Woo 24 AC 4372 Metropolitan Borough of Woolwich. ANNUAL REPORT of the Medical Officer of Health for WOOLWICH. 1924. by J. MACMILLAN, D.S.O.,M.C„ M.B., D.P.H., Medical Officer of Health. Woolwich : The Pioneer Press, Ltd. (T.U. Fed.), 3, New Road. 1925. Metropolitan Borough of Woolwich. ANNUAL REPORT of the Medical Officer of Health for WOOLWICH. 1924. by J. MACMILLAN, D.S.O.,M.C., M.B., D.P.H., Medical Officer of Health. Woolwich : The Pioneer Press, Ltd. (T.U. Fed.), 3, New Road. 1925. 2 Public Health and Housing Committee. At 31s/ December, 1924. His Worship the Mayor (Councillor J. Newman, J.P.). Councillor Miss G. E. Walters, J.P. (Chairman). Councillor Miss M. Crout, J.P. (Vice-Chairman). Alderman Mrs. E. Dormer. Councillors R. M. W. Allen. W. C. Montano. P. Chinnery. W. E. H. Narborough. H. A. Hart. S. H. Reed. A. A. Holden. H. C. E. Saville. J. Lee Mrs. M. E. T. Smith. Rev. J. F. Matthews. 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 Miss M. Crout, J.P. (Vice-Chairman). Alderman Mrs. E. Dormer. Councillor P. Chinnery. Councillor Rev. J. F. Matthews. Councillor Mrs. M. E. T. Smith. 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 9 II.—Vital Statistics. Summary of Statistics 12 Births 13 Marriages 16 Deaths 16 Deaths of Children 1 -5 years of age 25 Infantile Mortality 27 III.—Notifiable Diseases. Notifications 34 Deaths of Notified Cases 38 Notifications each year since 1901 39 Measles 40 Scarlet Fever 40 Diphtheria 43 Pneumonia, Malaria, Dysentery and Trench Fever 45 Ophthalmia Neonatorum 48 Puerperal Fever 49 Zymotic Enteritis 49 Acute Poliomyelitis 49 Cerebro-spinal Meningitis 51 Encephalitis Lethargica 51 Other Notifiable Infectious Diseases 52 Tuberculosis 54 4 page IV.—Causes of Sickness. Reports of Medical Practitioners 69 V.—Nursing Arrangements, Hospitals and Other Institutions. Professional Nursing in the Home 71 Midwives 72 Clinics and Treatment Centres 72 Hospitals 74 Institutional Provision for Unmarried Mothers 78 Ambulance Facilities 79 Maternity and Child Welfare. Administrative Action .. 79 Work of the Centres 80 Treatment 81 Dental Scheme 82 Work of the Health Visitors 82 Supply of Milk to Necessitous, Expectant and Nursing Mothers, and Y oung Children 84 Feeding of Infants in Woolwich 84 Rate of Growth of Woolwich Infants 86 VI.—Laboratory Work. Public Analyst . 91 Bacteriological Examinations 91 Supply of Anti-toxin 91 VII.—Sanitary Administration. Adoptive Acts, By-laws and Regulations in force in the Borough 92 Staff 95 Complaints 95 Scavenging 96 Closet Accommodation 96 Drainage 96 Sanitary Inspection of the Borough 97 Destruction of Rats 100 5 page Mosquitoes 100 Legal Proceedings 101 Rag Flock Act 104 Offensive Trades 104 Smoke Abatement 104 Disinfection and Disinfestation 104 Factories, Workshops and Workplaces 105 Mortuaries 108 Cemeteries 108 Inspection of Premises where Food is Prepared 109 Dairies, Cowsheds and Milkshops 112 Public Health (Milk and Cream) Regulations, 1912-1917 112 Slaughterhouses 113 Unsound Food 114 Food Poisoning 115 Sale of Food and Drugs 115 VIII.—Staff. Staff118 IX.—Housing. Housing Statistics 121 General Housing Conditions 123 Housing Survey 123 Increase of Rent and Mortgage Interest (Restrictions) Act 124 Underground Sleeping Rooms 125 Action taken under Housing Acts 125 Unhealthy Areas 126 New Houses 127 Meteorology. 6 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Me. Mayoe, Ladies and Gentlemen, I have the honour to submit the Twenty-fourth Annual Report on the health of the Metropolitan Borough of Woolwich. The report is an "Ordinary" report as defined in the appropriate circular of the Ministry of Health. Next year the first "Survey" report will be published, in accordance with the Ministry's programme, which lays down for a series of five years one Survey and four Ordinary reports. Survey reports are expected to deal with the general advancement of public health work in the previous five years. The chief vital statistics relating to the year are as follows: The civilian population is estimated by the Registrar General at 139,980, a figure which shews a decrease of 20 compared with last year. My own estimate is 141,088. The birth rate (18.5) is lower than last year. The marriage rate (15.7) compares with 16.9 in 1923. The death rate (11.0) is the second lowest in the metropolitan area and compares with 9.9 last year. The infantile mortality rate (65) compares with 43 last year. These figures shew that although there has been a slight set back in the vital statistics in 1924, the general improvement continues to be maintained. These increases in the mortality figures are in keeping with similar increases in England and Wales. • 7 The incidence of infectious diseases was higher last year mainly owing to the presence of measles in epidemic form. Slight increases are recorded in the number of cases of pneumonia, diphtheria and scarlet fever. Influenza was present in epidemic form in the first three months of the year. At the end of the year there were 1,868 cases of pulmonary tuberculosis and 539 cases of non-pulmonary tuberculosis making a total of 2,407 cases, known to be living in the Borough. These figures shew an increase over those of 1923. They are fallacious, in so far as they include cured cases. The Public Health (Tuberculosis) Regulations, 1924, however, now provide for the removal of cured cases from the Tuberculosis register and as this deletion will take place during 1925, a more reliable set of figures will be obtained by the end of the year, a matter of much importance in effective administration. The Care Committee, which came into being in 1923, continued to develop during the year. Details of the work done by this Committee will be found in the Tuberculosis Section of the report. Maternity and Child Welfare work has continued to grow in usefulness during the year. The attendances at the welfare centres have increased from 2,249 in 1918 to 26,706 in 1923, and 28,616 in 1924. These figures speak for themselves. Section VII. of the report deals with Sanitary Administration and the published statistics shew that a very great deal of work has been done in improving the existing conditions of houses. An inadequate number of houses for the needs of this Borough hampers this side of the work of the department. 8 This inadequacy is associated with overcrowding, which is detrimental not only to the health of the inmates, but also to the sanitary state of the houses in which they live. Until sufficient houses are provided for the needs of this Borough it will always be a difficult problem to improve permanently the sanitary state of existing houses. As in previous years, much attention has been paid during the year to the supervision of food supplies. I have again to express my appreciation of the work of the staff of the Health Department and to thank the members of the Public Health and Housing and Maternity and Child Welfare Committees for their support and sympathetic consideration which they have given to me, and for their keen attention to the problems which it has been my duty to lay before them during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JOHN MACMILLAN. 9 Twenty-fourth Annual Report on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1924. SECTION I.—GENERAL STATISTICS. TABLE No. 1. Area (acres) 8,282 Population, 1924 :— Total (including military) 144,400 Civilians 139,980 Number of Inhabited houses, 1921 26,048 Number of families or separate occupiers, 1921 33,647 Rateable value, October, 1924 £974,865 Sum represented by a penny rate, October, 1924 £4,061 Population. In June, 1921, at the time of the census, there were living in the Borough 140,389 persons, 136,307 of whom were civilians. In 1924 the civilian population was estimated by the Registrar General to be 139,980. Curiously enough, this estimate shows a decrease of 20 in the population as estimated by him in 1923. These figures of the Registrar 10 General are based on the adjusted 1921 census figures, after allowance has been made for the varying rate of natural increase, as evidenced by the births and deaths, and for migration as indicated from other sources. As Woolwich is one of the few London Boroughs where land is available for extensive building operations, and as houses are being erected in an increasing number each year, it is difficult to understand why this decrease is shown. A variation in the military elements of our population may have some effect. I estimate the civilian population of the Borough to be 141,088, but, in view of the necessity for presenting comparable statistics from year to year, the Registrar General's figures have been taken for the purposes of this report. In estimating the population of the various districts, due allowance has been made for the natural increase, for additional houses, and for such evidence as is available in the Housing Department as to movement from other parts of the Borough to Eltham. As a result, compared with 1923, an increase is shown in the population of Eltham and a slight decrease in the populations of the other three registration districts. The estimated figures are as follows :— TABLE No. 2. Estimated population Woolwich 32,578 West Plumstead 41,011 East Plumstead 35,438 Eltham 30,953 139,980 The above figures have been used throughout the report for calculating the rates in the Borough and in the various registration districts. 11 The civilian populations of the various registration districts of the Borough at each census since 1901 and also the estimated populations for the years 1922-1924 are as follows :— TABLE No. 3. Woolwich. West Plumstead. East Plumstead. Eltham. The Borough. *1901 35,998 38,569 29,758 7,226 111,551 *1911 31,204 40,328 30,888 13,450 115,870 *1921 32,097 40,955 34,947 28,308 136,307 1922 32,545 41,544 35,450 28,715 138,254 1923 32,620 41,249 35,552 30,579 140,000 1924 32,578 41,011 35,438 30,952 139,980 * Census years. 12 SECTION II.—VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shown below:— TABLE No. 4. Births—Legitimate 2,516 „ Illegitimate 74 2,590 Birth Rate 18-5 Deaths 1,543 Death rate 110 Number of women dying in, or in consequence of child birth 10 (a) From sepsis 2 (b) From other causes 8 Deaths of infants under one year 168 (a) Legitimate 157 (b) Illegitimate 11 Infantile mortality rate . 65 Deaths from Measles (all ages) 28 „ Whooping cough (all ages) 12 ,, Diarrhoea (under 2 years) 10 13 The chief Vital Statistics of the Borough during the quinquennial period 1920 to 1924 are shown in Table No. 5 :— TABLE No. 5. Year. Population estimated to middle of each Year. Births. Total DeaSts Registered in toe District. Transferable Deaths Nett deaths belonging to the District. Nett. of Non-re adents registered in the District. of Residents not registered in the District. Under 1 Yr. of Age. At all Ages. i Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 1920 a 141,666 3658 24.7 1328 113 272 224 61 1487 10.5 b 147,827 192*1 c 136,307 3197 23.5 1365 90 319 197 62 1594 11.7 d 140,389 1922 a 138,254 2941 21.3 1354 98 347 184 62 1603 11.6 d 142,350 1923 c 140,000 2867 20.5 1198 64 253 123 43 1387 9.9 1924 c 139,980 2590 18.5 1274 75 344 168 65 1543 11.0 * 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) 8,282 Census, ) Total Population, all ages 140,389 1921. J Civilian Population, all ages 136,307 BIRTHS. During the year 2,677 births were registered in Woolwich, 1,377 being boys and 1,300 girls. Corrected by outward and inward transfers these numbers become 2,590, 1,324 and 1,266 respectively. The estimated figures for the different registration districts were as shown in Table No. 6, which follows :— 14 TABLE No. 6. Registration Districts. Males. Females. Total Births. Woolwich 406 364 770 West Plumstead 364 326 690 East Plumstead 259 303 562 Eltham 295 273 568 The Borough 1324 1266 2590 The birth rate, calculated on the civil population, was 18 f> compared with 20'5 in 1923. Notification of Births. During the year 2,588 live births were notified. This is at the rate of 97 per cent, of the registered births and compares with 97 per cent, last year. 1,389 notifications were received from midwives, 197 from doctors, 588 from the British Hospital for Mothers and Babies, 152 from the Military Families Hospital, 38 from the Woolwich Infirmary, and 224 from other persons. The following Table No. 7 shows the number of births in each year since 1920, the number of live and still births notified each year, the percentage of notified births, and the birth rate for the same period for Woolwich, London, and England and Wales. TABLE No. 7. Year. No. of births. No. of live births notified. No. of still births. Percentage of births notified. Birth rate. Woolwich. London. England and Wales. 1920 3658 3463 112 95 24.7 26.5 25.4 1921 3197 3011 91 94 23.5 22.3 22.4 1922 2941 2884 72 98 21.3 21.0 20.6 1923 2867 2864 93 97 20.5 20.2 19.7 1924 2590 2588 84 97 18.5 18.7 18.8 15 Natural Increase of Population. The natural increase of population is the excess of births over deaths. In 1921 it was 1,603; in 1922 it was 1,338; in 1923 it was 1,480; and in 1924 it was 1,047. Table No. 8 shows the birth rates in each registration district (after correction for outward and inward transfers) each year since 1920 :— TABLE No. 8. Period Woolwich West Plumstead East Plumstead Eltham The Borough 1923 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 1923 25.2 18.2 18.5 20.7 20.5 1924 23.6 16.8 15.9 18.4 18.5 Illegitimate Births. The following Table shows the number of illegitimate births each year since 1920 and the illegitimate birth rate per 1,000 births. In 1924, 58 were registered in Woolwich, and 29 inward transfers and 13 outward transfers were made by the Registrar General. The nett figure for the Borough is therefore 74 :— TABLE No. 9. Year. Number of I Illegitimate births. legitimate birth rate per 1,000 births. 1920 141 38.5 1921 80 25.0 1922 106 36.0 1923 74 25.8 1924 74 28.6 16 MARRIAGES. There were 1,097 marriages (1,181 in 1923). The marriage rate was 15.7, as compared with 17.5, 17.2, 16.5 and 16.9 in the four preceding years. DEATHS. Table No. 5 shows the gross deaths, the nett deaths and the death rates, each year since 1920, and shows how the nett death figures are obtained. The nett deaths were 1,543 and the nett death rate 11.0. In 1923 the corresponding rate was 9.9. The death rate, 110, is the second lowest among the metropolitan boroughs, the death rate for Lewisham being 10.4. In 1924 the death rate for England and Wales was 12.2, for London 12.1, and the mean death rate for the 105 Great Towns was 12.3. The death rates for each registration district each year since 1920 are shown in the following Table No. 10:— TABLE No. 10. Period. Woolwich Parish West Plumstead East Plumstead Elthara The Borough 1920 13.4 10.4 10.1 7.8 10.5 1921 13.9 13.5 10.2 8.6 11.7 1922 13.9 11.7 10.5 10.1 11.6 1923 12.1 10.5 9.7 6.9 9.9 1924 13.9 11.5 10.1 8.5 11.0 The seasonal mortality in the four quarters of the year was as follows:—First quarter, 15.1; second quarter, 10.5; third quarter, 7.7 ; fourth quarter, 10.7. 17 DEATHS IN PUBLIC INSTITUTIONS. In tabular form is shown below the number of deaths of Woolwich residents which took place in various Institutions during the year :— TABLE No. 11. Hospital or Institution. Number of Deaths. Poor Law Institutions 433 London General Hospitals 79 Mental Hospitals 53 Special Hospitals 63 Infectious Diseases Hospitals 30 Sanatoria and Tuberculosis Institutions 29 Cottage Hospitals and Nursing Homes 27 714 The following three Tables are self-explanatory: — 18 Table No. 12.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1924. Birth rate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 years).4 Total Deaths under One Year. Causes of Death certified byRegistered Medical Practitioners. Inquest Cases. Uncertified Causes of Death. England and Wales. . 18.8 12.2 0.01 0.00 0.12 0.02 0.10 0.06 0.49 0.44 7.3 75 92.3 6.6 1.1 105 County Boroughs and Great Towns, including London. 19.4 12.3 0.01 0.00 0.18 0.03 0.12 0.08 0.45 0.40 9.2 80 92.5 6.9 0.6 157 Smaller Towns (1921 Adjusted Populations 20,000 —50,000). 18.9 11.2 0.01 0.00 0.08 0.02 0.09 0.06 0.50 0.36 6.2 71 93.3 5.5 1.2 London 18.7 12.1 0.01 — 0.29 0.03 0.11 0.12 0.36 0.44 8.4 69 91.3 8.6 0.1 WOOLWICH 18.5 11.0 0.00 — 0.20 0.03 0.08 0.06 0.42 0.28 3.9 65 90.9 9.1 — 19 TABLE No. 13. Deaths of Woolwich Residents Registered during the Calendar Year 1924, classified by age and cause. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. AH 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 years. 75 and upwards. All causes 1543 168 39 51 44 80 188 386 284 303 Enteric Fever 1 .. .. .. .. .. 1 .. .. .. Small-pox .. .. .. .. .. .. .. .. .. Measles 28 6 9 9 4 .. .. .. .. .. Scarlet Fever 4 .. .. 3 1 .. .. .. .. .. Whooping Cough 12 7 2 3 .. .. .. .. .. .. Diphtheria 9 .. 1 8 .. .. .. .. .. .. Influenza 59 2 1 3 1 1 14 20 9 8 Encephalitis lethargica 5 .. .. 2 .. .. 2 1 .. .. Meningococcal Meningitis 1 .. .. 1 .. .. .. •• .. .. Tuberculosis of Respiratory System 171 1 1 1 6 44 69 45 3 1 Other Tuberculous Diseases 28 5 2 8 6 2 4 .. 1 .. Cancer, malignant disease 181 .. .. .. .. .. 19 89 51 22 Rheumatic Fever 6 .. .. .. 3 1 .. 2 .. .. Diabetes 16 .. .. .. .. .. 2 7 6 1 Cerebral Hemorrhage, &c. 90 .. .. .. .. .. 2 23 31 34 20 TABLE No. 13.—continued. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 and under 75. years. 75 and upwards. Heart Disease 173 .. .. .. 3 4 9 58 62 37 Arterio-sclerosis 49 .. .. .. .. .. 1 9 17 22 Bronchitis 142 15 3 .. 1 .. 5 17 41 60 Pneumonia (all forms) 95 25 16 5 .. 3 12 15 10 9 Other Respiratory Diseases 10 1 .. .. .. .. .. 4 1 4 Ulcer of Stomach or Duodenum 11 .. .. .. 1 1 3 6 .. .. Diarrhoea, &c. 17 10 .. .. .. .. 1 2 1 3 Appendicitis and Typhlitis 7 .. .. .. 2 .. 1 2 2 .. Cirrhosis of Liver 9 .. .. .. .. .. 1 5 2 1 Acute and Chronic Nephritis 36 1 .. 1 2 1 4 14 8 5 Puerperal Sepsis 2 .. .. .. .. 1 1 .. .. .. Other accidents and diseases of pregnancy and parturition 8 .. .. .. .. 3 5 .. .. .. Congenital debility and malformation, premature birth 63 59 1 1 2 .. .. .. .. .. Suicide 12 .. .. .. .. 1 5 5 . . 1 Other deaths from violence 39 1 1 .. 5 5 6 8 7 6 Other defined diseases 259 35 2 6 7 13 21 54 32 89 Causes ill-defined or unknown •• .. .. .. .. .. .. .. .. .. 21 TABLE No. 14. Showing the nett deaths of Woolwich residents, all deaths occurring in Institutions in the Borough, and deaths of Woolwich residents occurring in Institutions outside the Borough, during the year 1924. Causes of Death. Male. Female. Woolwich. Plumstead. Eltham. Deaths in Public Institutions. In Borough. Outlying Institutions West. East. Residents. NonResidents. All causes 802 741 454 470 357 262 387 57 327 Enteric Fever .. 