LIBRARY Sou 49 Borough of Southwark. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1937. william stott, m.b., b.s., d.p.h., Medical Officer of Health. Administrative Tuberculosis Officer. Administrative Officer for Maternity and Child Welfare. Borough of Southwark ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1937. William Stott, m.b., b.s., d.p.h., Medical Officer of Health. Administrative Tuberculosis Officer. Administrative Officer for Maternity and Child Welfare. LONDON: Crusha & Son, Ltd., Tottenham, Enfield, Palmers Green and Wood Green. Borough of Southwark. Health Services Department, Walworth Road, S.E.17. To Her Worship the Mayor, Aldermen and Councillors, Madam, Ladies and Gentlemen, I beg to submit my Annual Report on the health of the Borough for the year 1937. This year will ever be a notable one in the Public Health history of the Borough, being marked by the completion and opening of the Health Services Department. This building is unique in its character and make up, and the Council can be well pleased with its achievement. Not only does it house the administrative staff, but it also provides accommodation for the Tuberculosis Dispensary —Dental Department —Solarium —Special Maternity Department and the Public Analyst. Thus, centralisation of the administration has been brought about, making for greater efficiency. Moreover, new accommodation has been provided, making it possible to increase the scope of the medical services, particularly those dealing with the health of the Mother and Child. Apart from the excitement of this red-letter day, the work of the various departments progressed smoothly. The health of the Borough remained good and there were no outbreaks of Infectious Disease to give rise to any alarm. In presenting this Report, I desire to place on record my appreciation of the continued 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. To the members of my Staff I tender my sincere thanks for their unfailing loyalty throughout the year. I am, Madam, Ladies and Gentlemen, Yours obediently, W. STOTT. SECTION A. Statistics and Social Conditions of the Area. 7 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 1,132 Population (estimated, 1937) 147,400 Number of inhabited houses (end of 1937) according to rate books 29,166 Rateable value £1,295,941 Sum represented by penny rate £5,144 SOCIAL CONDITIONS. Unemployment fluctuated considerably during the year, and at the end of December, the figures included 7,322 men, 2,415 women and 82 Juveniles, making a total of 9,819. VITAL STATISTICS. Total. M. F. Live Births—Legitimate 2,071 1,062 1,009 Live Births—Illegitimate 96 60 36 Birth Rate, 14.7 Still Births, 68. (Registered). Rate per 1,000 total births, 30.5 Deaths 2,074. Death rate, 14.1 Deaths from Puerperal Causes:— . Rate per 1,000 Deaths. (Live and Still Births). From Puerperal fever 1 0.45 From other Puerperal causes 6 2.69 Death rate of infants under 1 year of age per 1,000 live births:— Legitimate 64 Illegitimate 83 Deaths from Cancer (all ages) 279 Do. Measles (all ages) 1 Do. Whooping Cough (all ages) 13 Do. Diarrhoea (under 2 years of age) 21 8 POPULATION. As predicted in my Annual Report for 1936, the Annual Return of the Registrar-General reveals a further depletion of 4,800 persons in the population. This is largely accounted for by the Slum Clearance and Overcrowding activities of the London County Council, and the Borough Council. I feel, however, that when the cleared areas are re-built and families re-housed the population figure will show some increase on its present level. The population of the several divisions of the Borough at each Census since 1861, and also the estimated population for 1936 and 1937 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 1931 107,692 48,552 15,451 1936 95,404 43,104 13,692 1937 92,365 41,773 13,262 9 BIRTHS. The number of Births registered in the Borough during 1937 was 1,576 of which 802 were males, and 774 females. This represents a birth-rate of 10.7 per 1,000 inhabitants. The number of births registered in the individual parishes was as follows:—Newington, 470; St. George the Martyr, 229; Christchurch and St. Saviour's, 887. Of the 1,576 births registered in the Borough 539 were transferred away, the permanent residence of the parents being outside the Borough. 1,130 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 539 "outward'' transfers are deducted and the 1,130 "inward" transfers are added to the 1,576 births actually registered in the Borough, the net amount of births belonging to Southwark for the year is found to be 2,167. This gives a corrected birth-rate of 14.7. TABLE 1. Birth-rate for the last Ten Years for the Three Divisions of the Borough as formerly existed. Newington. St. George's. St. Saviour's and Christchurch. Whole Borough.[/##3] 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 1937 14.9 14.9 12.8 14.7 10 TABLE 2. Number of Births and Deaths belonging to each Ward, with the Birth and Death Rates, also the Infantile Mortality Rate, 1937. WARD. Births. Infantile Mortality. Deaths. Males. Females. Total. Birth-rate. Males. Females. Total. Death-rate. St. Mary 167 154 321 17.5 68 172 118 290 15.3 St. Paul 136 129 265 17.2 60 128 111 239 15.5 St. Peter 149 160 309 14.2 55 193 140 333 15.3 St. John 177 170 347 14.8 44 144 139 283 12.1 Trinity 67 65 132 10.5 99 109 58 167 13.1 St. Michael 121 114 235 14.2 85 148 88 236 14.2 St. Jude 94 77 171 15.6 111 98 84 182 16.7 St. George 118 99 217 15.3 42 77 61 138 9.7 Christchurch 43 30 73 12.2 82 63 48 111 18.8 St. Saviour 50 47 97 13.2 20 55 40 95 12.9 Borough 1122 1045 2167 14.7 64 1187 887 2074 14.1 11 DEATHS. 1,313 deaths were registered in the sub-districts of the Borough during 1937, the chief cause being Heart diseases, which accounted for 617, followed by Cancer with 279 deaths. 33 Southwark residents died in the street, or on the way to hospital. 737 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 161 belonging to Southwark and 576 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 1,337. When the 576 deaths of those persons who were non-parishioners, but who died in our Borough, have been deducted, and the 1,337 "outlying" deaths added, the actual or "corrected" number of deaths belonging to the sanitary area is found to be 2,074, of which number 1,187 were males and 887 females. The death-rate, when calculated on this "corrected" number, is 14.1 per 1,000 inhabitants for the whole Borough for the year 1937, as against a rate of 13.1 for 1936. The percentage of persons dying away from Southwark in relation to the total number of deaths belonging to the Borough was 64.0. The principal localities in which the "outlying" deaths occurred are as follows:— Lambeth Hospital 402 St. Giles' Hospital 416 Rotherhithe Hospital 114 East Dulwich Hospital 20 St. Thomas's Hospital 35 King's College Hospital 7 Belgrave Hospital 2 Royal Waterloo Hospital 9 General Lying-in Hospital 8 Mental Hospitals 85 In the Street and other Institutions 239 1,337 12 TABLE 3. Deaths belonging to the Sanitary Area, with the Causes of Death at all Ages during 1937. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. All Ages. 0. 1. 2. 5. 15. 25. 35. 45. 55. 65. 75. All causes 2074 140 24 17 23 63 81 105 174 376 512 559 1. Typhoid and Paratyphoid Fevers – – – – – – – – – – – – 2. Measles 1 – – 1 – – – – – – – – 3. Scarlet Fever – – – – – – – – – – – – 4. Whooping Cough 13 8 4 1 – – – – – – – – 6. Diphtheria 8 – 1 3 4 – – – – – – – 6. Influenza 73 1 – 1 – 5 2 2 12 12 12 26 7. Encephalitis Lethargica 2 — – — — — — 1 1 — — — 8. Cerebro-Spinal Fever 5 2 2 – – 1 – – – – – – 9. Tuberculosis of Respiratory System 116 – – – – 18 22 21 15 25 15 – 10. Other Tuberculous Diseases 13 1 — — 2 4 3 1 — 1 1 — 11. Syphilis 12 1 – – – – – 1 4 3 2 1 12. Gen. Paralysis of Insane, Tabes Dorsalis 12 – – – – 1 – 1 4 4 1 1 13. Cancer, Malignant Disease 279 – — — 3 1 3 15 45 73 92 47 14. Diabetes 24 – – – – – – 1 — 6 14 3 15. Cerebral Haemorrhage etc. 49 – – – – – – 2 3 5 19 20 16. Heart Disease 617 — — — 3 6 12 17 32 88 173 286 17. Aneurysm 11 – – – – – – 1 1 4 3 2 18. Other Circulatory Diseases 102 – – – – – – 1 1 19 40 41 19. Bronchitis 97 3 — — — 1 2 2 9 22 23 35 20. Pneumonia (all forms) 163 36 11 4 — 2 6 9 12 28 28 27 21. Other Respiratory Diseases 20 — — — — — 1 1 1 10 4 3 22. Peptic Ulcer 20 – – – – – 1 5 5 4 4 1 23. Diarrhoea, etc. 25 20 1 — — — 1 — 1 2 — — 24. Appendicitis 4 — — — 1 1 — — 1 — 1 — 25. Cirrhosis of Liver 5 – – – – – – – – 3 1 1 26. Other Diseases of Liver 4 – – – – – – – 1 2 1 — 27 . Other Digestive Diseases 24 1 — 1 1 — 1 — 2 6 9 3 28. Acute and Chronic Nephritis 80 — — — 1 3 4 3 8 24 20 17 29. Puerperal Sepsis 1 — — — — — — 1 — — — — 30. Other Puerperal Causes 6 — — — — 3 2 1 — — — — 31. Congenital Debility and Malformation, including Premature Birth, etc. 56 55 – – – – – – – 1 – – 32. Senility 17 – – – – – – – – – 4 13 33. Suicide 24 — — — — — 4 5 2 6 6 1 34. Other Violence 45 3 2 — 2 8 9 1 2 6 7 5 35. Other Defined Diseases 143 9 3 6 6 9 8 13 12 22 32 23 36. Causes (ill defined) 3 – – — – – – – – – – 3 Totals 2074 140 24 17 23 63 81 105 174 376 512 559 13 TABLE 4. BOROUGH OF SOUTHWARK. INFANT MORTALITY, 1937. 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 2 7 1 48 30 30 25 7 140 Measles – – – – – – – – – – Diphtheria – – – – – – – – – – Whooping Cough – – – – – 1 4 2 1 8 Diarrhoea – – – – – 6 7 6 1 20 Enteritis – – – – – – – – – – Influenza – – – – – – – 1 – 1 Cerebro-Spinal Fever – – – – – – 1 1 – 2 Scarlet Fever – – – – – – – – – – Phthisis – – – – – – – – – – Other Tuberculosis – – – – – – 1 – – 1 Congenital Malformations 8 — 2 – 10 3 — 1 – 14 Premature Birth 29 2 2 – 33 5 1 — – 39 Atrophy, Debility and Marasmus – – – – – 2 – – – 2 Atelectasis – – – – – – – – – – Erysipelas – – – – – – – – – – Syphilis – – – – – – 1 – – 1 Rickets – – – – – – – – – – Meningitis – – – – – 1 1 1 – 3 Laryngitis – – – – – – – – – – Convulsions – – – – – – – – – – Gastritis – – – – – – – – – – Intussusception – – – – – – – – – – Dentition – – – – – – – – – – Dermatitis – – – – – – – – – – Bronchitis – — 1 – 1 1 1 – – 3 Pneumonia (All Forms) – — 1 1 2 6 11 12 5 36 Suffocation (overlying) – – – – – – – – – – Accident (other) – – – – – 2 – 1 — 3 Nephritis, Acute – – – – – – – – – – Icterus Neonatorum 1 — – – 1 — – – — 1 Septic Pyaemia – – – – – – – – – – Otitis and Mastoiditis – – – – – – – – – – Other Causes – — 1 – 1 3 2 – — 6 Not classified above – – – – – – – – – – 38 2 7 1 48 30 30 25 7 140 Nett Births in the year Legitimate 2071 Illegitimate 96 Nett Deaths in the year . Legitimate Infants 132 Illegitimate Infants 8 14 TABLE 5. Death Rates for the last Ten Years for the Three Divisions of the Borough as formerly existed. Newington. St. George's. Christchurch and St. Saviour's. Whole Borough 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 15.2 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 1937 14.2 10.9 15.5 14.1 TABLE 6. DEATHS OF INFANTS UNDER ONE YEAR OF AGE. The deaths of Infants under one year of age to 1,000 births were 64 during the year 1937. The deaths under one year of age to 1,000 births for the last ten years were as follows:— 1928 70 1933 63 1929 81 1934 77 1930 57 1935 66 1931 61 1936 59 1932 72 1937 64 The average Infantile death rate for the last ten years is 67. 15 TABLE 7. Births and Deaths Registered in the Sub-Districts of the Borough in 1937. First Quarter. Second Quarter. Sub-Districts. Births. Deaths. Sub-Districts. Births. Deaths. Male. Female. Male. Female. Male. Female. Male. Female. Newington 72 67 79 107 Newington 61 56 44 62 St. George the Martyr, West 32 36 49 44 St. George the Martyr, West 35 34 34 24 Christchurch and St. Saviour 96 99 106 52 Christchurch and St. Saviour 127 127 86 54 Totals 200 202 234 203 Totals 223 217 164 ° Third Quarter. Fourth Quarter. Newington 45 59 22 32 Newington 57 53 60 60 St. George the Martyr, West 25 22 33 21 St. George the Martyr, West 24 21 37 25 Christchurch and St. Saviour 119 96 83 48 Christchurch and St. Saviour 109 104 103 48 Totals 189 177 138 101 Totals 190 178 200 133 Births. Deaths. M. F. M. F. In 1st Quarter 200 202 234 203 In 2nd Quarter 223 217 164 140 In 3rd Quarter 189 177 138 101 In 4th Quarter 190 178 200 133 Totals 802 774 736 577 16 TABLE 8. Showing the number of Deaths that occurred in Public Institutions in the Borough during the year 1937. Institution. In 1st Quarter. In 2nd Quarter. In 3rd Quarter. In 4th Quarter. During Year. Newington Institution 49 13 11 11 84 Christchurch do. – — 1 — 1 Evelina Hospital 18 18 15 8 59 Guy's Hospital 135 115 113 129 492 60, Lambeth Road (Catholic Nursing Home) 3 1 5 1 10 Royal Eye Hospital 1 — — — 1 All Saints' Hospital 12 14 11 8 45 Other Addresses 14 10 7 14 45 Total 232 171 163 171 737 17 TABLE 9. VITAL STATISTICS OF SEPARATE LOCALITIES (1933-37). Year. St. Mary's Ward. St. Paul's Ward. St. Peter's Ward. St. John's Ward. Trinity Ward. Births Registered. Deaths at all ages. Deaths under 1 year. Births Registered. Deaths at all ages. Deaths under 1 year. Births Registered. Deaths Deaths under 1 year. Births Registered. Deaths at all ages. Deaths under 1 year. Births Registered. Deaths at all ages. Deaths under 1 year. 1933 284 311 26 229 254 u 287 325 12 406 334 19 214 235 15 1934 317 280 23 236 224 14 321 312 21 367 317 20 210 161 12 1935 296 271 15 263 217 22 336 274 16 410 295 25 177 148 10 1936 328 290 21 241 209 6 328 291 14 336 299 23 153 133 3 1937 321 290 22 265 239 16 309 333 17 347 283 15 132 167 13 St. Michael's Ward. St. Jude's Ward. St. George's Ward. Christchurch Ward. St. Saviour's Ward. 1933 268 264 17 174 180 19 239 181 12 114 104 8 116 110 8 1934 251 273 28 199 189 24 257 199 26 107 108 8 126 97 8 1935 245 241 20 202 135 14 219 175 19 79 91 4 88 90 7 1936 259 233 24 168 173 13 231 169 17 96 102 5 85 94 8 1937 235 236 19 171 182 19 217 138 10 73 111 6 97 95 3 18 TABLE 10. ZYMOTIC MORTALITY FOR THE SANITARY AREA, 1937. Showing the localities where the deaths occurred. Locality . Influenza. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. The Borough 34 — — — 2 — 2 East Dulwich Hospital — — — — — — — Lambeth Hospital 5 — — — — — 7 Newington Institution 11 — — — — — — Evelina Hospital — — — — — — 7 Guy's Hospital — — — — — — 3 St. Thomas's Hospital — — — — — — — Belgrave Hospital — — — — — — — Royal Waterloo — — — — — — — L.C.C. Hospitals, etc. 17 1 — 7 11 — 4 St. Giles' Hospital 3 — — — — — 2 Rotherhithe Hospital 3 — — — — — — Total 73 1 — 8 13 — 25 TABLE 11. Deaths in the Sanitary Area from the principal Zymotic Diseases in the various Wards for 1937. WARD OR DISTRICT. Influenza. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. St. Mary 11 — — 4 1 — 4 St. Paul 15 — — 1 3 — — St. Peter 8 — — 1 3 — 2 St. John 12 1 — — — — 2 Trinity 3 — — — — — 2 St. Michael 9 — — 1 3 — 6 St. Jude 3 — — — 2 — 2 St. George 3 — — — 1 — 3 Christchurch 6 — — 1 — — 3 St. Saviour 3 — — — — — 1 Borough .. 73 1 — 8 13 — 25 SECTION B. General Provisions of Health Services for the Area. 21 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. Margaret Berlin, 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. Angel Valentine Crawford, M.B., B.Ch., B.A.O., D.P.H., Assistant Medical Officer, Maternity and Child Welfare (from 22.11.37). Norman L. Rusby, M.A., M.R.C.S., M.R.C.P., M.B., B.Ch., part-time Assistant Tuberculosis Officer. 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, 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, Sanitary Inspector (from 28.7.37). a b R. F. Stubbs, Sanitary Inspector (from 28.7.37). a b J. D. Walker, Temporary Sanitary Inspector (from 11.1.37). a de Gladys Briggs, Women's Workshops and Child Life Protection. a Cert. Sanitary Inspector. b Meat and other Foods, c 1st Class Engineer (Board of Trade). d C.M.B e S.R.N 22 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 (to 9.5.37). F. Smith, F.I.C., Assistant Analyst. D. F. H. Button, A.R.C.S., F.I.C., Assistant Analyst (from 1.9.37). W. H. Goodger, Clerk and Laboratory Attendant. A. D. R. Harrison Laboratory Assistants. D. Pearson Tuberculosis Dispensary. Florence Nightingale (Certificate of Apothecaries Society of London), Secretary and Dispenser. Phyllis Angell, Junior Clerk. 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. 4 Probationers, 1 Cook. Health Visitors. d e Annie Rogers. d g Mary George. d f g Clare Cottrill. d f g Annie Kingsmill. d f Winifred Sayer. d f g Florence Mary Mason. d e f Kathleen Hinde. d f g Evelyn M. Bevins d f g Florence Adair. (from 1.12.37). d f g Mary Freeth. d f g Elizabeth M. Western (from 1.12.37). 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 (to 29.4.37). E. Fairfield Thomas, M.D., Ch.B., D.P.H., Schick Immunisation Officer (from 20.5.37). R. K. Bowes, M.D., M.B., Ch.B., F.R.C.S., Gynaecological Clinic. G. Phyllis Brocklesby, Sunlight Clinic, Villa Street. 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. 23 Vaccination Officers. E. J. A. Holt. C. R. Fifer. Clerical Staff. G. H. Bell, Chief Clerk. R. A. Blaikie, Infectious 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. E. A. Clark, Shorthand-Typist (from 20.10.37). F. J. Goodman, General Clerk (from 20.10.37). 1 Temporary Clerk. 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. The new Laboratories, planned and designed by the Public Analyst, are equipped in the most up-to-date manner. They will enable the ever-increasing work of the department to be adequately dealt with and also make possible the conduct of investigations which could not be carried out in the old laboratories. Chemical analyses are undertaken of all samples submitted under the Food and Drug Acts and Regulations, samples of imported foods taken from the wharves, together with any other analytical work or investigations required. Bacteriological examinations of Sputa, Swabs, Blood, etc., are made for Medical Practitioners in the Borough and for the Tuberculosis Dispensary. Routine examinations of the Swimming-bath waters are conducted. Other examinations of a varied character are carried out as required. (b) Ambulance Facilities.—The arrangements for the removal of (a) infectious cases and (6) maternity patients are satisfactory. No change has been made during the year. (c) Nursing in the Home.—General Nursing is carried out by the Benson Nursing Association and the Catholic Nursing Home, 60, Lambeth Road. A few parishes also have their own private nurses. 