B68 POP 37 Metropolitan Borough Of Poplar. Annual Report FOR THE YEAR 1931 ON The Sanitary Condition and Vital Statistics of the Metropolitan Borough of Poplar. W. ALLAN YOUNG, D.S.O., M.D., Ch.B., D.P.H., Medical Officer of Health. Crusha & Son, Ltd., Tottenham, Enfield and Wood Green. Metropolitan Borough of Poplar. Annual FOR THE YEAR ON The Sanitary Condition and Vital Statistics of the Metropolitan Borough of Poplar. W. ALLAN YOUNG, D.S.O., M.D., Ch.B., D.P.H., Medical Officer of Health. 3 PUBLIC HEALTH COMMITTEE (As at October, 1931). Councillor: T. J. Blacketer, J .P., L .C .C., Mayor (ex-officio). Chairman: Alderman C. A. Tanner. Vice-Chairman: Councillor J. A. Ashley. Ald. Adams, D .M. (L.C.C.) Cllr. Anderson, G. Cllr. Ashley, J.A. (V.Ch.). Cllr. Cressall, Mrs. N. F. Cllr. Easteal, A. E. Cllr. Hammond, J. A. Cllr. Harris, Mrs. A. L. Ald. Lambert, Mrs. E.M. Cllr. Lancaster, Rev. G. H., M.A. Cllr. Sargent, A. R. Cllr. Shepherd, Mrs. A. I. Cllr. Simons, A. Cllr. Sloman, H. W. Cllr. Stavers, Mrs. E. Ald. Tanner, C. A. (Ch.) MATERNITY AND CHILD WELFARE COMMITTEE (As at October, 1931). Councillor: T. J. Blacketer, J .P., L ,C .C., Mayor (ex-officio). Chairman: Cllr. Mrs. E. Stavers. Vice-Chairman: Cllr. Mrs. A. L. Harris. Cllr. Cressall, Mrs. N. F. Cllr. Cressall, G. J., J.P. Cllr. Harris Mrs., A. L. (V.Ch.). Ald. Lambert, Mrs. E.L. Cllr. Mackay, Mrs. J. Cllr. Mudge, Mrs. E. Cllr. Sargent, A. R. Cllr. Shepherd, Mrs. A. I. Cllr. Stavers, Mrs. E. (Ch.). Ald. Tanner, C. A. Co-opted Members: Miss E. Herbert (Roy. Coll. of St. Katharine): Mrs. J. A. March; Mrs. M. Power; Mrs. A. M. Sumner. 4 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.) (Died). G. O. Mitchell, M.D., D.P.H. (from 29th May, 1931). Assistant Medical Officer of Health and Assistant Tuberculosis Officer: C. K. Cullen, M.R.C.S., L.R.C.P., D.P.H. (resigned.). L. D. Richards, M.R.C.S., L.R.C.P., D.P.H. (from 1st October.) Temporary Assistant to Medical Officer of Health: H. D. Chalke, M.A. (Camb ), M.R.C.S., L.R.C.P., D.P.H. (Appointment terminated 9th July.) Public Analyst: ALBERT E. PARKES, F.I.C., F.C.S. GENERAL PUBLIC HEALTH SECTION, PUBLIC HEALTH OFFICE. Chief Clerk and Administrative Assistant: HAROLD DYER.† Sanitary Inspectors: (a) H. A. Tibbatts.* (a) S. Kelly.* (c) H. W. Luke.†† (a) J. Johnson.*§ (Died) (a) F. A. Smith.*‡ A. H. T. Harris†† C. H. Brown.*†† § Miss D. A. E. (Temporary to 27th (a) W. J. Colborne†† Landkay.¶*††|| June) (a) H. J. Langley.* (a) A. L. Dove. ††‡ (d) E. A. MAY†† (a) C. S. Westbrook.*‡ (b) C. A. Grabham.*‡ (d) G. L. BELSHAw††‡ (a) Wm. Johnson.*‡ (b) H. A. Pearce.*†§‡ (a) District Inspectors. (b) Food Inspectors. (c) Inspector for Houses divided into separate tenements. (d) Housing Survey Inspectors. J. Chapman, A. Collyer, W. Cue††, C. F. Gregory, E. Willson, W. G. F. Colebeck (District Inspectors' Assistants). C. A. Webster (part-time unqualified Assistant to assist the Food Inspectors). H. Harbott (Chauffeur). Clerks: F. J. White.* H. A. Purdy (retired). D. Flynn. W. F. Roberts. Miss S. Fells. F. Petts (Transferred) A. Hamilton.†† J. T. Donovan S. B. Leader. E. W. Garrett. Mrs. E. Long. W. G. Barnett (Temporary) Caretaker and Messenger: C. E. Richardson Vaccination Officer: Asst. Vaccination Officer: P. Ryan. W. H. Cox (Retired). Public Vaccinators. 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, tt Cert. R.S.I. & S.I.E.J.B. † Cert. Meat and Food Inspector. § R.P.C. ¶ C.M B. || H.V. Cert. (Board of Education). †† 3 years' General Nursing Certificate. 5 TUBERCULOSIS SECTION. Assistant Medical Officer of Health and Tuberculosis Officer: W. C. P. Smith (Died). G. O. Mitchell (from 29th May). Assistant Medical Officer of Health and Assistant Tuberculosis Officer: C. K. Cullen (Resigned). L. D. Richards (from 1st October). Temporary Assistant: M. A. Hatt, B.M., M.Ch. (Oxford) (6th July to 30th September.) Dental Surgeon (part-time): C. Hammond Williams, L.D.S., R.C.S. Health Visitors: Miss H. Messem. Miss D. Wood.‡ Miss N. Roberts.** Dispenser: Mrs. a. M. Smith (Died). Mrs. F. E. Smith (from 6th July). 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. Hodge‡ (Chief). A. Barrows. There are also two Apparatus Attendants and one Motor Driver. Manufacture and Distribution of Electrolytic Disinfecting Fluid. Manufacturing: T. Kelleher and C. W. Shaw. Distributing at Depots: W. Hagon, D. Hogan and J. Hurley. 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 (Retired). D. Hogan (from 17th November). 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.) (Resigned). Miss Margaret B. Mackay, M.B., Ch.B. (Edin.), D.P.H. (Eng. •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.). † San. Insp. Cert. R.S.I. ** H.V. Cert. R.S.l. 6 Chief Health Visitor: Miss J. M. Cardozo, R.R.C.*¶†† Health Visitors: Miss E. A. Foskett.*¶ Mrs. M. J. Edgell.§¶ Miss M. Mallett.* Mrs. E. K. Haythobnthwaite.*¶ (c) Miss g. I. Hill*¶ (c) Miss B. E. Letts*¶ (c) Miss M. H. Stttcliepe*¶† (c) Miss E. A. H. Williams.*¶ Miss A. Eaton*† Sister-in-Charge Artificial Light Treatment. Clerk: Miss K. D. Evans. Observation Wards. Wellington Road, Bow, E.3. (Opened 11th November, 1927.) Consulting Physician: H. St. H. Vertue, M.A., M.D., Ch.B. (Oxford.) Emergency Medical Officer: D. G. Macrae, M.R.C.S. (Eng.), L.R.C.P. (Lond.) Matron-in-Charge: Miss A. C. Andrews.*¶ Sister: Miss J. Boone. Two Staff Nurses, three Probationers, one Cook, one Maid and a Porter. Free Milk Scheme. Clerks: Miss I. Collen. Miss K. Phelan. Miss C. Rudd. Investigation and Enquiry Officer (part-time): C. A. Webster. *O.M.B. †Cert. S.I.E.B. § Cert. Mid. Colonial Medical Association. ¶Three Years' General Nursing Certificate. ††Fully Trained at Children's Hospital. (c) New H.V. Certificate. 7 Public Health Office, Bow Road, E.3. 18th April, 1932. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar. Mr. Mayor, Ladies and Gentlemen, I beg to submit my Report upon the health of the Metropolitan Borough of Poplar for the year 1931. Statistics.—In the Preliminary Report of the Census of 1931 issued by the Registrar-General the population of the Borough is given as 155,083, a decrease of 7,495 or 4.6 per cent. on the figure for 1921. The Registrar-General's estimated population for the year 1931 is 156,300, and on this figure all rates per 1,000 of the population are calculated. The only rates which have varied to any extent from those of the previous year are the birth-rate and the notification of infectious disease rate, which were 17.5 and 18.9 respectively. Infectious Disease.—Beyond a slight rise in the incidence of Pneumonia and a substantial decrease in the notifications of Smallpox, Diphtheria and Scarlet Fever, there is nothing of special interest to record. Housing and Overcrowding.—During the year considerable progress was made. The Council proceeded with two "Clearance" areas and others are receiving consideration. Preliminary investigations of two of these latter areas were completed by officers of this Department. A summary of this work is given in Section IV of this Report. A good deal of time has been spent in investigating complaints and endeavouring either to abate the nuisance or mitigate the conditions arising from overcrowding. Maternity and Child Welfare.—The attendances at Clinics (both the Councils' and those of the Royal College of St. Katharine) continue to increase, and this is particularly noticeable in the "toddler" class of children. 8 The work at the Ante-natal Clinics has also increased during the year, and it is gratifying to record the increasing co-operation between midwives practising in the Borough and the staff of these clinics. The facilities afforded to clinic medical officers in charge of ante-natal clinics for referring abnormal cases to the Consultant at St. Andrew's Hospital are much appreciated. The co-operation between the officers of the Ante-natal Clinics and the officers in charge of the Maternity Wards at St. Andrew's Hospital is also maintained by the arrangements which exist for referring to St. Andrew's Hospital all cases intending to go there for confinement. Conferences.—During the year the Council appointed delegates to attend the following conferences: Royal Sanitary Institute; Sanitary Inspectors' Association; National Association for the Prevention of Infantile Mortality; National Association for the Prevention of Tuberculosis ; and the Central Council for Health Education. Survey.—The survey of the Council's public health services, which was carried out by a medical officer of the Ministry of Health, concluded during the year, and certain points which were raised as a result of the survey are referred to on page 19. I desire to thank the Members of the Council for the interest they have shown in the work of the Department, the officers of other Departments for their assistance and co-operation, and the members of my staff for the manner in which they have carried out their duties during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. ALLAN YOUNG, Medical Officer of Health. 9 Section I. NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. Area of Borough (excluding water) 2,136 acres Population (Census, 1931) unrevised figure 155,083 Population, Estimated Resident—mid 1931 (Reg.-General) 156,300 Number of Inhabited Houses (end of 1931) according to Rate Books 23,222 Rateable Value (October, 1931) £745,825 Sum represented by a Penny Rate (April, 1931) £2,892 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 2,674 1,330 1,3441 Birth Rate 17.5 per 1,000 of the estimated resident population. Illegitimate 65 41 24 Totals 2.739 1,371 1,368 Still Births 92 53 39 Rate per 1,000, total (live and still births) 32.5. Total M. F. Deaths 1,942 1,035 907 Death Rate 12.4 per 1,000 estimated resident population. 10 Deaths from diseases and accidents of pregnancy and childbirth* from sepsis 4 from other causes 3 *Note.—The Registrar-General's classification shows 3 deaths from Sepsis and 4 from other causes. It would appear that the RegistrarGeneral has excluded from the Sepsis group a death from General Peritonitis following Caesarean section for Contracted Pelvis. Death Rate of Infants under one year of age:— All infants, per 1,000 live births 77 Legitimate infants, per 1,000 legitimate live births 75 Illegitimate infants, per 1,000 illegitimate live births 138 Deaths from Measles (all ages) 9 ,, Whooping Cough (all ages) 19 ,, Diarrhoea and Enteritis (under 2 years of age) 20 The slight rise in the death rate for 1931 is due to the increase in the number of deaths from respiratory diseases, particularly marked in Bronchitis and Pneumonia and affecting in the main the later age groups. Area and Population. The area of the Borough is 2,136 acres, and the population, estimated to the middle of 1931 by the Registrar-General, was 156,3000. The population of 156,300 gives a density figure of 73 persons per acre. Births. Early in the year 1932, the Registrar-General supplied the following information relating to Births registered in the year 1931. Registered Inward Transfers. Outward Transfers. Nett. Total Births Males 1,084 313 26 1,371 2,739 Females 1,083 315 30 1,368 Illegitimate Males 35 9 3 41 65 Females 19 7 2 24 The corrected birth rate per 1,000 population was 17.5, as against 21.6, 19.8, 19.9, 19.1 and 19.1 for the years 1926-1930. 11 During the year 2,212 notifications were received under the Notification of Births Act, 1907. The following Table shows where the births in 1931 occurred:— At Home: 1. Attended by Doctors 14.8 per cent. 58.3 per cent. 2. Attended by Midwives 43.5 per cent. In Institutions: (a) In the Borough: 41.7 per cent. St. Andrew's Hospital 19.2 per cent. (b). Outside the Borough: 1. East End Maternity Hospital 18.2 per cent. 22.5 2. Other Institutions 4.3 per cent. 100 Marriages. During the year the marriages of 2,962 persons were registered, giving a rate of 18.9, as against 15.8, 17.5, 17.8, 17.8 and 18.4 in the five years 1926-1930. Deaths. 1,872 deaths were registered as having occurred in the Borough. 259 deaths of non-residents must be deducted, and 332 deaths of Poplar residents which occurred outside the Borough must be added, giving a net total of 1,945 and a rate of 12.4 per 1,000 of the estimated population. The Registrar-General's table shows a total of 1,942 deaths, but this does not affect the rate of 12.4 The natural increase of population represented by excess of births over deaths was 797. 12 Deaths during 1931 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 154 78 58 84 374 Bow and Bromley Sub-District 128 69 36 74 307 St. Andrew's Hospital 259 170 142 205 776 Poplar Institution 53 32 17 28 130 Bow Institution 62 23 20 35 140 Bromley House Institution 1 I — 1 3 Poplar Hospital 33 31 26 18 108 River Thames 1 3 2 3 9 ,, Lee — 1 1 — 2 Limehouse Cut — — — — — Bow Creek — — — — — Regents Canal — — — — — East India Docks 1 — — — 1 West India Docks — — 1 — 1 South-West India Docks — — — — — Millwall Docks — 1 1 1 3 Poplar Docks — 1 — — 1 Highways 5 1 5 2 13 Miscellaneous: (places of Employment ,etc) — — 1 3 4 697 411 310 454 1,872 Deaths occurring outside the Borough, of persons belonging thereto (add) 96 82 73 81 332 Deaths occurring within the Borough, of persons not belonging thereto (deduct) 9i 57 56 55 259 Deaths at all ages—nett 702 436 327 480 1,945 Principal Causes Of Death 1931 (.Registrar-General's Classification) Total Deaths during the year-1942-Males 1035: Females 907. Note: Percentage of deaths occurring in public Institutions-62.7 The following table, compiled and furnished by the Registrar-General, is inserted the request of the Ministry of Health (vide Circular 1,206 (England)). Causes of Death. Sex. All Ages 0— 1 — 2— 5— 15— 25— 35— 45— 55 — 65— 75— All Causes M 1035 114 27 25 27 39 51 62 132 180 214 164 F 907 97 30 14 17 51 30 54 81 121 207 205 1 Typhoid and paratyphoid fevers M — — — — — — — — — — — — F — — — — — — — — — — — — 2 Measles M 6 1 2 2 — — — — — — — — F 3 1 1 1 — — — — — — — — 3 Scarlet fever M — — — — — — — — — — — — F 3 — 1 2 — — — 4 Whooping cough M 7 2 4 1 — — — — — — — — F 12 6 5 1 — — — — — — — — 5 Diphtheria M 7 2 — 3 2 — — — — — — — F 4 1 1 1 — — — 1 — — 6 Influenza M 13 — 1 — — — 3 2 4 1 1 1 F 10 1 — — 1 1 — 3 3 1 7 Encephalitis lethargica M 3 — — — — 2 — — 1 — — — F 1 — — — — — — 1 — — — — 8 Cerebro-spinal fever M 4 2 2 — — — — — — — — — F 1 1 — — — — — — — 9 Tuberculosis of respiratory system M 96 2 — — — 13 19 20 24 15 3 F 56 1 — — 1 24 10 12 3 5 — — 10 Other tuberculous diseases M 11 2 2 1 1 1 1 3 — F 7 — — 2 1 2 1 1 — — 11 Syphilis M 1 — — 1 — — — — F 4 2 — — — 1 1 — — 12 General paralysis of the insane, tabes dorsalis M 6 — — — — — — 1 4 — 1 — F — — — — — — — — 13 Cancer, malignant disease M 121 1 — — 1 1 1 6 19 33 51 8 F 100 — — — — — 4 11 19 22 31 13 14 Diabetes M 1 — — — — — — 1 — — F 15 — — — — — — — 3 5 7 — 15 Cerebral haemorrhage, etc. M 23 — — — — — 1 — 3 6 8 5 F 31 — — — — — — 2 5 6 16 2 16 Heart disease M 229 — — — 6 1 1 4 19 36 74 88 F 248 — — — 3 9 3 7 14 28 79 105 17 Aneurysm M 6 1 — — — — 1 3 1 F 2 — — — — — 1 — — — 1 — 18 Other circulatory d iseases M 33 — — — — — — — 2 6 12 13 F 25 — — — — — 5 15 5 19 Bronchitis M 58 10 — — — — 1 4 6 14 13 10 F 64 12 2 — — — 1 — 3 5 15 26 20 Pneumonia (all forms) M 116 27 12 7 — 4 3 9 17 14 11 12 F 94 18 14 4 1 3 1 7 10 12 9 15 21 Other respiratory d iseases M 11 1 1 — — — — — 5 4 — — F 10 — — — — — — — 2 1 1 6 22 Peptic ulcer M 17 — — — — 1 1 —_ 4 8 3 — F 6 — — — — 1 — — 3 1 1 23 Diarrhoea, etc. M 8 6 — 1 — — — 1 — F 17 12 2 1 2 — — — — — 24 Appendicitis M 5 — — 1 2 2 — — F 8 — — 1 — 3 1 1 1 1 — 25 Cirrhosis of liver M 4 — — — — — — — — 2 2 — F 2 — — — 1 — 1 — 26 Otherdiseases of liver, etc. M 1 — — — — — — — — — 1 — F 3 — — — — — — — 1 1 1 — 27 Other digestive d iseases M 21 4 1 1 — 2 4 2 5 2 — F 18 1 1 1 — — 3 2 5 2 3 28 Acute and chronic nephritis M 27 — 1 — 3 2 — 3 11 5 2 F 25 — — — 2 1 2 2 6 8 4 29 Puerperal sepsis F 3 — — — — — 1 2 — — 30 Other puerperal causes F 4 — — — — 1 2 1 — — — 31 Congenital debility, premature birth, malformations, etc. M 45 44 — — — — — — — — — — F 31 31 — — — — — — — — — — 32 Senility M 11 — — — — — — 3 8 F 15 — — — — — — — — — 1 14 33 Suicide M 10 — — — — 1 3 3 2 1 F 3 — — — — 1 2 — — 34 Other violence M 58 3 3 7 4 13 5 4 7 7 5 F 13 3 1 1 — — — 1 3 4 35 Other defined diseases M 75 6 2 3 6 4 4 7 8 11 13 11 F 68 7 2 2 5 5 4 2 10 12 13 6 36 Causes ill-defined or unknown M 1 — — — 1 — — — F 1 — 1 — — — — — — — — — Legit. Iliegit. Deaths under 1 year M 108 6 F. 94 3 Totals 202 9 13 TABLE III. Infantile Mortality during the Year 1931. 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 48 12 9 5 74 43 39 31 24 105 106 211 Uncertified — — — — — — — — — — — — Smallpox — — — — — — — — — — — — Chickenpox — — — — — — — 1 — — 1 1 Measles — — — — — — — — — — 2 2 Scarlet Fever — — — — — —- — — — — — — Whooping Cough — — — — — 4 3 — 1 3 5 8 Diphtheria and Croup — — — — — — — — — 2 1 3 Erysipelas — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — 1 — 1 — 1 Abdominal Tuberculosis — — — — — — 1 — — — 1 1 Other Tuberculous Diseases — — — — — 1 — 2 — 2 1 3 Meningitis (not Tuberculous) — — 1 — 1 — 1 1 1 1 3 4 Convulsions 1 1 — — 1 — 1 Bronchitis — 1 — 1 2 5 6 1 9 5 14 Pneumonia (all forms) — 1 2 1 4 5 11 14 11 25 20 45 Diarrliceal Diseases — 1 — — 1 4 4 6 5 9 11 20 Gastritis — — — — — — — Syphilid — — — — — — — — — 2 — 2 Rickets — — — — — — — — — — — — Suffocation, overlying 1 — — — — — — — — — 1 1 Injury at birth 1 — — — 1 — 1 — 1 1 2 Atelectasis 1 1 — — 2 — — — — 1 1 2 Congenital Malformations 5 1 1 1 8 5 2 1 — 10 6 16 Premature birth 26 4 3 — 33 9 — — — 18 24 42 Atrophy, Debility and Marasmus 5 2 1 2 10 2 2 — — — 9 14 Other Causes 8 1 1 — 10 6 5 3 5 15 14 29 Total Deaths 48 12 9 5 74 43 39 31 24 105 106 211 Live Births in the year Legitimate 2.674* illegitimate 65* Nett Deaths in the year Legitimate 202* Illegitimate 9* *Registrar-General's figures. Neo-Natal Death Rate. 1926. 1927. 1928. 1929. 1930. Average 19261930. 1931. Nett Births (Registrar-General) 3,658 3,309 3,228 3,064 3,056 3,263 2,739 Deaths under 1 month.. 90 86 76 92 71 83 74 Neo-Natal rate per 1,000 nett Births 24.6 26.0 23.5 30.0 23.2 25.4 27.0 14 Infant Mortality. There were 211 deaths of children under one year of age, the death rates per 1,000 births for the past 24 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 (34) 59 1931 77 65 Note.—The figures in brackets are the mortality rates amongst infants visited by the Health Visitors. 15 TABLE IV. Birth-rate, Death-Rate, and Analysis of Mortality During the Year 1931 (Provisional Figures). (The Mortality Rates for England and Wales refer to the whole population, but for London and the towns to civilians only.) 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 15.8 0.67 12.3 0.01 0.00 0.08 0.01 0.06 0.07 0.36 0.54 6.0 66 91.18 6.17 1.70 0.95 107 County Boroughs and Great Towns, including London 16.0 0.67 12.3 0.00 0.00 0.10 0.01 0.07 0.08 0.33 0.48 8.4 71 91.43 5.84 2.24 0.49 159 Smaller Towns (1921 adjusted Populations 20,000-50,000) 15.6 0.73 11.3 0.00 0.00 0.07 0.01 0.05 0.05 0.36 0.43 4.0 62 92.17 5.49 1.25 1.09 London 15.0 0.50 12.4 0.01 0.00 0.03 0.02 0.07 0.06 0.26 0.57 9.7 65 89.52 6.23 4.24 0.1 Poplar Borough 17.5 0.58 12.4 0.00 o.oo 0.06 0.02 0.12 0.07 0.15 0.54 7.3 77 88.26 8.03 3.71 0.0 The maternal Mortality Rates for England and Wales are as follows:— Puerperal Sepsis. Others. Total. Per 1,000 live births 1.66 2.45 4.11 Per 1,000 total births 1.59 2.35 3.95 The Maternal Mortality Rates for London are as follows:— Per 1,000 live births 2.02 1.78 3.80 Per 1,000 total births 1.96 1.72 3.68 The Maternal Mortality Rates for Poplar are as follows:— Per 1,000 live births 1.09 1.46 2.55 Per 1,000 total births 1.06 1.41 2.47 16 TABLE V. (1931). 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 4,374,300 15.0 12.4 65 West Districts. Paddington 140,300 14.79 13.05 87 Kensington 174,800 14.2 14.0 76 Hammersmith 135,100 15.3 12.2 68 Fulham 151,200 15.08 12.8 67 Chelsea 57,220 12.8 14.1 42 City of Westminster 115,600 10.17 13.9 75.1 North Districts. St. Marylebone 97,620 11.4 12.4 65 Hampstead 87.740 11.2 11.7 60 St. Pancras 195,600 15.1 13.3 68 Islington 324,600 16.3 12.6 61 Stoke Newington 51,380 15.2 12.7 53.9 Hackney 217,000 15.5 11.4 60 Central Districts. Holborn 34,470 10.21 14.27 74 Finsbury 70,120 18.0 14.02 62 City of London 10,808 5.6 12.5 81 East Districts. Shoreditch 98,260 17.1 12.5 74.2 Bethnal Green 109,200 16.8 12.5 87.7 Stepney 225,800 17.5 13.1 78 Poplar 156,300 17.5 12.4 77 South Districts. Southwark 172,900 16.9 14.0 61 Bermondsey 112,410 17.4 12.5 57 Lambeth 295,900 15.28 12.66 60.35 Battersea 159,800 15.5 12.l 57.3 Wandsworth 353,200 12.27 11.30 59 Camberwell 252,100 14.7 11.9 56 Deptford 107,200 16.3 12.0 53 Greenwich 100,640 14.96 11.41 64 Lewisham 220,800 14.1 10 .2 49 Woolwich 142,600 15.1 11.-6 59 Note.—The information relating to London supplied by the Registrar-General and that for individual Boroughs by the Medical Officers of Health. 17 (These summaries are inserted for comparison with those shown in previous reports.) 1926. 1927. 1928. 1929. 1930. 1931. Population, estimated by Registrar-General :— 169,000 167,000 162,000 160,000 157,900 156,300 Births, Live, rate per 1,000 population 21.6 19.8 19.9 19.1 19.3 17.5 Deaths from all causes, rate per 1,000 population 11.4 11.8 11.8 14.2 10.6 12.4 Deaths under 1 year of age, rate per 1,000 nett births 70 66 71 75 53 77 Deaths over 65 years of age, rate per 1,000 total population 3.9 4.2 4.2 5.7 4.2 5.0 •Zymotic diseases:— Death rate per 1,000 population 0.9 0.6 0.6 0.8 0.5 0.4 Proportion of 1,000 deaths 75.2 51.6 55.5 53.4 47.6 34.5 Tuberculosis, all forms:— Death rate per 1,000 population 1.0 1.1 1.1 1.2 0.9 1.1 Proportion of 1,000 deaths 84.0 96.0 93 .2 85.6 86.8 87.5 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 2.4 2.0 1.0 3.1 1.0 2.2 Proportion of 1,000 deaths 207.9 172.4 162.4 219.8 98.1 181.8 *Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria and Mem, Croup, Typhoid Fever and Diarrhœal Diseases. Deaths from Various Diseases. Disease. 1926. 1927. 1928. 1929. 1930. 1931. Measles 39 8 56 11 30 9 Whooping-Cough 9 34 19 43 3 19 Influenza 23 36 24 71 3 23 Pneumonia (except Influenza] Pneumonia) 154 188 177 281 109 207 Diarrhoea and Enteritis (all ages) 69 39 47 44 25 25 18 Inquests and, Deaths from Violence. The number of inquests registered was 182. From this total must be deducted 56 of non-residents, and 30 added of residents who died outside the Borough, the nett total being 156. Mortuary. The number of bodies deposited in the Council's Mortuary, Cottage Street, Poplar, during the year was 245:— Residents Non-Residents* Totals Males Females Males Females No age stated 1 — — — 1 Stillborn — 1 — — 1 Under 1 year 6 4 1 — 11 1 to 5 years 7 7 — 3 17 5 to 15 years 11 1 1 2 15 15 to 25 years 7 1 — 2 10 25 to 65 years 69 24 6 2 101 65 years and upwards 54 25 6 4 89 Totals 155 63 14 13 245 *Brought from outside the Borough for the convenience of the Coroner. Inquests were held on 191, and 49 post-mortems were made by order of the Coroner. The total number of post-mortems made was 92. Five bodies were brought to the Mortuary for custody, pending burial. Section II. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Local Government Act, 1929. Under the provisions of the above Act, a survey of the public health services was carried out by Dr. Seymour of the Ministry of Health. Under date 22nd July, 1931, the following letter was received from the Ministry of Health:— 19 "111a. 733/4201 "Sir, "I am directed by the Minister of Health to state that he has received from Dr. Seymour, one of the Medical Officers of the Department, a report upon his recent general survey of the health services of the Borough Council. ''The Minister appreciates the interest taken by the Council and the zeal displayed by their officers in the conduct of the various health services. So far as can be judged from a general survey, it appears that a reasonable, and in some instances, a high standard of efficiency is being maintained in the work of the Public Health Department of the Borough. The Minister notes with special interest the arrangements for dealing promptly with infectious disease, the scheme for the supervision of the health of children up to the age of five years, and the general arrangements under the Council's Maternity and Child Welfare Scheme, in which the co-operation of the Royal College of St. Katharine has been successfully maintained. "At the same time the Minister desires to suggest that the Council might, with advantage, direct their attention to the following matters:— "(1) The possibility of providing a new X-ray apparatus at the Tuberculosis Dispensary. "(2) Where the premises used as Maternity and Child Welfare Centres are not entirely satisfactory, and especially where, as at Old Ford, they are also used as Ante-natal Clinics, the Council should take advantage of any opportunity of obtaining more satisfactory accommodation in other existing premises. "(3) Although good progress has been made in recent years in bringing up-to-date the Tuberculosis Notification Register for the Borough, there is still need for further revision. ''The Minister desires to express his appreciation of the assistance which was rendered to Dr. Seymour during the course of his survey by the Officers of the Council. "I am, Sir, "Your obedient Servant, "(Signed) H. A. Turner." 20 The letter was submitted to the Public Health Committee and to the Maternity and Child Welfare Committee, with the following observations by the Medical Officer of Health on the points raised:— (1) X-Ray plant.—Arrangements had been completed with the London County Council for the carrying-out of X-Ray examination of tuberculous patients at St. Andrew's Hospital, and this arrangement was a very satisfactory one. The old X-Ray plant at the Dispensary is still used for the screening of certain patients, and the installation of a new X-Ray plant will no doubt be considered when suitable accommodation can be provided. (2) Maternity and Child Welfare Centres.—The premises at Old Ford, which are rented by the Council, would be entirely rebuilt in the near future, and it was expected that the accommodation provided would then be adequate and in every way suitable for the purposes of a Maternity and Child Welfare Clinic. (3) Tuberculosis Notification Register.