POP 43 Metropolitan Borough of Poplar Annual Report FOR THE YEAR 1937 ON The Sanitary Condition and Vital Statistics of the Metropolitan Borough of Poplar BY W. ALLAN YOUNG, d.s.o., m.d., ch.b., d.p.h. Medical Officer of Health. Orusha & Son, Ltd., Tottenham, Enfield, Wood Green and Palmers Green. ' ■ . Metropolitan Borough of Poplar Annual Report FOR THE YEAR 1937 ON The Sanitary Condition and Vital Statistics of the Metropolitan Borough of Popl ar BY W. ALLAN YOUNG, d.s.o., m.d., ch.b., d.p.h. Medical Officer of Health. 3 PUBLIC HEALTH COMMITTEE (November, 1936). Councillor the Rt. Hon. G. Lansbury ,P.C.,J.P.,M.P., Mayor (ex-officio). Chairman : Councillor G. H. Mills. Vice-Chairman: Alderman J. H. Jones. Cllr. Ashley, J. A. Cllr. Baldock, F. T. Cllr. Bossley, J. W. Cllr. Boulton, H. Cllr. Butchins, S. Cllr. Cressall, G. J., JP- Cllr. Cressall, Mrs. N. F. Cllr. Goodway, T. J. Aid. Hammond, J. A. Cllr. Harris, Mrs. A. L. Aid. Jones J. H. (V.Ch.) Cllr. Mills, G. H. (Ch.) Aid. Overland, A. W. Cllr. Tyson, S. Cllr. Williams, Rev.H. MATERNITY AND CHILD WELFARE COMMITTEE (November, 1936). Councillor the Rt. Hon. G. Lansbury, P.C., J .P., M.P., Mayor (ex-officio). Chairman: Alderman Mrs. E. Stavers. Vice-Chairman: Alderman A. R. Sargent. Cllr. Baker, A. Cllr. Bossley, J. W. Cllr. Boulton, H. Cllr. Cressall, G. J., JP- Cllr. Cressall, Mrs- N. F. Cllr. Easteal, A. E. Cllr. Harris, Mrs. A. L. Cllr. Sadler, Mrs. L. M. Aid. Sargent, A. R. (V.Ch.) Cllr. Stadward, Mrs. E. Aid. Stavers, Mrs. E. (Ch.) Co-opted Members: Miss E. Herbert (Royal College of St. Katharine). Mrs. F. A. Cotton. Mrs. F. A. Sargent. Mrs. A.M. Sumner. Mrs. A. L. Topsom. 4 STAFF. Medical Officer of Health : W. ALLAN YOUNG, D.S.O., M.D. (Edin.), D.P.H. (Oamb.). Assistant Medical Officer of Health and Tuberculosis Officer: G. 0. Mitchell, M.D., M.R.C.P., D.P.H. Assistant Medical Officer of Health and Assistant Tuberculosis Officer: L. D. Richards, M.R.C.S., L.R.C.P., D.P.H. Public Analysts ( Part time): ALBERT E. PARKES, F.I.C., F.C.S. H. A. PARKES, B. Sc., F.I.C. GENERAL PUBLIC HEALTH SECTION, PUBLIC HEALTH OFFICE. Chief Clerk and Administrative Assistant: HAROLD DYER.† (a) H. A. Tibbatts.* (a) W. J. COLBOBNE†† (a) H. J. Langley. *† (a) C. S. Westbrook.*‡ (a) Wm. Johnson. *‡ (a) S. Kelly.* Sanitary Inspectors: (a) F. A. Smith.*‡ (a) A. L. DovE.††‡ (b) C. A. Grabham.*‡ (b) H. A. Pearce. *†§‡ (c) H. W. LUKE.††‡ (d) E. A. MAY.††‡ (d) G. L. BELSHAw††‡ (d) T. C. B. RosE.††‡ (e) I. M. G. FABBiES.†† (e) C. H. MEDLAND.††‡ Miss D. A. E. LANDBAY.¶*‡ (a) District Inspectors, (b) Food Inspectors and certain duties regarding child life protection. (c) Inspector for Houses divided into separate tenements, Common Lodging Houses, Seamen's Lodging Houses and Deputy Food Inspector, (d) Housing Inspectors. (e) Special Inspectors for Disinfestation. J. Chapman, C. F. Gbeooby, F. S. Jolliffe, N. L. Brown, C. J. Cooley and R. P. May (District Inspectors' Assistants). A. S. Collyeb (part-time unqualified Assistant to assist the Food Inspectors). F. J. White.* W. F. Roberts. Miss S. Fells. Mrs. E. Long. Clerks: A. Hamilton.†† J. T. Donovan. S. B. Leader. W. G. Babnett. D. G. Flynn. A. T. Bueton. †V. W. Martin (transferred to Finance Dept.). R. G. Andebson (Office Boy) from 27.9.37. Caretaker and Messenger: C. E. Richabdson. H. Harbott (Chauffeur). 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. M. Blasker. The Medical Superintendents of St. Andrew's Hospital, St. Clements Hospital 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. ¶ C. M.B. || H.V.Cert. (Board of Education).‡‡ 3 years' General Nursing Certificate. 5 TUBERCULOSIS SECTION. Assistant Medical Officer of Health and Tuberculosis Officer: Dr. G. 0. Mitchell. Assistant Medical Officer of Health and Assistant Tuberculosis Officer: Or. L. D. Richards. Health Visitors: Miss H. Messem. Miss D. Wood.‡ Miss N. Roberts.** Dispenser: Miss K. Gentry. Clerks: Miss A. D. Frost. Miss J. Smith. Secretary to Care Committee: Miss L. Nugent. N urse -Helper: Caretaker: Mrs. E. Tomlins (temporary). W. J. Parker. DISINFECTING STATION, YEO STREET. Disinfectors: W. Hodge‡ (Chief). F. Farrow. There are also two Apparatus Attendants and one Motor Driver. Four other men are employed in disinfestation work. Manufacture and Distribution of Electrolytic Disinfecting Fluid. Manufacturing: T. Kelleher and C. W. Shaw. There are also 3 Distributors, a Lorry Driver and Attendant. Shelter and Cleansing Station. Attendants: Mrs. A. Howe. Mrs. M. Allen. MORTUARY. Mortuary Keeper and Caretaker of Coroner's Court: D. Hogan. Relief 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). Mrs. D. F. Egan, M.R.C.S., L.R.C.P., D.P.H. *Alao Medical Officer-in-charge Artificial Light Treatment. ‡Sun. 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. Mallett.* Mrs. E. K. Haythornthwaitb.*¶ (c) Miss G.I. Hill*¶ (e) Miss B. E. LETTS*¶ (c) Miss M. H. SuTCLiFFE*¶† (e) Miss E. A. H. Williams .*¶ Miss A. Eaton*¶ Sister-in-Charge Artificial Light Treatment. Miss C. Harrison, Unqualified Assistant (Artificial Sunlight)—resigned 31.3.37. Miss J. Harris ,, ,, ,, ,, —from 13.4.37. Clerk: Miss K. d. Evans. Observation Wards. Wellington Road, Bow, E.3. Consulting Physician: H. St. H. Vertue, M.A., M.D., Ch.B. (Oxford.) Emergency Medical Officer: D. G. Macrae, M.R.C.S. (Eng.), L.R.C.P. (Lond.) Hatron-in-Charge: Miss A. C. Andrews.*¶ Sister: Miss K. Walker. Two Staff Nurses, three Probationers, one Cook, one Maid and a Porter. Free Milk Scheme. Clerks: Miss K. Phelan. Miss C. Rudd. Miss V. S. Roberts. Investigation and Enquiry Officer (part-time): A. S. Collyer. *C.M.B. † Cert. S.I.E.B. § Cert. Mid. Colonial Medical Association. ¶ Three Years' General Nursing Certificate. ††Fully Trained at Children's Hospital. (c) New H.V. Certificate. 7 Public Health Office, Harley College, Bow Road, E.3. May, 1938. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Poplar. Madam, Ladies and Gentlemen, I beg to submit my report upon the health of the Metropolitan Borough of Poplar for the year 1937. Statistics. Population.—Once again the Registrar-General's estimate of the population is lower than we anticipated. His estimate of 136,800 is 3,500 less than that for the previous year. Birth and Death Rates.—The slightly increased birth and death rates do not call for special comment. Infant Mortality.—The Infant mortality rate, which dropped considerably (from 72 to 61), is below the average for the preceding ten years. Infectious Disease.—The number of cases of Diphtheria, Puerperal Pyrexia, Erysipelas, Influenzal Pneumonia and Dysentery showed increases on the previous year's figures, but Scarlet Fever cases were considerably fewer. The net result was that the total number of cases of all diseases notified was practically the same as in 1936. Maternity and Child Welfare. The continued growth of this branch of our work necessitated the appointment of an additional Health Visitor and the establishment of additional clinics. The building of the new Old Ford Centre commenced in December. 8 Conferences. The Council was represented at the following Conferences during the year:— Maternity and Child Welfare—London, June 1st to 3rd. Royal Sanitary Institute- Birmingham, July 12th to 17th. Sanitary Inspectors' Association—Brighton, August 30th to September 4th. Staff. Several changes have taken place during the year and are indicated on the list of staff, pages 4-6. I thank the members of the Council for their continued interest in the work of the Department and once again I record my appreciation of the co-operation of Officers of other Departments. To the members of my staff who have during the year loyally supported me I offer my sincere thanks. Further, I again acknowledge my indebtedness to those who have furnished information for inclusion in this report. I am, Madam, Ladies and Gentlemen, Your obedient Servant, W. ALLAN YOUNG, Medical Officer of Health. 9 Section A. STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. Area of Borough (excluding water) 2,136 acres Population (Census, 1931) 155.089 Registrar-General's estimate of resident populationmid-1937 136,800 Number of Inhabited Houses (end of 1937) according to Rate Books 23,977 Rateable Value (October, 1937) £775,847 Sum represented by a Penny Rate (April, 1937) £3,061 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. EXTRACTS FROM VITAL STATISTICS. (Registrar-General's Figures.) Total M. F. Live Births Legitimate 2,071 1,049 1,022 Birth Rate 15.5 per 1,000 of the estimated resident population. Illegitimate 44 21 23. Totals 2,115 1,070 1.045 Still Births 62 32 30 Rate per 1,000 total (live and still) births 28.5. Total M. F. Deaths 1,728 935 793 Crude Death Rate 12.6 per 1,000 estimated resident population . Adjusted Death Rate 14.0. 10 Deaths from Puerperal causes (Headings 29 and 30 of the RegistrarGeneral 's Short List):— Deaths. Rate per 1,000 total (live and still) births. No. 29 Puerperal sepsis 1 0.46 No. 30 Other puerperal causes 1 0.46 Total 2 0.92 (A list of deaths from puerperal causes or otherwise associated with pregnancy, etc., is given on page 128.) Death Rate of Infants under one year of age:— All infants, per 1,000 live births 61 Legitimate infants, per 1,000 legitimate live births 59 Illegitimate infants, per 1,000 illegitimate live births 136 Deaths from Cancer (all ages) 241 ,, Measles (all ages) 4 ,, Whooping Cough (all ages) 8 ,, Diarrhoea (under 2 years of age) 26 Marriages. During the year the marriages of 2,908 persons were registered, giving a rate of 21.3 as against 17.8, 17.9, 20.1, 21.2 and 21.4, in the five years 1932-1936. Natural Increase. The natural increase of population represented by excess of births over deaths was 387. The principal causes of death are shown in the chart facing page 11. Heart disease, 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 76 per cent, of the deaths ascribed to this condition were of persons of 65 years or more. Principal causes or death 1937. ( Registrar - General's Classification) Total Deaths during the year 1728-Males 935: females793 Percentage of deaths in public Institutions to total deaths 67.3. The following table, compiled anil furnished by the Registrar-General, is inserted at the request of the Ministry of Health. Causes of Death. Sex. All Ages 0– 1– 2– 5– 15– 25– 35– 45– 55– 65– 75– All Causes M 935 75 13 9 18 35 45 40 112 189 206 193 F 793 54 8 13 17 24 34 31 68 112 188 244 1 Typhoid and paratyphoid fevers M – – – – – – – – – – – – F 1 – – – – – – – 1 – – – 2 Measles M 2 2 – – – – – – – – – – F 2 – 1 1 – – – – – – – – 3 Scarlet fever M 1 – – – 1 – – – – – – – F 1 – – – 1 – – – – – – – 4 Whooping cough M 3 – 1 1 1 – – – – – – – F 5 4 1 – – – – – – – – – 5 Diphtheria M 7 1 – 2 4 – – – – – – – F 8 – 1 5 2 – – – – – – – 6 Influenza M 21 – 1 – – 2 – – 5 7 2 4 F 15 – – – – 2 – – 3 3 3 4 7 Encephalitis lethargica M – – – – – – – – – – – – F – – – – – – – – – – – – 8 Cerebro-spinal fever M 2 1 – 1 – – – – – – – – f – – – – – – – – – – – – 9 Tuberculosis of respiratory system M 62 – – – – 11 15 7 15 9 5 – F 46 – – 1 – 12 15 6 6 5 1 – 10 Other tuberculous diseases M 9 – 2 2 1 1 1 2 – – – – F 2 – – – 1 – – – – 1 – – 11 Syphilis M 5 – – – – – – – – 3 2 – F – – – – – – – – – – – – 12 General paralysis of the insane, tabes dorsalis M 3 – – – – – – 1 1 – 1 – F 1 – – – – – – – – – – – 13 Cancer, malignant disease M 134 1 – – 1 – 4 3 16 44 49 16 F 107 – – – 2 1 1 8 14 25 32 24 14 Diabetes M 5 – – – 1 – – – 1 – 2 1 F 8 – – – – – – – – 4 3 1 15 Cerebral haemorrhage, etc. M 26 – – – – – – 1 3 9 4 9 F 34 – – – – – – – 4 8 14 8 16 Heart disease M 265 – – – 1 3 1 4 16 40 88 112 F 302 – – – – – 7 7 12 37 96 143 17 Aneurysm M 2 – – – – – – – – 2 – – F 3 – 1 – – – – – – 1 – 1 18 Other circulatory diseases M 31 – – – – – 1 – – 9 12 9 F 28 – – – – – – – 2 3 8 15 19 Bronchitis M 61 17 2 – – 1 – – 8 17 9 7 F 31 4 – 1 – – – – 1 4 9 12 20 Pneumonia (all forms) M 59 11 5 2 1 1 2 7 10 7 6 7 F 42 12 3 3 1 2 – 3 – 4 7 7 21 Other respiratory diseases M 12 – – – – – – 2 4 4 – 2 F 7 – – – – – – – 1 2 1 3 22 Peptic ulcer M 11 – – – – – 2 – 5 4 – – F 4 – – – – – – – 2 2 – – 23 Diarrhoea, etc. M 16 14 – – – – – – – – – – F 16 12 – – – 1 – – – – 1 2 24 Appendicitis M 4 – – – – 1 – – 2 1 – – F 4 – – – – – 1 1 – 1 – 1 25 Cirrhosis of liver M – – – – – – – – – – – – F – – – – – – – – – – – – 26 Other diseases of liver, etc. M 1 – – – – – 1 – – – – – F 3 – – – – – – – 1 2 – – 27 Other digestive diseases M 9 – – 1 – – – 1 1 2 3 1 F 6 – – – 2 – – – 1 2 1 – 28 Acute and chronic nephritis M 23 – – – – 3 3 2 1 7 3 4 F 12 – – – 1 – 2 – 2 3 1 3 29 Puerperal sepsis F 1 – – – – – – – – – – – 30 Other puerperal causes F 1 – – – – 1 – – – – – – 31 Congenital debility, premature birth, malformations, etc. M 25 24 – – – – – – 1 – – – F 19 17 – – 2 – – – – – – – 32 Senility M 4 – – – – – – – – 1 – 3 F 8 – – – – – – – – – – 8 33 Suicide M 12 – – – – – 2 3 3 1 2 1 F 3 – – – – – – 1 1 – 1 – 34 Other violence M 54 1 – – 6 7 5 5 10 11 3 6 F 17 – – 1 1 1 – 1 3 1 1 8 35 Other defined diseases M 64 3 2 – 1 5 8 2 10 9 15 9 F 55 5 1 1 4 4 7 4 14 3 9 3 36 Causes ill-defined or unknown M 2 – – – – – – – – – – 2 F 1 – – – – – – – – – – 1 Legit. lllegit. Deaths under 1 year M 73 2 F. 50 4 Totals 123 6 Footnotes:—(a) Highway, 1. (6) Highway, !• (c) Poplar Treatment Centre (L.C.C.), 1- (d) Royal College of St. Katharine, 1. (?) Highway, 1; Limehouse Cut, 1. (/) Highways, 7; River Lee, 1; River Thames, 1; South West India Dock, 1. TABLE II.—CAUSES OF, AND AGES AT DEATH DURING 1937. Causes of Death. (Manual of the International List of Causes of Death, 1931.) Ages at Death—in Years. Number of Deaths of Residents of Wards. Nett Deaths in Public Institutions (at all ages) Nett Total Deaths in Public Institutions, etc. Causes of Death. Total Deaths. Sex. Total All Ages Under 5 years. 5- 10- 15- 20- 25- 35- 45- 55- 65- 75 and over Bow. Bromley. Poplar. Poplar Institution. St. Andrew's Hospital. St. Clement's Hospital. Bromley House Institution. Poplar Hospital. See Footnotes. Outlying Institutions. 0- 1- 2- Total under 5years North. 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 All Causes Certified 1725 M 934 76 13 9 98 10 8 15 20 45 41 111 187 208 191 103 107 107 89 123 117 133 145 162 169 144 106 100 120 94 751 30 24 16 293 1208 All Causes Certified F 791 53 8 13 74 10 7 7 16 33 31 69 110 189 245 Uncertified M 1 . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . 2 . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . 3 3 Uncertified F 2 . . . . . . . . . . . . . . 1 . . . . . . . . 1 . . 1 Typhoid and Paratyphoid Fevers 1 M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . 1 1 1 Typhoid and Paratyphoid Fevers F 1 . . . . . . . . . . . . . . . . . . . . 1 . . . . . . 2 Measles 4 M 2 2 . . . . 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . 1 1 1 . . . . . . . . . . . . . . . . 4 4 2 Measles F 2 . . 1 1 2 . . . . . . . . . . . . . . . . . . . . 3 Scarlet Fever 2 M 1 . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . 2 2 3 Scarlet Fever F 1 . . . . . . . . 1 . . . . . . . . . . . . . . . . . . 4 Whooping Cough 3 M 3 . . 1 1 2 1 . . . . . . . . . . . . . . . . . . . . . . 1 . . . . 1 . . 1 2 1 . . 1 1 . . . . 1 . . . . . . . . 6 7 4 Whooping Cough F 5 4 1 . . 5 . . . . . . . . . . . . . . . . . . . . 5 Diphtheria 15 M 7 1 . . 2 3 4 . . . . . . . . . . . . . . . . . . 1 . . 1 . . 3 2 1 1 . . 1 1 1 1 2 . . . . . . . . . . . . 14 14 5 Diphtheria F 8 . . 1 5 6 2 . . . . . . . . . . . . . . . . . . 6 Influenza 35 M 20 . . 1 . . 1 . . . . 1 . . . . . . 5 7 3 3 1 1 5 . . 4 . . 3 8 2 2 3 4 1 1 . . 10 . . . . . . . . 6 16 6 Influenza F 15 . . . . . . . . . . . . 1 1 . . . . 3 3 3 4 7 Encephalitis lethargica M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Encephalitis lethargica F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Cerebro-spinal Fever 2 M 2 1 . . 1 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . 1 . . . . . . . . . . . . 1 . . . . . . . . 1 2 8 Cerebro-spinal Fever F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Tuberculosis of Respiratory 108 M 62 . . . . . . . . . . . . 3 8 15 7 15 9 5 . . 3 8 10 5 6 9 10 6 9 8 8 12 4 10 . . 62 . . . . . . . . 15 77 9 Tuberculosis of Respiratory system F 46 . . . . 1 1 . . . . 3 9 15 6 6 5 1 . . 10 Other Tuberculous Diseases 11 M 9 . . 2 2 4 . . 1 . . 1 . . 3 . . . . . . . . 1 . . 1 1 . . 1 2 . . 2 1 . . . . 1 1 . . 7 . . . . . . . . 4 11 10 Other Tuberculous Diseases F 2 . . . . . . . . . . l . . . . . . . . . . 1 . . . . 11 Syphilis 4 M 4 . . . . . . . . . . . . . . . . . . . . . . 3 1 . . . . . . . . 1 . . . . . . . . 1 . . 1 . . 1 . . 2 . . . . . . . . . . 2 4 11 Syphilis F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 General Paralysis of the Insane 4 M 3 . . . . . . . . . . . . . . . . . . 1 1 . . 1 . . 1 . . . . . . . . . . 1 . . 1 . . 1 . . . . . . . . 1 . . . . . . . . 3 4 12 General Paralysis of the Insane , tabes dorsalis F 1 . . . . . . . . . . . . . . . . . . . . . . 1 . . . . 13 Cancer, malignant disease 233 M 130 1 . . . . 1 . . l . . . . 3 3 16 41 48 17 14 16 16 10 19 20 22 22 15 8 17 18 14 12 8 106 2 . . 3 . . 34 153 13 Cancer, malignant disease F 103 . . . . . . . . . . l . . 1 1 8 14 23 31 24 14 Diabetes 13 M 5 . . . . . . . . . . l . . . . . . . . 1 . . 2 1 1 2 . . 3 1 . . . . 3 . . . . . . 1 1 . . 5 . . . . . . . . 14 Diabetes F 8 . . . . . . . . . . . . . . . . . . . . 4 3 1 15 Cerebral haemorrhage, etc. 61 M 29 1 . . . . 1 . . . . . . . . . . 1 3 10 5 9 6 5 4 3 4 4 4 8 3 3 6 1 5 5 5 37 1 . . . . . . 3 46 15 Cerebral haemorrhage, etc. F 32 . . . . . . . . . . . . . . . . . . . . 4 8 13 7 16 Heart Disease 569 M 264 . . . . . . . . . . . . . . 3 2 4 15 38 89 113 30 44 36 31 33 29 37 49 61 60 50 28 38 43 52 254 22 . . . . 1 (a) 42 371 16 Heart Disease F 305 . . . . . . . . . . . . . . . . 6 6 14 35 9/ 147 17 Aneurysm 6 M 3 . . . . . . . . . . . . . . . . . . . . . . 2 1 . . 1 . . 2 . . . . . . . . 1 . . . . 1 . . . . 1 . . . . . . . . . . . . 17 Aneurysm F 3 . . 1 . . 1 . . . . . . . . . . . . . . 1 . . 1 18 Other circulatory diseases 63 M 31 . . . . . . . . . . . . . . . . 1 . . 2 8 11 9 4 5 3 3 6 2 5 2 11 5 8 1 2 6 7 9 2 . . . . . . 6 24 18 Other circulatory diseases F 32 . . . . . . . . . . . . . . . . . . . . 1 4 10 17 19 Bronchitis 97 M 65 16 2 . . 18 . . . . . . . . . . 1 10 21 8 7 7 2 6 5 4 11 9 9 9 12 7 6 5 5 2 64 . . . . . . . . 4 70 19 Bronchitis F 32 6 . . 1 7 . . . . . . . . . . . . 1 4 9 11 20 Pneumonia (all forms) 100 M 59 11 5 l 17 . . l 1 . . 2 7 8 9 6 8 7 5 1 4 5 10 7 12 10 13 4 4 9 9 9 40 1 . . 2 1 (b) 14 67 20 Pneumonia (all forms) F 41 10 3 2 15 . . l 1 1 . . 3 . . 5 8 7 21 Other Respiratory Diseases 12 M 9 . . . . 1 1 . . . . . . . . . . 1 3 3 . . 1 . . . . . . . . 3 2 1 1 2 1 1 . . . . 1 . . 4 . . . . . . 5 9 21 Other Respiratory Diseases F 3 . . . . 1 1 . . . . . . . . . . . . 1 . . . . 1 22 Peptic Ulcer 15 M 11 . . . . . . . . . . . . . . . . 2 . . . . 5 . . . . 1 1 . . . . 1 2 2 1 2 3 . . . . 1 1 . . 9 . . . . . . 22. Peptic Ulcer F 4 . . . . . . . . . . . . . . . . . . . . 2 2 . . . . 23 Diarrhoea, etc. 31 M 17 16 . . . . 16 . . . . . . . . . . . . . . 1 . . . . 3 . . 1 . . 2 2 2 1 3 5 7 3 1 1 . . 9 . . . . . . 20 29 23 Diarrhœa, etc. F 14 11 . . . . 11 . . . . . . 1 . . . . . . . . . . 1 24 Appendicitis 6 M 3 . . . . . . . . . . . . 1 . . . . 1 1 . . . . . . 2 . . . . 1 . . 1 . . 1 . . . . . . . . 1 . . . . 3 . . . . . . 24 Appendicitis F 3 . . . . . . . . . . . . . . . . 1 1 . . 1 . . . . 25 Cirrhosis of Liver - M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Cirrhosis of Liver F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Other diseases of liver, etc. 5 M 2 . . . . . . . . . . . . . . . . 2 . . . . . . . . . . 2 . . 1 . . 1 . . . . 1 . . . . . . . . . . . . . . 5 . . . . . . 5 26 Other diseases of liver, etc. F 3 . . . . . . . . . . . . . . . . . . . . 1 1 . . 1 27 Other Digestive diseases 19 M 12 . . . . 1 1 . . . . . . . . . . . . 2 4 4 1 . . . . 2 3 1 1 1 . . 3 3 4 . . . . 1 . . 8 . . . . 1 1 (c) 3 13 27 Other Digestive diseases F 7 . . . . . . . . 2 . . . . . . . . . . 3 1 1 28 Acute and Chronic Nephritis 35 M 24 . . . . . . . . . . . . 1 2 3 3 2 6 3 4 3 1 . . 4 3 4 3 4 1 3 6 2 1 . . 1 12 . . . . 2 9 24 28 Acute and Chronic Nephritis F 11 . . . . . . . . . . 1 . . . . 2 1 2 3 . . 2 29 Puerperal Sepsis 1 M 1 . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . 1 . . . . . . 1 29 Puerperal Sepsis 30 Other Puerperal causes .. 1 F 1 . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . 1 30 Other Puerperal causes .. 31 Congenital Debility, Premature Birth, Malformations, etc. 42 M 23 23 . . . . 23 . . . . . . . . . . . . . . . . . . . . 4 3 1 2 6 1 1 3 6 4 2 3 2 4 . . 20 . . . . . . i (d) 14 35 31 Congenital Debility, Premature Birth, Malformations, etc. F 19 17 . . . . 17 . . 2 . . . . . . . . . . . . . . . . 32 Senility 12 M 4 . . . . . . . . . . . . . . . . . . . . . . 1 . . 3 1 2 1 . . 3 1 1 . . . . 1 . . 1 . . 1 3 . . . . . . . . 3 32 Senility F 8 . . . . . . . . . . . . . . . . . . . . . . . . . . 8 33 Suicide 15 M 12 . . . . . . . . . . . . . . . . 2 3 3 1 2 1 . . 2 3 1 . . . . . . 2 1 1 1 2 1 1 . . . . . . . . 1 2 (e) 4 7 33 Suicide F 3 . . . . . . . . . . . . . . . . 1 1 . . 1 . . 34 Other violence 71 M 52 1 . . . . 1 3 3 3 4 5 5 10 10 3 5 1 2 3 4 3 6 5 2 7 11 9 10 3 5 . . 27 . . . . 13 10 (/) 18 68 34 Other violence F 19 . . . . 1 1 1 . . 1 . . . . 1 4 1 2 8 35 Other defined causes 125 M 66 3 2 . . 5 1 1 5 2 8 1 10 8 17 8 9 6 10 8 14 6 16 6 10 12 6 6 8 8 4 55 2 . . 2 48 111 35 Other defined causes F 59 5 1 1 7 4 1 1 3 7 4 14 5 10 . . 36 Causes ill-defined, or unknown . 2 M 1 . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . 1 . . . . . . . . . . . . . . . . 1 . . . . 1 . . . . . . . . . . . . 1 36 Causes ill-defined, or unknown F 1 . . . . . . . . . . . . . . . . . . . . . . . . . . 1 All Causes 1728 M 935 76 13 9 98 10 8 15 20 45 41 111 187 209 191 103 107 109 89 123 117 133 145 162 169 144 106 101 120 94 751 30 . . 24 16 296 1211 All Causes F 793 53 8 13 74 10 7 7 17 33 31 69 110 190 245 Totals 1728 129 21 22 172 20 15 22 37 78 72 180 297 399 436 11 Deaths during 1937 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) 107 56 50 74 287 Bow and Bromley Sub-District (dwellings) 8l 49 40 62 232 St. Andrew's Hospital 321 198 165 191 875 Poplar Institution 56 45 23 35 159 St. Clement's Hospital 63 41 65 54 223 Bromley House Institution 2 1 – – 3 Poplar Hospital 20 18 17 16 71 River Thames – 4 2 2 8 ,, Lee – 1 – 1 2 Limehouse Cut – 2 – – 2 Bow Creek 1 – – – 1 East India Docks – 1 – 1 2 West India Docks – – – – – South-West India Docks – – – – – Millwall Docks – 1 – – 1 Poplar Dock – – – – – Highways 5 7 3 5 20 Miscellaneous: (places of Employment ,etc) – 2 2 1 5 656 426 367 442 1,891 Deaths occurring outside the Borough, of persons belonging thereto (add) 86 80 57 73 296 Deaths occurring within the Borough, of persons not belonging thereto (deduct) 134 117 99 109 459 Deaths at all ages—nett 608 389 325 406 1,728 12 TABLE III. Infantile Mobtality. 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 – – – – – – – – 2 1 i 2 – 1 – 1 Whooping Cough – – – – – 1 1 2 – 2 2 4 1 2 1 – Diphtheria – – – – – – 1 – – 1 – 1 – – – 1 Influenza – – – – – – – – – – – – – – – – Tuberculosis of Nervous System – – – – – – – – – – – – – – – – Tuberculosis of Intestines and Peritoneum – – – – – – – – – – – – – – – – Other Tuberculous Diseases – – – – – – – – – – – – – – – – Syphilis – – – – – – – – – – – – – – – – Meningitis – – – – – – – – 1 1 – 1 1 – – – Convulsions – – – – – – – – – – – – – – – – Bronchitis – – – 1 1 6 8 5 2 11 11 22 15 4 – 3 Pneumonia 1 – – – 1 7 5 3 5 13 8 21 10 3 3 5 Other Respiratory Diseases – – – – – – – – – – – – – – – – Inflammation of the Stomach – – – – – – – – – – – – – – – – Diarrhoea and Enteritis – – – – – 4 9 9 5 18 9 27 8 7 8 4 Hernia, Intestinal Obstruction – – – – – – – 1 – – 1 1 1 – – – Congenital malformations – 2 1 – 3 3 1 1 – 4 4 8 1 5 1 1 Congenital Debility and Sclerema 3 – – – 3 2 – – – 2 3 5 – 2 2 1 Icterus – 1 – – 1 – – – – 1 – 1 – – 1 – Premature Birth 14 – – 1 15 2 – – – 12 5 17 5 6 5 1 Injury at Birth 2 – – – 2 – – – – 1 1 2 1 – 1 – Disease of Umbilicus – – – – – – – – – – – – – – – – Atelectasis 4 1 – – 5 – – – – 2 3 5 2 1 – 2 Suffocation—in bed or not stated how 1 – – – 1 – – – – – 1 1 1 – – – Other causes 1 2 – – 3 3 2 1 2 5 6 11 3 4 4 – All causes 26 6 1 2 35 28 27 22 17 74 55 129 49 35 26 19 Live Births Legitimate 2,071* Nett Deaths Legitimate 123* in the year Illegitimate 44* in the year Illegitimate 6* *Reeistrar-General's figures. Neo-Natal Death Rate. 1932. 1933. 1934. 1935. 1936. Average 19321936. 1937. Nett Births (Registrar-General) Deaths under 1 month .. 2,616 65 2,295 67 2,267 43 2,215 52 2,110 39 2,426 60 2,115 35 Neo-Natal death rate per 1,000 nett Births 24.8 29.2 19.0 23.5 18.5 24.7 16.5 13 Births, Maternal Mortality and Infantile Mortality during the twenty years 1918 to 1937. The following Table shows the Birth rate, Maternal Mortality rate and 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). 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. 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 81 34 1934 2,267 15.5 3.53 3.40 37 16.3 103 45.4 140 62 72 31 1935 2,215 15.4 3.16 3.06 47 21.2 55 24.8 102 46 95 41 1936 2,110 15.0 1.89 1.84 35 16.6 118 55.9 153 72 99 44 1937 2,115 15.5 0.94 0.92 32 15.1 97 45.9 129 61 – – (Tables showing the causes of death are given as follows:— Deaths under 1 year, page 12. Deaths from puerperal causes, page 127. 14 TABLE IV. Bibth-bates, Death-rates, and Analysis of Mortality in the Year 1937. Rate per 1,000 Population. Anndal Death-rate per 1,000 Population . Rate per 1,000 Live Births. Percentage op Total Deaths. All Causes. Typhoid and Paratyphoid Fevers. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhœa and Enteritis (under 2 years). Total Deaths under One Year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P. M. No Inquest. Uncertified Causes of Death. Live Birthg Stillbirths *England and Wales 14.9 0.60 12.4 0.00 – 0.02 0.01 0.04 0.07 0.45 0.54 5.8 58 90.4 6.1 2.5 1.0 *125 County Boroughs And Great Towns, including London 14.9 0.67 12.5 0.01 – 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 90.8 5.5 3.2 0.5 *148 Smaller Towns (Populations 25,00050,000 at Census 1931) 15.3 0.64 11.9 0.00 – 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 92.1 5.1 1.7 1.1 *London Administrative County 13.3 0.54 12.3 0.00 – 0.01 0.01 0-06 0.05 0.38 0.51 12.0 60 87.5 5.9 6.6 0.0 Poplar Borough 15.5 0.46 12.6† 0.01 – 0.03 0.01 0.06 0.11 0.26 0.59 12.3 61 87.3 6.2 6.3 0.2 †Crude rate. The adjusted rate is 14.0. Puerperal Sepsis. Others. Total. *The Maternal Mortality Rates for England and Wales are as follows:— Per 1,000 total births 0.94 2.17 3.11 The Maternal Mortality Rates for Poplar are as follows:— Per 1,000 total births 0.46 0.46 0.92 *Provisional figures furnished by the Registrar-General. 15 TABLE V. (1937). s and Boboughs. Estimated Resident population (Mid-1937) Live Births, Annual rate per 1,000 population. Deathrate per 1,000 population. Deaths of Infants under one year to 1,000 births. LONDON 4,094,500 13.3 12.3 60 West Districts. Crude Adjusted Paddington 138,300 13.65 13.05 12.91 66 Kensington 175,600 12.1 13.3 12.4 83 Hammersmith 126,500 15.1 12.6 13.0 68 Fulham 138,900 13.9 13.08 13.2 56 Chelsea 56,510 10.8 14.1 12.0 59 City of Westminster 124,300 8.2 11.5 11.8 58.7 North Districts. St. Marylebone 92,110 9.36 13.10 12.98 73 Hampstead 90,690 11.2 11.6 10.9 54 St. Pancras 181,900 13.0 12.7 13.0 62 Islington 295,400 15.25 12.9 13.02 66 Stoke Newington 50,250 14.11 12.5 12.0 37.5 Hackney 206,700 13.8 11.1 11.7 43.38 Central Districts. Holborn 34,600 8.09 11.85 12.68 79 Finsbury 58,700 13.8 14.6 15.9 71 City of London 8,980 6.1 11.2 12.4 36.3 East Districts. Shoreditch 82,240 14.86 12.47 13.72 54 Bethnal Green 94,560 13.3 12.5 14.1 54 Stepney 203,100 13.5 12.2 14.2 60.5 Poplar 136,800 15.5 12.6 14.0 61 South Districts. Southwark 147,400 14.7 13.6 14.1 64 Bermondsey 98,790 14.4 12.3 14.0 59 Lambeth 273,800 14.1 13.2 13.0 68 Battersea 143,500 14.94 12.89 12.76 70.43 Wandsworth 341,700 11.53 12.36 11.43 62 Camberwell 224,800 14.08 12.83 12.83 58 Deptford 96,580 15.1 11.8 12.3 45 Greenwich 95,990 13.88 12.03 12.27 50 Lewisham 226,000 13.9 10.8 10.9 46 Woolwich 149,400 14.2 11.1 11.7 40 Note.—The information relating to London supplied by the Registrar-General and that for individual Boroughs by the Medical Officers of Health. 16 [This summary is inserted for comparison with those shown in previous reports.) 1932. 1933. 1934. 1935. 1936. 