1 .. .. 1 .. .. 1 1 Small-pox .. .. .. .. .. .. .. .. .. Measles 16 12 14 4 6 4 1 .. 8 Scarlet Fever .. 4 2 .. 1 1 .. .. 4 Whooping Cough 2 10 6 3 2 1 2 .. 1 Diphtheria 5 4 .. 5 2 2 .. .. 9 Influenza 34 25 14 18 16 11 27 6 7 Encephalitis Letliargica 3 2 .. 3 1 1 1 1 3 Meningococcal Meningitis .. 1 1 .. .. .. .. .. 1 Tuberculosis of Respiratory System 93 78 49 58 40 24 43 3 51 Other Tuberculous Diseases 19 9 8 10 8 2 9 1 11 Cancer, Malignant disease 87 94 45 59 42 35 42 8 39 Rheumatic Fever 2 4 2 1 .. 3 1 .. i Diabetes 8 8 5 7 1 3 5 .. 3 Cerebral Haemorrhage, &c. 37 53 24 29 23 14 34 7 5 22 TABLE No. 14.—continued. Causes of Death. Male. Female. Woolwich Plums tead. Eltham. Deaths in Public Institutions. West. East. In Borough. Outlying Institutions. Residents. NonResidents. H eart Disease 89 84 49 50 43 31 30 1 17 Arterio-sclerosis 32 17 12 17 6 14 15 2 10 Bronchitis 74 68 56 41 36 9 27 2 9 Pneumonia (all forms) 47 48 32 26 17 20 10 6 19 Other respiratory diseases . . 5 5 2 4 4 .. 1 1 1 Ulcer of Stomach or Duodenum 8 3 4 4 2 1 1 .. 4 Diarrhoea, &c. 10 7 8 1 6 2 8 1 5 Appendicitis and Typhlitis . . 3 4 2 3 2 .. 2 1 4 Cirrhosis of Liver 6 3 4 3 1 1 4 .. 1 Acute and Chronic Nephritis 25 11 10 9 12 5 11 .. 5 Puerperal Sepsis .. 2 1 .. .. 1 .. .. 1 Other Accidents and Diseases of Pregnancy and Parturition .. 8 1 3 2 2 3 .. 3 Congenital Debility and Malformation, Premature Birth 29 34 14 15 17 17 27 2 5 Suicide 9 3 5 1 4 2 1 .. 1 Other Deaths from Violence 25 14 8 11 9 11 10 5 16 Other Defined Diseases 134 125 76 85 53 45 72 9 82 Causes ill-defined or unknown •• .. .. •• .. .. •• •• .. 23 CAUSES OF DEATH. Table No. 13 shows that 181 deaths were due to Cancer, 173 to Heart Disease, 171 to Pulmonary Tuberculosis, 142 to Bronchitis, 95 to Pneumonia, 90 to Cerebral hemorrhage, 63 to Congenital Debility, and 59 to Influenza. These figures show an increase which is particularly marked in the case of respiratory diseases. There were 28 deaths from Measles compared with no deaths from this disease in 1923. 63 per cent, of all deaths occurred in persons over 45 years of age. Respiratory Diseases. The following Table, No. 15, shows the number of deaths each year since 1912 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. These diseases were most prevalent in the low-lying districts of the Borough :— TABLE No. 15. Year. Bronchitis. Pneumonia. Other Respiratory. Total Death Rate. No. under 5 years. Percentage under 5 years. 1912 105 93 23 221 1.8 78 35.8 1913 115 106 11 232 1.9 65 28.0 1914 118 137 11 266 2.2 91 34.2 1915 168 180 18 366 2.7 125 34.1 1916 130 130 13 273 2.1 60 21.9 1917 113 142 17 272 2.1 87 31.9 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 1923 93 65 10 168 1.2 22 13.1 1924 142 95 10 247 1.8 65 26.3 Diarrhoea. 17 deaths were certified to be due to diarrhceal diseases, and 10 of these occurred in children under two years of age. The figures for 1923 were identical. 24 Violence and Suicide. 39 deaths—25 males and 14 females —occurred from violence apart from suicide. 12 deaths were due to suicidal causes—9 males and 3 females. Puerperal Deaths. There were two deaths from puerperal fever and eight from other causes associated with the puerperium. The death rate per 1,000 births was 3.86, a figure above the average of the last five years. Of these ten deaths, seven occurred in hospitals. In detail the causes of death were as follows:—Puerperal sepsis, 2; eclampsia, 3; placenta praevia, 2; inversion of uterus, 1; concealed haemorrhage, 1; and embolism, 1. The three deaths which occurred at home were due to:—puerperal fever, 1; embolism, 1; and placenta praevia, 1. Tuberculosis and the Infectious Fevers. These are dealt with in the section dealing with the notifiable infectious diseases. Cancer and Malignant Disease. The deaths ascribed to Cancer or Malignant disease each year since 1920 are shown in Table No. 16:— TABLE No. 16. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 1920 60 95 155 1.09 10.42 1921 76 106 182 1.34 11.42 1922 72 94 166 1.20 10.36 1923 91 84 175 1.25 12.62 1924 87 94 181 1.29 11.73 25 The following Table, No. 17, shows the seat of the primary disease in all deaths from Cancer (excluding all other specified malignant tumours):— TABLE No. 17. Seat of Primary Disease. Males. Females. Total . Deaths in Hospital. Tongue 3 1 4 3 Mouth and Jaw 6 — 6 4 Pharynx 1 — 1 1 (Esophagus 10 4 14 7 Stomach 19 19 38 23 Liver and Gall Bladder 3 3 6 - Intestines 11 6 17 4 Rectum 0 9 14 4 Uterus - 17 17 9 Ovary - 4 4 2 Breast 1 18 19 4 Vagina and Vulva — — — — Skin 1 1 2 1 Larynx 3 2 5 1 Lung 2 1 3 2 Pancreas 1 2 3 - Neck 3 — 3 1 Bladder 8 — 8 6 Other specified organs 3 4 7 2 Abdominal Cavity (unspecified) — 2 2 2 Other and undefined 1 - 1 1 81 93 174 77 Inquests. There were 141 inquests held on Woolwich residents during the year, compared with the 128 in 1923, 144 in 1922, 102 in 1921, and 145 in 1920. DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 39, and between 2-5 years, 51. The causes of death are given in detail in Table No. 13. In 1923 these figures were 12 and 20 respectively. In the annual report for 1923, a table was published (Table No. 22) which showed the variation in the rates of infant mortality during three quinquennial periods 26 from 1904. Similar tables are set out below showing the variation in the rates of mortality in children aged 1-2 years and 2-5 years in the same quinquennial periods. These rates have been calculated on an estimated population living at these ages, the population being calculated in accordance with the method outlined by the Registrar General in the Census Report for 1911. The figures for 1924 are also given:— TABLE No. 18. Child Mortality (1-2 Years). Deaths and death rates per 1,000 estimated age population from stated groups of diseases, in quinquennial periods and for the year 1924. Period. Estimated Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhoeal Diseases. All other causes. Total Deaths. 1909-1913 13,189 90 43 102 28 72 335 1914-1918 13,078 110 23 125 18 57 333 1919-1923 14,040 57 20 67 8 46 198 1924 2,731 12 3 19 — 5 39 Corresponding Death Rates. 1909-1913 13,189 6.83 3.26 7.73 2.12 5.46 25.40 1914-1918 13,078 8.41 1.76 9.56 1.38 4.36 25.46 1919-1923 14,040 4.06 1.42 4.77 57 3.28 14.10 1924 2,731 4.40 1.10 6.96 .. 1.83 14.28 27 TABLE No. 19. Child Mortality (2-5 Years). Deaths and death rates per 1,000 estimated age population from stated groups of diseases, in quinquennial periods and for the year 1924. Period. Estimated Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1909-1913 41,068 123 48 45 10 59 285 1914-1918 37,549 116 55 72 4 89 336 1919-1923 39,389 75 23 42 8 56 204 1924 9,054 23 9 5 .. 14 51 Corresponding Death Rates. 1909-1913 41,068 2.99 1.17 1.10 .24 1.44 6.94 1914-1918 37,549 3.09 1.47 1.92 .11 2.37 8.95 1919-1923 39,389 1.90 .58 1.07 .20 1.42 5.18 1924 9,054 2.54 .99 .55 - 1.55 5.63 INFANTILE MORTALITY. The number of deaths under one year was 168, compared with 123 in 1923, 184 in 1922, and 197 in 1921. The Infantile mortality rate (deaths under one year per 1,000 births) was 65. The following Table, No. 20, shows the infantile mortality rate in each registration district, and it will be noticed that, as in 1923, the rate is highest in Woolwich and lowest in West Plumstead. The Table also shows the comparable figures each year since 1920:— Illegitimate Deaths. The number of deaths amongs illegitimate infants was 11. A comparison of the infantile mortality rates of legitimate and illegitimate infants shows that the rate for legitimate was 62 and for illegitimate" 149. Causes of Death. The chief causes of death were as follows : Premature Birth and Debility, 59 ; Pneumonia, 25 ; Bronchitis, 15 ; Diarrhoea, 10. Six deaths occurred from Measles and 7 from Whooping Cough. In 1923 the corresponding figures were as follows :—Pneumonia, 13; Bronchitis, 2, and Diarrhoea, 8. The increase in the rate, from 43 to 65, was in the main, due to Whooping Cough, Measles, and Respiratory diseases. Table No. 25 shows in detail a comparison of the rates of 1923 and 1924. The following Table, No. 21, has been constructed to show in detail the infant mortality rates under 4 weeks and under one year, each year since 1905 :— 28 TABLE No. 20. Year. The Borough Woolwich West Plumstead East Plumstead Eltham 1920 61 75 62 51 55 1921 62 59 57 64 70 1922 62 65 57 80 45 1923 43 51 37 42 39 1924 65 79 42 68 70 29 TABLE No. 21. 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 1923 2867 43 123 72 25 1924 2590 65 168 69 27 Total 59647 83 4940 1995 33 Table No. 21 shows that the death rate under 4 weeks was 27, an increase of two on that of the previous year, but well below the average of the preceding twenty years. The chief causes of death in this age period were:—Premature birth, 26; Congenital malformation, 11; Debility, 9; Atelectasis, 6 ; injury at birth, 6. On the next three pages are three Tables which classify in various ways the infant mortality figures of the Borough; while Table No. 25, which follows, shows the various rates for stated groups of diseases presented in a comparable form with the rates for 1923 and the preceding five-yearly period:— 30 TABLE No. 22. INFANT MORTALITY, 1924. Nett Deaths from stated Causes at various Ages under One Year of Age. Causes 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 .. .. .. .. .. .. .. 3 3 6 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. 1 .. 1 2 .. 2 2 7 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculuus Meningitis .. .. .. .. .. .. .. 2 2 4 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. 2 .. .. 2 Meningitis (not Tuberculous) .. .. .. .. .. 1 1 .. 1 3 Convulsions .. .. .. .. .. 2 1 .. .. 3 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. ... 2 1 3 3 5 .. 4 15 Pneumonia (all forms) .. 1 .. 1 2 5 8 8 2 25 Diarrhoea .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. 1 1 3 2 4 .. 10 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis 1 .. .. .. 1 2 .. 1 .. 4 Rickets .. .. .. .. .. .. .. .. 1 1 Suffocation, overlying .. .. .. .. .. 1 .. .. .. 1 Injury at Birth 5 1 .. .. 6 .. .. .. .. 6 Atelectasis 6 .. .. .. 6 .. .. .. .. 6 Congenital Malformation 8 3 .. .. 11 2 .. .. .. 13 Premature Birth 23 .. 2 1 26 .. .. .. .. 26 Atrophy, Debility and Marasmus 5 2 2 .. 9 7 2 2 .. 20 Other causes 1 1 1 3 6 2 3 2 16 49 8 7 5 69 34 23 25 17 168 Nett Births registered during Legitimate 2516 the calendar year Illegitimate 74 Nett Deaths registered during Legitimate 157 the calendar year Illegitimate 11 31 TABLE No. 23. INFANT DEATHS, 1924. Cause of Death. The Borough. Woolwich. West Plumstead. East Plumstead. Eltham. M. F. M. F. M. F. M. F. M. F. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles 5 1 4 1 .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough 1 6 1 .. .. 3 .. 2 .. 1 Diphtheria and Croup .. .. .. .. .. ... .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis 2 2 1 .. .. 1 .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases 1 1 1 .. .. .. .. .. .. 1 Meningitis (not Tuberculous) l 2 1 1 .. .. .. .. .. 1 Convulsions 2 1 2 .. .. .. .. .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 11 4 8 2 2 .. 1 1 .. 1 Pneumonia (all forms) 11 14 4 7 2 .. 1 3 4 4 Diarrhoea .. .. .. .. .. .. .. .. .. .. Enteritis 7 3 4 1 .. 1 2 .. 1 1 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis 3 1 2 .. .. 1 .. .. .. ... Rickets . . 1 .. .. .. .. .. .. .. 1 Suffocation, Overlying 1 .. .. .. 1 .. .. .. .. Injury at Birth 3 3 .. 1 1 1 .. .. 2 1 Atelectasis 2 4 .. 1 .. .. 1 2 1 1 Congenital Malformation 6 7 1 .. .. 2 2 2 3 3 Premature Birth 11 15 3 2 1 4 4 6 3 3 Atrophy, Debility and Marasmus 11 9 6 2 3 2 2 2 .. 3 Other Causes 10 6 2 3 3 .. 2 3 3 .. 87 81 40 21 13 16 16 22 18 22 168 61 29 38 40 co to TABLE No. 24. INFANT DEATHS, 1924. Cause of Death. The Borough. Woolwich. West Plumstead. East Plumstead. Eltham. Under 4 weeks 4 weeks1 year Under 4 weeks 4 weeks1 year Under 4 weeks 4 weeks1 year Under 4 weeks 4 weeks1 year Under 4 weeks 4 weeks1 year Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. 6 .. 5 .. .. .. .. .. 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough 1 6 1 .. .. 3 .. 2 .. 1 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous meningitis .. 4 .. 1 .. 1 .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. 2 .. 1 .. .. .. .. .. 1 Meningitis (not Tuberculous) .. 3 .. 2 .. .. .. .. .. 1 Convulsions .. 3 .. 2 .. .. .. .. .. ... Laryngitis .. .. .. .. .. .. .. .. .. l Bronchitis 3 12 2 8 .. 2 .. 2 1 .. Pneumonia (all forms) 2 23 .. 11 .. 2 2 2 .. 8 Diarrhoea .. .. .. .. .. .. .. .. .. .. Enteritis 1 9 .. 5 .. 1 .. 2 1 1 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis 1 3 .. 2 1 1 .. .. .. .. Rickets .. 1 .. .. .. .. .. .. .. .. Suffocation, overlying .. 1 .. .. .. 1 .. .. .. .. Injury at Birth 6 .. 1 .. 2 .. .. .. 3 .. Atelectasis 6 .. 1 .. .. .. 3 .. 2 .. Congenital malformation 11 2 1 .. 1 1 4 .. 5 1 Premature Birth 26 .. 5 .. 5 .. 10 .. 6 .. Atrophy,Debility & Marasmus 9 11 3 5 4 1 1 3 1 2 Other Causes 3 13 2 3 .. 3 1 4 .. 3 69 99 16 45 13 16 21 17 19 21 168 61 29 38 40 TABLE No. 25. INFANT MORTALITY, 1919—1924. Rates for stated groups of diseases and for stated age periods for the quinquennial period 1919-1923, and for the years 1923-1924. Groups. Total Sub-divisions of Group " G." Death rates. A B C D E F G H Period. Infectious Diseases. Tuberculous Diseases. Diseases of Nervous system. Diseases of Respiratory System. Diseases of Digestive System. Syphilis. Diseases of Development. All other Diseases. Congenital Defects. Prematurity. Debility. Under 4 weeks. Over 4 weeks 1919-1923 2.86 .98 2.86 10.78 6.95 .90 27.33 9.87 62.53 3.44 15.97 7.92 29.16 33.37 1923 1.39 .35 3.49 5.23 2.79 .35 21.97 7.33 42.90 3.48 14.30 4.19 25.11 17.79 1924 5.02 2.32 2.32 15.45 3.86 15.4 22.78 11.58 64.87 5.02 10.04 7.72 26.64 38.23 33 34 SECTION III.—NOTIFIABLE DISEASES. NOTIFICATIONS. The total number of notifications, excluding duplicates, was 1,472, compared with 1,187 in 1923. In addition, 2,679 cases of Measles (including German Measles) came to the knowledge of the Department, mainly through the school service. Compared with 1923, there is an increase of 43 in the number of cases of Diphtheria and 106 in the number of cases of Scarlet Fever. The number of notifications of Pneumonia received was 354, compared with 242 in the previous year. There is also an increase of 31 in the number of cases (342) of Tuberculosis notified. In 1923, 17 deaths from nonnotified Tuberculosis occurred and in 1924, 27 deaths. Of these non-notified deaths, 6 occurred in Asylums, 6 in Poor Law Infirmaries, 5 in special hospitals, and 3 in general hospitals. In the Annual Report for 1923, the diseases which are notifiable in the Borough of Woolwich were set out fully, and it is considered unnecessary to repeat the fist this year. The following four Tables are published in accordance with the requirements of the Ministry of Health and show the total number of cases of infectious diseases 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 in the Borough. Table No. 30, which follows thereafter, shows the incidence of infectious disease in the Borough each year since 1901. 35 TABLE No. 26. INFECTIOUS DISEASES. Diseases. Total cases notified. Cases admitted to Hospital. Total Deaths. Diphtheria 195 193 9 Scarlet Fever 440 417 4 Enteric Fever (including Paratyphoid) 11 11 1 Puerperal fever 7 7 2 Erysipelas 45 9 — † Pneumonia 354 110 95 Malaria 3 — — Ophthalmia neonatorum 27 7 — Dysentery 1 1 — Encephalitis Lethargica 17 13 5 Acute Polio-Encephalitis — — 1 Cerebro-spinal Meningitis 12 12 1 Poliomyelitis 5 3 — Zymotic Enteritis 13 5 17 Tuberculosis Males 159 195 93 Pulmonary Females 114 151 78 Total 273 346 171 Tuberculosis Males 40 40 19 Non-pulmonary Females 29 27 9 Total 69 67 28 Measles 2679 37 28 4151 1238 362 - * Not notifiable—information obtained from voluntary sources † Deaths from Influenzal Pneumonia not included. No cases of Smallpox, Typhus fever, Cholera, Continued fever, Relapsing fever, Plague, Trench fever, Anthrax, Glanders, or Hydrophobia were notified during the year. One death occurred from Acute Polio Encephalitis but no notification was received with regard to this case. 36 TABLE No. 27. CASES OF INFECTIOUS DISEASES NOTIFIED, 1924. 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 195 1 5 14 23 20 44 23 34 27 2 2 .. Scarlet Fever 440 1 8 16 48 56 187 60 46 17 1 .. ... Enteric Fever 11 .. .. .. 1 2 .. .. .. 4 3 1 .. Puerperal Fever 7 .. .. .. .. .. .. .. .. 5 2 .. .. Erysipelas 45 .. .. .. .. .. 1 1 2 6 12 20 3 Pneumonia 354 36 38 19 21 11 29 13 14 54 35 54 30 Malaria 3 .. .. .. .. .. .. .. .. 2 .. 1 .. Ophthalmia Neonatorum. 27 27 .. .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. .. .. .. .. 1 .. .. .. Encephalitis Lethargica 17 .. .. .. 2 .. .. .. 4 5 1 3 .. Cerebro-spinal Meningitis 12 4 3 1 2 .. 1 .. 1 .. .. .. .. Poliomyelitis 5 1 .. 2 1 .. .. .. .. 1 .. .. .. Zymotic Enteritis 13 5 6 .. .. .. 1 .. .. .. .. 1 .. Pulmonary Tuberculosis Males 159 .. 2 1 1 .. 7 7 22 58 28 34 .. Females 114 1 1 1 .. .. 7 3 16 63 11 11 .. Total 273 1 2 2 1 .. 14 10 38 121 39 45 .. Tuberculosis Non-pulmonary Males. 40 .. 1 2 1 1 9 5 5 10 1 4 1 Females 29 1 3 1 5 3 8 3 3 1 1 .. Total 69 .. 2 5 2 6 12 13 8 13 2 5 1 Measles (including German Measles) 2679 89 221 229 336 480 1247 64 7 5 1 .. .. 4151 165 285 288 437 577 1536 184 154 261 98 132 34 37 TABLE No. 28. Cases of Infectious Diseases Notified in the Borough and Parishes during the year 1924, shewing the Case Rate per 1,000 Population. Diseases. Borough. Total Cases notified in each locality. Case rates, per 1,000 Population. Woolwich. Plums te ad. Eltham. Borough. Woolwich. Plums tead. Eltham. West. East. West. East. Diphtheria 195 67 42 39 47 1.39 2.06 1.02 1.10 1.52 Scarlet Fever 440 134 103 96 107 3.14 4.11 2.51 2.71 3.45 Enteric Fever 11 4 3 2 2 0.08 0.12 0.07 0.06 0.06 Puerperal Fever 7 2 1 1 3 0.05 0.06 0.02 0.03 0.09 Erysipelas 45 7 15 13 10 0.32 0.21 0.37 0.37 0.32 Pneumonia 354 136 76 82 60 2.53 4.17 1.85 2.31 1.94 Malaria 3 .. 2 .. 1 0.02 .. 0.05 .. 0.03 Ophthalmia Neonatorum 27 10 7 4 6 0.19 0.31 0.17 0.11 0.19 Dysentery 1 1 .. .. .. 0.01 0.03 .. .. .. Encephalitis Lethargica 17 3 5 6 3 0.12 0.09 0.12 0.17 0.09 Cerebro spinal Meningitis 12 7 3 2 .. 0.09 0.21 0.07 0.06 .. Poliomyelitis 5 2 1 .. 2 0.04 0.06 0.02 .. 0.06 Zymotic Enteritis 13 9 2 .. 2 0.09 0.28 0.05 .. .. Pulmonary Tuberculosis 273 84 85 63 41 1.95 2.58 2.07 1.78 1.32 Tuberculosis (Non-pulmonary) 69 15 21 20 13 0.49. 