LIBRARY Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1945 LONDON Freame, Manning & Co., Ltd. 12a, Lee High Road, S.E.13 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1945 CONTENTS Pages Public Health, Maternity & Child Welfare Committee 3, 4 Introductory 6, 6 Section A.—General and Vital Statistics 7-10 „ B.—General Provisions of Health Services in the Area 11-16 „ C.—Sanitary Circumstances of the Area 17-20 „ D.—Housing 21, 22 „ E.—Inspection and Supervision of Food 23-25 „ F.—Prevalence of, and Control Over. Infectious Diseases 26-35 3 PUBLIC HEALTH, MATERNITY & CHILD WELFARE COMMITTEE. during the year 1944-1945. The Mayor: Councillor H. H. Gibbons, J.P. and 13 Members. Councillor Mrs. J. Gollogly (Chairman) Councillor L. Hilldrith (Vice-Chairman) Councillors : Mrs. O. Bennett. A. Miles. J. A. P. Brown. Miss M. Sherman. Mrs. F. Carter. Mrs. C. R. Turner, J.P. Mrs. M. M. E. Hayter. G. F. Westmacott. T. A. Keating. Mrs. K. M. Yarlett Mrs. A. Kennedy. Powers and Duties of the Public Health, Maternity and Child Welfare 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. 4 5.—The construction, maintenance and control of public sanitary conveniences, and conveniences maintained by the Council, shall be referred to this 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 Public Health Offices, Town Hall, Greenwich, S.E.10. 28th August, 1946. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Mr. Mayor, Ladies and Gentlemen, I beg to submit the report for 1945; it is compiled on standard lines and contains more detail than the preceding interim records but is not, of course, as comprehensive as those for the pre-war years, the last of which appeared for 1938. Up to his resignation in November, Dr. Charles Porter, during the absence on active service of your Medical Officer of Health, was responsible for the administration of the Department. The cessation of hostilities brought into high relief the cumulative problems of Health and Housing. It is gratifying to note that, despite the immensity of the difficulties, a satisfactory watch has been kept in the Borough and great credit is due to the staff of the Department whose effort is reflected in the record presented. During the year, the Casualty Services, which acquitted themselves well in the framework of the Council's Civil Defence Scheme, were disbanded and arrangements made for the handing over of equipment and premises. Turning to statistics, it is gratifying to record that the Birth Rate continues its upward trend and compares favourably with that for the preceding year. At 18.5 per 1,000 population it stands well against the figure of 13.6 for 1938. This tendency towards an increasing Birth Rate points to the necessity of retaining and even supplementing the Council's already comprehensive Maternity and Child Welfare service. The Death Rate is lower than 1944 and the Infantile Mortality Rate is well below that for the County of London and the country as a whole. Notification of Infectious Disease was again pleasingly low, and it will also be seen that reference is made to an improvement in the Diphtheria Immunisation figures for the second half of the year. From Midsummer onwards, Maternity and Child Welfare Clinics functioned on a pre-war basis and further sessions were added, where possible, to meet the increasing demand. 6 The supervision of local food supplies was carried out with the same efficiency as preceding years. There is no need to stress the importance of highly qualified attention in this respect, in the present circumstances especially. Large scale wastage is prevented and danger to health due to contaminated supplies filtering through is obviated. War damage and natural deterioration during the war years to dwellings has rendered the task of sanitary supervision of the area increasingly difficult. It is pleasing to record that, through the efforts of the Council's Inspectors, reasonable maintenance has been achieved. With attention being focussed on post war planning, it is hoped that, in the near future, it will be possible to make inroads on the problems of temporary repairs, the worn out house, and the increasingly difficult factor of overcrowding, which have psychological as well as physically dangerous angles. Before closing, I should like to say how pleasing it is on my return from service with H.M. Forces to find in my colleagues of the Department, and the Council's Services generally, instead of war weariness which might be excusable in the circumstances, a pleasing enthusiastic outlook towards the major problems which face us in the immediate future. Finally, I wish to thank, on behalf of the Department, the Chairman and members of the Public Health, Maternity and Child Welfare Committee for their interest and help during the year. I have the honour to be, Your obedient Servant, F. R. Waldron. 7 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, 1945 63,800 Density of Population— Average for the Borough 16 persons per acre Number of Inhabited Houses—1945 (according to Rate Books) 18,610 Structurally separate dwellings at Census, 1931 18,114 Number of Uninhabited Houses— At Census, 1931 250 At end 1945 590 Number of Families or Separate Occupiers— At Census, 1931 25,144 Rateable Value £867,001 Sum Represented by a 1d. Rate £3,307 POPULATION. The Registrar General has estimated the population for Greenwich at mid-year 1945 as 63,800 and it is upon these figures the Statistics in this Report have been based. 8 In common with other Boroughs in South London, Greenwich suffered acutely as a result of enemy action during the recent World War, the cumulative effect of which is shown when comparing the present figure with the population of 95,770 in 1938. Obviously the population will tend to increase during the next few years when the full effect of demobilisation of men and women from the Services is felt, as it did in the immediate years following the Great War of 1914-1918, but to what extent is partly dependant upon the progress made in housing. *EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total M. F. Live Births Legitimate 1,093 559 534 Birth Rate 18.59 Illegitimate 89 37 52 Still Births Legitimate 21 9 12 Rate per 1,000 total Births 19.9 Illegitimate 3 1 2 Deaths 813 455 358 Death Rate (Crude) 12.78 Deaths from Puerperal Causes:— Rate per 1.000 total Births Puerperal Sepsis 1 0.82 Other Puerperal Causes 1 0.82 Total 2 1.65 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 43 Legitimate Infants per 1,000 legitimate live births 40 Illegitimate Infants per 1,000 illegitimate live births 78 Deaths from Cancer (all ages) 117 „ „ Measles (all ages) - „ „ Whooping Cough (all ages) 1 ,, ,, Diarrhœa (under 2 years of age) 10 * These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 9 MARRIAGES. Mr. F. H. Searle, 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 Kidbrooke St. Nicholas 1931 291 138 34 62 247 772 100,640 1932 312 152 30 60 205 759 101,024 1933 286 136 48 84 247 801 97,830 1934 31 143 39 79 259 851 97,250 1935 340 158 42 102 250 892 96,600 1936 335 208 66 102 252 963 95,900 1937 320 198 39 80 240 882 95,990 1938 309 185 31 101 268 894 95,770 1939 395 218 31 128 397 1,169 94,90 1940 451 243 33 126 345 1,198 74,280 1941 277 174 7 91 241 790 57,070 1942 257 192 3 79 198 729 60,530 1943 209 166 2 73 171 621 62,870 1944 211 136 — 74 171 592 61,800 1945 228 211 2 87 233 761 63,800 BIRTHS. The total number of births registered in the Borough during the year was 1,208. Of this number 775 occurred in St. Alfege's Hospital, and 30 at various Nursing Homes in the Borough. Of this total of 805 Institution births, 263 only belong to Greenwich, the remainder being transferred to the appropriate Authorities. Five hundred and sixteen births belonging to the Borough took place in Institutions outside the Borough area, thus the actual figure for Greenwich becomes 1,182 ; Males 596, Females 586. This gives a birth rate figure of 18.59 per thousand of the population and is a fraction lower than last year's birth rate of 18.98. The average for the previous 10 years is 15.80. The birth rate for the County of London equals 15.7 per thousand of the population. The birth rate for all England and Wales was 16.1. 