Spare LIBRARY 13/7/37 Metropolitan GRE 3 6 Borough of Greenwich. «x REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938 LONDON Frames, Manning & Co., Ltd. (T.U.) 12s, Lee High Road, Lewisham, S.E.13 Metropolitan Bovougb of Greenwich. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1938 CONTENTS. Pages Public Health & Maternity & Child Welfare Committees 3-4 Staff 5-6 Introductory 7-8 Section A.—Natural and Social Conditions of the Area 9-11 Vital Statistics 12-22 B.—General Provisions of Health Services in the Area 23-26 Maternity and Child Welfare 26-36 „ C.—Sanitary Circumstances of the Area 37-52 „ D.—Housing 53-64 „ E.—Inspection and Supervision of Food 65-81 „ F.—Prevalence of, and Control Over, Infectious Diseases 82-101 3 PUBLIC HEALTH COMMITTEE during the year 1937-8 The Mayor: Councillor H. H. Gibbons, J.P. and 13 Members. Councillor Mrs. F. Carter (Chairman). Councillor G. F. Westmacott (Vice-Chairman). Councillors : W. Arter. F. Winchcombe. R. A. Challenor. G. F. Drakley. Mrs. O. Bennett. Mrs. A. Kennedy. A. L. Hewitt. R. G. Jaggers. G. H. Springett. Mrs. C. R. Turner, J.P. Mrs. K. M. Yarlett. Powers and Duties of the Public Health Committee : 1.—There shall be referred to the Committee the powers of the Council under Acts of Parliament relating to the Public Health and sanitary condition of the Borough, the sale of food and drugs, the repair, closing and demolition of individual insanitary houses (Section 9 and 12 of the Housing Act, 1936), and Vaccination, and the By-laws, orders and regulations made, or to be made hereafter, under the provisions of such Acts, which are not within the reference to any other Committee. 2.—All plans for drainage and redrainage of premises shall be laid before the Committee for consideration. 3.—All works of drainage of houses and premises shall be carried out under the direction of this Committee. 4.—The Committee shall have the control of Mortuaries erected or maintained by the Council, as the Sanitary Authority, and shall have control of the disinfecting staff, apparatus and plant. 5.—The construction, maintenance and control of public sanitary conveniences, and conveniences maintained by the Council, shall be referred to this Committee. 4 MATERNITY AND CHILD WELFARE COMMITTEE during the year 1937-8 The Mayor : Councillor H. H. Gibbons, J.P. and 13 Members. ♦Councillor Mrs. A. Kennedy (Chairman). ♦Alderman Mrs. P. M. Beacham (Vice-Chairman). Councillors : W. Arter. *Mrs. L. Hilldrith. *T. P. Jacques. *W. S. Manners. *Mrs. 0. Bennett. *Miss M. Sherman. *Mrs. F. Carter. *Mrs. C. R. Turner, J.P. R. G. Jaggers. A. L. Hewitt. *Mrs. K. M. Yarlett. *Denotes Members who served on the Assistance Sub-Committee. Powers and Duties of the Maternity and Child Welfare Committee : There shall be referred to the Committee all matters arising out of the powers and duties of the Council under the Maternity and Child Welfare Act, 1918, or any Act or Acts amending the same, or any Orders or Regulations made under such Act or Acts ; Section 226 of the Public Health (London) Act, 1936 so far as it enables the Council to provide Artificial Sunlight Treatment to adult residents in the Borough ; powers and duties referred to in Sec. 6 of the Widows, Orphans and Old Age Contributory Pensions Act, 1925 ; and the Committee shall make recommendations to the Council in relation to the matters aforesaid. 5 Staff. Medical Officer of Health and Administrative Medical Officer, Tuberculosis and Maternity and Child Welfare : F. R. Waldron M.D., D.P.H. Tuberculosis Officer and Deputy Medical Officer of Health : W. Alcock, M.B., D.P.H. (k) Assistant Medical Officers for Maternity and Child Welfare : Senior:— Violet Mizen, M.R.C.S., L.R.C.P., M.B., B.S. Junior :—Donald Cameron, M.B., Ch. B. Sessional Medical Officers Gladys M. Cox, M.B., B.S. (London) Isobel C. Johnson, M.B., Ch.B. Consultant Obstetricians : Alistair Gunn, M.D., M.C.O.G., F.R.C.S.Ed. Victor J. F. Lack, F.R.C.S., M.R.C.P. Consultants under Puerperal Fever Regulations : Margaret Basden, M.D., F.R.C.S. Alistair Gunn, M.D., M.C.O.G. Jocelyn Moore, M.B., B.S., M.C.O.G., F.R.C.S. Bacteriologist: Arthur Davies, M.D., M.R.C.P. Public Analyst: A. E. Brown, B.Sc., F.I.C. Deputy : H. A. Williams, A.C.G.F.C., F.I.C Dented Surgeon : G. F. Ferris, L.D.S., R.C.S. (Eng.). Public Vaccinators : D. Wilson, M.B., Ch.B. G. H. Garnett, M.D., Ch.B. (part of the year). D. Morien Thomas, M.B., M.R.C.S., L.R.C.P. Vaccination Officer : E. S. Elliott. Chiropodists : H. E. Taylor, M.C., Ch.A. Miss D. Thackeray, M.I.S., Ch. Housing Inspector : ab A. E. Morgan. Sanitary Inspectors : abc S. A. Radford. ab H. L. Bennett (Food). abc W. R. Drake. abc H. Archer. ac W. H. Collins. abk G. W. Heath. a Miss G. Davis. abc A. D. H. Johnstone (Food). ab J. Ashmore. 6 Health Visitors : Maternity and Child Welfare. Tuberculosis. fg Mrs. M. D. Morison. dfg Miss D. M. Wilkins. dfg Miss F. C. Jagot. dfg Mrs. D. E. Shepherd. dfg Miss A. Jenkins. dfg Miss W. J. Luxmoore. dfg Miss A. M. M. Hadfield. dfg Miss K. Walton. dfg Miss P. Steer. dfg Miss E. J. Upton. MAZE HILL CLINIC : Pharmacist: Caretaker : W. H. Green, M.P.S. J. F. Nash. ARTIFICIAL SUNLIGHT TREATMENT: Nurse-in-Charge : dhi Miss L. D'Oyly Watkins. Assistant Nurse : dhi Miss C. Meikle. MATERNITY HOME : Matron : Sister : dgi Miss E. M. Marlow. dg Miss E. Young. CLERICAL STAFF : F. W. Foulger (Principal Clerk), a H. Duck. R. G. Garratt. Miss L. Merricks. C. W. Spore. Mrs. L. E. Wright. E. P. Tidman. L. A. Westacott. Miss D. E. M. Goulding. A. H. Wilcox. Miss D. M. Chilvers. R. H. Robinson. E. J. D. Adamson. Miss G. Sibborn (Milk Saleswoman). Mrs. E. R. Sellens (Foot Clinic). Miss I. B. Mills (Tuberculosis). DISINFECTING STAFF: G. Hook. T. Smith. T. G. Griggs. A. Moore. A. Nash. T. Packham (Motor Driver). Mortuary Keeper: W. J. Lawley. a Certificated Sanitary Inspector. b „ Meat and Other Foods, etc. c „ Smoke Inspector. d „ Nurse. f „ Health Visitor. g ,, Midwife. h „ Bio-Physical Associate. i „ C.S.M.M.G. j „ Teacher of Midwifery. k „ Instructor, Civilian Anti-Gas School. 7 Health Department, Town Hall, Greenwich, S.E.10. May, 1939. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my report for the year 1938, in accordance with Circular 1728 of the Ministry of Health. During the year under review greatly increased duties in connection with the Air Raids Precautions scheme of the Council have devolved on the Department. In addition, the occupation of temporary quarters involving a degree of overcrowding has rendered heavier the work of the staff, and made difficult the task of administration. Notwithstanding the difficulties encountered, reference to the various statistics will indicate that the health services have not suffered, and it is gratifying to be able to report again that the health of the Borough is satisfactory. The Infantile Mortality rate is the lowest ever recorded for the Borough, and the Maternal Mortality rate is similar to last year. Both figures are very far below those recorded for the Country as a whole. The general Death Rate of 11.1 compares favourably with the figure of 12.05 returned for the previous year. The average for the past 10 years is 11.61. I regret to have to report a further decline in the Birth Rate, the figure for the current year being 13.64 per 1,000 of the population, as compared with a figure of 13.86 for the previous year. The population shows a decrease of 220 persons according to the estimate of the Registrar General. In previous reports attention has been drawn to the tendency towards population decline—a tendency which it is possible the approaching census may prove to have been apparent rather than real. Progress in connection with the replacement of the old Borough Hall Welfare Centre and the provision of additional facilities in the Kidbrooke district was interrupted during the year. Although under the circumstances it would be impossible to proceed rapidly, there is no doubt that in view of the overcrowding which exists in connection with some of the other clinics, the matter is one of urgency. The Foot Clinics continue to perform a public service. Early in the year an appointment system was introduced with success to overcome difficulties regarding waiting and overlapping with Infant Welfare and Ante-Natal sessions. The increased numbers 8 applying for treatment made it necessary for extra sessions to be provided, including one on Saturday afternoon. At the year end the position was again under review, and it is likely that further extension of facilities will be necessary. A report recommending the use of hydrogen cyanide for the treatment of verminous furniture and effects as a part of a comprehensive disinfestation scheme was accepted by the Public Health Committee. At the end of the year arrangements to put the scheme into effect were approaching completion. The question of rheumatism was also under review during the year, and it was decided to recommend that the manifestations of acute rheumatism in children up to the age of 16 years should be made notifiable, and that a suitable scheme of supervision should be established. It was recommended that an agreement be entered into with the authorities of King's College Hospital with regard to a scheme for the training of pupil midwives at the Maternity Home. Such a change in the existing arrangements was made necessary by reason of the alteration in the rules of the Central Midwives' Board. It was decided also that Home Helps should be provided as an additional service in your already comprehensive Maternity and Child Welfare scheme. A table is submitted in the Section on Housing showing the progress of slum clearance since 1930. In addition to the areas listed there are others under consideration, and in addition individual unfit houses and underground rooms have continued to receive attention. The Section devoted to Sanitary circumstances indicates the systematic supervision of the district. The examination of imported foodstuffs and the supervision and sampling of foods and drugs in the retail premises in the Borough has been carried out as thoroughly as in the previous year. Before closing, I should like to thank my colleagues in the other Departments for their kindness and assistance to me during the year, and to each member of the Health Department staff I tender my personal appreciation of their loyalty and good service. It has been a very trying year for all concerned, and it is true to say that it would have been impossible to carry on the work in a satisfactory manner during the difficult times experienced were it not for the cheerful co-operation of all concerned. Finally, I wish to thank the Chairmen and Members of the Public Health and Maternity and Child Welfare Committees for their kindness to me and the help afforded me during the past year. I have the honour to be, Your obedient Servant F. R. Waldron. 9 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics Elevation.—Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts— East Greenwich 1,300 acres West Greenwich 453 „ St. Nicholas, Deptford 115 „ Charlton and Kidbrooke 1,990 „ 3,858 acres Population— At Census, 1931 100,924 Estimated, 1938 95,770 Density of Population— East Greenwich 30 persons per acre West Greenwich 47 „ „ St. Nicholas, Deptford 51 „ „ Charlton and Kidbrooke 14 „ „ Average for the Borough 24 persons per acre Number of Inhabited Houses—1938 (according to Rate Books) 21,140 Structurally separate dwellings at Census, 1931 18,114 Number of Uninhabited Houses— At Census, 1931 250 At end 1938 594 Number of Families or Separate Occupiers— At Census, 1931 25,144 Rateable Value £986,882 Sum Represented by a Id. Rate £4,058 10 PUBLIC OPEN SPACES Borough Council— Acres. Charlton House and Gardens 9.25 R.N. College Cemetery 5.86 St. Alfege Recreation and Church grounds 2.3 Sayes Court Recreation grounds 1.43 St. Nicholas Recreation grounds 1.25 Hughes Fields Recreation grounds .74 Batley Park .97 Bellot Memorial Gardens .19 Other Open Spaces 5.25 approximately 27. H.M. Office of Works— Greenwich Park 185 L.C.C.— Blackheath (part of) 73 Maryon Park 46.70 Charlton Park 45.75 Charlton Lido 23 Mileage of Streets 72 SOCIAL CONDITIONS. The Metropolitan Borough of Greenwich comprises three districts, viz. : Greenwich, Charlton and Kidbrooke, and St. Nicholas, Deptford, all of which are now united into one civil Parish. The Borough is well catered for in the way of parks and open spaces, the largest being the famous Greenwich Park, with its historical surroundings, covering an area of 185 acres. Blackheath forms a Southern boundary, 73 acres of which are within the Borough. To these must now be added the recently opened L.C.C. Play Centre and Lido with its well-equipped swimming bath. The part situated near the River Thames is, generally speaking, an industrial area and is more densely populated than the upper parts of the Borough. Considerable alteration has taken place during recent years by the closing of courts and alleys, demolition of old houses and utilising of sites for the erection of modern houses and blocks 11 of flats. Kidbrooke, which has always been described as the rural, area of the Borough, is now almost entirely built over. The sub-soil of the greater portion of the Borough consists of gravel and sand, the exception being in the Kidbrooke area which is mostly clay. The altitude varies from a few feet below high-water mark on the marshes, up to 249 feet above sea level on the Shooter's Hill Road by the Borough boundary. The industries and sources of employment in the Borough are to be found in close proximity to the River Thames which forms the Borough boundary on the north side. Chief among these are large Cable and Engineering Works, Gasworks, Soap and Candle Works, L.P.T.B. Generating Station and Tramway Car Repair Depot, The London Power Company's Works, Glass Bottle Works, Linoleum Manufacturing Works, Merryweathers' Works (Fire Engines), Cement and Stone Works, Asbestos Works, Cold Meat Storage, Rope, Tin Box and Sack Manufacturers, Printers, Brewers, R.A.F. Works, Enamelling, Barge Builders, Cabinet Making and Saw Mills. POOR LAW RELIEF AND UNEMPLOYMENT. Some indication as to the social condition of the inhabitants of the Borough may be obtained from the following particulars supplied to me through the courtesy of the Local Public Assistance Officer :— Average weekly number of Greenwich residents (men, women and children) in receipt of domiciliary relief during 1938 1,801 Average weekly amount expended in outdoor relief in Greenwich £769 Through the kindness of the Divisional Controller, Ministry of Labour, the following information is given concerning the number of insured persons aged 16—64 years resident in Greenwich who were recorded as unemployed at the following periods. Comparative figures for the previous year are shown in brackets :— Males. Females. Total. 17th January, 1936 1,147 (1,164) 446 (351) 1,593 (1,515) 4th April, 1936 1,074(1,056) 429(256) 1,503 (1,312) 18th July, 1938 1,083 (823) 458 (285) 1,541 (1,108) 17th October, 1938 1,269 (892) 455 (301) 1,724 (1,193) Whilst the information from the Public Assistance Authority points to a slight decrease in the number seeking relief, it will be noticed there are significant increases in the numbers registered as unemployed. 12 POPULATION The Registrar General has estimated the population for Greenwich at mid-year 1938 as 95,770, as compared with 95,990 for the previous year, and it is upon these figures the statistics in this report have been based. Estimated population at Mid-Year, 1938 East Greenwich 39,010 West Greenwich 21,310 St. Nicholas, Deptford 5,880 Charlton and Kidbrooke 29,570 95,770 ♦EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total M. F. Live Births Legitimate 1,253 635 618 Birth Rate 13.64 Illegitimate 50 27 23 Still Births Legitimate 38 24 14 Rate per 1,000 Illegitimate 2 — 2 total Births 29.7 Deaths 1,041 551 490 Death Rate (Crude) 10.90 (Adjusted) 11.11 Deaths from Puerperal Causes :— Rate per 1,000 total Births Puerperal Sepsis — ... — Other Puerperal Causes 2 ... 1.5 Total 2 ... 1.5 Death Rate of Infants under one year of age :— All Infants per 1,000 live births 42 Legitimate Infants per 1,000 legitimate live births 41 Illegitimate Infants per 1,000 illegitimate live births 60 Deaths from Cancer (all ages) 153 ” ” Measles (all ages) 4 ” ” Whooping Cough (all ages) 2 ” ” Diarrhoea (under 2 years of age) 3 * These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 13 MARRIAGES. Mr. E. A. Bale, the Superintendent Registrar of the Greenwich Registration District, has kindly furnished me with particulars relating to the number of marriages solemnised or registered in the Borough of Greenwich. The following table shows these particulars giving the number of marriages in the Borough for each year since 1931 :— Year Churches of England Chapels and Roman Catholic Churches SuperintendentRegistrar's Office Total Approximate Population of the district concerned Greenwich Charlton and kld brooke St. Nicholas 1931 291 138 34 62 247 772 100640 1932 312 152 30 60 205 759 101024 1933 286 136 48 84 247 801 97830 1934 331 143 39 79 259 851 97250 1935 340 158 42 102 250 892 96600 1936 335 208 66 102 252 963 95900 1937 320 198 39 80 240 882 95990 1938 309 185 31 101 268 894 95770 14 METEOROLOGICAL OBSERVATIONS. I am indebted to Dr. H. Spencer Jones, Astronomer Royal, for the following meteorological data for the year ended December, 1938. The mean temperature was 51.3°, which is 1.8° higher than the average for 75 years, 1841-1915. The highest temperature in the shade was 84.0° registered on August 6th. Temperatures exceeding 80° were recorded on 8 days. The lowest temperature was 20.4° on December 20th. Temperatures of freezing point or below were recorded on 23 days, 11 of which were in December and only 1 in January. The mean daily horizontal movement of the air was 298 miles, which is 13 miles above the average for 50 years, 1867-1916. The greatest daily movement was 656 miles on January 15th ; the least daily movement was 131 miles on March 23rd. The greatest motion in one hour was 37 miles, on January 15th and the greatest pressure was 33.2 lbs. to the square foot, on November 23rd. The duration of bright sunshine recorded was 1341.8 hours or 30.0 per cent, of the possible total. There were 59 entirely sunless days, 15 being in January and 13 in December. The total rainfall was 19.51 inches, which is 4.72 inches less than the average for the 75 years 1841-1915. The whole amount occurring in the five months February to June was only 3.13 inches and there is no previous instance of such a small rainfall in a corresponding period at Greenwich. April was the driest month with 0.10 inch ; November was the wettest month with 3.09 inches. Measurable rain fell on 160 days. There were two periods of absolute drought exceeding 20 days, namely March 2nd to 23rd and April 4th to 24th. With regard to pollution of the air by solids in suspension, exceptionally bad days were February 6th and October 25th. At one time during October 25th the amount reached 5.8 milligrams per cubic metre, that is approximately 9.5 lbs. in the volume of air contained in a cube with one hundred yards edge. The mean amount of solid matter in suspension during the period covered by " Summer Time " increased from 0.48 milligrams per cubic metre in 1937 to 0.54 milligrams in 1938. It appears that conditions have not improved. With regard to gaseous pollution, the average amount over the whole period was found to be 0.046 parts of sulphur dioxide per million parts of air, which is rather less than the average for the previous twelve months. During the twenty-four hours ending noon October 26th, the amount was 0.531 parts per million, which is the greatest amount yet recorded. 16 I am indebted to Dr. Allan Young, Medical Officer of Health for Poplar, who has kindly furnished me with comparative rates for Births, Deaths and Infantile Mortality of the various Metropolitan Boroughs obtained direct from the Boroughs concerned. These particulars are set out in the following table :— Borough Estd. Res. Population (mid 1938) Live Births rate per 1,000 popn. 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 Not ava ilable. 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 60·7 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 W andsworth 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 ? 