AC 4367 Metropolitan Borough of Stepney ANNUAL REPORT For the Year 1038 OF THE Medical Officer of Health Administrative Tuberculosis Officer F. R. O'SHIEL, L.R.C.P.I., L.M., D|.H., REPORT OF THE PUBLIC ANALYST. Metropolitan Borough of Stepney ANNUAL REPORT For the Year 1938 OF THE Medical Officer of Health and Administrative Tuberculosis Officer F. R. O'SHIEL, L.R.C.P.I., L.M., D.P.H., together with the REPORT OF THE PUBLIC ANALYST. Vaij. & Co., Ltd Printers to the Council, 170, Farringdon Road, E.C4 2 PUBLIC HEALTH COMMITTEE (November, 1937, to October, 1938.) Ex-Officio : His Worship the Mayor (Councillor J. J. A. Long, J.P.) Chairman : Councillor (Mrs.) A. P. Bunn Vice-Chairman : Councillor J. L. Fine, J.P. Alderman H. F. Kober Alderman (Mrs.) G. E. IsawDer Alderman (Mrs.) E. M. Sinclair Councillor R. Askew Councillor (Mrs.) K. O'Connor ,, (Mrs.) C. Aylward „ G. Pendley „ (Miss) E. M. Prown „ P. Piratin „ (Mrs.) L. Frankel „ J. Sambrook „ G. Jacobs ,, (Mrs.) S. Spicer „ (Mrs.) A. M. Jolly ,, L. Tanaman „ (Mrs.) A. Kemp „ (Mrs.) A. Taylor „ (Mrs.) H. Long s MATERNITY AND CHILD WELFARE COMMITTEE. (November, 1937, to October, 1938.) Chairman : Councillor (Mrs.) K. O'Connor. Vice-Chairman : Councillor (Mrs.) C. Aylward. The Members of the Public Health Committee. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT on the 31st December, 1938. Medical Officcr of Health and Administrative Tuberculosis Officer: F. Roantree O'Shiel, l.r.c.p.i., l.h., d.p.h. (Liverp.) Deputy and Assistant Medical Officer of Health : E. j. O'keeffe, b.a., m.r.c.s., l.r.c.p., d.p.h. Public Analyst: D. Henville, f.i.c. Analytical Assistant: W, M. Paulley, b.a., f.i.c. Sanitary Inspectors : District. W. E. Anstee. (1, 3) If. J. Green. (1, 2, 4) J. Keniry. (3) J, H. Brownlee. (1, 3, 4) Temporarily in charge of S. S- Lowther. (3, 4) J. J. Coveney. (3) disinfestation. J. G. McCarthy. (3) W. Cue. (1, 3) C. F. Guy. (2) R. Roper. (3, 4) R. W. G. Day. ( 3) W. H. Haworth. (3) W. F. Smith. (2, 4) ] G. D. Freeland. (1, 3, 4) I W. H. Howard. (1, 3) W T. Twynham. (2) Food. H. Abson. (f, 2, 4) T. W. Dee (2, 4) A. C. Brown. (2, 4) S. Vogler. (3, 4) Other G. Bottomley. (1, 2, 4) Housing and Canal Boats. E. J. Edwards. (2. 4) fn charge of disinfestation. Seconded as Anti Gas Instructor for A.R.P. fMiss H. A. Whitty. Disinfestation and Female Common (3, 4, 5, 6, 8) Lodging Houses. Clerical Staff: W. F. Lellow, Chief Clerk (2) R. Bach. W. E. Hart. H. F. Matm). Miss G. Boulton. (m. &c.w.) Mrs. H. Hiles. (m. & c.w.) M. Pliskin. Miss G.A.Carthy. (m.&c.w.) W.P.Howard. Miss P. RDmaine. W. J. Dixon. Miss M. W. Hunt, (m.&c.w.) (m.&c.w.) S. Embleton. C. H. Lowry. E. P. Simpson. (3) Miss M. Fitzgerald. J. G. Lyons. E. P. Webber. (3) (4) (m. & C.w.) J. McMuClon. (Temporary Sanitary MissR. Frankel. (m.&c.w.) R. Mahoney Inspector). Vaccination Officers : E. Price. (3) E. J. Robertson. Medical Officers for Maternity and Child Welfare (Part Time); Norah Cotter, m.b., b.ch. Margaret Emslie, m.b., ch.b. Doris M. Pullen, m.b., Ch.b. Margaret Ward, m.b., Ch.b., d.p.h. tHealth Visitors : Miss M. Bailey. (5,6,7) Miss E. Clements. (5, 6) Miss A. E. Gibbs. (5, 6) „ D. E. Blackmore. (5, 6, 7) „ A. Clifford. (5, 6, 7) „ M. F. E. Styles. ,. W. Brazier. (6, 7) „ A. M. Cordwell. (1, 6,8) (5, 6, 7) „ A. Carty, (5, 6, 7) „ S. Foucar. (2, 5, 6, 7) Tuberculosis Officer : J. W. Crawford, m.d„ m.b., b.ch., d.p.h. Assistant Tuberculosis Officer: R. M Orpwood, m.r.c.s., l.r.c.p, d.p.h. Tuberculosis Visitors : Miss M. C. Hurley. (5, 6, 7) Miss M. Prickman. (5, 6, 7) „ E. Lindsley. (7) „ M. F. Weatherilt. (5, 6, 7) Nurse Dispensers : Miss M. Coulman. (5, 6, 7, 9), Miss A. O. Jones. (7, 8, 9) Clerk and Secretary to Care Committee : Miss M. Grant. Clerks : Miss O. M. Chapman and Miss P. Goldsmith. Consulting Gynecologist : R. Christie-Brown, M.B., M.S., F.R.C.S. Dental Surgeon (part-time) : f. L. Payne, L.D.s. Anesthetist (part-time): M. J. O'Toole, m.b., b.ch., b.a.o. . Diphtheria Immunisation: W. W. King-Brown, m.b., b.s. (lon.) Part time Medical Officer. Guy Bousfield, m.d., b.s. (lon.) Hon Advisory Expert. 1. Certificate Royal San Inst. 5. Health Visitors Certificate. 2. „ San. Insp Exam. Bd. 6. State Certificated Midwife. 3. ,, Royal San. Inst, and San. Insp. 7. State Registered Nurse. Exam. Joint Board. 8. Trained Nurse. 4. „ Meat and Other Foods. 9. Certificate Soc. of Apothecaries † Also Child Protection Officers. 4 Public Health Department, 43, White Horse Road, Stepney, E.l. 30th June, 1939. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Your Worship, Ladies and Gentlemen, I have the honour to submit to you my Annual Report on the health and sanitary conditions of the Metropolitan Borough of Stepney for the year 1938. The statistics for the year under review show that the infantile mortality rate is one of the lowest on record in the Borough, viz., 62.2 per 1,000 live births. The maternal mortality rate was 2.22 per 1,000 live and still births. There were six maternal deaths. Infectious disease notifications numbered 2,235. The biennial measles epidemic occurred this year and accounts for 844 of the above cases, and whooping cough for 102. Up to the 30th September measles was notifiable in children up to 5 years of age only, and whooping cough was not notifiable. After that date both measles and whooping cough were made notifiable at all ages. Were it not for these alterations in notification and for the biennial measles epidemic, the total number of infectious diseases notified would have been 146 less than last year. There were 244 fewer cases of diphtheria and 9 deaths from the disease, and 13 fewer cases of scarlet fever with 2 deaths from the disease. There was no smallpox. One case of anthrax occurred and one of undulant fever, and both recovered. Forty-one cases of dysentery occurred with no deaths. The cases were mostly of the mild Sonne type which was common in the Borough last year and often not diagnosed owing to its mild nature. There were 43 fewer deaths from tuberculosis. A small group of typhoid cases occurred in the Borough in the latter part of 1937 and the earlier part of this year, causing some little anxiety for a time, but precautionary measures were early adopted of a sufficiently comprehensive nature and the cases were limited to 11 with no deaths. One case which died in 1937 appeared to be connected with some of the 1938 cases. ***** The Registrar General estimates a fall in the population of the Borough of 2,600. The Birth Rate was 13.06 compared with 13.5 last year, and the Death Rate 11.05 compared with 12.2. ***** Dr. E. J. O'Keeffe resigned from the position of Deputy Medical Officer of Health on the 31st December, 1938. Dr. J. W. Crawford, who commenced 5 duty with the Council in 1937, was promoted to Tuberculosis Officer on 29th June, 1938, and succeeded Dr. O'Keeffe to the post of Deputy Medical Officer of Health on the 22nd February, 1939. Dr. R. M. Orpwood was appointed Assistant Tuberculosis Officer on the 2nd November, 1938. * * * * * Legislation passed during the year included the Food and Drugs Act, 1938, and the Increase of Rent and Mortgage Interest (Restrictions) Act, 1938. The Factories Act, 1937 came into force during the year. This is an important consolidating Act, superseding the Act of 1901, and various other enactments. The County of London (Measles and Whooping Cough) Regulations 1938 came into force on 1st October. * * * * * The report of the Public Analyst records the results of continued activity in the pursuit and prosecution of food offenders. Many persons were prosecuted and fined for selling rolls and margarine as "rolls and butter." This practice was fairly common in the Borough, and it is hoped that it will now cease. The Analyst's comments on cream cheese and artificial vinegar are also deserving of attention by the public. I have been much concerned by the poor quality of some of the poultry sold in the Borough, especially old fowls, known as "boilers." There is no doubt that the demand for cheapness is being satisfied at the expense of quality. The attention of the food inspectors has revealed that these poor quality fowls frequently show obvious evidence of tuberculosis in the livers and intestines, and, though this tuberculosis is not communicable to man, such fowls are unfit for food. * * * * * Housing activity during the year included two Compulsory Purchase Orders and four Clearance Orders made by the Borough Council, which were confirmed at the Ministry of Health's Inquiry without modification ; and two Clearance Orders were made by the London County Council. 620 cases of Overcrowding were abated. The " appointed day" under the Housing Act 1936 will not be reached in Stepney until 1st July, 1939. ***** The European Crisis occurring in the last week of September and the general disturbance caused thereby made itself felt here as everywhere, and as the brunt of the A.R.P. services, at the time, fell on the staff of the Council, normal duties were seriously interfered with. Though normality was restored for a time after the September crisis, steadily increasing responsibility and work are being placed upon the department in organising the A.R.P. Casualty Services for the Borough, and it appears likely that this will continue for many months to come. Finally, may I express my thanks to the Committees for their support and to the staff for their helpful co-operation during the year. I am, Your Worship, Ladies and Gentlemen, Your obedient servant, F. R. O'SHIEL, Medical Officer of Health. 6 SUMMARY OF STATISTICS, 1938. Area of Borough (in acres) 1902.766 Population (Registrar-General's estimate) 200,500 Number of inhabited houses (end of 1938) according to Rate Books 36,744 Rateable value, 1938 £1,710,020 Sum represented by a penny rate £6,804 Total. Male. Female. Legitimate 2,502 1,293 1,209 Birth Rate per Live Births Illegitimate 117 65 52 1,000 of the mated resident Total Live Births 2,619 1,358 1,261 population 13.06 Still Births 82 41 41 Rate per 1,000 total (live and still) births 30.3 Total Births 2,701 1,399 1,302 Deaths 2,217 1,218 999 Death rate per 1,000 of the estimated resident population 11.05 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List) Rate per 1,000 Deaths total (live and still) births. No. 29 Puerperal sepsis 3 1.11 No. 30 Other puerperal causes 3 1.11 Total 6 2.22 Death rate of Infants under one year of age:— All infants per 1,000 live births 62.2 Legitimate infants per 1,000 legitimate live births 60.7 Illegitimate infants per 1,000 illegitimate live births 94.0 Deaths from Cancer (all ages) 343 „ „ Measles (all ages) 17 ,, „ Whooping Cough (all ages) 13 „ „ Diarrhœa (under 2 years of age) 46 I.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Population.—The estimate of the Registrar-General to the mid-year 1938 is 200,500. Births.—The total number of live births of Stepney residents during the year was 2,619—1,358 males and 1,261 females—or 140 less than in the previous year. The birth-rate was 13.06 per 1,000 of the population. 7 Births in Public Institutions in the Borough. 4,150 births occurred in Public Institutions in the Borough of which 1,696 belonged to Stepney and 2,454 belonged to other Boroughs. 1,254 births occurred in the East End Maternity Hospital:— 306 belonged to Stepney, and 948 to outlying Districts. 1,019 births occurred in the London Hospital:— 399 belonged to Stepney, and 620 to outlying Districts. 350 births occurred in the St. George-in-the-East Hospital:— 238 belonged to Stepney, and 112 to outlying Districts. 968 births occurred in the Mile End Hospital:— 606 belonged to Stepney, and 362 to outlying Districts. 556 births occurred at 24, Underwood Road:— 145 belonged to Stepney, and 411 to outlying Districts. 1 birth occurred in the London Jewish Hospital which belonged to an outlying District. 2 births occurred in St. Peter's Hospital, both belonged to Stepney. Births in Outlying Districts.—151 births occurred outside the Borough, the parents being residents of Stepney. Twins.—39 sets of twins were born in the Borough during the year: 30 sets were live births. 4 sets were still-born. 5 sets were 1 live birth and 1 still birth in each case. and 1 set of Triplets. The latter were girls. The Notification of Births Act applies to the notification of any child which is born after the 28th week of pregnancy whether alive or dead. The net number of births notified under the Act was as follows:— Live Still Births. Births. (a) In Institutions 1,976 68 (b) At home:— Notified by doctors and parents 41 - „ private midwives 33 „ doctors and midwives from Institutions 620 8 2,670 76 Marriages.—The total number of marriages which took place during the year was 2,117, or 124 less than in the previous year. The proportion of persons married was 21.1 per 1,000 of the population. 8 Deaths.—The total number of deaths, after deducting deaths of nonresidents who died in the Borough and adding those residents who died in Outlying Institutions was 2,217—1,218 males and 999 females—or 262 less than in the previous year. The death-rate for the whole Borough was 11.05 per 1,000 of the population. Deaths in Public Institutions in the Borough.—2,136 deaths occurred in Public Institutions in the Borough, of which 1,212 belonged to Stepney and 924 belonged to other Boroughs. Belonging Belonging to to Stepney, other Boroughs. East End Maternity Hospital, Commercial Road 2 14 Princess Elizabeth of York Hospital for Children, Shadwell 14 50 London Hospital, Whitechapel Road 120 556 London Jewish Hospital, Stepney Green 45 36 Mile End Hospital, Bancroft Road 482 52 St. George's Hospital, Raine Street 227 83 St. Peter's Hospital, Vallance Road 318 118 Sick Room Help Society, 24, Underwood Road 1 5 Stepney Institution, South Grove 3 10 Deaths in Outlying Districts.—There were 466 deaths of persons belonging to the Borough in various Institutions outside the Borough Mental Hospitals 92 Hospitals for Infectious Diseases 56 Hospitals and Institutions 318 In addition there were 15 deaths of Stepney residents in private houses outside the Borough. Public Assistance and Unemployment.—The Chief Officer of Public Assistance and the Ministry of Labour have kindly supplied me with the following information:— (a) Stepney residents in receipt of out-door relief :— Children 1938. Men. Women, under 16. Total. 8th January 1,351 2,120 1,256 4,727 31st December 1,357 2,081 1,023 4,461 (b) Number of insured persons aged 16 to 64 years resident in Stepney who were recorded as unemployed at Employment Exchanges:— Total. 17th October, 1938—8,475 males 1,559 females 10,034 16th January, 1939—9,147 „ 2,510 „ 11,657 II.—GENERAL PROVISION OF HEALTH SERVICES. Changes in Staff.—The following changes in the staff took place during the year:— Dr. E. J. O'Keeffe, Deputy and Assistant Medical Officer of Health, resigned on the 31st December to take up a position elsewhere. 9 Dr. Harley Stevens, Senior Tuberculosis Officer, resigned on the 16th April to take up a position elsewhere. Dr. J. W. Crawford was appointed Tuberculosis Officer and Assistant Medical Officer of Health on the 29th June. He was afterwards promoted to the position of Deputy and Assistant Medical Officer of Health on the 22nd February, 1939. Dr. R. M. Orpwood was appointed Assistant Tuberculosis Officer and Assistant Medical Officer of Health on the 2nd November. Mr. E. P. Simpson left the service owing to ill-health on 31st January, 1939. Miss A. I. Ward, a clerk in the Maternity and Child Welfare Section, resigned on the 25th June to take up a position elsewhere, and Miss R. Frankel was appointed on the 29th June to take her place. Mr. P. Goldman, a clerk, was appointed on the 30th March to fill the vacancy of Mr. Coveney who was appointed a Sanitary Inspector. Mr. W. Swan was appointed Caretaker at the Tuberculosis Dispensary in Devonport Street on the 30th March to fill the vacancy of Mr. Crockford, deceased. Mr. H. Vaughan was appointed General Relief Man on the 27th July. Air Raid Precautions.—The Medical Officer of Health attended the Civilian Anti-Gas School at Easingwold from the 17th April to 23rd April where a course of instruction in anti-gas measures was given to Medical Officers of Health. Mr. E. J. Edwards a Sanitary Inspector attended the Civilian AntiGas School at Falfield from the 23rd May to 4th June, and on obtaining the Instructor's Certificate was seconded on the 17th September for the purpose of instructing the Air Raid Precautions personnel of the Council in anti-gas measures. Mr. H. J. Green, a Sanitary Inspector has temporarily taken over the normal duties of Mr. Edwards as from 10th October. Mr. E. P. Webber, a clerk who is a qualified Sanitary Inspector, has temporarily taken over the normal duties of Mr. Green as from 10th October. One temporary clerk has been engaged to replace Mr. Webber and one additional temporary clerk has been engaged owing to the increase of work in the department resulting from Air Raid Precautions. The duty of organising the Borough Council First Aid Casualty Services for Air Raid Precautions has been placed upon the Public Health Department. Nursing in the Home.—The arrangements made with the East London Nursing Society for the nursing of cases of Measles, Pneumonia following Measles, Ophthalmia Neonatorum, Puerperal Fever, Puerperal Pyrexia and Pemphigus Neonatorum were continued, and consequent upon the passing of the Midwives Act, 1936, were extended to include "all complications and illnesses arising out of maternity." The Council pay this Society 1s. 3d. per visit to such cases and 1,181 visits were made by them during the year i.e., 1,084 to Measles, 97 to Ophthalmia Neonatorum. 10 Midwives.—There are 4 Midwives practising in the Borough, and in addition there are 31 employed by the voluntary associations, and one Midwife employed by the London County Council under the Municipal Midwives Scheme. All the midwives are under the supervision of the London County Council. Laboratory facilities.—The number of bacteriological examinations made at the Mile End Hospital on behalf of the Public Health Department during the year was 2,514. These consisted of:- No. Positive. No. Negative. Totals. Swabs (for Diphtheria bacilli) 193 2,206 2,399 Blood (for Typhoid bacilli) - 16 16 Urine - 24 24 Faeces - 65 65 Faeces (for Dysentery) 3 7 10 There were 773 specimens of sputum examined at the Tuberculosis Dispensaries. 174 of these were found to be positive. During the year, the laboratory of the Main Dispensary at Devonport Street was equipped for the culturing of specimens of sputum. Suspicious specimens, which give a negative result on direct examination, are now cultured on Lowenstein-Jensen medium. This test is a valuable aid to the accurate determination of sputum positive cases. Hospital Facilities.—The following is a list of the hospital facilities in the Borough, showing particulars of each:- Situation, No. of Beds. In-patients admitted during the year. Out-patients No. dealt with during the year. Purpose. Management London Hospital, Whitechapel Road Male 350 15,213 New patients General and Maternity. Voluntary. Female 392 98,419 Children 79 Attendances Other 70 517,988 Mile End Hospital Bancroft Road 466 7,131 Ante-natal 930 General and Maternity. L.C.C. Other 18,211 St. George's-in-the-East Hospital, Raine Street. 410 4,425 Ante-natal 257 General. and Maternity. L.C.C. Other 10,721 St. Peter's Hospital, Vallance Road. 408 4,274 5,665 General. L.C.C. South Grove Institution, South Grove. 597 — Public , Assistance L.C.C. London Jewish Hospital, Stepney Green. Male 41 1,559 New patients 13,250 Attendances 78,635 General. Voluntary. Female 51 Children 12 Other 5 Princess Elizabeth of York Hospital for Children, Glamis Road. Children 135 1,821 Attendances 48,753 General. Voluntary. East End Maternity Hospital, Commercial Road. 59 1,401 1,290 Maternity. Voluntary. Bearstead Memorial Hospital, Underwood Road. (Late Jewish Maternity Hospital). Maternity beds 34 562 Midwifery 13 Maternity. Voluntary. Maternity 6 Anti-natal 540 Post-natal 226 11 Health Propaganda.—The National Health Campaign which commenced in September, 1937, was continued on the same lines during the year. Lectures and Film displays:- Date and place Lecture Films Chairman 10th January, St. George's Town Hall "Social Hygiene" (for adults) by Dr. I. Feldman (Br. Soc. Hyg. Council). " Trial for Marriage" Cr. (Mrs.) Bunn (Chairman of Public Health Committee). Attendance 400. 19th January, Liraehouse Library " Tragedy in the Family" (Diph. Immunisation) by Dr. W. W. King Brown (Med. Off. for Diph. Immunisation) " Circulation " " The Empty Bed " Cr. (Mrs.) O'Connor (Chairman of Maternity and ChildWelfare Committee) Attendance 157. 14th February Limehouse Town Hall "Social Hygiene" (for adults) by Dr. R. Forgan (Br. Soc. Hyg. Council). " Trial for Marriage" Cr. (Mrs.) Bunn (Chairman of Public Health Committee). Attendance 400. 28th February, Limehouse Library " The Conquest of Tuberculosis '' by Dr. J. W. Crawford (Asst. Tuberculosis Officer) " Contacts " " Consequences " Cr. (Mrs.) Bunn (Chairman of Public Health Committee). Attendance 95. 22nd March, Dame Colet House "Body Fitness" (Talk to fathers) by Dr. E. J. O'Keeffe (Dep. M.O.H.) Attendance 100. 8th December, Limehouse Library '' Food and Health '' (Afternoon lecture to mothers) by Dr. E. J. O' Keeffe. " Empty bed " Cr. (Mrs.)O'Connor (Chairman Maternity and Child Welfare Committee). Attendance 85. Propaganda by the display of Posters, etc.:- Month Subject Outdoor Indoor Classroom Folders January School Health Services 350 100 25 10,575 " Social Hygiene - 50 - - February Social Hygiene - 50 - - " Medical Services 350 100 25 9,575 May Dental - - - - " Milk - - - 10,000 June Veneral Disease - - - 10,000 July National Fitness ... 350 100 - 10,000 In addition, 7,000 leaflets on health subjects, and booklets on "Nutrition" and " Advice to Fathers and Mothers " were distributed at the lectures. Much enthusiasm was shown by the staff, and considerable work put in after hours and otherwise in connection with the lectures and distribution of literature, etc. I am most grateful for their help in this most important work, and there is no doubt an untold amount of good must have been done for the cause of the Health of the Public, by this most useful effort in propaganda. 12 TUBERCULOSIS. Tuberculosis Dispensaries.—The present time-table of routine sessions for old patients is as follows and in addition new patients and contacts are seen daily:— Main Dispensary, Steels Lane. Devonport Street. Branch Dispensary, 35, Stepney Green. m. t. w. th. f. s m. t. w th. f. s. Morning Men School Children Men Alternoon Women and Children Men Women and Children Women and Children Evening Workers Workers Tuberculosis After-care.—The Tuberculosis Care Committee held ten meetings during 1938, at which 417 cases were brought to their notice. Over 200 of these were special cases needing help of some kind through the dispensary and the Care Committee. Now that the Committee has its own fund, much more can be done for the poorest patients than was formerly possible, and that the assistance given is appreciated is shown by the grateful letters received from time to time by the Secretary. The greatest need still seems to be the provision of pocket money for destitute patients going to sanatorium, and twelve men have been supplied with this at different times during the year. The fund has also paid for six relatives to visit patients in sanatorium who could not afford the fare themselves. An advertisement, paid for from the fund, resulted in two ex-patients obtaining good domestic posts in the country. Extra nourishment was supplied temporarily to three patients who were not eligible for further help in this way through the Borough Council. The voluntary charitable associations again assisted many poor patients or their families referred to them. The Jewish Board of Guardians made weekly allowances in several cases, besides giving extra nourishment and convalescent treatment. The Charity Organisation Society and the Invalid Kitchens helped cases referred to them by the Committee in suitable ways. Six patients had the use of Borough Council beds and bedding on discharge from sanatorium to enable them to sleep alone. This year the Care Committee participated for the first time in the Christmas Seal Sale for Tuberculosis, organised by the National Association for the Prevention of Tuberculosis, and the satisfactory sum of £75 was raised. The balance sheet and particulars of the Sale will be given in the Care Committee's report to be printed at the end of the financial year in March. 13 Handicraft Class.—The handicraft class, which is now held on Wednesday afternoons instead of Monday, has had another successful year, holding the usual 36 classes. Three more orders were given for dressing gowns for the maternity and toddlers' clinics, and these kept the girls and women busy for the greater part of the year, and were much appreciated. The stall did very well at the combined sale of work of the Handicraft classes held at Kensington Town Hall in March, and Queen Mary purchased three brooches made by one of our men. The work of the ex-service men again sold excellently at the Imperial Institute Armistice Sale in November. Boarded-out Contacts.