W00 22 Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH. 1922. BY J. MACMILLAN, D.S.O., M.C., M.B., D.P.H., Medical Officer of Health. WoolWICh: Pryce & Son. Ltd. (T.U, Federation), 31-35 Powis Street. 1923. 2 Public Health and Housing Committee— His Worship The Mayor (Councillor J. A. Turnbull, J.P.). Councillor Miss G. E. Walters (Chairman). *Councillor A. E. Smith (Vice-Chairman). Councillor Miss M. Grout, J.P. (Vice-Chairman). Aldermen— Mrs. E. Dormer. *J. P. Jackson. *W. C. Martin. Councillors— †R. M. W. Allen. †W. E. H. Narborough. †P. Chinnery. *J. Newman. *S. H. Cuff, L.C.C. †T- Rance. §T. Davis. †S. H. Reed. H. A. Hart. †H. C. E. Saville. †J.Lee. *P. E. Sheridan. *V. Lister. Mrs. M. E. T. Smith. †Rev. J. F. Matthews. ‡H. Sykes. W. C. Montano. Miss S. Turnbull. Maternity and Child Welfare Committee. Comprising the Members of the Public Health and Housing Committee. Visiting Sub-Committee. Councillor Miss G. E. Walters (Chairman). *Councillor A. E. Smith (Vice-Chairman). Councillor Miss M. Crout, J.P. (Vice-Chairman) Alderman Mrs. E. Dormer. †Councillor P. Chinnery. *Councillor S. H. Cuff, L.C.C. †Councillor Rev. J. F. Matthews. Councillor Mrs. M. E. T. Smith. *To November, 1922. †From November, 1922. ‡To May, 1922. §From May-November, 1922. 3 TABLE OF CONTENTS. page Public Health and Housing Committee 2 Maternity and Child Welfare Committee 2 do. Visiting Sub-Committee 2 Preface 6 I.—General Statistics. Population 8 Census, 1921 9 II.—Vital Statistics. Summary of Statistics 14 Births 15 Marriages 17 Deaths 18 Infantile Mortality 27 Deaths in Public Institutions 31 III.—Notifiable Diseases. Notifications 32 Deaths of Notified Cases 36 Notifications each year since 1901 37 Measles 38 Scarlet Fever 39 Diphtheria 40 Pneumonia, Malaria, Dysentery and Trench Fever 42 Ophthalmia Neonatorum 44 Puerperal Fever 45 Zymotic Enteritis 45 Other Notifiable Infectious Diseases 45 Tuberculosis 46 IV.—Causes op Sickness. Reports of Medical Practitioners 56 a 2 4 page V.—Nursing Arrangements, Hospitals and other Institutions. Professional Nursing in the Home 57 Midwives 58 Clinics and Treatment Centres 58 Hospitals 60 Institutional Provision for Unmarried Mothers 63 Ambulance Facilities 64 Maternity and Child Welfare. Treatment 65 Voluntary Work 66 Work of the Health Visitors 66 Work of the Centres 68 Supply of Milk to Necessitous, Expectant and Nursing Mothers and to Young Children 70 Feeding of Infants in Woolwich 71 VI.—Laboratory Work. Public Analyst 73 Bacteriological Examinations 73 Supply of Antitoxin 73 Adoptive Acts, By-Laws and Regulations in force in the District 74 VII.—Sanitary Administration. Closet Accommodation 76 Scavenging 76 Complaints 76 Drainage 77 Increase of Rent and Mortgage Interest (Restrictions) Act 77 Inhabited House Duty 77 Houses Let in Lodgings 77 Underground Sleeping Rooms 77 Destruction of Rats 78 Rag Flock Act 78 5 page Offensive Trades 78 Sanitary Inspection of the Borough 78 Mortuaries 81 Cemeteries 82 Factories, Workshops and Workplaces 82 Vendors of Fried Fish 87 Vendors of Ice Cream 87 Other Premises where Food is Prepared for Sale or Sold 91 Unsound Food 92 Food Poisoning 92 Slaughterhouses 92 Disinfection and Disinfestation 92 Dairies, Cowsheds and Milkshops 93 Sale of Food and Drugs 94 Milk and Cream Regulations, 1912-1917 99 Smoke Abatement 100 VIII.—Staff. Staff 101 IX.—Housing. General Housing Conditions 104 Census, 1921—Statistics 106 Housing Survey— Fitness of Houses 110 Overcrowding 111 Unhealthy Areas 111 Closing Orders 112 New Houses 112 Appendix. Additional Census Tables 114 6 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Me. Mayor, Ladies and Gentlemen, I have the honour to submit the Twenty-second Annual Report on the health of the Metropolitan Borough of Woolwich. In accordance with the instructions of the Council, the Report follows the outline indicated by the Ministry of Health in order to ensure uniformity in the presentation of Annual Reports of Medical Officers of Health throughout the Country. The chief vital statistics relating to the year are as follows. The population has increased somewhat compared with last year, being now estimated by the Registrar General as 138,254 (civil) and 142,350, including non-civilians. The birth rate, 21.3, is lower than last year. The marriage rate, 16.5, shews a decrease compared with previous years. The death rate, 11.6, and the infantile mortality rate, 62, compare with 11.7 and 62 in 1921. At the beginning of the year, the 1921 Census figures were published and a considerable amount of space has been set apart in the Report in discussing them because they are of much importance and value in public health work. Briefly, they shew in Woolwich a large increase in the population, and a lower standard of housing judged by the amount of house room available for each family. This lower standard is due to the fact that the number of houses erected during the 7 decade has not been equal to the increase in "private" families. The increase in the population is in the main due to the influx of munition workers during the war, but the tendency of the population of London to become less dense in the centre boroughs and more dense in the outlying ones is also a factor. Judged by a recognised standard, namely, more than two persons per room, 10,270 persons, or 7.8 per cent, of the population were living under overcrowded conditions in 1921, compared with 7,110, or 6.3 per cent, in 1911. There was a considerable epidemic of measles in 1922, but, fortunately, the case mortality rate was low, the disease being mild in character. Apart from this disease there was no special epidemic during the year. The mortality from tuberculosis has continued to decline. Maternity and Child Welfare work, and work in connection with Tuberculosis has continued to grow in usefulness during the year. I have again to express my appreciation of the work of the staff of the Public Health Department, and to thank the Public Health and Housing and Maternity and Child Welfare Committees for the support they have given to me, and for their keen attention to the health problems which have been before them during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JOHN MACMILLAN. 8 Twenty-second Annual Report ON THE HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1922. SECTION I.—GENERAL STATISTICS. Area (acres) 8,282 Population, 1921 140,389 Number of Inhabited Houses, 1921 26,048 Number of Families or separate occupiers, 1921 33,647 Rateable Value, October, 1922 £945,032 Sum represented by a penny rate, October, 1922 £3,938 Population. The population of the Borough at the time of the Census, 1921, excluding non-civilians, was 136,307. For 1922, the population adopted by the Registrar General for calculating the death and birth rates is as follows:— For the death rate 138,254. For the birth rate 142,350. It is necessary to sub-divide these figures into populations for the various registration districts, and I estimate these to be as follows (excluding non-civilians):— 9 Parish. Estimated Population. Woolwich 32,545 West Plumstead 41,544 East Plumstead 35,450 Eltham 28,715 138,254 The above figures have been used throughout the report for calculating the rates in the Borough and the various registration districts. Census, 1921. At the end of 1922, and at the beginning of 1923, three volumes dealing with the Census figures of London were published by His Majesty's Stationery Office. I have abstracted from these volumes certain statistical information relating to Woolwich, and for comparative purposes have set out in many instances the corresponding figures for 1911. The population of Woolwich has increased during the decennium by 15 67 per cent. The following Table, No. 1, shows the number of persons and the sex groups in the various wards in 1911, and the corresponding numbers in 1921, the increase or decrease, the acreage, and the number of persons per acre in 1921:— 10 TABLE NO. 1. Ward. Acreage PERSONS. MALES. FEMALES. Persons per acre. 1911 1921 Increase or decrease 1911 1921 Increase or decrease 1911 1921 Increase or Decrease Dockyard 139 7199 7646 + 447 3545 3843 + 298 3654 3803 + 149 55 St. Mary's 99 6666 6783 +117 3693 3760 +67 2973 3023 .+ 50 69 River 572 13762 13001 — 761 7418 6689 — 729 6344 6312 — 32 23 St. George's 325 9083 8749 — 334 5783 5243 — 540 3300 3506 + 206 27 Burrage 184 8887 8763 — 124 4394 4329 — 65 4493 4434 — 59 48 Herbert 245 8780 9084 + 304 3955 4052 + 97 4825 5032 + 207 37 Glyndon 302 9501 9563 + 62 4883 4751 — 132 4618 4812 + 194 32 St. Margaret's . 552 13160 13545 + 385 6441 6578 + 137 6719 6967 + 248 25 Central 115 9083 8769 — 314 4481 4214 — 267 4602 4555 — 47 76 St. Nicholas 1989 21805 26178 + 4373 10874 13066 + 2192 10931 13112 + 2181 13 Eltham 3760 13450 28308 + 14858 5804 13136 + 7332 7646 15172 + 7526 8 The Borough 8283 121376 140389 + 19013 61271 69661 + 8390 60105 70728 + 10623 17 11 The population in North Woolwich was 4,409 in 1911, and was 3,970 in 1921, a decrease of 439 persons. The decrease here is due, in all probability, to the displacement of population caused by the demolition of many houses when the new dock was being constructed. The large increase in the population of St. Nicholas and Eltham Wards during the intercensal period is attributed by the Registrar General to the continued occupation of accommodation provided during the war for workers in munitions. The population in the registration districts was as follows:—Woolwich, 36,179; West Plumstead, 40,955; East Plumstead, 34,947; Eltham, 28,308. The number of persons per acre taken over the Administrative County was 60. Woolwich, with 17, shows the lowest density, being followed by Lewisham and Greenwich, with densities of 25 and 26, respectively. The following Table, No. 2, shows the age and sex groupings (quinquennial groups) of the population at the time of the Census. For comparative purposes the number of persons in 1911 is also shown, and the percentage increase or decrease at each age period. It may be inferred from this table that the population as a whole is becoming older, i.e., the average age is increasing. The small increase in the group (0-4 years), and the decrease in the group (5-9 years) must be attributed to the war. 12 TABLE NO. 2. Age Groups. (Age last birthday). PERSONS. MALES. FEMALES. PERSONS. 1911 1921 1921 1921 Increase or Decrease. Percentage Increase or Decrease. 0—4 12861 13021 6634 6387 + 160 + 1.24 5—9 13185 12508 6334 6174 — 677 — 5.13 10-14 12023 12960 6411 6549 + 937 + 779 15-19 11749 13551 7159 6392 + 1802 + 15.33 20—24 10141 12343 6072 6271 + 2202 + 21.71 25—29 9745 11571 5502 6069 + 1826 + 18.73 30—34 9694 10403 4893 5510 + 709 + 13.31 35—39 9266 10065 4919 5146 + 799 + 8. 64 40—44 8112 9814 4785 5029 + 1702 + 20.98 45—49 6643 9274 4766 4508 + 2631 + 39.61 50—54 5407 7745 3930 3815 + 2338 + 43.34 55—59 4090 5806 2970 2836 + 1716 + 41.96 60-64 3116 4262 2169 2093 + 1146 + 36.78 65—74 3808 5077 2331 2746 + 1269 + 33.33 75 and over 1536 1989 736 1253 + 453 + 29.49 Totals 121376 140389 69661 70728 + 19,013 + 15.67 SUB-GROUPS (included in above). 0-1 2504 3133 1607 1526 + 629 + 25.12 1—2 2450 3194 1653 1541 + 744 + 30.36 2—3 2639 2145 1124 1021 — 494 — 18.72 3—4 2591 2171 1120 1051 — 420 — 16.21 4 5 2677 2378 1180 1198 — 299 — 11.17 13 The following table, No. 3, shows the relative number of people at different ages living in Woolwich compared with London:— TABLE No. 3. Age last Birthday. MALES. FEMALES. London. Woolwich. Woolwich. London. 0—4 100 104 116 100 5—9 100 94 106 100 10—14 100 94 108 100 15—19 100 111 101 100 20—24 100 109 95 100 25—29 100 101 97 100 30-34 100 95 96 100 35—39 100 95 95 100 40—44 100 100 102 100 45—49 100 105 101 100 50—54 100 101 101 100 55—59 100 97 94 100 60—64 100 92 88 100 65—74 100 86 87 100 Over 75 100 86 91 100 This table shows two excesses of males, one from 15-29 years, and one from 45-54 years. The first excess is in all probability due to the military establishment, 4,118 males being enumerated in these buildings on the census night. The second excess is probably due to the influx of older men to work on munitions during the war. The smaller proportion of females in the age groups 20-39 may be due to young women leaving Woolwich to find employment elsewhere, or to the fact that the London female population at these ages is increased by provincial immigrants who would not be likely to settle in Woolwich where there is very little opportunity for them to find work. This explanation is supported by the fact that, comparatively speaking, there is less female labour employed in Woolwich than in any other Metropolitan Borough, and particularly is this so in the case of married women of whom, approximately, one in twenty is employed compared with one in nine in London as a whole. 14 SECTION II.—VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of year are shewn below. TABLE No. 4. Births—Legitimate 2,835 „ Illegitimate 106 2,941 Birth rate 21.3 Deaths 1,603 Death rate 1.6 Number of women dying in, or in consequence of, child birth 6 (a) From Sepsis 3 (6) From other causes 2 Deaths of infants under 1 year 184 (a) Legitimate 171 (b) Illegitimate 13 Infantile Mortality rate 62 Deaths from Measles (all ages) 21 ,, Whooping Cough (all ages) 20 ,, Diarrhoea (under 2 years) 7 The chief Vital Statistics of the Borough during 1922 and the preceding five years are shown in table No. 5:— 15 TABLE No. 5. 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 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 136,237 12737 19.3 1519 116 276 235 86 1679 12.3 b 141,918 * 1920 a 141,666 3658 24.7 1328 113 272 224 61 1487 10.5 b 147,827 * 1921 c 136,307 3197 23.5 1365 90 319 197 62 1594 11.7 d 140,389 * 1922 c 138,254 2941 21.3 1354 98 347 184 62 1603 11.6 d 142,350 * Estimate of Registrar General. a Population for Death Rate. b Population for Birth Rate. c Civil Population. d Including Military. Area of District in acres (exclusive of area covered by water) 8239.7 Census, Total Population, all ages 140,389 1921. Civilian Population, all ages 136,307 BIRTHS. The number of births, corrected by inward and outward transfers, was 2,941, of whom 1,474 were boys and 1,467 were girls. The birth rate, calculated on the total population, was 213, compared with 23.5 last year. Notification of Births. During the year 2,884 births were notified. This is at the rate of 98 per cent, of the 16 registered births and compares with 94 per cent, in 1921. 1,702 notifications were received from midwives, 403 from the British Hospital for Mothers and Babies, 268 from medical practitioners, 199 from parents, 149 from the Military Families Hospital, 54 from the Woolwich Infirmary, and 109 from other persons. The following table, No. 6, shows the number of births in each year since 1918, the birth rate for the same period for Woolwich, London, England and Wales, and the number of five and still births notified each year. TABLE No. 6. Year Woolwich. London England & Wales Woolwich. age of births notified No. of births Birthrate Birth- rate No. of live births notified No. of Stillbirths 1918 2578 16.5 16.1 17.7 2418 70 94 1919 2737 19.3 18.3 18.5 2645 67 97 1920 3658 24.7 26.5 25.4 3163 112 95 1921 3197 23.5 22.3 22.4 3011 91 94 1922 2941 21.3 21.0 206 2884 72 98 The natural increase of the population is the excess of births over deaths. In 1919 it was 1,058; in 1920 it was 2,171; in 1921 it was 1,603; and in 1922 it was 1,338. Table No. 7 shows the number of births in 1922 in each parish, and the respective birth rates (after correction for outward and inward transfers) since 1918. 