C.I AC 4368 Metropolitan Borough of Poplar. Annual Report FOR THE YEAR. 1930 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. Crueha 3c Son, LtdTottenham, Enfield, Wood Green and Palmers Green. 65983 Metropolitan Borough of Poplar. « Annual Report FOR THE YEAR 1930 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 COMMITTEE. Councillor: Peter Hubbart, J.P., Mayor (ex-officio). Chairman: Cr. G. Anderson. Vice-Chairman: Ald. C. A. Tanner. Anderson, G. (Ch.) Hammond, J. A. Shepherd, Mrs .A.I. Ashley, J. A. Harris, Mrs. A. L. Simons, A. Blacketer, T. J., J.P. Key,C.W. Sloman.H.W. (L .C .C.) Lancaster, Rev. G. H., Stavers, Mrs. E. Cowhey, E.H. M.A. Tanner, C. A. (V.Ch.) Cressall, Mrs. N. F. Roberts, T. J. MATERNITY AND CHILD WELFARE COMMITTEE. Councillor: Peter Hubbart, J.P., Mayor (ex-officio). Chairman: Cr. Mrs .A.I. Shepherd. Vice-Chairman: Aid. C. A. Tanner. Adams, D. M. Mackay, Mrs. J. Shepherd, Mrs. A. 1. Cressall, G. J., J .P. Mudge, Mrs. E. Cressall, Mrs. N. F. Sargent, A. R. Stavers, Mrs. E. „ . T Tanner, C. A. (V.Ch.) Harris, Mrs. A. L. * Co-opted Members: Miss E. Herbert (Roy. Coll. of St. Katharine); Mrs. J. A. March; Mrs. M. Power; Mrs. A. M. Sumner. 1 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.U Assistant Medical Officer of Health and Assistant Tuberculosis Officer: C. K. Cullen, M.R.C.S., L.R.C.P., D.P.H. Temporary Assistant to Medical Officer of Health : H. D. Chalkk, M.A. (Camb ), 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.t Sanitary Inspectors: (a) H. A. Tibbatts.* (a) F. A. Smith.*‡ (a) Dove, A.fti (a) J. Johnson.*§ Miss M. E. davies.*†¶|| (b) C. A. Grabham.*{ C. H. Brown.*†‡§ (resigned 24th February) (b) H. A. pearce.*†§‡ (a) H. J. Langley.* Miss D. A. E. (c) H. W. Luke.†† (a) C. S. Westbrook.*‡ LandrayA. H. T. Harris†† (a) Wm. Johnson.(from1stJune)(Temporary) (a) S. Kelly.* (a) H. W. Leonard.W. J. Colborne†† (resigned 30th November) (Temporary) (a) District Inspectors. (b) Food Inspectors. (c) Inspector for Houses divided into separate tenements. J. Chapman, A. Collyer, W. Cue, C. F. Gregory, E. Willson, E. Saphier (resigned), W. G. F. Colebeck (from 11th August) (unqualified Assistants to assist the District Inspectors). C. A. Webster (part-time unqualified Assistant to assist the Food Inspectors). H. Harbott (Chauffeur). Clerks: F. J. White.* H. A. Purdy. D. Flynn (Office Boy). W. F. Roberts. Miss S. Fells. F. Petts. A. Hamilton.†† J. T. Donovan S. B. Leader. E. W. Garrett. Mrs. E. Lono. W. G. Barnett Caretaker and Messenger: (from 28th March). C. E. Richardson Vaccination Officer: Asst. Vaccination Officer: P. Ryan. W. H. Cox. The following Public Vaccinators who are part-time medical staff, were transferred to the Borough Council under the Local Government Act, 1929:— Bow District Dr. D. G. Macrae. Bromley District Dr. C. Cotter. Poplar District Dr. H. J. O'Brien. Isle of Dogs District Dr. W. C. Millea. The Medical Superintendents of St. Andrew's Hospital, Bow Institution and Bromley House Institution are the Public Vaccinators to their respective Institutions. * Cert. S.I.E. Board. † Cert R.S.I, †† Cert. K.S.T. & S.I.K.J.B. ‡ Cert. Meat and Food Inspector. § R.P.C. ¶C.M.B. || H.V. Cert. (Board of Education). ‡‡ 3 years' General Nursing Certificate. 5 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. Temporary Assistant: H. B. Hodson, M.B., B.S. (Lond.), M.R.C.S., L.R.C.P. (June 10th to October 31st.) 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: Mks . 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). W. J. Parker DISINFECTING STATION, YEO STREET. Disinfectors: W. HodgeJ (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. Hog an. Lorry Driver: F. Farrow. Shelter and Cleansing Station. Attendants: Mrs. A. Howe, Mrs. A. Stollery (resigned), Mrs. M.Allan. MORTUARY. Mortuary Keeper and Caretaker of Coroner's Court: J. Brown. Asst. Mortuary Keeper: D. Hogan (part-time). J San. Iusp. Cert. R.S.I. ** H.V. Cert. R.S.I. 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.). 6 Chit] Health Visitor: Miss J. M. Cardozo, R.R.C.'TItt i Health Visitors: Miss E. A. Foskbtt.*¶ Mrs. M. J. Edgell.§¶ Miss M. Mallktt.* Mrs. E. K. Haythornthwaite.*¶ Miss G. E. paice*†† (resigned). Miss A. Eaton*¶ Sister-in-Charge Artificial Light Treatment. (o) Miss D. A. E. Landkay.*¶† (transferred to Public Health Section). (c) Miss E. A. H. Williams.*¶ (e) Miss E. M. Craigie*¶ (resigned). (c) Miss G.I. Hill*¶ (from 12th May). (c) Miss M. H. Sutcliffe*¶† (from 22nd July). (c) Miss B. E. Letts*H (from 29th September). Clerk: Miss K. D. Evans. Observation Wards. Wellington Road, Bow, E.3. (Opened 11th November, 1927.) Consulting Physician: H. St. H. Verttje, 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.*11 Sister: Miss J. Boone. 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. Rttdd. Investigation and Enquiry Officer (part-time): C. A. Webster. • C.M.B. t Cert. S.I.E.B. § Cert. Mid. Colonial Medical Association. IT Three Years' General Nursing Certificate, ft 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. 7 Public Health Office, Bow Road, E.3. 22nd May, 1931. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar. Mr. Mayor, Ladies and Gentlemen, I beg to submit my Report on the health of the Metropolitan Borough of Poplar for 1930. Statistics.—Beyond the fact that the General Death Rate and the Infantile Mortality Rate are the lowest on record (10.5 and 55 respectively) there is nothing of special interest in the Vital Statistics. Housing and Overcrowding.—During the year considerable attention has been given to housing. House-to-house inspections and surveys have been carried out, as a result of which proposals for dealing with certain unhealthy areas have been prepared by the Council. In the meantime, overcrowding still proves one of the most difficult questions with which the Department has to deal. Infectious Disease.—The incidence of infectious disease remained much the same as last year, except that the number of Smallpox cases increased in the early months of the year, mounting to 126 in February, following a decline during the summer months of 1929. The number declined gradually to the end of the year and in all 628 cases occurred in the 53 weeks ending January 3rd, 1931. The cases were of a mild type. The very considerable amount of work which the continuance of the outbreak entailed is referred to in the section of the Report dealing with infectious disease. Chickenpox also was prevalent, 1,281 cases being reported. Maternity and Child Welfare.—The section of the Report dealing with Maternity and Child Welfare again shows a general increase in the work done in the Borough. There is, however, one item which has given rise to considerable anxiety, namely, the difficulty experienced in obtaining trained nurses for the Observation Wards. There appears to be a general shortage of trained nurses who are willing to accept appointments in small institutions where there is little prospect of promotion. 8 Conferences.—Delegates were sent to the following Conferences during the year:— (a) Royal Sanitary Institute Conference (Margate). Chairman of the Public Health Committee (Councillor Mr. G. Anderson) and the Medical Officer of Health. (b) Provincial Meeting of the Tuberculosis Association (Oxford). Dr. C. K. Cullen. (c) National Association for the Prevention of Tuberculosis (London). Miss L. Nugent. (d) Sanitary Inspectors' Association (Ilfracombe). Mr. S. Kelly. (e) Maternity and Child Welfare (London). Miss J. M. Cardozo. During the latter part of the year, and in the early months of 1931, a Medical Officer of the Ministry of Health visited the Borough with a view to carrying out a survey of the Council's Public Health Seivices. I must acknowledge my indebtedness to members of the Council for their support, and to officers of the Council and others who have contributed to various sections of the Report. Again I wish to record my appreciation of the way in which the members of the staff of the Public Health Department have carried out their work during the year. It is with regret I have to record the deaths early in 1931 of three members of the staff, including Dr. W. C. P. Smith, the Tuberculosis Officer. I am, Ladies and Gentlemen, Your obedient Servant, W. ALLAN YOUNG, Medical Officer of Health. Chart showing estimates of Populatton,and Birth, Death, and Infantile Mortality Rates for 30 years. 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 (estimate remaining in use for 1930) 160,000 Number of Inhabited Houses (Census, 1921) 23,064 Number of Inhabited Houses (end of 1930) according to Rate Books 23,222 Number of families or separate occupiers (Census, 1921) 37,288 Rateable Value (April, 1930) £686,422 Sum represented by a Penny Rate (April, 1930) £2,681 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. Live Births Legitimate 2,990 1,498 1,492 Birth Rate 19.1 Illegitimate 66 37 29 Totals 3,056 1,535 1,521 Still Births 105 60 45 Rate per 1,000 total births 33.2 Total 10 M. F. Deaths 1,683 924 759 Death Rate 10.5 Percentage of total deaths occurring in Public Institutions 64.33 Number of women dying in, or in consequence of, from sepsis 4 childbirth from other causes — Maternal Death Rate (P^ 1,000 live births 1.3 [per x ,000 total births 1.33 Infantile Mortality Rate,555. (Legitimate, 55. Illegitimate,30.) Neo-natal deaths:—Number, 71; Rate per 1000 live births .23.2 Deaths from Measles (all ages) 30 ,, Whooping Cough (all ages) 3 ,, Diarrhoea and Enteritis (under 2 years of age) 20 VITAL STATISTICS. AREA AND POPULATION. The area of the Borough is 2,136 acres, and the population, estimated to the middle of 1929 Registrar-General, was 160,000. this estimated population is used in calculating various rates in the Report, as the estimated population for 1930 will not be available for some time. The population of 160,000 gives a density figure of 75 persons per acre. BIRTHS. Early in the year 1931, the Registrar-General supplied the following information relating to Births registered in the year1930:- Registered Inward Transfers. Outward Transfers. Nett. Total Births J Males 1,232 321 18 1,535) 3.05& Females 1,219 327 25 1,52l Illegitimate Males 31 8 2 37 66 Females 26 6 3 29 11 The corrected birth rate per 1,000 population was 19.1, as against 22.7, 21.6, 19.8, 19.9 and 19.1, for the years 1925-1929. During the year, 2,525 notifications were received under the Notification of Births Act, 1907. MARRIAGES. During the year the marriages of 2,952 persons were registered, giving a rate of 18.4, as against 16.2, 15.8, 17.5,17.8 and 17.8 in the five years 1925-1929. DEATHS. 1,618 deaths were registered as having occurred in the Borough. 245 deaths of non-residents must be deducted, and 309 deaths of Poplar residents which occurred outside the Borough must be added, giving a net total of x ,682 and a rate of 10.5 per 1,000 of the estimated population. The natural increase of population represented by excess of births over deaths was 1,374. 12 Deaths during 1930 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 91 67 60 84 302 Bow and Bromley Sub-District 8l 41 49 75 246 St. Andrew's Hospital 182 165 126 168 641 Poplar Institution 58 30 28 32 148 Bow Institution 42 38 29 28 137 Bromley House Institution i — — i Poplar Hospital 23 26 22 26 97 Guardians' Offices — — — — — Langley House — Adelaide Buildings Baffin ,, Council ,, — I — 1 2 Grosvenor ,, — — 2 z 3 Hanbury ,, Hudson ,, — — — — — Melbourne ,, i — — — 1 Montreal ,, — — 1 — 1 Ontario ,, Ottawa ,, Prestage ,, Quebec „ Sydney ,, Toronto ,, — — 1 — 1 Wellington ,, Winnipeg ,, River Thames 3 2 1 — 6 ,, Lee — 5 2 1 8 Limehouse Cut — 1 — 1 2 Bow Creek Regents Canal East India Docks — 1 — — 1 West India Docks South-West India Docks Millwall Docks — 1 — — 1 Highways 3 5 3 7 18 Christchurch Draw Dock — — 1 — 1 Bow Station, District Railway — 1 — — 1 485 384 325 424 1618 Deaths occurring outside the Borough of persons belonging thereto (add) 97 73 60 79 309 Deaths occurring within the Borough of persons not belonging thereto (deduct) 74 64 49 58 245 Deaths at all ages—nett 508 393 336 445 1682 PmCIPAL CAUSES OF MATH 1910. (Registrar - General's Classification) Total Deaths during the year - /6<fJ -Malts 927: females 7S6. JkU: ftrcenlage of deaths occurring in Public Inslil'jlions • 64-3 TABLE II. The Borough. Causes of, and Ages at, Death during the Year 1930. Causes of Death. 1 Total Deaths. Sex. Nett Deaths at Subjoined Ages. Nett Deaths in SubDistricts. Nett Deaths in Public Institutions and certain localities within and outside Borough (at all ages) belonging thereto. Nett Deaths in Public Institu tions, etc. All Ages. Under 1 year. 1 to 2 years. 2 to 5 year* Total under 5 years. 5 to 9 years. 10 to 14 years. 15 to 19 years. 20 to 24 years. 25 to 34 years. 35 to 44 years. 45 to 54 years. 55 to 64 years. 05 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 Certified All causes Uncertified 1682 1682 167 48 43 258 25 25 43 51 78 86 156 282 347 331 892 790 142 025 4 .. 28 24 207 1130 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• 1 Enteric Fever M •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• F •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 2 Smallpox 1 M •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 1 •• •• •• •• •• •• 1 1 F 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• 3 Measles 30 M 10 2 4 3 9 1 •• •• •• •• •• •• •• •• •• 14 16 •• 10 •• •• •• •• 13 23 4 Scarlet Fever F 20 3 12 4 19 1 •• •• •• •• •• •• •• •• •• 4 M 2 •• 1 1 2 •• •• 2 2 •• •• •• •• •• •• 4 4 5 Whooping Cough F 2 •• •• 2 2 •• •• •• •• •• •• •• •• •• •• 3 M 1 1 •• •• 1 •• •• •• •• •• •• •• •• •• •• 2 1 •• •• •• •• •• •• •• •• 8 Diphtheria F 2 1 1 •• 2 •• •• •• •• •• •• •• •• •• •• 17 M 12 ?. 3 3 8 3 1 •• •• •• •• •• •• •• •• 8 9 •• •• •• •• •• •• 14 16 F 5 1 4 5 •• •• •• •• •• •• •• •• •• •• 7 Influenza 3 M I •• 1 •• 1 •• •• •• •• •• •• •• •• •• •• 1 2 •• •• •• •• •• •• •• •• F 2 1 •• •• 1 •• •• •• •• •• •• 1 •• •• •• 8 Encephalitis lethareica. 1 M •• •• •• •• •• •• •• •• •• •• •• •• •• •• • • 1 •• •• •• •• •• •• •• •• •• F 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• 9 Meningococcal Meningitis 4 M 4 3 •• •• 3 •• 1 •• •• •• •• •• •• •• •• 2 2 •• 1 •• •• •• •• 3 4 F •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 10 Tuberculosis of respiratory svstem 134 M 81 •• •• •• •• 1 1 8 13 9 15 15 13 5 1 82 52 7 52 •• •• 1 •• 29 89 F 53 •• 1 1 2 1 2 6 10 14 8 8 1 •• 1 11 Other Tuberculous Diseases 12 M 2 •• 1 1 2 •• •• •• •• •• •• •• •• •• •• 4 8 •• •• •• •• 2 •• 5 10 F 10 1 1 1 3 2 •• 2 2 1 •• •• •• •• •• 12 Cancer, Mallgnaet disease 211 M 136 •• •• •• •• •• •• •• •• 2 4 22 48 41 19 ( 109 102 12 105 •• •• 2 •• 32 151 F 75 •• •• •• •• •• •• •• 3 1 2 12 2 19 16 IS Rheumatic Fever 10 M 7 •• •• •• •• 2 •• 1 •• •• 3 •• •• •• •• 6 4 •• 5 •• •• •• •• 2 7 F 3 •• •• •• •• •• 1 •• •• •• •• •• •• •• •• 14 D iabetes 21 M 6 •• •• •• •• •• •• •• 1 1 •• •• 2 1 1 10 13 F 15 •• •• •• •• •• •• •• •• •• •• 1 6 6 2 11 •• 8 •• •• •• •• 5 15 Cerebral haemorrbage, etc. 32 M 11 1 •• •• 1 •• •• •• •• •• •• •• •• •• •• 10 17 F 21 •• •• •• •• •• •• •• •• •• •• 3 3 7 8 10 2 9 •• • • 1 •• 5 16 Heart Disease 407 M 186 •• •• •• •• 1 1 5 1 1 5 13 36 69 54 212 251 F 221 •• •• 2 2 •• 2 1 3 9 •• 13 31 61 97 195 76 134 2 •• 1 3 35 17 Arterlo-sclerosis 66 M 39 •• •• •• •• •• •• •• •• •• 1 2 7 17 12 43 (a 32 F 27 •• •• •• •• •• •• •• •• •• •• 2 3 10 12 23 2 20 •• •• •• 3 7 18 Bronchitis 48 M 29 •• •• •• •• •• •• •• •• •• 2 •• 6 8 13 27 (b 10 F 19 1 •• •• 1 1 •• •• •• •• •• 1 3 6 7 21 5 4 •• • • •• •• •• 19 Pneumonia (all forms) 112 M 68 19 5 4 28 •• 2 •• •• 2 7 10 4 12 3 58 02 F 44 14 7 4 25 1 •• 2 •• •• 2 3 4 6 1 54 2 44 1 5 10 20 Other Respiratory Diseases 9 M 5 2 •• •• 2 •• •• •• •• •• •• 1 1 1 •• 5 0 F 4 •• •• 1 1 •• •• •• •• 1 •• •• 2 •• •• 4 •• 3 •• •• •• 1 2 21 Ulcer of Stomach or Duodenum 14 M 10 •• •• •• •• •• •• •• •• •• 1 3 4 •• •• 7 (c) 13 F 4 •• •• •• •• •• •• •• •• •• •• 3 1 •• •• 7 •• •• •• •• v •• 6 22 Diarrhoea, etc. 25 M 14 10 •• •• 12 •• •• •• •• •• •• •• •• •• •• 10 22 F 11 9 1 •• 10 •• •• •• •• •• •• •• 1 •• •• 15 •• 11 •• •• 1 •• 10 23 Appendicitis and Typhlitis 13 M 0 •• 1 •• 1 •• 1 •• 2 1 •• •• 1 •• •• 11 13 F 7 •• •• •• •• •• 1 1 •• 3 2 •• •• •• •• 2 •• 7 •• •• 4 •• 2 24 Cirrhosis of Liver M 10 •• •• •• •• •• •• •• •• •• 2 1 2 4 1 8 12 F 4 •• •• •• •• •• 1 •• •• •• 1 1 1 •• •• 6 1 9 •• •• •• •• 2 25 Acute and Chrouic Nephritis 78 M 47 •• •• •• •• •• •• 4 •• 2 2 1 13 15 10 42 57 F 31 •• •• •• •• •• 2 1 •• •• •• 5 8 8 4 30 10 38 •• •• •• •• 9 20 Puerperal Sepsis .. 4 M •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 4 4 F 4 •• •• •• •• •• •• •• 1 2 1 •• •• •• •• •• •• 1 •• •• •• •• 3 27 Other accidents and diseases of pregnancy and parturition M •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• F •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• 28 Congenital Debility and malformation, premature birth 77 M 44 42 2 •• 44 •• •• •• •• •• •• •• •• •• 1 42 47 F 33 33 •• •• 33 •• •• •• •• •• •• •• •• •• •• 35 •• 32 •• •• •• •• 15 29 Suicide M 15 •• •• •• •• •• •• •• 1 •• •• •• •• •• •• 0 13 18 F 3 •• •• •• •• •• •• •• •• 1 1 •• 1 •• •• 12 •• 2 • • • • 1 4 6 30 Other Deaths from Violence 79 M 59 •• 1 2 3 4 3 4 7 6 3 5 11 5 8 39 40 7 21 1 .. 0 (d) 12 27 74 F 20 4 •• •• 4 •• 1 1 •• 2 •• •• 2 •• 8 81 Other Defined Diseases 233 M 117 9 5 3 17 3 4 2 3 6 8 8 16 23 27 121 F 116 8 1 4 13 4 1 5 3 9 7 14 22 16 22 112 is 95 • • • • 1 00 177 82 Causes ill-defined or unknown 2 M 1 •• •• •• •• •• •• •• 1 •• •• •• •• (f) F 1 •• •• 1 1 •• •• •• •• •• •• •• •• •• •• •• 2 • 2 •• •• •• •• 2 Deaths from All Causbs M 923 91 24 19 134 15 14 24 28 34 57 87 170 207 153 892 790 142 625 4 •• 28 24 307 1130 F 759 76 24 24 124 10 11 19 23 44 29 69 112 140 178 Totals 1682 1682 107 48 43 258 25 25 43 51 78 86 156 282 347 331 (a) Highways, 3. (d) River Lee,3; Bow Station, District Railway,1. (b) Highways, 3. (e)River Lee,4; Bow Thames, 2; Limehouse Cut, 1; Millwall Dock, 1; Christchurch Draw Dock 1; Highways, 3. (c) Highways, 1. (a) Highways, 1. The following table, compiled and furnished by the Registrar-General, is inserted at the request of the Ministry of Health (vide Circular 1,119 (England) ). Causes of Death. Sex. All Ages 0– 1– 2– 5– 15– 25– 45– 65– 75– All Causes M 927 91 24 19 29 51 92 261 211 149 F 756 76 24 24 21 42 73 177 142 177 1 Enteric fever M – – – – – – – – – – F – – – – – – – – – – 2 Smallpox M – – – – – – – – – – F 1 – – – – – – 1 – – 3 Measles M 10 2 4 3 1 – – – – – F 20 4 11 4 1 – – – – – 4 Scarlet fever M 2 – 1 1 – – – – – – F 2 – – 2 – – – – – – 5 Whooping cough M 1 1 – – – – – – – – F 2 1 1 – – – – – – – 6 Diphtheria M 11 2 3 3 3 – – – – – F 6 1 1 4 – – – – – – 7 Influenza M 1 – 1 – – – – – – – F 2 1 – – – – – 1 – – 8 Encephalitis lethargica M – – – – – – – – – – F 1 – – – – – – 1 – – 9 Meningococcal meningitis M 4 3 – – 1 – – – – – F – – – – – – – – – – 10 Tuberculosis of respiratory system M 81 – – – 2 20 23 30 5 1 F 51 – 1 1 1 16 23 8 – 1 11 Other tuberculous diseases M 3 – 1 1 – 1 – – – – F 12 1 1 1 4 4 1 – – – 12 Cancer, malignant disease M 138 – – – – – 6 71 43 18 F 74 – – – – 3 4 34 19 14 13 Rheumatic fever M 5 – – – 2 1 2 – – – F 3 – – 1 1 1 – – – – 14 Diabetes M 6 – – – – 1 – 3 1 1 F 15 – – – – – – 7 6 2 15 Cerebral haemorrhage, etc. M 10 – – – – – 1 5 2 2 F 21 – – – – – – 7 6 8 16 Heart disease M 201 – – – 2 5 5 54 76 59 F 221 – – 1 1 4 12 42 63 98 17 Arterio-sclerosis M 31 – – – – – 1 7 12 11 F 26 – – – – – – 6 8 12 18 Bronchitis M 30 – – – – – 1 7 8 14 F 18 1 – – – – – 3 7 7 19 Pneumonia (all forms) M 73 20 10 4 2 – 9 13 13 2 F 48 15 8 4 1 2 2 7 7 2 20 Other respiratory diseases M 8 1 – – – – 2 – 3 2 F 6 – – – – – – 3 – 3 21 Ulcer of stomach or duodenum M 10 – – – – – 2 6 2 – F 5 – – – – 1 – 4 – – 22 Diarrhoea, etc. M 13 10 – 2 – – – 1 – – F 9 9 – – – – – – – – 23 Appendicitis and typhlitis M 6 – 1 – 1 2 1 1 – – F 7 – – – 1 1 5 – – – 24 Cirrhosis of liver M 6 – – – – – 2 2 1 1 F 3 – – – – – 1 2 – – 25 Acute and chronic nephritis M 42 – – – – 3 4 11 14 10 F 30 – – – 2 1 3 12 8 4 26 Puerperal sepsis M – – – – – – – – – – F 4 – – – – 1 3 – – – 27 Other accidents and diseases of pregnancy & parturition M – – – – – – – – – – F – – – – – – – – – – 28 Congenital debility and malformation, premature birth M 43 43 – – – – – – – – F 31 31 – – – – – – – – 29 Suicide M 15 – – – – 1 6 5 2 1 F 3 – – – – – 2 1 – – 30 Other deaths from violence M 57 – – 2 7 13 9 13 5 8 F 22 4 – – 1 1 2 4 1 9 31 Other defined diseases M 120 9 3 3 8 4 18 32 24 19 F 112 8 1 5 8 7 15 34 17 17 32 Causes ill-defined or unknown M – – – – – – – – – – F 1 – – 1 – – – – – – Legit. Illegit. Deaths under 1 year M 91 – F. 74 2 Totals 165 2 13 TABLE I. Vital Statistics during 1930 and Previous Years. (Old Table.) Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the Borough. Transferable Deaths.† Nett Deaths belonging to the Borough. Uncorrected Number. Nett. Of Non-residents registered in the Borough. Of Residents not registered in the Borough. Under 1 Year of Age. At all Ages. Number. Rate. Number.* Rate. Number.* Rate per 1000 Nett Births. Number.* Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1925 168,500 3387 3831 22.7 1973 11.7 311 308 288 75 1970 11.7 1926 169,000 3274 3658 21.6 1879 11.1 238 288 258 70 1929 11.4 1927 167,000 2901 3309 19.8 1918 11.5 258 318 218 66 1978 11.8 1928 162,000 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 1930 160,000 2451 3056 19.1 1618 10.1 245 309 167 55 1682 10.5 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 nf soldiers and sailors that have occurred in hospitals and institutions in the district. In Column 12 are entered the number in Column 6, corrected by subtraction of the number in Column 8 and by addition of the number in Column 9. Deaths in Column 10 are similarly corrected by subtraction of the deaths under 1, included in the number given in Column 8, and by addition of the deaths under 1 included in the number given in Column 9. †"Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence—e.g., casuals— are not included in Columns 8 or 9, except in certain instances under 3 (b)below. The following special cases arise as to Transferable Deaths— (1) Persons dying in institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses and nursing homes (but not almshouses) must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such institution to another, the death is transferable to the district of residence at the time of admission to the first institution. (2) The deaths of infants born and dying within a year of birth at any temporary address to which the mother went for her confinement should be referred to the district of fixed or usual residence of the mother. (3) Deaths from violence are referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occuired, if known; and (d) failing this, to the district where the body wrs found Area of District in acres (land and inland water) 2327.7 Total population at all ages 162,618 Number of inhabited houses 23,064 Average number of persona per house 7.05 Total families or separate occupiers 37,288 At Census of 1921. 14 TABLE III. Infantile Mortality during the Year 1930. Nett Deaths from stated Causes in Weeks and Months under One Year of Age. Causes of Death Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Nett total Deaths under 1 year. Poplar. Bow and Bromley Whole Borough All causes Certified 56 10 3 2 71 21 28 28 19 85 82 167 Uncertified – – – – – – – – – – – – Small-pox – – – – – – – – – – – – Chicken-pox – – – – – – – – – – – – Measles – – – – – – – 2 3 2 3 5 Scarlet fever – – – – – – – – – – – – Whooping Cough – – – – – 1 – – 1 1 1 2 Diphtheria and Croup – – – – – – – 1 2 1 2 3 Erysipelas – – – – – 2 – – – 2 – 2 Tuberculous Meningitis – – – – – – – – 1 1 – 1 Abdominal Tuberculosis – – – – – – – – – – – – Other Tuberculous Diseases – – – – – – – – – – – – Meningitis (not Tuberculous) – – – – – – – 1 2 2 1 3 Convulsions – – 1 – 1 – 1 – – 1 1 2 Laryngitis – – – – – – – – – – – – Bronchitis – – – – – – 1 – – – 1 1 Pneumonia (all forms) – – – – – 8 7 13 5 17 16 33 Diarrhœa – – – – – 1 4 4 1 3 7 10 Enteritis – – – – – 1 4 4 – 4 5 9 Gastritis – – – – – – – – – – – – Syphilis – – – – – – – – – – – – Rickets – – – – – – – – – – – – Suffocation, overlying – – – 1 1 – 2 – – – 3 3 Injury at birth 2 – – – 2 – – – – 1 1 2 Atelectasis 4 – – – 4 – 1 – – 4 1 5 Congenital Malformations 8 2 – – 10 1 2 – – 5 8 13 Premature birth 36 4 2 1 43 4 2 1 – 31 19 50 Atrophy, Debility and Marasmus 3 3 – – 6 3 2 – 1 5 7 12 Other Causes 3 1 – – 4 – 2 2 3 5 6 11 Total Deaths 56 10 3 2 71 21 28 28 19 85 82 167 Live Births in the year (Legitimate 2,990* (Illegitimate 66* Nett Deaths in the year Legitimate 165* Illegitimate 2* Registrar-General s figures. Neo-Natal Death Rate. 1925. 1926. 1927. 1928. 1929. Average 19251929. 1930. Nett Births (Registrar-General) 3,831 3,658 3,309 3,228 3,064 3,418 3,056 Deaths under 1 month 101 90 86 76 92 89 71 Neo-Natal rate per 1,000 nett Births 26.4 24.6 26.0 23.5 30.0 26.0 23.2 15 INFANT MORTALITY. There were 167 deaths of children under one year of age, the death rate per 1,000 births for the past 23 years being:— Borough of Poplar. County of London. 1908 124 (104) 113 1909 130 (99) 108 1910 119 (106) 103 1911 158 (116) 129 1912 108 (90) 90 1913 113 (83) 105 1914 117 (117) 104 1915 134 (98) 112 1916 104 (78) 89 1917 95 (79) 103 1918 107 (68) 107 1919 83 (69) 85 1920 81 (48) 75 1921 83 (66) 80 1922 79 (38) 74 1923 60 (44) 60 1924 72 (38) 69 1925 75 (50) 67 1926 70 (39) 64 1927 66 (42) 59 1928 71 (49) 67 1929 75 (40) 70 1930 55 59 Note.—The figures in brackets are the mortality rates amongst infants visited by the Health Visitors. 16 TABLE IV. Birth-rate, Death-rate, and Analysis of Mortality During the Year 1930. Birth-rate per 1 ,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Live Births. Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. . Whooping Cough. Diphtheria. Influenza. Violence. Diarrhœa and Enteritis (under 2 years). Total Deaths under One Year. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births Stillbirths. England and Wales† 16.3 0.69 11.4 0.01 0.00 0.10 0.02 0.05 0.09 0.12 0.55 6.0 60 90.4 6.9 1.7 1.0 107 County Boroughs and Great Towns, including London† 10.6 0.71 11.5 0.01 0.00 0.15 0.02 0.05 0.10 0.11 0.50 8.3 64 90.6 6.6 2.3 0.5 157 Smaller Towns (1921 adjusted Populations 20,000-50,000)† 16.2 0.69 10.5 0.00 0.00 0.08 0.01 0.05 0.07 0.13 0.43 4.4 55 91.8 5.9 1.2 1.1 London† 15.7 0.56 11.4 0.01 0.00 0.23 0.02 0.03 0.10 0.08 0.55 9.9 59 88.3 7.4 4.3 0.0 Poplar Borough * 19.1 0.66 10.5 0.00 0.01 0.19 0.02 0.02 0.11 0.02 0.49 6.5 55 80.3 15.4 4.3 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 1930, but those for the towns have been calculated on populations estimated to the middle of 1929. (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). *Rates for Poplar have been calculated on a population estimated to the middle of 1929 17 TABLE V. (1930). Cities and Boroughs. Estimated population to the middle of year. Live Births. Annual rate per 1,000 persons living. Deathrate per 1,000 living. Deaths of Infants under one year to 1,000 births. LONDON 4,417,900 15.7 11.4 59 West Districts. Paddington 142,800 15.12 12.64 78 Kensington 176,000 14.6 12. 