10 Illegitimate births numbered 89 representing 7.5 per cent of the total live births. DEATHS. The number of deaths registered during the year 1945 was 813, of which 454 were Males and 359 Females, as compared with 978 last year. This largo decrease is mainly attributable to deaths arising from war operations, the number returned being 26 from this cause as against 143 for the year 1944. The crude death rate for the Borough is 12.78 per thousand as compared with 15.90 for the previous year. The average death rate for the last 10 years is 13.39. The death rates for the County of London and for England and Wales are 13.8 and 11.4 respectively. The inset table showing causes of death for all ages has been supplied by the Registrar General and is included in accordance with the request contained in the Ministry of Health Circular No. 1650. 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 43 per thousand births, and is considerably lower than the rate for last year, viz., 52. The total number of deaths during the year was 52 as compared with 62, 24, 36, 51 and 62, the respective figures for the years 1940, 1941, 1942, 1943 and 1944. A table showing the causes of death and ages is included in the Appendix of the Report. For the whole of London the rate was 53 compared with 61 in 1944, 58 for 1943, 60 in 1942 and 68 in 1941. For England and Wales the rate was 46 compared with 46 for 1944, 49 in 1943, 49 in 1942 and 59 in 1941. No. in Short List. Causes of Death Sex Deaths at subjoined Ages of " Residents," whether occurring within or without the District. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 45. 45 and under 65. 65 and over. All Causes M 455 31 3 8 45 144 224 F 358 20 4 3 38 77 216 1. Typhoid and Paratyphoid Fever M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 2. Cerebro-spinal Fever M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 4. Whooping Cough M 1 1 ... ... ... ... ... F ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... F 1 ... 1 ... ... ... ... 6. Tuberculosis of Respiratory System M 34 ... ... ... 15 14 4 F 17 ... ... ... 12 4 1 7. Other forms of Tuberculosis M 1 ... ... 1 ... ... ... F 3 ... 1 1 1 ... ... 8. Syphilitic Disease M 9 ... ... ... ... 3 6 F 3 ... ... ... 1 1 1 9. Influenza M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 10. Measles M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 11. Ac : Poliomyelitis and Polioencephalitis M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 12. Ac : Infectious Encephalitis M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 13. Cancer of Buce. Cav. and Oesoph. Uterus M 4 ... ... ... ... 1 3 F 7 ... ... ... 1 3 3 14. Cancer of Stomach and Duodenum M 18 ... ... ... ... 8 10 F 2 ... ... ... ... ... 2 15. Cancer of Breast F 15 ... ... ... 1 7 7 16. Cancer of all other sites M 52 ... ... ... 3 23 26 F 19 ... ... 1 2 5 11 17. Diabetes M 2 ... ... ... ... 1 1 F 2 ... ... ... ... 1 1 18. Intra-cranial Vascular Lesions M 27 ... ... ... ... 7 20 F 33 ... ... ... ... 7 26 19 Heart Disease M 118 ... ... ... 4 33 81 F 107 ... ... ... 1 14 92 20. Other diseases of Circulatory System M 10 ... ... ... 1 ... 9 F 12 ... ... ... 2 5 5 21. Bronchitis M 30 ... ... ... 1 14 15 F 23 1 ... ... 1 3 18 22. Pneumonia M 21 3 1 ... 1 6 10 F 11 2 ... ... 1 2 6 23. Other Respiratory Diseases M 9 1 ... ... ... 8 ... F 6 ... ... ... ... 2 4 24. Ulcer of Stomach or Duodenum M 12 ... ... ... 2 3 7 F 1 ... ... ... ... ... 1 25. Diarrhoea (under 2 years) M 6 6 ... ... ... ... ... F 4 4 ... ... ... ... ... 26. Appendicitis M 1 ... ... ... ... ... 1 F 2 ... ... ... 1 ... 1 27. Other Digestive Diseases M 2 ... ... ... ... ... 2 F 10 1 ... ... ... 3 6 28. Nephritis M 8 ... ... ... 2 1 5 F 5 ... ... ... ... 2 3 29. Puerperal and Post-abortive Sepsis F 1 ... ... ... 1 ... ... 30. Other Maternal Causes F 1 ... ... ... 1 ... ... 31. Premature Birth M 7 7 ... ... ... ... ... F 1 1 ... ... ... ... ... 32. Congenital Malformations, Birth Injury, etc. M 16 11 2 ... 1 1 1 F 9 5 ... ... 1 2 1 33. Suicide M 3 ... ... ... ... 2 1 F 1 ... ... ... ... 1 ... 34. Road Traffic Accidents M 7 ... ... 1 4 1 1 F 1 ... ... ... ... ... 1 35. Other Violent Causes M 23 2 ... 4 6 7 4 F 30 4 1 1 7 6 11 36. All Other Causes M 34 ... ... 2 4 11 17 F 31 2 1 ... 4 9 15 11 SECTION B General Provisions of Health Services. Staff.—Dr. Charles Porter, the Acting Medical Officer of Health since January 1943, during the absence on Active Service of Dr. Waldron, relinquished his appointment in October 1945. Pending the appointment of Dr. Howard in November, the duties were fulfilled by Dr. M. Macdonald, Acting Tuberculosis Officer. Mr. W. R. Drake, District Sanitary Inspector since 1920, retired on health grounds in January 1946, and Miss Jenkins, Health Visitor since 1925, retired on reaching the age limit in November. Both these officers gave faithful and loyal service. Home Nursing.—Cases attending the various centres who are found to be in such a condition as to require special nursing at home, are referred either to the " Ranyard Mission " or the "Queen's District Nursing Association." Bacteriological Examinations.—The undermentioned specimens were submitted to the Seamen's Hospital Laboratory for bacteriological investigation, the results being:— Positive Negative Total Diphtheria 15 383 398 Tuberculosis 100 393 493 Typhoid — 2 2 Miscellaneous 7 10 17 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.. 1945. Table .4. Visits Re-visits Total Infants under 1 year 1,145 2,333 3,478 Children 1-—5 years 130 4,129 4,259 Measles (under 5 years) 184 64 248 „ (over 5 years) 91 9 100 Whooping Cough (under 5 years) 85 24 109 „ „ (over 5 years) 51 7 58 Pneumonia 7 7 14 Puerperal Pyrexia and Fever 4 9 13 Diarrhœa 19 16 35 Ophthalmia Neonatorum 2 4 6 Inflammation of Eyes 1 — 1 Pemphigus — — — 1,719 6,602 8,321 12 Table B. Visits Re-Visits Totals Dental Treatment 84 - 84 Ante-Natal Cases 798 252 1,050 Children Act 32 8 40 Miscellaneous 1,154 249 1,403 Infant Consultations 575 575 Ante-Natal Clinics 319 319 In addition to the above 528 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. Notification of Births.—The following Table gives the number and types of notifications received respecting births in the Borough:— Where Confined Midwives Doctors Greenwich Births Other Boroughs' Births Greenwich Births Other Boroughs' Births St. Alfege's Hospital 275 552 — — Nursing Homes — — 6 25 Other Hospitals 2 2 — — At home 410 — — — 687 554 6 25 Other Boroughs (Transfers Inwards) 325 — — — 1,012 — 6 — From a perusal of the above Table it will be seen that 1272 births actually took place in the Borough. Of this number 579 were transferred to Other Authorities. Against this, 325 births which occured in other areas were allocated to Greenwich, thus giving a nett figure of 1018. Infant Welfare Centres.—After cessation of hostilities, many mothers, together with their families, returned from evacuation areas and consequently all centres were fully engaged, the attendances generally being up to pre-war averages. Charlton Lane Centre which was utilised as a First Aid Post during the war period, reverted to its original use in July. Figures relating to each Centre are given in the following Tables:— 13 (a) Babies. Centre No. of Clinics No. of Attendances New Cases Medical Consultations Chevening Road 201 5,677 440 1,726 Shooter's Hill Road 91 3,721 273 1,091 Creek Road 92 1,744 157 450 Charlton House and Charlton Lane 28 851 89 311 Rochester Way 50 1,060 78 364 Bardsley Lane 51 1,260 99 442 Totals 513 14,313 1,136 4,384 All babies are weighed and advice given to the mothers at every attendance. (b) Children 1-5 years. Centre No. of Clinics No. of Attendances New Cases Medical Consultations Chevening Road , 201 3,539 237 1,583 Shooter's Hill Road 91 1,991 51 898 Creek Road 92 987 51 409 Charlton House and Charlton Lane 28 606 19 253 Rochester Way 50 791 25 359 Bardsley Lane... 51 493 34 220 Totals 513 8,407 417 3,722 Ante-Natal and Post-Natal Clinics.