17 TABLE No. 7. Period. Woolwich West Plumstead East Plumstead Eltham The Borough 1918 19.7 15.4 18.0 17.8 16.5 1919 21.4 16.9 19.1 20.6 19.3 1920 30.4 21.9 24.1 23.2 24.7 1921 29.9 22.0 21.2 21.3 23.5 1922 26.1 18.9 20.1 20.8 21.3 No. of Births 1922 849 784 711 597 2,941 Illegitimate Births. The following table, which is partly compiled from statistics given in the Annual Report of the Registrar General on Births, Deaths, and Marriages, shows the number of illegitimate births each year since 1918, and the illegitimate birth rate per 1,000 births. TABLE No. 8. Year. Number of Illegitimate birth rate Illegitimate births. per 1,000 births. 1918 162 63.6 1919 151 55.2 1920 141 38.5 1921 80 25.0 1922 106 36.0 MARRIAGES. There were 1,138 marriages (1,174 in 1921). The marriage rate was 165 as compared with 20.2, 19.8, 175 and 17.2 in the four preceding years. 18 DEATHS. Table No. 5 shows the gross and nett deaths and death rates in 1922 and each of the last five years, and shows how the nett death figure is obtained. The nett deaths were 1,603 and the nett death rate 11.6; in 1921 it was 11.7. In 1922 the death rate for England and Wales was 12.9, for London, 13.4, and the mean death rate for the 105 Great Towns was 13.0. The following table, No. 9, shows the death rate in the Borough and each registration district since 1918. TABLE No. 9. Period. The Borough Woolwich Parish West Plumstead East Plumstead Eltham 1918 14.3 18.1 15.5 12.4 10.8 1919 12.3 16.2 12.7 10.3 10.1 1920 10.5 13.4 10.4 10.1 7.8 1921 11.7 13.9 13.5 10.2 8.6 1922 11.6 13.9 11.7 10.5 10.1 The seasonal mortality in the four quarters of the year was as follows First quarter, 15.8; second quarter, 12.1; third quarter, 8.0; fourth quarter, 10 0. The next three tables are self-explanatory. 19 TABLE No. 10.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1922. Birth rate per 1,000 total population. Annual Death-rate per 1,000 Population. Bate per 1,000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whoopingcough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 Years) Total Deaths under One Year. Deaths in Public Institutions Certified Causes of Death. Inquest Cases. Uncertified Causes of Death. England and Wales 20.6 12.9 0.01 0.00 0.15 0.04 0.16 0.11 0.54 0.44 6.2 77 25.6 92.7 6.2 1.1 105 County Boroughs and Great Towns, including London 21.4 13.0 0.01 0.00 0.22 0.05 0.19 0.13 0.56 0.41 7.6 82 32.9 92.6 6.7 0.7 155 Smaller Towns (1921 adjusted Populations 20,000— 50,000) 20.5 11.7 0.01 0.00 0.10 0.03 0.15 0.09 0.58 0.35 5.6 75 16.9 93.6 5.1 1.3 London 21.0 13.4 0.01 0.00 0.35 0.07 0.25 0.25 0.57 0.45 7.1 74 48.7 92.1 7.8 0.1 WOOLWICH 213 11.6 0.01 0.00 0.15 0.08 0.14 0.26 0.48 0.29 2.4 62 42.0 91.0 9.0 0 .0 20 TABLE No. 11. Deaths of Woolwich Residents Registered during the Calendar Year 1922, 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 under 75 75 and upwards. All causes 1603 184 51 51 66 84 201 409 272 285 Enteric Fever 1 .. .. 1 .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Measles 21 4 6 9 1 .. 1 .. .. .. Scarlet Fever 11 .. 2 4 2 2 .. .. 1 .. Whooping Cough 20 9 9 2 .. .. .. .. .. .. Diphtheria 36 1 3 8 22 l .. 1 .. .. Influenza 66 1 4 .. 2 4 12 23 12 8 Encephalitis lethargica 2 .. .. .. .. .. 1 1 .. .. Meningococcal meningitis 3 2 .. .. l .. .. .. .. .. Tuberculosis of respiratory system 163 .. 1 .. 5 47 63 44 3 .. Other Tuberculous Diseases 27 2 2 4 7 5 3 3 1 .. Cancer, malignant disease 166 .. .. .. .. .. 20 82 38 26 Rheumatic Fever 4 .. .. .. 3 .. .. 1 .. .. Diabetes 15 .. .. .. .. .. 4 8 3 .. Cerebral haemorrhage, &c, 80 •• .. .. •• .. 2 38 20 20 21 TABLE No. ll—continued. Causes oT 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 under 75. 75 and upwards. Heart Disease 178 1 .. .. 3 4 20 62 45 43 Arterio-sclerosis 42 .. .. .. .. .. .. 8 18 16 Bronchitis 123 12 6 1 .. 2 6 20 28 48 Pneumonia (all forms) 116 30 8 6 3 5 10 19 22 13 Other Respiratory Diseases 5 .. .. 1 .. .. .. 2 2 .. Ulcer of Stomach or Duodenum 12 .. .. .. .. .. 5 7 .. .. Diarrhoea, &c. 9 7 .. 1 .. .. 1 .. .. .. Appendicitis and Typhlitis 7 .. .. .. 3 .. 2 2 .. .. Cirrhosis of Liver 6 .. .. .. .. .. 1 1 4 .. Acute and Chronic Nephritis 69 .. l l 1 3 13 21 20 9 Puerperal Sepsis 3 .. .. .. .. .. 3 .. .. . . Other accidents and diseases of pregnancy and parturition 3 .. .. .. .. 1 2 .. .. .. Congenital debility and malformation, premature birth 80 78 .. 1 1 .. .. .. .. .. Suicide 14 .. .. .. .. 1 2 8 2 l Other deaths from violence 40 5 .. 5 5 1 8 6 6 4 Other defined diseases 281 32 9 7 7 8 22 52 47 97 Causes ill-defined or unknown .. .. •• .. .. .. .. .. •• .. 22 TABLE No. 12. Shewing the nett deaths of Woolwich residents and all deaths occurring in Institutions in the Borough, and deaths of Woolwich residents occurring in Institutions outside the Borough, during the year 1922. Causes op Death. Male. Female. Woolwich. Plumstead. Eltham. Deaths in Public Institutions. In Borough. Outlying Institutions. West. East. Residents. NonResidents. All causes 840 763 451 488 373 291 363 71 311 Enteric Fever 1 .. .. .. 1 .. .. 1 1 Small-pox .. .. .. .. .. .. .. .. .. Measles 5 16 8 7 6 .. 1 1 4 Scarlet Fever 8 3 5 3 2 1 1 .. 10 Whooping Cough 6 14 6 3 8 3 2 1 .. Diphtheria. 16 20 3 11 14 8 .. .. 36 Influenza 35 31 19 19 13 15 17 5 9 Encephalitis Lethargica .. 2 .. .. .. 2 .. .. 2 Meningococcal Meningitis 2 1 1 1 1 1 .. .. 1 Tuberculosis of Respiratory System 107 56 48 40 46 29 37 5 37 Other Tuberculous Diseases 15 12 6 5 9 7 13 1 9 Cancer, malignant disease 72 94 47 58 30 31 34 2 41 Rheumatic Fever 2 2 1 1 1 1 3 .. . . Diabetes 8 7 2 4 6 3 3 .. 3 23 TABLE No. 12—continued. Causes OF DEATH. Male. Female. Woolwich. Plumstead. Eltham. Deaths in Public Institutions. In Borough. Outlying Institutions. West. East. Residents. NonResidents. Cerebral Haemorrhage, &c. 40 40 21 26 15 18 24 9 5 Heart Disease 80 98 48 58 38 34 23 .. 12 Arterio-solerosis 27 15 16 10 5 11 14 1 5 Bronchitis 68 55 34 40 34 15 18 5 8 Pneumonia 64 52 41 37 18 20 17 7 15 Other respiratory diseases 3 2 1 2 2 .. 1 .. .. Ulcer of Stomach or Duodenum 9 3 6 3 3 .. 2 .. 7 Diarrhoea, &c. 4 5 4 3 .. 2 2 .. 2 Appendicitis and Typhlitis 2 5 3 1 1 2 4 .. 3 Cirrhosis of Liver 6 .. 3 2 1 .. 4 .. .. Acute and Chronic Nephritis 36 33 21 22 10 16 20 1 16 Puerperal Sepsis .. 3 1 1 .. 1 1 .. 1 Other Accidents and Diseases of Parturition and Pregnancy .. 3 .. 1 1 1 2 .. 1 Congenital Debility and Malformation, Premature Birth 46 34 22 20 22 16 21 4 10 Suicide 10 4 3 5 2 4 4 2 .. Violence 24 16 8 9 15 8 15 5 6 Other Defined Diseases 144 137 73 96 70 42 80 21 67 Causes ill-defined or unknown .. .. .. • • • • .. .. .. .. 24 CAUSES OF DEATH. Table 11, shows that 178 deaths were due to heart disease, 166 to cancer, 163 to pulmonary tuberculosis, 123 to bronchitis, 116 to pneumonia, 80 to congenital debility and 66 to influenza. Only 9 deaths were due to diarrhoea as compared with 72 in the previous year. Cancer and Malignant Disease. The deaths ascribed to cancer or malignant disease each year since 1918 are shown in Table No. 13:— TABLE No. 13. Year. Males Females. Total. Rate. Percentage of total deaths 1917 58 72 130 0.88 8.39 1918 81 84 165 1.10 7.89 1919 76 81 157 1.15 9.35 1920 60 95 155 1.09 10.42 1921 76 106 182 1.34 11.42 1922 72 94 166 1.20 10.36 Cancer is one of the great causes of death of middle age and later life. As will be seen from the above table nearly 10 per cent, of the deaths of Woolwich occurring in the last six years have been due to cancer and the percentage of deaths over 45 is of course higher. There is little doubt that many of these people, if they have gone to a doctor in good time, would have been cured. The only cure for cancer known at present is its early and complete removal by operation, but the disease, if neglected and not removed in its early stages, is always fatal. Even in incurable cases some degrees of effective palliative treatment can be carried out if the requisite medical aid is sought, and it cannot be too widely 25 impressed upon the public that in no disease is the early diagnosis and prompt treatment so essential to success. The following table shows the seat of primary disease in all deaths from cancer (excluding other specified malignant tumours). TABLE No. 14. Seat of Primary Disease. Males. Females Total. Deaths in Hospital. Tongue 3 1 4 1 Mouth and Jaw 3 .. 3 2 Pharynx 3 .. 3 1 CEsophagus 7 2 9 3 Stomach 14 10 24 11 Liver and Gall Bladder 2 6 8 1 Intestines 7 7 14 9 Rectum 10 8 18 6 Uterus .. 20 20 5 Ovary .. 2 2 1 Breast .. 24 24 14 Vagina and Vulva .. 3 3 3 Skin 2 2 4 3 Larynx 2 1 3 1 Lung 2 1 3 2 Pancreas 3 .. 3 2 Kidneys and Suprarenals 1 .. 1 1 Bladder 3 .. 4 1 Other specified Organs 1 .. 1 1 Abdominal cavity (unspecified) .. 2 2 .. Other and undefined 1 1 2 1 64 91 155 69 Respiratory Diseases. 123 deaths were due to bronchitis, 116 to pneumonia and 5 to other respiratory diseases. The corresponding figures for 1921 were : bronchitis, 113 ; pneumonia, 98 ; other respiratory diseases, 21. It should be remembered, however, that influenzal and all other secondary pneumonias are ascribed to the primary diseases. 26 The following table No. 15, shows the number of deaths each year since 1918 from respiratory diseases, the annual death rate, the number of deaths under 5 years, and the percentage of deaths occurring in children under 5 years of age:— TABLE No. 15. Deaths from Respiratory Diseases. Year. Bronchitis. Pneumonia. Other Respiratory. Total. Death Rate. No. under 5 years. Percentage under 5 years. 1918 108 208 5 321 2.4 112 34.9 % 1919 114 125 15 254 1.9 71 27.9 %. 1920 101 97 16 214 1.5 70 32.7 % 1921 113 98 21 232 1.7 51 22.0 % 1922 123 116 5 244 1.8 64 26.2 % Diarrhoea. Only 9 deaths were ascribed to diarrhoeal diseases during the year, and 7 of these occurred under 2 years of age. The corresponding figures for 1921 were 72 and 60 respectively. Violence and Suicide. 40 deaths—24 males and 16 females—occurred from violence, apart from suicide. Fourteen deaths were due to suicidal causes, 10 males and 4 females. 27 Tuberculosis and the Infectious Fevers. These are dealt with in the section dealing with the notifiable infectious diseases. Inquests. There were 144 inquests held on Woolwich residents during the year compared with 102 in 1921, 145 in 1920, 135 in 1919, 112 in 1918, and 131 in 1917. INFANTILE MORTALITY. The deaths under one year were 184, as compared with 197 in 1921; 224 in 1920; and 235 in 1919. The infantile mortality rate (deaths under one year per 1,000 births) was 62. The number of infant deaths, 184, is the lowest ever recorded. The infantile mortality rate, 62, compares with 62 in 1921 and 61 in 1920. These three years show the lowest infantile mortality rates of Woolwich. It was 128 in 1901 and has fallen in an uneven way since then. At no period has it been so stable as during the preceding three years. There is little doubt that the intensive work which as been done in recent years in connection with maternity and child welfare in educating young mothers in the hygiene of pregnancy and infancy is bringing about the results which are so eminently desirable. The following table, No. 16, gives the infantile mortality rate in each registration district and it will be noted that the rate for Eltham is 45. This is the lowest rate which has ever been recorded in any year in any registration district in the Borough. 28 TABLE No. 16. Year. The Borough. Woolwich Parish. West Plumstead East Plumstead Eltham. 1918 104 125 99 85 109 1919 86 96 82 68 92 1920 61 75 62 51 55 1921 62 59 57 64 70 1922 62 65 57 80 45 Illegitimate Deaths. The number of deaths amongst illegitimate infants was 13. A comparison of the infantile mortality rates of legitimate and illegitimate infants shows that the rate for legitimate was 60 and for illegitimate, 123. Causes of Death. The chief causes of death were:— premature birth and debility, 66; pneumonia, 30; bronchitis, 12. Nine deaths occurred from whooping cough. These figures are practically the same as those for 1921 with the exception that 56 deaths occurred from diarrhoea, etc., in that year. The following table, No. 17, shows the infantile mortality rate, the number of infant deaths, the number of deaths under 4 weeks and the proportion under 4 weeks per 1,000 births each year since 1905. 29 TABLE No. 17. Year. No. of Births. Infantile Mortality Rate. Infant Deaths. Total Number Infant Deaths under 4 weeks Total Number under 4 weeks per 1,000 births. 1905 3549 103 366 130 37 1906 3524 111 391 146 41 1907 3295 111 372 140 42 1908 3082 95 292 116 38 1909 2937 82 240 87 30 1910 2844 84 241 104 37 1911 2814 98 273 92 33 1912 2747 73 201 90 33 1913 2876 80 229 92 32 1914 2824 84 239 97 34 1915 2815 95 268 81 30 1916 3074 70 215 104 34 1917 2698 79 214 89 33 1918 2578 104 268 109 42 1919 2737 86 235 117 43 1920 3658 61 224 101 28 1921 3197 62 197 72 23 1922 2941 62 184 87 29 Total 51190 86 4649 1854 34 As will be seen from the above table, in 1920 the number of deaths under 4 weeks per 1,000 births was 28; in 1921 it was 23, and in 1922 it was 29. These figures seem to suggest that an improvement in the infantile mortality rate of the first four weeks is taking place and this is significant because it is well known that this is the most dangerous month in an infant's life. The chief causes of death in this period were premature birth, 46; debility and marasmus, 9; congenital malformation, 9. Table No. 18 shows the deaths under 1 year, classified by age 'and cause, for the year 1922. 30 TABLE No. 18. INFANT MORTALITY, 1922. 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 1 month 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 .. .. .. .. .. .. .. 2 2 4 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. 2 2 1 4 9 Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. 1 .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculous) .. .. .. .. .. .. 2 1 .. 3 Convulsions 4 .. .. .. 4 2 .. .. 1 7 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. .. .. 1 3 6 .. 2 12 Pneumonia (all forms) 1 .. 1 2 4 7 8 4 7 30 Diarrhœa .. 1 .. .. 1 .. .. .. .. 1 Enteritis .. .. .. .. .. .. 2 3 1 6 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. 2 1 .. .. 3 Rickets .. .. .. .. .. .. 1 .. 1 2 Suffocation, overlying 1 .. .. .. 1 .. 1 .. .. 2 Injury at Birth 3 .. .. .. 3 .. .. .. .. 3 Atelectasis 4 .. 1 .. 5 1 .. .. .. 6 Congenital Malformation 5 1 1 2 9 2 .. 1 .. 12 Premature Birth 40 4 2 .. 46 .. .. .. .. 46 Atrophy, Debility, and Marasmus 7 2 .. .. 9 4 4 2 1 20 Other causes 2 1 .. 1 4 1 6 1 3 15 68 9 5 5 87 24 33 16 24 184 Nett Births registered during Legitimate 2835. the calendar year Illegitimate 106. Nett Deaths registered during (Legitimate 171. the calendar year Illegitimate 13. 31 Deaths in Public Institutions. In tabular form, is shewn below the number of deaths of Woolwich residents which occurred in various Institutions during the year :— TABLE No. 19. Hospital or Institution. Number of Deaths. Poor Law Institutions 407 London General Hospitals 69 Mental Hospitals 55 Infectious Diseases Hospitals 55 Special Hospitals 45 Cottage Hospitals and Nursing Homes 21 Sanatoria and Tuberculosis Institutions 17 Provincial Hospitals 5 674 32 SECTION III.-NOTIFIABLE DISEASES. NOTIFICATIONS. The total notifications, excluding duplicates, was 4,430, compared with 3,611 in 1921. The increase is entirely due to the outbreak of measles which occurred during the year. Measles is not compulsorily notifiable but knowledge of cases of this disease is obtained through the school medical service, and in the year 2,698 notifications were received, compared with 481 in 1921. Twenty-one deaths occurred from this disease. There was a fall in the number of cases of diphtheria and scarlet fever, viz., 437 and 511 in 1922, compared with 592 and 1,351 in 1921. The number of cases of pneumonia continues to increase each year. In 1921, 236 cases were notified and in 1922, 345. This increase is not entirely due to increased knowledge of notification amongst medical practitioners, but is a true increase, and is in the main due to the influenza outbreak at the beginning of the year. It is pleasing to record that the incidence of tuberculosis, as gauged by notifications, continues to decrease, the figures since 1918 being as follows:—660, 474, 428, 356 and 305. The following four tables are published in accordance with the requirements of the Ministry of Health, laid down in Circular 359, dated 10th January, 1923, and show the total number of cases of each infectious disease notified during the year; the total number of deaths occurring amongst these cases; and the distribution and case rate per 1,000 population in the various registration districts of the Borough. Table No. 24, which follows, shows the incidence of each infectious disease each year since 1901. 