With the Compliments of the Medical Officer of Health. Southwark Town Hall, Walworth Road, S.E.17. LONDON: Crusha & Son, Ltd., Tottenham, Enfield and Wood Green. Borough of Southwark. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1933. 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 & Son, Ltd., Tottenham, Enfield and Wood Green. INDEX. A. Page Acts and Bye-Laws (Additional) 52 Acute Influenzal Pneumonia 120 Acute Primary Pneumonia 120 Ambulance Services 24 Ante-Natal Clinics 27, 35 Area of Borough 5, 7 Agricultural Produce (Grading and Marking) Act 82 B. Bacteriological Specimens 24 Bakehouses 57, 102 Births 7, 8, 9 „ Illegitimate 5 Birth-rates 7, 8, 9 Black Smoke 52, 53 Blind Persons Act, 1920 120 Brushmakers 56, 57 Butter and Margarine Factories 101 Butchers' Shops 81 C. Cancer 120 Census, 1931 6 Cerebro-spinal Fever 119 Children and Young Persons' Act 29, 30 Clinics 25, 26 Common Lodging Houses 46, 47 Convalescent Treatment 28 Coroners' Court 61 Cowsheds 101 D. Day Nurseries 28, 30, 31 Deaths 9, 10. 11. 12 Deaths, Causes of, Table 12 „ Infants 13, 14 „ In Public Institutions 12, 17 „ In Wards 9 „ Zymotic Mortality 20 Death Rates 9, 10, 11, 15 Density of Population 7 Diarrhœa 118 Diphtheria 114, 115 „ Prevention 26, 115 ii Page Diphtheria Schick Test 115-116 Disinfection 124 Disposal of Unsound Food 86-96 Dressmakers, Milliners, etc. 56. 57 E. Eating Houses . . 57 Encephalitis Lethargica 119 Enteric Fever . . 114 F. Factories and Workshops 55, 57 Food and Drugs, Tables of Samples 106, 107, 108, 109 Food Inspection and Tables 81-96 G. General Hospitals 26 H. Health Services, Hospitals, etc. 26 „ Visitors, Summary 36, 38, 39 „ Visiting 36,39 House-to-house Inspections 45 Housing 65-77 Houses let in Lodgings 53 Home Workers, Table 56 I Ice Cream Premises 57, 81 Imported Food 84 Infant Life Protection 29, 30 Infant Mortality 5, 13, 14 „ „ of Illegitimates 5 Infectious Diseases, Control of 113 Influenza 119 Informal Samples 109 Inhabited Dwellings 5 Inspections 45 L. Laboratory Facilities 24 Laundries 55, 57 Legal Proceedings 50, 51, 103, 105 iii M. Page Maternity and Child Welfare 32, 33, 34 ,, Nursing Homes 29 Maternal Mortality 27 Measles 117, 118 "Merchandise Marks'' Act 82 Midwifery and Maternity Services 29 Milk and Dairies (Amendment) Act, 1922 97, 98 Milk (Special Designations) Order 98, 99 Milksellers 99 Mortality Statistics 5-20 Mortuary 61 Municipal Day Nursery 28, 30 N. Notices served 48 Notifiable Diseases 121 Notified Births 40 Nursing in the Home 24, 25 O. Offensive Trades 102 Ophthalmia Neonatorum 119 Orthopaedic Clinics 30 Outlying Deaths 10 P. Part-time Officers 23 Population 6 ,, in Wards 7 Poliomyelitis 119 Puerperal Fever 119 ,, Pyrexia 119 ,, Sepsis, Deaths 119 Public Cleansing 46 Public Health Officers 23, 24 ,, ,, (Condensed Milk) Regulations, 1923 and 1927 101 ,, ,, (Preservatives in Food) Regulations 84, 101 Public Vaccinators 24 R. Rag Flock Acts, 1911 and 1928 54 Rateable Value 5 Rats and Mice (Destruction) Act 58 Reception House, Families Admitted 122, 123 Registered Births and Deaths 16 Registered Workshops 57 iv S. Page. Sale of Food and Drugs Acts 104 Scabies 60 Scarlet Fever 113 Schick Test and Inoculation against Diphtheria 115. 116 Slaughterhouses 81 Smallpox 113 Smoke Abatement 52 Southwark Invalid Kitchens Society 28 Sputum, Examinations of 24 Statistics and Social Conditions 5 Still Births 5 Sunlight Treatment 28 T. Tailoring 57 Tuberculosis 125-136 Toddlers' Day 31 U. Underground Bakehouses 57, 102 Unsound Food 86-96 V. Vaccination Acts 41 Vaccination Officers 24 Venereal Disease Clinics 26 Verminous Persons and Children 60 ,, Rooms and Bedding 59, 60 Vital Statistics, Summary of 5 Table 18, 19 W. Ward Distribution 7 Water Supply (P.H. Act, Sec. 48) (L.C.C. G.P. Act, 1907) 54, 55 Whooping Cough 118, 119 Workshops (Women's) 57 Works Completed 48, 49 Z. Zymotic Mortality 20 Borough of Southwark. Public Health Department, Town Hall, Walworth Road, S.E.17. To His Worship the Mayor, Aldermen and Councillors, Sir, Ladies and Gentlemen, I have pleasure in presenting my Annual Report for the year 1933. The year as a whole was a healthy one. The number of smallpox cases decreased, although in the latter months of the year an outbreak of mild scarlet fever occurred; the interesting feature of the outbreak was the unusual number of adults affected. The death rate of 13.9 per 1,000 population shows a slight increase on the previous year, but nearly 50 per cent. of these deaths occurred in persons over 65 years of age. The chief causes of death were heart disease, bronchitis, pneumonia and cancer. The infant death rate of 63 per 1.000 births shows a great improvement on previous years. The birth rate has again fallen to 14.2. This figure is the lowest recorded in the history of the Borough. The work of the Public Health Department has been heavy, owing to increased activities, particularly in regard to housing. In April, additional duties of supervising the common lodging houses, infant life protection, offensive trades, slaughter-houses and slaughtermen, were transferred to the Borough Council, and in order to cope with this work it was found necessary to appoint an additional sanitary inspector. The dairies and milkshops in the Borough have received special attention owing to the fact that milk in many cases was being sold and 2 prepared for sale under very unsuitable conditions. It is satisfactory to be able to report that all the dairies have been brought up to a standard compatible with the Milk and Dairies Order. I again wish to express my appreciation of the encouragement and support given to me by the Chairmen and Committees under whom I serve. My best thanks are also due to the Chief Officers of the Council, and to the whole of the staff of the Public Health Department for their loyal support and ever willing assistance. I have the honour to be, Sir, Ladies and Gentlemen, Yours obediently, W. STOTT. SECTION A, Statistics and Social Conditions of the Area. 5 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 1,132 Population (estimated, 1935) 164,700 Number of inhabited houses (end of 1933) according to rate books 27,442 Rateable value £1,330,645 Sum represented by penny rate £5,226 SOCIAL CONDITIONS. The population is chiefly a working-class one, and a large proportion are employed in the printing and manufacturing trades, whilst others are engaged as waterside labourers or casual workers. None of these occupations have any definite effect on the health of the people. The unemployment figures, according to the Board of Trade Gazette, show a slow but steady decrease, the latest figures being 6,965 males, 1,940 females and 265 juvenilas, a total of 9,170, as against 10,578 last year. No case of actual malnutrition has come to my notice, but there ia no doubt a number of families have been hard hit during these lean months of unemployment. VITAL STATISTICS. Total. M. F. Live Births—Legitimate 2,220 1,128 1,092 Birth Rate, 14.2 Live Births—Illegitimate 111 63 48 Still Births, 85. Rate per 1,000 total births, 36 Deaths, 2,298. Death rate, 13 9 Percentage of total deaths occurring in public institutions, 70.3. Number of women dying in, or in consequence of childbirth:— From sepsis 3 Other causes 3 Death rate of infants under 1 year of age per 1,000 live births:— Legitimate 58 Illegitimate 162 Deaths from Measles (all ages) 6 Do. Whooping Cough (all ages) 23 Do. Diarrhoea (under 2 years of age) 32 No excessive or unusual mortality has occurred during the year. 6 POPULATION. The estimated population as supplied by the Registrar-General for mid-year, 1933, is 164,700, and the various rates in my Report have been calculated on this figure. It will be seen by the Table hereunder that the population of the Borough is steadily decreasing. The diminution in the number of inhabitants has not been uniform throughout the Borough. The northern end or riverside districts have suffered most in comparison, which 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, 1932 and 1933 are as follows :— Newington. St. George's. St. Saviour'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 107,692 48,552 15,451 1932 105,873 47,836 15,191 1933 103,240 46,646 14,814 7 The Ward distribution was as follows:— TABLE 1. WARD. Area in Acres. Population. Persons to the Acre. Males. Females. Total. St. Mary 127 10,619 10.571 21,190 167 St. Paul 133 8,468 8,801 17,269 130 St. Peter 146 11,842 12,547 24,389 167 St. John 118 12,633 13,514 26,147 222 Trinity 109 7.208 7,037 14,245 131 St. Michael 93 9,459 9,079 18,538 199 St. Jude 97 5,964 6,213 12,177 126 St. George 99 7,846 8,085 15,931 161 Christchurch 77 3,462 3,144 6,606 86 St. Saviour 133 3,770 4,438 8,208 ' 62 Whole Borough 1,132 81,271 83,429 164,700 145 BIRTHS. The number of Births registered in the Borough during 1933 was 1830, of which 934 were males, and 896 females. This represents a birth-rate of 11 1 per 1,000 inhabitants. The number of births registered in the individual parishes was a3 follows:—Newington, 838; St. George the Martyr, 405; Christchurch and St. Saviour's, 587. Of the 1,830 births registered in the Borough 308 were transferred away, the permanent residence of the parents being outside the Borough. 809 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 308 ' 'outward'' transfers are deducted and the 809 "inward" transfers are added to the 1,830 births actually registered in the Borough, the net amount of births belonging to Southwark for the year is found to be 2,331. This gives a corrected birth-rate of 14.2. 8 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. 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 1932 15.3 17.7 16.9 16.2 1933 13.8 14 .6 15.5 14.2 9 TABLE 3. Number of Births and Deaths belonging to each Ward, with the Birth and Death Rates, also the Infantile Mortality Rate, 1933. WARD. Births. Infantile Mortality. Deaths. Males. Females. Total. Birth-rate. Males. Females. Total. Death rate. St. Mary 165 119 284 13.4 92 175 136 311 14.7 St. Paul 116 113 229 13.3 48 141 113 254 14.7 St. Peter 133 154 287 11.8 42 174 151 325 13.3 St. John 196 210 406 15.5 47 185 149 334 12.8 Trinity 107 107 214 15.0 70 123 112 235 16.5 St. Michael 141 127 268 14.5 63 159 105 264 14.2 St. Jude 94 80 174 14.3 109 99 81 180 14.8 St. George 123 116 239 15.0 50 105 76 181 11.4 Christchurch 63 51 114 17.3 70 54 50 104 15.7 St. Saviour 53 63 116 14.1 69 54 56 110 13.4 Borough 1191 1140 2331 14.2 63 1269 1029 2298 13.9 10 DEATHS. 1,692 deaths were registered in the sub-districts of the Borough during 1933. 22 deaths occurred in the street, or on the way to hospital. 1,010 deaths occurred in 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 344 belonging to Southwark and 666 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 1,272. When the 666 deaths of those persons who were non-parishioners, but who died in our Borough, have been deducted, and the 1,272 "outlying" deaths added, the actual or "corrected" number of deaths belonging to the sanitary area is found to be 2,298, of which number 1,269 were males and 1,029 females. The death-rate, when calculated on this "corrected" number, is 13.9 per 1,000 inhabitants for the whole Borough for the year 1933, as against a rate of 13.1 for 1932. The percentage of persons dying away from Southwark in relation to the total number of deaths belonging to the Borough was 55.4. The principal localities in which the "outlying" deaths occurred are as follows :— Lambeth Hospital 437 St. Giles' Hospital 169 Rotherhithe Hospital 105 East Dulwich ,, 106 St. Thomas's Hospital 42 King's College Hospital 16 Belgrave Hospital 14 Royal Waterloo Hospital 9 General Lying-in Hospital 3 Mental Hospitals 99 In the Street and other Institutions 272 1,272 11 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. 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 1932 13.2 12.9 13.6 13.1 1933 14.1 13.4 14.4 13.9 12 TABLE 5. Deaths belonging to the Sanitary Area, with the Causes of Death at all Ages during 1933. 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 2298 - - - - - - - - - - - - 1. Typhoid and Paratyphoid Fevers 3 1 - - 1 - - 1 - - - - - 2. Measles 6 2 3 1 - - - - - - - - - 3. Scarlet Fever 3 - 1 2 - - - - - - - - 2 4. Whooping Cough 23 12 9 - 2 - - - - - - - 1 5. Diphtheria 12 1 1 5 5 - - - - - - - 10 6. Influenza 98 2 - - 2 4 5 15 22 18 15 15 - 7. Encephalitis Lethargica 1 - - - - - 1 - - - - - - 8. Cerebro-Spinal Fever 15 5 1 2 - 3 3 — 1 — — — 6 9. Tuberculosis of Respiratory System 172 - - 1 2 26 29 30 39 30 15 - 13 10. Other Tuberculous Diseases 21 — 1 5 7 6 — 1 — — — 1 16 11. Syphilis 10 1 - - - - - - 3 5 1 - 7 12. Gen. Paralysis of Insane, Tabes Dorsalis 11 - - - - - - 1 4 5 1 - - 13. Cancer, Malignant Disease 288 - - - - 3 5 24 42 87 94 33 169 14. Diabetes 20 - - 1 - - 1 1 3 3 8 3 8 15. Cerebral Haemorrhage etc. 63 - - - - 1 — 1 6 18 22 15 22 16. Heart Disease 615 — — — 5 11 11 22 32 89 179 266 203 17. Aneurysm 13 - - - - - - 1 4 6 1 1 6 18. Other Circulatory Diseases 61 - - - - - - - 5 9 21 26 29 19. Bronchitis 87 2 1 - - - 1 3 10 21 22 27 23 20. Pneumonia (all forms) 170 22 15 7 4 4 7 6 26 34 24 21 83 21. Other Respiratory Diseases 10 - - - - - 1 3 2 3 — 1 2 22. Peptic Ulcer 28 - - - - 1 1 3 6 10 7 - 18 23. Diarrhoea, etc. 36 29 3 — — 1 — — 1 1 1 — 16 24. Appendicitis 14 — — — 3 2 2 1 4 — 2 — 15 25. Cirrhosis of Liver 9 - - - - - - 1 1 4 3 — 3 26. Other Diseases of Liver 7 — — — — — 1 — — 1 4 1 3 27 . Other Digestive Diseases 39 3 — — 4 1 — 2 3 8 10 8 — 28. Acute and Chronic Nephritis 105 - - 1 1 2 7 2 11 11 34 36 81 29. Puerperal Sepsis 3 — — — — — 1 2 — — — — — 30. Other Puerperal Causes 3 — — — — — 2 1 — — — — 5 31. Congenital Debility and Malformation, including Premature Birth, etc. 56 56 - - - - - - - - - - 54 32. Senility 17 - - - - - - - - - 4 13 2 33. Suicide 35 - - - - - 7 4 12 9 2 1 16 34. Other Violence 90 - - 5 12 8 8 7 9 11 18 12 53 35. Other Defined Diseases 152 10 1 2 14 9 5 10 21 21 37 22 143 36. Causes ill-defined or unknown 2 1 1 - - - - - - - - - - Totals 2298 147 37 32 62 82 98 142 267 404 525 502 1010 13 TABLE 6. BOROUGH OF SOUTHWARK. INFANT MORTALITY, 1933. 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 45 4 3 4 56 17 30 24 20 147 Measles - - - - - - - - 2 2 Diphtheria - - - - - - 1 - — 1 Whooping Cough - - - - - 4 1 3 4 12 Diarrhoea - - - - - 3 8 8 4 23 Enteritis - - - - - - 4 2 - 6 Influenza - - - - - - 4 - 1 2 Cerebro-Spinal Fever - - - - - - 1 3 1 5 Enteric Fever — — — — — 1 — — — 1 Phthisis - - - - - - - - - - Other Tuberculosis - - - - - - - - - - Congenital Malformations 13 1 1 1 16 6 — — — 22 Premature Birth 26 2 1 2 31 — — — — 31 Atrophy, Debility and Marasmus - - - - - 2 - 1 — 3 Atelectasis - - - - - - - - - - Erysipelas - - - - - - 1 - 1 2 Syphilis - - - - - - 1 - - 1 Rickets - - - - - - - - - - Meningitis - - - - - - - - 1 1 Laryngitis - - - - - - - - - - Convulsions 2 - - - 2 - - - - 2 Gastritis - - - - - - - - - - Intussusception - - - - - - - - - - Dentition - - - - - - - - - - Dermatitis - - - - - - - - - - Bronchitis - - - - - - - 2 - 2 Pneumonia - - - - - 1 2 1 1 5 Broncho-Pneumonia 1 1 - 1 3 - 8 4 2 17 Lobar-Pneumonia - - - - - - - - - - Suffocation (overlying) - - - - - - - - - - Accident (other) 2 - - - 2 - - - 1 3 Nephritis, Acute - - - - - - - - - - Icterus Neonatorum - - - - - - - - - - Septic Pyaemia - - - - - - - - - - Otitis and Mastoiditis - - - - - - - - - - Other Causes — — 1 - 1 - 2 - 2 5 Not classified above 1 - - - 1 — — — — 1 45 4 3 4 56 17 30 24 20 147 Nett Births in the year Legitimate 2220 Illegitimate 111 Nett Deaths in the year Legitimate Infants 129 Illegitimate Infants 18 14 TABLE 7. DEATHS OF INFANTS UNDER ONE YEAR OF AGE. The deaths of Infants under one year of age to 1,000 births were 63 during the year 1933. The deaths under one year of age to 1,000 births for the last thirty years were as follows:— 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 1917 111 1932 72 1918 124 1933 63 The average number of Infantile deaths for the last thirty years is 101. 15 TABLE 8. Death Rates for the various Districts for the last Ten Years (1923.1931), 1932 and 1933. Ward. