C4368 POP 39 Metropolitan Borough of Poplar. Annual Report FOR THE YEAR 1933 ON The Sanitary Condition and Vital Statistics of the Metropolitan Borough of Poplar. W. ALLAN YOUNG, D.S.O.. M.D., Ch.B.. D.P.H , Medical Officer of Health. Crusha & Son, Ltd., Tottenham, Enfield, Wood Green and Palmera Green.. Metropolitan Borough of Poplar. Annual Report FOR THE YEAR 1933 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, 1932). Councillor C. W. Key, J.P., Mayor (ex-officio). Chairman: Councillor T. J. Goodway. Vice-Chairman: Alderman J. A. Hammond. Cllr. Baldock, F. T. Cllr. Harris, Mrs. Cllr. Shepherd, Mrs. A. L. A.I. Cllr. Boulton, H. Cllr. Mackay, Mrs. J. Cllr. Simons, A. Cllr. Cressall, G.J. Cllr. Mills, G. H. Cllr. Smith, F. A. Cllr. Goodway, T. J. Cllr. Newton, G. A. Aid. Stavers, Mrs. E. (Ch.) Aid. Hammond, J. A. Cllr. Sadler, Mrs. Cllr. Williams, Rev. H. (V.Ch.) L.M. MATERNITY AND CHILD WELFARE COMMITTEE (November, 1932). Councillor C. W. Key, J.P., Mayor (ex-officio). Chairman: Councillor Mrs. N. F. Cressall. Vice-Chairman: Alderman Mrs. E. Stavers. Cllr. Cressall, Mrs. Cllr. Newton, G. A. Cllr. Simons, A. N.F.(Ch.) Cllr. Easteal, A. Cllr. Power, Mrs. M. Cllr. Smith, F. A. Cllr. Hammond, E. Cllr. Sadler, Mrs. Aid. Stavers, Mrs. E. L.M. (V.Ch.) Cllr. Harris, Mrs. A. L. Co-opted Members: Miss E. 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. O. 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. Tibbatts.* (a) S. Kelly.* (b) C. A. Grabham.‡ C. h. Brown.*†‡ § (a) F. A. Smith.*‡ (b) H. A. pearce.†§‡ (a) W. J. Colborne†† Miss D. A. E. (c) H. W. Luke.††‡ (a) H. J. langley.*† landray.¶*‡|| (d) E. A. MAY††‡ (a) C. S. Westbrook.*‡ (a) A. l. Dove.††‡ (d) G. L. BELSHAW††‡ (a) Wm. Johnson.*‡ (a) District Inspectors. (b) Food Inspectors and certain duties under the Children, etc., Acts, 1908 and 1932. (c) Inspector for Houses divided into separate tenements, Common Lodging Houses, Seamen's Lodging Houses and Deputy Food Inspector. (d) Housing Survey Inspectors. J. Chapman, A. Collyer, W. cue†† (resigned), c. F. Gregory, E. WiLLSON††, W. G. F. CoLEBECK††‡, and c. H. Bossley (from 4th December, 1933) (District Inspectors' Assistants). C. A. Webster (part-time unqualified Assistant to assist the Food Inspectors). H. Harbott (Chauffeur). Clerks: F. J. White.* A. Hamilton.†† W. G. Barnett. W. F. Roberts. J. T. Donovan. D. Flynn. Miss S. Fells. E. W. Garrett. W. J. Wright (Office Boy), Mrs. E. Long. S. B. Leader. Caretaker and Messenger: C. E.Richardson. Vaccination Officer: P. Ryan. Public Vaccinators. Bow District .. .. .. Dr. D. G. Macrae. Bromley District .. .. Dr. C. Cotter. Poplar District .. .. .. Dr. H. J. O'Brien. Isle of Dogs District .. .. Dr. W. C. Millea. The Medical Superintendents of St. Andrew's Hospital, Bow Institution and Bromley House Institution are the Public Vaccinators to their respective Institutions. Cert. S.I.E. Board.† Cert R.S.I, †† Cert. R.S.I. & S.I.E.J.B. ‡ Cert. Meat and Food Inspector. § R.P.C. ¶HO. MM. || 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: Mbs. F. E. Smith (resigned). Miss D. S. Berry (from 18th September, 1933). Clerks: Miss A. I). Frost. Miss A. Rogers (resigned). Miss J. Smith (from 3rd April, 1933). Secretary to Care Committee: Miss L. Nugent. Nurse-Helper: Caretaker: Mrs. E. Tomlins (temporary). VV. 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. There are also 3 Distributors and a Lorry Driver and Attendant. Shelter and Cleansing Station. Attendants: Mrs. A. Howe. Mrs. M. Allan. MORTUARY. Mortuary Keeper and Caretaker of Coroner's Court: D. Hogan. Belief Mortuary Keeper: C. 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). Mrs. M. B. Graham Morton, M.D. Ch.B. (Glasgow). *Also Medical Officer-in-charge Artificial Light Treatment. ‡i 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. MallET.* Mrs. E. K. Haythornthwaite.*¶ (c) Miss g. I. Hill*¶ (c) Miss B. E. Letts*¶ (c) Miss M. H. sutclIFfe*¶† (c) Miss E. A. H. Williams. Miss A. Eaton*¶ Sister-in-Charge Artificial Light Treatment. Miss C. Harrison, Unqualified Assistant (Artificial Sunlight). 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. (LORD.) 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. ¶T Three Years' General Nursing Certificate. †† Fully Trained at Children's Hospital. (c) New H.V. Certificate. 7 Public Health Office, Bow Road, E.3. May, 1934. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar. Mr. Mayor, Ladies and Gentlemen, I beg to sumbit my Report upon the health of the Metropolitan Borough of Poplar for the year 1933. Statistics.—The Registrar-General's estimate of the population of the Borough is 149,300 (3,100 less than in the previous year) and on this figure al1 rates per 1,000 of the population are calculated. The birth rate (15.4) is lower and the death rate (12.4) is slightly higher than the corresponding rates for the year 1932. The infantile moratalityrate (54) is the lowest ever recorded in the Borough. Infectious Disease.—The number of cases of Scarlet Fever shows a definite increase over the figure for 1932, but the ' 'cyclic rise'' was not so great as anticipated. The disease was of a mild type. There was a slight rise in the number of cases of Diphtheria. Housing and Work of the District Inspectors.—It may be noted here that a considerable amount of work was done during the year in connection with housing "areas.'' The time taken in house-to-house inspections and in preparing statements concerning "areas" which were the subjects of enquiries early in 1934, necessarily affected the amount of routine district work done and accounts for the somewhat smaller figures shown in the table facing page 24, as compared with the figures for the previous year. Malnutrition.—The question of nutrition has received the attention of your Clinic Medical Officers during the year. No cases of severe malnutrition have been brought to my notice. It is difficult in the absence of definite criteria to make any precise statement as to the extent of minor degrees of malnutrition. The problem is so complex and so many factors are involved that its study is beyond the scope of routine Maternity and Child Welfare Clinic work. 8 As Dr. Robert Hutchison said in his "Sir Charles Hastings'' Lecture, delivered on March 7th, 1934 . . . "When all is said and done, malnutrition is mainly a clinical conception, and although an experienced doctor can say with fair certainty that such-and-such a child is suffering from it, yet it must be remembered that there is a large personal factor in his judgment; and this must always be borne in mind when you read that so many children in, say, a school, are reported to be ill-nourished.'' One of the Council's part-time Clinic Medical Officers who is Medical Officer of a Day Nursery in another part of the metropolis and who is also engaged in private practice has, at three of her clinic sessions, examined children for evidence of malnutrition as far as her routine work has permitted, and has recorded that severe malnutrition among children attending the clinics is very rare, but in her opinion a number of cases showed minor degrees of malnutrition. A comparison of the children in her Day Nursery with children seen at the clinics in Poplar gives her the impression that the children under one year of age in Poplar look better and weigh more than the children in the Day Nursery, but the general physique of the "toddlers" in the Day Nursery is better than that of the "toddlers" attending the clinics. She attributes the latter to the regular, wholesome dietary and regular life led by the Day Nursery children. As mentioned above, in the absence of any criteria or standards of malnutrition, and owing to the fact that there is no time at the ordinary Maternity and Child Welfare Clinics to devote to research work, it is difficult to say how much, if any, of the so-called minor degrees of malnutrition are due to:— 1. Inability of parents to provide a sufficient quantity of suitable food; 2. Faulty diet; 3. Digestive system of the child at fault rendering it unable to properly assimilate its food. Dr. H. K. Waller, in his report on the work of the Royal College of St. Katharine, page 138, goes more fully into this subject. Dr. G. O. Mitchell, the Tuberculosis Officer, also refers to malnutrition on page 105. 9 There is an impression among the Council's Maternity and Child I Welfare Clinic Medical Officers that the general physique of some of the mothers is not so good as that of the children attending the clinics and a number show some degree of anaemia. It is hoped that the issue of an iron preparation for mothers and babies which was commenced in - February of last year may prove beneficial. Staff.—Hitherto no record has been made of members of the staff i who have passed examinations and been awarded qualifying certificates by the appropriate examining bodies, but I should like to record that c since 1927 the following have obtained the certificates mentioned: Name. Certificate. Examining Body. Date. Mr. G. L. Belshaw Meat and Food In- Roy. Sanitary In- 1929 (Housing Survey spector stitute Inspector) *Mr. W. G. Colebeck Sanitary Inspector Roy. San. Inst. and 1932 (San. Insp. Asst.) San. Insp. Exam. Joint Board Ditto Meat and Food Roy. Sanitary In- 1933 Inspector stitute *Mr. W. Cue .. Sanitary Inspector Roy. San. Inst. and 1931 (San. Insp. Asst.) San. Insp. Exam. Joint Board Mr. A. L. Dove .. Smoke Inspector .. Roy. Sanitary In- 1931 (District Inspec- stitute tor) 1 Mr. A. Hamilton.. Sanitary Inspector Roy. San. Inst, and 1927 (Clerk) San. Insp. Exam. Joint Board Mr. E.A.May .. Meat and Food Roy. Sanitary In- 1932 (Housing Survey Inspector stitute Inspector) 1 *Mr. E. Saphier .. Sanitary Inspector Roy. San. Inst. and 1931 (San Insp. Asst.) San. Insp. Exam. Joint Board 10 Name. Certificate. Examining Body. Date. Miss M. H. Sutcliffe Sanitary Inspector Roy. San. Inst. and 1932 (Health Visitor, San. Insp. Exam. Maternity & Child Joint Board Welfare) *Mr. E.Wilson .. Sanitary Inspector Roy. San. Inst, and 1932 (San. Insp. Asst.) San. Insp. Exam. Joint Board ♦Since resigned on appointment as Sanitary Inspector elsewhere. 1 continue to appreciate the interest shown by members of the Council in the work of the Department, the co-operation of officers of other departments, and the way in which my staff have carried out their duties during the year. Further, I wish to acknowledge my indebtedness to those who, from time to time, supply items of information included in these reports. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, W. ALLAN YOUNG, Medical Officer of Health. Borough of Poplar. 11 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 1933 (Reg .-General) 149,300 Number of Inhabited Houses (end of 1933) according to Rate Books 23,292 Rateable Value (October, 1933) £748,524 Sum represented by a Penny Rate (April, 1933) £2,938 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. 12 SUMMARY OF VITAL STATISTICS. (Registrar-General's Figures.) Total M. F. Legitimate .. 2,236 1,159 1,077 .Birth Rate 15.4 per Live Births 11,000 of the estimated Illegitimate 59 32 27 resident population. Totals 2,295 1,191 1,104 Still Births 38 21 59 Rate per 1,000 total (live and still births) 25.1. Total M. F. Deaths 1,859 1,033 826 Death Rate 12.4 1,000 estimated resident population. Deaths from Puerperal causes (Headings 29 and 30 of the RegistrarGeneral's Short List):— Rate per 1,000 Deaths. total (live and still) births. No. 29 Puerperal sepsis 4 1.70 No. 30 Other puerperal causes — Total 4 1.70 Death Rate of Infants under one year of age:- All infants, per 1,000 live births 54 Legitimate infants, per 1,000 legitimate live births 53 Illegitimate infants, per 1,000 illegitimate live births 119 Deaths from Measles (all ages) 2 ,, Whooping Cough (all ages) 14 ,, Diarrhoea (under 2 years of age) 10 13 During the year 2,419 notifications were received under the notification of Births Act, 1907. The following Table shows where the births in 1933 occurred:— At Home:- 1. Attended by Doctors 11.8 per cent . 44.2 per 2. Attended by Midwives 32.4 per cent. cent. In Institutions: (a) In the Borough: St. Andrew's Hospital 27.8 per cent. (&) Outside the Borough: 1. East End Maternity 55.8 per cent. Hospital.. 19.8 per cent. ) 28.0 2. Other Institutions 8.2 per cent. 100 Marriages. During the year the marriages of 2,672 persons were registered, giving a rate of 17.9 as against 17.8, 17.8, 18.4, 18.9 and 17.8 in the five year 1928-1932. Deaths. 1,834 deaths were registered. After correction for inward and outward transfers the nett total was 1,857, giving a rate of 12.4. The Ragistrar-General's table shows a total of 1,859, but this does not affect the rate of 12.4. Natural Increase. The natural increase of population represented by excess of births over deaths was 436. The principal causes of death are shown in the chart facing page 14. 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 nearly 70 per cent, of the death ascribed to this condition were of persons of 65 years or more. 14 Deaths during 1933 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) 156 49 44 89 338 Bow and Bromley Sub-District (Dwellings) Il8 50 32 59 259 St. Andrew's Hospital 316 173 135 172 796 Poplar Institution 67 30 32 41 170 Bow Institution 38 20 17 35 11o Bromley House Institution 4 — — — 4 Poplar Hospital 24 16 38 28 106 River Thames 4 5 2 2 13 ,, Lee 3 1 I 1 6 Limehouse Cut — — I — 1 Bow Creek 1 — — 1 2 Ducketts Canal — — I — 1 East India Docks — — — — — West India Docks 1 — — — 1 South-West India Docks — — — — — Millwall Docks — — — — — Poplar Dry Dock — — — — — Highways 7 4 3 7 21 Miscellaneous: (places of Employment ,etc) 1 1 2 2 6 740 349 308 437 1,834 Death5 occurring outside the Borough, of persons belonging thereto .. (add) 79 71 64 68 282 Deaths occurring within the Borough, of persons not belonging thereto (deduct) 80 52 54 73 259 Deaths at all ages—nett 739 368 318 432 1,857 Principal causes of death 19)5. ( Registrar- Generals Classification) Total Deaths during the year 1859 — Males lO33. females 826. Percentage of deaths In Riblic Inslilulions to lolal deaths 69.5. Note:- Nearly 70 per cent. of deaths ascribed to Heart Disease were of persons of 65 or more years of age. The following table, compiled and furnished by the Registrar-General, is inserted at the request of the Ministry of Health. Cuases of Death Sex. All Ages 0— 1 — 2— 5— 15— 25— 35— 45- 55 — 65— 75— All Causes M 1033 77 17 24 37 31 52 54 135 181 236 189 F 826 48 21 19 22 43 40 60 76 121 174 202 1typhoid and paratyphoid fever M — — — — — — — — — — — — F 1 — — — — — — — — — 1 — 2 Measles M 2 — 1 1 — — — — — — — — F — — — — — — — — — — — — 3 Scarlet fever M 4 — — 2 1 1 — — — —— — — F 2 — 1 1 — — — — — 4 Whooping cough M 1 — — 1 — — — — — — — — F 13 2 — 6 — — — — — — — — 5 Diphthpheria M 10 — 1 5 4 — — — — — — — F 8 — — 4 4 — — — — — — — 6 Influenza M 41 — — — — 3 1 5 12 8 7 5 F 36 1 1 — — 2 2 3 5 2 7 13 7 Encephalitis lethargies M 1 — — — — — — 1 — — — — F 1 — — — — — — 1 — — — — 8 Cebro-spinal fever M 2 1 — — 1 — — — — — — F 2 — 1 — — — 1 — — — — — 9 Tuberculosis of respiratory system M 82 — — — — 8 20 14 21 13 6 — F 51 — 1 — — 21 14 9 4 2 — — 10 Other tuberculous diseases M 8 1 — 1 2 2 — — — — — — F 6 1 1 1 — 2 — 1 — — — — 11 Syphilis M 1 — — — — — — — — — 1 — F 1 — — — — — — —— — 1 — — 12 General paralyses of the insane, tabel dorsalis M 5 — — — — — — 2 1 2 — — F — — — — — — — — — — " — 13 Cancer, malignant disease M 116 — — — — 2 3 3 17 29 40 22 F 89 — — — — 1 1 12 17 19 27 12 14 Diabetes M 7 — — — — 1 1 — 1 3 1 — F 13 — — — — — — 1 — 7 3 2 15 Cerebral haemorrhange, etc. M 23 — — — — — — — 1 6 11 5 F 23 — — — — — — — — 8 8 7 16 Heart disease- M 266 — — — 3 3 3 3 13 51 OR oy ■7 A JLUl 1 1 n F 272 — — — 5 6 9 13 19 6 o 14 111/ 4V l& ^is6„0iro,»latr,. M 2 — 1 1 — 1 F 3 — 1 1 — 1 «ton ?Ses 0ry ao„ hit« •• •• M 48 1 — — — 7 9 20 11 F 30 o 2 2 10 14 "etnh 2l n ^0,»ia (a„ . M 65 7 — — — — 2 — 14 12 15 15 F 54 9 — — 2 1 2 11 18 11 °th6r (aU f°rm8) ^ t>4»J*Pirato« M 83 13 10 4 3 1 5 8 13 10 11 5 F 42 4 7 3 2 1 1 4 2 5 5 8 ®Pti ®s y 23 tj. ° ul°er ;; M 8 1 2 2 1 2 F 11 — — — 1 — 1 2 2 2 A 1 i 2 I M 15 1 8 4: i F 1 1 — r»„ M 4 3 1 — F 8 5 2 — — 1 — — — M 4 1 2 — — — 1 — — F 4 — — — 1 — — 3 — — 0tvd. Ver .. 1 27 f, 6t0 easea ., M 4 1 — — — 1 2 — F 2 — 1 1 — | 0tW .. «°f liver, 28 A ^iseo 'Sesti^ M 2 1 — 1 — F 4 1 2 1 — Acnteea«e8 ® 29 i> ^PhnfM oh* V M 17 2 1 1 1 2 3 2 2 3 F 10 2 1 1 1 1 1 — 2 1 .'ifj Nrw> Tronic 1 3) °ther al sen.,'-' M 29 1 — 1 — 2 — 3 6 5 8 3 F 24 3 1 2 4 8 3 3 1 Or, Pllo. P8l« F 4 2 2 — — — — F — — — — — * s^S>tio^i' M 46 44 1 1 — — — — — — — F 23 22 1 — 3s»ioid6 - •• 34 r\ M 3 — — — — — — — — — — 3 r F 6 — — 1 O 0tV „. 35 r\ lo'60ce M 11 — 3 1 2 ,3 2 F 7 — — 1 2 3 1 5 °ther . _ r|, ^sfiiiA J M 41 2 2 1 8 1 2 4 6 3 5 7 F 91 9 2 3 1 4 2 7 *r v ii*»i -i * • M •uJL 82 3 1 5 10 5 12 4 6 17 13 6 F 54 2 1 0 5 4 4 9 8 9 6 1 ^,;r n°wn lned or M F — — — — — — — — — Jlabo^,. 'ncluded ^^i-^allpox M 1 1 Legit. lllegit. M 74 3 F. 44 4 Totals 118 7 TABLE II.—CAUSES OF, AND AGES AT DEATH DURING 1933. of Death. \ e International List of ot neathi 1931,) Total Deaths. Sex. Ages at Death—in Years. Number of Deaths of Residents of Wards. Nett Deaths in Put )lic Insf itution s(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 BROMLEY. d s-l &! OJ +3 a M £-3 TJ P % CO 1 « 0 wg BO P W >> g a> 0. H "s ^ ff) g w p/P< O CO P-hO H 1 © 0 <0 d O O ft l! si 0! M 0- 1- 2- Total under 5years North, j West. Central. South. NorthWest. NorthEast. Southwest. SouthEast. Central. Northwest. West. East. Millwall. Cubitt Town. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ! 15 16 119 1 N* 1 Certified Uncertified 1856 1 { M F M F 1032 824 1 76 47 17 20 24 20 117 87 20 12 17 11 18 19 13 24 52 40 54 60 135 73 181 122 239 175 1 186 \ 201 / 106 138 119 96 124 119 161 .. | .. 1 144 178 202 124 132 94 1 154 752 8 40 24 281 1 1259 1 All Causes { I Uncertified $ k and Paratyphoid Fevers 5 SN" \>»« :: :: :: ; bwlB6co^ • »? V & ^°ePhai • % . itis lethargica .. fj %r piQal Fever , ^5k^Ui°Si8 of Respiratory * oik • • 2 erculous Diseases ONI' \{ a*J}j»i» of the Insane, k Vigilant disease f' ^ V%h" ^ aeQl°rrhage, etc. »s>- - %i 'iw Cl"atory diseases ! \ ' K (all forms) b h ^tin lratory Diseases >. V lcet ^ .Xe. *N> * V^°Ulver.. .. •• \ ^V^.64868 of liver, etc. h diseases .. k *MOK 31 ^onic Nephritis Ste^PsU , causes .. 5 4tauebi"ty, Premature S lty ^Uotmat^ng etc. .. h %. •■ A - hV^* \V;^ ca^ .. .. X*x\. e^ned, or unknown .. 1 r 2 4 / 14 / 19 « 76 2 4 / 133 r 17 i 3 V 4 / 201 1 21 45 / 542 / 5 87 / 120 / 120 / 16 16 13 8 I" 0 J" 6 23 49 / 4 67 11 / 17 ■< 58 142 / 1 / M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F M F F F M F M F M F M F M F M F i 2 2 2 1 13 11 8 40 36 1 1 2 2 82 51 11 6 2 1 4 113 88 8 13 23 22 269 273 2 3 55 32 70 50 78 42 6 10 15 1 5 8 4 4 4 2 3 3 12 11 24 25 4 46 21 5 6 11 6 40 18 81 61 1 2 1 1 i l 1 4 5 12 3 5 5 2 i 44 21 2 2 4 5 1 1 i 4 1 1 'i l 2 1 "2 *8 7 "2 2 i 2 1 2 1 1 7 5 4 i 1 '4 3 i 1 1 1 "2 1 2 4 1 2 2 2 1 13 6 4 2 1 1 i 4 3 1 6 5 24 13 5 7 1 3 1 2 46 21 5 4 9 8 1 4 3 i 2 1 2 1 1 'i 5 1 5 5 1 1 i 2 i 3 1 2 1 1 3 1 7 3 1 1 2 8 2 1 3 1 *5 2 2 1 i 1 1 1 4 3 1 5 13 1 1 i 'i 4 i i 1 1 1 1 1 2 1 20 14 i 3 1 1 3 10 2 1 5 1 1 1 i 1 1 2 3 2 11 5 3 1 1 14 9 1 2 2 12 1 1 '4 13 1 2 2 8 4 1 1 1 1 1 3 2 2 1 1 4 4 6 12 5 21 3 1 1 17 17 1 i 1 13 20 1 1 7 14 3 13 2 1 2 8 1 3 1 "2 3 1 6 5 2 2 6 1 6 6 8 2 14 2 i 2 27 17 3 7 6 6 43 34 1 1 14 4 12 11 8 5 2 3 4 1 i 1 1 2 4 9 3 2 4 5 18 9 1 7 7 6 1 39 28 1 3 11 8 91 74 22 12 18 16 10 6 2 1 1 2 1 1 i 3 5 3 1 1 2 1 5 1 13 9 5 \ 13 -f 22 \ 12 J "2 / 5 \ 7 / 102 X 111 / i / n x 14 / 16 X 12 / 5 \ 8 J 1 \ 2 / 1 \ "2 \ 1 J 2 \ 3 / 4 \ 5 / 5 \ 5 / 5 X 5 f 1 1 5 1 5 1 1 16 2 29 2 7 4 1 1 2 1 1 "7 2 2 2 12 1 3 2 14 1 8 2 5 43 7 9 11 2 2 2 5 "6 1 8 12 2 4 8 2 19 3 40 3 7 9 1 1 1 5 "l 3 3 7 2 2 1 1 6 1 13 1 2 19 4 3 8 1 2 1 3 2 1 "7 5 11 2 10 1 6 1 16 1 36 7 4 10 2 1 1 6 2 *3 2 3 2 9 8 6 2 10 4 3 42 3 8 8 1 2 1 1 2 6 1 5 6 2 1 6 1 14 2 18 4 6 37 10 10 13 2 3 2 1 4 1 "7 1 6 10 1 9 8 1 17 1 4 50 1 4 6 8 2 1 6 '*6 1 4 14 1 1 10 1 14 1 2 17 3 4 51 1 7 8 12 4 1 1 1 2 2 7 *5 1 1 4 16 1 3 2 9 14 1 14 1 6 64 1 6 21 10 3 1 2 2 2 2 5 *9 3 7 13 2 3 1 12 1 1 1 12 1 1 37 1 6 13 9 1 1 1 1 2 2 *4 2 4 5 1 1 1 8 1 8 1 2 12 4 48 12 10 5 1 1 1 2 *2 3 12 1 4 2 7 1 14 2 1 19 1 6 8 8 2 1 1 2 "2 2 1 5 6 1 1 2 4 11 1 15 1 4 27 10 6 5 2 1 1 1 2 4 1 3 2 5 9 1 1 5 1 1 5 1 1 119 1 6 2 1 1 2 6 1 2 1 13 2 46 6 82 9 27 212 31 67 50 6 6 10 4 3 2 12 29 3 30 1 3 20 74 1 1 1 2 3 3 2 5 1 2 1 1 1 14 4 4 (a) d) 1 (e) 3 (d) i (e) (1) 1 1 4 7 18 3 1 1 25 6 1 3 34 3 3 40 2 7 2 26 3 7 1 4 2 2 6 3 1 ie 3 3 8 34 1 1 2 4 9 19 17 2 4 76 14 2 4 124 13 31 384 3 43 76 86 10 14 13 8 5 4 20 35 4 47 4 8 55 118 1 1 Typhoid and Paratyphoid Fevers 2 Measles 5 Diphtheria 6 Influenza 7 Encephalitis lethargica 8 Cerebro-spinal Fever 9 Tuberculosis of Respiratory system 10 Other Tuberculous Diseases 12 General Paralysis of the Insane, tabes dorsalis 13 Cancer, malignant disease 14 Diabetes 15 Cerebral haemorrhage, etc. 17 Aneurysm 18 Other circulatory diseases 19 Bronchitis 20 Pneumonia (all forms) 21 Other Respiratory Diseases 22 Peptic Ulcer 24 Appendicitis 25 Cirrhosis of Liver 26 Other diseases of liver, etc. 27 Other Digestive diseases 28 Acute and Chronic Nephritis 29 Puerperal Sepsis 30 Other Puerperal causes .. .. }1 Congenital Debility, Premature Birth, Malformations, etc. 32 Senility 34 Other violence 35 Other defined causes 36 Causes ill-deftned, or unknown .. l^T— VVM., Totam •• •• \^lipixded!nNO-36 1857 ^ M F M 1032 825 76 47 17 20 24 20 117 87 20 12 17 11 18 19 13 24 52 40 54 60 135 73 181 122 239 176 186 ^ 201 I 387 j 106 138 1 119 96 124 119 161 144 178 202 124 132 95 119 154 752 8 40 24 282 1 1260 1 All Causes Smallpox 1857 1 123 37 44 1 201 1 32 28 37 37 92 114 208 803 415 .. •5* 0 0 H DTEs:—(a) Hi ghways 3; Electricit y Work g,l. (b) Highway, 1. ) Highway, 1. (d) West Ii idia Docks, 1; Highway 1; Roya 1 Coll. of St. Katharine, 1. (e) River Lee, 1. (/) River Lee, 1. (ff) River Lee, 1; River Thames 2; Highways, 9: L.M.S. Rly., 1. 15 TABLE III. Infantile Mortality during the Year 1933. Nett Deaths from stated Causes in Weeks and Months under One Year of Age. Causes Of Death Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Nett total Deaths under 1 year. No. of Deaths in each Quarter. Poplar. - Bow and Bromley Whole Borough] 1 2 3 4 Measles - - - - - - - - - - - - - - - - Whooping Cough - - - - - 1 - - 1 2 - 2 - 1 - 1 Diphtheria - - - - - - - - - - - - - - - - Influenza - 1 - - 1 - - - - 1 - 1 1 - - - - - - - - - - - 1 1 - 1 - 1 - - Tuberculosis of Intes- tines and Peritoneum - - - - - - - - - - - - - - - - Other Tuberculosis - - - - - 1 - - - - 1 1 - - 1 - Diseases - - - - - - - - - - - - - - - - Syphilis - - - - - 1 - - 2 1 2 3 1 1 I - Meningitis - - - - - - - - - - - - - - - - Bronchitis 1 - 1 - 2 4 2 1 - 5 4 9 3 1 2 3 Pneumonia - 1 1 - 2 3 5 3 2 9 6 15 8 - 4 3 Other Respiratory Diseases - - - - - - - - - - - - - - - - Inflammation of the stomach - - - - - - - - - - - - - - - - Diarrhœa and Enteritis - 1 1 - 2 2 2 3 1 3 7 10 3 1 3 3 Hernia, Intestinal Ob- struction - - - - - - 1 1 - - 2 2 - - - 2 Congenital malformations. 2 1 1 - 4 5 2 - 1 5 7 12 6 1 3 2 Congenital Debility and Selerema 2 - - - 2 - - - - 1 1 2 2 - - - Icterus 1 - - - 1 - - - - 1 - 1 - - 1 - Premature at Birth 32 - 1 1 34 4 - - - 16 22 38 11 10 12 5 Injury at Birth 5 - - - 5 - - - - - 3 5 1 1 1 2 Diseases of Umbilicus - - - - - - - - - - - - - - - - Atelectasis 7 - - - 7 - - - - 4 3 7 — 3 1 3 suffocation- in bed or not stated how - - - - - - - 1 - - 1 1 1 - - - Other causes 4 1 1 1 7 1 1 3 1 6 7 13 7 1 1 4 All causes 54 5 6 2 67 22 13 12 9 57 66 123 44 21 30 28 Live Birth Legitimate 2,236* Nett Deaths Legitimate 118* in the year Illegitimate 59* in the year lllegitimate 7* *Registrar-General's figures. Neo-Natal Death Rate. 1928. 1929. 1930. 1931. 1932. Average 19281932. 1933. Nett Birth (Registerar-General) Deaths under 1 month 3,228 3,064 3,056 2,739 2,616 2,941 2,295 76 92 71 74 65 76 67 Neo-Natal death rate per 1,000 nett Births 23.5 30.0 23.2 27.0 24.8 25.7 29.2 16 Infantile Mortality. The following Table has been compiled to indicate the number and rate per 1,000 births of:— (a) Deaths of infants under 2 weeks old; (b) Deaths of infants from 2 weeks to 12 months old; (c) Deaths of infants under 1 year of age (total and visited by the Health Visitors), during the twenty years 1914 to 1933. Year. Live Births. Birth rate per 1,000 population Maternal Mortality. Deaths of Infants: Deaths of visited infants. rate per 1,000 Under 2 weeks. 2 weeks to 12 months. Total under one year. Total under one year. Rate per 1,000 visited. Live Births. Total Births. No. Rate. No. Rate. No. Rate. 1914 5,059 31.5 3.95 - 112 22.1 481 95.1 593 117 302 117 1915 4,687 30.0 2.13 - 132 28.2 496 105.8 628 134 349 98 1916 4,543 26.9 3.08 - 108 23.8 364 80.1 472 104 261 78 1917 3,700 23.1 2.70 - 87 23.5 265 71.6 352 95 215 79 1918 3,203 20.4 4.01 - 79 24.7 265 82.7 344 107 173 68 1919 3,949 24.6 2.78 - 106 26.8 222 56.2 328 83 243 69 1920 5,457 34.1 3.48 - 121 22.2 326 59.7 447 82 213 48 1921 4,478 27.2 3.57 - 92 20.5 282 62.9 374 83 243 66 1922 4,417 26.6 3.17 - 108 24.5 241 54.5 349 79 147 38 ' 1923 4,256 25.6 3.29 - 101 23.7 154 36.1 255 60 163 44 1924 3,831 22.9 1.30 - 75 19.5 202 52.7 277 72 128 38 1925 3,831 22.7 3.13 - 73 19.0 215 56.1 288 75 174 50 1926 3,658 21.6 3.97 - 75 20.5 183 50.0 258 70 136 39 1927 3,309 19.8 2.72 - 68 20.6 150 45.3 218 66 138 42 1928 3,228 19.9 2.47 - 64 19.8 166 51.4 230 71 152 49 1929 3,064 19.1 3.26 - 77 25.1 153 49.9 230 75 123 40 1930 3,056 19.3 1.31 1.26 66 21.6 101 33.5 167 55 102 34 1931 2,739 17.5 2.55 2.47 60 21.8 151 55.1 211 77 139 50 1932 2,616 17.2 4.20 4.07 57 21.8 109 41.6 166 63 74 28 1933 2,295 15.4 1.74 1.70 59 25.7 64 27.9 123 54 - - 17 TABLE IV. Birth-rates, Death-rates, and Analysis of Mortality in the Year 1933. (Provisional figures. The rates for England and Wales and for London have been calculated on a population estimated to the middle of 1933, but those for the towns have been calculated on populations estimated to the middle of 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 14.4 0.62 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 0.54 7.1 64 90.9 6.3 1.9 0.9 *118 County Boroughs and Great Towns, including London 14.4 0.67 12.2 0.00 0.00 0.06 0.02 0.06 0.08 0.55 0.49 9.4 67 91.0 60 2.5 0.5 *132 Smaller Towns (Populations 25,00050,000 at Census 1931) 14.5 0.63 11.0 0.00 - 0.04 0.02 0.04 0.04 0.53 0.44 4.9 56 91.7 5.8 1.5 1.0 *London 13.2 0.45 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.51 0.58 11.6 59 88.3 6.3 5.4 0.0 Poplar Borough 15.4 0.4 12.4 0.01 0.01 0.01 0.04 0. 09 0.12 0.52 0.54 4.4 54 88.9 6.14 4.84 0.05 Puerperal Sepsis. Others. Total. Per 1,000 live births 1.79 2.63 4.42 *The maternal Mortality Rates for England and Wales are as follows:—Per 1 000 total births 1.71 2.52 4.23 The Maternal Mortality Rates for Poplar are as follows:— Per 1,000 total births 1.70 — 1.70 *Statistics furnished by the Registrar-General. 