7 69 Hammersmith 136,900 15.9 11.7 64 Fulham 153,700 15.3 10.8 57 Chelsea 62,680 12.7 12.5 40 City of Westminster 125,800 10.5 11.7 59.21 North Districts. St. Marylebone 102,400 12.1 10.6 62 Hampstead 84,830 11.8 11.5 58 St. Pancras 203,900 15.4 11.9 60 Islington 319,800 17.4 12.1 70 Stoke Newington 50,040 14.6 12.2 54.6 Hackney 214,400 16.4 11.1 49 Central Districts. Holborn 38,380 10.5 12.7 89 Finabury 66,860 19.4 13.8 63 City of London 10,700 8.3 12.0 89 East Districts. Shoreditch 99,710 20.1 12.2 65 Bethnal Green 110,500 17.7 11.1 60.3 Stepney 241,800 17.4 11.2 76 Poplar 160,000 19.1 10.5 55 South Districts. Southwark 178,500 16.8 12.5 67 Bermondsey 113,800 18.1 13.1 63 Lambeth 294,400 15.76 12.04 56.83 Batteries 161,800 16.4 11.4 54.7 Wandsworth 355,864 13.17 10.59 55 Camberwell 256,900 14.8 10.9 51 Deptford 111,000 15.9 11.3 61 Greenwich 104,430 15.38 9.99 45 Lewisham 207,900 15.1 9.7 42 Woolwich 141,600 15.5 10.9 42 Note.—The information relating to London supplied by the Registrar-General And that for individual Boroughs by the Medical Officers of Health. 18 (These summaries are inserted for comparison with those shown in previous reports.) 1925. 1926. 1927. 1928. 1929. 1930. Deaths from all causes, rate per 1,000 population 11.7 11.4 11.8 11.8 14.2 10.5 Deaths under 1 year of age, rate per 1,000 nett births 75 70 66 71 75 55 Deaths over 65 years of age, rate per 1,000 total population 4.1 3.9 4.2 4.2 5.7 4.2 *Zymotic diseases:— Death rate per 1,000 population 0.9 0.9 0.6 0.6 0.8 0.5 Proportion of 1,000 deaths 75.6 75.2 51.6 55.5 53.4 47.6 Tuberculosis, all forms:— Death rate per 1,000 population 1.1 1.0 1.1 1.1 1.2 0.9 Proportion of 1,000 deaths 96.9 84.0 96.0 93.2 85.6 86.8 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 2.9 2.4 2.0 1.9 3.1 1.0 Proportion of 1,000 deaths 246.2 207.9 172.4 162.4 219.8 98.1 Deaths from Various Diseases. Disease. 1925. 1926. 1927. 1928. 1929. 1930. Measles 27 39 8 56 11 30 Whooping-Cough 60 9 34 19 43 3 Influenza 20 23 36 24 71 3 Pneumonia (except Influenzal Pneumonia) 185 154 188 177 281 109 Diarrhœa and Enteritis (all ages) 54 69 39 47 44 25 *Smallpox, Measles, Scarlet Fever, Whooping-Cough, Diphtheria and Mem. Croup, Typhoid Fever and Diarrhœal Diseases. 19 TABLE VI. Total Deaths (at all ages) in Public Institutions within the Borough. (Residents and Non-Residents included.) Causes or Death. Poplar Institution. St. Andrew's Hospital. Bow Institution. Bromley House Institution. Poplar Hospital. Total deaths in Publio Institutions within the Borough. All causes Certified 148 641 137 1 97 1024 Uncertified – – – – – 1. Enteric Fever – – – – – – 2. Small-pox – – – – – – 3. Measles – 10 – – – 10 4. Scarlet Fever – – – – – – 5. Whooping Cough – – – – – – 6. Diphtheria – 2 – – – 2 7. Influenza – – – – – – 8. Encephalitis Lethargica – – – – – 9. Meningococcal Meningitis – 1 – – – 1 10. Tuberculosis of respiratory system 7 54 4 – 2 67 11. Other Tuberoulous Diseases – 3 – – 3 6 12. Cancer, malignant disease 12 105 3 – 8 128 13. Rheumatic Fever – 5 – – – 5 14. Diabetes – 8 – – –_ 8 15. Cerebral hæmorrhage, etc. 2 10 – – 2 14 16. Heart Disease 78 125 39 – 5 247 17. Arterio sclerosis 3 29 34 – 1 67 18. Bronchitis 6 4 – – 2 12 19. Pneumonia (all forms) 2 45 3 1 14 65 20. Other Respiratory Diseases – 3 – – 1 4 21. Ulcer of Stomach or Duodenum – 8 – – 1 9 22. Diarrhœa, etc. – 13 – – 4 17 23. Appendicitis and Typhlitis – 7 – – 7 14 24. Cirrhosis of Liver 1 9 – – – 10 25. Acute and Chronic Nephritis 10 38 37 – 3 88 26. Puerperal Sepsis – 1 – – – 1 27. Other accidents and diseases of pregnancy and parturition – – – – – – 28. Congenital Debility and malformation, premature birth – 32 – – 1 33 29. Suicide – 2 – – 1 3 30. Other Deaths from Violence 7 27 3 – 25 62 31. Other Defined Diseases 20 98 14 – 17 149 32. Causes ill-defined or unknown – 2 – – – 2 All Causes Totals 148 641 137 1 97 1024 20 DEATHS OF PERSONS OF UNKNOWN ADDRESSES, ETC., INCLUDED IN THE MORTALITY STATISTICS. The following deaths have been included in the Mortality Statistics of the Boiough, in accordance with the rules relating to "Transferable Deaths." 1930. Jan. 1 Poplar Institution Female, 79 (unknown) Myocardial degeneration. Senile decay. P.M. Inquest. ,, 15 1, Bexley Lane, Dartford, admitted from Casual Wards Male, 66 Gastric haemorrhage. Gastric ulcer. Pulmonary tubercuculosis. ,, 18 Poplar Institution, of no fixed abode Male, 74 Myocardial degeneration. Nephritis. Fall in Ward and injury to hip. Accidental cause. Inquest. ,, 31 Poplar Institution, address unknown Male, 69 Chronic bronchitis accelerated by shock of fall to floor. P.M. Inquest. Feb. 6 Poplar Institution, no fixed abode Male, 85 Chronic interstitial nephritis and chronic bronchitis accelerated by a fall. P.M. Inquest. Mar. 10 Poplar Institution, Dock Labourer of Aberdeen Male, 45 Broncho-pneumonia. Pulmonary tuberculosis. „ 10 St. Andrew's Hospital, no fixed abode Male, 50 Acute lobar pneumonia. April 8 Poplar Institution, no fixed abode Male, 68 Pernicious anaemia. Myocardial degeneration. June 4 Bow Institution, previous address unknown Male, 70 Myocarditis and nephritis. Fractured femur—fall after being pushed. P.M. Inquest. „ 14 Poplar Institution, no fixed abode Male, 49 Asphyxia while in bed during an epileptic fit. P.M. July 25 Poplar Institution, no fixed abode Male, 69 Cerebral apoplexy. High blood pressure. Sept. 22 St. Andrew's Hospital, no fixed abode Male, 77 Thrombosis of femoral artery. Gangrene of leg. Fall from a chair. Accidental cause. P.M. Nov. 28 Bow Institution Male, 65 (unknown) Lobar pneumonia. Exposure and self-neglect. P.M. Inquest. Dec. 8 Poplar Hospital, no fixed abode Male, 69 Cerebral haemorrhage. Chronio interstitial nephritis. Inquest. „ 13 Poplar Institution, no fixed abode Male, 85 Myocardial degeneration. Senility. ,, 15 Hundred Acres, Epsom, admitted from Poplar Institution, no fixed abode Male, 31 Exhaustion from mania. P.M. 21 INQUESTS AND DEATHS FROM VIOLENCE. The number of inquests registered was 280. From this total must be deducted 56 of non-residents, and 36 added of residents who died outside the Borough, the nett total being 260. Analysis of the 97 deaths classified to Suicide and other deaths from Violence (International Short List Headings Nos. 29 and 30):- Suicide 18 Food poisoning – Poisoning by venomous animals – Other acute accidental poisonings (not by gas) 1 Conflagration – Accidental burns (conflagrations excepted) 2 Accidental mechanical suffocation 4 Accidental absorption of irrespirable or poisonous gas – Accidental drowning 12 Accidental injury: By firearms – By cutting or piercing instruments – By fall 25 In mining and quarrying – By machinery 2 By other forms of crashing: Road vehicles 20 Railways 1 Other crushing accidents 1 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 2 Lightning – 22 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 5 Violent deaths of unstated nature (i.e., accidental, suicidal, etc.) and cause 2 97 For death rates from violence, and the percentage of inquest cases to total deaths, see Table IV. MORTUARY. The number of bodies deposited in the Council's Mortuary, Cottage Street, Poplar, during the year was 343:— Residents. Non-Residents .* No age stated 1 – Stillborn 1 – Under 1 year 26 1 1 to 5 years 12 – 5 to 15 years 21 4 15 to 25 years 15 1 25 to 65 years 147 6 65 years and upwards 104 4 Totals 327 16 *Brought from outside the Borough for the convenience of the Coroner. Inquests were held on 283, and 52 post-mortems were made by order of the Coroner. The total number of post-mortems made was 114. Eight bodies were brought to the Mortuary for custody only, pending burial. 23 Section II. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. (i) Public Health Officers of the Authority. A list of the Staff is shown at the commencement of the Report, page 4. During the year the following changes have taken place in the personnel of the Public Health Staff:— Sanitary Inspectors. Mr. H. Luke (vice Mr. S. Kelly, transferred to a District) commenced duty on 22nd January as Houses Let in Lodgings Inspector. Mr. H. Leonard resigned on 30th November and was succeeded by Mr. A. Dove who had been temporarily employed since 1st May on account of Smallpox. Miss M. E. Davies resigned the post of Lady Sanitary Inspector on 24th February, and Miss D. A. E. Landray, one of the Health Visitors, was appointed to the post and commenced these duties on 1st June. Disinfecting Station, Cleansing Station and Shelter. Mr. A. Fogg (apparatus attendant) resigned after 40 years' service on 16th August. His place was filled by Mr. M. Renwick, who was succeeded by Mr. A. E. Rogers. Mrs. Stollery (Assistant Attendant) retired on reaching the age-limit on 31st May and was succeeded by Mrs. Allan. Smallpox. In order to cope with the increase in Smallpox the following temporary staff was appointed:— Assistant to the M .0 .H.—Dr. H. D. Chalke (commenced 31st March). 24 Sanitary Inspectors— Mr. A. H. T. Harris (commenced 1st April). Mr. W. J. Colborne (commenced 5th May). Mr. A. L. Dove (commenced 1st May). Clerk.—Mr. W. G. Barnett (commenced 28th March). Shelter Attendant.—Mrs. A. Walker (commenced 26th May). It was also necessary to employ additional temporary men to assist in disinfection. As a result of the modification in the procedure in dealing with Smallpox, the services of most of the temporary staff were dispensed with during December, 1930, and January, 1931. Car Driver—Relief. A relief driver has been temporarily engaged to reduce as far as possible the abnormal hours of the regular driver. Tuberculosis. Dr. H. B. Hodson, M.B., B.S. Lond., M.R.C.S., L.R.C.P., was appointed as Assistant Temporary Tuberculosis Officer from 10th June to 31st October to assist at the Dispensary during the absence of Dr. Smith on sick leave. Maternity and Child Welfare. Health Visitors. Miss G. E. Paice resigned on 26th April and was succeeded by Miss G.I. Hill who commenced duties on 12 th May. Miss D. A. E. Landiay was appointed Lady Sanitary Inspector from 1st June and on 22nd July was succeeded by Miss M. H. Sutcliffe. Miss B. E. Letts commenced duty on 29th September vice Miss E. M. Craigie who resigned on 9th August. Observation Wards. (i) Staff Nurses.—Miss K. Goodwin and Miss S. C. Boyle resigned in October and December respectively. Miss E. Hodges commenced duty 25 on 14th November. It was necessary to obtain the temporary services of a Nurse from a Nursing Association. (ii) Probationers.—Changes have occurred in the personnel during the year and on account of illness during July temporary assistance had to be obtained. Two of the Probationers passed the elementary examination of the National Society of Day Nurseries. (iii) Domestic Staff.—Changes have taken place in the Domestic Staff during the year. Vaccination. The Public Vaccinator and his Assistant and the Public Vaccinators were transferred to the Borough Council Staff as from 1st April, 1930. A list of these officers is shown at the commencement of the Report. (2) Nursing in the Home. 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). (3) Midwives. The number of midwives practising in the area is 20. No arrangements are made for subsidising midwives in the Borough, but compensation is paid in certain circumstances (see Maternity and Child Welfare Section, page 143). (4) National Health Insurance. From time to time complaints of insanitary conditions are received from various Approved Societies and the conditions are investigated. The Tuberculosis Officers co-operate with panel practitioners respecting insured tuberculous patients in receipt of domiciliary treatment. 26 (5) Poor Law Medical Out Relief. The following information was furnished by the London County Council:— Outdoor Relief. Number of persons relieved. Cost. Medical relief only 1st January, 1930 15,448 £5,869 25 1st July, 1930 12,260 £4,329 20 (6) Laboratory Facilities. (a) Chemical Analysis. Arrangements are made with an analytical chemist who is approved by the Minister of Health. All examinations are carried out at the Public Analyst's own laboratory which is situate at 139, St. Leonard's Road, Poplar. The report of the Public Analyst is given on page 83. (b) Bacteriological. (i) All sputa examinations are made at the Council's Tuberculosis Dispensary. (ii) Examination of diphtheria swabs and Widal tests and examination of stools and urine are carried out by arrangement with the Seamen's Hospital Society, Dreadnought Hospital, Greenwich. (iii) Wasserman tests and examination of smears are done at the London Hospital under the Venereal Disease Scheme for London. (7) Legislation in force. In addition to the various Acts generally in force in London, and to the Orders under Agricultural Produce (Grading and Marking) Act, 1929, and the Merchandise Marks Acts, the following Byelaws, etc., are operative in the Borough:— 27 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 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. (See ''New Legislation" page 29.) 28 Date of Section. Adoption. 19 Bone boiler, manure manufacturer or tallow 25th Nov., 1907 melter 19 Gut scraper and catgut maker or catgut 25thNov., 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, 1924. 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. 29 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. (See ''New Legislation'' below.) Slaughterhouse, etc. (Metropolis) Acts, 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 Acts, 1925-26. Houses-let-in-Lodgings or occupied by mem- 5th Mar., 1926. bers of more than one family Section 55 of the Public Health (London) Act, 1891, has been applied to:— 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:— I. Acts. Housing Act, 1930, was passed on 1st August, 1930, and came into Operation 14 days after that date. 2. Byelaws and Regulations. New Drainage Byelaws made by the London County Council under Section 202 of the Metropolis Management Act, 1855, and the Metropolis Management (Amendment) Byelaw Act, 1899, were allowed by the Ministry of Health on the 4th day of March, 1930. 30 New Byelaws in respect of Water Closets, Urinals, Earth Closets, Privies, Cesspools, etc., submitted by the London County Council to the Ministry of Health in June, and allowed by the Ministry of Health on 21st August, 1930. The Public Health (Tuberculosis) Regulations, 1930, were issued under date 8th July, 1930, to come into operation on 1st January, 1931. (The Council delegated the powers under these regulations to the Public Health Committee. A copy of the regulations was sent to all medical practitioners practising in the Borough.) Revision of the Byelaws relating to ashpits and receptacles for dung was deferred in view of the appointment in 1929 by the Minister of Health of a Departmental Committee on London Cleansing. (8) Hospitals. Fever and. Smallpox. Hospitals for patients suffering from these diseases are provided by the London County Council. Tuberculosis. Residential Institutional Treatment for tuberculous patients is provided by the London County Council. Other Hospitals. There are no hospitals in the Borough provided or subsidised by the Council. There are two General Hospitals, Poplar Hospital (supported voluntarily), and St. Andrew's Hospital (maintained by the London County Council). Other Institutions in the Borough are:— Poplar Institution; Bow Institution ; Langley House; Bromley House Institution ; all of which are now maintained by the London County Council. 31 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 Voluntary Hospitals which serve the locality are the Dreadnought Hospital, Greenwich (for Seamen), the East London H cspital for Children, Shadwell, and the City of London Chest Hospital, Victoria Park. 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 144). The Royal College of St. Katharine also have accommodation for 6 children suffering from malnutrition, etc., and 6 cots for tonsillectomy cases. (9) Maternity and. Nursing Homes. At St. Andrew's Hospital there is a maternity block, consisting of three wards, labour rooms and theatre, with accommodation for approximately 36 cases. (10) Maternal Mortality. All maternal deaths and all cases of Puerperal Fever and Puerperal Pyrexia are specially investigated. (See Maternity and Child Welfare Section, page 143.) (11) 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. (12) Institutional provision, if any, for the care of Mental Defectives. Institutional treatment for mental defectives is provided by the London County Council. There are no institutions in the Borough dealing with this class of patient. 32 (13) Ambulance facilities. For infectious cases: This service, formerly provided by the Metropolitan Asylums Board, is now under the control of the London County Council. For non-infectious and accident cases: The ambulance service of the London County Council is available for non-infectious cases. The London County Council provide an ambulance for the conveyance of the sick poor. The ambulance service of the London County Council which deals with accident cases is available for removal of parturient women to hospital in cases of emergency. Further reference to the Ambulance service and the removal to hospital of parturient women is made in the Maternity and Child Welfare Section, page 155. (14) Clinics and Treatment Centres. Maternity and Child Welfare Centres, Ante-Natal Clinics and Day Nurseries. (See Maternity and Child Welfare Section, page 126.) Tuberculosis Dispensary. (See page 104, where a list of accommodation and hours of sessions, etc., is shown.) There are several school treatment centres in the Borough maintained by the London County Council. There is no centre in the Borough for the treatment of venereal disease. 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. (15) Other Matters. Removal of infirm and diseased persons.—During the year it has not been necessary to enforce the provisions of Section 28 of the London County Council (General Powers) Act, 1928. Three cases of elderly females who were living under insanitary conditions, and were unable to look after themselves properly, came to our notice, but we were able to persuade them to enter homes or institutions. 33 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. Improved methods of dust collection by low loading freighters at present under consideration. 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 1930. House refuse collected 34,214 tons. Trade refuse collected 99 „ Slop and sweepings 8,286 ,, Refuse from street markets 2,868 ,, 34 Work of Lady Sanitary Inspector. Tabulated statement of Inspections, of Insanitary Conditions found existing, and of Reinspections, etc., during the year 1930. Poplar. Bote and Bromley. Totals. Workshops, Workplaces, Laundries, etc., Number of, on the Register 45 87 132 Workshops, Number of Workrooms therein 52 96 148 „ Number of Inspections of 18 86 104 ,, Number of Reinspections of 5 5 10 Workrooms, Number of Inspections of 7 37 44 ,, found to be overcrowded – – – ,, found to be insufficiently ventilated – 2 2 ,, found to be in dirty condition – – – Workshops, etc., newly discovered and registered 4 3 7 ,, Workrooms therein measured – – – ,, Reported to H.M. Inspector on discovery 4 3 7 Factories, Number visited 20 76 96 ,, W. C.'s dirty, insufficient, etc. 3 11 14 Outworkers' premises visited 135 776 911 Written Intimations served and instances reported 6 28 34 Statutory Notices served – – – Final Notices served – – – Works carried out under supervision:— (a) Additional means of ventilation provided – – – (b) Rooms cleansed and whitewashed – – – (c) Yards, floors, roofs, etc., repaired – – – (d) Sanitary conveniences constructed, cleansed or repaired 2 9 11 (e) Dampness remedied – – – (f) Sink waste pipes renewed, etc. – – – (g) Miscellaneous – – – Overcrowding of Workrooms, Cases abated – – – Miscellaneous Visits (including visits to Council Houses] 412 186 598 Visits re Verminous Children 13 8 21 ,, Scabies 43 33 76 „ Outworkers' Lists 8 7 15 ,, Suspected Infectious Disease 183 85 268 Eye Infections 15 6 21 Visits to Schools 25 22 47 ,, cases of chickenpox – – – ,, re smallpox contacts 6 39 45 Factory and workshop inspections, 196; fair condition, 175; removed or discontinued. 2; required cleansing, 5; sanitary conveniences defective or insufficient, 14. DISTRICT SANITARY INSPECTORS' WORK, Etc. tabulated Statement of Inspections, Insanitary Conditions found existing, and Re-inspections during the year 1930. Work of Temporary Inspectors, 1930. (See Footnote.) East Combined West Combined Poplar South ley North Bromley Central Bow East Bow West Totals 1930 Totals 1929. Mr. W.J. Colborne. Mr. A. L. Dove. Mr. A. T. Harris. East West (a) (b) (a) (b) (a) (b) Total Inspection 1312 1620 1104 759 1703 1119 960 1109 9692 8559 524 291 571 328 300 88 on complaints of nuisance,etc. 615 779 442 409 945 399 430 632 4651 4322 215 114 274 159 131 44 On notification of infectious diseases 428 541 412 223 598 396 269 369 3236 2902 164 91 245 92 145 36 † House-to-house 93 82 8 56 31 73 32 46 421† *95 – – 9 26 6 – workshop,workplace,etc. 153 1 37 18 10 58 94 33 404 477 56 – 23 51 – – Miscellaneous 23 223 205 53 119 193 135 29 980 763 89 86 20 – 18 8 Premises found in fair condition 673 733 569 409 943 391 513 398 4629 3586 189 186 338 162 188 62 Do. Requiring amendment 639 893 535 350 760 728 447 711 5063 4973 192 105 233 166 106 26 Details of insanitary condition,etc. walls and ceilings dirty 200 297 119 171 377 417 304 414 2299 1968 133 74 40 49 69 36 yards,forecouts and areas insufficiently paved or drained 119 60 44 50 70 109 64 46 562 401 19 10 27 14 8 3 inlets to drains not properly trapped 1 2 – – 3 1 1 8 15 – – – – – – number of drains tested 177 85 241 57 93 160 215 498 1526 1750 64 50 31 14 2 5 Do. do. defective 43 41 45 20 9 4 65 38 265 256 5 4 1 9 – 1 Do. do. obstructed 56 73 33 39 67 29 55 29 381 387 10 6 15 21 4 2 sink waste pipes not trapped or otherwise defective 39 18 34 7 31 96 52 74 351 310 15 4 6 13 7 – Do. do. directly connected to drains I – – – – – 3 – 4 9 1 – – – – – soil pans pf w.c.'s without suitable water supply 39 20 13 18 65 21 21 1 201 300 4 2 10 9 2 2 Do. do. broken or unsuitable 20 23 4 12 20 30 16 20 145 168 5 7 4 2 4 2 Do. do. in foul condition 10 10 4 11 3 2 4 5 49 62 2 1 1 – – – Do. do. untrapped 2 – – 2 – – 2 2 8 2 – – – – – – roofs,guttering , and rain water pipes defective 286 279 283 168 367 395 224 251 2253 2070 76 66 112 71 51 32 water supplies to premises cut off (notified by metropolitan water board) – – – – 2 – 2 – 4 19 1 2 – – – – Water service fitting defective ,causing waste of water 36 13 46 14 13 10 19 12 163 183 6 3 3 2 5 1 Drinking water improperly stored – – – – – – – – – – – – – – Dampness 330 126 76 40 255 163 98 63 1151 834 37 19 36 22 12 – Inundation 22 39 1 12 7 – 37 – 118 31 – – – – 30 – Overcrowding 15 30 14 12 26 5 8 – 110 56 1 – 10 1 – – No proper receptacle for house refuse 149 174 145 54 157 141 74 115 1009 851 49 22 79 51 33 1 Accumulation of dung or refuse 23 28 15 3 20 5 10 11 115 84 5 1 3 2 1 2 Insanitary P.H. urinals – 7 – – – – 2 – 14 16 – – – – – – other nuisance, diplapidations, want of ventilation, etc. 365 271 351 286 412 488 241 396 2810 2722 195 116 135 92 125 64 Breaches of london country council's by-laws 79 11 13 – 85 – 65 – 253 156 3 – – – – – Breaches of council's by-laws 116 22 44 – 70 109 38 – 429 292 – – – – – – Intimations served 544 743 519 350 746 622 447 717 4688 4769 152 109 219 167 99 26 Final notices served 197 294 238 113 440 310 130 200 1922 1725 – 35 13 – – – Summoneses applied for 40 134 123 51 170 46 35 40 639 523 – 19 – – – – Passenger from continental ports- – 10 6 8 12 3 6 2 47 35 – 1 – – – – visited Undiscoverd 2 7 – – – – – – 9 17 – – – – – – Intimations served in respect of vermious rooms – 3 – – – – – – 3 1 – – – – – – Verminous rooms cleansed by owner ,etc. 35 27 8 27 50 22 14 3 186 172 6 1 – – 3 – RE-inspection 41 17 9 24 50 18 17 3 179 177 3 – – – 3 – 3144 2418 2511 2056 3528 1636 2121 2368 19782 15394 625 333 1063 580 261 164 visited to smallpox contacts number visited 4541 4073 2389 1263 7299 5540 895 741 26741 19655 589 238 1050 764 4371 531 premises visited 930 1807 287 385 1701 972 194 4045 10321 530 179 688 227 1171 156 Do. school absentees, etc. 11 83 48 30 22 83 16 26 319 268 227 2 3 1 5 17 House-to-house Visited re smallpox – – 117 – 190 391 – – 698 261 – – 17 – 40 – Visiter re typhoid fever contacts – – 6 – – – – – 6 3 – – – – – – Enquiries re re-housing 64 19 3 – 99 60 50 30 325 – – 3 24 29 103 5 in addition to the above, 642 house-to-house inspections were made by Mr. (J. H. Brown. *>116 House-to-house inspections by Mr. C. H. Brown not included in this Table. Notes.—Work done as—(a) Additional Inspector. (b) Deputy for absent District Inspector. Approximately two-thirds of the work carried out by the Temporary Inspectors is included in the first part of this Table. 35 HOUSES DIVIDED INTO SEPARATE TENEMENTS, ETC. Report of Inspector—Year 1930. House-to-House visits for registration purposes 32 Declarations, for information, sent out 14 ,, with information, returned i4 Rooms measured, etc 187 Houses registered 5 Notices sent out, re above 6 Inspections: (a) Routine 284 (b) On complaints 25 (c) On account of re-housing Re-inspections 872 Miscellaneous visits, enquiries, etc.12 Number of Intimations served 162 ,, Notices served 15 ,, Notices complied with 104 ,, Final Notices served 8 ,, Notices served under L.C.C. Bye-laws 17 ,, rooms cleansed and freed from vermin 41 Overcrowding, cases discovered 29 ,, ,, abated 9 Mixed sleeping, cases discovered 16 ,, ,, abated 7 Number of nuisances referred to District Inspectors: (a) Defective or obstructed drains 8 (b) Defective roofs, guttering, etc. 30 (c) Miscellaneous 52 Water supply in tenement houses (section 78, London County Council (General Powers) Act, 1907): (a) Number of Intimations served 4 (b) ,, Notices served — (c) ,, Notices complied with 1 Smallpox work: Primary enquiries re cases 45 Visits to school absentees 21 House-to-house visits 57 Remarks: During the year the Inspector deputised for District Inspectors and engaged on Smallpox work from time to time. 36 FACTORY AND WORKSHOPS ACTS. Table A. Table giving number and inspections, etc., of Bakehouse; Laundries, Workshops, Workplaces, places where food is prepared, Mil premises, Cowsheds, Slaughterhouses, Offensive Businesses, Ice Crear premises, and Homeworkers' premises. Premises. On Register during year 1930. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male Female. Total. Bakehouses (Factories) 47 _ 47 185 97 8 1 __ Bakehouses (W orkshops) 23 — 23 106 53 1 - — Bakehouses (Domestic Workshops) 6 - 6 17 12 - _ Factories (Laundries and Miscellaneous Factories) 24 125 149 129 10 1 - - Laundries (Workshops) — 4 4 4 — — - — Laundries (Domestic Workshops) - _ Workshops 190 11S 308 393 30 8 1 — Workshops (Domestic) 16 9 25 30 — 1 - — Workplaces 345 1 346 445 39 14 1 — Workplaces (Domestic) 49 — 49 73 5 2 — Places where food is sold or prepared 792* _ 792* 1986 408 25 4 _ Milk Premises 118 — 118 267 6 1 — — Cowsheds 3 — 3 20 — — — — Slaughterhouses (a) 9 — 9 52 34 — — Other offensive trade premises 7† 70† 6 1 - - Ice Cream premises 112 † — 112+ 251 9 — — — Homeworkers' premises 7 558 565 915 1 * Power is used in 67 of these premises. ‡ M M ,, ,, (a) Includes two registered Slaughterers of Poultry (12, Coborn Road, and 221, Roman Road). † Registered by the London County Council. 8 offensive trades oarried on; Fur Skin Dressers, 4. Soap Boiler, 1. Fat Boilers, 2. Tallow Melter, 1. 