nothing of outstanding importance to be mentioned beyond the fact that the Council's Maternity Wards at St. Andrew's Hospital were opened in September and referred to on page 160. The average number of beds occupied has been four, but for a short period there were as many as seven patients in at one time. During the time the Wards have been open 35 mothers entered the Wards and at the end of the year 58 agreements to enter the Wards had been signed. It was feared when the scheme was proposed that 12 beds were more than would be required by Council's patients and the question of future arrangements is being considered by the London County Council (who are now responsible for the administration of St. Andrew's Hospital) and the Poplar Borough Council. Public Education in Health.—The scheme for offering lectures on health subjects to social and political organisations in the Borough has continued in operation during the year. Lectures have been given at a greater number of Centres than last year and it is gratifying to find audiences are asking for definite courses of subjects. Conferences .—During the year delegates were sent to the following conferences:— (a) Royal Sanitary Institute (Sheffield). Chairman of the Public Health Committee (Councillor T. J. Blacketer, J.P., L .C .C.), and the Medical Officer of Health. (b) Sanitary Inspectors' Association (Lowestoft). Mr. F. A. Smith. (c) Smoke Conference—Greater London Joint Smoke Abatement Committee (Guildhall, London). Chairman and ViceChairman of the Public Health Committee (Councillors T.J. Blacketer, J ,P., L .C .C., and J. A. Hammond). (d) Maternity and Child Welfare (London). Miss J. M. Cardozo. Miss E. M. Davies, the Lady Sanitary Inspector, was also granted leave of absence to attend the Sanitary Inspectors' Association Conference as a representative of the Women Sanitary Inspectors' and Health Visitors' Association. 8 Staff.—As in previous years I am indebted to the members of the Public Health Committee and the Maternity and Child Welfare Committee for their support, and to the Chief Officers of other Departments for their help and co-operation. I must acknowledge, too, the assistance which I have received from Dr. W. C. P. Smith and Dr. C. K. Cullen in connection with the additional duties imposed by the prevalence of Smallpox. I also wish to place on record my appreciation of the work of the Council's staff, especially in connection with Smallpox. The question of utilising the services of the members of the Public Health Department staff for special work in times of epidemics, often to the detriment of regular work, is not a new problem and confronts local authorities from time to time. I am, Ladies and Gentlemen, Your obedient Servant, W. ALLAN YOUNG, Medical Officer of Health. 9 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 1929 160,000 Number of Inhabited Houses (Census, 1921) 23,064 Number of families or separate occupiers (Census, 1921) 37,288 Rateable Value (April, 1929) £869,481 Sum represented by a Penny Rate (April, 1929) £3,405 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. SUMMARY OF VITAL STATISTICS. Total M. F. Births Legitimate 3,000 1,496 1.504 Birth Rate 19.1 Illegitimate 64 31 33 Totals 3,064 1,527 ,.537 Total M. F. Deaths 2,266 1,187 1,079 Death Rate 14.2 Number of women dying in, or in consequence of, | from sepsis 4 childbirth from other causes 6 Maternal Death Rate 3.3 Infantile Mortality Rate, 75. (Legitimate, 74. Illegitimate, 156.) Deaths from Measles (all ages) 11 ,, Whooping Cough (all ages) 43 ,, Diarrhoea and Enteritis (under 2 years of age) 38 10 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 160,000. This estimated population is 2,000 less than the estimate for the year 1928 and adversely affects the death rates which are calculated upon the reduced estimate. The population of 160,000 gives a density figure of 75 persons per acre. BIRTHS. Early in the year 1930, the Registrar-General supplied the following information relating to Births registered in the year 1929:— Registered Inward Transfers. Outward Transfers. Nett. Total Births Males 1,253 287 13 1.527 3,064 Females 1,260 296 19 I.537 Illegitimate Males 26 5 3l 64 Females 30 7 4 33 The corrected birth rate per 1,000 population was 19.1, as against 22.9, 22.7, 21.6 19.8 and 19.9, for the years 1924-1928. During the year, 2,623 notifications were received under the Notification of Births Act, 1907. MARRIAGES. During the year the marriages of 2,856 persons were registered, giving a rate of 17.8, as against 15.3, 16.2, 15.8, 17.5 and 17.8, in the five years 1924-1928. DEATHS. 2,245 deaths were registered as having occurred in the Borough. 308 deaths of non-residents must be deducted, and 329 deaths of Poplar residents which occurred outside the Borough must be added, giving a net total of 2,266 and a rate of 14.2 per 1,000 of the estimated population. The natural increase of population represented by excess of births over deaths was 798. 11 Deaths during 1929 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 242 78 6l 79 460 Bow and Bromley Sub-District 209 63 40 73 385 St. Andrew's Hospital 350 l6l 138 174 823 Poplar Institution 98 44 36 47 225 Bow Institution 77 33 30 37 177 Bromley House Institution 2 — — 1 3 Poplar Hospital 35 20 25 28 108 Guardians Offices 1 — — — 1 Langley House 1 — i — 2 Adelaide Buildings 1 — — — 1 Baffin ,, — — — — — Council ,, — — — — — Grosvenor ,, 3 2 1 1 7 Hanbury ,, — — — — — Hudson ,, — — — — — Melbourne ,, — 1 i — 2 Montreal ,, — — i — 1 Ontario ,, — — — — — Ottawa ,, — — — — — Prestage ,, 1 — — — 1 Quebec ,, 1 — — 1 2 Sydney „ — — — — — Toronto ,, 1 — — — 1 Wellington ,, — — — — — Winnipeg ,, — — I — 1 River Thames 1 2 — 5 8 ,, Lee 2 1 I — 4 Limehouse Cut — 1 — 1 2 Bow Creek — — — — — Regents Canal — — — — — East India Docks 1 3 — — 4 West India Docks — — i — 1 South-West India Docks 1 — — 1 2 Millwall Docks — — — — — Highways 5 5 8 4 22 London Graving Dock 1 — — — 1 District Railway — 1 — — 1 1033 415 345 452 2245 Deaths occurring outside the Borough of persons belonging thereto (add) hi 82 59 77 329 Deaths occurring within the Borough of persons not belonging thereto (deduct) 120 61 56 7 308 Deaths at all ages—nett 1024 436 348 | 458 2266 12 TABLE I. Vital Statistics during 1929 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 i registered in the j Borough. U nder 1 Year cf Age. At all Ages. Number. Rate. Number." Rate. Number.* Rate per 1000 Nett Births. Number. * Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1924 167,300 3(12 3831 22.9 2122 12.7 442 343 277 72 2023 12.1 1925 168,500 3387 3831 22.7 1973 11.7 311 308 288 75 1970 11.7 1926 189,000 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 162.00? 2727 3228 19.9 1838 11.3 260 331 230 71 1909 11.8 1929 160,000 2513 ' 3064 19.1 2245 14. 0 308 329 230 75 2266 14.2 Notes.—This Table is arranged to show the gross births and deaths in the borough and the births and deaths properly belonging to it with the corresponding rates. The rates are calculated per 1000 of the estimated gross population. * In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the borough, but excluding the deaths of soldiers and sailors that have occurred in hospitals and institutions in the district. In Column 12 are entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. t "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence—e.g., casuals. are not included in Columns 8 or 9, except in certain instances under 3 (b) below. The following special cases arise as to Transferable Deaths— (1) Persons dying in institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses and nursing homes (but not almshouses) must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first institution. (2) The deaths of infants born and dying within a year of birth at any temporary address to which the mother went for her confinement should be referred to the district of fixed or usual residence of the mother. (3) Deaths from violence are referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known; and (d) failing this, to the district where the body was found. Area of District in 1 Total population at all ages 162,618^ At acres (land and 2327.7 Number of inhabited houses 23,064 I Census inland water) Average number of persons per house 7'05 I of 1921. Total families or separate ocoupiers 37,288; TABLE II. The Borough. Causes of, and Ages at, Death durinq the Year 1929. Causes ot Death. 1 Total Deaths. Sex. Nett Death* 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 Death in Publi Institu tion*, etc. All Ages. Under 1 year. 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 yeara. 35 to 44 years. 45 to 54 years. 55 to 64 years. 65 to 74 years. 75 years and over. Poplar. Bow and Bromley. Poplar Institution. St. Andrew's Hospital Bow Institution. Bromley House Institution. Poplar Hospital. See Footnotes. Outlying Institutions,etc. 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 All camcs Certified 2266 2266 230 101 62 393 49 26 52 46 112 119 213 341 439 478 1110 1076 217 603 1 .. 37 21 329 1408 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Enteric Fever 1 M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 F 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 2 Pmallpox 1 M I 1 .. .. 1 .. .. .. .. .. .. .. .. .... .. .. 1 .. .. .. .. .. .. 1 1 F .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Measles 11 M 4 .. 2 2 4 .. .. .. .. .. .. .. .. .. .. 7 4 .. .. .. .. .. .. 6 6 P 7 1 5 .. 6 1 .. .. .. .. .. .. .. .. .. .. 4 Scarlet Fever 4 M 3 .. .. 1 1 .. .. 1 .. 1 .. .. .. .. .. 3 1 .. .. .. .. .. .. 3 3 F 1 .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 5 Whooping Cough 43 M 23 4 16 3 23 .. .. .. .. .. .. .. .. .. .. 20 23 .. 3 .. .. .. .. 19 22 F 20 6 10 3 19 1 .. .. .. .. .. .. .. .. .. 6 Diphtheria 17 M 7 .. 1 2 3 2 2 .. .. .. .. .. .. .. .. 11 6 .. 3 .. .. 1 .. 13 17 F 10 1 1 3 5 4 .. .. 1 .. .. .. .. .. .. 7 Influenza 71 M 37 4 5 .. 9 .. 1 1 1 .. 4 7 5 4 5 44 27 4 7 .. .. .. .. 5 16 F 34 .. 2 1 3 .. .. 1 .. 2 1 3 8 9 7 8 Encephalitis letharglca 6 M 5 .. .. .. .. 1 .. .. .. 2 .. 1 1 .. .. 2 4 1 2 .. .. .. .. 2 5 F 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 9 Meningococcal Meningitis .. M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10 Tuberculosis of respiratory system 169 M 79 .. 1 .. 1 1 1 2 9 17 16 20 7 5 .. 93 76 11 50 .. .. .. 1 39 101 F 90 .. .. .. .. .. 3 13 14 23 17 11 6 2 1 (a) 11 Other Tuberculous Diseases 25 M 16 2 2 3 7 2 .. 1 1 1 .. 1 2 1 .. 11 14 .. 13 .. .. .. .. 7 20 F 9 1 .. .. 1 .. 1 2 1 .. 1 .. 3 .. .. 12 Cancer, Maiignnnt disease 210 M 114 .. .. .. .. .. .. 1 .. 2 1 18 42 32 18 112 98 12 83 .. .. 1 .. 28 124 F 96 .. .. .. .. .. .. .. 1 .. 5 21 20 27 22 18 Rheumatic Fever 19 M 10 .. .. .. .. 2 2 1 .. .. 3 .. 2 .. .. 9 10 .. 14 .. .. .. .. 1 15 F 9 .. .. .. .. 1 2 3 1 .. 1 1 .. .. .. 1 14 Diabetes 16 M 8 .. .. .. .. .. .. .. .. .. .. 1 1 5 1 7 9 1 9 .. .. .. .. 2 12 K 8 .. .. .. .. .. .. .. .. .. .. 2 4 .. 2 15 Cerebral haemorrhage, etc. 42 M 19 .. .. .. .. 1 .. .. .. .. .. 3 1 8 6 24 18 3 14 .. .. .. .. 4 21 F 23 .. .. .. .. .. .. 1 .. .. 1 1 4 3 13 16 Heart Disease 377 M 158 .. 1 1 2 4 .. 1 1 4 5 10 30 54 47 235 F 219 .. .. .. .. .. 2 3 .. 11 4 16 50 68 65 191 186 59 1 50 1 .. 5 3 17 235 17 Arterlo-sclerosls 181 M 95 .. .. .. .. .. .. .. .. .. .. 4 19 31 41 (b) F 86 .. .. .. .. .. .. .. .. .. .. 4 6 28 48 106 75 64 29 .. .. .. 2 20 115 18 Bronchitis 195 M 115 6 1 .. 7 .. .. .. .. .. 3 16 24 27 38 (c) F 80 4 .. 1 5 .. .. .. .. .. 1 4 6 22 42 90 105 24 48 .. .. .. .. 8 80 19 Pneumonia (all forms) 281 m 166 36 21 13 70 5 1 1 2 8 16 17 20 16 10 1 V 115 22 22 16 60 2 2 .. 1 1 5 5 9 18 12 144 137 4 125 .. .. 3 21 154 20 Other Respiratory Diseases 22 M 12 .. 1 .. 1 1 .. .. 1 1 3 2 1 2 .. (d) F 10 .. 1 .. 1 .. .. .. .. 1 1 .. .. 3 3 14 8 2 6 .. .. 1 .. 5 14 21 Ulcer of Stomach or Duodenum 23 M 17 .. .. .. .. .. .. 1 .. 2 1 3 5 3 2 V 6 .. .. .. .. .. .. .. .. .. 1 .. 2 2 l 10 13 .. 15 .. .. 1 .. 6 22 22 Diarrhoea, etc. 44 M 22 20 .. .. 20 .. .. .. .. 1 .. .. 1 .. .. F 22 14 4 .. 18 2 .. 1 .. 1 .. .. .. .. .. 22 22 27 .. .. 1 .. 10 38 23 Appendicitis and Typhlitis 15 M 7 .. .. .. .. 2 1 .. .. .. 1 .. 1 1 1 F 8 .. .. 1 1 .. .. 1 1 1 .. 2 1 1 .. 9 6 10 .. .. 2 .. 3 15 24 Cirrhosis of Liver 11 M 7 .. .. .. .. .. .. .. .. .. .. 1 3 3 .. F 4 .. .. .. .. .. .. .. .. 1 1 1 1 .. .. 5 6 8 .. .. .. .. 1 9 25 Acute and Chronic Nephritis 55 M 29 .. .. .. .. .. .. 1 2 1 4 1 6 7 6 F 27 .. .. .. .. .. .. 2 1 1 .. 3 3 11 6 32 23 24 .. .. 1 .. 9 38 26 Puerperal Sepsis 4 M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. F 4 .. .. .. .. .. .. .. 1 2 1 .. .. .. .. 1 3 3 .. .. .. .. 1 4 27 Other accidents and diseases of pregnancv and parturition 6 M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. F 6 .. .. .. .. .. .. 1 .. 4 1 .. .. .. .. 5 1 4 .. .. .. .. 2 6 28 Congenital Debility and malformation, premature birth 82 M 39 38 1 .. 39 .. .. .. .. .. .. .. .. .. .. .. F 43 41 .. 1 42 .. .. 1 .. .. .. .. .. .. .. 45 37 5 24 .. .. .. .. 13 42 29 Suicide 11 M 10 .. .. .. .. .. .. .. .. 1 2, 3 3 1 .. F 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. 8 3 1 .. .. 2 3 4 10 30 Other Deaths from Violence 81 M 56 .. 1 4 5 8 4 4 1 5 3 4 9 7 6 (e) F 25 .. .. 2 2 2 1 2 .. .. .. 3 .. 1 14 42 39 33 .. .. 10 11 19 77 31 Other Defined Diseases 243 M 129 18 1 2 21 4 1 3 1 8 10 17 21 20 23 (f) F 114 11 2 2 15 3 2 3 4 9 6 6 14 16 36 123 120 98 .. .. 9 .. 59 185 32 Causes lll-dcflrif-d or unknown .. M .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deaths from All Caubks M 1187 129 54 31 214 33 13 18 19 54 72 129 204 227 204 F 1079 101 47 31 179 16 13 34 27 58 47 84 137 212 272 Totals 2266 .. 2266 230 101 62 393 49 20 52 46 112 119 213 341 439 476 1190 1076 217 803 1 .. 37 21 329 1408 (a) Highway, 1. (b) Guardians Offices 1; Langley House 1 ; Highway 1. (c) Highway, 1; Victoria Park i. (d) Highway, 1. (e) River Thames, 1 ; Limehouse Cut, 1; Highway, 1. (f) Highways, 6 ; River Thamee, 1, River Lee, 1 ; Limehouse Cut, 1 ; East India Dock. 1; South West India Dock 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 1185 129 54 32 45 37 125 335 228 200 F 1082 102 47 30 29 61 106 222 218 267 1 Enteric fever M — — — — — — — — — F 1 — — 1 _ 2 Smallpox M 1 1 — — — — — — — — F — — — — — — — — — — 3 Measles M 4 — 2 2 — — — — — — F 8 1 5 1 1 — — — — — 4 Scarlet fever M 3 1 1 1 — F — — — — — — — — — — 6 Whooping cough M 23 4 16 3 — — — — — — F 20 6 10 3 1 — — — — — 6 Diphtheria M 6 — 1 2 3 — — — — — F 10 1 1 3 4 1 — — — — 7 Influenza M 37 4 5 — 1 2 4 12 4 — F 34 — 2 1 — 1 3 11 10 6 8 Encephalitis lethargica M 5 — — — 1 — 2 2 — — F — — — — — — — — — — 9 Meningococcal meningitis M — — — — — — — — — F — — — — — — — — — 10 Tuberculosis of respiratory system M 79 — 1 — 2 10 33 28 5 — F 88 — — 3 25 41 17 1 1 11 Other tuberculous diseases M 18 2 2 3 2 3 2 3 1 — F 11 1 — — 1 5 1 3 — — 12 Cancer, malignant disease M 117 — — — — 1 3 61 33 19 F 100 — — — — 1 5 41 29 24 13 Rheumatic fever M 7 — — — 2 1 2 2 — — F 6 — — — 1 3 1 1 — — 14 Diabetes M 8 — — — — — — 2 5 1 F 8 — — — — — — 6 — 2 15 Cerebral haemorrhage, etc. M 20 — — — 1 — — 5 8 6 F 26 — — — — 1 1 6 5 13 16 Heart disease M 192 — — 1 6 1 15 47 62 60 F 266 — — — 3 5 15 71 85 87 17 Arterio-sclerosis M 64 — — — — — — 16 21 27 F 55 — — — — — — 6 17 32 18 Bronchitis M 119 6 1 — 1 6 39 29 37 F 79 5 — 1 1 — 1 9 24 38 19 Pneumonia (all forms) M 166 36 23 14 6 3 22 36 16 10 F 118 25 23 16 4 2 7 14 17 10 20 Other respiratory diseases M 15 — 1 — 1 2 3 5 1 2 F 15 — — — — — 3 1 4 1 21 Ulcer of stomach or duodenum M 18 — — — — 1 4 8 3 2 F 4 — — — — — — 3 1 — 22 Diarrhoea, etc. M 24 21 1 — — — 1 1 — — F 18 11 4 — 1 1 1 — — — 23 Appendicitis and typhlitis M 6 — — 2 — 1 1 2 — F 9 — — 1 — 2 1 4 1 — 24 Cirrhosis of liver M 9 — — — — — — 5 4 — F 6 — — — 1 — 2 2 1 — 25 Acute and ohronic nephritis M 22 — — — — 3 2 8 5 4 F 18 — — — — 2 1 4 8 3 26 Puerperal sepsis M — — — — — — — — — — F 4 — — — — 1 3 — — 27 Other accidents and diseases of pregnancy & parturition M — — — — — — — — — — F 6 — — — — 1 6 — — — 28 Congenital debility and malformation, premature birth M 38 38 — — — — — — — - F 44 43 — — — 1 — — — — 29 Suicide M 10 — — — — — 3 6 1 — F 1 — — — — — — 1 — — 30 Other deaths from violence M 51 — 1 3 11 5 6 12 7 6 F 22 — — 2 2 1 — 3 1 13 31 Other defined diseases M 122 17 — 3 7 3 15 35 21 21 F 105 9 2 2 6 8 14 19 14 31 32 Causes ill-defined or unknown M 1 — — — — — 1 — — F — — — — — — — — — — Deaths under 1 year . M Legit. lllegit. 121 8 F. 100 2 Totals 221 10 13 TABLE III. Infantile Mortality during the Year 1929. ftett 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 62 15 8 7 92 34 35 34 35 119 111 230 — — — — — — — — — — — — Uncertified — — — — — — — — — — — — Smallpox — — — — — 1 — — — — 1 1 Chickenpox — — — — — — — — — — — — Measles — — — — — — — — 1 1 — 1 Scarlet Fever — — — — — — — — — — — — Whooping Cough 1 1 3 2 4 3 7 10 Diphtheria and Croup — — — — — — — — 1 — 1 1 Erysipelas — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — 1 1 1 1 2 Abdominal Tuberculosis .. — — — — — — — — — — — — Other Tuberculous — — — — — — — — 1 1 — 1 Meningitis (not Tuberculous) — — — — — — — 1 — 1 — 1 Convulsions 1 — 1 1 3 1 — — 1 3 4 Laryngitis — — — — — — — — — — — — Bronchitis 1 1 4 2 3 — 9 8 10 Pneumonia (all forms) — — 1 — 1 10 16 12 20 36 23 59 Diarrhoea — — 1 1 2 4 6 5 1 8 10 18 Enteritis — — 1 — 1 5 3 6 I 10 6 16 — — — — — — — — — — — — Syphilis 1 — — — 1 1 — 2 2 — — — — — — — — 1 1 1 Suffocation, overlying — — — — — — — — — — — — Injury at birth 4 — — — 4 — 2 2 4 Atelectasis 4 3 — — 7 3 4 7 Congenital Malformations 8 7 — 2 17 — — — — 8 11 19 Premature birth 41 3 2 2 48 3 31 20 51 Atrophy, Debility and Marasmus 2 1 1 4 3 1 3 5 8 Other Causes 1 1 — — 2 3 1 4 4 5 9 14 Total Deaths 62 15 8 7 92 34 35 34 35 119 111 230 Nett Births I Legitimate 3,000* Nett Deaths J Legitimate 220 in the year Illegitimate 64* in the year (.Illegitimate 10* *Registrar-General's figures. 14 INFANT MORTALITY. There were 230 deaths of children under one year of age, the death rate per 1,000 births for the past 22 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 I913 113 (83) 105 1914 117 (117) 104 1915 134 (98) 112 1916 104 (78) 89 1917 95 (79) 103 1918 107 (68) 107 1919 83 (69) 85 1920 81 (48) 75 1921 83 (66) 80 1922 79 (38) 74 1923 60 (44) 60 1924 72 (38) 69 1925 75 (50) 67 1926 70 (39) 64 1927 66 (42) 59 1928 71 (49) 67 1929 75 Note.—The figures in brackets are the mortality rates amongst infants visited by the Health Visitors. 15 TABLE IV. Bibth.bate, Death.bate, and Analysis of Mortality Dubinq the Yeab 1929. Bibthrate per 1,000 Total Population. Annual Death.rate peb 1,000 Population. Rate peb 1,000 Births. Percentage of Total Deaths. All Causes. Enterio Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea 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 Walesf 16.3 0.68 13.4 0.01 0.00 0.08 0.02 0.15 0.08 0.74 0.55 8.1 74 91.5 6.1 1.5 0.9 107 County Boroughs and Great Towns, including Londonf 16.6 0.69 13.7 0.01 0.00 0.12 0.02 0.19 0.09 0.76 0.50 109 79 91.8 5.8 1.9 0.5 157 Smaller Towns (adjusted Populations 20,000.50,000) † 16.0 071 12.3 0.01 0.00 0.06 0.02 0.15 0.07 0.71 0.45 5.9 69 92.6 5.4 1.0 1.3 London† 15.7 0.53 13.8 0.01 0.00 0.04 0.02 0.26 0.08 0.69 0.56 10.7 70 89.5 6.8 3.7 0.0 Poplar Borough * 19.1 0.62 14.2 0.01 001 0.07 0.02 0.27 0.11 0.44 0.57 12.4 75 83.1 13.3 3.6 0.0 †Note by Registrar.General. Provisional Figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1929, but those for the towns have been calculated on populations estimated to the middle of 1928. (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). * Kates for Poplar have been calculated on a population estimated to the middle of 1929. 16 TABLE V. (1929). Cities and Bokouohs. Estimated population to the middle of year. Births. Annual rate per 1,000 persons living. Death. rate per 1,000 living. Deaths of Infants under one year to 1,000 births. LONDON 4,417,900 15.7 13.8 70 West Districts. Paddington 142,800 14.9 15.4 101 Kensington 175,800 14.4 15 4 84 Hammersmith 136,900 15.8 13.7 62 Fulham 153,700 15.2 13.4 72 Chelsea 62,680 11.7 15.7 70 City of Westminster 125,800 10.4 14.8 77 North Districts. St. Marylebone 102,400 11.9 13.2 77 Hampstead 84.830 11.4 13.5 54 St. Pancras 203,900 15.5 15.3 83 Islington 319,800 17.2 14.8 73 Stoke Newington 50,040 161 13.4 47 Haokney 214,400 15.9 13.9 56 Central Districts Holborn 38,380 10.2 15.6 74 Finsbury 70,980 21.2 16.0 75 City of London 10,700 7.4 14.0 62 East Districts. Shoreditch 99,710 20.6 16.0 88 Bethnal Green 110,500 18.4 13.3 64 Stepney 241,800 17.2 13.6 89 Poplar 160,000 19 1 14 2 75 South Districts. Southwark 178,500 18.1 15.6 81 Bermondsey 113,800 19.8 14.5 71 Lambeth 294,400 15.6 14.9 67 Battersea 161,800 16.2 14.2 62 Wandsworth 346,700 13.0 12.8 61 Camberwell 256,900 15.3 13.6 68 Deptford 111,000 16.8 13.3 76 Greenwich 99,900 15.8 13.3 70 Lewisham 207,900 15.7 11.5 44 Woolwich 141,600 16.3 12.6 62 17 (These summaries are inserted for comparison with those shorvn in previous reports.) 1924. 1925. 1926. 1927. 1928. 1929. Deaths from all oauses, rate per 1,000 population 12.1 11.7 11.4 11.8 11.8 14.2 Deaths under 1 year of age, rate per 1,000 nett births 72 75 70 66 71 75 Deaths over 65 years of age, rate per 1,000 total population .. 3 .9 4.1 3.9 4.2 4.2 5.7 *Zymotic diseases:— Death rate per 1,000 population 0.8 0 9 0.9 0.6 0.6 0.8 Proportion of 1,000 deaths 65.7 75.6 75.2 51.6 55.5 53.4 Tuberculosis, all forms:— Death rate per 1,000 population 1.2 1.1 1.0 1.1 1.1 1.2 Proportion of 1,000 deaths 97.9 96.9 84.0 96.0 93.2 85.6 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 3.2 2.9 2.4 2.0 1.9 3.1 Proportion of 1,000 deaths 265.4 246.2 207.9 172.4 162 4 219.8 Deaths from Various Diseases. Disease. 1924. 1925. 1926. 1927. 1928. 1929. Measles 37 27 39 8 56 11 Whooping.Cough 39 60 9 34 19 43 Influenza 48 20 23 36 24 71 Pneumonia (except Influenzal Pneumonia) 230 185 154 188 177 281 Diarrhoea and Enteritis (all ages) 30 54 69 39 47 44 'Smallpox, Measles, Scarlet Fever, Whooping.Cough, Diphtheria and Mem. Croup, Typhoid Fever and Diarrheal Diseases. 18 TABLE VI. Total Deaths (at all ages) in Public Institutions within the Borough. (Residents and Non-Residents included.) Causes of Death. Poplar Institution, St. Andrew's Hospital. Bow Institution. Bromley House Institution. Poplar Hospital. Total deaths in Public Institutions within the Borough. Certified 225 823 178 3 108 1337 All causes Uncertified – – – – – – 1. Enteric Fever – – – – – – 2. Smallpox – – – – – – 3. Measles – – – – – – 4. Scarlet Fever – – – – – – 5. Whooping Cough — 3 – – – 3 6. Diphtheria — 3 — – 1 4 7. Influenza 5 7 – 1 13 8. Encephalitis Lethargica 1 2 1 – — 4 9. Meningococcal Meningitis — 1 – – 1 2 10. Tuberculosis of respiratory system 12 50 2 1 65 11. Other Tuberoulous Diseases – 14 1 – 2 17 12. Cancer, malignant disease 12 85 5 – 5 107 13. Rheumatic Fever — 14 1 – 1 16 14. Diabetes 1 9 3 – – 13 15. Cerebral hæmorrhage, etc. 3 14 — – — 17 16. Heart Disease 61 152 70 1 7 291 17. Arterio-sclerosig 64 29 32 1 3 129 18. Bronchitis 26 48 — – — 74 19. Pneumonia (all forms) 4 129 7 – 10 150 20. Other Respiratory Diseases 2 6 1 – 1 10 21. Ulcer of Stomach or Duodenum 15 2 17 22. Diarrhœa, etc. — 29 – 5 34 23. Appendicitis and Typhlitis – 10 – – 3 13 24. Cirrhosis of Liver – 8 – — 8 25. Acute and Chronic Nephritis 4 24 36 – 1 05 26. Puerperal Sepsis — 3 — – — 3 27. Other accidents and diseases of pregnancy and parturition – 4 – – – 4 28. Congenital Debility and malformation, premature birth 5 24 – – 1 30 29. Suicide 1 – – 3 4 30. Other Deaths from Violence 5 38 2 – 38 83 31. Other Defined Diseases 20 101 16 – 23 160 32. Causes ill-defined or unknown 1 – – 1 All Causes Males 132 446 128 2 78 786 Females 93 377 50 1 30 551 Totals 225 823 178 3 108 1337 19 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". 1929. Jan. 26. St. Andrew's Hospital, of no fixed abode. Male, 64. Malignant cachexia. Endothelioma of carotid body. P.M. Inquest. Natural causes. Feb. 18. Poplar Institution, of no fixed abode Male, 52. Chronic bronchitis. Bronchiectasis. P.M. Inquest. Natural causes. May 10 River Thames, off Aberdeen Wharf Male, 50 (unknown) Asphyxia due to drowning. Suicide, but not sufficient evidence to show state of mind at the time. P.M. Inquest. ,, 8 St. Andrew's Hospital, of no fixed abode Male, 63 Haemorrhage from gastric ulcer. „ 17 Bow Institution, of unknown address Female, 74 Myocardial degeneration. Bronchitis. ,, 30 Poplar Hospital, of no fixed abode Female, 54 Oxalic acid poisoning. Suicide while of unsound mind. P.M. Inqueat. Aug. 8 St. Andrew's Hospital, of no fixed abode Male, 68 Cardiac failure. Mitral stenosis and myocardial degeneration following coronary atheroma. P.M. Inquest. Natural causes. Nov. 2 St. Andrew's Hospital, of no fixed abode Male, 45 (unknown) Pulmonary tuberculosis. Osteoma of vertebra. Selfneglect and exposure. P.M. Inquest. Natural causes. ,, 17 River Thames, off Locks Wharf. Seaman of Dalhousie, Canada Male, 25 Asphyxia due to drowning. Fell from gangway of ship into river. Accidental cause. P.M. Inquest. INQUESTS AND DEATHS FROM VIOLENCE. The number of inquests registered was 360. From this total must be deducted 89 of non-residents, and 30 added of residents who died outside the Borough, the nett total being 301. Analysis of the 92 deaths classified to Suicide and other deaths from Violence (International Short List Headings Nos. 29 and 30):— 20 Suicide 11 Food poisoning — Poisoning by venomous animals 1 Other acute accidental poisonings (not by gas) — Conflagration — Accidental burns (conflagrations excepted) 2 Accidental mechanical suffocation — Accidental absorption of irrespirable or poisonous gas — Accidental drowning 7 Accidental injury: By firearms — By cutting or piercing instruments — By fall 32 In mining and quarrying — By machinery 3 By other forms of crushing: Road vehicles 25 Railways 1 Other crushing accidents 4 Injury by animals (poisoning by venomous animals excepted) – Wounds of war 2 Execution of civilians by belligerent armies — Hunger or thirst — Excessive cold — Excessive heat — Lightning — Electricity (lightning excepted) — Homicide: By firearms — By cutting or piercing instruments — By other means — Infanticide — Fracture (cause not specified) — Other and unstated forms of accidental violence 3 Violent deaths of unstated nature (i.e., accidental, suicidal, etc.) and cause 1 92 For death rates from violence, and the percentage of inquest cases to total deaths, see Table IV. 21 MORTUARY. The number of bodies deposited in the Mortuary, Cottage Street Poplar, during the year was 460:— Residents. Non-Residents.* No age stated 1 1 Stillborn 2 1 Under 1 year 23 5 1 to 5 years 27 3 5 to 15 years 33 2 15 to 25 years 26 3 25 to 65 years 187 20 65 years and upwards 111 15 Totals 410 50 *Brought from outside the Borough for the convenience of the Coroner. Inquests were held on 386, and 65 post-mortems were made by order of the Coroner. The total number of post-mortems made was 134. Nine 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. 22 Maternity. Nil. (See reference to the provision of maternity beds in St. Andrew's Hospital on page 160). 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 145). 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. 