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. St. Mary 14.6 14.4 12.8 12.2 13.5 13.7 16.2 13.6 16.4 14.0 14.7 St. Paul 12.3 14.5 12.7 12.0 12.7 11.8 15.9 11.6 14.2 12.5 14.7 St. Peter 10.0 12.0 11.9 12.3 10.8 9.1 12.3 10.1 11.0 12.6 13.3 St. John 12.8 14.0 13.8 13.0 13.6 13.4 17.1 14.4 11.7 13.4 12.8 Trinity 13.1 14.8 11.7 13.4 16.1 13.3 14.9 13.8 13.9 13.3 16.5 All Saints 10.4 11.8 11.2 10.9 11.6 11.5 13.8 11.7 14.5 — — St. Michael 14.2 16.7 15.6 14.2 14.6 14.7 17.2 13.7 15.5 15.0 14.2 St. Jude 14.3 15.4 12.9 12.6 16.1 13.4 18.2 13.1 15.3 12.7 14.8 St. George 12.4 13.5 12.4 12.9 12.6 11.8 14.5 11.5 12.4 10.7 11.4 Christchurch 16.0 19.2 18.2 16.6 13.3 16.5 17.5 13.4 18.0 17.7 15.7 St. Saviour 11.7 11.3 12.9 11.8 13.2 11.4 15.0 9.2 12.6 10.2 13.4 16 TABLE 9. Births and Deaths Registered in the Sub -Districts of the Borough in 1933. First Quarter. Second Quarter. Sub-Districts. Births. Deaths. Sub-Districts. Births. Deaths. Male. Female. Male. Female. Male. Female. Male. Female. Newington 114 109 135 154 Newington 120 125 56 73 St. George the Martyr, West 56 62 55 46 St. George the Martyr, West 54 53 39 21 Christchurch and St. Saviour 92 72 113 78 Christchurch and St. Saviour 82 82 84 54 Totals 262 243 303 278 Totals 256 260 179 148 Third Quarter. Fourth Quarter. Newington 110 106 70 63 Newington 72 82 83 108 St. George the Martyr, West 51 52 31 12 St. George the Martvr, West 47 30 39 24 Christchurch and St. Saviour 62 71 98 69 Christchurch and St. Saviour 74 52 125 62 Totals 223 229 199 144 Totals 193 164 247 194 In 1st Quarter .. .. .. .. Births. Deaths. M. F. M. F. 262 243 303 278 In 2nd Quarter .. .. .. .. 256 260 179 148 In 3rd Quarter .. .. .. 223 229 199 144 In 4th Quarter .. .. .. .. 193 164 247 194 Totals 934 896 928 764 17 TABLE 10. Showing the number of Deaths that occurred in Public Institutions in the Borough during the year 1933. Institution. In 1st Quarter. In 2nd Quarter. In 3rd Quarter. In 4th Quarter. During Year. Newington Institution 1ll 42 51 80 284 Christchurch do. — — — — — Evelina Hospital 12 7 11 10 40 Guy's Hospital 165 132 158 172 627 60, Lambeth Road 3 2 3 2 10 (Catholic Nursing Home) Royal Eye Hospital — — — 2 2 All Saints' Hospital 14 12 9 12 47 Other Addresses — — — — — Total 305 195 232 278 1010 18 19 TABLE 11. Vital Statistics of Separate Localities (1922-1933). 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 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. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 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 15,732 288 235 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 l6 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 1932 21,730 347 304 22 17,709 236 221 16 25,016 360 316 26 26,810 429 359 23 14,608 253 194 18 .. .. .. .. 1933 21,190 284 311 26 17,269 229 254 11 24,389 287 325 12 26,147 406 334 19 14,245 214 235 15 .. .. .. 7. St. Michael's Ward. 8. St. Jude's Ward. 9. St. George's Ward. 10. Christchurch Ward. 11. St. Saviour's Ward. 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 8,401 217 134 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 9,242 177 119 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 .. .. .. .. 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 .. .. .. .. 1932 19,012 313 286 29 12,487 207 158 24 16,337 327 175 21 6,774 127 120 10 8,417 130 86 8 .. .. .. .. 1933 18,538 268 264 17 12,177 174 180 19 15,931 239 181 12 6,606 114 104 8 8,208 116 110 8 .. .. .. .. 20 TABLE 12. Deaths in the Sanitary Area from the principal Zymotic Diseases in the various Wards for 1933. WARD OR DISTRICT. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. St. Mary - 3 - 1 4 - 5 St. Paul - - - 1 1 - 4 St. Peter - 1 2 3 1 - 3 St. John - 1 - 2 7 - 4 Trinity - - - 2 2 2 7 St. Michael — 1 — 1 4 — 5 St. Jude — — — 2 1 — 3 St. George — — — — 2 — 2 Christchurch — — 1 — 1 1 1 St. Saviour - - - - - - 2 Borough - 6 3 12 23 3 36 TABLE 13. ZYMOTIC MORTALITY FOR THE SANITARY AREA, 1933. Showing the localities where the deaths occurred. Locality. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. The Borough - - - - 2 - 3 East Dulwich Hospital - - - - - - - L ambeth Hospital - - - - 1 - 8 Newington Institution - - - - - - - Evelina Hospital - - - - - - 3 Guy's Hospital - - - - - 1 3 St. Thomas's Hospital - - - - - - 2 Belgrave Hospital - - - - 3 — 2 Royal Waterloo — — — — — — 2 L.C.C. Hospitals, etc. - 6 3 12 17 2 13 Total — 6 3 12 23 3 36 SECTION B. General Provision of Health Services for the Area. 23 PUBLIC HEALTH OFFICERS TO WHOSE SALARY CONTRIBUTION IS MADE. William Stott, M.B., B.S. (Hnrs.), D.P.H., Medical Officer of Health. E. Fairfield Thomas, M.D., Ch.B., D.P.H., Deputy Medical Officer of Health. Margaret Bergin, M. B., B.Ch., B.A.O. (N.U.I.). D P. H., 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 and Drugs Inspector). ‡ || J. A. Syms. ‡ || A. C. White. ‡ || W. H. Banham. ‡ || A. Ede. ‡ || H. E. Hattersley. || J. R. Findley. " ‡ || H. S. Steele. ‡ || F. J. Bryant. ‡ || F. Mayhew. ‡ || S. Bowers (Food Inspector). ‡ || G. H. Duffield (Food Inspector). ‡ || W. Richards (Appointed November 1st, 1933). || Margaret Burrows (Women's Workshops). || Cert. Sanitary Inspector. ‡ Meat and other Foods. * 1st Class Engineer (Board of Trade). Health Visitors. || 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. 24 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. (1) Laboratory Facilities.—The Chemical and Bacteriological Laboratories are maintained by the Council under the direct control of the Public Analyst, who is a full-time 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. (2) Ambulance Facilities.—The arrangements for the removal of (a) infectious cases and (b) maternity patients are satisfactory. No change has been made during the year. (3) Nursing in the Home.—General Nursing is carried out by the Ranyard Nurses, the Benson Nursing Association (which is subsidised 25 by the Newington Charities to the extent of £400 per annum) and the Catholic Nursing Home, GO, 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. CLINICS AND TREATMENT CENTRES. (1) Maternity and Child Welfare.—There are in all 14 centres. During the year St. Mary's Girls' Club, Union Street, was closed and two extra sessions were held at St. George's Dispensary, Pocock Street, re-named Southwark Boys' Hostel. Municipal Centres (Eight)— Sutherland House, Sutherland Square (St. Mary's). Sutherland House, Sutherland Square (St. Paul's). Working Boys' Club, Villa Street. All Saints' Parish Room, Surrey Square. Lady Margaret Parish Room, Chatham Street. Lansdowne Place Mission Hall. Southwark Boys' Hostel, Pocock Street. (Four sessions weekly from December 18th, 1933.) St. Mary's Girls' Club, Union Street. (Closed December 11th, 1933.) 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). 26 (2) Ante-Natal Clinics.— Sutherland House. Monday, 10.0 a.m. (Dr. D. Shepherd.) Sutherland House. Friday, 10.0 a.m. (Dr. M. Bergin.) 56, Lambeth Road. (One Session Monthly.) (Dr. D. Shepherd.) Salamon's Centre. Monday, Wednesday and Friday, 9.30—10.30; Tuesday, 1.30—2.30. (3) Diphtheria Prevention Clinic.— Sutherland House. Thursday, 2.0—4.0 p.m. (Dr. F. Porter-Smith.) (A detailed report will be found on page 115.) (4) Venereal Disease Clinics.— Guy's Hospital. Daily. 9.0 a.m.—8.0 p.m. St. Thomas's Hospital. Daily. 8.0 a.m.—10.0 p.m. King's College Hospital. Monday to Friday. (5) Hospitals.—The Borough is fortunately situated as regards hospital accommodation of all descriptions. Hospitals for infectious diseases and tuberculosis cases are provided by the London County Council. No change in these services has been made since my last report. The following General Hospitals are within the area :— Guy's Hospital. Evelina Hospital for Children. Royal Eye Hospital. All Saints' Hospital. The Hospitals available, but close to the borders of the Borough, are :— St. Thomas's Hospital. King's College Hospital. Royal Waterloo Hospital. General Lying-in Hospital, York Road. Belgrave Hospital for Children. 27 MATERNITY AND CHILD WELFARE. The Maternity and Child Welfare service continues to do much useful work. The infant mortality rate of 63 shows an improvement on the previous year, which is exceptionally good considering the overcrowded conditions in which many of our poorer citizens are compelled to live. The results of these conditions are somewhat reflected in the chief causes of the infant deaths, which, apart from prematurity, are chiefly due to diarrhoea and enteritis and respiratory diseases. As the environment of the people is improved, so the infantile mortality from these causes will decrease. Ante-natal work is increasing year by year, and the majority of mothers are now seeking medical advice in the early stages of pregnancy. Our records show that of the 2,453 Southwark mothers confined during the year, 2,271 received ante-natal care and advice. Six mothers lost their lives as a result of childbirth, and one of these was a woman of no fixed abode, who stayed in the Borough for one night only. ANTE-NATAL CLINICS. SUTHERLAND HOUSE. (Monday, Dr. Shepherd.) During the year 135 mothers were seen and given advice, they made 364 attendances. SUTHERLAND HOUSE. (Friday, Dr. Bergin.) 172 mothers were seen and given advice, they made 426 attendances. ST. JUDE'S CENTRE, LAMBETH ROAD. (Monthly, Dr. Shepherd.) 87 mothers were seen and given advice, they made 336 attendances. SALAMON'S CENTRE. 687 mothers were seen and given advice, they made 3,356 attendances. MATERNAL MORTALITY. During the year six deaths were recorded which were due directly to pregnancy or childbirth, three of these were due to septic causes, and three from other causes. 28 DAY NURSERY. Early in the year the Council decided to close the Nursery in Kennington Park Road owing to lack of support, the attendances having fallen off from approximately 40 children to 15. Later in the year I found it necessary to advise the closure of the Walworth Creche, and as a result of this action the Council decided to open a Municipal Creche at Sutherland House. The flat over the Maternity and Child Welfare Centre was accordingly equipped for the admission of infants and toddlers up to 25 in number. This Nursery has been well attended since that time, no doubt due to the fact that it is more central than Kennington Park Road. Owing to the shortage of staff, however, only 20 children can be accommodated at present, and it is hoped that as the applications for admission increase the Committee will feel justified in appointing another Probationer. 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 77 cases were sent for treatment. Many of the children have derived benefit from the treatment, which is of undoubted use, and worthy of continuance. CONVALESCENT TREATMENT. The arrangement between the Borough Council and the Invalid Children's Aid Association is still being carried on, and 26 children under five years of age were sent away in order to restore them to better health. DINNERS FOR NECESSITIOUS MOTHERS. Dinner coupons were given to necessitous mothers, who were referred to the Southwark Invalid Kitchen, at a cost to the Council of £6 7s. 6d. for the year. 29 MIDWIFERY AND MATERNITY SERVICES. Full provision for expectant and nursing mothers has been made by the establishment of Ante-Natal Clinics, Consultants and Nurses for cases of Puerperal Fever and Pyrexia. Sterilised maternity outfits are obtainable at reduced prices, and a home help is provided to assist mothers where necessary. The number of midwives practising in the Borough is approximately 37. There are no Municipal Maternity and Nursing Homes in the Borough. INSTITUTIONAL PROVISION FOR MOTHERS AND CHILDREN. 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 £25. HEALTH VISITORS. No changes have been made in the personnel during the year. Additional work has been placed on the Health Visitors under Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932. INFANT LIFE PROTECTION. On April 1st, 1933, the duties transferred to the Borough Council under the Transfer of Powers (London) Act, 1933, mainly comprise:— (а) The making of enquiries from time to time as to whether there are any persons residing in the Borough who undertake for reward the nursing and maintenance of children under the age of 9 years. (b) The appointment of one or more persons of either sex to act as Infant Protection Visitors, whose duty it will be to visit periodically any such children and to satisfy themselves as to the proper nursing and maintenance of such children. 30 Various powers are vested in the Council for the removal of any child who is kept in overcrowded, insanitary or dangerous premises, or kept by any person unfit by reason of old age, infirmity, ill health, ignorance, negligence, inebriety, immorality, or criminal conduct, or in an environment which is detrimental to the child. In this connection, the Council appointed myself, the Lady Assistant Medical Officer of Health, the Senior Sanitary Inspector and the whole of the Health Visitors (9) as Infant Protection Visitors to carry out the duties relating to infant life protection. On April 1st the records of 35 foster mothers were transferred to this Department from the London County Council. These foster mothers had under their care 42 children. They have all been visited and the particulars verified by the Health Visitors. During the year an application under Section 67 of the Children and Young Persons Act was made to the Magistrate sitting at Lambeth Police Court for the removal of a child to a place of safety. The Magistrate made an Order for the child to be removed to a London County Council Children's Home until restored to its relations, or until other arrangements could be made with respect to it. At the end of the year, 53 foster mothers and 43 foster children were under the supervision of the Visitors, and 427 visits have been made. ORTHOPAEDIC TREATMENT. This is undertaken by the London County Council and the General Hospitals in the Borough. Children attending the Welfare Centres needing attention are referred to the various hospitals for treatment by the Medical Officer in charge. DAY NURSERIES. There are three in the Borough. During the year, the Municipal Nursery situated at 63, Kennington Park Road, was closed and re-established later at Sutherland House, and at the present time accommodates 20 children. 31 9 The attendances to the end of the year were 1,069. 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 6,804. Crossways Mission, New Kent Road, has a Day Nursery accommodating 46 children, and the number of attendances during the year was 9,699. TODDLERS DAY, During the year an arrangement was made with the St. George's Infant Welfare Centre Committee to hold "Toddlers' Days" four times a year. The expense to the Council is £3 3s. 0d. per annum. The first session was held on July 3rd. Eighty-three children, between the ages of two and five years, attended, and all those in need of medical advice were seen by the Doctor in attendance. The second session was held on October 30th, when 36 children attended, and 29 of this number were seen by the Doctor in attendance. 32 MATERNITY AND CHILD WELFARE CENTRES. Assistant Medical Officer of Health (Maternity and Child Welfare) Dr. Margaret Bergin. 1a CENTRE (Voluntary). St. John's Institute, Larcom Street. District served by Centre Sessions held every Wednesday and Thursday Medical Officers Superintendent St. John's Ward. 2—4.0. Dr. E M. Saxton and Dr. M. 0. Cruickshank. 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. Margaret Bergin. Health Visitor Miss W. F. Cleverley. 33 3a CENTRE (Municipal). All Saints' Parish Room, Surrey Square District served by Centre Sessions held every Thursday Medical Officer Health Visitor The Southern portion of All Saints' District and the portion of St. George's Ward between East Street and Albany Road. 10.0—12. 2.0—4.0. Dr. A. C. Stevens. 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. Margaret 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. A. C. Stevens. Health Visitor Miss K. L. M. Hinde. 4b CENTRE (Municipal). Mission Hall, Lansdowne Place. District served by Centre Sessions held every Friday Medical Officer Health Visitor The Northern half of St. George's Ward and the streets between Trinity Street and Tabard Street. 10.0—12. 2.0—4.0. Dr. A. C. Stevens. Miss F. M. Adair. 34 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 Thursday 2—4.0. Medical Officer Dr. Dorothy Shepherd. Health Visitor Miss Pearson. 6a CENTRE (Municipal). Southwark Boys' Hostel, Pocock Street. District served by Centre Sessions held every Tuesday Medical Officer Health Visitor Christchurch Ward and a part of St. Michael and St. Jude's Wards. 10.0—12. 2.0—4.0. Dr. Margaret Bergin. Miss M. Freeth. 6b CENTRE (Municipal). St. Mary's Girls' Club, Union Street (to December 11th, 1933). District served by Centre St. Saviour's Ward. Sessions held every Monday 10.0—12. 2.0—-4.0. Medical Officer Dr. Margaret Bergin. Health Visitor Mrs. M. E. George. 6b CENTRE (Municipal). Southwark Boys' Hostel, Pocock Street from (December 18th, 1933). District served by Centre St. Saviour's Ward. Sessions held every Monday 10.0—12. 