24 MATERNITY AND CHILD WELFARE. In September the Council opened the new Health Services building in Walworth Road. The Maternity and Child Welfare Department is situated on the ground floor and the several services provided are:— (1) Toddlers' Clinic. (2) Breast Feeding Clinic. (3) Ante-natal Clinic. (4) Post-natal and Gynaecological Clinic. In order to relieve congestion it has been found desirable to arrange consultations for the above clinics by appointment and this method proves to be working satisfactorily. The other Maternity and Child Welfare services which are conducted by the Council and various voluntary organisations are dealt with under their respective headings in the following pages of this report. During the year under review two additional Health Visitors were appointed. For the purpose of arranging Home Visiting the Borough has been divided into ten areas, each with its own Health Visitor. The work of visiting Tuberculous patients is now carried out by the Health Visitors, each visitor dealing with all the cases in her own district. This arrangement does not apply to the four voluntary areas. The system of supervising the health of children under school age has been reviewed and a new card index method has been introduced. All children in this group are visited quarterly, enquiries being made by the Health Visitor as to the state of health. If any departure from normal health is observed, that fact is duly noted, and in necessary cases the mother is advised to consult a private doctor, or to take the child to the appropriate clinic for a medical examination. There are three creches in the Borough, one being Municipal and the others Voluntary. Supervision of these nurseries is under the control of an Assistant Medical Officer. Health records of all children cared for are properly kept. 25 MATERNAL MORTALITY. Resulting from 2,343 live and still births, 7 mothers lost their lives —a mortality rate of 2.9 per 1,000 births. The same mortality rate for the Country as a whole is 3.23. Puerperal Fever and Pyrexia Regulations. There has been no change in the Council's scheme. During the year 8 cases of Puerperal Fever and 15 cases of Puerperal Pyrexia were notified. All of these cases were removed to hospital. Consultation with the Borough Specialist was sought in 1 instance. One mother lost her life as the result of Puerperal Fever—a mortality rate of 0.42 per 1,000 births (live and still). The same mortality rate for the Country as a whole is 0.49. INFANT MORTALITY. The infant death rate of 64, is a slight increase on that of the previous year. This is accounted for by an increase in the number of deaths from premature birth and congenital abnormalities. SKILLED NURSING. During the year 26 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 £21 0s. Od. 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 448 sick children have been nursed under this arrangement. TODDLERS' CLINICS. During the year 12 toddlers' sessions were held at St. George's Infant Welfare Centre and 353 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. During the month of December 2 sessions were also held at the Health Services Department, Walworth Road, S. E.17, at which 10 toddlers attended, all of whom were seen by the Doctor. 26 MATERNITY BEDS. Three beds are reserved at Lambeth Hospital for necessitous expectant mothers and during the year under review 3 mothers were admitted for their confinement at a cost to the Council of £15 6s. Od. 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. One case was dealt with during the year. MATERNITY OUTFITS. Fifty-five 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 Health Services Department. Three Home Helps were provided in necessitous cases. 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 year. 105 mothers and 116 children were sent away at a cost of £400. 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. One consultation took place during the year at a cost to the Council of £4 4s. Od. DRIED AND LIQUID MILKS. Milk is supplied to expectant and nursing mothers, and to children under 3 years of age (in special circumstances 5 years). 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 necessary. During the year, 39,277 packets of dried milk and 46,983 pints of liquid milk was issued free to necessitous cases at a cost to the Council of £3,489 l1s. 6d. The amount charged to the Public Assistance Committee was £113 15s. 6d. The scheme of co-operation with the Public Assistance Committee has worked smoothly. 27 SUNLIGHT CLINIC, GUY'S HOSPITAL. 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 44 cases were sent for treatment. MUNICIPAL SUNLIGHT CLINIC, VILLA STREET. Two sessions were held each week throughout the year, with the exception of the months of June, July and August, when the Clinic was closed. During this period, 132 patients were treated in a total of 1,723 attendances. The usual results were a regular gain in weight, and a great improvement of appetite and sleeping. Cases of Bronchitis, Asthma, debility after Pneumonia and Whooping Cough, Rickets and delayed walking were all greatly improved, and the general health also benefited. SUNLIGHT CLINIC, HEALTH SERVICES DEPARTMENT, WALWORTH ROAD. This Clinic was commenced on 1st December. 21 children made 59 attendances. CONVALESCENT TREATMENT. The arrangement between the Borough Council and the Invalid Children's Aid Association is still being carried on, and 68 children under 5 years of age were sent away at a cost of £170 8s. 4d. 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 £32 8s. 8d. for the year. ORTHOPAEDIC TREATMENT. This is undertaken by the London County Council and the General Hospitals in the Borough. Children attending the Welfare Centres needing attention are referred by the Medical Officer in charge to the various hospitals for treatment. MUNICIPAL CENTRE—VILLA STREET. SEWING CLASSES. Classes at the above Centre were commenced on the 24th February, and to the end of the year 341 attendances were made. 28 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 4,273. 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 5,491. Crossways Mission, New Kent Road, has a Day Nursery accommodating 46 children. The number of attendances during the year was 8,145. INSTITUTIONAL PROVISION FOR MOTHERS AND CHILDREN. Cases coming to the knowledge of the Medical Officer of Health are referred to the Southwark and Newington Branch of the Southwark Diocesan Association for Moral Welfare, 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 at the end of the year who were receiving children for reward 32 Number of children on the Register 41 Number of Child Life Protection Visitors at the end of the year who were:— Health Visitors (to 11.7.1937) 9 Female, other than Health Visitors 1 (plus 1 Lady Sanitary Inspector from 12.7.1937) Male 2 Number of visits made by Infant Protection Visitors to the homes of foster mothers during the year 690 Number of night visits made during the year 39 Legal proceedings taken during the year — I have received the following report from Miss Briggs, Child Life Protection Visitor:— 29 CHILD LIFE PROTECTION. PUBLIC HEALTH (LONDON) ACT, 1936. Sections 256 -272. I have received the following report from Miss G. Briggs. At the beginning of the year under review, the names of 32 foster mothers and 47 foster children were on the register. During the year, 1 foster mother has removed from the district and the names of 6 others have been removed from the register at their request. The homes of 7 new foster mothers were inspected and found suitable for reception of 1 child each, and permission was accordingly given. Although the home conditions vary considerably, the children appear to be reasonably well cared for. Where conditions have been found unsatisfactory, a letter has been sent, but it has not been necessary to take any proceedings. Some foster parents become very attached to the children, and in 3 cases the children have been legally adopted. There are also several cases where the children are being kept, although no payment has been received for some time. All foster mothers with foster children under five years of age are encouraged to visit the Welfare Centre. During the year, 7 children had treatment in hospital, and 1—a baby 3 months old—died. One child, after being returned to its mother, was found to be without a proper home. The National Society for the Prevention of Cruelty to Children was informed, and arrangements were made for the child to be admitted to an L.C.C. home. In addition to foster children, there are, in some of the homes, several day children. The number varies from day to day, and has not been taken into account when the number of foster children has been fixed. There are now on the register 32 foster mothers and 41 foster children; 37 children have left the care of foster mothers or have reached the age of nine years, whilst 31 new children have been received. During the year, 729 visits were made, of which 39 were night visits. 30 MATERNITY AND CHILD WELFARE CENTRES. Whole-time Assistant Medical Officers (Municipal Centres) Part-time Assistant Medical Officers Other Assistant Medical Officers (Voluntary Centres) Dr. Margaret Bergin. Dr. E. A. Mower White. Dr. A. V. Crawford (From 22.11.37.) Dr. D. Shepherd. Dr. A. C. Stevens. Dr. E. M. Saxton. Dr. M. 0. Cruickshank. Dr. D. Davies. Dr. M. Fenwick. SESSIONS. St. John's Institute, Larcom Street— Sessions held every Wednesday and Thursday 2 p.m. to 4 p.m. Sutherland House, Sutherland Square— Monday 10—12 a.m. Medical Session. Tuesday 10—12.45 p.m. Milk Issues only. ,, 2—4 p.m. Medical Session. Wednesday 10—12.45 p.m. Milk Issues only. ,, 2—4 p.m. Ante-natal Session. Thursday 10—12 a.m. Medical Session. ,, 2—4.30 p.m. Schick Clinic and Milk Issues Friday 2—4 p.m. Medical Session. New Maternity Centre, Villa Street— Monday 10—12.45 p.m. Milk Issues only. ,, 2—4 p.m. Medical Session. Tuesday 10—12 a.m. Medical Session. ,, 2—4.30 p.m. Sunlight Clinic. Wednesday 10—12 a.m. Medical Session. ,, 2—4 p.m. Sewing Class. Thursday 10—12.45 p.m. Milk Issues only. ,, 2—4 p.m. Medical Session. Friday 10—12 a.m. Ante-natal Session. ,, 2—4.30 p.m. Sunlight Clinic and Milk Issues 31 Lady Margaret Church Parish Room, Chatham Street— Sessions held every Thursday .. 10—12 a.m. and 2—4 p.m. Crossway Mission Hall, New Kent Road— Sessions held every Wednesday .. 10—12 a.m. and 2—4 p.m. Mission Hall, Lansdowne Place— Sessions held every Friday.. .. 10—12 a.m. and 2—4 p.m. St. Jude's Centre, 56, Lambeth Road— Sessions held every Monday and Thursday Monday, 2—4 p.m. Thursday, 10—12 a.m. Southwark Boys' Hostel, Pocock Street— Sessions held every Monday and Tuesday 10—12 a.m. and 2—4 p.m. St. George's Centre, 86, Borough Road— Sessions held every Monday .. .. .. .. 2—4 p.m. Roman Catholic Centre, 148, New Kent Road— Sessions held every Thursday .. .. .. 2.30—4 p.m. Salamon's Centre, 28, Newcomen Street— Sessions held every Monday and Thursday Monday, 2—4 p.m. Thursday, 10—12 noon and 2—4 p.m. ANTE-NATAL CLINICS. Ante-natal Clinics are also held at the following Centres:— St. Jude's Centre, 56, Lambeth Road— Sessions held One monthly Salamon's Centre, 28, Newcomen Street— Sessions held—Monday, Wednesday and Friday 9.30—10.30 a.m. Tuesday 1.30—2.30 p.m. ANTE-NATAL CLINICS. Sutherland House, Sutherland Square. During the year, 146 expectant mothers were seen and given advice. They made 470 attendances. In addition, 73 post-natal cases were seen by the doctor. Municipal Centre, Villa Street. During the year, 122 expectant mothers were seen and given advice. They made 367 attendances. In addition, 6 post-natal cases were seen by the doctor. 32 St. Jude's Centre, 56, Lambeth Road. One session is held monthly at this Clinic, and during the year 35 expectant mothers were seen and given advice. They made 263 attendances. Salamon's Centre, 28, Newcomen Street. During the year, 724 expectant mothers were seen and given advice. They made 4,690 attendances. ANTE-NATAL CLINIC—HEALTH SERVICES DEPARTMENT, WALWORTH ROAD, S.E.17. Two sessions were held during the month of December under the direction of Dr. Crawford. GYNAECOLOGICAL CLINIC, HEALTH SERVICES DEPARTMENT, WALWORTH ROAD. The above Clinic was commenced on the 27th October. Fifty-three patients were seen by the specialist, Dr. Kenneth Bowes, and advice was given and treatment arranged where necessary. INFANT TEST FEEDING CLINIC, HEALTH SERVICES DEPARTMENT, WALWORTH ROAD. Three sessions were held during the month of December under the direction of Dr. Mower White, 10 cases attending, all of whom were seen by the doctor. 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. 34 35 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 12. St. John 1a. St. Mary 1b. St. Paul 2A. St. Peter 2B. All Saints 3A. Lady Margaret 3B. Cross way 4A. St. Stephen 4B. St. Jude. 5. St. Michael 6A. St. Saviour 6B. St. George 6c. Roman Catholic Guy's 7. Total. Number of Births notified during the year 280 263 347 190 177 188 106 116 184 197 155 81 — 33 2317 Number of individual children attending the Centres during the year 477 500 434 319 288 380 278 327 426 359 311 242 164 141 4646 Number of Sessions held during the year 97 91 95 93 95 98 92 94 93 96 88 45 45 125 1247 Number of children in 1—5 age group attending during the year 218 182 135 112 107 150 123 224 295 214 144 127 84 87 2202 Number of new cases attending the Centres during the year— (1) Expectant Mothers (Ante-natal Clinics) — 146 — 122 — — — — 35 — — — — 724 1027 (2) Infants under 1 year 201 213 246 157 117 137 105 92 141 159 98 70 72 58 1866 (3) Seen by Doctor 201 213 246 157 117 137 105 92 141 159 98 70 72 58 1866 (4) Children 1 to 5 years 66 39 39 37 28 31 35 18 38 36 16 10 28 6 427 (5) Seen by Doctor 66 39 39 37 28 31 35 18 38 36 16 10 28 6 427 Method of Feeding—(a) Breast 183 183 208 121 97 116 78 77 102 123 79 55 43 41 1506 (b) Breast and bottle 10 21 29 21 11 8 20 9 29 18 14 4 23 4 221 (c) Bottle 3 10 9 12 5 10 7 8 7 10 7 5 7 13 113 (d) Ordinary diet 71 38 39 40 32 34 35 16 41 44 14 16 27 6 453 Total number of attendances during the year— • U 40 O (1) Expectant Mothers (Ante-natal Clinics) seen by Doctor — 470 — 367 — — — — 263 — — — — 4690 5790 (2) Infants under 1 year 5543 2746 3238 2434 1839 2419 1799 1884 2171 2851 1576 1583 667 2275 33025 (3) Children 1 to 5 years 3837 1501 1290 1542 1144 2848 1951 1030 3746 2068 1514 1606 920 813 25810 Average number of attendances (infants under 1) 57.1 30.2 34.0 26.2 19.4 24.6 19.6 20.0 23.3 29.7 17.9 35.2 14.8 18.2 — do. do. (children 1—5) 39.5 16.5 13.6 16.6 12.0 29.1 20.8 10.9 10.3 21.5 17.2 35.7 20.4 6.5 — (4) Total number of attendances of Infants seen by Doctor during the year 1464 1364 1694 1130 968 926 885 966 1218 1022 696 733 356 805 14227 (5) Total number of attendances of children 1 to 5 years seen by Doctor during the year 747 653 627 622 606 1052 632 472 1089 715 573 660 376 407 9231 (6) Number of weighings recorded (Children) 6103 4243 4431 3905 3011 4698 3540 2674 4075 1526 2887 3154 1293 2466 51006 (7) Post-natal Cases seen by Doctor 259 165 252 146 131 149 81 16 324 177 89 53 — 497 2339 Total number of first visits paid by Health Visitors to homes of— Expectant Mothers 185 200 212 150 85 149 57 27 218 149 96 36 13 396 1973 Infants under 1 year 295 261 331 196 187 184 105 123 189 198 154 84 — 31 2338 Children 1 to 5 years 41 — — — — — — — 29 — — 37 49 6 162 Total number of revisits paid by Health Visitors to homes of— (1) Expectant Mothers 293 157 32 31 47 112 11 43 265 23 80 52 73 358 1577 (2) Infants under 1 year 1377 1465 1310 784 747 1423 661 1260 1311 956 890 688 261 524 13657 (3) Children 1 to 5 years 1763 1530 1589 1076 1679 1694 1084 1546 2256 1034 1342 1360 325 895 19173 36 HEALTH WORK. The number of visits made by the Health Visitors and other officers of the Health Services Department to houses in connection with Births, and other Health Work during 1937. TABLE 13. 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 261 12 3 1465 — — 357 22 42 1 138 — 36 3 2340 Miss Sayer 331 8 6 1310 2 — 244 8 25 — 95 — 1 1 2031 Mrs. George 196 23 — 784 3 — 181 — 25 — 93 — 4 1 1310 Miss Rogers 187 18 — 747 1 — 132 — 20 — 95 — 3 — 1203 Miss Cottrill 123 7 4 1260 2 1 70 — 26 — 92 — 50 — 1635 Miss Hinde 105 1 3 661 — — 68 — 54 — 90 — 49 — 1031 Miss Adair 184 3 4 1423 — — 261 14 52 2 96 — 70 1 2110 Miss Freeth 198 2 3 956 2 — 172 3 77 — 70 — 5 2 1490 Miss Mason 154 1 5 890 — — 176 1 14 1 150 — 41 3 1436 Miss Bevins (from 1.12.37) 16 2 2 102 — — 13 — — — 10 — 9 — 154 Miss Western (from 1.12.37) 8 1 52 — — 9 — — — 10 — 4 — 84 Total 1763 78 30 9650 10 1 1683 48 335 4 939 — 272 11 14824 37 TABLE 14. NOTIFIED BIRTHS. 1937. Where Born and by Whom Attended. Mothers Confined Notified Births. StillBirths. Total Live Births. Born in— Guy's Hospital 323 330 13 317 1, Kennington Park Place 8 8 — 8 General Lying-in Hospital 237 239 6 233 Lambeth Hospital 432 439 11 428 St. Thomas's Hospital 140 141 7 134 King's College Hospital 53 54 3 51 St. Giles's Hospital 170 173 6 167 St. Olave's Hospital 56 56 2 54 Westminster Hospital 9 9 — 9 Charing Cross Hospital 17 18 — 18 Clapham Maternity Hospital 2 2 — 2 Other Hospitals, etc. 86 87 1 86 1533 1556 49 1507 Born at Home and Attended by— Externs: Guy's Hospital 122 123 2 121 St. Thomas's Hospital 80 80 1 79 King's College Hospital — — — — Midwives: Guy's Hospital 116 118 1 117 St. Thomas's Hospital — — — — Lambeth Hospital — — — — General Lying-in Hospital 15 15 — 15 Heygate Street 131 131 1 130 77, Southampton Street — — — — Private 222 226 3 223 Doctors: Private 67 68 8 60 753 761 16 745 Totals *2286 2317 65 2252 *0f this number, 145, so far as our records show, did not receive antenatal advice. 38 TABLE 15. Vaccination Officers' Return respecting the Vaccination of Children whose Births were Registered in 1936. Date. 1936. Registration subdistricts comprised in vaccination officers' district. Number of births returned in birth list sheets. Number of these births duly entered in Columns 1,2,4 and 5 of the vaccination register (birth list sheets), viz.:— Number of these births which are not entered in the vaccination register, on account (as shown by report book), of Column 1, successfully vaccinated. Column 2. Insusceptible of vaccination. Column 4. Certificate of conscien- tious 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 1937. Ist Jan. to 31st Dec. Northern Division 890 365 4 271 36 — 78 73 63 581 Southern Division 569 241 1 238 22 — 5 28 34 635 Total 1459 606 5 509 58 — 83 101 97 1216 SECTION C. Sanitary Circumstances of the Area. 41 PUBLIC CLEANSING. Weekly collection of house refuse is in operation in the Borough although collections of refuse at tenement buildings, eating houses and places where food is prepared are made at more frequent intervals. The whole of the refuse is brought to the Council's Depot at Manor Place for transportation by rail to country depots at Longfield and Sevenoaks. The Sevenoaks Depot was closed on 22nd November, 1937, all the space used for tipping having been filled in. 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; the remainder is used as a covering for the rough dust at the tips. At the Longfield Depot, controlled tipping is operated satisfactorily. There are no cesspools, earth closets or privies in the Borough. SWIMMING BATH WATER. The Council possess 5 swimming pools. Three at Manor Place Baths and 2 at Lavington Street Baths. Manor Place Baths. During the last two years all these baths have been equipped with the most up-to-date plant for continuous filtration and sterilisation by ozone. In each bath there is a complete turnover of the water every two and a half hours. Weekly samples of the water are taken for analysis, and the results obtained even in the height of the summer season prove the plant to be most efficacious in keeping the water in a good state of bacterial purity. As is the case in all old-fasliioned baths there is lack of pre-ablution facilities for bathers. Lavington Street Baths. These baths have been condemned by the Council and new baths are shortly to be erected on a site in the Borough High Street to replace them. There is no filtration plant and the purity of the water has to be maintained by frequent emptying and refilling of the baths and by the addition of small quantities of Parazone. The water in these baths is completely changed 2 or 3 times weekly, depending on the number of persons using the baths. Bacteriological analysis proves that at the height of the season it is difficult to maintain a good standard of bacteriological purity, hence the condemnation of these baths. 