33 TABLE No. 20. INFECTIOUS DISEASES. Diseases. Total cases notified. Cases admitted to Hospital. Total Deaths. Diphtheria 437 432 36 Scarlet Fever 511 486 11 Enteric Fever (including Para-typhoid) 8 8 1 Puerperal Fever 11 11 3 Pneumonia 345 82 116 Erysipelas 37 5 3 Cerebro spinal meningitis 2 1 3 Poliomyelitis 3 3 .. Acute Polio-Encephalitis 1 1 1 Encephalitis lethargica 3 3 2 Malaria 11 .. 2 Dysentery .. 2 2 Continued Fever 1 1 .. Ophthalmia neonatorum 26 7 - Zymotic Enteritis 31 .. 9 Tuberculosis Pulmonary Males 143 162 107 Females 102 80 56 Total 245 242 163 Tuberculosis Non-pulmonary Males 30 24 15 Females 30 21 12 Total 60 45 27 †Measles 2698 11 21 4430 1340 400 †Not Notifiable—information obtained from voluntary sources. 34 TABLE No. 21. CASES OP INFECTIOUS DISEASES NOTIFIED—1922. Diseases. Number of Cases Notified. Age Groups. All Ages. Under 1 year. 1 and under 2 years. 2 and under 3 years. 3 and under 4 years. 4 and under 5 years. 5 and under 10 years. 10 and under 15 years. 15 and under 20 years. 20 and under 35 years. 35 and under 45 years. 45 and under 65 years. 65 and over. *Diphtheria 437 2 17 32 21 21 145 90 33 58 8 10 .. Scarlet Fever 511 .. 19 26 33 26 212 101 36 44 12 1 11 Enteric Fever 8 .. .. .. 1 .. 1 1 2 2 1 .. .. Puerperal Fever 11 .. .. .. .. .. .. .. .. 9 2 .. .. Pneumonia 345 38 30 26 13 18 24 11 15 41 41 58 30 Erysipelas 37 .. .. .. .. .. .. 1 .. 5 8 20 3 Cerebro-spinal meningitis 2 1 .. .. .. .. 1 .. . . .. .. .. .. Poliomyelitis 3 .. .. .. .. .. 3 .. .. .. .. .. .. Acute Polio-Encephalitis. 1 .. .. .. .. .. .. .. .. .. . . .. .. Encephalitis lethargica 3 .. .. .. .. .. .. 1 1 .. 1 .. .. Malaria 11 .. .. .. .. .. .. .. .. 4 5 2 .. Continued fever 1 1 .. .. .. .. .. .. .. .. .. . . .. Ophthalmia neonatorum 26 26 .. .. .. .. .. .. .. .. .. .. .. Zymotic enteritis 31 18 7 1 .. .. .. .. .. 3 .. 1 1 Tuberculosis Pulmonary Males 143 1 .. 1 1 .. 5 5 18 60 20 1 1 Females. 102 2 2 .. 2 1 5 11 19 39 16 36 .. Total 245 3 1 1 3 1 10 16 37 99 36 37 1 Tuberculosis Non-pulmonary Males 30 1 2 1 4 1 6 2 5 4 1 3 .. Females. 30 1 1 1 2 1 7 5 4 6 1 1 .. Total 60 2 3 2 6 2 13 7 9 10 2 4 .. †Measles (including German Measles) 2698 59 124 159 163 340 1720 125 7 1 .. .. .. 4430 150 201 248 240 408 2129 353 140 276 116 133 36 *Includes Membranous Croup. †Not Notifiable—Information obtained voluntarily. No cases of Smallpox, Typhus Fever, Relapsing Fever, Cholera, Plague, Dysentery, Trench Fever, Anthrax, Glanders, Hydrophobia, were notified during the year, 35 TABLE No. 22. Cases of Infectious Diseases Notified in the Borough and Parishes during the Year 1922, showing the Case Rate per 1,000 Population. Diseases. Borough. Total Cases notified in each locality. Case Bates per 1,000 Population. Woolwich. Plumstead Eltham. Borough. Woolwich. Plumstead. Eltham. West. East. West. East. Diphtheria 437 49 118 192 78 3.16 1.51 2.84 5.42 2.72 Scarlet Fever 511 129 155 120 107 3.70 3.96 3.73 3.39 3.73 Enteric Fever 8 2 1 5 .. 0 06 0.06 0.02 0.11 0.00 Puerperal Fever 11 3 4 3 1 0.08 0.09 0.10 0.09 0.03 Pneumonia 345 145 75 56 69 2.49 4.46 1.81 1.58 2.40 Erysipelas 37 6 15 8 8 0.27 0.18 0.36 0.23 0.28 Cerebro-spinal meningitis 2 1 1 .. . . 0.01 0.03 0.02 .. .. Poliomyelitis 3 2 .. .. 1 0.02 0.06 .. .. 0.03 Acute Polio-Encephalitis 1 1 .. .. .. 0.01 0.03 .. .. .. Encephalitis lethargica 3 1 .. .. 2 0.02 0.03 .. .. 0.07 Malaria 11 1 3 1 6 0.08 0.03 0.07 0.03 0.21 Continued Fever 1 1 .. .. .. 0.01 0.03 .. .. .. Ophthalmia neonatorum 26 7 5 10 4 0.19 0.22 0.12 0.28 0.14 Zymotic Enteritis 31 25 3 2 1 0.22 0.77 0.07 0 06 0.03 Pulmonary Tuberculosis 245 51 68 70 56 1.77 1.57 1.64 1.97 1.95 Tuberculosis (other forms) 60 13 23 16 8 0.43 0.40 0.55 0.45 0.28 Measles (including German Measles) 2698 613 904 721 460 19.52 18.84 21.76 20.34 16.02 36 TABLE 23. DEATHS OP NOTIFIED CASES OF INFECTIOUS DISEASES, 1922. Diseases. Number of Deaths. Age groups. All ages. Under 1 1- 2- 3- 4- 5-10 10-15 15-20 20-35 35-45 45-65 65- Diphtheria 36 1 3 4 3 1 16 6 1 .. .. 1 .. Scarlet Fever 11 .. 2 1 1 2 1 1 1 1 .. .. 1 Enteric Fever 1 .. .. .. 1 .. .. .. .. .. .. .. .. Puerperal Fever 3 .. .. .. .. .. .. .. .. 2 1 .. .. Pneumonia 116 30 8 3 2 1 1 2 3 8 4 19 35 Erysipelas 3 .. .. .. .. .. .. .. .. 1 .. .. 2 Cerebro-spinal Meningitis 3 2 .. .. .. .. l .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. Acute Polio-Encephalitis 1 .. .. 1 .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 2 .. .. .. .. .. .. .. .. .. 1 1 .. Malaria 2 .. .. .. .. .. .. .. .. 1 .. .. 1 Dysentery 2 .. .. .. .. .. .. .. .. .. 1 1 .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. Zymotic Enteritis 9 7 .. .. 1 .. .. .. .. .. l .. .. Tuberculosis—pulmonary Males 107 .. 1 .. .. .. .. 2 5 45 18 34 2 Females 56 .. .. .. .. .. 1 2 14 22 6 10 1 Total 163 . . 1 .. .. .. l 4 19 67 24 44 3 Tuberculosis—Non-pulmonary Males 15 1 1 1 1 . . 2 2 2 2 .. 2 1 Females 12 1 1 .. .. 2 1 2 1 3 .. 1 .. Total 27 2 2 1 1 2 3 4 3 5 .. 3 1 Measles 21 4 6 7 2 .. 1 .. .. 1 .. .. .. 400 46 22 17 11 6 24 17 27 86 32 69 43 37 TABLE No. 24. Notification of Infectious Diseases, 1901 to 1922. 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.† Measles.‡ 1901 21 216 311 68 72 8 .. 1 .. .. .. .. .. .. .. .. .. .. 323 1902 228 233 267 50 98 11 189 1 .. .. .. .. .. .. .. .. .. .. 646 1903 6 186 389 42 58 2 165 3 .. .. .. .. .. .. .. .. .. .. 661 1904 6 163 472 25 74 5 186 1 .. .. .. .. .. .. .. .. .. .. 1240 1905 7 273 513 27 83 12 115 1 .. .. .. 212 .. .. .. .. .. .. 465 1906 .. 387 528 40 97 8 176 .. .. .. .. 366 .. .. .. .. .. .. 825 1907 .. 275 1023 27 110 6 150 .. 1 .. .. 93 .. .. .. .. .. .. 1453 1908 .. 362 596 19 90 6 154 .. l .. .. 173 .. .. .. .. .. .. 519 1909 .. 268 1027 13 113 9 206 .. .. .. .. 149 .. .. .. .. .. .. 768 1910 1 171 524 10 89 7 196 .. 1 .. .. 102 .. .. .. .. .. .. 396 1911 .. 239 518 16 82 16 375 .. l 3 8 866 .. .. .. .. .. .. 801 1912 3 429 474 20 87 2 689 .. l 3 20 129 .. .. .. .. .. .. 775 1913 .. 321 626 14 70 8 675 .. .. 1 14 338 .. .. .. .. .. .. 387 1914 .. 416 714 18 107 7 498 .. l .. 18 199 .. .. .. .. .. .. 967 1915 .. 286 601 31 138 6 489 .. 50 2 19 173 .. .. .. .. .. .. 1179 1916 1 271 232 9 95 16 469 .. 14 .. 33 80 3 .. .. .. .. .. 1590 1917 .. 277 147 12 79 12 543 .. 17 1 41 101 5 .. .. .. .. .. 1710 1918 .. 240 222 12 61 14 660 .. 7 2 23 118 4 .. .. .. .. .. 800 1919 4 398 243 26 63 7 474 .. 6 1 34 123 1 .. 3 61 7 123 1886 1920 1 427 538 6 82 13 428 .. 3 .. 29 31 3 .. 3 29 1 136 1013 1921 .. 592 1351 11 59 14 356 .. 1 .. 32 454 1 .. 9 10 4 236 481 1922 .. 437 511 8 37 11 305 1 1 3 26 31 1 .. 4 11 .. 345 2698 *Voluntary Notification to 1910; partial to 1912; all cases thereafter, † Includes all forms of Pneumonia. ‡ Measles compulsorily notifiable from 1/1/1916 to 31/12/1919. § Compulsory notification of Zymotic Enteritis commenced 1913. 38 MEASLES. Notification Statistics. The number of notifications of measles received during the year was 2,698, as compared with 481 in 1921. This is the largest number of cases coming, to the knowledge of the Department in any year since the formation of the Borough. The disease assumed epidemic proportions about the beginning of March and continued as such until the end of June. In each of seven weeks over 150 cases were discovered. During recent years attention has repeatedly been drawn to the seriousness of measles which not only causes many deaths in young children, but in less serious cases leads to grave ill-health in after life. The seriousness of this disease is not generally appreciated by the public, and as measles is not a notifiable disease, our efforts to minimise its effects are seriously handicapped. In most of the London Boroughs we are almost entirely dependent on the school service for information regarding its prevalence. In 1921 a conference was held between Metropolitan Boroughs and the London County Council in order to devise means to develop the most efficient organisation available for dealing with this disease, particularly as the success of the nursing work of the Borough Councils is largely dependent on the earliest possible recognition of this disease. It is pleasing to record that as a result of this conference more cases are coming to the knowledge of the Department and are coming earlier than they used to do. It cannot be said that much advantage is gained by the original notification, because delay is inevitable, but it cannot be too strongly emphasized that the benefit of this earlier notification lies in the fact that secondary cases are under observation much earlier and the necessary steps for diminishing the severity of the disease can be taken in advance. In the course of the epidemic 39 692, or 26 per cent, of all known cases were discovered by the Health Visitors. Nursing. The Council made arrangements in 1916 for the home nursing of measles by voluntary nursing associations. During 1922, 50 cases were nursed at home at a total cost to the Council of £22 17s. 0d. The number of visits paid by nurses was 541, thus averaging 11 visits per case. School Closure. The London County Council during 1922 closed 9 departments in Schools, as compared with 3 in 1921. Removal to Hospital. Cases of Measles are received into the hospitals of the Metropolitan Asylums Board on the certificate of your Medical Officer. During the year 11 cases were so removed. SCARLET FEVER. Notification. During the year 511 cases of scarlet fever were notified compared with 1,351 in 1921. The case rate is shown in Table No. 22. Return Cases. Below is shown in tabular form the number of return cases, the period elapsing between date of discharge from hospital of the primary case and the date of occurrence of the secondary case for the years 1920, 1921 and 1922. TABLE No. 25. Period elapsing: Total. Under 1 month. 1-2 months. 2-3 months. Over 3 months. 1920 No. of oases 24 1 2 1 28 1921 Do. 62 12 6 16 96 1922 Do. 46 9 3 1 59 40 Home Isolation. 25 cases, or 4.9 per cent, of all cases, were isolated at home and in two instances return cases occurred. The cases were regularly inspected by your Sanitary Inspectors in order to ascertain that proper precautions for preventing the spread of infectious disease were being taken, and in no instance was there any ground for supposing that the pubhc safety is endangered by home isolation in suitable cases. Multiple Cases. The following Table No. 26, shows the house distribution of cases of scarlet fever in Wards. TABLE No. 26. Dockyard St. Mary's River St. George's Burrage Herbert Glyndon St. Margaret's Central St. Nicholas Eltham Total houses Total Cases No. of houses in which 1 case occurred 22 15 26 33 26 19 15 36 24 65 64 345 345 2 cases occurred .. 3 3 3 5 2 2 5 2 7 11 43 86 3 ,, „ 1 2 2 .. 1 1 1 3 1 2 3 17 51 4 „ „ .. .. .. .. .. 1 .. 1 .. 1 3 6 24 5 „ „ .. .. .. .. 1 .. .. .. .. .. .. 1 5 Total houses 23 20 31 36 33 23 18 45 27 75 81 412 511 DIPHTHERIA. Notifications. During the year 437 cases of diphtheria were notified compared with 592 in 1921. The case rate is shown in Table No. 22. Return Cases. Below is shown in tabular form the number of return cases, the period elapsing between date .of discharge from hospital of the primary case and the date of occurrence of the secondary case for the years 1920, 1921 and 1922. 41 TABLE No. 27. Period elapsing: Total. Under 1 month. 1-2 months. 2-3 months. Over 3 months. 1920 No. of cases 1 .. .. 1 2 1921 Do. 5 1 2 3 11 1922 Do. 16 4 1 1 22 Home Isolation. Five cases, or 11 per cent, of all cases, were isolated at home, and in no instance did a return case occur. Multiple Cases. The following Table No. 28, shows the house distribution of cases of diphtheria in Wards : TABLE No. 28. Dockyard St. Mary's River St. George's Burrage Herbert Glyndon St. Margaret's Central St. Nicholas Eltham Total houses Total Cases No. of houses in which 1 case occurred 6 9 11 16 16 13 30 27 16 103 48 295 295 2 cases occurred .. .. 1 1 1 3 2 3 4 14 10 39 78 3 .. .. 1 .. .. .. 2 1 1 8 2 15 45 4 .. .. .. .. .. .. .. .. 1 .. 1 2 8 5 .. .. .. .. 1 .. .. .. .. .. .. 1 5 6 .. .. .. .. .. .. .. .. .. 1 .. 1 6 Total houses 6 9 13 17 18 16 34 31 22 126 61 353 437 42 PNEUMONIA, MALARIA, DYSENTERY AND TRENCH FEVER. During the year the following number of cases were notified:— Pneumonia 345 Malaria 11 Dysentery — Trench Fever — These diseases are compulsorily notifiable under the Public Health Pneumonia, Malaria, Dysentery, etc.), Regulations, 1918. The deaths from pneumonia during the past four years were:— 1919 1920 1921 1922 125 97 98 116 It will be seen from Table No. 24 that there has been a steady increase each year in the number of notifications of pneumonia, but it must be pointed out that this increase is only partly a true increase. It is again desirable to draw the attention of medical practitioners to the fact that all forms of primary pneumonias are notifiable and that the only secondary pneumonia which is notifiable is influenzal pneumonia, because it is believed that some dubiety still exists amongst them with regard to this. Nursing Provision. I am informed by the Secretaries of the various voluntary Nursing Associations in the Borough that the following numbers of cases of pneumonia Were nursed during the year:— Woolwich and Plumstead Nursing Association 100 St. Luke's Parish, Eltham 22 43 Eltham Nursing Association 8 Silvertown and North Woolwich Nursing Association 2 The following Table, No. 29, shows the number of notifications of pneumonia received each month classified according to the description of pneumonia given on the certificate, and the sex incidence. It also shows the number of deaths occurring from all forms of pneumonia during these months. In this connection, however, it must be remembered that influenzal pneumonia deaths are classified as due to influenza. TABLE No. 29. Month. Male. Female. Total. Lobar. Type Acute Primary. No. of Deaths. Broncho. Influenzal January 49 54 103 4 3 86 10 19 February 31 24 55 3 6 31 15 14 March 15 15 30 10 11 3 6 21 April 28 7 35 14 11 1 9 10 May 15 11 26 13 8 1 4 14 June 9 7 16 3 7 2 4 8 July 2 2 4 — — — 4 3 August — - — — — — — 2 September 2 1 3 — 1 1 1 2 October 9 5 14 10 2 2 — 5 November 16 7 23 9 11 1 2 5 December 21 15 36 10 13 5 8 13 197 148 345 76 73 133 63 116 The following Table, No. 30, shows the distribution of the various forms of pneumonia, as set out in the medical certificates, in each Ward of the Borough:— 44 TABLE No. 30. NOTIFICATION OF PNEUMONIA. Ward. Lobar. Broncho. Influenzal. Acute Primary. Total. Dockyard 3 4 11 4 22 St. Mary's 6 15 15 .. 36 River 21 19 34 1 75 St. George's 5 1 2 4 12 Burrage 7 6 10 5 28 Herbert 4 .. 2 2 8 Glyndon 8 5 9 5 27 St. Margaret's 3 .. 6 3 12 Central 2 2 3 1 8 St. Nicholas 5 19 9 15 48 Eltham 12 2 32 23 69 76 73 133 63 345 OPHTHALMIA NEONATORUM. Twenty-six cases of ophthalmia neonatorum were notified during the year, and 7 were treated in hospital. In tabular form is shown below, as required by the Ministry of Healthy the results of each case TABLE No. 31. OPHTHALMIA NEONATORUM. No. notified. Treated: Vision unimpaired. Vision impaired. Total blindness. Deaths. At home. In hospital 26 19 7 25 1 .. .. 