18 TABLE V. (1933). Live Deaths Estimated Births, Death- of Cities Resident Annual rate Infants and population rate per per under Boroughs. (Mid-1933) 1,000 1,000 one year persons persons to 1,000 living. living, births. LONDON West Districts. 4,298,600 13.2 12.2 59 Paddington 141,900 13.41 13.36 85 Kensington 181,100 1.20 12.9 72 Hammersmith 131,400 13.9 12.9 65 Fulham 148,200 13.07 13.00 65 Chelsea 58,850 10.6 13.6 78 City of Westminster 126,300 8.7 12.4 68 North Districts. St. Marylebone 94,080 9.71 12.2 56 Hampstead 90,380 9.6 11.0 38 St. Pancras 190,900 13.6 13.7 58 *Islington 319,100 14.35 12.40 63 Stoke Newington 51,120 12.6 12.3 46 Hackney 214,300 14.0 11.5 50.6 Central Districts. Holborn 36,050 9.49 13.48 70 Finsbury 66,640 15.1 12.8 50 City of London 9,830 7.7 10.9 65 East Districts. Shoreditch 93,550 16.0 13.0 74 Bethnal Green 104,200 14.3 12.5 66 Stepney 219,100 15.1 12.9 65.3 Poplar 149,300 15.4 12.4 54 South Districts. Southwark 164,700 14.2 13.9 63 Bermondsey 107,300 14.0 12.5 61 Lambeth 289,000 13.6 13.1 63 Battersea 154,000 14.7 12.49 49.49 Wandsworth 350,200 10.93 11.49 50 Camberwell 243,700 13.32 12.33 49 Deptford 102,800 14.8 12.1 54 Greenwich 97,830 13.7 11.9 66 Lewisham 221,100 12.2 10.2 39 Woolwich 146,200 12.6 11.18 62 Note.—The information relating to London supplied by the Registrar-General and that for individual Boroughs by the Medical Officers of Health. *Estimated population for 1932 on which the birth and death rates have been calculated. These figures will appear in the annual report for 1933. 19 (This summary is inserted, for comparison with those shown in previous reports.) 1928. 1929. 1930. 1931. 1932. 1933. Population, estimated by Registrar- General:— 162,000 160,000 157,900 156 300 152,400 149,300 Births, Live, rate per 1,000 population 19.9 19.1 19.3 17.5 17.2 15.4 Deaths from all causes, rate per 1,000 population 11.8 14.2 10.6 12.4 12.1 12.4 Deaths under 1 year of age, rate per 1,000 nett births 71 75 55 77 63 54 Deaths over 65 years of age, rate per 1,000 total population .. 4.2 5.7 4.2 5.0 5.2 5.4 *Zymotic diseases:— Death rate per 1,000 population 0.6 0.8 0.5 0.4 0.5 0.4 Proportion of 1,000 deaths 55.5 53.4 47.6 34.5 40.6 29.0 Tuberculosis, all forms:— Death rate per 1,000 population 11 1.2 0.9 1.1 1.0 1.0 Proportion of 1,000 deaths 93.2 85.6 86.8 87.5 83.3 79.1 Respiratory diseases (excluding phthisis):— Death rate per 1,000 population 1.9 3.1 1.0 2.2 1.7 1.1 Proportion of 1,000 deaths 162.4 219.8 98.1 181.8 140.7 87.7 *Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria and Mem. Croup, Typhoid Fever and Diarrhœal Diseases. 20 Mortuary and Coroner's Court. The number of bodies deposited in the Council's Mortuary, Cottage Street, Poplar, during the year was 233:— Residents Non-Residents* Totals Males Females Males Females Age not stated i.e. unknown, newly born) .. 5 5 - 1 11 Stillborn -— 2 - - 2 Under 1 year 3 3 - - 6 1 to 5 years 6 5 1 3 15 5 to 15 years 14 5 4 - 23 15 to 25 years 6 1 1 1 9 25 to 45 years 22 5 2 6 35 45 to 65 years 47 16 6 1 70 65 years and upwards 33 21 2 6 62 Totals 136 63 16 18 233 *Brought from outside the Borough for the convenience of the Coroner. Inquests were held on 147 (post-mortem examinations, 33), and 76 other post-mortem examinations were made by order of the Coroner. The total number of post-mortem examinations made was 109. Ten bodies were brought to the Mortuary for custody (7 from Fever Hospitals and 3 awaiting inquests at Coroners Courts elsewhere). In a number of instances post-mortem examinations were made at the Poplar Mortuary and inquests held at either Stepney or Shoreditch Coroners Courts. Mortuary. A new zinc-lined shell (with tray), for the storage of drowned bodies was provided early in the year. 21 Section B. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. (1) Public Health Officers of the Authority. A list of the Staff is shown at the commencement of the Report, page 4. (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 17. 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:— Medical Number of persons relieved— Cost. relief only. Week 7th January, 1933 10,387 £3.204 62 ended 1st July, 1933 8,464 £2,576 72 (5) Laboratory Facilities. (a) Chemical Analysis. Arrangements are made with an analytical chemist who is approved by the Minister of Health. All examinations are carried out at the Public 22 Analyst's own laboratory which is situated at Bank Buildings, 161, Bow Road, E .3. The report of the Public Analyst is given on page 80. (n.b.—Examination of samples of milk for tubercle and bacteriological counts in graded milks are made at the Lister Institute.) [b) Bacteriological. (i) All sputa examinations are made at the Council's Tuberculosis Dispensary. (ii) Examination of diphtheria swabs and Widal tests and examination of stools and urine are carried out by arrangement with the Seamen's Hospital Society, Dreadnought Hospital, Greenwich. (iii) Wasserman tests and examination of smears are done at the London Hospital under the Venereal Disease Scheme for London. (6) New Legislation. During the year the following legislation, etc., came into operation:— Slaughter of Animals, Act, 1933. Transfer of Powers (London) Order, 1933. By the Transfer of Powers (London) Order, 1933, the following functions were transferred from the London County Council to the Borough Council as from 1st April, 1933:— (a) Licensing of Common Lodging Houses, Seamen's Lodging Houses, Cowhouses and places for the keeping of Cows, offensive Trades, Slaughterhouses and Knackers Yards. (b) Inspection and enforcement of Byelaws of Seamen's and Common Lodging houses. The Council delegated their powers to the Public Health Committee. Mr. Luke, the Houses-let-in-Lodgings Inspector, was appointed to carry out the duties regarding Seamen's and Common Lodging Houses. Licensing of Cowhouses, Slaughter-houses, etc. The Public Health Committee held a Special Meeting to consider applications for the granting, or renewal, of Licences for Cowhouses, Slaughter-houses, etc. 23 In order to bring all Licences into line, it has been agreed that all Annual Licences shall, in future, expire on 30th June each year. (7) Hospitals. Fever and Smallpox. Hospitals for patients suffering from these diseases are provided by the London County Council. Tuberculosis. Residential Institutional Treatment for tuberculous patients is provided by the London County Council. Other Hospitals. There are no hospitals in the Borough provided or subsidised by the Council. There are two General Hospitals, Poplar Hospital (supported voluntarily), and St. Andrew's Hospital (maintained by the London County Council). Other Institutions in the Borough are:— Poplar Institution; Bow Institution; Langley House; Bromley House Institution; all of which are maintained by the London County Council. 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 131.) 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. 24 (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 117.) Tuberculosis Dispensary. (See page 100, where a list of accommodation and hours of sessions, etc., is shown.) There are several school treatment centres in the Borough maintained by the London County Council. There is no centre in the Borough for the treatment of venereal disease. Posters published by the London County Council giving addresses of the nearest clinics are displayed in the public urinals throughout the Borough. These posters also state that a complete list of Hospitals where treatment is available can be had on application at the office of the Public Health Department. (11) Maternal Mortality. All maternal deaths and all cases of Puerperal Fever and Puerperal Pyrexia are specially investigated. (See Maternity and Child Welfare section, page 126.) (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. District Sanitary Inspectors' Work, Etc. Tabulated Statement of Inspections, Insanitary Conditions found existing, and lie-inspections during the year 1933. DISTRICT. Totals. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. Number of Complaints received 410 570 819 657 555 1,097 466 389 4,963 Number of Inspections f House-to-House 14 - 3 - 145 7 - 22 191 Dwelling Houses On Complaint 599 576 826 632 603 1,092 464 381 5,173 1 After Infectious Disease 358 1-60 250 219 259 157 263 171 1,837 Factories, including Factory Laundries 12 54 32 15 21 1 7 31 173 Workshops, including Workshop Laundries 45 29 30 13 46 11 26 7 207 Workplaces, other than outworkers 48 25 18 31 82 18 26 28 276 Outworkers 1 - - 1 3 - - - 5 Stables 78 16 51 48 118 24 51 59 445 Smoke observations 2 8 2 1 33 - 7 20 73 Miscellaneous visits and inspections (including visits to Infectious Disease contacts, school inspections, etc.) 1,764 506 676 441 805 1,385 401 558 6,536 Re-inspections 1,965 2,600 2,749 1,820 3,059 1,394 3,382 2,288 19,257 Premises requiring amendment a) Dwelling-houses 539 635 830 712 646 1,015 506 219 5,102 (b) Other premises 4 26 46 33 56 14 27 12 218 Service of Intimations, etc.: Intimations served 624 630 743 774 546 1,019 509 231 5,076 ,, complied with 209 372 442 750 412 497 258 116 3,056 Notices served 294 219 413 326 129 512 233 78 2,204 ,, complied with 271 194 1711 320 101 294 151 67 1,577 Final Notices served 118 74 136 38 26 160 98 26 676 ,, complied with 93 31 122 63 6 155 78 1 554 Summonses applied for 6 2 8 5 - 12 9 1 43 Work done, number of instances not included above: (a) After legal proceedings 2 1 4 5 27 8 8 3 58 (b) Voluntarily 14 22 72 238 60 32 70 47 555 Defects, etc., found in Dwelling Houses: Nuisances, etc., found. Works completed. Drainage: Drains defective 36 76 52 20 129 28 42 12 395 376 ,, obstructed 33 49 114 26 62 48 34 32 398 380 Waste pipes defective, etc. 55 44 48 98 53 30 73 5 406 323 Rainwater pipes not disconnected 2 2 - 1 2 - 7 4 18 32 W.C.'s and flushing apparatus defective 47 77 120 160 36 90 77 18 625 596 Dampness (not due to defects shown elsewhere) 58 62 218 89 171 177 133 27 935 890 Water: Supply cut off 4 - 4 2 - 1 2 8 21 58 Dust Receptacles: Insufficient or defective 71 71 200 182 135 210 75 93 1,037 1,111 Miscellaneous: Rooms, etc., dirty and/or verminous 417 299 556 373 404 561 509 265 3,383 3,031 Cases of overcrowding 5 1 6 3 4 11 7 7 44 23 Yards, etc., not properly paved or drained 38 33 62 112 78 36 113 21 493 572 Roofs defective 201 171 273 198 238 315 206 57 1,659 1,780 Rainwater pipes and gutters defective 49 103 167 140 242 146 80 38 965 871 Public House Urinals requiring cleansing 1 1 1 4 12 - - 6 25 20 Other nuisances or defects 426 294 1,888 676 1,007 1,445 1,168 458 7,362 6,783 Defects found in Factories, Workshops, etc.: Sanitary defects 3 - 38 1 3 17 4 - 66 53 W.C. accommodation, insufficient or unsuitable 1 - 4 2 2 1 - 3 13 7 Overcrowding - - - - - - - - - - Stables: Manure receptacles defective, etc. 2 2 7 10 3 1 1 1 27 20 Accumulations found - 5 7 6 10 - - 4 32 31 Re-housing: Number of families re-housed by— 1. Poplar Borough Council - - - - - - 9 - 9 - 2. London County Council - - 1 - - - 25 - 26 - Number of visits by Assistants (not included above) 2,660 2,783 4,576 4,227 3,363 4,152 3,720 48 25,529 - No. of premises inspected as a result of reference from Survey Inspectors 1,046 Work done, or no action necessary 202 I ntimations served 844 Statutory Notices served 295 Final Notices served 89 Legal proceedings 4 25 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. E. G. Timbrell, B.Sc., 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. All refuse is barged from a riverside wharf. Improved methods of dust collection by low loading freighters were in full operation throughout the Borough during the year. Trade Refuse.—This is collected only when specially requested, and is barged from a riverside wharf. Street Cleansing.—The system for street cleansing includes hand sweeping by gangs, orderly men, horse-drawn and motor machine brooms. The main and other important roads are swept daily and nightly; other roads mostly three times weekly. No road is swept less than twice weekly. The sweepings and/or slop are picked up and put into Barge at Northumberland Wharf, or sent by rail by contractors. Street Watering.—This service embraces the use of modern up-to-date motor water vans, supplemented by horse-drawn water vans. The extent of the watering depends almost entirely on weather conditions. Summary for the Year 1933. House refuse collected 30,267 tons Trade refuse collected 252 ,, Slop and sweepings 8,614 ,, Refuse from street markets 2,490 ,, 26 Alteration to Boundary of Bow East and Bromley North Sanitary Inspectors Districts.—In view of the fact that the boundary of these districts ran through one of the blocks of dwellings erected by the London County Council, on the Bow Brewery site, the boundary of these districts was adjusted so that the whole of the dwellings were placed in the Bow East Sanitary Inspector's district. Combined Drainage.—The following drainage works were approved by the Public Health Committee:— 2-12, Trego Road, estimated cost, £200 (February). 26, Harley Street, estimated cost, £40 (February). Suffolk and Northumberland Streets, estimated cost, £500 (April). 382-4, Manchester Road, estimated cost, £85 (29th May). 9, Maverton Road, estimated cost, £75 (10th July). 34, Canton Street, estimated cost, £70 (10th July). 139-153, Malmesbury Road, estimated cost, £150 (10th July). 9-12, Denbigh Road, estimated cost, £150 (nth September). 81 and 83, Gough Street, estimated cost, £110 (9th October). Work of Lady Sanitary Inspector. Tabulated statement of Inspections, of Insanitary Conditions found existing, and of Reinspections, etc., during the year 1933. Factories and Workshops newly discovered and Registered — Number of Inspections of:— Factories, including Factory Laundries 115 Workshops, including Workshop Laundries 88 Workplaces 27 Workrooms 5 Homeworkers' premises 490 Reinspections of above 40 Defects Found:— 1. Nuisances under Public Health (London) Act, 1891:— Found. Remedied. Refered to D.S.I. Refered to H.M.Insp. Want of cleanliness 3 2 1 - Want of ventilation .- - - - Overcrowding 1 1 - - Want of drainage of floors - - - - Other nuisances 4 2 2 - Insufficient - - - - Sanitary Unsuitable or defective 13 10 - - accommodation Not separate for sexes - - - - Want of cleanliness 14 12 - - 2. Offences under Factory and Workshop Acts - - - - 27 Action Taken Regarding Above:— Intimations served 19 ,, complied with 15 Notices served 1 ,, complied with 1 Final Notices served - Legal Proceedings taken - Nuisances remedied without service of Intimations, etc. - Other Matter:— Visits to Council Houses and Flats 392 Revisits ,, ,, 59 Visits re cases of Scabies 148 ,, Verminous children 77 ,, Outworkers' lists 30 ,, cases of Smallpox and Chickenpox - ,, Smallpox contacts 5 ,, Infectious Disease on Home workers' premises 12 ,, School Exclusions, etc 834 Miscellaneous visits 329 Inspections of Schools re Sanitary accommodation 42 Visits to prospective tenants of Council's Flats, etc. 97 Houses divided into separate Tenements, etc. Number of Houses on Register at end of 1932 162 ,, ,, removed from Register during 1933 10 152 registered during 1933 34 ,, ,, on Register at end of 1933 186 Visits for registration purposes 67 Declarations, for information, sent out 1 ,, with information, returned 2 Rooms measured, etc 11 Houses registered 34 Notices sent out, re above 38 Inspections: {a) Night inspections 6 (b) First annual inspections 115 (c) Other routine inspections 78 (d) On complaints 21 (e) On account of re-housing 5 Re-inspections 271 Miscellaneous visits, enquiries, etc 364 28 Number of informal notices served 113 ,, ,, ,, complied with 74 ,, Notices served 44 ,, ,, complied with 35 ,, Final Notices served 6 ,, cases in which legal proceedings were taken 2 Work done as a result of Final Notice or legal proceedings, number of cases 6 Overcrowding, cases discovered 8 ,, ,, abated 17 Mixed sleeping, cases discovered 1 ,, ,, abated 6 Number of nuisances referred to District Inspectors: (a) Defective or obstructed drains 4 (b) Defective roofs, guttering, etc. 16 (c) Water supply in tenement house 1 (d) Miscellaneous 26 Remarks: During the year the Inspector deputised for District Inspectors on 83 days, and in addition to this district work the Inspector made other visits as follows:- Enquiries on account of rehousing 373 Re-visits in connection therewith 149 Licensing of Common Lodging Houses. The Public Health Committee held a Special Meeting on 13th June for the licensing of Common Lodging Houses. The following 5 Common Lodging Houses were licensed to 30th June, 1934, subject to certain requirements of the Borough Council being carried out:- (1) 65, Bow Lane-Sidney Moore (40 men). (2) 196, Bow Road-Mrs. Elizabeth Betts (56 men). (3) East London Hostel, Garford Street (Salvation Army)-Edward J. Higgins (294 men). (4) 378, Old Ford Road-Mrs. Elizabeth Hooper (18 men). (5) 38, Pennyfields-Thomas Alfred Felton (43 men). 29 The application for licensing for a sixth common lodging house, viz., 207, High Street, Poplar, was withdrawn as the premises had been sold for housing purposes. 88 inspections of Common Lodging Houses and 4 night inspections were made in 1933. Licensing of Seamen's Lodging Houses. The Public Health Committee licensed the following four Seamen's Lodging Houses (subject to the carrying out of certain works) to 30th June,1934:- No. of Premises. Licensee. Men. 411, East India Dock Road, The Rev. Samuel King (The Poplar National Sailors' Society) 22 The Queen Victoria Seamen's The Rev. Thomas Athey EmbleRest, Jeremiah Street, ton (The Seamen's Mission) 115 Poplar 75, Garford Street, Poplar Arthur Pederson 7 235, West Ferry Road, Poplar Herbert Edward Barker (The British Sailors' Society) 12 22 inspections of Seamen's Lodging Houses were made in 1933. Seamen's Lodging Houses. During the course of his duties, the Sanitary Inspector has found several houses where one or two seamen had been lodged. An Order in Council, dated 13th June, 1917, stated that, none but persons licensed in pursuance of the Byelaws shall ''keep Seamen's Lodging Houses, or let lodgings to Seamen in the District of the Administrative County of London, or in any part thereof." In addition to being warned by the Inspector, 5 persons were written to by the Town Clerk, upon the instructions of the Public Health Committee, calling their attention to the Order in Council. 30 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 1933. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male. Female. Total. Bakehouses (Factories) 55 - 55 216 113 - - - Bakehouses (Workshops) 20 - 20 75 42 - - - Bakehouses (Domestic Workshops) 2 - 2 6 4 - - - Factories (Laundries and Miscellaneous Factories) 110 120 230 392 36 7 2 - Laundries (Workshops) - 2 2 2 - - - - Laundries (Domestic Workshops) - - - - - - - - Workshops 197 81 278 360 25 6 - - Workshops (Domestic) 17 - 17 31 4 1 1 - Workplaces 370 27 397 929 88 12 3 - Workplaces (Domestic) 45 - 45 114 9 3 1 - Places where food is sold or prepared 823* - 823 1511 366 - - - Milk Premises 109 - 109 319 1 - - - Cowsheds 3 - 3 27 - - - - Slaughterhouses (a) 8 - 8 42 33 - - - Other offensive trade premises 5 - 5 67 2 - - - Ice Cream premises 189‡ - 189 345 4 - - - Homeworkers' premises 15 493 508 496 1 - - - *Power is used in 88 of these premises. ‡ ,, ,, 32 ,, ,, (a) Includes three registered Slaughterers of Poultry. (Lists of Slaughterhouses and other offensive trade premises are given on page 36.) 31 Table C. factories, Workshops, Laundries, Workplaces and Homeworkers. i .—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Intimation. Statutory. Final. Factories (Including Factory Bakehouses and Laundries) 608 149 7 2 - Workshops † (Including Workshop Laundries.) 437 67 6 — — Domestic Workshops‡ 37 8 1 I — Workplaces 929 88 12 3 — Domestic Workplaces 114 9 3 1 — Places where food is sold or prepared§ 1511 366 - - — Homeworkers' Premises 496 1 - - - Total 4132 688 29 7 - †Including Workshop Bakehouses. ‡Including Domestic Bakehouses and Laundries. § The inspections of factories where food is prepared are included. Power is used in 88 of the premises. 2.—DEFECTS FOUND.* (Corresponding figures for 1932 are shown in brackets). Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H .M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Act: Want of cleanliness 639 (580) 638 — - Want of ventilation 1 (—) 1 — - Overcrowding 1 (—) 1 — - Want of drainage of floors 3 i —) 3 — - Other nuisances 100 (112) 106 — - Sanitary accommodation insufficient 2 (5) 2 — - unsuitable or defective 32 (23) 32 - - not separate for sexes 9 (4) 8 - - Offeences under the Factory and Workshop Act:- Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirement for bakehouse (ss. 97 to 100) Other offences (Excluding offences relating to outwork which are included in Table D of this Report.) 16 — 16 — Total 809 (724 791 16 - *These defects refer to premises as mentioned above under table of Inspection. 32 Nature of Work, Outworkers' List (Section 107). Prosecutions. Outwork in unwholesome premises. (Section 108). Outwork in infected premises, (Sections 109, 110). Table D.—Home Work. | | Lists received from Employers. Notice served on Occupiers as to keeping or sending lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 1101. Prosecutions (Sections 109, 110). Twice in the year. Once in the year. b ailing to keep or permit inspection of list. Failing to send lists. 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. 66 11 152 2 — 3 69 Cleaning and Washing .. Household Linen Lace, lace curtains and nets Curtains and furniture hangings .. Furniture and Upholstery.. Electro-plate File Making Brass and Brass Articles .. Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys .. Umbrellas, etc. Artificial Flowers .. 30* Nets, other than wire nets Tents Sacks Racquet and Tennis Balls.. Paper,etc.,Boxes, Paper Bags 8 — 50 — — — 8 Brush Making Pea Picking Feather Sorting Carding,etc. ,of buttons,etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas Crack ers, Chrisatmas Stockins, etc. Textile Weaving Miscellaneous 8 - 27 2 - 7 20 Totals 82 11 229 4 - 19 97 - - - - 30 - - 33 list of outworkers, factory and workshop act, 1901 (s. 107). 1933 Number of Lists received. Number of Addresses of Outworkers. Class of homework. Due Feb. 1st. Due Aug. 1st. Forwarded to other Authoriti es. Received from other Authorities. Total No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Due Feb. 1. Due Aug. 1. Due Feb. 1. Due Aug. 1. 44 114 42 136 221 247 253 243 Tailoring 33 74 31 83 \ Shirt making i 1 1 1 Miscellaneous 5 11 5 23 y 221 247 253 243 Boxes 4 27 4 23 Overalls 1 1 1 6 1 Table E. Registered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at the end of the year. (1) Number. (2) Important classes of workshops, such as workshops, bakehouses may be enumerated here. Bakehouse Workshops 20 Bakehouse Domestic Workshops 2 Laundries Workshops 2 Laundries Domestic Workshops - 278 Domestic Workshops 17 Workplaces 397 45 Places where food is sold or prepared 823† Total number of workshops and workplaces, etc., on Register 1784 †Power is used in 88 of these premise. Table F. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133).. 16 Action taken in matters referred by H.M. Inspector as remedi- Notified by H.M. Inspector 9 able under the Public Health Reports (of action taken) sent to act under the Fac- tory and Workshop Act(s.5) 7 (1 in 1934) Other Communications) 21 Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year 20 34 Smoke Abatement. 59 observations were made and 17 nuisances recorded. 33 complaints were received from the London County Council. 6 intimations and 2 notices were served. In addition, 7 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 is still receiving the attention of the Borough Electrical Engineer and the Electricity Committee of the Council. Houses Let in Lodgings. The report of the Inspector is given on page 27. Offensive Trades. Three applications to establish anew offensive trade businesses, have been dealt with during the year. These applications arose on account of major extensions or alterations in connection with businesses which had been already approved by the London County Council. Subject to the carrying out of certain works, the three applications were sanctioned:— (1) Dresser of Furskins at 43, White Post Lane. (Order granted to 31st March, 1937.) (2) Dresser of Furskins at 10-16, Aberfeldy Street. (3) Dresser of Furskins at 184, Bow Road. (Order granted to 31st December, 1934, only.) 35 The following are the offensive trade premises in the Borough:— Address. Proprietors. Business. 80, Whitepost Lane Sheppy Glue & Chemical Co. Fat melters. 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 December, 1934. ** Licence expires 31st March, 1937. Slaughter of Animals Act, 1933. This Act, which provides for the "humane and scientific slaughter of animals and for purposes connected therewith" received the Royal Assent on 28th July, 1933, and came into operation on 1st January, 1934. Under its provisions slaughtering and stunning in a slaughterhouse or knacker's yard is prohibited except by licensed slaughtermen. The powers under this Act were delegated to the Public Health Committee and the Medical Officer of Health, and Messrs. C. A. Grabham and H. A. Pearce were appointed Officers for the purposes of the Act. Upon the recommendation of the Public Health Committee, the Council agreed that Section 1 of the Act should be applied to Sheep, Ewes, Wethers, Rams and Lambs. (The necessary notices were being given early in 1934.) With regard to licensing of slaughtermen, the Committee agreed that primary licences be granted for a period of three years at a fee of 2S. and subsequent renewal be made at a fee of is. Twelve licences were issued early in 1934. Slaughter of Animals by Mohammedans.—The Public Health Committee authorised the Medical Officer of Health to issue, on personal application, "occasional" licences for a period of 14 days at a fee of 6d. Applicants, when applying for licences, must state where and at what time it is proposed to slaughter animals. 36 Slaughterhouses. 1. Bow Lane (West side).—Messrs. Henry Wickes & Sons, Ltd. 2. 220, Roman Road.—Mr. Arthur Edmund Fisher. On condition that the slaughtering of cattle on the premises was limited to the requirements of the shop attached to the premises. 3. 288, Roman Road.—Mr. Charles Valentine Applegate. On the undertaking of the Licencee to kill small cattle only at these premises. 4. 114, Tredegar Road.—Mr. Arthur Charles Tozer. 5. 48-50, West Ferry Road.—Mr. John William Faulconbridge (trading as J. Faulconbridge & Son). For number of Inspections, etc., see Table A, page 30. MiIkshops, Dairies, etc. The premises are reported upon on page 66. Rag and Bone Dealers. Legal proceedings were taken against a rag and bone dealer for infringing the byelaws made by the London County Council under Section 9 of the London County Council (General Powers) Act, 1908, and the defendant was fined 20s. or five days' imprisonment. 