42 MEN S COMMON LODGING HOUSES. There are 8 Common Lodging Houses for men in the Borough, containing 1,573 beds, two houses containing a total of 128 beds having been closed during the past year; the closing of these has not affected the remainder, which are now only about two-thirds full. The premises are inspected periodically by the District Inspectors, 77 visits having been made during 1937, and many defects have been remedied on verbal instructions. The houses are each supervised by a Keeper and, generally speaking, they are clean and well maintained, but there is one which is a little difficult, and if improvement is not made in the near future more drastic action will have to be taken. WOMEN'S COMMON LODGING HOUSES. I have received the following report from Miss G. Briggs:— There are 5 Women's Common Lodging Houses in the Borough, containing a total of 336 beds. There is no overcrowding, as only about two-thirds of the beds are occupied at the present time, although there was a slight increase in numbers at the time of the Coronation. These houses are visited and inspected regularly, 72 inspections having been made during the year under review, and defects such as broken sashcords, bed springs and balusters have been remedied on verbal instruction. Two Intimation Notices have been served for defective W.C.'s. In one case the work was completed without further action, and in the second case the work is proceeding. The cleansing of the walls and ceilings has been carried out at all the houses, and they have been kept in good condition. Use has been made of the Council's Cleansing Station for disinfection of bedding and cleansing of lodgers when this has been found necessary. One complaint was received during the year—this was anonymous— and when investigated was found to be without foundation. Improvements have been made at two of the houses. In one, a better means of storing crockery and kitchen utensils has been arranged, and in the other, heating apparatus for the bedrooms has been installed. The Deputy Keepers have remained the same at 4 houses, and at one house where the Deputy was unsuitable, a temporary Deputy is now in charge. 43 TABLE 16. Summary of Sanitary Works completed under the Public Health Act during the year 1937. Intimation Notices complied with 3,127 Drains reconstructed 61 Drains repaired 155 Drains intercepted and ventilated 87 Drains unstopped 204 Gullies provided 81 Soil-pipes provided or repaired 166 Closets provided 394 Closet pans and traps 628 Water apparatus repaired 593 Sink, Lavatory and waste pipes 1,181 Rainwater pipes repaired, etc. 252 Water supply to upper floors 33 Draw taps on main 33 New water supplies 30 Roofs and gutters repaired 1,540 Paving repaired 304 Dampness abated 897 Rooms cleansed 3,143 Sub-floor ventilation 36 Staircase ventilated 51 Dust-bins provided 1,200 Overcrowding abated 2 Miscellaneous nuisances abated 5,602 3,320 Intimation Notices were served during the year. 1,245 Statutory Notices were served during the year. 44 PROCEEDINGS TAKEN UNDER THE PUBLIC HEALTH AND OTHER ACTS. 7 summonses were taken out during the year 1937, in respect to offences, particulars of which are set out below. The above summonses had reference to the following:— Ordinary Nuisances 7 Exposing for Sale (Unsound Pood) — Total 7 Those proceedings resulted as follows:— Summonses withdrawn (with costs), the Council's requirements having been complied with 3 Penalties and Costs 3 Summons adjourned 1 Total 7 SHOPS ACT, 1934. During the year 1937, 467 premises have been inspected and recorded and 118 visits have been paid to premises already recorded. 66 notices have been served, 40 asking for the provision or maintenance of a reasonable temperature in the shops, in accordance with Section 10 (1) (b), and 26 asking for the provision of suitable sanitary conveniences, in accordance with Section 10 (2). Of these 66 notices, 49 have been complied with, and 17 have been withdrawn. There were 2 notices outstanding from 1936; 1 has now been complied with and the other has been withdrawn. 15 shops have been exempted from the provisions of Section 10 (2), in accordance with Section 10 (6). 45 TABLE 17. Proceedings taken under the Public Health and other Acts. Defendant. Cause of Proceedings. Result. 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. L. Galinski, trading as James Field, 130, High Street, Whitechapel, E.l General nuisance existing at 156, Old Kent Road Order to carry out work within 7 days. £1 1s. costs. C. Hammond, 19, Devonshire Road, Bexhill-on-Sea General nuisance existing at 157, Westmoreland Road Work done. Summons withdrawn. £1 1s. costs. Rebecca Benabo, trading as Charles Benabo & Sons, 240, Mile End Road, E.l General nuisances existing at 5 and 4, Stanford Place Work done. Summonses withdrawn. £2 2s. costs. W. E. Roberts, 69, Park Hill, S.W.4 General nuisance existing at 17, Frederick Road Summons adjourned sine die. Premises empty. Hales Stores, Ltd., 132, Long Lane, S.E.I Smoke nuisance existing at 301, Borough High Street Order to carry out work within 28 days. £1 1s. costs. 46 SMOKE ABATEMENT. During the year under review 221 observations were made by the several Inspectors, 5 nuisances were observed, and 1 intimation notice served. HOUSES LET IN LODGINGS. These houses are inspected by the District Sanitary Inspectors during their routine house-to-house inspection and on complaint, but any exceptionally dirty houses are inspected more frequently. Last year I reported on the difficulty of administering the Bye-laws due to the control or partial control of such houses under the Rent Restrictions Acts and the constant change in the method of sub-letting. The Local Authority have no control over sub-letting except in those tenements where overcrowding exists, and the owner appears to have no control except where premises are let under an agreement. The latter proves to be an exception rather than a rule in this district. In a large number of these houses there are many rooms let as tenements which should only be used as bedrooms. It appears that if the Gas Company will fix a gas cooker in a room or on the landing outside, and the owner fixes a water supply on the staircase, then the room is called a "tenement." This is a very unsatisfactory arrangement, as there is often no room to fix a ventilated food store or to provide watercloset and washing accommodation for the family occupying such a tenement. Many houses containing six to eight rooms which were originally built for one family are now occupied under the conditions stated by two, three and sometimes more families. Such houses are only fit for two families and would make two excellent flats with the necessary amenities for each family on their respective storeys. To put three or four water-closets food cupboards and washing accommodation into this type of house is a practical impossibility. Before improvements can be carried out the problem is to re-house the surplus families. 47 Another difficulty frequently met is that of the single person, usually an old age pensioner, occupying as principal tenant one room in a house which will accommodate two or more families, and who sub-lets a room or rooms to either several other single persons or to an old couple with no children. In the majority of these cases the principal tenant has at one time occupied the whole house and brought up a family in it, but on the death of the husband or wife and the marriage of the children they are left alone in the house with no income beyond the ten shillings weekly Old Age Pension, and in order to live and make ends meet they sub-let. These are the persons who should be occupying a one-roomed flat in order to make more accommodation for the families with children and who really require a house, but it is difficult to see how these old people are to pay the rent of a single flat and live on nothing more than ten shillings a week. Under the conditions related, we find they are doing quite well and are living rent free, but such indiscriminate letting makes it impossible for the Authority to insist on separate washing, cooking, food storage and lavatory accommodation for each separate family in order to comply with the Bye-law standards. Last year I discussed the difficulty of re-housing the large family, and it would appear that, from what is stated above, both problems should be considered side by side. Recently, we have found that several landlords, upon receiving a notice under the Bye-laws to provide the facilities required by those Bve-laws, have, in houses which they have let to two families, been able to evade the requirements by making one tenant the principal, and allowing the second family to become the sub-tenant. The Authority can only partially overcome this difficulty by enforcing separate cooking and food storage accommodation as provided by Section 184 of the Public Health (London) Act, 1936, and then only in so far as it is practicable. 48 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. Age. Institution. Mrs. Mary Harrison 83 years Newington. Mrs. Elizabeth Hornett 72 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. 49 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. Banks House, Tarn Street (53 flats) Messrs. Rowley Bros., Ltd., Tottenham, N. 17. Rankine House, Tarn Street (25 flats) Rennie House, Tarn Street (25 flats) Rumford House, Tarn Street (25 flats) Stevenson House, Tarn Street (78 flats) Telford House, Tarn Street (42 flats) Coleridge House, King and Queen Street (24 flats) Cowper House, King and Queen Street (24 flats) Shelley House, King and Queen Street (20 flats) Tennyson House, King and Queen Street (48 flats) 254, Old Kent Road (2 flats) Messrs. Ashby & Horner, Ltd., 8, Aldgate, E.C.3. "Two Brewers" P.H., Standard Street (1 house) Messrs. Snelling & Rayment, 282, Mitcham Lane, S.W. 16. "The George" P.H., Key worth Street (1 house) Messrs. W. Loweth & Sons, Ltd., Downs Park Road, E.8. Comus Place Wing (32 flats) Messrs. Unit Construction Co., 1, Robert Street, 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 1937. 50 TABLE 18. Factories, Workshops, Laundries, Workplaces and Homework. 1.—Inspection (including Inspections made by Sanitary Inspectors). Premises. Number. Inspections. Written Notices. Prosecutions. Factories (including Faotory Laundries) 447 22 .. Workshops (inoluding Workshop Laundries) Workplaces 244 115 27 29 .. Homeworkers' Premises (including Outworkers) 488 .. .. Total 1294 78 .. 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 94 65 .. .. Want of Ventilation 8 5 .. .. Overcrowding .. .. .. .. Want of drainage of floors .. .. .. .. Other nuisances 135 125 .. .. Sanitary accommodations Insufficient 12 20 .. .. Unsuitable or detective 84 79 .. .. Not separate for sexes 3 2 •• •• 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 172 172 .. •• Total 508 468 .. .. *Including those specified in Sections 2,3,7 and 8 of the Factory Act as remediable under the Public Health Acts. 51 TABLE 19. 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. (8s. 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. 49 42 50 46 266 359 — — 203 6 — — — — — (2) Cleaning and washing — — — — — — — — — — — — — — — Lace, lace curtains and nets — — — — — — — — — — — — — — — Furniture and Upholstery 1 3 1 2 — 6 — — — — — — — — — Fur pulling — — — — — — — — — — — — — — — Umbrellas — — — — 5 — — — 7 — — — — — — Paper Bags and Boxes 6 21 6 20 5 51 — — 44 — — — — — — Brushmaking 6 9 6 10 — 5 — — 21 — — — — — — Stuffed Toys — — — — — — — — — — — — — — — File making — — — — — — — — — — — — — — — Electro Plate — — — — — — — — — — — — — — — Cables and Chains — — — — — — — — — — — — — — — Anchors and Grapnels — — — — — — — — — — — — — — — Cart Gear — — — — — — — — — — — — — — — Locks. Latches and Keys — — — — — — — — — — — — — — — Miscellaneous 9 10 10 36 74 39 — — 211 — — — — — — Total 71 85 73 114 350 460 — — 488 6 — — — — — 52 TABLE 20. 4.—Registered Workshops. Workshops, Workplaces, etc., on the Register (S. 131) at the end of the year. Number. Bakehouses (including Factory Bakehouses) 89 Eating houses and places where food is prepared for sale 582 Ice Cream Shops 225 Laundries 13 Dressmakers, Milliners, etc. 18 Tailoring 33 Brushmakers 11 Miscellaneous 2004 Total number of Workshops, Workplaces, etc., on Register 2975 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) 2 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 18 Reports (of action taken) sent to H.M. Inspectors 18 Other — Underground Bakehouses (S. 101):— In use at end of the year 21 WOMEN'S WORKSHOPS. The supervision of the Women's Workshops was carried out during the year by Miss G. Briggs. 574 inspections and 187 re-inspections were made. The following defects were discovered, and 11 intimations and 1 statutory notice were served in order to obtain the abatement of the nuisances complained of:— Water apparatus defective 19 Roofs defective 2 Rooms dirty 35 Closet Pans and Traps 15 Miscellaneous nuisances 63 Total 134 All the above-mentioned nuisances were remedied. 53 RATS AND MICE DESTRUCTION ACT. I have received the following report from Mr. A. White — During the year 1937 a considerable amount of work has been done in rat repression, and many premises have been entirely freed of rats. Concentration has principally centred on the abolition of defects in sewers and drains, which in a Borough like Southwark, where most property has been rebuilt several times, is usually the source from which premises become infested. Although a riverside Borough, it is perhaps surprising that while one would expect to find the greater infestation in the northern section, which fronts on to the river, it is in the southern wards that most rats are found. While it must be acknowledged that there are undoubtedly many premises which are infested with rats, either continually or at intervals, of which the Council have no knowledge, it is a fact that the greater number of individual cases dealt with, through complaints or other information received by the Health Services Department, have been in the districts south and south-east of the Elephant and Castle. This is best explained when it is realised that in this part of the Borough there are very many more properties consisting mainly of dwelling-houses and flats. A great number of these houses are separately drained, and there are, therefore, many more miles of drains which may, and in many instances do, become defective, and allow rats to gain access to the adjoining property. Examination of the drains of these houses invariably proves that unless they have been reconstructed during the last 47 years, since the Public Health (London) Act, 1891, was passed into law, they are in a very poor condition and likely, at any time, to become the source of rat infestation. A number of cases have been found where, although the house has been redrained, the old disused drains have either never been abolished or have been ineffectively sealed off. 54 Frontage drains—that is, that portion of the house drain which is under the Council's highway, and which, except in certain instances, is the property of the owner—are, in 25 per cent. of the cases investigated, the principal cause of rats escaping from the sewers and entering nearby property. This is accounted for by two facts. Firstly, it has been the practice in past years for owners to reconstruct the drain under the building, and connect the new drain up to the old portion which is under the roadway. Thus, while the drain of the building itself is in perfect condition, the frontage drain is in such a bad state that it is an easy matter for rats to escape therefrom and enter the buildings below the foundation of the main front wall. Secondly, continual vibration by heavy traffic on the road surface is very apt to cause settlement and fracture of drainage pipes, especially if laid within a few feet of the road level. Considerable use has been made this year of the power provided in section 40 of the Public Health (London) Act, 1936, which enables the Council to enter premises after 24 hours' notice has been given to the occupier, and open up the ground and expose the drains for examination purposes. This method is exceptionally valuable where ordinary systems of drain testing have failed, and yet there are reasonable grounds to believe that the drains are at fault. It should be mentioned here that the cost of carrying out this work is borne by the owner of the property, if the examination reveals that the drain is defective. The problem presented by the Black Rat is somewhat different. It is principally warehouses, wharves and factories which are infested by this species. Investigations in these cases prove that occupiers of such buildings usually do everything that is possible to keep the rat population at a minimum, otherwise considerable financial loss is incurred by the destruction of valuable stocks. They are ever ready to accept and adopt the advice which is given them concerning the best methods to prevent harbouring and breeding of rats upon their premises. By arrangement with the Borough Engineer and Surveyor, large quantities of poisoned bait have been laid in the Council's sewers during the first week of each alternate month. While the immediate effect of this intensive poisoning cannot be calculated, it is undoubtedly a very powerful means of reducing the rat population in the sewers. 55 TABLE 21. RATS AND MICE (DESTRUCTION) ACT, 1919. Summary showing investigations and inspections made during the year 1937. Inspections:— By Inspector 376 By Rat Officer 373 Re-inspections:— By Inspector 1,031 By Rat Officer 2,698 Premises where rats were found 261 Action taken:— By Council's Official:— Poison Baits laid by Rat Officer 18,568 Wire Traps set 415 Break-back Traps set 1,216 Premises freed of rats 176 Probable source:— Rat runs and holes 224 Defective Drains 93 Defective Sewers 24 Notices 41 56 ERADICATION OF BED BUGS. The Council maintain a Disinfecting Station at King James Street at which all verminous clothing and bedding is dealt with. Adjoining the station is the Council's Reception House at which families are temporarily housed, when necessary, whilst the disinfestation of their homes is being carried out. Two methods are used for the treatment of verminous rooms:— (1) The spraying of the room with Solution D, and sealing. (2) Fumigating with sulphur and saltpetre, and sealing. Removal of Tenants from Clearance Areas to New Houses. The Glasgow method of disinfestation is used in these cases and is further explained later in this report. The method formerly used was by transporting furniture and effects in a gas-tight furniture van in which fumigation by formalin vapour was being carried out whilst in transit. This method was more or less satisfactory, but there were many difficulties, so the Glasgow method was adopted. The results of this system have proved to be very good. No cases of infestation of new premises have resulted from furniture dealt with in this Borough before its removal. Reinfestation has occurred in a few cases, but this has been due to the introduction of second-hand furniture at a later date. It is impracticable to use Hydrogen Cyanide for fumigation purposes of dwelling-houses in Southwark. When tenants are about to be re-housed a letter in the following terms is addressed to them, and whilst the instructions contained in the letter are being carried out the premises are under the direct supervision of a Sanitary Inspector assisted by a disinfector. No case is removed until a satisfactory report is received. Dear Sir or Madam, In re-housing the tenants from Clearance Areas, the Council are taking every precaution to prevent the transmission of hugs or vermin from the old to the new premises. Your attention is directed to the enclosed instructions which my Officers have orders to strictly enforce. This is in the interest of all concerned, and your active cooperation is earnestly requested. Yours faithfully, W. STOTT, Medical Officer of Health. 