—The number of new cases attending the various Centres was 1148 as compared with 1044 for the previous year. The numbers attending each Clinic were:— Centre No. of Clinics New Cases Total Attendances Chevening Road 150 596 2,760 Shooter's Hill Road 72 258 907 Creek Road 51 206 935 Charlton House and Charlton Lane 28 88 414 Totals 301 *1,148 5,016 *Includes 134 Post-Natal cases. 14 Other Ante-Natal Services.—In addition to the facilities provided at the Greenwich Borough Council Centres, 275 women received treatment at St. Alfege's Hospital, making approximately 1,650 attendances; whilst the British Home for Mothers and Babies, Woolwich was responsible for Ante-Natal supervision for 149 patients, who made 745 attendances. Artificial Sun-Light Treatment.—Ultra-Violet Ray treatment was available throughout the year at Chevening Road, Shooters Hill Road and Creek Road Centres, and with the closing down of the First Aid Post at Charlton Lane in July, facilities were once again available at this Centre. During the year 769 cases were given 12,472 treatments. In addition, 363 children from the War-Time Nurseries were given 4,005 treatments. Dental Clinic.—The dental surgeon, Mr. G. F. Ferris, L.D.S., R.C.S.(Eng.); attends 105, Shooters Hill Road once a fortnight to deal with cases referred to him from the Welfare Centres and Clinics. The following return shows the work performed during the year:— M. & C.W. T.B. Total No. of sessions 48 3 51 No. of new cases 206 3 209 No. of attendances 555 9 564 No. of extractions 1,048 44 1,092 No. of gas cases 146 2 148 No. of dentures supplied 43 1 44 Foot Clinics.—Chariton Lane Centre, which was closed in 1939 upon being taken over for Civil Defence Services, was again available in November. Following the visitation of the Fly Bomb attacks, Charlton House and Creek Road Centres were both affected by damage due to attacks by rocket projectiles, and a certain amount of dislocation of the services was entailed, necessitating for the time, a certain amount of over-crowding at other Centres. At the end of the year there were six Centres operating. The staff consists of two whole time Chiropodists and three who are engaged on a sessional basis. Patients are given an appointment and a charge of 1/- per treatment is made. During the year 11,194 attendances were recorded, the fees received being £637 2s. 0d. Maze Hill Clinic.—Work at the Council's Tuberculosis Dispensary was seriously interfered with owing to severe damage to the whole building, caused by a Fly Bomb attack in January. Temporary arrangements were made to carry on the work in the medical consultation room at the Town Hall. In June the building 15 was sufficiently repaired to enable sessions to be re-opened and normal consultations carried on. Child Life Peotection.—The supervision oi foster children and the homes of foster mothers is carried on by the Health Visitors who made 40 visits during the year. The number of foster mothers on the register at the end of the year was 9, and the number of children 10. Care of Premature Infants.—In order to assist the Ministry of Health in its efforts to reduce the Neo-Natal Mortality rate, immediate information is now available of all births occurring in the Borough where the weight at birth is 5½ lbs or less. This enables the Health Visitor to ascertain whether there is need of the services of the Home Help or if there is sufficient and suitable equipment in the home, and any other special arrangements that may be considered necessary. During the year there were 34 premature births notified, of which 10 were born at home and 24 in hospital. Of this number 9 and 18 respectively were alive at the end of one month. No calls were made for assistance in the way of extra equipment and in no instance was the services of a Home Help required. Care of Illegitimate Children.—The Council, under powers conferred by Section 251 (1) of the Public Health (London) Act 1936, assists financially Moral Welfare Associations in connection with their work for the care of illegitimate children and also guarantees payment to foster mothers who undertake the care of such children up to 5 years of age, not on the rolls of the school. Home Helps.—Increased demand was made upon the Council's Home Help Scheme during the year. Eighty applications were dealt with by the Assistance Committee, and in 73 instances the services of a Home Help were provided. In the remaining cases the applications were withdrawn. Supply of Sheets for Expectant Mothers.—The Board of Trade priority dockets are issued by the department to expectant mothers who are being confined in their own homes, enabling them to purchase utility sheets. Applicants must produce a certificate signed by the Midwife who has been booked for the case, that the applicant is genuinely in need of additional sheets. 931 dockets were issued during the year. Domestic Helps.—It has been apparent for some time past that there was a definite case for a Domestic Help Scheme, which could be organised on the lines of the Home Help Scheme. Such a scheme would be of great benefit during epidemics of influenza, 16 and in cases of illness in the family. During war time conditions many families found themselves in great difficulties in finding any sort of help, and unfortunately the department was unable to be of much assistance. The Ministry of Health have now empowered Local Authorities to engage the necessary Domestic Helps. The following are examples of the type of case which will be considered as coming within the provisions of the scheme:— (a) Where the house-wife falls sick or must have an operation. (b) Where the wife is suddenly called away to see hei'husband in hospital and arrangements have to be made to look after the children. (c) Elderly people who are infirm, or, one of whom suddenly falls ill. (d) Where several members of the family are ill at the same time, e.g. during influenza epidemic. It is suggested that the workers employed should be on a whole time or part time basis. As in the case of the Home Help Scheme, the whole or part of the cost, according to family circumstances, will be borne by the applicant. It must be confessed that the chief difficulty in operating the scheme is a lack of suitable applicants who are willing to undertake work of this nature. War-time Nurseries.—The three war-time nurseries continued to function throughout the year. It was inevitable that sometimes the average attendances fell below normal, solely due to the prevalence of infectious diseases and other forms of illness, and the question of closing the nursery at Pound Park, Charlton— which was only opened in May, 1944—was at one time contemplated by the Ministry of Health. It was felt that such a decision would cause great inconvenience and hardship to women engaged on war work, and strong representations were made to the Ministry to alter this decision, with the result that the former objections were waived and the Nursery was allowed to continue its useful work. Diabetes—Insulin Treatment.—During the year 10 cases were provided with Insulin under the special arrangements for assisting necessitious patients suffering from Diabetes at a cost bf £38 14s. 6d. 17 SECTION C Sanitary Circumstances of the Area. Great difficulties have been experienced in enforcing compliance of Sanitary Notices, due to the priority of war damage repairs and the consequent minimum of available labour and materials, but nevertheless the aim has been to maintain a reasonable standard of repair. and thus prevent further deterioration of dwellings. The following brief summaries serve to show the work carried out by the Sanitary Inspectors during the year. Summary of Work Performed. Houses inspected (War Damage) 6,071 ,, ,, (Complaints, Nuisances) 2,444 ,, ,, (Infectious Diseases) 649 ,, ,, (Overcrowding) 125 No. of re-inspections 11,433 Factories and other premises inspected 149 Shop Premises (Shops Act, 1934) 39 Investigations (Rats and Mice) 943 No. of Intimation Notices served 1,581 No. of Statutory Notices served 207 Factories Act 1937.