With 1 the Compliments of the Medical Officer of Health. fare. Southwark Town Hall, Walworth Road, S.E.17. * Borough of Southwark. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1931. William Stott, m.b., b.s., d.p.h., Medical Officer of Health, Administrative Tuberculosis Officer, Administrative Officer for Maternity and Child Welfare. LONDON: Crusha 6s Son, Ltd., Tottenham, Enfield and Wood Green. INDEX. A. Page Acts and Bye-Laws 38-39 Acute Influenzal Pneumonia 81 Acute Primary Pneumonia 81 Ambulance Services 9 Ante-Natal Clinics 87-89, 93 Area of Borough 3. 11 Artificial Cream Act, 1929 68 Agricultural Produce (Grading and Marking) Act 37 B. Bacteriological Specimens 97 Bakehouses 67, 68 Births 11,13 ,, Illegitimate 3 Birth-rates 12, 13 Black Smoke 39, 40 Blind Persons Act, 1920 81 Butter and Margarine Factories 68 C. Cancer 81 Census 4, 10 Cerebro-spinal Fever 81 Children's Act, 1908 9 Clinics 7 Convalescent Treatment 89 Coroners' Courts 47 Cowsheds 67 Customs and Inland Revenue Act, 1890 40 D. Day Nurseries 8 Deaths 13, 14, 19 Deaths. Causes of, Table 19 ,, Infants 20, 21 ,, In Public Institutions 14-17 ,, In Wards 13 ,, Zymotic Mortality 24 Death Rates 13, 15, 16 Density of Population 11 Diarrhoea 79, 80 Diphtheria 75 ,, Prevention 75 ii Page Diphtheria Schick Test 75-79 ,, Anti-toxin 75 Disinfection 85, 86 E. Eating Houses 43 Encephalitis Lethargica 81 Enteric Fever . . 75 F. Factories and Workshops 41-43 Families 3 Food and Drugs, Tables of Samples 70-72 Food Inspection and Tables 54-64 G. General Hospitals 5 Graded Milk 66 H. Health Services, Hospitals, etc. 5-7 ,, Visitors, Summary 94-96 ,, Visiting 9, 86 House-to-house Inspections 26, 27 Housing 32, 33, 48-52 ,, and Town Planning Act 40 Houses let in Lodgings 40 Home Workers, Table 42 I Ice Cream Regulations 37 Infant Mortality 13, 20, 21 ,, ,, of Illegitimates 3 Infectious Diseases, Control of 74 Influenza 80 Informal Samples 73 Inhabited Dwellings 3 Inspections 28, 29 L. Laboratory Facilities 9, 97 Laundries 43 Legal Proceedings 34-36, 69, 73 London County Council Bye-Laws 39 iii M. Page Maternity and Child Welfare Centres 86, 90-92, 94, 95 Nursing Homes 9 Maternal Mortality 9, 89 Measles 79 "Merchandise Marks" Act 37 Midwives 8 Milk and Dairies (Amendment) Act, 1922 65, 66 Milksellers 66 Mortality Statistics 19-25 Mortuaries 47 Municipal Day Nursery 8 N. Notices served 28-29 Notifiable Diseases 84 Nursing in the Home 8 O. Offensive Trades 67 Ophthalmia Neonatorum 80-81 Orthopoedic Clinics 8 P. Paratyphoid B. Fever 75 Part-time Officers 4 Population 10 ,, in Wards 11 Poliomyelitis 81 Puerperal Fever 80 ,, , Pyrexia 80 ,, Sepsis, Deaths 89 Public Health Officers 4-5 ,, ,, (Condensed Milk) Regulations, 1923 and 1927 68 ., ,, (Dried Milk) Regulations, 1923 and 1927 68 ,, ., (Preservatives in Food) Regulations, 1925 97 ,, ,, (Meat) Regulations, 1924 53 Public Vaccinators 5 R. Rag Flock Acts, 1911 and 1928 37 Rateable Value 3 Rats and Mice (Destruction) Act 44 Reception House, Families Admitted 82-83 Registered Births and Deaths 18 iv S. Page Sale of Food and Drugs Acts 69 Scabies 46 Scarlet Fever 74 Schick Test and Inoculation against Diphtheria 75-79 School Clinics 8 Slaughterhouses 53 Smoke Abatement 39-40 Smallpox 74 Separate Occupiers 3 Sputum, Examinations of 9, 97 Sunlight Treatment 89 Southwark Invalid Kitchens Society 90 Statistics and Social Conditions 3 Still Births . . 3 T. Tuberculosis . . 97-108 U. Underground Bakehouses 43, 68 Unmarried Mothers 9 Unsound Food 54-64 Ultra-Violet Rays Treatment 89 y. Vaccination Acts . ■ ■ ■ 25 Vaccination Officers 5 Venereal Disease Clinics 8 Verminous Persons and Children 46, 47 ,, Rooms and Bedding 45, 46 Vital Statistics, Summary of 3 Table 22-23 W. Water Supply (P.H. Act, Sec. 48) (L.C.C. G.P. Act, 1907) 40, 41 Whooping Cough 80 Workshops (Women's) 43 Works Completed 30, 31 Z. Zymotic Mortality 24 borough of Southwark. Public Health Department, Town Hall, Walworth Road, S.E.I7. To His Worship the Mayor, Aldermen and Councillors, Sir, Ladies and Gentlemen, I have the honour to present the Annual Report on the Health of your Borough for the year 1931 and, in so doing, I wish to place on record the death of your late Medical Officer, Dr. H. Wilson, in August, whom I succeeded in October. The Health of the Borough for the period under review was good, there being fewer epidemic diseases than for many years previous and fewer deaths from these diseases than ever before recorded. In spite of the above facts, the Crude Death Rate has increased to 14 as compared with 12-5 for the previous year; this is accounted for by a large increase in the number of deaths in the age period over 65 years of age, there being 200 more deaths in this age group than in the previous year. The estimated population figure has considerably decreased, there being 5,600 less persons than in 1929; nevertheless the birth-rate remained steady at 16-9. Infant mortality rate of 61 is extremely satisfactory and speaks well for the Maternity and Child Welfare services functioning in this Borough. The Maternal Mortality figure of 3.3 per 1,000 total births compares favourably with that for England and Wales which returns a figure of 3-95 per 1,000 total births. The Housing conditions in the Borough are receiving the special attention of the Council. Since coming into office, I have represented to you 10 small areas, comprising 373 dwellings, suitable for clearance and re-housing schemes concerning which, further remarks will be found under the appropriate headings. The London County Council granted housing accommodation to 161 Southwark families on grounds of health or serious overcrowding. 2 A very successful Health Week and Health Exhibition was organised by the Council and held from October 19th to the 24th. Your efforts were greatly appreciated by the citizens of the Borough, as indicated by the large attendance which numbered 23,824 persons. In conclusion, I wish to thank the various Chairmen and Committees on which I serve, for their i ndulgence and support. I also wish to place on record my appreciation of the ready help and advice given to me by the Town Clerk and other Chief Officials of the Council. To the Inspectoral and Clerical Staffs of the Health Department I tender my best thanks for their loyalty and support during the very difficult period of taking up a new appointment. I have the honour to be, Sir, Ladies and Gentlemen, Yours obediently, W. STOTT. 3 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 1,131 Population (Census, 1921) 184,404 Population (estimated, 1931) 172,900 Number of inhabited houses (1921) 26,496 Number of inhabited houses (end of 1931) according to rate books 26,382 Number of families or separate occupiers (Census, 1921) 46,727 Rateable value £1,301,551 Sum represented by penny rate £4,980 SOCIAL CONDITIONS. The northern end of this Borough is rapidly being commercialised, the industries chiefly represented being the warehouses and food factories on the river banks; within this area the printing trade is largely in evidence, while scattered through the Borough are engineering works of considerable size and well-known reputation. The Walworth area is largely inhabited by costermongers, and other districts are peopled by city workers and artizans. None of these occupations have any definite effect on the health of the people, which is quite up to the average for London. VITAL STATISTICS. Total. M. F. Live Births—Legitimate 2,792 1,412 1,380 Live Illegitimate Birth Rate, 16.9 Live Births—Illegitimate 136 79 57 Still Births, 99. Rate per 1,000 total births, 34. Deaths, 2,428. Death rate, 14.0 Percentage of total deaths occurring in public institutions, 66.9. Number of women dying in, or in consequence of childbirth:— From sepsis 5 Other causes 5 Death rate of infants under 1 year of age per 1,000 live births:— Legitimate 61 Illegitimate 88 Deaths from Measles (all ages) 3 Do. Whooping Cough (all ages) 18 Do. Diarrhoea (under 2 years of age) 16 No excessive or unusual mortality has occurred during the year. 4 PUBLIC HEALTH OFFICERS TO WHOSE SALARY CONTRIBUTION IS MADE. Horace Wilson, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H., Medical Officer of Health (to May 31st, 1931). E. Fairfield Thomas, M.D., Ch.B., D.P.H., Acting Medical Officer of Health (June 1st to September 30th, 1931). William Stott, M.B., B.S. (Hnrs.), D.P.H. (from October 1st, 1931). Margaret Bergin, M.B., B.Ch., B.A.O. (N.U.I.), D.P.H., Deputy Medical Officer of Health and Assistant Medical Officer, Maternity and Child Welfare. John T. Crowe, L.S.A., L.M.S.S.A., Tuberculosis Officer. Sanitary Inspectors. ‡ || G. Fisher (Senior Inspector). * ‡ || J. C. Nicholson (Food & Drugs Inspector). ‡ || J. A. Syms. ‡ || A. C. White. ‡ || W. H. Banham. ‡ || A. Ede. ‡ || H. E . Hattersley. || Cert. Sanitary Inspector. * 1st Class Engineer || J. R. Find ley. ‡ || H. S. Steele." ‡ || F. J. Bryant. ‡ || F. Mayhew. ‡ || S. Bowers. ‡ || G. H. Duffield (Assistant Food Inspector). || Margaret Burrows (Women's Workshops). ‡ Meat and other Foods. (Board of Trade.) Health Visitors. † * a Jane Holland (Superintendent) (to October 12th, 1931). || a Annie Rogers, † * a Clare Cottrill. * a Winifred Sayer. || * a Kathleen Hinde. * a Florence Adair, † * a Mary Freeth. † a Mary George. † * a Annie Kingsmill. || * a Winifred Cleverley. a Cert. Health Visitor. || Cert. Sanitary Inspector. * C.M.B. | Nursing. (1 Storekeeper. 1 Home Help.) Part Time Officers. Dorothy Shepherd, M.B., Ch.B., Maternity and Child Welfare Clinic. Arabella C. Stevens, M.B., B.Ch., B.A.O. do. do. Fredk. Porter-Smith, M.R.C.S., L.R.C.P., Schick Immunisation Clinic. 5 Public Vaccinators. P. O'Malley, M.B., B.Ch., B.A.O., N.U.I. G. G. Lawson, M.B., Ch.B., D.P.H. D. M. Clune, M.B., B.Ch., B.A.O., N.U.I. A. M. Foxe, M.B., B.Ch., B.A.O., N.U.I. Vaccination Officers. E.J. A. Holt. C. R. Fifer. Other Officers. Cyril Dickinson, B.Sc., F.I.C., F.C.S. (Public Analyst). Tuberculosis Dispensary. Secretary and Dispenser, Florence Nightingale (Certificate of Apothecaries Society, London). Nurses. M. E. Bennett, Cert, of Sanitary Institute, S.R.N. F. C. Rogers, C.M.B., S.R.N. F. K. Jay, C.M.B., S.R.N. GENERAL PROVISION OF HEALTH SERVICES. Hospitals.—Southwark is fortunately situated as regards hospital accommodation of all descriptions, and hospitals for infectious diseases and Tuberculosis cases are provided by the London County Council. The following General Hospitals are within the area:— Guy's Hospital. Evelina Hospital for Children. Royal Eye Hospital. The Hospitals available but beyond the borders are:— St. Thomas's Hospital. King's College Hospital. Royal Waterloo Hospital. General Lying-in Hospital, York Road. The Belgrave Hospital for Children. Guy's Hospital. Is situated within two minutes of London Bridge Station, contains 646 beds, of which the majority are allocated to general Medical and Surgical cases. Adequate accommodation is provided for the Special Departments, including Obstetrics and Gynaecology, 6 Children's Diseases; Diseases of the Eye, of the Ear, Nose and Throat, and of the Skin; Orthopaedics, Neurology, Genito-Urinary Diseases, etc. The Post-Mortem Room has recently been rebuilt, and new Clinical Laboratories have recently been completed. This hospital is largely used by the inhabitants of Southwark, roughly a fifth of the in-patients are from this Borough, and a very much larger proportion of the out-patients. Evelina Hospital, Southwark Bridge Road. For children, 80 cots. Royal Eye Hospital (London School of Ophthalmic Surgery), St. George's Circus, Southwark. 40 beds, 2 cots. St. Thomas's Hospital. This hospital is situated about J mile beyond the Southwark boundary, and contains 640 beds and a large well organised Outpatient Department. It is made considerable use of by Southwark patients who live adjacent to it or who find facilities for access easy. Its open situation makes it well known and adds to its popularity. Special Departments.—Diseases of the Eye, Ear, Throat, Skin, Teeth, and of Children, Nervous Diseases, Mental Diseases, Tuberculosis, Venereal Disease, Orthopaedic, Electrocardiographic, Massage, Electro-Therapeutic, Remedial Exercises, Radiology, also a Maternity Ward. King's College Hospital, Denmark Hill. Special and General Hospital, with 384 beds. Midwifery cases are attended at their own homes, and there is a Special Maternity Ward which is utilised by a few Southwark patients. Royal Waterloo Hospital, Waterloo Road. For Women and Children, 130 beds. Belgrave Hospital, 1. Clapham Road. For Children, 76 beds. General Lying-in Hospital, York Road. For Women, 45 beds. 255 Southwark mothers were treated at this hospital during 1931. Our Health Visitors are responsible for the supervision of the homes of these cases and the preparation for 7 their coming confinement; they are also followed up by our Health Visitors on their return from hospital. In addition to the above hospitals, facilities for confinement are also obtained at Newington Institution, where 149 mothers were treated during 1931, many of these cases coming from lodging houses, concerning which we had no information before the confinement. Ambulance Services are provided by the London County Council for Infectious, Public Assistance cases, Accidents, and also for the transit of parturient women to hospitals. CLINICS AND TREATMENT CENTRES. (1) Maternity and Child Welfare.—There are in all fourteen Centres which may be classified as follows:— Municipal Centres (Eight)— Sutherland House, Sutherland Square (St. Mary's). — Sutherland House, Sutherland Square (St. Paul's). Boys' Club, Villa Street. All Saints' Parish Room, Surrey Square. Lady Margaret Parish Room, Chatham Street. Lansdowne Place Mission Hall. St. George's Dispensary, Pocock Street. St. Mary's Girls' Club, Union Street. Partly Municipal, Partly Voluntary (Two)— Crossways Mission, New Kent Road. Welfare Centre, 56, Lambeth Road. Wholly Voluntary (Four)— St. John's Institute, Larcom Street. Roman Catholic Centre, 148, New Kent Road. Salamon's Centre, Newcomen Street. St. George's Welfare Centre (86, Borough Road). Ante-Natal Clinics— Sutherland House, Monday, 10 a.m. (Dr. D. Shepherd.) Sutherland House, Friday, 10 a.m. (Dr. M. Bergin.) 56, Lambeth Road, 1 session monthly. (Dr. D. Shepherd.) 8 (2) Day Nurseries.— There are 3 in the Borough. One is Municipal,, and is situated at 63, Kennington Park Road. This accommodates 45 children and is supervised by a Committee of Nursery Managers, a SubCommittee of the Maternity and Child AVelfare Committee. The number of attendances during the year was 7,845. Guy's Hospital have in connection with their Maternity scheme a Day Nursery which is used by children from Southwark and Bermondsey, and has accommodation for 40 children. The number of attendances during the year was 7,900. Crossways Mission, New Kent Road, has a Day Nursery accommodating 46 children, and the number of attendances during the year was 9,479. (3) School Clinics.-—As all the children attending the centres are under 5 years of age, there is no connection with the School Medical Service until they are transferred to school. (4) Orthopaedic Clinics.—This is undertaken by the London County Council and the General Hospitals in the Borough. (5) Tuberculosis Dispensary.—The Municipal Dispensary is at 82 and 84, Newington Causeway. (6) Schick Immunisation Clinic —Sutherland House. Sessions every Thursday afternoon at 2.30. (7) Venereal Disease Clinics .—These are held at the General Hospitals, they are free and are conducted under conditions of secrecy. The times of attendances may be obtained on application to the Medical Officer of Health, and they are also displayed in the Public Conveniences. NURSING IN THE HOME. General Nursing is carried out by the Ranyard Nurses, the Benson Nursing Association (which is subsidised by the Newington Charities to the extent of £400 per annum) and the Catholic Nursing Home, 60, Lambeth Road. A few parishes also have their own private nurses. Infectious diseases are not nursed in their own homes, but cases of puerperal pyrexia are nursed at home if necessary by arrangement with one of the aforesaid Associations. MIDWIVES. The number of midwives practising in the Borough is approximately 56. 9 No arrangements have been made for the employment of, or for subsidising midwives. LABORATORY FACILITIES. The examination or analysis of clinical matter (sputum, swabs, etc.), water, milk and foodstuffs are made by the Borough Analyst, who is a whole-time Officer of the Council. MATERNITY AND NURSING HOMES. There are no Municipal Maternity and Nursing Homes in the Borough. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ETC. Cases coming to the knowledge of the Medical Officer of Health are referred to the Southwark Diocesan Society to which the Council have this year made a grant of £'27. AMBULANCE FACILITIES. The arrangement for the removal of (a) infectious cases, (b) maternity patients, are satisfactory, and no change has been made during the year. MATERNAL MORTALITY. The Council have made full provision for expectant and nursing mothers by the establishment of Ante-Natal Clinics, Consultants and Nurses for cases of Puerperal Fever and Puerperal Pyrexia, sterilised maternity outfits and the appointment of a whole-time home help. In addition, the Borough is well served by general and lying-in hospitals. HEALTH VISITING. The arrangements made for visiting of children between the ages •of 1 and 5 years will be found on pages 86 and 87 (Maternity and Child Welfare Services). CHILDREN'S ACT, 1908. The functions under Part I of this Act are at present being carried out by the London County Council. 