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 16 BIRTHS. The total number of births registered in the Borough during the year was 1,881. Of this number 860 occurred in St. Alfege's Hospital, 337 in the Borough Maternity Home, and 216 at various Nursing Homes within the Borough. Of this total of 1,413 Institution births, 637 only belonged to Greenwich, the remainder being transferred to the appropriate localities. One hundred and ninety-eight births belonging to the Borough took place in Institutions outside the Borough area ; thus the actual figure for Greenwich becomes 1,303 : Males 662 ; Females 641. This figure gives a Birth Rate of 13.64 per 1,000 of the population, and is a fractio n below the previous year's Birth Rate of 13.86. This is the lowest rate ever recorded. The average for the last ten years is 14.6. The Birth Rate for the County of London equals 13.4 per 1,000 of the population. The Birth Rate for all England and Wales was 15.1. Illegitimate live-births numbered 50 representing 3.8 per cent, of the total live births. Under the Births and Deaths Registration Act, 1926, the registration of still-births became compulsory. Forty still-births were allocated to the Borough, representing a percentage of 2.9 of the total births registered. Each of such cases is separately investigated with a view to finding out whether the cause is of a preventable nature, and if so, an endeavour is made to take such appropriate action as will guard against a recurrence. Under the provisions of the Notification of Births Act, 1907 (now Section 255 of the Public Health (London) Act, 1936), intimations have been received from medical men, parents and others, with respect to 1927 births, but after adjustments for transfers this figure was reduced to 1,336. Thirty-eight of these were in respect of still-births. 17 DEATHS. The nett number of deaths registered during 1938 was 1,040 of which 551 were males and 489 females as compared with 1,153 last year. This gives a crude Death Rate for the Borough of 10.89, which figure is slightly increased to 11.10 when the comparability factor furnished by the Registrar General for adjusting Local Deaths is taken into account. The Comparability Factor for Greenwich is the same as last year, viz. 1.02, and may be regarded as the population handicap to be applied, which, when multiplied by the crude Death Rate for the year, modifies the latter so as to make it comparable with the Country as a whole or any other similarly adjusted area. The adjusted Death Rate is in effect a " corrected " Death Rate. The average Death Rate for the last 10 years is 11.61. The Death Rates for the County of London and for England and Wales are 11.4 and 11.6 respectively. The inset table showing causes of death at all ages, has been supplied by the Registrar-General, and is included in accordance with the request contained in the Ministry of Health's Circular No. 1728. 18 DEATHS IN INSTITUTIONS. The following table shows the number of deaths of Greenwich residents in Public Institutions during the last six years :— Year Total Deaths of Greenwich Residents Total Deaths of Greenwich Residents in Public Institutions 1933 1,167 707 1934 1,186 723 1935 1,043 671 1936 1,086 689 1937 1,153 724 1938 1,040 683 Average 1,112 697 AGE MORTALITY. The age mortality and the distributation of the deaths between the different quarters of the year is shown by the following table:- Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 18 13 11 13 55 Between 1 and 2 years — 4 2 1 7 Between 2 and 5 years 3 — 1 — 4 Between 5 and 16 years 7 6 8 3 24 Between 15 and 25 years 14 12 6 10 42 Between 25 and 45 years 22 21 28 23 94 Between 45 and 65 years 74 62 75 66 277 65 years and upwards 156 135 127 119 537 Total 294 253 258 235 1,040 19 Locally the Death Rate varied from 9.86 in Charlton and Kidbrooke, 10.74 in St. Nicholas, Deptford, 11.25 in East Greenwich to 11.67 in West Greenwich. Of the total number of deaths, three were of illegitimate birth, all of whom were under 1 year of age. The following table shows the variation in and the average of the death rates in each of the districts of the Borough in the five years 1933 to 1937, compared with the figures for 1938. District 1933 1934 1935 1936 1937 Average for 5 years 1938 East Greenwich 11.67 12.17 10.92 11.46 11.29 11.50 11.25 West Greenwich 12.55 13.84 11.14 11.68 13.31 12.50 11.67 St. Nicholas Deptford 19.37 13.14 11.93 13.44 13.92 14.36 10.74 Charlton and Kidbrooke 11.59 10.64 10.09 10.29 11.44 10.81 9.86 Whole Borough 11.96 12.23 10.83 11.36 12.05 11.68 10.89 INFANTILE MORTALITY. The Infantile Mortality rate measured by the deaths of children under 1 year of age to the number of live births registered was 42 per 1,000 births. This is the lowest rate ever recorded in the Borough, and is even four points below the figure returned in the year 1930, when Infantile Mortality rates generally throughout the Country were regarded as somewhat phenomenal. The average for the last ten years is 62. The total number of deaths during the year was 55 as compared with 116, 80, 66 and 67, the respective figures for the years 1934, 1935, 1936 and 1937. Locally the variations were 31 per 1,000 births in St. Nicholas, Deptford, 35 in East Greenwich, 41 in Charlton and Kidbrooke, to 58 in West Greenwich. A further reference to the Infantile Mortality rate will be found in the Section devoted to Maternity and Child Welfare, whilst a table showing the causes of death and age3, is included in the Appendix of the Report. 20 For the whole of London the rate was 57, compared with 60 in 1937, 66 in 1936, 58 in 1935, and 67 in 1934. For England and Wales the rate was 53, compared with 58 in 1937, 59 in 1936, 57 in 1935 and 59 in 1934. The following table shows the rate3 for the quinquennial periods since 1921, together with the rat33 for the years 1936, 1937 and 1938 District Average for five years 1921-1925 inclusive Average for five years 1926-1930 inclusive Average for five years 1931-1935 inclusive Year 1936 Year 1937 Year 1938 East Greenwich 62 60 75 64 50 35 West Greenwich 80 59 78 40 77 58 St. Nicholas, Deptford 88 78 77 40 63 31 Charlton and Kidbrooke 50 42 58 41 29 41 Borough 66 57 75 49 50 42 REMARKS ON VARIOUS DEATH CAUSES. Common Infectious Diseases.—The class known as common infectious diseases comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea, is credited with causing a total of 12 deaths equalling a Death Rate of .12 per 1,000. Locally the Death Rate varies from .0 in Charlton (.32 in 1937), .12 in East Greenwich (.22 in 1937), .17 in St. Nicholas (.16 in 1937), to .28 in West Greenwich (.30 in 1937). Smallpox.—There were no deaths from Smallpox, this being the thirty-fifth year since a death occurred from this cause in the Borough. Measles.—There were four deaths ascribed as due to this disease for the year 1938. The number of deaths recorded in the years 1934, 1935, 1936 and 1937 were 16, 9, 0 and 0 respectively. Causes of Death Sex Deaths at Subjoined ages of " Residents," whether occurring within or without the District. All Ages. Under 1. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and over. All Causes M 551 25 4 3 12 23 23 26 62 121 128 124 F 490 30 3 1 12 19 25 20 33 61 111 175 Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Measles M 1 ... ... 1 ... ... ... ... ... ... ... ... F 3 1 1 ... 1 ... ... ... ... ... ... ... Scarlet Fever M 1 ... ... 1 ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough M 1 1 ... ... ... ... ... ... ... ... ... ... F 1 1 ... ... ... ... ... ... ... ... ... ... Diphtheria M 1 ... ... ... 1 ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Influenza M 6 ... ... ... ... ... ... 1 1 2 1 1 F 4 ... ... ... ... ... ... ... ... 2 ... 2 Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System M 40 ... ... ... ... 7 8 6 10 6 3 ... F 20 ... ... ... 1 7 8 3 1 ... ... ... Other Tuberculous Diseases M 7 2 ... ... 1 ... 1 1 1 1 ... ... F 7 1 ... ... 2 1 2 ... ... ... ... 1 Syphilis M 1 ... ... ... ... ... ... ... ... 1 ... ... F ... ... ... ... ... ... ... ... ... ... ... ... General Paralysis of the Insane, tabes dorsalis M 7 ... ... ... 1 ... ... 1 2 1 2 ... F 1 ... ... ... ... ... ... 1 ... ... ... ... Cancer, malignant disease M 81 ... ... ... ... ... 2 5 10 25 27 12 F 72 ... ... ... ... ... 4 3 9 21 11 24 Diabetes M 4 ... ... ... ... ... ... ... 2 ... 2 ... F 13 ... ... ... ... ... ... ... 1 4 4 4 Cerebral Haemorrhage, etc M 24 ... ... ... ... ... ... 1 2 7 7 7 F 29 ... ... ... ... ... ... 1 3 8 10 7 Heart Disease M 153 ... ... ... 1 1 ... 2 10 25 51 63 F 158 ... ... ... 1 4 1 6 7 12 42 85 Aneurysm M 4 ... ... ... ... ... ... ... 2 2 ... ... F 3 ... ... ... ... ... ... ... ... 1 2 ... Other Circulatory Diseases M 22 ... ... ... ... ... ... 1 4 3 6 8 F 29 1 ... ... ... ... 1 ... 2 4 9 12 Bronchitis M 14 ... ... ... ... 1 ... ... 1 4 2 6 F 9 ... ... ... ... ... ... ... 1 ... 3 5 Pneumonia (all forms) M 42 6 2 1 ... 5 2 2 2 12 7 3 F 27 6 1 l 2 2 1 2 2 2 5 3 Other Respiratory Diseases M 3 ... ... ... ... ... 1 ... ... 1 1 ... F 3 ... ... ... ... ... ... ... ... ... 2 1 Peptic Ulcer M 5 ... ... ... ... ... ... ... ... 4 ... 1 F 2 ... ... ... ... ... ... ... ... ... 1 1 Diarrhoea, etc. M ... ... ... ... ... ... ... ... ... ... ... ... F 3 3 ... ... ... ... ... ... ... ... ... ... Appendicitis M 2 ... ... ... ... ... ... ... ... 2 ... ... F 6 ... ... ... 1 2 ... ... 1 ... 2 ... Cirrhosis of Liver M 4 ... ... ... ... ... ... ... ... 2 2 ... F 1 ... ... ... ... ... ... ... ... 1 ... ... Other Diseases of Liver, etc. M ... ... ... ... ... ... ... ... ... ... ... ... F 7 ... ... ... ... ... ... 1 ... 2 ... 4 Other Digestive Diseases M 8 ... ... ... 1 ... ... 1 1 2 2 1 F 4 ... ... ... ... ... ... ... ... 2 2 ... A. and Cr. Nephritis M 12 ... ... ... ... 1 ... ... 4 1 3 3 F 10 ... ... ... ... ... ... 2 2 1 3 2 Puerperal Sepsis F ... ... ... ... ... ... ... ... ... ... ... ... Other Puerperal Causes F 2 ... ... ... ... 1 ... 1 ... ... ... ... Congenital Debility, Premature Birth, Malformations, etc. M 17 16 ... ... 1 ... ... ... ... ... ... ... F 12 12 ... ... ... ... ... ... ... ... ... ... Senility M 6 ... ... ... ... ... ... ... ... ... ... 6 F 17 ... ... ... ... ... ... ... ... ... 4 13 Suicide M 6 ... ... ... ... ... 1 1 2 2 ... ... F 2 ... ... ... ... ... 2 ... ... ... ... ... Other Violence M 29 ... 1 ... 4 5 1 1 3 9 3 2 F 14 3 ... ... 1 ... 1 ... ... 1 4 4 Other Defined Diseases M 50 ... 1 ... 2 3 7 3 5 9 9 11 F 31 2 1 ... 3 2 5 ... 4 ... 7 7 Diseases ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 21 Scarlet Fever—This disease was responsible for one death during the year. Three deaths occurred in 1934, one in 1935, two in 1936 and two in 1937. Whooping Cough.—This disease was given as the cause of two deaths with a Death Rate of .02 per 1,000. There were 8 deaths in the year 1933, 6 in 1934, 1 in 1935, 5 in 1936, and 6 in 1937. Diphtheria.—There was one death during the year. This gives a Death Rate of .01 compared with .04 for the previous year. Four deaths occurred in 1937, 3 in 1936 and 1935, 5 in 1934, 14 in 1933 and 7 in 1932. Enteric Fever.—There were no deaths ascribed to this disease during the year. There was one in 1935 and 1936 respectively, and 0 in 1937. Diarrhoea, Dysentery and Zymotic Enteritis.—Four deaths were stated to be due to these causes, equalling a Death Rate of .04 per 1,000. Last year there were 14 deaths, 27 in 1936, 14 in 1935, 30 in 1934, 17 in 1933, and 24 in 1932. Influenza.—This disease was responsible for nine deaths. The age distribution was, 1 between 25 and 45 years, 4 between 45 and 65 years, and 4 over 65 years. Three occurred in East Greenwich, five in West Greenwich, and one in Charlton and Kidbrooke. Five cases received Hospital treatment. TUBERCULOSIS. This class includes the causes of 74 deaths during the year under review, with a rate of .77. These figures compare with 85, 78, 73 and 79, the totals of the years 1934, 1935, 1936 and 1937 respectively, and the respective rates of .87, .80, .76 and .82. Tuberculosis of the Lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 61 attributed to the cause, thus giving a rate of .63 per 1,000 as compared with .76 for the last year. Locally the deaths were 20 in East Greenwich (Death Rate .51) ; 4 in St. Nicholas, Deptford (Death Rate '68) ; 20 in Charlton and Kidbrooke (Death Rate -67) ; 17 in West Greenwich (Death Rate '80). The remaining forms of Tuberculosis were responsible for 13 deaths, 5 of which occurred in East Greenwich, 3 in West Greenwich, 2 in St. Nicholas, Deptford, and 3 in Charlton. 22 MALIGNANT DISEASES. Cancer was responsible for a total of 148 deaths for the year. The number of deaths in 1937, 1936, 1935, 1934 and 1933 were 159, 134, 156, 161 and 162 respectively. The distribution of deaths were as follow : 63 in East Greenwich, 31 in West Greenwich, 46 in Charlton and Kidbrooke, and 8 in St. Nicholas, Deptford. DISEASES OF THE CIRCULATORY SYSTEM. Heart Disease.—Once again the deaths from this cause occupy the principal place in the classification of diseases, there being 312 deaths as compared with 338 for the year 1937. This class is therefore responsible for 30% of the total deaths in the Borough. MORTUARY. During the year 110 bodies were received into the Mortuary. The details are as under:— Bodies brought in upon which inquests were held 94 Bodies brought in upon which post-mortems were held 44 Bodies brought in upon which inquests were considered unnecessary 16 Bodies brought in which were recovered from River Thames 8 Bodies brought in where death occurred from infectious disease 4 23 SECTION B. General provision of Health Services for the Area. Public Health Staff.—In accordance with the request contained in the Ministry of Health Circular No. 1728, particulars relating to the Staff of the Department are set out on pages 5 and 6. There were no alterations in the personnel of the Department during the year. Laboratory Work.—The long-standing arrangement with the Bacteriological Department of the Seamen's Hospital has been in force throughout the year, whereby that Institution carried out all necessary pathological and bacteriological work. In this connection 1,312 specimens have been examined for Diphtheria, 8 for Typhoid Fever, 393 for Tuberculosis, 179 in connection with the Council's Maternity Home, and 93 for other various conditions. Fuller details respecting the results of the examinations of these specimens will be found under the different headings of the individual diseases. Ambulance Facilities.—The arrangements for utilising the ambulance services provided by the L.C.C. continue to be in force and have again been entirely satisfactory. Diabetes—Insulin Treatment.—In accordance with Section 227, Public Health (London) Act, 1936, arrangements are in existence whereby necessitous patients suffering from this disease can obtain a supply of insulin upon application by the local doctor to the Public Health Department. A quarterly report is furnished to the Ministry of Health on patients who receive this service. During the year, 3 patients received such assistance. Treatment Centres and Clinics.—Particulars relating to the local health services are included in the monthly issue of "Better Health," 2,000 copies of which are distributed throughout the Borough. The following table shows the Centres and times in detail:— Infant Welfare Centres. Charlton Lane.—Wednesday, 10 a.m. and 2 p.m. Chevening Road.—Monday, 10 a.m.; Wednesday, 10 a.m. and 2 p.m.; Friday, 2 p.m. Creek Road. —Tuesday and Thursday at 2 p.m. Shooters Hill Road.—Tuesday and Friday at 2 p.m. 24 Artificial Sunlight Treatment Centres. Chevening Road.—Daily, 9.30 a.m. and 2 p.m. Shooters Hill Road.—Monday and Wednesday, 9.30 a.m. and 2 p.m. Charlton Lane.—Monday and Thursday at 2.30 p.m. Creek Road.—Tuesday, 9.30 a.m.; Friday, 2 p.m. Evening sessions for adult patients are held during the winter at Chevening Road Centre on Tuesday and Friday evenings from 5.30 to 7.30. For particulars of fees, etc., apply Medical Officer of Health. Centres for Expectant Mothers. Charlton Lane.—Monday, 10 a.m. Chevening Road.—Monday, 2 p.m. and Tuesday, 10 a.m. Creek Road.—Wednesday at 10 a.m.; Thursday at 10 a.m. Shooters Hill Road.—Thursday, 2 p.m.; Friday, 10 a.m. Centres for Toddlers. Creek Road.—1st, 2nd and 4th Fridays, 10 a.m. Shooters Hill Road.—Thursday, 10 a.m. Charlton Lane.—1st and 3rd Thursdays, 10 a.m. Chevening Road.—2nd and 3rd Fridays, 10 a.m. Maternity Home.—78 Shooters Hill Road, S.E.3. Forms of application can be obtained either from the Health Department or from the Matron at the Home. Low fees available for Greenwich residents. Maze Hill Clinic. 41 & 43 Maze Hill, S.E.10. The Council's Tuberculosis Officer is in attendance as follows:— Monday.—10.30 a.m.; 3 and 6 p.m. Tuesday.—2 p.m. Wednesday.—by appointment only. Thursday.—2.30 p.m. Friday.—10.30 a.m. Saturday.—10 a.m. (School children). Dental Clinic. Wednesday afternoons, at 41 & 43 Maze Hill, S.E.10, alternately for patients referred from the Maze Hill Clinic and Welfare Centres. Craftwork Centre. Monday afternoons, at 41 Maze Hill, S.E.10. Special Women's Clinic. Consultant attends at Chevening Road at 6 p.m. first Wednesday in the month. Foot Clinic. Charlton Lane.—Wednesday, 7.30 p.m.; Friday, 2.30 p.m. and 5 p.m. Chevening Road.—Tuesday, 2.30 p.m. and 6.30 p.m.; Thursday, 2.30 p.m. and 6.30 p.m.; Saturday, 2.30 p.m. Creek Road.—Monday, 2.30 p.m. and 7.30 p.m.; Wednesday, 2.30 p.m. Shooters Hill Road.—Wednesday, 6.30 p.m. The charge is 1s. per attendance. 25 Registrar of Births and Deaths. Register Office, Devonport House, Greenwich, S.E.10.—Daily, 9 a.m. to 12 noon (Saturday, 9 to 10.30 a.m.); Tuesday, 3 to 5 p.m.; Monday, Wednesday and Friday, 5 to 7 p.m. Nursing Associations. Queen's District Nursing Association for Blackheath and Charlton, 78 Elliscombe Road, S.E.7. Ranyard Mission, 25 Russell Square, W.C.1. Nursing Sisters of St. John the Divine, Watson Street, S.E.8. Home Helps.—The question of providing a service of home helps as part of the Council's Maternity and Child Welfare scheme was again considered by the Maternity and Child Welfare Committee, and towards the end of the year a scheme was finally adopted by the Committee and approved by the Ministry of Health. It is expected that as a result of the working of the new Midwives Act much use will be made of this service. Foot Clinics.—During the year 4,608 attendances were recorded, representing an income of £230 8s. 0d. The appointment system introduced at the beginning of the year has proved a great boon to patients, and in view of the great demand for chiropody, further extension of facilities is under consideration. This service is now available at every Centre, each district being served. The following table gives the attendances at each Clinic:— Chevening Road Charlton Lane Creek Road Shooter's Hill Road Total Sessions 233 153 147 19 552 Patients 2,255 956 1,301 96 4,608 Fees £230 8s. 0d. Ultra Violet Light Treatment.—Artificial Sunlight Clinics are held at all the Welfare Centres. As previously, evening sessions were held during the Winter months. These evening sessions are available for paying patients. The fees charged are 12/- for 6 treatments or 20/- for 12 treatments. During the year 22 patients were given 203 treatments, the fees received totalling £20 12s. 0d. The arrangements with the authorities of the Roan Schools for the treatment of certain selected cases continue to be in force. 26 The following table shows the type of abnormality treated during the year:— Rickets 248 Malnutrition and Underweight 211 Colds and Bronchial conditions 111 Anaemia and Debility 134 Convalescent from Infectious Diseases 63 Insomnia 16 Rheumatism 19 Cervical Adenitis 17 Skin Sepsis 12 Ante-Natal patients 65 Post-Natal 55 951 Particulars relating to the number of patients treated at the various Centres during 1938 are given in the following tables:— Under 5 5—15 Over 15 Total Number under treatment at end of previous year 323 31 26 380 Number of New Patients 802 33 120 955 Discharges 858 44 122 1,024 Number under treatment at end of 1938 267 20 24 311 Number of treatments given 14,159 612 1,888 16,659 Tumour Diagnostic Clinic.—As foreshadowed in last year's report, the usefulness of this clinic has been nullified by the decline in the number of residents availing themselves of this service, and early in the year it was decided to abolish the clinic in its present form and to establish in its place for an experimental period of six months a special clinic for women. MATERNITY AND CHILD WELFARE. Infant Welfare Centres.—The work at the various Centres has been conducted on similar lines as in previous years and particulars relating to attendances are shewn in the following tables:— 27 (a) Babies. Chevening Road Shooter's Hill Rd. Creek Road Charlton Lane Total No. of Clinics 201 101 101 102 505 No. of Attendances 6,765 5,478 3,699 2,616 18,558 New Cases 248 278 230 141 897 Medical Consultations 2,243 1,963 1,394 1,170 6,770 All babies are weighed and advice given to the mothers at every attendance. (b) Children 1-5 years. Chevening Road Shooter's Hill Rd. Creek Road Charlton Lane Total No. of Clinics 201 101 101 101 505 No. of Attendances 6,234 4,052 2,675 1,938 14,899 New Cases 220 200 31 119 570 Medical Consultations 2,311 1,516 1,216 709 5,752 Ante-Natal and Post-Natal Clinics.