CAC 4372 WOO 25 Metropolitan Borough of Woolwich. ANNUAL REPORT OF THE Medical Officer of Health FOR WOOLWICH. 1925. 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. 1926. Metropolitan Borough of Woolwich. ANNUAL REPORT of the Medical Officer of Health for WOOLWICH. 1925. 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. 1926. 2 Public Health and Housing Committee. At 31st December, 1925. His Worship the Mayor (Councillor W. Barefoot, J.P.). Councillor Miss M. Crout, J.P. (Chairman). Alderman Mrs. E. Dormer, J.P.. (Vice-Chairman). Alderman— A. Gorman. Councillors— R. M. W. Allen. W. E. Hughes Narborough. P. Chinnery. H. Sykes. T. Davis. Miss S. Turnbull. A. H. Gilder. H. J. Turner. W. G. McCartney. Miss G. E. Walters, J.P. J. E. Mills. R. A. M. Walters. Maternity and Child Welfare Committee. Comprising the Members of the Public Health and Housing Committee. Visiting Sub-Committee. Councillor Miss M. Crout, J.P. (Chairman). Alderman Mrs. E. Dormer, J.P. (Vice-Chairman). Alderman A. Gorman. Councillor P. Chinnery. Councillor W. E. Hughes Narborough. Councillor Miss G. E. Walters, J.P. 3 SUMMARY OF STATISTICS. 1916-1920. 1921-1925. 1925. Births:- Legitimate 2,805 2,753 2,506 Illegitimate 141 82 76 2,946 2,835 2,582 Birth Bates 22.0 20.4 18.3 Deaths 1,707 1,530 1,519 Death Bates 12.8 11.0 10.8 Number of Women dying in, or in consequence of child birth:- (a) From Sepsis 7 3 3 (6) From other causes 7 5 6 Deaths of Infants under 1 Year:— (a) Legitimate 208 163 132 (b) Illegitimate 24 11 9 Infant Mortality Rates 79 57 55 Deaths from Measles (all ages) 21 12 9 Deaths from Whooping Cough (all ages) 20 14 17 Deaths from Diarrhæa (under 2 Years) 22 19 7 Average yearly figures are shown for the five-yearly periods 4 TABLE OF CONTENTS. PAGE Public Health and Housing Committee 2 Maternity and Child Welfare Committee 2 do. Visiting Sub-Committee 2 Summary of Statistics 3 Preface 8 I.—Natural and Social Conditions. Area 13 Population 13 Physical Features and General Characteristics 15 Inhabited Houses 15 Families 15 Rateable Value 15 Causes of Sickness 15 Poor Law Relief 16 Occupations 16 II.—Vital Statistics. Annual Statistics 19 Births 20 Marriages 23 Deaths 23 Child Mortality 33 Infantile Mortality 34 III.—General Provision of Health Services. Hospitals 42 Institutional Provision for Unmarried Mothers 43 Ambulance Facilities 43 Clinics and Treatment Centres 44 Staff 45 Professional Nursing in the Home 48 Midwives 49 Chemical Work 49 Adoptive Acts, By-laws and Regulations in Force in the Borough 49 Health Week, 1925 52 5 PAGE IV.—Sanitary Administration. General Reference 35 Complaints 56 Closet Accommodation 56 Scavenging 56 Combined Drains 58 Sanitary Inspection of Area 58 Rats 60 Mosquitoes 61 Rag Flock Act 61 Offensive Trades 61 Smoke Abatement 61 Legal Proceedings 61 Factories and Workshops 63 Mortuaries and Cemeteries 66 V.—Housing. General Housing Conditions 67 Shortage of Houses 67 Overcrowding 69 Fitness of Houses 69 Unhealthy Areas 70 Houses Let in Lodgings 71 Tents and Vans 71 Underground Sleeping Rooms 72 Increase of Rent and Mortgage Interest (Restrictions) Acts 72 Housing Statistics 73 New Houses 75 VI.—Food. General Reference 79 Milk Supply 80 Cowkeepers 83 Dairymen and Purveyors of Milk 85 Designated Milks 87 Analysis of Milk 88 Tuberculous Milk and Tuberculous Cattle 88 Refresher Course for Sanitary Inspectors 88 Meat Supply 89 6 PAGE Slaughterhouses 92 Other Foods 93 Bakehouses 93 Fried Fish Shops 95 Ice Cream 95 Other Food Premises 98 Unsound Food 98 Food Poisoning 99 Sale of Food and Drugs Acts 99 Public Health (Condensed Milk) Regulations 101 Public Health (Dried Milk) Regulations 101 Adulteration of Food 102 Public Health (Milk and Cream) Regulations, 1912-1917 103 VII.—Infectious Diseases. Notification 105 Smallpox 111 Scarlet Fever 111 Diphtheria 114 Enteric Fever 115 Pneumonia 116 Encephalitis Lethargica 120 Cerebro Spinal Meningitis 120 Erysipelas 121 Other Notifiable Infectious Diseases 121 Disinfection 121 Disinfestation 122 Tuberculosis :— General Reference 123 Deaths 126 Notifications 129 Shelters 131 The Work of the Dispensary 132 Home Visiting 135 Work for Ministry of Pensions 135 Contacts 135 X-ray Examinations 136 Observation Cases 136 7 PAGE Co-operation with Local Practitioners 137 Co-operation with School Medical Service 137 Provision of Extra Nourishment 137 Dental Treatment 138 Finsen Light Treatment 139 Artificial Pneumothorax 139 The Work of the Care Committee 139 Institutional Treatment 143 Bacteriological Examinations 144 VIII.—Maternity and Child Welfare. General Reference 145 Administrative Action 146 Notification of Births Acts 148 Work of the Health Visitors 149 Welfare Centres 151 Treatment of Minor Ailments 153 Dental Treatment 153 Orthopaedic Treatment for Children under Five Years 154 Provision of Nursing Assistance 136 Home for Ailing Babies 157 Institutional Midwifery 158 Institutional Provision for Unmarried Mothers 160 Supply of Milk, etc., to Necessitous Mothers and Children 161 Collective Teaching 162 Voluntary Centre 163 Research Work on the Health of the Toddler 164 Feeding of Infants 164 Maternal Mortality 66 Infectious Diseases in Relation to this Work :— Puerperal Fever 168 Ophthalmia Neonatorum 168 Measles 169 Whooping Cough 170 Zymotic Enteritis 170 Anterior Poliomyelitis 170 Meteorology. 8 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich . Mr Mayor, Ladies and Gentlemen, I have the honour to submit the Twenty-fifth Annual Report on the health of the Metropolitan Borough of Woolwich. This report differs from its predecessors in that it is a survey report in contradistinction to the ordinary reports of previous years. A survey report is expected to deal with measures of progress made in the area during the preceding five years in the improvement of the public health and with the extent and character of the changes in the services which have taken place in that period. Accordingly, in writing this report, a review has been given of the Council's health activities and special reference has been made in the appropriate sections to the changes which have taken place during the quinquennium in addition to the ordinary matters dealt with each year. Progress has been made in many directions during the past five years in improving the conditions under which people live, and the changes which have taken place have all contributed to the health, care and comfort of the people. Woolwich maintains its foremost position amongst the sanitary districts of London. The work of the various services of this department are referred to in detail in the pages of the report, and it is only necessary here to refer to a few aspects of the work. 9 The incidence of infectious disease was lower in 1925 than in 1924, and much lower in the last quinquennium than in the previous five years. At the end of the year there were 1,628 cases of pulmonary and 528 cases of non-pulmonary tuberculosis, making a total of 2,156 cases known to be living in the Borough, a decrease on the figures for 1924. This decrease has been brought about mainly by the revision of the register which was rendered possible by the Public Health (Tuberculosis) Regulations, 1924. During recent years important developments have taken place in the investigation of the origin and prevention of diphtheria and scarlet fever. In the case of diphtheria, where the discovery of the causative organism, about 30 years ago. opened up a great field for research into infectious disease, progress has been very rapid. The most recent investigations have proved of extreme importance from the public health point of view since they embody certain aspects of preventive medicine which particularly appeal to a local authority. Taking diphtheria as an example, the work is based on the fact that a certain proportion of the population is naturally immune from the disease, while the remainder is susceptible. This susceptibility to the disease can be determined by a simple test known as the Schick test, which depends upon the fact that a small dose of diphtheria toxin (i.e., the poison elaborated by the microbe of diphtheria) injected into the skin of an individual is followed by a slight local reaction in a susceptible case, while there is no such reaction in the immune. Those who show the reaction and are therefore liable to take diphtheria, are termed "Schick positives," and on them a protective immunity may be conferred by inoculation of a mixture of toxin and antitoxin. The test is very simple and neither it nor the subsequent inoculations cause any particular distress to the individual. The results so far have been very 10 encouraging, and the immunity conferred is of at least two years duration. Most of the large fever hospitals have adopted it for their medical and nursing staff, and certain local authorities and large institutions have made practical use of it, particularly in children, with very encouraging results. Time is too short to permit statistics being of value, but the results obtained in certain areas seem to justify its use by local authorities in general. In the case of scarlet fever, the research work is not so complete, and it is only in the last two years that the Dicks in America have evolved a practical method of immunisation. The technique is practically similar to that already mentioned in diphtheria, the test in this case being termed the Dick test after the name of its authors. It has been tried on a small scale, chiefly in fever hospitals, with satisfactory results, but a practical estimate of its value as a universal protective measure cannot yet be made. Still more recent trials have been made of simultaneous inoculations for scarlet fever and diphtheria, and, if these are successful, immunity from both diseases would be conferred by a simple series of inoculations—a matter of very practical importance to the community. Sanitary administration has continued much on the same lines as in previous years. The housing shortage is still the chief problem in this Borough, and so long as this shortage continues it is impossible to obtain the full benefit of the work of the Sanitary Inspectors in improving the condition of the existing houses. It has not been possible, for example, to make closing orders on some houses requiring such procedure, and we have had to be content with palliative measures because any other action would render subsequent proceedings more difficult. Overcrowding appears to be slightly less than it was, but many families are still living under unsatisfactory conditions. 11 Increasing attention is being given each year to the supervision of the food supplies. During 1925 particular attention was paid to the conditions under which milk is produced and sold in the Borough and under which food is prepared for sale in restaurants and eating houses. The general demand for the sale of fresh milk in bottles has increased rapidly of late, and rightly so. If proper methods are used it means the supply of clean, fresh milk, in a clean bottle, properly filled and sealed under clean conditions. The idea fails if any of these points are not strictly adhered to. Experience has shown that the weakest link in the chain is the cleanliness of the bottle. If the bottle is not properly cleansed, the object, namely, prevention of contamination between the dairy and the house, is not attained. Valuable assistance to the work of this Department would be given if every housewife took steps, firstly, to ensure that the milk bottle leaves her house as clean as she can make it, and, secondly, to ascertain how her dairyman cleans his bottles ; and, if not satisfied with his methods, transfer her patronage to some other local dairyman who conducts his business in a cleaner and more wholesome way. When the new Milk and Dairies Order comes into force, the powers of local authorities in dealing with this aspect of the milk problem will be considerably amplified. The results of the maternity and child welfare work during the year and during the quinquennium speak for themselves. The attendances at the welfare centres have increased and now appear to have reached a maximum so long as this work of the Council is continued on the present lines. The various tables show, in a remarkable way, the saving in infant life which is demonstrated by the fall in the infantile mortality rates and in the rate of fall in the deaths of children under five years of age. If the various tables which appear in the 12 vital statistics section of the report are studied it will be noticed that, speaking in broad numbers, less than per cent. of all children born in the Borough have now the prospect of not attaining the age of five years, whereas a decade ago, 12½ per cent. died before reaching that age. In that period the infant mortality rate has diminished from 86 to 57. The first Health Exhibition organised by the Council, on its own health activities and those of the voluntary organisations working in the Borough, was held during the year. Judged by the number of attendances, it was greatly appreciated by the inhabitants of the Borough, and, demonstrating as it did in a simple way the various activities, must have been of great educational value to many. The organisation of such an exhibition means the expenditure of a large amount of time and energy and cannot be successfully accomplished without the active co-operation of the various organisations and individuals in the Borough, and we are indebted to all who helped to make it such a success. In conclusion, I take this opportunity of saying how much pleasure it gives me to express my appreciation of the keen, conscientious and able manner in which the staff of the Health Department have carried out their work. I have again to record my acknowledgements for the kindness and consideration which I have received from members of the Council and particularly from the members of the two Health Committees, to all of whom I accord my thanks. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JOHN MACMILLAN. 13 Twenty-fifth Annual Report on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH, Year ending 31st December, 1925. SECTION I.—NATURAL AND SOCIAL CONDITIONS OF THE AREA. Area. The Metropolitan Borough of Woolwich includes the three Civil Parishes of Woolwich, Plumstead and Eltham. The area of the Borough, including land and enclosed water, is 8,282 statute acres. The area of Woolwich Parish is 1,135 acres, Plumstead Parish 3,387 acres, and Eltham Parish 3,760 acres. In addition to this the area covered by the Thames amounts to approximately 645 acres. 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; the civilian populations of the parishes being respectively—Woolwich, 32,097 ; Plumstead, 75,902, and Eltham, 28,308. In 1925 the civilian population was estimated by the Registrar-General to be 140,740, and the total population, 145,440. The figures of the RegistrarGeneral are based on the adjusted 1921 Census figures, but 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. My own estimate of the civil population of the Borough is 141,690, but, in view of the necessity for presenting comparable statistics from year 14 to year, the Registrar-General's figures have been taken for the purposes of this report. In estimating the populations 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. The estimated figures are as follows :— TABLE No. 1. Estimated population. Woolwich 32,494 West Plumstead 40,830 East Plumstead 35,589 Eltham 31,827 140,740 The above figures have been used throughout the report in calculating the rates in the Borough and in the various registration districts. The civilian population of the various registration districts of the Borough at each Census since 1901, and also the estimated populations for the years 1922-1925, are as follows:- TABLE No. 2. 