—During the war period many of the factories in the Borough engaged on work of national importance found it necessary to build considerable extensions to accommodate the additional workers employed. Progress of the work was often interfered with by bomb damage, which necessitated numerous visits by the Inspectors in connection with the Sanitary work involved. Special attention was also given to ensure that all factories were provided with a proper supply of drinking water. The woman Sanitary Inspector made the usual routine visits to outworkers premises and certain factories where women are employed. Disinfestation of Verminous Premises.—The disinfestation of verminous premises has often been carried out under difficult and adverse conditions. Unquestionably the number of families living under overcrowded conditions is not conducive to ridding such premises of vermin. On numerous occasions, the Disinfestation Officer has 18 found, when called in to disinfest premises, that he is hampered in his efforts by reason of the overcrowded condition of the room. This is typical in the case of many bombed out families who have salvaged, and brought with them, more furniture than they have accommodation for. During the year, 307 premises came under the notice of the Department, and 665 rooms were treated and re-treated when occasion warranted. In all, 315 gallons of vermicine were used. Rat Repression.—Rat infestation in Greenwich can be classified as mainly "minor infestations." During the year, repairs have beeen carried out to houses in badly bombed areas, and the consequent return of families to these areas has led to an increase in the number of complaints received. Harbourages have also been cleared, forcing the rats to seek other refuge. The increase in the numbers of persons keeping chickens and rabbits provide an additional reason for the increased number of complaints received. Defective drains often prove another source of infestation. One full time rat catcher is employed and concentrates on rat destruction, using the methods recommended by the Ministry of Food, "Infestation Branch," prebaiting and poisoning. A part-time rat catcher is engaged at 3/- per hour, using dogs and ferrets where infestation occurs in chicken runs or beneath sheds. Baiting of Sewers.—Intensive baiting of sewers has taken place since 1943, thus linking up with the arrangements made in the neighbouring boroughs. In addition, the Council has again participated in the campaign sponsored by the Ministry of Food last year, and systematic disinfestation was carried out during the Months of May and December. From information supplied by the Borough Engineer, it can be stated that approximately 1,550 manholes were baited, either wdth:— (a) Sausage rusk and zinc phosphide, or, (b) Bread and barium carbonate. It is pleasing to be able to record that the technical staff of the Ministry of Food, expressed their entire satisfaction of the methods adopted in Greenwich to rid the sewers of rats. Scavenging and Refuse Disposal.—The collection of refuse 19 in the Borough is under the control of the "Borough Engineer, who has kindly supplied me with the following report as to collection of house refuse and salvage during the year under review. "During the war period it was necessary to concentrate on the collection of salvage and consequently a fortnightly collection of both house refuse and salvage was inaugurated; this has been maintained throughout and is at present in operation. Several of the Council's vehicles engaged on these services were destroyed and damaged by enemy action and additional vehicles will be required before a weekly collection of house refuse can be resumed. This will require some consideration in view of the number of new properties being, and to be, erected in the Borough. The war period also necessitated the closing down of the Refuse Disposal Plant from the point of view of the disposal of house refuse, and the plant was used as a depot for the reception and sorting of salvage, the house refuse being barged away down the River under the ' controlled tipping system.' During 1945 a total tonnage of approximately 12,000 tons of house refuse was collected and disposed of by this method. The amount of pig food and saleable salvage, collected during the same period was approximately 2,250 tons, (comprising paper, metals, rags, bones etc.) all of which was disposed of and from which a considerable income was derived." Rent and Mortgage Interest (Restrictions) Acts.—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, 5 Applications were received and 4 Certificates duly granted. Landlords may also apply to the Sanitary Authority for a report that the necessary works had been completed to the satisfaction of the Council. Three Applications were received and reports duly granted. Water Supply.—The whole of the Borough is supplied with water by the Metropolitan Water Board, and all dwelling houses are connected direct with the Boards mains. There was no evidence of any form of contamination during the year. Aged, Infirm and Physically Incapacitated Persons.— There were only a few cases which came to the notice of the 20 Department where it was reported old and infirm persons were living under insanitary conditions, owing to neglect. Such cases were investigated by the Woman Sanitary Inspector, and in no instance was it necesasry to obtain a Court Order for removal to a Public Institution. Pharmacy and Poisons Act 1933.—Under the above Act, the Medical Officer of Health and the Sanitary Inspectors are appointed to carry out the provisions so far as they relate to Part 11 of the Poisons List. During the year 6 applications to sell poisons under Part 11 were received and granted and 41 applied for retention in the Council's list. Thus at the end of the year there were 47 persons on the Register. 21 SECTION D Housing. Repair of War Damaged Dwellings.—With the cessation of hostilities, the work of repairing the thousands of damaged dwellings in the Borough has been one of major importance, calling for the closest co-operation of the many authorities and organisations engaged. Large numbers of men were drafted into the Borough to supplement the workers already employed, in the attempt to expedite repairs in those houses which had previously only been brought up to the emergency standard. At the end of the year, the Borough Engineer reported there were still some 13,000 dwellings remaining below 'Serial 25 Standard.' Housing of Homeless Persons.—One thousand, one hundred and fifty two, houses or parts of houses have been requisitioned by the Council in order to provide accommodation for persons rendered homeless as a result of enemy action. Emergency Dwellings.—During the year, 326 Emergency Factory-made dwellings have been erected on requisitioned sites. In addition, the Council propose to take over and convert an Emergency Hutment, formerly used by the Air Ministry at Tunnel Avenue, and 17 hutments acquired from the Admiralty at the Supply Reserve Depot, Deptford. Under powers conferred by the Housing (Temporary Accommodation) Act 1944, the London County Council propose to erect temporary dwellings on approximately 2.5 acres of Blackheath, fronting St. German's Place. From time to time, complaints have been received from the occupants of Emergency Hutments with regard to the damp condition existing through condensation. The attention of the Ministry of Works has been drawn to this matter with a view to mitigating this nuisance, but up to the present the difficulty has not been solved. Post War Housing Plan.—Plans were in operation in 1938 to develop the area known as the Cherry Orchard Housing Site, but progress was unavoidably suspended during the war period. Consent has now been given by the Ministry of Health to proceed with the erection of permanent houses as forming part of 22 the first year programme. By the end of the year the following schemes were adopted by the Council. Site. No. Remarks. Cherry Orchard Replacement of houses destroyed on Council's Housing Estates Cold Bath Street Cherry Orchard (Marlborough Lane) Victoria Way Champion Terrace, Charlton Road, S.E.7 112 Flats. 48 Houses. 77 Houses. 126 Flats. 28 Houses. 74 Flats. 