—As far as is practicable, appointments are made for expectant mothers in order to obviate the waiting period at the clinic. The number of new cases together with total attendances for the year, were as follows:— No. of clinics New cases Total attendances Chevening Road 98 238 1,289 Shooter's Hill Road 157 351 2,504 Charlton Lane 47 81 553 Creek Road 102 174 880 404 844 5,226 Post-Natal. No. of attendances made during the year 375 Other Ante-Natal Services.—In addition to the facilities provided at the Borough Council Centres 240 received Ante-Natal treatment at the St. Alfege's Hospital, making 1,500 attendances in all; whilst the British Home for Mothers and Babies, Woolwich, was responsible for Ante-Natal supervision in regard to 196 cases, 67 of whom were out-patients. The total number of attendances made was 1,176. 28 The Nursing Sisters of St. John the Divine state that 47 mothers attended their Centre making 240 attendances in all. Toddlers' Clinics.—Very useful work is carried out at these clinics, sessions being held weekly at Shooters Hill Road and fortnightly at Creek Road and Charlton Lane. 1,419 children between the age of 1 and 5 years attended these Centres making in all 3,744 attendances. Midwifery Services.—The new Midwives Act came into force on 1st January, 1938. The Act makes provision for a service of salaried midwives for domiciliary midwifery and maternity nursing. The midwives are employed under the London County Council and for the purposes of administration this Borough is grouped with Woolwich, Lewisham, Deptford and Camberwell and termed Area E. Twelve midwives are available for this Area. The result of the first year's working has proved in every way entirely satisfactory. Infantile Mortality.—The total number of deaths under 1 year of age was 55 as compared with 67 for the previous year. The Infantile Mortality Rate is thus equal to 42 per 1,000 Births. This is the lowest rate ever recorded in the Borough and is even 4 points below the figure returned in the year 1930 when Infantile Mortality Rates generally throughout the country were regarded as somewhat phenomenal. The average for the last 10 years is 62. The Infantile Mortality Rate for the County of London is 57 and that for England and Wales 53. The following are the local rates:— St. Nicholas, Deptford 31 East Greenwich 35 Charlton and Kidbrooke 41 West Greenwich 58 The chief causes of death were:— Gastro-Enteritis and Diarrhoea 4 Premature Birth 13 Pneumonia and Bronchitis 12 Congenital Malformations 6 Atrophy, Debility and Marasmus 3 29 T.B. Meningitis 3 Whooping Cough 2 Injury at Birth 2 Measles 1 Other causes 9 55 Of the above number 24 were boys and 31 girls. The number of neo-natal deaths, i.e., those dying before attaining the age of one month, was 28, which is equivalent to 52.7 per cent. of total Infantile Mortality deaths as compared with 66 per cent. for the previous year. 23 of these died in the first week. As usual the principal causes of this class were Prematurity and Congenital Malformations. In London the health services are now so comprehensive, that all Expectant and Nursing Mothers have the advantage of obtaining advice at Ante-Natal and Post-Natal Clinics either through the Borough Council, the L.C.C. or Voluntary Hospitals. As a result of investigations it was ascertained that in 6 cases the mother was under the care of her own doctor; 8 cases had had no supervision whatever. Two of the latter were no doubt of illegitimate origin, being found in the River Thames, whilst in one case the mother was admitted to hospital in a serious condition of health in early pregnancy to which she subsequently succumbed. Deaths of Children 1—5 Years of Age.—The number of deaths of children between the ages of 1 and 2 years was 7 and between 2 and 5 years 4. The previous year the figures were 9 and 7 respectively. Maternal Mortality.—The number of deaths from Puerperal Sepsis and other accidents and diseases of pregnancy was 2, which gives a maternal Death Rate of 1.5 per 1,000 total live Births. In the years 1934, 1935, 1936 and 1937, there were 4, 5, 2 and 2 deaths respectively. Maternity Home.—The number of patients admitted during the year was 380, of which 41 cases were admitted from the Centres for ante-natal treatment for periods varying from 2 to 7 days. The number of cases delivered by the Midwives of the Home was 307, the remainder by the Medical Staff. In 38 instances medical assistance was sought by the Midwives. 30 Operative interference was called for as follows:— Caesarian Section 1 Forceps 22 Episiotomy 9 Nine cases of Puerperal Pyrexia due to Mastitis (2), Pyelitis (3), Sapraemia (2), and Salpingitis and Influenza one each, were notified during the year. Amongst the Infants, 18 were not entirely breast fed whilst in the Home. There were no cases of Pemphigus Neonatorum and two cases of Ophthalmia Neonatorum, both of which recovered within a few days, the conditions in each case being so slight as not to warrant removal to hospital. There were 6 Still Births, the causes being attributed as follows:— 2 Ante-partum haemorrhage. 1 Anencephalic foetus. 1 No foetal heart on admission. 1 Shoulder presentation. 1 Macerated foetus. Two Infant deaths occurred within 10 days of birth, the causes being:— Placenta Praevia (Premature) 1 Haemorrhage disease of newly-born 1 Owing to the occurrence of several cases of minor infection among the patients and staff the Home was closed for the admission of patients on the 11th January. Complete fumigation and cleansing was carried out both at the Home and the Nurses' quarters at 105 Shooters Hill Road. The Home was subsequently re-opened on 5th February. Patients who ordinarily would have been admitted during this period were accommodated at either local hospitals or Nursing Homes. Puerperal Fever and Puerperal Pyrexia Regulations, 1926.—The arrangements made by the Council under the provisions of the Puerperal Fever and Puerperal Pyrexia Regulations, 1926, whereby obstetric consultants are available to assist local medical practitioners, continue in force. This service was provided on five occasions. Two cases of Puerperal Fever and thirty-five of Puerperal Pyrexia were notified as compared with 36 for the previous year. Twenty-seven occurred in Hospitals, 7 in the Council's Maternity 31 Home, 2 in private houses, and the remaining case was reported from a private Nursing Home. Pneumonia.—Facilities are available for examination of expectoration in order to discover the type of disease; in addition, serum for treatment may be supplied in necessitous cases on request from the local medical practitioner. Home Nursing.—Children attending the various Centres who are found to be in such a condition as to require special nursing at home are referred to the various Nursing Associations operating in the Borough, the Council paying 1/- per visit to the Queen's Nursing Association. The total number of cases referred from the Centre was 120. The Council also contributes £50 per annum to the Ranyard Mission. Institutional Provision for Mothers and Children.— Cases of mothers and children who, in the opinion of the Medical Officer would be materially benefited by a course of convalescent treatment, are dealt with from time to time. The Committee set aside the sum of £100 per annum for such cases. Three mothers and babies and 55 children were sent away during the year. Once again it was noticed that many mothers were not able to go away with their babies either on account of not being able to make arrangements for the care of their other children or objections being encountered by their husbands. Health Visitors.—The following tables show (A) the number of visits made by the Health Visitors during the year in connection with Births and cases of Infectious Diseases, and (B) number of Infant Consultations and Ante-Natal Clinics attended and miscellaneous visits:— Health Visitors' Visits, &c., 1938. Table A. Visits Re-Visits Total Infants under 1 year 1,299 3,939 5,238 Children 1—5 years 306 5,679 5,985 Measles (under 5 years) 1,045 235 1,280 „ (over 5 years) 709 60 769 Whooping Cough (under 5 years) 83 31 114 ,, ,, (over 5 years) 46 7 53 Pneumonia 19 19 38 Puerperal Pyrexia and Fever 36 33 69 Diarrhœa 95 88 183 Ophthalmia Neonatorum 26 22 48 Inflammation of Eyes 4 7 11 Pemphigus 1 1 2 Scabies 2 6 7 3,671 10,126 13,797 32 Table B. Visits Re-Visits Totals Dental Treatment 20 10 30 Milk Scheme 136 26 162 Ante-Natal Cases 933 378 1311 Infant Consultations Attended – – 1,084 Ante-Natal Clinics Attended – - 337 Children Act 45 71 116 Miscellaneous 821 456 1,277 Schools re Measles – 103 103 In addition to the above 567 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. Notification of Births Acts (1907 and 1915). Public Health (London) Act, 1936. All live births and all still births after 28th week of pregnancy must be notified within 36 hours. Early knowledge enables the Health Visitors to begin early visiting. Still-births must be certified either by the Doctor or by the Midwife or by declaration on a prescribed form, if no doctor or midwife was present. In these latter cases the Minister of Health requires the Medical Officer of Health to submit a special report in order that he may be satisfied that the child was really still-born. The following Table gives the number and character of the intimation received respecting births in the Borough:— Where Confined Midwives Doctors Greenwich Births Other Boroughs' Births Greenwich Births Other Boroughs' Births St. Alfege Hospital 359 524 4 – Greenwich Borough Council Maternity Home 244 90 - – Other Nursing Homes 25 102 14 58 Other Hospitals – – – – At Home 425 8 66 8 1,053 724 84 66 Other Boroughs (Transfers Inwards) 154 – 45 – 1,207 – 129 – From a perusal of the above Table it will be seen that 1,927 actually took place in the Borough of which number 790 were trans- 33 ferred to Other Authorities. Against this 199 births which took place in other areas were allocated to Greenwich, thus giving a nett figure of 1,336. Dental Clinic.—The Council's Dentist, Mr. G. F. Ferris, L.D.S., R.C.S. (Eng.), attends at the Dispensary, Maze Hill, once a fortnight to deal with cases referred to him from the Welfare Centres and Clinics. To enable him to cope with the increasing number of "fillings and scalings" an extra session is held once a month. The following Return shows the work performed during the year:— Number of Sessions 65 Number of Patients 204 Number of Attendances 426 Extractions (Local Anaesthesia) 157 „ (Gas) 72 Dentures and Repairs 9 Fillings and Scalings 174 Referred for X-Ray 1 Referred to Hospital re Gas 7 Advice given (no action necessary) 169 Minor Ailments.—On several occasions during the year attention was drawn to the fact that children referred from the Centres were kept for long periods on a waiting list for admission. At the end of the year the Maternity and Child Welfare Committee had under consideration the making of alternative arrangements which would obviate this delay in provision of necessary treatment. Birth Control The Greenwich Women's Welfare Centre opened its Clinic in March, 1935, at 118, Woolwich Road, S.E.10. The main object of this Clinic is to provide sound medical advice by a woman doctor for married women. Cases are recommended from the Council's Welfare Clinics when in the opinion of the Maternity Medical Officer such advice is necessary. During the year 1938, 11 cases were referred for treatment. In necessitous cases the Council meets the cost. L.C.C. School Clinic A clinic is provided at 22, Park Row, Greenwich, and the following facilities provided:— Dental.—Every morning except Saturday and also Friday afternoons. Treatment, except for urgent cases, is given only by previous appointment. 34 Minor Ailments.—A Doctor attends on Mondays at 2.30 p.m. and alternate Thursdays at 2 p.m.; a nurse attends daily (including Saturday mornings). Children can attend this clinic without appointment, but if in school attendance should only attend after school hours. A further clinic is held at Sherington Road School where a Doctor is in attendance on Tuesday afternoons. A nurse attends each day as in the clinic mentioned above. Nursery School The Rachel MacMillan L.C.C. Nursery School continues its good work in the St. Nicholas district of the Borough. I am informed there are 120 Greenwich children attending the school. The majority of the children attending are Toddlers and as it is conducted on open-air lines the benefit to the children of the locality is unquestionably of great value. The School has associated with it a Convalescent Home at Wrotham in Kent, to which children are drafted for holiday periods. Arrangements have been made for Greenwich children attending the School to have periods of convalescence as and when recommended by the Welfare Doctor. Milk, etc., Scheme The Council has continued to supply milk, etc., to necessitous cases, each case being investigated especially as to its financial condition before a supply is granted. The milk may be granted free or at a reduced cost to:— (a) Nursing Mothers; (b) Expectant Mothers from the first 3 months of pregnancy; (c) Children up to 3 years of age and in exceptionable stances to 5 years. In addition dinners may also be given to nursing and expectant mothers where the family income falls within the Council's scale. It is a condition that these dinners must not be taken home, but must be consumed by the mother herself on the premises. Particulars of the amount of milk, etc., distributed will be found in the following tables. The approximate cost to the Council under this heading during the year was £3,900. 35 It should be mentioned that included in the total amount of milk distributed free (table A), is 2,732 lbs. which is granted to the recipients under the Extra Nourishment Scheme by arrangement with the local Public Assistance Committee, and the amount of £273 was recovered from that Authority. (a) Dried Milk, Virol, &c., Distributed Free. Quarter ended Milk Virol Malt & Oil Cod Liver Oil Marmite March, 1938 11,399½ 1,850 2,198 418 2,496 June, ,, 10,913½ 1,540½ 1,854 340 2,180 Sept., „ 10,234 1,170½ 1,343 299 2,007 Dec., „ 10,493 1,185½ 1,579 310 2,178 Totals 43,040 5,746½ 6,974 1,367 8,861 (6) Dried Milk, Virol, &c., Sold at Full or Reduced Prices. Quarter ended Milk Virol Malt & Oil Cod Liver Oil MarMite Total Amount Received lbs. lbs. lbs. Bottles Cartons £ s. d. March, 1938 4,765½ 452½ 696 334 1,210 404 16 10 June, „ 4,958 324½ 296 258 949 389 9 11 Sept., „ 5,511½ 256½ 211 238 1,058 425 18 0 Dec., „ 5,391½ 336½ 608 299 1,077 444 17 2 Totals 20,626½ 1,370 1,811 1,129 4,294 1,665 1 11 In addition to the above, 12,253 pints of liquid milk were distributed free or sold at reduced prices at a nett cost to the Council of £172 5s. 2d. Children Acts, 1908 and 1932.—The duties under these Acts were transferred by the London County Council to the Borough Council on 1st April, 1933, and the powers under the Acts have been re-enacted in the Public Health (London) Act, 1936. The supervision of Foster-children and of the homes of fostermothers is carried out by the Health Visitors. Applications for registration as a Foster-mother under the Act is sanctioned by the Borough Council on the recommendation of the Maternity and Child Welfare Committee. 36 During the year 116 visits were made by the Health Visitors. The following particulars are taken from the Register:— Number of Foster-mothers on Register at end of 1938 41 Number of Applicants refused 2 Number of Foster-children 31 Number of Foster-children who died during the year – Number of Certificates of Exemption granted – Number of cases legal proceedings taken – There were several minor infringements again dealt with, the chief being failure to notify change of address of Infant, and in each case the Foster Mother was cautioned. 37 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The tables on pages 48 and 49 summarise, as far as possible the Sanitary work of the Department; from these it will be seen that a total of 19,187 houses and premises have been inspected or re-inspected during the year; 1,310 intimation notices and 218 statutory notices have been served. There were altogether throughout the year 753 complaints registered. FACTORIES. Factories Act, 1937.—This Act came into force on the 1st July, 1938. It consolidates and amends all previous legislation regarding Factories, Workshops and Workplaces, and removes the previous distinction. In general, the Local Authority will enforce the legislation as to sanitary conveniences in all factories and as to cleanliness, ventilation, overcrowding, and drainage of floors, in factories where mechanical power is not used. All factories, irrespective of size, must have an adequate supply of drinking water from a public main or some other source approved in writing by the Council. A register of factories must be kept and the Act applies to factories belonging to the Crown or Municipal Undertakings. Under the new Act in regard to Overcrowding, the cubic space allowed for each person is raised from 250 to 400 cubic feet, and no space more than 14 feet from the floor is to be taken into account in making the calculation. In the case of a room used as a workroom at the time of the passing of the Act, however, the old figure of 250 cubic feet is allowed for a period of 5 years, although during this period some form of mechanical ventilation may be demanded. Basement bakehouses are subject to special legislation. They may not be used as such in future unless so used at the time of the passing of the Act. In addition a certificate of suitability must have been issued by the Council. A basement bakehouse which has not been used as such for a period exceeding 12 months, shall not be so used again. It will be the duty of the Council to carry out during the year commencing 1st July, 1938, and every five years thereafter, an 38 examination of every bakehouse in respect of which a certificate has been issued, and to consider whether such certificate should be continued or revoked. By the end of the year a complete survey was made, as a result 15 were reported as being ineligible for re-opening as basement bakehouses. Certificates of continuance were granted in 10 cases after certain reconstruction work had been carried out. The number of Factories, etc., upon the Register at the close of the year was 330. This number includes 68 Factories where mechanical power is not used. These premises were kept under systematic observation by the Inspectors, who made 446 inspections. In the case of factories where mechanical power is used, the duty of inspection is mainly carried out by H.M. Factory Inspector. Outworkers' Register.—Six lists, containing 29 names and addresses, have been received from employers within the district. In addition to this, 40 lists containing 78 names and addresses of Outworkers residing in this Borough were received from Medical Officers of Health of other Boroughs (thus giving a total of 78 Outworkers in the Borough). Nine lists with 29 names and addresses were forwarded to other districts. 200 visits of inspection have been paid to these premises. FACTORIES ACT, 1937 1.—INSPECTIONS. Year 1938. Premises Number of Inspections Written Notices Occupiers Pros'cut'd Factories (with mechanical power) 277 15 – Factories (without mechanical power) 152 6 – *Other premises under the Act (including works of building and engineering construction, but not including outworkers premises). 17 - – Total 446 21 – * Electrical Stations should be reckoned as factories. 39 2.—DEFECTS FOUND. Particulars Number of Defects No. of prosecutions Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.l) 70 70 – – Overcrowding (S.2) – – – – Unreasonable Temperature (S.3) – – – – Inadequate Ventilation (S.4) 1 1 – – Ineffective drainage of floors (S.6) – – – – Sanitary Conveniences (S.7)— Insufficient 3 3 – – Unsuitable or defective 36 36 – – Not separate for sexes 1 1 – – Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories & Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937). 