23 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. 1929 „ 804,745 £318,222 18s. 8½d. 1,402 24 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, 1929, the total days maintenance for the year amounted to 180,988 days, giving an average daily number of 495. 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, 1929, are as follows:— Sick Wards, Poplar Institution 203 Maternity Wards, All Saints' Annexe, to July, 1929 36 On 8th July, 1929, the Maternity Department was transferred from Poplar Institution to St. Andrew's Hospital and the number of days maintenance from that date to the 31st December, 1929, was 916 for the Maternity Wards. The number of entries in the District Medical Officers' Registers of cases for medical treatment for the year ended 31st December, 1929, are as follows:— Poplar Districts. District Medical Officer. Medical District. Number of Entries. Dr. J. H. O 'Brien West 2,005 Dr. M. J. Byrne East 1.795 Dr. C. F. White Middle 1,869 St. Andrew's Hospital Part Bromley 1.337 Dr. W.C.Millea South 1,325 Dr. M. J. Hallissey S. Central 2,544 Bow Districts. Dr- C. Phelps Old Ford West 2,105 Dr. D. G. McRae Bow 2,390 St. Andrew's Hospital Old Ford East and part Bromley 3,237 25 STAFF. Medical Officer of Health : W. ALLAN YOUNG, D.S.O., M.D. (Edin.), D.P.H. (Camb.) Assistant Medical Officer of Health and Tuberculosis Officer: W. C. P. Smith, B.A. (Camb.), M.R.C.S., L.R.C.P., D.P.H. (Camb.). Assistant Medical Officer of Health and 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) J. Johnson.*§ (a) C. H. Bkown.*†‡§ (a) H. J. Lanqley.* C. S. Westbbook*‡ Commenced 11th March, (a) Wm, Johnson.*‡{ (a) A. J. Field.† (a) F. A. Smith.*‡ Miss M. E. Davies.* (a) H. W. Leonard.*‡ (b) C. A. Grabham.*‡ (b) H. A. PEARCE.*†§‡ (c) S. Kelly* (a) District Inspectors. (b) Food Inspectors. (c) Inspector for Houses divided into separate tenements. J. Chapman, A. Collyer, W. Cue, C. F. Gregory, G. A. Hale (retired), F. E. Quested (retired). E. Willson E. Saphier (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.†† E. W. Garratt. (from 19.8.29) H. A. Purdy. D. Evans (transferred) Miss S. Fells. J. T. Donovan (from 14.1.29). Mrs. E. Lono. D. Flynn (Office Boy). F. Petts (from 2.4.29). Caretaker and Messenger: C. E. Richardson *Cert. S.I.E. Board, and Food Inspector. † Cert R.S.I. †† Cert. §R.P.C. C.M.B. K.S.I. & S.I.E.J.B. ‡ Cert. Meat H.V. Cert. (Board of Education). 26 TUBERCULOSIS SECTION. Assistant Medical Officer of Health and Tuberculosis Officer: W. C. P. Smith. Assistant Medical Officer of Health and Assistant Tuberculosis Officer: C. K. Cullen. Dental Surgeon (part-time): C. Hammond Williams, L.D.S., R.C.S. Health Visitors: Miss H. Messem. Miss D. Wood.‡ Miss N. Roberts.** Dispenser: Mrs. A.M. Smith. Clerks: Miss A. D. Frost. Miss A. Rogers Secretary to Care Committee: Miss L. Nugent. Nurse-Helper: Caretaker: Mrs. E. Tomlins (temporary). J. Tyler (retired). W. J. Parker (from 7th September). DISINFECTING STATION, YEO STREET. Disinfectors: W. Hodge‡ (Chief). A. Barrows. 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). ‡ San. Insp. Cert. R.S.I. ** H.V. Cert. R.S.I. 27 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. FosKETr.* Mrs. M. J. Edqell.§ Miss M. Mallbtt.* Mrs. E. K. Haythornthwaite.* Miss G. E. PAICE.*†‡ Miss A. Eaton* Sister-in-Charge Artificial Light Treatment. (a)Miss D. A. E. Landray.*† (e) Miss E. A. H. Wilt.iams* (c) Miss E. M. Craigie.* Clerk: Miss k. D. Evans. 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 L. Green* (resigned). Miss. J. Boone (from September). 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. Investigation and Enquiry Officer (part-time): C. A. Webster * C.M.B. † Cert. S.I.E.B. § Cert. Mid. Colonial Medical Association. 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. 28 The general increase in the work of the Department, both normal and that occasioned by the presence of Smallpox, has necessitated the appointment of additional staff during the year. Public Health.—Mr. C. S. Westbrook commenced duty as Temporary Sanitary Inspector on the nth March. His appointment was made permanent during the latter part of the year, consequent upon the reorganisation due to the impending retirement of Mr. Field early in 1930. Mr. F. Petts commenced duty as additional clerk on the 2nd April. Mr. J. T. Donovan, temporary clerk for infectious diseases, and relief caretaker, commenced duty on the 14th January. This appointment was occasioned by the additional work on account of Smallpox, also owing to the fact that the Caretaker of the Public Health Office was working seven days a week. Mr. S. B. Leader was appointed additional clerk during the latter part of the year, and commenced duty early in 1930. In addition the following changes in the personnel of the Department have taken place during the year. Mr. E. W. Garrett commenced duty as clerk on the 19th August, vice Mr. Evans transferred to Finance Department. Mr. J. Tyler (Caretaker, Tuberculosis Dispensary) retired in September and was succeeded by Mr. W. J. Parker. Maternity and. Child Welfare (Observation Wards).—Miss J. Boone was promoted from Staff Nurse to Sister in September, vice Miss L. Green, resigned. Miss S. C. Boyle and Miss K. Goodwin commenced duties as Staff Nurses in September and October respectively, vice Miss Boone and a temporary Staff Nurse. Owing to the limited scope it offers some little difficulty has been experienced in keeping the Wards adequately staffed, and on one or two occasions nurses have been engaged who could only be here a limited time. 29 Probationers.—In addition to a course of lectures given by the Matron (and lectures given by the Medical Officer of Health), the Maternity and Child Welfare Committee approved of the attendance of the three Probationers at an elementary course of lectures arranged by the National Society of Day Nurseries at 117, Piccadilly, W. The three Probationers passed the elementary examination. Changes have taken place in the domestic staff during the year. Relief Mortuary Keeper.—On account of a difficulty of providing the relief mortuary keeper with accommodation at night during the absence on holiday of the Mortuary Keeper, arrangements were made for the keys of the Mortuary to be deposited after 9 p.m. at the Police Station, West India Dock Road, for use in cases of emergency. Sanitary Inspectors' Districts.—The Council agreed to the extension of the boundary of the Poplar South District to include that part of the West Combined District south of West India Dock Road, and to the division of Poplar South into two districts. Mr. H. J. Langley was transferred to the West side of the Isle of Dogs from Bromley North Division, and Mr. Westbrook took over Bromley North Division for the time being. Mr. Kelly was appointed to take over Bow East District for the time being in view of Mr. Field's retirement on reaching the age limit early in 1930. 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 is. 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 74. 30 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 Soap boiler 25th Nov., 1907. 19 Tripe boiler 25th Nov., 1907. 19 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., 1923. 9 Fish curer 28th Feb., 1914. 9 Vendor of fried fish 28th Feb., 1914. London County Council (General Powers) Act, 1903. 54 Conveyance of carcases of dead horses through 21st Feb., 1905. public streets Metropolis Management Act, 1855. 202 Drains, regulating dimensions of, keeping, 14th June, 1901. cleansing and repairing of 9th Nov., 1923. Metropolis Management Act, 1855 (Section 202), and Metropolis Acts (Amendment Bye-laws) Act, 1899. Plans to be deposited.—Construction, 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 33 Section 55 of the Public Health (London) Act, 1891, has been applied to:— 1. Zymotic Enteritis (1st June to 30th September in each year). 2. Chicken-pox. New Legislation. During the year the following Acts of Parliament, etc., have come into operation:— 1. Acts. Food and Drugs (Adulteration) Act, 1928. Artificial Cream Act. 2. Regulations and Orders, etc. Orders Under the Agricultural Produce (Grading and Marking) Act, 1929. Statutory Rules and Orders, 1928, No. 984, dated December, 15 th, 1928 Eggs. Statutory Rules and Orders, 1929, No. 201, dated March 27th, 1929 Broccoli. Statutory Rules and Orders, 1929, No. 350, dated May 7th, 1929 Tomatoes and Cucumbers. Statutory Rules and Orders, 1929, No. 497, dated June, 19th, 1929 Apples and Pears. Statutory Rules and Orders, 1929, No. 753, dated September 12th, 1929 Wheat Flour. Statutory Rules and Orders, 1929, No. 812, dated September 26th, 1929 Beef. Statutory Rules and Orders, 1929, N0.1010, S.70 dated November 13th, 1929 Malt Flour and Malt Extract. 34 Orders Under the Merchandise Marks Act, 1926. The Merchandise Marks (Imported Goods) No. 3 Order, 1928. Dated 13th July, 1928, and came into operation:— (a) Six months afterwards. (b) Four months afterwards. Relating to (a) Honey; (b) Fresh Apples. The Merchandise Marks (Imported Goods) No. 5 Order, 1928. Dated 21st December, 1928, and came into operation:— (a) Six months afterwards (re exposing for sale). (b) Four months afterwards. (c) Three months afterwards. (d) Six months afterwards (re exposing for sale). Relating to:— (a) Currants, Sultanas and Raisins. (b) Eggs in shell. (c) Dried Eggs. (d) Oat Products. The Merchandise Marks (Imported Goods) No. 4 Order, 1929. Dated 17th December, 1929, and came into operation three months afterwards. Relating to:— Raw Tomatoes. 35 Copy of a Return to the London County Council. Premises. No. in Borough on 31st December 1929. No. of Inspections. No. of Prosecutions. Cowsheds (No. of Premises) 4 29 – Slaughterhouses 8* 38 — Offensive Trades 6 premises 7 — 7 businesses Milkshops 116 273 Ice Cream Premises 89 453 Restaurants and Eating Houses 716 1,555 – * Includes 1 Slaughterer of Poultry. Smoke Nuisances. (1) No. of observations 28 (4) No. of Statutory Notices served 4 (2) No. of intimations served 16 (5) No. of legal proceedings .. Nil. (3) No. of complaints received (from L.C.C.) 16 (6) No. of convictions — (7) Amount of penalty and costs imposed in each case — Cleansing and Disinfection. No. of adults cleansed 65 No. of premises cleansed (a) After infectious diseases 2,240 No. of children cleansed 327 No. of cleansings 420 (b) For vermin 81 Water Supply to Tenement Houses. No. of premises supplied 17 No. of prosecutions Nil Sanitary Officers. Male. Female. No. of Sanitary Inspectors (whole-time) 12* 1 ,, ,, ,, (part-time) Nil. Nil. M.C.W. T.B. No. of Health Visitors (whole-time) 9† 3 And 1 Sister in charge of Light Centre. ,, ,, (part-time) Nil. * Includes 2 Meat and Food Inspectors. † Exclusive of Voluntary Association Health Visitors, numbering 9. 36 Total No. of houses in the Borough (Census 1921.) 23,248 No. of houses occupied by the working classes. 23,000 (Approx.) (a) On account of complaints or No. of illness (P.H. houses Act) 7,618 inspected (b) House-to-house (Housing Consolidated Regulations, 1925) 1,211 No. of notices served (a) Under P.H. Act:(i) Intimation 4,769 (ii) Statutory 1,725 (b) Under Housing Act Nil. No. of houses repaired or nuisances remedied under P.H. Act, 1891 4,453 No. of houses repaired under (a) By owners Nil. Sec. 3 of (b) By L.A. in Housing Act, default of 1925 owners Nil. No. of houses closed on notice by owner that they could not be made fit Nil. No. of houses (a) Erected during for the year 87 working (6) In course of classes erection 116 No. of representations by Medical Officer or other person Nil. No. of houses included in such representations Nil. No. of Closing Orders made Nil. No. of Closing Orders determined (i.e., houses made fit) Nil. No. of Demolition Orders Nil. (a) In pursuance No. of of Orders Nil. houses demolished .(b) Voluntarily Nil. Underground Rooms. Overcrowding. No. illegally occupied Nil. No. of cases of overcrowding found *64 No. closed or illegal occupation No. remedied *6 discontinued Nil. No. of prosecutions Nil. *Excluding re-housing cases reported by L.C.C. Houses Let in Lodgings. No. on register 126 No. of inspections made 250 No. of prosecutions 2 (i) £1 penalty; £2 2a. costs. (ii) Prohibition Order made; £5 penalty, and £2 8s. costs. Two further prosecutions in respect of (ii) for non-compliance with Magistrate's Orders:— (а) £2 penalty, and £2 2s. costs. (b) £2 penalty. 37 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. No road is swept less than twice weekly. The sweepings and/or slop are picked up and put into Barge at Northumberland Wharf, or sent by rail by contractors. 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 1929. House refuse collected 31,828 tons. Trade refuse collected 169 ,, Slop and sweepings 8,769 ,, Refuse from street markets 2,699 .. 38 Work of Lady Sanitary Inspector. Tabulated statement of Inspections, of Insanitary Conditions found existing, and of Reinspections, etc., during the year 1929. Poplar. Bow and Bromley. Totals. Workshops, Workplaces, Laundries, etc., Number of, on the Register 69 101 170 Workshops, Number of Workrooms therein 75 130 205 ,, Number of Inspections of 40 133 173 ,, Number of Reinspections of 38 73 111 Workrooms, Number of Inspections of 60 166 226 ,, found to be overcrowded — 2 2 ,, found to be insufficiently ventilated — — — ,, found to be in dirty condition 4 18 22 Workshops, etc., newly discovered and registered 2 5 7 ,, Workrooms therein measured 2 5 7 ,, Reported to H.M. Inspector on discovery 2 5 7 Factories, Number visited 79 138 217 ,, W. C.'s dirty, insufficient, etc. 36 74 110 Outworkers'premises visited 378 894 1,272 Written Intimations served and instances reported 89 128 217 Statutory Notices served 5 8 13 Final Notices served — 2 2 Works carried out under supervision:— (a) Additional means of ventilation provided — — — (b) Rooms cleansed and whitewashed 2 14 16 (c) Yards, floors, roofs, etc., repaired — — — d) Sanitary conveniences constructed, cleansed or repaired 16 72 88 (e) Dampness remedied — — — (f) Sink waste pipes renewed, etc. — — — (g) Miscellaneous 5 10 15 Overcrowding of Workrooms, Cases abated — — — Miscellaneous Visits (including visits to Council Houses) 371 387 758 Visits re Verminous Children 12 86 98 ,, Scabies 74 14 88 ,, Outworkers' Lists 16 12 38 ,, Suspected Infectious Disease 507 211 718 ,, Eye Infections 14 6 20 Visits to Schools 65 23 88 ,, cases of chickenpox 156 217 373 ,, re smallpox contacts 511 — 511 Factory and workshop inspections, 387; fair condition, 255; removed or discontinued, 7; required cleansing, 22; sanitary conveniences defective or insufficient, 110. DISTRICT SANITARY INSPECTORS WORK, Etc. Tubulated Statement of Inspections, Insanitary Conditions found existing, and Re-inspections during the year 1929. East Combined W est Combined Poplar South Bromley North Bromley Central Bow East Bow West Totals 1929 Totals 1928. Total Inspections: 1127 1470 1454 1424 1102 809 1173 8559 8595 On complaints of nuisances, etc. 409 681 665 974 414 420 759 4322 3878 On notification of infectious diseases 444 661 490 342 391 226 348 2902 2365 *House-to-House 73 — — 2 20 — — *95 212 Workshops, workplaces, etc. 183 8 50 55 72 43 66 477 817 Miscellaneous 18 120 249 51 205 120 — 763 1323 Premises found in fair condition 584 671 774 460 317 347 433 3586 3752 Do. requiring amendment 543 799 680 964 785 462 740 4973 4843 Details of Insanitary Conditions, etc. Walls and ceilings dirty 217 232 199 336 404 162 418 1968 1945 Yards, forecourts and areas insufficiently paved or drained 76 34 57 55 100 28 51 401 539 Inlets to drains not properly trapped 2 1 2 3 — 1 — 15 9 Number of drains tested 256 58 458 135 186 151 515 1750 1936 Do. do. defective 39 55 74 20 21 12 35 256 368 Do. do. obstructed 33 76 97 63 40 43 35 387 547 Sink waste pipes not trapped or otherwise defective 29 20 48 29 93 19 72 310 355 Do. do. directly connected to drains 5 1 — 1 2 — — 9 9 Soil pans of w.c.'s without suitable water supply 34 62 12 102 37 17 36 300 275 Do. do. broken or unsuitable 26 25 30 20 21 26 20 168 164 Do. do. in foul condition 13 8 7 4 16 10 4 62 96 Do. do. untrapped 1 — — 1 — — — 2 6 Roofs, guttering, and rainwater pipes defective 207 153 392 588 332 143 255 2070 1939 Water supplies to premises cut off (notified by Metropolitan Water Board) 5 2 2 1 9 19 4 Water service fittings defective, causing waste of water 21 29 61 29 27 16 — 183 176 Drinking water improperly stored — — — — — — — — 6 Dampness 199 168 90 81 141 88 67 834 695 Inundations 12 3 8 1 7 — 31 1204 Overcrowding 8 26 3 14 3 2 — 56 56 No proper receptacle for house refuse 90 89 127 155 155 72 16! 851 517 Accumulations of dung or refuse 21 10 18 17 — 12 6 84 165 Insanitary P.H. urinals — 3 4 3 5 1 — 16 35 Other nuisances, dilapidations, want of ventilation, etc. 347 170 517 409 486 386 407 2722 2683 Breaches of London County Council's By-laws 88 7 8 — — 53 — 156 183 Breaches of Council's Bv-laws 63 11 84 14 100 20 — 292 319 Intimations served 495 683 667 1035 720 435 734 4769 4466 Notices served 145 249 205 405 321 130 270 1725 1580 Final Notices served 25 107 71 173 29 39 79 523 531 Summonses applied for — 8 4 15 2 2 4 35 27 Passengers from Continental Ports:— Visited 3 11 3 — — — 17 — Undiscovered — 1 — — — — — 1 — Intimations served in respect of verminous rooms 33 23 21 37 49 9 — 172 146 Verminous rooms cleansed by owners, etc. 42 24 17 38 49 7 — 177 151 Re-inspections.. 2256 2297 2428 2772 1859 1659 2123 15394 17890 Visits to Smallpox contacts 5049 2283 1295 2026 4625 1142 3235 19655 9205 Do. school absentees. etc 96 50 43 — 51 5 23 268 210 House-to-house visits re smallpox — — — — 261 — — 261 471 Visits re typhoid fever contacts — — 3 — — — — 3 160 * In addition to the above 1,116 house-to-house inspections were made by Mr. C. H. Brown. 39 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. When submitting one of the reports of the Lady Sanitary Inspector upon the state and cleanliness of Council houses, the Medical Officer of Health referred to the question of bug-infested premises. The destruction of bugs in occupied premises is one of the most difficult problems with which the Public Health Department is confronted. This is due to the life history and habits of the bug. The most powerful disinfectants can only be effective if and when they are applied directly to the bug so that the mere spraying of the surface with solution "D," or any other disinfectant, whilst doing a certain amount of good, cannot be expected to be a remedy. It would make disinfection much more efficient if it were possible in the worst cases of infestation to remove the woodwork (skirting boards and picture rails) behind which bugs are secreted before spraying with insecticide. It must, however, be realised that repeated applications of the insecticide will be necessary before there is any likelihood of the nuisance being abated. He pointed out, however, that how far this procedure was a practicable proposition was a question for the Borough Surveyor. The Public Health Committee agreed to the report being submitted to the Special Housing Committee with the statement of the Medical Officer of Health regarding bug infestation. HOUSES DIVIDED INTO SEPARATE TENEMENTS, ETC. Report of Inspector—Year 1929. House-to-House visits for registration purposes 309 Declarations, for information, sent out 84 ,, with information, returned 36 Rooms measured, etc. 207 Houses registered 21 Notices sent out, re above 21 Inspections of registered houses 240 Re-inspections 818 40 Number of Intimations served 71 ,, Notices served 15 ,, Final Notices served 6 Number of Notices served under L .C .C. Bye-laws 9 Number of Notices under L .C .C. Bye-laws complied with 5 Number of rooms cleansed and freed from vermin 100 Overcrowding, cases discovered 8 ,, ,, abated 2 Number of nuisances referred to District Inspectors: (a) Defective or obstructed drains 4 (b) Defective roofs, guttering, etc. 1 (c) Miscellaneous 3 Water supply in tenement houses (section 78, London County Council (General Powers) Act, 1907): (a) Number of Notices served 7 (b) ,, ,, ,, complied with 6 Remarks: During the year the Inspector deputised for absent District Inspectors and was engaged on district work in Bow East Division continuously from 2nd December, 1929. STABLES. During the summer months weekly inspections of stable premises were continued and the frequent and complete removal of horse manure insisted upon. 195 stables were inspected and reported upon, the total number of inspections being 437. The following infringements of the Bye-laws were dealt with:— Accumulations of manure, 01 premises otherwise not clean 53 Floors not properly drained 4 Dung receptacles:— (a) Not provided 11 (b) Defective 11 (c) Not covered 3 Other defects 27 76 Intimations were served, followed by 11 Notices. The works required were completed before the end of the year. 41 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 1929. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male. Female. Total. Bakehouses (Factories) 46 — 46 170 96 8 — — Bakehouses (Workshops) 25 — 25 98 54 — — — Bakehouses (Domestic Workshops) 6 — 6 27 14 1 — — Factories (Laundries and Miscellaneous Factories) 17 133 150 224 69 — — — Laundries (Workshops) — 4 4 4 1 — v — Laundries (Domestic Workshops) .. — — — — — — — — Workshops 168 164 332 377 71 9 4 — Workshops (Domestic) 17 2 19 23 5 — — — Workplaces 351 — 351 609 106 16 2 — Workplaces (Domestic) 28 — 28 36 3 1 — — Places where food is sold or prepared 716* — 716* 1555 453 18 1 — Milk Premises 116 — 116 273 9 — — — Cowsheds 4 — 4 29 — — — Slaughterhouses (a) 8 — 8 38 13 — — — Other offensive trade premises 6† — 6† 7 — — — Ice Cream premises 89‡ — 89‡ 453 12 2 — — Homeworkers' premises 22 1019 1041 1292 17 3 — — * Power is used in 51 of these premises. (a) Includes one registered Slaughterer of Poultry (12, Coborn Road). † Registered by the London County Council. 7 offensive trades carried on; Fur Skin Dressers, 3. Soap Boiler, 1. Fat Boilers, 2. Tallow Melter, 1. 1 premises used for two offensive trades. Fat Boiler and Tallow Melter. 42 Table B. Workshops on Register (Male), 1929. 1 Acetylene gas making. 1 Maltsters. 1 Barge building. 3 Metal works. 1 Bath Salts making. 2 Oil stores. 1 Battery making. 4 Paint making. 2 Bedding making. 2 Plumbing. 1 Bitumen making. 1 Poultry food mixing. 1 Blind making. 3 Printing. 1 Boiler coverer. 4 Rag sorting. 2 Boat Building. 1 Range making. 21 Bootmaking. 2 Rope making. 2 Brush making. 1 Sack making. 1 Building, etc. 1 Sawyer. 11 Cabinet making. 1 Shellac bleaching. 3 Carpenters. 1 Ship painting. 1 Chemical works. 1 Show case making. 1 Cigar making. 1 Stonemasonry. 1 Clay pipe making. 16 Tailoring. 2 Confetti making. 1 Tank making. 3 Cork cutting. 4 Tarpaulin works. 3 Cooperages. 2 Tin toy making. 1 Dental workshop. 1 Transfer making. 1 Electrical engineering. 1 Trunk making. 3 Engineering. 3 Upholstering. 12 Farriers. 3 Undertaking. 2 French polishing. 2 Van building, etc. 1 Frilling making. 1 Waterproof working. 2 Furniture making. 2 Welding. 1 Furrier. 1 Wheelwright. 1 Garden Ticket making. 1 Wire working. 1 Glass works. 1 Wireless apparatus making 1 Horsehair working. 1 Wood Tar products. 4 Harness making. 1 Zinc working. 9 Motor garage works. As per List, Table A Workshops on Register, page 41. 43 Domestic Workshops on Register (where Men are Employed.)* 2 Blacksmiths. 7 Tailoring. 4 Boot repairing. 1 Wire working. 1 Decorative earthenware making. 1 Zinc working. 1 Mat making. Home Workers on Register (Male). 19 Bootmaking. 1 Tailoring. 1 Brush making. 1 Box making. Workshops and Domestic Workshops on Register (Females).* 1 Badger hair sorting. 3 Pickle and sauce making. 1 Bedding making. 3 Pressers and cleaners. 2 Boot factors. 1 Shirt and pvjama making. 1 Cap making. 1 Seal stamp making. 1 Confectionery making. 65 Tailoring. 3 Cork cutting. 1 Tarpaulin works. 14 Costume making. 2 Tiemaking. 20 Dressmaking. 1 Tin goods labelling and sorting. 2 Embroidering. 3 Toymaking. 3 Furriers. 3 Trimming making. 3 Infants' shoes making. 3 Underwear making. 4 Laundries. 2 Upholstering. 12 Milliners. 1 Waterproof garment making. 4 Packing. 1 Wood chopping. 3 Paper and rag sorting. * It is very difficult to separate Workshops and Domestic Workshops, as these premises are sometimes one and sometimes the other, according to the pressure of work. See Table A, page 41. Factories on Register (where Females are Employed). 3 Bedding manufacturing. 1 Perambulator builder. 1 Binder and carding. 1 Pianoforte manufacturer. 2 Blouse making. 1 Picture framing. 2 Boot making (Infants') 2 Preserved food. 7 Box making. 2 Ragwork. 44 Factories on Register (where Females are Employed).—contd. 1 Brush making. 1 Rice starch making. 1 Bunting and flag making. 4 Rope works. 1 Butter mixing factory. 1 Rubber goods making. 1 Buttons and buckles. 1 Rug making. 1 Cabinet making. 4 Sack making. 1 Cake and Biscuit making. 2 Sausage factory. 2 Chip basket making. 5 Shirt making. 1 Christmas cracker making. 1 Shroud making. 1 Cigarette paper making. 24 Tailoring. 1 Clay fuel and pipes. 3 Tarpaulin works. 3 Cleaners and dyers. 1 Ticket printing. 2 Confectionery making. 2 Overall making. 1 Cork cutting. 2 Timber works and wicker furniture making. 2 Corset making. 4 Costume making. 1 Tortoiseshell goods making. 1 Dog biscuit manufacturer. 1 Toy balloon making. 8 Dressmaking. 2 Toy making. 1 Feather works. 1 Trimming making. 1 Fibre, hemp and jute making, 1 Type founder. 1 Furrier. 1 Underwear making. 2 Glass works. 1 Varnish and paint works. 1 Gum works. 1 Wallpaper manufacturer. 1 Harness making. 2 Waterproof making. 1 Kapok works. 1 Whalebone works. 2 Laundries. 1 Wine bottling. 1 Match making. 1 Wood chopping. 1 Mineral water manufacturer. 2 Woollen garment making. 45 Table C. See note, page 43. Factories, Workshops, Laundries, Workplaces and Homeworkers 1.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Intimation. Statutory. Final. Factories 394 165 8 — (Including Factory Laundries.) — Workshops† (Including Workshop Laundries.) 479 126 9 4 — Domestic Workshops‡ 50 19 1 — — Workplaces 609 106 16 2 — Domestic Workplaces 36 3 1 — — Places where food is sold or prepared§ 1555 453 18 1 — Homeworkers' Premises 1292 17 3 — — Total 4415 889 56 7 — † Including Workshop Bakehouses. See Table A, page 41. ‡ Including Domestic Bakehouses and Laundries. See Table A, page 41. § The inspections of all factories where food is prepared areincluded. Power is used in 51 of the premises. 2.—DEFECTS FOUND* (Corresponding figures for 1928 are shown in italics). Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Act: Want of oleanliness 694 (606) 694 (606) .. .. Want of ventilation 1 (6) 1 (5) (1) .. Overcrowding 2 (10) 2 (10) .. Want of drainage of floors 4 4 .. .. Other nuisances 187 (186) 187 (185) (1) .. Sanitary accommodation insufficient 8 (5) 8 (5) .. .. unsuitable or defective 126 (146) 126 (146) .. .. not separate for sexes 5 (5) 5 (5) .. .. 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 (6) (6) (Excluding offences relating to outwork which are included in Table D of this Report.) Total 1027 (970) 1027 (962) (8) * These defects rofer to premises as mentioned above under table of Inspection. 