LIBRARY GRE 37 Metropolitan Borougb of Greenwich J X f/ 5 INTERIM REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1939 FRXAME, Manning & Co., Ltd. (T.u.), Printers, 12a, Lee High Road, Lewisham, S.E.13. Metropolitan Borougb of Greenwich INTERIM REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1939 CONTENTS Staff ... 3 Introductory ... 4-5 Section A.—Vital Statistics, Clinics, etc 6-10 „ B. —Sanitary Circumstances of the Area 11-12 „ C. —Housing 13 „ D. —Inspection and Supervision of Food ... ... 14 „ E. —Prevalence of, and Control Over Infectious Diseases 15 „ F. —Air Raid Precautions ... 16-18 Pages PUBLIC HEALTH STAFF Full particulars were given in the Report for 1938. The following changes took place during the year :— Dr. W. Alcock... ... T.B. Officer and Resigned 19th Dec., 1939. Deputy M.O.H. Mr. E. S. ELLIOTT ... Vaccination Officer... Died Feb. 16th, 1939. This Officer formerly held the office for Deptford and Greenwich. The Medical Officer of Health was appointed Vaccination Officer as from 25/5/39. Mr. S. S. GARRARD ... Sanitary Inspector... Appointed vice Mr. A. D. H. Johnstone in March. Mr. A. E. Morgan ... Housing Inspector ... Seconded for duty in Sept. 1939 with Food Control. Mr. R. H. Robinson ... Grade "A" Clerk ... Resigned July, 1939. Miss D. Thackeray ... Chiropodist Resigned in September. Miss E. M. Marlow, Matron, and Sister E. Young of the Maternity Home left in September to take up duty with the Essex County Council under the Emergency Midwifery Scheme of the Ministry of Health. At the end of the year it was decided to recall these officers and to transfer their services for use in the local Casualty Service Scheme. Health Department, Town Hall, Greenwich, S.E.10. July, 1940. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Madam Mayor, Ladies and Gentlemen, I have the honour to submit my report for the year 1939, in accordance with Circular No. 1961 of the Ministry of Health. This report must be regarded as an interim one. It has been curtailed at the request of the Ministry of Health in view of the necessity for economy, and the pressure of work generally. In June the Department was moved from the temporary quarters at Devonport House to the new offices in the municipal portion of the New Town Hall building, the change being effected with little or no dislocation of the services. Preparations were well under way for the holding of a Civic Week to coincide with the official opening of the New Town Hall in September, and it was hoped to display during that week all the activities of the health services provided by the Council. It is to be regretted that in the circumstances it was not possible to carry out the project. On September 4th, an Emergency Committee of the Council was formed with power to act for all Committees. From November a combined Committee was formed with the powers and duties of the Public Health and Maternity and Child Welfare Committees. During the year, Air Raid Precautions has demanded great efforts from every individual in the Department, and as a result of the devotion to National Service of the staff it is gratifying to be able to state that at the outbreak of war the allotted number of First Aid Posts and Stretcher Party Depots were staffed and equipped, the detailed organisation having been put into practice beforehand in most cases by a nucleus formed from the staff of the Department. The incidence of Infectious Diseases for the year has been well below the mean and in no case calls for comment. Comparative Birth and Death rates cannot be given owing to the difficulty of formulating basic figures for their assessment. Despite the adverse conditions obtaining throughout the year the district has been kept under close supervision in regard to nuisances and sanitary circumstances, and the supervision and sampling of food and drugs has been carried out as in previous years. The comprehensive disinfestation scheme and the scheme for supervision of rheumatic conditions in children, which were formally approved during the year, were held in abeyance. The Maternity Home was closed at the outbreak of hostilities. At the time of the closure the first portion of the new pupil midwives training scheme had been completed. Following the closure of the Home, the demand for Home Helps increased. At the end of the year it was found necessary to consider additional facilities in respect of this service. I have to acknowledge another year of loyal co-operation on the part of the Health Department staff, and the support afforded me by my colleagues in the other