—32 Children who were contacts of infectious cases of pulmonary tuberculosis were boarded out during the year. Special Treatment for Tuberculosis Patients.—The Council have arrangements by which they pay for the attendances of patients undergoing certain forms of treatment at various hospitals as follows:- No. of Patients. No. of Attendances Finsen Light treatment at the London Hospital 9 169 Pneumo-Thorax Refills at Brompton „ 2 47 ,, I, i) London Chest ,, 14 219 „ „ „ Royal Chest „ 9 110 „ „ „ Colindale ,, 2 13 Sanocrysin treatment at Brompton Hospital 1 10 Supply of Extra Nourishment.—Grants to Tuberculous patients were made on the recommendation of the Tuberculosis Officers for a period of 28 days in the first instance. The grant consists of one and a half pints of Pasteurised or Tuberculin Tested Milk per day, seven eggs per week, and a half pound of butter per week. During the year 695 grants were made to 233 persons, the total cost . being approximately £577. 14 Memo. 37/T (Revised). Ministry of Health Form T. 145. A. Return showing the work of the Dispensaries for the year 1938:- 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 tuberculosis 166 59 15 11 11 14 7 3 177 73 22 14 *(b) Diagnosis not completed - - - - - - - - 8 13 3 3 520 (c) Non-tuberculous - - - - - - - - 92 78 25 12 B.—Contacts examined during the year:- (a) Definitely tuberculous 2 2 - - - - - - 2 2 - - - *(b) Diagnosis not completed - - - - - - - - - - - - 747 (c) Non-tuberculous - - - - - - - - 107 166 222 248 C.—Cases written off the Dispensary Register as:- (a) Recovered 20 6 6 5 5 - 5 4 25 6 11 9 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 206 149 248 264 1,018 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 693 331 68 52 62 50 92 57 755 381 160 109 (b) Diagnosis not completed - - - - - - - - 8 13 3 3 1,432 1. Number of cases on Dispensary Register on January 1st 1,414 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 75 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 173 4. Cases written off during the year as Dead (all causes) 133 5. Number of attendances at the Dispensary (including Contacts) 5,294 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 330 7. Number of consultations with medical practitioners:- (a) Personal 410 (b) Other 553 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 556 9. Number of visits by Nurses or Health Visitors to homer, for Dispensary purposes 5,223 10. Number of (a) Specimens of sputum, etc., examined 773 (b) X-ray examinations made in connection with Dispensary work 459 11. Number of ' Recovered" cases restored to Dispensary Register, and included in A(a) and A(6) above 2 12. Number of " T.B. plus ' cases on Dispensary Register on December 31st 693 B. Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council 2 Provided by Voluntary Bodies - remaining undiagnosed on 31st December. 15 (a) PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates Previous to 1928 1928 1929 1930 1931 1932 Class T. B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. pius Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B.plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 11 7 12 - 19 4 - 2 - 2 1 3 2 - 5 2 5 3 1 9 8 2 4 - 6 4 3 4 2 9 F. 10 5 8 1 14 3 4 1 - 5 6 3 - - 3 2 1 2 - 3 3 3 3 - 6 - 4 2 - 6 Children 5 2 - - 2 3 - - - - 5 - - - 4 - - - - 1 - - - - 6 1 - - 1 Disease not Arrested Adults M. 2 13 13 3 29 2 1 5 - 6 1 3 9 - 12 - 5 5 - 10 - 3 7 - 10 1 2 11 - 13 F. 2 5 9 - 14 - 1 1 - 2 1 - - - - - 2 5 - 7 - 1 4 - 5 - 4 7 1 12 Children - - - - - - - - - - - - - - - - - - - - - - 2 - 2 - - 2 - 2 Condition not ascertained during the year 22 10 14 - 24 6 3 1 - 4 7 3 2 - 5 6 3 2 1 6 6 - 5 - 5 5 4 3 - 7 (b) Not now on Dispensary Register and reasons for removal therefrom. Total on Dispensary Register at 31st December 52 42 56 4 102 18 9 10 - 19 21 12 13 - 25 14 16 17 2 35 18 9 25 - 34 16 18 29 3 50 Discharged as Recovered Adults M. 51 25 10 - 35 11 3 4 - 7 11 5 2 - 7 8 3 1 - 4 8 3 3 - 6 7 1 3 - 4 F. 39 33 8 - 41 8 7 2 - 9 14 5 - - 5 7 6 1 - 7 8 6 1 - 7 6 2 1 - 3 Children 23 6 - - 6 8 5 - - 5 6 - - - - 10 1 - - 1 6 1 - - 1 8 - - - - Lost sight of, or otherwise removed from Dispensary Register 130 99 75 2 176 21 21 16 2 39 38 16 19 1 36 31 21 23 4 48 57 30 36 1 67 72 33 42 2 77 Dead. Adults M. 23 18 47 11 76 5 2 8 3 13 12 4 11 3 18 5 11 15 5 31 10 6 20 11 37 12 13 23 11 47 F. 12 12 19 4 35 5 3 3 1 7 8 8 10 2 20 9 3 8 5 16 9 11 15 4 30 4 8 8 6 22 Children 2 - - - - - - - - - - - 1 - 1 - 2 - - 2 - - - - - 1 1 - - 1 Total written off Dispensary Register. 280 193 159 17 369 58 41 33 6 80 89 38 43 6 87 70 47 48 14 109 98 57 75 16 148 110 58 77 19 154 Grand Totals 332 235 215 21 471 76 50 43 6 99 110 50 56 6 112 84 63 65 16 144 116 66 100 16 182 126 76 106 22 204 16 PULMONARY TUBERCULOSIS-continued. Condition at the time of the last record made during the year to which the return relates 1933 1934 1935 1936 1937 1938 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested. Adults M. 14 5 5 - 10 15 4 2 - 6 9 2 1 - 3 3 1 - 1 2 - - - - - - - - - - F. 5 4 1 - 5 7 4 - - 4 6 2 1 - 3 1 1 - - 1 - - - - - - - - - - Children 10 - - - - 10 - 1 - 1 9 1 - - 1 2 - - - - - - - - - - - - - - Disease not Arrested. Adults M. 2 3 10 2 15 6 11 17 - 28 4 10 25 1 36 15 11 26 - 37 24 8 47 4 59 55 14 54 5 73 F. 2 4 6 1 11 2 2 8 1 11 2 4 7 - 11 8 2 10 1 13 15 5 16 - 21 21 4 23 2 29 Children - - - - - - 1 1 - 2 3 2 2 - 4 3 1 - - 1 4 - - - - 18 - 1 - 1 Condition not ascertained during the year 8 6 9 1 16 10 6 2 - 8 9 2 5 1 8 8 2 3 - 5 2 - - - 3 - - - - Total on Dispensary Register at 31st December 41 22 31 4 57 50 28 31 1 60 42 23 41 2 66 40 18 39 2 59 45 13 66 4 83 94 18 78 7 103 (b) Not now on Dispensary register and reasons for removal therefrom. Discharged as Recovered Adults M. 5 1 - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - F. 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 68 42 33 3 78 55 28 27 3 58 38 16 24 2 42 22 8 23 2 33 16 2 17 1 20 9 3 11 - 14 Dead Adults M 10 14 34 18 66 8 16 22 28 66 12 7 38 11 56 6 3 32 21 56 4 - 31 19 50 5 - 14 14 28 F. 2 4 15 12 31 5 5 14 8 27 7 1 8 3 12 3 1 11 5 17 4 - 10 10 20 1 - 4 - 4 Childre 2 1 - 2 3 1 - 2 - 2 1 - - 1 1 - - - - - 3 - 1 - 1 3 - 1 1 Total written off Dispensary Register 92 62 82 35 179 69 49 65 39 153 58 24 70 17 111 31 12 66 28 106 27 2 59 30 91 18 3 29 15 47 Grand Totals 133 84 113 39 236 119 77 96 40 213 100 47 111 19 177 71 30 105 30 165 72 15 125 34 174 112 21 107 22 150 17 (b) NON-PULMONARY TUBERCULOSIS Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates. Previous to 1928 1928 1929 1930 1931 1932 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal , Other Organs Peripheral Glands Total Bones and Joints Abdominal OtherOrgans Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 - 1 - 3 - - - - - - - - 1 1 - - 1 - 1 - - 1 - 1 - - 1 - 1 F. 2 - - - 2 1 - - 1 2 - - - - - 1 - - - 1 1 - - - 1 - - 1 - 1 Children 3 - - 1 4 3 - 1 3 7 2 - 1 2 5 4 1 4 1 10 1 1 2 9 13 4 2 2 7 15 Disease not Arrested Adults M. 1 - - - 2 - - - - - - - - - - - - - - - 1 - - 1 - - - - - F. 1 - 2 - 3 - - 1 - 1 - - - - - - - - 1 1 - - - - - 2 - - - 2 Children 1 - 1 1 3 - - - - - 2 - - - 2 - - - - - 2 - - - 2 2 - - - 2 Condition not ascertained during the year 3 - 3 2 8 - - - - - 1 - - - 1 2 - - 1 3 - - - 2 2 2 - - 2 4 Total on Dispensary Register at 31st December 13 - 8 4 25 4 - 2 4 10 5 - 1 3 9 7 i 5 3 16 5 1 3 11 20 10 2 4 9 25 Transferred to Pulmonary - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 1 2 1 5 9 2 - - 2 4 1 1 - 1 3 2 - 1 2 5 1 - - 1 2 - 1 - - 1 F. 1 - 1 4 6 - - - - - 1 - 1 2 4 - - - - - 2 - 1 - 3 - 1 - 3 4 Children 20 6 4 17 47 3 1 2 16 22 4 3 1 7 15 2 2 - 11 15 3 3 - 7 13 3 - - 3 6 Lost sight of, or otherwise removed from Dispensary Register 22 7 11 30 70 7 1 3 2 13 11 3 6 6 26 8 4 9 9 30 15 3 9 13 40 11 4 1 17 33 Dead Adults M. 1 - 1 1 3 - - 1 - 1 - - 1 - 1 - - 1 2 3 - 1 1 - 2 - - - - - F. - - 2 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - Children 1 1 - 2 4 - - - - - - - - - - - - - 1 1 - - - 1 1 1 - 3 1 5 Total written off Dispensary Register 46 16 20 59 141 12 2 6 20 40 17 7 9 16 49 12 6 11 25 54 21 7 11 22 61 15 6 4 24 49 Grand Totals of (a) and (b) excluding those transferred to Pulmonary). 59 16 28 63 166 16 2 8 24 50 22 7 10 19 58 19 7 16 28 70 26 8 14 33 81 25 8 8 33 74 18 NON-PULMONARY TUBERCULOSIS—continued. Condition at the time of the last record made during the year to which the return relates. 1933 1934 1935 1936 1937 1938 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bonus and J oints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 — — 2 4 — — — — — 1 — — — 1 — 2 1 1 4 - - - - - - - - - - F. — — — 1 1 — — — 1 1 — — — — — — — 1 1 2 — 1 — 3 — — - — — Children 3 1 1 8 13 — 1 3 4 8 1 — — 6 7 — — — 2 2 — — — — — — — — — — Disease not Arrested Adults M. — 1 — — 1 1 — — — 1 1 — — — 1 3 — 3 — 6 2 — 3 1 6 6 — 3 — 9 F. 1 — 2 — 3 — — — — — — — — 1 1 1 — — — 1 2 — 2 1 5 3 3 5 2 13 Children 1 — — — 1 3 — 2 — 5 3 — — 2 5 3 — 1 3 7 5 1 — 7 13 4 1 1 2 8 Condition not ascertained during the year — — 2 3 5 2 1 2 2 7 2 — 1 2 5 — — 1 2 3 2 1 — 2 5 - - - - - Total on Dispensary Register at 31st December 7 2 5 14 28 6 2 7 7 22 8 — 1 11 20 7 2 6 9 24 13 2 6 11 32 13 4 9 4 30 Transferred to Pulmonary - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 1 — 2 2 5 1 F. — 1 — 2 3 Children — — 1 5 6 Lost sight of, or otherwise removed from Dispensary Register 8 3 3 15 29 3 o 4 13 22 4 2 5 6 17 4 3 3 6 16 2 1 — 4 7 „ «_ 1 — - 2 3 Dead Adults M. — — 1 1 2 1 1 1 — 3 — 3 — — 3 1 — — — 1 — — 1 — 1 — — — — — F. — — — — — — — — — — — — 1 — 1 2 — 1 — 3 — — — — — — 1 — — 1 Children — — 1 1 2 1 1 2 — 4 1 — 3 — 4 — — 3 — 3 — — 2 — 2 — 1 — — 1 Total written off Dispensary Register 9 4 8 26 47 6 5 7 13 31 6 5 9 6 26 7 3 7 6 23 2 1 3 4 10 1 2 — 2 5 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 16 6 13 40 75 12 7 14 20 53 14 5 10 17 46 14 5 13 15 47 15 3 9 15 42 14 6 9 6 35 19 SUMMARY OF WORK DONE AT THE DENTAL CLINIC—(a) TUBERCULOSIS. Particulars of Patients. Number of Fillings. Number of Scalings. Extraction Cases. Dentures. Number of Dressings. Number for Advice. Denture Visits. Number of New Patients. Number of Attendances. Simple. Root. Without Anaesthetic. Local Administrations. Gas Administrations. Number of Teeth Extracted. Upper. Lower. Re-models Repairs. Males 68 — — 3 — 2 5 42 6 7 — 3 - 18 43 8 Females 108 3 — 2 — 3 13 106 9 9 — 5 1 35 64 9 Children - - - - - - - — - - - — - - - - Total 176 3 — 5 — 5 18 148 15 16 — 8 1 53 107 17 No. of Ordinary sessions held 12 No. of Gas „ „ 12 (b) MATERNITY. Women 770 30 — 67 — 11 116 822 68 60 1 22 7 99 469 72 Children 46 - - - - - 21 77 - - - - - 24 1 24 Total 816 30 — 67 — 11 137 899 68 60 1 22 7 123 470 96 No. of Ordinary sessions held 27 No. of gas „ „ 27 20 MATERNITY AND CHILD WELFARE. Little change took place in the administration of the Maternity and Child Welfare section during the year. The premises at the Congregational Buildings, Burdett Road, whereat the Borough Council's Infant Welfare Centre for that district was held on Wednesdays, had long been considered unsuitable in lay-out and gloomy in aspect with the result that on 24th June this centre was transferred to 17, Rhondda Grove (late Cottage Grove) where it is now held on Tuesdays. The latter premises are rented by the Council and already house the Council's Mile End Infant Welfare Centre which is held there on Thursdays. Two centres for two districts are therefore being held there on separate days until such time as some better arrangements can be made. The voluntary Infant Welfare Centre known as Stepney Infant Welfare Centre and Babies' Nursing Home of 587, Commercial Road, E.l, was unfortunately obliged to close up these premises during the year owing to the building being declared structurally unsafe by the District Surveyor. The Babies' Nursing Home has been permanently closed and the Infant Welfare Centre is carrying on temporarily at St. Matthew's Hall, White Horse Road, E.l. The voluntary Infant Welfare Centre known as East Stepney Jewish Centre changed from their temporary premises at Redmans Road to the new Jewish Girls' Club at 2, Beaumont Grove—a very fine new building. A domiciliary service of midwives established under the Midwives Act, 1936, came into operation during the year. In London this service is administered by the London County Council. A useful feature of the scheme is the Emergency Obstetrical Service, by which the doctor (or midwife if necessary) in attendance on the mother in her home, can, in case of serious emergency call out from the local London County Council Hospital, an ambulance with obstetrical consultant, trained midwife and equipment for blood transfusions or other necessary operation, in those cases where it is not possible to immediately move an emergency case into hospital. One of the Council's Health Visitors, Miss Carty, attended the annual revision course for Health Visitors at the Winter School for Health Visitors held at Bedford College for Women, Regents Park, under the auspices of the Women's Public Health Officers' Association in December. During the year a knitting competition was held for the mothers attending the Infant Welfare Centres and was well supported by the mothers who take much interest in this work at the centres. The toddler clinic shows increased attendances and the figures relating to this clinic will be found on page 31. The clinic serves a useful purpose for those children who the Health Visitors consider require special attention. Infantile Mortality.—The deaths of infants during the year were slightly less than last year. In 1937 there were 167 deaths of infants under 1 year of age, giving an infantile mortality rate of 60.5 per 1,000 live births. This year 163 died and the infantile mortality rate is 62.2. Were it not for the measles epidemic which caused seven infantile deaths the infantile death rate would have been lower than last year, which was the Jowest on record in the Borough. 21 Maternal Mortality.—There were 6 maternal deaths in 2,701 live and still births, giving a maternal mortality rate of 2.22 as compared with 2.43 in 1937. Of the maternal deaths, 3 were due to puerperal sepsis and 3 to other causes. Three due to puerperal sepsis ; (1) Septicaemia following abortion. (2) Agranulocytosis following the medicinal administration of prontosil for puerperal sepsis. (3) Pulmonary embolism due to pelvic thrombophlebitis following childbirth. Three due to other causes ; (1) Pyelonephritis following retroverted gravid uterus impacted in the pelvis. (2) Pulmonary embolism due to thrombosis of the left internal iliac vein following recent childbirth. (3) Acute antepartem haemorrhage due to placenta praevia and natural abortion. Every maternal death occurring in the borough is investigated and reports are received from the doctors and midwives concerned. The reports are examined in order to determine whether any of the deaths could have been avoided. Of the above six deaths three were unavoidable. In one of these three cases the patient had apparently an unfortunate idiosyncrasy to the drug used in the treatment of the puerperal fever from which she was suffering. Of the remaining three cases one might have been saved had she sought hospital treatment sooner and two might have been saved if they had attended an ante-natal clinic earlier. There were no cases associated with criminal abortion. 22 MATERNITY MORTALITY IN LONDON BOROUGHS, 1938. Borough or City. Rate per 1,000 live births. Rate per 1,000 total births (live and still). Puerperal sepsis. Other causes. Total. Puerperal sepsis. Other causes. Total. West Districts. Paddington 0.53 1.06 1.59 0.51 1.02 1.53 Kensington 0.9 1.3 2.2 0.9 1.3 2.2 Hammersmith 0.00 1.07 1.07 0.00 1.04 1.04 Fulham 0.51 0.00 0.51 0.49 0.00 0.49 Chelsea 3.5 1.7 5.2 3.4 1.7 5.1 Westminster 1.9 4.8 6.7 1.8 4.6 6.5 North Districts. St. Marylebone 0.00 2.49 2.49 0.00 2.41 2.41 Hampstead 0.00 0.94 0.94 0.00 0.91 0.91 St. Pancras 0.00 0.8 0.8 0.00 0.8 0.8 Islington 1.12 1.56 2.68 1.08 1.52 2.60 Stoke Newington 0.00 1.4 1.4 0.00 1.4 1.4 Hackney 0.36 0.00 0.36 0.35 0.00 0.35 Central Districts. Holborn 0.00 4.00 4.00 0.00 3.76 3.76 Finsbury 0.00 4.05 4.05 0.00 3.84 3.84 City of London 0.00 0.00 0.00 0.00 0.00 0.00 East Districts. Shoreditch 0.85 1.69 2.54 0.82 1.64 2.46 Bethnal Green 0.76 0.76 1.52 0.74 0.74 1.47 Stepney 1.145 1.145 2.29 1 .11 1 .11 2.22 Poplar 1.50 1.00 2.50 1.45 0.97 2.42 South Districts. Southwark 0.00 0.98 0.98 0.00 0.95 0.95 Bermondsey 0.00 2.75 2.75 0.00 2.71 2.71 Lambeth 0.52 1.30 1.82 0.50 1.26 1.76 Battersea 2.37 0.47 2.84 2.30 0.46 2.76 Wandsworth 0.49 2.71 3.20 0.47 2.63 3.11 Camberwell 0.32 2.25 2.57 0.31 2.18 2.49 Deptford 0.00 1.4 1.4 0.00 1.4 1.4 Greenwich 0.00 1.5 1.5 0.00 1.4 1.4 Lewisham 1.56 0.62 2.19 1.52 0.61 2.13 Woolwich 0.00 0.48 0.48 0.00 0.47 0.47 Maternity and Child Welfare Services (Form M.C.W. 96 revised).—Return (1) showing the arrangements made for maternity and child welfare by the Council and by Voluntary Associations providing maternity and child welfare services in respect of which the Council pay contributions under Section 101 of the Local Government Act, 1929, or otherwise; and (2) giving particulars of the work done during the year 1938. 1.—Population of the area served by the Council as Welfare Authority:— 200,500. 2.—Number of births notified in that area during the year under Section 203 of the Public Health Act, 1936, or Section 255 of the Public Health (London) Act, 1936, as adjusted by any transferred notifications : (a) Live births, 2,670. (b) Still births, 76. (c) Total, 2,746. (d) By midwives, 2,560. (e) By doctors and parents, 186. 23 3.—Health Visiting. (a) Number of officers employed for health visiting at the end of the year : (i) by the Council 10 (ii) by Voluntary Associations 14 (b) Equivalent of whole-time services devoted by the whole staff to health visiting (including attendance at infant welfare centres):— (i) in the case of Health Visitors employed by the Council 10 (ii) in the case of Health Visitors employed by Voluntary Associations 13.5 (c) Number of visits paid during the year by all Health Visitors:— (i) to expectant mothers :—First visits, 1,553. Total visits, 2,822. (ii) to children under 1 year of age :—First visits, 2,463. Total visits, 18,770. (iii) to children between the ages of 1 and 5 years :—Total visits, 36,322. 4.—Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council 7 (2 of these are temporarily held in the same Centre premises). (b) Number of Centres provided and maintained by Voluntary Associations 9 (c) Total number of attendances at all Centres during the year:— (i) by children under 1 year of age, 29,527. (ii) by children between the ages of 1 and 5 years, 24,422 (d) Total number of children who first attended at the Centres during the year and who, on the date of their first attendance, were: (i) under 1 year of age, 2,211; (ii) between the ages of 1 and 5 years, 392. (e) Total number of children under 5 years who attended at the Centres during the year and who, at the end of the year, were: (i) under 1 year of age, 1,976; (ii) over 1 year of age, 4,543. (f) Percentage of notified live births represented by the number in (d): (i) 82.80. 5.—Ante-natal and Post-natal Services. (a) Ante-natal and Post-natal Clinics (whether held at Infant Welfare Centres or at other premises):— Ante-natal Post-natal (i) Number of Clinics provided and maintained These cases attend by the Council These cases attached the council's A.N. Clinics (ii) Number of Clinics provided and maintained by Voluntary Associations 3 2 (iii) Total number of attendances at all Clinics during the year 24,700 953 (iv) Total number of women who attended at the Clinics during the year * 4,317 809 24 (b) Total number of expectant mothers ante- natally examined and of cases post-natally examined during the year, under arrangements made by the Council with private medical practitioners, excluding cases included under 5 (a) (iv) nil nil (c) Percentage of total notified births (live and still) represented by the total numbers of women shown under 5 (a) (iv) and 5 (b) - - * Figures in 5 (a) (iv) include women not residing in Stepney. 6.—Supply of Milk and Food. (a) Arrangements made for this service:— Terms of Supply. Milk. Meals supplied at Dining Centres. Other Food. Expectant mothers. Nursing mothers. Children under 5 years of age. Expectant mothers. Nursing mothers. Children under 5 years of age. Expectant mothers. Nursing mothers. Children under 5 years of age. Free, or at less than cost price, in necessitous cases. Yes Yes Yes Yes Yes Yes Yes Yes Yes At cost price in other cases (e.g., sale of dried milk at Centres) Yes Yes Yes No. No. No. Yes Yes Yes (b) Total quantity of milk supplied during the year to expectant and nursing mothers and young children:- (i) By the Council: Dried milk 9,557½ packets. Liquid milk 32.629¼ gallons. (ii) By Voluntary Associations operating in the area of the Council: (Supplied through the Borough Council's scheme (i) above). 7.—Maternity Homes and Hospitals. I. Separate maternity institutions provided by the Council Other institutions with maternity wards provided by the Council. Institutions provided by Voluntary Associations and subsidised by the Council. Number of Institutions nil nil The Council make a grant of £100 per annum to the East End Maternity Hospital for one bed. Number of maternity beds (exclusive of isola tion and labour beds) nil nil 1 Total number of ( women admitted to these beds during the year nil nil 24 Number of beds (included in the figures above) allocated to. and reserved for, expectant mothers in need of hospital treatment nil nil - Total number of women admitted to these beds during the year. - - - II. Number of women (if any) sent by the Council during the year to other Maternity Institutions nil 25 8.—Homes and Hospitals for Sick or Ailing Children under 5 years of age. I. Separate Institutions provided by the Council for these cases. Other institutions (with accommodation for these cases) provided by the Council. Institutions provided by Voluntary Associations and subsidised by the Council. Number of Institutions nil nil nil Number of beds provided for such children nil nil nil Total number of children admitted to these beds during the year.. nil nil nil II. Number of such children (if any) sent by the Council during the year to other institutions nil 9.—Convalescent Homes. (a) Number of convalescent institutions with accommodation for expectant or nursing mothers or children under 5 years of age:— (i) provided by the Council nil (ii) provided by Voluntary Associations 1 (b) Number of beds for such cases in convalescent institutions:— (i) provided by the Council nil (ii) provided by Voluntary Associations 12 (c) Total number of cases admitted to the beds included in (b) during the year, 114. (d) Total number of such cases sent by the Council during the year to other convalescent institutions, 210. Total number sent to convalescent institutions by the Voluntary Association including (c), 475. 10.—Homes for Mothers and Babies. (а) Number of such homes:- (i) provided by the Council nil (ii) provided by Voluntary Associations nil (b) Number of beds in homes:— (i) provided by the Council nil (ii) provided by Voluntary Associations nil (c) Number of :- (i) maternity beds (exclusive of isolation and labour beds) included under (b) (i) or (ii) above nil (ii) women admitted to these maternity beds during the year nil 26 (d) Total number of cases admitted to these homes during the year:- (i) expectant mothers nil (ii) mothers and babies nil (iii) babies nil (e) Total number of such cases sent by the Council during the year to other homes for mothers and babies nil 11.—Homes or Residential Nurseries for Healthy Babies (excluding poor law institutions):- (a) Number of such institutions (i) provided by the Council nil (ii) provided by Voluntary Associations nil (b) Number of beds in these institutions:- (i) provided by the Council nil (ii) provided by Voluntary Associations nil (c) Number of children admitted to these beds during the year nil 12.—Day Nurseries. (a) Number of Day Nurseries:- (i) provided by the Council nil (ii) provided by Voluntary Associations 5 (b) Number of places for children under 5 years of age in the nurseries (i) provided by the Council nil (ii) provided by Voluntary Associations 194 (c) Total number of attendances of children at these nurseries during the year, 34,516. 13.