—This had been given very considerable attention during the last two years, and further revision was being carried out in conjunction with the Tuberculosis Officer. (1) Public Health Officers of the Authority. A list of the Staff is shown at the commencement of the Report, page 4. The only addition to the staff during the year has been the appointment of two Housing Inspectors. There have, however, been several changes in the personnel, owing to deaths occurring in the year, or to retirements. (2) Nursing in the Home. Agreements with local nursing associations are in operation, the fees payable being at the rate of 1s. 3d. per visit. (For number of cases visited and total visits paid, see Table in the Maternity and Child Welfare Section of this Report). 21 (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 to midwives, when, on the advice of a Clinic Medical Officer, the patient has been confined in an Institution. (4) 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, 1931 11,606 £3,919 27 1st July, 1931 10,031 £3,363 34 (5) 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 77. (n.b.—Examination of samples of milk for tubercle and bacteriological counts in graded milks are made at the Lister Institute). (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. 22 (6) New Legislation. During the year the following Acts of Parliament, etc., have come into operation:— Byelaws and Regulations: Byelaws re emission of smoke, made by the London County Council, 17th February, 1931, came into operation 19th May, 1931. Byelaws with respect to Houses divided into separate tenements, amending those made in 1926, made by the London County Council, 24th February, 1931, allowed by the Minister of Health, 8th June, 1931. Canal Boat Regulations. Amending regulations, dated 29th May, 1931, regarding boats used, or intended to be used, for the carriage of petroleum spirit. (7) 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 maintained by the London County Council. 23 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 129). The Royal College of St. Katharine also have accommodation for 6 children suffering from malnutrition, etc., and 6 cots for tonsillectomy cases. (8) 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. (9) Ambulance facilities. The ambulance services are provided by the London County Council. (10) Clinics and Treatment Centres. Maternity and Child Welfare Centres, Ante-Natal Clinics and Day Nurseries. (See Maternity and Child Welfare Section, page 110.) Tuberculosis Dispensary. (See page 97, 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. (11) Maternal Mortality. All maternal deaths and all cases of Puerperal Fever and Puerperal Pyrexia are specially investigated. (See Maternity and Child Welfare section, page 127.) 24 (12) Health Visiting. The Maternity and Child Welfare work of the Borough is divided between the M. and C.W. section of the Public Health Department and the Royal College of St. Katharine. The latter body is responsible for approximately one-third of the Borough, namely, the central portion lying between Bow Road in the north and East India Dock Road in the south. For home visiting purposes this area is divided into four districts with two health visitors working in each district. In the northern and southern portions of the Borough the work is undertaken by the Public Health Department, and is divided into eight districts, having one health visitor for each district. The Council's health visitors, in addition to visiting in their districts, attend at various clinics. With few exceptions, infants are visited on the nth day after birth, or as soon as possible thereafter. An endeavour is made to pay eight visits during the first year of life, six in the second year, four in the third year, three in the fourth year, and one or two in the fifth year. Owing to the increasing attendances at the various clinics the number of sessions has been gradually increased, with the result that the time taken up by the health visitors at these sessions has reduced considerably the time available for visiting on the district. Up to the present, however, it has been possible to maintain the number of routine home visits during years when visits in connection with cases of Measles and Whooping Cough have not been too numerous. London County Council (General Pow.rs) Act, 1928, sec. 28. Removal of infirm persons. During the year it has been necessary to obtain Magistrate's Orders for the removal of two persons. In addition, four other infirm persons were persuaded to enter institutions voluntarily. In one of these cases it was necessary to obtain a warrant to enter premises in order to ascertain the condition of the patient. 25 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. Three-fourths of the house refuse is incinerated at the Council's Refuse Destructor, where 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 fourth 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 include, 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 slops 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 1931. House refuse collected 33,794 tons Trade refuse collected 123 ,, Slop and sweepings 9.538 ,, Refuse from street markets 2,853 ,, 26 Work of Lady Sanitary Inspector. Tabulated statement of Inspections, of Insanitary Conditions found existing, and of Reinspections, etc., during the year 1931. Poplar. Bow and Bromley. Totals. Workshops, Workplaces, Laundries, etc., Number of, on the Register 26 94 120 Workshops, Number of Workrooms therein 29 124 153 ,, Number of Inspections of 30 59 89 ,, Number of Reinspections of — 1 1 Workrooms, Number of Inspections of 11 16 27 ,, found to be overcrowded — — — ,, found to be insufficiently ventilated — — — ,, found to be in dirty condition — — — Workshops, etc., newly discovered and registered 1 3 4 ,, Workrooms therein measured 1 — 1 ,, Reported to H.M. Inspector on discovery 1 3 4 Factories, Number visited 56 81 137 ,, W. C.'s dirty, insufficient, etc. 5 5 10 Outworkers' premises visited 260 493 753 Written Intimations served and instances reported 7 25 32 Statutory Notices served — 3 3 Final Notices served — — — Works carried out under supervision:— (a) Additional means of ventilation provided — — — (6) Rooms cleansed and whitewashed — — — (c) Yards, floors, roofs, etc., repaired — — — (d) Sanitary conveniences constructed, cleansed or repaired 4 6 10 (e) Dampness remedied — — — (f) Sink waste pipes renewed, etc. — — — (g) Miscellaneous 2 1 3 Overcrowding of Workrooms, Cases abated — — — Miscellaneous Visits (including visits to Council Houses) 432 188 620 Visits re Verminous Children 10 12 22 ,, Scabies 108 42 160 ,, Outworkers Lists — 5 5 ,, Suspected Infectious Disease 403 291 694 ,, Eye Infections 87 12 99 Visits to Schools 15 29 44 ,, re smallpox contacts — 37 37 Factory and workshop inspections, 255; fair condition, 219; removed or discontinued, 17; required cleansing, 7; sanitary conveniences defective or insufficient, 20. District Sanitary Inspectors Work, Etc. Tubulated Statement of Inspections, Insanitary Conditions found existing, and Re-inspections during the year 1931. Work of Temporary Inspectors (part of year only), 1931. (See Footnote.) East Combined West Combined Poplar South Bromley North Bromley Central Bow East Bow West Totals 1931 Totals 1930. Mr. G. L. Belshaw. Mr. A. T. Harris. East West (b) (a) (b) Total Inspections: 1188 1742 957 713 1639 1268 1120 1381 10008 9692 44 55 204 On complaints of nuisances, etc. 501 886 458 338 977 483 626 862 5131 4651 37 34 132 On notification of infectious diseases 343 679 327 224 491 358 256 250 2928 3236 5 16 67 †House-to - House 68 — 63 16 101 7 38 296 421† Workshops, workplaces, etc. 248 34 77 80 35 73 60 136 743 404 Miscellaneous 28 143 32 55 136 250 171 95 910 980 2 5 5 Premises found in fair condition 708 782 466 400 775 410 680 540 4761 4629 7 26 106 Do. requiring amendment 480 960 491 313 864 858 440 841 5247 5063 37 29 98 Details of Insanitary Conditions, etc. Walls and ceilings dirty 136 639 99 96 423 393 258 369 2413 2299 8 4 31 Yards, forecourts and areas insufficiently paved or drained 72 71 21 25 73 122 73 38 495 562 2 10 Inlets to drains not properly trapped 1 1 3 5 8 Number of drains tested 171 278 241 55 172 145 225 307 1594 1526 3 10 13 Do. do. defective 43 60 46 17 51 19 44 34 314 265 2 — Do. do. obstructed 29 67 55 42 105 29 44 16 387 381 4 8 Sink waste pipes not trapped or otherwise defective 38 26 29 62 104 58 79 396 351 5 Do. do. directly connected to drains 1 1 2 2 6 1 Soil pans of w.c.'s without suitable water supply 22 43 45 20 85 39 23 24 301 201 — 1 Do. do. broken or unsuitable 22 27 33 10 21 43 27 17 200 145 2 10 Do. do. in foul condition 18 21 10 5 5 13 2 74 49 1 Do. do. untrapped — 1 1 8 Roofs, guttering, and rainwater pipes defective 200 441 175 134 332 4 7 174 243 2106 2253 22 2 28 Water supplies to premises cut off (notified by Metropolitan Water Board) 1 9 ¯ 1 ¯ ¯ ¯ ¯ 4 4 ¯ ¯ ¯ Water service fittings defective, causing waste of water 29 27 59 4 26 5 16 10 176 163 2 2 3 Drinking water improperly stored 1 — 1 2 1 — 5 — — Dampness 230 202 64 19 242 192 95 92 1136 1151 — 4 17 Inundations 3 — 4 49 56 118 Overcrowding 10 14 4 10 14 7 59 110 2 No proper receptacle for house refuse 146 349 178 64 152 166 154 3 1212 1009 2 17 52 Accumulations of dung or refuse 22 35 16 11 25 10 18 304 441 115 9 3 Insanitary P.H. urinals — — 2 3 8 3 1 17 14 5 — 1 Other nuisances, dilapidations, want of ventilation, etc. 273 1361 286 256 512 497 289 371 2845 2810 5 6 61 Breaches of London County Council's By-laws 96 104 21 64 285 253 breaches of Council's By-laws 79 1 75 70 50 275 429 — — — Intimations served 429 953 481 312 849 653 430 841 4948 1688 28 99 Notices served 175 318 209 50 413 292 127 208 1792 1922 36 25 Final Notices served 38 117 101 46 149 51 20 51 573 639 ¯ 4 Summonses applied for — 11 5 11 4 4 1 36 47 1 Passengers from Continental Ports:— ¯ Visited ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 9 ¯ Undiscovered ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ 3 ntimations served in respect of verminous rooms 20 53 8 9 23 44 12 ¯ 169 186 — ¯ 2 Verminous rooms cleansed by owners, etc. 30 39 10 19 24 44 5 ¯ 171 179 — ¯ — Re-inspections 2871 1956 2514 1417 3691 1769 2018 2330 18566 19782 124 140 395 Number visited Visits ot Smallpox contacts 773 1070 148 776 901 709 147 212 4736 26741 1 118 182 J Premises visited 323 328 85 439 140 359 35 141 1850 10321 24 49 Do. school absentees, etc 13 50 17 84 28 9 16 32 249 319 23 Miscellaneous visits 42 380 249 34 84 154 87 72 1102 1029 111 137 25 † In addition to the above, 642 house-to-house inspections were made by Mr. C. H. Brown. Notes.—Work done as—(a) Additional Inspector. (b) Deputy for absent District Inspector, 27 Houses divided into separate Tenements, etc. Number of Houses on Register at end of 1930 114 ,, ,, removed from Register during 1931 2 112 ,, ,, registered during 1931 36 ,, ,, on Register at end of 1931 148 House-to House visits for registration purposes 484 Declarations, for information, sent out 90 ,, with information, returned 79 Rooms measured, etc 274 Houses registered 36 Notices sent out, re above 53 Inspections: (a) Night inspection 1 (b) First annual inspections 59 (c) Other routine inspections 205 (d) On complaints 24 (e) On account of re-housing 4 Re-inspections 783 Miscellaneous visits, enquiries, etc. 150 Number of Intimations served 80 ,, Notices served 3 ,, Notices complied with 138 ,, Final Notices served — ,, Notices served under L .C .C. Bye-laws 8 ,, rooms cleansed and freed from vermin 13 Overcrowding, cases discovered 17 ,, ,, abated 8 Mixed sleeping, cases discovered 3 ,, ,, abated 1 Number of nuisances referred to District Inspectors: (a) Defective or obstructed drains 18 (b) Defective roofs, guttering, etc. 25 (c) Miscellaneous 59 Water supply in tenement houses (section 78, London County Council (General Powers) Act, 1907): (a) Number of Intimations served — (b) ,, Notices served 1 (c) ,, Notices complied with 1 28 Smallpox work: Contacts Number visited 10 Premises visited 6 House-to-House visits 19 Revisits 17 Remarks: Daring the year the Inspector deputised for District Inspectors and was engaged on Smallpox work from time to time. Rehousing enquiries for District Inspectors 3 Legal Proceedings 1 Factory and Workshops Acts. Table A. Table giving number and inspections, etc., of Bakehouses, Laundries, Workshops, Workplaces, places where food is prepared, Milk premises, Cowsheds, Slaughterhouses, Offensive Businesses, Ice Cream premises, and Homeworkers' premises. Premises. On Register during year 1931. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male. Female. Total. Bakehouses (Factories) 51 — 51 208 102 — -— — Bakehouses (Workshops) 19 — 19 87 42 1 — — Bakehouses (Domestic Workshops) 4 -— 4 12 9 1 - Factories (Laundries and Miscellaneous Factories) 42 115 157 204 22 2 1 — Laundries (Workshops) 4 4 4 — — — — Laundries (Domestic Workshops) - - - - - — Workshops 195 107 302 360 31 9 1 — Workshops (Domestic) 18 9 27 27 2 1 — —- Workplaces 350 — 350 464 54 5 1 — Workplaces (Domestic) 48 — 48 96 10 1 — — Places where food is sold or prepared 813* — 813* 1842 387 11 3 — Milk Premises 105 — 105 298 — — — — Cowsheds 3 — 3 17 — — — — Slaughterhouses (a) 7 — 7 41 30 — — — Other offensive trade premises 4† 4† 7 — — — — Ice Cream premises 132† — 132‡ 262 6 — — — Homeworkers' premises 44 554 598 764 1 1 — — * Power is used in 84 of these premises. ‡ ” ” 27 “ “ (a) Includes two registered Slaughterers of Poultry (12, Coborn Road, and 221, Roman Road). † Registered by the London County Council. Fur Skin Dressers, 2. Soap Boiler, 1. Fat Boiler, 1. 29 Table B. Workshops on Register (Male,. 1 Acetylene gas making. 1 Maltster. 1 Accumulator making. 4 Metal works. 1 Asphalte making. 7 Motor garage works. 1 Bath Salts making. 2 Oil stores. 2 Bedding making. 1 Packing case making. 1 Bitumen making. 5 Paint making. 3 Blind making. 2 Plumbing. 1 Boiler covering. 1 Poultry food mixing. 2 Boat Building. 3 Printing. 22 Bootmaking. 4 Rag sorting. 1 Bottle sorting. 1 Range making. 1 Brush making. 3 Rope making. 11 Cabinet making. 1 Sack making. 2 Carpenters. 2 Sawyers. 1 Chemical works. 1 Shellac bleaching. 1 Cigar making. 1 Ship's painting. 1 Clay pipe making. 2 Stonemasonry. 3 Confetti making. 30 Tailoring. 3 Cork cutting. 1 Tank making. 3 Cooperages. 4 Tarpiulin works. 2 Copper miths. 1 Tin toy making. 1 Dental workshop. 5 Upholstering. 1 Electrical engineering. 3 Undertaking. 3 Engineering. 2 Van building, etc. 12 Farriers. 1 Vinegar making. 2 French polishing. 1 Wallpaper making. 1 Frilling making. 1 Waterproof working. 3 Furniture making. 2 Welding. 1 Furniture-polish making. 1 Wheelwright. 1 Furrier. 2 Wire working. 1 Garden Ticket making. 1 Wireless apparatus making 2 Glass blowing. 1 Wood Tar products. 1 Horsehair working. 1 Zinc working. 4 Harness making. 30 Domestic Workshops on Register (where Men are Employed.)* 1 Blacksmith. 1 Paper bag making. 4 Boot repairing. 7 Tailoring. 1 Cabinet making. 1 Wire working. 1 Decorative earthenware making. 1 Zinc working. 1 Dyeing and Cleaning. Home Workers on Register (Male). 13 Bootmaking. 1 Furrier. 1 Box making. 29 Tailoring. Workshops and Domestic Workshops on Register (Females) .* 1 Bedding making. 5 Packing. 1 Boot making. 4 Rag sorting. 1 Cabinet making. 1 Portable case making. 1 Cap making. 2 Pressers and cleaners. 2 Cork cutting. 1 Sack making. 10 Costume making. 1 Shirt making. 15 Dressmaking and altering. 1 Seal stamp making. 1 Embroidering. 33 Tailoring. 4 Furriers. 1 Tiemaking. 1 Glass instrument making. 1 Toymaking. 4 Laundries. 1 Trimming making. 1 Leather waste sorting. 1 Underwear making. 8 Milliners. 2 Upholstering. 2 Onion peeling and pickling. 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. 31 Factories on Register (where Females are Employed). 2 Bedding manufacturing. 2 Perambulator building. 1 Binder weaving. 1 Perfume making. 1 Blouse making. 1 Pianoforte manufacturer. 2 Boot making (Infants') 1 Pickle and sauce making. 6 Box making. 3 Preserved food. 1Brush making. 1 Printing works. 1 Bunting and flag making. 1 Rag sorting. 1 Butter mixing factory. 1 Rice starch making. 1 Button and buckle making. 4 Rope works. 1 Cake and Biscuit making. 2 Rubber goods making. 2 Chip basket making. 1 Rug making. 1 Cigarette paper making. 4 Sack making. 1 Clay fuel and pipes. 1 Sausage factory. 2 Cleaners and dyers. 4 Shirt making. 2 Confectionery making. 1 Shroud making. 1 Cork cutting. 1 Sugar refining. 2 Corset making. 19 Tailoring. 4 Costumes and mantle making. 2 Tarpaulin works. 1 Dog biscuit manufacturer. 1 Ticket printing. 5 Dressmaking. 1 Timber works and wicker 1 Dyemaking for leather goods. furniture making. 1 Feather works. 2 Toy making. 1 Fibre, hemp and jute making. 1 Type founder. 1 Furrier. 1 Underwear making. 1 Glassworks. 1 Uniform making. 1 Gum works. 1 Wallpaper manufacturer. 1 Harness and clog making. 1 Waterproof making. 1 Kapok works. 1 Whalebone works. 2 Laundries. 1 Wine bottling. 1 Matchmaking. 1 Wireless battery making. 1 Oil and colour works. 1 Woollen garment making. 2 Overall making. 32 Table C. Factories, Workshops, Laundries, Workplaces and Homeworkers. I.—INSPECTION. Premiaes. Number of Inspections. Written Notices. Prosecutions. Factories 412 Intimation. 124 Statutory 2 Final. 1 — (Including Factory ,Bakehouses and Laundries) Workshops† 451 73 10 1 — (Including Workshop Laundries.) Domestic Workshops‡ 39 11 2 — Workplaces 464 54 5 1 — Domestic Workplaces 96 10 1 — — Places where food is sold or prepared§ 1842 387 11 3 — Homeworkers' Premises 764 1 1 — — Total 4068 660 32 6 — † Including Workshop Bakehouses. ‡ Including Domestic Bakehouses and Laundries. § The inspections of factories where food is prepared are included. Power is used in 84 of the premises. 2.—DEFECTS FOUND * (Corresponding figures for 1930 are shown in italics). Particulars. (1) Number of Defects. Number of Prosecutions. (5) Pound. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Act: Want of cleanliness 590 (614) 590 1614 Want of ventilation 14 (2> 14 (2) Overcrowding 1 — 1 — Want of drainage of Floors 2 14 2 (4) Other nuisances 47 (84) 47 (84) Sanitary accommodation insufficient 11 (4) 11 (4) unsuitable or defective 25 (15) 25 (15) not separate for sexes 1 (3) 1 (3) 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 4 4 (Excluding offences relating to outwork which are included in Table D of this Report .) Total 695 (726) 691 (726) 4 .. * These defects refer to premises as mentioned above under table of Inspection. 33 Nature of Work. Outworkers' List (Section 107) . Prosecutions. outwork In unwholesome premises. (Section 108). Outwork In infected premises, (Sections 109, HO). Lists received from Employers. Notice served on Occupiers a. to keeping or sending lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110) Prosecutions (Sections 109, 110) Twice in the year. Once in the year. Failing to keep or permit inspection of list. Failing to send lists. Total Lists. Outworkers. Total Lists. Outworkers 1 Contractors. Workmen . Contractors Workmen. (1) (2) 1 (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Table D.—Home Work. Wearing Apparel— Making, etc. Cleaning and Washing Household Linen 74 — 256 4 — 16 107 17* Lace, lace curtains and nets Curtains and furniture hangings .. Furniture and Upholstery Electro-plate File Making Brass and Brass Articles Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, etc. Artificial Flowers Nets, other than wire nets Tents Sacks Racquet and Tennis Balls Paper,etc.,Boxes, Paper Bags Brush Making Pea Picking Feather Sorting Carding ,etc. ,of buttons ,etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, etc. 2 — 40 — — 3 — 1* Textile Weaving Miscellaneous 2 — 2 1 — 1 7 Totals 78 — 298 6 — 20 114 — — — — — 18* — — * Infectious Diseases see page 81. 34 LIST OF OUTWORKERS, FACTORY AND WORKSHOP ACT, 1901 (S. 107). Class of Homework. 1931 Number of Lists received. Number of Addresses of Outworkers. Due Feb. 1st. Due Aug. 1st. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Due Feb. 1. Due Aug. 1. Due Feb.1. Due Aug. 1. Total 42 172 41 143 231 222 282 260 Tailoring 34 121 34 89 Shirtmaking.. 2 6 1 1 Miscellaneous 3 13 2 10 231 222 282 260 Boxes 2 27 2 21 Overalls 1 5 2 22 Table E. Registered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshop bakehouses may be enumerated here. ' Bakehouse Workshops 19 Bakehouse Domestic Workshops 4 Laundries Workshops 4 Laundries Domestic Workshops — Workshops 302 Domestic Workshops 27 Workplaces 350 Workplaces Domestic 49 Places where food is sold or prepared 813† Total number of workshops and workplaces, etc., on Register .. 1568 † Power is used in 84 of these premises. Table F. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133).. 4 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 Reports (of action taken) sent to H.M. Inspector 15 14 (1 in 1932) Other (Communications) 5 Underground Bakehouses (s. 101):— — 21 35 Smoke A batement. 49 observations were made and 21 nuisances recorded. 15 complaints were received from the London County Council. 3 intimations were served. In addition, 17 cautions were sent and 1 letter to the L.C.C. 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 27. Offensive trades, Slaughterhouses. These aie referred to in Table A, page 28 . Milkshops, Dairies, etc. The premises are reported upon on page 59. Underground Rooms. In the early part of the year a letter was received from the Metropolitan Boroughs Standing Joint Committee regarding a communication which had been received from the Royal Borough of Kensington, in which, amongst other matters, it was proposed that powers should be sought to prevent the re-letting of certain underground rooms which are considered unfit for living or sleeping purposes. The Council agreed to support the proposals. One notice was served upon an occupier to discontinue the use of a basement front room which was unfit for human habitation. This notice was complied with. Rag and Bone Dealers. No legal proceedings were taken for non-compliance with the L.C.C. Bye-laws. Verminous Rooms. Verminous rooms are brought to the notice of owners upon the “Intimations,'' which are followed, if necessary, by “Statutory Notices'' 36 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. 231 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. 288 gallons of insecticide were distributed during the year. Licensed, Premises' Urinals. 17 urinals on licensed premises were found to be in insanitary condition and were subsequently cleansed. Water Certificates. One certificate was issued under Section 48 of the Public Health (London) Act, 1891. Stables. 188 stables were inspected and reported upon, the total number of inspections being 280. The following infringements of the Bye-laws were dealt with:— Accumulations of manure, or premises otherwise not clean 27 Floors not properly drained 3 Dung receptacles:— (a) Not provided 4 (b) Defective 3 (c) Not covered 2 Other defects 16 40 Intimations were served, followed by 3 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. 37 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 licenses being granted, and all storage premises are kept under supervision and periodically inspected. Rats and Mice (Destruction) Act, 1919. Barium carbonate paste and red squill baits are 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. A report on Rat Repression measures as carried out in the Borough was submitted to the Public Health Committee in September. (Appendix A.) 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 are only two private schools in the Borough. The accommodation in each was satisfactory and the sanitary arrangements sufficient and kept in a cleanly state. Rag Flock Act, 1911. Seven samples of Rag Flock were examined during the year and three were unsatisfactory. As a result of these three samples, legal proceedings were taken against a manufacturer, who was ordered to pay £10 10s. costs, and a letter of caution was sent to a vendor. Hairdressers' Premises. The number of inspections of hairdressers' premises was 145. Cleansing was necessary at 5 of the premises, and other nuisances found numbered 6. 38 10 intimations, 1 statutory notice and 1 final notice were served. The lequirements of these documents were complied with. Canal Boats Acts. For the year 1931, the inspections and reports of the Inspectors were as follows:— Registered boats. Non- Registered boats. *Mr. H. A. Tibbatts, East Combined Division — — Mr. W. J. Colborne, West Combined Division .. — — *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 4 Mr. S. Kelly, Bow East Division 4 — Mr. F. A. Smith, Bow West Division — — Totals 5 • 4 *There is no canal in either of these Divisions; the Inspectors deputise, when necessary, for other Inspectors. Mr. W. J. Colborne reported: "No canal boats have been seen at times of visits to the Canal." Mr. C. S. Westbrook reported : "No registrable boats seen at times of visits to canal bank." Mr. Wm. Johnson reported: "In two cases letters of caution re registration were sent. In two cases legal proceedings were taken. One boat was inspected thrice." Mr. S. Kelly reported : "In two cases cabins dirty, and in one of these cases there was no drinking water receptacle. In two cases there were 110 registration certificates on board. Letters of caution sent to owners." Mr. F. A. Smith reported : " No canal boats have been seen during 1931." Summonses were issued against the master and owner of an unregistered vessel for unlawfully using it as a dwelling place (in the case of the master) and for aiding and abetting by the owner. The summons against the master was dismissed without costs, and that against the owner was dismissed with £5 5s. costs against the Council, it being held that the vessel in question was registered under the Merchant Shipping Acts. 39 LEGAL PROCEEDINGS. Public Health (London) Act, 1891, Metropolis Management Acts, etc. Address. Nature of Complaint. Date of Decision. Result. Inspector. 42, Devas Street Various defects 1931. 22nd Jan 14 days' order; £2 8s. costs.. Luke, H. W. 115, Upper North Street Ceilings of ground floor, front and back rooms, part fallen and remainder dangerous 3rd Feb 7 days' order; £2 8s. costs.. Colborne, W.J. 37, Campbell Road Main roof defective and other defects.. 