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 30,953 139,980 1925 32,494 40,830 35,589 31,827 140,740 *Census years. 15 In 1891, the Census figures were as follows :— Woolwich, 40,848 ; Plumstead, 52,436 ; Eltham, 5,710. Physical Features and General Characteristics of the Area. In the physical configuration of the Borough the outstanding feature is Shooters Hill which rises over 400 feet above sealevel. It is composed entirely of London clay, but on its summit there is a small cap of gravel. At a little lower level on the Woolwich and Plumstead side, there is the well-marked plateau of Woolwich and Plumstead Commons due to the erosion of London clay from off the pebble beds. Lower down still there is the alluvial plain of the Thames. Southward, through Eltham and Lee, the land, after sloping downwards from Shooters Hill, rises slightly again in Eltham and then falls away towards New Eltham and Lee, ultimately rising as it approaches Chislehurst. In the main this area is composed of London clay. The Borough may be described as one of the suburban working-class Metropolitan Boroughs. Much of the Borough is unbuilt on. In Woolwich, the number of persons per acre is 32; in Plumstead, 22; in Eltham, 8, and in the Borough 17, compared with a London average of 60. Number of Inhabited Houses. The number of inhabited houses in 1921 was 26,048, 5,323 of which were in Woolwich, 14,716 in Plumstead, and 6,009 in Eltham. Number of Families. At the time of the Census the number of separate occupiers was 33,647, viz., 7,678 in Woolwich, 19,294 in Plumstead, and 6,675 in Eltham. Rateable Value. The rateable value of the Borough at October, 1925, was £986,001, and at that time the product of a 1d. rate was £4,108. Causes of Sickness and Invalidity. The incidence of the infectious fevers and other notifiable diseases is referred to 16 in detail in the appropriate sections of the report. So far as other diseases are concerned there were no noteworthy epidemics. So far as invalidity is concerned, it is very difficult indeed for a Medical Officer of Health to write on this matter because he has no direct access to the records dealing with this question, and so his knowledge must of necessity be largely a matter of impressions gained either from the local medical practitioners or from the death returns. I do not think that the causes of invalidity call for any special mention in this report. Poor Law Relief. I am indebted to the Clerks of the Woolwich and Lewisham Guardians for the following particulars regarding out-door relief—medical and ordinary— together with information as to the number of patients admitted to their respective institutions for the year ending 31st December, 1925. The figures furnished by the Clerk of the Woolwich Guardians relate to the area (including Charlton) for which that body is responsible, but the figures furnished by the Clerk of the Lewisham Guardians relate to Eltham parish only. The cost of out-door relief for the year was £113,029 16s. 10d. The average number of persons in receipt of such relief each week was 6,016. The cost of drugs and other medical necessaries, including surgical appliances, was £966. 3,014 medical orders were issued for attendance at the Dispensaries and 1,906 for the attendance of medical officers at the patients' homes. In Eltham, persons on permanent out-relief are entitled to medical relief without a special medical order. The average total number of Woolwich residents who were maintained at the Woolwich Infirmary and the Lewisham Hospital, each day during the year, was 302. Occupations of the Inhabitants. The following Table sets out under generalised headings the total number of males and females engaged in occupations at ages from 12 years 17 upwards at the time of the Census. The figures in the last two columns relate to males and females respectively, and show the proportion per 1,000, 12 years and upwards, engaged in various callings and occupations :— TABLE No. 3. Occupations of Woolwich Inhabitants (over 12 years). Males Females Proportion per 1,000. Males Females Fishermen 2 - 0 - Agricultural occupations 414 30 8 2 Mining and quarrying occupations 15 — 0 — Makers of coke, lime, cement, etc. 12 4 0 0 Makers of bricks, pottery, glass, etc. 106 18 2 1 Workers in chemicals, paints, etc. 1,223 66 23 4 Metal workers 8,525 214 157 14 Workers in precious metals 80 11 1 1 Electrical apparatus makers, fitters, etc. 1,894 923 35 59 Makers of watches, clocks, etc. 187 14 3 1 Workers in skins; leather goods makers 219 28 5 2 Textile workers 46 62 1 4 Makers of textile goods and articles of dress 645 1,823 12 116 Makers of foods, drinks and tobacco 528 189 9 12 Workers in wood and furniture 1,586 51 29 3 Paper workers; printers, etc. 416 140 8 9 Builders, bricklayers, etc. 1,488 3 27 0 Painters and Decorators 1,032 9 19 0 Workers in other materials 157 85 3 5 Workers in mixed or undefined materials (not elsewhere enumerated) 183 328 3 21 Workers in gas, water and electricity supply 138 - 3 - Transport workers 4,583 307 85 19 Commercial and financial occupations 3,241 1,822 60 116 Public administration and defence 7,080 629 131 40 Professional occupations 1,358 1,605 25 102 Persons employed in entertainments, etc. 210 118 4 7 Persons employed in personal service 1,344 4,451 25 282 Clerks and Draughtsmen 2,249 2,438 42 155 Warehousemen, Storekeepers and Packers 1,198 217 22 14 Stationary Engine Drivers, Dynamo and Motor Attendants 738 - 14 - Other and undefined 6,822 178 126 11 Total occupied 47,719 15,763 — 1,000 Total unoccupied 6,417 39,868 118 — Total occupied and unoccupied 54,136 55,631 1,000 — B 18 It will be observed that in calculating the proportions for males the Table deals with all males over 12 years, whereas, in the case of females, only those occupied are dealt with. This Table only shows how each 1,000 of our male and female population works, but it does not indicate certain features of interest which can only be seen by a comparative study of similar Tables produced for other London Boroughs and published by the Registrar-General in his report on the Census. Metal workers are most numerous in the SouthEastern area of London, and particularly so in Woolwich (157). The chief occupation concerned, that of fitter (29), is far more important in Woolwich than elsewhere, and machine tool workers are also far more frequent (27) there. General labourers are most numerous in Greenwich (120), Poplar (110) and Woolwich (108). In South-east London both horse and motor drivers are much below the average; in Woolwich (9) and (7) respectively. In the making of electric fittings there are two main centres in London: the larger is in the South-East and includes Woolwich, Greenwich and Deptford. Thirty-five per 1,000 males, and 59 per 1,000 occupied females are engaged in this occupation in Woolwich. 19 SECTION II.-VITAL STATISTICS. The chief Vital Statistics since 1901 are given in the following table:. TABLE No. 4. Year. Population estimated to middle of each Year. Births. Nett deaths belonging to the District. Nett. Under 1 year. At all Ages. Number. Rate. Number. Rate per 1,000 Net. Births. Number. ate. 1 2 3 4 5 6 7 8 1901 117,652 3536 30.1 457 129 1709 14.6 1902 119,285 3734 31.3 467 125 1837 15.4 1903 117,842 3684 31.3 398 108 1638 13.9 1904 118,456 3535 29.8 477 135 1763 14.9 1905 118,589 3546 29.9 362 102 1604 13.5 1906 119,143 3549 29.8 388 109 1668 140 1907 119,704 3330 27.8 373 112 1616 13.5 1908 122,258 3176 260 300 94 1516 12.4 1909 120,227 2947 24.5 242 82 1587 13.2 1910 121,197 2842 23.6 242 85 1418 11.7 1911 121,487 2810 23.1 272 97 1566 12.9 1912 121,932 2776 22.8 208 75 1456 11.9 1913 122,382 2833 231 228 80 1549 12.7 1914 122,431 2838 23.2 241 85 1706 13.9 1915a 138,200 2839 21.9 268 94 1837 14.2 b 129,505 1916 a 141,783 3068 23.5 213 69 1704 131 b 130,313 1917 a 147,078 2718 20.6 216 79 1566 11.9 b 131,942 1918a 150,650 2548 190 270 106 2100 15.6 b 134,453 1919a 141,918 2737 20.1 235 86 1679 12.3 b 136,237 1920 a 140,000 3658 26.9 224 61 1487 10.9 b 135,904 1921 a 141,700 3197 23.2 197 62 1594 11.6 b 137,604 1922 a 142,350 2941 21.3 184 63 1603 11.6 b 138,254 1923 a 143,530 2867 20.5 123 43 1387 9.9 b 140,000 1924 a 144,400 2590 18.5 168 65 1543 110 b 139,980 1925 a 145,440 2582 18.3 141 55 1519 10.8 b 140,740 a Total population. b Civil population. 20 BIRTHS. It is the duty of a parent or other person present at the birth to notify the Medical Officer of Health within 36 hours of a birth taking place, and it is further a statutory duty to register such birth within six weeks. During the year 2,650 births were registered in the Borough, 1,380 being boys and 1,270 girls. In order to obtain a correct birth rate it is necessary to deduct from these figures children born in Woolwich whose parents normally reside elsewhere, and to add to these figures children bom outside the Borough whose parents normally reside in the Borough. In official language these are known as outward and inward transfers respectively. When the necessary corrections are made the number of Woolwich births becomes 2,582. The estimated figures for the different registration districts are as shown in Table No. 5 as follows:. TABLE No. 5. Registration Districts. Males. Females. Total Births. Woolwich 398 354 752 West Plumstead 364 331 695 East Plumstead 301 272 573 Eltham 289 273 562 The Borough 1352 1230 2582 The following Table, No. 6, shows the birth rates in each registration district (after correction for outward and inward transfers) for each quinquennium since 1901 and for each year since 1921. 21 TABLE No. 6. Period Woolwich West Plumstead East Plumstead Eltham The Borough 1901.1905 30.1 30.1 330 25.7 30.5 1906.1910 28.8 250 26.7 21.8 26.3 1911.1915 26.6 211 23.2 17.6 22.8 1916.1920 24.5 19.6 22.3 22.3 22.0 1921.1925 25.4 18.5 18.5 19.7 20.4 1921 28.9 21.4 220 211 23.2 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 1925 23.1 17.0 16.1 17.6 18.3 Notification of Births. During the year 2,612 live births were notified. This is nearly 99 per cent. of the registered births and compares with 97 per cent. in 1924. 1,344 notifications were received from midwives, 208 from doctors, 626 from the British Hospital for Mothers and Babies, 185 from the Military Families Hospital, 44 from the Woolwich Infirmary, 55 from other institutions (including midwives' homes in the Borough), and 150 from other persons. In addition to these, 48 notifications were received from the Medical Officer of Health for Lewisham, 29 from the Medical Officer of Health for Greenwich, and 28 from other Medical Officers of Health. 76 still births were notified. It is known that 843 births took place in institutions either within or without the Borough, so that the percentage of institutional midwifery for the Borough as a whole was 32.6, the figures 22 in the various districts being:-Woolwich, 40 per cent., West Plumstead, 30 per cent.; East Plumstead, 31 per cent., and Eltham 28 per cent. The British Hospital for Mothers and Babies is situated in Woolwich Parish, and it will be noticed that the percentage figures are much higher in this parish. As institutional midwifery is more expensive than home midwifery, these figures, which are an increase on those of last year, indicate that there is a growing demand for this service. The following Table, No. 7, shows the number of corrected births each year since 1921, the number of live and still births notified, 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. 1921 3197 3011 91 94 23.2 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 1926 2582 2612 76 99 18.3 180 18.3 Natural Increase of Population. This term means the excess of births over deaths. In 1923 it was 1,480 ; in 1924 i t was 1,047, and in 1925 it was 1,063. 23 Illegitimate Births. The number of illegitimate births registered was 74. There were 21 inward transfers and 19 outward transfers, making a nett figure of 76, equivalent to 29 per 1,000 births. MARRIAGES. There were 1,096 marriages (1,097 in 1924). The marriage rate was 15.06, as compared with 17.2, 16.5, 16.9 and 15.7 in the four preceding years. DEATHS. The total deaths registered in the district were 1,306. This figure includes 102 non.residents who died in the district but does not include 315 residents who died outside the Borough. When allowance is made for inward and outward transfers, the nett death figure of 1,519 is obtained. The death rate for the year was 10 8. In 1924 the corresponding rate was 110. The death rate, 10'8, is the sixth lowest amongst the Metropolitan Boroughs, Hampstead taking first place with 10.1. In 1925, the death rate for England and Wales was 12.2 for London, 11.7, and the mean death rate for 105 Great Towns was 12.2. The following Table, No. 8, shows the death rates in each registration district (after correction for outward and inward transfers) for each quinquennial period since 1901 and for each year since 1921. 24 TABLE No. 8. Period. Woolwich West Plumstead East Plumstead Eltham The Borough 1901.1905 171 13.8 131 10.6 14.4 1906.1910 15.0 130 11.5 10.3 13.0 1911.1915 15.8 13 3 11.8 9.1 13.1 1916.1920 16.4 131 11.3 9.7 12.6 1921.1925 13.4 11.7 10.1 8.4 11.0 1921 13.4 131 10.6 8.5 11.6 1922 13.9 11.7 10.5 10.1 11.6 1923 12.2 10.5 9.7 6.9 9.9 1924 13.9 11.5 10.1 8.5 110 1926 13.6 11.6 9.7 8.2 10.8 The seasonal mortality in the four quarters of the year was as follows:-First quarter, 131; second quarter, 9 6; third quarter, 9T; fourth quarter, 11 3. 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. 9. Number of Deaths. Hospital or Institution. Deaths. Poor Law Institutions 375 London General Hospitals 84 Mental Hospitals 37 Special Hospitals 50 Infectious Diseases Hospitals 35 Sanatoria and Tuberculosis Institutions 24 Cottage Hospitals and Nursing Homes 30 635 The following Tables are self-explanatory. 25 Table No. 10.-Birth-rate, Death-rate, and Analysis of Mortality during the Year 1925. 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. Small-pox. Measles. Scarlet Fever. Whooping cough. Diphtheria. Influenza. Violence. Diarrhœ a and Enteritis (under 2 Years)., Total Deaths under One Year. Causes of Death certified by Registered Medical Practitioners. Inquest Cases. Uncertified Causes of Death. England and Wales 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 0.32 0.47 8.4 75 92.1 6.9 1.0 105 County Boroughs and Great Towns, including London. 18.8 12.2 0.01 0.00 0.17 0.03 0.18 0.09 0.30 0.43 10.8 79 92.1 7.3 0.6 157 Smaller Towns (1921 Adjusted Populations 20,000 -50,000). 18.3 11.2 0.01 0.00 0 .15 0.02 0.14 0.06 0.31 0.38 7.6 74 93.0 5.9 1.1 London 18.0 11.7 0.01 0.00 0.08 0.02 0.19 0.11 0.23 0.46 10.6 67 91.1 8.9 0.0 WOOLWICH 183 10.8 0.03 0.00 0.06 003 0.12 009 0.21 0.24 0 .05 55 90.7 9.3 0.0 26 TABLE No. 11. Deaths of Woolwich Residents Registered during the Calendar Year 1925, classified by age and cause. 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. All causes 1519 141 32 34 46 80 201 395 312 278 Enteric Fever 4 .. .. .. .. .. 1 3 .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Measles 9 3 3 2 1 .. .. .. .. .. Scarlet Fever 4 .. .. 2 2 .. .. .. .. .. Whooping Cough 17 7 4 5 1 .. .. .. .. .. Diphtheria 13 1 2 3 7 .. .. .. .. .. Influenza 30 1 .. .. 1 2 4 12 9 1 Encephalitis lethargica 3 .. .. .. 1 1 1 .. .. .. Meningococcal Meningitis 2 2 .. .. .. .. .. .. .. .. Tuberculosis of Respiratory System 100 1 .. .. 2 38 79 36 3 1 Other Tuberculous Diseases 27 8 3 2 5 5 2 1 1 .. Cancer, malignant disease 193 .. .. .. 1 .. 10 113 49 20 Rheumatic Fever 4 .. .. .. 2 .. 1 1 .. .. Diabetes 5 .. .. .. .. .. .. 3 2 .. Cerebral Haemorrhage, &c. 78 .. .. .. .. .. 4 15 27 32 27 TABLE No. 11.-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 197 .. 1 .. 6 4 14 65 70 37 Arterio.selerosis 59 .. .. .. .. .. 1 7 30 21 Bronchitis 110 10 1 2 .. 1 4 17 29 46 Pneumonia (all forms) 97 18 9 6 2 3 11 18 22 8 Other Respiratory Diseases 16 .. 1 .. 1 .. 4 5 5 .. Ulcer of Stomach or Duodenum 19 .. .. .. .. .. 