1937. Population, estimated by Registrar-General:— 152,400 149,300 146,370 143,700 140,300 136,800 Births, Live, rate per 1,000 population 17.2 15.4 15.5 15.4 15.0 15.5 Death rate from all causes, per 1,000 population Crude 12.1 12.4 12.3 11.0 12.5 12.6 Adjusted 13.4 13.8 13.7 12.3 13.8 14.0 Deaths under 1 year of age, rate per 1,000 nett births 63 54 62 46 72 61 Deaths over 65 years of age, rate per 1,000 total population 5.2 5.4 5.3 5.2 5.7 6.1 Zymotic diseases:— Death rate per 1,000 population 0.5 0.4 0.7 0.2 0.8 0.5 Proportion of 1,000 deaths 40.6 29.0 58.3 21.4 67.0 35.9 Tuberculosis:— Death rate per 1,000 population:— (i) of respiratory system 0.88 0.89 0.76 0.81 0.71 0.79 (ii) other forms 0.13 0.09 0.14 0.09 0.12 0.08 (iii) all forms 1.0 1.0 0.9 0.9 0.8 0.87 All forms: proportion of 1,000 deaths 83.3 79.1 73.8 81.9 67.0 69.0 Respiratory diseases (excluding phthisis and influenzal pneumonia):— Death rate per 1,000 population 1.7 1.1 1.7 1.0 1.6 1.5 Proportion of 1,000 deaths 140.1 87.7 142.2 93.8 126.5 122.7 * Smallpox, Measles, Scarlet Fever, Whooping Cough, Diphtheria and Mem. Croup, Typhoid Fever and Diarrhoeal Diseases. 17 Mortuary and Coroner's Court. During the latter part of the year the Public Health Committee considered the installation of refrigerating chambers and the modernisation of the post-mortem room, etc., and instructions were given for schemes to be submitted for consideration early in 1938. The number of bodies deposited in the Council's Mortuary, Cottage Street, Poplar, during the year was 235:— Residents Non-Residents* Totals Males Females Males Females Age not stated (i.e. unknown, newly born) . 1 1 1 2 5 Stillborn — — — — — Under 1 year 3 4 2 1 10 1 to 5 years — 4 2 3 9 5 to 15 years 5 2 3 — 10 15 to 25 years 6 4 1 2 13 25 to 45 years 16 4 5 4 29 45 to 65 years 44 12 18 4 78 65 years and upwards 31 27 10 13 81 Totals 106 58 42 29 235 *Brought from outside the Borough for the convenience of the Coroner. Inquests were held on 149 (post-mortem examinations, 56), and 77 other post-mortem examinations were made by order of the Coroner. The total number of post-mortem examinations made was 133. Nine bodies were brought to the Mortuary for custody (8 from Fever Hospitals and 1 from elsewhere). In several instances post-mortem examinations were made at the Poplar Mortuary and inquests held at either the Stepney or Shoreditch Coroner's Court. 18 Section B. GENERAL PROVISION OF HEALTH SERVICES FOR THE BOROUGH. Local Health Services—Information at Post Offices. In August Circular 1643A was issued by the Ministry of Health regarding the display of information in Post Offices respecting health services available in each locality. The Postmaster-General had expressed his readiness to co-operate with the Minister and with Local Authorities in making the best use of the available post office space for this purpose. With the approval of the Public Health Committee a special brochure was prepared and made available at each Post Office. (i) Public Health Officers of the Authority. A list of the Staff is shown at the commencement of the Report, pages 4-6. (ii) (a) Laboratory Facilities. (a) Chemical Analysis. Arrangements are made with analytical chemists who are approved by the Minister of Health. All examinations are carried out at the Public Analysts' own laboratory which is situate at Bank Buildings, 161, Bow Road, E .3. The report of the Public Analysts is given on page 78. (N.B.—Examination of samples of milk for tubercle and bacteriological counts in designated 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. 19 (ii) (b) Ambulance facilities. The ambulance services are provided by the London County Council. (ii) (c) Nursing in the Home. Agreements with local nursing associations are in operation, the fees payable being at the rate of is. 3d. per visit. (For number of cases visited and total visits paid, see Table in Maternity and Child Welfare Section of this Report.) (ii) (d) Treatment Centres and Clinics. Maternity and Child Welfare Centres, Ante-Natal Clinics and Day Nurseries. (See Maternity and Child Welfare Section, page no.) Tuberculosis Dispensary. (See page 95, 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. (ii) (e) Hospitals: Public and Voluntary. (i) Fever and Smallpox. Hospitals for patients suffering from these diseases are provided by the London County Council. (ii) T uberculosis. Residential Institutional Treatment for tuberculous patients is provided by the London County Council. (iii) Other Hospitals. There are no hospitals in the Borough provided or subsidised by the Council. 20 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; St. Clements Hospital (late Bow Institution); Langley House; Bromley House Institution; all of which are maintained by the London County Council. (iv) 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 130.) The Royal College of St. Katharine also have accommodation for 12 cots for children suffering from malnutrition, etc. During the months April to October, six of the cots are used for tonsillectomy cases. 2 (ii) Poor Law Out-Relief. The following information was furnished by the London County Council:— No. of persons Number of persons in receipt of domiciliary relief (excluding medical relief only). Cost. in receipt of medical relief only. Week ended 2nd January, 1937 5,746 £2,335 28 3rd July, 1937 4,894 £1,876 45 3 (i) Midwifery and Maternity Services. Midwives. The number of midwives practising in the area is 13. 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. Maternal Mortality. All maternal deaths and all cases of Puerperal Fever and Puerperal Pyrexia are specially investigated. (See Maternity and Child Welfare section, page 127.) 21 3 (ii) Institutional Provision for Mothers and Children. There is one Institution in the Borough, and, although it is not in any way connected officially with the Council, it receives a grant of ₤249 per annum from the London County Council. 3 (iii) Health Visitors. 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 and East India Dock Road. 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. 3 (iv) Child Life Protection, see page 129. New Legislation. (1) The Public Health (Imported Food) Regulations, 1937, dated 16th April, 1937, came into operation 1st January, 1938. Under the new regulations the importation into this country of bacon and ham and also meat products, such as canned meats, sausages and sausage casings, will be prohibited unless they are accompanied by an Official Certificate recognised by the Minister. At present Official Certificates were not required with these articles although they were required with other meat and certain animal fats. The effect of the new Regulations was thus to make such Certificates necessary for the importation of practically all admissible meat and meat products. The importation of certain defined classes of meat (such as scrap meat) remains, as before, prohibited. Official Certificates were given by the country of origin, but were not recognised by the Minister until he was satisfied that they could be regarded as evidence of hygienic preparation and satisfactory inspection. All food was subject to inspection at the port of entry, and to seizure and condemnation if it was found to be diseased, unsound or unwholesome , but the system of Official Certificates provided a special means of additional control. 22 The Council delegated their powers under these Regulations to the Public Health Committee and empowered the Medical Officer of Health and the Meat and Food Inspectors to carry out the provisions of the Regulations. In December, the Ministry of Health issued Circular 1666, enclosing a copy of provisional regulations postponing the date of operation of the Imported Food Regulations to 1st April, 1938. (2) London County Council (General Powers) Act, 1937. Sections 62, 63, 65, 66, 67, 68 and 69, dealt with matters of Public Health. Section 66 enacted that "a noise nuisance shall be a nuisance which may be dealt with summarily'' under the Public Health (London) Act, 1936. (3) Hydrogen Cyanide (Fumigation) Act, 1937. "An Act to regulate the fumigation of premises and articles with hydrogen cyanide; and for purposes connected with the matters aforesaid." This Act received Royal Assent on 6th July, 1937. 23 Section C. SANITARY CIRCUMSTANCES OF THE BOROUGH. Public Cleansing Services. Included under this heading is the collection, removal and disposal of household, trade and market refuse; street cleansing and watering; gully and cesspool emptying; and snow removal. I am indebted to Mr. Rees J. Williams, A.M.Inst.C.E., the Borough Engineer and Surveyor, for the following particulars:— House Refuse. A minimum bi-weekly collection service is in operation, most bins being placed on the kerb by the householder. The container system is in operation in connection with flats and institutions, and the growth of this system is maintained from year to year. Number of petrol vehicles engaged in the work 22 Number of horse-drawn vans engaged in the work 1 Number of men engaged in the work 80 Trade Refuse. This is collected and/or disposed of when requested by the trader, at his expense. Market Refuse. The container system, augmented by the use of horse-drawn vans, is in operation in the Street Markets. Number of men permanently engaged in the work 16 (Additional men are engaged in this work at week-ends.) Street Cleansing. Important roads are swept daily and nightly; other roads daily by beat system. In certain roads the beats are covered several times per day. A new type of orderly truck of lighter construction, fitted with pneumatic tyred wheels and two portable bins, has been introduced to replace the wooden trucks, which were heavy, cumbersome and noisy. This new type is in operation in half the Borough only. With the introduction of the new orderly trucks a dustless system of collection of street sweepings was put into operation in one half of 24 the Borough, and has proved so successful that it is being extended to the remaining portion of the Borough next year. A new mechanical vehicle of the sweeper-collector type was put into use during the year and has increased the efficiency of the work. Motor sweeping machines engaged on street cleansing 2 Motor vehicles employed on the collection of street sweepings 3 Horse-drawn vans employed on the collection of street sweepings 8 Number of men engaged 124 Street Watering. Three motor street watering tanks supplemented by six horse-drawn vans constitute the street watering service. Gully Cleansing. A programme of conversion of brick gullies of 170 gallons capacity to pot gullies of 30 gallons capacity is being proceeded with, and improved sanitary conditions result from this work. Three mechanical gully emptiers are employed and three men (including driver) are engaged with each vehicle, and the gullies receive regular attention. Number of street gullies in the Borough:— Brick gullies 2,625 Pot gullies 56I 3,186 Number of gully cleansings:— Brick (170 gallons) 10,693 Pot (30 gallons) 1.653 12,346 Refuse Disposal. Refuse is discharged into barge at Northumberland Wharf, where three hydraulic hoists render possible the discharge of loads at all states of the tide. It is then tipped at Bowers Gifford, near Pitsea, in strict Sanitary Inspectors' Work. Tabulated Statement of Inspections, Insanitary Conditions found existing, and Re-inspections during the year 1937. DISTRICT. Totals. (District Inspectors.) Housing Inspectors.* Totals. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6 No. 7. No. 8. Mr. G. L. Belshaw. Mr. E. A. May. Mr. T. C. B. Rose. Number of Complaints received 602 290 881 562 402 868 562 378 4,545 — — — 4,545 Number of Ins???ections Dwelling Houses House-to-House 6 6 — — 12 101 190 — 303 On Complaint 655 290 875 552 443 865 558 267 4,505 — — — 4,505 After Infectious Disease 134 78 133 141 177 123 76 111 973 — — — 973 Factories, including Factory Laundries 4 28 6 12 14 — 8 — 72 — — — 72 Workshops, including Workshop Laundries 14 21 3 11 36 5 10 — 100 — — — 100 Workplaces, other than outworkers 2 3 1 54 18 13 20 — 111 — — — 111 Outworkers 1 1 — 2 — — — 2 Stables 2 18 37 38 14 66 2 177 — — — 177 Smoke observations 2 3 21 1 8 6 41 — — — 41 Miscellaneous visits and inspections (including visits to Infectious Disease contacts, school inspections, etc.) 386 221 639 218 635 956 207 690 3,952 287 199 508 4,946 Re-inspections 2,498 2,375 2,096 1,692 2,986 1,788 3,059 2,403 18,897 7 298 96 20,298 Premises requiring amendment (a) Dwelling-houses 672 315 885 524 489 812 570 165 4,432 — — — 4,432 (6) Other premises 2 8 24 29 72 5 19 — 159 — — — 159 Service of Intimations, etc.: Intimations served 674 323 783 545 424 825 595 163 4,332 — — — 4,332 ,, complied with 424 136 474 366 321 426 291 157 2,595 — — 4 2,599 Notices served 232 102 305 223 103 322 337 33 1,657 — — — 1, 657 ,, complied with 176 79 176 100 90 153 163 33 970 — — 11 981 Final Notices served 56 19 86 47 18 108 183 4 521 — — 1 522 ,, complied with 55 6 85 43 18 63 180 4 454 — — 5 459 Summonses applied for 2 2 18 5 2 25 8 1 63 — — — 63 Work done, number of instances not included above: (a) After legal proceedings .. 2 — 18 16 6 — 42 — — — 42 (b) Voluntarily 9 10 66 3 172 46 25 23 354 — — — 354 Nuisances, etc., found. Works completed. Defects, etc., found in Dwelling Houses: Drainage: Drains defective 48 28 67 10 161 23 34 14 385 — — — 385 493 ,, obstructed 23 39 111 17 46 35 31 4 306 — — — 306 269 Waste pipes defective, etc. 37 29 60 69 91 29 56 4 375 — — — 375 334 Rainwater pipes not disconnected 2 3 1 — 6 — — — 6 6 W.Cs. and flushing apparatus defective 42 51 120 156 39 76 107 3 594 — — — 594 540 Dampness (not due to defects shown elsewhere) 118 60 210 51 219 520 262 15 1,455 — — — 1,455 1,298 Water: Supply cut off 1 2 4 5 1 — 13 — — — 13 11 Dust Receptacles: Insufficient or defective 153 50 105 177 145 157 106 24 917 — — — 917 871 Miscellaneous: Rooms, etc., dirty and/or verminous 327 290 761 367 555 547 823 86 3,756 — — — 3,756 3,389 Cases of overcrowding 2 5 1 6 5 10 29 — — — 29 7 Yards, etc., not properly paved or drained 22 115 108 55 117 45 105 12 579 — — — 579 512 Roofs defective 294 341 510 201 250 346 254 25 2,221 — — — 2,221 1,968 Rainwater pipes and gutters defective 49 190 222 76 208 134 99 12 990 — — — 990 878 Public House Urinals requiring cleansing 2 3 10 8 — 23 — — — 23 48 Other nuisances or defects 397 420 2,491 496 1,063 1,468 1,670 144 8,149 — — — 8,149 6,902 Defects found in Factories, Workshops, etc.: Sanitary defects 2 11 1 36 34 7 4 — 95 — — — 95 87 W.C. accommodation, insufficient or unsuitable 1 4 1 2 — — 8 — — — 8 15 Overcrowding — — — — — — — — — — — — — — Stables: Manure receptacles defective, etc. 4 8 4 7 — 23 — — — 23 29 Accumulations found — 3 4 1 10 — 2 3 23 — — — 23 22 Number of visits by Assistants (not included above) 2,494 2,221 6,177 3,615 4,867 3,114 4,317 — 26,805 — — — 26,805 * The Housing Inspectors were engaged in inspections, etc., in connection with "Areas," and inspections, reports, etc., of underground rooms, referred to elsewhere in this report. Mr. Belshaw also deputised for a District Inspector on 10 days. Mr. Rose worked in conjunction with Messrs. Belshaw and May in "Areas,'' and therefore does not give separate figures. He also deputised for a District Inspector on 9 days. 25 accordance with the Ministry of Health's suggested precautions for "controlled" tipping. Free shoots were found for 438 tons of street sweepings and boiler ashes and 44 tons of house and shop refuse were tipped at a neighbouring Authority's shoot. Summary for the Year 1937. House refuse 28,525 tons Trade refuse 382 ,, Street sweepings 4,604 ,, Solid gully detritus 944 „ Market refuse 1,750 ,, 36,205 ,, Combined Drainage.—The following drainage works were approved by the Public Health Committee:— 55, Glengarnock Avenue £80 7, Grove Villas £100 120, Canton Street £35 3 (iii) Sanitary Inspection of the Borough—see summarised, statement facing this page. 26 The Work of Lady Sanitary Inspector. . Tabulated statement of Inspections, of Insanitary Conditions found existing, and of Reinspections, etc., during the year. Factories and Workshops newly discovered and Registered 16 Number op Inspections of:— Factories, including Factory Laundries 108 Workshops, including Workshop Laundries 51 Workplaces 21 Workrooms — Homeworkers' premises 529 Reinspections of above 16 Premises requiring amendment 7 Defects Found:— 1. Nuisances under Public Health (London) Act:— Found. Remedied. Referred to D.s.i. Referred to H.M. Insp. Want of cleanliness 9 8 1 — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 4 1 3 — Sanitary accommodation Insufficient — — — — Unsuitable or defective 9 8 1 — Not separate for sexes — — — — Want of cleanliness 2 2 — — 2. Offences under Factory and Workshop Acts — — — — Action Taken Regarding Above:— Intimations served 2 ,, complied with 2 Notices served — ,, complied with — Final Notices served — Legal Proceedings taken 2* Nuisances remedied without service of Intimations, etc. 20 * Failure to send in lists of outworkers. Other Matters:— Visits re cases of Scabies 290 ,, Verminous children 15 ,, Outworkers' lists 18 ,, Infectious Disease on Homeworkers' premises 2 ,, School Exclusions, etc. 905 ,, aged and infirm persons 2 Other visits and inquiries 46 Inspections of Schools re Sanitary accommodation 42 Visits to prospective tenants of London County Council's Flats, etc. — Ineffective calls 380 27 Report of the Inspector for Houses Divided into Separate Tenements, etc. (a) Houses divided into separate Tenements, etc. Number of Houses on Register at end of 1936 315 ,, removed from Register during 1937 25 290 ,, ,, registered during 1937 57 ,, ,, on Register at end of 1937 347 Visits for registration purposes 153 Declarations, for information, sent out — ,, with information, returned — Rooms measured, etc. 23 Houses registered 57 Notices of registration sent out 13 Inspections: (a) Night inspections 17 (b) First annual inspections 201 (c) Other routine inspections 55 (d) On complaints 83 (e) On account of re-housing 11 Re-inspections 1,174 Miscellaneous visits, enquiries, etc. 482 Number of informal notices served 342 ,, ,, ,, complied with 213 ,, Notices served 146 ,, ,, complied with .. 60 ,, Final Notices served 40 cases in which legal proceedings were taken 6 Work done as a result of Final Notice or legal proceedings, number of cases 35 Number of rooms cleansed and freed from vermin 122 Overcrowding, cases discovered 18 ,, ,, abated 22 Mixed sleeping, cases discovered 3 ,, ,, abated 1 28 Number of nuisances referred to District Inspectors: (a) Defective or obstructed drains 17 (b) Defective roofs, guttering, etc. 17 (c) Water supply in tenement houses 2 (d) Miscellaneous 69 Remarks: During the year the Inspector was engaged on inspections in "Areas" 12 days and deputised for District Inspector one day. He paid 105 visits in connection with abatement of overcrowding. (b) Common Lodging Houses. The following 4 Common Lodging Houses were licensed to 30th June, 1938. (1) 65, Bow Lane—Sidney Moore (40 men). (2) East London Hostel, Garford Street (Salvation Army)— Evangeline Booth (294 men). (3) 378, Old Ford Road—Mrs. Elizabeth Hooper (18 men). (4) 38, Pennyfields—Thomas Alfred Felton (46 men). One application for renewal of licence was refused, the premises being unsuitable. 132 inspections of Common Lodging Houses, including 20 night inspections, were made in 1937. Homeless Persons. In connection with a census of homeless persons which it had been the practice of the London County Council to take for a number of years, the Council co-operated by furnishing information as to the number of beds occupied and vacant at Common Lodging Houses in the Borough on the night of 19th February. The total of licensed beds was 432 and beds occupied 374. The number of men known to be in receipt of Public Assistance was 17, and 12 beds were paid for by charitable organisations. 29 (c) Seamen's Lodging Houses. The Public Health Committee licensed the following Seamen's Lodging Houses to 30th June, 1938:— Premises. Licensee. No. of Men. 411, East India Dock Road, Poplar Rev. Samuel King (The National Sailors' Society) 22 (These premises were closed 20th November, 1937, and the licence was cancelled.) The Queen Victoria Seamen's Rest, Jeremiah Street, Poplar Rev. Thomas Athey Embleton (The Seamen's Mission) 115 48, Pennyfields Ah Chow 7 79 inspections of Seamen's Lodging Houses, including 5 night inspections, were made in 1937. Shops Act, 1934. Under the provisions of this Act 2 exemption certificates regarding sanitary accommodation were granted. One Notice calling attention to contraventions of the Act regarding lavatory accommodation was served and complied with. At the end of the year 1936 one notice regarding ventilation was outstanding and the work was completed in 1937. Smoke Abatement. 38 observations were made and 8 nuisances recorded. 19 complaints were received from the London County Council. 4 intimations and 1 notice were served. In addition, 3 cautions were issued. 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 National Smoke Abatement Society. The Council made a grant of £1 is. to the National Smoke Abatement Society, and Councillors J. A. Ashley and H. Boulton were appointed as the Council's representatives to the National Smoke Abatement Council till October, 1937. 30 Swimming Baths and Pools. As mentioned in previous Annual Reports, following upon the issue of the Ministry of Health Circular 1503, arrangements were made with the London County Council for the bacteriological examination of water from the swimming baths in the Borough, including the London County Council Open Air Bath at Millwall. In July, 1936, an agreement was entered into with the London County Council for the bacteriological examination of 25 samples each year at the Group Laboratory, Mile End Hospital, at an annual charge of £65. Only £10 of this sum (in respect of samples taken from the London County Council Open Air Bath) is chargeable to the Public Health Committee—the balance is a charge to the Baths Committee. The samples are collected and examined by the Bacteriologist in charge of the Group Laboratory, Mile End. During the year, 22 samples of bath water were taken and examined as follows:— East India Dock Road—1st class Bath 3 samples. East India Dock Road—2nd class Bath 5 samples. Roman Road—1st class Bath 3 samples. Roman Road—2nd class Bath 5 samples. Glengall Road Bath 3 samples. Millwall Open Air Bath (London County Council) 3 samples. The Bacteriologist reported that from the bacteriological point of view the results were very satisfactory. In no case was B. coli detected in 5 c.c. of bath water or B. Welchii in 25 c.c. of bath water. In one sample the Bacteriologist reported: "Centrifugal deposit shows an occasional epithelial cell, cotton wool fibre and micro-organisms." Reports regarding the Poplar Baths were sent to the Baths Superintendent for the information of the Baths Committee, and a copy of the report regarding the London County Council Open Air Bath was sent to the Chief Officer of the Parks Department, London County Council. Houses Let in Lodgings. The report of the Inspector is given on page 27. 31 Offensive Trades. 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. 10-16, Aberfeldy Street Nathan Cohen & Sons Dresser of fur skins. 43, Whitepost Lane Kestenbaum Bros., Petzold Fur Dyeing and Dressins: Works, Ltd. „ „ 12, Coborn Road M. Shriebhand Slaughterer of poultry. 221, Roman Road W. E. Prideaux „ „ 105, Grundy Street H. Jacobovitch „ „ For number of inspections see Table A page 35. Illegal Establishment of Offensive Trade. Following upon a complaint of smell, it was found that an offensive trade, viz., that of manufacture of manure had been established at ia, Blondin Street. By the Public Health (London) Act it was an offence to establish such a business in London. The Medical Officer of Health interviewed the Director and technical adviser of the firm who were under the impression that as they had given full information regarding their business when applying for derating they had informed the Sanitary Authority. The firm appreciated they were carrying on a business which was prohibited in London and ceased manufacturing manure. The premises were subsequently used for the storage of manure. Rag and Bone Dealers. Four infringements of the byelaws made by the London County Council under Section 9 of the London County Council (General Powers) Act, 1908, were reported. Legal proceedings were taken in three instances. One defendant was fined £2 with £2 2s. costs. One summons was dismissed and the other adjourned sine die. A letter of caution was sent in the fourth case. Licensed Premises Urinals. 23 urinals on licensed premises were found to be insanitary, and were subsequently cleansed. Water Certificates. 8 certificates regarding 2 houses, 236 tenements and 5 shops were issued under the provisions of the Public Health (London) Act. 32 Increase of Rent and Mortgage Interest (Restrictions) Acts. 55 certificates were issued to tenants, and at the request of owners 5 certificates that the work had been done were also issued. Stables. 154 stables were inspected and reported upon, the total number of inspections being 286. The following infringements of the Bye-laws were dealt with:— Accumulations of manure, or premises otherwise not clean 17 Floors not properly drained 2 Dung receptacles:— (a) Not provided 6 (b) Defective — (c) Not covered — Other defects 13 32 intimations and 7 notices were served. 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. The number of complaints received during the year was 106. No notices were served under the Rats and Mice (Destruction) Act, 1919. 33 The services of the rat-catcher who is employed by the Works Department are utilised by the Public Health Department in the following manner:— (1) The Sanitary Inspector when investigating a complaint of rats offers the occupier the services of a rat-catcher, and if these are accepted, visits the premises with the rat-catcher. (2) In cases where runs are traced under the footpaths, etc., arrangements are made with the Borough Surveyor's Department for the paving stones to be raised and for the rat-catcher to be present at the same time as the Sanitary Inspector for the tracing of runs, etc. A monthly report of the premises visited by the rat-catcher, baits laid, rats caught, etc., is submitted to the Public Health Department. summary of rat-catcher's work. (i) Dwelling-houses. No. of Premises. No. of Baits. No. of dead Rats. No. of Rats caught in Traps. Total No. of Rats. Laid. Taken. Dead. Alive. Council 41 1,020 650 40 13 7 60 Private 971 30,628 16,432 741 217 199 1,157 Totals 1,012 31,648 17,082 781 230 206 1,217 (ii) Sewers, etc. No. of Sewers, etc. No. of Baits. No. of dead Rats. No. of Rats caught in Traps. Total No. of Rats. Laid. Taken. Dead. Alive. Sewers 86 3,680 2,170 ─ ─ ─ ─ Conveniences, etc. 27 163 79 1 ─ ─ 1 Totals 113 3,843 2,249 1 ─ ─ 1 34 Inspection of Schools. The public elementary schools were inspected during the year. A few minor defects were discovered and reported to the London County Council. There is only one private school in the Borough. The accommodation was satisfactory and the sanitary arrangements sufficient and kept in a cleanly state. Rag Flock Act, 1911. 22 samples were taken. 17 samples were satisfactory, and 5 did not comply with the prescribed standard of cleanliness. Legal proceedings were taken in 3 cases, and letters of caution were sent in 2 other cases. 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 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 92 certificates were issued. Hairdressers' Premises. The number of inspections of hairdressers' premises was 80. Nuisances found numbered 4. Four intimations and one final notice were served. The requirements of these documents were complied with. Canal Boats. During the year visits were paid to the canals and locks, but only non-registered craft (dumb barges) were seen. At no time was there evidence of the vessels being used for residential purposes. Exhumations. One notice of exhumation was received. 35 Factory and Workshop Acts. Table A. Table giving number and inspections, etc., of Bakehouses, Laundries, Workshops, Workplaces,Places where food is prepired, Milk premises, Cowsheds, Slaughterhouses, Offensive Businesses, Ice Cream premises, and Homeworkers' premises:— Premises. On Register during year. Number of Inspections. Number of Intimations. Number of Notices. Number of Final Notices. Number of Prosecutions. Male. Female. Total. Bakehouses (Factories) 46 ─ 46 222 103 ─ ─ ─ Bakehouses (Workshops) 7 ─ 7 23 16 ─ ─ ─ Bakehouses (Domestic Workshops) 3 ─ 3 21 8 ─ ─ ─ Factories (Laundries and Miscellaneous Factories) 155 120 275 1125 16 5 2 ─ Laundries (Workshops) ─ 2 2 2 ─ ─ ─ ─ Laundries (Domestic Workshops) ─ ─ ─ ─ ─ ─ ─ ─ Workshops 178 49 227 136 11 1 ─ ─ Workshops (Domestic).. 22 ─ 22 8 1 1 ─ ─ Workplaces 347 19 366 461 44 8 ─ ─ Workplaces (Domestic) 44 ─ 44 21 1 ─ ─ ─ Places where food is sold or prepared* 1098 ─ 1098 1691 327 3 ─ ─ Milk Premises 85 ─ 85 355 3 ─ ─ ─ Cowsheds 1 ─ 1 19 ─ ─ ─ ─ Slaughterhouses 4 ─ 4 15 16 ─ ─ ─ Poultry Slaughterhouses 3 ─ 3 17 13 ─ ─ ─ Other offensive trade premises 4 ─ 4 83 4 ─ ─ ─ Ice Cream premises‡ 212 ─ 212 267 ─ ─ ─ ─ Homeworkers' premises 17 445 462 529 ─ ─ ─ ─ In this Table and in Table C on next page "reminders" that periodical cleansing was due are included as "Intimations" * Power is used in 81 of these premises. ‡ „ „ 31 „ „ (Lists of Slaughterhouses and other offensive trade premises are given on pages 68 and 31.) 