1 premises used for two offensive trades. (Fat Boiler and Tallow Melter.) 37 Table B. Workshops on Register (Male). i Accumulator making. 1 Leather working. i Bath Salts making. 9 Motor garage works. i Battery making. 1 Maltster. 2 Bedding making. 5 Metal works. i Bitumen making. 2 Oil stores. 3 Blind making. 4 Paint making. i Boiler covering. 2 Plumbing. 2 Boat Building. 1 Poultry food mixing. 23 Bootmaking. 3 Printing. 1 Bottle sorting. 4 Rag sorting. 2 Brush making. 1 Range making. 11 Cabinet making. 3 Rope making. 2 Carpenters. 1 Sack making. 1 Chemical works. 2 Sawyer. 1 Cigar making. 1 Shellac bleaching. 1 Clay pipe making. 1 Stonemasonry. 3 Confetti making. 22 Tailoring. 3 Cork cutting. 1 Tank making. 4 Cooperages. 1 Tarmac making. 1 Coppersmith. 4 Tarpaulin works. 1 Dental workshop. 2 Tin toy making. 1 Electrical engineering. 1 Trunk making. 3 Engineering. 4 Upholstering. 13 Farriers. 3 Undertaking. 3 French polishing. 2 Van building, etc. 1 Frilling making. 1 Vinegar making. 2 Furniture making. 2 Waterproof working. 1 Furniture-polish making. 2 Welding. 1 Furrier. 1 Wheelwright. 1 Garden Ticket making. 2 Wire working. 1 Glass blowing. 1 Wireless apparatus making 1 Horsehair working. 1 Wood Tar products. 4 Harness making. 1 Zinc working. 38 Domestic Workshops on Register (where Men are Employed.)* 1Blacksmiths. 4 Boot repairing. 1 Decorative earthenware making. 1 Mat making. 1 Paper bag making. 6 Tailoring. 1 Wire working, 1 Zinc working. Home Workers on Register (Male). 6 Bootmaking. i Box making. Workshops and Domestic Workshops on Register (Females).* 1Bedding making. 1Boot making. 1 Cabinet making. 1 Cap making. 2 Confectionery making. 3 Cork cutting. 11 Costume making. 18 Dressmaking and altering. 1 Embroidering. 5 Furriers. 1 Glass instrument making. 1 Horsehair drafting. 4 Laundries. 1Leather waste sorting. 13 Milliners. 2 Onion peeling and pickling. 7 Packing. 4 Rag sorting. 1 Portable case making. 3 Pressers and cleaners. 1 Sack making. 1 Shirt making. 1 Seal stamp making. 40 Tailoring. 1 Tiemaking. 1 Toymaking. 2 Underwear making. 3 Upholstering. 1 Wood chopping. *It is very difficult to separate Workshops and Domestic Workshops, as these premises are sometimes one and sometimes the other, according to the pressure of work. See Table A, page 36. One workplace included above. 39 Factories on Register (where Females are Employed) . 2 Bedding manufacturing. 1 Binder weaving. 1 Blouse making. 2 Boot making (Infants') 8 Box making. 1 Brush making. 2 Bunting and flag making, 1Butter mixing factory. 1 Button and buckle making. 1 Cake and Biscuit making, 1 Chip basket making. 1 Cigarette paper making. 1 Clay fuel and pipes. 2 Cleaners and dyers. 2 Confectionery making. 1 Cork cutting. 2 Corset making. 1Costume making. 1Dog biscuit manufacturer. 3 Dressmaking. 1Dyemaking for leather goods. 1Feather works. 1Fibre, hemp and jute making. 1 Furrier, 1 Glass works, 1Gum works. 1 Harness making. 1 Kapok works. 2 Laundries. 1Match making. 1Oil and colour works. 2 Overall making. 2 Perambulator bui'ding. 1 Pianoforte manufacturer, 1 Pickle and sauce making. 3 Preserved food. 1 Printing wo ks. 1 Ragwork. 1 Rice starch making. 4 Rope works. 2 Rubber goods making, 1 Rug making. 4 Sack making. 1 Sausage factory. 6 Shirt making. 1 Shroud making. 1 Sugar refining. 30 Tailoring. 2 Tarpaulin works. 1 Ticket printing. 1 Timber works and wicker furniture making. 2 Toy making. 1 Type founder. 1 Underwear making. 1 Uniform making. 1 Wallpaper manufacturer. 3 Waterproof making. 1 Whalebone works. 1 Wine bottling. 1 Woollen garment making. 40 Table C. See note, page 38. Factories, Workshops, Laundries, Workplaces and Homeworkers 1.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Intimation. Statutory. Final. Factories (Including Factory Laundries.) 324 107 9 1 — Workshops† (Including Workshop Laundries.) 503 83 9 1 — Domestic Workshops‡ 47 12 1 - — Workplaces 445 39 14 1 - Domestic Workplaces 73 5 2 — Places where food is sold or prepared§ 1986 408 25 4 - Homeworkers' Premises 915 1 - - — Total 4293 655 60 7 . t .. . — †Including Workshop Bakehouses. See Table A, page 36. ‡ Including Domestic Bakehouses and Laundries. See Table A, page 36. § The inspections of all factories where food is prepared are included. Power is used in 67 of the premises. 2.—DEFECTS FOUND* (Corresponding figures for 1929 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 cleanliness 614 (694) 614 1694) .. .. Want of ventilation 2 (1) 2 (1) .. .. Overcrowding — (2) - (2) .. .. Want of drainage of floors 4 I4) 4 (4) Other nuisances.. 84 (187) 84 (187) .. .. Sanitary accommodation insufficient 4 (8) 4 (8) .. .. unsuitable or defective 15 (126) 15 (126) .. .. not separate for sexes 3 (5) 3 (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 (Excluding offences relating to outwork which are included in Table D of this Report.) Total 726(1027) 726 (1027) .. .. * These defects refer to premises as mentioned above under table of Inspection. 41 Table D.— Home Work. wholesome premises. I (Section 108). premises, •Sections 139, 110). Nature of Work. Lists received from Employers. Notice served on Occupiers as to keeping or sending lists. Prosecutions. Failing to keep or permit inspection of list. Failing to send lists. Instances. Notices served Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Total Lists. Outworkers. Tola! Lists. Outworkers (1) Contractors. Workmen . Contractors. Workmen. (2) (3) (4) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16 Wearing Apparel— Making, etc. 77 134 604 4 20 24 Cleaning and Washing Household Linen Lace, lace ourtains and nets Curtains and furniture hangings Furniture and Upholstery Eleotro-plate File Making Brass and Brass Articles Fur pulling Cables and Chains Anohors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, etc. Artificial Flowers 13* Nets, other than wire nets Tents Sacks Racquet and Tennis Balis Paper,eto.,Boxes, Paper Bags 2 - 69 1 — 8 Brush Making 2 - 2 — — — Pea Picking Feather Sorting Carding,etc.,of buttons,etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, etc, Textile Weaving Miscellaneous 2 - 20 - — — Totals 83 134 695 5 20 32 - - - - - - 13* .. .. * For Infectious Diseases see page 85. 42 LIST OF OUTWORKERS, FACTORY AND WORKSHOP ACT, 1901 (S. 107). 1930 Number of Lists received. Number of Addresses of Outworkers. Class of Homework. Due Feb. 1st. Due Aug. 1st. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Due Feb. 1. Due Aug. 1. Due Feb. 1. Due Aug. 1. Total 46 407 — 449 227 336 389 325 Tailoring 38 334 37 321 267 244 351 325 Shirtmaking 1 11 1 10 Miscellaneous 2 10 2 12 Shoemakers 1 30 1 24 Boxes 1 4 2 12 Overalls 1 64 1 49 Table E. Registered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses may be enumerated here. Bakehouse Workshops 23 Bakehouse Domestic Workshops 6 Laundries Workshops 4 Laundries Domestic Workshops — Workshops 308 Domestic Workshops 25 Workplaces 346 Workplaces Domestic 49 Places where food is sold or prepared 792† Total number of workshops and workplaces, etc., on Register 1553‡ †Power is used in 67 of these premises. ‡ See Tables A and B, pages 36 and 37. Table F. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 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 22 Reports (of action taken) sent to H.M. Inspector 14 (8 sent in 1931) Other (Communications) — Underground Bakehouses (s. 101):— Certificates granted during the yea — In use at the end of the year 21 43 SMOKE ABATEMENT. 61 observations were made and 40 nuisances recorded. 16 complaints were received from the London County Council. 13 intimations were served and were followed by notices in 5 instances. It was not necessary to institute legal proceedings in any instance. Methods of observation and standards in use since 1927 are similar . to those of the Coal Smoke Abatement Society. Houses Let in Lodgings. The report of the Inspector is given on page 35. Offensive Trades, Slaughterhouses. These are referred to in Table A, page 36. Milkshops, Dairies, etc. The premises are reported upon on page 67. RAG AND BONE DEALERS. No legal proceedings were taken for non-compliance with the L.C.C. Bye-laws, but six dealers were cautioned for having toys, etc., on barrows. 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. 329 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. 285 gallons of insecticide were distributed during the year. 44 LICENSED PREMISES' URINALS. 14 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. STABLES. 193 stables were inspected and reported upon, the total number of inspections being 282. The following infringements of the Bye-laws were dealt with:— Accumulations of manure, or premises otherwise not clean 21 Floors not properly drained 4 Dung receptacles:— (a) Not provided 3 (b) Defective 5 (c) Not covered — Other defects 8 25 Intimations were served, followed by 7 Notices. The works required were completed before the end of the year. 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 new applications are reported upon prior to licences being granted, and all storage premises are kept under supervision and periodically inspected. 45 RATS AND MICE (DESTRUCTION) ACT, 1919. 141b. of barium carbonate paste and 141b. of red squill baits were distributed to applicants, the results being highly satisfactory. 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. 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. There is only one private school in the Borough. The accommodation was satisfactory and the sanitary arrangements sufficient and kept in a cleanly state. RAG FLOCK ACT, 1911. Two samples of rag flock were taken during the year and in both samples the amount of soluble chlorine came within the limits prescribed by the Regulations. A sample of Jute was taken and on examination was found to contain soluble chlorine in the proportion of 40 parts per 100,000. As the Jute was being prepared outside the Borough the Medical Officer of Health of the district was notified of the facts. HAIRDRESSERS' PREMISES. The number of inspections of hairdressers' premises was 86. Cleansing was necessary at 4 of the premises, and other nuisances found numbered 12. 6 intimations and 3 statutory notices were served. 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. 46 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 28 instances (including 10 cases reported in 1929) the nuisance was abated. CANAL BOATS ACTS. For the year ended 31st December, 1930, the inspections and reports of the Inspectors were as follows:- Registered boats. Registered boats. *Mr. H. A. Tibbatts, East Combined Division — — Mr. J. Johnson, West Combined Division — — *Mr. H. W. Leonard and Mr. A. L. Dove, Poplar South Division (East) .. *Mr. H.J. Langley, Poplar South Division (West) Mr. C. S. Westbrook, Bromley North Division Mr. Wm. Johnson, Bromley Central Division 1 - Mr. S. Kelly. Bow East Division 11 9 Mr. F. A. Smith. Bow West Division — — Totals 12 9 *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 1930." Mr. C. S. Westbrook reported: "No canal boats have been observed in the Bromley North section of the canal during 1930." Mr. Wm. Johnson reported: "The boat was fair and clean. No children carried. Several visits to Canal and Locks were made during the year, but mostly unregistered boats were seen.'' Mr. S. Kelly reported: "Only one boat was found to have children on board. Boat was in good order. Three registered boats were inspected twice and four non-registered boats were inspected four times. One registered boat was not legibly marked and six were found to have various defects. In each case letters were Bent to Owners and Registration Authority. Three non-registered boats were used as dwellings and letters were sent to Owners. Legal proceedings were taken against one Owner of a non-registered boat for obstruction and a fine of 5s. and 10s. 6d. costs was imposed." Mr. F. A. Smith reported" No canal boats have been seen during 1930." 47 Public Health (London) Act, 1891, Metropolis Management Acts, etc. Address. Nature of Complaint. Date of Decision. Result. Inspector. 1930. 17, Trego Road Roof over back addition defective Jan. 6th .. £1 penalty; £2 4s. costs Kelly, S. 21, Trego Road Various defects Jan. 6th 7 days' order; £2 6s. costs Kelly, S. 69, Libra Road Failed to comply with Magistrate's abatement order Jan. 6th £5 penalty; £2 2s. costs Smith, F. A. 71, Libra Road Roof defective and other defects Jan. 8th 7 days' order; £2 6s. costs Smith, F. A. 73, Libra Road Main roof defective Jan. 8th 7 days' order; £2 6s. costs Smith, F. A. 22, Park Street Failed to comply with Closing Order made by Magistrate Jan. 23rd £5 penalty; £2 2s. costs Johnson, J. 267, West Ferry Road Main roof and top back ceiling plaster defective Jan. 17th 14 days'order; £2 8s. costs Langley, H.J. 261, West Ferry Road Eaves gutter and hopper head defective Jan. 17th 14 days'order; £2 8s. costs Langley, II.J. 4, Tibbatts Road Failed to comply with Magistrate's abatement order Jan. 30th £10 penalty; £2 2s. costs Westbrook, C. S 30, Glaucus Street Various defects Feb.11th Work done; £2 4s. costs Westbrook, C. S 53, Market Street Various defects Feb.18th 7 days' order; £2 8s. costs Johnson, J. 24, Caxton Street Sink waste pipe and ceiling of off-room defective; no proper and sufficient ashpit Feb. 21st Work done; £1 2s. costs Kelly, S. 78, Wellington Road Various defects Feb. 21st £2 4s. costs (Summons withdrawn ; Defendant died) Westbrook, C. S 58, Merchant Street Various defects Feb.28th 7 days' order; £1 Is. costs Westbrook, C. S 73, Willis Street Various defects Feb.25th 7 days' order; £2 8s. costs Johnson, W. 48 LEGAL PROCEEDINGS—(continued). Public Health (London) Act, 1891, Metropolis Management Acts, etc. Address. Nature of Complaint. Date of Decision. Result. Inspector. 1930. 75, Willis Street Flooring and kitchen range defective Feb.25th 7 days' order; £2 8s. costs Johnson, W. 153, Stebondale Street Failed to comply with Magistrates' abatement order Apr. 15th 2s. 6d. penalty; £2 2s. costs Leonard, H. W 91, Bygrove Street Walls of ground floor front room damp Mar. 19th 10 days'order; £2 8s. costs Johnson, J. 91, Bygrove Street Failed to comply with Magistrate's abatement order Apr. 11th .. £1 penalty; £2 2s. costs Johnson, J. 2, Bath Cottages Roof defective Apr. 11th .. 7 days' order; £2 8s. costs Johnson, J. 3, Bath Cottages Roof and kitchen range defective Apr. 11th 7 days' order; £2 8s. costs. Johnson, J. 21, Grace Street Various defects July 16th 14 days' order; £2 4s. costs Westbrook, C. S 22, Grace Street Various defects July 16th 14 days' order; £2 4s. costs Westbrook, C.S 12, Portree Street Various defects Aug. 13th Work done; £2 5s. costs Johnson, W. 68, Barchester Street Failed to provide sufficient ashpit Aug. 26th Withdrawn on payment of £2 5s. costs Johnson, J. 5, Barchester Street Walls of ground floor front room damp Aug. 18th Work done; summons withdrawn on payment of £2 5s. costs Johnson, J. 2, Gaverick Street Various defects Aug. 27th Langley, H.J. 13, Claude Street Various defects Aug. 27th Work done; summonses withdrawn on payment of costs, £6 15s. Langley, H.J. 16, Claude Street Main roof, roof gutter defective and other defects Aug. 27th Langley, H.J. 21, Crew Street Various defects Aug. 13th 14 days' order; £2 8s. costs.. Langley, H.J. 49 LEGAL PROCEEDINGS-(continuea) Public Health (London) Act, 1891, Metropolis Management Acts, etc. Address. Nature of Complaint. Date of Decision. Result. Inspector. 1930. 40, Railway Street Main and back addition roofs and stoves in first floor front room and kitchen defective Aug. 29th 7 days' order; £4 4s. costs Johnson, W. 48, Glengall Road Main roof defective; premises damp Sept.15th.. £2 penalty; £5 5s. costs Leonard, H. W. 48, Glengall Road Failed to cleanse, alter and amend the drains Sept.15th.. £3 penalty Leonard, H. W. 230, West Ferry Road Various defects Sept. 5th .. £5 penalty; £2 2s. costs Langley, H.J. 14, Manilla Street Various defects Sept.12th.. Work done; £2 5s. costs Langley, H.J. 140, Parnell Road Failed to cleanse, alter and amend the drains Sept.20th.. Dismissed with costs against Council Smith, F. A. 166, West Ferry Road Main roof, valley gutter and slip roof defective Sept.16th.. Work done; £2 5s. costs Langley, H.J. Factory in Denbigh Road, rear of 147, Bow Road Failed to give notice of intention to construct waterclosets Sept. 29th, adjourned to Nov. 10th Summonses withdrawn on undertaking of Defendant to execute work to the I satisfaction of the Council; £12 125. costs V Kelly, S. Kelly, S. Ditto ditto Constructed W.C. on ground floor without means of ventilation Ditto ditto Ditto on first floor Kelly, S. Ditto ditto Branch drains not connected to another drain obliquely in direction of flow Kelly, S. 6, Newcastle Street Various defects .. Oct. 17th Work done; £2 5s. costs Leonard, H. W. 6, Tibbatts Road Main roof valley gutter and plaster of staircase ceiling defective Oct. 30th Part of work done; 7 days' order for remainder; £2 8s. costs West brook, C. S. 8, Tibbatts Road Main roof valley gutter and back addition roof and eaves gutter to same defective Oct. 30th Work done; £2 5s. costs Westbrook, C. S. 50 LEGAL PROCEEDINGS—(continued). Public Health (London) Act, 1891, Metropolis Management Acts, etc. Address. Nature of Complaint. Date of Decision. Result. Inspector. 1930. 92, Devons Road Roof defective and other defects Nov. 7th 14 days' order; £2 8s. costs Westbrook.C. S 78, Devons Road Eaves gutters, rainwater pipe, back addition roof defective and other defects Nov. 7th 14 days'order; £2 8s. costs Westbrook, C. S 80, Blackthorn Street Various defects Nov. 7th 14 days'order; £2 8s. costs Westbrook, C. S 62, Guildford Road Stone steps leading to yard and basement broken and dangerous Nov. 7th 14 days'order; £2 8s. costs Johnson, J. 16, Morris Road Roof over slip room and main roof defective and other defects Nov. 7th 14 days' order; £2 8s. costs.. Johnson, J. 40, Sabbarton Street Roof defective and other defects Nov. 6th £2 penalty; £2 2s. costs Johnson, J. 34, Vesey Street Roof defective Nov. 6th Work done; £2 2s. costs Johnson, J. 115, Upper North Street Various defects Nov. 6th 14 days' order; £2 8s. costs.. Johnson,J. 44, Devas Street Various defects .. Nov. 3rd £2 penalty; £2 4s. costs Johnson, W. 2, Bath Cottages Main roof defective and walls and ceilings of top rooms damp Nov. 11th Work done; £2 5s. costs Johnson, J. 3, Bath Cottages Roof defective Nov. 11th Work done; £2 5s. costs Johnson, J. 9, Bath Cottages Roofs over top rooms and wash-houses defective; walls and ceilings of top rooms defective Nov. 11th.. Work done; £2 5s. costs Johnson, J. 11, Harrow Lane Various defects Nov. 13th Work in hand; £2 5s. costs Johnson,J. 33, Whitethorn Street Main roof valley gutter and back addition roof defective Dec. 5th Work done; £3 penalty; £2 2s. costs Westbrook, C.S. 51 Defendant. Nature of Complaint, etc. Date of Decision. Result. Inspector. Canal Boats Acts and Regulations. 1030. Owner of canal boat "Lady Day" Obstruction contrary to Section 5 of Canal Boats Act, 1877 Mar. 5th 5s. penalty; 10s. 6d. costs Kelly, S. Public Health (London) Act, 189 1, and L.C.C. Byelaws. W. P. & Co. (Firm) Removal of offensive matter through streets during prohibited hours Aug. 7th £5 penalty; £2 2s. costs Johnson, W. W. B. (Driver) Removal of offensive matter through streets during prohibited hours Aug. 7th Dismissed under P.O. Act as firm accepted responsibility Johnson, W. W. B. (Driver) Removal of offensive matter in vessel not properly constructed Aug. 7th £5 penalty Johnson, W. Public Health (London) Act, 1891 (Section 66). Mr. M., of 21, Arrow Road Application for order for removal of Scarlet Fever patient Apr. 9th Order made by Magistrate (Patient re moved to Hospital same day.) 52 LEGAL PROCEEDINGS—(continued). Public Health (London) Act, 1891, Metropolis Management Acts, etc. Address. Nature of Complaint. Date of Decision. Result. Inspector. 1930. 264, Devons Road Various defects Dec. 5th 14 days' order; £2 8s. costs.. West brook, C.S. 264, Devons Road Yard paving defective Dec. 5th 10s. penalty; £2 2s. costs Westbrook, C.S. 73, Willis Street Roof and wall in first floor front room are defective Dec. 18th 7 days'order; £2 8s. costs Johnson, W. 138, Parnell Road Failed to cleanse, alter and amend the drain Dec. 29th, adjourned to 5.1.31 Dismissed with costs against Council Smith, F. A. 53 Copy of a Return to the London County Council. Premises. No. in Borough on 31st December 1930. No. of Inspections. No. of Prosecution Cowsheds (No. of Premises) 3 20 — Slaughterhouses 9* 52 — Offensive Trades 7 premises 6 — 8 businesses Milkshops 118 267 — Ice Cream Premises 112 251 — Restaurants and Eating Houses 792 1,986 — (all places where food is sold or prepared) *Includes z siaugnterers 01 rouitry. Smoke Nuisances. (1) No. of observations 61 (4) No. of Statutory Notices served 5 (2) No. of intimations served 13 (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 127 No. of T(a) After No of children cleansed 1192 premises tious diseases 1,746 cleansed (6) For vermin 97 Water Supply to Tenement Houses. No. of premises supplied 1 No. of prosecutions Nil. Sanitary Officers. Male. Female. No. of Sanitary Inspectors (whole-time) 14* 1 ,, ,, ,, (part-time) Nil. Nil M.C.W. T.B. No. of Health Visitors (whole-time) 9t J And 1 Sister in charge of Light Centre (M.&C.W.) ,, ,, (part-time ) Nil. * Includes 2 Meat and Food Inspectors and 2 Temporary Sanitary Inspectors, f Exclusive of Voluntary Association Health Visitors, numbering 9. No. of houses closed on notice by owner that they could not be made fit .. .. Nil. Total No. of houses in the Borough 23,927 No. of houses occupied by the working classes . 23,000 (Approx.) No. of houses for the working classes (а) Erected during year 116 (б) In course of erection Nil. No. of houses inspected a) un account oi complaints or illness (P.H. Act) b) House-to-house (Housing Consolidated Regulations, 1925) 7,423 1,063 So. of representations by Medical Officer or other person Nil.* So. of houses included in such representations Nil. 54 No. of notices served (а) Under F.H.. Act: (i) Intimation 5,158 No. of Closing Orders made Nil. (ii) Statutory 1,780 (б) Under Housing No. of Closing Orders deter Act Nil. mined (i.e., houses made fit) Nil. No. of houses repaired or nuisances remedied under P.H. Act, 1891 4,406 No. of Demolition Orders .. Nil. No. of house! repaired undei Sec. 3 of Housing Act 1925 i) By owners Nil. i) By L.A. in default of owners Nil. No. of houses demolished (а) in pursuance of Orders Nil. (б) Voluntarily Nil. (c) By L.C.C. 10 *10 areas reported to the Borough Council during the year, but formal represen. tations were not submitted. Representation of the first of the 10 areas was submitted in 1931. Underground Rooms. Overcrowding. No. illegally occupied . 2 No. of cases of overcrowding fonnd95 No. closed or illegal occupation No. remedied 28* discontinued 1 No. of prosecutions Nil. •Includes 10 cases reported in 1929. Houses Let in Lodgings. No. on register 114 No. of inspections made 1181 No. of prosecutions Nil. 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 of lectures were made to various social, political and educational organisations in the Borough, and three lecturers (2 medical and 1 lay) were available. A woman doctor addressed meetings of women on subjects of peculiar interest to women and girls, but lecturers were also available to speak on other matters. There have been some modifications of, and additions to, the syllabus of lectures shown in the Annual Report for 1929. The following report was submitted by Mr. T. Wigley, M.A., with whose assistance the original scheme had been prepared:— REPORT BY Mr. T. WIGLEY, M.A. (Cantab). Books, newspapers, advertisements and conversation to-day indicate a widespread interest in health and disease, and if the latter receives more attention than the former, it is because health and its conditions are not 55 properly understood by the public. To make such conditions known has been for some time the policy of the Poplar Public Health Committee by means of Health Lectures, available for any audience of men and women, boys and girls. The Committee has wisely recognised that its work includes not only the provision of Maternity and Child Welfare Clinics, the inspection of food, facilities for vaccination, and the hundred and one ways in which the health of the community is preserved, but the education of the people in the functioning of their bodies, the influence of their environment, the causes of the spread of disease, and the many ways in which each individual, no less than social group, can tread the way towards a young old-age and guard body and mind against disease and incapacity, which sometimes insidiously creep on. By means of such educational work public apathy and quiescence are disturbed, ignorance banished, the ideal raised, and a social sensitiveness created, which regards dirt as an indecency, defective ventilation a reproach, and adequate sleeping accommodation a necessity. In the words of Dr. W. Leslie Mackenzie, the phrase, ''Medical Officer of Health," is the embodiment of a new synthetic idea, which, on analysis, is no other than the transformation of cure into prevention, or rather the absorption of cure as a factor in prevention. The ''Doctor of medicine'' becomes once more the teacher of health, the expounder of remedies. But the remedies are no longer applied to individuals alone; they include the whole sweep of the environment as it affects the individual, and the individual as he is to be fitted to make his environment. In all teaching there are three factors involved, viz., the teacher, the matter which is taught, and those who learn. We can most surely say that the progressive Public Health Authority and the enlightened Medical Officer of Health are able to provide competent teachers. The advances in medical science, both preventive and curative, within the last 20 years form one of the great epochs in man's history and, reading like a romance, provide material which should stir the enthusiastic co-operation of all intelligent citizens. A glance at the syllabus of lectures, which are offered free of cost to any audience within the Borough of Poplar, and which deal with problems of the Child, Youth, the Mother, the Body in Health and Disease, and various subjects such as Social Hygiene, Mental Hygiene, the Wonder of Health, the Story of Preventive Medicine, will give some idea of the richness and variety of the material which is available for all who will take advantage of it. As in all education, the main problem is neither the teacher, nor the material, but the reaching of those who will most profit by them. There is room for improvement in this respect. While some organisations have taken 56 advantage of this offer of lectures, a large number remains which, so far, has not awakened to the need and the opportunity. The best work has been done often in comparatively small meetings, which have incorporated in their syllabuses a definite series of lectures, dealing with one group of related subjects. From my own experience of speaking at such meetings, and still more in the discussion which follows the lecture, it is a pleasure to note the growing interest and understanding appreciation of the subjects set forth. It cannot be emphasised too strongly that ignorance, and not a little stupidity, oan be dissipated only by the slow but sure method of continued enlightenment. In this realm results cannot be dazzlingly spectacular, but the success of what many regard as more ''practical'' measures ultimately depends on the steady advance against the enemy called ignorance. In all, 63 lectures have been arranged for 14 centres. 