46 Nature of Work. Outworkers'Li8fc (Section 107). Outwork in unwholesome premises. (Section 108). Outwork in infected premises, (Sections 109, 110). 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) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— Table D.—Home Work. Making, etc. 86 9 779 1 — 3 14* Cleaning and Washing Household Linen Lace, lace curtains and nets Curtains and furniture hangings Furniture and Upholstery Electro-plate File Making Brass and Brass Articles Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, etc. Artificial Flowers Nets, other than wire nets Tents Sacks Racquet and Tennis Balls.. Paper, etc., Boxes, Paper Bags 2 - 72 Brush Making Pea Picking Feather Sorting Carding,etc.,of buttons,etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, etc. 2 - 7 - - Textile Weaving Totals 90 9 858 1 - 3 - - - - - - 14* - 47 LIST OF OUTWORKERS, FACTORY AND WORKSHOP ACT, 1901 (S. 107). Class of Homework. 1929 Number of Lists received. Number of Addresses of Outworkers. Due Feb. 1st. Due Aug. 1st. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Due Feb. 1. Due Aug. 1. Due Feb.1. Due Aug. 1. Total 46 407 — 449 227 336 389 325 Tailoring 39 274 310 227 336 389 325 Shirtmaking 1 11 — 12 Miscellaneous 1 4 — 5 Shoemakers 2 24 33 Boxes 1 38 34 Overalls 2 56 55 Table E. Registered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses may be enumerated here. f Bakehouse Workshops 25 Bakehouse Domestic Workshops 6 Laundries Workshops 4 Laundries Domestic Workshops — Workshops 332 Domestic Workshops 19 Workplaces 351 Workplaces Domestic 28 Places where food is sold or prepared 716† Total number of workshops and workplaces, etc., on Register 1481‡ † Power is used in 51 of these premises. ‡ See Tables A and B, pages 41 and 42. Table F. Clasa. Number. (1) (2) Matters notified to H.M. Inspector of Factories:- Failure to affix Abstract of the Factory and Workshop Act (S. 133) 5 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 27 Reports (of action taken) sent to H.M. Inspector 27 Other (Communications) Underground Bakehouses (S. 101):— 2 Certificates granted during the year .. In use at the end of the year 21 48 SMOKE NUISANCES. 28 observations were made and 20 nuisances recorded. 16 complaints were received from the London County Council. 16 intimations were served and were followed by notices in 4 instances. It was not necessary to institute legal proceedings in any instance. 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. 173 rooms were sprayed with Solution "D ". A fluid insecticide is issued at the Disinfectant Depots, and sprayers loaned to tenants in order to rid rooms and contents of bugs. 2,448 orders for fluid were issued. 305 gallons of insecticide were distributed during the year. LICENSED PREMISES' URINALS. 16 urinals on licensed premises were found to be in insanitary condition and were subsequently cleansed. WATER CERTIFICATES. No certificates were applied for under Section 48 of the Public Health (London) Act, 1891. 49 CUSTOMS AND INLAND REVENUE ACTS, 1890-1891, AND REVENUE ACT, 1903. No applications for certificates for exemption under the Customs and Inland Revenue Acts, 1890-1891, and the Revenue Act, 1903, were made during the year. STREET TRADING. 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. 161b. of barium carbonate paste and 10lb. 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. The scheme of health education was continued, the Council approving an estimated expenditure of £200 for this branch of our work. Offers 50 of lectures were made to various social, political and educational organisations in the Borough, and four lecturers (3 medical and 1 lay) were available. Women doctors addressed meetings of women on subject of peculiar interest to women and girls, but lecturers were also available to speak on other matters. There was no radical change in the syllabus of lectures shown in last year's Annual Report. The following report was submitted by Mr. T. Wig ley, M.A., with whose assistance the original scheme had been prepared:— REPORT BY Mr. T. WIGLEY, M.A. All thinking people will agree with the statement made by "The Times" that "the intimate connexion between public health and education is perhaps the one indisputable fact upon which all progressive social legislation in every civilised country in the world has been based for nearly half a century." There can never be that intelligent cooperation between those who know and those who do not know, which is so essential to the success of all practical measures, until the gap between ignorance and knowledge is bridged. To build such a bridge is the object of those who would educate the public in matters which concern both social and individual wellbeing. Of the greatness of the need for an instructed mind in this important sphere, the following facts abundantly testify:—In 1918, nearly 2,500,000 men were examined for their fitness for service in the Army; but only one-third were perfectly fit and healthy, and the remaining two-thirds suffered from some marked ill-health or physical disability. In 1928, the loss of work from sickness among insured persons in England and Wales amounted to a total of no less than 26,500,000 weeks. Yet again, the results of medical inspection of school children show that no fewer than 1,000,000, or one-sixth of the total, are "so physically or mentally defective or diseased as to be unable to derive reasonable benefit from the ordinary form of education which the State provides." It has also recently been shown that about 10 per cent. of the population are so intellectually dull as to be fit only for unskilled work. It is not, of course, suggested that education will automatically, and to a marked extent, diminish the disease and deficit which these figures indicate. We can, however, assuredly affirm that much can be done by the individual and group, educated in mind and 51 honest in purpose, who will guard the avenues down which creep the beginnings of bodily and mentally disintegrating forces. A glance at the titles of the lectures offered free of cost by the Public Health Committee to any organisation which is willing to incorporate them in its programme, will sufficiently indicate the breadth of our appeal. There are lectures which deal with many aspects of child life, lectures which should interest women in particular, lectures which concern youth, and a number of lectures of a varied nature, which should interest as well as instruct any audience which is prepared to consider questions of vital importance to the individual and citizen. It is gratifying to note that the number of lectures given has increased during the past year, and appreciation of them has shown itself by the demand not for single lectures but for a course, which would enable the audience to view a problem against a larger background. The war of education is not spectacular, but it is sure; and the presence of enlightened bodies of men and women in a community must sooner or later make itself felt in an effective demand that health shall be the possession of us all. We cannot doubt that knowledge of the incidence and spread of such a group of diseases as "Venereal,'' one of the "killing diseases"; of Tuberculosis, a social plague; of the functions of the human body; of the meaning and need for preventive inoculation against diphtheria; of a sane view with regard to sex matters—that such knowledge is a necessity which every intelligent Authority must seek to make available is becoming increasingly clear to all students of social affairs. In all, 63 lectures have been given, and it is estimated that over 5,000 people attended. 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 63 To men and boys 6 ,, women and girls 40 ,, mixed audiences 17 63 52 Expenditure. £ s. d. Grant to Central Council for Health Education 5 0 0 Printing, Stationery and Postage 11 0 8 Fees to Lecturers 142 16 0 Total £158 16 8 RAG FLOCK ACT, 1911. No samples of rag flock were examined during the year 1929, there being no premises in the Borough where rag flock is stored. It was found that rag flock is ordered only in sufficient quantities to meet current demands. HAIRDRESSERS' PREMISES. The hairdressers' premises, numbering 96, were inspected during the year. The number of inspections was 73. Cleansing was necessary at 7 of the premises, and other nuisances found numbered 15. 12 intimations and 2 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. During the year, the Public Health Committee authorised the service of Statutory Notices in 19 cases of overcrowding. In 4 instances the nuisance was abated. 53 CANAL BOATS ACTS. For the year ended 31st December, 1929, 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 6 — Mr. A. J. Field. Bow East Division Mr. S. Kelly, 2 — Mr. F. A. Smith, Bow West Division — — Totals 8 — *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 1929." Mr. H. J. Langley reported: "No canal boats have been observed in the Bromley North section of the canal during 1929." Mr. Wm. Johnson reported: "Two boats, fair condition; 4 boats, various defects, chiefly broken skylights boarded over, obstructing light and ventilation." Mr. S. Kelly reported: "Only males on board boats inspected. Both boats in good order." Mr. F.A. Smith reported: "No canal boats have been seen during 1929 " 54 LEGAL PROCEEDINGS. (Public Health (London) Act, 1891, Metropolis Management Acts, etc.) Address. Nature of Complaint. Date of Decision. Result. Inspector. 1929. 74a, Mellish Street Failed to provide ashpit 1 st Jan. Fined £2; £2 2s. costs Kelly, S. 74(1, Mellish Street Ditto 1st Jan. Fined £1; £1 1s. costs Kelly, S. 93, East Ferry Road Yard paving defective 28th Jan. 14 days' order Leonard, H. 19, Sophia Street Roof defective 8th Feb. Fined £2; £2 2s. costs Johnson, J. 15, Sophia Street Roof defective 8th Feb. Fined £2; £2 2s. costs Johnson, J. 150, Roman Road Various defects 5th Feb. 7 days' order; £2 6s. costs .. Smith, F. A. 176, High Street, Poplar (tenement house) Ground floor back room and back cellar insufficiently lighted and ventilated; unfit for human habitation 20th Feb. Prohibition order made; fined £5; £2 8s. costs Kelly, S. 181, Bow Road Failed to deposit drainage plans 25th Feb. Fined £1; £4 4s. costs. Kelly, S. Ditto Failed to give notice of intention to fit W.C. pans and traps 25th Feb. Fined £2 Kelly, S. Ditto Failed to give notice of intention to fit W.C. 's 25thFeb. Fined £2 10s. Kelly, S. 58, Merchant Street Various defects 5th Mar. 14 days' order; £2 8s. costs. . Langley, H. . 94, High Street, Poplar (tenement house) Yard, staircase landing, passage and W.C.'s not kept thoroughly clean 2nd April Fined £1; £2 2s. costs Kelly, S. 3, Guerin Street Various defects 23rd April 7 days' order; £2 8s. costs Smith, F. A. 32, Addington Road Ditto 23rd April 7 days' order; £2 8s. costs Smith, F. A. 50, Roman Road Failed to comply with Magistrate's order of 5th Feb., 1929 25th April Fined £2; £3 3s. costs Smith, F. A . 55 legal proceedings—{continued). (Public Health (London) Act, 1891, Metropolis Management Acts, etc.) Address. Nature of Complaint. Date of Decision. Result. Inspector. 1929. 176, High Street, Poplar (tenement house) Failed to comply with Magistrate's Prohibition Order of 20th Feb., 1929 4th June Fined £2; £2 2s. costs Kelly, S. 18, Sophia Street Premises without proper and sufficient water supply 3rd June Closing Order made; fined £5; £2 2s. costs Johnson, J. 17, Sophia Street Ditto ditto 3rd June Closing Order made; fined £5; £2 2s. costs Johnson, J. 49, Norman Road Unlawfully obstructed the Medical Officer of Health 23rd July Fined 10s. Young, W. A (Medical Office of Health). 62, Swaton Road Various defects 29th July 14 days' order; £2 8s. costs Langley, H.J. 176, High Street, Poplar (tenement house) Failed to comply with Magistrate's Prohibition Order of 20th Feb., 1929 5th Nov. (after adjournment) Fined £2; £2 2s. costs Kelly, S. 40, Sabbarton Street Roof defective and other defects 10th Oct. Fined £2; £2 4s. costs Johnson, J. 155, Brunswick Road Roof, hopper head and rainwater pipe defective 25th Oct. Fined £1; £2 4s. costs Johnson, W. 8, Tibbatts Road Main roof, first floor ceiling and copper defective 31st Oct. Fined £2; £2 4s. costs Langley, H.J. 6, Priscilla Road Front gutter defective 31st Oct. Fined 10s.; £2 4s. costs Langley, H.J. 31, Whitethorn Street Roof defective and other defects 31st Oct. Fined £1; £2 4s. costs Langley, H.J. 9, Glaucus Street Various defects 15th Nov. 28 days' order; £2 8s. costs Langley, H.J. 11, Glaucus Street Ditto 15th Nov. 28 days' order; £2 8s. costs Langley, H.J. 56 LEGAL PROCEEDINGS—(continued). (Public Health (London) Act, 1891, Metropolis Management Acts, etc.) Address. Nature of Complaint. Date of Decision. Result. Inspector. 1929. 19, Tibbatts Road Roof defective, first floor back room damp 8th Nov. 14 days' order; £2 8s. costs Langley, H.J. 72, Reeves Road Main and slip roofs and main valley gutter defective 8th Nov. 14 days' order; £2 8s. costs Langley, H.J. 153, Stebondale Street Various defects 14th Oct. 14 days' order; £2 8s. costs Leonard, H. W. 22, Flint Street Various defects 13th Nov. 7 days' order; fined £2; £2 8s. costs Johnson,J. 119, Upper North Street Roof defective 13th Nov. 7 days' order; £2 8s. costs Johnson,J. 153, Stebondale Street Failed to comply with Magistrate's Order of 14th Oct., 1929 6th Dec. Fined £1; £3 3s. costs Leonard, H. W 119, Donald Street Various defects 4th Dec. Withdrawn on payment of £2 5s. costs Johnson, W. 69, Libra Road Main roof defective and other defects 9th Dee. 7 days' order; £2 8s. costs Smith, F. A. 22, Park Street Stables, without water supply and sanitary arrangements, unfit for human habitation 10th Dec. Closing Order made; £2 8s. costs Johnson,J. 4, Tibbatts Road Various defects 10th Dec. 14 days' order; £2 8s. costs Langley, H.J. 37, Tidey Street Main roof and valley gutter defective 10th Dec. 28 days' order; £2 8s. costs Langley, H.J. 15, Gale Street Main roof defective 10th Dec. 28 days'order Langley, H.J. 1, Box Street Various defects 20th Dec. £2 4s. costs Langley, H.J. 15, Tibbatts Road Main and back addition roofs and ceiling defective 20th Dec. £2 4s. costs Langley, H. J. 30, Glaucus Street Main roof gutters and back gutters and hopper liead defective 20th Dec. £2 4s. costs Langley , H . J. 57 Section IV. HOUSING CONDITIONS, Housing Accommodation provided during 1929. The number of families re-housed during the past year was as follows:— Families accommodated . Number of persons (approx.) (a) By the Poplar Borough Council:— (1) In newly-erected flats 86 516 (2) In adapted buildings 6 16 (6) By the London County Council 122 610 Totals 214 1142 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, and periodical reinspections are made. Statistics . Year Ended December, 1929. x .—General . (1) Estimated population 160,000 (2) General death rate 14.2 (3) Death rate from tuberculosis (all forms) 1.2 (4) Infantile mortality 75 (5) Number of dwelling-houses of all classes (Census 1921) 23,248 (6) Number of working-class dwelling-houses 23,000 (approx.) 58 17) Number of new working-class houses erected during 1929:— (a) Total (including numbers given separately under (b)) 87 (b) With State assistance under the Housing Acts:— (i) By the Local Authority 86 (ii) By other bodies or persons — 2.—Unfit Dwelling-houses. I.—Inspection of Dwelling-houses during the year. (i) Total number of dwelling-houses inspected for housing defects (under Public Health or other Acts) 7,618 (2) Number of dwelling-houses (included under sub-head(i) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 1,211 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation *3 (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 4,452 *Closing Orders made by Magistrate under Public Health (London) Act, 1891. 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 2,728 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. 59 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil. (b) By Local Authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,725 (2) Number of dwelling-houses in which defects were remedied— (a) By owners 1,725 (b) By Local Authority in default of owners Nil Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit .. Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 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. 60 Increase of Rent and Mortgage Interest (Restrictions) Acts. One certificate was issued under the above Acts. Unhealthy Areas. (a) West Ferry Road Area. As stated in last year's Annual Report, the London County Council, on 22nd April, 1929, agreed to make an Improvement Scheme under Part II of the Housing Act, 1925, for dealing with that portion of the West Ferry Road which lies on the North-east side of West Ferry Road (including Ingleheim Cottages). On account of a legal decision during the year no progress has been made during 1929. (b) Oliver's Court and High Street, Bow. During the latter part of last year the Solicitor and one of the Trustees of certain houses in High Street, Bow, interviewed the Medical Officer of Health as to the condition of their property. Dangerous structure notices had been served by the London County Council and the Trustees were of opinion the property was worn out and money spent on repairs would be wasted. They made certain suggestions for dealing with the property, but as these houses were part of an area which had been represented to the London County Council in 1919, the Council resolved that the London County Council should be urged to deal with the area, or to declare their intentions. The question was taken up with the London County Council and a Deputation with one of the Trustees and a Solicitor met officials at the County Hall, on 29th October. The matter was fully considered by the Public Health Committee, who resolved that the strongest possible representation should be made to the London County Council for them to deal with the area. On 5th December the Unhealthy Areas and Re-Housing Sub-Committee of the Housing Committee of the London County Council received a deputation, but at the end of the year the decision of the County Council had not been received. 61 (c) In September a letter was received from the London County Council stating that the Council had given consideration to the official representations made in 1919, and suggested that three of the ten Areas included in the representations, viz., Commodore Court (Collins Place) Area (1 acre), Silver Lion Court (1/3rd acre), and the Emmett Street (Providence Cottages) Area (1 acre), should be dealt with by the Council and asked the Borough Council to consider undertaking schemes for the clearance and reconstruction of the Areas in the near future. The Public Health and Housing Committee, and the Special Housing Committee, appointed their Chairmen and Vice-Chairmen to make a tour of slum areas within the Borough, with the Medical Officer of Health, with a view to the Medical Officer of Health submitting a report. The three areas referred to by the London County Council were visited and the Medical Officer of Health reported that he intended to submit them to the Council for consideration. The necessary inspections were carried out. The Town Clerk reported that in view of the Derby case there were considerable difficulties in representing areas at that time and it was anticipated that these difficulties would be removed by the Bill which had been promised by the Government. Under these circumstances the Committee resolved that in view of the present legal difficulties, the areas proposed to be represented by the Medical Officer of Health be submitted when the Bill promised to be introduced by the Government has become law. (d) Orchard Place Area. In September, 1929, the London County Council intimated that they were not prepared to deal with this area, which had been represented to them in 1919, and had been the subject of correspondence after the Thames Flood in January, 1928. Since this area had been represented Statutory Notices had not been served upon the owners of the property to remedy defects. When serious nuisances arose letters were addressed to the owners by the Medical Officer of Health asking for the premises to be made wind and weather-tight. 62 As, however, the London County Council did not intend to deal with the area and the Borough Council were not prepared to take it over, it was agreed that in future the usual procedure regarding service of Notices etc., should be carried out. Old Palace L.C .C. School. The London County Council asked for the observations of the Borough Council regarding their proposal to purchase Nos. 10 and 12, St. Leonards Street, with part of the gardens in the rear of Nos. 10 to 20 (even) Bruce Road, in order that adequate playground space may be available when a proposed enlargement of the school has been carried out. The following observations of the Medical Officer of Health were agreed to by the Public Health Committee for submission to the London County Council:— i. That the ground proposed to be taken be absorbed into the existing playground and kept as an open space and that any additions to the existing school building shall not extend beyond the present boundary wall of the playground, and ii. That as a result of the proposed extensions of the ground the boundary wall at the foot of the gardens in Bruce Road should not be less than 10ft. away from the scullery back addition walls of the Bruce Road houses. Re Underground Rooms. A letter was received from the Metropolitan Boroughs Standing Joint Committee in which it was stated that the Committee appointed by the Conference of Public Authorities on the Thames Floods had expressed the opinion that where basement rooms in low-lying areas were liable to floods did not comply with the existing statutory requirements, steps should be taken at the earliest practicable time to secure that they were no longer used as dwellings. Upon the suggestion of the Medical Officer of Health the Committee and Council agreed that it would certainly be desirable that underground rooms used as living and sleeping rooms should be closed, and that powers 63 should be extended and modified to permit the closing of part of a house as against the closing of the whole house, but owing to the shortage of housing accommodation the time did not appear to be opportune for proceeding with this as it would only cause overcrowding in other parts of the house. Later the Metropolitan Boroughs Standing Joint Committee wrote stating this question was also considered by the London County Council, who took the view that the use of many basement dwellings as living rooms, and not only their use as sleeping quarters, is injurious to health, and that the question should therefore be considered in its broader public health aspect and not merely in relation to dangers arising from floodings. The County Council have before them a proposal that legislation should be promoted to extend the scope of Part I of the Housing Act, 1925, in its application to London, so as to enable unsatisfactory basement rooms used as living rooms to be deemed to be so dangerous or injurious to health as to be unfit for human habitation and consequently to subject them to the provision of that part of the Act in relation to closing orders. It was not proposed that the making of a closing order in respect of an underground room should prevent the room being used for other than dwelling purposes or prevent the continued use of the remainder of the house for dwelling purposes, neither was it contemplated that the suggested statutory powers should connote the immediate closing of a large number of existing dwellings, but that the powers would be exercised only as and when circumstances permitted. As, however, any rehousing operations involved by the closing of underground rooms on a relatively large scale would probably have to be undertaken by the County Council it was proposed to safeguard their position so as to ensure that the proposed powers shall not be exercised in such a way as to embarrass their housing operations. The Metropolitan Boroughs Standing Joint Committee was informed that this Council supported the proposals of the London County Council. 64 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 Dairies Order, 1926, regarding lighting (natural and artificial) and cleansing; standings have been reconstructed to prevent fouling of the animals. MILK SHOPS. At the end of the year there were in the Borough 116 registered premises (including 4 cowhouses) where milk is sold. These premises were kept under strict observation, 273 inspections being made. The standard of cleanliness in cowhouses, milk shops and other premises where milk is dealt with has been well maintained. Sale of Milk in Bottles. During the year, 72 persons were registered for the sale of Sterilized Milk and Raw Milk in Sealed Bottles only. This makes a total of 292 persons registeied during the years 1928 and 1929. Cleansing of Milkshop premises was necessary in 9 instances. 4 other nuisances were found. 9 Intimations were served. The necessary cleansings and other matters were attended to, and it was not necessary to serve Statutory Notices. 10 persons were registered as retail purveyors of milk, 2 of these being on account of change of ownership of premises. For milkshops connected with infectious diseases, see page 87. 65 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. 21 dealers in sealed bottles only. 5 supplementary licences (principal licences issued by other Authorities). 1 licence for the sale of "Certified" Milk, and 1 supplementary licence. 2 supplementary licences for the sale of "Pasteurised" milk. 1 licence for the sale of Grade "A" milk. 2 licences 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, special inspections were made and reports submitted. In August, 1929, the Nestle & Anglo-Swiss Condensed Milk Company applied to this Authority for a "Pasteurising" Licence in respect of their new premises at 154a, Tredegar Road, Bow. On inspection their premises and plant were found to be satisfactory, and a licence was duly issued to them. A Dealer's Licence in respect of Grade "A" (T.T.) Milk was also issued to the Nestle & Anglo-Swiss Condensed Milk Company. For results of examination of samples see Public Analyst's report, page 76. 8 samples of Grade "A" (Tuberculin Tested) Milk were examined for tubercle bacilli. (7 negative and 1 examination not completed as the inoculated animal died.) 66 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. No samples were taken by officers of this Department, and no reports were received from the London County Council during 1929. ICE CREAM. London County Council (General Powers) Act, 1928. During the year, 89 Owners or Occupiers applied for registration under the above-mentioned Act. These applications were duly approved by the Medical Officer of Health. 127 other premises in the Borough have been visited. 453 Inspections were made of the above premises during the year. Cleansing of premises was necessary in 6 instances. 8 other nuisances existed. 