36 Table C. Factories, Workshops, Laundries, Workplaces and Homeworkers. i .—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Intimation. Statutory. Final. Factories 1347 119 5 2 ─ (Including Factory Bakehouses and Laundries) Workshops† 161 27 1 ─ ─ (Including Workshop Laundries.) Domestic Workshops‡ 29 9 1 ─ ─ Workplaces 461 44 8 1 ─ Domestic Workplaces 21 1 ─ ─ ─ Places where food is sold or prepared § 1691 327 3 ─ ─ Homeworkers' Premises 529 ─ ─ ─ ─ Total 4239 527 18 3 ─ †Including Workshop Bakehouses. ‡Including Domestic Bakehouses and Laundries. § The inspections of factories where food is prepared are included. Power is used in 81 of the premises. 2.—DEFECTS FOUND. * (Corresponding figures for 1936 are shown in brackets). Particulars. Number of Defects. Number of Prosecu tions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Act: Want of cleanliness 123 (541) 122 (539) ─ ─ Want of ventilation ─ (2) ─ (2) ─ ─ Overcrowding ─ ─ ─ ─ Want of drainage of floors 2 2 ─ ─ Other nuisances 69 (68) 67 (67) ─ ─ Sanitary accommodation insufficient 3 3 ─ ─ unsuitable or defective 28 (18) 27 (18) ─ ─ not separate for sexes ─ ─ ─ ─ Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) ─ ─ ─ ─ Breach of special sanitary requirements for bakehouses (ss. 97 to 100) ─ ─ ─ ─ Other offences ─ ─ ─ ─ (Excluding offences relating to outwork which are included in Table D of this Report.) Total 225(629) 221 (626) ─ ─ * These defects refer to premises mentioned above under table of Inspection. Nature of Work, 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. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of list. Failing to send lists. Total Lists. Outworkers. Total Lists. Outworkers Contractors. Workmen . Contractors . Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) in) (12) (13) (14) (16) (16) Wearing Apparel— Making, eto. 58 20 607 6 1 16 60 2 5 Cleaning and Washing Household Linen Laoe, lace curtains and nets Curtains and furniture hangings Furniture and Upholstery Eleotro-plate File Making Brass and Brass Articles Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, etc. Artificial Flowers Nets, other than wire nets Tents Sacks Racquet and Tennis Balls Paper,eto.,Boxes, Paper Bags 10 — 81 1 4 11 4 Brush Making Pea Picking Feather Sorting Carding,etc., of buttons,etc. Stuffed Toys Basket Making Chocolates and Sweetmeats Cosaques, Christmas Crackers Christmas Stockings, eto. Textile Weaving Lampshades Miscellaneous* 2 — 52 — — 1 1 Totals 70 20. 740 7 1 20 72 — 2 — — — 10 — — •Fancy jewellery, flags, pot scourers. 38 List of Outworkers, Factory and Workshop Act, 1901 (S. 107). Class of Homework. 1937 Number of Lists received. Number of Addresses of Outworkers. Due Feb. 1st. Due Aug. 1st. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Due Feb. 1. Due Aug. 1. Due Feb. 1. Due Aug. 1. Total 39 420 38 340 292 234 273 241 Wearing apparel 32 336 32 287 247 205 201 184 Paper bags, boxes, etc. 6 35 5 46 11 27 3 3 Miscellaneous 1 52 1 4 34 2 69 54 Table E. Registered Workshops and Workplaces. Workshops and Workplaces, etc., on the Register (s. 131) at the end of the year. Number. (1) (2) Important classes of workshops, such as workshop bakehouses, may be enumerated here. Bakehouse Workshops 7 Bakehouse Domestic Workshops 3 Laundries Workshops 2 Laundries Domestic Workshops — Workshops 227 Domestic Workshops 22 Workplaces 366 Domestic Workplaces 44 Places where food is sold or prepared 1098* Total number of workshops and workplaces, etc., on Register 1769 * Power is used in 81 of these premises. Table F. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) ─ Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 4 Reports (of action taken) sent to H. M. Inspector 3 Other (Communications) 19 Underground Bakehouses (s. 101):— Certificates granted during the year ─ In use at the end of the year 17 39 Public Health (London) Act, 1936, Metropolis Management Acts, etc. Address. Nature of Complaint. Result. Inspector. 194, Devons Road Failed to comply with Magistrate's Order to abate nuisance £3 penalty; £2 2s. costs West brook, C.S. 4, Arcadia Street Back addition roof leaky and other defects 7 days' order; £2 2s. costs Colborne, W. J. 48, Sabbarton Street Main roof leaky and other defects Work done; £1 penalty; £2 2s. costs do. 46, Sabbarton Street Main roof leaky and other defects 7 days' order; £1 penalty; £2 2s. costs do. 117, Upper North Street Main roof leaky and other defects Work done; £2 2s. costs do. 46, Arcadia Street Main roof defective and other defects 7 days' order; £2 8s. costs do. 238, Devons Road Main roof defective, causing dampness Work done; £2 2s. costs Westbrook, C.S. 139, Upper North Street Repaired w.c. without giving notice of intention £1 penalty; £1 1s. costs Colborne, W. J. 111, St. Leonards Road Rainwater pipes and boundary fence defective 7 days' order; £3 3s. costs Johnson, W. 77, Blackthorn Street Main roof defective and other defects 7 days' order; £2 8s. costs Westbrook, C.S. 20, Sherwood Street Main roof defective and other defects 7 days' order; £2 8s. costs do. 84, Whitethorn Street Eaves gutter defective, ground floor room wall damp Work done; £2 5s. costs do. 86, Whitethorn Street Main roof defective, landing wall and ceiling damp Work done; £2 5s. costs do. 18, Sherwood Street Various defects Work done; £2 5s. costs do. 4, Arcadia Street Failed to comply with Magistrate's Order to abate the nuisance £3 penalty; £2 2s. costs Colborne, W.J. 27, Grundy Street Drains obstructed Work done; £2 5s. costs do. 20, Merchant Street Various defects 14 days' order; £2 8s. costs Westbrook, C.S. 155, Fairfoot Road Various defects Work done; £2 5s. costs do. 143, Upper North Street Nuisance from smoke from stove and no proper ashpit 7 days' order; £2 8s. costs Colborne, W.J. 18, Stebondale Street Main roof leaky and other defects Work done; £2 5s. costs Dove, A.L. 103, Marner Street Main roof defective and other defects 7 days' order; £2 8s. costs Johnson, W. 37, Ruston Street Drains defective 14 days' order; £2 8s. costs Smith, F.A. 38, Ruston Street Sink waste pipe defective and other defects 14 days' order; 4s. costs do. 8, Tapley Street Main roof defective 14 days' order; £3 penalty; £2 8s. costs Johnson, W. 61, Barchester Street First floor back addition walls and ceiling damp, window sashes defective Work done; £2 5s. costs Colborne, W.J. 62, Guildford Road First floor rooms walls damp and first floor front room ceiling damp Work done; £2 5s. costs do. 76, Barchester Street Main roof defective Work done; £2 5s. costs do. 49, Barchester Street First floor back addition walls and flooring defective Work done; £2 5s. costs do. 40 Address. Nature of Complaint. Result. Inspector. 27, Barchester Street First floor back addition wall damp Work done; £1 2s. 6d. costs Colborne, W.J. 12, Ship Street Basement flooring, scullery roof and w.c. roof defective; no water supply to top storey 14 days' order; £2 8s. costs Dove, A.L. 13, Stebondale Street Top front room ceiling damp, defective and dirty; main roof defective 7 days' order; £2 8s. costs do. 59, Eglinton Road Various defects Work done; £1 penalty; £2 5s. costs Smith, F.A. 57, Eglinton Road Main and back addition roofs defective; wall of chimney breast damp Work done; £1 penalty; £2 5s. costs do. 165. Malmesbury Road Various defects 7 days' order; £2 8s. costs Kelly, S. 12, Caxton Street Main roof leaky and other defects Work done; £2 5s. costs do. 83, Bruce Road Main rocf defective and other defects Work done; £2 5s. costs Westbrook, C.S. 39, Marshfield Street Various defects 7 days' order; £2 penalty; £2 8s. costs Dove, A.L. 103, Marner Street Failed to comply with Magistrate's Order to abate the nuisance Adjourned sine die Johnson, W. 29, Carmen Street Various defects 14 days' order by consent; £2 8s. costs Colborne, W.J. 72, Tredegar Road Main roof defective Summons not served. Work since done Luke, H.W. 29, Carmen Street Failed to comply with Magistrate's Order to abate the nuisance £1 penalty; £2 2s. costs Colborne, W.J. 90, East India Dock Road Construction of w.c. without notice being given £1 penalty; £1 1s. costs do. 22, Vernon Road First floor front room roof defective and other defects 7 days' order; £2 8s. costs Smith, F.A. 41, Morville Street First floor back addition back room and scullery roofs defective and other defects 7 days' order; £2 8s. costs do. 21, Ellesmere Street Main roof defective 14 days' order; £2 penalty; £2 8s. costs Colborne, W.J. 25, Ellesmere Street Main roof defective and other defects 14 days' order; £2 penalty; £2 8s. costs do. 27, Ellesmere Street Main roof defective 14 days' order; £1 penalty; £2 8s. costs do. 61, Fern Street Main roof defective and other defects Work done; £2 5s. costs Westbrook, C.S. 65, Fern Street Main roof defective and other defects Work done; £1 1s. costs do. 75, Fern Street Main roof defective and other defects Work done; £1 1s. costs do. 79, Fern Street Main roof defective and other defects Work done; £1 1s. costs do. 81, Fern Street Roof defective and other defects Work done; £1 1s. costs do. 85, Fern Street Main roof defective and other defects Work done; £1 1s. costs do. 9, Goodliffe Place Main roof defective and other defects 7 days' order; £2 8s. costs Colborne, W.J. 41 Address. Nature of Complaint. Result. Inspector. 7, Goodliffe Place Failed to provide a sufficient ashpit £1 penalty; £2 2s. costs Colborne, W.J. 6, Goodliffe Place Main roof defective and other defects 7 days' order; £2 8s. costs do. 34, Ellerthorp Street Main roof defective; washhouse roof defective; and other defects Work done; £2 5s. costs do. 42, Broomfield Street Main roof defective and other defects Work done; £2 penalty; £2 2s. costs do. 24, Swale Street Main roof defective and other defects Work done; £2 5s. costs do. 2, Glengarnock Avenue Main and back addition roofs defective and other defects Work done; £2 penalty; £2 2s. costs Dove, A.L. 4, Glengarnock Avenue Back addition roof defective and other defects Work done; £2 penalty; £2 2s. costs do. 8, Portree Street Main roof gutter and w.c. roof defective, and other defects 7 days' order; £2 8s. costs Johnson, W. 194, Devons Road Main roof defective and other defects 14 days' order; £3 penalty; £2 8s. costs Westbrook, C.S. 155, Fairfoot Road Main roof defective and other defects 14 days' order; £2 8s. costs do. 18, Lawes Street Main rear eaves gutter and w.c. roof defective and other defects 14 days' order; £5 penalty; £2 8s. costs do. London County Council Byelaws with Respect to Houses Divided into Separate Tenements. Address. Nature of Complaint. Result. Inspector. 38, Cotton Street Front basement room used as sleeping apartment overcrowded £1 penalty; £1 1s. costs Luke, H.W. 38, Cotton Street Top front room used as a sleeping apartment overcrowded £1 penalty; £1 1s. costs do. 38, Cotton Street Top front room used as a sleeping place overcrowded £2 penalty; £1 1s. costs do. 72, Tredegar Road — — — (Summons under Public Health (London) Act. 1936. q. v. also 2 summonses under Housing Act, 1936, see below.) Housing Act, 1936. Address. Nature of Complaint. Result. Inspector. 38, Cotton Street Permitted use of back basement room contrary to Closing Order £1 penalty Luke, H.W. 38, Cotton Street Permitted use of back basement room contrary to Closing Order £2 penalty; £1 1s. costs do. 42 London County Council Byelaws—Rag and Bone Dealers. Address. Nature of Complaint. Result. Inspector. Henry Leader, 28, Chaucer Road, Forest Gate, E.7 Exchanged toy for rags £2 penalty; £1 1s. costs Langley, H.J. Wm. Hawkins, 8, Claude Street, Millwall, E.14 Aided, abetted, etc., in distributing toy for rags Adjourned sine die. (Some other person gave Hawkins' name and address.) Smith, F.A. Edward Ross, 3, Leonards Buildings, Payne Road, E.3 Distributed toy for rags outside Glengall Road School Adjourned sine die. Defendant gave an undertaking not to repeat the offence Dove, A.L. Factory and Workshop Act, 1901. Address. Nature of Complaint. Result. Inspector. H. Lyons, 180, East India Failed to send a list of outworkers £1 penalty; £2 2s. costs Landray, Dock Road, E.14 Miss D.A.E. Florence Winter, 23, Medway Road, E.3 (occupier of 58, Ford Street) Failed to send a list of outworkers £1 penalty; £2 2s. costs do. Public Health (London) Act, 1936, Sec. 136, and the Rag Flock Regulations, 1912. Address. Nature of Complaint. Result. Inspector. Resilient Fillings, Ltd., Athol Works, Athol Street, Poplar, E.14 In possession of rag flock which contained chlorine 440 parts per 100,000 £3 penalty; £5 5s. costs Tibbatts, H.A. Poplar Flock Mills, Ltd., Athol Works, Athol Street, Poplar, E.14 In possession of rag flock which contained chlorine 440 parts per 100,000 Summons withdrawn do. Food and Drugs (Adulteration) Act, 1928. Article. Result of Analysis, etc. Result. Inspector. Milk Deficient in fat 10 per cent. £2 penalty; £2 2s. costs Pearce, H.A. Note. Letters were sent to 11 vendors in respect of other unsatisfactory samples. Merchandise Marks Act, 1926, and Order No. 7. Defendant. Offence. Result. Inspector. Albert Batiste, 70a, Chrisp Street, E.14 Exposed for sale imported pork not marked with indication of origin Summons dismissed under Probation of Offenders Act; £3 3s. costs Grabham, C.A. 44 Summary of Penalties and Costs. Penalties. Costs. £ s. d. £ s. d. Public Health (London) Act, 1936 38 0 0 132 17 6 Housing Act, 1936 3 0 0 1 1 0 L.C.C. Byelaws—Houses divided into separate Tenements 4 0 0 3 3 0 Factory and Workshop Act, 1901 2 0 0 4 4 0 Rag Flock Regulations 3 0 0 5 5 0 L.C.C. Byelaws—Rag and Bone Dealers 2 0 0 1 1 0 Food and Drugs (Adulteration) Act, 1928 2 0 0 2 2 0 Merchandise Marks Acts and Orders — 3 3 0 Totals £54 0 0 £152 16 6 £206 16 6 London County Council (General Powers) Act, 1928, sec. 28, and Public Health (London) Act, 1936, sec. 224. Removal of infirm persons. It was not necessary to obtain Magistrates' Orders for the removal of infirm persons to institutions. Three persons were removed without recourse to Court Orders. 45 Copy of a Return to the London County Council. Premises. No. in Borough on 31st December, 1937. No. of Inspections. No. of Prosecutions. Common Lodging Houses 4 132 — Seamen's Lodging Houses 2 79 — Cowsheds (Licensed) 1 19 — Slaughterhouses (Licensed) 4 15* — Poultry Slaughterhouses 3 17 — Other Offensive Trades 4 83 — Milkshops 85 355 — Ice Cream Premises 212 267 — Restaurants and Eating Houses 1,098 1,691 — Registered Foster-Mothers 16 15 by Sanitary Inspectors. 207 by Chief Health Visitor. Nurse Children kept 16 *In addition, 864 visits were made in connection with the examination of carcases. Smoke Nuisances. (1) No. of observations 38 (4) No. of Statutory Notices served 1 (2) No. of intimations served 4 (5) No. of legal proceedings — (6) No. of convictions — (3) No. of complaints received (from L.C.C.) 19 (7) Amount of penalty and costs imposed in each case — Cleansing and Disinfection. No. of adults cleansed 150 No. of rooms cleansed (a) After infectious diseases 1543 No. of children cleansed 4120 (b) for vermin 1883 Water Supply to Tenement Houses. No. of premises supplied 18 No. of prosecutions 1 Sanitary Officers. No. of Sanitary Inspectors (whole-time) Male. Female. 16 1 ,, ,, ,, (part-time) — — No. of Health Visitors (whole-time)—Borough Council M. & C.W., 10; Tuberculosis, 3. ,, ,, ,, (part-time)—Nil. ,, ,, ,, (Voluntary Association)—M. & C.W., 9. 46 Housing. 1. Total No. of inhabited houses in the Borough 23,977 9. No. of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) Public Health Act— 2. No. of houses inspected on account of complaints or illness 5,478 10. No. of Closing Orders determined (i.e., houses made fit) 3. No. of Intimations served No. of statutory notices served 4,332 1,657 4. No. of houses repaired or nuisances remedied 4,081 11. Overcrowding (Housing Act, 1936)— No. of families found to be living in overcrowded conditions 190 Housing Act (1936)— 5. No. of houses inspected— house to house (Housing Consolidated Begs., 1925) — No. of overcrowded families who have obtained alternative accommodation 338 6. (a) No. of houses included in representations by the Borough Medical Officer under Sec. 25 of H.A., 1936 10 12. No. of houses erected by the Borough Council for working classes during year 36 (6) No. of houses demolished following representation by Borough Medical Officer under Sec. 25 of H. A., 1936 13 13. Underground Rooms— No. occupied but unfit* 64 7. No. of houses repaired under Sections 9 and 10 of H.A., 1936:— No. closed, or modified occupation approved 55† (a) By owners — 14. Houses Let in Lodgings— (6) By L.A. in default of owners No. in Borough 347 No. of inspections 2,176 8. No. of houses demolished:— No. of prosecutions 6 (a) In pursuance of orders under Sec. 11 of the H. A., 1936 38 No. of complaints remedied under the By-laws (not included under any other heading) 83 (6) Voluntarily 12 * On two occasions a basement room was found to be occupied contrary to a Closing Order; legal proceedings were taken and convictions obtained. t Specifications of remedial works accepted in respect of the remaining 9. Infectious Diseases. Infectious diseases—cases notified under local orders (excluding cases coming to knowledge otherwise than by notification). Disease. Cases notified. Period. Measles Not notifiable — — German Measles — — Whooping Cough _ — Rheumatic Fever (0-16) — — Chicken Pox — — Zymotic Enteritis 76 1st June to 30th September, 1937. 47 Section D. HOUSING. The following section on Housing has been prepared in accordance with Circular 1,650 (England) of the Ministry of Health, 1937:— 1.—Inspection of Dwelling Houses during the Year. (I) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5,324 (b) Number of inspections made for the purpose 25,276 (2) (a) Number of dwelling-houses (included under head (1) above, which were inspected and recorded under the Housing Consolidated Regulations, 1925 — (b) Number of inspections made for the purpose — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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 4,164 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 2,425 3.—Action under Statutory Powers during the Year. (a) Proceedings under Sections 9, 10 and 16 of the Homing Act, 1936— (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners — (b) By local authority in default of owners — 48 (b) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,547 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,503 (b) By local authority in default of owners - (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936— (1) Number of dwelling-houses in respect of which Demolition Orders were made 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (d) Proceedings under Section 12 of the Housing Act, 1936— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 55* (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 3† *Specifications approved in respect of 6 other rooms. †Specifications approved and Closing Orders determined 4.—Housing Act, 1936, Part IV.—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year 3,252 (ii) Number of families dwelling therein 3,252 (iii) Number of persons dwelling therein 20,905 (b) Number of new cases of overcrowding reported during the year 190* *Almost wholly due to the increased ages of children. 49 (c) (i) Number of cases of overcrowding relieved during the year 344 (ii) Number of persons concerned in such cases 2,021 (a) Rehoused by London County Council 206 (b) Rehoused by Popular Borough Council 66 (c) Rehoused by Housing Association 1 (d) Obtained other alternative accommodation 57 (e) Vacated accommodation taken over 14 344 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report (see page 56.) Number of new houses and tenements erected during 1937:— (a) Total (including numbers given separately under (b)) 410 (i) By the Local Authority 46 (ii) By other Local Authorities 364 (iii) By other bodies or persons — (b) With State assistance under the Housing Acts:— (i) By the Local Authority:— (a) For the purposes of the 1930 Act (Slum Clearance) 11 (b) For the purposes of the 1935 Act (Overcrowding) 35 (c) For other purposes Nil. 50 Number of Houses owned by the Local Authority. (a) Held under the Housing Acts:— (1) With State assistance:— Under the 1919 Act—New Housing 150 Rehousing 36 186 ,, ,, 1923 Act—New Housing 61 Rehousing 24 85 ,, ,, 1924 Act 544 ,, ,, 1930 Act (including 150 built during the last 2 years) 192 ,, ,, 1935 Act—Overcrowding 35 1,042 (2) Without State assistance:— Houses converted to tenements (tenements) 24 1,066 (3) Purchase for eventual demolition 5 (b) Held under other powers:— (1) Purchase for alternative accommodations 2 (2) Other properties 6 8 51 Housing Act, 1936. The progress of areas during 1937 has been as follows:— (I) Represented in 1937. No. Area. Approx. area, including added lands, (acres). Number of Date of Council's resolution declaring Area. Remarks. Houses in area. Families. Persons Title. In area. Added lands. 34b (a) Poplar Borough Council:— Lindale Street 0.03 3 3 15 — 25.2.37 Clearance only. Inquiry 20.4.37. Order confirmed 18.6.1937. 80 Glaucus Street 0.2304 7 9 35 — (b) London County Council:— 53 Grace Street 1.48 69 - 288 20 2.2.37 One block to be erected on site to accommodate approximately 411 persons. 12 Phoebe Street Areas (situate in Poplar and Stepney) Area 1 (Poplar & Stepney) 6.661 Area 8 (Poplar only) 0.266 192 (Poplar 140) also 28 houses and some other properties of which 22 houses and 1 store and 1 beerhouse are in Poplar.) 7 1118 (total) (Poplar) ? 47 176 (total) (Poplar) ? - 9.2.37 . Inquiry held at St. George's Town Hall, Cable Street, Stepney, 7th and 8th Dec., 1937. 22 Hinks Place 0.403 25 (and 1 shop) 94 - 4.5.37 Clearance only. Inquiry held 24.1.38. 26 Cottage Place 0.102 10 — 30 4.5.37 Clearance only. 52 (II) Represented prior to 1937. No. Area. Clearance Area. Whether additional lands acquired. No. of persons in added lands. Acreage of total area. Remarks and position at 31st December, 1937. Title. No. of houses. No. of persons. Date of resolution. (a) Poplar Borough Council: 16 Old Ford Road (Taylor's Buildings) 5 24 20.12.34 No — 0.07 Still occupied. 27 Ford Road (No. 1) 5 29 24.1.35 Yes 22 0.16 Site cleared. 46 Ford Road (No. 2) 3 14 24.1.35 No — 0.055 Rehousing in progress. 77 Wendon Street and Ruston Street 8 55 23.1.36 No 0.14 Site cleared. New Maternity and Child Welfare Clinic in course of erection. 34a Sarah Cottages (Lindale Street) 5 14 7.1.37 No — 0.04 Inquiry, 20th April, 1937. 62 Milton Place 9 54 7.1.37 No — 0.097 Objections withdrawn before Inquiry. Orders confirmed. (b) London County Council: 20 Vesey Street (2 areas) 44 250 30.7.35 Yes 46 1.04 Premises still occupied. 28 & 51 Bow Road (Areas Nos. 1-8) 39 110 31.3.36 Yes 115 4.26 Confirmation Orders issued, 26.2.37. Re-housing in progress. 38 Dock Cottages (2 areas) 71 322 19.11.35 Yes 143 2.7 Inquiry held 22.2.37. Confirmation orders issued 22.5.37. Majority of houses demolished. 52 High Street, Bow 18 117 14.5.35 Yes 17 0.81 Site cleared. 56 & 57 Devas Street (Areas 1-5) 305 2164 14.7.36 Yes See col. 4 11.299 (inc . added lands) - - 14.7.36 (acquired compulsorily under Part III Housing Act, 1925) 2.622 Inquiry held 12.4.37. Confirmation orders issued 14.8.37. Occupants being re-housed. 78 Spring Gardens Place 7 25 4.2.36 No - 0.15 Site cleared. 53 Poplar Area No. 33. "London County Council Bromley Maltings Housing Scheme."— Considerable progress has been made by the L.C.C. during the year. Many of the old properties have been acquired and blocks of flats have been erected. Underground Rooms.—Orders were made prohibiting the use of the following underground rooms for any purpose other than the storage of non-edible articles, except where otherwise stated:— 22, Selwyn Road Basement front and back (front basement for storage only, back basement for washing and bathing). 94, East India Dock Road Front and back basement and back addition basement. 1, Creswick Road Front and back basement and basement scullery. 10, Kerbey Street Basement front and back. 14, Stafford Road Basement front and back rooms. 76, Sussex Street Basement front and back rooms. 1, Barque Street Basement front and back rooms age of non-edible articles). 2, Kerbey Street Basement front room and basement scullery (storage of non-edible articles). 162, East India Dock Road Basement front and back and basement washhouse (basement front and back for storage only, basement washhouse for washing). * 17, Campbell Road Basement front and back rooms and scullery (storage of non - edible articles). *Re 17, Campbell Road.—An Appeal was entered at Bow County Court against these Closing Orders. Subsequently the Appeal was withdrawn and an agreed specification of work carried out and the Closing Orders determined. 54 11 , Alfred Street Basement front and back rooms (storage of non-edible articles). 50, Blackwall Way (late Basement front and back rooms and Brunswick Street) basement scullery (basement front and back rooms for storage, basement scullery for washing purposes only). 30, Bruce Road Basement front and back rooms and scullery (basement front and back for storage only, basement scullery for washing). 43, Sussex Street Basement front and back rooms and scullery (front and back rooms for storage only, basement scullery for washing). 4, Sussex Street Basement front and back rooms and scullery). 6, Paris Terrace Basement front and back rooms. 24, St. Leonard's Road Basement front and back rooms. 18, Driffield Road Basement front and back rooms. 3, Perry's Close Basement front and back rooms. 7, Stafford Road Basement front and back rooms. 6, Wansbeck Road Basement front and back rooms. 3, Ida Street Basement front and back rooms. 17, Drew Street Basement front and back rooms. 39, Saxon Road Basement front and back rooms. 9, Stebondale Street Basement front and back rooms. The Housing Committee accepted undertakings from the owners to carry out approved specifications of work in connection with underground rooms at the following premises:— 109, Cadogan Terrace Basement front and back rooms. 50, Saxon Road Basement front and back rooms. 93, Campbell Road Basement front and back rooms. Contravention of Closing Order.—The owner of No. 38, Cotton Street was summoned for contravening the Closing Order regarding the basement back room made on the 23rd April, 1936, and was fined £2 with £1 is. costs. 55 Individual Houses. No. 1a, Whitethorn Street.—This house, which was the subject of a Demolition Order on 1st December, 1936, has been closed. Nos. 34-36, Bow Common Lane.—Following upon the representation by the Medical Officer of Health on 25th November, 1937, a Demolition Order was made by the Council in 1938. No. 3, West Ferry Road.—On the 7th January, 1937, the Housing Committee made a Demolition Order regarding these premises, and they were subsequently demolished. (The house was not represented by the Medical Officer of Health.) Hanbury Buildings. The question of dealing with this unsatisfactory block of tenements has been exercising the minds of the Council and its Officers for some considerable time. As the owner was not prepared to carry out voluntarily a scheme which was submitted by the Officers of the Council, the Housing Committee were recommended to deal with this block of tenements by making Closing Orders under Section 12 of the Housing Act, 1936, regarding certain rooms and serving notices under Section 9 for the remainder of the building. On 22nd February, 1937, the Medical Officer of Health represented the following rooms as unfit for habitation and the Borough Engineer and Surveyor reported they were not capable of being rendered fit at a reasonable expense:— Ground Floor:— Bedroom of tenement No. 1. ,, ,, 2. ,, ,,3. Living room ,, 4. ,, ,, 7. First Floor:— Living room of tenement No. 11. ,, ,,14. Second Floor:— Living room of tenement No. 18. ,, ,, 21. 56 Third Floor:— Living room of tenement No. 25. ,, ,, 28. Fourth Floor:— Living room of tenement No. 32. ,, ,, 35. Regulations re Underground Rooms.