6th Mar Work done; 10s. penalty; £2 5s. costs Westbrook, C. S. 50, Broomfield Street Back wall taken down, leaving premises exposed to weather 2nd Mar 7 days' order; £2 8s. costs .. Colborne, W. J. 37, Stratfield Road Drain obstructed 6th Mar Work done; costs allowed, £1 1s. Westbrook, C. S. 52, Broomfield Street Back wall taken down leaving premises exposed to weather 2nd Mar 7 days' order; £2 8s. costs .. Colborne, W. J. 34, Ranwell Street Roof defective and other defects 6th Mar 7 days’ order; £2 8s. costs .. Harris, A. H. T. 319, Manchester Road Various defects .. .. .. .. .. 24th Mar £2 penalty; £2 5s. costs Dove, A. L. 9, Stebondale Street Various defects .. 26th Mar Work done; Summons withdrawn; costs paid, £2 5s. Dove, A. L. 115, Upper North Street Accumulation of rubbish in yard, walls of front and back rooms dirty 24th Apr 7 days’ order; £2 8s. costs .. Colborne, W.J. 2, Blackthorn Street Various defects .. 30th Apr 7 days' order; £2 penalty; £2 8s. costs Westbrook, C. S. 4, Blackthorn Street Various defects 30th Apr Work done; £2 penalty; £2 5s. costs ” ” 238, Devons Road Various defects .. 30th Apr 7 days' order; £2 penalty; £2 88. costs ” ” 63, Fairfoot Road Flues from stove without sufficient up-draught 12th June Work done; £2 4s. costs ” ” 47, Market Street W.C. obstructed; main roof defective and other defects 30th June 7 days' order; £2 8s. costs; additional costs for distress, 5s. Dove, A. L. ” ” Failed to comply with Magistrate's order 21st July £3 penalty; £3 3s. costs ” ” 2, Powis Road Main roof and ceiling of first floor front room defective 24th July Work done; £2 4s. costs Westbrook, C. S. 40 Legal Proceedings. —Continued. Address. Nature of Complaint. Date of Decision. Result. Inspector. 47, Market Street Failed to comply with Magistrate's order 1931. 7th Aug. £10 penalty; £5 5s. costs or 6 weeks' imprisonment Dove, A. L. 70, Reeves Road Front eaves gutter defective 7th Aug. Work done; £2 5s. costs Westbrook, C. S. 24, Bath Street Accumulation of refuse and verminous paper 17th Aug. Work done; £2 5s. costs Colborne, W.J. 63, Rathbury Road Roof defective and other defects 2nd Sept. Work done; Summons withdrawn on payment of £2 5s. costs Kelly, S. 9, Bath Cottages Main roof and cowls to chimney pots are defective 8th Oct. Work done; £2 5s. costs Colborne, W.J. 49, Merchant Street Various defects 8th Oct. 14 days' order; £2 penalty; £2 costs Westbrook, C. S. 62, Swaton Road .. Various defects 8th Oct. 14 days' order; £2 penalty; £2 costs ” ” 35, Market Street Various defects 15th Oct. 21 days' order; £2 8s. costs Colborne, W. J. 3, Addington Road Failed to deposit drainage plans 15th Oct. £2 penalty; £1 costs Kelly, S. ” ” Failed to give notice of intention to carry out construction of water closet 15th Oct. £1 penalty ” 123, Cadogan Terrace Failed to amend the drains 9th Dec. Work done; 10s. penalty; £2 2s. costs ” 20, Glengall Road Failed to provide a sufficient ashpit 30th Oct. 10s. penalty; £2 4s. costs Dove, A. L. 18, Glengall Road Failed to provide a sufficient ashpit 30th Oct. 10s. penalty; £2 4s. costs 7 days' order; £2 8s. costs Westbrook, C. S. 161, Fairfoot Road Various defects .. 12th Nov. 65, Stebondale Street Main roof defective and other defects 22nd Dec. £2 penalty; £2 2s. costs Dove, A. L. 41 Legal Proceedings. —Continued. Canal Boats Acts and Regulations. Defendant. Offence. Date of Decision. Result. Inspector. Master of barge "Sunday" Unlawfully used barge "Sunday" as a dwelling place, the vessel not being registered as a canal boat 1931. 13th Apr Summons dismissed Johnson, W. Owner of barge "Sunday" Aided, abetted, etc., the Master of barge ' 'Sunday" 13th Apr Summons dismissed with £5 5s. costs against the Council Johnson, W. Rag Flock Act and Regulations. F. M. (Limehouse Wool Works) Sold (lock containing 135 parts of soluble chlorine per 100,000 parts of flock 21st Dec Costs allowed, £10 10s. Smith, F. A. 42 Copy of a Return to the London County Council. Premises. No. in Borough on 31st December 1931. No. of Inspections. No. of Prosecutions. Cowsheds (No. of Premises) 3 17 Slaughterhouses 7* 41 — Offensive Trades 4 7 — Milkshops 105 298 — Ice Cream Premises 132 262 — Restaurants and Eating Houses (all places where food is sold or prepared) 813 1,842 — * Includes 2 Slaughterers of Poultry. Smoke Nuisancet. (1) No. of observations .. .. 49 No. of nuisances recorded .. 21 (4) No. of Statutory Notices served Nil. (2) Number of intimations served 3 (In addition 17 Cautions were sent and 1 letter sent (5) No. of legal proceedings Nil. to L.C.C.) (6) No. of convictions Nil, (3) No. of complaints received (from L.C.C.) 15 (7) Amount of penalty and costs imposed in each case — Cleansing and Disinfection. No. of adults cleansed 74 No. of premises cleansed ' (a) After infectious diseases 1.803 No. of children cleansed 2782 (b) For vermin 231 (rooms) by P.B.C. (171 rooms by Owners). Water Supply to Tenement Houses. No. of premises supplied 3 No. of prosecutions Nil Sanitary Officers. Male. Female. No. of Sanitary Inspectors (whole-time) ,, ,, ,, (part-time) 14* 1 Nil. Nil. M.C.W. T.B. No. of Health Visitors (whole-time) 9f 3 And 1 Sister in charge ,, ,, (part-time) Nil. of Light Clinics(M.&C.W.) * Includes 2 Meat and Food Inspectors and 3 Housing Survey Inspectors, † Does not include 9 employed by Voluntary Associations. Total No. of houses in the Borough 23,700* No. of houses closed on notice by owner that they could not be made fit Nil. 43 No. of houses occupied by the working classes 23,000 (Approx.) No. of houses for the working classes (a) Erected during year 15 No. of houses inspected (a) On account of complaints or illness (P.H. Act) 8,059 (b) In course of erection 111 No. of representations by Medical Officer or other person (b) House-to-house (Housing Consolidated Regulations, 1925) 2,213 No. of houses included in such representations 109 * Includes Licensed Premises, etc. † Includes 1 re-representation to London County Council. No. of notices served (a) UnderP.H. Act: (i) Intimation (ii) Statutory 4,992 1,655 No. of Closing Orders made .. Nil. (b) Under Housing Act Nil. No. of Closing Orders determined (i.e., houses made fit) Nil. No. of houses repaired or nuisances remedied under P.H. Act, 1891 4,856 No. of Demolition Orders 2* No. of houses demolished (a) In pursuance of Orders 1 No. of houses repaired under Sec. 3 of Housing Act, 1925 (a) By owners Nil. (b) Voluntarily Nil. (6) By L.A. in default of owners Nil. * 1 cancelled by County Court Judge after completion of certain specified works. Underground. Rooms. Overcrowding. No. illegally occupied 1 No. of cases of overcrowding found 69 No. closed or illegal occupation No. remedied 22 discontinued 1 No. of prosecutions Nil, Houses Let in Lodgings. No. on register 148 No. of inspections made 1076 No. of prosecutions 1 44 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 and girls on subjects of peculiar interest to them, but lecturers were also available to speak on other matters. 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. One hundred years ago cholera had established itself in England. We are told that there were cases at Rotherhithe, in Limehouse, and in a ship off Greenwich, and the first attempt to organise a local Board of Health was not very successful, "as they met at a public house and all got drunk and did nothing.'' But the establishment of Boards of Health did bring to light a terrible condition of misery, overcrowding and bad sanitation in the East End. In those days ignorance lay like a dark shadow over the whole field of disease, and medical science knew nothing of the causes or the cure of typhoid fever, typhus fever, tuberculosis, plague, malaria, diphtheria and many other diseases. Since that time research has made enormous strides forward. Discovery has followed quickly upon discovery. To-day, not only have the labours of Pasteur and Lister, Koch and Ross, and those who have built so well on their foundations, given us control over many of the enemies of mankind, but a large body of knowledge concerning the maintenance of health and the avoidance of disease is now available for those who desire to learn. To take but one instance of the new knowledge, which should be in the possession of all, the work of Professor Edward Mellanby and Mrs. Mellanby and others on vitamins, diet and disease, and their effect on rickets and dental development, has conclusively shown that by attention to the diet of infants and children rickets and dental caries may even be entirely prevented. 45 We are not surprised that the President of the British Medical Association, Dr. W. G. Willoughby, in a review of the causes of ill-health and the steps being taken to acquire new knowledge, should point out, with reference to this recent research: "The application of such discoveries by those whose duty it should be to look after the health of the persons concerned would result in a very large reduction in the suffering of children and in the subsequent defects of adults. It would be preventive medicine in its best form, incomparably better than treating these ailments in clinics.'' It is obvious that the greatest factor in prevention is education, but education will be slow so long as there is lacking a positive enthusiasm for it. When every parent and teacher becomes convinced that it is much more valuable for a child to be taught something of the working of his own body, and of the laws through which the body can be kept in health and efficiency, than to memorise the dates of the Kings of England a great step forward will have been taken. It is the recognition of this fact which has wisely led the Public Health Committee to offer free lectures on various aspects of health and disease to any group, which is sensible enough to arrange to have them. I venture to think that there is no public authority in our country which offers a better and wider selection of subjects, upon which information and advice are given, than that of Poplar, and the Public Health Committee may well take a legitimate pride in knowing that it is definitely leading a movement towards better health, the importance of which is being increasingly recognised both by experts and by the public. "In dealing with living creatures and with himself," says a wellknown biologist, "it is temptingly easy for men to muddle along." The days when men could be content to muddle along are rapidly passing, for muddle breeds muddle. Knowledge and foresight mean power. It is surely significant that in the great majority of cases in which lectures have been given the appreciation of the audience has shown itself in the request for more. This is a piece of work which should enlist the most cordial co-operation of all those who care for the well-being, not only of to-day, but of tomorrow. 46 Syllabus of Lectures. (a). THE CHILD (1) The Development of the Child. (2) The Fears of the Child. (3) "Peculiar" Children. (4) What to tell our Children about Sex. (5) The Care of the Child. (6) Environment and the Child. (7) The Child and the Race. (8) The Health of the Schoolchild. (9) The mind of the Child. (b). YOUTH. (10) Adolescence and its Problems. (11) Sex-hygiene for Boys. (12) Sex-hygiene for Girls. (13) Recreation and Health. (14) Education through Habit. (c). THE MOTHER (for Women's Meetings.) (15) Helping your Children to grow up. (16) The care of the Unborn Baby. (17) The Change of Life. (d). THE BODY IN HEALTH AND DISEASE. (18) Science and Health. (19) Our Bodies and how we live. (A Series of four Lectures.) (20) The Care of the Body. (21) The Worker's Health. (22) What is Disease ? (23) The Physiology of Sex. (24) Microbes, Friends and Foes. (25) Venereal Diseases. (26) Tuberculosis—a scourge of to-day. (27) Rheumatism. (28) Cancer. (29) Infectious Diseases. (30) The Fear of Disease. (31) Pathways to Health. 47 (32) Food and Drink—their use and abuse. (33) Food Values. (34) Environment and Health. (35) From Infancy to Age. (36) The Wonder of Health. (37) When to consult a Doctor. (For Women's Meetings). (38) Common Diseases and Home Remedies. (For Women's Meetings). (e). GENERAL LECTURES. (39) The Science of Life. (40) Social Hygiene. (41) Smoke and Health. (42) Sunlight and Health. (43) The Romance of Medical Science. (44) Recent Advances of Medical Research. (45) The Story of Preventive Medicine. (46) Preventive Medicine and what it can do. (47) Healthy and Unhealthy Minds. (48) Mental Hygiene. (49) The Problem of Sex-education. (50) Human Heredity. (51) Heredity and Disease. (52) The Lessons of Evolution. (53) Education for Health. In all, 82 lectures have been arranged for 17 centres, 72 lectures have been given up to time of writing this report. Again and again, members of audiences have expressed their appreciation of the opportunity, which has been provided by our Health Authority, of learning more about these vital matters, and wished that such knowledge had been theirs years ago. Summary . Number of Centres at which lectures have been arranged 17 Number of lectures given (at time of writing report) 72 To boys 1 (Attendances 14) To women and girls 71 ( ,, 8,953) 72 (Total attendances — nearly 9,000) 48 Expenditure to 31st March, 1932. £ s. d. Grant to Central Council for Health Education 5 0 0 Printing, Stationery and Postage 6 6 7 Fees to Lecturers 184 16 0 Total £196 2 7 Section IV. HOUSING. The following section on Housing has been prepared in accordance with Circular 1,206 (England) of the Ministry of Health, 1931:— (a) STATISTICS. Number of new houses erected during 1931:— (а) Total (including numbers given separately under (b) 17 (i) By the Local Authority 72 (In course of erection, 111.) (ii) By other Local Authorities (iii) By other bodies or persons 1 (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 14 (c) For other purposes Nil. I.—Inspection of Dwelling Houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 10.126 (b) Number of inspections made for the purpose 11,176 49 (2) (a) Number of dwelling-houses (included under subhead (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,213 (b) Number of inspections made for the purpose 2,594 {3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 31 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 4,856 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 3,214 3. Action under Statutory Powers during the Year. A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 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- B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,642 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,642 (b) By local authority in default of owners C. Proceedings under Sections 19 and 21 of the Housing Act, 1930 (1) Number of dwelling-houses in respect of which Demolition Orders were made 2* 50 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 *One order quashed on appeal after execution of certain works specified by Court. D. Proceedings under Section 20 of the Housing Act, 1930— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made— (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit— E. Proceedings under Section 3 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which notices were served requiring repairs— (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners— (b) By local authority in default of owners (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close— F. Proceedings under Sections 11, 14, and 15 of the Housing Act, I925— (1) Number of dwelling-houses in respect of which Closing Orders were made— (2) Number of dwelling-houses in which Closing Orders were determined, the dwelling-houses having been rendered fit— (3) Number of dwelling-houses in respect of which Demolition Orders were made— (4) Number of dwelling-houses demolished in pursuance of Demolition Orders— Note .—Sections 11 to 15 of the Housing Act, 1925, have been repealed by the Housing Act, 1930, but the proviso to Section 64 of the Act of 1930 continues in force any Closing Orders and Demolition Orders made 51 before the operation of the Act (15th August, 1930), and houses subject to those Orders must continue to be dealt with under the relative provisions of the Act of 1925. Of the 31 dwelling-houses found to be in a state unfit for human habitation (under heading 1 (3) of Table on page 49): 1 was demolished. 1 Demolition Order quashed on appeal. 8 were dealt with as a "Clearance Area.'' 9 were dealt with as a "Clearance Area." 12 were represented to the London County Council. Number of houses owned by the Local Authority, distinguishing those 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:— Total. Assisted under 1919 Act 150 ,, ,, 1923 „ 61 ,, „ 1924 „ 398 609 Houses converted to tenements (No State assistance) 35 tenements 644 (2) Part II of the Housing Act, 1925: Assisted under 19x9 Act 36 ,, „ 1923 Act (Sec. 1 (3)( ) 24 60 1. Survey of District. In order to carry out its responsibilities under the Housing Acts and with a view to ascertaining the actual conditions of properties and the need of further housing accommodation, the Council, with the approval of the Ministry of Health and the London County Council, appointed two sanitary inspectors for house-to-house inspection. They commenced duties in August. 52 With Mr. Brown, there are, therefore, three inspectors engaged in Survey work, and it is estimated that an inspection of the whole Borough will take approximately three years. No sanitary notices are served by these inspectors, but serious nuisances, and conditions likely to lead to them in the near future, are referred to the district inspectors for their action. This procedure has been adopted in order to prevent the time of the housing inspectors being taken up with re-inspections and the interference with the survey of the Borough as a whole, which, to be of any real value, should be completed as soon as possible. Each district inspector, when opportunity occurs, also carries out house-to-house inspection in his district. During the year the following house-to-house inspections have been carried out:— Work of Survey Inspectors. No. of houses inspected. Total. (i). Bow. Appian Road 48 Candy Street 70 Jodrell Road 78 Jodrell Terrace 4 Lamprell Street 76 Locton Street 70 Lyal Road 21 Parnell Road 165 Rushton Street 38 Usher Road 167 Wendon Street 49 - 786 (2). Bromley. Brickfield Road 6 Burdett Street 3 Church Avenue 9 Cross Street 5 Devas Street 98 Donald Street 103 Favonia Street 5 Gurley Street 34 Lingen Street 35 Marner Street 45 St. Leonards Street 4 - 347 53 (3). Poplar. To. of houses inspected. Total. Alpha Road 94 Byng Street 1 Cahir Street 18 Cheval Street 1 Cuba Street 31 Devonshire Terrace 7 Janet Street 26 Malabar Street 53 Manilla Cottages 2 Manilla Street 62 Maria Street 32 Mellish Street 165 Montague Place 4 Spring Gardens Place 7 Tobago Street 13 Tooke Street 26 West Ferry Road 197 - 739 Total 1,872 (Number of nuisances referred to District Inspectors, 480.) Work of District Inspectors. (i). Bow West. Lyal Road 8 Norman Road 3 Saxon Road 24 35 (2). Bow East. Leonards Buildings 4 Old Ford Road 3 - 7 (3). Bromley North. Nil. — — 54 (4). Bromley Central. No. of houses inspected. Total. Bromley Street 12 Clutton Street 11 Moness Street 19 Spey Street 8 Teviot Street 24 Uamvar Street 30 - 104 (5). East Combined. Bedford Street 13 Follett Street 9 Grundy Street 2 Ida Street 40 Prestons Road 8 St. Leonards Road 2 - 74 (6). West Combined. Nil — — (7). Poplar South East. East Ferry Road 64 - 64 (8). Poplar South West. Claude Street 5 Crew Street 1 Gaverick Street 12 - 18 Total 302 Summary . Houses inspected by Survey Inspectors 1,872 Houses inspected by District Inspectors 302 Total 2,174 55 2. "Clearance" or "Improvement'" Areas. In last year's Annual Report reference was made to 14 areas which had been considered by the Special Housing Act (1930) Committee and referred to in the questionnaire issued by the London County Council in connection with the preparation of the first quinquennial statement on housing. This statement showed that the Borough Council hoped to deal with five Clearance Areas during the five years, namely, Areas Nos.1, 2,3,4 and 6. In March, 1931, the Council declared a further area of nine houses to be a "Clearance Area" (No. 15), and at its meeting in September the Council resolved that the Minister of Health be requested to confirm the Order made in accordance with the Council's resolution of 23rd July, 1931. The progress made in dealing with the areas during the year is as follows:— Areas Nos. 1 and 6.—Following upon a Public Inquiry held on 22nd April, the Ministry of Health on 1st June issued the Poplar (Emmett Street Area) Housing Confirmation Order, 1931, confirming an Order made by the Council for the compulsory acquisition of lands which surround Area No. 1 for the purposes of Part III of the Housing Act, 1925. At its meeting in June the Council agreed to secure the clearance of Area No. 1 and also of Area No. 6 by purchasing the land with buildings thereon, and undertaking by themselves, or otherwise, to secure the demolition of the buildings thereon and made Orders for the compulsory purchase for the purpose of Part I of the Housing Act, 1930, of the land and buildings. A Public Inquiry into these applications was held by the Ministry of Health on 22nd September. The Ministry's Confirmation Orders were issued in December. Areas Nos. 2, 3 and 4.— Nothing further can be done until the development of Area No. 1. Area No. 9.—This was one of the areas submitted in 1930 for the consideration of the London County Council, but in view of the dangerous condition of some of the houses they were represented to the Public Health Committee at a meeting in July. The representation was referred to the Special Housing Act (1930) Committee. This portion of the area, 56 together with Area No. 8, is receiving the consideration of the Special Housing Committee. Progress of other Areas represented prior to the Housing Act, 1930. (a) West Ferry Road Area.—This area was originally represented to the London County Council in 1919, and, prior to the passing of the 1930 Act, the County Council had agreed to take part of the area. (The remaining portion of the Area, as put forward to the Borough Council, is now known as Area No. 13.) Early in 1931 the London County Council intimated they were extending their Area by including further houses (but not those in Area 13), and in May the London County Council decided to deal with the area as a ' 'Clearance Area.'' The County Council also decided to acquire a site known as Phoenix Wharf, Isle of Dogs, for the erection of dwellings for rehousing persons to be displaced from Clearance Areas in East London. (b) Baker's Alley and Oliver's Court.—During the year the London County Council has carried out certain demolitions in these areas. 3. Individual Houses. (a) No. 56, Ida Street, Poplar, was represented as unfit for human habitation. Persons interested were interviewed by the Special Housing Act (1930) Committee and a Demolition Order was made. The premises were demolished. (b) The Cottage, Quixley Street. This house was represented as unfit for human habitation. The owner was interviewed by the Special Housing Act (1930) Committee and on their recommendation the Council made a Demolition Order. When the premises were first empty the owner was informed that the house was to be represented as unfit for human habitation and that in the opinion of the Council it was not capable of being made fit at a reasonable cost. In spite of this, the owner had certain works carried out and when the Demolition Order was made he appealed to the County Court. 57 Prior to giving his decision the judge visited the premises. He then suspended the Order and stated it would be quashed if the owner undertook to do certain works within four months to the satisfaction of an independent surveyor appointed by the Court. The independent surveyor reported to the Court that the works required had been carried out to his satisfaction and the Demolition Order was then quashed and costs given against the Council. 4. Overcrowding. During the year 57 new instances of overcrowding were officially recorded. 38 of the more serious cases were reported to the Public Health Committee, but owing to the inability of the overcrowded families to find alternative accommodation, the Committee decided it was impossible for them to take action. Nine cases were referred by the Public Health Committee to the Housing Committee. 33 letters have been sent to tenants and sub-tenants, calling their attention to the fact that overcrowding is a nuisance. A number of cases were referred to the Town Clerk for submission to the London County Council or to the Borough Council's Housing Committee for housing accommodation. 9 of the 57 cases, and also 13 cases officially recorded in the past few years, have been abated. In 4 further cases the overcrowded conditions have been eased. The overcrowding was abated or eased as follows:— Abated. Eased Rehoused by the London County Council 11 (9) 3 (3) ,, ,, ,, Poplar Borough Council 3 (3) — Other accommodation found 8(1) 1 22 4 (Numbers in brackets are cases recorded prior to 1931.) The foregoing is a statement regarding cases of overcrowding officially reported to the Public Health Department, either by complaint or found by officers of the department in the course of their visits. It should be noted that many overcrowded families have made application for accommodation direct to the London County Council, or Borough Council Housing Departments, and the fact that their premises have been 58 overcrowded is unknown to the Public Health Department until inspection is carried out following upon notification of rehousing. During the year overcrowding was found to have been abated or eased in 128 such cases—120 through rehousing by the London County Council and 8 through the action of the Poplar Borough Council. In all such cases a letter is sent to the person responsible for the letting of the vacated rooms calling attention to the fact that overcrowding is a nuisance, and should the premises again become overcrowded the facts will be reported to the Public Health Committee. A number of premises where overcrowding had been abated through the activities of the London County Council and the Poplar Borough Council were revisited during the year, but in no instance was re-overcrowding found. Accommodation provided during 1931. The number of familes rehoused during the past year was as follows:—- Families accommodated . Number of persons (approx.) (a) By the Poplar Borough Council in:— (1) Newly-erected flats 10 60 (2) Adapted buildings 3 15 (3) Vacancies re-let 16 78 (a) New properties 13 (b) Adapted properties 3 (b) By the London County Council:— (1) By nomination 172 860 (2) By direct application 675 Total 876 *It is not possible to give approximate number of persons accommodated, under this heading. Increase of Rent and Mortgage Interest (Restrictions) Acts. 13 certificates were issued to tenants. On applications of owners, 2 certificates that the work had been done were also issued. 