pop 38 Do 6024 C 4368 Metropolitan Borough of Poplar. Annual Report FOR THE. YEAR 1932 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. Crush a &- Son, Ltd.. Tottenham, Enfield and Wood Green Metropolitan Borough of Poplar. Annual Report FOR THE YEAR 1932 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 (November, 1931). Councillor G. J. Cressall, J.P., Mayor (ex -officio). Chairman: Councillor T. J. Blacketer, J.P., L.C.C. Vice-Chairman: Alderman J. A. Hammond. Cllr. Anderson, G. Cllr. Baker, A. Cllr. Baldock, F. T. Cllr. Blacketer, T. J., J .P., L.C.C. (Ch.) Cllr. Boulton, H. Cllr. Cressall, Mrs. N. F. Cllr. Goodway, T.J. Ald. Hammond, J . A. (V.Ch.) Cllr. Harris, Mrs. A. L. Cllr. Jeans, S.J. Cllr. Mills, G. H. Cllr. Shepherd, Mrs. A. I. Cllr. Simons, A. Aid. Tanner, C. A. Cllr. Williams, Rev. H. MATERNITY AND CHILD WELFARE COMMITTEE (November, 1931). Councillor G.J. Cressall, J .P., Mayor (ex-officio). Chairman: Councillor Mrs. A. L. Harris. Vice-Chairman: Councillor Mrs. N. F. Cressall. Ald. Adams, D. M., M.P., L.C.C. Cllr. Baker, A. Cllr. Boulton, H. Cllr. Cressall, Mrs. N. F. (V.Ch.) Cllr. Easteal, A. Cllr. Harris, Mrs. A. L. (Ch.) Cllr. Smith, F. A. Ald. Stavers, Mrs. E. Cllr. Lansbury, The Rt. Hon. G., P.C., J.P., M.P. Cllr. Power, Mrs. M. Co-opted Members: MissE. Herbert (Royal College of St. Katharine). Mrs. J. A. March. Mrs. F. A. Sargent. 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: G. 0. Mitchell, M.D., M.R.C.P., D.P.H. Assistant Medical Officer of Health and Assistant Tuberculosis Officer: L. D. Richards, M.R.C.S., L.R.C.P., D.P.H. Public Analyst: ALBERT E. PARKES, F.I.C., F.C.S. GENERAL PUBLIC HEALTH SECTION, PUBLIC HEALTH OFFICE. Chief Clerk and Administrative Assistant: HAROLD DYER.† Sanitary Inspectors: (a) H. A. Tifbatts.* C. H . Brown.*†‡ § (a) W. J. Colborne†† (a) H. J. Lanoley.* (a) C. S. Westbrook.*† (a) Wm. Johnson.*‡ (a) S. Kelly.* (a) F. A. Smith.*† Miss D. A. E. landkay.*‡‡| (a) A. L. Dove. ††‡ (b) C. A. Grabham.*‡ (b) H. A. pearce.*†§‡ (c) H. W. Luke.††‡ (d) E. A. MAY†† (d) G. L. BELSHAW††‡ (a) District Inspectors. (b) Food Inspectors. (c) Inspector for Houses divided into separate tenements and Deputy Food Inspector. (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.* W. F. Roberts A. Hamilton.†† E. W. Garrett. Miss S. Fells. J. T. Donovan Mrs. E. Long. D. Flynn. S. B. Leader. W. G. Barnett. W. J. Wright (Office Boy). Caretaker and Messenger: C. E. Richardson Vaccination Officer: P. Ryan. Public Vaccinators. Bow District Bromley District Poplar District Isle of Dogs District Dr. D. G. Macrae. Dr. C. Cotter. Dr. H. J. O'Brien. Dr. W. C. Millea. The Medical Superintendents of St. Andrew's Hospital, How institution ana Bromley House Institution are the Public Vaccinators to their respective Institutions. * Cert. S.I.E. Board. † Cert R.S.I, †† Cert. R.S.I. & S.I.E.J.B. ‡ Cert. Meat ivnd 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: G. O. Mitchell. Assistant Medical Officer of Health and Assistant Tuberculosis Officer: L. D. Richards. Health Visitors: Miss H. Messem. Miss D. Wood.‡ Miss N. Roberts.** Dispenser: Mrs. F. E. Smith. Clerks: Miss A. D. Frost. Miss A. Rogers. Secretary to Care Committee: Miss L. Nugent. Nurse-Helper: Caretaker: Mrs. E. Tomlins (temporary). W. J. Parker. DISINFECTING STATION, YEO STREET. Disinfectors: W. 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: C. Hagon, J. Cummins (temporary) and J. Hurley. Lorry Driver: F. Farrow. Shelter and Cleansing Station. Attendants: Mrs. A. Howe, Mrs. M. Allan. MORTUARY. Mortuary Keeper and Caretaker of Coroner's Court: D. Hogan. Relief Mortuary Keeper: W. Hagon. 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 Margaret B. Mackay, M.B., Ch.B. (Edin.), D.P.H. (Eng.) (Resigned.) Mrs. M. B. Graham Morton, M.D.Ch.B. (Glasgow), (from 3rd August) *Also Medical Officer-in-charge Artificial Light Treatment. ‡ San. Insp. Cert. R.S.I. **H.V. Cert. R.S.I. 6 Dental Surgeon: C. Hammond Williams, L.D.S., R.C.S. (Eng.). Anaesthetist: S. Hutchinson, M.R.C.S. (Eng.), L.R.C.P. (Lond.). Chief Health Visitor: Miss J. M. Cardozo, R.R.C.*¶†† Health Visitors-. Miss E. A. Foskett.*¶ Mrs. M. J. Edgell.§¶ Miss M. Mallitt.* Mrs. E. K. Haythornthwaite.*¶ (c) Miss G. I. Hill*¶ (e) Miss B. E. Letts*¶ (c) Miss M. H. Sutclime*¶† (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. *C.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. June, 1933. 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 1932. Statistics.—The Registrar-General's estimate of the population is 152,400, and on this figure all rates per 1,000 of the population have been calculated. It should be noted that this estimate is 3,900 less than the estimated population for the year 1931 and the comparatively low figure adversely affects the mortality rates based upon it when compared with corresponding rates for previous years. The birth-rate (17.2) and the death-rate (12.1) are both slightly lower than the corresponding rates for the previous year, and the infantile mortality rate (63) is considerably lower than the rate for 1931. Statistics of Parliamentary Wards.—In order to ascertain if there are any marked variations in health conditions of the various Parliamentary Wards of the Borough the vital statistics of each Ward have been calculated and are shown on a map facing page 8. The number of deaths of Ward ' 'residents'' classified to certain causes is shown on Table II, facing page 13. Several years must elapse before the information thus obtained can be of any real value. Infectious Diseases. - There was a slight increase in the number of cases of Scarlet Fever and of Diphtheria, but on the other hand there was a considerable fall in the number of cases of Pneumonia notified. Housing and Overcrowding .—Section D of this Report is devoted to housing and associated matters, and the summary of the work of the Housing Survey Inspectors is of interest as it shows the first complete year's work of these officers. Work of District Inspectors, etc.—The work done by the District Inspectors is shown in the table facing page 24. The total inspections during the year was 14,123—an increase of over 4,000 compared with the previous year—and the re-inspections numbered 21,165, showing an increase of 2,599. These figures indicate the amount of work which is being done as compared with 10 years ago, when the inspections numbered 8,812 and the re-inspections 14,373. Even when allowance has been 8 made for the fact that there are now eight District Inspectors, as compared with seven in 1922, the figures are very satisfactory. The figures do not include the inspections carried out by the three Housing Survey Inspectors. The Lady Sanitary Inspector's Report, given on page 24, also shows a considerable increase in the amount of work done, and in this connection it may be pointed out that, whilst there is a slight drop in the number of visits to workshops, workplaces and home-workers' premises, there has been a considerable increase in the number of visits to Council houses and flats and to prospective tenants of Council houses, etc. Maternity and Child Welfare.—During the year one additional session at the Wellington Road Infant Consultation Clinic has been arranged to relieve the heavy pressure at that clinic. The attendances at all Clinics (both the Council's and those of the Royal College of St. Katharine) show a still further increase. There has been no other change in the services mentioned in my previous Report. Conferences.—During the year the Council has been represented at various conferences on public health, maternity and child welfare, tuberculosis , and associated health matters. Electro-Medical Apparatus.—Following upon the publication of the Ministry of Health memorandum on ' Precautions against shock from electro-medical apparatus," all electrical apparatus used by the Public Health Department was inspected by an officer of the Electricity Department and certain works were carried out in connection with the X-ray plant and artificial sunlight lamps. Once again I have to record my appreciation of the interest shown by members of the Council in the work of the Department, the assistance and co-operation of officers of other Departments, and the way in which my staff have carried out their duties during the year. Further, I take this opportunity of thanking those who, from time to time, afford various items of information included in these reports. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. ALLAN YOUNG, Medical Officer of Health. 9 Section A. NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. Area of Borough (excluding water) 2,136 acres Population (Census, 1931) 155.089 Population,Estimated Resident—mid 1932 (Reg.-General) 152,400 Number of Inhabited Houses (end of 1932) according to Rate Books 23,274 Rateable Value (October, 1932) £747,585 Sum represented by a Penny Rate (April, 1932) £2,936 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 (Registrar-General's figures). Total M. F. Live Births Legitimate 2,553 1,291 1,262] Birth Rate 17.2 per 1,000 of the estimated resident population. Illegitimate 63 32 31 Totals 2,616 1,323 1,293 Still Births 85 48 37 Rate per 1,000 total (live and still births) 31.5. Deaths Total 1,848 M. 1,032 F. 816 Death Rate 12.1 per 1,000 estimated resident population. 10 Deaths from Puerperal causes (Headings 29 and 30 of the RegistrarGeneral 's Short List):— Deaths.* Rate per 1,000 total (live and still) births. No. 29 Puerperal sepsis 5 1.85 No. 30 Other puerperal causes 6 2.22 Total 11 4.O7 * Registrar-General's figures. Death Rate of Infants under one year of age:— All infants, per 1,000 live births 63 Legitimate infants, per 1,000 legitimate live births 63 Illegitimate infants, per 1,000 illegitimate live births 95 Deaths from Measles (all ages) 31 ,, Whooping Cough (all ages) 6 ,, Diarrhoea (under 2 years of age) 15 Area and Population. The area of the Borough is 2,136 acres, and the population, estimated to the middle of 1932 by the Registrar-General, was 152,400, which gives a density figure of 71 persons per acre. Births. Early in the year 1933, the Registrar-General supplied the following information relating to Births registered in the year 1932. Registered Inward Transfers. Outward Transfers. Nett. Total Births Males 1,010 337 24 1,323 2,616 Females 974 342 23 1,293 Illegitimate Males 28 4 32 63 Females 26 7 2 3l The corrected birth rate per 1,000 population was 17.2, as against 19.8, 19.9, 19.1, 19.1 and 17.5 for the years 1927-1931. 11 During the year 2,724 notifications were received under the Notification of Births Act, 1907. The following Table shows where the births in 1932 occurred:— At Home: 1. Attended by Doctors 13.0 per cent. 50.1 per cent. 2. Attended by Midwives 37.1 per cent. In Institutions: (a) In the Borough: St. Andrew's Hospital 22.9 per cent. 49.9 per cent. (b) Outside the Borough: 1. East End Maternity Hospital 19.4 per cent. 27.0 2. Other Institutions 7.6 per cent. 100 Marriages. During the year the marriages of 2,706 persons were registered, giving a rate of 17.8 as against 17.5, 17.8, 17.8, 18.4 and 18.9 in the five years 1927-1931. Deaths. 1,748 deaths were registered as having occurred in the Borough. 279 deaths of non-residents must be deducted, and 378 deaths of Poplar residents which occurred outside the Borough must be added, giving a nett totalof 1,847 and a rate of 12.1 per 1,000 of the estimated population. The Registrar-General's table shows a total of 1,848 deaths, but this does not affect the rate of 12.1. The natural increase of population represented by excess of births over deaths was 768. The principal causes of death are shown in the form of a chart facing page 12. Heart disease, Cancer, and diseases of the Respiratory System (including Tuberculosis) account for the majority of the deaths, but in placing Heart disease first it should be noted that 71 per cent, of the 1 deaths ascribed to this condition were of persons of 65 years or more. 12 Deaths during 1932 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 (Dwellings) 124 80 54 90 348 Bow and Bromley Sub-District (Dwellings) 98 56 39 67 260 St. Andrew's Hospital 216 172 147 168 703 Poplar Institution 44 29 39 36 148 Bow Institution 47 34 37 27 145 Bromley House Institution — — — i 1 Poplar Hospital 30 30 25 24 109 River Thames 1 1 4 2 8 ,, Lee 2 — 1 i 4 Limehouse Cut — — — — — Bow Creek — — 1 — 1 Regents Canal — — — — — East India Docks — — — — — West India Docks — — — i 1 South-West India Docks — — — — — Millwall Docks — — — — — Poplar Dry Dock — — 1 — 1 Highways 2 1 3 8 14 Miscellaneous: (places of Employment ,etc) 1 2 2 — 5 565 405 353 425 1,748 Deaths occurring outside the Borough, of persons belonging thereto .. (add) no 106 79 83 378 Deaths occurring within the Borough, of persons not belonging thereto (deduct) 78 69 69 63 279 Deaths at all ages—nett 597 442 363 445 1,847 Principal causes of death 1932 (Registrar-General's Classification) TolalDeatfis during the vyear - 184,8-Males 1032--females 816. Percentage of deaths accurring in Public Institutions 64.8 Note.—71 per cent. of deaths ascribed to Heart Disease were of persons of 65 or more years of age. The folloiwing table, compiled and furnished by the Registrar-General, is inserted at the request of the Ministry of Health. Causes of Death. Sex. All Ages 0— 1 — 2— 5— 15— 25— 35— 45 — 55 — 65— 75— All Causes M 1032 93 24 19 25 53 48 55 111 186 225 193 F 816 73 26 22 24 50 44 40 56 106 188 187 1 Typhoid and paratyphoid fevers M 1 — — — — — — — — 1 — — F 2 — — — — — 1 — 1 — — — 2 Measles M 11 3 5 2 1 — — — — — — — F 20 6 5 9 — — — — — — — — 3 Scarlet fever M 3 — 1 2 — — — — — — — — F — — — — — — — — — — — — 4 Whooping cough M 4 3 — 1 — — — — — — — — F 2 1 — 1 — — — — — — — — 5 Diphtheria M 6 1 1 2 2 — — — — — — — F 10 — 3 3 3 1 — — — — — — 6 Influenza M 9 — — — — 1 — 1 — 3 1 3 F 16 — — — 1 2 — 1 1 2 4 5 7 Encephalitis lethargica M 1 — — — — — — 1 — — — — F 2 — — — — — 1 1 — — — — 8 Cerebro-spinal fever M 4 3 — — — — 1 — — — — — F 2 1 1 — — — _ — — 9 Tuberculosis of respiratory system M 73 — — — — 16 15 15 16 8 3 — F 61 1 1 — — 24 16 6 7 4 2 — 10 Other tuberculous diseases M 10 — 1 1 3 2 1 1 — 1 — — F 10 — 3 2 3 2 — — — — — — 11 Syphilis M 1 — — — — — — — — — 1 — F — — — — — — — — — — — — 12 General paralysis of the insane, tabes dorsalis M 7 — — — — 2 — 2 2 1 — — F 1 — — — — — — — — — 1 — 13 Cancer, malignant disease M 130 — — — 1 1 2 2 20 46 43 15 F 75 — 1 — — 2 3 10 21 26 12 14 Diabetes M 7 — — — — — — — 1 4 1 1 F 5 — — — — — — 1 — 2 2 — 15 Cerebral haemorrhage, etc M 28 — — — — — 1 — — 3 15 9 F 25 — — — — — — 1 2 5 8 9 16 Heart disease M 265 — — — 1 5 2 6 23 41 86 101 F 269 — — — 1 7 7 11 14 35 87 107 17 Aneurysm M 2 — — — — — — — 1 1 — — F 3 — — — — — — 1 1 — 1 18 Other circulatory diseases M 33 — — — — — — — 1 8 12 12 F 32 — — — — — — — — 8 12 12 19 Bronchitis M 60 11 2 — — 1 — 2 7 9 13 15 F 44 7 2 1 1 1 — 1 2 9 10 10 20 Pneumonia (all forms) M 87 15 10 6 — 3 4 5 12 14 11 7 F 54 11 7 2 1 4 — 3 4 5 8 9 21 Other respiratory diseases M 11 — — — 1 1 _ 1 — 4 2 2 F 4 — — — — — 2 — _ 1 1 22 Peptic ulcer M 24 — — — — — — 4 6 6 3 2 F 3 — — — — — — — 1 — 1 1 23 Diarrhoea, etc M 10 10 — — — — — — — — — — F 6 5 — — — — — 1 — — — — 24 Appendicitis M 6 — — 1 — — — 2 1 1 1 — F 1 — — — — — — — — — — — 25 Cirrhosis of liver M 5 — — — — — — — 1 3 1 — F 3 — — — — — — — 1 2 — — 26 Other diseases of liver, etc. M 2 — — — — — — — — 2 — F 2 — — — — — — — — — —] 1 27 Other digestive diseases M 18 1 — 1 1 — — 1 2 1 4 7 F 13 1 — 1 3 — 3 — — 2 1 2 28 Acute and chronic nephritis M 17 — — — — 4 1 1 2 4 2 3 F 26 1 — — 2 1 3 — 2 4 11 2 29 Puerperal sepsis F 5 — — — — 1 3 1 — — — — 30 Other PuerPeral causes F 6 — — — — 1 2 3 — — _ 31 Congenital debility, Premature birth, malformations,etc . M 34 32 _ 1 1 — — — — — — F 33 32 1 — — — — — — — — — 32 Senility M 4 — — — — — — — — — 1 3 F 5 — — — — — — — — 1 4 33 Suicicle M 15 — — — — 3 3 3 4 2 — — F 6 — — — — — 1 2 1 — 1 — 34 Other violence M 45 3 1 1 9 9 6 2 4 6 2 2 F 21 3 1 1 1 1 — — 2 2 4 6 35 Other defined diseases M 99 11 3 1 5 5 9 6 8 17 23 11 F 49 4 1 2 8 3 5 2 7 5 7 5 36 Causes ill-defined or unknown M — — — — — — — — — — — — F — — — — — — — — — — — — Deaths under 1 year M Legit. Illegit. 90 3 F. 70 3 Totals 160 6 TABLE II.—CAUSES OF, AND AGES AT DEATH DURING 1932. (This Table has been revised (1) to comply with latest classification of Causes of Death : and (2) to show the number of deaths allocated to each Parliamentary Ward in the Borough.) Causes of Death. (Manual of the International List of Causes of Death. 1931.) Total Deaths. Sex. Ages at Death- in Years. Number of Deaths of Residents of Wards. Nett Deaths in Public Institutions (at all ages) Nett Total Deaths in Public Institutions, etc. Causes of Death Total All Ages Under 5 years. 5- 10- 15- 20- 25- 35- 45- 55- 65- 75 and over Bow. Bromley. Poplar. Poplar Institution. St. Andrew's Hospital. Bow Institution. Bromley House Institution. Poplar Hospital. See Footnotes. Outlying Institutions. 0- 1- 2- Total under 5years North. West. Central. South. Northwest. NorthEast. Southwest. South East. Central. NorthWest. West. East. Millwall. Cubitt Town. 1 2 3 4 5 6 7 8 9 10 11 12 1 13 14 15 16 All Causes Certified 1847 166 50 41 257 28 21 46 58 90 95 ,167 292 412 381 I 113 126 107 70 128 145 146 144 152 194 172 124 91 135 131 675 5 31 18 378 1238 All Causes Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Typhoid and Paratyphoid Fevers 3 M 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .... .. 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. 3 3 1 Typhoid and Paratyphoid fevers F 2 .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. 2 Measles 31 M 11 3 5 2 10 1 .. .. .. .. .. .. .. .. .. 1 2 1 .. .. .. 3 2 2 .. 9 3 5 3 .. 1 .. .. .. .. 24 25 2 Measles F 20 6 5 9 20 .. .. .. .. .. .. .. .. .. .. 3 Scarlet Fever 3 M 3 .. 1 9 3 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. 3 3 3 Scarlet Fever F .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 Whooping Cough 6 M 4 3 .. 1 4 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. 1 .. .. .. .. 4 5 4 Whooping Cough F 2 1 .. 1 9 .. .. .. .. .. .. .. .. .. .. 5 Diphtheria 17 M 6 1 1 2 4 1 1 .. .. .. .. .. .. .. .. 1 1 .. 1 3 2 1 2 .. 1 .. 1 2 2 .. 2 .. .. .. .. 15 17 5 Diphtheria F 11 1 3 3 7 3 .. 1 .. .. .. .. .. .. .. 6 Influenza 25 M 9 .. .. .. .. .. 1 .. .. 1 .. 3 1 3 1 1 3 1 1 1 3 7 1 4 1 1 .. .. .. 1 .. .. .. .. 5 6 6 Influenza F 16 .. .. .. .. .. 1 2 .. .. 1 1 2 4 5 7 Encephalitis lethargica 3 M I .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. 1 1 .. .. .. .. .. 1 2 .. .. .. .. .. 3 7 Encephalitis lethargica F 2 .. .. .. .. .. .. .. .. 1 1 .. .. .. .. 8 Cerebro-spinal Fever 6 M 4 3 .. .. 3 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. 1 2 .. .. .. .. 6 .. .. .. .. .. 6 8 Cerebro-spinal Fever F 2 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 9 Tuberculosis of Respiratory 137 M 76 .. .. .. .. 4 13 15 16 16 9 3 .. 12 12 7 7 7 7 10 14 10 14 10 10 7 10 5 61 .. .. .. .. 26 92 9 Tuberculosis of Respiratory system F 61 1 1 2 10 14 16 6 7 4 2 .. 10 Other Tuberculous Diseases 18 M 9 .. 1 1 2 1 2 1 1 1 1 .. .. .. 4 2 .. .. 1 .. 1 1 .. 3 2 2 .. .. 9 .. .. .. .. 6 15 10 Other Tuberculous Diseases F 9 .. 2 2 4 2 1 9 .. .. .. .. .. .. .. 11 Syphilis 4 M 3 .. .. .. .. .. .. .. .. .. .. .. 1 2 .. .. .. .. .. .. 2 .. .. .. .. .. 2 .. .. .. .. .. .. .. .. 1 1 11 Syphilis F 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 12 General Paralysis of the Insane, 7 M 6 .. .. .. .. .. .. .. 2 .. 2 2 .. .. .. .. .. .. .. .. .. 1 .. .. 2 2 1 1 .. .. 1 .. .. .. .. 6 7 12 General Paralysis of the Insane tabes dorsalis F 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 13 Cancer, malignant disease 200 M 126 .. .. .. .. .. 1 1 .. 2 2 16 46 43 15 11 17 11 7 12 13 12 14 19 22 18 18 8 18 5 75 .. .. 3 35 118 13 Cancer, malignant disease F 74 .. 1 .. 1 .. .. .. .. 1 3 10 21 26 12 14 Diabetes 11 M 7 .. .. .. .. .. .. .. .. .. .. 1 4 1 1 2 .. 1 1 1 .. 1 1 1 1 .. 1 1 .. 1 6 .. .. .. 2 9 14 Diabetes F 4 .. .. .. .. .. .. .. .. 1 .. 1 2 .. 15 Cerebral haemorrhage, etc. 53 M 29 .. .. .. .. .. .. .. 1 .. .. 3 16 9 4 6 1 3 4 1 2 4 4 8 4 2 4 6 1 24 .. .. .. 1 26 15 Cerebral haemorrhage,etc. F 24 .. .. .. .. .. .. .. .. 1 3 4 7 9 16 Heart Disease 529 M 257 .. .. .. .. .. 1 3 2 i 5 22 40 85 98 34 34 38 18 39 48 46 40 45 55 52 30 26 24 96 186 3 .. 5 2 (a) 54 346 16 Heart Disease F 272 .. .. 1 .. 3 .. 3 3 7 11 14 3b 86 109 17 Aneurysm 4 M 2 .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. 2 .. .. .. .. .. .. 3 3 17 Aneurysm F 2 .. .. .. .. .. .. .. .. .. 1 1 .. .. 18 Other circulatory diseases 74 M 38 .. .. .. .. .. .. .. .. .. .. 1 9 14 14 1 3 2 7 5 6 7 3 4 6 7 4 4 15 1 20 1 .. 1 .. 17 40 18 Other circulatory diseases F 36 .. 1 .. 1 .. .. .. .. .. .. 1 10 11 13 19 Bronchitis 89 M 52 4 1 .. 5 .. 1 .. .. 2 6 10 14 14 6 3 2 5 6 12 8 15 10 5 7 6 4 .. 38 .. .. .. .. 4 42 19 Bronchitis F 37 2 1 1 4 .. 1 1 .. .. 1 2 9 10 9 20 Pneumonia (all forms) 131 M 82 12 8 5 25 .. 1 1 2 .. 6 13 13 10 7 6 7 6 8 13 15 15 9 14 17 5 4 5 6 46 .. .. 3 1 (b) 21 77 20 Other Respiratory Diseases F 49 10 6 1 17 .. .. .. 4 .. 2 4 7 9 21 Other Respiratory Diseases 14 m 9 .. .. .. .. .. 1 .. 1 1 3 3 .. 2 2 1 2 1 1 .. .. .. 2 1 1 1 1 6 .. .. .. .. 2 9 21 Peptic Ulcer F 5 .. 1 .. 1 .. .. .. .. 1 2 1 .. 22 Peptic Ulcer 28 M 25 .. .. .. .. .. .. .. .. 2 4 9 6 3 1 2 4 4 2 2 .. .. 2 2 5 1 3 .. 3 .. 11 .. .. .. .. 12 23 22 Peptic Ulcer F 3 .. .. .. .. .. .. .. .. .. .. 1 1 1 23 Diarrhoea, etc 28 M 18 15 2 1 18 .. .. .. .. .. .. .. .. .. .. 2 2 1 2 3 5 5 1 .. 1 .. 2 1 .. .. 19 .. .. 2 1 (c) 5 27 23 Diarrhoea, etc. F 10 10 .. 10 .. .. .. .. .. .. .. .. .. .. 24 Appendicitis 8 M 6 .. .. 1 1 .. .. .. .. .. .. 1 1 1 .. .. 1 .. 1 .. 2 .. 1 1 1 1 .. .. .. .. 4 .. .. 1 .. 3 8 24 Appendicitis F 2 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 25 Cirrhosis of Liver 7 M 5 .. .. .. .. .. .. .. .. .. .. 1 3 1 .. 1 1 .. .. .. 2 .. .. 1 .. 1 1 .. .. .. 3 .. .. .. .. 1 4 25 Cirrhosis of Liver F 9 .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 26 Other diseases of liver, etc. 4 M 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 2 .. .. 1 1 .. .. .. .. .. 1 .. .. .. .. 1 2 26 Other diseases of liver etc. F 3 .. .. .. .. .. .. .. .. .. .. 1 1 1 27 Other Digestive diseases 29 m 15 1 .. 1 2 .. 1 .. .. .. .. 1 3 8 1 2 3 1 2 1 4 2 2 3 2 1 2 3 .. 18 .. .. .. 1 (d) 4 23 27 Other Digestive diseases F 14 2 .... 1 3 2 .. .. .. .. .. 1 3 3 28 Acute and Chronic Nephritis 42 M 18 .. .. .. .. .. .. 1 3 .. 1 2 5 2 3 .. .. .. 2 3 4 1 2 5 6 2 3 3 5 2 19 .. .. .. .. 5 26 28 Acute and Chornic Nephritis F 24 .. .. .. .. .. 2 1 3 2 4 11 1 29 Puerperal Sepsis 6 F 6 .. .. .. .. .. .. i 4 1 .. .. .. .. .. 1 .. 1 .. 1 1 .. 2 .. .. .. 3 .. .. .. .. 3 6 29 Puerperal Sepsis 30 Other Puerperal causes 6 F 6 .. .. .. .. .. .. 1 2 3 .. .. .. .. .. .. .. .. 3 1 .. .. .. .. .. .. .. 2 .. 4 .. .. .. .. .. 4 30 Other Puerperal causes 31 Congenital Debility, Premature Birth, Malfornations,etc. 66 \r 32 31 .. 1 32 .. .. .. .. .. .. .. .. .. .. 2 5 3 2 8 7 6 3 5 7 2 4 4 8 .. 14 .. .. 1 .. 32 47 31 Congenital Debility, Premature Birth, Malformation,etc, F 34 33 1 34 .. .. .. .. .. .. .. .. .. .. 32 Senility 10 m 6 .. .. .. .. .. .. .. .. .. .. .. 1 5 2 1 .. 1 1 .. 1 1 1 .. 2 .. .. 1 1 .. .. .. .. 5 7 32 Senility F 4 .. .. .. .. .. .. .. .. .. .. .. .. 1 3 33 Suicide 21 M 15 .. .. .. .. .. .. 1 2 3 3 4 2 .. .. 1 4 1 2 1 .. 1 1 3 3 4 .. .. .. 5 .. .. 2 1 (c) 6 14 33 Suicide F 6 .. .. .. .. .. .. .. 1 1 2 1 .. i .. 34 Other violence 63 M 44 3 1 1 5 4 5 8 1 5 2 4 6 2 2 3 6 2 2 4 7 4 6 7 5 3 .. 5 .. 20 .. .. 9 11 (f) 19 59 34 Other violence F 19 2 1 1 4 .. 1 1 .. .. .. 1 2 4 6 35 Other defined causes 164 m 111 17 4 1 22 4 2 2 3 io 7 11 17 20 13 13 10 11 6 11 12 8 8 14 16 21 10 8 16 11 68 1 .. 4 1 (g) 50 135 35 Other defined caises F 53 4 2 9 8 6 1 4 5 4 6 5 8 6 36 Causes ill-defined, or unknown .. m .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 36 Causes ill-defined or unknown F .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. All Causes { m 1031 93 24 19 136 11 14 24 30 46 55 111 186 225 193 113 126 107 70 128 145 146 144 152 194 172 124 91 135 131 675 5 .. 31 18 378 1238 All Causes F 816 73 26 22 121 17 7 22 28 44 40 56 106 18V 188 Totals 1847 166 50 41 257 28 21 46 58 90 95 167 292 412 381 Footnotes (a) Highways, 2. (b) Highway, 1. (c) Observation Wards, 1. (d) Observation Wards, 1. (e) River Lee, 1. (f) River Thames, 2; River Lee, 3; West India Docks, 1; Poplar Dry Dock 1; Highways 4. (g) Observation Wards. 1. 13 TABLE III. Infantile Mortality during the Year 1932. 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. 1 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. No. of Deaths in each Quarter. Poplar. Bow and Bromley Whole Borough 1 2 3 4 All causes Certified 50 7 3 5 65 21 27 21 32 87 79 166 46 45 39 36 Uncertified — — — — — — — — — — — — — — — — Small pox — — — — — — — — — — — — — — — — Chickenpox — — — — — — — — 1 — 1 1 — 1 — — Measles — — — — — — — 2 7 7 2 9 3 6 — — Scarlet Fever — — — — — — — — — — — — — — — — Whooping Cough — — — — — — 3 — 1 4 — 4 — 1 1 2 Diphtheria and Croup — — — — — 1 — — 1 — 2 2 1 1 — — Erysipelas — — — — — — — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — 1 — 1 1 — 1 — — Meningitis (not Tuberculous — — — — — 1 2 — 9 3 2 5 4 1 — Convulsions 1 1 1 — — — — 2 9 — 1 ] — Bronchitis — 1 _ — 1 1 1 2 — 4 1 5 1 2 1 1 Pneumonia (all forms — — — 1 1 1 6 5 9 14 8 22 10 2 1 9 Diarrhoeal Diseases — 1 — — 1 4 8 5 7 6 19 25 5 3 q 8 Gastritis — — — — — 1 — 1 — 1 1 2 — — 2 — Syphilis — — — — — — — — — — — — — — — — Rickets — — — — — — — — — — — — — — — — Suffocation, overlying — — 1 — 1 — — — — 1 — 1 — 1 — — Injury at birth 3 — — — 3 — — — — 9 1 2 — 1 1 l Atelectasis 6 — — — 6 — — — — 3 3 6 9 1 2 1 Congenital Malformations 10 — 2 1 13 4 2 — — 9 10 19 8 7 2 2 Premature birth 20 2 — 2 24 3 — — — 15 12 27 4 6 12 5 Atrophy, Debility and Marasmus 1 2 — — 3 1 — — — 1 3 4 2 — 1 1 Other Causes 9 1 — 1 11 3 5 6 3 17 11 28 6 11 5 6 Total Deaths 50 7 3 5 65 21 27 21 32 87 79 166 46 45 39 36 Live Births Legitimate 2,553* in the year iIllegitimate 63* Nett Deaths Legitimate 160* in the year Illegitimate 6* *Registrar-General s figures. Neo-Natal Death Rate. Nett Births 1927. 1928. 1929. 1930. 1931. Average 19271931. 1932. 3,309 3,228 3,064 3,056 2,739 3,079 2,616 Registrar-General) Deaths under 1 month 86 76 92 71 74 80 65 Neo-Natal rate per 1,000 nett Births 26.0 23.5 30.0 23.2 27.0 25.9 24.8 14 Infant Mortality. There were 166 deaths of children under one year of age, the death rates per 1,000 births for the past 25 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 (50) 65 1932 63 67 Note.—The figures in brackets are the mortality rates amongst infants visited by the Health Visitors. The following Table shows that the greatest number of infant deaths occurs in the first quarter of the year, whereas formerly they occurred in the third and fourth quarters. The year 1931 was an exception, and the relatively large number of infant deaths in the last quarter of that year was due to Bronchitis and Pneumonia, caused no doubt by the prevalence of fog during November and December, which also caused an increase in the total deaths at all ages. 1st 2nd 3rd 4th Year. Quarter. Quarter. Quarter. Quarter. 1925 77 40 64 106 1926 66 53 74 65 1927 71 38 53 56 1928 72 49 52 57 1929 104 41 37 48 1930 55 44 27 41 1931 57 47 32 75 1932 45 46 39 36 15 TABLE IV. Birth-rate, Death-rate, and Analysis of Mortality in the Year 1932. Rate per 1,000 Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Live Births. Percentage of Total Deaths. All Causes. Typhoid and Paratyphoid Fevers. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years). Total Deaths under One Year. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.m. No Inquest. Uncertified Causes of Death. Live Births Stillbirths. England and Wales 15.3 0.66 12.0 0.01 0.00 0.08 0.01 0.07 0.06 0.33 0.54 6.6 65 91.1 6.2 1.8 0.9 118 County Boroughs and Great, Towns, including London 15.4 0.64 12.2 0.00 0.00 0.12 0.01 0.08 0.07 0.28 0.54 8.6 70 91.3 5.9 2.3 0.5 126 Smaller Towns (Populations 25,00050,000 at Census 1931) 15.2 0.68 11.4 0.01 - 0.07 0.01 0.07 0.04 0.31 0.53 5.3 61 91.9 5.8 1.3 1.0 London 14.3 0.46 12.3 0.00 0.00 0.19 0.02 0.08 0.07 0.28 0.57 12.5 67 89.4 6.2 4.4 0.0 Poplar Borough 17.2 0.56 12.1 0.02 0.00 0.20 0.02 0. 04 0.11 0.16 0.57 5.7 63 89.18 6.49 4.32 0.0 Puerperal Sepsis. Others. Total . The maternal Mortality Rates for England and Wales are as follows:— The Maternal Mortality Rates for Poplar are as follows:— Per 1,000 live births Per 1,000 total births Per 1,000 total births 1.61 1.54 1.85 2.63 2.52 2.22 4.24 4.06 4.07 16 TABLE V. (1932). 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 4,357,800 14.3 12.3 67 West Districts. Paddington 143,600 13.76 13.26 107 Kensington 183,500 12.9 13.6 98 Hammersmith 133,700 14.5 12.8 66 Fulham 149,600 14.28 12.35 58 Chelsea 59,430 11.9 12.9 52 City of Westminster 126,400 9.1 12.3 65.9 North Districts. St. Marylebone 96,430 10.97 12.4 87.2 Hampstead 90,130 10.9 11.6 54 St. Pancras 194,000 13.8 13.1 69 Islington 324,600 15.25 12.36 68 Stoke Newington 51,680 15.0 12.9 53 Hackney 214,200 14.5 11.5 53.9 Central Districts. Holborn 36,440 9.57 14.19 71.63 Finsbury 69,030 16.0 13.4 81 City of London 9,990 6.5 12.8 46 East Districts. Shoreditch 95,800 17.5 12.3 80 Bethnal Green 106,300 15.4 12.0 69 Stepney 223,000 16.7 12.3 61.6 Poplar 152,400 17.2 12.1 63 South Districts. Southwark 168,900 16.2 13.1 72 Bermondsey 110,100 16.6 12.0 56 Lambeth 292,300 14.7 12.5 56 Battersea 157,000 14.8 12.1 57.8 Wandsworth 353,300 11.86 11.56 62 Camberwell 248,000 14.6 12.0 65 Deptford 105,100 15.9 12.2 65 Greenwich 99,590 14.7 11.8 80 Lewisham 221,500 12.7 10.2 54 Woolwich 146,900 14.0 11.1 60 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.) 1927. 1928. 1929. 1930. 1931. 1932. Population, estimated by Registrar-General:— 167,000 162,000 160,000 157,900 156,300 152,400 Births, Live, rate per 1,000 population 19.8 19.9 19.1 19.3 17.5 17.2 Deaths from all causes, rate per 1,000 population 11.8 11.8 14.2 10.6 12.4 12.1 Deaths under 1 year of age, rate per 1,000 nett births 66 71 75 55 77 63 Deaths over 65 years of age, rate per 1,000 total population 4.2 4.2 5.7 4.2 5.0 5.2 *Zymotic diseases:— Death rate per 1,000 population 0.6 0.6 0.8 0.5 0.4 0.5 Proportion of 1,000 deaths 51.6 55.5 53.4 47.6 34.5 40.6 Tuberculosis, all forms:— Death rate per 1,000 population 1.1 1.1 1.2 0.9 1.1 1.0 Proportion of 1,000 deaths 96.0 93.2 85.6 86.8 87.5 83.3 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 2.0 1.9 3.1 1.0 2.2 1.7 Proportion of 1,000 deaths 172.4 162.4 219.8 98.1 181.8 140.7 *Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria and Mem. Croup, Typhoid Fever and Diarrhœal Diseases. Deaths from Various Diseases. Disease. 1927. 1928. 1929. 1930. 1931. 1932. Measles 8 56 11 30 9 31 Whooping-Cough 34 19 43 3 19 6 Influenza 36 24 71 3 23 25 Pneumonia (except Influenzal Pneumonia) 188 177 281 109 207 141 Diarrhoea and Enteritis (all ages) 39 47 44 25 25 16 18 Inquests. The number of inquests registered was 138. From this total be deducted 49 of non-residents, and 31 added of residents who died outside the Borough, the nett total being 120. Mortuary and Coroner's Court. The number of bodies deposited in the Council's Mortuary, Cottage Street, Poplar, during the year was 213:— Residents Males Females Non-Residents* Males Females Totals No age stated 2 2 1 — 5 Stillborn 1 — — — 1 Under 1 year 5 1 — — 6 1 to 5 years 10 5 — 1 16 5 to 15 years 8 4 1 2 15 15 to 25 years 12 2 1 — 15 25 to 45 years 16 8 7 3 34 45 to 65 years 38 11 11 4 64 65 years and upwards 25 23 5 4 57 Totals 117 56 26 14 213 *Brought from out side the Borough for the convenience of the Coroner, Inquests were held on 150, and 57 post-mortems were made by order of the Coroner. The total number of post-mortems made was 90. Six bodies were brought to the Mortuary for custody, pending burial. Arising from a communication received from the Metropolitan Boroughs' Standing Joint Committee, regarding the modernisation of Public Mortuaries, the Council provided moveable screens at the Mortuary in order to screen off from the viewing window the rest of the room shells are stored, thus making for the more reverent display of bodies. During the year 1932 there was some re-arrangement of the Coroners Courts in the eastern district of the metropolis. The only effect reflected in the figures so far is that, whilst the total number of bodies deposited shows a decrease on the previous year, the number of bodies brought outside the Borough shows an increase of 14. 19 Section B. General provision of health services FOR THE BOROUGH. (I) Public Health Officers of the Authority. page 4. Staff is shown at the commencement of the Report, (2 )Nursing in the Home. Agreements with local nursing associations are in operation, the fees payable being at the rate of 1s. 3d. per visit. (For number of cases visited and total visits paid, see Table in Maternity and Child Welfare Section of this Report.) (3) Midwives. The number of midwives practising in the area is 18. 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 Out Relief. The following information was furnished by the London County Council:- Number of persons relieved Week 2nd January, 1932 ended 2nd July, 1932 10,734 10,633 Cost. £3,476 £3,253 Medical relief only. 38 35 (5 )Laboratory Facilities. (a) Chemical Analysis. Arrangements are made with an analytical chemist who is approved by the Minister of Helath. All examinations are carried out at the Public Analyst's own laboratory which was situated at 139, St. Leonard's Road, Poplar in 1933 the laboratory was removed to Bank Buildings, 161, Bow Road, E .3. The report of the Public Analyst is given on page 71 (N.B.-Examination of samples of milk for tubercle and bacteriological counts in graded milks are made at the Lister Institute.) 20 (6) 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. (6) New Legislation. During the year the following Act of Parliament came into operation:— London County Council (General Powers) Act, 1932. This Act, which received Royal Assent on 12th July, 1932, deals inter alia with the following matters:— (a) Ice Cream and Preserved Food—Registration of premises. (b) Enables the London County Council (and the Common Council as respects the City of London) to make byelaws for promoting sanitary and cleanly conditions in the manufacture, preparation, storage, transport or exposure for sale of any article intended to be sold for food, such byelaws to be enforced by the Sanitary Authority. (c) Notification of Food Poisoning. (d) Unsound Food.—Extends Section 47 of the Public Health (London) Act, 1891, to animals or articles offered as prizes or rewards, or deposited for such purposes. (e) Housing Act, 1930.—Amends this Act to permit the London County Council to deal with areas consisting of 10 dwellings, or less. (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. 21 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. 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 127.) 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 93, 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 22 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 125 .) (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. 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. London County Council (General Powers) Act, 1928, sec. 28. Removal of infirm persons. During the year it has been necessary to obtain one Magistrate's Order for the removal of a person to an institution. In addition, four other infirm persons were persuaded to enter institutions voluntarily. In April a letter was received from the London County Council stating that the County Council had decided to make no claim on Metropolitan Borough Councils for the maintenance of patients admitted under the provisions of Section 28 of the London County Council (General Powers) Act, 1928, to any of its Hospitals or Institutions under the management of the Central Public Health Committee or of the Public Assistance Committee. 23 section C 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. Four-fifths 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 fifth is barged from a riverside wharf. Improved methods of dust collection by low loading freighters were put into full operation throughout the Borough during the year. Trade Refuse.—This is collected only when specially requested, and its method of disposal depends entirely on its composition, it being sent to the Destructor or Barge as circumstances warrant. Street Cleansing.—The system for street cleansing includes hand sweeping by gangs, orderly men, horse-drawn machine broom and motor sweepers. The main and other important roads are swept daily and nightly; other roads mostly three times weekly. No road is swept less than twice weekly. The sweepings and/or 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 1932. House refuse collected Trade refuse collected Slop and sweepings Refuse from street markets 32,578 tons 112 ,, 8,879 ,, 2,608 ,, 24 Work of Lady Sanitary Inspector. Tabulated statement of Inspections, of Insanitary Conditions found existing, and of Reinspections, etc., during the year 1932. Factories and Workshops newly discovered and Registered 11 Number of Inspections of:— Factories, including Factory Laundries Workshops, including Workshop Laundries Workplaces Workrooms Homeworkers' premises Reinspections of above 118 79 3 5 620 61 Defects Found:— 1. Nuisances under Public Health (London) Act, 1891:— Found. Remedied. Referred to D.S.I. Referred to H.M. Insp. Want of cleanliness Want of ventilation Overcrowding Want of drainage of floors Other nuisances Sanitary accommodation Insufficient Unsuitable or defective Not separate for sexes Want of cleanliness 2. Offences under Factory and Workshop Acts 9 – – – 2 1 17 1 18 – 1 – – – 1 1 13 11 – 4 – – – 2 1 – – – – – – – – – – – – – – Action Taken Regarding Above:— Intimations served ,, complied with Notices served ,, complied with Final Notices served Legal Proceedings taken Nuisances remedied without service of Intimations, etc. 30 29 1 1 – – 7 Other Matters :— Visits to Council Houses and Flats Revisits ,, ,, Visits re cases of Scabies ,, Verminous children ,, Outworkers' lists ,, cases of Smallpox and Chickenpox ,, Smallpox contacts ,, Infectious Disease on Homeworkers' premises ,, School Exclusions, etc. Miscellaneous visits Inspections of Schools re Sanitary accommodation Visits to prospective tenants of Council's Flats, etc. ,, ,, ,, Goodwill House (Presb. Hsg. Assocn.) 803 48 126 14 29 – – 15 786 564 45 169 14 District Sanitary Inspectors' Work, Etc. Tabulated Statement of Inspections, Insanitary Conditions found existing, and lie-inspections during the year 1932. DISTRICT. Totals. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. Number of Complaints received 466 325 818 841 827 1,051 1,028 528 5,884 Number of Inspections Dwelling Houses House-to-House 7* 11 — — 46 30 — — 94* On Complaint 882 298 896 806 824 1,077 1,028 528 6,339 After Infectious Disease 370 160 220 175 239 164 214 151 1,693 Factories, including Factory Laundries — 31 7 16 38 2 2 40 136 Workshops, including Workshop Laundries 1 36 10 44 63 17 25 22 218 Workplaces, other than outworkers 2 20 6 90 80 33 4 28 267 Outworkers — 1 — — — — — — 1 .Stables — 12 6 31 87 — 4 46 186 Smoke observations 8 6 12 6 20 2 5 22 81 Miscellaneous visits 1,597 596 549 420 297 1,187 303 413 5,362 Re-inspections 2,060 3,020 2,761 2,566 3,361 1,429 3,569 2,399 21,165 Premises requiring amendment (a) Dwelling-houses 900 450 813 852 725 1,064 1,030 435 6,269 (6) Other premises 3 51 37 60 85 18 — 11 265 Service of Intimations, etc.: Intimations served 907 455 772 938 716 1,161 1,007 468 6,424 ,, complied with 426 206 395 879 541 525 613 125 3,710 Notices served 257 106 456 494 154 531 374 239 2,611 ,, complied with 222 57 175 401 155 258 240 149 1,657 Final Notices served 62 7 144 54 24 155 116 71 636 ,, complied with 5 8 145 100 25 136 124 8 551 Legal Proceedings taken 2 5 10 — 35 8 18 78 Sanitary Defects, etc., in Dwelling-houses: Drainage Defects: Requiring entire reconstruction 22 75 159 17 37 16 11 Nuisances, etc., found. Works completed. 178 Add 159 236 ,, drains to be relaid, trapped or ventilated 9 29 34 14 2 2 1 87 76 ,, ,, ,, repaired, etc. 14 26 25 49 16 29 38 197 201 ,, ,, ,, cleared, flushed, etc. 22 58 15 60 43 122 52 372 411 Waste pipes not disconnected 7 4 — 2 7 1 34 1 56 67 ,, requiring renewal 101 22 45 81 64 37 65 13 428 328 Rainwater pipes not disconnected 3 4 — 2 4 — 2 2 17 34 W.C.'s and flushing apparatus defective .. 84 43 106 182 56 101 115 47 734 604 Soil pipes requiring renewal or replacement — 3 1 1 6 3 1 1 16 25 ,, ,, repair — 1 — — — — 2 — 3 3 ,, not ventilated — 3 — — 7 — — — 10 9 Dampness: Number of nuisances from 194 77 518 188 494 245 160 59 1,935 1,401 Water: Supply cut off 1 2 — — 4 1 1 1 10 48 Dust Receptacles: New required 105 57 131 154 203 362 184 100 1,296 1,300 Requiring repair — 2 — — — — — — 2 13 Miscellaneous: Houses or rooms dirty and/or verminous 458 292 544 448 272 692 298 233 3,237 2,657 Cases of overcrowding 4 1 9 8 14 7 12 6 61 17 Yards, etc., not properly paved or drained 42 35 66 149 133 62 125 91 703 650 Roofs defective 336 155 439 544 381 325 404 253 2,837 2,345 Gutters defective 150 57 101 212 349 171 168 165 1,373 1,185 Public House Urinals requiring cleansing — 1 3 32 7 10 — 53 25 Other nuisances or defects 630 313 2,473 921 821 1,576 681 641 8,056 7,081 Stables: Manure receptacles defective, etc. — — — 3 8 11 8 Accumulations found 1 4 4 4 14 1 — — 28 25 Re-housing: Number of families re-housed by— 1. Poplar Borough Council 5 1 2 11 9 8 2 38 2. London County Council 4 8 3 42 15 26 9 9 116 3. Presbyterian Housing Association — — 1 — — 7 — — 8 Number of visits by Assistants (not included above) 3,073 1,899 4,809 5,599 4,496 5,124 5,322 60 30,382 * Including 7 for revocation of Magistrate's Closing Orders 25 Houses divided into separate Tenements, etc. Number of Houses on Register at end of 1931 ,, ,, removed from Register during 1932 „ ,, registered during 1932 ,, ,, on Register at end of 1932 House-to-House visits for registration purposes Declarations, for information, sent out ,, with information, returned Rooms measured, etc. Houses registered Notices sent out, re above Inspections: (a) Night inspections (b) First annual inspections (c) Other routine inspections (d) On complaints (e) On account of re-housing Re-inspections Miscellaneous visits, enquiries, etc. Number of informal notices served ,, ,, ,, complied with ,, Notices served ,, ,, complied with ,, Final Notices served ,, cases in which legal proceedings were taken Work done as a result of Final Notice or legal proceedings, number of cases Overcrowding, cases discovered ,, ,, abated Mixed sleeping, cases discovered ,, ,, abated Number of nuisances referred to District Inspectors: (a) Defective or obstructed drains (b) Defective roofs, guttering, etc. (c) Water supply in tenement houses (d) Miscellaneous 148 7 – 141 21 – 162 64 7 15 11 21 13 7 115 206 17 19 398 338 127 89 16 5 – 3 – 21 16 2 1 7 17 2 33 26 Remarks: During the year the Inspector deputised for District Inspectors on 89 days, and in addition to this district work the Inspector made other visits as follows:— Enquiries on account of rehousing Re-visits in connection therewith 565 261 Factory and Workshop 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 1932. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male. Female Total. Bakehouses (Factories) 53 — 53 225 108 — 1 — Bakehouses (Workshops) 19 — 19 81 40 — — — Bakehouses (Domestic Workshops) 3 — 3 9 6 — — — Factories (Laundries and Miscellaneous Factories) 58 108 166 187 32 1 — — Laundries (Workshops) — 3 3 3 — — — — Laundries (Domestic Workshops) — — — — — — Workshops 205 85 290 324 38 3 1 — Workshops (Domestic) 16 7 23 24 2 1 — — Workplaces 365 — 365 509 77 5 — — Workplaces (Domestic) 47 — 47 53 5 — — — Places where food is sold or prepared 819* — 819* 1967 342 2 — — Milk Premises 107 — 107 365 1 — — — Cowsheds 3 — 3 23 — — — — Slaughterhouses (a) 8 — 8 31 30 — — — Other offensive trade premises 5† — 5† 18 — — — — Ice Cream premises 162‡ — 162‡ 297 11 2 — — Homeworkers' premises 23 516 539 620 1 1 — — * Power is used in 87 of these premises. ‡ ,, ,,30 ,, ,, (a) Includes three registered Slaughterers of Poultry, † Registered by the London County Council. (Lists of Slaughterhouses and other offensive trade premises are given on page 33.) 27 Table B. Workshops on Register (Male). 1 Acetylene gas making. 1 Accumulator making. 1 Asphalte making. 1 Bath Salts making. 2 Bedding making. 1 Bitumen making. 3 Blind making. 1 Boiler covering. 1 Boat building. 23 Bootmaking. 1 Bottle making. 1 Brush making. 12 Cabinet making. 3 Carpentry. 1 Chemical works. 1 Cigar making. 1 Clay pipe making. 1 Comb making. 2 Confetti making. 3 Cork cutting. 3 Cooperages. 1 Coppersmith. 1 Dental workshop. 1 Electrical engineering. 2 Engineering. 12 Farriers. 3 French polishing. 1 Frilling making. 1 Furniture making. 1 Furniture-polish making. 2 Furriers. 1 Garden Ticket making. 2 Glass blowing. 1 Horsehair working. 4 Harness making. 1 Maltster. 6 Metal works. 8 Motor garage works. 1 Nut and Bolt making. 3 Oil stores. 1 Packing-case making. 3 Paint making. 2 Plumbing. 1 Poultry food mixing. 3 Printing. 4 Rag sorting. 1 Range making. 3 Rope making. 1 Sack making. 3 Sawyers. 1 Shellac bleaching. 1 Ship's painting. 1 Sign making. 2 Stonemasonry. 35 Tailoring. 1 Tank making. 4 Tarpaulin works. 1 Tin toy making. 3 Undertaking. 5 Upholstering. 2 Van building, etc. 1 Vegetable Soap making. 1 Vinegar making. 1 Waterproof working. 2 Welding. 1 Wheelwright. 3 Wire working. 1 Wood Tar products. 1 Zinc working. 28 Domestic Workshops on Register (where Men are Employed.)* 6 Boot repairing. 1 Cabinet making. 1 Decorative earthenware making. 1 Paper bag making. 5 Tailoring, 1 Wire working, 1 Zinc working. Home Workers on Register (Male). 4 Bootmaking. 2 Box making. 1 Furrier. 16 Tailoring. Workshops and Domestic Workshops on Register (Females).* 1 Bedding making. 1 Boot making. 2 Cabinet making. 1 Cap making. 1 Clay pipe making. 1 Confectionery. 2 Cork cutting. 7 Costume making. 8 Dressmaking and altering. 1 Embroidering. 4 Furriers. 3 Laundries. 8 Milliners. 1 Onion peeling and pickling. 7 Packing. 4 Rag sorting. 1 Presser and cleaner. 2 Sack making. 2 Shirt making. 1 Seal stamp making. 31 Tailoring. 1 Toymaking. 1 Underwear making. 3 Upholstering. 1 Wood chopping. * It is very difficult to separate Workshops and Domestic Workshops, as these premises are sometimes one and sometimes the other, according to the pressure of work. 29 Factories on Register (where Females are Employed). 2 Bedding manufacturing. 1 Billiard Table making. 1 Blouse making. 2 Boot making (Infants'). 7 Box making. 1 Brush making. 1 Bunting and flag making. 1 Butter mixing factory. 1 Cake and Biscuit making. 2 Chip basket making. 1 Cigarette paper making. 1 Cleaner and dyer. 2 Confectionery making. 1 Cork cutting. 2 Corset making. 4 Costumes and mantle making. 1 Dog biscuit manufacturer. 3 Dressmaking. 1 Dyemaking for leather goods. 1 Feather works. 1 Fibre, hemp and jute making. 2 Furniture making. 2 Furriers. 1 Gum works. 1 Harness and clog making. 2 Laundries. 1 Leather handbags. 1 Match making. 1 Medical Glass Instruments. 1 Oil and colour works. 2 Overall making. 2 Perambulator building. 1 Perfume making. 1 Pickle and sauce making. 3 Preserved food. 1 Printing works. 1 Rag sorting. 1 Rice starch making. 4 Rope works. 2 Rubber goods making. 1 Rug making. 4 Sack making. 1 Sausage factory. 4 Shirt making, 1 Shroud making. 1 Soap making. 1 Sugar refining. 16 Tailoring. 2 Tarpaulin works. 1 Ticket printing. 1 Timber works and wicker furniture making. 1 Toy making. 1 Type founder. 1 Uniform making. 1 Wallpaper manufacturer. 1 Whalebone works. 1 Wine bottling. 1 Wireless battery making. 1 Woollen garment making. 30 Table C. Factories, Workshops, Laundries, Workplaces and Homeworkers. I.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Intimation. Statutory. Final. Factories 412 140 1 1 — (Including Factory Bakehouses and Laundries) Workshops† 408 78 3 1 — (Including Workshop Laundries.) Domestic Workshops‡ 33 8 1 — — Workplaces 509 77 15 — — Domestic Workplaces 53 5 — — — Places where food is sold or prepared§ 1967 342 2 — — Homeworkers' Premises 620 1 1 — — Total 4002 651 23 2 — † Including Workshop Bakehouses. ‡ Including Domestic Bakehouses and Laundries. § The inspections of factories where food is prepared are included. Power is used in 87 of the premises. 2.—DEFECTS FOUND* (Corresponding figures for 1931 are shown in italics). Particulars. Number of Defects. Number of Found. Remedied Referred to H.M. Inspector. Prosecutions. (1) (2) (3) (4) (5) Nuisances under the Public Health Act: Want of cleanliness 580 (590) 580 — — Want of ventilation — (14) — — — Overcrowding — (1) — — — Want of drainage of floors — 12) — — — Other nuisances 112 (47) 112 — — Sanitary recommodation insufficient 5 (11) 5 — — unsuitable or defective 23 (25) 23 — — not separate for sexes 4 (1) 4 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse(s.101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) Other offences — (4) — — — (Excluding offences relating to outwork which are included in Table D of this Report.) Total 724 (695) 724 — .. * These defects refer to premises as mentioned above under table of Inspection. 31 Nature of Work, Twice in the year. Once in the year. Notice sen on Occupier to keeping sending lists Failing to keep or permit inspection of list. Failing to send lists. Instances. Notices server Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110) Table D.—Home Work. Total Lists. Outworkers. Total Lists. Outworkers Contractors Workmen. Contractors Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— Making, etc. 77 17 244 2 __ 2 86 \ 15* Cleaning and Washing Household Linen Lace, lace ourtains and nets Curtains and furniture hangings Furniture and Upholstery Eleotro-plate File Making Brass and Brass Articles Fur pulling Cables and Chains 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 6 — 51 — — — 6 Brush Making Pea Picking Feather Sorting Carding,etc., of buttons, etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, etc. Textile Weaving Miscellaneous 2 — 3 1 — 1 3 Totals 85 17 298 3 — 3 95 — — — — 15* — — * Infectious Diseases see page 76. 32 LIST OF OUTWORKERS, FACTORY AND WORKSHOP ACT, 1901 (S. 107). Class of Homework. 1932 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 44 169 44 149 177 236 156 263 Tailoring 36 105 35 104 177 Shirtmaking 1 1 1 1 Miscellaneous 3 36 4 19 236 156 263 Boxes 3 23 3 18 Overalls 1 4 1 7 Table E. Kegistered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehousesmay be enumerated here. Bakehouse Workshops 19 Bakehouse Domestic Workshops 3 Laundries Workshops 3 Laundries Domestic Workshops — Workshops 290 Domestic Workshops 23 Workplaces 365 Workplaces Domestic 47 Places where food is sold or prepared 819† Total number of workshops and workplaces, etc., on Register 1569 † Power is used in 87 of these premises. Table F. Class. Number, (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) Nil 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 12 Reports (of action taken) sent to H.M. Inspector 9 (3 in 1933) Other (Communications) 18 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 20 Smoke Abatement. 61 observations were made and 34 nuisances recorded. 14 complaints were received from the London County Council. 11 intimations were served. In addition, 24 cautions were sent and in 2 instances Works Managers were interviewed. It was not necessary to institute legal proceedings in any instance. In this connection it should be mentioned that no formal action is taken on the receipt of a complaint by the London County Council, but observation is kept by our own inspectors and nuisances are then followed up. Methods of observation and standards in use since 1927 are similar to those of the Coal Smoke Abatement Society. Smoke and Grit—Electricity Station. During the year communications were received from the London County Council regarding the emission of smoke and grit from certain shafts at the Council's Electricity Station. This matter had for some time received the careful consideration of the Borough Electrical Engineer. The Public Health Committee asked the two representatives of the Council (The Mayor and Councillor Mr. G. Anderson) to attend a meeting of the Council of the National Smoke Abatement Society in London on 3rd June, 1932. Houses Let in Lodgings. The report of the Inspector is given on page 25. Offensive Trades. Address. Proprietors. Business. 80, Whitepost Lane Sheppy Glue & Chemical Co. Fat me Iters. East London Soap Works E. R. Cook & Co., Ltd... Soap boilers. 184, Bow Road A. Steinschneider Dresser of fur skins. 10-16, Aberfeldy Street .. Nathan Cohen & Sons ,, ,, *43, Whitepost Lane Kestenbaum Bros. ,, ,, 12, Coborn Road .. M. Shriebhand Slaughterer of poultry. 221, Roman Road W. E. Prideaux ,, ,, *105, Grundy Street H. Jacobovitch ,, ,, * Licence expires 31st March, 1937. 33 34 S laughterhouses. Address. Proprietors. Remarks. Bow Lane (West side) Hy. Wickes & Sons, Ltd. 220, Roman Road Arthur E. Fisher Limited to requirements of shop. 288, Roman Road Chas. V. Applegate Small cattle only. 48-50, West Frry Road J. W.. Faulconbridge (trading as J. W. Faulconbridge & Son) For number of Inspections, etc., see Table A, page 26. Offensive Businesses—Stone Crushing, etc. The Council informed the Standing Joint Committee that they supported representations which had been made to the Joint Committee for the promotion of legislation making it an offence to establish anew, without the sanction of the County Council, the business of stone crushing or mixing, or any trade from the carrying on of which a nuisance would be created by dust emitted from the plant used on the premises, on lines similar to those provided in Section 19 of the Public Health (London) Act, 1891. Milkshops, Dairies, etc. The premises are reported upon on page 59. Rag and Bone Dealers. Occasion for taking legal proceedings for offences against the London County Council Byelaws did not arise. Verminous Rooms. Verminous rooms are brought to the notice of owners upon the "Intimations", which are followed, if necessary, by Statutory Notices as there are usually other nuisances or defects upon the premises. Notices are also served under Section 10 of the London County Council (General Powers) Act, 1922. 283 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. 409½ gallons of insecticide were distributed during the year. A special report on Bug Infestation is printed as an appendix (page 139). Licensed Premises Urinals. 53 urinals on licensed premises were found to be in insanitary condition and were subsequently cleansed. 35 Water Certificates. Four certificates were issued under Section 48 of the Public Health (London) Act, 1891. Stables. 