17 17 - - Total 128 128 — — SMOKE ABATEMENT. Under the provisions of the Public Health (London) Act, 1936, and the Public Health (Smoke Abatement) Act, 1926, the expression "smoke" includes soot, ash, grit and gritty particles; during the year 118 observations of chimneys have been made. On several occasions excessive emissions were observed, and investigations revealed that the emissions were due to the use of inferior fuel or careless firing. Nuisances arising from the emission of large quantities of smoke from chimneys in connection with manufacturing or trade processes recur when the attention of the stoker is diverted from his work or when the fuel on a particular grate is varied. It is found that months may pass without nuisance from a chimney, and then for a few hours or days a marked increase in the smoke emission is noted. 40 Special Survey.—A concentrated survey of the atmospheric pollution in the Borough was undertaken following continued heavy grit deposit in the East Greenwich area. The services of two Chemical Consultants were engaged by the Council. As a preliminary, permission was obtained from the owners of the premises under observation, and samples of flue gases representative of the actual emission from the chimney shafts were taken at suitable points. In order to obtain correlation between the dust emission and the dust deposits which have given rise to complaints, a survey of the Borough was made with a view to locating suitable positions where the atmospheric deposit could be collected. Twenty-two deposit stations were selected at distances ranging from one hundred yards to one and quarter miles from the chimneys in question. Grit deposited from the atmosphere was allowed to fall into enamel trays—the dimensions of which were 18" x 14" x 2" deep—and was transferred with the application of distilled water to bottles; and in all, 881 samples of grit were submitted for analysis. The collections were made at the end of periods varying from several hours to seven days, and were carried out continuously during the six months from February to July. The results were collated and the climatic conditions, including wind direction and velocity and rainfall for the same periods, were recorded. During this special survey observations were regularly made of the smoke emission from the chimneys concerned and from those in the near vicinity. Special maps of the Borough showing the positions of the deposit stations were prepared. The deposits during each particular period were marked on a separate map for that period, and on correlation it was found that (1) the particles deposited varied inversely as the distance from the point of alleged emission, and (2) the amount of deposit varied directly as the direction of the wind. The analytical and microscopic examinations of the deposits and their comparison with the materials deposited in the flue system and extracted from the chimney gases left no room for doubt that the former were derived from the solids carried by the chimney gases. 41 At the end of the year the Council had under consideration the question of instituting proceedings in the High Court against the owner of the offending premises, and it is hoped that as a result of this action by the Council conditions may be ameliorated in the near future. THE ERADICATION OF BED BUGS. Further consideration was given to the organisation of a disinfestation scheme for the Borough to include the use of hydrogen cyanide for the fumigation of furniture. The scheme provides for the purchase of a 2-ton Commercial van with a capacity of 950 cubic feet. The van will be fitted with tubular electrical heating apparatus and blower fan at an approximate cost of £400. It is anticipated that the van will be capable of taking the furniture of 2 dwellings. Arrangements will be made for the disinfestation and removal of furniture from families granted new housing accommodation by the Council, and also to tenants given alternative accommodation by the London County Council. In addition cases where requests are received for disinfestation of private premises will be carried out with an appropriate charge being made. It is intended that the existing disinfecting staff with one additional disinfector will be able to cope with the work under the supervision of one of the Sanitary Inspectors. In accordance with the Ministry's Circular the following table is given:— (1) The number of— (а) Council houses found to be infested 11 „ ,, disinfested 11 (b) Other „ found to be infested 206 No. of rooms disinfested 433 (2) The methods employed for freeing infested houses from bed bugs:—In the case of Council houses, the Council's Estate Department staff employ the use of a blow lamp and loosen all skirtings, picture rails, etc. One hundred and twenty gallons of vermicine, which is a liquid contact spray, and 16 lbs. of sulphur were utilised during the year. 42 (3) The methods employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses:—Bedding is removed to the Council's Disinfecting Station and placed in the Steam Disinfector, and where necessary the rooms and contents are sprayed with the vermicine. (4) Whether the work of disinfestation is carried out by the Local Authority or by a contractor:—The whole of the work is done by the Local Authority. (5) The measures taken by way of supervision or education of tenants to prevent infestation or re-infestation after cleansing:—As far as possible the Inspectors instruct the tenants in the methods employed to prevent infestation and vermin fluid is placed at the disposal of tenants for their use. Offensive Trades.—No offensive trade scheduled by the London County Council can be carried on in any Metropolitan Borough without first obtaining the sanction of the local Council. Early in the year an application was received from a firm seeking to establish the business of an animal charcoal manufacturer. In accordance with the provisions of Sub-Section (3) of Section 140 of the Public Health (London) Act, 1936, public notice was given of the receipt of the application, and various objectors to the making of the Order were interviewed. The chief objections were against the practice of landing from the River Thames of animal bones which during the process of manufacture it was alleged caused a nuisance from the effluvia arising therefrom, and it was also stated that grubs migrated from the premises in question. After hearing the views of a representative of the Company, and receiving the assurance that the latest type of retorts and condensers had now been installed and that no bones would in future be landed in Greenwich, the Council decided to grant a temporary licence for a period of six months subject to the following conditions:— That subject to the installation of the retorts and condensers, above referred to, being found to be effective, to the bones being landed and treated elsewhere than in the Borough of Greenwich, and to the nuisance from grubs being eliminated, an Establishment Order be granted by the Council, authorising the carrying on of the business 43 of an Animal Charcoal Manufacturer for a period of six months from the date of the passing of the resolution. At the end of the period of the temporary licence the firm made other trading arrangements, and no further action was therefore necessary. Sewers.—Only a few complaints were received from residents as to emanations from the sewer gullies. These were immediately passed on to the Borough Engineer for suitable action. Rent and Mortgage Interest (Restrictions) Acts, 1920.— Under the provisions of these Acts landlords are permitted to make certain increases of rent and tenants whose houses are not in all respects reasonably fit for human habitation may apply to the Sanitary Authority for a Certificate to this effect enabling them to suspend payment of the increased rent until the necessary works shall have been completed to the satisfaction of the Sanitary Authority. During the year four applications were received and three certificates were duly granted. Landlords may also apply to the Sanitary Authority for a report that the necessary works had been executed to the satisfaction of the Council. Four applications were received, and reports duly granted. Rat Infestation.—Investigations in regard to premises, etc., alleged to be infested with rats or mice were carried out in 296 cases of which 68 were abated. Particular attention is given by the Inspectors to enforcing the law as regards sealing off of disused drains, thus preventing the ingress of rats. The special measures adopted during Rat Week were put into operation in conjunction with the Borough Engineer's Department. Cases recommended by the Sanitary Inspectors are given rat poison. Water Supply.—During the year 397 water supply certificates have been granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 278 cases, and extra water supply to tenement houses in 32 cases. Dogs—Fouling of the Footways.—Two infringements against the Council's Bye-laws dealing with this matter were reported. Small fines were inflicted in both cases. 44 Shops Act, 1934.—During the year 98 visits were made under the provisions of the above Act, and it was not necessary to serve any notices for infringements under the Act. No applications for Certificates of Exemption in regard to the provision of Sanitary convenience accommodation were received. Baths and Washhouses.—I am indebted to Mr. A. E. Read, the Baths Superintendent, for the following notes:— During 1938 an all-round increase in attendances has taken place in all sections of the baths, except the Public Washhouses in which case a decrease is shown. This decrease is probably due to Slum Clearance with consequent provision of adequate washing facilities in the home. The bath waters have been tested frequently during the year under review. In no case has action been called for and the uniformly good reports indicate the improbability of any infections occurring in the bathers attending. The filtration and chlorination plant is kept in a very efficient condition and is capable of entirely filtering, aerating and purifying all the baths every 3¼ hours. A special class of physically defective children attend the bath, these consisting of cases of amputations, infantile paralysis, etc., and much good both physically and morally has been the result. Many of these children can swim and have obtained certificates to this effect. Vapour and medicated sections are available and cases of rheumatism, neuritis and skin afflictions have derived much benefit. In cases of medicated baths it is expected that the patients will have a medical certificate authorising the baths. The number of bathers attending during the past two years was as follows:— 1938 1937 Slipper Baths 70,528 68,742 Vapour Baths 3,212 2,872 Swimming Baths 166,123 152,684 Public Washers 13,951 15,015 253,814 239,313 45 Common Lodging House.—One common lodging house exists in the Borough. It is regularly visited by the Sanitary Inspector and is well conducted. Scavenging and Refuse Disposal.—The collection of refuse in the Borough is under the control of the Borough Engineer who has kindly supplied me with the following information relating to disposal. The amount of refuse collected in the Borough during the year ended 31st December, 1938, was approximately 20,668 tons of which 19,123 tons were dealt with at the Council's Refuse Disposal Plant. The total tonnage collected has again fallen slightly compared with the previous year, whilst the percentage dealt with at the Refuse Disposal Plant has increased by 10% approximately. This increase is the result of improved working conditions at the Plant, particularly due to the new ash conveyor mentioned in last year's report. During the year under review the Council purchased a gully emptying machine and the results achieved have been entirely satisfactory. In November, 1938, a mechanical road sweeper and dust collector was purchased, but as the machine has not yet operated during the four seasons of the year it would be unreasonable to do more than mention the fact that it is now in use. Cleansing Station, Blackwall Lane.—The cleansing of persons and the disinfestation of clothing, etc., in a verminous state are carried out by the Disinfecting Staff. The arrangements made with the London County Council for the cleansing of verminous school-children continue in operation. 616 were treated for scabies and 1,310 examined for presence of nits. Pharmacy and Poisons Act, 1933.—This Act came into force on the 1st May, 1936, and has for its object a closer control of the sale of poisons and poisonous substances. Under the Act rules have been made and the names of the poisons are set out and described under Part I and Part II. The Council is only concerned with those included under Part II which contains poisons chiefly used for domestic, horticultural and sanitary purposes. The Medical Officer of Health and the Sanitary Inspectors are appointed to carry out the provisions as far as they relate to Part II. During the year 3 applications to sell Poisons under Part II of the Act were received and granted, whilst 53 applied for retention in the Council's list, 10 names were removed from the Register owing to discontinuance of sale, or vacating premises. At the end of 1938 there were 46 persons on the register. 46 Houses Let in Lodgings.—Under Section 6 of the Housing Act, 1925, the London County Council made Bye-laws which came into force in 1926. These Bye-laws define a house let in lodgings as ordinary tenement houses in which the rooms or floors are let out separately, and all houses suitable to the working classes and occupied by members of more than one family are subject to registration, and in them there must be compliance with certain requirements as to sanitation, cleanliness, etc. New Bye-laws under the Housing Act, 1936, were confirmed by the Minister of Health on the 13th December, but did not come into operation until the 1st January, 1939. At the end of the year 88 houses were on the Register and 211 inspections were made by the Woman Inspector. No case called for legal proceedings. Rag Flock Acts, 1911 and Public Health (London) Act, 1936Section 136.—These Acts prohibit the sale or use for the purpose of making any article of upholstery, cushions or bedding, of unclean flock manufactured from rags. Two samples were taken during the year. The Analyst's report is shown in the following table: Sample No. Date Analyst's Report Result 1. 8.11.38 Contained in 100,000 parts of flock, 76 parts of soluble chlorine. This sample was of a cotton waste and not Rag Flock and is therefore not required to comply with the Acts. 2. 8.11.38 Contained in 100,000 parts of flock, 9 parts of soluble chlorine. Satisfactory. Note:—Standard allowed is 30 parts of chlorine in 100,000 parts of Rag Flock. Drainage.—During the year 107 plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. Exhumations.—In accordance with a notice received from the Home Office of an exhumation at one of the Council's cemeteries the Sanitary Inspector for the district was present to see that the usual precautions were duly carried out. Removal of Aged, Infirm or Physically Incapacitated Persons.—During the year four such cases were brought to the knowledge of the Department and were visited to see if action was necessary and desirable. As a result of these visits one case was persuaded to enter an Institution voluntarily, and two were taken charge of by relatives. In the remaining case the conditions did not call for any action. 47 PUBLIC SANITARY CONVENIENCES, Etc. Speaking generally, the Borough is adequately served in the way of public sanitary accommodation. The conveniences are situated in the main arteries of traffic, and there is no doubt whatever that the use by the public of such conveniences is on the increase. Owing to the general dilapidated condition of the South Street convenience which was erected before 1900, it was decided to remodel the entire convenience at an estimated cost of £1,153, and at the end of the year the works were almost completed. Appended is a Table showing particulars of the Public Conveniences provided by the Council:— PARTICULARS OF PUBLIC SANITARY CONVENIENCES IN THE BOROUGH. Convenience Men Women W.C.s Lavatory Basins Urinal Stalls Open Close W.C.s Lavatory Basins Open Close a.m. p.m. a.m. p.m. Batley Park, Blackheath 6 2 12 7.0 11.0 4 2 9.0 11.0 Blackheath Hill (foot of) 3 – 10 7.0 11.0 4 – 9.0 11.0 Blackwall Lane, East Greenwich 5 2 16 7.30 11.30 4 2 9.30 11.30 Blackwall Tunnel 3 – 6 7.0 11.0 5 – 9.0 11.0 Charlton House 2 – 4 7.0 11.0 2 – 7.0 11.0 Creek Road, St. Nicholas, Deptford 4 2 10 7.30 11.30 4 2 9.30 11.30 King William Walk (near Greenwich Park, 4 2 9 7.0 11.0 7 2 9.0 11.0 Shooters Hill Rd. (Junction of Wellhall Rd.) 3 1 6 7.0 11.0 3 1 9.0 11.0 South Street (W. Greenwich) 4 1 10 7.0 11.0 4 2 9.0 11.0 Totals 34 10 83 37 11 Note.—On Sundays in Winter, Conveniences open 10.30 a.m. and close 10.30 p.m. On Sundays in Summer, Batley Park, Blackwall Lane, Creek Road, King William Walk—open 9 a.m. and close 10.30 p.m. Blackheath Hill, Shooters Hill Road, South Street and Tunnel Avenue —open 10.30 a.m. and close 10.30 p.m. 48 The following are the Drinking Fountains and Horse Troughs in the Borough, which are cleansed daily by the attendants attached to the Department:— Drinking Fountains. Church Lane, Charlton. Westcombe Hill, Blackheath. Blackwall Lane, East Greenwich. South Street, West Greenwich. Armada Street, Deptford. Blackheath (Greenwich Park Gates). Blackheath (Andrew Gibb Memorial). Blackheath Hill, West Greenwich. Horse Troughs. Church Lane, Charlton. Westcombe Hill, Blackheath. Tunnel Avenue, East Greenwich. Creek Road, Deptford. Armada Street. Deptford. SUMMARY of WORK PERFORMED by the SANITARY INSPECTORS DURING THE YEAR 1938. Inspections— Houses inspected (House to House) 209 „ „ (Complaints, nuisances) 1,704 „ „ (Infectious Disease) 588 „ „ (Overcrowding) 808 Re-inspections, calls made, etc. 12,310 Inspections of Factories 246 „ „ Shops 98 „ „ Stables and yards 67 „ „ Urinals 182 „ „ Offensive Trades 7 „ „ Markets and stalls 705 „ „ Miscellaneous 1,518 „ „ Houses let in Lodgings 211 „ „ Outworkers premises 200 Inspection of Premises (Pharmacy and Poisons Act, 1933) 38 Investigations (Rats and Mice) 296 19,187 49 Drains— Drains tested—by smoke 69 „ ,, —by water 281 Opened, cleansed and repaired 274 Reconstructions and additions 151 Inspection chambers constructed 118 New covers to manholes 67 Soil and vent shafts repaired or renewed 189 Traps (gully) 215 Drains sealed off, etc. 243 Yards and forecourts drained 101 waterclosets and urinals— Closets erected 113 W.C.s repaired 433 Sanitary conveniences or improvements effected to Factories, Workshops and Workplaces 56 Pans or traps furnished 418 Urinals cleansed or repaired 38 Dustbins— Provided 256 Pavings— Yards and Forecourts 283 General Water Supply— Water Fittings amended 278 Extra water supply to tenement houses 32 Water supply certificates granted (Sect. 95) 397 Other Improvements— Houses generally repaired 346 Rooms cleansed and repaired 2,917 Rooms and staircases lighted and ventilated 349 Verminous rooms cleansed 393 Roofs, gutters and rainwater pipes repaired 771 Dampness abated 477 Sinks, baths and lavatory basins 636 Sink, lavatory and bath waste pipes trapped or amended 748 Stoves and fireplaces 360 Washing coppers repaired or provided 119 Floors repaired 418 Provision for storage of food 177 Miscellaneous repairs 1,684 Other Nuisances Abated— Illegal use of Underground room discontinued — Overcrowdings abated 13 Animals kept in unfit places discontinued or removed 7 Dung receptacles provided — Houses abolished, unfit for habitation — Accumulation of manure and other obnoxious matter removed 47 Rftt infestation abated 68 50 Smoke Nuisances— Observations 118 Statutory Notices served (Sects. 147 and 148) — Notices, &c.