59 Section V. INSPECTION AND SUPERVISION OF FOOD. 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. MILK SUPPLY. (a) Cowsheds. The 3 cowsheds in the Borough licensed by the London County Council have been visited and inspected on 17 occasions. No intimations or Statutory Notices were served. (b) Dairies and Milkshops. At the end of the year there were in the Borough 105 registered premises where raw milk is sold. These premises were kept under strict observation, 298 inspections being made. The standard of cleanliness in cowsheds, milk shops and other premises where milk is dealt with has been well maintained. 2 premises were registered as Dairies during the year. 2 firms were registered as Wholesale Dealers in Milk (1 raw milk in ' 'Sealcones'' and 1 raw milk.) 15 persons (including 5 itinerant vendors) were registered as retail purveyors of milk, 6 of these being on account of change of ownership of premises. For milkshops connected with infectious diseases, see page 81. During the year the following were registered:— 2 Wholesale Dealers in Sterilized Milk. 42 Retail Purveyors of Sterilized Milk in Sealed Bottles. (23 on account of change of Ownership.) 60 18 Retail Purveyors of Raw Milk in "Sealcones" (i on account of change of Ownership.) 12 Retail Purveyors of Milk in Sealed Bottles (5 on account of change of Ownership.) Milk (Special Designations) Order, 1923. During the year the following licences under the above Order were issued:— Certified Milk. 3 Licences for the sale of "Certified'' Milk. 1 Supplementary Licence for the sale of "Certified'' Milk. Grade 'A' Milk. 2 Licences for the sale of Grade 'A' Milk. Grade 'A' (Tuberculin Tested) Milk. 8 Bottling Establishments. 25 Dealers in Sealed Bottles only. 6 Supplementary Licences (Principal Licences issued by other Authorities.) Grade 'A' Pasteurised Milk. 2 Licences for the sale of Grade 'A' Pasteurised Milk. 2 Supplementary Licences for the sale of 'Grade A' Pasteurised Milk. Pasteurised Milk. 3 Licences in respect of "Pasteurising" establishments. 5 Licences for the sale of "Pasteurised" Milk. 2 Supplementary Licences for the sale of ' 'Pasteurised'' Milk. 61 PARTICULARS OF SAMPLES TAKEN UNDER THE ORDER DURING THE YEAR 1931. Grade. Particulars (Where Taken). Result. Action Taken. Samples Examined for On Delivery at Railway Stations. Hospitals From Dealer before Bottling. From Dealer after Bottling. Number Satisfactory. Number Unsatisfactory. Grade "A" (Tuberculin Tested) — — - 8* 7 * One Examination not complete. Nil. Tubercle Bacilli. Grade "A" (Tuberculin Tested) 18 - 7 (1) 24 (1) 47 2 Letter to Ministry of Health Letter to County M.O.H. Berkshire Bacteria (Total Count and B. Coli) Pasteurised From November. - 2t 1 5(2) 6 2 Both unsatisfactory samples were from one Dealer. Premises inspected by M.O.H. and letter sent to Dealer. Further sample taken found to be satisfactory. Bacteria (Total Count) Grade "A" — — - — — — — — Certified — — - — - Pasteurised— Grade "A — — - — — — — — Figures in parentheses denote where unsatisfactory samples were obtained, † Taken at request of the London County Council. 62 The bottling establishments have been under constant supervision, and, for the purpose of renewal of licences, special inspections were made and reports submitted. Three purveyors holding Pasteurisers' Licences were sampled under the above Order. In two cases satisfactory results were reported. In the other case the result was unsatisfactory. A further sample was taken, which also was unsatisfactory. The Medical Officer of Health visited the dairy premises after report on the first sample and a letter was sent after the report on the second sample was received. The sale of '"Pasteurised"' milk was discontinued for the time being, and after the plant had been modified and improved methods of handling adopted, further samples were taken and reported satisfactory. 18 samples of Grade 'A' (Tuberculin Tested) milk were taken on delivery at Railway Stations for bacterial counts. Bacteriological Examination of Samples of Milk for Tuberculosis During the year the London County Council took 20 samples of milk for biological examination for the presence of the tubercle Baccillus. All the samples were taken from mixed bulk milk arriving in the Borough. The results of the examinations are the subject of special investigations by the London County Council. Public Health (Imported Milk) Regulations, 1926. In November a firm applied for registration under the above Regulations . One sample was taken and was found to comply with requirements. The registration was approved early in 1932. It is understood, however, that the firm has now discontinued the importation of milk. Milk delivered to L.C.C. Hospitals. For many years the Inspectors have taken samples of milk on delivery at Institutions formerly controlled by the Boards of Guardians and at the Poplar Hospital. The arrangements for taking samples at Poplar Hospital have continued throughout the year, and on a request being made by the London 63 County Council for samples to be taken at certain of their Institutions this was done. As the milk supplied to these Institutions is "Pasteurised'' milk, bacteriological examinations are carried out in addition to chemical analysis. Milk supplied to L .C .C. Schools. Towards the end of the year the London County Council asked if arrangements could be made for samples of the milk delivered at their schools to be examined. It was arranged that samples should be taken by our Inspectors in the ordinary course of their sampling work. During the few weeks remaining to the end of the year samples were taken at two schools. Both samples were reported to be genuine, and the London County Council was informed accordingly. Investigation into illnesses amongst Schoolchildren in which milk was suspected. In March, information was received that certain children attending an elementary school just outside the Borough boundary were suffering from Enteritis. In co-operation with the Public Health Department of the adjoining Borough, investigations were carried out in this Borough, as well as in the other Borough. Enquiries in Poplar resulted in the discovery of five children in five households suffering from symptoms of Enteritis, and although doctors in the district were communicated with no further cases were reported. All five patients recovered. Although there was no definite evidence that the milk supplied to the school was lesponsible for the outbreak of illness, yet when the milk was examined bacteriologically it was found on several occasions to have a high bacterial count and to contain Baccillus coli. The dairy in question was carefully inspected and milks from various farms were examined, and as a result certain supplies were discontinued. The pasteurising plant used by the wholesale dairyman was an old pattern "flash" type. After considering the reconstruction of the whole dairv premises, the dairyman decided to reconstruct the dairy and instal a modern plant. 64 Ice Cream. During the year, 20 Owners or Occupiers applied for registration. After the premises were visited and inspected these applications were duly approved. The number of owners or occupiers now on Register is 132. 262 Inspections of the above premises were made during the year. Cleansing of premises was necessary in 3 instances. 4 other nuisances existed. 6 intimations were served, and the necessary cleansings were carried out, and other nuisances abated. Bakehouses. There are 74 bakehouses in use, of which 21 are underground. In 51 bakehouses machinery is used. The bakehouses in the Borough were inspected at least twice during the year, the total inspections numbering 307. Cleansing was found to be necessary on 153 occasions, and 1 other nuisance was found. The cleansings were carried out and the nuisance abated after service of 153 intimations, followed in 2 instances by statutory notices. Slaughterhouses. There are 5 slaughterhouses licensed by the London County Council. For number of inspections, etc., see Table A, page 28, and reports of Food Inspectors, pages 65 and 66. 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. The number of premises in the Borough where food is sold or prepared for sale is 813; see Table A, page 28. 65 1,842 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 377 instances, and 17 other defects existed. 387 intimations were served, and in 11 cases were followed up by statutory notices, and 3 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. Reports of Food Inspectors. Mr . C. A. Grabham . (Inspections for 1930 in italics). Premises. Inspections. Intimations. NoticeB. Final Notices. Prosecutions. 1931 1930 Bakehouses 149 142 84 1 Slaughterhouses 13 9 8 - — — Cowhouses 2 1 — - — — Milkshops 104 91 — - — — Eating-houses 101 119 3 - — — Stalls 1292 877 1 - — — Other places where food is sold or prepared 394 448 8 - - - Ice cream premises 144 168 2 - — — Wharves where food is prepared or stored, etc 28 6 - - - - Fried Fish Vendors, etc 304 307 203 5 - - 214 Market Inspections:—Morning, 136; Evening, 78. Mr. Grabham also reported he had made 11 enquiries re Smallpox, and 1 enquiry re suspected food poisoning at an institution. 66 Mr. H. A. Pearce. (Inspections for 1930 in italics.) Premises. Inspections. Intimations. Notices. Final Notice?. Prosecutions. 1931 1930 Bakehouses 158 166 69 1 Slaughterhouses 28 43 22 — — — Cowhouses 15 19 - — — — Milkshops 194 176 - — — — Eating-houses 131 145 8 2 2 — Stalls 1,967 2,232 — — — — Other places where food is sold or prepared 607 702 9 - - - Ice cream premises 118 83 4 — — — Wharves where food is prepared or stored, etc 1 - - - - - Fried Fish Vendors, etc 276 259 156 4 1 — 245 Market Inspections:—Morning, 165; Evening, 80. The number of nuisances referred to district inspectors was 5. Mr. Grabham. Mr. Pearce. Totals. I. Slaughterhouses—Visits 353 242 595 Number of Carcases inspected 1,936 1,785 3,721 (a) Satisfactory 1,928 1,778 3,706 (6) Unsatisfactory 8 7 15 (c) Condemned and destroyed or otherwise disposed of (included in (6) above) Parts of 8* 2 and parts of 5* 2 and parts of 13 II. Number of Samples procured:— (a) Under Sale of Food and Drugs Act 421 365 786 (i) Number genuine 379 334 713 (ii) Number adulterated 42 31 73 (iii) Number poor quality, etc. (included in (i) genuine above) 11 12 23 (b) Under Special Orders and Regulations : 26 46 72 (i) Number satisfactory 26 41 67 (ii) Number unsatisfactory — 5 5 111. Action taken in respect of unsatisfactory samples:— (i) Summonses applied for 6 4 10 (ii) Letters of caution sent to vendors 11 11† 22† (iii) Reported to appropriate Government Department and/or County M.O.H. 1 3 4 IV. Public Health (Foreign Meat) Regulations—Visits to factories 141 5 146 * Total weights: 11 cwt. 191bs., and 15 cwt. 71bs. † Includes 1 verbal caution. (For foodstuffs inspected prior to export, see page 68.) 67 V. Organs, Etc., Condemned as a Result of Slaughterhouse Inspections. Mr. Grabham. Mr. Pearce. Totals. Lungs: Beasts 78 73 151 Sheep 262 244 506 Pigs 100 97 197 Livers: Beasts 45* 40 85* Sheep 46 51 97 Pigs 6 10 16 Mesenteries: Beasts 411 27 68† Pigs 3 14 17 Omenta: Beasts 17 17 34 Pigs 2 1 3 Pancreas: Beasts 21 13 34 Beasts 9 8 17 Spleens: Sheep 1 — 1 Pigs 4 2 6 Tripes: Beasts 8 9 17 Beasts 4 3 7 Hearts: Sheep 1 1 2 Pigs 2 3 5 Kidneys: Beasts 3 6 9 Intestines: Beasts 4 4 8 Udders: Beasts 38 17 55 Heads: Beasts 23 32 55 Pigs 5 11 16 Tongues: Beasts 23 32 55 Pigs 5 11 16 * And parts of 1. † And parts of 2. The following foodstuffs were seized, or surrendered, and destroyed:— 6 Hindquarters, 4 forequarters, 2 top pieces of beef, 10 cwt.—Seized. (Legal proceedings taken. See p. 76.) 74 Fowls, 10 Turkeys, 2 Hares, 1 Bovine Liver. 12 stones Skate, 96 tins Fruit Salad, 24 tins Peaches. 24 tins Tomatoes, 245 tins Evaporated Milk, 20 lb. damaged Tea. 15 cwt. Bacon, 240 tins Pilchards, 3¼ bushels Periwinkles. 5 tins Red Herrings, 1 tin Herrings in Tomato, 11 tins Fresh Herrings. 141 tins Herrings, 1 tin Haddock, 10 gross 3-oz. jars Fish Pastes. 130 lb. Pears, 166 tins Sliced Peaches. (Letter of caution sent.) 4 boxes Haddock, 100 tins Preserved Soups, 2 sets Pigs' lungs. 1 Pig's Liver, 6 stones Dog Fish, 46 lb. Cherries. 167 baskets Potatoes, 25 Fowls, 16 Ostend Rabbits. 122 tins and boxes Mixed Sweets.—Seized. Surrender accepted and letter of caution sent. 458 boxes Chocolates.—Seized. (Legal proceedings taken. See p. 76.) The following were released for technical purposes:— 57 lb. damaged Tea.—For caffeine making. 50 lb. damaged Tea—For other technical purposes. 8 Kegs Tartaric Acid.—For remaking. 36 boxes Pepper.—For reconditioning. 47 bales Cassia } 73 boxes Nutmegs } For reconditioning and grinding. 17 boxes Ginger 38 casks Tallow. 69 lb. Tea. 435 lb. Tea.—For fertilizer manufacture. 1,508 bags Flour.—For reconditioning. (1,508 Flour bags were destroyed.) 68 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 150 consignments of foodstuffs: Canada (51), Australia (34), United States of America and Dependencies (32), India (20), other countries (13). 146 visits were paid to factories in connection with the above. Foodstuffs Inspected for Export. (Inspected by .Mr. C. A. Grabham with the exceptions marked *, which were inspected by Mr. H. A. Pearce.) Tons. cwts. qrs. lbs. Hams (America) 6 14 3 1 - 5 — 15* - 6 — 5* Bellies of Bacon (America) 6 1 3 26 Hams (Argentina) 3 11 3 16 Hams (Australia) — 5 — 27 Fore-ends of Bacon (Sweden) — 3 3 20 Fore-ends of Bacon (Denmark) 1 — 1 6 Sides of Bacon (Denmark) 1 — 1 14 Gammons (Denmark) — 10 2 27 Belly pieces of Bacon (Denmark) — — — 20 Fores of Beef (Argentina) — 7 — 12 Crops of Beef (Argentina) — 11 — 7 Fillets and Sirloins of Beef (Argentina) 1 9 2 16 Beef (Brazil) — 4 1 27 Corned Beef (Brazil) — 9 2 4 Beef (England) — 5 1 23 Fores of Beef (New Zealand) — 1 3 10 Rumps of Beef (Australia) — 3 — — 1 9 13 Crops of Beef (Australia) 1 6 24* Fillets and Loins of Beef (Australia) - 17 3 18 Beef (Uruguay) — 14 2 4 Fillets of Beef (S. America) — 8 3 21 Fores of Veal (Uruguay) 2 6 3 17 Loins of Pork (Australia) — 17 3 17 Loins of Pork (New Zealand) — 12 1 23 Sows (New Zealand) 1 12 1 22 Sows (England) — 13 3 23 Pigs (England) — 11 2 22 2 4 - 21 Mutton (New Zealand) - 2 1 17* Lamb (New Zealand) - 10 2 14 Sheep (New Zealand) — 4 3 6 Real Oxford Sausages (England) 7 16 — — 69  Tons. cwts. qrs. lbs. Pure Pork Sausages (England) — 12 — — Oxford Sausages (B. & W.) (England) — 3 2 12 Cambridge Sausages (New Zealand) — 2 — — Pork Sausages (New Zealand) — 3 3 — Vienna Sausages (New Zealand) — 1 — — Breakfast Sausage (England) — — 1 16 Ox Tongues (Uruguay) — 3 2 5½ Tongue Meat (249 x 6 lb. tins) (Uruguay) — 13 1 10 Ox Tongues (Argentina) — 9 3 — Ox Tongues (Australia) 1 11 — 20 Kidney Suet (America) — — 1 16 Lard (America) — 4 — — Dripping (Uruguay) — 3 — — Bath Chaps (100) (England) — 2 — 18 Fowls (England) 1 7 — 1 Turkeys (England) — 3 1 8 Turkeys (Australia) — 16 2 26 Hares (Scotland) — 1 1 10 Inspected by:— 1. Mr. Grabham 51 1 2 3½ 2. Mr. Pearce — 19 3 5* Total Weight 52 1 1 8½ 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. 70 Food and Drugs (Adulteration) Act, 1928. The results of the analyses of 801 samples were reported to the Committee during the year:— Sample. Number examined, 1931. Adulterated . Action taken. Legal Proceedings.* Letters of caution sent. Milk 392 13* 3+ 7 (Including 2 verbal cautions) ,, Sterilised 3 — — — ,, Condensed 31 — — — Cream 2 — — — Butter 47 — — — Margarine 52 6 — 4 Cheese 4 — — — Dripping 14 3 — 3 Lard 6 — — — Shredded Suet 2 - — Mustard 6 — - — Pepper 8 1 - — Malt Vinegar 4 — - - Vinegar 30 5 - 2 Sauce — — - - Cocoa 4 — - - Coffee 1 — - - Chocolate Powder — — - - Coffee and Chicory 2 — - - Cornflour 2 — - - Rice 2 — - - Pearl Barley 4 — - - Sago 3 2 - 1 Tapioca 2 — - - Arrowroot 3 — - - Self-raising Flour 4 — - - Ground Ginger 4 — - - Baking Powder 7 3 - - Pea Flour 2 — - - Cake 2 — - - Jam 14 2 - 1 Table Jelly 5 — - Golden Syrup 0 — - - Tea 4 — - - Ice Cream 2 — - - Sweets 13 6 1 - Honey 2 — - - Hot Milk 2 1 1 - Carried forward 687 42 5 18 * Includes three samples taken from churns on delivery. Reported to Medical Officer of Health of area of production. † Summons withdrawn on payment of costs, and letter of caution sent it one case (not included). 71 Sample. Number examined, 1931. Adulterated . Action taken Legal Proceedings. Letters of caution sent. Brought forward 687 42 5 18 Camphorated Oil 2 - — — Cream of Tartar 2 - — — Ground Gentian 2 — — Lime Juice Cordial 2 - — — Lemon Squash 2 - — — Lemonade 1 - — — Lemonade Powder 2 - — — Brandy 2 - — — Gin 3 - — — Whisky 7 2 — 1 Rum 2 - — — Mincemeat, Fruit 4 - — — Minced Meat 21 7 2* 1 Sausage 12 4 1† 1 Brawn 1 — — — Fish Paste 2 — — — Frying Oil 2 — — — Bread 2 — — — Bread and Butter 4 — — — Cider 2 — — — Ground Cinnamon 2 — — — Orange and Quinine Wine 2 — — — Cod Liver Oil 2 — — — Powdered Liquorice 2 ** 1 — — Egg Powder 3 2 — — White Precipitate Ointment 3 1 - - Zinc Ointment 2 — — Carbolic Ointment 3 2 1 — Salicylic Ointment 2 — — — Liniment of Turpentine 2 — — — Sultanas 2 — — — Candied Peel 2 — — Canned Fruits 3 — — — Dried Herbs 7 — — — Totals, 1931 801 61‡ 9 21 Totals, 1930 807 54§ 13 16 *Proceedings taken against master and servant. For details of action taken see pages † Proceedings withheld pending appeal in another case. ‡ Including 20 informal samples. § Including 13 informal samples. 72 "Of the samples of milk, 60 were procured from itinerant vendors on Sundays and 235 from itinerant vendors on weekdays. Six samples were adulterated, and letters of caution were sent to 2 vendors and legal proceedings taken against 2 other vendors, 1 verbal caution and 1 reported to adjoining local authority. FOOD AND DRUGS (ADULTERATION) ACT, 1928. Administrative Action Taken Respecting Samples Reported to be Not Genuine. March Quarter, 1931. Sample No. Article. Result of Analysis. Action taken. G. 14 Whisky 36 deg. under proof No action. G. 25 Vinegar 5 per cent, deficient in acid Letter of caution. G. 23 Milk 3.3 per cent, deficient in fat Letter of caution. P. 34 Milk 4.7 per cent, added water Summons—withdrawn on payment of costs. (After withdrawa 1 of summons a letter of caution was sent.) P. 33 Vinegar 5 per cent, deficient in acid Letter of caution. P. 35 Milk 4.7 per cent, added water Letter of caution. B. 4 (Inf.) Margarine 17.5 per cent, water Formal sample taken G.49 G. 49 Margarine 16.8 per cent, water Letter to vendor. A. 13 (Inf.) Meat 140 parts per million of Sulphur dioxide Formal sample taken P.83 (P. 83 procured in June quarter. Contained Sulphur dioxide 140 parts per million. Summons—£5 penalty; £1 Is. costs.) 73 June Quarter, 1931. Sample No. Article. Result of Analysis. Action taken. G. 78 Milk 10 per cent, deficient in fat Letter of caution. P. 84 1 Meat (minced) Sulphur dioxide 40 parts per million Letter of caution. A. 14 (Inf.) White Pepper Ordinary Pepper No action. P. 83 Meat (minced) Sulphur dioxide 140 parts per million Summons, £5 penalty: £1 Is. costs. G. 92 Sweets Sulphur dioxide 750 parts per million Summons, £1 5s. costs. B. 24 (Inf.) Sweets Sulphur dioxide 740 parts per million Formal sample G. 92. P. 94 Margarine 16.8 per cent, water Letter to vendor. A. 16 (Inf.) Ground Liquorice Powder Compound Liquorice Powder supplied No action. A. 19 (Inf.) Sweets 0.25 per cent. Talc. No action. P. 98 Milk 3.3 per cent, deficient in fat 8 samples taken by a neighbouring authority at cowsheds in their district. No further action. P. 104 Milk 10 per cent, deficient in fat Summons, £2 penalty; £2 2s. costs. P. 112 Dripping 1.1 per cent, water, 2 per cent. free fatty acids Letter of caution. G. 115 Dripping 3.0 per cent free fatty acids Verbal caution. G. 129 Milk 3.3 per cent, deficient in fat These samples were taken G. 130 Milk 6.6 per cent, deficient in fat from sealed churns on G. 131 Milk 6.6 per cent, deficient in fat delivery. Letter sent to M.O.H. of area of production. B. 28 (Inf.) Meat (minced) .. Sulphur dioxide 150 parts per million Formal sample G. 147. G. 147 Meat (minced) .. Sulphur dioxide 260 parts per million Summonses against master and servant; £3 penalty and £2 2s. costs in each case. G. 146 Milk 13 per cent, deficient in fat Summons dismissed— "Warranty" proved. P. 144 Milk 3.3 per cent, deficient in fat Verbal caution. B. 23 (Inf.) Sweets Sulphur dioxide 900 parts per million Formal sample. G. 92 (see above). 74 September Quarter, 1931. Sample No. Article. Result of Analysis. Action taken. A. 25 (Inf.) Sago Tapioca supplied Formal sample P. 162. P. 162 Sago Tapioca supplied Letter of caution. G. 181 Vinegar 3.7 per cent, deficient in acid Further sample taken— Genuine. B. 29 (Inf.) Sausage Sulphur dioxide present 170 parts per million Formal sample G. 189. G. 189 Sausage Sulphur dioxide present 180 parts per million Letter of caution. G. 203 Milk 23 per cent, deficient in fat .. Letter of caution. B. 40 (Inf.) Strawberry Jam Sulphur dioxide present 55 parts per million Formal sample G. 221. G. 221 Strawberry Jam Sulphur dioxide present 65 parts per million Letter to vendor. A. 32 (Inf.) Minced Beef Sulphur dioxide present 130 parts per million Formal sample taken— "Genuine." P. 193 Dripping 1.5 per cent. water Letter of caution. G. 232 Margarine 16.2 per cent. water No action. B. 52 (Inf.) Sweets 0.27 per cent. Talc No action. A. 35 (Inf.) Baking Powder 66 per cent. deficient in available gas. Contained Arsenic l-50th grn. per lb. A. 36 (Inf.) Egg Powder 55 per cent deficient in available gas. Contained Arsenic l-50th grn. per lb. Egg substance absent. P. 218 Baking Powder 60 per cent. deficient in available gas. Contained Arsenic l-50th grn. per lb. See note * below. G. 255 Baking Powder 46 per cent. deficient in available gas. Contained Arsenic l-50th grn. per lb. P. 219 Egg Powder 50 per cent. deficient in available gas. Contained Arsenic l-50th grn. per lb. G. 261 Margarine 17 percent. water Letter to vendor and reported to Minister of Agriculture. Note.—The manufacturer was interviewed by the Medical Officer of Health and the facts were reported to the Ministry of Health. 75 December Quarter, 1931. Sample No. Article. Result of Analysis. Action taken. G. 267 Vinegar 5 per cent. deficient in acid Sample taken on delivery —genuine. B. 58 (Inf.) Sausage Sulphur dioxide present 400 parts per million Formal sample taken G. 279 below. B. 59 (Inf.) Minced Beef Sulphur dioxide present 130 parts per million Formal sample taken— genuine. A. 44 (Inf.) V inegar 5 per cent. deficient in acid Formal sample taken— genuine. G. 279 Sausage Sulphur dioxide present 500 parts per million Legal proceedings instituted but withheld pending an appeal in another case. G. 287 Whiskv 37 deg. under proof Letter of caution. B. 62 (Inf.) Carbolic Ointment 35 per cent. deficient in carbolic acid Formal sample taken G. 300 below. P. 280 Margarine 17.4 per cent. water Letter to vendor. G. 300 Carbolic Ointment 30 per cent, deficient in carbolic acid Summons, £4 4s. costs. G. 354 Hot Milk 15 per cent. added water Summons, £1 penalty; £2 2s. costs. P. 305 Sweets 0.6 per cent. Talc Manufacturer interviewed by M.O.H. P. 307 Milk 13.3 per cent. deficient in fat Letter of caution. A. 59 (Inf.) White Precipitate Ointment 28 per cent. deficient in white precipitate Formal sample taken— genuine. Milk and Dairies Acts and Order. Sold milk without being registered H. G. Summon* — withdrawn on payment of costs. Filled bottle with milk in street G. U Letter of caution sent. Milk bottled in street F. C. .. Letter of caution sent. Improper use of word "Pasteurised" on disc W.B. Letter of caution. Milk delivered in dirty bottle T. B. Letter of caution. Do. do. E. D. Letter of caution. Used description of milk resembling "Certi- S. R. Summons, £2 4s. fied" and "Grade A" while not licensed costs. Sold milk as "Certified" while not licensed S. R. Summons not proceeded with by Magistrate. Ditto ditto ditto W. L. Summons, £2 4s. costs. Milk (Special Designations) Order , 1923. Sold Grade A (Tuberculin Tested) milk while M. L. Letter of caution, not licensed Pasteurised milk contained 116,280 organ- T. B. Letter sent to proisms per c.c. ducers. 76 Public Health (Meat) Regulations, 1924. Oxtails on stall which was not properly F. H. Letter of caution, screened. Bacon cut up on stall which had no means of H. B. Reported to Public preventing contamination Health Committee and letter of caution sent by Town Clerk. Public Health (London) Act, 1891, Section 47. Seizures of Foodstuffs. Proceedings under the above Section were taken as follows:— Unsound Beef seized and condemned £2 2s. costs allowed on each of three summonses, which were dismissed under the Probation of Offenders Act. In subsequent proceedings against the wholesaler the latter was fined a total of £200 and ordered to pay £21 costs, or two months' imprisonment in respect of four summonses. In addition, defendant's slaughterhouse licence was cancelled by the Court. 458 boxes of Chocolates seized and condemned Two defendants each fined £20 and £5 5s. costs.. In two other cases letters of caution were sent. Other Action. Bread in mouldy condition at time of sale.. G. C. C. Manufacturer inter. viewed by M.O.H. who also sent a letter. MILK; AND CREAM NOT SOLD AS PRESERVED CREAM. (A) Number of Samples examined for the presence of preservative. (B) Number in which preservative was reported to be present, and percentage of preservative found in each case. Milk 392 Nil. Cream . 2 Nil. Butter and Margarine. During the year two premises were registered for wholesale dealing in margarine. 77 The following is the number of premises in the Borough registered under the above-mentioned Acts, up to and including 31st December, 1931. Margarine. Butter. Wholesale Dealer. Manufacturer. Factory. Wholesale Dealer in Milk-blended. 24 — 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. Report of the Public A nalyst. During the year 1931, 801 samples were examined under the Food and Drugs (Adulteration) Act. 145 of these were purchased informally, and all were submitted by the Inspectors. 