92.7 SOU Borough of Southwark ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1936. William Stott, m.b., b.s., d.p.h., Medical Officer of Health. Administrative Tuberculosis Officer. Administrative Officer for Maternity and Child Welfare. INDEX. A. Page. Acts and Bye-laws (Additional) 58 Acute Influenzal Pneumonia 148 „ Primary Pneumonia 148 Additional Maternity Services 27-30 Agricultural Produce (Grading and Marking) Act 103 Ambulance Services 25 Ante-Natal Clinics 44,45 Area of Borough 6 Artificial Cream Act, 1929 132 B. Bacteriological Specimens 25 Bakehouses 130,131 Births 7 ,. Illegitimate 5 Birth-rates 8,9 Black Smoke 58 Blind Persons Act. 1920 149 Brushmakers 64, 65 Butchers' Shops 99 Butter and Margarine Factories 132 C. Cancer 148 Census. 1931 6 Cerebro-spinal Fever 148 Chemical and Bacteriological Examinations 25 Clinics 26, 40, 43 Common Lodging Houses 53, 54, 55 Convalescent Treatment 30 Coroners' Court 70 Cowsheds 132 Children under School Age 32-40 D. Day Nurseries 31 Deaths 9, 10 Deaths, Causes of, Table 12 Infants 13, 14 „ In Public Institutions 10, 17 „ In Wards 9 „ Zymotic Mortality 20 Death Rates 9, 10, 11, 15 Density of Population 7 Diarrhoea 5,147 Dinners for Expectant Mothers 30 ii Page Diphtheria 145 „ Prevention 145,146 „ Schick Test 37,146 Disinfection 154 Disposal of Unsound Food 112-123 Dressmakers, Milliners, etc. 64, 65 E. Eating Houses 99-102 Encephalitis Lethargica 148 Enteric Fever 144 F. Factories and Workshops 63 Food and Drugs, Tables of Samples 136-139 „ „ (Adulteration) Act, 1928 132 „ Inspection and Tables 99-124 G. General Hospitals 26 H. Health Services, Hospitals, etc. 26 „ Visitors, Summary 46-48 „ Visiting 46-48 House-to-House Inspections 90 Housing 87-93 Houses let in Lodgings 59, 60 Home Workers, Table 64 I. Ice Cream Premises 99 Imported Food Regulations 103 Infant Life Protection 31 „ Mortality 28 „ „ of Illegitimates 5 Infectious Diseases, Control of 143-150 Influenza 148 Informal Samples 139 Inhabited Dwellings 5 Inspections 91, 92 L. Laboratory Facilities 25 Laundries 63-65 Legal Proceedings 56, 57, 134, 135 iii M. Page Maternal Mortality 27 Maternity and Child Welfare 27-48 Measles 5, 147 "Merchandise Marks" Act 103 Midwifery and Maternity Services 28, 29 Milk and Dairies (Amendment) Act, 1922 125 Order, 1926 125 „ (Special Designations) Order 126 Milksellers 125-129 Mortality Statistics 5, 27 Mortuary 70 Municipal Day Nursery 31 N. Notices served 55 Notifiable Diseases 150 Notified Births 49 Nursing in the Home 25 O. Offensive Trades 132 Ophthalmia Neonatorum 149 Orthopaedic Clinics 32 Outlying Deaths 10 Overcrowding Survey 73-87 P. Part-time Officers 24 Poisons and Pharmacy Act, 1933 133 Poliomyelitis 148 Population 5,6 „ in Wards 7 Puerperal Fever 27 „ Pyrexia 27 „ Sepsis, Deaths 5 Public Cleansing 53 Public Health (London) Act, 1936, Sec. 224 61 „ „ „ „ „ Sec .136 61 „ „ „ „ „ Sec. 95 62 „ Sec. 96 62 „ Health Officers 23,24,25 „ „ (Condensed Milk) Regulations, 1923 and 1927 132 „ „ (Preservatives in Food) Regulations 105-110 „ „ (Dried Milk) Regulations, 1923-7 132 „ Vaccinators 24 r. Rateable Value 5 Rats and Mice (Destruction) Act 66-68 Reception House, Families Admitted 152,153 Registered Births and Deaths 16 „ Workshops 65 iv S. Page Sale of Food and Drugs Acts 135 Scabies 70 Scarlet Fever 144 Schick Test and Inoculation against Diphtheria 146 Shop's Act 56 Slaughterhouses 99 Smallpox 144 Smoke Abatement 58 Southwark Invalid Kitchens Society 30 Sputum, Examinations of 25 Statistics and Social Conditions 5 Still Births 5,49 Sunlight Treatment 26 T. Tailoring 63,64,65 Tuberculosis 155-174 U. Underground Bakehouses 65,131 Unsound Food 112-124 V. Vaccination Officers' Return 50 „ Officers 25 Venereal Disease Clinics 26 Verminous Persons and Children 70 „ Rooms and Bedding 69 Vital Statistics, Summary of 5 „ „ Table 18, 19 W. Ward Distribution 7 Whooping Cough 5,147 Workshops (Women's) 65 Works Completed 55,95 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 beg to submit my Annual Report for the year 1936. This year has been one of extreme activity and advancement. The Maternity and Child Welfare scheme has worked satisfactorily and increasing use has been made of the various facilities offered. The new Centre at Villa Street was opened by the Mayor in June, and Dr. Mower White was appointed in December as a whole-time Officer to cope with the increased number of sessions. Plans of a new Centre to be built at Hemp Row to replace the present Lady Margaret Centre were discussed by the Maternity and Child Welfare Committee, and negotiations are now proceeding for acquisition of the site. Other sites for the erection of new Centres were under consideration, but apart from a site allocated for this purpose by the L.C.C. on Falmouth Road, nothing has yet transpired. The Tuberculosis service has also undergone changes. Dr. Crowe retired in the early part of the year and Dr. Pritchard was appointed in his stead on May 1st. Dr. Rusby was appointed as part-time assistant on June 3rd. The new Disinfecting Station at King James' Street was completed during the year, and officially opened by His Worship the Mayor of Southwark. The building of the new Health Services Department is proceeding very satisfactorily, and it is hoped that we shall be able to take over the new offices and departments by the middle of 1937. The health of the Borough for the year was very satisfactory. 2 The birth rate remains stationary, but the population, as computed by the Registrar-General, has again fallen by 3,900 persons. The death rate of 13.1 per 1,000 persons is a slight increase on that of the previous year, which was 12.4. The chief causes were Heart Diseases, 549 deaths; Cancer, 309 deaths; Pneumonia, 161 deaths; Tuberculosis, 135 deaths; all of which, with the exception of Tuberculosis, show an increase on the previous year. Infant deaths numbered 134, giving an Infant Mortality rate of 59 per 1,000 births, the lowest recorded since 1930. The late for 1935 was 66 per 1,000 births. The Maternal Mortality rate of 1.7 per 1,000 births (live and still) is a distinct improvement on previous years and extremely encouraging. The same rate for the country as a whole is 3.8. Whilst the Council may congratulate themselves on this result, they must, nevertheless, still press on and spare nothing to improve the lot of the expectant mother, and the conditions under which she is confined, in an endeavour to make maternal deaths calamities of the past. Infectious Diseases, with the exception of Measles, were comparatively few. It is gratifying to note that the ' 'Measles scheme,'' put into operation each "Measle year," is having the desired effect, and that the mortality of young children from this disease is slowly but surely lieing reduced. It is hoped that, before long, a similar scheme will be in operation in regard to cases of Whooping Cough, and that similar results will be obtained. Once again I desire to place on record my appreciation of the good will shown to me by the Chairmen and Members of the Committees on which I serve, and also of the ever willing advice and assistance rendered to me by the Chief Officers of the Council and by every member of my Staff. I am, 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, 1936) 152,200 Number of inhabited houses (end of 1936) according to rate books 28,198 Rateable value £1,302,199 Sum represented by penny rate £5,189 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. The unemployment figures, according to the Board of Trade Gazette, show a slow but steady decrease, the latest figures being 4,320 males, 1,545 females and 81 juveniles, a total of 5,928 as against 7,624 last year. VITAL STATISTICS. Total. M. F. Live Births—Legitimate 2,151 1,110 1,041 Birth Rate, 14.8 Live Births—Illegitimate 104 49 55 Still Births, 63. (Registered). Rate per 1,000 total births, 35.8 Deaths 1,993. Death rate, 13.1 Deaths from Puerperal Causes:— Rate per 1,000 Deaths. (Live and Still Births). From Puerperal fever 1 0.43 From other Puerperal causes 3 1.29 Death rate of infants under 1 year of age per 1,000 live births:— Legitimate 59 Illegitimate 67 Deaths from Measles (all ages) 23 Do. Whooping Cough (all ages) 16 Do. Diarrhoea (under 2 years of age; 19 6 POPULATION. According to the returns supplied by the Registrar-General, the population of this Borough has again been depleted by 3,900 persons. How far this figure is correct is difficult for one to say, but there is no doubt that many families have been removed from the Borough as a result of the Housing activities generally, including overcrowding and slum clearance. It is a matter of concern from the financial aspect, and I fear that there will be still further depletion during the next two or three years. I feel, however, that when the demolished areas are rebuilt and families re-housed, we shall see the population figure again rising; not to the same extent as it was some few years ago, but certainly on its present level. The population of the several divisions of the Borough at each Census since 1861, and also the estimated population for 1922, 1923, 1924, 1925, 1926, 1927, 1928, 1929, 1930, 1932, 1933, 1934, 1935 and 1936 are as follows:— Newington. St. George's. St. Saviour's and Christchurch. 1861 82,157 55,510 36,164 1871 88,691 56,083 31,299 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 1934 100,250 45,294 14,386 1935 97,849 44,209 14,042 1936 95,404 43,104 13,692 7 The Ward distribution was as follows:— TABLE 1. WARD. Area in Acres. Population. Persons to the Acre. Males. Females. Total. St. Mary 127 9,812 9,769 19,581 154 St. Paul 133 7,826 8,132 15,958 120 St. Peter 146 10,943 11,595 22,538 156 St. John 118 11,675 12,488 24,163 205 Trinity 109 6,662 6,502 13.164 117 St. Michael 93 8,741 8,390 17,131 185 St. Jude 97 5,511 5,742 11,253 117 St. George 99 7,250 7,470 14,720 148 Christchurch 77 3,200 2,906 6,106 79 St. Saviour 133 3,484 4,102 7,586 57 Whole Borough 1,132 75,104 27,096 152,200 135 BIRTHS. The number of Births registered in the Borough during 1936 was 1,462 of which 760 were males, and 702 females. This represents a. birth-rate of 9.6 per 1.000 inhabitants. The number of births registered in the individual parishes was as follows:—Newington, 574; St. George the Martyr, 288; Christchurch and St. Saviour's, 600. Of the 1,462 births registered in the Borough 345 were transferred away, the permanent residence of the parents being outside the Borough. 1,138 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 345 "outward" transfers are deducted and the 1,138 "inward" transfers are added to the 1.462 births actually registered in the Borough, the net amount of births belonging to Southwark for the year is found to be 2,255. This gives a corrected birth-rate of 14.8 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. 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 1934 14.5 15.6 16.2 14.9 1935 15.1 15.1 11.9 14.8 1936 14.8 15.3 13.2 14.8 9 TABLE 3. Number of Births and Deaths belonging to each Ward, with the Birth and Death Rates, also the Infantile Mortality Rate, 1936. WARD Births. Infantile Mortality. Deaths. Males. Females. Total. Birth-rate. Males. Females. Total. Death-rate. St. Mary 172 156 328 16.8 64 163 127 290 14.8 St. Paul 123 118 241 16.1 25 107 102 209 13.1 St. Peter 177 151 328 14.6 43 157 134 291 12.9 St. John 178 188 366 15.1 63 163 136 299 12.4 Trinity 65 88 153 11.6 20 76 57 133 10.1 St. Michael 130 129 259 15.1 93 142 91 233 13.6 St. Jude 91 77 168 14.9 77 98 75 173 15.5 St. George 125 106 231 15.7 74* 91 78 169 11.5 Christchurch 54 42 96 15.7 52 55 47 102 16.7 St. Saviour 44 41 85 11.2 94 46 48 94 12.4 Borough 1159 1096 2255 14.8 59 1098 895 1993 13.1 10 DEATHS. 1,310 deaths were registered in the sub-districts of the Borough during 1936, the chief cause being Heart diseases, which accounted for 549, followed by Cancer with 309 deaths. 19 Southwark residents died in the street, or on the way to hospital. 765 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 193 belonging to Southwark and 572 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 1,255 When the 572 deaths of those persons who were non-parishioners, but who died in our Borough, have been deducted, and the 1,255 "outlying" deaths added, the actual or "corrected" number of deaths belonging to the sanitary area is found to be 1,993, of which number 1,098 were males and 895 females. The death-rate, when calculated on this "corrected" number, is 13.1 per 1,000 inhabitants for the whole Borough for the year 1936, as against a rate of 12.4 for 1935. The percentage of persons dying away from Southwark in relation to the total number of deaths belonging to the Borough was 63.0. The principal localities in which the "outlying'' deaths occurred are as follows:— Lambeth Hospital 397 St. Giles' Hospital 353 Rotherhithe Hospital 86 East Dulwich Hospital 22 St. Thomas's Hospital 56 King's College Hospital 10 Belgrave Hospital 3 Royal Waterloo Hospital 17 General Lying-in Hospital 8 Mental Hospitals 73 In the Street and other Institutions 230 1,255 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 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 1934 12.9 14.6 14.2 13.5 1935 12.3 12.0 13.0 12.4 1936 12.8 13.3 14.3 13.1 12 TABLE 5. Deaths belonging to the Sanitary Area, with the Causes of Death at all Ages during 1936. 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 1993 - - - - - - - - - - - - 1. Typhoid and Paratyphoid Fevers 1 - - - - - 1 - - - - - 1 2. Measles 23 2 9 11 1 - - - - - - - 1 3. Scarlet Fever - - - - - - - - - - - - - 4. Whooping Cough 16 11 2 3 - - - - - - - - - 5. Diphtheria 9 — — 5 4 - - - - - - - - 6. Influenza 18 - - - - - - 1 5 4 4 4 2 7. Encephalitis Lethargica 1 - - - - - 1 - - - - - - 8. Cerebro-Spinal Fever 4 3 1 - - - - - - - - - 2 9. Tuberculosis of Respiratory System 126 - - 1 1 17 24 22 32 20 6 3 16 10. Other Tuberculous Diseases 9 — — 2 1 2 — 1 — 2 — 1 9 11. Syphilis 8 1 — — — 1 — — 1 3 2 — 3 12. Gen. Paralysis of Insane, Tabes Dorsalis 12 - - - - - - - 4 3 3 2 13. Cancer, Malignant Disease 309 — — — — 1 4 12 40 87 108 57 152 14. Diabetes 18 - - - - - - - 3 4 7 4 12 15. Cerebral Haemorrhage etc. 81 - - - - - 3 1 8 14 28 27 22 16. Heart Disease 549 — — — 2 12 9 14 38 86 170 218 148 17. Aneurysm 11 — — — — 1 1 — — 3 3 3 8 18. Other Circulatory Diseases 81 1 - - - - - 1 3 16 24 36 13 19. Bronchitis 82 2 - 1 - - - 2 8 18 21 30 20 20. Pneumonia (all forms) 161 35 14 8 3 4 4 9 16 24 26 18 52 21. Other Respiratory Diseases 14 1 — 2 — 2 — 2 — 3 — 4 2 22. Peptic Ulcer 32 - - - - - 1 2 9 15 5 — 19 23. Diarrhoea, etc. 22 17 2 — — — — 1 — 1 — 1 23 24. Appendicitis 9 — — — 3 — 1 — 2 — 2 1 6 25. Cirrhosis of Liver 5 — — — — — — — — 3 1 1 - 26. Other Diseases of Liver 5 — — — — - - — — — 4 1 - 27. Other Digestive Diseases 32 1 1 1 2 1 3 1 3 4 10 5 - 28. Acute and Chronic Nephritis 81 - - - 2 1 2 2 10 11 30 23 55 29. Puerperal Sepsis 1 - - - - - 1 — — — - — 1 30. Other Puerperal Causes 3 — — — — 1 1 1 - - - - - 31. Congenital Debility and Malformation, including Premature Birth, etc. 49 49 - - - - - - - - - - 40 32. Senility 15 — — — — — — — — — 3 12 2 33. Suicide 17 — — — — 1 — 1 3 8 4 — 3 34. Other Violence 62 4 — 2 3 7 8 4 5 7 8 14 52 35. Other Defined Diseases 127 7 — 4 9 6 10 15 15 18 19 24 101 36. Causes (ill defined) - - - - - - - - - - - - - Totals 1993 134 29 40 31 57 74 92 205 354 488 489 765 13 TABLE 6. BOROUGH OF SOUTHWARK. INFANT MORTALITY, 1936. 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 38 6 4 5 53 15 25 27 14 134 Measles — — — — — — — — 2 2 Diphtheria — — — — — — 2 3 6 11 Whooping Cough — — — — — — — — — — Diarrhoea — — — — — 2 9 6 — 17 Enteritis — — — — — — — — — — Influenza — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — 2 1 3 Scarlet Fever — — — — — — — — — — Phthisis — — — — — — — — — — Other Tuberculosis — — — — — — — — — — Congenital Malformations 4 2 — 2 8 3 2 — — 14 Premature Birth 21 3 2 1 27 3 — 1 — 30 Atrophy, Debility and Marasmus 1 — — — 1 1 l — 1 4 Atelectasis 1 — — — 1 — — — — 1 Erysipelas — — — — — 1 — 1 — 2 Syphilis — — — — — 1 — — — 1 Rickets — — — — — — — — — — Meningitis — — — — — — — — — — Laryngitis — — — — — — — — — — Convulsions — — — — — — — — — — Gastritis — — — — — — l — — 1 Intussusception — — — — — — — — — — Dentition — — — — — — — — — — Dermatitis — — — — — — — — — — Bronchitis — — — — — — — 2 — 2 Pneumonia (All Forms) 2 1 2 2 7 3 10 11 4 35 Suffocation (overlying) 1 — — — 1 — — — — 1 Accident (other) 3 — — — 3 — — — — 3 Nephritis, Acute — — — — — — — — — — Icterus Neonatorum — — — — — — — — — — Septic Pyaemia — — — — — — — — — — Otitis and Mastoiditis — — — — — — — — — — Other Causes 5 — — — 5 1 — 1 — 7 Not classified above — — — — — — — — — — 38 6 4 5 53 15 25 27 14 134 Nett Births in the year Legitimate 2151 Illegitimate 104 Nett Deaths in the year Legitimate Infants 127 Illegitimate Infants 7 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 59 during the year 1936. The deaths under one year of age to 1,000 births for the last thirty years were as follows:— 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 1919 95 1934 77 1920 86 1935 66 1921 90 1936 59 The average Infantile death rate for the last thirty years is 92. 15 TABLE 8. Death Rates for the various Districts for the last Ten Years (1926-1931) and 1932, 1933, 1934, 1935, 1936. Ward. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. St. Mary 12.2 13.5 13.7 16.2 13.6 16.4 14.0 14.7 13.6 13.5 14.8 St. Paul 12.0 12.7 11.8 15.9 11.6 14.2 12.5 14.7 13.4 13.3 13.1 St. Peter 12.3 10.8 9.1 12.3 10.1 11.0 12.6 13.3 13.2 11.9 12.9 St. John 13.0 13.6 13.4 17.1 14.4 11.7 13.4 12.8 12.5 11.9 12.4 Trinity 13.4 16.1 13.3 14.9 13.8 13.9 13.3 16.5 11.6 10.9 10.1 All Saints 10.9 11.6 11.5 13.8 11.7 14.5 — — — — — St. Michael 14.2 14.6 14.7 17.2 13.7 15.5 15.0 14.2 15.2 13.7 13.6 St. Jude 12.6 16.1 13.4 18.2 13.1 15.3 12.7 14.8 16.0 11.6 15.5 St. George 12.9 12.6 11.8 14.5 11.5 12.4 10.7 11.4 12.9 11.6 11.5 Christchurch 16.6 13.3 16.5 17.5 134 18.0 17.7 15.7 16.8 14.5 16.7 St. Saviour 11.8 13.2 11.4 15.0 9.2 12.6 10.2 13.4 12.2 11.7 12.4 16 TABLE 9. Births and Deaths Registered in the Sub-Districts of the Borough in 1936. First Quarter. Second Quarter. Sub-Districts. Births. Deaths. Sub-Districts. Births. Deaths. Male. Female. Male. Female. Male. Female. Male. Female. Newington 88 82 106 89 Newington 62 70 51 62 St. George the Martyr, West 39 41 59 27 St. George the Martyr, West 39 37 33 29 Christchurch and St. Saviour 84 76 96 51 Christchurch and St. Saviour 75 68 76 63 Totals 211 199 261 167 Totals 176 175 160 154 Third Quarter. Fourth Quarter. Newington 79 59 44 41 Newington 68 66 54 73 St. George the Martyr, West 38 28 24 13 St. George the Martyr, West 35 31 32 25 Christchurch and St. Saviour 69 69 75 49 Christchurch and St. Saviour 84 75 89 49 Totals 186 156 143 103 Totals 187 172 175 147 Births. Deaths. M. F. M. F. In 1st Quarter 211 199 261 167 In 2nd Quarter 176 175 160 154 In 3rd Quarter 186 156 143 103 In 4th Quarter 187 172 175 147 Totals 760 702 739 571 17 TABLE 10. Showing the number of Deaths that occurred in Public Institutions in the Borough during the year 1936. Institution. In 1st Quarter. In 2nd Quarter. In 3rd Quarter. In 4th Quarter. During Year. Newington Institution 53 32 31 31 147 Christchurch do. — — 1 — 1 Evelina Hospital 20 14 4 11 49 Guy's Hospital 129 118 106 119 472 60, Lambeth Road (Catholic Nursing Home) 2 4 3 1 10 Royal Eye Hospital 1 1 — — 2 All Saints' Hospital 11 10 9 11 41 Other Addresses 6 14 10 13 43 Total 222 193 164 186 765 18 19 TABLE 11. Vital Statistics of Separate Localities (1923-1936). BOROUGH OF SOUTHWARK. Names of Localities. 1. St. Mary's Ward. 2. St. Paul's Waiid, 3. St. Peter's Ward. 4. St. John's Ward. 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. 1923 22,034 524 335 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 10,479 396 282 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 16 1931 21,677 850 355 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 .. .. .. .. 1934 20,576 317 280 23 16,769 236 224 14 23,683 321 312 21 25,390 367 317 20 13,832 210 161 12 .. .. .. .. 1935 20,083 296 271 15 16,367 263 217 22 23,116 336 274 16 24,782 410 295 25 13,501 177 148 10 .. .. .. .. 1936 19,581 328 290 21 15,958 241 209 6 22,538 328 291 14 24,163 366 299 23 13,164 153 133 3 .. .. .. .. 7. St. Michael's Ward. 8. St. Jude's Ward. 9. St. George's Ward. 10. Christchurch Ward. 11. St. Saviour's Ward. 1923 20,683 522 293 47 13,939 341 199 23 18,068 476 224 30 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 6 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 .. .. .. .. 1934 18,001 251 273 28 11,824 199 189 24 15,469 257 199 26 6,415 107 108 8 7,971 126 97 8 .. .. .. .. 1935 17,570 245 241 20 11,541 202 135 14 15,098 219 175 19 6,262 79 91 4 7,780 88 90 7 .. .. .. .. 1936 17,131 259 233 24 11,253 168 173 13 14,720 231 169 17 6,106 96 102 5 7,586 85 94 8 .. .. .. .. 20 TABLE 12. Deaths in the Sanitary Area from the principal Zymotic Diseases in the various Wards for 1936. WARD OR DISTRICT. Influenza. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. St. Mary 1 1 — 1 — — 6 St. Paul 3 2 — 2 — — 1 St. Peter 3 2 — — 2 — 2 St. John — 6 — 2 3 1 3 Trinity 2 — — 1 — — — St. Michael — 4 — 2 3 — 1 St. Jude 2 3 — — 2 — 3 St. George 3 3 — — 5 — — Christchurch 2 — — — — 1 St. Saviour 2 2 — 1 1 — 2 Borough 18 23 — 9 16 1 19 TABLE 13. ZYMOTIC MORTALITY FOR THE SANITARY AREA, 1936. Showing the localities where the deaths occurred. Locality. Influenza. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. The Borough 15 4 — — — — — East Dulwich Hospital — — — — — — — Lambeth Hospital 3 — — — — — 4 Newington Institution — — — — — — — Evelina Hospital — — — — — — 4 Guy's Hospital — — — — — — 1 St. Thomas's Hospital — — — — 1 — 2 Belgrave Hospital — — — — — — 1 Royal Waterloo — — — — — — 1 L.C.C. Hospitals, etc. — 19 — 9 15 1 2 St. Giles' Hospital — — — — — — 4 Rotherithe Hospital — — — — — — — Total 18 23 — 9 16 1 19 SECTION B. General Provisions of Health Services for the Area. 23 PUBLIC HEALTH OFFICERS. William Stott, M.B., B.S. (Hnrs.), D.P.H., Medical Officer of Health. Edward K. Pritchard, M.R.C.S., L.R.C.P., D.P.H., Tuberculosis Officer and Deputy Medical Officer of Health (from 1.5.1936). E. Fairfield Thomas, M.D., Ch.B., D.P.H., Deputy Medical Officer of Health (to 30.4.1936). Margaret Bergin, M.B., B.Ch., B.A.O. (N.U.I.), D.P.H., Assistant Medical Officer, Maternity and Child Welfare. Evelyn Ann Mower White, M.R.C.S., L.R.C.P., D.P.H., Assistant Medical Officer, Maternity and Child Welfare (from 1.12.1936). John T. Crowe, L.S.A., L.M.S.S.A., Tuberculosis Officer (to 20.3.1936). Norman L. Rusby, M.A., M.R.C.S., L.R.C.P., M.B., B.Ch., part-time Assistant Tuberculosis Officer (from 3.6.1936). Sanitary Inspectors. a b G. Fisher, Senior Inspector. a b c J. C. Nicholson, Food and Drugs Inspector. a b W. H. Banham, Assistant to Food and Drugs Inspector. a b S. Bowers, Assistant Food Inspector. a b G. H. Duffield, Assistant Food Inspector. a b J. A. Syms, Sanitary Inspector. a b A. C. White, Sanitary Inspector. a b A. Ede, Sanitary Inspector. a b A. Groves (from 1.7.36), Sanitary Inspector. a b H. E. Hattersley, Sanitary Inspector. a J. R. Findley, Sanitary Inspector. a b H. S. Steele, Sanitary Inspector. a b F. J. Bryant, Sanitary Inspector. a b F. Mayhew, Sanitary Inspector. a b W. Richards, Sanitary Inspector. a b F. Dransfield, Temporary Sanitary Inspector. a b R. F. Stubbs, Temporary Sanitary Inspector. a Margaret Burrows, Women's Workshops (to 4.2.1936). a Gladys Briggs, Women's Workshops (from 5.2.1936). a Cert. Sanitary Inspector. b Meat and other Foods. c 1st Class Engineer (Board of Trade). 24 Other Officers. Cyril Dickinson, B.Sc., F.I.C., F.C.S., Public Analyst. R. E. Griffiths, B.Sc., F.I.C., Ph.C., Senior Assistant. F. Smith, F.I.C., Junior Assistant. 2 Laboratory Attendants. Tuberculosis Dispensary. Florence Nightingale (Certificate of Apothecaries Society of London), Secretary and Dispenser. 1 Junior Clerk (from 8.1.1936). Nurses. M. E. Bennett, Certificate Sanitary Institute, S.R.N. E. Plummer, C.M.B., S.R.N., Cert. Health Visitor. L. Gordon, S.R.N., S.C.M. Day Nursery. M. Noel, Matron. E. George, Staff Nurse. 3 Probationers, 1 Cook. Health Visitors. d e Annie Rogers. d f g Mary Freeth. dfg Clare Cottrill. dg Mary George. df Winifred Sayer. d fg Annie Kingsmill. d ef Kathleen Hinde. dfg Florence Mary Mason. d f Florence Adair. 1 Storekeeper, 1 Assistant Storekeeper (part time). d Cert. Health Visitor. e Cert. Sanitary Inspector. f C.M.B. g Nursing Part-time Officers. Dorothy Shepherd, M.B., Ch.B., Maternity and Child Welfare Clinic. Arabella C. Stevens, M.B., B.Ch., B.A.O., Maternity and Child Welfare Clinic. Fredk. Porter Smith, M.R.C.S., L.R.C.P., Schick Immunisation Officer. G. Phyllis Brocklesby (from 15.9.1936), Sunlight Clinic. Public Vaccinators. P. O' Malley, M.B., B.Ch., B.A.O., N.U.I. M. M. Scott, M.R.C.S., L.R.C.P. 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. 25 Vaccination Officers. E. J. A. Holt. C. R. Fifer. Clerical Staff. G. H. Bell, Chief Clerk. R. A. Blaikie, Infections Diseases Clerk. C. Savage, Maternity and Child Welfare Clerk. C. Duggan, Housing Clerk. F. Spearing, Housing Clerk. G. Stubbs, Registers Clerk. F. S. Bridges, Registers Clerk. J. Baillie, Registers Clerk. 3 Temporary Clerks. GENERAL PROVISION OF HEALTH SERVICES. (a) 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. (b) 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. (c) Nursing in the Home.—General Nursing is carried out by the Ranyard Nurses, the Benson Nursing Association (which is subsidised by the Newington Charities to the extent of £400 per annum) and the Catholic Nursing Home, 60, Lambeth Road. A few parishes also have their own private nurses. 26 TREATMENT CLINICS. DIPHTHERIA PREVENTION CLINIC.— Sutherland House. Thursday, 2.0—4.0 p.m. (Dr. F. Porter-Smith.) (A detailed report will be found on pages 146. 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. ULTRA-VIOLET RAY CLINIC.— Guy's Hospital. Daily. Municipal Welfare Centre, Villa Street. Every Tuesday and Friday (from 15.9.1936). 2.0—4.30 p.m. 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. Hospital for Diseases of the Skin. 