Woo 4 Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH. 1919. BY J. MACMILLAN, D.S.O., M.C., M.B., D.P.H., Medical Officer of Health. Woolwich : Pryce & Son, Ltd. (T.U. Federation), 31, 33 & 35 Powis Street. 1920. 2 Public Health and Housing Committee to November, 1919. His Worship the Mayor (Alderman H. S. Syer, J.P.) Aldermen— A. J. Walklin (Chairman). W. C. Martin (Vice-Chairman) J. P. Jackson. Councillors— R. M. W. Allen. W. Marlow. W. W. Bullworthy. E. J. Mayes. L. C. Chasteauneuf. J. Newman. W. E. Hughes-Narborough F. Penny. C. H. Langham. Miss S. Turnbull. V. Lister. Miss G. E. Walters. Public Health and Housing Committee from November, 1919. His Worship the Mayor (Councillor A. M. Tynemouth, J.P.) Councillor Miss G. E. Walters (Chairman). Councillor A. E. Smith (Vice-Chairman). Aldermen— Mrs. E. Dormer. J. P. Jackson. W. C. Martin. Councillors— W. W. Burr. S. H. Cuff. T. Scoble. W. C. Montano. H. A. Hart. Mrs. M. E. T. Smith. Miss M. Crout. V. Lister. Miss S. Turnbull. J. Newman. Maternity and Child Welfare Committee. Comprising the Members of the Public Health and Housing Committee. Visiting Sub-Committee—Home for Ailing Babies, Co-opted Members to November, 1919. Lady Kathleen Lindsay. Mrs. Melville Smith. Mrs. A. Callaghan. Miss H. E. Grinling. Miss A S Grecory 3 Staff of Public Health Department. Chief Sanitary Inspector— Albert G. Duck, F.S.I.A. Sanitary Inspectors — John W. Rance. William Tedham. William Little. Thomas Powell. William Wood. Harry Shaw. Alfred G. Potter. Miss Alice Middlebrooke. Sanitary Inspectors and Health Visitors- Mrs. Margaret Garside. Miss Catherine Ware. Health Visitors- Miss Kate Latham. Miss Winifred Burnett. Miss Eleanor Tibbitts. Clerks— Amyas Britter. Harold M. Collyer. Harry S. Smith. Herbert T. Prescott. Miss W. Smith (temporary). Mortuary Keeper— Frank Leason. Public Analyst— Sir William R. Smith, M.D., D.Sc. Assistant Medical Officer of Health— Miss Rachael Mackenzie, M.B., D.P.H. Rome for Ailing Babies— Visiting Physician Dr. Frederick Dodd. Matron Miss Janet Raymond. 4 Summary of Statistics, 1919. Area of Borough 8,276.6 Acres Population—Census, 1911 121,376 do. estimated to middle of 1919—for birth rate 141,918 do. do. for death rate 136,237 Persons to an acre—Census, 1911 14.7 do. do. do. 1919 17.2 Marriages 1,350 Births 2,737 Birth Rate 19.3 Deaths 1,679 Death Rate 12.3 Deaths under one year 235 Infantile Death Rate 86 5 TABLE OF CONTENTS. Page Public Health and Housing Committees 2 Maternity and Child Welfare Committees 2 Do. Visiting Sub-Committee 2 Staff of Public Health Department 3 Summary of Statistics 4 Preface 8 Vital Statistics. Population 9 Births 11 Births—Illegitimate 13 Marriages 14 Deaths 14 Cancer and Malignant Diseases 21 Respiratory Diseases 22 Influenza 23 Violence 23 Inquests 24 Infantile Mortality 24 Sanitary Circumstances of the District. Scavenging 27 Removal of House Refuse 27 Removal of Trade Refuse 27 Cleansing of Earth-closets, Privies and Cesspools 28 Sanitary Inspection of the Borough 29 Complaints 29 Inspections 29 Nuisances Abated 32 Houses Let in Lodgings 34 Cleansing of Verminous Persons—Cleansing of School Children 36 Underground Sleeping Rooms 38 Offensive Trades 38 Factories, Workshops and Work-places 38 Milk-premises, Cow-sheds, etc. 42 Mortuaries 45 Cemeteries 45 Inhabited House Duty 46 6 Page Destruction of Rats 46 Food. Milk 47 Dairies, Cowsheds and Milkshops Order 49 Milk Registration 50 Milk and Cream Regulations, 1912 and 1917 50 Milk (Mothers and Children Order), 1918 50 Unsound Pood and Food Inspection 51 Sale of Pood and Drugs 52 Prevalence of, and Control over, Infectious Disease. Notifications 55 Notifications each year since 1901 57 Small-pox 59 Measles 59 Whooping Cough 60 Enteric Fever 61 Scarlet Fever 61 Diphtheria 63 Pneumonia, Malaria, Dysentery and Trench Fever 65 Anthrax, Glanders and Hydrophobia 66 Erysipelas 66 Cerebro-Spinal Meningitis, etc. 66 Tuberculosis—Notifications 66 Deaths and Death-rates 68 Source of Infection 69 Administrative Action 70 Shelters 70 Institutional Treatment 71 Woolwich Tuberculosis Dispensary 71 Tuberculosis—After Care 72 Future Development 72 Administrative Action with regard to Infectious Diseases 72 Disinfection 73 Maternity and Child Welfare. Staff 74 Welfare Centres 74 Treatment 75 7 Page Voluntary Work in the Borough 75 Victory Club Welfare Centre 75 Woolwich Day Nursery 75 American Nursery 75 British Hospital for Mothers and Babies 76 Woolwich and Plumstead Maternity Home 76 Home for Ailing Babies 77 The Work of the Health Visitors 78 The Work of the Centres 79 The Needs of the Borough 80 Infectious Diseases 80 Puerperal Fever 80 Ophthalmia Neonatorum 81 Measles, Whooping Cough, and Poliomyelitis 81 Epidemic Diarrhœa 82 Administrative Measures 82 Sanitary Administration. Sanitary Staff 83 Public Analyst 83 Bacteriological Examinations 83 Housing. Population 84 Number of Houses 84 Shortage of Houses 84 Housing Scheme—Action to 31st December, 1919 88 Overcrowding 88 Extent 91 Causes 94 Fitness of Houses 95 Unhealthy Areas 96 Government Hutments and Houses 96 Details of House-to-House Inspection 96 River Ward 97 St. George's Ward 97 Glyndon Ward 97 Dockyard and St. Mary's Wards 98 St. Nicholas and Central Wards 98 Eltham Ward 99 Appendices 100 8 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor, Ladies, and Gentlemen, I have the honour to submit the Nineteenth Annual Report on the health of the Metropolitan Borough of Woolwich. The duties of Medical Officer of Health of this Borough were performed by Dr Sidney Davies until the 31st August, 1919, but although I only assumed responsibility on the 1st September, the Report for the year has been prepared by me for the sake of uniformity in the presentation of the records. I wish to acknowledge, however, the kindness of Dr. Davies in assisting to prepare this report. The Minister of Health issued in January, 1920, a Memorandum, in which a general outline was laid down for the Annual Reports of Medical Officers of Health. The suggestions put forward there have been carried out so that the form of this Report varies somewhat from the previous reports on the Health of the Metropolitan Borough of Woolwich. I desire to thank the Public Health and Housing Committee, and the Maternity and Child Welfare Committee, for their help, and for their keen and kindly consideration of the various Health problems brought to their notice during the year. I am, Mr. Mayor, Ladies, and Gentlemen, Your obedient Servant, J. MACMILLAN. 9 Nineteenth Annual Report on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH. Year ending 31st December, 1919. STATISTICS. POPULATION. 1. The population of the Borough of Woolwich, as estimated at the Census of 1911, was 121,376. This number included 5,743 soldiers. The estimated population adopted by the Registrar-General for the calculation of the birth-rate and deathrate of the Borough of Woolwich for the year 1919, is as follows: For the death-rate 136,237 For the birth-rate 141,918 The following extract from a circular letter from the General Register Office explains how these figures are arrived at:— "The death-rate population excludes all non-civilian males, whether serving at home or abroad. This is necessary for the purposes of local death-rates, because it has proved impossible to transfer the deaths of non-civilians to their areas of residence, or to deal in any other satisfactory manner with the local mortality 10 of this element in the population. These estimates are based mainly upon the rationing returns, kindly placed at the disposal of the Department by the Ministry of Food. "The birth-rate (and marriage-rate) population, on the other hand, is intended to include all the elements of the population contributing to the birth and marriage rates. It consists therefore of the death-rate or civilian population plus all non-civilians enlisted from this country, whether serving at home or abroad. This non-civilian element has been distributed over all the districts in the country in proportion to their estimated civilian population." The estimated population for the different parishes of the Borough is as follows :— Parish. For the Death-rate. For the Birth-rate. Woolwich 31,250 32,553 West Plumstead 40,078 41,749 East Plumstead 36,661 38,190 Eltham 28,248 29,426 136,237 141,918 The above figures are those which have been used throughout the Report for calculating the various rates in the Borough and in the different parishes, and have been mainly based on the rationing returns obtained from the Executive Officer of the Local Food Control Committee. During the preceding three years the population of the Borough was estimated by the Registrar-General as follows:— Year. For the Death-rate. For the Birth-rate. 1916 130,313 141,783 1917 131,942 147,078 1918 134,453 150,650 1919 136,237 141,918 The chief vital statistics of the Borough during 1919, and during the preceding five years, are shown in the next Table. 11 TABLE I. Vital Statistics of whole District during 1919 and previous years. Year. Population estimated to middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Nett. of Non-residents registered in the District. of Residents not registered in the District. Under 1 Yr. of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 1914 128,556 2824 22.0 1505 61 246 239 84 1690 13.2 1915 134,828 2815 20.9 1725 117 233 268 95 1841 13.7 1916 136,723 3074 21.7 1628 158 213 215 70 1683 12.3 1917 146,503 2698 17.1 1450 150 235 214 79 1550 10.6 1918 146,503 2578 16.5 1949 151 294 268 104 2092 14.3 1919 a b 136,237 141,918 12737 19.3 1519 116 276 235 86 1679 12.3 *Estimate of Registrar General. a Population for Death Rate. b Population for Birth Rate. Area of District in acres (exclusive of area covered by water) 8239.7 Total Population, all ages 121,376 Census, 1911 Number of Inhabited Houses 21,463 Average Number of Persons per House 5.6 BIRTHS. 2. The number of births was 2,737, and the birth-rate calculated on the estimate of the Registrar General was 19'3. A case of quadruplets falls to be recorded during the year. Unfortunately, all the children died within a few hours. It is estimated that quadruplets occur once in 385,000 births. Notification of a birth within 36 hours of birth is a statutory duty of the father of the child, and of any person in attendance on the mother. 12 During the year, 2,645 births were notified. This is at the rate of 97% of the registered births, and is, as will be seen from the following table, the highest ever recorded in the Borough. 1,642 notifications were received from midwives, 343 from medical practitioners, 153 from the British Hospital for Mothers and Babies, and 507 from other persons. Cautionary letters were sent to parents, midwives or medical practitioners in each case where no notification had been received of a birth subsequently registered in the Borough. The following table, No. 1, shows the number of births in each year since 1901, the birth-rate for the same period for Woolwich, London, and England and Wales, and the number of live and still births notified each year since 1908, when the notification of births became compulsory in Woolwich. TABLE No. 1. Year Woolwich. London England & Wales Woolwich. Percentage of births notified No. of births Birthrate Birth- rate No. of live births notified No. of Stillbirths 1901 3535 30.0 29.0 - - - - 1902 3730 29.9 28.5 28.6 - - - 1903 3691 30.0 28.4 28.4 - - - 1904 3531 28.1 28.0 27.9 - - - 1905 3549 28.2 27.1 27.9 - - - 1906 3524 28.5 26.6 27.0 - - - 1907 3295 26.5 25.8 26.3 - - - 1908 3082 24.9 25.2 26.5 2194* 62 - 1909 2937 23.8 24.3 25.6 2598 72 88 1910 2844 23.0 23.6 24.8 2653 94 93 1911 2814 23.2 25.5 24.4 2543 68 91 1912 2747 22.3 24.7 23.8 2639 64 96 1913 2876 22.5 24.5 23.9 2637 79 92 1914 2824 22.0 24.3 23.6 2506 59 89 1915 2815 20.9 22.6 21.8 2445 75 87 1916 3074 21.7 23.0 21.6 2642 77 86 1917 2698 17.1 17.4 17.8 2550 88 95 1918 2578 16.5 16.1 17.7 2418 70 94 1919 2737 19.3 18.3 18.5 2645 67 97 *10 months only in 1908. 13 NATURAL INCREASE OF THE POPULATION. 3. The natural increase of the population is the excess of births over deaths. In 1917, it was 1148; in 1918, it was 486; while in 1919, it was 1,058. The next Table, No. 2, below, shows the number of births in each Parish in 1919, and the respective Birth-rates (after correction for Institutional births) for Quinquennial periods, and for the last four years. TABLE No. 2. Period. Woolwich West Plumstead East Plumstead Eltham The Borough 1901-1905 29.0 30.1 24.0 29.2 1906-1910 27.9 24.7 21.6 25.3 1911-1915 25.2 20.7 22.7 17.3 22.2 1916 21.5 21.6 20.5 23.5 21.7 1917 19.6 17.4 18.7 18.2 17.1 1918 19.7 15.4 18.0 17.8 16.5 1919 21.4 16.9 19.1 20.6 19.3 No. of Births 1919 696 708 730 603 2737 4. Illegitimate Births. The following Table, which is partly compiled from statistics given in the Annual Reports of the Registrar General on Births, Deaths and Marriages, shows the number of illegitimate births each year since 1914, and the illegitimate Birth-rate per 1,000 births. 14 TABLE No. 3. Year. No. of illegitimate births. Illegitimate birth-rate per 1,000 births. 1914 74 26.1 1915 98 34.5 1916 106 34.5 1917 146 53.7 1918 162 63.6 1919 151 55.2 MARRIAGES. 5. There were 1,350 marriages. The marriage rate was 19.8 as compared with 27.1, 23.7, 19.7 and 20.2 in the four preceding years. DEATHS. 6. Table No. I. shows the gross and nett deaths and deathrates in 1919, and each of the last five years, and shows how the nett death figure is obtained. The nett deaths were 1,679, and the nett death-rate 12.3. In 1918, the death-rate was 14.3. The following Table, No. 4, shows the death-rate of Woolwich as compared with certain other districts in 1917, 1918 and 1919:— TABLE No. 4. 1917. 1918. 1919. England and Wales 14.4 17.6 13.8 96 Great Towns 14.6 18.2 13.8 London 15.0 18.9 13.4 Greenwich 15.1 18.8 13.5 Lewisham 11.6 13.6 11.4 West Ham 14.5 19.9 13.3 East Ham 11.4 14.5 9.7 Erith 9.6 12.7 10.7 Woolwich 10.6 14.3 12.3 15 The following Table, No. 5, shews the Death-rate in each registration district of the Borough in Quinquennial periods and during the last four years. TABLE No. 5. Periods. The Borough Woolwich Parish West Plumstead East Plumstead Eltham 1886-1890 - 20.4 16.4 - 1891-1895 17.2 19.3 16.0 13.0 1896-1900 16.9 20.1 15.1 14.6 1901-1905 13.9 16.5 12.9 10.2 1906-1910 12.5 14.8 12.0 10.1 1911-1915 12.7 14.9 13.2 11.8 8.9 1916 12.3 14.3 12.6 10.2 8.5 1917 10.6 13.9 11.8 8.4 8.0 1918 14.3 18.1 15.5 12.4 10.8 1919 12.3 16.2 12.7 10.3 10.1 The above table shews that ever since 1911, the death-rates in Woolwich parish and West Plumstead have been above the death-rate of the Borough. In 1917 the Death-rate in Woolwich was the lowest of all the Metropolitan Boroughs, and in 1918 three Boroughs, Hampstead, Lewisham and Wandsworth, had a lower death-rate. In 1919 four Boroughs, viz., Lewisham, Wandsworth, Hampstead, and Fulham, had lower death-rates than Woolwich. The next Tables are self-explanatory. 16 TABLE No. 6. Deaths at various Ages. Year. Under 1 1-5 5-15 15-25 25-45 45-65 65 and over All ages. Percentage over 45 1903 399 155 56 70 251 329 377 1637 43 % 1904 479 174 77 69 248 340 376 1763 41 % 1905 366 139 79 78 261 310 372 1605 42 % 1906 396 139 75 69 249 365 373 1666 44 % 1907 372 207 65 95 204 308 364 1615 42 % 1908 298 134 72 69 219 300 424 1516 48 % 1909 240 163 75 77 223 348 411 1537 49 % 1910 240 105 60 60 208 333 404 1410 52 % 1911 273 136 64 60 217 379 432 1561 52 % 1912 201 119 54 66 205 369 406 1420 55 % 1913 229 93 59 92 243 385 479 1580 55 % 1914 239 141 85 82 244 409 490 1690 53 % 1915 268 136 90 88 266 459 534 1841 54 % 1916 212 108 73 78 259 424 529 1683 57 % 1917 214 113 62 74 212 400 475 1550 56 % 1918 268 169 137 162 438 440 478 2092 44 % 1919 235 85 75 99 265 426 494 1679 55 % 17 TABLE 7.