5 letters of caution were sent to other persons but in 2 instances the letters were returned by the Postal Authorities marked "not known." In 2 other cases replies to the effect that the addressees were not connected with the rag and bone trade were received. It has been found in practice that some itinerant dealers have given false names and addresses and in one instance the assistance of a police officer was sought to confirm information about which the sanitary inspector was doubtful. Licensed Premises Urinals. 25 urinals on licensed premises were found to be in insanitary condition and were subsequently cleansed. Water Certificates. Eight certificates regarding 161 houses and flats were issued under Section 48 of the Public Health (London) Act, 1891. 37 Stables. 171 stables were inspected and reported upon, the total number of inspections being 580. The following infringements of the Bye-laws were dealt with:— Accumulations of manure, or premises otherwise not clean 39 Floors not properly drained 2 Dung receptacles:— (a) Not provided 10 (b) Defective 9 (c) Not covered 2 Other defects 21 66 intimations were served, followed by 8 notices and 2 final notices. 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 licences being granted, and all storage premises are kept under supervision and periodically inspected. Rats and Mice (Destruction) Act, 1919. When a complaint is received, the sanitary inspector visits the premises and if there is evidence of rat infestation, poison in the form of red squill baits is issued. Drains are tested and dealt with as circumstances require. The number of complaints received during the year was 83. No notices were served under the Rats and Mice (Destruction) Act, I9I9- Enquiries are now made of tenants complaining of rats as to the presence of black rats and any rats caught are kept for inspection by the 38 sanitary inspectors. Up to the time of writing no black rats have been found in the borough. At the suggestion of the Public Health Committee of Bethnal Green, our Public Health Committee agreed to co-operate in a concerted rat campaign. The plan proposed was for the Councils of Hackney, Poplar, Shoreditch, Stepney and Bethnal Green, to arrange special rat weeks, viz., the first weeks in February, May and August, and National Rat Week in November. At these periods baits were to be laid in the sewers in the Borough. This action was approved by the Council and baits were laid in the sewers during the year as follows:— Date. Baits laid. Baits taken. February 1,934 1,160 May 1,600 1,000 August 3,320 1,746 November 3,800 1,732 Tne council did not agree with the suggestion that sewers should be gassed. 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. Although visits have been paid to premises where rag flock may be in use, there was none on any of the premises at the time of the inspectors' visits. Consequently, no samples of rag flock have been procured for analysis. Rags—Certificates. At the request of a certain firm dealing in wiping rags, certificates that the rags have undergone a cleansing process are issued after inspection 39 by an officer of the department. A fee of £5 5s. is paid for inspection and the granting of certificates up to 70 with an additional is. 6d. for each certificate in excess of that number. During the year go certificates were issued. Hairdressers' Premises. The number of inspections of hairdressers' premises was 106. Cleansing was necessary at 5 of the premises, and other nuisances found numbered 14. 13 intimations, 3 statutory notices and 1 final notice were served. The requirements of these documents were complied with. In one instance a letter was sent to a proprietor calling attention to the need for a sufficient supply of clean towels, etc., to be kept. Canal Boats. During the year only 3 inspections were made, as follows:— "Westcliff"—not registered, nor liable to be registered under the Canal Boats Acts. ''Warsaw''—registered Ware 75. Everything in order. "Tyne"—registered Brentford 430. No contraventions of the Acts, etc. As mentioned in a previous report, very few vessels of the canal boat type now ply on the canals in the borough. Exhumations. Under a Home Office Licence a body was exhumed in the Tower Hamlets Cemetery and re-interred in another grave. The District Sanitary Inspector was present to see that the terms of the Licence were complied with. 40 LEGAL PROCEEDINGS. Public Health (London) Act, 1891, Metropolis Management Acts, etc. Address. Nature of Complaint. Result. Inspector. 17, Jodrell Road First floor landing ceiling defective Work done. Summons withdrawn on payment of £2 4s. costs. Smith, F. A. 27, Lyal Road Ground floor front and back rooms damp and kitchen walls and ceilings dirty 14 days order; £1 penalty; £2 6s. costs Smith, F. A. 9, Dewberry Street Copper flue pipe defective and dangerous. No gutter to roofing over yard 7 days' order; £2 penalty; £2 8s. costs Johnson, W. 22, Mellish Street Rainwater pipe from roof gutter defective £2 penalty; £2 2s. costs Langley, H.J. 72, Guildford Road Roof defective 14 days' order; £2 penalty; £2 8s. costs Colborne, W.J. 6, Ship Street Main roof defective Work done; Summons withdrawn on payment of £2 5s. costs. Dove, A. 46, Manchester Road Main roof defective £5 penalty; £3 3s. costs Dove, A. 49, Willis Street Various defects Work done; £2 penalty; £2 2s. costs Johnson, W. 188, Devons Road Various defects Work done; £5 penalty; £2 2s. costs Westbrook, C. 8. 104, Glengall Road Various defects 28 days'order; £2 8s. costs Dove, A. 106, Glengall Road Various defects 28 days'order; £2 8s. costs Dove, A. 110, Glengall Road Various defects 28 days'order; £2 8s. costs Dove, A. 112, Glengall Road Various defects 28 days' order; £2 8s. costs Dove, A. 84, Devons Road Various defects Work done; Summons withdrawn on payment of £2 5s. costs Westbrook, C. S. 5, Arnold Road Various defects 7 days' order; £2 8s. costs Westbrook, C. S. 6, Blackthorn Street Main roof and first floor front and back rooms ceilings defective 14 days'order; £2 penalty; £2 8s. costs Westbrook, C. S. 33, Marshfield Street Various defects 7 days' order; £2 8s. costs Dove, A. 33, Marshfield Street Failed to provide a proper and sufficient ashpit £3 penalty; £2 2s. costs Dove, A. 2, Stratfield Road Failed to amend the drains £5 penalty £15 15s. costs Westbrook, C. S. 4, Stratfield Road Failed to amend the drains £5 penalty 6, Stratfield Road Failed to amend the drains £5 penalty 8, Stratfield Road Failed to amend the drains £5 penalty 44, Sabbarton Street Various defects 14 days' order; £2 8s. costs Colborne, W. J. 41 Address. Nature of Complaint. Result. Inspector. 42, Sabbarton Street Various defects 14 days' order; £2 8s. costs Colborne, W. J. 40, Yesey Street Main roof and flooring of first floor back addition room defective Work done; £2 5s. costs Colborne, W.J. 40, Vesey Street W.C. soil pan broken Work done; £2 5s. costs Colborne, W.J. 122, Kerbey Street Various defects 7 days' order; £3 penalty; £2 8s. costs Colborne, W.J. 33, Jodrell Road First floor front room roof and staircase ceiling defective; walls and ceiling of staircase dirty Summons dismissed; £2 2s. costs against Council. Magistrate held the work was done prior to issue of summons Smith, F. A. 14, Mauve Street Various defects £1 penalty; £2 8s. costs Johnson, W. 157, Brunswick Road First floor front room walls and ceiling and ground floor front room fireplace defective Summons withdrawn; work done; £2 5s. costs Johnson, W. 69, Willis Street Gully in yard defective Work done; £2 5s. costs Johnson, W. 37, Pennyfields Ground floor back addition skylight defective, ceiling damp and scullery wall damp 7 days' order; £2 8s. costs Colborne, W.J. 46, Sabbarton Street Various defects 7 days' order; £2 penalty; £2 8s. costs Colborne, W.J. 5, Addington Road Ground floor off-room sink waste-pipe obstructed and defective, causing dampness in basement kitchen wall Work done; £2 5s. costs Kelly, S. 92, Upper North Street Main roof, first floor front room ceiling and passage floor defective Work done; £2 5s. costs Colborne, W.J. 10, Wansbeck Road Back addition rainwater pipe, main roof and steps leading to front door defective Work done; £2 5s. costs Kelly, S. 45, East Ferry Road Main roof defective and other defects 7 days' order; £2 8s. costs Dove, A. 49, East Ferry Road Basement back room ceiling plaster defective and dangerous 7 days' order; £1 Is. costs Dove, A. 49, East Ferry Road Main roof and gutter, rear gutter and washhouse roof defective 7 days' order; no costs Dove, A. 113, Upper North Street Various defects 14 days' order; £5 5s. penalty; £2 8s. costs Colborne, W.J. 26, Aberfeldy Street (Houselet-in-lodgings) First floor front and back rooms overcrowded 14 days' order; £1 penalty; £2 8s. costs Luke, H. W. 42 London County Council Byelaws with Respect to Houses Divided into Separaate Tenements. Address. Nature of Complaint. Result. Inspector. 42, Devas Street Failed to cleanse lodging house before 30th April £5 penalty; £1 Is. costs Luke, H. W. 42, Devas Street Window cords and fittings not kept in good order £2 penalty; £1 Is. costs Luke, H. W. London County Council Byelaws made under the London County Council (General Powers) Act, 1908. Defendant. Offence. Result. Inspector. T. L., of Stratford Distributed toy pistol in exchange for rags outside Harbinger Road School £1 penalty or 5 days' imprisonment Dove, A. (Note.—Letters of caution were sent in five other instances.) London County Council (General Powers) Act, 1922. Address. Nature of Complaint. Result. Inspector. 70, Guildford Road Walls and ceiling of first floor back room verminous £2 penalty; £2 2s. costs, or 21 days' imprisonment Colborne, W. J. et food and Drugs (Adulteration) Act, 1928. Article. Result of Analysis, etc. Result. Inspector. Milk 33% deficient in fat £1 Is. costs Grabham, C. A. Salicylic Ointment 25% deficient in salicylic acid £7 penalty; £5 5s. costs Pearce, H. A. Milk (3rd portion sent to Government Analyst) 23% deficient in fat £5 5s. costs Grabham, C. A. Milk 10% deficient in fat £2 penalty; £2 2s. costs Pearce, H. A. (3rd portion sent to Government Analyst.) Sulphur Ointment 10%deficient in sulphur Summons dismissed on "Warranty" defence Pearce, H. A. V inegar 20% deficient in acid £2 2s. costs Grabham, C. A. Milk 9.4% added water £2 2s. costs Grabham, C. A. Fresh Meat Sulphur dioxide 100 parts per million £2 penalty; £2 2s. costs Grabham, C. A. Milk 10% deficient in fat 10s. penalty; £2 2s. costs Pearce, H. A. Milk 4.7% added water £1 Is. penalty; £2 2s. costs Pearce, H. A. Lime Water 33% deficient in lime 10s. penalty; £2 2s. costs Grabham. C. A. Ginger Wine Ginger cordial Summonses against principal and servant issued but not served on principal, who has not been traced. Summons against servant dismissed under Probation of Offenders Act Pearce, H. A. Milk 5.8% added water £5 penalty; £5 5s. costs, or 1 month imprisonment Pearce, H. A. Milk 9.4% added water £5 penalty; £2 2s. costs, or 1 month imprisonment Pearce, H. A. (Note.—17 letters were sent to vendors in respect of other samples reported to be not genuine, etc.) 44 Milk and Dairies Acts and Order. Sold milk in street while not £2 penalty; £2 2s. costs.. Pearce, H. A. registered Sold milk from can not inscribed Summons not proceeded Pearce, H. A. with name and address (same with by Magistrate. Defendant) Pilled bottles in street .. £2 penalty; £2 2s. costs.. Pearce, H. A. Traded as a dairyman while not Summonses dismissed under Grabham, C. A. registered. Probation of Offenders Used as a dairy premises which Act were not registered (same Defendant) Aided and abetted in use of un- £2 penalty; £8 8s. costs.. Grabham, C. A. registered premises Letters of caution, etc., were sent to bottlers and dealers for infringements of the various Orders, etc., as follows:— Milk and Dairies Acts and Order 1 Milk (Special Designations) Order 4 (Four others reported to Ministry of Health and/or Essex County Council.) A letter of caution was sent to a vendor of a meat pie which was unfit for human consumption. SUMMARY OF PENALTIES AND COSTS. Penalties. Costs. £ 8. d. £ s. d. Public Health (London) Act, 1891 36 5 0 80 11 0 Metropolis Local Management Acts 20 0 0 15 15 0 L.C.C. Byelaws—Houses Divided into Separate Tenements 7 0 0 2 2 0 L.C.C. Byelaws—Rag and Bone Dealer 1 0 0 — L.C.C. (General Powers) Act, 1922 2 0 0 2 2 0 Food and Drugs (Adulteration) Act, 1928 23 1 0 33 12 0 Milk and Dairies Acts and Order 6 0 0 12 12 0 Public Health (London) Act, 1891, Sec. 47 (Unsound Food) - - Totals £95 6 0 £146 14 0 £242 0 0 45 Copy of a Return to the London County Council. Premises. No. in Borough on 31st December, 1933. No. of Inspections. No. of Prosecutions. Common Lodging Houses 5 92 Seamen's Lodging Houses 4 22 - Houses Let in Lodgings 186 927 3 Cowsheds (No. of Premises) 3 27 — Slaughterhouses 5 30* — Poultry Slaughterhouses 3 12 — Offensive Trades 5 67 — Milkshops 109 319 6+ Ice Cream Premises 189 345 — Restaurants and Eating Houses 823 1,511 — *In addition 711 visits were made in connection with the examination of carcases. †Six summonses for breaches of the Milk and Dairies Order. Smoke Nuisances. (1) No. of observations 59 (4) No. of Statutory Notices No. of nuisances 17 served 2 (2) No. of intimations served 6 (5) No. of legal proceedings— No. of cautions, etc. 9 (6) No. of convictions — (3) No. of complaints received (7) Amount of penalty and (from L.C.C.) 32 costs imposed in each case— Cleansing and Disinfection. No. of adults cleansed 105 No. of (a) After premises tious diseases.. 2245 cleansed rooms No. of children cleansed 3017 (6) for vermin 239 rooms (by P.B.C.) Water Supply to Tenement Houses. No. of premises supplied 3 No. of prosecutions— Sanitary Officers. Male. Female. No. of Sanitary Inspectors (whole-time) 14* 1 ,, ,, ,, (part-time)— - - No. of Borough Council Health Visitors (whole-time)—M. and C.W., 9; T.B., 3. No. of Borough Council Health Visitors (part-time), nil. 1 Sister-in-Charge Light Clinics (M.C.W.). No. of Voluntary Association Health Visitors, 9. *8 District Inspectors; 2 Meat and Food; 1 Houses-let-in-lodgings; 3 Housing Survey. 46 Census 1931. Total No. of houses in the No. of houses closed on notice by Borough 23,583 owner that they could not be made fit — No. of houses occupied by the No. of j (a) Erected during working classes 23,000 houses year 159 (approx.) for the working I (6) In course of (a) On account of classes tion Nil. complaints or (? Number by L.C.C.) No. of illness (P.H. No. of representations by Medical houses Act) 7,402 Officer or other person 12* inspected (6) House-to-house No. of houses included in such Housing Conrepresentations 77* solidatedRegNo. of closing Orders made 2* ulations, 1925 6,634 *2 Underground rooms. (a) Under P.H. Act: No. of (i) Intimation 5,078 No. of Closing Orders determined notices (ii) Statutory 2,204 (i.e. Houses made fit Nil. served I (b) Under Housing No. of Demolition Orders I Act 2 No. of houses repaired or No. of (a)In ance of orders 86 (plus ? nuisances remedied under P.H. houses number in Act, 1891 4,784 demolBakers Alley No. of housesr ished area by L.C.C. V repaired under (a) By owners 2 (b) Voluntarily Sec. 17 of (b) By L.A. in Housing Act, default of 1930 I owners Nil. Underground Rooms. Overcrowding. No. illegally occupied 5* No. of cases of overcrowding No. closed or illegal occupation found 40 discontinued 4 No. remedied 42 No. of prosecutions 1 *A special investigation regarding underground rooms is proceeding. 47 Section D. HOUSING. The following section on Housing has been prepared in accordance with Circular i ,346 (England) of the Ministry of Health, 1933:— STATISTICS. Number of new houses erected during 1933:— (а) Total (including numbers given separately under (b) ) 159 (i) By the Local Authority 159 (ii) By other Local Authorities 103 (iii) By other bodies or persons 6 (b) With State assistance under the Housing Acts:— (i) By the Local Authority:— (a) For the purpose of Part II of the Act of 1925 Nil. (b) For the purpose of Part III of the Act of 1925 50 (c) For other purposes Nil. 1.—Inspection of Dwelling Houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 13,703 (b) Number of inspections made for the purpose 32,672 (2) (a) Number of dwelling-houses (included under head (1) above, which were inspected and lecorded under the Housing Consolidated Regulations, 1925 6,634 (b) Number of inspections made for the purpose 8,132 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 78* * See Note on page 49. 48 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 4,823 2. Remedy of Defects during the Year without Service of Formal Notices— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 2,794 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 2 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 2 (b) By local authority in default of owners — (b) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,027 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,990 (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 — 49 (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 (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 — Of the 78 dwelling-houses found to be in a state unfit for human habitation (under heading 1 (3) of Housing Statistics, page 47): I was rebuilt by owners after they were interviewed to show cause why a Demolition Order should not be made. 74 were included in Areas dealt with under the Housing Act. 3 are under consideration. 50 Number of houses owned by the Local Authority, distinguishing those built in the last two years and held under (i) 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 ,, 544 (157 built during last 2 years) ,, „ 1930 ,, 31 (22 built during last 2 years) 786 Houses converted to tenements 35 (No State assistance) tenements 821 (2) Part II of the Housing Act, 1925:— Assisted under 1919 Act 36 1923 Act Sec. I (3) 24 60 (3) Various properties: (a) Purchased for eventual demolition, 16 houses, providing 20 tenements. (b) Purchased for alternative accommodation, 2 houses, providing 2 tenements. (c) Other properties, 7 houses. 51 Survey of District. During the year the inspection of 180 streets, comprising 6,101 houses, was completed. The following house-to-house inspections have been carried out:— Work of the Survey Inspectors. No. of houses (i). Mr. G. L. Belshaw. inspected. Addington Road 48 Alfred Street 48 Allanmouth Road 59 Atley Road 30 Autumn Street 22 Avenue Road 8 Baldock Street 6 Benworth Street 15 Blondin Street 40 Bow Road 198 Bream Street 26 British Street 64 Cadogan Terrace 62 Caxton Street 32 Claudius Mansions 18 Clayhall Road 47 Coborn Road 46 Coborn Street 17 Comboss Road 26 Craven Buildings 16 Creswick Road 7 Davey Road 21 Denbigh Road 8 Douro Street 24 Fairfield Road 102 Guerin Street 20 Harley Street 27 Hepscott Road 19 Iceland Road 5 Jebb Street 12 Kelday Road 28 Landseer Road 21 Lawrence Road 36 52 No. of houses (1). inspected. Lefevre Terrace 14 Leonards Buildings 24 Malmesbury Road 174 Maverton Road 36 Merchant Street 11 Mitford Terrace 7 Monier Road 104 Mostyn Road 1 Old Ford Road 141 Payne Road 3 Ridgdale Street 48 Rothbury Road 53 Spring Street 19 Stour Road 12 Summer Street 16 Trego Road 55 Trellis Street 16 Wallis Road 17 Wansbeck Road 57 Waterden Road 1 Whitepost Lane 41 Wick Lane 3 Wick Terrace 4 Wrexham Road 32 Total houses inspected 2,047 Total visits 2,536 (Number of nuisances referred to D .S .I's.—291.) (2) Mr. C. H. Brown. Abbott Road 170 Aberfeldy Street 23 Andrew Street 16 Athol Street. 1 Bow Lane 41 Bow Lane Almshouses 6 53 No. of houses (2). inspected. Bright Street 31 Bromley Hall Road 51 Brunswick Road 134 Brunswick Street 42 Burcham Street 71 Byron Street 53 Clutton Street 1 Cobden Street 20 Coldharbour 29 Cotton Street 65 Desart Street 18 Dewberry Street 26 Duff's Fields 1 East India Dock Road 144 Ettrick Street 26 Fairfoot Road 18 Findhorn Street 44 Gaselee Street 23 Glencoe Street 39 Gray Street 13 Greenfield Street 4 Hack Street 9 Harrap Street 16 High Street, Poplar 73 Highland Street 16 Ida Street 23 Joshua Street 24 Landseer Terrace 10 Layfield Place 10 Leven Road 93 Lochnagar Street 28 Major Cottages 1 Manisty Street 5 Mauve Street 18 Mountague Place 12 Nairn Street 46 Naval Row 17 Naval Row South 7 Newby Place 17 54 No. ot houses (2). inspected. Oban Street 57 Paradise Cottages 7 Portree Street 2 Prestage Street 37 Quixley Street 6 Railway Street 41 Robinhood Lane 14 Rounton Road 66 St. Leonards Road 135 Scouler Street 12 Susannah Street 8 Tapley Street 41 Tetley Street 48 Teviot Street 55 Ullin Street 27 Willis Street 80 Wilson Street 40 Total houses inspected 2,210 Total visits 2,614 [Number of nuisances referred to D .S.I's.—320.) (3). Mr. E.A.May. Alton Street 35 Annabel Street 18 Arcadia Street 69 Augusta Street 97 Bath Cottages 9 Bath Street 85 Birchfield Street7 Bygrove Cottages 2 Bygrove Street 100 Caledonian Cottage 1 Caledonian Terrace 4 Carmen Street 24 Carters Terrace 4 55 No. of houses (3). inspected. Castor Street 19 Charles Street 31 Chilcot Street 36 Chrisp Street 17 Church Path 1 Clifton Street 16 Cordelia Street 33 Cotall Street 19 Cottage Street 75 Cruden Place 3 Duff Street 23 Duncan Cottages 3 Elizabeth Place 13 Ellerthorpe Street 35 Ellesmere Street 76 Flint Avenue 12 Flint Street 55 Garford Street 6 Giraud Street 61 Goodliffe Place 10 Goodliffe Street 29 Grove Villas 17 Grundy Street 99 Guildford Road 56 Hale Street 28 Hillplace Street 29 Ivy Cottages 16 Jeremiah Street 20 Johnsons Buildings 9 Kerbey Street 139 Langton Street 18 Latham Street 16 Lion Street 31 Lower North Street 25 Market Street 47 Mary Place 20 Milton Place 9 Morant Street 85 Oriental Street 36 56 No. of houses (3) • inspected. Pennyfields 52 Perrys Close 8 Plimsoll Street 21 Prospect Place 6 Ricardo Street 30 Rigden Street 9 Sabbarton Street 52 Shirbutt Street 20 Southill Street 45 Sturry Street 33 Turners Buildings 5 Upper North Street 151 Vesey Street 25 Wade Street 42 Wades Place 22 Woodstock Road 34 Woollett Street 27 Total houses inspected 2,311 Total visits 2,916 (.Number of nuisances referred to D.S.I's.—328.) Summary of Survey Inspectors' Work. Year 1933. Number of houses inspected. Total number of visits. Number of urgent nuisances referred to District Sanitary Inspectors. Mr. G. L. Belshaw 2,047 2,536 291 Mr. C. H. Brown 2,210 2,614 320 Mr. E. A. May 2,311 2,916 328 Totals 6,568 8,066 939 57 In addition to the house-to-house inspections carried out by the Survey Inspectors, 66 house-to-house inspections were made by a District Inspector:— East Combined Division. St. Leonards Road 66 Summary . Houses inspected by Survey Inspectors 6,568 Houses inspected by District Inspector 66 Total 6,634 Progress of Areas. Arising from Ministry of Health's Circular 1331, dated 6th April, 1933, the Medical Officer of Health submitted to the appropriate Committee for their consideration a list of 40 areas, including 15 which have been previously considered and were referred to in the Annual Report for 1931. The list referred to approximately 872 houses, 1,563 families and 6,463 individuals. A copy of the list was forwarded to the London County Council, and subsequently representatives of the Borough Council met the Chairman of the London County Council Housing Committee and discussed the programme of slum clearance and improvement. The progress of the areas during 1933 has been as follows:— Area No. 1 (Providence Cottages, Emmett Street) .—The purchase of the lands surrounding the area was completed at the latter part of the year. It is proposed to erect 78 flats (49 two-bedroom and 29 three-bedroom type) on the site for re-housing persons in connection with clearance areas 2a, 2b, 3, 4, 10, 24, 29 and 32. Area Nos. 2a, 2b, 3, 4a and 4b. (Note.—Original areas 2 and 4 were split into areas 2a and 2b and 4a and 4b.) Re Nos. 2a, 2b and 4b (Silver Lion Court, Pennyfields, Surrey Place West).—The Council resolved to deal with these areas by Clearance Orders. 58 Re 3 and 4a (Collins Place and Commodore Court).—The Council were of opinion that these sites should be developed for housing purposes and made Compulsory Purchase Orders in respect of these two areas, together with adjoining lands. Area No. 5 (Ranwell Street).—In the quinquennial statement prepared in 1930, this area was submitted for consideration by the London County Council as a Clearance Area. On 25th July, 1933, the London County Council declared two areas in the vicinity of Ranwell Street to be Clearance Areas. These areas comprised 37 houses. The London County Council also made Compulsory Purchase Orders to acquire other property in the immediate neighbourhood. A Ministry of Health Inquiry into the subject matter of these Orders was held at the Council Offices, High Street, Poplar, on 10th January, 1934. Area No. 6 (Benworth Street).—Completed in 1932. Area No. 7.—No developments. Area No. 8.—Representations have again been made to the London County Council that this Area, in conjunction with surrounding property, should be dealt with by that Authority, and that the matter should be regarded as ' 'Urgent.'' The London County Council intimated that they were not prepared to deal with this area. The matter is receiving the earnest attention of the Borough Council. The question of re-housing is the most difficult problem, as three of the houses accommodate approximately 143 persons. Area No. 9 (Prospect Place).—Following upon the Borough Council's declaration of Nos. 1-12, Prospect Place to be a Clearance Area, a Ministry of Health Inquiry as to confirmation of a Compulsory Purchase Order was held at the Council Offices on 28th March. On 6th May, the Minister of Health issued the ' 'Metropolitan Borough of Poplar (Area No. 9) Housing Confirmation Order, 1933." Area No. 10 (Clifton Street).—In October, 1933, the Council resolved to make a Compulsory Purchase Order regarding this area, and to lay out the land as an open space. Areas Nos. 11, 12, 13 and 14.—No developments. 59 Area No. 15 (Old Ford Road).—This site was cleared in 1932. A scheme has now been prepared for the erection of 18 flats (12 two-bedroom and 6 three-bedroom type). It is intended to use the accommodation in connection with area No. 21—Prince Arthur's Avenue. Area No. 21 (Prince Arthur's Avenue).—In November the Council declared this area a Clearance Area, and made a Compulsory Purchase Order to acquire other property in the immediate neighbourhood. Area No. 24 (Ulmar Place). Area No. 29 (Cruden Place). Area No. 32 (The Retreat, St. Leonards Road). In October the Council made Clearance Orders in respect of these areas. A Ministerial Inquiry into the subject matter of the Compulsory Purchase Orders for Areas 3, 4a, 10 and 21, and Clearance Orders regarding areas 2a, 26, 46, 24, 29 and 32 was held at the Council Offices, Poplar, on 16th and 17th January, 1934. The Clearance Orders and the Compulsory Purchase Orders were confirmed by the Minister cf Health 17th and 18th April, 1934. (Modifications in respect of Collins Place, etc., and Commodore Court, etc.) Progress of Other Areas (London County Council). (a) West Ferry Road (East Side).