186 stables were inspected and reported upon, the total number of inspections being 272. The following infringements of the Bye-laws were dealt with:— Accumulations of manure, or premises otherwise not clean Floors not properly drained Dung receptacles:— (a) Not provided (b) Defective (c) Not covered Other defects 32 – 5 6 1 13 48 Intimations were served, followed by 1 Notice. The works required were completed, before the end of the year in most instances. Customs and Inland Revenue Acts, 1890-1891, and Revenue Act, 1903. No applications for certificates for exemption under the Customs and Inland Revenue Acts, 1890-1891, and the Revenue Act, 1903, were made during the year. Street Trading. A record is kept in the Public Health Office of street traders who have been licensed to deal in foodstuffs. All new applications are reported upon prior to licenses being granted, and all storage premises are kept under supervision and periodically inspected. Rats and Mice (Destruction) Act, 1919. 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, which contained certain suggestions, was submitted to the Council in September, 1931. (Appendix A, Annual Report, 1931.) 36 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. Four samples of Rag Flock were examined during the year and one was unsatisfactory. As a result legal proceedings were taken against a manufacturer, who was fined £5 and ordered to pay £15 15s. costs. Hairdressers' Premises. The number of inspections of hairdressers' premises was 86. Cleansing was necessary at 3 of the premises, and other nuisances found numbered 12. 7 intimations and 1 statutory notice were served. The requirements of these documents were complied with. Canal Boats Acts. By Section 3 of the Canal Boats Act, 1884, sanitary authorities are required to send to the Minister of Health, on or before 21st January, annual statements as to the number of canal boats inspected, the number and nature of contraventions of the Acts or Regulations discovered, and the action taken as a result thereof. The following statement was submitted:— During the year ended 31st December, 1932, no canal boats have been inspected, although the canals and locks have been visited by our Inspectors on a number of occasions. On enquiries being made of the authorities at the locks the Inspectors have been informed that very few vessels of the canal boat type now ply on the canals in the Borough. Provision of Scullery Sinks. Consideration was given to a letter from the Metropolitan Boroughs' Standing Joint Committee regarding the desirability of legislation being promoted to enforce the provision of scullery sinks in all dwelling-houses, and the Council agreed to support this recommendation. From the reports of the District Sanitary Inspectors it appeared that there were in the Borough approximately 600 houses where the water supplied was in the yard and not in the house and there were no sinks. 37 LEGAL PROCEEDINGS. Public Health (London) Act, 1891, Metropolis Management Acts, etc. Address. Nature of Complaint. Result. Inspector. 12, Swale Street Various defects 7 days' order; £2 8s. costs.. Colborne, W.J. 13, Willis Street Various defects £5 penalty; £2 5s. costs Johnson, W. 9, Goodliffe Place Various defects 14 days' order; £2 8s. costs Colborne, W. J. 20, Crew Street Various defects 14 days' order; £5 penalty; £2 8s. costs Langley, H.J. 2, Newcastle Street Insufficient ashpit £2 penalty Dove, A. L. 2, Newcastle Street Various defects 7 days' order; £2 8s. costs Dove, A. L. 166, West Ferry Road Various defects Work done; £2 penalty; £2 3s. costs Langley, H.J. 224, West Ferry Road Various defects Work done; £2 5s. costs Langley, H.J. 146, West Ferry Road Various defects £3 penalty; £2 2s. costs Langley, H.J. 160, West Ferry Road Various defects £3 penalty; £2 2s. costs Langley, H.J. 152, West Ferry Road Various defects £3 penalty; £2 2s. costs Langley, H.J. 17, Hanbury Buildings Walls and ceilings dirty and verminous 7 days' order; £2 8s. costs.. Colborne, W.J. 70, Guildford Road Main roof defective 7 days' order; £2 penalty; £2 8s. costs Colborne, W.J. 49, Bath Street Various defects Work done; £2 5s. costs Colborne, W.J. 22, Comboss Road W.C. pan broken; drain defective *Settled out of Court; £2 2s. costs Kelly, S. 106, Augusta Street Various defects Work done; £2 5s. costs Colborne, W. J. 17, East Ferry Road Roof defective Work done; £2 5s. costs Dove, A. L. 15, East Ferry Road Main roof defective Work done; £2 5s. costs Dove, A. L. 103, Brabazon Street Main roof defective Work done; £2 5s. costs Colborne, W.J. 42, Barehester Street Various defects Work done; £2 5s. costs Colborne, W. J. 17, Washington Street Failed to amend the drains Adjourned sine die for Defendant to arrange for work to be done Westbrook, C. S. 55, Marner Street Various defects £2 penalty; £2 5s. costs Johnson, W. 97, Brabazon Street Various defects 7 days' ordor; £1 penalty; £2 8s. costs Colborne, W.J. 53, Garford Street Main roof gutter and slip roof defective Work done; £2 5s. costs Langley, H.J. 57, Garford Street Main roof and roof gutter defective Work done; £2 5s. costs Langley, H.J. 30, Lawrence Road Failed to amend the drains Adjourned sine die for defendant to do the work Kelly, S. * Defendant gave an undertaking as to future conduct. 38 Address. Nature of Complaint. Result. Inspector. 69, Garford Street Main, back addition and lean-to roofs defective Work done; £2 5s. costs Langlcy, H. J. 71, Garford Street Roof defective Work done; £2 5s. costs Langley, H.J. 6, Smeed Road Failed to amend the drains Adjourned sine die, on account of death of Defendant Kelly, S. 73, Marner Street Washhouse roof defective 7 days' order; £2 penalty; £2 8s. costs Johnson, W. 165, Campbell Road Main roof defective and other defects Work done; 1s. penalty; £2 5s. costs Westbrook, C. S. 266, Devons Road Failed to amend the drains 10s. penalty Westbrook, C. S. 42, Broomfield Street Back addition roof defective 7 days' order; £1 penalty; £2 8s. costs Colborne, W.J. 50, Broomfield Street Main and back addition roofs defective Work done; 1s. penalty; £2 5s. costs Colborne, W.J. 35, Pennyfields No proper and sufficient water supply Closing Order made; £2 8s. costs Colborne, W.J. 30, Marshfield Street Various defects 7 days' order; £2 penalty; £2 8s. costs Dove, A. L. 32, Marshfield Street Various defects 7 days' order; £2 penalty; £2 8s. costs Dove, A. L. 39, Marshfield Street Various defects 7 days' order; £2 penalty; £2 8s. costs Dove, A. L. 171, Campbell Road Main roof defective and other defects 7 days' order; £2 8s. costs Westbrook, C. S. 72, Guildford Road Main roof defective Work done; £2 penalty; £2 5s. costs Colborne, W.J. 46, Sabbarton Street Main roof defective and other defects 7 days' order; £2 8s. costs Colborne, W. J 48, Sabbarton Street Roofs defective Work done; 1s. penalty; £2 5s. costs Colborne, W.J 10 Harrow Lane W.C. pan and trap fitted without notice £3 penalty; £1 1s. costs Colborne, W. J. 16, Mauve Street Main roof defective £1 penalty; £2 5s. costs Johnson, W. 14, Portree Street Main roof defective Work done; £2 5s. costs Johnson, W. 16, Ship Street Various defects Work done; £2 5s. costs Dove, A. L. 9, Goodliffe Place Main roof defective and other defects Work done; Summons withdrawn on payment of £2 5s. costs Colborne, W. J. 103, Donald Street Main roof defective and other defects £5 penalty; £2 5s. costs Johnson, W. 17, Wilson Street Various defects £5 penalty; £2 5s. costs Johnson, W. 39 London County Council Byelaws with Respect to Houses Divided into Separate Tenements. Address. Nature of Complaint. Result. Inspector. 13, Tapley Street Failed to furnish required particulars £2 penalty; £5 5s. costs Luke, H. W. 20, Cotton Street Overcrowding of 4 rooms used as sleeping apartments £2 penalty; £2 2s. costs Luke, H. W. 20, Cotton Street Overcrowding of 3 rooms used as sleeping apartments (continuing offence) £5 penalty; £5 5s. costs Luke, H. W. Rao Flock Act and Regulations. Defendant. Offence. Result. Inspector. D.U. Co., Westminster At Old Ford Road were in possession of flock containing 278 parts of chlorine per 100,000 parts of flock £5 penalty; £15 15s. costs Smith, F. A. Food and Drugs (Adulteration) Act, 1928. Article. Result of Analysis, etc. Result. Inspector. Whisky 40 deg. under proof £3 3s. costs Grabham, C. A. Ginger Wine Non-alcoholic; contained Zinc 0.3 grains per pint Defendants failed to appear Pearce, H. A. Sweets Sulphur dioxide 150 parts per million in excess £5 penalty; £1 Is. costs Pearce, H. A. Sweets Sulphur dioxide 268 parts per million in excess £5 penalty; £1 Is. costs Grabham, C. A. Milk 3.5% added water £2 2s. costs Pearce, H. A. Milk 3.5% added water £1 Is. costs Pearce, H. A. Vinegar 5% deficient in acid Summons dismissed; "Warranty" proved Grabham, C. A. V inegar 5% deficient in acid; Warrantors in above case £5 5s. costs Grabham, C. A. Vinegar 10% deficient in acid £1 penalty Grabham, C. A. Vinegar 35% deficient in acid £1 penalty Grabham, C. A. Vinegar 10% deficient in acid £1 penalty Pearce, H. A. Hot milk 11.7% added water £2 4s. costs Pearce, H. A. (Note.—10 letters of caution were sent to Vendors in respect of other samples reported to be not genuine.) 40 Public Health (London) Act, 1891, Section 47. Seizures of Unsound Food. 23 Baskets of Blackberries which were unsound, etc., exposed for sale on a stall in Chrisp Street, seized and condemned by Magistrate £1 penalty. {Note.—1 letter of caution sent in respect of unsound food, which was surrendered.) Milk and Dairies Order, 1926. Milk can and lid containing milk being delivered at teith Road School not thoroughly clean £3 penalty; £2 costs. Letters of caution were sent for infringements of various Orders, etc., as follows:— Milk and Dairies Acts and Order 5 Milk (Special Designations) Order 5 (In addition 5 were reported to Ministry of Health, etc.) Public Health (Meat) Regulations 1 SUMMARY OF PENALTIES AND COSTS. Penalties. Costs. £ 8. d. £ s. d. Public Health (London) Act, 1891 52 3 0 102 12 0 Metropolis Local Management Acts 0 10 0 — L.C.C. Byelaws—Houses divided into separate Tenements 9 0 0 12 12 0 Rag Flock Act 5 0 0 15 15 0 Food and Drugs Acts, etc. 26 0 0 24 5 0 Milk and Dairies Acts and Order 3 0 0 2 0 0 Public Health (London) Act, 1891, Sec. 47 (unsound food) 1 0 0 — Totals £96 13 0 £157 4 0 £253 17 0 41 Copy of a Return to the London County Council Premises. No. in Borough on 31st December 1932. No. of Inspections. No. of Prosecutions. Cowsheds (No. of Premises) 3 23 Slaughterhouses 5 20* — Poultry Slaughterhouses 3 11 — Offensive Trades 5 18 Milkshops 107 365 — Ice Cream Premises 162 297 Restaurants and Eating Houses (all places where food is sold or prepared) 819 1,967 *In addition 712 visits were made in connection with examination of carcases. Smoke Nuisances. (1) No. of observations 61 No. of nuisances recorded 34 (2) Number of intimations served 11 (In addition 26 Cautions were sent) (3) No. of complaints received (from L.C.C.) 14 (4) No. of Statutory Notices served Nil. (5) No. of legal proceedings Nil. (6) No. of convictions Nil. (7) Amount of penalty and costs imposed in each case — Cleansing and Disinfection. No. of adults cleansed 143 No. of children cleansed 2731 No. of premises cleansed (a) After infectious diseases 1,620 (6) For vermin 283 (rooms) by P.B.C. (207 rooms by Owners). Water Supply to Tenement Houses. No. of premises supplied Nil. Sanitary Officers. No. of Sanitary Inspectors (whole-time) ,, ,, „ (part-time) No. of prosecutions Nil. Male. Female. 14* 1 Nil. Nil. M.C.W. T.B. No. of Health Visitors (whole-time) ,, ,, (part-time) 9† 3 And 1 Sister in charge Nil. of Light Clinics(M.&C.W.) *8 District Inspectors, 2 Meat and Food Inspectors, 1 Houses-let-in-lodgings Inspector and 3 Housing Survey Inspectors. †Does not include 9 employed by a Voluntary Association. 42 Total No. of dwellings in the Borough (Census, 1931) 23,583 No. of houses, closed on notice by owner that they could not be made fit No. of houses occupied by the working classes .23,000 (Approx.) No. of houses for the working classes (а) Erected during year 134 (b) In course of erection 50* No. of houses inspected complaints or illness (P.H. Act) 8,835 b) House-to-liouse (Housing Consolidated Regulations, 1925) 7,303 No. of representations by Medical Officer or other person Nil. No. of houses included in such representations Nil *Exclusive of Bow Bridge Flats in course of erection by L.C.C. No. of notices served (а) Under P .H. Act: (i) Intimation 6,424 (ii) Statutory 2,611 (b) Under Housing Act 1 No. of Closing Orders made No. of Closing Orders determined (i.e., houses made fit) Nil No. of houses repaired or nuisances remedied under P.H. Act, 1891 5,689 No. of Demolition Orders Nil No. of houses demolished (a) In pursuance of Orders 30 10 (b) Voluntarily No. of houses repaired under Sec. 3 of Housing Act, 1925 (а) By owners Nil. (б) By L.A. in default of owners 1 *17 by P.B.C. in "Clearance Areas," 13 by L.C.C. Underground Rooms. None No. illegally occupied recorded. No. closed or illegal occupation discontinued Nil. Overcrowding. No. of cases of overcrowding found 55 No. remedied 34 No. of prosecutions Nil. Houses Let in Lodgings. No. on register 162 No. of inspections made 1164* No. of prosecutions 3 *Including visits for registration purposes and miscellaneous visit9- 43 Section D. HOUSING. The following section on Housing has been prepared in accordance with Circular 1 ,269 (England) of the Ministry of Health, 1932 STATISTICS. Number of new houses erected during 1932:- (a) Total (including numbers given separately under (b) 1 34 (i) By the Local Authority (In course of erection, 50.) (ii) By other Local Authorities - (iii) By other bodies or persons 5 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 127 (c) For other purposes Nil 1.-inspection of Dwelling Houses during the Year. («) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 15,257 (b) Number of inspections made for the purpose 33,210 (2) (a) Number of dwelling-houses (included under subhead (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 7,303 (b) Number of inspections made for the purpose 8,738 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 20* *See Note on page 45. 44 (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 5,745 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 3,451 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 1 (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 1 (b) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,273 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 2,238 (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) Number of dwelling-houses demolished in pursuance of Demolition Orders— 45 (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 became operative 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 n , 14, and 15 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which Closing Orders became operative — (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 became operative— (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Note.—Section 3 and 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 Notices, Closing Orders and Demolition Orders made before the operation of the Act (15th August, 1930), and houses subject to those Notices and Orders must continue to be dealt with under the relative provisions of the Act of 1925. Of the 20 dwelling-houses found to be in a state unfit for human habitation (under heading 1 (3) of Housing Statistics, page 43): 46 1 Closing Order was made by a Magistrate. 12 were inspections of premises which had been represented in 1931. 7 were subject to Magistrate's Closing Orders made in 1925 and were inspected with a view to "reconditioning" and consequent revocation of Closing Orders, but this was not done. 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 ,, 494 ,, ,, 1930 ,, 31 736 Houses converted to tenements (No State assistance) 35 tenements 771 (2) Part II of the Housing Act, 1925:— Assisted under 1919 Act 36 „ „ 1923 Act Sec. 1 (3) 24 60 47 1. Survey of District. During the year the inspection of 131 streets, comprising 6,147 nouses, was completed. The following house-to-house inspections have been carried out:— Work of Survey Inspectors. No. of houses inspected. (1). Bow. Antill Road 24 Armagh Road 166 Athelstane Road 38 Balmer Road 10 Beachy Road 40 Beale Place 14 Beale Road 51 Cardigan Road 58 Chad Street 25 Clarkes Place 3 Coborn Road 8 Driffield Road 43 Eglinton Road 74 Ford Road 70 Ford Street 80 Gawthorne Street 44 Hewlett Road 96 Lacey Street 32 Lefevre Road 10 Libra Road 78 Milton Road 73 Monier Road 30 Monteith Road 40 Morville Street 97 Mostyn Road 54 Old Ford Road 173 Ordell Road 37 Parnell Road 1 Ranwell Street 9 Rippoth Road 79 Roman Road 186 Rosebank Road 17 St. Stephen's Road 159 Selwyn Road 3 48 (1). Bow. No. of houses inspected. Smeed Road 10 Stafford Road 60 Sutherland Road 61 Tamar Street 9 Tredegar Road 173 Usher Road 9 Vernon Road 54 Wendon Street 1 Wrights Road 27 Wyke Road 97 2,423 Total visits 2,807 (umber of nuisances referred to D.S.I's., 546.) (2). Bromley. Abbott Road 51 Aberfeldy Street 68 Ailsa Street 33 Albert Street 28 Ashton Street 28 Athol Street 42 Bartlett Street 12 Benledi Street 60 Blair Street 116 Bloomsbury Street 32 Bromley Street 6 Bromley Hall Road 18 Brunswick Road 126 Burdett Street 39 Cantrell Road 36 Cawdor Street 35 Chadbourne Street 25 Chiltem Road. 36 Clutton Street 6 Cobden Street 19 Colin Street 30 Coventry Cross 2 Croucher Place 8 Culloden Street 6 49 (2). Bromley. No. of houses inspected. Dee Street 59 Desart Street 15 Devons Road 32 Dunkeld Street 49 Empson Street 99 Ettrick Street 35 Fairfoot Road 142 Knapp Road 85 Lochnagar Street 18 Marner Street 30 Peter Street 6 Railway Street 12 Reeves Road 63 Rowlett Street 34 St. Leonards Road 86 St. Leonards Street 70 Shenfield Place 15 Spanby Road 25 Spey Street 79 Swaton Road 95 Sydney Street 1 Teviot Street 61 Tibbatts Road 41 Union Street 4 Venue Street 36 Wellington Street 32 Wells Street 39 Woolmore Street 41 Wyvis Street 62 Yattan Street 51 Zetland Street 40 2,380 Total visits 2,785 (Number of nuisances referred to D .S.I's., 673.) (3). Poplar. Barque Street 12 Billson Street 33 Bridge Road 5 Brig Street 11 •50 (3). Poplar. No. of houses inspected. Cahir Street 7 Canton Buildings 4 Canton Street 120 Castalia Street 5 Chapelhouse Place 15 Chapelhouse Street 32 Chipka Street 21 College View 10 Cuba Street 1 Davis Street 23 Douglas Street 5 East Ferry Road 89 Factory Place 3 Ferry Street 28 Folly Wall 2 Galbraith Street 83 Garford Street 33 Gough Street 110. Graham Cottages 2 Harbinger Road 23 Hillplace Street 2 Hind Street 114 Johnson Street 9 Judkin Street 10 Lead Street 6 Manchester Road 439 Marshfield Street 43 Nankin Street 7 Newcastle Street 54 Northumberland Street 72 Paris Terrace 9 Park Street 63 Parsonage Street 14 Pekin Street 91 Pier Street 16 Plevna Street 60 Randalls Buildings 3 Samuda Street 22 Seyssell Street 39 Ship Street 28 51  No. of houses inspected. Silver Terrace 5 Stainsby Road 59 Stebondale Street 157 Stewart Street 65 Strattondale Street 57 Suffolk Street 91 Sussex Street 110 Swale Street 23 West Ferry Road 44 Wharf Road 11 2,400 Total visits 3,035 (Number of nuisances referred to D .S.I's., 849.) Summary of Survey Inspectors' Work. Number of house-to-house inspections 7,203 Mr. Belshaw 2,423 Mr. Brown 2,380 Mr. May 2,400 Total visits 8,627 Mr. Belshaw 2,807 Mr. Brown 2,785 Mr. May 3,035 Number of urgent nuisances referred to District Sanitary Inspectors 2,068 Mr. Belshaw 546 Mr. Brown 673 Mr. May 849 52 In addition to the house-to-house inspections carried out by the Survey Inspectors, house-to-house inspections were made by the District Inspectors in the following streets:— Work of District Inspectors. No. of houses inspected. (1). Bow West.—Nil. (2). Bow East. Autumn Street 2 Old Ford Road 6 Taylors Buildings 3 11 (3). Bromley North—Nil. (4). Bromley Central—Nil. (5). East Combined. Follett Street 21 St. Leonards Road 25 46 (6). West Combined. Broomfield Street 27 Upper North Street 3 30 (7). Poplar South East—Nil. (8). Poplar South West—Nil. Total 87 Summary . Houses inspected by Survey Inspectors 7,203 Houses inspected by District Inspectors 87 Total 7,290 53 Progress of Areas. The progress of the 15 areas referred to in last year's Annual Report during the year 1932 has been as follows:— Area No. 1—Providence Cottages, Emmett Street.—Throughout the year negotiations have been proceeding for the acquisition of lands surrounding the area referred to in the Compulsory Purchase and Housing Confirmation Orders. All the residential premises were vacated by the beginning of November, the majority of the residents having been rehoused at Glengall Road. Areas Nos. 2,3, and 4.—These areas remain untouched, as they are dependent upon the development of Area No. 1. Area No. 5.—No developments during 1932. Area No. 6—Benwortli Street.—The Council acquired the freehold interests of these 8 houses and the inhabitants were rehoused early in 1932. This area was cleared by the Borough Council and 16 flats were erected on the site. This accommodation was utilised for rehousing inhabitants from Area No. 15 (Old Ford Road). Area No. 7.—No developments. Area No. 8.—No developments. Area No. 9.—On account of their dangerous condition, some of the houses (Nos. 1-12, Prospect Place) included in this area were represented by the Medical Officer of Health in June, 1931. The L.C.C. were approached with a view to their taking over the whole area. In August, 1932, the L.C.C. wrote stating the area was too small to be the subject of a Housing Scheme and they were advised that the area was unsuitable for redevelopment for housing purposes. Referring to the Borough Council's difficulty of providing rehousing accommodation for the persons of the working classes who would be displaced, the L .C .C. suggested they might undertake to discharge the rehousing obligation by utilising some of the new dwellings now being erected on Bow Brewery site if the Borough Council declared the area to be a Clearance Area. Subsequently the Borough Council declared Prospect Place to be a Clearance Area and agreed to secure the clearance of the area by purchasing the land, and asked the Minister of Health to confirm the Order. 54 Areas Nos. 10, n, 12, 13, and 14.—No developments. Area No. 15.—On 25th May, 1932, the Ministry of Health issued the "Poplar (Old Ford Road Area No. 15) Housing Confirmation Order." Negotiations for purchase were proceeded with and the premises were vacated during the latter part of the year, the majority of the tenants being rehoused in the new flats erected on the Benworth Street Area. The site has been cleared, but consideration of the development of the site has been deferred until the position under the Housing (Financial Provisions) Bill, 1932, has been definitely ascertained. 2. Progress of Other Areas (L .C .C.). (a) West Ferry Road (East Side).—In June, 1932, the L .C .C. enlarged this area by the purchase of St. Cuthbert's House. (b) Oliver Court Area .—In December, 1932, the L .C .C. agreed (a) that the clearance of the remaining houses in the Oliver Court Area, viz., 1 -16, (all numbers), Oliver Court, should be effected by ordering the demolition of the said buildings; and (b) that a Clearance Order be made in respect of these premises and the Order submitted to the Minister of Health for confirmation. The area is not suitable for redevelopment by the erection of new buildings, and the necessary rehousing accommodation is being provided on the adjacent Bow Bridge Estate. 3. Individual Houses. No. 39, Glaucus Street.—Notices were served inviting persons interested to appear before the appropriate Committee to show causa why the premises should not be demolished, but none appeared. Having regard to the Borough Surveyor's report and the fact that other premises in this block which may have been in as bad or worse condition had been put in repair by the owners, it was subsequently agreed that the necessary notices under the Housing Acts be served and the work carried out by the Council in default of the Owners. Several firms were invited to submit prices on the Borough Surveyor's specification. The work was carried out by the Borough Surveyor's Department, and the Owner entered into an agreement with the Borough Council for the Council to collect the rent until the costs were met. 4. Overcrowding. The following table has been extracted from the Report of the Census (County of London Volume) and shows the number of families occupying a stated number of rooms. The heavy line indicates the limit of the unofficial standard of overcrowding (more than two persons per room), and it will be seen that approximately 12 per cent. of the total families are overcrowded when judged by that standard. 55 EXTRACT FROM CENSUS REPORT. Table II.—Page 27 County of London Volume. Number of Persons in Family. Number of Private Families occupying the following number of Rooms. Total Private Families Population in Private Families. Rooms Occupied Density of Occupation. Average number of Persons per room. Population at following densities of occupation (Persons per Room) 1 2 3 4 5 6—7 8—9 10 or more. Over 3 3 and over 2. 2 and over 1£. 1£ and over 1. Cols, a b c d e f 9 h j k l m n o P q r 1 2,387 1,179 535 111 21 16 6 1 4,256 4,256 7,056 0.60 - - - - 2 946 2,821 2,605 848 210 137 19 4 7,590 15,180 19,892 0.76 — — 1,892 — 3 695 2,303 2,748 1,531 432 270 21 5 8,005 24,015 23,721 1.01 2,085 6,909 4 397 1,373 2,179 1,620 593 373 32 9 6,576 26,304 21,783 1.21 1,588 - 5,492 8,716 5 154 696 1,456 1,355 553 386 25 14 4,639 23,195 16,849 1.38 770 3,480 7,280 6,775 6 77 380 965 977 425 299 31 9 3,163 18,978 11,962 1.59 462 2,280 5,790 8,412 7 32 213 636 625 317 221 12 5 2,061 14,427 7,960 1.81 1,715 4,452 4,375 3,528 8 13 100 354 412 211 131 6 3 1,230 9,840 4,866 2.02 904 2,832 4,984 1,048 9 4 55 162 245 115 108 8 2 699 6,291 2.911 2.16 531 3,663 1,035 1,035 10 1 26 67 149 79 66 2 — 390 3,900 1,665 2.34 940 1,490 1,380 90 11 — 8 43 56 32 26 1 166 1,826 695 2.63 561 968 286 11 12 — 1 16 30 14 13 2 — 76 912 338 2.70 204 528 156 24 13 — 2 5 12 6 6 - — 31 403 134 3.01 247 143 13 — 14 — 1 — 4 3 4 - — 12 168 58 2.90 70 84 14 — 15 and over — — — — 3 4 - — 7 105 39 2.69 — 105 — — 2 Persons and over 2,319 7,979 11,236 7,864 2,993 2,044 159 51 34,645 145,544 112,873 1.29 7,992 22,110 32,697 36,548 Total Private Families 4,706 9,158 11,771 7,975 3,014 2,060 165 52 38,901 — - - — — - — Population in Private Families 9,558 28,168 45,917 38,071 15,841 11,179 805 261 — 149,800 - 1.25 7,992 22,110 32,697 36,548 Rooms occupied 4,706 18,316 35,313 31,900 15,070 12,689 1,350 585 — — 119,929 — — — — — 12.1 23.5 30.3 20.5 7.8 5.3 0.4 0.1 100.0 1931. Percentage of Families living in various units of occupation. 11.7 21.2 29.5 21.7 8.6 6.4 0.7 0.2 100.0 1921. ,, , ,, ,, ,, ,,, 56 During the year 55 new instances of overcrowding were officially recorded. 18 of the more serious cases were reported to the Public Health Committee. 39 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. 18 of the 55 cases, and also 16 cases officially recorded in the past few years, have been abated. In 2 further cases the overcrowded conditions have been eased. The overcrowding was abated or eased as follows:— Abated. Eased Rehoused by the London County Council 2 (1) 1 ,, ,, ,, Poplar Borough Council 17 (12) — Other accommodation found 15 (3) 1 34 2 (Numbers in brackets are cases recorded prior to 1932.) 