24 Flats. Work in hand. Tenders accepted. Awaiting approval. Awaiting approval. Awaiting approval. Awaiting approval. Awaiting approval. L.C.C. Housing Scheme.—The London County Council are proceeding with the development of the Brook Estate at Kidbrooke, and work is in progress with regard to the erection of 554 houses and flats. Overcrowding.—A degree of overcrowding inevitably exists, due principally to conditions arising from the war. Despite a certain alleviation from the Council's Housing Scheme, many families who had been rendered homeless, and are either living with relatives or friends, are patiently waiting for new housing accommodation. Other contributory causes can be attributed to:— (a) Return of men and women from the Services, many of whom married during the war. (b) Return of families from evacuation areas, who now perforce, find themselves faced with living in one or two rooms. All the above cases will present a serious problem for some time to come. Official action under the Housing Act has been taken in 20 cases and particulars forwarded to the London County Council for re-housing. 23 SECTION E Inspection and Supervision of Food. Food Premises.—In the Spring of 1945, transition from war to peace heralded the end of certain war-time measures, and it was realised that some time would elapse before peace time standards could be attained. The need for finding weather-proof premises for caterers and other vendors of food, whose buildings were destroyed by high explosive missiles, became less accute. Repair work to the less heavily damaged structures continued. In addition to the war damage repairs, improvements were effected in many instances on premises where food was prepared or stored; such improvements included increased ventilation and lighting, cleansing and lime washing, etc. The checking of war damaged stock on behalf of claimants reimbursed by the Board of Trade and Ministry of Food, gradually lessened, and then finally ceased. Quantities of sound food carefully salvaged from damaged shops and stores also diminished as no more incidents occurred. Upon the termination of the hostilities in Europe, an opportunity was provided for resuming the efforts to maintain the highest standard of hygiene in all establishments where food is handled. During the year the Food Inspectors have made 4,326 visits to various premises, 107 of which repairs and improvements have been carried out. Food Rejected.—The amount of food rejected is shown in the following summary At Meat Depot— Leaky, blown or perforated tins of corned beef and mutton 2,254 lbs. Mutton, beef, etc. 3,601½ „ - 5,855½ lbs. At Shops— General provisions 10,138½ lbs. Flour and barley flakes 1,222 ,, Fish 700 „ Canned apples 308 „ - 12,368½ lbs. 24 At Wharves— Fruit pulp 4,145 lbs. General canned goods and provisions 3,898 „ Pork 1,061 „ Concentrated fruit juice 954 ,. Rice 490 „ Biscuits 240 „ Beef and mutton 235 „ At Shops and Stores (War damaged)— 11,023 1bs. General provisions and canned goods 16,570½ lbs. Milk.—It can be safely asserted that pasteurisation and other authorised forms of heat-treatment, eliminate the presence of harmful Bacteria, which was once tolerated in milk. Indeed, we have become so accustomed to a wholesale supply of this vital food that the effort involved in its production is seldom brought to mind. At the commencement of the year there were 71 purveyors of milk on the register. No new applications were received during the year, but one was struck off, thus leaving a total of 70 purveyors on the register. One hundred and seventy four visits and inspections were made by the Food Inspectors to ensure that the requirements of the Milk and Dairies Order were duly observed. Heat Treated Milk (Prescribed Tests) Order, 1944.—The above Order prescribes the technique to be adopted in applying the Methylene Blue Test and the Phosphatase Test to milk treated by heat. Briefly the Methylene Blue Test was instituted to estimate the souring properties of milk after treatment, and the Phosphatase Test is the method of ascertaining whether the milk has been correctly pasteurised. During the year, 56 samples were taken under this Order, and of these 18 failed the Methylene Blue Test and 2 the Phosphatase Test. Particulars of the unsatisfactory samples were forwarded to the Area Milk Officer of the Ministry of Food. Milk (Special Designations) Orders, 1936-43.—The issue of licences for the sale of milks known as Tuberculin tested, accredited and pasteurised, is required by the above mentioned orders, and for the year 1945 the following licences were issued:— Pasteurised Tuberculin Tested Total 22 7 29 *Supplementary Licences 9 8 17* * Supplementary Licences are granted in cases where licensed premises are situate outside the district and the Vendor desires to sell within the Borough. 25 Bacteriological Examination of Milk —With the aim of maintaining a high standard of purity, 23 samples of pasteurised milk were submitted for bacteriological examination, of which 3 proved to be unsatisfactory. Bacteriological Examination of Ice Cream.—Twelve samples of ice cream were taken and submitted for tests, of which number 9 were unsatisfactory. In each case the Vendor was cautioned and advice given in regard to sterile production. Preserved Food Premises.—In accordance with the provisions of the Food and Drugs Act 1938, all premises with the exception of clubs, hotels or restaurants used (a) for the sale or the manufacture for the purpose of sale 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. Ice-Cream Premises.—At the end of the year 98 premises were duly registered. These premises were inspected on 201 occasions and insanitary conditions remedied in 4 instances Preserved Meat, etc., Premises.—At the end of the year 97 premises were on the register and were visited on 355 occasions' As a result of such inspections, insanitary conditions were detected and remedied in 22 cases. There was no instance found which necessitated the cancellation of premises already registered. Food and Drugs Act, 1938.—During the year, 463 samples were submitted to the Public Analyst for analysis, of these 126 were formal and 337 informal. The number of samples reported as adulterated or not otherwise up to standard was 26, equivalent to 5.6% of the total samples examined. The chief article sampled was milk, 6 out of 95 were adulterated or below the standard fixed by the Ministry of Agriculture and Fisheries. Police Court proceedings were instituted in 4 instances. Two were in respect of milk samples. In one case the Vendor was fined; in the other, the case was dismissed as the Vendor had previously taken out a summons against the wholesaler who was found guilty and fined. In the remaining cases, 1 was dismissed (curry powder) and the other in regard to an adulterated sample of whisky, the defendant pleaded guilty and the case was dismissed under the probation of Offenders Act, costs being imposed. 26 SECTION F Prevalence of, and Control Over, Infectious and Other Diseases. The total number of infectious diseases notified excluding Tuberculosis, was 1,102 as compared with 1,268 for the previous year. Particulars relating to age groups and districts are shown 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 two contracts 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 Appendix to the Report. Measles.—Measles was responsible for 341 notifications during the year as compared with 330 for the previous year and 974 for the year 1943. Of this total no less than 237 were received during the second quarter of the year. One hundred and sixty two cases occurred in East Greenwich, 34 in West Greenwich, 21 in St. Nicholas Deptford and 124 in Charlton and Kidbrooke. Altogether 19 cases were removed to hospital for treatment. There were no fatal cases. Whooping Cough.—One hundred and thirty-three cases were notified as compared with 154 for the previous year. 91 occurred in East Greenwich, 6 in West Greenwich, 2 in St. Nicholas Deptford and 34 in Charlton and Kidbrooke. 