10 POPULATION. At the end of the year 1930, the Registrar-General intimated that in computing his estimate of population for mid-year, 1930, he intended to take into account the populations as ascertained by the 1931 Census. At the present time (February, 1932) the enumerated population is not to hand, but the Registrar-General has sent me an "estimated resident" population for mid-year, 1931, which is 172,900. This is no doubt very near to the Census figure, and the rates in my report have been calculated on this number. It will be seen by the Table hereunder that the population of the Borough has been steadily decreasing, which may be accounted for by the various clearance schemes undertaken during the last few years, in which dislodged persons have been accommodated on estates outside Southwark. The Census returns will no doubt show that the diminution in the number of inhabitants has not been uniform throughout the Borough, but that the northern end or riverside districts will have suffered most in this respect. This is accounted for by the fact that this portion of the Borough is becoming more commercialised each year. The population of the several divisions of the Borough at each Census since 1851, and also the estimated population for 1922, 1923, 1924, 1925, 1926, 1927, 1928, 1929, 1930 and 1931 are as follows:— Newiugton. St. George's. St. Savior's and Christchurch. 1851 64,816 51,824 35,731 1861 82,157 55,510 36,169 1871 88,691 56,083 31,294 1881 107,831 58,652 31,628 1891 115,663 59,740 27,116 1901 121,863 60,998 23,319 1911 116,819 55,782 19,316 1921 114,987 52,114 17,303 1922 116,683 52,996 17,541 1923 117,200 52,690 17,574 1924 117,500 52,610 17,604 1925 118,300 52,980 17,720 1926 118,120 52,760 17,720 1927 115,500 51,650 17,100 1928 113,850 50,730 16,720 1929 112,350 49,900 16,250 1930 112,350 49,900 16,250 1931 108,431 48,928 15,541 11 The Ward distribution was as follows:— TABLE 1. WARD. Area in Acres. Population. Persons to the Acre. Males. Females. Total. St. Mary 127 10,878 10,799 21,677 171 St. Paul 133 8,924 9,429 18,353 138 St. Peter 90 8,940 7,774 16,714 186 St. John 85 8,814 10,298 19,112 237 Trinity 109 7,725 7,627 15,352 141 All Saints 89 8,064 9,159 17,223 194 St. Michael 93 9,783 9.602 19,385 208 St. Jude 97 6,285 6,511 12,796 132 St. George 98 8,240 8,507 16,747 171 Christchurch 77 3,630 3,313 6,943 90 St. Saviour 133 4,001 4,597 8,598 65 Whole Borough 1,131 85,284 87,616 172,900 153 BIRTHS. The number of Births registered in the Borough during 1931 was 2,544, of which 1,296 were males, and 1,248 females. This represents a birth-rate of 14.7 per 1,000 inhabitants. The number of births registered in the individual parishes was as follows:—Newington, 1,322; St. George the Martyr, 596; Christchurch and St. Saviour's, 626. Of the 2,544 births registered in the Borough 292 were transferred away, the permanent residence of the parents being outside the Borough. 676 births occurring in various lying-in and other institutions outside the Borough, but belonging to Southwark parents, were notified to me by the Registrar-General. When the 292 "outward'' transfers are deducted and the 676 "inward" transfers are added to the 2,544 births actually registered in the Borough, the net amount of births belonging to Southwark for the year is found to be 2,928. This gives a corrected birth-rate of 16.9. 12 TABLE 2. Birth -rate for the last Thirty Years for the Three Divisions of the Borough as formerly existed. Newington. St. George's. St. Saviour's and Christchurch. Whole Borough. 1902 344 32.7 29.3 33.3 1903 33.3 31.3 30.0 32.3 1904 32.3 31.2 27.6 31.5 1905 30.3 30.6 26.2 30.0 1906 29.0 30.5 25.2 29.1 1907 29.1 29.2 25.1 28.7 1908 28.7 28.6 23.2 28.1 1909 27.7 27.5 23.0 28.3 1910 28.2 28.1 24.3 27.8 1911 29.0 31.7 27.9 29.6 1912 29.0 30.7 28.0 29.4 1913 31.8 32.7 26.0 31.5 1914 29.7 31.4 25.5 29.7 1915 28.8 30.2 29.2 29.2 1916 28.4 27.1 24.4 27.6 1917 25.2 24.8 20.2 24.6 1918 21.8 21.0 18.4 21.3 1919 24.1 23.6 16.8 23.2 1920 32.1 32.2 28.5 31.8 1921 27.7 28.7 21.3 27.3 1922 24.0 25.5 24.3 24.4 1923 23.9 25.4 23.7 24.3 1924 22.0 23.6 22.4 22.5 1925 20.1 23.9 21.1 21.2 1926 19.9 21.6 18.1 20.2 1927 18.6 20.6 17.4 19.0 1928 18.0 21.1 19.4 19.2 1929 17.4 20 .1 17.1 18.1 1930 16.0 18.6 16.4 16.8 1931 16.2 18.8 16.5 16.9 13 TABLE 3. Number of Births and Deaths belonging to each Ward, with the Birth and Death Rates, also the Infantile Mortality Rate, 1931. Ward Births. Infantile Mortality. Deaths. Males. Females. Total. Birth-rate. Males. Females. Total. Death-rate. St. Mary 181 169 350 16.1 63 207 148 355 16.4 St. Paul 160 149 309 16.8 52 138 123 261 14.2 St. Peter 105 125 230 13.8 52 102 82 184 11.0 St. John 170 174 344 18.0 58 108 115 223 11.7 Trinity 126 117 243 15.8 66 124 89 213 13.9 All Saints 130 147 277 16.1 61 145 111 256 14.5 St. Michael 175 142 317 16.4 63 159 141 300 15.5 St. Jude 148 124 272 21.3 62 108 88 196 15.3 St. George 171 159 330 19.7 61 114 93 207 12.4 Christchurch 62 63 125 18.0 72 72 53 125 18.0 St. Saviour 63 68 131 15.2 76 52 56 108 12.6 Borough 1491 1437 2928 16.9 61 1329 1099 2428 14.0 14 DEATHS. 1,750 deaths were registered in the sub-districts of the Borough during 1931. 27 of these deaths were of persons residing in other sanitary districts, but who died in our streets or on the way to hospitals. 920 deaths occurred in the Public Assistance Institutions, the various hospitals, and other public places for the treatment of the sick, found within our boundaries. These deaths in institutions comprised 415 belonging to Southwark and 505 to other sanitary districts. The number of inhabitants belonging to the Borough dying away from home—that is outside our boundaries in the various hospitals and infirmaries—was 1,210. When the 532 deaths of those persons who were non-parishioners, but who died in our Borough, have been deducted, and the 1.210 "out lying" deaths added, the actual or "corrected" number of deaths belonging to the sanitary area is found to be 2,428 of which number 1,329 were males and 1,099 females. The death-rate, when calculated on this "corrected" number, is 14.0 per 1,000 inhabitants for the whole Borough for the year 1931, as against a rate of 12.5 for 1930. The percentage of persons dying away from Southwark in relation to the total number of deaths belonging to the Borough was 49.8. The principal localities in which the "outlying" deaths occurred are as follows :— Southwark Hospital 589 Mental Hospitals 94 London County Council Hospitals 30 St. Thomas's Hospital 60 Lambeth Hospital 110 Belgrave Hospital 17 King's College Hospital 21 Royal Waterloo Hospital 13 In the Street and other Institutions 276 Total 1210 15 TABLE 4. Death Rates for the last Thirty Years for the Three Divisions of the Borough as formerly existed. Newington. St. George's. Christchurch and St. Saviour's. Whole Borough. 1902 20.4 24.0 22.5 21.7 1903 17.6 18.6 18.6 18.1 1904 19.0 21.4 21.6 20.0 1905 17.9 19.2 18.7 18.5 1906 17.8 18.5 17.5 18.0 1907 17.6 19.3 16.4 18.0 1908 16.1 17.2 14.3 16.3 1909 15.8 18.6 16.6 16.7 1910 15.9 15.6 16.5 15.9 1911 17.3 19.7 21.1 18.4 1912 15.8 18.5 17.4 16.8 1913 16.5 20.0 20.2 17.9 1914 16.5 19.6 20.7 17.8 1915 19.3 23.4 22.0 20.8 1916 16.5 18.4 17.3 17.1 1917 17.9 19.5 17.9 18.3 1918 22.9 23.7 23.1 23.2 1919 14.6 16.1 15.5 15.1 1920 14.4 14.6 12.9 14.4 1921 14.3 14.6 13.1 14.3 1922 15.2 16.1 15.4 15.5 1923 12.2 13.6 13.7 12.8 1924 13.5 15.3 15.1 14.2 1925 12.4 13.8 15.5 13.1 1926 12.3 13.3 14.1 12.7 1927 13.0 14.3 13.3 13.4 1928 12.3 13.4 13.8 12.7 1929 15.1 16.5 16.2 15.6 1930 12.6 12.8 11.2 12.5 1931 13.7 14.5 15.6 14.0 16 TABLE 5. Death Rates for the various Wards for the last Fifteen Years. Ward. 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. St. Mary 18.6 25.1 15.7 16.4 15.0 16.0 14.6 144 12.8 12.2 13.5 13.7 16.2 13.6 16.4 St. Paul 17.2 22.0 14.5 12.9 14.9 15.6 12.3 14.5 12.7 12.0 12.7 11.8 15.9 11.6 14 .2 St. Peter 17 .4 21.7 11.3 13.1 11.4 13.8 10.0 12.0 11.9 12.3 10.8 9.1 12.3 10 .1 11.0 St. John 18.0 21.0 14.0 14.2 14.3 16.5 12.8 14.0 13.8 13.0 13.6 13.4 17.1 14.4 11.7 Trinity 17.8 26.1 17.3 14.5 14.6 16.9 13.1 14.8 11.7 13.4 16.1 13.3 14.9 13.8 13.9 All Saints 16.6 21.8 15.0 15.2 15.4 12.8 10.4 11.8 11.2 10.9 11.6 11.5 13.8 11.7 14.5 St. Michael 19.1 23.1 15.4 14.4 15.7 17.4 14.2 16.7 15.6 14.2 14.6 14.7 17.2 13.7 15.5 St. Jude .. 20 .0 24.9 18.0 15.8 14.0 15.3 14.3 15.4 12.9 12.6 16 .1 13.4 18.2 13.1 15.3 St. George 19.8 23.7 15.7 14.1 13.8 15.1 12.4 13.5 12.4 12.9 126 11.8 14.5 11.5 12.4 Christchurch 20.8 25.1 16.9 14.5 14.4 17.9 16.0 19.2 18.2 16.6 13.3 16.5 17.5 13.4 18.0 St. Saviour 15.2 21.1 14.1 11.3 11.9 13.0 11.7 11.3 12.9 11.8 13.2 11.4 15.0 9.2 12.6 17 TABLE 6. Showing the number of Deaths that occurred in Public Institutions in the Borough during the year 1931. Institution. In 1st Quarter. In 2nd Quarter. In 3rd Quarter. In 4th Quarter. During Year. Newington Institution 90 59 39 70 258 Evelina Hospital 18 12 6 8 44 Guy's Hospital 181 144 123 162 610 60, Lambeth Road (Catholic Nursing Home) 1 2 1 — 4 Royal Eye Hospital — — — 3 3 Other Addresses — — 1 1 Total 290 217 169 244 920 18 TABLE 7. Births and Deaths Registered in the Sub -Districts of the Borough in 1931. First Quarter. Second Quarter. Sub-Districts. Births. Deaths. Sub-Districts. Births. Deaths. Male. Female. Male. Female. Male, Female. Male. Female. Newington 188 201 147 168 Newington 173 169 83 84 St. George the Martyr, West 85 76 50 63 St. George the Martyr, West 94 63 32 23 Christchurch and St. Saviour 73 78 139 78 Christchurch and St. Saviour 84 68 103 59 Totals 346 355 336 309 Totals 351 300 218 166 Third Quarter. Fourth Quarter. Newington 167 173 55 67 Newington 128 123 100 90 St. George the Martvr, West 67 73 15 17 St. George the Martyr, West 68 70 31 29 Christchurch and St. Saviour 77 73 83 55 Christchurch and St. Saviour 92 81 107 72 Totals 311 319 153 139 Totals 288 274 238 191 Births. Deaths. In 1st Quarter m. f. m. f. 346 355 336 309 In 2nd Quarter 351 300 218 166 In 3rd Quarter 311 319 153 139 In 4th Quarter 288 274 238 191 Totals 1296 1248 945 805 19 TABLE 8. Deaths belonging to the Sanitary Area, with the Causes of Death at all Ages during 1931. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Institutions. All Ages. 0. 1. 2. 5. 15. 25. 35. 45. 55. 65. 75. All causes 2428 179 44 30 69 123 88 137 278 416 574 490 — 1. Enteric Fever 1 — — — — 1 — — — — — — — 2. Measles 3 1 1 1 — — — — — — — — 1 3. Scarlet Fever 3 1 — 1 — 1 — — — — — — 1 4. Whooping Cough 18 10 5 3 — — — — — — — — 4 5. Diphtheria 8 — 2 3 1 2 — — — — — — 3 6. Influenza 35 1 — — — 1 3 5 5 12 6 2 3 7. Encephalitis Lethargica 1 — — — — 1 — — — — — — — 8. Cerebro-Spinal Fever 10 1 4 1 1 1 — 1 — 1 — — 7 9. Phthisis (Pulmonary Tuberculosis) 208 — 2 1 5 43 29 30 41 44 13 — 16 10. Other Tuberculous Diseases 28 1 2 1 8 7 2 2 3 1 1 15 11. Syphilis 6 — — — — — — 1 3 2 — — — 12. Gen. Paralysis of Insane, Tabes Dorsalis 12 — — — — — — 5 2 4 1 — — 13 . Cancer, Malignant Disease 290 — — 1 2 — 10 18 51 78 90 40 122 14. Diabetes 17 — — — — — 1 — 3 4 7 2 4 15. Cerebral Haemorrhage 67 — — — — — — 4 5 15 32 11 12 16. Heart Disease 676 — — 1 3 16 11 19 50 94 223 259 222 17. Aneurysm 8 — — — — — — — 2 2 3 1 — 18. Other Circulatory Diseases 84 — — — — — — — 5 21 26 32 41 19. Bronchitis 124 6 2 — — 2 2 5 9 14 41 43 21 20. Pneumonia (all forms) 204 43 15 9 10 4 10 13 23 30 32 15 69 21. Other Respiratory Diseases 20 — 1 2 — 1 — 1 5 6 3 1 — 22. Peptic Ulcer 24 — — — — — 1 4 4 5 8 2 27 23. Diarrhoea, etc. 18 13 3 — — — — — — — — — 11 24. Appendicitis 10 1 — 1 3 1 1 1 — 1 1 12 25. Cirrhosis of Liver 5 — — — — — — — 2 3 — — 3 26. Other Diseases of Liver 3 — — — — — — 1 1 — 1 — — 27. Other Digestive Diseases 41 2 1 — 4 — 2 3 5 9 7 8 — 28. Nephritis and Bright's Disease 119 — — — — 8 3 5 15 33 33 22 64 29. Puerperal Sepsis 5 — — — — 2 1 2 — — — — 3 30. Other Puerperal Causes 5 — — — — 1 2 2 — — — — 2 31. Congenital Debility and Malformation, including Premature Birth, etc. 82 79 — 1 2 — — — — — — — 35 32. Senility 19 — — — — — — — — — 1 18 — 33. Suicide 17 — — — — 1 — 3 6 4 3 — 4 34. Other Violence 90 3 2 1 11 13 1 4 15 12 15 13 54 35. Other Defined Diseases 166 18 3 4 21 15 9 8 20 22 26 20 — 36. Diseases ill-defined or unknown 1 — — — — — — — — — 1 — 164 Totals 2428 179 44 30 69 123 88 137 278 416 574 490 920 20 TABLE 9. DEATHS OF INFANTS UNDER ONE YEAR OF AGE. The deaths of Infants under one year of age to 1,000 births were 61 during the year 1931. The deaths under one year of age to 1,000 births for the last thirty years were as follows:— 1902 166 1917 111 1903 148 1918 124 1904 174 1919 95 1905 148 1920 86 1906 144 1921 90 1907 142 1922 79 1908 131 1923 68 1909 119 1924 71 1910 115 1925 77 1911 145 1926 70 1912 105 1927 61 1913 115 1928 70 1914 123 1929 81 1915 132 1930 57 1916 98 1931 61 The average number of Infantile deaths for the last thirty years is 108. 21 TABLE 10. BOROUGH OF SOUTHWARK. INFANT MORTALITY, 1931. Nett Deaths from stated causes at various ages under 1 Year of age. CAUSE OF DEATH. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 month. 4 weeks and under 3 Months 3 Months and under 6 6 Months and under 9 9 Months and under 12. Total Deaths under 1 Year. All causes 47 9 8 7 71 34 33 16 25 179 Measles — — — — — — — — 1 1 Diphtheria — — — — — — — — — — Whooping Cough — — — — — 1 4 3 2 10 Diarrhœa — — — 2 2 4 4 1 2 13 Enteritis — — — — — — — — — — Influenza — — — — — — — — 1 1 Cerebro-Spinal Fever — — — — — — — 1 — 1 Scarlet Fever — — — — — — — — 1 1 Tuberculous Meningitis — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — Other Tuberculosis 1 Congenital Malformations 7 — 1 1 9 5 4 1 2 21 Premature Birth 23 4 — — 27 3 — — — 30 Atrophy, Debility and Marasmus 3 — 1 — 4 6 5 1 — 16 Atelectasis 7 1 — — 8 1 — — — 9 Erysipelas — — — — — — 1 — — 1 Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Meningitis — — 1 — 1 1 — 1 — 3 Laryngitis — — — — — — — — — — Convulsions 3 — — — 3 — — — — 3 Gastritis — — — — — — — — — — Intussusception — — — — — — 1 — — 1 Dentition — — — — — — — — —— — Dermatitis — — — — — — — — — — Bronchitis — 1 — — 1 — 2 1 2 6 Pneumonia — 2 3 1 6 3 5 2 7 23 Broncho-Pneumonia — — 1 — 1 7 2 3 5 18 Lobar-Pneumonia — — — — — — 1 — 1 2 Suffocation (overlying) — — — 1 1 1 — — — 2 Accident (other) — — — — — 1 — — — 1 Nephritis, Acute — — — — — — — — — — Icterus Neonatorum 1 — — — 1 — — — — 1 Septic Pyaemia — — — — — 1 — — — 1 Otitis and Mastoiditis — — — — — — — — — — Other Causes 3 1 1 2 7 — 3 2 1 13 Not classified above — — — — — — — — — — 47 9 8 7 71 34 33 16 25 179 Nett Births in the year Legitimate 2792 Illegitimate 136 Nett Deaths in the year Legitimate Infants 167 Illegitimate Infants 12 22 23 TABLE 11. Vital Statistics of Separate Localities in 1931 and previous years. BOROUGH OF SOUTHWARK. Names of Localities . 1. St. Mary's Ward. 2. St. Paul's Ward. 3. St. Peter's District. 4. St. John's District. 5. Trinity Ward. 6. All Saints' District. Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 1921 21,570 529 324 54 19,053 439 284 35 17,846 451 204 35 20,500 610 294 52 15,560 481 227 36 18,677 626 287 58 1922 22,882 448 366 47 19,362 386 302 27 17,370 408 239 35 19,218 554 317 49 16,315 456 275 35 21,536 546 275 31 1923 22,934 524 335 41 19,429 408 237 23 17,458 375 175 18 19,314 513 247 37 16,409 449 215 31 21,656 534 225 32 1924 22,992 461 330 31 19,479 396 282 34 17,502 326 210 29 19,364 498 271 31 16,451 418 243 26 21,712 485 256 33 1925 23,154 440 298 35 19,561 363 248 21 17,619 329 210 27 19,538 451 269 46 16,566 354 194 26 21,862 441 244 30 1926 23,119 417 283 34 19,532 399 235 30 17,592 308 217 14 19,509 446 253 20 16,451 358 222 15 21,827 420 239 33 1927 22,598 373 304 25 19,100 360 243 18 17,204 272 186 20 19,077 424 259 18 16,174 337 261 12 21,347 381 247 31 1928 22,274 427 305 24 18,827 276 223 21 16,960 259 166 19 18,806 414 252 35 15,942 302 212 19 21,041 370 243 23 1929 21,981 347 357 18 18,579 330 295 18 16,736 297 206 26 18,559 378 317 36 15,731 288 235 19 20,763 315 287 29 1930 21,981 327 300 19 18,579 285 216 16 16,736 247 169 11 18,559 371 268 21 15,732 280 217 18 20,763 292 243 16 Averages of Years 1921 to 1930 22,548 429 320 33 18,150 364 256 2??? 17,302 327 198 23 19,144 466 275 34 16,142 372 230 24 21,118 441 255 32 1931 21,677 350 355 22 18,353 309 261 16 16,714 230 184 12 19,112 344 223 20 15,352 243 213 16 17,223 277 256 17 7. St. Michael's Ward. 8. St. Jude's Ward. 9. St. George's Ward. 10. Christchurch Ward. 11. St. Saviour's Ward. 1921 21,895 541 342 53 13,130 335 184 34 17,413 627 241 52 9,230 189 133 21 9,514 210 113 21 .. .. .. .. 1922 20,795 517 362 40 14,012 273 215 27 18,189 562 275 40 8,389 184 150 9 9,152 242 119 23 .. .. .. .. 1923 20,683 522 293 47 13,939 341 199 23 18,068 476 224 36 8,401 217 l34 14 9,173 199 107 10 .. .. .. .. 1924 20,644 442 345 42 13,912 342 214 19 18,045 458 244 31 8,424 207 162 13 9,180 187 104 14 .. .. .. .. 1925 20,788 468 324 44 14,018 334 181 18 18,174 463 227 34 8,478 197 154 15 8,242 177 119 13 .. .. .. .. 1926 20,702 425 294 39 13,961 311 176 25 18,097 405 234 34 8,480 170 141 13 9,240 151 109 8 .. .. .. .. 1927 20,264 434 295 20 13,666 265 220 23 17,720 364 223 28 8,183 155 109 8 8,917 143 118 12 .. .. .. .. 1928 19,903 404 292 28 13,523 290 181 21 17,304 410 205 13 8,000 152 132 15 8,720 172 99 7 .. .. .. .. 1929 19,577 338 337 33 13,302 279 242 28 17,021 386 246 30 7,775 150 136 16 8,475 128 127 10 .. .. .. .. 1930 19,577 366 268 24 13,302 246 174 17 17,021 316 195 17 7,775 119 104 5 8,475 148 78 8 .. .. .. .. Averages of Years 1921 to 1930 20,483 446 315 37 13,676 302 199 23 17,705 447 241 31 8,313 174 135 13 9,009 176 109 13 .. .. .. .. 1931 19,385 317 300 20 12,796 272 196 17 16,747 330 207 20 6,943 125 125 9 8,598 131 108 10 .. .. .. .. 24 TABLE 12. Deaths in the Sanitary Area from the principal Zymotic Diseases in the various Wards for 1931. WARD OR DISTRICT. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. St. Mary - - 1 - 2 1 1 St. Paul - - - 2 3 - 1 St. Peter - - - 2 - - 2 St. John - 1 - - 2 - 5 Trinity - - - 2 - - - All Saints - - - - 3 - 1 St. Michael - 1 - 1 3 - 1 St. Jude - - - - 3 - 1 St. George - 1 - - - - 2 Christchurch - - - - 2 - 2 St. Saviour - — 2 1 — - 2 Borough - 3 3 8 18 1 18 TABLE 13. ZYMOTIC MORTALITY FOR THE SANITARY AREA, 1931. Showing the localities where the deaths occurred. Locality. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. The Borough — 2 1 2 5 — 4 Southwark Hospital — — — I — 1 1 London County Council Hospitals — 1 2 5 10 — 1 Newington Institution — — — — — — — Evelina Hospital — — — — 2 — 2 Guy's Hospital — — — — — — 1 St. Thomas's Hospital — — — — — — — Belgrave Hospital — — — — — — 1 Royal Waterloo — — — — 1 — 3 Other Addresses — — — — — — 5 Total — 3 3 8 18 1 18 25 TABLE 14. Vaccination Officers' Return respecting the Vaccination of Children whose Births were Registered in 1930. Date. Registration subdistricts comprised in vaccination officers' district. Number of births returned in birth list sheets. Number of these births duly entered in Columns 1,2,4 and 5 of the vaccination register (birth list sheets), viz.:— Number of these births which are not entered in the vaccination register, on account (as shown by report book), of Column 1, successfully vaccinated. Column 2. Column 5, dead, unvaccinated. Postponement by medical certificate. Removed to other districts and notified to vaccination officers of the districts. Removal to places unknown, or which cannot be reached, and cases not having been Cases remaining or temporarily unaccounted for. Total number of certificates of successful vaccination received during the calendar Insusceptible of vaccination . Certificate of conscientious objection. 1930. 1 1 3 4 6 7 8 9 10 11 12 1st Jan. to 31st Dec. Northern Division 1,228 526 2 413 59 3 66 56 103 705 Southern Division 1,388 659 4 537 47 3 30 57 51 1,080 Total 2,616 1,185 6 950 106 6 96 113 154 1,785 26 SANITARY WORK. ST. MARY'S WARD. House-to-house inspections were carried out in the following localities:— Alberta Street, Ambergate Street, Berryfield Road, Borrett Road, Brook Street, Cavour Street, Dante Road, Delverton Road, Longville Road, Manor Place, Penton Place, Sherston Place, Suffield Road, Tarver Road. ST. PAUL'S WARD. Aldred Road, Finchley Road, Fleming Road, Goschen Street, Horsman Street, Montpelier Street, Olney Street, Royal Road. ST. PETER'S DISTRICT. Cancel Street, Faraday Street, Inville Road, Kingston Street, Liverpool Street, Mann Street, Phelp Street, Portland Street, South Street, Villa Street, Westmoreland Road. ST. JOHN'S DISTRICT. Bodley Street, Content Street, Munton Road, Pollock Road, Sayer Street. TRINITY WARD. Arch Street, Bath House, County Terrace Street, Dorset Street, Devonshire House, Harmers Buildings, Parel Place, Tarn Street, Upper Bland Street. ALL SAINTS' DISTRICT. Alvey Street, Ann's Buildings, Chatham Street, East Street, Faraday Street, Innis Place, Larissa Street, Lt. Chatham Place, Rodney Road, Shorncliffe Road, South Street Buildings, Wooler Street. ST. MICHAEL'S WARD. Bittern Street, Clandon Buildings, Gable Cottages, Gray Street, Gt. Suffolk Street, Ilfracombe Buildings, Jubilee Dwellings, King James 27 Street, Lancaster Street, Lt. Lant Street, Lt. Suffolk Street, Murphy Buildings, Nelson Place, Pocock Street, Priory Buildings, Redcross Street, Quilp Street. Rodney Street, Scovell Road, Sturge Street, Toulmin Street, Union Street, Victoria Buildings, Westminster Bridge Road. ST. JUDE'S WARD. Austral Street, Barbel Street, Borough Road, Gladstone Street, Hayles Street, Hayles Buildings, King Edward Street, Lambeth Road, Newington Causeway, Pineapple Buildings, St. George's Buildings, Southwark Bridge Road, Temple Street, White Horse Yard. ST. GEORGE'S WARD Beehive Cottages, Congreve Street, Cornbury Street, Dover Buildings, Kingsley Buildings. Laytons Grove, McBean's Buildings, Mailing Place, Mermaid Court, Minnow Street, Surrey Villas, Waleran Buildings. CHRISTCHURCH WARD. Blackfriars Road, Cavan Terrace, Dolben Street, Gt. Charlotte Street, Isabella Street, Jane Street, Milton House. Nelson House, New Cut, Ufford Street . ST. SAVIOUR'S WARD. Borough High Street, Farnham Place, Holland Street, Martagon Flats, Mowbray Buildings, Nelson Buildings, Peabody Buildings, Stanhope Buildings, Wagstaff Buildings, Winchester Buildings, Zoar Street. 28 29 Inspections and Re-Inspections, and Notices served and Complied with under the Public Health and Housing Acts, during the Year 1931. TABLE 15. Complaints. House to House. Infectious Disease. Factories, workshops, Workplaces, Housing. Houses Let in Lodgings. Notices Served Notices Complied with. WARD or DISTRICT. Inspections. Drains Tested. Re-Inspections. Intimation Notices. P.H. Act. Housing Notices. Inspections. Drains Tested. Re-Inspections. Intimation Notices, P.H. Act. Housing Notices. Inspections. Drains tested. ! Re-Inspections. Intimation Notices, P.H. Act. Housing Notices. Inspections. Re -Inspections. Notices. Inspections. Re-Inspections. Informal Notices. Statutory Notices. Inspections. Re-Inspections. Intimation Notices, P.H. Act. Informal Housing Notices. April Cleansing. Statutory Notices. Intimation Notices, P.H. Act. Statutory, P.H. Act. Housing. P.H. Act. Housing. April Cleansing Notices. St. Mary Mr. Syms. 756 7 1953 496 123 530 — 2051 320 138 110 3 156 39 6 273 64 21 300 914 300 15 38 238 25 33 35 901 406 300 910 302 35 St. Paul Mr. Mayhew. 728 32 2207 496 78 411 — 1312 247 68 82 53 221 47 7 178 60 13 160 548 160 63 18 34 9 7 14 812 390 160 904 167 14 St. Peter Mr. Banham. 483 10 1360 324 37 594 — 946 245 21 90 4 90 37 3 112 59 18 66 93 66 9 26 83 18 5 21 642 278 66 686 61 21 St. John Mr. White. 635 13 2692 364 76 177 — 334 85 23 74 38 119 32 5 280 15 5 106 231 106 9 26 48 19 2 19 505 282 106 525 93 19 Trinity Mr. Findley. 713 7 3441 578 234 177 1 478 161 114 87 10 252 54 23 224 337 50 383 1563 383 70 13 123 15 12 27 858 405 383 853 353 27 All Saints Mr. Steele. 792 8 2956 590 125 309 — 847 186 31 92 53 186 41 10 140 71 21 185 847 185 16 31 213 16 19 31 854 244 185 877 183 31 St. Michael Mr. Hattersley 482 19 1659 330 62 383 9 1540 208 82 60 14 48 21 5 295 32 17 185 310 185 17 85 467 29 36 65 605 288 185 680 193 65 Queen's Buildings Mr. Bryant. 66 4 155 35 3 103 — 215 47 17 14 12 13 6 1 — — — 21 102 21 — — — — — — 88 37 21 95 18 — S. Jude Mr. Bryant. 553 23 2501 553 127 282 — 888 175 51 53 43 131 41 8 387 143 83 194 1080 194 64 13 57 12 8 13 864 318 194 866 205 13 St. George .. Mr. Ede. 700 35 2516 475 85 366 — 716 172 50 81 6 148 41 10 244 115 35 172 423 172 1 34 119 31 27 30 754 401 172 803 162 30 Christchurch Mr. Bowers. 186 10 712 135 23 116 1 545 59 11 40 22 59 14 1 214 46 25 55 185 55 — 51 75 24 20 33 257 207 55 236 59 33 St. Saviour Mr. Bowers. 200 13 807 84 10 263 — 523 63 13 45 20 48 11 — 257 120 35 25 113 25 — 8 6 1 2 4 194 133 25 207 39 4 Total 6294 181 22959 4460 983 3711 11 10395 1968 619 828 278 1471 384 79 2604 1062 323 1852 6409 1852 2S4 343 1463 199 171 292 7334 3389 1852 7642 1835 292 30 31 TABLE 16. Summary of Sanitary Works Completed under the Public Health Act, during the year 1931. WARD or DISTRICT. Drain reconstructed. Drain repaired. Drain Intercepted and Ventilated. Drain Unstopped. Gullies provided. Soilpipe provided or repaired. Closet provided. Closet Pan and Trap. Water apparatus repaired. Sink, Lav. & Waste Pipes. Rain Water Pipes repaired, etc. Water supply to upper floors Draw Tap on Main. New Water Supply. Roof and Gutters repaired. Paving repaired. Dampness abated. Rooms cleansed. Sub-Floor Ventilation. Basement concreted. Staircase Ventilated. Dust-bin provided. Overcrowding abated. Miscellaneous Nuisances abated. St. Mary Mr. Syms. 16 22 2 33 13 23 1 115 84 44 45 2 1 — 298 95 67 1326 4 3 — 178 2 285 St. Paul Mr. Mayhew. 4 31 2 29 10 12 7 53 102 45 48 — — — 360 83 103 1233 6 — 8 239 3 406 St. Peter Mr. Banham. 1 12 — 8 3 4 2 23 58 49 60 — — — 180 41 79 1107 2 — — 217 3 417 St. John Mr. White. 9 14 2 24 27 14 50 120 110 111 29 — — 1 176 38 34 863 — 1 — 111 — 316 Trinity Mr. Findley. 23 41 9 53 27 17 29 122 143 119 97 2 36 — 465 201 150 1344 16 5 — 166 8 580 All Saints' Mr. Steele. 3 41 — 61 9 5 13 45 94 73 65 — 1 — 415 117 70 901 6 1 — 299 — 536 St. Michael Mr. Hattersley. 10 31 16 31 13 19 16 114 58 56 42 8 — — 156 74 29 1199 7 1 — 118 1 294 Queen's Bldgs. Mr. Bryant. — — — 1 — — — 5 10 3 — — — — 2 1 1 148 2 1 1 12 — 57 St. Jude Mr. Bryant. 17 47 2 46 28 14 12 58 126 105 90 3 14 — 295 130 64 1138 9 7 2 143 10 540 St. George Mr. Ede. 10 27 4 36 11 22 62 102 160 139 32 — — 2 280 57 75 915 — 1 — 167 — 361 Christchurch Mr. Bowers. 8 4 1 2 14 6 32 43 49 38 9 — — — 75 11 10 368 3 — — 34 — 79 St. Saviour Mr. Bowers. 21 3 7 9 46 11 59 81 82 79 7 — — 1 32 16 3 314 — — — 21 — 67 Total 122 273 45 333 201 147 283 881 1076 861 524 15 52 4 2734 864 685 10856 55 20 11 1705 27 3938 32 33 TABLE 17. Sanitary Works completed under the Housing Acts, during the year 1931. WARD or DISTRICT. Chimney flues repaired. Brickwork and pointing repaired. Window reveals and sills. Window sash repaired. New Sash Lines. Doors and woodwork repaired. Stair Treads and Risers repaired. Handrail and Balusters repaired. Floors repaired. Provision of ventilated food Storage. Plaster repaired. Stove and Fireplace repaired. Copper repaired. Stone Steps repaired. Skylight repaired and new Cords. Houses Let in Lodgings. Separation of Sexes and Overcrowding. Cleansing by Tenants and Lodgers. Cleansing of Bed Linen. Cleansing of Receptacles. Removal of Refuse Daily. Ventilation of Rooms by Lodgers. Animals in Tenements. Rooms cleansed. St. Mary 16 22 22 79 246 76 4 23 38 — 143 104 29 28 2 — — — — — — — 201* St. Paul 3 28 31 106 70 87 15 19 34 — 10 86 5 7 — — — — — — — — 57* St. Peter 7 15 27 7 27 17 3 3 11 — 31 47 6 8 — — — — — — — — 75* St. John 2 6 20 23 47 49 14 12 25 — 6 87 22 3 — — — — — — — — 54* Trinity 71 138 135 118 147 145 57 45 101 — 111 183 69 12 5 — 31* — — — — — 75* All Saints' 17 6 29 28 48 43 11 21 35 — 50 114 22 1 — — — — — — — — 99* St. Michael 14 13 105 103 93 101 41 5 72 — 18 78 21 2 — — — — — — — — 321* Queen's Buildings Mr. Bryant. — — — — — 11 — — 1 — — 7 11 — 1 — — — — — — — — St. Jude 33 112 154 117 280 166 246 59 99 — 154 191 37 17 13 — 2* — — — — — 48* St. George 1 — 2 22 29 31 16 21 70 — — 62 39 3 — — — — — — — — 140* Christchurch 1 1 4 7 13 5 6 — 6 — 17 51 10 — — — — — — — — — 157* St. Saviour 1 2 3 5 5 7 — — 3 — 3 22 9 — — — — — — — — — 12* Total 166 343 532 615 1005 738 413 208 495 — 543 1032 280 81 21 — 33* — — — — — 1239* * April Cleansing Notices. 34 PROCEEDINGS TAKEN UNDER THE PUBLIC HEALTH AND OTHER ACTS. 13 summonses were taken out during the year 1931, in respect to offences, particulars of which are set out below. The following table shows the number of summonses taken out in each of the several Wards:— TABLE 18. WARD OR DISTRICT. Total. St. Mary's. St. Paul's. St. Peter's. St. John's. Trinity. All Saints'. St. Michael's. St. Jude's. St. George's. Christchurch. St. Saviour's. Number of Summonses taken out .. 6 2 2 .. 1 2 .. .. .. .. 13 The above summonses had reference to the following:— Ordinary Nuisances 13 TABLE 19. These proceedings resulted as follows:— Summonses withdrawn (with costs), the Council's requirements having been complied with 10 Magistrates' Orders made 3 13 35 TABLE 20. Proceedings taken under the Public Health and Other Acts. Defendant. Cause of Proceedings. Result. Charles Benabo & Sons, 240, Mile End Road, E.1 Neglecting to cleanse dirty room at 2, Chapter Terrace Summons withdrawn, work done, with 10/6 costs. Charles Benabo & Sons, 240, Mile End Road, E. 1 Neglecting to amend defective sink at 14, Chapter Terrace Summons withdrawn, work done, with 10/6 costs. Charles Benabo & Sons, 240, Mile End Road, E. 1 Neglecting to cleanse dirty premises at 16, Chapter Terrace Summons withdrawn, work done, with 10/6 costs. Walter Keeble, 63, Brandon Street, S.E. Neglecting to cleanse dirty premises and amend defective roof, etc., at 73, Brandon Street Ordered to do work within 14 days, with 2/- costs. Walter Keeble, 63, Brandon Street, S.E. Neglecting to amend defective roof, vent shaft, etc., at 77, Brandon Street Ordered to do work within 14 days, with 2/- costs. H. Tilt, 59, Underhill Road, S.E.22 Neglecting to amend defective flushing cistern, roof, etc., at 110, Westmoreland Road Summons withdrawn, work done, with £1/1/- costs. 36 TABLE 20—continued. Defendant. Cause of Proceedings. Result. James B. Shallard, 253, Camden Road. N.7 Neglecting to amend defective roof at 227, East Street Summons withdrawn, work done, with 10/6 costs. Kate Fowles, 37. Northfield Road, N.16 Neglecting to amend defective main roof at 52, East Street Ordered to do work within 14 days, with £1 1/- costs. Thomas Evans, 9, Cedars Terrace, W. 14 Neglecting to cleanse dirty premises and amend defective roof at 127. Blackfriars Road Summons withdrawn, work done, with 10/6 costs. Thomas Evans, 9, Cedars Terrace, W. 14 Neglecting to provide sufficient water supply at 127, Blackfriars Road Summons withdrawn, work done, with 10/6 costs. Charles Benabo & Sons, 240, Mile End Road, E. l Neglecting to amend defective main roof at 11, Chapter Terrace Summons withdrawn, work done, with £1/1/- costs. Charles Benabo & Sons, 240, Mile End Road. E. l Neglecting to amend defective main roof at 13, Chapter Terrace Summons withdrawn, work done, with £1/1/- costs. Charles Benabo & Sons, 240, Mile End Road, E. l Neglecting to amend defective main roof at 18, Chapter Terrace Summons withdrawn, work done, with £1/1/- costs. 37 "MERCHANDISE MARKS ' ACT, 1926. Section 9 of the above Act confers on Food and Drugs Authorities (in London, the Borough Councils) the power to execute all provisions of the Act (except those relating to importation) in respect of foodstuffs which are subject to an Order in Council made under the Act. The Sanitary Inspectors have been empowered by the Council to undertake the duties imposed by the above Act, in regard to food exposed for sale, and have in many instances called the attention of traders to the fact where they have discovered negligence in the marking of their goods, and have had the omission rectified. One hundred and thirty-one visits were made by the several Inspectors during the year. In addition, printed notices have been circulated from time to time calling attention to the Orders mentioned above. On the whole the Orders are being carried out satisfactorily throughout the Borough. AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT, 1926. This Act provides for the grading and marking of agricultural produce and gives power to the Ministry of Agriculture and Fisheries by regulations to prescribe "designations" and "marks" to indicate the quality of such produce. Four cold stores in this district are registered under the 1930 Regulations, for the storage of English eggs. Many parcels have been marked in accordance with the Regulations under the supervision of the Inspectors. ICE CREAM REGULATIONS. During the year all premises where Ice Cream was manufactured or sold were registered in accordance Avith the London County Council General Powers Act, 1928, and inspections were made periodically to ascertain that the commodity was being protected from infection or contamination. No case of illness was reported. RAG FLOCK ACTS. Several visits have been paid under the above Acts, but no breach of the regulations contained therein was detected during the year. \ ery little Rag Flock is used in the Borough. 38 ACTS AND BYE-LAWS ADMINISTERED BY THE PUBLIC HEALTH DEPARTMENT. Acts os' Parliament— Infectious Diseases (Prevention) Act, 1890. The Public Health (London) Act, 1891. The Metropolis Management Act, 1855. The Factory and Workshops Acts, 1901 to 1907. The Rag and Flock Act, 1911 and 1928. Rats and Mice (Destruction) Act, 1919. Public Health (Smoke Abatement) Act, 1926. Sale of Food and Drugs Act, 1875 and 1927. Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies (Amendment) Act, 1922. Sale of Horse Flesh Regulation Act, 1889. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1923. Local Government Act, 1929. Agricultural Produce (Grading and Marking) Act, 1928. Food and Drugs (Adulteration) Act, 1928. Housing Acts, 1925-1930. London County Council (General Powers) Acts, 1893 to 1928. Cleansing of Persons Act, 1897. Merchandise Marks Act, 1926. Artificial Cream Act, 1929. Regulations— Regulations (Shell Fish), 1915. Sale of Milk Regulations, 1901 and 1912. Sale of Butter Regulations, 1902. Public Health (Condensed Milk) Regulations, 1923 and 1927. Public Health (Dried Milk) Regulations, 1923 and 1927. Public Health (Preservatives in Food, &c.) Regulations, 1925 to 1927. Public Health (Tuberculosis) Regulations, 1912 to 1930. Public Health (Meat) Regulations, 1924. Public Health (Imported Milk) Regulations, 1926. Public Health (Acute Encephalitis Lethargica and Acute Polio- Encephalitis) Regulations, 1918. Public Health (Ophthalmia Neonatorum) Regulations, 1926-1928. Public Health (Notilication of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926-1928. Infectious Diseases (London) Regulations, 1927. Public Health (Imported Food) Regulations, 1925. 39 London County Council. Vendors of Fried Fish, 1914. Fish Curers, 1914. Dressers of Fur Skins, 1922. Rag and Bone Dealers, 1923-1928. Houses divided into separate tenements, &c., 1926. Removal of offensive matter, 1901. Closing and filling of cesspools and removal of refuse, 1893. Ashpits, manure receptacles, &c., 1893. Construction of drains and W.C.s,, 1929. Business of a slaughterer of poultry, 1923. Slaughterhouses, 1891-1923. Water closets, &c., 1913-1930. Offensive trades. Conveyance of dead horses. Orders— Tuberculosis Orders (Cattle), 1925 (1) and (2). Factory and Workshop Welfare Order, 1927 (Bakehouses). Do. do. do. 1927 (Biscuit Factories). Registration of Margarine Factories, 1900. Registration of Butter Factories, 1907. Milk and Dairies Order, 1926. Milk (Special Designations) Order, 1922-1923. Milk (Special Designations) Amendment Order, 1922. Sale of Food Order. Part (3), 1921. Sanitary Accommodation Order, 1903. Home Work Orders, 1911, 1912, 1913. Merchandise Marks (Imported Goods) Order, No. 3, 1923. Merchandise Marks (Imported Goods) Order, No. 5, 1928. Do. do. Order No. 4, 1929. Sanitary Officers' Order, 1922. Other Acts referring to works of the Public Health Department :— Notification of Births Act, 1907-1915. Maternity and Child Welfare Act, 1918. Southwark Borough Council— Fouling of footway by dogs. Regulations, underground rooms. BLACK SMOKE. During the year 1931 one complaint was received at the Public Health Office from persons other than the Council's Inspectors. 