—In view of the amendment of Section 18 of the Housing Act, 1925, by the Housing Act, 1935, the Council considered the revision of the Regulations made in 1927. The model regulations of the Ministry of Health were adopted and these were confirmed by the Minister of Health on 30th December, 1936. Several underground rooms, which come within the ambit of the new regulations and where the occupants have already agreed to accept alternative accommodation, were represented early in 1937. Overcrowding. Special circumstances led to the investigation of 24 new instances of overcrowding, and seven of the more serious cases were reported to the Public Health Committee. Sixteen 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. In all 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 1937. The Town Clerk afforded the following information regarding the number of families rehoused during the past year:— The Town Clerk afforded the following information regarding the number of families rehoused during the past year:— 57  Families accommodated . Number of persons (approx.). (a) By the Poplar Borough Council in:— (1) Newly erected houses or flats 44 294 (including 38 Council tenants transferred (2) Adapted buildings - - (3) Vacancies re-let:— (i) New properties 74 301 (ii) Adapted or miscellaneous properties (iii) Tenants transferred (37) - - 118 595 ** (b) By the London County Council on direct application:— (1) (i) Ordinary cases 495 (ii) Rehousing cases 155 (iii) Special hardship cases 2 (iv) Tenants transferred (62) - (2) Housing Act, 1936, cases:— (i) Ordinary 109 (ii) Tenants transferred (35) - 661 Total 769 ** It is not possible to give the number of persons accommodated under this heading. Verminous Premises and Rooms. The service of notices regarding 363 premises and the contents of rooms at 20 premises was authorised by the Public Health Committee. 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 123 of the Public Health (London) Act, 1936. 58 Eradication of Bed Bugs. The Public Health Committee considered correspondence which had been received from the Metropolitan Boroughs' Standing Joint Committee and also a Memorandum of the London County Council regarding the general question of infestation by vermin. In adopting the Medical Officer of Health's report upon these documents, the Committee definitely disagreed with the use of HCN gas for fumigation of houses—whether single houses, in rows, or block dwellings. (The report is printed as an Appendix on page 141.) Summary of the Work done by the Special Inspectors for Disinfestation . Premises Inspected. Council Properties. Private Properties. Number of premises reported to Public Health Committee (P. H. (L.) A., 1936) — 381 Number of premises found to be infested 121 663 Number of premises disinfested 115 663 Inspections Made. Number of premises inspected 384 913 Number of premises re-inspected after disinfestation 35 687 Miscellaneous visits and calls 2,415 805 Total numbers of visits 2,834 2,405 Treatments Applied. Fumigations to 109 Council tenements 243 — ,, to 480 private tenements - 797 Sprayings to 6 Council tenements 36 - ,, to 183 private tenements - 849 Total treatments 279 1,646 Number of rooms to which treatments were applied 778 1,060 59 Articles Treated. Council Properties. Private Properties. Beds, bedding, etc., by steam disinfection . 30,477 3,003 ,, ,, by spraying with insecticide — 6,194 Furniture, by HCN in transit to Council tenements 4,321 by spraying with insecticide or by blowlamp 476 4.644 Miscellaneous articles (includes pictures, leather goods, crockery, wireless sets, etc.) 912 15,733 Totals of articles treated. 36,186 29.574 Verminous Articles Destroyed. Bedding — 74 Clothing — 116 Furniture 14 66 Miscellaneous articles — 158 Totals of articles destroyed 14 414 Removal of Families to L.C .C. Tenements. - - In 33 cases the household effects of such families were treated before they were allowed to move into L.C.C. flats or houses. Bedding—steam treatment 720 Furniture—spraying or blowlamp 540 Sundries—spraying or blowlamp 1,373 Total of articles treated 2,633 Removal of Families to Poplar Borough Council Tenements. In 104 cases the household effects of such families were treated by HCN in transit. Bedding 29,773 Furniture 4,321 In 7 cases the household effects of such families were treated with vermicide. Bedding 704 Furniture 476 Sundries 912 Totals 36,186 In 96 cases the household effects were clean and free from vermin and required no treatment 60 Re-inspections of Tenements Previously Disinfested. Council Properties. Private Properties. Number of premises re-inspected 35 335 Number of premises found satisfactory 35 203 Number of premises found satisfactory after further treatment - 69 Number of premises found re-infested — 63 Percentage re-infestation — 20% The following report was submitted by the Inspectors, Messrs. I. M. G. Farries and C. H. Medland:— Fumigation by sulphur dioxide and spraying with a commercial liquid insecticide are still the principal methods employed for freeing infested houses from bed bugs, and such methods are substantially the same for both Council and private properties. Although fairly effective, the greatest disadvantage of sulphur fumigation is the amount of stripping of woodwork, wallpaper, etc., involved and the consequent additional expense. For this reason, efforts are being made by many authorities to produce a fumigant as safe as— but more effective than—sulphur dioxide, and the Council's Special Inspectors for Disinfestation have attended various lectures and demonstrations dealing with the latest developments in methods of disinfestation. The most promising results appear to have been obtained with heavy naphtha fumigation, which is claimed to be safe and effective, but there are some difficulties in the technique of its application to be overcome before this method of fumigation is perfected. Its use at present would entail either an increase in staff or a great decrease in the number of private properties treated. Consequently there is, in the opinion of the Special Inspectors for Disinfestation, no justification for recommending any alteration in the present disinfestation procedure until other methods have been sufficiently developed as to obtain comparable results with sulphur fumigation from a practical and economical point of view. Van-fumigation by hydrocyanic acid gas remains the most efficient method of freeing infested furniture and is used in cases of severe infestation or in cases where a penetrative treatment is necessary, as in the fumigation of upholstered chairs, etc. 61 The furniture of all prospective Council tenants, or of tenants transferring from one Council tenement to another, is inspected a few days prior to the date of removal, and, if found to be infested, one of the following two methods is employed to free the furniture from vermin, according to whether the infestation is slight or severe:— (i) Spraying of furniture, with or without steam disinfestation of bedding; (ii) HCN fumigation of furniture in vans during transit to Council houses and steam disinfestation of bedding. The spraying of furniture and steam disinfestation of bedding is carried out by the staff of the Public Health Department, and HCN fumigation of furniture is carried out by a contractor. An inventory of furniture is made in all cases where HCN fumigation is necessary, so that the number and capacity of the vans required can be ascertained. Two horse-drawn vans are owned by the Council and retained for the sole purpose of furniture fumigation by HCN, and when additional vans are required these are hired from a contractor. 62 Section E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. Lectures and Demonstrations on Milk Pasteurising Plants. The Public Health Committee agreed to the two Meat and Food Inspectors attending a course of training on the inspection of milk pasteurising plants, at a fee of one guinea each. Cowshed. The cowshed in the Borough was inspected on 19 occasions. Application for a licence was considered by the Public Health Committee, as follows:— 17-19, Morville Street—Mr. John Henry Chandler—licensed to keep 19 cows. Dairies and Milkshops. The registration of one new dairy was approved and at the end of the year there were in the Borough 85 registered premises where raw milk is sold. These premises were kept under strict observation, 355 inspections being made. 3 intimations were served in respect of various defects. The necessary work was done without need for further action by the department. 5 persons (including 1 itinerant vendor) were registered as retail purveyors of milk, 3 being on account of change of ownership of premises. The following retail purveyors also were registered during the year:— 42 for sale of sterilized milk in sealed bottles (33 on account of change of ownership). 16 for sale of raw milk in sealed cartons (2 on account of change of ownership). 14 for sale of raw milk in sealed bottles (8 on account of change of ownership). 2 for sale of raw milk in sealed bottles and cartons. Note.—One wholesale purveyor of raw milk was registered, his premises being outside the Borough of Poplar. 63 Milk (Special Designations) Order, 1936. Licences Issued during the Year. Designation. Bottlers. Pasteurisers. Dealers in Sealed Bottles only. Supplementary Licences. Tuberculin Tested 6 — 28 8 Pasteurised — 2 27 10 Totals 1 6 2 55 18 The bottling establishments have been under constant supervision and, for the purpose of renewal of licences, special inspections were made and reports submitted. 64 Bacteriological Examination of Milk. Number of Samples Examined por Bacteria (Total Count and B.Coli)—117. Designated Milk. Where taken: Number satisfactory. Number unsatisfactory. Action taken. On delivery at— From Dealers— Railway Stations. L.C.C. Hospitals, and Schools Before bottling. After bottling. Tuberculin Tested 3 — 16(1) 32 (4) 46 5 3 letters to dealers; 1 letter to producer and 4 letters to Medical Officers of Health of other Authorities. Pasteurised 26 (8) 11*(1) 26 (4) 50 13 4 letters to dealers; 7 letters to producers and 8 letters to Medical Officers of Health of other Authorities. Tuberculin Tested Pasteurised — — — 2 2 — Tuberculin Tested (Certified) — — — 1 1 — Totals 3 26 27 61 99 18 The figures in parentheses denote number of unsatisfactory samples and are included in the totals. * 8 for B. Coli count only. Note.—Three samples of Tuberculin Tested milk were centrifuged for the biological test for B. tuberculosis before the necessary sample h i been withdrawn for the B. Coli test which could not therefore be carried out. Further samples were taken. Examination of Milk for Tubercle Bacilli (Biological Examination). Number of Samples Examined—37. (An extract from a report of the London County Council of samples of bulk milk taken on delivery and at cowsheds in the Borough is given on page 66.) Number reported Tubercle bacilli absent. Tubercle bacilli present. Examination incomplete. Remarks. Designated Milks-.— Tuberculin Tested 11 — — Tuberculin Tested Pasteurised 2 — — Tuberculin Tested Certified 1 — — Pasteurised 12 — — 4 of these were taken at L. C. C. schools. Other Milks:— Sterilised 2 — — Bottled (from Dairies) 8 — — ,, (from Cowsheds) 1 — — Totals 37 — — 65 66 In addition to the samples shown in the table on page 65, the London County Council took samples of milk for biological examination for the presence of tubercle bacillus, as follows:— Premises. Grade. No. of samples taken No. Tuberculous. 3 Dairies - Ungraded 19 3 Accredited 23 3 Tuberculin Tested 3 — 45 6 Where samples were found to be tuberculous, as a result of consequent inspection, cows believed to be the source of infection were slaughtered under the Tuberculosis Order in three cases; in the other three cases animals believed to be the source of infection had been disposed of before further action could be taken. Inspection by L .C .C. Veterinary Officers in cowsheds:— Premises. Date Inspected. No. of Cows. Cows suffering with Mastitis. *17 and 19, Morville 1.2.37 12 — Street 27.4.37 12 1 4.8.37 11 2 7.10.37 10 3 *Two bulk samples were taken at these premises on 15th June, 1937, for examination for tubercle and proved to be negative. Milk delivered, to Hospitals and Schools. The arrangements for taking samples at St. Andrew's Hospital, St. Clement's Hospital, and Bow Road Open-Air School, belonging to the London County Council, and at Poplar Hospital, have continued throughout the year. Samples have also been taken at Poplar Institution and Bromley House Institution (both L.C.C. Institutions). As the milk supplied to some of the L.C.C. Institutions is "Pasteurised" milk, bacteriological examinations are carried out in addition to chemical analysis. (See table, page 64.) Meat Inspection. Note.—It is not possible to afford information on the lines set out in Circular 1650 (England) as our records for 1937 do not permit of tabulation in the form required. This will, however, be available in future. In the meantime the following table is submitted to correspond with that given in the report for 1936. (1.) Retail Meat. The Meat and Food Inspectors, during the course of their inspections of retail butcher's shops, find that the general condition of meat which is exposed for sale is satisfactory. A very large proportion of the meat sold in the Borough is imported. The bulk of the remainder is slaughtered either in this Borough or in adjoining Boroughs, and a small proportion of home-killed meat is obtained from Smithfield Market. Cleanliness, storage, marking, etc., are satisfactory, as the provisions of the Public Health (Meat) Regulations and the Meat Marking Order made under the Merchandise Marks Act are rigidly enforced, copies of the latter being supplied to the retailers. Number of inspections of retail butchers shops and meat and offal stalls 3,891 Number of cases in which meat has been found unsound Nil (2.) Ante Mortem Inspection—Nil. There is no central abattoir in the Borough where a Veterinary Superintendent is employed. The slaughterhouses are visited regularly by the London County Council Veterinary Surgeon. (3.) Post-Mortem Inspection at Slaughterhouses. Class of Animal. Total Killings. Number Inspected. CONDEMNATIONS. Tuberculosis. Other Diseases. Entire Carcases. Parts of Carcases. Organs, etc. Entire Carcases. Parts of Carcases. Organs, etc. Lungs. Livers. Mesenteries. Omenta. Pancreas. Spleens. Tripes. Hearts. Kidneys. Intestines. Udders. Heads. Tongues. Lungs. Livers. Mesenteries. Omenta. Pancreas. Spleens. Tripes. Hearts. Kidneys. Intestines. Udders. Heads. Tongues. Cattle 176 176 — — 11 2 5 — 1 — — — — — — 11 11 — — 2 9 3 2 — 1 1 1 1 — — 5 4 Cows 461 461 1 10 159 25 50 14 19 7 10 1 11 2 3 65 65 3 8 17 67 5 17 4 6 4 5 9 1 19 4 4 Calves 442 442 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Sheep and Lambs 3,136 3,136 — — — — — — — — — — — — — — — 5 — 338 88 — — — 1 — 2 — — — — — Pigs 1,225 1,225 3 1 28 24 73 19 1 15 — 20 — — — 43 43 1 1 167 16 6 3 — 2 19 1 — — 3 3 67 During the year 20 samples were taken at 17 elementary schools and one dairy. All the samples were genuine. Ice Cream. During the year, 15 owners or occupiers were registered for the manufacture, storage or sale of ice cream. Of these 14 were for sale only. The number of Ice Cream vendors now on register is 212. 267 Inspections of premises were made during the year. Meat Inspection — see table facing this page. 68 Slaughterhouses. The following 4 slaughterhouses were licensed to 30th June, 1938:— 1. Bazeley Street (East 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 understanding that the Licensee was to kill small cattle only at these premises. 4. 48-50, West Ferry Road.—Mr. John William Faulconbridge (trading as J. Faulconbridge & Son.) 15 inspections of slaughterhouses were made and 16 "reminders" that periodical cleansing was due were served. The cleansings were carried out without need for further action. Slaughter of Animals Act, 1933. With regard to licensing of slaughtermen, the Public Health 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. No licences were issued or renewed during the year. Slaughter of Animals by Mohammedans. The Medical Officer of Health has been authorised 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. 19 licences were issued during the year. 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 17. 12 "reminders" that periodical cleansing was due and one intimation in respect of want of cleanliness were served. The necessary work was carried out without need for further action. 69 Bakehouses. At the end of the year there were 56 bakehouses in use, of which 17 are underground. In 46 bakehouses machinery is used. Each bakehouse in the Borough was inspected at least twice during the year, the total inspections numbering 266. 119 "reminders" that periodical cleansing was due were sent out. 8 intimations were served in respect of want of cleanliness and other defects, and the work was done without need for further action by the department. Places where Food is Sold or Prepared (other than Premises referred to elsewhere). The number of premises in the Borough where the sale or preparation, etc., of food is carried on is 1,098—Eating Houses, 178; Fruiterers, etc., 121; Fish Shops, 75; Butchers' Shops, 53; other premises (mainly "general" shops), 631. 1,691 visits were paid to these premises during the year. Want of cleanliness was found in 50 instances, and 11 other defects existed. In addition to 295 "reminders" that cleansing of fish shops was due, 32 intimations and 3 statutory notices were served. The necessary works were carried out without need for further action by the department. 70 Reports of Food Inspectors. (i) Mr. C. A. Grabham. Totals. Inspections. Intimations. Reminders. Notices served. Stat. Final. Bakehouses:— Factories 116 3 49 — — Workshops 13 — 8 — — Dom. Workshops 14 — 6 — — Slaughterhouses 19 1 12 — — Cowhouses 1 — — — — Milkshops 112 2 — — — Restaurants and Eating Houses 137 5 — — — Fried Fish Vendors and Fish Curers— Where power is used 105 5 77 — — Others 128 2 78 — — Stalls 2,177 — — — — Other places where food is sold, etc.— Where Power is used 49 — — — — Others 264 5 — — — Ice Cream Premises— Where Power is used 25 — — — — Others 70 — — — — Wharves, etc., where food is prepared or stored, etc. — Where Power is used — — — — — Others 85 — — — — Markets— Morning 178 — — — — Evening 81 — — — — Miscellaneous 106 — — — — 3,680 23 230 — — Mr. Grabham also made 12 visits under the Infant Life Protection Act (figures included in above table under "Miscellaneous"). 71 Slaughterhouses: Number of Visits 550 Number of Carcases Inspected:— Oxen 116 Bulls — Cows 254 Calves 212 Sheep 1,554 Lambs 530 Pigs 612 Organs condemned and destroyed consequent on slaughterhouse visits See table facing page 67. Heads and Tongues condemned and destroyed Number of Samples procured: (a) Under Food and Drugs (Adulteration) Act 387 (b) Under other Acts, Orders, etc. 59 (including5 for T.B. only.) (i) Number satisfactory 52 (ii) Number not satisfactory 7* *Action taken in respect of unsatisfactory samples: (a) Legal proceedings — (b) Letters sent to Vendors, Bottlers, etc. 6 (c) Reported to appropriate Government Department, or Local Authority 5 Public Health (Foreign Meat) Regulations— Certificates issued 84 Visits to Factories 168 Assistant's Time—Hours 471 72 (2) Mr. H. A. Pearce. Totals. Inspections. Intimations. Reminders. Notices served Stat. Final Bakehouses:— Factories 106 3 48 — — Workshops 10 2 6 — — Dom. Workshops 7 — 2 — — Slaughterhouses 13 — 16 — — Cowhouses 18 — — — — Milkshops 243 1 — — — Restaurants and Eating Houses 145 5 — — — Fried Fish Vendors and Fish Curers— Where Power is used 75 2 37 1 — Others 183 1 103 — — Stalls 2,597 — — — Other places where food is sold, etc.— Where Power is used 137 1 — 1 — Others 382 6 — 1 — Ice Cream Premises— Where Power is used 45 — — — — Others 127 — — — — Wharves, etc., where food is prepared or stored, etc.:— Where Power is used — — — — — Others 1 — — — — Markets— Morning 206 — — — — Evening 71 — — — — Miscellaneous 57 — — — — 4,423 21 212 3 — Mr. Pearce also made 3 visits under the Infant Life Protection Act (figures included in above table under ' 'Miscellaneous''). 73 Slaughterhouses: Number of Visits 314 Number of Carcases Inspected:— Oxen 60 Bulls — Cows 207 Calves 230 Sheep 620 Lambs 432 Pigs 613 Organs condemned and destroyed consequent on slaughterhouse visits See table facing page 67. Heads and Tongues condemned and destroyed Number of samples procured: (a) Under Food and Drugs (Adulteration) Act 382 (6) Under other Acts, Orders, etc. 108‡ (i) Number satisfactory 92 (ii) Number not satisfactory 16* (including 3 phosphatase tests.) *Action taken in respect of unsatisfactory samples: (a) Legal proceedings — (6) Letters sent to Vendors, Bottlers, etc. 12 (c) Reported to appropriate Local Authority 7 Public Health (Foreign Meat) Regulations— Certificates issued 4 Visits to Factories 9 Assistant's Time—Hours 480 ‡Including 11 for phosphatase test; 6 for T.B.; and 3 for the purposes of the Pharmacy and Poisons Act. 74 The following were condemned by Mr. C. A. Grabham and destroyed:— 314 casks Grape Fruit Juice, comprising 16 tins Sardines. 12,132 gallons. 9 tins Hors D' Oeuvres. 14 casks South African Grape Juice, 6 tins Sheep Tongues. prising 560 gallons. 24 6-lb. tins Corned Beef. 83 casks Orange Juice, comprising 5,040 17 6-lb. tins Jellied Veal. gallons. 12 6-lb. tins Turkey. 10 casks Lemon Juice, comprising 600 2 3-lb. tins Ham. gallons. 159 tins Condensed Milk, M.S. 13 casks Pineapple Juice, comprising 2 tins Condensed Milk. 1,040 gallons. 1 tin Evaporated Milk. 49 1-gal. tins Grape Fruit Juice. 1 tin Ham and Tongue Paste. 15 1-gal. tins Pineapple Juice. 1 tin Meat Paste. 545 tins Pineapple. 1 6-lb. tin Beef. 1 tin Fruit Salad. 1 jar Chicken and Ham Paste. 8 tins Golden Berries. 96 jars Meat and Fish Paste. 61 tins Loganberries. 36 Glass Barrels Meat and Fish Paste. 401 tins Peas. 1 jar Pickle. 6 tins Herrings. 1 jar Mince Meat. 160 tins Salmon. 1 bottle Anchovies. 1 tin Bloaters. 2 bottles Mustard. 2 tins Crab. 24 bottles Sauce. 5 tins Tomatoes. 324 jars Pickle. 24 tins Tomato Puree. 12 jars Lemon Curd. 7 7-lb. tins Tomato Puree. 3 jars Cod Roes. 48 tins Tongue. 2 packets Jellies. 139 tins Lobster. 504 small packets Mint Fizz. 14 tins Mixed Vegetables. 216 small packets Fizz Cola. 265 tins Sprats. 72 small packets Lemon Fizz. 19 tins Asparagus. 72 small packets Ginger Beer. 164 tins Mushrooms. 22 baskets Gorgonzola Cheese. 28 tins Prawns. 17 cases each 5 boxes Mandarine Orange 1 tin Lunch Tongues. 40 cases Oranges. 5 tins Haricots. 1 box Mixed Peel. 30 tins Oysters. 105 baskets Orange Peel, weight 5 tons. 5 tins Crayfish. 2 stone Skate. 2 tins Truffles. 3 Rabbit Livers. 2 tins Tunney Fish. 26 Chickens. 1 tin Caviare. 20 Turkeys. 7 tins Herring and Tomato Sauce. 8 bags Meat Pieces, weight 200 lbs. 293 tins Celery. 1 Pudding. 6 tins Haricot Verts. The following were condemned by Mr. H. A. Pearce and destroyed:— 4 casks Orange Juice at 80 gallons (320 gallons). 10 tins Ox Tongues. 3 tins Macedonie. 2 casks Grape Fruit Juice at 40 gallons 2 tins Champignon. (80 gallons). 1 tin Fruit Salad. 144 pint tins Pineapple Juice. 1 bag Mussels, weight 1 cwt. 56 small tins Pineapple Juice. 11 Pigs' Heads, weight 1 cwt. 10 lbs. 166 1-gallon tins Grape Fruit Juice. 75 The following unsound foodstuffs were released on condition that they were not used for human consumption:— 1 435/496 qrs. Wheat For animal food. 361 qrs. Wheat.. ,, ,, 32 131/496 qrs. Wheat ,, ,, 92 qrs. Wheat ,, ,, 3 148/480 qrs. Maize For poultry food. 7 56-lb. boxes Lard For soap manufacture. 7 56-lb. boxes Lard ,, ,, Released to other Authorities for purposes of Soap Manufacture and Grease making:— 61 casks Tallow. 45 casks Tallow. 135 drums ,, 50 casks ,, 90 casks ,, 68 casks ,, 50 casks ,, 61 casks ,, 61 casks ,, 23 casks ,, 100 casks ,, 11 casks ,, Released to another Authority for purposes of Cattle Food:— 20 tons Peanuts and Dessicated Cocoanut damaged by fire and water. Placed under stop pending receipt of Guarantee:— 50 casks Tallow. Certain other foodstuffs were damaged aboard a vessel in collision in the River Thames. Those foodstuffs condemned and destroyed are shown in the list elsewhere under the heading "Condemned and Destroyed." Small quantities of mixed foodstuffs ex the above vessel are still on hand to be dealt with. These goods are at present placed under stop. The following were released for technical and other purposes:— 17 barrels Cream of Tartar For re-manufacture. 21 kegs Tartaric Acid For re-manufacture. Released to other Authorities:— 20 cases Sardines For reconditioning. 9 cases Fruits For reconditioning. 40 drums Malt Extract To be dealt with under supervision of another Authority. 4 cartons Cereals 6 chests Confectionery 2 cartons Crispbread 28 packages Vermicelli 5 cartons Vermicelli 20 casks Butter 28 boxes Margarine 1 case Ground Almonds To be dealt with under supervision of another Authority. For soap manufacture. To be dealt with under supervision of another Authority. 6 cases 19 half-cases 2 part ½-cases 20 chests 2 tons and 5 cwts. Tea. For chemical purposes. 76 (c) Food and Drugs (Adulteration) Act, 1928. The results of the analyses of 794 samples were reported to the Public Health Committee during the year:— Sample. Number examined, 1937. Number Adulterated. Action taken. Legal Proceedings. (See page 43.) Letters of caution sent. 1. Drugs. Ammoniated Tincture of Quinine Tablets 1 1 — — Health Salts 2 — — — Lime Water 2 — — — Oil, Camphorated 6 — — — Oil, Olive 6 — — — Ointments Boracie 2 — — — Sulphur 4 — — — Zinc 4 — — — 2. Spirits. Gin 1 — — — Rum 2 — — — Whisky 3 — — — 3. Other Articles. Bacon and Ham 17 — — — Barley, Pearl 8 — — — Blanc Mange Powder 2 — — — Brawn 2 — — — Bread and Butter 9 2 — 1 Butter 38 3 — 3 Cake 6 — — — Cheese 4 — — — Cocoa 4 — — — Coffee 6 — — — Coffee and Chicory extract 2 — — — Cooking Fat 2 — — — Cordials 7 — — — Cornflour 4 — — — Cream 6 — — — Cream, Canned 2 — — — Cream Buns 2 — — — Custard Powder 2 — — — Dripping 9 — — — Fish 2 — — — ,, Canned 7 — — — ,, Smoked 6 — — — Fish Paste 4 — — — Flour 6 — — — Flour, Self-raising 2 — — — Fruits, Canned and Dried 8 — — — Frying Oil 2 — — — Jams 7 2 — 1 Carried forward 209 8 — 5 77 Sample. Number examined, 1937. Number Adulterated. Action taken. Legal Proceedings. (See page 43.) Letters of caution sent. Brought forward 209 8 — 5 Lard 4 — — — Lemon Curd 4 — — — Lemonade Powder 4 — — — Margarine 38 — — — Marmalade 2 — — — Meat, Fresh 17 — — — ,, Pies 5 — — — ,, Paste 3 — — — ,, Cooked 1 — — — Milk 362 4 1 3 ,, Condensed 18 — — — ,, Dried 2 — — — ,, Sterilised 2 — — — Mincemeat 4 — — — Mint Sauce 2 — — — Mustard 2 — — — Oatmeal 4 — — — Pea Flour 2 — — — Peas, Split 2 — — — Peel, Candied 4 — — — Pepper 6 — — — Rice 4 — — — Sago 2 — — — Salt 2 — — — ,, Table 2 — — — Sauce 2 — — — Sausages 25 1 — — Shredded Suet 4 — — — Spice, Mixed 2 — — — Sweets 6 — — — Table Jelly 8 — — — Tapioca 4 — — — Tea 6 — — — Tripe 4 — — — Vinegar 24 — — — Vinegar, Malt 2 — — — Totals, 1937 794 13* 1 8 Totals, 1936 813 34** 6 14 * Including 3 informal samples. ** Including 5 informal samples. Of the samples of milk, 121 were procured from itinerant vendors, 77 on Sundays and 44 on weekdays. All these samples were genuine. 78 Milk; and Cream, not Sold as Preserved Cream. (A) Number of Samples examined for the presence of preservative. (B) Number in which preservative was reported to be present, and percentage of preservative found in each case. Milk 362 Nil. Cream 8 Nil. Formaldehyde in Food. Certain articles of food (smoked bacon and fish) were reported by the Public Analyst to contain formaldehyde. Experiments with certain ''smoked'' products were carried out by one or two authorities and the whole facts were submitted to the Ministry of Health. A reply was received stating that the Minister was aware that formaldehyde may be present in smoked bacon and fish as a result of the smoking process, but in such cases it would not appear there was any question of an offence under the Public Health (Preservatives in Food) Regulations, 1925 to 1927, since for the purposes of those Regulations "preservative" was defined as not including any substance added to food by the process of curing known as smoking. It was primarily for the Analyst concerned to form an opinion whether in any particular case the formaldehyde had been derived from the smoking process or whether it had been otherwise added. Where, however, there was no reason to believe that formaldehyde had been added except as a result of the smoking process, it seemed to the Minister to be doubtful whether a local authority would be justified in instituting legal proceedings for alleged contravention of the provisions of the Food and Drugs (Adulteration) Act, 1928. Annual Report of the Public Analysts. During the year 1937, 794 samples were examined under the Food and Drugs (Adulteration) Act. All samples were submitted by the Inspectors. 79 No samples were submitted by the Public under the Act. 228 of the samples were purchased informally. 13 samples were found to be adulterated, 10 formal and 3 informal. The adulteration was at the rate of 1.63 per cent., as compared with 3.38 per cent, for the whole of London, and 5.3 per cent, for the whole of England and Wales in 1936. The rate of adulteration in the Borough for the past ten years was as follows:— Year. No. of Samples examined. Percentage of adulteration. 