0.46 0.51 0.56 0.42 Measles (including German Measles) 2679 809 760 676 425 19.14 24.83 18.76 19.07 13.73 4151 1290 1135 1004 722 29.65 39.59 27.68 28.36 23.33 38 TABLE No. 29. DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES (INCLUDING MEASLES), 1924. Diseases. Number of Deaths. All ages. Age Groups. Under 1 1- 2- 3- 4- 5-10 10-15 15-20 20-35 35-45 45-65 65- Diphtheria 9 . 1 1 4 3 .. .. .. .. .. .. .. Scarlet Fever 4 .. .. .. 1 2 1 .. .. .. .. .. .. Enteric Fever 1 .. .. .. .. .. .. .. .. 1 .. .. .. Puerperal Fever 2 .. .. .. .. .. .. .. .. 1 1 .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. ... .. Pneumonia 95 25 16 3 2 .. .. .. .. 8 6 15 19 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 5 .. .. .. 2 .. .. .. .. 2 .. 1 ... Acute Polio Encephalitis 1 .. .. .. 1 .. .. .. .. .. .. .. .. Cerebrospinal Meningitis 1 .. .. .. 1 .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. Zymotic Enteritis 17 10 .. .. .. .. .. .. .. 1 .. 2 4 Tuberculosis Pulmonary Males 93 .. 1 1 .. .. 1 4 3 34 16 32 1 Females 78 1 .. .. .. .. .. 1 15 37 8 13 3 Total 171 l 1 1 .. .. 1 5 18 71 24 45 4 Tuberculosis Non-pulmonary Males 19 3 1 3 1 .. 4 1 1 4 .. .. 1 Females 9 2 1 2 1 1 1 .. .. 1 .. .. .. Total 28 5 2 5 2 1 5 1 l 5 .. .. 1 Measles 28 6 9 6 2 1 4 .. .. .. .. .. .. 362 47 29 16 15 7 11 6 20 89 31 63 28 TABLE No. 30. Notification of Infectious Diseases, 1901 to 1924. Y ear. Small-pox. Diphtheria and Mem. Croup. Scarlet Fever. Enteric Fever. Erysipelas. Puerperal Fever. Tuberculosis.* Continued Fever. Cerebro-Spinal Fever. Anterior Poliomyelitis. Encephalitis lethargica. Ophthalmia Neonatorum. Zymotic Enteritis.§ Anthrax. 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 12 145 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 .. .. .. .. .. 173 .. .. .. .. 519 1909 .. 268 1027 13 113 9 206 .. .. .. .. .. 149 .. .. .. .. 768 1910 .. 171 524 10 89 7 196 .. 1 .. .. .. 102 .. .. .. .. 396 1911 .. 239 518 16 82 16 375 .. 1 3 .. 8 866 .. .. .. .. 801 1912 .. 429 474 20 87 2 689 .. 1 3 .. 20 129 .. .. .. .. 775 1913 .. 321 626 14 70 8 675 .. .. 1 .. 14 338 .. .. .. .. 387 1914 .. 416 714 18 107 7 498 .. 1 .. .. 18 199 .. .. .. .. 967 1915 .. 286 601 31 138 6 489 .. 50 2 .. 19 173 .. .. .. . 1179 1916 .. 271 232 9 95 16 469 .. 17 .. .. 33 80 .. .. .. .. 1590 1917 .. 277 147 12 79 12 543 .. 22 1 .. 41 101 .. .. .. .. 1710 1918 .. 240 222 12 61 14 660 .. 11 3 .. 23 118 .. .. .. .. 800 1919 4 398 243 26 63 7 474 .. 7 1 3 34 123 1 61 7 123 1886 1920 1 427 538 6 82 13 428 .. 6 .. 3 29 31 .. 29 1 136 1013 1921 .. 592 1351 11 59 14 356 .. 2 .. 9 32 454 .. 10 4 236 481 1922 .. 437 511 8 37 11 305 1 2 4 3 26 31 .. 11 .. 345 2698 1923 .. 152 334 16 40 8 311 .. 5 6 1 18 49 .. 4 1 242 194 1924 .. 195 440 11 45 7 342 .. 12 5 17 27 13 .. 3 1 354 2679 *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. 40 MEASLES. Notification Statistics. The number of cases coming to the knowledge of the Department during the year was 2,679, 18 being cases of German Measles. In 1923, the number was 194. This disease is not notifiable and we depend upon notifications received from the school medical service and cases discovered by Health Visitors as an index of its prevalence. 715 of the cases were discovered by the Health Visitors, who, in view of the serious nature of this disease, devote much time to visiting children suffering from it and give advice as to the steps necessary to avoid complications. Deaths. The number of deaths was 28, 24 of which were in children under five years of age. Nursing. The Council made arrangements in 1916 for the home nursing of Measles by the voluntary Nursing Associations in the Borough. During 1924, 36 cases were nursed at home at a total cost of £18 19s. Od. to the Council. The number of visits paid by nurses was 400, thus averaging 11 visits per case. School Closure. Thirty-two departments in schools were closed by the London County Council during the year. Removal to Hospital. Cases of Measles are received in the hospitals of the Metropolitan Asylums Board on the certificate of the Medical Officer of Health. During the year 37 cases were removed. SCARLET FEVER. Notification. During the year 440 cases of Scarlet fever were notified, compared with 334 cases in 1923 and 511 in 1922. The case rate is shown in Table No. 28. The number of notifications received each quarter was as follows:— First quarter, 113. Third quarter, 96 Second quarter, 102. Fourth quarter, 129 TABLE No. 31. Total No. in register. Date admitted to hospital. Date discharged. days in hospital. Onset of secondary case. Remarks on primary case. 249 23/10/23 8/12/23 46 3/1/24 Nasal discharge. 286 28/11/23 7/2/24 71 9/2/24 3 5/1/24 23/2/24 49 3/3/24 Do. 12 16/1/24 7/3/24 51 12/3/24 Do. 23 26/1/24 29/3/24 63 3/4/24 Do. 4/4/24 5/4/24 320 19/12/23 19/4/24 122 23/4/24 Nasal discharge: enlarged tonsils 137 12/4/24 19/6/24 68 23/6/24 24/6/24 1/7/24 3/7/24 171 15/5/24 26/7/24 72 4/8/24 7/8/24 28/8/24 201 12/6/24 27/8/24 76 12/9/24 Left otorrhœa. 165 9/5/24 10/9/24 124 21/9/24 175 19/5/24 27/8/24 100 22/9/24 216 27/6/24 15/8/24 49 25/9/24 255 11/8/24 23/9/24 43 30/11/24 Nasal discharge. 41 Deaths. There were four deaths. Return Cases. The following Table shows the number of return cases, the dates of notification, the dates of discharge from hospital and some observations on the condition of the primary cases on discharge. Home Isolation. 23 cases, or 5.2 per cent. of cases, were isolated at home and in no instance did a return case occur. Regular inspections were made by the Sanitary Inspectors in order to ascertain that proper precautions for preventing the spread of disease were being taken, and in no instance has there been any ground for supposing that the public safety is endangered by home isolation in suitable cases. The Royal Arsenal authorities require cases to be removed to hospital, or a certificate from the Medical Officer of Health TABLE No. 32. 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 9 9 39 49 6 10 18 33 15 48 71 307 307 2 cases occurred .. 3 4 2 1 3 1 6 3 9 11 43 86 3 „ ,, .. .. .. .. 2 1 .. .. 1 2 2 8 24 4 ,, ,, .. .. .. .. .. .. .. .. .. .. 2 2 8 5 ,, ,, .. .. 2 .. .. .. .. 1 .. .. .. 3 15 Total houses 9 12 45 51 9 14 19 40 19 59 86 363 440 42 of efficient home isolation, before their employees are allowed to return to work. During the year one certificate was issued. Multiple Cases. The following Table No. 32 shows the house distribution, by wards, of cases of scarlet fever notified during the year. The term "house" in this Table is synonymous with the term "family" except in seven instances where two families are involved. The Ministry of Health have asked again this year for information regarding the attack rate per 1,000 persons under 15, not known to have had a previous attack of the disease in question, according as they are housed under different conditions—for example: less than one person per room; one-two persons per room; more than two persons per room. The records do not give this information and so the Table has been calculated showing the case rate according to the total population living under these conditions at the time of the Census, 1921. The record cards show the information required by the Ministry for a portion of the year only, but steps have been taken to ensure that, when the Annual Report for 1925 comes to be written, the information will be available. 43 TABLE No. 33. [##]Population in private families. k rates per 1,000. Less than 1 person per room 67,239 .98 1-2 persons per room 54,447 5.18 More than 2 persons per room 10,270 4.97 DIPHTHERIA. Notification. During the year 195 cases of diphtheria were notified, compared with 152 in 1923. The case rate is shown in Table No. 28. The number of notifications received each quarter was as follows:- First quarter, 44. Third quarter, 38. Second quarter, 37. Fourth quarter, 76. Deaths. The number of deaths from diphtheria was 9, all of which were in children under five years of age. Return Cases. The following Table shows the number of return cases, the dates of notification and the date of discharge from hospital of the primary cases. TABLE No. 34. Total No. in register. Date admitted to hospital. Date discharged. days in hospital. Onset of secondary case. Remarks on primary case. 120 22/9/23 21/12/23 90 3/1/24 - (1923) 8 23/10/23 20/2/24 120 18/3/24 — 16 4/2/24 27/3/24 52 23/4/24 — 33 7/3/24 9/4/24 33 8/6/24 — 12/6/24 - TABLE No. 35. Dockyard. St. Mary's. River. St. George's. Burrage. Herbert. Glyndon. St. Margaret's. Central. St Nicholas. Eltliam. Total Houses. Total Cases. No. of houses in which 1 case occurred 9 6 20 20 10 8 10 10 9 26 31 159 159 2 cases occurred 1 .. 2 .. 1 1 .. .. 1 1 5 12 24 3 „ ,, .. .. 2 •• .. .. .. .. .. .. 2 4 12 Total houses 10 6 24 20 11 9 10 10 10 27 38 175 195 Similar information with regard to the attack rate with reference to housing conditions has been asked for by the Ministry of Health in the case of diphtheria as with scarlet fever, and the corresponding Table is given below.:— 44 Home Isolation. Two cases, or 1.0 per cent. of all cases were isolated at home and in neither instance did a return case occur. Multiple Cases. The following Table No. 35 shows the house distribution, by wards, of cases of diphtheria notified during the year. The term "house" is synonymous with the term "family" except in three instances where two families are involved. TABLE No. 36. Population in private families. Attack rates per 1,000. Less than 1 person per room 67,239 .28 1-2 persons per room 54,447 2.31 More than 2 persons per room 10,270 2.4 45 ENTERIC FEVER. Eleven cases of enteric fever were notified during the year. In three cases the diagnosis was not confirmed. In the following Table the details relating to each case are shown:— TABLE No. 37. No. Date. 1924. Sex. Age. Diagnosis. Final Diagnosis. Result 1 Jan. 23 M. 8 Enteric Fever Para Typhoid A. B Cured 2 Feb. 23 F. 40 Enteric Fever Typhoid Fever Cured 3 June 4 F. 4 Enteric Fever Para Typhoid B Cured 4 July 5 F. 31 Enteric Fever Enteric Fever Cured 6 July 7 F. 25 Para Typhoid Para Typhoid Cured 6 July 30 F. 52 Typhoid Fever Bronchitis Cured 7 Aug. 23 M. 36 Enteric Fever Enteric Fever Cured 8 Sept. 2 F. 4 Enteric Fever Scarlet Fever Died 9 Sept. 28 F. 40 Typhoid Fever Intestinal Obstruction Died 10 Dec. 3 F. 30 Typhoid Fever Enteric Fever Died 11 Dec. 3 M. 3 Typhoid Fever Enteric Fever Cured In the series of the notified cases, three deaths occurred but only one of them was due to enteric fever, the diagnosis of enteric fever being not confirmed in the other two cases. PNEUMONIA, MALARIA, DYSENTERY AND TRENCH FEVER. These diseases are compulsorily notifiable under the Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919. During the year the following number of cases were notified: Pneumonia 354 Malaria 3 Dysentery 1 Trench fever 0 Pneumonia. All primary pneumonias, lobar or lobular, are notifiable and the only secondary pneumonia which is notifiable is influenzal pneumonia. 46 The notifications and deaths from pneumonia during the past five years have been as follow :— Notifications. Deaths. 1920 136 97 1921 236 98 1922 345 116 1923 242 65 1924 354 95 Nursing Provision. I am informed by the Secretaries of the various voluntary Nursing Associations in the Borough that the following number of cases of pneumonia were nursed during the year:— Woolwich and Plumstead Nursing Association 105 Eltham District Nursing Association 1 Silvertown and North Woolwich Nursing Association 3 St. Luke's Parish Nursing Association 12 The Council resolved to put into force the power granted to them by the Pneumonia Regulations and to provide nursing assistance for all cases of pneumonia occurring in the Borough. Agreements were made with the various nursing associations whereby the sum of 1s. 3d. a visit is paid for each case where the Medical Officer of Health asks for nursing assistance to be furnished. During the year 37 cases were nursed at a total cost to the Council of £43 7s. 9d. The number of visits paid by the nurses was 700, thus averaging 19 per case. When the scheme becomes better known, nursing assistance will be provided in more cases, and one of the chief objects of notification, namely, the provision of nursing assistance, will be more completely carried out by this Council. On the assumption that one death is equivalent to three cases of pneumonia, 87 cases were treated in hospital. It is known that 110 notified cases were so treated. 47 The following Table No. 38 shows the number of notifications of pneumonia received each month, classified by sex according to type incidence. It shows also the number of deaths occurring from all forms of pneumonia during the year:— TABLE No. 38. Monthly incidence of Pneumonia. Month. Male. Female. Total Type. No. of Deaths. Lobar. Broncho. Influenzal. A cute Primary (not specified) Acute Primary Pneumonia Influenzal Pneumonia January 30 21 51 13 8 16 14 12 4 February 35 34 69 11 21 30 7 17 11 March 34 18 52 10 10 27 5 14 8 April 22 16 38 10 3 16 9 8 6 May 7 8 15 5 3 3 4 3 .. June 9 3 12 2 2 2 6 2 ... July 13 5 18 7 3 3 5 5 .. August 3 2 5 1 1 2 1 3 .. September 9 5 14 5 7 1 1 6 .. October .. 15 14 29 9 5 4 11 7 .. November 16 11 27 5 13 9 5 .. December 15 9 24 6 9 1 8 13 .. Total 208 146 354 84 85 105 80 95 .9 The next Table, No. 39, shows the distribution of pneumonia in each Ward of the Borough, classified according to the type of pneumonia given on the notification certificate:— TABLE No. 39. Notification of Pneumonia. Ward. Lobar. Broncho. Influenzal. Acute Primary. Total. Dockyard 3 4 3 8 18 St. Mary's 6 10 10 3 29 River 19 17 18 5 59 St. George's 5 11 9 5 30 Burrage 6 5 8 3 22 Herbert 4 4 2 0 10 Glyndon 5 11 9 5 30 St. Margaret's 5 — 5 4 14 Central 4 1 3 5 13 St. Nicholas 10 15 20 24 69 Eltham 17 7 18 18 60 84 85 105 80 354 48 Malaria. The Regulations provide that it is the duty of the Medical Officer of Health to take all practical steps to ensure that persons suffering from malaria are supplied with sufficient mosquito netting; receive the necessary quinine treatment; receive proper advice as to the continuation of quinine treatment in order to prevent relapses, and receive proper advice as to the precautions to be taken to prevent the spread of infection. Three cases of malaria were notified but in none of them was it necessary to take the action contemplated under the Regualtions of 1919. OPHTHALMIA NEONATORUM. Twenty-seven cases of ophthalmia neonatorum were notified during the year and seven cases were treated in hospital. In tabular form is shown below, as required by the Ministry fo Health, the result of each case:— TABLE No. 40. Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. No. Notified. Treated. At Home. In Hospital. 27 20 7 27 — — — Nursing. The Council made arrangements in 1920 for the home nursing of patients suffering from the disease. During 1924, nine cases were nursed at home at a total cost to the Council of £6 10s. Od. The number of visits paid by nurses was 130. 49 PUERPERAL FEVER. Seven cases of Puerperal fever were notified during the year and all of them were treated in hospital, three being in hospitals of the Metropolitan Asylums Board, three in Poor Law Institutions and one in a Maternity Hospital. Two deaths occurred. The number of cases notified is below the average of the last ten years. ZYMOTIC ENTERITIS. Thirteen cases of zymotic enteritis were notified, compared with 49 in 1923. The number of cases notified and the number of deaths certified to be due to diarrœeal diseases in each quarter are shown below:— Quarter. Cases. Deaths. First 5 Second 2 1 Third 8 6 Fourth 3 5 13 17 ACUTE POLIOMYELITIS. Five cases of this disease were notified during the year. In 1923, six cases were notified. The following Table shows in detail the condition of each patient notified, in 1923 and 1924, at the end of the year:— 50 TABLE No. 41. Poliomyelitis. Date notified. Sex Age Condition on 31st December, 1924, Treatment obtained. 1923. Mar. 18 F. 2½ Right leg affected. Gradual improvement in right leg. Child walks well. General condition good. Receiving electrical treatment and massage as outpatient twice a week. May 25 F. 3 Right leg affected. Right leg improving very much and child is just beginning to walk. General condition is good. Receiving electrical treatment and massage as outpatient, Guy's Hospital. July 7 F. ½ Left arm affected. Can now move arm slightly and grasp with hand. Physical condition fair. Receiving electrical treatment and massage as outpatient, Miller Hospital. July 27 F. 2½ In good health — Aug. 16 F. 3 Was in-patient, 13 months, Woolwich Infirmary. Now in-patient Queen Mary's H o s pi t a 1, Carshalton. Making good progress. Can walk. Receiving electrical treatment and massage. Aug. 31 F. 3 Was in-patient, 12 months, Woolwich Infirmary. Now in-patient, Queen Mary's Hospital, Carshalton. Making good progress, Can walk. Receiving electrical treatment and massage. 1924. July 19 F. 1 Unable to crawl or walk. Both lower limbs affected. Massage and feet i n splints at nigh t. July 23 F. 2 Both legs affected, right more than left. Cannot stand or walk. General condition good. In-patient, Great Ormond Street Hospital. Aug. 24 M. 8 Both legs affected. Beginning to walk with aid of supporting stand. General condition good. In-patient, South Eastern Hospital & Queen Mary's Hospital. Oct. 25 F. 24 Left leg and right arm affected. Improving. Out-patient, Lewisham Hospital. Massage and electrical treatment. 51 CEREBROSPINAL MENINGITIS. The number of cases of Cerebrospinal Meningitis notified during the year was 12. All of these cases were treated in hospital, and in the following Table the details relating to each case are shown. It will be noticed that only two deaths were certified to be due to meningococcal meningitis, one of which belonged to another area. TABLE No. 42. Cerebrospinal Meningitis. Date notified. Sex Age Result of Treatment. Ultimate Diagnosis. 