14 cases were removed to hospital for treatment. There were no fatal cases. As in the case of measles, every case was visited by the Health Visitor 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 54, as compared with 59, 91, 72 and 50 for the years 1944, 1943, 1942 and 1941. All the cases were removed to hospital. Nineteen cases were reported by the hospital authorities as* not suffering from this disease. 27 The corrected attack rate is equivalent to .56 per 1,000 population, but taking the estimated child population of the Borough (0/15 years) as 14,000, the attack rate per 1,000 child population is 3.0. There was one fatality which gives a case mortality of 1.8%. There hundred and ninety eight swabs wore forwarded by medical practitioners for bacteriological examination from cases suspected to be Diphtheria. Of this number 383 were reported to give negative or doubtful results and 15 were positive in character, being dealt with accordingly. Diphtheria Immunisation.—Facilities for diphtheria immunisation are available in the Borough either by arrangement with the Seamen's Hospital, or through local Medical Practitioners. In addition, inoculations are carried out at the London County Council Schools by the School Medical Officer. Toxoid Antitoxin Floccules is the antigen given at the Seamen's Hospital and three inoculations are considered necessary, whilst under the London County Council and local Medical Practitioners' schemes, two only of Alum Precipitated Toxoid are required. During the year, 544 children were immunised at Seamen's Hospital; 53 by local Medical Practitioners; 232 by School Medical Officers; and 5 were reported by other local authorities— thus making a total of 834 cases completed, as compared with 669 for the previous year. 640 cases were under 5 years of age, and 194 cases were between the ages of 5 and 15.227 cases were given Post-Schick tests. Despite the extensive propaganda campaign, both nationally and locally, it must be confessed that the number of children immunised during the year, fell far short of the target figure. No doubt a contributing factor was a further exodus of young children to "Safe" areas, in the latter part of the previous year during the rocket projectile attacks, and also to the consequent disorganisation of the L.C.C. Schools scheme. Scabies.—This disease became compulsorily notifiable on the 1st August, 1943 and was responsible for 312 cases. There were 405 for the previous year. 134 occurred in East Greenwich, 60 in West Greenwich, 36 in St. Nicholas, Deptford, and 82 in Charlton and Kidbrooke. Residents who are suffering from this disease may obtain treatment at the Council's Cleansing Station. Adults, and children under school age, are accommodated at St. Alfege's Hospital Centre, and school children at the Tunnel Avenue Centre. Puerperal Fever.—Four cases were reported during the year as compared with 9 for the previous year. 28 Puerperal Pyrexia.—There were 4 cases attributed to this disease as compared with 4 for 1944. One patient died subsequently, the cause being returned as General Peritonitis. Acute Primary Pneumonia and Acute Influenzal-Pneumonia.—This cause was responsible for 64 cases as compared with 120 for the previous year. Thirty-three occurred in East Greenwich, 4 in West Greenwich, 2 in St. Nicholas, Deptford, and 25 in Charlton and Kidbrooke. There were 4 deaths arising from this disease. Typhoid Fever.—No cases were notified during the year. Two specimens were forwarded by Medical Practitioners for Bacteriological Examination, from cases suspected to be Typhoid Fever. Both specimens gave negative results. Scarlet Fever.—Eighty-three cases were notified during the year as compared with 129 for the previous year. Forty-seven occurred in East Greenwich, 15 in West Greenwich, 5 in St. Nicholas, Deptford, and 16 in Charlton and Kidbrooke. Sixty-seven cases were removed to Hospital, and of these 8 on discharge were still suffering from other conditions. There were no deaths from Scarlet Fever during the year. Erysipelas.—There were 24 cases of this disease notified as compared with 15 of the previous year. Zymotic Enteritis or Epidemic Diarrhoea.—Thirty-seven cases were notified during the year. Of this number, 23 were under 1 year of age, and 14 between the ages of 1 and 5 years. All the cases were removed to Hospital. There were 13 deaths ascribed to this disease. Dysentery.—Twenty-eight cases of Dysentery were notified; of which number 27 were removed to Hospital. Of this number, 15 cases were notified during the third quarter of the year from the Miller General Hospital. Investigations at the Hospital revealed that they were transferred by a "Carrier." All these cases were transferred to Infectious Disease Hospitals. Ophthalmia Neonatorum.—Four cases were notified during the year, 3 being in Charlton, and 1 in St. Nicholas. Two were removed to Hospital for treatment. Three of the cases were, followed up by the Health Visitors and kept under observation, and treatment ultimately proved satisfactory. In the remaining case, the mother had used her parents address, and no information was available after discharge from Hospital as to her present address. Cerebro-Spinal Fever.—Four cases were notified during the 29 year, as compared with seven cases in the previous year. All were removed to Hospital for treatment. Tuberculosis.—In the year under review, there were 114 cases notified in the Borough, as compared with 129 for the previous year. Of this number 101 were of the pulmonary type, ordinarily known as consumption, and 13 were non-pulmonary cases, i.e., Tuberculosis of other parts of the body than the lungs. Of this number, 28 pulmonary and 4 non-pulmonary occurred in East Greenwich, 28 pulmonary and 4 non-pulmonary in West Greenwich, 4 pulmonary and 1 non-pulmonary in St. Nicholas, 41 pulmonary and 4 non-pulmonary in Charlton and Kidbrooke. Four hundred and ninety-three specimens were forwarded by medical practitioners for bacteriological investigation and of these 393 were reported to be negative and 100 positive for tuberculosis. Disinfection has been offered and carried out in 49 cases, including 149 rooms and 373 articles of bedding, etc. Disinfectant has been supplied to patients to disinfect sputum pots, etc., where necessary. Epidemics — Assistance to House-holders.— During November, the Ministry of Health issued a circular, calling upon Local Authorities to take certain action to assist householders should infectious diseases assume epidemic proportions this winter, particularly having regard to the possibility of an outbreak of influenza not requiring hospitalization on a large scale. Acting upon suggestions contained in the circular, a local scheme was formulated embracing the assistance of the following services— (a) Local Medical Practitioners. (b) Co-operation of Nursing Association and Voluntary Aid Societies in regard to Home Nursing. (c) Arrangements with Local Voluntary Associations, including Youth Organisations who would be willing to supplement the Council's panel of Home Helps, and thus provide the necessary assistance in looking after the children in the home, and also to be responsible for the shopping needs of the household. (d) Supply of meals through the London County Council Meals Services, together with the necessary arrangements for transport. It was realised that should it be necessary to put the above scheme into operation, a certain amount of dislocation of the ordinary. Health Services would result, and for that reason the Minister of Health has requested the scheme should not be put into force until specific instructions are given by the Ministry. 30 Fortunately during the remainder of the year under review, the occasion did not arise to put the scheme into effect. Verminous Conditions.—No change has taken place in the procedure adopted to combat infestation by lice and general verminous conditions. All notified cases of Scabies, as also suspected, cases are followed up and the homes visited by the Woman Sanitary Inspector, assisted by a qualified nurse who gives advice and instruction concerning treatment. School children arc dealt with at the Council's Cleansing Station at Tunnel Avenue.