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 Scheme has progressed a step further during the year under review. The opening of the new Municipal Welfare Centre in Villa Street, and the appointment of an Assistant full-time Medical Officer has increased the efficiency of the service, inasmuch as the additional medical sessions in this particular district have become an accomplished fact. The Council have realised that more medical sessions are a necessity at several other centres, especially in the northern end of the Borough, and for this reason they are contemplating the establishing of new centres in the near future. The two up-to-date and well-equipped Municipal Antenatal Clinics are doing good work and we are looking forward to the completion of the new health services department, when another Antenatal Clinic will become available. The Voluntary Maternity Hospitals, with which the Borough is well supplied, are dealing with a large number of cases, and out of a total of 2,349 confinements, 872 mothers were confined in these Hospitals, and 547 in the L.C.C. Hospitals. MATERNAL MORTALITY. Resulting from 2,318 live and still births, 4 mothers lost their lives —a mortality rate of 1.7 per 1,000 births. This figure compares very favourably with that for England and Wales, which is 3.81. The Borough maternal mortality rate is a distinct improvement on that of last year. One death occurred as a result of Puerperal Fever, and three were due to other causes. Puerperal Fever and Pyrexia Regulations. The Council have made full provisions under these Regulations. During the year under review, 13 cases of Puerperal Fever and 17 cases of Puerperal Pyrexia were notified. Of these, 11 cases of 28 Puerperal Fever and 17 cases of Puerperal Pyrexia were removed to hospital. 2 cases were nursed at home, nursing facilities being supplied by the Council in both cases. Consultation with a Borough specialist was sought in 1 instance. One mother lost her life as a result of Puerperal Fever, which gives the low mortality figure of 0.43 per 1,000 births (live and still). This is an extremely satisfactory figure, and indicates the high degree of skill displayed by those responsible for the treatment of these infections. INFANT MORTALITY. The infant death rate of 59 is an improvement on the previous year, and the lowest in the history of the Borough, with the exception of 1930, when the rate was 57. This decrease is due to several causes, chief of which is the greater activity and improvements in the schemes of the maternity and child welfare Authority. SKILLED NURSING. During the year 25 mothers, who were unable to afford both doctor and a nurse, and who were confined at home, received skilled nursing by fully-trained qualified nurse-midwives, at a cost to the Council of £24 3s. 0d. HOME NURSING. The Council have made arrangements with the Benson Nursing Association, and the Catholic Nursing Home, for the home nursing of children under 5 years of age, suffering from pneumonia, bronchitis, whooping cough, measles, diarrhoea, etc. During the past year 303 sick children have been nursed under this arrangement. TODDLERS' CLINICS. During the year 8 toddlers' sessions were held at St. George's Infant Welfare Centre and 236 toddlers were seen by the Medical Officer in charge. She reports that 80 to 85 per cent. of the children were normally developed for their age, the remainder having definite cause for backwardness which should respond to treatment. 29 MATERNITY BEDS. Three beds are reserved at Lambeth Hospital for necessitous expectant mothers and during the year under review 4 mothers were admitted for their confinement at a cost to the Council of £36 9s. 0d. COMPENSATION TO MIDWIVES. An arrangement has been made by the Council whereby compensation at the rate of 10s. per case is paid to a midwife for the loss of a case (i.e., removal to Hospital) on the advice of the doctor at the Antenatal Clinic. MATERNITY OUTFITS. Thirty maternity outfits were supplied to expectant mothers at cost price, or in necessitous cases free of charge at the Antenatal Clinics. HOME HELPS. A panel of selected women to act as Home Helps is kept in the Public Health Department, and application should be made to the Medical Officer of Health. WOMEN'S COUNTRY HOLIDAY FUND. The Council approved a scheme on 1st April, 1936, whereby nursing mothers and children attending the Welfare Centres could be recommended by the Medical Officer for convalescent treatment. During the 9 months, 86 mothers and 97 children were sent away at a cost of approximately £350. CONSULTANTS. The Council have a panel of two Obstetric Consultants who may be called in by any general practitioner in any midwifery case which presents difficulty or abnormality. Four consultations took place during the year at a cost to the Council of £21. DRIED AND LIQUID MILKS. Milk is supplied to expectant and nursing mothers, and to child under 3 years of age (in special circumstances 5 years). 30 It is supplied in accordance with the Minister of Health's Circular, and the Medical Officer in charge of the Council's Welfare Clinic recommends a supply when she considers it is nccessary. During the year 40,206 packets of dried milk and 21,120 pints of liquid milk was issued free to necessitous cases at a cost to the Council of £3,214 8s. 4d. The amount charged to the Public Assistance Committee was £174 5s. 7d. The scheme of co-operation with the Public Assistance Committee has worked smoothly. 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 90 cases were sent for treatment. MUNICIPAL SUNLIGHT CLINIC, VILLA STREET. This Clinic came into operation on 15th September, 1936, and from that time to the end of the year 49 patients were treated; they made 426 attendances. Those who have attended regularly for at least 10 treatments consecutively have greatly improved and increased in weight, they sleep better and are less irritable. It is also noticeable how their teeth are cut without the frequent accompaniment of bronchitis and internal trouble at this time. After the first two or three treatments both babies and toddlers become used to it and are good during the time of exposure. CONVALESCENT TREATMENT. The arrangement between the Borough Council and the Invalid Children's Aid Association is still being carried on, and 71 children under 5 years of age were sent away at a cost of £162 4s. 5d. in order to restore them to better health. DINNERS FOR NECESSITOUS MOTHERS. Dinner coupons were given to necessitous expectant and nursing mothers, who were referred to the Southwark Invalid Kitchen, at a cost to the Council of £22 8s. 6d. for the year. 31 DAY NURSERIES. There are three Day Nurseries in the Borough. One is Municipal, and is situated at Sutherland House, Sutherland Square. The nursery accommodates 20 to 25 children and is supervised by a Committee of Nursery Managers. The number of attendances during the year was 3,813. 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 6,278. Crossways Mission, New Kent Road, has a Day Nursery accommodating 46 children. The number of attendances during the year was 7,809. 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 £50. CHILD LIFE PROTECTION. Hereunder will be found the number of foster mothers and foster children in the Borough, together with the work in connection therewith. Number of persons on the Register who were receiving children for reward at the end of the year 32 Number of children on the Register 47 Number of Infant Protection Visitors at the end of the year who were:— Health Visitors 9 Female, other than Health Visitors 1 Male 2 Number of visits made by Infant Protection Visitors to the homes of foster mothers during the year 858 No proceedings were taken during the year. 32 ORTHOPAEDIC TREATMENT. This i.s undertaken by the London County Council and the General Hospitals in the Borough. Children attending the Welfare Centres needing attention are referred by the Medical Officer in charge to the various hospitals for treatment. CHILDREN UNDER SCHOOL AGE. (Ministry Circular 1550—England.) On 29th May, 1936, the Ministry of Health issued the above Circular for the consideration of the Maternity and Child Welfare authorities throughout England and Wales. In the first place it is my intention to give a short outline on the various sections of the Circular, to be followed by an outline of the services already provided by the Council, as a guide to the Committee, should they desire to review the present arrangements with a view to providing a more extensive system of health visiting of children between the ages of 1—5 years. In Section 2 of the Circular the Minister is concerned to find that in many areas insufficient attention is being given to the health of young children between the ages of 18 months and 5 years, and he understands that more than 16 per cent. of the children entering school are found to require treatment for some disease or defect. Section 3 deals with the policy of the Government in regard to the provision of nursery schools, but, as the Minister points out, whatever provision is made a very considerable number of children under the age of 5 will remain at home, it is therefore essential that in all areas there should be systematic periodical health visiting of those young children who are not in attendance at school. In Section 4 the Minister reminds Local Authorities that it should be the duty of the health visitor to see these children at regular intervals, and in all cases where there is ground for suspecting disease or defect, the mother should be advised to consult the family doctor or to take the child to the appropriate clinic for medical examination without delay. It is also noted that in some areas special arrangements have been made for the holding of "toddlers' clinics" at infant welfare centres. 33 The success of these clinics will depend to a very great extent on the regular visiting of the homes and the persuasive powers of the health visitors. In Section 6, the Minister points out that, in many areas, a school clinic is available for the treatment of minor ailments and special defects in young children, and it is desirable that such arrangements should be more generally made. Further, that it is clearly desirable that the Medical Officer who will supervise the health of the children after they enter school should be responsible for their supervision during the preschool years. It is also suggested that, in those areas where the Maternity and Child Welfare Authority is not the local Education Authority, it might be possible to secure this desirable arrangement by agreement between the two authorities. Section 7 puts forward the suggestion that in Section 60 of the Local Government Act, 1929, where the two authorities are separate, the local Education Authority, by representation to the Minister, might take over the child welfare services as part of the educational services. Section 60 of the Local Government Act, 1929, does not apply to London. The Minister then goes on to state that in order to secure adequate supervision of the health of young children it may be necessary to increase the health visiting staff. He also encourages the Council to consider the desirability of establishing Day Nurseries in those districts where any considerable number of mothers are regularly employed away from home; and, lastly, he asks the Council to review their arrangements for the supervision of the health of young children and to inform him as soon as possible the result of their consideration of his Circular. In order that the Maternity and Child Welfare Committee may adequately consider the Minister's proposals, it is necessary for them to know the extent of the problem. In the Borough, the estimated number of children between the ages of 1 and 5 is, approximately, 9,700, and this is the gross total for which provision is to be made. 34 I have ascertained that out of this total, 1,947 toddlers are in attendance at the Elementary Schools or at the Nursery School, and 146 are in attendance at Day Nurseries in the Borough. It will thus be seen that 7,607 toddlers remain at home and require to be visited regularly by the visiting staff. The arrangements which the Council has already made may be described under the following headings:— A. Infant Welfare Centres. B. Medical Staff and Supervision. C. Health Visiting Staff and Home Visiting. D. Minor Ailment Treatment. E. Hospital Treatment. F. Home Nursing. G. Schick Clinic. H. Convalescent Homes. I. Day Nurseries. J. Extra Nourishment. Infant Welfare Centres. There are 14 Welfare Centres in the Borough; 8 municipal and 4 voluntary, and 2 partly municipal and partly voluntary. Each centre has its own district and health visiting staff, and each is attended by a Medical Officer. In all, 23 sessions are held during the week, and mothers are encouraged to bring both infants and toddlers. In addition to this, one of the voluntary centres hold a special toddlers' session every three months; this is now to be held monthly owing to the large attendance. The records show that 83 per cent. of the births occurring in the Borough each year attend one or other of the Welfare Centres, but after the first year there is certainly a falling off in the attendances of toddlers. Although this latter group made 27,624 attendances during the year 1935, and 8,819 were seen and examined by the Doctors, there is no doubt that more encouragement is required to bring this group of children into the centres more frequently, and when the Council has completed building the six new Maternity and Child Welfare Centres which they have under consideration, additional facilities for dealing with the toddlers' class can better be offered than at the present time. Moreover, it is very desirable to increase the number of sessions at the various centres in order to limit the attendance, as the present sessions are grossly overcrowded and neither Nurses nor Doctors are able to deal efficiently with the work. 35 Medical Staff and Supervision. At the present time the Council employ one whole-time and two part-time Medical Officers for the purpose of Maternity and Child Welfare, in addition to which, the voluntary centres employ three part-time Medical Officers. The Committee has already under consideration the advisability of appointing full-time Medical Officers, and I would stress this as an urgent matter owing to the desirability of increasing the number of sessions to be held, particularly as an when the new Welfare Centres are completed. Health Visiting Staff and Home Visiting. The Council employ nine whole-time health visitors who are paid according to the London District Council scale of salaries, and, therefore, the Minister's observations regarding inadequate salaries do not apply to this Borough. In addition, the voluntary centres employ three health visitors, making a total of twelve health visitors employed in the Borough. It has always been the policy of the Council for the visitors to follow up regularly all infants and toddlers until they attend school, but, owing to the increasing duties thrown upon the health visitors during the past few years, it has been extremely difficult to pay the requisite number of visits as desired by the Minister. In spite of this, however, the twelve health visitors concerned made a total of 19,588 visits to children between the ages of 12 months and 5 years during the year 1935. It is a recognised principle that these children should be visited at least three times during the year. It therefore follows that if all the children not attending school or nursery are to be visited according to the Circular, at least one more health visitor is required immediately. As previously mentioned in this report, it is the intention of the Maternity and Child Welfare Committee to increase the number of sessions when the new centres are completed, it is, therefore, obvious that there will be still less time for the health visitors for visiting purposes, and additional staff will be required as and when the centres are completed. In addition to the one required immediately, I estimate that the services of two further health visitors will be required when the maternity scheme is completed. 36 Hospital and Minor Treatment. This chiefly includes minor diseases of the skin, eye, throat, nose and ear. At the present time the centres which are used by the Borough Council do not lend themselves for the treatment of even very minor conditions, and other arrangements have accordingly been made. Fortunately, the Borough is well served by Hospitals, both general and special, and minor conditions are referred by the Medical Officers of the centres chiefly to Guy's Hospital, Evelina Hospital for Sick Children, and St. Thomas's Hospital. Special skin conditions are referred to the Royal Skin Hospital, and eye conditions both to Guy's Hospital and the Royal Eye Hospital. All these Hospitals arc situated in the Borough or on the borders of the Borough. Other cases, which, in the opinion of the Doctor, can afford to pay for medical attention, are referred to their private practitioner. Dental treatment has been arranged by the Borough Council through St. George's Dispensary and Guy's Hospital. Artificial sunlight has been arranged at Guy's Hospital, and since the new centre at Villa, Street was opened on 23rd June, artificial light has been installed in the south end of the Borough. Special arrangements also exist for treatment of wasting diseases at St. Thomas's Babies' Hostel, and at the L.C.C. Hospitals. Orthopaedic, treatment for minor cases are dealt with through Guy's and St. Thomas's Hospitals, and more severe cases, requiring prolonged in-treatment, through the L.C.C. at Carshalton. It will be noted that in the Circular, the Minister suggests that arrangements might with advantage be made between the local Education Authority and the Child Welfare Authority for the treatment of minor ailments and toddlers at the school clinics. There are only two school clinics in the Borough, both worked under the control of St. George's Dispensary. 37 My own view is that there should be more, and I suggest to you that minor ailment clinics should be established in certain of the new welfare centres, and that the County Council be invited to co-operate with us to see how far they can make use of these treatment clinics for school medical purposes. The new health services department, which will be completed next year, will be equipped with solarium, X.rays, dental and early rheumatic clinics, which would lend themselves admirably for the above-mentioned purposes. Additional clinics could be added, such as massage, orthopaedic, etc., as found necessary and desirable. It might be well to point out that there is close co-operation between the Tuberculosis Dispensary and the Child Welfare work. Any chest condition upon which the Medical Officer of the Welfare Centre desires to obtain a second opinion, is referred to the Tuberculosis Dispensary, and particularly so where the case is a known contact of tuberculosis. A special session held each Saturday morning at the Tuberculosis Dispensary is devoted to children. Home Nursing. The Council has arrangements with two district nursing associations for the home nursing of children under 5 years of age suffering from pneumonia (all forms), bronchitis, diarrhoea, whooping cough, measles, and any other condition where the medical attendant deems such assistance desirable, and where the Medical Officer of Health approves. Schick Clinic (Prevention of Diphtheria Clinic). The Council has established a Clinic at the Welfare Centre, Sutherland House, for the prevention of diphtheria. This Clinic is held each Thursday afternoon, and was particularly established for the inoculation of the toddler group of children. It is the intention of the Council to make provision for these preventive clinics in the new centres. 38 Convalescent Homes. The Authority has arrangements with the I.C.A.A. for the convalescent home treatment of all children up to 5 years of age in attendance at the centres on the recommendation of the Medical Officer in charge. Day Nurseries. There are three day nurseries situated in the Borough; two conducted by voluntary agencies and one managed by the local authority; total accommodation is for 150 infants and toddlers. One voluntary maintained by Guy's Hospital is regularly inspected by the Medical Staff of the Hospital. One voluntary maintained by the Crossway Mission, and the one municipal, are inspected weekly by the Medical Staff of the Health Department. At the present time the three nurseries meet the requirements of the Borough, but should the time arrive when more accommodation in this respect is required, I feel that the Borough Council would provide the additional accommodation. Extra Nourishment. Under the Maternity and Child Welfare Act, the Council provides free grants of milk, cod liver oil, malt, etc., to necessitous mothers and children according to the scale of income adopted by the Council. Free milk is applicable to all children up to the age of 3, and is extended, on a special medical certificate, up to the time of attending school. In addition to free milk, dinners are provided through the London Invalid Kitchens to expectant mothers and toddlers specially recommended by the Medical Officer in charge of the Welfare Centre. Conclusions. It will be seen from the report that it is very desirable to increase the number of sessions held at the Welfare Centres to prevent the present overcrowding, and, in order to accomplish this satisfactorily, it is necessary to employ whole-time Medical Officers and to enlarge the health visiting staff by at least three health visitors. I further suggest that "toddlers' clinics" should be established on an experimental basis at two of our centres for a period of six months to 39 observe how it works, after which period the Committee could consider the results. It is also evident that further home visits should be made to the toddler group of children, and that at least three visits should be paid to each individual child per annum. This can only be done adequately with the suggested increase in the health visiting staff. It is also desirable that further minor ailment treatment facilities should be made at some of the Welfare Centres, and the co-operation of the London County Council sought in this direction. Additional dental treatment might well be undertaken in the new health service department next year. The remaining services would appear to be adequate and comprehensive. The suggestion of the Minister in paragraph 6 of the Circular, that supervision of the pre-school children could be more readily effected if maternity and child welfare services were in the hands of the local authority responsible for the school medical services, is a thorny problem, and although the transfer of services under Section 60, Local Government Act, is not applicable to London, nevertheless I feel that any movement in this direction on the part of the London County Council should be most vigorously opposed. Maternity and child welfare work is essentially a local question, closely associated with the home, and must be handled in a personal manner. It is extremely difficult to conceive how such services could be conducted by a large central authority in the same manner as they are at present by the Borough Councils. Recommendations. I beg to recommend :— 1. That the Maternity and Child Welfare Committee should recommend the Council to appoint two whole-time women Assistant Medical Officers. One as soon as possible after September next, to be followed by a further appointment during the early part of the next financial year (see page 43). 2. That the Maternity and Child Welfare Committee should recommend the Council to appoint three health visitors to carry out the additional work urged by the Minister of Health. 40 3. That the appointment should be made in the next financial year, and that the Finance Committee should be asked to provide in next year's estimate for this purpose. 4. "Toddlers' clinics" should be set up at two of the Infant Welfare Centres, and that the Medical Officer should be authorised to make the necessary arrangements and report upon the results in six months time. 5. That three of the new Welfare Centres should be equipped for treatment of minor ailments, and that the co-operation of the London County Council for school medical purposes should be sought. 6. That a copy of this report should be forwarded to the Minister of Health with an assurance that the needs of the toddlers will receive the continued attention of the Council. MATERNITY AND CHILD WELFARE CENTRES. Assistant Medical Officers Dr. Margaret Bergin. (Maternity and Child Welfare) Dr. E. A. Mower White (from 1.12.1936.) (14 Centres.) 1a CENTRE (Voluntary). St. John's Institute, Larcom Street. District served by Centre St. John's Ward. Sessions held every Wednesday and Thursday 2.0—4.0. Medical Officers Dr. E. M. Saxton and Dr. M. O. Cruickshank. Superintendent Miss Kaye. 1b CENTRE (Municipal). Sutherland House, Sutherland Square (to 28.11.1936). 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. 41 2a CENTRE (Municipal). Sutherland House, Sutherland Square (to 28.11.1936). 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 (to 24.6.1936). 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 Visitors Mrs. M. E. George. 2b CENTRE (Municipal). Villa Street (from 1.7.36). District served by Centre Sessions held every Wednesday Medical Officer Health Visitor St. Peter's District. 10.0—12. 2.0—4.0. Dr. Margaret Bergin. Mrs. M. E. George. 3a CENTRE (Municipal). All Saints' Parish Room, Surrey Square (to 25.6.1936). District served by Centre The Southern portion of All Saints' District and the portion of St. George's Ward between East Street and Albany Road. Sessions held every Thursday 10.0—12. 2.0—4.0. Medical Officer Dr. A. C. Stevens. Health Visitor Miss A. Rogers. 3a CENTRE (Municipal). Villa Street (from 2.7.1936). District served by Centre The Southern portion of All Saints' District and the portion of St. George's Ward between East Street and Albany Road. Sessions held every Thursday 10.0—12. 2.0—4.0. Medical Officer Dr. A. C. Stevens. Health Visitor Miss A. Rogers. 42 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 F. M. Adair. 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 The Northern half of St. George's Ward and the streets between Trinity Street and Tabard Street. Sessions held every Friday 10.0—12. 