47 lectures have been given up to time of writing this report. 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 have been arranged 14 Number of lectures given (at time of writing report) 47 To men and boys 5 (Attendances 950) To women and girls 38 ( 3.100) To mixed audiences .. 4 ( 55) 47 (Total attendances upwards of 4,100) Expenditure to 31ST March, 1931. £ s. d. Grant to Central Council for Health Education 5 0 0 Printing, Stationery and Postage 3 19 11 Fees to Lecturers 98 14 0 Total £107 13 11 57 Section IV. HOUSING. Accommodation provided during 1930. 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 116 696 (2) In adapted buildings 2 10 (3) Vacancies re-let 26 150 (b) By the London County Council:— (1) By nomination 110 550 (2) By direct application 508 * Total 762 *It is not possible to give approximate number of persons in the 508 families, no data being available. 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 or owners who are responsible for sub-letting, warning them that action will be taken if the vacated accommodation again becomes overcrowded, and periodical re-inspections are made. During 1930, although premises which formerly had been occupied by families rehoused by the London County Council since 1927 were revisited, in only 3 instances had overcrowding recurred and these were ultimately abated. 58 The following section on Housing has been prepared in accordance vith Circular 1,119 (England) of the Ministry of Health, 1930:— (a) STATISTICS, dumber of new houses erected during 1930:— (a) Total (including numbers given separately under (b) 116 (i) By the Local Authority 116 (ii) By other Local Authorities — (iii) By other bodies or persons — (b) With State assistance under the Housing Acts:— (i) By the Local Authority:— (a) For the purpose of Part II of the Act of 1925 Nil. (b) For the purpose of Part III of the Act of 1925 116 (c) For other purposes Nil. 1.—Inspection of Dwelling-houses during the year. No. of No. of (1) Total number of dwelling-houses inspected houses spections. for housing defects (under Public Health inspected or other Acts) and number of inspections.. 8,486 30,480 (2) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925, and the number of inspections made 1,063 1,922 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil.* (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 4,407 *Owing to the shortage of accommodation for rehousing, little or no action has been taken in the condemnation of unfit individual houses, but since the coming into operation of the Housing Act, 1930, many unfit houses have been inspected with a view to dealing with them under that Act. 59 2.—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 2,627 3.—Action under Statutory Powers during the year. A. Proceedings under Section 3 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which notices were served requiring repair Nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices (a) By owners Nil. (b) By Local Authority in default of owners Nil. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. B. Proceedings under Public Health Acts (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied1,780 (2) Number of dwelling-houses in which defects were remedied:— (a) By owners 1,779 (b) By Local Authority in default of owners Nil (Appeal pending in one case—question of ''sewer " or ' 'drain.'') C. 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. 60 (4) Number of dwelling-houses in respect of which tion Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 4.—Number of houses owned by the Local Authority, distinguishing thos • built in the last two years and held under (1) Part III of the Housing Act, 1925; (2) Part II of the Housing Act, 1925; and (3) other powers. 1) Part III of the Housing Act, 1925 :— During last 2 years Total Assisted under 1919 Act 150 1923 61 ,, ,,1924 202 384 202 595 Houses converted to tenements (No S ate assistance) 6 35 tenements tenements 208 630 (2) Part II of the Housing Act, 1925:— Assisted under 1919 Act - 36 1923 Act (Sec. 1 (3)) - 24 — 60 (1b) HOUSING CONDITIONS. General observations. A large proportion of houses in the Borough were built 60—70 years ago; certain groups of houses are much older, probably 150—200 years old, while some are only about 50—60 years old. The prevalent type of house is a two-storey brick building with 5 or 6 rooms and erected in rows, but there are a number of larger houses in various parts of the Borough. A number of basements are used as dwellings, many of them being unfit for this purpose. The majority of the houses originally built for occupation by one family now house two or more families, and this indirectly results in increased wear and tear of the structures. 61 The prevailing forms of defects may be grouped under the heading of general disrepair, due partly to age and partly to repairs which are more or less unsatisfactory, that is to say, after service of formal Notices defects are "patched up'' sufficiently to abate the nuisance and so prevent the institution of legal proceedings. Sufficiency of supply of houses. There is a definite shortage of houses in the Borough, as is evidenced by the fact that practically every house in the Borough is occupied and that when the list of applications for new houses was closed there were 3,500 families on the waiting list. The majority of applicants were living in houses in which there was definite overcrowding. In an attempt to meet the shortage the Local Authority has, since 1920, erected 655 houses and flats, and in addition have converted a number of houses into 35 tenements, and contemplate erecting flats in certain "clearance areas" in the Borough which they intend to deal with in the near future. There are practically no vacant sites in the Borough and it is only by planning "learance areas'' that sites can be made available for the erection of flats. The London County Council have, during the last six years, rehoused on their estates approximately 1,207 families. Overcrowding. This still proves one of the most difficult questions with which the Department has to deal. On account of the shortage of houses, together with the fact that persons whose employment is in the Borough are probably unable to accept accommodation on the London County Council Housing Estates, and further, their economic position may preclude them from so doing, action has only been taken when overcrowding was very gross or accompanied by mixing of sexes. 95 cases of serious overcrowding and mixing of sexes were reported to the Public Health Committee during 1930, but owing to the inability of the overcrowded families to find alternative accommodation the Committee decided it was impossible for them to take any action. Of the 95 cases, 18 were abated as follows:— 62 1930 1929 cases. cases. Rehoused by Poplar Borough Council 2 6 Rehoused by London County Council 2 1 Rooms re-arranged 7 — Other accommodation found 7 3 18 10 The following is a summary of a report submitted by the Medical Officer of Health to the Special Committee re Housing (1930) Act:— The report submitted the records relating to 2,304 houses visited by the House-to-House Inspectors during 1929 and 1930, by which it appeared that of this total number 269 houses or 11.7 per cent., had more than 2 individuals per room in residence, and 465 or 20.2 per cent. had more than 2½ persons per bedroom. In these 2,304 houses the total population was 17,315 persons and on the basis of 2 persons per room, 694 families or 16.6 per cent, were overcrowded or, if the 2½ persons per bedroom standard is taken, the number of families is 981 and the percentage 23.5. The report also submitted a return of the number of rooms occupied by 4,194 families whose records had been ascertained by House-to-House Inspection during 1929 and 1930. These records, which were not specially selected for the purpose, show that approximately 17 per cent, of the families of the Borough are living under overcrowded conditions judged by the standard of more than 2 individuals per room. Judged by the bedroom standard of more than 2½ persons per bedroom, overcrowding is even greater (nearly 24 per cent.). While it is possible that these examples may show too high a percentage and may not be a true index of the conditions in the Borough as a whole, there is no doubt that considerable overcrowding exists and probably at least 5,000 families require accommodation if existing overcrowding is to be abated. Fitness of Houses. It is the policy of this Council when dealing with insanitary property to take action under the Public Health Acts, and from the report it will be seen that a considerable amount of work has been done by the sanitary 63 inspectors in this connection. No action has been taken under Section 3 of the Housing Act, 1925, owing to the difficulties experienced in recovering the cost of works executed by the Local Authority. All the houses in the Borough have waterclosets. In a few older tenements the sanitary accommodation is common to several families. Unhealthy Areas. Surveys and inspections have been carried out with a view to declaring groups of unfit houses as "clearance " or "'improvement'' areas. After carefully considering in all 14 areas the Housing Act (1930) Committee prepared a reply to the questionnaire of the London County Council in connection with the preparation for the first quinquennial statement on housing. This was eventually approved by the Council and was forwarded to the London County Council. The following is an extract from the statement:— (1) Housing Act, 1925—Part III. (General Powers of Local Authorities.) Particulars of any new houses (including the number of houses) which the Borough Council propose to provide (other than those required for re-housing purposes). (N .P ,=Non-Parlour.) Recommendations of Sub-Committee. An average of 50 houses per annum during the next 5 years, say— 60% A2 Type (2 bedrooms, N .P.) 30% A3 Type (3 bedrooms, N .P.) 10% A4 Type (4 bedrooms, N .P.) Provided that sites can be obtained and provision made for tenants dehoused under Clearance or Improvement Schemes. The Committee recognise that it may be necessary to appropriate a proportion or the whole of these houses for re-housing if it is not possible to provide accommodation on Clearance or Improvement areas which may be undertaken during the five years. 64 (2) Particulars of any clearance and reconstruction schemes under Part II of the 1925 Act, which the Borough Council has in hand and proposes to proceed with or complete during the next 5 years. Number of Houses. Nil. (3) 1930 Act—Clearance Areas. Estimate of number of dwellings (with number of persons to be accommodated) likely to be provided by the Borough Council in connection with clearance areas in the next 5 years. No. of Dwellings. 86 Persons to be accommodated. 430 The areas included in this estimate are:— Area. Number of Houses. Number of Families. Number of Inhabitants. Area No. 1 11 12 68 Area No .2 11 23 55 Area No. 3 9 11 41 Area No. 4 18 22 98 Area No. 6 8 10 (Not known say 40) 57 78 302 (4) 1930 Act—Improvement Areas . Estimate of number of dwellings (with number of persons to be accommodated) in connection with Improvement Areas proposed to be dealt with by the Borough Council in the next 5 years. Number of Dwellings. Nil. Number of persons to be accommodated. Nil. 65 (5) 1930 Act—Individual Insanitary Houses, etc. Estimate of number of dwellings likely to be provided by the Borough Council in the next five years in connection with the demolition of individual insanitary houses or closing of parts of buildings under Part II of the Act. Owing to prospective difficulty in obtaining eligible sites, and to the impossibility of foreseeing the number of houses likely to become insanitary, no satisfactory answer can be given to this question until a survey of the Borough has been completed. (6) 1930 Act. Any suggestions of a general kind to offer for the carrying out by the County Council or the Borough Council during the next 5 years, of operations re (a) Clearance areas (other than those before mentioned and already included in the County Council's provisional programme) and (b) Improvement areas in the Boroueh. The following areas are submitted for consideration by the London County Council:— (a) As Clearance Areas:— Houses Families. Area No. 13 27 70 The Council are strongly of opinion that this should be included in the contiguous area already being dealt with by the London County Council. Houses. Families. Area No. 14 78 121 This area was first represented in 1919 and was not considered suitable by the London County Council. It is still very unsatisfactory, the houses 66 being old, damp, decayed and very confined. It was badly flooded during the Thames floods of 1028. Houses. Families. Area No. 5 37 60 Area No. 8 23 82 Area No. 9 34 63 Area No. 10 16 31 Area No.11 100 178 Area No. 12 76 128 Total number of houses or flats to be provided for the above areas—733. (b) As Improvement Areas:— Houses . Families. Area No. 7 137 274 (c) As Improvement or Clearance Area. Area No. 8.—Note: This Area has been included in the Clearance Areas submitted to the London County Council. (See above.) In putting forward these areas the Committee of the Borough Council emphasized the difficulty which they have found in giving any estimate, having regard to the Act having only recently been passed and to the short time which has been available for a review of the housing conditions of the Poplar area. The Borough Council hope to commence with Areas Nos. 1 and 2 this year (1930). During the latter part of 1930 the London County Council declared Olivers Court and certain houses in High Street, Bow, to be a clearance area. These houses were included in an area which was represented to the London County Council in 1919. Increase of Rent and Mortgage Interest (Restrictions) Acts. One certificate was issued under the above Acts. 67 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 3 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 118 registered premises where milk is sold. These premises were kept under strict observation, 287 inspections being made. The standard of cleanliness in cowhouses, milk shops and other premises where milk is dealt with has been well maintained. Cleansing of Milkshop premises was necessary in 5 instances 1 other nuisance was found; 6 Intimations were served. The necessary cleansings and other matters were attended to, and it was necessary to serve a Statutory Notice in 1 instance only. 12 persons (including 3 itinerant vendors) were registered as retail purveyors of milk, 3 of these being on account of change of ownership of premises. For milkshops connected with infectious diseases, see page 85. 68 Sale of Milk in Bottles. During the year, 68 persons were registered for the sale of Sterilized Milk and Raw Milk in Sealed Bottles only. 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). Pasteurised Milk:— 2 licences for a "Pasteurising'' establishment. 1 licence for the sale of "Pasteurised'' milk. 2 supplementary licences for the sale of ' 'Pasteurised'' milk. Grade "A" Milk:— 1 licence for the sale of Grade "A " milk. Certified Milk:— 1 licence for the sale of "Certified" milk, and 1 supplementary licence. Pasteurised Grade "A" Milk:— 1 supplementary licence. The bottling establishments have been under constant supervision, and, for the purpose of renewal of licences, special inspections were made and reports submitted. 8 samples of Grade "A" (Tuberculin Tested) Milk were examined for tubercle bacilli, the result in each case being negative. 69 Bacteriological Examination of Samples of Milk for Tuberculosis. In August, 1930, the Medical Officer of Health for the County forwarded particulars of samples of milk taken in the Poplar Borough by his inspectors for examination for the presence of the tubercle bacillus. Two of the samples had given positive results. Further samples were taken by our own inspector and again two positive results were given. The facts were communicated to the County Medical Officer of Health who, in October, replied that the milk was traced to a particular farm and two cows were slaughtered under the Tuberculosis Order. ICE CREAM. London County Council (General Powers) Act, 1928. During the year, 23 Owners or Occupiers applied for registration under the above-mentioned Act. These applications were duly approved by the Medical Officer of Health. 55 other premises in the Borough have been visited. The number of owners or occupiers now on Register is 112. 251 Inspections of the above premises were made during the year. Cleansing of premises was necessary in 5 instances. 6 other nuisances existed. 9 intimations notices were served, and the necessary cleansings were carried out, and other nuisances were abated. BAKEHOUSES. There are 76 bakehouses in use, of which 21 are underground. In 47 bakehouses machinery is used. See Table A, page 36, number made up to end of year. Inspections . The bakehouses in the Borough were inspected at least twice during the year, the total inspections numbering 308. 70 Cleansing was found to be necessary on 158 occasions, and 5 other nuisances were found. The cleansings were carried out and the nuisances abated after service of 162 intimations, followed in 9 instances by statutory notices and 1 final notice. SLAUGHTERHOUSES. There are 7 slaughterhouses licensed by the London County Council. For number of inspections see Table A, page 36, and reports of Food Inspectors, pages 71 and 73. SLAUGHTERER OF POULTRY. The business of a slaughterer of poultry is carried on at two premises in the Borough under licence of the London County Council. 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 792; see Table A, page 36. 1,986 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 392 instances, and 28 other defects existed. 408 intimations were served, and in 25 cases were followed up by statutory notices, and 4 final notices. It was not necessary to take legal proceedings to secure compliance with the terms of the notices, as the necessary work was carried out. 71 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 the first three months of the year. (Inspections for 1929 in italics). Premises. Inspections. Intimations. Notices. Final Notices. Prosecution*. 1930 1929 Bakehouses 142 143 88 5 1 — Slaughterhouses 9 11 8 — — — Cowhouses 1 4 — — — — Milkshops 91 104 2 — — — Eating-houses 119 124 2 4 — — Stalls 877 512 — — — — Other places where food is sold or prepared 448 183 9 — — — Ice cream premises 168 229 4 — — — Wharves where food is prepared or stored, etc 6 8 — — — — Fried Pish Vendors, etc 307 290 213 9 — — 185 Market Inspections:—Morning, 79; Evening, 185. Slaughterhouses: 367 visits. Number of Carcases inspected: 2203 (а) Satisfactory 2195 (b) Unsatisfactory 8 (c) Condemned and destroyed or otherwise disposed of (included in (6) above) 1 and parts of 7 Number of Samples procured:— Formal. Informal. Total (a) Under Sale of Food and Drugs Acts: (i) Number genuine 292 61 353 (ii) Number adulterated 20 9 29 (iii) Number poor quality, etc. (included in (i) genuine above) 14 — 14 (6) Under Special Orders and Regulations: (i) Number satisfactory 27 — 27 (ii) Number unsatisfactory 3 — 3 Action taken in respect of unsatisfactory samples:— (i) Summonses applied for 5 — 5 (ii) Letters of caution sent to vendors 11 — 11 (iii) Reported to Ministry of Agriculture, etc — — — Public Health (Foreign Meat) Regulations—Certificates — issued by M.O.H 150 (116 visits to factories). 72 Foodstuffs Inspected fob Export. Tons. cwts. qrs. lbs. Long Cut Hams (America) 13 9 — — Bellies of Ham (America) 7 2 3 14 Picnic Hams (America) 1 7 — 2 Ox Tongues (Argentina) — 19 3 2 Ox Tongues (Uruguay) — 19 1 15 Ox Tongues (Australia) 1 18 — 27 Gammons (Denmark) — 10 3 14 Sides of Bacon (Denmark) — 5 2 17 Fore-ends of Bacon (Denmark) — 1 1 4 Fores of Beef (New Zealand) — 6 — 22 Fores of Veal (Uruguay) — 8 2 20 Crops of Veal (Uruguay) — 1 1 — Turkeys (England) — 16 2 20 Fowls (England) — 8 2 21 Turkeys (Hungary) — 9 3 18 Sows (England) 2 10 1 8 Pork (England) — 1 — 4 Kidneys (Uruguay) — — — 9 Sheep (New Zealand) — — 3 — Sows (New Zealand) — 2 2 25 Pure Pork Sausages (England) — 10 — — Real Oxford Sausages (England) 4 — — — Hams (Argentina) — 12 — 21 Sheep (S. America) — — 2 3 Beef (Australia) — 10 — 11 Beef (Argentina) — 11 2 25 Calves (England) — 11 3 17 Middles of Bacon (England) — 1 — — Ducks (England) — — 1 — Bath Chaps (England) 100, weight not recorded — — — Hams, Northern Star (America) 2 — 3 19 Foodstuffs Destroyed. (a) Condemned at Slaughterhouse Inspections:— Cwt. qrs. lbs. (i) Beef 6 2 24 Pork — 3 9 (ii) Organs condemned and destroyed:— Bovine:—Lungs, 89; Livers, 38. and parts of 2; Mesenteries, 30, and parts of 3; Omenta, 25, and parts of 2; Pancreas, 9; Spleens, 5; Tripes, 4; Udders, 24; Kidneys, 4; Intestines, 3; Heart, 1. Sheep:—Lungs, 311; Livers, 40. Pigs:—Lungs, 61; Livers, 18; Mesenteries, 9; Omenta, 2; Spleens, 5; Hearts, 3; Kidney, 1. Heads and Tongues:—Bovine, 20; Pigs, 10. (6) Surrendered by owners as being unsound, or seized while exposed or deposited for sale:— Tomato Puree, 25 cases and 10 tins.—Surrendered. Brawn, 38 71b. tins.—Surrendered. Mincemeat, 132 l1b. jars.—Surrendered. Strawberry Pulp, 1 cask.—Surrendered. Crabs, 1 barrel.—Surrendered. Mussels, 2 bags.—Surrendered. Bartlett Pears, 3 cases.—Surrendered. Condensed Milk, 5 cases and 301 tins.—Surrendered. Turkeys, 4; Weight, 45½lb.—Surrendered. Fowls, 21; Weight, 631b.—Surrendered. 73 The following were released for technical purposes:— Damaged Tea and Tea Sweepings, 4 tons 12 cwt.—Released for "Caffeine" making. Tallow, 5 barrels.-—Released for technical purposes. Eggs, 85 boxes.—Released after being candled and bad eggs rejected. (Only about 100 bad eggs.) Ground Nut Sweepings, 7 cwt. 3 qrs. 14 lb.—Released for making Cattle Food. Ground Nut Kernels, 167 bags.—Released for use in Confectionery after being cleansed, roasted, skinned and re-cleansed. Sugar, 435 bags.—Released for refining and making Syrup. Sugar Sweepings, 5 bags.—Released for refining. Rice Sweepings, 20 cwt.—Released for Poultry Food. Number of nuisances discovered and referred to District Inspectors—12. MR. H. A. PEARCE. (Inspections for 1929 in italics.) Premises. Inspections. Intimations. Notices. Final Notice*. Prosecutions. 1930 1929 Bakehouses 166 152 74 4 Slaughterhouses 43 27 26 — — — Cowhouses 19 ?5 — — — — Milkshops 176 169 4 1 — — Eating-houses 145 136 9 2 — Stalls 2,232 1,439 — — — 3 Other places where food is sold or prepared 702 559 15 4 1 — Ice cream premises 83 224 5 — — — Wharves where food is prepared or stored, etc. — — — — — — Fried Fish Vendors, etc 259 255 160 8 — — 268 Market Inspections:—Morning, 193; Evening, 75. Slaughterhouses:—271 visits Number of Carcases inspected: 2019 (а) Satisfactory 2009 (b) Unsatisfactory 10 (c) Condemned and destroyed or otherwise disposed of (included in (6) above) Parts of 10 74 Formal. Informal Total. Number of Samples procured:— (а) Under Sale of Food and Drugs Acts: (i) Number genuine 303 69 372 (ii) Number adulterated 23 4 27 (iii) Number poor quality, etc. (included in (i) genuine above) 16 — 16 (b) Under Special Orders and Regulations: (i) Number satisfactory 43 — 43 (ii) Number unsatisfactory 6 — 6 Action taken in respect of unsatisfactory samples:— (i) Summonses applied for 11 — 11 (ii) Letters of caution sent to vendors 10 — 10 (iii) Reported to Ministry of Agriculture, etc — — — Public Health (Foreign Meat) Regulations—Certificates issued by M.O.H. 6 (8 visits to factories). Foodstuffs Inspected for Export. Tons cwt. qrs. lbs. Long Cut Hams (America) — 5 2 12 Beef (Australia) 1 11 3 18 Foodstuffs Destroyed. (a Condemned at Slaughterhouse Inspections:— (i) Beef:— (3 briskets; 5 thin flanks; 2 thick flanks; 3 top ribs; 1 mid-rib; 1 back rib; 10 thin skirts; 3 thick skirts; 3 rumps; 3 loins; 2 forequarters.) Pork (1 fore-end). Total Weight .. 7 cwt. 1 qr. 20 lb. (ii) Organs condemned and destroyed:— Bovine:—Lungs, 80; Livers, 47, and parts of, 1; Mesenteries, 35, Omenta, 20; Pancreas, 20; Spleens, 8; Tripes, 7; Udders, 23; Kidneys, 11; Intestines, 2. Sheep:—Lungs, 368; Livers, 76; Spleens, 3; Heart, 1. Pigs:—Lungs, 55; Livers, 7; Mesenteries, 9; Omenta, 2; Kidneys, 6; Hearts, 3; Spleens, 2. Bovine Heads, 33; Tongues, 34. Pigs' Heads and Tongues, 12. (6) Surrendered by owners as being unsound, or seized while exposed or deposited for sale:— Dogfish, 8 st.—Surrendered. Tomatoes, 25 boxes and 6 lb.—Surrendered. Lamb, 1 caroase, 28 lb.—Surrendered. Crabs, 25 baskets.—Surrendered. Crabs, 2 barrels.—Surrendered. Prawns, 1 tin.—Surrendered. Chestnuts, 30 lb.—Surrendered. Strawberries, 5 baskets.—Surrendered. Black Currants, 3 boats.—Surrendered. Rabbits, 12 Ostend.—Surrendered. Rabbits, 2 Wild.—Surrendered. 75 The following were released for technical purposes:— Corned Beef, 7,250 tins.—Released for fat boiling. Rolled Beef, 9 tins.—Released for fat boiling. Tomatoes, 76 tins.—Released for fat boiling. Tomatoes, 50 tins.—Released for fat boiling. Damaged Flour, 780 bags.—Released to be made merchantable. Damaged Flour, 45 bags.—Released for Cattle Food. Damaged Flour, 110 bags.—Destroyed. Flour Sweepings, 25 bags.—Released for Cattle Food. Damaged Wheat, 441 lb.—Released for Cattle Food. Damaged Wheat, 15 qrs. 70 lb.—Released for Cattle Food. Argentine Sheep, 28 Carcases.—Released for fat boiling. Mutton, 5 Carcases.—Released for soap-making. Quantity of Loose Tallow.—Released for soap-making. Tallow, 3 casks.—Released for grease-making. 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 156 consignments of foodstuffs: Canada (70), Australia (48), United States of America and Dependencies (32), other countries (6). 124 visits were paid to factories in connection with the above. For details of foodstuffs inspected for export, see pp. 72 and 74. 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. 76 FOOD AND DRUGS ACTS. The results of the analyses of 807 samples were reported to the Committee during the year:— Sample. Number examined, 1930. Adulterated . Action taken. Legal Proceedings.* Letters of caution sent. Milk 426 17 6 6 ,, Sterilised 2 — — — ,, Condensed .. Cream 23 2 — 1 2 — — — Butter 54 1 *1 — Margarine 50 — — — Cheese 2 — — — Dripping 12 1 — 1 Lard — — — — Shredded Suet 4 — — Mustard 2 — — — Pepper 4 — — — Malt Vinegar 6 2 — 1 Vinegar 18 3 — 2 Sauce 2 — — — Cocoa 6 3 — 1 Coffee 2 — — — Chocolate Powder 1 — — — Coffee and Chicory Essence 4 — — — Cornflour 1 — — — Rice 6 — — —. Pearl Barley 9 2 — 1 Sago 2 — — — Oatmeal 4 — — — Flour 2 — — — Self-raising Flour 4 — — — Ground Ginger 4 — — — Baking Powder 2 — — — Pea Flour 2 — — — Chocolate 2 — — — Cake 2 — — — Jam 19 5 1 — Blancmange Powder 2 — — — Table Jelly 4 — — — Golden Syrup 4 — — — Tea 5 — — — Sugar 2 — — — Sweets 21 7 — 3 Milk of Sulphur 2 — — — Lime Water 2 — — — Aspirin Tablets 2 — — — Carried forward 722 43 8 16 *Margarine not properly labelled. 