40 TABLE 21. Showing the Number of Observations, etc., in regard to Smoke Nuisances made by the several Ward Inspectors during 1931. St. Mary's Ward. St. Paul's Ward. St. Peter's District. St. John's District. Trinity Ward. All Saints' District. St. Michael's Ward. St. Jude's Ward. St. George's Ward. Christchurch Ward. St. Saviour's Ward. Total for Borough. No. of observations made by the Inspectors .. 1 .. 1 1 .. .. .. .. .. 3 6 No. of Nuisances observed .. 1 .. 1 1 .. .. .. .. .. 1 4 No. of Intimation Notices served .. 1 .. 1 1 .. .. .. .. .. 1 4 No. of Statutory Notices served .. 1 .. .. .. .. .. .. .. .. .. 1 No. of Summonses taken out .. .. .. .. .. .. .. .. .. .. .. .. HOUSES LET IN LODGINGS. Notices are sent to those concerned to proceed with the cleansing each April, and from time to time leaflets are distributed to tenants and lodgers, drawing their attention to their obligations under these Regulations. CUSTOMS AND INLAND REVENUE ACT, 1890. No Certificate for exemption from Inhabited House Duty was granted during the year 1931. HOUSING, TOWN PLANNING, ETC., ACT, 1909. No certificate for exemption from Inhabited House Duty in respect to lodging houses for working classes was granted during the year. WATER SUPPLY. PUBLIC HEALTH (LONDON) ACT, 1891. Section 48. Certificates in regard to water supply have been granted in respect of the under-mentioned (new) houses during the year. Premises. Certificates granted to. Pilgrim House (36 flats) Messrs. J. E. Billings & Co., 39, Victoria Street, S.W.I. Orb Street (9 flats) D. T. Griffiths, Esq., Town Hall, Southwark, S.E. Sumner Street (50 flats) Messrs. W. Lawrence, City Road, E.C. 145, Old Kent Road Messrs. H. Somerford & Sons, 104, Manor Street, S.W. 41 WATER SUPPLIES TO TENEMENT HOUSES. London County Council (General Powers) Act, 1907. Fifteen additional water supplies were provided to houses during the year 1931. TABLE 22. Factories, Workshops, Laundries, Workplaces and Homework. 1.—Inspection (including Inspections made by Sanitary Inspectors). Premises. Number. Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 367 57 .. Workshops (including Workshop Laundries) 582 63 .. Workplaces 4361 238 .. Homeworkers' Premises (including Outworkers) 346 1 .. Total 5656 359 .. 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. *Nuisances under the Public Health Acts:— Want of Cleanliness 199 175 Want of Ventilation 5 9 .. Overcrowding .. 1 .. .. Want of drainage of floors .. .. .. .. Other nuisances 358 327 .. .. Sanitary accommodations: Insufficient 2 9 .. .. Unsuitable or defective 22 21 .. .. Not separate for sexes 1 .. .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse(S. 101) .. .. Breach of special sanitary requirements for bakehouses (SS .97 -100) 42 42 .. .. Other offences .. .. Total 629 584 .. .. Including those specified in Sections 2, 3, 7 and 8 of the Factory Act as remediable under the Public Health Acts. 48 TABLE 23. 3.—Home Work. Nature of Work. Outworkers' Lists, Section 107. Number of Inspections of Outworkers' Premises. Outwork in Unwholesome Premises, S.108. Outwork in Infected Premises, Sections 109-10 Lists received from Employers. Nos. of Addresses of Outworkers received from other Councils. Nos. of Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions. (Ss. 109, 10). Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers Lists. Outworkers Wearing Apparel— (1) Making, &c. 63 37 67 46 330 428 - - 188 3 1 - - - - (2) Cleaning and washing — — — — — — - - - - - - - - - Lace, lace curtains and nets - - - - - - - - - - - - - - - Furniture and Upholstery 1 3 1 2 1 2 - - - - - - - - - Fur pulling - - - - 1 - - - - - - - - - - Umbrellas 1 - 1 — 9 - - - 5 - - - - - - Paper Bags and Boxes 11 16 8 18 4 17 - - 46 - - - - - - Brushmaking 7 8 7 8 3 8 - - 19 - - - - - - Stuffed Toys 1 3 1 4 - 4 - - 6 - - - - - - File making - - - - - - - - - - - - - - - Electro Plate - - - - - - - - - - - - - - - Cables and Chains - - - - - - - - - - - - - - - Anchors and Grapnels - - - - - - - - - - - - - - - Cart Gear - - - - - - - - - - - - - - - Locks. Latches and Keys - - - - - - - - - - - - - - - Miscellaneous 12 19 10 26 134 29 - - 82 - - - 1 - - Total 96 86 95 104 482 488 - - 346 3 1 - 1 - - 43 TABLE 24. 4.— Registered Workshops. Workshops, Workplaces, etc., on the Register (S. 131) at the end of the year. Number. Bakehouses 98 Factory Bakehouses Eating houses and places where food is prepared for sale 376 Ice Cream Shops 176 Laundries 12 Dressmakers, Milliners, etc. 32 Tailoring 24 Brushmakers 14 Miscellaneous 1873 Total number of Workshops, Workplaces, etc., on Register 2605 5.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 1 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5): Notified by H.M. Inspector 12 Reports (of action taken) sent to H.M. Inspectors 8 Other — Underground Bakehouses (S. 101):— In use at end of the year 28 WOMEN'S WORKSHOPS. The supervision of the Women's Workshops was carried out during the year by Miss Burrows. 731 inspections and 655 re-inspections were made. The following defects were discovered, and 11 intimations and 6 statutory notices were served in order to obtain the abatement of the nuisances complained of :— Closet provided 5 Water apparatus defective 8 Roofs defective 6 Paving defective 1 Rooms dirty 62 Cloiset Pans and Traps 3 Overcrowding - Miscellaneous nuisances 44 Total 129 All the above-mentioned nuisances were remedied. Miss Burrows also made 1,677 inspections of the women's conveniences throughout the Borough. 44 TABLE 25. RATS AND MICE (DESTRUCTION) ACT, 1919. Summary showing investigations and inspections made during the year 1931. WARD or DISTRICT. Inspections. Re-inspections. Premises where Rats were found. Action taken. Probable Source. Notices. By Council's Official. By Occupiers. By Inspectors By Rat Officer. By Inspectors By Rat Officer. Baits laid by Rat Officer with poison Wire Traps Set. Breakback Traps Set. Cats or Dogs. Ferrets. Rat Runs and Holes. Defective Drains. Defective Sewers. St. Mary 27 28 25 452 20 3337 191 675 - - 7 1 - 1 St. Paul 50 52 22 334 23 1339 30 243 7 - 11 10 - - St. Peter 26 50 12 146 22 673 41 103 4 - 9 3 - 1 St. John 43 37 193 301 31 888 47 362 10 - 19 6 - 1 Trinity 42 56 103 566 43 2619 45 553 4 - 32 6 - 19 All Saints' 28 38 70 902 35 3554 107 1070 6 - 21 2 - 7 St. Michael 31 59 80 389 15 1827 26 361 3 - 3 7 - 2 St. Jude 31 38 77 302 16 1207 13 207 1 - 10 2 - 13 St. George 94 85 106 285 33 1155 61 192 2 - 22 8 -- 5 Christchurch 29 16 14 112 11 482 41 100 4 - 5 1 - 4 St. Saviour 11 10 9 36 4 300 10 31 1 - 2 1 - — Total 412 469 711 3825 253 17381 612 3897 42 - 141 47 - 53 Number of Rats destroyed 1425 45 Cleansing of Verminous Rooms and their Contents. During the year 1931 the number of verminous rooms with the bedding and other articles cleansed and disinfected in accordance with the requirements of the London County Council (General Powers) Acts, 1907 and 1922, has decreased in comparison with 1930. I append a table showing the number of notices served upon the owners or occupiers of the several premises in question, and the number of verminous rooms stripped and cleansed by the owners, and fumigated by the Council's disinfecting stall, respectively. I also submit tables showing the number of articles dealt with at the disinfecting stations. TABLE 26. Verminous Rooms Cleansed. WARD or DISTRICT. No. of Intimation Notices served. No. of Statutory Notices served. Police Court proceedings taken. Verminous rooms treated. (a) by Owners of Premises. (b) by the Council's Disinfecting Staff. St. Mary 39 21 — 55 67 St. Paul 58 28 - 64 130 St. Peter 14 10 — 16 36 St. John 19 12 — 27 62 Trinity 128 62 — 176 198 All Saints 17 4 — 20 108 St. Michael 33 14 — 38 71 St. Jude 108 51 — 143 68 St. George 36 20 — 53 77 Christchurch 8 6 — 11 32 St. Saviour 1 — — 1 26 Total 461 228 - *604 875 * Note—These 604 rooms were stripped by the owners. 46 TABLE 27. Verminous Bedding, etc., Disinfected at the Council's Stations during 1931. Articles. Disinfected. Destroyed. Beds 200 — Palliasses 36 — Bolsters and Pillows 219 — Cushions 22 — Blankets 812 - Sheets 540 - Quilts 213 - Articles of Clothing, etc. 30,711 - Books 1 - Total 32,754 - In addition, one carpet, one mat, and one piece of felt were disinfected. VERMINOUS PERSONS CLEANSED DURING 1931. During the year 4.648 persons were cleansed at the station in King James Street. Of these under our agreement with the London County Council, were 2,955 children. Many of the children treated were suffering from Scabies. In every cases the treatment at our Station was thoroughly efficacious, and no recurrence of the trouble was experienced. 47 1,693 adults sent from the various common lodging houses and other places in our borough were cleansed during the year, as against 1,301 dealt with under the provisions of the Cleansing of Persons Act, 1897, in 1930. MORTUARIES. TABLE 28. During the year 501 bodies were received into the Mortuaries:— Reasons bodies were brought to Mortuary. Collier's Rents Mortuary. Manor Place Mortuary. Total. Bodies brought in upon which Inquests were held 139 14 153 Bodies brought in for convenience 9 326 335 Bodies brought in in cases where death had occurred from Infectious Disease 5 8 13 Total 153 348 501 There are two mortuaries each having a Coroner's Court attached; one is situated at Manor Place and the other at Collier's Rents. The Coroner's Court at Manor Place is not so satisfactory as that at Collier's Rents, inasmuch as there is no retiring room for the Coroner, also the accommodation is limited. There is a resident caretaker at each and telephonic communication has been installed. 48 TABLE 29. HOUSING. 1. Inspection of Dwelling Houses:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 10,888 (b) Number of inspections made for the purpose 11,176 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3,711 (b) Number of inspections made for the purpose 3,711 (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 8,575 2. Remedy of Defects without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,885 -3. Action under Statutory Powers during the Tear:— A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 264 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) by owners 228 (b) by Local Authority in default of owners — 49 TABLE 29 — continued. B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 6,723 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) by owners 7,319 (b) by Local Authority in default of owners C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— D. Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil E. Proceedings under Section 3 of the Housing Act, 1925 (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil F. Proceedings under Section 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which Closing Orders were made Nil G. Proceedings under Section 1 of the Housing Act, 1930:— (1) Clearance Areas (10). 373* These are not included in the total number of dwelling-houses inspected. 50 HOUSING. Since taking up office as your Medical Officer of Health on October 1st, I have made a rapid survey of the housing conditions obtaining in the Borough, and have inspected several hundred dwellings. In the course of my survey I realised that the housing question in Southwark was a very difficult problem, inasmuch as there are no vacant sites suitable for building purposes, owing to high land values, and the only means of dealing with the re-housing question is by taking areas for clearance under the Housing Act, 1930; the erection of flats sufficient to re-house displaced persons; and the provision of a surplus for the purpose of decanting persons who are living in decayed and dilapidated houses on sites which are too small for re-housing purposes. With this object in view, I have represented to you the following areas:— Kinglake Street No. 1 Area. Amery Place Kinglake Street Area. Orb Street No. 2 Area. Gray Street No. 1 Area. Gray Street No. 2 Area. Keyworth Street No. 1 Area. Keyworth Street No. 2 Area. Cook's Cottages. Alvey Mews. South Street Area. I would suggest that none of the above areas is large enough in themselves to fulfil the requirements of the above policy, and it would be wise for the Council, when dealing with each area, to consider the advisability of including other properties adjoining the area, with a view to making the scheme meet all our requirements so far as possible. With these points in view, it would be well to concentrate primarily on the areas containing the largest amount of open space, and, consequently, the least populated proportionately. As to the number of dwellings required, our Housing Survey shows that at the present time there are 2,113 families housed in 1,531 decayed and dilapidated houses or dwellings, many of which are grossly overcrowded. This does not necessarily mean that the Council will have to build 2,000 dwellings, as there is evidence of private enterprise and the L.C.C. providing a goodly proportion. Whilst on the subject of housing, I have found that in addition to the existing single type of house, there are many large blocks of 51 tenement dwellings, some of which, although probably meeting the requirements of the time when they were erected, do not now come up to the modern standard, but are capable of being modernised and reconditioned. This matter should receive the serious consideration of both the Owners and the Sanitary Authority. There are, however, a few of these tenements which, owing to their bad construction and arrangements, are incapable of being redesigned, and should eventually be demolished as and when more houses become available for the re-housing of the occupants. In this category I have already placed Trinity Buildings, which were represented in December as unfit for human habitation. These and similar dwellings have been accounted for in the 1,531 decayed and dilapidated houses. 75, BOROUGH ROAD. Sec. 18, Housing Act, 1925. Sec. 20, Housing Act, 1930. I represented the above cellar dwelling as being unfit for human habitation, with a view to a Closing Order being made. The Order was duly served and the premiss have now been vacated. Other matters dealt with during the year 1931, in relation to housing conditions are as follow:— The number of houses granted to families from Southwark by the London County Council amounted to 161. They were distributed as follow:— Morden 92 Becontree 42 Downham 6 Bellingham 2 Hendon 2 Local 17 ORB STREET HOUSING SCHEME. Part III, Housing Act, 1925. The Minister of Health approved the Council's proposals for grant purposes and nine flats have been erected, all of which are occupied. LANT STREET AND TOULMIN STREET SITE. Sec. 16, Housing Act, 1930. The London County Council declared that they did not intend to deal with this area as a Clearance Area or part of a Clearance Area. 52 The Borough Council proceeded by means of a Compulsory Purchase Order, under Part 111 of the Housing Act, 1925, the Order to be cited as "The Lant Street, etc., Compulsory Purchase Order, 1931." This Order was subsequently confirmed by the Minister of Health and became operative on July 1st, 1931. The Borough Council have had under consideration what further steps should be taken, and have resolved that, in view of the consequential high value of the site, it was unsuitable for development for housing purposes. The site has now been cleared by the Owners of the property. DODDINGTON GROVE. Part III, Housing Act, 1925. The Minister of Health confirmed the "Doddington Grove Compulsory Purchase Order," and Blocks A and B are being proceeded with. ORPHAN HOME, AUSTRAL STREET. The above site comprising 31,000 super feet, was inspected with a view to the erection of flats, and the Council approached the Ministry with a view to the sanction of a Compulsory Purchase Order. The financial considerations, however, were not favourable, and the Minister declined to confirm an Order. The project was therefore not proceeded with. HARD STREET AREA. This area was originally represented as an Improvement Scheme under Part II of the Housing Act, 1925. Subsequently, the London County Council decided that, consequent upon the passing of the Housing Act, 1930, their previous decision to deal with the area under the Housing Act, 1925, became ineffective. They then passed a resolution declaring the area to be a Clearance Area under the Housing Act, 1930. Since that time, owing to financial consideration it appears that if this scheme is to be proceeded with, the Borough Council will have to take some action in the matter. 53 TABLE 30. VISITS MADE UNDER THE PUBLIC HEALTH (MEAT) REGULATIONS, 1924. St. Mary's Ward. St. Paul's Ward. St. Peter's District. St. John's District. Trinity Ward. All Saint's District. St. Michael's Ward. St. Jude's Ward. St. George's Ward. Christchurch Ward. St. Saviour's Ward. Total. Stalls and Shops visited 103 42 310 269 77 44 54 39 53 30 19 1040 The following defects were discovered and two Intimation Notices were served in order to obtain the abatement of the nuisances complained of:— Paving defective 8 Dirty rooms 35 Other insanitary conditions 11 54 All the above-mentioned nuisances were remedied. SLAUGHTERHOUSES. The various Slaughterhouses were periodically inspected during the year, and 287 oxen, 2,415 sheep and 37 pigs were slaughtered under the supervision of Mr. Fisher and Mr. Duffield. There are four licensed Slaughterhouses in the Borough. The following are the premises and the licensees:— Situation of Premises. Name of Licensee. 129, Hillingdon Street Frederick George Jacques. 70, Union Road George Challis. 244, Walworth Road Messrs. Chalk & Cox, Ltd. 283-5, Walworth Road William Charles Brady. 