57 Instructions to Tenants about to be Re-housed at the Council's Housing Estate. The contents of all rooms must be thoroughly cleansed on the day of removal. Where the rooms have shown evidence of vermin, the following method of cleansing must be adopted:— (1) Take down all wall hangings and pictures. The brown paper and wooden backing must be removed and the frame cleansed with the solution supplied. (2) All cupboards, tables, chairs and wooden furniture, bedsteads, spring mattresses, etc., must be thoroughly scrubbed inside and out with solution. (3) Linos and floor coverings when taken up must be cleansed on both sides and rolled up ready for removal. (4) All beds, bedding and mattresses, and all verminous articles of clothing must be surrendered to the Disinfecting Staff for removal and treatment. (5) Old and defective mattresses, bedding and stuffed furniture will be removed and destroyed by the Department free of cost. In no case will such furniture be removed or allowed in the new flats. Your present apartment will be inspected by the Sanitary Inspector and advice given prior to removal. Before any article of furniture is taken into your new premises a thorough inspection will be made and any evidence of vermin or of dirty conditions will cause the same to be rejected until the cleansing has been effectively carried out. Your new premises will be periodically inspected to ascertain whether reinfestation has occurred; any evidence of neglect will be seriously dealt with. Tenants are warned against the introduction of second-hand furniture into their new quarters; the risk of reinfestation from such sources is very considerable. A cheap and effective solution can be made from soft soap 3 parts mixed in hot water 15 parts, and shaken up with paraffin 82 parts while still hot. This solution may be used with perfect safety for all domestic cleaning. CLEANSING OF VERMINOUS ROOMS AND THEIR CONTENTS. During the year 1,417 verminous rooms and their contents were treated by the disinfecting staff. Council Houses found to be infested 7 Council Houses disinfested 7 Other premises found to be infested 1,410 Other premises disinfested 1,410 58 TABLE 22. Verminous Bedding, etc., Disinfected at the Council's Station during 1937. Articles. Disinfected. Destroyed. Beds 178 21 Palliasses 93 21 Bolsters and Pillows 234 39 Cushions 47 11 Blankets 1,609 18 Sheets 834 2 Quilts 317 6 Articles of Clothing, etc. 44,102 200 Books — — Total 47,414 - 318 487 cwts. of bedding, household furniture, etc., were destroyed. VERMINOUS PERSONS CLEANSED DURING 1937. During the year 7,750 persons were cleansed at the Cleansing Station in King James Street. Of these, 5,547 were children who were cleansed under the Council's agreement with the London County Council. Many of the children so treated were suffering from Scabies. 2,203 persons sent from the various Common Lodging Houses and other places in the Borough were cleansed during the year, as against 2,047 in the year 1936. COLLIER'S RENTS MORTUARY. (Coroners' Court.) During the year 377 bodies were received into the Mortuary:— Bodies brought in, upon which Inquests or Post-Mortems were held 218 Bodies brought in, upon which Inquests were considered unnecessary 150 Bodies brought, in for convenience for which payment was made 1 Bodies brought in where death had occurred from Infectious Disease 8 Total 377 SECTION D. Housing. 61 OVERCROWDING. In June, 1937, the Council were informed that it was the intention of the Minister to fix the 1st July,1937, and the 1st January, 1938, as the appointed days for the purposes of Section 62 and Sections 6 (2), 59, 60, and 69, respectively. With few exceptions, the houses in this Borough had been previously measured by the District Inspectors, and so the amount of work necessary for supplying permitted numbers of persons to landlords was considerably reduced. It was, however, necessary to engage the services of a comptometer operator and machine for the purpose of computing the floor areas from the measurements supplied by the Inspectors. Unfortunately, the survey carried out in 1935, failed to reveal the positions of the rooms in houses occupied by two or more families; Form A showed only the number of rooms occupied, and Form B, the purposes for which the rooms were used, i.e., sleeping, living or living and sleeping, so that although the sizes of the rooms were known, it was impossible to identify families with particular rooms, and consequently, in houses having several rooms under 110 square feet in area, the permitted number could not be given. It was apparent that the only means of solving this difficulty was to re-enumerate those houses occupied by more than one family, and a temporary staff of 29 enumerators and clerks was engaged for this purpose. For this survey, the form, of which a specimen completed copy is reproduced later in this report, was used. It will be seen that this form, when completed, provides all the necessary information, and, in addition, will lend itself to alterations caused by changes in tenancies. The period for "review cases" was the same as that taken for the 1935 Survey, i.e., two years. 62 The survey revealed the existence of 369 new cases of overcrowding, and the unrecorded abatement of 1,034 cases. The number of dwellings which will become overcrowded within the next two years is 232. Supply of Information to Landlords. In order to carry out the Council's obligations under Section 62 (2), two temporary typists were engaged for the purpose of supplying landlords with permitted numbers of persons in relation to their properties. Although a considerable number of applications for permitted numbers were received from property owners, only three such applications were received from householders who, by virtue of sub-letting part or parts of their premises, became landlords within the meaning of the Act; and this despite the fact that notices setting out the duties and obligations of landlords in respect of overcrowding, were posted up in all parts of the Borough; and that the Town Clerk, at my request, drew attention to these obligations through the medium of the local press. It would appear, therefore, that this type of landlord does not appreciate his position, and it is my intention in the new year to institute a campaign for the purpose of instructing these landlords as to their obligations, in order that the provisions of the Act in respect of the prevention of overcrowding may be strictly enforced. OVERCROWDING IN 1937. During the year, and in addition to the 369 cases of overcrowding revealed by the survey, 97 new cases were discovered, in 83 of which, the overcrowding was due to children attaining the ages of one or ten years, making a total of 466 new cases of overcrowding. 63 ABATEMENT OF OVERCROWDING. 1,424 cases of overcrowding, inclusive of the 1,034 revealed by the survey, were abated during the year as follows:— Re-housed by the London County Council:— By way of slum clearance 95 As overcrowded and other cases 206 Re-housed by Borough Council:— By way of slum clearance 13 As overcrowded cases 2 Re-housed by the Church Army:— By way of slum clearance 7 Re-housed by the City Corporation:— By way of slum clearance 10 Re-housed or provided with additional accommodation by landlords 277 Overcrowding abated by domestic re-arrangement, deaths, marriages, etc. 216 Families moved away 598 SUMMARY. Number of cases of overcrowding on the register at the end of 1936 3,727 Number of new cases found 466 Tota 4,193 Number of cases of overcrowding abated during the year 1,424 Number of cases on register at end of 1937 2,769 At the end of the year, there were 95 single persons living in overcrowded conditions; 85 were occupying rooms having floor areas of between 50 and 70 square feet, and 10 were occupying rooms having floor areas of less than 50 square feet. 64 One instance of re-overcrowding in a dwelling after steps had been taken to abate the overcrowding was discovered. In this case, a man and wife with three children, two over ten and one aged 5 years, took possession of a two-roomed flat having a permitted number of three persons, after having previously arranged for the two children over ten to live with a relative. This arrangement proved satisfactory for a few months; but following a domestic quarrel, broke down, and the two children returned to their parents, thereby overcrowding the flat. The facts were explained to the London County Council who agreed to consider the family for accommodation on one of their estates and, in the circumstances, further action was withheld. 65 BOROUGH OF SOUTHWARK. Housing Act, 1936—Part IV. Address of Premises. .147 Smith Street Description of Premises . .Basement & 3 Storey House Owner . .A. J. Somerton, 2547, High Street, S.E.I Landlord A. Brown NUMBER OF ROOMS IN DWELLING: 9 PERMITTED NUMBER FOR DWELLING: 16 ROOMS. Number Allowed per room on Table II. Name of Tenant(or subtenant) Numbers of Rooms Occupied. Date. Persons normally sleeping in premises. Equivalent adults Permitted Number. If overcrowded put + Date for review. Number of persons over 10 years of age. Number and ages of persons under 10 years. No. Position. Length, ft. ins. Breadth, ft. ins. Floor Area sq. ft. As Married Couples. Other Males. Other Females. Males. Females. 1 Base F. — — 110 + 2 Brown 1 . 2 27/9/37 2 7½ 5¼ 41/6 3½ 3 + 2 B. — — 110 + 2 Green 3 . 4 2 2 3 3 G.F.F. — — 110 + 2 Black 5 2 2 2 7/38 4 B. — — 110 + 2 White 6 2 2 2 5 F.F.F. — — 110 + 2 Gray 7. 8. 9 2 1 9½ 34 4 6 B. — — 110 + 2 7 T. F. F. — — 110 + 2 8 Slip 9 —9 5 — 6 54 ½ 9 B. 10 — 9 — 6 95 1½ 10 — — 11 — — 12 — — 13 — — 14 —- — 66 REVIEW OF HOUSING ACTIVITIES DURING 1937. Great progress has been made during the year under consideration for the amelioration of housing conditions in Southwark. Primarily, out of 384 families re-housed from Slum Clearance Areas by the L.C.C., 333 of these have been accommodated in the Southwark District. This is extremely gratifying and justifies the Council's slogan "Southwark Homes for Southwark People." 40 families have been re-housed in new flats at Stopher House by the City Corporation, and a number of others in flats owned by the Ecclesiastical Commissioners and the Church Army Housing Association, Ltd. With regard to the Council's own Estates, 49 families have been dealt with from Slum Areas, and are now occupying homes of which they can be justly proud. In addition, 47 families were removed from premises or parts of premises which were the subject of action under Sections 11 and 12 of the Housing Act, 1936. The task of re-housing is still going forward with renewed vigour, and there is every indication that next year will show an even greater number of families accommodated in decent dwellings, especially when it is realised that several Slum Areas are ripe for Clearance, and many others have been represented with a view to Clearance Orders being made. If the present rate of progress is maintained, I believe I am justified in saying that in a few years' time Southwark will have the distinction of being a model Borough in every sense of the word. Applications for alternative accommodation on medical grounds have received my special attention, and I give below the number of families re-housed and the estates to which they have been allocated. In the great majority of these cases, I have made strong representations to the L.C.C. for preferential treatment:— Becontree 24 Morden 80 Downham 29 Bellingham 24 Mottingham 57 Hanwell 11 Central London Estates 136 Other Estates 21 Total 382 67 It will be observed that the greater number of these medical cases have secured accommodation outside Southwark, and this is due mainly to the fact that country air is essential for the rehabilitation of persons suffering from bronchial and other respiratory troubles. There are, however, 136 families which have been re-housed in the Central London Area, the reason in most cases being the necessity of being as near as possible to their places of employment, and the inability to afford economically the extra cost of travelling to and from work if they resided in outlying districts. In addition to the above, 83 unfit basement dwellings have been the subject of Closing Orders, and 12 houses were represented for Demolition. Some idea of the amount of work entailed in dealing with these cases can be arrived at by the fact that during 1937, nearly 3,000 applications for housing accommodation have been dealt with, and between 6,000 and 7,000 people have been interviewed and advised on housing matters. 68 HOUSING ACT, 1936—SECTION 25. The following areas were represented for Clearance and Re-Housing Schemes during the year under consideration:— Kings Place Area. (13 Houses.) (Represented to Housing Committee 15th March, 1937.) Speech Street Area. (7 Houses.) (Represented to Housing Committee 15th March, 1937.) Dodson Street Area. (23 Houses.) (Represented to Housing Committee 19th April, 1937.) Dolben Street Area. (5 Houses.) (Represented to Housing Committee 19th April, 1937.) Stanford Place Area. (13 Houses.) (Represented to Housing Committee 19th April, 1937.) Beckford Place Area. (12 Houses.) (Represented to Housing Committee 21st May, 1937.) Farnham Place Area. (9 Houses.) (Represented to Housing Committee 21st May, 1937.) Gravel Lane Area. (8 Houses.) (Represented to Housing Committee 14th June, 1937.) Causeway Place Area' (4 Houses.) (Represented to Housing Committee 14th June, 1937.) Valentine Row (Nos. 1 and 2) Areas. (5 Houses.) (Represented to Housing Committee 14th June, 1937.) Sumner Street Area. (5 Houses.) (Represented to Housing Committee 4th October, 1937.) HOUSING ACT, 1936—SECTION 11. The following properties were represented for demolition during the year under consideration:— 13, Kingston Street. (Closed.) 71, Upper Ground. (Closed.) (Undertaking not to be used for human habitation.) 10, Zoar Street. (Closed.) 7, Innis Place. (Undertaking not to be used for human habitation.) 1, Canvey Street. 41, Zoar Street. 28, Zoar Street. (Closed.) 22, Zoar Street. (Closed.) 1, Boddy's Bridge. 35, Flint Street. 62, County Street. 35, Horsman Street. 69 HOUSING ACT, 1936-SECTION 11. During 1937, 83 underground rooms or parts of premises were represented for Closing Orders, 24 of which have been closed and 4 made fit. 219, New Kent Road (parts of premises). 36, Adam Street (parts of premises). (Closed.) 37, Dante Road. 7, DeLaune Street. (Closed.) 87, Great Dover Street. (Closed.) 12, Manor Place. 39, Faunce Street. (Made fit.) 1, Scoresby Street. 166, Southwark Bridge Road. (Closed.) 84, Great Dover Street. (Made fit.) 49, Swan Street. (Closed.) 56, Dolben Street. 90, Westmoreland Road. (Closed.) 26, DeLaune Street. (Made fit.) 108, Walworth Road. (Closed.) 80, Mann Street. (Closed.) 87, Kennington Road. (Closed.) 8, Chapter Road. 259, Union Street. (Closed.) 25, Dante Road. 30, Newington Crescent. 20, DeLaune Street. (Closed.) 7 and 7a, Britannia Chambers. (Closed.) 6, Amelia Street (parts of premises). (Closed.) 170, Walworth Road (parts of premises). (Closed.) 172, Walworth Road (parts of premises). (Closed.) 174, Walworth Road (parts of premises). (Closed.) 4, Britannia Chambers. 5, Britannia Chambers. 6, Britannia Chambers. 248, East Street (parts of premises). (Closed.) 32, Marshall Street. 57, Nelson Square. (Closed.) 55, Nelson Square. (Closed.) 41, Faunce Street. (Closed.) 47, Lant Street. 194, Blackfriars Road. 10, Alberta Street. 15, Alberta Street. 70 25, Carter Street. 162a, Southwark Bridge Road. 2, Brockham Street. 204, Great Dover Street. 205, Great Dover Street. 206, Great Dover Street. 207, Great Dover Street. 208, Great Dover Street. 209, Great Dover Street. 210, Great Dover Street. 211, Great Dover Street. 225, New Kent Road. (Made fit.) 143, Blackfriars Road. 5, Princess Street. (Closed.) 138, Walworth Road. (Closed.) 144, Walworth Road. (Closed.) 85, Lancaster Street. 181, Southwark Bridge Road. 1, Bath Terrace. 35, Hopton Street. 235, Walworth Road. 37, Trinity Street. 131, Kennington Park Road. 136, Walworth Road. 146, Walworth Road. 9, Gaywood Street. 81, Kennington Road. (Closed ) 4, Camberwell Gate. 120, John Ruskin Street. 122, John Ruskin Street. 13, Horsman Street. 15, Horsman Street. 17, Horsman Street. 19, Horsman Street. 21, Horsman Street. 23, Horsman Street. 28, Boyson Road. 2, Boyson Road. 110, Westmoreland Road 106, Westmoreland Road. 13, Shorncliffe Road. 29, Queen's Row. 51, Sharsted Street. 251, Union Street. 71 HOUSING CONSOLIDATED REGULATIONS, 1925. Houses in the following localities were inspected and recorded under the above-mentioned Regulations during the year:- Blackfriars Road. Kennington Park Road. Boyson Road. Lorrimore Road. Browning Street. Lant Street. Colling wood Street. Little Chatham Street. Chapter Road. Larcom Street. Charles Street. Mason Street. Chatham Street. Mann Street. Cavour Street. Madron Street. Chatham Place. Newington Butts. Delverton Road. New Kent Road. Frederick Road. New Street. Faraday Street. Old Kent Road. Faunce Street. Penrose Street. Great Bland Street. Quinn Square. Grosvenor Park. Runham Street. Gloster House. St. Paul's Road. Gurney Street. Surrey Square. Great Suffolk Street. South Street. Great Charlotte Street. Sharsted Street. Great Dover Street. Trafalgar Street. Gladstone Street. Union Street. Heygate Street. Walcorde Avenue. Inville Road. Wansey Street. Imperial Chambers. Westmoreland Road. Jane Street. Walworth Road. 72 TABLE 23. HOUSING. 1. Inspection of Dwelling Houses :— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3,671 (b) Number of inspections made for the purpose 33,456 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,965 (b) Number of inspections made for the purpose 1,965 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 116 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,345 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 1,677 3. Action under Statutory Powers during the Year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 474 73 TABLE 23.—continued. (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 132 (b) By Local Authority in default of owners 2 B. Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2,871 ;2) Number of dwelling houses in which defects were remedied after service of formal and informal notices:— (a) by owners 2,697 (b) by Local Authority in default of owners — C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made .. 8 (2) Number of dwelling houses demolished in pursuance of Demolition Orders — D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 83 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 4 (3) Number occupied but unfit 3,471 74 T ABLE 23.—continued 4. Housing Act, 1936—Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 2,769 (2) Number of families dwelling therein 2,769 (3) Number of persons dwelling therein 16,559 (b) Number of new cases of overcrowding reported during the year 446 (c) (1) Number of cases of overcrowding relieved during the year 1,424 (2) Number of persons concerned in such cases 8,528 (d) Particulars of any cases in which dwelling houses have again become overcrowded 1 In addition to the visits enumerated in the above table 20,000 houses were visited by the Sanitary Inspectors for the purpose of taking measurements under the Overcrowding Survey. TENEMENT BUILDINGS. At the end of 1936 there were 154 tenement buildings containing 9,014 separate dwellings. During the past year 11 blocks of tenements have been erected containing 396 separate dwellings. Much constructional work has been carried out during the year in the provision of new soil pipes, sinks, and sink waste pipes. Many of these buildings were erected between 60 and 70 years ago, and at that time were considered to be the best method of dealing with the housing problem. They were very substantially built, and no complaint can be made in regard to the structure. The chief defects are: (1) severe congestion causing dark rooms; (2) communal sanitary conveniences causing many offensive nuisances and requiring a very large amount of supervision: (3) obsolete brick-built dust shoots which have become very foul internally. 