77 Sample. Number examined, 1930. Adulterated . Action taken Legal Proceedings.* Letters of caution sent. Brought forward 722 43 8 16 Camphorated Oil 2 — — — Cream of Tartar 2 — — — Ammoniated Tincture of Quinine 2 — — — Lime Juice Cordial 2 — — — Lemon Squash 2 — — — Lemonade 2 — — — Cordials 5 — — — Ginger Wine 1 1 — — Gin 1 — — — Whisky 6 1 — — Bum 1 1 — — Mincemeat, Fruit 2 — — — Minced Meat 1 — — — Black Pudding 2 — — — Sausage 11 2 1 — Fresh Meat 14 6 4 — Pork with Beans 1 — — — Tomato Puree 1 — — — Fish Paste 2 — — — Tripe 2 — — — Table Salt — — — — Bread and Butter — — — — Citrate of Magnesia 2 — — — Ground Cinnamon — — — — Orange and Quinine Wine — — — — Borax — — — — Citric Acid — — — — Crushed Linseed — — — — Jelly Crystals 1 — — — Iron Pills 3 — — — Egg Powder 2 — — — Gregory's Powder — — — — Calomel Ointment — — — — Carbolic Ointment — — — — Salicylic Ointment — — — — Oil of Turpentine — — — — White Pepper 4 — — — Mixed Spice 2 — — — Sultanas 4 — — — Cut Peel 2 — — — Liniment — — — — Ice Cream 2 — — — Food Colour 1 — — — Totals, 1930 807 54‡ 13 16 Totals, 1929 801 70† 16 23 * See pages 78-81. † Including 28 informal samples. $ Including 13 informal samples. 78 Of the samples of milk, 42 were procured from itinerant vendors on Sundays and 198 from itinerant vendors on weekdays. Seven samples were adulterated and a letter of caution was sent to 1 vendor and legal proceedings taken against 6 other vendors. Samples of milk were taken on delivery as follows:—Poplar Institution, 1; Poplar Hospital, 2; St. Andrew's Hospital, 1; Bromley House Institution, 1. All these samples were genuine. Thirty-one samples of milk were taken on delivery at Railway Stations (all Grade "A" (Tuberculin-tested) milk). FOOD AND DRUGS (ADULTERATION) ACT, 1928. Administrative Action Taken Respecting Samples Reported to be Not Genuine. March Quarter, 1930. Sample No. Article. Result of Analysis. Action taken. G. 11 G. 12 Condensed Milk Condensed Milk.. 2.2 per cent, deficient in fat 2.2 per cent, deficient in fat Letter of caution—same vendor. b. 7 (Inf.) Sweets Sulphur dioxide 240 parts per million Formal sample taken (G.29). G. 29 Sweets Sulphur dioxide 270 parts per million Further sample taken (SO.2, 80 parts per million—no further action). P. 38 Vinegar 5 per cent, deficient in acid.. Letter of caution. P. 48 Vinegar 2.5 per cent, deficient in acid Further sample taken, "Genuine"—no action. A. 16 (Inf.) Cocoa 2 per cent, added alkali Formal sample taken (P. 54). P. 54 Cocoa 2.5 per cent, added alkali Letter of caution. P. 66 Milk 10 per cent, deficient in fat Summons, £3 penalty; £2 2s. costs. A. 27 (Inf.) Cocoa 2.5 per cent, added alkali Formal sample taken (P. 54 above). P. 56 Milk 6.6 per cent, deficient in fat Letter of caution. G. 61 Milk 3.5 per cent. added water Letter of caution. G. 71 Milk 6.6 per cent, deficient fat Letter of caution. G. 55 Pork with beans (canned) Very little evidence of pork.. Letter of caution. P. 22 Shredded Suet 10 per cent, starch—not labelled Letter of caution. G. 19 (Inf.) Shredded Suet 15.3 per cent, starch—not labelled Letter of caution. G. 60 Margarine Boracic acid ¾ grain per lb No action. 79 June Quarter, 1930. Sample No. Article. Result of Analysis. Action taken. A. 31 (Inf.) Whisky 36 deg. under proof No action. 694 (Inf.) Rum 36 deg. under proof No action. P. 94 Malt Vinegar 20 per cent, deficient in acid Letter of caution. P. 102 Milk 5 per cent, deficient in fat Letter to vendor. P. 108 Sausage Sulphur dioxide 130 parts per million Wholesaler summoned; £10 penalty; £2 2s. costs. 854 Milk 3.3 per cent. deficient in fat ' Samples taken at cowsheds by adjoining authorities. Results . received too late for action to be taken. 856 Milk 3.3 per cent. deficient in fat 857 Milk 3.3 per cent. deficient in fat 894 Milk 6.6 per cent. deficient in fat 896 Milk 6.6 per cent. deficient in fat P. 134 Milk 5 per cent. deficient in fat Letter of caution. G. 153 Milk 9.4 per cent. added water Summons, £5 penalty; £2 2s. costs. B. 47 Pearl Barley 0.2 per cent. Talc Formal sample to be taken. P. 142 Vinegar 2.5 per cent. deficient in acid Letter of caution. 80 September Quarter, 1930. Sample No. Article. Result of Analysis. Action taken. P. 170 Butter 79.8 per cent, foreign fat (Margarine sold not properly labelled) Summons, £2 penalty; £2 2s. costs. G. 198 Strawberry Jam 66 per cent, deficient in fruit See G.211 and G.223. G. 184 Fresh Meat Sulphur dioxide 957 parts per million Summons, £1 penalty; £2 2s. costs. G. 185 Fresh Meat Sulphur dioxide 50 parts per million Further sample G. 197. G. 197 Fresh Meat Sulphur dioxide 570 parts per million Summons, £1 penalty; £2 2s. costs. G. 186 Fresh Meat Sulphur dioxide 380 parts per million Summons, £1 penalty; £2 2s. costs. G. 190 Fresh Meat Sulphur dioxide 880 parts per million Summons, 8s. penalty; £2 2s. costs. B. 51 (Inf.) Strawberry Jam 10 per cent, apple pulp Formal sample G. 198. B. 52 (Inf.) Fresh Meat Sulphur dioxide 750 parts per million Formal sample G. 197. B. 53 (Inf.) Strawberry Jam 10 per cent, apple pulp Formal sample G. 198. G. 207 Milk 13.3 per cent, deficient in fat Letter of caution. G. 211 Strawberry Jam 10 per cent, apple pulp See G. 223. G. 223 Strawberry Jam 10 per cent, apple pulp Summons—withdrawn on payment of £2 4s. costs. P. 176 Milk (Magistrate held 5 per cent, deficient in fat .. milk was sold as it was given by Summons—dismissed. cow.) A. 52 (Inf.) Sausage Sulphur dioxide 75 parts per million Formal sample taken— reported "genuine." P. 208 Milk 8.2 per cent, added water Summons—withdrawn on payment of £2 4s. costs. P. 300 Milk 8.2 per cent, added water Summons—withdrawn on payment of £3 3s. costs. P. 235 Sweets 0.6 per cent. Talc Letter to vendor. G. 243 Sweets 0.2 per cent. Talc Letter to vendor. B. 54 (Inf.) Sweets 1 per cent. Talc and excess of colour Formal sample G. 252. G. 252 Sweets 1 per cent. Talc and excess of colour Letter to vendor. G. 258 Dripping 2.8 per cent. free fatty acids Letter to vendor. 31 December Quarter, 1930. Sample No. Article. Result of Analysis. Action taken. P. 273 Pearl Barley 0.2 per cent. Talc Letter to vendor. P. 280 Shredded Suet 15 per cent. starch—not labelled. Letter of caution. P. 325 Milk Deficient in non-fatty solids 0.7 per cent. Summons. £3 3s. costs. B. 59 (Inf.) Ginger Wine (Purchased from Alcohol absent itinerant vendor.) Formal sample to be taken if possible. B. 70 (Inf.) Sweets 0.17 per cent. Talc Formal sample to be taken Milk and Dairies (Consolidation) Act, 1915, and Amendment Act, 1922. Milk and Dairies Acts and Order . Filled cartons with cream on unregistered Mrs. P. Letter of caution, premises Milk bottled in street T. C. Letter of caution. Ditto T. Bros. Letter of caution. Ditto W. L. Letter of caution. Ditto Mrs. L. Letter of caution. Ditto H.V.S. Letter of caution. Ditto T. Bros. Letter of caution. Ditto E.S. Letter of caution. Ditto G. G. £2 penalty; £2 2s. costs. Delivered milk in bottles which were not M. L. £5 penalty; £3 3s. filled and closed on registered premises costs. Ditto ditto ditto R. P. E. £2 penalty. Filled bottles with milk in street S. K. Letter of caution. Milk served by opening bottle when vendor H. V. S. Letter of caution, registered for sale in bottles only Ditto ditto ditto Mrs. L. Letter of caution. Milk (special designations) order. Grade "A" (Tuberculin 386,000 bacteria Tested) Milk Ditto ditto 529,000 bacteria and B. coli in 3 tests Ditto ditto 177,000 bacteria, and B. coli in (on delivery) 3 tests Letter to dealer. (C. T. C.) Grade "A" (Tuberculin 74,290 bacteria, and B. coli in 1 Tested) Milk 3 tests Ditto ditto *30,300 bacteria .. .. /on delivery^ Letter to dealer. (H. & S.) * .Satisfactory. Grade "A" (Tuberculin 4,900,000 bacteria and B. coli in Tested) Milk 3 tests Ditto ditto Satisfactory (on delivery) Letter to dealer. (H. & S.) 82 Public Health (Meat) Regulations, 1924. No proper head covering while carrying meat A.I. Letter of caution Meat exposed on barrow which was not A. C. Letter of caution screened Public Health (London) Act, 1891, Section 47. Seizures of Foodstuffs. Proceedings under the above Section were taken as follows:— Nil. Merchandise Marks Acts and Orders. Exposed for sale Apples and Tomatoes not A. S. Letter of caution marked with country of origin Exposed for sale raw Tomatoes which did E. O. £2 penalty, not bear indication of country of origin Ditto ditto ditto R. C. D. £2 penalty. Ditto ditto ditto W. W. £2 penalty. Public Health (Milk and Cream) Regulations, 1912 and 1917. 1.-MILK; AND CREAM NOT SOLD AS PRESERVED CREAM. (A) (b) Number of Samples examined for the presence of preservative. Number in which preservative was reported to be present, and percentage of preservative found in each case. Milk 426 Nil. Cream 2 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. 83 The following is the number of premises in the Borough registered under the above-mentioned Acts, up to and including 31st December, 1930. Margarine. Butter. Wholesale Dealer. Manufacturer. Factory. Wholesale Dealer in Milk-blended. 22 — 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. ANNUAL REPORT OF THE PUBLIC ANALYST. During the year 1930, 807 samples were examined under the Food and Drugs (Adulteration) Act, 19 of these samples (milks) were submitted by a neighbouring Authority, the remainder by the Inspectors. No samples were submitted during the year by the general public. 143 of the samples were purchased informally. 54 of the samples were found to be adulterated, in addition 43 other samples were of inferior quality or doubtful purity. 1 Iteration for the past 10 years was as follows:— Year. No. of samples examined. Percentage of adulteration. 1930 807 6.7 1929 801 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 Average 780 6.4 84 The amount of adulteration which was for some years on the increase still shows indications of declining. The average rate of adulteration for the London Boroughs in 1929 was 3.7 per cent., and for the whole of England and Wales 5.4 per cent. The number of samples examined was at the rate of 5.0 per thousand of the population, as compared with an average of 9.0 per thousand for the London Boroughs and 3.5 per thousand for the whole of England and Wales. Milks. 426 samples of milk were examined, of which 17 samples, or 4.0 per cent. were found to be adulterated. The amount of milk adulteration has remained consistently low for some years as indicated by the following figures:— Year. No. of Milks examined. Percentage of adulteration. 1930 426 4.0 1929 284 4.9 1928 386 4.4 1927 351 4.6 1926 372 5.4 1925 382 3.9 1924 430 3.5 1923 437 3.4 1922 452 2.0 Average (1922-1929) 387 4.0 Condensed Milks. 23 samples of Condensed Milk were examined, 2 of which failed to reach the standard of composition. Preservatives . 10 contraventions of the Preservatives Regulations were found. 2 samples of sausage containing sulphur dioxide and sold in an unlabelled condition, 2 samples of sweets, and 6 samples of fresh meat found to contain sulphur dioxide. TABLE VII. Notifiable diseases during the Year. (53 Weeks ended 3rd January, 1931.) 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. 1 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. Small pox 628 11 9 12 15 16 126 115 94 121 35 68 6 256 372 256 372 628 1 — — — — — — — — — — 1 — — 1 Chicken pox 1281 73 87 76 134 184 634 70 12 7 3 1 — 832 449 29 10 44 1 — 1 — — — — — — — — — — — — Cholera (c) Plague(P) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Duphtheria (including membranous Croup) 560 15 35 — 56 64 203 65 27 30 3 6 1 342 218 341 215 556 17 3 3 — 4 3 3 1 — — — — — 8 9 Erysipelas 110 6 5 1 1 — 6 3 4 13 19 45 7 61 49 17 27 44 — — — — — — — — — — — — — — — Scarlet fever 615 2 34 42 60 60 246 91 37 33 8 2 — 359 256 354 254 608 4 — 1 3 — — — — — — — — — — 2 Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 2 — — 1 — — 1 — 1 3 — — — 2 4 9 4 6 — — — — — — — — — — — — — — Relapsing fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 10 — — — — — — — — 6 4 — — 9 1 8 1 9 4 — — — — — — — — 3 1 — — 4 — Puerperal Pyerxia 7 — — — — — — — — 6 1 — — 4 3 4 3 7 — — — — — — — — — — — — — — 2 Cerebri Spinal fever 4 3 — — — — — 1 — — — — — 2 2 2 2 4 4 3 — — — — — 1 — — — — — — — Acute poliomyelitis 2. — — — 2 — — — — — — — — — 2 — 2 2 — — — — — — — — — — — — — — — Acute Encephalitis lethargica — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — 1 — — — Ophthamia Neonatorum 42 42 — — — — — — — — — — — 34 8 2 — 4 — — — — — — — — — — — — — — — * Zymotic Enteritis 169 51 29 16 10 11 14 8 9 12 — 10 1 — 103 5 9 14 — 10 1 2 — — — — — — — 3 — 10 — Anthrax — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia, Acute Primary 468 72 63 42 36 17 47 14 22 54 30 52 19 282 186 67 86 153 70 21 10 3 2 2 — — 1 3 8 16 6 36 36 „ Acute Influenzal 5 — — 1 — — —— — — 2 — 2 — 4 1 1 1 2 — — — — — — — — — — — — — — 1 Dysentery — — — — — — — — — — — —— —— — — —— — — 1 — — — — — — — — — — 1 — — — Totals 3907 275 262 246 314 352 1277 367 190 287 108 186 34 2253 1654 1088 993 2081 130 46 16 8 6 5 3 2 1 6 9 22 6 63 67 This table does not include cases in which original diagnosis was not confirmed, N.B.—The deaths from Acute Primary Pnenmonia are of notified patients only. * Notifiable 1st June to 30th September, but the number of deaths relates to the whole year. 85 Other samples examined were:— 16 samples of Grade "A" Milk, bacteriologically, all of which were satisfactory. 2 Breads. 4 Flours. 1 Pressed yeast. 5 Butters. 4 Limes. 4 Electrolytic Fluids. 3 Rag Flocks, 1 of which failed to reach the standard of cleanliness. ALBERT E. PARKES, F.I.C., Public Analyst. Section VI. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. INFECTIOUS DISEASE. Notifications . 3,907 cases of Infectious Disease (Smallpox 628) were notified during the year. In addition there were 99 other cases notified as Infectious Diseases in which the diagnosis was not confirmed. The notification rate was 24.4, compared with 21.5 in 1929, 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. The increase in the notification rate was due almost entirely to the prevalence of Smallpox. The number of Chickenpox cases was greater than in 1929. The incidence of the commoner infectious diseases, Diphtheria and Scarlet Fever, varied only slightly. Infectious Diseases in Milkshops and Homeworkers' Premises. One case of infectious disease (Diphtheria) occurred in a family engaged in the sale of milk. The sale of milk was stopped for a period of 7 days and the family contacts of the patient were swabbed, with negative results. The case of a dairyman who was found to be Tuberculous and gave up his business is referred to in the Tuberculosis Section, page 116. Three contacts of infectious disease patients (1 Smallpox, 1 Diphtheria and 1 Scarlet Fever) employed in the milk trade were dealt with during the year. 86 13 cases of infectious disease occurred in homeworkers' premises— 5 Smallpox, 4 Diphtheria, 3 Scarlet Fever and 1 Erysipelas. 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. L.C.C. Fever Hospitals Other L.C.C. Institutions. General Hospitals etc. Total Removals. Percentage of cases notified. Smallpox 628 — — 628 100. Chickenpox 10 33 1 44 3.8 Diphtheria 553 2 1 556 99.3 Erysipelas 1* 41 2 44 40.0 Scarlet Fever 607 — 1 608 98.9 Enteric Fever 4 2 — 6 100. Puerperal Fever 7 1 1 9 90.0 Puerperal Pyrexia 3 4 — 7 100. Cerebro-spinal Fever 1 1 2 4 100. Encephalitis Lethargica — — — — — Ophthalmia Neonatorum 3 — 1 4 9.5 Pneumonia (Primary) — 152 1 153 32.7 Pneumonia (Influenzal) — 2 — 2 40.0 Zymotic Enteritis — 12 2 14 8.3 Acute Poliomyelitis — i 1i 2 100. Totals 1,817 251 13 2,081 52.9 *Admitted with Measles. N.B.—Cases reported to be "not suffering" have been excluded from above table. 87 Mortality from Diphtheria, Scarlet Fever and Enteric Fever. Diphtheria. Scarlet Fever. Enteric Fever. 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 1930 Cases 560 615 6 Deaths 17 4 0 Fatality Rate 3.0 0.6 0.0 SCARLET FEVER. The total notifications received numbered 639 and the total removals were 632. Of these, 24 cases were later certified to be not suffering from Scarlet Fever, leaving a total of 615 cases, the attack-rate being 3.8 per 1,000 of population. 4 deaths occurred, giving a fatality rate of 0.6 per cent. 88 DIPHTHERIA. The total notifications received numbered 598 and the total removals to hospital were 594. 38 patients were certified to be suffering from other diseases, leaving a total of 560 cases, the attack-rate being 3.5 per 1,000 of population. 17 deaths occurred, giving a fatality rate of 3.0 per cent. SCHICK TEST AND IMMUNISATION FROM DIPHTHERIA. DIPHTHERIA IMMUNISATION CLINIC. The Clinic was opened on 5th June, 1928, and was held at the Maternity and Child Welfare Centre, Wellington Road. The Medical Officer in charge was Dr. F. Porter-Smith, M.R.C.S. (Lond.), L.R.C.P. (Eng.). At the Public Health Committee Meeting in June the Medical Officer of Health reported that the number of patients attending did not warrant the continuation of the Clinic. The total attendances from the 5th June, 1928, to 20th May, 1930, were 1,077, and of these only 153 had been made during 1930. During the whole period 121 children had been immunised. Since 1st January, 1930, there had been only 27 new cases. Reference was made to the efforts which had been made to bring this Clinic to the notice of parents, which, in addition to the issue of handbills at the Maternity Centres, and to all homes where cases of Diphtheria had occurred, included visits to schools by the Divisional School Medical Officer, in company with the Medical Officer of Health. Under the circumstances the Committee agreed to close the Clinic and this was done on 24th June. Two further sessions were, however, held in October, to complete the cases which were already in hand. The following leport was submitted by the Medical Officer in charge of the Clinic:— 89 I beg to make the following report on the working of the Diphtheria Immunisation Clinic held at Wellington Road The weekly attendance, which had been far from satisfactory during the previous year, shewed a gradual diminution, and this in spite of every effort to make known to the residents of the Borough the presence of such an important Clinic. Under the circumstances I felt obliged to suggest that the Clinic be closed, until such time as the demand for protection against Diphtheria warranted the expense of the upkeep of the Clinic. The Clinic was closed at the end of June, 1930—two further sessions were held in the following October, to complete outstanding cases. I find it extremely difficult to account for the lack of response on the part of parents to avail themselves of such a simple and perfectly safe method of protection against Diphtheria. In a neighbouring Borough a similar Clinic has been working for three and a-half years, and the attendance, which has always been very good, has shewn a marked increase during the last year. I mentioned in a previous report the main difficulties of this style of Clinic—(1) The difficulty in arranging one Clinic which would be readily accessible to residents of all parts of the Borough; (2) The loss of school attendance marks to the children (in some cases). At the request of the London County Council, and the parents, I have immunised a few children from Poplar, at the neighbouring Clinic of Hackney. The work at the Clinic at Wellington Road was quite satisfactory and the few parents who attended appeared extremely grateful. F. PORTER SMITH. DIPHTHERIA ANTI-TOXIN. 134,000 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 (of which four related to Paratyphoid Fever), and the patients were removed to hospital, the attack-rate being 0.04 per 1,000 of population. No deaths occurred. 90 BACTERIOLOGICAL EXAMINATIONS. 2,140 swabbings from doubtful cases of diphtheria were examined. Of these, 312 gave positive results (14.6 per cent.). 4 blood specimens from doubtful cases of Enteric Fever were examined. 2 positive results were obtained. These examinations were carried out at Seamen's Hospital, Greenwich. SMALLPOX. The outbreak of Smallpox, which commenced in Poplar in March, 1928, continued through 1929 and 1930. TABLE I. Showing Smallpox and Chickenpox Cases Notified during each Month. (The Table does not include cases of Chickenpox reported by parents or others.) 1930. Month. Smallpox. Chickenpox. January 85 107 February 118 67 March 83 95 April 87 66 May 83 102 June 49 105 July 47 96 August 26 122 September 17 61 October 6 109 November 14 171 December 10 161 Totals 625* 1262 * This figure refers to the calendar year, but in other parts of this Report the figure 628 referring to the statistical year of 53 weeks is used. 91 No sanitary district was immune, although Bow West District suffered least, the chief centres of infection being Bromley North, Bromley Central, West Combined and Bow East Districts. The number of cases in each Sanitary District was as follows:— East Combined 53 West Combined 105 Poplar South (East) 23 „ „ (West) 22 Bromley North 194 Bromley Central 105 Bow East 96 Bow West 30 628 The incidence of Smallpox in houses is shown below. Cases. 186 houses in which 1 case of Smallpox occurred 186 49 „ „ 2 cases „ „ 98 40 „ „ 3 „ „ „ 120 16 „ „ 4 „ „ 64 15 „ „ 5 „ „ „ 75 6„ „ 6 „ „ „ 36 4 „ „ 7 „ „ „ 28 1 house „ 8 „ „ „ 8 1 „ „ 13 „ „ „ 13 Total 628 Total number of cases 628 „ „ houses 318 In Table II it will be seen that of the 628 cases no less than 537 were unvaccinated, and that in this group nearly 95 per cent. of 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—except one patient who was stated to have been re-vaccinated during the South African War, 1899-1901. 92 TABLE II. Showing the Ages, Sex and Vaccinated State of Cases of Smallpox. Ages. Under 5 years. 5— 10— 15— 20— 35— 45— 65 and over. All Ages. Vaccinated M. — — — — 2 6 22 5 35 F. — — — — 5 8 32 2 47 Unvaccinated M. 28 67 61 59 53 2 4 — 274 F. 34 55 53 34 64 17 6 — 263 Doubtful (no marks) M. — — — — 3 — — — 3 F. — 1 1 — — 1 3 — 6 Totals 62 123 115 93 127 34 67 7 628 The type of the disease continued to remain mild, only one death occurring, and that in a woman, aged 45 years, who was suffering from heart disease. The cause of death as certified was:—Mitral stenosis, Pleurisy, Pneumonia, Smallpox. The disease did not invade Common Lodging Houses or Casual Wards, cases coming only from private dwellings and hospitals. Owing to the mildness of the epidemic and the fact that Chickenpox was also prevalent in the district, cases of Chickenpox were visited by the medical staff of the department. With the exception of 8 cases all Smallpox patients were seen by a medical officer of the department. Of these 8 patients, 3 were removed from Institutions outside the Borough, 1 from a hospital in the Borough, and 1 from a Doctor's surgery in a neighbouring Borough. Of the total number of patients removed as suffering from Smallpox less than 2 per cent. were not confirmed as suffering from this disease:— Smallpox. Not S.P. Patients removed as Smallpox 606 594 (98.1%) 12 (1.9%) „ „ for observation 43 34 (79%) 9 (21%) Totals 649 628 (96.8%) 21 (3.2%) 93 Non-Resident Cases. During the year 25 cases of Smallpox were removed irom the OutPatient Department of Poplar Hospital—all residents of West Ham. The majority of these cases were seen by the Medical Officer of Health or an Assistant. I desire to record our appreciation of the vigilance exercised by the staff at Poplar Hospital in dealing with suspected cases. Action taken. 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. Following upon a report which was submitted to the Public Health Committee and forwarded to the Ministry of Health the Ministry approved certain modified procedure which was put into force in December. 318 houses have been disinfected. 2,708 persons removed and disinfected. 69,418 articles, including beds, bedding and clothing, removed and disinfected. The question of providing a special vehicle for the conveyance of contacts to the Council's Shelter was considered early in the year, and a special ambulance type of vehicle was provided. Contacts.—During the year, no less than 7,829 contacts have been kept under observation; the total visits paid by the Sanitary Inspectors to those resident or employed in the Borough numbered 26,741. Of the 7,154 contacts resident in Poplar only 1,185 were vaccinated or re-vaccinated. In addition to following up contacts, 698 house-to-house inspections have been carried out in affected areas. Leaflets have been left at each house explaining the symptoms of Smallpox, and urging the necessity for seeking medical advice should eruptions appear, and also urging vaccination or re-vaccination. 94 School Medical Inspections, Absentees, etc.—Medical inspection of school children was carried out by the London County Council staff at several schools, and arrangements were made for the notification of absentees, in addition to the usual notification on Form 84. All suspicious cases were kept under observation by the Public Health Staff, the number of visits paid by the Sanitary Inspectors to school absentees was 339. Notification of Chickenpox.—The notification of Chickenpox was continued during the calendar year 1930, and 1,365 cases reported:— 1,326 notified by medical practitioners. 24 reported by the school authority. 15 reported by parents or from other sources. Of the 1,365 cases, 35 were not confirmed. All cases notified as Chickenpox were visited by a member of the Medical Staff. This procedure resulted in the discovery of 18 cases of Smallpox. The following table shows the visits paid by the Medical Staff to cases of doubtful Smallpox, Chickenpox and Smallpox contacts. Several ot these visits represent visits paid to workplaces in order to examine contacts of cases who had been at work in an infectious condition:— 95 Number of Visits by Medical Staff. Reason for Visit Smallpox or 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) 110 6 38 9 8G 17 376 (c) 60 182 884 (b) 8 — 4 — — — — — — 15 Tuberculosis Officer (a) 32 2 10 2 33 5 82 (d) 6 23 195 (b) — — — — — — — — — 2 Assistant Tuberculosis Officer (a) 50 10 20 3 104 4 160 (e) 59 21 431 (b) 2 — — — — — — — — 2 Temporary Asst. M.O.H. (a) 140 33 71 7 744 44 656 (/) 168 213 2,076 (b) 9 2 3 — — — — — 3 17 Total 3,622 Notes, (a) Poplar residents. (b) Non-residents seen at Poplar Hospital. (c) 81 persons found to be suffering from Smallpox. (d) 25 „ „ „ „ (e) 22 „ „ „ „ (f) 95 „ „ „ „ 96 VACCINATION. Local Government Act, 1929—Vaccination. The powers conferred by the Local Government Act concerning Vaccination and the Vaccination Order, 1930, were delegated by the Council to the Public Health Committee. The Vaccination Officer, with his Assistant, and the Public Vaccinators, were transferred to the Borough Council Staff as from 1st April, 1930. The following particulars regarding vaccination have been taken from the Vaccination Officer'sreport:— 97 Extract from the Report of the Vaccination Officer, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1929, inclusive:— Registration Sub-Districts. Number of Births registered 1st Jan. to 31st Dec., 1929. 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 1930. Number of Statutory Declarations of Conscientious Objection actually received during the calendar year 1930. 