2.0—4.0. Medical Officer Dr. Margaret 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. 35 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. Margaret Bergin. 56, Lambeth Road. District served by Clinic St. Jude's Ward. Sessions held One monthly. Medical Officer Dr. Dorothy Shepherd. The local Midwives refer all cases needing advice and treatment to the above Clinics. SALAMONS WELFARE CENTRE. Sessions held Monday, Wednesday and Friday, 9.30—10.30. Tuesday, 1.30—2.30. Medical Officer Assistant Obstetric Surgeon. 36 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 1933. TABLE 14. Original Visits. Revisits . Visits to AnteNatal Cases. Visits to PostNatal Cases. Visits to Foster Children 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. Kingsmill 232 55 - 3450 3 - 263 - 63 1 128 50 44 5 4294 Miss Saver 297 40 3 2743 10 - 220 - 29 2 96 52 9 - 3501 Miss Cleverlev 202 44 5 2587 3 - 158 - 32 1 135 82 20 5 3274 Miss Rogers 166 76 1 3016 16 - 97 - 35 2 90 42 28 - 3569 Miss Cottrill 204 75 7 3254 2 - 114 - 33 4 88 24 21 6 3832 Miss Hinde 163 62 2 2253 6 - 83 2 92 - 76 122 65 1 2927 Miss Adair 145 14 1 3459 6 - 114 - 38 3 104 3 - 2 3889 Miss Freeth 231 100 9 3729 22 - 180 2 46 - 88 20 36 1 4464 Mrs. George 180 107 6 2342 23 - 75 3 59 - 90 49 43 2 2979 Mrs. George (home help) - - - - - - - - - - 378 - 45 - 423 Total 1820 573 34 26833 91 1304 7 427 13 1273 444 311 22 33152 38 39 MATERNITY AND CHILD WELFARE CENTRES. 45 Sewing Classes were held during the year at Showing the Attendances at the Several Centres and Visits paid to the homes of Mothers and Children by Health Visitors. TABLE 15. St. John la. 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. 6n. Guy's. 7. Total. Number of Births notified during the year 335 232 297 202 166 204 163 145 197 231 180 95 30 2477 Number of individual children attending the Centre during the year 431 461 479 251 222 273 284 274 389 346 312 153 68 3943 Number of Sessions held during the year 92 90 90 90 90 90 90 90 90 90 86 43 92 1123 Number of children coming into (1.5) age group during the year Number of new cases attending the Centres during the year— 150 207 193 122 113 149 129 132 176 160 143 80 37 1791 (1) Expectant Mothers 124 . 12 5 5 16 6 30 . 45 2 . 687 932 (2) Infants under 1 year 247 205 200 116 92 115 137 112 157 147 149 60 30 1767 (3) Seen by Doctor 247 205 200 116 92 115 137 112 157 147 149 60 30 1767 (4) Children 1 to 5 years 34 49 86 13 17 9 18 30 56 39 20 13 1 385 (5) Seen by Doctor 34 49 86 13 17 9 18 30 56 39 20 13 1 385 Method of Feeding—(a) Breast 220 173 176 76 76 106 100 102 119 130 127 50 26 1481 (b) Breast and bottle 16 15 14 16 7 1 8 6 8 4 18 6 2 121 (c) Bottle 12 32 36 18 12 8 26 6 30 11 10 4 2 207 (d) Ordinary diet 33 34 60 19 14 9 21 28 56 41 14 13 1 343 Total number of attendances at the Centres during the year— (1) Mothers 9747 5232 4456 3923 2737 4467 4868 4366 6472 3701 4105 2520 106 56700 (2) Expectant Mothers 747 — 20 14 22 59 20 107 — 101 73 2 3356 4521 (3) Infants under 1 year 5163 3273 3457 2433 1928 2951 2246 2611 2315 2405 2471 1221 1380 33854 (4) Children 1 to 5 years 3053 1840 1796 1285 1754 1626 2554 2085 4357 1491 1696 1345 989 25871 (1) Average number of attendances 105.9 58.1 49.5 43.6 30.4 49.6 54.1 48.5 71.9 41.1 47.7 58.6 - - (2) do. do. 8.1 - - - - - - - - - - - 36.5 - (3) do. do. 56.2 36.4 38.4 27.0 21.4 32.8 25.2 29.0 25.7 26.7 28.7 28.4 15.0 - (4) do. do. 33.2 20.4 20.0 14.3 19.5 18.1 28.4 23.2 48.4 16 6 19.7 31.3 10.7 - (5) Total number of attendances of Infants seen by Doctor during the year 1556 1591 1522 938 913 1279 786 1383 1046 1300 1044 634 1403 15395 (6) Total number of attendances of children 1 to 5 years seen by Doctor during the year 547 757 746 1456 771 547 544 918 1229 614 456 885 680 10150 (7) Total number of Expectant Mothers seen by Doctor — — 1 — — 16 3 53 — 7 - - - 80 (8) Children weighed 4057 4146 3913 3790 3211 4362 4641 4049 4747 4983 4014 3698 5733 55344 (9) Post.natal cases 2102 18 1 1 - 74 20 163 2190 107 4 292 402 5374 Total number of first visits paid by Health Visitors to homes of— (1) Expectant Mothers 249 157 191 140 88 114 76 114 141 180 74 28 935 2487 (2) Infants under 1 year 335 232 297 202 166 204 163 145 197 232 180 95 30 2478 (3) Children 1 to 5 years 152 44 28 63 — 9 - 30 6 39 13 13 - 397 Total number of revisits paid by Health Visitors to homes of— (1) Expectant Mothers 142 106 29 18 9 — 17 - 188 — 1 78 497 1085 (2) Infants under 1 year 1955 1598 1254 869 1328 1620 882 1736 1086 2082 731 1216 410 16767 (3) Children 1 to 5 years 2504 1852 1489 1718 1688 1634 1371 1723 1982 1647 1611 2435 1530 23184 Sutherland House with a total attendance of 297. 40 TABLE 16. NOTIFIED BIRTHS. 1933. Where Born and by Whom Attended. Notified Births. StillBirths . Total Live Births. Born IN- Guy's Hospital 188 13 175 1, Kennington Park Place 8 — 8 30, Surrey Square 1 — 1 General Lying-in Hospital 251 15 236 Lambeth Hospital 240 6 234 St. Thomas's Hospital 112 4 108 King's College Hospital 68 — 68 St. Giles's Hospital 61 3 58 St. Olave's Hospital 26 — 26 Westminster Hospital 17 — 17 Charing Cross Hospital 29 — 29 Clapham Maternity Hospital 19 1 18 Other Hospitals, etc. 57 1 56 1077 43 1034 Born at Home and Attended by- Extents: Guy's Hospital 260 4 256 St. Thomas's Hospital 70 — 70 King's College Hospital 3 1 2 St. Bartholomew's Hospital 1 — 1 Lambeth Hospital 1 — 1 Midwives: Guy's Hospital 233 5 228 St. Thomas's Hospital 18 — 18 Lambeth Hospital 5 — 5 General Lying-in Hospital 34 3 31 Heygate Street 206 5 201 Private 370 14 356 Doctors: Private 199 7 192 Inward Transfers — 3 — 1400 42 1361 Totals 2477 85 2395 2,453 Mothers were confined during the year. 41 TABLE 17. Vaccination Officers' Return respecting the Vaccination of Children whose Births were Registered in 1932. 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 found. Cases remaining or temporarily unaccounted for. Total number of successful vaccination received during the calendar year 1933. Insusceptible of vaccination. Certificate of conscientious objection. 1932. 1 2 3 4 5 6 7 8 9 10 11 1st Jan. to 31st Dec. Northern Division 1199 529 12 401 60 1 64 53 79 621 Southern Division 1022 530 C 375 33 2 9 34 33 884 Total 2221 1059 18 776 93 3 73 87 112 1505 SECTION C. Sanitary Circumstances of the Area. 45 SANITARY WORK. House-to-house inspections were carried out in the following localities:— No. 1 DISTRICT. Arcot Place, Crampton Street, Doddington Grove, Gaza Street, Peacock Square. No. 2 DISTRICT. Beresford Street, Carter Street, Chapter Terrace, Grosvenor Terrace, Kennington Park Gardens. No. 3 DISTRICT. Blewett Street, Boundary Lane, Boyson Road, Kingston Street. Westmoreland Road. No. 4 DISTRICT. Heygate Street, Ladysmith Dwellings, Larcom Street, York Mansions. No. 5 DISTRICT. Arch Street, Meadow Row, Rockingham Street. No. 6 DISTRICT. Alfreton Street, Barlow Street, Beckway Street, Surrey Square, Woods Cottages. No. 7 DISTRICT. Aster Place, Collinson Street, Dodson Street, Gerridge Street, Montague Street, Queen's Buildings, Red Cross Street, St. George's Buildings, Tower Street, Townsend Yard, Valentine Row, Webber Row. No. 9 DISTRICT. Golden Place, Jane Street, Lizette Place, Nelson House, Peabody Buildings, Pepper Street, Prices Street, Streets Buildings, Victoria Place. 46 PUBLIC CLEANSING. (a) Generally speaking, weekly collection is in operation, although more frequent collections are made from tenement buildings, eating houses and places where food is prepared. (b) The whole of the refuse is brought to the Council's Depot at Manor Place, Walworth, for transport by rail to the country depots at Longfield and Sevenoaks, Kent. Approximately 50 per cent. of the house refuse is passed through pulverising machines, the crushed material being disposed of partly by sale to Kent farmers as a dressing for heavy soil, and the remainder is used for covering the rough dust at the tips. At Longfield controlled tipping is operated satisfactorily. The Sevenoaks Depot will shortly be closed, the available space having been filled in. There are no cesspools, earths closets or privies in the Borough. COMMON LODGING HOUSES. I beg to report that on April 1st, 1933, the duty of supervising and the licensing of Common Lodging Houses was transferred from the London County Council to the Borough Council. There are 18 of these houses in Southwark, 12 for men and 6 for women; they contain 1,897 beds for the former and 410 for the latter, and they are comprised chiefly of old houses converted for this particular purpose. During the year the whole of the Common Lodging Houses were visited by the Medical Officer of Health and myself, and several were inspected by the Chairman of the Public Health Committee. In the course of the inspection it was found that 9 premises were badly infested with the bed bug; they were discovered in the walls, ceilings, beds and bedsteads, and accordingly notices were served under the Bye-laws by the Town Clerk on the several keepers to abate the nuisances complained of. 47 It was found necessary, in order to eradicate the vermin, to remove a large amount of woodwork from the walls, hack off the plaster, and scrape the lime from the walls and ceilings. A large number of beds and blankets were removed. Some were destroyed and the remainder treated at the disinfecting station. It was also found necessary to destroy some of the bedsteads on account of their dilapidated condition. Visits were made daily by the Sanitary Inspectors for the following 14 days. In order to prevent the recurrence of the nuisances complained of we advised the keepers as to the necessary action, and I am pleased to state that a great improvement has been made, although constant supervision is still necessary in order to keep the premises up to the required standard. Several of the keepers stated that the cause of these serious conditions was brought about by the class of persons using the beds, likewise the hot summer. This statement, however, was not proved, inasmuch as in those houses, which had been specially constructed or reconstructed, and where strict supervision was maintained by the keeper, there was an absence of vermin. This goes to prove that it is possible to run Common Lodging Houses in a cleanly and wholesome manner. In Southwark a standard has been set up which will entail an immense amount of work in future to bring some of the older buildings into line, and if the necessary work to effect such improvements cannot be carried out, several houses will have to be closed. There will be no great hardship in this proceeding as a large proportion of the beds in these particular houses are not continuously occupied. In conclusion an up-to-date Common Lodging House should be constructed with solid floors, hard plastered walls and ceilings. The bedsteads should be of iron with diamond mesh mattresses; the palliasses should be made of straw, so as to be easily destroyed and renewed, and further the ideal to be aimed at is to minimise the amount of lodgment for dust and vermin, thereby reducing the amount of labour in keeping the premises clean. G. FISHER, Senior Sanitary Inspector. 48 49 TABLE 18. Summary of Sanitary Works Completed under the Public Health Act, during the year 1933. DISTRICT. Intimation Notices Complied with. 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. No. 1 478 70 85 55 62 319 124 266 357 296 595 170 2 329 98 169 126 82 657 32 5 18 156 1 933 Mr. Bryant. No. 2 464 8 21 9 30 13 1 2 26 62 47 33 — — — 236 72 70 420 12 — 5 238 4 560 Mr. Mayhew. No. 3 311 4 15 5 25 5 5 4 30 21 66 28 — — 1 133 35 66 261 3 — — 169 — 472 Mr. Banbam. No. 4 346 5 22 6 30 8 13 12 82 56 81 19 1 8 4 153 17 26 203 3 — — 51 7 276 Mr. White. No. 5 670 40 52 32 62 51 13 32 117 88 222 66 7 34 4 307 100 95 866 15 2 — 155 40 910 Mr. Findley. No. 6 416 6 26 13 26 14 7 11 43 55 63 41 — 4 4 247 58 60 354 1 2 — 161 5 562 Mr. Steele. No. 7 336 15 11 5 11 12 9 1 91 34 91 21 2 1 — 81 32 44 517 6 — — 18 — 394 Mr. Hattersley. No. 8 243 6 8 3 12 15 — 22 35 14 39 11 1 — 4 72 17 29 249 — — — 102 8 231 Mr. Syma. No. 9 207 4 16 4 15 5 25 188 15 8 171 15 1 — 2 94 21 28 199 — — 1 30 — 233 Mr. Ede. Total 3471 158 256 132 273 442 197 538 796 634 1375 404 14 376 117 1492 478 500 3726 72 9 24 1080 65 4571 3242 Intimation Notices were served during the year. 1318 Statutory Notices were served during the year. 50 PROCEEDINGS TAKEN UNDER THE PUBLIC HEALTH AND OTHER ACTS. 4 summonses were taken out during the year 1933, 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 Districts:— TABLE 19. DISTRICT. Total. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. No. 9. Number of Summonses taken out 1 — - 1 1 1 - — — 4 The above summonses had reference to the following:— Ordinary Nuisances 2 Vaccination Acts 1 Exposing for Sale (Unsound Food) 1 TABLE 20. These proceedings resulted as follows:— Summonses withdrawn (with costs), the Council's requirements having been complied with 1 Magistrates' Orders made 2 Dismissed with a caution 1 4 51 TABLE 21. Proceedings taken under the Public Health and Other Acts. Defendant. Cause of Proceedings. Result. Alfred Condon 8, Rodney Road. Failing to have his child (Joyce Condon) vaccinated Ordered child to be vaccinated within 14 days, 6s. costs. T. Evans 9, Cedar Terrace, Kensington. W. Neglecting to amend defective and insufficient sink waste at 66, Newington Butts Ordered to do work within 14 days, £1 1s. Od. costs. T. Evans 9, Cedars Terrace, Kensington, W. Neglecting to provide sufficient ashpit accommodation at 29, Newington Causeway Summons withdrawn, dustbin supplied, 10s. 6d. costs. Geo. Martin 6, Dunne Place, Rotherithe Exposing for sale 5 unsound fowls in Tower Bridge Road Dismissed with a caution, no costs. 52 ADDITIONAL ACTS AND BYE-LAWS COMING INTO FORCE DURING THE YEAR. Acts of Parliament. Children and Young Persons Act, 1933. Slaughter of Animals Act, 1933. Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. Regulations. Public Health Prevention of Infectious and Epidemic Diseases. The Port Sanitary Regulations, 1933. Public Health (Imported Food) Amendment Regulations, 1933. Orders. The Transfer of Powers (London) Order, 1933. SMOKE ABATEMENT. During the year we received several complaints from the Bankside District concerning a large quantity of grit which was being deposited, particularly when the wind was in a certain direction. This nuisance caused a considerable amount of time being involved in investigation, and the Sanitary Inspector on this District spent many hours in carrying out experiments in order to trace the offending chimneys. Observation is still being kept. BLACK SMOKE. During the year 1933 seven complaints were received at the Public Health Office from persons other than the Council's Inspectors. 53 TABLE 22. Showing the Number of Observations, etc., in regard to Smoke Nuisances made by the several District Inspectors during 1933. DISTRICT Total for Borough. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. No. 9. No. of observations made by the Inspectors - - - 7 2 - - - 109 118 No. of Nuisances observed — — — 1 — — — - 6 7 No. of Intimation Notices served — — — 1 — — — - 4 5 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. The number on the Register at the end of the year was 868. TABLE 23. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. No. 9. Total. Number on Register 133 134 121 155 43 84 58 56 84 868 54 RAG FLOCK ACTS, 1911 and 1928. The Act. requires that the amount of Chlorine found shall not exceed 30 parts in 100,000 parts of flock. Visits under the Act have been made by the several inspectors to premises, but rag flock is not being sold at any of them at the present time. 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. 23, 25, 27, 29, Camberwoll Road.. A. V. Goad, Esq., 241, Camberwell Road, S.E.5. 6, 8, Southwark Street Messrs. S. Parker Sons, 124, Sumner Road, Peckham, S. E. 8, Victory Place C. H. Moon, Esq., 38, Ontario Street, S. E. 1. Universal House. Bankside Messrs. E. D. Winn & Co., Ltd., 36, Wilton Place, S. W. 1. 36a, Doddington Grove Messrs. John Marsland & Sons, 56, S. Molton Street, W. 1. Blocks C, D and E, Doddington The Mayor, Aldermen and CounGrove (93 Hats) cillors of the Borough of wark. 55 WATER SUPPLIES TO TENEMENT HOUSES. London County Council (General Powers) Act, 1907. Fourteen additional water supplies were provided to houses during the year 1933. TABLE 24. Factories, Workshops, Laundries, Workplaces and Homework. 1.—Inspection (including Inspections made by Sanitary Inspectors). Premises. Number. Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 276 9 .. Workshops (including Workshop Laundries) 350 24 .. Workplaces 69 9 .. Homeworkers' Premises (including Outworkers) 225 .. .. Total 920 42 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 73 53 Want of Ventilation .. 