75 In order to deal with buildings which are congested, portions of the tenements should be demolished to admit sufficient light and air; odd dark rooms closed, or two rooms converted into one; and the internal arrangements re-planned. These improvements could be effected only by the removal of numerous tenants. There would be little objection to communal sanitary conveniences being provided where tenements are occupied as single rooms for single persons, but any tenement occupied by three or more persons should be provided with its own water closet and sink. The present powers for dealing with this problem are very weak. Brick dust shoots should be demolished and proper glazed pipe shoots erected, discharging into a movable receptacle which should be emptied daily. Where supervision is not strict, a very offensive nuisance is caused by the occupiers throwing refuse from the windows into the inner quadrangle. It is most difficult to determine the offenders, and the Council have from time to time circulated a leaflet as follows:— METROPOLITAN BOROUGH OF SOUTHWARK. It has been brought to my notice that RUBBISH AND REFUSE is often thrown out of the windows into the yard below and adjoining premises. This is a dirty and lazy habit and the presence of this refuse in the yard is bad for health and attracts flies and rats. All such refuse must be put into the place provided for it. Proceedings will be taken against any person disobeying this Notice. W. STOTT, Medical Officer of Health. Health Services Department, Walworth Road, S.E.17. 76 TABLE 24. Sanitary Works completed under the Housing Acts, during the year 1937. Formal Notices complied with 132 Chimney flues repaired 21 Brickwork and pointing repaired 98 Window sashes repaired 425 New sash lines 163 Doors and woodwork repaired 409 Stair treads and risers repaired 63 Floors repaired 57 Provision of ventilated food storage 21 Plaster repaired 279 Stove and fireplace repaired 266 Copper repaired 35 Roofs repaired 65 Sinks provided 36 Walls and ceilings repaired 285 W.C.s amended 42 Dampness abated 132 Paving amended 82 Light and ventilation provided 103 Door and window sills repaired 50 SECTION E. Inspection and Supervision of Food. 79 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 4 slaughter-houses in the Borough which are licensed annually. The following are the premises and licensees:— Situation of Premises. Name of Licensee. 129, Hillingdon Street Reuben Newbury. 70, Harper Road George Challis. 244, Walworth Road Messrs. Chalk & Cox. 283-5, Walworth Road Messrs. R. C. Hammett, Ltd. During the year, 245 oxen, 2,057 sheep and 420 pigs were slaughtered. The total weight found to be unsound was 13 cwts. 1 qr. 23 lbs., of which 2 cwts. 3 qrs. 5 lbs. were destroyed on the premises where found, and 10 cwts. 2 qrs. 18 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 222 310 Butchers' premises 84 493 Provision Dealers 69 110 80 I have received the following report from Mr. J. A. Syms, Sanitary Inspector:— ICE CREAM. Systematic inspection of the premises and plant of all Makers and Sellers of Ice Cream has been carried out during the season of 1937. Special attention has been given to the method of sterilization of plant and utensils, and the standard of cleanliness enforced. Bacteriological samples of Ice Cream were procured and submitted for analysis. To a great extent this was confined to Italian Ice Cream, as this is a commodity exposed to greater possibilities of contamination, owing to it being sold from street barrows. In each case a sequence of samples was obtained, the first being one of the boiled or prepared mix; second, the mix immediately after freezing, and the third the final mix under the conditions of sale. The data thus obtained proved to be of considerable value and evinced the fact that where the first sample was low in the bacterial count, the second and third samples were relatively higher but well below the permitted count, i.e., the Pasteurised Milk Standard. The good results thus obtained tend to prove that the essential details in regard to the prevention of contamination are being better understood and guarded against. The period of cooking of the prepared mix loomed large as a factor in the presence of bacteria on analysis. Where the sample was high in the bacterial count, the makers were interviewed and persuaded to increase the period of cooking; further samples were taken with very favourable results. The value of this side of the work cannot be over-estimated, and although it is no easy matter to explain to many of the Italian trade the meaning of the bacterial count, it inspires them with a keen desire to obtain a good result and a readiness to adopt the advice given. At the close of the year the Register reveals the following facts:— Manufacture and Sale of Ice Cream. Number of Premises on the Register at end of 1936 92 Number of Premises registered during 1937 5 Number of Premises discontinued during 1937 14 Number of Premises on the Register at end of 1937 83 Sale of Ice Cream only. Number of Premises on the Register at end of 1936 96 Number of Premises registered during 1937 43 Number of Premises discontinued during 1937 0 Number of Premises on the Register at end of 1937 139 81 PREMISES WHERE FOOD IS PREPARED. The routine inspection of premises where food is prepared and sold has been considerably curtailed during the period under review owing to the time given to other work connected with the Overcrowding Survey. Special attention has been given to the general hygienic conditions of the premises, and a demand made for increased care and cleanliness in all food handling. First-class equipment, good utensils and, above all, suitable storage accommodation are the chief matters requiring attention. The educational value of the work becomes more obvious and I feel that the appreciation of the more important factors which lead to food contamination are being better understood. With but few exceptions, it may be said that the various food trades are conducted under clean conditions and the food supplied wholesome. The following is a summary of the premises under inspection:— Restaurants in Licensed Premises 77 Restaurants in Unlicensed Premises 26 Coffee Houses 104 Cafes 96 Stalls 15 Other Premises 24 During the year, 16 premises have been closed or the trade discontinued and 22 have been re-opened or newly established. The record cards show the following facts:— Reconstructed. Improved. Refrigerators Cleansed. Installed. Public Houses Restaurants 8 2 25 45 Restaurants — — 6 20 Coffee Houses — 6 31 43 Cafes 9 5 12 30 Other Premises 3 1 4 7 FRIED FISH PREMISES. The number of premises on the Register at the end of 1936 was 54. 4 have been closed or the trade discontinued, and 4 have been registered during the year. The total number now registered is 54. The following represents the work carried out during the year:— Reconstructed 4 Cold storage is now provided in 32 shops and electrically driven potato peelers are installed in 49. 82 FISH CURERS' PREMISES. The number of Fish Curers' premises on the Register at the end of 1936 was 33. This number remains the same at the close of 1937. The general cleansing and upkeep of the premises used has been maintained without difficulty. OLD COCOA FACTORY,DARWIN STREET. During the latter end of the year this factory, which is situate at the corner of Old Kent Road and Darwin Street, has been under conversion as a modern Food Factory. The frontage has been reconstructed as a row of shops with a Milk Bar at the corner. This bar has been fitted with the most up-to-date equipment. The premises at the rear have been adapted as a central store for the supply of the various Milk Bars and other undertakings of the firm. On the upper floor is a wellconstructed kitchen for the preparation of soups and, ultimately, fruit essences. The lower part of the building has been converted into a modern Ice Cream Factory and, although not yet complete, will prove an ideal factory for the purpose. The upper floors of the main building have been made the central offices of the Company. I have received the following report from Messrs. Bowers and Duffield, Food Inspectors:— FOOD FACTORIES. A modern factory for the preparation and canning of hams, tongues, veal and the making of sausages has been established during the year. The latest type of machinery and methods are in use. All food factories are under constant supervision, and it is worthy of favourable comment that more utensils made of stainless steel are now in use. BACON STOVES. There are 5 Stoves used for the smoking of Bacon in the Borough, and these are periodically inspected. MERCHANDISE MARKS ACT, 1926 Shops are supervised in order to see that the requirements of this Act are carried out. Special attention has been paid to the marking of Dried Fruits. No difficulties with traders in regard to this matter have been experienced. 83 AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT, 1926. 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. During 1937 the Public Health (Imported Food) Regulations, 1937, have been received, together with Provisional Rules and Orders of 2nd December, 1937, postponing the operation of these Regulations until 1st April, 1938. The principal alterations in the new Regulations relate to the requirement of Official Certificates of the Country of Origin with regard to meat and meat products. Official Certificates for the purposes of these Regulations have been approved by the Minister of Health for the following countries:— United States of America. Bechuanaland Protectorate. United States of Brazil. Kingdom of Bulgaria. Kingdom of Denmark. Republic of Estonia. Republic of Finland. Government of French West Africa. Government of Hong-Kong. Kingdom of Hungary. Kingdom of Iceland. Republic of Latvia. Republic of Lithuania. Government of Madagascar and Dependencies. Republic of Poland. Kingdom of Roumania. Union of South Africa. Colony of Southern Rhodesia. Confederation of Switzerland. Kingdom of Yugoslavia. 84 During the period under review, apart from the routine inspection of Imported Food, the following items were dealt with:— Imported Mutton. The routine 5 per cent. examination of all imported mutton and 100 per cent. of all pieces was carried out, and the diminution noticed in previous years of the number affected with Caseous Lymphadenitis has been maintained. It is interesting to note that when carcases are jointed for Retail Butchers' Shops lesions are frequently found in the muscular tissues. Three shipments of Imported hind-quarters of Mutton were found to be unfit for food owing to acid fermentation. A large consignment of Mutton had to be condemned owing to defective machinery on the ship. Two separate cargoes of meat were found to have been contaminated with oil fumes during transport. On being subjected to ozonization, the parcels were released. Sausage Casings. Cases of Sausage Casings were found to have been damaged by beetles and had to be destroyed. Sausage Casings were imported from Arabia in old petrol tins. These were seized and taken to a Magistrate, who condemned them as unfit for food, although the Owners represented that, after processing, they could be made fit for human consumption. The parcel was destroyed. Coffee. 250 cases of Coffee were found to have a cheesy flavour and were destroyed. Fruit. Large quantities of Oranges from Spain and Jaffa were found on arrival to be unsound and were destroyed. 85 A parcel of Imported Dried Orange Peel was infested with insects. LETTUCE. Samples of Lettuce from France and Spain were submitted for bacteriological examination and proved negative for Bacillus Typhosis. Ten railway trucks of Lettuce, weighing 26 tons 10 cwts., which were imported from Spain were found to be unfit for food and were destroyed by the Council. CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 245 2057 420 Number inspected 245 — — 2057 420 All Diseases except Tuberculosis. Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 5 — — — 20 Percentage of the number inspected affected with disease other than T. B. Tuberculosis only. 2.0 — — — 4.8 Whole carcases condemned 1 — — — 2 Carcases of which some part or organ was condemned 10 30 Percentage of the number inspected affected with Tuberculosis 4.5 — — — 7.6 86 PUBLIC HEALTH (PRESERVATIVES IN FOOD) REGULATIONS, 1925. As reported last year, strict supervision has been maintained over food imported into the Borough, for the purposes of the above Regulations, and many samples have been taken by me and examined by the Public Analyst. Lead in Sardines has slowly decreased to 5 and under 5 parts per million. During the year my attention was drawn to the large quantities of copper contained in certain brands of Tomato Puree. Later in the year this resulted in a Conference being called of all Port Medical Officers and Officers of the Ministry of Health. At this Conference it was decided to deal with the matter on similar lines to those adopted for the abolition of lead in Sardines. Accordingly, all importers have been warned that as and from 1st January, 1939, all Tomato Puree with copper content exceeding 50 parts per million of the dried material will be condemned as unfit for food. It has also been pointed out that this quantity is not final and that in due course an even less copper content will be demanded. 125 samples of foodstuffs were taken at the Wharves and submitted to the Public Analyst. Details of the results of analysis are shown in the following tables. 89 88 ANALYSIS OF PORT SANITARY SAMPLES, 1937. Sample of Condition of Can. Condition of Contents or Sample. Report. External. Internal. Sardines Very satisfactory No corrosion Sound Lead 6.3 parts per million. Tin not found. Sardines Very satisfactory No corrosion Sound Lead 6 parts per million. Tin not found. Sardines Very satisfactory No corrosion Sound Lead 3.5 parts per million. Tin not found. Sardines Very satisfactory No corrosion Sound Lead 3.5 parts per million. Tin not found. The above four were samples from same consignment—Average, Lead 4.8 parts per million. Sultanas — — Sound Sulphur dioxide 660 parts per million. Sultanas — — Sound Sulphur dioxide 580 parts per million. Sultanas — — Sound Sulphur dioxide 800 parts per million. Frozen Egg — — Sound Boracic compounds not detected. Egg Yolk — — Sound Boracic compounds not detected. Apricot Kernels — — Sound Sulphur dioxide not detected. Almonds — — Sound Sulphur dioxide not detected. Cashew Kernels — — Sound Sulphur dioxide not detected. Walnuts — — Sound Sulphur dioxide not detected. Filberts — — Sound Sulphur dioxide not detected. Hazel Nut Kernels — — Sound Sulphur dioxide not detected. Sultanas — — Sound Sulphur dioxide 655 parts per million. Lead not found. Egg Yolk — — Sound Boracic compounds not detected. Egg Yolk — — Sound Boracic compounds not detected. "Deodorol" — — Organic compound, contained 10 per cent. available Chlorine. Frozen Egg — — Sound Boracic compounds not detected. Egg Yolk — — Sound Boracic compounds not detected. Pork and Beans Very satisfactory No corrosion Sound Lead not found. Tin not found. Glace Cherries — Some brown and shrivelled. Sulphur dioxide not found. Copper 6.5 parts per million. Lead not found. Arsenic not found. "Musty" taste Frozen Egg Yolk — — Sound Boracic compounds not detected. Frozen Whole Egg — — Sound Boracic compounds not detected. Sardines Very satisfactory No corrosion Sound Lead not found. Tin not found. Sardines Very satisfactory No corrosion Sound Lead less than 5 parts per million. Tin not found. Sardines Very satisfactory No corrosion Sound Lead less than 3 parts per million. Tin not found. Sardines Very satisfactory No corrosion Sound Lead not found. Tin not found. The above four samples are from the same consignment. Salmon Very satisfactory No corrosion Sound Lead not found. Tin not found. Salmon Very satisfactory No corrosion Sound Lead not found. Tin not found. Frozen Whole Egg — — Sound Boracic compounds not detected. Egg Yolk — — Sound Boracic compounds not detected. Frozen Whole Egg — — Sound Boracic compounds not detected. Confectionery — — Sound Sulphur dioxide not found. Copper, Lead and Arsenic not found. Frozen Whole Egg — Sound Boracic compounds not detected. 90 91 Sample of Condition of Can. Condition of Contents or Sample. Report. External. Internal. Frozen Whole Egg Sound Boracic compounds not detected. Frozen Whole Egg Sound Boracic compounds not detected. Frozen Whole Egg Sound Boracic compounds not detected. Frozen Whole Egg Sound Boracic compounds not detected. Dill Pickles Very satisfactory No corrosion .. Sound Lead less than 2 parts per million. Tin not found. Copper not found. Yams Very satisfactory No corrosion .. Sound Lead not found. Tin not found. Copper not found. Sauerkraut Juice Very satisfactory No corrosion .. Sound Lead not found. Tin not found. Copper not found. Frozen Whole Egg — Sound Boracic compounds not detected. Salmon Very satisfactory No corrosion .. Sound Lead not found. Tin not found. Frozen Whole Egg — — Sound Boracic compounds not detected. Frozen Whole Egg Sound Boracic compounds not detected. Frozen Whole Egg Sound Boracic compounds not detected. Egg Yolk Sound Boracic compounds not detected. Frozen Whole Egg Sound Boracic compounds not detected. Egg Yolk Sound Boracic compounds not detected. Egg Yolk Sound Contained boracic compounds. Frozen Whole Egg Sound Boracic compounds not detected. Frozen Whole Egg Sound Boracic compounds not detected. Frozen Whole Egg Sound Boracic compounds not detected. Sardines Blown .. Badly corroded Sound Tin 1.8 grains to the pound. Lead 10 parts per million. Egg Yolk Sound Boracic compounds not detected. Sardines Satisfactory Slightly corroded Sound Tin 0.7 grain to the pound. Lead 12 parts per million. Sardines Satisfactory Slightly corroded Sound Tin 0.9 grain to the pound. Lead 8 parts per million. Frozen Whole Egg — _ Sound Boracic compounds not detected. Duck Yolk Sound Contained boracic compounds. Egg Yolk — Sound Boracic compounds not detected. Frozen Whole Egg — Sound Boracic compounds not detected. Egg Yolk Sound Contained boracic compounds. Egg Yolk — Sound Contained boracic compounds. Egg Yolk Sound Boracic compounds not detected. Frozen Whole Egg Sound Boracic compounds not detected. Egg Yolk — — Sound Contained boracic compounds. Egg Yolk — — bound Boracic compounds not detected. Egg Yolk — — Sound Boracic compounds not detected. Frozen Whole Egg — Sound Boracic compounds not detected. Frozen Whole Egg — Sound Boracic compounds not detected. Egg Yolk — Sound Boracic compounds not detected. Duck Yolk Sound Contained boracic compounds. Egg Yolk Sound Contained boracic compounds. Duck Yolk — — Sound Contained boracic compounds. Frozen Whole Egg — — Sound Boracic compounds not detected. 