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. In addition, overcrowding was found to have been abated or eased in 158 cases which came to our knowledge as the result of enquiries into the housing conditions of families who had been re-housed, either by the London County Council or by the 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 57 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. As an indication of the amount of overcrowding, judged by the bedroom standard of more than 2½ persons per bedroom, the house -to-house inspection records from 1928 to 1932 give the following figures:— Year. Total number of Families. Families Overcrowded. Number. Percentage of Total. 1928 147 34 23.1 1929 2,272 607 26.7 1930 1,894 374 19.7 1931 3.530 660 18.7 1932 13,048 1.557 11.9 It should be mentioned that for the years 1928-1931 overcrowding as found is shown, whereas for the year 1932 the families living in overcrowded conditions which could be remedied by rearranging the sleeping accommodation and utilising all the available rooms have been excluded, otherwise the figure of 11.9 would have been somewhat higher. The percentage of overcrowding as revealed by this method of investigation is 11.9 compared with 12 per cent. shown by the Table published in the Census Report (see page 55). Accommodation provided during 1932. The number of families 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 131 786 (2) Adapted buildings 3 13 58  Families accommodated . Number of persons (approx.). (3) Vacancies re-let:— (a) New properties 40 (ib) Adapted or miscellaneous properties 5 — 45 291 (b) By the London County Council:— (1) By nomination 69 276 (2) By direct application:— (a) New tenements 585 (b) Rehousing accommodation 16 601 * Total 849 *It is not possible to give approximate number of persons accommodated under this heading. 5. Bug Infestation. Bug infestation is referred to in the special report which is printed as an Appendix, page 139. Increase of Rent and Mortgage Interest (Restrictions) Acts. 11 certificates were issued to tenants. On applications of owners, 3 certificates that the work had been done were also issued. 59 Section E. INSPECTION AND SUPERVISION OF FOOD. The work of inspecting premises where food is prepared, sold, or stored is carried out by two qualified food inspectors, who ensure that foodstuffs are handled with care and are 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 23 occasions. No intimations or Statutory Notices were served. (b) Dairies and Milkshops. At the end of the year there were in the Borough 107 registered premises where raw milk is sold. These premises were kept under strict observation, 365 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. 24 persons (including 10 itinerant vendors) were registered as retail purveyors of milk, 12 of these being on account of change of ownership of premises. For milkshops connected with infectious diseases, see page 76. During the year the following were registered:— 91 Retail Purveyors of Sterilized Milk in Sealed Bottles. (34 on account of change of Ownership.) 16 Retail Purveyors of Raw Milk in "Sealcones" (1 on account of change of Ownership.) 60 ii Retail Purveyors of Milk in Sealed Bottles (3 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. 2 Supplementary Licences 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. 23 Dealers in Sealed Bottles only. 6 Supplementary Licences (Principal Licences issued by other Authorities.) Grade ''A" Pasteurised Milk. 2 Supplementary Licences for the sale of Grade ''A" Pasteurised Milk. Pasteurised Milk. 3 Licences in respect of "Pasteurising" establishments. 6 Licences for the sale of "Pasteurised" Milk. 5 Supplementary Licences for the sale of "Pasteurised" Milk. 61 Number of Samples Examined for Bacteria (Total Count)—68. Designated Milk. W here taken: Number unsatisfactory. Action taken. On delivery at— From Dealers— Number satisfactory. Railway Stations. L.C.C. Hospitals, etc. Before bottling. After bottling. Grade "A" (Tuberculin Tested) 18(1) - 7 (3) 24 (5) 40 9 2 letters of caution sent; 4 reported to Ministry of Health and to County Medical Officers of Health Pasteurised - 10 (3) - 9 (1) 15 4 M.O.H. visited 2 premises and examined the plants; 3 letters to L.C.C. and to various other authorities; 4 later samples were satisfactory. Totals 18 10 7 33 55 13 The figures in parentheses denote number of unsatisfactory samples and are included in the totals. BIOLOGICAL EXAMINATION OF MILK. Number of Samples Examined for Tubercle Bacilli—28. Number reported: Remarks. Tubercle bacilli absent. Tubercle bacilli present. Examination incomplete. Designated Milks:— Grade "A" (Tuberculin Tested) 8 — — — Pasteurised 3 — — — Other Milk:- Sterilised 2 1* *Further samples were taken and reported Tubercle bacilli absent. These are included in the 24 shown in Column 2. Bottled (from Dairies) 7 1* ,, (from Cowsheds) 3 — 2* In carton 1 — — — Totals 24 - 4* - 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 Pasteuriser's Licences were sampled under the above Order; 9 samples were taken, of which 8 were satisfactory. With regard to the unsatisfactory sample, the Medical Officer of Health visited the Dealer's premises and thoroughly examined the plant, after which a further sample was taken and reported to be satisfactory. 18 samples of Grade "A" (Tuberculin Tested) milk were taken on delivery at Railway Stations for bacterial counts. One was unsatisfactory and information of this was sent to the Ministry of Health and the County Medical Officer of Health. Examination of Milk for Tuberculosis. In addition to the samples shown in the table on page 6r, the London County Council took 85 samples of milk for biological examination for the presence of tubercle Bacillus. All the samples were taken from mixed bulk milk arriving in the Borough. Milk delivered to Hospitals and the Open-Air School, Bow Road. The arrangements for taking samples at St. Andrew's Hospital and Bow Institution belonging to the London County Council and at Poplar Hospital have continued throughout the year, and on a request being made by the London County Council for samples to be taken at Bow Road Open-Air School this was done. As the milk supplied to the L.C.C. Institutions is "Pasteurised" milk, bacteriological examinations are carried out in addition to chemical analysis. 21 samples were taken (10 for bacteriological examination and 11 for chemical analysis). Milk supplied to L.C.C. Schools. In 1931 the London County Council asked if arrangements could be made for samples of the milk delivered at their schools to be examined, and it was arranged that samples should be taken by our Inspectors in the ordinary course of their sampling work. During 1932 20 samples were taken at 16 schools. All the samples were reported to be genuine, and the London County Council was informed accordingly. In one instance legal proceedings were taken for an infringement of Article 21 of the Milk and Dairies Order, 1926. A penalty of £3 and £2 costs was imposed. Ice Cream. During the year, 30 Owners or Occupiers were registered for the manufacture, storage or sale of ice cream. 63 The number of owners or occupiers now on Register is 162. 297 Inspections of the above premises were made during the year. Cleansing of premises was necessary in 1 instance. 14 other nuisances existed. 11 intimations and 2 notices were served, and the necessary cleansings were carried out, and other nuisances abated. Bakehouses. There are 75 bakehouses in use, of which 20 are underground. In 53 bakehouses machinery is used. The bakehouses in the Borough were inspected at least twice during the year, the total inspections numbering 315. Cleansing was found to be necessary on 153 occasions, and 3 other nuisances were found. The cleansings were carried out and the nuisances abated after service of 108 intimations, followed in 1 instance by a final notice., Slaughterhouses. There are 5 slaughterhouses licensed by the London County Council. For number of inspections, etc., see Table A, page 26, and reports of Food Inspectors, pages 64 and 65. A list is given on page 34. Slaughterer of Poultry. The business of a slaughterer of poultry is carried on at three 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 819; see Table A, page 26. 1,967 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 321 instances, and 21 other defects existed. 342 intimations were served, and in 2 cases were followed up by statutory 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. 64 Reports of Food Inspectors. Mr . C. A. Grabham. Totals. Notices Inspections. Intimations. Stat. Final. No. of Inspections of: Bakehouses— Factories 113 2 — 1 Workshops 26 1 — — Dom. Workshops 5 — — — Slaughterhouses 7 — — — Cowhouses 6 — — — Milkshops 141 - — — Restaurants and Eating Houses 152 5 — — Fried Fish Vendors and Fish Curers— Where power is used 107 — — — Others 204 4 — — Stalls 1,283 — — — Other Places where Food is sold, etc.— Where power is used 70 — — — Others 445 3 — — Ice Cream Premises— Where power is used 33 3 — — Others 117 4 2 — Wharves, etc., where Food is prepared or stored, etc.— Where power is used 4 — — — Others 1 — — — Markets— Morning 149 — — — Evening 78 — — — Miscellaneous 86 — — — Total Defects, etc, Found. Remedied. Referred to d.s.i. Defects, etc., Found: 1. Nuisances under Public Health (London ) Act— Want of cleanliness 19 19* — Other nuisances 21 17† 4 2. Offences under Factory and Workshop Act— Other offences 1 — — Slaughterhouses : Number of Visits 392 Number of Carcases Inspected— Beasts 239 Calves 73 Sheep 986 Lambs 625 Pigs 473 Organs condemned and destroyed consequent on slaughterhouse visits See list on page 67. Heads and Tongues condemned and destroyed 65 Number of Samples procured: (a) Under Food and Drugs (Adulteration) Act 391 (b) Under Special Orders and Regulations— 31 (i) Number satisfactory 25 (ii) Number not satisfactory 6 Action taken in respect of unsatisfactory samples: (a) Legal proceedings - (b) Letters sent to Vendors 2 (c) Reported to appropriate Government Department, etc. 4 Public Health (Foreign Meat) Regulations— Certificates issued 116 Visits to Factories 116 Assistant's Time—Hours 391 * 5 Without Intimations. † 7 Without Intimations. Mr . H. A. Pearce . Totals. Inspections. Intimations. Notices. Statutory. No. or Inspections of: Bakehouses— Factories 112 - - Workshops 55 1 - Dom. Workshops 4 — — Slaughterhouses 24 — - Cowhouses 17 - - Milkshops 224 1 - Restaurants and Eating Houses 125 6 2 Fried Fish Vendors and Fish Curers— Where power is used 43 1 - Others 200 3 - Stalls 2,213 - - Other places where Food is sold, etc.— Where power is used 67 1 - Others 549 6 - Ice Cream Premises— Where power is used 23 - - Others 124 4 - Markets— Morning 187 - - Evening 78 - - Miscellaneous 59 — — 66 Total Defects, etc. Found. Remedied. Referred to d.s.I. Defects, etc., Found: 1. Nuisances under Public Health (London) Act— Want of cleanliness 9 9 — Other nuisances 21 16 5 2. Offences under Factory and Workshop Act— Other offences — — — Slaughterhouses : Number of Visits 320 Number of Carcases Inspected— Beasts 238 Calves 100 Sheep 907 Lambs 526 Pigs 471 Organs condemned and destroyed consequent on Slaughterhouse Visits See list on page 67. Heads and Tongues condemned and destroyed Number of samples procured: (a) Under Foods and Drugs (Adulteration) Act 407 (b) Under Special Orders and Regulations 49 (i) Number satisfactory 42 (ii) Number not satisfactory 7 Public Health (Foreign Meat) Regulations— Certificates issued 9 Visits to Factories 8 Assistant's Time—Hours 300 67 V. Organs, Etc., Condemned as a Result of Slaughterhouse Inspections. Mr. Grabham. Mr. Pearce. Totals, Lungs: Beasts 80 113 193 Sheep 257 307 564 Pigs 137 166 303 Livers: Beasts 40* 56 96 Sheep 57 73 130 Pigs 13 11 24 Mesenteries: Beasts 24† 40 64 Pigs 9 15 24 Omenta: Beasts 6 14 20 Pigs 2 1 3 Pancreas: Beasts 9 14 23 Spleens: Beasts 6 8 14 Sheep 3 3 6 Tripes: Beasts 3 7 10 Hearts: Beasts — 6 6 Sheep 2 1 3 Pigs 1 6 7 Kidneys: Beasts 12‡ 16 28 Intestines: Beasts 2 4 6 Udders: Beasts 10 12 22 Heads: Beasts 21 33 54 Pigs 12 6 18 Tongues: Beasts 21 33 54 Pigs 12 6 18 * And parts of 7. †And parts of 2. ‡ And 1 fat. In addition to the foregoing there were condemned and destroyed, as a result of inspections at slaughterhouses:— 2 whole carcases, l0cwt 2qrs. 71bs. 2 Pigs' plucks, weight not recorded. 1 Ox-tail. and other sundries which totalled 11cwt 2qrs. lllbs. The following foodstuffs were seized, or surrendered, and destroyed:— Cauliflowers 62 (2 Nets) Chocolates 61bs. Haddocks 6 stone Grapes 16 boxes Apples 201bs. Tea l,3831bs. Pork and Beans 34 tins Cake Powder 27 pkts. Custard Powder 47 pkts. Egg Powder 18 pkts. Blanc Mange Powder 28 pkts. Soup Powder 62 pkts. Corn Flour 8 pkts. Mixed Spice 28 pkts. Prepared Breakfast Food 3 pkts. Granulated Gravy 12 tins Blackberries 4 handles Blackberries 15lbs. Turkeys 150 Kippers 2 boxes Honey 23 cwts. Fowls 13 *Blackberries 23 baskets Kippers 3 boxes Halibut 4 (7st.) Oranges (Brazil) 1 case (pt.) Skate 10 stones Kidney and Fat 1 (911bs.) Damaged Tea 751bs. Peaches 26 cases Fowls 28 (11st. 61b.) Forequarter of Beef 1 Tea 353 c/s—17tons 13cwts 0qrs. * Seized, and condemned by Magistrate. 68 Released for Technical Purposes:— 114 Geese For rendering down. Rice Sweepings (17cwt. 3qrs. 251bs.) For Pig or Poultry Food (after screening). Haricot Bean Sweepings (2cwt 2qrs. 0lbs.) ,, ,, ,, Damaged Maize (7551bs.) For Cattle Food. Tea Sweepings (20owt.) For Caffeine making. 9 Barrels Tallow For Grease making. 2 Casks ,, ,, ,, ,, 1 Cask ,, ,, ,, ,, 11 Casks ,, For Soap making. 12 Barrels Sardine Oil For Grease making. 2 Barrels Tallow ,, ,, ,, 1 Barrel „ For Printing Ink. 1 " " " " " Food and Drugs (Adulteration) Act, 1928. The results of the analyses of 818 samples were reported to the Committee during the year:— Sample. Number examined, 1932. Adulterated. Action taken. Legal Proceedings. Letters of caution sent. Milk 367 8 2 2 ,, Sterilised 1 — — — ,, Condensed 27 2 — 2 Cream 6 — — — Butter 46 — — — Margarine 47 1 — 1 Cheese 4 — — — Dripping 14 — — — Lard 4 — — — Shredded Suet 7 — — — Mustard 2 — — — Pepper 8 — — — Malt Vinegar 4 — — — Vinegar 25 5 4 — Sauce 9 — — — Cocoa 1 — — — Coffee 4 — — — Sugars 2 — — — Table Salt 2 — — — Cornflour 4 — — — Rice 4 — — — Pearl Barley 4 — — — Flour 4 — — — Ground Ginger 4 — — — Baking Powder 4 — — — Oatmeal 4 — — — Cake 4 Carried forward 612 16 6 5 69 Sample. Number examined, 1932. Adulterated. Action taken. Legal Proceedings.* Letters of caution sent. Brought forward 612 16 6 5 Biscuits 2 - — — Jam 22 — — — Table Jelly 2 — — — Jelly Crystals 2 — — — Golden Syrup 4 — — — Tea 4 — — — Ice Cream 2 — — — Sweets 22 5 2 1 Lemon Curd 2 — — — Hot Milk 4 1 1 — Formaldehyde Tablets 3 2 — 1 Aspirin Tablets 4 — — — Ginger Wine 1 1 1 — Lemon, and Grape Fruit Squashes 4 — — — Lime Juice Cordial 1 — — — Lemon Squash 1 — — — Lemonade Crystals 2 — — — Lemonade Powder 2 — — — Cordials 6 — — — Gin 2 — — — Whisky 9 3 1 1 Rum 2 — — — Mincemeat, Fruit 2 — — — Meat 18 1 — 1 Soups 3 — — — Tripe 2 — — — Minced Meat 2 — — — Sausage 11 1 — — Brawn 4 — — — Fish Paste 6 — — — Meat Paste 2 — — — Bread 2 — — - Bread and Butter 4 1 — 1 Filleted Fish 5 - - — Ground Cinnamon 5 — — — Lime-water 2 — — — Malt 1 — — — Liquorice Extract 2 — — — Egg Powder 2 — — — Custard Powder 4 — — — Zinc Ointment 2 — — — Boracic Acid Ointment 2 - — - Salicylic Ointment 2 — — - Sulphur Ointment 2 — — — Health Salts 2 — — — Glycerine 2 — — — Canned Peas 3 — — — Dried Fruits 8 - - - Bismuth Lozenges and Tablets 3 2 — 1 Totals, 1932 818 33* 11 11 Totals, 1931 801 61† 9 21 * Including 6 informal samples. † Including 20 informal samples. 70 Of the samples of milk, 70 were procured from itinerant vendors on Sundays and 142 from itinerant vendors on weekdays. Six samples were adulterated. Legal proceedings taken against 2 vendors. In connection with 2 samples an adjoining County Authority took 7 samples at a farm; all the samples were genuine. The farmer was interviewed and one cow which gave poor quality milk was removed from the herd. 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 367 Nil. Cream 6 Nil. Butter and Margarine. The following is the number of premises in the Borough registered under the above-mentioned Acts, up to and including 31st December, 1932. Margarine. Butter. Wholesale Dealer. Manufacturer. Factory. Wholesale Dealer in Milk-blended. 24 — 4 — Agricultural Produce (Grading and Marking) Act, 1928. The premises registered under the above Act (Section 4—Storage of Eggs) have been visited from time to time and on no occasion have English eggs been seen at the premises. Notice of Registration was conspicuously displayed. 71 Merchandise Marks Act and Orders. Occupiers of shops and stallholders have been supplied with appropriate circulars respecting marking of foreign produce. Inspections and observations have been made from time to time and where necessary attention has been drawn to breaches of the Orders. Public Analyst's Annual Report. During the year 1932, 818 samples were examined under the Food and Drugs (Adulteration) Act. Seven of these samples were taken by a neighbouring Authority, the remainder by the Inspectors. No samples under the Act were submitted by the Public. 202 samples were purchased informally. 33 samples were found to be adulterated. In addition 57 other samples were found to be of inferior quality, or doubtful purity. The adulteration was at the rate of 4.0 per cent., as compared with 2.9 per cent, for the whole of London and 4.6 per cent, for the whole of England and Wales in 1931. The rate of adulteration for the past ten years was as follows:— Year. No. of samples examined. Percentage of adulteration. 1932 818 4.0 I931 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 Average 798 7.2 It will be observed that the adulteration is now much lower than it has been for some years. 72 The number of samples examined was at the rate of 5.2 per 1,000 of the population as compared with 9.9 per 1,000 for the whole of London, and 3.4 per 1,000 for the whole of England and Wales, in 1931. 367 samples of milk were examined, of which 8, or 2.2 per cent, were found to be adulterated. This is the lowest milk adulteration recorded for some years. For comparison the figures for milk adulteration for the past years are given below:— Year. No. of milks examined. Percentage of adulteration. 1932 367 2.2 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 Average 383 4.0 Condensed Milks. 27 samples of condensed milk were examined of which 2 samples were unsatisfactory. Preservatives. 7 contraventions of the Preservatives Regulations were found. Other samples examined during the year were:— 4 Rag Flocks, one of which was unsatisfactory. 2 Electrolytic Fluids. 1 Sterilising Agent. 6 Preservatives. These were all for the Public Health Department. ALBERT E. PARKES, F.I.C. 73 Ice Cream and Preserved Food. Posters were issued and advertisements were inserted in the local Press calling attention to the provisions of the London County Council (General Powers) Act, 1932. In accordance with an undertaking given to the Metropolitan Boroughs Standing Joint Committee, the Department is working in close co-operation with H.M. Factory Inspector. Food Poisoning. A circular letter was sent to all general practitioners practising in the Borough enclosing a form of notification. Copies of certificates received, together with reports which may be of general interest, are sent to the County Medical Officer of Health for general circulation. During the year 24 notifications were received. Difficulty is being experienced as "food poisoning" is not defined. It is left to the medical practitioner attending on any patient to send a certificate "if he suspects or becomes aware that such person is suffering from food poisoning.'' Investigations into the 24 notified cases resulted in them being classified as follows:— Sporadic cases 8 Personal susceptibility 4 Not true food poisoning or doubtful cases 12 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 125 consignments of foodstuffs: Canada (18), Australia (41), United States of America and Dependencies (31), India (21), other countries (14). 124 visits were paid to factories in connection with the above. 74 Foodstuffs Inspected for Export. (Mr. C. A. Grabham.) Tons. cwts. qrs. lbs. Fore-ends of Bacon (Denmark) — 12 2 7 Fores of Beef (Argentina) — 5 1 4 Fillets of Beef (Argentina) — 8 3 17 Beef Dripping( Argentina) — 1 — — Sirloins of Beef (Australia) - 11 1 3 Crops of Beef (Australia) 1 1 3 8 Boned Brisket (Australia) — — 2 25 Fillets of Beef (Uruguay) — 4 1 25 Loins of Pork (New Zealand) — 10 2 7 Sows (New Zealand) — 15 1 4 Mutton (New Zealand) 2 8 — 5 Pure Pork Sausages (England) — 3 — — Oxford Sausages (B. & W.) (England) — 7 2 — Real Oxford Sausages (England) 9 — — — Sows (England) 1 5 1 22½ Crops of Beef (Argentina) — 6 3 21 Sirloins of Beef (Argentina) — 5 — 5 Fillets of Beef (South America) — 15 2 15 Sirloins of Beef (Australia) (B.) — 8 1 18 Boned Beef (Australia) — 11 3 3 Rumps of Beef (Australia) — 1 — 4 Sirloins of Beef (New Zealand) (B.) — 2 — 25 Loins of Pork (Australia) — 10 3 7 Sheep (New Zealand) — 1 2 18 Lamb (New Zealand) — 8 3 21 Cambridge Sausages (England) — 1 1 — No. 2 Beef Sausages (England) — 1 — — Sheep's Kidneys (New Zealand) — — — 6 Ox Tongues (Australia) 1 14 2 27 Fores of Veal (Australia) — 14 — 21 Crops of Veal (Uruguay) — — 3 19 Boneless Veal (Uruguay) — 1 3 15 Legs and Necks of Veal (England) — — 3 18 Calves'Sweetbreads (Argentina) — — — 16 Fowls (England) — 14 — 13 Streaky Bacon (Denmark) — — — 8 Veal (Australia) — 18 — 16 Crops of Veal (Australia) — 11 1 17 Fores of Veal (Uruguay) — 2 — 4 Veal (Argentina) — 9 — 14 Crops of Veal (New Zealand) — 4 2 18 Ox Tripe (England) — — — 11 Turkeys (England) 2 2 (Mr. H. A. Pearce.) Sows (England) — 3 3 8 Sirloins of Beef (Australia) — 4 1 15 Brisket (Argentina) — — — 23 Veal (Uruguay) — — 2 14 Loins of Pork (New Zealand) — 3 2 10 Saddles of Mutton (New Zealand) — 4 1 22 Fore-ends of Bacon (Denmark) — — — 15 Fillets of Beef (South America) — 4 1 22 Fores of Beef (Argentina) — 3 2 9 Streaky Bacon (Denmark) — — — 10 Ox Tongues (Australia) — — 3 13 Necks of Lamb (New Zealand) — 2 24 75 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. Wrapping of Food. The Public Health Committee considered a letter from the Metropolitan Borough of Hackney stating that the Hackney Borough Council were strongly of opinion that it should be compulsory to wrap bread before delivery, and that newspapers or waste paper of that description should not be used for the wrapping of foodstuffs such as fish, meats and sweets. The Committee agreed to recommend the Council to support Hackney's representations to the London County Council in asking for the inclusion of clauses in the next General Powers Bill to provide for:— (a) The compulsory wrapping of bread, and (b) The prohibition of the use of newspapers or waste paper of that description for the wrapping of such foodstuffs as are abovementioned . 76 Section F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifications. 2,938 cases of Infectious Disease (Smallpox 177) were notified during the year. In addition there were 85 other cases notified as Infectious Diseases in which the diagnosis was not confirmed. The notification rate was 19.3, compared with 18.9 in 1931. The incidence of the commoner infectious diseases generally was slightly greater than in 1931; particularly so in the following diseases:— (a) Smallpox 70 more cases. (b) Diphtheria 74 ,, ,, (c) Scarlet Fever 74 ,, ,, The disease in which there was a decrease during the year was Pneumonia (225 cases less than in 1931). Infectious Diseases in Milkshops and Homeworkers' Premises. Six contacts of infectious disease patients employed in the milk trade were dealt with during the year. No notices under Article 17 of the Milk and Dairies Order, 1926, were served. 15 cases of infectious disease occurred in homeworkers' premises: Smallpox, 3; Scarlet Fever, 4; Chickenpox, 7; and Acute Primary Pneumonia, 1. No notice was served under the Factory and Workshop Act, 1901, Sections 108 and 110. Where there was any risk of infection the work was discontinued, and any work found on the premises was disinfected before being returned. TABLE VII. Notifiable diseases during the Year 1932. (52 Weeks.) Notifiable Disease. Cases Notified in Whole Borough. Total cases notified in each Sub-District No. of Cases removed to Hospital from each Sub-District Total Deaths in Age-Peeiods: Total deaths in each Sub-District. At all Ages. At Ages—Years. At all Ages. At Ages—Years. 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. 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 177 1 2 3 3 1 42 39 21 33 12 14 6 29 148 29 147 176 - - - - - - - - - - - - - - - Chickenpox 1101 37 70 72 87 128 595 87 17 7 1 — — 392 709 16 34 50 - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 404 8 27 32 41 52 169 34 17 18 5 1 — 275 129 275 i2y 404 17 2 4 1 3 1 4 1 1 — — 8 9 Erysipilas 81 — 2 1 1 — 5 — 2 13 14 27 16 44 37 12 14 26 3 — — - — - — - - - — 1 2 1 2 Scarlet Fever 611 5 24 46 54 68 270 91 25 24 3 1 — 263 348 261 339 600 3 — 1 — 1 1 — — - - — - __ 1 2 Typhus Fever - - — - - — - - - - - - — - — - — - - — — - — - — - - - — - — — — Enteric Fever (including Paratyphoid) 4 — — - - — - - 1 1 1 1 — 4 — 4 — 4 3† — — - — - — - - 1 — 2 — 2 1 Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 9 - - - - — - - - 7 2 - — 6 3 6 3 9 6 — — - — - — - - 5 1 — — 4 2 Cerebro-Spinal Fever 28 — — - - — - - 1 21 6 - — 13 15 12 15 27 — — — - — - — - - — — — — — — Acute Poliomyelitis 12 3 3 - - — 2 1 2 1 — - — 6 6 6 6 12 6 4 1 - — - — - - 1 — — — 4 2 Acute Encephalitis Lethargica 3 - 2 1 - - - - - - - - - 2 1 2 1 3 - - - - - - - - - - - - - - - Oythalmia Neonatorum 1 - - - - - - - - 1 - - - 1 - 1 - 1 3 - - - - - - - - 1 2 - - 2 1 Zymotic Enteris 27 27 - - - - - - - - - - - 19 8 4 5 9 - - - - - - - - - - - - - - - Anthrax 98 30 20 10 8 2 6 2 4 8 4 3 1 57 41 2 5 7 28 25 2 1 - - - - - - - - - 14 14 Pneumonia, Acute Primary - — — — — — — — — — — — — — — — — — — — — - — - - - - — — — — — — Pnemonia Acute Influenzal 352 36 48 32 23 14 27 13 27 39 19 49 25 190 162 64 62 126 80 14 11 5 1 1 — - 5 8 4 19 12 46 34 Acute Polioencephalitis 26 — — — 1 — 1 — 4 6 5 5 4 9 17 1 4 5 7 - - - - - — - 2 — 3 1 1 3 4 Despensery 2 1 - - - 1 - - — — - — - - 2 — 1 1 - — — — - - — - — - - - - 2 — — 1 1 - - - - - - - - 1 1 1 1 2 - - - - - - - - - - - - - - - Totals 2938 148 198 198 | 219 266 1117 267 121 179 72 101 52 1311 1627 696 766 1462 156 45 19 7 5 3 4 1 8 16 10 23 15 85 71 This table does not include cases in which the original diagnosis was not confirmed, N.B.—The deaths from Pneumonia are of notified patients only. * Notifiable 1st June to 30th September, but the number of deaths relates to the whole year. †lncludes 2 non-notified cases. 77 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 177 176 - — 176 99.4 Chickenpox 1,101 22 27 1 50 4.5 Diphtheria 404 398 5 1 404 100. Erysipelas 81 — 21 5 26 32.1 Scarlet Fever 611 600 — — 600 98.2 Enteric Fever 4 1 2 1 4 100. Puerperal Fever 9 7 1 1 9 100. Puerperal Pyrexia 28 4 19 4 27 96.4 Cerebro-spinal Fever 12 4 8 — 12 100. Encephalitis Lethargica 1 - 1 - 1 100. Ophthalmia Neonatorum 27 4 4 1 9 33.3 Pneumonia (Primary) 352 — 119 7 126 35.8 Pneumonia (Influenzal) 26 5 - 5 19.2 Zymotic Enteritis 98 — 6 1 7 7.1 Acute Poliomyelitis 3 1 — 2 3 100. Acute Polioencephalitis 2 - - 1 1 50. Dysentery 2 — 1 1 2 100. Totals 2,938 1,217 219 26 1,462 49.8 N.B.