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 1311 168 1 1 843 50 2 9 45 192 1639 1543 Bow and Bromley 1204 123 — 2 804 69 6 10 24 166 Total 2515 291 1 3 1647 119 8 19 69 358 1639 1543 Note.—(a) The total of the figures in Columns 3 to 11 should agree with the figure in Column 2.—The number of children successfully vaccinated after the declaration of conscientious objection had been made was 19. This number is included in Column 6 and not in Column 3. (b) The figures in Columns 2 to 11 should not include re-registered births. 98 The following analysis of the Vaccination Return reveals the fact that over 86 per cent. of the children whose births were registered in 1929 were not protected by successful vaccination:— Births registered 2,515 Deduct:— Died unvaccinated 119 Removals to other districts 19 Removals to places unknown, etc. 69 207 Surviving residents 2,308 Successful vaccinations numbered 310 314=13.6 per cent. Insusceptible of Vaccination 1 Had Smallpox 3 Conscientious Objections declared 1,628 Vaccinations postponed on Medical Certificates 8 Number not accounted for 358 Total unvaccinated children 1,994=86.4 per cent. 2,308=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 101. PLAGUE. No case of this disease was notified during the year. ANTHRAX, GLANDERS AND HYDROPHOBIA IN MAN. No cases of these diseases occurred. 99 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. 110 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 10 7 Removed to L .C .C. Fever Hospitals 7 3 Treated in other Hospitals 2 4 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. 4 cases of Cerebro-Spinal Fever were notified, and the patients were removed to hospital. All 4 cases terminated fatally. 100 ACUTE POLIOMYELITIS. 3 notifications were received. The 3 cases were treated in hospital and 1 was subsequently certified to be not suffering from the disease, leaving 2 true cases. ACUTE ENCEPHALITIS LETHARGICA. No notifications were received. The death of a patient who was notified in 1924 was recorded. 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 case which died during the year, 25 cases were investigated . The following is a summary of the reports submitted:— Recovered or much improved and returned to work or school 8 In Institutions:— Mental Hospitals 2 Other Hospitals 4 6 Attending hospitals or otherwise undergoing treatment 10 Suffering from after-effects but not receiving treatment 1 25 The 11 patients suffering from after-effects (excluding those in Institutions) were affected as follows:— Intelligence below normal 1 Sleep, poor or excessive 3 Paralysis—severe 3, slight 2 5 Movements of limbs impaired 1 Subject to faintness 1 11 101 ACUTE POLIO-ENCEPHALITIS. No case of Acute Polio-Encephalitis was notified. POST-VACCINAL ENCEPHALITIS, Etc. One case of Post-Vaccinal infection was reported. The patient, a girl aged 4 years, fell ill 13 days after vaccination. She was admitted to hospital the following day and died 8 days later. A detailed report of the case was sent to the Ministry of Health. MEASLES. 1,993 cases of measles were reported to the Medical Officer of Health from various sources (principally from L.C.C. schools). 30 deaths were attributed to measles. During the year 143 cases of measles were admitted to L.C.C. Hospitals from the Borough. A summary of the cases reported and visited under the London County Council Scheme of Control is given in the Section relating to Maternity and Child Welfare, page 133. PNEUMONIA. 468 cases of Acute Primary Pneumonia and 5 cases of Acute Influenzal Pneumonia were notified during the year, 155 of the patients being treated in hospitals. 72 notified patients died—72 Acute Primary Pneumonia. MALARIA. No case of Malaria was notified during the year. DYSENTERY. No notifications were received. One death from Chronic Dysentery was recorded—an inmate of a Mental Hospital outside the Borough. 102 ALTERED DIAGNOSIS CASES. 99 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:— 24 Scarlet Fever; 38 Diphtheria; 1 Acute Poliomyelitis; 1 Puerperal Pyrexia, altered to Puerperal Sepsis; 12 Smallpox ; 24 Chickenpox. The final diagnosis in the 24 Scarlet Fever cases was:— Tonsillitis 3 Erythema 1 Measles 2 Diphtheria with Erythema 1 Dermatitis 2 Disease not specified *15 24 *These were reported "Negative case", "Not notifiable", etc. The final diagnosis in the 38 Diphtheria cases was:— Tonsillitis 4 Measles I Scarlet Fever 3 Disease not specified *30 38 *These were reported "Negative case", "Not notifiable", etc. The Acute Poliomyelitis was reported to be "Negative case." The Puerperal Pyrexia patient died from Puerperal Sepsis and the notification has been transferred to Puerperal Fever. 103 CANCER. The number of deaths from Cancer for the last five years is shown below:— Year. Males. Females. Total. 1926 122 93 215 1927 120 120 240 1928 115 89 204 1929 114 96 210 1930 136 75 211 Deaths from Cancer in 1930. Number of Heading in International Manual. Site of Primary Growth. Males. Females. Totals. 43 Buccal cavity 12 — 12 44 Pharynx, Oesophagus, Stomach, Liver and annexa 48 29 77 45 Peritoneum, Intestines and rectum 32 16 48 46 Female Genital Organs — 10 10 47 Breast — 16 16 48 Skin 2 1 3 49 Other or unspecified organs 42 3 45 Totals 136 75 211 OPHTHALMIA NEONATORUM. A complete summary of cases notified and visited is given in the Section of this Report dealing with Maternity and Child Welfare, page 139. TUBERCULOSIS DISPENSARY. The Council's Tuberculosis Dispensary is at No. 1, Wellington Road, Bow, E.3, and the following table shows the accommodation, hours of sessions, etc.:— 104 Accommodation. Day and time of session. Type of session. Two Tuberculosis Officers' Rooms, Dispensary, X-Ray Room, Waiting Room, Dressing Room and accommodation for Health Visitors, Clerks and Resident Caretaker Monday, 4.30 p .m. Children attending School. Monday, 6 p.m. Adults who are working. Tuesday 11 a.m. and 2 p.m. Any person not at work or not attending School. Thursday Friday Tuberculosis Officer's Report. Owing to the sudden death, early in 1931, of Dr. W. C. P. Smith, the Tuberculosis Officer, the following report has been prepared by Dr. C. K. Cullen, Tuberculosis Officer of the Metropolitan Borough of Shoreditch, formerly Assistant Tuberculosis Officer and Assistant Medical Officer of Health in Poplar:— Information Required by Ministry of Health. (i.) A list of dispensaries, specifying also branch dispensaries and visiting stations; a list of the Tuberculosis Officers employed; a statement of the number of other officers employed in dispensary work; a list of residential institutions, specifying for each the number of beds normally available for patients from the area of the Local Authority, and the type of case for which these beds are used. In the case of residential institutions belonging to the Local Authority, the names of Medical Officers and the number of other officers should be given. (a) Borough Tuberculosis Dispensary—1, Wellington Road, Bow, e.3. (b) Staff:— Tuberculosis Officer: W. C. P. Smith. Asst. Tuberculosis Officer: C. K. Cullen. 3 Health Visitors. 1 Dispenser. 1 Care Secretary. 1 Clerk. 1 Asst. Clerk. 1 Part-time Helper (female). 1 Caretaker. 105 The work of the Dispensary was handicapped during the year by the absence for five months, through illness, of the Tuberculosis Officer, Dr. W. C. P. Smith. For most of this period, however, we had the able and conscientious services of Dr. H. B. Hodson as temporary Assistant Tuberculosis Officer. (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. (London County Council.) (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 London Hospital under the London County Council scheme for consultative purposes. Cases of lupus are sent to the London Hospital for special treatment by means of the Finsen Light and general phototherapy. These cases are treated on the authority of the Tuberculosis Officer, the cost of the treatment being charged to the Borough Council. During the year, 4 new cases and 2 old cases have been undergoing this treatment, a total of 824 applications of one or other form of light having been given. A few cases requiring general arc-light treatment (mainly cases with discharging sinuses) were also referred to the London Hospital. There were 7 such cases and 381 applications of light were given. (b) Special Hospitals:— patients requiring refills following upon the induction of artificial pneumothorax are by arrangement sent to either Brompton, Victoria 106 Park, or other approved hospitals, a charge of 10s. 6d. being made for each refill. Eight patients have attended for this purpose, receiving altogether 112 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 London County Council have been referred to St. Margaret's Hospital, Kentish Town; while patients who have been at Lord Mayor Treloar's Hospital, Alton, are seen at the Farringdon Dispensary by Sir Henry Gauvain. Arrangements for co-operation with St. Andrew's Hospital have been continued and somewhat extended. Consultations were held with the Acting Medical Superintendent and various suggestions for improved co-ordination of Tuberculosis work were considered. Arising out of these, regular fortnightly visits were made during the latter part of the year by the Tuberculosis Officer or his deputy to the Tuberculosis wards and suitable cases were recommended to the London County Council for transfer to Sanatoria or other more suitable hospitals for treatment. A satisfactory feature of this arrangement was that patients were found to be more willing to accept admission to St. Andrew's Hospital pending the allocation of vacancies in Sanatoria, and treatment was therefore begun earlier. (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 165 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. 107 On receipt of a notification, the Tuberculosis Officer at once communicates with the notifying practitioner offering his assistance in dealing with the case, and calling attention to the services the Care Committee may be able to render the patient and his family. In all cases where patients are referred to the Dispensary, a report is sent to the practitioner and, where necessary, arrangements are made for treatment. 715 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. 535 reports have been sent to, and 197 received from, panel doctors in respect of patients having "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 Park Hospitals for further investigation. Cases of doubtful non-pulmonary tuberculosis are sent to the London Hospital, as are also a few cases of suspected tuberculosis who are unable to accept offers of admission to hospital as in-patients. In other doubtful cases, where admission to hospital is not considered necessary, arrangements are made for the patient to attend the Dispensary after a lapse of a suitable period of time so that the case can be reconsidered . (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. 464 contacts were examined, 254 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 apparatus at the Dispensary is only suitable for screen examinations. Where actual photographs are required, cases are usually referred to the London Hospital for examination and report. 108 (viii.) The results of local experience as to the relative value of each form of treatment. See vii. (ix.) The nature and extent of any dental treatment provided by the Council for tuberculous patients. Patients requiring dental treatment are referred to the Council's Dental Clinic, 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. The continued economic depression, with the increase in unemployment and short time, has brought a much larger number of patients and their families face to face with the problem of obtaining sufficient food and clothing to maintain their health, and the facilities for securing extra nourishment for the patients themselves have been used to the utmost. 116 patients have been in receipt of extra nourishment for varying periods during the year. Of these, 62 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. Patients in receipt of relief from the Public Assistance Committees are usually given cards recommending them for extra nourishment from that source and in some instances representations have been made to the committees for more generous treatment for tuberculous patients and their families. 109 (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. Cases requiring residential treatment are dealt with under the London County Council's scheme. Cases of tuberculosis of the skin, as stated above, are sent to the London Hospital for Finsen or other light treatment. No special arrangements exist for the provision of surgical apparatus. Generally speaking, what is required is provided through the Almoner's office of the hospital where the patient has been under surgical treatment. In the event of any difficulty, the matter would be referred to the Care Committee for them to deal with. (xii) The arrangements for "care" and "after-care" and their working. Care and after care are in the hands of the Tuberculosis Care Committee. The Secretary reports as follows:— The Tuberculosis Care Committee continues to meet once a fortnight at the Dispensary to deal with the care of the patients from the social or economic aspect. Increasing interest is shown in this side of the work and members of the Committee have attended regularly and given much practical help. During the year there have been 21 meetings of the Care Committee and 9 meetings of the Committee of the Poplar Tuberculosis Fund. The Care Committee has dealt with 432 cases. 206 recommendations regarding assessment for institutional treatment have been sent to the London County Council and contributions collected for the London County Council in paying cases. 15 dental cases have been considered and 98 "special cases"—i.e., cases in which some particular form of help or advice is needed—have been dealt with. The Care Committee is representative of, or in touch with, most of the public charitable organisations in the district and many cases have 110 been referred to these agencies for help, but the Committee has been greatly assisted in its work by having its own fund to fall back on when necessary. During the year 98 grants were made by the Poplar Tuberculosis Fund. The majority of these were in the form of clothing for sanatorium, but assistance had also been given towards cost of dentures, cost of putting out laundry for women patients unable to undertake this work themselves, and fares for patients to be visited at sanatorium under special circumstances. Convalescent treatment has also been provided, work advertised for, etc., etc. The main income of the Poplar Tuberculosis Fund during the year has been the grant from the Poplar Hippodrome in respect of Sunday performances, but this has been augmented by various efforts on the part of the Care Committee and their friends. A dance, three dramatic entertainments, and the usual Household and Jumble Sale, have been held during the year. The Committee of the Poplar Tuberculosis Fund publish their own annual report giving details of their activities, together with their balance sheet. The Handicraft Class continues to be held at the Dispensary once a week, the London County Council kindly supplying a teacher. The patients attending the class show increased keenness and there has been a marked improvement in the standard of the work done during 1930. Goods were sent to two exhibitions, one being organised by the Standing Conference of Tuberculosis Care Committees and held at the Carpenters' Hall, in March, and the other being the Ex-service men's Exhibition at the Imperial Institute in November. Only ex-service men were eligible for the latter. Several of them won certificates for work entered for competition. The exhibitions are useful, as they give the class an object for which to work as well as being a means of disposing of the goods made. The Tuberculosis Care Committee is represented on the Standing Conference of Metropolitan Borough Tuberculosis Care Committees and representatives have attended two conferences at the County Hall during 1930. The Tuberculosis Care Committee gratefully acknowledge the assistance they have received during the year from the various public authorities and centres of social work in the borough. They are particularly grateful to the Poplar Branch of the Invalid Children's Aid Association for the work of visiting and convalescing children. 111 The unemployment problem, causing increased poverty, continues to be the chief difficulty confronting the Committee, and the housing shortage is still a serious handicap, although some families in which tuberculosis occurs have been rehoused by the Borough Council and the London County Council during the year. (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 at the Spero Leather Factory. (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. 4 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. (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. Where infective patients have to remain at home or are still in an infective condition on discharge from sanatorium or hospital every effort is made to see that these patients sleep in separate beds (and, if possible, in separate rooms). Beds and bedding are supplied in some cases by the Borough Council and in other cases (where the family is in receipt of relief) by the Public Assistance Committee. Where home conditions are such that the children are exposed to serious risk of infection application can be made to the County Council for these children to be boarded out— usually in the country—until these conditions can be improved. 112 The Tuberculosis Visitors also advise patients and their relatives as to the importance of keeping separate utensils for food (particularly cups and forks), separate tea-cloths and separate towels, for infective cases. (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 1930. Attendances at Dispensary (Insured, 2,103; Uninsured, 3,150) 5,253 New Patients examined 1,070 Contacts examined 464 Notifications by Tuberculosis Officers (Pulmonary, 175; NonPulmonary, 26) 201 Patients sent away for Sanatorium Treatment 232 Patients away in Institutions, 31st December 110 Patients receiving Domiciliary Treatment, 31st December 200 Under Observation, pending Diagnosis, 31st December 45 In receipt of Extra Nourishment during the year 116 In receipt of Extra Nourishment, 31st December 62 Health Visitors'visits 6,971 Doctors' visits 172 Sputum examinations made (Dispensary, 1,661; for Public Health Department, 417) 2,078 Reports sent to Private Practitioners, 715; Public Authorities, 928) 1,643 TUBERCULOSIS DENTAL CLINIC. Report of Dental Surgeon. I beg to submit my Annual Report of the work carried out at the Tuberculosis Dental Clinic for the year 1930. No great change over the previous year is to be noted, and my reports of previous years, setting out our difficulties, still apply. 113 24 Sessions have been held at which 97 Patients have been treated; 145 Diseased teeth have been extracted; 15 Scalings; 9 Fillings. In addition, dentures have been fitted, dressings and gum treatment have been carried out. Approximately 24 new patients have come to the Clinic. The average attendance per session works out at 4 patients, a trifle more than the previous year. The patients are difficult to treat, their mental outlook as well as their physical condition rendering them difficult to convince of the necessity for a clean and healthy mouth. Added to this is the fact that only two sessions are held each month and only comparatively little work can be done for each patient at each session, which makes the treatment very protracted and tedious for them. C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. During the latter part of the year negotiations were entered into with the London County Council with a view to possible arrangements being made for this work to be carried on at St. Andrew's Hospital on an agreed financial basis. If the Borough Council's proposals are accepted by the London County Council it will be possible to have tuberculous patients requiring dental treatment seen twice a week, instead of once a fortnight as at present. 114 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications received during the period 29th December, 1929, to 27th December, 1930. 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 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards . Total Primary Notifications. Under 5 5 to 10 10 to 15 Total Primary Notifications. PoorLaw Institutions. Sanatoria. Pulmonary — Males — 2 4 10 15 45 25 27 20 3 157 303 — — — — — 16 105 Females — 2 4 5 21 20 24 14 0 5 — 104 194 — — — — — 4 73 Non-Pulmonary— Males — 2 8 8 8 4 5 1 1 2 1 40 68 — — 1 1 1 6 21 Females 1 4 8 2 6 3 1 1 — — — 26 35 — — 1 1 1 2 18 Totals 1 10 24 15 51 42 75 41 37 27 4 327 600 — — 2 2 2 28 217 (continued over). 115 Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health, during the period 29th December 1929, to 27th December, 1930, 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 oases. Pulmonary— Males — — — 1 1 1 — 1 2 4 5 15 Females — — — — — — 2 — 1 1 1 5 Non-pulmonary— Males — 2 — — — — — — — — — 2 Females 1 2 2 — — 2 1 — — — — 8 Source of Information. Number of Cases. Pulmonary. NonPulmonary. Death Returns From Local Registrars.. Transferable Deaths from Registrar-General Transfers from other areas 9 7 4 4 5 1 These 30 deaths of non-notified cases are equivalent to 20'5 per cent, of the total deaths from Tubertulosis. Number of cases notified only ajter death :—Nil. 116 Analysis of 25 non-notified cases who died (excluding the 5 transfers from other areas):— Pulmonary. NonPulmonary. Condition discovered by post-mortem inations (including 6 "inward transfers") 7 7 Other ' 'inward transfers'' (Hospitals, Mental Hospitals, etc.) 5 1 Certified by Medical Practitioners'in Borough:- Coroner . 3 — Institution 1* 1† 16 9 * Resident of Aberdeen. † Diagnosis not confirmed until after death. (Examination of cerebrospinal fluid.) PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. During the year a registered dairyman was notified as suffering from Pulmonary Tuberculosis. He was examined by the Tuberculosis Officer, and the diagnosis confirmed. The man voluntarily cancelled his registration, removed to another district to relatives, and his business was transferred to a son. 117 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, i924 and 1930. Summary of Quarterly Returns to the London County Council. Quarter ended March. June. September. December. Number of Cases on Register at commencement of quarter 1,999 1,909 1,922 1,968 Number of New Cases notified 73 87 98 74 Number of Cases removed from Register 163 74 52 145 Number of Cases on Register at end of quarter. Pulmonary 1,317 1,329 1,362 1,335 Non-Pulmonary 592 593 606 562 Totals 1,909 1,922 1.968 1,897 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 — 1 1 — 2 2 2 4 2 2 2 5 — 4 4 8 8 1 1 — 2 10— — 5 9 3 1 2 — 15— 16 21 8 6 8 6 — 2 20— 15 20 4 3 13 10 — 2 25— 45 24 5 1 9 14 — 1 35— 25 14 1 1 15 8 45— 27 9 1 15 8 55— 20 5 2 13 1 65 and upwards 3 — 1 — 6 1 — — Totals 157 104 41 27 81 53 2 10 Deaths from Tuberculosis. It will be seen on reference to Table II. that the deaths were 134 from tuberculosis of the respiratory system (lungs, larynx and throat) and 12 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). 118 Heading in International Manual. Part affected. Number of Deaths. 32 Central Nervous System 4 33 Intestines and peritoneum 3 34 Vertebral column — 35 Joints — 36 Other organs:— (a) Skin and subcutaneous tissues — (6) Bones (vertebral column excepted) . — (c) Lymphatic glands (abdominal glands excepted) (d) Genito-urinary system — (e) Other sites — 37 Disseminated tuberculosis:— (a) Acute 4 (b) Chronic or unstated 1 12 DISINFECTING DEPARTMENT. SUMMARY OF WORK DONE—DISINFECTING DEPARTMENT. 52 Weeks ended 27th December, 1930. Poplar. Bow and Bromley. Totals. Premises Disinfected 1,117 660 1,777* ,, visited re Disinfection 1,378 1,102 2,480 *Does not include premises disinfected on account of Smallpox (318). Number of Verminous Rooms sprayed with Solution "D" .329. Articles Disinfected. Smallpox. Other Infectious. Diseases. Tuberculosis. Verminous. Miscellaneous. Totals. (a) From Infected Pre mises 11,918 13,032 230 327 2,190 27,697 (6) From Cleansing Station — 100 9,230 17,932 27,262 (c) From Contacts 40,388 51 — —- — 40,439 (d) ,, Shelter 17,112 — — — — 17,112 Totals 69,418 13,083 330 9,557 2( ),122 112,510 Articles destroyed by request, 386. Vermicide—Quantity issued from Depots, 285 gallons. 119 Cleansing Station. Totals. M. F. Verminous persons cleansed 42 ,, children ,, 123 846 Scabies cases, cleansed, adults 35 21 ,, ,, children 423 395 Total cleansings 623 1,262 Number of children treated with special comb:—Boys, 121: Girls, 926. Motor Vehicles. Vehicle. Speedometer register (miles). Petrol consumption (gallons). Average m.p.g. Blue Van 4,244 321½ 13.2 (a) Brown Van 4,934 345½ 14.3 (d) Lorry 3,959 299½ 13.9 (d) M.O.H. Car 10,848 612½ 18.0 (d) Hired Car 284 26 10.9 Special Vehicle for Contacts 1,532 121 12.7 (a) 3 weeks in workshop for overhaul. (b) 3 ,, ,, ,, and speedometer not working for 1 week. (c) 5 ,, ,, ,, ,, ,, ,, ,, 3 weeks. (d) 3 ,, ,, ,, ELECTROLYTIC DISINFECTING FLUID. The electrolytic disinfecting fluid as manufactured contains approximately 9—io grammes per litre of free chlorine and is broken down to a strength of approximately 4 grammes per litre for distribution. During the year 1930, 43,695 gallons were manufactured and broken down to 97,780 gallons of weaker solution for distribution. The production of the solution at a strength of 4 grammes of available chlorine per litre has averaged 128,725 gallons per annum for three years at an average annual cost of £2,334, the cost per gallon thus being 4.35d. 120 Quantity Produced. As Manufactured. Gallons. As Issued. (i.e.. Weaker Solution.) Gallons. Electricity Consumed. Units. No. 1 Apparatus 7,560 15,120 3,906 No. 2 Apparatus 7,890 15,780 3,983½ No. 3 Apparatus 28,245 66,880 12,385½ Totals 43,695 97,780 20,275 Distribution of Fluid. The fluid was distributed as follows:— galls. Violet Road Depot 32,908 Bickmore Street Depot 14,440 Old Ford Road Depot 8,965 Ford Road Depot 6,898 Trego Road Depot 6,190 Stebondale Street Depot 9,985 West Ferry Road Depot 3,060 Public Health Office 54 Poplar Baths 2,065 Bow Baths 2,354 Island Baths 358 W ick Lane Baths 204 Empson Street Baths 349 Weston Street Baths 60 Open Air Bath, Bromley 1,070 Poplar Town Hall 123 Bromley Public Hall 71 Works Department 156 Public Assistance Committee Offices, Poplar 132 Public Assistance Committee Offices, Bow 93 Poplar Institution 3,835 Langley House 184 Poplar Training School, Hutton 54 Public Libraries 392 London County Council Schools 1,148 London County Council School Clinic 170 Mortuary, High Street, Poplar 330 Tuberculosis Dispensary h0 Royal College of St. Katharine 167 Council Offices, Poplar 70 Finance Department Offices 30 Kingsley Hall 55 M. and C. W. Centre, Simpsons Road 75 M. and C. W. Centre, Wellington Road 100 M. and C. W. Clinic, West Ferry Road 18 Howrah House Convent 228 Electricity Department— Poplar Showrooms 22 Bow Showrooms S. Mildred's House 54 Sold to Private Firms in Borough, etc. 1,213 Used at premises where smallpox occurred 20 97,780 121 Cost of Materials and Electricity. The cost of materials and electricity for manufacturing the electrolytic fluid was as follows:— Electricity, 20,275 units at 1½ per unit (with £ s. d. 50 per cent. advance) 190 1 7 Lime, 12 cwt. 1 qtr. 3 4 4 Salt, 29 tons 97 16 0 Water, 53,695 gals 2 0 7 Total cost of materials and electricity to produce 43'695 gallons (strong) broken down to 97,780 gallons 293 2 6 Stirrer dismantled for greater part of year (9 months). Bottles, Corks and Labels. Bottles — Corks 10 5 0 Labels 5 5 0 £15 10 0 Total quantity of water used for all purposes, 315,000 gallons, cast £11 19s. gd. 122 Total Quantity Manufactured since Installation of Plant. Since the installation of the plant, a period of 24 years, 1,239,670 gallons of fluid have been manufactured (see footnote) at a cost of for electricity £2,431 7s. 5½d., and chemicals £2,573 15s. 4d. The amount of fluid manufactured, and the cost of chemicals and electricity, in each of the last ten years is shown below:— Year. Output, gallons. Chemicals and Water. Electricity. Total. £ 8. d. £ 8. d. £ 9. d. 1919 33,285† 139 4 0 77 7 9 216 11 9 1920 39,255† 153 11 4 105 7 3 258 18 7 1921 51,330† 220 7 10 134 18 8 355 6 6 1922 56,520† 166 0 1 119 13 9 285 13 10 1923 64,740† 118 0 7 123 11 3 241 11 10 1924 70,350† 132 7 2 136 2 5 268 9 7 1925 72,165† 145 10 5 133 13 9 279 4 2 1926 65,317½† 177 8 5 168 3 2 345 11 7 1927 76,538½† 182 10 10 197 5 9 379 16 7 1928 84,712½† 193 8 8 215 14 9 409 3 5 1929 77,551½† 196 15 10 242 19 0 439 14 10 1930 43,695† 103 0 11 190 1 7 293 2 6 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 late Board of Guardians (within and without the Borough) are supplied with an unlimited quantity free, as required. t Since 1914 the fluid has been made of greater strength than originally, and afterwards broken down for distribution. Quantity distributed:— 1914 88,425 gallons. 