—Infectious Diseases. Disease. Number of cases notified during the year. Number of cases visited by officers of the Council. Number of cases for whom home nursing was provided by the Council. Number of cases removed to hospitals. (1) (2) (3) (4) (5) (1) Ophthalmia Neonatorum *10 9 4 9 (2) Pemphigus Neonatorum Not notifiable - - - (3) Puerperal fever 8 8 - 7 (4) Puerperal pyrexia 41 41 - 36 (6) Measles and German measles (in children under 5 years of age) †838 ‡1,876 76 194 (6) Whooping Cough (do ) 86 179 — 44 (7) Epidemic Diarrhœa (do.) Not notifiable — — — (8) Poliomyelitis (do.) 3 3 — 3 *Number of cases in which vision, was unimpaired 9, impaired —, or lost — ,, ,, ,, the patient died ... —, removed from district ... 1, or was still under treatment at the end of the year ... — ,, any other category —. †Only Measles officially notified by doctors. ‡Includes additional cases brought to notice otherwise than by official notification. 27 14.—Home Nursing. (a) Number of Nurses employed at the end of the year (otherwise than for purposes of the Midwives Act, 1936) for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal pyrexia (including cases classified in London as puerperal fever):— (i) by the Council, 1; (ii) by Voluntary Associations, 2. (b) Total number of cases attended during the year by these nurses, 581. 15.—Emergency Units. Number of cases in which the services of an emergency unit have been provided during the year nil 16.—Consultants. Number of cases (including any shown against Item 15) in which the services of a consultant have been provided during the year for a private medical practitioner under the Council's maternity arrangements nil 17.—Home Helps. Number of cases in which home helps have been provided during the year (the numbers of cases where this assistance has been given by Voluntary Agencies, by arrangement with the Council, should, if possible, be stated separately) 65 18.—Maternal Deaths. (a) Number of women who died in, or in consequence of, childbirth in the area served by the Council for maternity and child welfare during the year:— (i) from sepsis 3 (ii) from other causes 3 (b) Number of these cases which died :— (i) at home nil (ii) in institutions 6 19.—Child Life Protection (Sections 206 to 220 of the Public Health Act, 1936, or Part XIII of the Public Health (London) Act, 1936). (a) Number of persons who were receiving children for reward at the end of the year 20 (b) Number of children:— (i) at the end of the year 23 (ii) who died during the year nil (iii) on whom inquests were held during the year nil (c) Number of Child Protection Visitors at the end of the year who were:- (i) Health Visitors 10 (ii) Female, other than Health Visitors 1 (iii) Male nil (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or societies authorised to visit under the proviso to Sec. 209 (2) of the Public Health Act, 1936, or Sec. 258 (3) of the Public Health (London) Act, 1936 nil 28 (e) Proceedings taken during the year:— No. of cases. Act and Section under which proceedings were taken. 1 Public Health (London) Act, 1936, section 257 (4) and section 259 (a). (f) Number of cases in which the local authority has given a sanction during the year:- (i) under Sec. 210 of the Public Health Act, 1936, or Sec. 259 of the Public Health (London) Act, 1936 nil (ii) under (b) „ „ „ nil (iii) under (c) „ „ „ nil (g) Number of orders obtained during the year under Sec. 212 of the Public Health Act, 1936, or Sec. 261 of the Public Health (London) Act, 1936 (i) from a court of summary jurisdiction nil (ii) from a single Justice nil Feeding of Infants, etc.. Breast fed at birth 95.6% ,, ,, at six months 63.2% Artificially fed at birth 4.4% ,, „ at six months 36.8% No. of Infants breast fed at birth 2,346 ,, „ artificially fed at birth 117 „ „ dead before the visit of Health Visitor 45 „ „ removed before the visit of the Health Visitor 129 „ „ untraced 17 Health Visiting.—There are 7 Municipal Infant Welfare Centres and 9 Voluntary Centres in the Borough. Details of the work of the Health Visitors and Centres are given on pages 30 and 31. Prevention of Deafness.—Three cases received treatment under the arrangements with the London County Council for the treatment of children, suffering from ear defects. Convalescent Treatment.—During the year, mothers and children were sent away to the homes mentioned below:- Mothers Children. St. Mary's, Dover 46 76 All Saints' Convalescent Home, Eastbourne 2 54 Zachary Merton, Rustington 5 10 St. Mary's, Birchington 10 7 63 147 29 Provision of Milk and Meals to Expectant and Nursing Mothers and Children.—The following table shows the approximate quantity and cost of milk, etc., distributed during the year:— No. of Grants authorised. Quantity. Cost. Cows' Milk— £ s. d. Free 9,099 31,798 gals. 3,395 2 0¼ Half-Price 241 831½ „ 45 1 9¾ Dried— Free 2,103 9,335½ pkts. 739 0 9½ Half-Price 50 222 „ 8 10 3 Virol, etc.— Free 3,875 3,8551½ lbs. 242 13 5 Half-Price 101 101 „ 3 2 5 Total 15,469 32,629½gals. 4,433 10 8½ 9,557½ pkts. 3,956½ lbs. The number of dinners supplied by the Stepney Invalid Kitchen, White Horse Road, on the grounds of health, to expectant and nursing mothers who are in necessitous circumstances, was 3,126, at a cost to the Council of £104 4s. Od. Home Helps.—The number of cases in which home helps have been provided under the Borough Council's Scheme has increased from 15 in 1936, which was the first complete year of working the Scheme, to 65 during the year under review. The scheme has worked smoothly during the year and in no case has there been any serious complaint from mother or home help. The Council's panel of home helps consists of 13 women. Artificial Sunlight Treatment.—The arrangements with the London County Council to provide artificial sunlight treatment at St. Peter's Hospital for children attending the local municipal centre, were extended to the Mile End Hospital. 72 children received such treatment free of cost, compared with 9 last year. Maternity Nursing.—As the London County Council have now established a Maternity Nursing Scheme in conjunction with their Municipal Midwives Scheme, the Borough Council's Maternity Nursing Scheme may now be little used. Child Life Protection.—Total visits of the eleven Child Protection Visitors to homes of foster mothers 164 Total visits of the eleven Child Protection Visitors to foster children 247 Other visits made by these visitors 165 30 Visits by Health Visitors.—The following table shows the number of visits, etc., paid by the Municipal Health Visitors during the year. HEALTH VISITORS' REPORT. DISTRICT Wapping Shad well, S.W. Mile End, N.W Spitalfields. Whitechapel, M Mile End, W. and part S. Whitechapel, E. Limehouse, S. Ratcliffe, S. St. George's, N. and part S. Shadwell, N. Whitechapel, S. St. Geoige's, W. Tower. Mile End, S.E. Mile End, N.E., part N. part S. Mile End, C. Limehouse, N.W. Limehouse, N. Ratcliffe, N. Mile End, part S. NAME Miss Railey Miss Blackmore Miss Brazier Miss Carty Miss Clements Miss Clifford Miss Cordwell Miss Foucar Miss Gibbs Miss Styles Total Visits:— Primary 112 319 252 217 229 262 211 314 202 34.5 2,463 Revisits:— To infants under 1 year 327 847 656 479 497 448 607 535 637 582 5,115 To children between 1-5 years 864 1,184 1,313 1,025 726 1,047 979 1,036 1,212 1,334 10,720 Ante-natal:— Primary 50 95 33 60 70 69 68 87 25 42 599 Subsequent - 7 1 17 - 67 - 1 1 94 Ophthalmia Neonatorum - 3 3 1 - 2 - - 1 - 10 Puerperal Fever - - - - 2 1 - 3 1 1 8 „ Pyrexia 2 7 6 3 3 3 3 6 3 5 41 Measles 70 253 47 85 104 118 110 162 121 221 1,291 ,, Revisits 4 33 9 47 5 12 98 30 6 12 256 Miscellaneous 280 268 106 188 184 452 497 174 26 72 2,247 Attempted visits 251 423 539 306 276 482 333 263 164 422 3,459 Infant Life Protection: Visits to homes of foster mothers 3 47 27 5 - 1 2 15 2 - 102 Visits to foster children - 69 27 14 - - 11 17 11 10 159 Other visits - 18 - 2 - - - 1 - - 21 Totals 1,963 3,073 3,019 2,449 2,096 2,964 2,919 2,644 2,412 3,046 26,585 CENTRES ATTENDED:— Municipal 197 191 190 232 197 175 105 121 20 183 1,611 Voluntary 14 - - - - 2 - 95 157 - 268 Totals 211 191 190 232 197 177 105 216 177 183 1,879 31 Municipal Infant Welfare and Ante-Natal Centres. Details of the work at the Municipal Infant Welfare and Ante-Natal Centres will be seen in the following table. MUNICIPAL INFANT WELFARE AND ANTE-NATAL CENTRES. Limehouse. Mile End. St. George's. Spitalfields. Wapping. Whitechapel. Total. Cottage Grove Burdett Road Mon. Wed. Thurs. Thurs. Tues. Tues. Fri. Tues. Thurs. Wed. Fri. Wed. No. of Infant Welfare Sessions (total) 48 52 - 62 51 51 48 51 52 52 42 62 561 Attendances of Infants 1,390 1,330 - 1,751 1,443 1,509 1,018 804 1,704 1,348 175 838 13,310 „ „ Children 1 to 5 964 966 - 1,570 750 1,314 941 620 1,421 1,073 125 869 10,613 „ Infants on Registers at end of the year 189 - 423 - 148 - 175 86 54 1,075 „ Children on Registers at end of the year 356 - 229 - 414 - 327 160 134 103 „ Ante-Natal Sessions - - 62 - - - - 51 - - - - - „ „ New Cases - - 122 - - - - 88 - - - - 210 „ „ Subsequent Attendances - - 304 - - - - 300 - - - - 604 „ Doctors' Consultations 48 62 52 52 61 51 48 51 52 52 - 62 561 Toddlers Clinics: 4th Friday in each month 12 2nd Friday in each month 12 No. of sessions held - - - - - - - 24 No. of first attendances 64 - - - - 57 - - - 121 Total Attendances 104 - - - - 94 - - - 198 No. of toddlers found with defects 76 - - - - 59 - - - 135 Total No. of defects found 132 - - - - 102 - - - 234 32 Infantile Mortality.—The deaths from stated causes at various ages under one year of age are shown in the table below:- Cause of Death Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under One Year All Causes. Certified. m 22 2 5 3 32 18 16 15 10 91 F. 12 3 5 1 21 9 22 12 8 74 Small-pox m. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Chicken-pox m. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 2 Measles m. ... ... ... ... ... ... 1 1 2 4 F. ... ... ... ... ... ... 1 1 1 3 3 Scarlet Fever m. ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 4 Whooping Cough m. ... ... ... ... ... 1 ... 1 ... 2 F ... ... ... ... ... 1 1 1 2 5 5 Diphtheria and Croup M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 10a Tuberculous Meningitis m. ... ... ... ... ... ... ... ... 1 1 F. ... ... ... ... ... ... ... ... 1 1 10b Abdominal Tuberculosis M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 10c Other Tuberculous Diseases m. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... 1 ... ... 1 11 Syphilis M ... ... ... ... ... 2 ... ... ... 2 F. ... ... ... ... 1 ... ... ... 1 2 19 Bronchitis M. ... ... ... ... ... ... 1 ... ... 1 F. ... ... ... ... ... 1 ... ... ... 1 20 Pneumonia (all forms) m. ... ... 2 ... 6 4 2 5 2 19 F ... ... 2 ... 2 4 5 2 ... 13 23a Diarrhoea M. ... ... ... ... ... 7 6 6 5 24 F. ... ... ... ... ... 2 7 4 1 14 23b Enteritis M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 27 Gastritis M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 31a Congenital Malformations M. ... ... ... ... ... 1 ... ... ... 1 F. ... ... 2 ... 2 ... ... ... ... 2 31b Premature Birth M. 13 ... 3 ... 17 ... ... ... ... 17 F. 7 2 ... ... 9 1 ... ... ... 10 31c Atrophy, Debility & Marasmus M. ... ... ... 1 1 1 1 ... ... 3 F. ... ... ... ... ... ... 2 ... ... 2 31 Atelectasis M. 3 ... ... ... 3 ... ... ... ... 3 F. 2 ... ... ... 2 ... ... ... ... 2 31e Injury at Birth m. 1 ... ... ... 1 ... ... ... ... 1 F. 1 ... ... ... 1 ... ... ... ... 1 31f Convulsions M. 1 ... ... ... 1 ... ... ... ... 1 F. ... ... ... ... ... ... ... ... ... ... 34 Suffocation, overlying M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 35a Rickets M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 35b Meningitis (not tuberculous) M. ... ... ... ... ... ... ... ... ... 2 F. ... ... ... 1 1 ... ... ... 1 2 35c Laryngitis M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 35 d Erysipelas M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 35e Other causes M. 3 ... ... ... 3 ... 2 ... ... 6 f. 1 ... ... ... 3 ... 4 2 ... 9 36 11 defined M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Totals 34 5 10 4 53 27 38 27 18 163 33 INFANTILE MORTALITY Etc., IN LONDON BOROUGHS, 1938. Borough. Estd. Res. population (mid. 1938). Live births rate per 1,000 population Death rate per 1,000 population. Infantile Mortality rate per 1,000 live births. Crude. Adjusted. West districts. Paddington 137,400 13.74 11.33 11.21 66 Kensington 174,100 12.8 11.7 10.9 78 Hammersmith 125,100 15.5 11.3 11.6 61 Fulham 137,700 14.2 11.6 11.7 51 Chelsea 56,050 10.2 13.5 11.5 80 City of Westminster 124,400 8.3 10.4 10.7 54.9 North districts. St. Marylebone 90,680 8.84 11.12 11.00 60 Hampstead 90,480 11.7 11.4 10.7 57 St. Pancras 179,400 13.5 11.5 11.7 64 Islington 292,300 15.32 11.90 12.02 65 Stoke Newington 50,480 13.8 11.0 10.5 43.2 Hackney 205,200 13.4 10.7 11.2 56.46 Central districts. Holborn 34,350 7.28 10.51 11.25 84 Finsbury 56,960 13.0 12.9 14.1 73 City of London 8,780 6.6 10.7 11.8 51.8 East districts. Shoreditch 80,360 14.7 11.4 12.5 64 Bethnal Green 92,910 14.2 11.3 12.8 59.3 Stepney 200,500 13.06 11.05 12.92 62.2 Poplar 134,400 14.9 11.4 12.7 60 South districts. Southwark 145,300 14.0 12.5 13.4 57 Bermondsey 97,420 14.8 11.0 12.54 45 Lambeth 272,800 14.09 11.9 11.7 51 Battersea 141,700 14.92 11.82 11.70 53.45 Wandsworth 340,100 11.92 11.17 10.38 46 Camberwell 222,400 13.97 12.27 12.27 61 Deptford 95,460 14.4 11.8 2 54 Greenwich 95,770 13.64 10.89 11.1 42 Lewisham 229,000 13.9 10.49 10.5 47 Woolwich 150,900 13.6 10.4 11.0 50 34 LIST OF MATERNITY AND CHILD WELFARE CENTRES, ETC., IN THE METROPOLITAN BOROUGH OF STEPNEY. CENTRES. MONDAY. TUESDAY, WEDNESDAY. THURSDAY. FRIDAY. REMARKS: morning. afternoon. morning. afternoon. morning. afternoon. morning. | afternoon. morning. afternoon. (a) Municipal : I«imehouse Town Hall, Commercial Road ... 2 to 5* ... ... ... 2 to 5* ... ... 10 a.m. roddlers 4th Friday in month ... Advice to mothers, health talks and knitting classes are held in connection with these Municipal Centres. (Burdett Road, transferred temporarilly to 17, Rhondda Grove, End, on Tuesday). ... ... ... ... ... St. George's Town Hall, Cable Street ... ... 10 to 12 2 to 5* ... ... ... ... ... 2 to 5* Riverside Mansions, New Gravel Lane ... ... ... ... 10 to 12 2 to 5* ... ... ... 2 to 5 Hughes Mansions, Vallance Road ... ... ... ... 2 to 5 ... ... ... 2 to 5* 10 a.m. roddlers 2nc Friday in month ... St. Phillips Institute, Newark Street ... ... ... ... ... 2 to 5* ... ... ... ... 17, Rhondda Grove Mile End Road ... ... ... 2 to 5* ... ... ... 2 to 5* ... ... (b)Voluntary : Mission Hall, Carr Street ... ... ... 2 to 5* (also sewing) ... ... ... ... ... ... Stepney Infant Welfare Centre, St. Matthews Hall, 86a, White Horse Road 10.30 (sunlight) 2* ... ... 10.30* (sunlight) 2.15 to 4.15 (sewing) 10.30 (dental) 2.30 (lectures on home nursing and infant care) 10.30 (sunlight) 2* The Superintendent is available at her flat nearby for . consultation any day from 8 a.m. to 10 p.m. Memorial Hall, High Street, Shad well 2 to 4* ... 2 to 4* 2.30 to 4 (sewing) ... Dame Colet House— 29, Luckett Street also 9.15 to 11 (minor dressings) 2* 9.15 to 11 (minor dressings) 2* 9.15 to 11 (minor dressings) 2.30 (sewing and health talk) 9.15 to 11 (minor dressings) 9.15 to 11 (minor dressings) Sunlight with the doctor by arrangement. 10, Duckett Street 3 (sunlight) ... 2.30 (sunlight) 2.30 (sunlight) 12, St. Clare Street, Minories 2 to 4* 2.30 to 4 (knitting) 2.30 to 4 (sewing and lectures) 2 to 4*' ... Toddlers' 1 dinners daily, 1 12.30. Mothers i dinners daily,2. Jewish Infant Welfare Centre, Bernard Baron Settlement, Berner Street 9-11 (advice to mothers and minor ailments) 2 to 5* 2 to 4 (sewing) ... 2 to 5* Jewish Mothers Welcome, Bernard Baron Settlement, Berner Street 9 to 11 (advice to 1 mothers \ and minor 1 nilments) 2 to 4 (sewing) 1 9 to 11 (advice to mothers and minor ailments) 1.45 to 4* Health talks 3 to 3.30 9 to 11 (advice to mothers 1 and minor | ailments) ... 9 to 11 (advice to mothers and minor ailments) Dental 11-12 L .45 to 4* Health talks 3-3.30 9 to 11 (advice to mothers and minor ailments) Toddlers first Tuesday each month, 11 to 12.30. * Denotes that there is a Doctor in a attendance. 35 LIST OF MATERNITY AND CHILD WELFARE CENTRES, ETC., IN THE BOROUGH—continued. CENTRES. MONDAY. TUESDAY. WEDNESDAY. THURSDAY. FRIDAY. REMARKS morning. afternoon. morning. afternoon. morning. afternoon. morning. afternoon. morning. afternoon. Bearsted Memorial Hospital, Underwood Road, E-l 9.30 to 12 (dental) 2.30 to 5.30 (sewing) ... 2 to 4* ... 2 to 4* ... 2.30 to 5.30 (sewing) ... ... East Stepney Jewish Centre, 2 Beaumont Grove Mile End Ra 10 to 12.30 2 to 4* ... ... 10 to 12.30 ... ... ... ... ... ANTE-NATAL CLINICS ... ... (a) Municipal : Limehouse Town Hall, Commercial Road ... ... ... ... ... ... 10 to l* ... ... ... Hughes Mansions, Vallance Road ... ... 10 to 1* ... ... ... ... ... ... ... (b) London County Council : Mile End Hospital, Bancroft Road ... ... 10 a.m.* ... ... 2 p.m.* 10 a.m.* ... Post-natal 2 p.m.* St. George's Hospital, Raine Street ... ... ... ... 11 a.m.* ... ... ... ... 2 p.m.* (c) Voluntary: East End Maternity Hospital, 39b, Commercial Road 9-12.30* New patients 1.30* New patients 9-12.30* 2* Special appointment only 9-12.30* 2-4* post natal 9-12.30* 1.30* Dagenham patients only 9-12.30* ... Doctor in attendance at nearly all clinics Bearsted Memorial Hospital, Underwood Road, E-l 10 to 12* ... ... ... ... ... 10 to 12* ... ... ... London Hospital, Whitechapel Road ... ... 9* ... 9* ... 9.30 ... 9.30 ••• For CRECHES. Voluntary : Day Nursery, Memorial Hall, High Street, Shadwell ... ... This is an open it is open from may to October. ... consultation Jewish Day Nursery, 23, New Road ... ... Open Monday to Thursday, 7.30 a.m. to 6.30 p.m. Friday 7.30 a.m. to 5.30 p.m. ... Port of London Day Nursery, 5, Pier Head, Wapping ... ... ... Open Monday to Friday, 7.30 a.m. to 6 p.m. ... ... ... Marie Hilton Creche, Stepney Causeway ... ... ... " " 7.30 a.m. to 6 p.m. ... ... St. Paul's Day Nursery, Wellclose Square ... ... ... " " 7 a.m. to 6 p.m. ... ... ... DAY NURSERY SCHOOL—L-C.C. Old Church Road ... ... ... ... Open Monday to Friday ... ... ... ... *Denotes that there is a doctor in attendance 36 III.—SANITARY CIRCUMSTANCES OF THE AREA. Scavenging.—I am informed by the Public Cleansing Officer that there have been no alterations during the year in the Cleansing Services controlled by the Public Cleansing Department. Shops Act, 1934.—1,543 inspections were carried out during the year. It was found necessary to serve 27 notices, i.e., 6 with respect to sanitary accommodation, 8 to ventilation, and 13 with respect to temperature. No applications were received for exemption under Section 10 (2) of the Act. Pharmacy and Poisons Act, 1933.—87 persons are entered in the List of Persons entitled to sell Poisons included in part II of the Poisons List. 274 inspections and visits were made by the sanitary inspectors during the year. Smoke Nuisances.—464 observations were made by the Sanitary Inspectors for the detection of nuisances from smoke, which necessitated the serving of 25 Intimations for the abatement of the nuisance. Complaints.—2,392 written complaints were made to me during the year, which were duly investigated. Of these, 60 were from H.M. Inspector of Factories relating to workshops, 96 from the London County Council respecting verminous school children, and 2,236 related to the condition of houses, etc. In addition, numerous complaints were made to the Sanitary Inspectors. Drainage.—The Sanitary Inspectors supervise all drainage work. Full particulars as to the work done by them are given on pages 47 and 48. 2,707 drains were tested during the year. Of these, 542 were found to be defective. Rats and Mice.—During the year 750 complaints were received as to nuisances from rats or mice. As a consequence 743 drains were tested and in 210 instances they were found to be defective. 499 complaints were forwarded to the Borough Engineer and Surveyor, so that the Council's ratcatchers could call and assist the tenants concerned. The Borough Engineer and Surveyor has kindly supplied the following information as to work carried out during the year by his department. Record of Rat Destruction carried, out by the Council's Ratcatchers from 1st January to 31 st December. No. of premises visited 1,408 „ „ visits 18,687 „ „ dead rats found poisoned 48 „ „ rats caught in our traps 1,674* „ „ premises cleared of rats as reported by the Occupiers 374 „ „ new rat complaints during this period 596 *1,327 of these were actually brought into the Depot and destroyed. The poisons used were as follows:- Rodine 41,487 cubes. Barium carbonate 38,856 „ Phosphor paste 23,063 „ Extract of Squills 27,831 portions (2 oz.) 37 National Rat Week—1th to 12th November. The Council adopted a similar procedure as in previous years. Notices, drawing the attention of the public to the matter, were inserted in four local newspapers. Communications were sent to 11 local cinemas, requesting that notices be displayed on the screen, drawing attention to National Rat Week. 69 chemists and oilmen within the Borough were supplied with copies of the Ministry of Agriculture's form No. 618/T.R., bulletin No. 30 the official pictorial bills and bills " Rat Poison Sold Here," and were requested to display the same in their shop windows. Rat poison, consisting of barium carbonate, phosphor paste and rodine, were placed in the sewer manholes and side entrances at 276 different positions throughout the Borough. A total of 1,695 portions of bait were laid, of which number 1,537 were eaten. The Council employ three men as ratcatchers, who give their whole time to rat destruction. In addition to the National Rat Week in November, three extra Rat Weeks were held in February, May and August, in collaboration with the adjoining Boroughs of Bethnal Green, Shoreditch and Poplar, when poisoned bait was laid in the manholes and side entrances of the sewers in and adjoining the boundary roads of the respective Boroughs. The following is a record of the work done in Stepney during these extra Rat Weeks in 1938:— Extra Rat Weeks Dates (inc.) Poison baits laid in Manholes and Side-entrances Baits Eaten Baits Uneaten First 31st Jan. to 5th Feb 173 positions 901 43 Second 2nd to 7th May 175 ,, 909 103 Third 25th to 30th July 191 „ 1,310 287 Houses Let in Lodgings.—There are 3,472 houses let in lodgings. 3,467 inspections were carried out during the year, and it became necessary to serve 1,473 "intimations" for contravention of the byelaws. Legal proceedings were taken in 4 instances. Rent and Mortgage Interest Restrictions Acts.—180 certificates were issued to tenants as to houses not being in a reasonable state of repair, and 12 applications for such certificates were refused. 18 certificates to landlords were issued as to houses being in a reasonable state of repair and 8 such applications were refused. Water Certificates.—Certificates were granted under the provisions of the Public Health (London) Acts as to dwelling houses having a proper and sufficient supply of water with respect to 7 houses and 248 flats. 38 Hairdressers' Shops.—Annual certificates are granted respecting Hairdressers' Shops in the Borough, which come up to a certain standard of cleanliness. Four certificates were granted during the year. Mortuary and Shelter.—The number of bodies deposited in the Mortuary during the year was 95 as compared with 342 in the previous year. 8 Jewish bodies were officially "watched" (42 in 1937) and 58 inquests were held in the Coroner's Court compared with 166 last year. 47 Post-mortem examinations were made whilst the number in the previous year was 235. It will be noticed that there is a very marked decrease in the use being made of the Council's mortuary service and of the accommodation provided for the conducting of post-mortem examinations. This diminution is explained by the decision of the Council that it is not the duty of the mortuary keeper employed by this Borough Council to assist doctors in the conduction of post-mortem examinations. As his services are not now available for this purpose more inquests are being held elsewhere. The shelter is used for the accommodation of contacts of infectious disease while their homes are being disinfected. It was not found necessary to admit any persons during the year. Report supplied to the L.C.C.:- Premises. No. in borough on 31st December, 1938. No. of Inspections. No. of Prosecutions. Common lodging houses 13 272 - Seamen's lodging houses 11 153 - Cowsheds (licensed) 17 98 - Slaughterhouses (licensed) nil nil - Other offensive trades 45 384 - Milkshops:— Dairy premises 181 1,172 4 Purveyors bottled milk 428 Ice cream premises 395 529 2 Registered foster mothers 20 164 1 Nurse children kept 25 247 - Restaurants and eating houses 417 733 - Smoke Nuisances. (1) No. of observations 464 (2) No. of intimations served 25 (3) No. of complaints received 64 (4) No. of Statutory notices served- (5) No. of legal proceedings - (6) No. of convictions - (7) Amount of penalty and costs imposed in each case - 39 Cleansing and Disinfection. No. of adults cleansed 182 No. of children cleansed - Water Supply to Tenement Houses. No. of premises supplied 24 Sanitary Officers. No. of Sanitary inspectors (whole-time)—M (part-time)—Male No. of health visitors (whole-time) „ (part-time) Housing. 