1924. Yrs. Died 8/2/24 General Miliary Tuberculosis. Tuberculous Meningitis. Feb. 6 M. Feb. 8 M. 3 Recovered Measles. Mar. 11 F. 3 Died 14/4/24 Cerebrospinal Meningitis. Apr. 1 M. ¾ Died 2/4/24 Tuberculous Meningitis. Apr. 22 F. 1¼ Recovered Meningismus. May 25 F. 1 Died 28/5/24 . Post Basic Meningitis. Aug. 13 F. 1 Recovered No obvious disease. Aug. 17 M. 2 Died 25/8/24 Tuberculous Meningitis. Aug. 24 M. 8 Recovered Acute Anterior Poliomyelitis. Nov. 20 F. ½ Died 25/11/24 Acute Spinal Meningitis. Nov. 22 M. 19 Died 23/11/24 Cerebrospinal Meningitis. Dec. 3 M. 1 Recovered Broncho Pneumonia. Encephalitis Lethargica. Seventeen cases of encephalitis lethargica were notified during the year. In addition there was one death which was not notified. The total number of deaths was six, but only five of these related to Woolwich residents. One case occurred in March, four in April, four in May, three in June, four in July, one in October, and one in December. Two cases were definitely regarded as not cases of encephalitis lethargica. Excluding these two, thirteen cases were treated in hospital, four being treated in general hospitals, six in hospitals of the Metropolitan Asylums Board, 52 two in the Woolwich Infirmary and one in a general hospital and subsequently in one of the hospitals of the Metropolitan Asylums Board. This disease is infectious but the infectivity is of a very low nature. Although the origin of every case was thoroughly investigated, it was impossible to trace any connection between any two cases. The sequelae of this disease may be serious, as in most cases some permanent damage to the brain occurs. OTHER NOTIFIABLE INFECTIOUS DISEASES. No case of Smallpox occurred and no special comment is required on the incidence of Whooping Cough or Erysipelas. 53 TABLE No. 43. Tuberculosis. Summary of Notifications received during the year ended 31st December, 1924. 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. Age-periods— 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 1 45 to 55. 55 to 65. 65 & upwards. Total Primary Notifications. Under 5. 5 to 10. 10 to 15. Total Primary Notifications. Poor Law Institutions. Sanatoria. Pulmonary Males . .. 3 7 6 22 25 33 28 17 17 .. 158 182 .. .. 1 1 3 25 121 „ Females 1 2 7 3 16 16 47 11 5 6 .. 114 136 .. .. .. .. .. 19 80 Non-Pulmonary Males. .. 5 9 4 5 5 5 1 2 2 1 39 41 .. .. 1 1 1 2 25 „ Females .. 10 3 8 3 1 2 1 .. 1 .. 29 29 .. .. .. .. .. 1 24 Total 1 20 26 21 46 47 87 41 24 26 1 340 388 .. .. 2 2 4 47 250 New Cases Not Notified. Pulmonary Males 1 1 1 1 .. 2 5 4 1 .. .. 16 .. .. .. .. .. .. .. .. ,, Females .. .. .. .. 1 .. 6 3 .. 3 .. 13 .. .. .. .. .. .. .. .. Non-Pulmonary Males 2, 2 .. 1 .. .. 1 .. .. .. .. 6 .. .. .. .. .. .. .. .. „ Females 1 1 .. 1 .. 1 .. .. 1 .. .. 5 .. .. .. .. .. .. .. .. Grand Total 5 24 27 24 4 7 50 99 48 26 | 29 1 380 .. .. .. .. .. .. .. .. 54 TUBERCULOSIS. This part of the report 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 of that scheme. Staff. The staff of the Dispensary is set out in detail in Section VIII. No change has taken place during the year. Notifications. The total number of notifications received was 392, but 50 of these related to cases which had been previously notified, so that the total number of new notifications was 342. In 1923 the corresponding number was 311. Twenty-seven cases of Tuberculosis died before notification, an increase of ten compared with 1923. The notifications received on forms C. and D., i.e., notifications from institutions regarding admission and discharge, are not included in the above figures. In Table No. 43 are shown the detailed figures relating to all notifications received during the year. In Circular 549, issued by the Ministry of Health towards the end of the year, particular attention is directed to securing a greater measure of uniformity in the procedure of notification, and a stricter compliance with the requirements of the Tuberculosis Regulations in each district. It appears that there has been a good deal of variation in practice in the various districts throughout the country. In some districts notifications have been accepted after the patient was dead—a procedure which is obviously wrong when it is remembered that the medical practitioner is required to certify that the person is suffering from the disease. In other districts the first notification received and accepted has been on institutional admission or discharge notification forms, and, in others, 55 cases have escaped notification altogether, because, when cases were seen in consultation between a general practitioner and the Tuberculosis Officer, there has been a misunderstanding between the Tuberculosis Officer and the general practitioner on the furnishing of the notification certificate. In the Circular the appropriate procedure is set out and provision is made for a more systematic and careful enumeration of the actual cases notified throughout the country in any given year. The distribution of the various cases notified since 1920 is as follows:— TABLE No. 44. Year. Lungs. Menings. Intestine and Peri toneum. Glands. Joints. Spine. Other Forms. All Causes.[/##] 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 1923 245 9 6 31 8 10 12 311 1924 273 8 6 16 22 6 11 342 Cases of Tuberculosis in the District. The Public Health (Tuberculosis) Regulations, 1924, impose a duty on the Medical Officer of Health to furnish to the County Medical Officer, as soon as practicable after the end of each quarter, a statement compiled from the register of notifications kept by him showing:— (a) The number of cases of Tuberculosis on his register at the commencement of the quarter; 56 (b) The number of cases notified to him under the Regulations, 1912, for the first time during the quarter ; (c) The number of cases removed from the register during the quarter, giving name and address of each such case and the reason for such removal ; and (d) The number of cases remaining on the register at the end of the quarter. Separate figures are to be given in each case for males and females and for pulmonary and non-pulmonary cases. In accordance with these Regulations the records were tabulated and it was found that the number of cases of Tuberculosis in the Borough on the 31st December was as follows:— Males. Females. Total. Pulmonary 1,009 859 1,868 Non-pulmonary 276 263 539 1,285 1,122 2,407 These are the actual number of cases who were suffering from Tuberculosis and whose address in the Borough was known. There are other cases in the Borough who have been lost sight of for various reasons and there must be cases who were notified in other districts who are now residing- in Woolwich. These Regulations are interesting in another way, because, for the first time in dealing with Tuberculosis, a definition of "cured" has been given. This is important because, previous to the issue of this Circular, a notified case of Tuberculosis could only be removed from the register on death or after removal from the district. The definition is as follows:— 57 "The Minister is advised that the removal of a case from the register as "cured" is justified in pulmonary cases in which, for a period of five years, there have been no symptoms of tuberculosis and no signs of tuberculous disease, except such as are compatible with a completely healed lesion, and sputum, if present, has been free from tubercle bacilli; and in non-pulmonary cases in which three years have elapsed without any signs or symptoms of active disease." Table No. 45 has been constructed to show the number of oases of tuberculosis, classified by sex and type, notified each year since 1911, and the numbers remaining on the register at the end of 1924:— 58 TABLE No. 45. Year. Notifications. Pulmonary. Non-pulmonary. TABLE No. 45 Males. Percentage on Register. Females. Males. Percentage on Register. Notifications. Females Number on Register 31st December, 1924. Notifications. Number on Register. 31st December, 1924. Percentage on Register. Notifications. Number on Register, 31st December, 1924. Number on Register, 31st December, 1924. Percentage on Register. 1911 212 28 13.2 163 29 17.8 .. .. .. .. 3 .. 1912 369 109 29.5 320 107 33.4 .. 5 .. .. 4 .. 1913 273 57 20.9 259 98 37.1 80 34 42.5 63 33 52.4 1914 226 48 21.2 174 53 30.5 49 12 24.5 49 10 20.4 1915 261 47 18.0 159 46 28.9 40 9 22.5 29 15 51.7 1916 247 54 21.9 145 45 31.0 38 12 31.6 39 19 48.7 1917 257 77 30.0 190 60 31.6 50 26 52.0 50 19 38.0 1918 370 139 37.6 193 75 38.9 65 42 64.6 36 26 72.2 1919 232 73 31. 162 61 37.6 35 16 45.7 45 28 62.2 1920 214 76 35. 145 52 35.8 37 28 75.7 32 18 56.3 1921 152 50 32.9 124 48 38.7 37 22 59.5 43 18 41.9 1922 143 67 46.9 102 40 39.2 30 20 66.7 30 23 76.7 1923 128 64 50.0 117 60 51.3 30 21 70.0 36 27 75.0 1924 159 120 75.5 114 85 74.6 40 29 72.5 29 20 69.0 It will be seen from the above Table that 199 deaths were certified to be due to Tuberculosis during the year. In addition to these, 9 persons who had been notified as suffering from Tuberculosis died during the year and information relating to these is given in detail in the following Table :— 59 Deaths. The following Table No. 46 shows the number of deaths from Tuberculosis and the total deaths and death rates each year since 1920:— TABLE No. 46. Year. Deaths. Death-rates. All Forms. Pulmonary. NonPulmonary. All Forms. Pulmonary. Non. P ulmonary. 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 1923 191 172 19 1.36 1.22 0.14 1924 199 172 27 1.42 1.23 0.19 The ratio between non-notified and the total Tuberculosis deaths, as will be seen from the above Table, is therefore as one is to seven. 60 TABLE No. 47. Case No. Date notified as Tuberculosis. Cause of Death. Remarks of Tuberculosis Officer. 1 6/7/23 Gastric Ulcer, Hæmatemesis. Sputum positive. 2 4/1/13 Bronchiectasis Sputum negative. 3 27/7/24 Gumma of Lung. Perihepatitis Ascites. Heart failure. 4 15/10/23 Aortic Valvular Disease. 5 14/8/22 Mitral Disease. Chronic Bronchitis. Nephritis. Sputum positive. 6 27/7/20 Pyonephritis Uraemia 7 22/11/21 Bronchitis. BronchoPneumonia. 8 1/8/23 Carcinoma of Neck 9 22/8/17 Bronchitis. Influenza Old Spinal and Pulmonary Tuberculosis Case. The period which elapsed between notification and death was as shown below:— TABLE No. 48. Pulmonary. Percentage. NonPulmonary. Percentage. Not Notified 16 9.30 11 40.74 0-1 month 36 20.93 8 29.63 1-3 ,, 14 814 4 14.82 3-6 ,, 13 7.56 - - 6-12 „ 28 16.28 3 11.11 1-2 years 21 12.21 - - 2-5 „ 28 16.28 — — Over 5 years 16 9.30 1 3.70 172 - 27 - 61 Co-operation with Hospitals and Invalid Children's Aid Association. The existing arrangements for special hospital examination and treatment continue to give satisfaction. These arrangements are with the Seamen's Hospital for X-ray examinations of difficult cases, with the London Hospital for the treatment of lupus, and with the Brompton Hospital for the provision of artificial pneumo-thorax refills. Sixty-five cases were referred to the Seamen's Hospital. One case, involving 50 attendances, was referred to the London Hospital, and six cases, involving 58 attendances, to the Brompton Hospital. Many patients, both adults and children, who come to the Dispensary for examination, either as contacts or on their own initiative, are found to be suffering from conditions, other than Tuberculosis, which require treatment, and so it is necessary to advise them to obtain this treatment, either from private practitioners or at general hospitals. During the year 140 children who were suffering from anemia, malnutrition, and kindred diseases, were referred to the Woolwich branch of the Woolwich Invalid Children's Aid Association for convalescent home treatment, or for treatment at the remedial clinic of the Association. In considering dispensary work one is very apt to fail to realise what a valuable asset this preventive work is to the Dispensary. Co-operation with the School Medical Service. The relationship between the School Medical service and the Tuberculosis Dispensary continues to prove satisfactory. The District School Medical Officer and the Tuberculosis Officer meet at intervals to discuss various children and decide what supervision is desirable. Many children are referred direct to the School Clinic for the treatment of minor ailments and dental caries. 62 Co-operation with Medical Practitioners. During the year the Tuberculosis Officer saw 47 new cases at the homes of the patients, and 260 cases were referred to him at the Dispensary by medical practitioners in the Borough. These figures show a slight increase over the previous year. Home Contacts. The number of home contacts of tuberculous patients examined at the Dispensary during the year was 418, a decrease of 107 compared with 1923. The number of new cases attending the Dispensary during the year was 194, so that the average number of contacts to each case was a fraction over two. This figure is unsatisfactory, but, of course, it does not include those contacts examined by general practitioners. It is difficult to impress upon patients, or the general public, the necessity for the examination of contacts of sufferers from Tuberculosis. Home Nursing. When home nursing is required, the assistance of the various local nursing associations has been sought, and, as in previous years, they have been of great assistance in nursing such patients as are confined to bed. Extra Nourishment. The Woolwich Tuberculosis CareCommittee has appointed a sub-committee which reviews each week the recommendations of the Tuberculosis Officer for a supply of extra nourishment to certain selected cases of Tuberculosis. Their recommendations, which are put in operation immediately, are afterwards subject to the approval of the Public Health Committee of the Council. Extra nourishment is only sanctioned for four weeks at a time. The total number of applications (affecting 89 persons) was 280, the total cost to the Council being £216 2s. l0d. Dental Treatment. A scheme for the dental treatment of tuberculous patients has been in existence since 1922. During 63 the year 20 patients received treatment, the total number of attendances being 56. Patients receive dental treatment free, and, if dentures are required, patients are assessed according to their means, each case being treated on its merits. Dentures were supplied in 17 cases at a cost of £69 4s. 6d., and during the year the income received under this head was £15 16s. Od. Shelters. Two new shelters were provided during the year, the total now available being 13. These have been used generally throughout the year, but, in certain instances, it was difficult to get patients to continue their use during the winter. Bacteriological Examinations. During the year 515 specimens of sputum were examined at the Dispensary, of which 105 were positive, and 410 negative. These were in addition to the 256 specimens of sputum sent by medical practitioners to the Seamen's Hospital, Greenwich, for examination, of which 69 were positive and 187 negative. Institutional Treatment. The following Table shows the number of admissions to hospitals, sanatoria, Poor Law institutions and training colonies. TABLE No. 49. Hospitals. Sanatoria. Infirmary. Training Colonies. Insured 78 112 39 1 Uninsured 38 41 21 — Children 59 15 9 — Totals 175 168 69 1 64 These numbers refer to 323 persons and the monthly admissions from January to December were as follows:— January 28 July 27 February 31 August 38 March 33 September 37 April 27 October 35 May 47 November 47 June 38 December 25 Care Work. The Tuberculosis Care Committee was formed during 1923 and came into being that year. At the end of 1924 it was constituted as follows:— Bodies. Represen tati ves. Woolwich Borough Council Alderman Mrs. E. Dormer; Councillors P. Chinnery, S. H. Reed and Miss G. E. Walters, J.P. Woolwich Board of Guardians Captain W. T. Cusheon, Mrs. E. M. Newman. Lewisham Board of Guardians Miss E. P. Goody. London County Council Miss E. E. Faulkner, Dr. H. R. Kidner. Trade Unions Mr. W. H. Bullock, Mr. T. R. Goy, Mr. W. H. Newell. Employers Mr. S. J. Clothier, Miss Fletcher, Mr. R. A. E. Welford. Friendly Societies Mr. W. A. Lyon, Mr. A. G. Rourke, Mr. F. D. Smyth. London Insurance Committee Panel Committee for County of Mr. W. Edwards. Dr. J. J. O'Mullane. London. War Pensions Committee Mrs. E. E. Taylor. Woolwich Invalid Children's Aid Mrs. J. B. Great Rex. Association. Late Tuberculosis Dispensary Committee. Mr. E. G. Dixon, J.P. Ex-officio Members:— Voluntary Visitors Miss L. P. Bloxam, Mr. A. Dennis,. Miss McDermott, Miss M. Shaw, Miss R. C. Wild. Tuberculosis Officer Dr. F. J. C. Blackmore. Medical Officer of Health Dr. J. Macmillan. 65 The Care Committee has appointed Sub-Committees, one of which (General Purposes) meets weekly, and the other two (Finance and Grancher) when required. The full Committee meets once every quarter and, having considered the reports of the various Sub-Committees, reports to the Public Health Committee of the Borough Council. The General Purposes Sub-Committee deals with assessments of patients for institutional treatment under the London County Council's scheme, and with the assessment of patients who require dental treatment under the Borough Council's scheme. It also deals with general care work, provision of clothing, the provision of domestic help in casfs where the mother is too ill to attend to the home, and arranges for the loan of nursing requisites, e.g., pillows, bed rests, etc. The Grancher SubCommittee was constituted with a view to adopting the system of boarding out the healthy child of parents suffering from Tuberculosis. This scheme, which has been successful in France, will probably require some alteration before it is adapted to the English point of view, but, if it cannot be adopted in its entirety, useful work can still be done by boarding out children when the infection is greatest, or pending the removal of an infected parent to an institution. Experience has shown that if Care Committees are to discharge the duties which have been imposed upon them, financial assist, ance is necessary, as these Committees have to consider many problems which involve financial assistance, directly or indirectly. In many areas such assistance can be obtained from voluntary sources, but, in others, where these sources do not exist, Care Committees can only give wholesome advice and deal with the fringe of the problem of the aftercare of the tuberculous. No matter how willing and efficient they are, they cannot do much more. At the present time the only items of expenditure which rank for grant are postages, 66 stationery, and the salary of the Secretary. The Borough Council considered this aspect of Tuberculosis care work and were of opinion that grants-in-aid of this work should be part of the scheme for the control and eradication of tuberculosis, and towards the end of the year made representations to the Ministry of Health and to the London County Council to this effect , and asked the Metropolitan Borough Councils to support their action. Form R (a return as to the work carried out in connection with the Tuberculosis Dispensary during the year) is appended as Table No. 50. If this Table be compared with Table No. 43, it will be seen that, although 342 cases were notified, only 194 attended the Dispensary, i.e., 57 per cent. It is a matter of some importance to discover the reasons why the remaining cases did not come to the Dispensary, and certain figures are available which throw some light on this matter. Complete information is not, of course, available, but it is a matter of interest to note that 58 persons died shortly after notification, 25 were inmates of hospitals or infirmaries, 10 were inmates of asylums, and 13 were under the care of medical practitioners and did not wish to attend the Dispensary. 