12 intimations and 2 statutory notices were served. The necessary cleansings were carried out, and other nuisances were abated. BAKEHOUSES. There are 77 bakehouses in use, of which 21 are underground. In 46 bakehouses machinery is used. See Table A, page 41, number made up to end of year. 67 Inspections . The bakehouses in the Borough were inspected at least twice during the year, the total inspections numbering 295. Cleansing was found to be necessary on 161 occasions, and 12 other nuisances were found. The cleansings were carried out and the nuisances abated after service of 164 intimations, followed in 8 instances by statutory notices. SLAUGHTERHOUSES. There are 7 slaughterhouses licensed by the London County Council. For number of inspections see Table A, page 41, and reports of Food Inspectors, pages 68 and 70. 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 716; see Table A, page 41. 1,555 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 422 instances, and 54 other defects existed. 453 intimations were served, and in 18 cases were followed up by statutory notices, and 1 final notice. It was not necessary to take legal proceedings to secure compliance with the terms of the notices, as the necessary work was carried out. 68 STATISTICAL REPORTS OF FOOD INSPECTORS. MR. C. A. GRABHAM. In submitting the following Mr. Grabham reported he had been engaged on Smallpox work also during a large part of the year. (Inspections for 1928 in italics). Premises. Inspections. Intimations. Notices. Final Notices. Prosecutions. 1929 1928 Bakehouses 143 141 91 6 Slaughterhouses 11 1 2 — — — Cowhouses 4 2 — — — Milkshops 104 94 5 — — — Eating-houses 124 56 19 2 — — Stalls 512 340 — — — Other places where food is sold or prepared 183 221 11 1 — — Ice cream premises .. 229 131 3 — — — Wharves where food is prepared or stored, etc. 8 24 — — — — Fried Fish Vendors, etc. 290 339 209 8 __ 156 Market Inspections:—Morning, 87; Evening, 69. Slaughterhouses: 354 visits. Number of Carcases inspected: 2384 (а) Satisfactory 2369 (б) Unsatisfactory 15 (c) Condemned and destroyed or otherwise disposed of (included in (b) above) 2 and parts of 13 Number of Samples procured:— Formal. Informal. Total. (a) Under Sale of Food and Drugs Acts: (i) Number genuine 247 99 346 (ii) Number adulterated 14 13 27 (iii) Number poor quality, etc. (included in (i) genuine above) — — — (6) Under Special Orders and Regulations: (i) Number satisfactory 41 — 41 (ii) Number unsatisfactory 10 — 10 Action taken in respect of unsatisfactory samples:— (i) Summonses applied for 2 — 2 (ii) Letters of caution sent to vendors .. 7 — 7 (iii) Reported to Ministry of Agriculture, etc. — — — Public Health (Foreign Meat) Regulations—Certificates issued by M.O.H. 221 (182 visits to factories). 69 Foodstuffs Inspected for Export. Tons. cwts. qrs. lbs. Fores of Beef (Argentina) 3 16 2 6 Fores of Veal (Argentina) 1 8 2 10 Hinds of Beef (Argentina) 1 0 3 16 Fores of Veal (Uruguay) — 5 3 5 Real Oxford Sausages and Oxford Sausages (Great Britain) 23 9 0 0 Beef, Steak Meat (Argentina) 1 3 3 26 Fores of Beef (New Zealand) — 1 3 13 Sows (Great Britain) 4 3 2 18 Boiled Beef (Australia) — 12 3 12 Corned Beef (Paraguay) — 9 2 16 Real Cambridge Sausages and Cambridge Sausages (Great Britain) 4 0 0 0 Ox Kidneys (Canada) — 3 1 6 Bacon, Belly Pieces (U.S.A.) 8 18 2 24 Hams (U.S. America) 13 0 0 20 Bacon, Middle Pieces (Great Britain) — 5 1 0 Tongue Meats (Uruguay) 1 18 3 22 Pork Sausages (Great Britain) — 6 — — Fore Ends Bacon (Denmark) — 1 1 1½ Vienna Sausages (Great Britain) — 4 2 25 Gammons (Denmark) — 5 2 11 Hams, Jong cut (U.S. America) 8 15 2 3 Hams, North Star (U.S. America) 2 5 — 10 Bacon Sides (Denmark) 1 — — — Ox Tongues (Uruguay) — 8 2 18 Fowls (Great Britain) 1 12 3 26 Sheep (New Zealand) — 19 0 18 Turkeys (France and Czecho-Slovakia) — 5 3 5 York Hams (Great Britain) — 5 1 20 Real York Hams (Great Britain) — 13 2 2 Bellies of Bacon (Denmark) — — — 24 Middles of Bacon (Denmark) — 8 — 3 Ox Tongues (Argentina) 2 3 0 8½ Turkeys (Argentina) — 5 1 13 Short Fores Beef (Australia) — 3 — 10 Foodstuffs Destroyed. (a) Condemned at Slaughterhouse Inspections:— Cwt. qrs. lbs (i) Beef 15 1 8 Pork — 2 15 (ii) Organs condemned and destroyed:— BovineLungs, 109; Livers, 54, and parts of, 16; Mesenteries, 49, and parts of, 12; Omenta, 26, and parts of, 10; Pancreas, 25; Spleens, 13; Tripes, 8; Udders, 42; Kidneys, 10; Intestines, 3; Hearts, 4. Sheep:—Lungs, 362; Livers, 55; Spleens, 2; Hearts, 2. Pigs:—Lungs, 105; Livers, 12; Mesenteries, 22; Omenta, 7; Spleens, 5; Pancreas, 3; Heart, 1. Heads and Tongues:—Bovine, 30; Pigs, 18. 70 {!>) Surrendered by owners as being unsound, or seized while exposed or deposited for sale:— Beef Pieces, 27 lb.—Surrendered and destroyed. Salmon, 1 tin.—Surrendered. Onions, 3 tins.—Surrendered. Lard, 4 lb.—Surrendered. Skate, 2 trunks. Weight, 1 cwt. 1 qr. 4 lb.—Surrendered. Hams, 34. Weight, 3 cwt. 0 qr. 4 lb.—Surrendered. Liver (Pig's), 1. Weight, 4 ½ lb.—Surrendered. Strawberries. Weight, 17 cwt. 3 qr. 21J lb.—Surrendered. Pine Cubes (96 tins).—Surrendered. Fowls, 41. Weight, 1 cwt. 0 qr. 12 lb.—Surrendered. Haddock, 1 trunk. 1 qr. 4 lb.—Surrendered. The following were released for technical purposes:— Wheat (damaged), 332 lb.—For pig feeding. Hams, 1 case.—Released for export. Dessicated Coconut, 7 cases. Weight, 9 cwt. 1 qr. 14 lb.—Released for crushing. Sugar Sweepings, 1 bag.—Released for reconditioning. Dried Fruits, 69 cases and 6 half-cases.—Released for vinegar manufacture. Dried Fruits, 14 cases.—Released for reconditioning. Condensed Milk, 24,000 tins.—Released for pig feeding. Tea Sweepings, 30 cwt.—Released for technical purposes. Tallow, 5 casks.—Released for technical purposes. MR. H. A. PEARCE. (Inspections for 1928 in italics.) Premises. Inspections. Intimations. Notices. Final Notices. Prosecution!.[### 1929 1928 Bakehouses 152 124 73 3 Slaughterhouses 27 7 11 — — — Cowhouses 25 16 — — — — Milkshops 169 171 4 — — — Eating-houses 136 92 20 3 — — Stalls 1,439 877 — — — — Other places where food is sold or prepared 559 391 21 3 1 — Ioe cream premises 224 66 9 2 — — Wharves where food is prepared or stored, etc. — — — — — — Fried Fish Vendors, etc. 255 231 173 1 — — 232 Market Inspections:—Morning, 151; Evening, 81. 71 Slaughterhouses:—298 visits. Number of Carcases inspected: 2291 (а) Satisfactory 2281 (б) Unsatisfactory 10 (c) Condemned and destroyed or otherwise disposed of (included in (6) above) .. 1 and parts of 9 Formal. Informal Total. Number of Samples procured:— (а) Under Sale of Pood and Drugs Acts: (i) Number genuine 268 107 375 (ii) Number adulterated .29 16 45 (iii) Number poor quality, etc. (included in (i) genuine above) 12 1 13 (б) Under Special Orders and Regulations * 44 — *44 (ii) Number unsatisfactory 9 — 9 * 1 reported as suspicious. Action taken in respect of unsatisfactory samples :— (i) Summonses applied for 10 — 10 (ii) Letters of caution sent to vendors 16 — 16 (iii) Reported to Ministry of Agriculture, etc 6—6 Public Health (Foreign Meat) Regulations—Certificates issued byM.O.h18 (12 visits to factories). Foodstuffs Inspected fob Export. Tons. cwt. qrs. lbs. Real Oxford Sausages (Great Britain) 1 — — — 16 Bags of Ox Tongues (Argentina) — 12 2 21 3 Boxes Hams (U.S.A.) — 13 3 27 4 Forequarters Beef (Argentina) — 6 2 6 3 Boxes Bellies of Bacon (U.S.A.) — is 3 9 3 Fore-ends of Bacon (Denmark) — — 1 20 20 Fores of Veal (Argentina) — 12 3 10 5 Sows (Great Britain) — 16 3 14 136 Fowls (Great Britain) — 3 2 23 3 Cases of Turkeys (Argentina) — 1 3 0 Foodstuffs Destroyed. (a) Condemned at Slaughterhouse Inspections:— (i) Beef:— (6 briskets; 9 flanks; 3 fore-ribs; 7 back ribs; 9 thin skirts; 3 thick skirts; 2 rumps; 4 loins; 1 forequarter; 1 whole carcase; 1 clod and sticking). Pork (3 fore-ends; 1 leg; 4 loins; 2 bellies). Total Weight 12 cwt. 0 qr. 13 lb. (ii) Organs condemned and destroyed:— Bovine:—Lungs, 92; Livers, 55, and parts of, 4; Mesenteries, 34, and part of, 1; Omenta, 30; Pancreas, 18; Spleens, 9; Tripes, 11; Udders, 31; Kidneys, 10; Intestines, 3; Hearts, 2. Sheep:—Lungs, 539; Livers, 119; Spleens, 3; Heart, 1. Pigs:—Lungs, 101; Livers, 16; Mesenteries, 16; Omenta, 5; Kidneys, 4; Hearts, 6; Spleens, 4. Bovine Heads, 38; Tongues, 39. Pigs'Heads and Tongues, 14. 72 (6) Surrendered by owners as being unsound, or seized while exposed or deposited for sale:— Rock Salmon, 1 box. Weight, 60 lb.—Surrendered. Biscuits, 4 lb.—Surrendered. Fruit, 3 tins.—Surrendered. Pears, 13 lb.—Surrendered. Condensed Milk, 2 tins.—Surrendered. Plums, 16 lb.—Surrendered. Ostend Rabbits. Weight, 1 qr. 7 lb.—Surrendered. Mutton, 6 Shank Ends, Shoulders.—Surrendered. Pigs' Heads, 3 halves.—Surrendered. Haddock, 1 trunk, Weight, 64 lb.—Surrendered. Candied Peel, 1 box.—Surrendered. Crystallised Pears, 1 box.—Surrendered. Dripping, 3 lb.—Surrendered. Bovine Liver, 1. Weight, 9J lb.—Surrendered. Assorted Biscuits, 11 lb.—Seized and condemned. The following were released for technical purposes:— Mutton, 65 carcases.—Released for soap-making. Tallow, 189 casks.—Released for soap-making. Tallow (loose), 7 lots.—Released for soap-making. Pig and Ox Tongues, 46 casks.—Released for soap-making. Condensed Milk, 458 cases (each 4 doz. 1 lb. tins).—Released for confectionery making. Condensed Milk, 104 cases (each 1 doz. 4 lb. tins).—Released for confectionery making. Evaporated Milk, 165 cases.-—Released for cattle food. Damaged Wheat, 693 lb.—Released for cattle food. Corned Beef, 592 tins.—Released for fat boiling. Pressed Beef, 64 tins.—Released for Fat Boiling. Rolled Beef, 68 tins.-—Released for fat boiling. Ox Tongues, 18 tins.—Released for fat boiling. 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. CERTIFICATION OF CERTAIN FOOD PRODUCTS FOR EXPORT TO THE DOMINIONS AND FOREIGN COUNTRIES. In view of the requirements of the Food Laws in operation in the Dominions and elsewhere, the system of certification for food products which are derived from the flesh of cattle, sheep, swine or goats, or from game or poultry, and are prepared or packed in England and Wales for export, has been continued. Certificates were issued in connection with 239 consignments of foodstuffs: Canada (85), Australia (90), United States of America and Dependencies (35), Venezuela (15), other countries (14). 73 194 visits were paid to factories in connection with the above. For details of foodstuffs inspected for export, see pp. 69 and 71. The Medical Officer of Health reported to the Public Health Committee that for the last 20 years, viz., from 1909, Meat Products prepared in this country for export have to be certified by the Medical Officer of Health that they comply with the food laws of Great Britain and of the country to which they are being despatched, and are fit for human consumption. This work involves the inspection of raw materials and the finished products, and entails a considerable amount of time on the part of the Food Inspectors. Recently, certain countries required such certificates for other products besides Meat Products. There are in this Borough three firms preparing Meat Products, as well as other products, and at least one other firm dealing with food products other than Meat. During 1928, the number of inspections and certificates issued were as follows:— Visits for Inspections 173 Certificates 260 In view of recent requirements of certain foreign countries, the Medical Officer of Health interviewed Medical Officers of the Ministry of Health and also communicated with the firms concerned. He suggested that, in future, a fee of 2s. 6d. should be paid for certificates covering each batch of finished products. Further, the following form of certificate should be furnished to the Medical Officer of Health by each firm:— We Hereby Certify: (1) That all foodstuffs specified on Meat Certificates issued by us comply with the food laws of the various countries to which they are consigned. (2) That the inspected, finished products shall not be altered or interchanged in any respect after being passed by the Food Inspector, and that records shall be kept to enable identification of the products for which certificates are issued. Signature 74 At the same time, each firm should agree to the following conditions:— (1) The firm's Chemist to give the Medical Officer of Health a certificate of purity of goods specified in the Medical Certificate. (2) That the firm will be prepared to pay for examination of any samples submitted by the Food and Drugs Inspector to the Public Analyst for examination from time to time. (3) When goods are being sent to countries where a certificate is required to state that foodstuffs must comply with the laws of that country, in addition to the laws of Great Britain, and where the foodstuffs have not been packed in this country but merely re-labelled, it may be necessary to have a statutory declaration from the firm stating that the goods comply with the terms of the certificate required. The Council approved of the suggestions of the Medical Officer of Health. PUBLIC ANALYST'S ANNUAL REPORT. During the year 1929, 801 samples were examined under the Sale of Food and Drugs Act. All of these were submitted by the Inspectors. 234 of the samples were purchased informally. 70 of the samples were found to be adulterated and, in addition, 28 samples were of inferior quality or doubtful purity. The adulteration for the past 10 years was as follows:— Year. No. of samples examined. Percentage of adulteration. 1929 8ox 8.7 1928 807 11.0 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 773 5.8 75 It will be observed that the proportion of adulterated samples which had been steadily increasing has now fallen. The average adulteration for the London Boroughs during 1928 was at the rate of 3.52 per cent., and for the whole of England and Wales, 5.8 per cent. The number of samples examined was in the ratio of 4.94 per 1,000 of the population, as compared with an average of 8.99 per 1,000 for the London Boroughs, and 3.4 per 1,000 for the whole of England and Wales. Preservatives . The following samples were found to contain preservatives:— Article. Number examined. Percentage preserved. Dried fruit 6 50.0 Fresh meat 6 16.7 Lemon squash 2 50.0 Lime juice cordial 2 50.0 Malt vinegar 9 33.3 Sausage 12 25.0 Sweets 10 20.0 Tapioca 1 100.0 Total 48 31.3 The number of samples containing preservatives shows a considerable decline on previous years. In only 5 of these cases were there contraventions of the Preservatives Regulations. The practice of polishing rice grains with talc or French chalk, which appeared to have disappeared for some years, was again noticed. Four of the 8 samples examined contained small amounts of talc. Two samples of sweets were also found to have been treated with talc. Milks . 410 samples of milk were examined, of which 16 were found to be adulterated. This is at the rate of 3.9 per cent. In the previous year, 4.4 per cent. were found to be adulterated. The quality of the milk supply generally was good, the composition being well up to average. 76 Grade "A" Milks. 99 samples of Grade "A" (Tuberculin Tested) Milk taken by the Inspectors were examined bacteriologically. 15 samples, or 15.2 per cent., were found to be unsatisfactory. This, however, is an improvement on the previous year, when the proportion of Inspectors' samples found to be unsatisfactory was 27.1 per cent. In 8 cases the unsatisfactory condition was due to the presence of Bacillus coli, in 5 cases to the presence of an excess of total organisms, and in 2 cases both Bacillus coli and an excess of organisms were present. 32 of the samples were taken in course of delivery, either at the Railway Station or at the Bottler's premises, and 67 were taken after bottling. In 3 cases the milk taken on delivery was unsatisfactory. In 2 cases it was found that the milk taken on delivery was satisfactory, but that the same milk after bottling was unsatisfactory. The total number of organisms found varied from 55 to 400,000 per i c.c. In 76 cases the number was below 100,000. In 54 cases it was below 10,000, and in 25 cases it was below 1,000. In addition to these, 5 samples were examined privately for the Bottlers, of which 4 were found unsatisfactory. 2 samples of Pasteurised Milk were also examined, 1 taken by the Inspectors and 1 submitted by a Bottler. Both of these milks were satisfactory. Other samples examined were:— For the Public Health Department— 6 samples of Electrolytic Fluid. 1 sample of Condensed Milk, examined bacteriologically, at the request of the Coroner. ALBERT E. PARKES, F.I.C., Public Analyst. 77 THE SALE OF FOOD AND DRUGS ACTS. The results of the analyses of 801 samples were reported to the Committee during the year:— Sample. Number examined, 1929. Adulterated. Action taken. Legal Proceedings.* Letters of caution sent. Milk 410 16 9 5 ,, Dried — — — — ,, Condensed 15 1 — — Cream 4 — — — Butter 47 4 1 3 Margarine 46 5 — 5 Cheese 4 — — — Dripping 18 4 — 2 Lard 12 3 — 1 Shredded Suet — — — Mustard 5 2 1 1 Pepper 8 — — — Malt Vinegar 9 2 1 — Vinegar 28 7 3 — Sauce 1 — — — Cocoa 6 — Coffee 6 — — — Coffee and Chicory — — — — Coffee and Chicory Essence — — — — Cornflour 4 — — — Rice 8 — — — Ground Rice 2 — — Pearl Barley 8 — — — Sago 1 1 — 1 Oatmeal 2 — — — Flour — — — — Self-raising Flour 4 — — — Ground Ginger 2 — — — Baking Powder 4 — — — Custard Powder 2 — — — Chocolate — — Cake 3 — Jam 11 — — Tapioca 1 — — — Table Jelly 4 — — — Lemon Curd — — — — Golden Syrup 4 — — — Tea — — — — Sugar — — — — Sweets 10 2 — 1 Dried Fruit 4 — — — Cyder — — — — Zinc Ointment — — — — Boracic Ointment — — — — Sulphur Ointment — — — — Milk of Sulphur — — — — Lime Water 2 — — — Carried forward 695 47 15 19 78 Sample. Number examined, 1929. Adulterated . Action taken Legal Proceedings.* Letters of caution sent Brought forward 695 47 15 19 Camphorated Oil 4 — — — Cream of Tartar — — — — Glycerine — — — — Lime Juice Cordial 2 — — — Lemon Squash 2 — — — Lemonade 3 2 — 1 Lemonade Crystals 2 — — — Soda Water — — — — Ginger Wine 2 1 — — Gin 2 — — — Whisky 9 5 — — Rum 1 — — — Beer — — — — Mincemeat, Fruit 2 — — — Meat Pie — — — — Meat Paste 2 — — — Brawn — — — — Sausage 12 2 — 1 Fresh Meat 6 1 1 — Beans and Pork I — — — Bacon — — — — Fish Paste 2 — — — Cordials 1 — — — Olive Oil — — — — Table Salt — — — — Bread and Butter — — — — Tea Dust 2 — — — Ground Cinnamon 5 3 — — Orange and Quinine Wine 2 1 — 1 Borax 2 — — — Citric Acid 2 — — — Crushed Linseed 2 — — — Jelly Crystals 4 — — — Formalin 3 1 — — Hydrogen Peroxide o — — — Pickles 3 — — — Egg Powder 2 — — — Gregory's Powder 2 2 — — Calomel Ointment 2 — — — Carbolic Ointment 5 4 — 1 Salicylic Ointment 2 — — — Oil of Turpentine 2 — — — White Pepper 2 — — — Mixed Spice 2 — — — Sultanas 2 — — — W ine 1 — — — Liniment 2 1 — — Ice Cream 2 — — — Totals, 1929 801 70‡ 16 23 Totals, 1928 807 89† 19 31 * See pages 79-82. †Including 34 informal samples. ‡ Including 28 informal samples. 79 Of the samples of milk, 38 were procured from itinerant vendors on Sundays and 149 from itinerant vendors on weekdays. Two samples were adulterated and a letter of caution was sent to the vendor. Samples of milk were taken on delivery as follows:—Poplar Institution, 5; Poplar Hospital, 4; St. Andrew's Hospital, 4; Bromley House Institution, 4. Two of these samples were adulterated. A letter of caution was sent in one instance, and in the other a report was sent to the Institution Authority. Thirty-seven samples of milk were taken on delivery at Railway Stations (21 Grade A (Tuberculin-tested) milk and 16 other samples). FOOD AND DRUGS (ADULTERATION) ACT, 1928. Administrative Action Taken Respecting Samples Reported to be Not Genuine. March Quarter, 1929. Sample No. Article. Result of Analysis. Action Taken. P.7 Sago Tapioca Letter of caution. P.19 Butter 16.5 per cent. water Letter of caution. B. 2 (Inf.) Dripping 2.8 per cent. free fatty acids Formal sample, G.12. G. 12 Dripping 2.8 per cent. free fatty acids Letter of caution. G. 13 Milk 26.6 per cent. deficient in fat £1 penalty; £1 1s. costs. *P. 25 Milk 10 per cent. deficient in fat Summonses dismissed. Magistrate held milk was sold as given by cow. *P. 26 Milk 6.6 per cent. deficient in fat *P. 27 Milk 6.6 per cent. deficient in fat A. 14 (Inf.) Lard 50 per cent. beef fat Formal sample, P. 42. (Genuine.) P. 40 Butter 16.4 per cent. water Letter of caution. P. 45 Milk 26.6 per cent. deficient in fat £4 penalty; £1 1s. costs. P. 47 Orange & Quinine Wine Alcohol absent, and 52 per cent. deficient in quinine Letter of caution. G. 62 Milk 2.3 per cent. deficient in fat Letter of caution. A. 31 (Inf.) Ginger Wine Alcohol absent Formal sample taken. (Similar result—Letter of caution.) G. 67 Condensed Milk 5 per cent. deficient in fat Further sample to be taken. *These samples were taken in course of delivery at a Railway Station. 80 June Quarter, 1929. Sample No. Article. Result of Analysis. Action Taken. A. 34 (Inf.) Vinegar 5 per cent. deficient in acid Formal sample, P. 77. P. 77 Vinegar 5 per cent. deficient in acid See P. 84. P. 84 Vinegar 6 per cent. deficient in acid Summons dismissed; "warranty" upheld. A. 37 (Inf.) Vinegar 5 per cent. deficient in acid Formal sample, P. 84. A. 39 (Inf.) Dripping 4.1 per cent. free fatty acids Formal sample, P. 89. P. 89 Dripping 4.1 per cent. free fatty acids Letter of caution. G. 83 Lard 4.3 per cent. free fatty acids Letter of caution. B. 35 (Inf.) Lard 4.3 per cent. free fatty acids Formal sample, G. 83. B. 37 (Inf.) Formalin 5 per cent. deficient in formaldehyde Formal sample, G. 94. (Genuine.) P. 93 Butter 10½ per cent. foreign fat Adjourned sine die (3rd portion to Government Analyst). P. 103 Margarine 16.1 per cent. water Letter of caution. G. 97 Milk 22 per cent. added water Summons. £3 penalty; £1 1s. costs. P. 122 Milk 5 per cent. deficient in fat Letter of caution. A. 66 (Inf.) Malt Vinegar Sulphur dioxide, 150 parts per million Formal samples, P. 131, P. 136. P. 136 Malt Vinegar Sulphur dioxide, 150 parts per million Wholesaler summoned. Dismissed. Offence held to be not wilful. P. 130 Vinegar 7.5 per cent. deficient in acid *Wholesaler summoned for giving false warranty. Dismissed. A. 65 (Inf.) Vinegar 7.5 per cent. deficient in acid Formal sample, P. 130. G. 129 Milk 2.3 per cent. added water Same vendor; letter of caution). G. 130 Milk 2.3 per cent. added water P. 146 Fresh Meat Sulphur dioxide, 142 parts per million Summons. £2 penalty; £1 1s. costs. *P. 130.—Magistrate held the vinegar was genuine at the time when warranty was issued. 81 September Quarter, 1929. Sample No. Article. Result of Analysis. Action Taken. B. 67 Lemonade Lemon essence absent Formal sample taken, G. 153. G. 153 Lemonade Lemon essence absent Letter of caution. B. 68 (Inf.) Vinegar 4 per cent. deficient in acid Formal sample taken, G. 154, which was genuine. P. 168 Butter 16.7 per cent. water Letter of caution. P. 170 Margarine 16.6 per cent. water Letter to vendor and reported to Minister of Agriculture. G. 166 Margarine 16.2 per cent. water No action. G. 166 Margarine Sold in unstamped wrapper Letter of caution. B. 75 (Inf.) Carbolic Ointment 20 per cent. deficient in carbolic acid Formal sample taken, G. 179. G. 179 Carbolic Ointment 50 per cent. deficient in carbolic acid Letter of caution. B. 76 (Inf.) Carbolic Ointment 45 per cent. deficient in carbolic acid Further informal sample taken, B. 81. B. 81 (Inf.) Carbolic Ointment 40 per cent. deficient in carbolic acid Formal sample taken, which was genuine. A. 93 (Inf.) Sausage Contained sulphur dioxide, 75 parts per million Formal sample taken, P. 192. P. 192 Sausage Contained sulphur dioxide, 22 parts per million Letter of caution. A. 94 (Inf.) Gregory's Powder 20 per cent. deficient in magnesia No action. G. 197 Milk 3.3 per cent. deficient in fat Institution authority informed. No further action. (Taken on delivery at Institution.) B. 82 (Inf.) Gregory's Powder 15 per cent. deficient in magnesia No action. 82 December Quarter, 1929. Sample No. Nature of Sample. Result of Analysis. Action Taken. P. 222 Margarine 16.8 per cent. water Letter of caution. P. 226 Milk 5 per cent. deficient in fat Letter of caution. A. 103 (Inf.) Sweets 0.25 per cent. talc. Formal sample taken. P. 232 Sweets 0.15 per cent. talc. Letter sent to vendor and wholesaler. G. 247 Mustard 20 per cent. starch Letter of caution. A. 110 (Inf.) Whisky 36 degrees under proof No action. A. 111 (Inf.) Whisky 36 degrees under proof No action. P. 257 Margarine 16.5 per cent. water Letter to vendor. A. 112 (Inf.) Whisky 40 degrees under proof Formal sample, P. 261, and informal sample, A. 114. P. 261 Whisky 36 degrees under proof No action. B. 111 (Inf.) Ground cinnamon 3 per cent. sand Attempt to procure further sample was unsuccessful. B. 112 (Inf.) Ground cinnamon 2 per cent. sand No action. A. 120 (Inf.) Ground cinnamon 2 per cent. sand No action. G. 303 Milk 3.3 per cent. deficient in fat Letter of caution. P. 298 Liniment of Turpentine 53 per cent. deficient in turpentine Summons. £2 penalty; £3 3s. costs. P. 7 Milk 10.5 per cent. added water Summons. £5 penalty; £5 5s. costs. Second and third summonses not dealt with by Magistrate. P. 8 Milk 10.5 per cent. added water P. 9 Milk 8.2 per cent. added water 83 Milk and Dairies (Consolidation) Act, 1915, and Amendment Act, 1922. Milk and Dairies Acts and Order . Sold sterilised milk otherwise than in a sealed bottle G. Garrett, 212, West Ferry Road Letter of caution. Ditto ditto L. Edmonds, 337, West Ferry Road Letter of caution. Sold milk otherwise than in a sealed bottle not being registered for the sale of milk L. Marsh, 155, Chrisp Street Letter of caution. Sold milk (sterilised) other than in a sealed bottle at 48, Gaselee Street, Poplar T. W. Rees, 100, Tunmarsh Lane, West Ham Letter of caution. Sold loose milk, but registered for sale of bottled milk only J. T. Smith, 17, Jodrell Road Letter of caution. Milk churns not properly cleansed at Milk Depot, Old Ford Thomas Bros., 10, Beale Road Letter of caution. Delivered milk in bottles which were not filled and closed on registered premises Arthur Gale, 5, Beale Road Fined £2, including costs. Filled bottles with milk in street G. Piercey, 278, St. Leonard's Road Letter of caution. Ditto ditto W. Clark, 7, Southill Street Letter of caution. Served loose milk while registered for sale of sterilised milk in bottles only Mrs. Ablewhite, 18, Ordell Road Letter of caution. Filled bottle with milk in street Mr. Griffiths, 155, Devons Road Letter of caution. Ditto ditto J. Palmer, 62, Abbott Road. (Roundsman.) Letter of caution. Ditto ditto J. Hitchman & Sons, 111, Kerbey Street. (Proprietors.) Letter of caution. Added water to milk M. Levy, 58, Alfred Street Summons. £3 penalty; £2 2s. costs. Sold milk to which water had been added Ditto £2 penalty; £2 2s. costs. Filled bottle with milk in street G. D. Newing, 10, St. Anne's Street, Limehouse Letter of caution. Unlawfully used as a dairy premises which were not registered Premises—67a, High Street, Bow Robert D. Steel, 384, Romford Road, Forest Gate Summons. £2 2s. costs. 84 Public Health (Meat) Regulations, 1924. Carried meat while not wearing a proper head covering Fred Pike. 42, Chalgrove Road, E.9. (Employee) Letter of caution. Ditto ditto Samuel Taylor & Sons, 88a, Tooley Street, S.E.I. (Employers of above.) Letter of caution. Bacon exposed for sale on stall which was not properly screened H. Bach, 92-94, Chrisp Street Letter of caution. 