1. Total number of houses in the borough 38,239 Public Health Act. 2. No. of houses inspected on account of complaints or Illness 3,559 3. Number of statutory notices served 2,295 4. Number of houses repaired or nuisances remedied 9,069 Housing Act (1936). 5. Number of houses inspected— house to house (Housing Consolidated Regs. 1925) 333 6. (a)Number of houses included in representations by the BoroughMedical Officer under Sec. 25 of H.A. 1936 82 (b) Number of houses demolished following representation by Borough Medical Officer under Sec. 25 of H.A. 1936 136 7. Number of houses repaired under Sections 9 and 10 of H.A.1936: (a) by owners nil (b)by L. A. in default of owners nil 8. Number of houses demolished : (a) in pursuance of orders under Sec. 11 of the Housing Act, 1936 2 (b) Voluntarily - No. of (a) after infectious premises diseases 1,587 cleansed (b) for vermin 1,369 (c) after Tuberculosis 150 No. of prosecutions - 22 Female 1 Female - 10 9. Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) nil 10. Number of Closing Orders determined (i.e., houses made fit) nil 11. Overcrowding (Housing Act, 1936) Number of families found during the year to be living in overcrowded conditions ... 6,574 Number of overcrowded families who have obtained alternative accommodation during the year 342 12. Number of houses erected by the Borough Council for working classes during year nil 13. Underground Rooms. Number occupied but unfit 5,843 Number closed or modified occupation approved 106 14. Houses Let in Lodgings. Number in Borough 3,472 Number of inspections 3,467 Number of prosecutions 4 Number of complaints remedied under the By-laws (not included under any other heading) 85 Infectious diseases—cases notified under local orders (excluding cases coming to knowledge otherwise than by notification). Disease. Cases notified. Period. *Measles 844 1st January to 31st December German Measles - - †Whooping Cough 102 1st Ocober to 31st December Rheumatic Fever (0-16) - - Chicken Pox - - Zymotic Enteritis - - *Notifiable in children up to 5 years to 30th September and in children of all ages from 1st October. † Only made notifiable from the 1st October. 40 Canal Boats.—Pursuant to Section 249 (3) of the Public Health Act, 1030, part X, the Metropolitan Borough of Stepney, being the Registration Authority within the meaning of that Section, has to report as follows with regard to the steps taken by them during the year 1938 to carry into effect the provisions and Regulations relating to Canal Boats, namely:— (1) Canal Boats coming within the District are inspected by a Sanitary Inspector, who receives a sum of £10 per annum for the performance of this duty. His inspection is irrespective of the examination of Boats made by the Examining Officer prior to their registration. (2) The number of boats inspected was 16. Eight children were found on the boats. There were no contraventions of the Act and Regulations. No boats were registered during the year. The Factories Act, 1937.—The Factories Act, 1937, came into force during the year is an important consolidating and amending Act and replaces the Act of 1901 and various other enactments. A new factory register has had to be prepared under this Act. The compilation of this register was carried out during the year and following the suggestion of the Home Office, the District Inspector of Factories co-operated with this Department and gave every assistance. A good deal of work was involved in the preparation of this register and it will be necessary to revise the register constantly to keep it up to date. The old distinction between a "Factory" and a "Workshop" is abolished and the expression "workshop" disappears. The term "Factory" now covers both workshop and factory. The Council in general deal with factories where mechanical power is not used. Broadly speaking, it is the duty of the Borough Council to enforce various general provisions for protecting the health of persons employed in establishments where mechanical power is not used, keeping lists of Outworkers, and taking steps to prevent the carrying-on of homework in unwholesome premises. The Act of 1901 proceeded by applying the Public Health Acts and treating defaults as nuisances. Under the new Act, operative provisions are contained in the Act itself, and when not observed, the firm concerned becomes liable to a fine without, except in a few cases, the necessity for serving any notices. In factories both with and without mechanical power, the Council enforce the provisions with regard to sanitary accommodation, and in non-mechanical power factories with regard to cleanliness, overcrowding, temperature, ventilation, lighting and drainage of floors. The L.C.C. regulates the means for escape in case of fire. Drinking Water.—The Factory Inspectors must see that a wholesome supply of drinking water is available to the e mployees, but the Borough Council must approve the source of supply. This may involve chemical or bacteriological examination of the water by the Council, before the source can be approved, and it is necessary to consider as to whether the Council should bear the cost of these examinations. Homework.—Lists of Outworkers must be sent as heretofore by the firms employing them to the Local Authority, but "during February and August" not " before February and August" as previously. Basement Bakehouse.—Under the 1901 Act certificates were issued for Underground Bakehouses. Only those then certified were allowed to continue as underground bakehouses. Under the new Act it should be noted that no certificates may be issued, but, if on inspection, a bakehouse is considered unfit, the old certificate must be revoked. If fit, the old certificate may be 41 allowed to continue. Under the old act, provision was made to permit alteration to make an underground bakehouse fit before issuing a certificate. Under the new Act, if an underground bakehouse is found unfit on inspection, no power is given by the Act to permit alterations to make it fit so as to enable the certificate to continue. Unfit bakehouses must close in a specified time, not less than one month. Fit bakehouses may continue, but without prejudice, and at a future examination may be held unfit and closed. A basement bakehouse not used for a year may not be used again. A basement bakehouse not in use on the 30th July, 1937 may not be used again. In the year beginning 1st July, 1938, and in every fifth year, examinations of Underground Bakehouses must be carried out. The Act requires the Medical Officer of Health to report specifically' in his Annual Report re matters under Part 1 and Part 8 of the Act. FACTORIES ACT. HOME OFFICE. FORM 572. 1.—Inspections tor purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories with mechanical power 1,800 256 - Factories without mechanical power 602 285 - † Other Premises under the Act (including works of building and engineering construction but not including outworkers'premises) 334 65 - Total 2,736 606 - † Electrical Stations should be reckoned as factories. 2.—Defects Found. Particulars Number of Defects Number of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Want of cleanliness (S. 1) 196 192 4 - Overcrowding (S. 2) 3 3 - - Unreasonable temperature (S. 3) 8 8 - - Inadequate ventilation (S. 4) 33 33 2 - Ineffective drainage of floors (S. 6) 4 4 - - Sanitary Conveniences (S. 7) insufficient 67 67 - - unsuitable or defective 179 179 - - not separate for sexes 48 48 - - Other nuisances ... 183 183 - Other offences (Not including offences relating to Homework or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 29 - 29 - Total 750 717 35 - 42 Outwork in Unwholesome Premises.-(Section 108 of Act of 1901 ; Section III of Act of 1937.) Nature of Work Instances Notices served Prosecutions (1) (2) (3) (4) Wearing apparel- Making, etc. 249 190 - Cleansing and washing ... 7 2 - Household linen - - - Hats 1 1 - Lace, lace curtains and nets - - - Boots 4 4 - Curtains and furniture hangings - - - Furniture and upholstery 23 16 - Electro-plate - - - File making - - - Brass and brass articles - - - Furriers 2 2 - Cables and chains - - - Anchors and grapnels - - - Cart gear - - - Locks, latches and keys - - - Umbrellas, etc 1 1 - Artificial flowers 2 2 - Nets, other than wire nets - - - Tents - - - Sacks - - - Racquet and tennis balls - - - Paper, etc., boxes, paper bags 1 1 - Brush making - - - Pea picking - - - Feather sorting - - - Carding, etc., of buttons, etc. - - - Stuffed toys - - - Basket making - - - Chocolates and sweetmeats - - - Cosaques Christmas crackers, Christmas stockings etc. - - - Textile weaving - - - Lampshades - - - Total 291 220 43 Outworkers.—The net number of outworkers on the Register is 2,161 and they are engaged in the trades as follows:- Making, cleaning, etc., of ing apparel 2,042 Invisible mending 1 Dolls 1 Furriers 21 Bristles 1 Umbrellas 18 Christmas crackers 8 Boots and shoes 33 Art needlework 1 Boxes 12 Leather goods 3 Flag making 1 Ties 3 Christmas cards 1 Toys 1 Carnival novelties 1 Pattern making 3 Artificial flowers 3 Paper garlands 1 Handbags 3 Fancy goods 1 Feather curling 2 2,161 The number of inspections made to outworkers' premises was 581. Notifiable diseases occurred in 82 premises. There are 93 firms in the Borough employing outworkers, and of these firms 84 sent in lists twice in the year and 9 once. These related to a net number of 1,754 outworkers, of which 1,053 were resident in the Borough and 701 were transferred to other Districts. In addition, 484 lists relating to a net number of 1,108 outworkers were received from other Boroughs during the year. The number of factories in the Borough without mechanical power is as follows:- Bakehouses 85 Boot, shoe and slipper making 63- Cabinet making 74 Furriers 112 Hat and cap manufacturers 49 Laundries 13 Rag sorting, etc. 52 Wearing apparel (tailors, milliners, dressmakers, etc., etc.) 887 Miscellaneous 432 Total 1,767 In addition there are 1,787 factories in the Borough with mechanical power. Rag Flock Acts.—4 inspections were made during the year to premises subject to the provisions of the Rag Flock Acts. Cowsheds.—There are 17 cowsheds in the Borough. During the year 98 inspections were made to the cowsheds, and it was found necessary to serve 18 notices for minor matters. Offensive Businesses.—There are 45 authorised Offensive Businesses in the Borough, i.e., 1 Knacker's Yard, 1 Soap Boiler, 2 Tripe Boilers, 5 Dressers of Fur Skins and 36 Slaughterers of Poultry. 384 inspections were made to these premises during the year and 11 notices were served for minor matters. 44 10 persons were licensed under the Slaughter of Animals Act, 1933, as Slaughtermen at a Knacker's Yard in the Borough. Lodging Houses.—There are 13 common lodging houses in the Borough. 272 inspections were carried out during the year and 15 notices were served for various defects found to exist. The usual annual census of persons in Common Lodging Houses was taken on the night of Friday the 17th February and the following information ascertained:- I icensed Number of beds. Beds occupied. Number known to be in receipt of public assistance. Number of beds paid for by charitable organisations Meu Women Married Couples Men Women Children Married Couples Men Women Children Men | Women Children 1890 553 41 1128 349 12 14 55 32 - 69 35 8 In addition to the above, there are 11 Seamen's Lodging Houses. 153 inspections were made of them during the year, 3 notices were served for minor nuisances. Aged and Infirm Person (Sec. 224, Public Health (London) Act, 1936).— On 28th October, Mrs. N. D., an aged and infirm person, was removed from her place of residence in Spitalfields, E.l, to the Mile End Hospital under an Order of the Magistrate at the Thames Police Court of the same day. 45 Sanitary Inspection-The following tables show the work of the District Sanitary Inspectors:- REPORT OF INSPECTIONS, Etc. BY THE DISTRICT SANITARY INSPECTORS-1938. W. E. Anstee. J. H. Brownlee. J.J.Coveney. W. Cue. R. W. G. Day G. D. Freeland. H. J. Green. C. F. Guy. W. H. Haworth W. H. Howard. J. Keniry. S. Lowther. J. G. McCarthy. R. Roper. W. F. Smith. W. T. Twynham. E. P. Webber. Totals Bakehouses 35 41 13 16 42 24 7 16 4 11 10 34 24 82 23 34 2 418 Common Lodging Houses 50 18 1 23 2 11 8 - 9 - 26 - - 53 - 28 7 236* Complaints 504 782 634 446 844 638 647 769 543 1,380 915 810 1,085 757 583 609 189 12,135 Factories 69 138 46 110 99 51 180 75 54 65 28 94 20 432 86 195 58 1,800 Houses let in Lodgings 254 96 69 36 124 1,074 189 286 240 38 128 41 49 188 395 216 44 3,467 House to House 91 55 51 - 14 102 64 111 119 16 122 51 - 38 113 319 - 1,266 Infectious Disease 69 61 105 64 78 86 52 60 49 70 114 148 111 56 97 76 27 1,323 Offensive Trades 2 33 5 - 1 60 8 2 1 - 22 64 13 124 17 29 3 384 Outworkers 8 54 24 17 37 2 106 23 63 9 2 8 9 51 7 117 44 581 Restaurants and Eating Houses 54 72 - 105 53 19 14 10 30 11 108 81 - 113 13 34 16 733 Markets (week-end) 3 2 4 3 1 1 2 2 3 2 2 2 2 3 2 4 1 39 Seamen's Lodging Houses - - - 70 - 2 - - 7 - 74 - - - - - - 153 Workplaces 12 31 10 7 4 27 38 19 20 10 44 31 - 48 4 18 11 334 Workshops 30 119 29 28 26 15 52 49 19 19 6 34 12 28 34 60 42 602 Shops Act 87 123 59 85 15 70 195 44 94 8 143 134 13 272 63 63 75 1,543 * In addition, 36 inspections to Women's Common Lodging Houses were made by Miss Whitty. 46 REPORT OF INSPECTIONS, ETC. BY THE DISTRICT SANITARY INSPECTORS-1938-Continued. W. E. Anstee. J. H. Brownlee. J.J. Coveney. W. Cue. R. W. G. Day G. D. Freeland. H. J. Green. C. F. Guy. | W. H. Haworth W. H. Howard. J. Keniry. S. Lowther. j J. G. McCarthy. R. Roper W. F. Smith. W. T. Twynham. E. P. Webber. Totals Pharmacy & Poisons Act 27 18 8 70 38 10 4 5 2 8 16 16 - 20 12 20 - 274 Rag Flock Acts - - 2 2 - - - - - - - - - - - - - 4 Miscellaneous 1,561 1,126 704 827 1,457 492 701 997 1,151 983 1,431 843 547 1,982 1,164 1,327 222 17,515 Observations re Smoke Nuisance 2 8 79 132 110 37 - 2 3 3 15 38 - 9 24 2 - 464 Re-Visits 1,422 1,925 1,503 1,441 2,075 1,971 1,331 1,408 789 1,774 1,298 1,621 1,759 1,190 1,456 1,814 397 25,174 Intimations served 399 545 387 348 580 619 590 574 527 988 362 524 771 417 642 738 195 9,206 Statutory Notices served 58 124 84 42 199 136 167 210 113 305 88 176 122 34 188 173 76 2,295 No. of Summonses taken out - 2 - - - - 8 1 1 - - 2 2 3 - - 19 47 RETURN OF SANITARY WORK, 1938 W. E. Anstee. J. H. Brownlee. J. J. Coveney. W. Cue. R. W. G. Day G. D. Freeland. H. J. Green. C. F. Guy. W. H. Haworth W. H. Howard. J. Keniry. S. Lowther. J. G. McCarthy. R. Roper. W. F. Smith. W. T. Twynham. E. P. Webber. Totals. Animals kept so as to constitute a nuisance, removed - 3 - - - - 2 1 - 2 1 - - 5 1 3 - 18 Bakehouses: No.of cleansingsof 17 20 10 - 15 20 14 14 12 8 1 10 16 11 34 43 - 245 Cisterns cleansed, covered and repaired 5 34 - - - - 31 1 11 - 5 8 1 12 1 18 - 127 Dampness in premises remedied 67 111 126 94 167 129 92 103 115 105 82 183 251 156 223 205 43 2,252 Drains—Cleansed or repaired 40 68 44 23 101 71 51 59 60 72 59 30 50 81 97 55 24 985 Constructed or reconstructed 21 38 67 32 15 10 10 14 22 22 68 53 11 68 21 20 2 504 Dust receptacles provided 63 81 44 71 111 92 46 178 60 195 87 84 196 69 49 41 24 1,501 Number of dwelling rooms cleansed 291 349 357 528 916 413 356 419 226 485 236 468 753 351 274 324 44 6,796 Houses ventilated beneath the ower floor 8 7 - 27 - - - 3 9 3 1 - 4 - 26 - - 88 Improved light and ventilation provided to rooms 2 7 2 7 1 - - - 13 1 1 4 1 - 24 - - 67 Manure receptacles provided or reconstructed - - 12 - - - - 2 - - - - - - - - - 14 Offensive accumulations removed 7 40 17 5 16 51 46 12 54 15 34 28 14 48 12 65 14 479 48 RETURN OF SANITARY WORK, 1988—Continued. W. E. Anstee. J. H. Brownlee. J.J. Coveney. W. Cue. R. W. G. Day G. D. Freeland. H. J. Green. C. F. Guy. W. H. Haworth W. H. Howard. J. Keniry. S. Lowther. J. G. McCarthy. R. Roper W. F. Smith. W. T. Twynham. E. P. Webber. Totals. No. of gutters and rain-water pipes fixed or repaired 76 44 28 140 125 12 61 73 82 70 74 50 85 63 82 109 26 1,200 No. of repairs to roofs 90 114 72 278 351 116 45 130 95 228 87 128 123 82 155 90 53 2,237 Sink, bath and lavatory pipes fixed or repaired 10 89 84 169 138 35 59 25 78 78 120 184 43 55 75 94 32 1,368 Smoke nuisances abated 12 12 29 5 5 3 - 1 - - - - - 10 1 2 - 80 Urinals fixed or repaired 2 17 10 7 5 - 16 11 27 6 9 9 7 20 3 18 4 171 Verminous rooms cleansed - 60 26 22 5 7 62 43 113 56 2 8 - 73 53 99 2 701 Waterclosets—Cleansed or repaired 47 111 51 110 109 117 174 64 100 57 77 126 90 148 38 142 61 1,622 „ Light and ventilation provided 2 24 9 4 - 1 32 1 16 - 10 - - 63 13 30 9 214 „ Pans and traps fixed 29 51 89 190 63 33 57 45 65 39 127 65 35 86 49 71 19 1,213 „ Provision or repair of flushing apparatus 23 53 56 65 53 29 62 36 65 100 127 77 69 112 38 108 32 1,105 Water supply to houses reinstated or repaired - 23 9 17 14 8 12 9 21 8 11 6 16 38 24 26 4 246 Yards, areas and forecourts cleansed, paved, or paving repaired 75 35 21 63 82 92 46 28 41 44 8 52 34 51 36 43 2 753 Floors,windows, staircases, fireplaces and coppers repaired 222 147 201 355 492 209 192 247 174 416 193 419 472 157 240 259 53 4,448 Miscellaneous 143 235 41 295 342 235 259 361 222 359 121 221 160 249 228 259 100 3,830 49 Legal Proceedings :— Date. Matter of Information or Complaint. Result. Public Health (London) Act, 1936. 19th Jan. Failing to make the roof of No. 3, Grosvenor Street weatherproof. Pay £2 8s. 0d. costs and ordered to do work in fourteen days. 25th Jan. Failing to abate a nuisance caused by accumulation of rubbish at Turner House. Work completed at time of hearing. Pay £2 5s. 0d. costs. 26th Jan. Failing to abate a nuisance caused by dirty walls and ceiling of room at 6, Milward Street. Work completed at time of hearing. Pay £2 8s. 0d. costs. 31st Jan. Failing to abate a nuisance arising from defective and dirty walls and ceilings at 10, Edwards Road. Work completed at time of hearing. Pay £2 5s. 0d. 2nd Feb. Failing to abate a nuisance arising from obstructed water-closet, defective dustbin ; defective and dirty walls and ceilings at 33, Eric Street. Work done at the time of hearing of summons. Pay £2 5s. 0d. costs. 3rd Feb. Failing to abate a nuisance arising from defective water-closet, pan and trap at 263, Fieldgate Mansions. Work done at the time of hearing of summons. Pay £2 2s. 0d. costs. 9th Feb. Failing to abate a nuisance caused by defective drain at 7, Milward Street. Pay £2 8s. 0d. costs. Order to do work within 21 days. 11th Feb. Exposing for sale a tubercular pig's head and collar at 56, Watney Street on 21st December, 1937. Dismissed under Probation of Offenders Act on payment of £5 5s. 0d. costs. Defendant pleaded guilty. 24th Feb. Failing to abate a nuisance arising from defective roof, etc., at 79, Moody Street. Fined £3. Pay £2 8s. 0d. costs. Order to do work within 14 days. 16th March Failing to keep the rooms in his occupation in a cleanly state. Ordered to abate nuisance in seven days. Pay £2 8s. 0d. costs. 23rd March Depositing filth in a room where food was" deposited for the purpose of sale on 19th January. Fined £1. Pay £2 2s. 0d. costs. 23rd March Using as a sleeping place on 19th January, a room where food was deposited for the purpose of sale. Summons dismissed. 30th March Failing to abate nuisance due to verminous rooms at 20, Brady Street Mansions, Brady Street. Fined £5. Pay £2 8s. 0d. costs. Ordered to do work in 7 days. 30th March Exposing for sale a diseased (tuberculous) fowl on the 24th February, at 14, Hessel Street. Fined £2. Pay £3 3s. 0d. costs. 26th April (i) Undertaking for reward the nursing and maintenance of a foster child without giving the requisite notice to the Council; and (ii) failing to give a similar notice to the Council of the removal of the child from her care after such removal. Sent to prison for a period of four months with hard labour. 50 Date. Matter of information or complaint. Result. 11th May Failing to abate a nuisance caused by an accumulation of rubbish at 134, Whitechapel Road. Case dismissed. £1 Is. 0d costs to defendant. 13th May Failing to abate a nuisance caused by an accumulation of rubbish at 10, Greenfield Street. Rubbish removed. £2 8s. 0d. costs. 13th May. Failing to abate a nuisance caused by accumulation of rubbish at 33, Plumbers Row. £2 8s. Od. costs. Ordered to do work in 7 days. 20th May Failing to comply with a Nuisance Abatement Order made against him on 10th March. (Hearing adjourned from 13th May, 1938). £5 fine, £1 Is. Od. costs. 23rd May Having deposited in preparation for sale 4 tubercular pigs' heads on 26th January. Case dismissed under Probation of Offenders' Act on payment of £5 5s. Od. costs. 4th July Not observing due cleanliness at the grocery and milkshop on 13th May. Fined £1 and £1 Is. Od. costs. 15th July Accumulation of rubbish Case dismissed. Magistrate ruled there was no nuisance arising out of the accumulation. Defendant awarded £5 5s. Od. 30th Sept. Storing ice cream at 450, Mile End Road, such premises not being registered. Case dismissed under Probation of Offenders'Act with £1 Is. Od. costs. 30th Sept. Failing to keep ice cream wafer machine and drinking glasses in a cleanly state. Case dismissed under Probation of Offenders' Act. 7th Oct. Exposing for sale 2 tubercular fowls at 28, Burslem Street on 8th August. Fined £25. Pay £10 costs. 26th Oct. Failing to maintain the prepared food premises (fried fish) at 82, Cable Street in a cleanly condition on 1st July. Fined £1. Pay £2 2s. Od. costs. 10th Nov. Failing to abate a nuisance caused by defective eaves gutter and rainwater pipe ; also defective and untrapped sink waste pipe at 129, Hanbury Street. Ordered to do work within 7 days. Pay £2 8s. Od. costs. 24th Nov. Exposing for sale on 1st September, a quantity of sultanas which were unsound, unwholesome and unfit for the food of man. Case adjourned sine die owing to illness of defendant. (The case was adjourned from 10th Nov., 1938.) 15th Dec. Failing to abate a nuisance arising from defective roof at 123, Sidney Street. Fined £5. Pay £2 8s. Od. costs. 23rd Dec. Failing to abate a nuisance arising from defective roof, ceiling, dustbin, &c., at 44, Durham Row. The work was done before hearing of the case. Fined £3. Pay £2 8s. Od. costs. 26th Dec. Exposing for sale on 8th November, 18 packages of figs which were unsound and unfit for human food. Fined £2. Pay £1 Is. Od. costs. 51 Date. Matter of information or complaint. Result. • Food and Drugs (Adulteration) Act, 1928. 14th Jan. Selling butter on 25th Nov., 1937, which contained at least 50% margarine. Sample B.705. Fined £1. Pay £2 2s. Od. costs. 14th Jan. Selling rolls and butter on 7th Dec., 1937, the fat of which consisted of 100% margarine. Sample B.722. Case dismissed under Probation of Offenders Act on payment of £2 2s. Od. costs. 17th Jan. Using the premises, 18 Hessel Street, for the purpose of the manufacture of margarine, such premises not being registered. Fined £10. Pay £3 3s. Od. costs. 17th Jan. Selling margarine on 25th Nov., 1937, which contained 60% of milk fat. Sample B.704. Fined £10. Pay £3 3s. Od. costs. 17th Jan. Having in their possession on 25th Nov., 1937, a package containing margarine, such package not having the word "margarine" branded or durably marked on the top, bottom and sides thereof in printed capital letters not less than three-quarters of an inch square. Fined £10. Pay £3 3s. Od. costs. 17th Jan. Selling by retail margarine in an unstamped wrapper on 25th Nov., 1937. Case withdrawn. 17th Jan. Exposing for sale on 26th Nov., 1937 a parcel of margarine, such parcel not being labelled with the word " margarine." Case withdrawn. 24th March Selling rolls and butter on 14th February, the fat of which contained at least 60 per cent, margarine. Fined £1. Pay £2 2s. Od. costs. 24th March Selling rolls and butter on 14th February, the fat of which contained at least 60 per cent, margarine. Case was adjourned sine die. 24th March Selling rolls and butter on 14th February, the fat of which consisted of 100 per cent. margarine. Fined £5. Pay £2 2s. Od. costs. 25th March Selling milk on the 8th February, which was deficient of 41.0 per cent, of fat. Fined £2. Pay £2 2s. Od. costs. 12th April Selling rolls and butter on 3rd March, the fat of which contained at least 10% margarine (Sample B.144). £2 fine, £1 ls. Od. costs. 25th April Selling rolls and butter on 25th March, the fat of which consisted of 100% margarine. £1 fine, £2 2s. Od. costs. 20th June Selling on the 3rd May, cream cheese which contained only 8.8% of fat and was made from partially skimmed milk and not from cream, at 27, Fieldgate Street (Sample C.291.) Fined £1. Pay £2 2s. Od. costs. 52 Date. Matter of information or complaint. Result. 20th June Selling on the 3rd May, cream cheese which contained ony 9.8% of fat and was made from whole milk and not cream at 4, Wentworth Street. (Sample C.292) Fined £1. Pay £2 2s. Od. costs. 