AC4373 GRE 44 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946 LONDON Freame, Manning &Co., Ltd. 12a. Lee High Road, S.E.13 65874 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946 CONTENTS Pages Public Health Committee 3 Maternity & Child Welfare Committee 4 Introductory 6-10 Section A.—General and Vital Statistics 11-20 „ B.—General Provisions or Health Services in the Area 21-31 „ C.—Sanitary Circumstances or the Area 32-40 „ D.—Housing 41-42 „ E.—Inspection and Supervision of Food 43-49 „ F.—Prevalence of, and Control Over, Infectious Diseases 50-59 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE during the year 1945-1946. The Mayor : Councillor A. G. E. Woolven, J.P. and 13 Members. Alderman T. H. P. Beacham (Chairman). Councillors : Councillor Mrs. M. M. E. Hayter (Vice-Chairman). Mrs. P. M. Beacham. Mrs. I. Jaggers. Mrs. M. L. Bennett. T. A. Keating. J. A. P. Brown. A. Miles. J. R. Dabin, J.P. G. F. Westmacott. Mrs. J. Gollogly. Mrs. K. M. Yarlett. R. H. Hayter. Powers and Duties of the Public Health Committee : 1.—There shall be referred to the Committee the powers of the Council under Acts of Parliament relating to the Public Health and sanitary condition of the Borough, the sale of food and drugs, the repair, closing and demolition of in dividual insanitary houses (Section 9 and 12 of the Housing Act, 1936), and Vaccination, and the By-laws, orders and regulations made, or to be made hereafter, under the provisions of such Acts, which are not within the reference to any other Committee. 2.—All plans for drainage and redrainage of premises shall be laid before the Committee for consideration. 3.—All works of drainage of houses and premises shall be carried out under the direction of this Committee. 4.—The Committee shall have the control of Mortuaries erected or maintained by the Council, as the Sanitary Authority, and shall have control of the disinfecting staff, apparatus and plant. 5.—The construction, maintenance and control of public sanitary conveniences, and conveniences maintained by the Council, shall be referred to this Committee. 4 MATERNITY AND CHILD WELFARE COMMITTEE during the year 1945-1946. The Mayor: Councillor A. G. E. Woolven, J.P. and 13 Members. Councillor Mrs. J. Gollogly (Chairman). Alderman Mrs. F. Carter (Vice-Chairman). Councillors : Mrs. P. M. Beacham (Nov. to Mar.) T. P. Jaques, J.P. (Nov. to Feb.) Mrs. M. L. Bennett. T. A. Keating. J. R. Dabin, J.P. Mrs. A. D. A. Kennedy. T. L. Dawes (from Feb.) Major L. F. Land. W. J. Evans (from March). A. D. Patton. Mrs. M. M. E. Hayter. Mrs. K. M. Yarlett. Mrs. I. Jaggers. Powers and duties of the Maternity and Child Welfare Committee : There shall be referred to the Committee all matters arising out of the powers and duties of the Council under the Maternity and Child Welfare Act, 1918, or any Act or Acts amending the same, or any Orders or Regulations made under such Act or Acts; Section 226 of the Public Health (London) Act, 1936 so far as it enables the Council to provide Artificial Sunlight Treatment to adult residents in the Borough; powers and duties referred to in Sec. 6 of the Widows, Orphans and Old Age Contributory Pensions Act, 1925; and the Committee shall make recommendations to the Council in relation to the matters aforesaid. 5 STAFF. Medical Officer of Health and Administrative Medical Officer, Tuberculosis and Maternity and Child Welfare : Vaccination Officer : F. R. Waldron, M.D., D.P.H. Deputy Medical Officer of Health and Clinical Tuberculosis Officer (Temporary—whole-time—appointed September, 1946) : C. W. L. Jeanes, M.R.C.S., L.R.C.P. Maternity and Child Welfare Medical Officers : Senior—J. M. Oldfield, M.R.C.S., L.R.C.P. Junior—(Position vacant). Sessional Medical Officers : F.E.T.Ross,M.B.,Ch.B(Edin) A. H. Elliott, M.B., B.Ch. J. Morton, M.B., Ch.B (Edin) S. Livingstone M.B., Ch.B (Edin) D.P.H. B. W. Hordern, M.B., Ch.B. Consultants under Puerperal Fever Regulations : Margaret Basden, M.D., F.R.C.S. Amy M. Fleming, M.D., D.Sc., F.R.C.O.G. Alistair Gunn, M.D., M.C.OG. Jocelyn Moore, M.B., B.S., M.C.O.G., F.R.C.S. Bacteriologist: G. L. Robinson, M.D. Public Analyst: A. E. Brown, B.Sc., F.I.C. Deputy—H. A. Williams, A.C.G.F.C., F.I.C. Dental Surgeon : G. F. Ferris, L.D.S., R.C.S. (Eng) Public Vaccinators :. G. H. Garnett, M.D., Ch.B. E. A. Clegg, M.R.C.S., L.R.C.P. Chief Administrative Assistant : F. W. Foulger. Chiropodists : Senior— H. Rosenstein, F.Ch.S. Junior—Miss A. F. Pratt, M.Ch.S. Sessional—Mrs. N. Adami, L.Ch. Mrs. A. E. Cole, M.Ch.S. Mrs. D. W. Grant, M.Ch.S. Mrs. M. M. Brand, M.Ch.S. 6 Sanitary Inspectors : Senior ac W. H. Collins. abc S. A. Radford. ab H. L. Bennett (Food). abc H. Archer (resigned December). ab G. W. Heath. abj J. Ashmore. ab S. S. Garrard (Food) (resigned June). a Miss E. Arnold. a F. H. D. Boddy (commenced August). Health Visitors : Maternity and, Child Welfare Tuberculosis dfg Miss K. Walton. dfg Miss D. M. Wilkins. dfg Miss P. N. Steer (retired Sept.). dfg Mrs. D. E. Shepherd. dfg Miss G. A. Hulse. df Miss H. M. Forrest. dfg Miss J. M. Brydson. Miss L. Merricks (Clerk). dfg Miss M. E. Morris. dfg Mrs. D. M. Coe (commenced Feb.) Scabies Clinic Nurse dfg Miss A. M. Van Dyk. (commenced df Miss R. Rae. May) dfg Miss F. M. E. Horton (commenced Aug., permanent in Dec.). dfg Miss M. A. Mitchell (resigned July) MAZE HILL CLINIC. Pharmacist: W. H. Green, M.P.S. Caretaker : J. F. Nash. ARTIFICIAL SUNLIGHT TREATMENT Nurse-in-Charge : di Miss L. D'Oyly-Watkins. Assistant Nurse : di Miss M. Denney. Sessional Nurse : i Miss H. Trethowan (from March). CONLEY STREET DAY NURSERY. Matron : Mrs. A. Copp, S.R.N. Sister : Mrs. E. E. A. Greening, S.R.N. 7 CLERICAL STAFF. a H. Duck (Senior Assistant) A. H. Hammond (Temporary). Mrs. L. E. Wright. Miss G. Sibborn (Milk Saleswoman) L. A. Westacott. Mrs. E. R. Sellens (Foot Clinic A. H. Wilcox. Receptionist) R. G. Garratt. Miss M. L. Williamson (Clinic C. W. Spore. Clerk) F. A. Saunders. 6 Sessional Clinic Clerks. E. P. Tidman. W. A. Pearce (Conveniences Mrs. V. Starr. Supervisor) Mrs. P. Brooker. DISINFECTING STAFF. G. Hook. T. Moore. T. Smith. W. Clements. A. Nash. T. Packham (Motor Driver). MORTUARY KEEPER. W. J. Lawley. a Certificated Sanitary Inspector. b „ Meat and Other Foods, etc. c „ Smoke Inspector. d „ Nurse. f „ Health Visitor. g „ Midwife. i „ Chartered Society of Physiotherapy. j „ Housing Officer 8 Town Hall, Greenwich, S.E.10. June, 1947. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Ladies and Gentlemen, I beg to submit herewith, as Medical Officer of Health, the Annual Report for 1946. This is the first complete post-war year, and, as such, lends itself for comparison. Accordingly, a table is included in the Appendix to this report, setting out selected vital statistics for 1901 (the first year of the Council's era), 1938, the war years, and the year under review. It is pleasing to record that, in general, the health of the people of Greenwich, notwithstanding trying experiences, is satisfactory, and indeed, by comparison, the position is encouraging. For many years there has been a gradual decline in the National birth-rate, ascribed to manifold causes. Wherever the truth lies, the definite decline is reflected locally in the difference between a figure of just below 30 per 1,000 population in 1901 and 13.6 in 1938. An upward trend is noticed for the war years when population movement factors affect the validity of conclusions, but there is no doubt at all as to the gratifying figure of 22.6 per 1,000 for 1946. Social Welfare in its widest sense will be needed to foster this trend so that it may not be recorded at some future date as just a biological reflection in the population of the change from war to peace. Infantile mortality rates are tabled of 130 for 1901, 42 in 1938, and 34 in 1946. Gradual improvement from the " good old days," due to social enlightenment, was accelerated by the adoption and far-sighted development of welfare schemes in the inter-war years. As a result, the local return of a rate of 42 for 1938 was hailed with justifiable acclamation as a " lowest ever." As the National rate of 43 for the year under review is the lowest ever recorded, it is indeed satisfying to put before you a rate of 34 for Greenwich, which, except for the " evacuation " years of 1941 and 1942, is another "lowest ever." This figure reflects the greatest credit on the effect of the Council's scheme, in view of the adverse factors of overcrowding and difficult housing met with. No praise can be too high for the Medical Practitioners, Health Visitors, and Social Workers generally, the cumulative effect of whose services in the Borough it 9 is my pleasing duty to record. Nor must one forget the individual others in the Borough who respond so splendidly in trying conditions to the medical and nursing supervision given at Welfare Centres, Surgery or Hospital. Experts suggest that a rate of 25 is an ideal: if this is true, then this Borough is proceeding well towards the irreducible minimum. A somewhat disquieting tendency is shown in connection with Tuberculosis. The death rate had dropped between 1901 and 1938 from 1.83 to .77 per 1,000 population. The figure for 1946 is .97, and is a reminder that there must be no complacency felt in face of those twin enemies of Public Health: overcrowding and bad housing. Turning to Infectious Diseases, it is pleasing to note that despite the usual biennial increase in incidence of Measles, the total notifications of 1,580 for this year are below the average. For 1945 and 1938 the figures were 1,102 and 2,811 respectively. Encouraging results had been obtained up to the end of 1945 in the Council's Diphtheria Immunisation scheme. During the year under review a special appeal arrangement was instituted, and produced a marked increase in applications for the service. At the end of the year it was estimated that 50% of children under 15 years of age had completed courses of immunisation. The four ad hoc Welfare Centres provided by the Council were well attended during the year. In addition, part-time use was being made of three other premises as relief Centres, and plans were under consideration for the adaptation of Fairfield House, Charlton Village, and the temporary conversion of a hutment in Ridgebrook Road, Kid brook Estate. Recommendations have been made and considered relative to the acquisition of a suitable site for a comprehensive Health Centre. This was a matter left in abeyance for the war, and had been considered in 1938/39 because of the loss of the Old Borough Hall Centre. While it is not envisaged that any building operations could be expected in the near future, it was, I feel, a wise step for the Committee to review the matter. Another problem in abeyance since the crisis year, was the replacement of the old Disinfecting and Cleansing Station, where the fabric of the buildings and the installations are worn-out or out-ofdate. A recommendation to group personal cleansing and disinfecting plant in a modern building, centrally placed and with up-to-date fitments, was before the Public Health Committee at the year end. The Day Nurseries in Shooter's Hill Road and Pound Park Road were transferred to the County Council in April. At the same time that portion of Conley Street Nursery which catered for 10 children from 2—5 was handed over ; the remainder, dealing with children under the age of 2 years, continues under your jurisdiction to provide a useful service. The supervision of food supplies in the Borough was carried out with the usual thoroughness directed towards ensuring that unsound supplies should not reach the public, and that wastage should not occur. Constructive effort in the field of sanitary circumstances and housing in the area has been hampered by factors over which we have no control. Nevertheless, commendable work has been done by the Council's inspectorial staff. As far as environmental hygiene is concerned, there is a larger field than ever for action, overloaded as the schedule is by the leprous decay due to the war. It is to be devoutly wished that the problems of overcrowding and occupation of unsuitable basements and unfit houses, with the physical and psychological illnesses they bequeath, may be completely solved in the near future. With the coming into force of the National Health Service Act, 1946, functions belonging to Maternity and Child Welfare Authorities will, in the main, become "transferable. "On the" appointed day" the County Council as the Local Health Authority will take over a personal service of whose lusty growth and development you may feel justly proud of having fostered. In the interests of uniformity of practice and integration of services, this proposal is the logical outcome of recent trends in Social Welfare. The operation should be regarded as one, not of amputation, but rather as a transfer of healthy tissue, which with other such transfers may in smooth growth cover existing scars and gaps in the structure of the National health. In completing my general remarks, may I express my appreciation of the kindness and assistance afforded me by the Chairmen and Members of the Public Health and M. & C.W. Committees and my colleagues in other departments. I acknowledge whole-heartedly the support of every member of the staff under my control, many of whom have voluntarily shouldered extra burdens, and all of whom have given loyal service during very trying times. I have the honour to be, Your obedient Servant, F. R. Waldron, Medical Officer of Health. 