2.0—4.0. Medical Officer Dr. A. C. Stevens. Health Visitor Miss A. C. Cottrill. 5 CENTRE (Partly Municipal and partly Voluntary). 56, Lambeth Road. District served by Centre A part of St. Jude and St. Michael's Wards. Sessions held every Monday and Thursday 2.0—4.0. Medical Officer Dr. Dorothy Shepherd. Health Visitors Miss Pearson and Miss McCurdy. 43 6a CENTRE (Municipal). Southwark Boys' Hostel, Pocock Street. District served by Centre Christchurch Ward and a part of St. Michael and St. Jude's Wards. Sessions held every Tuesday 10.0—12. 2.0—4.0. Medical Officer Dr. Margaret Bergin. Health Visitor Miss M. Freeth. 6b CENTRE (Municipal). Southwark Boys' Hostel, Pocock Street. 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 Miss F. M. Mason. 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. Davies. Health Visitor Miss Weatherall. 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. Early in November, 1936, the Council appointed an additional full-time Assistant Medical Officer for the Maternity and Child Welfare services, and dispensed with the services of the part-time Medical Officers at the Municipal Centres. The Officer appointed (Dr. Mower White) assumed duty on 1st December, 1936, and on that date a reorganisation of the two Municipal Centres, i.e., Sutherland House, and the new Municipal Centre, Villa Street, came into operation. The alterations are as follows:— 44 Sutherland House, Sutherland Square— 1b Monday 10—12 a.m. Medical Session ,, 2— 4 p.m. Sewing Class Tuesday 10—12.45 p.m. Milk Issues only 1b ,, 2— 4 p.m. Medical Session Dr. Wednesday 10—12.45 p.m. Milk Issues only Mower ,, 2— 4 p.m. Antenatal Session White. 2a Thursday 10—12 a.m. Medical Session ,, 2— 4.30 p.m. Milk Issues only 2a Friday 2— 4 p.m. Medical Session New Maternity Centre, Villa Street— Monday 10—12.45 p.m. Milk Issues only 2b ,, 2— 4 p.m. Medical Session 2b Tuesday 10—12 a.m. Medical Session 3a Wednesday 10—12 a.m. Medical Session Dr. ,, 2— 4 p.m. Sewing Class Mower Thursday 10—12.45 p.m. Milk Issues only White. 3a ,, 2— 4 p.m. Medical Session Friday 10—12 a.m. Antenatal Session ,, 2— 4.30 p.m. Milk Issues only ANTENATAL CLINICS. Sutherland House, Sutherland Square (to 30-11-1936). District served by Clinic St. Mary and St. Paul Wards. Sessions held every Monday 10.0—12.0. Medical Officer Dr. Dorothy Shepherd and Dr. Mower White. During the year 116 mothers were seen and given advice. They made 386 attendances. Sutherland House, Sutherland Square (to 3.7.36). 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. During the year 78 mothers were seen and given advice. They made 192 attendances. 45 New Municipal Centre, Villa Street (from 10.7.1936). District 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. During this period 76 mothers were seen and given advice. They made 197 attendances. 56, Lambeth Road. District served by Clinic St. Jude's Ward. Sessions held One monthly. Medical Officer Dr. Dorothy Shepherd. During the year 75 mothers were seen and given advice. They made 406 attendances. 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. During the year 674 mothers were seen and given advice. They made 3,752 attendances. 46 47 MATERNITY AND CHILD WELFARE CENTRES. Showing the Attendances at the Several Centres and Visits paid to the homes of Mothers and Children by Health Visitors. TABLE 14. St. John 1a. St. Mary. 1b. St. Paul. 2a. St. Peter, 2b. J All Saints. 3a. Lady Margaret 3b. Crossway. 4a. St. Stephens. 4b. St. Jude. 5. St. Michael. 6a . St. Saviour. 6b. St. George. 6c. Guy's. 7. Total. Number of Births notified during the year 265 272 329 221 174 190 131 130 184 221 129 81 42 2369 Number of individual children attending the Centres during the year 371 414 456 338 225 308 264 205 392 348 272 202 162 3957 Number of Sessions held during the year 94 93 95 95 95 95 92 94 93 94 90 44 103 1177 Number of children in (1-5) age group attending during the year 167 209 201 177 107 171 181 99 229 167 178 127 84 2097 Number of new cases attending the Centres during the year— (1) Expectant Mothers (Ante-natal Clinics) — 116 78 76 — — — — 75 — — — 674 1019 (2) Infants under 1 year 204 205 255 161 108 137 83 106 163 181 94 75 78 1850 (3) Seen by Doctor 204 205 255 161 108 137 83 106 163 181 94 75 78 1850 (4) Children 1 to 5 years 68 42 40 29 17 41 19 13 33 34 30 26 3 395 (5) Seen of Doctor 68 42 40 29 17 41 19 13 33 34 30 26 3 395 Method of —(a) Breast 193 148 185 129 88 116 60 101 115 151 76 52 50 1464 Breast and bottle 5 31 51 17 15 11 13 3 31 21 10 15 6 229 (c) Bottle 6 21 12 11 5 9 8 3 17 9 5 10 18 134 (d) Ordinary diet 68 47 47 33 17 42 21 12 33 34 33 24 7 418 Total number of attendances during the year— (1) Expectant Mothers (Ante-natal Clinics) seen by Doctor — 386 192 197 — — — — 406 — — — 3752 4933 (2) Infants under 1 year 6029 3280 4017 3014 2068 3095 1754 2073 2135 3088 1591 1596 2492 36232 (3) Children 1 to 5 years 3514 1896 1821 2050 1653 2511 2178 971 3908 1665 1824 1283 1025 26299 Average number of attendances (infants under 1) 64.1 35.3 42.3 31.7 21.7 32.6 19.1 22.1 23.0 32.9 17.7 36.3 24.2 — do. do. (children 1-5) 37.4 20.4 19.2 21.6 17.4 26.4 23.7 10.3 42.0 17.7 20.3 29.2 10.0 — (4) Total number of attendances of Infants seen by Doctor during the year 1508 1500 1802 1110 1034 1532 855 1012 1178 1176 621 739 641 14708 (5) Total number of attendances of children 1 to 5 years seen by Doctor during the year 634 779 812 438 568 641 754 421 1075 563 650 528 322 8185 (6) Children weighed 6549 4919 5387 4716 3644 4845 3764 2807 4190 4687 3273 2833 1855 53469 Total number of first visits paid by Health Visitors to homes of— Expectant Mothers 199 197 146 153 113 169 49 48 351 156 65 42 504 2192 Infants under 1 year 327 279 298 227 164 195 126 136 180 202 136 91 41 2402 Children 1 to 5 years 248 — — — — — — — 124 — — 138 7 517 Total number of revisits paid by Health Visitors to homes of— (1) Expectant Mothers 276 134 48 10 30 111 17 24 355 40 34 32 520 1631 Infants under 1 Year. 1697 1204 1234 671 1055 1356 644 1431 1412 1064 871 494 387 13520 (3) Children 1 to 5 years 2102 1526 1120 996 1251 1395 1098 1618 2364 877 1247 1610 1058 18262 48 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 1936. TABLE 15. 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 279 266 5 1204 14 — 331 — 64 — 139 — 69 — 2371 Miss Saver 298 235 2 1234 2 — 194 2 39 — 95 — 13 5 2119 Mrs. George 227 260 2 671 10 — 163 — 38 — 95 — 10 3 1479 Miss Rogers 164 212 1 1055 — — 143 — 50 — 95 — 21 1 1742 Miss Cottrill 136 194 1 1431 6 — 72 4 54 1 92 — 77 2 2070 Miss Hinde 126 244 4 644 — — 66 1 130 — 96 — 147 5 1463 Miss Adair 195 216 4 1356 5 — 280 38 101 1 95 — 141 1 2433 Miss Freeth 202 228 3 1064 27 — 196 4 165 — 88 — 21 1 1999 Miss Mason 136 118 — 871 2 — 99 — 68 6 136 — 217 3 1656 Total 1763 1973 22 9530 66 — 1544 49 709 8 931 — 716 21 17332 49 TABLE 16. NOTIFIED BIRTHS. 1936. Where Born and by Whom Attended. Mothers Confined Notified Births. StillBirths . Total Live Births. Born in— Guy's Hospital 206 208 8 200 1, Kennington Park Place 10 10 — 10 General Lying-in Hospital 285 287 5 282 Lambeth Hospital 344 349 14 335 St. Thomas's Hospital 165 165 5 160 King's College Hospital 72 72 1 71 St. Giles's Hospital 139 142 6 136 St. Olave's Hospital 64 64 — 64 Westminster Hospital 14 14 1 13 Charing Cross Hospital 29 29 2 27 Clapham Maternity Hospital 6 6 — 6 Other Hospitals, etc. 85 87 — 87 1419 1433 42 1391 Born at Home and Attended by— Externs: Guy's Hospital 168 171 — 171 St. Thomas's Hospital 41 41 1 40 King's College Hospital — — — — Midwives: Guy's Hospital 161 162 1 161 St. Thomas's Hospital 30 30 — 30 Lambeth Hospital — — — — General Lying-In Hospital 13 13 — 13 Heygate Street 141 141 3 138 77, Southampton Street 18 18 — 18 Private 245 247 6 241 Doctors: Private 113 113 5 108 930 936 16 920 Totals *2349 2369 58 2311 *Of this number, 156, so far as our records show, did not receive antenatal advice. 50 TABLE 17. Vaccination Officers' Return respecting the Vaccination of Children whose Births were Registered in 1935. 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 Date. Registration subdistricts comprised in vaccination officers' district. Number of births returned in birth list sheets. Column 1, successfully vaccinated. Column 2. Insusceptible of vaccination. Column 4. Certificate of conscientious objection. 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 certificates of successful vaccination received during the calendar year 1936. 1935. 1 2 3 4 5 6 7 8 9 10 11 1st Jan. to 31st Dec. Northern Division 859 354 — 281 39 3 58 52 72 531 Southern Division 690 310 — 271 29 — 11 33 36 631 Total 1549 664 — 552 68 3 69 85 108 1162 SECTION C. Sanitary Circumstances of the Area. 53 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, earth closets or privies in the Borough. MEN'S COMMON LODGING HOUSES. There are 10 common lodging houses for men in the Borough containing 1,711 beds. During the year 46 inspections have been made, and 4 notices served for contravention of the Byelaws, all of which were complied with. Various minor defects have been remedied on verbal instructions. It is necessary to make frequent inspections and keep strict observation in order to prevent infestation of the premises by vermin, and on instructions from my staff the deputy keepers are making a periodical inspection and cleansing of the beds. In the near future one house, namely, 226, East Street, will be closed altogether, but this will not cause inconvenience or overcrowding as only about 70 per cent. of the accommodation is used in the other houses. 54 WOMEN'S COMMON LODGING HOUSES. I have received the following report from Miss G. Brings:— During the year under review, two of these houses have been closed :— (a) 12, Lombard Street (closed voluntarily). (b) 7-8, Dorrit Street (closed following Demolition Order). The closing of these two houses has caused no overcrowding or inconvenience, as a large number of beds are vacant every night at the remainder, with the exception of Cecil House. At the present time, there are 5 Women's Common Lodging Houses in the Borough, containing 336 beds; 4 of them were originally dwelling houses, and the remaining 1 (Cecil House) is a modern building, especially constructed for the purpose. At the time of their conversion, it is to be regretted that the former were not equipped with up-to-date fittings such as baths, metal lockers, or other suitable provision for clothing and the belongings of the lodgers which are so much in evidence at Cecil House. This house is provided with ample facilities for bathing, also for washing and drying clothes. For this reason it has its full complement of lodgers every night (50 women or 49 women and 2 babies). When babies are admitted, cots are provided and a bed is taken down. Visitors are welcomed, and the house is open for inspection two hours each week. Deputies. A deputy keeper is in charge at most of the houses, who is responsible to the keeper for the cleanliness and smooth-running of the house, and she must be capable of controlling the lodgers should any prove troublesome. Periodical visits to these houses cause one to feel strongly the necessity of having suitable persons for this work. It is essential that she must constantly attend to her duties or the condition of the beds, floors and utensils will quickly deteriorate if she is in any way neglectful. On one or two occasions this neglect has been apparent; more especially has this been the case when a deputy keeper has been leaving. During the year, several changes have taken place and in one case there is at present a temporary deputy. Night visits are paid periodically between 11 p.m. and 1.30 a.m. At each house visited there were some lodgers in bed and some in the kitchen, but there was orderliness and quietness throughout. 55 During inspections, various defects have been found—defective bed springs, torn mattress covers, unsatisfactory W. C. flush, and defective sashcords and windows. The keeper has been informed either verbally or by letter, and the defects have been remedied. Vermin were found at one of the houses, but measures were taken to free the premises. The bedding was sent to the disinfecting station, the bedclothes washed, the bedsteads and springs well cleansed with paraffin, and the walls and floors washed and sprayed with disinfectant. A strict observation is now being kept. Painting and cleansing has been going on throughout the year, and a reasonable standard of cleanliness has been maintained. 78 visits were made. TABLE 18. Summary of Sanitary Works completed under the Public Health Act during the year 1936. Intimation Notices complied with 3,537 Drains reconstructed 68 Drains repaired 131 Drains intercepted and ventilated 142 Drains unstopped 238 Gullies provided 157 Soil-pipes provided or repaired 167 Closets provided 574 Closet pans and traps 833 Water apparatus repaired 665 Sink, Lavatory and waste pipes 1,629 Rainwater pipes repaired, etc. 290 Water supply to upper floors 30 Draw taps on main 251 New water supplies 19 Roofs and gutters repaired 1,634 Paving repaired 308 Dampness abated 811 Rooms cleansed 3,249 Sub-floor ventilation 50 Staircase ventilated 26 Dust-bins provided 1,056 Overcrowding abated 2 Miscellaneous nuisances abated 5,087 3,057 Intimation Notices were served during the year. 1,075 Statutory Notices were served during the year. 56 PROCEEDINGS TAKEN UNDER THE PUBLIC HEALTH AND OTHER ACTS. 5 summonses were taken out during the year 1936, in respect to offences, particulars of which are set out below. The above summonses had reference to the following:— Ordinary Nuisances 4 Exposing for Sale (Unsound Food) 1 Total 5 These proceedings resulted as follows:— Summonses withdrawn (with costs), the Council's requirements having been complied with 4 Penalties and costs 1 Total 5 SHOP'S ACT, 1934. Since the Shops Act, 1934, came into operation, 71 premises have been inspected and recorded, and 24 visits have been paid to premises already recorded. 15 notices have been served, 6 asking for the provision of a reasonable temperature in the shops, in accordance with Section 10, Sub-section 1 (b), and 9 asking for the provision of sanitary conveniences in the shops, in accordance with Section 10, Sub-section 2. Of these 15 notices, 10 have been complied with, 3 have been withdrawn consequent upon the granting of exemption certificates, and 2 are still outstanding. 12 shops have been exempted from the provisions of Section 10, Sub-section 2, in accordance with Section 10, Sub-section 6. 57 TABLE 19. Proceedings taken under the Public Health and other Acts. Defendant. Cause of Proceedings. Result. Miss D. Tilt 152, Peckham Rye, S.E.22 Nuisance existing at 110, Westmoreland Road Summons withdrawn. £1 1s. costs. Work done. Arthur Benabo 53, Commercial Road, E.l General nuisance existing at 41, Milcote Street Summons withdrawn. £1 1s. costs. Work done. H. J. Golby 99, Malvern Road, N.W.6 General nuisance existing at 87, Red Cross Street Summons withdrawn. 10s. 6d. costs. Work done. Frank Cornes 51, Knapmill Road, Catford Failing to take reasonable precautions to prevent exposure of meat to contamination Fined 7s. 6d. and 10s. 6d. costs. S. E. Milborrow 17, Wellesley Road, Ilford General nuisance existing at 30, Shorncliffe Road Order to carry out work within 7 days. £1 1s. costs. 68 NEW LEGISLATION DURING THE YEAR. ACTS OF PARLIAMENT. Public Health Act, 1936. Midwives Act, 1936. STATUTORY RULES AND ORDERS. 739, Housing Acts (Form of Orders and Notices) Regulations, 1936. 705, Housing Acts (Overcrowding and Miscellaneous Forms) Regulations, 1930. 1017, Housing (England). CIRCULARS. 1518, Draft Milk (Special Designations) Order. 1520, Certification of Blindness. 1520, Welfare of the Blind. 1535, Draft Milk (Special Designations) Order, 1930. 1533, 1580, Milk (Special Designations) Order, 1930. 1534, 1585, 1566, Public Health (Imported Food) Regulations, 1925. Public Health (Imported Food) Amendment Regulations, 1933. 1530a, Venereal Diseases. 1540, Port Sanitary Administration. 1539, Housing Act, 1935. 1541, (1) Local Government Act, 1929; (2) Maternity and Child Welfare; (3) Voluntary Associations. 1644, Orthodichlorbenzone. 1550, Children under school ago. 1552, Local Government Act, 1929, Part VI. 1559, Housing Act, 1935, Forms R, R1, R2, R3. 1560, Housing Act, 1935 (Appointed Day). 1568, Maternity and Child Welfare. 1574, Nursing Homes Registration Act, 1927. 1582, Fees of Medical Practitioners called in by Midwives. MEMORANDUM. Memo /197, Foods, Sets out in general terms the effect of the Milk (Special Designations) Order, 1930. SMOKE ABATEMENT. During the year under review 815 observations wore made by the several Inspectors, 7 nuisances were observed, and 1 intimation notice served. 59 HOUSES LET IN LODGINGS. The number on the Register at the end of the year was 1,885, and in this connection there are still certain difficulties in the application of the bye-laws, the chief of which are:— (1) The question of "Control" under the Rent Restriction Act. (2) The question of sub-letting; and (3) A new difficulty which has arisen since the overcrowding survey, i.e., the question of re-housing the families requiring six or more rooms. (1) The Question of Control.—The most important provisions of the above bye-laws are contained in Clauses Nos. 13, 17, 18 and 25. By virtue, however, of the amending Bye-laws made on the 24th February, 1931, these particular clauses only apply to a "decontrolled house." A "decontrolled house" is defined as a lodging house to which the principal Bye-laws apply, and which is not a dwelling house to any part of which the increase of Rent and Mortgage Interest Restrictions Act, 1920, applies. By virtue of the Rent and Mortgage Interest (Amendment) Act, 1933, dwelling houses not already decontrolled before the 18th July, 1933, of which the rateable value on the 6th April, 1931, did not exceed £20, remain subject to control until the expiration of the Acts, namely, 24th June, 1938. "Dwelling house" within the meaning of the Rent Restriction Acts is a house let as a separate dwelling or a part of a house, being a part so let. In this Borough there are many large houses which, if occupied by one family, would, by virtue of Section 1 (1) of the Rent and Mortgage Interest Restrictions (Amendment) Act, 1933, be automatically decontrolled as from the 29th September, 1933, having regard to the fact that the annual amount of the recoverable rent, and the rateable value, exceed £45. These houses, however, are let to several families in separate tenements and, as such, are lodging houses within the meaning of the Tenement House Bye-laws. Moreover, each tenement is a "dwelling house" within the meaning of the Rent Restriction Acts and if (as is often the case) any of such tenements remain controlled, Clauses 13, 17, 18 and 25, of the Bye-laws have no application to the house as a whole. (2) The Question of Sub-letting.—The constant change of tenant and sub-tenant in this type of dwelling is a continual source of difficulty. 60 and I am convinced that until there is some form of "controlled subletting" there can be no satisfactory application of the Bye-laws, particularly of those sections requiring water, cooking, etc., for each family. It has happened in this Borough on several occasions, and it must have in others, where the Bye-laws have been enforced in all respects, that within a comparatively short space of time the letting of the house has completely changed and the entire sanitary and other arrangements upset. (3) The Question of re-housing large Families.—The overcrowding survey has disclosed the fact that there are many families who require six or more rooms in order to be decently housed. At the present time no authority is building flats or houses of more than six rooms and these are exceptional; moreover, it is not possible to provide this large accommodation in buildings now being erected at anything like the rental which the large family can afford. The question, therefore, is how and where can these people be housed ? It may be possible by some arrangement of exchange between the various housing authorities and the private owners of the larger type of houses, which are now being used as tenement houses, that these large families may be re-housed in these larger houses at reasonable rentals. Having regard to these suggestions it is very doubtful whether it is the right and proper thing to do to apply the Bye-laws, even where it is possible especially at this juncture, as the future usage of any particular house has yet to be determined. 61 PUBLIC HEALTH (LONDON) ACT, 1936. Section 224. The Act provides for the removal, upon an order from a petty sessional court, into a suitable hospital or institution, of any aged or infirm or physically incapacitated person residing in premises under insanitary conditions, or suffering from any grave chronic disease, who is unable to devote to himself (or herself) or receive from persons with whom he (or she) resides, proper care and attention, and who may, therefore, suffer in health or become a serious nuisance to other persons. In this connection, the following persons have been removed during the year under review:— Name and Address. Age. Institution. Mrs. Selina Laundon, 1, Alberta Street 76 years Newington. Mrs. Eliza Crane, 141, Douglas Buildings 93 years Newington. Mr. Walter Mudge, 7, Williams Grove 72 years Newington. Mrs. Emily Britton, 7, Blewitt Street 73 years Newington. RAG FLOCK. PUBLIC HEALTH (LONDON) ACT, 1936. Section 136. No person shall sell rag flock, or have the same in his possession for the purpose of selling it, or use rag flock for the purpose of making bedding, cushions or any article of upholstery, or have in his possession rag flock intended to be used for that purpose, unless the flock conforms to the standard of cleanliness as may be prescribed by regulations made by the Minister. There are no dealers or manufacturers of rag flock in the Borough at the present time. 62 WATER SUPPLY. PUBLIC HEALTH (LONDON) ACT, 1936. Section 95. Certificates in regard to water supply have been granted in respect of the under-mentioned (new) houses during the year:— Premises. Certificates granted to. Aird House, Tarn Street (24 flats) Arrol House (23 flats) Binnie House (19 flats) United Construction Co., 1, Robert Street, W.2. Gerridge Court Estate (25 flats) A. Goldstein, Esq., Gerridge Court Estate. Thorold House, Pepper Street (19 Messrs. E. H. Smith (Croydon), flats) Ltd., Croydon. Doddington Grove (West) (28 flats) Amery House, Kinglake Street (58 flats) The Mayor, Aldermen and Councillors of the Borough of Southwark. 70/72, South Street (4 flats) Messrs. J. Parsons, 190, Waterloo Road, S.E.1. 34/40, Tabard Street (1 house) Messrs. T. Rider & Sons, 181, Union Street, S.E.1. Arrol House, Tarn Street (57 flats) Brunlees House (23 flats) Messrs. Rowley Bros., Tottenham, N.17. Eriars Close, Bear Lane; 1 and 3, Burrell Street (28 flats) Messrs. Hill & Gurr, 15, West Street Bromley. Stopher House, Silex Street (15 Y. Wilkins, Esq., 12, York flats) Buildings, W.C.2. WATER SUPPLY TO TENEMENT HOUSES. PUBLIC HEALTH (LONDON) ACT, 1936. Section 96. 30 additional water supplies were provided to houses during the year 1936. 63 TABLE 20. Factories, Workshops, Laundries, Workplaces and Homework. 1..—Inspection (including Inspections made by Sanitary Inspectors). Premises. Number. Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 415 36 .. Workshops (including Workshop Laundries) 302 37 .. Workplaces 167 45 Homeworkers' Premises (including Outworkers) 514 .. .. Total 1398 118 .. 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 33 27 .. .. Want of Ventilation 3 2 .. .. Overcrowding .. .. .. .. Want of drainage of floors 1 .. .. .. Other nuisances 77 63 .. .. Sanitary accommodations: Insufficient 33 9 .. .. Unsuitable or defective 207 193 .. .. Not separate for sexes 1 .. .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (SS.97-100) Other offences 147 147 .. .. Total 502 441 .. .. *Including those specified in Sections 2, 3, 7 and 8 of the Factory Act as remediable under the Public Health Acts. 64 TABLE 21. 3.—Home Work. Nature of Work. Outworkers' Lists, Section 107. Number of Inspections of Outworkers' Premises. Outwork in Unwholesome Premises, S.108. Outwork in Infected Premises , Sections 109-10 Lists received from Employers. Nos. of Addresses of Outworkers received from other Councils. Nos. of Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions. (Ss. 109-10). Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers Lists. Outworkers Wearing Apparel— (1) Making, &c. 52 55 50 54 265 354 — — 263 4 — — — — — (2) Cleaning and washing - - - - - - - - - - - - - - - Lace, lace curtains and nets — — — — — — - - - - - - - - - Furniture and Upholstery 1 4 1 4 1 2 - — — — — — - - - Fur pulling — — — — — — - - - - - - - - - Umbrellas — — — — 8 — - — 12 - - - - - - Paper Bags and Boxes 8 16 7 21 9 34 - — 47 - - - - - - Brushmaking 6 9 5 8 1 6 - — 19 — — - - - Stuffed Toys 1 — 1 3 — 7 - — 9 — — — - - File making - - - - - - - - - - - - - - - Electro Plate - - - - - - - - - - - - - - - Cables and Chains - - - - - - - - - - - - - - - Anchors and Grapnels - - - - - - - - - - - - - - - Cart Gear - - - - - - - - - - - - - - - Locks. Latches and Keys - - - - - - - - - - - - - - - Miscellaneous 8 12 7 10 114 36 - - 164 — - - - - - Total 76 96 71 100 398 439 - — 514 4 — — — - - 65 TABLE 22. 4.—Registered Workshops. Workshops, Workplaces, etc., on the Register (S. 131) at the end of the year. Number. Bakehouses (including Factory Bakehouses) 90 Eating houses and places where food is prepared for sale 574 Ice Cream Shops 205 Laundries 13 Dressmakers, Milliners, etc. 17 Tailoring 30 Brushmakers 11 Miscellaneous 1972 Total number of Workshops, Workplaces, etc., on Register 2912 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 5 Reports (of action taken) sent to H.M. Inspectors 5 Other - Underground Bakehouses (S. 101):— In use at end of the year 23 WOMEN'S WORKSHOPS. The supervision of the Women's Workshops was carried out by Miss Burrows to 4th February, 1936, and by Miss G. Briggs to the end of the year. 558 inspections and 490 re-inspections were made. The following defects were discovered, and 21 intimations and 4 statutory notices were served in order to obtain the abatement of the nuisances complained of:— Water apparatus defective 21 Roofs defective 2 Rooms dirty 37 Closet Pans and Traps 39 Miscellaneous nuisances 34 Total 133 All the above-mentioned nuisances were remedied. 