105 inspections were made during the year. No nuisance was discovered. Each Slaughterhouse was limewashed every three months during the year. 54 55 EXAMINATION OF FOOD. TABLE 31 . Showing the quantity of Foodstuffs found unsound during the year 1931 by the several Inspectors throughout the Borough. (The amount shown in this table is in addition to the total shown in Table 32.) Foodstuffs. Quantity and Weight found Unsound. Surrendered by Owners. Seized by Inspector. Remarks. Quantity. Weight. Quantity. Weight. Quantity. Weight. T. c. Q. L. T. c. Q L. T. C. Q- L. Artichokes 58 crates 1 0 2 24 58 crates 1 0 2 24 - - Destroyed at the Council's Depot. Apples 179 boxes 3 1 0 18 179 boxes 3 1 0 18 - — Do. do. Bacon - 4 13 2 7 - 4 13 2 7 - - 3 tons 7 cwt. 0 qrs. 1 lb. were released for soap boiling; 1 ton 6 cwt. 0 qrs. 14 lbs. were destroyed at the Council's Depot, and 1 qr. 20 lbs. were destroyed on premises where found. Beef, tinned 4 cases, 67 tins 5 2 14 4 cases, 67 tins 5 2 14 - — Destroyed at the Council's Depot. Condensed Milk 2 cases, 92 tins 1 2 8 2 cases, 92 tins 1 2 8 - - Do. do. Cheese 42 5 1 0 42 5 1 0 - — Do. do. Chestnuts 57 bags 1 7 0 0 57 bags 1 7 0 0 - — Do. do. Cream, tinned 6 cases, 145 tins 2 2 23 6 cases, 145 tins 2 2 23 - — Do. do. Figs - 16 0 0 - 16 0 0 - — Do. do. Fowls - 9 3 26 - 9 3 26 - — Do. do. Fruit, tinned 4 cases, 49 tins 2 3 11 4 cases, 49 tins. 2 3 11 - - Do. do. Grape Fruit 1 case 2 4 1 case 2 4 - — Do. do. Ham Paste 6 tins 1 2 6 tins 1 2 - — Do. do. Haddocks 1 box 2 6 1 box 2 6 - - Destroyed on premises where found. Hams 43 3 1 10 43 3 1 10 - — Released for soap boiling. Heads, Pigs' 7549 36 11 0 7 7549 36 11 0 7 - - Do. do. Carried forward 49 2 0 20 49 2 0 20 .56 57 Foodstuffs. Quantity and Weight found Unsound. Surrendered by Owners. Seized by Inspector. Remarks. Quantity. Weight. Quantity. Weight. Quantity. Weight. Brought forward T. c. Q. L. T. c. Q. L. T C. Q. L. 49 2 0 20 49 2 0 20 Offal - 2 0 7 - 2 0 7 - - 1 cwt. 2 qrs. 7 lbs. were destroyed at the Council's Depot, and 2 qrs. were released for soap boiling. Onions 34 cases 1 14 0 0 34 cases 1 14 0 0 - - Destroyed at the Council's Depot. Oranges 19 boxes 8 1 2 19 boxes 8 1 2 - - Do. do. Pork Carcases and pieces 15 17 3 1 Carcases and pieces 15 17 3 1 - - 15 tons 17 cwt. 2 qrs. 19 lbs. were released for soap boiling and 10 lbs. were destroyed on premises where found. Potatoes 469 bags 23 9 0 0 469 bags 23 9 0 0 - - 18 tons 4 cwt. were released for pig feeding and 5 tons 5 cwt. were destroyed at the Council's Depot. Pears 224 boxes 2 4 3 2 224 boxes 2 4 3 2 - - Destroyed at the Council's Depot. Rabbits — 4 1 25 — 4 1 25 -- - Do. do. Skate 1 box 2 14 1 box 2 14 - - Destroyed on premises where found. Tomatoes Boxes and chips 5 17 2 12 Boxes and chips 5 17 2 12 - - Destroyed at the Council's Depot. Turnips 20 bags 8 0 0 20 bags 8 0 0 - - Do. do. Turnip Tops 50 bags 12 2 0 50 bags 12 2 0 - - Do. do. Turkeys 3 1 0 3 1 0 - - Do. do. Veal 1 carcase 1 10 1 carcase 1 10 - - Destroyed on premises where found. Winkles 4 bags 5 2 0 4 bags 5 2 0 - - Destroyed at the Council's Depot. 100 7 1 9 100 7 1 9 58 59 TABLE 32. Table showing the quantity of Foodstuffs examined at the wharves during the year 1931, the quantity found to be unsound, the notices served and the method of disposal of the unsound portion. Foodstuffs. Quantity and Weight examined. Weight found to be unsound. Surrendered by Owner. Seized by Inspector. Notices served. How unsound portion disposed of. Quantity. Weight. (a Detention. (b) Release . T. c. Q. L. T. c. Q. L. Apples, tinned 463 cases, 180 tins 8 17 1 0 1 0 3 6 Yes - 1 1 Destroyed at the Council's Depot. Asparagus, tinned 112 cases 2 7 3 20 11 0 8 Yes - 4 - Do. do. Apricot pulp, tinned 90 cases 3 5 0 0 - - - - - — Apricots, tinned 664 cases 16 11 0 6 3 8 0 8 Yes - 9 - Do. do. Apricots, dried 52 boxes, 46 bundles 1 18 2 4 1 3 0 0 Yes - 1 - Do. do. Almonds 60 bags 2 15 0 0 - - - - - - Apricots 128 crates 1 7 2 4 3 3 24 Yes - 3 - Destroyed in railway truck. Apples dried 72 boxes 12 3 12 - - - - - — Apples 865 cases 16 0 2 16 14 17 1 12 Yes - 5 - Destroyed at the Council's Depot. Bacon 812 bales 83 1 0 0 - - - 1 - — Beef Carcases, pieces, etc. 195 8 3 20 20 14 0 0 Yes - 22 10 Released for soap boiling. Beef, tinned 6650 cases, 4669 tins 173 5 0 6 15 6 1 26 Yes - 17 5 4 tons 4 cwt. 3 qrs. 5 lbs. were destroyed at the Council's Depot; 8 tons 1 cwt. 3 qrs. 22 lbs. were released for pig feeding; 2 tons 13 cwt. 1 qr. 27 lbs. were released for soap boiling; and 6 cwt. 1 qr. were released for other technical purposes. Beef, salted 65 barrels 6 10 1 6 - - - - - - Butter 511 boxes 17 9 2 0 - Yes - - - - Blackcurrant pulp 18 casks, 977 cases 40 12 2 12 32 16 0 0 - - 3 - 24 tons 10 cwt were destroyed at the Council's Depot, and 8 tons 6 cwt. were released for pig feeding. Beans, tinned .. 110 cases 2 10 1 0 - Yes - - - Beans 48 bags 2 2 3 12 2 2 3 12 - - 1 - - Blackcurrants 110 billots 1 3 2 8 — Yes - - - Destroyed at the Council's Depot. Bread 23 packages 11 2 0 11 2 0 Yes - 1 - - Cheese Crates, bundles .. 5 13 3 20 5 0 26 Yes - 2 1 Released for pig feeding. Cherries, tinned 462 cases 12 8 0 24 1 3 4 Yes - 1 1 Destroyed at the Council's Depot. Crab, tinned 442 cases 9 11 1 2 8 2 8 Yes - 1 - Do. do. Condensed milk 2406 cases 42 7 3 14 7 7 0 14 - - 11 - Do. do. Currants 51 cases 12 3 0 — Yes - - - Do. do. Cherries 24 billots 5 0 4 3 0 - - 2 - - Casings, hogs 10 casks 2 12 0 0 — - - 1 1 Destroyed in railway truck. Dates 89 cases 15 3 16 — - - 1 - - Dripping 168 crates 6 14 0 0 — Yes - - - Still under "Stop." Ducks 307 boxes .. 4 19 3 16 9 2 16 - - Yes - - - Sprayed with carbolic and released for soap boiling. Eggs 83 cases 2 14 1 20 2 6 0 0 Yes - 2 1 Destroyed at the Council's Depot. Egg liquid 3 casks, 2555 tins 46 1 3 16 3 0 0 3 cwt. Released for leather dressing, 42 tons 1 cwt. 3qrs. 16 lbs. still under "Stop." OO 1 Carried forward . . 711 8 2 6 103 17 0 24 89 20 60 61 Foodstuffs. Quantity and Weight examined. Weight found to be unsound. Surrendered by Owner. Seized by Inspector. Notices served. How unsound portion disposed of. Quantity. Weight. (a) Detention. (6) Release . T. C. Q. L. T. C. Q. L. Brought forward 711 8 2 6 103 17 0 24 89 20 Fat, refined 106 tierces 22 7 0 0 - - - - - - Fish, canned 15 cases 5 1 12 5 1 12 Yes - - - Destroyed at the Council's Depot. Fowls 736 cases 14 5 1 24 1 1 0 Yes - 1 - Released for soap boiling. Fruit pulp 80 barrels 28 0 0 0 - - - - - - Fruit, tinned 624 cases 12 16 2 22 6 2 0 Yes - 4 1 Destroyed at the Council's Depot. Grape fruit, tinned 413 cases 11 1 0 14 - - - - - Ginger, preserved 48 cases 1 8 1 20 6 1 20 Yes - 1 - Do. do. Geese 2620 cases 56 8 2 3 5 16 2 8 Yes - 1 - Released for soap boiling. Greengages 20 crates 4 1 2 1 2 Yes - - - Destroyed in railway truck. Grapes 100 boxes 1 1 1 20 - - - - - - Hams 321 boxes and 100 61 4 0 0 - - - - - - Herrings, tinned 265 cases 5 15 1 2 - - - - - - Hams, tinned 50 boxes 17 3 2 - - - - - - Honey, tinned 30 tins 7 1 18 - - - - - - Lard 423 boxes 11 7 0 0 2 10 0 0 Yes - 2 2 Released for export to Holland. Loganberries, tinned 277 cases 7 8 1 16 - - - - - - Lobster, tinned 95 cases 2 2 0 8 - - - - - - Lard oil 90 tierces 21 0 0 0 21 0 0 0 Yes - 3 1 6 tons released for technical purposes; 15 tons still under '"Stop.'' Mutton Carcases and pieces 2588 11 0 12 37 19 1 26 Yes - 562 558 Released for soap boiling. Mutton, tinned 64 cases 1 7 1 10 - - - - - - Macaroni 160 boxes 2 0 0 0 18 3 0 Yes - - - Released for pig feeding. Meats, canned 71 cases 1 18 2 8 1 18 2 8 Yes - 1 - 1 ton 10 cwt. were released for poultry feeding and 8 cwt. 2qrs. 8 lbs. were destroyed at the Council's Depot. Offal - 39 8 2 11 3 13 1 6 Yes - 11 1 3 tons 10 cwt. 1 qr. 6 lbs. were released for soap boiling and 2 cwt. 2 qrs. were destroyed on premises where found. Olives, bottled 4 cases 1 1 20 1 1 20 Yes - 1 - Destroyed at the Council's Depot. Oatmeal 10 bags 10 0 0 4 0 22 Yes - 1 - Burnt in furnace on premises where found. Onions 821 bags 18 4 0 0 18 4 0 0 Yes - 1 - Destroyed at the Council's Depot. Pears, tinned 236 cases 6 3 3 22 3 2 0 Yes - 1 - Do. do. Peaches, tinned 664 cases 18 1 3 18 1 18 3 0 Yes - 3 - Do. do. Plums, tinned 532 cases 14 4 1 16 1 10 0 0 Yes - 1 - Do. do. Pineapple, tinned 990 cases .. 26 10 0 12 5 4 o 16 Yes - 6 - Do. do. Prunes 363 boxes 4 14 2 6 10 3 16 Yes - - - Do. do. Prunes, tinned 110 cases 2 18 3 20 -. - - - - - Pork Carcases and pieces 6 16 1 16 12 Yes - - - Released for soap boiling. Peaches, dried 75 boxes 13 1 16 - - - - - Pork and Beans, tinned 186 cases 4 0 3 8 - - - - - Peas, tinned 45 cases 1 0 0 10 - - - - - Carried forward 3706 14 1 10 216 9 2 24 689 583 62 63 Foodstuffs. Quantity and Weight examined. Weight found to be unsound. Surrendered by Owner. j Seized - by J n!spector. Notices served. 1 How unsound portion disposed of. ' , Quantity. Weight. (a) Detention . (b) Release . T. c. Q. L. T. c. Q. L. Brought forward 3706 14 1 10 216 9 2 24 689 583 Pears 37 boxes 17 2 8 17 2 8 Yes - 2 - Destroyed at the Council's Depot. Peaches 1 billot 24 24 Yes - - - Destroyed in railway truck. Plums 1 crate 22 22 Yes - - - Do. do. Potatoes 240 bags 12 0 0 0 2 0 0 0 Yes - 1 - Destroyed at the Council's Depot. Rabbits 527 crates 32 12 2 0 11 3 4 Yes - 1 - Released for soap boiling Raspberries, tinned 234 cases 7 0 1 4 - - - - - - Raspberry pulp 1704 cases 48 0 0 0 26 6 1 4 Yes - 3 - Destroyed at the Council's Depot. Raisins 32 boxes 7 2 20 25 Yes - 1 - Do. do. Rice 233 bags 11 4 0 22 11 4 0 22 Yes - 2 2 Released for cattle feeding. Salmon, tinned 1450 cases and 2534 tins 32 18 3 21 4 4 2 3 Yes - 15 - Destroyed at the Council's Depot. Strawberries, tinned 58 cases 1 11 0 8 - - - - - - Sultanas 2599 cases 32 16 3 4 4 9 3 6 Yes - 4 3 3 tons 10 cwt. 2 qrs. 19 lbs. released for export to Hamburg; 19 cwt. 2 qrs. 15 lbs. destroyed on premises where found. Sardines, tinned 94 cases 2 1 3 24 - - - - - - Spinach, tinned 18 cases 8 0 4 - - - - —. Soup, tinned 49 cases 16 2 14 3 3 2 Yes - 1 - Destroyed at the Council's Depot. Suet 16 boxes 8 0 0 - - - - - - Sweets 10 cases 10 0 0 - - - - - - Strawberry pulp 6 casks 18 0 0 - - - - - - Tongues, tinned 575 cases 15 7 1 8 - - - - - - Tomatoes, tinned 736 cases and 1510 tins 24 0 2 6 3 13 1 3 Yes - 3 - Destroyed at the Council's Depot. Tongues, Ox 262 bags, 72 boxes 8 4 1 27 2 1 3 19 Yes - 2 1 Released for soap boiling. Turkeys 36 cases 18 0 0 - - - - - - Tomatoe puree, tinned 18 cases 17 2 20 - - - - - Tongues, Sheep 12 bags 6 0 0 - - - - - - Tripe, tinned 30 boxes 5 1 12 - - - - - - Veal 35 bags, 50 sides 3 2 0 16 - - - - - - Total 3944 7 3 22 272 3 1 26 724 589 64 TABLE 33. Inspections of Food at Wharves, Markets and other places where food is stored, and the action taken by the officials during the year 1931. INSPECTION OF WHARVES, Etc. FOOD EXAMINED, Etc. WARD or DISTRICT. Inspections of Wharves and Warehouses. Inspections of Markets. Inspections of Shops or Street Stalls. Total. Parcels of Food Examined. Parcels of Food Stopped. Parcels of Food Released. Parcels of Food destroyed by consent of owner. Parcels of Food seized by Inspector. Parcels of Food condemned by Magistrate . Summonses taken out. St. Mary's - 619 53 672 723 - - - - - - St. Paul's 12 - 10 22 27 - - 1 - - - St. Peter's - 4868 153 5021 5126 - - 4 - - - St. John's - 1932 3 1935 1933 - - - - - - Trinity 7 - 55 62 95 - - 13 - - - All Saints' - - - - - - - - - - - St. Michael's 30 - 3 33 41 - - 9 - - - St. Jude's - 76 - 76 76 - - - - - - St. George's 2 - - 2 2 - - 1 - - - Christchurch 750 - 1 751 1456 - - 122 - - - St. Saviour's 562 - - 562 972 3 2 197 - - - By M.O.H. - - - - - - - - - - - Brought to Town Hall - - 12 12 12 - - 11 - - - Total 1363 7495 290 9148 10465 3 9 351 - - - 65 MILK AND DAIRIES (AMENDMENT) ACT, 1922, AND ORDERS MADE THEREUNDER. At the end of the year 1930 the number of milksellers on the Registers were as follows:— Retail 367 names 361 premises Wholesale 37 ,, 37 ,, During the year 1931, 76 applications from 76 persons respecting 74 premises were received for registration as Retail Milksellers. Two applications from two persons respecting two premises were received for registration as Wholesale Milksellers. These were entered in the respective Registers. Retail Register. Entered in Register. Removal from Register. Not Registered. (Unsuitable, etc.) Total Applications. Names. Premises. Names. Premises. Names. Premises. Names. Premises. 76 74 62 57 -| - 76 74 The sale of milk was started afresh at 21 premises The sale of milk was discontinued at 4 ,, Total number of Milksellers on Retail Register at end of 1931 381 Total number of Milksellers' premises 378 Wholesale Register. Entered in Register. Removal from Register. Not Registered. (Unsuitable, etc.) Total Applications. Names. Premises. Names. Premises. Names. Premises. Names. Premises. 2 2 2 2 - - 2 2 Total number of Wholesale Milksellers on Register at end of 1931 37 Total number of Wholesale premises 37 66 Of the 378 Retail Milksellers' premises, 280 are dairies, 77 where milk is sold in containers as received, 17 where milk is sold for consumption on the premises only, and four are used as depots only. There is one dairy used for wholesale only. There are two premises licensed to bottle "Grade A (Tuberculin Tested)" milk and at these premises six samples of "Grade A (Tuberculin Tested)" milk were procured and submitted to the Public Analyst for bacteriological examination. These were certified to comply with the requirements of the Order. Total number of licences to sell graded milk 43 viz.:—Certified 7 premises. Grade A (T.T.) 19 „ Grade A 4 ,, Pasteurised 13 ,, One Licence was continued by the purchaser of an existing business at which Grade A (T.T.) milk was sold. MILKSELLERS. 1,787 inspections of the various milkshops, dairies, etc., were made. The following nuisances were discovered, in respect of which eight intimation notices were served:— Dirty condition of walls 3 cases. Dirty condition of ceilings 3 cases. Unsuitable utensils 1 case. Milkshop opening into sleeping room 1 rase. Total 8 cases. In addition to the above, cleansing generally was carried out as required. During the year eight retail and five wholesale milksellers, whose premises are outside this Borough, were registered to sell milk in the Borough of Southwark. One retailer discontinued to sell milk in the Borough. Total number of (outside) retail milksellers on Register 51 Total number of (outside) wholesale milksellers on Register 29 67 NOXIOUS TRADES. There are four premises in the Borough upon which noxious businesses or trades are carried on. The following are the premises:— Situation of Premises. Description of Business. Name of Occupiers. 24 & 25, Gt. Suffolk St. Tripe boilers J. Martin. 5, Hatfield Street Fat melters J. Ewen & Sons, Ltd. Harrow Street Skin Dressers Messrs. Leeding & Co. Wansey Street Works Soap Boilers Holders Soap Works, Ltd. Sixteen inspections of these premises were made during the year. The periodical process of limewashing and cleansing was duly carried out. COWSHEDS. No cows are being kept in the Borough at the present time. BAKEHOUSES. During the year 408 inspections were made of the various bakehouses and factories. The following defects were discovered and 18 intimation notices were served in order to obtain the abatement of the nuisances complained of:— Dirty ceilings 15 cases. Dirty walls 15 cases. Dirty oven-front 1 case. Dirty flour store 3 cases. Defective ceilings 4 cases. Other insanitary conditions 4 cases. Total 42 cases. All the above-mentioned nuisances were remedied. Each bakehouse was limewashed or the walls washed as required. 68 PARTICULARS OF BAKEHOUSES (FACTORIES AND WORKSHOPS). Position. Good. Fair. Not satisfactory. Not in use. In use. Totals. Above ground 15 28 1 18 44 62 Underground 15 13 - 8 28 36 Total 30 41 1 26 72 98 BUTTER AND MARGARINE FACTORIES, ETC. Five inspections were made of the Butter Factories during the year. The periodical cleansing was carried out as required. Seven samples of Butter were procured and submitted to the Public Analyst, who certified them as genuine. TOTAL INSPECTIONS DURING 1931. Premises. No. of Inspections. Notices. Intimation. Statutory. Milkshops 1787 7 -. Bakehouses 408 18 - Tripe Boilers 4 - - Fat Melters 4 - - Butter Factories 5 - - Skin Dresser 4 - - Soap Boiler 4 - - Total 2216 25 - ARTIFICIAL CREAM ACT, 1929. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 1927. (DRIED MILK). 13 Samples under the above Regulations were purchased during 1931. Artificial Cream and Dried Milk do not appear to be on sale in the retail shops in the Borough. 69 SALE OF FOOD AND DRUGS ACT. During the year ended December 31st, 1,408 ''official' samples were taken by the Inspector. The following Table shows the localities in which these samples were taken:— TABLE 34. Showing the number of samples taken in each Ward of the Borough during the year. St. Mary's Ward. St. Paul's Ward. St. Peter's District. St. John's District. Trinity Ward. All Saints' District. St. Michael's Ward. St. Jude's Ward. St. George's Ward. Christchurch Ward. St. Saviour's Ward. Total. Number of samples taken 137 150 144 154 135 135 133 117 175 70 58 1408 19 of these samples were certified as adulterated, a percentage of 1.35 as compared with 1.2 in 1930. Particulars of the samples taken together with the results of the analyses are given in Table 36. POLICE COURT PROCEEDINGS TAKEN UNDER THE FOOD AND DRUGS ACT. One summons was taken out during the year 1931. TABLE 35. Showing the Wards in which proceedings were taken under the Food and Drugs Act. St. Mary's Ward. St. Paul's Ward. St. Peter's District. St. John's District. Trinity Ward. All Saints' District. | St. Michael's Ward. St. Jude's Ward. St. George's Ward. Christchurch Ward. St. Saviour's Ward. Total. Number of Summonses taken out - - - - - - - 1 - - - 1 The proceedings taken before the Magistrates resulted as follows:— Dismissed on payment of costs. 