—Birthrate, Death-rate, and Analysis of Mortality during the Year 1919. (Populations estimated to the middle of 1919 have been used for the purpose of this Table). — Birth rate per 1,000 Total Population. Annual Death-rate per 1,000 Civil Population. Rate per 1,000 Births. Percentage of Total Deaths. * All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whoopingcough. Diphtheria. Violence. Diarrhoea and Enteritis (under 2 Years) Total Deaths under One Year. Deaths in Public Institutions. Certified Causes. Inquest Cases. Uncertified Causes of Death. England and Wales 18.5 13.8 0.01 0.00 0.10 0.03 0.07 0.13 0.47 9.59 89 23.9 92.5 6.2 1.3 96 Great Towns, including London (Census Populations exceeding 50,000) 19.0 13.8 0.01 0.00 0.13 0.04 0.07 0.14 0.45 12.24 93 29.2 92.3 6.9 0.8 148 Smaller Towns (Census Populations 20,000—50,000) 18.3 12.6 0.01 0.00 0.10 0.03 0.08 0.12 0.39 8.67 90 16.6 93.6 4.9 1.5 London 18.3 13.4 0.01 0.00 0.08 0.03 0.05 0.18 0.47 16.22 85 44.7 91.2 8.6 0.2 WOOLWICH 19.4 12.3 0.04 0.01 0.05 0.02 0.08 0.19 0.30 6.58 86 31.8 91.8 8.1 0.1 *Non- civilians are included in these figures lor England and Wales, but not for other areas. 18 TABLE II. Deaths Registered during the Calendar Year 1919, classified by age and cause. Causes op Death. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. A11 causes 1679 235 38 47 75 99 265 426 494 Enteric Fever 5 .. .. .. .. 1 2 2 .. Small-pox 2 .. .. .. .. .. 1 1 .. Measles 7 .. 3 3 1 .. .. .. .. Scarlet Fever 3 .. .. 2 .. 1 .. .. .. Whooping Cough 11 4 3 3 1 .. .. .. .. Diphtheria and Croup 28 1 2 9 15 .. 1 .. .. Influenza 124 8 1 6 5 17 56 20 11 Erysipelas 2 .. .. .. .. .. 1 .. 1 Phthisis (Pulmonary Tuberculosis) 171 2 .. 1 8 38 72 43 7 Tuberculous Meningitis 9 1 1 2 5 .. .. .. .. Other Tuberculous Diseases 16 1 .. 1 2 7 4 1 .. Cancer, malignant disease 157 .. .. 1 .. 1 13 80 62 Rheumatic Fever 1 .. .. .. 1 .. .. .. .. Meningitis 13 2 2 1 2 1 3 2 .. Organic Heart Disease 164 .. .. 1 5 7 19 64 68 Bronchitis 114 14 3 1 .. 1 .. 23 72 19 TABLE II.— continued. Causes of Death. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards Pneumonia (all forms) 125 27 16 9 11 5 21 20 16 Other Diseases of Respiratory Organs 15 1 .. .. 1 .. 3 4 6 Diarrhœa and Enterits 32 18 .. .. 1 1 3 4 5 Appendicitis and Typhlitis 16 .. 1 1 3 5 .. 5 1 Cirrhosis of Liver 6 .. .. .. .. .. 2 1 3 Alcoholism .. .. .. .. .. .. .. .. .. Nephritis and Bright's Disease 39 .. .. .. 1 .. 4 22 12 Puerperal Fever 5 .. .. .. .. .. 5 .. .. Other Accidents and Diseases of Pregnancy and Parturition 8 .. .. .. .. 1 6 1 .. Congenital Debility and Malformation, including Premature Birth 110 110 .. .. .. .. .. .. .. Violent Deaths, excluding Suicide 41 4 2 3 1 3 6 17 5 Suicide 12 .. .. .. .. .. 2 9 1 Other defined diseases 440 41 2 3 12 10 41 107 224 Diseases ill-defined, or unknown 3 1 2 .. .. .. .. .. .. 20 TABLE IIA. Deaths registered during the Calendar Year 1919 classified in districts, corrected for Institutional deaths. Causes of Death. Male. Female. Woolwich. Plumstead. Eltham. West. East. All causes 875 804 507 508 378 286 Enteric Fever 2 3 2 .. 1 2 Small-pox 1 1 .. .. 2 .. Measles 5 2 1 2 3 1 Scarlet Fever 2 1 2 .. 1 .. Whooping Cough 5 6 2 .. 2 7 Diphtheria and Croup 12 16 8 10 6 4 Inflenza 65 59 27 38 38 21 Erysipelas 1 1 1 1 .. .. Phthisis (Pulmonary Tuberculosis) 94 77 65 41 43 22 Tuberculous Meningitis 5 4 2 2 3 2 Other Tuberculous Diseases 12 4 5 6 3 2 Cancer, malignant disease 76 81 46 44 39 28 Rheumatic Fever .. 1 .. 1 .. .. Meningitis 7 6 4 6 1 2 Organic Heart Disease 88 76 44 60 41 19 Bronchitis 63 51 31 44 32 7 Pneumonia (all forms) 58 67 52 27 25 21 Other diseases of respiratory organs 9 6 6 5 2 2 Diarrhœa and Enteritis 14 18 8 9 9 6 Appendicitis and Typhlitis 9 7 4 3 5 4 Cirrhosis of Liver 3 3 1 3 2 .. Alcoholism .. .. .. .. .. .. Nephritis and Bright's Disease 25 14 18 13 3 5 Puerperal Fever .. 5 1 2 .. 2 Other accidents and Diseases of Pregnancy and Parturition .. 8 3 1 3 1 Congenital Debility and Malformation, including Premature Birth 63 47 29 38 20 23 Violent Deaths, excluding Suicide 25 16 17 9 10 5 Suicide 9 3 4 3 3 2 Other Defined Diseases 220 220 123 140 81 96 Diseases ill-defined or unknown 2 1 1 .. .. 2 21 Causes of Death. 7. Table No. II. shews that 171 deaths were due to pulmonary tuberculosis, 157 to cancer or malignant disease, 164 to heart disease, 125 to pneumonia, 114 to bronchitis, 110 to congenital debility, and 41 to violence. Cancer and Malignant Disease. 8. The number of deaths due to cancer or malignant disease (including sarcoma) each year since 1901 is shewn in the next Table:- TABLE No. 8. Deaths. Total. Death-rate. Males. Females. 1901 - - 82 0.70 1902 - - 104 0.83 1903 39 54 93 0.75 1904 34 59 93 0.74 1905 42 44 86 0.70 1906 59 56 115 0.90 1907 44 63 107 0.83 1908 39 57 96 0.75 1909 53 66 119 0.93 1910 47 59 106 0.82 1911 62 62 124 1.02 1912 63 56 119 0.97 1913 55 72 127 0.99 1914 62 75 137 1.06 1915 50 71 121 0.90 1916 54 76 130 0.95 1917 57 72 129 0.88 1918 79 82 161 1.10 1919 76 81 157 1.15 22 From the preceding table it will be noted that the death-rates from cancer in 1918 and 1919 are the highest ever recorded in the Borough. Deaths from carcinoma (excluding other malignant tumours) have been classified, according to situation, in the Annual Reports each year since 1903. The details for 1919 are shewn in the next Table No. 9. TABLE No. 9. Seat of Primary Disease. Male. Female. Total. Tongue 7 - 7 Pharynx 2 1 3 Œsophagus 5 1 6 Stomach 22 10 32 Liver and Gall Bladder 6 10 16 Intestines 5 8 13 Rectum 10 4 14 Uterus - 23 23 Vagina and Vulva - 3 3 Breast - 14 14 Skin - 2 2 Larynx 1 1 2 Pancreas 3 - 3 Kidneys 1 - 1 Bladder 6 - 6 Other specified Organs 3 2 5 71 79 150 Respiratory Diseases. 9. 114 deaths were due to bronchitis, 125 to pneumonia, and 15 to other respiratory diseases. The corresponding figures for 1918 were:—bronchitis 108, pneumonia 208, other respiratory diseases 5. The next table shews the number of deaths classified according to age grouping. 23 TABLE No. 10. Under 5 years of age. Over 5 years of age. M. F. Total. M. F. Total. Bronchitis 11 7 18 52 44 96 Pneumonia (all forms) 26 26 52 32 41 73 Other respiratory diseases 1 — 1 8 6 14 38 33 71 92 91 183 From the above table it will be seen that 71 or 27.9% of the deaths occurred in children under five years of age. The percentage for 1918 was 33.9. Influenza. 10. The number of deaths due to influenza was 124 (65 males and 59 females). 15 of these occurred in children under five years of age. The number of deaths ascribed to this disease in 1918 was 454, and it will be seen from the following table that most of the deaths occurring in 1919 are due to the tail end of the epidemic which swept over England in 1918. TABLE No. 11. Quarter. Deaths from influenza. 1918. 1919. January to March 4 103 April to June 6 15 July to September 27 - October to December 417 6 454 124 Violence. 11. Forty-one deaths, 25 of males and 16 of females, occurred from violence, apart from suicide. Twelve deaths were due to suicidal causes, 9 of males and 3 of females. 24 Inquests. 12. There were 135 inquests held in the Borough compared with 146, 180, 181, 131 and 112, in the preceding five years. INFANTILE MORTALITY. 13. The deaths under one year were 235, as compared with 268 in 1918. The infantile mortality rate (deaths under one year per 1000 births) was 86. The Infantile Mortality rate for London was 85; for England and Wales it was 89. In Lewisham the rate was 60, in Stoke Newington 64, in Wandsworth 72, in Battersea 73, in Stepney 79, in Chelsea 80, in Hampstead 81, in Camberwell and Hackney 82, in Fulham and Poplar 83, in Bethnal Green 84, and in Deptford and Lambeth, 85. From the figures in the preceding sentence and from the note after table 5, it will be seen that, although in the general death-rate Woolwich had the fifth lowest rate, in the infantile death-rate it is bracketed for the fourteenth place with two other Boroughs. The following table, No. 12, gives the infantile mortality rate in each registration district of the Borough in quinquennial periods and during the last four years: 25 TABLE No. 12. Periods. The Borough Woolwich Parish. Plumstead West. Plumstead East. Eltham. 1886-1890 - 151 121 - 1891-1895 140 157 120 163 1896-1900 146 170 132 160 1901-1905 119 134 113 97 1906-1910 97 109 91 89 1911-1915 86 101 75 81 67 1916 70 84 54 65 83 1917 79 97 70 84 67 1918 104 125 99 85 109 1919 86 96 82 68 92 14. Illegitimate Deaths. The number of deaths amongst illegitimate infants was 28. A comparison of the infantile mortality rates of legitimate and illegitimate children shows that the rate for legitimate was 80, and for illegitimate children, 186. 15. Causes of Death.— The number of deaths under one year of age, 235, compares with 268 last year. A decrease occurs in deaths from Diphtheria, Bronchitis and Pneumonia, and Enteritis. Figures for deaths due to other causes are practically the same. 16. Age at Death.— The age at death is shown in Table III. 117 or 49% of infant deaths were under four weeks of age. In 1918, 109 or 40.7% occurred under four weeks. 26 TABLE III.- INFANT MORTALITY. 1919. Nett Deaths from stated Causes at various Ages under One Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total Deaths under 1 year. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. 1 1 2 4 Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. 1 .. .. .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. 1 .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. 1 1 2 Meningitis (not Tuberculous) .. .. .. .. .. .. 2 .. .. 2 Convulsions .. .. 1 .. 1 1 .. 2 3 7 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 4 6 2 2 14 Pneumonia (all Forms) .. 2 1 .. 3 5 5 4 10 27 Diarrhœa .. .. .. .. .. .. .. .. .. .. Enteritis .. 2 1 .. 3 2 4 4 2 15 Gastritis .. .. .. .. .. 3 .. .. .. 3 Syphilis 1 .. .. .. 1 1 .. .. .. 2 Rickets .. .. .. .. .. .. .. 1 .. 1 Suffocation, overlying 2 .. .. .. 2 .. .. .. .. 2 Injury at Birth 4 .. .. .. 4 .. .. .. .. 4 Atelectasis 9 .. .. .. 9 .. .. .. .. 9 Congenital Malformations 7 .. 2 1 10 1 .. .. .. 11 Premature Birth 49 4 4 6 63 5 .. .. .. 68 Atrophy, Debility, and Marasmus 11 1 4 .. 16 8 5 2 .. 31 Other causes 2 2 1 .. 5 11 4 7 3 30 85 11 14 7 117 42 27 25 24 235 Nett Births registered during (Legitimate 2586. the calendar year (Illegitimate 151. Nett Deaths registered during Legitimate Infants, 207. the calendar year of Illegitimate Infants 28. 27 SANITARY CIRCUMSTANCES OF THE DISTRICT. SCAVENGING. Removal of House Refuse. 17. There has been no alteration in the system of the removal of house refuse during the year. House refuse is collected by contract in the Parishes of Plumstead and Eltham, and by the Works Committee in the Parish of Woolwich. In Eltham it is disposed of by tipping, and in Woolwich and Plumstead by a destructor. The Council's contractors are Messrs. Tuff & Hoar. In Plumstead 14,846 loads, in Woolwich 6,969 loads, and in Eltham 5,995 loads (estimated), were collected and disposed of. The total cost of collection and disposal in Eltham was £2,495 12s. 5d., as compared with £2038 16s. 5d. in 1918. In Plumstead the cost of removal was £5,137 11s. 5d., compared with £4360 12s. 7d. in the preceding year. The frequency of removal is weekly, although in certain parts of Woolwich and Plumstead it is twice weekly. The number of dustbins which it was found necessary to renew was 609, compared with 434 in 1918, and 447 in 1917. Removal of Trade Refuse. (a) In-offensive. The arrangements for the removal of trade refuse are similar to those for house refuse, with the exception that it is removed in Plumstead mainly by the Works Department. In Woolwich 169 loads, in Plumstead 359 loads, and in Eltham 16 loads were removed. All trade refuse, with the exception of 41 loads, was removed by the Borough Engineer. The charge made for the removal is 2s. per load. 28 (b) Offensive. Offensive trade refuse is removed by the Borough Engineer. The Borough Council make a systematic collection principally from butchers and fishmongers. For this purpose specially prepared airtight receptacles, of a capacity of two bushels, are provided, and in the scheme an empty one is left with the dealer whenever a full one is removed. These receptacles are collected regularly, and whenever a lorry load (18) is obtained, the refuse is carted to a guano manufacturer in Poplar. Soiled receptacles are cleansed externally and internally by scalding and scrubbing before re-issue. The charge made per receptacle is 3d., payable quarterly in advance. There are 39 tradesmen from whom this refuse is collected, and during the year 4,222 receptacles were removed, compared with 2,317 in the preceding year. Cleansing of Earth-closets, Privies, and Cesspools. 18. In the outlying parts of the Borough, where the sewers are not within the statutory distance of the houses, it is still necessary to resort to the temporary expedient of earth-closets and cesspools. Under the provisions of the Bye-laws of the London County Council, where cesspools are constructed they are made watertight, and where earth-closets are in use the receptacle is of galvanised iron. The Borough Council, under the provisions of Section 30 of the Public Health (London) Act, 1891, undertake the cleansing and emptying of earth-closets and cesspools. For the emptying of cesspools the Works Department has an equipment of tank carts and pumps and, where necessary, carry this work out during night time. 29 SANITARY INSPECTION OF THE BOROUGH. 19. This part of the report, which has been largely prepared by your Chief Sanitary Inspector, deals with the work of the District Inspectors and of the Lady Sanitary Inspector. During the year, as last year, two Sanitary Inspectors have been acting under the Food Control Committee and, in consequence, have not been available for general sanitary work, although they have been extremely useful in dealing with the supervision of food. Tables 13 to 16 shew in detail the work of the Inspectors. 20. The number of complaints received and attended to was 719, as compared with 492, 630 and 599, in the three preceding years. 27 of these complaints related to the non-removal of dust: 2 of these were from Woolwich, 10 from Plumstead and 15 from Eltham. 21. Tables Nos. 13 and 14 below shew the number of the various inspections carried out during the year. 30 TABLE No. 13. PREMISES INSPECTED. Sanitary Inspectors' Districts. St. Mary's and Dockyard. River. Herbert. Central and St. Margaret's. St, Nicholas. Burrage and Glyndon. Eltham. St. George's. Total. No. of Houses inspected, house to house 291 229 .. 64 414 224 478 480 2180 „ Re-inspections after service of Notice (estimated) 1424 1512 1064 950 2306 1076 2826 1328 12486 „ Houses and premises specially inspected, including infectious diseases and complaints 421 527 532 411 739 314 935 184 4062 „ Houses where drains have been tested by smoke test 5 5 9 6 1 6 23 6 61 „ Houses where drains have been tested by water test 3 6 5 5 2 0 17 4 42 „ New Houses inspected for Water Certificates .. .. .. .. 1 .. .. .. 1 „ Inspections of Registered Houses 172 251 6 23 84 48 .. 114 698 MISCELLANEOUS INSPECTIONS. No. of Observations re Smoke Nuisance .. .. 1 .. .. .. 4 .. 5 „ Tents, Vans &c., Inspected .. .. .. .. 1 .. 50 .. 51 „ Urinals accessible to Public Inspected 72 164 7 55 26 20 42 20 405 „ Animals kept so as to be a Nuisance 6 1 2 .. 