—Cases reported to be "not suffering" etc., have been excluded from above table. Mortality from Diphtheria, Scarlet Fever and Enteric Fever, Diphtheria. Scarlet Fever Enteric Fever.  Cases 404 611 4 1932 Deaths 17* 3 1† Fatality Rate 4.2 0.5 25.0 * 1 death from Diphtheritic infection of scalds included. † 2 non-notified cases not included. (These were inmates of mental hospitals situated outside London.) 78 Scarlet Fever. The total notifications received numbered 643 and the total removals were 632. Of these, 32 cases were later certified to be not suffering from Scarlet Fever, leaving a total of 611 cases, the attack-rate being 4.0 per 1,000 of population. 3 deaths occurred, giving a fatality rate of 0.5 per cent. Diphtheria. The total notifications received numbered 453 and the total removals to hospital were 453. 49 patients were certified to be suffering from other diseases, leaving a total of 404 cases, the attack-rate being 2.6 per 1,000 of population. 17 deaths occurred, giving a fatality rate of 4.2 per cent. The following table shows the intervals between (a) onset of the disease and the calling in of a Doctor and (b) onset of the disease and removal to hospital:— The average time was (a) 2.45 days; (range same day to 8 days). (b) 3.45 " (" " " 16 "). Diphtheria Anti-toxin. 178,000 units of diphtheria anti-toxin were issued to medical practitioners during the year. This is 30,000 units less than the quantity issued in the previous year, when there were fewer cases; but it is explained by the fact that medical practitioners are urged, as soon as a diagnosis is made, to have the patient removed to a fever hospital. 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. 79 ''Carriers.'' During the year a number of "carriers'' were reported and as far as possible were referred to special "carrier" clinics. Enteric Fever. Four notifications were received (of which two related to Paratyphoid Fever), and the patients were removed to hospital. The attack-rate was 0.03 per 1,000 of population. One of the notified cases died; 2 other deaths occurred in Mental Hospitals, but these cases were not notified to this Authority. Bacteriological Examinations. 1,816 swabbings from doubtful cases of diphtheria were examined. Of these, 277 gave positive results (15.2 per cent.). One positive swab (growth scanty) was submitted to virulence test and the result was positive. The patient did not present clinical symptoms and was referred to a "carrier'' clinic. 3 blood specimens from doubtful cases of Enteric Fever were examined. One positive result was obtained. (Serum in dilutions of 1.20 to 1.320 agglutinated Paratyphosus B. No agglutination of Typhoid or Paratyphoid A.) 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 1932 178* cases occurred (see footnote to Table I overleaf). 80 TABLE I. Smallpox and Chickenpox Cases Notified during each month. 1932. Month. Smallpox. Chickenpox. January — 114 February 1 59 March 1 93 April 5 153 May 5 155 June 6 181 July 4 178 August 1 40 September 21 16 October 38 28 November 43 38 December 53 54 Totals 178* 1109* * These figures refer to the calendar year, but in other parts of this Report the figures, Smallpox 177 and Chickenpox 1101, referring to the statistical year of 52 weeks are used. The cases occurred in the under mentioned sanitary districts East Combined 8 West Combined 2 Poplar South (East) 4 Poplar South (West) 11 Bromley North 4 Bromley Central 2 Bow East 3 Bow West 143 177 81 The incidence of Smallpox in houses is shown below. Cases. 31 houses in which 1 case of Smallpox occurred 31 16 ,, ,, 2 cases ,, ,, 32 11 " " 3 " " " 33 7 " " 4 " " 28 2 " " 5 " " 10 1 house " 7 " " 12 3 houses " 8 " " " 24 Total 177 Total number of cases 177 ,, ,, houses 73 Table II it will be seen that of the 177 cases no less than 162 were unvaccinated, and that in this group nearly 90 per cent, of the cases occured before the age of 35, whereas in the vaccinated group all the cases occurred after the age of 35. The vaccinated cases were vaccinated once only—in infancy. 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. - - - - - - 5 3 8 F. - - - - - 1 4 1 6 Unvaccinated M. 6 21 20 14 19 2 1 2 85 f. 4 21 19 7 14 8 4 — 77 Doubtful M. - - - - - 1 - - 1 F. - - - - - - - - - Totals 10 42 39 21 33 12 14 6 177 T1-1 e type of disease continued mild and no deaths occurred. cases were removed from a Common Lodging House. Ojj ^ ^ to the middle of September there were only 24 cases notified, but Cfjj , l2th September a patient in Bow was notified as suffering from '>ox > and on being examined by a medical officer of this DepartWas ^ound to be suffering from Smallpox. Enquiry at the home of 82 one of his playmates led to the discovery of a ' 'missed'' case—a boy who had had Smallpox about three weeks previously and at the time of his examination was non-infectious. He had attended school regularly since the rash appeared. In the household of this "missed" case four other cases were discovered and removed to hospital. Some of the patients had been at work and others at school while in an infectious condition. It was impossible to trace all persons who had been in contact with these cases, but 25 cases have been definitely traced to this source of infection. Since then other cases of Smallpox have continued to occur in this neigbourhood, but it has not been possible to definitely associate them with the "missed'' cases mentioned above. In November a case of Smallpox occurred on the Isle of Dogs and on investigation the source of infection was traced to a barber who, whilst having a barber's business on the Island, lived in a neighbouring Borough This man continued at work with a rash for a few days before he was removed to hospital by the Authority of that Borough. He, however, did not inform them that he worked in Poplar, with the result that it was not until other cases began to occur on the Island that this case became known to us. In all 22 cases occurred in this area during the months of November and December, and it is highly probable that some ''missed" cases continued the infection from the month of August, when the barber patient was removed, until we picked up the infection in a "missed" case who was ill about the beginning of October. When investigating the source of infection of cases of Smallpox occurring during the year, no less than 22 "missed'' cases were discovered These were non-infectious at the time of examination and are not included in the 177 cases. In spite of the efforts made to deal with it, this disease continues to spread, as only a very small proportion of the population is protected by efficient vaccination and the disease itself is extremely mild. As will be seen by the Vaccination Officer's Report on page 86 and the corresponding tables in previous Annual Reports, only 18 per cent, (in I932 this has fallen to 14.3 per cent.) of children born in each year are vaccinated, and although Smallpox contacts are offered vaccination or re-vaccination, very few of them accept this, the only means of protection against an attack. 83 It would appear that with the exception of an occasional more marked case( frequently one household), the disease facts relating to the cases which in the early days of the epidemic. Certain tabulated ''' cases which occurred in 1928-9 and 1932-3 have been tabulated for comparison. The latter group occurred between the 12th September, 1932, and (8th March) 1933 March, 1928, to December, 1929 228 cases. I2th September, 1932, to 8th March, 1933 244 cases. 1928-9 1. Initial Symptoms. None. Under 12 year of age Over 12 years of age. All ages. 17 very mild Mod. severe. Severe. None. Very mild. Mod. severe. Severe. None. Very mild. Mod. severe. Severe. 1932-3 17 47 27 - 4 60 68 5 21 107 95 5 75 13 1 20 75 43 - 37 150 56 1 Notes —Very mild—not in bed. Moderately severe—in bed. Severe—in bed. ii. Rash . 1928-9 verv slight under 20 lesions. 24 Under 12 years of age. Over 12 years of age. All ages. % Moderate. 50-100 Profuse. Over 100 Very slight, Under 20 lesions. Slight. 20-50 Moderate. 50-100 Profuse. Over 100 Very slight, Under 20 lesions. Slight. 20-50 Moderate. 50-100 Profuse. Over 100 1932-3 32 37 24 6 22 43 50 22 46 80 74 28 53 19 2 34 61 31 12 66 114 50 14 iii. "Missed" Cases Discovered. 1928-9 16 Remarks. 1932-3 30 The Tables—Initial Symptoms—and ii—Rash—need no comment. cases were discovered, to note that during the two years 1928-9,16"missed" to March, discovered, whereas during the six months September, 1932, 33, 30 missed" cases were found. 84 The mildness of the infection is such that frequently the disease is only discovered when one of a secondary crop develops more pronounced symptoms or a more marked rash than the primary case. Patients, and often medical practitioners, have not suspected Smallpox until subsequent cases have occurred in the same family. So long as these conditions remain the disease will not entirely disappear from the Borough. 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 from the place of employment 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 .. 175 174(99.4%) 1(0.57%) ,, for observation 4 2(50.0%) 2(50.0%) Totals .. 179 176(98.3%) 3(i-7%) Disinfection. 73 premises (177 rooms) were disinfected. 2,694 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. Notification of Chickenpox.—The notification of Chickenpox was continued during the year 1932, and 1,101 cases were notified. Practically all cases notified as Chickenpox were visited by a member of the Medical Staff. This procedure resulted in the discovery of 4 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:— 85 Number or 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) 55 15 26 3 453 15 160 (c) 174 (f) 73 974 (b) — — 1 — — - — — — 1 Assistant M.O.H. and Tuberculosis Officer (a) 37 12 8 1 192 4 99 (d) 61 (g) 30 444 (b) — - 1 - - - - - - 1 Assistant M.O.H. and Assistant Tuberculosis Officer (a) 2 7 5 9 62 1 15 (e) 30 8 132 (6) - — - - — — - — — Total 1,552 Notes, (a) Poplar residents. (6) Non-residents seen at Poplar Hospital. (c) 50 persons found to be suffering from Smallpox. (<*) 31 ,, («) 6 (/) 9 (?) 5 (Note.—A large number of Smallpox Suspects among contacts were seen by the Medical Officer of Health and the Tuberculosis Officer jointly, and therefore the number of persons found to be suffering from Smallpox is greatly overstated, 00 <Ji Vaccination. 86 The following particulars regarding vaccination have been taken from the Vaccination Officer's reports:— Extract from the Report of the Vacoination Officer, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1931, inclusive: — Registration Sub-Districts. Number of Births registered 1st Jan. to 31st Dec., 1931. Number of Births entered by 31st January, 1933, in "Vaccination Register." Number of Births which on 31st January, 1933, 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 1932. Number of Statutory Declarations of Conscientiom Objection actually received during the calendar year 1932. Col. 1 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 1254 155 2 1 779 94 6 26 16 175 712 1275 Bow and Bromley 910 121 1 — 596 49 3 9 16 115 Total 2164 276 3 1 1375 143 9 35 32 290 712 1275 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 One. (6) The figures in Columns 2 to 11 should not include re-registered births. (c) The total number of copies of certificates for the year 1932 sent to other Vaccination Officers was 225. 87 Return showing the numbers of persons successfully vaccinated and re-vaccinated at the cost of the rates by the Medical Officers of the Poor Law Institutions and the Public Vaccinators during the year ended 30th September, 1932. 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. The figures for the Poor Law Institutions should be shown separately. Totals 321 220 626 85 Bromley Dr. C. Cotter 99 52 165 14 Poplar Dr. H. J. O'Brien 80 65 152 7 Bow Dr. D. G. Macrae 89 58 161 14 Millwall Dr. VV. C. Millea 50 27 78 1 St. Andrew's Hospital Dr. J. Whigham — 18 67 49 Poplar Institution Dr. J. Whigham 3 — 3 — Bromley House Inst Dr. Butler Hogan — — — — Bow Institution Dr. E. T. Pinhey — — — — Col. 1 2 3 4 5 6 7 M. 379a. Dated this Third day of February, 1933. (Signed) H. E. DENNIS, Clerk of the Council. 88 The following analysis of the Vaccination Return reveals the fact that nearly 86 per cent. of the children whose births were registered in 1931 were not protected by successful vaccination:— Births registered 2,164 Deduct:— Died unvaccinated 143 Removals to other districts 35 Removals to places unknown, etc. 32 210 Surviving residents 1,954 Successful vaccinations numbered 276 Insusceptible of Vaccination 3 Had Smallpox 1 280=14.3 per cent. Conscientious Objections declared 1,375 Vaccinations postponed on Medical Certificates 9 Number not accounted for 290 Total unvaccinated children 1,674=85.7 per cent. 1.954 = 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. 89 London Notification of Glanders Order, 1907. No notice was received from the Veterinary Inspector of the London County Council of the existence of glanders at premises in the Borough. Erysipelas. 81 cases of erysipelas were notified during the year. Three deaths occurred. Puerperal Fever, etc. Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. The Consulting Obstetrician appointed under the above Regulations, Dr. Malcolm Donaldson, was not called in during the year. The following is a summary of the notifications, etc., during the year:— Puerperal Fever. Puerperal Pyrexia. Cases notified 9 28 Removed to L .C .C. Fever Hospitals 7 4 Treated in other Hospitals 2 23 Treated at home — 1 Specialist called in — — Deaths 6* 1† * Two were not notified patients; our first intimation in each case was the report of the death. † Cause of death, "Cardiac failure. Lobar Pneumonia." Continued and Typhus Fevers. No case of continued fever occurred. No case of typhus fever occurred. 90 Cerebro-Spinal Fever. 12 cases of Cerebro-Spinal Fever were notified, and the patients were removed to hospital. Six patients died. Acute Poliomyelitis. 3 cases were notified, and were removed to hospital. Acute Encephalitis Lethargica. 2 notifications were received, and one other case was reported. The 2 notified patients were treated in hospital and both died. In one instance the diagnosis was not confirmed, the final diagnosis being Tuberculous Meningitis due to Tuberculoma. 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 Country 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, 19 cases were investigated. 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 5 8 Attending hospitals or otherwise undergoing treatment 7 Suffering from after-effects but not receiving treatment 2 19 91 The 9 patients suffering from after-effects (excluding those in institutions) were affected as follows:- Intelligence below normal 1 Sleep, poor or excessive — Paralysis—severe 1, slight 4 5 Movements of limbs impaired, twitching, etc. 1 Vision impaired 2 9 Acute Polio-Encephalitis. Two cases of Acute Polio-Encephalitis were notified and treated in hospital. The other was treated as an out-patient. Post-Vaccinal Encephalitis, etc. No case of Post-Vaccinal infection was reported. Measles. 1,574 cases of Measles were reported to the Medical from various sources (principally from L.C.C. schools). 31 deaths attributed to Measles. During the year 264 cases of measles were admitted to Hospitals from the Borough . A summary of the cases reported and visited is given in the section relating to Maternity and Child Welfare, page 118. Pneumonia. 352 cases of Acute Primary Pneumonia and 26 cases of Acute Influezal Pneumonia were notified during the year, 131 of the patient being treated in hospitals. 87 notified patients died-8o Acute Primary Pneumonia and 7 Acute Influenzal Pneumonia. 92 Malaria. No case of Malaria was notified during the year. One death from Malaria induced in a mental patient was recorded during the year. Dysentery. Two notifications were received. Both cases were treated in hospitals. 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 122. Altered Diagnosis Cases. 85 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:— 32 Scarlet Fever; 49 Diphtheria; 2 Puerperal Pyrexia, altered to Puerperal Sepsis; 1 Encephalitis Lethargica; 1 Smallpox.l The final diagnosis in the 32 Scarlet Fever cases was:— Erythema 3 Measles and German Measles 6 Diphtheria and Vincents Angina 1 Tonsillitis 2 Pharyngitis 1 Disease not specified *19 32 * These were reported "Negative case," "Not notifiable," etc. The final diagnosis in the 49 Diphtheria cases was Tonsillitis 11 Pharyngitis 2 Laryngitis 2 Measles (with Tonsillitis 1) 2 Scarlet Fever 1 Nasal Catarrh 1 Disease not specified *30 49 93 In addition, there were 19 cases reported as Bacteriological Diphtheria. These have been included as cases of Diphtheria. * These were reported "Negative case," "Not notifiable," etc. 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 1932 130 75 205 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 ,6p.m. Adults who are working. Tuesday 11a.m. and 2p.m. Any person not at work or not attending School. Thursday Friday Tuberculosis Officer's Report. Statistics for 1932. The three following tables comprise the annual return for 1932 required by the Ministry of Health. The first provides a concise summary of the clinical work carried out during the year at the Dispensary, 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. 94 Return for the year 1932. 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 Contacts):— (a) Definitely Tuberculous 66 70 1 3 3 9 11 8 69 79 12 11 171 (b) Diagnosis not completed — — — — — — — — 5 14 4 4 27 (c) Non-Tuberculous — — — — — — — — 121 160 113 116 510 B.—Contacts examined during the year:— (a) D finitely Tuberculous 7 8 2 — 1 — — 1 8 8 2 1 19 (b) Diagnosis not completed — — — — — — — — 1 — — 4 5 (c) Non-Tuberculous — — — — — — — — 86 119 104 137 446 C.—Cases written off the Dispensary Register as:— (a) Recovered 6 9 5 3 1 1 5 5 7 10 10 8 35 (b) Non-Tuberculous (including any such cases previously diagnosed and entered on the Dispensary Eegister as Tuberculous) — — — — — — — — 215 286 229 261 991 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely Tuberculous 302 246 20 46 42 52 76 70 344 298 96 116 854 (b) Diagnosis not completed — — — — — — — — 6 14 4 8 32 1. Number of Cases on Dispensary Register on January 1st, 1932 892 2. Number of Cases transferred from other areas, and Cases returned after discharge under Head 3 in previous years 63 3. Number of Cases transferred to other areas, Cases not desiring further assistance under the scheme, and Cases "lost sight of" 110 4. Cases written off during the year as Dead (all causes) 1ll 5. Number of attendances at the Dispensary (including Contacts) 5,577 6. Number of Insured Persons under Domiciliary Treatment on December 31st 249 7. Number of Consultations with Medical Practitioners:— (a) Personal 13 (b) Other 342 8. Number of visits by Tuberculosis Officers to homes (including personal Consultations) 200 9. Number of visits by Health Visitors to homes 6,756 10. Number of:— (a) Specimens of Sputa examined P.H 378 Dispensary 1,041 (b) X-RAY examination made Screen 127 Ellms 105 11. Number of "Recovered" cases restored to dispensary Register, and included in A(a) and B(b)above 1 12. Number of " T.B. plus" Cases on Dispensary Register on December 31st 454 2. PULMONARY TUBERCULOSIS. Showing in summary form (a) the condition at the end of 1932 of all Patients remaining on the Dispensary Register; and (6) 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 Condition at the time of the last record made during the year 1932 . 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 Dispensary Register on December 31st. Disease Arrested Adults M. 5 3 12 — 15 1 1 2 — 3 2 1 — — 1 5 3 — — 3 F. 6 5 5 — 10 1 1 — — 1 4 1 — — 1 2 1 — 3 Children 3 — 2 — 2 4 — — — — 5 — 1 — 1 2 — — — — Disease not Arrested Adults M. 3 8 27 6 41 1 2 13 — 15 1 2 6 — 8 1 7 7 1 15 F. 3 6 22 1 29 2 — 4 1 5 3 1 5 1 7 1 4 8 — 12 Children 2 1 1 1 3 1 — — — — 2 — — — — 1 1 — — 1 Condition not ascertained during the year 5 2 5 1 8 3 — — — — 3 2 — — 2 1 1 1 — 2 Total on Dispensary Register at Dec. 31st 27 25 74 9 108 13 4 19 1 24 20 7 12 1 20 11 18 17 1 36 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 34 18 22 — 40 1 — 1 — 1 — — — — — — — — — — F. 61 19 20 — 39 2 1 — — 1 — 1 — — 1 — — — — — Children 79 7 9 — 16 2 — — — — — — — — — —, — — — — Lost sight of or otherwise removed from Dispensary Register 39 30 72 3 105 15 7 12 — 19 19 12 12 — 24 18 4 12 — 16 Dead Adults M. 11 17 53 13 83 2 3 25 4 32 4 9 17 5 31 10 6 23 4 33 F. 6 14 37 8 59 5 23 2 30 3 5 26 5 36 2 1 24 3 28 Children 1 — 6 — 6 — — — 1 1 1 — — 1 1 4 — 2 — 2 Total written off Dispensary Register 231 105 219 24 348 22 16 61 7 84 27 27 55 11 93 34 11 61 7 79 Totals . 258 130 293 33 456 35 20 80 8 108 47 34 67 12 113 45 29 78 8 115 1929. 1930. 1931. 1932. (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M. 1 2 1 — 3 1 — — — — — — — — — — — — — — F. 1 — — — — 1 — — — — — — — — — — — — — — Children 1 — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults M. 5 11 16 10 11 16 1 28 7 21 16 3 40 6 31 20 3 54 F. 6 10 11 2 23 7 12 18 1 31 9 7 12 2 21 14 13 23 3 39 Children 3 1 1 — 2 11 1 — — 1 6 2 1 — 3 3 — 1 — 1 Condition not ascertained during the year 1 1 — 2 — 1 — — 1 2 — 1 — 1 — — — — — Total on Dispensary Register at Dec. 31st 12 19 25 2 46 30 25 34 2 61 24 30 30 5 65 23 44 44 6 94 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Dispensary Register 4 9 12 2 23 12 9 12 2 23 6 8 4 2 14 1 2 1 — 3 Dead Adults M. 4 11 19 8 38 3 5 28 14 47 3 3 11 11 25 — 1 5 5 11 F. 6 7 24 4 35 4 3 16 7 26 — 1 8 15 24 3 1 5 13 19 Children 1 — 1 — 1 — 1 2 — 3 — — — 1 1 1 — — — — Total written off Dispensary Register 15 27 56 14 97 19 18 58 23 99 9 12 23 29 64 5 4 11 18 33 Grand Totals 27 46 81 16 143 49 43 92 25 160 33 42 53 34 129 28 48 55 24 127 3. NON-PULMONARY TUBERCULOSIS. Showing in summary form (a) the condition at the end of 1932 of all Patients remaining on the Dispensary Register; and (b) 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. Periph'al Glands. Total. Bones & Joints. Abdominal. Other Organs. Periph'al Glands. Total. Bones & Joints. Abdominal. Other Organs. Periph'al Glands. Total. Bones & Joints. Abdominal. Other Organs. Periph'al Glands. Total. (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M. 2 — — — 2 — — — — — — — — — — — — — 1 1 F. 1 — 3 1 5 — — — 1 1 2 — — — 2 1 — — — 1 Children 5 1 1 4 11 1 — — 3 4 1 1 — 3 5 2 2 — — 4 Disease not Arrested Adults M. — — — — — — — — — — — — — — — — — 1 — 1 F. 1 — 2 1 4 — — — 2 2 I — — — 1 3 — — — 3 Children 1 — — 2 3 — — — 1 1 6 — — 1 7 3 — — 2 5 Condition not ascertained during the year 2 — — — 2 2 — — — 2 2 1 — 2 5 1 1 — 3 5 Total on Dispensary Register, December 31st 12 1 6 8 27 3 — — 7 10 12 2 — 6 20 10 3 1 6 20 Transferred to Pulmonary — — — 1 1 — — — — — — — — 1 1 — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 5 2 4 5 16 — 2 — 1 3 2 — — — 2 — — — — — F. 6 — 4 6 16 — — — 1 1 — — 1 1 2 — — — — — Children 18 7 11 58 94 — 2 1 5 8 2 — — 4 6 — 1 — 1 2 Lost sight of or otherwise removed from Dispensary Register 8 — 8 18 34 3 2 2 2 9 1 1 — 5 7 2 2 1 5 10 Dead Adults M. 2 — — — 2 3 — — — 3 — — — — — — — 1 — 1 F. 1 — — — 1 — — — — — — — — — — — — — — — Children 1 — — 1 2 — — — — — — — — — — — — — 1 1 Total written off Dispensary Register 41 9 27 88 165 6 6 3 9 24 5 1 1 10 17 2 3 2 7 14 Grand Totals of (a)and (b) (excluding those transferred to Pulmonary) 53 10 33 96 192 9 6 3 16 34 17 3 1 16 37 12 6 3 13 34 1929. 1930. 1931. 1932. (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M. 3 1 — — 4 — 1 — 1 2 — — — — — — — — — — F. — — 2 2 — — 1 — 1 — — — — — — — — — — Children 2 2 2 5 11 3 1 — 5 9 1 — 1 — 2 — — — — — Disease not Arrested Adults M. 2 — 1 — 3 4 — 5 — 9 7 — 2 1 10 2 — 2 — 4 F. 1 — — 1 2 3 1 1 — 5 4 2 2 1 9 6 — — 2 8 Children 9 — 1 — 10 8 4 1 5 18 14 2 1 9 26 3 1 2 10 16 Condition not ascertained during the year 1 — 1 2 4 2 — 1 1 4 1 — 1 2 4 — — — — — Total on Dispensary Register, December 31st 18 3 5 10 36 20 7 9 12 48 27 4 7 13 51 11 1 4 12 28 Transferred to Pulmonary — — — 1 1 — — — — — 1 — — — 1 — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — F — — — — — — — — — — — — — — — — — — — — Children 1 — — — 1 — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Dispensary Register 1 1 1 2 5 1 — 1 2 4 3 — 1 — 4 — — — — — Dead Adults M. 1 — — — 1 — — — — — — — — — — — — — — — F 1 — — — 1 — — — — — — 1 — — 1 — — — —. — Children — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 4 1 1 2 8 1 — 1 2 4 3 1 1 — 5 — — — — — Grand Totals of (a)and (b) (excluding those transferred to Pulmonary) 22 4 6 12 44 21 7 10 14 52 30 5 8 13 56 11 1 4 12 28 95 Comments on Table I. Item A.-547 new cases (other than contacts) attended during the year for examination. In addition to these, 161 cases (other than contacts) who were examined in previous years and discharged as nontuberculous, Presented themselves for re-examination during the year with a roccurence of symptoms, and were, in accordance with the instructions in the Minister of Health's Memorandum 37/T. Revised, grouped as new cases under Item A on Table I. Of this total number of 708 new cases (excluding contacts), 171 were found to be suffering from Tuberculosis. Item B.-366 new contacts attended during the year for examination. In addition to these, 104 contacts who were examined in previous years and discharged as non-tuberculous, presented themselves for re-examination during the year with suspicious symptoms, and were similarly grouped as new cases under item B on Table I. Of this total number of 470 new contacts, 19 were found to be tuberculous. On this figures an incidence of tuberculosis is revealed of roughly 24 per cent. among non-contacts and of 4 per cent. among contacts. It should be pointed out, however, that the majority of the 366 contacts attending for the first time came up for examination purely as contacts— that is to say, they were free from symptoms. Now the whole of the 708 new cases (excluding contacts) attended for examination on account of suspicious symptoms. Therefore, for purposes of comparison, it would be truer to compare the group of contacts presenting definite symptoms, namely, 104, with the 708 non-contacts. When this is done the figures are roughly 24 Per cent. tuberculous among non-contacts and 18 per cent. among contacts. Both new cases (excluding contacts) and contacts attending for examination again show an increase over the preceding year. 96 There is a striking fall among the number of cases of non-pulmonary tuberculosis. In 1929, 1930 and 1931 there were 44, 52 and 56 cases respectively, an average of 51 cases each year, whereas in 1932 the number has dropped abruptly to 28. In the absence of any precise knowledge as to the relative incidence of human and bovine infection among the non- pulmonary group in Poplar, either during the year under review or in previous years, the reasons for the drop in non-pulmonary cases remain merely conjectural. There is no reflection so far in the Tuberculosis Statistics of the adverse economic conditions. The remaining figures on Table I explain themselves. There has been a notable increase in the X-ray work; the plant at the Dispensary has been increasingly used for screen examinations, while full advantage has been taken of the arrangements whereby films, when necessary, are taken at St. Andrew's Hospital. Comments on Tables II and III. These returns remain optional. Their compilation involve a lot of time and close attention, but they form a valuable commentary on the work done under the Tuberculosis Scheme. On these tables the condition of each patient is recorded year by year, while no patient who comes under the Tuberculosis Scheme in Poplar will ever cease to appear on them in one place or another. During the year 35 patients have been removed from the Dispensary Register as Recovered (Item C, Table I), and have been added to those similarly removed in former years on Tables II and III in the appropriate columns. On Table III one case which originated in 1931 developed pulmonary tuberculosis during the year, and has accordingly been transferred to Table II. This makes a total of only 4 cases of non-pulmonary tuberculosis which have, since 1926, developed pulmonary tuberculosis. 