70 FOOD AND DRUGS ACTS. TABLE 36. Return of Official Samples for the Year ending 31st December, 1931, showing the number taken, and the percentage of adulterated Samples for the year. Article. Number of Samples taken. Adulterated. Milk 468 14 Condensed Milk 13 - Butter 113 - Cheese 8 - Margarine 105 - Lard 81 - Dripping 18 - Coffee 12 - Cocoa 29 - Tea 38 - Sugar 58 - Mustard 11 - Port Wine 5 - Ruby Wine 2 - Whisky 16 - Gin 8 2 Rum 8 - Brandy 8 - Prunes 4 - Self-raising Flour 41 - Table Jelly 23 - Bisto 14 - Chicken and Ham Paste 1 - Marzipan Mixture 1 - Chocolate Caramels 1 - Tea Dust 2 - Saxa Salt 4 - Tapioca 4 - Rice 22 - Pea Soup Flour 13 - Custard Powder 6 - Ox Tail Soup 5 - Pearl Barley 17 1 Desiccated Soup 3 - Cake 18 - Carried forward 1180 17 Percentage of adulterated samples for the year—1.35. 71 Article. Number of Samples taken. terated. Brought forward 1180 17 Celery Soup 1 - Breakfast Sausage 6 - Brawn 4 - Fish Paste 12 - Muscatels 1 - Soup 2 - Mixed Fruits 5 - Cornflour 19 - Arrowroot 4 - Table Salt 7 - Gravy Thick 7 - Corned Beef 2 - Mixed Creams 1 - Blanc Mange 2 - Tomato Soup 5 - Gravy Salt 4 - Soup Mixture 1 - Rolled Oats 5 - Preserved Sausage 4 - Milk Chocolate 1 - Nut Creams 1 - French Coffee 4 - Sweets 4 - Chocolate 1 - Chocolate Creams 1 - Luncheon Sausage 2 - Fruit Salad 1 - Oatmeal 1 - Jam Sandwich 9 - Ground Rice 3 - Figs 3 - Mustard Condiment 1 - Jam Roll 5 - Crushed Linseed 7 - Compound Liquorice Powder 1 - Ground Ginger 1 1 Glauber Salts 1 - Epsom Salts 1 - Bicarbonate of Soda 2 - Cream of Tartar 1 - Castor Oil 1 - Liquid Paraffin 1 - Linseed Oil 1 - Glycerine 1 - Carried forward 1320 18 72 Article. Number of Samples taken. Adulterated. Brought forward 1320 18 Oil of Turpentine 1 - Eucalyptus Oil 1 - Sultanas 5 1 Ginger Wine 1 - Cheese and Tomato Paste 1 - Currants 5 - Raisins 6 - Cakeoma 2 - Flaked Tapioca 4 - Sponge Mixture 1 - Prepared Groats 2 - Milk Pudding 2 - Flaked Rice 3 - Mixed Herbs 2 - Peas 1 - Chicken and Ham Roll 2 - Hun Flour 1 - Curry Powder 2 - Suet and Rice Flour 4 - Seed Tapioca 2 - Mixed Tablets 1 - Ginger Pieces 1 - Mustard Compound 3 - Mixed Fruit Gums 1 - Jelly Crystals 3 - Lemonade Powder 3 - Sago 2 - Sandwich 1 - Boracic Powder 2 - Pepper 3 - Sponge Cake 2 - Tea Siftings 1 - Dried Fruits 2 - Prepared Barley 1 - Baking Powder 2 - Preserved Pears 1 - Parsley 1 - Preserved Pork Sausage 1 - Salmon and Shrimp Paste 1 - Mixed Spice 2 - Lemon Peel 1 - Lentils 1 - Desiccated Coconut 1 - Jellied Veal 1 - Mixed Peel 1 - Soup Powder 1 - Total 1408 19 73 INFORMAL SAMPLES. In addition to the samples taken under the Food and Drugs Acts as shown in (Table 36), 563 samples were purchased informally by the Inspector through his several agents. The whole of these samples were submitted to the Public Analyst for analysis, with the following result:— TABLE 37. Article. Number of samples purchased by Agents. Result of Analysis. Percentage of adulterated samples. Genuine. Adulterated. Milk 135 133 2 1.5 Butter 282 282 - - Lard 122 122 - - Dripping 5 5 - - Golden Syrup 4 4 - - Syrup 1 1 - - Iodine (Phenolated) 1 1 - - Tincture of Iodine 1 1 - - Sausages 10 9 1 10.0 Sauce 1 1 - - Herbal Tablets 1 1 - - 563 560 | 3 0.53 TABLE 38. SALE OF FOOD AND DRUGS AND OTHER ACTS. PROCEEDINGS TAKEN, WITH THE RESULT. Name and Address of Vendor. Sample and Number. Result of Analysis. Result of Proceedings. Express Dairy Co., Ltd., 12, St. George's Road Milk 1214 13 per cent. deficient in Milk Fat Dismissed on payment of £3/3/0 costs. 74 INFECTIOUS DISEASES. All homes are visited by a Sanitary Inspector and an Enquiry Officer, who investigates the possible sources of infection, arranges for admission to Hospital, and deals with schools and contacts. He also arranges for the rooms to be closed and disinfected and for the admission of contacts to the Reception House if necessary. Your Medical Officer is available for consultations with Medical Practitioners in doubtful or difficult cases. In addition to the usual notification from Medical Practitioners, there is close co-operation between the Public Health Department and the School Medical Service of the London County Council. School intimation notices are received regularly and visits are made to the houses by our Health Visitors and conditions reported upon to the Medical Officer of Health. SMALLPOX. There were 31 cases notified during 1931 as against 106 in 1930. Towards the end of the year this disease became more prevalent, owing to the infection being spread by mild unrecognised cases. It is interesting to note that I saw no case occurring in a vaccinated person. The disease has continued a mild type and no deaths have occurred. No action was found necessary under the Smallpox Prevention Regulations, 1917. SCARLET FEVER The notifications of this disease were the lowest on record since 1923. The disease continues to be very mild in character as shown by the fact that only 3 deaths occurred out of 514 known cases. The number of cases notified and the number of deaths during the last five years were as follows:— Notified. Deaths. 1927 540 1 1928 673 3 1929 662 3 1930 763 4 1931 514 3 The Dick test has not been used for diagnosis or for susceptibility tests. 75 ENTERIC FEVER. 2 cases of Enteric Fever were notified during the year, and 3 of Paratyphoid. The number of cases notified and the number of deaths during the last five vears were as follows:— Notified. Deaths. 1927 10 1 1928 2 1 1929 5 1 1930 2 1 1931 5 1 DIPHTHERIA. Fewer cases of Diphtheria occurred than ever previously, except in the year 1915, when there were 387 known cases, but the number of deaths in that year was 37, whereas, during this year, there have only been 8 deaths. The Borough Council are taking all possible steps to combat this disease, and in this connection have established a "Schick Clinic" at Sutherland House where preventive inoculations are given free of charge, and by the issuing of anti-toxin to all Medical Practitioners, practising in the Borough, for the purpose of curing the disease when it occurs. Regarding the "Schick Clinic," I made the following report to the Public Health Committee in December last. (The 1931 table has been brought up to date.) The number of cases of Diphtheria notified and the number of deaths during the last five years were as follows:— Notified. Deaths. 1927 774 21 1928 668 13 1929 603 22 1930 667 17 1931 426 8 IMMUNISATION AGAINST DIPHTHERIA. Your Immunisation Clinic commenced in March, 1929, at Sutherland House, and is held every Thursday afternoon. Since that time until November 1st, 1931, 424 persons have been rendered immune to Diphtheria at the Clinic. At the outset it will be quite obvious to the Committee that this number is far too small to have any effect on the number of cases of 76 Diphtheria which occur annually in the Borough. The figure, however, shows that either (1) Our system of propaganda and education regarding the benefits of being protected against Diphtheria is inadequate; or (2) That parents are failing to realise the dangers of Diphtheria and are not supporting your scheme of prevention, in spite of warnings. The statistics of your Borough in connection with Diphtheria are as follow:— Average past 5 years Average notified cases per annum (over 5 years period) 733 ,, number of deaths per annum (over 5 vears period) 21 ,, deaths per 100 cases 2.9 1930. Number of notified cases of Diphtheria. 1930 677 ,, deaths from Diphtheria, 1930 17 ,, deaths per 100 cases .. 2-5 ,, persons rendered immune, 1930 124 1931. Number of notified cases of Diphtheria, 1931 426 ,, deaths from Diphtheria 8 ,, deaths per 100 cases 1.9 ,, persons rendered immune, 1931 116 These statistics show that there has been a decline in the number of notifications of Diphtheria during the past two years, and also in the number of deaths, but, as previously stated, this decline can hardly be attributed to the work of the Immunisation Clinic; the figures do. however, answer definitely in the negative the question raised at the last Committee Meeting, i.e., "that the deaths from Diphtheria have increased since the introduction of the immunisation process." From the various discussions at the Committee Meeting, I gathered that Members wished to know the value of Immunisation against Diphtheria. I am fortunately able to give you some first-hand information on the subject, having been one of the first Medical Officers to use this method— I take extracts of reports from (1) Privy Council Medical Research Council, issued in 1927; and (2) Sir George Newman's Report on the "State of the Public Health for the year 1928." LOWESTOFT. (1) "In June, 1925, a small outbreak of diphtheria occurred at the Lovewell Road Infants' School, a frequent centre of infection, and. as the result of investigation at the school, 10 children were removed as 77 diphtheria 'carriers,' 3 of whom proved to be virulent, and were appropriately treated. As subsequent re-swabbing yielded negative results on four occasions, they were allowed to return to school. Four months later further cases of Diphtheria occurred, and it was then found that two of the former 'carriers' again yielded Diphtheria Bacilli on swabbing and were evidently the source of infection. It was therefore decided to exclude them again, and to protect the children by Schick-testing and immunisation. Help from Dr. Lethem, of the Ministry of Health, was obtained. A meeting of parents was summoned and addressed by the Chairman of the Health and Education Committees, by Dr. Lethem, and Dr. W. Stott, the Medical Officer of Health for Lowestoft. Owing to the enthusiastic address of the Chairman of the Education Committee, a well-known anti-vaccinator, the response by parents was regarded as extremely satisfactory, 50 per cent. presenting their children for immunisation. The work of testing was done at the end of September, and 173 children were tested and yielded as many as 130 Schick-positives (75 per cent.)—23 out of 24, aged 1—5; 79 out of 99, aged 5—10; and 28 out of 50, aged 10 years and over. In all, 122 were immunised, 8 having failed to attend. Dr. Stott writes that, up to the present date (October 12th, 1926), it is interesting to note that no further cases of Diphtheria have occurred in this school or even in the district in which it is situated." (2) "In Lowestoft a school outbreak was checked by immunisation in 1925. Last year Diphtheria again broke out, but in another school, and in spite of all precautions soon spread to different parts of the town. None of the 173 children treated in 1925 took the disease, although cases occurred in that school among unprotected children. Acting on the experience gained two years ago, the Council are now offering immunisation to all children in Infant Departments, and have also opened a Clinic at the Child Welfare Centre." Conclusions and Recommendations:— From the above short report it will be gathered that where a large proportion of the susceptible people in a district are immunised, the disease is more or less quickly eradicated, thus proving the value of immunisation. It is uncertain as to the length of time a person remains immune, and as the process is new it is impossible to give any exact idea on the subject. It is, however, known that people who have been immunised in school age have remained immune for 15 to 20 years afterwards, and it is possible there may be immunity for life. I would, therefore, recommend the Committee to continue this work of immunisation with increased vigour, and beg to suggest that:— 78 (a) A small notice be stamped on every weight card at the Centres: (b) Frequent mothers' meetings be addressed by Dr. Porter Smith or one of your Medical Staff, on this important subject. (c) Handbill enclosed in each book issued from the Public Libraries; (d) A lantern slide be prepared on the subject and shown on the screen in local cinemas. TABLE 39. SHOWING THE NUMBER OF ATTENDANCES AT THE SCHICK CLINIC, 1931. A. Schick Test. New Cases. Number Tested. Protection Inoculation given without Test. Children, 0-5 34 Children, 0-5 23 Children, 5-14 56 Children, 5-14 1 Adults 3 Adults -- Old Cases (Reading of Schick Test). Immune. Susceptible. Children, 0-5 3 Children, 0-5 31 Children, 5-14 19 Children, 5-14 36 Adults 3 Adults — Miscellaneous Readings. Children, 0-5 Children, 5-14 1 Adults B. Protective Inoculations given to old Cases. Cases. Inoculations. Children, 0-5 57 1 had 1 2 do. 3 3 do. 53 Children, 5-14 35 1 had 3 3 do. 31 5 do. 1 79 c. Number Re-Tested after 3 months. Found Immune. Children, 0-5 49 Children, 0-5 48 Children, 5-14 71 Children, 5-14 67 Adults 1 Adults 1 Found Susceptible. Miscellanous Readings. Adults 1 Children, 0-5 - Children, 5-14 3 Children, 5-14 1 Children, 0-5 - Adults - Total Attendances. Children, 0-5 295 Children, 5-14 295 Adults 8—Total 598 MEASLES. This fever, the most serious of the Infantile complaints, requires skilled attention, particularly in cases occurring between the ages of 1 to 5 years. Accordingly, many cases are now admitted to the various Fever Hospitals under the control of the London County Council and it is hoped that by these means many of the lives formerly lost from this disease, will be saved. Where found necessary, other cases not severe enough for admittance to Hospital, are referred to the District Nurses for home nursing. All cases are visited by a Health Visitor who gives advice and instruction and, if necessary, visits them subsequently. A report on each case is made to the Medical Officer of Health. The number of cases notified during the year was 302. Of these, 194 were under 5 years of age, and 45 cases were removed to hospital. The number of deaths from Measles during the last five years were as follow:— 1927 27 1928 72 1929 16 1930 77 1931 3 DIARRHOEA. It is gratifying to learn that the number of deaths from Diarrhoea occurring during the year is lowest in the history of the Borough. In Southwark, Summer Diarrhoea is notifiable during the months of July, August and September, and in these three months, only one case was notified, which was sent to Hospital. 80 Deaths from Diarrhoea during the last 5 years:— Deaths. 1927 36 1928 31 1929 41 1930 24 1931 16 WHOOPING COUGH. The number of fatal cases being 18 as against 10 in 1930. The number of fatal cases during the last 5 years was as follows:— Deaths. 1927 30 1928 26 1929 49 1930 10 1931 18 My remarks regarding Measles, apply equally to Whooping Cough. INFLUENZA. The deaths from Influenza during the last 5 years:— Deaths. 1927 43 1928 29 1929 135 1930 20 1931 35 This disease was not very prevalent during the year. There are no reasons for any special remarks. When there is a threatened epidemic, leaflets are circulated through the Borough. PUERPERAL FEVER AND PUERPERAL PYREXIA. 12 cases of Puerperal Fever and 36 cases of Puerperal Pyrexia were notified during the year. The whole of the former and 28 of the latter were removed to Hospital. There were 5 deaths from Puerperal Fever. (See Maternity and Child Welfare report.) OPHTHALMIA NEONATORUM. This is a disease of the eyes occurring in infants shortly after birth. It is preventable, and the prevention lies entirely in the hands of the doctor or midwife attending the birth. 20 cases occurred, as against 28 in 1930. No cases of blindness occurred as a result. 81 An analysis of the cases will be found hereunder:— Notified. Cases treated. Vision unimpaired . Vision impaired. Total Blindness. Deaths. At home. Hospital. 20 10 *10 Nil Nil Nil Nil *These 10 cases were treated at the various Hospitals as out-patients. PREVENTION OF BLINDNESS. A record is kept under the Blind Persons Act, 1920, of all cases under 5 years of age reported from the Welfare Centres, which are referred to the Metropolitan Society for the Blind, 296, Vauxhall Bridge Road. CEREBRO-SPINAL FEVER, ENCEPHALITIS LETHARGICA AND POLIOMYELITIS. 12 cases of Cerebro-Spinal Fever were notified during the year, 10 of which died. 2 cases of Poliomyelitis were also notified and sent to hospital. 1 case of Encephalitis Lethargica died at home, having been notified in 1930. ACUTE PRIMARY AND INFLUENZAL PNEUMONIA. 411 cases were notified during the year. 278 of these were removed to hospital or infirmary. There were 84 deaths of these notified cases. CANCER. This disease shows a steady increase year by year. Of the 290 deaths, 259 occurred in persons over the age of 45. The age groups are as follows:— There were 51 deaths aged 45 to 55. ,, ,, 78 ,, ,, 55 to 65. ,, ,, 90 ,, ,, 65 to 75. ,, ,, 40 ,, ,, 75 and upwards. The greatest number of deaths occurred in males. The principal sites of the cancer were the stomach and intestines in the male, and the breast and genital organs in the female. The number of deaths from cancer in the last five years is as follows:— Deaths. 1927 260 1928 252 1929 254 1930 250 1931 290 82 TABLE 40. Return of Families Admitted into the Council's Reception House during the year 1931. 1931. Scarlet Fever. Diphtheria. Smallpox. Other Diseases, etc. Verminous Persons. Week ending No. of Families No. of Persons No. of Days No. of Families No. of Persons No. of Days No. of Families No. of Persons No. of Days No. of Families No. of Persons No. of Days No. of Families No. of Persons No. or Days Jan. 10 — — — 2 8 29 1 2 6 — — — — — — „ 17 — — — 2 11 22 — — — — — — — — — „24 1 4 16 — — — — — — — — — — — — „ 31 — — — — — — — — — — — — — — — Feb. 7 — — — 1 3 9 — — — — — — — — — „ 14 — — — 1 3 9 — — — — — — — — — „ 21 — — — 1 8 16 — — — — — — — — — „28 — — — 1 3 9 — — — — — — — — — March 7 1 1 2 — — — — — — — — — — — — ,, 14 — -— — — — — — — — — — — — — — ,, 21 — — — — — — 1 9 8 — — — — — — ,, 28 — — — 1 2 4 1 4 12 — — — — — — April 4 — — — — — — — — — — — — — — — ,, 11 — — — 1 3 9 — — — — — — — — — ,, 18 — — — — — — — — — — — — — — — „25 1 2 6 — — — — — — — — — — — — May 2 — — — — — — 1 2 10 — — — — — — ,, 9 — — — — — — — — — — — — — — — ,, 16 — — — 1 2 6 1 5 15 — — — — — — „23 — — — 1 4 12 — — — — — — — — — ,, 30 — — — — — — 1 5 15 — — — — — — June 6 — — — — — — — — — — — — — — — ,, 13 — — — — — — 2 7 21 1 2 6 — — — ,, 20 — — — 1 2 6 — — — — — — — — — „ 27 1 5 15 — — — — — — — — — — — — 83 July 4 — — — — — — 2 7 7 — — — — — — „ 11 — — — — — — — — — — — — — — — „ 18 1 6 24 — — — — — — — — — — — — „ 25 1 3 9 — — — — — — — — — — — — Aug.1 1 2 6 — — — — — — — — — — — — „ 8 — — — — — — — — — — — — — — — „ 15 — — — 1 3 9 — — — — — — — — — „ 22 — — — 1 5 15 — — — — — — — — — „ 29 — — — 1 4 16 — — — — — — — — — Sept.5 — — — 1 3 9 — — — — — — — — — „ 12 — — — — — — — — — — — — — — — ,, 19 1 4 12 — — — — — — — — — — — — ,, 26 — — — 2 10 30 — — — — — — — — — Oct. 3 1 2 4 1 3 9 — — — — — — — — — „ 10 — — — — — — 1 7 21 — — — — — — „ 17 — — — 1 2 6 — — — — — — — — — „ 24 1 6 18 — — — 1 6 42 — — — — — — „ 31 2 4 12 — — — — — — — — — — — — Nov. 7 — — — 2 5 13 1 4 20 — — — — — — ,, 14 — — — — — — — — — — — — — — — ,, 21 — — — — — — — — — — — — — — — „ 28 — — — 1 2 6 — — — — — — — — — Dec. 5 — — — — — — 2 8 24 — — — — — — ,, 12 — — — — — — 1 3 12 — — — — — — ,, 19 — — — — — — 1 1 3 — — — — — — „ 26 — — — 1 4 12 — — — — — — — — — Total 12 39 124 25 90 256 17 63 216 1 2 6 — — — 84 TABLE 41. NOTIFIABLE DISEASES (other than Tuberculosis) during the year 1931. Disease. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Males. Females. Total Cases admitted to Hospital Total Deaths Scarlet Fever 9 152 202 74 32 19 21 2 3 — — — — 246 268 514 497 3 Smallpox — 1 6 5 7 4 3 2 1 2 — — — 18 13 31 31 — Diphtheria 6 141 160 55 23 19 11 9 2 — — — — 202 224 426 426 8 Memb. Croup — — — — — — — — — — — — — — — — — — Enteric Fever — — 1 — — 1 — — — — — — — — 2 2 2 — Paratyphoid — — — — 1 1 — — 1 — — — — 1 2 3 3 1 Puerperal Fever — — — — — 2 8 2 — — — — — — 12 12 12 5 Puerperal Pyrexia — — — — 2 7 20 7 — — — — — — 36 36 28 5 Cerebro-Spinal Fever 1 7 — — 2 — — 1 — 1 — — — 6 6 12 12 10 Measles 33 161 94 7 2 3 1 1 — — — — — 146 156 302 45 3 Malaria — — — — — — 1 — — — — — — 1 — 1 — — Dysentery — 1 — — — — — — — — — — — — 1 1 1 — Epidemic Diarrhoea — 2 — — — — — — — — — — — 1 1 2 — 18 Encephalitis Lethargica — — — — — — — — — — — — — — — — — 1 Pneumonia 23 70 46 14 32 95 42 42 43 41 25 6 2 270 141 411 278 84 Ophthalmia Neonatorum 20 — — — — — — — — — — — — 15 5 20 — — Ervsipelas 5 7 6 6 9 6 8 21 29 22 3 7 — 59 70 129 — — Polio-Encephalitis — — — — — — — — — — — — — — — — — — Polio-Myelitis — 1 — 1 — — — — — — — — — 2 — 2 2 — Chickenpox — — — — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — Totals 97 543 515 162 110 87 115 87 79 66 28 13 2 967 937 1904 1337 138 85 DISINFECTION. The total number of disinfections of rooms during the year by the Council's disinfecting staff was 7,361. Of this number 2,173 rooms were disinfected after the occurrence of the ordinary notifiable infectious diseases, as against 3,553 rooms in 1930. 4,584 periodical sprayings of rooms occupied by phthisical patients were also carried out during the year. 604 verminous rooms were sulphured and otherwise cleansed by the Council's staff during the year, as against 907 in 1930. Among the total number of disinfections (7,361) it was found necessary to strip 64 rooms. Of these 25 were in relation to the notifiable diseases, and 39 after the termination of cases of phthisis. TABLE 42. The Locality of Rooms Disinfected and Stripped after the occurrence of Infectious Disease. St. Mary's Ward. St. Paul's Ward. St. Peter's District. St. John's District. Trinity Ward. All Saints' District. St. Michael's Ward. St. Jude's Ward. St. George's Ward. Christchurch Ward. St. Saviour's Ward. Total. Disinfected 253 227 203 254 186 178 289 170 180 124 109 2173 Stripped 6 9 2 2 1 2 3 - — — — 25 86 TABLE 43. Bedding, etc., disinfected and destroyed after the occurrence of Infectious Disease during the Year 1931. Articles. No. Disinfected. No. Destroyed. Beds 992 61 Palliasses 589 59 Bolsters 579 17 Pillows 1,750 57 Cushions 260 34 Blankets 1,442 12 Sheets 1,062 12 Quilts 947 16 Articles of Clothing, etc. 2,611 108 Books 236 — Total 10,468 376 In addition, one attache case of papers was disinfected and two mats were destroyed. MATERNITY AND CHILD WELFARE. At the present time the Maternity services of the Borough are carried on with eight municipal, two partly municipal and partly voluntary, and four voluntary centres. HEALTH VISITING. The arrangements made for the visiting of children between the ages of 1 and 5 years for the present appear to be fairly satisfactory. During the year under consideration 868 more children between these ages have been visited in their homes by the Health visitors. Of this number 730 were visited by the Municipal health visitors and 138 by Voluntary workers. Cases of measles, whooping cough, pneumonia, ophthalmia neonatorum, etc., are visited and reported on by the health visitors employed by the Council; likewise enquiries into cases of puerperal pyrexia, maternal and infant deaths. 87 In this connection I must state that I am of opinion that all enquiries and visits to newly-born infants, as well as those from 1 to 5 years, should be made by the health visitors employed by the Council. ANTENATAL CLINICS. Antenatal Clinics are held at Sutherland House every Monday and Friday mornings and one session is held monthly at St. Jude's Centre, Lambeth Road. The attendances for the years are as follow:— SUTHERLAND HOUSE. (Monday, Dr. Shepherd.) During the year 171 mothers were seen and given advice, they made 467 attendances. Of this number, 36 were sent by midwives, 85 by the health visitors, 4 by various hospitals, 1 by a private practitioner, and 45 came of their own accord. SUTHERLAND HOUSE. (Friday, Dr. Bergin.) 228 mothers were seen and given advice; they made 498 attendances. Dr. Bergin reports:— The following figures show the increase in the work done at the Antenatal Session held on Friday mornings at Sutherland House:— New. Total. 1930 202 433 1931 228 498 During the last year we arranged a new system of cards which are transferred to the midwife before the confinement and afterwards returned to the Medical Officer; in this way the Doctor may check his findings antenatally with the result. The midwives are now realising the importance of returning these records, but there are still a number outstanding whose records have not been returned. I would suggest that the midwives receive a small fee for filling in and sending back these record cards, and also if a Doctor transfers a midwife's case to Hospital for the confinement some compensation should be made. The majority of cases attending are referred by midwives, the figures for 1931 being—199 sent by midwives; 20 sent by Health Visitors; 4 sent by Relieving Officers; 1 sent by T.B. Clinical Officer; 2 came of their own accord; and 2 sent by the Centre Medical Officers. 88 Out of the total number of mothers who attended, there was one death —pneumonia after parturition; it is interesting to note that this patient suffered from pyorrhoea alveolaris, and although advised and warned of the dangers, she refused to have treatment. It is difficult to get the mothers to realise the necessity for treatment of dental caries and other dental conditions. Perhaps a special clinic for this class of patient where they would meet each other, instead of a general dental department at a hospital, might be an improvement. There were three still-births out of the total attendances. Of the 228 expectant mothers seen during the year, 17 were found on examination to be abnormal. 1 case of hydramnios, 2 cases of antepartum haemorrhage, and 8 cases of malposition were referred to Hospital, and 6 cases of albumin in urine were referred to their own Doctors. With the present staff at the Antenatal Clinic—one Medical Officer and one Health Visitor—most of the time is taken up with the clinical side of the work, very little being done on the educational side. The number of patients who can be efficiently dealt with in a session is about 10. It frequently occurs that mothers come to the Clinic in a depressed state of mind; this condition is observed by the Medical Officer in charge and it is at once realised that advice at this stage is not expedient, but help from a psychological point of view is really what is required, and it is gratifying to report that in several instances a friendly and intimate chat has had the effect of relieving the depression and causing the prospective mothers to go away in a more cheerful frame of mind. There is some difficulty in getting the patients to return monthly or weekly if necessary, although if they do not return on the day appointed for them, they are visited or get a reminder to attend. Some of them seem to think that one visit is sufficient. The Clinic is too great a distance for some, and especially if they have to attend more than twice. They usually make the effort to come once, but very often stop at that, and in the abnormal cases it is most essential that they attend as often as required. This suggests more Antenatal Clinics situated nearer the homes of the prospective mothers. There has been very little difficulty in securing beds for patients referred to Hospitals for their confinements. In necessitous cases, milk and sometimes food are supplied to the mothers. 89 ST. JUDE'S CENTRE, LAMBETH ROAD. (1 session monthly, Dr. Shepherd.) 88 mothers were seen and given advice; they made 249 attendances. MATERNAL MORTALITY. The number of deaths during 1931, due directly to pregnancy or childbirth, was 10; of these 5 were due to septic causes and 5 from other causes. All cases of Maternal Deaths are visited by your Health Visitors and reported upon. Maternal mortalitv rates per 1,000 total births are as follow:— London (Administrative County.) South wark. Puerperal sepsis 1.96 1.65 Other accidents and diseases of pregnancy and parturition 1.72 1.65 ARTIFICIAL LIGHT TREATMENT. The arrangement with Guy's Hospital, whereby Ultra Violet Rays are applied to ailing and delicate children is still carried on and during the year the number of cases sent for treatment was 102. Many of the children have made good progress, particularly in cases of rickets, malnutrition and wasting, and in the winter when natural sunlight is deficient, this treatment is of undoubted use and is worthy of continuance. CONVALESCENT TREATMENT. An arrangement was entered into between the Borough Council and the Invalid Children's Aid Association by which the Council undertook part payment for children under 5 years of age sent to Convalescent Homes by that Association and 59 children were thus assisted to have the necessary treatment and fresh air to restore them to health. 16 children were referred to the Public Assistance Committee for convalescence. The treatment of convalescent children has been carried out by the Invalid Children's Aid Association for some years, but by the arrangements mentioned above, the Council now bears part of the cost incurred up to £300 per annum for children attending our centres requiring convalescence. 90 DINNERS TO NECESSITOUS MOTHERS. 697 Dinner Coupons were given to necessitous mothers who were referred to the Southwark Invalid Kitchen, at a cost to the Council of £17 8s. 6d. for the year. MATERNITY AND CHILD WELFARE CENTRES. Assistant Medical Officer of Health (Maternity and Child Welfare) Dr. M. Bergin. Superintendent Health Visitor Mrs. J. A.Holland. (to October 12th, 1931). 1a CENTRE (Voluntary). St. John's Institute, Larcom Street. District served by Centre St. John's Ward. Sessions held every Wednesday and Thursday 2—4.0. Medical Officers Dr. E. M. Saxton and Dr. M. O. Cruickshank. Superintendent Mrs. A. Parkins. 1b CENTRE (Municipal). Sutherland House, Sutherland Square. District served by Centre St. Mary's Ward. Sessions held every Tuesday 10.0—12. 2.0—4.0. Medical Officer Dr. Dorothy Shepherd. Health Visitor Mrs. Kingsmill. 2a CENTRE (Municipal). Sutherland House, Sutherland Square. District served by Centre St. Paul's Ward. Sessions held every Wednesday 10.0—12. 2.0—4.0. Medical Officer Dr. Dorothy Shepherd. Health Visitor Miss W. Sayer. 2b CENTRE (Municipal). Working Boys' Club, Villa Street. District served by Centre St. Peter's District. Sessions held every Wednesday 10.0—12. 2.0—4.0. Medical Officer Dr. M. Bergin Health Visitor Miss W. F. Cleverley. 91 3a CENTRE (Municipal). All Saints' Parish Room, Surrey Square. District served by Centre The Southern portion of All Saints' District and the portion of St. George's Ward between East Street and Albany Road. Sessions held every Thursday 10.0—12. 2.0—4.0. Medical Officer Dr. A. C. Stevens. Health Visitor Miss A. Rogers. 3b CENTRE (Municipal). Lady Margaret Church Parish Room, Chatham Street. District served by Centre The Northern half of All Saints' District and the portion of St George's Ward between East Street and New Kent Road. Sessions held every Thursday 10.0—12. 2.0—4.0. Medical Officer Dr. M. Bergin. Health Visitor Miss A. C. Cottrill. 4a CENTRE (Partly Municipal and partly Voluntary). Crossways Mission Hall, New Kent Road. District served by Centre Trinity Ward. Sessions held every Wednesday 10.0—12. 2.0—4.0. Medical Officer Dr. Jackson Smith. Health Visitor Miss K. L. M. Hinde (from January 19th, 1931). 4b CENTRE (Municipal). Mission Hall, Lansdowne Place. District served by Centre The Northern half of St. George's Ward and the streets between Trinity Street and Tabard Street. Sessions held every Friday 10.0—12. 2.0—4.0. Medical Officer Dr. A. C. Stevens. Health Visitor Miss F. M. Adair. 92 5 CENTRE (Partly Municipal and partly Voluntary) 56, Lambeth Road. District served by Centre A part of St. Jude's and St. Michael's Wards. Sessions held every Monday and Friday 2—4 0 Medical Officer Dr. Dorothy Shepherd. Health Visitor Miss Pearson. 6a CENTRE (Municipal). St. George's Dispensary, Pocock Street. District served by Centre Christchurch Ward and a part of St. Michael and St. Jude's Wards. Sessions held every Tuesday 10.0—12. 2.0—4.0. Medical Officer Dr. M. Bergin. 17 Health Visitor Miss M. Freeth. 6b CENTRE (Municipal). St. Mary's Girls' Club, Union Street. District served by Centre St. Saviour's Ward. Sessions held every Monday 10.0—12. 2.0—4.0. Medical Officer Dr. M. Bergin. Health Visitor Mrs. M. E. George. 6c CENTRE (Voluntary). 86, Borough Road. District served by Centre A part of St. Michael's Ward. Sessions held every Monday 2.0—4.0. Medical Officer Dr. Vernon. Health Visitor Miss Oxley. In addition to the above, the Roman Catholic Centre, 148, New Kent Road (Voluntary), holds a session every Thursday from 2.30—4, and Salamon's Centre, 28, Newcomen Street (Voluntary), holds two sessions, Monday, 2—5, and Thursday, 10—12. 93 ANTE-NATAL CLINICS. Sutherland House, Sutherland Square. District served by Clinic St. Mary and St. Paul Wards. Sessions held every Monday 10.0—12.0. Medical Officer Dr. Dorothy Shepherd. Sutherland House, Sutherland Square. Districts served by Clinic St. Peter, St. John Trinity, All Saints, St. Michael, St. George, Christchurch and St. Saviour's Wards. Sessions held every Friday 10.0—12.0. Medical Officer Dr. M. Bergin. 56, Lambeth Road. District served by Clinic St. Jude's Ward. Sessions held One monthly. Medical Officer Dr. D. Shepherd. The local Midwives refer all cases needing advice and treatment to the above Clinics. 94 95 MATERNITY AND CHILD WELFARE CENTRES. Showing the Attendances at the Several Centres and Visits paid to the homes of Mothers and Children by Health Visitors. TABLE 44. St. John 1a. St. Mary. 1b. St. Paul. 2a. St. Peter. 2b. All Saints. 3a. Lady Margaret 3b. Crossway. 4a. St. Stephens. 4b . St. Jude. 5. St. Michael. 6a. St. Saviour. 6b. St. George. 6o. Guy's. 7. Total. Number of Births notified during the year 362 314 389 238 206 237 213 153 282 323 219 90 57 3083 Number of individual children attending the Centre during year 517 503 503 244 239 258 339 266 456 393 234 64 78 4094 Number of Sessions held during the year 94 96 94 94 94 94 96 92 93 96 90 46 95 1174 Number of new cases attending the Centres during the year— (1) Expectant Mothers 194 - 11 - 15 13 1 54 45 12 5 - 881 1231 (2) Infants under 1 year 368 334 344 179 170 193 206 155 292 263 174 59 75 2812 (3) Seen by Doctor 235 230 261 116 110 140 143 97 252 156 151 58 75 2024 (4) Children 1 to 5 years 149 169 159 65 69 65 133 111 164 130 60 5 3 1282 (5) Seen by Doctor 34 38 66 13 14 8 33 19 110 29 6 3 3 376 Method of Feeding—(a) Breast 265 259 267 124 123 175 163 129 208 210 147 52 70 2192 (b) Breast and bottle 22 17 19 11 13 7 18 11 31 27 13 1 1 191 (c) Bottle 37 58 65 47 34 9 26 19 54 27 14 6 4 400 (d) Ordinary diet 193 169 152 62 69 67 132 107 163 129 60 5 3 1311 Total number of attendances at the Centres during the year—- (1) Mothers 7120 5952 5761 4280 3771 4069 4816 4012 4562 5582 4725 1844 159 56653 (2) Expectant Mothers 554 12 20 1 30 42 3 138 114 75 100 5 3382 4476 (3) Infants under 1 year 4309 3785 3899 2363 2158 2491 2250 2135 2265 3329 2840 1025 1773 34622 (4) Children 1 to 5 years 2287 2118 1822 1512 1555 1433 2622 1981 2440 1822 1809 988 892 23281 (1) Average number of attendances 75.7 62.0 61.3 45.5 40.1 43.3 50.2 43.6 49.1 58.1 52.5 40.1 1.7 — (2) clo. do. 5.9 - - - - - - - - - - - 35.6 — (3) do. do. 45.8 39.4 41.5 25.1 23.0 26.5 23.4 23.2 24.4 34.7 31.6 22.3 18.7 — (4) do. do. 24.3 22.1 19.4 16.1 16.5 15.2 27.3 21.5 26.2 19.0 20.1 21.5 9.4 — (5) Total number of attendances of Infants seen by Doctor during the year 1458 1590 1713 975 1158 1190 1015 1272 1123 1326 1254 538 1231 15843 (6) Total number of attendances of children 1 to 5 years seen by Doctor during the year 545 910 880 637 722 716 835 1033 972 763 657 497 664 9831 (7) Total number of Expectant Mothers seen by Doctor 194 11 - 7 20 1 80 45 14 5 - 881 1258 (8) Children weighed 5527 5653 5649 3841 3580 3768 4747 3621 3872 4997 4372 2011 2665 54303 (9) Post-natal cases 1976 - - 1 1 65 - 412 825 128 64 260 438 4170 Total number of first visits paid by Health Visitors to homes of— (1) Expectant Mothers 202 167 172 81 65 45 68 87 241 151 70 26 784 2159 (2) Infants under 1 year 392 329 432 282 252 277 229 191 287 370 205 64 61 3371 (3) Children 1 to 5 years 94 — — — — — — — 12 — — 76 9 191 Total number of revisits paid by Health Visitors to homes of— (1) Expectant Mothers 224 35 13 6 7 2 - - 266 - 4 55 1037 1649 (2) Infants under 1 year 1829 1377 1150 699 1040 1473 803 1829 1528 1706 923 903 503 15763 (3) Children 1 to 5 years 2603 1690 1281 1463 1551 1147 1930 1819 2877 1740 1594 3017 1378 24090 Sewing Classes were held during the year at Sutherland House with a total attendance of 346. 