11 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 & Kidbrooke 1,990 „ 3,858 acres Population— At Census, 1931 100,924 Estimated, 1946 76,840 Density of Population— 19 persons per acre Number of Inhabited Houses—end 1946 (according to Rate Books) 20,020 Structurally separate dwellings at Census, 1931 18,114 Number of Uninhabited Houses— At Census, 1931 250 At end 1946 98 Number of Families or Separate Occupiers— At Census, 1931 25,144 Rateable Value,1946 £874,972 Sum Represented by a 1d. Rate, 1946 £3,504 12 PUBLIC OPEN SPACES. Borough Council— Charlton House and Gardens 9.25 acres R.N. College Cemetery 5.86 „ St. Alfege Recreation and Church Grounds 2.3 „ Sayes Court Recreation Grounds 1.43 „ St. Nicholas Recreation Grounds 1.25 „ Hughes Fields Recreation Grounds .74 „ Batley Park .97 „ Bellot Memorial Gardens .19 „ Other Open Spaces 5.25 „ Approximately 27.00 acres H.M. Office of Works— Greenwich Park 185 acres L.C.C.— Blackheath (part of) 73 acres Maryon Park 46.70 „ Charlton Park 45.75 „ Charlton Lido 23 Mileage of Streets Approximately 75 SOCIAL CONDITIONS. The Metropolitan Borough of Greenwich comprises three districts, viz., Greenwich, Charlton and Kidbrooke, and St. Nicholas, Deptford, all of which are now united into one civil Parish. The sub-soil of the greater portion of the Borough consists of gravel and sand, the exception being in the Kidbrooke area which is mostly clay. The altitude varies from a few feet below high-water mark on the marshes, up to 249 feet above sea-level on the Shooter's Hill Road by the Borough boundary. The Borough is well catered for in the way of parks and open spaces, the largest being the famous Greenwich Park, with its historical surroundings, covering an area of 185 acres. Blackheath forms a Southern boundary, 73 acres of which are within the 13 Borough. To these must now be added the L.C.C. Play Centre and Lido with its well-equipped swimming bath. The part situated near the River Thames is, generally speaking, an industrial area and is more densely populated than the upper parts of the Borough. Considerable activity and much good work has been accomplished during the year towards restoring and repairing bomb damaged sites and the planning of new estates. Reference to the Section of the Report devoted to Housing gives particulars of the types and number of houses erected during the year. The majority of the industries and sources of employment in the Borough are to be found in close proximity to the River Thames which forms the Borough boundary on the north side. Chief among these are large Cable and Engineering Works, Ship Repairing Works, Gasworks, Soap and Candle Works, L.P.T.B. Generating Station and Tramway Car Repair Depot, The London Power Company's Works, Glass Bottle Works, Rope Works, Ship Propelling Works, Merryweathers' Works (Fire Engines), Cement and Stone Works, Asbestos Works, Cold Meat Storage, Pressed Tool Works, Constructional Engineering Works, Galvanising and Sheet Metal Works, Brewery, Flour Mills, Aero Parts, Wireless and Vehicle Parts and Tin Box Manufacturing Works. The numbers employed at 11 of the larger factories range between 500 and 5,000 each, whilst 17 smaller works each employ between 100 and 400. POPULATION. The Registrar-General has estimated the civilian population for Greenwich at mid-year 1946 as 76,840. This shows an increase of 13,040 over the previous year, and it is upon these figures the statistics in this report have been based. * EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total M. F. Live Births Legitimate 1,643 873 770 Birth Rate 22.65 Illegitimate 92 50 42 1,735 923 812 Still Births Legitimate 22 14 8 Rate per 1,000 total Births 12.5 Illegitimate - - - Deaths 872 502 370 Death Rate (Crude) 11.38 14 Rate per 1,000 total Births Deaths from Puerperal Causes:— Puerperal Sepsis — Other Puerperal Causes 3 ... 1.70 Total 3 ... 1.70 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 34 Legitimate Infants per 1,000 legitimate live births 35 Illegitimate Infants per 1,000 illegitimate live births 21 Deaths from Cancer (all ages) 129 „ ,, Measles (all ages) — ,, ,, Whooping Cough (all ages) 2 „ „ Diarrhoea (under 2 years of age) 2 *These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 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 1938:— Churches of England Chapels and Roman Catholic Churches SuperintendentRegistrar's Office Total Approximate Population Year Greenwich Charlton and Kidbrooke St. Nicholas 1938 309 185 31 101 268 894 95,770 1939 395 218 31 128 397 1,169 94,790 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 Whole Borough Free Churches 1946 — 455 — 38 283* 776 76,840 †Parish Church destroyed by enemy action. *Also includes R. C. Churches. 15 METEOROLOGICAL OBSERVATIONS. I am indebted to Sir H. Spencer Jones, F.R.S., Astronomer Royal, for the following meteorological data for the year ended December, 1946. The mean temperature was 50.0°, which is 0.3° higher than the average for the 100 years 1841-1940. The highest temperature in the shade was 87.0° on July 24th. Temperatures exceeding 80.0° were recorded on nine days. The lowest temperature was 19.0° on December 21st. Temperatures of freezing point, or below, were recorded on sixteen days in both January and December, and on nineteen other days, a total of 51 days. During November, the temperature did not fall below 34.0°, which was a record for that month. The mean daily horizontal movement of the air was 269 miles, which is sixteen miles below the average for 50 years, 1867-1916. The greatest daily movement was 737 miles on February 8th ; the least daily movement was 77 miles on March 24th. The greatest motion in one hour was 40 miles on February 23rd and September 20th, and the greatest pressure was 31.0 lbs. to the square foot on August 28th. The duration of bright sunshine recorded was 1,331.6 hours or 30 per cent, of the possible total. The sunniest day was July 10th with 13.6 hours. There were 79 entirely sunless days, of which eight were in the period of six months April to September. The total rainfall was 27.72 inches, which is 3.39 inches more than the average for the 100 years 1841-1940. October was the driest month with 0.71 inch ; August was the wettest month with 4.23 inches. Measurable rain fell on 187 days. The five months May to September had a record total of 90 rainy days, which is 48 per cent, above average. July 26th was the wettest day with 1.45 inches. There was no period of absolute drought. The longest periods without rain were January 13th to 25th and March 23rd to April 4th, both of 13 days. With regard to pollution of the air by solids in suspension, a bad period was December 10th to 14th. At one time during December 12th, the amount reached 4.2 milligrams per cubic metre, that is approximately 7 lbs. in the volume of air contained in a cub with one hundred yards edge. 16 BIRTHS. The total number of births registered in the Borough during the year was 2,208 of which 1,425 occurred in St. Alfege's Hospital, 85 in various Nursing Homes and 698 in private dwellings. In 1,060 cases the parents resided in areas outside the Borough and the births were consequently transferred to the appropriate districts. Five hundred and eighty-seven births belonging to the Borough took place in Institutions outside the Borough Area; thus the actual figure for Greenwich becomes 1,735, an increase of 553 over the previous year, 923 were males and 812 females. This is equivalent to a Birth Rate of 22.65 per thousand of the population and is 4.06 higher than the rate for 1945. This is the highest rate since the year 1921 when it was 22.70 per thousand. The average for the previous 10 years was 16.41. The Rates for the County of London and for England and Wales were 21.5 and 19.1 per thousand. DEATHS. The net number of deaths registered during 1946 was 874, of which 500 were males and 374 females, as compared with 813 for last year. This gives a crude death rate for the Borough of 11.38 per thousand of the population which is 1.40 lower than for the previous year and considerably below the average for the last 10 years, viz., 13.44. The Death Rates for the County of London and for England and Wales are 12.7 and 11.5 respectively. The inset table showing causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with requests contained in the Ministry of Health Circular No. 1728. DEATHS IN INSTITUTIONS. The following table shows the number of deaths of Greenwich residents in Public Institutions during the last six years:— DEATHS IN INSTITUTIONS. The following table shows the number of deaths of Greenwich residents in Public Institutions during the last six years:— No. in Short List. Causes or 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 502 43 6 4 50 137 262 F 370 17 4 2 42 93 212 1. Typhoid and Paratyphoid Fevers M • •• ... ... ... ••• ... ... F ... ... ... ... ... ... ... 2. Cerebro-spinal Fever M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 4. Whooping Cough M 1 1 ... ... ... ... ... F 1 ... 1 ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... F 2 ... 2 ... ... ... ... 6. Tuberculosis of Respiratory System M 42 ... 1 ... 16 23 2 F 22 ... ... 17 4 1 7. Other forms of Tuberculosis M 9 ... 2 3 3 ... 1 F 2 1 ... ... ... ... ... 8. Syphilitic Disease M 5 ... ... ... ... 2 2 F 3 ... ... ... ... 1 2 9. Influenza M 3 ... 1 ... ... ... 2 F 1 ... ... ... ... ... 1 10. Measles M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 11. Ac: Poliomyelitis and Pol ioencephali tis M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 12. Ac: Infectious Encephalitis M ... ... ... F ... ... ... ... ... ... ... 13. Cancer of Bucc. Cav. and Oeaoph. Uterus M 6 ... ... ... ... 3 3 F 13 ... ... ... 2 9 2 14. Cancer of Stomach and Duodenum M 11 ... ... ... ... 6 5 F 6 ... ... ... ... ... 6 15. Cancer of Breast M 1 ... ... ... ... ... 1 F 5 ... ... ... ... 3 1 16. Cancer of all other sites M 58 ... ... ... 7 25 26 F 29 ... ... ... 1 15 13 17. Diabetes M 1 ... ... ... ... 1 ... F 5 ... ... ... 1 1 3 18. Intra-cranial Vascular Lesions M 29 ... ... ... l 6 22 F 31 ... ... ... ... 5 26 19 Heart Disease M 137 ... ... ... 4 31 102 F 99 ... ... ... 3 14 81 20. Other diseases of Circulatory System M 25 ... ... ... 3 8 14 F 19 ... ... ... ... 4 15 21. Bronchitis M 27 1 ... ... ... 8 18 F 31 2 ... ... 1 7 21 22. Pneumonia M 23 7 ... ... 2 4 10 F 13 2 ... ... 1 2 8 23. Other Respiratory Diseases M 8 ... ... ... ... 4 4 F 5 ... ... ... 1 2 2 24. Ulcer of Stomach or Duodenum M 8 ... ... ... 2 3 3 F 4 ... ... ... ... 1 3 25. Diarrhoea (under 2 years) M 2 2 ... ... ... ... ... F ... ... ... ... ... ... ... 26. Appendicitis M 1 ... ... ... ... ... 1 F ... ... ... ... ... ... ... 27. Other Digestive Diseases M 15 1 ... ... ... 2 11 F 12 1 1 ... ... 4 6 28. Nephritis M 7 ... ... ... 2 1 4 F 12 ... ... ... 2 6 4 29. Puerperal and Post-abortive Sepsis F ... ... ... ... ... ... ... 30. Other Maternal Causes F 3 ... ... ... 3 ... ... 31. Premature Birth M 15 15 ... ... ... ... ... F 5 5 ... ... ... ... ... 32. Congenital Malformations, Birth Injury, etc. M 15 13 1 ... ... ... ... F 5 4 ... 1 ... ... ... 33. Suicide M 6 ... ... ... 2 1 3 F 8 ... ... ... 4 3 1 34. Road Traffic Accidents M 5 ... 1 1 1 1 1 F 4 ... ... ... 1 2 1 35. Other Violent Causes M 11 2 ... ... 3 2 4 F 7 2 ... ... ... 2 3 36. All Other Causes M 31 1 ... ... 1 6 23 F 23 ... ... ... 4 7 12 17 Total Deaths Total Deaths of Year of Greenwich Greenwich Residents in Residents Public Institutions. 1941 944 594 1942 828 569 1943 888 609 1944 978 616 1945 813 521 1946 874 585 Average 887 582 AGE MORTALITY. The age mortality and the distribution of the deaths between the different quarters of the year is shown by the following table:— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 16 9 15 19 59 Between 1 and 2 years 2 4 — 1 7 Between 2 and 5 years 1 2 — — 3 Between 5 and 15 years 2 1 — 2 5 Between 15 and 25 years 6 7 4 7 24 Between 25 and 45 years 16 10 19 24 69 Between 45 and 65 years 76 41 48 68 233 65 years and upwards 152 111 89 122 474 Totals 271 185 175 243 874 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 34 per thousand live births, as compared with 43 for the previous year. For the County of London the Rate was 41 and for England and Wales, 43. This is the lowest Infantile Mortality Rate ever recorded in the Borough, with the exception of the years 1941 and 1942 when the figures were 31 and 32 respectively. (During those years, however, owing to evacuation and war conditions generally, dependable figures were difficult to obtain). The total number of deaths during the year was 59 as compared with 52 for the previous year. 18 A further reference to the Infantile Mortality Rate will be found in the section devoted to Maternity and Child Welfare, whilst a table showing the causes of death and ages is included in the Appendix of the Report. The following Table shows the Comparative Infantile Mortality Rates for the quinquennial periods since 1931, together with the Rate for the year 1946:— District Average for five years 1931-1935 Average for five years 1936-1940 Average for five years 1941-1945 Year 1946 Greenwich 75 50 40 34 London 63 56 60 41 England & Wales 62 55 50 43 REMARKS ON VARIOUS DEATH CAUSES. Classification of Deaths.