97 On Table III a comparison of the 1931 and 1932 columns shows that the fall in the non-pulmonary cases during 1932 is largely accounted for by a decrease in the number of cases of bone and joint tuberculosis, and, to a less extent, of those of tuberculosis of the abdomen and of other organs, while the number of cases of glandular tuberculosis remains much the same. A decreased incidence of infection with the human type of bacillus might account for these figures, but, as hinted above, such an explanation is purely speculative. Additional Statistics not dealt with in the Preceding Tables :— Patients sent away for Institutional Treatment 222 Patients in receipt of extra nourishment during the year 90 Patients in receipt of extra nourishment on December 31st 39 Reports on Children to Divisional School Medical Officer 135 Letters to General Practitioners concerning patients 354 Reports to General Practitioners on Official Forms 197 Progress reports received from General Practitioners 158 Clinical reports to London County Council 682 Reports to Ministry of Pensions 7 Shelters on loan during the year 3 Shelters on loan on December 31st 2 Bed and Bedding on loan during the year Cases 28 Bed and bedding on loan on December 31st ,, 20 During the year 7 new cases and 9 old cases have attended Brompton and Victoria Park Hospitals for 156 artificial pneumothorax refills, while 1 new case and 3 old cases of Lupus have attended the London Hospital for 81 applications of Finsen Light and 378 applications of General Light. No other cases of non-pulmonary tuberculosis have attended the London Hospital for light treatment during the year. 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. As was foreshadowed in last year's report, there has been an increase in the number of Artificial Pneumothorax refills, and a further rise may be anticipated. During the year no tuberculous children have been recommended for admission to open-Air Schools. There have been a few suitable cases, but the consent of the parents could not be obtained. 98 Cases remaining on the Medical Officer of Health's Tuberculosis Register on December 31st 1,197 Cases remaining on the Tuberculosis Dispensary Register on December 31st 886 It is gratifying to note that of the total number of cases of Tuberculosis in the Borough, practically 75 per cent. pass through the Dispensary machinery. Dental Treatment. Under the arrangement which came into force during 1931 tuberculous patients requiring dental treatment are referred to St. Andrew's Hospital on Tuesdays and Fridays at 12 noon. The number of patients so referred is not great, for the following reasons:— 1. If Institutional Treatment for Tuberculosis is urgently needed this is immediately arranged, and any necessary dental treatment is carried out while the patient is away. 2. Wholesale dental treatment in cases of advanced tuberculosis is generally contra-indicated, and dental interference is limited in these cases to the occasional extraction of a carious tooth purely for the relief of pain. 3. The usual type of case referred is one awaiting admission Sanatorium, where preliminary dental treatment is indicated in order that the full benefit of Sanatorium treatment may be obtained. Report of Dental Treatment for Tuberculosis Dispensary Poplar Borough Council. During Year January 1st, 1932, to December 31 st, 1932. Number of Sessions 52 Number of Patients' attendances 61 Anaesthetics—Gas 15 Local 8 Abscesses opened 2 Attendances (in Gingivitis treatment) 6 Dentures eased 2 Number of teeth extracted 80 F. G. HUTCHINSON. 99 REPORT OF THE Secretary of the Tuberculosis Care Committee. The tuberculosis Care Committee has continued to meet fortnightly at the Dispensary. The Care Committee, which is appointed by the Council, is representative of most of the public agencies and charitable societies in the Borough, and co-operation with these bodies, in the interest of the tuberculosis patient, is effected by this means. The work of the tuberculosis Care Committee has been rendered more than ever necessary by the prevailing economic conditions during 1932. There have been 21 meetings of the Care Committee during the year and 398 cases have been dealt with. Of these, 171 were primarily in connection with assessment for hospital and sanatorium treatment. The committee has been responsible for the collection of contributions, for the London County Council, in the cases in which an assessment was made. In the 227 other cases brought to its notice, the Care Committee has endeavoured to supply such help or advice as has been required in connection with any adverse conditions brought about by the occurrence of tuberculosis. Considerable material assistance has been obtained from other agencies, but the majority of cases needing practical help have been referred to our own Charity, the Poplar Tuberculosis Fund for the Provision of Accessories to Institutional Treatment and After-care. The Poplar Tuberculosis Fund (which is a Charity approved by the London County Council) is administered by a separate Committee, and this has met six times during 1932. Ninety-eight grants have been made to needy patients. Of these, 48 were in the form of clothing and boots, warm outfits for sanatorium being continually in demand. Other assistance given has included provision of dentures, glasses and surgical appliances, payment of the cost of laundry being put out for women patients who are not able to do this work themselves, convalescence and general assistance. No case has been assisted where help could be more suitably obtained from the Public Assistance Committee. The main income of the Poplar Tuberculosis Fund has once again come from local Cinemas, in respect of Sunday opening. The Associated British Cinemas have contributed, in respect of the Poplar Hippodrome, throughout the year, and the Fund has been fortunate in receiving contributions from two other Cinemas—the Poplar Pavilion and the Ideal Picture Theatre, Poplar—as from November 20th. A grant was again received from the Alexandra Rose Day Fund, and the amounts received from these sources have been augmented by the various efforts on the part 100 of the Committee of the Fund, the Tuberculosis Care Committee and their friends. The annual Household and Jumble Sale was held in November and a concert, a dance, a whist drive, and a collection at the Clapton Stadium (the latter by kind permission of the Management) have taken place during the year. The Committee of the Poplar Tuberculosis Fund publishes its own report and balance sheet at the end of the financial year The Handicraft Class, which provides some occupation for about 16 unemployed patients, continues to meet every Monday morning at the Dispensary and is much appreciated by the members. The subject taught now include leather-work, basket-work, pewter-work, bead-work, glove-making, stool-seating and hand painting, and the standard of the work is improving. The disposal of the finished articles is always a difficulty, but a good many of the goods made during the year were sold at two Exhibitions in which we took part—the Exhibition of Handicrafts organised by the Standing Conference of Metropolitan Borough Tuberculosis Care Committees, and held at the Carpenters' Hall in October, and the Disabled Ex-Servicemen's Exhibition at South Kensington, in November. The Committee also organised a small Christmas Sale and Exhibition, which was held at the Dispensary, in December. The Poplar Tuberculosis Care Committee is represented on the Standing Conference of Metropolitan Borough Tuberculosis Care Committees, which has met at the County Hall twice during the year, and in connection with the Conference, a visit was paid to King George V Sanatorium, Godalming, in June. Members of the Committee were also present on the second day of the Conference of the National Association for the Prevention of Tuberculosis, owing to a special invitation issued to Care Committees. The Committee gratefully acknowledges the assistance of all those who have co-operated in the work of the care of the tuberculosis patient and his family, particularly that given by the Poplar Branch of the Invalid Children's Aid Association, whose work in connection with the visiting, convalescing, and boarding out of children has been most helpful. The chief problem confronting the Committee has again been the finding of employment for patients, the present state of the labour market making the search for suitable, light work—the great need of the ex-sanatorium patient—a very thankless task, and the reduced family income, brought about by unemployment, has made it very difficult for sufferers from tuberculosis to maintain the desirable standard of living. 101 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part I.-summary of Notifications during the period from the 3rd January, 1932, to the 31st December, 1932, in the area of the Metropolitan Borough of Poplar (to which this Return relates) Age Periods. Formal Notifications. Number of Primary Notifications of New Cases of Tuberculosis. Total Notifications. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages). Pulmonary- Males — — 2 3 12 12 23 18 21 14 4 109 231 ,, Females 1 4 — 1 21 19 23 11 5 5 1 91 202 Non-Pulmonary- Males — 9 3 2 2 1 3 — 1 — — 21 30 ,, females 1 1 3 5 2 1 3 — 1 — — 17 23 Col. (1) (2) (3) (4) (5) (6) (7) (8) (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 7 1 2 1 14 ,, Females — 1 — 1 2 2 4 1 1 — 1 13 Non-Pulmonary- Males — — 3 2 — — — — — 1 — 6 ,, Females — 2 5 2 — 1 2 — 1 — — 13 The source or sources from 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 Registers 3 1 Death Returns transferable deaths from Register-General 3 2 Posthumous notifications 7 3 "Transfers" from other areas (other than transferable deaths) 6 4 Other Sources, if any (specify) Forms 1& 2 8 9 PART III.—NOTIFICATION REGISTER Pulmonary. Non-Pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. Number of cases of Tuberculosis remaining at the 31st December, 1932, on the Registers of Notifications kept by the Medical Officer of Health of the politan Borough 462 353 815 220 162 382 1,197 Number of cases removed from the Register during the year by reason inter alia of:- 1. Recovery from the desease, cured and no longer suffering 20 28 48 17 16 33 81 2. Diagnosis not confirmed 7 3 10 1 2 3 13 3. Deaths 93 78 171 8 8 16 187 102 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. Quarter ended March. J une. September. December. Number of Cases on Register at commencement of quarter 1,362 1,273 1,254 1,242 Number of New Cases notified 75 83 49 51 Number of Cases restored to Register, etc. 4 — 3 9 Number of Cases removed from Register 198 102 64 106 Number of Cases on Register at end of quarter. * Pulmonary 869 851 847 815 Non-Pulmonary 404 403 395 382 Totals 1,273 1,254 1,242 1,197 Particulars of new cases of Tuberculosis and of all Deaths from the disease:— Age Periods. New Cases. Deaths. (Reg. General s figuress). Pulmonary. NonPulmonary. Pulmonary. Non- Pulmonary M. F. M. F. M. F. M. F. Under 1 .. — 1 — 1 — 1 — — 1 — — 4 9 1 — 1 2 5 5 — 2 — 3 3 — — 3 3 10— 3 1 2 5 15— 12 21 2 2 16 24 2 2 20— 12 19 1 1 25— 23 23 3 3 15 16 1 — 35— 18 11 — — 15 6 1 — 45— 21 5 1 1 16 7 — — 55— 14 5 — — 8 4 1 — 65 and upwards 4 1 — — 3 2 — — Totals 109 91 21 17 73 61 10 10 The ratio of non-notified Tuberculosis deaths to total Tuberculosis deaths was 5.8%. 103 Disinfecting Department. Totals. Premises Disinfected 2,068 „ visited re Disinfection 2,224 number of Verminous Rooms sprayed with Solution "D" 231 Articles Disinfected. Smallpox. Other Infectious Diseases. Tuberculosis. Verminous. Miscellaneous. Totals (a) From Infected Premises 2,694 11,589 458 320 1,363 16,424 (b)Cleansing Station — — — 4,946 15,451 20,397 Totals 2,694 11,589 458 5,266 16,814 36,821 Articles destroyed by request, 1,049. Vermicide— Quantity issued from Depots, 409½ gallons. Cleansing Station. Totals. M. F. Verminous persons cleansed 57 4 „ children ,, 298 1,482 Scabies cases, cleansed, adults 41 41 ,, ,, children 414 537 Total cleansings 810 2,064 All verminous children are treated with special comb. Motor Vehicles. Vehicle. Speedometer register (miles). Petrol consumption (gallons). Average m.p.g. Blue Van 2,846 213 13.3 (a) Brown Van 2,094 164½ 12.7 (b) Lorry 4,338 339½ 12.7 M.O.H. Car 9,393 571½ 16.4 Special Vehicles for Contacts 1,613 127½ 12.6 (c) (a) 3 weeks in workshop for overhaul, and repairs, etc. (b) 8 ,, ,, ,, etc., and speedometer defective, 3 weeks. (c) ,, not used. 104 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 1932, 61,940 gallons were manufactured and broken down to 127,500 gallons of weaker solution for distribution. The production of the solution at a strength of 4 grammes of available chlorine per litre has averaged 111,373 gallons per annum for three years at an average annual cost of £2,274, the cost per gallon thus being 5d. Quantity Produced. As Manufactured. As Issued. (i.e., Weaker Solution.) Electricity Consumed. Gallons. Gallons. Units. No. 1 Apparatus 21,870 44,880 11,268½ No. 2 Apparatus 21,510 44,100 11,082½ No. 3 Apparatus (11 months only) 18,560 38,520 9,594½ Totals 61,940 127,500 31,945½ 105 EXTRACT FROM ANNUAL ESTIMATES, ETC. Electrolytic Disinfecting Fluid. Estimate for Year ended 31st March, 1932. Expenditure for Year ended 31st March, 1932. Average Expenditure for 3 Years ended 31st March, 1932. Estimate for Year ending 31st March, 1933. Estimate for Year ending 31st March, 1934. £ £ £ £ £ £ £ £ £ £ Wages 1,277 1,251 1,303 1,241 1,195 Rates, Taxes and Insurance—Main Depot 84 81 84 82 81 Rent (Issuing Depots) 46 46 46 46 46 Electricity and Water 270 307 270 300 330 Chemicals 160 122 129 120 130 Testing Apparatus 5 — 1 5 5 Bottles, Carboys, Hampers, Corks, etc. 70 52 56 50 60 Overalls and Clogs 9 10 10 8 10 Supervision of Plant 15 15 15 15 15 Repairs and Renewal of Plant 50 43 47 140 120 Replacing part of Plant — — 152 — — Repairs (Works Dept.) Main Depot 200 97 137 60 50 ,, ,, Issuing Depots 100 72 86 100 100 Petty Expenses and Sundrios 12 7 10 10 10 2,298 2,103 2,346 2,177 2,152 Less Income 50 2,248 14 2,089 72 2,274 50 2,127 50 2,102 106 1,435 gallons were supplied to London County Council Schools for spraying and cleansing floors of classrooms. 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. Quarter. Number of Children Cleansed. Total number of Cleansings. Amount payable by L.C.C. to the Borough Council. 1932. £ s. d. March 425 749 55 16 0 June 548 736 65 5 0 September 352 457 40 10 0 December 515 737 60 3 0 Totals 1,840 2,679 £221 14 0 Miss Landray made 14 visits in connection with verminous schoolchildren and 126 visits in connection with children suffering from Scabies. Arrangements were made for the children to be bathed, and for bedding and clothing to be disinfected. Cleansing of Persons Act, 1897. During the year, 143 persons—including 35 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:— 107 Lodging House, etc. Male. Female. Total. 196, Bow Road — — — St. James's Chambers, 207, High Street, Poplar 2 — 2 65, Bow Lane — — — 378, Old Ford Road — — — 38, Pennyfields — — — Salvation Army Home, Bow Road — — — ,, ,, Hostel, Garford Street 27 — 27 411, East India Dock Road 1 — 1 30 — 30 From Common Lodging Houses without the Borough of Poplar (by agreement with L.C.C. at a charge of is. per person cleansed) 5 — 5 Totals 35 — 35 For cleansing of verminous rooms see page 34. Public Education in Health. Report by Mr. T. Wigley. There is to-day no need to argue that prevention is better than cure, for even the stupid is made painfully aware of the fact, whether it be as member of a family, as worker in industry, or citizen of the world. Recognition of a fact, however, does not always mean that appropriate measures are taken to deal with it. The ignorant man may desire knowledge, but if he is unwilling to apply himself to the labours which the attainment of knowledge involves, he remains—ignorant. Unfortunately, where matters of health and disease are concerned, ignorance brings disorders, which are not confined to the individual; they spread like waves in ever-widening circles and engulf others. "There is one great outstanding difference between men—Knowledge,'' says Sir George Newman. "Some men know how they live, others do not; some men 108 know how to behave in varying circumstances, others do not; some men find truth and strive to live by it, others do not. 'Ignorance,' it has been well said, 'is the great human curse.' " If, then, ignorance is the great human curse, with disastrous results for mind and body, the duty of making knowledge accessible to and understandable by all is of first importance, and is being rightly urged by medical men and laymen. Sir Arthur Newsholme, in his valuable book, "Medicine and the State," tells his readers: "Personal hygiene has secured triumphs over disease in the individual as striking as those previously attained by measures of environmental hygiene affecting the health of the aggregate of mankind.'' Lord Horder has said that the condition of vague ill-health was often due to preventible causes, which could be dealt with by concentration on education work; in matters of hygiene, and in the general prevention of ill-health, education was far more important than legislation. From practical knowledge of the campaign against ignorance the Poplar Public Health Authority may well stress the truth of this point of view, and it is to be congratulated on both its wisdom and imagination in promoting good health by laying the foundations of knowledge. As one who has been able to have a small share in this work of education, I would point out that the work has grown beyond a grateful appreciation of knowledge made available; it has now developed into a warm and friendly relationship between all kinds of gatherings of men and women and those who have the privilege of teaching them. What this means, not only for the dissemination of sound knowledge concerning health and disease, but for the building-up of a wholesome esprit de corps in personal relationships between a Public Authority and those whom it seeks to serve, there is no need for me to make clear, for it must be obvious to all. Much more remains to be done, but what has been done so far has more than indicated the confidence of those who, seeing the most urgent need, set themselves to meet it. Eighty-eight lectures have been arranged to be given at 14 centres and 76 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. 109 Summary. Number of Centres at which lectures have been arranged 14 Number of lectures given (at time of writing report) 76 To men and boys 2 (Attendances 165) To women and girls 67 (,, 6,793) To mixed audiences 7 ( ,, 265) 76 (Total attendances — over 7,000) Expenditure to 31st March, 1933. £ s. d. Grant to Central Council for Health Education 5 0 0 Printing, Stationery and Postage 0 18 9 Fees to Lecturers 172 4 0 Total £178 2 9 Public Health Education and British social Hygiene Council. Arrangements were made with the British Social Hygiene Council for four film displays and addresses on Venereal Diseases to be given at four of the halls in the Borough during the winter 1932-33. Two of these were given in November (Bromley Public Hall and Bow Baths) and two in January, 1933 (Island Baths, Millwall, and Poplar Town Hall). 110 Section G. 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. Under the Local Government Act, 1929, the Borough Council contributes £4,442 to the Royal College of St. Katharine. 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 19 31 42 ,340 34,275 1932 48,167 35,413 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. MATERNITY AND CHILD WELFARE CLINICS. Situation. Nature of Accommodation. Clinics . a) Provided by the Borough Council:— Simpsons Road, Poplar Medical Officer's, Weighing and Waiting Rooms (Weighing Room also used for Artificial Sunlight Treatment) Infant Consultations: Wednesdays, 10.30 a.m. to 12.30 p.m. and 2 to 4 p.m. Ante-Natal-. Mondays 2 to 4 p.m. Sewing Class: 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. Methodist Mission, Old Ford Road Medical Officer's Room and Weighing and Waiting Room combined Infant Consultations: Tuesdays and Fridays, 2 to 4 p.m. Ante-Natal: Fridays, 10.30 a.m. to 12.30 p.m. Methodist Chapel, Manchester Road Medical Officer's, Weighing and Waiting Rooms 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, 10.30 a.m. to 12.30 p.m., and 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. b) Provided by the Royal College of St. Katharine:— Special Clinic: (By appointment only) Fridays, 2 to 4 p.m. 228-230, Brunswick Road Two Medical Officers' Rooms; 1 Weighing and 2 Waiting Rooms; 1 Dental Clinic; 1 Artificial Light Room and Waiting Room; 2 Observation Wards, with Kitchen, Bathroom and Out-Patient Room for mothers Infant Consultations. Tuesdays, Thursdays and Fridays, 2 p.m. Sewing Class: Wednesdays, 2 p.m. Dental: (By appointment only) Mondays, 1.30 and 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 Trinity Hall, Augusta Street Medical Officer's Room and Large Hall for weighing and waiting Ditto Ditto Ditto Infant Consultations: Wednesdays, 2 p.m Infant Consultations: Wednesdays, 2 p.m. 111 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. I. Population of the area served by the Council:—156,300 (Reg.-General's estimate, Mid. 1931.) 2. Number of Births notified in that area during the year under the Notification of Births Act, 1907 :— (a) Live births, 2,642; (b) Still births, 82; (c) Total, 2,724. (d) By midwives, 1,010; (e) By doctors and parents, 355; (f) Institutions in Borough, 1,359. 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. 8 for 6 months, a temporary arrangement. (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—7/8; 1/8 whole- time service being spent at the Artificial Light Clinic. (b) In the case of Health Visitors employed by Voluntary Associations— ??? ½; 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, 1,367; Total visits, 4,598. (b) To children under 1 year of age—First visits, 2,423; Total visits, 23,261. (c) To children between the ages of 1 and 5 years—Total visits, 42,569; plus visits paid to children over 5, L.C.C. Measles Scheme, 495; Puerperal Pyrexia, Fever, Maternal Deaths, 170; Total visits paid, 71,093. 112 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—25,666. (ii) By children between the ages of 1 and 5 years—30,284. (d) Total number of children who attended at the Centres for the first time during the year— (i) Children under 1 year of age—1,930. (ii) Children between the ages of 1 and 5 years—529. (e) Total number of children who were in attendance at the Centres at th« end of the year. (i) Children under 1 year of age—1,437. (ii) Children between the ages of 1 and 5 years—3,742. Total number of children who attended the Centres during the year— (i) Children under 1 year of age—1,556. (ii) Children between the ages of 1 and 5 years— 4,160. (f) Percentage of notified live births, represented by the number in (d)(i)—73.0 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—3,551. (d) Total number of expectant mothers who attended at the Clinics during the year—1,337. (e) Percentage of total notified births (live and still) represented by the number in (d)—49.1. Other Clinics additional to above-mentioned. Total Attendances. Average Attendance per session. C. &V. Artificial Light Clinics 13,536 16.7 C. & V. Dental Clinics 2,584 13.4 C. & V. Sewing Classes 3,030 33.0 V. Remedial Exercises Clinic 1,207 12.8 V. Mothers'Clinic (Post-natal) 440 9.5 V. Garden Clinic 2,282 — C.—Council. V.—Voluntary. * Including Ante-natal Clinics provided at institutions transferred to the Council under Part I of the Local Government Act, 1929. 113 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 Nil. Nil Nil Number of maternity beds Nil. Nil Nil Total number of women admitted to these beds during the year Nil. 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 Institutions 1 Nil 1 Number of beds provided for such children 11 Nil 12 6 for Observation Ward, 6 for Tonsillectomy. Total number of children admitted to these beds during the year Children remaining, 31.12.31, 10; admitted, 1932, 63. Nil 202 59 for Observation Ward, 143 for Tonsillectomy. II. Number of such children (if any) sent by the Council during the year to other Institutions—Nil. 114 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, 29; Mothers, 2; Children, 21. (e) Sent by Voluntary Associations—Mothers and babies, 15; Mothers, 3; Children, 30. 9. Homes for Mothers and Babies. (a) Number of such homes— (i) Provided by the Council—Nil. (ii) Provided by Voluntary Associations—Nil. (b) Number of beds in homes— (i) Provided by the Council—Nil. (ii) Provided by Voluntary Associations—Nil. (o) 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—- Nil. 115 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 27 27 10 9 (2) Pemphigus Neonatorum 7 Not notifiable, Reported cases 7 3 (3) Puerperal fever 9 9 — 9 (4) Puerperal pyrexia 28 28 3 27 (5) Measles and german measles (in children)— Under 5 years of age 939 939 21 225 Over 5 years 495 Not notifiable, Reported cases 495 2 39 (6) Whooping cough (in children under 5 years of age) 322 Not notifiable, Reported cases 322 1 39 (7) Epidemic diarrhoea (do.) 67 67 6 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; 69 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 during the year in which the Council paid or contributed to the fee of a midwife—22. (d) Compensation paid to midwives when cases were referred to Hospital—16. 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—6. (ii) From other causes—6. (b) Number of these cases which died— (i) At home—2. (ii) In institutions—10. 116 Miss J. M. Cardozo, Chief Health Visitor, reported as follows- Home Visiting.—As usual, this branch of our work is the first line of attack. Visits to expectant mothers totalled 2,217. Every effort was made to see that each mother attending the Ante-Natal Clinic kept the appointment made for her at the Clinic, and this was only possible through regular and systematic booking and visiting. At the request of the Lady Almoners of various London Hospitals, homes of expectant mothers were visited and reports given. Visits were paid in addition to the expectant mothers who were slow to book or who did not wish to attend the AnteNatal Clinics. This work of following up "difficult" mothers entails a lot of additional visits and takes up much time, but we feel it is so important that visits are paid until the confinement takes place. It is obvious that there are still mothers who do not yet realise the importance of regular medical supervision for their children. These mothers do not recognise the first signs of rickets or faulty posture, or other errors which, if dealt with at a very early stage, can be remedied and so save months of ill-health for the child and many journeys to hospital for the mother. It is only by visiting that these difficulties can be overcome. Clinics. Ante-Natal.