1923 129,480 gallons. 1915 73,970 ,, 1924 140,700 ,, 1916 53,580 ,, 1925 144,330 „ 1917 55,800 ,, 1926 130,635 ,, 1918 61,500 ,, 1927 147,655 ,, 1919 66.570 ,, 1928 151,590 ,, 1920 78,510 ,, 1929 136,805 „ 1921 102,660 ,, 1930 97,780 ,, 1922 113,040 ,, 123 EXTRACT FROM ANNUAL ESTIMATES, ETC. Eleotrolytic Disinfecting Fluid. Estimate for Year ended 31st March, 1930. Expenditure for Year ended 31st March, 1930. Average Expenditure for 3 years ended 31st March, 1930. Estimate for Year ending 31st March, 1931. Estimate for Year ending 31st Maroh, 1932. £ £ £ £ £ £ £ £ £ Wages 1277 1334 1347 1277 1277 Rates, Taxes and Insurance—Main Depot 100 82 98 92 84 Rent (Issuing Depots) 46 46 43 46 46 Electricity and Water 220 250 231 265 270 Chemicals 200 168 186 200 160 Testing Apparatus 5 1 — 5 5 Bottles, Carboys, Hampers, Corks, etc 70 80 69 70 70 Overalls and Clogs 9 10 4 9 9 Supervision of Plant 15 15 15 15 15 Repairs and Renewal of Plant 50 57 44 70 50 Replacing part of Plant — — — 600 Repairs (Works Dept.) Main Depot 100 143 59 150 200 ,, ,, Issuing Depots 150 110 92 100 100 Petty Expenses and Sundries 3 13 5 5 ' 12 Capital Account—Cost in excess of Loan — — 223 — — 2245 2309 2416 2904 2298 Less Income 25 150 82 30 50 2220 2159 2334 2874 2248 124 Spraying and Cleansing Floors of London County Council Schools with Electrolytic Disinfecting Fluid. 1,148 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. 2,065 gallons were supplied to the Poplar Baths, 2,354 gallons to the Bow Baths, 358 gallons to the Island Baths, and 1,070 gallons to the open-air swimming baths, making a total of 5,847 gallons. VERMINOUS CHILDREN ATTENDING SCHOOLS, LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1907. CHILDREN ACT, 1908. Cleansing of Verminous Children. The arrangements for cleansing of verminous school children were continued throughout the year. The bathing, etc., of the children and the disinfection of their clothing is kept quite distinct and separate from the bathing and disinfection of Smallpox contacts and their clothing. Number of Verminous Children Bathed under Agreement with the London County Council. Quarter. Number of Children Cleansed. Total number of Cleansings. Amount payable by L .C .C. to the Borough Council. 1930. £ s. d. March 261 441 33 ii 0 June 258 356 28 13 0 September 344 486 39 13 0 December 329 596 43 16 0 Totals 1192 1879 £145 13 0 125 Miss Davies and Miss Landray made 21 visits in connection with verminous school-children and 76 visits in connection with children suffering from Scabies. Arrangements were made for the children to be bathed, and for bedding and clothing to be disinfected. CLEANSING OF PERSONS ACT, 1927. During the year, 127 persons—including 44 from common lodging houses (see below)—applied for baths and for their clothes to be disinfested. VERMINOUS PERSONS IN COMMON LODGING HOUSES, LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1907. Number of Persons Cleansed from Common Lodging Houses and Seamen's Lodging Houses Within and Without the Borough. The number of persons from Common Lodging Houses and Seamen's Lodging Houses cleansed at the Council's Cleansing Station, Glaucus Street, during the year was:— Lodging House. Male. Female. Total. 196, Bow Road — — — St. James's Chambers, 207, High Street, Poplar 3 — 3 65, Bow Lane 1 — 1 378, Old Ford Road I — 1 38, Pennyfields — — — Salvation Army Home, Bow Road 3 — 3 ,, ,, Hostel, Garford Street 13 — 13 20 20 From Common Lodging Houses without the Borough of Poplar (by agreement with L.C.C. at a charge of is. per person cleansed) 24 — 24 Totals 44 — 44 For cleansing of verminous rooms see page 43. 126 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 15,7io 9,856 1922 17,404 8,992 1923 24,058 11,718 1924 27,137 13,598 1925 31,540 17,809 1926 35,084 20,473 1927 36,110 23,588 1928 41,420 27,653 1929 38,504 28,250 1930 40,924 32,173 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. There has been one additional Clinic (Post-natal) commenced this year. MATERNITY AND CHILD WELFARE CLINICS. Situation. Nature or Accommodation. Clinics . (i) Provided by the Borough Council:— Simpsons Road, Poplar Medical Officer's, Weighing and Waiting Rooms (Weighing Room also used for Artificial Sunlight Treatment) Infant Consultations: Wednesdays, 10.30a.m. to 12.30 p.m. and 2 to 4 p.m. Ante-Natal: Mondays 2 to 4 p.m. Sewing Class: Thursdays, 2 to 4 p.m. Artificial Light Treatment: (By appointment only) Tuesdays and Thursdays, 9.30 a.m. to 12.30 p.m. and 2.30 to 4.30 p.m.; Saturdays, 9.30 a.m. to 12.30 p.m. Wesleyan Mission, Old Ford Road Medical Officer's Room and Weighing and Waiting Room combined Infant Consultations: Tuesdays and Fridays, 2 to 4 p.m. Methodist Chapel, Manchester Road 64, West Ferry Road Medical Officer's, Weighing and Waiting Rooms Ditto Ditto Ditto .. Ante-Natal: Fridays, 10.30 a.m. to 12.30 p.m. Infant Consultations: Wednesdays, 10.30 a.m. to 12.30 p.m., and 2 to 4 p.m. Infant Consultations: Fridays, 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. b) 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 Consultation& . Tuesdays, Thursdays and Fridays, 2 p.m. Sewing Class: Wednesdays, 2 p.m. Dental: (By appointment only) Mondays, 1.30 and 3p.m. Artificial Light Treatment: (By appointment only) Mondays to Fridays, 9.30 a.m. to 12.30 p.m., and 2 to 4.30 p.m. Ante-Natal: Tuesdays, 9.30 a.m. Tonsil Clinic: (By appointment only) Twice monthly. Remedial Exercise: (By appointment only) Mondays, 2.30 p.m., and Thursdays 10 a.m. The Lighthouse Mission, Blackthorn Street Trinity Hall, Augusta Street Medical Officer's Room and Large Hall for weighing and waiting Ditto Ditto Ditto Post-Natal Clinic: Wednesdays, 9.30 to 12.30 Infant Consultations: Wednesdays, 2 p.m Infant Consultations: Wednesdays, 2 p.m. 127 Extract from Form M.C.W. 96 (revised) (Ministry of Health). MATERNITY AND CHILD WELFARE. Return (1) showing the arrangements made for Maternity and Child Welfare by the Council and by Voluntary Associations providing Maternity and Child Welfare Services in respect of which the Council pay contributions under Section 101 of the Local Government Act, 1929, or otherwise; and (2) giving particulars of the work done during the year. 1. Population of the area served by the Council:—160,000 (Reg.-General's figure). 2. Number of Births notified in that area during the year under the Notification of Births Act, 1907 :— (a) Live births, 2,445; (b) Still births, 80; (c) Total, 2,525. (d) By midwives, 1,437; (e) By doctors and parents, 544; (f) Institutions in Borough, 544. 3. Health Visiting. (i) Number of officers employed for health visiting at the end of the year— (a) By the Council—Chief Health Visitor, 1; Health Visitors, 8. (b) By Voluntary Associations—9. (ii) If any of the Health Visitors arc engaged on other work during part of their time, state the equivalent of whole-time services devoted by the whole staff to health visiting— (a) In the case of Health Visitors employed by the Council—J whole- time service being spent at the Artificial Light Clinic. (b) In the case of Health Visitors employed by Voluntary Associations— No. (iii) Number of visits paid during the year by all Health Visitors— (a) To expectant mothers—First visits, 1,306; Total visits, 4,194. (b) To children under 1 year of age—First visits, 3,094; Total visits, 23,434. (c) To children between the ages of 1 and 5 years—Total visits, 46,740; plus visits paid to children over 5, L.C.C. Measles Scheme, 2,083; Puerperal Pyrexia, Fever, Maternal Deaths, 50; Total visits paid, 76,501. 4. Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council—5. (b) Number of Centres provided and maintained by Voluntary Associations—3. 128 (c) Total number of attendances at all Centres during the year— (i) By children under 1 year of age—23,391. (ii) By children between the ages of 1 and 5 years—23,415. (d) Average attendance of children per session at all Centres during the year—76.8. (e) Total number of children who attended at the Centres for the first time during the year— (i) Children under 1 year of age—2,039. (ii) Children between the ages of 1 and 5 years—409. (f) (1) Percentage of total notified births, corrected, represented by the number in (e) (i)—63.7. (2) Percentage of total registered births, corrected, represented by the number in (e) (i)—66.7. 5. Ante-natal Clinics (whether held at Infant Welfare Centres or at other premises)— (a) Number of Clinics* provided and maintained by the Council—3 (2 sessions weekly and 1 fortnightly). (b) Number of Clinics provided and maintained by Voluntary Associations—1 (1 session weekly). (c) Total number of attendances by expectant mothers at all Clinics during the year—3,127. (d) Average attendance of expectant mothers per session at all Clinics during the year—18. (e) Total number of expectant mothers who attended at the Clinics during the year—1,242. (f) (1) Percentage of total notified births, corrected, represented by the number in (e)—38.8. (2) Percentage of total registered births, corrected, represented by the number in (e)—40.6. Other Clinics additional to above-mentioned. Total Attendances. Average Attendance per session. Artificial Light Clinics 15,320 18.7 Dental Clinics 2,321 12.3 Sewing Classes 2,791 31.4 Remedial Exercises Clinic 923 9.9 Mothers' Clinic (Post-natal) 315 6.8 Garden Clinic 1,494 * Including Ante-natal Clinics provided at institutions transferred to the Council under Part I of *he Local Government Act, 1929. 129 6. Maternity Homes and Hospitals:— I. Separate maternity institutions provided by the Council. Institutions (with maternity wards) transferred to the Council under Part I of the Local Government Act, 1929. Institutions provided by Voluntary Associations. Number of Institutions St. Andrew's Hospital, Devons Road, Bow, E.3 1 ward. Arrangements made with late Guardians, now L.C.C. Nil Nil Number of maternity beds 12 Nil Nil Total number of women admitted to these beds during the year 74 Nil Nil II. Number of women (if any) sent by the Council during the year to other Maternity Institutions—Nil. 7. Homes and Hospitals for Sick or Ailing Children under 5 years of age:— I. Separate institutions provided by the Council for these cases. Institutions (with accommodation for these cases) transferred to the Council under Part I of the Local Government Act, 1929. Institutions provided by Voluntary Associations. Number of Institutions 1 Nil 1 Number of beds provided for such children 11 Nil 12 (5 for Observation Ward, 6 for Tonsillectomy . Total number of "women admitted to these beds during the year * Nil Children remaining, 31.12.29, 10; admitted, 1930, 50; in addition, 2 of these children were re-admitted Nil 125 50 for Observation Ward, 75 for Tonsillectomy. II. Number of such children (if any) sent by the Council during the year to other Institutions—is il. 130 8. Convalescent Homes. (a) Number of convalescent institutions with accommodation for expectant or nursing mothers or children under 5 years of age— (i) Provided by the Council—Nil. (ii) Provided by Voluntary Associations—Nil. (b) Number of beds for such cases in convalescent institutions—J (i) Provided by the Council*—Nil. (ii) Provided by Voluntary Associations—Nil. (c) Total number of cases admitted to the beds included in (b) during the year—Nil. (d) Total number of such cases sent by the Council during the year to other convalescent institutions—Mothers and babies, 14; Children, 18. (e) Sent by Voluntary Associations—Mothers and babies, 7; Children, 19; Mothers, 6. Homes for Mothers and Babies. (a) Number of such homes— (i) Provided by the Council—Nil. (ii) Provided by Voluntary Associations—Nil. (b) Number of beds in homes— (i) Provided by the Council—Nil. (ii) Provided by Voluntary Associations—Nil. (c) Total number of cases admitted to these homes during the year— (i) Expectant mothers—Nil. (ii) Mothers and Babies—Nil. (iii) Babies—Nil. (d) Total number of such cases sent by the Council during the year to other homes for mothers and babies—Nil. * Including any beds for convalescent cases of these classes in institutions transferred to the Council under Part I of the Local Government Act, 1929. 10. Day Nurseries. (a) Number of day nurseries— (i) Provided by the Council—Nil. (ii) Provided by Voluntary Associations—Nil. (b) Number of places for children under 5 years of age in the nurseries— (i) Provided by the Council—Nil. (ii) Provided by Voluntary Associations—Nil. (c) Total number of attendances of children at these nurseries during the year— (i) Whole day—Nil. (ii) Half-day—Nil. 131 11. Infectious Diseases:— Disease. Number of cases notified during the year. Number of cases visited by officers of the Council. Number of cases for whom home nursing was provided by the Council. Number of cases removed to hospitals. (1) Ophthalmia Neonatorum 42 42 14 4 (2) Pemphigus Neonatorum Not notifiable Reported 2 2 1 1 (3) Puerperal fever 10 10 Nil 9 (4) Puerperal pyrexia 7 7 1 7 (5) Measles and german measles (in children)— Not notifiable Reported Under 5 years of age 1130 1130 74 87 Over 5 years Reported 784 784 22 56 (6) Whooping cough (in children under 5 years of age) Not notifiable Reported 94 94 1 3 (7) Epidemic diarrhoea (do.) 117 117 Nil 14 (8) Poliomyelitis (do.) 2 2 Nil 2 12. Home Nursing. (a) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever— (i) By the Council—Nil. (ii) By Voluntary Associations—Nil. (b) Total number of cases attended during the year by these nurses—Arrangements made with three Local Nursing Associations; 166 cases attended. 13. Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year—20. (b) Number— (i) Employed by the Council—Nil. (ii) Subsidised by the Council—Nil. (iii) Employed by Voluntary Associations—Nil. (c) Number of cases attended by midwives during the year— (i) As midwives—1,437, exclusive of midwives in Institutions. (ii) As maternity nurses—29. (d) Number of cases during the year in which the Council paid or contributed to the fee of a midwife—5. (e) Compensation paid to midwives when cases were referred to Hospital—17. 14. Maternal Deaths. (a) Number of women who died in, or in consequence of, childbirth in the area served by the Council for maternity and child welfare during the year— (i) From sepsis—4. (ii) From other causes—Nil. (b) Number of these cases which died— (i) At home—Nil. (ii) In institutions—4. 132 Form M.C.W. 96a. MATERNITY AND CHILD WELFARE. Return relating to Maternity Hospitals and Homes maintained or subsidised by the Council during the year. 1. Name and address of Institution—St. Andrew's Hospital, Devons Road, Bow, E.3. 2. Number of beds in the Institution—12. 3. Number of cases admitted during the year—74. 4. Average duration of stay—14.66 days. 5. Number of cases delivered by— (a) Midwives—69. (b) Doctors—5 (forceps deliveries). 6. Number of cases in which medical assistance was sought by a midwife—18. 7. Number of cases notified as— (a) Puerperal fever—Nil. (b) Puerperal pyrexia—Nil. 8. Number of cases of pemphigus neonatorum—Nil. 9. Number of infants not entirely breastfed while in the Institution—10. 10. (a) Number of cases notified as ophthalmia neonatorum—Nil. (b) Result of treatment in each case— 11. (a) Number of maternal deaths—Nil. (b) Cause of death in each case. 12. (a) N umber of foetal deaths— (i) Stillborn—Nil. (ii) Within 10 days of birth—1. (b) Cause of death in each case, and results of post-mortem examination (if obtainable)—Cerebral Anaemia; no post-mortem was held. Miss J. M. Cardozo, Chief Health Visitor, reports as follows:— Home Visiting.—Home visiting, as usual, takes first place in the Maternity and Child Welfare Scheme. It is well to remember that it is the mother who is anxious to do the best for her children who comes to the Infant Consultations, but there are many who cannot come and still more who do not wish to come. These last need constant and patient visiting. In spite of the re-housing that is taking place there are many cases of overcrowding. Mothers struggle on under almost unsurmountable difficulties, some with extraordinarily good results due to cleanliness and management, but others give up and make little or no effort to improve 133 conditions. Those who have been fortunate enough to move into a new house also need advice, for it is an adventure and considerable adjustment is needed in many instances to ensure a happy and comfortable home. L.C .C. Scheme of Measles Control.—Additional visiting was undertaken during the Measles epidemic in the first five months of the year when school children of all ages were visited when notified as absentees by the Education Authority. Visits were paid as early as possible on the day of notification. There is no doubt that cases were seen earlier than heretofore, and in this way earlier attendance of a doctor or removal to hospital was secured. Although the number of cases visited during the period was 1,914, the total visits paid was much in excess of that number, as 37 per cent. of the children visited were not cases of Measles. Ante-Natal Clinics.—The attendances at the Ante-Natal Clinics steadily increase. It is interesting to note that the first report of attendances at the Borough Clinic was in 1917, when the total attendances for the year were 2. In 1930 the total attendances numbered 1,562. The co-operation between the clinics and all authorities immediately concerned with expectant mothers is now on a much firmer basis. Nearly all the midwives are making good use of the Council's Ante-Natal Clinics and very kindly send a short history of the confinement. This enables the records at the clinic to be completed. The mothers also are more ready to come along for examination. This is due to the advice given by the Health Visitors when visiting, to the special instructions given at the clinics and at public lectures, and to the advice and example of other women who have benefited by their attendance at Ante-Natal Clinics. The result of this special effort was that during 1930 approximately 88.5 per cent, of the total registered births received ante-natal care— not all at the Council's Clinics, of course, but at Institutions or from the person with whom booking had been made. Infant Consultation Clinics.—These clinics also are expanding. The Clinics at Wellington Road and Old Ford have the highest average attendance per session, namely, 85.4 and 76.3 respectively. With these large numbers it is difficult to do satisfactory work, especially at Old Ford where the accommodation is so poor. It is possible that these premises will be enlarged and improved and this will mean better rooms for the Clinics and, it is hoped, accommodation will be made for perambulators which is so urgently needed. 134 The Clinic at 54, West Ferry Road did very well during the year when the average attendance increased to 63.5 per session as compared with 55 per session. Artificial Light Clinics.—A report on these Clinics will be found on pages 148-150. The attendances have increased, mothers and children show a marked improvement after a course of this treatment. Dental Clinic.—Many mothers are now really keen to get their children's teeth examined before they commence school. Unfortunately, they are not so eager to act on their own behalf. This is especially noticeable with expectant mothers, who often are not seen until late in pregnancy when there is no time for extensive extractions. These cases are followed up and treatment commenced after the confinement. Every effort is being made to get into touch with the expectant mother during the early months of pregnancy. Sewing Class.—The Sewing Class is now held at Simpsons Road. This is much more satisfactory, as there is plenty of room for the children to play, and is more convenient for health talks and demonstrations. Some very useful garments have been made from both old and new material. Our special thanks are due to the voluntary workers at the Clinics and Sewing Class, 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 more effective. We also wish to acknowledge, with thanks, grants from the United Services Fund for Convalescent Home treatment, grants from the Hospital Sunday Fund for Artificial Dentures, gifts of woollies, children's clothing and toys, parcels for Jumble Sales and donations for the Mothers' Christmas Tea. 135 STATISTICAL SUMMARY OF HOME VISITING FOR 1930. Public Health Department. The Royal College of St. Katharine. Total 1930. Total 1929. Cases. Visits. Cases. Visits. Cases. Visits. Cases. Visits. Ante-Natal:— No. of Cases 717 — 589 — 1,306 — 1,310 — Primary visits — 717 — 589 — 1,306 — 1,310 Re-visits — 1,292 — 1,596 — 2,888 — 3,425 Infant Child Welfare visits:— Primary visits (Infants) — 1,429 — 1,380 — 2,809 — 2,865 Removed before visit — 38 — 37 — 75 — 64 Died before visit — 31 — 34 — 65 — 82 Stillbirths — 55 — 48 — 103 — 92 Re-visits— Under 1 — 8,973 — 11,179 — 20,152 — 19,013 1—5 19,527 — 22,654 — 42,181 — 43,088 Removed 504 — 701 — 1.205 — 965 Died 76 — 80 — 156 — 233 Ophthalmia Neonatorum:— No. of Cases notified 42 — — — 42 — 56 — Primary visits — 42 — — — 42 — 56 Re-visits — 99 — — — 99 — 124 Removed to Hospital *Enteritis:— (a) No. of Cases reported.. — — 5 — 5 — — — 1 (6) No. of Cases notified (Z.E.) 27 — 91 — 118 — 188 — (a) Primary visits — — — 5 — 5 — 6 Re-visits — — — 12 — 12 — 50 Removed to Hospital — — — — — — — — Died — — — — — — — 5 | (6) Primary visits — 27 — 91 — 118 — 112 Re-visits — 30 — 193 — 223 — 176 Removed to Hospital 14 — — — 14 — 27 — Died — 4 — — — 4 — 16 Measles:— No. of Cases under 5 years 633 — 497 — 1,130 — 982 — Primary visits — 633 — 497 — 1,130 — 982 Re-visits — 314 — 451 — 765 — 270 Removed to Hospital 87 — — — 87 — 152 — Died — 14 — 14 — 28 — 10 Other visits under L.C.C. scheme of control to children over 5 years — 964 — 1,302 — 2,266 — — Whooping Cough:— No. of Cases 71 — 23 — 94 — 531 — Primary visits — 71 — 23 — 94 — 531 Re-visits — 26 — 10 — 36 — 270 Removed to Hospital 3 — — — 3 — 80 — Died — 3 — — — 3 — 42 †Puerperal Fever:— No. of Cases notified 4 — 6 — 10 — 12 — Primary visits — 10 — — — 10 — 12 Re-visits — 8 — — — 8 — 13 Removed to Hospital 9 — — — 9 — 11 — Died 2 — 2 — 4 — 4 — †Puerperal Pyrexia:— No. of Cases notified 3 — 4 — 7 10 Primary visits — 7 — — — 7 — 10 Re-visits — 9 — — — 9 9 Removed to Hospital 7 — — — 7 — 10 — Died — — — — — — — — Maternal Deaths (enquiries) 4 — — — 4 — 10 — Maternal Deaths:— 2 — 2 — 4 — 10 — Primary Visits — 4 — — — 4 — 10 Re-visits — 12 — — — 12 — 42 Miscellaneous Visits — 137 — 549 — 686 — 1,231 Total Visits:— Primary — 4,034 — 3,999 — 8,033 — 5,893 Re-visits — 31,022 — 37,446 — 68,468 — 69,224 Total Visits paid, 1930 — 35,056 — 41,445 76,501 — — Total Visits paid, 1929 — 33,755 — 41,362 — — — 75,117 * Zymotic Enteritis is notifiable from 1st June to 30th September. † All eases are visited by Health Visitors of the Public Health Department. Enquiries re Maternal Deaths are made by the Public Health Department. 136 The following table shows the attendances at each of the Clinics during the year 1930:— Bow West Ferry Road. Manchester Road. Simpsons Road. Wellington Road. P.H. Dept. Total. Royal College of St. Katharine Total. Ante-Natal Clinics:— Attendances 583 — — 688 291 1,562 1,565 Average per session 11.6 — — 14.3 12 12.8 30.6 Dble Infant Consultations:— session. First attendances 385 159 196 290 309 1,339 1,109 Total attendances 7,639 3,046 5,942 6,696 4,361 27,684 19,122 Average per session 76.3 63.5 64.4 63.4 85.4 68 76.8 Dble Average attendance of session. each child 14 7.2 10 12 9.5 11 9.8 Light Clinics:— Attendances — — — 4,024 5,596 9,620 5,700 Average per session — — — 16.8 19.5 18.3 19.25 Dental Clinics:— Attendances — — — — 1,097 1,097 1,224 Average per session — — — — 14.2 14.2 10.9 Sewing Class — — — 961 — 961 1,830 Garden attendances — — — — — — 1,494 Mothers' Clinic (PostNatal) — — — — — — 315 Remedial Clinic — — — — — — 923 Total attendances at all Clinics:— 1930. 1929. P.H. Department 40,924 38,504 Royal College of St. Katharine 32,173 28,250 Total 73,097 66,754 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:— 137 £ s. d. Dried Milk, 8,270 lbs 620 5 0 ,, ,, Humanized, 163 lbs. 16 6 0 Aberdeen Emulsion 15 9 0 Dusting Powder 1 0 0 Medicinal Paraffin 0 0 0 Medical Sundries 10 2 6 Dentures 76 0 l Materials at Sewing Class 15 12 i Convalescent Treatment 10 10 6 Virol 21 2 3 Oil and Malt 95 7 4 Concentrated Food 25 9 0 Payments for Gas (Dental Clinic) 4 6 6 Maternity Ward Fees 266 5 6 Total 1,184 4 2 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. 2,138 such vouchers were issued during the year. Convalescent Treatment, etc. Convalescent Treatment (mothers with babies) 14 cases. ,, ,, (mothers alone) — ,, ,, ,, (children under 5 years) .. 18 ,, Payment of Midwives' fees 5 ,, Compensation to Midwife 17 ,, Loan of maternity bag containing clothing, etc. 10 ,, (The following tables refer to the whole Borough.) Statistics Respecting Infants Born in 1929. All births, including those occurring in outlying districts, but belonging to the Borough 3.234 Doctors in attendance 549 Midwives in attendance 1,479 Delivered in institutions 1,179 Not stated 27 Moved into Borough 65 3.299 138 Stillborn (Stillbirths per 1,000 births, 27.9) 92 Died before visit 80 Not requiring or desiring visits 94 266 Visited 3.033 Removed within the year 305 Died during visitation 123 428 Remaining under supervision end of first year 2,605 Mortality per 1,000 visited 40.5 The 3,033 children visited during 1930 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 77.2 per cent. Mixed feeding 16.2 ,, Hand-fed 6. ,, The 123 children who died during the first year of life, were fed during the first six months of life as follows:— Breast-fed 44.7 per cent. Mixed feeding 33.3 ,, Hand-fed 21.9 ,, Below is a statement comparing the mortality rates of children fed by the various methods:— (a) Babies breast-fed 27 (b) ,, who received mixed food (breast and hand) .. 