Departments. Finally, I desire to thank the Chairman and members of the Public Health and Maternity Committees for the consideration shown to me during the past year. I have the honour to be, Your obedient Servant, F. R. Waldron. SECTION A. VITAL STATISTICS. Owing to the widespread evacuation in consequence of the war, the Registrar General has had to put into operation certain modifications in the rules for transferable Births and Deaths which have caused considerable delay. The Registrar General also points out that pressure of work in connection with other national duties has presented many difficulties and therefore it is not possible at this date to supply the usual complete statistics relating to Births and Deaths. BIRTHS. The number of births registered in the Borough was 1,724, of which 654 were transferred to other authorities. Inward transfers numbered 179 thus giving a net total of 1,249 births, 593 were males and 656 females. DEATHS. The total number of deaths registered was 1,715. Of these 908 were non-residents and were accordingly transferred to the appropriate areas. The number of Greenwich residents who died outside the Borough was 170, thus giving a net figure of 977 of which 528 were males and 449 females. MARRIAGES. The number of marriages solemnised or registered was 1,169, an increase of 275 over the previous year. TREATMENT CENTRES AND CLINICS. Full details were given in last year's Annual Report of all treatment centres and clinics provided by the Borough Council. It was found necessary, owing to the outbreak of war, evacuation and the heavy burden of A.R.P. work generally on the Department, to reduce substantially the facilities offered. It may be mentioned that, while during the early weeks of the war the reduction was necessarily very marked, towards the end of the year a full scheme was in operation only slightly below that functioning earlier. The chief changes owing to the outbreak of war are referred to hereunder. Maternity Services. —As mentioned in the introductory remarks, the Maternity Home provided by the Council was closed at the outbreak of war, and at the year end no decision had been reached with regard to its re-opening. Towards the end of the year as a result of the closure of the Home and other factors, it was found necessary to increase the provision of Home Helps in the area. Arrangements previously in existence with the Invalid Children's Aid Association regarding the provision of convalescent home treatment were in operation throughout the year. Some dislocation was necessarily occasioned during the early weeks of the war period, but by December the demand in this direction was being sufficiently provided for. Health Visitors.—More home visiting has been possible in individual cases because of evacuation and the taking over of one welfare centre completely for use as a First-Aid Post. Immediately prior to, and for some weeks following the declaration of war, a portion of the health visiting staff was necessarily retained for almost continuous duty supervising First-Aid Post personnel. At the end of the year the position had become more or less stabilised, the majority of the health visitors being allocated to First-Aid Posts in a part-time capacity, but devoting practically the whole of the usual time to their normal functions. Artificial Sunlight Treatment Clinics, though reduced in number, have still been available. The Special Women's Clinic, established early in the year, was discontinued at the outbreak of war. The proposed establishment of a central dental clinic was held in abeyance. Following a short period during which dental sessions were discontinued, these facilities were provided on a reduced basis. At the end of the year four sessions per month were available. The following table indicates briefly the extent of the work of the centres and clinics during 1939. Services. New Cases. Total Attendances. Infant Welfare Centres 1,668 29,591 Ante-Natal and Post-Natal Clinics 756 4,554 Artificial Sunlight Clinics 645 11,540 Dental Clinic 181 511 Foot Clinic - 4,766 Maternity Home 271 - Health Visitors Visits:— Visits. Re-visits. Children 0—5 1,531 9,016 Re Infectious Diseases 738 460 Miscellaneous Visits 1,990 829 Notification of Births Acts (1907 and 1915). Public Health (London) Act, 1936. 