45 Nursing. The Council made arrangements in 1920 for the home nursing of patients suffering from this disease. During 1922, 8 cases were nursed at home at a total cost to the Council of £9 10s. Od. The number of visits paid by nurses was 190. PUERPERAL FEVER. Eleven cases of puerperal fever were notified during the year, and 11 were treated in hospital—4 being in hospitals of the Metropolitan Asylums Board, 4 in Poor Law Institutions, and 3 in voluntary hospitals. Three deaths occurred. ZYMOTIC ENTERITIS. Thirty-one cases of zymotic enteritis were notified compared with 451 in 1921. The quarterly incidence and deaths for each quarter were as shown below. Quarter. Cases. Deaths. First 0 2 Second 4 2 Third 19 3 Fourth 8 2 31 9 OTHER NOTIFIABLE INFECTIOUS DISEASES. No cases of smallpox occurred, and no special comment is required on the incidence of enteric fever, whooping cough, erysipelas, or cerebro-spinal meningitis and poliomyelitis. The number of cases of each of these diseases is shown in Table No. 21, and is below the average of preceding years. 46 TABLE No. 32. TUBERCULOSIS. Summary of Notifications received during year ended 31st December, 1922. 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. Poor Law Institutions. Sanatoria. Oto 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. Pulmonary Males 1 2 5 5 18 21 39 20 23 8 1 143 172 .. .. .. .. 1 31 165 ,, Females 2 4 5 11 19 14 25 16 3 3 .. 102 121 .. .. .. .. .. 15 72 Non-Pulmonary Males 1 8 4 2 5 2 2 1 3 .. .. 28 29 .. 2 .. 2 4 2 16 „ Females 1 5 6 5 4 6 .. 1 .. 1 .. 29 30 .. 1 .. 1 1 7 8 5 19 20 23 46 43 66 38 29 12 1 302 352 .. 3 .. 3 6 55 261 47 TUBERCULOSIS. This part of the report, which has been prepared in the main by the Tuberculosis Officer, deals with the work of the Department under the Public Health (Tuberculosis) Regulations, 1912, and under the dispensary scheme approved by the Ministry of Health and the London County Council who contribute 50 per cent, and 25 per cent, respectively, of the nett expenditure. The dispensary staff consists of two Tuberculosis Officers, three Tuberculosis Visitors, one Nurse-Dispenser and one Lay Organiser. Notification Statistics. The total number of primary notifications received was 358, but 53 of these related to cases which had been previously notified, so that the total number of new cases coming under observation during the year was 305. The corresponding figure for 1921 was 356, thus showing a decrease for 1922 of 51 cases. The increase in duplicate notifications from 16, 10 and 14 in the last three years is an indication that there is less tendency on the part of medical practitioners to assume that when they see a case of old tuberculosis that some one else must have notified it before. Notifications received on Forms "C" and "D,". i.e., notifications from institutions regarding admission and discharges, are not included in the above figures. The distribution of the various cases notified since 1918 is as follows:— 48 TABLE No. 33. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 1918 563 6 14 41 19 6 11 660 1919 394 4 3 35 19 5 14 474 1920 359 7 5 24 17 11 5 428 1921 285 14 5 17 17 9 9 356 1922 245 8 5 16 20 5 6 305 Cases of Tuberculosis in the District. In accordance with the Public Health (Tuberculosis) Regulations, 1921, the register of notifications kept by the Medical Officer of Health under the Tuberculosis Regulations, 1912, has been revised by the removal of the entries which relate to persons who have died or who have ceased to permanently reside within the Borough of Woolwich. This has necessitated a large amount of work involving, as it did, approximately 6,000 notifications spread over a period of ten years. The position at the end of the year 1922 is as follows:— Number of cases reported to be well 1278 Number of cases presumably suffering from active tuberculosis 933 Total known cases of tuberculosis in the Borough 2211 It has been impossible to trace 665 notified cases. The number of cases stated to have moved to other districts was 544, and in every case where the new address was definitely ascertained, the Medical Officer of Health of that district was notified of the case and of all relevant particulars contained in the Register of notifications kept by me. 49 Since 1912, 114 Army cases have been notified, but the subsequent history of these is unknown to this department. It should be explained that only in cases where the soldier is discharged to live in the Borough is the Medical Officer of Health likely to gain any further knowledge of the patient. Cases classified as "well" are those who were found to be well and working and not in need of medical treatment at the time of the visit by the Tuberculosis Visitor. It is unfortunate that over a period of years so large a proportion of patients are untraced, but it must be remembered that the European War lasted five of these years and that the complete co-ordination of municipal and dispensary activities in connection with tuberculosis only occurred in 1921. The following table shows the number of deaths from tuberculosis, and the total deaths and death rates since 1917. It will be noted that the total number of deaths from tuberculosis was less by 17 than in 1921. TABLE No. 34. Year. Deaths. Death-rates. All Forms. Pulmonary. NonPulmonary All Forms. Pulmonary. NonPulmonary. 1917 215 176 39 1.63 1.34 0.20 1918 222 190 32 1.65 1.41 0.24 1919 196 171 25 1.45 1.26 019 1920 188 161 27 1.32 1.13 0.19 1921 207 168 39 1.52 1.23 0.29 1922 190 163 27 1.37 1.18 0.19 50 TABLE No. 35. Pulmonary. Percentage. Non-Pulmonary. Percentage. Not Notified 15 9.2 17 63.0 0—1 Months 19 11.7 8 29.6 1-3 „ 17 10.4 — — 3-6 „ 17 10'4 — — 6—12 ,, 23 14.1 — — 1—2 years 34 20.9 1 3.7 2—5 32 19.6 — — Over 5 years 6 3.7 1 3.7 163 27 The ratio between non-notified and the total tuberculosis deaths, as will be seen from the table shown above, is therefore as one is to six. Co-operation with Hospital and School Clinic. The existing agreements with the Seamen's Hospital, Greenwich, and with the London Hospital for X-Ray examination of difficult cases, and for the treatment of lupus, respectively, have been continued, and arrangements were concluded whereby patients requiring artificial pneumo-thorax could receive treatment at the Brompton Hospital. Co-operation between the School Medical Service and the School Clinic, Brewer Street, continued to work satisfactorily, and there is little doubt but that the preventive work done by this service is very largely responsible for the striking decrease in the number of patients who present themselves with tuberculous glands. Co-operation with Medical Practitioners. Harmonious relations continue to exist between the Dispensary and the Medical Practitioners in the Borough. During the year, the Tuberculosis Officer saw 72 cases in consultation at the homes of the patients, and 227 cases were referred to him at the Dispensary for the purpose of diagnosis. 51 Home Contacts. The percentage of contacts who were examined at the Dispensary is still not as satisfactory as it might be. It must, however, be remembered that a certain proportion of contacts are examined by the family medical attendant. This is a very important part of dispensary practice, which is not always appreciated by those most affected, and which requires much persuasion and tact on the part of the Dispensary staff . Dental Treatment. In July, 1922, the Council received the sanction of the Ministry of Health and the London County Council to proceed with the dental scheme submitted for approval in November, 1921. The dental clinics, in coordination with the Council's work in connection with Maternity and Child Welfare, are held on one half-day a week at the Brewer Street School Clinic, two half days per month being devoted to Tuberculosis. For various reasons it was not possible to hold the first clinic until the end of November. To the end of the year, ten patients had received treatment under the scheme. Patients receive dental treatment free, but when artificial teeth are necessary, patients are assessed for payment according to their means, each case being treated on its merits. Home Nursing. The local branch of the Queen Victoria Nursing Association and other local Nursing Associations continue to render very valuable assistance in the nursing of patients who are confined to bed. Extra Nourishment. Under the scheme sanctioned by the Ministry of Health extra nourishment was supplied to certain selected cases of tuberculosis. This is the first complete year in which the scheme has been in force. The total number of applications dealt with was 203, at a cost of £155 11s. 5d. D 2 52 After Care. The Council's Tuberculosis Care Scheme was not completed at the close of the year, but it was found possible to assist several cases in one way and another. During the year, gifts including a bath-chair and a spinal carriage were presented to the Dispensary for the use of patients, and have been greatly appreciated. Nursing requisites such as water-beds, air-rings, etc., have been provided, and are in constant demand. Shelters. The eleven shelters available for patients were in constant use during the year. Bacteriological Examinations. During the year, 658 specimens of sputum were examined at the Dispensary of which 520 were negative, and 138 positive. This is in addition to specimens sent by individual general practitioners to the Seamen's Hospital, Greenwich, for examination. Institutional Treatment. The following table shows the number of cases admitted to hospitals, sanatoria, Poor Law institutions and training colonies during the year. TABLE No. 36. Hospitals. Sanatoria. Infirmary . Training Colonies. Insured 152 79 38 1 Uninsured 33 26 15 — Children 22 17 8 — 207 122 61 1 These admissions represent a total of 287 individual patients and the monthly admissions from January to December were as follows:— 53 January 27 July 27 February 26 August 27 March 42 September 32 April 32 October 39 May 36 November 35 June 43 December 25 Treatment. Treatment at the Dispensary, as distinct from •diagnosis, consultation, and general supervision, has been on a smaller scale than in previous years. This is in accordance with Circular 149 issued by the Ministry of Health in December, 1920, in which it is stated:— "Patients who require treatment which can, consistently with the best interests of the patient, be properly undertaken by a general practitioner of ordinary professional competence and skill, and who are either insured persons or can afford to pay for medical attendance, should not be encouraged to attend the dispensary for routine treatment." In effect, therefore, treatment, as distinct from diagnosis and general supervision, has been limited to patients requiring treatment of a highly technical order, or who cannot otherwise obtain medical attendance. Whether this is the proper policy or not is a matter of opinion, but it at any rate tends to place a brake on the investigation of new and special methods of treatment of the tuberculous, a matter of much importance when it is remembered that the present day sheet-anchor in tuberculosis is sanatorium treatment, a method which is costly and is limited now by the financial stringency existing in the country. Form " R " (a return as to work carried out in connection with the Dispensary during the year) is appended. 54 TABLE No. 37. Return as to work carried out in connection with the Maxey Road Tuberculosis Dispensary for the year 1922. (Form " R " (revised)). Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Found to be Under observation at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary. NonPulmonary. (a) All persons (including " Contacts." Adults. M. .. 325 .. 99 9 225 12 .. F. .. 269 .. 52 5 205 9 .. Children under 15. M. .. 299 .. 9 6 299 13 .. F. .. 278 .. 10 5 276 12 .. Total .. 1,171 .. 170 25 1,005 46 .. (b) "Contacts" (included in (a). Adults. M. .. 56 .. 11 .. 44 1 .. F. .. 80 .. 13 1 63 3 Children under 15. M. .. 109 .. 2 3 103 1 .. F. .. 117 .. 1 3 112 1 .. (c) Insured persons included in (a). M. .. 282 .. 92 5 177 8 .. F. .. 79 .. 16 2 60 1 .. 55 TABLE No. 37 (continued). 1 . Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 650 2, . Total number of attendances of patients at the Dispensary during the year— Insured 3,884 Uninsured 4,723 3 . Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 364 4. , Number of cases in which the period of observation at the Dispensary exceeded two months ? 5. , Number of insured patients under domiciliary treatment on December 31st 319 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 112 7. Number of persons referred to affiliated hospitals for consultation 8. Number of consultations with medical practitioners at the homes of patients— Insured 44 Uninsured 28 9. Number of other visits paid by Tuberculosis Officers to the homes of patients 755 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 4,597 11. Number of specimens of sputum examined in connection with the work of the Dispensary 658 56 SECTION IV.—CAUSES OF SICKNESS. Specify any muses of sickness and invalidity which have been specially noteworthy in the district during the year. (This should include information obtained from local general practitioners). There was a small epidemic of influenza at the beginning of the year, 86 cases of acute influenzal pneumonia being notified in January and 31 in February; 56 deaths were certified to be due to influenza in the first quarter of the year, compared with 12 and 9 respectively in the same quarter in the previous two years. It would appear from enquiries I have made among general practitioners that there has been an increase in the number of skin diseases during the year, and it is suggested that the cause of this is due to defective nutrition associated with the long spells of unemployment which unfortunately has been present in the district during the past years. Since March, however, I think it is clear that the total sickness in the district has been below the average for many years. In this connection one practitioner says that there has been a marked improvement in the physique of young persons employed in local factories and workshops, especially in those factories which make an effort to maintain the health of their employees by means of their Welfare organisations. 57 SECTION V.