— Intimations served under Public Health (London) Act, 1936 1,310 Statutory Notices served 218 Houses rendered fit by informal action 506 Return Made to London County Council. Proceedings during 1938. Premises No. in Borough at end 1938 No. of Inspections No. of Prosecutions Common lodging houses 1 2 - Seamen's lodging houses — — — Cowsheds (licensed) — — — Slaughterhouses (licensed) 3 256 — Other Offensive Trades 1 7 — Milkshops 202 298 — Ice Cream Premises 159 172 — Restaurants and Eating houses 106 295 — Registered Foster Mothers 41 116 — Nurse Children kept 31 — Smoke Nuisances. Number of observations 118 Number of Intimations served 2 Number of Statutory Notices served — Number of Complaints received 20 Number of legal proceedings — Cleansing and Disinfection. Number of adults cleansed 4 Number of children cleansed 1,310 Number of premises cleansed— After infectious disease 510 For vermin 133 Water Supply to Tenement Houses. Number of Premises supplied 32 Number of Prosecutions Number of houses in the Borough 21,674 Public Health (London) Act, 1936. Number of houses inspected on account of complaints or illness 2,503 Number of Statutory Notices served 218 Number of houses repaired or nuisances remedied 1,351 51 Housing Act (1936). Number of houses inspected—house to house. (Housing Consolidated Regs. 1925) 209 Number of houses included in representations by Medical Officer of Health under Sec. 25 of H. A. 1936 64 Number of houses demolished following representation of Medical Officer of Health under Sec. 25 of H. A. 1936 60 Number of houses repaired under Sections 9 and 10 of Housing Act, 1936:— By Owners 6 By Local Authority in default of Owners — Number of houses demolished:— (a) In pursuance of Orders under Sec. 11 of H. A. 1936 7 (b) Voluntarily 5 *Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) 14 Number of Closing Orders determined — Houses let in lodgings. Number of houses let in lodgings 95 Number of inspections made in respect of above 211 Number of prosecutions — Underground rooms. Number occupied but unfit 65 Number closed or modified, occupation approved 33 Overcrowding (Housing Act 1936). Number of families known to be living in overcrowded conditions 485 Number of overcrowded families who have obtained alternative accommodation 41 Number of houses erected during the year:— Borough Council 134 London County Council (Flats) 56 Private Enterprise 207 397 *Owners' undertakings to avoid service of Closing Orders (Houses made fit) 10 52 Legal Proceedings. Premises. Offence. Result of Proceedings. Fine. Costs. 107 Creek Road Non compliance with Sanitary Notice Work done Withdrawn 113 do. do. do. 119 do. do. do. 10 South Street do. do. 40 do. do. do. 58 Swallowfield Road Non deposit of plans Plans received. Withdrawn 1 Victoria Mews Non compliance with Closing Order. Dismissed. — £1 1s. 53 Ruthin Road Non compliance with Sanitary Notice. Fined. 10/- 10/- 48 Wellington Road do. Work done Withdrawn 27 Siebert Road do. Abatement Order made — 4/- 31 do. do. do. — 4/- 49 Sherington Road do. do. — 4/- 151 Church Lane do. Work done Withdrawn 9 Floyd Road do. do. 52 Delafield Road do. do. 181 Eastcombe Avenue do. do. 225 Westcombe Hill do. Abatement Order made — 4/- 44 Glenluce Road do. Work done Withdrawn 28 Greenwich Church Street Exposing and offering meat for sale in contravention of Public Health (Meat) Regs. 1924. Dismissed. £2. 2s. 195 Trafalgar Road do. Fined. 40/- - Wayside Cafe, 517a Woolwich Road Milk—addition of not less than 25% water water and not less than 5% fat extracted. Fined. 5/- 17/- do. Bread and Butter found to be Bread and Margarine. Fined. 20/- 17/- 123 Old Dover Road Selling T.T. Milk without a licence. Fined. 40/each 40 Tyler Street Milk contained less than 8.5 of solids not fat and the addition if not less than 3% of water. Dismissed. (Plaintiff pleaded warranty). partn'r 53 SECTION D. HOUSING. Slum Clearance.—In continuance of the housing scheme ten representations were made by your Medical Officer of Health and submitted to the Council during the year. The number of houses involved was sixty-nine. Progress generally in regard to slum clearance since 1930 is shown in the following table which gives the position at the end of 1938. 54 55 HOUSING PROGRESS. Area Houses Population Action by Borough Council Action by L.C.C. Date of Inquiry Date of Confirmation Position at end of 1938 South Thames Street 732 — Compulsory Purchase Orders, November, 1933. 18.12.33 Feb., 1934 Houses demolished. Site developed. 6 Blocks of dwellings, equiv. to 263 Flats. No. 1 Area 129 No. 2 Area 10 Lamb Lane South 84 448 Compulsory Purchase Order, July, 1934. - 18.12.34 Mar., 1935 Houses demolished. Site developed. 5 Blocks of dwellings. Equiv. 94 flats. Eastney Street 440 — Compulsory Purchase Orders, June, 1935. 16.9.35 Feb., 1936 Houses demolished. Site in process of development. One Block of dwellings built equiv. to 55 Flats. No. 1 Area 27 No. 2 Area 28 No. 3 Area 16 No. 4 Area 8 Lamb Lane Extension 125 — Clearance Orders, 31.7.35. 25.11.35 Feb., 1936 Houses demolished. Site part developed as Factory extension. Remainder left cleared. No. 1 Area 20 No. 2 Area 10 Plume Place 78 — Clearance Orders, May, 1935. — Aug., 1935 Houses demolished. Site developed by private enterprise. 7 houses. No. 1 Area 21 No. 2 Area 8 Haddo Street 515 — Purchased by Agreement. - - Houses demolished. Site developed. 2 Blocks of dwellings equiv. to 150 dwellings. No. 1 Area 5 No. 2 Area 92 Dutton Street 5 27 Compulsory Purchase Order, Sept., 1935. - - Feb., 1936 Houses demolished. Site incorporated in Blackheath Hill Development Scheme. 24 Flats. Collington Street 6 15 Clearance Order, Dec., 1935. — 7.4.36 Sept., 1936 Houses demolished. Site used for commercial purposes. Felma Court 6 28 Clearance Order, Dec., 1935. — 7.4.36 Sept., 1936 Site cleared. Not rebuilt. Prince of Orange Lane 9 24 Compulsory Purchase Order, December, 1935. — 7.4.36 Sept., 1936 Site cleared. Not rebuilt. Richardsons Place 20 80 Compulsory Purchase Order, March, 1936. — 30.6.36 Sept., 1936 Site cleared. Not rebuilt. Coldbath Street 31 121 Compulsory Purchase Order, May, 1936. — 22.9.36 Sept., 1936 Some houses empty. Sparta Street 12 42 — Compulsory Purchase Order, Dec., 1936. 2.3.36 July, 1936 Houses boarded up. Awaiting demolition. East Street Area No. 1 163 828 — Clearance Order, June, 1937. 11.10.37 Feb., 1938 Mainly cleared. Site not developed. Tunnel Avenue Area No. 1 31 172 Clearance Order, Sept., 1936. - - May, 1937 Houses demolished. Sit not redeveloped. 56 57 Area Houses Population Action by Borough Council Action by L.C.C. Date of Inquiry Date of Confirmation Position at end of 1938 Tunnel Avenue Hutments Clearance Orders, Dec., 1936. — — June, 1937 No. 2—site cleared. In process of development. 12 houses built. No. 3—site cleared, not redeveloped. No. 4—site cleared, not developed. No. 5—site cleared, not developed. Area No. 2 29 126 Area No. 3 6 20 Area No. 4 6 23 Area No. 5 4 7 Rodmere Street 24 79 Clearance Order, Dec., 1936. — — May, 1937 Houses demolished. Site not developed. Norman Road Clearance Orders, Feb., 1937. — 27.5.37 July, 1937 Demolition proceeding. Area No. 1 20 76 Area No. 2 13 46 Kirkland Place 13 44 Clearance Order, Feb., 1937. — — July, 1937 Site cleared. Not developed. Miles Street 14 46 Clearance Order, Feb., 1937. — - May, 1937 Houses demolished. To be developed by private arrangement. North Thames Street 891 - Compulsory Purchase Orders, Dec., 1936 14.6.37 Sept., 1937 Demolition proceeding. Area No. 1 115 Area No. 2 42 Area No. 3 6 Area No. 4 20 Straightsmouth 6 24 Clearance Order, Feb., 1937. — 27.5.37 July, 1937 Premises vacated except one shop. Sparta Street 4 14 Clearance Order, March, 1937. — — Sept., 1937 Houses demolished. Site not redeveloped. Rentarn Cottages 5 14 Clearance Order, March, 1937. — — Sept., 1937 Site cleared. No development. Skinner's Row 4 19 Clearance Order, April, 1937. — — Jan., 1938 All houses save one vacated. Hoskins Street 4 15 Clearance Order, April, 1937. — — Jan., 1938 Houses vacated. Woolwich Road Area No. 1 10 51 Clearance Order, October, 1937. — — Nov., 1937 Some houses empty. Tunnel Avenue Hutments Area No. 6 2 18 Clearance Order, September, 1937. — — 28 Sept., 1938 Site cleared. Not de veloped. Vine Cottages 3 8 Clearance Order, 18th May, 1938. — — — Awaiting decision of Ministry of Health. Creek Road Area No. 1 17 65 Clearance Order, January, 1938. — 26.4.38 28 Sept.,1938 Some houses empty. Cottages rear of 9/11 South Street 3 21 Clearance Order, December, 1937 — 22.2.38 April, 1938 Some houses empty. 58 59 Area Houses Population Action by Borough Council Action by L.C.C. Date of Inquiry Date of Confirmation Position at end of 1938 Brigade Place 110 — Area No. 1—Compulsory Purchase Order, July, 1937. Areas Nos. 2 and 3— Clearance Orders, July, 1937. 21.2.38 11 June, 1938 No. 1—Mainly occupied— one house boarded up. Nos. 2 and 3—Site cleared. No development. Area No. 1 12 Area No. 2 11 Area No. 3 4 Commerell Street 72 317 — Compulsory Purchase Order, March, 1937. — Oct., 1937 Site cleared. The Stowage 327 - Areas No. 1 and 2— Compulsory Purchase Orders. Areas No. 3 and 4— Clearance Orders, December, 1937. 21.3.38 27 July, 1938 Area No. 1—Some houses empty. Area No. 2—Houses Occupied. Area 3—Demolished. Area 4—Demolition proceeding. Area No. 1 23 Area No. 2 4 Area No. 3 4 Area No. 4 11 Christchurch Way 369 — Clearance Orders, 27th May, 1938. 21.11.38 — Awaiting Ministry of Health's decision. Area No. 1 45 Area No. 2 5 Area No. 3 39 Creek Road 31 Clearance Order, 28th September, 1938 — — — Awaiting Ministry of Health's decision. Area No. 2 4 Creek Road 16 Clearance Order, 28th September, 1938 - - - Awaiting Ministry of Health's decision. Area No. 3 4 Topham Place 3 14 Clearance Order, 28th September, 1938 - — — Awaiting Ministry of Health's decision. Lassell Street 6 20 Clearance Order, 28th September, 1938 - — — Awaiting Ministry of Health's decision. Grove Street 123 Compulsory Purchase Orders, 8th July, 1938. 19.12.38 Awaiting Ministry of Health's decision. Area No. 2 6 — — Area No. 3 9 — — Area No. 7 22 Greenwich Road 3 11 Clearance Order, 26th October, 1938. — — — Awaiting Ministry of Health's decision. — Old Woolwich Road 17 56 Clearance Order, 26th October, 1938. — — — Awaiting Ministry of Health's decision. 60 Rehousing.—The provision of new dwelling houses is being continued at a rate equal to the average for the last 10 years. 134 houses or flats were erected by the Council in 1938. In addition, 55 flats were built by the London County Council whilst private enterprise was responsible for the further 207. The following Table shows the progress made in providing new housing accommodation since 1928. Completed in Year By Borough Council. By London County Council. By Private Enterprise. Total. 1929 120 48 155 323 1930 – – 115 115 1931 126 10 160 296 1932 9 – 140 149 1933 13 – 292 305 1934 85 – 340 425 1935 16 88 490 594 1936 79 396 263 738 1937 76 331 205 612 1938 134 55 207 396 Overcrowding.—At the end of 1937 there were 751 overcrowded houses in the Borough. Families found to be living in overcrowded conditions after the "Appointed Day" (1st July, 1937) are thereby contravening the Housing Act. Fourteen cases of overcrowding were found but these were 'protected' under the provisions of the Housing Act due to increases in the ages of children. There was unfortunately a check on the following up of "border line" cases revealed from the Overcrowding Survey due to the National Crisis and duties involved through Air Raids Precautions but 808 overcrowded or "border line" cases were re-visited by the Inspectors in order to note movement of overcrowded families. Requests from Landlords for permitted numbers were received and given in 2,215 cases. The number of cases of overcrowding abated during the year was 389. Included in this total were 26 owned by the Council and 82 by the London County Council. In 72 cases new housing accommodation was given following action taken in respect of slum clearance. 61 Underground Rooms.—At the end of 1937 there were approximately 1,000 basement rooms in occupation, but it was found that many could, with very little adaptation, comply with the requirements of the Housing Act. During the year 49 were closed as a result of official action, and in nine cases owners carried out works required to be executed to comply with the regulations. The Regulations in force at present were made under Section 18 of the Housing Act, 1925, and with a view to fulfilling present day requirements certain amendments are under consideration. The following statement indicates the work of the Housing Inspector in regard to unfit houses dealt with under the Housing Act, 1936. Notices—Section 157 327 Houses reported on for Clearance 108 Individual Houses:— Houses or parts surveyed 98 Houses subject to informal notice requiring repair:— 36, Ruthin Road 1 25, Lansdowne Road 1 14, 16, 18, Armitage Road 3 5 Houses reconditioned:— Formal Notices—1937 4 Informal Notices—1937 11 Informal Notices—1938 1 — 16 Work in progress 14 Houses or Parts reported on for demolition or closure 65 Houses or Parts demolished or closed 43 Underground rooms inspected for closure 65 Re-conditioning Schemes under Housing Act, 1936:— Submitted—Grove Street, 9 houses. Completed—Hadrian Street, 23 houses. Total Visits:— Surveys 206 Visits for sampling and Enquiry 505 Re-Visits 1,124 Miscellaneous 119 1,954 62 HOUSING RETURN, 1938. 1. Inspection of Dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,918 (b) Number of inspections made for the purpose 8,440 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 209 (b) Number of inspections made for the purpose 313 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 69 (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 857 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 506 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 4 (b) By local authority in default of owners — (2a) Ditto—after service of informal notices 12 63 (b) Proceedings under Public Health Acts:— Notices served: (1) Number of dwelling-houses} in respect of which notices} Intimation 1,310 were served requiring de-} Statutory 218 fects to be remedied} (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 845 (b) By local authority in default of owners — (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 5 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 7 (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 49 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 4. Housing Act, 1936—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 485 (ii) Number of families dwelling therein 485 (iii) Number of persons dwelling therein 3,045 64 (b) Number of new cases of overcrowding reported during the year 14 (c) (i) Number of cases of overcrowding relieved during the year 389 (ii) Number of persons concerned in such cases 2,104 (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 over- crowding conditions upon which the Medical Officer of Health may consider it desirable to report — 65 SECTION E. Inspection and Supervision of Food. Milk Supply.—This is obtained from farms, and supply companies situate outside the Borough. Almost the whole of the milk consumed is now Pasteurised. Milk and Dairies (Amendment) Act, 1922—Milk and Dairies Order, 1926.—At the commencement of the year, there were 194 purveyors of milk on the Register of Dairies and Milkshops. 8 new applications have been received during the year and added to the Register, thus leaving a total of 202 purveyors and dairy premises registered. Special attention has again been given to dairy premises to ensure that the provisions of the Milk and Dairies Order have been observed, particularly with regard to washing and cleansing of milk vessels and utensils. In all, 298 visits of inspection were made as a result of which the following defects, etc., were noted and remedied:— Action taken re dairy premises. New Fans 2 Offensive Accumulation Removed 2 Bottling Tank Overhauled 1 Vehicles Renovated 2 Dairies Cleansed and Limewashed 13 Dustbins Supplied 2 Yard Paved 1 Milk (Special Designations) Orders, 1936 and 1938.— These orders regulate the issue of licences for the sale of milks known as Tuberculin Tested, Accredited, and. Pasteurised. During the year the following licences were granted Distribution of Tuberculin Tested Milk 10 „ „ Pasteurised Milk 26 Pasteurising Process 2 *Supplementary Licences 4 *Supplementary Licences are granted in cases of Traders whose licensed premises are situated outside the District, but who sell within the Borough. 66 Result of Analytical Examinations.—136 samples of milk were taken, of which 6 were found to be adulterated or below the standard fixed by the Ministry of Agriculture and Fisheries. 41 of these samples were taken from local hospitals and schools. The administrative action taken is set out in Table on Page 79. Bacteriological Examinations.—In accordance with arrangements made with the London County Council, 56 samples of milk were taken on arrival at the Brook and St. Alfege's hospitals and local schools. Four samples were found not to conform with requirements of the Milk (Special Designations) Orders, 1936 and 1938, by reason of high bacterial counts. Particulars of these infringements were forwarded to the County Council, and warning letters sent to the Vendors. One of the Vendors concerned was a local dairyman who had only newly installed a pasteurising plant and following investigation of the Food Inspector, minor modifications were carried out. Examination of subsequent samples taken proved entirely satisfactory. In addition 14 samples were taken from local and itinerant vendors. With one exception, all these were found to comply with the standards required. The question as to what action should be taken with regard to this unsatisfactory sample was one of some difficulty. The firm in question were large dairymen operating in various Boroughs. All milk supplied to their branches was pasteurised at their Headquarters in another Borough. During the past few years this Council has several times successfully proceeded against this firm for selling impure milk, and the London County Council has also been apprised of various unsatisfactory bacteriological examinations. Possibly as the result of this action it was noted the firm ceased to supply milk to schools in the Greenwich and Woolwich areas after 1935. From information received from the Medical Officer of Health of the Borough concerned, I am informed that this firm has been guilty of grave malpractices at their dairy premises and that their Council has decided to remove the name of the firm from their Register. (N.B. This firm closed their premises in Greenwich early in 1939). Examination for Presence of T.B.—Two samples of milk (Tuberculin Tested (Certified) and Raw) were submitted to the Council's Bacteriologist for examination for the presence of tubercle bacilli. Both gave negative results. Inspection of Meat and Other Foods.—During 1938 the following diseased and unsound goods were voluntarily surrendered at slaughter-houses and shops:- 67 lbs. Beef, Pork, Mutton, Lamb, Offals, etc. 966 Rabbits 60 Canned Fish (85 tins) 20 Fish 91 Fruit 40 Table Jellies 173 Ice Cream 60 1,410 Although 4,294 visits have been made to premises where food is stored, prepared or sold, on no occasion has it been found necessary to seize unsound food. Slaughter-houses and Knackers' Yards.—At the end of 1938 there were 2 slaughter-houses and 1 knackers' yard in the Borough, all of which are licensed annually. 256 visits were made to these premises which are maintained satisfactorily. The following table indicates the number of animals slaughtered and examined:— Bullocks and Heifers 189 Sheep and Lambs 1,113 Pigs 280 1,582 Every carcase and the viscera therein is examined at time of slaughter. The system necessitates attendance for late nights and early morning duties in the Slaughter-houses. The following table ia given in accordance with Circular No. 1728:- 68  Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) 189 — — 1,113 280 Number inspected 189 — — 1,113 280 All diseases except Tuberculosis. Whole carcases condemned Nil Nil Nil Nil Nil Carcases of which some part or organ was condemned 47 Nil Nil 1 29 Percentage of the number inspected affected with disease other than tuberculosis 24.868 — — .0898 10.357 Tuberculosis only. Whole carcases condemned Nil — — — — Carcases of which some part or organ was condemned 4 — — — 15 Percentage of the number inspected affected with tuberculosis 2.116 — — — 5.357 Public Health (Meat) Regulations, 1924.—These Regulations provide for the supervision of slaughter-houses, butchers' shops, stalls and the protection of meat against contamination by dirt and flies, etc. in transport and handling. Butchers' shops and stalls are under the constant supervision of the Inspectors and proceedings are only instituted after flagrant disregard of the Officer's warning. It was found necessary to caution Vendors on 10 occasions during the year. In March, as a result of information laid by the Police, proceedings were taken against a Meat Trader for contravening the above Regulations. This case presented one unusual feature; the defending Counsel pleaded that it was the duty of the Local Authority and not the Police to enforce the Regulations. It was admitted the Council's Inspector regularly inspected the premises but no complaint had been made by Council's Officers. The Magistrate, after adjourning the case for consideration on a point of law, eventually dismissed the case under the Probation of Offenders Act on payment of £2 2s. 0d. costs. Proceedings were also instituted on two occasions by the Council, fines being imposed in both instances. 