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 382 568 1 - Greenwich Borough Council Maternity Home 199 85 1 - Other Nursing Homes 32 91 5 18 Other Hospitals - 2 - - At Home 453 - 33 - 1,066 746 40 18 Other Boroughs (Transfers Inwards) 186 - 1 - 1,252 - 41 - Particulars of the amount of milk, etc., distributed are shown in the following table:— (a) Dried Milk, Virol, &c., Distributed Free. Quarter ended *Milk Pkts. Virol Malt & Oil Cod Liver Oil Marmite lbs. lbs. Bottles Cartons March, 1939 10,841 1,125½ 1,591 403 2,097 June, „ 10,302½ 934 1,333 390 1,993 Sept., „ 7,060 510½ 781 342 1,335 Dec., „ 5,102 — 863 377 984 Totals 33.305½ 2,570 4,568 1,512 6,409 ♦Includes 2,176 Pkts. given under L.C.C. Extra Nourishment Scheme. Amount recovered £195. (b) Dried Milk, Virol, &c., Sold at Full or Reduced Prices. Quarter ended Virol Total Amount Received Milk Malt & Oil Cod Liver Oil Marmite Bottles Cartons Pkts. lbs. lbs. £ s. d. 421 11 6 March, 1939 291 1,094 4,934 360 532 June, „ 4,201 201½ 269 240 801 338 17 11 324 11 1 Sept., „ 3,986 115½ 192 247 614 393 276 678 303 1 3 Dec., „ 3,573 - 16,694 1,386 1,054 3,187 1,388 1 9 Totals 677 In addition to the above, 9,676 pints of liquid milk were distributed free or sold at reduced prices at a nett cost to the Council of £139 8s. 8d. In December the re-established Public Health and Maternity and Child Welfare Committee had under consideration various reports on the establishment of a revised scheme for the supply of liquid milk at reduced prices to nursing and expectant mothers and children under 5 throughout the Borough. It was considered probable that during the following year it would be possible to introduce such a scheme in accordance with the recommendation of the Ministry of Health. Children Acts, 1908 and 1932. The following particulars are taken from the Register : — Number of Foster-mothers on Register at end of 1939 ... 29 Number of Foster-children „ „ „ ... 22 Supplemental Vaccination Return for 1938. Return made on or before the 14th of February, 1940, by Dr. F. R. Waldron, Vaccination Officer of the Sub-Districts of the Borough of Greenwich, respecting the vaccination of children whose births were registered from Ist January to 31st December, 1938. inclusive:— Registration Sub Districts comprised In the Vaccination Officer's District No. of Births from 1st Jan. to 31st Dec., 1938 Number of these Births duly entered by 31st Jan., 1940 No. of Births which on 31st Jan., 1940, remained unentered in the Vaccination Register on account of — No. of these births remaining on 31st Jan., 1940, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1939 No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1939 Successfully Vaccinated Had Smallpox Certificate of Conscientious objection received Died, Unvaccinated Insusceptible of Vaccination Removal to Districts, V.O. of which apprised Postponement by Medical Certificate Removal to places unknown and cases not found West Greenwich ... (Jan.-July) 47 - - - - 38 4 6 - 10 27 125 3 650 330 18 - - 187 29 51 East Greenwich ... (Jan.-July) 23 - - 12 9 - Charlton ... (Jan.-July) 384 184 - - 157 7 9 8 10 - 174 396 - 117 45 North Greenwich... (Aug.-Dec.) - 29 - 8 13 10 - - - 107 9 11 - South Greenwich... (Aug.-Dec.) 317 155 12 15 8 - 620 - 79 890 43 1,872 - 606 56 144 54 885 Dated. 31 st March, 1940. F. R. Waldron, Vaccination Officer. 11 SECTION B. SANITARY CIRCUMSTANCES OF THE AREA. The visits made by the District Sanitary Inspectors were necessarily restricted during the year owing to the time devoted to A.R.P. work. During September and October most of the Inspectors spent a considerable time at the various First Aid Posts. Nevertheless a total of 14,156 houses and premises were inspected or re-inspected during the year. 1,211 Intimation Notices and 147 Statutory Notices were served. 724 complaints were registered. FACTORIES ACT, 1937 All premises coming within the jurisdiction of the Local Authority were kept under systematic supervision during the year by the sanitary inspectors who made 448 inspections. 111 defects were found and appropriate action taken in each case. In the case of matters which were considered to be within the purview of H.M. Inspector of Factories, reports were forwarded to him for action. The number of factories on the register at the close of the year was 330. This number includes 68 factories where mechanical power is not used. SMOKE ABATEMENT. Ten complaints were received and dealt with during the year. THE ERADICATION OF BED BUGS. Reference was made in last year's Annual Report to the organisation of a comprehensive disinfestation scheme for the bed bug. This scheme was necessarily interrupted by the outbreak of hostilities and is being held in abeyance for the duration of the war. In accordance with the Ministry's Circular, the following table is given:— (1) The