61 samples were found to be adulterated. In addition, 53 other samples were of inferior quality or doubtful purity. The rate of adulteration for the past 10 years was as follows:— Year. No. of samples examined. Percentage of adulterat ion. 1931 801 7.6 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 Average 790 7.1 78 The average rate of adulteration for the London Boroughs in 1930 was 2.9 per cent., and for the whole of England and Wales, 4.8 per cent. In previous quarterly and annual reports, attention has been drawn to the fact that the rate of adulteration in the Borough is higher than that of some neighbouring districts. The recorded figures for other Districts can only be commented upon. Without a knowledge of their specific problems and conditions any criticism must be withheld, but it is extremely doubtful if there is much difference in the amount of existing adulteration in Districts of similar character. Owing to the particular and vigorous manner in which this work hasbeen attacked in the Borough, it will be observed that there has been a steady decline in the figures since the years 1927 and 1928. The practice carried on for some years past of concentrating on certain articles which by informal sampling have been shown to be adulterated, or of inferior quality or doubtful purity, will always produce relatively high figures. This should be taken not solely as an indication of unsatisfactory state of affairs, but should be regarded at the same time as a result of the activities of the Officers concerned and the methods employed. The number of samples examined was at the rate of 5.0 per 1,000 of the population, as compared with 9.1 per 1,000 for the London Boroughs, and 3.6 per 1,000 for the whole of England and Wales. Milks . 392 milks were examined, of which 13, or 3.3 per cent., were found to be adulterated. 79 The rate of milk adulteration for the past 10 years was as follows:— Year. No. of milks examined. Percentage of adulteration. 1931 392 3.3 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 391 3.9 It is satisfactory to note the steady decline in the adulteration of milk. Condensed Milks. 31 samples were examined under the Condensed Milk Regulations, all of which were satisfactory. Preservatives. There were 15 contraventions of the Preservatives Regulations. It was found necessary during the year to interview three manufacturers of foodstuffs which had been examined and found unsatisfactory. In one case a sample of Strawberry Jam was purchased which was labelled "of the finest quality." On examination, it was found to have been made from preserved pulp, and contained sulphur dioxide. The manufacturer admitted that he made a better grade of jam from fresh fruit. He promised to alter the wording of future labels for this particular class of jam. A manufacturer of a product labelled ''Egg Powder" was interviewed, as a result of an unsatisfactory report on his samples. 80 The powder was found to be a coloured Baking Powder made from inferior ingredients containing a trace of arsenic and was deficient in available gas. The manufacturer promised to call his product Egg "Substitute" Powder and to pay more attention to the quality of the ingredients. Further samples of the same brand have been found satisfactory. A manufacturer of sweets which contained o .6 per cent. of talc stated that he bought the latter as a "dusting powder" and was unaware of its nature. He promised to discontinue the use of this powder. Other samples examined were:— 4 Electrolytic Fluids, 1 Mouldy Bread, 1 Rat Poison. 7 samples of Rag Flock, 3 of which were not up to the required standards of cleanliness. ALBERT E. PARKES, F.I.C., Public Analyst. TABLE VII. Notifiable diseases during the Year. (52 Weeks ended 2nd January, 1932.) Notifiable Disease. Cases Notified in Whole Bobough. Total cases notified in each Sub-District. No. of Cases removed to Hospital from each Sub-District. Total Deaths in Age-Periods. Total deaths in each Sub-District. At all Ages. At Ages—Years. At all Ages. At Ages—Years. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards. Poplar. Bow and Bromley. Poplar. Bow and Bromley Total Cases Removed . Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards. Poplar. Bow and Bromley. Smallpox 101 1 — 1 2 2 19 16 16 27 10 7 _ 52 49 52 49 101 — — — — — — — — — — — — — — — Chickenpox 1103 59 77 66 118 134 542 81 15 10 1 — — 651 452 19 30 49 2 1 1 — — — — — — — — — — — 2 Cholera (C), Plague (P) — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 330 10 20 22 48 38 125 35 12 16 3 1 — 216 114 215 113 328 11† 3 1 — 3 1 2 — — — — — — 5 6 Erysiipelas 99 4 1 — — — 3 — 7 12 13 38 21 44 55 18 28 46 6 — 1 — — — — — — — — 1 2 2 4 Scarlet Fever 537 5 18 27 42 58 218 102 22 39 4 2 — 263 274 257 269 526 3 — — 1 — — 2 — — 1 — — 1 2 Typhus Fever —. — — — — — — — — — — — — — — — — — — — — — — — — 2 — — — — Enteric Fever (including Paratyphoid) 5 — — — — — 1 2 1 1 — — — 4 1 4 1 5 —— — — — — — — — — — — — — — — Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Contunued Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 15 — — — — — — — — 8 7 — — 11 4 11 3 14 4 — — — — — — — — 2 2 — — 2 — Puerperal Pyrexia 23 — — — — — — — 2 16 5 — — 8 15 8 14 22 — — — — — — — — — — — — — — — Cerebro-Spinal Fever 8 4 1 1 — — — —• — 2 — — — 4 4 4 4 8 5 3 2 — — — — — — — — — — — 2 Acute Poliomyelitis 5 — — 2 1 — 1 — 1 — — — — 5 ~~ 5 — 5 — — — — — — — — — — — — — — — Acute Encephalitis Lethargica 4 — — — 1 — — — 1 — 1 1 — 3 1 3 — 3 4† — — — — — — — 2 — 1 1 — 3 1 Ophthalmia Neonatorum 37 37 — — — — — — — — — — — 30 7 2 — 2 — — — — — — — — — — — — — — — *Zymotic Enteritis 81 28 20 5 3 1 7 3 3 1 2 6 2 30 51 4 3 7 25 18 2 — — 1 — — 1 2 — — 1 11 14 Anthrax — — — — — — — —. — — — — — — — — — — — — — — — — 1 — — — — — — — Pneumonia, Acute Primary 578 112 83 50 32 16 46 15 17 38 42 86 41 345 233 113 94 207 170 44 21 4 2 1 1 — 2 5 17 40 32 96 74 „ Acute Influenzal 25 2 — — 3 2 4 1 1 2 4 4 2 17 8 1 1 2 5 1 — — — — 1 — — — 2 1 2 3 Acute Polioencephalitis 1 — — — — — — — — 1 — — — — 1 — 1 1 1† — — 1† — — — — — — — — — 1 — Totals 2952 2(52 220 174 250 251 966 255 98 173 92 145 66 1683 1269 716 610 1326 236 70 28 6 5 3 6 1 5 9 23 44 36 126 110 This table does not include cases in which original diagnosis was not confirmed, N.M.deaths from Acute Primary Pneumonia are of notified patients only. * Notifiable 1st June to 30th September, but the number of deaths relates to the whole year. † Icludes 1 non-notified case. 81 Section VI. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifications. 2,952 cases of Infectious Disease (Smallpox 101) were notified during the year. In addition there were 120 other cases notified as Infectious Diseases in which the diagnosis was not confirmed. The notification rate was 18.9, compared with 24.4 in 1930. The incidence of the commoner infectious diseases generally was less than in 1930; particularly so in the following diseases:— (a) Smallpox 527 fewer cases. (b) Diphtheria 230 ,, ,, (c) Scarlet Fever 78 ,, ,, The only disease in which there was an increase during the year was Pneumonia (no cases more than in 1930), and the higher incidence coincided roughly with the weeks of greatest fog. On investigation none of the infectious diseases showed any tendency to grouping as a result of common sources of infection. In the main cases occurred sporadically throughout the Borough. Infectious Diseases in Milkshops and Homeworkers' Premises. Two contacts of infectious disease patients (1 Diphtheria, and 1 Scarlet Fever) employed in the milk trade were dealt with during the year. One notice under Article 17 of the Milk and Dairies Order, 1926, was served. 18 cases of infectious disease occurred in homeworkers' premises— 5 Diphtheria, 9 Scarlet Fever, 3 Chickenpox and 1 Measles. No notice was served under the Factory and Workshop Act, 1901, Sections 108 and no. Where there was any risk of infection the work was discontinued, and any work found on the premises was disinfected before being returned. 82 Cases of Notifiable Diseases Treated in Hospitals. Disease. Cases Notified. L.C.C. Fever Hospitals. Other L.C.C. Institutions . General Hospitals, etc. Total Removals. Percentage of cases notified. Smallpox 101 101 101 100 Chickenpox 1,103 36 10 3 49 4.4 Diphtheria 330 324 2 2 328 99.4 Erysipelas 99 1* 40 5 46 46.5 Scarlet Fever 537 526 — — 526 97.9 Enteric Fever 5 4 — 1 5 100. Puerperal Fever 15 8 5 1 14 93.3 Puerperal Pyrexia 23 3 17 2 22 95.6 Cerebro-spinal Fever 8 2 1 5 8 100. Encephalitis Lethargic® 4 — 2 1 3 75. Ophthalmia Neonatorum 37 1 1 — 2 5.4 Pneumonia (Primary) 578 1† 178 28 207 35.8 Pneumonia (Influenzal) 25 — 1 1 2 8.0 Zymotic Enteritis 81 — 3 4 7 8.6 Acute Poliomyelitis 5 1 1 3 5 100. Acute Polioencephalitis 1 — 1 — 1 100. Totals 2,952 1,008 262 56 1,326 44.9 * Admitted with Chickenpox. f† Admitted with Diphtheria. N.B.—Cases reported to be "not suffering" have been excluded from above table. Mortality from Diphtheria, Scarlet Fever and. Enteric Fever. Diphtheria. Scarlet Fever Enteric Fever. Cases 330 537 5 1931 Deaths 10* 3 0 Fatality Rate 3.o 0-5 0.0 * 1 non-notified case not included. Scarlet Fever. The total notifications received numbered 583 and the total removals were 572. Of these, 46 cases were later certified to be not suffering from 83 Scarlet Fever, leaving a total of 537 cases, the attack-rate being 3.4 per 1,000 of population. 3 deaths occurred, giving a fatality rate of 0.5 per cent. Diphtheria. The total notifications received numbered 387 and the total removals to hospital were 385. 57 patients were certified to be suffering from other diseases, leaving a total of 330 cases, the attack-rate being 2.1 per 1,000 of population. 11 deaths occurred, including 1 case which occurred outside the Borough and was not notified, leaving 10 deaths, which give a fatality rate of 3.0 per cent. Diphtheria Anti-toxin. 208,000 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. In the latter part of the year a circular letter was sent to medical practitioners practising in the Borough reminding them of the facilities offered for the supply of anti-toxin and drawing attention to the danger of waiting for results of swabs before either removing the suspected patient to hospital or delaying the administration of anti-toxin. Enteric Fever. Six notifications were received (of which two related to Paratyphoid Fever), and the patients were removed to hospital. In one case the diagnosis was not confirmed, leaving five actual cases, the attack-rate being o .03 per 1,000 of population. No deaths occurred. Bacteriological Examinations. 1,985 swabbings from doubtful cases of diphtheria were examined. Of these, 219 gave positive results (11 per cent.). 84 9 blood specimens from doubtful cases of Enteric Fever were examined. One positive result was obtained. One swabbing from a doubtful case of Puerperal Fever was submitted, and the result of the examination was reported negative. All these examinations were carried out at the Seamen's Hospital, Greenwich. Smallpox. The outbreak of Smallpox, which commenced in Poplar in March, 1928, continued, and during 1931 102 cases occurred (see footnote.) TABLE I. Smallpox and Chickenpox Cases Notified during each month. 1931- Month. Smallpox. Chickenpox. January 21 129 February 14 71 March 8 93 April 20 67 May 19 111 June 3 101 July 4 60 August 6 51 September 2 46 October 3 108 November — 124 December 2 162 Totals 102* 1123* * These figures refer to the calendar year, but in other parts of this Report the figures, Smallpox 101 and Chickenpox 1103, referring to the statistical year of 52 weeks are used. 85 The cases occurred in the under-mentioned sanitary districts:— East Combined 23 West Combined 17 Poplar South (West) 15 Bromley North 19 Bromley Central 6 Bow East 9 Bow West 12 101 The incidence of Smallpox in houses is shown below. Cases 32 houses in which 1 case of Smallpox occurred 32 8 ,, ,, 2 cases ,, ,, 16 6 ,, ,, 3 ,, ,, ,, 18 2 ,, ,, 4 ,, ,, ,, S 2,, ,, 6 ,, ,, ,, 12 1 house ,, 7 ,, ,, ,, 7 1 ,, ,, 8,, ,, ,, 8 Total 101 Total number of cases 101 ,, ,, houses 52 In Table II it will be seen that of the 101 cases no less than 85 were unvaccinated, and that in this group nearly 94 per cent. of the cases occurred before the age of 35, whereas in the vaccinated group, the majority of cases occurred after the age of 35. The vaccinated cases were vaccinated once only—13 in infancy and one at 21 years of age. This patient showed only one cicatrice. 86 TABLE II. Age, 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 2 4 — 8 F. — — — — — 9 2 — 6 Unvaccinated M. 4 10 9 6 12 2 — 43 F. 2 9 7 10 11 2 1 — 42 Doubtful (no marks) M. — — — — — — — — — F. — — — — — 2 — — 2 Totals 6 19 16 16 27 10 7 — 101 The type of the disease continued to remain mild, and there were no deaths. One instance may be quoted to illustrate how easily this mild type of Smallpox may be missed, and how difficult it is to trace the source of infection in many cases. A Medical Officer of the Department was asked to see a suspected case of Smallpox. On visiting the house he found three patients suffering from the disease but could not discover the source of infection. Later it was admitted that the house had been visited daily by a married daughter who had been confined seven days prior to the visit of the Medical Officer and the discovery of Smallpox. The woman had been admitted later to a general hospital with her baby because the latter had been diagnosed as a case of Pemphigus. On visiting the hospital the baby was found to be suffering from Smallpox, and the mother, who denied having had any illness, showed definite lesions of recent Smallpox. Further enquiries indicated that the husband was the first case in this family. Fortunately, no further cases occurred and the baby recovered. It is almost certain that had this baby not suffered from a rather severe eruption the source of infection of the three cases mentioned above would not have been traced. Six cases were removed from a Common Lodging House. 87 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 one case all Smallpox patients were seen by a medical officer of the department. In this instance the patient was removed with a friend from a house in an adjoining Borough. Of the total number of patients removed as suffering from Smallpox less than one per cent. were not confirmed as suffering from this disease:— Smallpox. Not S.P. Patients removed as Smallpox 102 101 (99%) 1 (0.98%) ,, ,, for observation 3 2 (66.6%) 1 (33.3%) Totals 105 103 (98.1%) 2 (1.9%) Non-Resident Cases. During the year 7 cases of Smallpox were removed from the OutPatient Department of Poplar Hospital—all residents of West Ham. Disinfection. 52 houses have been disinfected. 8 contacts removed and disinfected. 1,654 articles, including beds, bedding and clothing, removed and disinfected. 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. On receipt of Form 84 reporting that a child had been absent from school on account of Chickenpox infection in the house, the house was visited by one of the Medical Officers of the Department and a case of Smallpox was discovered and within a week six cases in all were removed. 88 Notification of Chickenpox.—The notification of Chickenpox was continued during the calendar year 1931, and x ,123 cases reported:— 1,118 notified by medical practitioners. 2 reported by the school authority. 3 reported by parents or from other sources. Of the 1,123 cases, 24 were not confirmed. All cases notified as Chickenpox were visited by a member of the Medical Staff. This procedure resulted in the discovery of 5 cases of Smallpox. The following table shows the visits paid by the Medical Staff to cases of doubtful Smallpox, Chickenpox and Smallpox contacts. Several of these visits represent visits paid to workplaces in order to examine contacts of cases who had been at work in an infectious condition:— 89 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) 28 15 19 2 301 5 70 (c) 110 57 607 (6) 2 — ' — — — — — — — 2 Tuberculosis Officer (a) 10 11 9 1 81 2 20 (d) 36 14 184 (b) 1 — — — — — — 1 Assistant Tuberculosis Officer (a) 2 3 4 91 3 5 (e) 16 11 135 (6) - — — — — — — — — — Temporary Asst. M.O.H. (a) 32 11 20 3 395 5 121 (f) 112 79 778 (6) 3 — — — — — — — — 3 Total 1,710 Notes, (a) Poplar residents. (6) Non-residents seen at Poplar Hospital. (c) 13 persons found to be suffering from Smallpox. (d) 2 „ „ „ „ (e) — „ „ „ „ (f) 12 „ „ „ „ 90 Vaccination. The following particulars regarding vaccination have been taken from the Vaccination Officer's reports:— Extraot from the Report of the Vaccination Officer, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1930, inclusive:— Registration Sub-Districts. Number of Births registered 1st Jan. to 31st Dec., 1930. Number of Births entered by 31st January, 1930, in "Vaccination Register." Number of Births which on 31st January, 1931, 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 1931. Number of Statutory Declarations of Conscientious Objection actually received during the calendar year 1931. 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 1402 206 — 1 869 71 — 22 30 203 708 1472 Bow and Bromley 1047 199 1 — 651 43 — 16 24 113 Total 2449 405 1 1 1520 114 — 38 54 316 708 1472 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 Nil. (b) The figures in Columns 2 to 11 should not include re-registered births. (c) The total number of copies of certificates for the year 1931 sent to other Vaccination Officers was 201. 91 POPLAR BOROUGH COUNCIL. Name of the Poor Law Institution or Vaccination District. Name of Medical Officer or Public Vaccinator. Numbers of Successful Primary Vaccinations of persons:— Number of Successful Re - vaccinations— i.e., Successful Vaccinations of persons who had been successfully vaccinated at some previous time. Observations. Under one year of age. One year and upwards. Total. Tho figures for the Poor Law Institutions should be shown separately. Totals Bromley Dr. C. Cotter 155 143 298 72 Poplar Dr. J. O'Brien 113 102 215 83 Bow Dr. G. Macrae 79 81 160 47 Millwall Dr. W. C. Millea 39 20 59 9 St. Andrew's Hospital Dr. J. Whigham — 30 30 42 Poplar Institution Dr. J. Whigham 1 — 1 — Bromley House Inst Dr. Butler Hogan — — — — Bow Institution Dr. K. T. Pinhey — — — — Col. 1 2 3 4 5 6 7 M. 379a. Dated this Fourth day of February, 1932. (Signed) H. E. DENNIS, Cleric of the Council. (Copy.) Form in Duplicate.—One eopy for the Clerk of the Council, the other for the Return to be sent to the Registrar-General, General Register Office, Somerset House, London, W.C.2. Vaccination. This Return may be transmitted without a letter. Return showing the numbers of persons successfully vaccinated and re-vaccinated at the cost of tho rates by the Medical Officers of the Poor Law Institutions and the Public Vaccinators during the year ended 30th September, 1931. 92 The following analysis of the Vaccination Return reveals the fact that nearly 82 per cent. of the children whose births were registered in 1930 were not protected by successful vaccination:— Births registered — 2,449 Deduct:— Died unvaccinated 114 Removals to other districts 38 Removals to places unknown, etc. 54 206 Surviving residents — 2,243 Successful vaccinations numbered 405 407= 18.1 per cent. Insusceptible of Vaccination 1 Had Smallpox 1 Conscientious Objections declared 1,520 Vaccinations postponed on Medical Certificates Number not accounted for 316 Total unvaccinated children 1,836= 81.8 per cent. 2,243= 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. Plague. No case of this disease was notified during the year. Anthrax, Glanders and Hydrophobia in Man. No cases of these diseases occurred. London Notification of Glanders Order, 1907. No notice was received from the Veterinary Inspector of the London County Council of the existence of glanders at premises in the Borough. 93 Erysipelas. 99 cases of erysipelas were notified during the year. Six 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 called upon to visit two cases of Puerperal Fever. The following is a summary of the notifications, etc., during the year Puerperal Fever. Puerperal Pyrexia. Cases notified 15 23 Removed to L.C.C. Fever Hospitals 6 4 Treated in other Hospitals 8 18 Treated at home 1 1 Specialist called in 2 — Deaths 4 * * One patient died from Pulmonary Tuberculosis. Continued and Typhus Fevers. No case of continued fever occurred. No case of typhus fever occurred. Cerebrospinal Fever. 8 cases of Cerebro-Spinal Fever were notified, and the patients were removed to hospital. Five cases terminated fatally. Acute Poliomyelitis. 5 cases were notified, and were treated in various hospitals. 94 Acute Encephalitis Lethargica. 4notifications were received, and 3 other cases were reported from various sources, 3 of the notified patients were treated in hospital. 4 deaths occurred. 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. From time to time reports as to cases admitted to the Encephalitis Lethargica unit at the Northern Hospital are received from the London County Council. Excluding the cases which died during the year, 21 cases were in vestigated. The following is a summary of the reports submitted:— Recovered or much improved and returned to work or school 2 In Institutions:— Mental Hospitals 3 Other Hospitals and Institutions 7 10 Attending hospitals or otherwise undergoing treatment 7 Suffering from after-effects but not receiving treatment 2 21 The 9 patients suffering from after-effects (excluding those in Institutions) were affected as follows:— Intelligence below normal 2 Sleep, poor or excessive 1 Paralysis—severe 1, slight 3 4 Movements of limbs impaired 1 Vision impaired 1 9 95 Acutc Polio-Encephalitis. One case of Acute Polio-Encephalitis was notified and was treated in hospital. One other case was not notified as the condition was not discovered until after death. Post-Vaccinal Encephalitis, etc. No case of Post-Vaccinal infection was reported. Measles. 851 cases of measles were reported to the Medical Officer of Health from various sources (principally from L.C.C. schools). 9 deaths were attributed to measles. During the year 166 cases of measles were admitted to 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 119. Pneumonia. 578 cases of Acute Primary Pneumonia and 25 cases of Acute Influenzal Pneumonia were notified during the year, 209 of the patients being treated in hospitals. 175 notified patients died—170 Acute Primary Pneumonia and 5 Acute Influenzal Pneumonia. Malaria. No case of Malaria was notified during the year. Dysentery. No notifications were received. 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 123. 96 Altered Diagnosis Cases. 120 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:— 46 Scarlet Fever; 57 Diphtheria; 1 Puerperal Pyrexia, altered to Puerperal Sepsis, and 4 Pueiperal Fever altered to Puerperal Pyrexia; 1 Smallpox; 10 Chickenpox. The final diagnosis in the 46 Scarlet Fever cases was:— Chickenpox 1 Erythema 1 Measles 6 Diphtheria 2 Stomatitis 1 Bronchitis 1 Common Cold 1 Disease not specified , * 1 Co 46 * These were reported "Negative case," "Not notifiable," etc. The final diagnosis in the 57 Diphtheria cases was:— Tonsilitis 14 Laryngitis 1 Measles 1 Scarlet Fever 2 Common Cold 1 Disease not specified *38 57 In addition, there were 18 cases reported as Bacteriological Diphtheria. These have been included as cases of Diphtheria. * These were reported "Negative case," "Not notifiable," etc. 97 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 1931 121 100 221 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.:— 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 1 11a.m. and 2 p.m. Any person not at work or not attending School. Thursday - Friday J Tuberculosis Officer's Report. The changes which have occurred in the Dispensary Staff during the year have been referred to by the Medical Officer of Health. Prior to the appointment of Dr. L. D. Richards as Assistant Tuberculosis Officer and Assistant Medical Officer of Health we had the services in the dispensary of Dr. H. D. Chalke, and, later, of Dr. M. A. Hatt. Statistics for 1931. The three following tables comprise the annual return for 1931 required by the Ministry of Health. The first provides a concise summary of the clinical work carried out during the year, while the other two show the classification of all patients remaining on the Dispensary Register on December 31st, together with a cumulative summary of all cases. 98 Return for the year 1931. 1. Return showing the work of the Dispensary. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding («) Definitely Tuberculous 66 51 3 5 12 14 12 11 78 65 15 16 174 (b) Diagnosis not completed — — — — — — — — 4 5 6 5 20 (c) Non-Tuberculous — — — — — — — — 118 129 96 94 437 B..—Contacts examined during the year:— (a) D finitely Tuberculous 16 8 1 2 1 — — 2 17 8 1 4 30 (b) Diagnosis not completed — — — — — — — — 1 1 2 4 8 (c) Non-Tuberculous — — — — — — — 19 33 50 67 169 C.—Cases written off the Dispensary Register as:— (a) Recovered 2 2 1 — — — — — 2 9 1 — 5 (b) Non-Tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as Tuberculous) _ — — 145 174 158 170 647 D.—Number of Cases on Dispensary Register on (a) Definitely Tuberculous 328 248 26 53 37 45 69 61 365 293 95 114 867 (b) Diagnosis not completed — — — — — — — — 5 4 7 9 25 1. Number of Cases on Dispensary Register on January 1st 821 2. Number of Cases transferred from other areas, and Cases returned after discharge under Head 3 in previous years 71 3. Number of Cases transferred to other areas, Cases not desiring further assistance under the scheme, and Cases "lost sight of" 58 4. Cases written off during the year as Dead (all causes) .. 128 5. Number of attendances at the Dispensary (including Contacts).. 5,364 6. Number of Insured Persons under Domiciliary Treatment on December 31st 246 7. Number of Consultations with Medical Practitioners:— (a) Personal 11 8. Number of visits by Tuberculosis Officers to homes (including personal Consultations) (b) Other 349 229 9. Number of visits by Health Visitors to homes for Dispensary purposes 7,051 10. Number of:— (a) Specimens of Sputa examined P.H. 438 Dispensary 1,202 (b) X-RAY examinations made Screen .. 73 Films 21 11. Number of "Recovered" Cases restored to Dispensary Register, and included in A (a) and A (b) above 12. Number of ''T.B. plus'' Cases on Dispensary Register on December 31st 1 477 2. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all Patients remaining on the Dispensary Register; and (b) the reasons for the removal of all Cases written off the Register. The table is arranged according to the years in which the Patients were first entered on the Dispensary Register as definite Cases of Pulmonary Tuberculosis. Condition at the time of the last record made during the year. Previous to 1926. 1926. 1927. 1928. Class T.B.—. Class T.B. +. Class T.B.—. Class T.B.+. Class T.B.—. Class T.B.+ . Class T.B.—. Class T.B.+ . Group I. Group II. Group III. Total (T.B. + ). Group I. Group II. Group III. Total (T.B. + ). Group I. Group II. Group III. Total (T.B. + ). Group I. Group II. Group III. Total (T.B. + ). (a) Remaining on Di& pensary Register or December 31st. Disease Arrested Adults M. 9 5 11 — 16 1 1 2 — 3 2 1 2 — 3 4 3 3 F. 3 5 6 — 11 5 1 1 — 2 5 2 — — 2 3 1 — — 1 Children 5 — 6 6 7 1 — 1 7 — 1 — 1 2 — — — — Disease not Arrested Adults M. 4 4 31 11 46 1 1 14 — 15 3 2 5 1 8 5 7 12 2 21 F. 6 8 26 2 36 — 3 1 4 1 5 2 8 1 3 9 — 12 Children 3 1 3 1 5 2 — — — — 1 — 1 — 1 2 2 — 2 Condition not ascertained during the year 8 6 10 — 16 1 2 3 — 5 4 — 2 — 2 3 2 1 — 3 (b) Not now on Dispensary Register and reasons for removal therefrom. Total on Dispensary Register on Dec. 31st 38 29 93 14 136 20 6 23 1 30 24 6 16 3 25 20 18 22 2 42 Discharged as Recovered Adults M. 32 18 20 — 38 — — — — — — — — — — — — — — F. 59 17 19 — 36 — — — — — — — — — — — — — — Children 75 7 7 — 14 — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Dispensary Register 37 29 61 3 93 13 6 10 — 16 16 11 8 — 19 11 3 8 — 11 Dead Adults M. 10 16 52 9 77 2 3 24 4 31 3 9 17 4 30 10 6 22 3 31 F. 6 14 37 7 58 5 23 2 30 3 5 26 4 35 2 1 24 3 28 Children 1 4 — 4 — — — 1 1 1 — — 1 I 3 — 2 — 2 Total written off Dispensary Register 220 101 200 19 320 15 14 57 7 78 23 25 51 9 85 26 10 56 6 72 Grand Totals 258 130 293 33 456 35 20 80 8 108 47 31 67 12 110 46 28 78 8 114 (aJ Remaining on Dispensary Register on December 31st. 1929. 1930. 1931. Disease Arrested Adults M. — — — F. — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — Disease not Arrested Adults M. 1 9 18 3 30 13 11 23 8 42 12 22 26 8 56 F. 6 12 11 2 25 8 12 18 4 34 11 13 16 8 37 Children 4 1 2 — 3 11 2 — — 2 5 2 1 — 3 Condition not ascertained during the year 2 1 3 — 4 3 4 3 1 8 — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom. Total on Dispensary Register on Dec. 31st 13 23 34 5 62 35 29 44 13 86 28 37 43 16 96 Discharged as Recovered Adults M. _ F. — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Dispensary Register 3 8 11 1 20 6 5 6 1 12 3 — — — — Dead Adults M. 4 9 14 6 29 3 4 24 7 35 2 1 4 8 13 F. 6 6 22 4 32 4 2 13 4 19 — — 2 8 10 Children 1 — — — — — 1 2 — 3 — — — 1 1 Total written off Dispensary Register 14 23 4- 11 81 13 12 45 12 69 5 1 6 17 24 Grand Totals 27 46 81 16 143 48 41 89 25 155 33 38 49 33 120 3. NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all Patients remaining on the Dispensary Register; and (ft) the reasons for the removal of all Cases written off the Register. Condition at the time of the last record made during the year. Previous to 1926. 1926. 1927. 1928. Bones & Joints. Abdominal. Other Organs. Glands. Total. Bonos & Joints. Abdominal. Other Organs. Glands. Total. Bones & Joints. Abdominal . Other Organs. Glands. Total. Bones & Joints. Abdominal . Other Organs. Glands. Total. (a) Remaining on Dispensary Register on December 31st. disease Arrested Adults M. — — — — — — — — — — 1 — — — 1 — — 1 1 F. — — — — 2 — — — — — 1 — — — 1 1 — — 1 Children 4 1 1 4 10 1 — — 2 3 3 1 — 3 7 2 2 1 3 8 M. 2 — — — 2 — — — — — — — — — — 1 1 2 Disease not Arrested Adults F. 3 — 2 2 7 — — — 2 2 — — 2 — — — 2 Children — — — 3 3 2 — — 3 5 3 — — 2 5 2 — — 2 4 Condition not ascertained during the year 2 — 5 7 14 2 1 — — 3 — 2 — 4 6 1 1 — — 2 Total on Dispensary Register, December 31st 12 1 9 16 38 5 1 — 7 13 8 3 — 9 20 8 3 2 7 20 (b) Not now on Dispensary Register and reasons for removal therefrom. Transferred to Pulmonary — — — 1 1 — — — — — — 1 1 — — — — — Discharged as Recovered Adults M. 5 2 4 5 16 2 1 3 1 — — — 1 — — — — — F. 5 — 4 6 15 — — — 1 1 — — 1 1 2 — — — — — Children 18 7 10 56 91 — 2 1 4 7 — — 3 3 — — — — — Lost sight of or otherwise removed from Dispensary 7 — 6 12 25 1 1 2 3 7 1 — — 3 4 1 2 — 5 8 Dead Adults M. 2 _ 2 3 3 _ — — 1 — 1 F. 1 1 — — — — — — — — — Children 1 — — 1 2 — — — — — — — — — — — — 1 1 Total written off Dspensary Register 39 9 24 80 152 4 5 3 9 21 2 — 1 7 10 1 2 1 6 10 Grand Totals of (a) and (b) (excluding those transferred to Pulmanary) 51 10 33 96 190 9 6 3 16 34 10 3 1 16 30 9 5 3 13 30 (a) Remaining on Dis- pensary Register on Decem ber 31st. 1929. 1930. 1931. Disease Arrested Adults M. — 1 1 — — — — — — — — — — F. — — — — — — 1 — 1 — — — — — Children 2 2 1 2 7 — — — 1 1 — — — — — Disease not Arrested M. 5 — — — 5 3 1 4 1 9 8 3 2 13 F. — — — 3 3 1 2 — 3 7 2 2 2 13 Children 6 — 1 2 9 5 5 2 9 21 11 2 2 9 24 Condition not ascertained during the year.. — 1 2 3 6 1 — 1 3 5 — — — — — Dispensary Register, December 31st 13 3 5 10 31 10 6 10 14 40 26 4 7 13 50 (b) N^ot now on Dispensary Register and reasons forremoval therefrom. Transferred Pulmonary — — 1 1 — — — — — — — — — — ^charged as Recovered Adults M. — F. — — — — — — — — — — — Children — — — — — — — — — — — — — Lost sight of or otherwise removed from Dispensary Register — — 1 2 3 — 1 — — 1 — — 1 1 Dead Adults M. — — — — — — — — — — — — — — — F. 1 — — — 1 — — — — — 1 — — 1 Children — — — — — — — — — — — — — — — Total written off Dispensary Regiser 1 — 1 2 4 — 1 — — 1 — 1 1 — 2 Grand Totals of (a) and (b) (exeluding those transferred to Pulmonary) 14 3 6 12 35 10 7 10 14 41 26 5 8 13 52 99 Comments on Table I. The number of new cases, including contacts, presenting themselves for examination during the year shows a decrease as compared with 1930. The total number of new cases found to be suffering from Tuberculosis is 204, as compared with 200 in 1930. The increase in the number on the Dispensary Register, 892, as compared with 821 in 1930, is explained by the fact that some 36 cases which originated at outside Hospitals before 1931 have been taken on to the register under Head 2. Also, such cases which originated during 1931 at outside Hospitals have been automatically taken on to the register as they arise, and this practice will be continued in future years. Coupled with this there has been an increase in the number of inward transfers during the year. Attendances at the dispensary, Health Visitors' and Tuberculosis Officers' visits to homes all show an increase as compared with 1930. Good co-operation with the General Practitioners in the Borough continues, and is reflected in the figures shown under Head 7. The X-ray Plant at the Dispensary continues to be used for screening. When necessary, X-ray photographs are taken at St. Andrew's Hospital. Comments on Tables II and III. These returns are at present optional. They look complicated, but a great deal of interesting information may be extracted from them. For example, take the Column headed 1926 on Table II. It will be seen that, out of a total of 143 patients (35 with negative, 108 with positive sputa) coming under treatment for Tuberculosis in 1926, only 50 now remain on the register, 29 having left the district and 64 having died. Of the 50 remaining on the register the disease in 19 has become arrested. The columns for the other years of origin may be similarly analysed. Throughout the table the higher death rate in positive sputum cases will be noted. The infrequency of positive sputum cases among children may also be pointed cut. 100 Table III shows the non-pulmonary cases analysed in a similar way. The very low death rate in these cases, together with a tendency to earlier arrest and cure are at once apparent, while the infrequency with which these cases contract pulmonary tuberculosis is revealed by the fact that during the last seven years only three of them have been transferred to Table II. Additional Statistics not dealt with in the Preceding Tables:— Patients sent away for Institutional Treatment 238 Patients in receipt of extra nourishment during the year 106 Patients in receipt of Extra Nourishment, 31st December 41 Reports on Children to Divisional School Medical Officer 131 Children recommended for admission to Open-Air Schools 5 Letters to General Practitioners concerning patients 385 Reports to General Practitioners on official forms 239 Progress reports received from General Practitioners 168 Clinical reports to London County Council 709 Shelters on loan during the year 4 Shelters on loan on 31st December 2 Bed and bedding on loan during the year Cases 34 Bed and bedding on loan on 31st December 26 During the year 6 new cases and 6 old cases have attended Brompton, Victoria Park and St. Thomas's Hospitals for 127 Artificial Pneumothorax refills, while 3 new cases and 4 old cases of Lupus have attended the London Hospital for 126 applications of Finsen light and 647 applications of General light. Also, 4 old cases of non-pulmonary tuberculosis (Glands, etc.), have attended the London Hospital for 63 applications of General light. Patients receiving Artificial Pneumothorax treatment (as well as patients needing Finsen Light treatment) are treated on the authority of the Tuberculosis Officer, the cost of treatment being charged to the Borough Council. It is probable that Artificial Pneumothorax treatment will become increasingly popular. It is the most valuable method of treatment in suitable cases, and there is a growing tendency to institute it earlier and more frequently. The small number of children recommended for Open Air Schools is explained by the fact that such recommendations are limited to children suffering from Pulmonary or Glandular Tuberculosis between the ages of 101 7 and 16 years who are fit to undertake the journey without escort or undue fatigue. Delicate non-tuberculous children are sent to Open Air Schools through the School Medical Service. In addition to the contacts enumerated on the first table, 177 were re-examined during the year. The work of revising the Medical Officer of Health's Tuberculosis Register, which was begun by the late Dr. W. C. P. Smith, has been successfully continued, and during the year 506 cases have been removed. These have been apportioned as follows:— Dead 132 Left or lost sight of 187 No longer suffering from Tuberculosis 187 Cases remaining on the Medical Officer of Health's Tuberculosis Register on 31st December 1,392 Cases remaining on the Tuberculosis Dispensary Register on 31st December 892 It may be well to point out that these two Registers, being each differently defined, can never be identical. Report of the Secretary of the Tuberculosis Care Committee. The Tuberculosis Care Committee continues to meet fortnightly at the Dispensary. The Committee, which is appointed by the Council, is representative of most of the public, social and charitable agencies in the Borough. Many of the members are in personal touch with the patients and much useful work is effected in this way. During the year there have been 21 meetings of the Tuberculosis Care Committee and 395 cases have been dealt with. The Committee considers the financial and home conditions of each new case of tuberculosis as it occurs and endeavours to give such help or advice as is needed. In addition to this, recommendations regarding assessment for institutional treatment are made to the London County Council, and 180 such recommendations were made during 1931. Contributions are collected for the L.C.C. in cases in which payments are made. The Care Committee has also considered 14 dental cases during the year, and 80 "Special cases" [i.e., cases in which some special form of help is required) have been dealt with. 102 The Care Committee has felt more than ever, during the past year, the advantage of having its own fund—the Poplar Tuberculosis Fundfor the provision of clothing and other necessities which cannot be obtained from other sources. The fund (which is a charity approved by the L.C.C.) is administered by a separate Committee which has met 7 seven times during 1931. 62 grants have been made to assist needy patients. 30 of these were in the form of clothing, and other assistance given includes the provision of dentures, payment of fares to visit relatives in sanatorium, laundry expenses for women patients who are unable to do this work themselves, cost of removal to better accommodation, special nourishment and general help. The main income of the Poplar Tuberculosis Fund during the year has again come from the Associated British Cinemas, who give a weekly grant in respect of Sunday entertainments at the Poplar Hippodrome; we have also been fortunate in obtaining, for the first time, a grant from the Alexandra Rose Day Fund. These grants have been augmented by various efforts on the part of the Tuberculosis Care Committee and their friends. The annual Household and Jumble Sale was held in November and two dances and two concerts were also organised in aid of the fund during the year. The Committee of the Poplar Tuberculosis Fund publishes its own Annual Report and Balance Sheet at the end of the financial year. The Handicraft Class for ex-sanatorium patients continues to be held at the Dispensary once a week, and is much appreciated by the members. The subjects taught now include leather-work, basket-making, cane-work, stool-seating, glove-making and pewter-work. The Poplar Handicraft Class had a stall at the Exhibition of Handicrafts organised by the Standing Conference of Metropolitan Tuberculosis Care Committees at the Carpenters' Hall last April, and goods were also sent to the Exservicemen's Exhibition at the Imperial Institute in November. In addition, a Christmas Exhibition and Sale was held at the Dispensary in December, which was opened by his Worship, the Mayor of Poplar. A grant of £10 for running expenses was given to the Handicraft Class by the National Association for the prevention of Tuberculosis during the year, and this sum, together with amounts received from sales, has enabled the Class to run without any assistance from the Poplar Tuberculosis Fund. The Poplar Tuberculosis Care Committee is represented on the Standing Conference of Metropolitan Borough Tuberculosis Care Committees and three meetings of that body have been attended at the County Hall. Members of the Committee have also visited Papworth Colony with a party organised by the Conference. 103 The Tuberculosis Care Committee has had to face greater difficulties than ever during 1931 as a result of the conditions arising from increased unemployment. It has become practically impossible for the Committee to assist patients to obtain work, and the general economic depression has, unfortunately, prevented many families from maintaining such a standard of life as would contribute towards the prevention of tuberculosis. The Tuberculosis Care Committee gratefully acknowledges the cooperation and assistance that has been received from other societies, particularly the Poplar Branch of the Invalid Children's Aid Association, which has done much useful work in visiting children and arranging convalescence. Tuberculosis Dental Clinic. (a) Report of Dental Surgeon. I beg to submit a Report of the Dental Work carried out during 1931 (January to September) in connection with the Tuberculosis Clinic. On account of our difficulties with this work, the Dental Clinic closed down at the end of September, more advantageous arrangements being made elsewhere. A steady falling-off of work was noted, and as we were only holding two sessions per month, treatment, in most cases, was very protracted. Owing to that fact, and difficulties which I have explained in previous reports, I was of the opinion that the patients affected were not having the best treatment, though it was obvious that they were the ones who needed it particularly. Our figures for the nine months of 1931 were:— 18 Sessions held; 53 Attendances; 2 Fillings; 87 Extractions; 7 Scalings. In addition, dentures were fitted, and the usual routine work carried out. C. HAMMOND WILLIAMS, L.D.S., R.C.S., Eng. 104 (b) Report of Dental Surgeon , St . Andrew's Hospital . October 1st to December 31st, 1931. Number of Patients 8 Attendances 14 Extractions—No. of Teeth 18 Anaesthetics—Nitrous Oxide and Oxygen 6 Local Anaesthetics 1 (Signed) F.G. HUTCHISON. Under the new arrangements a dental clinic is held at St. Andrew's Hospital on two days in each week. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part I.—Summary of Notifications during the period from the 28th December, 1930, to the 2nd January, 1932, in the area of the Metropolitan Borough of Poplar (to which this Return relates). Formal Notifications. Age Periods. Number of Primary Notifications of New Cases of Tuberculosis. Total Notiflcations. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages). Pulmonary—Males 1 1 2 5 14 16 21 31 28 8 7 134 264 Fema les - 1 4 3 16 20 22 13 12 5 - 96 186 Non-Pulmonary—Males 4 6 5 8 6 4 2 2 1 - 1 39 58 ,, Females 1 4 7 5 4 7 3 3 3 1 1 39 55 Col. (1) (2) (8) (4) (5) (6) (7) (ft) (9) (10) (11) (12) (13) (14) PART II.—SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total. Pulmonary—Males 1 - - - 1 1 - 3 6 2 - 14 ,, Females - - - 2 - 2 2 - - - 6 Non-Pulmonary—Males - - - - - - - - 1 - - 1 ,, Females - 1 - - - - 1 - - - - 2 The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of Information. Number of Cases. Pulmonary. NonPulmonary. Death Returns from Local Registrars 14 2 transferable deaths from Registrar-General — — Posthumous notifications 2 1 "Transfers" from other areas (other than transferable deaths) 4 — Other Sources, if any (specify) — — 105 PART III.— NOTIFICATION REGISTER Number of cases of Tuberculosis remaining at the 31st December, 1931, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough Pulmonary. Non-Pulmonary. Total Cases. Males. Females Total. Males. Females Total. 530 426 956 246 190 436 1,392 Number of cases removed from the Register during the year by reason inter alia, of:— 1. Withdrawal of notification 5 2 7 1 - 1 8 2. Recovery from the disease 71 93 164 59 48 107 271 3. Death 147 118 265 10 15 25 290 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was taken under the above Regulations during the year. Public Health (Tuberculosis) Regulations, 1924 and 1930. Summary of Quarterly Returns to the London County Council. Number of Cases on Register at commencement of quarter Quarter ended March. June. September December. 1,897 1,838 1.851 1,619 Number of New Cases notified 89 79 68 70 Number of Cases restored to Register, etc 8 5 3 6 Number of Cases removed from Register 156 71 303 303 Number of Cases on Register at end of quarter. Pulmonary 1,289 1,297 1 ,124 956 Non-Pulmonary 549 554 495 436 Totals 1.838 1.851 1.619 1,392 106 Particulars of new cases of Tuberculosis and of all Deaths from the disease:— Age Periods. New Cases. Deaths. (Reg. General's figures). Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 1 — 4 1 2 1 2 — 1 — 1 1 6 4 — — 3 2 5 — 2 4 5 7 — 1 1 1 10— 5 3 8 5 15— 14 16 6 4 13 24 1 2 20— 16 20 4 7 25— 21 22 2 3 19 10 1 1 35— 31 13 2 3 20 12 — 1 45— 28 12 1 3 24 3 3 — 55— 8 5 — 1 15 5 — — 65 and upwards 7 — 1 1 3 — — — Totals 134 96 39 39 96 56 11 7 The ratio of non-notifiied Tuberculosis deaths to total Tuberculosis deaths was 9.4%. Disinfecting Department. Bow and Poplar. Bromley. Totals. Premises Disinfected 1,064 644 1,708* ,, visited re Disinfection 1,160 646 1,806 *Does not include premises disinfected on account of Smallpox (95). Number of Verminous Rooms sprayed with Solution "D" 231. Articles Disinfected. Smallpox. Other Infectious. Diseases. Tuberculosis. Verminous. Miscellaneous. Totals. (a) From Infected Premises 1,512 12,982 608 68 1,916 16.986 (b) From Cleansing Station — — — 6,226 28,004 34,230 (c) From Contacts 135 68 — — — 203 (d) ,, Shelter 7 — — — — 7 Totals 1,654 13,050 508 6,294 29,920 51,426 Articles destroyed by request, 1,485. Vermicide—Quantity issued from Depots, 288 gallons. 107 ■Cleansing Station. Totals. M. F. Verminous persons cleansed .. 44 1 ,, children ,, 196 952 Scabies cases, cleansed, adults 10 19 ,, ,, children 705 930 Total cleansings 955 1,902 Vehicle. Average m.p.g. Blue Van 13.1 (a) Brown Van 13.5 Lorry 13.2 (6) M.O.H.Car 16.5 Special Vehicle for Contacts 12.6 (a) 4 weeks in workshop for overhaul, speedometer out of order for 3 weeks. (b) 4 ,, „ ,, Electrolytic Disinfecting Fluid. The electrolytic disinfecting fluid as manufactured contains approximately 9-10 grammes per litre of free chlorine and is broken down to a strength of approximately 4 grammes per litre for distribution. During the year 1931, 53,730 gallons were manufactured and broken down to 108,840 gallons of weaker solution for distribution. The production of the solution at a strength of 4 grammes of available chlorine per litre has averaged 114,475 gallons per annum for three years at an average annual cost of £2,250, the cost per gallon thus being 472d. Quantity Produced. As Manufactured. Gallons. As Issued. (».e., Weaker Solution.) Gallons. Electricity Consumed., Units. No. 1 Apparatus 19,380 39,360 10,013 No. 2 Apparatus 18,810 38,220 9,703 No. 3 Apparatus (11 months 011 ly) 15,540 31,260 7,983 Totals 53,730 108,840 27,699 108 EXTRACT FROM ANNUAL ESTIMATES, Etc. Electrolytic Disinfecting Fluid. Estimate for Year ended 31st March, 1931. Expenditure for Year ended 31st March, 1931. Average Expenditure for 3 years ended 31st March, 1931. Estimate for Year ended 31st March, 1932. Estimate for Year ending 31st March, 1933. £ £ £ £ £ £ £ £ £ Wages 1277 1326 1309 1277 1241 Rates, Taxes and Insurance—Main Depot 92 89 91 84 82 Rent (Issuing Depots) 46 46 46 46 46 Electricity and Water 265 252 253 270 300 Chemicals 200 99 163 160 120 Testing Apparatus 5 1 1 5 5 Bottles, Carboys, Hampers, Corks, etc 70 38 56 70 50 Overalls and Clogs 9 11 7 9 8 Supervision of Plant 15 15 15 15 15 Repairs and Renewal of Plant 70 40 43 50 140 Replacing part of Plant 600 455 152 - Repairs (Works Dept.) Main Depot 150 171 112 200 60 ,, ,, Issuing Depots 100 75 78 100 100 Petty Expenses and Sundries 5 9 8 12 10 2904 2627 2334 2298 2177 Lest Income 30 2874 52 2575 84 2250 50 2248 50 2127 109 1,361 gallons were supplied to London County Council Schools for spraying and cleansing floors of classrooms. The addition of electrolytic disinfecting fluid to the water in the swimming baths continues in the proportions mentioned in the Annual Report for the year 1909, viz., 1 part of Chlorine to 2,000,000 parts of water. 4,215 gallons were supplied to the Poplar Baths, 1,404 gallons to the Bow Baths, 485 gallons to the Island Baths, and 1,410 gallons to the open-air swimming baths, making a total of 7,514 gallons. 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. 1931. £ s. d. March 276 786 49 19 0 June 260 765 47 17 0 September 308 540 40 7 0 December 452 691 55 0 0 Totals 1,296 2,782 £193 3 0 Miss Landray made 22 visits in connection with verminous schoolchildren and 150 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. 110 Cleansing of Persons Act, 1897. During the year, 74 persons—including 64 from common and seamen's lodging houses (see below)—applied for baths and for their clothes to be disinfested. Verminous Persons in Common Lodging Houses. The number of persons from Common Lodging Houses and Seamen's Lodging Houses, etc., cleansed at the Council's Cleansing Station, Glaucus Street, during the year was:— Lodging House, etc. Male. Female Total. 196, Bow Road 1 — 1 St. James's Chambers, 207, High Street, Poplar 1 1 65, Bow Lane — — — 378, Old Ford Road — — — 38, Pennyfields — — — Salvation Army Home, Bow Road 2 — 2 ,, ,, Hostel, Garford Street 18 — 18 411, East India Dock Road 2 — 2 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 l6 16 Totals 40 — 40 For cleansing of verminous rooms see page 35. MATERNITY AND CHILD WELFARE CLINICS. Situation. Nature of Accommodation. Clinics. (1) Provided by the Borough Council:— Simpsons Road, Poplar Medical Officer's, Weighing and Waiting Rooms (Weighing Room also used for Artificial Sunlight Treatment) Infant Consultations: Wednesdays, 10.30 a.m. to 12.30 p.m. and 2 to 4 p.m. Ante-Natal: Mondays 2 to 4 p.m. Sewing Class: 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. Wesley an Mission, Old Ford Road Medical Officer's Room and Weighing and Waiting Room combined Infant Consultations: Tuesdays and Fridays, 2 to 4 p.m. Methodist Chapel, Manchester Road Medical Officer's, Weighing and Waiting Rooms Ante-Natal: Fridays, 10.30 a.m. to 12.30 p.m. Infant Consultations: Wednesdays, 10.30 a.m. to 12.30 p.m., and 2 to 4 p.m. 54, West Ferry Road Ditto Ditto Ditto Infant Consultations: Fridays, 2 to 4 p.m. 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: Alternate Wednesdays 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. (2) 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 Special Clinic: (By appointment only) Fridays, 2 to 4 p.m. Infant Consultations. Tuesdays, Thursdays and Fridays, 2 p.m. Sewing Class: Wednesdays, 2 p.m. Dental: (By appointment only) Mondays, 1.30 and 3 p.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. Post-Natal Clinic: Wednesdays, 9.30 to 12.30 The Lighthouse Mission, Blackthorn Street Medical Officer's Room and Large Hall for weighing and waiting Infant Consultations: Wednesdays, 2 p.m Trinity Hall, Augusta Street Ditto Ditto Ditto Infant Consultations: Wednesdays, 2 p.m. 1ll 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 1920 is shown below Borough Council. Royal College. 1920 14,490 13,147 1921 15,710 9,856 1922 17,404 8,992 1923 24,058 11,718 1924 27,137 13,598 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 1931 42,340 34,275 In the 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. 112 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:—156,300 (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, 2,783; (b) Still births, 88; (c) Total, 2,871. (d) By midwives, 1,216; (e) By doctors and parents, 447; (f) Institutions in Borough, 1,208. 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) Equivalent of whole-time services devoted by the whole staff to health visiting including attendance at Infant Welfare Centres:— (a) In the case of Health Visitors employed by the Council—⅞; ⅛ whole- time service being spent at the Artificial Light Clinic. (b) In the case of Health Visitors employed by Voluntary Associations— 1 Health Visitor spends J of her time in the Test Feeding Dept. (iii) Number of visits paid during the year by all Health Visitors— (a) To expectant mothers—First visits, 1,332; Total visits, 4,330. (b) To children under 1 year of age—First visits, 2,794; Total visits, 22,812. (c) To children between the ages of 1 and 5 years—Total visits, 45,309; plus visits paid to children over 5, L.C.C. Measles Scheme, 312; Puerperal Pyrexia, Fever, Maternal Deaths, 248; Total visits paid, 72,911. 