—On 4th April, 1933, the London County Council resolved to make a Clearance Order regarding 1,2,3 and 4, Laura Cottages, 1,2,3 and 4, Ingleheim Place, and Nos. 337 to 355 (odd), West Ferry Road. (The greater portion of the area had been acquired by the London County Council and two blocks of dwellings were in course of erection.) It was intended to deal with the remainder of the area by Clearance Orders. On 17th June, 1933, the Minister of Health issued the County of London (West Ferry Road) Housing Confirmation Order, 1933. 60 (b) Oliver Court, Nos. 1-16.—Minister of Health Inquiry regarding the Confirmation of the London County Council Clearance Order was held at the Council Offices, Poplar, on 5th April, 1933. On 26th May, 1933, the Minister of Health issued the “County of London (Oliver Court) Housing Confirmation Order, 1933." (c) Baker's Alley.-—This site has been cleared by the London County Council and is in course of development. Part of the accommodation is to be utilised for re-housing persons from the Ranwell Street Area. Individual Houses. (a) No. 103, Brabazon Street and 55, Barchester Street.—Notices under Section 17 of the Housing Act, 1930, were served upon the owners. Following a conference between the owners and officers of the Council, the necessary works were carried out by the owners. (b) Underground Rooms Used for Sleeping Purposes.—Under the provision of Section 20 of the Housing Act, 1930, Orders prohibiting the use of underground rooms for sleeping purposes were made by the Council regarding the following premises:— 4, Hale Street—Back basement room. 92, Suffolk Street—Front basement room. Overcrowding. During the year 40 new instances of overcrowding were officially recorded. Twenty-six of the more serious cases were reported to the Public Health Committee. Twenty-two 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. Legal proceedings were instituted against the owner of one house where after a family had been re-housed by the Borough Council, on account of overcrowded conditions, certain rooms were re-let to another family, allowing the premises to be still overcrowded. The Magistrate made an 61 Order for the abatement of the nuisance in 14 days, inflicted a penalty of £1 and gave the Council £2 8s. costs. In two further cases, upon the instructions of the Public Health Committee, intimations were served upon the persons responsible. In one case the owner himself took proceedings against a sub-tenant and obtained possession. In the second case Statutory Notices were subsequently served. The tenant has obtained a Magistrate's Order which has to be complied with early in 1934. Nine of the 40 cases, and also 33 cases officially recorded in the past few years, have been abated. In one further case the overcrowded conditions have been eased. The overcrowding was abated or eased as follows:— Abated. Eased. Re-housed by L.C.C. 5 (4) — P.B.C 8 (6) — Other accommodation found 29 (23) 1 42 (Numbers in brackets are cases recorded prior to 1932.) In cases where overcrowding has been abated or eased by rehousing, letters are sent to responsible persons calling attention to the fact that overcrowding is a nuisance, and should the premises again become overcrowded the facts will be reported to the Public Health Committee. Accommodation provided during 1933. The number of families rehoused during the past year was as follows:— Families Number of accompersons modated. (approx.). (a) By the Poplar Borough Council in:— (1) Newly erected houses or flats 50 300 (2) Adapted buildings — — 62 Families Number of accom- persons modated. (approx.). (3) Vacancies re-let:— (a) New properties 30 (b) Adapted or miscellaneous properties 3 — 33 192 (b) By the London County Council:— (1) By nomination 49 196 (2) By direct application:— (а) New tenements 538 (б) Rehousing accommodation 153 691* Total 823 *It is not possible to give the approximate number of persons accommodated under this heading. Verminous Rooms (L.C.C. (General Powers) Act, 1922). 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. 239 rooms were sprayed with Solution "D " or fumigated with sulphur, etc. A fluid insecticide is issued at the Disinfectant Depots, and sprayers loaned to tenants in order to rid rooms and contents of bugs. 351 gallons of insecticide were distributed during the year. Bug Infestation. Bug infestation is referred to in the special report which was printed as an Appendix in the Annual Report for 1932. This subject received the attention of the Public Health Committee on 10th June, 1933, when the Medical Officer of Health submitted the following statement: "The Medical Officer of Health reminds the Committee that on 6th June, 1932, they received a report on 'Bug Infestation' in which reference 63 was made to the difficulties experienced in ridding dwelling-houses of bugs. Although this is a problem which affects Local Authorities-both as Sanitary Authorities and Housing Authorities, owners of dwellinghouses and tenants—it is only within recent years that the attention of scientists has been directed to the problem, but most of the work done has been carried out in laboratories, or in connection with insect pests in foodstuffs. For the destruction of bugs, many insecticides are being tried,but it would appear that none of them up to the present have been entirely satisfactory, although Hydrocyanic Acid gas promises to be more effective than any, but more experimental work on bug-infested dwelling-houses will have to be carried out to ascertain what general control is necessary before this gas can be used with safety. The whole question of disinfestation and fumigation requires further investigation. The problem of ridding dwelling-houses of bugs is surely of sufficient importance to receive the consideration of the Ministry of Health who might institute an enquiry; if necessary, conduct investigations, and issue an authoritative statement for the guidance of Local Authorities and others concerned.'' The Committee adopted the statement of the Medical Officer of Health and agreed to recommend the Council to submit the suggestions to the Metropolitan Boroughs Standing Joint Committee with a view to that Committee approaching the Ministry of Health. Subsequently, the Committee were informed that on the 18th August a letter was received from the Ministry of Health referring to a Departmental Committee which had been recently appointed to review the position and, if necessary, to submit proposals for further experimental work with a view to devising a satisfactory method which could safely be recommended to Local Authorities for the eradication of bugs in working-class houses generally, and in houses which had been provided by local authorities under the Housing Acts. This Departmental Committee had decided to ascertain what information was available as to the extent of the problem of infestation by 64 bugs and what measures had been or were being taken for eradicating them in the administrative County of London and in the County and Metropolitan Boroughs, and asked for certain information regarding the Borough of Poplar. The Committee were informed that a comprehensive reply had been sent to the Ministry of Health on 25th August. At the request of the Secretary of the Departmental Committee, copies of Dr. Young's report of June 1932, which appeared as an Appendix to the Annual Report, had been forwarded to the Ministry of Health for the information of the Committee. During the year 310 complaints were received in respect of 280 premises of which 28 were owned by the Council. In 16 of these latter woodwork was stripped before spraying with solution "D" or fumigating with sulphur or "Cimex." The 28 premises were all sprayed with solution "D" and in 4 instances bedding also was disinfested. Further, in 9 other houses owned by the Council, woodwork was stripped and rooms sprayed in consequence of verminous conditions discovered by Council's workmen during periodical cleansing of, premises. The total number of Council properties dealt with was 37. In addition to the above action, 14 orders each for one half-pint of vermicide were issued to Council tenants for use in houses where only a single bug had been seen, or for use as a precautionary measure against re-infestation. 249 certificates relating to verminous premises were submitted to the Public Health Committee. It has been noticed that in some infested houses bugs harbour under the wooden casings of electric light wires. This method of protecting electric light wires affords an ideal retreat for bugs, and, as occasion arises, the Electricity Department now takes the opportunity of replacing wooden casings with metal tubing which is less suited to the habits of the bug. The Standard of Domestic Cleanliness. In spite of the practical application of the advances made in preventive medicine, a considerable amount of ill-health and suffering prevails. Some of this is due to the neglect of the most elementary of all rules of hygiene, namely, the need for cleanliness. The freer use of soap and 65 water, neither of which is expensive, would do much to improve the conditions of many homes and to a certain extent prevent some of the septic conditions and intestinal disorders met with in individuals of all ages. It must not be inferred that all houses in Poplar are dirty—far from it—for I have visited many very poor homes where the floors, furnishings (such as they were), and bedding were spotlessly clean, proving that poverty is no bar to cleanliness. While some believe that conditions are no worse than they used to be, in my opinion there is still much work to be done in order to raise the standard of general cleanliness and to impress on some mothers the need for frequent and methodical cleaning of the home. The Health Visitors and Inspectors have this constantly in mind when carrying out their routine duties; tactful suggestions on the part of the staff have effected much, but some cases seem to call for action on the part of the local authority. Increase of Rent and Mortgage Interest (Restrictions) Acts. 13 certificates were issued to tenants. On applications of owners, 7 certificates that the work had been done were also issued. 10, Alton Street. 10, Alton Street. (At request of owner.) 55, Kelday Road. 8, Addington Road. (At request of owner.) 557, Manchester Road. 67 Stebondale Street. (At request of owner.) 29, Wansbeck Road. 77, Lefevre Road. 40, Northumberland Street. (At request of owner.) 58, Kerbey Street. 33, Jodrell Road. 9, Guildford Road. 109, Sussex Street. 4, Wendon Street. 33, Jodrell Road. (At request of owner.) 27, Guildford Road. 4, Glaucus Street. 71, Libra Road. 47, Barchester Street. (At request of owner.) 4, Wendon Street. (At request of owner.) 66 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 protected from contamination. MILK SUPPLY. (a) Cowsheds. The 3 cowsheds in the Borough have been visited and inspected on 27 occasions. One intimation was served in respect of want of cleanliness and the necessary cleansing was carried out. Applications for licences were considered by the Public Health Committee, as follows:— 1. 213, Grundy Street—Mr. Edgar Ernest Culshaw—licensed to keep 17 cows. (Note.—Early in 1934 this Licence was transferred to Mr. Hugh Pritchard Williams.) 2. 17-19, Morville Street—Mr. John Henry Chandler—licensed to keep 19 cows. 3. 48, St. Leonard's Street—Mr. Charles Robert Neall. No. 1 Shed licensed for 19 cows to 30th June, 1934, subject to certain works being carried out by the next licensing meeting; No. 2 Shed not licensed. (b) Dairies and Milkshops. During the year 3 premises were registered as dairies and one registration was cancelled. At the end of the year there were in the Borough 109 registered premises where raw milk is sold. These premises were kept under strict observation, 319 inspections being made. The standard of cleanliness in cowsheds, milkshops and other premises where milk is dealt with has been well maintained. 23 persons (including 8 itinerant vendors) were registered as retail purveyors of milk, 11 of these being on account of change of ownership of premises. 67 The following also were registered during the year:— 58 Retail Purveyors of Sterilized Milk in Sealed Bottles. (35 on account of change of Ownership.) 5 Retail Purveyors of Raw Milk in "Sealcones" (1 on account of change of Ownership.) 10 Retail Purveyors of Milk in Sealed Bottles (5 on account of change of ownership.) Milk (Special Designations) Order, 1923. During the year the following licences under the above Order were issued:— Certified Milk. 5 Licences for the sale of "Certified" Milk. 3 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. 9 Bottling Establishments. 21 Dealers in Sealed Bottles only. 7 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. 7 Licences for the sale of ' 'Pasteurised'' Milk. 5 Supplementary Licences for the sale of "Pasteurised" Milk . 89 BACTERIOLOGICAL EXAMINATION OF MILK. Number of Samples Examined foe Bacteria (Total Count and B.Coli)—81. Designated Milk. Where taken: Number satisfactory. Number unsatisfactory. Action taken. On delivery at— From Dealers— Railway Stations. L.C.C. Hospitals, and OpenAir School Before bottling. After bottling. Grade "A" (Tuberculin Tested) 14 - 13(1) -27 (2) 51 3 1 letter of caution sent; 1 letter to vendor; 2 reported to Ministry of Health and to County Medical Officers of Health. Pasteurised - 10(1) 1 10(2) 18 3 1 further sample taken— satisfactory; 2 letters of caution sent. Certified - - - 2(2) - 2 2 reported to Ministry of Health. Grade "A" - - - 4 4 - - Totals 14 10 14 43 73 8 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—31. Number reported: Remarks. Tubercle bacilli absent. Tubercle bacilli present. Examination incomplete. Designated Milks:— Certified 2 - - - Grade "A" 4 - - - Grade "A" (Tuberculin Tested) 8 1 - One cow taken from herd. Pasteurised 4 - - - Other Milks:— Sterilised 2 - - - Bottled (from Dairies) 8 - - - ,, (from Cowsheds) 2 - - - In carton - - - - 69 The bottling establishments have been under constant supervision, and, for the purpose of renewal of licences, special inspections were made and reports submitted. Examination of Milk for Tuberculosis. In addition to the samples shown in the table on page 68, the London County Council took samples of milk for biological examination for the presence of tubercle Bacillus. Four samples were taken from a rail tank containing mixed bulk milk and three of the samples gave positive results. Samples were also taken from the licensed cowsheds in the borough and gave negative results. Milk delivered to Hospitals and the Open-Air School, Bow Road. The arrangements for taking samples at St. Andrew's Hospital, Bow Institution, and Bow Road Open-Air School, belonging to the London County Council, and at Poplar Hospital, have continued throughout the year. As the milk supplied to the L.C.C. Institutions is "Pasteurised'' milk, bacteriological examinations are carried out in addition to chemical analysis. (See table, page 68.) 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 1933 22 samples were taken at 19 schools. In one instance legal proceedings were taken for deficiency of fat, 23 per cent. The summons was dismissed and the defendant was ordered to pay £5 5s. costs. Ice Cream. During the year, 27 Owners or Occupiers were registered for the manufacture, storage or sale of ice cream. London County Council (General Powers) Act, 1932. Five applicants for registration for the sale and manufacture of Ice Cream were invited to attend before the Public Health Committee to show cause why their applications for registration should not be refused. Two of the applicants did not appear and the Committee refused to register the premises. The third applicant subsequently intimated he had ceased selling and manufacturing Ice Cream. The fourth applicant after interview was refused registration. 70 The fifth applicant was required to give an undertaking in writing that he would employ one person solely for the sale of Ice Cream outside his shop (a greengrocery business). No appeals were made against the decisions. The number of owners or occupiers now on Register is 189. 345 Inspections of the above premises were made during the year. Cleansing of premises was necessary in 3 instances; 2 other nuisances existed. 4 intimations were served, and the necessary cleansings were carried out and other nuisances abated. Bakehouses. There are 77 bakehouses in use, of which 20 are underground. In 55 bakehouses machinery is used. The bakehouses in the Borough were inspected at least twice during the year, the total inspections numbering 297. Cleansing was found to be necessary on 156 occasions, and 5 other nuisances were found. The cleansings were carried out and the nuisances abated after service of 159 intimations. Slaughterhouses. A list of the 5 slaughterhouses is given on page 36. For number of inspections, etc., see Table A, page 30, and reports of Food Inspectors, pages 71-74. The Slaughter of Animals Act is referred to on page 35. Slaughterer of Poultry. The business of a slaughterer of poultry is carried on at three premises in the Borough and inspections of these premises numbered 12. 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 823. 1,511 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 352 instances, and 21 other defects existed. 344 intimations were served and the necessary works were carried out without need for further action by the department. 71 Reports of Food Inspectors. Mr. C. A. Grabham. Totals. Inspections. Intimations. Notices. Stat. Final. No. or Inspections of: Bakehouses- Factories 97 61 - - Workshops 28 18 - - Dom. Workshops 6 4 - - Slaughterhouses 16 13 - - Cowhouses 6 - - - Milkshops 148 1 - - Restaurants and Eating Houses 116 8 - - Fried Fish Vendors and Fish Curers— Where power is used 112 187 - - Others 174 1 - - Stalls 1,184 - - - Other Places where Food is sold, etc.— Where power is used 81 2 - - Others 172 1 - - Ice Cream Premises— Where power is used 25 1 - - Others 161 3 - - Wharves, etc., where Food is prepared or stored, etc.— Where power is used 1 - - - Others 25 - - - Markets— Morning 137 - - - Evening 72 - - - Miscellaneous 108 - - - Total Defects, etc., Found. Remedied. Referred to D.S.I. Defects, etc., Found: 1. Nuisances under Public Health (London ) Act— Want of cleanliness 14 14 - Want of ventilation 1 1 - Other nuisances 27 22* 5 2. Offences under Factory and Workshop Act— Other offences 1 - - * 4 without service of Intimations. 72 Slaughterhouses: Number of Visits 397 Number of Carcases Inspected— Beasts 258 Calves 158 Sheep 954 Lambs 511 Pigs 490 Organs condemned and destroyed quent on slaughterhouse visits see list on page 75. Heads and Tongues condemned and destroyed Number of Samples procured: (a) Under Food and Drugs (Adulteration) Act 390 (b) Under Special Orders and Regulations— 28 (i) Number satisfactory 23 (ii) Number not satisfactory 5 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 117 Visits to Factories 136 Assistant's Time—Hours 575¼ 73 Mr. H. A. Pearce. Totals. Inspections. Intimations. Notices. Stat. Final. No. of Inspections of: Bakehouses— Factories 119 52 - - Workshops 47 24 - - Dom. Workshops - - - - Slaughterhouses 26 20 - - Cowhouses 21 - - - Milkshops 171 - - - Restaurants and Eating Houses 140 11 - - Fried Fish Vendors and Fish Curers— Where power is used 59 - - - Others 202 153 - - Stalls 2,292 - - - Other places where Food is sold, etc.— Where power is used 103 - - - Others 325 3 - - Ice Cream Premises— Where power is used 15 - - - Others 144 - - - Wharves, etc., where Food is prepared or stored, etc.:— Where power is used - - - - Others 1 - - - Markets— Morning 185 - - - Evening 81 - - - Miscellaneous 90 - - - Total Defects, etc. Found. Remedied. Referred to D.S.I. Defects, etc., Found: 1. Nuisances under Public Health (London) Act— Want of cleanliness 12 12 - Other nuisances 19 13 6 2. Offences under Factory and Workshop Act— Other offences - - - 74 Slaughterhouses: Number of Visits 314 Number of Carcases Inspected— Beasts 223 Calves 195 Sheep 850 Lambs 494 Pigs 514 Organs condemned and destroyed quent on Slaughterhouse Visits See list on page 75. Heads and Tongues condemned and destroyed Number of samples procured: (a) Under Food and Drugs (Adulteration) Act 408 (b) Under Special Orders and Regulations 53 (i) Number satisfactory 50 (ii) Number not satisfactory 3* Action taken in respect of unsatisfactory samples: (a) Legal proceedings - (b) Letters sent to Vendors 2 (c) Reported to appropriate Government Department, etc. - Public Health (Foreign Meat) Regulations— Certificates issued 10 Visits to Factories 7 Assistant's Time—Hours 454½ * In one instance a further sample was taken and found satisfactory. 75 Organs, Etc., Condemned as a Result of Slaughterhouse Inspections. Mr. Grabham. Mr. Pearce. Totals. Lungs: Beasts 101 82 183 Sheep 213 316 529 Pigs 134 162 296 Livers: Beasts 50* 35 85 Sheep 65 114 179 Pigs 13 22 35 Mesenteries: Beasts 36† 19 55 Pigs 18 22 40 Omenta: Beasts 12 10 22 Pigs - 6 6 Pancreas: Beasts 18 9 27 Pigs - 1 1 Spleens: Beasts 13 3 16 Sheep - 1 1 Pigs 1 4 5 Tripes: Beasts 11 6 17 Hearts: Beasts 4 5 9 Sheep - - - Pigs 1 19 20 Kidneys: Beasts 12 6 18 Pigs - 5 5 Intestines: Beasts 6 4 10 Udders: Beasts 10 14 24 Heads: Beasts 35 30 65 Pigs 9 14 23 Tongues: Beasts 35 30 65 Pigs 9 14 23 * And parts of 1. † And parts of 2. In addition to the foregoing there were condemned and destroyed, as a result of inspections at slaughterhouses:— 3 Beasts' carcases, 13cwt. 241bs. 3 Pigs' plucks, weight not recorded. 4 Briskets, 2qrs. 211bs. 3 Pigs' carcases, 2cwt. 1qr. 91bs. 1 Sheep carcase, 2qrs. 81bs. and other sundries which totalled 17cwt. 3qrs. 1-lb. The following foodstuffs were seized, or surrendered, and destroyed:— Mr. C. A. Grabham. 5 Casks Lemon Skins (lton 16cwt. 2qrs. 141bs.) 537 Bags Damaged Potatoes (17 ton llcwt. Oqrs. 01b.). 432 ½ cases Australian Dried Fruit. 17 cases Australian Dried Fruit. 27 Casks Orange Crush. 5 Casks Orange and Lemon Peel. 110 Kegs Raspberries. 286 Cartons (each 48 Jars) Assorted Meat and Fish Paste. 10 cases Oranges. 3 cases Apples. 11 cases (and odd tins) Apricots. 6 cases Plums. 9 cases Sardines (each 100 tins). 1 cases Tomatoes (24 Tins). 40 Packets Pasteurised Cheese (each 51bs.). 1 Box Skate (5st.). 2 Hindquarters Pork (22st.). 1 Pig's Liver and Lungs. 27 Fowls. 1 Box Rabbits. 76 Mr. H. A. Pearce. 54 Bags Walnuts. 46 Wild Rabbits (1171bs.). 1 Tin Beef (61bs.). 3 Boxes Kippers. 1 Bag Mussels. 1 Box Kippers. At request of Maconochies & Morton's:— 13 tins Beef, 24 tins Herrings, 49 tins Salmon, 6 tins Lobster, 34 tins Apricots, 7 tins Sprats, 25 tins Crayfish, 25 tins Cream, 13 tins Tomatoes, 1 tin Strawberries, 3 tins Pressed Pork, 13 tins Pineapple, 3 tins Tongue, 7 tins Loganberries, 15 tins Black Currants, 3 tins Asparagus, 6 tins Blackberries, 7 tins Prawns, 7 tins Pea3, 1 tin Sardines, 12 tins Parsnips, 6 tins Pimentos, 1 tin Fruit Salad, 2 tins Kipper Snacks, 3 tins Mushrooms, 3 tins Fruit. The following were released for technical purposes. 42 Casks Tallow For Grease making, etc415 Boxes Australian Dried Fruit For Cattle Food. 33 Packages Sultanas ,, ,, 10 Bags Sugar For manufacturing purposes . 5 casks Tallow For Grease making, etc. 13 Bags Wheat (12.3.0.) For Poultry and Cattle Food. 2 90/496 Damaged Wheat ,, ,, The following were released for sorting under supervision of other Authorities. 462 cases Australian Dried Fruit. 227 cases ,, ,, 53 J-cases Currants. 77 Food and Drugs (Adulteration) Act, 1928. The results of the analyses of 799 samples were reported to the Committee during the year:— Sample. Number examined, 1933. Adulterated. Action taken. Legal Proceedings. (See page 43). Letters of caution sent. Milk 382 15 7 7 ,, Sterilised 6 - - - ,, Condensed 24 - - - Cream 2 - - - Butter ,, 48 3 - 2 Margarine 46 1 - 1 Dripping 12 - - - Lard 8 - - - Shredded Suet 10 1 - 1 Mustard 4 - - - Pepper 7 - - - Malt Vinegar 2 1 - 1 Vinegar 26 2 1 1 Sauce 4 - - - Cocoa 3 - - - Coffee 2 - - - Sugars 2 - - - Coffee and Chicory 2 - - - Ground Rice 4 - - - Rice 4 - - - Pearl Barley 8 - - - Sago 2 - - - Pea Flour 2 - - - Flour 2 - - - Ground Ginger 2 - - - Baking Powder 4 - - - Oatmeal 2 - - - Cake 6 - - - Carried forward 626 23 8 13 4 78 Sample. Number examined, 1933. Adulterated. Action taken. Legal Proceedings . (see page 43) Letters of caution sent. Brought forward 626 23 8 13 Jams 14 - - - Table Jelly 8 2 - - Golden Syrup 2 - - - Tea 3 - - - Ice Cream 2 - - - Sweets 13 - - - Lemon Curd 2 - - - Ginger Wine 2 2 1 - Cider 2 - - - Cordials 13 2 - 1 Gin 1 - - Whisky 10 1 - - Bum 6 - - - Mincemeat, Fruit 2 - - - Mixed Peel 2 - - - Meat 12 2 1 - Tripe 4 - - - Breakfast Sausage 2 - - - Sausage 12 1 - 1 Brawn 4 - - - Black Pudding 2 - - - Bread and Butter 6 - - - Egg Powder 6 - - - Aspirin Tablets 4 - - - Custard Powder 3 - - - Lime-water 4 1 1 - Zinc Ointment 2 - - - Boracic Ointment.. 5 - - - Salicylic Ointment 5 1 1 - Sulphur Ointment 3 1 1 - Carbolic Ointment 3 - - - Camphorated Oil 6 - - - Liniment of Turpentine 2 - - - Dried Herbs 2 - - - Canned Peas 2 - - - Canned Fruit 2 - - - Totals, 1933 799 36* 13 16 Totals, 1932 818 33† 11 11 * Including 6 informal samples. † Including 6 informal samples. Of the samples of milk, 69 were procured from itinerant vendors on Sundays and 182 from itinerant vendors on weekdays. Seven samples were adulterated. Legal proceedings were taken against 5 vendors and letters of caution were sent in 2 instances. 79 Milk; and Cream not Sold as Preserved Cream. (A) (B) Number of Samples examined for the presence of preservative. Number in which preservative was reported to be present, and percentage of preservative found in each case. Milk 382 Nil. Cream 2 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, 1933 • Margarine. Butter. Wholesale Dealer. facturer. 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. Notice of Registration was conspicuously displayed. On four occasions English eggs were found to be in cold storage and were being marked in accordance with the requirements of the Act. There were no contraventions of the Act. 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. 80 Public Analyst's Annual Report. During the year 1933, 799 samples were examined under the Food and Drugs (Adulteration) Act, all of which were submitted by the Inspectors. No samples under the Act were submitted by the Public. 141 samples were purchased informally. 