—SUMMARY (for reference) of Nursing Arrangements, Hospitals, and other Institutions available for the District (including Report on Maternity and Child Welfare Work). In tabular form is set out a summary of the Nursing arrangements, Hospitals, and other Institutions available for the district: Professional Nursing in the Home. There are four nursing institutions in the district, as follows:— The Woolwich and Plumstead Nursing Association, 22 Nightingale Place, Woolwich, S.E. 18. The Eltham District Nursing Association, (Nurse) Miss M. Alexander, The Hostel, Eltham. St. Luke's Parish, Eltham, (Nurse) Miss Bloomfield, 9 Maudslay Road, Eltham. Silvertown and North Woolwich District Nursing Association, Saville Road, Silvertown, E. 16. The Woolwich and Plumstead Nursing Association deals with cases in Woolwich and Plumstead; the Eltham Nursing Association deals with cases in that part of Eltham which lies south of the Blackheath-Bexley Heath railway line; St. Luke's Parish Nursing Association deals with cases in that part of Eltham lying to the east of Well Hall Road and north of the above-mentioned railway line. There are no arrangements for nursing in that part of Eltham west of Well Hall Road and north of the railway line. All these Nursing Associations will nurse cases of certain infectious diseases, viz., measles, whooping cough, ophthalmia neonatorum and tuberculosis. They will not, however, 58 vide nursing assistance in the case of scarlet fever, diphtheria or enteric fever. The Borough Council have entered into an agreement with all these Nursing Associations whereby nursing assistance, in necessitous cases, is paid for by the Borough Council for patients requiring such assistance and suffering from measles or ophthalmia neonatorum. The rates paid per visit are as follows: 1/- per visit; two or more cases in one home, 6d. per case, per visit. Midwives. I am informed by the County Medical Officer of Health that 37 midwives gave notice during the year of their intention to practise as midwives in the Borough of Woolwich. The Borough Council does not employ, or subsidise, practising midwives. TABLE No. 38. CLINICS AND TREATMENT CENTRES. Situation. Nature of Accommodation. By whom provided. Sessions weekly. Maternity and Child Welfare Centres. Town Hall, Woolwich Doctor's room, Weighing room, Waiting rooms, etc. Woolwich Borough Council 4 289 High Street, Plumstead Do. Do. 4 179 Well Hall Boad, Eltham Do. Do. 4 Wesley Hall, Timbercroft Lane, Plumstead Doctor's room, Weighing room, Do. 1 59 TABLE No. 38—continued. Situation. Nature of Accommodation. By whom provided. Sessions weekly. Church Army Hut, New Eltham Doctor's room, Weighing room. Woolwich Borough Council 1 St. John's Hall. North Woolwich Do. Do. 1 Victory Club, Beresford Street Doctor's room, Weighing room, Waiting room. Voluntary Organisation 1 Day Nurseries. Nil School Clinics. Brewer Street, Woolwich Doctor's rooms, Treatment rooms, Waiting rooms. Local Medical Association Daily Plumstead Road, Plums tead Do. Do. Daily Cyril Henry Treatment Centre, St. Mary Street, Woolwich Accommodation for operating on, and detention of, cases of enlarged tonsils and adenoids London County Council Daily Borough Disinfecting Station, White Hart Road, Plumstead Accommodation for cleansing of verminous children Woolwich Borough Council Daily Tuberculosis Dispensary Maxey Road, Plumstead Doctor's rooms, Waiting rooms, Dressing rooms, Dispensary, etc. Woolwich Borough Council Daily Venereal Diseases. Nil. 60 Hospitals Provided or Subsidised by the Local Authority. (1) Tuberculosis. Nil. (2) Maternity. British Hospital for Mothers and Babies, Samuel Street, Woolwich (40 beds). In March, 1922, the new buildings of the British Hospital for Mothers and Babies were opened. The new Hospital is in Samuel Street and sufficient accommodation (including isolation wards) is available for 40 indoor cases. The old Hospital in Wood Street, which could only accommodate 14 indoor cases, has been retained as an ante-natal clinic. The Borough Council have entered into an agreement whereby sufficient accommodation for 144 confinements per annum is reserved at a cost of £1,500 per annum. This agreement only operated from the 1st June, 1922, but by the end of the year 71 cases had been admitted. Each patient admitted is required to pay fees according to the earnings of her husband. The amount received thus by the Council during the year was £213 1s. Od. The amount paid to the Hospital was £875, making the net cost, £661 19s. 0d., fifty per cent, of which is recoverable from the Ministry of Health. With regard to the general working of the Hospital, I am informed by the Secretary, Miss Gregory, that the number of cases (including Borough Council patients) admitted during the year was 431; that the number of births was 431, and that the number of outdoor cases was 243. The attendances at the ante-natal and child welfare clinics associated with the hospital were 869 mothers and 220 infants. (3) Children. Home for Ailing Babies, Eglinton Road, Plumstead. Provided by the Woolwich Borough Council 61 (21 beds). The following table shows certain statistical information for the Home for the year 1922 : TABLE No. 39. (a) Number of cases in hospital on the 1st January, 1922 9 Number of cases admitted during the year 96 Number of cases remaining in on the 31st December 5 (b) Average duration of stay 45 days (c) Reasons for admission:— Malnutrition, Marasmus and Debility 53 Bronchitis and Pneumonia 5 Enteritis and Colitis 2 Vomiting, Dyspepsia and Constipation 19 Rickets 2 For observation 6 Miscellaneous—Skin conditions, etc. 9 96 (d) Number of cases discharged:— (a) In good health 62 (b) Improved 20 (c) No improvement 9 91 (e) Number of cases of infectious diseases:— – (a) Measles 4 (b) Whooping Cough – (c) Epidemic Diarrhoea 1 (d) Continued fever (/) Number of Deaths 9 (4) Fever. Nil. 62 TABLE No. 39—continued. (5) Smallpox. Nil. (6) Other. There is no General Hospital in Woolwich, and in consequence considerable use is made of the London General Hospitals, but no actual figures showing the extent are available. Some information, however, can be obtained from the death returns and the following table, No. 40, shows the number of deaths of Woolwich residents occurring in London General Hospitals during the year. The number of deaths of Woolwich residents which occurred in the local Infirmaries was as follows:—Woolwich, 321; Lewisham, 75. TABLE No. 40. Hospitals. Number of Deaths. Miller 19 Guy's 16 Seamen's 10 London 5 Charing Cross 5 St. Bartholomew's 4 St. Thomas's 3 Middlesex 3 Royal Waterloo 2 King's College 1 Westminster 1 69 The plans for the erection of a general Hospital in Woolwich, referred to in the Annual Reports for 1920 and 1921, are slowly maturing, and it is understood that sufficient 63 funds are now available to enable the Committee to erect the first section. N.B.—Since the above was written, the Borough Council, with the sanction of the Ministry of Health and the approval of the Unemployment Grants Committee, have, in view of the urgent necessity of providing work for the unemployed, undertaken to do the necessary manual work in connection with the construction of roads, paths and terraces, and excavations for foundations of the new Hospital. The estimate for this work is £23,365, and the Borough Council are making a contribution of 40 per cent., but not exceeding £6,000, towards the wages paid in carrying out the work. Woolwich suffers from a lack of hospital accommodation and considerable delay very often takes place in the removal of acute cases from this Borough to London Hospitals. When this Hospital is in use that considerable waste of time, which is so important in the treatment of acute emergencies and accidents will be ehminated, a fact which will greatly benefit the inhabitants of this Borough. There are two Cottage Hospitals in the district, one at Eltham with 22 beds and one in Shooter's Hill with 13 beds. In addition there is the Military Families Hospital available for the Garrison, and the Royal Arsenal Hospital available for workers in the Royal Arsenal. Institutional Provision for Unmarried Mothers. Woolwich and Plumstead Maternity Home. This is a small home for unmarried mothers, which is situated at 23 Vicarage Park, Plumstead, and provides accommodation for 8 mothers and babies. Through the courtesy of the Superintendent I am able to give the following information with regard to this Home:— 64 Mothers and Babies in the Home, 1st January, 1922 4 mothers and 4 babies Mothers admitted during the year 10 Mothers with babies admitted during the year 2 Births in the Home 7 Deaths — Average duration of stay of each completed case 6-7 months. When the girls are due to leave the Home, situations are found for them, and, if possible, the mother takes the child with her, otherwise a foster mother is found for the child. During the year all the girls, with one exception, have taken their babies with them to service. The Superintendent keeps in touch with the girls after they have left, either by letters, or, when they are near enough, by asking them to visit the Home in their off-duty times. Nearly all the girls attended the Ante-Natal Clinics of the Borough Council. A grant of £50 was made by the Council during the year, towards the funds of the Home. Ambulance Facilities. (a) Infectious Cases. Under the Public Health (London) Act, persons in London suffering from certain notifiable diseases may be conveyed to Hospital and treated gratuitously in a Hospital of the Metropolitan Asylums Board, and persons suffering from any dangerous infectious disease may be conveyed by ambulance to other places on payment. (b) For non-infectious and accident cases. An ambulance service was established by the London County Council in London in 1915 in order to deal at all times with persons suffering from accidents or sudden illnesses in the streets or in public places. Subsequently this service was extended 65 to include the removal, under certain circumstances, of maternity cases to hospital, but it is not, under ordinary circumstances, intended or available for the removal of persons suffering from illness in private houses. For this purpose, however, ambulances can be obtained on payment to the Metropolitan Asylums Board. The nearest ambulance station to Woolwich is situated in Lee High Road, Lewisham, nearly four miles from the thickly populated part of the Borough. The maternity service referred to above is not available for the removal of maternity cases from Woolwich. The ambulances of the Guardians are available for admission to their Institutions. There is no doubt that the ambulance services available for Woolwich are inadequate. Representations have been made to the London County Council on this subject but as yet no action has been taken. MATERNITY AND CHILD WELFARE. It will be convenient to deal here with the work of the Council in connection with Maternity and Child Welfare during the year. Staff. The staff at the end of the year is shown in detail in Section VIII. Welfare Centres. These are set out in tabular form in table No. 38. At the end of the year, 3 ante-natal sessions and 12 infant consultations were being held each week. Treatment. During the year the approval of the Minister of Health was received to the Council's Dental Scheme. Under this scheme dental treatment is given to expectant and nursing mothers, and to children under school age. The work E 66 was only commenced in December, and by the end of the year 7 new patients had attended. The dental work is carried out under the aegis of a local Association of Medical Practitioners at their Clinic in Brewer Street. Children requiring medical or surgical treatment are referred to the School Clinic. The Borough Council pays 5/- for each case so referred. During the year 54 cases were sent there for treatment. Voluntary Centre. The Voluntary Centre at the Victory Club, Beresford Street, has continued to do good work during the year. The total number of children attending this Centre during the year was 127, and the total number of attendances, including mothers, was 989. Convalescent Home, Brent Road. This Home was closed in September, 1922. The Work of Health Visitors. At the end of the year, the number of Health Visitors was 8, two of whom hold the combined appointment of Sanitary Inspector and Health Visitor. Their work, which consists of 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; enquiry into still births and the deaths of young children, and the attendance at Centres to which children and women come for medical and hygienic advice, becomes increasingly valuable year by year. Experience gained in the last few years has shown that the younger mothers are desirous of acquiring information on the rearing of children, take instruction in these matters very kindly, and recognise that in these times more than instinct and tradition is necessary if baby is to develop as they would wish. Now-a-days the first visit of the Health Visitor is taken as a matter of course—indeed it is looked forward to. The first Health Visitor was appointed 67 in 1906. In that year, the infantile mortality rate was 111; it has now fallen to a steady 62 per 1,000 births, which, expressed otherwise, represents a saving of 140 infant lives in 1922. In 1922, the Council, with the approval of the Ministry of Health, paid the class fees of two Health Visitors attending a refresher course for Health Visitors. Administrative Action in Connection with the Notification of Births. As a matter of routine, as soon as a notification of a birth is received, suitable literature is sent to the mother by post and a first visit is made between the tenth and fourteenth day. It has been found as a matter of experience that it is not easy to ascertain at a first visit how much the mother knows, and how much she requires to be told, and so the necessity for subsequent visits is gauged by the impression gained at the first. As a general rule, an endeavour is made to work to the following standard 4 visits during the first year, and 1 visit in subsequent years up to school age. Other Work. In addition to these visits, the Health Visitors have made investigations into the cause of infant deaths and still-births, and have visited notified cases of Ophthalmia Neonatorum, Puerperal Fever, and Pneumonia in children under 5 years. A considerable amount of their time in the early part of the year was taken up with work in connection with the distribution of free milk under the Council's assisted milk scheme, but it was found possible, by the issue of a suitable form, to diminish their work in connection with this very considerably and so enable them to devote more time to Health Visiting. The following table, No. 41, shows the classification of visits paid by the Health Visitors in 1921 and 1922. E 2 68 TABLE No. 41. 1921 1922 Births—First visits 2,800 2,677 „ Re-visits 8,904 9,271 Infant deaths investigated 163 175 Still-births investigated 80 55 Expectant Mothers—home visits to 263 330 Infectious Diseases— Ophthalmia Neonatorum—First visits 31 26 „ „ Re-visits 30 40 Measles—First visits 153 2,080 „ Re-visits 79 741 Puerperal Fever—First visits 10 7 „ Re-visits 6 2 Zymotic Enteritis—First visits 319 25 „ „ Re-visits 264 27 Tuberculosis Visits 92 57 Pneumonia (all forms) under 5 years 115 204 Visits unclassified 713 562 Visits unsuccessful—No admission 2,814 1,873 Totals 16,836 18,152 The Work of the Centres. In tabular form below are shown the detailed statistics for the year 1922 and the consolidated statistics for 1919, 1920 and 1921. The Slade Centre, situated at Wesley Hall, Timbercroft Lane, was opened on the 24th October, 1922. 69 TABLE No. 42. No. on Roll of Centre. No. of Attendances at Centre. Mothers : Children. Mothers : Children. Expectant. Nursing. Expectant. Nursing. Town Hall 209 247 1,721 330 492 8,233 Plumstead 153 159 1,107 253 298 5,837 Eltham 150 149 934 260 241 5,236 North Woolwich .. 1 130 .. 3 687 New Eltham .. 7 112 .. 28 842 Slade .. 1 109 .. 2 240 Beresford Street (Voluntary) 8 26 127 17 59 913 Totals 1922 520 590 4,240 860 1,123 21,968 „ 1921 489 588 4,150 943 1,046 23,156 „ 1920 309 445 3,122 789 1,047 21,613 „ 1919 178 54 1,263 436 101 7,450 The following table, No. 43, shows the children attending each Centre and the number of attendances during the year. 70 TABLE No. 43. Children in attendance at each Centre. Year of Birth. Woolwich. Plumstead. Eltham. N. Woolwich. New Eltham. Slade. Beresford Street (Voluntary). Total. 1922 554 319 242 42 34 49 36 1276 1921 630 393 270 45 37 31 43 1449 1920 344 243 211 28 21 23 20 896 1919 138 95 113 11 14 1 16 388 1918 37 43 65 2 4 5 5 161 1917 18 14 33 2 2 — 1 70 Totals 1721 1107 934 130 112 109 127 4240 Attendances of Children at each Centre. 1922 2972 2045 1694 237 313 134 257 7652 1921 3340 2385 1922 271 369 56 322 8665 1920 1391 943 927 139 92 37 219 3748 1919 429 321 368 34 50 4 98 1304 1918 65 111 210 3 15 9 16 429 1917 36 32 95 3 3 1 170 Totals 8233 5837 5216 687 842 240 913 21968 Supply of Milk, etc. to Necessitous, Expectant and Nursing Mothers and to Young Children. The approximate cost of milk and dinners supplied to expectant and nursing mothers during the year was as follows:—Dried Milk, £2,084 7s. 1d.; Fresh Milk, £50 1s. 7d., and Dinners, £36 1s. 6d. The economic circumstances scale under which milk was distributed at cost price was as follows 71 Number in Family. Scale. s. d. One 16 0 Two 13 0 Three 10 6 Four 9 6 Five 8 6 Six (or more) 8 0 Deductions Rent. During the year, legal proceedings were instituted against a man who was alleged to have obtained milk by false pretences. The Magistrate dismissed the summons. Feeding of Infants in Woolwich. An enquiry on the same lines as that set out in detail in the Annual Report for 1921 was carried out on two occasions in 1922, namely, in June and December, and the consolidated results are set out in detail in Table No. 44 below. This table shows (a) a slight improvement in breast feeding compared with last year; and (b) a higher percentage amongst children between the age of six and nine months than one would have expected; and (c) that a mother who feeds her baby at the breast for four months is likely to do so until the end of the seventh month. 