—It should be borne in mind that the statistical data compiled locally relating to cause of death may not agree entirely with the figures furnished to Local Authorities. Classification of the cause of death is taken from one or more causes as stated on the medical certificate in accordance with the Rules generally adopted throughout England and Wales. The Registrar-General is able, in cases where it is deemed desirable, to obtain fuller information from the certifying Practitioner. This enables his Department to modify the original classification—hence the possibilities of discrepancies in some cases between the figures prepared locally and those referred by the Registrar- General. Common Infectious Diseases.—The class known as Common Infectious Diseases, comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea is credited with causing the total of 9 deaths, equalling a Death Rate of 0.11 per thousand. Small Pox.—There were no deaths from Small Pox, this being the 44th year since a death occurred from this cause. Measles.—During the year there was one death arising from this cause. There were no deaths recorded for the years 1943, 1944 and 1945. Scarlet Fever.—This disease was responsible for one death during the year. 19 No deaths occurred in 1942 and 1943, one death in 1944 and none in 1945. Whooping Cough.—This disease was given as the cause of two deaths, with a Death Rate of 0.02 per thousand. There was one each for the years 1943 and 1944, and none in 1945. Diphtheria.—There was one death during the year. This gives a Death Rate of 0.01 per thousand. The deceased child was between the ages of 1—2 years and had not been immunised against Diphtheria. Three deaths occurred in 1942, three in 1943, seven in 1944 and one in 1945. Enteric Fever.—No deaths have been recorded from this disease since the year 1941, when there was one. Diarrhoea and Zymotic Enteritis.—Four deaths were stated to be due from this cause, equalling a Death Rate of 0.05 per thousand. Last year there were 13 deaths, 9 in 1944, 7 in 1943 and 0 in 1942. Tuberculosis.—This class includes the causes of 75 deaths during the year under review, giving a rate of 0.97. These figures compare with 64, 60, 50 and 53, the totals for the years 1942, 1943, 1944 and 1945 respectively, and the respective Rates of 1.05, 0.94, 0.81 and 0.82. Tuberculosis of the Respiratory System is, as usual, credited with the major portion of these deaths. There being 67 attributed to the cause, or a Rate of 0.87 per thousand as compared with 0.78 for the previous year. The deaths were allocated to: 18 in East Greenwich, 17 in West Greenwich, 6 in St. Nicholas, Deptford, and 26 in Charlton and Kidbrooke. The remaining forms of Tuberculosis were responsible for 8 deaths. Cancer.—This disease was responsible for a total of 137 deaths, with a Death Rate of 1.78 per thousand. The number of deaths for the previous 4 years were 141, 127, 130 and 127. The distribution of the deaths were as follow:—52 in East Greenwich, 43 in West Greenwich,. 7 in St. Nicholas, Deptford, and 35 in Charlton and Kidbrooke. 20 The sites of the affected parts were:— Cancer of buccal cavity and oesophagus (males only) 7 Cancer of Uterus 9 Cancer of Stomach and Duodenum 19 Cancer of Breast 4 Cancer of all other sites 98 137 Intra-Cranial Lesions of Vascular Origin.—This class which includes deaths arising from Cerebral Haemmorhage, Thrombosis, Hemiplegia, etc., was responsible for a total of 71 deaths. Of this number 15 died between the ages of 45-65 years and 53 from 65 years and upwards. Diseases of the Circulatory System—Heart Disease.—As usual, the deaths from this cause oooupied the principal place in the classification of diseases. There were 240 deaths under this class as compared with 226 for the previous year. Eighty-nine were allocated to East Greenwioh, 65 to West Greenwich, 13 to St. Nicholas, Deptford, and 73 to Charlton and Kidbrooke. Diseases of the Respiratory System.—Bronchitis was responsible for 40 deaths, and Pneumonia (all forms) 58 as compared with the total of 85 for the year 1945. The distribution of the deaths were, 30 in East Greenwich, 17 in West Greenwich, 10 in St. Nicholas, Deptford, and 41 Charlton and Kidbrooke. Deaths from Violence.—The number of deaths from this cause numbered 46. Of these 14 were from Suicide, 8 due to Road Traffic Accidents and 24 from various Violent Causes. 21 SECTION B General Provision of Health Services for the Area. Public Health Staff.—There were numerous changes in the personnel of the Department during the year. Dr. J. E. Howard relinquished his duties as Acting Medical Officer of Health upon my return from service with H.M. Forces in July. Dr. M. Macdonald, a former Medical Officer of Health who, during the war period, came out of retirement to undertake duties as Tuberculosis Officer, died in February and was succeeded by Dr. C. W. L. Jeanes. Sanitary Inspectors.—Mr. F.H.D. Boddy joined the staff in August whilst Messrs. Garrard and Archer left to take up other appointments. Health Visitors.—Four new Health Visitors took up duties during the year whilst one retired on health grounds. Miss Forrest, who had been engaged temporarily as Nurse at the Dispensary since 1944, was placed on the permanent staff. Clerical Staff.—Four members of this section were welcomed back from service overseas with H.M. Forces. Chiropodists.—Mr. H. Rosenstein was appointed as Senior Chiropodist in place of Mr. Philpott. Bacteriological Examinations.—The undermentioned specimens were submitted to the Seamen's Hospital Laboratory for bacteriological investigation, the results being:— Positive Negative. Total. Diphtheria 6 441 447 Tuberculosis 118 299 417 Typhoid — 2 2 Dysentry - 5 5 Miscellaneous - 19 19 Treatment Centres and Clinics.—Particulars relating to the local health services throughout the Borough are given below:— Infant Welfare Centres— Charlton Lane Friday 9.30 a.m. Chevening Road Tuesday 9.30 a.m. Wednesday 1.30 p.m. Thursday 9.30 a.m. Friday 9.30 a.m. Creek Road Monday 9.30 a.m. Friday 1.30 p.m. Shooter's Hill Road Monday 1.30 p.m. Tuesday 1.30 p.m. Rochester Way Thursday 1.30 p.m. Bardsley Lane Thursday 1.30 p.m. 22 Artificial Sunlight Treatment Centres— Charlton Lane Tuesday 1.30 p.m. Thursday 10 a.m. and 2 p.m. Chevening Road Daily 9.30 a.m. and 2 p.m. Creek Road Tuesday 2 p.m. Friday 9.30 a.m. Shooter's Hill Road Monday 9.30 a.m. Wednesday 9.30 a.m. and 2 p.m. Thursday 2 p.m. Friday 9.30 a.m. and 2 p.m. Centres for Expectant Mothers— Charlton Lane Friday 1.30 p.m. Chevening Road Monday 1.30 p.m. Tuesday 1.30 p.m. Wednesday 1.30 p.m. Friday 1.30 p.m. Creek Road Thursday 9.30 a.m. and 1.30 p.m. Shooter's Hill Road Tuesday 9.30 a.m. Friday 9.30 a.m. Diphtheria Immunisation— Devonport Laboratories, Tuesday 2.30 p.m. King William Walk, Friday 2.30 p.m. S.E.10. Maze Hill Clinic, 41 & 43 Maze Hill, S.E.10. The Council's Tuberculosis Officer is in attendance as follows:— Monday 2 p.m. Tuesday 10 a.m. and 2 p.m. Thursday 10 a.m. and 5 p.m. Dental Clinic— Monday and Wednesday afternoons at 105 Shooter's Hill Road, S.E.3, for patients referred from the Maze Hill Clinic and Welfare Centres. Craftwork Centre— Friday afternoons at 41 Maze Hill, S.E.10. Foot Clinics— Charlton Lane Monday 1 p.m. and 5.30 p.m. Chevening Road Thursday 2 p.m. and 5.30 p.m. Saturday 9 a.m. Creek Road Monday 1 p.m. and 5.30 p.m. Wednesday 9.30 a.m. and 2 p.m. Shooter's Hill Road Monday 9.30 a.m. and 2 p.m. Wednesday 9.30 a.m. and 2 p.m. Thursday 2 p.m. and 5.30 p.m. Friday 9.30 a.m. and 2 p.m. The charge is Is. per attendance. Scabies Clinics— Tunnel Avenue Daily St. Alfege's Hospital Annexe Men—Tuesdays and Fridays Women and Children—Daily Diabetes—Insulin Treatment.—During the year 12 cases were provided with Insulin under the special arrangements for assisting necessitous patients suffering from Diabetes at a cost of £52. 23 Foot Clinics.—Sessions were held regularly at each of the six Borough Centres throughout the year. The staff consists of 2 whole-time and 4 sessional chiropodists. A clerk-receptionist is also in attendance at each Centre. An advance booking system is in operation, thus avoiding tedious waiting. The charge is at the rate of 1/- per treatment. The Clinics continue to work at high pressure, the numbers attending during the year under review being as follow:— Shooter's Hill Road 3,966 Chevening Road 2,806 Creek Road 2,466 Bardsley Lane 1,059 Charlton Lane 868 Rochester Way 802 11,967 Artificial Sunlight Treatment.—Ultra-violet ray treatment was available throughout the year at Chevening Road, Shooter's Hill Road, Creek Road and Charlton Lane Centres. Arrangements were again made for children attending Day Nurseries to receive treatment upon the recommendation of the clinic Doctor. Particulars relating to the number of patients treated at the various Centres during 1946 are given in the following table:— Daily Sessions. Under 5 6—15 Over 15 Total Number under treatment at end of previous year 413 3 9 425 Number of New Patients 967 22 47 1,036 Discharges 1,119 14 51 1,184 Number under treatment at end of 1946 261 11 5 277 N umber of treatments given 18,019 307 775 19,101 The following table shows the type of abnormality among children up to 5 years of age treated during the year. In the majority of cases marked improvement was noted. 24 Conditions Treated Rickets and prevention of Rickets 211 Bronchial Conditions 69 Underweight 66 Anaemia and Debility 60 Colds 53 Skin Disorders (Eczema, etc.) 49 Sore Buttocks 43 Convalescence from Infectious Disease 39 Overweight 34 Enlarged Glands 16 Tonsillitis 15 Gastric Disorders 11 Rheumatism 9 Dental Caries 4 Insomnia 4 Torticollis 4 Asthma 3 Otorrhoea 2 Total' 692 MATERNITY & CHILD WELFARE. Infant Welfare Centres.—The year under review being the first complete year since the end of the World War has once again proved the popularity of the Welfare Centres. When it is realised that the population of the Borough has decreased by approximately 19,000 since 1938, it is interesting to note that the total attendance of babies at the Centres during the year, viz. 18,422, was almost the same as for the year 1938. This can to some extent be attributed to the very much higher birth-rate recorded. The actual number of new cases seen at the Centres was 1,440 as compared with 1,136 for the previous year and 897 for the year 1938. Particulars relating to the various Centres are given in the following tables:— 25 (a) Babies. Centre No. of Clinics No. of Attendances New Cases Medical Consultations Chevening Road 206 6,778 536 2,293 Creek Road 99 2,529 199 576 Shooter's Hill Road 102 3,963 314 1,190 Charlton Lane 51 1,946 170 660 Rochester Way 51 1,436 101 332 Bardsley Lane 51 1,770 120 534 Totals 560 18,422 1,440 5,585 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 206 3,279 156 1,474 Creek Road 99 1,088 27 368 Shooter's Hill Road 102 2,188 51 976 Bardsley Lane 51 659 53 220 Rochester Way 51 872 38 320 Charlton Lane 51 997 61 453 Totals 560 9,083 386 3,811 Ante-Natal and Post-Natal Clinics.—The number of new cases attending the various Centres was 1,569 as compared with 1,148 for the previous year. The numbers attending each Clinic were:— Centre No. of Clinics New Cases Total Attendances Chevening Road 232 733 4,639 Shooter's Hill Road 93 368 1,829 Creek Road 53 267 1,361 Charlton Lane 49 201 1,129 Totals 427 1,569 8,958 *Includes 142 Post-Natal cases. 26 Other Ante-Natal Services.—In addition to the facilities provided at the Borough Council Centres, 461 women received treatment at St. Alfege Hospital, making approximately 2,760 attendances, whilst the British Home for Mothers and Babies, Woolwich, was responsible for Ante-Natal supervision for 160 patients who made 900 attendances. Infantile Mortality.—The number of deaths under one year of age was 59 as compared with 52 for the previous year, representing an Infantile Mortality Rate of 34 per 1,000 live births, compared with 43 for England and Wales and 41 for the County of London. This is the lowest Infantile Mortality Rate ever recorded in the Borough, with the exception of the years 1941 and 1942 when the figures were 31 and 32 respectively. (During those years, however, owing to evacuation and war conditions generally, dependable figures were difficult to obtain). Prior to the introduction of the Maternity and Child Welfare Act, 1918, the Rate was over 100 and the marked saving in infant life, mainly as a result of the Council's comprehensive Maternity & Child Welfare Scheme, will be appreciated. The causes of the 59 deaths were:— Premature Births 20 Pneumonia and Bronchitis 12 Congenital Malformation 6 Atelectasis 5 Asphyxia 5 Gastro-Enteriiis 4 All other causes 7 Of the above number, 42 were male and 17 female. Infants dying before attaining the age of one month numbered 35, equivalent to 59.3 per cent of the total Infantile deaths—all but 2 dying in the first week. As usual, the principal causes of death were Prematurity and Atelectasis. Enquiries are made in connection with all infantile deaths. In 23 cases the mother had not attended the Council's Ante-Natal Clinics, but 16 had attended either Hospital or Nursing Homes; 4 had been under the care of General Practitioners or Midwives. In the remaining 3 cases, one had received no supervision whatever, no history being available in regard to the remaining 2. Deaths of Children between 1 and 5 Years of Age.—The number of deaths of children between the age of 1 and 2 years was 7, and between 2 and 5 years—3. The corresponding figures ten years ago were 11 and 19 respectively. 27 Maternal Mortality.—The number of deaths from Puerperal Sepsis and other Maternal Causes was 2, which gives a Maternal Death Rate of 1.15 per 1,000 total births. In the years 1945, 1944, 1943, 1942, there were 2, 1,0, and 1 deaths respectively. Dental Clinic.