21st June Selling on the 3rd May, double cream cheese which contained only 11.5% of fat and was made from partially skimmed milk and not from cream at 28, Shepherd St. (Sample C.293.) Fined £5. Pay £3 3s. Od. costs. 27th June Selling milk on the 19th May, which was 4.7% deficient of the minimum amount of fat 14 Wentworth Street. (Sample C.335) Fined £5. Pay £2 2s. Od. costs. 30th June Selling rolls and butter on the 16th May, the fat of which consisted of 100% margarine. (Sample B.328.) Fined £1. Pay £2 2s. Od. costs. *18th July Selling, on 27th May, butter which contained at least 36% margarine. (B.368) Fined £10 and £10 10s. Od. costs jointly. 19th July Selling, on 8th June, bread and butter the fat of which consisted of 100% margarine. (B.833) Fined 10s. and £1 ls. Od. costs. 19th July Selling, on 8th June, bread and butter the fat of which consisted of 100% margarine. (B.833) Fined 10s. and £1 Is. Od. costs. 19th July Selling, on 8th June, rolls and butter the fat of which consisted 100% of margarine. (B.382) Fined £20 and £2 2s. Od. costs. *25th July Wilfully obstructing the Inspector in the course of his duties on 27th May. Fined £5. 8th August Selling, on 20th June, rolls and butter the fat of which consisted of 100% margarine. (C.412) Fined £1 and £1 ls. Od. costs. 9th August Selling, on 20th June, rolls and butter the fat of which consisted of 100% margarine. (C.412) Fined £1 and £1 ls. Od. costs. 8th Sept. Selling, on 28th July, rolls and butter the fat of which contained 38% margarine. (B.505) Case dismissed under Probation of Offenders Act, with £2 2s. Od. costs. 26th Sept. Selling, on 5th August, rolls and butter the fat of which consisted of 100% margarine. (B.539) Fined £1 and £2 2s. Od. costs. 21st Nov. Exposing for sale by retail on 12th October, a parcel of margarine, such margarine being unlabelled. Fined £1. 30th Nov. Selling rolls and butter on 17th October, the fat in which consisted of 100% margarine. (B.670.) Fined £2. Pay £2 2s. Od. costs. 30th Nov. Selling rolls and butter on 17th October, the fat in which consisted of 100% margarine. (B.671) Fined £2. Pay £2 2s. Od. costs. *The same defendants. 53 Date- Matter of information or complaint. Result. 8th Dec. Selling sal-volatile on 7th October, which was 95.4% deficient of alcohol. (C.633.) Case dismissed under Probation of Offenders Act. Pay £2 2s. Od costs. 8th Dec. Selling rolls and butter on 17th October, the fat in which consisted of 100% margarine. (B.674.) Milk and Dairies Order, 1926. Fined £1. Pay £2 2s Od. costs. 17th March Carrying on the business of a dairyman at 64, Bedford Street, on 14th January, the premises not being registered as a dairy. Fined £1. Pay £1 ls. Od. costs. 25th March Carrying on the business of a dairyman on 8th February, at 184, Cable Street without being registered. Fined £1. 7th April Carrying on the trade of a dairyman in Stepney without being registered. Case dismissed under Probation of Offenders Act on payment of £2 2s. Od. costs. 4th July Carrying on the trade of a dairyman on 2nd June, the premises not being registered as a dairy. Milk and Dairies (Amendment) Act, 1922. Fined £2 and £1 ls. Od. costs. 18th March Selling on 13th January, pasteurised milk without being licensed. Dismissed under Probation of Offenders Act on payment of £1 ls. Od. costs. 5th July Selling pasteurised milk on 16th May without a licence. Housing Act, 1936. Fined £2 and £2 2s. Od. costs. 26th July Permitting an underground room to be used for human habitation in contravention of a Closing Order. London County Council bye-laws. Fined £5 and £3 3s. Od. costs. 5th April Failing to maintain the roof of the fish gutting yard in proper repair on 14th June. £2 fine. £2 penalty. £2 2s. Od. costs. 22nd Sept. Constructing a water closet without giving notification or submitting plans, in contravention of Bye-laws. Fined £3 and £1 ls. Od. costs. 54 Fines. Costs. Penalties. £ s. d. £ s. d. £ Public Health (London) Act, 1936 (31) 53 0 0 67 6 0 Food and Drugs (Adulteration) Act, 1928 (32) 100 0 0 64 1 0 — Milk and Dairies (Amendment) Act, 1922 (2) 2 0 0 3 3 0 — Order, 1926 (4) 4 0 0 4 4 0 Housing Act, 1936 (1) 5 0 0 3 3 0 — L.C.C. Bye-laws—Vendor of Fried Fish (1) 2 0 0 2 2 0 2 L.C.C. Drainage Bye-laws (1) 3 0 0 1 1 0 — (72) 169 0 0 145 0 0 2 IV.—HOUSING. Slum Clearance.—During the year the Council made Compulsory Purchase Orders as follows :— Persons to be Houses. displaced. Gill Street Area 31 218 Prittlewell Place Area 19 60 The Council also made Clearance Orders, as follows:— Person to be Houses. displaced. Rugg Street Area 4 15 Willow Row Area 21 81 Amoy Place Area 8 18 Birchfield Street Area 3 11 An Inquiry was held by the Ministry of Health and all the Orders were confirmed without modification. The L.C.C. also passed Clearance Order resolutions in respect to the following areas within the Borough:— Persons to be Houses. displaced. Umberston Street Area 292 1,524 Solander Street Area 99 656 Overcrowding.—The overcrowding survey in 1935 revealed the fact that 7,632 families were overcrowded. The number of cases to date not included in the above total is 456. From May, 1936 to the end of December, 1938, 1,832 certificates of overcrowding (Orange Forms) had been sent to the L.C.C. Of this number the L.C.C. have rehoused 457 families, 78 within the Borough and 379 outside. 55 In the process of slum clearance, 567 cases of overcrowding have been abated. 490 cases of overcrowding have been abated by Owners transferring tenants and by reduction or removal of families. Summary. Number of families overcrowded as per 1935 survey 7,632 Additional to December, 1938 456 8,088 Number Abated since 1935 Survey. By L.C.C. as result of Orange Forms 457 By Slum Clearance 567 Abated privately 490 1,514 Number of Families overcrowded December, 1938 6,574 Underground Rooms. -At the beginning of the year there were 5,949 underground rooms which did not comply with the Housing Act and the Regulations made thereunder. During the year closing orders were made in respect of 4 underground rooms. 14 other underground rooms were altered and made to comply with the regulations and 88 unfit underground rooms were demolished in clearance areas and in the demolition of unfit houses, thus leaving 5,843 still to be dealt with. Number of Flats in the Borough owned by Public Authorities. No. of flats owned by S.B.C. 1,310 L.C.C 1,387 „ „ City Corporation 169 „ „ Stepney Housing Trust 66 (The Stepney Housing Trust are included as they house tenants for the L.C.C. from slum clearance areas or overcrowding.) Stepney Borough Council Flats in course of erection. Beccles Street 100 Ring House 15 West India House 31 Limehouse Fields 41 Further sites to be developed. Gill Street Area (confirmed) 43 Prittlewell Place Area (confirmed) 10 Solebay Street Area (C.P.O. represented) 30 ? Limehouse Fields, 2 blocks which will probably be surplus 40 56 L.C.C. Areas already confirmed or declared. 1935 Shadwell Place 194 Partly cleared. Building commenced. Pennington Street 180 „ „ „ Chicksand Street 193 Cleared. Partly developed. Pedley St. (part in Stepney) 20 1936 Waley Street, No.2 8 Clearance Area only. James St. (part in Stepney) 4 Malay Street 128 Partly cleared. 1937 Ocean Street 729 Phoebe St. (part in Stepney) 274 Small portion cleared. Christian Street 270 Partly cleared. 1938 Umberston Street 292 Solander Street 99 2,391 Note.—This figure, 2,391 houses (less those already dealt with) to be cleared, will represent a much larger number of flats to be provided, as the number of families will far exceed the number of houses. The L.C.C. have, therefore, a very large building programme before them to complete the rehousing of areas already in hand. The L.C.C. are able to rehouse a certain number of families outside the borough as will be seen by the reports on overcrowding and underground rooms on pages 54 and 55. Having regard to the large and urgent demand for accommodation for rehousing from slum clearance areas, it is evident that it will take some considerable time to complete the task of dealing with overcrowding and underground rooms other than those included in such areas. There are other factors which may ultimately affect the problem. Of these, the yearly reduction in population and the question of the location of industry have to be borne in mind. The latter is receiving considerable attention at the present time. The affect of the above factors in reducing the population may in time be counteracted in other ways. There are many families now living outside the Borough though working locally, who are doing so at considerable sacrifice and who are naturally anxious to reside locally as soon as the housing conditions make this possible. With the improvement of local housing and environmental conditions therefore, the population of the borough will tend to become stabilized and may even increase. We are building and planning for the future, and the ultimate aim is to attain the standard set out in the Housing Act, when every occupier and his family will have a house suitable to their needs and means, with security of tenure and reasonable proximity to the place of employment. Moreover, the social conditions and environment of such a home should be favourable to the enjoyment of a full and happy life. HOUSING ACT, 1936 re Overcrowding Anstee Brownlee Coveney Cue Day Freeland Green Guy Haworth Howard Keniry Lowther McCarthy Roper Smith Twynham Webber Bottom ley Total No. of houses in which the rooms were measured and the permitted numbers ascertained 160 61 29 13 14 109 22 439 241 37 216 4 157 271 146 84 14 1,165 3,182 No. of visits for such purpose 194 83 29 8 9 206 22 531 360 43 225 4 133 288 198 109 21 1,165 3,628 No. of houses for which information has been supplied on request to owners and occupiers 71 61 30 13 14 39 22 429 206 — 160 4 157 271 102 84 14 1,085 2,762 57 68 Statistics.—I.—Inspection of dwelling houses during the year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 21,144 (6) Number of inspections made for the purpose 26,243 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 333 (b) Number of inspections made for the purpose 333 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitatation 262 (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 9,069 2.—Remedy of defects during the Year without service of formal Notices:— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 7,083 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 — (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners — (b) By local authority in default of owners— (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2,003 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— {a) By owners 2,003 (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 tion Orders were made 1 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 2 (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 4 (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.—Housing Act, 1936—Part IV.—Overcrowding :— (a) (i) Number of dwellings overcrowded at the end of the year 6,574 (ii) Number of families dwelling therein 6,574 (iii) Number of persons dwelling therein 36,157 59 (b) Number of new cases of overcrowding reported during the year 30 ((f) (i) Number of cases of overcrowding relieved during the year 342 (ii) Number of persons concerned in such cases 1,881 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report(See page 63.) — Housing accommodation provided.—703 families in the Borough took accommodation on the London County Council housing estates as follows:— Ann Street, E.14 3 Banbury Road, E.8 1 Becontree, Essex 277 Bekesbourne Bldgs., E.14 9 Bellingham, S.E.6 8 Betts Street, E.1 40 Birchfield Street, E.14 1 Boundary Street, E.2 22 Bow Bridge, E.3 3 Brightlingsea Bldgs., E.14 2 Brook Street, E.l 2 Cable Street, E.l 9 Chicksand, E.l 21 Collingwood, E.l 4 Coventry Cross, E.3 1 Darcy Buildings, E.8 1 Dinmont, E.2 3 Downham, Kent 21 Downs, E.5 2 Ellen Street, E.l 7 Haggerston, E.8 1 Hanwell, W.7 1 Hanbury Street, E.l 4 Holland, E.l 7 Honor Oak, S.E.22 1 Horwood, E.2 1 Hughes Fields, S.E.8 1 Kennington Park, S.E.11 1 Kings Mead, E.9 1 Millwall, E.14 3 Mottingham, Kent 16 North Avenue, N.l 1 Northwold, E.5 1 Old Ford Road, E.3 1 Pembury, E.5 21 Potts Street, E.2 1 Prestons Road, E.14 13 Quaker Street, E.l 20 Roehampton, S.W.15 1 St. Helier, Surrey 4 St. Katherines, E.l 89 Shipwright House, E.14 31 Shore, E.9 1 Stamford Hill, N.l6 21 Wapping, E.l 16 Wellington, E.2 1 West Ferry Road, E.14 4 White Hart Lane, N.l7 2 Whitmore, N.l 1 House to House inspection.—List of streets in which all houses have been inspected as a result of House to House inspection during the year 1938 :— Limehouse. Mr. Coveney. Giles Place. Manor Court. Medland Street Ratcliffe Cross St Schoolhouse Lane Stepney Causeway Mr. Cue. Nil. Mile End. Mr. Day. Nil. Mr. Guy. . Cleveland Grove. . Coburgh Place. Goveys Place. . Grebe Court. Osier Street. Stayners Road. XX Place. ST. GEORGE S. Mr. Anstee. Cornwall Street. Hunger ford St. Whites Gardens. Mr. Freeland. Rogers Court. Virginia Place. Walburgh Place. Whitechapel. Mr. Brownlee. Pavilion Bldgs. Rowland Street. Victoria Cottages. Mr. Green. Zion Lodge. Mr. Roper. Brownsons Court. Margarets Bldgs. Fleur de Lis Bldgs. 60 Limehouse. Mr. McCarthy. Nil. Mile End. Mr. Howard. Nil. Mr. Lowther. Maplin Place Murdock Cottages. Mr. Smith. Antcliff Street. Bedford Cottages. Oley Place. Vine Cottages. St. George's. Mr. Haworth. Durer Place. East Tenter St. Meredith Bldgs. Morrison's Bldgs South. Rupert Street. Sander Street. Scarborough St. Mr. Keniry. Clifford House. Whitechapel. Mr. Twynham. Easington Bldgs. Frostic Place. Irene House. Lolesworth Bldgs. Perrys Avenue. Samuel Court. Sir Georges Houses. Sir Georges Residences. Wilkes Street. V. INSPECTION AND SUPERVISION OF FOOD. Since February, 1938, there have been systematic inspections of poultry exposed for sale on market stalls and in shops in the Borough. The main cause for condemnation of poultry has been the presence of tuberculosis, generally of the livers and intestines. Other conditions warranting condemnation were dropsy, emaciation and cancer. As a result, 906 fowls were condemned during the year. Some difficulty was at first experienced in securing the co-operation of poultry vendors but this has now been largely overcome and the vendors are now on the whole co-operating more willingly. In only two instances was it found necessary to seize fowls and the subsequent proceedings resulted in the imposition of fines and costs. There were three other instances where legal proceedings were taken as the result of seizures of unsound food exposed for sale. The sampling of milk reveals that the standard is being maintained. There has been much less evidence of adulteration by the addition of water, and there has been a small increase in the average amount of non-fatty solids. Samples of milk have been taken in course of delivery to the various schools, hospitals and institutions in the Borough for bacteriological and chemical examination. The improvement in the condition of food premises in the Borough has been maintained. 61 The following is a summary of the inspections, etc., by the four special Inspectors engaged in the supervision and inspection of food:— H. Abson. A. C. Brown. T. W. Dee. S. Vogler. Totals. Bishopsgate Goods Station *13 — †195 208 Butcher and Bacon shops 395 — — 1 396 Butcher and Bacon stalls 310 — — 310 Butter and Margarine premises — 25 — 32 57 Complaints 15 68 29 41 153 Cowsheds — 40 — 58 98 Fish shops 37 — 15 52 Greengrocers and Fruiterers — - 165 — 165 Ice Cream premises — 250 — 279 529 London Fruit Exchange — — 376 — 376 Markets (Daily) 334 390 21 459 1,404 Markets (Week-end) 3 3 3 3 12† Milkshops — 560 — 612 1,172 Prepared Food premises 225 147 — 142 514 Spitalfields Market — — 378 — 378 Wharves 419 — 757 — 1,176 Wholesale Grocers. — 67 — 155 222 Miscellaneous visits 106 397 80 433 1,016 Revisits 162 497 388 662 1,709 Samples taken—-Food and Drugs 9 796 — 788 1,593 „ „ Other 11 74 47 83 215 No. of Summonses taken out 4 27 1 18 50 *Of these, 10 were special night or early morning inspections. † „ 59 „ „ „ „ „ „ „ „„ „ † 39 inspections were also made by the District Sanitary Inspectors. Milk Supply. Dairy premises 181 1,172 96 Purveyors (Bottled) Milk 428 122 Itinerant Vendors 75 — 6 Cowsheds 17 98 18 7 Samples of milk were submitted to the Bacteriologist for the detection of tuberculosis (guinea pig inoculation). In 1 case, the two animals inoculated both died of an extraneous infection, therefore no report of tuberculosis was available. 1 sample gave a positive result to tuberculosis. The Ministry of Agriculture and Fisheries were informed and their Veterinary Surgeon visited the cowshed, carried out an inspection of the herd and took group samples of milk from 80 cows. One sample from 14 cows gave a positive result biologically on first investigation. On re-examination it was found that two cows from this group had been slaughtered since the first visit, and a sample of milk from the remaining 12 cows gave a negative result on biological examination. The Divisional Inspector of the Ministry of Agriculture and Fisheries, in his report, states, " It would therefore appear reasonable to assume that one of these two cows was responsible for the contamination." 95 samples of milk were taken in course of delivery to various schools in the Borough. 49 of the samples were submitted for chemical analysis and 46 for bacteriological examination. Of these, 4 samples (C.257, C.435, B.452 and B.668) examined bacteriologically proved to be unsatisfactory (see following table). The remainder of the samples were satisfactory. 26 samples of milk were taken in course of delivery to various hospitals and institutions in the Borough. 24 were submitted for chemical analysis 62 and 2 for bacteriological examination. 1 sample (B.631) submitted for chemical analysis was found to be deficient in fat—the vendors were cautioned, and 1 sample (C.251) examined bacteriologically also proved to be unsatisfactory (see following table). 4 " Appeal to the cow " samples were taken because a dairyman in the Borough was receiving milk which was deficient in fat from a farmer in Essex. The samples were taken by the Essex County Council and were all found to be deficient in fat. A cautionary letter was sent to the farmer and the Essex County Medical Officer communicated with to take the necessary action to bring the milk up to standard. 28 samples of milk were taken from individual cows in a cowshed in the Borough for bacteriological examination in view of the fact that a roundsman employed to deliver milk from this cowshed was removed to hospital suffering from typhoid fever. The samples gave a negative result for organisms of the enteric group. Arrangements were made for this dairy to sell only pasteurised bottled milk obtained from another firm and all other necessary precautions were taken. The following samples were submitted for bacteriological examination:— Nature of sample No. of samples taken Number unsatisfactory and action taken Milk (Pasteurised) 53 5. C.251 and B.668. The M.O.H.'s of the Boroughs concerned were informed. C.257 and C.435 (taken from same vendor). Improvements were made regarding storage of the clean milk bottles). B.152. Further samples from the same source proved satisfactory. Milk (Undesignated) 29 1. Advice was given regarding the method of production. Milk (Tuberculin Tested) 3 1. M.O.H. of Borough concerned was notified. Milk (Evaporated) 1 — Milk Drinking Straws 1 — Tinned Salmon 3 — Cooked Mussels 1 — Olives 1 — Water 2 — Watercress 1 — Boiled Salt Beef 1 - Designated Milk.—84 licences were issued under the Milk (Special Designations) Orders, 1936 and 1938, being 8 more than in the previous year, as follows :— Dealer's Supplementary Licences. licences. "Pasteurised" 48 12 " Tuberculin Tested" 18 6 Ice Cream.—22 samples of ice cream and commodities used in its manufacture were submitted for bacteriological examination. 8 samples showed the presence of Coliform bacilli in 1 c.c. of the ice cream. In these cases, steps were taken to procure improved sterilisation and storage of the utensils, and, in some, the manufacturers were advised to use Pasteurised milk. As 63 a result, there were decided improvements in the subsequent samples. 1 sample was found to contain over a million bacteria per c.c. The subsequent sample procured after the manufacturer had been advised as above, showed that the amount of bacteria had been reduced to 150,000 per c.c. Ice Cream Premises.—The number on the register at the end of the year was 395. 529 inspections were made and 59 notices served. Butchers' Shops and Stalls.—706 inspections were made during the year and 5 notices were served for minor infringements of the Meat Regulations. Butter and Margarine Factories, etc. No. on No. of No. of Register. Notices Inspections, served. Butter and Margarine Factories 5 — 57 Wholesale Dealers in Margarine 46 6 Preserved Food Premises. Preserved Fish Premises 113 100 514 Preserved Meat Premises 164 19 Merchandise Marks Act.—Inspections were made to various premises in connection with the marking of imported goods, particularly apples, tomatoes, butter, dried fruits and meat, and in this respect, it was found necessary to serve 68 notices for infringements of the Act. Greengrocers' and Fruiterers' Shops and Stalls.—165 inspections were made and 7 notices were served. Wholesale Grocers, etc.—222 visits were made to Wholesale Grocers and 16 notices were served. 84 notices were served in respect of miscellaneous food premises. Bakehouses.—418 inspections were made during the year to the 103 in the Borough. Restaurants and Eating Houses.—733 inspections were made during the year to the 417 in the Borough. Certification of Food Products for Export.—31 certificates have been issued respecting the export of consignments of food products prepared within the Borough :— 12 to Australia. 2 to Syria. 9 to Canada. 1 to Italy. 4 to Holland. 3 to The United States of America. 1,186 other certificates were issued in respect to unsound food destroyed. Unsound Food.—1,176 inspections were made at the various wharves in the Borough. The following is a list and quantity of the foodstuffs from the wharves destroyed during the year under the Public Health (Imported) Food Regulations, 1937:— 64 Preserved Meat and Poultry. Tons Cwts. Qtrs. lbs. 566 tins Beef 1 6 1 16 267 „ Ox Tongues — 17 2 26 21 „ Veal — 1 2 0 Fresh Fruit and Vegetables. 625 bags Figs 7 16 1 0 198 barrels Grapes 6 10 3 6 149 boxes Grape Fruit 5 7 3 0 122 cases Lemons 3 8 2 0 947 boxes Mandarines 2 14 3 22 105 cases Onions 6 13 2 8 8,007 boxes Oranges 257 17 1 5 62 packages Plums — 7 1 3 1 bundle Tomatoes — — — 26 Preserved Fruit and Vegetables. 1,104 tins Assorted Fruits — 15 0 21 139 „ Apricot Pulp — 16 1 8 2 „ Black-currant Pulp — — — 22 Currants 1 2 2 20 29 packages of Dried Fruits — 13 2 23 7,105 tins Oranges 2 14 0 24 16 „ Peaches — — 3 12 1,680 „ Pears — 11 0 0 870 „ Pineapple — 12 2 0 26 boxes Raisins — 5 2 26 2,329 tins Tomatoes 1 11 1 18 468 „ Tomato Pulp 2 1 0 0 Prunes — 2 0 11 Preserved Fish. 230 tins Assorted Fish — 1 0 3 1,731 „ Crab — 4 3 19 420 „ Herring Roes — 4 0 12 Sundries. Assorted Canned Goods 18 9 1 17 9 cartons Biscuits — 5 0 0 1 bag Cocoa Sweepings — — 2 7 11 cases Desiccated Cocoanut — 12 1 2 3 boxes Lard — 1 2 19 9 barrels Lemon Juice 2 5 0 0 Miscellaneous foodstuffs 4 15 1 15 60 cartons Quaker Oats 2 8 0 0 2 bags Sugar Sweepings — 3 2 0 2 barrels Orange Juice — 10 0 0 1 box Tapioca — 1 1 15 53 cases Walnuts 1 7 0 12 335 18 1 26 65 The following foodstuffs have been destroyed during the year under the Public Health (London) Act, 1936:— (a) Spitalfields Market and London Fruit Exchange. Tons Cwts. Qtrs. lbs. 2,455 boxes Apples 51 11 2 25 Carrots 5 9 2 1 36 packages Grapes 1 4 0 24 131 boxes Grape Fruit 4 10 2 24 97 „ Lemons 3 10 3 0 27 crates Lettuce — 3 0 0 112 boxes Mandarines — 8 3 20 275 crates Melons 3 13 3 0 Onions 5 0 0 0 316 boxes Oranges 12 1 3 26 43 boxes Peaches — 5 1 4 1,068 boxes Pears 20 3 3 22 2 crates Plums — — 2 20 449 bags Potatoes 4 13 0 18 19 boxes Rhubarb — 5 2 0 778 boats Tomatoes 4 13 0 18 117 16 1 6 (b) Other Premises. Meat and Poultry. Tons Cwts. Qtrs. lbs. Bacon — — — — 1,313 tins Assorted Meats 2 5 2 18 1 piece Beef — — 3 13 20 sets Calves Lungs — — 1 12 2 Cows Udders — — 2 2 5 Ducks — — — 18 906 Fowls 1 5 2 24 Ham — 5 1 20 5 pieces Ox Liver — — — 12 4 Pigs' Heads — — 2 0 1 Pig's Head and Collar — — — 7 80 Rabbits - 2 0 2 Fish. Cockles — — — 26 1 box Haddock — 1 0 0 7 chilled Salmon — — 2 5 Skate — — 1 7 Soles - — — 6 66 Fruit and Vegetables. Tons. Cwts. Qtrs. lbs. Apples — — — 2 3 packages Bananas — 1 2 0 Butter Beans 50 0 0 0 4 bags Currants — 4 1 16 49 tins Cucumbers — 6 0 0 189 cartons Dates — 3 0 0 81 packets Figs — — 1 9 Gherkins and Olives — 17 0 0 65 barrels Grapes — 12 0 0 343 packages Horse-radish 6 7 0 0 Melons 1 8 0 0 326 boxes Oranges 19 13 1 2 184 boxes Pears 3 8 0 16 2 bags Peas — 1 3 20 Sultanas 3 Sundries. Assorted Canned Goods 4 14 2 0 Assorted Confectionery — 7 0 3 10 tins Frozen Eggs — 2 2 24 114 bags Flour 6 14 1 24 Gelatine 7 1 2 25 5 bags Rice and Rice Flour — 5 1 18 30 bags Sago and Sago Flour 2 3 2 23 108 15 2 21 67 198 Detention Notices and 224 Release Notices were issued during the year in respect of the undermentioned foodstuffs:— Article. Detention Notices. Release Notices. Quantity. No. of notices. Weight. Quantity. No. of notices. Weight. T. C. Q- lbs. T. C. Q. lbs. Mutton 23,271 carcases. 