10 8 1 .. Diarrhoea, &c. 9 6 1 1 .. .. .. .. .. .. Appendicitis and Typhlitis 12 .. .. 1 2 3 3 3 .. .. Cirrhosis of Liver 4 .. .. .. .. .. 1 2 1 .. Acute and Chronic Nephritis 44 1 .. .. 2 2 5 16 13 5 Puerperal Sepsis 3 .. .. .. .. 1 2 .. .. .. Other accidents and diseases of pregnancy and parturition 6 .. .. .. .. 1 5 .. .. .. Congenital debility and malformation, premature birth 59 58 .. .. .. 1 .. .. .. .. Suicide 14 .. .. .. .. 2 3 7 2 .. Other deaths from violence 34 2 4 1 3 3 9 5 2 5 Other defined diseases 287 23 3 9 7 13 27 58 46 101 Causes ill.defined or unknown .. .. .. .. .. .. .. .. .. .. 28 TABLE No. 12. 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 1925. Causes of Death. Male. Female. Woolwich. Plumstead. Eltham. Deaths in Public Institutions. West. East. In Borough. Outlying Institutions. Residents. Non. Residente. All causes 769 750 441 472 346 260 334 74 301 Enteric Fever 2 2 2 .. 2 .. 1 .. 3 Small-pox .. .. .. .. .. .. .. .. .. Measles 5 4 3 2 1 3 .. .. 5 Scarlet Fever 3 1 2 2 .. .. .. .. 4 Whooping Cough 8 9 5 2 3 7 2 1 4 Diphtheria 9 4 8 .. 2 3 .. .. 12 Influenza 17 13 6 10 8 6 11 1 1 Encephalitis Lethargica .. 3 .. 1 1 1 .. .. 3 Meningococcal Meningitis .. 2 1 1 .. .. .. .. 1 Tuberculosis of Respiratory System 91 69 46 53 40 21 37 .. 32 Other Tuberculous Diseases 14 13 7 4 7 9 6 .. 13 Cancer, Malignant disease 83 110 59 51 45 38 36 10 40 Rheumatic Fever 1 3 2 1 1 .. 1 .. 1 Diabetes 3 2 1 3 1 .. .. 2 1 Cerebral Haemorrhage, &c. 33 45 28 27 10 13 25 3 5 29 TABLE No. 12.-continued. Causes of Death. Male. Female. Woolwien. Plumstead. Eltham. Deaths in Public Institutions. In Borough. West. East. Residents. Non. Residents. Outlying Institutions. Heart Disease 96 101 44 60 56 37 38 10 19 Arterio.sclerosis 47 12 15 21 10 13 10 3 8 Bronchitis 51 59 38 28 33 11 18 4 8 Pneumonia (all forms) 55 42 35 31 15 16 13 4 13 Other respiratory diseases 7 9 3 6 5 2 1 1 4 Ulcer of Stomach or Duodenum 10 9 6 7 2 4 2 1 8 Diarrhoea, &c. 3 6 3 4 1 1 4 1 2 Appendicitis and Typhlitis 9 3 2 3 5 2 1 1 11 Cirrhosis of Liver 4 .. 2 1 1 2 .. .. Acute and Chronic Nephritis 20 24 10 22 7 5 11 5 7 Puerperal Sepsis .. 3 1 .. 2 .. 1 .. .. Other Accidents and Diseases of Pregnancy and Parturition .. 6 1 1 2 2 2 2 1 Congenital Debility and Malformation, Premature Birth 33 26 17 15 14 13 17 1 10 Suicide 10 4 3 5 3 3 1 1 1 Other Deaths from Violence 24 10 10 8 8 8 11 1 9 Other Defined Diseases 131 156 81 103 61 42 83 22 75 Causes ill.defined or unknown .. .. .. .. .. .. .. .. .. 30 CAUSES OF DEATH. Table No. 11 shows that 197 deaths were due to Heart Disease, 193 to Cancer, 160 to Pulmonary Tuberculosis, 110 to Bronchitis, 97 to Pneumonia, 78 to Cerebral Haemorrhage, 59 to Congenital Debility and 59 to Arterio.sclerosis. There were only 30 deaths from Influenza and 9 from Measles, compared with 59 and 28 respectively in 1924. 65 per cent, of all deaths occurred in persons over 45 years of age. Tuberculosis and Infectious Fevers. These are referred to in the section dealing with the notifiable infectious diseases. Influenza. There were 30 deaths from Influenza, 17 males and 13 females. Three deaths occurred in January, 10 in February, 9 in March, 3 in April, 1 in May, 2 in June and 2 in December. Respiratory Diseases. The following Table No. 13 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 lowdying districts of the Borough. TABLE No. 13. 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 2.7 125 341 1916 130 130 13 273 2.1 60 21.9 1917 113 142 17 272 21 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 22 131 1924 142 95 10 247 1.8 65 26.3 1925 110 97 16 223 1.6 47 21.1 31 Heart Disease. The deaths from heart disease, which numbered 149 in 1921, 178 in 1922, 166 in 1923, and 173 in 1924, numbered 197 in 1925. In that year, all except 25, were of persons over 45 years of age. Diarrœha. Nine deaths were certified as due to diarrhœal diseases and 7 of these occurred in children under 2 years of age. In 1924 the figures were 17 and 10 respectively. Maternal Mortality. The deaths from Puerperal fever and other causes associated with childbirth are dealt with in the Maternity and Child Welfare section of the report. Violence and Suicide. Thirty.four deaths, 24 males and 10 females, occurred from violence apart from suicide. Fourteen deaths were due to suicidal causes, 10 males and 4 females. Cancer. The total number of deaths was 193, of which 83 occurred in males and 110 in females. At all ages there was a preponderance of deaths among females. The deaths certified as due to Cancer or Malignant disease each year since 1921 are shown in Table No. 14. TABLE No. 14. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 1921 76 106 182 1.34 11.42 1922 72 94 166 1.20 10.36 1923 91 84 176 1.25 12.62 1924 87 94 181 1.29 11.73 1925 83 110 193 1.37 12.71 The following Table No. 15 shows the seat of primary disease in all deaths from Cancer (including all other specified malignant tumours). 32 TABLE No. 15. Seat of Primary Disease. Males. Females. Total. Deaths in Hospital. Tongue 6 - 6 4 Mouth and Jaw 8 - 8 3 Pharynx - - - - (Esophagus 5 1 6 5 Stomach 18 15 33 10 Liver and Gall Bladder 6 10 16 3 Intestines 10 16 26 10 Rectum 3 13 16 7 Uterus - 21 21 6 Ovary - 2 2 - Breast - 19 19 5 Vagina and Vulva - - - - Skin - - - - Larynx 5 - 5 4 Lung 2 2 4 1 Pancreas 1 1 2 2 Neck - - - Bladder 4 - 4 3 Kidney 1 2 3 o Other specified organs 2 1 3 2 Abdominal Cavity (unspecified) 1 1 2 1 Other and undefined 5 - 5 o Sarcoma 6 6 12 6 83 110 193 76 The death rate in quinquennial periods for each Parish and for the Borough are shown below, and the increase which has taken place in Woolwich Parish is well marked. TABLE No. 16. Death rates from Cancer in Quinquennial periods. Period Woolwich West Plumstead East Plumstead Eltham The Borough 1911.1915 .95 1.20 90 1.01 1.03 1916.1920 1.28 119 101 .88 1.10 1921.1925 1.52 1.37 114 109 1.29 33 Inquests. There were 141 inquests held on Woolwich residents during the year, compared with 141 in 1924, 128 in 1923, 144 in 1922 and 102 in 1921. DEATHS OF CHILDREN 1.5 YEARS OF AGE. The number of deaths of children between 1.2 years of age was 32, and between 2.5 years, 34. In 1924 these figures were 39 and 51 respectively. For the quinquennium 1921.5, the average figure for both age groups was 38. The causes of death are given in detail in Table No. 11. Below are set out Tables showing the variation in the rates of mortality in these age groups in the last three quinquennia. These rates have been calculated on estimated populations living at these ages and in stated groups of diseases. It will be noted that in children between 1.2 there has been a fall in the last ten years of 50 per cent. in the rates of mortality, the fall being more or less spread evenly throughout all groups of diseases. In the 2.5 years old group the fall has not been so uniform. There Was a slight rise in the quinquennium before this one, which increase was largely due to the influenza epidemic of 1918. The fall in this group is mainly in infectious fevers, tuberculosis, and respiratory diseases, but these diseases are subject to yearly fluctuations. c 34 TABLE No. 17. Child Mortality (1.2 Years). Death rates per 1,000 estimated age population from stated groups of diseases, in quinquennial periods. Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhceal Diseases. All other causes. Total Deaths. 1911-1915 2,581 7.67 2.87 8.76 2.56 4.96 26.82 1916-1920 2,536 6.86 1.42 8.28 .63 4.42 21.61 1921-1925 2,876 3.69 1.46 4.52 .49 2.99 13.15 TABLE No. 18. Child Mortality (2.5 Years). Death rates per 1,000 estimated age population from stated groups of diseases, in quinquennial periods. Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1911-1915 7,681 3.05 1.20 1.56 .26 1.30 7.37 1916-1920 7,547 2.70 1.09 1.54 .02 2.52 7.87 1921-1925 8,266 1.79 .61 .77 .22 1.23 4.62 INFANTILE MORTALITY. The number of deaths under one year of age was 141, compared with 168 in 1924 and 123 in 1923. The infantile mortality rate (deaths under one year per 1,000 births) was 35 55. This is the second lowest rate in London and is the second lowest rate in the records of the Borough. The following Table, No. 19, shows the infantile mortality rate in the Borough and registration districts for each quinquennium since 1901 and for each year since 1921:- TABLE No. 19. Period. Woolwich West Plumst.ead East Plumstead Elthara The Borough 1901-1905 138 99 128 97 120 1906-1910 110 89 93 91 98 1911-1915 103 76 83 68 86 1916-1920 94 70 70 81 79 1921-1925 63 46 62 59 57 1921 61 53 64 71 62 1922 68 52 80 46 63 1923 51 37 42 39 43 1924 79 42 68 70 65 1925 59 42 51 69 55 Tables are set out in the following pages which classify in various ways the causes of death during 1925, followed by two Tables which show the death rates from stated groups of diseases in each five.yearly period since 1901, and a comparative study of the rates in the four registration districts during the last five years. 36 It will be noted that in the last twenty years the re has been a drop of more than 50 per cent. in the infantile mortality rate, and that the decrease is particularly well marked in the case of developmental diseases, respiratory diseases, and diseases of the respiratory system. It will also be seen that there is a fall of just under 33 per cent. in the case of neonatal deaths, that is to say, in the first four weeks of life, and nearly 50 per cent. in the remainder of the year. These quinquennial tables probably best represent the general movement which is in progress. Causes of Death. The chief causes of death were as follows: Premature birth and debility, 58; Pneumonia, 18; Bronchitis, 10; Diarrhoea, 5; Tuberculosis, 9. Three deaths occurred from Measles, 7 from Whooping Cough and one from Diphtheria. In 1924, the corresponding figures were as follows:-Premature Birth and Debility, 59; Pneumonia, 25; Bronchitis, 15; Diarrhœa, 10; Tuberculosis, 6; Measles, 6; Whooping Cough, 7; Diphtheria, 0. Compared with 1924 the decrease in the rate is mainly among children over four weeks old and is most marked in the respiratory and miscellaneous groups. Of the neo.natal deaths the chief causes were Premature Birth, 25; Congenital Malformations, 9; Injury at Birth, 8, and Debility, 7. Deaths of Illegitimate Children. The number of deaths of illegitimate infants was 9. A comparison of the infantile mortality rates of legitimate and illegitimate infants shows that the rate for legitimate was 53 and for illegitimate, 118. 37 TABLE No. 20. INFANT MORTALITY, 1925. 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 .. .. .. .. .. .. .. 2 3 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. 1 4 .. 7 Diphtheria and Croup .. .. .. .. .. .. 1 .. .. 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. 2 2 .. 6 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. • • .. .. .. 2 1 .. 3 Meningitis (not Tuberculous) .. .. .. .. .. .. 1 .. 1 2 Convulsions .. .. .. .. .. 1 .. .. .. 6 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 4 2 1 3 10 Pneumonia (all forms) .. .. .. .. .. .. 7 4 .. 18 Diarrhœ a .. .. .. .. .. .. 2 .. .. 3 Enteritis .. .. .. .. .. 1 .. .. .. 2 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth 6 .. 2 .. .. .. .. .. .. .. Atelectasis 1 .. .. .. 2 .. .. .. .. 2 Congenital Malformation 7 .. 1 1 9 3 1 .. 1 14 Premature Birth 18 .. 5 1 25 5 1 .. .. 31 Atrophy, Debility and Marasmus 5 .. 1 1 7 1 4 .. 1 13 Other causes 1 2 1 .. 4 .. 4 2 1 11 39 6 12 4 61 21 29 16 14 141 Nett Births registered during Legitimate 2506 the calendar year Illegitimate 76 Nett Deaths registered during ( Legitimate 132 the calendar year Illegitimate 9 38 TABLE No. 21. INFANT DEATHS, 1925. Cause of Death. The Borough. Woolwich. West Plumstead. East Plumstead. Eltliam. M. F. M. F. M. F. M. F. M. F. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles 2 .. 1 .. .. .. .. .. 1 .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough 4 .. 2 .. .. .. .. 1 1 .. Diphtheria and Croup 1 .. .. .. .. .. .. .. 1 .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis 3 3 .. .. .. .. .. 1 3 .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases 2 1 1 .. 1 .. .. 1 .. .. Meningitis (not Tuberculous) .. 2 .. 1 .. 1 .. .. .. .. Convulsions 4 2 2 .. .. .. 2 2 .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 6 4 1 2 1 .. 3 2 1 .. Pneumonia (all forms) 9 9 4 3 2 2 .. 1 3 3 Diarrhœa 1 2 1 1 .. .. .. .. .. 1 Enteritis 2 1 .. .. 2 1 .. .. .. .. Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, Overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth 7 1 2 1 .. .. 2 .. 3 .. Atelectasis 2 .. 1 .. .. .. .. .. 1 .. Congenital Malformation 8 6 2 .. 1 2 3 .. 2 4 Premature Birth 17 14 6 6 5 2 3 5 3 1 Atrophy, Debility and Marasmus 7 6 1 2 4 1 .. 2 2 1 Other Causes 2 9 .. 3 .. 2 .. 2 2 2 77 64 24 20 16 13 12 17 25 14 141 44 29 29 39 39 TABLE No. 22. INFANT DEATHS, 1925. 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 .. 3 .. 1 .. 1 .. .. .. 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. 7 .. 3 .. .. .. 2 .. 1 Diphtheria and Croup .. 1 .. .. .. .. .. .. .. l Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. 6 .. .. .. 1 .. 1 .. 4 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. 3 .. 1 .. 1 .. 1 .. .. Meningitis (not Tuberculous) .. 2 .. 1 .. l .. .. .. .. Convulsions 5 1 2 .. .. .. 2 .. 1 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 10 .. 3 .. 1 .. 5 .. 1 Pneumonia (all forms) .. 18 .. 7 .. 4 .. 1 .. 6 Diarrhœa 1 2 .. 2 .. .. .. .. 1 .. Enteritis .. 3 .. .. .. 3 .. .. .. .. Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth 8 .. 3 .. .. .. 2 .. 3 .. Atelectasis 2 .. 1 .. .. .. .. .. 1 .. Congenital Malformation 9 5 .. 2 2 1 2 1 5 1 Premature Birth 25 6 9 3 5 2 7 l 4 .. Atrophy,Debility & Marasmus 7 6 .. 3 5 .. 1 l 1 2 Other Causes 4 7 1 2 .. 2 1 1 2 2 61 80 16 28 12 17 15 14 18 21 141 44 29 29 39 40 TABLE No. 23. INFANT MORTALITY, 1901—1925. Rates for stated groups of diseases and for stated age periods for the quinquennial periods 1901-1925. Period. Groups. Totals. Sub-divisions of Group "G." Death rates. A B C D E F G H 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. 1901-1905 7.26 4.33 8.48 19.30 24.62 .94 44.14 10.76 119.83 - - - - - 1906-1910 6.75 3.41 6.81 17.50 14.39 1.58 38.50 8.58 97.52 6.81 19.95 11.74 37.50 60.02 1911-1915 5.04 2.55 4.19 17.10 13.77 1.06 31.99 10.64 86.34 3.12 18.30 10.57 32.27 54.07 1916-1920 4.08 1.09 3.53 16.30 7.74 1.29 33.67 10.92 78.62 3.19 19.96 10.52 35.44 43.18 1921-1925 3.81 1.55 2.82 10.52 6.13 .70 23.07 8.75 57.35 4.30 12.84 5.93 25.47 31.88 The rates in each case are per 1000 births. 41 TABLE No. 24. INFANT MORTALITY, 1921-1925. Rates for stated groups of diseases and for stated age periods classified by Registration districts. District. Groups. Totals. Sub-divisions of Group "G." Death rates. A B C D E F G H 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. Woolwich 4.36 1.21 2.42 16.47 7 02 .97 23.98 7.02 63.45 2.66 16.47 4.85 25.18 38.27 West Plumstead 2.36 1.58 2.36 5.52 6.05 .79 20.50 6.57 45.73 4.21 9.46 6.83 19.97 25.76 East Plumstead 3.96 1.83 3.66 10.36 5.49 .31 24.99 10.97 61.57 2.74 14.63 7.62 29.26 32.31 Eltham 4.73 1.69 3.04 8.78 5.73 .67 22.96 11.48 59.08 8.44 10.13 4.39 28.70 30.38 The Borough 3.81 1.55 2.82 10.52 6.13 .70 23.07 8.75 57.35 4.30 12.84 5.93 25.47 31.88 The rates in each case are per 1,000 births. 42 SECTION III.— GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. In this section is set forth, more or less in tabular form, certain information relating to the Health services of the Borough. As a matter of convenience reference is made to other sections of the report where these services are dealt with in detail. i. Hospitals Provided or Subsidised by the Local Authority or by the County Council. (a) Tuberculosis. The London County Council are responsible for the institutional treatment of tuberculosis in London, and they maintain no institution in Woolwich. Certain statistical information relating to the number of persons who received institutional treatment for this disease during the year will be found on page 143. (b) Maternity. British Hospital for Mothers and Babies. The Council pay a grant of £1,500 per annum to this hospital for the provision of beds for maternity cases. Detailed information regarding this institution will be found on page 158 in the Maternity and Child Welfare Section. (c) Children. The Council's Home for Ailing Babies, Eglinton Road, Plumstead. Detailed information regarding this home will be found on page 157. (d) Fever and Small Pox. The fever hospital authority is the Metropolitan Asylums Board, who maintain no hospital in the Borough. Detailed information regarding the use made of the Asylums Board's hospitals by Woolwich residents is set out in Table No. 46. in the section dealing with the prevention and control of infectious disease. 43 (e) Other. There are no other hospitals in Woolwich maintained or subsidised by the Local Authority or by the County Council, but the Borough Council during the year received the approval of the Minister of Health to a scheme whereby the Council's Home for Ailing Babies will be closed and equivalent accommodation provided in the Woolwich War Memorial Hospital, which is nearing completion and will be opened in September, 1926. The Council's proposals provided for the maintenance of children's and maternity beds, but up to the present the Minister has only approved the scheme so far as it relates to children's beds. ii. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the Area. Woolwich and Plumstead Maternity Home, Vicarage Park, Plumstead. Detailed information regarding this home will be found on page 160 in the Maternity and Child Welfare Section of the report. iii. Ambulance Facilities. (a) Ambulances for persons suffering from infectious disease are provided by the Metropolitan Asylums Board, and patients are removed free of charge to the hospitals of that Board and to the London Fever Hospital. (b) Non-infectious and accident cases. The London County Council provide an ambulance service for the County of London for dealing with cases of accident and sudden illness arising in the streets or public buildings. This service has recently been extended to include maternity cases between the hours of 11 p.m. and 8 a.m., and urgent cases during the day time when accompanied by a doctor or a nurse. The ambulances of the Asylums Board are available, on payment, for the removal of non-infectious cases to hospitals or homes. 44 iv. Clinics and Treatment Centres. In tabular form is shown below a list of Clinics and Treatment Centres in the Borough. The list is the same as last year. Details regarding the work of the Maternity and Child Welfare Centres will be found on pages 151 and 152 of the report, and with regard to tuberculosis on pages 132 to 134. Persons requiring treatment for venereal disease have to attend one of the London Hospitals, the nearest to this Borough being the Seamen's Hospital, Greenwich, and St. John's Hospital, Lewisham. TABLE No. 25. 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 45 TABLE No. 25—continued. Situation. Nature of Accommodation. By whom provided. Sessions weekly. 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 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. v. Public Health Officers of the Local Authority. The names, qualifications, and year of appointment of the Health Staff at the 31st December, 1925, are shown below in the form requested by the Ministry of Health. Dr. A. Topping, Assistant Medical Officer of Health, resigned his appointment on the 31st January, 1925, and was succeeded by Dr. N. M. Maclennan. Mr. E. B. Pindar was appointed as Sanitary Inspector in the place of Mr. A. G. Potter, who was superannuated in 1924. The nursing and Domestic staff of the Home for Ailing Babies is not included. 46 Year appointName. Qualifications. Appointment. ed. †l918 Mackenzie, R E. W. M.B., D.P.H. Assistant Medical cer of Health for Maternity and Child Welfare †l921 Blackmore, F. J. C. M.R.C.S., L.R.C.P. Assistant Medical Officer of Health and Tuberculosis Officer. †1925 Maclennan, N. M. M.D., Ch.B., D.P.H. Assistant Medical Officer (General Purposes) 1891 Smith, Sir W. R. M.D., D.Sc., D.P.H., Public Analyst L.L.D., F.R.S.(Edin.) (Part time) *1890 Duck, A. G. F.S.I.A., Cert. Royal Chief Sanitary San. Inst., Cert. Meat tor and other foods *1896 Little, W. Cert. Royal San. Inst., Sanitary Inspector Cert. Meat and other foods *1897 Wood, W. Cert. Royal San. Inst. Sanitary Inspector *1901 Tedham, W. Cert. Royal San. Inst., Sanitary Inspector Cert. Meat and other foods *1904 Powell, T. Cert. Royal San. Inst., Sanitary Inspector Cert. Meat and other foods *1909 Shaw, H. Cert. Royal San. Inst., Sanitary Inspector Cert. San. Insp. Exam Board., Cert. San. Insp. Assocn., Cert. Meat and other foods *1920 Pendrill, H. W. Cert. San. Insp. Exam. Sanitary Inspector Board, Cert. Meat and other foods *1921 Harris, C. V. Cert. San. Insp. Exam. Sanitary Inspector Board, Cert. Royal San. Inst., Cert. Meat and other foods *1922 Couch, C. Cert. San. Insp. Exam. Sanitary Inspector Board, Cert. Royal San. Inst., Cert. Meat and other foods *1925 Pindar, E. B. Cert. San. Insp. Exam. Sanitary Inspector Board, Cert. Royal San. Inst., Cert. Meat and other foods. *1904 Farrugia, Mrs. A. Cert. San. Insp. Exam. Woman Sanitary Board, Cert. Royal spector San. Inst. 47 Year appointName. Qualifications. Appointment. ed. †1917 Latham, Miss K. Cert. San. Insp. Exam. Health Visitor Board, Cert. Royal San. Inst., C.M.B. Health Visitors' Cert., Cert. approved by Board of Education †1918 Garside, Mrs. M. Cert. San. Insp. Exam. Health Visitor and Board,C.M.B..Health Sanitary Inspector Visitors' Certificate †1919 Burnett, Miss W. Cert. San. Insp. Exam. Health Visitor Board, C.M.B. Health Visitors' Diploma, Cert. approved by Board of Education †l919 Tibbits, Miss E. Cert. San. Insp. Exam. Health Visitor Board, Health Visitors' Diploma, Cert. approved by Board of Education *†l919 Ware, Miss C. Cert. San. Insp. Exam. Health Visitor and Board., C.M.B., Cert. Sanitary Inspector approved by Board of Education †l920 Campbell, Miss M. Cert. General Hospital Health Visitor Training, C. M. B., Cert. San. Insp. Exam Board †l920 Morgan, Miss F. Cert. General Hospital Health Visitor Training, C. M. B., Health Visitors' Cert . Maternity and Child Welfare Cert. †1922 Seccombe, Miss W. Cert. General Hospital Health Visitor Training, C. M. B., Health Visitors' Cert. †1921 Castledine, Mrs. L. Cert. General Hospital Tuberculosis Visitor Training †l921 Hunter, Miss M. Cert. San. Insp. Exam. Tuberculosis Visitor Board, C.M.B., Health Visitors' Diploma †l921 Mahony, Miss N. Cert. General Hospital Tuberculosis Visitor Training, Health Visitors' Cert. †l923 Luffman, Miss M. Dispensing Certificate Clerk-Dispenser †1922 Morrison, Mrs. L. — Lay Organiser †1921 Cross, Miss S. Cert. General Hospital Matron, Home for Training, C.M.B. ing Babies 48 Clerks: Britter, A. Prescott, H. T. Collyer, H. M. Smith, H. S. †Edwards, Mrs. E. †Stephenson, Miss D. Pike, L. 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. †alary contributions made by Exchequer Grants. vi. Professional Nursing in the Home. At the end of the year there were four nursing associations in the district, as follows:— The Woolwich and Plum stead 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 Eltham and District Nursing Association became defunct on the 31st December, 1925, and at the present time there are no nursing arrangements in the larger part of Eltham. The areas in which these associations work are sufficiently well-defined by their names. These associations 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 is under the supervision of a medical man and the illness is not infectious. However, they will nurse cases of measles, whooping cough, ophthalmia neonatorum, tuberculosis, anterior poliomyelitis and puerperal fever. 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 49 patients requiring such assistance suffering from measles or ophthalmia neonatorum. The rates paid are as follows:— 1s. 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. One shilling and three pence is paid by the Council for each approved visit. vii. Midwives. Through the courtesy of Dr. Menzies, the County Medical Officer of Health, I have been able to ascertain that 37 midwives gave notice during the year of their intention to practise as midwives in the Borough of Woolwich. viii. Chemical Work. The Public Analyst is Sir W. R. Smith who carries out the laboratory work of the Council at the Royal Institute of Public Health. Detailed results of the analyses made will be found in Tables Nos. 42—45 in the section dealing with the inspection and supervision of food. ix. 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 1925, the Borough Treasurer tells me, the Council made 285 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:— D 50 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. 16 (2) Removal of faecal and offensive 26th Nov., 1901 matter. 39(1) Construction of closets, privies, ash28th June, 1893 pits, cesspools, and dung recep14th 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 51 Section. Date of Adoption. 19 Slaughterer of Poultry 22nd Dec., 1923 19 Soap boiler 25th Nov., 1907 19 Tripe Boiler 25th Nov., 1907 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 52 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. Health Week. The Council co-operated in the autumn in the general scheme of health propaganda throughout the country organised by the Health Week Committee. The following report presented by the Public Health and Housing Committee to the Council gives the details of the week's programme. In accordance with the Council's resolution of 1st April last, we arranged a suitable programme for Health Week, 1925. In this we were fortunate in securing the co-operation of the Works, Electricity and Housing Committees and the approval of the Minister of Health, not only in authorising the expenditure, but allowing a certain proportion to rank for grant under the Maternity and Child Welfare scheme. The chief object of a Health Week is education, and as a rule the programme consists of addresses and health talks, exhibits, and visits to municipal works and works of similar character. The Health Exhibition was the central focus of our activities, but we recognised that it was necessary to secure the co-operation of Ministers of Religion, Employers of Labour, School Teachers, individual townspeople and representative associations, to help us in many diverse ways in health propaganda work, and so make Health Week an effective force. To all of them we have extended, in accordance with the pleasure of the Council, our hearty thanks. 53 From Sunday morning, 27th September, when Health Week commenced, until Saturday night, when the exhibition closed, "Self-help in Health," which was our motive, was promulgated throughout the Borough. In organising the Exhibition, we resolved that we should show the people of the Borough what the Council is doing in health matters in conjunction with those bodies with whom it co-operates. The Exhibition therefore illustrated the Council's Maternity and Child Welfare scheme, the work of the Tuberculosis service, the general sanitary and epidemiological work of the Health Department, certain aspects of the work of the Works Department relating to health, the Woolwich housing scheme, with model furnished houses, the Remedial Clinic of the Woolwich Invalid Children's Aid Association, the work of the British Hospital for Mothers and Babies, and of the Woolwich and Plumstead Nursing Association, and how the Metropolitan Water Board keeps London's water pure, while the British Social Hygiene Council showed the measures to be taken against venereal diseases. The exhibit of the War Memorial Hospital consisted mainly of demonstrations on the types of equipment, particularly of modern X-ray and electro-therapeutic apparatus, to be used in the new hospital, and was specially interesting. Two trade exhibits were provided by Ambrosia, Ltd., and Virol, Ltd. In addition, we arranged for private demonstrations to medical practitioners and midwives of medical and nursing equipment through the agency of the Medical Supply Association. The Electricity Committee showed excellent demonstrations of the domestic uses of electricity, a feature which proved exceedingly popular. 54 We think we can say that the attitude of the public throughout showed that the Exhibition struck a new note, demonstrating a subject of such vital importance as public health in a manner interesting, popular and instructive. We were also able to arrange for distinguished openers each day, popular lectures, varied and interesting cinema pictures, for music recitals, and for the production of a Health Play, written by a member of the staff of the Health Department, and performed by the 3rd Royal Eltham Girl Guides, on three occasions, which proved not only delightful, but helpful in demonstrating, in a very simple way, certain cardinal principles of the laws of health. A pleasing feature of the Exhibition was the large number of entries for the various prize competitions which were organised. Many of the exhibits gave evidence of skill and ingenuity, while the children's paintings and the mothers' garments were of high merit. The popularity of these competitions was mainly due to the energetic work carried out at the Council's Maternity and Child Welfare Centres, where every effort had been made to encourage industry and interest among the mothers attending. We are grateful to the various firms who contributed to the prize fund, which enabled us to reward in a suitable manner the prize winners. The attendance during the five days totalled 25,551 (including 1,575 school children in conducted parties)—figures much in excess of what we had anticipated. The success of the Exhibition could not have been achieved without the united support of the Council, the keen co-operation of the staff, the allied associations and the voluntary workers, and we take this opportunity of thanking all those who so contributed for the energy and enthusiasm with which they carried out their share. 55 SECTION IV.—SANITARY ADMINISTRATION. It is the duty of the Council to see that the occupied dwelling houses in the Borough are sound; that they are provided with a proper and sufficient water supply; that they are reasonably clean and damp proof; that the drainage and sanitary conveniences are in working order, and that sufficient dust-bins are provided. Furthermore, provision has to be made for the removal of house refuse and scavenging. In addition, it is the duty of the Medical Officer of Health to report specially on the administration of the Factory Acts with reference to workshops and workplaces. For general sanitary and housing purposes the Council administer the following Acts and Regulations (and associated bye-laws). 1. The Public Health (London) Act, 1891. 2. The London County Council (General Powers) Acts, 1907, 1908, 1909, 1922. 3. The Housing Act, 1925. 4. Metropolis Management Acts, 1855. 5. Increase of Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923. 6. Factory and Workshop Act, 1901 (certain provisions). 7. Rats and Mice (Destruction) Act, 1919. 