1937 794 1.6 1936 813 4.2 1935 822 4.5 1934 849 6.3 1933 799 4.5 1932 818 4.0 1931 801 7.6 1930 807 6.7 1929 801 8.7 1928 807 11.0 Average 811 5.9 The number of samples examined was at the rate of 5.67 per 1,000 of the population as compared with 9.92 per 1,000 for the whole of London and 3.6 per 1,000 for the whole of England and Wales in 1936. 362 samples of milk were examined, of which 4 samples, or 1.1 per cent., were reported as adulterated. This is the lowest milk adulteration recorded for many years. The milk adulteration in the Borough for the past ten years was as follows:— 80 Year. No. of Milks examined. Percentage of adulteration. 1937 362 1.1 1936 391 4.9 1935 383 3.7 1934 451 7.8 1933 382 3.9 1932 367 2.2 1931 392 3.3 1930 426 4.0 1929 284 4.9 1928 386 4.4 Average 382 4.0 The average milk adulteration for the whole of London was at the rate of 2.45 per cent., and for the whole of England and Wales 7.1 per cent, in 1936. Condensed Milks. 18 samples of condensed and evaporated milks were examined, all of which were satisfactory. Preservatives. Three contraventions of the Preservatives Regulations were found. 1 sample of unlabelled sausage contained sulphur dioxide. 2 Jams contained excess of sulphur dioxide. Other samples examined during the year were:— For the Public Health Department:— 11 Pasteurised Milks. 22 Rag Flocks, 5 of which were unsatisfactory. 1 Dust. 3 samples under the Poisons and Pharmacy Act. 2 Salts. 3 Electrolytic fluids. For the Engineer's Department:— 1 Motor Spirit. 1 Disinfecting fluid. 3 Pigments. ALBERT E. PARKES, H. A. PARKES, Public Analysts. 81 Butter and Margarine Acts. The following is the number of premises in the Borough registered under the above-mentioned Acts:— Margarine. Butter. Wholesale Dealer. Manufacturer. Factory. Wholesale Dealer in Milk-blended. 15 — 2 — Agricultural Produce (Grading and Marking) Act, 1928. There are no premises registered for storage of English eggs. 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. Legal proceedings were taken in one instance, see page 43. Manufacture of Preserved Foods. No applications for the manufacture of preserved food were submitted. The number of premises now on the register is 49. Food Poisoning. During the year 7 notifications were received. Investigations into the 7 notified cases resulted in them being classified as follows:— True cases 3 Personal susceptibility — Not true food poisoning or doubtful cases 4 The three true cases were as follows:— Sporadic cases 3 These cases recovered without serious illness. 82 Certification of Certain Food Products for Export to the Dominions and Foreign Countries. In view of the requirements of the Food Laws in operation in the Dominions and elsewhere, the system of certification for food products which are derived from the flesh of cattle, sheep, swine or goats, or from game or poultry, and are prepared or packed in England and Wales for export, has been continued. Certificates were issued in connection with 88 consignments of foodstuffs: Canada (9), Australia (26), United States of America and Dependencies (31), India (10), other countries (12). 177 visits were paid to factories and 20 tons 4 cwts. o qrs. 1 st. 10½ lbs. of foodstuffs were inspected and passed for export. 34 Turkeys and 100 Irish chickens were also certified for export. 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. Pharmacy and Poisons Act, 1933. This Act, which received the Royal Assent on 28th June, 1933, came into operation on various "appointed days." The portions of the Act to be enforced by Local Authorities came into operation on 1st May, 1936. The Council delegated their powers under this Act to the Public Health Committee, and during 1937 the Committee approved 47 re-entries and 2 new entries in the Council's list. One other entry was revised. TABLE VII. notifiable diseases during the year 1937. (52 Weeks.) Notifiable disease. Cases Notified in Whole Borough. Number of Cases admitted to Hospital. Total Deaths in Age-Periods. 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. 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. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 453 8 24 21 40 69 201 50 15 21 2 1 1 452 15 1 1 1 2 4 6 — — — — — — Erysipelas 87 2 — — 1 1 5 4 1 15 8 36 14 69 2 — — — — — — — — — — 1 1 Scarlet Fever 306 — 15 20 37 47 124 37 12 12 2 — — 300 2 — — — — — 2 — — — — — — Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever (including Paratyphoid) 9 — — — — 1 3 1 — 2 — 2 — 9 1 — — — — — — — — — — 1 — Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued Fever 1 — — — — — — — — — — 1 — 1 — — — — — — — — — — — — — Puerperal Fever 5 — — — — — — — — 4 1 — — 5 1 — — — — — — — — 1 — — — Puerperal Pyrexia 31 — — — — — — — 1 25 5 — — 28 — — — — — — — — — — — — — Cerebro-Spinal Fever 5 3 — 1 — 1 — — — — — — — 5 — — — — — — — — — — — — — Acute Poliomyelitis s — 2 — 2 — 1 — — — — — — 5 1 — 1 — — — — — — — — — — Acute Encephalitis Lethargica 1 — — — — — — — — 1 — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 5 5 — — — — — — — — — — — 3 — — — — — — — — — — — — — Zymotic Enteritis 76 28 11 2 1 2 6 1 3 10 2 10 — 31 31 27 — — — — — — 1 — — 1 2 Pneumonia, Acute Primary 284 40 40 25 20 13 24 8 11 27 18 41 17 129 62† 13 6 3 1 1 1 1 1 4 5 18 8 ,, Acute Influenzal 47 1 — 2 2 1 2 — — 4 6 21 8 8 11† — — — — — — — — — — 8 3 Dysentery 20 — 3 2 1 2 5 2 4 1 — — 15 1 1 — — — — — — — — — — — Malaria 3 — — — — — — —— — 1 1 1 — 1 — — — — — — — — — — — — — Totals 1338 87 95 73 104 136 372 103 47 128 45 113 40 1061 127 42 8 4 3 5 9 1 2 5 5 29 14 † Notified patients only. This table does not include cases in which the original diagnosis was not confirmed. * Notifiable 1st June to 30th September, but the number of deaths relates to the whole year. (An analysis of cases and deaths by Wards is given in a separate Table on next page.) TABLE VIIa. Notifiable diseases, cases and deaths by wards, 1937. Notifiable Disease. Cases Notified. Deaths. Whole Borough. Bow. Bromley. Poplar. Whole. Borough. Bow. Bromley. Poplar. North. West. Cent. South. NorthWest. NorthEast. SouthWest. SouthEast. Cent. NorthWest. West. East. Millwall. Cubitt Town. Worth. West. Cent. South. NorthWest. NorthEast. SouthWest. SouthEast. Cent. NorthWest. West. East. Millwall. Cubitt Town. Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 453 30 20 11 24 31 35 56 2??? 33 32 41 32 56 27 15 1 — 1 — 3 2 1 1 — 1 1 1 1 2 Erysipelas 87 1 6 6 5 8 4 5 5 12 8 9 8 6 4 2 — — — — — 1 — — — — — — Scarlet Fever 305 9 36 17 30 8 18 24 16 28 21 15 20 24 40 2 — 1 — — — — — 1 — — — — — Typhus Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Enteric Fever (including Paratyphoid) 9 — — 2 — 1 — — 1 — 2 1 — — 2 1 — — — — — — — — — — — — — 1 Relapsing Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Continued Fever 1 — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 5 — — — — — — 1 — — 2 2 — — — 1 — — — — — 1 — — — — — — — — Puerperal Pyrexia 31 3 2 4 5 2 1 2 1 3 2 1 2 2 1 — — — — — — — — — — — — — — — Cerebro-Spinal Fever 5 2 — — — — 1 — — — — — — — 1 — — — — — — — — — — — — — — — Acute Poliomyelitis 5 — — — 1 2 — 1 — — — — 1 — — 1 — — — — 1 — — — — — — — — — Acute Encephalitis Lethargica 1 — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 5 1 1 — 1 — — — — — — — 1 1 — — — — — — — — — — — — — — — *Zymotio Enteritis 76 — — 1 6 5 21 5 6 10 6 13 2 — 1 31 3 — 1 — 2 2 2 1 3 5 7 3 1 1 Pneumonia, Acute Primary 284 19 12 6 15 13 35 30 16 23 28 17 19 32 19 62† 7 — 2 3 2 8 4 8 5 9 2 3 5 4 ,, Acute Influenzal 47 1 3 5 2 6 2 4 7 5 — 2 1 5 4 11† — — 3 — 1 — 1 4 — — 1 — — 1 Dysentery 20 — 1 — 5 — — 1 1 1 2 2 6 1 — 1 — — — — 1 — — — — — — — — — Malaria 3 1 — — — 2 — — — — — — 1 — — — — — — — — — — — — — — — — — Totals 1338 67 81 52 94 76 118 129 79 115 104 104 93 127 99 127 11 1 7 3 11 13 8 16 8 15 11 7 7 9 * † See notes at foot of Table VII. 83 Section F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifications. 1,338 cases of Infectious Disease were notified during the year. In addition there were 186 other cases notified as Infectious Diseases in which the diagnosis was not confirmed. The notification rate was 9.8, compared with 9.5 in 1936. Mortality from Diphtheria, Scarlet Fever and. Enteric Fever. Diphtheria. Scarlet Fever Enteric and Paratyphoid Fevers. Cases 453 306 9 Deaths 15 2 1 Fatality Rate 3.3 0.7 11.1 Scarlet Fever. The total notifications received numbered 352 and the total removals were 346. Of these, 46 cases were later certified to be not suffering from Scarlet Fever, leaving a total of 306 cases, the attack-rate being 2.2 per 1,000 population. Two deaths occurred. Diphtheria. The total notifications received numbered 572 and the total removals to hospital were 570.119 patients were certified to be suffering from other diseases, leaving a total of 453 cases, the attack-rate being 3.3 per 1,000 population. 15 deaths occurred, giving a fatality rate of 3.3 per cent. Diphtheria Immunisation. Applicants are dealt with at the Hackney Borough Council Clinic for which the Poplar Council pay a sum of 10s. for a complete immunisation and certificate, and 2s. 6d. for a certificate of natural immunity. These charges are on the understanding that the Poplar children do not require a special clinic. 84 The number dealt with during the year was as follows:— Cases referred to Hackney during 1937 96 Certificates of immunisation received during 1937 23 Certificates of natural immunity received during 1937 5 Re-Schick only 2 Cost £12 7s. 6d. Diphtheria Anti-toxin. 200,000 units of diphtheria anti-toxin were issued to medical practitioners during the year. The main supply of anti-toxin is kept at the Public Health Office and is available for the use of medical practitioners in the Borough. By the courtesy of the Medical Superintendent of St. Andrew's Hospital, a supply is kept at that hospital for the use of medical practitioners who apply when the Public Health Office is closed. 150,000 units were issued from St. Andrew's Hospital during the year. Care is taken to see that old stock is replaced periodically. Diphtheria "Carriers." As the result of investigations carried out at schools, one case was referred to the Special "Carrier" Clinic at the London Hospital and was allowed to resume school attendance after treatment. Arrangements were made for two other cases to attend the "Carrier" Clinic, but the patients were notified and removed to hospital as suffering from Diphtheria. Enteric Fever. Eleven notifications of cases of Typhoid Fever and Paratyphoid Fever were received and the patients were removed to hospital. In 2 cases the diagnosis was not confirmed, leaving 9 cases and an attack rate of 0.07. There was one death. Bacteriological Examinations. 2,272 swabbings were examined. Of these, 307 gave positive results (13.5 per cent.). In addition, six virulence tests gave positive results and eight gave negative results. One blood specimen from a doubtful case of Typhoid Fever gave a negative result. Two specimens of faeces gave positive results and four gave negative results. 85 One sample of drinking water was examined and gave a negative result. Three swabs examined for meningococci gave negative results. Cultures from one vaginal smear showed moderate growth of staphylococci, short chain streptococci and B. coli. Scanty growth of Neiser-positive bacilli resembling K.L.B. All but one of the examinations were carried out at the Seamen's Hospital, Greenwich. Smallpox. No cases of Smallpox were notified during the year. Vaccination. The following particulars regarding vaccination have been taken from the Vaccination Officer's reports:— 86 Extract from the Report of the Vaccination Officer, respecting tho Vaccination of Children whose Births were registered from 1st January to 31st December, 1936, inclusive:— Registration Sub-Districts. Number of Births registered 1st Jan. to 31st Dec., 1930. Number of Births entered by 31st January, 1938, in "Vaccination Register." Number of Births which on 31st January, 1938, 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 1937. Number of Statutory Declarations of Conscientious Objection actually received during the calendar year 1937. Col. 1 Successfully vaccinated. Col. II Col. IV Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V Died unvacclnated. 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) (6) (6) (7) (8) (9) (10) (U) (12) (13) Bow and Bromley 1212 140 — — 784 85 — 29 31 143 ■ t 341 / 858 Poplar 442 58 — — 307 21 — 8 12 36 ^ 286 Total 1054 198 — — 1091 106 — 37 43 179 341 1144 Note.—(a) The total of the figures in Columns 3 to 11 should agree with the figure in Column 2.—The number of children successfully vaccinated after the declaration of conscientious objection had been made was—Nil. (6) The figures in Columns 2 to 11 should not include re-registered births. The total number of copies of certificates for the year 1937 sent to other Vaccination Officers was 101 m. 379. 87 Return showing the numbers of persons successfully vaccinated and re-vaccinated at the cost of the rates by the Medical Officers of Institutions and the Public Vaccinators during the year ended 30th September, 1937. POPLAR BOROUGH COUNCIL. Name of the 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 Institutions should be shown separately. Totals 213 79 292 41 Bromley Dr. C. Cotter 57 26 83 22 Poplar Dr. H. J. 0' Brien 47 28 75 14 Bow Dr. i). G. Macrae 75 10 85 4 Millwall Dr. M. Blaskcr 34 15 49 1 St. Andrew's Hospital Dr. J. R. M. Whigham — — — — Poplar Institution Dr. J. R. M. Whigham — — — St. Clement's Hospital Dr. E. T. Pinhey — — — Col. 1 2 3 4 5 6 7 M. 379a. 88 The following analysis of the Report of the Vaccination Officer reveals the fact that more than 86 per cent, of the children whose births were registered in 1936 were not protected by successful vaccination:— Births registered 1,654 Deduct:— Died unvaccinated 106 Removals to other districts 37 Removals to places unknown, etc. 43 186 Surviving residents 1,468 Successful vaccinations numbered 198 198=13.5 per cent. Insusceptible of Vaccination Had Smallpox Conscientious Objections declared .. 1,091 Vaccinations postponed on Medical Certificates .. ... .. — Number not accounted for .. .. 179 Total unvaccinated children 1,270=86.5 per cent. 1,468 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. One case was notified as Anthrax but the diagnosis was not confirmed. No cases of Glanders or Hydrophobia 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. 89 Erysipelas. 93 cases of Erysipelas were notified, and in 6 cases the diagnosis was not confirmed, leaving 87 cases. There were two deaths from this disease. Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. The Consulting Obstetrician appointed under the above Regulations, Dr. Malcolm Donaldson, was not called in to any case during the year. The following is a summary of the cases notified, etc., during year:— Puerperal Fever. Puerperal Pyrexia. Cases notified 5* 31 Removed to L .C .C. Fever Hospitals 3 8 Treated in other Hospitals 2 20 Treated at home — 3 Consultant called in — — Deaths 1** 1† * One other case which was not notified died. All the notified cases recovered. ** †See list of maternal deaths, page 128 Continued and Typhus Fevers. Two cases of continued fever were notified, but in one case the diagnosis was not confirmed. No case of typhus fever occurred. Five cases of Cerebro-Spinal Fever were notified and were treated in hospital. Four patients received serum treatment and three recovered. Deaths numbered two (one a case which was notified in 1936). Acute Poliomyelitis. Five cases were notified and removed to hospital. One patient died. A cute Polio-Encephalitis. No cases of Acute Polio-Encephalitis were notified. Acute Encephalitis Lethargica. One case was notified and was treated at home. The patient has since removed to another district. No deaths were certified as being due to Encephalitis Lethargica. 90 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. The following is a summary of the reports received regarding 21 patients:— (a) From Institutions (14). Patient. Notified. Institution. Report. Remarks. E. B. — Northern Hospital Sleep normal; severe hysteria if upset; right hand clenched and wasted. Right arm tremors. Genuine E. L. Removed against medical advice. H. B. ? 1929 Northern Hospital Sleep normal; intelligence bright; conduct and physical condition good. Genuine E.L. E. A. B. — Northern Hospital Sleep normal; intelligence good; conduct fairly good, much improved since admission ; speech indistinct; mild generalised Parkinsonism. Improving on Stramonium. Genuine P.E.L. J. T. C. — Northern Hospital Sleep normal; slow cerebration; getting very fat (19st. 21bs.); slow movements but no paralysis. Having Stramonium (dried extract.) Genuine P.E.L. H. R. C. — Northern Hospital Definite crippling — cannot walk without assistance, but can feed himself. Movements very jerky. (Chorea-form.) Genuine P.E.L. G. E. — Northern Hospital Very mild generalised Parkinsonism. Severe oculogyric crises. Genuine E.L. E. F. 1921 Rampton State Institution, Retford Sleepy during day; noisy; violent; destructive; outbursts of screaming and stertorous breathing with opisthotonos. Parkinsonism without paralysis. E.L. B. F. — Northern Hospital Sometimes sleepy during day; cannot concentrate. Under drug treatment. Post -encepha litic. 91 Patient. Notified. Institution. Report. Remarks. R.G. 1929 Claybury Mental Hospital P.E.L. dementia. Slow in movement and retarded in cerebration. Has become a certified patient. P.E. Parkinsonism; rather unco-operative and negativistic; mask-like facies. Pupils do not react to L. or A. Tongue tremulous Genuine E.L. G. J. 1933 Northern Hospital Sleepy periods during day. Unable to do useful work. Under drug treatment and massage Genuine P. E. L. R. L. — Northern Hospital Right side stiff, walks with a limp; very little use in right arm Genuine E.L. L. St. G. — Leavesden Mental Hospital Lethargic during day, insomnia at night; mental age 7 8-12 years. Parkinsonism. Transverse smile Genuine E.L. R. S. — The Manor, Epsom Mental age 8-9 years. No paralysis. Conduct improving — W. W. ~ Banstead Hospital, Sutton Sleep normal. No paresis, tremor of right arm and right leg. Stramonium treatment Genuine E.L. (b) From Sanitary Inspectors (7). Report. Patient. Apparently recovered. Much improved. Remarks. Treatment. A. B. — — Completely paralysed and gradually sinking — — T. C. — — Last attended Doctor about 3 years ago — G. H. .. — — Gone away—address not known — J. I. At work — Said to be quite well — E. M. .. — — Occasional loss of use of legs (probably due to age) Private practitioner every month. J.N. .. — — Uses crutches Private practitioner. A. S. .. — — Sleepy by day, insomnia at night. Dazed and staring expression. Private practitioner. 92 Post-Vaccinal Encephalitis, etc. No case of Post-Vaccinal infection was reported. Meales. 441 cases of Measles and German Measles were reported to the Medical Officer of Health from various sources (principally from L.C.C. schools). 100 of the cases were treated in hospitals. Four deaths were attributed to Measles. Notification 0/ Zymotic Enteritis. Although there were no deaths from Dysentery, Typhoid or Paratyphoid during 1936, four cases of Dysentery and nine cases of Typhoid including Paratyphoid were notified. It was, therefore, important that the more simple cases of Diarrhoea should be made notifiable throughout the year. The Council, therefore, agreed to determine the Order made in January, 1915, requiring the notification of Zymotic Enteritis during the four calendar months—June, July, August and September—and requested the Minister of Health to make an Order under Section 143 of the Public Health (London) Act, 1936, requiring that the notification of Infectious Disease shall apply in the Metropolitan Borough of Poplar to the disease of Zymotic Enteritis (Epidemic Diarrhoea) when occurring in children under the age of five years. (The Minister of Health has now made the Order and it came into operation on 15th March, 1938.) (A summary of the notified cases which were visited by the Health Visitors is given in the Maternity and Child Welfare Section, page 125.) Pneumonia. 284 cases of Acute Primary Pneumonia and 47 cases of Acute Influenzal Pneumonia were notified during the year, 137 of the patients being treated in hospitals. 73 notified patients died—62 Acute Primary Pneumonia and 11 Acute Influenzal Pneumonia. Malaria. Three cases of Malaria were notified during the year. One patient was treated in hospital. 93 Dysentery. 30 cases were notified and were treated in hospital. In 10 instances the diagnosis was not confirmed. There were two deaths. 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 124. Altered Diagnosis Cases. 186 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:— 46 Scarlet Fever; 119 Diphtheria; 2 Enteric Fever and Paratyphoid Fever; 10 Dysentery; 6 Erysipelas; 1 Anthrax; 1 Continued Fever; and 1 Zymotic Enteritis. The final diagnosis in the 46 Scarlet Fever cases was:— Erythema 5 Measles 2 Rubella 10 Tonsillitis 12 Tonsillitis and Measles 1 Acute Coryza 1 Acute Bronchitis 1 Whooping Cough .. 2 Influenza 1 Sudaminal Rash 1 Urticaria 1 Chickenpox 1 Scabies 1 Disease not specified 7* 46 * These were reported "Not notifiable," "Negative case," etc. 94 The final diagnosis in the 119 Diphtheria cases was:— Tonsillitis 73 Tonsillitis with Measles 1 Tonsillitis and Laryngitis 1 Laryngitis 8 Catarrhal Sore Throat 1 Pharyngitis 1 Scarlet Fever 2 Scarlet Fever and Scabies 1 Enteritis and Otitis Media 1 Mumps 1 Otitis Media 2 Otitis Media with Eczema 1 Rhinitis 7 Rhinorrhoea 1 Acute Coryza 2 Acute Bronchitis 1 Pyrexia 1 Cervical Adenitis 1 Disease not specified *13 119 * These were reported "Negative case," "Not notifiable," etc. In addition, there were 23 cases reported as Bacteriological Diphtheria. These have been included as cases of Diphtheria. Cancer. The number of deaths from Cancer for the last ten years is shown below:— Year. Males. Females. Total. 1928 115 89 204 1929 114 96 210 1930 136 75 211 1931 121 100 221 1932 130 75 205 1933 116 89 205 1934 123 126 249 1935 129 92 221 1936 118 94 212 1937 134 107 241 95 Tuberculosis Officer's Report. Tuberculosis. The London County Council continued from 1st April, 1937, the arrangements whereby Tuberculosis Officers of the Metropolitan Boroughs are deemed to be honorary consultants for tuberculosis in the general hospitals under the London County Council's control. The Council's Tuberculosis Dispensary is at No. 1, Wellington Road, Bow, E.3, and the following table shows the accommodation, hours of sessions, etc.:— Accommodation. Day and time of session. Type of session. Two Tuberculosis Officers' Rooms, Dispensary, X-Ray Room, Waiting Room, Dressing Room, 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 Thursday Friday 11a.m. and 2p.m. Any person not at work or not attending School. X-Ray Apparatus, Tuberculosis Dispensary. During the year the London County Council informed the Borough Council they had decided to raise no objection to Borough Councils installing X-Ray apparatus in Tuberculosis Dispensaries subject to certain conditions. The existing X-Ray plant at the Dispensary was unsatisfactory (this was referred to in the Ministry of Health's letter of July, 1931, following upon the survey of the health services under the Local Government Act), and the present X-Ray room was not of a size capable of taking a modern X-Ray photography plant. By arrangement with the London County Council, X-Ray photographs of the chest of each patient were taken at St. Andrew's Hospital and a report sent to the Tuberculosis Officer. While continuing this arrangement (which had worked very 96 satisfactorily), the Public Health Committee agreed that provision should be made in the Annual Estimates for 1938-39 for the provision and installation of an X-Ray screening plant. Early in 1938 a letter was received from the London County Council approving the proposal to renew the X-Ray screening apparatus at the Dispensary by the purchase and installation of the Watson "Telestat" unit. Statistics for 1937. The three following tables comprise the annual return for 1937 required by the Ministry of Health. The first provides a concise summary of the 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, whether lost sight of, recovered or dead. 97 Return for the year 1937. 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):— 633 (a) Definitely Tuberculous 70 57 2 2 3 8 4 5 73 05 6 7 151 (b) Diagnosis not completed — — — — — — — — 6 8 — 1 15 (c) Non-Tuberculous — — — — — — — — 129 102 91 85 407 B.—Contacts examined during the year:— 280 (a) Definitely Tuberculous 2 2 — 1 — — — — 2 2 — 1 5 (b) Diagnosis not completed — — — — — — — — 1 (c) Non-Tuberculous — — — — — — — — 78 91 48 57 274 C.—Cases written off the Dispensary Register as:— 821 (a) Recovered 9 15 2 5 3 3 5 3 12 18 7 8 45 (b) Non-Tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as Tuberculous) — — — — — — — — 210 201 149 150 770 D.—Number of Cases on Dispensary Register on 716 (a) Definitely Tuberculous 201 225 14 29 30 43 47 45 297 208 01 74 700 (b) Diagnosis not completed — — — — — — — — 7 8 — 1 16 1. Number of cases on Dispensary Register on January 1st, 1937 770 2. Number of cases transferred from other areas, and cases returned after discharge under Head 3 in previous years 28 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 80 94 6. Number of attendances at the Dispensary (including Contacts) 5,321 6. Number of Insured Persons under Domiciliary Treatment on December 31st 249 Number of consultations with Medical Practitioners:- 8. Number of visits by Tuberculosis Officers to homes (including personal 010 (a) Personal 23 (b) Other 270 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 7,128 10. Number of:— P.H. 312 (a) Specimens of Sputum, etc., examined Dispensary 616 (b) X-RAY examinations made in connection with Dispensary work /Screenings at Dispensary 4 Films at st. Andrews Hosp. 357 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 3 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 402 98 Comments on Table I. Items A and B.—The total new cases and contacts examined during the year show a decrease of 147 as compared with 1936. The 633 new cases of Item A is a composite figure made up as follows: 385 cases (excluding contacts) attending for the first time during 1937, and 248 cases examined during preceding years (including contacts examined during preceding years) and discharged as non-tuberculous, who presented themselves for re-examination during 1937. These are grouped together under Item A according to instructions in the Ministry of Health's Memorandum 37/T. Revised. Of these 633 new cases, 151 were found to be suffering from Tuberculosis. 280 new contacts (Item B) were examined during the year, and of these five were found to be suffering from Tuberculosis. Item 5.—The number of attendances during the year shows a decrease of 1,443. Item 8.—Tuberculosis Officers, visits during the year decreased by 37. Item 9.—In addition to the 7,128 visits paid by the Health Visitors for dispensary purposes, 232 "non-dispensary" visits were paid under the Public Health (Tuberculosis) Regulations, 1930. Item 10.—Included in the 616 specimens of sputum, etc., examined at the Dispensary were four specimens of urine examined for the presence of tubercle bacilli. Comments on Tables II and III. These returns continue to remain optional. During the year 45 cases were removed from the Dispensary Register as ' 'Recovered'' (there were 69 in 1936), and are analysed in Item C on Table I. These have been added to those similarly removed in former years in the appropriate columns of Tables II and III. 2. PULMONARY TUBERCULOSIS. Showing in summary form {a) the condition at the end of 1937 of all Patients remaining on the Dispensary Register; and (6) the reasons for the removal of all cases written off the Register. The table is arranged according to the years in which the patients were first entered on 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 1937. Previous to 1927. 1927. 1928. 1929. 1930. 1931. 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. + ). Class T.B.—. Group I. Group II. Group III. Total (T.B. + ). Group I. Group II. Group III. Total (T.B.+). Class T.B.—. Group I. Group II. Group III. Total (T.B. + ). Group I. Group II. Group 111. Total (T.B. + ). Group I. Group II. Group III. Total (T.B.