36 samples were found to be adulterated, 30 formal and 6 informal. In addition, 57 other samples were of doubtful purity or inferior quality. The adulteration was at the rate of 4.5 per cent., as compared with 2.7 per cent. for the whole of London and 5.1 per cent. for the whole of England and Wales in 1932. The rate of adulteration in the Borough for the past ten years was as follows:— Year. No. of samples examined. Percentage of adulteration. 1933 799 4.6 1932 818 4.0 1931 801 7.6 1930 807 6.7 1929 801 8.7 1928 807 11.0 1927 793 10.1 1926 812 9.0 1925 811 8.0 1924 764 3.7 Average 801 7.3 The adulteration is much lower than the average of previous years. The number of samples examined was at the rate of 5.2 per 1,000 of the population, as compared with 10.0 per 1,000 for the whole of London, and 3.4 per 1,ooo for the whole of England and Wales in 1932. 382 samples of milk were examined, of which 15, or 3.9 per cent., were found to be adulterated, and 41 samples were reported as of poor quality. 81 During the past ten years the milk adulteration in the Borough was as follows:— Year. No. of milks examined. Percentage of adulteration. 1933 382 3.9 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 Average 377 4.0 The average milk adulteration for the whole of London was at the rate of 2.4 per cent. and for the whole of England and Wales, 7.3 per cent., in 1932. Condensed Milks. Twenty-four samples of condensed milk were examined, all of which were satisfactory. Preservatives. There were seven contraventions of the Preservatives Regulations. Other samples examined during the year were:— 1 Canned Fish. 1 Cooked Meat. For the Public Health Department. 1 Effluent. 1 Water. 1 Sand. For the Engineer's Department. ALBERT E. PARKES, F.I.C., Public Analyst. 82 Food Poisoning. In 1932 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 circulation. During the year 31 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 31 notified cases resulted in them being classified as follows:— True cases 9 Personal susceptibility 5 Not true food poisoning or doubtful cases 17 The nine true cases were as follows:— Sporadic case 1 In one family 2 In one family 6 The six cases in one family suffered from diarrhoea etc., which lasted only a day or two. Specimens of blood from two of the six cases gave negative results but a faecal specimen from one of the patients gave a positive result to B. paratyphosus. (B. paratyphosus isolated in moderate numbers. The bacillus was agglutinated by Para B serum up to dilutions; not by B Gaertner serum.) 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. 83 In connection with the scheme for the official certification of meat food products exported to the Dominion of Canada and the United States of America, the Minister of Health has designated Dr. G. O. Mitchell, the Tuberculosis Officer and Assistant Medical Officer of Health, as a Certifying Officer. Certificates were issued in connection with 127 consignments of foodstuffs: Canada (23), Australia (48), United States of America and Dependencies (25), India (21), other countries (10). 143 visits were paid to factories and 26 tons 14 cwts. 2 lbs. of foodstuffs were inspected and passed in connection with the above. 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. 84 Section F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifications. 2,732 cases of Infectious Disease (Smallpox 140) were notified during the year. In addition there were 155 other cases notified as Infectious Diseases in which the diagnosis was not confirmed. The notification rate was 18.3, compared with 19.3 in 1932. The incidence of infectious disease generally was slightly less than in 1932; particularly so in the following diseases:— (a) Smallpox 37 fewer cases (b) Chickenpox 476 ,, ,, There was, however, a marked increase in the number of cases of Scarlet Fever (231 more than in 1932) and Diphtheria (80 cases more than in 1932). Infectious Diseases in Milkshops and Homeworkers' Premises. Five 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. 30 cases of infectious disease occurred in homeworkers' premises: Smallpox, 2; Diphtheria, 14; Scarlet Fever, 8; Chickenpox, 5; 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 1933. (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-Periods. Total deaths in each Sub-District. At all Ages. At Ages—Years. At all Ages. At Ages—Years. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards. Poplar. Bow and Bromley. Poplar. Bow and Bromley. Total Cases Removed. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards. Poplar. Bow and ' Bromley. Smallpox 140 2, 4 2 4 1 21 28 19 33 6 19 1 29 111 29 111 140 1 - - - - - - - - - - - - - 1 Chikenpox 623 17 44 41 60 76 301 57 14 10 1 2 - 321 302 22 23 45 - - - - - - - - - - - - - - - Diptheria(including Membranous Croup) 484 6 1 1 36 48 47 198 93 20 19 6 - - 203 281 203 279 482 19 - 1 2 3 4 7 2 - - - - - - - Erysipeias 92 2 1 1 2 1 3 6 10 20 14 25 7 48 44 17 15 32 4 - - - - - - - - 1 - 3 - 2 2 Scarlet fever 842 4 26 65 85 87 330 144 45 44 12 - - 433 409 432 405 837 4 - 1 1 2 - - - - - - - - 1 3 Typhus fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric fever (including Paratyphoid) 4 - - - - - 1 1 1 1 - - - 1 3 1 3 4 1† - - - - - - - - - - - 1 1 - Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 8 - - - - - - - - 6 2 - - 5 3 5 3 8 4 - - - - - - - - 2 2 - - 1 3 Cerebro-spinal fever 24 - - - - - - - 3 19 2 - - 12 12 10 12 22 - - - - - - - - - - - - - - - Acute Poliomyelitis 8 2 2 1 - - 1 - 1 1 - - - 6 2 6 2 8 4 1 1 - - - - - 1 1 - - - 2 2 Acute Encephalitis Lethargica 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 1 - - - - - - - - - - - - - - - 1 1 2§ - - - - - - - - - - - - 1 1 * Zymotic Enteritis 23 23 - - - - - - - - - - - 20 3 8 - 8 - - - - - - - - - - - - - - - Anthrax 44 19 10 3 1 3 5 1 7! 4 2 1 - 12 32 2 1 3 13 10 2 - - - - - - - - - - 5 8 Pneumonia, Acute primary - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Influenzal 368 19 28 26 16 9 37 14 13 60 42 69 35 210 158 78 76 154 79 3 11 1 2 - - 2 - 4 14 20 22 34 45 Acute polioencephalitis 69 - 2 - 2 - 1 1 8 16 9 16 14 36 33 10 3 13 33 1 1 - - - - 1 1 4 4 9 12 19 14 Dysentry - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Malaria 1 — — — — — — — — 1 — — — 1 — 1 — 1 — — — — — — — — - — — — — — Totals 2732 87 128 175 218 224 898 345 137 235 96 132 57 1338 1394 825 934 1759 164 15 17 5 7 4 7 5 2 12 23 32 35 75 89 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. †Not a notified ease. § Includes 1 non-notified case. 85 Cases of Notifiable Diseases treated in Hospitals. Disease. Cases Notified. L.C.C. Fever Hospitals. Other L.C.C. Institutions. Voluntary Hospitals, etc. Total Removals. Percentage of eases notified. Smallpox 140 140 - - 140 100. Chickenpox 623 36 9 - 45 7.2 Diphtheria 484 480* 2 - 482 99.6 Erysipelas 92 2 29 1 32 34.8 Scarlet Fever 842 837† - —- 837 99.4 Enteric Fever 4 2 - 2 4 100. Puerperal Fever 8 6 1 1 8 100. Puerperal Pyrexia 24 2 16 4 22 91.7 Cerebro-spinal Fever 8 2 4 2 8 100. Encephalitis Lethargica 1 - - 1 1 100. Ophthalmia Neonatorum 23 5 1 2 8 34.8 Pneumonia (Primary) Pneumonia (Influenzal) .. 363 69 - 147 12 7 1 154 13 41.8 18.8 Zymotic Enteritis 44 - 1 2 3 6.8 Acute Poliomyelitis 1 1 - - 1 100. Acute Polioencephalitis - - - - - - Dysentery - - - - - - Malaria 1 - - 1 1 100. Totals 2,732 1,513 222 24 1,759 64.S N.B.—Cases reported to bo "not suffering" etc., have been excluded from above table. *Includes 1 to London Fever Hospital. †lncludes 2 to London Fever Hospital. Mortality from Diphtheria, Scarlet Fever and, Enteric Fever. Diphtheria. Scarlet Fever Enteric Fever. Cases 484 842 4 Deaths 18 6 o† Fatality Rate 3.7 0.7 - ‡1 non-notified case not shown. (Patient was an inmate of a mental hospital situate outside London.) 86 Scarlet Fever. The total notifications received numbered 904 and the total removals were 899. Of these, 62 cases were later certified to be not suffering from Scarlet Fever, leaving a total of 842 cases, the attack-rate being 5.6 per 1,000 of population. 6 deaths occurred, giving a fatality rate of 0.7 per cent. Diphtheria. The total notifications received numbered 570 and the total removals to hospital were 568. 86 patients were certified to be suffering from other diseases, leaving a total of 484 cases, the attack-rate being 3.2 per 1,000 of population. 18 deaths occurred, giving a fatality rate of 3.7 per cent. Diphtheria Immunisation. Since the closing of our Immunisation Clinic, occasional requests for treatment have been received. During the year arrangements were made with the Hackney Borough Council for such applicants to be dealt with at their Clinic, the Poplar Council paying a sum of 10s. for a complete Immunisation and certificate, and 2s. 6d. for a certificate of natural immunity. These charges are on the undertaking that the Poplar children do not require a special clinic. The number completed under this arrangement up to 31st December, 1933, was 5. Diphtheria Anti-toxin. 306,000 units of diphtheria anti-toxin were issued to medical practitioners during the year. The supply of anti-toxin is kept at the Public Health Office and is available day or night for the use of medical practitioners in the Borough. Care is taken to see that old stock is renewed in accordance with the instructions on each phial. "Carriers". During the year information was received from the London County Council of 18 patients referred to the "Carrier" Clinic. Two of the 87 patients were removed to Fever Hospitals as suffering from Diphtheria and the remaining 16 were certified to be fit to resume attendance at school after treatment. Enteric Fever. Five notifications were received (of which two related to Paratyphoid Fever), and the patients were removed to hospital. One patient was later certified to be suffering from Apical Pneumonia and not Typhoid Fever, leaving 4 actual cases. The attack-rate was 0.03 per 1,000 of population. None of the notified cases died; I death occurred in a Mental Hospital, but this case was not notified to this Authority. Following upon one case enquiries elicited the fact that the patient was a member of a cycling club, the members of which had been infected while touring. On reporting the facts to the Ministry of Health it was learned that there were other cycling clubs involved, some of their members having been infected in the same locality. Fortunately none of the other members of the cycling club living in the Borough contracted the disease. Bacteriological Examinations. 2,637 swabbings were examined. Of these, 319 gave positive results (12.1 per cent.). 5 blood specimens and I faecal specimen from doubtful cases of Enteric Fever were examined. All gave negative results. All the 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 1933 140* cases occurred (see footnote to Table I overleaf). 88 TABLE I. Smallpox and Chickenpox Cases Notified during each month. 1933. Month. Smallpox. Chickenpox. January 40 33 February 37 37 March 29 62 April 13 49 May 13 47 June 4 45 July 3 66 August — 40 September — 41 October — 39 November — 81 December — 83 Totals 139* 623 * The Smallpox figures refer to the calendar year, but in other parts of this Report the figure 140, referring to the statistical year of 52 weeks is used. Smallpox cases occurred in the under-mentioned sanitary districts:— East Combined 7 West Combined 20 Poplar South (East) 4 Poplar South (West) 7 Bromley North 16 Bromley Central 1 Bow East 6 Bow West 79 140 89 The incidence of Smallpox in houses is shown below. Cases. 18 houses in which 1 case of Smallpox occurred 18 12 ,, ,, 2 cases ,, ,, 24 11 ,, ,, 3 cases ,, ,, 33 4 ,, ,, 4 cases ,, ,, 16 1 ,, ,, 5 cases ,, ,, 5 5 ,, ,, 6 cases ,, ,, 30 2 ,, ,, 7 cases ,, ,, 14 Total 140 Total number of cases 140 „ „ houses 53 In Table II it will be seen that of the 140 cases no less than 118 were unvaccinated, and that in this group nearly 95 per cent. of the cases occurred before the age of 35, whereas in the vaccinated group all except two of 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. – – – – 2 – 6 – 8 22 f. – – – – – 4 9 1 14 Unvaccinated M. 6 11 7 11 13 – 1 – 49 118 F. 7 10 21 8 18 2 3 – 69 Totals 13 21 28 19 33 6 19 1 140 The type of disease continued mild. Only one death occurred, a boy, aged 2 years, and after a postmortem examination the cause of death was certified "I(a), Acute miliary Tuberculosis; II, Smallpox, unvaccinated.'' No cases were removed from a Common Lodging House. 90 Notification of Chickenpox.— The notification of Chickenpox was continued during the year 1933, and 623 cases were notified. Practically all cases reported as Chickenpox were visited by a member of the Medical Staff. This procedure resulted in the discovery of 7 cases of Smallpox. The following table shows the visits paid by the Medical Staff to cases of doubtful Smallpox, cases of Chickenpox and to Smallpox contacts. Several of these represent visits paid to workplaces in order to examine contacts of cases who had been at work in an infectious condition:— 91 Number of Visits by Medical Staff. Reason for Visit Smallpox or Doubtful Smallpox. Chickenpox. Smallpox Contacts. School exclusions. Miscellaneous. Total visits by medical staff. Diagnosis S.P. C.P. Not S.P. or C.P. S.P. C.P. Not C.P. or S.P. Medical Officer of Health (a) 22 14 19 4 212 10 96 (c) 83 (f) 66 526 (b) — — 1 — — — — — — 1 Assistant M.O.H. and Tuberculosis Officer (a) 29 10 17 1 175 15 56 (d) 73 57 433 (b) — — — — — — — — — — Assistant M.O.H. and Assistant Tuberculosis Officer (a) 7 2 6 — 37 3 7 (e) 14 17 93 (b) — — — — — — — — — — Total 1,053 Notes. (a) Poplar residents. (b) Non-residents seen at Poplar Hospital. (c) 46 persons found to be suffering from Smallpox. (d) 25 ,, ,, ,, „ (e) 1 ,, ,, ,, „ (f) 1 ,, ,, ,, „ Note.—A large number of visits were made by the Medical Officer of Health and the Tuberculosis Officer jointly. Vaccination. 92 The following particulars regarding vaccination have been taken from the Vaccination Officer's reports:— Extract from the Report of the Vaccination Officer, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1932, inclusive:— Registration Sub-Districts. Number of Births registered 1st Jan. to 31st Dec., 1932. Number of Births entered by 31st January, 1934, in "Vaccination Register." Number of Births which on 31st January, 1934, 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 1933. Number of Statutory Declarations of Conscientious Objection actually received during the calendar year 1933. Col. I Successfully vaccinated . Col. II Col. IV Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V Died unvaccinated. Postponement by Medical Certificate. Removals to Districts the Vaccination Officers of which have been duly apprised. Removals to places unknown, cases not found, etc. Insusceptible of Vaccination. Had SmallPox. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Bow and Bromley 1221 156 — 4 767 62 — 16 29 187 639 1195 Poplar 761 119 — — 497 22 — 12 13 98 Total 1982 275 — 4 1264 84 — 28 42 285 639 1195 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 Seven. (b) The figures in Columns 2 to 11 should not include re-registered births. The total number of copies of certificates for the year 1933 sent to other Vaccination Officers was 191 (1 Insusceptible). M. 379. 93 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, 1933. 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 267 351 618 117 Bromley Dr. C. Cotter 95 69 164 12 Poplar Dr. H.J. O'Brien 69 81 150 28 Bow Dr. D. G. Macrae 80 155 235 24 Millwall Dr. W. C. Millea 19 28 47 5 St. Andrew's Hospital Dr. J. R. M. Whigham 2 18 20 48 Poplar Institution Dr. J. R. M. Whigham 2 2 Col. 1 2 3 4 5 6 7 M. 379a. Dated this First day of February, 1934. (Signed) H. E. DENNIS, Clerk of the Council. 94 The following analysis of the Report of Vaccination Officer reveals the fact that nearly 85 per cent. of the children whose births were registered in 1932 were not protected by successful vaccination:— Births registered 1,982 Deduct:— Died unvaccinated 84 Removals to other districts 28 Removals to places unknown, etc. 42 154 Surviving residents 1,828 Successful vaccinations numbered } 275 Insusceptible of Vaccination — } 279=15.3 per cent. Had Smallpox 4 } Conscientious Objections declared 1,264 Vaccinations postponed on Medical Certificates — Number not accounted for 285 Total unvaccinated children 1,549=84.7 per cent. 1,828= 100 per cent. Public Health (Smallpox Prevention) Regulations, 1917. There were no vaccinations or re-vaccinations performed by the Medical Officer of Health during the year. Plague. No case of this disease was notified during the year. Anthrax, Glanders and Hydrophobia in Man. No cases of these diseases occurred. London Notification of Glanders Order, 1907. No notice was received from the Veterinary Inspector of the London County Council of the existence of glanders at premises in the Borough. 95 Erysipelas. 92 cases of erysipelas were notified during the year. Four deaths occurred. 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 cases notified, etc., during the year:— Puerperal Puerperal Fever Pyrexia. Cases notified 8 24* Removed to L. C. C. Fever Hospitals 6 2 Treated in other Hospitals 2 20 Treated at home — 2 Specialist called in — — Deaths 4** if * Excludes 3 later notified as Puerperal Fever. ** One was not notified; our first intimation was the report of the deaths. † Cause of death, "Cardiac Syncope, Lobar Pneumonia, Mitral Stenosis." Continued and Typhus Fevers. No case of continued fever occurred. No case of typhus fever occurred. Cerebro-Spinal Fever. Eight cases of Cerebro-Spinal Fever were notified and treated in hospital. Seven of the patients received serum treatment and of these five recovered. One patient died before diagnosis was complete and did not received serum treatment. 96 In all there were three deaths of patients who were notified during 1933, and one of a patient notified in 1932, making a total of four deaths from the disease. Acute Poliomyelitis. One case was notified and removed to hospital. Acute Encephalitis Lethargica. Two notifications were received. The patients were treated in hospital, but in one instance the diagnosis was not confirmed, the final diagnosis being Albuminuria. Two deaths were recorded. Cases of Encephalitis Lethargica are kept under observation until the acute stage has passed. Subsequently, periodical visits are made and reports as to the condition of patients are forwarded to the London County Council. 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, 23 cases were investigated. The following is a summary of the reports submitted:— Recovered or much improved and returned to work or school 4 Removed to other district 1 and to address not known 1 2 In Institutions:— Mental Hospitals 3 Other Hospitals and Institutions 7 — 10 Attending hospitals or otherwise undergoing treatment 5 Suffering from after-effects but not receiving treatment 2 23 97 The seven patients suffering from after-effects (excluding those in Institutions) were affected as follows:— Intelligence below normal — Sleep, poor or excessive — Paralysis—severe 1, slight 3, condition getting worse 1 5 Movements of limbs impaired, twitching, etc. — Vision impaired — Periodic headaches (severe) 1 Slightly dazed expression 1 7 Acute Polio-Encephalitis. No cases of Acute Polio-Encephalitis were notified. Post-Vaccinal Encephalitis, etc. No case of Post-Vaccinal infection was reported. Measles. 572 cases of Measles and German Measles were reported to the Medical Officer of Health from various sources (principally from L .C .C. schools). 51 of the cases were admitted to hospitals. Two deaths were attributed to Measles. A summary of the cases reported and visited is given in the Section relating to Maternity and Child Welfare, page 119. Pneumonia. 368 cases of Acute Primary Pneumonia and 69 cases of Acute Influenzal Pneumonia were notified during the year, 157 of the patients being treated in hospitals. 112 notified patients died—79 Acute Primary Pneumonia and 33 Acute Influenzal Pneumonia. Malaria. One case of Malaria was notified and removed to the Seamen's Hospital, Greenwich, where the diagnosis was confirmed (Sub-tertian). Dysentery. No cases were notified. In two doubtful cases blood and faeces were examined, with negative results. 98 Ophthalmia Neonatorum. A complete summary of cases notified and visited is given in the Section of this Report dealing with Maternity and Child Welfare, page 123. Altered Diagnosis Cases. 155 patients who had been notified and removed to hospitals as suffering from infectious disease were later certified to be suffering from some condition other than that which was notified:— 62 Scarlet Fever; 86 Diphtheria; 3 Puerperal Pyrexia (altered to Puerperal Sepsis); 1 Encephalitis Lethargica; 2 Chickenpox; 1 Typhoid Fever. The final diagnosis in the 62 Scarlet Fever cases was:— Chickenpox 1 Erythema 2 Sulphur Dermatitis 1 Rubella 12 Common Cold 1 Simple Gastro-enteritis 1 Tonsillitis 10 Urticaria 3 Protein Sensitization 1 Disease not specified *30 62 * These were reported "Negative case," "Not notifiable," etc. The final diagnosis in the 86 Diphtheria cases was:— Tonsillitis, Peritonsillar Abscess, etc. 36 Whooping Cough 1 Laryngitis 1 Influenza 1 Scarlet Fever (with Chickenpox, 1) 2 Common Cold, Coryza, etc. 5 Rhinitis 1 Rhinorrhoea 1 Otorrhoea 1 Erythema 1 99 Vincents Angina 1 Gastro-enteritis 1 Anaemia 1 Disease not specified *33 86 * These were reported "Negative case," "Not notifiable," etc. In addition, there were 15 cases reported as Bacteriological Diphtheria. These have been included as cases of Diphtheria. Influenza. During the first quarter of the year the Borough suffered from an epidemic of influenza and in that period 69 deaths were certified as being due to influenzal conditions. Leaflets drawing attention to the need for seeking medical advice in the early stages of the disease and to the steps which should be taken to prevent the spread of infection were distributed at the Maternity and Child Welfare Clinics, and at the schools through the agency of the London County Council Education Authority. Cancer. The number of deaths from Cancer for the last eight 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 1933 116 89 205 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.:— 100 Accommodation. Day and time of session. Type of session. Two Tuberculosis Officers' Rooms, Dispensary, X-Ray Room, Waiting Room, Dressing Room and accommodation for Health Visitors, Clerks and Resident Caretaker Monday, 4.30 p.m. Children, attending School. Monday, 6 p.m. Adults who are working. Tuesday 11 a.m. and 2 p.m. Any person not at work or not attending School. Thursday Friday The Council agreed to the arrangement made by the London County Council whereby Dr. G. O. Mitchell, the Tuberculosis Officer, should be deemed to be Honorary Consultant (Tuberculosis) to St. Andrew's Hospital Tuberculosis Officer's Report. Statistics for 1933. The three following tables comprise the annual return for 1933 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. Comments on Table I. Item A.—512 new cases (other than contacts) attended during the year for examination. In addition to these, 200 cases (other than contacts) who were examined in previous years and discharged as nontuberculous, presented themselves with a recurrence of symptoms for re-examination during the year, and were, in accordance with the instructions in the Minister of Health's Memorandum 37T. Revised, grouped as new cases under Item A on Table I. Of this total number of 712 new cases (excluding contacts), 204 were found to be suffering from Tuberculosis. 101 Return for the year 1933. 1. Return showing the work of the Dispensary. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. Grand Total M. F. M. F. M. F. M. F. M. F. M. F. A.— New Cases examined during the year (excluding Contacts):– (a) Definitely Tuberculous 98 70 3 4 7 8 6 8 105 78 9 12 204 (b) Diagnosis not completed — — — — — — — — 3 3 4 3 13 (c) Non-Tuberculous — — — — — — — — 125 169 99 102 495 B.— Contacts examined during the year:— (a) Definitely Tuberculous 7 9 — 2 1 — 1 — 8 9 1 2 20 (b) Diagnosis not completed — — — — — — — — — 1 2 4 7 (c) Non-Tuberculous — — — — — — — — 89 120 131 120 460 C.— Cases written off the Dispensary Register as:— (a) Recovered 13 10 — 5 — — 3 8 13 10 3 13 39 (b) Non-Tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as Tuberculous) — — — — — — — — 220 305 234 230 989 D.— Number of Cases on Dispensary Register on December 31st:— (a) Definitely Tuberculous 319 249 20 41 40 52 79 64 359 301 99 105 864 (b) Diagnosis not completed — — — — — — — — 3 4 6 7 20 1. Number of Cases on Dispensary Register on January 1st, 1933 886 2. Number of Cases transferred from other areas, and Cases returned after discharge under Head 3 in previous years 27 3. Number of Cases transferred to other areas, Cases not desiring further assistance under the scheme, and Cases "lost sight of" 81 4. Cases written off during the year as Dead (all causes) 119 5. Number of attendances at the Dispensary (including Contacts) 6,201 6. Number of Insured Persons under Domiciliary Treatment on December 31st 252 7. Number of Consultations with Medical Practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal Consultations) 420 (a) Personal 14 (b) Other 314 9. Number of visits by Health Visitors to homes 5,640 10. Number of:— (a) Specimens of Sputum, etc., examined P. H. 370 Dispensary 1,119 (b) X-RAY examinations made Screen 124 Films 138 11. Number of "Recovered" Cases restored to Dispensary Register, and included in A (a) and A (b) above 1 12. Number of "T.B. plus" Cases on Dispensary Register on December 31st 472 102 Item B.—398 new contacts attended during the year for examination. In addition to these, 89 contacts who were examined in previous years and discharged as non-tuberculous, presented themselves with suspicious symptoms for re-examination during the year, and were similarly grouped as new cases under Item B on Table I. Of this total number of 487 new contacts, 20 were found to be tuberculous. The apparently much smaller incidence of Tuberculosis among contacts as compared with non-contacts is to be explained by the fact that the majority of contacts examined for the first time during the year (namely 398) came up for examination purely as contacts, that is to say, they were free from symptoms; whereas all the non-contacts seen for the first time during the year (namely 512) attended for examination on account of suspicious symptoms. Therefore, to get a reliable comparison between the incidence rate cf Tuberculosis in contacts and non-contacts, it would be necessary to include a comparable number of healthy noncontacts who, of course, have no reason to attend the dispensary. Both new cases (excluding contacts) and contacts attending for examination again show an increase over the preceding year. Items A and B.