8. Rag Flock Act, 1911. Staff. For these purposes the Council has a sanitary staff consisting of a Chief Inspector, seven District Inspectors, one Woman Sanitary Inspector, and two part-time Women Sanitary Inspectors. There are two other Sanitary Inspectors who are engaged in Food and Drugs work and in the supervision of food. The vacancy created in 1924 by the super- 56 animation of Mr. A. G. Potter was filled by the appointment of Mr. E. B. Pindar, who started work on 25th March, 1925. Complaints. Under the provisions of the Public Health (London) Act, a complaint book is kept in the Health Department in which all complaints made of any infringement of the provisions of the Acts, or of By-laws made thereunder, or of any nuisance, are entered. During the year, 1690 complaints were received, compared with 1624 in the previous year. Twenty-four of these complaints related to the nonremoval of household refuse—9 in Woolwich, 8 in Plumstead, and 7 in Eltham. These complaints were all investigated, and suitable action was taken in each case. Closet Accommodation. A system of water conservancy is general throughout the Borough, except in the outlying portions, where no sewers are available and where, as temporary expedients, cesspools and earth closets have to be made use of The number of cesspools which were regularly emptied by the Works Department during the year was 31, 19 of which were situated in Plumstead and 12 in Eltham. Scavenging. Household Refuse. A further change took place in the arrangements for the removal of refuse in the Borough in 1925. At the beginning of the year house refuse was collected in the parishes of Woolwich and Eltham by the Works Department and in Plumstead by contractors. At the end of March the Works Department undertook the collection in Plumstead, and so the collection throughout the whole Borough is now done direct by the Council. During the year three electric vehicles were purchased for this purpose and by December the Council owned five such vehicles, four with an approximate capacity of 5 to 6 tons and one smaller one with an approximate capacity of 2 tons. The smaller vehicle was purchased for use in the hutments area of Eltham, 57 where the roads are not suitable for the working of heavy vehicles. In consequence of this improved method of transport it has been found possible to take all the refuse to the destructors at Plumstead and Woolwich, and shoots are no longer being used in the Borough, nor is any of the Borough refuse being dumped outside the Borough as in previous years. The Council have established a plant at the Plumstead Destructor for the conversion of clinker into road material, and during the year this material—a mixture of clinker and bitumen—has been used, with satisfactory results, on certain roads in the Borough. This experiment promises well. Trade Refuse. Arrangements also exist for the removal of inoffensive trade refuse, which is usually taken to the Plumstead Destructor for disposal. A charge of 5s. per load is made for this service. Offensive Trade Refuse. This is collected in specially made receptacles at a charge of 6d. a receptacle, and is conveyed to a firm in the east end of London for conversion into manure. As the removal and destruction of refuse is essential to the public and individual health, the regular performance of these services is a material advantage in protecting the health of the public against the evil results of decay., decomposition, putrefaction and contamination. Emptying of Street Gullies. During the year the Council made a start in abolishing the old method of emptying street gullies—by lifting the foul contents of the same by means of a hand ladle and transferring them on to the surface of the public highway, to be subsequently picked up by the slop cart—and is now using a method of mechanical suction, by vacuum power, direct from the gulley, through a hose pipe, into an enclosed receptacle tank, by means of which it is carried away direct. 58 Combined Drains. Twenty-six combined drains, connected with 151 houses, were reported on at various times throughout the year. When it has been ascertained that such a system is choked, investigation is made, and, if the stoppage is only of a temporary character and not due to any defect, the drains are cleared and the fact is recorded. Occasionally it is an economic policy to remedy defects while the examination is being carried out, and, if application is made by the owners at the time, the Council do the necessary work. During the year small repairs, costing in all £6 17s. 10d., were done in this connection, this amount being recovered from the owners concerned. If, however, reconstruction of the whole or of part of the system is necessary, the Council serves notices under the Metropolis Management Act, and in most cases the work is carried out by the Works Department at the expense of the owners. During the year reconstruction was necessary in only two cases involving connections with 18 houses. Sanitary Inspection of the Area. The Sanitary Officers' Order of 1922 imposes certain duties on Sanitary Inspectors. These duties may be classified as obligatory and optional. The following optional duties were carried out by the Inspectors during the year :— (a) The supervision of scavenging in Plumstead Parish until 31st March, 1925. (b) Duties imposed under the Rats and Mice (Destruction) Act, 1919. With regard to the routine obligatory duties of the Sanitary Inspectors, statistical tables are set out below showing the number of inspections made and the character and type of the nuisances abated. 3,223 intimation and 858 statutory notices were served during the year, compared with 3,638 59 and 1,048, respectively, during the previous year. There were 140 cases in which the owners neglected to comply with the statutory notices, and these were reported to the Town Clerk for legal proceedings. In 1924 the corresponding figure was 204. The Town Clerk followed his usual practice of writing a letter reminding the owner that he was in default in not complying with the requirements of the notice and requesting his attention forthwith. In consequence of these letters it was found necessary to issue only nine summonses, details of which are set out in tabular form in Table No. 28. TABLE No. 26. Inspections. Housing Survey—Houses Inspected 3,197 Complaints Investigated 1,690 Investigations re Infectious and Other Diseases 1,863 Registered Houses 775 Shops and Markets 2,050 Milk Shops 558 Bakehouses 124 Cowhouses 144 Slaughterhouses 35 Fried Fish Shops 243 Ice Cream Premises 751 Butchers' Shops 482 Premises where Food is Prepared (other than above) 829 Factories, Workshops, Workplaces 761 Outworkers' Premises 645 Homes re Verminous Cases 475 Homes re Scabies Cases 84 Women's Lavatories 235 Urinals accessible to the Public 308 Smoke Observations 16 Theatres and Cinemas 25 Tents and Vans 16 Special Inspections re Rats 148 Drainage Inspections 199 Drains Tested by Smoke Test 73 60 Drains Tested by Water Test 4 Rag and Bone Premises 24 Inspections re Mosquitoes 708 New Houses 241 Miscellaneous (unclassified) 2,311 Re-inspections 8,434 TABLE No. 27. Nuisances, etc., Abated. Dirty Conditions Cleansed 3,473 Damp Conditions Remedied 1,262 Defective Roofs 949 Dilapidated Walls and Ceilings 1,340 Other Dilapidations 878 Yards Repaved and Repaired 311 Choked and Defective House Drains 291 Defective Drainage Fittings 188 W.C. Flushing Apparatus 349 New w.c. Pans and Traps 128 Foul w.c. Pans Cleansed 109 Defective Ventilation 574 Lighting Conditions Improved 176 Verminous Rooms Cleansed 162 Dust Bins Provided 729 Cases of Overcrowding Remedied 16 Water Supply Reinstated and Improved 32 Offensive Accumulations Removed 152 Miscellaneous 117 Rats. During the year many investigations were made under the Rats and Mice (Destruction) Act, 1919. The Council, in accordance with the request of the Ministry of Agriculture and Fisheries, took part in the organised Rat Week in November. The co-operation of all the large firms in the Borough, together with the authorities of the Royal 61 Arsenal and Dockyard, was obtained. With the assistance of the officers of the Works Department, 6,432 baits were laid in 98 manholes of the old sewers likely to be infested with rats. Advice was given during the year to many persons as to the best means of dealing with rat nuisances. Mosquitoes. Complaints regarding mosquitoes in the Plumstead and Abbey Wood area were not so numerous during the year. The drainage of the marshes is probably beginning to have some effect. The Council's scheme of concreting the inverts of the ditches and providing smooth surfaces had progressed during the year, but is not yet completed. Rag Flock Act. This Act prohibits the use of dirty flock for the making of bedding and upholstery, and empowers the Sanitary Authority to take samples of rag flock, found on premises, being used or suspected of being used for this purpose. No samples were 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 duty of a Sanitary Inspector to observe any nuisances arising from smoke coming from premises other than private dwelling houses, and, although there were only 16 recorded observations, the chimneys may be regarded as subject to daily observation by the Inspectors. There were two complaints of smoke nuisance investigated. Legal Proceedings. In Table No. 28 which follows are set out details of the various prosecutions instituted during the year under the Public Health (London) Act and kindred Acts, for conditions associated with the sanitary circumstances of the area. 62 TABLE No. 28. Prosecutions under Public Health and kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1 1925. Feb. 13 (Adjourned from 9th Dec., 1924.) Non-compliance w i t h Magistrate's Order made on 21st July, 1924. 15, Nightingale Place. £3 3s. costs. 2 Feb. 19 Dirty passage ceiling; dirty, defective and damp walls and dirty ceiling of ground floor back addition room; dirty walls and ceilings of scullery and water closet, leaky roof of house; defective scullery floor; defective and dangerous ceiling of first floor front room. 40, Majendie Road Fined, £1. Costs £2 2s. Order to abate in 14 days. 3 Mar. 6 Leaky roofs of house, back addition and front bay window; defective eaves gutters of back addition and front bay window; defective ceiling of front room first floor. 129, Tewson Road Fined 10s. Costs 2s. Order to abate in 28 days. 2 May 14 Defective roof 216, Albert Road Work done. Withdrawn. Costs 10s. 6d. 6 May 14 Defective roof 218, Albert Road Work done. Withdrawn. Costs 10s. 6d. 6 May 14 No accommodation for cooking of food on the Second floor storey. First floor storey not provided with an efficient supply of water. Second floor storey not provided with an efficient supply of water. 98, Woolwich High Street Work done. Withdrawn. Costs 2s. 63 TABLE No. 28—continued. No. Date of Hearing. Offence. Situation. Result. 7 Aug. 27 Occupied dwelling house without a proper and sufficient supply of water. Hut in field off Occupation Lane Closing Order in 14 days. Costs £2 2s. 8 Oct. 6 Leaky roof of back addition building. 46, Timbercroft Lane Work done. Withdrawn. Cost3 7s. 6d. 9 Nov. 4 Dirty and defective walls and ceilings of first floor room and staircase and damp wall of ground floor room. 1, Cumberland Cottages, Princes Road Work done. Withdrawn. Factory and Workshop Act. The Medical Officer of Health is required to include in his Annual Report the 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 122. The number of inspections made was 761, which compares with 912 in 1924 and 881 in 1923. Sanitary defects were found in 81 instances. Bakehouses are specially reported on in the section dealing with the supervision of food. The following table is in the form adopted by the Home Office in order to ensure uniformity in the presentation of the figures. 64 TABLE No. 29. Factories, Workshops, Laundries, Workplaces, and .Homeworkers' Premises. 1.—Inspection. Including inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 211 14 — Workshops (Including Workshop Laundries) 525 9 — Workplaces 25 2 — Homeworkers' Premises 645 1 — Total 1406 26 — 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 12 12 - — Want of Ventilation 2 2 - — Overcrowding — — — — Want of drainage of floors 1 1 — — Other nuisances 9 9 — — Sanitary Accommodation insufficient 1 1 — — unsuitable or defective 23 23 — — not separate for sexes 2 2 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) — — — — Other offences —• — — — Total 50 50 — — 65 TABLE 29—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. Twice in the year. Once in the year. Failing to keep or permit inspection of Lists. Failing to send Lists. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109 Prosecutions (Sees. 109, 110). Lists. Outworkers. Lists. Outworkers. i 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Wearing Apparel 44 159 4 16 90 5 — — 236 17 6 4 — — Tennis Balls, etc. G 384 — — 63 51 — — 407 25 — — 1 — — Umbrella covering — — — — 2 — — — 2 — — — — — 50 513 4 16 155 56 — — 645 42 11 — 5 — — 66 Mortuaries and Cemeteries. In tabular form is set out below information with regard to 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 that regarding the Eltham churchyard through the courtesy of the Vicar of Eltham. Under the terms of the Home Office Order of 1893, twenty-four hours' notice of any proposed interment in Plumstead Churchyard has to be given to the Medical Officer of Health. When an exhumation licence is issued by the Home Office under the Burial Act of 1857, the Medical Officer of Health of the district is notified in order that he may be in a position to take any action which may appear to him to be necessary in the interests of public health. During the year three such notices were received from the Home Office, and every exhumation was supervised by officers of this department. MORTUARIES TABLE No. 30. Sun Street. Sun Street (Infectious) Eltham. All Mortuaries. Number of Bodies received: 1925 1924 (a) for inquest 82 — — 82 67 (6) for custody 7 — 1 8 15 89 — 1 90 82 No. of Post-Mortem Examinations 56 — — 56 50 CEMETERIES. TABLE No. 31. Number of Interments. 1923 1924 1925 Woolwich Cemetery 515 570 607 Plumstead Cemetery 599 656 634 Eltham Cemetery 153 196 188 Plumstead Churchyard 23 27 16 1,290 1,449 1,445 67 SECTION V.—HOUSING. General Housing Conditions. In all the three parishes of the Borough the large majority of the houses are occupied by the working classes. 