+). (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M. — 2 5 — 7 1 2 — 3 — — — — — — 1 2 — 3 2 2 1 — 3 2 2 3 — 5 F, — 1 6 — 7 2 — — — — 1 — 1 — I — 1 1 — 2 — — I — 1 1 1 — 1 2 Children 1 — — — — — — — — — — 1 — — 1 1 — — — 3 1 — — — — 2 — — — — Disease not Arrested Adults M. 2 5 1 8 — — — — — — 1 3 — 4 — — 3 — — 4 4 —_ 8 — 3 — — 3 F. 2 — 4 — 4 — — — — — 1 2 — 3 — 1 2 — 3 — 2 1 I 4 — 1 3 — 4 Children 1 — — — — — — 1 1 — — — — — 1 — 1 — 1 — — — — Condition not ascertained during the year 1 1 1 — 2 — — — — — — — 1 — 1 — — — — 2 — — — — — — — — — Total on Dispensary Register at Dec. 31st 5 6 21 1 28 2 1 3 — 4 1 3 7 — 10 1 3 8 — 11 6 8 8 1 17 5 7 6 1 14 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 44 24 40 — 64 2 1 2 — 3 5 5 1 — 6 1 I — 1 4 1 2 _ 3 3 3 3 F. 75 25 28 — 53 - 4 2 3 — 5 — 4 3 — 7 4 6 — — 6 3 3 1 — 4 3 1 2 — 3 Children 87 8 12 — 20 9 — 1 — 1 3 — — — 2 2 — — 2 5 — — — — 4 1 — — 1 Lost sight of or otherwise removed from Dispensary Register 59 42 100 5 147 22 15 11 — 26 22 10 6 14 — 20 6 12 22 2 36 21 15 20 3 38 13 12 12 3 27 Dead Adults M. 16 25 100 23 148 5 9 19 5 33 10 25 5 40 4 14 24 9 47 5 8 37 14 59 4 13 28 13 54 F. 7 22 69 11 102 3 6 29 6 41 2 27 3 32 7 12 28 6 46 4 6 25 7 38 1 5 14 16 35 Children 1 — 6 1 7 1 ~~ 1 2 4 2 1 ~ 1 ~ 1 1 2 2 — 4 1 1 1 3 Total written off Dispensary Register 289 146 355 40 541 46 33 66 12 111 46 27 72 8 107 25 47 75 17 139 43 35 87 24 146 28 36 57 33 126 Grand Totals 294 152 376 41 569 48 34 69 12 115 47 30 79 8 117 26 50 83 17 150 49 43 95 25 163 33 43 63 34 140 1932. 1933. 1934. 1935. 1936. 1937. (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M. 3 6 1 — 7 2 1 6 2 — 8 5 5 2 — 7 1 — — — F. 2 — 3 — 3 4 4 2 — 6 4 2 2 — 4 2 — — — — — — — — — — — — — — Children 1 — — — — 3 ~ ~ 6 1 —* — — — — — — — — — — — — Disease not Arrested Adults M 1 6 7 — 13 11 2 13 5 9 — 14 4 8 13 21 8 10 25 35 15 7 33 40 F. 2 8 5 13 2 5 6 — 11 3 10 2 — 12 4 8 14 1 23 7 7 19 2 28 15 9 28 1 38 Children — — — — — — 2 1 3 — 3 1 4 1 — — — — 5 1 3 — 4 3 1 1 — 2 Condition not ascertained during the year — — 2 — 2 — 1 1 — 2 2 — — — — 2 — 1 — 1 — 1 2 — 3 — | — — — — Total on Dispensary Register at Dec. 31st 9 20 18 — 38 11 29 14 — 43 20 26 16 — 42 14 16 28 1 45 20 19 49 2 70 33 17 62 1 80 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — 1 — — 1 — — — — — — — — — — — — — — — — — — — — — — — — F. 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — — —_ — — — — — — — Lost sight of or otherwise removed from Dispensary Register 9 17 10 — 27 12 1 5 11 1 27 20 11 15 — 26 15 (! 12 — 21 29 10 4 9 — 13 3 3 4 1 8 Dead Adults M. — 14 14 9 37 4 17 24 16 57 5 8 16 9 33 2 2 21 6 4 3 16 7 26 1 6 6 13 F. 3 4 20 16 40 2 13 22 11 46 3 4 20 3 27 2 3 7 6 16 1 1 3 1 5 — — 2 2 4 Children 1 — 1 — 1 — 1 2 1 4 1 — 1 — 1 — — — — — 2 — — — — — — — — — Total written off Dispensary Register 14 36 45 25 106 18 46 59 29 134 29 23 52 12 87 19 14 40 12 66 17 8 28 8 44 3 4 12 9 25 Grand Totals 23 56 63 25 144 29 75 73 29 177 49 49 68 12 123 33 30 68 13 111 37 27 77 10 114 36 21 74 10 105 3. NON-PULMONARY TUBERCULOSIS. Showing in summary form (a) the condition at the end of 1937 of all patients remaining on the Dispensary Register; and (ft) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year 1937. Previous to 1927. 1927. 1928. 1929. 1930. 1931. 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. Bones & Joints. Abdominal. Other Organs. Periph' a Glands. Total. (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M. — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — 1 1 2 F. 1 — — — 1 1 — — — 1 — — — — — — — — — — — — — — — 2 — — 1 3 Children 3 — — 1 4 — — — — — — — — 1 1 2 — — — 2 4 — 1 — 5 3 — — — 3 Disease not Arrested Adults M. — — 1 — 1 1 — — — 1 — — — — — — — — — — — — 1 — 1 1 — 1 — 2 F. 1 — 2 1 4 — — — — — — — — — — — — — 1 1 — — 1 — 1 1 — 2 — 3 Children — — — — — 1 — — — 1 — — — — — 2 — — — 2 1 — — 2 3 2 — — 1 3_. Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register, December 31st 5 — 3 2 10 3 — — — 3 — — — 1 1 4 — — i 5 5 — 4 2 11 9 — 4 3 16 Transferred to Pulmonary — — — 1 1 — — — 2 2 — — — — — — — 1 1 2 — — — — — 2 — — — 2 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 7 4 4 6 21 2 — — — 2 — — — 2 2 5 1 1 — 7 1 1 1 1 4 3 — 1 — 4 F 7 — 6 10 23 — — 1 1 2 2 — — — 2 1 — — 3 4 2 — 2 — 4 1 2 1 1 5 Children 21 10 13 68 112 6 2 — 9 17 4 3 — 3 10 5 2 2 5 14 4 5 1 7 17 3 1 1 6 11 Lost sight of or otherwise removed from Dispense Register iry 13 2 11 25 51 5 1 — 6 12 6 3 2 7 18 6 1 2 3 12 9 1 3 4 17 9 1 2 4 16. Dead Adults M. 6 — — — 6 — — — — — — — 1 — 1 1 — — — 1 — — — 2 — — — 2 F. 1 — — — 1 — — — — — 1 — — — 1 1 — — — 1 — — — — — 1 1 — — 2 Children 3 — — 1 4 1 — — — 1 — — — 1 1 1 — — — 1 — — — — — 1 — — — 1 Total written off Dispensary Register 58 16 34 110 218 14 3 1 16 34 13 6 3 13 35 20 4 5 11 40 16 7 7 12 42 20 5 5 11 41 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary) 63 16 37 112 228 17 3 1 16 37 13 6 3 14 36 24 4 5 12 45 21 7 11 14 53 29 5 9 14 57 1932. 1933. 1 1934. 1935. 1936. 1937. (a) Remaining on Dispensary Register on December 31st. Disease Arrested Adults M 1 — 1 — 2 1 — 1 — 2 — — 1 2 — — — — 1 1 — — — — — — — — — — F. — — — — — — 2 1 — 3 1 1 1 1 4 — — — — — — — — — — — — — — — Children —' — — 2 2 1 2 — 6 9 1 — 1 8 11 1 — — 1 2 — — — — — — — — — — Disease not Arrested Adults M. 1 — 2 — 3 1 — 1 — 2 1 — 1 — 2 — — 1 1 2 4 — 2 — 6 2 — — 1 3 F. 1 — — — 1 — — — — —- — 1 2 3 — 1 — — 1 2 — 1 5 8 2 — 2 3 7 Children 2 — 1 — 3 1 — — 2 3 I — — 3 4 4 2 — 5 11 5 1 2 7 15 4 — — 3 7 Condition not ascertained during the year.. 1 — — 1 2 — — — — — — — — — — — — — 1 1 1 — 1 — 2 — — — — — Total on Dispensary Register, December 31st 6 — 4 3 13 4 4 3 8 19 4 2 5 16 27 — 5 3 1 9 18 12 1 6 12 31 8 — 2 7 17 Transferred to Pulmonary — — — 1 1 — — — 1 1 — — — — — — — — — 1 — — — 1 — — — — — (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. 1 — — — 1 — — — 1 1 — — — — — — — — — — — — — — — — — — — — Children — 2 1 5 8 1 ~~ — 1 2 — — — — — — — — — — — — — — — — — — — — Lost sight of or otherwise removed from Dispensary Register 4 — — — 4 8 2 1 13 — 3 9 2 — 2 6 10 5 1 — 2 8 2 — 2 1 5 — — — 1 1 Dead Adults M. 1 — — 1 1 — 1 2 — — l — 1 — — — 1 1 — — 1 — 1 — — — — .— F. — — — — — — — — — — — — — — 1 — — — 1 — — — — — — — 1 — 1 Children — — — — — — — — — — — — — — — — — — — — — — — 1 1 — — 1 — 1 Total written off Dispensary Register 6 2 1 5 9 18 4 i 3 6 14 2 — 3 6 11 6 1 — 3 10 2 — 3 2 7 — — 2 1 3 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary) 12 2 12 31 8 5 6 14 33 6 2 8 22 38 11 4 1 12 28 14 1 9 14 38 8 — 4 8 20 99 Additional Statistics. Patients sent away for institutional treatment 194 Patients in receipt of extra nourishment from Dispensary during the year 95 Patients in receipt of extra nourishment from Dispensary on December 31st 44 Reports on child contacts to Divisional School Medical Officer 59 Letters to General Practitioners concerning patients 400 Reports to General Practitioners on official forms 121 Progress reports received from General Practitioners 17 Clinical reports to London County Council 415 Reports to Ministry of Pensions 1 Shelters on loan during year 2 Shelters on loan on December 31st 2 Beds and bedding on loan during year Cases 15 Beds and bedding on loan on December 31st 11 During the year 24 new cases and 30 old cases have attended Colindale, Grove Park, Victoria Park, Brompton and St. Andrew's Hospitals for 476 refills. As was anticipated, this number shows an increase over the number for 1936 (438). 2 new cases and 3 old cases of Lupus have attended the London Hospital during the year for 87 applications of Finsen Light and 557 applications of general light. Patients receiving artificial pneumothorax treatment and patients reeding Finsen or general light treatment are treated on the recommendation of the Tuberculosis Officer, the cost of treatment being charged to the Borough Council. During the year one tuberculous child was recommended for admission to Open Air School, and two children were boarded out under the London County Council Contact Scheme. 25 Contacts were examined during the year at the Dispensary by the Prophit Scholar for the Royal College of Physicians, working under the supervision of the Tuberculosis Officer. Dental Treatment. Tuberculous patients requiring dental treatment are referred to St. Andrew's Hospital under an agreement with the London County Council. During the year 11 patients were seen by the Dental Officer who reports as follows on the work done:— 100 Patients 11 Attendances 21 Extractions 43 Four patients were given general anaesthetics, and four patients local anaesthetics. Report of the Secretary to the Tuberculosis Care Committee. The Poplar Tuberculosis Care Committee continues to meet monthly at the Dispensary to deal with matters affecting the welfare of persons suffering from tuberculosis. The home conditions and financial circumstances of every new case of tuberculosis are reported to the Committee— provided that the patient or person responsible has first given his or her consent—and the Committee endeavours to arrange for the provision of any assistance that may be required. Old cases in which some special need arises are also referred to the Committee as they occur. Eleven meetings of the Tuberculosis Care Committee were held during 1937 and 186 individual cases were considered, about one-third of these being in need of some kind of practical help. This was obtained, when possible, through other agencies, i.e., the London County Council, the Public Assistance Committee, the Unemployment Assistance Board, etc., and the various societies represented on the Care Committee have co-operated very helpfully, but in the majority of cases the necessary assistance has been given by the Care Committee's voluntary fund, the Poplar Tuberculosis Fund. The Committee of the Poplar Tuberculosis Fund has met 11 times during the year and has dealt with 150 applications for help. Clothing and boots have been provided in 80 cases, fares paid for relatives to visit patients away in sanatorium on 32 occasions, and 20 destitute persons undergoing institutional treatment have been given small pocket money allowances. Other assistance given by the Fund has included the provision of convalescence, dentures and surgical appliances, the payment of removal expenses when improved housing accommodation has been obtained, the provision of wireless for bed-ridden patients, etc. The income of the Poplar Tuberculosis Fund is raised by voluntary effort. We have been fortunate in continuing to receive contributions in 101 respect of Sunday opening of two Cinemas—the Poplar Pavilion and the Poplar Hippodrome—but the present maximum contribution of £2 per Sunday which the Fund is permitted by the London County Council to receive from this source, is in danger of being reduced. With this possibility in mind, the Committee of the Fund has made every effort to maintain a good bank balance and very acceptable help has been given by others who have shown a friendly interest in the work. A collection was held at the Clapton Stadium, by kind permission of the proprietors, in March, and the same month the 23rd, North Poplar Rover Scouts kindly handed over the proceeds of a Concert. The Annual Christmas Sale was held at the Dispensary in December. In July 1937 the Poplar Tuberculosis Care Committee became an affiliated society to the National Association for the Prevention of Tuberculosis, and, as such, was entitled to take part in the Annual Christmas Seal Sale organised by that body. The net proceeds of the Christmas Seal Sale in Poplar, amounting to £37 13s- 3d., were paid to the Fund. Other contributions came from the Poplar Benevolent Society, the Alexandra Rose Day Committee, the National Deposit Friendly Society, the Prudential Societies, as well as several private subscribers. A surprisingly large sum (£27) was raised during the year by the collection of "Daily Mirror" Tokens, value onetenth of a penny each. The Annual Report and Balance Sheet of the Poplar Tuberculosis Fund are published at the end of the financial year. The Handicraft Class, an occupational centre for patients unable to do ordinary work, continues to meet weekly at the Dispensary under a teacher provided by the London County Council. There were 14 names on the register at the end of 1937 and there has been a good average attendance throughout the year. Goods made in the class were disposed of at the ex-Servicemen's Armistice Exhibition at the Imperial Institute in November and also at the Christmas Sale at the Dispensary. The Poplar Tuberculosis Care Committee is represented on the Standing Conference of Metropolitan Borough Tuberculosis Care Committees. Two meetings of the Conference were attended during the year and a visit was paid to Burrow Hill Sanatorium, Frimley, during the summer, under the auspices of the Conference. 102 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Part i.—Summary of Notifications during the period from the 1st January, 1937, to the 3l9t December, 1937, in the area of the Metropolitan Borough of Poplar (to which this Return relates). Age Periods Formal Notifications. Number of Primary Notifications of New Cases of Tuberculosis. Total Notifications. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages). Pulmonary—Males — — 2 — 13 11 20 13 — — — — — Females — — 1 2 11 22 12 4 7 4 5 68 103 Non-Pulmonary—Males — 4 1 2 1 1 1 1 — — — — — ,, Females — 2 2 1 1 5 3 2 — — — 16 21 Col. (1) (2) (3) (4) (5) (6) (7) (S) (9) (10) (11) (12) (13) (14) The source or sources from which information as to the above-mentioned cases was obtained should be stated below:— Source of Information. Number of Cases. Pulmonary. NonPulmonary. Death Returns from Local Registrars 3 1 transferable deaths from Registrar-General 3 2 Pasthumous notifications 1 2 "Transfers" from other areas (other than transferable deaths) 13 4 Other Sources, if any (specify) Forms 1 & 2 3 — Part III.—NOTIFICATION REGISTER Number of cases of Tuberculosis remaining at the 31st December, 1937, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough Pulmonary. Non-Pulmonary. Total Cases. Males. Females Total. Males. Females Total. 356 290 646 116 125 241 887 Number of cases removed from the Register(s) during the year by reason of:— 1. Withdrawal of notification — — — — — — — 2. Recovery from the disease 12 21 33 12 9 21 54 3. Death (all causes) 72 45 117 10 4 14 131 4. Otherwise 50 34 84 13 9 22 106 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 — — 5 3 1 1 3 1 15 „ Females — — — 1 1 — 4 1 1 — — 8 Non-Pulmonary—Males — 2, 1 — — — 1 1 — — 5 ,, Females — — 1 1 — 1 — — — 1 — 4 103 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 941 940 918 920 Number of New Cases notified 56 60 35 36 Number of Cases restored to Register, etc. 17 10 11 12 Number of Cases removed from Register 74 92 44 81 Number of Cases on Register at end of quarter. ' Pulmonary 674 655 663 646 Non-Pulmonary 266 263 257 241 Totals 940 918 920 837 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 — — — 6 2 — 1 4 — 5 — 3 1 2 3 — — 1 — 10— — 3 2 2 — — 15— 13 12 1 1 1 20— 16 22 1 6 } U 12 1 — 25— 23 16 1 3 15 15 1 — 35— 14 5 j 2 2 7 6 2 — 45— 20 8 1 15 6 v — 65— 19 4 1 9 5 — 1 65 and upwards 5 5 — — 5 1 — — Totals 113 76 16 20 62 46 9 2 The ratio of non-notified Tuberculosis deaths to total Tuberculosis deaths was 8.3%. Death rates per 1,000 population:— Tuberculosis of respiratory system 0.79 Other forms of Tuberculosis 0.08 All forms 0.87 104 Proposed Disinfecting Station. During the early part of the year the Council considered a report of the General Purposes Committee regarding the development of land owned by the Borough Council in the Bromley area in the vicinity of the Electricity Generating Station and present Disinfecting Station. This report, which was subsequently adopted by the Council, provided for the new Disinfecting Station to be erected on a site in the Dust Destructor Yard, near to the present building. The re-allocation of sites included the transfer of the present Electrolytic Manufacturing Depot in Violet Road to the new Disinfecting Station site. The proposals of the Council were submitted to the Ministry of Health and approved. Steps were taken for the drawings to be revised preparatory to being sent to the Quantity Surveyors. The scheme, however, has met with a further setback, as in January, 1938, the Council considered a letter from the Electricity Commissioners asking for the site, where it was proposed to build the Disinfecting Station, te be reserved for use in connection with the Electricity undertaking. Disinfecting Department. Totals. Rooms Disinfected 1,543 Premises visited re Disinfection 1,733 Articles Disinfected. Smallpox. Other Infectious Diseases. Tuberculosis. Scabies and Verminous. Miscellaneous. Totals (a) From Infected Premises — 10,213 425 1649* 592 12,879 (6) From Cleansing Station — —- — 60,009† — 60,009 (c) From Contacts — 29 — — — 29 Totals — 10,242 425 61,658 592 72,917 * Scabies only. t Verminous and Scabies. Articles destroyed, by request, 174. Vermicide—Quantity issued from Depots, nil. 105 Cleansing Station. M. F. Totals. Verminous persons cleansed 26 3 29 ,, children ,, 319 1,17a 1,491 Scabies cases, cleansed, adults 48 73 121 ,, ,, children 1,253 1,376 2,629 Total cleansings 1,646 2,624 4,270 All verminous children are treated with special comb. Motor Vehicles. Vehicle. Speedometer register (miles). Petrol consumption (gallons). Average m.p.g. Blue Van 4,867 307 15.8 Brown Van 5,064 342 14.8 Lorry 5,421 330 1/2 16.4 Medical Officer of Health's Car 7,523 536 14.0 Special Vehicle for Contacts 6,199 557 11.1 Hired Car 130 9 14.4 Electrolytic Disinfecting Fluid. The electrolytic disinfecting fluid as manufactured contains approximately 9-10 grammes per litre of free chlorine and is broken down to a strength of approximately 4 grammes per litre for distribution. During the year 1937, 57,904 gallons were manufactured and broken down to 116,460 gallons of weaker solution for distribution. The production of the solution at a strength of 4 grammes of available chlorine per litre has averaged 126,677 gallons per annum for three years at an average annual cost of £2,054, the cost per gallon thus being nearly 4d. 106 Quantity Produced. As Manufactured. Gallons. As Issued. (i.e.. Weaker Solution.) Gallons. Electricity Consumed. Units. No. 1 Apparatus 24,870 49,980 9,982 No. 2 Apparatus 25,174 50,580 9,845 No. 3 Apparatus* 7,800 15,900 4,062 Totals 57,904 116,460 23,889 * From 19th June No. 3 was closed down and dismantled, the four electrolysers being added to Nos. 1 and 2. 975 gallons were supplied to London County Council Elementary Schools for spraying and cleansing floors of classrooms. Cleansing of Verminous School Children. The arrangements for cleansing of verminous school children were continued throughout the year. Quarter. Number of Children Cleansed. Total number of Cleansings. Amount payable by L.C.C. to the Borough Council. 1937 £ s. d. March 390 1,267 76 11 0 June 484 1,039 73 5 0 September 498 808 64 8 0 December 469 1,255 80 13 0 Totals 1,841 4,369 £294 17 0 Miss Landray made 15 visits in connection with verminous schoolchildren and 290 visits in connection with children suffering from Scabies. Arrangements were made for the children to be bathed, and for bedding and clothing to be disinfested. Cleansing of Persons. During the year, 150 persons—including 25 from common and seamen's lodging houses (see next page)—applied for baths and for their clothes to be disinfested. 107 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. 65, Bow Lane 378, Old Ford Road — — — 38, Pennyfields — — — Salvation Army Home, Bow Road — — — East London Hostel, Garford Street 24 — 24 411, East India Dock Road — — — 24 — 24 From Common Lodging Houses without the Borough of Poplar (by agreement with L.C.C. at a charge of is. per person cleansed) 1 — 1 Totals 25 — 25 For cleansing of verminous rooms see page 57. Public Health Education. Report by Mr. T. Wigley. Some years ago, Mr. Neville Chamberlain wrote a foreword to a book which had for its title "The Health of the Nation." In it he calls attention to the surprise with which the utilitarian and the individualist of a century ago would have discovered that our modern understanding of public health organisation contains provisions for dealing with maternity and infant welfare, with the child before and during its school life, with 108 health insurance, and with the education in hygiene of the people as a whole. He stresses the fact that "the greatest need of to-day is the further education of our people, so that they may be able to take full advantage of the opportunities offered to them. Above all there must be the cultivation of the public health conscience in the minds of the people themselves." Without such cultivation the work of the most vigilant central or local authority will be largely ineffective, and the newer knowledge of conditions which make for health and disease remain unknown and unavailable to those who can most profit by it. Perhaps the most interesting feature of present-day medical opinion is the recognition of the important part played by general causes of disease. Attention is being given more and more to nutritional and environmental factors, which not only play an important part in the maintenance of the healthy life, but also are within individual and social control. We cannot afford to neglect the soil which favours the growth of disease and disorder, mental as well as physical. Education may therefore be regarded as the cultivation of the soil and the provision of the good seed of knowledge, and in its work of public health education your Health Committee has kept both needs clearly before it. A glance through the syllabus of lectures offered free to all organisations in the Borough will show the all-round view which is taken of health and disease. We rccognise that we cannot separate the healthy body from the healthy mind, nor either of them from its social setting, in the case of any man, woman or child. Nothing is more gratifying than the almost pathetic eagerness with which our audiences welcome what is provided, and in the discussion and questions which follow each lecture individual difficulties can be cleared up; appreciation is again and again expressed of help received, and the fact that so many organisations make a monthly lecture on health matters a feature of their regular programmes shows that such appreciation is more than a matter of common courtesy. In the last few months, for example; out of a large women's meeting a group of young mothers asked whether they could not have a series of lectures on "The Child," since this was naturally a subject in which they were deeply interested. This was arranged, and thus the work of cultivation goes on in centres for the unemployed, in meetings of boy scouts, in political, social and religious gatherings. More and more ground is being won from the desert of unhappiness and inefficiency which ill-health creates; the area of the cultivated is growing. 109 summary. Number of Centres at which lectures were given 19 Number of lectures given (January-December, 1937) 171 To men and boys 45 (Attendances 1,327) To women and girls 116 ( 7,997) To mixed audiences 10 ( 300) 171 (Total attendances 9,624) expenditure year ending 3ist march, 1938. £ s. d. Grant to Central Council for Health Education 5 0 0 Printing, Stationery and Postage 0 15 0 Fees to Lecturers 403 4 0 Total £408 19 0 In addition to the grant to the Central Council for Health Education, the following grant was made:— To the Industrial Health Education Society, £2 2s. Two public meetings (with film displays), arranged by the British Social Hygiene Council, were held at Poplar Town Hall and Bow Baths respectively. ' 'National Health Campaign.'' The Public Health and Maternity and Child Welfare Committee agreed to co-operate with the Central Council for Health Education in the display and distribution of literature. Further, arrangements were made for certain of the Maternity and Child Welfare Clinics and the Tuberculosis Dispensary to be open on certain days to afford the general public an opportunity of seeing the work carried out. 110 Section G. MATERNITY AND CHILD WELFARE. The Maternity and Child Welfare work is divided between the Borough Council and the Royal College of St. Katharine, the Borough Council taking approximately 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. Extension of Maternity and Child Welfare Services. The following extensions which were approved when Circular 1550 was considered in September, 1936, were carried into effect during the year:— (a) An additional Health Visitor for work on the Isle of Dogs commenced duty on 1st June. Her district is south of a line drawn from Devonshire Terrace on the west to Billson Street on the east of the Isle of Dogs. (b) An additional Infant Welfare session was commenced at Simpsons Road Clinic, on Tuesday afternoons, on 7th September. (c) An additional Infant Welfare session was commenced at West Ferrv Road, on Friday mornings, on 23rd July. The continued increase of the work has also necessitated the following additional facilities:— (1) Old Ford Clinic.—An additional session was established as from 7th December. The sessions at this Clinic have been re-arranged as follows:— Infant Consultations: Tuesday afternoons and Friday mornings and afternoons. Ante-Natal: Tuesday mornings (except first Tuesday in each month). Post-Natal: First Tuesday morning in each month. (2) West Ferry Road.—Provision has been made for an additional weekly session from April 1938. MATERNITY AND CHILD WELFARE CLINICS ON DECEMBER 31st, 1937. 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: Tuesdays, 2 to 4 p.m.; 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. (except first and third in each month), and 2 to 4 p. m. Post-Natal: First and third Mondays in each month, 10.30 a.m. to 12.30 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. Sewing Class and Cookery Class: Thursdays, 2 to 4 p. m. Methodist Mission, Old Ford Road Medical Officer's Room and Weighing and Waiting Room combined Infant Consultations: Tuesdays, 2 to 4 p.m.; Fridays, 10.30 a.m. to 12.30 p.m. and 2 to 4 p.m. Ante-Natal: Tuesdays, 10.30 a.m. to 12.30 p.m. (except first Tuesday in the month). Post-Natal: First Tuesday in month, 10.30 a.m. to 12.30 p.m. 54, West Ferry Road Ditto Ditto Ditto Infant Consultations: Fridays, 10.30 a.m. to 12.30 p.m. and 2 to 4 p.m. Ante-Natal: Thursdays, 2 to 4 p.m. Methodist Chapel, Manchester Road .. Medical Officer's, Weighing and Waiting Rooms Infant Consultations: Wednesdays, 10.30 a.m. to 12.30 p.m. and 2 to 4 p.m. 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 p.m. to 4.30 p. m. Dental: (By appointment only) Tuesdays and Wednesdays, 10 a.m. to 12 noon. Special Clinic: (By appointment only) Fridays, 2 to 4 p. m. b) Provided by the Royal College of St. Katharine:— 228-230, Brunswick Road Two Medical Officers' Rooms; 1 Weighing and 2 Waiting Rooms; 1 Dental Clinic; 1 Artificial Light Room and Waiting Room; 2 Observation Wards, with Kitchen, Bathroom and Out-Patient Room for mothers Infant Consultations: Tuesdays, Thursdays and Fridays, 2 p.m. Sewing Class: Mondays, 2 p.m. Dental: (By appointment only) Thursdays, 9.30 a. 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) Once weekly. Remedial Exercise: (Bv appointment only) Mondays, 2.30 p.m., and Thursdays. 10 a. m. Post-Natal Clinic: Wednesdays, 9.30 a.m. to 12.30 p. m. The Lighthouse Mission, Blackthorn Street Medical Officer's Room and Large Hall for weighing and waiting Infant Consultations: Wednesdays, 2 p.m. Trinity Hall, Augusta Street Ditto Ditto Ditto Infant Consultations: Wednesdays, 2 p.m. 111 Maternal Mortality—Ministry of Health Circular 1622. Following upon the receipt of the Ministry of Health Circular 1622 the Medical Officer of Health submitted to the Maternity and Child Welfare Committee a statement showing—(a) the recommendations in the Maternal Mortality Report; (b) the services already supplied by the Poplar Borough Council; and (c) the suggestions of the Medical Officer of Health for meeting the recommendations in the report. The following recommendations of the Maternity and Child Welfare Committee were adopted by the Council:— (a) Post-Natal Consultative Clinic.— That a monthly post-natal consultative clinic—for advice and treatment of women suffering from gynaecological conditions, and where advice and instruction on contraceptive methods shall be given to women attending the clinic in whose cases further pregnancy would, in the opinion of the Medical Officer, be detrimental to their health—be established and that the London County Council be approached with a view to the establishment of this Clinic at St. Andrew's Hospital. (b) Flying Scarfs .—That as this service can only be supplied by an Authority having control of general hospitals and ambulance facilities, and in view of the fact that domiciliary midwifery is to be taken over by the London County Council, this is a question for the London County Council to decide and to make arrangements for "flying squads" to be in readiness at certain of their hospitals should they think this necessary. (In forwarding this to the London County Council the Committee considered that there might be circumstances in which it would be advisable to have such a service available.) (c) Home Helps.