3 2 12 .. 26 31 TABLE No. 14. No. of Inspections of Shops and Market re Pood (estimated) 450 „ Inspections of Premises where food is prepared 118 „ Inspections of Milkshops 76 „ Inspections of Bakehouses 92 „ Inspections of Cowhouses and Slaughterhouses, &c. 125 „ Inspections of Outworkers' Premises 98 „ Inspections of Factories, Workshops and Workplaces 502 „ Inspections of Homes, re Verminous Cases 416 „ Inspections of Houses on Defective Combined Drains 88 „ Inspections re Scabies Cases 403 „ Inspections re Women's Lavatories 104 „ Miscellaneous (unclassified), including Re-inspections 1560 As compared with 1918, the number of inspections, house-tohouse, has diminished (2,180 as against 2,754), but the number of re-inspections has increased (12,486 as against 6,530). Difficulty in securing the prompt attention to notices served, caused mainly by the increased cost of both material and labour, has necessitated the giving of increased time to re-inspections by your Inspectors. The mere inspection of defective conditions, although valuable, is relatively futile if the necessary repairs are not carried out. The number of drains tested was 103 compared with 59 in 1918. 22. In accordance with the provisions of the Metropolis Management Act, plans are submitted where the repair of drains is of an extensive nature, and the information is likely to be of use for future reference. It is not insisted that an elaborate drawing should be provided, but a plan reasonably interpreting the drains that have been attended to, is accepted. There have been during the year, 32 plans submitted, Nos. 335 to 366. 23. Notices for the repair and reconstruction of 17 combined drains, relating to the connections of 88 houses, were served on the owners. These compare with 3 and 23 respectively in the previous year. In four cases in the present year the owners were in default, and these were referred to the Borough Engineer to carry out the necessary work and recover the cost. 32 24. Table No. 15 below shows the various nuisances abated during the year in the various wards of the Borough. TABLE No. 15. NUISANCES ABATED. Sanitary Inspectors' Districts. St. Mary's and Dockyard. River. Herbert. Central and St. Margaret's. St. Nicholas. Burrage and Glyndon Eltham. |St. George's. Total. Waste-pipe from baths, lavatories, and washhouse sinks, repaired or disconnected 9 10 12 12 37 6 16 10 112 Choked and defective drains 28 53 41 32 68 19 44 7 292 Defective traps .. .. 3 .. 1 2 7 .. 13 Defective and unventilated soil pipes .. 2 2 .. .. .. 4 .. 8 W.G.'s repaired, new traps or pans provided 30 25 33 29 36 44 34 29 360 Water supply apparatus repaired or renewed 46 31 20 40 116 35 66 32 386 Foul pans cleansed 6 22 5 7 19 19 26 9 113 Additional w.c.'s provided to Factories and Workshops, &c. .. .. .. .. .. .. .. .. .. Additional w.c.'s provided to dwelling houses .. .. .. .. .. .. .. .. .. Underground rooms not in accordance with Act .. .. .. .. .. .. .. .. .. Interiors cleansed and defective roofs repaired 175 245 238 158 321 336 313 363 2149 Damp walls remedied 20 59 51 20 51 59 38 77 375 Paving in yards and wash-houses repaired 12 10 13 20 37 12 15 13 132 Improved ventilation provided .. 12 2 .. 2 16 5 6 43 Wash-houses provided with sinks and outlets for waste water .. .. .. .. .. .. 6 .. 6 33 TABLE No. 15—continued. NUISANCES ABATED. Sanitary Inspectors' Districts. St. Mary's and Dockyard. River. Herbert. Central and St. Margaret's. St. Nicholas. Burrage and Glyndon. Eltham. St. George's. Total. Defective guttering and rain-water pipes 35 20 23 26 113 40 37 23 317 Dustbins supplied 21 80 21 51 170 43 90 133 609 Cases of overcrowding remedied 4 8 5 .. 8 4 9 11 48 Deficient light—windows supplied, or enlarged, or other works 12 .. 1 11 1 2 16 .. 43 Dampness in premises from defective water pipes 11 4 11 3 22 16 7 6 80 Accumulations of manure removed 6 .. 17 6 15 11 12 .. 66 Dung pits provided .. .. .. .. .. .. .. .. .. Defective and foul cisterns used for dietary purposes .. 1 .. .. 4 .. 6 .. 11 Defective and foul rain-water tanks remedied .. .. 1 .. .. 1 2 .. 4 Insufficient supply, and water cut off by Water Board 7 8 3 6 4 7 14 .. 49 Additional water supply for two or more families .. .. .. .. .. 1 .. .. 1 Smoke Nuisances .. .. 1 .. .. .. .. .. 1 Verminous rooms cleansed 9 13 5 5 6 14 9 13 74 34 25. The total number of intimation notices served was 2,470, as compared with 2,308 in 1918. It was found necessary to serve 846 statutory notices, as compared with 810 in 1918. The number of cases reported to the Town Clerk for legal proceedings was 79; 7 summonses were taken out, the necessary work in the other cases being done. 26. The following table shows the number of summonses taken out during the year, and the result of the proceedings :— TABLE No. 16. Prosecutions under the Public Health, Housing, Town Planning, &c., and London County Council (General Powers) Acts. No. Date of Hearing. Offence. Situation. Result. 1 1919 April 16 Filthy and unwholesome top room, and an accumulation of offensive refuse 38 Warwick Street Order to abate in 7 days. 4/costs 2 May 22 Defective roof 80 Bannockburn Road £1 1s. 0d. costs 3 Dec. 4 Dirty conditions and defective roof 5 High Street, Plumstead £1 1s. 0d. costs 4 „ 4 No dustbin Do. do. 8/- costs 5 „ 4 Defective w.c. apparatus Do. do. £1 1s. 0d. costs 6 „ 4 Dirty conditions of house 77 Tewson Road £1 1s. 0d. costs 7 „ 31 Dirty conditions of house 6 Vicarage Road Order to abate in 14 days. 11/costs HOUSES LET IN LODGINGS. 27. Detailed statistics with regard to the number of these on the register are given in Table 20 on page 43, and with regard 35 to their inspection in Table 13 on page 30. These houses have been regularly inspected during the year by the Lady Sanitary Inspector. The difficulties in obtaining the prompt abatement of nuisances in houses let in lodgings have been similar to those experienced in the routine bouse inspections, the costs of labour and materials being the trouble, thereby necessitating increased supervision. There is always a greater tendency to overcrowd in these houses, but the difficulty in abating this is obviously the shortage of houses. The circumstances are, as far as possible, mitigated by a re-distribution of the occupants on the advice of the Inspector. 28. Power is given under the Housing, Town Planning, &c., Act of 1919, Section 26, to the London County Council to prepare bye-laws— (а) for fixing and from time to time varying the number of persons who may occupy a house or part of a house which is let in lodgings or occupied by members of more than one family, and for separation of the sexes therein ; (b) for the registration and inspection of such houses ; (c) for enforcing drainage and promoting cleanliness and ventilation of such houses; (d) for requiring provision adequate for the use of and readily accessible to each family of— (i) closet accommodation; (ii) water supply and washing accommodation ; (iii) accommodation for the storage, preparation, and cooking of food ; and, where necessary, for securing separate accommodation as aforesaid for every part of such house which is occupied as a separate dwelling ; (e) for the keeping in repair and adequate lighting of any common staircase in such houses; 36 (f) for securing stability, and the prevention of and safety from fire; (g) for the cleansing and redecoration of the premises at stated times, and for the paving of the courts and courtyards; (h) for the provision of handrails, where necessary, for all staircases of such houses; (i) for securing the adequate lighting of every room in such houses; and when these bye-laws come into force, the anomalous position at present existing in the Borough (no bye-laws operating in the parish of Eltham) will automatically come to an end. CLEANSING OF VERMINOUS PERSONS. 29. The station for cleansing verminous persons was opened in November, 1906. It is situated in White Hart Lane, Plumstead, in premises adjoining the Disinfection Station. An agreement was entered into with the London County Council in August, 1911, to allow the London County Council to use the Borough Council's Cleansing Station for cleansing school children. The station is now reserved for the use of these children every day between 9 a.m. and 4.30 p.m., except Saturday and Sunday. Girls are cleansed in the morning and boys in the afternoon. The Borough Council must cleanse the children to the reasonable satifaction of the London County Council, which pays 1/- for each cleansing. During the year, the London County Council pointed out that the accommodation provided was inadequate, and, in consequence, the premises are now being enlarged by the addition of a waiting room, so that at least 125 cases can be dealt with per week. A new agreement has been entered into with the London County Council whereby, as soon as these alterations are 37 pleted, they guarantee a minimum payment of £275 per annum to the Borough Council. The Borough Council employs a female attendant to cleanse the children, who acts under the supervision of a London County Council School Nurse, who is responsible for the treatment of the children at the Station. The children with verminous heads are given a box of Stavesacre ointment and printed instructions as to its use. The names and addresses of all children are entered in a book, and the Lady Sanitary Inspector visits the children's homes and makes the necessary arrangements for the cleansing and disinfection of verminous bedding and rooms. Table No. 17 below shows the extent to which the Station has been used in the last five years. TABLE 17. Children. Adults. Grand Total. Year. Boys. Girls. Total. Males. Females Total. 1915 315 551 866 72 16 88 954 1916 625 440 1065 44 15 59 1124 1917 1131 1652 2783 9 8 17 2800 1918 1930 1737 3667 14 3 17 3684 1919 1919 1816 3735 13 8 21 3756 It will be noted that, for the years 1917-18-19. the numbers cleansed have considerably increased. The increase is partly due to an arrangement entered into in 1917, whereby cases of scabies are treated. 38 UNDERGROUND SLEEPING ROOMS. 30. No underground rooms were found to be occupied for sleeping contrary to the regulations. OFFENSIVE TRADES. 31. There are no offensive trades in Woolwich. FACTORIES, WORK-SHOPS & WORK-PLACES. 32. The total number of factories, workshops, and workplaces on the register at the end of the year was 314. The total number of inspections made, 502, compares with 570 last year; it was found necessary to serve 67 notices compared with 37 in 1918. 98 inspections of home-workers' premises were made, and 7 notices were sent and attended to. The Lady Sanitary Inspector devoted a large amount of her time to the inspection of workshops, factories and houses where women are employed. No cases of Infectious Diseases were notified as having occurred in the homes of outworkers. The houses of outworkers are subject to the regular inspection that takes place as the routine work of the Sanitary Inspectors in house-to-house inspection, and in connection with complaints, and are therefore maintained in a fairly satisfactory condition. The following Tables, Nos. 18a and 18b, are in the form suggested by the Home Office for the guidance of Medical Officers of Health so as to ensure uniformity in the presentation of statistics. 39 TABLE 18A. Factories, Workshops, Laundries, Workplaces, and Homeworkers' Premises. 1.—Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Factories (Including Factory Laundries) 142 30 Workshops (Including Workshop Laundries) 242 10 Workplaces 118 27 Homeworkers' Premises 98 7 Total 600 74 2.—Defects found. Description. Number of Defects. Found. Remedied. Nuisances under Public Health Act: Want of Cleanliness 39 39 Want of Ventilation 4 4 Overcrowding 3 3 Want of Drainage of floors — — Other nuisances 4 4 Sanitary Accommodation insufficient 1 1 unsuitable or defective 4 4 not separate for sexes 1 1 Total 56 56 40 TABLE 18a.—continiied. 3.—Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act. (S. 133) 1 Action taken in matters remediable under the Public Health Acts, but not under the Factory Act (S. 5). Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspectors 3 Underground Bakehouses (S. 101) :— In use during 1903 24 Certificates granted in 1906 1 in 1910 1 In use during 1919 10 Workshops on the Register (S. 131) at end of 1919:— Workshop Laundries 13 „ Bakehouses 46 Other Workshops 242 Total number of Workshops on Register 301 41 TABLE 18B. 4.—Home Work. Nature of Work. Out Workers' Lists, Section 107. Number of Inspections of Outworkers' premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sections 109,110. Lists received from Employers. Number of Addresses of Outworkers received from Other Councils. Number of Addresses of Outworkers forwarded to Other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions (Sees. 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing Apparel 28 105 7 22 36 18 .. .. 30 .. 3 .. .. .. .. Tennis Balls, etc. 6 552 .. .. .. 105 .. .. 68 .. 4 .. .. .. .. Artificial Flowers .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 34 657 7 22 37 123 .. .. 98 .. 7 .. .. .. .. 42 TABLE 19. 33. List of Certified Underground Bakehouses. Name. Address. A. B. Adams 223, High Street, Plumstead J.Werner 1, Park Road, do. F. Cox 46, Hudson Road, do. Virgoe & Sons 13, Eton Road, do. J. Colver 57, Plumstead Road, do. A. E. Sims 24, St. James's Place, do. H. M. Goss 30, Burrage Road, do. F. Wilkening 72, Henry Street, Woolwich W. C. Clothier 51, Albion Road, do. Irons & Co. 15, New Road do. (unoccupied) 50, Herbert Road, Plumstead (unoccupied) 16, Armstrong Place, do. (unoccupied) 2, Crescent Road, do. (unoccupied) 33, Eglinton Road, do. (unoccupied) 14, Westdale Road, do. (unoccupied) 58, Pattison Road, do. (unoccupied) 14, Conway Road, do. (unoccupied) 165, Sandy Hill Road, do. (unoccupied) 57, Burrage Road, do. (unoccupied) 31, Beresford Street, Woolwich (unoccupied) 16, Woolwich Common, do. (unoccupied) 23, George Street, do. (unoccupied) 21, Albion Road, do. (unoccupied) 32, Church Street, do. (unoccupied) 81/82, Brookhill Road, do. (unoccupied) 8, Hill Street, do. MILK PREMISES, COW-SHEDS, ETC. 34. The following Table, No. 20, shews the number of milk premises, etc., on the various registers at the beginning and end of the year; the number of inspections, number of notices served, and proceedings instituted. 43 TABLE 20. Proceedings, etc., during 1919. Premises. Number of Places. Number of Inspections. Number of Notices. Number of Prosecutions. On Register at end of 1918. Added in 1919. Removed in 1919. On Register at end of 1919. Milk Premises 84 4 12 76 76 0 0 Cowsheds 14 0 0 14 52 5 0 Slaughter-houses 9 0 0 9 27 0 0 Ice Cream Premises 46 0 0 46 46 0 0 Registered houses let) in Lodgings 448 5 10 443 678 510 0 The number of milk retailers has been reduced by eight during the year. The reduction is mainly due to the difficulties of small dealers in obtaining their supplies, and to the narrow margin of profit during the operation of the milk prices orders of the Food Controller. There is no reason to regret this diminution, as those who have discontinued were keepers of small general shops where the facilities for keeping the milk were not ideal. The Cow-houses are systematically inspected, and the sheds are maintained in a fairly satisfactory condition. Efforts are made to obtain an observance of cleanliness by the cowmen, both of himself and the animals. A reasonable standard of cleanliness is maintained, but there are still possibilities of improvement. There has been an average of 458 cows in the Borough. The milk from these is mainly consumed in this area. 44 The Slaughterhouses are subject to systematic inspection, in addition to which they are constantly seen during the inspection of unsound or diseased meat. The slaughterhouse belonging to the Royal Arsenal Co-operative Society is the one most extensively used in the Borough. TABLE 21. List of Slaughterhouses. No. Name of Owner. Situation. l Harry Chaston 168, High Street, Eltham 2 H. Reed & Co., Ltd. 6, High Street, Plumstead 3 William Francis Bartlett Rear of 14, Church Street, Woolwich 4 H. Reed & Co., Ltd. Love Lane (rear of Wellington Street), Woolwich 5 James & George Mitchell 25, Hare Street, Woolwich 6 Hedley Vicars 30, Hare Street, Woolwich 7 H. Reed & Co., Ltd. 38, Plumstead Common Road, Plumstead 8 Henry Fretter 33, Herbert Road, Plumstead 9 Royal Arsenal Co-operative Society Bostal Farm, Plumstead There was not a large amount of Ice Cream manufactured in the Borough, due to the shortage of sugar, but an allowance of sugar was granted to six ice cream makers. The list of ice cream premises is still being maintained. 