1 .. Overcrowding 1 2 .. .. Want of drainage of floors .. .. .. .. Other nuisances 54 35 .. .. Sanitary accommodations: .. Insufficient 1 .. .. .. Unsuitable or defective 28 19 .. .. Not separate for sexes .. .. .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) .. .. Breach of special sanitary requirements for bakehouses (SS .97-100) Other offences 86 86 .. .. Total 243 196 .. .. *Including those specified in Sec, 3, 7 and 8 of the Factory Act as remediable undetions 2r the Public Health Acts. 56 TABLE 25. 3.—Home Work. nature of work. Outworkers' Lists, Section 107. Number of Inspections of Outworkers' Premises. Outwork is 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. 47 29 50 41 278 321 — — 117 3 — — 1 — — (2) Cleaning and washing — — — — — — — — — — — — — — — Lace, lace curtains and nets — — — — — — — — — — — — — — — Furniture and Upholstery- 1 4 1 4 2 4 — — — — — — — — — Fur pulling — — — — — — — — — — — — — — — Umbrellas — — — — 2 — — — 2 — — — — — — Paper Bags and Boxes 7 10 7 10 3 25 — — 22 1 — — — — — Brushmaking 5 7 5 7 3 8 — — 17 — — — — — — Stuffed Toys 1 2 1 5 — 8 — — 1 — — — — — — File making — — — — — — — — — — — — — — — Electro Plate — — — — — — — — — — — — — — — Cables and Chains — — — — — — — — — — — — — — — Anchors and Grapnels — — — — — — — — — — — — — — — Cart Gear — — — — — — — — — — — — — — — Locks Latches and Keys — — — — — — — — — — — — — — — Miscellaneous 15 18 14 11 83 51 — — 66 1 — — 1 — — Total 76 70 78 78 371 417 — — 225 5 — — 2 — — 57 TABLE 26. 4.—Registered Workshops. Workshops, Workplaces, etc., on the Register (S. 131) at the end of the year. Number. Bakehouses 93 Factory Bakehouses Eating houses and places where food is prepared for sale 424 Ice Cream Shops 270 Laundries 13 Dressmakers, Milliners, etc. 14 Tailoring 12 Brushmakers 12 Miscellaneous 1876 Total number of Workshops, Workplaces, etc., on Register 2714 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 9 Reports (of action taken) sent to H.M. Inspectors 7 Other — Underground Bakehouses (S. 101)— In use at end of the year 26 WOMEN'S WORKSHOPS. The supervision of the Women's Workshops was carried out during the year by Miss Burrows. 410 inspections and 426 re-inspections were made. The following defects were discovered, and 3 intimations and 4 statutory notices were served in order to obtain the abatement of the nuisances complained of:— Water apparatus defective 12 Roofs defective 3 Rooms dirty 52 Closet Pans and Traps 7 Miscellaneous nuisances 36 Total 110 All the above-mentioned nuisances were remedied. Miss Burrows also made 1,377 inspections of the women's con veniences throughout the Borough. 58 TABLE 27. RATS AND MICE (DESTRUCTION) ACT, 1919. Summary showing investigations and inspections made during the year 1933. 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. No. 1 50 69 34 301 11 1122 22 166 1 — 16 22 — 9 No. 2 23 41 23 272 3 1387 6 231 4 — 12 8 — 3 No. 3 33 45 51 118 12 605 19 77 5 — 13 10 2 5 No. 4 32 42 85 474 16 2377 23 449 5 — 26 6 2 10 No. 5 33 41 91 157 21 942 23 114 8 — 19 11 3 9 No. 6 17 23 76 387 7 1828 33 366 3 — 8 3 1 — No. 7 28 56 28 382 13 1900 11 385 4 — 20 22 2 — No. 8 28 35 15 144 2 593 — 88 1 — 6 2 — — No. 9 59 62 42 375 11 2080 134 565 3 — 17 15 5 3 Total 303 414 445 2610 96 12834 271 2441 34 — 137 99 15 39 Number of Rats destroyed 712. During "Rat Week" 4,132 additional baits were laid at the Council's Depots. 59 Cleansing of Verminous Rooms and their Contents. During the year 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 increased in comparison with 1932. 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, cleansed and fumigated by the Council's disinfecting staff. I also submit tables showing the number of articles dealt with at the disinfecting stations. TABLE 28. Verminous Rooms Cleansed. DISTRICT. No. of Intimation Notices served. No. of Statutory Notices served. Police Court proceedings taken. Verminous rooms treated by the Council's Disinfecting Staff. No. 1 107 49 — 209 No. 2 63 15 — 246 No. 3 16 5 — 55 No. 4 27 8 — 144 No. 5 128 56 — 297 No. 6 28 5 — 137 No. 7 40 15 — 114 No. 8 44 25 — 88 No. 9 9 8 — 159 Total 462 186 — *1,449 * 778 of these rooms were stripped. 60 TABLE 29. Verminous Bedding, etc., Disinfected at the Council's Station during 1933. Articles. Disinfected. Destroyed. Beds 233 29 Palliasses 217 33 Bolsters and Pillows 285 50 Cushions 26 7 Blankets 345 11 Sheets 249 6 Quilts 139 11 Articles of Clothing, etc. 33,192 302 Books — — Total 34,686 449 VERMINOUS PERSONS CLEANSED DURING 1933. During the year 6.804 persons were cleansed at the station in King James Street. Of these, under our agreement with the London County Council, were 4,875 children. Many of the children treated were suffering from Scabies. In every case the treatment at our Station was thoroughly efficacious, and no recurrence of the trouble was experienced. 1,929 adults sent from the various common lodging houses and other places in our borough were cleansed during the year, as against 1,705 dealt with under the provisions of the Cleansing of Persons Act, 1897, in 1932. 61 COLLIER'S RENTS MORTUARY. (Coroners' Court.) TABLE 30. During the year 256 bodies were received into the Mortuary:— Reasons bodies were brought to Mortuary. Bodies brought in, upon which Inquests were held 172 Bodies brought in, upon which Inquests were considered unnecessary 68 Bodies brought in for convenience for which payment was made 5 Bodies brought in where death had occurred from Infectious Disease 11 Total 256 SECTION D Housing. 65 HOUSING. There has been no relaxation of the housing activities of the Public Health Department during the year under review. From the table appended it will be seen that many houses have been inspected, of which a large number have been rendered fit for human habitation, and many demolished. The general housing survey of the Borough was completed early in the year and a map of the unhealthy areas and unfit houses prepared. In June, the memorable Circular 1331 of the Ministry of Health, for the preparation of schemes for expediting the clearance of slums, was received. We were in the happy position of having anticipated such a plan of action, and accordingly the Council's scheme for the clearance of all Southwark slums was submitted to the London County Council at the end of August. It was the wish of the Minister that such a scheme should be timed on a five-years basis; this was obviously impossible in such a Borough as Southwark, where sites for rehousing purposes are almost impossible to obtain, and the time of clearance must of necessity depend largely on the activities of the London County Council, with which the Borough schemes must be closely linked. Progress in putting the scheme into operation is very slow. Ten small areas were represented during the year, but none at the time of writing have been cleared and the people rehoused; in fact, the Council have only been able to make Clearance Orders in two cases owing to the many difficulties which unexpectedly arise from one quarter or another, which hold up proceedings, sometimes for several months. The chief obstacle to rapid progress is the present difficulty of obtaining alternative accommodation in or adjacent to the Borough; there are hopes, however, that in the course of another few months this difficulty will to some extent be overcome, when possibly some of our efforts will bear fruit. 66 In the meantime, the Council's rehousing scheme on the S.E. side of Doddington Grove nears completion. Already out of a total of 219 flats 158 have been completed, which are all occupied. It has been decided to erect in the near future a further 64 flats on the N.W. side of Doddington Grove to enable the Council to rehouse families from a few small areas on the sites of which rehousing is impossible. Apart from the Municipal housing activities, other voluntary agencies are assisting, or have expressed their wish to assist, in the general campaign. The Church Army Housing, Ltd., have expresed their willingness to assist the Council in rehousing on suitable sites, and to this end two or three suggested sites are under their consideration. Recently the Southwark Housing Association came into being, and this small body of people has already done useful work in reconstructing large three or four-storied houses and converting them into three or four self-contained flats, which they let at reasonable rentals. Many of the remarks I made in last year's Report could well be repeated again, but I content myself by once more emphasising the fact that the problem of overcrowding with all its attendant horrors is still as acute as ever. Several bad cases had been found other accommodation during the year, but many, owing to the large size of the families or the smallness of the income, have had to be left in their miserable condition. One is very reluctant to take action in these cases; in fact it would be wantonly callous to do so unless suitable accommodation can be offered. The present working rule of your Health Department is as follows:— Records of all cases of abated overcrowding are kept and the owner of the The house or rooms is notified that they must not be let in such a manner as to cause overcrowding in the future. To ensure that such instructions are carried out, the premises are visited periodically by the Inspector of the district. Towards the end of the year the Council decided that better use should be made of the "repairing" section of the Housing Act than 67 previously, and accordingly an additional Sanitary Inspector was appointed who could give his special attention as part of his duties to this side of the work. This Inspector commenced duties in December, and next year I hope to be able to report much satisfactory progress in this respect. The question of Tenement House Bye-laws and their efficient enforcement will soon have to be considered by the Council, because since the partial abolition of the Rent Restriction Act during this year, many such houses are now decontrolled, and the work of enforcing the various requirements of the Bye-laws is throwing extra strain on both the clerical and inspectorial staff. There are 3,323 basement dwellings in the Borough, i.e., a room or rooms the floor of which is three feet or more below the adjoining ground or street. Of this number 83 are illegally occupied and are being dealt with as rapidly as rehousing accommodation can be obtained for the inhabitants. HOUSING ACT, 1930, Section 1. The following Area was represented in January, 1932:— (A) Amery Place—Kinglake Street Area—64 houses. The Ministry of Health enquiry was held in the Town Hall in May, 1933, but owing to legal difficulties the people were not rehoused until early December, 1933. It was found impossible to rehouse a few of the families in the new flats at Doddington Grove, owing to their inability to afford even the State-aided rent, and they have accordingly been decanted at one end of Amery Place until cheaper accommodation becomes available. I fear the further we proceed with slum clearance, the greater will become the number of families who will require cheaper accommodation than that which at present is being provided by the Council, and it is hoped that attention will be given to the needs of our poorest citizens and bousing facilities afforded them necessary for their health and self respect. 68 HOUSING ACT, 1930, Section 1. The following areas were represented for olearance and rehousing schemes during the year:— (1) Townsend Yard Area (6 houses). This area is at present in abeyance according to the wishes of the London County Council, who intimated that they intended to include this small area in a larger one comprising Pepper Street and Union Street. (2) Keyworth Street Area (27 houses). Owing to difficulties which have arisen regarding the re-development of this area, the matter is still awaiting a final settlement between the several authorities concerned. (3) Surrey Place Area (3 houses). This area is at present under the consideration of the London County Council in conjunction with the proposed Borough High Street Improvement Scheme. (4) Surrey Row Area. (5 houses). Declared a Clearance Area by the Council on January 3rd, 1934, and submitted to the Minister of Health for confirmation. (5) Mander Place Area (16 houses). Declared a Clearance Area on February 28th, 1934. (6) Avon Place Area (10 houses). Waiting decision of London County Council. (7) Pitney Place Area (24 houses). This Area is still before this Council, who are in communication with the London County Council upon a suggestion of that Authority that this Area should be somewhat extended. (8) Bear Lane Area (29 houses). Declared a Clearance Area by the Council on February 28th, 1934, and submitted to the Ministry of Health for confirmation. 69 (9) Prices Street Area (16 houses, 1 store). Declared a Clearance Area by the Council on February 28th, 1934, and to be developed by owners of the land. (10) Doddington Grove (West) Area (12 houses). Declared a Clearance Area by the Council on January 3rd, 1934, and submitted to the Ministry of Health for confirmation. HOUSING ACT, 1930, Section 17. The number of dwelling houses in respect of which Notices were served requiring repairs was 83. Of this number 57 were rendered fit; leaving 26 outstanding at the end of the year. HOUSING ACT, 1930, Section 19. The following properties were represented during 1932 and have not yet been demolished:— 2, 3, 4, 5, 6, Cavan Terrace. 49, Friar Street. 20, Townley Street. 58, 59, St. Margaret's Court 7, 8, 14, 15, 16, 17, 18, 19, 20, Baron's Place. Two houses only remain occupied, by 14 persons, at 8 and 17, Baron's Place. During 1933, the following houses were represented . for demolition:— 2, 4, 6, 8, 10, 12, Peacock Street. 102, 104, Blackfriars Road. 39, East Street. 11, 12, 13, Valentine Row. 78, 80, Brandon Street. 4, Prices Street. 2, Disney Street. 16, 18, Westminster Bridge Road. 8, 9, Cavan Terrace. 1, Old Barge House Street 5, Uxbridge Place. Winchester House. 70 3, Kinglake Street. 87, Broadwall. 4, Hatfield Street. 2, Old Barge House Street. 9, 11, Holland Street. 53, Great Guildford Street. 1, Montague Street. 81, Tower Street. 9, Warren Place. 9, Globe Street. 33, Beddome Street. 24, Zoar Street. 1, 2, 3, Lizette Place. The following have been demolished:— 2, 4, 6, 8, 10, 12, Peacock Street. 39, East Street. 13, Valentine Row. 78, 80, Brandon Street. 5, Uxbridge Place. 4, Hatfield Street. 1, 2, 3, Lizette Place. 4, Prices Street. Winchester House. The following have been closed, but not demolished:— 104, Blackfriars Road. 11 and 12, Valentine Row. 16, 18, Westminster Bridge Road. 8, 9, Cavan Terrace. 5, Uxbridge Place. 87, Broadwall. 1, Montague Street. 9, Warren Place. In pursuance of the Orders made by the Council the undermentioned will be dealt with in due course:— 102, Blackfriars Road. 2, Disney Street. 1, Old Barge House Street. 3, Kinglake Street. 2, Old Barge House Street. 71 9, 11, Holland Street. 53, Great Guildford Street. 1, Montague Street. 81, Tower Street. 9, Globe Street. 33, Beddome Street. 24, Zoar Street. HOUSING ACT, 1930, Section 20. The following underground rooms (and parts of premises were represented for Closing Orders during 1932, and have now been closed or rendered fit for human habitation:— 358, 360, 362, 364, 434, 434a, 436, 436a, MUNTON ROAD. These basements have been entirely reconstructed and made habitable. The Closing Orders were therefore determined. CLOSED.— 17, Bear Lane. 28, Hatfield Street. 91, East Street. 147, Kennington Park Road. During 1933 the following underground rooms and parts of premises were represented for Closing Orders:— 118, 120, 122, 124, 166, 168, 170, 172, Munton Road. 73, Kennington Road. 22/28 (4), 70/76 (4), 214/220 (4), 262, 264, 266, 270, Munton Road. 122, Newington Causeway. 83, Lancaster Street. 189, Blackfriars Road. 118, 120, 122, 124, 166, 168, 170, 172, MUNTON ROAD. Of the above, the following basements have been entirely reconstructed and made habitable and the Closing Orders determined. 22/28, (4), 70/76 (4), 214/220 (4), 262, 264, 266, 270, MUNTON ROAD. The above were rendered fit without service of Notice. 72 73, KENNINGTON ROAD. 122, NEWINGTON CAUSEWAY. These premises now closed. 83, LANCASTER STREET. 189, BLACKFRIARS ROAD. Will be vacated in due course as soon as other accommodation is available. OTHER HOUSING SCHEMES AND ACTIVITIES. 