—The small number of cases of non-pulmonary tuberculosis arising in 1932 was commented upon last year. During 1933 the number again remains comparably small at 31. Item 5.—The number of attendances at the Dispensary during the year, namely, 6,201, is the highest recorded since 1923. Item 8.—The number of visits by the Tuberculosis Officers shows a substantial rise. Item 9.—The drop in the number of visits paid by the Health Visitors is to be explained by the absence of one of the Health Visitors for several months owing to illness. Item 10.—The X-ray plant at the Dispensary continues to be used for screen examinations when indicated, while the facilities for having films taken at St. Andrew's Hospital are being increasingly made use of. Comments on Tables II and III. These returns continue to remain optional. During the year 39 patients have been removed from the Dispensary Register as Recovered 2. PULMONARY TUBERCULOSIS. Showing in summary form (a) the condition at the end of 1933 of all Patients remaining on the Dispensary Register; and (&) the reasons for the removal of all Cases written off the Register. The table is arranged according to the years in which the Patients were first entered on the Dispensary Register as definite Cases of Pulmonary Tuberculosis, and their classification at that time. Condition at the time of the last record made during the year 1933 . Previous to 1926. 1926. 1927. 1928. 1929. Class T.B.—. Class T.B.+. 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.+). Group I. Group II. Group III. Total (T.B.+). (a) Remaining on Dispensary Register on December 31 st. Disease Arrested Adults M. 7 3 7 — 10 — — 4 — 4 2 — 2 — 2 4 4 — — 4 1 2 — — 2 F. 3 3 4 — 7 1 — 1 — 1 6 1 1 — 2 — 3 1 — 4 3 5 — — 5 Children .. 3 — 2 — 2 2 — — — — 6 — 1 — 1 2 — — — — 2 1 — — 1 Disease not Arrested Adults M. 1 7 22 6 35 1 1 8 — 9 — 2 3 — 5 1 7 6 — 13 — 5 10 — 15 F. 4 5 16 1 22 1 — 1 1 2 2 — 4 1 5 1 1 7 — 8 3 8 7 1 16 Children .. 2 2 — — 2 1 — — — — 2 — — — —- — 1 — — 1 2 1 1 — 2 Condition not ascertained during the year 1 1 1 — 2 — — — — — 2 — — — — — — — — — — — — — — Total on Dispensary Register at Dec. 31st 21 21 52 7 80 6 1 14 1 16 20 3 11 1 15 8 16 14 — 30 11 22 18 1 41 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 36 19 26 — 45 2 1 1 — 2 1 1 1 — 2 1 — — — — — — — — — F. 64 20 22 — 42 4 2 — — 2 — 1 — — 1 — 1 — — 1 — — — — — Children .. 80 7 10 — 17 3 — — — — 1 — — — — 1 — — — — — — — — — Lost sight of or otherwise removed from Dispensary Register 39 32 78 4 114 18 7 15 — 22 19 14 12 — 26 19 5 15 — 20 4 10 15 2 27 Dead Adults M. 11 18 59 14 91 2 4 26 4 34 5 9 17 6 31 10 6 23 5 34 4 11 21 9 41 F. 7 14 41 8 63 — 5 24 2 31 3 6 26 5 37 2 2 24 3 29 6 7 27 5 39 Children .. 1 — 6 — 6 — — — 1 1 1 — — 1 1 4 — 2 — 2 1 — 1 — 1 Total written off Dispensary Register 238 110 242 26 378 29 19 66 7 92 30 31 56 11 98 37 14 64 8 86 15 28 64 16 108 Grand Totals 259 131 294 33 458 35 20 80 8 108 50 34 67 12 113 48 30 78 8 116 26 50 82 17 149 (a) Remaining on Dispensary Register on December 31st. 1930. 1931. 1932. 1933. Disease Arrested Adults M. 3 — — — — — — — — — — — — — — — — — — — F. 3 — — — — — — — — — — — — — — — — — — — Children .. 3 — — — — — — — — — — — — — — — — — — — Diseases not Arrested Adults M. 8 10 13 1 24 6 16 15 3 34 6 28 12 — 40 10 37 24 6 67 F. 1 7 9 1 17 7 6 7 1 14 11 13 16 — 29 11 23 29 3 55 Children .. 7 1 — — 1 6 1 — — 1 3 — 1 — 1 4 2 2 — 4 Condition not ascertained during the year — 1 — — 1 1 — — — — 1 1 1 — 2 — — — — — Total on Dispensary Register at Dec. 31st 25 19 22 2 43 20 23 22 4 49 21 42 30 — 72 25 62 55 9 126 (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 17 12 15 2 29 9 10 7 2 19 3 4 5 — 9 4 3 2 — 5 Dead Adults M. 4 6 31 14 51 3 8 15 11 34 — 4 12 8 24 3 1 8 9 18 F. 4 5 22 7 34 — 1 12 16 29 3 1 10 16 27 — 1 4 8 13 Children .. — 1 2 — 3 — 1 1 1 3 1 — •— — — — — — 1 1 Total written off Dispensary Register 25 24 70 23 117 12 20 35 30 85 7 9 27 24 60 7 5 14 18 37 Totals 50 43 92 25 160 32 43 57 34 134 28 51 57 24 132 32 67 69 27 163 3. NON-PULMONARY TUBERCULOSIS. Showing in summary form (a) the condition at the end of 1933 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. 1929. 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. Bones & Joints. Abdominal. Other Organs. Periph'al Glands. Total. (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M. 1 — — — 1 — — — — — 1 — — — 1 — — — 2 2 4 1 1 — 6 F. 2 — 2 1 5 — — — 1 1 1 — — — 1 2 — — — 2 1 — — 2 3 Children .. 4 — 1 2 7 — — — 2 2 3 — — 5 8 2 — — 1 3 2 1 1 4 8 Disease not Arrested Adults M. — — — — — — — — — — — — — — — — — — — — 1 — 1 — 2 F. 2 — 2 1 5 — — — 2 2 1 — — — 1 1 — — — 1 — — — 1 1 Children .. — — — 1 1 1 — — 2 3 6 — — 1 7 2 — — 3 5 8 — — — 8 Condition not ascertained during the year 1 — 1 — 2 — — — — — — — — — — 1 1 1 — 3 1 — — 1 2 Total on Dispensary Register, December 31st 10 — 6 5 21 1 — — 7 8 12 — — 6 18 8 1 1 6 16 17 2 3 8 30 Transferred to Pulmonary — — — 1 1 — — — — — — — — 1 1 — — — — — — — 1 1 2 (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 .. 19 8 11 59 97 — 2 1 5 8 2 1 — 5 8 1 2 — 2 5 1 1 1 1 4 Lost sight of or otherwise removed from Dispensary Register 8 — 8 20 36 4 2 2 2 10 1 2 — 5 8 3 3 1 5 12 2 1 1 3 7 Dead Adults M. 2 — — — 2 3 — — — 3 — — — — — — — 1 — 1 1 — — — 1 F. 1 — — — 1 — — — — — — — — — — 1 — — — 1 1 — — — 1 Children .. 2 — — 1 3 1 — — — 1 — — — — — — — — 1 1 — — — — — Total written off Dispensary Register 43 10 27 91 171 8 6 3 9 26 5 3 1 11 20 5 5 2 8 20 5 2 2 4 13 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary) 53 10 33 96 192 9 6 3 16 34 17 3 1 17 38 13 6 3 14 36 22 4 5 12 43 1930. 1931. 1932. 1933. (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M. — 1 1 1 3 — — — — — — — — — — — — — — — F. — — 1 — 1 1 1 1 — — — — — — — — — — — — Children .. 4 5 — 6 15 4 1 2 3 10 — — — — — — — — — — Disease not Arrested Adults M. 2 — 4 — 6 3 — 2 1 6 1 — 3 — 4 4 — 2 1 7 F. 2 — 1 — 3 4 1 1 1 7 6 — — 2 8 — 2 1 3 6 Children .. 7 — 2 3 12 11 1 — 5 17 3 1 2 9 15 4 2 1 8 15 Condition not ascertained during the year 2 — — 1 3 — — — — — — — — 1 1 — — — — — Total on Dispensary Register, December 31st 17 6 9 11 43 23 4 6 10 43 10 1 5 12 28 8 4 4 12 28 Transferred to Pulmonary — — — — — 2 — — — 2 — — — — — — — — — — (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 1 1 3 9 4 — 2 3 9 — — — — — — — 1 1 2 Dead Adults M. — — — — — 2 — — — 2 1 — — — 1 — — — 1 1 F. — — — — — — 1 — — 1 — — — — — — — — — — Children .. — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 4 1 1 3 9 6 1 2 3 12 1 — — — 1 — — 1 2 3 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 21 7 10 14 52 29 5 8 13 55 11 1 5 12 29 8 4 5 14 31 103 (Item C (a) Table I), and have been added to those similarly removed in former years in the appropriate columns on Tables II and III. On Table III two cases during the year developed pulmonary tuberculosis, and have accordingly been transferred to Table II, making a total of 6 cases of non-pulmonary tuberculosis who have, since 1926, developed Pulmonary tuberculosis. Additional Statistics not dealt with in the preceding Tables:— Patients sent away for institutional treatment 238 Patients in receipt of extra nourishment during the year 91 Patients in receipt of extra nourishment on December 31st 46 Reports on children to Divisional School Medical Officer 144 Letters to General Practitioners concerning patients 434 Reports to General Practitioners on Official Forms 191 Progress reports received from General Practitioners 87 Clinical reports to London County Council 636 Reports to Ministry of Pensions 3 Shelters on loan during the year 4 Shelters on loan on December 31st 3 Beds and Bedding on loan during the year Cases 21 Beds and Bedding on loan on December 31st ,, 14 During the year 10 new cases and 10 old cases have attended Charing Cross, Victoria Park, Colindale and Grove Park Hospitals for 201 artificial pneumothorax refills, while x new case and 2 old cases of lupus have attended the London Hospital for 45 applications of Finsen Light and 188 applications of General Light. Patients receiving Artificial Pneumothorax treatment, as well as patients needing Finsen Light treatment, are treated on the authority of the Tuberculosis Officer, the cost of treatment being charged to the Borough Council. There has been a further rise during the year in the number of artificial Pneumothorax refills. In April, 1933, the County Medical Officer of Health stated that it had been decided to admit to Open-Air Schools for Tuberculous Children, children suspected to be suffering from Tuberculosis and those living in conditions rendering them particularly liable to the disease. These admissions would be made on the recommendation of the Tuberculosis Officer and with the consent of the parents, and it was pointed out that no tuberculous children were admitted to such schools while in an 104 tious condition. During the year 3 tuberculous children and 2 nontuberculous children were recommended for admission to Geere House, a school of the above-mentioned type. In addition to and apart from the above arrangement, 2 delicate non-tuberculous children were recommended to the Divisional School Medical Officer for admission to ordinary Open-Air Schools. During the year 6 children were boarded out under the London County Council Contact Scheme. Cases remaining on the Medical Officer of Health's Tuberculosis Register on December 31st 1,190 Cases remaining on the Tuberculosis Dispensary Register on December 31st 884 London County Council Tuberculosis Scheme. On and after April 1st, 1933, the distinction between "Municipal'' and "Tuberculosis Scheme'' patients ceased to operate, and all necessary residential treatment for tuberculosis, whether in London County Council General or Special Tuberculosis Hospitals or in Voluntary Sanatoria, was provided under the London County Council Tuberculosis Scheme. On and from this date, all applications for residential treatment of tuberculosis, whether emanating from patients personally, medical attendants, district medical officers or hospitals, have been referred in the first place to the Tuberculosis Officer, who has thus been brought into immediate touch with many cases which previously failed to come fully under the control of the Dispensary, or only came under Dispensary control at a much later date. In addition, all such cases are now dealt with by the Care Committee for assessment and After-Care. Mantoux Tests. In May, 1933, on the suggestion of the County Medical Officer of Health, and with the concurrence of the Medical Officer of Health, arrangements were made at the Dispensary for the carrying out of the Mantoux test in certain cases of doubtful pulmonary tuberculosis in children where the X-ray findings were negative or inconclusive. During the year the Mantoux test was performed on six occasions, and will be used in future when indicated. 105 Malnutrition. Obvious malnutrition due to underfeeding is not, in my experience, prevalent among the patients attending the dispensary. Concerning minor degrees of malnutrition it is not, however, possible to speak definitely. The problem is a complex one, for slight malnutrition is difficult to define, and its detection clinically is often uncertain. The majority of children attending for observation gain weight steadily, which may be an indication that they are not seriously underfed. On the other hand, many children seen are definitely ill, and if some of these are debilitated or below par it is reasonable to ascribe this in some measure to illness, although it may be impossible in all cases to rule out malnutrition as a causal factor in such illness. These debilitated (non-tuberculous) children who fail to progress satisfactorily are recommended for convalescence, and during the year convalescence was arranged for 12 such children through the Invalid Children's Aid Association. Some of these children failed to gain weight during convalescence, and this fact would appear to rule out underfeeding as a cause of their debility. Suspected malnutrition should not necessarily be sought primarily in the children. Some of the healthiest children seen during the year were members of a family of eleven occupying two rooms. The father was unemployed, and there was a net income of £2 14s. 6d. after only rent and insurance had been deducted. In this case the mother, a quiescent, non-infectious case of tuberculosis, was, I thought, undernourished, and I formed the opinion that she was going without proper food for the sake of the children. I therefore recommended the granting to her of extra nourishment, which was arranged through the Public Assistance Committee. On receipt of this the patient began to gain weight and is now maintaining a steady weight 5lbs. better than her weight previously. Dental Treatment. Tuberculous patients requiring dental treatment are referred to St. Andrew's Hospital on Tuesdays and Fridays at 12 noon. 16 patients were referred during the year, and the small number referred is accounted for by 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. 106 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 to sanatorium, where preliminary dental treatment is indicated in order that the full benefit of sanatorium treatment may be obtained. Dental Surgeon's Report of Dental Treatment for the Poplar Tuberculosis Dispensary for Year 1933. Number of attendances 40 Number of teeth extracted 58 Anaesthetics—N2O II } Procaine 14 } 25 Other treatment 15 A number of patients referred did not attend for treatment. F. G. HUTCHINSON. Report of the Secretary of the Tuberculosis Care Committee. The Tuberculosis Care Committee continues to meet fortnightly at the Dispensary to deal with the social welfare of persons suffering from tuberculosis. In this work the Care Committee is greatly assisted by the Poplar Tuberculosis Fund, the Committee of which also meets once a fortnight, immediately after the Care Committee meetings. There have been 21 meetings of the Poplar Tuberculosis Care Committee during the year. In April, 1933, the review of assessments for institutional treatment of tuberculosis in the London area was undertaken by the Public Assistance Committee of the London County Council and Tuberculosis Care Committees were asked to make their recommendations to that body instead of to the Public Health Committee of the L.C.C., as hitherto. In addition, Care Committees were asked to deal with the assessment of all 107 persons receiving treatment for tuberculosis in L.C.C. general hospitals, such cases having been brought under the tuberculosis scheme as from 1st April. This change-over has considerably increased the assessment work of the Poplar Tuberculosis Care Committee. So far there has been no noticeable difference in the policy of the L.C.C. with regard to the acceptance of the Care Committee's recommendations and the change has, on the whole, proved advantageous, in that all tuberculosis assessments are now dealt with, in the first place, by the Tuberculosis Care Committee. 245 recommendations regarding assessment for institutional treatment were made during 1933, as against 171 in 1932. This figure is not an indication of the number of persons admitted to institutions for treatment of tuberculosis, as there are still a number of cases (e.g., insured heads of families, or persons with no income but sickness benefit) which are passed as non-assessable without the Home Inquiry Form being brought before the Care Committee. In cases where payment is made the Tuberculosis Care Committee has been responsible for the collection of contributions for the L.C.C. In addition to the cases considered by the Care Committee primarily in connection with assessment, 125 other cases have been dealt with, and the Committee has endeavoured to supply such help or advice as has been required. Many of these have been referred to the Poplar Tuberculosis Fund, or to some other agency, for practical assistance. The Committee of the Poplar Tuberculosis Fund has met 18 times during the year and 145 grants have been made to needy patients. Of these, 82 were in the form of clothing and boots, 27 for expenses of relatives visiting patients in sanatorium, and 10 for dentures, glasses or surgical appliances. Other assistance given by the Fund has included the provision of convalescent holidays, payment of laundry expenses for women patients unfit to do this work themselves, cost of removal to improved housing conditions, provision of pocket money for penniless people away in sanatorium, payment of insurance arrears to entitle patients to benefit, etc., etc. In the early part of the year the Committee of the Poplar Tuberculosis Fund, feeling that its scope was somewhat restricted by adherence to the ten specific objects of the fund approved by the L.C.C. at the time of the formation of the Charity, submitted the following omnibus clause to the L.C.C., by which it was approved:— "'To assist, in certain specific cases approved by the Tuberculosis Officer, patients and/or their families in ways which are not specifically mentioned in the preceding ten clauses, provided that the 108 persons assisted are ineligible to obtain such assistance from any other charitable organisation or from the Public Assistance Committee, and provided that the members of the Charity are agreed that such assistance would be legitimately supplied through a Charity of this nature.'' The income of the Poplar Tuberculosis Fund has again come mainly from contributions in respect of Sunday opening of three local Cinemas— the Poplar Hippodrome, the Poplar Pavilion and the Ideal Picture Theatre—and this assistance has been much appreciated. Grants have also been received from the Committee of Alexandra Rose Day (thanks to the recommendation of his Worship the Mayor of Poplar), the National Deposit Friendly Society, the Prudential Approved Society, and the Poplar Benevolent Society, and a dance, a whist drive and a sale were organised during the year to raise funds. The Committee of the Poplar Tuberculosis Fund publishes its own Annual Report and Balance Sheet at the end of the financial year. The Handicraft Class, attended by about sixteen ex-sanatorium patients, continues to be held at the Dispensary, once a week, and is appreciated by the members as a means of occupation. Goods made by the ex-Service men in the class were disposed of at the Armistice Exhibition at South Kensington in November, and an Exhibition and Sale of Work was organised, in co-operation with the Stepney Handicraft Class, at Toynbee Hall in December. The Poplar Tuberculosis Care Committee is represented on the Standing Conference of Metropolitan Borough Tuberculosis Care Committees and three meetings of the Conference have been attended during the year. In connection with the Conference a visit was paid to Pinewood Sanatorium in July. The Poplar Tuberculosis Care Committee acknowledges with thanks the assistance of all those who have co-operated in its activities during the year, and particularly the help of the Poplar branch of the Invalid Children's Aid Association in connection with the visiting, boarding-out and convalescence of children. 109 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. part i.— Summary of Notifications during the period from the 1st January, 1933, to the 3lst December, 1933, 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 — 1 1 3 12 21 21 22 24 14 5 124 253 „ Fema les — 2 — 4 19 23 21 9 10 5 — 93 171 Non-Pulmonary—Males 1 3 3 1 4 2 — 1 1 1 — 17 23 ,, Females 1 2 3 3 2 4 4 1 — — — 20 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 — 2 1 7 8 5 4 1 29 ,, Females 1 1 2 ] — 1 2 3 2 — — 13 Non-Pulmonary—Males — 1 3 5 1 2 1 — — — — 13 ,, Females — 2 1 1 1 1 — 1 — — — 7 The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of Information. Number of Cases. Pulmonary. NonPulmonary. Death Returns from Local Registrara 7 1 transferable deaths from Registrar-General 2 3 Posthumous no Iflications 8 5 "Transfers" from other areas (other than transferable deaths) 6 6 Other Sources, if any (specify) Forms l & 2 19 5 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, 1933, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough 472 347 819 218 153 371 1,190 Number of cases removed from the Register during the year by reason inter alia, of:— 1. Withdrawal of notification 2 — 2 — — — 2 2. Recovery from the disease, cured and no longer suffering 12 13 25 7 11 18 43 3. Diagnosis not confirmed — 4 4 1 2 3 7 4. Death 93 61 154 13 10 23 177 110 Public Health (Prevention of Tuberculosis) Regulations, 1925. In September 17 male employees of a local dairy were examined by the Tuberculosis Officer. None of the employees showed any evidence of tuberculosis. Public Health (Tuberculosis) Regulations, 1924 and 1930. Summary of Quarterly Returns to the London County Council. Quarter ended March. June. September. December Number of Cases on Register at commencement of quarter 1,197 1,179 1,194 1,210 Number of New Cases notified 85 68 67 53 Number of Cases restored to Register, etc. 16 6 11 15 Number of Cases removed from Register 119 59 62 88 Number of Cases on Register at end of quarter. Pulmonary 801 815 837 819 Non-Pulmonary 378 379 373 371 Totals 1,179 1,194 1,210 1,190 Particulars of new cases of Tuberculosis and of all Deaths from the disease:— Age Periods. New Cases. Deaths. (Reg. General's figures). Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 — 1 1 1 — — 1 1 1 — 1 3 4 4 — 1 3 2 5 — 2 2 6 4 — — 2 — 10— 3 5 6 4 15— 14 19 5 3 8 21 2 2 20— 22 24 4 5 25— 28 23 1 4 20 14 — 35— 30 12 1 2 14 9 — 1 45— 29 12 1 — 21 4 — — 55— 18 5 1 — 13 2 — — 65 and upwards 6 — — — 6 — — — Totals 153 106 30 27 82 51 8 6 The ratio of non-notified Tuberculosis deaths to total Tuberculosis deaths was 8.8%. 111 Disinfecting Department. Totals. Rooms Disinfected 2,245 Premises visited re Disinfection 2,217 Number of Verminous Rooms sprayed with Solution "D" or formalin or treated with "Cimex," sulphur, etc. 239 Other Articles Disinfected. Small Pox Infectious Diseases. Tuberculosis. Vermin Diseases. Miscellaneous Totals (а) From Infected mises 1,669 14,538 546 1,611 509 18,873 (b) From Cleansing Station — — — 20,198 3,032 23,230 (c) From Contacts 18 48 — — — 66 Totals 1,687 14,586 546 21,809 3,541 42,169 Articles destroyed by request, 619. Vermicide—Quantity issued from Depots, 351 gallons. Cleansing Station. M. F. Totals. Verminous persons cleansed 33 2 35 ,, children ,, 387 1,583 1,970 Scabies cases, cleansed, adults 41 29 70 ,, ,, children 404 643 1,047 Total cleansings 865 2,257 3,122 All verminous children are treated with special comb. Motor Vehicles. Vehicle. Speedometer register (miles). Petrol consumption (gallons). Average m.p.g. Blue Van 2,275 184½ 12.3 (a) Brown Van 3,357 260 12.9 (b) Lorry 4,359 345½ 12.6 (c) M.O.H. Car 8,855 496 17.7 Special Vehicle for Contacts 1,674 136½ 12.4 (d) (a) 47 weeks' readings. (b) 51 ,, „ (c) 51 ,, „ (d) 45 ,, „ 112 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 1933, 62,070 gallons were manufactured and broken down to 138,220 gallons of weaker solution for distribution. The production of the solution at a strength of 4 grammes of available chlorine per litre has averaged 124,853 gallons per annum for three years at an average annual cost of £2,233, the cost per gallon thus being less than 4½d. Quantity Produced. As As Electricity Manufactured. Issued Consumed. (i.e., Weaker Solution.) Gallons. Gallons. Units. No. 1 Apparatus 20,730 47,160 10,692 No. 2 Apparatus 20,700 47,160 10,672 No. 3 Apparatus (11 months only) 20,640 43,900 10,692 Totals 62,070 138,220 32,056 1,086 gallons were supplied to London County Council Elementary 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. 113 Quarter. Number of Children Cleansed. Total number of Cleansings. Amount payable by L.C.C. to the Borough Council. 1933. £ s. d. March 538 927 71 3 0 June 553 733 63 9 0 September 416 550 47 12 0 December 644 897 75 11 0 Totals 2,151 3,107 £257 15 0 Miss Landray made 77 visits in connection with verminous schoolchildren and 148 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, 105 persons—including 30 from common and seamen's lodging houses (see next page)—applied for baths and for their clothes to be disinfested. 114 Verminous Persons in Common Lodging Houses, etc. The number of persons from Common Lodging Houses and Seamen's Lodging Houses, etc., cleansed at the Council's Cleansing Station, Glaucus Street, during the year was:— Lodging House, etc. Male. Female. Total. 196, Bow Road — — — St. James's Chambers, 207, High Street, Poplar 1 — 1 65, Bow Lane 1 — 1 378, Old Ford Road — — 38, Pennyfields — — — Salvation Army Home, Bow Road — — — ,, ,, Hostel, Garford Street 25 — 25 411, East India Dock Road — — — 27 — 27 From Common Lodging Houses without the Borough of Poplar (by agreement with L.C.C. at a charge of 1s. per person cleansed) 3 — 3 Totals 30 — 30 For cleansing of verminous rooms see page 62. Education in Health. Report by Mr. T. Wigley. Most people will admit that knowledge is better than ignorance, that to know the truth and to live by it is to enter into a richer and more efficient life; and, while knowledge is good in and for itself alone, it is indispensable as a means towards self-harmony and social well-being. The task of education is two-fold, viz.: to make knowledge available, and to stimulate the mind to receive it and to act upon it. Day by day the advance of science goes on, bringing more and more knowledge to be used for the benefit of humanity. Almost daily, reports come through from the front line of research, telling of yet another position taken from the enemy called Ignorance. Not always, however, is the position consolidated and occupied. Once it could be said with truth that the people perished for lack of knowledge; now this is no longer the case, 115 but the people continue to perish from their unwillingness to learn and to apply the knowledge which is to be had for the asking. Recognising the importance both of making knowledge accessible and of encouraging the desire for it in view of the obvious need, the Public Health Committee has wisely continued its offer of free lectures on health and disease. Anyone reading the titles of the subjects suggested for consideration cannot fail to be impressed by the practical note which is struck by them, and by the way in which the whole gamut of human life from childhood to maturity is included. Here the parent will find advice on development and possible departures from it in the child and youth. Here is to be found sound knowledge of the working of the body in health, of the disharmonies which we call disease, of the importance of diet and environment. Here also can be learned the thrilling story of man's unceasing quest to understand the influence of heredity, of sunlight, of mental maladjustments and of preventive medicine. In a sentence, here we have the material of the science of healthy living made available for all. Many gatherings, large and small, have taken advantage of this offer of lectures. What is of special significance is the fact that, increasingly, audiences which have begun by asking only for a single lecture, have asked for more. The result is that many organisations now include in their programmes a monthly lecture from our list, and I am told by the leaders of such orgnisations that their members are indeed grateful for this opportunity of learning more on such vital subjects. Such appreciation is noteworthy, not only among adult audiences, but among young people as well. There is still room for improvement, for a number of social, political and religious gatherings has not yet appreciated what is being missed. But the work grows, it is meeting the needs of the people, and already it is showing results in an awakened interest and a growing sense of responsibility for personal and social health. Summary. Number of Centres at which lectures have been arranged 13 Number of lectures given (September-March) 54 To men 5 (Attendances 615) To women and girls 48 ( ,, 3,174) To mixed audience 1 ( ,, 40) 54 (Total attendances 3,829) At the time of writing this Report lectures booked but not yet given number 12. 