62 - 23,271 carcases. 62 - Tallow 1,759 casks. 36 703 12 0 0 3,789 casks. 104 1,515 12 0 0 Sugar Sweepings 133 bags. 28 11 6 1 10 109 bags. 10 9 14 2 1 Miscellaneous foodstuffs (flood damaged) 1,385 packages. 23 - 459 packages. 17 — Sugar 398 bags. 16 19 11 0 21 390 bags. 15 19 0 0 0 Walnuts (shelled) 95 cases. 4 2 8 1 16 42 cases. 1 1 1 1 16 Ox Tongues 263 tins. 4 — 8 0 17 — — - Raisins 479 boxes. 3 5 19 3 0 774 boxes. 3 9 13 3 0 Cocoa 704 bags. 2 44 12 3 8 703 bags (repkd.) 2 44 7 2 25 Sausages 6 cases. 2 — 3 1 0 6 cases. 2 — 3 1 0 Assorted Meats 1,470 tins. 2 1 19 1 3 — — Pearl Barley 100 bags. 1 5 0 0 0 — — — Crab 1,331 tins. 1 — 6 0 2 — — - Meat Extract 44 cases. 1 2 4 0 0 — — - Victoria Plums 1,872 tins. 1 1 19 2 16 — — - Drained Cherries 1 case. 1 — 2 0 0 — — - Tomatoes 1,106 tins. 1 — 5 0 0 — — - Liquid Glucose 1 barrel. 1 — 5 0 20 — — - Grape Fruit Juice 90 barrels. 1 27 14 0 0 1 barrel. 1 — 3 0 0 Peaches 96 tins. 1 — 5 0 16 80 tins. 1 — 4 1 4 Grape Juice 22 barrels. 1 11 15 2 24 22 barrels. 4 11 15 2 24 Oranges 300 tins. 1 — 1 0 14 — — — Tomato Puree 78 tins. 1 1 19 0 0 — — - Dried Pears 33 boxes. 1 — 7 0 0 — — - Cocoa Sweepings 1 bag. 1 — — 2 7 — — — Onions 256 boxes. 1 16 0 0 0 158 boxes. 1 9 17 2 0 Grapes 851 barrels. 1 22 15 3 16 655 barrels. 1 16 5 3 10 68 There were 1,275 carcases of imported mutton examined for Caseous Lymphadenitis by the cutting of the lymphatic glands. All the carcases were found to be free from disease. The number of diseased carcases found in 1937 was 3 or 13 per cent. Tea Sweepings weighing 45 tons 16 cwts were removed from warehouses for chemical purposes. Proceedings were taken under the Food and Drugs (Adulteration) Act, 1028, against a firm in the Borough, for manufacturing margarine on unregistered premises, for selling margarine containing 60 per cent, of milk fat and for having in their possession a package containing margarine which was not correctly labelled. Fines and costs totalling £39 9s. Od. were imposed. Another firm were summoned under the Food and Drugs (Adulteration) Act, 1928, for selling butter containing at least 36 per cent, margarine, and one of the partners was summoned for obstruction. Informal sampling was carried out for several weeks prior to the purchase of the official sample and these samples showed the presence of amounts varying from 36 per cent, to 60 per cent, of margarine. Fines and costs totalling £25 10s. Od. were imposed. Copper in imported tomato pulp, tomato puree, etc.—In view of the proposal of Port Sanitary Authorities to exclude from 1st January, 1939, consignments of tomato products containing more than 50 parts per million of the dried total solids, various wharfingers in the Borough handling such goods were circularised in March and asked to co-operate by informing the merchants concerned. Owing to subsequent representation by the exporting countries that the suggested action was somewhat drastic, it was modified to a tolerance of 100 parts per million from 1st January, 1939 to 1st January, 1940, after which, the standard of 50 parts per million would be enforced. The wharfingers were circularised to this effect in December, 1938. 18 samples of tomato products were taken during the year and the copper content ranged from 39 to 129 parts per million of the dried total solids. During February, large quantities of foodstuffs were damaged by flood water as a result of the exceptionally high tide causing the flooding of many warehouses on the river side. These were detained, the sound portion removed and the unsound portion surrendered for destruction. Zeebrugge-Harwich Train Ferry.—69 special midnight and early morning visits were made by the Food Inspectors. In addition, 139 inspections were made by day. At Bishopsgate Station.—-The total weight of the fresh fruit and vegetables entered was approximately 11,335 tons. This consisted of :— Belgian Carrots. Bulgarian Grapes and Plums. 69 Egyptian Mandarines. Greek Grapes and Mandarines. Hungarian Apricots, Gooseberries, Grapes, Melons, Peaches, Plums and Red Currants. Italian Apricots, Aubergines, Cauliflowers, Cherries, Figs, Grapes, Lemons, Mandarines, Melons, Onions, Oranges, Peaches, Pears, Peas, Plums, Potatoes and Tomatoes. Yugo Slavian Plums. Bulgarian Strawberry Pulp, Belgian Bacon, Biscuits and Eggs, Dutch Butter, Hungarian Bacon, Frozen Liquid Eggs and Poultry, Italian Cheese, Chestnuts and Poultry, Roumanian Eggs and Poultry, Yugo Slavian Bacon, Frozen Liquid Eggs, Eggs and Poultry were also examined. The following foodstuffs were found to be unsound and were destroyed:- tons. cwts. qrs. lbs. 411 crates of Apricots 4 11 2 20 598 packages of Grapes 5 5 2 12 1,350 Melons 13 2 3 8 16 trays of Peaches — 1 3 18 2 crates of Pears — — 1 0 9,969 packages of Plums 78 16 1 6 3 bags of Potatoes — 1 1 12 3 casks Strawberry Pulp — 9 0 0 102 8 3 20 A first consignment of Yugo Slavian Frozen Liquid Eggs arrived on 14th March and considerable consignments have since been received. A sample taken was found to be free from preservatives. Consignments of this commodity were also received from Hungary and a sample taken on 26th May also proved to be free from preservatives. 6 cases of Sausages were detained as they were not officially certificated in accordance with the Public Health (Imported Food) Regulations, 1937. 1 case arrived from Switzerland on 25th April, and a certificate from a competent authority was submitted on 10th May, and the case subsequently released. The remaining 5 cases arrived from Italy on 11th October. Permission was given for these to be re-exported on 4th November. Large consignments of Bulgarian Strawberry Pulp arrived during May and June. A sample taken on 11th June was found to contain 914 parts of sulphur dioxide per million, which is within the limit permitted by the Public Health (Preservatives, etc., in Food) Regulations, 1925. During the first two weeks in September, large quantities of Hungarian and Yugo Slavian fruit arrived in an unsound condition. This was due to delay occasioned by railway dislocation on the Continent, caused by the international crisis at that time. (For further matters relating to Foods, see the Public Analyst's report on the following pages). 71 Borough Analyst's Annual Report. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Stepney. Ladies and Gentlemen, I have the honour to submit to you my fifteenth Annual Report, dealing with the work carried out in the Borough Laboratory during the year 1938. During the year 1,738 samples were submitted to me for examination. These samples were made up as under :— Foods 1,459 1,586 Drags 127 Public Health Department 130 Borough Engineer 9 Public Cleansing Officer 3 Private 6 Essex County Council 4 1,738 The 1,586 samples of foods and drugs were purchased or taken by Inspectors under the Food and Drugs (Adulteration) Act and consisted of:— Formal Samples 976 Informal Samples 610 1,586 Out of 976 formal samples 49, or 5.0 per cent., were adulterated and of 610 informal samples 58, or 9.5 per cent., were adulterated, making a total of 1,586 samples, out of which 107, or 6.7 per cent, were adulterated. Table A shows the nature of the samples taken under the Food and Drugs (Adulteration) Act, and gives the numbers and percentages found to be adulterated, and the number of samples found to contain preservative. Table A. Nature. Number of Samples. Number Adulterated Percentage Adulterated Preservative Found. Ammoniated Quinine Tablets 11 8 72.7 - Ammoniated Tincture of Quinine 3 — — — Arrowroot 3 — — None Aspirin Tablets 2 — — — Baking Powder 5 — - None Basilicon Ointment 2 - - - Beer 3 - - 2 Blancmange 3 — — None 72 Table A—Continued. Nature. Number of Samples. Number Adulterated Percentage Adulterate Preservative Found Boracic Powder 3 - - - Borax 2 — — — Boric Ointment 6 — — — Bread 4 — — — Bread and Butter 185 41 22.2 — Butter 53 9 17.0 None Cake 7 — — - Camphorated Oil 3 — — - Caraway Seeds 3 — - - Cascara Sagrada Tablets 1 — — - Castor Oil 3 — — - Chocolate Cakes 15 7 46.7 - Cider 3 — — 3 Cinnamon 9 — — — Cocoa 6 — — — Cod Liver Oil 1 — — — Coffee 3 — — — Condensed Milk 10 — — None Cooked Meats 3 — — None Corn Flour 2 — — None Cream 12 1 8.3 None Cream Cheese 27 10 37.0 None Cream of Tartar 3 — — — Curry Powder 2 — — None Custard Powder 5 — — None Dried Fruit 11 — — 6 Dried Milk 3 — — None Dried Mint 3 - — - Dripping 6 — — — Egg Substitute Powder 6 — — 1 Epsom Salts 2 — — — Eucalyptus Oil 3 — — — Fish Paste 2 — — None Flour 3 - — None Glauber's Salt 3 - - - Glycerine 3 — — - Glycerine, Honey and Lemon 3 — — - Gregory's Powder 3 — — - Grey Powder 5 3 60.0 - Ground Almonds 3 — — - Ground Ginger 9 4 44.4 None Honey 3 — — None Hydrogen Peroxide 1 — — - Iodine Ointment 3 — — - Iodine Paint 1 — —- - Jam 3 — — 2 Jelly 15 — — 6 73 Table A.—Continued. Nature. Number of Samples Number Adulterated Percentage Adulteratec Preservative Found Junket 2 - - - Lard 8 — — — Lard Substitute 2 — — — Lemonade Powder 3 — — None Liniment of Turpentine 2 — — — Margarine 34 — — None Meat Paste 1 — — None Milk 886 13 1.5 None Minced Meat 2 — - None Mincemeat 3 — - None Mineral Waters 3 - - None Mustard 5 — - — Oatmeal 3 - - None Olive Oil 6 - - — Parrish's Food 3 — - — Pearl Barley 3 — - None Pepper 10 — - None Potassium Citrate 1 — - — Quinine and Cinnamon Tablets 5 2 40.0 — Rice 8 — — None Saccharine Tablets 3 — — — Sago 3 1 33.3 None Sal Volatile 10 4 40.0 — Sauce 3 — — None Sausage 11 1 9.1 7 Seidlitz Powder 6 — — — Sodium Bicarbonate 6 — — — Sodium Citrate 2 — — — Spice 2 — — — Spirits 3 — — — Suet 7 1 14.3 — Sulphur Ointment 4 — — — Sweets 5 — — 3 Tartaric Acid 3 — — — Tea 6 — — — Tincture of Iodine 9 — — — Tinned Fish 3 — — — Vinegar 7 2 28.6 None Zinc Ointment 6 — — — 1,586 107 6.7 30 Details of samples shown in the above table to contain preservative are given under the respective headings in those cases where an offence had been committed. 74 Table B shows the number of samples taken under the Act with the percentage of adulteration, and also the total number of samples examined during the past ten years. Table B. Year. Samples taken under the Act. Number Adulterated. Percentage Adulterated. Bact. Examinations. Miscellaneous Samples. Total Samples. 1929 1,537 63 4.1 - 72 1,609 1930 1,518 35 2.3 1 83 1,602 1931 1,488 43 2.9 46 173 1,707 1932 1,546 48 31 38 185 1,769 1933 1,513 37 2.4 20 112 1,645 1934 1,614 74 4.6 — 111 1,725 1935 1,630 139 8.5 — 109 1,739 1936 1,575 125 7.9 — 241 1,816 1937 1,544 134 8.7 — 162 1,706 1938 1,586 107 6.7 — 152 1,738 Of the samples taken under the Act 1,459 consisted of foods and of these 90, or 6.2 per cent., were adulterated ; of the remaining 127 samples consisting of drugs 17, or 13.4 per cent., were adulterated. Legal Proceedings.—Offences were committed in 117 cases. These were dealt with as shown below:— Adulterated. Other offences. Total. Formal Proceedings 27 10 37 Caution 20 — 20 No action 2 — 2 Informal 58 — 58 107 10 117 Fines and costs totalled £156 17s. 6d. Milk .—886 samples of milk were analysed. Of these 13, or 1.5 per cent., were adulterated. Only 3 of the adulterated samples were watered. Table C shows the number of samples of milk examined and the percentages of adulteration during the last ten years. Table C. 1929. 1930. 1931. 1932. 1933 1934. 1935. 1936. 1937. 1938. Number of samples. 923 900 881 974 928 1005 965 984 890 886 Percentage of adulteration. 8.9 22 3.0 26 22 4.6 7.7 8.6 7.5 1.5 The year shows a great decrease in the percentage of adulteration. This is the result of the successful use of the freezing point method in the previous year. 75 Table D shows the extent of the adulteration and the action taken in each case. Table D. Number. Deficient in Fat per cent. Deficient in Solids-notfat per cent. Minimum added water per cent. Hortvet. Action : Result of Proceedings. B 66 12.3 - - Vendor cautioned. C 76 41.0 — — Vendor fined £2 with £2 2s. costs. C 108 22.7 30.1 30.3 Vendor cautioned. B 270 3.7 4.4 5.5 Vendor cautioned. C 317 8.3 — — Vendor cautioned. C 335 4.7 — — Vendor fined £5 with £2 2s. costs. C 350 11.3 — — Vendor cautioned. B 506 — 3.1 2.8 Vendor cautioned. B 631 27.0 — — Vendor cautioned. C 717 18.0 — — Vendor cautioned. C 720 24.7 — — Vendor cautioned. C 772 21.0 — — Vendor cautioned. C 802 71.0 — — Vendor cautioned. In connection with the above samples C717 and C 720, four samples of milk were taken on request by the Essex County Council from the farms concerned. Three of these samples were deficient in fat and solids-not-fat and the fourth was deficient in fat only. The average composition of the samples of milk genuine and adulterated received during the year is shown below. The four samples from Essex are not included. Table E. Month. Number examined. Fat per cent. Solids-not-fat per cent. Total Solids per cent. January 67 3.56 8.75 12.31 February 73 337 8.71 12.08 March 78 341 8.73 12.14 April 68 3.39 8.71 12.10 May 77 3.31 8.75 12.06 June 80 3.44 8.75 1219 July 63 3.47 8.73 12.20 August 60 3.59 8.66 12.25 September 70 349 8.71 12.20 October 86 3.63 8.78 12.41 November 81 3.54 8.73 12.27 December 83 3.55 874 12.29 Whole Year 886 3.48 8.73 12.21 Legal Minimum — 30 8.50 " 76 The yearly averages, including adulterated samples are given in the following table :— Table F. Year. Fat per cent. Solids-not-fat per cent. Total Solids per cent. 1929 3.62 8.65 1227 1930 3.65 8.70 12.35 1931 3.69 8.69 12.38 1932 3.60 8.69 12.29 1933 3.63 8.74 12.37 1934 3.61 8.74 12.35 1935 3.54 8.73 12.27 1936 3.50 8.74 12.24 1937 3.50 8.67 12.17 1938 3.48 8.73 12.21 Hospitals, etc., Samples.—24 samples of milk were taken on delivery for chemical examination from various institutions in the Borough. The average composition of the milk was:—Fat, 3.47 per cent., and solids-not-fat 8.72 per cent. School Samples.—49 samples of milk were taken on delivery at schools in the Borough. The average composition of the samples was Fat 3.46 per cent., and solids-not-fat 8.72 per cent. Bread and Butter.—185 samples consisting of either bread and butter or rolls and butter were examined. Of these, 6 samples of bread and butter and 35 samples of rolls and butter were adulterated. The adulterated samples comprised:— Informal Samples— Bread and Butter.—B 174, B 359, B 466, B 660 and B 739. In these five samples the fat consisted entirely of margarine fat. Rolls and Butter.—B 55, B 74, B 102, B 176, B 192, B 193, B 293, C 399 B 414, B 490, B 656, B 657, B 699, B 805, C 834 and B 820. In these 16 samples the fat consisted entirely of margarine fat, also— B 123. The fat contained at least 30 per cent, of margarine fat. C 401. The fat contained at least 80 per cent, of margarine fat. B 463. The fat contained at least 50 per cent, of margarine fat. Formal Samples. B 92. Rolls and butter. The fat contained at least 60 per cent, of margarine fat. Vendor fined £1 with £2 2s. Od. costs. B 93. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £5 with £2 2s. Od. costs. B 144. Rolls and butter. The fat contained at least 10 per cent, of margarine fat. Vendor fined £2 with £l 1s. Od. costs. B 191. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £1 with £2 2s. Od. costs. B 328. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £1 with £2 2s. Od. costs. 77 B 382. Buttered rolls. The fat consisted entirely of margarine fat. Vendor fined £20 with £2 2s. Od. costs. B 833. Bread and butter. The fat consisted entirely of margarine fat. Vendor fined £1 with £2 2s. Od. costs. C 412. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £2 with £2 2s. Od. costs. B 505. Rolls and butter. The fat contained at least 38 per cent, of margarine fat. Discharged under the Probation of Offenders Act. Vendor paid £2 2s. Od. costs. B 539. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £1 with £2 2s. Od. costs. B 670. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £2 with £2 2s. Od. costs. B 671. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £2 with £2 2s. Od. costs. B 674. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £1 with £2 2s. Od. costs. B 767. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £1 with £1 1s. Od. costs. B 768. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £l with £1 1s. Od. costs. B 815. Rolls and butter. The fat consisted entirely of margarine fat. Vendor fined £l with 10s. 6d. costs. C 839. Rolls and butter. The fat consisted entirely of margarine fat. Discharged under the Probation of Offenders Act. Vendor paid £2 2s. Od. costs. Considerably more samples of bread and butter and rolls and butter have been taken during the year. The figures for the years during which these samples have been taken are given below. Year. Number of Samples. Number Adulterated. Percentage Adulterated. 1935 23 5 21.7 1936 43 6 14.0 1937 69 12 17.4 1938 185 41 22.0 Butter.—Out of 53 samples of butter analysed 9, or 17 per cent., were adulterated. B 310 (Informal). Contained at least 37 per cent, of margarine. B 325 (Informal). Contained at least 50 per cent, of margarine. B 335 (Informal). Contained at least 45 per cent, of margarine. B 337 (Informal). Contained at least 60 per cent, of margarine. B 338 (Informal). Contained at least 55 per cent, of margarine. B 342 (Informal). Contained at least 55 per cent, of margarine. B 349 (Informal). Contained at least 57 per cent, of margarine. B 371 (Informal). Contained at least 36 per cent, of margarine. B 368 (Same vendor as the above eight samples). Contained at least 36 per cent, of margarine. Vendors fined £10 with £10 10s. Od. costs. 78 The vendors of the above samples had paid £42 in fines and costs in the previous year for similar offences. During three weeks in May the above series of samples were taken, genuine samples being occasionally obtained. Eventually the formal sample B 368 was obtained through an agent. Condensed and Dried Milk.—10 samples of condensed milk and 3 samples of dried milk were genuine and free from preservative. These samples complied with the requirements of the Condensed Milk and Dried Milk Regulations respectively as regards percentage composition of milk fat and milk solids, and each tin contained sufficient condensed or dried milk to produce the number of pints of standard milk as stated on the label. Chocolate Cakes.—Out of 15 samples analysed 7 samples were found to be adulterated. Informal samples B 257, B 258, B 259, B 260, B 261 and B 262 contained 0.3, 0.3, 0.6, 0.4, 0.3 and 0.6 per cent, dry fat free cocoa material respectively. B 375 contained no chocolate. Vendor cautioned. To have a reasonable taste of chocolate, cakes should contain 4 per cent, of dry fat-free cocoa material. Cream.—12 samples of cream were examined and one sample was adulterated. C 794 contained at least 35 per cent, of foreign fat. The sample was sold as cream, but the carton from which it had been obtained was labelled with a fancy name with " Grade A Milk Product " beneath. In smaller print at the back of the carton were the words " best fresh milk enriched with a highly refined and very digestible fat." A more satisfactory labelling would be to print " A cream substitute " in letters of the same size under the fancy name. The description " Artificial Cream " can only be used when only milk products are used in the manufacture. Cream Cheese.—Of 27 samples of cream cheese analysed 10 samples had not been made from cream. C 52. Double Cream Cheese. Consisted of Single Cream Cheese. Vendor cautioned. C 248 (Informal). Consisted of soft cheese made from whole milk. C 249 (Informal). Double Cream Cheese. Consisted of soft cheese made from whole milk. C 250 (Informal). Consisted of soft cheese made from whole milk. C291. Consisted of soft cheese made from partially skimmed milk. Vendor fined £1 with £2 2s. Od. costs. C 292. Consisted of soft cheese made from whole milk. Vendor fined £1 with £2 2s. Od. costs. C 293. Double Cream Cheese. Soft cheese made from partially skimmed milk. Vendor fined £5 with £3 3s. Od. costs. B 341 (Informal). Consisted of soft cheese made from partially skimmed milk. C 742 (Informal). Consisted of soft cheese made from whole milk. C 776. Consisted of soft cheese made from whole milk, Vendor fined £2 with £2 2s. Od. costs. 79 Ground Ginger.—9 samples of ground ginger were analysed and of these, 4 samples were adulterated. B 644 and B 646 (Informal). Deficient in water soluble constituents B 689. Deficient in water soluble constituents. Vendor cautioned. B 690. Deficient in water soluble constituents. Vendor cautioned. A sample taken on delivery to one vendor was satisfactory. Sago.—Out of three samples of sago examined, 1 sample, C 455 (Informal), consisted of tapioca. Sausage.—Of 11 samples of sausage examined, 1 sample was found to be adulterated. A 83. Pork Sausage. Contained 22 parts sulphur dioxide per million without declaration or notice of the presence of preservative. Vendor cautioned. Suet.—7 samples of shredded suet were analysed and of these, 1 sample was adulterated. C 178 (Informal). Contained 10.7 per cent, of starch without declaration. Vinegar.—Of 7 samples of vinegar examined, 2 samples were found to be adulterated. C 371 (Informal). Consisted entirely of artificial vinegar. C 398 (Same vendor as C 371). Consisted entirely of artificial vinegar. Vendor cautioned. In Sutton v. Tame, the County of London Sessions Appeal Committee on 15th June, 1937, decided that "to sell a substance as vinegar or table vinegar without any qualification or explanation as to its origin being given by the seller to the purchaser implies that the substance sold is produced by a process of fermentation." According to this decision if artificial vinegar is supplied when vinegar is asked for, it must be shown by label or declaration that the vinegar is a nonbrewed product. Before this decision most of the vinegar sold in the Borough consisted of artificial vinegar, i.e., diluted acetic acid coloured with caramel. Drugs.—Of 127 drugs analysed, 17 or 13.4 per cent, failed to comply with the requirements of the British Pharmacopoeia and were returned as adulterated. Ammoniated Quinine Tablets. B 726 (Informal). 4.7 per cent deficient in quinine sulphate and 47.8 per cent, deficient in ammonia. B 727 (Informal). 31.1 per cent, deficient in quinine sulphate and 61.1 per cent, deficient in ammonia. B 728 (Informal). 5.8 per cent, deficient in quinine sulphate and 93.3 per cent, deficient in ammonia. B 729 (Informal). 36.8 per cent, deficient in quinine sulphate and 83.3 per cent, deficient in ammonia. B 797. 61.2 per cent, deficient in ammonia. Vendor cautioned. B 799. 33.7 per cent, deficient in quinine sulphate and 61.2 per cent, deficient in ammonia. Vendor fined £2 with £1 1s, Od. costs, 80 B 800. 4.8 per cent, deficient in quinine sulphate and contained only traces of ammonia. Vendor cautioned. C 816. 34.6 per cent, deficient in quinine sulphate and 90.8 per cent, deficient in ammonia. Vendor fined £2 with £2 2s. Od. costs. Regarding the ammonia content these tablets are of little use as the ammonium bicarbonate gives off its ammonia which penetrates the coating and is lost. There is no excuse for the deficiency of quinine sulphate. A satisfactory preparation is given in the Codex to the British Pharmacopoeia, the quinine sulphate and ammonium bicarbonate being mixed with paraffin and enclosed in a capsule. Grey Powder. C 130 (Informal). 14.2 per cent, deficient in mercury. C 131 (Informal). 13.5 per cent, deficient in mercury. C 166. 19 per cent, deficient in mercury. No action taken. Quinine and Cinnamon Tablets. B 730 (Informal). 32.4 per cent, deficient in quinine sulphate. B 798. 32.8 per cent, deficient in quinine sulphate. Vendor cautioned. The formula on the bottle showed 12.5 per cent, quinine sulphate, whereas only 8.4 per cent, was found. The manufacturers stated that their declaration was based on the uncoated weight of the tablets, the uncoated tablet weighing 3 grains and sugar coated 5 grains. This is misleading as the purchaser does not know how much quinine sulphate is present in each tablet. A tablet might be 90 per cent, coating, in which case the amount of quinine sulphate in the remainder would be very small. To avoid misunderstanding, the label should show the actual content of quinine sulphate per tablet. Sal Volatile. C 605 (Informal). 95.4 per cent, deficient in alcohol. C 633. 95.4 per cent, deficient in alcohol. Dismissed under the Probation of Offenders Act. Vendor paid £2 2s. Od. costs. (Liq. Ammon. Aromat. had been supplied instead of Sp. Ammon. Aromat. and the same price charged.) C 666 (Informal). 20 per cent, deficient in ammonia and 1.2 per cent, deficient in carbon dioxide. C 685 (Informal). 