45 MORTUARIES. 35. There are two Mortuaries in the Borough, one in Sun Street, and one in Eltham. The one in Eltham is only regarded as a place for the temporary deposit of a body, the accommodation being limited to one apartment. At Sun Street there is separate accommodation for non-infectious and infectious bodies. There is no Coroner's Court. The following Table, No. 22, shows the extent these Mortuaries were used during the year. Sun Street. Sun Street (Infectious). Eltham. Number of bodies removed— (a) for inquest 135 2 3 (b) for custody 18 2 5 Total number 153 4 8 Number of Post-Mortem Examinations 80 — — CEMETERIES. 36. The two Borough Cemeteries were well maintained, and no complaints were received. The following statistics relating to interments have been supplied by the various Cemetery Superintendents, and by the Vicar of Eltham:— TABLE 23. Number of Interments. 1919. 1918. 1917. Woolwich Cemetery 606 839 701 Plumstead Cemetery 740 915 665 Eltham Cemetery 192 218 159 Plumstead Churchyard 37 32 36 1575 2004 1561 46 INHABITED HOUSE DUTY. 37. No Certificate under the Inland Revenue Act was granted during 1919. 38. The following matters are dealt with in the Housing part of the Report:—Overcrowding; Fitness of Houses; Action under the Housing Acts. RAT DESTRUCTION. 39. There were 75 complaints received as to the existence of rats. These referred to rats that were infesting 141 premises, and related to 38 business premises (including premises where food is prepared and stored), 16 stables and 87 private houses. In the private houses complained of there were always chickens or rabbits kept. The premises were inspected and occupiers advised that they were responsible for the extermination. The occupiers were advised as to the best methods that should be adopted to meet their case. Poisons, traps and varnished boards were recommended. The two principal factors always kept in mind were rat-proofing the premises and killing all rats. In cases where there was any suspicion that the rats were coming from defective drains, the drainage systems were tested and examined. The complaints received were from all parts of the Borough, and principally related to only a small number of rats in each case. There were, however, two business premises investigated which are largely infested, but in these cases action is continually being taken by the firm to reduce the numbers. In one instance, a rat-catcher is constantly employed, and records are kept of his work. 47 FOOD. MILK. 40. During the winter months of the year a return was obtained by the Food Control Committee of the amount of milk available each week in the Borough. This is set out below in tabular form, and the maximum price per quart is set out also. TABLE 24. Week ending Amount in gallons. Cost per quart. January 4th 33,853 8d. 11th 35,124 8d. 18th 35,081 8d. 25th 35,294 8d. February 1st 35,539 8d. 8th 35,314 8d. 15th 36,009 8d. August 30th 35,130 8d. Sept. 27 th 32,997 9d. October 4th 23,738 11d. 11th 30,426 11d. 18th 31.380 11d. 25th 30,257 11d. November 1st 30,976 1/- 8th 30,102 1/- 15th 29,968 1/- 22nd 30,288 1/- 29 th 29,950 1/- December 6th 30,735 1/- 13th 31,080 1/- 20th 30,934 1/- 27th 31,787 1/- 48 These figures mean that the average amount of milk coming into Woolwich was approximately a quarter of a pint per bead of population per day. Actually during the weeks when the return was obtained, it varied (excluding the railway strike week when it was only 3¾ ozs.) from 5 02 ozs. to 6.04 ozs. The Ministry of Food estimated that the amount of liquid milk available in January and February for the whole country was roughly a quarter of a pint per head of population per day, so that the Woolwich milk supply may be considered an average one, or perhaps very slightly over the average. This supply is of course insufficient, and the liquid milk must be supplemented from other sources. In London, it is estimated that the number of tins of condensed milk used per head of population per annum is 16. The supply may also be supplemented by the use of dried milk, but no figures are available to show the extent to which dried milk is used. From the above figures it must be apparent that there is an inadequate supply of pure fresh milk, and it is reasonable to assume that many children do not get fresh milk. This is rather confirmed by the fact, that during the railway strike, 994 priority cards were supplied for condensed milk, and 557 for fresh milk on behalf of children under 6, and invalids, out of a total number of 1,551 cards. There are eleven farms within the district where milch cows are kept, and the total strength of the herds amounts to 458. During the summer months there appeared to be a more plentiful milk supply, but the quantity used by those mostly in need of it, viz., the children of the poor, must be regulated in a large measure by their ability to pay the price. This, unfortunately, was on an ascending scale during the year. 49 Dairies, Cowsheds, and Milkshops Order. 41. There are 14 licensed cowsheds in the Borough, in which there are approximately 458 cows in milk. These have been regularly inspected quarterly during the year, and are kept in a satisfactory condition. In consequence of their being subject to annual license, a direct stimulus is given to efficient maintenance. There were no objections to the renewal of the licences, but the attention of the London Couuty Council was drawn to an unlicensed shed being used by one of the cowkeepers. This matter was dealt with at the licensing sessions. TABLE 25. List of Cowhouses. No. Name of Owner. Situation. l William Frederick Fisher Cold Harbour Farm, Chislehurst 2 Alfred Low Avery Hill Farm, Eltham 3 W. F. Corp Lyme Farm, Eltham 4 Charles Umfreville Fisher and William F. Fisher, Crescent Farm, Sidcup Belmont Park Farm, Eltham 5 James Grace Pippinhall Farm, Eltham 6 Charles Umfreville Fisher Chapel Farm, Eltham 7 Thomas W. Keen and Stanley A. Keen Clay Farm, New Eltham 8 Elizabeth Compton Bayley Middle Park Farm, Eltham 9 Harry Furber Southend Farm, Eltham 10 Charles William Killick 52, St. James' Place, Plumstead 11 Charles William Killick 13, Princes Road, Plumstead 12 Herbert J Wolsey, George E. Wolsey, Nelson W. Wolsey 50, Francis Street, Plumstead 13 F. G. Cock 13, Raglan Road, Plumstead 14 Edwards & Sons, Ltd. Rear of 14, 15 & 16, Pellipar Road, Woolwich 50 At the end of the year there were 76 milkshops on the register, a diminution of 8 from 1918,12 being removed from the register, and 4 added. There have been no prosecutions, and no notices served. Milk Registration. 42. The following applications for registration as a retail dealer in milk have been granted since January, 1919, to December, 1919:— Sidney L. Bartlett, 59 Piedmont Road, Plumstead. 11-3-19. (Business taken over from Brown, 40 Garibaldi Street, Plumstead). William Wells, 164 High Street, Eltham. 11-3-19. (Business taken over by F. W. Weeb, 2-3-1920). L. H. Wise, 6 Herbert Road, Plumstead. 16-6-1919. (Business taken over from Large & Sons, 6 Herbert Road, Plumstead). Thomas H. Craig, 46 Church Street, Woolwich. 8-9-1919. (Business taken over from Aldridge, 46 Church Street, Woolwich). MILK AND CREAM REGULATIONS, 1912 and 1917. 43. All samples of milk were examined for the presence of preservatives and colouring matter. In no case were these reported to be present. The sale of cream was restricted from 12th April to 1st September, 1920. Milk (Mothers and Children) Order, 1918. 44. The Council on the 10th April, 1918, authorised the Medical Officer to supply necessitous mothers and babies with milk at a reduced cost or free of cost, and in November, 1919, at a time when the price of milk was rising, they re-considered 51 their previous arrangements, and resolved to supply milk free to all eligible applicants who came within the scale set out below. The Medical Officer was authorised in addition to supply milk to applicants above this scale provided he obtained the covering approval of the Maternity and Child Welfare Committee at their next meeting. The scale at present in force is as follows:— No. in Family. Average Income per head.* s. d. One 10 0 Two 10 0 Three 8 8 Four 7 9 Five 7 5 Six or more 7 2 * After deduction of rent, fares and insurances. During the year fresh milk was supplied in 81 cases at a cost of £137 2s. 0d., and dried milk in 57 cases at a cost of £112 10s. 6d. Dinners have been supplied in 10 cases at a cost of £12 14s. 2d. Dried milk has been sold at all the Centres during the year to those who cannot afford to pay the ordinary trade price. UNSOUND FOOD AND FOOD INSPECTION. 45. The District Inspectors when on duty in their districts are always on the outlook for unsound food, but in addition to this, the two sanitary inspectors doing duty with the Food Control Committee, have kept under regular inspection food exposed or deposited for sale in shops, slaughterhouses, and the market stalls. 52 There were three seizures during the year. These related to 33½ cwt. of mussels. These were delivered direct into the district and did not pass through Billingsgate Market. Samples examined bacteriologically showed that these were polluted. The circumstances, however, did not justify proceedings. On 120 occasions unsound food was surrendered. Included in the food surrendered were 10,380 lbs. of dates; 7,573 lbs. of beef; 3,690 lbs. of bacon; 9 boxes, 7 barrels, 5 bags, and 36 cwt. of fish, and smaller quantities of cheese, rabbits,calves' livers, ox livers, butter and condensed milk. The number of carcasses or parts of carcasses condemned on account of tuberculosis was 13. On one inspection of the market place in Beresford Square your inspector was obstructed. Legal proceedings followed, and the stall-holder was fined. The condition of Bakehouses and Slaughterhouses, and the report of the sanitary condition of premises is dealt with in that part of the report dealing with the sanitary inspection of the district. SALE OF FOOD AND DRUGS. 46. The following Table, No. 26, shows the nature and number of the various analyses made during the year, and the result of the analyses:— TABLE 26. Sale of Food and Drugs Act. List of Articles Analysed during 1919. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated Milk 209 5 214 7 Margarine 31 4 35 — Cocoa 40 26 66 — Coffee 51 14 65 - 53 TABLE 26— continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated Pepper 8 5 13 — Vinegar 11 3 14 — Dripping 1 3 4 — Tomato Soup 2 3 5 — Mustard 20 4 24 1 Butter 1 6 7 — Lard 3 5 8 — Drugs — 16 16 — Cream of Tartar - 4 4 — Baking Powder 3 5 8 — Fish Paste — 1 1 — 380 104 484 8 The percentage of adulterated samples, l.6 per cent., is the lowest recorded in the last five years, and compares with 7'3, 7.9, 9.4, 7.2, and 3.2, in the preceding years. None of the imformal samples were found to be adulterated. The number of samples taken on a Sunday was 20, and 1 of these was found adulterated. In the certificate furnished by the Analyst, a fat percentage figure is given in the case of each sample of Milk. The minimum legal standard is 3 per cent. The 214 samples analysed show the following fat percentage figures:— Above 4.5% 2 4%—4.5% 20 3.5—4% 95 3%—3.5% 92 Below 3% 5 214 54 TABLE 27. Prosecutions under the Food & Drugs Acts during 1919. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 1 Milk 10.0% deficient in fat Eltham Dairies Fine £3; costs £1 l1s. 6d. 2 Milk 9.3% added water W. S. Aldridge, 10 Chapel Street Fine £3; costs £1 l1s. 6d. 3 Milk 38.35% Emily A. Gill, 398 High Street, Plumstead Fine £5; costs £4 l1s. 6d. 4 Mustard 15.0% foreign starch Agnes Etherington, 34 Abery Street Withdrawn on payment of £2 2s. 0d. costs 5 Milk 5.41% added water W. Wren, 9 Elizabeth Street, North Woolwich Warranty proved 6 Milk 5.17% Eltham Dairies, High Street, Eltham Fine £5; costs £1 l1s, 6d. 7 Milk 29.3% deficient in fat S. L. Bartlett, 31 Piedmont Road Pine £1; costs £1 1s. 0d. 8 Milk 9.17% added water P. W. Webb & Co., Lakedale Road Dismissed; Warranty proved Prosecution under the Public Health (London) Act, 1891. 1 Wilful obstruction of Sanitary Inspector while examining unsound meat in Beresford Square Edward Gilder, 2 Wellington Mansions, Charlton Fine £2; costs £1 1s. 0d. 55 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Notifications. 47. The total number of Notifications received during the year was 3,461. Table No. IV. below shows these notifications in detail for each disease and in year groups. It also shows the numbers occurring in each parish in the Borough, and the numbers removed to Hospital. For comparative purposes, the number of cases of Notifiable Infectious Diseases occurring in the Borough each year since 1901 are shown in Table 28 on page 57. During 1919, there was an increase in the incidence of Infectious Diseases, and more particularly in the case of Diphtheria and Enteric Fever. 56 TABLE IV. Cases of Infectious Diseases notified during the Year 1919. Notifiable Diseases. Number of Cases Notified. Total Cases Notified in each Locality. Mistaken Diagnosis. Total Cases removed to Hospital or Sanatorium. At all Ages. At Ages—Years. Woolwich. Plumstead. Eltham. Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards West East Small-pox 4 ... ... 1 ... 2 1 ... ... ... 4 ... ... 4 Anthrax 1 ... ... ... ... 1 ... ... ... 1 ... ... ... 1 Cholera (C), Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 398 5 73 244 51 23 2 ... 149 108 84 57 24 345 Erysipelas 63 1 2 5 9 22 16 8 13 20 22 8 ... 8 Scarlet Fever 243 2 52 155 30 4 ... ... 82 62 41 58 1 200 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Zymotic Enteritis 123 57 43 8 4 6 5 ... 23 28 37 35 1 8 Enteric Fever 26 ... 3 8 5 8 2 ... 17 2 3 4 2 23 Pneumonia 123 4 12 17 21 47 17 5 35 43 14 31 ... ... Puerperal Fever 7 ... ... ... ... 7 ... ... 1 3 ... 3 ... 5 Cerebro-Spinal Men. 6 ... 1 ... 4 1 ... ... 2 1 2 1 1 5 Post Basic „ 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... Poliomyelitis 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... Encephalitis Lethargica 3 ... ... 3 ... ... ... ... ... ... 1 2 ... ... Ophthalmia Neonatorum 34 34 ... ... ... ... ... ... 12 4 8 10 ... 9 Pulmonary Tuberculosis 394 1 8 62 107 154 57 5 103 117 92 82 ... 207 Other forms of „ 80 2 10 43 15 7 3 ... 14 29 24 13 ... 22 Measles 1886 14 618 1237 9 8 ... ... 334 635 550 367 ... ... Malaria 61 ... ... ... 14 45 2 ... 18 22 10 11 ... ... Dysentery 7 ... ... ... ... 5 2 ... 2 2 ... 