2, 4, 6, 8, COOKS ROAD. By arrangement with the owner these premises have been put into habitable condition. The drains have been reconstructed and the water supply has been removed from the yards to the sculleries, with proper glazed sinks. Sub-floor ventilation has been obtained by lowering the front forecourt areas in each house and dampness remedied by vertical damp-proof course. The roofs have been retimbered and tiled; all rooms and woodwork thoroughly repaired and painted. The scullery roofs have been made higher and more room obtained by removing chimney breast. 1, 2, 3, PEACOCK SQUARE. These premises have also been reconditioned without Notice. New water closets have been built with new back addition sculleries and sinks; main and back addition walls repaired, pointed and rendered. Boundary walls rebuilt; additional windows provided for light and ventilation; new roofs. No. 3 has been demolished and a modern new brickwork common wash-house constructed with deep sink, lowered skylight and casement sashes. 73 LAW STREET, LANSDOWNE PLACE and WESTCOTT STREET. In my Annual Report for 1932 I reported that these properties were represented by Dr. Millson in 1909 as unfit for human habitation and, further, that the London County Council were contemplating reconditioning them. I protested against this policy, and now have to report that nine houses in Westcott Street have been demolished and three others are being used for storage only. 74 TABLE 31. HOUSING. 1. Inspection of Dwelling Houses:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,138 (b) Number of inspections made for the purpose 7,194 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,198 (b) Number of inspections made for the purpose 1,198 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 216 (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 3,371 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 434 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 83 (2) Number of dwelling houses which were rendered fit after service of formal notices:— 57 (a) by owners (b) by Local Authority in default of owners - 75 TABLE 31.—continued. B. Proceedings under Public Health Acts: — (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2,836 (2) Number of dwelling houses in which defects were remedied after service of formal and informal notices:— (a) by owners 3,099 (b) by Local Authority in default of owners Nil. C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made 39 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 15 (3) Number of dwelling houses rendered fit (Sub. Sec. 2) — 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 28 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room, having been rendered fit 32 (3) Number of separate tenements or underground rooms which have been closed, with out making of orders 6 (4) Number of separate tenements or underground rooms which have been rendered fit, without making of orders E. (1) Representations. Housing Act, 1930. Sec. 1. *149 * These are included in 1 (a). 76 77 TABLE 32. Sanitary Works completed under the Housing Acts, during the year 1933. DISTRICT. Houses Let in Lodgings. Formal Notices complied with. 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. 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. No. 1 - 3 41 27 10 35 16 45 13 26 4 21 30 9 2 2 - - - - - - - 439 No. 2 8 4 22 60 139 154 106 4 13 35 75 30 91 6 - 18 - - - - - - - 387 No. 3 5 3 10 16 15 18 24 6 2 14 6 18 24 6 3 1 - - - - - - - 268 No. 4 1 - - 5 2 4 4 6 2 9 - 1 12 3 2 - - - - - - - - 378 No. 5 28 22 68 64 42 39 29 18 10 30 47 26 49 27 14 15 - - - - - - - 281 No. 6 2 3 33 16 35 38 36 2 3 9 — 6 24 4 - - - - - - - - - 208 No. 7 3 2 1 10 57 25 28 15 1 14 - 8 32 4 - - - - - - - - - 175 No. 8 8 - 1 18 7 38 1 1 3 1 - 6 6 - - - - - - - - - - 195 No. 9 2 3 7 5 12 12 7 9 15 - - 5 1 1 - - - - - - - - 183 Total 57 37 179 223 312 363 256 104 56 153 132 116 273 60 22 36 - - - - - - - 2514 SECTION E. Inspection and Supervision of Food. 81 INSPECTION AND SUPERVISION OF FOOD. Regular observation is kept of all food exposed or deposited for sale in slaughter-houses, butchers' shops, cooked meat shops, fishmongers' premises, stalls, market places, etc. SLAUGHTER -HOUSES. There are four in the Borough which are licensed annually. Notice is given to this department when animals are to be slaughtered, and all carcases and viscera are examined before being offered for sale. The following are the premises and the licensees:— Situation of Premises. Name of Licensee. 129, Hillingdon Street Messrs. Newbury & Manktelow. 70, Union Road George Challis. 244, Walworth Road Messrs. Chalk & Cox, Ltd. 283-5, Walworth Road Messrs. R. C. Hammett, Ltd. During the year 762 oxen, 4,104 sheep and 1,346 pigs were slaughtered. The total weight found to be unsound was 11 cwts. 1 qr. 10 lbs., of which 7 cwts. 1 qr. 1 lb. were destroyed on premises where found, and 4 cwts. 0 qr. 9 lbs. were destroyed at the Council's Depot. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1932, SEC.5. Registration of Premises for Sale, etc., of Ice Cream and Preserved Food. The following table shows the number of premises registered and the inspections made:— Premises. Registered. Inspections. Ice Cream 270 458 Butchers' premises 92 734 Provision Dealers 57 455 82 "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. 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. PERSONAL CLEANLINESS IN PERSONS ENGAGED IN HANDLING FOOD. Increased attention is rightly being given to the question of the exposure of foodstuffs in genera], and meat in particular, to contamination by dust and dirt in the atmosphere. From the point of view of real damage to health, however, the most serious contamination which food is exposed to is from the hands of those persons whose business it is to handle it in the ordinary way of trade. Many of such persons are not nearly so particular about washing their hands as they should be, though it must be admitted in fairness to them that adequate and convenient facilities for washing are not always provided by those who employ them. With a view to encouraging more attention to cleanliness in this manner, the following letter has been 83 and is being addressed to the proprietors of such trades as butchers and meat salesmen, bakers and confectioners, greengrocers and fruiterers, dairies, sweet shops and, indeed, any trade where human food is handled:— ''Dear Sirs, "The Public Health Committee are very desirous of encouraging personal cleanliness amongst all those whose occupation involves the handling of food. Especially do they wish to inculcate the need of washing of hands after using W.C. The importance of this is obvious; it is not only a matter of elementary hygiene, but the neglect of it may directly lead to the spread of disease. "With this object in view, we are asking the proprietors of businesses in the various branches of the food trade to allow a printed notice (specimen enclosed) to be affixed to the doors of each W.C. used by their employees. "If you are willing to help us in this matter, I shall be glad if you will fill up the enclosed card and return it to me. "It is assumed that suitable facilities, in the form of fixed wash-basins, with water laid on and provided with soap and towels, already exist and are available for the use of your employees. If not, the Public Health Committee hope that you will see your way to providing them. It is desirable that such facilities should be in convenient proximity to the W.C. "Yours, etc., "Medical Officer of Health.'' Enclosed with the letter was a card 6in. by 4in., inscribed:— AS HANDLERS OF FOOD YOU SHOULD ALWAYS WASH YOUR HANDS AFTER USING A W.C. Public Health Department, Southwark. Also enclosed with the letter was a printed reply postcard, to be returned to us, stating how many of the cards they could make use of. The response to this letter has been on the whole satisfactory, and already over 1 000 of these cards have been issued. 84 PUBLIC HEALTH (PRESERVATIVES IN FOOD) REGULATIONS. Samples under these Regulations are now taken on the Wharves by Mr. Bowers and Mr. Duffield and submitted to the Borough Analyst for examination. The following samples have been taken during the year:— Gelatin 438 parts sulphur dioxide per million. Caviare (3) 16.1, 21.7, 19.6 grains to the pound boracic preservative. Strawberry Jam (2) Free from sulphur dioxide. Strawberry Pulp 2,280 parts sulphur dioxide per million. Do 1,370 do. do. White Cherry Pulp 2,440 do. do. Egg Yolk Free from boracic preservative. Butter "Typical" b coli not found. Sterogen Contained 5% solution of caustic soda in water. Salmon Contained lead 2 parts per million. Sardines Do. 7.8 do. do. Do Do. 11 do. do. Canned Fish Do. 5 do. do. Do. Free from lead. Ox Tongue Do. Salmon (2) Do. Pigs' Tongues Do. Pilchards in Tomato Do. Crab Do. "Posts" Instant Jelly: Average of 3 English packets Contained lead 24 parts per million. Do. 3 Swedish packets Do. 29 do. do. 80 87 TABLE 33. Showing the quantity of foodstuffs examined at the wharves, the amount of food 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 1406 boxes, 140 cases 31 2 2 - 14 17 0 6 Yes - 5 5 2 cwt. 3 qrs. 12 lbs. were destroyed at the Council's Depot; 4 cwt. 2 qrs. were destroyed in a barge; 14 tons 9 cwt. 2 qrs. 22 lbs. were destroyed on the premises where found. Apricots 1141 crates 12 3 0 3 1 5 2 11 Yes - 4 4 3 qrs. 10 lbs. were destroyed at the Council's Depot and 1 ton 4 cwt. 3 qrs. 1 lb. destroyed in a railway truck. Apricot Pulp 50 casks 100 cases 12 tins 15 8 0 4 1 1 6 Yes - - - 3 qrs. 6 lbs. were destroyed at the Council's Depot and 2 qrs. were destroyed in a barge. Apricots, tinned 80 cases 1 11 2 16 - - - - - — Asparagus 1 crate 24 24 Yes - 1 1 Destroyed in a railway truck. Bacon 2380 bales 238 12 0 0 - - - 3 3 - Beans 3 billots 2 4 2 4 Yes - — — Destroyed on premises where found. Beef 79 4 3 0 3 12 2 2 Yes - 25 25 Released for technical purposes. Beef, Salted 60 barrels 7 11 1 20 - - - - - - Beef, tinned cases and tins 35 1 3 26 6 3 3 10 Yes - 1 1 5 tons 3 qrs. 10 lbs. were destroyed at the Council's Depot and 1 ton 3 cwts. were released for technical purposes. Biscuits 267 cases 9 8 2 0 - - - - - - Blackcurrant Pulp 181 casks 100 crates 40 0 0 0 - - - - - - Blackcurrants 100 crates 13 cases 1 7 0 0 - - - - - - Bread 54 cases 1 4 0 12 1 4 0 12 Yes - - - Destroyed at the Council's Depot. Butter 50 boxes 14 cases 1 8 2 0 - - - 1 1 - Casings, hog 79 tierces 15 6 0 0 - - - - - - Casings, sausage 52 casks 9 16 0 0 - - - - 1 12 cwt. under. "stop"1932 release Caviare 129 casks . . 19 19 0 0 - Yes - - - Destroyed at the Council's Depot. Cherries, tinned 35 cases 14 3 16 14 3 16 - - - - - Cherry Pulp 160 casks 32 0 0 0 - - - - - Cocoa 120 bags 12 0 0 0 - Yes - 2 2 5 tons 19 cwt. 3 qrs. were destroyed at the Condensed Milk 1931 cases 41 3 0 16 28 6 0 16 Council's Depot and 3 qrs. 12 lbs. were destroyed in a barge; 22 tons 5 cwt. 2 qrs. 4 lbs. were released for technical purposes. Crab, tinned 476 cases 11 18 0 0 - - - - - - Dates 600 cases 500 boxes 24 10 0 0 - - - - - - Ducks 114 boxes 2 17 0 0 - - - - - - 42 43 Carried forward 644 8 1 1 56 6 0 23 88 89 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. Brought forward 644 8 1 1 56 6 0 23 42 43 Egg, liquid 6 tierces 23 tins 7 1 7 4 2 17 Yes — 4 4 Destroyed on premises where found. Egg, yolk 60 tins 48 casks 10 18 3 0 4 16 0 0 — — 1 1 Released for technical purposes. Fish, tinned 8193 cases 180 2 2 0 2 2 0 Yes — — — Destroyed at the Council's Depot. Fruitpulp 40 cases 1 0 0 0 - — — — — — Fruits, Crystalized 300 cases 7 10 0 0 - — — — — — Fruits, dried 40 cases 17 0 6 - Yes - 2 2 10 tons 8 cwt. 2 qrs. 14 lbs. were destroyed at the Council's Depot, and 15 cwt. were released for technical purposes. Fruits, assorted, tinned 1956 cases 37 18 1 24 11 3 2 14 — — — — — Gelatine 100 bags 2 10 0 0 - — — — — — Grape-Fruit, tinned 53 cases 1 5 2 0 1 5 2 0 Yes - - - 5 cwt. 1 qr. 4 lbs. were destroyed at the Council's Depot, and 1 ton 24 lbs. were destroyed on premises where found. Greengages 604 crates 49 billots 6 12 3 17 16 1 5 Yes — - - Destroyed on premises where found. Greengage pulp 62 cases 1 10 0 0 - •— — 1 - Still under SStop. Hams 2 cases 15 boxes 3 0 0 0 — — 2 2 — Honey 1315 cases 39 12 2 0 2 2 0 — — — — Destroyed at the Council's Depot. Jelly 879 cartons 4 10 0 0 4 10 0 0 - — 1 1 Do. do. Lard 40 boxes 10 0 0 - — — — - Lard Oil 208 tierces 167 barrels 73 18 0 0 28 12 0 0 Yes — 4 5 Released for technical purposes, including 6 tons under "Stop" from 1932. Lettuce 89 crates 9 1 18 6 1 18 Yes — — — Destroyed in a railway truck. Lobster, tinned 41 tins 21 Yes — — — Destroyed at the Council's Depot. Loganberries, tinned 326 cases 6 19 2 17 1 0 2 8 Yes — 1 1 Do. do. Meat, Chicken 225 cases 5 12 2 0 - - — — — - Meats, tinned 631 cases 50 tins. 14 17 3 6 5 3 0 0 Yes — 1 1 2 cwt. destroyed at the Council s Depot and 5 tons 1 cwt. released for technical purposes. Mutton Carcases & pieces 1967 0 0 2 23 6 3 24 Yes — 427 427 Released for technical purposes. Offal - 38 o 1 17 1 8 1 9 Yes — 6 5 2 cwt. 27 lbs. were destroyed at the Council s J. Depot, and 3 cwt. 3 qrs. 12 lbs. were destroyed on the premises where found; 1 ton 2 cwt. 26 lbs. were released for technical purposes; 29 tons 4 cwt. 1 qr. 24 lbs. still under "Stop." Onions 80 bags 4 0 0 0 - - —-~ 1 1 - Oranges, tinned 7 cases 3 0 0 3 0 0 yes - - - Destroyed at the Council's Depot Peaches 100 boxes 75 crates 2 baskets 2 0 3 6 5 0 10 yes - 1 1 2 cwt. 16 lbs. were destroyed at the Council s Depot; 1 qr. 2 lbs. were destroyed on the premises where found, and 2 cwt. 2 qrs. 20 lbs. were destroyed in a railway truck. Peaches, dried 40 cases 10 0 0 - - 1 - - - Peaches, tinned 306 cases 64 tins 6 12 1 12 3 11 3 16 Yes - 1 1 1 cwt. 16 lbs. were destroyed at the Council/s Depot, and 3 tons 10 cwt. 3 qrs. were released for technical purposes. Carried forward 3062 17 1 14 143 4 2 25 495 495 90 91 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. 3062 17 1 14 143 4 2 25 495 495 Pears 50 cases 100 bags 7403 boxes 21 bundles 32 crates 186 19 2 25 3 7 2 7 Yes - 3 3 15 cwt. were destroyed at the Council's Depot; 2 tons 10 cwt. 7 lbs. were destroyed on premises where found, and 2 cwt. 2 qrs. were destroyed in a barge. Peas 670 bags 32 5 0 0 - — — — — — Pineapple, tinned 643 tins 100 cases. 2 8 1 8 5 3 20 Yes — — — Destroyed at the Council's Depot. Plums 1926 crates 32 cases 23 4 0 5 2 9 3 5 Yes 3 3 16 cwt. 2 qrs. were destroyed at the Council's Depot, and 1 ton 13 cwt. 1 qr. 5 lbs. were destroyed in a railway truck. Pork 1 carcase 1 2 0 1 2 0 Yes — 1 1 Released for technical purposes. Potatoes 50 barrels 2 10 0 0 - — — — — — Prunes 2 bags 2 boxes 4 0 20 4 0 20 Yes 1 1 3 cwt. 2 qrs. 20 lbs. were destroyed at the Council's Depot, and 2 qrs. were destroyed on premises where found. Prunes, tinned 21 cases 9 0 0 9 0 0 Yes — 1 1 Destroyed at the Council's Depot. Rabbits 2073 crates 27 9 3 12 8 6 3 16 Yes — 4 4 Released for technical purposes. Raisins 50 boxes 1 1 1 20 - — — — — - Raspberry pulp, tinned 200 cases 181 casks 40 13 0 0 — — — — Redcurrants 50 crates 50 boats 1 0 2 24 — — — — - Rice 1500 bags 75 0 0 0 17 1 2 Yes — 1 1 Destroyed at the Council's Depot. Salmon, tinned 1517 cases 6307 tins 28 18 3 8 6 4 1 24 Yes - 1 1 Do. do. Sardines 300 cases 10 2 0 - — — — — — Sausage Meat 4 cases 1 box 3 2 12 1 2 12 Yes — 1 1 Destroyed at the Council's Depot. Soup, tinned 10 cases 4 1 4 4 1 4 Yes — — — Do. do. Strawberry pulp 151 casks 50 cases 31 9 0 0 - — — — — - Strawberries, tinned . . 13 cases 5 2 8 - — — — — - Sugar 47 bags 4 14 0 0 1 6 0 0 Yes — 1 1 Released for technical purposes. Sultanas Cases and boxes .. 15 12 3 0 3 16 Yes — 2 1 Destroyed at the Council's Depot; 3 tons 14 cwt. still under "Stop." Sweets 888 cases 22 4 0 0 — - - Tomatoes, tinned 50 cases 1 1 1 20 - — — — — — Tomato Paste 373 cases 19 3 0 0 6 15 0 0 Yes - 1 — 6 tons 15 cwt. destroyed at the Council's Depot; 12 tons 8 cwt. still under "Stop." Tongues, Ox 120 bags 307 cases 23 13 2 13 12 6 3 5 Yes — 2 2 Released for technical purposes. Tongues, Ox, tinned 117 cases 3 10 2 16 10 2 16 Yes 1 1 9 cwts. 2 qrs. 16 lbs. were released for technical purposes, and 1 cwt. was destroyed at the Council's Depot. Tongues, Pork 1 tierce 218 cases. . 5 7 1 12 - — — — - — Tongues, Sheeps' ..j 128 cases 2 16 3 2 - - — — - - Tripe 8 boxes 2 0 0 - - — — - - Turkeys 120 cases 6 0 0 0 1 4 2 23 Yes — — 1 Released for technical purposes. Veal 5 hinds 3 2 0 - — — — - - Vegetables, canned 10 packages 2 0 0 - — — — - - Walnuts 20 boxes i 1 0 0 0 - - - - - - Total 3623 6 3 27 188 1 0 27 518 517 92 93 TABLE 34. Showing the quantity of Foodstuffs found unsound throughout the Borough during the year 1933 by the several Inspectors. 