number of— (a) Council houses found to be infested 66 „ „ disinfested 66 (b) Other „ found to be infested 440 No. of rooms disinfested 1,011 12 SCAVENGING AND REFUSE DISPOSAL. These essential services in the Borough are under the control of the Borough Engineer and Surveyor who has kindly supplied me with the following information relating to them. The cleansing of the 71 miles of streets within the Borough is done by both hand and mechanical sweeping : about 20 miles daily, 30 miles three times weekly and 21 miles twice weekly. The emptying and flushing of over 4,000 road gullies is efficiently carried out by a mechanical gully emptying vehicle. The household refuse is collected from over 20,000 dwellings within the Borough and averages about 400 tons weekly, and there is also a special collection of trade refuse from markets and stalls. Since the commencement of hostilities a special effort is being made to induce the householders to keep newspapers and wrappings, etc., bones, and metals separate from the other refuse. The whole of the household refuse collected in the Borough was, until the outbreak of War, disposed of by separation and incineration at the Council's Refuse Disposal Plant, the ashes separated from the refuse were sold for brickmaking, and tins, scrap metal, bottles and rags were sorted out and provided a revenue from their sale. Since the outbreak of hostilities it has been found necessary to close down the Plant and barge away the refuse direct with separation. The newspapers and wrappings, etc., bones and metals which are kept separate from the other refuse by the householder are, of course, disposed of and form a source of income as well as being helpful for the prosecution of the War. CLEANSING STATION, BLACKWALL LANE. In connection with the Government's Evacuation Scheme, the Station was placed unreservedly at the County Council's disposal from the end of October. Little use, however, was made of this service, so presumably it can be stated that very few Greenwich children were found to be in a verminous condition. WATER FROM WELLS. A special survey was made during the year of wells and borings in the Borough. Much useful information was obtained and forwarded to the Ministry of Health. LEGAL PROCEEDINGS. It was found necessary in one case only to institute proceedings in regard to insanitary premises. An Order was made, but no fine was imposed. 13 SECTION C. HOUSING. On the outbreak of war the Sections of the Housing Act, 1936 relevant to slum clearance were rendered inoperative for the duration of hostilities. Brief particulars are given of action taken up to September: Houses surveyed by Housing Inspector for official action 297 Ditto—Re-visits 536 Number of houses erected during the year:— Greenwich Borough Council 2 London County Council (Flats) 40 Private enterprise 68 110 Houses demolished 65 Overcrowding. Number of dwellings overcrowded at the end of the year 376 Number of families dwelling therein 376 Number of persons dwelling therein 3,045 Number of new cases of overcrowding reported during the year 81 Number of cases of overcrowding relieved during the year 190 Number of persons concerned in such cases 1,028 14 SECTION D. INSPECTION AND SUPERVISION OF FOOD. As in previous years all Milkshops and Food premises were kept under regular supervision by the Food Inspectors. In all 3,906 visits were made and improvements carried out in 137 cases. MEAT DEPOT. A new feature brought about by war time conditions was the establishment by the Ministry of Food of Area Meat Depots. A Meat Supply Depot was set up in Greenwich. Here, meat is received and allotted for the needs of Greenwich and Woolwich. The premises are under continual supervision, one of the Food Inspectors visiting daily. FOOD & DRUGS ACT, 1938 This Act came into force on the Ist October, 1939, and consolidates with amendments, various enactments relating to food, drugs, markets, slaughterhouses and knackers' yards. Altogether some 29 Acts dating from the 16th Century are embodied. The consolidation of the many existing food laws should greatly simplify the administration of this section of public health work. It should be mentioned that during the period from Ist January until 30th September the samples reported upon were under the Food & Drugs (Adulteration) Act, 1928, and from the Ist October under the new Act. 186 formal and 272 informal samples, 458 in all, were taken during the year. Of these 142 were milk, 4of which were found to be adulterated. Of the total samples taken 13 or 2.8 per cent, were reported against, as compared with 4.8 per cent, in 1938. 