3 ... ... Total 3461 121 822 1784 269 340 107 18 806 1078 892 685 29 837 57 TABLE 28. Notification of Infectious Diseases, 1901 to 1919. Year. Small-pox. Diphtheria and Mem. Croup. Scarlet Fever. Enteric Fever. Erysipelas. Puerperal Fever. Tuberculosis.* Continued Fever. Cerebro-Spinal Fever. Anterior Poliomyelitis. Ophthalmia Neonatorum. Zymotic Enteritis. Post basic Meningitis. Anthrax. Encephalitis. Malaria. Dysentery. Pneumonia.† 1901 21 216 311 68 72 8 .. 1 .. .. .. .. .. .. .. .. .. .. 1902 228 233 267 50 98 11 189 1 .. .. .. .. .. .. .. .. .. .. 1903 6 186 389 42 58 2 165 3 .. .. .. .. .. .. .. .. .. .. 1904 6 163 472 25 74 5 186 1 .. .. .. .. .. .. .. .. .. .. 1905 7 273 513 27 83 12 145 1 .. .. .. .. .. .. .. .. .. .. 1906 .. 387 528 40 97 8 176 .. .. .. .. .. .. .. .. .. .. .. 1907 .. 275 1023 27 110 6 150 .. 1 .. .. .. .. .. .. .. .. .. 1908 .. 362 596 19 90 6 154 .. 1 .. .. .. .. .. .. .. .. .. 1909 .. 268 1027 13 113 9 206 .. .. .. .. .. .. .. .. .. .. .. 1910 1 171 524 10 89 7 196 .. 1 .. .. .. .. .. .. .. .. .. 1911 .. 239 518 16 82 16 375 .. 1 3 8 .. .. .. .. .. .. .. 1912 3 429 474 20 87 2 689 .. 1 3 20 .. .. .. .. .. .. .. 1913 .. 321 626 14 70 8 675 .. .. 1 14 338 .. .. .. .. .. .. 1914 .. 416 714 18 107 7 498 .. 1 .. 18 199 .. .. .. .. .. .. 1915 .. 286 601 31 138 6 489 .. 50 2 19 173 .. .. .. .. .. .. 1916 1 271 232 9 95 16 469 .. 14 .. 33 80 3 .. .. .. .. .. 1917 .. 277 147 12 79 12 543 .. 17 1 41 101 5 .. .. .. .. .. 1918 .. 240 222 12 61 14 660 .. 7 2 23 118 4 .. .. .. .. .. 1919 4 398 243 26 63 7 474 .. 6 1 34 123 1 1 3 61 7 123 * Voluntary Notification to 1910: partial to 1912: all oases thereafter. † Includes all forms of Pneumonia. 58 The following Table shows the number of Deaths and Deathrates from certain Infectious Diseases each year since 1901:— TABLE 29. Year. Small-pox Diphtheria Scarlet Fever. Enteric Fever. Puerperal Fever. Measles. Erysipelas Zymotic Enteritis. Deaths. Rate. Deaths. Rate. Deaths. Rate. Deaths. Rate. Deaths. Rate. Deaths. Rate. Deaths. Rate. Deaths. Rate. 1901 ... ... 19 0.16 5 0.04 13 0.11 3 0.02 21 0.18 1 0.00 96 0.82 1902 38 0.30 23 0.18 8 0.06 13 0.10 6 0.05 41 0.33 1 0.00 59 0.48 1903 ... ... 13 0.11 4 0.03 6 0.05 1 0-01 25 0-20 44 036 1904 29 0-23 16 013 6 0.05 2 0.02 28 0.22 4 0.03 150 1.19 1905 ... ... 18 0.14 10 0.08 7 0.06 6 0.05 13 0.10 5 0.04 65 0.52 1906 ... ... 22 0.17 5 0.04 8 0.06 2 0.02 31 0.24 3 0.02 163 0.81 1907 ... ... 15 0.12 14 0.11 4 0.03 1 0.01 70 0.54 6 0.04 34 0.26 1908 ... ... 20 0.16 9 0.07 2 0.02 2 0.02 10 0.08 7 0.05 46 0.36 1909 ... ... 25 0.20 19 0.15 3 0.02 1 0.01 55 0.43 1 0.01 19 0.15 1910 ... ... 5 0.04 13 0.10 1 0.01 3 0.02 21 0.16 3 0.02 17 0.13 1911 ... ... 11 0.09 3 0.02 0 ... 3 0.02 28 0.23 8 0.07 101 0.13 1912 1 0.01 20 0.16 4 0.03 2 0.02 1 0.01 30 0.24 3 0.02 10 0.08 1913 ... ... 17 0.13 8 0.06 1 0.01 3 0.02 9 0.07 ... 0.00 46 0.37 1914 ... ... 34 0.26 9 0.07 4 0.03 3 0.02 25 0.19 7 0.05 28 0.22 1915 ... ... 20 0.15 8 0.06 5 0.04 3 0.02 45 0.33 8 0.06 30 0.22 1916 ... ... 11 0.08 4 0.03 1 0.01 8 0.05 23 0.17 2 0.01 27 0.20 1917 ... ... 16 0.11 1 0.01 3 0.02 6 0.04 31 0.21 4 0.03 24 0.16 1918 ... ... 25 0.17 4 0.03 2 0.01 9 0.06 21 0.14 2 0.01 26 0.18 1919 2 0.01 28 0.21 3 0.02 5 0.04 5 0.04 7 0.05 2 0.01 18 0.13 59 Small-Pox. 48. Four cases of Small-pox, in two adjoining houses in West Plumstead, were notified in July. All were removed to hospital, and two of them died there. The source of infection was not definitely traced, but it was probably connected in some way with a case which occurred a short time previously at Gravesend. Considering that these cases were not notified until the disease was well advanced, it is a matter for congratulation that the measures taken by Dr. Sidney Davies prevented any further spread. The Health Shelter has been maintained during the year, but no contacts entered it during the period. The upper flat remains let on a weekly tenancy of 8/-. Very little use has been made of this Shelter since it was erected, and it seems desirable to consider whether this building could not be devoted to a more useful purpose than at present. No contacts of Small-pox were vaccinated by your Medical Officer during the year in accordance with the Public Health (Small-pox Prevention) Regulations, 1917, but 18 contacts were re-vaccinated by the Public Vaccinator. Twenty-one contacts of Small-pox, notified as such by Medical Officers of other authorities, were kept under observation for the necessary period during the year. Measles. 49. Notification Statistics. The number of notifications of measles received during the year was 1,886. Of these notifications 1,214 were by medical practitioners, 487 were by school teachers, 157 were by parents, and 28 were from various other sources. On the certification of your Medical Officer, two were removed to hospital, as compared with 12 in 1918, and 45 in 1917. 60 50. Nursing. The Council made arrangements in 1916 for the home nursing of measles cases by voluntary nursing associations. During 1919, 98 cases were nursed at home at a total cost of £28 13s. 4d. The number of visits paid by nurses was 1,024, thus averaging 10 visits per case. All cases occurring in children under 5 were visited by the Health Visitors. 51. Deaths. The number of deaths due to measles was 7, as compared with 21 in 1918, and 31 in 1917. Six of these occurred in children under five years of age. The death-rate from measles, namely 0 05, is the lowest which has ever occurred in the history of the borough. There has been a slight reduction in the death-rate from measles since 1901. The reduction this year is exceptional, but it must be borne in mind that the falling birth-rate was a factor in this reduction. Measles is a disease which affects young children and, generally speaking, the younger the child the graver the prognosis; and owing to the diminution in the number of children living under five years of age, the death-rate has accordingly fallen. The provision of nursing assistance is an additional factor, and probably more important in the reduction of the death-rate. 52. School Closure. To prevent the spread of measles in school, the London County Council have continued to close schools or departments (24 in 1919 as compared with 6 in 1918), and to exclude unprotected children from school. The period of exclusion or closure was usually for a few days only, but in some cases for two weeks. Whooping - Cough. 53. During the year, 129 cases of whooping-cough came to the knowledge of the department through the school services. No 61 cases were admitted to hospital on the recommendation of your Medical Officer. The number of deaths was 11 as compared with 29 in 1918, and 10 in 1917. Ten of the deaths occurred in children under five years of age. Enteric Fever. 54. There were 26 cases of enteric fever notified during the year. One of these cases was ultimately diagnosed as pleurisy, and one as Tuberculosis. The number of deaths was five, giving a death-rate of 0.03. Bacteriological diagnosis. Similar facilities as for diphtheria (q.v.) are provided at the Seamen's Hospital, Greenwich, and during the year, 20 samples of blood were examined for Widals re-action. A positive result was obtained in 8. The following table, No. 30, shows the average number of cases notified in each quinquennial period since 1901, and the number of cases notified in the last four years, with the percentage removed to hospital:— TABLE 30. 1901—5 1906-10 1911-15 1916 1917 1918 1919 Woolwich 13 8 9 2 5 2 17 Plumstead 21 West 11 6 3 2 5 2 East — 3 3 1 1 3 Eltham 9 3 2 1 4 2 4 Totals 43 22 20 9 12 10 26 Percentage removed to Hospital 72% 69% 80% 89% 83% 90% 88% Scarlet Fever. 55. Notifications. During the year 243 cases of scarlet fever were notified as compared with 222 in 1918, and 147 in 1917. 62 Table No. IV. shows the age distribution, the number in each parish, and the number removed to hospital. 56. Hospital. It will be seen that only 200 cases, or 82 per cent. were removed to hospital. This is the smallest percentage removed to hospital in the preceding six years, and is in part attributable to the great demands made on isolation accommodation in the latter months of the year owing to the prevalence of this disease and of diphtheria in London as a whole. 57. Home Isolation. The Arsenal authorities require cases to be removed to hospital or a certificate from your Medical Officer of efficient home isolation before their employees are allowed to return to work. During the year 22 such certificates were issued as compared with 21, 15 and 18 in the three preceding years. The cases isolated at home have been frequently inspected by your Sanitary Inspectors, and in no case has there been any ground for supposing that the public safety has been endangered by home isolation. 58. Return Cases. The number of return cases was 3. A "Return Case" is defined as a secondary case occurring in a tenement after the return of the primary case from Hospital or from home isolation. 59. Deaths. The number of deaths due to scarlet fever was 3. The deaths and death-rate from this disease since 1901 are shown in Table 29. The following Table, No. 31, shows the case-rate of scarlet fever in each registration district and in the Borough (not corrected for mistaken diagnosis), and the percentage removed to hospital, in each year since 1901. The term "case rate" means the number of cases occurring per thousand of population. 03 TABLE 31. Year. Woolwich. Plumstead. Eltham. The Borough. Percentage removed to Hospital. West. East. 1901 2.55 2.63 3.42 2.64 85 1902 2.49 1.88 2.45 2.14 86 1903 3.05 3.19 3.40 3.16 84 1904 3.76 4.08 1.44 3.75 84 1905 310 4.42 5.34 4.07 80 1906 3.83 4.22 4.71 4.15 78 1907 610 8.56 9.65 7.91 85 1909 3.85 5.22 3.94 4.67 80 1909 10.40 8.38 6.47 4.04 7.77 92 1910 8.46 3.94 5.94 1.64 3.94 80 1911 2.89 3.77 7.51 2.09 4.09 79 1912 2.41 4.96 4.88 2.64 3.80 89 1913 5.44 4.68 5.11 4.36 4.80 89 1914 6.11 5.45 4.18 7.45 5.46 88 1915 4.48 400 6.55 3.85 4.31 85 1916 1.94 1.30 1.98 1.67 1.69 90 1917 1.19 0.84 0.74 1.38 0.99 85 1918 2.80 1.25 0.99 1.18 1.48 85 1919 2.62 1.55 1.12 2.06 1.78 82 Diphtheria. 60. Notifications. During the year 398 cases of Diphtheria were notified, as compared with 208 in 1918, and 277 in 1917. 61. Isolation. Of these, 345 were removed to hospital, giving a percentage rate of 87.0. As in Scarlet Fever, this is the lowest percentage recorded for the last six years, and it is due to the same cause. No untoward effects of home isolation were noted. Cases of diphtheria are removed to hospital for two reasons (a) treatment, (6) isolation. The lack of sufficient accommodation during the latter months of the year was therefore of more serious import than in the case of scarlet fever. Eleven certificates of home isolation were issued to enable Arsenal employees to resume work. 64 62. Contacts. Contacts of cases were examined during the year as in previous years, and 9 cases presenting no symptoms were discovered as "carriers" of the diphtheria germs. The usual steps were taken in each case. The number of return cases was 2. 63. Bacteriological Examination. Since January, 1913, the Council's bacteriological work has been done by the Bacteriological Department of the Seamen's Hospital, Greenwich. 749 swabs were examined for Diphtheria bacilli, and 90 were found positive. 64. Anti-toxin. Diphtheria anti-toxin is kept at the Town Hall and the Plumstead and Eltham Free Libraries, and supplied to medical practitioners on application at cost price, or free where there is inability to pay. The amount supplied during the year was 204,000 units, at a total cost of £13 12s. 3d., all of which was, with the exception of £3, recovered from medical practitioners. 65. Deaths. The number of deaths due to Diphtheria was 28. The deaths and death-rates from this disease each year since 1901 are shown in Table 29. 66. The following Table, No. 32, shows the case-rate in each registration district and in the Borough (not corrected for mistaken diagnosis), and the percentage removed to hospital in each year since 1901. 65 TABLE 32. Year. Woolwich. Plumstead. Eltham. Whole Borough. Percentage removed to Hospital. West. East. 1901 1.56 1.90 2.33 1.84 73 1902 1.67 2.09 1.08 1.87 81 1903 1.27 1.67 1.40 1.51 84 1904 1.22 1.47 0.45 1.30 82 1905 2.45 2.22 0.86 2.01 80 1906 3.43 2.26 6.70 2.80 67 1907 1.85 2.36 1.57 1.83 84 1908 3.18 2.88 1.69 2.61 89 1909 1.97 3.08 1.71 0.68 1.88 89 1910 1.06 1.66 1.63 0.50 1.15 81 1911 2.40 1.19 2.33 2.30 1.68 93 1912 4.38 3.79 2.81 1.71 3.09 81 1913 4.43 2.32 1.02 1.29 1.91 85 1914 4.92 2.36 2.39 3.33 2.72 94 1915 2.23 1.99 2.87 0.88 1.77 92 1916 2.80 211 1.23 1.72 1.81 91 1917 1.76 1.60 1.50 2.96 1.65 91 1918 2.11 1.74 1.37 1.32 1.42 94 1919 4.77 2.69 2.29 2.02 2.92 87 Ophthalmia Neonatorum, Puerperal Fever and Epidemic Diarrhœ. 67. These diseases are dealt with under the Maternity and Child Welfare Section of the report. Pneumonia, Malaria, Dysentery and Trench Fever. 68. During the year the following number of cases were notified:— Pneumonia 123 Malaria 61 Dysentery 7 Trench Fever - These diseases became compulsorily notifiable under the Public Health Regulations of 7th January, 1919. The value of notification without adequate machinery for dealing further with these cases is very doubtful and little or no experience except as to incidence has been gained. Even these figures of 66 incidence are of doubtful value as although only 123 cases of primary pneumonia were notified, 125 deaths occurred. The fact that these diseases are notifiable requires to be more widely disseminated as without doubt many practitioners, even now, do not realise this fact. Under these regulations medical and nursing assistance may be provided. Anthrax, Glanders and Hydrophobia. 69. One case of anthrax was notified during the year. The source of infection was traced to an English "string shaver" all samples of which were withdrawn from sale. The patient recovered. Erysipelas. 70. During the year 63 cases of erysipelas were notified as compared with 95, 79 and 61 in the preceding three years. There were two deaths. The death-rates from this disease since 1901 are shewn in Table 29. Cerebro-spinal Meningitis, Post Basic Meningitis, Poliomyelitis, and Encephalitis Lethargica. 71. Six cases of cerebro-spinal meningitis, one of post basic meningitis, one of poliomyelitis, and three of encephalitis lethargica were notified during the year. The numbers notified in previous years are seen in Table No. 28. Five cases of cerebro-spinal meningitis were removed to isolation hospitals, and one was treated at home. The number of deaths wascerebro-spinal meningitis, 2; post basic meningitis, nil; poliomyelitis, nil; encephalitis lethargica, 3. TUBERCULOSIS. 72. Notification Statistics. The total number of notifications received was 490. This number includes 16 duplicate notifications but does not include notifications on Forms C and D, viz., notifications from Hospital Doctors, etc., regarding admissions and discharges. 67 TABLE 33. Summary of Notifications of Tuberculosis during year ended 31st December, 1919. Age-periods— Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 & upwards Total Primary Notifications. Under 5 5 to 10 10 to 15 Total Primary Notifications. Poor Law Institutions. Sanatoria. Pulmonary Males 1 3 20 12 27 36 58 37 19 14 3 230 241 .. 2 .. 2 2 36 141 „ Females .. 5 15 13 18 26 43 16 14 10 2 162 166 .. .. .. .. .. 15 91 Non-Pulmonary Males 2 4 7 10 3 4 3 .. .. 1 .. 34 34 .. .. 1 1 1 6 7 „ Females .. 6 14 9 3 5 4 .. 2 .. .. 43 43 .. 2 .. 