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. Apples 101 cases, 1 box 2 11 3 8 101 cases, 1 box 2 11 3 8 — — Destroyed at the Council's Depot. Bacon 3 5 3 19 3 5 3 19 1 ton 18 cwt. 2 qrs. 11 lbs. were destroyed at the Council's Depot, and 26 lbs. were destroyed on premises where found; 1 ton 7 cwt. 10 lbs. were released for technical purposes. Bananas 10 boxes, 3 crates 3 0 0 10 boxes, 3 crates 3 0 0 — — Destroyed at the Council's Depot. Beef 2 Buttocks 1 0 0 2 Buttocks 1 0 0 — - Released for technical purposes. Beef, tinned 1 case, 108 tins 6 0 22 1 case, 108 tins 6 0 22 - - Destroyed at the Council's Depot. Cheese - 4 1 17 - 4 1 17 - - Do. do. Cod fillets 1 box 1 1 0 1 box 1 1 0 - . . - Do. do. Condensed Milk 6 cases 2 1 12 6 cases 2 1 12 - . . - Do. do. Cucumbers 14 flats 4 2 0 14 flats 4 2 0 - . . - Do. do. Dripping 1 tin 14 1 tin 14 - . . - Do. do. Egg Yolk 8 casks 1 12 0 0 8 casks 1 12 0 0 - - Released for technical purposes. Fowls 2,268 4 10 2 18 2,263 4 10 2 8 5 10 4 tons 9 cwt. 3 qrs. 2 lbs. were destroyed at the Council's Depot, and 3 qrs. 6 lbs. were released for technical purposes. 5 fowls weighing 10 lbs. were seized by the Inspector and submitted to the Magistrate. (See Legal Proceedings). Fruits. Assorted, tinned 33 cases 13 1 2 33 cases 13 1 2 - - Destroyed at the Council's Depot. Haddocks 1 case 3 0 1 case 3 0 - - Do. do Hams 8 1 0 12 8 1 0 12 2 qrs. 16 lbs. were destroyed at the Council s Depot, and 1 qr. 24 lbs. were released for technical purposes. Ham, tinned 33 tins 3 2 24 33 tins 3 2 24 - - 1 cwt. 2 qrs. 21 lbs. were destroyed at the Council's Depot, and 2 cwt. 3 lbs. were destroyed on the premises where found. Heads, Pigs 10,065 55 19 1 27 10,065 55 19 1 27 - - 14 cwt. 9 lbs. were destroyed at the Council's Depot, and 55 tons 5 cwt. 1 qr. 18 lbs. were released for technical purposes. Horse Radish 149 barrels 1 11 0 16 149 barrels 1 11 0 16 - - Destroyed at the Council's Depot. Kippers 1 box 1 2 1 box 1 2 - - Do. do Lettuce 66 crates 7 0 16 66 crates 7 0 16 - - Do. do Lobster, tinned 13 cases 5 2 8 13 cases 5 2 8 - — Do Mutton 1 leg 4 1 leg 4 - -- Destroyed on the premises where found. Offal 11 1 10 11 1 10 4 cwt. 9 lbs. were destroyed at the Council's Depot, and 7 cwt. 1 qr. 1 lb. were destroyed on premises where found. Onions 18 bags 18 0 0 18 bags 18 0 0 - — Destroyed at the Council's Depot. Oranges 10 cases 5 0 0 10 cases 5 0 0 - - Do. do. Carried forward 74 0 0 7 73 19 3 25 5 10 94 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. Brought forward 74 0 0 7 73 19 3 25 5 10 Pears 20 boxes, 50 cases, 12 baskets 1 7 1 8 20 boxes, 50 cases, 12 baskets 1 7 1 8 - - Destroyed at the Council's Depot. Peas, split - 4 - - - 4 Condemned by a Magistrate and destroyed at the Town Hall Pheasants 256 2 2 1 256 2 2 1 - - Destroyed at the Council's Depot. Plaice 1 box 1 0 1 box 1 0 - Do. do. Plums 80 sieves 14 1 0 80 sieves 14 1 0 - - Do. do. Pork Carcases & pieces 26 5 3 5 Carcases & pieces 26 5 3 5 - - Beleased for technical purposes. Potatoes 30 bags. ] 10 0 0 30 bags 1 10 0 0 - Destroyed at the Council's Depot. Babbits - 1 19 2 6 - 1 19 2 6 - Do. do. Radishes 11 crates 2 3 0 11 crates 2 3 0 - Do. do. Roe, Cod 2 boxes 3 14 2 boxes 3. 14 — -— Do. do. Salmon, tinned 2 cases 3 16 2 cases 3 16 - Do. do. Skate 2 boxes 2 24 2 boxes 2 24 - - Destroyed on the premises where found. Sloes 3 chips 2 4 3 chips 2 4 - -— Do. do. Tomatoes 29 bundles, 56 boxes, 12 baskets 19 2 2 29 bundles, 56 boxes, 12 baskets 19 2 2 -• 18 cwt. 3 qrs. 2 lbs. were destroyed at the Council's Depot, and 3 qrs. were destroyed at the premises where found. Turkeys - 8 0 9 - 8 0 9 — Destroyed at the Council's Depot. Walnuts 9 pockets 3 10 9 pockets 3 10 Do. do. 107 13 3 26 107 13 3 12 5 14 95 TABLE 35. Inspections of Food at Wharves, Markets and other places where food is stored, and the action taken by the officials during the year 1933. INSPECTION OF WHARVES, Etc. FOOD EXAMINED, Etc. WARD or DISTRICT. Inspections of Wharves and Warehouses. Inspections of Markets. Inspections of Shops or Street Stalls. Slaughter Houses. 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. Mr. Bowers 451 — 926 217 1863 14 15 339 — 2 2 Mr. Duffield 918 - 263 117 2107 504 502 910 — — — Market Inspections — 7866 — — 7866 — — — — — — Total 1369 7866 1189 334 11836 518 517 1249 — 2 2 96 97 MILK AND DAIRIES (AMENDMENT) ACT, 1922, AND ORDERS MADE THEREUNDER. I have received the following report from Mr. Nicholson of the work which he has carried out during the year under:— (1) The Milk and Dairies (Amendment) Act, 1922, and the various Orders and Regulations dealing with milk; and (2) The Factory and Workshop Act in so far as it appertains to Bakehouses. In this connection I particularly wish to draw the attention of the Council to the former. It will be remembered that in my last Annual Report I expressed dissatisfaction regarding the insanitary conditions and methods of several of the registered dairies as they did not comply with the Milk and Dairies Order. Since that time much work and great improvements have been effected. Three Conferences were held by your Officers with the Master Dairymen's Association, and it is gratifying to be able to report that this Association gave their support and every assistance. This has had the effect of bringing into line all the dairymen operating in your Borough, and all have expressed their willingness to co-operate with the Public Health Authority in bringing their dairies and premises into conformity with the Milk and Dairies Order. From the following report it will be seen that a large number of dairies have already been reconstructed, or are in process of reconstruction and Mr. Nicholson is to be congratulated on this useful and very necessary work. At the end of 1932 there were on the Milksellers Registers. Retail 394 names 388 premises. Wholesale 36 ,, 36 ,, Retail 62 ,, Outsiders Wholesale 30 ,, ,, During the year 1933, 61 persons were registered as retail milksellers, 14 as dairies, 44 for sale of milk in containers as received, 2 for use as distributing depots for sale of bottled milk on rounds, and 1 for consumption of milk on the premises only. 98 2 of the said persons were registered also as wholesale milksellers and their premises as dairies. 8 retailers and 7 wholesalers who are registered in other Boroughs, were registered as Outsiders to sell milk in the Borough of Southwark. Sale of milk newly started at 21 premises (Retail) Sale of milk discontinued at 11 ,, ,, Removed from Retail Register 51 names 51 premises Removed from Wholesale Register 2 ,, 2 ,, Removed from Outsiders' Register 1 name (Retail) Totals on Registers at end of 1933. Retail 404 names 398 premises* Wholesale 36 ,, 36 ,, Retail 70 ,, Outsiders Wholesale 37 ,, ,, The 398 premises :— 184 are dairies 192 for sale of milk in containers as received 18 for consumption on premises 4 for depots (for sale of milk on rounds in bottles) †From the 184 dairies, 42 sell milk on the round. The sale of milk in containers as received is steadily increasing, in place of the old-fashioned method of selling loose milk from a counter pan or other receptacle. MILK (SPECIAL DESIGNATIONS) ORDER. 1 Dairy is licensed to pasteurise milk. 2 Dairies are licensed to bottle Grade A (TT) milk. 5 samples of graded milk and 11 samples of ordinary milk were procured for bacteriological examination. 2 of the graded milks did not comply with the requirements of the Special Designation Order, 1923. Letters were sent to the Dairymen concerned. All the said samples were free from Tubercle Bacilli. Practically the whole of the ordinary milk sold in this Borough, is passed through the pasteurising process. 99 Total number of persons and premises licensed to sell graded milk, are as follows:— Certified 7 Includes 1 supplementary Licence Grade A (TT) 19 Includes 1 supplementary and 2 Bottling Licences. Grade A 5 Pasteurised 16 Includes 1 Pasteurising Licence Total 47 MILKSELLERS PREMISES, DAIRIES, BAKEHOUSES AND OTHER PREMISES. 1707 inspections were made of the above premises. 58 Notices served and verbal instructions given. In consequence of Notices served the following nuisances have been abated:— Dirty floors 10 Dirty walls 20 Dirty ceilings 15 Cockroaches 1 Defective paving 3 Absence of Lavatory basin 1 Closet pans foul 5 Miscellaneous 31 Total 86 RECONSTRUCTION OF DAIRIES, UNDER MILK AND DAIRIES ORDER. In addition to the foregoing, a great deal of work has been (and is still being) carried out at the various dairies, some of which are the following:— 13, Lorrimore Street. Ground floor, back addition converted for a dairy. Provided accommodation for washing and sterilizing bottles, etc., storage and filling same. Utensils provided:—steam boiler, washing trough, and bottle washer, sterilizing chest, bottle capper. Milk and utensil store. Covered barrow, etc. 100 62, Beckway Street. Dairy built in yard; two parts, one for store and bottling, and one for cleaning, etc. Provided a gas copper, 2 dipping crates, 2 benches and bottle capper. 129, Walworth Road. Old dairy at rear demolished. New dairy constructed on part of yard and by the conversion of scullery. Bottle capper provided, other items under consideration. 134, Beresford Street. Existing building in yard converted into dairy, two divisions. Appliances to follow. 22, Beresford Street. Dairy in yard reconstructed and divided into two parts. Additional appliances to follow. 19, Barlow Street. Dairy being remodelled and further extension to follow. 103, Villa Street. Dairy in yard reconstructed, two parts. Additional apparatus to follow. 35, Bagshot Street. Dairy in yard reconstructed, two parts. Provided gas copper, dipping tank and crate, bottle capper and bench. 152, Blackfriars Road. A new dairy constructed (to replace 150, Blackfriars Road, dairy in basement). Installed steam boiler, bottle filling machine, etc. Other appliances ordered. 17, Surrey Row. Bottle filling and store room, and capper provided. Other items to follow. 58, Larcom Street. Bottle filling and store room, and capper provided. Boiler being adapted for generation of steam. Other items to follow. Rear of 26, Villa Street. Adjoining premises have been adapted for dairy purposes, so that now there are two rooms, one for washing, etc., the other for bottling and store. Capper provided, other items to follow. 17, Vowler Street. A new dairy being built to displace dairy in basement at 25, Deacon Street, this dairy being insufficient for the business now carried on. 342, East Street. Back addition of premises converted into dairy, two parts. Old W.C. discontinued and a new one provided in yard.. Provided gas copper, bench, rack, sink, trough, etc. Other items to follow. 61, Rodney Road. Dairy being constructed in yard. 1, 2, 3, Gt. Suffolk Street. Newly installed churn washer and sterilizer, cold store and the necessary refrigerating plant, steam boiler. Other works are in contemplation. 101 70/74, Ambergate Street. Newly built depot and cold store, for sale of bottled milk on rounds. Rear of 49/53, Surrey Row. Newly built depot for sale of bottled milk on round. 2, Clapton Buildings. New dairy being constructed rear of shop. BUTTER AND MARGARINE FACTORIES, ETC. 4 inspections were made and 6 samples of butter procured for analysis. Certified genuine. 1 inspection of Wholesale Dealer in margarine. There are 19 Wholesale Dealers in margarine in the Borough. 1 was registered and 1 discontinued during the year. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS 1923—7. 12 samples of condensed milk were purchased under the said Regulations and were certified by the Public Analyst to be satisfactory. COWSHEDS. No cows are kept in the Borough. MERCHANDISE MARKS ACT 1926 AND ORDERS. PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) REGULATIONS. FOOD AND DRUGS (ADULTERATION) ACT, 1928, PART II, Etc. Special attention has been given at the various shops, etc., when purchasing samples, or when inspecting, in regard to the carrying out of the requirements of the above Acts and Orders, etc. Where necessary the Orders have been explained and the Occupiers cautioned. This has had the desired effect in the carrying out of the said requirements, etc. 102 BAKEHOUSES. Particulars at the end of the Year. Position. In use. Not in use. Totals. Remarks. Above ground 39 20 59 92, East Street, discontinued. Underground 26 8 34 Totals 65 28 93 The periodical cleansing was carried out. NOXIOUS TRADES. Situation. Trade. Occupier. Inspts. Notices. 24, Gt. Suffolk Street Tripe Boilers J. Martin 5 Wansey Street Soap Boilers Holders Soap Works, Ltd. 4 1 Harrow Street Furriers, etc. Leeding & Co. 5 – 5, Hatfield Street Fat Melters J. Ewen & Sons, Ltd. 4 — (5, Hatfield Street, Fat Melters, now discontinued, premises are to be pulled down.) The periodical limewashing and cleansing generally, was carried out. 103 POLICE COURT PROCEEDINGS TAKEN UNDER THE FOOD AND DRUGS ACT. 14 summonses were taken out during the year 1933. TABLE 36. Showing the Districts in which proceedings were taken under the Food and Drugs Act. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. i No. 7. No. 8. No. 9. Total. Number of Summonses taken out 2 3 2 2 1 1 3 — — 14 The offences for which the above-mentioned summonses were taken out are tabulated hereunder :— Milk deficient in fat 1,case Vinegar deficient in acetic acid 4 cases Dried mint (foreign leaves) 6 cases Crushed linseed deficient in oil 3 cases Total 14 cases 104 SALE OF FOOD AND DRUGS ACT. During the year ended 31st December, 1,196 "official" samples were taken by the Inspector. The following Table shows the localities in which these samples were taken:— TABLE 37. Showing the number of samples taken in each District of the Borough during the year. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. No. 9. Total. Number of samples taken 156 146 114 164 153 156 127 108 72 1196 13 of these samples were certified as adulterated, a percentage of 1.09, as compared with 1.74 in 1932. Particulars of the samples taken, together with the results of the analyses are given in Tables 38 and 39. 105 SALE OF FOOD AND DRUGS AND OTHER ACTS. Proceedings taken, with the Result. Name and Address of Vendor. Sample. Result of Analysis. Result of Proceedings. G. E. Burgess, 12, Beresford Street Vinegar 27 per cent. deficient in Acetic Acid Fined £2 and £1/1/- costs. Louisa Bird, 206, Trafalgar Street Dried Mint 40 per cent. foreign dried leaves .. Dismissed under the First Offenders Act; 10/6 costs. Brinkler, Osborne & Young, 245, Coldharbour Lane, S.E. Do. 40 per cent. foreign dried leaves .. (Sold to Louisa Bird) Dismissed on Warranty. Hirsh Lewis, 6, Draper Street Do. 40 per cent. foreign dried leaves .. Dismissed on Warranty. Pearce, Duff & Co., Spa Road, S.E. Do. 40 per cent. foreign dried leaves (Sold to Hirsh Lewi Fined £10 and £15/15/- costs. A. G. Hicks, 137, Southwark Bridge Road Do. 40 per cent. foreign dried leaves .. Dismissed under First Offenders Act. S. Dodman & Sons, Ltd., 2, Banyard Road, Bermondsey Do. 40 per cent. foreign dried leaves (Sold to A. G. Hicks) Fined £10 and £15/15/- costs. L. Friend, 20, Aylesbury Road Vinegar 19 per cent. deficient in Acetic Acid Fined £3 and £1/1/- costs. B. Woolley, 20, King James Street Milk 11 per cent. deficient in milk fat .. Dismissed on payment of £l/l/-costs. A. Ball, 225, Beresford Street Vinegar 72 per cent. deficient Acetic Acid.. Fined £3 and £1/1/- costs. W. Willmott, 17, Lucas Road Do. 17.5 per cent. deficient in Acetic Acid Fined £1 and £1/1/- costs. Messrs. Dowling & Newcombe, 54, New Kent Road Crushed Linseed 65 per cent. deficient in Oil Fined £2 and £3/3/- costs. A. Sinclair (Assistant to above firm), 54, New Kent Road Do. 65 per cent. deficient in Oil Dismissed on payment of 2/- costs. Sydney Gale, 8, Trinity Street Do. 19 per cent. deficient in Oil Dismissed on payment of £l/l/-costs. 106 FOOD AND DRUGS ACTS. TABLE 38. Return of Official Samples for the Year ending 31st December, 1933, showing the number taken, and the percentage of adulterated Samples for the year. FORMAL SAMPLES. Article. Number of Samples taken. Adulterated . Milk 349 2 Condensed Milk 12 Butter 107 — Margarine 90 — Lard 63 — Coffee 9 — Cocoa 27 — Tea 40 — Sugar 38 — Mustard 9 — Jelly Crystals 3 — Table Jelly 23 — Chicken and Ham Paste 1 — Liver Sausage 1 — Cake 12 — Preserved Ginger 1 — Dripping 15 — Self-raising Flour 33 — Pea Soup Flour 13 — Saxa Salt 4 — Vinegar 5 3 Cornflour 16 — Suet and Rice Flour. 