13.8 per cent, deficient in ammonia and 10.7 per cent, deficient in carbon dioxide. Poor Quality Samples.—These comprise samples of inferior grade or of doubtful character and are 20 in number. 12 of these consisted of milk. Other poor quality samples were :—Sal Volatile (3), Shredded Suet, Sausage, Ground Ginger, Glycerine and Eucalyptus Oil, 81 Offences other than Adulteration. Milk.—3 unregistered vendors were fined £1 with £1 1s. 0d. costs, £1, and £2 with £1 1s. Od. costs, respectively. The unregistered vendor of adulterated sample C 76 was fined £1. For selling pasteurised milk without a licence one vendor was fined £2 with £2 2s. Od. costs and in another case the summons was dismissed under the Probation of Offenders Act, the vendor paying £1 1s. 0d. costs. Butter.—The vendor of adulterated sample B 368 was fined £5 for obstruction. Ice Cream.—One unregistered vendor was discharged under the Probation of Offenders Act and paid £1 1s. Od. costs. Margarine.—One vendor was fined £1 for a labelling offence. Cream.—For filling bottles with cream on unregistered premises one vendor was fined £2 with £2 2s. Od. costs. Miscellaneous Samples.—152 miscellaneous samples were submitted for analysis. These include 4 cowshed samples. Of the remaining 148 samples, 120 were foods, and of these, 21 or 17.5 per cent, were unsatisfactory. The samples were submitted by:— Public Health Department.—130 samples submitted by the Public Health Department comprised the following :— Metallic Contamination.—37 samples were examined and of these, 4 were unsatisfactory. Satisfactory samples were:—Tinned Tomatoes (12) and Tomato Puree (6) examined for copper. (Port Medical Officers have agreed that not more than 100 parts per million of copper should be permitted in tomato products from 1st January, 1939.). Meat Extract (5), Tinned Herrings (4), Tinned Plums (2), Tinned Salmon (2) and Tinned Oranges (1), examined for tin. Grapes (1) examined for arsenic. Unsatisfactory samples were:—Tinned Herrings (4) (contained 2.2, 2.6, 3.1 and 2.5 grains tin per pound respectively). Preservatives.—53 samples were examined and of these 4 were unsatisfactory. Satisfactory samples were:—Tinned Tomatoes (5), Tinned Peas (2), Liquid Egg (2) and Mint Salad Cream. These were free from preservative. Other satisfactory samples which contained preservative in amount less than the permitted quantity were:—Sultanas (24), Raisins (14) and Strawberry Pulp (1). Unsatisfactory samples were:—Grape Fruit Juice (2), Pearl Barley (1) and Sultanas (1) (contained 700, 730, 25 and 928 parts sulphur dioxide respectively). Fit for Food.—18 samples were examined with regard to their fitness for human consumption. 9 of these samples were unsatisfactory. Satisfactory samples were:—Self-Raising Flour (2), Condensed Milk (2), Milk (2), Vinegar Essence (1), Wine (1) and Tinned Brisling (1). 82 Unsatisfactory samples were:—Olives (2) (metallic contamination), Milk (contained salt), Sultanas (insect infested), Pickled Onions (turbid, etc.), Figs (in bad condition), Bread (dirty), Dried Milk (unsatisfactory condition) and Bacon Rind (Metallic contamination). Cause of Illness.—Of 6 samples said to have caused illness, 4 samples were free from harmful ingredients or impurities. These were:— Mineral Water, Lemonade, Tea and Tea Infusion. The remaining samples were Wine (smell of coal tar) and Milk (contained a small percentage of soap). Other Samples.—Other samples were:—Formalin (9) (2 deficient in formalin), Well Water (3), Bath Water, "Dust and Insecticide. Rag Flock Act.—According to the standard of cleanliness required by the Rag Flock Regulations, rag flock must not contain more than 30 parts of chlorine in 100,000 parts of the flock. One informal sample was satisfactory. Borough Engineer.—9 samples comprised Carbolic Powder (6) (2 deficient in cresols) and Cold Bitumen (3). Public Cleansing Officer.—3 samples of Carbolic Powder (2 deficient in cresols) were examined. Private Samples.—6 samples consisted of Evaporated Milk (2), Cream, Chocolates, Pearl Barley and Vegetarian Jelly. I wish to express my appreciation of the able assistance given me throughout the year by Mr. W. M. Paulley, B.A., F.I.C. I have the honour to be, Ladies and Gentlemen, Your obedient servant, DOUGLAS HENVILLE, Borough Analyst. Chemical Laboratory, 43, White Horse Road, E.l. April, 1939. 83 VI.—PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Notifications.—2,235 notifications (other than of tuberculosis) were received, or 639 more than in the previous year, largely due to Measles and Whooping Cough. The notification rate for the whole Borough was 11.1 per 1,000 of the population. Wrong Diagnosis.—91 cases of infectious diseases removed to hospital were found not to be suffering from the disease stated on the certificate. Of these, 15 were cases of scarlet fever, 56 of Diphtheria, 8 of Dysentery, 1 of Enteric Fever, 3 of Membranous Croup, 4 of Measles, 2 of Erysipelas and 2 of Poliomyelitis, 28 cases were notified by private practitioners and 63 were from public institutions. Scarlet Fever.—368 cases were notified during the year, or 13 less than in the previous year. 356 of these cases were removed to hospital. There were 2 deaths from scarlet fever during the year, case mortality was 0.54 per cent. Diphtheria.—400 cases were notified during the year, or 244 less than in the previous year. 397 of these cases were removed to hospital. The death rate for the whole Borough was .04 per 1,000 of the population. There were 9 deaths, of which 7 were of children from 1 to 5 years of age, and 2 over 5 years of age ; the case mortality was 2.25 per cent. Anti-Diphtheritic Serum.—This serum is supplied on request to the general practitioners of the Borough. During the year 42 tubes, each containing 4,000 units, were issued from the Public Health Office. Diphtheria Immunisation.—At the free Diphtheria Immunisation Clinic, 535 new cases attended during the year. This shows an improvement on last year, and I have no doubt the numbers at the Clinic will continue to go up as the clinic beco nes better known. The change made last year in the medium used for innoculation has proved successful. I refer to the change from the three inoculation method with T.A.M. to the two inoculation method with A.P.T. Only 2.1 per cent, of the children were found to be still susceptible after the completion of the immunising inoculations. It was interesting to note that 23 per cent, of the children were found to be naturally immune from Diphtheria, and so did not require to be inoculated. This high degree of "herd immunity" is found among crowded city populations and is the result partly of a hereditary immunity, and partly of the immunising effect of many slight contacts with the diphtheria bacillus, insufficiently severe to cause symptoms of the disease. These mild infections in themselves stimulate the body to develop an immunity. Efforts to make known the Diphtheria Immunisation Clinic have been continued during the year. Leaflets were distributed throughout the Schools of the Borough, and at the Infant Welfare Centres. Posters are exhibited throughout the Borough and every opportunity is taken to bring home to the parents of the Borough the desirability of having their young children protected from this most dangerous disease, 84 (a) Total number of clinics held 56 (b) Total number of all attendances of children at same (either for Schick or Immunisation) 1933 (c) Number of Primary Schick tests 525 (d) Number of Final Schick tests 288 (s) Number of Immunisation Inoculations given 734 (/) Number of Immunisation Certificates given 359 (g) Number of individuals who have attended the clinic for the first time during the year 535 (h) Number aged 12 months and under when they made first attendance 11 (i) Number aged 1 year to 5 years inclusive when they made first attendance 372 (j) Number aged 6 years to 14 years inclusive when they made first attendance 143 (,k) Number of adults, viz., from 15th birthday upwards who attended 9 (I) Number who failed to return for reading of first Schick 5 (m) Number who began but failed to complete their immunisation doses 25 (n) Number who failed to come for final Schick (or for reading of final Schick) 15 (o) Number found immune after first Schick and not therefore inoculated 23% 120 (p) Number found to be still susceptible after one complete course 6 2.1% (q) Number of latter given a second course 6 (r) Number of (q) found immune after second course 6 (s) Number still in course of treatment at end of year and not yet completed 112 (t) Number of cases notified as diphtheria in the Borough during the year who were found to have been immunised at the Borough clinic at any time 2 (u) Number of cases (from t) found to be suffering from Diphtheria 1 (v) Number removed from Borough before treatment completed 7 Enteric Fever (Typhoid and Paratyphoid).—Eleven cases of Typhoid Fever were notified during the year. There were no deaths. Investigation of these cases showed that they arranged themselves roughly into three groups. Group X.—Only one of the cases in this group was notified in 1938, but as it was connected with 2 cases which occurred at the end of 1937 it is necessary to trace the history of the group from September, 1937. All cases or suspected cases in this group were members of the same family living in the same house. 85 History of Group and Action taken.—The family consisted of father, mother and seven children. In September, 1937, the mother and three members of the family, a daughter ("a" below), a son and baby, were "hopping" in Kent and were in temporary residence in a hut on the hopfields. Whilst there, the mother developed Ulcerative Colitis, and a fortnight later, on returning home, was admitted to hospital where she was found negative for Typhoid, but discharged herself before the completion of the investigation. There is no evidence that this woman had Typhoid. In October the daughter "a" became ill and was found to have Typhoid and died in hospital in December, 1937. Early in December another daughter "b" became ill and was later diagnosed as Typhoid and admitted to hospital, and recovered after a lengthy illness. The local medical practitioners were circularised in December, their attention was drawn to the occurrence of Typhoid and to the facilities for diagnoses provided by the Borough Council. Meantime, a daughter "c," aged 5, who was under observation, was found to be infected and notified as Typhoid on the 5th January this year, having previously been removed to hospital on the 31st December, 1937, where she eventually recovered. The remaining members of the family remained well. Enquiries made through the Kent Authorities revealed no evidence of any contact with Typhoid during the mother's residence in the hop-fields, and no evidence could be found as to the original source of the Group X cases. Group Y.—The origin of this Group also apparently arose in 1937. The cases will be described by the letters "d," "e," "i," "g" and "h." "d" was notified in 1937. "d"—The first case "d," a boy, was first unwell at the end of August, 1937. He was seen by a private doctor and sent to hospital in September where blood cultures and Widal tests later revealed that he had Typhoid. The source of his infection could not be traced. He was discharged fit at the end of November. "e"—A young girl, unrelated to the above, was notified to me as a case of Typhoid early in January, 1938. The case was diagnosed in the fever hospital to which she had been removed some time after the onset of her illness, which commenced early in December. She eventually recovered. "f"—An adult male whose illness commenced in the middle of January, was notified to me as Typhoid a week after his onset. He was removed to hospital and recovered. "g"—The wife of "f," who had nursed her husband at home before his removal to hospital, was notified as Typhoid five days after her husband went to hospital. She also recovered. "h"—The baby boy, only child of above. This child was not ill, but Widal test appeared to indicate that he was a missed case of Typhoid. He was removed to hospital as a precautionary measure and as both parents were in hospital. He was therefore " notified " as Typhoid. 86 Probable Sources of Infection in Group X.—"d," first case, source untraced, was related to "f," "g" and "h" all of whom he frequently visited at their house. "d" may have infected "h." If so, he infected "h" before going to fever hospital early in September. "h" may have infected "e." There was a history of "h" being "very ill" while away from home from October to December, 1937. The case "e" was in fairly close contact with "h" for three weeks in November. She began symptoms of Typhoid early in December. "f," the father of "h," who was related to "d" may have been infected by "h" after the latter's return home in December, or by "d" after the latter's discharge from hospital in November. This is assuming that "h" was a missed case of Typhoid or that "d" was a "carrier" after discharge from hospital. "g" was most probably infected by her husband "i" whom she nursed. Action taken in Group Y Cases.—Some anxiety was caused after the notification of "f" who was a roundsman distributing bottled milk. He was at once removed to hospital and all his family and the family of his relative and the family of his employer and all his fellow employees had blood, faeces and urine examined in a search for missed cases or carriers. All were found healthy except his wife and baby who were removed to hospital. Immediate steps had been taken to stop the sale of loose milk from the dairy of his employer and only bottled pasteurised milk obtained from another source was allowed to be sold from this dairy. All local general practitioners and Medical Officers of Health concerned were notified and an unobtrusive watch was kept for any signs of infection developing amongst customers who had been supplied with milk when " f " was on duty as roundsman. No infection whatever occurred to any of these customers, and as " f " had had very little to do with the actual handling of the milk, none was expected. The Ministry of Health was kept informed of the situation in Group Y after the notification of "i" and medical officers of the Ministry consulted with me as to the measures to be taken. It should be mentioned that this minor outbreak Y occurred at a time when much publicity had been given in the Press to a much larger epidemic occurring elsewhere. Minor groups of Typhoid, however, do occur, not unusually, throughout the country, and in any other year would probably be dealt with equally successfully, but with less anxiety. Group Z.—The remaining five cases notified in 1938 were of little epidemiological interest, and might be regarded as not more than the normal number of isolated cases which occur in a crowded population. One, however, remained a " carrier " after her return home from hospital and has had to be kept under surveillance. One was a paratyphoid case. One case was found not to be typhoid. It will be seen therefore that out of the eleven cases of Typhoid (or paratyphoid) which were notified as such during this year, there were no deaths. Anthrax.—One case of Anthrax occurred during the year, and recovered. The history of the case was as follows:—The patient was a dock labourer aged 36. On Thursday, 10th November, the patient who was working on a wharf in the Borough developed an anthrax pustule on the left shoulder 87 blade, and saw his panel doctor the following day, and was admitted to hospital on the 12th, where he was diagnosed as anthrax and given the specific serum treatment. There was a history of the patient's having handled during the seven days previous to his onset, bales of wool, country of origin, Iraq ; bales of wool, country of origin, Australia; and bales of rabbits' skins from New Zealand. A difference of opinion existed as to whether the patient handled dry goat skins from Lagos—the employers appeared to be able to prove that these latter skins were not handled by the patient. It is quite impossible therefore, to say which, if any, of the above consignments infected the patient, and all had left the country by the time of his onset. All known contacts in this country were followed up, and no second case occurred. As much of the above material had already been stored in a wool warehouse before being handled by the patient it is also possible that stray anthrax spores from the dust of the warehouse may have been the cause of the infection. The case was further investigated by the Medical Inspector of Factories, and I understand further preventive measures have been adopted. Undulant Fever.—One case, an adult female, of Undulant Fever occurred in the Borough during the year, and recovered. This disease is due to the Bacillus Abortus (Brucella Abortus), and infection occurs through the milk of cows which are infected with the Bacillus. The typical symptom of Undulant Fever in man, as the name suggests, is a recurring high temperature over a prolonged period, and the diagnosis is confirmed by laboratory tests. The case occurred at the end of August. The woman had been on holiday in the country for twelve days, and two days after returning home the symptoms of her illness began. After a few days she consulted her doctor and attended the out-patient department of a hospital. She was admitted to the hospital, and notified to me on the 10th September as a case of Undulant Fever. The case was reported to the Ministry of Health. Acute Poliomyelitis.—3 cases of acute poliomyelitis were notified. All were removed to hospital. Polio-encephalitis.—One case was notified. Cerebro-Spinal Meningitis.—8 patients were notified during the year, of which 2 died. The death rate for the whole Borough was .009 per 1,000 of the population. Encephalitis Lethargica.—One case was notified during the year and removed to hospital. 5 deaths occurred, the death-rate being .02 per 1,000 of the population. Puerperal Fever and Puerperal Pyrexia.—8 cases of puerperal fever and 41 cases of puerperal pyrexia were notified during the year, or 9 more than in the previous year. All these cases were duly investigated and there were 3 deaths. 43 cases were removed to hospital. Ophthalmia Neonatorum.—There were 10 cases notified as against 14 in the previous year. 9 cases were removed to hospital. Pneumonia Malaria and Dysentery Regulations.—241 cases of Pneumonia and 41 of Dysentery were notified under the Regulations during the year. There were 172 deaths from Pneumonia, or 1 more than in the previous year. 105 of these were in persons over 45 years of age. 1 case of Malaria was notified. 88 Zymotic Diseases.—The total deaths from diseases of a Zymotic character was 87, or 17 more than in the previous year. They include all deaths from Small Pox, Scarlet Fever, Diphtheria, Typhoid Fever, Measles, Whooping Cough and Diarrhoea. The death rate was .43 per 1,000 of the population. Influenza.—The number of deaths was 7, or 66 less than in the previous year. As usual these occurred in elderly persons. The death-rate for the whole Borough was .03 per 1,000 of the population. Cancer.—The number of deaths from cancer was 343, or 12 more than in the previous year. The death-rate for the whole Borough was 1.7 per 1,000 of the population. 26 were under 45 years of age—5 males and 21 females. 148 were between 45 and 65 years of age—74 males and 74 females. 117 were between 65 and 75 years of age—63 males and 54 females. 52 were 75 years of age and over—28 males and 24 females. The organs and parts of the body affected were as follows:— Male. Female. Mouth, Throat and Alimentary Canal 36 10 Other abdominal organs 56 59 Generative organs — 15 Breast — 28 Skin 1 — Lung and Pleura 16 6 Bones 3 1 Other specified organs 58 54 Other undefined — — Totals 170 173 Food Poisoning.—20 cases were notified, or 10 more than in the previous year. Small Pox.—No cases of small pox were notified during the year and it was not found necessary for me to take action under the Public Health (Small Pox) Regulations, 1917. Measles and Whooping Cough.—The County of London (Measles and Whooping Cough) Regulations, 1938, came into force on 1st October throughout the whole of London, and by this measure the Stepney (Measles) Regulations, 1935, were suspended. By the new regulations Whooping Cough is made notifiable in addition to Measles; that is to say, every case of measles or whooping cough, provided it is the first case occurring in the house within two months. The Stepney (Measles) Regulations, 1935, applied only to measles occurring in children up to the age of 5 years. The new Regulations apply to all ages in both diseases. The very large number of notifications resulting from the new Regulations must be borne in mind when comparing the total number of infectious diseases notified in Stepney before 1938, with corresponding totals occurring in later years. Measles.—The Biennial measles epidemic occurred this year. 844 cases were notified. There were 17 deaths, the death rate being .08 per 1,000 of the population. 89 Whooping Cough.—102 cases were notified. The number of deaths was 13, or 1 less than in the previous year. All of these occurred in children under 5 years of age (7 of them under 1 year). The death rate was .06 per 1,000 of the population. Diarrhoea.—There were 46 deaths, 2 less than in the previous year. 41 of these deaths, or 89 per cent., were in children under 1 year of age. The death rate was .22 per 1,000 of the population. Heart Disease.—There were 705 deaths from Heart disease (379 males and 326 females) or 79 less than in the previous year. The death-rate for the whole Borough was 3.5 per 1,000 of the population. Diseases of the Respiratory Organs.—The number of deaths from diseases of the Respiratory Organs (excluding Tuberculosis) was 241 or 21 less than in the previous year. The death-rate for the whole Borough was 1.2 per 1,000 of the population. Scabies.—The arrangements with Bethnal Green Borough Council for the treatment of adults and with the London County Council for the treatment of children under school age were continued. During the year 174 adults were sent to Bethnal Green and 435 children were treated at the L.C.C. Bathing Station. Cleansing and Disinfection.—-182 persons were cleansed during the year and had their clothing disinfected. All were adults and they were cleansed because of vermin. 3,106 premises were fumigated and the bedding, etc., removed and disinfected by steam. Of these, 1,587 rooms were fumigated because of infectious disease, 150 as a result of pulmonary tuberculosis, and 1,369 because they were verminous. In addition to these, scabies occurred in 1,388 families and the bedding was taken away and disinfected by steam. The disinfection of second-hand clothing, prior to export to South Africa and the supervision of the packing of the goods was carried out as in previous years. The number of such articles dealt with this year reached 55,852. The total number of articles disinfected for all purposes was 79,818. Bug Eradication.—The furniture and effects of 113 families were treated in the H.C.N. Fumigation Chamber, before being rehoused : of this number 8 were done for the Stepney Housing Trust, thus leaving a total of 105 for families rehoused in Council Flats. 1,408 inspections were made to 952 flats during the year and of this number 309 were found verminous, and suitable steps taken for the eradication of vermin either by means of fumigation or spraying with insecticide. This shows a definite improvement of 32.45 per cent, as'against 43.78 per cent, for 1937. The following table gives the sum Chamber : mary of work done at the Disinfestation Inspections etc., by the Specialist Inspectors. fMr. E. J. Edwards, Jan-Sept. Mr. H. J. Green, Oct.-Dec. *Miss Whitty. No. inspections for vermin 406 1,273 No. found verminous ... 219 484 No. miscellaneous visits 809 511 No. revisits 193 138 * Miss Whitty also has charge of Women's Common Lodging Houses and Infant Life Protection investigations; returns of these inspections are to be found under their appropriate headings. 