72 TABLE No. 44. Feeding of Children attending Centres, 1922. Method of Feeding. Age in Months. Grand Total 0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 Total 0-9 9-10 10-11 11-12 Breast 88 148 90 71 70 66 61 34 26 654 11 8 2 675 Breast and Hand 6 24 12 24 19 17 22 22 23 169 30 28 35 262 Hand 5 30 42 44 56 62 63 48 60 410 56 56 87 609 90 202 144 139 145 145 146 104 109 1233 97 92 124 1546 Percentages. Breast 88.8 73.3 62.5 51.1 48.3 45.5 41.8 32.7 23.9 53.0 11.4 8.7 1.6 43.7 Breast and Hand 6.1 11.9 8.3 17.3 13.1 11.7 15.1 21.1 21.1 13.7 30.9 30.4 28.2 16.9 Hand 5.1 14.8 29.2 31.6 38.6 42.8 43.1 46.2 55.0 33.3 57.7 60.9 70.2 39.4 73 SECTION VI.—LABORATORY WORK. Analysis of Food and Drugs. The Public Analyst is Sir W. R. Smith and the laboratory work in connection therewith is carried out at the Royal Institute of Public Health. The detailed results of analyses made will be found in the section dealing with the Food and Drugs Acts. Bacteriological Examinations. Bacteriological examinations are carried out at the Seamen's Hospital, Greenwich. In tabular form is shewn below the number and result of the various examinations made during the year. For comparative purposes the figures for 1921 are also given. TABLE No. 45. Associated Disease. Positive Result. Negative Result. Total 1922. Total 1921. Diphtheria 123 751 874 966 Enteric Fever 1 8 9 10 Tuberculosis 28 159 187 206 152 918 1,070 1,182 Anti-Toxin. Diphtheria anti-toxin is kept at the Town Hall and the Plumstead and Eltham Free Libraries, and is supplied to Medical Practitioners, on application, at cost price, or free where there is inability to pay. The amount supplied during the year was 64,000 units at a total cost of £4 16s. 0d. 74 ADOPTIVE ACTS, BY-LAWS AND REGULATIONS RELATING TO PUBLIC HEALTH IN FORCE IN THE DISTRICT. There are no adoptive Acts in force in the district. The following is a list of By-laws and Regulations made under various Acts, with the date of adoption:— By-laws made under— Date of Adoption. Public Health (London) Act, 1891 S. 16 (1) 15th May, 1903. Do. do. S 16 (2) 22nd June, 1893. 10th October, 1901. Do. do. S. 39 (1) 22nd June, 1893. Do. do. S. 39 (2) 15th May, 1903. Do. do. S. 45 15th May, 1903. Do. do. S. 50 15th May, 1903. Do. do. S. 88 15th May, 1903. Do. do. S. 94* 13th August, 1895. Do. do. S. 95 15th May, 1903. London County Council (General Powers) Act, 1902 S. 53 22nd Nov., 1883. Do. do. 1903 S. 54 1st February, 1905. Do. do. 1908 S. 9 17th June, 1913. Baths and Washhouses Act, 1846 15th May, 1903. Public Health (London) Act, 1875 S. 167 Do. Metropolis Management Act, Act, 1885 S. 202 30th October, 1900. 21st July, 1903. * Woolwich and Plumstead Parishes only. 75 Regulations made under- Factories and Workshops Acts and Public Health (London) Act, 1891, with regard to Bakehouses 31st January, 1902. Dairies, Cowsheds and Milkshops Order, 1885 S. 13 3rd July, 1885. Slaughterhouse, etc., Metropolis Act, 1874 and Local Government Act, 1888 28th July, 1891. Housing, Town Planning, etc., Act, 1909 S. 17 (7) 9th February, 1911. Section 55 of the Public Health (London) Act, 1891, has been applied to Zymotic Enteritis. 76 SECTION VII.—SANITARY ADMINISTRATION. This part of the Report, which has been largely prepared by the Chief Sanitary Inspector, deals statistically with the sanitary administration of the Borough. Closet Accommodation. There are a few earth closets, and 29 cesspools in the Borough. Scavenging. (a) Removal of House Refuse— Loads removed in Woolwich 7,975 Loads removed in Plumstead 13,936 Loads removed in Eltham 4,930 Frequency Weekly. Cost in Plumstead £5,507 8s. 10d. (b) Removal of Trade Refuse— Inoffensive : Loads removed in Woolwich 929 Loads removed in Plumstead 25 Loads removed in Eltham 109 Charge per load 5s. Offensive— Tradesmen on Books 60 Receptacles removed 6,681 Charge per Receptacle 6d. Complaints. The number of complaints received during the year was 1,865, compared with 2,064 last year. 37 of these complaints related to the non-removal of dust—8 in Woolwich, 27 in Plumstead, and 2 in Eltham. 77 Drainage. Thirty-one combined drains were reported upon at the meetings of the Public Health and Housing Committee throughout the year. These related to 156 houses. It was found necessary to reconstruct 8 combined drains. These were connected with 44 houses and 54 notices for the reconstruction were served. Various small repairs to drains were undertaken at the time of the examination at the request of the owners and the total cost of this work amounted to £5 16s. 6d. for the year. This amount has been recovered from the owners of the respective houses. Increase of Rent and Mortgage Interest (Restrictions) Act, 1920. During the year 6 applications were made for certificates. In each case the owner of the premises was notified and notices were served for the abatement of the nuisances. These notices were readily complied with so that it was only necessary to issue one certificate, reports being given in the other instances. Inhabited House Duty. There have been no applications for certificates under the Inland Revenue Act. HOUSES LET IN LODGINGS. Number on Register at beginning of year 439 „ „ end of year 422 Number of Inspections made 273 „ Notices served 192 „ Prosecutions — Underground Sleeping Rooms. There were no closing orders made during the year with respect to underground rooms. 78 Rats. During the year 127 investigations were made under the Rats and Mice (Destruction) Act. A " rat week " was held in November, and by arrangement with the Works Department, 7,279 baits were laid in 57 old sewers likely to be infested with rats. Rag Flock Act. No samples were taken during the year. Offensive Trades. There are no offensive trades in Woolwich. Action under Public Health Acts or By-Laws. Statistical tables are set out on the two following pages, showing the number of inspections made by your Sanitary Inspectors during the year, and the number of nuisances abated. The total number of intimation notices served was 4,191, compared with 4,537 in 1921. The total number of statutory notices served was 1,294, compared with 1,403 in 1921. The number of summonses issued for legal proceedings was 6, compared with 24 in 1921. In this Borough it is a practice of many years standing for the Town Clerk to write a letter to the owner reminding him of his neglect to comply with a statutory notice and requesting his attention forthwith, and only in the event of continued neglect is a summons issued. The number of cases reported to him during the year was 137. TABLE No. 46. Premises Inspected. Total. Milkshops 211 Bakehouses 171 Cowhouses 66 Ice Cream Premises 619 Slaughterhouses 23 Fried Fish Shops 340 79 TABLE No. 46—continued. Premises Inspected. Total. Premises where Food is prepared (other than above) 633 Shops and Markets re Food (estimated) 1,533 Factories, Workshops, Workplaces 512 Outworkers' Premises 180 Homes re Verminous Cases 549 Homes re Scabies Cases 324 Women's Lavatories 73 Smoke Observations 23 Tents and Vans 17 Urinals accessible to Public 241 Animals so kept as to be a nuisance 38 Housing Survey, Houses inspected 3,987 Do., number of following up primary inspections 2,643 Complaints investigated 1,865 Enquiries re Notified Infectious Disease 1,170 School Reports 473 Special Inspections re Rats 127 Drains tested by Smoke Test 65 „ Water Test 26 New Houses Inspected—Water Certificates 138 Registered Houses 273 Miscellaneous (Unclassified) 769 Re-inspections (estimated) 15,103 TABLE No. 47. Nuisances, etc., Abated. Total. Interiors cleansed 2,942 Damp conditions in houses remedied 638 Defective guttering and rain water pipes 755 Improved ventilation 193 Defective Roofs 1,013 Deficient light, windows supplied or enlarged 6 80 TABLE No. 47—continued. Nuisances, etc., abated. Total. Paving in yards and washhouses repaired 653 Underground rooms not in accordance with Acts 2 Waste pipes from baths, lavatories and wash-houses repaired or disconnected 198 Choked and defective drains 299 Defective traps 26 Defective or unventilated soil pipes 17 W.C.'s repaired; new traps or pans provided 317 Foul pans cleansed 132 Flushing apparatus repaired or renewed 387 Additional w.c.'s provided to dwelling houses — Do., factories and workshops 1 Wash-houses provided with sinks 7 Defective and foul cisterns used for dietary purposes 15 Defective and foul rain water tanks 11 Insufficient supply of water or water cut off by M.W.B. 46 Additional Water Supply 1 Cases of overcrowding remedied 55 Dust bins supplied 751 Verminous rooms cleansed 181 Accumulations of manure removed 69 Dung pits provided 1 Smoke nuisances 4 Coppers repaired 196 Cooking stoves repaired 252 Sundry other nuisances 1,324 The prosecutions instituted during the year under the Public Health and Housing Acts and under the London CountyCouncil (General Powers) Acts are shewn below. 81 TABLE No. 48. No. Date of Hearing. Offence. Situation. Result. 1 March 8 No cooking accommodation on top storey 65a High Street, Plumstead Work done. Withdrawn. 2/- costs 2 March 8 Dirty and defective conditions 65a High Street, Plumstead Work done. Withdrawn. 25/- costs 3 August 2 Premises without a proper and sufficient supply of water 56 Princes Road, Plumstead Order to abate. 10/costs 4 Sept. 13 Failure to comply with a Nuisance Order 56 Princes Road, Plumstead Fined £4 10s. 0d. Costs £3 3s. 0d. 5 Oct. 17 Failure to comply with a Nuisance Order 56 Princes Road, Plumstead Work done. Fined £3 15s. 0d. 6 Oct. 3 Dirty and dilapidated walls and ceilings of the scullery and w.c. apartment 63 Earl Street, Plumstead Order to abate. Fined £3. Costs £2. MORTUARIES. TABLE No. 49. Sun Street. Sun Street (Infectious). Eltham. All Mortuaries. Number of bodies received: 1922 1921 (a) for inquest 104 — — 104 90 (b) for custody 15 2 3 20 42 119 2 3 124 132 Number of Post-Mortem Examinations 68 — — 68 55 f 82 CEMETERIES. TABLE No. 50. Number of Interments. 1920. 1921. 1922. Woolwich Cemetery 617 647 612 Plumstead Cemetery 641 730 720 Eltham Churchyard 173 179 199 Plumstead Churchyard 41 24 33 1,472 1,580 1,564 Number of Exhumations carried out during the year 5 Factories, Workshops and Workplaces. It is the duty of the Medical Officer of Health under Section 132 of the Factory and Workshops Act, 1901, to report specifically in his Annual Report as to the administration of the Act. The total number of factories, workshops and workplaces on the register at the end of the year was 228. The number of inspections, 512, compares with 971 last year and 310 for 1920. It was found necessary to serve 19 notices compared with 54 in 1921. The following tables are in the form adopted by the Home Office so as to ensure uniformity in the presentation of statistics:— 83 TABLE 51. 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) 127 8 Workshops (Including Workshop Laundries) 347 10 Workplaces 38 1 Homeworkers' Premises 180 2 Total 692 21 2.—Defects Found. Description. Number of Defects. Found. Remedied. Nuisances under Public Health Act Want of Cleanliness 4 4 Want of Ventilation 1 1 Overcrowding — — Want of Drainage of floors — — Other nuisances 1 1 Sanitary Accommodation insufficient 1 1 unsuitable or defective 15 15 not separate for sexes — — Total 22 22 f 2 84 TABLE 51—continued. 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) 2 Action taken in matters remediable under the Public Health Acts, but not under the Factory Act (S. 5). Notified by H.M. Inspector 5 Reports (of action taken) sent to H.M. Inspectors 5 Underground Bakehouses (S. 101):— In use during 1903 24 Certificates granted in. 1906 1 in 1910 1 In use during 1922 9 Workshops on the Register (S. 131) at end of 1922:— Workshop Laundries 3 „ Bakehouses 34 Other Workshops 110 Total number of Workshops on the Register 147 85 TABLE 51—continued. 4.—Home 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. Nature of Work. 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 (Secs. 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 46 162 2 5 76 18 .. .. 22 2 2 .. .. .. .. Tennis Balls, etc. 6 755 .. .. 78 126 .. .. 158 .. .. .. 1 .. .. 52 917 2 5 154 144 .. .. 180 2 2 .. 1 .. .. 86 The Ministry of Health ask that in the report on Sanitary Administration during the year, information should be given under the heads set out below. Work of the Sanitary Inspectors under Article 19 of the Sanitary Officers' Order, 1922. Article 19 of the Sanitary Officers Order, 1922, deals with the duties of Sanitary Inspectors. These duties may be classified as obligatory and optional. The optional duties referred to are as follows :—(a) Paragraph 8 reads : " If so directed by the Local Authority supervise the the scavenging of his district or any part thereof." The work of scavenging in Woolwich is done in two Parishes by the Works Department of the Council, and in the Parish of Plumstead it is done by a firm of Contractors. It is part of the duty of Sanitary Inspectors to supervise this work. (b) Paragraph 9 deals with certain Acts amongst them being the Rats and Mice (Destruction) Act, 1919. All the district Sanitary Inspectors have been directed by the Council to act as Rats Officers within their respective districts. The general work of the Sanitary Inspectors under this Order has been shown in Tables No. 46 and 47. The sanitary staff consists of one Chief Inspector, six District Inspectors, one Food and Drugs Inspector, oneWoman Sanitary Inspector, two part-time Health Visitors and Sanitary Inspectors, and two other Inspectors, one who is entirely engaged on Housing Survey work and one who is partially engaged on this work and partly acts as a District Inspector. Inspection of Premises where Food is Prepared. It is the duty of each Inspector, whilst on his district, to have under observation the food supply, but in addition, arrangements have been made whereby three Inspectors specially inspect the food exposed for sale on the market places and make 87 regular inspections of the slaughterhouses in the Borough. Within the past year, more attention has been devoted to the supervision of food supplies as will be evident from a comparison of the figures shown in this report compared with those in the 1921 Report. 