67 TABLE No. 50. Return as to work carried out in connection with the Maxey Road Tuberculosis Dispensary for the year 1924 (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. XonPulmonary i) All persons Adults M. 15 291 306 82 5 207 7 5 F. 11 306 317 68 4 226 7 12 " Contacts ") Children under 15 M. 7 269 276 7 9 240 5 15 F. 8 249 257 9 10 223 2 13 Total 41 1,115 1,156 166 28 896 21 45 Adults M. 8 63 71 6 1 62 1 1 (b)" Contacts" (included in (a) F. 7 102 109 20 85 2 2 Children under 15 M. 4 105 109 — 3 100 1 5 F. 6 123 129 3 — 121 — 3 c) Insured persons include in (a) M. 13 232 245 68 3 169 4 1 F 4 74 78 23 2 47 5 1 TABLE No. 50 (continued). (1) Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 675 (2) Total number of attendances of patients at the Dispensary during the year:— Insured 2,702 Uninsured 3,458 (3) Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 267 (4) Number of cases in which the period of observation at the Dispensary exceeded two months 46 (5) Number of insured patients under domiciliary treatment on December 31st 321 (6) Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year (7) Number of persons referred to affiliated hospital for consultation 83 (8) Number of consultations with medical practitioners at the homes of patients:— Insured 23 Uninsured 24 (9) Number of other visits paid by Tuberculosis Officers to the homes of patients 455 (10) Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes . 3,464 (11) Number of specimens of sputum examined in connection with the work of the Dispensary 515 68 69 SECTION IV.—CAUSES OF SICKNESS. Specify any causes of sickness and invalidity which have been specially noteworthy in the district during the year. (This should include information obtained from local general practitioners). It is very difficult to write definitely on this section of the Annual Report, because the Medical Officer of Health has no access to any sickness returns such as those which are available to the officers of approved societies under the National Insurance Act, and the information which is expected to be given in this section can only be a matter of impressions gleaned from such sources as the local general practitioner, or the monthly certificates of illness handed in by members of the Council's staff, and such deductions as can be made on the incidence of certain diseases in the death returns. It is on this basis that this section is written. The impression which the year left on most of us from a meteorological point of view was an unfavourable one. The weather was cold and damp, particularly in the early part of the year, and, as a consequence, there was an excess amount of respiratory and rheumatic affections, the deaths from these diseases being higher than they have been for some years. It should be mentioned here that the number of deaths is not a definite measure of sickness and can only be regarded as an index. Influenza, of a milder type than has been experienced in recent years, was present in epidemic form in January, February and March, and its distribution was general throughout the Borough. Judging by the notifications received, there was an increase in the amount of pneumonia, 354 notifications being received compared with 242 in the previous year. This 70 number probably under-estimates the incidence of pneumonia because many cases still escape notification. There was an increase in the number of cases of infectious diseases, particularly so in the case of measles, which, as has been pointed out before, occurs in epidemic form, practically speaking, every two years. Unfortunately this measles epidemic was accompanied by a higher death rate than usual. The incidence of gastro-intestinal infections was low. I take this opportunity of expressing my thanks to those general practitioners who were kind enough to supply me with the information which enabled this section to be written. 71 SECTION V.—SUMMARY (forreference) 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 below a summary of the nursing arrangements, hospitals and other institutions available for the district:— Professional Nursing in the Home. There are four Nursing Associations in the district, as follows:— The Woolwich and Plumstead Nursing Association, 22, Nightingale Place, Woolwich, S.E.18. The Silvertown and North Woolwich District Nursing Association, Saville Road, Silvertown, E.16. The Eltham District Nursing Association. (Nurse), Miss Melling, The Ferns, Eltham Hill. St. Luke's Parish, Eltham. (Nurse), Miss Trewin, 172, Well Hall Road, Eltham. The areas in which these Nursing Associations work are sufficiently well-defined by their names. The Woolwich and Plumstead District Nursing Association, in addition to doing general nursing in the district, provides nurses for the London County Council School Clinics and for the Garrison. When an allowance is made for this, it is estimated that the whole time of eight to nine nurses is devoted to general nursing in the district, an increase of one compared with the previous year. It is well to explain here that the nurses give their services free, in all cases of sickness in the district, at the request of doctors or friends of the patients provided that the patient 72 is under the supervision of a medical man and the illness is not infectious. In addition, they will nurse cases of measles whooping cough, ophthalmia neonatorum, and tuberculosis. The Borough Council have entered into agreements with all these Nursing Associations whereby nursing assistance in necessitous cases is paid for by the Borough Council for patients requiring such assistance suffering from measles or ophthalmia neonatorum. The rates paid are as follows :— Is. per visit; two or more cases in one home, 6d. per case per visit. In January, 1924, the Council entered into agreements, in accordance with their powers contained in the Public Health (Pneumonia, etc.), Regulations, 1919, with these Nursing Associations for the provision of nursing assistance to persons suffering from acute primary pneumonia and acute influenzal pneumonia. At the same time an opportunity was taken to provide for the nursing of these diseases in that part of Eltham which lies between the Well Hall Road and the western boundary of the Borough and between Shooters Hill Road and the Bexley Heath railway line. The rates payable are as follows: Is. 3d. per visit, except in the area of Eltham above mentioned where the rate payable to the Woolwich and Plumstead District Nursing Association is Is. 8d. per visit. Midwives. Through the courtesy of Sir William Hamer, the County Medical Officer of Health, I have been able to ascertain that 38 midwives gave notice during the year of their intention to practise as midwives in the Borough of Woolwich. Clinics and Treatment Centres. In tabular form is shown below a list of clinics and treatment centres in the borough. This list is the same as that published last year, with the exception that The Tenants' Institute, New Eltham, is substituted for the Church Army Hut, New Eltham. TABLE No. 51. 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 6 289, High Street, Plumstead Do. Do. 6 179, Well Hall Road, Eltham Do. Do 4 Wesley Hall, Timbercroft Lane, Plumstead Doctor's room, Weighing room, Do 2 Tenants' Hall, New Eltham Doctor's room, Weighing room Do 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 Doctors' rooms, Treatment rooms, Waiting rooms Local Medical Association Daily Plumstead Road, Plumstead 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 73 74 TABLE No. 51—continued. Situation. Nature of Accommodation. By whom provided. Sessions weekly. Borough Disinfecting Station, White Hart Road, Plumstead Accommodation for cleansing of verminous children Woolwich Borough Council Daily Tuberculosis Dispensary. Maxey Road, Plumstead Doctors' rooms, Waiting rooms, Dressing rooms, Dispensary, etc. Woolwich Borough Council Daily Venereal Diseases. Nil. Hospitals Provided or Subsidised by the Local Authority, or by the County Council. (1) Tuberculosis. The County Council are responsible for the institutional treatment of tuberculosis in London and they maintain no institution in Woolwich. (2) Maternity. The British Hospital for Mothers and Babies, Samuel Street, Woolwich (40 beds). This voluntary hospital was opened in March, 1922, and provides 40 beds, including a few for isolation purposes in a separate building. It does excellent work in the neighbourhood providing an intern and extern midwifery service, and, in addition, is a recognised school for the training of mid wives. LTnfortunately the desire of the Managing Committee to provide a complete hospital and training school on one site has not yet fructified, and it has been necessary to retain the old hospital—two adapted houses—in Wood Street as an Ante-natal Depart- 75 ment. The new building—in Samuel Street—has been constructed in such a way as to allow for further extension. I am indebted to Miss Gregory, the Secretary of the Hospital, for the following information which shows, statistically, the number of cases dealt with during the year Mothers admitted during the year 616 Children born 623 Maternal Death 1 Outdoor Cases 209 Ante-Natal and Post-Natal Clinics:— Mothers attending clinics 1,153 Attendances of mothers 2,691 Infants attending clinics 341 Attendances of infants 833 The Council have entered into an agreement with the Hospital authorities whereby sufficient accommodation for 144 confinements per annum is reserved at a cost of £1,500 per annum. In addition, the Hospital has undertaken to provide ante-natal accommodation for such cases as require ante-natal treatment. Each patient admitted is required to pay fees according to the earnings of her husband, and the minimum fee has been fixed at £3 per confinement in the case of multiparas, and £4 per confinement in the case of primiparæ. This charge is based on a normal residence of 14 days, but an additional fee of 3s. per day is charged if this period is exceeded. The amount recovered in patients' fees during the year was £493 16s. 0d., making a net cost of £1,006 4s. 0d., 50 per cent. of which is recoverable from the Ministry of Health. (3) Children. The Home for Ailing Babies, Eglinton Road, Plumstead. Provided by the Borough Council (21 beds). The following Table (No. 52) shews certain statistical information for the Home for the year 1924:— 76 TABLE No. 52. Number of beds 21 (1) (i.) Number of cases in hospital on the 1st January, 1924 9 (ii.) Number of cases admitted during the year 100 (iii.) Number remaining in on the 31st December 13 (2) Average duration of stay 40 days (3) Reasons for admission:— Malnutrition, Marasmus and Debility 51 Vomiting, Dyspepsia and Constipation 12 Bronchitis 11 Rickets 7 Diarrhoea 6 Pneumonia 2 Miscellaneous 11 100 (4) Number of cases discharged:— (a) In good health 61 (b) Improved 16 (c) No improvement 10 87 (5) Number of cases of infectious disease:— (a) Measles 1 (b) Whooping Cough — (c) Epidemic Diarrhoea — (d) Other infectious conditions — (6) Number of deaths 9 (4) Fever. Nil. (5) Smallpox. Nil. (6) Other. 77 There are no other hospitals in the Borough subsidised by the local authority or by the London County Council. The following institutions are available for general treatment:— Beds. Eltham Cottage Hospital 22 Woolwich and Plumstead Cottage Hospital 13 Military Families' Hospital 24 London general hospitals are largely used by the inhabitants of the Borough, but no definite information is available. Some information can be obtained, however, from the death returns and the following Table shews the number of deaths of Woolwich residents occurring in London general hospitals during the vear:— TABLE No. 53. Hospitals. Number of Deaths. Guy's 22 Miller 20 Seamen's 9 St. Thomas's 4 London 4 Charing Cross 4 St. John's 4 King's College 3 St. Bartholomew's 2 Royal Free 2 University College 1 Westminster 1 West End 1 Poplar 1 Homoeopathic 1 79 78 During the year a start was made on the superstructure of the Woolwich War Memorial Hospital and it is anticipated that this Hospital will be opened some time in 1926. At the present time a scheme is being considered whereby the Council's Home for Ailing Babies will be closed and beds in the new general hospital, subsidised by the Council, will be substituted. The number of deaths of Woolwich residents which occurred in the local Infirmaries was as follows:—Woolwich Infirmary, 347 ; Lewisham Infirmary, 78. Institutional Provision for Unmarried Mothers. Woolwich and Plumstead Maternity Home. There is a small home for unmarried mothers, situated at 23, Vicarage Park, Plumstead, which provides accommodation for eight mothers and babies. Through the courtesy of the Superintendent I am able to give the following information:— Number. Mothers in the Home on 1st January, 1924 Babies in the Home on 1st January, 1924 Mothers admitted during 1924 11 Babies do. do. Births 9 Deaths — Average duration of stay of each completed case 5½ months. Mothers who attended ante-natal clinics of the Borough Council 5 The function of the Home is to give illegitimate children a chance of survival and the mothers are kept in the Home doing the light work of the Home for about six months. When they leave, situations are found for them, if possible, where the child can be taken. For some years now the Council has made a grant of £50 towards the funds of the Home. This grant was again made in 1924. 79 Ambulance Facilities. (a) Infectious cases. Under the Public Health (London) Act, persons in London suffering from certain notifiable diseases may be conveyed, free of charge to, and treated in, a hospital of the Metropolitan Asylums Board, and persons suffering from infectious disease may be conveyed by ambulance to other places on payment. (b) For non-infectious and accident cases. The London County Council have now provided an ambulance station in High Street, Woolwich, where a service is provided not only for accidents and cases of sudden illness but also for maternity •cases. This station enables Woolwich to have the same ambulance service as the rest of London and the average call time per case has been materially diminished. The ambulances of the Asylums Board are available, on payment, for the removal of non-infectious cases to hospitals or homes. 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 shewn in detail in Section VIII. 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 the first visit is made by the Health Visitor between the tenth and fourteenth day in all cases where such visits are considered necessary or desirable. The necessity for second visits is gauged by what is discovered at the first visit, but as a general rule it has been found possible to work up to the following standard: Three visits during the first year and one visit in each subsequent year up to the age of five. 80 Welfare Centres. These are set out in detail in Table No. 51. At the end of the year 3 ante-natal and 18 infant consultations were being held each week. Voluntary Centre. There is only one Voluntary Centre in Woolwich which is held at the Victory Club, Beresford Street. It serves one of the most difficult areas in the Borough and meets once a week on Monday afternoon. It continues to do excellent work. The number of children attending the centre during the year was 143 and the total number of attendances, including mothers, was 779. The Council do not make a grant towards the expenses of this centre but provide for the services of a Medical Officer and a Health Visitor. The Work of the Centres. The following Table No. 54 gives detailed statistics for the year 1924 and consolidated statistics for the year 1923. The figures shew an increase in the number of attendances compared with those of the previous year, particularly at the Slade and New Eltham Centres. TABLE No. 54. Centre. No. on Roll of Centre. No. of Attendances. Mothers. Children. Mothers. Children. Expectant. Nursing. Expectant. Nursing. Town Hall 305 327 2,200 430 627 8,141 Plumstead 148 150 1.207 249 250 5,331 Eltham 171 108 1,369 385 184 6,759 Slade 9 35 470 11 65 3,213 North Woolwich — 3 151 — 3 851 New Eltham 6 8 175 11 8 1,319 Beresford Street (Voluntary). 22 28 143 41 119 619 Totals 1924 661 659 5,715 1,127 1,256 26,233 1923 513 701 4.204 827 1.368 24.511 81 The next Table (No. 55) shews the number of children, classified by year of birth, attending each centre, and the number of attendances made by them during the year. The Table is interesting in that it shews an increase, compared with previous years, in the number of attendances in the ages between one and five years. TABLE No. 55. Children in attendance at each Centre. Year of Birth. Town Hall. Eltham. Plumstead. Slade. New Eltham. North Woolwich. Beresford St. (Voluntary). Totals. 1924 491 242 259 88 42 59 34 1,215 1923 620 395 385 136 49 47 41 1,673 1922 541 229 250 118 36 23 34 1,231 1921 295 213 165 69 22 14 17 795 1920 198 202 100 49 16 7 14 586 1919 55 88 48 10 10 1 3 215 2,200 1,369 1,207 470 175 151 143 5,715 Attendances of Children at each Centre. 1924 2,823 1,827 1,658 748 516 357 206 8,135 1923 3,000 2,920 2,303 1,530 549 312 178 10,792 1922 1,468 684 735 517 182 100 153 3,839 1921 520 626 343 184 33 59 44 1,809 1920 268 562 217 181 22 22 20 1,292 1919 62 140 75 53 17 1 18 366 8,141 6,759 5,331 3,213 1,319 851 619 26,233 Treatment. Children requiring medical or surgical treatment are referred to the School Clinic, Brewer Street, and the Borough Council pays 5s. for each case so referred. During the year 13 cases were sent there for treatment. 