3 — Pearl Barley 9 — Rice 22 — Semolina 6 — Tapioca 20 — Custard Powder 10 — Mustard Compound 4 — Dried Mint 6 4 Fish Paste 7 — Oatmeal 2 — Arrowroot 2 — Desiccated Cocoanut 2 — Curry Powder 2 — Ground Ginger 3 — Carried forward 969 9 Article. Number of Samples taken. Adulterated . Brought forward 969 9 Ox-tail Soup — Rolled-Oats 2, — Bisto 9 Dried Parsley 1 Tea Siftings 2 Prepared Barley 1 Black Pudding 2 Gravy Thick Jam Sandwich a Sweets 14 Breakfast Sausage Roast Pork and Stuffing Roll 1 Preserved Sausage Pork Brawn 6 Bun Flour ej Sherry Port Wine Whisky 16 1 Brandy 7 Gin Rum 9 Cheese Citrate of Magnesia 1 Glauber Salts Bicarbonate of Soda I Boracic Powder 1 Crushed Linseed tv 3 Camphorated Oil 1 — Olive Oil 1 — Eucalyptus Oil 1 — Compound Liquorice Powder 1 — Bismuth sub-carbonate 2 — Sulphate of Quinine 2 — Tartaric Acid 1 — Linseed Oil 1 — Castor Oil 1 — Liquid Paraffin 1 — Caraway Seeds — Peas 1 — Table Salt o — Gravy Granules — Blanc Mange 7 — Carried forward 1139 13 107 108 Artica Number Brought forward 1139 13 Gravy Salt 4 Gravy Powder 2 Flaked Rice 4 Raspberryade 1 Milk Pudding 1 Mixed Spice 3 Orangeade 2 Soup Mixture 2 Swiss Roll 2 Sponge Mixture 3 Witch Salt 1 Lemonade Crystals 1 Malted Milk Cocoa 1 Patent Barley 2 Linseed Meal 1 Sherbet 3 Tomato Soup 2 Lemonade Powder 2 Chocolate 4 French Coffee 5 Yorkshire Pudding Powder 1 Grapeade 1 Corned Beef 1 Sago 1 Grape Nuts 1 Rice Custard 1 French Cream Slices 1 Ginger Beer Powder 4 Total 1196 13 Percentage of adulterated samples for the year—1.09 109 INFORMAL SAMPLES. In addition to the samples taken under the Food and Drugs Acts as shown in Table 38, 731 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 39. Article. Number of samples. Adulterated. Milk 40 Cream 21 — Butter 309 1 Lard 101 — Coffee 29 2 Dripping- 1 1 Vinegar 200 22 Crushed Linseed 19 3 Golden Syrup 9 — Sherbet 1 — Malt Vinegar 1 — Total 731 29 Percentage of adulterated samples for the year—3.97. SECTION F. Prevalence of and Control over, Infectious and other Diseases. 113 INFECTIOUS DISEASES. All homes are visited by a Sanitary Inspector and an Enquiry Officer, the possible source of infection is investigated and arrangements for admission to hospital are made, together with the admission of contacts to the Reception House, if necessary. SMALLPOX. During the year under review 63 cases were notified. The number of cases notified during the last five years is as follows :— 1929 153 1932 161 1930 106 1933 63 1931 31 Mild Smallpox still smoulders in London, owing to " missed " cases spreading the disease amongst the population, of which over 50 per cent. is unprotected. The mildness of the disease is responsible for the " missed " cases; many sufferers are so slightly ill that they do not consult a doctor, whilst in others the rash is not recognised ; nevertheless your Officers, by careful vigilance, have been able to control the disease and prevent an outbreak of any alarming proportions. SCARLET FEVER. One thousand two hundred and sixty-eight cases of this disease were notified during the year. The annual death rate per 1,000 population for England and Wales was 0.02; for London, 0.02; and for Southwark, 0.01. The number of cases notified and the number of deaths during the last five years were as follows:— Notified. Deaths. 1929 662 3 1930 763 4 1931 514 3 1932 623 4 1933 1268 3 114 Scarlet Fever, of recent years, has changed from a severe to a mild disease of childhood; so mild, in fact, that many children contract the disease but are not sufficiently ill to be taken to a doctor, or even to be kept indoors for more than a day or two; the disease, therefore, goes unrecognised, and as the incubation period is a short one, large numbers of children can quickly become infected, thereby rendering control difficult; for this reason towards the end of the year under review a short but sharp outbreak of this disease was experienced. ENTERIC FEVER. Five cases of Enteric Fever were notified during the year, and 1 case of Paratyphoid. The number of cases notified and the number of deaths during the last five years were as follows :— Notified. Deaths. 1929 5 1 1930 2 1 1931 5 1 19 2 ™ 1933 6 3 The group of fevers coming under this heading are usually contracted through the medium of infected food or the drinking of contaminated water. Two of the cases were due to the eating of shell fish and one to the drinking of foul water whilst on holiday; the fourth case occurred in an infant and the source of infection was not traced, whilst the fifth proved not to be Enteric when admitted to hospital. The case of Paratyphoid is of interest, as the disease Avas not diagnosed during life. The patient, a young child, was admitted to hospital with meningitis, which quickly proved fatal; after post mortem examination the meningitis was found to be caused by the Paratyphoid Bacillus. The mode of infection in this case could not be ascertained. DIPHTHERIA, Four hundred and eighty-six cases of this disease were notified, with 12 deaths. The annual death rate per 1,000 population was 0.06 for England and Wales, 0.08 for London and 0.07 for Southwark. Antitoxin is supplied free of charge, and 24 phials of 8,000 units have been supplied to Medical Practitioners in the Borough during the year. 115 The number of cases notified and the number of deaths during the last five years were as follows :— Notified. Deaths. 1929 603 22 1930 667 17 1931 426 8 1932 448 14 1933 486 12 SCHICK TESTING AND DIPHTHERIA PREVENTION CLINIC. This Clinic is held every Thursday afternoon at Sutherland House. Dr. Porter Smith is the Medical Officer in charge of the session. The attendances are gradually increasing, inasmuch as the Council have sanctioned another session being held in the northern part of the Borough. During the year 194 patients were immunised. The number tested and immunised during the last five years is set out in the following table:— 116 SCHICK CLINIC 1929-1933. Number tested, 0—5. Inoculation without test. Immunised. Number tested, 5—14. Inoculation without test. Immunised. Number tested, Adults. Immunised. Total. 1929 (9 months) 23 (4 immune) 20 18 142 (60 immune) — 46 9 (2 immune) 2 66 1930 27 (4 immune) 16 33 78 (29 immune) 1 86 (1 immune) – 119 1931 34 (3 immune) 23 48 75 (9 immune) 1 67 3 (2 immune) 1 116 1932 67 (11 immune) 66 88 83 (39 immune) 1 45 — — 133 1933 71 (8 immune) 74 112 171 (67 immune) 8 82 — — 194 628 117 MEASLES. The number of cases of this disease notified during the year was 1,219. Of these, 573 were under five years of age, and 167 were, removed to hospital. Forty-two of those over five were also removed to hospital. All cases treated in their homes were visited by the Health Visitors, who gave advice and instruction where necessary. The scheme of control now in force, and in co-operation with the London County Council, is as follows:— The daily visitation by School Nurses of Infants' Departments affected by measles during epidemic periods, priority being given to schools situated in congested areas. They examine the children, especially those under five years of age, exclude suspicious cases and report them immediately to the Borough Medical Officer, obtain the names and addresses of children absent owing to illness or unknown causes and hand the information to the Borough Health Visitors, who at once visit the homes. The assistance of the whole of the school organisation is enlisted to ensure that notice is directed to all cases needing attention. As already stated, the Head Teachers supply information regarding all cases of Measles or suspected Measles that come to their notice, and the School Attendance Officers forward immediately to the Borough Medical Officer particulars of children found to be suffering from Measles in the course of their work. In the case of ailing children further enquiries are made by these Officers after the lapse of a few days to ascertain whether Measles has developed. Leaflets containing advice to parents are supplied by the Borough Medical Officers of Health and are distributed through the school organisation. Head Teachers of all departments are asked to ensure that these warning notices reach every family represented throughout the schools. A specimen copy of a leaflet is printed hereunder:— MEASLES WARNING. Measles has appeared in your neighbourhood, and there is a possibility that the disease may become prevalent. Measles is a highly infectious disease, especially in the early stages of illness, before the rash appears. The early symptoms are those of a cold, which may be at first slight ; there is generally running at the eyes and nose, sneezing, and possibly a dry cough, followed by a rash about the fourth day after the first appearance of illness. 118 Measles should always be treated as a serious disease, especially in young children. As soon as it is suspected, the child should be put to bed in a well ventilated room (as far as possible away from other children) and be kept warm. A doctor should be called in at once, for many children lose their lives, or suffer from ill-health for years, as a result of the after effects of the disease, mainly because the disease is neglected in the early stages. The child should on no account be exposed to chill or draughts or allowed to run about until the doctor or nurse gives consent. Immediately Measles occurs in your family you should inform the Head Teacher of the school attended by your children, or the Health Visitor at the Infant Welfare Centre, or send word to the Medical Officer of Health at the Town Hall. A child showing signs of sickening for, or suffering from. Measles must not attend Sunday School, cinemas, public baths or any place of entertainment, or mix with other children. Arrangements for the removal of a Measles patient to hospital or for nursing assistance in the home may be made in special cases when the need for this is known to the Medical Officer of Health. The sooner you send word of the existence of Measles in the home the sooner will help be forthcoming. Do not wait until Bronchitis or Pneumonia develops—it may then be too late. The number of deaths from Measles during the last five years will be found hereunder :— 1929 16 1932 53 1930 77 1933 6 1931 3 DIARRHOEA. This disease is notifiable during the months of July, August and September in the Borough of Southwark. During this period 5 cases were notified, of which 1 was removed to hospital. Deaths of infants under two years of age during the last five yea were as follows:— 1929 36 1932 34 1930 19 1933 32 1931 16 WHOOPING COUGH. This disease is not notifiable in the Borough, but cases come to the knowledge of the Public Health Department through the medium ot 119 the various local hospitals, or the general practitioners. 89 cases were removed to hospital during the year. The number of fatal cases during the last five years will be found hereunder :— 1929 49 1932 20 1930 10 1933 23 1931 18 INFLUENZA. The deaths from this disease during the last five years were as follows :— 1929 135 1932 43 1930 20 1933 98 1931 35 PUERPERAL FEVER AND PUERPERAL PYREXIA. Twelve cases of Puerperal Fever and 26 cases of Puerperal Pyrexia were notified during the year, as against 7 and 36 respectively for 1932. The whole of the cases of the former disease were sent to hospital, and 23 of the latter. There were 3 deaths from Puerperal Fever and 3 from other accidents or diseases of pregnancy. The maternal mortality rates are as follows:— Puerperal Fever. Puerperal Pyrexia England and Wales 1.79 2.63 The Borough 1.29 1.29 OPHTHALMIA NEONATORUM. Nineteen cases occurred during the year, as against 26 in 1932. An analysis of the cases will be found hereunder:— Notified. Cases treated. Vision unimpaired. Vision impaired. Total Blindness. Deaths. At home. Hospital. 19 10 9 18 — 1 Nil. CEREBROSPINAL FEVER, ENCEPHALITIS LETHARGICA AND POLIOMYELITIS. Twenty-one cases of Cerebro-spinal Fever were notified during the year, of which 15 died. Three cases of Poliomyelitis were also notified; they were all sent to hospital. One case of Encephalitis Lethargica was notified, with 1 death. 120 ACUTE PRIMARY AND INFLUENZAL PNEUMONIA. Two hundred and eighteen cases were notified during the year, of which 78 were removed to hospital. There were 44 deaths of these notified cases. ANTHRAX. Two cases of this disease were notified and both occurred in persons employed in brush-making, the disease being contracted from contaminated imported Chinese bristles. CANCER. The number of deaths during the last five years together with a table showing the site of disease for the period 1933 will be found hereunder:— 1929 254 1932 263 1930 250 1933 288 1931 290 TABLE 40. Deaths from Cancer (1933). Site of Disease. under 15 15-25 25-35 35-45 45-55 55-65 65-75 75 and above Total Buccal Cavity, Pharynx, Oesophagus, Stomach, Liver and Annexa M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. — — — o 4 5 11 5 31 19 35 22 7 5 88 58 Peritoneum, Intestines, Heetum, Bladder.. — — — 1 — 1 — 3 3 3 13 10 17 7 7 11 40 30 Genital Organs — — — — — 1 — 5 — 7 — 4 — — — o — 19 Breast — — — — — — — 4 — 9 — 4 — 5 — 1 — 23 Other and unspecified organs. . — — 1 1 — 1 1 2 1 3 5 1 4 4 — — 12 12 — — 1 2 — 5 5 10 15 27 49 38 56 38 14 19 140 148 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. These are referred to the Metropolitan Society for the Blind. 121 TABLE 41. NOTIFIABLE DISEASES (other than Tuberculosis) during the year 1933. Disease. 0- 1- 6- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Males. Females. Total Cases admitted to Hospital Total Deaths Scarlet Fever 8 374 520 229 39 47 32 13 6 - - - - 563 705 1268 1200 3 Smallpox 1 3 9 9 12 9 9 3 4 4 - — — 28 35 63 63 — Diphtheria 3 159 185 80 21 13 11 12 2 - — — 230 256 486 486 12 Memb. Croup — — — — — — - — — - - — — — — — — — Enteric Fever — 1 1 2 - - - - 1 - - - - 3 2 5 5 2 Paratyphoid 1 - - - - - - - - - - - - - 1 1 1 1 Puerperal Fever — — — - — 4 7 1 - - - - — — 12 12 12 3 Puerperal Pyrexia — — - - 2 8 12 4 - - - - - - 26 26 23 3 Cerebro-Spinal Fever 6 4 3 1 3 1 3 - - - — 13 8 21 21 15 Measles 53 520 557 53 11 19 5 1 — - — — — 562 657 1219 209 6 Malaria - - - - - - - - - D)*sentery — — — — — — 1 — - - — - 1 — 1 — — Epidemic Diarrhoea 2 3 - - - - - - - - - - - 2 3 5 1 1 Encephalitis Lethargica — — — — — — 1 — — — — 1 1 1 1 Pneumonia 3 22 6 17 15 10 32 30 38 30 13 1 1 127 91 218 78 44 Ophthalmia Neonatorum 19 — — — — — — — — — — - 10 9 19 9 — Erysipelas 5 7 1 5 10 9 14 14 34 23 12 4 60 78 138 66 — Polio-Encephalitis - - - - - - - - - - - - - - - - - -— Polio-Myelitis 1 1 1 — — — — - - — - 2 1 3 3 — Chickenpox - - - - - - - - - - - - - - - - - - Anthrax — — — — 1 1 — 1 1 2 1 — Totals 102 1094 1283 396 113 120 127 79 86 57 25 5 1 1602 1886 3488 2179 91 122 TABLE 42. Return of Families Admitted into the Council's Reception House during the year 1933. 1933. Scarlet Fever. Diphtheria. Smallpox. Other Diseases, etc. Verminous Persons. Week ending No. of No. of No. of No. of No. of No. of No. of No. of 1 No. of No. of No. of No. of No. of No. of No. of Families Persons Days Families Persons Days Families Persons Days Families Persons Days Families Persons Days Jan. 7 - - - - - - - - - - - - - - - ,, 14 — — — 1 3 12 - - - - - - - - - „ 21 1 1 2 - - - - - - - - - - - - ,, 28 1 3 9 - - - 1 2 4 - - - - - - Feb. 4 — — — - - - - - - - - - - - - ,, 11 — — — - - - 1 2 4 ,, 18 — — — 1 3 6 - - - — 25 — — - - - - - - - - - - - - - March 1 — — — - - - - - - - - - - - - ,, 11 — — — - - - 2 5 12 - - - - - - ,, 18 — — — - - - — - - - - - - - - 95 y j — - — 1 5 10 — - - - - - - - April 1 — — — — — — - - - - - - - - ,, 8 — - - - 1 1 2 - - - - - - ,, 15 - — — -- - - 2 10 28 - - - - - - „ 22 1 3 6 - - - - - - - - - ,,29 — — — - - - 2 5 15 - - - - - - May 6 — — — - - - - - - - - - - - - ,, 13 1 3 6 1 4 8 — - - - - - - ,,20 — — — 1 3 6 2 4 12 - - - - - - ,, 27 — — — — - - 1 5 15 - - - - - - June 3 — — — — - - 4 6 11 - - - - - - 10 — — — 1 2 4 3 3 4 ,, 17 — — — — — - — ,, 24 - - - - - - 2 6 12 - - - - - - 123 July 1 1 2 6 — — — 2 4 11 - - - - - - „ 8 - - - - - - 1 1 2 - - - - - - „ 15 - - - - - - - - - - - - ,, 22 - - - - - - 1 5 10 - - - - - - ,,29 - - - - - - - - - - - - - - — Aug. 5 - - - - - - - - - - - - - - - „ 12 - - - - - - 1 3 12 - - - - - - ,, 19 - - - - - - - - - - - - - - - ,,26 1 2 6 - - - - - - - - - - - - Sept.2 - - - - - - - - - - - - ,, 9 1 2 4 - - - - - - - - - - - - ,, 16 1 5 15 - - - - - - - - - - - - „ 23 - - - - - - - - - - - - ,,30 1 4 8 - - - - - - - - - - - - Oct. 7 — — — - — 1 - 14 - - — - - - ,, H — — - - - - - - - - - 1 3 6 ,, 21 1 1 3 - - - - - -- - - - - - - ,,28 - - - - - - - - - - - - - Nov. 4 - - - - - - 1 1 3 - - - - - - ,, 11 •• - - - - - - 1 8 24 - - - - - - ,, 13 - - - - - - 1 1 2 - - - - - - ,,25 - - - - - - - - - - - - - - - Dec. 2 1 5 10 — — — 1 1 3 - - - - - - ,, 9 - - - - - - ,, 16 - - - - - - 2 4 8 - - - - - - ,, 23 - - - - - - - - - - - - - - - ,, 30 — — — - - - - - - - - - - - - Total 11 31 75 6 20 46 33 84 208 1 3 6 124 DISINFECTION. The total number of disinfections of rooms during the year by the Council's disinfecting staff was 2,298. Of this number 2,082 rooms were disinfected after the occurrence of the ordinary notifiable infectious diseases, and 216 after cases of phthisis. 