96 HEALTH WORK. The number of visits made by the Health Visitors and other officers of the Public Health Department to houses in connection with Births, and other Health Work during 1931. TABLE 45. Original Visits. Revisits . Visits to AnteNatal Cases. Visits to PostNatal Cases. Visits to Delicate Infants. Visits to Cases of Diarrhoea and Sick Children. Attendances at Welfare Centres. Visits where Mothers were found to be out. Special Visits, etc. Puerperal Pyrexia. Total. Births. Measles. Ophthalmia Neonatorum. Births. Measles. Ophthalmia Neonatorum. Mrs. Holland (to Oct. 12th) — — — — — — — — — — 244 — — — 244 Mrs. Kingsmill 329 47 3 3067 9 — 202 — — — 142 8 — 6 3813 Miss Saver 432 20 1 2431 2 — 185 — — — 97 274 2 3 3447 Miss Cleverley 282 14 4 2162 — — 87 2 — — 139 193 2 4 2389 Miss Rogers 252 22 1 2591 3 — 72 — — — 92 220 1 1 3255 Miss Cottrill 277 60 7 2620 20 — 47 — — — 90 30 7 3 3161 Miss Hinde 229 72 6 2733 17 — 68 — — 1 94 361 4 10 3595 Miss Adair 191 12 2 3648 — — 87 — — — 94 — — 5 4039 Miss Freeth 370 20 1 3446 2 — 151 — — — 98 83 1 3 4175 Mrs. George 205 15 1 2517 — — 74 — — 1 107 106 2 7 3035 Mrs. George (home help) — — — — — — — — — — 478 — 28 — 506 Total 2567 282 26 25215 53 — 973 2 — 2 1675 1275 47 42 32159 97 LABORATORY FACILITIES. The Chemical and Bacteriological laboratories are maintained by the Council under the direct control of the Public Analyst who is a fulltime officer. Chemical analyses are undertaken of all samples submitted under the Food and Drug Acts and Regulations, together with any other analytical work or investigations required. Bacteriological examinations of Sputa for Tubercle, Swabs for Diphtheria and Blood for the Widal reaction for Typhoid are made for Medical Practitioners in the Borough and for the Tuberculosis Dispensary. BACTERIOLOGICAL SPECIMENS. Number of specimens examined during 1931 2718 Positive results 381 FOOD AND DRUG SAMPLES. 1,977 samples of Foods and Drugs, both formal and informal, have been examined during 1931. Nearly all these samples have been tested for preservatives, as the practice in the Public Analyst's department is to examine for preservatives all articles of food which experience has shown are liable to contain them. Details of the above matters are given in full in the reports sent bv the Public Analyst to the Ministry of Health in each quarter of the year. CYRIL DICKINSON, B.Sc., F.I.C., Public Analyst. TUBERCULOSIS SCHEMES. The Borough Council has for some years carried out a scheme for dealing with Tuberculosis, and the cases in Southwark are visited by a staff of specially trained nurses from the Municipal Dispensary, which also is a centre for the treatment of out-patients, and for the examination of suspects or contacts. Through this dispensary also pass all cases who are admitted and discharged from Hospital or Sanatoria. Arrangements are made for the examination of Sputa, X-ray examination and treatment by artificial pneumothorax or ultra-violet rays. The dispensary is under the charge of a Clinical Tuberculosis Officer, who is a whole-time officer of the Council. All notifications from Medical Practitioners are recorded in the Statutory Register which is kept in the Public Health Department. The whole of the above work is under the supervision of the Medical Officer of Health as Administrative Tuberculosis Officer. 98 The number of notified cases and deaths for the last 5 years is as follows:— Notified. Deaths. 1927 343 197 1928 319 194 1929 339 232 1930 339 210 1931 312 208 The mortality rate was 1.20 per 1,000 as against 1.17 per 1,000 in 1930. The following tables give, in tabular form, the number of cases of Tuberculosis on the Medical Officer's Register; the number of new cases coming to the knowledge of the Medical Officer of Health, and the number of deaths from Tuberculosis for the period under review. PHTHISIS. TABLE 46. Notification Register. Pulmonary. Non-Pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. Number of cases of Tuberculosis remaining at the 31st December, 1931, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough 763 478 1241 303 233 536 1777 Number of cases removed from the Register(s) during the year by reason inter alia of:— 178 120 298 31 27 58 356 (1) Withdrawal of notification 49 38 87 14 14 28 115 (2) Recovery from the disease 6 11 17 4 9 13 30 (3) Deaths 123 71 194 13 4 17 211 99 TABLE 47. TUBERCULOSIS. Age Periods. New Cases.* Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. 0 — 1 — 1 1 1 16 2 2 5 8 14 2 1 10 8 7 4 8 15 29 11 20 7 20 47 6 23 — 25 69 5 29 2 35 45 3 30 2 45 51 3 41 3 55 42 3 44 1 65 and upwards 12 2 13 1 Total 312 71 208 28 (1) The ratio of non-notified tuberculosis deaths to total tuberculosis deaths is 1 in 8. This figure is represented in 28 deaths; of this number 16 were found to be suffering from tuberculosis as a result of post-mortem examination, and 8 died in institutions outside the Borough, which leaves 4 un-notified or notified after death, so that strictly speaking the rate is 1 in 59. There is no evidence of wilful neglect on the part of the private practitioner to notify, neither is there evidence of excessive incidence of or mortality from tuberculosis, in any particular occupation in the Borough. 100 TABLE 48. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 28th December, 1930, to the 2nd January, 1932, in the Metropolitan Borough of Southwark. Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A. Age-periods 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and upw'rds Total Primary Notifications. Pulmonary Males — — 4 1 10 28 33 30 35 29 10 180 214 ,, Females — 1 4 6 17 13 27 12 12 6 2 100 121 Non-Pulmonary Males — 10 9 4 5 3 2 1 2 2 2 40 41 ,, ,, Females — 4 5 1 3 2 2 1 — — — 18 22 Primary Notifications relate to patients who have previously been formally notified in the area to which the return relates. Any additional notification of a case which has been previously notified in the area is to be regarded as duplicate. 101 TABLE 49. SUPPLEMENTAL RETURN. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health or Chief (Administrative) Tuberculosis Officer during the period from the 28th December, 1930, to the 2nd January, 1932, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912. Age Periods .. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 & upwards Total Cases Pulmonary Males — — — — 1 2 8 2 3 4 — 20 ,, Females — — — 1 1 4 1 1 1 3 — 12 Non-pulmonary Males 1 1 — 1 1 — 1 — 1 1 — 7 ,, ,, Females —- 1 — 1 2 1 - 1 — — — 6 102 DEATHS FROM PULMONARY TUBERCULOSIS. TABLE 50. Shewing the number of Patients who died in their own homes and the number who died away from home in Hospitals or other Institutions, 1931. 0- 1- 2- 5- 15- 25- 45- 65- 75- All Ages. Males. Females. Total. Number of patients who died at home - - - 1 12 18 27 6 - 31 33 64 Number of patients who died in hospitals, etc. - 2 2 3 31 41 58 7 - 105 39 144 - 2 2 4 43 59 85 13 - 136 72 208 Of the total number of deaths from Pulmonary Tuberculosis 69.2 per cent. occurred in hospitals or other institutions. 103 Disinfection was carried out as follows :— TABLE 51. The Locality of the Rooms Disinfected and Stripped after the occurrence of Phthisis. St. Mary's Ward. St. Paul's Ward. St. Peter's District. St. John's District. Trinity Ward. All Saints' District. St. Michael's Ward. St. Jude's Ward. St. George's Ward. | Christchurch W ard. St. Saviour's Ward. Total. Disinfected 556 460 408 503 483 434 655 257 431 160 237 4584 Stripped 5 2 2 2 4 7 6 3 6 1 1 39 WORK OF THE TUBERCULOSIS DISPENSARY. I have received the following report from Dr. Crowe, your Clinical Tuberculosis Officer. The work of the Dispensary was carried out as usual during the year, sessions being held as follow:— Tuesday Wednesday „ Tuesday „ „ Thursday Thursday 6-8p.m. Saturday The number of new cases examined and the total number of attendances, etc., at the Dispensary will be found in the table on page 106. DIAGNOSIS OF TUBERCULOSIS. The Dispensary has played its part as an aid to diagnosis in doubtful cases. It is to be regretted that the majority of patients referred to the Dispensary cannot be said to be in the early stages of disease, and a happier state of affairs will not be reached until earlier medical advice is sought for symptoms which often herald an attack of Tuberculosis, such as lassitude, loss of appetite and persistent coughs, or even miscalled Influenza. Special forms of investigation were again utilised whenever necessary. 40 cases were sent to Guy's Hospital for X-Ray examination under the existing arrangement with that body, and sputum examinations were made in 509 cases. 104 PROVISION OF EXTRA NOURISHMENT. Allowances of milk, cod-liver oil, etc., are provided to Tuberculosis patients in accordance with the conditions laid down by the Ministry of Health. 47 patients were granted extra nourishment under this scheme. The Public Assistance Committee of the London County Council render valuable assistance in granting relief, food and clothing to many of our poorer patients. In addition to these Public bodies, the Charity Organisations Association, the British Red Cross Society, United Services Fund and the National Association for the Prevention of Tuberculosis have all helped in many ways. SUPERVISION OF HOME CONDITIONS. This very good work is carried out by three T.B. Visitors attached to the Dispensary. Their duty is to supervise the homes of sufferers; to see that all precautions are taken for preventing the spread of the disease to others living in the home; to persuade contacts and sufferers to attend the Dispensary regularly; to report to the Clinical T.B. Officer as to the patients' general condition and the conditions under which they are living; to make suggestions for any improvement which will benefit them. For these purposes, your Nurses made 4,169 visits. ISSUE OF SHELTERS, ETC. Shelters and bedsteads have been lent to suitable patients. HOME NURSING. Home Nursing, when required, is carried out by the Benson Home and the Ranyard Nursing Association. CO-ORDINATION OF DISPENSARY WITH OTHER HEALTH SERVICES. There is complete co-ordination between the School Medical Services of the L.C.C. and the Borough Maternity and Child Welfare Services and the Dispensary. A special Saturday morning session is devoted to the examination of children, and reports of children are examined and furnished to the appropriate departments. Relations between the Ministry of Pensions, the L.C.C., Medical Practitioners and ourselves are well maintained. 105 INSTITUTIONAL TREATMENT. A total of 328 persons were recommended to the L.C.C. for Institutional treatment and 27 other persons were recommended to that Authority for observation and diagnosis. A large number of advanced cases were sent to the Public Assistance Committee of the L.C.C. for admission to the old Poor Law Hospitals. They are still dealt with by the Relieving Officers. NON-PULMONARY TUBERCULOSIS. Surgical cases of bones, glands and joints are admitted to suitable sanatoria or to the Orthopaedic Departments of Children's Hospitals. Three patients received artificial sunlight treatment at Guy's Hospital and the Council's liability is Is. per head for each sitting in these cases. ARTIFICIAL PNEUMO-THORAX TREATMENT. This form of treatment has again been a large item in the Dispensary routine. 19 patients are undergoing such a course at the present time either at the Brompton Hospital or elsewhere. Refills are given once a week, decreasing to once a month according to the progress of the patient. The Borough Council remunerates the hospital authorities at the rate of 10s. 6d. for each of these refills. During the period under review the total cost for this form of treatment was £120 4s. 6d. COLONY TRAINING. Two of our youthful patients between 14 and 19 years of age underwent training at Burrow Hill Colony, Frimley, Surrey. INVALID CHILDREN'S AID ASSOCIATION. This Association continues to give us great assistance in dealing with delicate children I have recommended for convalescent treatment, and the boarding out of contact children of advanced T.B. cases living at home, under the L.C.C. Scheme. 11 children were thus dealt with during the year. TUBERCULOSIS CARE COMMITTEE. The Care Committee met weekly during the year and did a large amount of work most useful to the Dispensary; the full report of the Committee follows hereafter. 106 TABLE 52. RETURN FOR THE YEAR 1931 SHOWING THE WORK OF THE TUBERCULOSIS DISPENSARY. Diagnosis . Pulmonary . Non-Pulmonary Total. Grand Total. Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): — (a) Definitely tuberculous 110 54 4 8 8 8 18 6 118 62 22 14 216 (6) Diagnosis not completed 7 4 4 9 — — 2 1 7 4 6 10 27 (c) Non-tuberculous 65 58 12 10 — — 1 2 65 58 12 12 147 B.—Contacts examined during the year:— (a) Definitely tuberculous 5 4 — 1 1 1 4 2 6 5 4 3 18 (6) Diagnosis not completed — 1 4 4 — — 1 - — 1 5 4 10 (c) Non-tuberculous 47 7 4 82 81 — — 47 74 82 81 284 C.—Cases written off the Dispensary Register as:— (a) Recovered 4 10 — — 0 6 1 1 9 16 1 1 27 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) 112 13 2 94 91 - - - 2 112 132 94 93 431 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 330 220 17 20 17 26 30 33 347 246 47 53 693 (6) Diagnosis not completed 7 5 8 13 — — 3 1 7 5 11 14 37 1. Number of cases on Dispensary Register on January 1st 2 690 Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 25 3. Number of cases transferred to other areas, cases not desiring further assistance under the schme, and cases "lost sight of" 108 4. Cases written off during the year as Dead (all causes) 121 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 86 5. Number of attendances at the Dispensary (including Contacts) 4122 7. dumber of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 26 (a) Personal 2 (b) Other z41 10. Number of : — 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3296 (a) Specimens of sputum, etc., examined 509 (b) X-ray examinations made in connection with Dispensary work. 40 11. Number of "recovered"cases restored to Dispensary Register and include in (a)and A(b) above 5 12.Number of "T.B plus" cases on Dispensary Registry on ber 31st 279 107 REPORT OF THE TUBERCULOSIS CARE COMMITTEE, 1931. As in former years the Committee has met weekly. It consists of representatives of the Borough Tuberculosis Dispensary (the Tuberculosis Officer is the Chairman), the Borough Council, the London County Council Organiser of School Care Committees, the Invalid Children's Aid Association, the Charity Organisation Society, the British Legion, the United Services Fund, the Soldiers' and Sailors' Help Society, the Red Cross and the Women's University Settlement. THE COMMITTEE'S WORK. The Committee consider cases referred to it by the Borough Tuberculosis Officer for Sanatorium or Hospital treatment under the London County Council Tuberculosis scheme, cases brought up for some special need by the Tuberculosis Officer, the Nurses or any member of the Committee and sees that the required help is obtained from the various agencies to which the Committee refer the cases and assesses the amount which the patient's family should contribute towards the cost of the treatment when their means allow. Many cases go away for months, even years, who could not do so if allowances were not provided for their families in their absence. Children have sometimes to be looked after or placed in homes during the mother's absence and many patients have to be provided with the necessary clothes. For these, and other, purposes, 28 persons have been referred to the Charity Organisation Society, 27 to the Soldiers' and Sailors' Help Society, 37 to the United Services Fund and the British Legion, 4- to the Society for the Relief of Distress and 11 to regimental agencies and the Royal Naval Benevolent Trust. The Friends of the Poor, the Red Cross, the Mayor's Fund and private individuals have also rendered great assistance. On 12 occasions the Public Assistance Committee has supplied outfits of clothes, and the Invalid Kitchens co-operated in the supply of suitable meals. We work in close co-operation with the two branches of the Invalid Children's Aid Association who take charge of the children's cases by filling in the Home Enquiry forms, collecting the payments, visiting the families, caring for the children's future and making known to the Care Committee any special needs. 108 Apart from the visits paid by the Borough Tuberculosis Dispensary Staff, the Honorary Secretary of the Care Committee visits, or arranges for the visit of every adult case before they go away and after their return, to see that any help needed is, if possible, given. The Committee wishes to thank the various agencies that make the help possible as, apart from a grant for extra nourishment administered by the Tuberculosis Officer to special cases requiring it as part of their treatment, the Council has no funds of its own. Contributions are required by the London County Council from the patients' families towards the cost of their treatment when circumstances permit. Our Committee recommended the amounts in the cases of 253 adults and 73 children which came before it in 1931. The families of 48 adults and 28 children contributed sums varying from two shillings to twenty shillings. Should any adverse change occur in the family circumstances, leave is asked of, and always given by the London County Council, to return the payments either for a time or altogether. We conclude by giving warm thanks to all societies and individuals who have co-operated with us in our work in trying to carry on the war against Tuberculosis. L. ASHE, Hon. Sec.