-—That no action be taken to provide Home Helps. (d) That a copy of the Medical Officer of Health's Report and the action taken thereon be forwarded to the Minister of Health in accordance with the requirements of Circular 1622. In December, the County Council stated that, subject to certain conditions, they would be willing to allow the Borough Council to hold a post-natal (consulting) clinic at St. Andrew's Hospital, Bow, and the necessary arrangements for the establishment of this clinic are in hand. 112 Midwives Act, 1936. On 1st September, 1937, the Ministry of Health gave general approval to the London County Council's scheme for Domiciliary Midwifery which came into operation on 1st January, 1938. Poplar is one of the six districts comprising Area "A" (Metropolitan Boroughs of Bethnal Green, Hackney, Poplar, Shoreditch, Stepney and Stoke Newington). Conferences were held with Medical Officers of the London County Council and also Medical Officers of Health of Area "A" with the County Medical Officer of Health with a view to securing co-operation between the London County Council and the Borough Council. The London County Council arranged with a Voluntary Association (The Nursing Sisters of St. John the Divine) for the carrying out of midwifery work in the greater part of the Borough. With the coming into operation of this Scheme, the Maternity Committee and Borough Council have agreed to the following:— (a) To discontinue the payment to midwives of compensation for loss of cases sent into hospital for confinement, upon the advice of Clinic Medical Officers. (b) As the fee charged by the London County Council for the attendance of their midwives included the cost of a sterilised outfit, the Council agreed to supply sterilised maternity outfits free to persons who were being attended by midwives of the Nursing Sisters of St. John the Divine. (c) To supply sterilised maternity outfits to persons being attended by independent midwives at cost price, or half cost price, according to income scale. (d) To discontinue the part payment of fees to midwives in necessitous cases. (e) To arrange with the three Local Nursing Societies for payment by block grants and the revision of the conditions and cases which might be nursed so as to include nursing during pregnancy. (/) Consulting Obstetricians.— Formulation of a panel of Obstetricians to serve the whole of Area "A" (the Council's Consulting Obstetricians, Mr. Brews and Mr. Dodds, have agreed to serve in a wider area). 113 (g) That the London County Council should provide "Flying Squads" (transfusion services). Discussions are still proceeding with the London County Council with a view to this service being available from certain County Council hospitals situate in Area "A." (h) It has been agreed that where a case has been made out by the Medical Officer of an adjoining Borough for an occasional mother, or so, from that Borough to attend an ante-natal clinic in this Borough, arrangements be made for the medical supervision at one of our clinics on the understanding that the social services are provided by the Borough from which the mother comes. Co-operation with Voluntary Organisations, etc. (a) Royal College of St. Katharine. The Minister of Health's Maternity and Child Welfare Contributions (London) Scheme, 1937, made under Section 101 (6) of the Local Government Act, 1929, for the grant period 1st April, 1937, to 31st March, 1942, required the Borough Council to make an annual contribution to the Royal College of St. Katharine of £4,442. (b) Co-operation with St. Andrew's Hospital. (i) In order to improve the co-operation between the Borough Council's Ante-natal Clinics and St. Andrew's Hospital, meetings of the Clinic Medical Officers and the Medical Staff of the Maternity Department of St. Andrew's Hospital have been held. (ii) Training of Midwives.- At the request of the Matron of St. Andrew's Hospital, arrangements were made for nurses undergoing midwifery training at St. Andrew's Hospital to visit the Maternity and Child Welfare Clinics in order that they may have some knowledge of the work carried on at Infant Consultation. 52 nurse-midwives attended our clinics during the year. (c) The Queen Mary Day Nursery and Social Settlement. The Minister of Health has approved an annual contribution of £500 for the five years 1st April, 1937, to 31st March, 1942, to the Queen Mary Day Nursery and Social Settlement in connection with the work of the Day Nursery and Creche. The new building was opened early in 1937 by Her Royal Highness the Duchess of Gloucester. 114 (d) Co-operation with the General Hospitals. As reported last year it had been found that the records of many of the children under 5 years of age attending the clinics were incomplete in respect of serious illnesses which had necessitated hospital treatment, and with the willing co-operation of the hospital officials a scheme was arranged whereby a report on each Poplar child treated in their hospitals is sent to the Medical Officer of Health. The report, in addition to giving information regarding the clinical condition of the child, calls attention to any after-care which is required, and so enables our Health Visitors to follow up and see that the Hospital recommendations are carried out. Books of 100 forms are supplied to each hospital, together with "Business Reply" envelopes, in order to reduce to a minimum the work of the Hospital staffs. 947 reports were received:— from St. Andrew's Hospital 797 from Voluntary Hospitals 150 (In addition to the above the London County Council sent 356 reports of children discharged from the Fever Hospitals, and again the Health Visitors follow up to see that the Hospital recommendations are carried out.) (e) Co-operation with the Education Authority. (a) 47 of the senior girls attending Domestic Science classes visited Wellington Road Maternity and Child Welfare Centre for instruction in mothercraft. (b) 1,752 case sheets relating to the children who reached the age of 5 years were forwarded to the Education Department. 501 special reports were also forwarded regarding children attending school, not yet 5 years of age. (/) Co-operation with the Invalid Children's Aid Association. The Council at their meeting on 29th November, 1934, agreed— 1. To make a grant of £10 per annum to the Invalid Children's Aid Association (local branch) towards the cost of providing surgical appliances for children under the age of 5 years; 115 2. (a) That an amount of £30 (affording 4 week's convalescent treatment for 15 cases, at 10s. a week) be included in the annual estimates and earmarked for this purpose; (b) That any such child for whom convalescent treatment is desired must be referred to the appropriate Maternity and Child Welfare Centre for examination by the Clinic Medical Officer for his, or her, approval; (c) That payment of the Convalescent Home account and collection of any monies towards the cost of the treatment be undertaken by the Invalid Children's Aid Association, who shall submit each month an account to the Borough Council for payment of the balance. The Association assisted 21 children in obtaining surgical appliances and provided convalescent treatment in 8 cases during 1937. Centres. In the table facing page 110 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. The number of attendances at the Centres during the last 10 years is shown below:— Borough Council. Royal College. 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 1934 48,048 34,600 1935 45,101 33,253 1936 44,099 29,478 1937 41,530 28,335 Old Ford Clinic. Reference was made in previous reports to the preparations made for the erection of a modern clinic in Old Ford. Although the London County Council School Medical Officer's Department suggested that provision might be made on the first floor 116 of this proposed building for a School Treatment Centre, it was only after protracted negotiations with the Valuer's Department that agreement was reached regarding rental, etc. The Quantity Surveyor's estimate for the erection of the new Maternity and Child Welfare Centre, including the first floor for a School Treatment Centre was £8,889, to which sum had to be added £326 for architectural services and £150 for demolition work, making a total of £9,365—an increase of £4,270 over the amount already sanctioned. Revised plans of the whole scheme were submitted to the Ministry of Health and the borrowing of an additional sum of £4,270 was sanctioned. The following are the terms agreed upon between the Borough Council and the London County Council for the renting of the first floor accommodation:— (1) The Council to take a lease for 21 years from a date to be agreed. (2) The rent to be £260 a year, or such amended figure as is agreed on the same basis when the actual cost of the building is known. (3) The Council to pay rates for the portion of the building in its occupation on a separate assessment. (4) Gas, water and electricity for the Treatment Centre to be metered separately. (5) The Council to pay one-half of the costs of services exclusive of the cost of coke, in which case the payment by the Council is to be two-thirds of the cost. (6) The Borough Council to be liable for all repairs, insurance and Schedule "A" tax. It is understood that the Borough Council would undertake all works of repair and maintenance and arrange for the provision of all services required and that payments due from the Council will be adjusted annually as in similar cases. The erection of the Centre commenced in December. Miss J. M. Cardozo, Chief Health Visitor, reports as follows:— Health Visiting. During 1937 a large number of our visits have been to say goodbye to many of our mothers and their children, as they have moved out of the Borough to one of the new Housing Estates, and to visit and welcome new families as they came into the new flats. 117 Visiting these new families calls for special care. The mother naturally feels strange in her new surroundings, and several visits are necessary to gain her confidence and co-operation. Ante-Natal Visiting. These visits increase each year. All mothers who failed to keep their appointment at the Borough Clinics, or at St. Andrew's Hospital, were visited and a fresh appointment made. At the request of several Voluntary Hospitals, visits were paid to the homes of mothers who had booked with them, and reports of the home conditions were forwarded to the hospitals. Clinics. Infant Consultation. The additional sessions at Simpsons Road, 54, West Ferry Road, and Old Ford have been most valuable, relieving the overcrowding and giving opportunity for satisfactory test feeding with nursing mothers. Ante-Natal. The new Ante-Natal session at 54, West Ferry Road has met a real need, saving the Island mothers the journey to the Poplar Clinics. Post-Natal. The number of mothers attending this Clinic is increasing yearly:— 1935 80 1936 120 1937 279 Health Talks—Education. The need of so many of our mothers is a sound training in Mothercraft, and this we endeavour to give in our talks at the Centres. Not a new-fangled system of bringing up babies by a strict schedule only, but a perfectly sound and simple method by which the baby is given the very best chance of health and happiness, and the mother shown the joys of motherhood instead of a life of drudgery, broken rest and ill-health. This teaching is most important when given at the AnteNatal sessions, as the result of wrong feeding and bad handling during the first year of life can never be completely remedied; and failure to breast-feed the baby is usually due to lack of preparation. 118 Several groups of senior school girls have attended with their teachers at some of our Centres, and have been given elementary mothercraft instruction by the Staff. The value of these visits cannot be overestimated, and this is a branch of the work which should be extended. The co-operation of the Royal College of St. Katharine is of the greatest assistance in our work, and our thanks are due to the voluntary workers at the Clinics, to the various associations who have given grants towards dentures, and to the many friends who have sent woollies and clothing for the Jumble Sales. Ante-Natal Work—Isle of Dogs. Prior to the ist April, 1937, expectant mothers on the Isle of Dogs had to attend the Ante-Natal Clinic at Simpsons Road, Poplar. In view of the increased housing accommodation which had been, and was being, provided on the Isle of Dogs, the work at Simpsons Road was becoming very heavy. The Council, upon the recommendation of the Maternity Committee, agreed to establish an ante-natal clinic at 54, West Ferry Road, on Thursday afternoons, which would be more convenient for mothers living on the Island; would also relieve the pressure at Simpsons Road Clinic, and greatly improve the scheme of co-operation with the Sisters of St. John the Divine, who were now carrying out the midwifery work on the Island. Dr. D. F. Egan was appointed Medical Officer of this Clinic, which commenced on 1st April, 1937. Ante-Natal Clinic, Public Health Department. 1,134 live births and 28 stillbirths were notified in the area served by the Public Health Department during the year 1937. The following table shows the distribution of these births:— Live Births Stillbirths. Doctors' patients 79 — Midwives' patients 301 8 St. Andrew's Hospital 418 14 East End Maternity Hospital 159 2 Other Institutions 177 4 1,134 28 119 Of this number the following attended our Ante-Natal Clinics:— Doctors' patients 6 (7.6%) Midwives' patients 238* (77.0%) St. Andrew's Hospital 308 (71.3%) East End Maternity Hospital 18 (11.2%) Other Institutions 6 (3.3%) 576 (49.6%) * This number refers to the cases in the practices of private midwives. The patients of midwives attached to nursing associations attend the associations' antenatal clinics. Clinic A ttendances. Number of individual patients 755 New Cases 680 Total attendances 2,913 Average attendance per session 15.3 (compared with 33.8 at R. Coll. double sessions) Home Visitation by Health Visitors. First visits 882 Revisits 1,796 120 STATISTICAL SUMMARY OF HOME VISITING FOR 1937. Public Health Department. The Royal College of St. Katharine. Total 1937. Total 1936. Cases Visits. Cases. Visits. Cases. Visits. Cases Visits. Ante-Natal:— No. of Cases 882 — 729 — 1,611 — 1,501 — Primary visits — 882 — 729 — 1,611 — 1,501 Re-visits — 1,796 — 2,092 — 3,888 — 3,397 Infant Child Welfare visits:— Primary visits (Infants) — 1,030 — 961 — 1,991 — 2,014 Removed before visit — 32 — 32 — 64 — 51 Died before visit — 20 — 13 — 33 — 36 Stillbirths — 27 — 30 — 57 — 64 Re-visits- Under 1 — 7,953 — 9,854 — 17,807 — 16,650 1—5 — 19,857 — 23,016 — 42,873 — 40,669 Removed — 681 — 746 — 1,427 — 1,450 Died — 43 — 65 — 108 — 124 †(Ophthalmia Neonatorum:— No. of Cases notified 5 — — — 5 — 5 — Primary visits — 5 — — — 5 — 5 Re-visits — 7 — — 7 — 14 Removed to Hospital 4 — — 4 — 4 — *Enteritis:— (a) No. of Cases reported 16 — 5 — 21 — — — (a) Primary visits — 16 — 5 — 21 — — Re-visits — 3 — 3 — 6 — — Removed to Hospital 15 — — — 15 — — — Died — 1 — 1 — 2 — 2 (6) No. of Cases notified (Z.E.) 17 28 45 42 _ (b) Primary visits — 17 — 28 — 45 — 42 Re-visits — 3 — 59 — 62 — 64 Removed to Hospital 31 — — — 31 — 28 — Died — 8 — 7 — 15 — 14 Measles:— No of Cases under 5 years 115 — 107 — 222 — 1298 Primary visits — 115 — 107 — 222 — 1,298 Re-visits — 68 — 57 — 125 — 502 Removed to Hospital 89 — — — 89 — 377 — Died — 2 — 2 — 4 — 41 Primary visits:Over 5 years — 145 — 74 — 219 — 726 Revisits — 27 — 8 — 35 — 118 Whooping Cough:— No. of Cases 357 — 177 — 534 — 502 — Primary visits — 357 — 177 — 534 — 502 Re-visits — 217 — 103 — 320 — 259 Removed to Hospital 57 — — — 57 — 57 — Died — 3 — 4 — 7 — 14 †Puerperal Fever:— No. of Cases notified 5 — — — 5 — 5 — Primary visits — 5 — — — 5 — 5 Re-visits — 10 — — — 10 — 10 Removed to Hospital 5 — — — 5 — 5 — Died:— (a) Notified Cases — — — — — — 3 — (b) Non-notified Cases 1 — — — 1 — — †Puerperal Pyrexia:— No. of Cases notified 31 — — — 31 — 15 — Primary visits — 31 — — — 31 — 15 Re-visits — 53 — — — 53 — 31 Removed to Hospital 28 — — — 28 — 14 — Died 1 — — — 1 — 1 — Maternal Deaths:— Maternal Deaths (number) 5 — — — 5 — 6 — Primary visits — 6 — — 5 — 6 Re-visits 6 — — — 6 — 16 Miscellaneous Visits.. — 832 — 299 — 1,131 — 1,181 Total Visits: — Primary — 2,687 — 2,156 — 4,843 — 6,265 Re-visits — 31,570 — 36,316 — 67,886 — 64,554 Total Visits paid, 1937 34,257 — 38,472 72,729 ___ Total Visits paid, 1936 34.117 36,702 70.819 * Zymotic Enteritis is notifiable from 1st June to 30th September, †All cases are visited b.v Health Visitors of the Public Health Department. Enquiries re Maternal Deaths are made by the Public Health Department. 121 The following table shows the attendances at each of the Clinics during the year 1937:— Bow West Ferry Road. Manchester Road. Simpsons Road. Wellington Road. P.H. Dept. Total. Royal College of St. Katharine Total. Ante-Natal Clinics:— Attendances 861 613 — 1,065 374 2,913 1,691 Average per session 16.5 15.3 — 14.7 14.4 15.3 33. 8Dble. Infant Consultations:— Session. First attendances 309 226 171 270 281 1,257 936 Total attendances 6,507 4,654 5,352 6,027 6,632 29,172 17,827 Average per session 61.4 62.9 52.5 50.6 63.8 57.8 71.6Dble. Average attendance of each child 9.2 7.7 11.6 9.1 7.9 9.0 Session. 8.4 Light Clinics:— Attendances — — — 2,642 4,591 7,233 3,512 Average per session — — — 11. 8 15.8 14.1 18.4 Dental Clinics:— Attendances — — — — 1,253 1,253 1,081 Average per session — — — — 12.4 12.4 9.0 Sewing Class — — — 680 — 680 1,221 Oarden attendances 1,825 Mothers' Clinic (PostNatal) 279 279 530 Remedial Clinic 648 Total attendances at all Clinics:— 1937. 1936. P .H. Department 41,530 44.099 Royal College of St. Katharine 28,335 29,478 Total 69,865 73,577 Special Ante-Natal Consulting Clinic—St. Andrew's Hospital. The number of patients seen at the Ante-Natal Consultation Clinic was as follows:— (a) Referred by private practitioners 2 (6) Referred by clinic medical officers 43 45 122 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:— £ s. d. Dried Milk, 10,899 lbs 772 0 3 Special Milk, 491 lbs 34 15 7 Dried Milk, Humanised, 106 lbs 10 12 0 Aberdeen Emulsion 1 18 0 Dusting Powder 1 0 0 Medicinal Paraffin 4 2 5 Medical Sundries 15 19 11 Dentines 86 11 8 Materials at Sewing Class 20 5 1 Convalescent Treatment 19 2 0 Virol 20 7 9 Oil and Malt 77 4 1 Concentrated Food 85 6 7 Payments for Gas (Dental Clinic) 4 2 6 Accouchement Sets 17 8 0 Cod Liver Oil 24 4 0 Total £1,194 19 10 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. 1,024 such vouchers were issued during the year. Convalescent Treatment, etc. Convalescent Treatment (mothers with babies) 41 cases. ,, ,, (mothers alone) 4 ,, ,, ,, (children under 5 years) 39 ,, Loan of maternity bag, containing clothing, etc 20 ,, Grants by .Maternity and Child Welfare Committee during the Calendar Year, 1937. Part payment of Midwives' Fees 15 (14 at 13s .6d. & 1 at 6/-.) Compensations to Midwives 24 (10s. in each case). Maternity Outfits at half-price 44 123 The Committee provided dentures to six necessitous mothers who were unable to complete their payments, the cost to the Committee being £12 17s. 9d. (The following tables refer to the whole Borough.) Statistics Respecting Infants Born in 1936. All births, including those occurring in outlying districts, but belonging to the Borough 2,232 Doctors in attendance 214 Midwives in attendance 599 Delivered in institutions 1,418 Not stated 1 Moved into Borough 196 2,428 Stillborn (Stillbirths per 1,000 births, 29.6) 66 Died before visit 37 Not requiring or desiring visits 90 — 193 Visited 2.233 Removed within the year 399 Died during visitation 99 498 Remaining under supervision end of first year 1,737 Mortality per 1,000 visited 44.3 The 1,737 children visited during 1936 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 72.2 per cent. Mixed feeding 20.3 Hand-fed 7-5 The 99 children who died during the first year of life, were fed during the first six months of life as follows:— Breast-fed 19.2 per cent. Mixed feeding 42.4 „ Hand-fed 38.3 „ 124 Below is a statement comparing the mortality rates per 1,000 visited of children fed by the various methods:— (a) Babies breast-fed 15 (b) ,, who received mixed food (breast and hand) 107 (c) ,, hand-fed 225 Stillbirths. (This refers to the whole Borough.) 60 Stillbirths were investigated during the year 1937. Number of Stillbirths 60 Doctors in attendance 1 Midwives in attendance 16 Delivered in Institutions 42 B.B.A 1 (Doctor's case) Ophthalmia Neonatorum. Five cases of Ophthalmia Neonatorum were notified during the year:— (This table refers to the whole Borough.) Year. Cases. Vision unimpaired. Vision impaired. Total Blindness. Death* Notified. Treated. At home. In hospital. 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 — — — 1934 21 10 11 21 — — — 1935 10 5 5 10 — — — 1936 5 1 4 5 — — — 1937 5 1 4 5 — — — 125 Cases Notified and Visited. Number of notifications received 5 Very slight cases 1 Sight of one eye damaged — Recovered 5 Occurred in Institutions 1 Occurred in the practice of medical practitioners — Occurred in the practice of midwives 4 Admitted to hospital as in-patients 4 Treated as hospital out-patients — Treated privately 1 Visited by nurse — Prevention of Blindness. During the year the Ministry of Health issued Circular 1621 on the "Prevention of Blindness." The paragraphs regarding children under school age were considered by the Maternity and Child Welfare Committee. When eye conditions were recognised in children either by the Health Visitors when visiting, or Clinic Medical Officers when carrying out their work at the Clinics, children are immediately referred to an eye hospital. Specialists at the hospitals are asked for reports on the cases and the children are followed up by the Health Visitors in order to see that the treatment advised is carried out. Zymotic Enteritis. (See notes on page 92 —Notification of Zymotic Enteritis.) Notifications received (patients under 5 years) 45 Under 1 year (see feeding below) 28 1 to 2 years 12 2 to 3 years 2 3 to 4 years 1 4 to 5 years 2 Died before notification received 4 Visited 45 Treated in hospitals 32 Of the 28 cases of Zymotic Enteritis under 1 year of age which were notified, 15 died. These were fed as follows:— Breast fed 2; mixed feeding 2; hand-fed 11. 126 Home Nursing. By arrangement with the Nursing Associations nursing is provided (with the consent of the practitioner attending a patient) and paid for by the Council at the rate of 1s. 3d. per visit, in cases of Ophthalmia Neonatorum, Measles, Whooping Cough, Pneumonia, Zymotic Enteritis, Pemphigus, Puerperal Fever and Puerperal Pyrexia. The following is a summary of visits paid by Nurses during 1937:— (This table refers to the whole Borough.) E.L.N.S. St. John Divine. St. John's Isle of Dogs. Totals. Cases Visits. Oph. Neon. Cases — — — — — Visits — — — — — Slight Inflamma tion of Eyes* Cases 23 8 1 32 — Visits 351 192 14 557 Measles Cases Under 5 13 1 14 5-10 2 1 — 3 — Visits Under 5 149 10 — — 159 5-10 25 6 — — 31 Pneumonia Cases Under 5 19 5 1 25 5-10 4 4 Visits Under 5 209 130 15 354 5-10 93 — — — 93 Pemphigus Cases 5 3 1 9 Visits 85 49 12 — 146 WhoopingCough Cases Under 5 2 — — 2 — Visits Under 5 56 — — — 56 Zymotic Enteritis Cases — — — — — Visits — — — — — Puerperal Pyrexia Cases — Visits — — — — — Maternity Nursing Cases 5 1 — 6 — Visits 97 11 — — 108 Totals Cases 73 19 3 95 Visits 1,065 398 41 1,504 *Reported by L.C.C. 127 The following table relates to visited children of ages 1 to 5 years:— Year of Birth. 1932. 1933 1934 1935 Remaining under supervision End of first year — — — 1,834 ,, second year — — 1,737 — ,, third year — 1,692 — — ,, fourth year 1,847 — — — Inward Transfers 123 72 122 135 Visits discontinued — — 2 7 Outward Transfers 216 187 224 289 Died 2 11 15 30 Remaining under supervision End of second year — — 1,643 ,, third year — — 1,618 — ,, fourth year 1,566 — — ,, fifth year 1,752 — — — Mortality per 1,000 visited £econd year — — — 15.2(13.6) Third year — — 8.1 (7.8) — Fourth year — 6.2 (5.8) — — Fifth year 1.0 (3.9) — — — The figures in parentheses are the rates for the previous years. Maternal Deaths.—The Council agreed that the investigation of maternal deaths should continue to be carried out on the lines suggested by the Ministry of Health. There were 5 deaths associated with pregnancy, etc., investigated and the maternal mortality rate was 2.30 per 1,000 total births (live and still.) See list, page 128. 128 List of Maternal Deaths. Cause of Death. Attended at Institution. Attended at home by Treated in Institution subsequently. No. of previous pregnancies. Received Ante-natal care or Treatment at M.C.W. Clinic. Elsewhere. Puerperal Sepsis (1 case). General peritonitis. Acute Endometritis. Natural abortion. Coroner's P.M. without Inquest _ Doctor. Yes. 9 _ _ Other Puerperal Causes (1 case). Post-partum haemorrhage. Coroner's P.M. without Inquest _ Midwife. Yes. 2 Yes. _ Other Deaths Associated with Pregnancy (3 cases). (1) Heart failure. Myocardial degeneration. Full term pregnancy. Haematoma of broad ligament .. .. .. (Classified to Tumours.) Yes. _ Yes. 13 _ Yes. (2) Rupture of uterus. Fibrosis of uterus. Fatty degeneration of heart. P.M. .. .. (Classified to Tumours.) Yes. _ Yes. 11 _ Yes. (3) Pulmonary tuberculosis. Delivery of fullterm baby on 20.11.37 .. .. .. .. (Classified to Tuberculosis.) Yes. _ Yes. _ Yes. _ 129 The Council have given serious consideration to the question of maternal mortality, and for some years past arrangements have been made with a Consulting Obstetrician to visit cases of Puerperal Fever and Puerperal Pyrexia in consultation with general practitioners (see page 89). The arrangements made with two 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, 1937- (During 1937, Consulting Obstetricians were called in to four cases.) Infantile Mortality. The infantile mortality rate was 61. Infant Life Protection. Number of Foster Mothers under supervision at 31st December, 1937 16 Number of Foster Children under supervision at 31st December, 1937 16 Number of new Foster Mothers registered during 1937 6 Number of children legally adopted during 1937 — Number of children who attained the age of 9 years during 1937 1 Under Supervision during some part of 1937:— Foster Mothers 20 Foster Children 20 Number of visits:— Chief Health Visitor, or Deputy 207 Male Inspectors 15 The Foster Mothers and homes are all satisfactory and although in some cases the payments are in arrears, this has made no difference to the way in which the children have been cared for. The health of the children was good. Those under 5 years of age attend the Infant Welfare Consultations. 130 Student Health Visitors. During the year six Student Health Visitors from the Royal College of Nursing have been given a course of practical training. Post-Graduate Course. Two Health Visitors attended a Post-graduate Refresher Course during the year. 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. Observation Wards. Report of Dr. H. St. H. Vertue, Consulting Physician at the Maternity and Child Welfare Observation Wards. In-patients. Number of Admissions 76 Nature of Cases Admitted:— Malnutrition 23 Difficulty in Artificial Feeding 18 Rickets 10 Neuroses 10 Miscellaneous 15 Remarks.—Poorly nourished children below the normal weight, with physique below the average, are frequently admitted. No disease is found to account for their condition. In the good environment of the Wards they gain weight and improve in strength, colour and vigour in an extremely rapid way. Sometimes care has to be taken in feeding them at first, especially in the amount of fat given, as being unaccustomed to a rich diet, they are apt to get indigestion. The results of treatment are in all such cases good. But now and again it transpires that one is, after all, suffering from an organic disease. Among such we found Tumour of the Chest, Mental Deficiency, Diseases of the Nervous System and Congenital Disease of the Muscles. We usually send these to hospital. Rickets is now only present in minor degrees. No doubt the distribution of cod-liver oil 131 has something to do with this gratifying result. Neurotic children, on the other hand, show not the slightest sign of diminishing in number or severity. The chief performances are refusal to eat and staying awake most of the night, varied by bed-wetting and bilious attacks. These are all due to faults of management at home. They are very easily cured by a stay in the wards, but may relapse if the parents persist in their faults. The treatment of delicate and difficult bottle-fed babies is a source of great technical interest, and very good results are obtained. The number of them is not so great as it was, owing to the improved skill of the mothers. Results of Treatment. Recovered 51 Improved 8 Removed before treatment completed 5 Transferred to Hospital 8 No change 4 76 Out-patients. Number of New Cases 154 Number of Cases Seen 293 Nature of New Cases:— Cases for Admission 66 Difficulty in Breast Feeding 46 Difficulty in Bottle Feeding 11 Various Consultations 31 154 Remarks.