66 RATS AND MICE DESTRUCTION ACT. I have received the following report from Mr. A. White:— During the year considerable progress has been made in rat repression in Southwark, and from observations made it would appear that the rat menace in the Borough is not so acute as formerly. No set procedure could be adopted in investigation, and each premises visited had to be dealt with in an individual manner according to the type of building, the locality in which it was situated, and the extent of infestation. The usual method employed is to eliminate every known factor until the point of ingress to the premises has been ascertained. This involves considerable work being carried out by the Council as the defect which causes the infestation is frequently found to be under the Council's highways. The system of investigation employed can be best illustrated when the rat-proofing of the Lion Street area was undertaken. The preliminary inspection revealed that it would be necessary for a considerable amount of work to be carried out. First, an examination of the Council's Sewer revealed that there were a number of disused unsealed junctions; these were then sealed off. Next, the frontage drains were exposed and several were found to be defective; these were repaired at the owners' cost. The rats were then very troublesome in many of the flats because their food and water supply had been cut off. Arrangements were then made with the owners of the premises to accommodate the tenants elsewhere. The floorings of the tenements were taken up and the rat runs were traced by means of the smoke machine. This test revealed that the rats were still coming from the drains. All main drains, branch drains and sewers in the immediate vicinity were again uncovered, when many defects were revealed. A considerable number of disused drains were found which had not been sealed off, also three disused brick barrel drains which had not been filled in. These defects were remedied. The owners then concreted the site affected, also the dust chutes, and rendered them rat-proof. 67 Many rats were caught during the time this work was in progress, and, since the completion of the work, no further complaints have been received. Two types of rat are found in the Borough—(1) the black rat (rattus rattus), also known as the house rat or ship rat, and (2) the brown rat (rattus norvegicus). The former type is prevalent in the northern parts of Southwark, and while the number of premises found to be infested was few, none were found in the southern districts. Considerable difficulty is experienced in exterminating this rat which generally establishes itself in walls, between floors and ceilings and in roofs. The older buildings are constructed in such a manner as to afford a suitable harbourage, while only the most modern buildings can be considered to be rat-proof and invulnerable to attack. The progress of the Clearance Areas Schemes, whereby old properties are being demolished, has a direct bearing on the prevalence and extermination of the black rat. Harbourage is destroyed and both breeding and feeding made impossible. The sewer or brown rat does not offer such a problem. After careful investigation, sometimes extending over long periods, its source is generally traced to either defective and disused drainage or defective sewers. In the older part of the Borough, there are a considerable number of old disused brick barrel drains of which there is no record. These drains are often the main cause of rats entering adjoining premises; when they are located they are removed, cut off or filled in. Owners of property have been called upon to carry out a considerable amount of work during the year. Where upon examination of the frontage drains under the Council's highways, defects have been located, the cost of the work has been charged against the owners. Further, it would appear from observation that the Council's sewer reconstruction programme is the most efficient method by which certain areas are being freed of rats. This is evidenced by the entire absence of rats in whole streets of houses, the sewers in the vicinity of which have been recently reconstructed. In conclusion, I beg to state that every effort is being made so as to ensure, as far as possible, a thoroughly efficient campaign against these pests throughout the Borough. 68 TABLE 23. RATS AND MICE (DESTRUCTION) ACT, 1919. Summary showing investigations and inspections made during the year 1936. Inspections:— By Inspector 421 By Rat Officer 431 Re-inspections:— By Inspector 925 By Rat Officer 2,602 Premises where rats were found 282 Action taken:— By Council's Official:— Poison Baits laid by Rat Officer 12,234 Wire Traps set 593 Break-back Traps set 1,751 By Occupiers:— Cats or Dogs 16 Premises freed of rats 231 Probable source:— Rat runs and holes 193 Defective Drains 107 Defective Sewers 29 Notices 4 During "Rat Week" 3,215 additional baits were laid in the Council's Sewers. 69 CLEANSING OF VERMINOUS ROOMS AND THEIR CONTENTS. During the year 1,513 verminous rooms were treated by the disinfecting staff and 44,620 articles of bedding, clothing, etc., were dealt with at the Council's Disinfecting Station. 503 Intimations and 152 Statutory Notices were served on various owners, and 809 verminous rooms were stripped. TABLE 24. Verminous Bedding, etc., Disinfected at the Council's Station during 1936. Articles. Disinfected. Destroyed. Beds 318 24 Palliasses 156 34 Bolsters and Pillows 472 33 Cushions 86 — Blankets 2,383 4 Sheets 765 4 Quilts 389 2 Articles of Clothing, etc. 40,050 59 Books 1 — Total 44,620 160 513 cwts. of bedding, household furniture, etc., were destroyed, and 2 cases of horsehair, 1 parcel, weighing 197 lbs., and 1 sack of clothing were also destroyed. 70 VERMINOUS PERSONS CLEANSED DURING 1936. During the year 7,344 persons were cleansed at the station in King James Street. Of these, under our agreement with the London County Council, were 5,297 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. 2,047 adults sent from the various common lodging houses and other places in our borough were cleansed during the year, as against 2,305 dealt with under the provisions of Section 125 of the Public Health (London) Act, 1936, in 1935. COLLIER'S RENTS MORTUARY. (Coroners' Court.) TABLE 25. During the year 336 bodies were received into the Mortuary:— Reasons bodies were brought to Mortuary. Bodies brought in, upon which Inquests or Post Mortems were held 180 Bodies brought in, upon which Inquests were considered unnecessary 147 Bodies brought in for convenience for which payment was made Bodies brought in where death had occurred from Infectious Disease 9 Total 336 SECTION D. Housing. 73 HOUSING. THE OVERCROWDING SURVEY. The Housing Act, 1935, in addition to setting up a new standard for measuring overcrowding, imposes upon every local authority the duty of carrying out an inspection of their district in order to ascertain what dwelling houses are overcrowded and to prepare and submit to the Minister a report showing the number of new houses required to abate the overcrowding in their district, and, unless they are satisfied that the required number of new houses will be otherwise provided, to prepare and submit to the Minister proposals for the provision thereof. The Overcrowding Standard. The overcrowding standard consists of two parts. Section 2 (1) (a) provides that there must be sufficient sleeping accommodation to secure proper sex separation. Section 2 (1) (b) is a standard of capacity, and in conjunction with Schedule I, fixes in relation to the accommodation in any particular house the maximum number of persons, irrespective of sex, who may be permitted to sleep in that house at one time. The First Schedule contains the following two tables:— Table I. Where a house consists of:— The permitted number of persons is:— (a) One room 2 (b) Two rooms 3 (c) Three rooms 5 (d) Four rooms 7* (e) Five rooms 10 (with an additional 2 in respect of each room in excess of five) (In using this Table, a room of less than 50 sq. ft. is not counted as a room.) Table II. Where a room in a house has a floor area of:— The permitted number of persons is:— (a) 110 sq. ft. or more 2 (b) 90 sq. ft. or more, but less than 110 1½ (c) 70 sq. ft. or more, but less than 90 1 (d) 50 sq. ft. or more, but less than 70 ½ (e) Under 50 sq. ft. Nil. 74 In applying Table II, each room of the size mentioned is to be reckoned as capable of accommodating the number set out in the Table, and the aggregate for all the rooms in the house is ascertained in this manner. The "Permitted Number" for the house is the aggregate number so obtained or the number given by Table I, whichever is the less. It will be seen that if all the rooms in a house to which the Tables are to be applied are of 110 square feet or more in area, only Table I will have to be applied. Table II is applied only when one or more of the rooms is between 50 and 110 square feet in size. In such a case the total number of persons which would be allowed under Table II according to the size of the rooms in the house is calculated. The number so reached will be the permitted number if it is less than the number given in Table I. In considering the application of the standard in relation to particular families it is to be noted:— (a) That in a house, part of which is sublet, the rooms occupied by the sub-tenant constitute a separate house; (b) That children between the ages of 1 and 10 years count as half a person, and that a child under 1 year does not count at all; (c) That, apart from the number of persons who may occupy a house, there is an overriding condition that the accommodation available for a particular family must be such that no two persons, both of 10 years of age or over of opposite sexes, except persons living together as husband and wife, must sleep in the same room; (d) That only rooms normally used in the locality for sleeping or living purposes are counted as rooms. (This excludes bathrooms, sculleries, etc.). The Survey. The survey, which was divided into two parts, was carried out by a temporary staff of 60 Enumerators, Survey Assistants and Clerical Assistants. First Stage (Form A). The first stage, carried out by the Enumerators, consisted of a house to house enquiry in order to ascertain (a) the number of families in each house, and (b) the number of persons in, and the number of rooms occupied by, each family. 75 The survey included every house in the Borough occupied, or of a suitable type for occupation, by the working classes, and excluded Metropolitan Police estates, certain Crown properties, public houses and those premises occupied wholly by shopkeepers, medical practitioners and dentists, etc. For the purpose of this part of the survey, each child under 10 years of age was counted as a half-person. The enumeration showed (1) the families which were overcrowded, irrespective of the sizes of the rooms occupied; (2) the families which were not overcrowded; and (3) the doubtful cases of overcrowding, i.e., those families which were not overcrowded when regard was had solely to the number of rooms occupied in accordance with Table I, but might be overcrowded when Table II, which takes into account the sizes of the rooms, was applied. These doubtful cases were ascertained by comparison of the information obtained with the following Table :— Number of rooms in letting. Maximum permitted number (Table I). Maximum number reduced by l-5th to the nearest half. 1 2 3 4 5 6 7 8 9 10 11 12 2 3 5 7½ 10 12 14 16 18 20 22 24 1½ 2½ 4 6 8 9½ 11 13½ 14½ 16 17½ 19 In applying this Table it was assumed that if the "equivalent number" of persons (i.e., counting each child under 10 as half a person) in a dwelling was less than the reduced permitted number, such a dwelling would not be overcrowded on the standard of Table II. If, however, the equivalent number of persons was equal to, or in excess of, the reduced permitted number and the family was not overcrowded on the standard of Table I, the case was considered doubtful. The analysis of the information obtained as a result of the preliminary survey revealed 3,138 definitely overcrowded families, 29,337 definitely not overcrowded families and 8,733 possibly overcrowded families occupying 7,711 houses. 76 Second Stage (Form B). The second stage of the survey for the purpose of measuring all the rooms in the houses in which these "possible" cases were found, was carried out by the survey assistants and, as it was necessary for them to enter the houses, each was issued with a written authority signed by the Town Clerk. In addition to the room measurements, more detailed information was obtained with regard to the population, i.e., the number of persons living as married couples, the number of males and females over 10 years of age and the ages to the nearest month of all children under 10. A comparison with Table II of the information thus obtained disclosed a further 958 overcrowded families, 14 of which were found to infringe Section 2 (1) (a), i.e., two persons over 10 of opposite sexes and not living together as husband and wife occupying one room. The final figures showed that during the course of the survey 27,810 premises were visited and particulars obtained in respect of 41,208 families, 4,096 of which were found to be overcrowded and 37,112 not overcrowded. The whole of the information obtained was tabulated on Form C, which showed the distribution of the families concerned, in relation to the size of the family and the size of the accommodation occupied. The following Tables show the result in terms of the sizes of the dwellings for the Borough as a whole, and each of the 10 Wards therein, together with the percentage of overcrowded families in relation to the total families. The Borough. Percentage Overcrowded, 9.94. Lettings. Size. Families. Total. Overcrowded. Not Overcrowded. One room 518 5,733 6,251 Two rooms 2,042 9,711 11,753 Three rooms 1,170 11,464 12,634 Four rooms 336 6,532 6,868 Five rooms 30 3,235 3,265 Six rooms or more - 437 437 Total 4,096 37,112 41,208 77 St. Mary's Ward. Percentage Overcrowded, 7.8. Lettings. Size. Families. Total. Overcrowded . Not Overcrowded . One room 38 508 546 Two rooms 218 1,288 1,506 Three rooms 165 2,332 2,497 Four rooms 38 966 1,004 Five rooms - 274 274 Six rooms or more - 54 54 Total 459 5,422 5,881 St. Paul's Ward. Percentage Overcrowded, 3.9. Lettings. Size. Families. Total. Overcrowded. Not Overcrowded. One room 39 706 745 Two rooms 69 973 1,042 Three rooms 60 1,139 1,199 Four rooms 26 1 ,179 1,205 Five rooms 3 716 719 Six rooms or more — 87 87 Total 197 4,800 4,997 St. Peter s Ward. Percentage Overcrowded, 6.2. Lettings. Size. Families. Total. Overcrowded. Not Overcrowded . One room 57 757 814 Two rooms 175 1,403 1,578 Three rooms 101 2,016 2,117 Four rooms 59 1,112 1,171 Five rooms 7 679 686 Six rooms or more — 47 47 Total 399 6,014 6,413 78 St. John's Ward. Percentage Overcrowded, 10.7. Lettings. Size. Families. Total. Overcrowded. Not Overcrowded. One room 81 805 886 Two rooms 361 1,758 2,119 Three rooms 200 1,841 2,041 Four rooms 59 1,057 1,116 Five rooms 4 361 365 Six rooms or more — 37 37 Total 705 5,859 6,564 Trinity Ward. Percentage Overcrowded, 9.4. Lettings. Size. Families. Total. Overcrowded. Not Overcrowded. One room 43 411 454 Two rooms 128 573 701 Three rooms 71 668 739 Four rooms 34 527 561 Five rooms 1 416 417 Six rooms or more — 77 77 Total 277 2,672 2,949 St. Michael s Ward. Percentage Overcrowded, 17.5. Lettings. Size. Families. Total. Overcrowded. Not Overcrowded. One room 75 585 660 Two rooms 438 1,298 1,736 Three rooms 191 1,053 1,244 Four rooms 32 354 386 Five rooms 6 182 188 Six rooms or more - 15 15 Total 742 3,487 4,229 79 St. Jude's Ward. Percentage Overcrowded, 8.7. Lettings. Size. Families. Total. Overcrowded . Not Overcrowded . One room 83 1,033 1,116 Two rooms 123 837 960 Three rooms 85 713 798 Four rooms 14 381 395 Five rooms 2 205 207 Six rooms or more — 54 54 Total 307 3,223 3,530 St. George's Ward. Percentage Overcrowded, 15.9. Lettings. Size. Families. Total. Overcrowded. Not Overcrowded . One room 43 300 343 Two rooms 307 888 1,195 Three rooms 194 1,132 1,326 Four rooms 39 542 581 Five rooms 5 234 239 Six rooms or more — 15 15 Total 588 3,111 3,699 Christchurch Ward. Percentage Overcrowded, 12.8. Lettings. Size. Families. Total. Overcrowded. Not Overcrowded. One room 28 377 405 Two rooms 90 312 402 Three rooms 39 214 253 Four rooms 10 143 153 Five rooms 66 66 Six rooms or more 23 23 Total 167 1,135 1,302 80 St. Saviour's Ward. Percentage Overcrowded, 15.5. Lettings. Size. Families. Total. Overcrowded . Not Overcrowded. One room 31 251 282 Two rooms 133 381 514 Three rooms 64 356 420 Four rooms 25 271 296 Five rooms 2 102 104 Six rooms or more — 28 28 Total 255 1,389 1,644 It will be seen that no case of overcrowding was found in a dwelling containing six or more rooms, and that the greatest number of overcrowded families occupied dwellings having two or three rooms; 3,212 or approximately 78 per cent, of the total. Nearly 35 per cent, of the total overcrowded families were living in tenement buildings, and, in St. Michael's Ward, where this type of dwelling predominates, the percentage of overcrowding was 17.5 as compared with 9.94 for the whole Borough. Of the total number of overcrowded families 67 per cent, had equivalent populations of to 6 persons, and 449 families were occupying dwellings which will be dealt with under Clearance, Demolition and Closing Orders. The overcrowded families, with the exception of those in tenement buildings, did not appear to be confined to any particular areas and were found chiefly in dwellings which, by reason of their size, lend themselves to sub-letting. The most severe cases of overcrowding in the various sizes of letting were:— One room 7 equated persons. Two rooms 9½ ,, ,, Three rooms 11½ ,, Four rooms 11 Five rooms 12½ ,, 81 Of the 37,112 families found to be not overcrowded, 3,664 or 8.9 per cent, were occupying accommodation of the minimum size required by the Act ; of this number 286 families will, by reason of children attaining the age of one or ten years, become overcrowded within the next two years. The Estimate of Additional Accommodation required to Abate the Overcrowding. In estimating the amount of additional accommodation to be provided several factors had to be taken into consideration, among them being (a) the number of dwellings vacant at the time of the survey which might be utilised for rehousing the overcrowded families. In this connection it should be borne in mind that there must always be a margin of vacant accommodation owing to the changes in tenancy, and that this margin could not be taken into account as being available for the relief of overcrowding. No reliable statistics were available to determine just what this margin should be, but experience suggests that it is probably 2 per cent, of the total accommodation in the Borough. As, however, the amount of accommodation found to be vacant was less than 2 per cent., it was disregarded in estimating the amount of additional accommodation required. (6) The number of dwellings to be vacated by the overcrowded families which would be available for re-housing the smaller overcrowded families, (c) The number of overcrowded families for whom accommodation would be provided by re-housing operations under the Housing Act, 1930; and (d) the number of rooms which, combined with others would be available to increase the letting in a house where more than one overcrowded family was found. In order that the estimates submitted by the various boroughs should be calculated on a uniform basis, the London County Council agreed with the Metropolitan Boroughs Standing Joint Committee a method for calculating from the information obtained during the survey, the amount of additional accommodation required. This method may be summarised as follows:— (1) The accommodation required for re-housing all the families overcrowded on the standard of Table I in the First Schedule to the Housing Act, 1935, was determined from the information obtained by the completion of Form C. (2) As the number of 1-room and 2-room dwellings to be vacated by overcrowded families will be considerably in excess of the number of such dwellings required, no provision was made for additional dwellings of these sizes. 82 (3) The number of rooms to be vacated in dwellings of three or more rooms occupied by overcrowded families plus one-half of the number of excess rooms in 1-room and 2-room dwellings, as above, was used in calculating on the standard of Table I, the extent to which the existing accommodation would provide dwellings of the various sizes of three or more rooms required. (4) The difference between (1) and (2) above, representing the amount of new accommodation in dwellings of three or more rooms to be provided on the standard of Table I, was reduced by the number of dwellings to be provided by re-housing operations under the 1930 Act, and then converted into the requirements on the standard of 1½ persons a room in accordance with a table based on the 1931 census figure. The estimate, whilst being an approximate and, to a large extent, a theoretical one, was considered sufficient to form the basis of the first re-housing proposals. Two of the factors likely to influence the estimate are (1) the difficulty in practice of re-allocating the vacated accommodation, involving, as it does, the maximum co-operation of the landlords, and (2) the possible reluctance of landlords to let their dwellings to large families. The survey, tabulation and estimate were all completed, and the results forwarded to the London County Council within the specified time, and the staff engaged in connection therewith carried out their duties in a very satisfactory manner. A noteworthy feature of the survey was that it was carried out with so little friction between the staff and the inhabitants of the Borough, particularly in view of the fact that, in numerous instances, tenants who were out at work during the daytime, had to be visited in the evenings or on Saturday afternoons in order that the necessary information could be obtained. There were, of course, one or two troublesome cases, but generally there was a genuine desire on the part of the people to assist the enumerators and survey assistants in their task. S3 Distribution of working-class families in relation to size of family and size of dwelling occupied. Size of family "equivalent number'' of persons. Size of dwelling occupied, in terms of the maximum "equivalent numb; r" of persons permitted to occupy it without causing it to be overcrowded Totals of Families. *0 *½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 and over. Overcrowded. Not Over crowded. Total. 1 - 21 101 3449 1121 1285 322 2 494 16 67 1 127 2 4 9 21 — 1 14 — — 2 — — 1 5 21 7044 7065 1½ — — — 5 27 62 10 — 12 1 1 — 2 1 - - 1 - - - - - - - - 122 122 2 — 3 16 95 1044 3602 1247 10 2973 50 401 9 990 13 28 50 146 — 9 69 4 — 5 — 2 — 14 +l28 10652 10780 2½ — — 1 124 73 53 1523 10 1148 23 151 4 360 4 6 10 31 2 7 9 — — 4 — — - 2 198 3347 3545 3 — — 2 63 45 41 1607 10 2540 72 390 17 1306 31 56 91 313 3 6 173 4 28 1 3 — 22 151 6673 6824 3½ — — — 14 9 393 156] 7 598 31 147 2 299 7 18 33 54 — — 22 4 - 3 — — — 4 572 1229 1801 4 — — 1 11 10 473 204 23 101 134 1176 23 1033 28 58 119 374 15 19 226 14 1 20 2 3 1 22 722 3369 4091 4½ — — — 5 1 144 44 3 17 38 274 10 234 5 11 27 68 3 4 28 5 — 6 — — — 6 214 719 933 5 — — - 1 2 212 68 8 26 59 587 17 669 25 29 56 3.8 10 13 232 8 3 40 10 2 — 24 376 2053 2429 5½ — — - 1 - 71 20 1 187 8 65 7 165 9 17 20 58 2 3 52 — — 4 3 — — 3 353 343 696 6 - - — - 1 88 16 6 267 19 91 18 45 43 73 133 181 5 8 137 14 — 26 4 1 1 31 510 702 1212 6½ - - - - 27 10 — 97 6 21 4 20 _15 19 50 69 4 1 39 — 1 4 — — — 3 185 205 390 7 — — - 1 31 1 — 90 7 32 12 17 19 30 71 97 5 5 78 7 1 17 4 — — 21 210 336 546 7½ — - — - — 13 5 - 30 1 9 3 8 3 12 19 39 4 2 23 — 1 7 — 1 — 3 84 99 183 8 — — — — — 12 1 1 42 2 9 — 84 6 10 12 5 7 5 45 7 — 8 1 - 13 179 92 271 8½ — — — — — 5 — — 14 — 3 — 20 2 4 4 2 - 3 27 3 1 3 1 - - 2 63 40 103 9 — — — — — 4 — — 14 — 1 1 24 1 1 9 1 2 3 32 6 1 3 1 — — 4 58 50 108 9½ - — — - — 2 1 — 4 — — — 12 — 3 1 1 1 2 5 4 3 2 — — — 1 27 15 42 10 — - - - - - - - 5 - - - 10 - - 2 3 — 2 4 2 2 6 1 1 — 2 26 14 40 10½ - - - - - - - - - - - - - - - - - - - - - - - 7 — 7 11 -- - - - - - - - - - - - 2 - - - 2 — 1 1 1 - 1 - — - 7 2 9 11½ - - - - - - - - - - - - - - - - 1 - - - - - - - - 2 — 2 12 - - - - - - - - - - - - - - - -- 1 - - - 1 - - - - 1 2 1 3 12½ - - - - - - - - - - - - - - - - 1 - - - - - - - - 2 1 2 3 13 and over - - - - - - - - - - - - - - - - - - - - - - - — - - 3 — 3 3 Totals of Dwellings. Overcrowded — 24 20 318 +l56 1516 526 42 794 102 232 38 209 31 30 28 15 3 5 5 2 - - - - - - +4096 - Not Overcrowded — — 101 3454 2178 5002 4709 39 7866 365 3194 90 5230 183 349 688 1785 60 89 1211 82 14 189 | 28 13 4 189 37112 - Total — 24 121 3772 2334 6518 5235 81 8660 467 3426 128 5439 214 379 716 1800 63 94 1216 84 14 189 28 13 4 189 41208 *0=a dwelling of 1 room under 50 square feet : ½=a dwelling of 1 room between 50 and 70 square feet, + Including 14 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 84 Table showing the percentage of overcrowding in each of the Metropolitan Boroughs. Borough. Total Families. Overcrowded. Percentage Overcrowded. Battersea 40,863 1,968 4.8 Bermondsey 27,502 3,163 11.5 Bethnal Green 26,093 3,894 14.9 Camberwell 59,722 2,950 4.9 Chelsea 8,496 749 8.8 Deptford 29,724 1,317 4.4 Finsbury 16,097 2,458 15.3 Fulham 38,882 1,795 4.6 Greenwich 20,542 1,091 5.3 Hackney 60,899 2,651 4.3 Hammersmith 35,286 1,728 4.9 Hampstead 17,917 449 2.5 Holborn 5,858 700 12.0 Islington 89,428 6,757 7.5 Kensington 24,296 2,529 10.4 Lambeth 76,924 3,881 4.9 Lewisham 35,182 1,057 3.0 Paddington 27,212 1,998 7.3 Poplar 37,102 4,080 11.0 St. Marylebone 16,009 1,619 10.1 St. Pancras 48,210 4,464 9.3 Shored itch 22,595 3,898 17.2 Southwark 41,208 4,096 9.9 Stepney 49,317 7,632 15.5 Stoke Newington 12,149 462 3.8 Wandsworth 81,365 1,801 2.2 Westminster 26,136 1,083 4.1 Woolwich 39,621 683 1.7 County of London 1,014,633 70,953 7.0 85 Table showing the numbers and sizes of additional dwellings required after deducting those overcrowded dwellings likely to be dealt with under Part I (clearance area procedure), and Part II (closing or demolition orders) of the Housing Act, 1930:— (a) On the standard of Table I in the First Schedule to the 1935 Act: (b) On the standard of If persons a room. The number and sizes of the dwellings required on the standard of 1½ persons per room are based on a Table prepared by the L.C.C. from figures given in the Census report of 1931. Additional dwellings required on the standard of Table I in the First Schedule to the 1935 Act. Additional dwellings required on the standard of 1½ persons a room. Size. Number. 