92 93 Sample of Condition of Can. Condition of Contents or Sample. Report. External. Internal. Egg Yolk Sound Boracic compounds not detected. Egg Yolk — — Sound Boracic compounds not detected. Egg Yolk — — Sound Boracic compounds not detected. Egg Yolk — — Sound Contained boracic compounds. Egg Yolk — — Sound Boracic compounds not detected. Egg Yolk — — Sound Contained boracic compounds. Egg Yolk — — Sound Contained boracic compounds. Frozen Whole Egg — — Sound Boracic compounds not detected. Frozen Whole Egg — — Sound Boracic compounds not detected. Egg Yolk — — Sound Boracic compounds not detected. Egg Yolk — — Sound Contained boracic compounds. Orange Juice — — Sound Boracic compounds, sulphur dioxide, benzoic acid, salicylic acid not detected. Frozen Whole Egg — — Sound Boracic compounds not detected. Egg Yolk — — Sound Boracic compounds not detected. Frozen Whole Egg — — Sound Boracic compounds not detected. Lard — — Sound Genuine. Frozen Whole Egg — — Sound Boracic compounds not detected. Coffee Satisfactory Satisfactory Sound Genuine. Lobster Satisfactory Satisfactory Sound Lead not found. Tin not found. Crab Satisfactory Satisfactory Sound Lead not found. Tin not found. Pears — — Sound Sulphur dioxide 770 parts per million. Raisins — — Sound Sulphur dioxide 660 parts per million. Apricots — — Sound Sulphur dioxide 690 parts per million. Raisins — — Sound Sulphur dioxide 40 parts per million. Apples — Sound Sulphur dioxide 470 parts per million. Apricots — — Sound Sulphur dioxide 1,350 parts per million. Nectarines — — Sound Sulphur dioxide 1,430 parts per million. Evaporated Apples — — Sound Sulphur dioxide 656 parts per million. Frozen Whole Egg — — Sound Boracic compounds not detected. Confectionery — — Sound Sulphite preservative not found. Boracic preservative not found. Arsenic not found. Lead not found. Copper not found. Raisins — — Sound Sulphur dioxide 915 parts per million. Prunes — — Sound Sulphite compounds not detected. Frozen Whole Egg — — Sound Boracic compounds not detected. Raisins — — Sound Sulphur dioxide 1,070 parts per million. Raisins — — Sound Sulphur dioxide 605 parts per million. Raisins — — Sound Sulphur dioxide 680 parts per million. "Valtime" — — Sound Arsenic not found. Heavy metals less than 5 parts per million. Lobster Paste Satisfactory Satisfactory Satisfactory Lead 3 parts per million. Tin not found. Pilchards Satisfactory Satisfactory Sound Tin not found. Lead 14 parts per million. Tomato Puree Satisfactory No corrosion Sound Lead 1.5 parts per million. Tin not found. Copper 9 parts per million. Zinc less than 10 parts per million. 94 95 Sample of Condition of Can. Condition of Contents or Sample. Report. External. Internal. Tomato Puree Satisfactory No corrosion Sound Lead 2 parts per million. Tin not found. Copper 8 parts per million. Zinc 10 parts per million. Tomato Puree Satisfactory No corrosion Sound Lead 3 parts per million. Tin 0.8 grain to the pound. Copper 7 parts per million. Zinc 20 parts per million. Tomato Puree Satisfactory No corrosion Sound Lead 1.5 parts per million. Tin not found. Copper not found. Zinc less than 10 parts per million. Tomato Puree Satisfactory No corrosion Sound Lead 1 part per million. Tin not found. Copper 2 parts per million. Zinc 15 parts per million. Tomato Puree Satisfactory No corrosion Sound Lead not found. Tin 0.7 grain to the pound. Copper 17 parts per million. Zinc 35 parts per million. Tomato Puree Satisfactory No corrosion Sound Lead 1.5 parts per million. Tin not found. Copper 6 parts per million. Zinc less than 10 parts per million. Tomato Puree Satisfactory No corrosion Sound Lead 2.5 parts per million. Tin less than 0.5 grain to the pound. Copper 22 parts per million. Zinc less than 10 parts per million. 96 97 TABLE 25. Showing the quantity of foodstuffs examined at the wharves, method of disposal the amount found to be unsound, the Notices served, and the 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. (6) Release. T. C. Q. L. T. c. Q. L. Almonds 890 packages 35 5 0 0 — Apples 100 cases, 1917 boxes 41 15 0 4 8 19 1 6 Yes — 6 6 Barged to sea. Apples, evaporated 200 boxes 2 13 0 0 — — Apples, tinned 201 cases 5 0 3 0 6 3 0 Yes — — — — Apricots 5201 crates, 50 boxes 55 19 1 6 55 8 2 6 Yes — 2 2 Destroyed at Council's Depot. — 2 2 4 cwt. 2 qrs. 24 lbs. destroyed on premises where found and 55 tons 3 cwt. 3 qrs. 10 lbs. destroyed at Council's Depot. Apricots, dried 89 boxes 1 3 3 10 1 3 3 10 Yes Apricot Kernels 139 bags 3 9 2 0 — — — — — Destroyed at Council's Depot. Apricot Pulp 1196 cases 59 16 0 0 3 17 0 7 Yes — — — Bacon 6556 boxes, 24484 bales 4976 17 2 0 — — — 3 3 Destroyed at Council's Depot. — — — — Beans 68 cases, 263 crates 4 0 1 20 1 4 0 5 Yes — — Destroyed at Council's Depot. Beef 217 13 0 8 6 11 0 21 Beef, tinned 1840 cases, 1476 tins 61 19 3 16 4 0 3 24 Yes — 8 8 Released for technical purposes. Yes — — — Destroyed at Council's Depot. Biscuits 398 cases 20 6 0 0 16 0 0 Black-currant Pulp 50 cases 2 10 0 0 4 0 25 Yes — — — Do. do. Butter 1028 boxes 12 17 0 0 — Yes — 1 1 Do. do. Casings 93 cases, 31 tierces, 6 cases and 1 keg 27 11 0 22 4½ 16 0 0 — — 1 1 — — Yes 3 2 4 cwt. seized by Inspector and condemned by Magistrate, Tower Bridge Police Court; 12 cwt. destroyed on premises where found. 1 tin destroyed on premises. Caviare 3 barrels, 1 tin 3 0 4½ Yes — Cereals 100 packages 2 10 0 0 — — — 1 1 Cheese 460 baskets, 150 bundles, 25 packages 12 5 2 5 11 1 1 26 Yes — 2 1 11 tons 3 qrs. 12 lbs. released for technical purposes; 2 qrs. 14 lbs. destroyed at Council's Depot. Cherries 100 packages 18 0 0 — Cherries, glace 15 cases 2 5 0 0 8 1 8 — — 1 — Chicken, tinned 16 cases, 14 tins 1 8 1 8 1 7 0 0 — 1 — — Coffee 250 cases I 7 0 0 2 0 Yes — — 1 Destroyed at Council's Depot. Confectionery 600 cases, 2 pails 17 13 1 26 Yes — 1 — Do. do. Crab, tinned 250 cases 5 7 0 1 0 24 Yes — — — Do. do. Currants, black 77 cases, 1 billot 3 9 1 4 Yes — — — — Dill Pickles, tinned 11 cases 5 3 16 — — — — Destroyed on premises where found. Dripping 1270 crates 31 15 0 0 — — — — Carried forward 5607 5 0 9½ 96 5 1 26½ 31 29 98 99 Foodstuffs. Quantity and Weight examined. Weight found to be unsound. Surrendered by Owner. Notices served. Seized by Inspector. (a) Detention. (6) Release. How unsound portion disposed of. Quantity. Weight. t. c. Q. l. t. c. Q. l. Brought forward 5607 5 0 9½ 96 5 1 26½ 31 29 Ducks 100 cases, 50 boxes 2 3 0 0 — — — — — Egg, Liquid 176612 packages, 41287 packings, 36385 tins 5599 3 1 19 1 1 Egg Yolk, liquid 1436 casks, 800 tins 369 16 0 0 — — 17 13 — Flour 9 bags 8 0 4 — — — — Fowls 270 cases, 35 boxes 7 4 0 4 3 16 Yes — 2 2 Released for soap boiling. Fruits, dried 50 cases 1 1 1 20 — — — — Fruit, tinned 1035 cases, 132 tins 24 15 1 4 13 16 1 20 Yes — — — Destroyed at Council's Depot. Game 150 boxes, 2 cases 6 6 0 5 1 0 5 Yes — 1 1 Do. do. Geese 100 boxes 1 10 0 0 — — — — Grapes 8 crates 3 0 3 0 Yes — — — — Grape Fruit 24910 boxes, 6566 cases 1134 7 2 24 15 8 1 24 Yes 18 18 Barged to sea. Greengages 82 crates, 7 halfsieves 16 0 23 16 0 23 Yes — — — Destroyed at Council's Depot. Hams 4 cases, 262 boxes 63 5 0 0 — — — — — Hams, canned 114 tins, 989 cases 41 6 1 16 14 1 0 Yes — — — Destroyed at Council's Depot. Jam, tinned 1208 tins, 20 cases 12 3 4 — 1 1 — Lard 30 barrels, 3814 boxes, 1500 cases 134 14 2 0 15 0 14 — 1 1 Released for technical purposes. Lard Oil 153 barrels 30 12 0 0 — — — — Lemons 366 boxes, 499 cases 30 13 0 0 2 16 1 4 Yes — 4 4 Barged to sea. Lettuce 4000 crates 30 7 2 12 28 3 0 12 Yes 26 tons 10 cwt. destroyed at Council's Depot; 1 ton 13 cwt. 12 lbs. destroyed on premises where found. Li Chees 25 cases 13 1 16 — — — — — Lobster, tinned 105 cases 2 11 0 0 — — — — — Meat, tinned 1238 cases 31 16 0 0 8 0 4 Yes — 1 1 Destroyed at Council's Depot. Milk, condensed 7432 cases 153 10 3 4 11 2 1 6 Yes 9 tons 14 cwt. 1 qr. 22 lbs. destroyed at Council's Depot; 1 ton 7 cwt. 3 qrs. 12 lbs. released for technical purposes. Mutton — 2031 17 3 12 9 14 0 20 Yes — 806 806 Released for technical purposes. Offal — 97 19 0 27 28 16 0 0 Yes — 23 23 Do. do. Onions 13943 boxes 692 6 2 0 2 19 0 0 Yes 1 1 1 ton 5 cwt. barged to sea; 1 ton 14 cwt. destroyed at Council's Depot. Oranges 53900 boxes, 15280 cases 2850 4 2 10 79 18 1 16 Yes 44 44 79 tons 1 qr. 16 lbs. barged to sea; 18 cwt. destroyed at Council's Depot. Oranges, tinned 1910 cases 160 10 2 24 16 3 14 Yes — — — Destroyed at Council's Depot. Carried forward 19107 18 1 13½ 292 12 3 8½ 951 945 100 101 Foodstuffs. Quantity and Weight examined. Weight found to be unsound. Surrendered by Owner. Seized by Inspector. Notices served. How unsound portion disposed of. (a) Detention. (6) Release. Quantity. Weight. T. c. Q. L. T. c. Q. Brought forward . . 19107 18 1 13½ 292 12 3 8½ 951 945 Orange Juice 300 cases 9 7 2 0 — — — — — — Orange Peel, dried 40 cases 8 0 0 0 9 0 20 Yes — — — Destroyed on premises. Peaches, canned 50 cases 2 1 0 0 — — — — — — Pears 14 boats, 2 cases, 22590 boxes 549 10 2 4 6 12 2 0 Yes — 13 13 3 cwt. 3 qrs. destroyed at Council's Depot; 6 tons 8 cwt. 3 qrs. barged to sea. Pears, tinned 423 cases 11 6 2 12 11 2 10 Yes — 1 1 Destroyed at Council's Depot. Peas 205 billots, 92 packages, 15 crates, 700 bags 38 2 1 20 4 16 2 21 Yes — 3 3 3 tons 2 cwt. 1 qr. 20 lbs. destroyed at Council's Depot; 1 ton 14 cwt. 1 qr. 1 lb. released for technical purposes. Pigeons 100 boxes 5 2 0 — — — — — — Pimentoes 3 barrels, 50 cases 1 14 1 8 — — — — — — Pineapple, tinned 50 cases 1 1 0 0 — — — — — — Plums 373 packages 3 8 0 4 2 10 0 4 Yes — — — 6 cwt. 12 lbs. destroyed on premises where found, and 2 tons 3 cwt. 3 qrs. 20 lbs. destroyed at Council's Depot. Plums, tinned 326 cases 5 4 0 0 5 0 0 Yes 1 1 Destroyed at Council's Depot. Poivrons 4 cases 4 0 0 4 0 0 Yes — — Destroyed on premises where found. Pork — 15 19 0 27 1 5 0 11 Yes — 28 28 Released for technical purposes. Pork and Beans, tinned 4 cases, 8 tins 2 1 12 2 1 12 Yes — — — Destroyed at Council's Depot. Potatoes 100 baskets 5 0 0 0 — — — — — — Prunes 422 boxes 6 1 3 14 3 11 3 14 Yes — — — Destroyed at Council's Depot. Rabbits 260 crates, 80 boxes 8 16 1 0 — — — Raisins 609 boxes 10 15 0 0 — — 1 — — Red Currants 67 cases 3 7 0 0 — — — — — Rice 2020 bags 101 0 0 0 — — — — Salmon, tinned 25135 cases, 150 tins 537 19 1 2 3 6 1 10 Yes — 1 1 Destroyed at Council's Depot. Sardines 1283 cases 18 11 2 1 — — — — Sauerkraut Juice, tinned 3 cases 1 2 12 — — Soups, tinned 6 cases 2 2 8 2 2 8 Yes — — — Destroyed at Council's Depot. Spinach 116 crates 1 4 2 20 1 4 2 20 Yes — — — Do. do. Strawberries 3 crates 2 0 2 0 Yes — — — Do. do. Sugar 50 bags 5 0 0 0 — — — — — Sultanas 1075 boxes 14 7 3 22 — — — — — Tangerines 198 boxes 4 19 0 0 12 2 0 Yes — 1 1 Barged to sea. Tomatoes 216 crates 2 16 0 0 2 16 0 0 Yes — — — Destroyed at Council's Depot. Tomatoes, tinned 65 cases, 124 tins 2 0 1 2 2 0 1 2 Yes 2 2 Do. do. Carried forward .. 20476 8 1 13½ 323 4 0 0½ 1002 995 102 103 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) Dtention. (b) Itlease. T. c. Q. L. T. c. Q. L. Brought forward 20476 8 1 13½ 323 4 0 0* 1002 995 Tomato Puree 79 cases, 131 tins 4 3 2 14 4 3 2 14 Yes __ 4 4 Destroyed at Council's Depot. Tongues 33 cases 1 1 0 4 7 1 21 Yes __ — — Do. do. Tongues, tinned 34 tins, 50 cases 1 13 0 18 1 2 18 Yes __ 1 1 Turkeys 60 cases 2 1 2 0 — — __ 1 1 — Veal 64 sides 1 12 0 0 — — __ — — — Veal, canned — 4 0 0 4 0 0 Yes __ — — Destroyed at Council's Depot. Walnuts, shelled 21 cases 10 2 0 — — __ 1 1 — Wheat 10 bags 10 0 0 10 0 0 Yes __ 1 1 Released for technical purposes. Yams, tinned 5 cases 2 2 20 — — __ __ __ __ Total 20488 6 3 13½ 328 10 2 25½ 1010 1003 104 105 TABLE 26 Showing the quantity of Foodstuffs found unsound throughout the Borough during the year 1937 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 3 cases 3 6 3 cases 3 6 Destroyed at Council's Depot. Bacon 3 19 1 13 __ 3 19 1 13 9 cwt. 2 qrs. 17 lbs. destroyed at Council's Depot, and 3 tons 9 cwt. 2 qrs. 24 lbs. released for technical purposes. Beans, canned — 6 0 0 — 6 0 0 — Destroyed at Council's Depot. Beef 16 3 15 __ 16 3 15 9 cwt. 1 qr. 21 lbs. released for technical purposes, and 7 cwt. 1 qr. 22 lbs. destroyed on premises where found. Beef, tinned 25 tins 1 1 8 25 tins 1 1 8 — Destroyed at Council's Depot. Caramels — 6 — 6 — Destroyed on premises where found. Cheese, tinned 2 cases 2 0 2 cases 2 0 — Destroyed at Council's Depot. Chestnuts, dried 20 __ 20 Seized by Inspector; condemned by Magistrate, Tower Bridge Police Court; destroyed at Health Services Department. Eggs 2880 eggs 2 0 16 2880 eggs 2 0 16 — Destroyed at Council's Depot. Fish 8 boxes 1 0 18 8 boxes 1 0 18 Do. do. Fish, tinned 25 cases 10 0 0 25 cases 10 0 0 Do. do. Fowls — 1 0 2 18 — 1 0 2 18 — 1 ton 2 qrs. 14 lbs. destroyed at Council's Depot, and 4 lbs. destroyed at Town Hall. Fruits, tinned 60 cases, 227 tins 1 12 2 0 60 cases, 227 tins 1 12 2 0 — Destroyed at Council's Depot. Goods, assorted tinned — 1 0 0 __ 1 0 0 — Do. do. Grape Fruit 256 boxes 12 16 0 0 256 boxes 12 16 0 0 — Do. do. Haddocks 1 box 2 14 1 box 2 14 Do. do. Hams — 14 14 Do. do. Hams, canned 79 tins, 2 hams 10 1 4 79 tins, 2 hams 10 1 4 Do. do. Heads, Pigs 15370 heads 80 19 0 26 15370 heads 80 19 0 26 — Released for technical purposes. Kippers 18 boxes 2 1 18 18 boxes 2 1 18 — Destroyed at Council's Depot. Lemons 139 boxes 6 19 0 0 139 boxes 6 19 0 0 — Do. do. Melons 52 crates, 3 trays 5 3 12 52 crates, 3 trays 5 3 12 Do. do. Mutton — 1 1 12 — 1 1 12 — 3 qrs. 16 lbs. destroyed on premises where found; 1 qr. 24 lbs. released for technical purposes. Offal __ 18 0 27 __ 18 0 27 — 10 cwt. 2 qrs. 18 lbs. destroyed at Council's Depot; 2 cwt. 3 qrs. 5 lbs. destroyed on premises where found, and 4 cwt. 3 qrs. 4 lbs. released for technical purposes. Oranges 1715 cases, 2293 boxes 201 10 0 24 1715 cases, 2293 boxes 201 10 0 24 — Destroyed at Council's Depot. Ovaltine __ 16 0 0 — 16 0 0 — Do. do. Carried forward 313 11 3 19 313 11 2 27 — 20 106 107 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. T. Brought forward 313 11 3 19 313 11 2 27 20 Pears 78 boxes 1 5 3 0 78 boxes 1 5 3 0 — — Destroyed at Council's Depot. Pork 42 1 1 23 _ 42 1 1 23 — — 42 tns 2 qrs. 2 lbs. released for technical purposes, and 3 qrs. 21 lbs. destroyed on premises. Prunes 9 boxes 3 1 0 9 boxes 3 1 0 — — Destroyed on premises where found. Rabbits — 3 1 8 — 3 1 8 — — Destroyed at Council's Depot. Salmon, tinned 37 cases 16 2 0 37 cases 16 2 0 — Do. do. Sardines 6 cases 2 3 0 6 cases 2 3 0 — Do. do. Sultanas 8 packages 8 0 0 8 packages 8 0 0 — Do. do. Tomatoes 32 boats 7 0 16 32 boats 7 0 16 — Do. do. Tomatoes, tinned 17 cases 7 0 0 17 cases 7 0 0 — Do. do. Tongues, tinned 74 tins 2 3 26 74 tins 2 3 26 — Do. do. Vegetables, tinned 1 case 1 20 1 case 1 20 — — Do. do. 359 10 2 0 359 10 1 8 — 20 108 TABLE 27. Inspections of Food at Wharves, Markets and other places where food is stored, and the action taken by the officials during the year 1937. 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 521 — 909 102 552 26 22 119 1 1 — Mr. Duffield 533 — 782 127 1402 1056 1056 513 1 1 — Market Inspections — 6981 — — — — — — — — Total 1054 6981 1691 229 1954 1082 1078 632 2 2 — 109 MILK AND DAIRIES (AMENDMENT) ACT, 1922, AND ORDERS MADE THEREUNDER, ETC. At the end of 1936, there were on the Milksellers' Registers:— Retail names 404 and premises 401 Wholesale names 31 ,, 30 Retail names .. 79 Outsiders. Wholesale names 46 ,, During the year 1937 the following entries were made in the respective Registers, viz. :— Retail names 56 and premises 56 entered.* Retail names 64 ,, 63 removed. *The 56 premises are:— 4 Dairies. 50 Bottled Milk only sold. 2 Bottled Milk and for consumption on premises. The sale of Milk was discontinued at 27 premises. The sale of Milk was newly started at 20 premises. Totals on Retail Register at the end of 1937:— 396 names; 394 premises.* *The 394 premises are:— 55 Dairies of these, 39 sell Milk on rounds. 6 Depots 309 Sale of Milk in containers only (as received). 20 For consumption on the premises only. Wholesale during the year:— 7 names and 7 premises were entered in the Register. 2 names and 2 premises were removed from the Register. Business newly started at 5 premises. Total at the end of the year:— 36 names; 35 premises on the Register. Outsiders:— During the year 5 names entered and 1 removed. Retail. During the year 4 names entered and 1 removed. Wholesale. Total on Register at the end of the year 1937 :— 83 names Retail, and 49 names Wholesale. 18 Milksellers sell milk from open pans for consumption on the premises. 25 Milksellers sell milk from counter pans to be taken away. Most of these have dairy premises at the rear. 110 MILK (SPECIAL DESIGNATIONS) ORDER, 1936, ETC. 1 Dairy was licensed to Bottle and Sell Tuberculin Tested Milk. 6 Dairies were licensed to Bottle and Sell Pasteurised Milk. The total number of Licences issued for the sale of Graded Milks were as follows:— Tuberculin Tested Milk 26 (includes 1 bottling and 1 supplementary Licence) Accredited Milk 2 Pasteurised Milk 113 (includes 6 bottling and 4 — supplementary Licences) Total 141 During the year, 24 samples of Pasteurised Milk were obtained on behalf of the National Institute of Research in Dairying, for purposes of further research. BACTERIOLOGICAL AND PHOSPHATASE EXAMINATIONS. 118 samples of Milk were submitted for Phosphatase Test during the year. Of these, 4 were not satisfactory. 44 of these samples were Pasteurised Milk. 13 samples of Pasteurised Milk were submitted to the Public Analyst for Bacteriological Examination, all of which complied with the requirements of the Milk Special Designations Order, 1936. There are 49 London County Council schools with 117 departments which are supplied with Pasteurised Milk by 14 Dairy firms. These Milks are periodically sampled and are included in the above. INSPECTIONS OF VARIOUS PREMISES. The following inspections have been made during the year:— Milkshops, Dairies, etc. 1,540 1 Notice. Bakehouses, etc. 343 5 Notices. Soap Works 3 Tripe Boilers 5 Butter Factory 4 8 Samples taken. Fur Skin Dresser 2 Public Houses 411 Pharmacy and Poisons Act 205 Other premises 51 2,564 7 Notices. Verbal instructions and suggestions were given as required. 111 NUISANCES ABATED IN CONSEQUENCE OF NOTICES. Dirty walls 32 ,, ceilings 27 ,, floors 19 ,, paving 3 Defective walls 10 ,, ceilings 5 ,, floors 1 ,, paving 3 ,, and dirty utensils 17 ,, roofs 2 Light and ventilation 1 Utensils provided 8 Dustbins provided 7 Miscellaneous items 45 180 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. Works Done without Notice. 92, Thurlow Street.—New chimney installed to steam generator. 3, Monarch Buildings.—Cold Store installed for Milk. 120, Trafalgar Street.—Filling room walls relined, cleansed and repainted. 103, Villa Street.— Dairy painted throughout. 61, Rodney Road.—New covered barrow provided. 24, Gt. Bland Street.— Dairy walls and ceiling cleansed and repainted. 38, Penton Place.—Milkshop cleansed and repainted. 17, Vowler Street.—New high pressure steam boiler installed in place of old one removed. 152½, Blackfriars Road.—Dairy walls and ceilings cleansed and repainted. 58, Larcom Street.—Dairy walls and ceilings cleansed and repainted. 181, Manor Place.—Dairy walls and ceilings cleansed and repainted. 146, Lorrimore Road.—Dairy walls and ceilings cleansed and repainted. 10, Sutherland Place.—Depot walls and ceilings cleansed and repainted. 112 17, Sutherland Square.—Dairy walls and ceilings cleansed and repainted. 84, Villa Street.—Dairy walls and ceilings cleansed and repainted. 41a, Alvey Street.—Newbottle-filling machine and new bottle-capping machine for metal caps. 54, Old Kent Road.—Black and White Milk Bar.—The following appliances were provided:— 8 Milk containers in refrigerator of counter. 24 Syrup Pumps. 12 Electrical Mixers. 3 Wooden troughs with hot and cold water, trapped wastes. 1 Water softener. 1 Brush appliance for cleansing drinking vessels. 