116 Expenditure Year ending 31st March, 1934. £ s. d. Grant to Central Council for Health Education 5 0 0 Printing, Stationery and Postage 1 13 0 Fees to Lecturers 174 6 0 Total £180 19 0 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 1933-34. Two of these were given in December (Poplar Town Hall and Bow Baths) and two in April, 1934 (Island Baths, Millwall, and Bromley Public Hall). 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, 10.30 a.m. to 12.30 p.m. and 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. Methodist Chapel, Manchester Road Medical Officer's, Weighing and Waiting Rooms Ante-Natal: Fridays, 10.30 a.m. to 12.30 p.m. Infant Consultations: Wednesdays, 10.30a.m. to 12.30 p.m., and 2 to 4 p.m. 54, West Ferry Road Ditto Ditto Ditto Infant Consultations: Fridays, 2 to 4 p.m. Wellington Road Medical Officer's, Weighing and Waiting Rooms, Dispensary Infant Consultations: Thursdays, 10.30 a.m. to 12.30 p.m., and 2 to 4 p.m. Dentist's Room, Recovery Room, Artificial Light Room 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:— 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-Paatient Room for mothers Special Clinic: (By appointment only) Fridays, 2 to 4 p.m. 228-230, Brunswick Road Infant Consultations. Tuesdays, Thursdays and Fridays, 2 p.m. Sewing Class: Wednesdays, 2 p.m. Dental: (By appointment only) Mondays, 1.30 and 3 p.m. Artificial Light Treatment: (By appointment only) Mondays to Fridays, 9.30 a.m. to 12.30 p.m., and 2 to 4.30 p.m. Ante-Natal: Tuesdays, 9.30 a.m. Tonsil Clinic: (By appointment only) Twice monthly. Remedial Exercise: (By appointment only) Mondays, 2.30 p.m., and Thursdays 10 a.m. Post-Natal Clinic: Wednesdays, 9.30 to 12.30 The Lighthouse Mission, Blackthorn Street Medical Officer's Room and Large Hall for weighing and waiting Infant Consultations: Wednesdays, 2 p.m. Trinity Hall, Augusta Street Ditto Ditto Ditto Infant Consultations: Wednesdays, 2 p.m. 117 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 annually to the Royal College of St. Katharine. The Ministry of Health's scheme provides for this payment for the four financial years 1933-1937. In January the Council were informed that the Chapter of the Royal College of St. Katharine had decided: (a) To appoint Dr. H. K. Waller as whole-time Medical Officer, and (b) to re-arrange parts of the buildings of Bromley Hall, the cost of the alteration being borne by the Chapter. Changes in staff during the year were approved by the Council. The number of attendances at the Centres since 1920 is shown below:— Borough Council. Royal College. 1920 14,490 13,147 1921 15,710 9,856 1922 17,404 8,992 1923 24,058 11,718 1924 27,137 13,598 1925 31,540 17,809 1926 35,084 20,473 1927 36,110 23,588 1928 41,420 27,653 1929 38,504 28,250 1930 40,924 32,173 1931 42,340 34,275 1932 48,167 35,413 1933 50,599 35,713 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. 118 Miss J. M. Cardozo, Chief Health Visitor, reports as follows:— Home Visiting.—During the last 12 months' visiting, one thing is outstanding—the inestimable value of the mother who is a good housekeeper. In one home with a small income, the care and self-sacrifice of the mother is reflected in the well-being of the whole family. The children and home are clean, the food carefully purchased and well cooked. In a second home with the same, or even larger, income and a bad manager, there is squalor and want. No praise is too high for many of our mothers who are putting up such a good fight under great difficulties and getting excellent results. For the rest, it is only by constant visiting and advice that we can hope to instil into them the benefit of cleanliness and good housekeeping, and to get them to realise that bread and margarine is not the cheapest food available. It is interesting to note that the mortality rate among infants visited (28.1) is the lowest ever recorded. Clinics. Ante-Natal.— The mothers now come voluntarily to the Clinics. 569 expectant mothers attended and were closely followed up by visiting. There have been no maternal deaths among the mothers who have been in attendance at the Ante-Natal Clinics of the Borough Council and of the Royal College of St. Katharine. The additional morning session at Simpsons Road from April 3rd has relieved the overcrowding, and post-natal mothers are now attending. Infant Consultation.— The attendances at all Clinics has increased, the large numbers making the work difficult, especially at Old Ford, where we are severely handicapped by the inconvenient premises. We are now reaping the benefit of the teaching given at the Clinics during the past years. Clinic mothers of early days are now grandmothers—no longer obstructionists, as was so often the case, but our true allies. Some of our present-day mothers and fathers were at one time Clinic babies. This makes the work interesting, and is a valuable asset to the Maternity and Child Welfare Scheme. Our thanks are due to the Royal College of St. Katharine for their readiness to co-operate in the work, and also to the various associations who have given grants towards dentures, and to friends who have sent woollies and clothes for the Jumble Sales. 119 STATISTICAL SUMMARY OF HOME VISITING FOR 1933. Public Health Department. The Royal College of St. Katharine. Total 1933. Total 1932. Cases. Visits. Cases. Visits. Cases. Visits. Cases. Visits. Ante-Natal:— No. of Cases 836 — 574 — 1,410 — 1,367 — Primary visits — 836 — 574 — 1,410 — 1,367 Re-visits — 1,469 — 2,289 — 3,758 — 3,231 Infant Child Welfare visits:— Primary visits (Infants) — 1,151 — 1,087 — 2,238 — 2,423 Removed before visit — 35 — 28 — 63 — 79 Died before visit — 26 — 30 56 — 51 Still births — 31 — 29 60 — 69 Re-visits— Under 1 — 7,960 — 10,515 — 18,475 — 17,109 1—5 — 19,631 — 24,899 — 44,530 — 40,094 Removed — 552 — 774 — 1,326 — 1,292 Died — 62 — 52 — 114 — 155 †Ophthalmia Neonatorum:— No. of Cases notified 23 — — — 23 — 27 — Primary visits — 23 — — — 23 — 27 Re-visits — 91 — — — 91 — 52 Removed to Hospital 8 — — — 8 — 9 — *Enteritis:– (a) No. of Cases reported — — — — — — — — (b) No. of Cases notified (Z.E.) 11 — 18 — 29 — 67 — (a) Primary visits — — — — — — — — Re-visits — — — — — — — — Removed to Hospital — — — — — — — — Died — — — — — — — — (b) Primary visits — 11 — 18 — 29 — 67 Re-visits — 14 — 42 — 56 — 118 Removed to Hospital 3 — — — 3 — — — Died — 1 — 1 — 2 — 6 Measles:— No. of Cases under 5 years 216 — 98 — 314 — 939 — Primary visits — 216 — 98 — 314 — 939 Re-visits — 70 — 9 — 79 — 263 Removed to Hospital 31 — — — 31 — 260 — Died — 1 — — — 1 — 30 Total visits— Children over 5 years 138 138 120 120 258 258 495 495 Whooping Cough:— No. of Cases 373 — 366 — 739 — 322 .— Primary visits — 373 — 366 — 739 — 322 Re-visits — 176 — 230 — 406 — 145 Removed to Hospital 64 — — — 64 — — — Died — 8 — 6 — 14 — 2 †Puerperal Fever:— No. of Cases notified 8 — — — 8 — 9 — Primary visits — 8 — — — 8 . — 9 Re-visits — 18 — — — 18 — 20 Removed to Hospital 8 — — — 8 — 9 — Died:— (a) Notified Cases 3 — — — 3 — — 4 (b) Non-notified Cases 1 — — — 1 — — 2 †Puerperal Pyrexia:— No. of Cases notified 24 — — — 24 — 28 — Primary Visits — 24 — — — 24 — 28 Re-visits — 36 — — — 36 — 49 Removed to Hospital 22 — — — 22 — 27 — Died — — — — — — — — Maternal Deaths (enquiries) 4 — — — 4 — 12 — Maternal Deaths:— Primary visits — 4 — — — 4 — 12 Re-visits — 18 — — — 18 — 52 Miscellaneous Visits — 1,032 — 196 — 1,228 — 2,581 Total Visits:— Primary — 2,646 — 2,143 — 4,789 — 5,888 Re-visits — 31,369 — 39,220 — 70,589 — 65,205 Total Visits Paid, 1933 — 34,015 — 41,363 — 75,378 — — Total Visits paid, 1932 — 33,833 — 37,260 — — — 71,093 * Zymotic Enteritis is notifiable from 1st June to 30th September. † All cases are visited by Health Visitors of the Public Health Department. Enquiries re Maternal Deaths are made by the Public Health Department. 120 The following table shows the attendances at each of the Clinics during the year 1933:— Bow West Ferry Road. Manchester Road. Simpsons Road. Wellington Road. P.H. Dept. Total. Royal College of St. Katharine Total. Ante-Natal Clinics:— Attendances 767 — — 1,208 318 2,293 1,564 Average per session 15.0 — — 15.5 12.2 14.8 30.6 Dble Infant Consultations:— session. First attendances 314 156 203 314 342 1,329 1,107 Total attendances 7,820 4,873 8,429 8,264 7,583 36,969 23,790 Average per session 76.6 95.5 81.0 79.5 72.9 79.5 93.3 Dble Average attendance of session. each child 10.8 11.7 15.4 13.0 12.7 12.7 8.9 Light Clinics:— Attendances — — — 3,771 5,443 9,214 3,794 Average per session — — — 15.3 19.0 17.4 13.1 Dental Clinics:— Attendances — — — — 1,370 1,370 1,468 Average per session — — — — 18.0 18.0 12.5 Sewing Class — — — 753 — 753 1,965 Garden attendances — — — — — — 1,794 Mothers' Clinic (PostNatal) — — — — — — 486 Remedial Clinic — — — — — — 852 Total attendances at all Clinics:— 1933. 1932. P.H. Department 50,599 48,167 Royal College of St. Katharine 35,713 35,413 Total 86,312 83,580 Sale of Food Accessories, etc. The following table shows the sales of food accessories, simple remedies, and materials for making clothing, which are sold at cost price to mothers attending the clinics and payments at clinics for various services:— 121  £ s. d. Dried Milk, 6,096 lbs. 437 1 7 Special Milk, 230 lbs. 18 7 3 Dried Milk, Humanised, 326 lbs. 32 12 0 Aberdeen Emulsion 6 16 8 Dusting Powder 0 14 0 Medicinal Paraffin 3 17 5 Medical Sundries 8 12 8 Dentures 87 14 6 Materials at Sewing Class 14 16 11 Convalescent Treatment 5 11 0 Virol 10 3 8 Oil and Malt 98 5 0 Concentrated Food 36 4 7 Payments for Gas (Dental Clinic) 3 18 6 Accouchement Sets 10 4 0 Cod Liver Oil 20 10 7 Total £795 10 4 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. 1,804 such vouchers were issued during the year. Convalescent Treatment, etc. Convalescent Treatment (mothers with babies) 35 cases. ,, ,, (mothers alone) 7 ,, ,, ,, (children under 5 years) 31 ,, Payment of Midwives' fees 17 ,, Compensation to Midwives 25 ,, Loan of maternity bag, containing clothing, etc. 35 ,, Grant allowed for Accouchement Sets 32 ,, Grants by Maternity and Child Welfare Committee during the Calendar Year, 1933. Midwives' Fees 22 (13s. 6d. in each case). Compensations to Midwives 25 (10s. in each case). Maternity Outfits at half-price 42 122 The Council supplied dentures to two mothers who, on account of their economic position, were unable to meet the whole cost. The cases were strongly recommended by Clinic Medical Officers. (The following tables refer to the whole Borough.) Statistics Respecting Infants Born in 1932. All births, including those occurring in outlying districts, but belonging to the Borough 2,724 Doctors in attendance 317 Midwives in attendance 1,010 Delivered in institutions 1,359 Not stated 38 Moved into Borough 108 2,832 Stillborn (Stillbirths per 1,000 births, 29.2) 82 Died before visit 61 Not requiring or desiring visits 57 200 Visited 2,632 Removed within the year 367 Died during visitation 74 441 Remaining under supervision end of first year 2,191 Mortality per 1,000 visited 28.1 The 2,191 children visited during 1933 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 72.8 per cent. Mixed feeding 20.2 ,, Hand-fed 7.0 „ The 74 children who died during the first year of life, were fed during the first six months of life as follows:— Breast-fed 28.4 per cent. Mixed feeding 27.0 ,, Hand-fed 44.6 ,, 123 Below is a statement comparing the mortality rates per 1,000 visited of children fed by the various methods:— (a) Babies breast-fed 13 (b) „ who received mixed food (breast and hand) 43 (c) ,, hand-fed 177 Stillbirths. (This refers to the whole Borough.) 59 Stillbirths were investigated during the year 1933. Number of Stillbirths 59 Doctors in attendance 7 Midwives in attendance 14 Delivered in Institutions 38 B.B.A. Nil Two other stillbirths were recorded, but information regarding these could not be obtained. Ophthalmia Neonatorum. Twenty-three cases of Ophthalmia Neonatorum were notified during the year:— (This table refers to the whole Borough.) Year. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths Notified. Treated. At home. In hospital. 1914 75 70 5 73 — — 2 1915 64 62 2 62 1 — 1 1916 60 60 — 60 — — — 1917 39 ** 37 1 36 1 — 1 1918 40 38 2 39 1 — — 1919 61 51 10 60 1 — — 1920 61 51 10 59 — — 2 1921 47 41 6 42 2 1 2 1922 36 33 3 34 1 — 1 1923 38 30 8 35 — — 3 1924 46 38 8 46 — — — 1925 44 39 5 42 — — 2 1926 43 35 8* 42 — — 1 1927 48 44 4 48 — 1 — 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 1933 23 15 8 23 — — — Total 946 835 110 921 7 1 17 ** 1 born in Institution—not visited, no information available. * Including 3 which occurred in Institution. 124 Cases Notified and Visited. Number of notifications received 23 Very slight cases 13 Sight of one eye damaged — Recovered 23 Occurred in Institutions 5 Occurred in the practice of medical practitioners 2 Occurred in the practice of midwives 16 Admitted to hospital as in-patients 8 Treated as hospital out-patients 3 Treated privately 12 Visited by nurse 16 Zymotic Enteritis.— Notifiable June-September. (Whole Borough). Notifications received (Patients under 5 years) 29 Under 1 year (see feeding below) 12 1 to 2 years 10 2 to 3 years 3 3 to 4 years 1 4 to 5 years 3 Died before notification received 2 Visited 29 Treated in hospitals 3 Of the 12 cases of Zymotic Enteritis under 1 year of age which were notified, 2 died. Both were hand-fed. The remaining 10 were fed as follows:—Breast-fed, 5; mixed feeding, 3; hand-fed, 2. 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. 125 During the year St. Mildred's House ceased district nursing on the Isle of Dogs. The East London Nursing Society took over part of this area, and for the remaining part an agreement was entered into with the Vicar of St. John's Church, Isle of Dogs. The agreement with St. John's does not apply to members of families who make weekly contributions to the St. John's Isle of Dogs Nursing Association and are members of that Association. The following is a summary of visits paid by Nurses during 1933:— (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 16 — — 16 Visits 402 — — 402 Measles Cases Under 5 2 — 2 5-10 — — — — Visits Under 5 32 — — — 32 5-10 — — — — — Pneumonia Cases Under 5 14 — — 14 5-10 5 — — 5 Visits Under 5 253 — — 253 5-10 62 — — 62 Pemphigus Cases 5 — — 5 Visits 90 — — 90 WhoopingCough Cases Under 5 — — — — — Visits Under 5 — — — — — Zymotic Enteritis Cases 2 — — 2 Visits 53 — — 53 Puerperal Pyrexia Cases — — — — Visits — — — — Totals Cases 44 — — 44 Visits 892 — — 892 126 The following table relates to visited children of ages 1 to 5 years:— Year of Birth. 1928 1929. 1930. 1931. Remaining under supervision: End of first year — — — 2,285 ,, second year — — 2,348 — ,, third year — 2,209 — — ,, fourth year 2,204 — — — Inward Transfers 77 113 122 97 Visits discontinued 4 — 2 2 Outward Transfers 131 159 194 233 Died 8 7 16 45 Remaining under supervision: End of second year — — — 2,102 ,, third year — — 2,258 — ,, fourth year — 2,156 — — ,, fifth year 2,138 — — — Mortality per 1,000 visited: Second year — — — 18.9(15.1) Third year — — 6.5(9.4) — Fourth year — 3.0(5.9) — — Fifth year 3.5(4.6) — — — The figures in parentheses are the rates for the previous years. Co-operation with the Education Authority. 2,138 case sheets relating to the children who have reached the age of 5 years were forwarded to the Education Department. 1,722 special reports were also forwarded regarding children attending school, not yet 5 years of age. Maternal Deaths.— The Council agreed that the investigation of maternal deaths should continue to be carried out on the lines suggested 127 by the Ministry of Health. There were 4 maternal deaths, and the mortality rate was 1.70 per 1,000 total births (live and still). Attended Treated Number of Received Cause of Death. at home in Institution. previous Ante-natal Care by Pregnancies or Treatment. Puerperal Sepsis, 4 cases— 1. Puerperal septicaemia. Septic — Yes — Yes, at Institution. endometritis following full term labour. No p.m. 2. Septicaemia. Septic abortion Doctor Yes 10 No. set up by falling down some steps. P.M., Misadventure 3. Streptococcal septicaemia. Doctor Yes 4 No. Miscarriage 2 months. P.M., Natural cause 4. Puerperal septicaemia. Normal Midwife Yes 5 Yes, by Midwife at confinement, 11.10.33. home. Did not P.M. attend Ante- natal Clinic. 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 95). The arrangements 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, were continued for 12 months from 1st April, 1933. (During 1933 Consulting Obstetricians were called for on four occasions.) Special Ante-Natal Consulting Clinic—St. Andrew's Hospital. In the early part of the year Mr. McNair gave notice of the termination of his undertaking with the Borough Council as from 31st March, 1933, but continued seeing patients until the end of June. The London County Council granted facilities for the continuation of the service, and arrangements were made with Mr. A. C. McAllister to carry on this work, as from August. 128 The number of patients seen at the Ante-Natal Consultation Clinic was as follows:— (a) Referred by private practitioners 5 (b) Referred by clinic medical officers 14 19 Infantile Mortality.— The infantile mortality rate (54) is the lowest recorded in the Borough. Ambulance.— In 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 4 non-urgent cases during the year 1933. Measles.—In view of the expected increase of measles cases during the winter 1933-34, the Council approved of a scheme of co-operation with the London County Council Education Authority, as on previous occasions. The Medical Officer of Health has been given power to appoint one or two temporary Health Visitors if the position demands this. Prevention of Deafness.—Under date 22nd May, 1933, the Ministry of Health issued Circular 1337a, on this subject. In submitting this to the Maternity and Child Welfare Committee, the Medical Officer of Health pointed out that the Health Visitors in their home visitations at present make special enquiries as to these defects. Mothers were persuaded to bring their children to Infant Welfare Centres to be seen by the Clinic Medical Officers. If there was any ear or throat disease, or abnormal condition, the children were referred to the Special Departments at the various Hospitals. Special work is also carried out. at the Royal College of St. Katharine. The following suggestions of the Medical Officer of Health were adopted:— 129 (a) A copy of the Ministry's Circular sent to each Clinic Medical Officer. (b) The Clinic Medical Officers were supplied with a list of the hospitals having a special department for this work, giving the days and times when patients may be seen by the Specialist. Clinic Medical Officers refer any cases with disease, or abnormality of the ear, nose or throat to the Specialist for a report and treatment, if necessary. (c) When the child is 3 years of age or over, and the parents are willing, the child is referred to the Divisional School Medical Officer for special examination, and if suitable, for education in a special school. Transfer of Powers (London) Order, 1933.—Under the above Order, which came into operation on 1st April, 1933, the duties regarding Infant Life Protection were transferred from the London County Council to the Borough Council. The following arrangements were made in order to carry out the provisions of Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932:— (a) Officers.—The Chief Health Visitor, Miss J. M. Cardozo, was authorised, in writing, to carry out the duties, with the exception of the institution of legal proceedings, and Miss E. A. H. Williams was authorised to act during Miss Cardozo's absence. As this work might involve Court proceedings, and if such proceedings were taken by the Health Visiting Staff, it would prove detrimental to the ordinary work carried out by them, the Council appointed Messrs. C. A. Grabham and H. A. Pearce as Officers under Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932, for this work. The Medical Officer of Health was authorised to exercise the powers. (b) Reception of Notices.—The Medical Officer of Health, Public Health Office, Bow Road, is the authorised person to receive Notices required to be given to the Council. 130 (c) Advertisements.—Advertisements, posters and handbills were issued. Proposed Day Nursery and Creche.— The Bow Methodist Mission applied to the Borough Council during the latter part of the year for a grant towards a Day Nursery and Creche which it was proposed to establish in the Bow Common Area. The Rev. Clapham, in writing, on behalf of the Methodist Church, stated they sought for the very closest co-operation with the Borough Council. Discussions have taken place between officers of the Council and the Church as to the proposed building, and the Medical Officer of Health has had informal discussions with officers of the Ministry of Health. The Borough Council has agreed to contribute a sum of £500 annually towards the cost of the maintenance of the proposed Creche and Day Nursery. The Minister of Health has intimated that he will be prepared to approve of this arrangement on conditions providing for the establishment and maintenance of the premises to the satisfaction of the Borough Council and for the necessary access of the Medical Officer of Health, and of any other officer designated by the Borough Council, for the purposes of general supervision. Supply of Extra Nourishment—Co-operation with London County Council.—In December, the Chief Officer of Public Assistance, London County Council, suggested certain procedure in a proposed scheme of co-operation between the Borough Council as regards the supply of extra nourishment to maternity cases where domiciliary relief is being granted by the London County Council. The scheme referred to nursing and expectant mothers. After considering the proposals, the Council adopted the following resolutions:— (a) To recommend the Borough Council to co-operate on the lines suggested by the London County Council for a period, at the commencement, of six months, and that it be left in the hands 131 of the Medical Officer of Health to arrange details of the scheme with the Local Public Assistance Officer; (b) That after three months' working the Medical Officer of Health submit a report as to the operation of the scheme; (c) That any cases reported to be adversely affected by the scheme to be taken up by the Medical Officer of Health with the Local Public Assistance Officer and reported to the next meeting of the Maternity Committee; (d) In the event of any case being refused nourishment by the Public Assistance Committee, the nourishment be granted under the ordinary Maternity and Child Welfare Scheme, if the case was eligible. Student Health Visitors. During the year four Student Health Visitors from the Royal College of Nursing and one from the Bedford College for Women have been given a course of practical training. Post-Graduate Course. Two Health Visitors attended a Post-graduate Refresher Course during the year. Training of Probationers at the Observation Wards. 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 number of cases admitted was again greater than it had been in the previous year. The conditions were exceptionally favourable and the results have been very good. There was an absence of any very trying weather, and nine months at least were warmer and sunnier than usual. There were no epidemics and no infections of any seriousness to combat. The results of the year's work may be safely considered highly satisfactory. The following is a list of the cases that were admitted:— Difficulty in Artificial Feeding 16 Marasmus 3 Difficulty in Breast-feeding 1 132 Malnutrition 22 Rickets 9 Neuroses 14 Various 3 68 The number of babies who were not thriving on artificial feeds was slightly smaller than in the previous year; if this means that the skill of the mothers is improving, or that the number of bottle-fed babies is diminishing, it is all to the good. There was, as usual, a large number of pallid, undersized, catarrhal children. They are called Malnutrition for want of a better word. The causes are various. In some cases a previous infection, such as pneumonia, is responsible, or else a series of minor infections, usually catarrhal, which have reduced the child's health, his appetite, his digestion and his power of absorbing food. In others the diet is wrongly chosen or given in the wrong way, as in the all-too-common instances where the child is allowed to eat starchy food between meals. They respond very well to treatment in the Wards, especially when they have learned to digest a diet which is better chosen than that to which they are accustomed. The neurotics were mostly cases of food-refusal, a condition brought about generally by an excess of zeal on the parents' part in trying to make the child eat. A few days in the right atmosphere effect an almost miraculous cure. The results obtained among the in-patients are as follows:— Recovered 62 Improved 1 Transferred to Hospitals 2 Removed by Parents 3 68 Although these figures do give an idea of what is being done, the real way to understand is to see the babies—to see a thin, miserable, crying child go home plump, sleek and rosy; or a drooping, pot-bellied, undernourished little boy or girl become in a short time sturdy, upright, the richer by several pounds of added weight. Regular physical exercises 133 have been started this year for the "toddlers,'' with, it is believed, good results. Out-Patients. Total number of attendances at Special Clinics 403 (319) Total number of New Cases 167 (132) Attendances for Test-feeding and Re-establishment 598 (439) This shows a really large advance on last year's figures, which are put in brackets for comparison. It can be seen therefore, that the outpatient Department was very busy this year. The cases in the Out-patient Department were:— Difficulty in Breast-feeding 62 Difficulty in Bottle-feeding 12 Cases for Admission 61 Single Consultations (children referred for opinion by Clinic Medical Officers) 28 Miscellaneous 4 167 Dealing with difficulties in breast-feeding is a very important part of the work, and the time spent on it cannot be grudged. In last year's Report the mortality-rate per thousand of infants visited in the Borough is given:— Breast-fed 36 Partially-Breast-fed 92 Bottle-fed 167 Nothing could emphasise more clearly the need for perseverance in dealing with difficulty in breast-feeding. Our results were:— Breast-fed only 27 Partially Breast-fed 25 Bottle-fed 2 Transferred to Hospital 1 134 As far as possible complete breast-feeding is re-established, but there are often insurmountable obstacles to it, such as ill-health in mother or child, or delay in seeking advice leading to partial involution of the breast. Preservation of partial breast-feeding however, is infinitely better than a complete relapse to the bottle, which would have occurred in most cases if help had not been at hand. Illness or some other cause prevented a few cases from completing attendance and the exact result in them is not known. I must, in conclusion, thank the Nursing Staff for their skill and care, and my colleagues for their cordial co-operation. H. ST. H. VERTUE. 