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 biscuits exposed for sale in Roman Road July 4th Condemnation Order made Pearce, H. A. Ditto July 23rd Fined £1 1s. 0d.; £2 2s. costs Pearce, H. A. Condensed milk, of which two tins were blown and unfit for human consumption exposed for sale on stall at corner of Armagh Road Mr. Israel, 38, Alfred Street Two tins surrendered and destroyed . Letter of caution. Unsound meat which was unfit for human consumption exposed for sale A. Bradstock, 34, Devons Road Meat surrendered and destroyed. Letter of caution. Flukey liver exposed for sale London Co-operative Society, Bow Branch Manager interviewed and cautioned. 85 Public Health (Milk and Cream) Regulations, 1912 and 1917. 1.–MILK; AND CREAM NOT SOLD AS PRESERVED CREAM. (A) Number of Samples examined for the presence of preservative. (B) Number in which preservative was reported to be present, and percentage of preservative found in each case. Milk 410 Nil. Cream 4 Nil. Margarine Act, 1887, Sale of Food and Drugs Act, 1899, and the Butter and Margarine Act, 1907. During the year two premises were registered for wholesale dealing in margarine. The following is the number of premises in the Borough registered under the above-mentioned Acts, up to and including 31st December, 1929, viz.:— Margarine. Butter. Wholesale Dealer. Manufacturer. Factory. Wholesale Dealer in Milk-blended. 20 — 4 — Agricultural Produce (Grading and Marking) Act, 1928. In 1928 the Council appointed the Medical Officer 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. The premises of Messrs. Fairfields, Limited, Gale Street, Bromley, were registered under section 4 (Storage of Eggs) of the Agricultural Produce (Grading and Marking) Act, 1928. 86 The Artificial Cream Act, 1929, which regulates the sale and manufacture of artificial cream received Royal Assent on 10th May, 1929, and came into operation on 1st June, 1929. Inter alia it is enacted that artificial cream shall not be manufactured, sold, or exposed, or kept for sale for human consumption except at premises registered with the Food and Drugs Authority. The powers under this Act were delegated to the Public Health and Housing Committee, and the Medical Officer of Health and Messrs. Grabham and Pearce (the two Meat and Food Inspectors) appointed the duly authorised officers under the Act. 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. Damaged Wheat. Quantities of damaged wheat were released by various Authorities to be used in this Borough for poultry food. Section VI. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. INFECTIOUS DISEASE. Notifications . 3,444 cases of Infectious Disease (Smallpox 157) were notified during the year. In addition there were 159 cases notified as Infectious Diseases (Smallpox 1), but in which the diagnosis was not confirmed. The notification rate was 21.5, compared with 16.1 in 1928, 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. TABLE VII. Notifiable diseases during the Year. (52 Weeks ended 28th December, 1929). Notifiable Disease. Cases Notified in Whole Borough. Total cases notified in each Sub-District. No. of Cases removed to Hospital from each Sub-District. Total Deaths in Age-Periods. Total deaths in each Sub-District. At all Ages. At Ages—Years. At all Ages. At Ages—Years. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards. Poplar. Bow and Bromley. Poplar. Bow and Bromley. Total Cases Removed. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards. Poplar. Bow and Bromley. Smallpox 157 2 3 1 4 5 36 29 18 37 14 7 1 79 78 79 78 157 1 1 — — — — — — — — — — — — 1 Cholera (C), Plague (P) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 494 8 31 35 57 44 215 61 17 19 4 3 — 309 185 308 185 493 17 1 2 1 3 1 6 2 — 1 — — — 11 6 Erysipelas 84 1 2 — 1 1 3 4 4 11 14 31 12 41 43 16 17 33 5 — — — — — — — — — — 3 2 1 4 Scarlet Fever 737 4 24 37 65 69 338 113 38 45 2 2 — 457 280 454 278 732 4 — — 1 — 1 — — 1 1 — — — 3 1 Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever 4 — — — — — — — — 3 1 — — 1 3 1 3 4 1 — — — — — — — — 1 — — — — 1 Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 12 — — — — — — — — 11 1 — — 6 6 6 6 12 4 — — — — — — — — 3 1 — — 1 3 Puerperal Pyrexia 10 — — — — — — — 1 7 2 — — 3 7 2 7 9 — — — — — — — — — — — — — — — Cerebro-Spinal Fever 4 — 1 1 — — 1 — — 1 — — — 4 — 4 — 4 — — — — — — — — — — — — — — — Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Acute Encephalitis Lethargica 12 — — — — — 2 1 1 4 2 2 — 6 6 4 5 9 6 — — — — — 1 — — 3 — 2 — 2 4 Ophthalmia Neonatorum 57 57 — — — — — — — — — — — 40 17 4 1 5 — — — — — — — — — — — — — — — *Zymotic Enteritis 149 53 39 9 5 5 14 — — 10 4 8 2 75 74 11 16 27 44 34 4 — — — 2 — 1 2 — 1 — 22 22 Anthrax 1 — — — — — — — — 1 — — — 1 — 1 — 1 — — — — — — — — — — — — — — — Pneumonia, Acute Primary 674 73 97 62 39 34 78 18 29 68 36 81 59 414 260 82 119 201 108 15 16 4 5 2 5 — 2 9 7 22 21 50 58 ,, Acute Influenzal 61 2 3 2 3 — 3 1 10 9 7 14 7 47 14 1 3 4 13 — 1 1 — — — — 1 1 1 4 4 8 5 Chickenpox 987 48 74 71 98 122 09 49 9 7 — — — 568 419 6 17 23 — — — — — — — — — — — — — — — Dysentery 1 — — — — — — — — — — 1 — 1 — 1 — 1 1 — — — — — — — — — — 1 — 1 — Totals 3444 248 274 218 272 280 1199 276 127 233 87 149 81 2052 1392 980 735 1715 204 51 23 7 8 4 14 2 5 21 9 33 27 99 105 This table does not include cases in which original diagnosis was not continued, N. B. —The deaths from Acute Primary Pneumonia are of notified patients only *Notifiable 1st June to 30th September. 87 Cases of the Commoner Infectious Diseases Occurring in Institutions. (This Table does not include cases admitted with the disease.) Notifications. Removals. Smallpox. Chickenpox Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Zymotic Enteritis. Smallpox. Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Zymotic Enteritis. Poplar Institution .. .. .. *1 .. .. 3 .. .. 1* .. .. .. St. Andrew's Hospital 2 12 †22 17 §5 1 8 2** 20** .. 5** 1** .. Bow Institution .. .. .. .. 1 .. .. .. .. .. 1** .. .. Bromley House Institution .. .. .. 2 .. .. .. .. .. .. .. .. .. Langley House, 54, East India Dock Road .. .. .. .. .. .. .. .. .. .. .. .. .. Poplar Hospital .. .. 1 .. .. .. .. .. 1** .. .. .. .. * Admitted to St. Andrew's Hospital. ** Removed to M. A.B. Hospitals. †6 Staff. §1 Staff. Infectious Diseases in Milkshops and Homeworkers' Premises. Two cases of infectious disease (1 Scarlet Fever and 1 Diphtheria) occurred in families connected with the sale of milk. The sale of milk was stopped until the premises were disinfected. The family contacts of the diphtheria patient were all swabbed, with negative results. One notice was served under Article 17 of the Milk and Dairies Order, 1926, where a person engaged in the milk trade had been a contact of a case of infectious disease. 14 cases of infectious disease occurred in homeworkers' premises— 1 smallpox, 5 diphtheria, 6 scarlet fever, 1 erysipelas and 1 enteric fever. 88 No notice was served under the Factory and Workshop Act, 1901, Sections 108 and 110. Where there was any risk of infection the work was discontinued, and any work found on the premises was disinfected before being returned. Cases of Notifiable Diseases Treated in Hospitals. Disease. M. A. B. Hospitals Poor Law Institutions . General Hospitals etc. Total Removals. Percentage of cases notified. Smallpox 157 — — 157 100. Chickenpox — 23 — 23 2.3 Diphtheria 489 3 1 493 99.3 Erysipelas — 32 1 33 39.3 Scarlet Fever 728 — 4 732 99.8 Enteric Fever 3 — 1 4 100. Puerperal Fever 7 3 2 12 100. Puerperal Pyrexia 3 6 — 9 90. Cerebro-spinal Fever — 2 2 4 100. Encephalitis Lethargica — 8 1 9 100. Ophthalmia Neonatorum 5 — — 5 8.8 Pneumonia Primary — 196 5 201 29.8 Pneumonia Influenzal — 4 — 4 6.6 Zymotic Enteritis — 22 5 27 18.1 Malaria — — — — — Dysentery — — 1 1 100. Anthrax — 1 — 1 100. Totals 1.392 300 23 1,715 49.8 N.B.—Cases reported to be "not suffering" have been excluded from above table. 89 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 75.0 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 1929 Cases 494 737 4 Deaths 17 4 1 Fatality Rate 3.4 0.5 25.0 90 SCARLET FEVER. The total notifications received numbered 812 and the total removals were 807. Of these, 75 cases were later certified to be not suffering from Scarlet Fever, leaving a total of 737 cases, the attack-rate being 4.6 per 1,000 of population. 4 deaths occurred, giving a fatality rate of 0.5 per cent. DIPHTHERIA. The total notifications received numbered 569 and the total removals to hospital were 568.75 patients were certified to be suffering from other diseases, leaving a total of 494 cases, the attack-rate being 3.1 per 1,000 of population. 17 deaths occurred, giving a fatality rate of 3.4 per cent. SCHICK TEST AND IMMUNISATION FROM DIPHTHERIA. DIPHTHERIA IMMUNISATION CLINIC. The Clinic was opened on 5th June, 1928, and is held at the Maternity and Child Welfare Centre, Wellington Road. The Medical Officer in charge is Dr. F. Porter-Smith, M.R.C.S. (Lond.), L.R.C.P. (Eng.). The number of children who have attended the clinic and their attendance during the year 1929 are shown below. Number of Schick tests 115 Number of children immunised 66 Number of children with natural immunisation 26 Number of children receiving immunisation treatment 39 Number of attendances 509 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. 91 (2) Reference to the work has been made in lectures and health talks. Further, the Medical Officer of Health with Dr. Chaikin, the Divisional Medical Officer of the London County Council, visited 13 schools (16 departments) and interviewed the Head Teachers. Further supplies of leaflets were sent for distribution after these visits, and in 8 departments further supplies for another distribution were sent 6 months later. The following is a statement submitted by the Medical Officer in charge of the Clinic:— The attendance at the Clinic is inclined to be spasmodic, and on the whole is rather disappointing, considering the gravity of such a mortal disease as Diphtheria, and the great boon that this preventative treatment offers. On careful consideration of the peculiar distribution of the Borough, I have little doubt that many find the clinic inaccessible; but it is difficult to see how this can be remedied without establishing further clinics, which is scarcely warranted with the present lack of response on the part of the parents. I feel that closer co-operation with the schools would materially assist the attendance of school children. The arrangements at Wellington Road Clinic are extremely satisfactory, and I hope the residents of Poplar will avail themselves of this important Public Service. DIPHTHERIA ANTI-TOXIN. 183,500 units of diphtheria anti-toxin were issued to medical practitioners during the year. The supply of anti-toxin is kept at the Public Health Office and is available day or night for the use of medical practitioners in the Borough. Care is taken to see that old stock is renewed in accordance with the instructions on each phial. ENTERIC FEVER. Six notifications were received and the patients were removed to hospital. Two patients were later certified to be not suffering from Enteric Fever, leaving a total of four cases for the year, the attack-rate being 0.01 per 1,000 of population. One death from Enteric Fever occurred, the fatality rate being 25 per cent. 92 BACTERIOLOGICAL EXAMINATIONS. 2,163 swabbings from doubtful cases of diphtheria were examined. Of these, 294 gave positive results (13.6 per cent.). 7 blood specimens from doubtful cases of Enteric Fever were examined. 6 gave negative results, and one gave a doubtful positive (serum in dilutions of 1/10 and 1/20, but not higher, agglutinate B. Typhosus. No agglutination of Para. Typh. A or B). These examinations were carried out at the Seamen's Hospital, Greenwich. SMALLPOX. The outbreak of Smallpox, which commenced in Poplar in March, 1928, continued its course in 1929, when 157 cases occurred. TABLE I. Showing Smallpox and Chickenpox Cases Notified during each month. (The Table does not include cases of Chickenpox reported by parents or others.) 1929. Month. Smallpox. Chickenpox. January 2 60 February 4 42 March 15 55 April 11 103 May 22 123 June 19 185 July 13 99 August 20 93 September 13 37 October 6 32 November 16 81 December 16 77 Totals 157 987 93 No sanitary district was immune, although Poplar South District suffered least, the chief centres of infection being Bromley North and Bromley Central Districts. The number of cases in each Sanitary District was as follows:— The incidence of Smallpox in houses is shown below. Cases. 79 houses in which i case of Smallpox occurred .. .. 79 16 ,, ,, 2 cases ,, ,, .. .. 32 >> .» 3 »> it m m '' 24 2 9, >>4 M > I •• ..8 1 house 1,6 ., ,, .. 6 1 ,, ,,8 ,, ,, .. .. 8 Total .. .. 157 Total number of cases .. .. .. 157 ,, ,, houses .. .. .. 107 In Table II it will be seen that of the 157 cases no less than 141 were unvaccinated, and that in this group practically all the cases occurred before the age of 35; whereas in the vaccinated group, almost all the cases occurred after the age of 35. The vaccinated cases were vaccinated once only—in infancy. East Combined 22 West Combined 28 Poplar South 3 Bromley North 40 Bromley Central 32 Bow East 15 Bow West 17 157 94 TABLE II. Showing the Ages, Sex and Vaccinated State of Cases of Smallpox Notified in Poplar during 1929. Ages. Under 5 years. 5— 10— 15— 20— 35— 45— 65 and over. All Ages. Vaccinated M. — — — — 1 3 3 1 8 F. — — — — — 3 4 — 7 Unvaccinated M. 7 21 13 6 17 1 — — 65 F. 8 15 16 12 18 7 — — 76 Doubtful (no marks) M. — — — — 1 — — — 1 F. — — — — — — — — — Totals 15 36 29 18 37 14 7 1 157 The type of the disease continued to remain mild, only one death occurring, and that in a premature infant whose mother had contracted the disease before confinement. The disease did not invade Common Lodging Houses or Casual Wards, cases coming only from private dwellings and hospitals. It is customary in Poplar for the Medical Officer of Health or one of his Assistants to visit every case of Smallpox with a view to confirming the diagnosis and to note, if possible, any change in type. Owing to the mildness of the epidemic and the fact that Chickenpox was also prevalent in the district cases of Chickenpox were visited, and the services of the Metropolitan Asylums Board's Consultants were frequently made use of and greatly appreciated. With the exception of the two under-mentioned cases, all the patients were seen by a Medical Officer of the Department before their removal to hospital:— (a) A child of 9 years was admitted to the London Hospital with Appendicitis on 16th May, and removed from there with Smallpox on 19th May. 95 (b) A girl of 12 years was removed to a Metropolitan Asylums Board Hospital with Scarlet Fever on 20th December; transferred to Smallpox Hospital on 23rd December. In addition to the 157 cases of Smallpox, 2 other patients were removed to South Wharf, but not accepted as Smallpox:— Case I. A. L.—Vaccinated on fourth day of husband's rash, i.e., day of his removal. Developed 4 papules 15 days after husband's removal. Removed for observation. Returned not Smallpox. Case II. J. H.—Removed with brother and sister from house in which there had been 4 previous cases. Removed for observation as he had papules on wrists and hands. Vaccinated (+) 12 days before removal. Returned not Smallpox after 10 days in hospital. The average age of the rash on day of removal to hospital was 3 days. The average stay in hospital was 23 days, being as short as 7 days in 1 case, and as long as 51 days in another. Age of Rash on Day of Removal. Days. 1. 2. 3. 4. 5. 6. 7. 8. 9. Total. Cases 11 40 42 32 18 5 1 3 3 155 ' 'Missed'' case from hopfields, 30-day rash 1 2 "Missed" case, 16-day rash 1 157 During the course of the year's work, the following impressions have been formed regarding the incubation period, initial symptoms, and interval between the onset and appearance of the eruption in the present type of the disease. 96 While the incubation period of 12 days was by far the most common, there would appear to be cases in which this time was prolonged. The commonest initial symptoms, given in order of their frequency, were:— Headache, Feverishness, Backache, Giddiness, Pains in Limbs. There appeared to be no very definite relationship between the severity of the initial symptoms and the amount of the rash; in fact, in one or two cases in which the rash was fairly profuse, the patients (children) gave no history of illness at all. The average interval between the onset of illness and the appearance of the rash was 3 days. In the great majority of cases the rash appeared on the second or third day, but cases have been examined daily in which the rash did not appear until the fourth or fifth day. When, however, the rash did appear, it tended to mature rapidly. The diseases seen when visiting suspected Smallpox cases have been:— Chickenpox, Measles, German Measles, Scabies, Impetiginous Eruptions, Drag and Serum Rashes, Acne and other skin conditions. In young babies, a papulo-vesicular eruption, mainly on the limbs and generally accompanied by gastro-intestinal disturbance and associated with teething, has been noted in several instances. SOURCE OF INFECTION. As mentioned in last year's Report, the mildness of the type of infection rendered the tracing of the sources of infection very difficult; in some instances the primary case in a house only being discovered when the contacts were examined. 157 NOTIFIED CASES. "Missed" case in house (Not notified—noninfectious when discovered). Primary case in house. Subsequent cases associated with primary cases. Not traced. Other cases in immediate neighbourhood. Probably Imported. In same house. Elsewhere in Borough. 16 22 6 30 54 45 97 Non-Resident Cases. During the year, no less than 55 cases of Smallpox were removed from the Out Patients' Department of Poplar Hospital. 52 patients resided in West Ham, and 3 in Stepney, and the majority of them were seen by the Medical Officer of Health or an Assistant. Slight "missed" or concealed cases, and it is almost impossible to say when a case has been concealed, have again been responsible for several little groups of cases. For example:— In March, a "missed" case attending school resulted in 11 cases. In July, a "missed" case accounted for 8 cases in one house. In December, a "missed" case caused quite a large group of cases affecting several families. ACTION TAKEN. (a) Each case was removed to hospital at once. The home contacts were removed to the Council's Shelter, where they were disinfected, examined, offered vaccination or re-vaccination, and returned after the house had been disinfected, in accordance with the suggestions contained in Memo. 71a (Med.) of the Ministry of Health, dated November, 1922. In May, 1929, circular letters re Smallpox were sent to Barbers and Hairdressers, Rag and Bone Dealers, Laundries and Receiving Offices, Pawnbrokers and Undertakers. 137 houses have been disinfected (including some more than once). 912 persons removed and disinfected. 7,187 articles, including beds, bedding and clothing, removed and disinfected. In connection with the conveyance of contacts to the Shelter, it might be mentioned here that the Morris vans used for removing infected bedding, etc., were adapted for transporting the contacts. 98 The question of providing a special vehicle for this purpose was considered early in 1930, and a special ambulance type of vehicle has now been provided. (b) Contacts.—During the year, no less than 4,796 contacts have been kept under observation; the total visits paid by the Sanitary Inspectors to those resident in the Borough numbered 22,059. This does not include contacts (Staff and Patients) in St. Andrew's Hospital. Of the 4,796 contacts visited, only 889 were vaccinated or re-vaccinated. In addition to following up contacts, 955 house-to-house inspections have been carried out in affected areas, and 3 cases of Smallpox found. 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. In July, a woman was summoned and convicted for obstructing the Medical Officer of Health in the execution of his duties. She withheld the name and address of a certain member of hei family who had been in close contact with her daughter, who was suffering from Smallpox. The contact ultimately developed Smallpox and infected other inmates of the house to which he had been removed. (c) 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 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. The number of visits paid by the Sanitary Inspectors to school absentees was 627. (d) Notification of Chickenpox.—The notification of Chickenpox was continued during 1929, and 1,084 cases reported:— 987 notified by medical practitioners. 61 reported by the school authority. 36 reported by parents. All cases notified as Chickenpox were visited by a member of the Medical Staff. This procedure resulted in the discovery of 13 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:— Number of Visits by Medical Staff. Reason for Visit Doubtful Smallpox. Chickenpox. Smallpox Contacts. School exclusions. Miscellaneous. Total visits by medical staff. Diagnosis S.P. C.P. Not S.P. or C.P.* S.P. C.P. Not C.P. or S.P. Medical Officer of Health (a) 63 16 68 8 585 31 453 (c) 140 194 1,558 (b) 11 — 5 — — — — — — 16 Tuberculosis Officer (a) 22 7 19 3 193 3 119 (d) 22 18 406 (b) 1 2 1 — — — — — — 4 Assistant Tuberculosis Officer 3 3 8 2 62 2 46 5 6 137 Total 2,121 Notes, (a) Poplar residents. (b) Non-residents seen at Poplar Hospital. (c) 47 persons found to be suffering from Smallpox. (b) 7 *Details of conditions found are referred to on page 96. 99 100 (e) Other Action.—As a result of the working arrangements between the Clerk to the Guardians and the Public Health Department, the closest co-operation existed between the Vaccination Officer and Public Vaccinators and the Department. VACCINATION. The proportion of contacts who accepted vaccination in the early part of the year (approximately 20 per cent.) tended to decline as the year went on, until at the end of the year few contacts were being vaccinated. It is unfortunate there is no means of compelling the vaccination of all persons who have been in contact with cases of Smallpox, subject to the certification by the Medical Officer of Health (or his Deputy), that it is necessary for the prevention of the spread of the disease. This qualification is advisable, since the case of Smallpox may be discovered too late for the vaccination to be of any protective value. The Vaccination Officer, Mr. P. Ryan, has kindly furnished me with the following particulars regarding vaccination in the Borough:— Extract from the Report of the Vaccination Officer, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1928, inclusive:— Registration Sub-Districts. Number of Births registered 1st Jan. to 31st Dec., 1928. Number of Births entered by 31st January, 1930, in "Vaccination Register." Number of Births which on 31st January, 1930, 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 1929. Number of Statutory Declarations of Conscientious Objection actually received during the calendar year 1929. 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 1675 245 — — 1016 73 7 13 43 278 2141 1631 Bow and Bromley 1054 156 — — 626 64 5 8 32 163 Total 2729 401 — — 1642 137 12 21 75 441 2141 1631 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. 101 102 The following analysis of the Vaccination Return reveals the fact that nearly 84 per cent, of the children whose births were registered in 1928 were not protected by successful vaccination:— Births registered 2,729 Deduct:— Died unvaccinated 137 Removals to other districts 21 Removals to places unknown, etc. 75 233 Surviving residents 2,496 Successful vaccinations numbered 401=16.1 per cent. Conscientious Objections declared 1,642 Vaccinations postponed on Medical Certificates 12 Number not accounted for 441 Total unvaccinated children 2,095=83.9 per cent. 2,496= 100 per cent. Public Health (Smallpox Prevention) Regulations, 1917. There were no vaccinations or re-vaccinations performed by the Medical Officer of Health during the year. For cases of Post-vaccinal Encephalitis, etc., see page 105. PLAGUE. No case of this disease was notified during the year. ANTHRAX, GLANDERS AND HYDROPHOBIA IN MAN. 1 case of Anthrax occurred. Patient had been unloading hides in Millwall Dock. He was treated as an In-patient at St. Andrew's Hospital, and later as an Out-patient at that hospital. 103 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. 84 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 12 10 Removed to M .A .B. Hospitals 7 3 Removed to other hospitals 5 6 Treated at home — 1 Specialist called in — — Deaths 4 — CONTINUED AND TYPHUS FEVERS. No case of continued fever occurred. No case of typhus fever occurred. CEREBRO-SPINAL FEVER. 5 cases of Cerebro-Spinal Fever were notified, 1 being subsequently certified as suffering from slight Cerebral Haemorrhage and not Cerebrospinal Fever. The 4 true cases were removed to hospitals. No deaths occurred. 104 ACUTE POLIOMYELITIS. 1 notification was received, but subsequently cancelled. ACUTE ENCEPHALITIS LETHARGICA. 15 notifications were received. In 3 cases diagnosis was not confirmed, leaving 12 true cases. 6 deaths occurred, including 2 non-notified cases— 1 an ex-Army pensioner, and 1 (post-vaccinal encephalitis lethargica) the subject of a post-mortem and inquest. 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, 34 cases were investigated. The following is a summary of the reports submitted:— Recovered or much improved and returned to work or school 11 In Institutions:— Mental Hospitals 2 Other Hospitals 4 Convent 1 - 7 Attending hospitals or otherwise undergoing treatment 9 Suffering from after-effects but not receiving treatment 4 Left the District 3 34 105 The 13 patients suffering from after-effects (excluding those in Institutions) were affected as follows:— Intelligence below normal 1 Sleep, poor or excessive, with defects of vision in one case 5 Paralysis—severe 1, slight 1 2 Conduct abnormal (very spiteful, tendency to become hysterical, bad tempered, etc.) 4 Suffering from after-effects of accident, otherwise apparently well 1 13 ACUTE POLIO-ENCEPHALITIS. No case of Acute Polio-Encephalitis was notified. POST-VACCINAL ENCEPHALITIS, Etc. 3 cases of Post-Vaccinal infection were reported. 2 of the cases were notified as Encephalitis Lethargica. 1 patient died in Poplar Hospital, and the other recovered. The cause of death was certified "Post-Vaccinal Meningo-Encephalitis." The third case was not notified. This patient also died in Poplar Hospital, the cause of death being certified as "Encephalo-Meningitis due to Vaccination.'' Reports on these cases were forwarded to the Ministry of Health. 1 other case was reported, but there was some doubt as to the diagnosis. This case was seen by a Medical Officer from the Ministry of Health. MEASLES. 1,059 cases of measles were reported to the Medical Officer of Health from various sources (principally from L.C.C. schools). 11 deaths were attributed to measles. During the year 152 cases of measles were admitted to M.A.B. Hospitals from the Borough. 