—The Council's Dentist, Mr. G. F. Ferris, L.D.S., R.C.S.(Eng.), attends at the Dental Clinic, Shooter's Hill Road, once a week to deal with cases referred to him from the Welfare Centres and Clinics. To enable him to cope with the increasing number of "fillings and scalings" an extra session is held on Mondays. The following Return shows the work performed during the year:— M. & C.W. Number of Sessions 78 Number of Patients 282 Number of Attendances 772 Number of Extractions 931 Number of Extractions (Gas) 145 Number of Dentures supplied 80 Number of Fillings and Scalings 194 Supply of Milk to Mothers and Children.—The Council's scheme for the provision of dried milk to mothers and children is still in operation, though, of course, on a reduced scale since the introduction of the National Scheme. The following Table shows the amounts distributed at the various Welfare Centres during the year:— M. & C.W. Scheme. Under National Scheme* (a) Distributed free 1,138 lbs. Full Cream 17,290 lbs. (b) Sold at full or reduced prices 33,936 lbs. Half Cream 472½ lbs. *Information kindly supplied by Ministry of Food, Local Office. Supply of Vitamins to Expectant Mothers and Children.— As in previous years, vitamin products are available at the Welfare Centres. The following quantities were distributed under the arrangements with the Ministry of Food. Cod Liver Oil 14,625 bottles Orange Juice 79,158 bottles A. & D. Tablets 3,775 packets Institutional Provision for Mothers and Children.— Cases requiring convalescent home treatment, who are recommended by the Medical Officer of the various Centres, are considered by the Maternity and Child Welfare Committee. 28 During the year 10 children were sent to Homes arranged through the I.C.A.A. for periods varying from one to three months. It should be mentioned that many of the Convalescent Homes utilised by the Association have not yet been re-opened, and this, together with staffing difficulties, has resulted in a long waiting period before a case could be accepted for admission. There were no Mothers in need of convalescence. Home Nursing.—Children attending the various Centres who are found to be in such a condition as to require special nursing at home are referred to the various Nursing Associations operating in the Borough. The Council pay 1/- per visit to the Queen's Nursing Association, and for many years contributed a sum of £50 per annum to the Ranyard Mission in regard to the services of the Ranyard Nurses. In consequence of adopting the recommendations of the Rushcliffe Committee, the Council agreed to a revision of the annual grant and now pay the Mission on a basis of 2/2d. per visit. The total number of cases referred from the Centres was 91. Home and Domestic Help Schemes.—The Domestic Help Scheme inaugurated last year is now incorporated with the Home Help Scheme. One whole-time Home Help is emp.oyed and a panel of 13 women are available as required. A total of 107 applications were dealt with during the year, of which 95 were in respect of confinement cases, the remainder being required either for illness or elderly and infirm cases. The duration of stay for confinement cases was two weeks, except in six instances, where this was extended on medical grounds. Regarding the domestic cases, the periods varied according to the needs of the applicant and the availability of the service. There were in addition a number of illness cases where the applicant desired the service of a Home Help for a few hours a day only for a limited period. In such cases the applicants were placed in contact with a Home Help on the panel and asked to make their own arrangements for assistance. Although the number of cases dealt with have varied considerably, on no occasion was it necessary to decline assistance owing to a Home Help not being available. The total amount received from applicants towards the cost of the services given was £415 9s. Od. Child Life Protection.—The supervision of foster children 29 and the homes of foster mothers is carried out by the Health Visitors who made 82 visits during the year. The number of foster mothers on the Register at the end of the year was 14, and the number of children 17. Care of Illegitimate Children.—The Council continue to assist financially Moral Welfare Associations in connection with their work for the care of illegitimate children. The Health Visitor also co-operates with the Associations when called upon. Care of Premature Infants.—The procedure outlined in M.H. Circular 20/44 has again been followed. The total number of Premature Births in the Borough, i.e., Residents and Non-Residents was 172. Of these 15 were born at home and 157 in hospitals. Of the domiciliary births 8 were entirely nursed at home, 2 died within 24 hours and 11 survived at the end of one month; whilst 28 of those born in hospital died during the first 24 hours and 110 survived at the end of one month. 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. The applicant must produce a certificate signed by the Midwife who has been booked for the case, that she is genuinely in need of additional sheets. The maximum number of dockets granted to each applicant is 3. A total of 1,730 dockets were issued during the year. Day Nurseries.—Early in the year the Council were asked to consider as to the continuance of the War-Time Nurseries. In view of the changed conditions it was decided to transfer the Shooter's Hill Road and Pound Park Road Nurseries to the London County Council for use as Nursery Schools or Classes, in addition to the portion of the Conley Street Nursery utilised for children between the ages of 2 and 5 years. The remaining part of the Nursery accommodating children up to 2 years continues to be administered by the Borough Council. Negotiations were carried out very smoothly and the transferace duly took effect on the 15th April, 1946. 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:— 30 Health Visitors' Visits, &c., 1946. Table A. Visits Re-visits Total Infants under 1 year 1,666 1,943 3,609 Children 1—5 years 163 3,537 3,700 Measles (under 5 years) 518 8 526 ,, (over 5 years) 449 3 452 Whooping Cough (under 5 years) 144 28 172 „ „ (over 5 years) 102 11 113 Pneumonia 7 3 10 Puerperal Pyrexia and Fever 17 — 17 Diarrhcea 16 1 17 Ophthalmia Neonatorum 5 3 8 Inflammation of Eyes 11 5 16 Chicken Pox 2 3 5 3,100 5,545 8,645 Table B. Visits Re-Visits Totals Maternity Survey 14 — 14 Dental Treatment 62 — 62 Ante-Natal Cases 823 180 1,003 Children Act 36 46 82 Miscellaneous 794 366 1,160 Infant Consultations 531 531 Ante-Natal Clinics 425 425 Dental Clinic 75 75 In addition to the above 807 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 461 1,053 - - Nursing Homes — — 9 106 Other Residences 2 1 — 2 At home 711 — — — 1,174 1,054 9 108 Other Boroughs (Transfers Inwards) 517 — — — 1,691 1,054 9 108 31 From a perusal of the above Table it will be seen that 2,345 births actually took place in the Borough. Of this number 1,162 were transferred to Other Authorities. Against this, 517 births which occurred in other areas were allocated to Greenwich, thus giving a nett figure of 1,700—an increase of 682 over the previous year. 32 SECTION C Sanitary Circumstances of the Area Intensive work has been carried out during the year by the Sanitary Inspectors in maintaining a reasonable state of living conditions in the existing houses. The volume of necessary inspections and revisits coupled with shortage of staff has greatly handicapped constructive effort. House-to-house inspection has been found impossible to carry out. Following a report to the Health Committee, sanction has now been given to the appointment of an additional District Inspector and it is hoped that in the near future it may be possible once again to carry out inspections under the Housing Act. The Tables on pages 38 and 39 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 16,137 houses and premises have been inspected or re-inspected during the year. 2,458 Intimation Notices and 325 Statutory Notices have been issued. Factories Act, 1937.—There has been a steady increase in the number of Factories in the Borough ; many of the extensions commenced in the previous year have now been completed. It is pleasing to record the co-operation given by employers of labour in meeting with the Local Authorities' requirements. The workers have been adequately catered for by the enforcement of the provisions dealing with washing and drying facilities, canteen quarters, sanitary accommodation, etc. Much has been achieved in recent years owing to the appreciation by industrial undertakings of the value of hygienic conditions in factory buildings. Owing to varying circumstances it was not possible to carry out routine inspections during the year under review but 213 visits were made by the Inspectors to factories where mechanical power is used and 26 visits to other factories. Factories where Women are Employed.—Since the termination of the war there has been some diminution in the employment of women. As a general rule employers continue to show an increased interest in the welfare of their women workers, although their efforts are hampered by the general shortage of necessary material. Outworkers.—Premises where homework is carried on were visited on 30 occasions by the Woman Inspector. No case of Infectious Disease was reported during the year. It is significant 33 to note that the number of Outworkers has increased, which indicates that many married women with home ties prefer to work in their own time. The majority of the homes inspected were found to be very satisfactory. Disinfestation of Verminous Premises.—The work of disinfestation of verminous houses has continued on the lines noted upon in previous Reports. The Sanitary Inspectors dealt with 181 cases where the rooms were either verminous or dirty; in addition the Disinfestation Staff sprayed 481 rooms and contents with vermicidal fluid, whilst in 24 cases bedding, etc., was removed to the Council's Disinfecting Station and treated by steam disinfection. Aged, Infirm and Physically Incapacitated Persons.— Cases of infirm persons who are unable to maintain a standard of cleanliness owing to senility or ill-health are usually brought to the notice of the Department through complaint by neighbours. Such cases were visited on 72 occasions by the Woman Sanitary Inspector. By means of these visits, much is done to encourage the individuals to take an interest in their own welfare. In addition, Domestic Help has been provided through the Council's Scheme to assist in keeping accommodation clean and tidy. This assistance usually entails the provision of a few hours per week of time in cases recommended to the Committee. Shops Act, 1934.—During the year 43 visits were made under the provisions of the above Act, and it was only necessary to serve 3 notices for infringements. No applications for Certificates of Exemption in regard to the provision of sanitary convenience accommodation were received. Drainage.—Seventy-five plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. 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 referred to in Part II of the Poisons List. These chiefly relate to the Sale of Poisons used for domestic, horticultural and sanitary purposes. During the year 17 applications to sell poisons under Part II were received and granted and 46 applied for retention in the Council's list. Baths and Washhouses.—The water at the Public Baths has been subjected to periodical tests. Adverse reports of a minor character were received only on two occasions. Subsequent 34 gation pointed to slight defects in the chlorination system and adjustments to the machinery were accordingly made with satisfactory results. The number of attendances during the year were as follow:— Slipper Baths 94,766 Swimming Baths 102,521 Vapour Baths 7,627 Public Washers 11,705 It is interesting to observe the numbers attending the Vapour Baths were over 100% more than in the years 1937 and 1938. Rent and Mortgage Interest (Restrictions) Acts, 1920.— 1939. 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 twenty applications were received and certificates were duly granted. Landlords may also apply to the Sanitary Authority for a report that the necessary works had been executed to the satisfaction of the Council. Seven applications were received, and reports duly granted. Water Supply.—During the year 516 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 95 cases and extra water supply to tenement houses in 11 cases. Rodent Control.—The source of information of infestation of rats or mice from premises in the Borough, other than in relation to the Council's property, is usually on receipt of casual complaint. Each case is investigated by the Assistant Rodent Control Officer and advice and assistance given where necessary. The methods adopted have been pre-baiting and poisoning and in a few cases, gassing, trapping and the use of ferrets by a professional ratcatcher. From the 1st January to 13th October, 279 complaints were received. In 134 cases it was reported the premises had been cleared. Control Scheme approved by the Ministry of Food.