—The attendances have increased, although the number of births is less and the number of mothers confined in Institutions outside the Borough has increased. 972 reports, referring to 486 mothers, were sent by the Clinic Medical Officers, through the Public Health Office, to midwives re mothers to be delivered by them in the Borough. 16 cases were referred by the Clinic Medical Officers to hospitals for confinement owing to abnormality. 525 reports were sent by the Clinic Medical Officers, through the Public Health Office, to St. Andrew's Hospital. Of this number 50 referred to abnormal cases. Infant Consultation.—The large attendance at all Clinics make the work difficult for both the staff and the mothers. Very little teaching 117 can be done where there is such a large number to deal with. The extra session at Wellington Road started on November 10th has already relieved things where the average attendance for the year was 94 per session, but at Old Ford, with an average of 83.9 and inconvenient premises, it is only possible to carry on to the best of our ability and hope for better accommodation as soon as possible. Health Talks, Sewing Class.—Still a valuable part of the Maternity and Child Welfare Scheme. Useful garments were made and talks given on various subjects, amongst which were "Home Budgets" and "Suitable Diets for Children and for the Family," practical demonstrations being given and the prices and food values of articles purchased locally discussed. These talks are excellent for the mothers who attend, but it must be remembered that this information is just as valuable for the mothers who, for various reasons, cannot get away, again demostrating the importance of Home Visiting. A booklet issued by the Public Health Department contains among other things suitable diets for children up to the age of five years, and a special pamphlet on Diets is issued. The co-operation of the Royal College of St. Katharine is a great asset to work, for by this means the various activities on behalf of the mother and child are drawn together and uniformity of advice and treatment is made possible. Thanks are due to the various Associations which have kindly given grants towards the cost of dentures, and to the many friends who have sent clothing for the Jumble Sales and new woollies for the children, and donations for the fund for Christmas Tea and parcels. 118 STATISTICAL SUMMARY OF HOME VISITING FOR 1932. Public Health Department. The Royal College of St. Katharine. Total 1932. Total 1931 Cases. Visits. Cases. Visits. Cases. Visits. Cases Visits. Ante-Natal:— No. of Cases 769 — 598 — 1,367 — 1,332 — Primary visits — 769 — 598 — 1,367 — 1,333 Re-visits — 1,448 — 1,783 — 3,231 — 2,995 Infant Child Welfare visits:— Primary visits (Infants) — 1,237 — 1,186 — 2,423 — 2,576 Removed before visit — 51 — 28 — 79 — 65 Died before visit — 25 — 26 — 51 — 67 Stillbirths — 37 — 32 — 69 — 88 Re-visits— Under 1 — 7,669 — 9,440 — 17,109 — 19,187 1—5 — 18,503 — 21,591 — 40,094 — 41,682 Removed — 508 — 784 — 1,292 — 1,279 Died — 74 — 81 — 155 — 219 † Ophthalmia Neonatorum:— No. of Cases notified 27 — — — 27 — 37 — Primary visits — 27 — — — 27 — 37 Re-visits — 52 — — — 52 — 76 Removed to Hospital 9 — — — 9 — 1 — Enteritis:— (a) No. of Cases reported.. — — — — — — — — (b) No. of Cases notified (Z-E.) 24 — 43 — 67 — — — (a) Primary visits — — — — — — 57 — Re-visits — — — — — — — — Removed to Hospital — — — — — — — — Died — — — — — — — 57 (6) Primary visits — 24 — 43 — 67 — 84 Re-visits — 27 — 91 — 118 — — Removed to Hospital — — — — — 7 2 Died — 5 — 1 — 6 — — Measles:— No. of Cases under 5 years 534 — 405 — 939 — 539 — Primary visits — 534 — 405 — 939 — 532 Re-visits — 158 — 105 — 263 — 272 Removed to Hospital 260 — — — 260 —— 136 — Died — 23 — 7 — 30 — 2 Total visits— — Children over 5 years — 371 — 124 — 495 — 312 Whooping Cough:— No. of Cases 166 — 156 — 322 — 804 — Primary visits — 166 — 156 — 322 — 804 Re-visits — 50 — 95 — 145 — 296 Removed to Hospital — — — — — — 104 — Died — — — 2 — 2 — 8 fPuerperal Fever:— No. of Cases notified 9 — — — 9 — 15 — Primary visits — 9 — — — 9 — 15 Re-visits — 20 — — — 20 — 44 Removed to Hospital 9 — — — 9 — 14 — Died:— 4 (a) Notified Cases. — 4 — — — 4 — (6) Non-notified Cases — 2 — — — 2 — — † Puerperal Pyrexia:— No. of Cases notified 28 — — — 28 — 23 — Primary visits — 28 — — — 28 — 23 Re-visits — 49 — — — 49 — 27 Removed to Hospital 27 — — — 27 — 22 — Died — — — — — — — — Maternal Deaths (enquiries) 12 — — — 12 — 7 — Maternal Deaths:— Primary visits — 12 — — — 12 — 7 Re-visits — 52 — — — 52 — 32 Miscellaneous Visits — 1,899 — 682 — 2,581 — 772 Total Visits:— Primary — 3,290 — 2,598 — 5,888 — 5,380 Re-visits — 30,543 — 34,662 — 65,205 — 67,531 Total Visits paid, 1932 — 33,833 — 37,260 — 71,093 — — Total Visits paid, 1931 — 33,381 — 39.530 — — — 72,911 * Zymotic Enteritis is notifiable from 1st June to 30th September. † All eases are visited by Health Visitors of the Public Health Department. Enquiries re Maternal Deaths are made by the Public Health Department 119 The following table shows the attendances at each of the Clinics during the year 1932:— Bow West Ferry Road. Manchester Road. Simpsons Road. Weilington Road. P.H. Dept. Total. Royal College of St. Katharine Total. Ante-Natal Clinics:- Attendances 854 — — 802 300 1,956 1,595 Average per session 16.4 — — 16.7 11.5 15.5 31.2 Dble session. Infant Consultations:- First attendances 411 169 188 339 279 1,386 1,073 Average per session 8,639 4,423 7,474 7,991 5,639 34,166 21,784 Average of attandance of each child 83.9 85.0 71.9 76.8 94.0 80.8 84.7 Light Clinics:- 11.1 9.8 11.7 10.8 10.8 10.4 — Attendances — — — 4,531 5,461 9,992 Average per session — — — — 19.0 — Dental Clinics:- Attendances — 1,171 1,171 — Average per session — — — 15.6 15.6 — Sewing Class — — — 882 — 882 — Garden attendances — — — — — Mothers' Clinic Natal) — Remedial Clinic — — — — — — — T°tal attendances at all Clinics:— 1932. 1931- P. H. Department 48,167 42,340 Royal College of St. Katharine 35,413 34,275 Total 83,580 76,615 Sale of Food Accessories, etc. 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 120 £ s. d. Dried Milk, 5,751 lbs. 431 6 6 ,, ,, Humanized, 285 lbs. 28 10 0 Aberdeen Emulsion 10 2 7 Dusting Powder 1 6 0 Medicinal Paraffin 6 10 0 Medical Sundries 6 17 5 Dentures 75 9 6 Materials at Sewing Class 16 14 7 Convalescent Treatment 7 7 6 Virol 19 16 9 Oil and Malt 95 15 1 Concentrated Food 27 8 6 Payments for Gas (Dental Clinic) 3 19 6 Accouchement Sets 18 9 0 Cod Liver Oil 11 12 9 Total £761 5 8 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. 1,600 such vouchers were issued during the year. Convalescent Treatment, etc. Convalescent Treatment (mothers with babies) 29 cases. ,, ,, (mothers alone) 2 ,, ,, ,, (children under 5 years) 21 ,, Payment of Midwives' fees 22 ,, Compensation to Midwives 12 ,, Loan of maternity bag, containing clothing, etc 25 ,, Grant allowed for Accouchement Sets 59 ,, [The following tables refer to the whole Borough.) Statistics Respecting Infants Born in 1931. All births, including those occurring in outlying districts, but belonging to the Borough 2,893 Doctors in attendance 420 Midwives in attendance 1,220 Delivered in institutions 1,220 Not stated 33 Moved into Borough 108 3,001 121 Stillborn (Stillbirths per 1,000 births, 30.6) 88 Died before visit 58 Not requiring or desiring visits 64 210 Visited 2,791 Removed within the year 367 Died during visitation 139 506 Remaining under supervision end of first year 2,285 Mortality per 1,000 visited 49.8 The 2,285 children visited during 1932 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 73.9 percent. Mixed feeding 19.1 ,, Hand-fed 7.0 ,, The 139 children who died during the first year of life, were fed during the first six months of life as follows:— Breast-fed 45.3 per cent. Mixed feeding 31.7 ,, Hand-fed 23.0 ,, Below is a statement comparing the mortality rates per 1,000 visited of children fed by the various methods:— (a) Babies breast-fed 36 (b) ,, who received mixed food (breast and hand) 92 (c) ,, hand-fed 167 Stillbirths. (This refers to the whole Borough.) 82 Stillbirths were investigated during the year 1932. Number of Stillbirths 82 Doctors in attendance 14 Midwives in attendance 20 Delivered in Institutions 45 B.B.A 3 122 Ophthalmia Neonatorum. Twenty-seven cases of Ophthalmia Neonatoium 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 — — — 1932 27 18 9 27 — — 1 Total 923 820 102 898 7 1 17 ** 1 born in Institution—not viaited, no information available. * Including 3 which occurred in Institution. Cases Notified and Visited. Number of notifications received 27 Very slight cases 22 Died in Institutions (intercurrent disease) 1 Sight of one eye damaged — Recovered 26 Occurred in Institutions 5 Occurred in the practice of medical practitioners 3 Occurred in the practice of midwives 19 Admitted to hospital as in-patients 4 Treated as hospital out-patients 4 Treated privately 17 Visited by nurse 10 123 Zymotic Enteritis.—Notifiable June-September. (Whole Borough). Notifications received (Patients under 5 years) 67 Under 1 year (see feeding below) 30 1 to 2 years 19 2 to 3 years 9 3 to 4 years 7 4 to 5 years 2 Died before notification received 3 Visited 67 Treated in hospitals 7 Of the 30 cases of Zymotic Enteritis under 1 year of age which were notified, 5 died. All were hand-fed. The remaining 25 were fed as follows:—Breast-fed, 10; mixed feeding, 6; hand-fed, 9. Home Nursing. By arrangement with the Nursing Associations nursing is provided (with the consent of the practitioner attending a patient) and paid for by the Council at the rate of 1s. 3d. per visit, in cases of Ophthalmia Neonatorum, Measles, Whooping Cough, Pneumonia, Zymotic Enteritis, Pemphigus, Puerperal Fever and Puerperal Pyrexia. The following is a summary of visits paid by Nurses during 1932:— (This table refers to the whole Borough.) E.L.N.S. St. John Divine. St. Mildred's District Nurse. Totals. Cases Visits. Oph. Neon. Cases 9 1 10 - Visits 180 — 7 — 187 Measles Cases Under 5 14 4 3 21 — 5-10 1 1 2 — Visits Under 5 206 42 13 261 5-10 9 10 — — 19 Pneumonia Cases Under 5 16 5 2 23 — 5-10 7 1 8 — Visits Under 5 250 87 45 382 5-10 165 10 —— — 175 Pemphigus Cases Visits 3 52 — — 3 52 WhoopingCough Cases Under 5 1 1 Visits Under 5 18 — — — 18 Zymotic Enteritis Cases 6 6 Visits 104 — — — 104 Puerperal Pyrexia Cases 2 1 3 Visits 18 — 11 — 29 Totals Cases 59 11 7 77 Visits 1002 149 76 1227 124 The following table relates to visited children of ages 1 to 5 years:— Year of Birth. 1927. 1928. 1929. 1930. Remaining under supervision: End of first year — — — 2,543 ,, second year — — 2,363 — ,, third year — 2,286 — — ,, fourth year 2,308 — — Inward Transfers 70 89 77 107 Visits discontinued 1 — 3 2 Outward Transfers 167 157 205 260 Died 11 14 23 40 Remaining under supervision: End of second year — — — 2,348 ,, third year — — 2,209 — ,, fourth year — 2,204 — — ,, fifth year 2,199 — — — Mortality per 1,000 visited: Second year — — — 15.1(17.9) Third year — — 9.4 (4.8) — Fourth year — 5.9 (4.0) — — Fifth year 4.6 (2.0) The figures in parentheses are the rates for the previous years. Co-operation with the Education Authority. 2,199 case sheets relating to the children who have reached the age of 5 years were forwarded to the Education Department. 1,686 special reports were also forwarded regarding children attending school, not yet 5 years of age. 125 Maternal Deaths.—The Council agreed that the investigation of maternal deaths should continue to be carried out on the lines suggested by the Ministry of Health. There were 12 maternal deaths, and the mortality rate was 4.07 per 1,000 total births (live and still). Cause of Death. Attended at home by Treated in Institution. Number of previous Pregnancies. Received Antenatal Care or Treatment Remarks. Puerperal Sepsis, 6 cases— *1. Peritonitis; Pelvic abscess; Pelvic haematoma due to tubal abortion. — Yes 2 No Tubal abortion 2. Septicaemia from premature labour induced by falling at her house Doctor Yes 5 No Miscarriage 3. Septicaemia; Septic endometritis Midwife Yes — Yes Child alive *4. Septicaemia; Abortion Doctor Yes 1 No Miscarriage 5. Puerperal septic intoxication — Yes — Yes Child alive 6. Septic pneumonia following abortion and septic infection of unknown cause Doctor Yes 7 No Miscarriage Other causes, 6 cases— 1. Antepartum haemorrhage; Placenta praevia Midwife Yes 5 No Stillbirth 2. Haemorrhage following miscarriage Doctor No 9 No Miscarriage 3. Eclampsia — Yes — No Miscarriage 4. Post-partum haemorrhage Doctor No 2 No Child alive 5. Obstetric shock; Excessive development of foetus; Instrumental delivery — Yes — Yes Stillbirth 6. Paralytic ileus; Caesarean section; Disproportion — Yes — No Miscarriago * The first intimation of these cases was the death return from the Registrar. Cases of septicaemia following abortion are regrettably on the increase, and investigation into these cases proves most unsatisfactory, as reliable information is very difficult to obtain. In cases where interference with the normal physiological process is suspected the patient, while in hospital, gives little or no information which will assist in the investigation. 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 (see page 89). 126 During the year 1931 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. 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 three 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. (During 1932 Consulting Obstetricians were called for on two occasions.) The number of patients seen at St. Andrew's Hospital (as mentioned in paragraph 3) was as follows:— (a) Referred by private practitioners 9 (b) Referred by clinic medical officers 11 20 In addition to the above, in the year 1931, the Council decided to supply sterile maternity outfits at cost price or at half-price, according to family incomes. 127 Infantile Mortality.—The infantile mortality rate (63) is considerably lower than the figure for the previous year and does not call for special comment. Ambulance.—During the month of August, 1931, 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. Payment was made by the Borough Council for the removal of 10 non-urgent cases during the year 1932. Strident Health Visitors. During the year five Health Visitors of the Royal College of Nursing have been given a course of practical training. Post-Graduate Course. Two Health Visitors attended a Post-graduate Refresher Course during the year. The Observation Wards, Wellington Road. During the year certain improvements have been effected. The ground where the cots stand has been paved; the Borough Surveyor has arranged for grass seed to be sown in the garden at the rear; and through the kindness of one of the members of the Committee some fruit trees have been planted. Training of Probationers. As in previous years lectures have been given by the Matron, and the Probationers have also attended the Courses arranged by the National Society of Day Nurseries. Report of Dr. H. St. H. Vertue, Consulting Physician at the Maternity and Child Welfare Observation Wards. The past year at Wellington Road has been an exceptionally busy one. The number of cases admitted has been greater than that in any previous year, and there was a bigger proportion than usual of babies that were difficult and very delicate. During late winter and early spring there was a prolonged drought, with a practically unbroken spell for many weeks of hard, dry, cold east winds, which have such a deleterious effect 128 on fragile human beings. It was necessary for the medical staff to devote much care to these tiny scraps of life and for the nursing staff to put forward all its powers. The results were highly satisfactory in almost all cases. Very good results were obtained by importing breast-milk for wasting artificially-fed babies. Some of it was supplied by our mothers living near the Wards, some was kindly sent by our neighbour the Royal College of St. Katharine, and a considerable amount was obtained from one of the great hospitals. There is no doubt that several lives were saved by this means. Other cases, less severe, or at times when breastmilk could not be obtained, needed very careful artificial feeding. But with three exceptions all were gradually coaxed on to feeds on which they were able to gain weight; all were kept in the Wards until they were in a strong condition with sound digestions, and all were finally sent home with directions for feeding that their mothers could easily carry out. It was highly pleasurable to see some of them return some months later for inspection in excellent condition, having maintained at home the progress they had begun in the Wards. The three exceptions require notice. One child was transferred to hospital, when we were very hardpressed and there was illness among the staff; one, I regret to say, resisted all our efforts to get him well, and another also succumbed. But this last was never any more than a forlorn hope; he was almost at death's door when admitted, having only recently come out of hospital and relapsed alarmingly when he had got home. It was deemed too risky to send him on the journey back to hospital again and he was taken in and every effort made to revive him. The feeble flame of life flickered for three days and then, to the bitter disappointment of everyone, went out. It is some satisfaction to know that nowhere would he have received more devoted care than at Wellington Road, and nowhere would he have stood a greater chance of survival. The summer was warm and genial and there were unlimited opportunities for administering fresh air and sunshine, which, when all is said, are the best medicines. I append now a list of In-patients, and diagnoses:— Dyspepsia and Failure to Progress in Artificially-fed Infants 19 Marasmus 4 Coeliac Disease 1 Malnutrition 19 129 Debility after an Infection 4 Rickets 6 Food-refusal 7 Nervous Unrest 1 Difficulty in Breast-feeding 1 62 Marasmus and Coeliac Disease are severe forms of wasting. The group called "Malnutrition" consisted of children in the "toddling" stage, over a year old, who were remarkable for being under-nourished, thin, flabby, pallid, catarrhal, and generally the owners of very weak digestions. This group of children always does very well in the Ward, and last year was no exception. The change in their appearance is generally quite dramatic: they generally gain immense amount of weight, and with improvement in health comes improvement in temper and spirits. The results obtained among the in-patients are as follows:— Recovered 54 Improved 1 Transferred to Hospital 1 Died 3 Removed by Parents 3 62 These results are in reality the tale of many difficulties surmounted and anxieties overcome; nevertheless, this year we hope to do better still and see neither of the last two headings. It may be mentioned that the third death occurred in a "toddler" afflicted with the form of degeneracy called Mongolism. The victims never reach adult life, seldom go beyond the age of seven, and usually die in infancy. Twenty-eight old cases presented themselves for inspection. The results showed great credit to the mothers:— In very good health and condition 19 In good health and condition 7 In moderate health and condition 2 28 No child inspected was in a bad state. 130 Out-patients. Total number of Attendances at Special Clinics 319 Total number of New Cases 132 Attendances for Test-feeding and Re-establishment 459 Among the new cases were a number that came up for admission to the Wards. These having been seen and examined, were put on the waitinglist and admitted as soon as a vacancy occurred. There was a number also that came up for a consultation. They were sent up by the Clinic Medical Officers with a request for an opinion on some point. A single consultation was usually enough. The rest were principally difficulties in breast-feeding and bottle-feeding. Cases for Admission 55 Single Consultations 16 Difficulty in Breast-feeding 51 Difficulty in Bottle-feeding 8 Miscellaneous 2 132 Dealing with the breast-feeding cases annually forms a large paaart of the work of the Observation Wards. To those who understand the immense value of its natural food to an infant, it is also a mostimportant part. Time and trouble spent in re-establishing breast-milk on a placing a mixed diet of breast-milk supplemented by cow's milk on a firm basis and preventing a waning yield of milk from disappearing are never thrown away. The results were:— Breast-fed only 24 Partial Breast-feeding 15 Bottle-feeding only 2 Transferred to Hospital 1 The child transferred to hospital was suffering from Pyloric Stenosis. There were a few who did not complete their attendances. The proportion in which breast-feeding was re-established is seen to be high. The bottle-fed babies all recovered, and none presented any great difficulty. In conclusion, I wish to express my warm gratitude to the Nursing Staff for the splendid way they have worked, the excellence of their nursing, and the happy and harmonious spirit among them. H. ST. H. VERTUE. 131 Artificial Sunlight Treatment. Dr.E. M. Layman, the Medical Officer in charge of Artificial Sunlight Treatment, has submitted the following interesting report:- I have pleasure in submitting my report on the Light Clinics for 1932. I reports on 396 children, the remaining few having attended five or six times at most. I could not pronounce on the effect of the treatment without longer observation on these'. For lassification the children fall into the following groups:— 1. Rickets 63 Cases. 2. Disturbed Dentition 133 ,, 3. Delayed Dentition 15 ,, 4. Malnutrition 46 ,, 5. Debility 62 ,, 6. After illness 20 ,, 7. Bronchitis 10 ,, 8. Various 20 ,, Rickets.—Eight were cases of muscular rickets, which responds extremely well to treatment. The rest were skeletal or mixed forms, of various degree of severity, including a few cases of badly deformed bowed legs. Of the 63, 51 successes, 7 were moderate successes, 5 were poor attenders. Rickets call for much patience on the part of the mothers, as the course usually must be a long one and each treatment with U.V.R. is preceded by exposure to red light. Results (in cases of bowing of legs, for example) are so encouraging that most of the mothers in this group have persevered admirably in devoting the necessary time. I am greatly the results in the Rickets group, both as to the bony and muscular systems and as to the improvement in general health of the 2 Disturbed Dentition.—A group only second in importance to Rickets. Various disorders are included, some children arriving for treatment in a very low state of health. Nervous excitability, exhaustion from broken sleep, catarrh and complete loss of appetite are common and often occur simultaneously. I find U .V .R. of great value during morbid teething and markedly so for its sedative effect on the restless wakeful children. 132 Of the 133 cases, 101 were successes, 19 moderate successes, 2 failed to respond adequately, 11 were poor attendances. 3. Delayed Dentition.—Of the 15 cases, 8 were successes and 7 moderate successes. 4. Malnutrition.—Of the 46 cases, 28 were successes, 10 moderated successes, 5 failures and 3 were poor attenders. 5. Debility.—Of the 62 cases, 24 were successes, 20 moderated successes, 2 failures and 15 were poor attenders. Certain children arrive at our Light Clinic who are obviously suffering from one or both conditions in groups 4 and 5. The various producing these states are beyond our clinical control, but we find a pleasing proportion of the cases definitely improved, and often restored to normal spirits and behaviour after previous languor and misery. One or two marked successes in putting on weight have also occurred- 6. After Illness.—Of the 20 cases, 16 were successes, 2 moderate successes, and 2 were poor attenders. 7. Bronchitis.—Of the 10 cases, 5 were successes, 4 moderate successes, and 1 failed (sent to hospital). 8. Various Disorders.—These include Adenoids, fretfulness, Prematurity, etc., unclassifiable, but important and interesting individually. I find, as might be expected, that enlarged tonsils and adenoids, if severely obstructing, retard the child in spite of U.V.R. (or any other treatment), but that slight cases benefit greatly by U .V ,R. and sometimes can thereby avoid operation. A case of birth injury improved considerably during a long course. In this case there was no mental defect, but slow co-ordination of movements. Slow development was to be expected and this has gone I think the child's interest and vigour was aided by U.V.R. Poor A ttendances .—These are not quite so unsatisfactory as they look on paper. A certain proportion have excellent reasons for failing to continue attendance, though they have to be classed with the disappointing 133 ones. Some mothers, however, still withdraw their children after a week or two, because they have noted improvement and thinking no more need be done. We are doing our best to forestall this mistake. Mothers.—45 mothers attended, not all classifiable, but several for debelityduringpregnancy, some for exhaustion during lactation, some after illness and a few who could well be considered ill-nourished and debilitated A good many completed a course of 12 to 20 or more exposures All who did so benefited and one or two markedly improved in every way. One mother with psoriasis having failed to obtain relief from hospitals, took a long course of U.V.R. with complete success, the skin trouble disappearing. Several mothers were able to come for six or eight exposures and obviously benefited. I recognise that poor attenders among mothers were for the most part the victims of circumstance, having, in fact, no time to give for their personal treatment. We would be glad, however to extend our work to fresh mothers. I think many within reach might come with benefit who have never thought of seeking treatment for themselves. I cannot express in a word how much the Department owes to the Sister-in -Charge for her unfailing good work during the year, as in previous years. I should like to record my thorough appreciation of it in all its aspects. E. M. LAYMAN. Statistical Summary. January 1st to December 31st, 1932. Bow. Poplar. Totals. Number of attendances 5.461 4.531 9.992 " " sessions 288 241 529 " '' Patients 288 261 549 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 reports:- 134 I beg to submit my report of the work carried out at the Dental Clinic in connection with the Maternity and Child Welfare Department for the year 1932. 75 Sessions have been held at which we have had 1,171 attendances, an increase over the previous year as far as attendances are concerned. with the number of sessions reduced by one. This increases our average attendance from 14 to 15.5 per session. 79 Fillings. 133 Scalings. 1,072 Permanent teeth have been extracted. 