88 (c) ,, hand-fed 136 139 STILLBIRTHS. (This refers to the whole Borough.) 103 Stillbirths were investigated during the year 1930. Number of Stillbirths 103 Doctors in attendance 24 Midwives in attendance 27 Delivered in Institutions 47 B.B.A 5 OPHTHALMIA NEONATORUM. Forty-two 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 - - - 1930 42 38 4 42 — — — Total 859 744 92 834 7 1 16 ** 1 born in Institution—not visited, no information available. * Including 3 which occurred in Institution. 140 Cases Notified and Visited. Number of notifications received 42 Very slight cases 29 Died in Institutions (intercurrent disease) Sight of one eye damaged — Recovered 42 Occurred in Institutions 1 Occurred in the practice of medical practitioners 4 Occurred in the practice of midwives 37 Admitted to hospital as in-patients 4 Treated as hospital out-patients 4 Treated privately 34 Visited by nurse 14 ZYMOTIC ENTERITIS. Notifiable June—September. (Whole Borough). Notifications received 117 Under 1 year (see feeding below) 51 1 to 2 years 29 2 to 3 years 16 3 to 4 years 10 4 to 5 years 11 Died before notification received 5 Visited 112 Admitted to, or occurred in, hospitals 14 141 Of the 51 cases of Zymotic Enteritis under 1 year of age which were notified, 9 died. All hand-fed. The remaining 42 were fed as follows:— Breast-fed, 25; mixed feeding, 6; hand-fed, 11. 5 children under 1 year of age died before notifications were received, and of this number all 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 1s. 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 1930:— (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 9 3 2 14 - Visits 228 78 25 — 331 Measles Cases Under 5 29 45 74 — 5-10 11 10 1 22 — Visits Under 5 421 640 1061 5-10 127 156 7 — 290 Pneumonia Cases Under 5 18 26 2 46 — 5-10 4 3 7 — Visits Under 5 358 370 21 749 5-10 84 71 — — 155 Pemphigus Cases 1 — — 1 Visits 35 — — — 35 WhoopingCough Cases under 5 1 — — 1 — Visits under 5 7 — — — 7 Puerperal Pyrexia Cases — 1 — 1 — Visits — 4 — — 4 Totals Cases 73 88 5 166 — Visits 1260 1319 35 2632 142 The following table relates to visited children of ages 1 to 5 years:— Year of Birth. 1925 1026. 1927. 1928. Remaining under supervision: End of first year — — — 2,638 ,, second year — — 2,544 — ,, third year — 2,572 — — ,, fourth year 2,601 — — — Inward Transfers 23 67 74 66 Visits discontinued — 2 3 4 Outward Transfers 154 152 186 205 Died 9 18 19 65 Remaining under supervision: End of second year — — — 2,430 ,, third year — — 2,410 — ,, fourth year — 2,467 — — ,, fifth year 2 ,461 — — — Mortality per 1,000 visited: Second year — — — 24. (22.) Third year — — 7.2 (7.4) — Fourth year — 6.8 (6.1) — — Fifth year 3.4 (5.6) — — — The figures in parentheses are the rates for the previous years. CO-OPERATION WITH THE EDUCATION AUTHORITY. 2,461 case sheets relating to the children who have reached the age of 5 years were forwarded to the Education Department. Maternity Wards, St. Andrew's Hospital.—74 mothers were confined in the Council's Ward at St. Andrew's Hospital. The small number shows that we have not enough mothers to fill a ward of 12 beds at the higher assessment. The mothers who have been confined in the Maternity Block were most appreciative of the kindness and attention they received. 143 Compensation to Midwives.-Compensation has been paid to midwives in respect of 17 cases sent by them to the Ante-Natal Clinics which on the advice of the Clinic Medical Officer were transferred to maternity hospitals for confinement. Assistance in paying midwives' fees.—The Maternity and Child Welfare Committee agreed to pay part of the midwives' fees in 6 necessitous cases. Of these 5 were paid, and 1 was cancelled. Maternal mortality.-The investigation into all deaths associated with childbirth, which was referred to in the 1929 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. There were 4 maternal deaths registered, according to the information supplied by the Registrar-General, representing a mortality rate of 1.31 per 1,000 live births, as against 10 in 1929, with a rate of 3.26. Puerperal Sepsis was given as the cause of death in each instance. Two of the 4 cases were first pregnancies. Only 1 of the patients had received ante-natal treatment, and that at an Institution outside the Borough. Death Certificates. (1) Puerperal Septicaemia, Contracted Pelvis, Induction of Labour, Prolonged Labour. (2) Puerperal Septicaemia. (3) Septicaemia, due to miscarriage. (P .M.) (4) Puerperal Peritonitis, Septic Endometritis. (Full term labour.) Infant Mortality.—The infantile mortality rate, 55, is the lowest recorded in the Borough. Observation Wards.—A number of our clinic babies whose alimentary system became disorganised have spent a profitable time in the wards. No matter how severe the disturbance, it is a joy to see them change 144 from puny, dyspeptic infants to jolly, smiling babies. The array of cots outside the Wards when weather permits is an object lesson to the mothers attending the various clinics at Wellington Road. Student Health Visitors.—The College of Nursing continued to send Student Health Visitors and Public Health Workers from overseas for practical experience in the clinics and on the district. The whole of the Maternity and Child Welfare Scheme was explained to them from the Ante-Natal Clinic to the transference of the child's history sheet at 5 years of age to the Education Authority. In addition opportunities of seeing some of the general work of the Public Health Department were afforded. Changes in Staff.—For the first time for several years we have had changes in the health visiting staff. We were very sorry to part with Miss Landray, who became lady Sanitary Inspector, and Miss Paice and Miss Craigie who have taken other appointments. Post Graduate Refresher Course for Health Visitors, etc.—With the approval of the Ministry of Health, two of the Health Visitors (Miss Mallett and Mrs. Haythornthwaite) were granted permission to attend the "Ninth Winter School for Health Visitors," held in London from 30th December, 1929, to 10th January, 1930. Day Nursery-There have been no developments regarding the proposed establishment of a Day Nursery by a Voluntary Association. THE OBSERVATION WARDS, WELLINGTON ROAD. Report of Dr. H. St. H. Vertue, Consulting Physician at the Maternity and Child Welfare Observation Wards. Both In-Patients and Out-Patients are treated at the Observation Wards. Clinics are held every Friday, and the children in the Wards are kept under close observation by numerous visits. In-Patients.—The number of cases admitted this year is greater than was the case last year, and the results have been equally satisfactory.- 145 There were 50 admissions, comprising the following kinds of case:— Dyspepsia and Malnutrition due to Difficulty in Artificial Feeding 20 Malnutrition due to Faulty Environment 17 Rickets 6 Food Refusal 2 Coeliac Disease 2 Cretinism 1 Nervous Unrest 1 Pyloric Stenosis x 50 Difficulty in artificial feeding is always the most frequent cause for admission. Sometimes it is due to mistakes in feeding on the part of the mother, which have temporarily spoilt the child's power of digestion, sometimes to a constitutional inability to digest foods like cow's milk or a dried milk, which are suitable to most infants. A quicker result is obtained by admitting the child to the Observation Wards than by treating it as an Out-Patient. The method of procedure is, in the first place, to give a rest to the child's digestion, which has usually been overworked. During this stage enough has been learnt about its peculiarities to give an idea as to what kind of food it would be likely to thrive on. As soon as a suitable diet has been found the child is kept on it until it has put on plenty of weight and become thoroughly strong and well. Attention then has to be paid to the question whether the food is suitable for preparation at home; if it is not a further change in the now strong and thriving child can be carried out safely. When the child goes home it is in a thoroughly healthy condition, with a good digestion, able to manage a simple feed which the mother can easily prepare. Among the older children the commonest diagnosis is Malnutrition due to Faulty Environment. Lack of fresh air, lack of sunshine, inadequate or ill-chosen food are common faults from which they suffer. In the Observation Wards these faults can be readily corrected. The children are put on a generous but easily digestible diet, with addition of cod-liver oil, or anything else that may be necessary. They are kept out of doors as much as possible, and are treated in the Light Department. The six cases of Rickets are allied to these, since this disease is due to 146 lack of light and air, or to poverty of food, or to both. Very good results are obtained with these children in a very short space of time. The most striking features are a very rapid gain in weight, a great increase in vigour, and a complete change in the child's appearance. The results obtained in the cases admitted this year have been as follows:— Recovery 40 Improvement 6 Transferred to Hospital 3 Removed by Parents 1 50 A number of the old patients were inspected afterwards. The results shew that once the children had been given a start in the Ward the mothers were thoroughly successful in maintaining their good condition. This, of course, is the result we hope to get; it is very creditable to the mothers that they managed to achieve it. In Excellent Health and Condition 10 In Good Health and Condition 5 In Fair Health 2 17 Out-Patients Number of New Out-Patients 61 Number of Attendances at Special Clinic 277 Attendances for Test Feeds 404 Much of the work in the Out-Patients' Department consists in assisting and encouraging the natural feeding of infants. Difficulties in breast-feeding were the chief cause for attendance:— Difficulty in Breast Feeding 43 Difficulty in Artificial Feeding 6 49 147 Whenever possible a complete return to normal breast-feeding is achieved. If this cannot be done the child is given as much breast-milk as can be obtained, supplemented by other food according to its requirements. If this is done accurately, not only does the child make good progress, but the breast-milk is also conserved for a long period. As soon as the amount of milk secreted was found to be stable, and the child was gaining weight well, it was returned to its regular clinic. The number of test feeds indicates the amount of time required to get the desired result. The following shews what results were obtained:— Complete re-establishment of Breast Feeding 20 Partial re-establishment with Correct Supplementary Feeding 18 Failed to complete Attendances 5 43 Single Consultations.—The remaining Out-Patients are made up of cases attending singly, not for treatment, but for a consultation. They form a varied list:— Rickets 5 Deformities 4 Chronic Infections 2 Mental Deficiency 1 12 After being examined these children are sent back to their regular Clinics with suggestions as to diagnosis and treatment. Work of the Staff.—It is a pleasure to be able to record the excellent way in which members of the Staff have carried out their duties. Good nursing is the first essential in the treatment of delicate babies. Keen powers of observation are a necessity in providing the right material for diagnosis. The very successful results obtained in the treatment of these delicate infants at Wellington Road reflects great credit on the Staff. H.ST.H. VERTUE, M.A., M.D. 148 ARTIFICIAL SUNLIGHT TREATMENT. Dr. E. M. Layman, the Medical Officer in charge of Artificial Sunlight Treatment, has submitted the following interesting report:— I have pleasure in submitting my report on Light Treatment at the Bow and Simpsons Road Clinics. 400 children are reported on. 74 others made too few attendances and are not included. I have classified the 400 cases as follows:— Rickets, 71. (а) Severe 29 (б) Slight 24 (c) Muscular 18 Disturbed Dentition, 90. Delayed Dentition, 34. Malnutrition, 59. Debility, 74. For Recovery after Illness, 45. Bronchitis, 16. Adenoids, 5. Others, 6. Results of Treatment:— Rickets. (a) Severe, 29 cases. Success 22 Moderate success 4 Poor attendance 3 (b) Slight, 24 cases. Success 11 Moderate success 9 Poor attendance 4 149 (c) Muscular, r8 cases. Success 11 Moderate Success 6 Poor Attendance 1 Disturbed Dentition, go cases. Success 55 Moderate Success 27 Poor Attendance 8 Delayed Dentition, 34 cases. Success 24 Moderate Success 7 Poor Attendance 3 Malnutrition, 59 cases. Success 37 Moderate success 10 Failures 7 Poor Attendance 5 Debility, 74 cases. Success 36 Moderate Success 23 Failures 7 Poor attendance 8 For Recovery after Illness, 45 cases. Success 34 Moderate Success 8 Poor Attendance 3 Bronchitis, 16 cases. Success 9 Moderate Success 6 Poor Attendance 1 Adenoids, 5 cases. Success 1 Failures 2 Poor Attendance 2 Others, 6 cases. Success 4 Moderate Success 1 Poor Attendance 1 150 Of the 244 successes recorded, 61 per cent., there were 52 marked successes. This result alone is a great encouragement to those who see the change taking place in the patients. Children under 3 years almost invariably respond well, given a long enough course and regular attendance. Failure, or a disappointing response, in spite of diligent attendance, nearly always occurs in older children. Many of these have worms, and light treatment is disappointing until thorough removal of the worms has been carried out. I have repeatedly noted a marked improvement in weight and wellbeing as soon as the child is free from worms, and this is maintained under light treatment . Were it not for the prevalence of worms among elder children, we should have almost uniformly successful results with these; as it is, some sufferers from worms drift away before they have time to do well. 40 Mothers were treated. I have classified them as follows:— Debility 23 Rheumatism 6 Lactating 7 (one showed increased milk supply) Pregnant 4 Results of treatment (General Health and Spirits):— Success 18 Moderate Success 13 Poor Attendance 9 I am now well used to Sister's excellent management and individual attention. They are certainly appreciated by all concerned. E. M. LAYMAN. Statistical Summary. January 1st to December 31 st, 1930. Bow. Poplar. Totals. Number of attendances 5.596 4,024 9,620 ,, ,, sessions 286 239 525 ,, ,, patients 311 274 585 151 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 the work carried out at the Maternity and Child Welfare Dental Clinic for the year 1930. Our figures in many instances show a slight increase, and, in general, we have kept well up to average. The work has been spread over a greater number of sessions in 1930, on account of postponing those sessions normally falling on public holidays to more suitable dates. 77 Sessions have been held, at which 1,097 Attendances have been made. An average of over 14 patients per session throughout the year is, I think you will agree, very gratifying. 2,419 Diseased teeth have been removed, 116 with local anaesthesia, 1,384 permanent teeth and 919 temporary teeth under gas. This shows an increase of over 500 teeth on the previous year. 85 Fillings have been inserted, a slight increase, but this is a form of treatment not very popular with our type of patient. 147 Scalings have been carried out, and probably more could be done of this necessary treatment if time permitted. 323 New patients have reported, the same number as the previous year. In addition dentures have been made and inserted, the actual numbers of which I have not available. A point which is becoming most marked is the few children's mouths needing wholesale extractions. Only a few years ago it was customary to have to remove as man}' as 10 or 12 temporary teeth from children under school age. Now such drastic treatment is not often necessary, the number of extractions varying between four and six teeth in the 152 majority of cases. This is an excellent sign, definite proof, surely, of the points of personal advice and propaganda on the questions of diet and the care of the teeth. In the adult patients oral sepsis is still rife, though it is gratifying to note a marked desire on the patient's part to get rid of teeth which can and do constitute a menace to general health. Our equipment is well maintained and in good condition, and our excellent premises are a great help in the efficient working of the Clinic. May I take this opportunity again of thanking the staff with whom I come in contact for their generous help and keenness. C. HAMMOND WILLIAMS, L.D.S., R.C.S. (Eng.). THE ROYAL COLLEGE OF ST. KATHARINE. Report of the Senior Medical Officer. The Dental Department here was the first in this country to be started as an essential part of the equipment of an Infant Welfare Centre. The good effects on the women's powers of lactation, due to the improvement in health after efficient dentistry, were quickly seen. Some account of the work was published and attracted notice, and since then arrangements for dental treatment at Infant Welfare Clinics have become general. When the work was started, the advice to attend the Department was received with surprise and often with real scepticism, for the women had become accustomed to the state of their mouths and to the various stages of caries, dental abscesses, broken crowns and so forth. It seemed that they had accustomed themselves also to the suffering this state of things entails. At any rate they had not noticed the decline in their health which goes with it, or, if they had, the connection had not been realised. Many were very timid about undergoing extractions, particularly at taking nitrous oxide. But after 16 years work the refusals are few by comparison. When pain has been severe or of long standing, we see sometimes quite remarkable changes due to the relief from sleeplessness, irritability 153 and nervous exhaustion. Moreover, a common result of toothache is that the sufferer stays indoors to avoid the contact of cold air on the face. Extraction thus effects a radical change of habit, and one that greatly benefits the baby as well as the mother. When the operation results in clearing up a source of chronic sepsis the main benefits are seen in improved appetite and digestion, and a gain in strength, vigour and weight. A great change in the complexion is also often seen. Improvement in the quality and quantity of the milk has been mentioned. In certain instances the milk of women suffering from gross dental sepsis may contain large numbers of micro-organisms— streptococci and even B. coli have been identified. As soon as these findings were established, the treatment was recommended to women attending the Ante-natal Department. For clearly it must be an advantage to obtain a healthy state of the mouth as early as possible in pregnancy. But here the response has not been so good. Pregnancy is claimed as an excuse for postponement, though we urge strongly it is a reason for not admitting delay. Unfortunately the plea to put off treatment until after delivery seems still to receive a certain amount of support from both doctors and midwives and sometimes from dentists. One fancies it is partly out of sympathy with the woman, who is felt to be sufficiently burdened. There is also in some minds a vague feeling of apprehension that extraction may provoke the onset of premature labour. In many hundreds of operations here on pregnant women we have never once known this happen, no matter at what stage of pregnancy the operation has been performed. (On the other hand, we have reason to know that extractions have been applied for in the hope that pregnancy would thereby be terminated, and quite candid expressions of disappointment at its failure have followed!) A few troublesome instances of bleeding have occurred and we now give a mixture containing Calcium Lactate to be taken for three days before the operation is performed, and are very satisfied with the results.* When it is considered how really severe is the condition of sepsis which the mouth often harbours, it is strange that greater insistence is not laid on its eradication before childbirth. At present this policy seems the exception rather than the rule, and we still have to combat a great deal of popular prejudice in carrying it out. There is little appreciation that dental sepsis and puerperal sepsis may be connected with each other, * The formula for the prescription is: Acidi Lacfc. Cone. grs. 200. Calcii Garb. ppt. grs. 75. Aq. Chloroform 8 ozs. 1 Tablespoonful twice daily. 3 ozs. of this mixture is supplied to each patient—the cost is 3d. 154 yet a sudden "flare up" of a dental abscess is a formidable occurrence in a puerperal woman. We see a number of cases of acute mastitis where this has been a direct antecedent, and believe the two conditions are often closely associated. Even if infection does not take place through the blood stream, an obvious method of spread is by the direct transmission of pus on the fingers from the mouth to the nipple. If every patient making application for admission to a lying-in institution were referred automatically after the first examination to the dental department, the whole subject would soon assume a different importance in the public mind. It may be hazarded that there would soon be a considerable lessening in the number of cases of puerperal sepsis at present called autogenous, but in which the infecting focus remains unidentified. H. K. WALLER, Senior Medical Officer. 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 53 weeks ended 3rd January, 1931, 7,216 applications for free milk were received, of which 6,693 were granted. (The number of persons granted milk was 9,271.) Orders were issued for 28,247 pints of Grade "A" (Tuberculin Tested) milk, and 33,147 pounds of Dried Milk, the total commitments amounting to approximately £2,820. Six hundred and ten (610) cases were investigated by the Enquiry Officer, and with two exceptions were reported satisfactory. The unsatisfactory cases were reported to the Maternity and Child Welfare Committee. 155 "A." "G." lbs. lbs. Dried Milk distributed at Clinics (including the Royal College of St. Katharine) 21,341 725 Distributed by Office Staff 8,686 — Total 30,027 725 A revised scale was approved by the Ministry of Health in January, 1930, and put into operation on 3rd February, 1930. Number of applications 13 ,, individuals represented 19 Individuals granted milk with medical certificate 15 Individuals granted milk without medical certificate Nil. Individuals refused milk on report of Clinic Medical Officer or Health Visitor 4 The following table shows in comparative form the applications, etc., during the years 1920-30:— Year. Applications. Applications granted. Cost (approx) £ Orders issued. Cases investigated by I.O. (6). Unsatisfactory cases. fresh. Pints). Dried. (Lbs.). 1920 (a) ? 17,095 ? 873,585 3,454 - - 1921 (c) 23,799 18,270 14,500 782,012 1,236 1,611 107 1922 18,082 16,215 8,500 621,796 1,664 2,969 15 1923 15,537 14,086 6,600 512,614 3,230 2,974 34 1924 14,828 13,597 6,150 487,070 4,902 2,922 14 1925 12,475 11,358 4,994 410,587 3,727 1,633 9 1926 12,928 11,905 7,249 426,762 2,917 593 6 1927 11,702 11,117 5,961 294,515 16,896 598 10 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 — 1930 7,216 6,693 2,820 28,247 33,147 610 2 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. AMBULANCE FOR MATERNITY CASES. Negotiations were opened with the London County Council, and towards the end of the year, although no definite agreement had been reached, it was hoped, within a month or two, to have a definite agreement. 156 INDEX. Page Age Mortality 18 Altered Diagnosis Cases 102 Analyst's Report 83 Anthrax 98 Antitoxin, quantity issued 89 Area and Population 10 Artificial Sunlight Treatment 148 liacteriological Examinations 90 Bakehouses 69 Births 10 Bye laws, etc., in force 27 Canal Boats 46 Cancer 103 Cerebro-spinal Fever 99 Cleansing of Verminous Persons, etc. 124 Clinics, M. & C.W. 126 Clinics, Tuberculosis 104 Committees 3 Continued and Typhus Fevers 99 Cowhouses 67 Customs and Inland Revenue Acts, Certificates 44 Day Nursery 144 Death Rate amongst Infants Visited 15 Deaths and Death Rates 11-18 Deaths, Classified Causes, Table Facing 12 and 13 ,, Infantile, Table 14 Dentist's Reports 112, 151 Diarrhoea and Enteritis, Deaths 18 Diphtheria 88 Disinfectant, Electrolytic 119 Disinfecting Department 118 Electrolytic Disinfecting Fluid 119 Encephalitis Lethargica 100 Enteric Fever 89 Erysipelas 99 Export of Meat Foods 75 Factory and Workshops Acts—Tables 36-42 Food, Supervision of 67 Food and Drugs Acts, etc. 76 Food Inspectors'Reports 71.75 Free Milk Scheme 154 Glanders 98 Hairdressers'Premises 45 Health Visitor, Chief, Report of 132 Home Nursing 141 Houses Let in Lodgings 35 Housing 57 Hydrophobia 98 Ice Cream 69 Infantile Mortality 14, 15 Infectious Diseases, Table of Notifications Facing 84 Inquests and Deaths from Violence 21 157 INDEX—(con tinned). Page Lady Sanitary Inspector, Report 34 Lectures on Health Subjects 54 Legal Proceedings, etc. 47 Marriages 11 Maternal Mortality '43 Maternity and Child Welfare 126 Maternity Wards in St. Andrew's Hospital 142 Measles 101 Meat Food Products, Certification 76 Milk (Special Designations) Order 1923 68 Milkshops, etc. 67 Mortuary 22 Notification of Births Act 11 Notifications of Infectious Diseases, Table Facing 84 Observation Wards 144 Offensive Trades 36 Ophthalmia Neonatorum 103,139 Overcrowding 45 Plague 98 Pneumonia 101 Poliomyelitis, etc. 100 Poor Law Relief, etc. 26 Population 10 Post-vaccinal Encephalitis, eto. 101 Public Education in Health 54 Puerperal Fever and Puerperal Pyrexia 99 Rag and Bone Dealer 43 Rag Flock Act. 46 Rats and Mice Destruction Act . 45 Reports:— Artificial Sunlight Clinics, Medical Officer 148 Chief Health Visitor 132 Dental Surgeon (M. & C.W.) 151 Dental Surgeon (Tuberculosis) 112 Lecturer on Health Subjects 54 Observation Wards, Consulting Physician 144 Public Analyst 83 Royal College of St. Katharine, Senior Medical Officer 152 Schick Clinic, Medical Officer 88 Tuberculosis Officer 104 Sanitary Inspectors' Work, Summaries 34 Scarlet Fever 87 Schick Test 88 Schools, Inspection of 45 ,, Use of Electrolytic Fluid in 124 Slaughterer of Poultry 70 Slaughterhouses 70 Smallpox 90 Smoke Nuisances 43 Stables 44 Staff 4 Stillbirths 139 Street Trading 44 Swimming Baths, Use of Electrolytic Fluid in 124 158 INDEX—(continued). Page Tables A to F (Workshops, etc.) 36-42 „ of Deaths 12-19 ,, of Infectious Diseases Facing 84 Tuberculosis, Death Rate 18 ,, Deaths 18, 118 ,, Officer's Report 104 ,, Regulations, Notifications, etc. 114 Typhoid Fever 89 Unhealthy Areas 63 Urinals on Licensed Premises 44 Vaccination 96 Verminous Children and Persons 124 ,, Rooms 43 Violence, Deaths from 21 Vital Statistics, Summary 9 Table 12-19 Water Certificate 44 Workshops, Workplaces, etc. iTables) 36-42 Zymotic Diseases, Death Rate 18 ,, Enteritis 140