89 per cent, of the dwellings are structurally undivided private houses, 4 per cent, are flats, maisonettes, tenements, etc., and 7 per cent, are attached to shops, warehouses, offices, etc. Most of the houses contain four to six rooms and over 63 per cent, of the population live in houses of this capacity. The houses in the Borough are situated in roads or streets, but there are a few in courts and alleys in the old parts of the Borough. There are no backto-back houses. During the war period the Government erected 1,298 houses of the garden city type in Eltham and 1,885 hutments in East Plumstead and Eltham. Shortage of Houses. There is a very serious shortage in the number of houses in the Borough. During the years 1901-1910, 453 new houses were built annually ; in the period 1911-1920, 533 were built annually, and in the last five years the numbers have been as follows:—202, 138, 172, 230 and 324, giving a yearly average of 213. Empty houses have been unknown in the Borough since the early days of the war. Woolwich is one of the peripheral London Boroughs and London's central population is always moving outwards. As a result of the operation of these factors one would expect to find the population of this Borough had less house room. A comparative study of the Census returns of 1911 and 1921 shows that in 1921, 141 per cent, of Woolwich families were living in two rooms, whereas in 1911 only 9.7 per cent, were so living. We find evidence also that 17.9 per cent, of Woolwich families in 1921 had available dwelling space of six or more rooms, whereas in 1911 25T per cent, had this accommodation. The number of persons living more than two per 68 room has increased from 6 3 per cent, in 1911 to 7.8 per cent, in 1921. Taking all these facts into consideration, it is not overstating the case to say that additional accommodation is now required for 6,000 persons—say 1,200 families, to make up the arrears; and, furthermore, that provision should be made for the natural increase which is taking place and for the substitution of houses for the existing hutments. Measures Taken or Contemplated to Meet the Shortage. In 1919 the Council purchased 334 acres of land at Eltham for the purposes of a housing scheme. All this land was not suitable for building, but all was required in order to provide the necessary open spaces for the area, and, therefore, 72 acres were appropriated for this purpose. On a basis of twelve houses to the acre, 3,144 houses might therefore be erected on this land. Certain deductions will have to be made for spaces required for schools, churches and shops. The Council commenced building in 1920, and, by the end of 1925, 635 houses had been completed and occupied, 74 were in course of construction, and sanction had been obtained to erect 91 more. Practically all the houses have been built of brick, but at the end of the year alternative methods of construction were being considered by the Housing Committee. Anticipated Changes in the Population. The development of arterial roads, the electrification of the Southern Railway, and the fact that Woolwich is one of the few metropolitan boroughs where there is any considerable amount of building land, leads to the natural conclusion that the population of this Borough will increase rapidly within the next few years, and that the area, particularly in Eltham, will be developed. The inclusion of Eltham in the Town Planning Scheme of the London County Council for South-East London has not come too soon. 69 Overcrowding. From the paragraph dealing with the shortage of houses it is easily deduced that much overcrowding exists in the Borough, and that this is more than it was a decade ago. This increased overcrowding is a legacy of the war; the influx of the number of munition workers required led to overcrowding of the dwellings at the time, and it is the remnants of these conditions which now exist. During the year nearly 400 cases of overcrowding were discovered, but it was only possible to remedy 16. The glaring cases which are sometimes described are rare, but when they do exist the solution is unfortunately difficult. When any. serious case of overcrowding comes to the knowledge of the Department, consideration is given to all the circumstances of the case and recommendations are sometimes made to the Allocation Sub-Committee of the Housing Committee, who may allocate a house or may recommend the case to the London County Council for accommodation on one of their estates. In all other instances every endeavour is made to secure a more equitable re-distribution of the persons in the house in which overcrowding exists, either by the provision of additional room for a sub-tenant, or by the use of a living room as a bed room. Fitness of Houses. General Standard of Housing in the Area. Most of the houses in Woolwich have been built in the last 30 or 40 years, and have come under the provisions of the London Building Acts. Most of them have a reasonable open space at the back ; they are rarely more than two storeys high, except in the older parts of the town, and they are maintained in a reasonable state of repair. In the main they are occupied by members of the working classes. Over 30 per cent, of the houses are occupied by owner-occupiers— particularly in Plumstead and Eltham—and the policy of the Council with regard to the Small Dwellings Acquisition 70 Acts will no doubt lead to a considerable increase in this percentage. The general standard, therefore, can be regarded as favourable when considered in relation to some of the more congested areas of London. The hutments, which were reasonable temporary dwellings, are not suitable for permanent dwellings. They are conconstructed partially of wood and partially of uralite, an impermeable material used for inner lining. They are cold in the winter and hot in the summer, and there is considerable condensation on the inner walls. 289 have recently been sold by the Government to a private owner. The character of the defects discovered, as a result of inspection, varies in different parts of the Borough, but, in the main, the defects are of the usual type that occur in working class dwellings. Decay, dilapidation and dampness are the defects found in the older houses, where often, in cases where the lease is about to expire, we find a rooted objection by the leaseholder to doing any extensive repairs to improve property succeeding to a freeholder. Action taken to Remedy Defects It has been found most convenient to obtain the abatement of nuisances under the provisions of the Public Health Acts. The details of the work carried out will be found in Table No. 27. In consequence of the shortage of houses it was not deemed expedient to take any action under the Housing Acts, and therefore no representations were made by the Medical Officer of Health during the year. In one case, viz., 98a, Woolwich High Street, the Council made a Closing Order on the 15th January, the house having been represented in December, 1924. Unhealthy Areas. No representations have been made under the Housing Acts, and no complaints were made that any areas were unhealthy. 71 Houses Let in Lodgings. By-laws relating to houses let in lodgings were made by the Woolwich Board of Health, and and the Plumstead Vestry, and are still applied to these parts of the Borough. No by-laws applying to Eltham have been made. In the administration of these by-laws, difficulties have arisen in the past mainly because of ambiguity in the definition of landlord, e.g., in many cases it may be interpreted as the tenant who sublets. Only in rare instances has it been possible to enforce structural provisions necessary on the weekly tenant, and so the action required has been taken under the Public Health Act against the owner. This difficulty will disappear when the new by-laws, made by the London County Council under the Housing Act of 1925, and applicable to all London, receive the approval of the Minister of Health. Incidentally they will abolish registration. In statistical form is given below information relating to the action taken with regard to houses let in lodgings during the year. TABLE No. 32. On register at beginning of year 394 On register at end of year 325 Inspections made 775 Notices served 183 Prosecutions Nil. Tents and Vans. By-laws regulating the use of these were made by the Council in 1903. The number of these habitations is, fortunately, very small. There are three small permanent colonies of tent and van dwellers, numbering 18 dwellings in all. Reports on these are generally satisfactory, and in many respects, particularly cleanliness, some of them are better maintained than many dwelling houses. The wandering gipsy, however, is not of the same type, and 72 requires more supervision. These tents and vans are regularly inspected to ensure that the by-laws are being observed, and no infringements were noted during the year. Underground Sleeping Rooms. By-laws dealing with the use of such rooms for sleeping purposes were made by the Council under the Housing, Town Planning Act, 1909, and have been in operation since 1911. Although the Act has been repealed by the Housing (Consolidation) Act, 1925, the by-laws have been preserved. During the year no orders were made in respect of underground rooms. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1923. During the year 11 applications were made by the occupiers of 11 houses for certificates that the houses occupied by them were not in a reasonable state of repair. Four certificates were granted. One application was made by an owner for a certificate that the work at the premises concerned had been completed. This was issued. Five applications relating to hutments were refused because the rent had not been raised above the standard rent, and two applications were withdrawn before they were considered by the Public Health Committee as all the work necessary had been carried out expeditiously. When an application is received the house is inspected at once by the District Inspector, and notices are served to remedy such defects as exist, and prior to the meeting of the Public Health Committee the house is inspected by the Medical Officer of Health. If the nuisances which existed are remedied before the meeting of the Committee, it is found in practice that no further action is necessary. 73 HOUSING STATISTICS FOR THE YEAR 1925. In accordance with the instructions of the Ministry of Health, the following tabular statement is shown :— TABLE No. 33. Number of new houses erected during the year:— (a) Total 324 (6) With State assistance under the Housing Acts, 1919 or 1923 (i) By the Local Authority 122 (ii) By other bodies or persons 64 1. Unfit Dwelling Houses. Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,238 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Consolidated Regulations, 1925 3,197 {3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,415 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 1,836 * Includes intimation notices. 74 3.—Action under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925. (1) Number of dwelling houses in respect of which notices were served requiring repairs - (2) Number of dwelling houses which were rendered fit:— (a) By Owners - (b) By Local Authority in default of Owners - (3) Number of dwelling houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close - (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 842 (2) Number of dwelling houses in which defects were remedied:— (a) By Owners 752 (6) By Local Authority in default of owners — (c) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of representations made with a view to the making of closing orders — (2) Number of dwelling houses in respect of which closing orders were made - (3) Number of dwelling houses in respect of which closing orders were determined, the dwelling houses having been rendered fit.. - (4) Number of dwelling houses in respect of which demolition orders were made - (5) Number of dwelling houses demolished in pursuance of demolition orders .. - 75 New Houses. Water certificates were granted during the year for the following new houses erected in the Borough:— Council's Housing Scheme. Eltham 17 13th March. 16 17th April. 10 15th May. 22 19th June 2 10th July. 33 18th September. 22 13th November. Private Enterprise. Woolwich— " Enon Cottage," Woolwich High Street 18th September. Plumstead, West— " On Top," Shrewsbury Lane 17th April. " Newbury Villa," Cleanthus Road do. " Petersham," do. do. 11 and 13, Foxcroft Road 15th May. " Tree Top," Shooters Hill 19th June. 26, The Slade 18th September. " Glen Tor," Brent Road do. 61, Hargor Road do. 27, The Slade 16th October. " Westray," Eaglesfield Road do. " Carna," Cleanthus Road 13th November. Plumstead, East— 308, Wickham Lane 16th January. 1, The Terrace, Kings Highway do. 45, 47, 49, 51, 53, 55, 57, 59 and 61, Congress Road 13th March. 304 and 306, Wickham Lane 17th April. 25, 27, 29, 31, 33, 35, 37, 39, 41 and 43, Congress Road do. 76 300, Wickhain Lane 15th May. 2, The Terrace, King's Highway 19th June. 90, 92, 94, 96, 98, 100, 102, 104 and 106, McLecd Road do. 36, 38, 40, 42, 44, 46, 48, 50, 52 and 54, Crumpsall Street 10th July. 56, 58, 60, 62, 64, 66, 68, 70, 72 and 74, Crumpsall Street 18th September. 302, Wickham Lane 16th October. 3, The Terrace, King's Highway do. 1 and 3, Verdun Road 13th November. 4, The Terrace, King's Highway 11th December. 80, 82, 84, 86, 88, 90, 92, 94, 96 and 98, Basildon Road do. Eltham— 56, Gerda Road 16th January. " Chez Nous," Avery Hill Road do. 52 and 58, Archery Road do. 13 and 14, Sarona Villas, Footscray Road do. " Uvick " Winn Road do. 3 and 4, Sherard Mansions, Well Hall Road 13th February 15 and 16, Sarona Villas, Footscray Road do. " Kenwyn," Avery Hill Road do. 54, Westmount Road 13th March. 52, Well Hall Road do. 54, Gerda Road do. 17 and 18, Sarona Villas, Footscray Road do. 5, 6, 7 and 8, Sherard Parade do. " Kelso " and " Favhurst," Avery Hill, Road do. " School Keeper's House," Haimo Road 17th April. 50, 52 and " Windora," Westmount Road do. "Leahurst," Glenesk Road do. 77 60 and 62, Archery Road do. 50, Well Hall Road do. 19, Sarona Villas, and " The Bungalow," Footscray Road loth May. 15, Croft Villas, Green Lane do. " Collingwood," Bexley Road do. " The Firs," Avery Hill Road . . do. 31, Glenlea Road 19th June 48 and 126, Westmount Road do. 31, Winn Road do. 20, Sarona Villas, Footscray Road do. "Crohamhurst " and "Nanven," Avery Hill Road 10th July. 3, 4, 5 and 6, Park View Road do. 47, South wood Road do. "Southgate Lodge," Footscray Road do. 65 and 67, Southend Road do. 33, Glenlea Road 18th September "Maudene," " Homestead," "Coombe Cottage," "Timberley," " Rayleigh," " Lulworth " and "Lynton," Avery Hill Road do. "Lemonwell Lodge," and "Harbour St. Mary," Bexley Road do. "Collingdale " and "Fairholme," Glenesk Road do. 61, 59, Gourock Road do. 61 and 63, Southend Road do. " Colliston," Greenholm Road do. 29, Winn Road do. 64 and 66, Archery Road do. 46, 48, 50 and 52, Gerda Road do. 16, Croft Villas, Green Lane do. 47,48 and 49, Well Hall Road do. 78 "Marita," Park View Road 16th October. 49 and 128, Westmount Road do. 1 and 2, The Olives, Footscray Road do. "Fairfield," Avery Hill Road do. "Donovan" and " Bristolian," Bexley Road do. "Birkdale," Archery Road do. 2, 4, 5, 6, 7 and 8, Dobell Road do. "Windermere,"Archery Road 13th November. "Erywin " and "San Toy," Glenlea Road do. "Redcot," Avery Hill Road do. 85, 89, and 91, Westmount Road do. 57, Gourock Road do. 7, 8, 9 and 10, Park View Road do. 69, Southend Road do. "West Mark," Guibal Road do. 30 and 34, Glenesk Road do. "Carlton," Glenesk Road 11th December. "Allendale," Park View Road do. 55, Gourock Road do. 1 and 2, Woodview Terrace, Westmount Road do. 3, 10, and 12, Dobell Road do. 71, Southend Road do. " Avery Crest," Bexley Road do. 79 SECTION VI.—INSPECTION AND SUPERVISION OF FOOD. It is the duty of the Council, so far as the inspection and supervision of food is concerned, to administer the following Acts, Regulations and associated By-laws:— (a) Public Health (London) Act, 1891. (b) London County Council (General Powers) Acts, 1902, 1908, 1909. (c) Sale of Food and Drugs Acts, 1875-1907. (d) Milk and Dairies Acts, 1915, 1922. (e) Margarine Act, 1887. (f) Milk and Dairies Order, 1885. (g) The Milk and Cream Regulations, 1912-1917. (h) Sale of Food Order, 1921. (i) The Public Health (Dried Milk) Regulations, 1923. (j) The Public Health (Condensed Milk) Regulations, 1923. (k) The Milk (Special Designation) Order, 1923. (1) The Public Health (Meat) Regulations, 1924. (m) The Tuberculosis Order, No. 2, 1925. (n) The Public Health (Preservatives, &c., in Food) Regulations, 1925. (Not yet operative). The work of food inspection, although carried out as part of their daily routine by all the district Sanitary Inspectors, is mainly performed by two Inspectors. 80 MILK SUPPLY. Registration. It is not lawful for any person to carry on in the district the trade of a cowkeeper, dairyman, or purveyor of milk, unless he is registered as such with the local authority. The Council is obliged to keep a register of all such persons, differentiating between producers, wholesalers, and retailers, and is empowered to refuse registration and remove from the register the name of any person who is carrying on such trade upon any premises which, in the opinion of the local authority, are unsuitable for the sale of milk. There is a right of appeal of any aggrieved person to a Court of Summary Jurisdiction. During the year 8 persons made application for registration as purveyors of milk; 7 were registered and consideration of the other one was pending at the end of the year. Four persons were removed from the registers on the grounds that they had ceased to carry on the business of a purveyor of milk. A summary is given below of the alterations which took place in the registers during the year:— TABLE No. 34. Retail. Wholesale. Total. On register on 1st January 85 9 94 Removed during the year 4 - 4 Added during the year 7 - 7 On register on 31st December 88 9 97 The premises on the retail register are detailed in tabular form below. 