3 rooms. 4 rooms. 5 rooms. 6 rooms. 7 rooms. 8 rooms. 9 rooms. 10 rooms. Total. 3 rooms 785 628 118 39 — — — — — 785 4 rooms 557 — 223 306 28 — — — — 557 5 rooms 147 — _ 29 52 59 7 — — 147 6 rooms 8 — — — — 2 4 2 — 8 7 rooms 1 — — — — — 1 — 1 Total 1,498 628 341 374 80 61 11 3 — 1,498 80 During the year under review, and since the completion of the survey, 2.39 additional cases were discovered, making a total of 4,335 cases. In the majority of the new cases, the overcrowding was due to children attaining the age of one or ten years. PREVENTION AND ABATEMENT OF OVERCROWDING. Overcrowding is not yet an offence in this Borough, but the following steps were taken to ensure, as far as possible, that dwellings vacated by overcrowded families, were not re-let so as to cause fresh overcrowding to ensue. Before any case was recommended for re-housing, the person responsible for letting was informed of the permitted number of persons for the dwelling occupied, and was asked to give an assurance that, when vacated, it would not be re-let in an overcrowded condition. On the vacation of the premises, enquiries were made to ascertain the number of persons taking over the accommodation, and the landlords advised to re-let to a family in which the number of persons equated to less than the permitted number for the dwelling. This method has proved effective during the past year, and in only one instance was a vacated dwelling found to be re-overcrowded, and this where the incoming tenant gave false information regarding the number of persons in the family. This tenant promised to seek other accommodation, and the premises are being kept under observation. After the removal of an overcrowded family from a house in which two or more such cases were found, the landlord was asked to offer the vacated accommodation to the remaining families. Unfortunately, except where the owners or owners' agents were responsible for letting, this proved unsuccessful, as in houses, part or parts of which were sub-let by the principal tenant, the offers of additional accommodation were generally turned down on the grounds that the extra rent could not be afforded. 87 609 cases of overcrowding were relieved during the year, as follows :— Re-housed by the L.C.C. :— By way of slum clearance, etc. 127 As overcrowded and other cases 287 Re-housed by Borough Council:— By way of slum clearance 24 As overcrowded cases 1 Re-housed or provided with additional accommodation by landlords 34 By domestic re-arrangement, deaths, marriages, etc. 72 Families moved away 64 Total 609 130 of these cases were in dwellings belonging to the London County Council, and one was in a dwelling belonging to the Borough Council. During the past year it has become evident that when overcrowding becomes an offence in this Borough, the services of an outdoor enquiry officer will be necessary, if overcrowding is to be given the attention necessary for its effective control. HOUSING ACT, 1930, SECTION 1. The following areas were represented for Clearance and Re-housing Schemes during the year under consideration:— Loman Street Area. (6 Houses.) Represented to Housing Committee, 11th March, 1936. Hemp Row Area No. 1. (8 Houses.) Represented to Housing Committee, 13th May, 1936. Hemp Row Area No. 2. (7 Houses.) Represented to Housing Committee, 13th May, 1936. Bar oil s Place Area. (24 Houses.) Clearance Order made by Council, 6th May, 1936. Kinglake Street Area. (139 Houses.) Represented to Housing Committee, 13th May, 1936. Tower Street Area. (24 Houses.) Represented, 19th June, 1936. Valentine Place Area. (30 Houses.) Represented, 30th September, 1936. 88 Meymott Street Area. (3 Houses.) Represented, 30th September, 1936. Bear Lane Area (A). (3 Houses.) Represented, 18th November, 1936. Bear Lane Area (B). (2 Houses.) Represented 18th November, 1936. HOUSING ACT, 1930, SECTION 19. The following properties were represented for demolition during the vear under consideration :— 70, Orange Street. (Closed.) 7, Risborough Street. (Closed.) 1, Alberta Street. (Undertaking to be made fit.) 2, Eltham Street. 4, Eltham Street. (Closed.) 59, Burrell Street. 15, Kingston Street. (Undertaking to be made fit.) 101, Barlow Street. (Undertaking to be made fit.) 58, Collingwood Street. (Closed.) 47, Tiverton Street. (Undertaking not to re-let.) 105, Blackfriars Road. (Closed.) 7a, Colliers Rents. 9, Zoar Street. 30, Zoar Street. HOUSING ACT, 1935, SECTION 84. During 1936, 53 underground rooms or parts of premises were represented for Closing Orders, 11 of which have been closed, and 3 made fit. 37, Lant Street. (Closed.) 67, Swan Street. (Closed.) 85, Gurney Street. (Closed.) 147-9, Newington Causeway. (Closed.) 265, Union Street. (Closed.) 20, Sturge Street. (Closed.) 6, Gladstone Street. (Rendered fit.) 8, Gladstone Street. (Rendered fit.) 39, Newington Crescent. 49, Gurney Street. 89 65, Gurney Street. 71, Gurney Street. 217, Walworth Road. (Closed.) 20, Carter Street. (Made fit.) 14, Gladstone Street. (Closed.) 139, Great Dover Street. (Closed.) 13, Union Square. (Closed.) 14, Union Square. (Closed.) 8, Union Square. (Closed.) 40, Lambeth Road. 20, Great Charlotte Street. (Undertaking not to be re-let until made fit.) 19, De Laune Street. 24, Elsted Street. (Closed.) 6, Colnbrook Street. (Closed.) 37, Carter Street. 55, Swan Street. (Closed.) 18, Dodson Street. 15, Queen's Buildings, Montague Street. 51, Gurney Street. 92, Penrose Street. 46D, Queen's Buildings. 36, Cavour Street. 7, Dante Road. 21, Sturge Street. 9, Dodson Street. 11 & 11a, Blackwood Street. (Closed.) 30, Great Charlotte Street. 13, Collinson Street. 32, Camberwell Gate. 10, Lambeth Road. (Demolished.) 47, Carter Street. 22, Newington Crescent. 78, Blackfriars Road. 30, Marshall Street. 11, Faunce Street. 27, Dante Road. 125, Great Dover Street. 10, Gladstone Street. 1, Brockham Street. 23, Queen's Row. 3, De Laune Street. 31, Horsman Street. 148, Walworth Road. 90 HOUSING CONSOLIDATED REGULATIONS, 1925. TABLE 26. The following localities were inspected and recorded under the above-mentioned Regulations during the year:— Alberta Cottages. Marsland Road. Alberta Street. Meadow Row. Alsace Street. Milton House. Alpha Square. Minnow Street. Arcadia. Northampton Street. Arch Street Buildings. Old Kent Road. Beresford Street. Oswin Street. Bath Street. Park Street. Blackfriars Road. Peabody Square. Burman Street. Pineapple Buildings. Cardinal Bourne Street. Runham Street. Chatteris Square. St. George's Mansions. Dunton Road. Sedan Street. Earl Street. Shorncliffe Road. Emerson Place. Silvester Buildings. Garden Row. Silvester Street. Great Dover Street. Southwark Bridge Road. Hendre Road. Sumner Street. Lebanon Street. Tabard Street. Marcia Road. Valentine Row. Marshall's Buildings. Webber Street. Marshall Street. 91 TABLE 27. HOUSING. 1. Inspection of Dwelling Houses:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,990 (b) Number of inspections made for the purpose 7,456 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 .. 979 (6) Number of inspections made for the purpose 979 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 287 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 5,608 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 its officers Nil 3. Action under Statutory Powers during the Year:— A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 471 (2) Number of dwelling houses which were rendered fit after service of forma] notices :— (a) by owners 536 (b) By Local Authority in default of owners .. — 92 TABLE 27.—continued. B. Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2.418 (2) Number of dwelling houses in which defects were remedied after service of formal and informal notices:— (a) by owners 2,723 (b) by Local Authority in default of owners .. — C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made 16 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 5 D. Proceedings under Section 20 of the Housing Act, 1930 and Section 84 of the Housing Act, 1935 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 53 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 3 (3) Number occupied but unfit 2,349 4. Housing Act, 1935—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 3,727 (2) Number of families dwelling therein 3,727 (3) Number of persons dwelling therein 16,500 approx. (b) Number of new cases of overcrowding reported during the year 239 93 TABLE 27—continued. (c) (1) Number of cases of overcrowding relieved during the year 609 (2) Number of persons concerned in such cases 2,655 (d) Particulars of any cases in which dwelling houses have again become overcrowded (See page 88, para. 4) 1 TENEMENT BUILDINGS. There are 154 tenement buildings in the Borough of Southwark, containing approximately 9,014 dwellings. Some of these are of modern design and require no comment; others are badly planned, congested and badly arranged, both externally and internally, resulting in numerous cases in dark staircases and landings, and frequently dark rooms which have to be continuously lighted by artificial means. Many of these tenements have common waterclosets, wash-houses, sinks and water supplies on the landings, all of which are supposed to be kept clean by the tenants using them. One of the most striking features of these buildings is the lack of cleanliness of many of these common staircases, passages, landings, wash-houses, etc. On enquiry, we found that this was frequently due to the lack of proper supervision on the part of the caretaker, and the failure to enforce the regulations made by the owners governing these buildings. Another feature which was most noticeable, where lack of supervision occurred, was the damage and defacement of the walls, etc., by children and other persons. If owners would insist on cleansing being carried out according to their rules, a very great improvement could be quickly effected. It was found that where locks were provided for the waterclosets, a greater degree of cleanliness prevailed. It was also found that in many of these dwellings the owners had a systematic method of cleansing and decorating the rooms; in others there was a lack of any such system, and in these cases the landlord usually depended upon complaints from the tenants, or else relied entirely on sanitary notices being served. These latter are definitely the worst type of landlords, and such buildings quickly depreciate and require constant supervision. 94 On the other hand the landlord was not to blame in all cases; even where we found that the required cleansing and decoration took place we came across bad tenants who were not only dirty in themselves, but committed wilful damage to the property. This type of tenant, fortunately, is in the minority, but such do exist, and the neglect of their flats is not due to a bad landlord, but to a bad tenant; these people are a problem unto themselves. It may be well to indicate that after each visit, action was taken in one way or another to deal with the defects found, and already a large number of improvements have been effected. UNDERGROUND ROOMS. As a result of new legislation dealing with underground rooms in the Borough, a survey of these rooms has been made. The number of underground rooms which do not comply with the Council's Regulations, and which will have to be dealt with under the Housing Act totals 2,349. Of this number, 1,636 can be rendered fit for human habitation, if certain alterations are made, whilst the remainder are totally unfit. The work of sub-dividing these rooms into those which can be closed immediately without causing inconvenience to the tenants or overcrowding the premises, and those occupied by persons for whom fresh accommodation will have to be found, is now proceeding. OUINN SQUARE. I have received the following report from Mr. Hattersley:— During the year I made a comprehensive inspection of these buildings with a view to a general improvement, and eight schedules were served (one on each block) for the entire reconstruction of the drainage system, new sinks, food cupboards, etc. The buildings consist of 234 tenements in eight blocks of six floors, one floor semi-basement; these semi-basement rooms comply with the Council's underground rooms regulations. There are 32 three-roomed and 128 two-roomed tenements, and 74 single room lettings. 95 With the exception of the single room lettings, the sinks are fitted in the living rooms; the rendering over and under the sinks is not impervious and in a very bad condition. Many of the sinks are cracked and worn. The sink waste pipes and the soil pipes are old and in a defective condition. Some of the tenements have a food cupboard provided, but these are not ventilated to the external air. All the tenements are supplied with means of cooking, either by closed or open range, and a gas cooker. The majority of the stoves are in a defective condition. The structure of the buildings is very good although the internal arrangement is bad and out of date and will, unless drastic alterations are made, soon become unlettable, as there are no separate amenities provided for each tenement. There is evidence of dampness in the basement walls and in some of the flank walls. The roofs show signs of leakage. There is also much evidence of vermin, and many of the tenants have painted the walls in order to prevent further invasion of the pest. TABLE 28. Sanitary Works completed under the Housing Acts, during the year 1936. Formal Notices complied with 536 Chimney flues repaired 35 Brickwork and pointing repaired 525 Window sash repaired 255 New sash lines 400 Doors and woodwork repaired 1765 Stair treads and risers repaired 325 Floors repaired 170 Provision of ventilated food storage 15 Plaster repaired 695 Stove and fireplace repaired 690 Copper repaired 115 Roofs repaired 425 Sinks provided 190 Ceilings repaired 360 W.C.s amended 210 Dampness abated 115 Paving amended 280 Light and ventilation provided 364 SECTION E. Inspection and Supervision of Food. 99 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., and the standard of cleanliness has been high. 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 358 oxen, 2,692 sheep and 699 pigs were slaughtered. The total weight found to be unsound was 1 ton 3 cwts. 3 qrs. 16 lbs., of which 8 cwts. 2 qrs. 14 lbs. were destroyed on premises where found, and 15 cwts. 1 qr. 2 lbs. were destroyed at the Council's Depot. PUBLIC HEALTH (LONDON) ACT, 1936, SECTION 187. 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 205 478 Butchers' premises 85 982 Provision Dealers 61 737 100 I have received the following report from Mr. Syms:— During the period under review the Ice Cream Trade has suffered from the effects of a bad season. Several makers have reverted to Sale only, obtaining their supplies from the wholesale manufacturers. The number of Itinerant Vendors has increased but as this commodity is now sold mostly in cartons or wrapped packets, the supervision required is small. The practice of cutting the packet cream to allow serving halfpenny portions is impossible to stop. I have stressed the necessity for a special knife, to be kept in the top of the conservator when not in use and to be sterilized in boiling water each day. Towards the end of the season examination of these knives revealed that a marked improvement had been made in their condition. At the close of the year the Register reveals the following facts:— Premises registered for Manufacture and Sale 92 Premises registered during 1936 6 Discontinued during 1936 15 Premises registered for Sale 96 Premises registered during 1936 11 Discontinued during 1936 25 Periodical inspection has been carried out and with a few exceptions the trade is conducted on hygienic lines. Where conditions were found unsatisfactory immediate steps were taken to ensure the necessary alteration. The power to close unsatisfactory Ice Cream premises is a very heplful factor when dealing with such cases. The importance of sterilization of all equipment and plant has been stressed and no case of serious neglect was found during my inspections. Modern equipment, both for manufacture and storage has been considerably increased and the advance in this connection among the Italian Trade is marked. The former method of hand churning had many disadvantages and was fraught with danger in regard to contamination by careless handling. The wholesale factory rebuilt last year has been in full commission during the year. Alteration and improvement of the mechanical plant is still in progress. The management have from time to time taken samples for bacteriological examination, to ascertain that the standard of purity was being maintained. The Cream Room and Packing Room are now entirely separated from the other sections of the business. 101 During the year 16 makers' premises have been improved, 65 cleansed and 39 have had refrigerating plant installed. Of the 53 who still use the ice and salt method the majority have now electrically driven motor churns. Among those who are engaged in the sale of Ice Cream 84 have either refrigerating plant or dry ice conservators. Only 12 use the old method of salt and ice tubs, these are entirely engaged in the sale of Italian Ice Cream. PREMISES WHERE FOOD IS PREPARED. Regular quarterly inspection of all premises where food is prepared and sold has been carried out during the year. Special attention has been given to storage of food and in many cases the modern refrigerator has been installed. Speaking generally the trade is conducted on hygienic lines and clean food is served to the public. The following is a summary of the premises under inspection:— Restaurants in Licensed Premises 72 Restaurants in Unlicensed Premises 27 Coffee Houses 102 Cafes 95 Stalls 15 Other Premises 25 43 premises have been closed or the trade discontinued and 54 have been either newly established or old premises re-opened. The smaller Eating Houses have taken advantage of the opportunity to instal at reasonable cost the gas refrigerators and small gas geysers now on the market. The record cards show the following facts:— Reconstructed. Improved. Cleansed. Refrigerators. P.H. Restaurants 5 10 21 8 Restaurants — 4 10 19 Coffee Houses 2 25 52 43 Cafes 4 14 22 24 Other Premises 2 4 5 9 102 Fried Fish Premises. 54 promises are on the Register, 7 have been closed during the year and 6 have been opened. Of these 3 were formerly used as Fried Fish Shops. The reconstruction of the old type of shops proceeds slowly. The following represents the work carried out during the year:— Reconstructed 5 Improved 4 Cleansed 9 Cold storage is now provided in 20 shops and electrically driven potato peelers arc installed in 48. Fish Curers' Premises. 33 premises are on the Register, two having been closed during the year. One has been reconstructed, one altered and five have installed cold storage. As a local trade the business of Fish Curing is rapidly decreasing, the quantity of fish smoked has been small in comparison with other years. In general the removal of offal has been conducted in a satisfactory manner and no complaints have been received. The periodical cleansing of fish shops is carried out at frequent intervals and is invariably done without the service of notices. FOOD FACTORIES. Factories where food is prepared are inspected periodically. During the year two new food factories have been established on the riverside. The factories supply many retail Butchers' shops all over the country. BACON STOVES. There are five bacon stoves in the Borough which are subject to periodical inspection. Complaints were received in regard to smoke and odour; which were dealt with. 103 "MERCHANDISE MARKS'' ACT, 1926. Cases of imported fowls without the metal disc in the wing were found in a Butcher's shop and the matter was reported to the Ministry of Agriculture. 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. PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925. PUBLIC HEALTH (IMPORTED FOOD) AMENDMENT REGULATIONS, 1933. The Council is a Riparian Authority, and is responsible for the administration of these Regulations over an area on the south side of the river from the premises of the Union Cold Storage Company, Blackfriars Bridge, to the west side of London Bridge. The following are some of the items which the food inspectors have had to deal with during the year:— Frozen Pigs. Several cases of imported pigs were found to be affected with a greenish discolouration of the glands. Samples of these were submitted to the Ministry of Health's laboratory but the presence of tubercle bacilli was not detected. Imported Mutton. A 5 per cent. examination of all imported carcases of mutton and 100 per cent. of all pieces is still being carried out; the number found affected with caseous lymphadenitis is steadily diminishing. 104 Fruit. A large wharf has been opened for dealing with fruit from overseas, and a parcel of 534 cases of pineapples from Brazil was found to be unsound and destroyed. 4,388 boxes of pears from South America were also found unfit for food on arrival; these were also destroyed. Gas Storage of Fruit. Large quantities of home-grown apples are now being kept by means of gas storage in one of our riverside food premises. Lard. A quantity of lard was found to be damaged by water. The damaged portion was released for technical purposes. Flour. 2,000 bags of flour were placed under "stop notice" owing to damage from coal dust working through from the bunkers by stress of weather. A portion of the consignment was found to be free from contamination and released, the damaged portion was released for animal food. Imported Bacon. Bales of imported bacon were found to be damaged and discoloured on the skin nearest the canvas wrappings. The stained skin was cut off and the flesh was found to be in good order and was accordingly released. Official Certificates. During the year Circulars 1534, 1566 and 1585 have been issued by the Ministry of Health, recognising official certificates from the following countries Country. Purpose. Second Schedule. Belgium (b) Danzig (b) France (b) Madagascar and Dependencies (a), (b), (c) French West Africa (a), (b), (c) Yugo-Slavia (b) Iceland (a), (c) Roumania (b) Union of South Africa (a), (c) Commonwealth of Australia (a), (c) 105 PUBLIC HEALTH (PRESERVATIVES IN FOOD) REGULATIONS, 1925. Glace Cherries. Samples of glace cherries were found to contain copper. I immediately took the matter up with the firm concerned, and they informed the manufacturers. On investigation it was found that the presence of copper was due to defective boilers, these were immediately remedied and samples taken since have shewn no evidence of copper. Silds and Sardines. Samples taken were found to contain lead, and all exporting countries of this product were notified, with the result that considerable improvement has been noted during the last few months. Strict supervision is being exercised over these commodities, and samples are taken frequently. 151 samples were taken during the year on the Wharves and submitted to the Borough Analyst for examination:— Wafers Faint traces of Boron compounds amounting to 160 parts per million (or 1.1 grains to the pound) expressed as Boric acid. It was considered that Boric acid had not been added to the sample as the very small amount found was utterly useless for preservative purposes. Salmon Roe The sample contained very faint traces of Boron compounds. It was considered that Boric acid had not been added to the sample as the very small amount was utterly useless for preservative purposes. Egg Yolk Boracic compounds were not found. Egg Yolk Boracic compounds were not found. Marmalade Tin, not more than 0.7 grain per pound; Sulphites, Boric acid, Salicylic acid, Benzoic acid not found. Canned Oranges Sulphites, Boric acid, Salicylic acid. Benzoic acid not found. 106 Canned Crab Sulphites, Boric acid not found. Canned Oranges Sulphites, Boric acid, Salicylic acid, Benzoic acid not found. Canned Oranges Tin, not more than 0.4 grain per pound; Sulphites, Boric acid, Salicylic acid, Benzoic acid not found. Canned Mandarin Oranges Sulphites, Boric acid, Salicylic acid, Benzoic acid not found. Canned Mandarin Oranges Sulphites, Boric acid, Salicylic acid, Benzoic acid not found. Frozen Egg Boracic compounds were not found. Raspberry Pulp Sulphites, Boric acid, Salicylic acid, Benzoic acid not found. Tomato Puree Sulphites, Boric acid, Salicylic acid, Benzoic acid not found; Lead and copper not found; Tin, less than 1 grain per pound. Canned Apricots Lead not found. Canned Peaches Lead not found. Canned Pears Cans in good condition; no signs of decomposition. Canned Peeled Tomatoes Tin, Lead and Copper not found. Egg Yolk Boracic compounds were not found. Canned Salmon Can in good condition; no signs of decomposition. Tomato Puree Tin not found; Sulphites, Boric acid, Salicylic acid, Benzoic acid not found. Canned Crab Sulphites, Boric acid not found. Canned Oranges Tin, 1 grain per pound; Lead not found ; Sulphites, Boric acid, Salicylic acid, Benzoic acid not found. Canned Sild Lead and Tin not found. Canned Salmon (2 cans) Tins blown; combined volume of gas— 15 c.c. of which 5 per cent. was carbon dioxide and 28 per cent. hydrogen; Tin, less than 0.5 grain per pound. Canned Salmon (2 cans) Tins blown; combined volume of gas— 50 c.c., of which 7.7 per cent. was carbon dioxide and 34 per cent. hydrogen; Tin, 1.2 grains per pound. Canned Salmon Lead and Tin not found. Canned Pilchards Can in good condition; no signs of decomposition. 