2 3 3 10 68 The distribution of the various cases was as follows:—Lung, 409; Meninges, 4; Intestines, nil; other forms, 77. The numbers notified in previous years are shown in Table 28 facing page 56. Since 1909, when a limited notification of Tuberculosis became compulsory, 5,269 persons have been notified as suffering from Tuberculosis in one form or another. At the end of 1919, 2,081 were known to be living in the district. 73. The following Table, No. 34, shows the number of deaths from certain forms of Tuberculosis, and the total deaths and death-rates each year since 1901:— Year. Deaths. Death-rates. All Forms. Pulmonary. NonPulmonary. All Forms. Pulmonary. NonPulmonary. 1901 269 215 54 2.29 1.80 0.46 1902 232 183 49 1.86 1.49 0.40 1903 237 171 66 1.92 1.39 0.54 1904 259 206 53 2.06 1.64 0.42 1905 230 185 45 1.83 1.47 0.36 1906 221 164 57 1.74 1.29 0.45 1907 206 154 52 1.60 1.19 0.40 1908 224 156 68 1.76 1.23 0.54 1909 209 150 59 1.63 1.17 0.46 1910 176 133 43 1.40 104 0.34 1911 200 146 54 1.65 1.20 0.44 1912 168 124 44 1.34 1.01 0.34 1913 216 182 34 1.69 1.42 0.27 1914 216 163 53 1.68 1.27 0.41 1915 232 201 31 1.72 1.49 0.23 1916 203 167 36 1.48 1.22 0.26 1917 207 172 38 1.41 1.17 0.26 1918 225 194 31 1.54 1.32 0.21 1919 196 171 25 1.44 1.26 0.19 74. Deaths. The number of deaths from Tuberculosis was 196: pulmonary 171, other forms 25. The period which elapsed between notification and death is shown below:— 69 TABLE 35. Pulmonary. Non-Pulmonary. No. Percentage. No. Percentage. Death before notification 6 3.5 1 4 „ 0—1 months after notification 18 10.5 5 20 „ 1-3 „ „ 21 12.3 1 4 „ 3-12 „ „ 42 24.6 1 4 „ 1—2 years „ 16 9.4 2 8 „ 2-5 „ „ 25 14.6 4 16 „ over 5 years „ 11 6.4 1 4 „ no information available (Asylum cases, etc.) 32 18.7 10 40 171 25 It must be understood that tuberculosis is a chronic disease, and that in combating its effects action must be undertaken early. Any action taken must be seriously handicapped by the lateness of the date of notification as is evidenced from the preceding table, and this table of course shows fuller use should be made of the arrangement whereby the tuberculosis officer is available for consultative work. 75. Source of Infection. Of the 474 cases notified 70 occurred in families where a previous case had been notified either this year or in preceding years. The primary cases (as notified) in these cases were as follows:— Father 11 Mother 9 Brother 8 Sister 10 Husband 4 Wife 1 Son — Daughter 2 Other relatives 25 70 76. Administrative Action. The administrative action taken was described in the Annual Report for 1915. Dispensary cases are visited by the Dispensary staff for the purpose of ascertaining the home conditions and of searching for contacts. Cases notified by private practitioners are visited by the Sanitary Staff of the Public Health Department. This is an undesirable arrangement and one which calls for change. An endeavour is made to visit each case every six months. Purely sanitary defects discovered are referred to the sanitary inspectors for remedial action. The same routine is followed out when cases return from hospitals or sanatoria, and no effort is spared to encourage the patient to tide over any initial difficulties which may occur, and to see that the value of the lessons learned in institutions is not lost. The number of visits paid by the staff of the Public Health Department was 254, and by the Dispensary Staff, 6,449. In addition to the above, administrative action includes the distribution of appropriate literature to each notified case, disinfection of infected premises after removal to institutions or after death, and provision of facilities for the bacteriological examination of sputum sent by private practitioners. During the year 190 specimens were examined at the Seamen's Hospital, Greenwich, and 316 at the Voluntary Dispensary. 77. Shelters. The Council have provided 11 shelters which are loaned out at a charge of from 6d. to 1s. 6d. per week. The shelters have been specially constructed in sections so that they can be taken through houses and easily erected in back gardens. They are open on all sides and are valuable in continuing the open-air treatment in the home. Their use, however, is limited in many cases only to the warmer weather. Patients when away from the sanatorium regulations are disposed to coddle themselves by sleeping indoors during the winter thus undoing the good results obtained by the use of the shelters during the summer time. 71 During the year the shelters have been in use for 311 weeks out of a possible 572 weeks. 78. Institution Treatment. During the year 312 cases were sent to residential institutions, compared with 201 in 1918. WOOLWICH VOLUNTARY DISPENSARY. Statistics, 1919. 79. Tuberculosis Dispensary. A voluntary Dispensary was established in Woolwich in 1911 and in 1910 the Borough Council entered into an agreement with it for the dispensary treatment of tuberculosis. The staff consist of: —One Clinical Tuberculosis Officer—Dr. F. J. Blackmore, Secretary; Assistant Voluntary Secretary; two nurses; one Health Visitor; Nursedispenser and one voluntary worker. The Medical Staff, as will been seen from the statistics published below, requires to be increased by the appointment of another Tuberculosis Officer. The following is the summary of the work referring to the period 1st January to 31st December, 1919. Insured persons examined and treated 2,402 Uninsured 4,093 Total attendances, including home visits by staff 18,008 Number of new patients examined 1,719 „ with definite pulmonary tuberculosis 244 „ with surgical tuberculosis 36 „ of suspect and observation cases 530 „ found non-tuberculous 909 „ of home visits of medical officers 733 „ „ nurses 6,449 „ of sputum examinations 316 „ found positive 49 „ of children, new cases 934 „ of contacts examined 697 72 The Medical Officer of Health is Administrative Tuberculosis Officer and is a member of the Tuberculosis Dispensary Committee. 80. After Care Work. The after-care work in this Borough has not been very successful as the Interim Tuberculosis Care Committee has had no funds at its disposal to assist patients and great difficulty has been experienced in providing suitable employment for the tuberculous person. 81. Future Development. The large question of the treatment of tuberculosis is again being considered by the Ministry of Health and by the London County Council, and it may be that various present arrangements are at the moment subject to revision and re-arrangement. In London the treatment of tuberculosis may be roughly divided into two:— (a) Treatment within the Borough. (b) Treatment in residential institutions. (b) may be dismissed in a few lines as a broad general principle has been laid down that this is the function of the London County Council. With regard to (a) future development requires to be considered on the following lines:— (1) Provision of dental treatment. (2) Provision of more adequate dispensary accommodation. (3) Establishment of a Tuberculosis After Care Committee. (4) A more intimate association of the Administrative and Clinical work of the Borough in connection with Tuberculosis ADMINISTRATIVE ACTION WITH REGARD TO INFECTIOUS DISEASES. 82. On receipt of notification the district sanitary inspector visits the house and enquires into the circumstances of each 73 case with a view to eliciting the source of infection. If the case is to be left at home he reports the home conditions to your Medical Officer who authorises or refuses to allow isolation at home. Generally speaking an effort is made to remove all cases to hospital, although owing to stress on hospital accommodation during the latter months of the year a small proportion of these cases had to be left at home. If the case is removed to hospital, the infected articles, bedding, etc., are removed to the Council's Disinfecting Station at White Hart Lane, the rooms are disinfected, and contacts are excluded from school in accordance with the regulations of the London County Council. If the case is isolated at home, a card of instructions regarding isolation is given, and the process of disinfection is delayed until the medical attendant certifies that the case is free from infection. After diphtheria the contacts attend at the Town Hall for examination and for swabbing whenever, in the opinion of your Medical Officer, this is necessary. By an arrangement made with the Royal Arsenal, the names of persons employed therein residing in a house where infectious disease has occurred are sent to the Arsenal daily. Certificates of disinfection are issued after removal to hospital or on recovery of a case nursed at home. In the latter case, certificates of efficient home isolation are also issued to workmen if the Medical Officer of Health is satisfied that the conditions are satisfactory. Disinfection. Number of rooms disinfected after ordinary fevers 660 Do. do. Tuberculosis 384 Do. do. Verminous cases 58 Number of rooms stripped after Small-pox 6 Do. do. for any other reason — Total number of articles disinfected 26,380 74 MATERNITY AND CHILD WELFARE WORK. 83. Staff. The Maternity and Child Welfare Staff now consists of (а) One whole time Assistant Medical Officer of Health— Dr. Rachel Mackenzie. (b) A part time Medical Officer (in charge of cases at the cil's Home for Ailing Babies)— Dr. F. H. Dodd. (c) Five Health Visitors (two of whom hold the combined office of Sanitary Inspector and Health Visitor). (d) One temporary female clerk. (e) The nursing and domestic staff of the Home for Ailing Babies. 84. Welfare Centres. The following Infant Welfare Centres were in operation at the beginning of the year:— Town Hall Infant Consultations Wednesday, 2.30 p.m. 179 Well Hall Road, Eltham do. Thursday, 2.30 p.m. Ante-natal Clinics and Clinics for Nursing Mothers were as follows:— Town Hall Maternity Clinics Friday, 2.30 p.m. Eltham do. Thursday, 11 a.m. * Owing to the growth of this work, it was found necessary during the year to increase the number of sessions at each of these Centres, and, in addition, the Council opened a Centre at St. John's Church Hall, N. Woolwich, in March, and took over in June the American Red Cross Centre at 289 High Street, Plumstead. The number of sessions per week during which these Centres were open at the end of the year, was 3 Ante-natal, and 9 Infant Consultations. In detail, this is as follows:— Infant Ante-natal, Consultations. etc. Town Hall 2 1 North Woolwich 1 — Plumstead 3 1 Eltham 3 1 75 85. Treatment. No arrangements for the treatment of mothers and children at the Centres have yet been made, but, by arrangement with the London County Council and the Woolwich Branch of the British Medical Association, children requiring medical, surgical or dental treatment, are referred to the School Treatment Centre in Brewer Street. The Borough Council pays 5/- for each case so referred. During the year 8 cases were sent there for treatment. Voluntary Work. 86. (a) Infant Welfare Centre. A Voluntary Centre was opened during the year at 127 High Street, Woolwich, but towards the end of the year this was transferred to the Victory Club, Beresford Street. The Assistant Medical Officer of Health and a Health Visitor attend there at each session (Mondays 2 p.m.) and assist the voluntary workers. This Centre was opened for the people living in the North end of the River Ward, as it had been noticed that they could not be induced to attend at the Town Hall, although this is quite close. Possibly the explanation of this is a social one. The number of children attending this Centre since its opening was 72, and the total number of attendances 404. 87. (b) Day Nursery. Dr. Mackenzie acts as Medical Officer in charge of the Woolwich Nursery (a voluntary nursery established by Lady Henry). During 1919, there was an average of 35 infants in the Nursery, viz., 8 under one year, and 27 from one to five years. 87a. (c) American Nursery, Brent Road. This Nursery was opened in 1918 for the care of children of women munition workers. In July, 1919, the Women Munition Workers' Rest Committee asked the Council to assume control or make a substantial grant towards its maintenance. Having regard to the fact that this Nursery was carrying out similar work to that 76 undertaken at the Home for Ailing Babies, which at that time was not fully occupied, the Council decided to take no action in the matter. The Nursery was then taken over by the National League for Health, Maternity and Child Welfare, and is now a Convalescent Home for mothers and infants sent by Municipal and Voluntary Centres and Associations affiliated to the League. Maternity Hospitals. 88. (d) British Hospital for Mothers and Babies. This is a Maternity Hospital and School for Midwives. The arrangement by which Dr. Mackenzie acted as Medical Officer to this hospital terminated on the 1st September, 1919, owing to the return of the Medical Officer from War service. The number of beds is 14; the number of indoor cases during the year was 206, and outdoor cases 224. In addition there is an ante.natal and post.natal clinic at which 764 cases attended during the year. This hospital takes cases from Boroughs other than Woolwich, so that these maternity beds cannot be considered as entirely available for the needs of Woolwich. It is proposed to increase the number of beds to 42, and it is hoped that a building on a new site in Samuel Street will be commenced early in 1920. 89. (e) Woolwich and Plumstead Maternity Home. For unmarried mothers there is a small Home at 23 Vicarage Park, Plumstead. The accommodation is for eight mothers and babies. It is practically always full, but the girls are encouraged to stay with their babies as long as possible. The average stay may be taken as 4¼ months, and since its opening on the 25th November, 1918, 29 girls were in the Home. Nearly all these girls attended at the Ante.natal Clinics of the Borough Council. A grant of £50 was made by the Council during the year toward the funds of the Home. 77 HOME FOR AILING BABIES. 90. Perran Lodge. The Council assumed responsibility for this Home, which is situated at Perran Lodge, Eglinton Road, Plumstead, on 1st April, 1919. Accommodation is provided for 21 cases. The staff consists of a Matron, 2 Sisters, 1 Assistant Nurse> and 2—4 Probationers, with 3 domestic staff. Since April 1st, 49 babies have been treated in the Home. 29 were discharged, 8 died, and 12 remained in residence at the end of the year. A charge of 10/. per week is made for maintenance. This is reduced if the parent's circumstances so justify. The patients are under the care of Dr. F. H. Dodd and Dr. R. E. Mackenzie. The following Table shows the reasons for admission, the number of each type, the numbers discharged, and remaining at end of year, the number of deaths, and the average duration oi stay (in days) of completed cases for the period 1st April to 31st December. Reason for Admission. No. Improved. I.S.Q. Died. Remaining at end of year. Average duration of stay. Malnutrition, Marasmus, Debility 22 13 1 2 6 47 Bronchitis 4 1 .. 1 2 31 Broncho.Pneumonia 2 1 1 .. 19 Diarrhoea 4 3 1 . . 47 Vomiting,Dyspepsia 4 2 1 1 66 Congenital Heart Disease 2 .. 2 .. 10 For Observation (ultimately diagnosed Tuberculosis) 4 .. 1 2 1 37 Miscellaneous Skin Conditions, etc. 7 5 .. 