69 PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925-33. The Metropolitan Borough of Greenwich with a river frontage of five miles, with more than 30 wharves and 2 of London's largest and most modern cold stores, receives a large percentage of London's imported meats. In addition, considerable quantities of fresh fruit, tinned foods, and miscellaneous provisions are dealt with. Daily visits to wharves and cold stores are made by the Food Inspectors, and imported food generally is carefully supervised. Various Foods Landed during 1938. U.S.A., New Zealand, Australia and Egypt— Tons Apples, Pears, Grapefruit, Oranges, Lemons, and Onions 1,220 Norway— Margarine, Canned Goods, etc. 105 Empire Colonies, U.S.A. and South America— Beef, Mutton, Lamb, Pork, Poultry, Rabbits 77,448 Total imports from all sources 78,773 A decrease of 6,670 tons compared to 1937. Export Certificates.—Certificates have been issued in respect of meats exported to Gibraltar, Bermuda, and Jamaica as follows:— 250 Hinds, Fores or Crops of Frozen Beef. 298 Carcases of Frozen Mutton and Lamb. 43 Packages of Pieces, Frozen Mutton and Lamb. 25 Cases of Frozen Rabbits. 132 Packages of Offals and Cuts of Frozen Beef and Mutton. Fees received in respect of above examinations totalled £21 4s. 11d. Ozonisation of Meat.—During the year consignments of imported meat have reached cold stores situated in certain Riparian Boroughs smelling and tasting of such substances as orange, apple, or even fuel oil, without any visible sign of contamination. While most of this meat is not unsound it would be distasteful to the public palate. Large consignments are, therefore, aerated to remove any odour, and for this operation cold stores here are equipped with ozone generators. 70 The following consignments have been so treated:— 38,863 Carcases of Frozen Mutton 7,441 Cases of Frozen Offals Ozonised for 163 Packages of Frozen Pork Orange and 9,940 Quarters of Frozen Beef Oil Taint 116 Pieces of Frozen Beef 218 Bags of Frozen Mutton Cuts Imported Food Surrendered.—During the year 1938 the following unsound or diseased imported foods were surrendered. The meat was passed for non-edible purposes only, and the unsound fruit was destroyed. Tons. Cwts. Qrs. lbs. 55 Carcases Frozen Mutton and Lamb (Caseous Lymphadenitis) 1 1 1 25 48 Sides Frozen Mutton and Lamb (Caseous Lymphadenitis) 12 2 20 68 Pieces Frozen Mutton and Lamb (Caseous Lymphadenitis) 10 0 23 33 Carcases Frozen Mutton and Lamb (Decomposition, Mould, Vermin, Brine Damaged) 13 1 7 733 Pieces Frozen Mutton and Lamb (Decomposition, Mould, Vermin, Brine Damaged) 16 1 23 18 Fores and Hindquarters Frozen Beef (Decomposition, Mould, Vermin, Brine Damaged) 1 7 3 10 49 Pieces (Miscellaneous) Frozen Beef (Decomposition, Mould, Vermin, Brine Damaged) 5 0 7 108 Pieces Frozen Pork (Decomposition, Mould, Vermin, Brine Damaged) 3 22 277 Tins of Frozen Lamb, Pork and Pigs Livers (Decomposition, Mould, Vermin, Brine Damaged) 1 5 0 0 205 Pieces Frozen Veal (Decomposition, Mould, Vermin, Brine Damaged) 13 1 13 83 Frozen Offals (Various) (Decomposition, Mould, Vermin, Brine Damaged) 1 9 71  Tons. Cwts. Qrs. lbs. 444 Tins of Corned Beef (Unsound) 2 3 25 1 Canister of Biscuits (Unsound) 25 Fruit, Citrous Various (Unsound) 9 10 0 20 197 Bags Sugar (River-Damaged) 19 7 3 10 Total weight unsound or diseased foodstuffs 36 7 3 15 This is a decrease of nearly 8 tons as compared with 1937. Examination of Foodstuffs imported at Wharves.—In addition to the general inspection of foodstuffs landed at wharves, the following called for detailed examination. Meat, Offals, Fruit and Provisions, etc. 39,333 Carcases of Mutton and Lamb. 1 Side of Veal. 218 Bags of Pieces Mutton and Lamb. 605 Bags of Boneless Veal. 793 Quarters of Beef. 600 Ox-skirts. 117 Carcases of Pork. 4 Ox-tripes. 100 Sides of Pork. 80 Ox-livers. 344 Loins of Pork. 415 Tins Lambs' Livers. 2 Legs of Pork. 42 Tins Pork and Pigs' 163 Packages of Pork. Livers. 8,921 Packages of Offals (various). 40 Cartons Pigs' Kidneys. 34,092 Packages of Fruit (Oranges, 66 Lambs' Hearts. Apples, Grapefruit, etc.). 100 Cases Canned Shrimps. 150 Cheeses. 25 Cases Mackerel Roes. 197 Bags of Sugar. In addition 6,275 lbs. of Biscuits and 413 lbs. of Canned Beef were examined at the request of the War Office. Of these 25 lbs. Biscuits and 333 lbs. Canned Beef were rejected as unfit for human consumption. Caseous Lymphadenitis.—During the year the proportion of carcases examined for this condition, irrespective of Country of origin, remained at 5% and that for pieces of Mutton at 100%. The results of the examination of the Mutton and lambs of 42 lbs. weight and over, from Australia, New Zealand, Iceland and South America, were as follows:— Carcases Landed. 653,042 Pieces of Cut Mutton Landed. 23,279 Examined. 35,252 Examined. 23,279 Carcases Diseased. 55=. 156% Pieces Diseased. 116= .498% 72 It is worthy of note that a 100% examination of cut mutton yields .498% diseased pieces—whilst the 5% carcase examination shows a diseased percentage of only .156%. MERCHANDISE MARKS ACT, 1926. Under the powers conferred by this Act, Orders in Council have been made prohibiting the sale, or exposure for sale, of the undermentioned imported foodstuffs, unless such bear an indication of the country of origin. Honey Apples Currants Sultanas Raisins Eggs in shell Dried Eggs Oat Products Frozen or Chilled Salmon Butter Dead Poultry Meat Routine inspections are made to secure compliance with the various Orders, and on 20 occasions warnings were given because of minor infringements and three warning letters were sent. SUPERVISION OF FACTORIES WHERE FOOD IS PREPARED. Included among the premises where food is prepared are:— flour-millers, brewers, mineral water, pharmaceutical sundries and fruit canning factories. 16 inspections have been made of these factories, and a satisfactory state of hygiene is maintained. It was only found necessary to serve notices to cleanse and limewash on two occasions. The following Table shows the number of inspections made and improvements effected at the several types of premises visited. Food Premises. No. of visits No. of improvements carried out Slaughterhouses and Knackers' Yards 256 3 Eating Houses and Hotel Kitchens, etc. 295 28 Butchers' Shops 609 30 Dairies and Milkshops 298 30 Wharves and Cold Stores 466 1 Ice-cream Shops 172 8 Bakehouses 281 77 Fried Fish Shops 211 25 Preserved or Cooked Meat and Fish Shops 320 11 Other Premises where Food is Prepared or Stored 496 5 Visits re Merchandise Marks Acts and Orders 607 — Miscellaneous Visits 97 1 Sampling visits, Food & Drugs (Adulteration) Act, 1928 186 — 4,294 219 73 Food Bye-laws.—Bye-laws made by the London County Council under Section 183 Public Health (London) Act, 1936, came into force on 1st January, 1937. These bye-laws regulate the sanitary and cleanly condition of foodstuffs during manufacture, storage, transport or exposure for sale for human consumption. The provisions of these bye-laws generally have been satisfactorily observed, and during the year no action was necessary, other than to issue warnings on two occasions. Blackheath Fair.—At holiday times this ancient custom attracts thousands of visitors and a Sanitary Inspector is always on duty to see that the large number of stalls where food is prepared or exposed for sale are conducted in a cleanly and satisfactory manner. During the August Bank Holiday it was noticed there were a number of food stalls situated in the large gravel pit in close proximity to the mechanical amusement roundabouts, etc. and there was a possibility that food stuffs would be contaminated by reason of the dust-laden atmosphere. The attention of the Parks Dept. of the London County Council was drawn to the advisability of withdrawing the refreshment stalls from the pit to the higher surrounding ground. It is gratifying to be able to report that the County Council have agreed to adopt this suggestion in future. Artificial Cream Act, 1929.—There were no offences committed under this Act. At the end of 1938 there was only one manufacturer of artificial cream on the register. These premises were visited on four occasions. Street Traders.—There are 99 Street Traders who are engaged in selling articles of food and licensed in accordance with the provisions of the London County Council (General Powers) Act, 1927. Generally speaking, it was found that the premises where such articles of food were stored, were in all respects reasonably clean. Preserved Food Premises.—In accordance with the provisions of the Public Health (London) Act, 1936, all premises with the exception of clubs, hotels or restaurants used:— (а) for the sale or the manufacture for the purpose of sale of ice-cream or other similar commodity, or the storage of ice-cream or other similar commodity intended for sale; or (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish, or other food intended for sale; are required to be registered by the owner or occupier with the sanitary authority. 74 Ice-Cream Premises.—At the end of the year 159 premises were duly registered. These premises were inspected on 172 occasions and insanitary conditions remedied in 8 instances. Preserved Meat, etc., Premises.—At the end of the year 152 premises were on the register and were visited on 320 occasions. As a result of such inspections insanitary conditions were detected and remedied in 11 cases. There was no instance found which necessitated the cancellation of premises already registered. Food and Drugs (Adulteration) Act, 1928.—The following figures are submitted by Mr. A. E. Brown, the Public Analyst, regarding the samples forwarded to him during the year:— 164 formal and 315 informal samples, 479 in all, were taken during the year. Of these 23 or 4.8 per cent. were reported against, as compared with 4.5 per cent. in 1937. A full description of the articles analysed and the administrative action taken is set out on pages 76-80. Public Health (Preservatives, etc. in Food) Regulations. —All samples of foodstuffs submitted to the Public Analyst are examined for preservatives and prohibited colouring matter. Infringements were detected in seven instances, necessitating warnings in five cases. Canned Foods.—41 various kinds of canned foods were examined by the Public Analyst for the presence of tin. Although there is no standard laid down for tin contamination it is generally accepted that tinned food should not exceed two grains per pound. Four samples of Norwegian sild were found to contain tin greatly in excess of this standard. The worst sample contained 4.62 grains per pound. Immediate steps were taken to ascertain, if possible, the reason for this high contamination, and interviews took place between the Council's Inspector and representatives of the wholesalers and their suppliers. The wholesalers were greatly concerned because the article was marketed under their best brand whilst the suppliers' representative appeared to be only too eager to find the solution, and gave the assurance that the matter would have their immediate attention. In view of the high contamination of this article and the difficulty of controlling tinned foods which are packed abroad it was considered advisable to draw the attention of the Ministry of Health to this condition of affairs. In the report for 1937 the Public Analyst referred to the improvement in the packing of foodstuffs generally, but it is considered desirable to keep this type of food under constant supervision. 75 Public Health (Dried Milk) Regulations, 1923 and 1927.— Four samples were taken during the year. All were found to comply with the above Regulations. Public Health (Condensed Milk) Regulations, 1923, 1927.—Fifteen samples were taken during the year and in every instance were reported upon as genuine. The rules regarding proper labelling were also observed. Wholesale Margarine Dealers.—There were no alterations to the register during the year and the following premises are still registered under the Food and Drugs (Adulteration) Act, 1928, where the business of a Wholesale Dealer in Margarine is carried on in the Borough:— 190, Greenwich High Road 144, Trafalgar Road. 42, Old Dover Road. 76 FOOD AND DRUGS (ADULTERATION) ACT, 1928. Number and Description of Samples Submitted for Analysis under the above Act during the Year 1938. FORMAL SAMPLES. Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Apricots, Dried 1 1 Brandy 2 2 — Bread and Butter 4 3 1 Butter 6 6 — Coffee Extract 1 — 1 Coffee Extract with Chicory 1 — 1 Ice Cream 5 5 — Margarine 3 3 — Milk 135 129 6 Sausages 2 2 — Sild, Canned 2 1 1 Whisky 2 1 1 164 153 11 INFORMAL SAMPLES. The following samples were taken from Vendors and submitted to the Public Analyst, by the Food Inspector or his agent without recourse to the usual provisions as required by the Food and Drugs(Adulteration) Act, 1928. Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Anchovies, Canned 1 1 Apple Crush 1 1 — Apple Sauce, Canned 1 1 — Apricots, Dried 3 2 1 Aspirin Tablets 2 2 — Baking Powder 2 2 — Bicarbonate of Soda 1 1 — Brawn 2 2 — Bread and Butter 1 — 1 Brisling, Canned 1 1 — Butter 25 25 — Camphorated Oil 1 1 — Castor Oil 1 1 — Cheese 11 10 1 Cheese and Tomato Spread 1 1 — Cherries, Canned 1 1 — Cherries, Glace 1 1 — Chocolate Cream Roll 1 1 — Chocolate Pudding, Canned 1 1 — 77 Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Cocoa 5 5 – Coffee 1 1 – Coffee and Chicory Extract 2 2 – Coffee Extract with Chicory 2 1 1 Cooking Fat 2 2 – Corn Flour 1 1 – Corned Beef, Canned 1 1 – Crab, Canned 2 2 – Cream 2 2 – Cream, Canned 2 2 – Cream Slice 1 1 – Creamed Rice, Canned 1 1 – Custard Powder 2 2 – Dripping 1 1 – Egg Substitute Powder 2 2 – Epsom Salts 1 1 – Figs, Canned 1 1 – Figs, Compound Syrup of 1 1 – Fish Paste 3 3 – Fish Paste, Canned 1 1 – Flavouring Essences 3 3 – Flour 2 2 – Flour, Self-Raising 12 12 – Foam Crystals 1 1 – Fruit Balls (Sweets) 1 1 – Fruit Butter, Orange 1 1 – Fruit Dessert, Canned 1 1 – Fruit Mixed, Dried 1 1 – Fruit Salad, Dried 2 2 – Ginger Beer 1 1 – Ginger, Ground 2 2 – Glycerine 1 1 – Grape Fruit Squash 1 1 – Grape Jelly 1 1 – Grape Juice 1 1 – Gravy Salt 2 2 – Gregory's Powder 1 1 – Health Salts 1 1 – Herrings in Tomato Sauce, Canned 1 1 – Honey 2 2 – Horseradish Cream 1 1 – Horseradish, Shredded 1 1 – Jam 2 2 – Jam, Canned 1 1 – Kipper Snacks, Canned 1 1 – Lard 6 6 – Lemon Cheese 2 2 – Lemon Curd 3 3 – Lemonade Powder 2 2 – Lemonade Tablets 1 1 – Malt Extract with Cod Liver Oil 1 1 – Margarine 16 15 1 Marmalade 1 1 – 78 Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Meat Paste 4 4 – Milk 1 1 – Milk, Condensed 15 15 – Milk, Dried 4 4 – Mincemeat 1 1 – Mint, Dried 1 1 – Mint Sauce 1 1 – Mushrooms, Canned 1 1 – Mussels in Vinegar 1 1 – Mustard 4 4 – Nut Chocolate 1 1 – Olive Oil 3 3 – Orange, Canned Mandarin 1 1 – Pea Flour 2 2 – Peaches, Canned 1 1 – Peaches, Dried 1 1 – Pearl Barley 1 1 – Pears, Dried 2 2 – Peas, Canned 7 7 – Pepper 2 2 – Piccalilli 1 1 – Pickles 1 1 – Pineapple, Canned 2 2 – Prunes, Canned 1 1 – Prunes, Dried 1 1 – Pudding Sugar 3 3 – Raisins, Seedless 1 1 – Rice 4 4 – Salad Cream 1 1 – Salmon, Canned 2 2 – Sardines, Canned 4 4 – Sauce 8 8 – Sausage Roll 1 1 – Sausages 4 4 – Sild, Canned 9 5 4 Spice 1 1 – Suet, Shredded 2 2 – Sugar 5 5 – Sweets 1 1 – Syrup, Greengage 1 1 – Table Jelly 15 12 3 Tapioca 2 2 – Tea 11 11 – Tomato Ketchup 1 1 – Tomato Sauce 1 1 – Tomatoes, Canned 3 3 – Turkish Delight 1 1 – Veal and Ham Loaf 1 1 – Vinegar 3 3 – Vinegar, Malt 1 1 – Wintergreen Ointment 1 1 – 315 303 12 79 Administrative Action Taken Regarding Samples reported to be NOT GENUINE. No. of Sample Description of Sample Nature of Adulteration Action taken T. 28 Sild, Canned Contained tin to the extent of 2.03 grains per pound. Warning Letter T. 58 Coffee Extract with Chicory Contained benzoic acid to the extent of not less than 160 parts per million. Formal Sample Taken 34 Coffee Extract with Chicory Contained benzoic acid to the extent of not less than 180 parts per million Warning Letter. Particulars furnished to Local Authority where article manufactured 35 Coffee Extract Contained benzoic acid to the extent of not less than 180 parts per million Warning Letter 39 Milk Admixed with not less than 4% of water. Warning Letter T. 98 Table Jelly Contained benzoic acid to the extent of not less than 300 parts per million Vendor Cautioned T. 101 Sild, Canned Contained tin to the extent of 4.62 grains per pound Remaining Stock destroyed (85 tins) T. 102 Margarine Contained 16.4% of water Formal Sample Taken T. 110 Table Jelly Contained benzoic acid to the extent of not less than 320 parts per million Vendor Cautioned 62 Milk Admixed with not less than 1% of water Warning Letter T. 141 Apricots, Dried Contained sulphur dioxide to the extent of 2,200 parts per million Formal Sample Taken (proved satisfactory) T. 156 Sild, Canned Contained tin to the extent of 4.06 grains per pound Formal Sample Taken 88 Milk Deficient in fat to the extent of 1 % Warning Letter 92 Sild, Canned Contained tin to the extent of 3.01 grains per pound Warning Letter. (Remaining stock destroyed) T. 181 Table Jelly Contained benzoic acid to the extent of 280 parts per million Remaining stock destroyed (Manufacturer interviewed and warned) 99 Milk Admixed with not less than 3% of water Warranty Proved 104 Milk Slightly deficient in solids not fat Vendor Cautioned 80 No. of Sample Description of Sample Nature of Adulteration Action taken 109 Glass of Milk Addition of not less than 25% of water and the abstraction of not less than 5% of fat. Vendor Fined 5/-. Costs 17/- T. 210 Bread and Butter Consisted of bread and margarine Formal Sample Taken 114 Bread and Butter Consisted of bread and margarine Vendor Fined 5/Costs 17/- T. 221 Finest Cheddar Cheese Contained 34.38% of fat on the moisture-free substance and was therefore not made from full-cream cow's milk Manufacturer notified and all similar stock withdrawn T. 280 Sild, Canned Contained tin to the extent of 4.48 grains per pound Formal Sample Taken 157 Whisky The alcoholic strength of the sample was 35.4 degrees under proof Vendor Cautioned 81 NOTIFICATION OF FOOD POISONING. Under the provisions of the London County Council (General Powers) Act, 1932, now re-enacted in the Public Health (London) Act, 1936, every registered medical practitioner attending on any person shall, if he suspects or becomes aware that any person is suffering from food poisoning forthwith notify such case to the Medical Officer of Health. There were 18 cases notified during the year as compared with thirty-six for the previous year. Each case was investigated with a view to ascertaining the source of infection, but there was no instance where the food suspected could be regarded as a definite cause of specific food poisoning and recovery followed rapidly. Details of the cases are given in the following table:— Case No. Initials of Patient Age and Sex District Date Notified Suspected Cause 1 D. G. 33 F West Greenwich 19. 1.38 Shrimps, Fried Fish 2 J. B. 18 M West Greenwich 14. 2.38 Egg 3 O. L. 15 F West Greenwich 18. 7.38 Sausage Roll 4 M. F. 19 F West Greenwich 24. 7.38 Meat Pie 5 G. G. 32 F West Greenwich 2. 8.38 Jellied Eels 6 A. F. 28 M West Greenwich 10. 8.38 Fried Skate 7 A. C. 50 F West Greenwich 20. 8.38 Fried Fish 8 J. W. 28 M West Greenwich 30. 8.38 Cockles 9 E. D. 17 F West Greenwich 30. 8.38 Cream Cake 10 A. G. 62 M West Greenwich 3. 9.38 Mackerel 11 E. K. 36 F West Greenwich 20. 9.38 Pork 12 J. K. 9 F West Greenwich 20. 9.38 Pork 13 J. L. 29 M Charlton 24. 9.38 Chicken and Ham Roll 14 T. S. 20 M West Greenwich 9.10.38 Steak and Kidney Pie 15 V. C. 30 F East Greenwich 21.11.38 Sausages 16 F. A. 23 F West Greenwich 5.12.38 Fish 17 W. G. 52 M West Greenwich 8.12.38 Pork 18 P. S. 50 M West Greenwich 28.12.38 Pork 82 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Under the compulsory notification Section of the Public Health (London) Act, 1936, and the Orders and Regulations made thereunder, and the Tuberculosis Regulations 1930, 2,963 cases of Infectious Diseases were reported during the year. The following table shows the comparison since 1933. No. Year. 3,267 1933 3,226 1934 1,191 1935 3,587 1936 1,635 1937 2,963 1938 Particulars relating to age groups and districts are shewn in the tables at the end of the Report. Smallpox.—There were no cases reported during the year, but as a result of cases reported in another district some contacts were kept under observation for the requisite period. Public Health (Smallpox Prevention), Regulations, 1917.—It was not found necessary for your Medical Officer of Health to undertake any vaccinations during the year. Details respecting vaccination in the Borough are given in the Supplementary Vaccination Report on page 102. Measles and Whooping Cough.