107 Canned Salmon Can in good condition; no signs of decomposition. Frozen Egg Boracic compounds not found. Canned Crab Can in good condition; no signs of decomposition. Canned Sardines Lead, 6.4 parts per million; Tin, less than 0.5 grain per pound. Canned Sardines Lead, 10 parts per million; Tin, 1.6 grains per pound. Canned Sardines in Tomato Lead, 6.5 parts per million; Tin, 1.8 grains per pound. Canned Sardines Lead, 5 parts per million. Canned Sardines Lead, 5 parts per million; Tin, less than 0.5 grain per pound. Canned Tunny Lead, 2 parts per million. Canned Sild Tin, 2 grains per pound. Canned Sild Tin, 1.1 grains per pound. Canned Sardines Lead, 4 parts per million; Tin not found. Canned Sardines Lead, 6 parts per million; Tin not found. Canned Sild Tin, 3.1 grains per pound. Canned Sild Tin, 1.4 grains per pound. Canned Oranges Tin, less than 1 grain per pound. Canned Oranges Can slightly discoloured; no signs of decomposition. Canned Oranges Can slightly discoloured; no signs of decomposition. Canned Sardines Lead, 4 parts per million; Tin not found. Canned Sardines Lead, 10 parts per million; Tin not found. Canned Sild Tin, 0.6 grain per pound. Canned Pineapple Can in good condition; no signs of decomposition. Canned Pineapple Tin, less than 0.5 grain per pound. Frozen Egg Boracic compounds not found. Egg Yolk (Glycerine) .. Boracic compounds not found. Flour (close to inside of bag) A few black particles were present in the flour; Lead and Arsenic not found. Flour (interior of bag) .. Lead and Arsenic not found. Sack (containing above samples) Black deposit on the outside which consisted of Carbon; Lead was not found. Frozen Egg Boracic compounds not found. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. 108 Canned Sild (2 cans) First can—Tin, 0.8 grain per pound; Second can—Tin, 0.5 grain per pound. Frozen Egg Boracic compounds not found. Rind and Fat taken from a wide of Bacon The Bind was stained light green due to the presence of Copper compounds. The stain was confined to the Rind and did not penetrate into the fat. Arsenic was not found. Egg Yolk Boracic compounds not found. Canned Sild Tin, 2.4 grains per pound. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. Canned Cherries (2 cans) Cans in good condition; no sign of decomposition. Egg Yolk Boracic compounds not found. Egg Liquid—Whites Boracic compounds not found. Egg Yolk Boracic compounds not found. Egg Liquid—Whole Egg Boracic compounds not found. Lemon Fruit Cells Sample contained 240 parts of sulphur dioxide per million parts of the sample. Canned Artichokes Can in good condition; no signs of decomposition. Canned Asparagus The drained vegetable contained Tin, 0.7 grain per pound. Canned Figs Can in good condition; no signs of decomposition. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. Canned Salmon Tin not found. Egg Yolk Contained Boracic compounds. Egg Yolk Boracic compounds not found. Egg Yolk Contained Boracic compounds. Egg Yolk Contained Boracic compounds. Egg Yolk Contained Boracic compounds. Duck Yolk Contained Boracic compounds. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. Egg Yolk Contained Boracic compounds. Egg Yolk Boracic compounds not found. Canned Lichees Can in good condition; no sign of decomposition. Canned Sild Tin, 2.7 grains per pound. 109 Frozen Egg Boracic compounds not found. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. Canned Oranges Can, faint discolouration; no sign of decomposition. Canned Oranges Can, faint discolouration; no sign of decomposition. Egg Yolk Boracic compounds not found Egg Yolk Boracic compounds not found. Tomato Puree Tin not found. Egg Yolk Contained Boracic compounds. Egg Yolk Boracic compounds not found. Dried Whole Egg Boracic compounds not found. Frozen Egg Boracic compounds not found. Egg Yolk Boracic compounds not found. Egg Yolk Contained Boracic compounds. Egg Yolk Boracic compounds not found.' Egg Yolk Boracic compounds not found. Canned Sild Tin, 0.8 grain per pound. Clace Cherries Copper compounds equivalent to metallic Copper 30 parts per million. Fish Liver Boracic and Sulphate Preservatives not found. Glace Cherries Copper compounds equivalent to metallic Copper 3 parts per million. Frozen Egg Boracic compounds not found. Canned Pears Tin, 0.5 grain per pound; Copper, less than 2 parts per million; Lead not found. Canned Peaches Tin, Copper and Lead not found. Canned Apricots Tin, Copper and Lead not found. Canned Raspberry Jam Lead, 5 parts per million; Tin and Copper not found. Canned Blackcurrant Jam Tin, 0.7 grain per pound; Copper, 6.5 parts per million; Lead, less than 2 parts per million. Canned Apricot Jam Tin, 0.4 grain per pound; Copper, less than 2 parts per million; Lead, 5 parts per million. Canned Apricot Jam Tin, 0.4 grain per pound; Lead, 5 parts per million; Copper not found. Canned Lichees Tin, 0.3 grain per pound; Lead, less than 4 parts per million; Copper not found. 110 Canned Sardines Tin, 0.2 grain per pound; Lead, less than 4 parts per million. Canned Sardines Lead, less than 4 parts per million; Tin not found. Canned Sardines Lead, less than 4 parts per million; Tin not found. Canned Sardines Lead, less than 5 parts per million; Tin not found. Canned Sardines Lead, less than 4 parts per million; Tin not found. Canned Tomatoes Tin, Lead and Copper not found. Canned Brisling Tin, 0.3 grain per pound; Lead not found. Canned Brisling Tin, 0.5 grain per pound; Lead not found. Canned Salmon Lead and Tin not found. Canned Salmon Lead and Tin not found. Canned Salmon Lead and Tin not found. Canned Salmon Lead and Tin not found. Canned Salmon Lead and Tin not found. Canned Salmon Lead and Tin not found. Canned Salmon Lead and Tin not found. Canned Salmon Lead and Tin not found. Canned Salmon Lead and Tin not found. Canned Peaches Tin, 0.3 grain per pound; Lead and Copper not found. Canned Salmon Lead and Tin not found. Canned Salmon Lead and Tin not found. Canned Nectarines Lead, Tin and Copper not found. Egg Yolk Boracic compounds not found. Egg Yolk Boracic compounds not found. Pectin 1,000 parts of Sulphur dioxide per million parts of sample. 112 113 TABLE 29. Showing the quantity of foodstuffs examined at the wharves, the amount found to be unsound, the Notices served, and the method of disposal of the unsound portion. Foodstuffs. Quantity and Weight examined. Weight found to be unsound. Surrendered by Owner. Seized by Inspector. Notices served. How unsound portion disposed of. Quantity. Weight. (a) Detention. (b) Release. T. c. Q. L. T. c. Q. L. Almonds 220 bags 16 10 0 0 — — — — — — Apples 965 boxes, 200 cases 24 4 3 0 1 3 1 20 Yes — 3 3 13 cwt. 8 lbs. destroyed on premises where found and 10 cwt. 1 qr. 12 lbs. barged to sea. Apples, tinned 191 cases, 6 tins 4 16 0 4 2 4 Yes — 1 — 2 qrs. 4 lbs. destroyed at the Council's Depot and 4 tons 15 cwt. 2 qrs. under "Stop" . Apricots 1641 crates, 119 packages and 5 trays 18 14 0 0 5 6 0 26 Yes — — — 4 tons 19 cwt. 18 lbs. destroyed on premises where found and 7 cwt. 8 lbs. destroyed at the Council's Depot. Apricots, tinned 500 cases 10 0 3 16 — — — — — — Apricot pulp 312 casks 15 15 3 12 — — — — — — Artichokes, tinned 50 cases 1 1 1 20 — — — — — — Asparagus, tinned 250 cases 6 13 3 20 — — — — — — Bacon 684 bales, 88 boxes 103 10 0 0 2 5 Yes — — — Destroyed at the Council s Depot. Beans 31 baskets 8 1 16 8 1 16 Yes — — — Destroyed on premises where found. Beef — 132 0 1 23 9 6 2 1 Yes — 80 80 Released for technical purposes. Beef extract 286 cases 9 13 0 0 — — — — — — Beef powder 2072 cases 103 16 0 0 — — — — — — Beef, salted 5 barrels 10 0 0 — — — — — — Beef, tinned 846 cases, 1685 tins 24 3 0 12 5 18 0 20 Yes — 2 2 Destroyed at the Council's Depot. Blackberries 75 cases 2 8 0 24 — — — — — — Brisling 50 cases 1 1 1 20 — — — — — — Casings 131 casks, 60 tierces 31 1 3 11 — — — — — __ Caviare 3 barrels 7 0 0 — — — — 1 — Cheese 150 bundles, 26 cases 2 12 1 0 12 0 8 Yes — — — Destroyed on premises where found. Cherries, tinned 250 cases 4 0 1 12 — — — — — — Chestnuts 100 bags 2 0 0 0 2 0 0 0 Yes — 1 1 Destroyed at the Council's Depot. Confectionery 591 cases 23 2 1 0 1 0 3 0 Yes — 8 8 Do. do. Crab, tinned 372 cases 7 19 1 10 6 2 16 Yes — — — Do. do. Currants, black 1 crate 24 24 Yes — — — Destroyed on premises where found. Damsons, tinned 5 cases 2 2 20 — — — — — — Dates 51 boxes 1 13 3 0 3 0 Yes — 1 1 Destroyed at the Council's Depot. Eggs 449 2 0 2 0 Yes — — — Destroyed on premises where found. Egg, dried 20 cases 1 0 0 0 — — — — — — Egg Yolk, liquid 1665 casks 333 18 0 o 17 tons 8 4 Seized by Inspector but released by Order of Magistrate; to be exported for technical purposes; 33 tons still under ' 'Stop''. Carried forward 883 5 2 20 26 4 3 0 17 tons 104 100 114 115 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. 17 tons 104 100 Brought forward 883 5 2 20 26 4 3 0 Egg, liquid 25494 packages, 148 casks and 62 tins 917 15 3 5 1 0 Yes — — — Destroyed on premises where found. Endive 21 crates 7 0 0 7 0 0 Yes — — — Do. do. Fat, hog 5 casks 1 0 0 0 — — — — — — Figs, tinned 388 cases 10 6 3 4 16 0 8 Yes 1 1 Destroyed at the Council's Depot. Fish, tinned 50 cases 1 1 0 0 — — — — — — Fish — 6 0 0 — — — — — — Fish livers, tinned 27 tins 3 0 0 — — — — — — Flour 2134 bags 148 9 0 12 — — — 1 1 — Fowls 50 cases 1 3 0 0 8 Yes — — — Destroyed at the Council's Depot. Fruits, assorted, tinned 1062 cases, 31 tins 24 6 2 10 10 10 3 2 Yes — - - Do. do. Fruit juice 60 casks 6 0 0 0 6 0 0 0 Yes — 1 1 Destroyed on premises where found. Game 70 cases 3 10 0 1 1 Yes — 1 1 Released for technical purposes. Geese 94 cases 3 14 2 16 3 14 2 16 Yes - 1 1 Do. do. Grapes 100 boxes 1 1 0 0 — Yes - - - - Grape fruit 24751 boxes, 10586 cases 1251 12 0 24 56 17 1 24 Yes - 20 20 29 tons 13 cwt. 2 qrs. 16 lbs. barged to sea and 27 tons 3 cwt. 3 qrs. 8 lbs. destroyed on premises where found. Grape fruit juice 26 casks 2 12 0 0 2 12 0 0 Yes - 1 1 Destroyed on premises where found. Greengages 24 packages 3 3 22 3 3 22 Yes - - - Do. do. Hams 67 bags, 29 boxes and 5 hams 9 18 3 25 3 25 Yes - 2 2 Released for technical purposes. Hams, tinned 220 tins 1 18 3 14 1 18 3 14 Yes - 1 1 1 ton 17 cwt. 14 lbs. destroyed on premises where found, and 1 cwt. 3 qrs. destroyed at the Council's Depot. Jam, tinned 2544 cases 127 14 0 0 — - - - - 1208 tins under "Stop". Lard 3246 boxes, 1043 cases and 5 barrels 121 7 0 0 1 3 2 3 Yes - 5 5 Released for technical purposes. Lard oil 162 barrels, 31 casks 36 7 0 0 — - - - - - Lemon pulp 19 barrels 3 16 0 0 — - - - - - Lemons 7988 cases, 1392 boxes 330 9 0 0 3 10 1 4 Yes - 3 3 Destroyed on premises where found. Lettuce 771 crates 7 11 0 14 7 11 0 14 Yes - - - Do. do. Lichees, tinned 25 cases 2 2 3 12 — - - - - - Marmalade, tinned 500 cases 16 1 1 20 — - - - - - Meat, tinned 500 cases 10 14 0 0 — - - - - - Carried forward 3924 18 0 3 121 11 3 1 17 tons 142 137 116 117 Foodstuffs. Quantity and Weight examined. Weight found to he 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. L. L. Brought forward 3924 18 0 3 121 11 3 1 17 tons 142 137 Melons 75 crates 1 17 2 0 1 16 0 0 Yes — 1 1 Destroyed on premises where found. Milk, condensed 4252 cases, 66 tins 4 barrels 91 11 3 11 35 8 2 7 Yes — — — 27 tons 9 cwt. 3 lbs. released for technical purposes, and 7 tons 19 cwt. 2 qrs. 4 lbs. destroyed at the Council's Depot. Mutton Carcases and pieces 1491 4 1 20 19 1 3 6 Yes — 751 751 Released for technical purposes. Nectarines 100 cases 2 2 3 12 - - — — — — Offal - 47 16 0 18 1 5 1 22 Yes — 30 30 1 ton 5 cwt. 1 qr. 13 lbs. released for technical purposes and 9 lbs. destroyed at the Council's Depot. Onions 100 cases 10 0 0 0 - — — — — — Oranges 33423 boxes, 7837 cases 1436 3 2 8 42 18 1 26 Yes — 20 20 25 tons 8 cwt. 3 qrs. 12 lbs. barged to sea and 17 tons 9 cwt. 2 qrs. 14 lbs. destroyed on premises where found. Oranges, tinned 2160 cases 48 13 1 12 3 3 21 Yes — 1 1 Destroyed at the Council's Depot. Peaches 1505 cases, 214 crates 42 10 0 10 1 15 0 10 Yes — — — Destroyed on premises where found. Peaches, tinned 898 cases 24 1 0 8 - — — — — — Pears 5911 boxes, 100 cases 151 6 3 24 3 1 2 14 Yes — 6 6 2 tons 22 lbs. destroyed on premises where found and 1 ton 1 cwt. 1 qr. 20 lbs. barged to sea. Pears, tinned 1625 cases 29 10 3 14 1 8 1 0 Yes — 2 2 Destroyed at Council's Depot. Peas 1407 boxes, 383 bags 43 1 3 16 2 11 2 11 Yes — 6 6 1 ton 1 cwt. 2 qrs. 7 lbs. destroyed at Council's Depot and 1 ton 10 cwt. 4 lbs. released for technical purposes. Pepper dust - 1 1 7 1 1 7 Yes — — — Destroyed at the Council's Depot. Pilchards 30 cases 12 3 0 - — — — — — Pineapples 604 cases, 6 boxes 16 5 1 0 15 0 1 0 Yes — 2 2 Destroyed on premises where found. Pineapples, tinned 303 cases 7 16 3 12 1 3 20 Yes — 1 1 Destroyed at the Council's Depot. Plums 430 crates 4 11 2 4 4 1 0 4 Yes — 1 1 3 tons 13 cwt. 2 qrs. 4 lbs. destroyed on premises where found and 7 cwt. 2 qrs. destroyed at the Council's Depot. Pork - 38 16 1 15 2 2 3 17 Yes — 38 38 1 ton 17 cwt. 3 qrs. 17 lbs. released for technical purposes and 5 cwt. destroyed at the Council's Depot. Potatoes 216 baskets, 5 bags 21 10 1 0 1 10 1 0 Yes — — — Destroyed on premises where found. Prawns 2 cases 1 0 0 1 0 0 Yes — 1 1 Destroyed at Council's Depot. Puddings, Christmas 3 10 10 Yes — — — Do. do. Rabbits.. 253 crates, 171 cases, 53 rabbits 11 4 3 12 7 1 6 Yes — 6 6 5 cwt. 3 qrs. 24 lbs. released for technical purposes and 1 cwt. 1 qr. 10 lbs. destroyed at Council's Depot. Raisins 1 box 25 25 Yes — 1 1 Destroyed at the Council's Depot. Raspberry pulp 50 cases 1 6 3 4 — - — — — — Carried forward 7447 5 3 21 254 8 3 11 17 tons 1009 1004 118 119 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 744 5 3 21 254 8 3 11 17 tons 1009 1004 Rice 189 bags 9 9 0 0 5 1 13 Yes — 3 3 Destroyed on premises where found. Roe, Salmon 8 barrels 5 3 0 5 1 0 Yes — 2 2 Released for technical purposes. Salmon, tinned 3314 cases, 120 tins 72 1 1 12 5 8 3 24 Yes — — — Destroyed at the Council's Depot. Sardines 672 cases, 1155 tins 16 7 2 18 1 22 Yes — — — Do. do. Sauces, mixed 29 bottles 25 25 Yes — — — Do. do. Sausage, Frankfurter 6 cases 3 0 0 3 0 0 Yes — — — Do. do. Sild 50 cases 15 0 0 — — — — — — Soups, tinned 1 case, 100 packages 2 2 1 20 1 20 Yes — — — Do. do. Strawberries, tinned 100 cases 2 2 2 16 — — — — — — Sultanas 968 boxes 10 16 0 16 2 0 16 Yes — — — Do. do. Tallow 137 drums 27 8 0 0 — — — — — — Tomatoes 594 boats, 1 crate 6 14 0 24 5 15 0 24 Yes — 2 2 3 tons barged to sea, 24 lbs. destroyed on premises where found and 2 tons 15 cwt. destroyed at the Council's Depot. Tomato Puree 828 cases 28 18 1 20 6 0 0 Yes — — — Destroyed at the Council's Depot. Tomatoes, tinned 227 cases, 74 tins 5 15 2 8 2 0 20 Yes — — — Do. do. Tongues, tinned 163 cases 4 1 1 4 8 3 10 Yes — — — Do. do. Turkeys 448 cases 19 4 1 4 — — — 1 1 — Veal — 1 16 2 8 1 1 4 Yes — 3 3 Released for technical purposes. Veal, tinned 4 tins 12 12 Yes — — — Destroyed at the Council's Depot. Vegetables, assorted, tinned 90 tins 1 2 12 1 2 12 Yes — — — Do. Do. Vermicelli Half case 10 10 Yes — — — Do. do. Walnuts 1200 bags 15 0 0 0 15 0 0 0 Yes — 1 1 Destroyed on premises where found . 7670 9 1 6 282 9 3 27 17 tons 1021 1016 120 121 TABLE 30. Showing the quantity of Foodstuffs found unsound throughout the Borough during the year 1936 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 1 box 1 2 1 box 1 2 — — Destroyed at Council's Depot. Asparagus 10 bundles 10 10 bundles 10 — — Do. do. Bacon — 6 4 1 0 — 6 4 1 0 — — 4 tons 11 cwt. 15 lbs. destroyed at the Council's Depot, and 1 ton 13 cwt. 13 lbs. released for technical purposes. Bananas 21 crates 10 2 0 21 crates 10 2 0 — — Destroyed at the Council's Depot. Beef — 10 1 10 — 10 1 10 — — 6 cwt. 2 qrs. 21 lbs. released for technical purposes, 3 cwt. 1 qr. 2 lbs. destroyed at the Council's Depot and 1 qr. 15 lbs. destroyed on premises where found. Beef, tinned 26 tins 1 1 10 26 tins 1 1 10 — — Destroyed at the Council's Depot. Brawn, tinned 1 tin 6 1 tin 6 — — Destroyed on premises where found. Bread — 4 — 4 — — Do. do. Carrots 45 bags 1 2 2 0 45 bags 1 2 2 0 — — Destroyed at the Council's Depot. Celery 6 bundles 20 6 bundles 20 — — Do. do. Chestnuts 20 bags 8 3 20 20 bags 8 3 20 — — Do. do. Chicken, tinned 1 case, 645 tins 8 0 14 1 case, 645 tins 8 0 14 — — Do. do. Cod — 2 0 — 2 0 — — Do. do. Currants 27 cases 11 1 26 27 cases 11 1 26 — — Released for technical purposes. Dabs 1 box 1 0 1 box 1 0 — — Destroyed at the Council's Depot. Doe Fish 4 boxes 2 0 0 4 boxes 2 0 0 — — Do. do. Eggs 300 1 12 300 1 12 — — Destroyed on premises where found. Fish, tinned 18 cases 7 2 24 18 cases 7 2 24 — — Destroyed at the Council's Depot. Fowls — 1 10 3 16 — 1 10 3 16 — — Do. do. Fruits, tinned 7 cases 3 0 0 7 cases 3 0 0 — — Do. do. Grapes 11 barrels, 7 trays 5 1 2 11 barrels, 7 trays 5 1 2 — — 4 cwt. 3 qrs. 21 lbs. destroyed at the Council's Depot and 1 qr. 9 lbs. destroyed on premises where found. Grape Fruit 97 cases 2 8 2 0 97 cases 2 8 2 0 — — Destroyed at the Council's Depot. Hams 5 hams 2 21 5 hams 2 21 — — 2 qrs. 6 lbs. destroyed at the Council's Depot and 15 lbs. released for technical purposes. Hams, tinned 18 tins 1 3 16 18 tins 1 3 16 — — 1 cwt. 2 qrs. 26 lbs. destroyed at the Council's Depot and 18 lbs. destroyed on premises where found. Heads, Pigs 17,742 92 8 1 1 17,742 92 8 1 1 — — Released for technical purposes. Kippers 10 boxes 1 1 0 10 boxes 1 1 0 — — Destroyed at the Council's Depot. Lard — 1 5 — 1 5 — — Do. do. Lemons 112 boxes 2 16 0 0 112 boxes 2 16 0 0 — — Do. do. Loganberries, tinned 10 cases 4 1 4 10 cases 4 1 4 — — Do. do. Mutton — 3 20 — 3 20 — — 2 qrs. 6 lbs. destroyed at Council's Depot and 1 qr. 14 lbs. destroyed on premises where found. Carried forward 110 10 0 19 110 10 0 19 — — 122 123 Foodstuffs. Quantity and Weight found Unsound Surrendered by Owners. Seized by Inspector. Remarks. Quantity. Weight. Quantity. Weight. Quantity. Weight. Brought forward T. c. Q- L. T. c. Q. L. T. C. Q. L. 110 10 0 19 110 10 0 19 -— — Oatmeal — 20 — 20 — Destroyed on premises where found. Offal — 1 5 1 15 — 1 5 1 15 — — 15 cwt. 2 qrs. 14 lbs. destroyed at Council's Depot and 9 cwt. 3 qrs. 1 lb. destroyed on premises where found. Onions — 2 4 — 2 4 —- — Destroyed at the Council's Depot. Oranges 65 boxes 1 12 2 0 — 1 12 2 0 — — Do. do. Peaches 78 crates 8 0 0 78 crates 8 0 0 — — Do. do. Pears 55 boxes and 38 ½-sieves 17 1 20 55 crates and 38 ½-sieves 17 1 20 — — Do. do. Peas 230 bags 3 1 2 12 230 bags 3 1 2 12 — — Do. do. Pineapples 47 cases 17 0 0 47 cases 17 0 0 — — Do. do. Plums 87 boxes 1 10 0 0 87 boxes 1 10 0 0 — — Do. do. Plums, tinned 24 cases 10 3 8 24 cases 10 3 8 — — Do. do. Pork Carcases and pieces 41 4 2 4 Carcases and pieces 41 4 2 4 — — Released for technical purposes. Pork Pies 1 pie — 1 pie — — — Destroyed on premises where found. Potatoes 61 bags, 50 ½-bags 4 6 0 0 61 bags, 50 ½-bags 4 6 0 0 — — Destroyed at the Council's Depot. Prawns 7 tins 1 21 7 tins 1 21 -— — Do. do. Prunes — — — — — — 2 tons 12 cwt. 16 lbs. under "Stop." Rabbits 265 rabbits 10 3 12 265 rabbits 10 3 12 — — Destroyed at the Council's Depot. Sild 193 tins, 2 cases 3 8 2 cases 1 12 193 tins 1 24 1 qr. 12 lbs. destroyed at the Council's Depot and 1 qr. 24 lbs. were condemned by a Magistrate and destroyed at the Council's Depot. Skate 3 boxes 1 3 14 3 boxes 1 3 14 — — Destroyed at the Council's Depot. Soup Squares 74 12 74 12 — — Do. do. Swede Tops 20 bags 5 0 0 20 bags 5 0 0 — — Do. do. Tomatoes 16 bundles, 6 boats 8 0 16 16 bundles, 6 boats 8 0 16 — — Destroyed at the Council's Depot. Tomato Puree 31 cases, 762 tins 1 4 3 21 31 cases, 762 tins 1 4 3 21 — — Destroyed on premises where found. Tomatoes, tinned 41 cases 17 0 0 41 cases 17 0 0 — — Destroyed at the Council's Depot. Tongues, Ox 1 tongue 7 1 tongue 7 — — Released for technical purposes. Tongues, tinned 123 tins 5 1 26 123 tins 5 1 26 — — 5 cwt. 1 qr. 6 lbs. destroyed on premises where found and 20 lbs. destroyed at the Council's Depot. Turkeys 4 1 18 4 1 18 — — Released for technical purposes. Veal — 1 2 21 — 1 2 21 — — 1 cwt. 1 qr. 25 lbs. released for technical purposes and 24 lbs. destroyed at Council's Depot. 170 0 3 26 170 0 2 2 193 tins 1 24 124 TABLE 31. Inspections of Food at Wharves, Markets and other places where food is stored, and the action taken by the officials during the year 1936. 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 421 — 906 168 1362 31 22 380 3 2 1 Mr. Duffield 581 — 813 173 2207 999 996 1215 — — — Market Inspections — 7671 — — 7218 — — — — — — Total 1002 7671 1719 341 11240 1030 1018 1595 3 2 1 125 MILK AND DAIRIES (AMENDMENT) ACT, 1922, AND ORDERS MADE THEREUNDER, ETC. At the end of 1935, there were on the Milksellers' Registers:— Retail names 413 and premises 407 Wholesale names 32 ,, ,, 31 Retail names 77 Outsiders. Wholesale names 43 ,, During the year 1936 the following entries were made in the respective Registers, viz.:— Retail names 64 and premises 64 entered.* Retail names 73 ,, ,, 70 removed. *The 64 premises are:— 1 Depot for delivering Milk on rounds. 3 Dairies. 50 Bottled Milk only sold. 9 Bottled Milk and for consumption on premises. 1 For consumption on premises only. The sale of Milk was discontinued at 26 premises. The Sale of Milk was newly started at 20 premises. Totals on Retail Register at the end of 1936:— 404 names; 401 premises.* *The 401 premises are:— 57 Dairies, of these 36 sell Milk on rounds. 5 Depots (for sale of Bottled Milk on rounds). 322 Sale of Milk in containers only (as received). 17 For consumption on the premises only. Wholesale during the year:— 2 names and 2 premises were entered in the Register. 3 names and 3 premises were removed from the Register. Discontinued at 3 premises and newly started at 2. Total at the end of the year:— 31 names; 30 premises on the Register. 126 Outsiders:— During the year 4 names entered and 2 removed. Retail. During the year 4 names entered and 1 removed. Wholesale. Total on Register at the end of the year 1936:— 79 names Retail, and 46 names Wholesale. MILK (SPECIAL DESIGNATIONS) ORDER, 1923 AND 1936, ETC. 2 Dairies were licensed to Bottle and Sell Grade A (T.T.) Milk. In only 1 was this carried out. The total number of persons licensed to Sell Graded Milk at or from their premises was as follows:— Certified, 5. Grade A (T.T.), 19; these include 2 bottling and 1 supplementary licences. Grade A, 1. Grade A (Pasteurised), 5. Pasteurised, 38; these include 3 supplementary licences. Total, 68. BACTERIOLOGICAL AND PHOSPHATASE EXAMINATIONS. No. 1 is Bacteriological Examination. No. 2 is Microscopic Examination. No. 3 is Inoculation. Kind. No. 1. Nos. 1, 2 and 3. Nos. 2 and 3. Phosphatase only. Total. Pasteurised 26 13 — 29 68 Grade A (T.T.) — 3 — — 3 Ordinary — 1 18 — 19 Totals 26 17 18 29 90 127 These 90 samples were found to be satisfactory. In addition to the above, throughout the year the Public Analyst has examined by the Phosphatase Test for information purposes, 187 samples of various Milks obtained from 15 wholesale firms who supply Milk in this Borough. 26 of these did not pass the test. The Dairymen concerned were informed and the Medical Officer of Health of the district in which the Milk was pasteurised was notified. There are 49 L.C.C. Schools with 117 departments supplied with Pasteurised Milk by 14 dairy firms. These Milks have been regularly sampled and are included in the above Table, "Pasteurised." INSPECTIONS OF VARIOUS PREMISES. The following inspections have been made during the year:— Milkshops, Dairies, etc. 1,911 2 Notices. Bakehouses, etc. 592 14 ,, Soap Works 6 Tripe Boilers 7 Butter Factory 9 7 Samples taken. Fur Skin Dresser 6 Shops Act 16 Pharmacy and Poisons Act 361 Other premises 10 2,918 16 Notices. Verbal instructions and suggestions as required. 128 NUISANCES ABATED IN CONSEQUENCE OF NOTICES. Dirty walls 13 ,, ceilings 11 ,, floors 7 ,, paving 6 Defective walls 3 ,, ceilings 3 ,, floors 2 ,, paving 2 ,, and dirty utensils 17 ,, roofs 3 ,, oven walls 1 Light and ventilation 7 Utensils provided 8 Dustbins provided 4 New sinks 3 Dressing rooms 2 Miscellaneous items 55 147 14 Bakehouses repainted. 11 Dairies repainted. 5 Milk Barrows repainted. In addition to the works carried out under notice, the following is a brief account of other works carried out and utensils provided at the various premises. DAIRIES. 17, Vowler Street.—Dairy walls and ceilings, and all paint work, washed down and repainted. Ceiling repaired. New cold store (Kelvinator) installed. 17, Surrey Row.—Dairy walls and ceiling and all paint work washed down and repainted. New bulking tank, rotary pump and fittings to bottle filling machine provided. 342, East Street.—Dairy walls and ceiling and all paint work washed down and repainted. York Place.—Bottle filling room, walls and ceilings repainted. New bottle washing and sterilising machine installed. 1,500 bottles per hour. 129 3, Old Kent Road.—Provided a bottle capping appliance, crate for dipping and sterilising bottles and a filling and store room. 29, Southwark Street.—Dairy paintwork cleansed and repainted. 146, Lorrimore Road.—Dairy paintwork cleansed and repainted. 22, Beresford Street.-—Dairy paintwork cleansed and repainted. 120, Trafalgar Street.—Walls of bottling room renewed. Dairy paintwork cleansed and repainted. 17, Sutherland Square.—Dairy paintwork cleansed and repainted. Rear of 32, Earl Street.—Dairy walls and ceilings and paintwork repainted. 16, Pilgrimage Street.—5 milk barrows cleansed and repainted. 7, Charles Street.—Dairy paintwork cleansed and repainted. Rear of 201-3, Old Kent Road.—New depot for sale of sterilized bottled milk on round. Well lighted and ventilated. Cold water supply provided. A store room for bottled milk at front of premises. 201-3, Old Kent Road.—On ground floor, milk bar, with the following fittings:—Hall's (ammonia) refrigerator, cold chest, 4 electric mixers for milk drinks (with syrups and flavours), 4 electric milk soup warmers, stoneware sink with hot and cold water supply for washing and sterilizing milk vessels and appliances, hot water boiler (boiling water) in boiler room off yard. Ground floor, W.C. and lavatory basin and cloak room. First floor, offices, 2 W.C.'s and lavatory basin. These rooms are used in connection with the Depot at rear. 58, Larcom Street.—A new brush bottle washing machine installed. There are also in course of construction or installation at the rear of 2-4, New Street, a depot for sale of bottled sterilized milk on round. At 2, Burrows Mews a new dairy is under construction. 130 BAKEHOUSES. 151, Borough High Street.