16 SECTION E. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The number of cases of Infectious Diseases was 1,216 as compared with 2,963 for 1938. Particulars relating to age groups and districts are shewn in the tables at the end of the Report. The County of London (Measles and Whooping Cough) Amendment Regulations, 1939. These amend the 1938 Regulations and came into force on the 23rd October, 1939. Under the old Regulations when a Medical Practitioner had given a notification, no further notification from the same household was required within a period of 2 months from the date of the first one. The new Regulations which apply throughout the country remove this limitation, also the fee payable for each certificate will be 1/-. No individual infection calls for comment. TUBERCULOSIS OFFICER'S REPORT FOR 1939. Sir, The report for the year under review is regrettably brief owing to the present situation. The activities of the Department as a whole having been considerably curtailed from the beginning of the year until the outbreak of hostilities, when the Maze Hill Clinic closed down for a month, all the staff being engaged on civil defence duties. It was soon realised however that a skeleton service would be necessary and a start was made on these lines. Slowly the number of sessions was increased until by the end of the year, I am pleased to report that with the exception of an evening clinic, which it was felt undesirable to resume, normal working arrangements of the Clinic were in operation at the close of the year. During the early days of the War, arrangements for residential treatment under the L.C.C. scheme were likewise seriously dislocated, partly owing to the rapid discharge of patients to their homes in order to make beds available for emergency services. By the year end facilities for residential treatment were normally available. In conclusion I should like to acknowledge my indebtedness to the other members of the Tuberculosis Dispensary Staff, who have had to carry on their routine duties in conjunction with many tasks cheerfully undertaken in connection with Air Raid Precautions Scheme. I am, Sir, Yours faithfully, W. ALCOCK, m.b., d.p.h., Tuberculosis Officer. 16 SECTION F. AIR RAID PRECAUTIONS. CASUALTY SERVICES. At the beginning of the year under review six premises had been tentatively earmarked for the establishment of First Aid Posts. This proposal provided where possible for First Aid Posts at or near Hospitals in the area, and was a definite improvement on the emergency arrangements made in 1938 when the buildings selected were at considerable distances from the Institutions. In addition the Borough was approved for the establishment of one Mobile Unit. Plans were made for the best utilisation of the premises selected, and while considerable numbers of volunteers were under training those already trained were being allocated to their various Posts. At the same time contact was made with local members of the St. John Ambulance Brigade and the British Red Cross Society with a view to the organisation of stretcher parties to be based at definite points within the Borough. Steps were also being taken to take delivery of stores and equipment to supplement the materia] already at hand in order that, should the necessity arise, initial supplies could be quickly delivered to the Posts. On March 4th an A.R.P. exercise was held in which the Casualty Services co-operated. Two of the premises earmarked as First Aid Posts were staffed by trained volunteers and a Medical Officer was in attendance at each place. Four Stretcher Parties were utilised and the opportunity was taken of testing out the use of ambulance trailers as compared with the commercial type of van, such vans being at that period suggested as being capable of easy conversion to stretcher-carrying units. The Stretcher Parties were called out by a message from the Control Centre on receipt of Wardens' reports concerning various incidents. The incidents included ones where " gas-contaminated casualties " had to be dealt with. In addition, from points near the First Aid Posts large numbers of walking and sitting " casualties " were sent for attention. The results of the exercise were very encouraging and added to the enthusiasm and keenness of the personnel. Resulting from such enthusiasm and progress in training and the co-operation of the Hospital authorities, it was possible in May to commence fortnightly meetings at each First Aid Post and Stretcher Party Depot of personnel allocated to these services. Medical Officers had been appointed in April to take charge of collective training of staffs of First Aid Posts. 