—Although both these diseases have been notifiable in Greenwich for many years, it has been considered necessary to make these diseases compulsorily notifiable throughout the County of London, and accordingly the local Regulations and Order were revoked when the new Regulations came into force, viz: 1st October, 1938. Measles.—The usual biennial epidemic of Measles was responsible for 1930 notifications, 67 of which were returned as German Measles. In the year 1936 there were 2,071 notifications. Measles Graph shewing to what extent each district was effected during the Epidemic period 1938 83 Of the 1930 cases, 179 were removed to Hospital. The age incidence and fatality of the disease were as follows: There were 63 cases under 1 year of age with 1 death thus giving a case mortality of 1.58 per cent. Between the ages of 1 to 5 years there were 949 cases with 2 deaths at this age period, giving a case mortality of 0.21 per cent. Between 5 to 15 years, 888 cases with 1 death with a case mortality of 0.11 per cent. and 30 eases 15 years and over. The case mortality for the whole Borough is 0.20 per cent. It will be seen by the accompanying graph that the epidemic commenced in the first week in February, reached its peak during the second week in May and subsided very rapidly after the first week of July. The epidemic in the early stages appeared to be more pronounced in the Charlton district. West Greenwich then came into more prominence for a period of two weeks, being quickly superseded by East Greenwich at approximately half way through the epidemic. This lead was maintained by this area till the close of the epidemic in Mid-July. The Scheme of Control in conjunction with the L.C.C. was put into operation and 6,500 leaflets were sent to 19 Schools for distribution. Of a total of 1,754 children suffering from measles, who were revisited by the Health Visitors before the end of the year, it was found that 70 were still suffering from complaints attributable to the attack of measles. 32 of such children had discharging ears and 12 were suffering from bronchial catarrh, 9 children were found to have large cervical glands, and the remaining children included 4 with chronic conjunctivitis, 4 with enlarged tonsils, 4 with a chronic nasal discharge, 2 with partial deafness, and 3 with asthmatical tendencies. All of the children thus found with sequelae as a result of measles were under supervision and treatment. The quarterly incidence and distribution of the cases is shewn in the following table:— 84 TABLE SHOWING NUMBER OF MEASLES CASES REPORTED DURING THE YEAR 1938. 1st Quarter. under 1 1 to 5 5 to 15 15 to 25 25 and over Total East Greenwich 1 45 66 4 1 117 West Greenwich 4 73 46 1 2 126 St. Nicholas, Deptford 5 56 25 1 - 87 Charlton and Kidbrooke 3 136 153 2 1 295 Total 13 310 290 8 4 625 Source of Notification: Medical Practitioners 396 Females 329 Parents 73 Males 296 Reported from L.C.C. Schools 156 625 625 2nd Quarter. under 1 1 to 5 5 to 15 15 to 25 25 and over Total East Greenwich 16 316 314 5 3 654 West Greenwich 15 131 88 4 238 St. Nicholas, Deptford 2 33 9 - - 44 Charlton and Kidbrooke 7 109 129 2 — 247 Total 40 589 540 11 3 1,183 Source of Notification: Medical Practitioners 791 Females 618 Parents 174 Males 565 Reported from L.C.C. Schools 218 1,183 1,183 85 3rd Quarter. under 1 1 to 5 5 to 15 15 to 25 25 and over Total East Greenwich 3 15 16 – – 34 West Greenwich 2 10 21 – – 33 St. Nicholas, Deptford – 2 1 – – 3 Charlton and Kidbrooke 4 17 15 3 – 39 Total 9 44 53 3 – 109 Source of Notification: Medical Practitioners 84 Females 52 Parents 13 Males 57 Reported from L.C.C. Schools 12 109 109 4th Quarter. under 1 1 to 5 5 to 15 15 to 25 25 and over Total East Greenwich – 1 2 – – 3 West Greenwich – 2 1 1 – 4 St. Nicholas, Deptford – 2 1 – – 3 Charlton and Kidbrooke 1 1 1 – – 3 Total 1 6 5 1 – 13 Source of Notification: Medical Practitioners 10 Females 9 Parent 1 Males 4 Reported from L.C.C. Schools 2 13 13 Total Cases in Year, 1930 86 Whooping Cough.—Altogether 129 cases were reported compared with 574 for the previous year. 26 occurred in East Greenwich, 39 in West Greenwich, 6 in St. Nicholas and 58 in Charlton and Kidbrooke. There were 2 deaths giving a mortality of 1.5 per cent. Twelve cases were removed to Hospital for treatment. Every case was visited by the Health Visitors and leaflets left with the parents or guardians with a view to advising them as to the care of the patient. Diphtheria.—The number of patients notified as suffering from Diphtheria during the year was 253 (including 9 returned as Membranous Croup), as compared with 307, 258, 367 and 422 for the years 1937, 1936, 1935 and 1934. Two hundred and nine cases were removed to Hospital. Four were reported by the Hospital authorities as not suffering from this disease, and 26 Reports were received concerning patients who were discharged but still suffering from the following conditions: Tonsillitis 18, Otitis Media 2, Laryngitis 2, and Vincents Angina, Rhinitis, and Croup one each. One case was discharged as a carrier and received treatment at a carrier clinic. The attack rate is equivalent to 2.60 per 1,000 population, but taking the estimated child population of the Borough (0—15 years) as 23,000, the attack rate per 1,000 child population is 9.4. There was 1 fatality due to Diphtheria which gives a case mortality of 0.4 per cent. In accordance with the Antitoxin Order, 1910, a supply of Antitoxin is provided by the Council for the use of general practitioners in emergency cases. Sixteen phials of Antitoxin, each containing 10,000 units of serum, have been supplied during the year. One thousand three hundred and twelve swabs were forwarded by medical practitioners for bacteriological examination from cases suspected to be diphtheria. Of this number, 1,148 were reported to give negative or doubtful results and 164 were positive in character, being dealt with accordingly. Diphtheria Immunisation. Under the Council's scheme 147 children were dealt with during the year. 122 of these were inoculated with Toxoid Antitoxin Floccules, and 7 with Alum Precipitated Toxoid. The remaining 18 cases were ones where the preliminary schick tests were negative. 87 No reactions were reported in any of the cases and since the commencement of the scheme at the end of 1936, no inoculated child has been found suffering from diphtheria. The scheme in general appears to function quite well, but it must be stated that the number of cases dealt with are too few, relative to the child population, to be a factor in the prevention of diphtheria. Zymotic Enteritis or Epidemic Diarrhoea.—One hundred and fourteen cases were notified throughout the whole of the Borough, 80 being under one year of age, and 34 one to five. 48 of such notifications related to patients in East Greenwich, 40 in West Greenwich, 5 in St. Nicholas, Deptford, and 21 in Charlton and Kidbrooke. Four deaths were certified as being due to Diarrhoeal diseases. Dysentery.—Twenty-three cases of this disease were notified, seventeen of which were in the first quarter of the year. Fifteen occurred in East Greenwich, 2 in West Greenwich, and six in Charlton. Eleven cases were removed to Hospital for treatment. Ophthalmia Neonatorum.—Fifteen cases of this disease were notified compared with 12 in the previous year. Six occurred in East Greenwich, 5 in West Greenwich, 1 in St. Nicholas and 3 in Charlton and Kidbrooke. 9 cases were removed to Hospital for treatment. In no case was the type proved venereal, nor were any permanent effects reported. Scarlet Fever.—The number of notifications received during the year was 161, as compared with 183, 305 and 301 for the years 1937, 1936 and 1935, and is the lowest number recorded since the year 1917. Of the cases, 43 were in East Greenwich, 38 in West Greenwich, 16 in St. Nicholas, Deptford, and 64 in Charlton and Kidbrooke. 149 cases were removed to Hospital and of these 7 were discharged but still suffering from Erythema (3), Tonsillitis (2) and Measles (2). There was one death from Scarlet Fever during the year. Enteric Fever.—There were three cases of Enteric Fever notified during the year. Two were removed to Hospital, the remaining case being a nurse who had contracted the disease from another case in hospital. There were no fatalities. Thorough investigations were made with a view to ascertaining the source of infection but without success. 88 In one case, a schoolgirl of 8 years, suspicion was aroused as a result of her attending a Christmas party at her grandmother's house. Further enquiry elicited the fact that the grandmother had had Typhoid Fever many years before and there was a possibility that she might have been a carrier. Arrangements were accordingly made for her attendance to hospital for pathological tests. These, however, proved negative. Eight specimens were forwarded by medical practitioners for bacteriological examination, all of which proved negative. Puerperal Fever.—Two cases of this disease were notified, as compared with eight last year. One occurred in East Greenwich and one in West Greenwich. Both were removed to Hospital for treatment. Puerperal Pyrexia.—There were thirty-five cases attributed to this condition as compared with twenty-eight for the previous year. Ten of the patients resided in East Greenwich, four in West Greenwich, three in St. Nicholas, and eighteen in Charlton and Kidbrooke. The majority were notified from either hospitals or Maternity Homes. Epidemic Cerebro-Spinal Meningitis, Cerebro-Spinal Fever or Post-Basal Meningitis.—There was one case of this disease. Acute Polio-Myelitis and Polio-Encephalitis.—Five cases were notified, as compared with two for the previous year. Influenzal Pneumonia and Acute Primary Pneumonia.— During 1937, 92 cases of Influenzal Pneumonia and Primary Pneumonia were notified as compared with 119 in 1937. As provided in the regulations, where nursing was inadequate a district nurse was sent in accordance with an arrangement with the local Nursing Association. Influenza, unless accompanied by pneumonia, is not notifiable. Tuberculosis.—In the year under review, there were 152 cases notified in the Borough, as compared with 111 for the previous year. Of this number 122 were of the pulmonary type, ordinarily known as consumption, and 30 were non-pulmonary cases, i.e., Tuberculosis of other parts of the body than the lungs. Of this number, 35 pulmonary and 8 non-pulmonary occurred in East Greenwich, 27 pulmonary and 8 non-pulmonary in West Greenwich, 10 pulmonary and 1 non-pulmonary in St. Nicholas, 50 pulmonary and 13 non-pulmonary in Charlton and Kidbrooke. 89 Three hundred and ninety-three specimens were forwarded by medical practitioners for bacteriological investigation and of these, 322 were reported to be negative and 71 positive for tuberculosis. Disinfection has been offered and carried out in 99 cases, including 171 rooms and 611 articles of bedding, etc. Disinfectant has been supplied to patients to disinfect sputum pots, etc., where necessary. Sickness and Invalidity.—So far as is known, there are no occupations in the Borough which would appear to cause undue sickness or invalidity. DISINFECTION OF PREMISES. The disinfection of rooms from which patients suffering from notifiable infectious diseases have been removed is carried out by means of the formaldehyde spray. For other than notifiable conditions disinfection is carried out on request, and a charge made according to the circumstances of the case. Bedding and wearing material are removed to the Disinfecting Station, Tunnel Avenue, and are there submitted to steam disinfection. Books are treated with Formalin. The following returns show in detail the amount of work performed during the year by the Disinfecting Staff:— 90 Rooms and Articles Disinfected, Year 1938. Diseases, etc. Premises Entered Rooms Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Disinfected Scarlet Fever 151 214 77 – 94 64 239 337 200 19 181 494 1,705 Diphtheria 229 350 122 – 125 107 382 481 300 27 284 742 2,570 Tuberculosis 99 171 39 – 51 48 124 129 88 26 56 50 611 Cancer 26 35 4 – 14 9 38 29 6 18 13 33 164 Cerebro-Spinal Fever 1 2 1 – 1 1 2 3 2 – 1 4 15 Puerperal Fever 2 3 2 – 2 1 5 6 5 1 3 1 26 Typhoid Fever 3 4 1 – 1 2 7 6 5 1 4 28 55 Polio-Myelitis 4 4 4 – 1 3 10 7 6 – 7 9 47 Erysipelas 6 8 2 – 4 3 13 7 6 – 6 7 47 Impetigo 1 5 1 – 1 1 2 2 2 – 1 5 15 Measles 15 23 5 – 8 7 24 28 17 4 9 23 125 Scabies 21 42 25 2 21 17 57 72 33 10 44 66 347 Other Diseases 112 162 28 2 86 20 328 326 24 69 56 803 1,742 Verminous Premises 36 77 11 – 28 6 43 98 34 1 4 – 225 Verminous (Housing G.B.C.) 68 - 110 6 135 136 223 173 68 17 56 24 948 Verminous (Housing L.C.C.) 8 18 17 – 19 17 36 39 25 2 18 4 177 Total 782 1,118 449 10 591 442 1,533 1,743 821 195 742 2,293 8,819 91 Articles Destroyed, Year 1938. Diseases, etc. Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Destroyed Scarlet Fever 3 – 4 – 1 2 2 1 3 41 57 Diphtheria 2 – 2 2 3 4 2 – 1 19 35 Tuberculosis 9 2 8 4 15 3 6 2 2 56 107 Cancer 8 2 3 5 8 4 – 2 2 64 98 Other Diseases 17 10 14 12 24 3 14 1 1 154 250 Verminous Premised 9 2 13 6 16 13 – 6 3 210 278 Total 48 16 44 29 67 29 24 12 12 544 825 92 TUBERCULOSIS OFFICER'S REPORT FOR 1938. Sir, In presenting my Report for the current year, I should like to record the continued friendly co-operation which exists in my relations with other departments and local medical practitioners. In addition, I would like to express my thanks to the staffs of the various local Hospitals, Charity Organisations, and Public Assistance Committees for their help in dealing with the cases attending Maze Hill Clinic. Complete details of the statistical data for the year are given at the back of the report, but the following table is submitted showing comparative figures for some of the main items over the past ten years in connection with Dispensary cases. Year No. of cases on Dispensary Register Deaths No. of "T.B.+" Cases Death Rate per 1,000 1929 750 80 230 .76 1930 770 64 222 .60 1931 712 78 234 .78 1932 712 52 234 .50 1933 673 76 242 .77 1934 683 59 238 .60 1935 577 65 252 .67 1936 532 58 257 .60 1937 517 64 258 .66 1938 533 53 267 .55 It is satisfactory to note a further decrease in the number of deaths from tuberculosis in 1938 as compared with previous years. It is still felt that much effort remains to be expended if this downward trend in mortality is to be maintained. Notifications.—Notifications were received during the year in respect of 122 pulmonary and 30 non-pulmonary cases, representing an incidence of 1.27 per 1,000 population for the pulmonary and .31 for the non-pulmonary forms of the disease. At the end of 1938, the Notification Register (*) consisted of 694 cases as compared with 646 cases in 1937. The total is made up as follows:— Adults. Children. Total. Males. Females. Pulmonary 268 229 45 542 Non-Pulmonary 33 40 79 152 93 (*) N.B.—There is always a discrepancy between the Notification Register and the Dispensary Register, e.g., a case not desirous of Public Medical Treatment appears on the Notification Register, but not on the Dispensary Register. Deaths.—The total number of Deaths in the Borough during 1938 was 74, representing a rate of .76 per 1,000 population for all forms of the disease. The pulmonary type accounted for 61 of the deaths—a rate of .63 per 1,000. Public Health (Tuberculosis) Regulations, 1925.—During the year under review, no action was taken under these regulations. Occupations.—A consideration of this question does not reveal any influence of occupation in the incidence of tuberculosis in the Borough. Housing.—-In some 40 cases during the year special recommendations were made to the Public Health Committee of the Council and to the London County Council for re-housing of families that included a person with tuberculosis. In many cases suitable offers of accommodation had to be refused because of distance from work or an increase in rent. It would seem that from whatever aspect the tuberculosis family is approached the economic factor becomes an obstacle at some point, under the present circumstances. In some of the worst cases of overcrowding, beds and bedding have been loaned in an effort to secure segregation of infectious cases. New Patients.—637 new patients were dealt with during the year including 23 transfers. The sources from which these patients came were as follow:— Doctors 339 Hospitals 65 Schools 4 Own application 31 Nurses 198 (including 180 Contacts). Contacts.—180 contacts were examined during the year, of whom 10 were found to be tuberculous—7 with pulmonary tuberculosis and 3 non-pulmonary. It is to be regretted that the number examined is not larger, and particularly that more of the age-group 15-25 could not be persuaded to avail themselves of the facilities provided—for much valuable preventive work is to be done in this field. 94 As has been pointed out in previous reports however, a further number of Contacts find their way to the Dispensary via Medical Practitioners or on their own application and are then classed as New Patients. Residential Treatment.—The London County Council's revised scheme for treatment of tuberculosis issued in 1936, includes provision for the issue of travelling expenses to necessitous patients accepted for admission to the Council's institutions. It also provides for the issue of travelling expenses in necessitous cases where a relative was obliged to visit a patient in an emergency upon the request of a Medical Officer of a Sanatorium. Only a few applications for assistance were received during the year. Hospital Visits.—The excellent arrangement, whereby the Tuberculosis Officer pays visits to St. Alfege's Hospital, has been continued. Close supervision of the patients is thus maintained and the interchange of information is of much mutual benefit. X-Ray Examinations.—The arrangements made with the London County Council continue to give every satisfaction. The work in this connection tends to increase each year, as the attached table indicates. No. of Films taken Year. during the Year. 1934 387 1935 533 1936 554 1937 618 1938 768 In addition to the above, a large number of screen examinations are carried out by the Tuberculosis Officer. Artificial Pneumothorax Refills.—The arrangement made in 1934 with the London County Council regarding the provision of this treatment is continued. The attached 5 year table indicates how the scope of this work has increased during recent years. No. of Refills given Year. during the Year. 1934 45 1935 100 1936 200 1937 353 1938 513 95 Ultra Violet Light Treatment.—70 cases were referred for treatment in 1938, as compared with 89 in the previous year. The following table shows the classification of cases for whom it was recommended: No. Debility and Underweight 14 Cervical Adenitis 14 Bronchial Catarrh 10 Rheumatism 10 Colds, and Nasal Catarrh 8 Asthma 3 Tuberculous Glands 2 Post-Pneumonia 1 Post-Tonsillitis 1 Neuritis 2 Anaemia 1 Alopecia 1 Acne 1 Enuresis 1 Otitis 1 2,105 treatments were given altogether, the majority being general exposures. It is hardly necessary to add that the greatest care is taken to prevent contact between tuberculous and other patients. This is possible because of the small number of tuberculous cases considered suitable for this treatment. Dental Report.—Mr. G. F. Ferris, the Council's Dentist, submits the following figures relative to tuberculous cases treated during the year. Sessions 14 Filling and Scalings 18 New Patients 31 Advice 19 Attendances 70 X Ray — Dentures 6 Extractions:— Gas 2 Local 40 42 Open Air School.—Ten children were recommended for admission to the Open Air School during 1938. 27 children are on the roll and are seen once a term by the Tuberculosis Officer. 96 The type of child usually referred is that showing subnormal nutrition or children who are contacts of tuberculous patients. The improvement after a period at the School is in many eases very marked. Convalescent Treatment.—13 children were recommended for periods of convalescent treatment. For the chronic Pulmonary Catarrh of childhood, this seems to be the most effective treatment. It needs to be prolonged however, if a relapse is to be avoided. For the child debilitated by sickness, a change of air often works wonders, and enables it to thrive in adverse conditions. This admirable work so ably carried out by the Invalid Children's Aid Association is deserving of the highest praise. "Boarding-Out" of Contacts.—Ten children were boarded out under the London County Council's scheme. Children up to the age of 14 years are dealt with under the scheme. They live in cottages in the country under the care of an approved foster mother. Care Work.