- Children under 5 years of age and adults were treated at the Seamen's Hospital Bathing Centre up to March, when it became necessary to vacate the premises. Fortunately arrangements were made to transfer the Centre to a building attached to St. Alfege's Hospital, which had been formerly used as a First Aid Post. The total attendances at the two Centres was 7,238 as compared with 6,694 for the previous year. No doubt part of this increase can be attributed to the return of children from evacuation areas to the overcrowded conditions under which many families are living at the present time. Exceptional cases were also found to require at least six treatments before they could be considered free from verminous conditions. The following return summarises the work earned out during the year:— Attendances Vermin Scabies Adults 17 2,635 Children under School age - 1,114 School Children 800 2,672 No. of home visits by Nurse - 540 ,, ,, ,, re-visits by Nurse - 400 Disinfection of Premises.—The usual routine has been followed regarding the disinfection of rooms of persons suffering from notifiable infectious diseases. There were many calls on the Disinfecting Staff from the various Civil Defence Services, and on the termination of hostilities, special arrangements were entered into with the National Fire Service and no less than 2,188 mattresses and 2,038 pillows were disinfected. The following Return shows in detail the amount of work performed during the year:— Rooms and Articles Disinfected, Year 1945. Diseases, etc. Premises Entered Rooms Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Disinfected Scarlet Fever 80 170 37 — 55 50 143 204 118 23 88 283 1,001 Diphtheria 48 101 25 — 25 27 82 115 68 6 51 137 536 Tuberculosis 49 149 20 — 26 26 83 78 41 13 27 59 373 Cancer 4 12 4 — 5 4 10 7 5 9 4 1 49 Cerebro-Spinal Fever 3 6 2 — 2 3 6 8 6 1 2 8 38 Puerperal Fever 1 2 — — 1 1 2 4 2 — 1 — 11 Chicken-pox 9 17 8 — 43 — 17 66 3 — 14 36 187 Measles 7 10 2 — 6 2 7 19 6 1 3 — 46 Scabies 3 6 2 — 5 3 8 12 7 1 6 — 44 Verminous 28 18 17 — 40 16 53 114 26 11 21 59 357 „ (C.D. Shelters, etc.) 34 69 1 3 129 — 113 346 2 2 — 40 636 „ (Rest Centres) 26 8 — — 256 10 13 1,511 — 3 3 — 1,796 „ (N.F.S.) 46 — — — 2,188 — 2,038 — — — — — 4,226 Miscellaneous 77 99 32 2 139 30 209 299 19 25 42 27 824 Total 415 667 150 5 2,920 172 2,784 2,783 303 95 262 650 10,124 No. of articles destroyed 172 31 32 TUBERCULOSIS. I am indebted to Dr. Macdonald, Acting Tuberculosis Officer, for the following report. The work at the Tuberculosis Dispensary was seriously dislocated when the building suffered serious damage as the result of enemy action early in January 1945, when it was necessary to vacate the whole of the premises, with the exception of the Pharmacist's quarters. Immediate arrangements were made to transfer the Clinic to the Health Department at the Town Hall, and sessions were held regularly, though admittedly, under somewhat adverse conditions. By June, the Maze Hill Clinic was so far repaired as to warrant a return. Notifications.—Notifications during 1945 numbered 165, of which 149 were cases of pulmonary tuberculosis and 16 of nonpulmonary tuberculosis. In the same period, 50 died suffering from pulmonary tuberculosis and 3 from non-pulmonary tuberculosis. New Cases and Mortality Age-Periods, Years New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0— 1 — — — — — — — — 1—5 2 — 1 2 — — — 1 5—15 2 5 2 2 1 — —| 1 15—25 21 31 — 2 1 9 — — 25—35 19 21 1 1 7 1 — 1 35—45 9 6 2 1 7 2 — — 45—55 14 2 — 2 5 3 — — 55—65 13 1 — — 9 1 — — 65 and upwards 3 — — — 3 1 — — Totals 83 66 6 10 33 1.7 — 3 620 new cases were examined, of these 120 were suffering from Pulmonary Tuberculosis and 11 from Non-Pulmonary Tuberculosis; the remainder were diagnosed as not suffering from Tuberculosis in any form. Of the 620 new cases, it is again interesting to know that 66 were referred by the various Medical Boards. 33 At the close of the year the number of definite cases of tuberculosis on the Dispensary register, was as follows:— Adults Children Males. Females. Males. Females. Pulmonary 267 212 32 12 Non-pulmonary 24 38 16 18 No. of attendances by patients 2,238 No. of visits by Tuberculosis Health Visitors 3,069 No. of Sputum examinations 414 of which 95 were positive No. of X-rays 625 Dental Cases.—Cases needing dental treatment are seen by the Tuberculosis Officer and referred to the Dental Clinic. Only a few such cases were dealt with during the year. Artificial Pneumothorax.—652 refills were given by the Tuberculosis Officer at St. Alfege's Hospital. By arrangement with the hospital, patients who are working and cannot attend the afternoon clinic are treated by the hospital staff. Extra Nourishment.—Grants of extra nourishment (milk) were made in 16 cases at a cost of £51 to patients not in receipt of the Social Welfare Assistance or Maintenance Allowance. The closest oo-operation is maintained with the Social Welfare Officers who have dealt very sympathetically with patients referred to them by the Dispensary. Care Committee.—The Care Committee met on two occasions during the year, but as in previous years, emergency matters were dealt with by the Chairman and Tuberculosis Officer and reported later to the Committee. The Chairman makes a weekly visit to the Dispensary for this purpose. A sum of £55 14s. 1d. was realised by the sale of Seals in connection with the Christmas Seals Campaign; as in previous years, this Fund is utilised to assist needy patients who require clothing, etc. and for the purpose of materials for those who are engaged on handicraft work. Handicraft Class.—It was hoped to reform the Handicraft Class soon after the termination of the war, but difficulties were encountered in repairing the hut which had suffered severely from bomb damage. Members were again encouraged to interest 24 themselves in handicraft work and carry out such work in their own homes. Every assistance was given to enable them to obtain the necessary materials. Tuberculosis Allowances.—This scheme introduced in June 1943 to provide maintenance allowances to certain patients and their dependents has continued to function. During the year 103 patients received allowances. The amount paid during this period was £3,085 5s. 7d. 35 Supplemental Vaccination Return for 1944. Return made on or before the 14th of February, 1946, by Dr. J. E. Howard, 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, 1944, inclusive:— Registration SubDistricts comprised in the Vaccination Officer's District No. of Births from 1st Jan., to 31st Dec., 1944 Slumber of these Births duly entered by 31st Jan., 1946. No. of Births which on 31st Jan., 1946, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1946, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1945 No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1945 Successfully Vaccinated Insusceptible of Vaccination Had Smallpox 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 North Greenwich 645 170 2 Nil 96 24 2 282 50 19 708 304 South Greenwich 244 89 1 Nil 64 9 Nil 45 29 7 Total 889 259 3 Nil 160 33 2 327 79 26 708 304 7th February, 1946. Dr. J. E. Howard, Acting Vaccination Officer. INDEX Page A Adoptive Acts, By-laws and Local Regulations 3, 4 Aged, Infirm and Physically Incapacitated Persons 19, 20 Ante-Natal Clinics 13 Area of Borough 7 Articles and Rooms Disinfected 31 Articles Destroyed 31 Artificial Pneumothorax 33 Artificial Sunlight Treatment 14 B Bacteriological Examinations 11, 25 Baiting of Sewers 18 Births 9 C Cerebro-Spinal Fever 28, 29 Child Life Protection 15 Cleansing Children 30 Clinics and Centres 13, 14 Complaints 17 D Deaths 10 Deaths, Tables showing Causes of and Ages at Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Density of Population 7 Dental Work 14, 33 Diabetes 16 Diarrhoea and Zymotic Enteritis 28 Diphtheria 26 Diphtheria Immunisation 27 Disinfection 30 Disinfestation 17, 18 Domestic Helps 15, 16 Duties and Powers of the Public Health, Maternity and Child Welfare Committee 3, 4 Dysentery 28 Page E Elevation of Borough 7 Emergency Dwellings 21 Epidemics—Assistance to Householders 29 Erysipelas 28 Extra Nourishment 33 Extracts from Vital Statistics 8 F