17 The Health Visitors and Sanitary Inspectors volunteered their services, as did the members of the clerical staff. It was thus possible at this stage to have a trained individual taking charge in the skeleton organisation of personnel and equipment, while the keeping of logs and clerical work generally was also undertaken. Up to the outbreak of hostilities these fortnightly meetings for advanced training were kept up, volunteers being added to those already allocated according as they finished their preliminary training. Officers-in-charge, Deputies and Quartermasters had been designated for the Stretcher Party Stations. In June a portion of the old Town Hall premises became available as a base for First Aid supplies and equipment for all services including the Wardens and Rescue organisations. By this time also a certain amount of work had been carried out at the buildings earmarked as Posts, this of course being governed by the necessity of not interfering with the ordinary use of the premises. During the week prior to the outbreak of hostilities arrangements were made for the mobilisation of full-time personnel. Equipment and stores were despatched where possible or were ready for instant despatch, and at the time of the outbreak of war all Posts were staffed and equipped and Stretcher Parties standing by with a certain number of volunteer cars adapted for the transport of stretchers, equipment and personnel. Early in September it became obvious that the quarters occupied by two of the Stretcher Party Units were unsuitable, and steps were taken to obtain other accommodation in nearby schools. Arrangements were made for the hiring and adaptation of a sufficient number of cars for the transport of parties, and the organisation was consolidated generally. Although to the end of the year it was fortunately not necessary to deal with air raid casualties, it was evident as a result of exercises and the advance of training that the Units would be capable of dealing with any emergency. From the middle of May onwards practices had been held in co-operation with the auxiliary ambulance service so that the personnel might become accustomed to the use of the vehicles and co-operation generally. Similarly contact with the Hospitals was established. In the many large scale exercises the casualty services were fully utilised and with the other sections of the A.R.P. organisation, displayed keenness and enthusiasm. By the end of December the Stretcher Party to represent Greenwich in the Group Competition had been selected. That the Party should, after winning this competition, go on later to win first place in the London Region Trials against representatives of over 90 Authorities, is evidence of the standard of training reached. 18 Much could be written of the work of certain individuals, part-time and full-time, in the strengthening of the developing organisation. Apart from the pure first aid aspect there were other circumstances which brought to light hidden talent and enthusiasm. The problem of catering for many scattered Units was not easy. The developing of recreations to combat staleness, the arrangement of rotas, etc., in the case of each Post or Depot presented peculiar difficulties. These difficulties were obviated, and arrangements went smoothly because of the unselfish endeavours of some of those with whom I have the privilege to work and to whose service I refer in this record. i. Index of Contents A. Page Air Raid Precautions ... 16-18 Ante-Natal Services ... ... ... ... ... ... 8 Artificial Sunlight Treatment ... ... ... ... 7 B. Births ... ... ... ... ... 6&8 C. Cancer ... ... ... ... ... ... ... ... Appendix Cerebro-Spinal Fever ... ... ... ... ... Appendix Children Acts ... ... ... ... ... ... ... 9 Cleansing Station ... ... ... ... ... ... 12 Clinics and Centres ... ... ... ... ... ... 6-8 Complaints ... ... ... ... ... ... ... 11 D. Dairies, Cowsheds and Milkshops ... ... ... ... 14 Deaths ... ... ... ... ... ... ... ... 6 Deaths, Tables showing Causes of and Ages at ... ... Appendix Deaths, Tables showing Causes of and Ages under 1 ... Appendix Dental Work ... ... ... ... ... ... ... 8 Diabetes ... ... ... ... ... ... ... Appendix Diarrhoea and Zymotic Enteritis ... ... ... ... Appendix Diphtheria ... ... ... ... ... ... ... Appendix Disinfestation ... ... ... ... ... ... ... 11 Dried Milk ... ... ... ... ... ... ... 