—The Council decided to participate in the special Rat Campaign sponsored by the Ministry of Food during 1946 on a grant basis from the Ministry of 60% of its cost. Sixteen Special Investigators and Operatives were appointed. A 35 team comprising 1 Investigator and 3 Operatives were attached to the following areas:—Blackheath and Kidbrooke, East Greenwich, Charlton, and West Greenwich. From the 14th October each team working under the supervision of the District Sanitary Inspector conducted a systematic house-to-house survey. Report sheets were handed to the Record Clerk for collation and statistical purposes. All premises shewing evidence of infestation were treated in accordance with procedure adopted by the Ministry of Food. Prebaits consisting of clean sausage rusk were laid at suspected points for a period of four days and then followed by a poison bait of zinc phosphide. Soon after the commencement of the scheme it was realised that owing to the large number of business premises and wharves in the Borough it was necessary to transfer one team to deal solely with these premises and the following scheme was adopted. The investigator was provided with special forms of request for. treatment. These were then handed to the proprietor or responsible official of the firm concerned and when the document was signed treatment was immediately put in hand. The charges made were based upon the size of the business and the work entailed, the minimum charge being 5/-. When the premises were clear of infestation and the applicant satisfied, information was sent to the Borough Treasurer with the appropriate charge assessed and an account rendered for payment. From the inception of the scheme until the end of the year no less than 7,566 premises were visited and where necessary, investigations made. Of this number 310 were found to be infested by rats and 107 by mice. In addition many bombed sites were also investigated and these were found to afford excellent harbourage. Many difficulties were encountered at several of the factory premises, chiefly owing to the nature of the business concerned. While a satisfactory measure of success has been attained, there have been several instances of re-infestation. In 6 cases drainage defects were discovered and remedied. The following figures shew in detail the work performed at business premises :— Pre-Bait and Post-Bait Poison Bait Complete Takes 246 23 Good Takes 261 73 Small Takes 421 257 No Takes 1,129 280 Baiting of Sewers.—The Borough Engineer has kindly supplied me with the undermentioned information of the treatments carried out in the Council's sewers in connection with the scheme :— The following figures shew in detail the work performed at business premises:— Pre-Bait and Post-Bait Poison Bait Complete Takes 246 23 Good Takes 261 73 Small Takes 421 257 No Takes 1,129 280 Baiting of Sewers.—The Borough Engineer has kindly supplied me with the undermentioned information of the treatments carried out in the Council's sewers in connection with the scheme:— 36  Date of Treatment 2nd to 12th Dec., 1946. 11th Feb., 1946, to 6th April, 1946. 1. No. of Manholes in foul and connected systems 963 914 2. Bait base and poison used Rusk and zinc phosphide 3. No. of Manholes baited 935 893 4. No. of Manholes showing prebait takes 620 695 5. No. of Manholes showing complete takes 440 246 6. Schemes of baiting used (e.g., consecutive days or 1st, 3rd and 5th days) Consecutive days Consecutive days 7. No. of Manholes test-baited in conjunction with this treatment and not included in No. 3 above 60 - Scavenging and Refuse Disposal.—The collection of refuse in the Borough is under the control of the Borough Engineer who has kindly supplied me with the following information relating to disposal:— " 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 was maintained until December, 1946, when a weekly collection of house refuse was resumed, the salvage being collected fortnightly. During the period of bombing several of the Council's vehicles engaged on salvage and cleansing services were destroyed by enemy action, and although a number of new vehicles have been put into commission the full number required to complete this organisation have not yet been delivered, including two of the latest type totally enclosed hygienic refuse collecting vehicles. A considerable number of new, rebuilt and repaired properties are daily becoming occupied with the consequent increase in the amount of material now being collected, a great proportion of which is coming from the outlying areas of the Borough which are being developed as Housing Sites. 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 to dumps down the River Thames under the " controlled tipping system." During 1946 a total tonnage of approximately 17,400 tons of house and street refuse was disposed of by this method. The amount 37 of pig food and saleable salvage (comprising paper, metals, rags, bones, etc.) collected during the same period was approximately 2,600 tons, from which a considerable income was derived." Public Sanitary Conveniences, Etc.—The public sanitary conveniences of the Borough are situated in the main arteries of traffic. The convenience at Charlton House was closed in January, 1945, owing to extensive damage by enemy action. Towards the end of the year negotiations were in operation to purchase a site to erect a convenience to provide accommodation for persons in the Woolwich Road district, near Anchor & Hope Lane, Charlton. This is an important industrial area and is also frequented by large crowds visiting adjacent sporting grounds. Appended is a Table showing particulars of the Public Conveniences provided by the Council:— Particulars of Public Sanitary Conveniences in the Borough. Convenience Men Women W.C.s Lavatory Basins Urinal Stalls Open Close W.C.s Lavatory Basins Open Close a.m. p.m. a.m. p.m. Batley Park, Blackheath 6 0 12 4 2 Blackheath Hill (foot of) 3 - 10 4 - Blackwall Lane, East Greenwich 5 2 16 4 2 Blackwall Tunnel 3 - 6 5 - Creek Road, St. Nicholas, Deptford 4 2 10 7.0 10.0 4 2 7.0 10.0 King William Walk (near Greenwich Park) 4 2 9 7 2 Shooter's Hill Rd. (junction of Wellhall Rd.) 3 1 6 3 1 Greenwich South Street (near Town Hall) 4 1 10 4 2 Totals 32 10 79 35 11 Note :—Women's Conveniences are without an attendant between 7 a.m. and 9 a.m. On Sundays, Conveniences open at 10 a.m., with the exoeption that Batley Park (Men) opens at 9 a.m. 38 The following are the Drinking Fountains and Horse Troughs in the Borough, which are cleansed daily by the attendants attached to the Department:— Drinking Fountains. Church Lane, Charlton. Westcombe Hill, Blackheath. Blackwall Lane, East Greenwich. South Street, West Greenwich. Armada Street, Deptford. Blackheath (Greenwich Park Gates). Blackheath (Andrew Gibb Memorial). Blackheath Hill, West Greenwich. Horse Troughs. Church Lane, Charlton. Westcombe Hill, Blackheath. Tunnel Avenue, East Greenwich. Creek Road, Deptford. Armada Street, Deptford. Summary of Work Performed by the Sanitary Inspectors during the Year 1946 INSPECTIONS- Houses inspected (Complaints, nuisances) 3,034 „ „ (Infectious Disease) 220 ,, ,, (Overcrowding) 506 Re-inspections, calls made, etc. 10,151 Inspections of Factories 239 ,, ,, Shops 43 „ „ Stables and yards 9 „ „ Urinals 28 „ „ Miscellaneous 167 ,, „ Houses let in Lodgings 20 „ „ Outworkers premises 30 Inspection of Premises (Pharmacy and Poisons Act, 1933) 13 Investigations (Rats and Mice) 715 On notice from Builder 962 16,137 Drains— Drains tested—by smoke 20 „ „ —by water 78 Opened, cleansed and repaired 239 Reconstructions and additions 99 Inspection chambers constructed 65 New covers to manholes 45 Roil and vent shafts repaired or renewed 73 Traps (gully) 91 Drains sealed off, etc. 28 Yards and forecourts drained 45 39 Waterclosets and Urinals— Closets erected 31 W.C.s repaired 198 Sanitary conveniences or improvements effected to Factories, Workshops and Workplaces 21 Pans or traps furnished 267 Urinals cleansed or repaired 26 Dustbins— Provided 137 Pavings— Yards and Forecourts 53 General Water Supply— Water Fittings amended 95 Extra water supply to tenement houses 11 Water supply certificates granted (Sect. 95) 516 • Other Improvements— Houses generally repaired 170 Rooms cleansed and repaired 838 Rooms and staircases lighted and ventilated 72 Verminous rooms cleansed 181 Roofs, gutters and rainwater pipes repaired 1,233 Dampness abated 328 Sinks, baths and lavatory basins 212 Sink, lavatory and bath waste pipes trapped or amended 274 Stoves and fireplaces 162 Washing coppers repaired or provided 31 Floors repaired 228 Provision for storage of food — Miscellaneous repairs 443 Other Nuisances Abated— Illegal use of Underground room discontinued - Overcrowding abated 79 Animals kept in unfit places discontinued or removed - Dung receptacles provided — Houses abolished, unfit for habitation - Accumulation of manure and other obnoxious matter removed 9 Rat infestation abated 155 Smoke Nuisances— Observations - Statutory Notices served (Sects. 147 and 148) — Notices, &c — Intimations served under Public Health (London) Act, 1936 2,458 Statutory Notices served 325 Houses rendered fit by informal action 185 40 Legal Proceedings Premises. Offence. Result of Proceedings. 26 /44 (Even), Ormiston Non-Compliance with Abatement Orders made. Road. Statutory No tire. 78, 84 & 88, Earlswood Do. Do. Street. 61, Lenthorp Road Do. Adjourned sine die in view of Defendants abating nuisance. 50, Invicta Road Do. Do. 41 SECTION D Housing. Repair of War Damaged Dwellings.—The work of repairing war damaged houses has continued to be carried out by Contractors controlled by the Council and it can be stated fair progress has been made with the re-instatement of these dwellings. There are many properties in the Borough which would normally have been dealt with under Housing Act procedure. These houses have further deteriorated and owing to the difficulty of enforcing even essential repairs, have become neglected. In many cases, builders have had to contend with the restriction in the issue of building licences. Work has also been delayed owing to the shortage of materials and labour and there is no doubt much inconvenience and discomfort has been experienced by the tenants concerned. Points System.—At the commencement of the year a "Points" system was introduced by the Council to deal with the enormous number of applications for housing accommodation. The scheme provides for dividing the type of applications into five groups and awarding points to applicants falling within each group, thus the applications are sifted and placed in order of priority. Housing of Homeless Persons.—A total of 1,201 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, or who are otherwise inadequately housed. New Housing Accommodation.—The undermentioned dwell ings were erected and occupied during the year:— Emergency Factory-made Dwellings 348 L.C.C. Brook Estate (Permanent Houses) 164 Borough Council (Re-built) 2 Private Enterprise 2 Concrete-Hutment (ex Admiralty) 1 517 Post-War Housing.—Steady progress continues to be made in the area known as the Cherry Orchard Site and the first portion was nearing completion at the end of the year. The following Table shows the programme of proposed developments:— 42 Housing Programme Site. No. Type. Accommodation. Position at end of 1946. Cherry Orchard 112 Flats in 7 blocks each of 4 storeys Living room, 3 bedrooms, kitchen, separate bathroom and W.C.; pram and cycle shed. Work in progress; portion nearing completion. Cherry Orchard 48 Houses, semidetached 'Orlit' pre-cast block concrete. Living room, dining room, kitchen, 3 bedrooms, separate bathroom and W.C. Work in progress. Cherry Orchard (Marlborough Lane) 28 2-storey permanent brick-built houses. 4 blocks of 4 storeys; 56 pairs of semidetached houses. Living room, dining room, kitchen, 3 bedrooms, bathroom, separate W.C., outside W.C. and fuel store. Work commenced. Coldbath Street < 128 Flats in 4 blocks, each of 4 storeys Living room, dining room, kitchen, bathroom, separate W.C. 6 will contain 4 bedrooms 73 will contain 3 bedrooms 49 will contain 2 bedrooms Layout approved by L.C.C. Victoria Way (South) • 74 Flats in blocks 3 blocks of 2 storeys 10 blocks of 3 storeys 1 block of 4 storeys Living room, dining room,kitchen, bathroom and separate W.C. Garage accommodation. 68 will contain 3 bedrooms 6 will contain 2 bedrooms Scheme approved. Extension of East Mascalls (late Champion Terrace) 24 Flats for aged persons 2 blocks of 3 storeys each. 12 combined bed sitting room. 12 one-bedroom, each with kitchen, combined bathroom and W.C. Tender accepted—work about to start. Overcrowding.—The number of cases of overcrowding reported during the year was 506. These were investigated by the Sanitary Inspectors and 261 were found to be overcrowded according to the standards laid down by the Housing Act 1036. Seventy-nine of these cases were granted new accommodation on the L.C.C. Housing Estates. 43 SECTION E Inspection and Supervision of Food Much of the work in connection with our food and food supply is restricted in so far as the premises and equipment are concerned, due to damage caused by enemy action. Shortage of labour and materials which are being devoted to housing priorities restricts the progress which should normally result from the efforts of our Food Inspectors. While the peace-time standards have not been reached in all respects, the traders have shown a willingness to co-operate and with the improvement of building materials and supplies, even higher standards than hitherto should be attained. Much time has been given to the inspection of imported and home-produced foods with a view to ensuring a wholesome food supply and reducing waste to a minimum. Milk Supply.