113 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. (c) Total number of attendances at all Centres during the year— (i) By children under 1 year of age—25,074. (ii) By children between the ages of 1 and 5 years—24,774. (d) Average attendance of children per session at all Centres during the year—77.9. (e) Total number of children who attended at the Centres for the first time during the year— (i) Children under 1 year of age—1,918. (ii) Children between the ages of 1 and 5 years—505. (f) Percentage of notified live births, represented by the number in (e)(i)—69.0 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. (b) Number of Clinics provided and maintained by Voluntary Associations—1. (c) Total number of attendances by expectant mothers at all Clinics during the year—3,354. (d) Average attendance of expectant mothers per session at all Clinics during the year—19.2. (e) Total number of expectant mothers who attended at the Clinics during the year—1,233. (f) Percentage of total notified births (live and still) represented by the number in (e)—43.0. Other Clinics additional to above-mentioned. Total Attendances. Average Attendance per session. Artificial Light Clinics 14,634 17.0 Dental Clinics 2,415 8.3 Sewing Classes 3,051 33.2 Remedial Exercises Clinic 1,092 11.74 Mothers' Clinic (Post-natal) 405 9.4 Garden Clinic 1,816 — *Including Ante-natal Clinics provided at institutions transferred to the Council under Part I of the Local Government Act, 1929. 114 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 and subsidised by the Council. Number of Institutions St. Andrew's Hospital, Devons Road, Bow, E.3 1 ward. Arrangements made with L.C.C. terminated 31.3.31. Nil Nil Number of maternity beds 12 Nil Nil Total number of women admitted to these beds during the year 3 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 and subsidised by the Council. Number of tutions 1 Nil 1 Number of beds provided for such children 11 Nil 12 6 for Observation Ward, 6 for Ton sillectomy. Total number of children admitted to these beds during the year Children remaining, 31.12.30, 10 admitted, 1931, 45; in addition, 6 of these children were re-admitted Nil i 198 55 for Observation Ward, 143 for Tonsillectomy. II. Number of such children (if any) sent by the Council during the year to other Institutions—Nil. 115 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— (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; Mothers, 2; Children, 15. (e) Sent by Voluntary Associations—Mothers and babies, 20; Mothers, 2; Children, 27. 9. Homes for Mothers and Babies. (a) Number of such homes— (i) Provided by the Council—Nil. (ii) Provided by Voluntary Associations—Nil. (b) Ntimber 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) HaIf-day—N i 1. 116 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 37 37 7 1 (2) Pemphigus Neonatorum 15 15 7 4 Not notifiable, Reported cases (3) Puerperal fever 15 14 1 14 (4) Puerperal pyrexia 23 23 4 22 (5) Measles and german measles (in children)— Under 5 years of age 539 539 7 136 Over 5 years 312 312 1 30 Not notifiable, Reported cases Whooping cough (in children (6) under 5 years of age) 804 804 8 127 Not notifiable, Reported cases (7) Epidemic diarrhoea (do.) 57 57 8 7 (8) Poliomyelitis (do.) 3 3 - 3 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; 89 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—18. (b) Number— (i) Employed by the Council—Nil. (ii) Directly Subsidised by the Council—Nil. (iii) Employed by Voluntary Associations—Nil. (c) Number of cases attended by midwives during the year— (i) As midwives—1,216, exclusive of midwives in Institutions. (ii) As maternity nurses. (d) Number of cases during the year in which the Council paid or contributed to the fee of a midwife—17. (e) Compensation paid to midwives when cases were referred to Hospital—12. 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—3. (b) Number of these cases which died— (i) At home—1. (ii) In institutions—6. 117 MATERNITY AND CHILD WELFARE. Return relating to Maternity Hospitals and Homes maintained or subsidised by the Council during the period 1st January to 31st March, 1931 (Agreement with L.C.C. terminated 31st March, 1931). 1. Name and address of Institution—St. Andrew's Hospital, Devons Road, Bow, E.3. 2. Number of Maternity beds in the Institution—12. 3. Number of Maternity cases admitted during the year 3 months ended 31st March, 1931 (termination of agreement)—3. 4. Average duration of stay—14 days. 5. Number of cases delivered by— (a) Midwives—3. (b) Doctors—Nil. 6. Number of cases in which medical assistance was sought by a midwife in emergency—N il. 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 breast fed while in the Institution—Nil. 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) Number of foetal deaths— (i) Stillborn—Nil. (ii) Within 10 days of birth—Nil. (b) Cause of death in each case, and results of post-mortem examination (if obtainable). Miss J. M. Cardozo, Chief Health Visitor, reported as follows:— Home Visiting.—During the past year a special effort has been made with regard to the welfare of the Toddler. The overcrowding which still exists in many homes makes this a serious problem. Once the child is over one year, he needs room to develop his rapidly-increasing activities. Advice to the mother at this time is most essential, so that she may make the best of a difficult situation. 118 The increased attendance at the Clinics of children of this class shows that the effort has not been in vain. At the request of the L.C.C. a special report has been sent to the Education Authority with regard to children who have commenced attendance at school before the age of five years. Since March to December, 1931, 1,702 completed forms have been forwarded. This applies to the whole Borough. The additional visiting under the L.C.C. Scheme of Measles Control commenced in December, 1931, the procedure being the same as during the last epidemic. The Health Visitors find that it is now the exception to find a case of Measles at which a Doctor is not attending. More than one mother has said how useful she has found the advice given at the Health Talks on the Nursing of Measles. Clinics.—The attendance at the Infant Consultation Clinics is steadily increasing, and it is encouraging to note that the increase is well marked in the Toddler Class, showing that the mothers have benefited by the advice given by the Health Visitors when home visiting, and that the rights of the ex-baby are not lost sight of in the interest caused by the arrival of the new baby. The average attendances continue very high, especially at Wellington Road. We are still working under difficulties at Old Ford Wesleyan Mission, but hope that the suggested alterations there will be carried out this summer, and that better accommodation including a pram shelter, will be provided. The Sewing Class has been most successful, and useful garments have been made. A keen interest has been taken in the Health Talks. It was suggested that the mothers might like to write a short account of these Talks, and a good response was made. The papers naturally varied in merit, some were excellent, but all who made the effort are to be commended . Our thanks are due to the Voluntary Workers at the Clinics, and to the Royal College of St. Katharine for their co-operation and ready help in all things concerning the welfare of the mothers and children of the Borough. Thanks, also, are due to all who kindly contributed to the expense of the Mother's Christmas Tea, and sent gifts of woollies and clothing for the Jumble Sales. 119 STATISTICAL SUMMARY OF HOME VISITING FOR 1931. Public Health Department. The Royal College of St. Katharine. Total 1931. Total 1930. Cases. Visits. Cases. Visits. Cases. Visits. Cases Visits. Ante-Natal:— No. of Cases 733 — 599 — 1,332 — 1,306 — Primary visits — 733 — 599 — 1,332 — 1,306 Re-visits — 1,404 — 1,594 — 2,998 — 2,888 Infant Child Welfare visits:— Primary visits (Infants) — 1,310 — 1,266 — 2,576 — 2,809 Removed before visit — 19 — 44 — 63 — 75 Died before visit — 30 — 37 — 67 — 65 Stillbirths — 39 — 49 — 88 — 103 Re-visits— Under 1 — 8,889 — 10,298 — 19,187 — 20,152 1-5 — 18,536 — 23,146 — 41,682 — 42,181 Removed — 546 — 733 — 1,279 — 1,205 Died — 106 — 113 — 219 — 156 †Ophthalmia Neonatorum:— No. of Cases notified 37 — — — 37 — 42 — Primary visits — 37 — — — 37 — 42 Re-visits 76 — — 76 — 99 Removed to Hospital 1 — — — 1 — — — Enteritis:— (a) No. of Cases reported — — — — — — 5 — (b) No. of Cases notified (Z.E.) 16 — 41 — 57 — 118 — (a) Primary visits — — — — — — — 5 Re-visits — — — — — — — 12 Removed to Hospital — — — — — — — — Died — — — — — — — — (b) Primary visits — 16 — 41 — 57 — 118 Re-visits — 8 — 76 — 84 — 223 Removed to Hospital 7 — — — 7 — 14 — Died — 1 — 1 — 2 — 4 Measles:— No. of Cases under 5 years 239 — 300 — 539 — 1130 — Primary visits — 239 — 300 — 539 — 1130 Re-visits — 66 — 206 — 272 — 765 Removed to Hospital 136 — — — 136 — 87 — Died — 2 — 7 — 9 — 28 Total visits— Children over 5 years — 100 — 212 — 312 — 2,266 Whooping Cough:— No. of Cases 423 — 381 — 804 — 94 — Primary visits — 423 — 381 — 804 — 94 Re-visits — 144 — 152 — 296 — 36 Removed to Hospital 104 — — — 104 — 3 — Died — 2 — 6 — 8 — 3 †Puerperal Fever:— No. of Cases notified 15 — — — 15 — 10 — Primary visits — 15 — — — 15 — 10 Re-visits — 44 — — — 44 — 8 Removed to Hospital 14 — — — 14 — 9 — Died — 4 — — — 4 4 — †Puerperal Pyrexia:— No. of Cases notified 23 — — — 23 — 7 — Primary visits — 23 — — — 23 — 7 Re-visits — 27 — — — 27 — 9 Removed to Hospital 22 — — — 22 — 7 — Died — — — — — — — — Maternal Deaths (enquiries) 7 — — — 7 — 4 — Maternal Deaths:- — — — — — — 4 — Primary Visits — 7 — — — 7 — 4 Re-visits — 32 — — — 32 — 12 Miscellaneous Visits — 503 — 269 — 772 — 686 visits:— Primary — 2,803 — 2,587 — 5,380 — 8,033 Re-visits — 30,578 — 36,943 — 67,531 — 68,468 Total Visits paid, 1931 — 33,381 39,530 — 72,911 — — Total Visits paid, 1930 — 35,056 — 41,445 — — — 76,501 * Zymotic Enteritis is notifiable from 1st June to 30th September. †All cases are visited by Health Visitors of the Public Health Department. Enquiries re Maternal Deaths are made by the Public Health Department. 120 The following table shows the attendances at each of the Clinics during the year 1931:— 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 — — 720 343 1,646 1,708 Average per session 11.7 — — 15.0 13.7 13.4 33.4 Dble session. Infant Consultations:— First attendances 309 153 196 295 299 1,252 1,171 Total attendances 7,417 3,470 6,505 6,712 5,144 29,248 20,600 Average per session 74.2 69.4 62.5 64.5 98.9 71.3 81.4 Dble Average attendance of each child 12.6 7.8 12.0 11.3 10.0 10.9 session. 8.4 Light Clinics:— Attendances — — — 3,665 5,764 9,429 5,205 Average per session — — — 15.1 20.1 17.9 16.0 Dental Clinics:— Attendances — — — — 1,079 1,079 1,336 Average per session — — — — 14.2 14.2 11.7 Sewing Class — — — 938 — 938 2,113 Garden attendances — — — — — — 1,816 Mothers' Clinic (PostNatal) — — — — — — 405 Remedial Clinic — — — — — — 1,092 Total attendances at all Clinics:— 1931. 1930. P.H. Department 42,340 40,924 Royal College of St. Katharine 34,275 32,173 Total 76,615 73,097 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:— 121 £ s. d. Dried Milk, 8,270 lbs. 508 19 0 ,, ,, Humanized, 163 lbs 43 6 0 Aberdeen Emulsion 10 1 7 Dusting Powder 1 0 0 Medicinal Paraffin 4 10 0 Medical Sundries 12 17 4 Dentures 67 5 6 Materials at Sewing Class 16 8 9 Convalescent Treatment Virol 9 20 9 18 0 3 Oil and Malt 93 4 10 Concentrated Food 24 7 10 Payments for Gas (Dental Clinic) 3 15 0 Maternity Ward Fees 4 13 0 Accouchement Sets 14 5 0 Total £835 1 1 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. 1,892 such vouchers were issued during the year. Convalescent Treatment, etc. Convalescent Treatment (mothers with babies) 14 cases. ,, ,, (mothers alone) 2 ,, ,, ,, (children under 5 years) 15 ,, Payment of Midwives' fees 17 ,, Compensation to Midwives 12 ,, Loan of maternity bag, containing clothing, etc 15 ,, Grant allowed for Accouchement Sets 37 ,, (The following tables refer to the whole Borough.) Statistics Respecting Infants Born in 1930. All births, including those occurring in outlying districts, but belonging to the Borough 3,203 Doctors in attendance 536 Midwives in attendance 1,437 Delivered in institutions 1,222 Not stated 8 Moved into Borough 79 3,282 122 Stillborn (Stillbirths per 1,000 births, 32.1) 103 Died before visit 67 Not requiring or desiring visits 77 247 Visited 3,035 Removed within the year 390 Died during visitation 102 492 Remaining under supervision end of first year 2,543 Mortality per 1,000 visited 33.6 The 2,543 children visited during 1931 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 77.9 percent. Mixed feeding 16.6 ,, Hand-fed 5.4 ,, The 102 children who died during the first year of life, were fed during the first six months of life as follows:— Breast-fed 46.1 per cent. Mixed feeding 33.3 ,, Hand-fed 20.6 ,, Below is a statement comparing the mortality rates per 1,000 visited of children fed by the various methods:— (a) Babies breast-fed 23 (b) ,, who received mixed food (breast and hand) 74 (c) ,, hand-fed 132 Stillbirths. (This refers to the whole Borough.) 88 Stillbirths were investigated during the year 1931. Number of Stillbirths 88 Doctors in attendance 15 Midwives in attendance 27 Delivered in Institutions 44 B.B.A 2 123 Ophthalmia Neonatorum. Thirty-seven 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 48 11 58 — — 1 1929 56 51 5 56 — — — 1930 42 38 4 42 — — — 1931 37 36 1 37 — — — Total 896 802 93 871 7 1 16 ** 1 born in Institution—not visited, no information available. * Including 3 which occurred in Institution. Cases Notified and Visited. Number of notifications received 37 Very slight cases 32 Died in Institutions (intercurrent disease) — Sight of one eye damaged — Recovered 37 Occurred in Institutions 4 Occurred in the practice of medical practitioners 3 Occurred in the practice of midwives 30 Admitted to hospital as in-patients 1 Treated as hospital out-patients 1 Treated privately 31 Visited by nurse 7 124 Zymotic Enteritis.—Notifiable June-September. (Whole Borough). Notifications received .. 57 Under 1 year (see feeding below) 28 1 to 2 years 20 2 to 3 years 5 3 to 4 years 3 4 to 5 years 1 Died before notification received •• Nil Visited •• 57 Treated in hospitals 7 Of the 28 cases of Zymotic Enteritis under 1 year of age which were notified, 1 died. This was hand-fed. The remaining 27 were fed as follows:—Breast-fed, 10; mixed feeding, 9; hand-fed, 8. Home Nursing. By arrangement with the Nursing Associations nursing is provided (with the consent of the practitioner attending a patient) and paid for by the Council at the rate of is. 3d. per visit, in cases of Ophthalmia Neonatorum, Measles, Whooping Cough, Pneumonia, Zymotic Enteritis, Pemphigus, Puerperal Fever and Puerperal Pyrexia. 125 The following is a summary of visits paid by Nurses during 1931:— (This table refers to the whole Borough.) E.L.N.S. St. John Divine. St. Mildred's District Nurse. Totals. Cases. Visits. Oph. Neon. Cases 6 — 1 7 — Visits 194 — 4 — 198 Measles Cases Under 5 — 7 — 7 — 5-10 — 1 — 1 — Visits Under 5 — 93 — 93 5-10 — 8 — — 8 Pneumonia Cases Under 5 19 20 5 44 — 5-10 1 3 1 5 — Visits Under 5 311 404 56 — 771 5-10 27 24 10 — 61 Pemphigus Cases 1 — 6 7 — Visits 35 — 68 — 103 Whooping- Cough Cases under 5 3 1 — 4 — 5-10 — 1 — 1 — Visits under 5 34 30 — — 64 5-10 — 12 — — 12 Zymotic Enteritis Cases 8 — — 8 — Visits 85 — — — 85 Puerperal Pyrexia Cases 4 — 1 5 — Visits 103 — 5 — 108 Totals Cases 42 33 14 89 — Visits 789 571 143 — 1503 126 The following table relates to visited children of ages 1 to 5 years:— Year of Birth. 1926 1927. 1928. 1929. Remaining under supervision: End of first year — — — 2,605 „ second year — — 2,430 — „ third year — 2,410 — — „ fourth year 2,467 — — — Inward Transfers 41 92 88 71 Visits discontinued — — — 2 Outward Transfers 182 183 220 263 Died 5 10 12 48 Remaining under supervision: End of second year — — — 2,363 „ third year — — 2,286 — „ fourth year — 2,308 — — „ fifth year 2,321 — — — Mortality per 1,000 visited: Second year — — — 17.9 (24.) Third year — — 4.8 (7.2) — Fourth year — 4.0 (6.8) — — Fifth year 2.0 (3.4) — — — The figures in parentheses are the rates for the previous years. Co-operation with the Education Authority. 2,321 case sheets relating to the children who have reached the age of 5 years were forwarded to the Education Department. 1,702 special reports were also forwarded regarding children attending school, not yet 5 years of age. 127 Maternal Deaths.—The investigation of maternal deaths was carried out as in previous years on the lines suggested by the Ministry of Health. There were 7 maternal deaths, and the mortality rate was 2.5 per 1,000 live births. Cause of Death. Attended at home by Treated in Institution. Number of previous Pregnancies. If attended Antenatal Clinic. Condition of Child. Puerperal Sepsis, 4 cases— 1. Puerperal Septicaemia Midwife Yes 9 Yes Alive. 2. Puerperal Septicaemia Midwife (B.B.A.) Yes 7 No Alive. 3. Puerperal Septicaemia Placenta praevia — Yes 5 No Stillborn 4. General Peritonitis Caesarean Section. Contracted Pelvis. — Yes Nil Yes Alive. Other Causes, 3 cases— 1. Inversion of Uterus — Yes Nil Yes Alive. 2. Shock; Rupture of Uterus; Delivery of child — Yes 7 Yes Alive. 3. Postpartum uterine haemorrhage; Uterine atony; Multiparity Doctor No 7 No Stillborn The Council have given serious consideration to the question of maternal mortality, and for some years past arrangements have been made with a Consulting Obstetrician to visit cases of Puerperal Fever and Puerperal Pyrexia in consultation with general practitioners. During the year two consultations were held. During the year the Maternity and Child Welfare Committee considered Circular 1,167 and Memorandum 156 MCW, and upon their recommendation the Council extended the Maternity and Child Welfare Scheme in the following respects:— 1. Increased the number of ante-natal clinics held at Wellington Road. 2. Arranged for part payment of midwives' fees provided the income fell below a scale already approved, but irrespective of whether the applicant would be receiving maternity benefit. 128 3. Arranged for the Consulting Obstetrician at St. Andrew's Hospital to hold a weekly ante-natal consultation clinic for the examination of patients referred to him by general practitioners practising in the Borough or by clinic Medical Officers on account of some abnormality of pregnancy in the treatment of which the practitioner or clinic Medical Officer is of opinion that the opinion of a consultant is desirable. A brief report upon each case is sent to the medical practitioner by the consultant immediately after the examination of the patient. 4. Arrangements were made with four Consulting Obstetricians for their services to be available at the request of a general practitioner attending any midwifery case which presented special difficulty or abnormality at or after the confinement. The attention of all doctors and midwives was specially drawn to the services provided by the Borough Council. Since the scheme came into operation on 7th July, 1931, the number of patients seen at St. Andrew's Hospital (as mentioned in paragraph 3) was as follows:— (a) Referred by private practitioners 3 (b) Referred by clinic medical officers 10 13 In addition to the above, earlier in the year the Council decided to supply sterile maternity outfits at cost price or at half-price, according to family incomes. Infantile Mortality.—The infantile mortality rate (77) is considerably higher than the figure for the previous year. Whilst the total number of births has decreased, there was an increase of 44 in the number of infantile deaths as compared with last year. The chief cause of the increase was deaths due to Bronchitis and Pneumonia. The majority of these occurred in the early part of the first quarter of the year and the latter part of the last quarter, when there were considerable spells of cold weather accompanied by fogs. 129 Ambulance.—During the month of August an agreement was entered into with the London County Council for the removal of non-urgent maternity cases between the hours of 8 a.m. and 11 p.m. Up to the end of the year 14 applications had been made, and payment was made by the Borough Council for the removal of one non-urgent case during the year. Lying-in Ward at St. Andrew's Hospital. The agreement with the London County Council for the provision of a lying-in ward at St. Andrew's Hospital was terminated 31st March, 1931. During the three months no applications for admission were received, and only three confinements took place there. Student Health Visitors. During the year seven Health Visitors of the Royal College of Nursing have been given a course of practical training. Measles. The Council agreed to co-operate with the L.C.C. Education Authority in a scheme similar to that in operation during the winter of 1929-30. The scheme is detailed in the report for 1929. So far it has been unnecessary to augment the Health Visiting Staff to deal with the additional work in connection with the scheme. Post-Graduate Course. Two Health Visitors attended a Post-graduate Refresher Course during the year. The Observation Wards, Wellington Road. Report of Dr. H. St. H. Vertue, Consulting Physician at the Maternity and Child Welfare Observation Wards. During the past year a large number of cases has been referred to the Special Clinic at Wellington Road, and so many have sought admission to the Wards that a waiting list has had to be kept. The method of dealing with the cases is the same as that which has been used before, namely: those which are likely to present some difficulty are admitted to the Wards, and the simpler kinds are treated as Out-patients. All 130 cases, whether In-patient or Out-patient, are in the first place referred to the Special Clinic by the Medical Officers at the ordinary Clinics. They are either of the opinion that the child is in need of such extra help as the Ward can give, or else they consider that there is some special obstacle to the child's progress, which only a more prolonged and elaborate investigation can elucidate than that which can be given at the ordinary weekly clinics. As soon as the case has been satisfactorily investigated and the child is on the fair way to health and recovery, it is sent back to the Clinic Medical Officer with a report. In-patients in the Wards.—47 cases were admitted altogether, a number slightly larger than that of last year. The table shows the variety of cases and the number of each kind: Difficulty in Artificial Feeding 19 Malnutrition 7 Rickets 10 Neurosis 3 Food-refusal 2 Debility after Illness 2 Coeliac D sease 2 Diaphragmatic Hernia 1 Marasmus 1 47 The number of cases of artificial feeding that required treatment in the Wards well exemplifies the difficulty of bottle-feeding as compared with breast-feeding. These cases require very careful attention. Often a good many varieties of food have been tried before the child comes in, but without success. Frequently we have to deal not only with a very ill-nourished child, but also with a badly-damaged digestive apparatus. Nevertheless, it is possible, by careful observation, and perhaps by means of several trials, to find a form of diet suitable to the child's needs. Often it is of a more elaborate kind than is suitable for use at home. We have to wait a little then, until the child becomes thoroughly well and strong, and its digestion is quite restored and then carefully change it to a diet within the capacity of its mother to make and administer. It is wonderful how well these children grow away when once they are digesting a good diet. If the good work begun in the 131 Ward is continued conscientiously by the mother at home (it nearly always is), it becomes impossible in a little while to detect any traces of the former wasting. The Malnutrition of older children, usually between the ages of one and four years, is due to a variety of faults in their environment. When the children are taken in the faults are removed, and it is really wonderful to see what progress they make. Plenty of fine food, fresh air, sunlight (natural or artificial), any medical treatment that seems necessary, and, especially, good nursing work, work wonders in a short space of time. They usually put on weight very fast, their colour becomes healthier and their vigour improves in a remarkable way. Similar very good results are obtained in Debility after Illness, and in Rickets. In the latter we have the pleasure of seeing crooked limbs grow straight, in addition. It might be supposed that when the child was returned to its old environment the former symptoms would recur; but this is not the case. Once got into a sound state he will withstand adverse conditions that he could not before. Of the remaining cases, Food-refusal and the other, Neurosis, yield well to institutional treatment, although the former is rather apt to recur unless the parents are both willing and intelligent in their co-operation. Both cases of Coeliac Disease made complete recovery. The results of treatment in the Wards may now be shown Recovered 37 Improved 6 Removal by Parents 2 Transferred to Hospital 2 47 These results seem to speak for themselves. It should be noted that the cases marked 'improved' were left to make a complete recoverv at home, it being regarded as morally certain that they would do so. Two were removed by their parents after a stay of only four days: they were twins. One of the cases transferred to hospital was the intractable and dangerous form of wasting called Marasmus; the other was the rather uncommon internal deformity known as a Diaphragmatic Hernia. The exact nature of this was not diagnosed with certainty until the child was 132 X-rayed at Guy's Hospital. As soon as the result was known it was transferred there for operation, the only means of cure. Out-patients. Number of New Cases 107 Number of Attendances at Special Clinics 400 Number of Attendances for Test-feeds 510 The large number of attendances for test-feeds shows how great is the importance of breast-feeding. The regulation and, if possible, re-establishment of breast-feeding that has gone amiss form no inconsiderable part of the work of the Wards. The table shows the different kinds of cases treated and the number of each kind. I. Treated as Out-patients. Difficulty in Breast-feeding 39 Difficulty in Bottle-feeding 12 Infected Tonsils and Adenoids 2 Food-refusal 2 Errors in Diet 1 Rickets 1 Subthyroidism 1 Cerebral Diplegia 1 59 II. Cases for Admission 48 107 The two cases of infected tonsils were not amenable to more than general treatment and advice on health and hygiene at the Clinic, and their mothers were advised to take them to hospital for operation. Cerebral Diplegia was at the patient's age, not treatable at all. The case of subthyroidism improved very well on small doses of dried thyroid. The bulk of the work consisted in dealing with difficulties in breast or bottle feeding. 