—Several garden shelters belonging to the Council are in continuous use and as has been previously noted a number of bedsteads, mattresses and blankets are on loan to patients. Gifts of personal clothing have been made to necessitous patients, as a result of the kindness of various friends of the Dispensary Nursing staff. As in previous years, much valuable help has been forthcoming from the British Red Cross Society, Mayor's Fund, etc. Extra Nourishment.—A working arrangement with the Public Assistance Authorities exists whereby tuberculous patients receiving Public Assistance, are granted an extra allowance of nourishment on receipt of a recommendation from the Tuberculosis Officer. The amount granted is usually of the order of 7 pints of milk, 7 eggs and ½ lb. butter weekly. For those patients not in receipt of Public Assistance, the scheme commenced in 1936 under Article XII of the Tuberculosis Regulations, 1930, is continued and is much appreciated. Grants similar to the above are made, but the scope of the scheme is limited to patients awaiting admission to Sanatorium or are convalescing after discharge and where a reasonable probability of eventual return to work exists. It should also be mentioned that where considered necessary, contacts of school age are recommended for free milk, dinners and cod liver oil and malt, to the School Medical Officer for consideration by the School Care Committee. 97 Handicraft Centre.—The Centre continues its good work, thanks to the zeal of its able leader Mr. Worlock. The Committee consist of the following members, Mr. W. J. Worlock (Chairman), and the offices of Vice-Chairman, Hon. Treasurer and Hon. Secretary are held by Dr. Watson, Dr. W. Alcock and Miss I. B. Mills respectively. Included on the Committee are the Chairman of the Public Health Committee, Councillor Mrs. F. Carter, and the Chairman of the Maternity and Child Welfare Committee, Councillor Mrs. A. Kennedy. The other members are Mrs. Dabin, the Medical Officer of Health, together with one member of the Nursing Staff. As a result of the Christmas Seals Sale during the Christmas 1937, owing to the satisfactory response which was made by the public, it was possible for the Committee to provide help to expatients during the year. For the current season it is anticipated that a record response will be made to the appeal and it is hoped that during the coming year very much more in the way of assistance to patients will be possible. I should like to take this opportunity on behalf of the Committee and the patients at the Handicraft Centre, to sincerely thank all helpers and the members of the public who have assisted in this good work. The usual summer outing and Christmas party were organised by members of the Handicraft Aid Committee to whom much praise is due for their good gifts on behalf of the social side of the Handicraft Centre. In conclusion I should like to acknowledge my indebtedness to the other members of the Tuberculosis Department Staff, whose work is reflected in the body of this report and the statistical tables appended. I am, Sir, Yours faithfully, W. ALCOCK, M.B., D.P.H., Tuberculosis Officer. 98 TUBERCULOSIS. NEW CASES and MORTALITY-Year 1938. Age-Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 2 1 2 1 1 1 1 2 — — — — — 5 1 2 1 3 — 1 1 1 10 3 1 — 3 — — — 1 15 8 14 3 4 2 3 — 1 20 10 19 2 2 4 4 1 — 25 16 19 4 5 8 9 1 1 35 13 15 1 2 6 3 1 — 45 9 2 2 — 10 1 1 — 55 13 4 — — 7 — — — 65 and upwards 2 — — 1 3 — — 1 Totals 76 77 17 21 40 21 7 6 Particulars relating to the above Table are dealt with in the Report of the Tuberculosis Officer on pages 92 to 97. 99 Return showing the work of the Dispensary for the Year 1938. DIAGNOSIS Pulmonary Non-Pulmovary Total / Total Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 56 57 5 — 8 9 4 3 64 66 9 3 142 (b) Diagnosis not completed — — — — — — — — 4 3 1 2 10 (c) Non-tuberculous — — — — — — — — 116 111 24 31 282 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 4 — 1 1 — — 2 3 4 — 3 10 (b) Diagnosis not completed — — — — — — — — 2 1 — — 3 (c) Non-tuberculous — — — — — — — — 27 54 42 44 167 C.—Cases written off the Dispensary Register as:— (a) Recovered 4 2 2 — — 1 3 1 4 3 5 1 13 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 156 169 66 77 468 D.—Number of Cases on Dispensary Register on December 31st (a) Definitely tuberculous 217 185 16 9 24 31 30 8 241 216 46 17 520 (b) Diagnosis not completed — — — — — — — — 6 4 1 2 13 100 1. Number of cases on Dispensary Register on 1st January 517 2. Number of cases transferred from other areas and cases returned after discharge under Head .3 in previous years 23 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases "lost sight of" 87 4. Cases written off during the year as Dead (all causes) 53 5. Number of attendances at the Dispensary (including Contacts) 2,617 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 17 7. Number of consultations with medical practitioners:— (а) Personal 19 (b) Other 339 8. Niunber of visits by Tuberculosis Officers to homes (including personal consultations) 108 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,790 10. Number of:— (а) Specimens of sputum, etc., examined 262 (b) X-ray examinations made in connexion with Dispensary work 768 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above — 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 267 101 Supplemental Vaccination Return for 1937. Return made on or before the 14th of February, 1939, by Mr. R. O. Budds, Acting Vaccination Officer of the several Districts of the Borough of Greenwich, respecting the vaccination of children whose births were registered from 1st January to 31st December, 1937, inclusive:— Registration SubDistricts comprised in the Vaccination Officer's District No. of Births from 1st Jan. to 31st Dec., 1937 Number of these Births duly entered by 31st Jan., 1939 No. of Births which on 31st Jan., 1939, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1939, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1938 No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1938 Successfully Vaccinated Insusceptible of Vaccination Had Small, pox Certificates of Conscientious objection received Died. Unvaccinated Postponement by Medical Certificate Removal to Districts, V.O. of which apprised Removal to places unknown and cases not found East Greenwich 978 470 3 236 41 29 56 43 100 — West Greenwich 188 73 — — 60 14 6 26 2 7 — — Charlton and Kidbrooke 665 247 2 — 282 14 17 36 11 56 — — Total 1,831 790 5 — 578 69 52 118 56 163 879 641 ·Includes St. Nicholas District. R. O. Budds, Acting Vaccination Officer. Dated 31st March, 1939. i Index of Contents. a. Page Adoptive Acts, By-laws and Local Regulations 3 & 4 Age Mortality18 Ambulance Facilities 23 Ante-Natal Services 27 Area of Borough 9 Articles and Rooms Disinfected 90 Articles Destroyed 91 Artificial Cream Act, 1929 73 Artificial Sunlight Treatment 25 B. Baths and Washhouses 44 Bacteriological Examinations 23, 66 Bakehouses 37 Birth Control 33 Births 16 Blackheath Fair 73 c. Cancer 22 Care Work 96 Cerebro-Spinal Fever 88 Cerebro-Spinal Meningitis 88 Children Acts 35 Cleansing Children 45 Clearance Areas 53-60 Clinics and Centres 23, 24, 25 Common Lodging Houses 37 Condensed Milk 75 Contacts 93, 96 Convalescent Treatment 31, 96 d. Dairies and Milkshops 65 Deaths 17 Deaths, Tables showing Causes of and Ages at Appendix Deaths, Tables showing Causes of find Ages under 1 Appendix Deaths, with Age Mortality 18, 19 Density of Population 9 Dental Work 33, 95 Diabetes 23 Diarrhoea and Zymotic Enteritis 21, 87 Diphtheria 86 Diphtheria Anti-Toxin 86 Diphtheria Immunisation 86 Disinfection 89, 90, 91 Disinfestation Drainage Work Dried Milk 35 Duties and Powers of the Public Health and Maternity and Child Welfare Committees 3, 4 Dysentery 87 ii INDEX—continued. Page e. Elevation of Borough 9 Enteric Fever 87 Enteritis 87 E. Epidemic Diseases 88 Eradication of the Bed Bug 41 Exhumations 46 Extracts from Vital Statistics 12 Extra Nourishment 96 F. Factories and Workshops 37-39 Food Bye-Laws 73 Food and Drugs—Samples of 76-80 Food Poisoning—Notification of 81 Food—Premises for Preparation of, etc. 72 Food—Inspection of 65 Foot Clinic 25 Footway—Fouling of 43 g. General Statistics 9 & Appendix H. Handicraft Centre 97 Health Centres 23-25 Health Visitors, Visits, etc 31, 32 Heart Disease 22 Home Helps 25 Home Nursing 31 House Drainage 46 Houses Let in Lodgings 46 Housing 53-64 I. Ice-Cream Premises 74 Imported Food Surrendered 70 Infant Consultations 26 Infant Welfare Centres 23 Infantile Mortality 19, 20 ft Appendix Infectious Disease, Cases of Appendix Influenza 21, 88 Inhabited Houses 9 Institution Deaths 18 Institutional Provision for Mothers and Children 31 Insulin Treatment 23 Introductory Review 7, 8 iii. Page INDEX—continued. L. Laboratory Work 23 L.C.C. School Clinic 33, 34 M. Malignant Diseases 22 Margarine Dealers 75 Marriages 13 Maternal Mortality 29 M. Maternity and Child Welfare 26, 27 Maternity and Child Welfare Committee 4 Maternity Home29 Measles 82 Meat 66-72 Merchandise Marks Act, 1926 72 Meteorological Observations 14 Midwifery Services 28 Milk, Analysis of 66 Milk and Dairies (Amendment) Act, 1922,etc. 65 Milk—Bacteriological Examination 66 Milk Supply 34, 65 Milk Supply for Expectant and Nursing Mothers 34 Milk (Special Designations) Order, 1936 65 Minor Ailments 33 Mortuary 22 N Notices, etc 37, 50 Notifications 82-89 Notification of liirths Act 32 Nursery School 34 Nursing in the Home 31 Nutrition 34 O. Offensive Trades 42 Open-Air School 95 Ophthalmia Neonatorum 87 Outworkers' Register 38 Overcrowding 60 Ozonisation of Moatm 69 P. Persons Cleansed45 Pneumonia 31, 88 Pharmacy and Poisons Act, 1933 45 Polio-encephalitis Polio-myelitis 88 Poor Law Relief and Unemployment 11 vi. Page IND EX—continued. R. Population 12 Post-Basal Meningitis 88 Post Natal Clinics 27 Preserved Food Premises 73 Public Health (Imported Food) Regulations, 1925 69 Public Health (Preservatives, etc., in Food) Regulations 74 Public Health Committee 3 Public Open Spaces 10 Public Sanitary Conveniences 47, 48 Puerperal Fever, etc 30, 88 R. Rag Flock Acts 46 Rateable Value 9 Rates, Birth & Death 15 Rat Infestation 43 Rehousing 60 Remarks on Death Causes 20, 21 Removal of Aged Persons 46 Rent & Mortgage Interest (Restrictions) Acts, 1920 43 Results of Analytical Examinations 66 S. St. Alfege's Hospital 94 Sanitary Work—Summaries, etc 48-52 Scarlet Fever 87 Scavenging and Refuse Removal 45 Sewers 43 Shops Act 44 Sickness, etc 89 Slaughterhouses 67 Slum Clearance 53 Smallpox 82 Smoke Nuisances 39-41 Social Conditions 10, 11 Staff 5, 6, 23 Statistical Tables Appendix Street Traders 73 Swimming Baths 44 T. Toddlers' Clinic 28 Tuberculosis 21, 88 & 89, 92-100 Tuberculosis Care Committee 96 Tuberculosis Dispensary—Returns 98-100 Tuberculosis Officer's Report 92-97 Tumour Diagnostic Clinic 26 V. Page INDEX—continued. U. Ultra-Violet Light Treatment 25, 26, 95 Underground Bakehouses 37 Underground Rooms 61 Unemployment 11 Uninhabited Houses 9 Unsound Food 71 V. Vaccination 101 Verminous Children 45 Verminous Premises 41 Virol 35 Vital Statistics 12-22 W. Water Supply 43 Wholesale Margarine Dealers 75 Whooping Coughm 82,86 Workshops and Factories 37-39 X. X-Kay Examinations 94 Z. Zymotic Diseases 87 RETURN OF BIRTHS AND DEATHS. Registered during the year ended 31st December, 1938. Districts. Census Population. 1931. Estimated Population at the middle of the Year, 1938. Births Registered during the year ended 31st Dec., 1938. Deaths Registered during the year ended 31st Dec., 1938. Age Mortality. Seven Zymotic Diseases. Tuberculosis, Pulmonary. All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1,000. Under 1 year. Over 1 and under 5 years. Persons aged 65 and upwards. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. Diarrhoea. All Causes. Seven Zymotics. Typhoid. Others. During the corresponding period year previous During the year ended 31st December. 1938 During the corresponding period year previous During the year ended 31st December, 1938 m. f. M. F. Greenwich East 41,697 39,010 237 237 232 206 17 4 241 ... 2 1 1 ... ... ... 1 20 5 36 134 63 175 11.29 11.25 .22 .12 Do. West 24,967 21,310 133 141 134 114 16 3 122 ... 1 ... ... 2 ... ... 3 17 3 26 72 31 93 13.31 11.67 .30 .28 St. Nicholas, Deptford 6,573 5,880 55 41 40 23 3 ... 31 ... 1 ... ... ... ... ... ... 4 2 6 22 8 20 13.92 10.74 .16 .17 Charlton and Kidbrooke 27,687 29,570 237 222 145 146 19 4 143 ... ... ... ... ... ... ... ... 20 3 27 84 46 111 11.44 9.86 .32 ... S. Alfege's Hospital Resident 239 206 28 2 225 ... ... ... ... ... ... ... 2 21 6 46 124 60 186 Non-Resident 381 284 44 8 357 ... ... ... ... ... 1 ... 3 21 7 84 198 86 265 Seamen's Hospital Resident 27 ... ... 1 3 ... ... ... ... ... ... ... ... 5 ... 3 2 3 14 Non-Resident 69 8 1 1 16 ... ... ... ... ... ... ... ... 4 ... 6 7 20 40 Miller Hospital Resident 22 7 ... ... 8 ... ... ... ... ... ... ... ... 1 ... 1 4 7 16 Non-Resident 69 53 9 4 34 ... ... ... ... ... ... ... 3 ... 1 9 26 25 58 Herbert Hospital Resident 3 ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... Non-Resident 15 ... ... ... ... ... ... ... ... ... ... ... ... 6 ... 2 1 ... 6 Brook Hospital Resident 4 4 1 3 ... ... 3 1 1 ... ... ... ... ... ... 1 ... ... 2 Non-Resident 44 30 36 20 1 ... 11 1 11 7 ... ... 26 1 1 1 1 ... 14 Cottage Hospital Resident 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 4 Non-Resident 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 Other Institutions Resident 7 15 4 ... 13 ... ... ... ... ... ... ... ... ... ... 2 5 1 14 Non-Resident 10 13 5 ... 11 ... ... ... ... ... ... ... ... ... 2 5 1 15 Outside Institutions Resident 68 75 11 2 49 ... 1 ... ... 2 ... ... 3 17 2 8 32 21 57 Borough 100,924 95,770 662 641 551 489 55 11 537 ... 4 1 1 2 ... ... 4 61 13 95 312 148 299 Rate per 1,000 of Estimated Population ... ... 1,303 1,040 ... .04 .01 01 .02 ... ... .04 .64 .14 1.00 3.27 1.55 3.13 12.05 10.89 .26 .12 13.64 10.89 Deaths of Children under one year per 1,000 births, 42 Death Rate of 126 large English Towns 11.7, of the County of London 11.4. previous ,, ,, ,, corresponding 50. period ,, ,, ,, County of London, 57. Birt.h Rate ,, 15.0, „ 13.4. CAUSES OF, AND AGES AT, DEATH, during the year ended 31st December, 1938 Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether oocurring in or beyond the District Deaths of "Residents" In Public Institutions Total Deaths whether of "Residents" or "NonResidenta" in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital L.C.C. Cottage Hospital Other Institutions Outside Institutions All Causes Certified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Measles 4 1 1 1 1 ... ... ... ... 2 1 1 ... ... ... ... 3 ... ... 1 14 Scarlet Fever 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 Whooping Cough 2 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 2 7 Diphtheria 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 12 Influenza 9 ... ... ... ... ... 1 4 4 3 5 ... 1 2 ... ... ... 1 ... ... 2 2 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... ... 2 Tuberculosis of Respiratory System 61 ... ... ... 1 13 26 18 3 20 17 4 20 20 5 1 3 ... ... ... 17 61 Other Tuberculous Diseases 13 3 ... ... 3 2 3 1 1 5 3 2 3 8 ... ... ... ... ... ... 2 17 Syphilis 3 ... ... ... ... ... 1 2 ... ... 1 1 1 ... ... 2 ... ... ... ... 1 3 General Paralysis of the Insane, tabes dorsalis 7 ... ... ... 1 ... 1 3 2 2 1 1 3 3 ... ... ... ... ... ... 3 7 Cancer 148 ... ... ... ... ... 13 63 72 63 31 8 46 59 3 7 ... ... 1 1 21 203 Diabetes 15 ... ... ... ... ... ... 7 8 6 ... 1 8 12 ... ... ... ... ... ... ... 25 Cerebral Haemorrhage 46 ... ... ... ... ... 1 17 28 23 9 3 11 22 2 ... ... ... ... ... 5 56 Heart Disease 312 ... ... ... 3 6 9 55 39 134 72 22 84 124 2 4 ... ... 1 6 32 375 Aneurysm 5 ... ... ... ... ... ... 3 2 ... 1 1 3 4 ... ... ... ... ... ... ... 7 Other Circulatory Diseases 61 ... ... ... ... ... 2 18 41 30 17 1 13 32 2 ... ... ... ... 3 7 105 Bronchitis 26 1 ... ... ... ... ... 5 20 11 7 2 6 9 1 ... ... ... ... 1 2 28 Pneumonia (all forms) 69 11 3 2 2 5 6 17 23 25 19 4 21 37 2 1 ... 1 ... 1 6 130 Other Respiratory Diseases 11 ... ... ... ... 1 3 4 3 6 2 ... 3 6 1 ... ... ... ... ... 2 21 Peptic Ulcer 7 ... ... ... ... ... 1 3 3 1 2 ... 4 1 1 2 ... ... ... ... 3 17 Diarrhoea 4 4 ... ... ... ... ... ... ... 1 3 ... ... 1 ... ... ... ... ... ... 3 34 Appendicitis 10 ... ... ... 1 2 1 4 2 3 2 1 4 7 ... 1 ... ... 1 ... 1 22 Cirrhosis of Liver 4 ... ... ... ... ... ... 3 1 ... 1 ... 3 2 ... ... ... ... ... ... 1 5 Other Diseases of Liver, etc. 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 2 Other Digestive Diseases 17 ... ... ... 1 1 ... 8 7 7 6 ... 4 10 ... 3 ... ... ... 2 ... 44 Ac. & Cr. Nephritis 22 ... ... ... ... 1 3 8 10 12 4 ... 6 8 1 ... ... ... 1 1 1 30 Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Puerperal Causes 2 ... ... ... ... 1 1 ... ... ... ... ... 2 1 ... ... ... ... ... ... ... 1 Congenital Debility, Premature Birth, Malformations, etc 29 29 ... ... ... ... ... ... ... 12 5 1 11 16 ... ... ... ... ... 4 3 52 Senility 30 ... ... ... ... ... ... ... 30 13 9 2 6 12 ... ... ... ... ... 2 1 34 Suicide 8 ... ... ... ... ... 4 4 ... 2 2 2 2 2 ... 1 ... ... ... ... ... 8 Other Violence 40 1 1 ... 5 5 3 12 13 19 11 2 8 16 2 3 ... ... 1 ... 12 70 Other Defined Causes 72 3 2 ... 5 5 14 18 25 36 14 4 18 31 5 4 ... 2 1 1 14 121 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1040 55 7 4 24 42 94 277 537 438 248 63 291 445 27 29 3 8 6 22 143 1518 Note.—All "Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who died in the Borough in like manner have been excluded.. CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1938. NOTIFIABLE DISEASE. Cases Notified in Whole District Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality Total At Ages — Years At all Ages Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke (H) Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke (H) Small-Fox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 244 5 65 142 22 8 2 ... 80 61 26 77 76 60 26 77 239 Membranous Croup 9 ... 8 1 ... ... ... ... ... 9 ... ... ... 6 ... ... 6 Erysipelas 48 1 2 4 5 15 15 6 19 12 4 13 7 5 3 10 25 Acute Polio-Myelitis 5 ... 1 3 1 ... ... ... ... 2 1 2 ... 2 1 2 5 Scarlet Fever 161 ... 60 71 18 11 1 ... 43 38 16 64 38 35 15 61 149 Enteric Fever 3 ... ... 1 1 ... 1 ... 1 1 ... 1 1 1 ... 1 3 Dysentery 23 1 5 6 4 2 2 3 15 2 ... 6 5 2 ... 4 11 Puerperal Fever 2 ... ... ... 1 1 ... ... 1 1 ... ... 1 1 ... ... 2 Puerperal Pyrexia 35 ... ... ... 12 23 ... ... 10 4 3 18 8 4 2 17 31 Cerebro-Spinal Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 1 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1930 63 949 888 23 7 ... ... 808 401 137 584 69 57 22 31 179 Whooping Cough 129 14 70 44 ... 1 ... ... 26 39 6 58 3 5 4 ... 12 Diarrhoea 114 80 34 ... ... ... ... ... 48 40 5 21 21 12 ... 5 38 Ophthalmia Neonatorum 15 15 ... ... ... ... ... ... 6 5 1 3 6 1 1 1 9 Tuberculosis, Pulmonary 122 ... 1 4 41 52 22 2 35 27 10 50 16 17 9 24 66 „ Non-Pulmonary 30 3 3 7 7 8 1 1 8 8 1 13 7 8 1 6 22 Pneumonia, Acute Primary or Acute Influenzal 92 1 17 16 12 23 18 5 33 27 7 25 16 20 5 12 53 Totals 2963 183 1215 1187 147 152 62 17 1133 677 217 936 274 236 89 252 851 (H) Cases of Infectious Disease are treated in the Hospitals of the London County Council, whose Brook Hospital is situated in Kidbrooke. INFANTILE MORTALITY DURING THE YEAR 1938. Deaths from stated Causes in Weeks and Months under One Year of Age. 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. Small-Pox ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 1 ... ... 2 Diphtheria—Croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Tuberculous Diseases Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... ... 1 2 3 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculosis) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... ... ... ... 1 Diseases of Trachea ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... 1 1 Pneumonia, all forms ... ... ... ... ... 2 5 2 2 11 Diarrhoeal Diseases Diarrhoea, all forms ... ... ... ... ... ... ... ... ... ... Gastro -Enteritis ... ... ... ... ... 1 2 1 ... 4 Pemphigus Neonatorum ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... 1 ... ... ... 1 ,, otherwise ... ... ... ... ... ... ... ... ... ... Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis ... ... 1 ... 1 ... ... ... ... 1 Congenital Malformations 4 ... ... ... 4 ... 1 1 ... 6 Premature Birth 11 1 ... ... 12 ... ... ... ... 12 Atrophy, Debility and Marasmus 1 ... ... ... 1 ... ... ... ... 1 Other Causes 4 ... 1 .1 6 ... ... ... 2 8 Totals 24 1 2 1 28 5 9 5 8 55 Boys 24 Girls 31 55