Factories Act, 1937 17 Food and Drugs Act, 1938 25 Food—Inspection of 23-25 Food—Premises for Preparation of 25 Food Rejected 23, 24 Food and Drugs—Samples 25 Foot Clinic 14 G General Statistics 7, 8 H Handicraft Centre 33, 34 Health Centres 12-14 Health Visitors, Visits, etc. 11 Heat-Treated Milk (Prescribed Tests) Order, 1944 24 Home Helps 15 Home Nursing 11 Housing 21, 22 Housing Homeless Persons 21 I Ice-cream — Bacteriological Examinations 25 Ice-Cream Premises 25 Illegitimate Children—Care of 15 Infant Consultations 13 Infantile Mortality 10 Infant Welfare Centres 12, 13 Inhabited Houses 7 Insulin Treatment—Diabetes 16 Introductory Review 5, 6 INDEX—continued Page L Laboratory Work 11 M Marriages 9 Maze Hill Clinic 14,15 Measles 26 Meat Surrendered 23, 24 Milk, Analysis of 25 Milk—Bacteriological Examination 25 Milk Supply 24 Milk (Special Designations) Order, 1936 24 N Notices, etc. 17 Notifications 12,26-30,32 Nurseries 16 O Ophthalmia Neonatorum 28 Overcrowding 22 P Persons Cleansed 30 Pharmacy & Poisons Act, 1933 20 Pneumonia 28 Population 7 Post-Natal Clinics 13 Post-War Housing Plan 21 Premature Infants, Care of 15 Preserved Food Premises 25 Public Health, Maternity and Child Welfare Committee 3 Puerperal Fever 27 Puerperal Pyrexia 28 R Rateable Value 7 Rates, Births and Deaths 8 Rat Repression 18 Refuse Disposal 18, 19 Rent & Mortgage Interest (Restrictions) Act 19 Page S Sanitary Work—Summaries, etc. 17 Scabies 27, 30 Scarlet Fever 28 Scavenging and Refuse Disposal 18, 19 Sewers—Baiting of 18 Sheets—Supply of for Expectant Mothers 15 Shops Act, 1934 17 Smallpox 26 Staff of Public Health Department 11 Statistical Tables Appendix T Tuberculosis 29 Tuberculosis Allowances 34 Tuberculosis Care Committee 33 Tuberculosis Dispensary— Returns 32, 33 Tuberculosis Officer's Report 32-34 Typhoid Fever 28 U Uninhabited Houses 7 Unsound Food 23, 24 V Vaccination 35 Verminous Children 30 Verminous Premises 30 Vital Statistics 8, 9, 10 & Appendix W War Damaged Dwellings 17, 21 War-time Nurseries 16 Water Supply 19 Whooping Cough 26 Workshops and Factories 17 X X-Ray Examinations 33 Z Zymotic Diseases 28 CAUSES OF, AND AGES AT, DEATH, during the year ended 31st December, 1945. No. in Short List 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 occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents " 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 G reenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. Alfege's Hospital Seamen's Hospital Milier Hospital Herbert Military Hospital Brook Hospital L.C.C. Other Institutions Outside Institutions 1 Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 Diphtheria 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 6 6 Tuberculosis of Respiratory System 50 ... ... ... 1 10 17 18 4 18 15 1 16 9 2 2 ... ... ... 17 61 7 Other Forms of Tuberculosis 3 ... ... ... 1 ... 1 ... ... 1 ... ... 2 1 ... ... ... 1 ... ... 13 8 Syphilitic Disease 10 ... ... ... ... ... 1 4 5 4 ... ... 5 2 ... 1 ... ... ... 3 9 9 Influenza 7 ... ... ... ... ... 1 3 3 4 ... ... 3 3 ... 1 ... ... ... 1 14 10 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 11 Acute Poliomyelitis and Polioencephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Acute Infectious Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13m Cancer of buccal cavity and oesophagus (males only) 7 ... ... ... ... ... ... 1 6 2 ... 2 3 4 ... ... ... ... ... 3 7 13f Cancer of Uterus 8 ... ... ... ... ... ... 4 4 6 ... ... 2 4 ... ... ... ... ... ... 8 14 Cancer of Stomach and Duodenum 19 ... ... ... ... ... ... 8 11 8 4 ... 7 11 ... 2 ... ... ... 2 34 15 Cancer of Breast 16 ... ... ... ... ... 1 6 9 7 4 ... 5 5 ... ... ... ... ... 4 10 16 Cancer of all other sites 77 ... ... ... 1 ... 5 29 42 22 22 2 31 39 ... 1 ... ... ... 17 121 17 Diabetes 3 ... ... ... ... ... ... 2 1 1 ... 1 1 1 ... 1 ... ... ... 1 9 18 Intra-cranial Vascular Lesions 64 ... ... ... ... ... 1 17 46 24 17 1 22 32 1 1 ... ... 2 7 112 19 Heart Disease 226 ... ... ... ... 1 3 58 164 85 53 14 74 66 2 6 ... 1 1 41 266 20 Other Disease of the Circulatory System 11 ... ... ... ... ... ... 1 10 5 4 ... 2 7 ... 1 ... ... ... 1 28 21 Bronchitis 33 3 ... ... ... ... 2 11 17 12 9 4 8 6 ... ... ... ... ... 6 32 22 Pneumonia 57 7 ... ... ... 1 ... 16 32 21 14 2 20 35 ... 1 ... 1 ... 11 113 23 Other Respiratory Diseases 20 1 ... ... ... ... 5 7 7 6 5 1 8 5 ... 1 ... ... ... 9 13 24 Ulceration of the Stomach or Duodenum 11 ... ... ... ... ... 1 2 8 6 3 ... 2 10 ... ... ... ... ... 1 30 25 Diarrhoea (under 2 years of age) 13 12 1 ... ... ... ... ... ... 7 2 1 3 6 ... ... ... 2 ... 3 57 26 Appendicitis 3 ... ... ... ... 1 ... 1 1 2 1 ... ... 2 1 ... ... ... ... ... 9 27 Other Digestive Diseases 10 ... ... ... ... ... 1 2 7 6 ... ... 4 7 ... 1 ... 1 ... 1 40 28 Nephritis 11 ... ... ... 1 ... 3 3 4 5 2 1 3 2 ... ... ... ... ... 3 10 29 Puerperal and Post-abortive Sepsis 1 ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 30 Other Maternal Causes 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 31 Premature Birth 5 5 ... ... ... ... ... ... ... 3 ... ... 2 4 ... ... ... ... ... 1 23 32 Congenital Malformations, Birth Injury, Infantile Disease 21 19 ... 2 ... ... ... ... ... 7 7 1 6 8 ... ... ... ... ... 4 27 33 Suicide 4 ... ... ... ... ... ... 3 1 2 ... 2 ... ... ... ... ... ... ... 2 6 34 Road Traffic Accidents 4 ... ... ... 1 2 1 ... ... 3 1 ... ... 4 ... ... ... ... ... ... 10 35 Other Violent Causes 27 4 ... ... 1 4 2 3 13 12 3 2 10 18 ... ... ... ... ... 6 51 35a War Operations 26 ... ... 1 4 2 5 11 3 6 3 ... 17 3 ... ... ... 1 ... 1 22 36 All Other Causes 64 1 ... ... l 4 6 10 42 22 17 ... 25 29 2 ... ... ... ... 14 89 813 52 2 5 11 26 57 220 440 308 187 37 281 324 8 19 8 3 159 1,238 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, and who died in the Borough in like manner have been excluded. CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1945. 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 j 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 j St. Nicholas ! Charlton and Kidbrooke <H) Small-Pox Chicken-Pox Diphtheria 54 20 22 5 7 17 19 3 15 17 19 3 15 54 Dysentery 28 i 8 5 4 3 5 2 11 9 3 5 10 9 3 5 27 Erysipelas 24 3 2 2 6 5 6 9 4 11 4 2 8 14 Acute Polio-Myelitis ... 1 1 1 1 1 Scarlet Fever ... 83 i 21 51 5 4 1 47 15 5 16 39 10 5 13 67 Enteric Fever ... Scabies ... 312 5 45 95 64 63 34 6 134 60 36 82 1 1 Puerperal Fever 4 1 3 1 3 1 3 4 „ Pyrexia 12 4 8 4 4 2 2 4 4 2 2 12 Cerebro-Spinal Fever ... 4 3 1 1 1 1 1 1 1 1 1 4 Malaria ... 1 .... 1 1 ... 1 1 Measles ... 341 20 200 115 4 2 162 34 21 124 5 3 2 9 19 Whooping Cough 133 17 76 40 91 6 2 34 10 2 2 14 Diarrhoea 37 23 14 17 7 3 10 17 7 3 10 37 Ophthalmia Neonatorum . 4 4 • 1 3 1 1 2 Tuberculosis, Pulmonary 101 2 6 42 27 22 2 28 28 4 41 22 15 2 18 57 ,, Non-Pulmonary 13 2 3 2 5 1 4 4 I 4 4 3 1 2 10 Pneumonia, Acute Primary or Acute Influenzal 64 5 9 6 5 6 24 9 33 4 2 25 17 3 2 15 37 Totals ... 1216 79 400 345 140 135 92 25 559 197 84 376 152 80 25 104 361 (±1) Cases 01 Inlectious Disease are treated in the Hospitals of the London County Council, whose Brook Hospital, is situated in Kidbrooke. INFANTILE MORTALITY DURING THE YEAR 1945 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause op 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 ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria—Croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculosis) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... 1 ... ... ... 1 Diseases of Trachea ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 2 ... ... ... 3 Pneumonia (all forms) ... 1 ... 1 2 1 2 2 ... 7 Diarrhoea (all forms) ... 1 ... 1 2 4 3 3 ... 12 Gastro-Enteritis ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 7 1 ... ... 8 ... ... ... ... 8 Congenital Malformation 5 ... 1 ... 6 3 ... ... ... 9 Premature Birth 5 ... ... ... 5 ... ... ... ... 5 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... Suffocation, Overlay ... ... ... ... ... ... ... ... ... ... ,, Otherwise ... ... 1 ... 1 ... 2 ... ... 3 Other Causes 3 ... ... ... 3 1 ... ... ... 4 Totals • 20 3 2 3 28 12 7 5 ... 52 Boys 31 Girls 21