8,9 E. Enteric Fever Appendix Enteritis Appendix Epidemic Diseases ... ... ... ... ... ... Appendix Eradication of the Bed Bug... ... ... ... ... 11 Extracts from Vital Statistics ... ... ... .. 6 & Appendix F. Factories and Workshops ... ... ... ... ... 11 Food and Drugs—Samples of ... ... ... ... 14 Food —Premises for Preparation of, etc. ... ... ... 14 Food —Inspection of ... ... ... ... ... ... 14 Foot Clinic ... ... ... ... ... ... ... 8 G. General Statistics ... ... ... ... ... ... Appendix H. Health Centres ... ... ... ... ... ... 6 Health Visitors, Visits, etc. ... ... ... ... ... 7 & 8 Heart Disease ... ... ... ... ... ... ... Appendix Home Helps ... ... ... ... ... ... ... 7 Housing 13 ii. INDEX —continued. I. Page Infantile Mortality ... ... ... ... ... ... Appendix Infectious Diseases ... ... ... ... ... ... 15 Influenza ... ... ... ... ... ... ... Appendix Introductory Review ... ... ... ... ... 4 & 5 L. Legal Proceedings ... ... ... ... ... ... 12 M. Malaria ... ... ... ... ... ... ... Appendix Marriages ... ... ... ... ... ... ... 6 Maternity and Child Welfare ... ... ... ... 6-9 Maternity Home ... ... ... ... ... ... 7 & 8 Measles ... ... ... ... ... ... ... 15 & Appendix Meat ... ... ... ... ... ... ... ... 14 Milk, Analysis of ... ... ... ... ... ... 14 Milk and Dairies (Amendment) Act, 1922, etc. ... ... 14 Milk Supply for Expectant and Nursing Mothers ... 9 N. Notices, etc. ... ... ... ... ... ... ... 11 Notifications ... ... ... ... ... ... ... 15 Notification of Births Act ... ... ... ... ... 8 O. Ophthalmia Neonatorum ... ... ... ... ... Appendix Overcrowding ... ... ... ... ... ... ... 13 P. Pneumonia ... ... ... ... ... ... ... Appendix Polio-myelitis ... ... ... ... ... ... ... Appendix Public Health Committee ... ... ... ... ... 4&5 Puerperal Fever, etc. ... ... ... ... ... Appendix S. St. Alfege's Hospital ... ... ... ... ... ... 8 Sanitary Work ... ... ... ... ... ... 11 Scarlet Fever ... ... ... ... ... ... ... Appendix Scavenging and Refuse Removal ... ... ... ... 12 Slaughterhouses ... ... ... ... ... ... 14 Slum Clearance ... ... ... ... ... ... 13 Smoke Nuisances ... ... ... ... ... ... 11 Staff of Public Health Department ... ... ... 3 Statistical Tables ... ... ... ... ... ... Appendix T. Tuberculosis ... ... ... ... ... ... ... 15 Tuberculosis Officer's Report ... ... ... ... 15 V. Vaccination ... ... ... ... ... ... ... 10 Verminous Children ... ... ... ... ... ... 12 Virol ... ... ... ... ... ... ... ... 8 Vital Statistics ... ... ... ... ... ... Sec. A, 6 W. Well Water-Survey ... ... 12 Whooping Cough ... ... ... ... ... ... 15 & Appendix CAUSES OF, AND AGES AT, DEATH, during the year ended 31st December, 1939 Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Greenwich East Greenwich West St. Nicholas, Deptford Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Charlton and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital L.C.C. Deaths of "Residents" in Public Institutions Cottage Hospital Other Institution Outside Institutions Total Deaths whether of "Residents" or "Non- Residents" in Public Institutions in The District Under 1 2 and under 5 15 and under 25 ... 45 and under 65 65 and upwards 1 and under 2 5 and under 15 25 and under 45 All Ages ... ... ... ... ... ... ... ... All Causes Certified Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 4 4 ... 2 ... ... ... ... 1 1 ... ... ... 4 ... ... ... 12 ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Influenza ... ... ... ... ... 12 ... ... 4 8 5 3 4 2 9 ... ... ... ... ... ... ... ... 1 ... ... Encephalitis Lethargica ... 1 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Cerebro-Spinal Fever 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 54 ... ... 16 16 2 ... 1 13 56 1 21 10 7 22 1 ... Tuberculosis of Respiratory System 19 20 ... ... ... 1 2 Other Tuberculous Diseases 6 ... ... ... 2 1 1 1 1 3 3 3 1 ... ... ... ... ... ... ... Syphilis 3 ... 1 1 1 ... ... ... 2 ... ... 1 1 1 3 ... ... ... ... ... ... ... General Paralysis of the Insane, tabes dorsalis 2 ... ... 1 2 ... 1 1 ... .... ... 1 ... ... 1 ... 1 ... ... ... ... ... Cancer 154 14 61 ... ... ... 1 78 62 37 10 45 6 1 3 33 217 ... 58 4 ... ... Diabetes 11 1 8 3 .... ... ... ... 2 5 3 5 1 1 17 ... ... ... ... ... ... ... Cerebral Haemorrhage 36 ... ... 2 8 26 11 ... ... 11 ... 14 12 ... ... ... ... 3 5 39 Heart Disease 315 ... ... ... ... 11 67 237 127 81 87 133 2 36 ... ... ... 20 1 1 ... 1 9 405 Aneurysm ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Other Circulatory Diseases 64 ... 45 16 ... ... ... ... 18 25 3 20 30 1 1 4 10 86 23 ... ... ... ... Bronchitis 1 ... 6 16 12 4 ... ... ... ... 