—Dough and cake mixer installed. Part of flooring over concreted. (These premises are now unoccupied.) 128-132, New Kent Road.—Ceilings provided to outer store rooms. Bench and wall at back (on first gallery) cleansed and covered with zinc so as same can be kept in a cleanly condition. 126, Southward Bridge Road.—Ventilated lobby to W.C. provided. Bakehouse repainted. 304, Old Kent Road.—New food store provided. Bakehouse walla and ceilings repainted. New ceiling provided. 182, Grosvenor Terrace.—Oven front rebuilt. 185, Blackfriars Road.—Vaults off bakehouse, walls and floor rendered waterproof, three louvred lights and extractor fan for ventilation purposes installed. Vaults separated by partition so as to provide ventilated lobby to W.C. 55, Rodney Road.—Gas-heated steam generator installed. III, Trafalgar Street.—Flour loft ceiling provided, walls and floor cleansed, sashes and sash frames amended and repainted. New hopper to flour shoot. Three new trough tops. Gambia Street.—First floor bakehouse flooring amended as required by red tiling. Walls at rear of doughnut frying pan and supporting piers of apparatus white tiled, and sloping zinc tray under and flooring under red tiled. Dished concrete platform for ice chest, and walls behind white tiled. 2, Stoney Street.—New skylight with hinged sashes provided. 15, Old Kent Road.—Bakehouse floor red tiled, white glazed asbestos ceiling provided, all woodwork cleansed and repainted. Further works to be carried out later. 272, Old Kent Road.—Yard repaved, bakehouse, new vent shaft in roof. Flour store, floor at side of oven red tiled, remainder of floor concreted. Coal store in bakehouse enclosed. W.C. in yard, new seat, rafters, roof, gutter, rain-pipe and walls rendered. Dough mixing room, new roof and ceiling and shelves, woodwork repainted, dough mixer cleansed. Two food stores in yard and a dressing room (for men) provided. 131 97a, Brandon Street.—Bakehouse flooring red tiled, oven front amended, new sink, trap and waste, new cold drinking water supply on rising main provided. Interior walls and ceiling repainted. Two dough troughs and tops cleansed. Dough mixer cleansed and repainted. New staircase in yard to flour loft. Flour loft, walls repaired and cleansed, new corrugated asbestos roof, sheet asbestos ceiling, and window to street provided. Floor repaired and cleansed. W.C. in yard cleansed. Barrow store at rear, walls and back of oven amended and cleansed. Concrete floor and asbestos ceiling provided. 325, Walworth Road.—Five window sashes amended, cleansed and painted and made to open. Wall at sink white tiled. A new sink and trap and waste pipe in men's dressing room. Walls and ceiling cleansed. W.C. in yard (men's), new pan trap and seat. Walls and ceiling cleansed. Other works on order. 101, Gt. Dover Street.—Shop redecorated. Other works on order. 214, Manor Place.—New dough mixer and oven installed. 168, Borough High Street.—Oven front rebuilt. 388. Walworth Road.—Bakehouse ventilation improved by new window over oven, a vent pipe into external air, new door to yard, with glazed hinged sash to open. Stair treads renewed. Coal cupboard enclosed. Four portable benches on iron supports, and portable shelves. Tiled flooring retiled and extended. New roof over steps to yard. Premises throughout thoroughly scraped and cleansed, and accumulation of rubbish removed. Other works on hand. Particulars of Bakehouses at the end of the year 1936:— Position. In use. Not in use. Totals. Remarks. Above ground 33 23 56 6 Bakehouses have been discontinued. Under ground 23 11 34 Totals 56 34 90 * See below *11 and 47, Stamford Street 1 and 33, Tarn Street These Bakehouses have been discontinued or demolished. 1, Harper Street 195, Waterloo Road Total number of Bakehouses at end of 1936:90. 132 NOXIOUS TRADES. Situation. Trade. Occupier. Inspections. Remarks. 24. Gt. Suffolk Street Tripe Boiler J. Martin 7 Periodical cleansing was duly carried out. Wansey Street Soap Works Holder's Soap Works, Ltd. 6 Harrow Street Skin Dresser Leeding & Co. 6 Wansey Street, Soap Works.—New corrugated iron roof provided. There are no Cowsheds in the Borough. BUTTER AND MARGARINE FACTORIES. 9 inspections made. 7 samples of butter procured for analysis. These were certified genuine. There are 17 wholesale dealers in margarine in the Borough. 2 were discontinued during the year. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. 13 samples of condensed milk were purchased under the above Regulations for analysis. They were certified by the Public Analyst to comply with the said Orders. ARTIFICIAL CREAM ACT, 1929. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923-27. MILK AND DAIRIES ORDER, 1926. MERCHANDISE MARKS ACT, 1926, AND ORDERS. PUBLIC HEALTH (PRESERVATIVES IN FOOD) REGULATIONS. FOOD AND DRUGS (ADULTERATION) ACT, 1928, ETC. Special attention has been given at the various premises visited in the carrying out of the above Orders, etc., and where necessary these were explained and shopkeepers advised. This has had the desired effect. 133 POISONS AND PHARMACY ACT, 1933, AND ORDERS MADE THEREUNDER. During the year 361 premises have been visited under the above Act; of these, 81 names of occupiers who have complied with the requirements of the said Act and Orders have been entered on the Council's list of Sellers of Part 2 Poisons, as set out in the Poisons List Confirmation Order, 1935. The following is a list of Poisons sold:— Kind of Poison Sold. No. of Premises. Remarks. Spirits of Salts 41 5 Registers have been provided as required for sale of certain Poisons. Ammonia 60 Phenols 67 Caustic Soda 30 Caustic Potash 11 Sulphuric Acid 1 Nitric Acid 1 Salts of Lemon 3 Arsenical Poisons 4 Mercurial Poisons 2 Nicotine 1 Barium 1 Hair Dyes 5 All Part 2 Poisons 2 134 SALE OF FOOD AND DRUGS AND OTHER ACTS. Name and Address of Vendor. Sample. Result of Analysis. Result of Proceedings. J. R. Taaffe, 104, Union Street Milk 7.4 per cent. added water Fined £5 and £1 1s. costs. Henry David Welch, 37, Courthill Road, Lewisham — Carrying on the trade of a dairyman without being registered by the Local Authority Fined £3 and £2 2s. costs. Do. do. — Selling milk from a vehicle which had not inscribed thereon his name and address Fined 2s. 6d. Do. do. — Failing to keep in a clean condition vessels used for containing milk Fined £2. 135 POLICE COURT PROCEEDINGS TAKEN UNDER THE FOOD AND DRUGS ACT. 4 summonses were taken out during the year 1936. The offences for which the above-mentioned summonses were taken out are tabulated hereunder:— Milk (added water) 1 case Carrying on trade of dairyman without being registered 1 case Selling milk from a vehicle which had not inscribed thereon his name and address 1 case Failing to keep in a clean condition vessels used for containing milk 1 case Total 4 cases SALE OF FOOD AND DRUGS ACT. During the year ended 31st December, 1,032 "official" samples were taken by the Inspector. 5 of these samples were certified as adulterated, a percentage of 0.5, as compared with 1.8 in 1935. Particulars of the samples taken, together with the results of the analyses are given in Tables 32 and 33. 136 FOOD AND DRUGS ACTS. TABLE 32. Return of Official Samples for the Year ending 31st December, 1936, showing the number taken, and the percentage of adulterated Samples for the year. FORMAL SAMPLES. Article. Number of Samples taken. Adulterated. Milk 451 4 Butter 77 — Cheese 12 — Margarine 57 — Lard 27 — Tea 15 — Coffee 6 — Cocoa 19 — Sugar 9 — Mustard 7 — Port Wine 2 — Whisky 4 — Gin 2 — Brandy 2 — Rum 2 — White Pepper 5 — Cake 13 — Quaker Oats 1 — Sponge Mixture 1 — Table Jelly 16 — Self-raising Flour 18 — Cornflour 11 — Luncheon Sausage 5 — Breakfast Sausage 4 — Ground Nutmeg 2 — Bisto 9 — Ox-Tail Soup 7 — Oatmeal 1 Semolina 3 — Custard Powder 7 — Rice 12 — Pearl Barley 9 — Carraway Seeds 1 — Meat Paste 2 — Tea Siftings 1 — Curry Powder 6 — Ground Ginger 1 — Carried forward 827 4 137 Article. Number of Samples taken. Adulterated. Brought forward 827 4 Condensed Milk 13 — Separated Milk 2 — Arrowroot 4 — Tapioca 12 — Saxa Salt 5 — Jam Sandwich 2 — Lemonade Powder 4 — Beef Galantine 1 — Rice Custard 2 — Sifta Salt 2 — Pea Soup Flour 8 — Blanc-Mange Powder 1 — Dripping 11 — Gravy Thick 2 — Brawn 4 — Corned Beef 4 — Swiss Roll 3 — Preserved Sausage 7 — Liver Sausage 1 — Rolled Oats 1 — French Cream Slices 1 — Flaked Rice 2 — Flaked Tapioca 2 — Gravylets 1 — French Coffee 6 — Mustard Compound 5 — Sage and Onion Stuffing 1 — Velda 1 — Gravy Powder 1 — Fish Paste 9 — Pepper 2 — Sherbet 3 — Oat Puffs 1 — Cakeoma 1 — Mints 1 — Green Peas 1 — Macaroni 2 — Blue Peas 1 — Gravy Salt 3 — Jam Roll 1 — Crushed Linseed 3 — Bicarbonate of Soda 1 — Ground Rice 4 — Tomato Soup 2 — Sago 2 — Carried forward 973 4 138 Article. Number of Samples taken. Adulterated. Brought forward 973 4 Desiccated Soup 3 — Orange Fizz 1 — Suet and Rice Flour 7 — Mixed Spice 6 — Lemon Barley 1 — Sweets 6 — Soup Mixture 2 — Glace Cherries 1 — Forcemeat Stuffing 1 — Table Salt 4 — Locust Beans 1 — Lentils 3 — Pea Flour 1 — Walnut Cream Sandwich 1 — Pastry Puffs 1 — Shortening 1 — Bun Flour 3 — Milk Pudding Powder 2 — Cooking Salt 1 — Pudding Spice 1 — Rice Cake Flour 1 — Bourn Vita 1 — Desiccated Coconut 2 — Jelly Crystals 3 — Pudding Mixture 1 — Patent Barley 1 — Sausages 1 1 Yorkshire Pudding Powder 1 — Boracic Powder 1 — Total 1032 5 Percentage of adulterated samples for the year—0.5. 139 INFORMAL SAMPLES. In addition to the samples taken under the Food and Drugs Acts as shown in Table 32, 820 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 33. Article. Number of samples. Adulterated Milk 47 — Pasteurised Milk 16 4 Butter 165 — Lard 17 — Self-raising Flour 13 — Dripping 95 — Pepper 15 — Cake and Sponge (various) 40 — Cereals 22 — Spices, Herbs and Condiments 80 — Flour and Cooking Powders 26 — Breakfast, Lunch and Preserved Sausage 43 1 Sausages 4 2 Ground Ginger 9 — Tea 32 — Vinegar 78 6 Brawn 9 — Cordials and Soft Drinks 6 — Cooked Ham 21 — Margarine 4 — Paste (Meat and Fish) 8 — Cocoa 10 — Coffee 5 — Soups 4 — Boracic Powder 12 — Bi-carbonate of Soda 12 — Borax 12 — London Milk Ale 4 4 Sild 2 2 Other Commodities 9 — Total 820 19 Percentage of adulterated samples for the year—2.3. SECTION F. Prevalence of, and Control over, Infectious and other Diseases. 143 INFECTIOUS DISEASES. With the exception of Measles, the number of certified infectious diseases was low, as compared with previous years. Although a "Measles year," it is very gratifying to find that the deaths from this disease were lower than ever, numbering in all 23. There is no doubt that the very close co-operation which exists between the L.C.C. Educational Medical Service and the Borough Health Department, for keeping in touch with all known cases of Measles and contacts, and the removal of severe cases to hospital, are together responsible for this decreasing mortality. The question of a "Whooping Cough scheme" on similar lines to the "Measles scheme," and the making of Whooping Cough a notifiable disease, was considered desirable by the Council, and, in fact, by the majority of the Metropolitan Borough Councils. It is to be hoped that this scheme is not long delayed, as there is no doubt that Whooping Cough is not only the most distressing, but the most deadly of the infectious diseases to young life. This latter statement is well illustrated by the infectious diseases recorded during the year in the Health Department; whereas there were 23 deaths out of a total of 2,093 known cases of Measles, there were 17 deaths out of 74 known cases of Whooping Cough. The number of deaths from Diarrhœa is also showing a gradual improvement. In 1935, this complaint caused 25 deaths of infants under 2 years of age, and in 1936, the year under review, there were 19 such deaths. This is only to be expected, as explained in my previous reports, on account of the rapid slum clearance giving better housing conditions and facilities for cleanliness to the people, to which may be added a cleaner milk and food supply. Although not an infectious disease, so far as is known, the deaths from Cancer have been tabulated in this section of the Report. These deaths show a considerable increase as compared with previous years, in spite of the educational propaganda carried out by this Council on the subject, and the increasing facilities for early diagnosis and treatment now available at the hospitals in and around the Borough. An examination of this table shows that the increase is due to cancer of the alimentary tract, but unfortunately the cause is not clear, otherwise preventive measures could be adopted. 144 In our present state of knowledge on the subject, these preventive measures, with the exception of certain chemical irritants, are more or less generalised—there is nothing specific—and we have to rely on "cure'' by X-rays, radium, or by surgical operations. SMALLPOX. During the year under review no cases were notified. The number of cases notified during the last five years is as follows:— 1932 161 1935 — 1933 63 1936 — 1934 22 SCARLET FEVER. Three hundred and fifty-two cases of this disease were notified during the year. The annual death-rate per 1,000 population for England and Wales was 0.01; for London, 0.0l; and for Southwark, 0.00. The number of cases notified and the number of deaths during the last five years were as follows:— Notified. Deaths. 1932 623 4 1933 1.268 3 1934 748 5 1935 513 2 1936 352 - ENTERIC FEVER. Two cases of Enteric Fever were notified during the year. One death occurred in a L.C.C. Institution. The number of cases notified and the number of deaths during the last five years were as follows:— Notified. Deaths. 1932 2 — 1933 6 3 1934 — — 1935 3 — 1936 2 1 145 DIPHTHERIA. Three hundred and thirty-eight cases of this disease were notified, with 9 deaths. The annual death-rate per 1,000 population was 0.07 for England and Wales; 0.08 for London; and 0.06 for Southwark. Antitoxin is supplied free of charge and 60 phials of 8,000 units have been supplied to Medical Practitioners in the Borough during the year. The number of cases notified and the number of deaths during the last five years were as follows:— Notified. Deaths. 1932 448 14 1933 486 12 1934 600 21 1935 362 14 1936 338 9 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 number of patients tested and immunised during the last seven years is set out in the following table:— 146 SCHICK CLINIC 1929-1936. Number tested, 0—5. Inoculation without test. Immunised. Number tested, 5—14. Inoculation without test. 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 (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 8 (67 immune) 82 — — 194 1934 60 (11 immune) 113 147 119 (52 immune) 3 130 7 (5 immune) — 277 1935 34 (9 immune) 154 178 183 (76 immune) 14 152 9 (8 immune) 1 331 1936 27 (3 immune) 137 162 123 (41 immune) 12 139 2 (I immune) 1 302 147 MEASLES. The number of cases of this disease notified during the year was 2,098. Of these, 1,336 were under five years of age, and 733 were removed to hospital. One hundred and fifty 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 number of deaths from Measles during the last five years will be found hereunder:— 1932 53 1935 1 1933 6 1936 23 1934 65 DIARRHOEA. This disease is notifiable during the months of July, August and September in the Borough of Southwark. During this period no cases were notified. Deaths of infants under two years of age during the last five years were as follows:— 1932 34 1935 25 1933 32 1936 19 1934 39 WHOOPING COUGH. This disease is not notifiable in the Borough, but cases come to the knowledge of the Public Health Department through the medium of the various local hospitals, or the general practitioners; 74 cases were removed to hospital during the year. The number of fatal cases during the last five years will be found hereunder:— 1932 20 1935 15 1933 23 1936 16 1934 13 148 INFLUENZA. The deaths from this disease during the last five years were as follows:— 1932 43 1935 13 1933 98 1936 18 1934 24 CEREBRO-SPINAL FEVER, ENCEPHALITIS LETHARGICA, AND POLIOMYELITIS. Nine cases of Cerebro-Spinal Fever were notified during the year, of which 4 died. One case of Poliomyelitis was also notified, which was sent to hospital. ACUTE PRIMARY AND INFLUENZAL PNEUMONIA. One hundred and twenty-seven cases were notified during the year, of which 54 were removed to hospital. There were 19 deaths of these notified cases. CANCER. The number of deaths during the last five years, together with a table showing the site of disease, for the period 1936 will be found hereunder:— 1932 263 1935 284 1933 288 1936 309 1934 269 TABLE 34. Deaths from Cancer (1936). Site of Disease. Under 15. 15—25. 25—35. 35—45. 45—55. 55—65. 65—75. 75 and over. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Buccal Cavity, Pharynx, (Esophagus, Stomach, Liver and Annexa — — — 2 3 — 2 3 18 11 39 7 29 21 21 12 112 56 Peritoneum, Intestines, Rectum, Bladder — — — — — — 1 1 2 2 16 8 18 12 7 4 44 27 Genital Organs — — — — — 2 — 2 — 7 2 8 6 4 1 3 9 26 Breast — — — — — — — — — 4 — 6 — 8 — 4 — 22 Other and unspecified organs — — — — — — 1 1 1 — — 2 4 2 1 1 7 6 — — — 2 3 2 4 7 21 24 57 31 57 47 30 24 172 137 149 OPHTHALMIA NEONATORUM. Twenty-six cases occurred during the year, as against 29 in 1935. An analysis of the cases will be found hereunder:— Noti¬ fied. Cases treated. Vision unimpaired. Vision impaired. Total Blindness. Deaths. At home. Hospital. 26 10 16 26 — — 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. 150 TABLE 35. NOTIFIABLE DISEASES (other than Tuberculosis) during the year 1936. Disease. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Males. Females. Total Cases admitted to Hospital Total Deaths Scarlet Fever 1 100 118 58 26 24 17 5 1 2 — — — 146 206 352 327 — Smallpox — — — — — — — — — — — — — — — — — — Diphtheria 2 109 153 37 16 10 7 3 — — — — — 153 184 337 337 9 Memb. Croup — — 1 — — — — — — — — — — — 1 1 1 — Enteric Fever — — — — — — 1 — — — — — — 1 — 1 1 1 Paratyphoid — — — — — 1 — — — — — — — — 1 1 1 — Puerperal Fever — — — — — 5 7 1 — — — — — — 13 13 11 1 Puerperal Pyrexia — — — — 2 5 9 1 — — — — — — 17 17 17 1 Cerebro-Spinal Fever 2 4 1 1 — — 1 — — — — — — 5 4 9 9 4 Measles 121 1215 716 36 5 3 2 — — — — — — 1028 1070 2098 883 23 Malaria — — — — — — — — — — — — — — — — — — Dysentery — 5 3 — — — — — — — — — — 4 4 8 6 — Epidemic Diarrhoea — — — — — — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — — — — — — Pneumonia 9 20 13 4 11 8 15 11 16 15 3 1 1 68 59 127 54 19 Ophthalmia Neonatorum 26 — — — — — — — — — — — — 10 16 26 16 — Erysipelas 1 1 3 2 5 5 4 14 15 10 12 2 — 30 44 74 36 — Polio-Encephalitis — — — — — — — — — — — — — — — — — — Poliomyelitis 1 — — — — — — — — — — — — 1 — 1 1 — Chickenpox — — — — — — — — — — — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — Totals 163 1454 1008 138 65 61 63 35 32 27 15 3 1 1446 1619 3065 1700 58 152 TABLE 36. Return of Families Admitted into the Council's Reception House during the year 1936. 1936. Scarlet Fever. Diphtheria. Smallpox. Other Diseases, etc. Verminous Persons. Week ending No. of 1 Families No. of Persons No. of Days No. of Families No. of Persons No. of Days No. of Families No. of Persons No. of Days No. of Families No. of Persons No. of Days No. of Families No. of Persons No. of Days Jan. 4 — — — — — — — — — — — — — — — „ 11 — — — — — — — — — — — — — — — ,, 18 — — — — — — — — — — — — — — — ,, 25 — — — — — — — — — — — — — — — Feb. 1 — — — — — — — — — — — — — — — ,, 8 — — — — — — — — — — — — — — — ,, 15 — — — — — — — — — — — — — — — ,,22 — — — — — — — — — — — — — — — ,, 29 — — — — — — — — — — — — — — — March 7 — — — — — — — — — — — — — — — ,, 14 — — — — — — — — — — — — — — — ,, 21 — — — — — — — — — — — — — — ,, 28 — — — — — — — — — — — — — — — April 4 — — — — — — — — — — — — — — — ,, 11 — — — — — — — — — — — — — — — ,, 18 — — — — — — — — — — — — — — — ,, 25 — — — — — — — — — — — — — — — May 2 — — — — — — — — — — — — — — — ,, 9 — — — — — — — — — — — — — — — „ 16 — — — — — — — — — — — — — — — ,, 23 — — — — — — — — — — — — — — — ,, 30 — — — — — — — — — — — — 1 1 2 June 6 — — — — — — — — — — — — — — — ,, 13 — — — — — — — — — — — — — — — ,, 20 — — — — — — — — — — — — 1 1 17 ,, 27 — — — — — — — — — — — — — — — 153 Brght. forwd. — — — — — — — — — — — — 2 2 19 July 4 — — — — — — — — — — — — — — — „ 11 — — — — — — — — — — — — — — — ,, 18 — — — — — — — — — — — — — — — „ 25 — — — — — — — — — — — — — — — Aug. 1 — — — — — — — — — — — — 1 1 2 ,, 8 — — — — — — — — — — — — — — — ,, 15 — — — — — — — — — — — — — — — „ 22 — — — — — — — — — — — — — — — „ 29 — — — — — — — — — — — — — — — Sept. 5 — — — — — — — — — — — — — — — ,, 12 — — — — — — — — — — — — — — — ,, 19 — — — — — — — — — — — — — — — „ 26 — — — — — — — — — — — — — — — Oct. 3 — — — — — — — — — — — — — — — „ 10 — — — — — — — — — — — — — — „ 17 — — — — — — — — — — — — — — — ,, 24 — — — — — — — — — — — — — — — ,, 31 — — — — — — — — — — — — — — — Nov. 7 — — — — — — — — — — — — — — — ,, 14 — — — — — — — — — — — — — — — „ 21 — — — — — — — — — — — — — — — ,,28 — — — — — — — — — — — — — — — Dec. 5 — — — — — — — — — — — — — — — ,, 12 — — — — — — — — — — — — — — — ,, 19 — — — — — — —— — — — — — — — — ,, 26 — — — — — — — — — — — — — — — Total — — — — — — — — — — — — 3 3 21 154 DISINFECTION. The total number of disinfections of rooms during the year by the Council's disinfecting staff was 942. Of this number 805 rooms were disinfected after the occurrence of the ordinary notifiable infectious diseases, and 137 after cases of phthisis. 1,513 verminous rooms were sulphured and otherwise cleansed by the Council's staff during the year, as against 1,483 in 1935. Among the total number of disinfections (942) it was found unnecessary to strip any rooms. TABLE Bedding, etc., disinfected and destroyed after the occurrence of Infectious Disease during the year 1936. Articles. No. Disinfected. No. Destroyed. Beds 438 48 Palliasses 421 41 Bolsters 316 21 Pillows 1,264 55 Cushions 104 27 Blankets 1,240 13 Sheets 727 16 Quilts 696 16 Articles of Clothing, etc. 18,726 647 Books 277 — Total 24,209 884 8 cwt. 55 lbs. of horsehair and 60½ lbs. of bristles were disinfected. 16 cwt. 18 lbs. of household effect were destroyed. 155 TABLE 38. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from the 1st January, 1936, to the 31st December, 1936, in the Metropolitan Borough of Southwark. Age-periods Notifications on Form A. Number of Primary Notifications. Total Notifications on Form A. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and upw'rds Total Primary Notifications. Pulmonary Males — 1 1 2 6 10 37 24 32 16 11 140 166 ,, Females — 1 3 3 13 17 18 8 8 6 — 77 100 Non-Pulmonary Males 1 2 4 1 3 2 2 3 4 4 — 26 28 ,, ,, Females — 2 1 3 1 2 1 1 — 2 1 14 15 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. 156 TABLE 39. 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, 1936, to the 31st December, 1936, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1930. 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 1 1 3 4 1 —- 12 ,, Females —- —- —- —- 4 2 5 2 —- 1 —- 14 Non-pulmonary Males —- —- —- —- —- 1 —- 1 —- 1 —- 3 ,, ,, Female? —- —- —- 1 —- —- —- —- —- —- —- 1 157 DEATHS FROM PULMONARY TUBERCULOSIS. TABLE 40. Shewing the number of Patients who died in their own homes and the number who died away from home in Hospitals or other Institutions, 1936. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- All Ages. Males. Females. Total. Number of patients who died at home —- —- —- —- 5 3 4 3 4 3 2 11 13 24 Number of patients who died in hospitals, etc. —- 1 —- 1 12 21 18 29 16 3 1 73 29 102 —- 1 —- 1 17 24 22 32 20 6 3 84 42 126 Of the total number of deaths from Pulmonary Tuberculosis 80.0 per cent. occurred in hospitals or other institutions. 158 TABLE 41. TUBERCULOSIS. Age Periods. New Cases.* Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. 0 —- 1 —- —- 1 2 4 1 2 6 9 9 1 1 15 46 8 17 2 25 55 3 24 —- 35 32 4 22 1 45 40 4 32 —- 55 22 6 20 2 65 and upwards.. 11 1 9 1 Total 217 40 126 9 (1) The ratio of non-notified tuberculosis deaths to total tuberculosis deaths is nil. 159 The number of notified cases and deaths for the last five years is as follows:— Notified. Deaths. 1932 329 171 1933 285 172 1934 339 142 1935 253 130 1936 217 126 The mortality rate was 0.81 per 1,000, as against 0.83 per 1,000 in 1935. 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 42. Notification Register. Pulmonary. Non-Pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. Number of cases of Tuberculosis remaining at the 31st December, 1935, on the Registers of Notifications kept by the Medical Officer of Health of the Metropolitan Borough 738 394 1132 198 173 371 1503 Number of cases removed from the Register(s) 167 109 276 41 25 66 342 during the year by reason inter alia of:— (1) Withdrawal of notification 74 57 131 19 17 36 167 (2) Recovery from the disease 9 8 17 12 7 19 36 (3) Deaths 84 42 126 4 5 9 135 160 Disinfection was carried out as follows :— TABLE 43. 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 14 12 13 23 16 8 21 14 16 137 WORK OF THE TUBERCULOSIS DISPENSARY. The following report has been received from Dr. E. K. Pritchard, your Clinical Tuberculosis Officer:— In April, 1936, Dr. J. T. Crowe reached retiring age and Dr. Pritchard was appointed Tuberculosis Officer and Deputy Medical Officer of Health. In June, 1936, Dr. N. L. Rusby was appointed part-time Assistant Tuberculosis Officer. The times for sessions for patients are unchanged and are as follows:— Monday Tuesday Wednesday Thursday Saturday 9.30 a.m. to Tuesday 6 to 8 p.m. 12 noon. Thursday Monday and Wednesday, 12 noon.—Artificial pneumothorax refills. Tuesday and Thursday, 6 to 8 p.m.—Artificial pneumothorax refills. These evening sessions are primarily intended for workers only. Saturday.