82 Dental Scheme. The dental work is carried out at the School Clinic and the following Table (No. 56) shews the number of cases attending and the number of attendances during the year. These figures shew over a 200 per cent. increase on those of 1923. Dentures are provided, either free, at part cost, or cost, the payment by mothers being spread over many weeks. In consequence the income during the year included money due for dentures supplied in 1923. The number of dentures ordered was 18 ; the number supplied, 20: the liability incurred by the Council was £74 15s. 0d., and the income received was £58 13s. 6d. TABLE No. 56. Number. Attendances. Expectant Mothers 37 83 Nursing mothers 74 195 Children under 5 151 220 262 498 The Work of the Health Visitors. No change has taken place in the personnel of the Health Visitors during the year. There are eight Health Visitors, two of whom hold the combined appointment of Sanitary Inspector and Health Visitor. The extensive nature of their work can be seen from a study of Table No. 57 which shews in detail the number of visits paid by them during the year. In addition to paying these visits they attend centres at which women and children come for medical and hygienic advice, and arrangements have been made whereby the Health Visitor is in attendance at the centres serving the district in which she works. Their visits are welcomed by the mothers. 83 In 1924, the Council, with the approval of the Ministry of Health, paid the class fees of one Health Visitor attending a refresher course for Health Visitors. Four Health Visitors received the Board of Education Certificate during the year, namely, Miss Latham, Miss Burnett Miss Tibbits and Miss Ware, and, between them, they received twelve distinctions in the various subjects. The following Table (No. 57) shews the classification of visits paid by the Health Visitors in 1923 and 1924, and it will be noted that there is a considerable increase in the number of visits paid on account of measles. The number of measles visits naturally varies from year to year according to whether the disease is present in an epidemic form or not. During epidemic periods of this disease the Health Visitors discontinue the re-visiting of births, except in urgent cases, and concentrate on the visiting of measles cases. TABLE No. 57. 1923. 1924. Births—First Visits 2,672 2,299 ,, Re-visits 14,024 13,360 Infant deaths investigated 117 132 Still-births investigated 81 63 Expectant mothers—home visits 440 392 Infectious diseases:— Ophthalmia Neonatorum—First visits 18 27 ,, ,, Re-visits 33 46 Measles—First visits 19 2,263 ,, Re-visits 9 989 Puerperal fever—First 5 6 „ ,, Re-visits 1 8 84 Table No. 57 (continued)). Zymotic Enteritis—First 41 11 „ „ Re-visits 37 2 Tuberculosis Visits 70 42 Pneumonia 104 207 Visits unclassified 666 562 Visits unsuccessful 2,736 1,739 121,073 22,148 Supply of Milk, etc., to Necessitous, Expectant and Nursing Mothers and Milk to Young Children. The approximate cost of this service during the year was as follows:— Dried milk, £1,260 19s. Id.; Fresh milk, nil; Dinners, 9s. A scale of income approved by the Ministry of Health is used as a test of necessity and the details of this scale will be found in the annual report for 1923. No cases were found during the year where milk was obtained by false pretences. Feeding of Infants in Woolwich. The usual enquiry was carried out in the month of June and the results are verisimilar to those obtained in the three previous years. Table No. 58 shews the results of the enquiry:— TABLE No. 58. Feeding of Infants attending Centres, 1924. 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. 9-10. 10-11. 11-12. Breast 38 58 60 29 29 32 30 21 23 320 5 3 4 332 Breast and Hand 1 5 14 10 9 6 12 9 10 76 22 9 17 124 Hand 4 13 16 23 29 44 23 31 26 209 40 34 37 320 43 76 90 62 67 82 65 61 59 605 67 46 58 776 Percentages. Breast 88.1 76.3 66.7 46.8 43.3 39.0 46.1 34.4 39.0 52.9 7.5 6.5 6.9 42.8 Breast and hand 2.3 6.6 15.5 16.1 13.4 7.3 18.5 14.8 17.0 12.0 32.8 19.6 29.3 16.0 Hand 9.3 17.1 17.8 37.1 43.3 53.7 35.4 50.8 44.0 34.5 59.7 73.9 63.8 41.2 85 86 Enquiry into the Rate of Growth (weight) in the Second Year of Life of Woolwich Infants born in 1921. In the Annual Report for 1923, tables and diagrams were published shewing the results of an enquiry into the rate of growth during the first year of life of Woolwich infants who were born in 1921. It was considered desirable to continue the investigation so as to shew the rate of growth, in the second year of life, of the same infants, and during 1924 summaries were made of the weights recorded in the previous two years. Although many observations of the rate of growth of children under one year have been made in infant clinics, and although many of these results have been published and tables constructed for different areas of this country and for other countries, we find that there is a marked paucity in the number of tables published of the rate of growth in the second year. I have been able to find only one, which was published in 1899 in the "New York Medical Journal" by Dr. Griffith who also discussed some figures obtained from another observer (Lorey). Method of Enquiry. The enquiry was limited to children born in the year 1921 who had attended the infant welfare centres in the years 1922 and 1923. The total number of male infants whose weight was tabulated was 447 and the number of female infants was 450; the total weighings for males being 2,141 and for females, 1,971. In the construction of tables, however, only one weighing of each infant in each month was used; if more than one was recorded in the same month the average figure for that infant was taken. Thus the total weighings used in the tables were reduced to 1,664 for males and 1,547 for females. The weight was recorded at the centres to the nearest ounce, the age was taken in half-monthly periods, and the result is shewn as the weight at the end of each completed calendar month. In the second year of life children do not attend the centres so frequently as in the first. 87 year and consequently it was found impossible to construct a table shewing a weekly increase. The number of observations is somewhat inadequate for the purpose but a glance at the tables will shew that the weights indicate a steady if somewhat irregular gain. Type of Case. The weights of all young children who conformed to the age shewn above were tabulated and con. solidated and no selection whatever was made. Every recorded weight was used in the construction of the tables. Tables. The results of the enquiry are seen in the two following Tables (No. 59 and No. 60), which shew, for boys and girls respectively, their average weights at intervals of one calendar month. There are some irregularities but these are more or less inevitable when one has regard to the small number of figures available and to the irregular intervals at which the weights of children were recorded. An attempt has been made to adjust these irregularities by means of curves which are shewn in the diagrams. These curves probably give results which are sufficiently accurate and practical for the every-day work of the infant welfare centres. The Tables shew, in addition, the number of observations made each month, the weight in lbs, the standard deviation and the co-efficient of variation for each set of observations. The standard deviation is a statistical method of expressing how closely rates of different babies at the same age approximate to each other, and the co-efficient of variation is one hundred times the standard deviation divided by the average weight. In reading these mean (average) weights, the co-efficient of variation will enable one to express the extent of variation which can occur at any given age, e.g., at 15 months it can be stated that 68.27 per cent. of all Woolwich malt infants will be within the following limits of weight:—22.81 lbs. plus 88 METROPOLITAN BOROUGH OF WOOLWICH. Male: children born in 1921. MEAN WEICHTS. 89 METROPOLITAN BOROUGH OF WOOLWICH. FEMALE CHILDREN BORN 1921, MEAN WEICHTS. 90 11.1 per cent., and 22.81 lbs. minus 11.1 per cent. In the diagrams continuous curves have been constructed from birth until the end of the second year. In the last two months of the first year there is some variation in these curves compared with the curves given last year, as they have been slightly adjusted in view of the additional information now available. TABLE No. 59. Male Babies—The Borough. Age in Months. No. of Observations. Weight in 1bs. Standard deviation. Co-efficient of variation. 53 weeks. 159 21.53 2.51 11.6 13 201 21.92 2.61 11.9 14 184 22.34 2.66 11.9 15 167 22.81 2.54 11.1 16 147 23.32 2.71 11.6 17 143 23.43 2.93 12.5 18 130 24.15 2.93 12.1 19 120 24.78 3.00 12.1 20 94 24.87 3.30 13.3 21 101 25.58 3.19 12.5 22 83 25.51 3.59 14.1 23 80 26.06 3.07 11.4 24 55 26.23 3.49 13.3 TABLE No. 60. Female Babies—The Borough. Age in Months. No. of Observations. Weight in lbs. Standard deviation. Co-efficient of variation. 53 weeks 146 19.67 2.31 11.7 13 203 20.14 2.11 10.5 14 170 20.58 2.15 10.5 15 162 21.25 2.35 11.0 16 142 21.49 2.52 11.7 17 141 22.09 2.28 10.3 18 115 22.60 2.54 11.2 19 93 23.21 2.66 11.4 20 93 23.22 3.12 13. 4 21 79 23.56 3.19 13.6 22 73 24.28 3.29 13.6 23 80 25.03 3.08 12.3 24 50 24.68 3.27 13.3 91 SECTION VI.—LABORATORY WORK. Analysis of Food and Drugs. The Public Analyst is Sir William 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 Tables Nos. 73 and 76, in Section VII. 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 the year 1923 are also given:— TABLE No. 61. Associated Disease. Positive Result. Negative Result. Total 1924. Total 1923. Diphtheria 94 520 614 551 Enteric Fever 3 6 9 26 Tuberculosis 69 187 256 220 Dysentery — 1 1 2 Cerebro Spinal Fever — 1 1 — 166 715 881 799 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 88,000 units, 16,000 of which was supplied free. The total cost to the Council was £6 12s. 0d. of which £5 8s. 0d. was recovered. 92 SECTION VII. SANITARY ADMINISTRATION. This section of the Report deals statistically with the work of the Sanitary Inspectors and Sanitary Administration, and has been prepared by the Chief Sanitary Inspector. The Ministry of Health, in a circular dealing with the contents, and arrangement, of annual reports of Medical Officers of Health, request that a list of adoptive acts, by-laws, and local regulations relating to public health in force in the district, with date of adoption, should be given. ADOPTIVE ACTS, BY-LAWS AND REGULATIONS RELATING TO PUBLIC HEALTH IN FORCE IN THE DISTRICT. Adoptive Acts. The Small Dwellings Acquisition Act, 1899, was adopted by the Council in 1901. During 1924, the Borough Treasurer tells me, the Council made 158 advances to purchasers of houses in accordance with the provisions of this Act. The following is a List of By-laws and Regulations made under the various Acts, with date of adoption:— By-laws made under:— Public Health (London) Act, 1891. Section. Date of Adoption. 16 (1) Prevention of nuisances arising from 15th May, 1903 matter thrown in any street; offensive matter running into an uncovered place; keeping of animals; paving of yards and open spaces. 16 (2) Closing of cesspools and privies: 28th June, 1893 removal and disposal of refuse. 93 Section. Date of Adoption. 16 (2) Removal of faecal and offensive 26th Nov., 1901 matter. 39(1) Construction of closets, privies, ash- 28th June, 1893 pits, cesspools, and dung recep- 14th June, 1901 tacles. 3rd Jan., 1905 39 (2) Keeping water closets supplied with 24th June, 1903 sufficient water. 45 Decent conduct of persons using 24th June, 1903 public lavatories, etc. 50 Securing cleanliness and freedom 24th June, 1903 from pollution of tanks, cisterns and other receptacles used for storing water. 88 Management of Mortuaries 24th June, 1903 94 Houses let in lodgings (Woolwich 13th Aug., 1895 and Plumstead Parishes only). 95 Tents, Vans, Sheds 24th June, 1903 19 Bone boiler, Manure manufacturer 25th Nov., 1907 or Tallow melter 19 Gut scraper and Catgut maker or 25th Nov., 1907 Catgut manufacturer. 19 Fat Melter or Fat Extractor 25th Nov., 1907 19 Fellmonger 25th Nov.. 1907 19 Dresser of Fish Skins 25th Nov., 1907 19 Dresser of Fur Skins 22nd March, 1922 19 Glue and Size Manufacturer 25th Nov., 1907 19 Knacker 25th Nov., 1907 19 Slaughterer of Poultry 22nd Dec., 1923 19 Soap boiler 25th Nov., 1907 19 Tripe Boiler 25th Nov., 1907 94 Section. Date of Adoption. London County Council (General Powers) Act, 1908:— 9 Rag and Bone dealer 18th Sept., 1923 9 Fish Curer 28th Feb., 1914 9 Vendor of Fried Fish 28th Feb.. 1914 London County Council (General Powers) Act, 1902:— 53 Common Lodging Houses 14th Aug., 1903 London County Council (General Powers) Act, 1903:— 54 Conveyance of carcases of dead 21st Feb., 1905 horses through public streets. Metropolis Management Act, 1855:— 202 Drains, regulating dimensions of, 14th June, 1901 keeping, cleansing and repairing of. Metropolis Management Act, 1855 (Section 202) and Metropolis Management Acts (Amendment—By-laws) Act, 1899:— Plans to be deposited. Construction, re- 20th Aug., 1903 construction, or alteration of pipes, drains, traps and other apparatus. Slaughterhouse, Etc. (Metropolis) Act, 1874 and the Local Government Act, 1888:— Slaughterer of Cattle 27th Oct., 1891 Baths and Washhouses Act, 1846:— 34 Management, Use and Regulations 24th June, 1903 of Public Baths. Public Health Act, 1875:— 167 Regulating the use of the Market 24th June, 1903 place. Regulations made under:— Factories and Workshops Acts and Public Health (London) Act, 1891 Bakehouses 31st Jan., 1902 95 Section. Date of adoption. Dairies, Cowsheds and Milkshops Order, 1885:— 13 Dairies, Cowsheds and Milkshops 3rd July, 1885 Housing, Town Planning, etc. Act, 1909:— 17 (7) Underground Rooms 9th Feb., 1911 Section 55 of the Public Health (London) Act, 1891, has been applied to Zymotic Enteritis. Staff. The Sanitary Staff consists of one Chief Inspector, seven District Inspectors, one Food and Drugs Inspector, one Woman Inspector, two part-time Health Visitors and Sanitary Inspectors, and one Inspector who is entirely engaged on Housing Survey work and on special investigations. In May, 1924, one of the Sanitary Inspectors, Mr. A. G. Potter, was certified to be unable to follow his employment by reason of permanent infirmity of body, and the Council resolved to superannuate him. Mr. Potter was appointed by the Plumstead Vestry in 1898, and had thus completed 25 years' service, during which period he carried out the duties assigned to him in a methodical, efficient and careful manner. At the end of the year the appointment had not been filled. Complaints. The number of complaints entered in the Complaint Book during the year was 1,624, compared with 1,718 last year. The complaints are mostly from the occupiers of houses and deal with alleged nuisances. These complaints are investigated by the District Inspectors, who, when the circumstances justify, serve the necessary notices required for the abatement of the nuisances. Thirty-two of the complaints related to the non-removal of household refuse— 6 in Woolwich, 19 in Plumstead, and 7 in Eltham. 96 Scavenging. House refuse is removed by the Works Department of the Council in the Parishes of Woolwich and Eltham. In Plumstead, it is removed by contractors. When the Council took over the collection of refuse in Eltham, refuse was being collected in carts and dumped in dust shoots on some farms in the district. In 1924, the Council purchased two electric vehicles of six tons capacity, and in consequence it has been possible to bring this house refuse to the Plumstead Destructor, where it has been burnt. The subsequent disposal of the burnt refuse is interesting. By the installation of a plant (also in 1924) the Council are now able to use the clinker for road construction purposes, a much more sanitary and useful method of disposing of this material. Inoffensive trade refuse is also removed at a charge of 5s. a load and disposed of at the Destructor. Offensive trade refuse is collected in specially made receptacles, at a charge of 6d. a receptacle, and conveyed to a firm in the East End of London for conversion into soap. Closet Accommodation. With the exception of a few earth closets, used by sports clubs in the rural parts of the Borough, water conservancy is general. The number of cesspools is 29, two less than in the previous year. Combined Drains. Twenty-seven combined drains, connected with 132 houses, were reported on at various times throughout the year. Full investigation is made in each case, and it is found that, when the Department learns of these defects, there is usually a stoppage in the system. If the stoppage is only of a temporary character and not due to any defect in the system, the drain is cleared, the details of the investigation being simply recorded. If, however, some further action is necessary, the facts are reported to the Committee, and notices are served under the Metropolis 97 Management Act, the work in most cases being undertaken by the Works Department at the expense of the owners. Reconstruction was necessary in 7 cases (involving connections with 30 houses) and the usual notices were served and complied with. In 3 instances the work of repair was undertaken by the owners without service of any notices. At the request of the owners, various small repairs to drains were undertaken at the time of examination, and the total cost of £12 4s. 6d. was recovered from the owners concerned. Work of Sanitary Inspectors under Article 19 of the Sanitary Officers Order, 1922. This Article deals with the duties of Sanitary Inspectors. These duties may be classified as obligatory and optional. The obligatory duties referred to are as follows:—Paragraph (8) reads: "If so directed by the Local Authority, supervise the scavenging of his district or any part thereof." The work of scavenging in Woolwich and Eltham is done by direct labour; in Plumstead by a firm of contractors ; and there it is supervised by the Sanitary Inspectors. Paragraph (9) deals with certain Acts—the Diseases of Animals Acts, 1894 to 1909, the Canal Boats Acts, 1877 and 1884, the Rats and Mice (Destruction) Act, 1919. All the Council's Sanitary Inspectors act as Rats Officers in their respective districts. The routine and special work of the Sanitary Inspectors under the Order is shewn in Tables Nos. 62 and 63. Action taken under Public Health Acts or By-laws. Statistical tables are set out on the following two pages shewing the number of inspections made by the Sanitary Inspectors and the number of nuisances abated. 