1,449 verminous rooms were sulphured and otherwise cleansed by the Council's staff during the year, as against 943 in 1932. Among the total number of disinfections (2,298) it was found necessary to strip 17 rooms. TABLE 43. Bedding, etc., disinfected and destroyed after the occurrence of Infectious Disease during the year 1933. Articles. No. Disinfected. No. Destroyed. Beds 1,336 67 Palliasses 1,079 83 Bolsters 933 14 Pillows 2,846 23 Cushions 427 22 Blankets 2,787 21 Sheets 1,796 13 Quilts 1,574 12 Articles of Clothing, etc. 12,440 87 Books 448 — Total 25,666 342 125 TABLE 44. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Summary of Notifications during the period from the 1st January, 1933, to the 31st December, 1933, in the Metropolitan Borough of Southwark. Age-periods Notifications on Form A. Number of Primary Notifications. Total Notifications 011 Form A. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 | 45-55 | 55-65 65 and j upw'rds Total Primary Notifications . Pulmonary Males — 5 3 9 27 29 25 35 26 9 168 199 ,. Females 1 — 2 5 16 16 27 12 9 9 — 97 115 Non-Pulmonary Males.. — 5 6 9 3 1 1 2 1 — 1 29 31 ,, Females 1 4 4 6 6 3 3 2 2 31 34 Primary Notifications relate to patients who have not 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. 126 TABLE 45. 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 1st January, 1933, to the 31st December, 1933, 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 — 1 3 2 1 O O 2 13 ,, Females - - - - - 2 3 — 1 1 7 Non-pulmonary Males — 2 - - — — — 1 — - - 3 ,, ,, Females — 1 — 1 - — 1 - 1 - — 4 127 DEATHS FROM PULMONARY TUBERCULOSIS. TABLE 46. Shewing the number of Patients who died in their own homes and the number who died away from home in Hospitals or other Institutions, 1933. 0- i o 5- 15- 25- 35- 45- 55- 65- 75- All Ages. Males. Females. Total. Number of patients who died at home 1 9 6 7 9 10 7 28 21 49 Number of patients who died in hospitals, etc. — — — 2 17 23 23 30 20 8 — 90 33 123 — 1 2 26 29 30 39 30 15 — 118 54 172 Of the total number of deaths from Pulmonary Tuberculosis 71.5 per cent. occurred in hospitals or other institutions. 128 TABLE 47. TUBERCULOSIS. Age Periods. New Cases.* Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. 0 1 1 - - 1 — 12 — 1 5 16 26 3 12 15 71 13 26 6 25 62 5 29 — 35 39 3 30 1 45 46 4 39 — 55 38 — 30 — 65 and upwards.. 12 3 15 1 Total 285 67 172 21 (1) The ratio of non-notified tuberculosis deaths to total tuberculosis deaths is 1 in 23. This figure is represented in 8 deaths; and as a result of post-mortem examination these were all found to be suffering from tuberculosis. 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. 129 The number of notified cases and deaths for the last five years is as follows:— Notified. Deaths. 1929 339 232 1930 339 210 1931 312 208 1932 329 171 1933 285 172 The mortality rate was 1.02 per 1,000, as against 0.9b per 1,000 in 1932. 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. TABLE 48. Notification Register. Pulmonary. Non-Pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. Number of cases of Tuberculosis remaining at the 31st December, 1933, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough 760 449 1209 254 206 460 1669 Number of cases removed from the Register(s) during the year by reason inter alia of:— 210 145 355 61 51 112 467 (1) Withdrawal of notification 79 68 147 27 23 50 197 (2) Recovery from the disease 13 23 36 25 16 41 77 (3) Deaths 118 54 172 9 12 21 193 130 Disinfection wan carried out as follows :— TABLE 49. The Locality of the Rooms Disinfected after the occurrence of Phthisis. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. No. 8. No. 9. Total. Disinfected 29 24 19 22 31 29 23 22 17 210 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS 1925. It was unnecessary to take action under these Regulations during the year. WORK OF THE TUBERCULOSIS DISPENSARY. The following report has been received from Dr. Crowe, your, Clinical Tuberculosis Officer :— The work of the Dispensary was carried out as usual during the year, the sessions being held as follows : Tuesday Tuesday Thursday 9.30—12. 6—8 p.m. Saturday Thursday The number of new cases examined and the total number of attendances, etc., at The Dispensary will be found in Table No. 50. During The year under review the Wednesday morning session for patients at the Dispensary has been discontinued. Instead, on that morning domiciliary patients have been visited in their own homes by the Tuberculosis Officer. 303 such visits have been paid. Fifty special reports have been sent to the Medical Officer of Health recommending families, in which there are one or more cases of Tuberculosis, for preferential housing accommodation on health grounds. The Handicraft Centre, inaugurated in the early autumn of 193.2, is still being held weekly at the Dispensary, and articles of a decorative and useful nature are made by the patients. The class meets each Wednesday afternoon, the teacher being appointed by the L.C.C. There is also a Voluntary Organise)'. 131 Patients who are actually fit for work, but who are unable to obtain employment, greatly appreciate the class and find real enjoyment in useful occupation. The average weekly attendance is from 10 to 14 patients. A most encouraging Sale of Work was held in December, when the goods made by the patients were on view at the Dispensary, and the sum of £10 10s. Od. was raised. The amount was divided between the General Fund and the patients concerned. DIAGNOSIS OF TUBERCULOSIS. X-Ray examination of patients for the purposes of investigation and diagnosis is carried out at Guy's Hospital, 74 patients being sent there for such examination during the year. Sputum examinations were carried out for Dispensary patients to the extent of 475 specimens. PROVISION OF EXTRA NOURISHMENT. The Ministry of Health Regulations allow extra nourishment to be given to necessitous patients attending the Dispensary. Allowances of milk, butter, eggs, etc., have been granted to 39 patients during the year. Patients already in receipt of relief from the Public Assistance Committee of the L.C.C. have been recommended to the appropriate Committee for extra nourishment suitable to their state of health. All such recommendations have received every consideration. Cases also sent for the supplying of necessary clothes have been promptly dealt Avith by the Committee concerned. Very excellent help has also been given in various ways by the Charity Organisation Society, the British Red Cross, the United Services Fund and the National Association for the Prevention of Tuberculosis. SUPERVISION OF HOME CONDITIONS. Visits are paid by the three Tuberculosis Nurses on the Dispensary staff to all notified cases of Tuberculosis. Reports relating to the home conditions of the patients are made to the Clinical Tuberculosis Officer. 132 This home visiting is a most important part of the work, as the Nurses instruct the relatives with regard to the best methods to be employed to prevent the spread of the disease. They also make suggestions as to how the patient can obtain the maximum of benefit for his health while living at home. The homes are visited from time to time, and in this way it is possible to see that satisfactory methods are being carried out with regard to precautionary measures. The number of such visits paid by the Nurses during the year was 4,603. Contacts are persuaded to attend the Dispensary for examination. ISSUE OF SHELTERS, ETC. Shelters are lent to patients who have suitable accommodation for their erection in either gardens or yards attached to their homes. This enables the patient to sleep alone and at the same time in the open-air. Bedsteads have been lent to patients who have been found to be sleeping with other members of the family, and who have been unable to afford the extra expense incurred in purchasing new ones. HOME NURSING. When necessary, home nursing has been carried out to bed-ridden patients by members of the Ranyard Nursing Association and the Benson Nurses' Home. CO-ORDINATION OF DISPENSARY WITH OTHER HEALTH SERVICES. As in previous years, there has been complete co-ordination between the L.C.C. and the School Medical Services and the Maternity and Child Welfare Services of the Borough. The relations between the L.C.C., the Ministry of Pensions, and the Medical Practitioners in the district, and the Dispensary have been most satisfactory. Each Saturday morning session is given over entirely to children under and of school age. 133 Children attending school who are examined as contacts of definite cases of Tuberculosis of the Lungs are referred to the School Medical Officers for constant supervision. Should their health prove to be unsatisfactory, or should any symptoms arise suggestive of Tuberculosis, they are again referred to the Tuberculosis Officer for further examination at the Dispensary. INSTITUTIONAL TREATMENT. Two hundred and sixty-one persons were recommended to the L.C.C. for Sanatorium treatment. Recommendations made to that authority for admissions to hospital for the purposes of observation and diagnosis numbered 28. Sixteen children were recommended to the L.C.C. for admission to Open-Air School after their discharge from Sanatoria. Patients who were unsuitable for Sanatorium treatment were recommended to the L.C.C. for admission to one of the General Hospitals in London. The number of such recommendations was 60. Two persons were recommended for convalescence. The total number of recommendations to the L.C.C. for all forms of institutional treatment was 367. NON-PULMONARY TUBERCULOSIS. Tuberculosis of Bones, Joints and Glands, and all forms of Surgical Tuberculosis are sent by the L.C.C. to Sanatoria which deal only with these types of cases. On the completion of institutional treatment and on the patient's return home, arrangements are made for their attendance at either the Orthopaedic Department of a General Hospital, or at the After-Care Clinic, held at the County Hall, by the Medical Superintendent of the Sanatorium at which they received treatment. Two patients suffering from Lupus of the Face have received Finsen Light Treatment, with very excellent results. One patient suffering from old-standing Lupus of the Palate has received Artificial Sunlight Treatment, also with very good results. 134 ARTIFICIAL PNEUMOTHORAX TREATMENT. This form of treatment continues to be greatly used in cases of Pulmonary Tuberculosis with, in most instances, very satisfactory results. After the treatment has been induced, refills are given at fairly frequent intervals varying from one to four weeks. The treatment is generally continued for some two or three years, unless the lung condition necessitates the complete cessation of the refills. Thirty-four patients received such treatment in the Out-Patient Department of Brompton, Guy's, St. Thomas's and other hospitals. The cost to the Borough Council of such treatment was ,£190, the hospitals being remunerated at the rate of 10s. Gd. for each refill given. COLONY TRAINING. A woman patient, admitted by the L.C.C. to Papworth Colony in 1932, is reported to be doing well and is happy in her life at tho Colony. INVALID CHILDREN'S AID ASSOCIATION. Children examined at the Dispensary as suspected cases of Tuberculosis, but who, on investigation, are proved to be not suffering from the disease, but in many cases from debility and general delicacy, are referred to this Association for convalescent treatment at either seaside or country homes. The Association also deals with children who have been examined as contacts of infectious cases of Pulmonary Tuberculosis, who, when either the patient is living at home, or the mother is being admitted to Sanatorium, are recommended to the L.C.C. for boarding-out under the " Contact Scheme." All arrangements for this boarding-out of children are made by the Association. Sixteen children were dealt with under this scheme during the year. TUBERCULOSIS CARE COMMITTEE. Miss Ashe has kindly sent me a full report on the year's work of the above Committee. The Committee meets weekly during the year and is composed of representatives of the Borough Council, Public Assistance Committee, Charity Organisation Society, United Services Fund, British Legion, Invalid Children's Aid Association, Soldiers and Sailors Help Society. Local Association of Care Committees, etc. 135 Its functions are manifold, but consist principally in (1) assessing patients as to their ability to pay a contribution towards their maintenance in Hospital or Sanatorium and collecting of same; (2) care of family when "bread-winner" is unable to work or is confined to Hospital; (3) provision of extra nourishment; (4) provision of clothing for patients before admission to Sanatorium, etc.; (5) assisting patients returned from Hospital. This work has been considerably increased during the year, as the Committee now undertake the care and assessment of Tuberculosis patients admitted to L.C.C. General Hospitals, in addition to those admitted to Sanatoria. Four hundred and seventy-four casew were thus dealt with during the year, of which number 413 were adults and 63 children. Of this number, 38 adults and the parents of 23 children were asked to pay weekly sums varying from 2s. to 2()s. towards their maintenance. The Committee has no funds; it has to rely entirely on the assistance afforded by various voluntary societies and gifts of friends. Lastly, Miss Ashe reports on the valuable work of the Handicraft Centre, which was commenced in the autumn of 1932. This Centre is attended by non-infectious Tuberculous patients who are either unfitted for work or unable to obtain work. The classes are organised by an Honorary Organiser and instruction is given in Leather-work, Pewter-work, Lamp-shade making and many other crafts by a teacher provided by the L.C.C. Thus the Centre serves the function of providing occupation and interest for many who otherwise would have to spend many hours in enforced idleness with nothing more to do than worry over their own sad affliction, a state of affairs which quickly undoes all the good obtained from Sanatorium or Hospital treatment. 1 wish to place on record my best thanks to Miss Ashe for the energy and zeal which she displays in her work, and I would like to associate myself with her in thanking all those ladies and gentlemen who give their time to serving on the Committees, and the various societies for assistance given to our patients during the year. W. STOTT, Medical Officer of Health. 136 TABLE 50. Return for the year 1933. (A) Return showing the work of the Dispensary. Diagnosis . Pulmonary . Non-Pulmonary Total. Grand Total. Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. ' M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 93 61 5 7 4 12 14 3 97 73 19 10 199 (b) Diagnosis not completed 8 4 4 — — — 1 2 8 4 5 2 19 (c) Non-tuberculous 55 48 10 5 — 1 4 1 55 49 14 6 124 B.—Contacts examined during the year:— (a) Definitely tuberculous 10 6 — — — — 2 1 10 6 2 1 19 (b) Diagnosis not completed - 1 2 - - 2 - - - 3 ?, 5 (r) Non-tuberculous 43 73 94 63 — — — 1 43 73 94 64 274 C.—Cases written off the Dispensary Register as:— (a) Recovered 16 22 1 5 6 4 15 5 22 26 16 10 74 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) .. 103 125 104 68 1 1 6 2 104 126 110 70 410 D.—Number of Cases on Dispensary Register on December 31 st:— (a) Definitely tuberculous 278 181 15 18 20 33 27 31 298 214 42 49 603 (b) Diagnosis not completed 8 4 5 2 — — 3 2 8 4 8 4 24 1. Number of cases on Dispensary Register on January 1st 714 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 39 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 156 4. Cases written off during the year as Dead (all causes) 126 5. Number of attendances at the Dispensary (including Contacts) 2810 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 88 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including (a) Personal 4 personal consultations) 303 (b) Other 209 9. Number of visits by Nurses or Health Visitors to homes for 10. Number of:— (a) Specimens of sputum, etc., examined 494 Dispensary purposes 3804 (b) X-ray examinations made in connection with Dispensary work. 74 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 1 12. Number of "T.B. plus" cases on Dispensary Register on December 31st.. 285 (B) Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment). Provided by the Council—One.