106 The scheme for the control ot Measles is referred to on page 157. (Maternity and Child Welfare Section.) Pneumonia . 674 cases of Acute Primary Pneumonia and 61 cases of Acute Influenzal Pneumonia were notified during the year, 205 of the patients being treated in hospitals. 121 notified patients died—108 Acute Primary Pneumonia and 13 Acute Influenzal Pneumonia. Malaria . No case of Malaria was notified during the year. Dysentery. One case of Dysentery was notified. Patient died in the Seamen's Hospital, Greenwich. ALTERED DIAGNOSIS CASES. 159 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:— 75 Scarlet Fever; 75 Diphtheria; 2 Enteric Fever; 1 Encephalitis Lethargica; 3 Puerperal Fever; 1 Puerperal Pyrexia; 1 Cerebro-Spinal Fever; 1 Smallpox. The final diagnosis in the 75 Scarlet Fever cases was:— Tonsillitis 6 Tonsillitis and Otorrhoea 1 Erythema 24 Measles 11 Diphtheria 1 Dermatitis 1 Pityriasis, Streptococcal 1 Lobar Pneumonia 1 Nephritis 1 Disease not specified *28 75 *These were reported "Negative case", "Not notifiable", etc. 107 The final diagnosis in the 75 Diphtheria cases was:— Tonsillitis 24 Tonsillitis with Vincent's Angina 1 Vincent's Angina 2 Laryngitis 7 Pharyngitis 1 Measles and Laryngitis 1 Scarlet Fever 4 Broncho-Pneumonia 1 Broncho-Pneumonia and Empyema 1 Catarrh 1 Bronchitis 1 Stomatitis and Rheumatism 1 Dermatitis, with Otitis and Mastoiditis 1 Otitis Media, Otorrhoea and Avirulent K .L .B. 1 Disease not specified *28 75 *These were reported "Negative case", "Not notifiable", etc. The 2 patients notified as suffering from Enteric Fever were certified to be suffering from:—(i) Acute Diarrhœa; (2) Lobar Pneumonia, Incipient Gangrene of Lung. The final diagnosis in the case notified as Encephalitis Lethargica was Cerebral Syphilis. CANCER. The number of deaths from Cancer for the last five years is shown below:— Year. Males. Females. Total. 1925 104 87 191 1926 122 93 215 1927 120 120 240 1928 115 89 204 1929 114 96 210 108 Number of Heading in International Manual. Site of Primary Growth. Males. Females. Totals. 43 Buccal cavity 11 3 14 44 Pharynx, Oesophagus, Stomach, Liver and annexa 44 33 77 45 Peritoneum, Intestines and rectum 20 17 37 46 Female Genital Organs — 18 18 47 Breast — 13 13 48 Skin 2 2 4 49 Other or unspecified organs 37 10 47 Totals 114 96 210 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. TUBERCULOSIS. Report of Dr. W. C. P. Smith, Tuberculosis Officer and Assistant Medical Officer of Health. Information Required by Ministry of Health. (i.) A list of dispensaries, specifying also branch dispensaries and visiting stations; a list of the Tuberculosis Officers employed; a statement of the number of other officers employed in dispensary work; a list of residential institutions, specifying for each the number of beds normally available for patients from the area of the Local Authority, and the type of case for 109 which these beds are used. In the case of residential institutions belonging to the Local Authority, the names of Medical Officers and the number of other officers should be given. (а) Borough Tuberculosis Dispensary—1, Wellington Road, Bow, E.3. (б) Staff:- Tuberculosis Officer: W. C.P.Smith. Asst. Tuberculousis 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:— (a) Sanatoria, hospitals and homes available under the London County Council scheme for both pulmonary and nonpulmonary cases. (b) St. Andrew's Hospital. (Poplar Board of Guardians.) (c) Occasional In-Patient letters for hospitals or homes, obtained from charitable sources. (ii.) In the case of administrative counties, precise particulars of arrangements for co-operation with Sanitary Authorities and their officers. The London County Council is the County Administrative Authority. (iii.) The nature and extent of co-operation with general and special hospitals, school clinics, and other institutions. (a) General Hospitals.—The Dispensary is "linked" to the I.ondon 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. 110 These cases are treated on the authority of the Tuberculosis Officer, the cost of the treatment being charged to the Borough Council. During the year, 3 new cases and 3 old cases have been undergoing this treatment, a total of 167 applications of one or other form of light having been given. (b) Special Hospitals.—The Tuberculosis Officer is visiting physician to the tuberculosis wards of St. Andrew's Hospital. Patients requiring refills following upon the induction of artificial pneumothorax are by arrangement sent to either Brompton, Victoria Park, or other approved hospitals, a charge of 10s. 6d. being made for each refill. Eight patients have attended for this purpose, receiving altogether 103 refills. 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. Where this has not been possible, patients who have received treatment in the institutions of the Metropolitan Asylums Board have been referred to St. Margaret's Hospital, Kentish Town; while patients who have been at Loid 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. Co-operation with the School Medical Service, as explained in previous Reports, continues to work satisfactorily. Some 119 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. (iv.) Any special arrangements made to secure the co-operation of medical practitioners and the working of the arrangements for periodical reports on insured patients under domiciliary treatment. 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. 111 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. 631 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. 553 reports have been sent to, and 170 received from, panel doctors in respect of patients having "domiciliary" treatment. 196 patients were on ' 'domiciliary'' treatment on 31st December. (v.) The arrangements for following up patients in cases where the diagnosis is doubtful. Cases in which a diagnosis cannot be arrived at after a reasonable period of Dispensary observation, are referred to the London County Council for admission to Brompton or Victoria Paik Hospitals for further investigation. Cases of doubtful non-pulmonary tuberculosis are sent to the London Hospital, as are also a few cases of suspected pulmonary tuberculosis who are unable to accept offers of admission to hospital as in-patients. In other doubtful cases, where admission to hospital is not consideied necessary, arrangements are made foi the patient to attend the Dispensary again after a lapse of a suitable period of time, so that the case can be reconsidered. (vi.) The arrangements for securing the examination and systematic supervision of " home contacts." A list of all contacts is prepared by the Health Visitor of the district concerned, who arranges for their attendance at a convenient time for examination and, where necessary, re-examination. All contacts of school age are dealt with in co-operation with the School Medical Service. 363 contacts were examined, 194 being adults and the remainder children. (vii.) Information as to special methods of diagnosis and treatment in use and the number of persons to whom these special methods have been applied. The X-Ray ap paratus has continued in use for diagnostic purposes. Cases of special difficulty have been referred to the London Hospital for the opinion of their physicians. No special form of treatment has been in use. 112 (viii.) The results of local experience as to the relative value of each form of treatment. See 7. (ix.) The nature and extent of any dental treatment provided by the Council for tuberculous patients. Patients requiring dental treatment are referred to the Council's Dental Clinic, two sessions being held during the month for tuberculous patients. Particulars of the number of patients dealt with and the work carried out will be found in the Dental Surgeon's return. Arrangements for defraying the cost of dentures are made by the Care Committee. (x.) Any arrangements for the provision of nursing or of extra nourishment for patients living at home. The Council has power to provide nursing if required for children up to 10 years of age; for older children and adults no special provision is made, but the services of a district nurse are generally forthcoming. Extra nourishment in the form of Ambrosia (dried milk) and eggs has been granted to suitable cases on the same lines as previously. The grant is made for a period of 12 weeks, after which the case is reconsidered. Owing to the general worsening of economic conditions, there has been a further steady increase in the number of patients requiring this form of Dispensary assistance. 100 patients have been in receipt of extra nourishment for varying periods during the year. Of these, 49 were still receiving it on the 31st December. For the convenience of patients living in the southern end of the Borough, the weekly allowance can be drawn at Simpsons Road, Poplar, instead of at the Dispensary. (xi.) The arrangements for treating non-pulmonary tuberculosis, especially tuberculosis of bones and joints in adults and in children, and for the provision of surgical apparatus, etc. Non-pulmonary cases which can suitably be treated as outpatients are referred for treatment to the London Hospital under the arrangement already referred to. 113 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. The patient who was sent to Leysin in 1927 returned to this country in August, 1929. Her condition has very materially improved, and she is now able to get about, to some extent, by herself. The disease cannot yet be considered to be entirely arrested, and a short period of further treatment in this country has been recommended owing to the presence of a small superficial sinus. No special arrangements exist for the provision of surgical apparatus. Generally speaking, what is required is provided through the Almoner's office of the hospital where the patient has been under surgical treatment. In the event of any difficulty, the matter would be referred to the Care Committee for them to deal with. (xii) The arrangements for "care" and "after-care" and their working. Care and after care are in the hands of the Tuberculosis Care Committee. The Secretary reports as follows:— The Tuberculosis Care Committee continues to meet fortnightly at the Dispensary. During 1929, there were 24 meetings of the Care Committee and 8 meetings of the Committee of the Poplar Tuberculosis Fund. The attendance of the members has been very good, and an increasing interest appears to be shown in the work. There has been no decrease in the number of cases dealt with by the Committee. During the year, 214 assessment cases were investigated for the London County Council and contributions collected for them in paying cases. 15 dental cases were considered and 97 special cases dealt with. Thanks to the Committee's own fund, it was possible to make 71 grants to needy patients in the form of clothing for sanatorium and various other requirements. The Poplar Tuberculosis Fund is fortunate in continuing to receive contributions from local cinematograph theatres in respect of Sunday performances and these sums have been augmented during the year by various donations, and efforts to raise money on the part of the Care Committee and their friends. A dramatic entertainment took place in the early part of the 114 year, and the usual annual sale was arranged in the autumn. The Committee of the Poplar Tuberculosis Fund publish their own annual report, which gives a detailed account of their activities, together with their balance sheet. The Handicraft Class for ex-sanatorium patients, organised by the Tuberculosis Care Committee, continues to meet every week at the Dispensary, and is much appreciated by the members. A sale of the work of the Class was held before Christmas. The Committee were very grateful for the permission which was given to exhibit goods in the window of the Electricity Showrooms in Bow Road, and some sales have been effected by this means. The Tuberculosis Care Committee gratefully acknowledge the help they have received throughout the year from the various public and charitable institutions which are represented on it. Special mention should be made of the Poplar Branch of the Invalid Children's Aid Association, which undertakes a lot of work in connection with tubercular and pre-tubercular children. The Committee are also very grateful for the assistance given to tubercular patients by the Poplar Board of Guardians during their last year of office, and they hope that their successors will continue to show special interest in the care of those suffering from tuberculosis. (xiii.) Particulars as to any local arrangements for finding employment for patients. No further facilities for finding employment exist beyond those mentioned in previous Reports. A few of our patients have been employed during the year at the Spero Firewood Factory and 2 at the Spero Leather Factor}'. (xiv.) Statement as to the supply and supervision of shelters at the homes of patients. Shelters are provided on loan by the Borough Council in cases where there is suitable accommodation and the patient appears likely to make proper use of them. Two 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. 115 (xv.) Any special points noted locally as to the incidence of tuberculosis (i.e., occupation). No special occupational incidence has been noted. (xvi.) Any special methods adopted or proposed for the prevention of tuberculosis. No special methods have been adopted beyond those already mentioned in previous Reports. (xvii.) Special difficulties encountered. The lack of suitable employment for patients and of suitable accommodation for badly-housed patients and their families continue to be the chief difficulties encountered. STATISTICS FOR 1929. Attendances at Dispensary (Insured, 1,676; Uninsured, 2,866) 4,542 New Patients examined 931 Contacts examined 363 Notifications by Tuberculosis Officer (Pulmonary, 149; NonPulmonary ,18) 167 Patients sent away for Sanatorium Treatment 243 Patients away in Institutions, 31st December 85 Patients receiving Domiciliary Treatment, 31st December 196 Patients receiving Dispensary Treatment, 31st December 106 Under Observation, pending Diagnosis, 31st December .. 33 In receipt of Extra Nourishment during the year 100 In receipt of Extra Nourishment, 31st December 49 Health Visitors'visits 7,173 Doctors' visits 161 Sputum examinations made (Dispensary, 1,438; for Public Health Department, 373) 1,811 Reports sent to Private Practitioners, 576; Public Authorities, 809) 1,385 TUBERCULOSIS PATIENT AND TREATMENT AT LEYSIN. The patient who was sent to Leysin for treatment in February, 1927, returned home at the end of July, 1929. Dr. Smith, in reporting upon the patient's condition on return home stated, inter alia:— 116 "Although the case has shown marked improvement as the result of the treatment at Leysin, the girl is still badly crippled and must remain so, owing to the actual destruction of bone which had occurred and which cannot be replaced, so that she is never likely to be fit for any but the lightest kind of work.'' The patient had, unfortunately, other complications which delayed progress. TUBERCULOSIS DENTAL CLINIC. Report of Dental Surgeon. Mr. C. Hammond Williams, Dental Surgeon, submitted the following report:— At the Tuberculosis Dental Clinic during the year 1929:— 25 Sessions have been held. 76 Attendances. 4 Fillings. 11 Scalings. 199 Extractions. Dressings, Fitting of Dentures, etc. It will be observed that the number of sessions has been halved, two per month now being held, both of which are Anaesthetic Sessions. Our attendances are about the same in proportion, but such work as the fitting of dentures is made more difficult under these arrangements owing to the considerable time elapsing between the commencement and finish of the work. Owing to the difficulty of keeping touch with patients, by reason of their having been admitted to Sanatoria, etc., it is not possible to claim a very comprehensive service in this branch of our work. Another point I would like to mention is the inadvisability of making wholesale clearances at one sitting for some of the patients. Their condition is definitely against this, in fact there may be the possibility that extractions in some cases do more harm than good. If it could be arranged I would prefer the same member of the staff to assist regularly at the Clinic, as it seems to me that by having a rota of helpers we cannot co-ordinate properly. C. HAMMOND WILLTAMS, L.D.S., R.C.S. 117 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications received during the period 30th December, 1928, to 28th December, 1929. Age Periods. Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Form C. 0 to 1 1 to 5 5 to 10 10 to IS 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards . Total Primary Notification)*. Under 5 5 to 10 10 to 15 Total Primary Notifications. PoorLaw Institutions. Sanatoria. Pulmonary— Males — 1 2 :■ 11 21 20 23 28 12 1 128 222 — — — — — 2 120 Females — — 3 7 25 24 31 26 9 8 1 134 247 — — — — — 4 82 Non-Pulmonary— Males 1 11 16 3 9 2 2 1 1 1 1 48 59 — 1 — 1 2 8 13 Females 2 9 7 i 7 9 2 3 2 3 — 45 59 — — — — — 6 13 Totals 3 21 28 14 52 56 61 53 40 24 3 355 587 — 1 — 1 2 20 228 (continued over). Supplemental Keturn. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, during the period 30th December 1928, to 28th December, 1929, 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 case*. Pulmonary— Males - - - - 1 2 - 1 3 3 - 10 Females .. - - - - - 1 2 1 2 2 - 8 Non-pulmonary— Males 1 2 - - - - - - - - - - Females - - - - - - - - - - - - Source of Information. Number of Cases. Pulmonary. NonPulmonarv. Death Returns From Local Registrars 10 1 Transferable Deaths from Registrar-General 8 2 7 hese 21 deaths of non-notified cases are equivalent to 10'8 per cent, of the total deaths from Tuberzulosi*. Number of cases notified only after death:—Nil. 118 119 Analysis of 21 non-notified cases who died:— Pulmonary. NonPulmonary Condition discovered by post-mortem examinations .. .. .. .. .. 9 2 Other "inward transfers" (Hospitals, Mental Hospitals, etc.) .. .. .. .. 6 1 Certified by Medical Practitioners in Borough:— Private .. .. .. .. .. 2* — Institution .. .. .. .. if — 18 3 * Practitioner thought these cases had been notified by his predecessor (i case) and from elsewhere (i case). f Practitioner thought case had been notified prior to admission. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. It was not necessary to take any action under the above Regulations. 120 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 2,213 2,090 1,986 2,020 Number of New Cases notified 94 90 104 69 Number of Cases removed from Register 217 194 70 90 Number of Cases on Register at end of quarter. Pulmonary 1,440 1,376 1,400 1,383 Non-Pulmonary 650 610 6??? 0 616 Totals 2,090 1.986 2,020 1,999 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 - - 1 2 - - 2 1 1 — 1 — 11 9 1 — 5 — 5 — 2 3 17 7 1 — 2 — 10— 3 7 3 1 1 3 — 1 15— 11 25 9 7 2 13 1 2 20— 21 24 2 9 9 14 1 1 25— 26 31 2 2 17 23 1 — 35— 23 26 1 3 16 17 — 1 45— 28 9 1 2 20 11 1 — 55— 12 8 1 3 7 6 2 3 65 and upwards 1 1 1 — 5 3 1 — Totals 128 134 49 44 79 90 16 9 Deaths from Tuberculosis. It will be seen on reference to Table II. that the deaths were 169 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). 121 Heading in International Manual. Part affected. Number of Deaths. 32 Central Nervous System 10 33 Intestines and peritoneum 4 34 Vertebral column — 35 Joints 2 36 Other organs:— (a) Skin and subcutaneous tissues — (b) Bones (vertebral column excepted) 1 (c) Lymphatic glands (abdominal glands excepted) (d) Genito-urinary system 3 (e) Other sites — 37 Disseminated tuberculosis:— (a) Acute 1 (b) Chronic or unstated 4 25 HOP-PICKERS AND INFECTIOUS DISEASE. During the year, the Council were asked by some of the Authorities in the hop fields to accept responsibility for any case of infectious disease occurring amongst hop-pickers from the Borough, including the removal of the cases back to London. This question had also been considered by the London County Council, who had resolved:— "That, in the opinion of the Council, it is undesirable that London Public Health Authorities should accept responsibility for cases of infectious disease occurring amongst persons who go to districts outside London for hop-picking." The Council informed the Authorities that they could not accept responsibility for cases of infectious disease occurring amongst persons who go to districts outside London for hop-picking. 122 INFLUENZA. Leaflets upon Influenza were circulated through the Maternity and Child Welfare Centres and by the Health Visitors and Sanitary Inspectors. These leaflets were also distributed through all the schools in the Borough by permission of the London County Council. DISINFECTING DEPARTMENT. SUMMARY OF WORK DONE—DISINFECTING DEPARTMENT 52 Weeks ended 28th December, 1929. Poplar. Bow and Bromley. Totals. Premises Disinfected 1,393 740 2,133* ,, visited re Disinfection 747 546 1,293 *Does not include premises disinfected on account of Smallpox (137). Number of Verminous Rooms sprayed with Solution "D" 173. Articles Disinfected. Smallpox . Other Infectious Diseases. Tuberculosis Verminous. Miscellaneous. Totals. (а) From Infected mises 7,121 13,952 305 294 687 22,359 (b) From Cleansing Station — — 28 2,755 4,537 7,320 (c) From Contacts 13,824 43 — — — 13,867 (d) ,, Shelter 7,965 — — — — 7,965 Totals 28,910 13,995 333 3,049 5,224 51,511 Articles destroyed—By request, 308. Vermicide—Quantity issued from Depots, 305 gallons. Cleansing Station. Poplar. Stepney, etc. Totals. M. F. M. F. M. F. Verminous persons cleansed 18 - 34 - 52 - ,, children ,, 18 280 — - 18 280 Scabies cases, cleansed, adults 4 — — — 4 — ,, ,, children 7 103 — 9 7 112 Total cleansings 47 383 34 9 81 392 Number of children treated with special comb:—Boys, 18; Girls, 280. 123 Motor Vehicles. Vehicle. Speedometer register (miles). Petrol consumption (gallons). Average m.p.g. Blue Van 5377 403 13.3 Brown Van 2364 173½ 13.6 Lorry 5312 399 13.3 M.O.H.Car 7378* 397 18.6 Hired Car 307 28 11.0 •Speedometer of old Car not working for 8 weeks—mileage and petrol consumption not recorded. ELECTROLYTIC DISINFECTING 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 1929, 77,551½ gallons were manufactured. 136,805 gallons of the weaker solution were produced, which, with a balance of 180 gallons on hand at the beginning of the year, were distributed, a total of 136,985 gallons. The production of the solution at a strength of 4 grammes of available chlorine per litre has averaged 148,686 gallons per annum for three years at an average annual cost of £2,464, the cost per gallon thus being approximately 4d. Quantity Produced. As Manufactured As Issued. (i .e., Weaker Solution.) Electricity Consumed., Gallons. Gallons. Units. Old Plant 47,619 76,995 9,828 New Machine 29,932½ 59,810 12,384½ Totals 77.551½ 136,805 22.212½ 124 Distribution of Fluid. The fluid was distributed as follows:— galls. Violet Road Depot 53,062 Bickmore Street Depot 19,580 Old Ford Road Depot 10,910 Ford Road Depot 7,245 Trego Road Depot 6,405 Stebondale Street Depot 9,810 West Ferry Road Depot 3,120 Public Health Office 75 Poplar Baths 4,196 Bow Baths 4,223 Island Baths 2,124 Wick Lane Baths 665 Empson Street Baths 447 Open Air Bath, Bromley 1,219 Poplar Town Hall 114 Bromley Public Hall 112 Works Department 194 Guardians' Offices 126 Poplar Institution 7,470 Langley House 114 Poplar Training School, Hutton 87 Public Libraries 538 London County Council Schools 1,705 London County Council School Clinic 15 Mortuary, High Street, Poplar 405 Tuberculosis Dispensary 73 Royal College of St. Katharine 218 Council Offices, Poplar 80 Finance Department Offices 57 Kingsley Hall 78 Simpsons Road Clinic 105 M. and C. W. Centre, Wellington Road 171 M. and C. W. Clinic, West Ferry Road 33 Howrah House Convent 156 Bow Relief Offices 110 Electricity Department— Poplar Showrooms 5 Bow Showrooms 25 All Hallows'Vicarage 3 S. Mildred's House 51 Sold to Private Firms ia Borough, etc. 1,557 Used at premises where smallpox occurred 302 136,985 125 Cost of Materials and Electricity. The cost of materials and electricity for manufacturing the electrolytic fluid was as follows:— Electricity, 22,212½ units at 1½ per unit (with 50 per cent. advance) £ s. d. 242 19 0 Chloride of Magnesium, 7 tons, 15 cwts. 52 10 2 Salt, 30 tons, 5 cwts. 111 18 6 Caustic Soda, 19 cwt. 2 qtrs. 201b. 29 10 4 Water, 77,551½ gals 2 16 10 Total cost of materials and electricity to produce 77,551½ gallons (strong) broken down to 136,805 gallons 439 14 10 Electric motor for stirring; 366 units 3 8 8 Bottles, Corks and Labels. Bottles 21 16 4 Corks 15 9 0 Labels 8 5 0 £45 10 4 Total quantity of water used for all purposes, 558,000 gallons,cost £20 8s. 0d. 126 Total Quantity Manufactured since Installation of Plant. Since the installation of the plant, a period of 23 years, 1,195,984 gallons of fluid have been manufactured (see footnote) at a cost of for electricity £2,241 5s. 10£d., and materials £2,470 14s. 5d. 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† l66 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 1929 77,551½† 196 15 10 242 19 0 439 14 10 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 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 for distribution. Quantity distributed:— 1914 88,425 gallons. 1922 113,040 gallons 1915 73,970 1923 129,480 ,, 1916 53,580 1924 140,700 ,, 1917 55,800 1925 144,330 ,, 1918 61,500 1926 130,635 ,, 1919 66,570 1927 147,655 ,, 1920 78,510 1928 151,590 ,, 1921 102,660 1929 l36,805 ,, 127 EXTRACT FROM ANNUAL ESTIMATES, ETC. Electrolytic Disinfecting Fluid. Estimate for Year ended 31st March, 1929. Expenditure for Year ended 31st March, 1929. Average Expenditure for 3 years ended 31st March, 1929. Estimate for Year ending 31st March, 1930. Estimate for Year ending 31st March, 1931. £ £ £ £ £ £ £ £ £ Wages 1291 1268 1436 1277 1277 Rates Taxes and Insurance—Main Depot 108 102 106 100 92 Rent (Issuing Depots) 39 40 39 46 46 Electricity and Water 220 257 234 220 265 Chemicals 204 221 185 200 200 Testing Apparatus 5 5 5 Bottles, Carboys, Hampers, Corks, etc. 75 50 85 70 70 Overalls and Clogs 9 1 9 9 Supervision of Plant 15 15 15 15 15 Repairs and Renewal of Plant 60 33 56 50 70 Replacing part of Plant — — — 600 Repairs (Works Dept.) Main Depot 22 20 33 100 150 ,, ,, Issuing Depots 11 50 92 150 100 Petty Expenses and Sundries 2 1 3 5 Capital Account—Cost in excess of Loan — — 223 — — 2052 2065 2505 2245 2904 Less Income 25 49 41 25 30 2027 2016 2464 2220 2874 128 Spraying and Cleansing Floors of London County Council Schools with Electrolytic Disinfecting Fluid. 1,705 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. 