81 TABLE No. 35. Name. Address. Ward. Edwards & Sons, Ltd. 16, Pellipar Road Dockyard Atten borough, F. R. 18, Prospect Place Do. Foote, E. 6, Samuel Street Do. Dann, E. A. 101, Sand Street Do. Dove, E. A. 827, Woolwich Road Do. Cavell, M. H. 1, Chapel Street St. Mary's Ball, G. H. 10, Chapel Street Do. Emmerton, A. F. 46, Church Street Do. Davies, J. 170, Albert Road River Webb, Y. 10, Beresford Square Do. Dennis, E. 90, Brookhill Road Do. Townsend, R. 104, Brookhill Road Do. Mendham & Dalton 6, Green's End Do. Bartrum, A. 167, Kingsman Street Do. Lyons & Co. 18-20, Powis Street Do. R.A.C.S., Ltd. 147, Powis Street Do. Express Dairy Co. 3, Wellington Street Do. Johnson. E. S. 50, Wellington Street Do. Espline, G. 46, Woolwich High Street Do. Hawkes, W. 142, Woolwich High Street Do. Butter, A. E. 10, Jackson Street St. George's Willis & Sons 2, Ritter Street Do. Baldwin, T. 5, Spearman Street Do. Butter, A. E. 49, Woolwich Common Do. Balster, W. H. 147, Burrage Road Burrage Cock, E. V. 13, Raglan Road Do. Morris, D. E. 6, Herbert Road Herbert Attree, H. J. 62, Plumstead Common Road Do. Killick, C. W. 21, Princes Road Do. Rowsell, E. R. 21, Princes Road Do. Wilkinson, F. F. 52, Whitworth Road Do. Johnson, J. H. 102, Ann Street Glyndon Webb, F. W. 58, Brewery Road Do. J ones, D. 65, Maxey Road Do. Dolphin, T. G. 89, Maxey Road Do. Wilson, A. J. 89, Park Road Do. Brown, F. W. 58, Pattison Road Do. Wallace. A. 107, Pattison Road Do. Nayler, L. 82, Plumstead Road Do. Thomas, A. R. 127, Plumstead Road Do. Gouge, A. H. 34, Durham Road St. Margaret's Green, H. J. 13, Hinstock Road Do. Woolsey Bros. 68, Kirkham Street Do. Wilkenning, H. & A. 175, Plumstead Common Road Do. Butler, J. 175, Plumstead Common Road Do. Pearce, R. A. 175, Plumstead Common Road Do. F 82 Table No. 35 (continued)). Name. Address. Ward. R.A.C.S., Ltd. The Links, Plumstead Common Road. St. Margaret's Rouse, S. W. " Ashurst," Shrewsbury Lane Do. Goodfellow, N. m. 65, Vicarage Road Do. Ambler, R. G. 28, Conway Road Central Webb, F. W 16, Lakedale Road Do. Barnes, H. 22, Plumstead High Street Do. R.A.C.S., Ltd. 75, Basildon Road St. Nicholas Cole, e. j. 18, Camrose Street Do. Brinkworth, W. J. 40, Garibaldi Street Do. Bartlett, S. L. 40, Garibaldi Street Do. Smith, P. 40, Garibaldi Street Do. Fincham, J. 40, Garibaldi Street Do. Gill, A. e 35, Gatling Road (rear of) Do. Gallier, W. A. 21, Harrow Manorway Do. Thomas, J. 170. Plumstead High Street Do. R.A.C.S., Ltd. 223, Plumstead High Street Do. R.A.C.S., Ltd. 75, McLeod Road Do. Arnold, C. H. 2, St. Nicholas Road Do. Perkin, P. 40, Saunders Road Do. Hiscock, E. 27, Wickham Lane Do. Look, A. G 60, Avery Hill Road Eltham Mitchell, J. W. " Cathay," Court Road " Cathay," Court Road Do. Tyler, E. Do. Slater, A. E. 30, High Street Do. Eltham and Sidcup Farm Dairies, Ltd. 82, High Street Do. Ridewood, C. 116, High Street Do. Corp, W. F Middle Park Farm Do. Churchill, H. E. W. Lyme Farm Dairy Do. Castleton, A. G. Messiter Place Do. Bayley, M. Middle Park Farm Do. Furber, H. Southend Farm Do. Grace, J. 18, The Broadway Do. Eltham and Sidcup Farm Dairies, Ltd. 2, The Parade Do. R.A.C.S., Ltd. Well Hall Road Do. Porter, W. J. 18, Well Hall Parade Do. Eltham and Sidcup Farm Dairies, Ltd. 102, West mount Road Do. Edwards & Sons, Ltd. 124, West mount Road Do. Hopper, W. H. 152, West mount Road Do. Webb, F. W. 168, West mount Road Do. Price, W. G. 258, West mount Road Do. R.A.C.S., Ltd. 289, West mount Road Do. Chapman, F. E. 28, Overton Road Erith U.D.C. 83 Prosecution. Proceedings were instituted against a person who was carrying on the trade of a vendor of milk without being registered. He was fined £2 and £1 1s. costs, on the 18th November, at the Woolwich Police Court. Cowkeepers. The cowsheds in the Borough are subject to licensing each year by the London County Council. Nine occupiers held licences during the year for 22 cowsheds. The total licensed accommodation is for 473 cows, but the average number of cows kept was just under 400. Detailed information regarding each licence holder is given below in the next Table No. 36. TABLE No. 36. Name of Occupier. Premises. No. of Sheds. Licensed Accommodation. Grace, J. Avery Hill Farm, Eltham 3 69 Fisher, C. U. & W. F. Belmont Park Farm, Eltham 1 29 Fisher, C. U. Chapel Farm, Eltham 3 59 Keen. T. W. Clay 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 These cowsheds are regularly inspected by one of the Sanitary Inspectors who usually makes his visits at milking times. In this way he is able to see under what conditions the cows are being milked and to concentrate his attention on the production of clean milk and maintenance in that condition whilst on the farm. In supervising this work the Inspector has always to bear in mind that the average cowman and dairy employee is ignorant of many elementary facts 84 regarding the product which he handles, and often does not realise the danger which may accrue to the general public, and particularly to infants, by carelessness on his part. During the year there has been a marked improvement in the general conditions under which milk is produced in the Borough. The toilet of the cows—the use of the curry comb and brush and the washing of the udder before milking— has been the subject of gradual education, and, similarly, the clothing and apparatus used by the milker have been brought under review and improvements suggested. Attention has been given to the actual details of milking, and special stress has been laid on the fact that milk in the udder is clean and that it is very easily contaminated once it gets outside. The grooming of the cows before milking is an essential, the necessity of which comes slowly to the conservative cowman. It means additional work, as all manure adhering to the hairs must be removed by curry comb or brush, and occasionally washing is necessary. Every endeavour is being taken to foster in each milker pride in the cleanliness of his cows. Washing facilities for the milker are provided at most of the farms, and it is usual for the milkers to wash their hands before milking. Most of the milkers use suitable overalls and head coverings when milking. At several cowsheds covered milk pails are used, designed to prevent particles of dirt, filth, or debris falling into the milk during the milking. Progress has been made in maintaining the milking stool in a clean condition, a small but important point, as it has to be handled when going from cow to cow, and if it is dirty, the dirt is easily transferred to the cows' teats and thence to the milking pail. Supervision is also exercised over the farm dairy, where the milk is passed through a strainer and then cooled ready for the retailer. The dairy should be kept exclusively for the 85 treatment and storage of milk, and such articles as cleansing materials, brass polish, soda and soap, paraffin, oil cans, tools, etc., as well as the out-door clothes of the farm hands, must not be kept there. Fortunately, these extraneous articles are now rarely found there by the Inspector. The farm manure heap also has consideration. It has usually been placed, as a matter of convenience, near the cowshed, and the manure has been allowed to mature for a long period. In consequence, during the warm weather, flies breed there in great numbers and may infect the milk. Every effort is made, therefore, to secure frequent removals of the manure to a more distant place, and the use of the farmyard manure heap, instead of the field manure heap, is being discouraged. As a result of the recent improvements that have taken place at the farms, special designated milks could be produced there, and it may be that ere another report is published, more than one producer will have taken the necessary steps to secure the appropriate licence. Dairymen and Purveyors of Milk. Most of the Woolwich milk comes from the country districts of Dorset and Wiltshire. It is carried in churns in open and covered railway vans and arrives at the stations in the early hours of the morning. The churns are not sealed. Most of them are taken direct to local dairies, but a few are received by itinerant vendors and taken straight on to their rounds. The milk taken to the dairies is usually treated either by pasteurisation or cooling, and is then ready for distribution, either from churns or from bottles. The distribution of milk in bottles has considerably increased of late, and a demand for, and confidence in bottled milk has been developed by the public. The use of bottles for delivery presents many advantages provided proper 86 methods are adopted. These methods are simple and may be summarised as follows:—clean milk, placed in clean bottles and sealed in a clean, well-appointed dairy. So far as actual practice is concerned, the greatest weakness in the scheme is the clean bottle. Milk usually arrives in the Borough in a satisfactory condition. At times the cleanliness of a dairy is not all that could be desired, and sometimes the sealing of the bottle is omitted, but these circumstances are relatively rare. Occasionally we have seen roundsmen bottling milk in the streets—an objectionable practice, not only because of dust, but also because the milk may be put into bottles returned unwashed from other houses. The cleansing of bottles is often unsatisfactory. The responsibility rests partly on the householder, but mainly on the retailer. So far as the householder is concerned bottles are often returned, after some days' retention, with milk, dried and sticky, adherent to them, thus increasing the difficulties of the milk purveyor in cleansing them. So far as the retailer is concerned, he always complies with the provisions of the Milk and Dairies Order as to the supply of hot water, but he often forgets that hot water rapidly becomes cold and so loses its effect as a cleansing agent. With regard to cleansing, the general practice appears to be that the milkmen, when they return from their rounds, wash the churns, cans, bottles and other milk utensils that they individually use. Up-to-date methods of washing milk utensils require to be adopted and more adequate facilities for efficient cleansing require to be provided in some dairies. At present wooden tubs, or galvanised iron tanks are used in which the bottles and cans are soaked, cleansed and rinsed. In some instances insufficient tanks are available for these processes, and all of them may be carried out in one tank without any change of water. The cleaning of the bottle, internally, requires some care, 87 and the present method of using a hand brush—often kept in use after it has lost most of its bristles—is not satisfactory. Power driven brushes are necessary for efficient cleansing. Milk churns should be cleansed and then sterilised over a steam jet, and this is done in many dairies. Sterilisation of cans and bottles is essential to maintain the purity and keeping properties of the milk, but, as far as I am aware, this is not undertaken in this Borough. Dairies are usually inspected in the afternoons at cleansing times, and frequent conversations have taken place with dairymen in order to try and obtain an improvement in their methods. The Inspector, however, cannot always be present and the co-operation of the dairymen must therefore be secured. In this connection it is found that many dairymen are appreciative of the advice of the inspector. The education of all is slow, but it is progressing. In all retail milk shops, where milk is sold over the counter, properly protected counter pans are used. Designated Milks. The Milk (Special Designations) Order, 1923, provides for the issue of licences for the production, bottling, and sale of designated milks; prescribes such conditions which should ensure that these milks are more reliable than ordinary milk and reasonably safe in all ordinary circumstances, and at the same time sets a standard which is not beyond the average careful dairyman. These designated milks are described as follows:—"Certified," "Grade A (Tuberculin Tested)," "Grade A Pasteurised," "Grade A," and "Pasteurised." Supplementary licences may be issued to sell milk in one area from licensed premises in another. The following Table No. 37 shows the number and character of the licences issued during the year. No licences were refused. The fees payable in respect of each dealer's licence 88 is 5s., and each supplementary licence 2s., but where a licence is granted for a period less than a year, a smaller payment may be accepted. The total amount received in fees was £1 4s. TABLE No. 37. Name and Address. Nature of Licence. Premises to sell at or from. Designation Express Dairy Co., Ltd., 26-30, Tavistock Place, W.C.I. Dealer's 3, Wellington Street Certified. Do. Do. Do. Grade A (T.T.) Edwards & Sons, Ltd., Station Buildings, Forest Hill, S.E.23 Do. 124, West mount Road Pasteurised. Do. Do. Do. Grade A. Do. Do. Do. Grade A. (Pasteurised) Do. Do. Do. Grade A (T.T.) Do. Do. Do. Certified. Do. Supplementary 74, Little Heath Certified. Do. Do. 30, Burnt Ash Road . . Certified. Analysis of Milk. 214 samples of milk were submitted to the Public Analyst during the year, and only four were found to be below the standard. Eleven of these samples were taken on Sundays, all of which were genuine. Bacteriological Examinations. No samples of milk, designated or otherwise, were submitted to bacteriological examination during the year. Tuberculous Milk and Tuberculous Cattle. In London the County Council is the Authority which deals with this aspect of the pure milk problem. Refresher Course for Sanitary Inspectors. In December Inspector Shaw attended for one week a course on " Clean 89 Milk" at the Ministry of Agriculture and Fisheries Dairy Farm at Shin field, near Reading. His expenses, amounting to £6 were, with the approval of the Minister of Health, paid by the Council. The Course was most valuable, a week's intensive study of modern milk technique being made. This Inspector is now transmitting the information thus acquired, so far as applicable, to the cowkeepers and dairymen of this district. MEAT. Regulations. The Public Health (Meat) Regulations, 1924, came into force on 1st April, 1925. These regulations were designed to secure:— (a) A more adequate inspection of animals, slaughtered in this country. (b) Cleanliness in the handling, distribution and sale of meat. They provide for notice of intention to slaughter, and of suspected disease, to be given to the local authority, and contain provisions relating to the transport, exposure and sale of meat. Furthermore a local authority may, with the approval of the Minister, mark with a distinctive mark, meat passed by a qualified officer. The Council took the following steps to make these regulations effective:— (a) Issued authorities to the Medical Officer of Health and male Sanitary Inspectors to enter and inspect any slaughter-house, room or other place, shop or stall, or vehicle, to which these Regulations apply, for the purpose of seeing whether the Regulations were being observed. (b) Duly advertised the Regulations in the local press and served copies of them on all persons concerned. 