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 work of the Light Department for 1933. I report on 343 children, classifying them as follows:— Rickets 53 Disturbed Dentition 124 Delayed Dentition 10 Malnutrition 56 Debility 52 After illness 20 Various 28 1. Rickets.— Five cases were purely muscular, and all did well. The fat, flabby child, too weak to stand, develops under our eyes into a prize toddler, given a long and regular course. The majority, mixed and bony rickets, were, as usual, good attenders and benefited greatly. Of the 53 cases, 45 were successes, 10 being "marked successes," 7 were moderate successes, and one ceased too soon. For this disease we are a necessity. Sunlight, real or artificial, with cod liver oil, is now everywhere known to be the specific treatment for avoidance, arrest and cure. 135 I am glad that mothers in this group do attend well. They are to be congratulated on persevering over long courses of weeks, and express their pleasure at the results. 2. Disturbed Dentition.—I have before referred to the severe disorders that fall into this group. Some teething children arrive afflicted in various ways and in a very low state of health. They respond remarkably well to U.V.R., and many leave us in excellent health. The benefit to their spirits and tempers is equally marked. Of the 124 cases, 111 were successes, 9 were moderate successes and 4 failed to benefit. 3. Delayed Dentition.—Of the 10 cases, 8 were successes, one moderate success, one ceased to attend on account of illness. 4. Malnutrition.—Of the 56 cases, 37 were successes, 13 moderate successes, 1 ceased too soon, and 5 failed to benefit. 5. Debility.—Of the 52 cases, 26 were successes, 21 moderate successes, 2 ceased too soon, and 3 failed to benefit. 6. After Illness.—Of the 20 cases, 16 were successes, 1 moderate success, and 3 failed to improve. 7. Various. Enlarged tonsils and adenoids, bronchitis and other disorders have been grouped together. Of the 28 cases, 14 were successes, 8 moderate successes, 1 ceased too soon, and 5 failed to improve. One, in the Wards, could not have benefited permanently, having a congenital malformation, and was sent to hospital. One, a Mongol, I accepted for treatment only at the mother's urgent wish, as these children cannot develop normally. One brilliant success occurred in a "skin case" regarded as intractable. This responded to U.V.R. in a highly gratifying manner. The Department has continued its steady work. We now have some regular clients, having one or two long courses a year and maintaining much better health while under U.V.R. than away from it. In most of my groups there are children suffering from "nervous strain." They come fretful, sleepless, (or so described), bad-tempered, 136 solitary and miserable. The causes are sometimes apparently physical, often among the elders from difficulties in the home. These distressing states, peculiarly unnatural in young children, react surprisingly well to the tonic we can supply, and we are told of a pleasant change in the home atmosphere. U.V.R., though not, of course, a panacea for all ills, is extremely useful in reinforcing Nature's tendency to cure. Mothers.—70 adults were treated, chiefly for debility during pregnancy or lactation. Of the 70 cases, 39 were successes, 13 moderate successes, 16 ceased too soon, and 2 failed to improve. The poor attenders usually withdraw from unavoidable pressure of circumstances, and the successes greatly appreciated their better health and spirits. This year, as before, I record my thorough appreciation of the excellent work done by the Sister-in-Charge. My warm thanks are due to her, and to her assistant, for their dealings both with the mothers and children. E. M. LAYMAN. Statistical Summary. January 1st to December 31st, 1933. Bow. Poplar. Totals. Number of attendances 5,443 3,771 9,214 ,, ,, sessions 284 245 529 ,, ,, patients 306 255 561 Maternity and Child Welfare Dental Clinic. Mr. C. Hammond Williams, L.D.S., R.C.S. (Eng.), the Dental Surgeon in charge of the Dental Clinic, has submitted the following report:— I beg to submit my annual report of the work carried out at the Dental Clinic in connection with the Maternity and Child Welfare Department. Our figures for 1933 show a considerable increase of work done over the previous year, chiefly under the heading of extractions. There is also a marked increase in the number of attendances. 137 76 Sessions have been held. 1,370 Total attendances. 370 New Patients have attended. 78 Fillings. 101 Scalings. 49 Permanent teeth have been extracted under local anaesthesia. 1,569 Permanent teeth have been extracted under nitrous oxide anaesthesia. 1,417 Temporary teeth have been extracted under ethyl chloride anaesthesia. In addition, dressings, dentures, etc. It will be observed that the average attendance per session has increased to 18 patients from 15 in 1932. In order to reach this average, at some sessions as many as 25 to 30 patients attend, which is rather too great a number to cope with in a limited time. I am of the opinion that such attendances as these are to be discouraged in dental work, for little can be done for each patient, and though such figures help to swell the total attendances, each patient needing a greater number of visits, it can have no good effect on the amount of work performed. I consider an average attendance of 15 patients per session about the best number from every point of view. The return of many old patients for further work has been noticeable during the year. It is gratifying not only that the patients return to us, but that they show the interest in their mouths to keep them in good order. It may be remembered in previous years I have called attention to the fact that there are fewer "clearances'' in children's mouths now than formerly. It is quite the exception now to find a child with 16-20 decayed teeth. I am particularly glad of this fact; it tends to show a very important advance in the rearing of children. Our equipment and furnishings continue to give satisfaction and once again I am happy to have the opportunity of thanking all those who assist me so excellently in my work. C. HAMMOND WILLIAMS, L .D .S., R .C .S. (Eng.). 138 Royal College of St. Katharine. Report of the Senior Medical Officer. The Diet of the Infant at the Age of Weaning. The chart which accompanies these notes records the weight of a healthy first-born baby during its first two years of life. The curve almost divides itself into three sections. The first extends from birth to nine months, during which time the weight rises steadily. The second extends from nine months to a year and eight months, and in this period no progress is made. In the third a sharp recovery occurs, but is checked just before the end of the year. During the first nine months the baby was practically free from illness. It was fed at the breast for six and a half months and then transferred to cow's milk as the mother was losing weight. Small amounts of solid food were recommended at this age but were not readily taken. There were a few mild catarrhal infections during these first months, and arrows on the chart mark where they occur. They had but slight effect on the rate of growth. In the latter part of the year, and in the second year it will be seen that they interfere greatly with progress. They were, also, clinically much more severe illnesses; thus at fourteen months the child was ill for three weeks with otitis media and bronchitis. During the second period, and while no growth is recorded, the child's general health declined steadily. Appetite was capricious and food refusal was a constant source of anxiety to the parents. With any attempt to advance the diet, or even to modify it to the state of health at a particular stage, some symptom, such as retching, vomiting, flatulence or disordered stools was reported. Bad sleeping habits, with long periods of crying and wakefulness at night, were added difficulties. The appearance of the baby at eighteen months of age was in striking contrast with that at any time during the first nine months; it was now undersized and pallid, with poorly-developed muscles and little subcutaneous fat. There were no clinical signs of rickets; iron was prescribed, but was said to provoke vomiting. At the age of a year and eight months the baby was removed from its home and placed in the charge of trained nurses on a controlled diet, under a regime which included several hours a day out of doors. For the first fortnight after the change a most stubborn refusal of food was encountered and the ordeal by hunger was necessary to overcome it. WEIGHT CHART OF A CHILD FROM BIRTH TO 2 YEARS OF AGE, TO SHOW:— 1. Steadiness of growth during the milk feeding period, with good resistance to catarrhal infections. 2. A halt in progress from the start of mixed feeding, and an increase in the severity of the catarrhal illnesses. 3. Rapid recovery on a controlled diet while under supervision as an in-patient (A—B). 139 That much of the vomiting was self-induced was clear, for the child could do it at will, and its satisfaction at the return of a meal which had taken half-an-hour to coax down was quite unmistakable. Once this was given up and meals were taken regularly with other children a rapid gain in weight followed. It was clear there was a normal power of digesting a wide range of food. In fourteen weeks 5lbs. of weight was added, at which point the child was returned to its home. It was able to walk for the first time and was in greatly improved condition. This failure, after about eight months of age, to maintain the steady rate of growth seen during the milk-feeding period, is so common among children attending the infant clinics that it is selected for brief discussion. In the instance just described the halt is, perhaps, too marked and prolonged to be taken as quite typical; and the delay certainly owed something to the neurotic habits which the child developed. Nevertheless, it will serve to illustrate features common to many others. The early progress certainly denotes a perfect harmony between food and physiological requirements. There are two usual explanations given for the slightness of the reaction to infection at this age, some attributing it to an immunity derived from the mother and prolonged by breastfeeding, others considering that it denotes merely an adequate supply of suitable food. The well-known immunity to measles during the first six months or more is brought forward in support of the first view; its opponents claim that infants fed on suitable preparations of artificial milk show equally good and uninterrupted progress. Whichever is correct, a decline in growth commonly occurs at about the same age in both breast- and bottle-fed—that is in the last quarter of the year, the stage at which some food other than milk must be added if good nutrition is to be maintained. It seems fair to argue that the test of whether the additions are suitable and the amount of milk still enough is closely reflected in the rate of gain. Resistance to illness must remain an open question, though by analogy with rickets its dependence on proper food is probably close. Taking the test of weight alone, of how many can we say it is satisfactorily passed? An impartial review of a large number of charts and of the notes referring to the children, leaves the impression that failure at this stage is very common. It is difficult to avoid the conclusion that this period of transitional feeding marks a crucial stage in child welfare, so often does a decline in general health set in—a decline which is certainly not made good by the age of five in many instances. 140 Stated in reverse order, the child that enters school undersized and four or five pounds under weight was often a thriving baby, well up to, or even above standard until it was nearly a year old. By two it has fallen two or more pounds below the average, and by three, three or four pounds. If the complaint of Sir George Newman is to be met, that school entrants are of little better physique than they were when the rate of infant mortality was high, and reveal much the same defects as formerly, one of the commonest faults to be corrected is, surely, the failure which occurs towards the end of the first year of life, to maintain a proper rate of growth. It is easy to blame mistakes in feeding for this halt in the child's development, but it is far from simple to see how to rectify them. Most workers in this field will realise where the main difficulties lie. Nowadays it is comparatively easy to give clear instructions about milk and its modification to suit most babies of ordinary health who have to be reared by hand. But when it comes to mixed feeding, the quality and preparation of the food devolves upon the mother, and her skill as a marketer, housekeeper and cook becomes an all-important factor. Again, babies vary widely in the readiness with which they take to solid or semi-solid food. Some are eager to experiment freely at a very early age; others are timid in the extreme, and having learnt the taste of one new substance remain obstinately conservative for weeks at a stretch, and will advance no further. Their diet thus remains limited and unbalanced. Mothers of several children will often describe great differences in the ease with which weaning is accomplished, one child giving no trouble, another offering stubborn resistance for months. H. C. Cameron has shown convincingly in his writings how important here is the part played by the mother's skill and confidence in the matter of training. "A good mother, like a good cricketer, may prove wholly ineffective if selfconfidence is lost." Food refusal is made use of by the child to assert its authority and may lead to most erratic habits. If we may suppose none of these hindrances to exist, there still remains the question of what food to prescribe; what substances should be added, and in what order and amount; what are unsuitable and should be withheld. We need to know what amount of milk is required and the rate at which it can be safely reduced. Many have no doubt reached working rules which seem to serve most purposes, and to such the suggestion that the diet of the child at this age still needs research will appear unnecessary. Nevertheless, there are these unsatisfactory weight charts, 141 and there exist, without doubt, great differences in teaching on the subject. This may very easily be seen by anyone who cares to spend an hour or two in a medical library and reads the instructions in a group of text-books. Diets based on caloric requirements have not been made sufficiently simple to afford practical help to most practitioners, and the same drawback attaches to them as to others, that there is no settled agreement as to what is suitable to include. Even where there is a fairly general measure of agreement—as, for example, on the amount of milk still required by a child at the age of a year—the evidence in its support is not very convincing. There is seldom more to be found than the statement that "a pint and a half should be continued." In the case of other foodstuffs, what one forbids another allows. The physiologist seems content if the protein, fat and carbohydrate content reach a certain total and are in correct proportions, and cares not in what form it is supplied. The prices of food and what is available in different markets receive scarcely any consideration, yet these are matters which play a preponderant part at infant welfare centres. The enormous number of children passing under review at these centres seems to offer an unexampled opportunity for observation on these points and the chance that something like an agreed plan of diet could be reached. That the truth of the matter is yet to be sought is suggested both by the difference in the instructions current, and by the high proportion of unsatisfactory results which can be seen whatever plan of feeding is recommended. It is reinforced by another somewhat significant fact; and that is the deep reluctance shown by many mothers to reveal what food they are giving their babies, even, and perhaps specially, when the babies are thriving and growing at the normal rate. Whether from a polite reluctance to wound our feelings, or for fear of some reprimand, many interviews at the clinics undoubtedly end without the facts coming to light at all. When one is fortunate enough to receive their confidence, details of the food given often differ in the sharpest possible manner from what is usually accepted as safe and orthodox. Babies who are still, according to most text-book teaching, at an age when they should be having Scarcely more than a little prepared starch added to a milk feed, are found to be eating—and seemingly digesting with ease—such things as the uncooked fat of meat, slightly cooked meat, liver, conger eel, kippers, and so forth. So stern is the usual denunciation of these discoveries that the healthiness of many of the children is commonly overlooked. Should the consumption of such food be always forbidden? Or are we, perchance, doing the child an injustice, and are its powers cf 142 digestion sometimes more advanced, versatile and robust than they are credited with being? How much of the solution of unsatisfactory weight curves lie in the answer to this question? Lastly, is prolonged milk feeding essential to satisfactory growth, or may it be merely the best we can do in the absence of precise knowledge? The baby whose weight chart has been quoted was given, during the time it was under observation, what may conveniently, if unscientifically be described as "grown-up food." At first the diet included 200zs. of milk, then 150ZS., and later 120ZS. daily. Meat, fish, eggs, vegetables, fruit, bread, butter, cheese and simple puddings were all allowed. Cod liver oil up to 3 teaspoonsful daily was taken without difficulty. The anaemia responded readily to the administration of iron, and the haemoglobin rose from 64 per cent. to 92 per cent. in twelve week. The value of the food was calculated to be between 1,000 and l,200 calories daily, and its cost about 3s. 8d. a week. No special cookery was employed, and the mother was shown its general character on many occasions, and observed the. child contentedly at its meals. But on its return home the old complaints of refusal, retching and dyspepsia recurred, and the weight came to an immediate standstill. Advice from other sources was sought and the child was admitted into another institution for a "thorough investigation of its dietetic needs." To add to the confusion, the parents were led to understand that the infant illhealth was attributable to the gravely unsuitable nature of the previous feeding. No further data are available. H. K. WALLER- Free Milk Scheme. Milk is supplied to expectant and nursing mothers and children under 3 years of age (in special circumstances 5 years), under the Ministry of Health Circular 185. As reported in the Annual Report for 1927, dried milk is supplied under the scheme, with the exception that Grade "A" (Tuberculin Tested) milk is supplied in special cases (infants) where the Medical Officers in charge of the Council's Child Welfare Clinics consider its use specially desirable. 143 During the latter part of 1932 the Council, upon the recommendation of the Maternity and Child Welfare Committee, agreed that it be a condition of the supply 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, 1933, 15,859 applications for free milk were received, of which 13,878 were granted. (The number of persons granted milk was 18,169.) Orders were issued for 78,373 pints of Grade "A" (Tuberculin Tested) milk, and 64,206 pounds of Dried milk, the total commitments amounting to approximately £5,845. In addition, orders were issued for 305 bottles (40Z.) of iron solution and 8,273 bottles (40Z.) of cod liver oil. Six hundred and forty-six (646) cases were investigated by the Enquiry Officer, and all were reported satisfactory. Distribution from 1st January, 1933, to 31st December, 1933. C.L.O. Iron "A." "G." "S." (40Z. (40Z. lbs. lbs. lbs. bottles). bottles.) By Distributing Centres 1,136 By Clinics (including Royal College of St. Katharine) 54,223 2,660 2,966 8,174 259 55,359 2,660 2,966 8,174 259 Distribution from Centres ceased from 17th March, 1933. "S," C.L.O., and Iron distribution operated from 6th February, 1933. 144 The following table shows in comparative form the applications, etc., during the years 1920-33:— Year. Applications. Applications granted. Cost (approx) £ Orders issued. Cases investigated by I.O. (b). 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 — 1933 15,859 13,878 5,845 78,373 64,206 646 — Notes.—(a) In 1920, 49 tins of condensed milk were also issued; (b) the Enquiry and Investigation Officer commenced duty in March, 1921; (c) by Circular 185, dated 31st March, 1921, children between the ages of 3 and 5 years are only allowed milk upon a special medical certificate. Nutritional Anaemia, Rickets, etc. In 1932 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 40Z. bottles to recipients of free milk on the recommendation of Clinic medical officers. The issue of iron solution and cod liver oil commenced 6th February, 1933. (Quantities issued are shown at the foot of preceding page.) 145 INDEX. Page Age Mortality 19 Agricultural Produce (GradingandMarking)Act, 1928 79 Altered Diagnosis Cases 98 Analyst's Report 80 Ante-natal Clinic at St. Andrew's Hospital 127 Anthrax 94 Antitoxin, quantity issued 86 Area and Population 11 Artificial Sunlight Treatment 134 Bacteriological Examinations 87 ,, Examination of Milk 68 Bakehouses 70 Births 12 Bug Infestation 62 Butter and Margarine Factories 79 Canal Boats 39 Cancer, Deaths from 99 Cerebro-spinal Fever 95 Cleansing Station 111, 112-114 Clinics, M. & C. W. 117 Clinics, Tuberculosis 100 Combined Drainage 26 Committees 3 Common Lodging Houses 28 Consultants:— 1. Puerperal Fever, etc. 95 2. Obstetric 127 Continued and Typhus Fevers 95 Coroner's Courts 20 Cowsheds 66 Customs and Inland Revenue Acts, Certificates 37 Day Nursery, Proposed 130 Deaths and Death Rates 12-19 Deaths, Classified Causes, Table Facing 14 ,, Infantile, Table 15 Dentist's Reports 106, 136 Diarrhoea and Enteritis, Deaths 12 Diphtheria 86 Disinfectant, Electrolytic 112 Disinfecting Department 1ll Domestic Cleanliness 64 Dysentery 97 Electrolytic Disinfecting Fluid 112 Encephalitis Lethargica 96 Enteric Fever 87 Erysipelas 95 Export of Meat Foods 82 Factory and Workshops Acts—Tables 30-33 Food, Supervision of 66 Food and Drugs Acts, etc. 77 Food Inspectors' Reports 71-76 Food Poisoning 82 Free Milk Scheme 1421-44 146 INDEX—(continued). Page Glanders 94 Hairdressers' Premises 39 Health Education 114 ,, Services 21 ,, Visitor, Chief, Report of 118 Home Nursing 124 Houses Let in Lodgings 27 Housing 47 Hydrophobia 94 Ice Cream 69 Infant Life Protection 129 Infantile Mortality 12, 15, 16 Infectious Diseases, Table of Notifications Facing 84 Influenza 99 Inquests 20 Lady Sanitary Inspector, Report 26 Lectures on Health Subjects 114 Legal Proceedings, etc. 40-44 Malaria 97 Malnutrition 7, 105, 138 Marriages 13 Maternal Mortality 12, 16, 126 Maternity and Child Welfare 117 Measles 97 Meat Food Products, Certification 82 Merchandise Marks Act 79 Milk (Special Designations) Order, 1923, Bacteriological Examinations 68 Milkshops, etc. 66 Mortuary 20 Neo-Natal Deaths 15, 16 Notification of Births Act 13 Notifications of Infectious Diseases, Table Facing 84 Nutritional Anaemia, etc. 144 Observation Wards 131 Offensive Trades 34 Ophthalmia Neonatorum 123 Overcrowding 60 Parliamentary Wards, Statistics Facing 10 Plague 94 Pneumonia 97 Poliomyelitis, etc. 96 Poor Law Relief, etc. 21 Population 11 Post-vaccinal Encephalitis, etc. 97 Public Education in Health 114 Puerperal Fever and Puerperal Pyrexia 95 Rag and Bone Dealer 36 Rag Flock Act 38 Rats and Mice Destruction Act 37 Refuse Disposal 25 Removal of Infirm Persons 24 147 INDEX—(continued). Page Rent Restriction Acts, Certificates 65 Reports:— Artificial Sunlight Clinics, Medical Officer 134 Chief Health Visitor 118 Dental Surgeon (M. & C.W.) 136 Dental Surgeon (Tuberculosis) 106 Lecturer on Health Subjects 114 Observation Wards, Consulting Physician 131 Public Analyst 80 Royal College of St. Katharine, Senior Medical Officer 138 Tuberculosis Officer 100 Samples under Food and Drugs Act 77 Sanitary Inspectors' Work, Summaries 24-28 Scarlet Fever 86 Scavenging, Street Cleansing, etc. 25 Schools, Inspection of 38 ,, Use of Electrolytic Fluid in 112 Seamen's Lodging Houses 28 Slaughterer of Poultry 35 Slaughterhouses 36 Smallpox 87 Smoke Nuisances 34 Stables 37 Staff 4 Stillbirths 12, 123 Street Trading 37 Survey of District 51 Tables A to F (Workshops, etc.) 30-33 ,, of Deaths 14-19 „ of Infectious Diseases Facing 84 Tubercle bacilli in Milk, Examinations for 68,69 Tuberculosis, Death Rate 19 ,, Deaths 110 ,, Notifications, etc. 109 ,, Officer's Report 99 Typhoid and Paratyphoid Fevers 87 Unhealthy Areas 57 Urinals on Licensed Premises 36 Vaccination 92-94 Verminous Children and Persons 111, 113 ,, Rooms 62 Vital Statistics, Summary 12 ,, ,, Tables 12-19 Wards, Statistics of Facing 10 Water Certificates 36 Workshops, Workplaces, etc. (Tables) 30-33 Zymotic Diseases, Death Rate 19 ,, Enteritis 124