—Under the direction of the Milk Marketing Board there has been little change in the source of supplies to this Borough. No milk is produced locally, bulk transport being responsible for the transit into the Borough of milk produced largely in the Home Counties. Only approved designated milks are on sale in this area—raw milk is unobtainable. Pasteurisation or similar heat-treatment is general. Milk and Dairies (Amendment) Act, 1922—Milk and Dairies Regulations 1926-1943.—At the commencement of the year, there were 71 purveyors of milk on the Register of Dairies and Milkshops, 2 new applications have been received during the year and added to the Register and 2 were struck off, thus leaving a total of 71 purveyors and dairy premises registered. Special attention has again been given to dairy premises to ensure that the provisions of the Milk and Dairies Regulations have been observed, particularly with regard to washing and cleansing of milk vessels and utensils, and use of adequate detergent. In all, 198 visits of inspection were made as a result of which the following defects, etc., were noted and remedied. Action taken re dairy premises:— New Bottling Machines installed 2 Bottling Machines overhauled 2 Dairies cleansed and limewashed 11 Ceilings repaired 1 44 Milk (Special Designations) Regulations, 1936-1946.— These regulations concern the issue of Licences for the sale of milks known as Tuberculin Tested, Accredited and Pasteurised. During the year the following Licences were granted:— Principal Licences Distribution of Tuberculin Tested Milk 5 „ Pasteurised Milk 20 * Supplementary Licences Distribution of Tuberculin Tested Milk 9 „ Pasteurised Milk 10 Heat Tkeated 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 83 samples were taken under this Order, and of these 6 failed the Methylene Blue Test and 1 the Phosphatase Test. Particulars of the unsatisfactory samples were forwarded to the Area Milk Officer of the Ministry of Food. Bacteriological Examinations of Milk.—In accordance with arrangements with the L.C.C., the sampling of milk at L.C.C. Hospitals and Schools was resumed towards the latter end of 1946 so far as a reduced personnel permitted. Results of these examinations are reported quarterly to the L.C.C., while in the case of the unsatisfactory samples the information is communicated immediately to both the L.C.C. and the Area Milk Officer of the Ministry of Food. On the 1st March, 1946, the Orders relating to Bacteriological Examinations, based on the plate count, were rescinded by the Ministry of Health and the Methylene Blue and Phosphatase Tests, having proved more accurate, substituted in respect of Specially Designated milks subjected to Heat treatment. Analytical Examination of Milk.—Seventy-seven samples of milk were taken, of which one was found to be adulterated or below the standard fixed by the Ministry of Agriculture and Fisheries. * Supplementary Licences are granted in cases where licensed premises are situated outside the District and the Vendor desires to sell within the Borough. 45 As this sample was only slightly deficient in milk solids other than fat no action was deemed necessary. Food Rejected.—The amount of food rejected is shown in the following summary:— Meat Depot— Meat (canned) 1,539½ lbs. Hindquarters of Beef 767 „ Beef Trimmings 13 „ Pork 75½ „ Lamb Carcases 340 „ 2,735 lbs. Shops— Meat (canned) 315¾ lbs. Meat (fresh) 612¾ ,, Fish 2,956 „ Poultry 39 „ Biscuits and Cereals 346 „ Chocolate 60 „ Oranges 729 „ Onions 12 „ Fruit and Vegetables 70 „ Provisions (various) 9,924 „ Provisions (canned) 2,110¾ „ 17,175¼ lbs. Slaughterhouses and Knacker's Yards.—Owing to the enforcement of the Livestock (Restriction of Slaughtering) Order, 1940, the two existing slaughterhouses have not been used and during the year the Knacker's Yard has, of its own volition, closed down and transferred its activities to another locality. Public Health (Meat) Regulations, 1924-1933.—These regulations provide for the supervision of slaughterhouses, butchers' shops, stalls and the protection of meat against contamination by dirt and flies, etc., in transport and handling. Butchers' shops and stalls are under the constant supervision of the Inspectors and proceedings are only instituted after flagrant disregard of the Officer's warning. It was not found necessary to caution Vendors during the year and in spite of staff deficiencies, etc., the standard of hygiene in butchers' shops was never so high. Public Health (Imported Food) Regulations.—The Metropolitan Borough of Greenwich with a river frontage of five miles, with more than 30 wharves and two of London's largest and most modern cold stores receives a considerable percentage of London's imported meats stored on behalf of the Ministry of Food. In addition, considerable quantities of fresh fruit, tinned foods and 46 miscellaneous provisions are dealt with. Visits to wharves and cold stores are made by the Food Inspectors and imported food generally is carefully supervised. Such are the storage facilities of the Greenwich Wharves that the Ministry of Food has seen fit to utilise a very large area of warehouse space for food and raw materials, the tonnage of which is far in excess of that of pre-war years. Imported Food Rejected.—During the year 1946 the following unsound or diseased imported foods were surrendered. The meat was passed for non-edible and refining purposes only, and other unsound food was processed for stock feeding. The following foods were rejected at Wharves:— Meat— Lamb and Mutton Carcases 363 lbs. Lamb Trimmings 171 „ Beef 10 „ Meat (canned) 2,516 „ Other Foods— Flour, Canadian 78,260 lbs. Fruit Pulp 44,107 „ Fruit (tinned) 2,347½„ Fish (canned) 92 „ Milk (tinned) 628 „ Caseous Lymphadenitis.—During the year the following carcases, etc., were examined for this condition and the results of the examinations were as follows:— Muttton Carcases Landed Examined Rejected Weight 142,923 1,458 6 shoulders 33 lbs. Mutton Cuts (bags) 9,543 187 1 leg 9½ lbs. Sides of Mutton 1,176 12 Merchandise Marks Act, 1926.—Under the powers conferred by this Act, Orders in Council have been made prohibiting the sale, or exposure for sale, of imported foodstuff's unless such bear an indication of the country of origin. Routine inspections are made to secure compliance with the various Orders but for the year in question on no occasion was it found necessary to take action against vendors. 47 Supervision of Premises Including Factories where Food is Prepared.—Included among the premises where food is prepared are flour-millers, brewers, mineral water, pharmaceutical sundries and fruit canning factories ; 3,940 inspections have been made of these premises and a satisfactory state of hygiene is maintained. It was found necessary to serve notices, to cleanse and limewash or otherwise improve premises, on 72 occasions—improvements being effected mainly on verbal instructions. Food Premises. No. of Visits. No. of Improvements effected. Knacker's Yard 18 - Caterers 695 69 Butchers 346 16 Meat Depot 177 1 Dairies and Milkshops 198 7 Wharves 122 2 Bakehouses 186 25 Fried Fish Shops 198 13 Eel and Pie Shops 13 Shellfish Shops 79 6 Preserved Food Shops 174 9 Ice Cream Shops 205 7 Brewery 1 — Mineral Waters 5 - Other Food Premises 534 18 Miscellaneous Visits 546 - Sampling Visits, Food & Drugs Act 448 — 3,940 173 Blackheath Fair.—In order to ensure that a safe standard of cleanliness is maintained amongst the numerous vendors of light refreshments, including shellfish, stewed eels, ice cream, minerals, etc., a Food Inspector is in attendance on all Bank Holidays. There, vendors cater for the needs of thousands of visitors and constant supervision of the food stalls is therefore necessary. With the passage of time it has been noted that the " Sanitary Idea " has taken root. Such is the spirit today that the Inspector is proudly invited to see the new equipment or improved apparatus obtained by the > tallholders. (A clean water supply and adequate sanitary accommodation is provided by the London County Council Parks Department). Street Traders.—There are 86 Street Traders who are engaged in selling articles of food and licensed in accordance with the provisions 48 of the London County Council (General Powers) Act, 1927. Generally speaking, it was found that the premises where such articles of food were stored, were in all respects reasonably clean. Food and Drugs Act, 1938.—In accordance with the provisions of the above Act, all premises with the exception of clubs, hotels or restaurants used:— (а) for the sale or manufacture for the purpose of sale of ice cream or other similar commodity, or the storage of ice cream or other similar commodity intended for sale; or (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish, or other food intended for sale; are required to be registered by the owner or occupier with the Sanitary Authority. Ice Cream Premises.—With the resumption of supplies of raw materials and the great demand for ice cream, due largely to sugar and sweets rationing, certain manufacturers and vendors offered the public products of low quality and doubtful purity. Pending the issue by the Ministry of Health of more stringent control regulations, the need for improving premises, equipment and methods employed in the newly resuscitated ice cream trade was apparent. Scientifically approved bacteriological standards of purity were adopted by this department and measures were taken to impress the trade with the urgent need for greater cleanliness. Apart from advocating heat-treatment and sterilisation of equipment, the elimination of unhygienic wafer-servers has been largely successful. During this year 39 samples of ice cream were taken for bacteriological examination, 10 of which failed to reach the relatively high standards adopted by this Borough. At the end of the year 104 premises were registered for the sale, manufacture or storage of ice cream and these premises were inspected on 205 occasions. As a result of the inspections, insanitary conditions were remedied, and premises improved in 7 instances. Preserved Meat, etc., Premises.—At the end of the year 105 premises were on the register and were visited on 174 occasions. As a result of such inspections insanitary conditions were detected and remedied in 9 cases. 49 Sampling of Foods.—During the year, 433 samples were submitted to the Public Analyst for analysis, of these 89 were formal and 344 informal. The number of samples reported as adulterated or not otherwise up to standard was 11 (10 informal and 1 formal), equivalent to 2.5% of the total samples examined. After investigations, it was not found necessary to institute legal proceedings against vendors of the non-genuine samples. Public Health (Dried Milk) Regulations, 1923 and 1927.—Four samples were taken during the year of which 3 were found to comply with the above regulations. Particulars of the non-genuine sample were forwarded to the Ministry of Food for appropriate action. Public Health (Condensed Milk)Regulations, 1923-1927.—Twelve samples were taken during the year and in ten instances were reported upon as genuine. The remaining samples were found not to comply with the labelling regulations and the particulars were reported to the Ministry of Food for necessary action. 50 SECTION F Prevalence of, and Control Over, Infectious and Other Diseases. The total number of infectious diseases notified, excluding Tuberculosis, was 1,605 as compared with 1,102 for the previous year. Of the 1,605 notifications received, in 25 cases the diagnosis was not confirmed, thus giving a corrected figure of 1,580 cases. Particulars relating to age groups and districts are shown in the tables at the end of the Report. Smallpox.—No cases of this disease were notified during the year. There were, however, several contacts reported arriving in the Borough from abroad : these 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.—There were 902 cases of Measles notified as compared with 341 for the previous year and 330 for the year 1944. Twenty-three cases were removed to hospital. The outbreak began in February and reached the peak during April, when 80 cases were notified in one week, after which the number gradually diminished and finally subsided in August. One of the cases proved fatal. Whooping Cough.—Two hundred and eleven cases were notified as compared with 133 for the previous year: 101 occurred in East Greenwich, 30 in West Greenwich, 12 in St. Nicholas Deptford and 68 in Charlton and Kidbrooke. Eighteen cases were removed to hospital for treatment. There were two fatal cases. As in the case of Measles, every case nursed at home 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 patients. Twenty-one children were immunised against Whooping Cough at the Seamen's Hospital. Diphtheria.—The number of patients notified by Medical Practitioners as suffering from this disease was 42 as compared with 54 for the previous year and 59 for the year 1944. All the cases were removed to hospital for treatment. Fourteen cases, however, were reported by the hospital authorities to be suffering from diseases other than Diphtheria so that the number was accordingly reduced to 28. The distribution of the cases was 5 in East Greenwich, 10 in West Greenwich, 6 in St. Nicholas Deptford and 7 in Charlton and Kidbrooke. There were two deaths from this disease, one of which was associated also with Measles. Neither case had been immunised. Four hundred and forty-seven swabs were forwarded by Medical Practitioners for bacteriological examination from cases suspected to be Diphtheria. Of this number, 441 were reported to give negative or doubtful results and 6 were positive in character, being dealt with accordingly. Diphtheria Immunisation.