4,196 gallons were supplied to the Poplar Baths, 4,223 gallons to the Bow Baths, 2,124 gallons to the Island Baths, and 1,219 gallons to the open-air swimming baths, making a total of 11,762 gallons. In November, burglars entered the main Electrolytic Depot and removed the platinum from a number of the electrodes. A month later the Depot was again entered, but nothing taken. In view of these occurrences, the old plant was dismantled by removal of the platinum, and the Medical Officer of Health considered whether the old plant (with its use of platinum) could not be efficiently replaced by additional cells in the new plant. Early in 1930 the Council agreed to the replacement of the old plant. VERMINOUS CHILDREN ATTENDING SCHOOLS, LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1907. CHILDREN ACT, 1908. Cleansing of Verminous Children. The cleansing of verminous children (under agreement with the London County Council), which had been suspended on account of Smallpox, was resumed on the 7th October, after consultation with the Divisional Medical Officer of the London County Council. Arrangements were made that when there were Smallpox contacts in the Shelter, there would be one female assistant with the School Nurse who would have nothing whatever to do with the Shelter. Also, the clothing from the children for disinfection is kept quite distinct and separate from the Smallpox disinfection work. 129 Number of Verminous Children Bathed. Quarter. Number of Children Cleansed. Total number of Cleansings. Amount. 1929. £ s. d. March Cleansing Nil Nil — June Station Nil Nil — September closed Nil Nil — December 327 420 36 6 0 Totals 327 420 £36 6 0 In 298 of the cleansings a special comb was used. (18 boys, 280 girls.) Cleansing Station. To enable the heads of children to be properly cleansed, a sink with a hot and cold water spray has been installed. Miss Davies made 98 visits in connection with verminous schoolchildren—12 Poplar, and 86 Bow and Bromley. For cleansing of verminous rooms, see table facing page 38. Scabies . Miss Davies made 88 visits in connection with children suffering from Scabies—74 Poplar, and 14 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, 65 persons—including 56 from common lodging houses (see below)—applied for baths and for their clothes to be disinfested . 130 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 — — — St. James's Chambers, 207, High Street, Poplar 13 — 13 65, Bow Lane 1 — 1 378, Old Ford Road — — — 38, Pennyfields — — — Salvation Army Home, Bow Road 1 — 1 15 — 15 From Common Lodging Houses without the Borough of Poplar 41 — 41 Totals 56 — 56 131 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 number of attendances at the Centres since their opening in 1920 is shown below:— 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 I925 31,540 17,809 1926 35,084 20,473 1927 36,110 23,588 1928 41,420 27,653 1929 38,504 28,250 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 number of Ante-Natal Clinics was increased by 2 per month—making a total of 10 per month. To cope with the work at the Dental Clinic, 2 additional sessions per month were started in February, 1929, one of the sessions being an anaesthetic session. There have been no further increases to the Clinics held during the year. 132 Maternity and Child Welfare. Extract from Form M.C.W. 96 (Ministry of Health). STATISTICS FOR THE YEAR 1929. Metropolitan Borough Council of Poplar. POPULATION according to the Census of 1921.—162,618. Births. Registered— (1) Legitimate (a) Live Births 3,000 (2) Illegitimate (a) Live Births 64 (6) Still Births 98 (6) Still Births 2 (3) Total (a) Live Births 3,064 (b) Still Births 100 Notified within 36 hours of Birth— (1) Live Births 2,546 (2) Still Births 77 (3) Total 2,623 (1) By Midwives 1,479 (2) By Parents and Doctors 576 (3) Institutions 568 Infant Deaths. Number— (1) Legitimate 221 (2) Illegitimate 10 (3) Total 231 Rate per 1,000 Births— (1) Legitimate 74 (2) Illegitimate 156 (3) Total 75 Maternal Deaths. Number of Women dying in, or in consequence of, Childbirth—- (a) From Sepsis—4. (6) Other causes—6. Health Visitors. Visits paid by Health Visitors during the year:— To Expectant Mothers (1) First Visits 1,310 (2) Total Visits 4,735 To Infants under 1 (1) First Visits 3,103 (2) Total Visits 23,853 To Children 1—5 Total Visits 45,198 Miscellaneous 1,331 Municipal Homes and Hospitals for Children under 5. Number of Beds—11. Number of Children under 5 received during the year—37. Total number of weeks spent in the Homes by such cases—340. Total Visits 75,117 MUNICIPAL CENTRES AND CLINICS. Address. Whether Sessions are held weekly, fortnightly, ete. Day and time of meeting. Average attendance per Session. Number who attended for first time. Present arrangements for Medical Supervision. Expectant Mothers. Children. Expectant Mothers. Children. Simpsons Road, Poplar Infant Consultation 2 weekly Wednesday, 10.30— 12.30, 2—4 p.m. — 62.3 — 287 Medical Officer present at all Infant Consultations, Ante - Natal Clinics and 1 Light Clinic weekly (Tuesday, 10.30 a.m.— 12.30 noon). Expectant Mothers 1 fortnightly to 15th April, 1 weekly since Mondays, 2—4 p.m. 14.2 — 194 — Light Clinic 5 weekly Tuesday, Thursday and Saturday, 9.30 —12.30, 2.30— 4.30 p.m. Mothers, 0.4 13.7 Mothers, 8 186 Sewing Class 1 weekly Monday, 2—4 p.m. Mothers, 19.4 — Mothers, 12 — Wesleyan Mission, Old Ford Road Infant Consultation 2 weekly Tuesday and Friday, 2—4 p.m. — 77.7 — 394 Medical Officer present at all Clinics. Expectant Mothers 1 weekly Friday, 10.30 a.m. —12".30 10.6 — 194 — Manchester Road, Poplar Infant Consultation 2 weekly Wednesday, 10.30— 12.30, 2—4 p.m. — 56.1 — 229 Medical Officer present at all Clinics. 54, West Ferry Road, Poplar Infant Consultation 1 weekly Friday, 2—4 p.m. — 55 — 138 Medical Officer present at all Clinics. Sewing Class 1 weekly Monday, 2—4 p.m. Mothers, 8.1 — Mothers, 10 — Wellington Road, Bow Infant Consultation 1 weekly Thursday, 2—4 p.m. — 79.8 — 290 Medical Officer present at all Infant Consultations, Ante-Natal Clinics and at 1 Light Clinic weekly (Friday 10.30 a.m. — 12.30 noon). Medical Officer attends Dental Clinic at Gas Session twice monthly. (Anaesthetist.) Special Infant Consultation Friday, 2—4 p.m. — 6.2 — 93 Dental Clinic 1 weekly and 1 fortnightly from 4th February Wednesday, 10.30— 12.30; Monday, 10.30—12.30 Mothers, 10.1 5 Mothers, 264 156 Light Clinic 6 weekly Monday, Wednesday, Friday, 9.30— 12.30, 2.30—4.30 Mothers, 0.7 16.5 Mothers, 23 228 Expectant Mothers 1 fortnightly Wednesday, 2nd and 4th, 2—4 p.m. 11.5 82 — 133 INFECTIOUS DISEASES. Number of cases notified. Number of cases visited. Arrangements made for nursing, and terms. Number of cases nursed. Number of cases removed to Hospital. Ophthalmia Neonatorum 56 56 12 5 Puerperal Fever 12 12 Nil. 12 Puerperal Pyrexia 10 10 Nil. 9 Measles and German Measles (children under 5) Not Notifiable Reported 982 Not Notifiable Reported 982 (1) East London Nursing Society (2) Nursing Sisters, St. John Divine (3) St. Mildred's District Nurses 12 152 Whooping Cough (do.) 531 531 8 80 Epidemic Diarrhoea (do.) 112 112 1 28 Poliomyelitis (do.) Nil. Nil. Nil. Nil. 134 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:— The following table shows the attendances at each of the Clinics during the year 1929:— Bow West Ferry Road. Manchester Road. Simpsons Road. Wellington Road. P.H. Dept. Total. Royal College of St. Katharin Total. Ante-Natal Clinics:— Attendances 540 — — 533 253 1,326 1322 Average per session 10.6 — — 14.2 11.5 11.8 26.4 Infant Consultations: — First attendances 394 138 229 287 290 1,338 968 Total attendances 8,005 2,806 5,721 6,356 3,829 26,717 16,033 Average per session 77.7 55. 561 62.3 79.8 65.8 68.2 Average attendance of each child 13.2 8. 10.8 12.8 7. 10.5 8.3 Light Clinics:— Attendances — — — 3,484 4,935 8,419 6,908 Average per session — — — 14.1 17.3 15.8 16.7 Dental Clinics:— Attendances — — — — 967 967 1,059 Average per session — — — — 15. 15. 9.9 Sewing Class — — 316 739 — 1055 1066 Garden attendances — — — — — — 1,706 Mothers' Clinic — — — — — — 16 Remedial Clinic — — — — — — 1140 Total attendances at all Clinics:— 1929. 1928. P .H. Department 38,504 41,420 Royal College of St. Katharine 28,250 27,653 Total 66,754 69,073 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, 10.30 a.m. to 12.30 p.m. and 2 to 4 p.m. Ante-Natal: Mondays 2 to 4 p.m. Sewing 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. Wesley an 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, 10.30a.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; first and third Mondays in each month. 10 a.m. to 12 noon. Special Clinic: (By appointment only) Fridays, 2 to 4 p.m. (6) 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 Medical Officer's Room and Large Hall for weighing and waiting Infant Consultations: Wednesdays, 2 p.m. Trinity Hall, Auausta Street Ditto Ditto Ditto Infant Consultations: Wednesdays, 2 p.m. STATISTICAL SUMMARY OF HOME VISITING FOR 1929. Public Health Department. The Royal College of St. Katharine. Total 1929. Total 1928. Cases. Visits. Cases. Visits. Cases Visits. Cases Visits. ???ite-Natal:— No. of Cases 703 — 607 — 1,310 — 1,230 — Primary visits — 703 — 607 — 1,310 — 1,230 Re-visits — 1,134 — 2,291 — 3,425 — 2,413 Infant Child Welfare visits:— Primary visits (Infants) — 1,445 — 1,420 — 2,865 — 3,037 Removed before visit — 24 — 40 — 64 — 74 Died before visit — 33 — 49 — 82 — 75 Stillbirths — 46 — 46 — 92 — 100 Re-visits— Under 1 — 7,824 — 11,189 — 19,013 — 20,232 1—5 — 20,068 — 23,020 — 43,088 — 44,779 Removed — 466 — 499 — 965 — 1,170 Died — 111 — 122 — 233 — 196 Ophthalmia Neonatorum:— No. of Cases notified 56 — — — 56 — 59 — Primary visits — 56 — — — 56 — 59 Re-visits — 124 — — — 124 — 132 Removed to Hospital 5 — — — 5 — 11 — Enteritis:— (a) No. of Cases reported 5 — — — 5 — 17 — (6) No. of Cases notified (Z.E.) 38 — 74 — 112 — 188 — (a) Primary visits — 5 — — — 5 — 17 Re-visits — 13 — 37 — 50 — 3 Removed to Hospital — — — — — — — — Died — 2 — 3 — 5 — 11 (b) Primary visits — 38 — 74 — 112 — 188 Re-visits — 38 — 138 — 176 — 286 Removed to Hospital 27 — — — 27 — 33 — Died — 8 — 8 — 16 — 22 sasles:— No. of Cases 553 — 429 — 982 — 1,320 — Primary visits — 553 — 429 — 982 1,320 Re-visits — 115 — 155 — 270 — 468 Removed to Hospital 152 — — — 152 — 175 — Died — 2 — 8 — 10 — 48 hooping Cough:— No. of Cases 329 — 202 — 531 — 546 — Primary visits — 329 — 202 — 531 — 546 Re-visits — 188 — 82 — 270 — 253 Removed to Hospital 80 — — — 80 — 26 — Died — 25 — 17 — 42 — 17 Puerperal Fever:— No. of Cases notified 6 — 6 — 12 — 5 — Primary visits — 12 — — — 12 — 5 Re-visits — 13 — — — 13 — 5 Removed to Hospital 11 — — — 11 — 5 — Died 3 3 1 1 — 4 — — Puerperal Pyrexia:— No. of Cases notified 8 — 2 — 10 — 11 — Primary visits — 10 — — — 10 — 11 Re-visits — 9 — — — 9 — 11 Removed to Hospital 10 — — — 10 — 9 — Died Maternal Deaths (enquiries) 10 — — — 10 — — — Maternal Deaths:— 7 — 3 — 10 — 8 — Primary Visits — 10 — — — 10 — 8 Re-visits — 42 — — — 42 — 20 Miscellaneous Visits — 306 — 925 — 1,231 — 1,446 Total Visits:— Primary — 3,161 — 2,732 — 5,892 — 6,420 Re-visits — 30,594 — 38,630 — 69,224 — 71,761 Total Visits paid, 1929 — 33,755 — 41,362 — 75,117 — — Total Visits paid. 1928 33.677 44.505 — — 78,182 135 *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. 136 Ante-Natal Clinics .—Steady progress has been made at these Clinics. Two extra sessions monthly have been found necessary for the increased amount of work at Simpson's Road. The co-operation between the Council's Ante-Natal Clinics and the local Midwives and Institutions is increasing. This is all to the good, but it is obvious that, in spite of this and increased hospital accommodation, the maternal death-rate remains about the same. It is only by looking ahead and aiming at a normal labour that any improvement can be expected. Compensation to Midwives.—Compensation is now granted to midwives in respect of patients who are confined in Maternity Hospital upon the recommendation of the Council's Clinic Medical Officers. During the year, i such case occurred and a compensation fee of ios. was paid. Maternity Wards, St. Andrew's Hospital.—The Council's Maternity Ward has been much appreciated by the mothers who can afford the charges made; but in almost every case, it has been a hard struggle to meet the assessment. The mothers who have been confined in any one of the three wards are full of praise for the kindness and attention they have received. Infant Consultation Clinics.—The amount of illness amongst the children during the first three months of the year affected the attendances at most of the Clinics. The highest average attendance was at Wellington Road—79.8 per session. This is too high, but as the accommodation is so good, it is fairly easy to deal with this large number. Old Ford Clinic, with an average attendance of 77.7, is at times so overcrowded that it is impossible to do justice to the work. A separate weighing room and a perambulator shelter are both urgently needed. It is hoped that the accommodation at this Clinic will be improved. Artificial Sunlight Clinic.—This Clinic continues to be a very valuable asset to the work, and the results are most encouraging. At this Clinic, even more than at the infant consultations, mothers learn the wisdom of discarding heavy clothing which they formerly thought necessary for the well-being of their children. A statement of the work of these Clinics will be found on pages 148-154. Dental Clinic.—Owing to the increased demand for treatment, 2 extra monthly sessions have been added, from 4th February. Many of 137 the mothers who would otherwise be unable to afford their artificial dentures are able to do so by paying small sums weekly. This is frequently spread over a long period, but with the aid of a Hospital Sunday Fund letter the cost is met. Sewing Classes.—The attendances here have increased, and useful garments have been made from old and new material. The children put in good work with the toys—in the garden when weather permits. After the cramped home conditions, they thoroughly enjoy this chance of a good run. At these classes "Health Talks" and simple demonstrations are given. Home Visiting.—There is an increase in the visits paid by the Health Visitors, although there was a total of 38 additional sessions—AnteNatal and Dental—at the Clinics during the year. It is duiing these visits to the homes that the most effective teaching can be done. There is no more valuable visit than that paid on the eleventh or twelfth day after the confinement. The mother is usually receptive, a lasting friendship is often made, and the mother's confidence gained, which is so essential to our work. Student Health Visitors.—These Students came to Poplar for practical training before taking the Health Visitor's examination, and we were pleased to show them all that we could in the office, Clinics, and on the Districts. Two of the Students have since taken the examination and passed. Observation Wards.—Some of our Clinic babies have spent a very happy and profitable time in the wards and, on discharge, most of them have maintained the progress which was established whilst in the wards. The report of the Medical Officer in charge of the wards is given on pages 145-148. Sale of Food Accessories, etc. 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 and payments at clinics for various services :— 138 £ s. d. Dried Milk, 11,447 lbs 858 10 6 ,, ,, Humanized, 173 lbs. 17 6 0 Aberdeen Emulsion 29 2 1 Dusting Powder 1 15 0 Medicinal Paraffin 6 3 0 Medical Sundries 11 5 5 Dentures 90 14 0 Materials at Sewing Class 19 17 11 Convalescent Treatment 9 5 0 Virol 22 6 0 Oil and Malt 111 6 8 Concentrated Food 28 8 5 Payments for Gas (Dental Clinic) 3 6 0 Maternity Ward Fees 145 11 0 Total 1.345 17 0 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. 3,744 such vouchers were issued during the year. Convalescent Treatment, etc. Convalescent Treatment (mothers with babies) 13 cases. ,, ,, (mothers alone) 2 ,1 ,, ,, (children under 5 years) 20 ,, Payment of Midwives' fees 6 ,, Compensation to Midwife 1,, Loan of maternity bag containing clothing, etc. 20 ,, [The following tables refer to the whole Borough.) Statistics Respecting Infants Born in 1928. All births, including those occurring in outlying districts, but belonging to the Borough 3,357 Doctors in attendance 576 Midwives in attendance 1,522 Delivered in institutions 1,207 Not stated 52 Moved into Borough 51 3,408 139 Stillborn (Stillbirths per 1,000 births, 29.3) 100 Died before visit 85 Not requiring or desiring visits 113 298 Visited 3.110 Removed within the year 320 Died during visitation 152 472 Remaining under supervision end of first year 2,638 Mortality per 1,000 visited 49 The 2,638 children visited during 1929 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 78.8 per cent. Mixed feeding 16.4 Hand-fed 4.8 The 152 children who died during the first year of life, were fed during the first six months of life as follows:— Breast-fed 48. per cent. Mixed feeding 30.2 Hand-fed 21.7 Below is a statement comparing the mortality rates of children fed by the various methods:— (a) Babies breast-fed 34 (b) ,, who received mixed food (breast and hand) 96 (c) ,, hand-fed 207 140 MATERNAL MORTALITY. The investigation into all deaths associated with childbirth, which was referred to in last year's Annual Report, has been carried out on the lines suggested by the Ministry of Health. Although the Council has authorised the employment of an Obstetric Consultant for their investigations, it was not found necessary to make use of his services during the year. Theie were 10 maternal deaths registered as belonging to the Borough, according to the information supplied by the Registrar-General, representing a mortality rate of 3.3 per 1,000 live births. Puerperal Sepsis was given as the cause of death in 4 instances. Four of the 10 cases were first pregnancies, and only 4 of the 10 had attended an AnteNatal Clinic. From Sepsis, 4. Other causes, 6. Death Certificates:— Sepsis . (1) Puerperal Sepsis and Early Malignant Endocarditis following miscarriage (idiopathic) at 3 months. P.M., Natural. (2) Puerperal Septicaemia. (3) Puerperal Septicaemia, following childbirth. (4) General Peritonitis, following full-term labour. Other Causes. (5) Pulmonary Thiombosis, Iliac Thrombosis, Caesarean Section. (6) Incomplete Puerperal Inversion of Uterus, P.P.H. P.M. (7) Accidental A.P.H. P.M. (8) Eclamptic Fits, Eclampsia, Nephritis of Pregnancy. No P.M. (9) Shock of Parturition, Br. Pneumonia. P.M. (10) Rupture of Uterus at Parturition. Shock of Operation, following anaesthesia for Laparotomy. P.M., Misadventure. 141 STILLBIRTHS. (This refers to the whole Borough.) 92 Stillbirths were investigated during the year 1929. Number of Stillbirths 92 Doctors in attendance 22 Midwives in attendance 36 Delivered in Institutions 34 B.B.A 5 Premature Births 31 First Pregnancies 30 Mothers who had had previous Stillbirths:— One. Two. 5 1 OPHTHALMIA NEONATORUM. Fifty-six cases of Ophthalmia Neonatorum were notified during the year:— [This table refers to the whole Borough.) Year. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths Notified. Treated. At home. In hospital. 1914 75 70 5 73 — — 2 1915 64 62 2 62 1 — 1 1916 60 60 — 60 — — — 1917 39 ** 37 1 36 1 — 1 1918 40 38 2 39 1 — — 1919 61 51 10 60 1 — — 1920 61 51 10 59 — — 2 1921 47 41 6 42 2 1 2 1922 36 33 3 34 1 — 1 1923 38 30 8 35 — — 3 1924 46 38 8 46 — — — 1925 44 39 5 42 — — 2 1926 43 35 8* 42 — — 1 1927 48 44 4 48 — — — 1928 59 26 11 58 — — 1 1929 56 51 5 56 — — — Total 817 706 88 792 7 1 16 ** 1 born in Institution—not visited, no information available. * Including 3 which occurred in Institution. 142 Cases Notified and Visited. Number of notifications received 56 Very slight cases 44 Died in Institutions (intercurrent disease) — Sight of one eye damaged — Recovered 56 Occurred in Institutions 1 Occurred in the practice of medical practitioners 4 Occurred in the practice of midwives 5i Admitted to hospital as in-patients 5 Treated as hospital out-patients 3 Treated privately 48 Visited by nurse 12 ZYMOTIC ENTERITIS. Notifiable June—September. (Whole Borough). Notifications received 112 Died before notification received, under 1 year 12 " " 1- 2 years 2 Not traced — Visited 98 Under 1 year (see feeding below) 40 1 to 2 years 37 2 to 3 years 10 3 to 4 years 5 4 to 5 years 6 Admitted to or occurred in Hospital 27 143 Of the 40 cases of Zymotic Enteritis under 1 year of age which were notified, r died. This child was hand-fed. The remaining 39 were fed as follows:—Breast-fed, 20; mixed feeding, 5; hand-fed, 14. 12 children under 1 year of age died before notifications were received, and of this number 2 were breast-fed, 2 were on mixed feeding, and 8 were hand-fed. 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 1929 (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 4 1 12 — Visits 102 80 5 — 187 MeaBlea Cases Under 5 3 9 — 12 — 5-10 4 3 — 7 — Visits Under 5 31 149 — — 180 5-10 45 41 — — 86 Pneumonia Cases Under 5 11 30 — 41 — 5-10 4 1 — 5 — Visits Under 5 233 626 — — 859 5-10 59 14 — — 73 Zymotic Cases 1 — — 1 — Enteritis Visits 2 — — — 0 Whooping- Cases under 5 3 4 1 8 — Cough Visits under 5 43 83 8 — 134 Totals Cases 33 51 2 86 — Visits 515 993 13 — 1521 144 The following table relates to visited children of ages i to 5 years Year of Birth. 1924. 1925. 1926. 1927. Remaining under supervision: End of first year — — — 2,786 ,, second year — — 2,793 — ,, third year — 2,804 — — ,, fourth year 2,652 — — — Inward Transfers 59 67 52 79 Visits discontinued 1 3 2 3 Outward Transfers 160 184 184 233 Died 9 16 35 85 Remaining under supervision: End of second year — — — 2,544 ,, third year — — 2,572 — ,, fourth year — 2,601 — — ,, fifth year 2,482 — — Mortality per 1,000 visited: Second year — — — 29.7(22.) Third year — — 12-5(7-4) — Fourth year — 5-7(6-I) — — Fifth year 3-3 (5-6) The figures in parentheses are the rates for the previous years. CO-OPERATION WITH THE EDUCATION AUTHORITY. 2,482 case sheets relating to the children who have reached the age of 5 years were forwarded to the Education Department. Our special thanks are due to the voluntary workers at the Clinics and Sewing Classes, and to the Royal College of St. Katharine for the close co-operation which exists between us, making the work in the Borough so much easier and effective; to the many kind friends who have sent 145 woollies for the babies, clothes and shoes for jumble sales, toys and rocking-horses, motor-cars, etc., for the Clinics, gifts for the Mothers' Christmas Tea; to the United Services Fund for grants towards Convalescent Home treatment; the Hospital Sunday Fund for grants towards artificial dentures. THE OBSERVATION WARDS, WELLINGTON ROAD. 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 observe the progress of the cases in the Wards. In-Patienis.—The number of cases admitted to the Observation Wards this year was 38. The following is a list of the various kinds of case admitted:— Dyspepsia and Malnutrition due to difficulty in Artificial Feeding 20 Intolerance for Cow's Milk 1 Habitual Vomiting 1 Malnutrition due to Faulty Diet or Environment 9 Food refusal 3 Rickets 4 38 As has been the previous experience, cases of difficulty in artificial feeding formed the majority. As a rule, these children when they come in are not only poorly nourished, but also have a very impaired digestive power. Mistakes have often been made by the mother in the first place, either in the food chosen or in the method of giving it. Seeing her offspring not thriving, the mother has usually attempted to remedy matters by giving more and more food or by frequent changes of diet. The Observation Wards afford an admirable opportunity firstly, of resting the child's harassed digestive functions and, secondly, of restoring it's nutrition. Quite a simple method of feeding will usually attain this object. In the worst cases, however, the food (usually milk) has to be subjected to some comparatively elaborate preparation until the digestive functions are fully restored. After that, a food is introduced which the mother herself can easily prepare at home. Our objects in all such cases 146 are the same, namely, to see the child thoroughly healthy, with a good digestion, a rising weight, and an ability to take a good and simple form of food. Before taking her child home the mother is given practical instruction in how to make and give the child's feeds and how to manage it at home. Those children included under the heading, "Malnutrition due to Faulty Diet or Environment," are past the infant feeding stage. They have been attending the Infant Welfare Clinics, but have not been making the progress desired, for some time. A change to a better environment does them an enormous amount of good. Very often it is found that they, too, have impaired digestions from having been given wrong kinds of food at home. They nearly all have suffered from deficient fresh air and sunlight. Careful feeding has to be resorted to at first; afterwards, on a liberal diet, they put on weight in a way that is truly astounding. A striking change takes place in the vigour of the child and the tone of its muscles. The temper, appetite and sleep all improve also. The first change, however, and one of the most obvious, is in the colour, which alters from a sickly pallor to a really healthy glow. The treatment given in the Light Department is a great help in effecting these improvements, especially in winter. Again, in dealing with these children, we try to obtain a good nutrition, a good digestion, a rising weight, and a thoroughly satisfactory state of health before we discharge them. I append the results obtained in the Wards this year:— Recovery 34 Improvement 2 Transferred to Hospital 1 Removed by Parents 1 38 As practically all the children leave in such good condition, it becomes interesting to see how far the parents can keep it up afterwards. A certain number were inspected several months after discharge. The results seem gratifying:— in Excellent Health and Condition 10 In Good Health and Condition 4 In Fair Health and Condition 2 16 147 Thus, in the majority, the continuance by the mother of the work done in the Ward had been absolutely successful. In none had there been a relapse to anything like the former condition. Out-Patients.—They form a large part of the work at Wellington Road:— Number of New Out-Patients 44 Total Attendances at Special Clinic 282 Attendances for Test Feeds 560 The cases came up from the Infant Welfare Clinics, and it will be seen that each makes, on an average, 4 or 5 attendances. When their difficulties have been elucidated, they return to their own Clinics. Difficulties in breast-feeding were the chief cause for attendance:— Difficulty in Breast Feeding 38 Difficulty in Artificial Feeding 5 Difficulty in Weaning 1 44 The re-establishment of normal breast feeding is, of course, the ideal aimed at in the first group. In the majority, this was attained. In a good number, not all the milk, but some, was restored, and a mixture of breast and artificial feeding had to be adopted. When it was seen in such a case that there was not likely to be any further increase in the breast milk and that the child was doing well on the mixed feeding, it was sent back. The following shows the results obtained:— Re-establishment of Normal Breast Feeding *7 Partial Re-establishment with Correct Supplementary Feeding 14 No Re-establishment 2 Failed to Complete Attendances 5 38 148 The 560 attendances for test feeds show what an amount of time and patience had to be expended by the staff on this work. Single Consultations .