133 Results of Treatment of Difficulty in Breast-feeding. Pure Breast-feeding 13 Breast-feeding supplemented by Artificial Feeding 15 Artificial Feeding only 7 Failed to complete Attendances 4 In considering the number of complete and partial successes in re-establishing breast-feeding, one must remember that often the amount of breast-milk to start with was almost zero. It is a long way, too, from some of the homes to the Clinic. So many test-feeds and such a fair proportion of good results represent a great deal of zeal on the part of the mothers. Result of Treatment of Difficulties in Bottle-feeding. Good Result 10 Failed to complete Attendances 2 Neither in breast nor bottle-feeding was a child deemed to have achieved a good result and to be fit to go back to its ordinary clinic until it was gaining weight at the normal or more than the normal rate, was digesting perfectly and showed signs of being quite settled on the feeding prescribed. It may have been noticed that there were six failures in all to complete attendance. Most of these could be accounted for by illness in the family or some other adequate cause: there were few backsliders. One case transferred herself elsewhere for advice instead of taking advantage of a cot in the Ward for her offspring. Such slight disappointments are bound to occur. Taken on the whole, the year 1931 saw solidly good results achieved at Wellington Road. In conclusion, I must give expression to my hearty sense of gratitude to the staff. As usual, the children were beautifully nursed. Without the care and skill that were so lavishly expended on them the good results we had could never have been obtained. H.ST.H.VERTUE. Artificial Sunlight Treatment. Ur.E.M. Layman, the Medical Officer in charge of Artificial Sunlight Treatment, has submitted the following interesting report:— 134 I have pleasure in submitting my report on the work of the Light Clinics during 1931. 336 children were regularly treated. 37 mothers were regularly treated. The 336 children are classified as follows:— Rickets, 49; of which 13 were Severe 23 „ Slight 13 „ Muscular. 36 were successes, 7 moderate successes, and 6 failed to attend regularly. Disturbed Dentition, 102. 69 were successes, 15 moderate successes, and 18 failed in attendance. Delayed Dentition, 26. 19 were successes, 4 moderate successes, and 3 failed in attendance. Malnutrition, 59. 35 were successes, 12 moderate successes, 7 failed in attendance and 5 were disappointing in response to treatment. These disappointments, as others in the series, almost all needed change to country air, and improved remarkably on being sent away. I find a course of Light given after convalescence keeps them fit. Debility, 55. 30 were successes, 20 moderate successes, 2 failed in attendance, 3 were disappointing. For Recovery after Illness, 18. 13 were successes, 4 moderate successes, 1 failed in attendance. 135 Bronchitis, 8. 4 were successes, 4 were disappointing. Tonsilitis, Adenoids and Adenitis, 9. 6 were successes, 3 moderate successes. Dyspepsia of Infants, 10. 9 were successes, 1 failed in attendance. Successes and moderate successes together amount to 286. Of these, at least 40 were "brilliant successes," giving great pleasure to the mothers and encouragement to ourselves. Failures in attendance, irregularity and premature withdrawal amount to 38, far too large a group. I find with experience of their troubles, that perhaps half of the mothers really could not help their failure to attend owing to home difficulties. The rest, I am afraid, could have persevered if they would. Some, having been complimented on improvement already shown, promptly ceased to attend, evidently thinking the cure complete. We are therefore emphasising the need for continuing till the children are discharged by us. All cases are asked to report to me after a period of weeks from the first discharge, and most cases do so. 37 mothers were treated. 24 were successes, 5 moderate successes, 7 failed in attendance, 1 left the district. Several were marked cases of debility and exhaustion after confinement, several of anaemia, debility and depression during pregnancy, 4 came for stimulation of lactation. The successes persevered well in attendance, coming for 20 exposures or more. I wish to record my appreciation of the Sister's steady work and influence in her department, and to thank all concerned for the ready and able assistance. E. M. LAYMAN. 136 Statistical Summary. January 1st to December 31st, 1931. Bow. Poplar. Totals. Number of attendances 5,764 3,665 9,129 „ „ sessions 286 242 528 „ „ patients 311 242 553 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 Dental Clinic in connection with the Maternity and Child Welfare Department, for the year 1931. We have held 76 Sessions, at which we have had 1,079 attendances, one session less and five attendances less than the previous year. This gives us an average of over 14 attendances per session. The following is a summary of the work carried out 90 Fillings. 139 Scalings. 1,223 Diseased permanent teeth have been extracted. 1,101 Diseased temporary teeth have been extracted. In addition, dentures have been made and fitted; dressings and minor treatment. During the year we have had 404 new patients, a considerable increase over last year. The proportion of children's work appears to be greater than the previous year, as evidenced by the increase in the number of temporary teeth dealt with. A considerable number of old patients return after varying periods when they become aware of further treatment being necessary. This 137 applies to the mothers chiefly; in the case of children, effort is made to ensure that further treatment will not be necessary until the child comes under the care of the school dentist. We find that some patients in an advanced stage of pregnancy are being sent up for dental treatment. Where the mouth is in a very septic condition, or where the patient is actually having pain, we attempt to clear things up more or less temporarily. In the majority of these cases, however, we find a rooted objection on the patients' part to having treatment carried out then. In those cases a note is made on the chart and the patient is sent for later. Although there seems to be no medical objection to the immediate treatment of these cases, it is difficult to convince the patient of the advantages of a clean mouth both for her health and that of the child, and in consequence we have to wait until after the birth of the child before we can render the mother's mouth healthy. We are now making full use of our new continuous nasal gas outfit for extraction work. This has proved most useful, and is a great improvement on old methods. Our equipment and premises are all that could be desired from the point of view of quick and efficient work, and I have to thank the staff for their help in the running of the clinic. C. HAMMOND WILLIAMS, L.D.S., R.C.S. (Eng.). The Royal College of St. Katharine. Report of the Senior Medical Officer. The treatment of otorrhoea in young children is a problem which must often perplex those engaged in Infant Welfare Work. The known tendency of the disease sometimes to heal quickly and spontaneously is a reason why many parents do not seek treatment early; and the very persistence of the discharge, despite treatment, is a reason, on the other hand, for their tending to discontinue attendance at hospital. One can hardly blame them when one remembers the time and expense which it involves. The fact remains that in children under five, cases of otitis media are often seen which have continued, with or without intermission, for months or years. This is another way of saying that it is a most 138 intractable complaint, and that there are no satisfactory arrangements for its treatment at present when it afflicts the infants of the poorest class. The following is a fairly typical history. A child aged three years and two months is brought to the centre with the complaint that he is "not getting on." He has been liable to feverish catarrhal infections since about nine months of age. When fifteen months old, double otitis media occurred in one such attack. One ear healed in a few days, the other continued to discharge. He attended the out-patient department of a general hospital for two or three months, but without relief. The mother then ceased to take him, and some six months from the start of the illness the ear became dry (July). At the age of two (October) he contracted whooping cough, and a month later otorrhoea reappeared. He received treatment from the doctor who attended him at his home, and later reattended the hospital. After six weeks' treatment without benefit, he was taken to a children's hospital instead, and attended for three months. The ears were sometimes dry for a few days, but always relapsed. Attendance, therefore, ceased, and for the past nine months the discharge has been practically continuous. He is five pounds underweight for his age. He is said to have no appetite, and is in poor condition. The chest is malformed, he breathes stertorously through the mouth, and is said to snore in sleep. There is a chronic mucopurulent nasal discharge with soreness of the nostrils. Both ears are discharging copiously. With slight difference in detail, this history will cover a large number of the chronic cases seen at the infant clinics. There is also a fair degree of uniformity in the treatment prescribed. The usual instruction is to dry the discharge, clean the ear with wool, and then insert drops. These mostly contain hydrogen peroxide or spirit. The parent is directed to carry out the treatment two or three times daily. One has only to watch the mother attempt this singlehanded with a struggling baby to realise that it can seldom contribute anything to the healing of the disease. One suspects that the "three times a day" becomes once daily, or even less. We have made the experiment of having a number of these cases brought to the clinic every morning and left with us until the evening. A thorough toilet of the auditory meatus is undertaken three times in the day with strict cleanliness, and the ear is kept covered in the intervals with a pad and bandage to prevent the child's fingers being thrust into it. A 10 per cent, solution of Argyrol is dropped into the nose at each dressing. The day is spent out of doors in a cot. Unless the discharge 139 has been going on for months, it is found that a good proportion of cases will clear up in two or three weeks, and will remain healed. The first attack usually yields more rapidly than a relapse. The first sign of improvement is a lessening of the nasal discharge and of catarrhal symptoms of the nose and air passages. We believe that the out-of-door treatment plays a great part in bringing this about. In infants nursed at the breast the ability to obtain milk sometimes shows a remarkable increase in a few days as the nasal passages become free from obstruction. Nutrition improves and this probably has a bearing on the tendency of the infection to subside. If it is obvious that there is obstruction by adenoids, its removal by operation is advocated as soon as is practicable, and the same is recommended if otorrhoea persists despite treatment in the open air. The amount of adenoid growth found as early as a year or eighteen months is sometimes remarkable. If the discharge persists after the operation, the treatment by drops and open air is continued. Most cases do heal on this plan, but a proportion do not, and these are referred direct to a nose and throat surgeon at a children's hospital, with full details of their history. It is suggested that in this way a more concentrated attack on the disease can be instituted than is possible when the child's home is distant from the hospital, and most of the treatment is bound to devolve on the parent. The good effect of keeping the child in the open is in line with what occurs in other respiratory infections and in part is due to the improvement in nutrition which sets in, especially in the very young. 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 52 weeks ended 2nd January, 1932, 10,562 applications for free milk were received, of which 8,816 were granted. (The number of 142 Under this Act the onus of destroying these vermin is placed upon the "occupier" of land, and he is enjoined to take such steps as may from time to time be necessary and reasonably practicable for the destruction of rats and mice on or in any land of which he is the "occupier," or for preventing such land from becoming infested with rats or mice. In default, he is liable on summary conviction, to a fine not exceeding £5, or not exceeding £20, where he has been served with a Notice under the Act requiring him to take such steps. Where land is not occupied by any tenant or other person, the expression "occupier" means the "owner" of the land. The expression "land," includes any buildings and any other erection on land and any cellar, sewer, drain or culvert in or under land. In London the Metropolitan Borough Councils are charged with the duty of executing and enforcing this Act. The Act permits a Local Authority having power to enforce it, from time to time, by public notice within its area, to give instructions as to the most effective methods that can be adopted, both individually and collectively, to destroy rats and mice; and it further orders local authorities, as far as it may be possible, to take or secure collective action for the destruction of rats or mice. A Local Authority under the Act has also power, after not less than 24 hours' previous notice to the occupier, to enter upon his land and take such steps as are necessary and reasonably practicable for the purpose of destroying the rats and mice thereon or for preventing the land from becoming infested; and it may recover any reasonable expenses so incurred from the occupier of the land, summarily as a civil debt. A person authorised in writing by a Local Authority under the Act may enter any land in the district of such local authority to ascertain whether steps are being taken to destroy rats and mice on the land or to prevent the infestation thereof by rats and mice; or for the purpose of executing and enforcing the Act in any other respect. The present procedure in dealing with Rat Complaints is as follows:— (1) The inspector visits, looks for evidence of rat infestation, endeavours to trace the source of the trouble, and in all cases tests the drains and leaves pamphlets on the destruction of rats and mice with the occupier, and arranges for a supply of poison. 143 It has been found that defective drainage systems either on the complainant's premises, or adjoining property, account in many instances for rat infestation. It has also been noted that frequently rat infestation is associated with the keeping of animals (rabbits) or birds (pigeons or fowls.) (2) Rat Poisons: Barium Carbonate and Red Squill pastes are supplied with instructions how to prepare and lay the baits. (3) If defective drains are found Notice is served on the owner and the defects remedied, and if need be the drains are relaid. (4) Tracing and destroying rat runs under footways is carried out in co-operation with the Works Department. (5) Poisoned baits have been laid in the sewers on occasions by the Works Department. (a) Briefly, the chief preventive measures for dealing with Rat Infestation are as follows:— (1) The Protection of Food Supplies. (2) The removal and destruction of refuse. Pending removal, all garbage, refuse and waste food should be placed in metal bins, with lids. The old saying: "No scraps, no rats," has a large element of truth in it. (3) Rat proofing of buildings.—All new buildings should be made rat-proof by the liberal use of cement in cellars and foundations, and by the proper protection of doors, basement windows, ventilators, and all openings to drains. Unfortunately, it is practically impossible to render ratproof the great majority of the old dwellings in this Borough. (4) Protection of Drains. All drains opening into sewers should be efficiently sealed and all ventilators guarded with wire cages. 144 All defective drainage systems should be repaired and, if necessary, relaid, and all connections to the sewers properly cut off. (b) Rat Destruction. This may be carried out by any of the following methods, but it has been found that the best results are obtained when the methods of attack are changed from time to time:— (1) Trapping. There are many varieties of traps:— (a) The Nipper, or Break-back trap. (b) The Steel Gin trap. (c) Wire Cage traps. (d) Dust-bin trap—fitted with hinged cover which tilts under the weight of a rat—suitable for sewers and warehouses. (e) Varnish and bird-lime traps. A certain amount of care and experience is required in setting any of these traps if good results are to be obtained. It is important to remember that the baits used should be different from the food the rats usually obtain and that an occasional change of bait is recommended. (2) Poisoning. The commonest poisons used may be divided into two groups: In the first group deadly poisons are used such as Phosphorus, Strychnine and Arsenic, but are in my opinion, too dangerous for general use. They may, however, be employed with success in sewers where the risk to humans and animals is very remote. The Red Squill and Barium Carbonate preparations are suitable for general use. In any case, poisoned baits should be laid only by responsible people. 145 The places where baits are laid should be noted and visited regularly, and the baits destroyed if not taken within a short time. It should also be remembered that when trapping or poisoning is being carried out all other sources of food supply should be cut off from rats as far as possible. (3) Rat Viruses. Rat viruses consist of cultures of microbes that cause intestinal diseases in rats. They are uncertain in action, and as there is a risk that human beings may become infected, their employment is not recommended. (4) Fumigation by Sulphur Dioxide is of little use in dwelling- houses , or where food is stored. (5) The employment of the natural enemies of the rat:— (a) The Mongoose. (b)The Ferret. (c) A well-trained ratting dog. (d) A ratting cat. In dwelling-houses much trouble can be prevented if a good ratting cat is kept and properly fed. (6) Rat Catchers. Suggested Procedure. So long as the law does not provide for the co-operation of the owner and occupier in carrying out measures of rat prevention and destruction, very little of an effective nature can be done in making premises rat-proof, and, as already mentioned, occupiers of the majority of houses are unable to engage the services of a rat catcher. To meet this difficulty and to offer some practical assistance to occupiers of dwelling-houses, an adjoining Borough has employed two 146 of the permanent staff of the Borough Engineer's Department to devote their time to visiting rat-infested dwelling-houses where the occupiers have asked for assistance in rat destruction. These men do not visit wharves, warehouses or premises of persons in a position to engage a rat-catcher. Their duties include the keeping of records of visits made, the number of poison baits laid, the kind of poison used, and the results obtained; also the number of rats caught in traps is recorded. The work is carried out under the general supervision of the Borough Engineer's Department. Reports as to the work done, with results obtained, are submitted quarterly to the Public Health Committee. The men are paid at the labourer's rate of wage. I am informed that the results generally are satisfactory. Considering the number of rat complaints which have been received in the Department during the last year or so, it does not appear that there would be sufficient work in private dwelling-houses for a whole-time rat catcher, but I consider that the laying of poisoned baits and trapping of rats in the sewers of the Borough should be carried out systematically. I suggest, therefore, that a suitable individual on the Borough Surveyor's staff be employed to lay poisoned baits and set traps in the sewers of the Borough, and that his services should be available for those occupiers of houses requiring assistance. This matter has been discussed with the Borough Surveyor,who has given his general approval to the suggestion. If such a suggestion were approved, the co-ordination between the Public Health Department and the person employed to lay poisoned baits and set traps, could be effected in the following way: On receipt of complaints of rats, the Sanitary Inspector would visit the address given, carry out his investigation, as at present, and would, in addition, offer the services of this rat catcher. Several houses may be visited, and when he is satisfied that he has come to the extent of the infestation, and has arranged co-operation between the occupiers of those premises involved, the names and addresses of those occupiers who wish to avail themselves of the services of the rat-catcher will be sent to the Borough Surveyor. 147 Each quarter this rat-catcher would submit a report through the Borough Surveyor for submission to the Public Health Committee, detailing:— The addresses of premises visited. Number of visits paid. Number of baits laid. Type of poison laid. Number of baits taken. Number of rats caught in traps. It is recommended that only preparations of Barium Carbonate and Red Squill be used in dwelling houses. In sewers, on the other hand, proprietary preparations of the more deadly poisons might be used, but these must be kept under lock and key, and handled with caution by the person responsible. The cost of the baits used in private dwelling-houses would, as at present, be charged to the Public Health Department. There must be no illusions as to the limitations of the measures suggested to deal with the rat problem, but they may go a little way to assist the unfortunate householder, who at present is unable to cope with the difficulty. 148 INDEX. Page Age Mortality 17 Altered Diagnosis Cases 96 Analyst's Report 77 Anthrax 92 Antitoxin, quantity issued 83 Area and Population 10 Artificial Sunlight Treatment 133 Bacteriological Examinations 83 Bakehouses 64 Births 10 Canal Boats 38 Cancer 97 Cerebro-spinal Fever 93 Cleansing of Verminous Persons, etc. 107, 109, 110 Clinics, M. & C.W. 110 Clinics, Tuberculosis 97 Committees 3 Continued and Typhus Fevers 93 Cowsheds 59 Customs and Inland Revenue Acts, Certificates 36 Day Nursery Nil Death Rate amongst Infants Visited 14 Deaths and Death Rates 12-17 Deaths, Classified Causes, Table Facing 12 and 13 „ Infantile, Table 13 Dentist's Reports 103, 136 Diarrhoea and Enteritis, Deaths 17 Diphtheria 83 Disinfectant, Electrolytic 107 Disinfecting Department 106 Electrolytic Disinfecting Fluid 107 Encephalitis Lethargica 94 Enteric Fever 83 Erysipelas 93 Export of Meat Foods 68 Factory and Workshops Acts—Tables 28-34 Food, Supervision of 59 Food and Drugs Acts, etc. 70 Food Inspectors'Reports 65-67 Free Milk Scheme 139 Glanders 92 Hairdressers' Premises 37 Health Visitor, Chief, Report of 117 Home Nursing 125 Houses Let in Lodgings 27 Housing 48 Hydrophobia 92 Ice Cream 64 Infantile Mortality 13, 14, 128 Infectious Diseases, Table of Notifications Facing 80 Inquests and Deaths from Violence 18 149 INDEX- (continued). Page Lady Sanitary Inspector, Report 26 Lectures on Health Subjects 44 Legal Proceedings, etc. 39 Marriages 11 Maternal Mortality 15. 127 Maternity and Child Welfare 111 Maternity Wards in St. Andrew's Hospital 129 Measles 95 Meat Food Products, Certification 68 Milk (Special Designations) Order 1923 60 Milkshops, etc. 59 Mortuary 18 Notification of Births Act 11 Notifications of Infectious Diseases, Table Facing 80 Observation Wards 129 Offensive Trades 28 Ophthalmia Neonatorum 123 Overcrowding 57 Plague 92 Pneumonia 95 Poliomyelitis, etc. 93 Poor Law Relief, etc. 21 Population 10 Post-vaccinal Encephalitis, etc. 95 Public Education in Health 44 Puerperal Fever and Puerperal Pyrexia 93 Rag and Bone Dealer 35 Rag Flock Act 37 Rat Repression—Report Appendix Rats and Mice Destruction Act 37 Refuse Disposal 25 Removal of Infirm Persons 24 Reports:— Artificial Sunlight Clinics, Medical Officer 133 Chief Health Visitor 117 Dental Surgeon (M. & C.W.) 136 Dental Surgeon (Tuberculosis) 103,104 Lecturer on Health Subjects 44 Observation Wards, Consulting Physician 129 Public Analyst 77 Royal College of St. Katharine, Senior Medical Officer 137 Tuberculosis Officer 97 Sanitary Inspectors Work, Summaries 26 Scarlet Fever 82 Scavenging, Street Cleansing, etc. 25 Schools, Inspection of 37 „ Use of Electrolytic Fluid in 109 Slaughterer of Poultry 64 Slaughterhouses 64 Smallpox 84 Smoke Nuisances 35 Stables 36 150 INDEX—(continued). Page Staff 4 Stillbirths 122 Street Trading 37 Survey of District 51 Survey of Public Health Services 18 Swimming Baths, Use of Electrolytic Fluid in 109 Tables A to F (Workshops, etc.) 28-34 „ of Deaths 12-17 of Infectious Diseases Facing 80 Tuberoulosis, Death Rate 17 „ Deaths 106 „ Officer's Report 97 „ Regulations, Notifications, etc. 104 Typhoid Fever 83 Unhealthy Areas 55 Urinals on Licensed Premises 36 Vaccination 90-92 Verminous Children and Persons 107, 109, 110 „ Rooms 35 Vital Statistics, Summary 9 Tables 12.17 Water Certificates 36 Workshops, Workplaces, etc. (Tables) 28.34 Zymotic Diseases, Death Rate 17 Enteritis 124