—Inoculations are carried out by arrangement with the Seamen's Hospital or through local Medical Practitioners and, in the case of school children, immunisations are effected mainly by the London County Council. The antigens in use are of two types, Toxoid Antitoxin Floccules and Alum Precipitated Toxoid; the latter appears to the more favoured as the inoculations are limited to two whereas three are necessary in respect of the former antigen. Existing facilities for Diphtheria Immunisation in the Borough have been more widely used during the year under review than previously. This was probably due in no small measure to extensive propaganda, both locally and nationally. In addition to the normal propaganda, the parents of all children attaining the age of eight months are circularised with regard to having their children immunised before or as they reach the age of 1 year. It was estimated that as a result of such letters sent to parents, 247 children were immunised under the Council's scheme. Table Showing Treatments in Connection with Diphtheria Immunisation during 1946. Complete Immunisation. Supplementary or Reinforcing Doses. Schick Tests. Seamen's Hospital Under 5 yrs. 910 — 20 5—14 yrs. 53 Medical Practitioners Under 5 yrs. 61 — — 5—14 yrs. 5 Reported from other L.As. Under 5 yrs. 6 — — 5—14 yrs. 1 London County Council Under 5 yrs. 131 165 — 5—14 yrs. 474 Total Under 5 yrs. 1,108 165 20 5—14 yrs. 533 52 Under 5 yrs. 5—14 yrs. Total number of Children who have completed 2,375 4,777 a course of immunisation. Estimated population 6,410 10,050 Acute Primary Pneumonia and Acute Influenzal Pneumonia.—These causes were responsible for 74 cases as compared with 64 for the previous year and 120 for the year 1944. Thirty-two occurred in East Greenwich, 12 in West Greenwich, 2 in St. Nicholas Deptford and 28 in Charlton and Kidbrooke. There were three deaths arising from these diseases. Typhoid Fever.—Four cases of Para-Typhoid were notified during the year : two of these related to Nurses residing in hospitals' nurses' homes in the Borough. In order to eliminate the possibility of infection through the water supply, samples of tap water were taken at these Homes ; both proved negative. Two specimens were forwarded by Medical Practitioners for bacteriological examination from' cases suspected to be Typhoid Fever : both specimens gave negative results. Scarlet Fever.—One hundred and eight cases were notified as compared with 83 for the previous year and 129 for the year 1944. In 5 cases the diagnosis was not confirmed, thus the actual number of cases was 103. Of these, 58 were treated in Hospital. Fifty-six occurred in East Greenwich, 15 in West Greenwich, 3 in St. Nicholas Deptford and 29 in Charlton and Kidbrooke. There was one death from this cause. Erysipelas.—There were 17 cases of this disease notified as compared with 24 for the previous year. Zymotic Enteritis or Epidemic Diarrhoea.—Twenty-six cases were originally notified as compared with 37 for the previous year. In 3 cases the diagnosis was not confirmed. Of the 23 cases, 10 were under one year. There were four deaths ascribed to this cause, 3 of which were not notified. Dysentery.—There were 8 cases originally notified during the year : in one case the diagnosis was not confirmed. The number for the previous year was 28. 53 Scabies.—This disease became compulsorily notifiable on the 1st August, 1943, and was responsible for 179 cases. There were 312 for the previous year. Ninety-one occurred in East Greenwich, 41 in West Greenwich, 7 in St. Nicholas Deptford and 40 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.—One case was reported during the year as compared with 4 for the previous year. Puerperal Pyrexia.—There were 16 cases attributed to this disease as compared with 4 for 1945. Six cases were removed to the North Western Hospital and 9 were admitted to St. Alfege's Hospit al. All the patients subsequently recovered. Ophthalmia Neonatorum.—Six notifications were received during the year : two were babies born in St. Alfege's Hospital, one was admitted to White Oak Hospital, Swanley; the remaining three cases were treated at home. All cases were followed up by the Health Visitor and kept under observation until full recovery. Cerebro-Spinal Fever.—Seven cases were notified during the year as compared with 4 cases for the previous year. In 2 cases the diagnosis was not confirmed. There was 1 death, the cause being attributed to Tuberculous Meningitis. Tuberculosis.—In the year under review, there were 111 cases notified in the Borough as compared with 114 for the previous year. Of this number, 103 were of the pulmonary type, ordinarily known as consumption, and 8 were non-pulmonary cases, i.e., Tuberculosis of other parts of the body than the lungs. Of this number, 36 pulmonary and 4 non-pulmonary occurred in East Greenwich, 25 pulmonary and 2 non-pulmonary in West Greenwich, 6 pulmonary and 1 non-pulmonary in St. Nicholas Deptford, and 36 pulmonary and 1 non-pulmonary in Charlton and Kidbrooke. Four hundred and seventeen specimens were forwarded by Medical Practitioners for bacteriological investigation and of these 299 were reported to be negative and 118 positive for Tuberculosis. Disinfection was offered and carried out in 57 cases including 160 rooms and 631 articles of bedding, etc. Disinfectant was supplied to patients to disinfect sputum pots, etc., where necessary. 54 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 are dealt with at the Council's Cleansing Station at Tunnel Avenue. Children under 5 years of age and adults are treated at the Bathing Centre attached to St. Alfege's Hospital. There was a marked decrease in the number of cases treated at the two Centres, the total attendances being 5,897 as compared with 7,238 for the previous year. It will be noted that the number of Scabies notifications fell by approximately 50%. This suggests that with the return from war to peace conditions, more attention has been given to personal hygiene and cleanliness in the home, notwithstanding the overcrowded and drab surroundings generally under which many families are living at the present time. The following return summarises the work carried out during the year:— Attendances Vermin Scabies Adults 24 2,009 Children under School age — 832 School Children 1001 2,031 No. of home visits by Nurse — 635 ,, „ ,, re-visits by Nurse - 665 Disinfection of Premises.—The usual routine has been followed regarding the disinfection of rooms of persons suffering from notifiable Infectious Diseases. The following Return shows in detail the amount of work performed during the year:— 55 Rooms and Articles Disinfected, Year 1946. Diseases, etc. Premises Entered Rooms Beds Paillasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Disinfected Scarlet Fever 91 174 57 4 65 63 195 251 158 24 123 365 1,305 Diphtheria 40 70 21 — 26 29 75 134 82 11 49 176 603 Tuberculosis 57 160 25 — 37 31 119 127 59 25 48 160 631 Cancer 13 22 10 — 10 6 28 27 16 10 11 24 142 Cerebro-Spinal Fever 10 18 7 — 6 8 29 30 19 2 12 31 144 Puerperal Fever 2 4 1 — 2 2 6 8 4 1 2 4 30 Puerperal Sepsis 1 1 — — 1 1 2 5 — — 1 10 Paratyphoid Fever 1 2 1 — — 1 1 1 3 — 2 2 11 Dysentery 1 2 1 — 1 1 3 4 2 2 1 6 z1 Erysipelas 7 12 5 — 3 5 16 19 10 2 5 33 98 Measles 3 7 2 — 12 — 13 70 — - 2 44 143 Scabies 3 5 - — 3 1 3 7 4 - 1 12 31 Other Diseases 63 95 26 — 69 21 85 361 26 25 36 143 792 Verminous Premises 43 1 22 4 24 20 56 84 26 12 24 45 317 Miscellaneous - - - - 1 1 - 3 - - 2 - 7 Total 335 573 178 8 260 190 631 1,131 409 114 319 1,045 4,285 No. of articles destroyed 34 56 TUBERCULOSIS REPORT I am indebted to Dr. C. W. L. Jeanes, Tuberculosis Officer, for the following report. New Cases and Transfers in 1946 numbered 191, of which 171 were entered on the Dispensary register. Of these, 156 were suffering from Pulmonary Tuberculosis and 15 from Non-Pulmonary Tuberculosis. This is the highest number of new cases since 1921 and is accounted for chiefly by the large number of transfers (65) to new houses in the Borough. The incidence of Tuberculosis generally is higher, however, than it was before the war owing to bad living conditions and inadequate diet. It is hoped that the new housing schemes will eventually not only provide better homes for those who have contracted Tuberculosis, but will tend to decrease the incidence of the disease. Figures for recent years are:— Year. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Deaths. 1938 153 38 53 1939 93 14 60 1940 125 17 73 1941 138 32 74 1942 164 18 64 1943 117 26 60 1944 113 16 47 1945 149 16 53 1946 173 18 56 It is interesting to note that in 1941 the incidence of Pulmonary Tuberculosis started to increase. In these figures, however, the apparent decrease from 1940 to 1945 is accounted for by the much diminished population of the Borough during these years. There has, however, been a definite decrease in the number of cases of Non-Pulmonary Tuberculosis during recent years. The reason for this is not entirely clear but must, in part at least, be due to elimination of milk as a source of infection by pasteurisation. At the Clinic, 634 new cases were examined during the year: of these, 96 were found to be suffering from Pulmonary Tuberculosis and 6 from Non-Pulmonary Tuberculosis. There were 56 deaths. Analysis of these cases is as follows:— 57 New Cases. Deaths. Respiratory Non-Respiratory Respiratory Non-Respiratory Adults C. Adults C. Adults C. Adults C. M. F. M. F. M. F. M. F. 53 29 14 2 2 2 33 17 2 — — 4 96 6 52 4 Artificial Pneumothorax.—This Clinic has continued to. increase in size, and in 1946 refills numbered 707. Patients attending were:— 41 with unilateral A.P's. 7 with bilateral A.P's. 4 with Pneumoperitoneum. At the close of the year there were 683 patients on the Dispensary Register made up as follows:— Adults. Children. M. F. Pulmonary 283 210 56 Non-Pulmonary 19 33 82 59 patients have been crossed off the register as recovered:— Adults. Children. M. F. Pulmonary 17 22 5 Non-Pulmonary 5 3 7 No. of visits made by Health Visitors 2,759 No. of medical consultations at patients' homes 195 No. of X-rays 989 58 TUBERCULOSIS. New Cases and Mortality—Year 1946. Age-Periods New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 — — — 1 — — — 1 1 6 7 1 1 1 — 2 — 5 2 5 1 — — — 1 — 10 2 3 3 2 — — 2 — 15 8 5 1 1 1 5 — — 20 15 18 1 2 2 5 — — 25 25 21 2 — 4 6 1 — 35 24 7 — — 9 1 1 — 45 9 2 1 1 16 4 — — 55 5 4 — — 9 1 — — 65 and upwards 1 4 — — 2 1 — — Totals 97 76 10 8 44 23 7 1 59 Supplemental Vaccination Return for 1945. Return made on or before the 14th of February, 1947, by Dr. F. R. Waldron, 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, 1945, inclusive:— Registration SubDistricts comprised in the Vaccination Officer's District No. of Births from 1st Jan., to 31st Dec., 1945 Number of these Births duly entered by 31st Jan., 1947. No. of Births which on 31st Jan., 1947, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1947. not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during Calendar Year 1946 No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1946 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 716 200 Nil Nil 113 24 2 296 78 3 944 405 South Greenwich 269 127 1 Nil 55 4 1 32 44 5 Total 985 327 1 Nil 168 28 3 328 122 26 944 405 7th February, 1947. Dr. F. R. Waldron, Vaccination Officer. INDEX Page A Adoptive Acts, By-laws and Local Regulations 3, 4 Ago Mortality 17 Aged, Infirm and Physically Incapacitated Persons 33 Ante-Natal Clinics 25 Area of Borough 12 Articles and Rooms Disinfected 55 Articles Destroyed 55 Artificial Pneumothorax 57 Artificial Sunlight Treatment 23, 24 B Bacteriological Examinations 21,44 Baiting of Sewers 35, 36 Baths & Wash-houses 33, 34 Births 16 Birth Notifications 30 Blackheath Fair 47 Bronchitis 20 C Cancer 19 Caseous Lymphadenitis 46 Cerebro-Spinal Fever 53 Child Life Protection 28, 29 Circulatory System—Diseases of 20 Classification of Deaths 18 Cleansing Children 54 Clinics and Centres 21, 22 Common Infectious Diseases 18 Complaints 38 D Day Nurseries 29 Deaths 16 Death Causes, Remarks 18-20 Deaths from Violence 20 Deaths in Institutions 16,17 Deaths, Tables showing Causes of and Ages at Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Page Density of Population 11 Dental Clinic 27 Diabetes 22 Diarrhoea and Zymotic Enteritis 19, 52 Diphtheria 19, 50, 51 Diphtheria Immunisation 51, 52 Diseases of Circulatory System 20 Diseases of Respiratory System 20 Disinfection 54, 55 Disinfestation 33 Domestic Helps 28 Drinking Fountains 38 Duties and Powers of the Public Health, &, Maternity and Child Welfare Committees 3, 4 Dysentery 52 E Elevation of Borough 11 Emergency Dwellings 41 Enteric Fever 19 Erysipelas 52 Extracts from Vital Statistics 13, 14 F Factories Act, 1937 32 Food and Drugs Act, 1938 48 Food—Inspection of 43-48 Food—Premises for Preparation of 47, 48 Food Rejected 45, 46 Food and Drugs—Samples 49 Foot Clinics 23 G General Statistics 11-14 H Health Centres 21, 22, 25 Health Visitors, Visits, etc. 29, 30 Heart Disease 20 Heat-Treated Milk (Prescribed Tests) Order, 1944 44 INDEX—continued Page Home Helps 28 Home Nursing 28 Horse Troughs 38 Housing 41, 42 Housing Accommodation 