—These are children who do not attend regularly as Out-Patients, but come up once from their Clinics for an opinion on their condition. A list of the different kinds of case may be of interest:— Chronic Infections 3 Deformities 2 Cyclical Vomiting 1 Mental Deficiency 1 Mismanagement 1 8 Work of the Staff.—Throughout the year, the Staff have worked admirably and shown the greatest enthusiasm. The excellence of the results obtained reflects great credit on them. Good nursing is most important in getting good results in these delicate children, and there must be coupled with it in this special work a power of close observation. For the Out-Patients, not only enthusiasm but a capacity for infusing it into the mothers must be displayed. Success, in fact, depends very greatly upon the Staff possessing these qualities. It is a pleasure to be able to record the manner in which they have worked and the good results that they have obtained. ARTIFICIAL SUNLIGHT TREATMENT. Dr. E. M. Layman, the Medical Officer in charge of Artificial Sunlight Treatment, has submitted the following interesting report:— I have pleasuie in submitting my report on the work of the Light Department for 1929. 398 cases were treated, exclusive of those that failed to attend sufficiently. In order to comment on the effects of the treatment, I have classified the cases according to their diseases or disordered states, and give in each group the successes, moderate successes, and failures. Of all the cases together (children), 233 were successes, or over two-thirds of the 149 total, and 84 were moderate successes. Most of the moderate successes would have been complete ones if their course of treatment had not been interrupted (by infectious disease sometimes, or unavoidable home conditions). The largest group is Rickets, 97 cases. I have divided this group into:— (a) Severe Rickets, 37. Of these: 25 were successes. 7 ,, moderate successes. 5 ,, failures (through poor attendance). (b) Slight Rickets, 46. Of these: 32 were successes. 10 ,, moderate successes. 4 ,, failures. These two sub-groups of bony rickets received treatment with red light for 10 minutes (5 minutes front and back) immediately before each exposure to ultra-violet light. This I find makes for a more rapid cure in rickets, which usually needs a long course, or several courses, in any case. (c) Muscular Rickets, 14. Of these: 9 were successes. 5 ,, moderate successes. There were no failuies. 150 Examples of success:— (i) W. H. ii months. Weight, 151b. A very weakly, miserable child with no teeth. General rickets marked. After 27 exposures, child now 15 months old, very well and animated, with 5 teeth. Weight, 171b. A second course of 27 exposures (he had relapsed in the interval) had further good results. On discharge, child walking well, vigorous, and had gained another pound in weight. (ii) R. H. 1 year 8 months. Very rickety, hardly walks, sits huddled up, has iepeated chest attacks. 12 teeth. After 9 exposures child had gained 3lb., markedly improved all round, and teething well. After 23 exposures, discharged very well with a further gain of lib. Disturbed Health in Dentition, 53. Of these: 40 were successes. 8 ,, moderate successes. 5 ,, failures. One failure I discharged because he was deriving no benefit. On returning to report after some weeks, he had greatly improved. I considered it wise to leave him without any more light treatment. The other failures failed to attend. This is an important group. I find in the Infant Clinics many children really ill with the strain of teething. Some "light'' patients are attacked by broncho-pneumonia, severe diarrhoea, etc., in the middle of a course of treatment. But for those that can attend before they break down, the light usually has a remarkably bracing effect. Example of success:— H. R. 16 months. 7 teeth. Walked late. Child restless and fretful, very poor appetite, has disturbed nights and is in poor condition. After 2 weeks, child much improved, with 9 teeth. Continued steady improve. 151 ment, with gain of 2lb., during 22 exposures. This child had 2 further courses, with intervals, each time cutting teeth easily, gaining weight, and developing well. Delayed Dentition, 20. Of these: 13 were successes. 7 ,, moderate successes. There were no failures. For Recovery after Illness, 49 cases. Of these: 38 were successes. 7 ,, moderate successes. 4 ,, failures (through poor attendance). Malnutrition, 58 cases. Of these: 38 were successes. 12 ,, moderate successes. 8 ,, failures. Examples of success:— (i) V. A. (premature at 8 months). Aged, 13 months. Weight, 181b. Very frail baby with 5 teeth. Treated for 5 weeks while in the Observation Wards and there did excellently, gaining 2lb. in weight. Readmitted to treatment a month later, as out-patient, she had hardly gained any ground. After 28 exposures she had improved enormously, walking well, teething well, and gained 41b. (ii) P. C. Aged 31 years. Weight, 28½lb. Pale and thin, with a tumid abdomen and unhealthy tonsils. After 33 exposures, child well and happy and had gained 2Jib. He relapsed without light treatment, but gained again lib. in a second short course. Sent to school. 152 Debility, 66 cases. Of these: 29 were successes. 23 ,, moderate successes. 14 ,, failures. Most children in this group needed long courses. A few, on persistent investigation, proved to their mothers that they had worms. This condition I often diagnose at a first interview, but it requires time (and effort on their own part) to convince the mothers. Once thoroughly treated, these children usually improved immediately with light treatment. Of the failures, 1 was unsatisfactory till sent into the country, 1 till bad teeth were extracted, and 1, evidently very ill, I recommended to hospital with abdominal disease. Bronchitis, 4 cases. Of these: 2 were successes. 1 moderate success. 1 failure. Asthma, 1 case. Success. Enlarged. Glands and Tonsils, 6 cases. Of these, all simple cases: 4 were successful. 1 moderate success. 1 failed to attend sufficiently. Rheumatism, 2 cases. Girls. Both were failures. I am inclined to refuse light treatment to any child with a rheumatic heart lesion. These 2 derived no benefit (but, apparently, no harm). 153 Fretfulness, 5 cases. Of these: 1 was a success. 3 were moderate successes. 1 failure. 1 Staff (nurse at Wellington Road). 12 exposures. Fatigue and debility. Moderate success. 36 mothers were treated, nearly all for exhaustion, depression, malnutrition and debility from overwork and confinement to the house. 5 cases of deficient lactation did improve in milk secretion; several others improved in general health, but not in milk secretion. All who attended for 6, 10 or 12 exposures derived benefit—a few, marked benefit. One case of rheumatism was a moderate success. In conclusion, I wish to express my sincere appreciation and thanks to the Sister-in-Charge for her excellent work at the two Light Clinics. Statistical Summary. January 1st to December 31 st, 1929. Bow. Poplar. Totals. Number of attendances 4.935 3,484 8,419 ,, ,, sessions 284 246 530 ,, ,, patients 292 229 52i The cases have been grouped as follows Group 1.—Rachitic:— (a) Severe 37 (b) Slight skeletal 46 (c) Muscular 14 97 ,, 2.—Delayed dentition 20 154 ,,3 —Disturbances with dentition 53 ,, 4 —Bronchitis 4 ,, 5 —Enlarged glands and Tonsils 6 ,, 6 —Recovery after illness 49 ,, 7 —Fretfulness 5 ,, 8 —Rheumatism 2 ,, 9 —Asthma 1 ,, 10 —Malnutritution 58 ,, 11 —Debility 66 ,, 12. —Mothers 36 ,, 13 —Miscellaneous cases (n.ot reported). Less than 5 attendances and Current cases 123 Staff 1 124 521 MATERNITY AND CHILD WELFARE DENTAL CLINIC. Mr. C. Hammond Williams, L.D.S., R.C.S. (Eng.), the Dental Surgeon in charge of the Dental Clinic, has submitted the following report:— I beg to submit my Annual Report of work carried out at the Dental Clinics for the year 1929. In the Maternity and Child Welfare Dental Clinic:— 64 Sessions have been held. 323 New Patients have attended. 967 Total Attendances have been made. 77 Fillings were inseited. 1,905 Teeth, Temporary and Permanent, were extracted. 118 Scalings. In addition, dressings, dentures, etc. 155 Our figures show an increase in most instances. In the case of the increased number of Sessions, it became necessary to have more working time to cope with the increasing amount of work. Two extra Sessions per month were instituted, therefore, one of which is an Anaesthetic Session. It seems that the mothers who attend the Clinic are becoming aware of the danger of septic teeth in their children. We do not seem to have so many cases where wholesale clearances have to be made in children's mouths. In fact, whereas it was usual to have to extract ten or twelve teeth from a child's mouth, such drastic treatment is now the exception. The majority of the work is extraction, in the case of adults as well as children, the condition of the mouths generally indicating that elaborate conservative work would not prove permanent and would certainly not be appreciated. C. HAMMOND WILLIAMS, L.D.S., R.C.S. (Eng.). 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. During the 12 months ended 28th December, 1929, 6,849 applications for free milk were received, of which 6,146 were granted. (The number of persons granted milk was 8,283.) Orders were issued for 16,810 pints of Grade "A" (Tuberculin Tested) milk, and 30,729 pounds of Dried Milk, the total commitments amounting to approximately £2,471. Five hundred and eighty-eight (588) cases were investigated by the Enquiry Officer, and were all reported satisfactory. 156 "A." lbs. "G." lbs. Dried Milk distributed at Clinics (including the Royal College of St. Katharine) 18,498 550 Distributed by Office Staff 9,936 — Total 28,434 550 The following is a statement of the special cases (viz., those applicants already receiving milk under the old scale who were over the revised scale) dealt with by the Maternity and Child Welfare Sub-Committee during the year:— Number of applications 216 ,, individuals represented 291 Individuals granted milk with medical certificate 242 Individuals granted milk without medical certificate 6 Individuals refused milk on report of Clinic Medical Officer or Health Visitor 26 Individuals refused milk as medical certificate was not obtained 17 Questions arose during the year as to the inclusion of National Health Insurance benefit as income for the purposes of assessment. After due consideration, the Council adopted a scale which was in operation in an adjoining Borough. This scale was approved by the Ministry of Health in January, 1930, and put into operation on 3rd February, 1930. 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 I.O. (ft). Unsatisfactory cases. F resh. Pints). Dried. (Lbs.). 1920 (a) ? 17,095 ? 873,585 3,454 — — 1921 (c) 23,799 18,270 14,500 782,012 1,236 1,611 107 1922 18,082 16,215 8,500 621,796 1,664 2,969 15 1923 15,537 14,086 6,600 512,614 3,230 2,974 34 1924 14,828 13,597 6,150 487,070 4,902 2,922 14 1925 12,475 11,358 4,994 410,587 3,727 1,633 9 1926 12,928 11.905 7,249 426,762 2,917 593 6 1927 11,702 11,117 5,961 294,515 16,896 598 10 1928 8.449 7 772 3,090 11,639 40,909 343 2 1929 6,849 6,146 2,471 16,810 30,729 588 — Notes.—(a) In 1920, 49 tins of condensed milk were also issued; (b) the Enquiry and Investigation Officer commenced duty in March, 1921; (c) by Circular 185, dated 31st March, 1921, children between the ages of 3 and 5 -years are only allowed milk upon a special medical certificate. 157 CONTROL OF MEASLES. In view of the biennial epidemic of measles which was expected to occur during the winter of 1929-30, the Maternity and Child Welfare Committee considered a report of the Medical Officer of Health consequent upon a letter from the Metropolitan Branch of the Society of Medical Officers of Health, and a report of the London County Council on the measles epidemic of 1927-1928. The Medical Officer of Health reminded the Committee that measles causes more deaths and greater ill-health than any of the other common infectious diseases; and whilst from the nature of its method of spread it is impossible at present by any administrative measures to limit the spread of the disease, yet by ensuring that the patients receive medical attention and efficient nursing sufficiently early, much may be done to lessen the loss of life and reduce the amount of permanent injury done to those who recover. With this object in view, the Medical Officer of Health submitted the following suggestions for the Committee's consideration (1) To ensure the early receipt of information of cases of measles, arrangements will be made with the Education Authority for the School Nurses to deliver at the Public Health Office all known or suspected cases of measles at 12.30 p.m. and 4.30 p.m. each day. (2) These cases will be immediately visited by Health Visitors who, in addition to obtaining full particulars and advising immediate medical attention, will give advice regarding the care and nursing of such children. (3) Where cases are retained at home, the Health Visitors will also endeavour to get medical attention and make arrangements for the nursing of the cases by the District Nurses. (4) Where the home conditions are very bad, and where complications are likely to arise or have arisen, efforts will be made to have such cases removed to hospital. (5) When Health Visitors discover cases of measles (either at Clinics or when visiting) which have not been reported by the School Authorities, particulars must be immediately telephoned to the 158 Public Health Office, and the information will then be telephoned to the office of the London County Council Divisional School Medical Officer. As urged by the London County Council and the Society of Medical Officers of Health, he recommended that, subject to the approval of the Ministry of Health, when this Borough becomes involved in the outbreak of measles, the Medical Officer of Health be authorised to appoint, in the first instance, two temporary Health Visitors at a salary rate of £225 per annum to assist the permanent staff in dealing with these cases, with power to increase this number if it becomes necessary; and in the event of not being able to obtain suitable Health Visitors, suitable nurses be appointed to act in the capacity of Health Visitors during the measles epidemic. This scheme was adopted by the Council and submitted to the Ministry of Health, and approved. COLLEGE OF NURSING AND STUDENT HEALTH VISITORS. At the request of the College of Nursing, the Council afforded facilities for Student Health Visitors to obtain practical experience under the supervision of our Health Visiting Staff. Arrangements were made to take one Student at a time for a period of about six weeks, and there is no financial obligation on either party. These Students are all trained nurses with the additional qualification of the Certificate of the Central Midwives Board, and attend for practical experience on three days a week. During the year, four Students completed a period of practical training. DAY NURSERY. Arising out of an enquiry from a voluntary body as to the need of a Day Nursery in the Borough, the Council appointed two representatives to attend a preliminary meeting of the local Committee. Consideration of the matter has been adjourned until some definite scheme is submitted to the Council. 159 LOCAL GOVERNMENT ACT, 1929. The Maternity and Child Welfare Committee considered the Ministry of Health Memorandum L.GA. 25, which outlined the scheme made by the Minister of Health under Section 101 (6) of the Local Government Act, 1929; and (1) Determines, in relation to voluntary associations providing Maternity and Child Welfare Services, which of those Services are to be treated as Services in respect of which the London County Council are to contribute, and which are Services in respect of which the Councils of Metropolitan Boroughs are to contribute; and (2) provides for the payment of contributions to those Associations by the several Councils. In so far as it affects this Borough, it does not take from the Poplar Borough Council control of the Maternity and Child Welfare work carried out within the Borough, whether that work is performed through the Council's own Clinics or by the Royal College of St. Katharine. The amount of annual contribution for the next three years which shall be paid by the Borough Council to the Royal College of St. Katharine, according to the second schedule of the scheme, will be £4,442. The only comment raised with the Ministry of Health referred to Ministry grants which had been received by a certain District Nursing Association. The Committee were informed that this Society was federated to the Central Council for District Nursing in London, and the grant was paid to the Nursing Society through the Central Council. ROYAL COLLEGE OF ST. KATHARINE. In view of the pending changes in the grants system occasioned by the Local Government Act, the Council were asked for their observations regarding a proposal of the Royal College of St. Katharine to establish an additional Post-Natal Clinic. This proposal was to establish a weekly Clinic in place of an existing fortnightly Clinic. The Council, upon the recommendation of the Medical Officer of Health, informed the Ministry that the proposed extra Clinic should be approved, and this was sanctioned by the Minister of Health. 160 MATERNITY WARD, ST. ANDREW'S HOSPITAL. The following is a copy of the agreement which was executed by the Council and the Poplar Board of Guardians during the year, and approved by the Ministry of Health:— THIS AGREEMENT made this Twenty-eighth day of AUGUST, One thousand, nine hundred and twenty-nine, between the Guardians of the Poor of the Parish of Poplar Borough (hereinafter referred to as the Guardians) of the one part and the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar (hereinafter referred to as the Council) of the other part, wherein it is agreed that the Guardians shall provide for the use of the Council certain accommodation and services for lying-in mothers, including services incidental thereto as more particularly detailed as follows:— (1) A self-contained suite of wards at the Guardians' St. Andrew's Hospital, Devons Road, Bow, E.3, consisting of a Labour Ward of 12 beds and Labour Room, together with lavatories, etc., shall be provided for the use only of such maternity patients as shall be admitted to the said wards upon the authority of the Council. (2) In consideration of the Guardians providing for such patients' maintenance and the services (including medical attendance and nursing) and accommodation herein stated, the Council shall pay to the Guardians a sum of three pounds (£3) for each and every bed occupied for each and every week and a proportionate sum for each day on which any bed is occupied for a number of days less than seven, and further, the Council shall pay a sum of ten shillings (10s. od.) per week in respect of each and every bed wholly unoccupied for each and every week and a proportionate rate for each day on which any bed is unoccupied for a number of days less than seven. For the purpose of this clause, the number of days on which the said 12 beds are occupied or unoccupied as the case may be, shall be aggregated and the Guardians shall render an account to the Council accordingly. 161 (3) The Guardians shall appoint a Consultant Obstetrician whose services shall be available to the Council for the benefit of persons admitted to the said wards by the Council, and the said Consultant Obstetrician shall be required to accept personal responsibility for such duties as he undertakes to carry out. (4) The admission of patients to the wards hereby reseived shall be effected only upon an order issued by the Medical Officer of Health of the said Council or his authorised agent directed to the Medical Superintendent of the Hospital. (5) The nurses to be employed in the said wards shall be women who have undergone a course of three years' training in a general hospital or other recognised training school for nurses and have passed the necessary examinations, and have, in addition, passed the examination of the Central Midwives Board and have special qualifications or training in maternity work. (6) The responsibility for the treatment and care of all patients admitted to the said wards shall vest in the Medical Superintendent of St. Andrew's Hospital. (7) The Medical Staff to be employed in attendance on the patients in the said wards shall, in addition to the Medical Superintendent and the Consultant Obstetrician, consist of an Assistant Medical Officer and his Deputy, each of whom shall have had such special experience and training in midwifery as required by the Council and approved by the Minister of Health. (8) The Medical Officer of Health shall have right of access to the said wards at reasonable hours. (9) The Medical Officer of Health shall inform the Medical Superintendent of the name of two members of the Council's Maternity and Child Welfare Committee, who will visit the wards each month, and such members shall have right of access to the said wards at reasonable hours. 162 (10) The days and hours during which relatives and friends of patients shall be allowed to visit the said wards shall be such as are decided upon conjointly by the Medical Officer of Health, the Medical Superintendent and the Consultant Obstetrician, provided that no children shall be admitted to the said wards as visitors. (11) The garments to be supplied by the Guardians for the use of patients in the said wards shall be of the best quality, and such garments shall bear a distinguishing laundry mark. (12) This Agreement shall commence on the 1st day of September, 1929, and shall expire on the 31st day of March, 1930. (13) In the event of any question arising as to the interpretation or meaning of this Agreement or any part thereof, which question the parties hereto are unable to settle, such question or questions shall be referred to an independent person to be agreed upon by the Council and the Guardians, or in default of agreement to be nominated by the Minister of Health, whose decision shall be final and binding upon each of the said parties, and the expenses attending upon such arbitration shall be paid by the party against whom the decision is given Provided that the parties may share the cost of such arbitration in such proportions as are mutually agreed between them. IN WITNESS whereof the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar and the Guardians of the Poor of the Parish of Poplar Borough have hereto affixed their respective Common Seals. SEALED by order of the Mayor, Aldeimen and Councillors of the Metropolitan Borough of Poplar in the presence of (Sgd.) C. W. KEY, Mayor. (Sgd.) H. E. DENNIS, Town Clerk. 163 SEALED by order of the Guardians of the Poor of the Parish of Poplar Borough in the presence of (Sgd.) W. H. HANCOCK, Deputy Clerk to the Guardians. The scale of income for assessing patients was included in the Annual Report for 1927. As stated in the Agreement, a ward for the reception of patients recommended by the Council was taken over on the 1st September. Up to the end of the year, 35 mothers had entered the ward for their confinement. The numbers of applications received and agreements signed to the end of 1929 were 92 and 58 respectively. In order that prospective patients should be informed as soon as possible of the amount they would be expected to contribute, the Maternity and Child Welfare Committee agreed that applications, as received, should be assessed by the Medical Officer of Health and submitted to the first meeting of the Committee for confirmation or modification. Patients who are unable to pay the Council's assessment are advised to see the Lady Almoner at St. Andrew's Hospital, with a view to being admitted to the Guardians' wards. 164 INDEX. Page Age Mortality 17 Altered Diagnosis Cases 106 Analyst's Report 74 Anthrax 102 Antitoxin, quantity issued 91 Area and Population 10 Artificial Sunlight Treatment 148 Bacteriological Examinations 02 Bakehouses 66 Births 10 Byelaws, etc., in force 30 Canal Boats 53 Cancer 107 Cerebro-spinal Fever 103 Cleansing of Verminous Persons, etc 128 Clinics, M. & C.W. 132,134 Committees 3 Continued and Typhus Fevers 103 Cowhouses 64 Customs and Inland Revenue Acts, Certificates 49 Day Nursery 158 Death Rate amongst Infants Visited 14 Deaths and Death Rates 10-13, 17-19 Deaths, Classified Causes, Table Facing 12 and 13 ,, Infantile, Table 13 Dentist's Reports 116, 154 Diarrhoea and Enteritis, Deaths 17 Diphtheria 90 Disinfectant, Electrolytic 123 Disinfecting Department 122 Electrolytic Disinfecting Fluid 123 Encephalitis Lethargica 104 Enteric Fever 91 Erysipelas 103 Export of Meat Foods 72 Factory and Workshops Acts—Tables 41-47 Food, Supervision of 64 Food and Drugs Acts, etc. 77 Food Inspectors'Reports 68-72 Free Milk Scheme 155 Glanders 102 Hairdressers'Premises 52 Health Visitor, Chief, Report of 134 Home Nursing 143 Hop-pickers and Infectious Disease 121 Houses Let in Lodgings 39 Housing 57 Hydrophobia 102 Ice Cream 66 Infantile Mortality 13,14 Infectious Diseases, Table of Notifications Facing 86 Influenza 122 Inquests and Deaths from Violence 19 165 INDEX—(continued). Page Lady Sanitary Inspector, Report 38 Lectures on Health Subjects 49 Legal Proceedings, etc 54 Local Government Act, 1929 159 Marriages 10 Maternal Mortality 140 Maternity and Child Welfare 131 Maternity Wards in St. Andrew's Hospital 160 Measles 105, 157 Meat Food Produots, Certification 72 Milk (Special Designations) Order, 1923 65 Milkshops, etc. 64 Mortuary 21 Notification ol Births Act 10 Notifications of Infectious Diseases. Table Facing 86 Observation Wards 145 Offensive Trades 41 Ophthalmia Neonatorum 108,141 Overcrowding 52 Plague 102 Pneumonia 106 Poliomyelitis, etc. 104 Poor Law Relief, etc. 23 Population 10 Post-vaccinal Encephalitis, etc. 105 Public Education in Health 49 Puerperal Fever and Puerperal Pyrexia 103 Rag and Bone Dealer 48 Rag Flock Act 52 Rats and Mice Destruction Act 49 Reports:— Artificial Sunlight Clinics, Medical Officer 148 Chief Health Visitor 134 Dental Surgeon (M. &C.W.) 154 Dental Surgeon (Tuberculosis) 116 Lecturer on Health Subjects 49 Observation Wards, Consulting Physician 145 Public Analyst 74 Schick Clinic, Medical Officer 90 Tuberculosis Officer 108 Sanitary Inspectors' Work, Summaries 88 Scarlet Fever 90 Schick Test 90 Schools, Inspection of 49 ,, Use of Electrolytic Fluid in 128 Slaughterer of Poultry 72 Slaughterhouses 66 Smallpox 92 Smoke Nuisances 48 Stables 40 Staff 25 Stillbirths 141 Street Trading 49 Swimming Baths, Use of Electrolytic Fluid in 128 166 600-38 INDEX—(continued). Page Tables A to F (Workshops, etc.) 41-47 ,, of Deaths 11-18 ,, of Infectious Diseases Facing 86 Tuberoulosis, Death Rate 17 ,, Deaths 17, 121 ,, Officer's Report 108 ,, Regulations, Notifications, etc. 117 Typhoid Fever 91 Unhealthy Areas 60 Urinals on Licensed Premises 48 Vaccination 100 Verminous Children and Persons 128 ,, Rooms 48 Violence, Deaths from 19 Vital Statistics, Summary 9 ,, ,, Tables 11-18 Water Certificates 48 Workshops, Workplaces, etc. (Tables) 41-47 Zymotic Diseases, Death Rate 17 ,, Enteritis 142