1 Lumley's Sterilizer for sterilizing drinking vessels and appliances. 1 Ice crusher. 1 Additional refrigerator in Basement store room. 36a, Gt. Dover Street.—Butter Factory.—Installed a new butter wrapping machine. Butter blender and hand packing machine reconditioned. Ceiling to factory provided. Concrete floor repaired and channels made to gully outside. Old turntable blender taken away. 195, Gt. Dover Street.— Bakehouse repainted throughout. 111, Trafalgar Street.—Bakehouse repainted throughout. 61, Webber Street.—Baking room repainted. Flour store cleansed. First floor bakehouse distempered. 185, Blackfriars Road.-—Baking room repainted. 68, Alvey Street.—Bakehouse repainted. 50, East Street.—Bakehouse and baking room repainted. Particulars of Bakehouses at the end of the year 1937:— Position. In use. Not in use. Totals. Remarks. Above ground 34 21 55 Under ground 21 13 34 Totals 55 34 89 29, St. David's Street.—Bakehouse demolished. 113 BAKEHOUSES. Works Done without Notice. 15. Old Kent Road.—Steam injector and new hot water tank. 80-82, Old Kent Road.—Bakehouse repainted. Flour store repainted. Dressing room painted. 5, Vine Place.—Bakehouse repainted. 126, Southward Bridge Road.—Bakehouse repainted. Spiers & Pond's, Gambia Street.—Bakehouse ceiling renewed in cork slabs expanding wire mesh covered and finished Keen's cement, whitened. Urinal bays removed from stokehold, new urinal provided (plans submitted). 257, Walworth Road.—Walls by benches zinc lined. Boilers and pipes painted aluminium. Ceiling repaired. Floor repaired. W.C. wall reconstructed. Dressing room cleansed. 113, Newington Butts.— Baking room floor relaid and tiled. Walls to benches zinc lined. New metal top to bench. New racks provided. 118-32, New Kent Road.—Top floor store cleansed and whitened. Second floor packing room cleansed and whitened. First floor packing room painted and whitened. First floor bakehouse cleansed. First floor balcony painted and whitened. Ground floor bakehouse and despatch cleansed, painted and whitened. Men's and women's lavatories painted throughout. Tin cleansing room painted and whitened. 388, Walworth Road.—1 new dough mixer. I new trough and board. I gas heated steam injector. Extractor fan for improved ventilation. Woodwork to staircase repainted. Prover repainted. 101, Gt. Dover Street.— Floor relaid and tiled. 325, Walworth Road.—Bakehouse repainted throughout. Floor relaid and tiled. 119, Walworth Road.—Ground floor bakehouse and baking room floors relaid and tiled. 304, Old Kent Road.—Yard paving repaired. New sink waste pipe. New gutter and rain pipe. 128 ENTERIC FEVER. Five cases of Enteric Fever were notified during the year. The number of cases notified and the number of deaths during the last five years were as follows:— Notified. Deaths. 1933 1934 1935 1936 1937 6 - 3 2 5 3 - 114 NOXIOUS TRADES. Situation. Trade. Occupier. Inspections. Remarks. 24. Gt. Suffolk Street Tripe Boiler J. Martin 5 Periodical cleansing was duly carried out. Wansey Street Soap Works Holder's Soap Works, Ltd. 3 Sanctuary Street Skin Dresser Leeding & Co. 2 24, Gt. Suffolk Street.—Passage floor renewed. Shop floor cleansed. There are no Cowsheds in the Borough. BUTTER AND MARGARINE FACTORIES. 4 inspections were made at the Butter Factory and 8 samples of butter were procured for analysis. They were all certified genuine. There are 17 wholesale dealers in margarine in the Borough. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 and 1927. 17 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. 115 POISONS AND PHARMACY ACT, 1933, AND ORDERS MADE THEREUNDER. During the year, 205 visits were paid to the various premises listed by the Council for the sale of Part 2 Poisons under the above Act. There are 80 names of persons on the Council's List of Sellers of Part 2 Poisons. During the year, 7 names of persons were newly entered on the list, 8 names of persons were removed, and one change of address entered. The following is a list of Poisons sold:— Kind of Poison Sold. No. of Premises. Remarks. Spirits of Salts 42 Ammonia 53 3 Registers have been provided as required for sale of certain Poisons. Phenols 70 Caustic Soda 25 Caustic Potash 2 Sulphuric Acid 4 Nitric Acid 2 Salts of Lemon 3 Arsenical Poisons 0 Mercurial Poisons 2 Nicotine 0 Barium 1 Hair Dyes 5 116 PUBLIC HOUSES. During the year, 172 Public Houses belonging to 7 Brewery Firms have been inspected. In these inspections attention was given to the structural condition of the business parts of the premises, the methods and appliances used in the conduct of the business, and, where catering was carried on, the condition of the kitchens, utensils, stores, etc. Considerable information has thereby been obtained. On the completion of the inspections of all the Public Houses belonging to each particular Brewery, the Owners have been notified of certain undesirable conditions existing at their various premises. Representatives of the Breweries have been interviewed and an undertaking received from them that the matters referred to would be given attention and remedied. There were other matters left in abeyance until the completion of the inspections of all the Public Houses in the Borough, when a common policy may be evolved after consultation with all the Brewers concerned, with the object of bringing about a general improvement in the conditions and conduct of the business and their premises. 117 SALE OF FOOD AND DRUGS AND OTHER ACTS. Name and Address of Vendor. Sample. Result of Analysis. Result of Proceedings. Emily E. Morgan (Mrs.), 7, Crampton Street — Filling and closing a bottle of Milk on unregistered premises Fined 10s. and 10s. 6d. costs. William A. Beagle, 9, Faunce Street Milk 4.5 per cent, added water Fined £1 and 10s. 6d. costs. Hannah Hoare (Mrs.), 37, Olney Road Milk 4.5 per cent, added water Fined £1 and 10s. 6d. costs. Martha Yeates (Mrs.), 184, Hillingdon Street Milk 6.5 per cent, added water Fined £1 and 10s. 6d. costs. Thomas H. Weatherstone, 127, Hillingdon Street Milk 6.5 per cent, added water Fined £1 and 10s. 6d. costs. Bertha B. Walker (Mrs.), 22, John Ruskin Street Milk 3.5 per cent, added water Fined £5 and £2 2s. costs. 118 SALE OF FOOD AND DRUGS ACT. During the year ended 31st December, 1,024 "official" samples were taken by the Inspector. 13 of these samples were certified as adulterated, a percentage of 1.3, as compared with 0.5 in 1936. Particulars of the samples taken, together with the results of the analyses are given in Table? 28 and 29. 119 FOOD AND DRUGS ACTS. TABLE 28. Return of Official Samples for the Year ending 31st December, 1937, showing the number taken, and the percentage of adulterated Samples for the year. FORMAL SAMPLES. Article. Number of Samples taken. Adulterated . "All-bran" 1 - Arrowroot 2 — Baking Mixtures 2 — Barley 4 — Barley Kernels 1 — Bicarbonate of Soda 8 — "Bisto" 2 — Black Pudding 1 — Blanc Mange Powder 4 — Boracic Crystals 1 - Boracic Powder 1 - Borax 4 — "Bospur" 1 — Brandy 7 — Brawn 10 — Breakfast Sausage 1 - Butter 68 — Cakes and Biscuits 19 — Cake, Bun and Pudding Mixtures 16 — Camphorated Oil 1 — Castor Oil 1 — Cheese 10 — Chocolates and Sweets 3 — Cocoa 19 — Coffee 6 — Compound Liquorice Powder 1 — Condensed Milk 17 — Corned Beef 2 — Cornflour 7 — Cream of Tartar 1 — Crushed Linseed 1 — Curry Powder 3 - Custard Powder 7 - Carried forward 232 - 120 Article. Number of Samples taken. Adulterated. Brought forward 232 - Desiccated Cocoanut 1 — Dripping 4 — Eucalyptus Oil 1 — Fish Paste 11 — Flaked Oats 1 — Flaked Rice 1 — French Coffee 4 — Fruit Crystals and Powders 2 — Gin 6 — Ginger Wine 1 — Glauber Salts 1 — Glycerine 1 — Grape Fruit Juice 1 — Gravy Thick 2 — Ground Ginger 1 — "Honey-grains" 1 — Improved Cornflour Mixture 2 - Jellies and Jelly Crystals 15 - Lard 21 — Lemonade Powder and Crystals 4 — Lentils 2 — Liver Sausage 1 — Liquid Paraffin 1 — Macaroni 4 — Margarine 54 — Meat Paste 1 — Milk 437 10 Mixed Spice 1 - Mustard Compound 1 — Mustard 7 — Oats and Oatmeal 3 — Olive Oil 1 — "Ovaltine'' 1 — Pasteurised Milk 30 2 Pea Flour 2 — Pearl Barley 3 — Pepper 2 — Preserved Sausage 3 — ' 'Quaker Oats'' 1 - Raspberry Crystals 1 — Rice 16 — Rice Custard 1 — Ruby Wine 1 — Rum 6 1 Carried forward 893 13 121 Article. Number of Samples taken. Adulterated. Brought forward 893 13 Sago 1 — Salt 3 — Sausages 15 — Seed Tapioca 1 — Self-raising Flour 17 — Semolina 3 — Senna Leaves 1 — Sherry 1 — Soups 14 — Spices and Condiments 22 — Suet and Flour 1 — Suet and Rice Flour 5 — Sugar 1 — Tapioca 12 — Tapioca Flakes 2 — Tartaric Acid 1 — Tea 17 — Tea Dust 1 — Veal Brawn 1 — Whisky 8 — Wine 4 — Total 1024 13 Percentage of adulterated samples for the year—1.3. 122 INFORMAL SAMPLES. In addition to the samples taken under the Food and Drugs Acts as shown in Table 28, 754 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 29. Article. Number of samples. Adulterated. Anti-Germ Ointment 1 - Arrowroot 9 — Aspirin Tablets 2 — Basilicon Ointment 1 — Blue Ointment 3 — Boracic Ointment 9 — Bread 3 — Butter 94 — Cakes and Biscuits 93 — Camphorated Oil 3 - Cane Syrup 1 — Canned Fish 10 — Canned Meat 2 — Canned Vegetables 4 — Castor Oil 3 — Chocolates and Sweets 26 — Cordials 4 — Cornflour 1 — Custard Powder 33 — Dripping 46 1 Eucalyptus Oil "Ex-lax" 3 — 1 — French Coffee 2 — Glycerine 1 — Golden Eye Ointment 1 — Gravo Thick, 1 — Gravy Thick, 2 — Ground Ginger 35 — Ground Rice 8 — Herbs 1 — Iodine Paint 1 — Jams 5 — Jellies and Jelly Crystals 2 — Junket Crystals 5 — Carried forward 416 1 123 Article Number of samples. Adulterated. Brought forward 416 1 Lard 43 Liquid Paraffin 1 — Malt Vinegar 1 — Margarine 10 — Menthol and Eucalyptus Gums 1 — Milk 53 — Mineral Waters 22 — Mixed Herbs 5 — Oats and Oatmeal 3 — Olive Oil 5 — Pea Flour 3 — Pepper 21 — Pepper Compound 1 — Preserved Sausage 5 — Rice 19 — Rice Custard Pudding 1 — Sage 6 — Salt 2 — Sauces 27 — Sausages 39 6 Self-raising Flour 1 — Soups 20 — Spices and Condiments 12 — Suet and Rice Flour 1 — Sugar 1 — Sulphur Ointment 4 — Sweet Herbs 1 — Tea 7 — Tincture of Iodine 4 2 Veal Stuffing 6 — Zinc Ointment 13 1 Total 754 10 Percentage of adulterated samples for the year—1.3. SECTION F. Prevalence of, and Control over, Infectious and other Diseases. 127 INFECTIOUS DISEASES. Apart from an epidemic of Influenza in the early months of the year which was responsible for 73 deaths, the Borough remained comparatively free from Infectious Diseases. The number of cases of Scarlet Fever and Diphtheria remained more or less stationary, and fortunately there were fewer deaths from these causes than usual. I find myself in the happy position of being able to report that there is nothing further worthy of note to be said regarding the incidence of Infectious Disease in Southwark. SMALLPOX. During the year under review no cases were notified. The number of cases notified during the last five years is as follows:— 1933 63 1936 - 1934 22 1937 — 1935 SCARLET FEVER. Three hundred and eight cases of this disease were notified during the year. The annual death-rate per 1,000 population for England and Wales was 2.33; for London, 2.09; 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. 1933 1,268 3 1934 748 5 1935 513 2 1936 352 — 1937 308 — 128 ENTERIC FEVER. Five cases of Enteric Fever were notified during the year. The number of cases notified and the number of deaths during the last five years were as follows:— Notified. Deaths. 1933 6 3 1934 — — 1935 3 — 1936 2 1 1937 5 — DIPHTHERIA. Three hundred and sixty-four cases of this disease were notified, with 8 deaths. The annual death-rate per 1,000 population was 1.49 for England and Wales; 1.93 for London; and 0.05 for Southwark. Antitoxin is supplied free of charge and 24 phials of 8,000 units have been supplied to Medical Practitioners in the Borough during the year. The number of cases notified and the number of deaths during the last five years were as follows:— Notified. Deaths. 1933 486 12 1934 600 21 1935 362 14 1936 338 9 1937 364 8 SCHICK TESTING AND DIPHTHERIA PREVENTION CLINIC. This Clinic is held every Thursday afternoon at Sutherland House. Dr. Fairfield Thomas is the Medical Officer in charge of the session. The number of patients tested and immunised during the year is set out in the following table:— 129 SCHICK CLINIC, 1937. Age Group. Primary Schick Test. Schick Test after 3 months. Number Tested. Reading of Test. Inoculation. Reading of Test. Immune. Susceptible. Miscellaneous. 1st without Primary S. Test. 1st. 2nd. 3rd. 4th. 5th. Number Tested. Immune. Susceptible. Miscellaneous. 0-5 17 2 15 4 175 23 186 193 2 1 195 188 — 5 5-14 59 6 31 7 31 42 68 70 — — 93 104 — 1 Adults 3 — 3 — — 4 4 3 — — 1 1 — — 79 8 49 11 206 69 258 266 2 1 289 293 — 6 130 MEASLES. The number of cases of this disease notified during the year was 176. Of these, 98 were under five years of age, and 52 were removed to hospital. Nineteen 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:— 1933 6 1936 23 1934 65 1937 1 1935 1 DIARRHOEA. This disease is notifiable during the months of July, August and September in the Borough of Southwark. During this period 1 case was notified. Deaths of infants under two years of age during the last five years were as follows:— 1933 32 1936 19 1934 39 1937 21 1935 25 131 INFLUENZA. The deaths from this disease during the last five years were as follows:— 1933 98 1936 18 1934 24 1937 73 1935 13 CEREBRO-SPINAL FEVER, ENCEPHALITIS LETHARGICA, AND POLIOMYELITIS. Eight cases of Cerebro-Spinal Fever were notified during the year, of which 5 died. Three cases of Poliomyelitis were also notified, which were sent to hospital. ACUTE PRIMARY AND INFLUENZAL PNEUMONIA. One hundred and sixty-five cases were notified during the year, of which 63 were removed to hospital. There were 20 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 1937 will be found hereunder:— 1933 288 1936 309 1934 269 1937 279 1935 284 Deaths from Cancer (1937). Site of Disease. Under 16. 16—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 1 1 1 — 2 2 20 3 35 8 47 9 15 11 122 35 Peritoneum, Intestines, Rectum, Bladder — — — — 2 — 3 1 4 4 12 5 11 11 4 6 36 27 Genital Organs - - - - - - - 7 - 8 2 4 1 6 3 4 6 29 Breast - - - - - - - - - 5 - 7 — 3 — 3 - 18 Other and unspecified organs - - - - - - - - 1 - - - 1 3 - 1 2 4 2 1 — 1 3 — 5 10 25 20 49 24 60 32 22 25 160 113 132 OPHTHALMIA NEONATORUM. Twenty-nine cases occurred during the year, as against 26 in 1936. An analysis of the cases will be found hereunder:— fied. Cases treated. Vision unimpaired. Vision impaired. Total Blindness. Deaths. At home. Hospital. 29 19 10 29 — — — 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. 133 TABLE 31. NOTIFIABLE DISEASES (other than Tuberculosis) during the year 1937. Disease. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- 85- Males. Females. Total Cases admitted to Hospital Total Deatns Scarlet Fever 6 109 105 41 19 12 9 5 2 - - - - 162 146 308 280 - Smallpox ___ __ Diphtheria 2 104 175 44 16 7 11 3 1 1 — — — 167 197 364 363 8 Memb. Croup — — — — — — — — - — — — — — — — — — Enteric Fever - - - - 1 - - - - - - - - - 1 1 1 — Paratyphoid — — 2 — 2 — — — - - — — — 2 2 4 4 — Puerperal Fever — — — — — 2 6 — - — — — — — 8 8 8 1 Puerperal Pyrexia — — — — — 7 7 1 - — — — — — 15 15 15 — Cerebro-Spinal Fever 4 1 1 — — 1 1 — - — — — — 5 3 8 8 5 Measles 25 75 59 9 4 — 3 1 - - — - - 95 81 176 71 1 Malaria - _ — — — — — - - Dysentery 4 10 3 1 2 3 1 - - - - - - 12 12 24 20 — Epidemic Diarrhoea 1 - - - - - - - - - - - - 1 1 — — Encephalitis Lethargica — — — — — — — — - — — — — — — — — — Pneumonia 5 20 14 4 16 22 12 22 23 18 5 4 — 92 73 165 63 20 Ophthalmia Neonatorum 29 - - - - - - - - - - - - 17 12 29 10 — Erysipelas 1 — 2 3 4 2 10 10 11 9 1 2 — 22 33 55 18 — Polio-Encephalitis - - - - - - - - - - - - - - - - - - Poliomyelitis 1 1 1 - - - - - - - - - 3 — 3 3 — Chickenpox - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - Totals 78 320 362 102 64 56 60 42 37 28 6 6 — 577 581 1161 864 35 134 DISINFECTION. The total number of disinfections of rooms during the year by the Council's disinfecting staff was 892. Of this number 749 rooms were disinfected after the occurrence of the ordinary notifiable infectious diseases, and .143 after cases of phthisis. 1,417 verminous rooms were sulphured and otherwise cleansed by the Council's staff during the year, as against 1,513 in 1936. Among the total number of disinfections (892) it w#,s found unnecessary to strip any rooms. TABLE 32. Bedding, etc., disinfected and destroyed after the occurrence of Infectious Disease during the year 1937. Articles. No. Disinfected. No. Destroyed. Beds 388 72 Palliasses 389 51 Bolsters 320 23 Pillows 732 79 Cushions 160 15 Blankets 1,694 15 Sheets 683 8 Quilts 666 14 Articles of Clothing, etc. 26,397 261 Books 285 — Total 31,714 538 6 cwt. 100 lbs. of horsehair and 64 lbs. of bristles were disinfected. 319 cwt. 19 lbs. of household effects were destroyed. RECEPTION HOUSE, KING JAMES STREET. The Reception House is maintained by the Council for the temporary accommodation of persons displaced from their homes whilst disinfection and disinfestation is in progress. The total number of families housed was 9, consisting of 14 persons. 135 TABLE 33. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. Summary of Notifications during the period from the 1st January, 1937, to the 31st December, 1937, in the Metropolitan Borough of Southwark. Notifications on Form A. Age-periods 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'rd8 Total Primary Notifications. Pulmonary Males 1 1 4 1 10 16 28 20 25 19 12 137 166 ,, Females — 1 3 4 14 19 23 7 9 4 4 88 109 Non-Pulmonary Males.. 1 — 5 3 4 3 3 3 3 — 1 26 29 ,, ,, Females — 2 2 3 2 3 3 5 — 1 1 22 25 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. 136 TABLE 34. 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, 1937, to the 31st December, 1937, 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 1 45-55 55-65 65 & upwards Total Cases Pulmonary Males - - - - - 1 5 3 4 1 — 14 ,, Females — 1 — — — 2 4 1 — 1 — 9 Non-pulmonary Males — — 1 — 1 — — — - 1 — 3 ,, ,, Females - - - - - 1 1 1 — — — 3 137 DEATHS FROM PULMONARY TUBERCULOSIS. TABLE 35. Shewing the number of Patients who died in their own homes and the number who died away from home in Hospitals or other Institutions, 1937. 0- ]- 2- 5- 15- 25- 35- 45- 55- 65- 75- All Ages. Males. Females. Total. Number of patients who died at home — — — — 9 7 4 2 8 2 — 16 16 32 Number of patients who died iu hospitals, etc. — — — — 9 15 17 13 17 13 — 59 25 84 — — — — 18 22 21 15 25 15 — 75 41 116 Of the total number of deaths from Pulmonary Tuberculosis 70.0 per cent. occurred in hospitals or other institutions. 138 TABLE 36. TUBERCULOSIS. Age Periods. New Cases.* Deat hs. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. 0 1 1 - 1 1 2 2 — — 5 12 13 — 2 15 59 12 18 4 25 51 6 22 3 35 27 8 21 1 45 34 3 15 — 55 23 1 25 1 65 and upwards 16 2 15 1 Total 225 48 116 13 (1) The ratio of non-notified tuberculosis deaths to total tuberculosis deaths is nil» 139 The number of notified cases and deaths for the last five years is as follows:— Notified. Deaths. 1933 285 172 1934 339 142 1935 253 130 1936 217 126 1937 225 116 The mortality rate was 0.80 per 1,000, as against 0.81 per 1,000 in 1936. 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 37. Notification Register. Pulmonary. Non-Pclmonaky. Total Cases. Males. Females. Total. Males. Females. Total. Number of cases of Tuberculosis remaining at the 31st December, 1937, on the Registers of Notifications kept by the Medical Officerof Health of the Metropolitan Borough 609 328 937 149 140 289 1226 Number of cases removed from the Register(s) during the year by reason inter alia of:— 265 155 420 75 55 130 550 (1) Withdrawal of notification 29 20 49 3 2 5 54 (2) Recovery from the disease 52 35 87 40 25 65 152 (3) Deaths 75 41 116 6 7 13 129 (4) Otherwise 109 59 168 26 21 47 215 140 Disinfection was carried out as follows:— TABLE 38. 