—Much importance is attached to efforts to maintain or re-establish breast-feeding. Altogether 296 attendances were made by mothers, apart from those at the Clinic itself. The results were:— Breast only 13 Partial Breast Feeding 24 Bottle only 1 Incomplete attendances 8 An extraordinary variety of behaviour is seen among the mothers in this matter. Some are heroic and will take any amount of trouble: no effort is too great. These nearly always succeed. Others have much 132 less energy, faith or patience, or sometimes less real desire to feed their child. These are less likely to do well. Useful signs of probable failure are:—(i) a tendency to talk more about her own health than the baby's; and (ii) a marked predilection for cosmetics. H. ST. H. VERTUE, M.D. Artificial Sunlight Treatment. Report of Dr. E. M. Layman, the Medical Officer in charge of Light Clinics. I have pleasure in submitting my report on the work of the Light Clinics in 1937. Children.—296 cases are reported on, classified as follows:— Marked Success Success Moderate Success Failure Rickets 25 13 8 2 2 Knock Knee 3 1 2 — — Disturbed Dentition 109 52 46 10 1 Malnutrition 37 18 11 7 1 Debility 50 16 17 11 6 After Illness 40 26 9 4 1 Bronchitis and Catarrh 12 6 4 2 — Prematurity 4 2 2 — — Various Ailments 16 8 1 7 — Total 296 142 100 43 11 Rickets. Three of the 25 cases were purely muscular and 22 had bony changes, 6 being severely affected and the rest slighter cases, mostly of bowed legs with muscular flabbiness as well. The two failures were a young child in very feeble health, sent into the Wards for building up; and an older boy who needed a long stay in country air and was sent to Carshalton. Two severe cases attended Hospital for surgical treatment and also our Clinic at suitable intervals for many months with unflagging zeal, pursuing light treatment on hospital advice. This was no easy task for the mothers and has been rewarded by great benefit to the patients. Disturbed Dentition. Our largest group gave us considerable satisfaction as usual. The disorders attending dentition are often severe, and the children reduced by loss of sleep. They respond extremely well to U.V.R. 133 After Illness. We had a high proportion of cures in this group and should be glad to see more convalescents from infectious disease. The ideal convalescence of course is bracing air, but in winter and while awaiting a change the children could recover tone under U.V.R. Mothers. 68 mothers are reported on, classified as follows:— Debility during Pregnancy 16 Post-Natal Weakness 16 Rheumatism and Sciatica 7 After Illness 3 Debility and other Ailments 26 Of these 68 cases, 30 were Marked Successes, 17 were Successes, 20 were Moderate Successes; one failed to improve. The year's work has provided nothing surprising for comment. It has afforded a good many minor problems concerning the health and happiness of the "patients." It has also given us much interest in the steady improvement of the large majority. I should like to express my great indebtedness to the Sister-in-Charge for her patience, wise judgment and devotion to the interests of mothers and children. We are fortunate also with the helpful efficiency and kindness of her assistant. E. M. LAYMAN. Statistical Summary. January 1st to December 31st, 1937. Bow. Poplar. Totals. Number of attendances 4.591 2,642 7.233 ,, ,, sessions 289 223 512 ,, ,, patients 326 214 540 134 Royal College of St. Katharine. Report of Dr. H. K. Waller, Senior Medical Officer of the Royal College of St. Katharine. Statistics for the year ended 31 st December, 1937. (Figures for the same period last year are included for comparison.) Number of Visits. 1936. 1937. First visits to Expectant Mothers 664 729 Re-visits to Expectant Mothers 1.845 2,092 First visits to children 1,016 1,036 Re-visits to children 33,177 34,615 36,702 38,472 Total number of children on register 4,579 4,028 Attendances at Clinics. Infant Clinics. New cases 919 936 Attendances—Under 1 year 8,509 8,764 1—3 years 6,757 6,163 3—5 years 3,154 2,900 18,420 17,827 Average attendance per clinic 73.7 71.6 Number of individual children 2,251 2,116 Number of individual mothers 1,818 1,761 Ante-Natal Clinics. New cases 489 538 Total attendances 1,516 1,691 Average attendance per clinic 30.3 33.8 Number of individual mothers 537 605 135 Post-Natal Clinics. 1936. 1937. New cases 188 198 Total attendances 524 53° Average attendance per clinic 10.5 10.8 Number of individual mothers 213 229 Dental Clinics. Mothers. New cases 142 165 Total attendances 652 613 Average attendance per clinic 9.2 8.6 Number of individual mothers 261 265 Children. New cases 199 180 Total attendances 460 468 Average attendance per clinic 9.4 9.7 Number of individual children 238 236 Artificial Sunlight Clinics. New cases 206 200 Total attendances 3,347 3,512 Average attendance per clinic 15.9 18.4 Number of individual children 239 222 Number of individual mothers 6 12 Garden attendances for open-air treatment 2,125 1,825 Remedial Exercises and Massage Clinics. New cases 67 66 Total attendances 776 648 Average attendance per clinic 8.8 7.4 Number of individual children 76 78 Number of individual mothers 7 6 Sewing Class. New cases 68 50 Total attendances 1,658 1,221 Average attendance per class 37.7 27.7 Observation Ward. Number of children admitted 65 64 Average duration of stay .. .. days 40.4 31.6 136 Tonsil Clinic. 1936. 1937. Number of children admitted 100 113 Average duration of stay .. .. days 5 5 Out-Patients' Departments. Test-Feeding Department. Total attendances 1 228 1,291 Number of mothers who attended with their babies for test feeds 184 221 Treatments. Mothers. Total treatments given to mothers 152 270 Number of individual mothers treated 44 51 Children. Total treatments given to children 2,809 2,388 Number of individual children treated 409 362 Ante-Natal Department. Births. In the area allotted to St. Katharine's there were 1,036 (1936—1,015) live and 32 (30) stillbirths during the year, making a total of 1,068 (1,045). Attended 1936 St. Katharine's Ante-Natal Clinic Attended 1937 St. Katharine's Ante-Natal Clinic Doctor's patients .. ., .. 118 6 (5.0%) 98 8 (8.2%) Mid-wives' patients .. .. 284 145 (51.0%) 242 168 (69.4%) St. Andrew's Hospital .. .. 421 255 (60.6%) 454 294 (64.8%) East End Maternity Hospital .. 167 11 (6.5%) 186 15 (8.1%) Other Institutions .. .. 51 1 (1.8%) 56 0 (0.0%) In all 605 (1936—537) women have attended this Clinic during the year, making 1,691 (1,516) visits, or 2.8 (2.8) visits apiece. The average attendance has been 33.8 (30.3) per Clinic. There were 538 (489) new cases during the year. Post-Natal Department. 229 women (1936—213), or rather over a quarter of the number delivered during the year, have been seen, 198 (188) being new cases. They have averaged 2.3 (2.5) visits apiece. Total attendances 530 (524). 137 Observation Ward. 64 infants were admitted during the year and made an average stay of 31.6 days each. The reasons for admissionwere as follows:— Nutritional disorders 18 Illness of Mother 12 Preparation for tonsillectomy 9 Recovery from tonsillectomy 11 Nervous disorders 3 Rickets 2 Prematurity, Skin Disease, Morbus Cordis, Epilepsy, Jaundice, Enuresis, Dental Extraction, Otitis Media 9 64 Results of admission:— Fully recovered 21 Improved 36 Not improved 2 Transferred to Hospital 4 Died i 64 In addition 113 children were admitted for the surgical removal of unhealthy tonsils and adenoids. All made good recoveries. The routine length of stay in the ward for this operation is 5 days. Specially delicate children are admitted earlier and kept longer afterwards. H. K. Waller, M.D. Maternity and Child Welfare Dental Clinic. Report of Mr. C. Hammond Williams, L.D.S., R.C.S. (Eng.), Dental Surgeon in Charge of the Maternity and Child Welfare Dental Clinic. I beg to submit my report of the dental work carried out in connection with the Maternity and Child Welfare Department for the year ended 31st December, 1937. 138 The following is a summary:— 101 Sessions have been held. 1,253 Total attendances. 106 Permanent teeth filled. 228 Temporary teeth filled. 32 Permanent teeth extracted with local anaesthesia. 1,319 Permanent teeth extracted under nitrous oxide gas. 1,232 Temporary teeth extracted under ethyl chloride. 175 Scalings. The duties also include the fitting of dentures, dressings and minor treatment. 374 new patients have been seen during the year, and an average of 12.4 has been maintained per session. Fewer sessions than in the previous year help to account for the slight decrease in some items, though it may be said fairly that our figures are quite up to average. I have been anxious to find out the results of the early extraction of the majority of temporary molars in our children, following an examination of similar cases at Guy's Hospital, and a list was made out last summer of children, now from 12 to 17 years of age, for whom extractions were made before school age. In spite of our efforts, only four attended, however. It is interesting to note that three of the four showed signs of overcrowding of the permanent teeth, directly due to the early loss of the temporaries. But none of the four showed any sign of having been treated by the school dentist: caries was well advanced in each mouth. There can be no doubt that had these children had dental care at the school clinic the signs of overcrowding would have been easily recognisable and treated by the school dentist quite easily. Both Dr. Hutchinson and myself have been struck by the number of young mothers who attended for dental treatment, a very patent sign that an intelligent interest in their welfare is being taken. This, of course, is due entirely to the propaganda in the welfare clinics, and without which treatment would be put off until the last extremity. C. HAMMOND WILLIAMS, L.D.S., R.C.S. (Eng.). 139 Free Milk Scheme. Milk is supplied to expectant and nursing mothers and to children under 3 years of age (in special circumstances 5 years). Dried milk is supplied under the scheme, with the exception that 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. It is a condition of the supply of free milk that unless prevented on medical grounds, all recipients should be seen at regular intervals at their nearest Maternity and Child Welfare Centre. The Ministry of Health Circular 1519 was considered by the Maternity and Child Welfare Committee in May and the Council agreed to extend the Free Milk Scheme to include provision of milk in the following cases when the persons came within the income scale and were recommended by Clinic Medical Officers:— (a) To expectant mothers whose pregnancies for any reason terminated at or before term without living child; (b) To mothers whose babies died during the first four weeks of life (neo-natal period); (c) To mothers whose condition is debilitated at the termination of breast feeding; (d) To mothers whose babies are artificially fed and whose general condition is debilitated. In these cases one pint of milk (or its equivalent in dried milk) to be supplied when recommended by Clinic Medical Officers for as long as they consider there is need on medical grounds, but this period not to exceed three months except in very special cases which must be the subject of a special report to the Medical Officer of Health for subsequent report to the Committee. (In three cases during the year milk was granted for longer than three months.) The Council also adopted the following recommendations:— (a) That the maximum amount of milk which may be received by one family be increased from 3 pints per day (or its equivalent in dried milk) to 4 pints per day (or its equivalent in dried milk); (b) That while continuing the use of dried milks of reputable brands for general supply, "Pasteurised" milk be supplied upon 140 recommendations of Clinic Medical Officers instead of "Tuberculin Tested" milk, and that the local dairymen be given notice that the present arrangements for supply of ' 'Tuberculin Tested" milk will terminate at the end of September; (c) That provision of meals is not necessary in view of the foregoing extensions of the Free Milk Scheme. In December, upon the recommendation of the Maternity and Child Welfare Committee, the Council agreed that in assessing cases under the Free Milk Scheme, the first 5s. of any sickness benefit, disability pension or accident pay, and also the first 5s. of the earnings of any children at work should be ignored. During the 52 weeks ended 1st January, 1938, 7,547 applications for free milk were received, of which 6,133 were granted. (The number of persons granted milk was 9,278.) Orders were issued for 75,911 pints of Tuberculin Tested milk and 29,747 pints of Pasteurised milk, and 25,430 pounds of dried milk, the total commitments amounting to approximately £3,476. In addition, orders were issued for 1,432 bottles (40z.) of iron solution and 9,936 bottles (40z.) of cod liver oil. 461 cases were investigated by the Enquiry Officer. All cases were found satisfactory. Distribution from ist January, 1937, to 31st December, 1937 Iron Solution. C.L.O. (40z. bottles.) "A." "G." "S." (40z. Double lbs. lbs. lbs. bottles.) strength t7,279 5.210 1.335 8.959 336 496 The following table shows in comparative form the applications, etc., during the last ten years:— 141 Year. Applications. Applications granted. Cost (approx:] £ Orders issued. Cases investigated by I.O. Unsatisfactory cases. Fresh. (Pints) Dried, (lbs.) 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 1934 12,762 11,098 5,069 78,902 53,387 493 1 1935 10,568 9,348 4,807 109,102 42,626 384 1936 8,661 7,439 3,984 98,000 33,295 547 1937 7,547 6,133 3,476 105,6.i8 25,430 461 — Supply of Extra Nourishment—Co-operation with London County Council. The scheme of co-operation with the Public Assistance Committee has worked smoothly and no case has been reported to be adversely affected. The amount chargeable to the Public Assistance Committee during 1937 was approximately £548. APPENDIX. Report of the Medical Officer of Health to the Public Health Committee. Disinfestation. The Medical Officer of Health informed the Committee he had received a letter from the Town Clerk, dated 7th October, 1937, enclosing a copy of correspondence received from the Metropolitan Boroughs' Standing Joint Committee regarding the general question of infestation by vermin and asking if he would suggest a suitable reply. The following correspondence was read to the Committee:— (a) Letter from Honorary Clerk to the General Purposes SubCommittee of the Metropolitan Boroughs' Standing Joint Committee to the Town Clerk, dated 30th September. (b) Letter dated 21st July, 1937, sent by the Clerk of the London County Council to the Honorary Clerk, Metropolitan Boroughs' Standing Toint Committee. 142 (c) Memorandum of London County Council enclosed with the foregoing letter. The Medical Officer of Health submitted the following report, going through the London County Council's Memorandum paragraph by paragraph:— With reference to the letter from the Metropolitan Boroughs' Standing Joint Committee, enclosing a letter from the London County Council, dated 21st July, in relation to disinfestation and also a memorandum on the same subject by the London County Council, the Medical Officer of Health submits to the Committee observations on:— 1. The London County Council's Memorandum. 2. The suggestions of the London County Council. 3. A statement of the action taken to comply with the visions of the Public Health (London) Act, 1936, as regards disinfestation in this Borough. 1. The London County Council's Memorandum. Paragraphs 1 and 2 require no comment except to agree and emphasise the possible cause of re-infestation, viz., the five points enumerated at the head of page 2. Paragraph 3—Methods of Disinfestation.—With the exception of Hydrogen Cyanide gas (HCN) (prussic acid) we have not yet found an agent which will give anything approachirg 100 per cent, efficiency in bug destruction, but owing to the very dangerous nature of prussic acid a potential risk to human life is always present when this gas is used for the fumigation of dwellings. For this reason it has never been used in this Borough for this purpose. Properly used and following the instructions issued by the Ministry of Health for its use, it is the best known method of disinfesting furniture in transit. Paragraph 4—Regulations Controlling Contractors using HCN.— I am in agreement with the suggestions made under this heading and to the further implementing of them, as suggested in the London County Council's letter of 21st July. Paragraph 5.—I agree. Paragraph 6.—I agree. Paragraph 7.—I agree. (See statement regarding action taken.) 143 Paragraph 8.—No comments. Paragraph 9.—Whilst we should be willing to co-operate with the London County Council in the steam disinfection of bedding (subject to the incidence of infectious disease and cleansing of school children permitting), this could only be done when the new Disinfecting Station is in operation as at present the existing plant is barely able to cope with the existing work. With regard to the suggestion that Borough Councils "would probably be able to allocate space near their disinfecting station for the HCN disinfestation of the furniture in the vans" I would point out that the Borough Council had very great difficulty in finding a small space where their vans for HCN treatment of furniture could be housed and there was no other site in the Borough. Paragraph 10.—No comments. I agree in general with the memorandum, but I definitely do not agree with the use of Hydrogen Cyanide Gas (prussic acid) for fumigation of houses, whether single houses, in rows, or block dwellings. In my opinion the Borough Council could not possibly undertake HCN fumigation of furniture in transit to London County Council flats even if the London County Council paid for such a service, as there is no site available in the Borough for the vans, etc. 2.—The Suggestions of the London County Council. The main suggestion of the London County Council in drawing the Borough Council's attention to section 7 of the enclosed memorandum and to the duties under the Public Health (London) Act, 1936, in respect of verminous premises and articles is to request consideration of the proposal that Borough Councils should, as soon as practicable, undertake the complete disinfestation of such premises and articles including the provision of temporary alternative accommodation. If by this the London County Council mean the treatment by Hydrogen Cyanide gas, then I think we are in a position to reply that we cannot undertake complete disinfestation by Hydrogen Cyanide gas, but confine the use of HCN for fumigation of furniture in transit from infested dwelling houses to our own Council flats, treating the bedding with steam; that in all other cases of infestation in the Borough we are at present carrying out as far as practicable the complete disinfestation of those premises by using either sulphur fumigation, a vermicide solution, the 144 lamp, or a combination of all three, combined with steam disinfection of bedding when this can be carried out. Further, that we would be prepared to assist the London CountyCouncil with steam disinfection of bedding on the lines set out in the communication referred to in Paragraph 9, when the new Disinfecting Station is built. 3—Action Taken at Present. As long ago as 1929 the Medical Officer of Health reported to the Public Health Committee that the destruction of bugs in occupied premises is one of the most difficult problems with which a Public Health Department is confronted. This is due to the life history and habits of the bug. The most powerful disinfectants can only be effective if and when they are applied directly to the bug so that the mere spraying of the surface with Solution "D" or any other disinfectant, whilst doing a certain amount of good, cannot be expected to be a remedy. In July 1932 a detailed report was submitted to the Committee outlining the procedure then carried out which, in the main, consists of steam disinfection of bedding, the removal of woodwork followed by the use of a blow-lamp and the use of Solution "D" as an insecticide. In September 1934 a Special Inspector for disinfestation work was appointed, and shortly afterwards the Council decided to employ a firm of fumigators to treat with Hydrogen Cyanide gas (prussic acid) furniture of families who were removing from bug-infested premises to Borough Council flats, at the same time the bedding was to be steam disinfected. Later a second Special Inspector was appointed, as it was found the first Inspector's whole time was taken up in dealing with Council property. The second Inspector is engaged in the general work of disinfestation of all dwelling houses in the Borough other than Poplar Borough Council and London County Council property. The methods used at present are still very much the same as those advocated in 1932—the removal of woodwork and tracing bug infestation, subsequent fumigation with sulphur in empty houses, the use of a certain insecticide (Solution "D") and the use of the blow-lamp when woodwork has been removed. 145 (a) For Council Properties. Steam disinfection of bedding and fumigation of furniture in transit with Hydrogen Cyanide gas (prussic acid). The latter is carried out by a firm of contractors. (b) For Houses Generally. Removal of woodwork and fumigation with sulphur where possible and the spraying of walls, woodwork, cracks and crevices, and furniture with Solution "D" combined with steam disinfection of bedding where possible. The following figures are of interest:— 1st January, 1935, to 31st December, 1936. Premises treated 860 Premises re-inspected 315 Premises found to be re-infested 95 Percentage of re-infestations 30 From April, 1935, to December, 1936. HCN treatment of furniture going into Poplar Borough Council flats:— Number of families concerned 225 Articles of furniture 5,046 The following instances arc quoted for comparison with the London County Council's statistics and report:— (1) Block 64 flats (Sumner House, P.B.C.) Occupied for 7 years. All tenants went in without any serious treatment of furniture or effects. Infestations 56-87 per cent. (2) Block 78 flats (Providence House, P.B.C.) Occupied since April 1935. Practically the effects of all the families were treated with HCN. Re-infestations 5-6.4 per cent. (3) Block 20 flats (Edgar House, P.B.C.) Occupied since June 1935. All tenants HCN treated. Re-infestations 6-30 per cent. The Committee, after consideration of the London County Council Memorandum and the Medical Officer of Health's report, agreed with the Memorandum in general but definitely did not agree with the use 146 of HCN gas for fumigation of houses, whether single houses, in rows, or block dwellings. The Committee also agreed that:— (a) The Borough Council are responsible for the treatment of bug-infested premises and effects in general, and since November, 1934, they have dealt with them by the removal of woodwork, the use of blow-lamps and Solution "D," and in certain cases, where practicable, fumigation by sulphur, at the same time offering steam disinfection; (b) It is necessary to have alternative accommodation available and power should be sought; (c) When the new Disinfecting Station is in full operation the Borough Council will be very glad, when required, to co-operate with the London County Council in having bedding steam disinfected, but they could not undertake HCN treatment of furniture in transit except for persons removing to Borough Council accommodation; (d) HCN to be reserved for treatment of furniture of infested families going to Borough Council accommodation, the work of fumigation being carried out by a firm of private contractors. 147 INDEX. Sections of the Report:— Page A. Statistics and Social Conditions 9 B. General Provision of Health Services 18 C. Sanitary Circumstances of the Area 23 D. Housing 47 E. Inspection and Supervision of Food 62 F. Infectious Disease 83 G. Maternity and Child Welfare 110 Age Mortality 16 Agricultural Produce (Grading and Marking) Act, 1928 81 Altered Diagnosis Cases 93 Analysts' Report 78 Ante-natal Clinics, Attendances:— (a) Public Health Department 118 (b) Royal College of St. Katharine 136 Ante-natal Consultant Clinic at St. Andrew's Hospital 121 Anthrax 88 Antitoxin, quantity issued 83 Area, Population, etc. 9 Artificial Sunlight Treatment 132 Bacteriological Examinations 84 ,, Examination of Milk 64 Bakehouses 69 Bed-bug Eradication 58 Births and Birth Rates 9, 13, 16 Blindness, Prevention of 125 Butter and Margarine Factories 81 Canal Boats 34 Cancer, Deaths from 94 Cerebro-spinal Fever 89 Child Life Protection 129 Cleansing Station 105 Clinics, M. & C.W Facing 110 Clinics, Tuberculosis 95 Combined Drainage 25 Committees 3 Common Lodging Houses 28 Consultants:— 1. Puerperal Fever, etc. 89 2. Obstetric 129 Continued and Typhus Fevers 89 ConvalescentTreatment 122 Co-operation with Voluntary Organisations, etc. 113 Coroner's Court 17 Cowsheds 62 Customs and Inland Revenue Acts, Certificates 32 Day Nursery 113 Deaths and Death Rates 9-16 Deaths, Classified Causes, Table Facing 11 ,, Infantile, Table 12 Dentists'Reports 99, 137 Diarrhoea and Enteritis, Deaths 10 Diphtheria 83 148 INDEX—(continued). Page Diphtheria Immunisation 83 Disinfectant, Electrolytic 105 Disinfecting Department 104 Disinfestation .. .. .. 58 and Appendix 141 Dysentery 93 Electrolytic Disinfecting Fluid 105 Encephalitis Lethargica 89 Enteric Fever 84 Erysipelas 89 Exhumations 34 Export of Meat Foods 82 Factory and Workshop Acts—Tables 35-38 Food, Supervision of 62 Food and Drugs Acts, etc. 76 Food Inspectors'Reports 70-75 Food Poisoning 81 Formalin in foods 78 Free Milk Scheme 139 Fumigation by HCN 58 Glanders 88 Hairdressers'Premises 34 Health Campaign, National 109 Health Education 107 ,, Servioes 18 ,, Visitor, Chief, Report of 116 Home Nursing 126 Home Visiting Summary 120 Homeless Persons, Census 28 Houses Let in Lodgings 27 Housing 47 Hydrophobia in Man 88 Ice Cream 67 Infant Life Protection 129 Infantile Mortality 10,12,13 Infectious Diseases. Table of Notitications Facing 83 Infirm Persons, Removal 44 Inhabited Houses 9 Inquests 17 Invalid Children's Aid Association 114 Lady Sanitary Inspector, Report 26 Lectures on Health Subjects 107 Legal Proceedings, etc. 39 Legislation 22 Malaria 92 Marriages 10 Maternal Mortality 10,14,127 Maternity and Child Welfare 110 Measles 92 Meat Food Products, Certification 82 Meat Inspect ion Facing 67 Merchandise Marks Act 81 Midwives' Fees and Compensations 122 149 INDEX—(continued). Page Milk, Bacteriological and Biological Examinations 64. 65 Milkshops, etc. 62 Mortuary 17 Motor Vehicles 105 Neo-Natal Deaths 12, 13 Notifications of Infectious Diseases, Table Facing 83 Observation Wards 130 Offensive Trades 31 Ophthalmia Neonatorum 93-124 Overcrowding 56 Parliamentary Wards, Statistics Map Facing 8 Pharmacy and Poisons Act 82 Plague 88 Pneumonia 92 Poliomyelitis, etc 89 Poor Law Relief, etc. 20 Population 9 Post-vaccinal Encephalitis, etc. 92 Preserved Foods. Manufacture 81 Public Cleansing Services, etc. 23 Public Education in Health 107 Puerperal Fever and Puerperal Pyrexia 89 Queen Mary Day Nursery, etc. 113 Rag and Bone Dealers 31 Rag Flock Act 34 Rags for Export 34 Rats and Mice Destruction Act 32 Refuse Disposal 23 Removal of Infirm Persons 44 Rent Restriction Acts, Certificates 32 Reports:— Artificial Sunlight Clinics, Medical Officer 132 Chief Health Visitor 116 Dental Surgeon (M. & C.W.) 137 Dental Surgeon (Tuberculosis) 99 Lecturer on Health Subjects 107 Observation Wards, Consulting Physician 130 Public Analyst 78 Royal College of St. Katharine, Senior Medical Officer 134 Tuberculosis Officer 95 Royal College of St. Katharine 134 Samples under Food and Drugs Act 76 Sanitary Inspectors'Work, Summaries 26-29 Scarlet Fever 83 Scavenging, Street Cleansing, etc. 23 Schools, Inspection of 34 ,, Use of Electrolytic Fluid in 106 Seamen's Lodging Houses 28 Shops Act 29 Slaughterer of Poultry 68 Slaughterhouses 68 Smallpox 85 150 INDEX—(continued). Page Smoke Nuisances 9 Stables 32 Staff 4 Stillbirths 9, 124 Street Cleansing, etc. 23 Street Trading 32 Swimming Baths, etc. 30 Tables of Deaths 1-16 ,, of fnfectious Diseases Facing 83 Tubercle bacilli in Milk, Examinations for 65 Tuberculosis, Death Rate 16 ,, Deaths 103 ,, Notifications, eto. 102,103 ,, Officer's Report 95 Typhoid and Paratyphoid Fevers. 84 Underground Rooms 53 Unhealthy Areas 1 Urinals on Licensed Premises 31 Vaccination 86-88 Verminous Children and Persons 106, 107 ,, Rooms 57 Vital Statistics, Summary „ ,, Tables Wards Statistics, Map Facing 8 Water Certificates 31 Workshops, Workplaces, etc. (Tables) 35-38 Zymotic Diseases, Death Rate 16 ,, Enteritis — 92 and 125