—Children and contacts of school age. (Whenever possible children are seen on Saturdays for the convenience of the parents, but when necessary can be seen at any of the other sessions.) Home visiting of patients is carried out every Wednesday morning by Dr. Rusby, but any additional cases are seen by Dr. Pritchard on other days during the week. 161 Every effort is made to keep in close touch with the general practitioners in the Borough, and to give them every assistance in the diagnosis and treatment of their cases which are referred to the Dispensary. Dr. Pritchard has been appointed Honorary Consultant in Tuberculosis at St. Giles's Hospital, Camberwell, and attends there every Friday morning and is in this way enabled to keep in touch with the Southwark patients in the Hospital. Figures showing the work of the Dispensary are on page 171. This is a copy of the form which is sent to the Ministry of Health and the London County Council. DIAGNOSIS. In most cases new patients are referred to the Dispensary for an opinion by their own Doctors, but sometimes patients present themselves for examination on their own initiative. The examination of contacts is a further source of new patients and in every case the examination of contacts is as thorough as that of a new case. Early diagnosis of tubercular troubles is important if the results of treatment are to be successful. 229 patients were sent up by general practitioners for an opinion during the year. Since the Dispensary has been equipped with an X-Ray plant it has been possible to diminish the interval between the first attendance of the patient and the formation of a diagnosis. A further advantage of this arrangement is that while we are still able to avail ourselves of the opinion of the Consultants at the big Hospitals in the district, it is now possible for practically every patient to be dealt with by the Dispensary thus saving time and a considerable amount of inconvenience for the patient. Before the X-Ray was installed it was very often necessary for patients to attend the Out-Patient Department of other Hospitals in order to arrive at an ultimate diagnosis. The examination of sputum is carried out by the Public Analyst as it has been done in the past, and the number of examinations made have been 453. Of this total 143 were positive and 310 were negative. In addition to the usual physical examination which is carried out in every case, the Mantoux Test is also employed in the examination of children. This test is performed by an intra dermal injection of a solution into the forearm which produces a mild local reaction in a case which has been infected with the tubercle bacillus. It must be emphasised that infection with the tubercle bacillus does not necessarily mean that the patient is suffering from tuberculosis as it has been proved that nearly 162 every town dweller has been infected with this bacillus by the time he attains adult age. It will be seen, however, that this test provides valuable information in the case of children who present symptoms which might be ascribed to tuberculosis. The younger a patient with a positive reaction the more importance can be attached to it. A Mantoux reaction can vary in degree and sometimes may give an indication of the efficiency or otherwise of the isolation of the infectious patient in the home. During the year 29 Mantoux Tests have been carried out on children. X-RAY DEPARTMENT. In February, 1936, an X-Ray plant was installed in the small room behind the consulting room in the Dispensary. This comprises a NonRectified Unit and a combined Couch and Screening Stand. Though this unit was comparatively inexpensive it is possible to do really good chest work, and though the room in which it is now housed is too small for comfortable work it has proved of enormous value in the increasing work of this Dispensary. In a number of cases X-Ray photographs are taken on paper films which have the advantage of being half the price of the normal X-Ray films and we have now adopted a technique for their use which gives most satisfactory results. An X-Ray photograph is taken of every case, even if it has been referred to us already diagnosed and there is no doubt these photographic records of cases will be of great value in subsequent years when patients return for Dispensary supervision after sanatorium treatment. Every adult and adolescent contact is screened and if necessary a confirmatory photograph is taken. Younger children are always X-Rayed should there be any indication for it. The progress of patients who are having Artificial Pneumothorax refills (which will be explained later) is also checked by frequent screen examination. In fact it would be highly undesirable to carry out this treatment at the Dispensary without convenient access to an X-Ray plant. We have recently acquired a small attachment for the existing X-Ray tube which makes it possible to do Dental X-Ray, and it is expected that this will prove of considerable help to the Dental Officer in the future. 716 patients have been screened and 272 photographs taken during the year. 163 INSTITUTIONAL TREATMENT. The London County Council is responsible for all Institutional treatment of patients suffering from tuberculosis, and all patients so suffering spend some of their time in a Hospital or Sanatorium during the course of their disease. The Dispensary acts as a Clearing Station and is responsible for recommending patients to the L.C.C. at the appropriate time. In August, 1934, the L.C.C. decided that all Institutional treatment for tuberculous patients for whom they were responsible should not be subjected to any payment whatever on the part of the patient or his family. The object being that the financial strain of payment in some cases might hinder the patient's recovery by preventing adequate supplies of necessary nourishment. In certain cases it is necessary for the patients to undergo a period of observation in a Special Hospital for Diseases of the Chest before a final diagnosis can be made. Such patients are usually sent to Brompton Hospital. This Hospital also accepts early cases of tuberculosis, and cases requiring specialised surgical treatment. High Wood Hospital admits children for observation and diagnosis and definite cases of Pulmonary Tuberculosis. The great majority of cases are sent to Sanatorium as soon as a diagnosis is completed. Sanatorium routine is the mainstay of all treatment of tuberculosis and of great educational value after the patient's discharge as he has then been taught the mode of life which gives him the best chance of maintaining the improvement in his health which he has gained while being away. General Hospital treatment is usually advised for those patients whose condition is so acute or advanced that removal to a sanatorium is inadvisable, but it must be remembered that many of these patients improve so much after a few months in a general hospital that they are subsequently transferred to a sanatorium. General Hospitals also accept chronic cases who are not expected to benefit from a further period of Sanatorium treatment. Another type of Institutional treatment is the Sanatorium Colony— Papworth near Cambridge, Preston Hall near Maidstone. Papworth takes both male and female adult patients, and Preston Hall takes male patients only. After a suitable period of Sanatorium routine the patients 164 are trained in various spheres of useful work, e.g., Cabinet Making, Gardening, Poultry Farming, Leather Work of all kinds and Printing, etc., and the patients are paid for the work they do. Suitable cases are allowed to "Colonise," that is to say, they make the Colony their home and if married they are given adequate accommodation for their families. Burrow Hill Colony, near Frimley, trains male adolescents between the ages of 13 and 19. They specialise in two distinct courses of training— (1) Clerical: (2) Horticultural. These patients may be kept in the Colony for a period of up to two years and on their discharge, after a complete course of training, should be fitted both physically and economically to take their place in the outside world. The following cases were recommended to the London County Council for Institutional treatment during the year:— Adults. Under 15 years. Hospital for Observation 11 15 Sanatorium 151 10 Hospital 74 3 SPECIAL TREATMENTS. For many years the treatment of tuberculosis consisted of rest, good food and fresh air. Some 35 years ago an additional principle of treatment was introduced, based on the theory of auto-inoculation. After an initial period of rest patients were put on gradually increasing amounts of exercise and work, the aim being for the patients progressively to immunise themselves against the increasing amounts of poisons liberated by the tuberculous lesion in the course of the graduated exercise. In the last 20 years further advances have been made by the application of surgical treatment of lung disease ; and by this means to the principle of rest to the body as a whole, is added the method of rest to the diseased part. This process, collectively called collapse therapy, may be attained in several different ways. The most widely used of these operations is that known as Artificial Pneumothorax which consists of introducing a cushion of air between the lung and the chest wall. This operation has the merit of being simple and practically painless, but the air has to be replaced at intervals owing to its gradual absorption. Since the installation of the x.Ray plant in the Dispensary it has been possible to carry out these refills on the premises, thus saving the patient the inconvenience of attending both the Dispensary for supervision and a Hospital for refills. 165 During 1936, 405 refills have been given to 36 patients. Treatment by the injection of Gold Salts in selected cases give good results and usually reduces the amount and infectivity of the sputum. Injections are given once per week. 121 injections of Gold have been given to nine selected patients at the Dispensary with most satisfactory and encouraging results. NON-PULMONARY TUBERCULOSIS. All cases of Surgical Tuberculosis, such as Tuberculosis of Bones, Joints and Glands, are sent by the London County Council to special Sanatoria which deal only with this type of case. On the completion of the Sanatorium treatment, arrangements are made for patients to attend at an Orthopaedic Department of a General Hospital at frequent intervals, or at the After-Care Clinic held at the County Hall, by the Medical Superintendent of the Sanatorium at which their treatment was obtained. Cases who require Actino-therapy are referred either to General Hospital, or to one of the L.C.C. General Hospitals. Four patients were recommended for Light Treatment during the year. OCCUPATIONAL THERAPY. Occupational therapy may be included amongst special treatment for tuberculous patients who are not yet well enough to resume their ordinary work. The object is to give them some outside interest by training them in a useful hobby. For this purpose the Handicraft Class was commenced at the Dispensary a few years ago. This is held each Wednesday afternoon; but in September it was thought that the keenness of the students justified a further session and now the Class also meets every Friday morning. The patients definitely enjoy their work and appear to derive both physical and psychological benefit. At the end of 1936 there were 22 patients on the Class Register, with an average weekly attendance of 16. 166 DENTAL TREATMENT. The Dental Clinic which was inaugurated at the Dispensary in October, 1935, held fortnightly sessions until June, 1936, when it was found that there was sufficient dental work to justify a weekly session. The arrangements with the British Dental Hospital have been highly satisfactory and Mr. G. E. King Turner, L.D.S., H.D.D., attends every Monday afternoon. The Tuberculosis Officers recommend the patients for attendance at the Clinic. All extractions, fillings and scalings are done free of charge. The cost of dentures is, in the case of insured persons, paid in part by the Society of which the patient is a member and the remainder by the person concerned. If the patient is unable to afford anything towards dentures or does not belong to any Society under the National Health Insurance Act, the cost is met either in part or whole by some charitable organisation or by the Borough Council. The average attendance at each session is between 12 to 15 patients and it has been found in many cases that patients who have steadfastly refused necessary dental treatment for years, now attend willingly at the Dispensary Dental Clinic. During the year there have been 520 attendances at the Clinic, and the dental work done was as follows:— Extractions, 253; Gas administrations, 26; Fillings, 54; Scalings, 25; Dentures supplied, 40. EXTRA NOURISHMENT. Under the Ministry of Health Regulations, extra nourishment can be supplied at the expense of the Borough to patients attending the Dispensary who are unable to afford necessary nourishing food. This scheme is employed for patients who are waiting a Sanatorium vacancy and also to tide them over the difficult period between their discharge from Sanatorium and their return to work, but in the case of patients who are in receipt of Public Assistance no call is made upon the Borough funds, but recommendations are made to the Public Assistance Committee by the Tuberculosis Officers for the supply of extra food in necessitous cases and there is no doubt that patients greatly benefit by this scheme. 84 patients have been granted extra nourishment at the expense of the Borough. 167 Both the Public Assistance Committee and the Unemployment Assistance Board have been most helpful in this respect and the Invalid Kitchens have also given much generous help to any patients who have been recommended to them from the Dispensary. The Charity Organisation Society, the British Red Cross, the United Services Fund and the National Association for the Prevention of Tuberculosis have all given most valuable help to cases sent for assistance. CONTACTS. A most essential part of the Dispensary work is aimed at the prevention of the spread of the disease. It is well known that tuberculosis is characterised by an extremely insidious onset and some patients have obviously suffered for a long period from the disease before they considered their symptoms serious enough to justify their consulting a Doctor. During this time these patients may have been unconsciously infecting their children and relatives. In the hopes of finding such cases, wherever possible the contacts of a known case of tuberculosis are examined both physically and radiologically at the Dispensary. Amongst the contacts examined last year we found 11 suffering from Tuberculosis and there is every reason to believe that some of these positive cases although examined as contacts were actually the primary infector in the family. Children of school age, who are examined as contacts of notified cases of Pulmonary Tuberculosis, are referred to the School Medical Service for constant supervision. Should the School Medical Officer at any time consider that the health of these children is not entirely satisfactory, they are again referred to the Dispensary for further examination and, if necessary, observation by the Tuberculosis Officer. The L.C.C. also provides for the Boarding-out Scheme for child contacts of infectious tuberculous patients when it is considered that they are in danger of contracting the disease and also when the mother of the family is found to be suffering from tuberculosis and is having Sanatorium treatment and not other provision can be made for the care of the children. It is felt that this boarding-out of contacts is of great value in preventing the spread of tuberculosis amongst children and wherever possible the parents are encouraged to avail themselves of this scheme. As in the case of Institutional treatment for tuberculous patients the L.C.C. do not require any payment. The actual housing of the children while they are away from home is arranged through the Invalid Children's Aid Association. 168 This Association is also most helpful in arranging for Convalescent Treatment for children in a poor state of health, but not suffering from any form of tuberculosis, who come to the notice of the Dispensary. In certain cases the L.C.C. arranges for child contacts of infectious patients to be educated in one of the Open-Air Schools as it is felt that closer general supervision at such a school may help to prevent the child falling a victim to tuberculosis. This is an additional function of the Open-Air Schools which were primarily intended for cases of quiescent tuberculosis. During the year 21 children were recommended to the London County Council for Boarding-out under the "Contact Scheme." 9 contact children were recommended to the Invalid Children's Aid Association for Convalescence, and 5 contact children were recommended for admission to Open-Air School. SUPERVISION OF HOME CONDITIONS. There are three Tuberculosis Nurses on the Staff of the Dispensary and their duties include the home visiting of all notified cases of tuberculosis occurring in the Borough. It is their duty to report to the Tuberculosis Officer details relating to the home conditions of all patients. The homes are visited at frequent intervals and the Nurses endeavour to obtain the confidence of the patients and their families, and to help them to so arrange their homes that other members of the family are subjected as little as possible to infection. At the same time when the patient is at home they offer suggestions of a simple and commonsense nature, as to how the patient can obtain the maximum amount of benefit to his health while living a more or less normal life. It is also the duty of the visiting nurses to encourage the other members of the family to present themselves at the Dispensary as "Contacts'' and to a great extent the necessary attendances of contacts at the Dispensary is dependent on these tactful approaches by the Nurses. During the year 4,979 such visits were paid. The Ranyard Nursing Association, the Benson Nursing Association and the Institute of Trained Nurses of Our Lady of Consolation, have very willingly carried out home nursing to bedridden patients who were either unwilling to enter an Institution, or who were too ill to be removed to a Hospital. 169 In the case of patients whose homes have suitable yards or gardens, shelters can be lent if the patient so desires. Under this arrangement the patient is able to live and sleep in the open air, and, at the same time, if there is overcrowding in the home, the use of a shelter is a very useful means of alleviating such overcrowding. Owing to the district being thickly populated, however, the use of Shelters cannot very often be employed. Patients requiring an extra bedstead, but who are unable to afford this added expense, can be loaned a bedstead from the Dispensary. In many cases this allows the patient to sleep alone even though the room may, under difficult housing accommodation, have to be shared with another member of the family. TUBERCULOSIS CARE COMMITTEE. The Tuberculosis Care Committee, which is a voluntary Committee, continues to do very useful work on behalf of the tuberculosis patients of the Borough. Miss Ashe, the Honorary Secretary, reports that help was asked for and obtained in 176 cases, apart from recommendations to the Public Assistance Committee and requests for clothes from the London County Council. Our best thanks are due to the following Societies for the help they have rendered:— British Legion and United Services Fund. The Charity Organisation Society. The Diocesan Association. Friends of the Poor. Invalid Kitchens of London. Musicians' Benevolent Society. Society for the Relief of Distress. Soldiers' and Sailors' Help Society. Various Regimental Societies. Public Assistance for Special Purposes. Invalid Children's Aid Association. The latter take entire charge of our children's cases, and arrange, through the London County Council "Contact Scheme," for children from infectious homes to be boarded out in healthier surroundings. 170 In addition, Queen Mary's Needlework Guild have given a grant of clothes. One of the chief difficulties of the Care Committee is the obtaining of funds, and reliance has to be placed on the generosity of our friends. The Mayor subscribed £5, and Alexandra Rose Day collection £10. The Honorary Secretary raised £11 10s., and other funds were forthcoming from sales of work, dances, etc. From this money, the Care Committee make grants of pocket money to patients in hospitals or sanatoria, who have no friends or relatives able to supply this need. Fares are also provided to enable mothers to visit their children, or wives their husbands, etc., etc. 171 TABLE 44. Return for the year 1936. (A) Return showing the work of the Dispensary (or Dispensaries). 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 62 32 1 2 7 6 3 5 69 38 4 7 118 (b) Diagnosis not completed 26 6 6 6 — — 1 1 26 6 7 7 46 (c) Non-tuberculous 69 49 5 7 2 — 1 3 71 49 6 10 136 B.—Contacts examined during the year:— (a) Definitely tuberculous 6 2 — 2 — — 1 — 6 2 1 2 11 (b) Diagnosis not completed 1 3 — 3 — — 2 1 1 3 2 4 10 (c) Non-tuberculous 42 57 75 61 — 1 — — 42 58 75 61 236 C.—Cases written off the Dispensary Register as:— (a) Recovered 6 9 1 1 3 2 10 6 9 11 11 7 38 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) 114 106 80 69 2 1 1 3 116 107 81 72 376 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 276 148 21 23 23 28 15 23 299 176 36 46 557 (b) Diagnosis not completed 27 9 6 9 — — 3 2 27 9 9 11 56 1. Number of cases on Dispensary Register on January 1st 653 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 50 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 153 4. Cases written off during the year as Dead (all causes) 80 5. Number of attendances at the Dispensary (including Contacts) 4315 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 56 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 315 (a) Personal 16 (b) Other 229 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4139 10. Number of: — (a) Specimens of sputum, etc., examined 495 (b) X-ray examinations made in connection with Dispensary work. 988 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (ft) above 2 12. Number of "T.B, plus" cases on Dispensary Register on December 31st.. 297 (B) Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment). Provided by the Council—One. 172 STATISTICAL REVIEW OF TUBERCULOSIS IN THE BOROUGH FROM 1920 TO 1936. It was thought that a complete review of the tuberculosis question with regard to the statistics of tuberculosis in the Borough might be of interest and prove instructive as to the degree of progress which has been made in this branch of work. It must be emphasised that though the figures given are correct in actual fact for any one year, extraneous factors may lead to false conclusions if the following graphs are not regarded as evidence of the general trend of events. In each graph the figures have been worked out on a basis of the population of 100,000, as the population of the Borough has been gradually diminishing during the period under review except in the peak years of 1925 and 1926. It will be noticed that the improvement in the death rate from tuberculosis has extended over the whole period, but it has been most satisfactory and progressive during the last few years. One can only surmise that this is the result of the recent progress in the technique of treatment of the disease and the gradual improvement of the living conditions of the people. GRAPH No. 1. It will be seen that the number of notifications of pulmonary tuberculosis has considerably diminished during the period under review 2nd the deaths have decreased to an even greater extent. The high death rate from 1920 to 1924 may be ascribed to the immediate after effects of the Great War. The second high level of death rate from 1929 to 1931 may have some relation to the industrial depression at that time. The gradual decrease of the population must signify the lessening of the overcrowding in the Borough, and this also had some effect. 173 GRAPH No. 2. This graph refers entirely to non-pulmonary tuberculosis (i.e., tuberculosis of bones, joints, glands, etc.), and here is seen the most remarkable improvement which has been progressive throughout the sixteen years under review. The factors described in Graph No. 1 have probably had some effect in this sphere, but there is no doubt that the plentiful supply of safe (i.e., pasteurised) milk is largely responsible for the dramatic decrease from this form of tuberculosis. GRAPH No. 3. This graph shows the percentage of the total deaths from pulmonary tuberculosis in each age group over different periods. The peaks in the 25 to 35 and in the 45 to 55 age groups may be taken as the deaths arising from the periods of maximum incidence of the disease—i.e., 15 to 25 and 35 to 45. It will be noticed that these peaks are less defined in the period 1931 to 1935, and that the deaths are increased in the 55 to 65 group. The assumption from this is that patients suffering from pulmonary tuberculosis are living longer, and this may be ascribed to improved methods of treatment and to better conditions in general. Working from this graph the following interesting figures arise:— Total Percentage of Deaths from Pulmonary Tuberculosis in Age Groups from 45 onwards. 1925 to 1929 41.33 1930 to 1935 45.56 1936 48.24 Less reliance must be placed on the figure given for 1936 because the period under review is shorter, but the figure is indicative of an increasing control of the disease. 174 SUMMARY OF TUBERCULOSIS STATISTICS from 1920 to 1936. 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Population in 1,000's 187 184 187 187 187 189 188 184 181 178 174 172 168 164 159 156 152 Total Notifications— Actual 557 557 573 541 571 452 471 448 422 415 408 383 395 352 398 301 257 Per 100,000 298 302 306 289 304 240 250 243 233 232 233 221 234 213 249 192 169 Total Deaths— Actual 292 305 303 279 298 234 232 230 230 263 231 236 190 193 160 146 135 Per 100,000 156 165 163 150 159 124 123 125 127 147 126 136 112 117 100 93 89 Pulmonary Notifications— Actual 415 430 444 423 424 336 363 343 319 339 339 312 329 285 339 253 217 Per 100,000 222 233 237 226 226 177 193 186 176 190 193 180 195 173 212 161 143 Pulmonary Deaths— Actual 243 262 249 231 260 192 199 197 194 232 210 208 171 172 142 130 126 Per 100,000 130 142 133 124 139 102 106 107 107 130 114 120 101 104 89 83 83 Non-Pulmonary Notifications— Actual 42 127 129 118 147 116 108 105 103 76 69 71 66 67 59 48 40 Per 100,000 76 69 69 63 78 63 57 57 57 42 40 41 39 40 37 31 26 Non-Pulmonary Deaths— Actual 49 43 54 48 38 42 33 33 36 31 21 28 19 21 18 16 9 Per 100,000 26 23 30 26 20 22 17 18 20 17 12 16 11 13 11 10 6