3,638 intimation and 1,048 statutory notices were served during the year. These compare with 3,446 and 1,262, respectively, in 1923. There were 204 cases in which the owners neglected to comply with the statutory notices, and these were reported to the Town 98 Clerk for legal proceedings. In 1923, the corresponding figure was 165. The Town Clerk followed his usual procedure of writing a letter reminding the owner that he was in default in not complying with the notice, and requesting his attention forthwith and stating that, in the event of his continued neglect to the terms of the notice, a summons would be issued. It was found necessary to issue 16 summonses (39 in 1923), the details of which are set out in tabular form in Table No. 64. TABLE No. 62. Premises Inspected. Total. Milkshops 257 Bakehouses 199 Cowhouses 55 Ice-cream premises 796 Slaughterhouses 32 Fried Fish Shops 353 Premises where Food is Prepared (other than above) 503 Shops and Markets re Food (estimated) 2,514 Factories, Workshops, Workplaces 912 Outworkers' Premises 916 Homes re Verminous Cases 236 Homes re Scabies Cases 47 Women's Lavatories 198 Smoke Observations 10 Tents and Vans 24 Urinals accessible to the Public 229 Animals so kept as to be a Nuisance 26 Housing Survey—Houses Inspected 3,453 Do. Number of following up primary visits 1,784 Complaints Investigated 1,624 Enquiries re Notified Infectious Diseases 997 School Reports 267 99 TABLE No. 62—continued. Premises Inspected. Total. Special Inspections re Rats 72 Drains tested by Smoke Test 77 Do. Water Test 6 New Houses Inspected—Water Certificates 230 Registered Houses 433 Theatres, Cinemas, etc., 38 Miscellaneous (Unclassified) 3,492 Re-inspections 12,297 TABLE No. 63. Nuisances, etc., Abated. Total. Interiors Cleansed 2,576 Damp conditions in houses remedied 870 Defective Guttering and Rain Water Pipes 701 Improved Ventilation 335 Defective Roofs 1,109 Deficient Light—Windows supplied or enlarged 13 Paving in Yards and Washhouses Repaired 615 Underground Rooms not in accordance with Acts 8 Waste-pipes from Baths, Lavatories and Washhouses Repaired or Disconnected 112 Choked and Defective Drains 255 Defective Traps 30 Defective or Unventilated Soil Pipes 8 W.C.'s Repaired—New Traps or pans provided 192 Foul Pans Cleansed 126 Flushing Apparatus Repaired or Renewed 348 Additional w.c.'s provided to Dwelling Houses — Do. Factories and Workshops 3 Washhouses provided with Sinks 6 Defective and Foul Cisterns used for dietary purposes 8 Defective and Foul Rain-water Tanks 8 100 TABLE No. 63—continued. Nuisances, etc., Abated. Total. Insufficient supply of water or water cut off by Metropolitan Water Board 45 Additional Water Supply — Cases of overcrowding remedied 49 Dust Bins supplied 535 Verminous Rooms Cleansed 159 Accumulations of Manure Removed 46 Dung Pits provided 1 Smoke Nuisances 4 Coppers Repaired 208 Cooking Stoves Repaired 347 Miscellaneous 1,115 Rats. During the year 72 investigations were made under the Rats and Mice (Destruction) Act. A Rat Week was held in November and by arrangement with the Works Department 6,927 baits were laid in 102 old sewers likely to be infested with rats. During the year many persons were advised as to the best means of dealing with the rat nuisance so far as it affected their respective premises. Mosquitoes. During the summer complaints were again received from persons living in the Abbey Wood area that they were troubled with mosquitoes, but from investigation it appears that the menace was not quite so serious as in the previous year. The mosquito causing the trouble was the culicine variety; no specimens of the malaria mosquito (anopheline) were discovered. The area from which the complaints were received is near the Plumstead marshes and the ditches dividing these constitute a convenient breeding ground for mosquitoes. In addition there is a large allotment area nearby where allotment holders use an improvised type 101 of well or tank, in some cases sunk below the surface, and these were found to be suitable breeding places. Constant attention was given to these places and as a result a considerable diminution in the number of mosquitoes was noted. The Borough Engineer made arrangements for the ditches to be systematically sprayed with paraffin. The Council resolved, in order to improve the ditches and mitigate the mosquito nuisance so far as they were concerned, to concrete the inverts of the ditches and provide a smooth surface. This work is now in progress. Legal Proceedings. In Table No. 64, which follows, are set out the details of the various prosecutions instituted during the year under the Public Health (London) Act, 1891. 102 TABLE No. 64. Prosecutions under Public Health and kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1 Feb. 19 Dirty walls and ceilings of ground floor shop parlour, ground floor back addition room and landing. Dirty and defective walls and ceilings of passage and staircase. Defective back steps to basement. Defective back addition rain water pipes. Dirty walls and defective ceiling of first floor back room. 16, Armstrong Place. Work done. With drawn. 21s. costs. 2 July 21 Dirty conditions. Defective sink waste. Defective sash cords. 15, Nightingale Place. Fined £5 and 21s. costs. Order to abate in 28 days. 3 Aug. 11 Dirty walls and ceiling of kitchen on first floor. Defective scullery floor. 3, Hartville Road. Work done. Costs 21s. 4 Sept. 16 Dirty walls and ceilings of ground floor front room, passage, staircases, landings, washhouse, and water closet. Dirty walls of first floor front room. Defective plastering of staircase wall. Defective sashlines in second floor front room. 68, Anglesea Road. Fined 10s. Order to abate in 14 days. 5 Sept. 16 Defective yard paving.. 68, Anglesea Road Costs 10s. 6 Sept. 16 Defective flushing apparatus to w.c. 68, Anglesea Road Work done. Withdrawn. 7 Sept. 16 Dirty walls and ceilings of back basement room, top landing of staircase and washhouse. 26, Burrage Road Fined 10s. Order to abate in 14 days. 8 Sept. 16 Defective yard paving .. 26, Burrage Road Costs 20s. 9 Sept. 16 No dust bin 26, Burrage Road Withdrawn. Work done. 103 TABLE No. 64—continued. No. Date of Hearing. Offence. Situation. Result. 10 Sept. 16 Defective drain 11, High Street, N. Woolwich. Work done. Withdrawn. Costs 10s. 11 Oct. 28 Damp and dirty walls and dirty ceilings of both rooms. Dirty walls and ceilings of scullery and water closet. Defective floor of scullery. Defective copper. Defective sink in scullery causing floor to be damp. Defective front street door, back door and door sill. Defective sash cords— windows fixed. 27, Barnfield Place Work done. Withdrawn. Costs 10s. 6d. 12 Oct. 28 Damp walls of ground floor front room 1, Hull Place Work done. Withdrawn. 10s. 6d. costs. 13 Oct. 28 Defective and dirty walls and ceilings of back addition room. Defective roof. Dirty walls and ceiling and defective walls of scullery. 29, Belson Boad Withdrawn. 14 Oct. 28 Defective yard paving .. 17, Prospect Row Work done. Withdrawn. 10s. costs. 15 Dec. 9 Damp and dilapidated wall of ground floor front room. 14, Coupland Terrace Work done. Withdrawn. 16 Dec. 9 Non-compliance with Magistrate's Order made on 21st July, 1924. 15, Nightingale Place. (Adjourned at end of year.) 104 Rag Flock Act. No samples have been taken during the year. Offensive Trades. There are no offensive trades in the district. Action taken with regard to Smoke Abatement. It is part of the work of a Sanitary Inspector to observe any nuisance arising from smoke and though there were only ten recorded instances of observations the chimneys can be regarded as being subject to daily observation by the Inspectors. There were two complaints of smoke nuisances received and the attention of the offenders was called to the nuisances. Arrangements for Disinfection and Disinfestation and the extent of their use. Disinfection. The Council's Disinfecting Station is situated at White Hart Road and two steam disinfectors are provided. The disinfecting staff numbers three. The following Table No. 65 shews the various rooms and articles disinfected during the year. TABLE No. 65. Rooms disinfected after ordinary fevers 596 ,, ,, tuberculosis 306 ,, ,, verminous cases 45 ,, ,, for other reasons 59 Total articles disinfected 18,986 Applications for special disinfection, not associated with the notifiable infectious diseases, are considered, and, if the work of the Department permits it, are carried out at the expense of the applicant. Sixty of these disinfections were carried out during the year and the total charges amounted to £18 12s. 6d. 105 Disinfestation. The number of children attending the Cleansing Station shews an increase over the last two years amounting to 12½ per cent. The figures are shewn in detail in the next Table. It is difficult to account for this increase in view of the policy of the London County Council of treating slight verminous cases at their Minor Ailment Centres. The following Table No. 66 shews the extent to which the Station has been used each year since 1920.:— TABLE No. 66. Children. Adults. Grand Total. Year. Boys. Girls. Total. Males. Females. Total. 1920 1955 1678 3633 23 6 29 3662 1921 1219 1112 2331 26 6 32 2363 1922 394 1493 1887 9 7 16 1903 1923 280 1731 2011 18 1 19 2030 1924 337 1924 2261 17 10 27 2388 Factories, Workshops and Workplaces. The Medical Officer of Health is required under Section 132 of the Factory and Workshops Act, 1901, to include in his annual report details of the administration of this Act in his district. The total number of factories, workshops and workplaces on the register at the end of the year was 147. The number of inspections of these premises was 912, which compares with 881 for 1923 and 512 for 1922. Sanitary defects were found in 32 instances. The following Table No. 67 is in the form adopted by the Home Office in order to ensure uniformity in the presentation of statistics:— 106 TABLE No. 67. Factories, Workshops, Laundries, Workplaces, and Homeworkers' Premises. 1.—Inspection. Including inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories 205 18 - (Including Factory Laundries) Workshops 627 12 - (Including Workshop Laundries) Workplaces 80 2 - Homeworkers' Premises 916 29 - Total 1828 61 — 2.—Defects Found. Description. Number of Defects Found. Remedied. Referred to H.M. Inspect'r Number of Prosecutions. Nuisances under Public Health Act:— Want of Cleanliness.. 25 25 — — Want of Ventilation 1 1 - — Overcrowding — — - — Want of drainage of floors 2 2 — — Other nuisances 11 11 - — Sanitary Accommodation insufficient unsuitable or defective not separate for sexes 2 2 — — 25 25 — — 1 1 — — Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouses (s. 101) Other offences — — — — Total 67 67 — — TABLE 67—continued. 3.—Home Work. Nature of Work. Outworkers' Lists, Section 107. Number of Inspections of Outworkers' Premises. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Secs. 109, 110. Lists received from Employers. Number of Addresses of Outworkers received from other Councils. Number of Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. 1 Instances. Orders made (Sec. 109). Prosecutions (Sees. 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists. Lists. Outworkers. Lists. Outworkers. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing Apparel 40 144 6 35 93 21 - - 207 23 17 - — — — Tennis Balls, etc. 6 591 — — 55 70 - - 705 20 12 — 9 — — Artificial Flowers - - - - - - - - - - - - - - - Haberdashery - - - - 2 - - - 2 — - — — — - Dyeing & Cleaning - - - - 1 - - - 1 — — - — — — Umbrella covering - - - - 1 - - - 1 - - - - — — 46 735 6 35 152 91 - - 916 43 29 - 9 — — 107 108 In tabular form is set out below information with regard to the Mortuaries and Cemeteries in the Borough. I am able to give the information regarding the Woolwich and Plumstead Cemeteries, through the courtesy of the Town Clerk, and regarding the Eltham Churchyard, through the courtesy of the Vicar of Eltham. MORTUARIES. TABLE No. 68. Sun Street. Sun Street (Infectious) Eltham. All Mortuaries. Number of Bodies received : 1924 1923 (a) for inquest 67 - — 67 70 (6) for custody 13 - 2 15 10 80 — 2 82 80 No. of Post-Mortem Examinations 50 — — 50 47 CEMETERIES. TABLE No. 69. Number of Interments. 1922 1923 1924 Woolwich Cemetery 612 515 570 Plumstead Cemetery 720 599 656 Eltham Cemetery 199 153 196 Plumstead Churchyard 33 23 27 1,564 1,290 1,449 Number of Exhumations carried out during year 5 109 Inspection of Premises where Food is prepared. Three Sanitary Inspectors regularly inspect the market places where food is exposed for sale, at all periods of the day, and maintain a systematic supervision of the slaughterhouses. The district Inspectors keep under observation, whilst on the district, food exposed for sale, and included in this supervision is the inspection of fried fish shops, bakehouses and premises where ice cream is made or sold. 199 inspections of bakehouses were made, compared with 192 in 1923. Reference is made in subsequent paragraphs to the conditions under which fried fish is sold and ice cream made and sold. There are 148 premises other than those already mentioned where food is prepared and/or sold, and 503 inspections of these premises were made during the year. Vendors of Fried Fish. At the end of the year there were 82 premises at which fish were sold by retail, and in 70 of these premises frying of fish was carried on. The larger part of the fresh fish consumed in the Borough is retailed in the markets where there are eight dealers. The premises where fish frying is carried on are systematically inspected and it is found that a reasonable standard of cleanliness is now being maintained, but it is necessary for the Inspectors to maintain a constant vigilance to impress upon the vendors the necessity for the systematic observance of cleanliness. 353 inspections were made and 16 notices served. During the year under review several consignments of fish which had been purchased on a sample were found to be unsound. The fish so surrendered were destroyed and a certificate was given to the fishmonger who, by this means, was able to obtain a refund from the wholesaler. This practice deserves much encouragement. Ice-cream Vendors. Of the 226 vendors of ice-cream on 110 the register it was found that 155 of them actually sold icecream during the summer months. It is probable that the weather which we had then did not justify the systematic making of ice-cream, not so much from the lack of warmth but from the extreme variation of temperature which took place from day to day. There were 796 inspections of these premises compared with 557 in 1923. In concise form is given below a Table relating to premises where food was prepared and sold. TABLE No. 70. Premises. On Register 31st December. Number of Proceedings. Inspections. Notices. Bakehouses 42 199 4 — Cowsheds 9 55 — — Milkshops 85 257 3 — Ice Cream Premises 226 796 6 — Slaughterhouses 8 32 — — Fried Fish Shops 70 353 16 — Premises where food is prepared (other than above) 148 503 11 — Action taken with regard to Dairies, Cowsheds and Milk Shops. The premises at which registered purveyors of milk carry on their business have been subject to regular inspection. During the year there were 13 applications made for registration as retail purveyors of milk, 9 of which were approved by the Council. In two instances the applications were withdrawn and in two other instances the Council considered that the premises were unsuitable and inadequate for the business. 111 In tabular form below is shewn the alterations which took place on the registers during the year:— TABLE No. 71. Retail. Wholesale. Total. On register on 1st January 81 9 90 Removed during the year 5 — 5 Added during the year 9 — 9 On register on 31st December 85 9 94 There were four applications under the Milk (Special Designations) Order for licences to sell special grades of milk. Two were from one applicant for the renewal of licences to sell Certified and Grade A. (Tuberculin Tested) milk, one for the renewal of a supplementary licence to sell Grade A. (Tuberculin Tested) milk. These licences were issued. In the Borough there are 9 licensed cowkeepers and 20 licensed cowsheds in which there are 382 milch cows. These cowsheds are subject to annual licensing by the London County Council. The following Table shews the licensed accommodation of each cowkeeper:— TABLE No. 72. Name of Occupier. Premises. No. of Sheds Licensed Accommodation. Grace, J. Avery Hill Farm, Eltham. 1 13 Fisher & Sons Belmont Park Farm, Eltham 1 29 Kisher, C. U. Chapel Farm, Eltham 3 59 Keen, T. W. & S. A. Clav Farm, New Eltham 5 65 Fisher, W. F. Coldharbour Farm, Chislehurst 2 88 Corp, W. F. Middle Park Farm, Eltham 4 100 Grace, J. Pippen Hall Farm, Eltham 2 27 Killick, C. W. 13, Princes Road, Plumstead 1 20 Furber, H. Victoria Road, Eltham 1 16 112 Dairies, Cowsheds and Milkshops Order, 1885. On the 3rd September, 1924, a retailer was summoned at the Woolwich Police Court for selling milk without being registered as a purveyor. He was convicted and fined £2. Public Health (Milk and Cream) Regulations, 1912-1917. During the year 240 samples of milk and four samples of cream were purchased and submitted to the Public Analyst. None of the milk samples shewed any preservative. Three samples of cream contained preservative but none exceeded the amount allowed by the Regulations. In tabular form, as required by the Ministry, are set out below the details of this work:— TABLE No. 73. REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK & CREAM) REGULATIONS, 1912-1917, FOR THE YEAR ENDED 31st DECEMBER, 1924. 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 240 (including 5 separated milk.) Nil. - - Cream 4 Nil. - — 113 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 3 (i) Correct statements made 3 (ii) Incorrect statements made Nil (iii) Percentage of Preservative Percentage stated found in each sample : on statutory label: .21 per cent. Not .26 per cent. exceeding .32 per cent. .4 per cent. (b) Determinations made of milk fat in cream sold as Preserved Cream:— (i) Above 35 per cent. 3 (ii) Below 35 per cent. Nil (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 Number and Condition of Slaughterhouses, Registered or Licensed. In tabular form below is shewn the number of Slaughterhouses licensed in 1914, and in January and December, 1924. These premises have been regularly inspected. There is no public abattoir in the Borough. 