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 15 13 15 25 15 8 20 16 16 143 WORK OF THE TUBERCULOSIS DISPENSARY. The following report has been received from Dr. E. K. Pritchard, your Clinical Tuberculosis Officer :— In August, 1937, the Dispensary was transferred from 82, Newington Causeway, to the ground floor of the Health Services Department. The improved accommodation and equipment has made it possible to increase the scope of the work done by the Dispensary, and already there has been a marked increase in the attendances especially of cases sent to the Dispensary by their own doctors for an opinion on their chest condition. The times for sessions for patients are unchanged and are as follows:— Monday Tuesday 9.30 a.m. to Tuesday 6 to 8 p.m. Wednesday 12 noon. Thursday Thursday Saturday 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). 141 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. 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 continues to act as 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 154. Th:s 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. 348 patients were sent up by general practitioners for an opinion during the year. During this, the second year of its installation, the X-Ray plant has given even more useful service, and it is felt that the X-Ray plant has done a great deal towards the Dispensary now being recognised as the diagnostic centre for chest conditions in this Borough. 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 476. Of this total 149 were positive and 327 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 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 10 Mantoux Tests have been carried out on children. 142 X-RAY DEPARTMENT. When the Dispensary moved to the Health Services Department in August, 1937, the X-Ray plant which was installed in February, 1936, was transferred to the new building. In the process of reassembling, the whole apparatus was inspected and was found to be in excellent condition, and there was no need for any repairs beyond the usual service. 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 XRayed 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 also acquired a small attachment for the existing X-Ray tube which makes it possible to do Dental X-Ray, and this proves of considerable help to the Dental Officer. 1,040 patients have been screened and 653 photographs taken during the year. 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. 143 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 oases 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 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. 144 The following cases were recommended to the London County Council for Institutional treatment during the year :— Adults. Under 15 years. Hospital for Observation 17 11 Sanatorium 133 16 Hospital 77 5 Convalescence — 3 Open Air School — 6 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 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. During 1937, 801 refills have been given to 46 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 each week. 88 injections of Gold have been given to 10 selected patients at the Dispensary with most satisfactory and encouraging results. 145 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 requiring Actinotherapy are now referred for treatment in the Solarium of the Health Services Department, instead of being sent to General Hospitals as in the past. This scheme has the advantage that it is more convenient for the Tuberculosis Officer to maintain supervision over these patients. 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. The class is held each Tuesday afternoon and each Friday morning, under the tuition of an Instructress from the L.C.C. At the end of 1937, there were 22 patients on the Class Register, with an average weekly attendance of 17. In September, 1937, it was decided to extend the activities of the class to woodwork for the male patients. We are lucky in having the services of a voluntary Instructor who attends on Thursday evenings. The men are showing great keenness and the quality of the work done is most satisfactory considering the short time the class has been in existence. 146 DENTAL TREATMENT. The arrangements with the British Dental Hospital continue to prove very satisfactory and Mr. G. E. King Turner, L.D.S., H.D.D., attends the Clinic 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. It 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 510 attendances at the Clinic and the dental work done includes—Extractions, Gas Administrations, Fillings, Scalings and Dentures. 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. 118 patients have been granted extra nourishment at the expense of the Borough. 147 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 prevent ion 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 10 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 no 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. 148 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 9 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. 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 4,680 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. 149 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. 150 I have received the following report from Miss L. Ashe, Hon. Organiser TUBERCULOSIS CARE COMMITTEE. In presenting our Report for 1937, we feel we must mention the great event which occurred last September in the opening of the new Health Services Department in Walworth Road. It concerns this Committee inasmuch as it deals with the same people, who now have facilities available to receive the most up-to-date treatment combined with every comfort and convenience while waiting for it. It contains a spacious, airy, up-to-date Tuberculosis Dispensary. The Tuberculosis Care Committee have continued with little change. It consists of the Tuberculosis Officer, three nurses from the Dispensary, two representatives of the Borough Council, two of the Public Assistance Committee, and the remainder represent the various social and charitable organisations in Southwark. We meet weekly, and the Committee is a live one, thie cases being well known to many of its members, who are also encouraged to bring up special cases which have come to their notice for help and advice. Our work is to act as supplement to the medical services of the Borough; to see that no one under their care is suffering privation, and, when the patient is in hospital or sanatorium, do everything possible to ensure that his or her family is cared for so as not to cause anxiety for their welfare. The funds available for use by the Committee are too small to carry out schemes of help, so that much of our work consists of interesting various charitable agencies and getting them to render the substantial assistance needed. During 1937, 201 appeals were made, either personally or by letter, to 26 agencies and individuals, viz :— Our Own Tuberculosis Care Committee. The Charity Organisation Society. Soldiers' and Sailors' Help Society. British Legion and United Services Fund. Queen Mary's Needlework Guild. Invalid Kitchens for London. Society for Relief of Distress. Friends of the Poor. National Society for Prevention of Tuberculosis. National Union of Printers and Bookbinders. Actors' Benevolent Society. Red Cross Emergency Committee. Charing Cross Hospital Benevolent Fund. John Bull War Sufferers Fund. 151 General Workers' Union. Rockingham Estate Office. North Lambeth Approved Society. St. Patrick's Benevolent Society. Royal Air Force Memorial Fund. Queens R. Regiment Old Comrades Association. Royal Field Artillery War Commemoration Fund. East Surrey Regiment Old Comrades Association, and several individuals. The Committee work in close co-operation with the Invalid Children's Aid Society, who take entire charge of our children's oases, and cooperate with our Tuberculosis Officer in arranging for the removal of children of patients suffering from tuberculosis to homes under the London County Council Contact Scheme, to keep them free from infection, or to be cared for in their mother's absence. Members of our Committee were very busy on Queen Alexandra Rose Day. Our Chairman (Mrs. E. Saunders) had a depot, and she and helpers collected a record sum. We wish heartily to thank the Fund for its continued help in sending us a donation of £10. Special thanks are due to Queen Mary's Needlework Guild who have again sent us a parcel of really useful and tasteful articles—just what are wanted for people in sanatorium, or returned from them unable to work. One mother said, on seeing what we had provided her daughter with, " It looks more like a wedding trousseau than a hospital outfit." We are very grateful for the support given by the Mayor and Councillor Mr. C. J. Mills, who contributed £15 to the joint fund of the Handicraft Centre and the Tuberculosis Care Committee. Our Hon. Organiser was fortunate this year in selling £20 of her sketches. Now what we do with all this money in addition to the help obtained from the societies mentioned. We have many destitute men and a few women who have no National Insurance, or who have run out of it; Women whose husbands are out of work, and all they have is needed for keeping up the home, or young boys and girls whose parents are in too poor circumstances to send them anything. All these would have a sad time in hospitals and sanatoria without a little pocket-money—it makes all the difference. To enable them to take their part in what is going on, and to keep themselves in cigarettes, stamps, newspapers, etc. We are at present sending pocketmoney to 28 patients, and with the exception of 7 cases helped by some of the agencies we have appealed to, the rest comes from our Tuberculosis 152 Car© Committee Fund. It is administered by the Medical Superintendent of the Sanatoria and the Almoner of the Hospitals, and we wish to express our thanks for the kind interest and trouble they take in doing so. One destitute orphan boy of 18, writes, "It is kind of you to take such a welcome interest in me, and I will never forget it.' We are also called upon to pay fares, mothers and wives especially anxious to see their relatives, and get letters pressing them to come, but the fares are beyond their small means. This we give from our Fund, with a little extra to take something for the patient. We had one urgent appeal for the fare home from one young man to whom a week-end was offered by the Medical Superintendent. "You can realise what I feel in not seeing my home for three months, but I have no money. Can you get me out of this ghastly fix?" The fare was sent him, and he had a very happy week-end in one of the poorest streets of Southwark, with his father out of work, but his mother assured me all had gone off well, and he returned "all the better for it." The same boy, notwithstanding his longing for a visit home, said the sanatorium was splendid—good food and every care were given him. We often come across people who assure us that their approved societies have ceased paying them sickness benefit, and with the kind and skilled help of Mr. Dorling, who represents approved societies on our Committee, this can often be put right, and a sum given for pocketmoney while they have institutional treatment. The rest is either paid to relatives or kept until their discharge. To get the sickness benefit, arrears have often to be paid up. The Charity Organisation Society have done this in several cases, and when the amount is small we pay it from our Fund. In the case of ex-service men, help in this connection is obtained through the Soldiers' and Sailors' Help Society. Our Handicraft class is now established in a large convenient room in the Health Services Department. The pupils, men and women, numbering 18. Mrs. Bridgeman continues her very able tuition, and they now meet twice a week. In addition to this, they have now the very able voluntary help of Mr. Charles Grey who conducts an evening class for the men in woodwork. An Exhibition and Sale was held in December. The Mayor (Mrs. Tidy) opened it and gave practical appreciation of the contents of the stalls by purchasing many exhibits. It was a really good exhibition—of embroidery, leather work, gloves, rugs, trays, as well as the new woodwork, tea trolleys, egg stands, stools, etc.—which formed a ready sale, realising £28. 153 I am sorry to announce that our Hon. Organiser, Mrs. Ollard, to whose zeal, patience, tact and energy much of the growth and success of the class was due, had to resign at Christmas owing to domestic circumstances. Mrs. Ollard received very grateful thanks from all. To end, we must say that our work, although of necessity is sometimes sad, has its bright and encouraging signs as we realise that tuberculosis is decreasing, and that the skilled care of our Public Authorities is bearing fruit. May we not feel that our efforts on the social side may, in a small way, be helping on this result? L. ASHE, Hon. Organiser. March, 1938. 154 TABLE 39. Return for the year 1937. (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 (b) Diagnosis not completed (c) Non-tuberculous 63 37 97 54 21 83 2 13 10 5 4 3 10 6 5 2 5 2 1 73 37 97 60 21 83 7 15 10 10 6 4 150 79 194 b.—Contacts examined during the year:— (a) Definitely tuberculous (b) Diagnosis not completed (r) Non-tuberculous 4 9 52 2 12 91 3 59 3 64 — — 1 1 4 1 4 9 52 2 12 91 1 4 59 3 4 65 10 29 267 C.—Cases written off the Dispensary Register as:— (a) Recovered (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) 15 150 8 174 3 72 3 68 3 1 4 7 9 3 18 151 12 174 10 72 12 71 52 468 D.—Number of Cases on Dispensary Register on December 31st: — (а) Definitely tuberculous (b) Diagnosis not completed 261 46 145 33 19 16 34 4 18 23 14 3 12 6 279 46 168 33 S3 19 46 10 526 108 1. Number of cases on Dispensary Register on January 1st 613 2 Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 49 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 155 4 . Cases written off during the year as Dead (all causes) 82 5. Number of attendances at the Dispensary (including Contacts) 4782 6 . Number of Insured Persons under Domiciliary Treatment on the 31st December 54 7. Number of consultations with medical practitioners:— (а) Personal (б) Other 22 348 8 . Number of visits by Tuberculosis Officers to homes (including personal consultations) 198 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3777 10 . Number of :— (а) Specimens of sputum, etc., examined (b) X-ray examinations made in connection with Dispensary work. 510 1693 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 12 . Number of '' T .B. plus" cases on Dispensary Register on December 31st 303 (B) Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment). Provided by the Council—One. INDEX A. Page. Abatement of Overcrowding 61-65 Acute Influenzal Pneumonia 131 ,, Primary Pneumonia 131 Additional Maternity Services 25-28 Agricultural Produce (Grading and Marking) Act, 1926 83 Ambulance Services 23 Analysis of Port Sanitary Samples 86-95 Ante-Natal Clinics 30, 31, 32 Area of Borough 7 Artificial Cream Act, 1929 114 B. Bacon Stoves 82 Bacteriological Specimens 23, 110 Bakehouses 52, 112, 113 Bed Bugs, Eradication of 56 Births 9, 10, 15 ,, Illegitimate 7, 13 Birth Rates 7, 9,10 Black Smoke 46 Blind Persons Act. 1920 132 Brushmakers 51 Butchers' Shops 79 Butter and Margarine Factories 114 C. Cancer 131 Carcases Inspected and Condemned 85 Census, 1931 8 Cerebro-spinal Fever 131 Chemical and Bacteriological Examinations 23, 110 Child Life Protection 28, 29 Clinics 30, 31 Common Lodging Houses 42 Compensation to Midwives 26 Consultants 26 Convalescent Treatment 27 Coroners' Court 58 Country Holiday Fund 26 Cowsheds 114 D. Dairies 111 Day Nurseries 22, 28 Deaths 11, 15 Deaths, Causes of, Table 12 ,, Infants 13,14, 25 ii Page. Deaths, in Public Institutions 11, 16, 18 ,, in Wards 10 ,, Zymotic Mortality 18 Death Rates 7, 14 Dental Treatment 146 Diarrhoea 130 Dinners for Necessitous Mothers 27 Diphtheria 128, 133 ,, Prevention 128 ,, Schick Test 128-129 Disinfection 134, 140 Disposal of Unsound Food 96-107 Dressmakers, Milliners, etc. 52 E. Eating Houses 52 Encephalitis Lethargica 131 Enteric Fever 128, 133 Eradication of Bed Bugs 56 F. Factories and Workshops 50. 52 Fish Curers Premises 82 Food and Drugs, Tables of Samples 119-123 ,, ,, ,, (Adulteration) Act, 1928 114 Food Inspection and Tables 79-123 Fried Fish Premises 81 G. General Hospitals 32 Gynaecological Clinic 32 H. Health Services Department 3, 24 Health Services, Hospitals, Etc. 23 Health Visiting 34, 35, 36 Health Visitors, Summary 22 Home Helps 26 Home Nursing 23, 25 Home Workers 50, 51 Houses Let in Lodgings 46 Housing 66-76 I. Ice Cream 52, 79, 80 Imported Food Regulations 83, 85 Infant Mortality 13, 14, 25 ,, ,, of Illegitimates 13 ,, Test Feeding Clinic 32 iii Page. Infectious Diseases, Control of 127-154 Influenza 131 Informal Samples 122 Inhabited Dwellings 7 Institutional Provisions 28 ,, Treatment of Tuberculosis 142 L. Laboratory Facilities 23 Laundries 52 Legal Proceedings 44, 45,117 M. Maternal Mortality 25 Maternity and Child Welfare 24, 38 Measles 130 " Merchandise Marks " Act, 1926 82 Milk and Dairies (Amendment) Act, 1922 109 ,, (Special Designations) Order, 1936 110 Milksellers 109 Mortality Statistics 7,10-18,25 Mortuary 58 Municipal Day Nursery 28 N. Notices served 43, 110 Notifiable Diseases 133 Notified Births 37 Nursing in the Home 23 O. Occupational Therapy 145 Offensive Trades 114 Ophthalmia Neonatorum 132 Orthopaedic Clinics and Treatment 27 Outlying Deaths 11 Overcrowding 61-65 P. Part-time Officers 22 Phosphatase Examinations 110 Poisons and Pharmacy Act, 1933 115 Poliomyelitis 131 Population 7, 8 Puerperal Fever 25, 133 ,, Pyrexia 25, 133 ,, Sepsis, Deaths 25 Public Baths 41 ,, Cleansing 41 iv Page. Public Health (London) Act, 1936 Sec. 224 48 ,, ,, ,, ,, ,, Sec. 187 79 ,, ,, ,, ,, Sec. 136 48 ,, ,. Sec. 95 49 ,, ,, ,, ,, ,, Sec .96 49 ,, ,, Officers 21 ,, ,, (Condensed Milk) Regulations 1923 and 1927 114 ,, ,, (Dried Milk) Regulations, 1923-7 114 ,, ,, (Imported Food) Regulations, 1925, 1933 83 ,, ,, (Preservatives in Food) Regulations, 1925 86-95 ,, Houses 116 ,, Vaccinators 22 R. Rateable Value 7 Rats and Mice (Destruction) Act 53, 54, 55 Reception House 134 Registered Births and Deaths 15 Workshops 50 Review of Housing Activities 66, 67 S. Sale of Food and Drugs Acts 117-123 Scabies 58 Scarlet Fever 127, 133 Schick Test and Inoculation against Diphtheria 128-129 Sewing Classes 27 Shops Act 44 Skilled Nursing 25 Slaughterhouses 79 Smallpox 127. 133 Smoke Abatement 46 Southwark Invalid Kitchens Society 27 Sputum, Examination of 23 Statistics and Social Conditions 7 Still Births 7 Sunlight Treatment 27 Swimming Bath Water 41 T. Tailoring 51.52 Tenement Buildings 74 Toddlers' Clinic 25 Tuberculosis 135-154 ,, Care Committee Report 150 V U. Page. Underground Bakehouses 52, 112 Unsound Food 96-107 V. Vaccination Officers .. 23 ,, Officers' Return 38 Verminous Persons and Children 58 ,,, Rooms and Bedding 57 Vital Statistics, Summary of 7 ,, ,, Table 17 W. Water Supply 49 Whooping Cough 130 Works Completed 43, 76, 111 Workshops (Women's) 52 X. X-Ray Department 142 Z. Zymotic Mortality 18