2 30 49 25 4 8 12 41 78 91. The Work of the Health Visitors. The Local Government Board, in a Circular dated August, 1918, has set out the following as the duties of a Health Visitor:—The visiting and supervision of all children under school age needing this attention ; the visiting of expectant mothers who have attended at an Ante.natal Clinic or for whom visits are desirable; inquiry into still births, and the deaths of young children, and attendance at the Centre to which women and children come for medical and hygienic advice. Attendance at the increased number of sessions, which have been found necessary at the Centres owing to the large increase in the number of children attending there, has of necessity curtailed the time at the disposal of the Health Visitors for home visiting, and the number of Health Visitors (five) is below the standard set out by the Ministry in the Circular referred to above. On that standard the number should be seven. The actual number of infants visited was 1,562 out of 2,737 births. The practice adopted is to send by post, as soon as a notification of a birth is received, suitable literature, and the Health Visitor calls as soon as possible after the baby is ten days old. Visits are not paid earlier unless on request by the midwife or doctor concerned. During the year, the Health Visitors have been in nearly every case well received, their advice has been carefully listened to, but of course, it has not always been acted on. Any sanitary defects discovered by the Health Visitors in the course of their visits have been referred to the Sanitary Inspectors for remedial action. The following Table, No. 36, shows a classification of the visits paid by the Health Visitors during the years 1919 and 1918:— 79 TABLE No. 36. 1919. 1918. Births—Visits 1,562 1,145 Re.visits 1,526 1,183 Home visits to expectant mothers 74 38 Infants deaths investigated 8 0 Still.births investigated 0 0 Infections diseases: Puerperal fever 9 11 Zymotic Enteritis—Visits 81 82 Re.visits 28 11 Ophthalmia Neonatorum—Visits 24 22 Re.visits 17 20 Measles—Visits 992 772 Re.visits 111 69 Tuberculosis 254 407 Visits—Unclassified 327 180 Do. Unsuccessful, no admission 783 873 92. The Work of the Centres. The work of the Centres has gradually increased during the year, and the following table shows the attendances during 1918 and 1919:— TABLE No. 37. No. on Roll of Centre. No. of Attendances. 1919. Mothers : Children. Mothers: Children. Expectant. Nursing. Expectant. Nursing. Town Hall 89 9 450 273 25 2,448 Eltham 48 32 340 106 44 2,621 Plumstead 41 13 404 57 32 2,014 North Woolwich •• •• 69 •• •• 367 178 54 1,263 436 101 7,450 1918. Total all Centres 152 2,212 80 During the later months, owing to the more general knowledge of the Council's milk scheme, and to the regulation requiring all children requiring extra nourishment to attend the Centres (except in exceptional cases) the numbers attending largely increased, and it is interesting to note that those children who attended the Centres since infancy are in better condition than those who have not been under such observation. At the Centres advice is given to expectant and nursing mothers, and to children under five years of age. Mothercraft classes, sewing classes, etc., are held at two of the Centres, Eltham and Plumstead. 93. The Needs of the Borough. There is a very definite need for the provision of more ante.natal work, for the provision of more maternity beds, for the provision of medical and surgical treatment of young children, and for the dental treatment for children under school age, and for expectant and nursing mothers. At the present time there are two schemes under consideration to amplify the hospital accommodation of the Borough : — (1). The provision of a general hospital for Woolwich, with maternity and children's beds ; (2). The extension of the British Hospital for Mothers and Babies. The need of these institutions is urgent, and when completed they will form a very important part in the saving of infant life in the Borough. Infectious Diseases in relation to this Work. 94. Puerperal Fever. During the year, 7 cases of Puerperal Fever were notified, as compared with 14 in 1918. The case.rate per 1,000 births was 2.55, as compared with 5.20, 4.44 and 5.43 in the three preceding years. The number of cases which received hospital treatment was 5. There were 5 deaths. 81 95. Ophthalmia Neonatorum. During the year, 34 cases were notified. The following Table, No. 38, shows in detail the eve condition of each case, and the permanent result:— TABLE No. 38. Date of Notification. Condition of Right eye. Result. Condition of Left eye. Result. Remarks. 1919. Feb. 10 Infected — Infected — Hospital.Died 19 do. Cured do. Cured 26 do. do. do. do. March 29 do. do. do. do. April 4 do. do. do. do. 7 . — — — Left district June 4 . — — — do. 21 Infected Cured Infected Cured do. 26 . . — — 30 Infected Cured Infected Cured July 11 11 do. do. do. do. Twins do. do. do. do. 21 Not infected — do. do. 22 Infected Cured do. do. August 14 do. do. do. do. 21 do. do. do. do. 25 do. — do. — Died 27 do. Cured do. Cured 28 do. do. do. do. 30 do. do. do. do. Sept. 6 do. do. do. do. 13 do. do. do. do. 23 — — Not visited Oct. 10 Infected Cured Infected Cured Nov. 3 do. Blind do. Eye removd. 10 do. Cured Not infected — 12 do. do. Infected Cured 25 do. — do. — Died Dec. 3 do. Cured do. Cured 4 do. do. do. do. 4 do. do. do. do. 4 do. — do. — Died 25 do. Cured do. Cured 96. Measles, Whooping.cough and Poliomyelitis. These diseases are dealt with in the infectious diseases sections of the report (see pages 59, 60 and 66). 82 97. Epidemic Diarrhoea. Zymotic enteritis or epidemic diarrhoea has been notifiable in Woolwich since 1913. The number of cases notified during the year was 123, and the number notified each year since notification commenced is shown on Table 28. Notification in Woolwich is not now limited as to season. The quarterly incidence and deaths is shown in Table 39 below :— TABLE No. 39. Notifications. Deaths under 2. January to March 1 3 April to June 13 4 July to September 101 7 October to December 7 4 Total 122 18 The total number of deaths at all ages, 32, compares with 32 in 1918, and 39 in 1917. 98. Administrative Measures. Cases of puerperal fever, ophthalmia neonatorum, and epidemic diarrhoea are visited by the Health Visitors. Any insanitary conditions noted by them are reported to the Sanitary Inspectors for necessary action, and during the summer months particular vigilance is exercised by the Sanitary Inspectors for the detection and abatement of nuisances. In the case of measles, as far as practicable, all cases under 5 years are visited, and, in addition to the procedure shown above, the necessary advice for the prevention of the spread of the disease is given. Care is taken that no child suffers from lack of the necessary nursing assistance. The Council has an arrangement with four voluntary nursing associations in the district whereby trained nursing is available in all cases of children under five years requiring such assistance. 83 SANITARY ADMINISTRATION. 99. Sanitary Staff. The Staff of the Public Health Department is shown in detail on page 3. 100. Public Analyst. The detailed results of the various analyses during the year are given under the section on the Sale of Food and Drugs Acts. 101. Bacteriological Examinations. Bacteriological examinations are carried out at the Dreadnought Hospital, Greenwich, by Dr. Arthur Davies. Each examination costs 4/.. The number and nature of the various examinations made during the year is shown below:— TABLE No. 40. Associated disease. Positive result Negative result. Total. Diphtheria 90 659 749 Enteric Fever 8 12 20 Tuberculosis 35 155 190 133 826 959 84 HOUSING. 102. Population. The population of the Borough is estimated to be 141,918, and is referred to in detail in the General Report. No important changes have taken place during the year, but it is well to bear in mind that history may repeat itself (as after the South African War), and reductions in employment at the Royal Arsenal may affect the population of Woolwich. On the other hand, a large percentage of the additional staff employed in the Royal Arsenal during the War did not reside in the Borough, so that even if discharges are drastic, they will have to be very drastic indeed before their effect is apparent on the numbers included in the present.day population. The general tendency of the population of London to migrate from the centre to the periphery has also a bearing on the population of Woolwich, tending towards its increase. 103. The following table shews in statistical form information relating to the number of houses in the Borough : . No. of houses 26,211 do. for the working classes 22,072 New houses for the working classes erected during the year 1 No. of houses for the working classes in course of erection Nil Shortage of Houses. 104. The following report which was presented to the Council by the Public Health and Housing Committee, on the 16th July, 1919, shews the extent of the shortage of houses in Woolwich and the measures contemplated to meet that shortage :— "As desired by the Council, we appointed a Special Committee to consider the provisions of the Housing and Town Planning Bill and the necessity for providing houses in 85 the Borough, and of submitting a scheme for their erection thereunder. The Sub.Committee have met on several occasions, and have had before them reports from the Town Clerk and Medical Officer of Health upon the matter, and have viewed suggested sites. They inform us that they have obtained the best information possible to enable them to form an estimate of the number of houses required in the Borough to satisfy the present demand. The Housing Department of the Ministry of Munitions (Woolwich Estates) has already received over 2,000 applications which they are unable to satisfy ; most of the house agents in the Borough have also been inundated with applications, one firm alone putting the number as high as 2,000 ; and many agents have put up notices in their offices that there are no houses to let, which, of course, has the effect of stopping applications. The Medical Officer has obtained estimates, through the Sanitary Inspectors, of overcrowding, and informs us that he estimates the new accommodation required will exceed 2,000 houses, and that the general shortage of housing accommodation in the London Area will, no doubt, still further largely increase this demand. The percentage of empty houses in the Borough is the lowest on record, and amounts to only 0'45 per cent., many of these empty properties being unsuitable for housing purposes. There are approximately 3,000 acres of land in the Borough upon which houses could be erected. Of the sites considered, the Housing Sub.Committee unanimously came to the conclusion that that on the Page Estate, Eltham, was the most suitable, and would allow of the most comprehensive scheme. This site extends south from the Greenwich Cemetery on the west side of Well Hall Road to "Harrowfield" in Eltham Road, and runs at the back of the 86 Government Housing Estate on the west side of Well Hall Road along the Borough boundary, and to the Eltham Road near its junction with Sherard Road, and from there abuts upon Eltham Road and Eltham Green to "Harrowfield." The site is bisected by the Bexley Heath Railway, which affords the accommodation of two railway stations—Kidbrook and Well Hall—and is otherwise supplied by the Eltham trams, which the Council will remember are about to be extended from Well Road to Lee Green. The area of the site is 334 acres, and it has been surveyed and valued in accordance with the instructions of the Local Government Board, by the District Valuer, and the Committee have had his report at their disposal in considering the price to be paid for the land. A portion of the site (about 85½ acres) is not suitable for building houses without involving a considerable outlay, and this portion will be dealt with as an open space in connection with the Housing Scheme, and will form part of the cost of the Scheme. Having visited the site and come to the conclusion that it was in every way suitable for the purpose, we instructed the Town Clerk to negotiate with the owners for its acquisition, and we are glad to be able to inform the Council that these negotiations have been concluded, and that a price has been provisionally agreed, which we consider most satisfactory, for the purchase of the freehold, subject to certain agricultural tenancies which can be determined at short notice and in respect of which there will be some small compensation payable. The Acting London Housing Commissioner has viewed the site, and approves of it and of the price at which the Council is able to acquire it, and is prepared to recommend it to the Ministry of Health. It is proposed that the Council shall enter into a provisional contract for the acquisition of the land, which will be subject to the approval of the Ministry of Health and to the necessary Loan being obtained. 87 We estimate that the site will afford accommodation for about 3,000 houses, on a layout similar to that adopted on the Government Housing Estate at Well Hall, although the Committee do not propose that the Council should be in any way bound by this type or arrangement of house. The Ministry of Health recommend that the Council should obtain the services of a competent architect or architects, who will be nominated by the Royal Institution of British Architects by arrangement with the Ministry, for the purpose of laying out the estate and of superintending the erection of the houses. The Council are aware that their liability in respect of the scheme will be limited to the product of a penny rate, the balance of the amount required being provided out of Imperial Funds. Under Clause 36 of the Bill, any loss which a Metropolitan Borough Council may incur in carrying out a scheme in respect of which financial assistance is available will be repaid to them by the London County Council, and any payments so made by the London County Council will be deemed to have been made as part of the expenses incurred by them, so that the loss on all London schemes will be borne primarily by the London County Council, and so far as they can be met by the proceeds of a penny rate on the County will be defrayed from that source, the excess being bourne by the Exchequer. Ratepayers in the Metropolitan Boroughs will not have to pay both in respect of their own schemes and in respect of the County Council schemes, and the maximum they can be called upon to pay, as we have already said, is the product of a penny rate in the pound. We have given the most careful consideration to this matter, and have unanimously come to the conclusion that the Council should, with the least possible delay, take the necessary steps to acquire the site, particulars of which we have given, and submit a scheme to the Ministry of Health for approval; and we 88 Recommend— (а) That the Seal of the Council be affixed to a provisional agreement for the acquisition, subject to the approval of the Ministry of Health and to the necessary Loan being obtained, of the site referred to, at the price which has been reported to us in Committee. (b) That a Housing Scheme be submitted to the Ministry of Health for their approval in respect of this site. (c) That, notwithstanding Standing Order No. 16, application be made to the London County Council for sanction to borrow the amount required for the purchase of the site. Statement of Action taken to 31st December, 1919. 105. On the 31st July, 1919, the Ministry of Health approved the purchase of the site at Eltham, and the Council thereupon appointed Superintending and Executant Architects. The lay.out of the site in five sections was subsequently generally, but not finally, approved, and it was decided to start building on Section "D," where accommodation is available for approximately 553 houses. The types of houses to be built were also approved, and tenders were invited for the first 50 houses. Overcrowding. 