41,42 Housing Homeless Persons 41 I Ice-cream — Bacteriological Examinations 48 Ice-Cream Premises 48 Illegitimate Children—Care of 29 Imported Food Rejected 46 Infant Consultation 21, 22, 25 Infantile Mortality 17, 18, 26 Infant Welfare Centres 24, 25 Infectious Diseases 50-52 Inhabited Houses 11 Institution Deaths 16, 17 Institutional Provision for Mothers and Children 27,28 Insulin Treatment—Diabetes 22 Intra-Cranial Lesions 20 Introductory Review 8-10 L Laboratory Work 21 Legal Proceedings 40 M Marriages 14 Maternal Mortality 27 Maternity & Child Welfare 24-31 Maternity & Child Welfare Committee 4 Maze Hill Clinic 22 Measles 18, 50 Meat Regulations 44 Meat Surrendered 45 Meteorological Observations 15 Merchandise Marks Act, 1926 46 Milk & Dairies Regs 43 Milk, Analysis of 44 Milk—Bacteriological Examination 44 Milk Supply 43 Milk—Supply to Mothers and Children 27 Milk (Special Designations) Regs. 1936/44 44 Milk—Heat Treated 44 Page N Notices, etc 32, 39 Notifications 50-53 Notifications of Births 30 Nurseries 29 O Ophthalmia Neonatorum 53 Outworkers 32,33 Overcrowding 42 P Persons Cleansed 54 Pharmacy & Poisons Act, 1933 33 P.H. (Condensed Milk) Regs. 49 P.H. (Dried Milk) Regs. 49 P.H. (Imported Food) Regs. 45, 46 P.H. (Meat) Regs 45 P.H. (Smallpox Prevention) Regs. 50 Pneumonia 20, 52 Points System—Housing 41 Population 13 Post-Natal Clinics 25 Post-War Housing Plan 41, 42 Premature Infants, Care of 29 Preserved Food Premises 48 Public Health Committee 3 Public Sanitary Conveniences 37 Puerperal Fever 53 Puerperal Pyrexia 53 R Rateable Value 11 Rates, Births and Deaths 13 Rat Repression 34-36 Refuse Disposal 36 Remarks on Various Death Causes 18-20 Rent & Mortgage Interest (Restrictions) Act 34 Respiratory System—Diseases of 20 S Sanitary Conveniences 37 Sanitary Work—Summaries, etc. 38, 39 Scabies 53 Scarlet Fever 18, 52 Scavenging and Refuse Disposal 36 INDEX (concluded) Sewers—Baiting of 35, 36 Sheets—Supply of for Expectant Mothers 29 Shops Act, 1934 33 Slaughterhouses 44 Smallpox 18, 50 Social Conditions of the Area 11-13 Staff of Public Health Department 5-7 Statistical Tables Appendix Street Traders 47 T Treatment Centres 21, 22 Tuberculosis 19,53 Tuberculosis Officer's Report 56-58 Typhoid Fever 19, 52 U Uninhabited Houses 11 Unsound Food 45, 46 V Vaccination 50 & Appendix Verminous Conditions 54 Verminous Premises 33, 55 Violent Deaths 20 Vital Statistics 11-20 & Appendix Vitamins—Supply of to Expectant Mothers and Children 27 W War Damaged Dwellings 41 Water Supply 34 Whooping Cough 19, 50 X X-Ray Examinations 57 Z Zymotic Diseases 52 INFECTIOUS DISEASE NOTIFICATIONS showing Comparison of Year of Inception of the Borough with Year 1938, the Years of the War Period 1939-1945 and Year 1946. Notifiable Disease. War Period. 1901 1938 1939 1940 1941 1942 1943 1944 1945 1946 Chicken-Pox 52 — — — — — — — — — Small-Pox 11 — — — — — — — — — Scabies — — — — — — 263 405 312 179 Diphtheria 183 244 121 45 50 72 91 59 54 28 Membranous Croup 5 9 — — — — __ — — — Dysentery — 23 3 1 2 22 9 8 28 7 Erysipelas 110 48 40 19 30 32 24 15 24 17 Acute Polio-Myelitis — 5 — — 4 — — 1 — Scarlet Fever 417 161 144 64 53 159 303 129 83 103 Enteric Fever 67 3 6 9 3 3 — — — 4 Continued Fever — — — — — 1 — — — — Puerperal Fever 6 2 7 1 4 5 2 9 4 1 Puerperal Pyrexia — 35 13 11 6 8 4 4 12 16 Cerebro-Spinal Fever — 1 4 23 12 15 2 7 4 5 Malaria — — — — 2 3 2 — 1 4 Measles — 1,930 44 114 327 650 974 330 341 902 Whooping Cough — 129 524 22 221 235 276 154 133 211 Diarrhœa — 114 60 16 13 27 25 25 37 23 Ophthalmia Neonatorum — 15 9 3 5 6 2 3 4 6 Tuberculosis, Pulmonary — 122 90 95 95 164 128 115 101 103 „ Non-Pulmonary — 30 13 9 19 18 27 14 13 8 Pneumonia, Acute Primary or Acute Influenzal — 92 138 69 83 81 207 120 64 74 Totals 851 2,963 1,216 501 929 1,501 2,339 1,397 1,216 1,691 VITAL STATISTICS showing comparison of year of inception of the Borough with Year 1938, the Years of the War Period 1939-1945 and Year 1946. 1901 1938 1939 1940 1941 1942 1943 1944 1945 1946 Population 96,188 95,770 89,710* 74,280 57,070 60,530 62,870 61,800 63,800 77,480 Live Births (Total) 2,775 1.303 1,348 1,168 920 1,132 1,187 1,170 1,182 1,735 Live Births (Illegitimate) ? 50 37 34 49 49 61 62 89 92 Birth Rate per 1,000 population 28.94 13.64 14.62 15.76 16.17 18.75 18.94 18.98 18.59 22.65 Still Births ? 40 36 18 26 27 25 22 24 22 Still Birth Rate per 1,000 Total Births ? 29.7 26.0 15.2 27.4 23.3 20.6 18.4 19.9 12.5 Marriages †553 894 1,169 1,198 790 729 621 592 761 776 Marriage Rate per 1,000 Population 5.76 9.36 12.36 16.18 13.88 12.08 9.91 9.60 11.97 10.09 Deaths 1,468 1,041 979 1,273 950 827 885 980 813 874 Death Rate per 1,000 Population 15.31 10.9 10.96 17.18 16.70 13.72 14.12 15.90 12.78 11.38 Maternal Mortality Rate per 1,000 Total Births 1.8 1.5 0.72 0.89 1.29 0.86 0.00 0.83 1.65 1.13 Deaths of Infants under 1 year of age 362 55 69 62 24 37 50 62 51 59 Death Rate of Infants under 1 year of age per 1,000 live births 130 42 53 56 31 32 42 52 43 34 Death Rate of Legitimate Infants (0—1) per 1,000 Legitimate Live Births ? 41 49 54 34 29 42 51 40 35 Death Rate of Illegitimate Infants per 1,000 Illegitimate Live Births ? 60 188 117 — 102 32 80 78 21 Tuberculosis Death Rate per 1,000 Population (all forms) 1.83 0.77 0.71 0.93 1.28 1.05 0.94 0.81 0.86 0.97 †Excludes Parish of Charlton and Kidbrooke. *Year 1939. Population for Birth Rate 94,790. INFANTILE MORTALITY DURING THE YEAR 1946 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death. Under 1 week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under One Year. Small-Pox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 ... ... 1 Diphtheria—Croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... ... ... 1 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... Diseases of Trachea ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... 1 2 3 Pneumonia (all forms) 2 ... ... ... 2 2 4 1 ... 9 Diarrhoea (all forms) ... ... ... ... ... ... ... ... ... ... Gastro-Enteritis ... ... ... ... ... 1 2 ... 1 4 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 5 ... ... ... 5 ... ... ... ... 5 Congenital Malformation 4 ... ... 1 5 1 ... ... ... 6 Premature Birth 19 ... ... ... 19 1 ... ... ... 20 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... Suffocation, Overlay ... ... ... ... ... ... 1 ... ... 1 „ Otherwise 2 ... ... ... 2 1 2 ... ... 5 Other Causes 1 ... 1 ... 2 1 ... ... ... 3 Totals 33 ... 1 1 35 7 10 3 4 59 Male 42 Female 17 CAUSES OF, AND AGES AT, DEATH, during the year ended 31st December, 1946. 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 Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. Alfege's Hospital Bennett's Hospital Miller Hospital Herbert Military Hospital Brook Hospital L.C.C. Other Outside Institutions 1 Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 Scarlet Fever 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 4 Whooping Cough 2 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 ... ... 15 5 Diphtheria 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 3 6 Tuberculosis of Respiratory System 67 ... ... 1 ... ... 21 29 3 18 17 6 26 21 ... 1 ... 1 ... 16 63 7 Other Forms of Tuberculosis 8 1 1 1 ... ... 2 ... ... 5 2 ... 1 5 1 ... ... ... ... 1 20 8 Syphilitic Disease 7 ... ... ... ... ... ... 2 4 2 1 ... 4 2 ... ... ... ... ... 3 12 9 Influenza 2 ... 1 ... ... ... ... ... 1 1 ... ... 1 1 ... ... ... ... 1 ... 4 10 Measles 1 ... l ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 11 Acute Poliomyelitis and Polioencephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Acute Infectious Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13M Cancer of buccal cavity and oesophagus (males only) 7 ... ... ... ... ... ... 3 4 2 3 ... 2 3 ... ... ... ... ... 2 10 13F Cancer of Uterus 9 ... ... ... ... ... 2 5 2 4 1 2 2 4 ... ... ... ... ... 1 11 14 Cancer of Stomach and Duodenum 19 ... ... ... ... ... 1 7 11 7 9 1 2 11 1 ... ... ... ... 3 28 15 Cancer of Breast 4 ... ... ... ... ... 1 2 1 3 ... 1 ... 2 ... ... ... ... ... 1 7 16 Cancer of all other sites 97 ... ... ... ... 1 6 45 45 36 29 3 29 42 4 3 ... ... 1 10 153 17 Diabetes 6 ... ... ... ... 1 ... 2 3 ... 5 ... 1 3 ... ... ... ... ... 1 15 18 Intra-cranial Vascular Lesions 71 ... ... ... ... 1 2 15 53 34 15 3 19 34 ... 1 ... ... ... 11 100 19 Heart Disease 240 ... ... ... ... 1 8 53 178 89 65 13 73 96 ... 4 ... ... 3 35 284 20 Other Diseases of the Circu- latory System 26 ... ... ... ... ... ... 4 22 8 5 2 11 21 1 ... ... ... ... 1 58 21 Bronchitis 40 3 ... ... ... ... ... 8 29 12 10 4 14 9 ... ... ... ... ... 3 25 22 Pneumonia 58 8 ... ... ... ... 3 15 32 18 7 6 27 32 ... 1 ... ... ... 13 98 23 Other Respiratory Diseases 24 ... ... ... ... 1 3 6 14 11 7 ... 6 11 1 1 ... ... 1 2 32 24 Ulceration of the Stomach or Duodenum 11 ... ... ... ... ... 2 4 5 3 1 3 4 10 ... ... ... ... ... 1 28 25 Diarrhoea (under 2 years of age) 4 4 ... ... ... ... ... ... ... 2 1 ... 1 3 ... ... ... ... ... 1 28 26 Appendicitis 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 4 27 Other Digestive Diseases 27 1 ... ... ... 1 2 6 17 12 5 1 9 22 ... ... ... ... ... 2 53 28 Nephritis 17 ... ... ... ... ... 4 6 7 9 3 ... 5 10 1 ... ... ... ... 2 22 29 Puerperal and Post-abortive Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Other Maternal Causes 2 ... ... ... ... 1 1 ... ... 1 ... ... 1 2 ... ... ... ... ... ... 2 31 Premature Birth .24 23 1 ... ... ... ... ... ... 10 7 1 6 22 ... ... ... ... ... 1 DO 32 Congenital Malformations, Birth Injury, Infantile Disease 15 13 1 ... 1 ... ... ... ... 8 5 ... 2 7 ... 1 ... ... ... 2 23 5 ... ... ... ... ... 3 7 33 Suicide 14 ... ... ... ... 1 5 4 4 7 3 ... 4 6 ... ... ... ... ... 2 13 34 Road Traffic Accidents 8 ... ... 1 1 1 1 2 2 2 2 ... 4 1 ... ... ... 5 42 35 Other Violent Causes 24 3 ... ... ... ... 4 7 10 8 6 1 9 14 ... l ... ... ... 13 58 36 All Other Causes 37 2 ... ... ... ... 1 8 26 12 8 2 15 16 ... 874 59 7 3 5 24 69 233 474 325 220 49 280 415 9 14 — 3 7 137 1,277 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. CAUSES OF, AND AGES AT, DEATH, during the year ended 31st December, 1946. 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 Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital L.C.C. Other Institutions Outside Institutions 1 Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 Scarlet Fever 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 4 Whooping Cough 2 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 2 ... ... 15 5 Diphtheria 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 3 6 Tuberculosis of Respiratory System 67 ... ... 1 ... 13 21 29 3 18 17 6 26 21 ... 1 ... 1 ... 16 63 7 Other Forms of Tuberculosis 8 1 1 1 3 ... 2 ... ... 5 2 ... 1 5 1 ... ... ... ... 1 20 8 Syphilitic Disease 7 ... ... ... ... 1 ... 2 4 2 1 ... 4 2 ... ... ... ... ... 3 12 9 Influenza 2 ... 1 ... ... ... ... ... 1 1 ... ... 1 1 ... ... ... ... 1 ... 4 10 Measles 1 ... l ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 11 Acute Poliomyelitis and Polioencephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Acute Infectious Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13m Cancer of buccal cavity and oesophagus (males only) 7 ... ... ... ... ... ... 3 4 2 3 ... 2 3 ... ... ... ... ... 2 10 13f Cancer of Uterus 9 ... ... ... ... ... 2 5 2 4 1 2 2 4 ... ... ... ... ... 1 11 14 Cancer of Stomach and Duodenum 19 ... ... ... ... ... 1 7 11 7 9 1 2 11 1 ... ... ... ... 3 28 15 Cancer of Breast 4 ... ... ... ... ... 1 2 1 3 ... 1 ... 2 ... ... ... ... ... 1 7 16 Cancer of all other sites 97 ... ... ... ... 1 6 45 45 36 29 3 29 42 4 3 ... ... ... 10 153 17 Diabetes 6 ... ... ... ... 1 ... 2 3 ... 5 ... 1 3 ... ... ... ... ... 1 15 18 Intra-cranial Vascular Lesions 71 ... ... ... ... 1 2 15 53 34 15 3 19 34 ... 1 ... ... ... 11 100 l9 Heart Disease 240 ... ... ... ... 1 8 53 178 89 65 13 73 96 ... 4 ... ... 3 35 284 20 Other Diseases of the Circulatory System 26 ... ... ... ... ... ... 4 22 8 5 2 11 21 1 ... ... ... ... 1 58 21 Bronchitis 40 3 ... ... ... ... ... 8 29 12 10 4 14 9 ... ... ... ... ... 3 25 22 Pneumonia 58 8 ... ... ... ... 3 15 32 18 7 6 27 32 ... 1 ... ... ... 13 98 23 Other Respiratory Diseases 24 ... ... ... ... 1 3 6 14 11 7 ... 6 11 1 1 ... ... 1 2 32 24 Ulceration of the Stomach or Duodenum 11 ... ... ... ... ... 2 4 5 3 1 3 4 10 ... ... ... ... ... 1 28 25 Diarrhoea (under 2 years of age) 4 4 ... ... ... ... ... ... ... 2 1 ... 1 3 ... ... ... ... ... 1 28 26 Appendicitis 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 4 27 Other Digestive Diseases 27 1 ... ... ... 1 2 6 17 12 5 1 9 22 ... ... ... ... ... 2 53 28 Nephritis 17 ... ... ... ... ... 4 6 7 9 3 ... 5 10 1 ... ... ... ... 2 22 29 Puerperal and Post-abortive Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Other Maternal Causes 2 ... ... ... ... 1 1 ... ... 1 ... ... 1 2 ... ... ... ... ... ... 2 31 Premature Birth 24 23 1 ... ... ... ... ... ... 10 7 1 6 22 ... ... ... ... ... 1 56 32 Congenital Malformations, Birth Injury, Infantile Disease 15 13 l ... 1 ... ... ... ... 8 5 ... 2 7 ... 1 ... ... ... 2 23 33 Suicide 14 ... ... ... ... l 5 4 4 7 3 ... 4 5 ... ... ... ... ... 3 7 34 Road Traffic Accidents 8 ... ... 1 1 l 1 2 2 2 2 ... 4 6 ... ... ... ... ... 2 13 35 Other Violent Causes 24 3 ... ... ... 4 7 10 8 6 1 9 14 ... 1 ... ... ... 5 42 36 All Other Causes 37 2 ... ... ... ... 1 8 26 12 8 2 15 16 ... 1 ... ... ... 13 58 874 59 7 3 5 24 69 233 474 325 220 49 280 415 9 14 — 3 7 137 1,277 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.