114 TABLE No. 74. In 1914. In January, 1924. In December, 1924. Registered . - — — Licensed 12 8 8 The following is a list of the Slaughterhouses in respect of which licences were granted by the London County Council: TABLE No. 75. Name of Occupier. Address. The Royal Arsenal Co-operative Society, Ltd. Bostall Farm, Abbey Wood Portlock, T. W. 14, Church Street Vicars, H. 30, Hare Street Anderson, F. 33, Herbert Road Garnsey, A. S. 168, High Street, Eltham Reed, H., & Co., Ltd. 6, High Street, Plumstead Do. Love Lane, Woolwich Do. 38, Plumstead Common Rd. Unsound Food. On 45 occasions during the year unsound food was surrendered, compared with 54 in 1923. Included in the food surrendered was:—12½ cwt. Beef, 2½ cwt. Pork, 49 stone of Fish, 26 lbs. Bacon, 700 Eggs, 42 cwt. Strawberries, 27 lbs. Mushrooms, 30 cwt. Potatoes, and 26 lb. Tomatoes. The number of carcases condemned on account of tuberculosis was three—all pigs. No intimation was received during the year that farmers in the district had purchased unsound food to be used for cattle food. One seizure was made consisting of 28 pieces of bacon weighing in all 26 1bs. This unsound bacon was condemned by a Justice of the Peace and an Order was made for its destruction. 115 The Public Health Committee considered the circumstances of the case, and having regard to the facts, decided that the Town Clerk should write a letter to the vendor cautioning and warning him that in the event of a repetition of the offence proceedings would be taken. Food Poisoning. There were no cases of food poisoning brought to the notice of the Department during the year. Action Taken under the Sale of Food and Drugs Acts. Table No. 76 shews the number of the various analyses made during the year and the result of the analyses. 3 6 per cent. of all the samples were adulterated. In 1923, the corresponding figure was 5.3 per cent., and in 1922, 6 per cent. The number of samples taken on Sundays was 12, none of which were adulterated. TABLE No. 76. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Milk 234 1 235 8 Separated Milk 5 — 5 1 Cream 4 — 4 — Preserved Cream 3 — 3 — Condensed Milk. 12 — 12 — Dried Milk 3 — 3 — Butter 8 64 72 1 Lard 8 13 21 — Margarine — 11 11 — Coffee 2 22 24 — Cocoa - 9 9 — Whisky — 3 3 — Beer — 3 3 — 116 TABLE No. 76—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated Mustard — 2 2 — Honey — 3 3 — Sausages — 8 8 — Saveloys — 6 6 — Brawn — 6 6 — Pork Pie — 4 4 — Breakfast Sausage — 9 9 — Tinned Plums 2 1 3 2 Tinned Peaches 1 — 1 — Tinned Pineapple 1 — 1 — Tinned Tomatoes — 10 10 — Prescriptions 6 — 6 — Cream of Tartar — 8 8 — Castor Oil — 10 10 — Camphorated Oil 3 38 41 7 Borax — 6 6 — 292 237 529 19 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 shews the fat percentage figures for 1922, 1923 and 1924. The minimum legal standard is 3 per cent. TABLE No. 77. 1922. 1923. 1924. 4.5% and over 1 1 1 4% and under 4.5% 31 12 14 3.5% and under 4% 104 84 121 3% and under 3.5% 113 85 96 Below 3% 9 2 3 258 184 235 117 The following Table shews the number of adulterated samples and the action taken in each case. TABLE No. 78. ADULTERATED SAMPLES—ACTION TAKEN. Sample No. Sample of Particulars of Adulteration. Action taken. 695 Plums in Juice. 5.25 grains of tin per lb. Informal sample. 717 Do. 4.14 do. Vendor cautioned. Stock surrendered. 761 Milk 4% deficient in fat No proceedings. 796 Do. 3.33% do. No proceedings. 110 Do. 27.66% do. Fined £2 and £3 3s. 0d. costs. 127 Do. 19.5% added water and 20% deficient in fat. Fined £4 and £1 1s. 0d. costs. 135 Separated Milk 42.8% added water Fined £15 and £1 costs. 166 Butter 0.71 excess water Informal sample. 212 Camphorated Oil. 12.1 deficient in camphor Informal sample. 217 Do. 46.7% do. Informal sample. 227 Do. 46.7% do. Costs 10s. 6d. 235 Do. 67.85% deficient in camphor and 93.57% mineral oil. Informal sample. 242 Do. 67.85% deficient in camphor and 93.57% mineral oil. Fined £2 and £1 1s. 0d. costs. 273 Milk 3.3% added water No proceedings. 285 Do. Artificially coloured with annatto. Costs £1 1s. 0d. 290 Camphorated Oil. 11.8% deficient in camphor. Informal sample. 298 Do. 40.5% deficient in camphor and 88*1 % mineral oil. Dismissed with £2 2s. 0d. costs against Council. 308 Milk 22.66% deficient in fat Fined £15 and £2 2s. 0d. costs. 309 Do. 12% deficient in fat Costs 2s. 118 SECTION VIII.—PUBLIC HEALTH STAFF. The names, qualifications, and year of appointment of members of the Health Staff at the 31st December, 1924, are shewn below in the form requested by the Ministry of Health. Mr. A. G. Potter, one of the Sanitary Inspectors, was superannuated early in the year, and his name does not appear in this list. At the end of the year the appointment had not been filled. 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 Assistant Medical Officer (General Purposes) †1923 Topping, A. M.A., M.D., D.P.H. 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 *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 119 Year appointed. Name. Qualifications. Appointment. *1909 Shaw, H. Cert. Royal San. Inst., Cert. San. Insp. Exam Board., Cert. San. Insp. Assocn., Cert. Meat and other foods Sanitary Inspector *1920 Pendrill, H. W Cert. San. Insp. Exam. Board. Cert. Meat and other foods Cert. San. Insp. Exam. Sanitary Inspector *1921 Harris, C. V. Sanitary Inspector Board, Cert. Royal San. Inst., Cert.Meat and other foods *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. Woman Sanitary Board, Cert. Royal San. Inst. spector †1917 Latham, Miss K. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., C.M.B. Health Visitors'Cert., Cert. approved by Board of Education Health Visitor *†1918 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. Cert. approved by Board of Education Health Visitor †1919 Tibbits, Miss E. Cert. San. Insp. Exam. Board, Health Visitors' Diploma. Cert. approved by Board of Education Health Visitor *†1919 Ware, Miss C. Cert. San. Insp. Exam. Board., C.M.B., Cert. approved by Board of Education Health Visitor and Sanitary Inspector †1920 Campbell, Miss M. Cert. General Hospital Training, C. M. B., Cert. San. Insp. Exam Board Health Visitor 120 Year appointed. Name. Qualifications. Appointment. †1920 Morgan, Miss F. Cert. General Hospital Training, C. M. B., Health Visitors' Cert. Maternity and Child Welfare Cert. Health Visitor †1922 Seccombe, Miss W. Cert. General Hospital Training, C. M. B., Health Visitors' Cert. Health Visitor †1921 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 †1923 Luffman, Miss M. Dispensing Certificate Clerk-Dispenser †1922 Morrison, Mrs. L. - Lay Organiser †l921 Cross, Miss S. Cert. General Hospital Training, C.M.B. Matron, Home for Ailing Babies Britter, A. Collyer, H. M. †Edwards, Mrs. E. Pike, L. Clerks: Prescott, H. T. Smith, H. S. †Stephenson, Miss D. Taylor, S. G. 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 contributions made under Public Health Acts. † Salary contributions made by Exchequer Grants. 121 SECTION IX.—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement is shewn:— TABLE No. 79. Number of new houses erected during the year:— (a) Total 230 (b) With State assistance under the Housing Acts, 1919 or 1923:— (i) By the Local Authority 110 (ii) By other bodies or persons 30 1.—Unfit Dwelling Houses. Inspection. (]) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,248 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 3,453 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 12 (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 743 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 2,487 * Includes intimation notices. 3.—Action under Statutory Powers. 122 (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 3 (2) Number of dwelling houses which were rendered fit:— (a) By Owners 2 (b) By Local Authority in default of Owners 1 (3) Number of dwelling houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close 0 (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 977 (2) Number of dwelling houses in which defects were remedied:— (а) By Owners 980 (b) By Local Authority in default of owners 0 (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 *14 (2) Number of dwelling houses in respect of which closing orders were made. 11 (3) Number of dwelling houses in respect of which closing orders were determined, the dwelling houses having been rendered fit 3 (4) Number of dwelling houses in respect of which demolition orders were made 3 (5) Number of dwelling houses demolished in pursuance of demolition orders 3 * Eight Underground Rooms. 123 Housing in the Borough. The housing conditions of the Borough have somewhat improved since last year, but they are still far from satisfactory. Houses are again being built in increasing numbers by private enterprise, particularly in Eltham. During the year 120 were built, compared with 62 in 1923, 30 in 1922, and 10 in 1921. The Council's new housing scheme progresses slowly. At the end of 1924, 504 houses had been built and occupied and an additional 104 were in course of erection. The total number of new houses built during the year was 230 and 4 houses were demolished, leaving a nett increase of 226. Housing Survey. The house-to-house inspection was continued on the same lines as last year and records were kept in accordance with the provisions of the Housing (Inspection of District) Regulations, 1910. During the year 3,453 houses were inspected and recorded by the Inspectors engaged in this work, compared with 3,192 in the previous year. The results of the survey were periodically reported to the Public Health Committee. The summarised results of the complete 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 20 Grade 2.—Unfit for human habitation by reason of extensive dilapidations and dirty conditions, but subjective to effective remedy under a Closing Order 1 124 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 266 Grade 4.—Few defects, capable of being remedied under the Public Health (London) Act, 1891 1,347 Grade 5.—Satisfactory 1,819 Total 3,453 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1923. During the year seven applications were made by the occupiers of seven houses for certificates that the houses occupied by them were not in a reasonable state of repair. Two certificates were granted. In three cases the applications were withdrawn before they were considered by the Public Health Committee as all the work necessary to put the houses in a reasonable state of repair had been carried out expeditiously. It is the usual practice, when such an application is received, to inspect the house and serve notices for the defects which exist. If these are amended it is found in practice that no further action is necessary. An owner is entitled to a certificate when he has complied with the terms of the original certificate given by the Council to the occupier. In one instance an application was made by an owner for this certificate ; as the work had been satisfactorily carried out his request was complied with. HOUSES LET IN LODGINGS. No. •On register at beginning of year 425 •On register at end of year 394 Inspections made 433 Notices served 235 Prosecutions Nil 125 Underground Sleeping Rooms. The Medical Officer of Health reported that during the year eight underground rooms were being illegally used for sleeping purposes. Closing orders were made by the Council in all cases. Action taken under the Housing Acts, 1909 and 1919. Under these Housing Acts the Council have power to secure the closing of underground rooms illegally occupied as sleeping places, to make closing and demolition orders and to serve notices on the owners calling on them to render houses fit for human habitation, and in default have the power to do the work themselves and recover the cost from the owners. During the year under review eight underground rooms were the subject of representations and closing orders were made forbidding the use of them for sleeping purposes. In addition, six other representations were made by your Medical Officer of Health and in three of the cases closing orders, which were subsequently followed by demolition orders, were made. In one case the closing order was not made until the 25th January, 1925, and so it is shown in the table as pending at the end of the year. In the other three cases notices under Section 28 of the Housing, Town Planning, etc., Act, 1919, were served. The work was completed in all three cases, in two instances by the owners and in one case by the Council. In tabular form is shewn below the details relating to each representation. 126 TABLE No. 80. ACTION UNDER THE HOUSING ACTS. Date of Representation. Premises. Date of Closing Order. Remarks. 1923. Dec. 14 12, Fenwick Street 1924 Jan. 9 Underground room. Dec. 14 102, Wickham Lane — Notice served under Section 28. 1924. Jan. 18 5, Nelson Street Feb. 6 Underground room. Jan. 18 "Melladew," High St., Eltham. Feb. 6 Underground room. Jan. 18 101, Parkdale Road Feb. 6 Underground room. Jan. 24 8, Market Hill Feb. 6 Demolition Order, July 30. Jan. 24 9, Market Hill Feb. 6 Demolition Order, July 30. Jan. 24 10, Market Hill Feb. 6 Demolition Order. July 30. Feb. 15 1, Kirk's Yard — House rendered fit. May 16 107, Parkdale Road June 4 Underground room. May 16 63, Earl Street - Notices served under Section 28. J uly 11 3, Joseph Street July 30 Underground room. July 11 108, Wickham Lane — Notice served under Section 28. Sept. 19 46, Brewer Street Oct. 8 Underground room. Oct. 17 103, Parkdale Road Nov. 10 Underground room. Dec. 12 98a, Woolwich High Street. — Action pending at end of year. Unhealthy Areas. No areas have been represented under Part I. of the Housing Act, 1890, and no complaints that areas were unhealthy have been made. 127 New Houses. Water certificates were granted duringth< year for the following new houses erected in the Borough Council's Housing Scheme. Eltham 18 January 18th 16 February 15th 16 March 14th 26 September 19th 17 October 17th 7 November 14th 10 December 12th Private Enterprise. Woolwich— 42a, Wood Street September 19th " Sunnyside," Shooters Hill December 12th 42b, Wood Street do. 42c, Wood Street do. Plumstead, West— "Trevone," Eaglesfield Road March 14th "Shrewsbury House," Shrewsbury Lane April 11th "Welcomyn," Foxcroft Road June 20th "The Lodge," Shrewsbury Park do. "The White Cottage," Cleanthus Road September 19th "Four Marks," Eaglesfield Road October 17th Plumstead, East— 44, 46, 48, Howarth Road January 18th 32, 34, 36, 38, 40 & 42, Howarth Road July 11th 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, Howarth Road September 19th 2, 4, 6, 8, Howarth Road October 17th 47, Harrow Manorway October 17th 306, Wickham Lane December 12th 128 Eltham— 71, Glenesk Road January 18th 122, Westmount Road do. 67, Glenesk Road do. 21, Winn Road do. 3 and 4, Brickhill Villas, Footscray Road do. "Lambourne," Glenlea Road do. "Europa," Glenlea Road do. "Rothley," Glenlea Road do. "Con Amour," Glenlea Road do. "Sarnia," Glenlea Road do. 8, Glenesk Road March 14th 32 and 34, Archery Road do. 215, Grangehill Road do. Sports Pavilion, Eltham Road do. 40 and 42, Archery Road do. 7, Guibal Road do. 37, Winn Road April 11th 6, Brickhill Villas, Footscray Road do. "Overdale," Glenlea Road do. "Glenside," Glenlea Road do. 6, High Street do. 36 and 38, Archery Road do. 6, Glenesk Road do. "Oldheath," Avery Hill Road 16th May 5, 6, 7 and 8, Sherard Parade do. "The Bungalow," Glenlea Road do. 5, Brickhill Villas, Footscray Road do. 54 and 55, Spencer Gardens June 20th 46 and 48, Archery Road do. 8, Brickhill Villas, Footscray Road do. "Wynterley," Parkview Road July 11th 129 "Woodlands," Avery Hill Road .. July 11th. 41, 43, 45, 47, 49, 51, Gerda Road do. 33 and 35, Winn Road do. 60, Westmount Road do. 44 and 50, Archery Road September 19th 7, Sarona Villas, Footscray Road do. "Merlwood," Parkview Road do. "Milborne," Dunvegan Road do. "Doddington," Avery Hill Road do. "Springfield," Avery Hill Road do. 131 and 139, Westmount Road do. 53, Spencer Gardens do. "Etheldene," Avery Hill Road do. "St. Helens," Avery Hill Road do. 9 and 10, Sarona Villas, Footscray Road October 17th 35, Glenlea Road do. "Swinton House," Parkview Road do. 52, Spencer Gardens do. "White House," Footscray Road do. "Leyland," Dunvegan Road do. "Lamorna," Glenesk Road do. "Salisbury," Glenesk Road do. 56 and 58, Westmount Road do. 124, Westmount Road November 14th "Rangers," Avery Hill Road do. 11 and 12, Sarona Villas, Footscray Road do. "Helwan," Dunvegan Road do. "Ecleton House," Parkview Road do. "Sumerling," Guibal Road December ^12th 7 and 8, Sherard Mansions do. 54, Archery Road do. 56, Archery Road do. 130 METEOROLOGY. Meteorological Observations taken at the Royal Observatory, Greenwich, during the year 1924. Week ending 11)24. Temperature of the Air. Departure from average mean air temperature for 65 years. Average Temperature 4 feet below ground. Number of days on which rain fell. Rainfall in inches. Highest during Week. Lowest during Week. Mean Temperature. Jan. 5 49.3 25.9 38.7 + 0.2 43.0 4 0.49 12 52.0 27.4 37.2 - 0.7 42.3 4 0.56 19 51.4 32.4 43.0 + 4.7 42.0 3 0.84 26 50.2 32.8 43.1 + 4.2 42.6 6 1.35 Feb. 2 48.9 33.6 41.7 + 21 42.7 1 0.01 9 50.5 371 43.8 + 4.3 42.6 2 0.27 16 43.3 21.2 34.8 — 4.3 42.6 3 0.03 23 421 24.7 34.9 — 4.7 41.5 2 0.11 March 1 141) 28.3 34.9 — 5.4 40.9 4 0.24 8 506 251 37.5 — 3.3 40.4 3 0.22 15 55.9 25.1 40.2 10 40.5 22 68.0 26.1 410 — 1.0 40.6 1 001 29 58.9 32.7 43.5 + 0.5 41.4 4 0.47 April 5 53.6 450 38.9 - 6.7 41.8 2 0.03 12 59.8 27.6 40.6 5.4 41.9 4 0.76 19 67.0 311 471 — 01 42.4 3 0.48 26 75.6 40.6 53.1 + 4.5 440 3 0.40 May 3 64'6 421 50.6 + 1.4 45.6 7 1.54 10 63.5 361 48.6 . 21 46.8 3 0.34 17 76.3 38.7 56.5 + 3.9 47.8 3 0.46 24 70S 470 59.2 + 4.9 49.9 6 0.72 31 751 42.8 58.8 + 2.6 51.3 3 0.63 June 7 74.7 41.6 55.7 — 2.4 52.5 6 1.78 14 67.5 44.7 55.7 — 2.6 53.5 6 0.60 21 76.9 430 61.8 + 2.4 54.2 2 0.32 28 81.7 47.2 63.9 + 2.7 55.2 1 006 131 METEOROLOGY—continued. Week ending 1924. Temperature of the Air. Departure from average mean air temperature for 65 years. Average Temperature 4 feet below*ground. Number of days on which rain fell. Rainfall in inches. Highest during Week. Lowest during Week. Mean Temperature. July 5 72.9 44.0 59.5 — 2.3 56.0 3 0.13 12 88.8 51.2 66.0 + 3.5 56.3 — — 19 811 49.4 630 — 0.3 571 3 1.06 26 78.1 47.6 59.7 — 3.2 571 5 103 Aug. 2 73.2 471 59.9 — 2.4 57.0 5 2.13 9 79.9 45.9 60.6 — 1.6 57.2 2 0.39 16 79.0 471 61.2 — 1.2 57.6 2 0.09 23 70.2 45.6 56.8 — 4.7 57.7 7 0.49 30 70.4 45.6 56.9 — 3.6 57.1 4 0.62 Sept. 6 71.9 48.9 59.3 — 0.3 57.2 3 0.38 13 71.7 45.1 59.3 + 0.9 57.4 6 0.28 20 67.9 450 58.6 + 1.5 57.2 5 0.66 27 65.8 41.7 530 . 2.4 56.9 6 1.16 Oct. 4 65.9 38.7 52.6 — 1.4 56.1 2 0.74 11 64.3 431 53.6 + 1.7 55.2 5 0.92 18 68.7 35.9 53.6 + 3.6 55.0 — .— 25 57.0 331 47.2 — 11 54.3 3 0.80 Nov. 1 630 41.3 52.7 + 5.4 530 7 1.89 8 .V.HI 26.0 45.5 — 0.5 52.3 — — 15 57.0 36.6 46.2 + 2.4 50.9 4 1.23 22 52.2 25.2 41'8 — 0.5 49.9 2 003 29 55.3 37.8 47.4 + 5.7 49.2 5 100 Dec. 6 55.4 38.4 48.4 + 7.2 490 6 0.85 13 50.1 29.0 37.8 — 2.9 48.3 1 0.15 20 44.4 32.7 44.5 + 4.3 47.1 2 0.29 27 52.8 36.6 45.8 + 7.3 46.9 4 1.40 1925. Jan. 3 51.3 351 44.8 + 61 46.5 6 1.35