619 visits were paid to ice-cream premises as compared with 195 in 1921; 340 visits were paid to fried fish shops, compared with 251 in 1921; 171 visits were paid to bakehouses, compared with 142 in 1921, and other premises where food is prepared, 633, compared with 226 in 1921. (a) Vendors of Fried Fish. At the end of the year there were '69 premises where the business of a vendor of fried fish was carried on. This number compares with 65 in 1921. All these premises were specially inspected by the Chief Sanitary Inspector and myself at the end of 1921 and the beginning of the year under review, and many unsatisfactory conditions were found. As a result of this special inspection and the increased vigilance which followed on the part of the sanitary staff, it may be said that the improvement in the standard which was noted at the end of 1921 has continued during the year under review. (b) Vendors of Ice Cream. At the beginning of the summer season it occurred to a good many men who were out of employment that the production and sale of ice cream was a profitable employment, and consequently there was a large increase in the number of people who dealt in these commodities. A special survey of the Borough was made by the Sanitary Inspectors with a view of ascertaining where people were making and selling ice-cream. There is no obhgation on ice-cream vendors to register and their premises could only be found out by a systematic search on the part of the sanitary inspectors. This was of course by no means difficult because it is obvious that dealers in ice cream must advertise 88 their wares widely to the public if they want to sell. In many instances it was found that ice cream was being made, stored or sold under unsuitable conditions. The necessary notices were served, but in no cases were legal proceedings instituted. Six samples of ice cream, 3 of which were scrapings from the ice cream holder used for making wafers, were sent to the Seamen's Hospital for bacteriological examination during the year. A copy of the report of the Bacteriologist on each sample is shewn below. No. 1 Ice Cream Scraping—27th July, 1922. Naked eye appearances : Normal. Microscopical appearances : A few epithelial cells only. (Gram stain). The number of micro-organisms is small and in marked contrast to No. 3 scraping. The following organisms are seen :— 1. A Gram negative diplobacillus. 2. A Gram negative bacillus with polar staining. 3. Gram positive cocci in chains (streptococci). 4. Gram negative diplococci. 5. Gram positive diplococci. Cultural appearances : The preponderating organism on trypagar medium is a short coccobacillus in short and long chains. Gram negative. On MacConkey medium a few lactose fermenting colonies have appeared. No. 3 Ice Cream Scraping—27th July, 1922. Naked eye appearances : Dark grey in colour. Microscopical appearances : 1. Moulds + + 2. Red Cotton Fibre. 3. Debris + + 4. Fat globules. 89 5. Very numerous motile and non-motile organisms. (Gram stain—Gram negative bacilli preponderate). Cultural Appearances : Plate is covered with a bacillus of the B. Mesenteriae type. Commentary : In neither case has evidence of the presence of organisms likely to cause epidemic illness been obtained. Taking the whole of the observations made into consideration, I consider that scraping No. 1 is fairly good, and that scraping No. 3 affords evidence of a lack of cleanliness which, if continued, might be a danger to the public health. No. 2 Ice Cream—27th July, 1922. Direct Films : 1. Yeasts + 2. Organisms of the B. subtilis type + 3. Gram negative bacilli + + 4. Gram negative cocci (? cocco-bacilli) + + + + Quantitative estimation : One c.c. contains 64 million organisms. MacConkey plate cultures at 37 degrees C. A slight growth only has been obtained, including a few non-lactose fermenting organisms. Sub-cultures from these latter give none of the re-actions of B. Gaertener nor of the B. Coli groups. No. 4—Ice Cream—27th July, 1922. Direct Films : 1. Gram positive diplococci + 2. Gram negative bacilli + + 3. Gram negative cocci (? cocco-bacilli) + + + + Quantitative estimation : One c.c. contains 500,000 organisms. MacConkey plate cultures, at 37 degrees C. : No growth has been obtained after 48 hours. 90 No. 5 Ice Cream—5th September, 1922. Direct Films : Staphylococci Streptococci, Gram negative cocci and bacilli all present in considerable numbers. Yeasts also present—occasional epithelial cells seen. Quantitative estimation : Both in cold incubator and at 37 degrees C., the total count is approximately 80 million bacteria per 1 c.c. Films from these plates show a strong growth of yeasts and Gram negative bacilli. Search for B. Coli Communis and Organisms of the Enterica group : Ice-cream, in quantities from lc.c. down to .00001 c.c., was inoculated into liquid MacConkey lactose and glucose media. Acid and gas appeared in all but the lowest dilution. From those glucose tubes showing acid and gas, MacConkey plates were made with the following results:— Ice Cream, .001 and .0001 c.c.—No growth on MacConkey. Ice Cream, .25, .1 and .01c.c.—A moderate growth of both lactose and non-lactose fermenters. (a) The non-lactose fermenters all gave acid and gas with saccharose, so serological tests were not proceeded with. (b) Lactose fermenters—A number of colonies tested out. Result, B. Coli Communis present in .25 c.c. of ice cream—not present in 1 c.c. of ice cream. Streptococci were absent in all hang drop preparations from the liquid MacConkey cultures. No. 6 Ice Cream Scraping—5th September, 1922. Appearance : A greenish colour. Direct Films : Moulds, Yeasts, Staphylococci and Streptococci diphtheroids and gram negative bacilli present. 91 Plates : A strong growth of Yeasts, Staphylococci and Gram negative bacilli. Commentary : Pathogenic organisms of the Enterica and B. Gaertner groups absent. The absence of B. Coli Communis in all but one of the dilutions and the total absence of faecal streptococci are against faecal contamination either of ice cream or its components. (c) Other Premises where Food is Prepared for Sale or Sold. Special attention, in pursuance of the policy of the Council, has been paid during the year to premises where food is prepared for sale, 633 inspections being made, compared with 226 in the previous year. It was found necessary to serve 21 notices which were complied with. In concise form is given below statistics relating to premises where food is prepared or sold. TABLE No. 52. On Register, Dec., 1922. Inspections. Notices. Proceedings. Bakehouses 49 171 15 — Cowsheds 32 66 — — Milkshops 78 211 13 — Ice Cream Premises 224 619 31 — Slaughter-houses 8 23 — — Fried Fish Shops 69 340 35 — Premises where food is prepared (other than above) 115 633 21 — 92 Unsound Food. On 59 occasions during the year, unsound food was surrendered compared with 65 in 1921. Included in the food surrendered were 1 ton 4 cwt. of Beef, 1 cwt. of Mutton, 3¼ cwt. of Pork, 200 stone of Fish, 109 lbs. of Rabbits, 135 tins of Fish, 47 bushels of Apples, 275 lbs. of Tomatoes and 16 Ducks. The number of carcases condemned on account of tuberculosis was 3 (2 pigs and 1 bullock). No intimation has been received during the year that farmers in the district have purchased unsound food for the food of cattle. There were no seizures. Food Poisoning. There has been no case of food poisoning in the Borough during 1922. Number and Condition of Slaughterhouses, Registered or Licensed. In tabular form below is shown the number of slaughterhouses licensed in 1914 and in January and December, 1922. These premises have been regularly inspected during the year. There is no public abbatoir in the Borough. TABLE No. 53. SLAUGHTERHOUSES. In 1914. In January, 1922. In December, 1922 Registered — — — Licensed 12 8 8 Arrangements for Disinfection and Disinfestation and the extent of their use. Disinfection. The Council's Disinfection Station is situated in White Hart Road and two steam disinfectors are provided. The disinfecting staff numbers three. The following table shows the various rooms and articles disinfected during the year : 93 TABLE No. 54. Number of Rooms disinfected after ordinary fevers 966 „ „ tuberculosis 261 „ „ Verminous cases 48 Total number of articles disinfected 27,734 Disinfestation. The Council's Station for cleansing verminous persons is in adjoining premises to the Disinfecting Station. The routine followed there was described in the Annual Report for 1919, and no change has taken place during the year. It is to be noted that there is a continued decline in the number of children attending this Cleansing Station and there is little doubt that the policy of the London County Council in treating slight verminous cases at their Minor Ailment Centre is responsible for this fall. The following table shows the extent to which the Station has been used each year since 1919 : TABLE No. 55. Children Adults. Grand Total. Year. Boys. Girls. Total. Males. Females Total. 1919 1919 1816 3735 13 8 21 3756 1920 1955 1678 3633 23 6 29 3662 1921 1219 1112 2331 26 6 32 2363 1922 394 1493 1887 9 7 16 1903 Action Taken with Regard to Dairies, Cowsheds and Milkshops. The Milk and Dairies (Amendment) Act, 1922, makes it obligatory upon the Council to maintain two registers of purveyors of milk, one restricted to retail purveyors and the 94 other to wholesale purveyors and producers who do not sell milk retail. The Act gives the Council power under certain conditions to refuse to register a retail purveyor of milk or to remove such a person from the register. This Act came into force on the 1st September, 1922, and considerably amplifies the powers of the Council already existing under the London County Council (General Powers) Act, 1908 and under the Dairies, Cowsheds and Milkshops Order, 1885. In accordance with the Act the register of purveyors of milk has been revised, and at the end of the year there were 81 retail purveyors of milk and 8 wholesalers or producers on the register. In December, 1922, the Minister of Health in exercise of the powers conferred upon him by Section 3 of the Milk and Dairies (Amendment) Act, made an Order regulating the sale of milk sold under the following designations: Certified, Grade A (Tuberculin tested), Grade A, and Pasteurised. This Order empowers the local Authority to grant licences under certain conditions, but no such licence had been issued by the end of the year. All the dairies and milkshops in the Borough have been regularly inspected during the year. There are 12 cowsheds in the Borough in which there are 524 milch cows. These cowsheds are subject to annual licensing by the London County Council, and in consequence a standard of cleanliness of a fairly high level is maintained. No objection was made to the renewal of any licence by the Borough Council at the annual licensing sessions of the London County Council. Action taken under the Sale of Foods and Drugs Acts and the Milk and Cream Regulations, 1912-1917. The following table shows the number of the various analyses made during the year and the result of the analyses:— 95 TABLE No. 56. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated Milk 248 10 258 13 Separated Milk 7 — 7 — Cream — 3 3 2 Preserved Cream 3 5 8 1 Butter 18 78 96 — Lard — 7 7 — Coffee 2 8 10 2 Cocoa — 19 19 — Mustard — 4 4 — Ground Ginger — 4 4 — Tinned Peas 1 3 4 2 Tinned Fruit — 2 2 — Jam — 6 6 — Beef Sausages — 6 6 — Dripping — 8 8 — Fish Paste — 4 4 — Meat Paste — 2 2 — Whisky — 6 6 — Dried Milk 6 — 6 — Ice Cream Powder — 6 6 — Cream of Tartar — 18 18 — Borax — 6 6 — Oil of Eucalyptus — 6 6 — Epsom Salts 4 — 4 — Zinc Ointment — 6 6 — 289 217 506 20 The percentage of adulterated samples, 3.9, compares with 6 and 1.6 in the preceding two years. 96 The number of samples taken on Sundays was 16, one of which was adulterated. In the certificate furnished by the Public Analyst in the case of milk, a fat percentage figure is given for each sample. The following table shows the fact percentage figures for 1920, 1921 and 1922. The minimum legal standard is 3 per cent. TABLE No. 57. 1920. 1921. 1922. 4.5 % and over — 2 1 4 % and under 4.5 % 17 12 31 3.5 % and under 4.0 % 131 95 104 3 % and under 3.5 % 80 98 113 Below 3 % 6 14 9 234 221 258 Tables shewing the prosecutions instituted under the Sale of Food and Drugs Acts and the action taken under the Milk and Cream Regulations are given below. 97 TABLE No. 58. Prosecutions under the Sale of Food & Drugs Acts during 1922. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 1. Bread and Butter Consisted of Bread and Margarine Joyce's Cafe, Ltd., la Herbert Road, Plumstead Pine £2 and £1/18/0 costs 2 Bread and Butter Consisted of Bread and Margarine A. Harrington, 148 Sandy Hill Road, Plumstead Fine £1 and £1/18/0 costs 3 Coffee Contained 7% of chicory T. M. Hall, 205 Albert Road, North Woolwich Pine 5s. and £1/10/0 costs 4 Milk Contained 23.53% of added water and deficient in fat 15.34% G. Woolsey, 68 Kirkham Street, Plumstead Dismissed—warranty proved 5 do. Contained 5% of added water and colouring matter F. F. Wilkinson, 52 Whitworth Road, Plumstead Pine £2 and 15s. costs 6 do. False Warranty to G. Woolsey United Dairies Wholesale, Ltd. Dismissed 7 do. 14.33% deficient in fat and coloured with annatto W. G. Gittings, 59 Tuam Road, Plumstead Pine £1 and 21s. costs G 98 TABLE No. 58—continued. No. Article. Nature of Offence. Name and Address of Vendor. Result of Proceedings. 8 Milk 26.6% deficient in fat S. Curtis, 181 Abbey Wood Road, Abbey Wood Dismissed—" Milk as from cow " 9 do. 15.33% deficient in fat L. Gibb, Little Cold Harbour Farm, Horsmonden Fine £3 and 21s. costs 10 do. 14% deficient in fat L. Gibb, Little Cold Harbour Farm, Horsmonden Fine £3 and 21s. costs 11 do. 14.33% deficient in fat W. M. Forward, North Moor Farm, Gillingnam, Dorset £2/2/0 costs 12 do. 12.66% deficient in fat and contained 10.24% added water J. Grace, 18 Broadway, Bexley Road, Eltham Fine £2 and 21s. costs 13 do. Contained 4.82% of added water F. F. Wilkinson, 52 Whitworth Road, Plumstead Fine £3 and 21s. costs 99 TABLE No. 59. REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK & CREAM) REGULATIONS, 1912-1917. Report for the year ended 31st December, 1922. 1.—Milk and Cream not sold as " Preserved Cream." Number of samples examined for presence of a preservative. Number in which preservative was reported to be present. Percentage and Nature of preservative found in each sample. Action taken. Milk 265 (including 7 separated milk) 1 .018 % boric acid Explanation asked for and accepted Cream 3 2 .39 % boric acid Informal sample .09 % „ „ „ 2. Cream sold as Preserved Cream : (a) Instances in which samples have been submitted to analysis to ascertain if the statements on the label as to preservatives were correct 8 (i) Correct statements made 7 (ii) Incorrect statements 1 (iii) Percentage of Preservative Percentage stated found in each sample : on statutory label: .37% .38% .33% .40% In each case,"Not .40% .21% .55% .37% exceeding 0.4%." (b) Determinations made of milk fat in cream sold as Preserved Cream : (i) Above 35 per cent. 8 (ii) Below 35 per cent. — G 2 100 (c) Instances where (apart from analysis) the quirements as to labelling or declaration of Preserved Cream in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed Nil (d) Particulars of each case in which the Regulations have not been complied with, and action taken Nil 3. Thickening substances Nil 4. Other observations (if any) Nil Action Taken with Regard to Smoke Abatement. During the year, 6 complaints were received by the Borough Council from persons other than the Sanitary Inspectors. The chief source of smoke in Woolwich is from the Royal Arsenal and this, of course, is exempt from control by the local authority. 23 observations of smoke nuisances were made by the various district Inspectors during the year. 101 SECTION VIII.—PUBLIC HEALTH STAFF. In the form requested by the Ministry of Health is shewn below the names and qualifications and year of appointment of the members of the Public Health staff at the 31st December, 1922. The nursing and domestic staff of the Home for Ailing Babies is not included. Year appointed. Name. Qualifications. Appointment. †1918 Mackenzie, R. M.B., Ch.B., D.P.H. Assistant Medical Officer of Health for Maternity and Child Welfare †1921 Blackmore, F. J. C. M.R.C.S., L.R.C.P. Assistant Medical Officer of Health and Tuberculosis Officer †1921 O'Connor, E. M.A., M.D., D.P.H., D.T.M., Barrister-atLaw Deputy Tuberculosis Officer †1920 Dodd, F. H. M.R.C.S., L.R.C.P. Assistant Medical Officer for Maternity and Child Welfare (Part time) 1891 Smith, Sir W. R. M.D., D.Sc., D.P.H., L.L.D., F.R.S. (Edin.) Public Analyst (Part time) *1890 Duck, A. G. F.S.I.A., Cert. Royal San.Inst., Cert. Meat and other foods Chief Sanitary Inspector *1896 Little, W. Cert. Royal San. Inst., Cert. Meat and other foods Sanitary Inspector *1897 Wood, W. Cert. Royal San. Inst. Sanitary Inspector *1898 Potter, A. G. Cert. Royal San. Inst. Sanitary Inspector *1901 Tedham, W. Cert. Royal San. Inst., Cert. Meat and other foods Sanitary Inspector *1904 Powell, T. Cert. Royal San. Inst., Cert. Meat and other foods Sanitary Inspector 102 Year appointed. Name. Qualifications. Appointment. *1909 Shaw, H. Cert. Royal San. Inst., Cert. San. Insp. Exam. Board., Cert. San. Insp. Assocn.. Cert. Meatand other foods Sanitary Inspector *1920 Pendrill, H. W. Cert. San. Insp. Exam. Board, Cert. Meat and other foods Sanitary Inspector *1921 Harris, C. V. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other foods Sanitary Inspector *1922 Couch, C. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other foods Sanitary Inspector *1904 Farrugia, Mrs. A. Cert. San. Insp. Exam. Board. Cert. Royal San. Inst. Woman Sanitary Inspector †1917 Latham, Miss K. Cert. San. Insp. Exam. Board., Cert. Royal San. Inst., C.MB. Health Visitors' Certificate Health Visitor *†l918 Garside, Mrs. M. Cert. San. Insp. Exam. Board, C.M.B. Health Visitors' Certificate Health Visitor and Sanitary Inspector †1919 Burnett, Miss W. Cert. San. Insp. Exam. Board, C.M.B. Health Visitors' Diploma Health Visitor † 1919 Tibbits, Miss E. Cert. San. Insp. Exam. Board, Health Visitors' Diploma Health Visitor *†1919 Ware, Miss C. Cert. San. Insp. Exam. Board. C.M.B. Health Visitor and Sanitary Inspector †1920 Campbell, Miss M. Cert. General Hospital Training. C. M. B. Cert. San.Insp.Exam. Board Health Visitor †1920 Morgan, Miss F. Cert. General Hospital Training, C. M. B. Health Visitors' Cert. Maternity and Child Welfare Cert. Health Visitor 103 Year appointed. Name. Qualifications. Appointment. †1922 Seccombe, Miss W. Cert. General Hospital Training. C. M. B. Health Visitors' Cert. Health Visitor †l921 Castledine, Mrs. L. Cert. General Hospital Training Tuberculosis Visitor †1921 Hunter, Miss M. Cert. San. Insp. Exam. Board. C.M.B. Health Visitors' Diploma Tuberculosis Visitor †1921 Mahony, Miss N. Cert. General Hospital Training. Health Visitors' Cert. Tuberculosis Visitor †l921 Walker, Miss C. Dispensing Cert. Health Visitors' Cert. Dispenser, and Tuberculosis Visitor †1922 Morrison, Mrs. L. - Lay Organiser †1921 Cross, Miss S. Cert. General Hospital Training. C.M.B. Matron, Home for Ailing Babies Clerks: Britter, A. Taylor, S. G. Smith, H, S. †Stephenson, Miss D. Collyer, H. M. †Ed wards, Mrs. E. (temporary). Prescott, H. T. Pike, L. (temporary). Mortuary Keeper: F. Leason. The Medical Officer of Health* is Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme. *Salary contribution made under Public Health Acts. †Salary contribution made by Exchequer Grants. 104 SECTION IX.—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement is shown:— TABLE No. 60. Number of new houses erected during the year :— (a) Total 138 (b) As part of a municipal housing scheme 108 I.—Unfit Dwelling Houses. Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 8,025 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 3,987 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 31 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,561 2.—Remedy of Defects without Service of Formal Notices.* Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 3,193 *Includes intimation notices. 105 3.—Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, etc. Act, 1919:— (1) Number of dwelling houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling houses which were rendered fit:— (a) By Owners Nil (b) By Local Authority in default of Owners Nil (3) Number of dwelling houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close Nil (6) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 1,146 (2) Number of dwelling houses in which defects were remedied:— (a) By Owners 1,026 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc. Act, 1909:— (1) Number of representations made with a view to the making of closing orders 10 (2) Number of dwelling houses in respect of which closing orders were made 6 (3) Number of dwelling houses in respect of which closing orders were determined, the dwelling houses having been rendered fit 2 (4) Number of dwelling houses in respect of which demolition orders were made Nil 106 (5) Number of dwelling houses demolished in pursuance of demolition orders Nil Four houses were adapted for purposes other than that of human habitation. Housing in the Borough. The housing conditions have somewhat improved compared with last year. This has been brought about in two ways, (a) by the erection of 138 new houses, and (b) by migration from the Borough due to the gradual diminution of work in the Government establishments. The Council's Housing Scheme proceeds slowly. At the end of 1922, 300 new houses had been occupied, 98 were in course of erection and, subject to satisfactory tenders being received, the erection of 50 additional houses had been approved, making a grand total of 448 houses. The number of houses completed by private enterprise during 1922 was 30. Census Statistics. The Census figures for 1921 were available at the beginning of the year, and I have extracted from them certain information with regard to housing in the Borough. It should be explained that in these tables a private family is any group of persons, or a person included in a separate return and being in separate occupation of any premises or part of premises, lodgers being so treated only when returned as boarding separately; a structurally separate dwelling has been defined as any room or set of rooms intended for human habitation, having separate access either to a street or common landing or staircase. Sculleries, landings, bath rooms, etc., are not included in the number of rooms. It should be noted that the number of rooms per person is 1.03, compared with 0.96, the figure for the Administrative County of London. 107 TABLE No. 61. Ward. Private Families. Population in Private Families. Structurally separate dwellings occupied. Rooms occupied. Rooms per Person. Persons per House. Dockyard 1894 7458 1270 6443 0.86 5.87 St. Mary's 1421 5517 1035 4959 0.90 5.33 River 3073 12180 2165 10773 0.88 5.63 St. George's 1290 5403 853 4811 0.89 6.33 Burrage 2354 8606 1688 9333 1.08 5.10 Herbert 2362 8935 1839 11105 1.24 4.85 Glyndon 2463 9541 1829 8998 0.94 5.22 St. Margaret's 3455 13490 2750 14810 1.10 4.90 Central 2501 8739 1851 10148 1.16 4.72 St. Nicholas 6159 24682 4759 23380 0.95 5.19 Eltham 6675 27405 6009 31447 1.15 4.56 The Borough 33,647 131,956 26,048 136,207 1.03 5.07 108 Of the 26,048 structurally separate dwellings occupied by private families:—1,760, or 7 per cent., consisted of 1-3 rooms and were occupied by 1,819 families; 14,010 or 54 per cent., consisted of 4-5 rooms and were occupied by 16,424 families; 9,474, or 36 per cent., consisted of 6-8 rooms and were occupied by 14,232 families; 804, or 3 per cent., consisted of 9 or more rooms and were occupied by 1,172 families. 89 per cent, of all structurally separate dwellings in Woolwich consisted of structurally undivided private houses, 4 per cent, of flats and tenements, and 7 per cent, were attached to offices, shops, etc. The corresponding figures for the administrative county were 68, 21 and 11 per cent. The number of unoccupied dwellings on Census night was 361, made up of the following structurally separate dwellings: 1-3 rooms, 31; 4-5 rooms, 173; 6-8 rooms, 131; 9 or more rooms, 26. In 1911 there were 21,295 occupied dwellings and 1,225 unoccupied. In tabular from is shewn below the number of rooms occupied by private families and the percentage of families living in these units of occupation. It shews that families have less accommodation than they had in 1911. In London, most families live in three rooms, whereas four is the predominant figure in Woolwich. In Woolwich the number of persons living three or more in a room was 1,094; more than two per room, 10,270; between one and two persons per room, 54,477. The percentage living more than two to a room was 7.8 compared with 6.3 in 1911, the corresponding London figures being 16.1 in 1921, and 17.8 in 1911. 109 TABLE No. 62. Number or Private Families Occupying the Following Number of Rooms: 1 2 3 4 5 6-7 8-9 10 and over Total. Total Private Families 2222 4751 5484 9202 5967 5013 642 366 33,647 Private families, less "families" of only 1 person 1104 4177 5232 9015 5893 4946 628 363 31,358 Census: Percentage Living in These Units of Occupation: 1911 4.7 9.7 16.4 23.3 20.8 20.4 2.8 1.9 100.00 1921 6.6 14.1 16.3 27.4 17.7 14.9 1.9 1.1 100.00 110 Housing Survey. The Housing Survey was commenced in 1920 and is continuing to occupy the whole time of one and a half Inspectors. The worst areas in the district were inspected in 1920 so that the houses inspected during this year are of a slightly better character and are therefore not comparable with those of the previous two years. The records have been made on cards and the details have been recorded under the headings set out in the Housing (Inspection of District) Regulations, 1910. During the year, a total of 3,987 houses were surveyed and recorded by the Inspectors engaged in this work compared with 2,800 in 1921. The results of the survey were periodically reported in detail to the Public Health Committee. The summarised results for the year are as follows:— Grade 1.—In such a state by reason of impossibility to provide adequate light, ventilation, floor levels, height and size of rooms, and other defects of construction, as not to be capable of remedy, and should be on a schedule or included in an area 27 Grade 2.—Unfit for human habitation by reason of extensive dilapidations and dirty conditions, but subjective to effective remedy under a Closing Order 24 Grade 3.—Generally dilapidated, damp, dark, and dirty, but subject to remedy either under Sec. 28 of the Housing, Town Planning, etc. Act, 1919, or the Public Health (London) Act, 1891 887 Grade 4.—Pew defects, capable of being remedied under the Public Health (London) Act, 1891 1,323 Grade 5.—Satisfactory 1,726 Total 3,987 111 In addition to the details required to be recorded by the above-mentioned Regulations, a record is made of the number of persons who are occupying the house. This distribution of the population is shewn below and similar figures obtained in 1920 and 1921 are given for purposes of comparison. TABLE No. 63. Year. Houses or Tenements. No. of persons in excess of two persons per room Houses originally built for one family now occupied by more than one family. Persons per House. Rooms per person. With less than two persons per room. With two persons per room. With more than two persons per room. 1920 2075 333 272 437 604 5.6 .83 1921 2145 298 357 364 697 5.5 .87 1922 3384 371 232 390 1309 5.3 .94 Unhealthy Areas. No areas have been represented under Part 1 of the Housing Act, 1890, and no complaints that areas were unhealthy have been made. ACTION UNDER THE HOUSING, TOWN PLANNING, ETC., ACT, 1909. Closing Orders. During the year 10 houses were represented as unfit for human habitation, and in six cases closing orders were made. In four instances the owners converted the houses into business premises; and in two cases the necessary repairs were carried out and the closing orders were determined. In the remaining four cases no closing order was made. 112 TABLE No. 64. Date of representation. Premises. Date of Closing Order. Remarks. 1922. 1922. Jan. 13 56a Elm Street Mar. 17 Cenverted for other purposes Feb. 10 5 Thrift Cottages April 10 Do. Feb. 10 7 Thrift Cottages May 12 Do. April 7 22 Walmer Road — House rendered fit without further action April 7 20 Earl Street — Do. May 12 51 Earl Street July 10 House rendered fit May 12 77 Earl Street - House rendered fit without further action May 12 18 Swetenham Place July 10 House rendered fit May 12 Harrowfield Farm House, Eltham July 10 Converted for other purposes Oct. 13 32 The Slade - House rendered fit without further action New Houses. Water Certificates were granted during the year for the following new houses erected in the Borough:— Council's Housing Scheme, Eltham. :— Houses Date. 22 January 13th. 14 February 10th. 24 March 10th. 10 April 7th. 15 May 12th. 14 June 16th. 1 October 13th. Private Enterprise:— 51 Artillery Place January 13th. "Brynewelon," Eaglesfield Road January 13th. 113 "Pitlochrie," Shooters Hill Road January 13th. 21 Glenlea Road March 10th. 23 Glenlea Road March 10th. 131 Eglinton Hill March 10th. The London County, Westminster and Parr's Bank, Eltham March 10th. "Granville," Dunvegan Road April 7th. "Pentillie," Dunvegan Road April 7th. 49 Westmount Road April 7th. 25 Glenlea Road April 7th. "The Nook," Shooter's Hill June 3rd. "Kalgan," The Broadway, Eltham July 7th. "The Bungalow," Glenlea Road May 12th. "Clovelly," Dunvegan Road May 12th. la Glenlyon Road June 16th. "Melinda," Glenlea Road June 16th. "Lindenlea," Halfway Street June 16th. "Langley," Westmount Road September 15th. 12 Glenlyon Road September 15th. "Hazeldene," Westmount Road October 13th. " Glen Haven," Westmount Road October 13th. 107 Dunvegan Road October 13th. 105 Dunvegan Road October 13th. 4 Glenlyon Road November 10th. 6 Glenlyon Road December 8th. 8 Glenlyon Road December 8th. 10 Glenlyon Road December 8th. 53 Westmount Road December 8th. "The King's Arms," P.H., Eltham December 8th. H 114 APPENDICES. ADDITIONAL CENSUS TABLES. 1. Occupations of Woolwich Inhabitants (over 12 years). Males Females I Fishermen 2 - II Agricultural occupations 414 30 III Mining and quarrying occupations 15 — IV Makers of coke, lime, cement, etc. 12 4 V Makers of bricks, pottery, glass, etc. 106 18 VI Workers in chemicals, paints, etc. 1,223 66 VII Metal workers 8,525 214 VIII Workers in precious metals 80 11 IX Electrical apparatus makers, fitters, etc. 1,894 923 X Makers of watches, clocks, etc. 187 14 XI Workers in skins; leather goods makers 219 28 XII Textile workers 46 62 XIII Makers of textile goods and articles of dress 645 1,823 XIV Makers of foods, drinks and tobacco 528 189 XV Workers in wood and furniture 1,586 51 XVI Paper workers ; printers, etc. 416 140 XVII Builders, bricklayers, etc. 1,488 3 XVIII Painters and Decorators 1,032 9 XIX Workers in other materials 157 85 XX Workers in mixed or undefined materials (not elsewhere enumerated) 183 328 XXI Workers in gas, water and electricity supply. 138 - XXII Transport workers 4,583 307 XXIII Commercial and financial occupations 3,241 1,822 XXIV Public administration and defence 7,080 629 XXV Professional occupations 1,358 1,605 XXVI Persons employed in entertainments, etc. 210 118 XXVII Persons employed in personal service 1,344 4,451 XXIX Warehousemen, packers, etc. 2,249 2,438 XXX Stationary engine drivers 1,198 217 XXXI All other occupations 6,822 178 Total occupied 47,719 15,763 XXXII Total unoccupied 6,417 39,868 Total occupied and unoccupied 54,136 55,631 115 2. Birth-places of the Population.—Woolwich, 1921. Country of Birth. Males. Females. Persons. England 64,854 66,494 131,348 Wales 442 402 844 Scotland 956 685 1,641 Ireland 1,470 1,411 2,881 Isle of Man & Channel Islands 122 128 250 British Colonies, ete. 1,168 1,048 2,216 Foreign Countries 427 342 769 Born at Sea 25 22 47 Not Stated 197 196 393 3. Marital State in Age Groups.—Woolwich. 1921. Age. Sex. Single. Married. Widowed. Divorced. 0—15 Males 19,429 - - - Females 19,060 — — — 15—45 Males 16,675 16,360 265 30 Females 14,853 18,612 932 20 Over 45 Males 1,497 13.506 1,887 12 Females 1,559 11,134 4,551 7 All Ages Males 37,601 29,866 2,152 42 Females 35,472 29,746 5,483 27 4. Orphanhood of Children under 15.—Woolwich, 1921. Males. Females. Totals. Total Children living under 15 years 19,429 19,060 38,489 Both Parents alive 17,578 17,172 34,750 Father dead 1,115 1,170 2,285 Mother dead 418 426 844 Both Parents dead 73 84 157 No Statement or Not Known 245 208 453