1,232 Temporary teeth have been extracted. Dentures have been fitted, dressings and minor treatment have been carried out. 386 new patients have been seen—a lower number than the previous year. On the whole the year's work has been very satisfactory and shows every sign of continuing so. Referring to last year's report, it will be recollected that I called attention to cases which have to be postponed on account of the pregnant condition of the mothers. This is still rather a problem. When a case has been left in abeyance for, say, three months, it is sometimes difficult to raise sufficient keenness on the part of the patients to ensure their attendance when suddenly sent for. I am of the opinion that, unless the patient is definitely in pain, or the mouth is really septic, it would be better if she were not sent Dental Clinic until the child is born. In other words, it is better to get on with the work as soon after the patient's initial visit as possible than to have to give the patient a long period in which to contemplate a rather dreaded ordeal. Our equipment and premises continue to give every satisfaction, and I should like to record again my great appreciation of the co-operation of the staff. C. HAMMOND WILLIAMS L.D.S., R.C.S- (Eng.). 135 The Royal College of St. Katharine. Report of the Senior Medical Officer. The Circular (1290) issued by the Ministry of Health on October 22nd 1932 headed ''Nutrition," and calling attention to the results of recent research work, has been acted upon in this Borough. Dried milk containing iron has been acted available for bottle-fed babies, and a supplied free in the Circular citrate for the breast-fed. Cod liver oil is The advice in for those who cannot buy it, and at cost price for others. The advice in the Circular implies that nutritional anaemia, and rickets in its milder forms are sufficiently prevalent for it to be simplest to take their occurrence for granted to prescribe prophylactic measures for Recommendations as to the diet of expectant and nursing mothers are also given; and cod liver oil is advised in cases where Calcium and Vitamin D deficiency suspected. A fall in the incidence and severity of dental caries is looked for in the children through an improvement in the health of their mothers. The last point mentioned is the need to ensure adequate milk in the diet of the growing child. In the Clinics here we have often identified cases of anaemia and referred them for treatment, particularly in twins and premature babies; but we had not suspected it to be anything like so prevalent as Dr. Helen Mackay's findings imply- A much more careful search was started when her paper was published, and the first impression gained is that it is very difficult, if not impossible, to make anything near a correct guess at the degree of anæmia by ordinary inspection. A haemoglobin count as low as 50-60 per cent. is not reliably shown in the tint of the skin or mucous membranes; and one of 80—85 per cent. may exist in a child whose pallor suggests a much lower level. This goes far to explain how easy it is to overlook the condition, and since haemoglobin estimation is not possible in more than a small proportion of babies seen in the Clinics, the mass prescription of iron offers the best hope of security. So far the response to iron seems to be variable, but it is possible that lack of regular administration accounts for some of this; or that all are not instances of simple nutritional anaemia. The definition of rickets, in its early stages and in a mild degree, we have always held to be a difficulty, especially when a large number of babies is under review, when many problems of upbringing also have to be considered first detection of head sweating, failure of muscle 136 tone and pallor has been taken as sufficient to call for active treatment; beading of the ribs and bossing of the skull bones seem less easy to be sure about. Even so, none of these signs are unequivocal, and instances of rickets are frequent, particularly a type which develops quickly towards the end of the first year. They give support to the view that general prophylaxis is the best plan. The experiment is being made of giving a short printed leaflet on diet to all expectant and nursing mothers. The Circular thus is really a call to apply certain preventive measures on a wide scale and marks an interesting step linking experimental work with public health administration. Next to deficiencies of diet, the overcrowded rooms in which so large a proportion of the children have to spend their infancy are nearly as great an enemy to health. The improvement in a baby that follows several hours' regular outing every day is often as dramatic as anything that can be seen in medicine. Yet, as things have existed hitherto, it may be the hardest remedy for the mothers to apply. Some cannot do more than take the baby out for the short daily journey to the shops. Rules confining the use of the backyard to the ground floor tenants are rigidly enforced, and if they are relaxed often enough the favour is not easy to accept. The hopes aroused by recent plans to start rehousing will see little good result to young babies in their first two years of life, if this point is not taken into account. The remedy lies in the provision of a small open balcony to every dwelling, whether house or flat. It could be made of iron and the cost would be small, for something large enough to contain a cradle is all that is needed. If the Borough Surveyor were given power to insist on this small addition being included in every plan, the balcony being on the south or west aspect wherever possible, the general improvement in infant health would be incalculable. H. K. WALLER, Senior Medical Officer. 137 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. The economic depression with its consequential increase in unemployment is reflected in the large increase in the number of applications. Through the operation of the block grant system the whole of the additional cost has to be met by the Borough Council. During the latter part of the year the Council, upon the recommendation of the Maternity and Child Welfare Committee, agreed that it be a condition of the supply of free milk that unless prevented on medical grounds, all recipients should be seen at regular intervals at their nearest Maternity and Child Welfare Centre. During the 52 weeks ended 31st December, 1932, 14,914 applications for free milk were received, of which 13,213 were granted. (The number of persons granted milk was 17,461.) Orders were issued for 73,512 pints of Grade "A" (Tuberculin Tested) milk, and 60,094 pounds of Dried Milk, the total commitments amounting to approximately £5,459. Six hundred and thirty-three (633) cases were investigated by the Enquiry Officer, and all were reported satisfactory. "A." "G." lbs. lbs. Dried Milk distributed at Clinics (including the Royal College of St. Katharine) 47,720 1,728 Distributed at Public Health Office 7,504 — Total 55,224 1,728 138 The following table shows in comparative form the applications, etc., during the years 1920-32:— Year. Applications. Applications granted. Cost (approx) £ Orders issued. Cases investigated by I.O. (6). Unsatisfactory cases. Fresh. (Pints). Dried. (Lbs.). 1920 (a) ? 17,095 ? 873,585 3,454 1921 (c) 23,799 18,270 14,500 782,012 1,236 1,611 107 1922 18,082 16,215 8.500 621,796 1,664 2,969 15 1923 15,537 14,086 6,600 512,614 3,230 2,974 34 1924 14,828 13,597 6,150 487,070 4,902 2,922 14 1925 12,475 11,358 4,994 410,587 3,727 1,633 9 1926 12,928 11,905 7,249 426,762 2,917 593 6 1927 11,702 11,117 5,961 294,515 16,896 598 10 1928 8,449 7,772 3,090 11,639 40,909 343 2 1929 6,849 6,146 2,471 16,810 30,729 588 — 1930 7,216 6,693 2,820 28,247 33,147 610 2 1931 10,562 8,816 3.718 57,736 39,366 656 1 1932 14,914 13,213 5,459 73,512 60,094 633 Notes.—(a) In 1920, 49 tins of condensed milk were also issued; (6) the Enquiry and Investigation Officer commenced duty in March, 1921; (c) by Circular 185, dated 31st March, 1921, children between the ages of 3 and 5 years are only allowed milk upon a special medical certificate. Nutritional Anaemia, Rickets, etc. The Maternity and Child Welfare Committee considered the Ministry of Health Circular No. 1290, which was issued in October, 1932, and after a report from the Medical Officer of Health recommended the Council to supply special dried milk containing iron (or iron solution in addition to Grade "A" Tuberculin Tested Milk) in cases which were specially recommended by the Clinic medical officers. The Committee also approved of the supply of cod liver oil in 4-ounce bottles to recipients of free milk on the recommendation of Clinic medical officers. The issue of iron solution and cod liver oil was commenced in February, 1933. 139 APPENDIX. Bug Infestation. The Public Health Committee, at their meeting in June, received the following report of the Medical Officer of Health upon bug infestation:— To the Chairman and Members of the Public Health Committee. Re Bug Infestation. The Medical Officer of Health submits the following report on Bug Infestation. Bug infestation of dwelling-houses is not a new condition; it has been the cause of complaints for many years. Now that the Council have become owners of many dwelling-houses— converted premises, as well as new buildings—their responsibilities have increased, and the problem of dealing with this nuisance has to be considered from an owner's point of view, as well as from that of a Local Sanitary Authority. In London, bug-infested houses are dealt with mainly under section 10 of the London County Council (General Powers) Act, 1922, sub-section 1 of which states:— ''10.—(1) Where it appears to any sanitary authority on a report from their medical officer of health that any house or part thereof in • their district is infested with vermin such authority shall give notice in writing to the owner or occupier of such house or part thereof requiring him within a period to be specified in such notice to cleanse such house or portion thereof specified in the notice, and if so required in the notice to remove wall paper from the walls of such house or portion thereof and to take such other steps for the purpose of destroying and removing vermin as the case may require.'' On the receipt of a complaint of "bugs," as a rule an inspection is 1 made and an Intimation served on the owner. If necessary, the bedding i is steam disinfected and the rooms sprayed. A fluid disinfectant 140 (Solution "D") is issued at the Disinfectant Distributing Depots on the presentation there of a requisition from a Sanitary Inspector, and sprayers are occasionally loaned to tenants to assist them in dealing with the nuisance. In July, 1929, when submitting the Lady Sanitary Inspector's Quarterly Report on Council houses, the Medical Officer of Health, in an introductory statement, drew attention to bug-infested premises, and, among other things, he then said:— ' 'The destruction of bugs in occupied premises is one of the most difficult problems with which a Public Health Department is confronted. This is due to the life history and habits of the bug. The most powerful disinfectants can only be effective if and when they are applied directly to the bug so that the mere spraying of the surface with solution "D," or any other disinfectant, whilst doing a certain amount of good, cannot be expected to be a remedy.'' To enable the Committee to appreciate-more fully the difficulty in ridding premises of bugs, the following brief outline of the habits and life history of the bed bug, together with a reference to some of the remedies which may be used is given. Habits. Although bed-bugs are usually associated with old and dirty premises, they are occasionally found, in spite of all precautions, in houses which are kept scrupulously clean. Bed-bugs, although unable to fly, walk rapidly and can migrate from one house to another, passing along crevices in walls, pipes, and electric light wires; they may also be introduced with boxes and clothing, which have been left standing in a bug-infested place. It is stated that a bug can travel a considerable distance in order to suck its victim's blood, returning later to its resting place. The bed-bug is nocturnal in its habits. During the day it lives in crevices and cracks of all kinds. It is found in and behind woodwork, walls and floors of rooms; behind wainscoting and loose wall-paper frequently near a bed. It may also be discovered actually in the framework of the bed itself. At night these insects come out in search of food— which is the blood of warm-blooded animals—particularly that of man, although it is stated they will also feed on the blood of rats and mice. It is important to note, however, that they are able to live for quite long periods without food. 141 The offensive odour of bed-bugs is due to the presence of stink-glands. Life History. The female bed-bug deposits batches of small white eggs, about a millimeter long, in cracks and crevices, one female laying from 1 to 10 eggs in the course of a day. In a period varying from about one to three weeks the young bed-bug, small and semi-transparent, makes its appearance. Given an opportunity this young bed-bug begins to feed at once, although it may live for many weeks without food. Before reaching maturity young bed-bugs cast their skins, or moult, five times. At each moult the bed-bug becomes a little darker in colour. Before the first moult, four or five meals may be required before it is ready to moult, but after that one full meal is generally sufficient between each moult. Under most favourable conditions an average interval of eight days elapses between the laying and hatching of the egg and between each successive moult. This gives a period of about seven weeks to complete the cycle from egg to adult. This may, under normal conditions, be very much extended and may occupy anything up to one year. The adult female is said to live on an average six to eight months, and in that time deposits about 200 eggs. Bed-bugs and Disease. In addition to causing inflammation and irritation in those whom it bites, it may also interfere with sleep. As a carrier of disease bed-bugs are known to convey a relapsing fever if they have previously fed upon infected persons. In India the tropical bed-bug is also credited with conveying plague. Remedies. Fumigation with Sulphur Dioxide has been used with varying results, but fumigation with Hydrocyanic-acid is a very effective method of destroying bed-bugs. This treatment, however, is too dangerous to apply generally. The other remedies are dependent upon their being applied directly to the bug, and are:— (1) A naked flame—blow-lamp. This, whilst being effective, cannot always be used because of the danger of fire. 142 (2) Several solutions may be used, e.g., paraffin-soap emulsion, which is difficult to prepare; benzine and petrol, which are dangerous, and solution "D," a proprietary preparation which is used by the Public Health Department. With the exception of Hydrocyanic-acid and Sulphur Dioxide all of these are dependent upon the direct application of the vermicide tothe bug. This means, that in order to be effective, the bugs must be exposed; woodwork, etc., must be removed and the bugs sprayed with the solution. The bugs must be traced and the stripping process continued as long as bugs are found. Since it is doubtful whether a vermicide will destroy the eggs, it is necessary to repeat the spraying at least two or three times; the interval between the first and last application should not be less than a fortnight. After treatment, all cracks and crevices in brickwork and woodwork should be filled in and plaster made good. Even with this procedure it cannot be guaranteed that bugs will not re-appear, as it is practically impossible to treat every likely portion of the premises where bugs may be secreted. After drastic treatment as above outlined, the tenants of infested premises should be encouraged to take prompt action should bugs re-appear. Much may be achieved no doubt if tenants took prompt action immediately upon seeing evidence of the presence of bugs; but to be successful any treatment which is applied must be continued systematically for a considerable time. With the knowledge of the habits and life history of the bug, and the limitations of the ordinary vermicides, it will, therefore, be appreciated that the ridding of dwelling-houses, particularly old dwelling-houses, from bugs, is a very difficult problem. The present tendency to reduce the amount of woodwork in the construction of modern dwellings and for their internal fittings, is in itself an important preventive measure against vermin infestation, whether it be bugs, cockroaches, beetles, rats or mice. The substitution of metal for woodwork, or the use of some other smooth, impervious and unshrinkable material, for internal surfaces would render serious bug-infestation practically impossible and lesser infestations more easily dealt with. During the past few weeks serious bug-infestation has been reported in no less than 10 Council houses and flats, in addition to 12 privatelyowned houses. Disinfestation of these premises has taken a long time 143 as woodwork has to be removed and several visits paid to each premises in order to carry out the spraying. Twenty-seven gallons of vermicide have been used on Council property, and as this solution costs approximately 5s. per gallon, the expenditure on this item alone has already exceeded half of the amount estimated for the whole of the current financial year. The Medical Officer of Health considers that the Public Health Department ought not to bear the cost of providing solution "D" for the treatment of Council houses. With regard to the actual disinfestation, should the number of "bug-infested" Council houses increase, as seems extremely probable, the disinfecting staff will be unable to carry out the periodical spraying necessary without interfering with the routine disinfection following infectious diseases. The supply of vermicide given to tenants should be regarded only as a means for providing temporary relief while the owners of property deal with the infestation. Apart from the disinfestation, the question of following-up the Council's bug-infested property is one which will have to be given serious consideration, since the time which the Lady Sanitary Inspector can devote to the visitation of Council property is limited and has to be regulated so as not to interfere with the carrying out of the duties for which she was specifically appointed, namely, inspection of premises where female labour is employed, outworkers' homes, etc. At the request of the "Special Housing Committee" this Officer has endeavoured to visit all Council property once a year (and in addition follows up those cases which need re-visits) and submits a quarterly report, but the Medical Officer of Health would remind the Committee that he has on previous occasions referred to the fact that with the continued increase of accommodation provided by the Council, this work ' will not be possible without seriously interfering with her ordinary duties. In addition to the periodical visiting of occupants of Council houses, the Lady Sanitary Inspector visits all prospective tenants to ascertain, as far as is practicable, whether or not disinfection is required. This has entailed an additional amount of work. W. ALLAN YOUNG, Medical Officer of Health. 2nd June, 1932. 144 The report was referred to the Housing Committee, and by that Committee to the General Purposes Committee. A leaflet on "The Bed Bug, and Preventive Measures "was prepared for general circulation and copies were delivered by the Housing Departs ment to all the Council's tenants. A copy of the leaflet is printed below. When he submitted the report the Medical Officer of Health referred to the difficulty of disinfesting furniture and pointed out that the spraying of surfaces could not be expected to destroy bugs which were secreted under the upholstery or in the joints. metropolitan Borough of Poplar. THE BED BUG, AND PREVENTIVE MEASURES. Life History.—Although usually associated with old and dirty premises, bugs occasionally find their way into houses kept scrupulously clean. During the day they hide in crevices and cracks of all kinds—in the woodwork, behind wainscoting and loose wall paper, generally near a bed, sometimes in the bed itself and occasionally in other articles of furniture. Their food is the blood of warm-blooded animals, particularly that of man. These insects are very prolific, and in favourable circumstances breed continuously throughout the year. The white eggs are laid in crevices and cracks in batches of from 2 to 50, and in a period of from one to three weeks the young bug, white in colour, emerges from the egg. . Before it is full grown, the bug casts its skin or moults five times, and before each moult a full meal of blood is taken. Given the chance, the bug will feed frequently, until gorged, but it is capable of subsisting for many weeks without food. Preventive Measures.—In order to prevent and combat bug infestation, the following details should be carefully followed, but it should be understood that efficient and sustained efforts are necessary to overcome this pest. (1) The fight against bugs must be commenced when the first bug isi seen, and prosecuted with vigour before they are able to establish themselves in the house. 145 (2) The home must be kept clean. (3) If the walls are papered and the paper is loose, the loose paper should be stripped, any holes in the walls filled and the walls colour-washed or distempered. (4) Care of beds, etc.—Keep a sharp look-out for bugs, wipe bedsteads, especially joints where bugs can harbour, with paraffin or fluid vermicide weekly. Wood frames of other articles of furniture, picture frames, etc., may be treated in the same way. (Do not use these preparations near a naked light.) (5) A cheap and useful preparation for dealing with small infestations is paraffin oil soap emulsion, which is prepared as follows:— Dissolve four ounces (¼-lb.) of soft soap in one pint of hot water, to which while still hot, three to four pints of paraffin oil are added gradually, with much shaking and stirring. The final mixture should be white and milky with no free oil. Do not add paraffin oil to soap solution near a fire or naked light. Three table-spoonfuls of this emulsion in a pint of water should be forced into all cracks and crevices by use of a hand-syringe or brush. This treatment should be repeated at intervals of four or five days. (6) Fumigation of a single room can be carried out with sulphur, using at least 3 to 4 lbs. for a room 10 feet wide, 12 feet long and 8 feet high. (For a larger room the amount of sulphur should be proportionately increased.) The sulphur must be placed in a pail, or similar receptacle, containing water so as to prevent danger from fire. As the action of sulphur is most effective when used in a moist atmosphere, water should also be sprinkled over the floor, etc. All windows, fireplaces and crevices must be sealed up before lighting the sulphur, the door must then be closed and sealed, and the room left sealed for at least six hours. 146 (7) Whilst the spraying of cracks and crevices may assist in keeping down the nuisance, it should be realised that the bugs will not be destroyed unless the vermicide is actually applied directly to the bug. When treating a room in the early stage of infestation, do not discontinue your efforts because you have not seen a bug for a few days. Persevere with the treatment for some weeks, for unless you have killed every one, the trouble will recur. Constant perseverance and watchfulness is necessary. If you find you are unable to deal with the infestation, application for advice and assistance should be made to the Public Health Office, Bow Road, E.3. NOTE.—A form for fluid vermicide will be supplied on application to the Public Health Office. W. ALLAN YOUNG, Medical Officer of Health. Public Health Office, Bow Road, E.3. December, 1932. 147 INDEX. Page Age Mortality 17 Agricultural Produce (Grading and Marking) Act, 1928 70 Altered Diagnosis Cases 92 Analyst's Report 71 Anthrax 88 Antitoxin, quantity issued 78 Area and Population 10 Artificial Sunlight Treatment 131 Bacteriological Examinations 79 ,, Examination of Milk 61 Bakehouses 63 Births 10 Bug Infestation, Report on Appendix 139 Butter and Margarine Factories 70 Canal Boats 36 Cancer, Deaths from 93 Census, Table 55 Cerebro-spinalFever 90 Cleansing Station 103,106 Clinics, M. & C.W. 110 Clinics, Tuberculosi 93 Committees 3 Consultants:— 1. Puerperal Fever, etc. 89 2. Obstetric 126 Continued and Typhus Fevers 89 Coroner's Courts 18 Cowsheds 59 Customs and Inland Revenue Acts, Certificates 35 Deaths and Death Rates 11-17 Deaths, Classified Causes, Table Facing 12 and 13 ,, Infantile, Table 13 Dentist's Reports 98, 133 Diarrhoea and Enteritis, Deaths 17 Diphtheria 78 Disinfectant, Electrolytic 104 Disinfecting Department 103 Dysentery 92 Electrolytic Disinfecting Fluid 104 Encephalitis Lethargica 90 Enteric Fever 79 Erysipelas 89 Export of Meat Foods 73 Factory and Workshops Acts—Tables 26-32 Food, Supervision of 59 Food and Drugs Acts, etc. 68 Food Inspectors'Reports 64-68 Food Poisoning 73 Free Milk Scheme 137 Glanders 88 Hairdressers'Premises 36 Health Education 107 ,, Services 19 ,, Visitor, Chief, Report of 116 148 INDEX—(continued). Page Home Nursing 123 Houses Let in Lodgings 25 Housing 43 Hydrophobia 88 Ice Cream 62, 73 Infantile Mortality 13, 14 Infectious Diseases, Table of Notifications Facing 76 Inquests 18 Lady Sanitary Inspector, Report 24 Lectures on Health Subjects 107 Legal Proceedings, etc. 37 Malaria 92 Marriages11 Maternal Mortality 15, 125 Maternity and Child Welfare 110 Measles 91 Meat Food Products, Certification 73 Merchandise Marks Act 71 Milk (Special Designations) Order, 1923, Bacteriological Examinations 61 Milkshops, etc.59 Mortuary.18 Notification of Births Act. 11 Notifications of Infectious Diseases, Table Facing 76 Nutritional Anaemia, etc.138 Observation Wards 127 Offensive Trades 33 Ophthalmia Neonatorum 122 Overcrowding 54 Parliamentary Wards, Statistics Facing 8 Plague 88 Pneumonia 91 Poliomyelitis, etc. 90 Poor Law Relief, etc. 19 Population 9 and 10 Post-vaccinal Encephalitis, etc. 91 Public Education in Health 107 Puerperal Fever and Puerperal Pyrexia 89 Rag and Bone Dealer 34 Rag Flock Act 36 Rats and Mice Destruction Act 35 Refuse Disposal 23 Removal of Infirm Persons 22 Rent Restriction Acts, Certificates 58 Reports:— Artificial Sunlight Clinics, Medical Officer 131 Chief Health Visitor 116 Dental Surgeon (M. &C.W.) 133 Dental Surgeon (Tuberculosis) 98 Lecturer on Health Subjects 107 Observation Wards, Consulting Physician 127 Public Analyst 71 Royal College of St. Katharine, Senior Medical Officer 135 Tuberculosis Officer 93 149 INDEX—(continued). page Samples under Food and Drugs Act 68 Sanitary Inspectors' Work. Summaries 24 Scarlet Fever 78 Scavenging, Street Cleansing, ertc. 23 School, Inspection of 36 ,, Use of Electrolytic Fluid in 106 Slaughterer of poultry 63 Slaughtererhouses 34, 63 Smallpox 80 Smoke Nuisances 33 Stables 35 Staff 4 Stillbirths 121 Street Trading 35 Survey of District 45 Tables A to F (W orkshops, etc.) 26-32 ,, of Deaths 11-17 ,, of Infectious Diseases Facing 76 Tubercle bacilli in Milk Examinations for 61 and 62 Tuberculosis, Death Rate 17 ,, Deaths 102 ,, Oficers Report 93 ,, Regulations, Notifications, etc. 101 Typhoid Fever 79 Unhealthy Areas 53 Urinals on Licensed Premises 34 Vaccination 86-88 Verminous Children and Persons 103, 106 ,, Rooms 34 Vital Statistics, Summary 9 ,, ,, Tables 11-17 Wards, Statistics of Facing 8 Water Certificates 35 Workshops, Workplaces. etc. (Tables) 26-32 Zymonic Diseases, Death Rate 17 ,, Enteritis 123 -