7 3 ... ... ... ... ... 4 14 ... ... Pneumonia (all forms) 60 13 2 1 1 4 13 26 22 11 2 13 75 ... 7 20 20 ... ... 1 ... 3 10 ... 1 Other Respiratory Diseases ... ... 1 7 1 4 3 3 3 1 ... 1 11 ... ... ... ... ... Peptic Ulcer 15 ... 4 ... ... ... 11 6 5 1 3 10 2 3 36 ... ... ... ... ... ... ... Diarrhoea 16 12 2 1 ... 1 5 5 ... ... ... ... 3 3 4 ... ... 6 6 40 ... ... ... Appendicitis 5 ... ... 2 2 1 2 ... ... ... ... ... 3 5 ... ... ... 16 Cirrhosis of Liver 4 1 ... ... ... ... ... ... ... 2 1 1 ... 3 2 ... 6 ... ... ... ... ... ... ... ... ... Other Diseases of Liver, etc. 1 1 ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... Other Digestive Diseases 16 2 1 7 3 ... ... ... ... 6 6 1 6 9 1 1 ... 2 37 Ac. & Cr. Nephritis ... ... ... ... 21 ... ... 1 3 7 10 9 4 3 1 ... ... 5 13 ... ... ... 2 31 Puerperal Sepsis ... ... 1 ... ... 1 ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Other Puerperal Causes ... ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... ... 64 35 3 2 5 Congenital Debility, Premature Birth, Malformations, etc. 35 ... 21 3 6 ... ... ... 12 14 ... ... ... ... Senility 17 ... ... ... ... 17 8 5 1 3 5 ... 3 15 ... ... ... ... ... ... ... ... Suicide 9 ... ... ... ... 2 3 4 2 4 ... 3 3 ... 1 2 7 31 ... ... ... ... ... ... Other Violence 3 1 2 ... 6 3 14 11 ... 8 4 8 10 2 2 1 13 57 Other Defined Causes 49 1 5 ... ... ... 7 8 13 15 15 20 1 19 3 1 13 ... ... 13 4 ... ... 1 98 ... ... ... ... Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 977 34 80 503 1389 69 4 3 15 269 375 243 66 293 394 20 20 ... 14 29 170 4 Note. All " Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The non-residents, i.e.,of Pareons resident elsewhere in England and Wales who died in the Borough in like manner have been ecocluded. CASES OF INFECTIOUS DISEASE notified during the Year ended 30th December, 1939 NOTIFIABLE DISEASE. Cases Notified in Whole District At Ages — Years Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality Total 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 Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke (H) Charlton and Kidbrooke (H) ... ... ... ... Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... 121 36 63 Diphtheria 11 4 3 1 7 ... 39 21 57 37 20 4 57 118 Dysentery 3 ... 1 1 ... ... 1 ... 3 ... 3 3 ... ... ... ... ... Erysipelas 10 8 40 1 3 ... 2 16 24 17 7 3 13 8 4 3 9 ... Acute Polio-Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 49 8 144 ... 68 19 ... 1 34 15 Scarlet Fever ... 51 15 44 34 46 39 134 4 ... ... 1 ... Enteric Fever 6 ... 7 13 4 ... 44 524 60 9 90 13 138 1216 ... 4 2 4 ... 1 5 ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 3 Puerperal Fever ... ... ... 2 2 3 2 2 ... 2 6 ... ... 7 ... ... ... 5 1 ... ... 6 Puerperal Pyrexia ... 2 5 5 2 5 12 ... Cerebro-Spinal Fever 3 ... 1 ... ... 1 3 1 3 4 ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... 4 22 Measles 4 11 25 ... ... 2 3 17 3 ... 2 5 ... ... Whooping Cough 182 2 1 135 275 216 38 17 63 1 ... 135 12 2 15 46 Diarrhoea ... 34 26 ... 29 16 8 7 8 32 ... ... :... 17 4 3 ... 9 ... ... ... Ophthalmia Neonatorum 5 1 3 5 ... 5 ... ... ... ... ... 28 Tuberculosis, Pulmonary 2 ... 17 4 32 39 1 20 7 35 13 20 43 ... ... 6 4 Non-Pulmonary 1 3 ... 6 2 1 1 1 7 4 1 7 13 ... 7 17 5 16 19 53 Pneumonia, Acute Primary or Acute Influenzal 31 16 32 25 11 49 37 16 29 87 120 365 108 Totals 417 92 181 537 71 24 459 41 282 111 383 120 195 (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 1939. 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. Common Infectious Diseases Small-Pox ... ... ... ... .... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 2 1 4 Diphtheria —Croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tuberculous Diseases Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculosis) 1 ... ... ... 1 ... ... ... ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... Diseases of Trachea ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... 1 1 Pneumonia, all forms ... 3 ... ... 3 1 6 1 2 13 Diarrhoeal Diseases Diarrhoea, all forms ... ... 1 2 3 1 1 4 1 10 Gastro-Enteritis ... ... ... ... ... ... ... ... ... ... Pemphigus Neonatorum ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... „ otherwise 1 ... ... ... 1 1 ... ... ... 2 Injury at Birth 4 ... ... ... 4 ... ... ... ... 4 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 1 ... ... ... 1 ... ... ... ... 1 Premature Birth 6 2 2 ... 10 ... ... ... ... 10 Atrophy, Debility and Marasmus ... 2 3 1 6 3 ... 1 ... 10 Other Causes 3 1 2 ... 6 ... ... ... 3 9 Totals 16 8 8 3 35 7 7 8 8 65 Boys 37 Girls 28