90 In April of this year the disinfestation of verminous premises was transferred to the disinfestation station from the disinfecting station. The disinfestation of bedding, etc., both in rehousing into Council properties and in infestation of private houses is carried out by steam at the disinfecting station, both stations co-operating closely in the general eradication of vermin. The scheme is working very well. Most of the tenants appreciate the efforts of the Council to assist them in keeping their houses clean and welcome the treatment of their effects before entering into their new dwellings. Most tenants co-operate well and their homes do them credit. In only a very few cases have we found re-infestation of flats after the effects have once been subjected to Hydrogen Cyanide Gas. Out of 604 flats where the tenants effects were subjected to H.C.N., 46 have been found re-infested, or 7.6 per cent. The cause is not always apparent, though on several occasions it can be definitely traced to the bringing in of second-hand furniture. The caretakers of the buildings co-operate by informing the Sanitary Inspector if second-hand furniture is brought in, when it can be inspected and, if necessary, disinfested, with the consent of the tenant. A quantity of old furniture, etc., amounting to 3 tons 13 cwts. 1 qr. was collected from houses vacated by tenants on being rehoused by the Council. This was all destroyed in the incinerator, with the consent of the tenants. The number of : (a) Council houses (i) found to be infested 309 (ii) disinfested 309 (b) Other houses (i) found to be infested 705 (ii) disinfested 705 Three methods are employed for freeing infested houses of bed-bugs : (a) stripping woodwork where necessary and application of blowlamp to same. (b) fumigation with Cimex candles or sulphur. (c) spraying with insecticides, i.e., Vermicine or Zaldecide. The method employed for ensuring that belongings of tenants arc free from vermin before removal to Council houses, is that all the furniture and effects are fumigated with H.C.N., the bedding being dealt with by steam disinfection. All the work is carried out by the Local Authority. To ensure that the flats are kept clean and not re-infested, two specialist inspectors revisit Council's flats continuously. † In September, Mr. Edwards was seconded for work in the Air Raid Precautions Department and Mr. Green took charge of the Disinfestation Chamber. Council. Private. No. of flats and dwellings fumigated 40 385 No. of rooms involved in the above fumigations 136 526 No. of flats and dwellings sprayed 349 320 No. of rooms involved in the above sprayings 967 544 No. of families whose effects were treated by H.C.N, at the Council's disinfestation chamber 105 8 92 Public Health (Tuberculosis) Regulations, 1930. Ministry of Health. Form T.137 1938. PART I—Summary of Notifications during the period from the 1st January, 1938, to the 31st December, 1938,in the area of the Metropolitan Borough of STEPNEY. Age periods Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis Total Notifications. 0— 1— 5— 10— 15—20— 25— 35— 45— 55— 65— Total (all ages) Pulmonary Males - 6 3 5 17 25 33 36 37 27 6 195 239 „ Females 2 4 2 2 13 13 16 8 7 4 2 73 93 Non-pulmonary Males 1 2 5 1 3 5 2 3 1 1 1 25 25 ,, „ Females 2 1 1 1 6 2 3 1 1 3 21 23 SUPPLEMENTAL RETURN. PART II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age periods 0— 1— 5— 10- 15— 20— 25— 35— 45—55— 65— Total Pulmonary Males 1 - 4 4 10 1 1 4 25 „ Females - 1 1 1 2 1 4 - 10 Non-pulmonary Males - 1 — 1 — 1 - - 3 „ „ Females 2 - — 2 2 - - 6 The source or sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information. No. of Cases. Pulmonary NonPulmonary. Death Returns from local Registrars - - transferable deaths from Registrar General - - Posthumous notifications 12 2 " Transfers " from other areas (other than transferable deaths) 23 7 Other Sources - - PART III. NOTIFICATION REGISTER. Number of cases of Tuberculosis remaining at the 31st December, 1937, on the Registers of Notifications kept by the Medical Officer of Health. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total 960 515 1475 262 198 460 1,935 Number of cases removed from the Register(s) during the year by reason inter alia of :— 1. Withdrawal of notification 5 3 8 3 - 3 11 2. Recovery from disease 24 16 40 7 10 17 57 3. Death (all causes) 107 51 158 7 5 12 170 4. therwise : " Transfers" to other areas 75 44 119 11 14 25 144 93 New Cases of Tuberculosis and Mortality.—Particulars of new cases of tuberculosis and of all deaths from the disease in Stepney during 1938. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. 0 - 2 1 2 - - 1 2 1 6 4 2 1 — 1 1 2 5 3 2 5 1 — — — — 10 5 2 1 1 1 1 — 1 15 17 13 3 6 4 6 — 1 20 25 13 5 2 11 4 — — 25 33 16 2 3 15 8 — — 35 36 8 3 — 14 4 — — 45 37 7 1 1 15 6 1 — 55 27 4 1 1 15 8 — — 65 and upwards 6 2 1 3 8 — — — Totals 195 73 25 21 83 36 3 6 The death rate for the whole Borough was "(33 per 1,000 of the population. Public Health (Prevention of Tuberculosis) Regulations, 1925.—These regulations provide that persons suffering from Tuberculosis of the Respiratory tract shall not be employed in the handling of milk or milk receptacles. Power is given to the Council to cause such persons to discontinue their employment. It was not found necessary to take action under the regulations during the year. 94 RETURN RESPECTING THE VACCINATION OF CHILDREN WHOSE BIRTHS WERE REGISTERED IN STEPNEY FROM JANUARY 1st TO DECEMBER 31st, 1937 INCLUSIVE. M.379 Registration Sub-Districts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st December, 1937. Number of these Births duly entered by 31st January, 1939, in Columns I., II., IV. and V. of the " Vaccination Register " (Birth List Sheets), viz. : Col. I. Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col. V. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Died unvaccinated. (1) (2) (3) (4) (5) (6) (7) Limehouse 1,717 404 2 — 950 49 St. Georges, East 527 198 — - 197 18 Total 2,244 602 2 — 1,147 67 Whitechapel 1,490 725 1 - 498 55 Mile End 1,225 330 1 - 637 71 Total 2,715 1,055 2 - 1,135 126 Registration Sub-Districts comprised in the Vaccination Officer's District. Number of these Births which on 31st January, 1939, remained unentered in the " Vaccination Register " on account (as shown by "Report Book") of Number of these Births remaining on 31st Jan., 1939, neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the " Report Book " (columns 8, 9 and 10 of this Return). Total number of Certificates of Successful primary Vaccination of Children under 14 received during the Calendar Year 1938. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate, during the Calendar Year 1938. Postponement by Medical Certificate. Removal to Districts the Vaccination Officers of which have been duly apprised. Removal to places unknown, or which cannot be reached ; and cases not having been found. (8) (9) (10) (11) (12) (13) Limehouse - 260 8 44 512 894 St. Georges, East — 36 13 65 356 221 Total — 296 21 109 868 1,115 Whitechapel — 165 10 36 873 558 Mile End 4 93 16 73 413 572 Total 4 258 26 109 1,286 1,130 95 Limehouse and St. Georges. Whitechapel and Mile End. Number of children successfully vaccinated after declaration of conscientious objection had been made. These numbers are included in Column 6 4 2 Total number of certificates for the year 1938 sent to other Vaccination Officers 204 116 96 SUMMARY OF PRIMARY VACCINATIONS DURING THE YEAR JANUARY TO DECEMBER, 1938 (Form N). No. of cases in birth lists received during the year. No of certificates of vaccination received. No. of certificates of postponement owing to No. of statutory declarations under section 1 of the Vaccination Act, 1907. No. of certificates of insusceptibility or of having had smallpox. No. of cases No. of entries in lists sent to public vaccinator Parents removed out of district. Otherwise not found. Health of child. Condition of house. Prevalence of infectious disease. Whitechapel 1,047 873 114 - 1 558 2 1,019 19 343 Mile End 1,158 413 43 - - 572 1 430 15 278 Other vaccinations 4 — — — - — — — Limehouse 1,515 512 46 - - 894 - 753 80 209 St. Georges 590 356 61 - - 221 - 122 74 276 Other Vaccinations 27 - — — - - — — — Total 4,910 2,185 264 - 1 2,245 3 * 2,324 188 1,106 97 Return showing the number of persons successfully vaccinated and re-vaccinated at the cost of the Rates by the Medical Officers of Institutions and the Public Vaccinators during the year ended 30th September, 1938. Name of Institution or Vaccination District. Name of Medical Officer or Public Vaccinator. Number of successful primary vaccinations of persons. Number of successful re-vaccinations. Under one year of age. One year and upwards. Total. Limehouse District Dr. W. S. R. Thomas 78 23 101 17 Mile End do. Dr. S. Mikhail 163 20 183 6 St. George-in-the-East District Dr. H. Billig 271 17 288 10 Shadwell do. Dr. E. Lipman 121 15 136 24 Whitechapel District Dr. D. F. Kennard 255 24 279 12 Dr. S. H. Chazen 47 — 47 2 St. Peter's Hospital Dr. S. Craig 1 — 1 — Totals 936 99 1035 71 98 VII.—STATISTICS PROVIDED BY THE REGISTRAR GENERAL CAUSE OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF STEPNEY—1938. S.D.25 CAUSES OF DEATH. Sex. All Ages. 0— 1— 2— 5- 15— 25— 35— 45— 55— 65— 75— ALL CAUSES M. 1,218 93 13 5 17 46 49 53 126 252 336 228 F. 999 72 14 17 15 25 31 47 95 199 248 236 1. Typhoid and paratyphoid fevers M. ••• ... ... ••• ••• ••• ••• ••• ... ••• ... ••• F. ... ••• ••• ••• ••• ••• ... ••• ••• ••• ••• ••• 2. Measles M. 9 5 2 2 ••• ••• ••• ••• ••• ••• ... ••• F. 8 4 2 2 ••• ••• ••• ••• ••• ••• ••• ••• 3. Scarlet Fever M. 1 ••• ... ••• 1 ••• ••• ••• ... ••• ... ••• F. 1 ••• 1 ... ••• ••• ••• ••• ••• ••• ••• ••• 4. Whooping cough M. 4 2 2 ... ••• ••• ••• ••• ••• ••• ••• F. 9 5 1 3 ••• ••• ••• ••• ••• ••• ... ••• 6. Diphtheria M. 1 1 ••• ... ••• ••• ••• ••• ... ••• ••• ••• F. 8 1 ••• 5 2 ••• ••• ••• ••• ••• ••• ••• 6. Influenza M. 4 ••• ••• ••• ••• ••• ••• ••• 1 2 ••• 1 F. 3 ••• ••• ••• ••• ... ••• ••• ••• 2 ••• 1 7. Encephalitis lethargica M. 3 ••• ••• ••• ••• 2 1 ••• ••• ••• ••• ••• F. 2 ••• ••• ••• ••• ••• 1 ••• 1 ... ... ••• 8. Cerebro-spinal fever M. 2 1 ••• ... ••• ... ... ••• ••• ••• ... ••• F. ••• ••• ••• ••• ••• ••• ••• ... ••• ••• ••• 9. Tuberculosis of respiratory system. M. 85 ••• ••• ••• 1 16 12 14 15 16 11 ... F. 36 ••• ••• 1 1 9 8 4 6 7 ... ••• 10. Other tuberculous diseases M. 4 1 1 ••• ••• ... ••• ... 1 ••• 1 ••• F. 6 2 1 1 1 1 ••• ... ... ... ••• ... 11. Syphilis M. 14 2 ••• ••• ••• ••• ••• ... 6 3 2 1 F. 5 2 ••• ... ••• ... ... 1 ... 1 1 ••• 12. General paralysis of the insane, tabes dorsalis. M. 8 ••• ••• ••• ••• ... ••• 4 ... 2 2 ••• F. 3 ••• ••• ••• ••• ... ... 1 ••• 2 ... ... 13. Cancer, malignant disease M. 170 ••• ••• ••• ••• 2 3 24 50 63 28 F. 173 ••• ••• ••• 1 1 3 16 28 46 54 24 14. Diabetes M. 12 ••• ••• ••• ••• ... ... 1 ... 6 6 ... F. 36 ••• ••• ... 1 ••• ... ••• 6 8 16 5 15. Cerebral haemorrhage, etc. M. 19 ••• ••• ••• ••• ••• ... ... ... 8 9 2 F. 26 1 ••• ••• ••• ... 1 ••• 2 6 9 7 16. Heart disease M. 379 ••• ••• ••• ••• 5 6 6 25 80 139 118 F. 326 ••• ••• ••• 2 3 5 7 21 65 98 125 17. Aneurysm M. 5 ••• ••• ••• ••• 1 1 ... 1 1 1 ••• F. 8 ••• ••• ... ••• 1 1 1 2 1 2 ••• 18 Other circulatory diseases M. 40 ••• ••• ••• ••• ... ... 2 2 11 13 12 F. 59 ••• ••• ••• ••• ... ... ••• 2 13 19 25 19. Bronchitis M. 40 2 ••• ••• ••• 1 ... 1 6 7 15 8 F. 13 ••• ••• ••• ••• 1 ••• ... ... 6 3 3 99 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN THE METROPOLITAN BOROUGH OF STEPNEY, 1938—(continued). CAUSES OF DEATH. Sex. AU Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— 20. Pneumonia (all forms) M. 103 18 3 2 2 4 7 3 9 18 22 15 F. 69 10 5 2 3 4 4 6 12 4 19 21. Other respiratory diseases M. 8 1 2 2 3 F. 8 1 l 3 3 22. Peptic ulcer M. 20 1 3 5 7 3 1 F. 4 l 1 1 1 23. Diarrhoea, etc. [Uuder 2 yrs.] M. 28 26 2 F. 18 15 3 24. Appendicitis M. 6 1 1 l 1 F. 4 1 2 1 25. Cirrhosis of liver M. 2 l 1 F. 1 1 26. Other diseases of liver, etc. M. 4 1 1 I 1 F. 5 2 3 27. Other digestive diseases M. 19 1 1 1 3 3 3 4 3 F. 19 1 1 1 2 3 9 2 28. Acute and chronic nephritis M. 33 1 1 1 4 1 6 5 9 5 F. 18 1 1 2 6 7 1 29. 30. Puerperal sepsis Other puerperal causes F. 3 1 1 1 F. 3 1 2 81. Congenital debility, premature birth, malformations, etc. M. 26 26 F. 23 23 32. Senility M. 4 4 F. 5 2 3 33. Suicide M. 21 3 2 3 3 7 2 1 F. 10 1 1 2 3 2 1 34. Other violence M. 46 2 1 4 2 3 3 5 11 7 8 F. 24 1 1 1 3 3 4 11 35. Other defined causes M. 97 6 l 6 8 8 4 11 12 23 18 F. 61 8 5 1 4 5 9 10 10 6 36. Causes illdefined, or unknown M. 1 1 F. 2 1 1 Deaths under 1 year of age : Legitimate Illegitimate M. 85 8 F. 69 3 100 S.D. 52.A. and S.D. 30.B. (1) Estimated Midyear Resident Population (a) 200,500 (b) Males. Females. (2) Live Births Total 1,358 1,261 Legitimate 1,293 1,209 Illegitimate 65 52 Stillbirths Total 41 41 Legitimate 39 39 Illegitimate 2 4 (3) NOTIFIABLE INFECTIOUS DISEASES. (number of cases notified during the 52 weeks ended 31st December, 1938) Smallpox Scarlet fever Diphtheria Enteric fever Pneumonia Puerperal fever Pueperal pyrexia Erysipelas — 368 405 11 238 8 41 128 (4) applicable to the Area Comparability Factor, All Causes " crude death rate only, 1.17 101 S.D.55 Birthrates, Deathrates, Analysis of Mortality Maternal Deathrates, and Caserates for certain Infectious Diseases in the year 1938. England and Wales, London, 126 Great Towns and 148 Smaller Towns. Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns.) England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 census). London Administrative County. Rates per 1,000 population. Births:— Live 15.1 15.0 15.4 13.4 Still 0.60 0.65 0.60 0.48 Deaths:— All causes 11.6 11.7 11.0 11.4 Typhoid and Paratyphoid Fever 0.00 0.00 0.00 0.00 Smallpox 0.00 — 0.00 — Measles 0.04 0.05 0.03 0.06 Scarlet Fever 0.01 0.01 0.01 0.01 Whooping Cough 0.03 0.03 0.02 0.03 Diphtheria 0.07 0.07 0.06 0.05 Influenza 0.11 0.10 0.11 0.06 Notifications:— Smallpox 0.00 0.00 0.00 — Scarlet Fever 2.41 2.60 2.58 2.05 Diphtheria 1.58 1.85 1.53 1.90 Enteric Fever 0.03 0.03 0.04 0.05 Erysipelas 0.40 0.46 0.39 0.46 Pneumonia 1.10 1.28 0.98 0.98 Rates per 1,000 Live Births. Deaths under 1 year of age 53 57 51 57 Deaths from Diarrhoea and Enteritis under 2 years of 5.5 7.8 3.6 13.1 age Maternal Mortality:— Not available. Puerperal Sepsis 0.89 Others 2.19 Total 3.08 Rates per 1,000 Total Births (i.e. Live and Still.) Maternal Mortality:— Not available. Puerperal Sepsis 0.86 Others 2.11 Total 2.97 Notifications:— 14.42 18.08 12.51 3,53 Puerperal Fever Puerperal Pyrexia 15,46 102 APPENDIX. (Leaflet of Information issued to local Post Offices in response to Circular 1643a of the Ministry of Health.) METROPOLITAN BOROUGH OF STEPNEY. HEALTH SERVICES. AMBULANCES—Accidents: To call a London County Council ambulance by phone in case of accident, (a) where a dialling system is in operation—dial 999 and ask the exchange simply for ambulance, or, (6) where no dialling system is in use follow the directions given in the kiosk. Other purposes : Application to be made to the London County Council, County Hall, S.E.I. Tel.: Waterloo 3311. BIRTHS, DEATHS AND MARRIAGES. The address and hours of attendance of the Registrars are as follows:— Births and Deaths. Limehouse 532/4, Commercial Monday to Friday, 10 a.m. to 12.30 p.m. Road, E.l. Tuesday, 2 p.m. to 4 p.m. Thursday, 5 p.m. to 7 p.m. Saturday, 10 a.m. to 11 a.m.. Mile End Old Town 100, Burdett Road, Monday to Saturday, 9.30 a.m. to 12.30 p.m. E.3. Monday and Thursday, 2.30 p.m. to 4.30 p.m. Tuesday, 5 p.m. to 7 p.m. St. George's 242, Cable Street, Monday to Saturday, 10 a.m. to 1 p.m. E.l. Monday, Tuesday and Wednesday, 2 to 4.30 p.m. Friday, 5.30 p.m. to 7.30 p.m. Whitechapel 36a, Newark Street, Monday to Friday, 10 a.m. to 1 p.m. E.l. Tuesday and Thursday, 4 p.m. to 5 p.m. Friday, 5 p.m. to 7 p.m. Saturday, 10 a.m. to 12 noon. Marriages.—The Superintendent of Births, Deaths and Marriages attends at the Register Office, 25, East Arbour Street, on Monday to Friday from 10 a.m. to 4 p.m. and on Saturday from 10 a.m. to 1 p.m. DENTAL CLINIC. A dental clinic for mothers, and children under school age attending the infant welfare centres and for tuberculosis patients is held at 35, Stepney Green, E. Applications to be made at the infant welfare centres or the tuberculosis dispensaries. DIPHTHERIA A clinic is held at 35, Stepney Green, E.1., every Friday at 2 p.m., where IMMUNISATION. the necessary appointments can be made. DISTRICT Enquiries to be made at the East London Nursing Society, 7, Stainsby NURSING. Road, E.14. Telephone No.: East 2381. HOSPITALS. Time table for outpatients at local voluntary hospitals is as follows:— East End Maternity Hospital (STEpney Green 1536), 384398, Commercial Road, E.l Obstetric (booking) Tu., Th., 912; Mon. to Fri., 68. Bearstead Memorial Hospital (BIShopsgate 1929), 24, Underwood Road, E.l. Antenatal Mon., Th., 1012. *Infant Welfare Tu., Wed., 24.30. Postnatal Alternate Wed., Teeth Mon., 10.3012.30 9.3012. * For Children born in the Hospital District only. London Jewish Hospital (STEpney Green 4251), Stepney Green, E.l. Medical Mon. to Fri., 1. Children Tu., 1; Fri., 9.30. Surgical Wed., 1; Fri., 9.30. Eye Tu., 8.45; Fri.,1. Diseases of Women Tu., 9.30. Throat, Nose and Ear Mon., Wed., 8.30 a.m. Obstetric Skin Th., 1. 103 London Hospital (BIShopsgate 8333), Whitechapel, E.l. Medical Weekdays, Men, 1; Throat, Nose and Ear Mon., Tu., Th., Fri., 9. Women, 2. Skin Tu., Th., Men, 8.30 a m, Surgical Weekdays, 1. Women, 10. Diseases of Women Wed., 1; Sat., 9. Teeth Mon. to Fri., 9. Obstetric Tu., Wed., 9. Orthopaedic Tu., Fri., 9. Antenatal GenitoUrinary Wed., Th., 1; Fri., 8.30; Sat., Men, 9, Women, 10. Children's Dept. Tu., Wed., Fri., 9. Electrical Mon., Tu., Wed., Fri., 9. Eye Mon., Wed., Th., Heart Mon., Th., 1. Sat., 9. Nervous Mon., Wed., 1.30. New patients should attend the receiving room of the Hospital 30 minutes before the times mentioned. Princess Elizabeth of York Hospital for Children (STEpney Green 33413342), Shadwell, E.l. Medical Mon. Th., 12; Skin Th., 910. Tu., Fri., Sat., 910. Teeth Th., 12. Surgical Tu., Sat., 910; Orthopaedic Wed., 12. Wed., Th., 12. GenitoUrinary Th., 12. Eye Mon., 12. Plastic Surgery Wed., 10.30 by ment. Throat, Nose and Mon., 12; Fri., 910. Rheumatism Fri., 12. Ear Nervous and Mental Mon., Tu., 12. Whooping Cough Th., 910. Facilities for outpatients are also always available at the London County Council Hospitals: Mile End Hospital, Bancroft Road; St. GeorgeintheEast Hospital, Raine Street; St. Peter's Hospital, Vallance Road. MATERNITY AND CHILD WELFARE. The addresses of the child welfare centres and antenatal clinics, etc., are as follows Centres : Bearsted Memorial Hospital, Underwood Road. St. Phillip's Institute, Newark Street. Jewish Mothers' Welcome, Bernard Baron Settlement, Berner Street. St. George's Town Hall, Cable Street. Riverside Mansions, New Gravel Lane. Stepney Infant Welfare Centre, St. Matthew's Hall, 86a White Horse Road. 17, Rhondda Grove. East Stepney Jewish Centre, 1, Beaumont Grove. Hughes Mansions, Vallance Road. 12, St. Clare Street, Minories. Jewish Infant Welfare Centre, Bernard Baron Settlement, Berner Street. Memorial Hall,The Highway, Shadwell. Limehouse Town Hall, Commercial Road. Dame Colet House, 10 and 29, Duckett Street. Mission Hall, Carr Street. AnteNatal Limehouse Town Hall, Commercial Clinics: Road. St. George's Hospital, Raine Street. Hughes Mansions, Vallance Road. London Hospital, Whitechapel. East End Maternity Hospital, 396, Commercial Road. Mile End Hospital, Bancroft Road. Jewish Maternity Hospital, 24, Underwood Road. Creches : Marie Hilton Creche, Stepney Causeway. St. Paul's Day Nursery, Wellclose Square. Jewish Day Nursery, 23, New Road. Day Nursery, Memorial Hall, The Highway, Shadwell. Port of London Day Nursery, 5, Pier Head, Wapping. Full particulars as to the areas and times of sessions of all the above centres can be obtained from Medical Officer of Health, 43, White Horse Road, E.l. PUBLIC ASSISTANCE. The addresses of the day relief stations serving the Borough of Stepney are:— Hanbury Street, Whitechapel, E.l; Barnes Street, Limehouse, E.14; Raine Street, Wapping, E.l.; Bancroft Road, Mile End, E.l. A night and weekend duty office to deal with applications after the normal office hours is established at— Hanbury Street relief station; Harley College, Bow Road, E.3; and 86, High Street, Poplar, E.14. 104 TUBERCULOSIS DISPENSARIES. These dispensaries are situated at— Devonport Street, E.l, and at 35, Stepney Green, E.l. Particulars as to hours of attendance can be obtained at the Dispensaries. UNEMPLOYMENT ASSISTANCE BOARD. Area Office: 14, West India Dock Road, E.14. 'Phone No.: East 1280. VACCINATION OFFICERS. The address of the Vaccination Officers is the Public Health Offices, 43, White Horse Road, E.l. The hours of attendance are Monday to Friday 9.30 a.m. to 5 p.m. and on Saturday 9.30 a.m. to 1 p.m. VENEREAL DISEASE. All enquiries can be made at: L.C.C. (Whitechapel) Clinic, Turner Street, E.l. For further information on all the above services apply to: The Medical Officer of Health, 43, White Horse Road, E.l. Office hours: Monday to Friday, 9.30 a.m. to 5 p.m. Saturday, 9.30 a.m. to 1 p.m. Telephone No.: STEpney Green 2484 (4 lines). 105 INDEX. PAGE. I. Statistics and Social Conditions of the Area 6 II. General Provision of Health Services 8 III. Sanitary Circumstances of the Area 36 IV. Housing 54 V. Inspection and Supervision of Food 60 VI. Prevalence of, and Control over Infectious and other Diseases 83 VII. Statistics provided by the Registrar-General 98 After care, Tuberculosis 12 Air Raid Precautions 9 Aged and Infirm Persons 44 Analyst's Report 71 Ante-Natal Clinics 31,34 Ante-Natal and post-natal Services 34 Anthrax 86,87 Area of Borough 6 Artificial Sunlight Treatment 29 Bacteriological Examinations 10 Bakehouses 63 Births 6 Births Act, Notification of 7 Bishopsgate Goods Station 68 Boarded out Contacts (Tuberculosis) 13 Bug Eradication 89,90 Butcher Shops and Stalls 63 Butter and Margarine Factories 63 Canal Boats Acts 40 Cancer 88 Cerebro-Spinal Fever 87 Cheese, Cream 78 Child Life Protection 27,29 Cleansing of persons 39,89 Committees, List of Members 2 Complaints of nuisances 36 Convalescent Treatment 28 Cowsheds 38,43 Crệches, List of 35 Dairies and Milkshops 38,61 Day Nurseries 26 Deafness, prevention of 28 Deaths 8 Dental Clinic 19 Diarrhoea 89 106 PAGE. Diphtheria 83 Diphtheria Immunisation 83, 84 Diphtheritic Serum 83 Disinfection 39, 89 Drainage 36 Dysentery 37 Eating Houses 38 Encephalitis Lethargica 87 Enteric Fever 84, 85 Extra Nourishment, Supply of 13 Factories Act 40, 41 Fines and Costs 54 Finsen Light 13 Food and Drugs Acts 5l, 54 „ Detention and Release Notices 67 „ Inspection 60 „ Poisoning 88 ,, Premises 63 ,, Products, Certification of 63 „ Regulations (Imported) 68 „ Sampling 71-82 „ ZeebruggeHarwich Ferry 68 Foster Mothers 38 Greengrocers and Fruiterers 63 Grocers—Wholesale 63 Hairdressers' Shops 38 Handicraft Class 13 Health Propaganda 11 Health Services 102-104 Health Visitors, work of 30 Heart Disease 89 Home Helps 27, 29 Home nursing 27 Home Office, report to (form 572) 41 Hospital facilities 10 Houses-let-in-Lodgings 37 House to House Inspection 59, 60 Housing:—Statistics 39, 5459 „ Slum Clearance 54 „ Accommodation 59 „ Overcrowding 39, 54 Ice Cream Premises, etc. 38, 62, 63 Infant Welfare Centres, List of 34, 35 Infant Welfare Centres, Work at 30, 31 Infantile Mortality 20, 32, 33 Infants, Feeding of 28 107 PAGE, Infectious Diseases 8388, 91 „ „ Summary of, 91 „ „ Wrong Diagnosis 83 Influenza 88 Laboratory facilities 10 Legal Proceedings 49-53 Lodging houses, Common and Seamen's 38, 44 London County Council, Report to 38, 39 Malaria 87 Marriages 7 Margarine premises 63 Maternal Mortality 21, 22, 27 Maternity Nursing 29 Maternity and Child Welfare Centres, etc., List of 20 „ „ „ Committee, List of members 2 „ „ „ Services (Form MCW 96 Revised) 22-28 „ Centres, Work at 30, 31 Measles 26, 39, 88 Merchandise Marks Act 63 Midwives 10 Milk—(Special Designations) Order 62 „ Analysis of 74-76 Milk Proceedings re 53 „ and Meals, Provision of 29 Milkshops 38 Milk Supply 61 Ministry of Health, Returns to 14-19 Mortuary 38 National Health Campaign 11 Notifiable diseases 83, 91 Nursing in the Home 9 Offensive Businesses 33, 43 Ophthalmia Neonatorum 26, 87 Outworkers 42, 43 Overcrowding 39, 54, 57 Pharmacy & Poisons Act 36 Pneumo-Thorax refills 13 Pneumonia 87 Polio Encephalilis 87 Polio-Myelitis 87 Population 6 Preserved Food Premises 63 Public Assistance and Unemployment 8 Public Cleansing 39 Public Health Committee, List of members 2 Puerperal Fever and Pyrexia 87 108 PAGE. Rag Flock Acts 43 Rats and Mice Destruction 36, 37 Registrar General Statistics 98-101 Rent and Mortgage Interest, etc., Act . 37 Respiratory Diseases 89 Restaurants and Eating Houses 38, 63 Sampling 71-82 Sanitary Inspectors:—Inspections 45, 46 „ „ Notices served 46 „ „ Return of sanitary work 47, 48 Sanocrysin Treatment 13 Scabies 89 Scarlet Fever 83 Scavenging 36 Shelter 38 Shops Act 36 Slaughter of Animals Act, 1933 44 Slum Clearance 54 Smallpox 88 Smoke Nuisances 36, 38 Social Conditions 6 Special Treatment (Tuberculosis) 13 Staff 3, 8, 9 Statistics, Summary of 6, 7, 8 Sunlight Treatment, Artificial 29 Toddlers' Clinic 31 Tuberculosis: Dental clinic 19 „ Dispensaries, Report on 12-14 „ „ Returns (Forms T 145 & T 145a) 15-18 „ New Cases and Mortality 93 „ Summary of Notifications, (Form T 137—1938) 92 „ Regulations, 1930 92 „ „ 1925 93 „ Deaths 93 Twins and Triplets 7 Underground Rooms 39, 55 Undulant Fever 87 Unemployment 8 Unsound Food 64-66 Vaccination 94-97 „ by Public Vaccinators 97 „ Officers Returns (form M. 379 and form N) 94-96 Verminous persons and premises 39, 89 Water Certificates 37 Whooping Cough 26, 39, 88, 89 Wrong Diagnosis of Infectious Diseases 83 Zymotic Diseases 88