106. There is no exact definition of overcrowding, but in actual practice there are two generally accepted standards: (a) The Registrar.General, for census purposes, accepts as a standard of overcrowding the occupation of a room by more than two persons; 89 (b) Sanitary Officers take as their guide the minimum standard laid down by the Local Government Board in their model bye.laws, viz.: 400 cubic feet per head for rooms where persons live and sleep, and 300 cubic feet per head for rooms used solely for sleeping apartments or for living rooms only. Any house, or part of a house, so overcrowded as to be injurious or dangerous to the health of the inmates, whether or not members of the same family, is a statutory nuisance, and when a Medical Officer of Health so certifies the Sanitary Authority shall take action for the abatement of such nuisance. The first standard given above is a more practical one than the second when comparisons are made between different areas. On the standard of the Registrar.General at the time of the Census (1911), the population in Woolwich living more than two per room was 6'3 per cent. This figure was lower than any other Borough in London with the exception of Lewisham, which was 3.9 per cent. The percentage for the County of London was 17.8. This percentage of the population occupied 1,000 tenements, and numbered 7,110 persons. In detail, the figures are as shewn below:— No. of rooms per tenement. No. of tenements. No. of persons occupying them. No. per room. 1 186 625 33 2 217 1,184 2.7 3 292 2,205 2.5 4 218 2,068 2.3 5 74 852 2.3 6 11 146 2.1 7 2 30 2.1 1,000 7,110 2.5 90 At the present time, the population living thus can only be estimated. The following table, which is partly compiled from figures supplied by the Rating Department, shews the number of houses used as dwellings in the Borough in 1911 and in 1919, the civil population at these two periods, and the number of persons per dwelline :— Year. No. of dwellings. Population. No. of persons per dwelling. 1911 22,254 115,633 5.19 1919 26,211 141,918 5.41 The above table shews a net increase in the number of houses used as dwellings of 3,957, and an estimated increase in the population of 26,285. If this increase were housed in the new dwellings the number per house would be 6.64, i.e., that the number of houses erected since the Census has not been sufficient to maintain the Censal standard of density of population per house. In 1911, 6.3 percent. of the population were living more than two persons per room. If the same percentage of the population is living under similar conditions to.day, it follows that at least 8,940 persons are living more than two to a room. This number is probably a low estimate owing to (а) The tendency of overcrowding in this sense to move outwards from the inner Boroughs of London ; (b) The increased accommodation demanded by workers in better economic circumstances, leaving less room for others less fortunately situated. There are no unoccupied dwelling houses in the Borough. The number of houses which are occupied by two or more families, and which have not been specially adapted for this purpose, is estimated to be 4,000. 91 107. The state of overcrowding in Woolwich is worse than would appear from the above figures. The following examples illustrate the housing conditions at present existing : — (a) Details of population per house in a street in Woolwich parish;— Index No. No. of Families. No. of Rooms. Persons over 10 Children under 10. Total No. of Persons. Persons per room. M. F. 1. 2. 3. 4. 5. 6 7. 8. 1 1 3 3 3 3 9 30 2 1 3 1 1 3 5 1.8 3 3 2 3 .. 5 1.8 4 1 3 1 1 4 6 2.0 5 1 3 2 2 .. 4 1.3 6 3 1 1 2 4 1.3 7 1 3 1 1 . . 2 0.7 8 1 3 2 1 4 7 2.3 9 1 3 1 1 1 3 1.0 10 1 3 2 2 2 6 2.0 11 1 3 1 1 6 8 2.7 12 1 3 1 1 4 6 2.0 13 1 3 1 1 4 6 2.0 14 1 3 2 2 .. 4 1.3 15 3 1 1 1 3 1.0 16 1 3 2 2 .. 4 1.3 17 1 3 1 1 2 4 0.7 1 3 2 2 4 1.3 18 1 3 1 1 2 4 1.3 1 3 1 2 1 4 1.8 19 1 3 1 1 2 4 1.8 1 3 1 1 2 4 1.3 20 1 2 1 1 1 3 1.5 1 4 3 3 1 7 1.8 21 1 3 1 1 4 6 2.0 3 1 1 2 4 1.3 22 1 3 1 2 2 5 1.7 1 3 1 2 5 8 2.7 23 1 3 1 1 4 6 2.0 1 3 1 1 1 3 1.0 24 1 6 3 3 6 12 2 0 25 1 3 1 1 2 4 1.3 26 1 3 2 2 4 8 27 27 1 3 2 2 1 5 1.7 28 1 3 1 1 4 6 2.0 29 1 3 1 1 •• 2 0.7 92 Index No No. of Families. No. of Rooms. Persons over 10. Children under 10. Total No. of Persons. Persons per room. M. F. 30 1 3 1 3 .. 4 1.3 31 1 3 2 2 2 6 2.0 32 1 3 1 1 4 6 2.0 33 1 3 2 3 .. 5 1.7 34 1 3 1 1 1 3 1.0 35 1 3 1 1 4 6 2.0 36 1 3 2 5 10 3.3 37 1 3 2 1 .. 3 1.0 38 1 3 2 6 10 3.3 39 1 3 1 1 2 4 1.3 40 1 3 3 .. 6 2.0 41 1 3 1 1 .. 2 0.7 42 1 3 1 1 2 4 1.3 43 1 3 1 1 3 5 1.7 44 1 3 1 1 .. 2 0.7 45 1 3 1 1 .. 2 0.7 46 1 3 1 1 2 4 1.3 47 1 3 1 1 4 6 2.0 48 1 3 2 1 4 7 2.3 49 1 3 1 1 1 3 1.0 50 1 3 1 1 3 5 1.7 51 1 3 1 1 .. 2 0.7 52 1 3 1 1 3 5 1.7 53 1 3 2 1 .. 3 1.0 54 1 3 1 2 .. 3 1.0 55 1 3 1 1 3 5 1.7 56 1 3 1 1 2 4 1.3 57 1 3 1 1 1 3 1.0 58 1 3 3 4 .. 7 2.3 59 1 3 1 1 3 5 1.7 1 3 1 1 3 5 1.7 60 1 6 2 4 1 7 1.2 61 1 6 2 2 1 5 0.9 62 1 3 1 2 4 7 2.3 1 3 1 2 4 7 2.3 Summary Houses 62 Families 71 Rooms 221 Total number of persons 356 Number of families living more than two per room 11 93 (b) Summary of housing conditions in another street in the Borough :— (a) Houses 73 Families 110 Rooms 352 Persons 472 Number of Families living more than two per room 13 Number of families per house 1½ (b) Cases of Overcrowding. The following reports by the Sanitary Inspectors shew the conditions existing in some houses in the Borough:— (1) This house contains 4 small rooms on 2 floors. There are 2 families with a total of 10 persons in the house. The top floor front room is used as a sleeping room by a man, wife and 5 children (2 girls aged 10 and 8 years ; 2 boys aged 6 and 4 years, and a baby 6 weeks old). The wife attends Maxey Road Dispensary for Tuberculosis. This family also has the ground front room as a living room. The other two rooms are occupied by the landlady (who is the wife's mother) and 2 children, as one living and one sleeping room. (2) This house contains 4 small rooms on 2 floors. There are 3 families with a total of 10 persons in the house. The top floor front room is used as a sleeping room by a widow and her 4 children (2 girls aged 17 and 14 years, and 2 boys aged 11 and 9 years). This woman is in straitened circumstances and is compelled to let her rooms as she is behind with her rent. She is going to ask the Guardians to take the two boys off her hands. This family also uses the ground floor back room as a living 94 room. The top floor back room is occupied as a living and sleeping room by a man, wife and baby and the ground floor front room as a living and sleeping room by an elderly man and wife. (3) This house is a downstairs flat and contains 3 small rooms, 2 of which are used as bedrooms. There is one family consisting of 7 persons, 5 adult males and 2 adult females (man, wife and 5 children). (4) This house contains 5 rooms, 3 rooms on upper floor and 2 rooms on bottom floor. The two bottom floor rooms are living rooms and the 3 upper rooms are sleeping rooms. There are 2 families with a total of 11 persons in the house. There are man, wife and 2 children under 12 sleeping in 1 room and 3 adult males, 3 adult females, 1 child under 12 years sleeping in the other 2 bedrooms. Both these families are relatives. There are no large empty houses, so that the problem of overcrowding in Woolwich largely resolves itself into the provision of more houses. It is not possible to redistribute the population within its present houses, except in a few exaggerated cases. 108. Causes. The Chief Superintendent, Ordnance Factories, Royal Arsenal, states that the average number of employees in the Royal Arsenal before the War was 16,000. At one time the number employed rose to 112,000. Most of these of course were housed outside the Borough, and some no doubt were residents who were engaged on munition work during the War, but from this source there was a large influx of population into the Borough owing to the desire of workers to live near their work. When work at the Royal Arsenal began to diminish, and men were paid off, the difficulty in obtaining accommodation elsewhere meant that the vast majority continued to reside in the Borough. 95 The return of the military elements of the population is an additional factor, and last of all there is the present shortage of houses. In the five years previous to the War it is estimated that, on an average, 156 houses per annum were erected. During the War, 3436 houses (including 1930 huts) were erected, but this was insufficient for the abnormal increase of population during that period. 109. Fitness of Houses. Woolwich is one of the Metropolitan Boroughs situated on the outer circle of London, and in consequence it would be reasonable to expect that housing conditions would be less congested and in a more satisfactory condition than they would be in the centre of the County. Such is the case except in the older parts of the Borough. A large number of the houses have been built in the last 30 years, and there has, of course, been no repetition of the condition of affairs which was permitted before the passing of the London Building Act; but it must be borne in mind that some of the houses in the older parts of the Borough are more crowded together than is desirable and will require serious consideration whenever housing conditions improve and accommodation exists for those occupants who are likely to be displaced as the result of the demolition of various small areas. It is one of the primary duties of a Sanitary Authority to see that the houses of its inhabitants are maintained at such a standard as to render them reasonably fit for human habitation; but in the carrying out of this work it must be borne in mind that the difficulties which the Sanitary Authority have had to contend with in this matter are now greatly increased. There is a legitimate outcry for a better standard of housing, for the provision of houses possessing additional amenities rather than immediate necessities. The changed economic conditions, the increase in cost of labour and materials, and the demand on 96 labour and materials for new houses, are all part of the housing problem. Difficulty is also experienced in maintaining the prewar standard of efficiency in the repair work done. There are no matters, other than those referred to in the general section of the report, requiring special comment in connection with water.supply, closet accommodation and refuse disposal. UNHEALTHY AREAS. 110. No areas have been represented under Part I. or II. of the Housing Act of 1890, in 1918 and 1919, and no complaints that areas were unhealthy have been made. GOVERNMENT HUTMENTS AND HOUSES. 111. The Government Housing Estate is under the control of the London County Council, who act as agents for H.M. Office of Works. The Government Hutments are under the control of a Government Department which has a Works Department for carrying out the repairs. There are local Estate Managers. Complaints are occasionally received at the Town Hall relative to defects in these hutments, and a certain amount of overcrowding is beginning to be noticed there. The hutments, although far from ideal residences, are a reasonable temporary arrangement. They are cold in winter and warm in summer, and in consequence of the material with which they are made being impermeable there are times when there is a great deal of condensation on the internal walls. The extent of this appears to be governed by the situation of the hut. The adaptability of the hut as a home is, in the main, dependent on the occupier; some are very comfortable and the occupants are quite satisfied with them. 112. The next table shows the details of House.to.House Inspections during the year. 97 TABLE 40. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were found. RIVER WARD. Meeting House Lane 5 2 Brookhill Road 23 12 Clara Place 16 7 Monk Street 16 7 Nelson Street 12 9 Eleanor Road 49 14 Mulgrave Place 18 6 Creton Street 28 11 Myrtle Street 12 4 The Flats, High Street 29 13 Globe Lane 9 5 Rodney Street 12 3 229 93 41.0 % Defects. ST. GEORGE'S WARD. Dicey Street 36 30 Manor Street 24 21 Jackson Street 40 26 Engineer Road 28 17 Gildersome Street 47 29 Milward Street 42 26 James Street 44 32 Ordnance Road 50 39 Keemor Street 25 14 Fenwick Street 49 36 Nightingale Vale 39 28 Sandy Hill Road 10 6 Brookhill Road 46 23 480 327 68.1 % Defects. 98 TABLE 40.—continued. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were found. GLYNDONWARD. Railway Place 18 7 Ann Street 52 41 Lenton Street 21 19 Down Street 13 11 Down Place 6 6 Richmond Place 47 25 Waimer Road 28 19 Glyndon Road 39 20 224 148 66.0% Defects. DOCKYARD AND ST. MARY'S WARDS. Rectory Grove 11 3 "Sheer Hulk " Cottages 4 4 Church Street 70 31 Artillery Place 18 3 Borgard Road 14 13 Limbrey's Buildings 8 7 Sims' Buildings 10 9 Warwick Street 65 48 Acorn Street 22 13 St. Mary's Street 69 51 291 182 62.5% Defects. ST. NICHOLAS AN D CENTRAL WARDS. Bannockburn Road 31 22 Balgowan Street 36 32 Hylton Street 45 40 Abbey Grove 43 27 Grove Road 20 12 White Hart Road 20 13 Kashgar Road 48 23 99 TABLE 40.—continud. Details of House to House Inspection. Name of Street. Number of Houses Inspected. Number where Defects were found. St. NICHOLAS AND CENTRAL WARDS —cont. Barth Road 86 54 Salisbury Cottages, High Street 6 5 Lakedale Road 92 37 Sladedale Road 51 22 478 287 60.1 % Defects. ELTHAM WARD. Merchland Road 20 10 Novar Road 26 9 Roper Street 22 12 Elizabeth Terrace 22 13 Howitzer Street 8 4 Grangehill Road 9 6 Grenade Gardens 10 1 Bilberry Road 10 7 Allenwood Road 8 8 Mortar Gardens 8 4 Mars Avenue 13 8 Mercury Road 11 7 Deansfield Road 12 10 Battery Road 4 2 Sherard Road 9 7 Reventlow Road 36 25 Osborne Terrace 12 10 Brentwood Cottages 25 14 Pelham Terrace 25 23 Southwood Road 18 13 Middle Park Cottages 13 6 Horn Park Cottages 11 3 Footscray Road 18 8 High Street 52 31 Blanmerle Road 66 61 468 302 64.5 % Defects. 100 Appendices. (1) Number of dwelling.houses in respect of which plaints were made that they are unfit for human habitation: (a) by householders nil (2) Action under Section 17 of the Housing Act, 1909: (а) Number of dwelling.houses inspected 2180 (b) Number of dwelling.houses considered to be unfit for human habitation 7 (c) Number of dwelling.houses the defects in which were remedied without the making of closing orders 4 (3) Action under Section 28 of the Housing Act, 1919 : (а) Number of orders for repairs issued 2 (b) Number of cases in which repairs were carried out by the local authority nil (c) Number of dwelling.houses voluntarily closed on notice by owner that they could not be made fit without reconstruction nil (4) Closing Orders: (a) Number of representations made to the local authority with a view to the making of closing orders 7 (b) Number of closing orders made 3 (c) Number of dwelling houses in regard to which closing orders were determined on the houses being made fit for human habitation 2 (5) Demolition Orders: (a) Number of demolition orders made nil (b) Number of houses demolished in pursuance of demolition orders nil (6) Number of dwelling.houses demolished voluntarily nil (7) Obstructive Buildings: (a) Number of representations made nil (b) Number of buildings demolished nil (c) Number of representations still under sideration nil