90 (c) Ordered that notices of slaughtering were to be sent to the Medical Officer of Health at the Town Hall. Previous to the 1st April the inspection of meat in slaughterhouses was carried out intermittently, as there was no obligation on the part of the butchers to give notice of their intention to slaughter. In practice, however, a system of co-operation had developed by which the butchers, whenever they were suspicious that there was anything wrong with any carcase, asked for an examination by one of the sanitary staff. Since the Meat Regulations came into force there has been cooperation of all concerned and notices of slaughtering have been received regularly and in good time. No instances of slaughtering without notice have been detected, and in consequence the carcase and internal organs of every animal slaughtered in the Borough have been examined by an officer of the Department. This work has been allocated to two officers—one responsible for one large slaughter-house and the other dealing with all the smaller ones. During the nine months the Regulations have been in operation, 1,938 cattle, 7,911 sheep and lambs, 3,314 pigs, and 47 calves—a total of 13,210 animals, have been killed in the Borough. The practice in connection with inspection is to observe the recommendations of the Ministry of Health set out in a memorandum issued on 16th March, 1922. It is not necessary to condemn the whole carcase when only the organs are diseased, and so, e.g., in the case of tuberculosis, when the disease is localised the organs or part affected only are dealt with ; but if the disease is generalised or extensive, the whole carcase is condemned. Only three of the 1,938 beef carcases were affected with generalised tuberculosis. Of the 3,314 pigs, 41 were affected with generalised tuberculosis and these were all destroyed. A large contribution to this number 91 was made in consequence of two consignments of pigs in which a larger percentage than usual were affected, i.e., in two groups of about 30 each, there was a total of 14 affected. Three animals were condemned in consequence of dying from injuries received during transit. There were 471 livers affected with flukes, a larger proportion than generally obtains. Fifteen of the pigs had cirrhosis of the liver and 3 ox tongues were affected with actinomycosis. There were no cases of anthrax or foot and mouth disease. In the 7,911 sheep and lambs, there was no disease present to justify the condemnation of any one carcase. A total of 634 separate instances of diseased carcases or organs were dealt with. The amount of time devoted to this section of the work is amply justified by results, as some of the defective meat, if undetected, might have been used for human food. The retail shops and stalls were systematically inspected, and it was found generally that the vendors adopted a reasonable attitude and made efforts to being the conduct of their business into line with the spirit of the Regulations. There is no Regulation that could deal with the unsatisfactory practice of customers handling meat while in the shops, but, in compliance with a circular of the Ministry of Health (where it was suggested that the co-operation of the trade might be invited) the Borough Council had the following notice printed on enamelled tin:— WOOLWICH BOROUGH COUNCIL. PUBLIC HEALTH (MEAT) REGULATIONS. CUSTOMERS ARE REQUESTED NOT TO HANDLE THE MEAT. 92 Copies of these were distributed to all the meat shops. They have been hung in conspicuous places, and, from the observations of Inspectors and the reports of the tradesmen, have been very beneficial. Slaughterhouses. In tabular form below is shown the number of slaughterhouses licensed in 1920 and in January and December, 1925. These premises have been regularly inspected. There is no public slaughterhouse in the Borough. TABLE No. 38. 1920 1925 January December Registered — — — Licensed 9 8 8 Slaughterhouses are licensed annually by the London County Council, and the following list shows those licensed in}1925:- TABLE No. 39. Name of Occupier. Address. 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. Love Lane, Woolwich. Do. 6, Plumstead High Street. Do. 38, Plumstead Common Road. 93 OTHER FOODS. All food exposed for sale or produced in the district is kept under supervision by the district Sanitary Inspectors, but, in addition, three Inspectors regularly inspect the market places at all periods of the day. The conditions under which, and the places where, it is produced or sold are also subject to control. As a result, improvements are constantly being made. In concise form is given below, in Table No. 40, a summary of the inspections made in connection with food and food premises during the year. TABLE No. 40. Premises. On Register 31st December. Number of Legal Proceed ings. Inspections. Notices. Bakehouses 44 124 9 - Cowsheds 9 144 3 - Milkshops 88 558 13 - Ice Cream Shops 221 751 10 - Slaughterhouses 8 35 1 - Fried Fish Shops 68 243 14 - Butchers' Shops 93 482 11 - Premises where food is prepared (other than above) 73 829 4 - Shops and Markets - 2050 — - Bakehouses. 124 inspections were made of bakehouses, and on 28 occasions offences were found. These offences consisted in the main of dirty structural conditions, but there was some evidence of carelessness in the cleansing of these places. In 9 instances notices were served, all of which were complied with. The following Table is a list of the bakehouses, factory, workshop, and underground, in use at the end of the year:— 94 TABLE No. 41. Name. Address. Ward. Type. Clothier, W. C. 51, Albion Road Dockyard Underground Workshop. Meyer, H. 33, Samuel Street Do. Do. Attenborough. F. & H. 60, Sand Street Do. Do. Barnard, W. J. 48, Artillery Place St. Mary's Factory. Rickman, J. 72, Henry Street Do. Underground Workshop. Haas, C. 122, Albert Road River Factory. Andrews, F. 184, Elizabeth Street Do. Workshop. Bradshaw, A. 3, Green's End Do. Factory. Mendham & Dalton 6, Green's End Do. Do. Walkling, A. 15, New Road Do. Underground Factory. Royal Arsenal Cooperative Society, Ltd. Powis Street Do. Factory. Fairbrother & Co. 94, Wellington Street Do. Do. Mack, P. H. 111, Woolwich High Street Do. Do. Alderton, Ltd. 57, Burrage Road Burrage Do. Wood, R. J. 13, Eton Road Do. Underground Workshop. Colver, J. 57, Plumstead Road Do. Do. Miles, J. A. 24, St. James' Place Do. Underground Factory. Joyce, A. la, Herbert Road Herbert Workshop. Chadwell Brothers. 60, Plumstead Common Road Do. Do. Meckiff, H. G. 46, Hudson Road Glyndon Underground Workshop. Werner, J. 1, Park Road Do. Underground Factory. Alderton, Ltd. 81, Park Road Do. Factory. Cannon & Gaze 109, Plumstead Road Do. Workshop. Clark, J. 153, Plumstead Road Do. Factory. Alderton, Ltd. 2, Malton Street St. Margaret's Do. Pullen, C. 105, Plumstead Common Road Do. Workshop. Chapman, A. 2, Plumstead High Street Central Factory. Alderton, Ltd. Warwich Terrace Do. Do. Moakes, R. 53, Cordite Street St. Nicholas Do. Paine, A. E. 14, Gunning Street Do. Workshop. Tucker, C. 53, Lakedale Road Do. Do. Gilder & Gansden 83, Marmadon Road Do. Do. Barnard, W. J. 119, Plumstead High Street Do. Do. Cheeseman, C. 126, Plumstead High Street Do. Factory. Margetts, S. 307, Plumstead High Street Do. Underground Factory. Hollingsworth, F. H. 1, Riverdale Road Do. Workshop. Fyson, J. B. 94, High Street, Eltham Eltham Factory. Orridge, T. 114, High Street, Eltham Do. Do. Cook, F. 142, High Street, Eltham Do. Workshop. Cook, F. 5, The Parade, New Eltham Do. Workshop. Fyson, J. B. 13, The Parade, New Eltham Do. Factory. Fyson, J. B. 6, Well Hall Parade Do. Do. Mourse, T. 114, Westmount Road Do. Workshop. 95 Fried Fish Shops. There were, at the end of the year, 68 premises where the frying of fish was carried on, and 243 inspections were made of these premises. These businesses require to be regularly inspected, as it is only by means of systematic inspection that a reasonable standard of cleanliness is maintained. Speaking generally, there was distinct evidence of further improvement during the year. Ice Cream Premises. During the year the manufacture or sale of ice cream was carried out at 221 premises. Many of these premises are private houses. 751 inspections were made, 46 offences discovered, and 10 notices served. Nine samples of ice cream were submitted to the Public Analyst for analysis under the Sale of Food and Drugs Acts. The detailed results, which show a wide variation in the fat content of each sample, were as follows:— Sample No Fat Percentage. Remarks. 1 1.98 Starch present. 2 2.42 do. 3 8.74 4 9.34 5 11.90 6 13.71 7 12.62 8 2.08 Starch present. 9 3.75 do. Cane sugar was present in all samples and flavouring essence and colouring matter in most of them. Further, it would appear that the basis of most of these samples was custard powder, although one or two of them, particularly those rich in fat, were probably made from full cream dried milk. Six samples of ice cream were submitted for bacteriological examination, and the bacteriologist reported as follows:— 96 Nos. 1, 3 and 5—Ice Cream—September, 1925. Dilutions of 1/100 and 1/1000 were plated on agar in quantities of .lcc and .25cc. Dilutions from lcc to •0000lcc into McConkey Bile Salts. Nos. 2, 4 and 6—Ice Cream Scrapings and Deposits—lst September, 1925. Inoculated .lcc into McConkey Bile Salts. No. 1. Ice Cream. Average No. of colonies = 3,613,900 per cc. Bile Salts lcc •lcc) •Olcc ) All gave acid and gas. •001 cc) •OOOlcc) •0000 lcc) Direct films—Staphylococci, gram negative bacilli and yeasts. Total count—3,613,000 per lcc. Acid and gas appeared in all dilutions. Flaginæ reactions negative for B. Coli. No. 2. Ice Cream Scrapings. Appearance—greenish colour. Direct films—Staphylococci, streptococci, gram negative bacilli and yeasts present. Plates—Strong growth of staphylococci. No change in McConkey Bile Salts. No. 3. Ice Cream. Average No. of colonies—2,888,700 per cc. Bile salts lcc •lcc) •Olcc) •00 lcc)All gave acid and gas. •OOOlcc) •OOOOlcc) 97 Direct films—Staphylococci, streptococci, gram neg. bacilli. Total count—2,888,700 per cc. Acid and gas appeared in all dilutions. Flaginæ reaction negative for B. Coli. No. 4. Ice Cream Deposits. Greenish liquid. Direct films—Only showed staphylococci and streptococci Plates—Gram negative bacilli. Acid and gas given in McConkey Bile Salts. Flaginæ reaction negative for B. Coli. No. 5. Ice Cream. Average No. of colonies—1,678,400 per cc. Bile Salts lcc .lcc .Olcc) All gave acid and gas. •OOlcc) •OOOlcc •0000lcc Direct films—Staphylococci, Streptococci, gram neg. bacilli and yeasts. Total count, 1,678,400 per cc. Acid and gas appeared in all dilutions. Flaginæ reaction negative for B. Coli. No. 6. Ice Cream Deposits. Greenish liquid. Direct films—Staphylococci, Streptococci and yeasts present. Plates—Gram negative bacilli and Staphylococci acid and gas given in Bile Salts. Commentary. In none of the plate cultures examined have non-lactose fermenting organisms of the Enterica and Dysentery Groups been found, nor have colonies of streptococci grown in cultures. G 98 The bacterial counts are high, but, as compared with the ice creams examined in 1922 (when the bacterial count was approximately 80 millions per cc.), the present specimens are more satisfactory, and demonstrate the value of the steps taken to improve the standard and quality of the ice cream sold in the Metropolitan Borough of Woolwich. Other Food Premises. During the year 166 such premises, mostly restaurants and eating houses, were regularly inspected. Many of these are a combination of small dwelling and eating house, and possess many disadvantages, of which want of space is probably the most important. Cramped accommodation almost always means uncleanliness, and particularly so when an attempt is made to use a kitchen tor domestic and public purposes. In addition, make-shift appliances are often used. These places require much supervision by the Inspector. The restaurants, particularly the newer ones, usually maintain a reasonable standard of cleanliness in the preparation and storage of food and in the disposal of refuse. UNSOUND FOOD. On 210 occasions during the year unsound food was surrendered, compared with 45 in 1924. Included in the food surrendered was 3 tons, 8 cwts. of beef; 2 tons 1 cwt. of pork, 12 cwts. of fish, 39 lbs. of chickens, 2 tons 17 cwts. of raspberries, 2 cwts. of pears, 16 lbs. of ox tongues. The number of carcases condemned on account of tuberculosis was 44—41 of pork and 3 of beef. Four seizures were made. No action was taken in 3 cases, but in the other, where 12 unsound codlings were exposed for sale from a stall outside the Railway Tavern, Plumstead Road, proceedings were taken at the Woolwich Police Court on 20th July, and the vendor was fined 10s. No notification was received during the year that unsound food was being sent into the district for animal food. 99 FOOD POISONING. No cases of food poisoning came to the knowledge of the Department during the year but one suspected case was investigated. In September I was informed by the Acting Medical Superintendent of Lewisham Hospital that a woman had been admitted there three days previously and that it was believed she had died from food poisoning. I attended the post-mortem and sent material obtained there to the Ministry of Health laboratory, where it was examined for the presence of organisms associated with food poisoning. The examination was negative, there being no bacteriological evidence of the cause of death. Enquiries made regarding the food under suspicion were equally negative, and, in possession of this information, I gave evidence at the inquest to the effect that there was no evidence supporting a diagnosis of food poisoning. The evidence of the pathologist was to the effect that the woman died from phlegmonous gastritis and the Coroner recorded a verdict of death from natural causes. SALE OF FOOD AND DRUGS ACTS. These Acts provide for the appointment of a Public Analyst, for the purchase of food and drugs for the purpose of analysis, and for subsequent proceedings where adulteration is found. The number of samples taken, and the result of the various analyses made, are given in the following Table No. 42 The percentage of adulterated samples was 3.9 compared with 3.6 in 1924. Eleven samples were taken on a Sunday, but none of these were adulterated. There were 10 informal samples adulterated, but when formal samples of the same articles were purchased only four were found adulterated. The impression gained, by a review of the sampling under the Food and Drugs Acts during the past five years, is that 100 this regular work is having a deterrent effect on those vendors who were inclined to intentionally defraud or who were careless. TABLE No. 42. Article. Formal Samples Informal Samples. Number Analysed. Number Adulterated. Milk 212 2 214 4 Separated Milk- 1 - 1 - Cream 5 11 16 10 Preserved Cream 2 3 5 — Butter 3 105 108 2 Cheese 1 — 1 — Condensed Milk — 4 4 - Lard — 19 19 — Coffee 32 32 2 Coffee Mixture 1 — 1 — Puff Paste 1 1 — Ice Cream — 9 9 — Ice Cream Powder — 3 3 - Bread Substitute for Sausages - 1 1 - Olive Oil — 13 13 — Camphorated Oil — 4 4 - Turpentine 1 — 1 - Prescriptions 8 — 8 2 Fish Paste — 2 2 — Anchovy Paste — 1 1 — Meat Paste — 2 2 — Pepper — 14 14 - Apples — 3 3 — Whisky — 4 4 — Baking Powder — 8 8 — Dripping — 8 8 — Cocoa — 14 14 — Brandy — 2 2 — Zinc Ointment — 8 8 — Cream of Tartar — 8 8 — 234 281 515 20 101 The following figures, relating to the fat percentage figures of each sample of milk examined in the last three years are interesting. The minimum legal standard is 3 per cent. TABLE No. 43. 1923. 1924. 1925. 4.5% and over 1 1 1 4.0% and under 4.5% 12 14 12 3.5% and under 4.0% 84 121 90 3.0% and under 3.5% 85 96 109 Below 3.0% 2 3 2 184 235 214 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. These Regulations lay down the standard for condensed milk and the conditions under which it may be described and sold. No infringements of the Regulations were discovered and four samples which were analysed by the Public Analyst during the year were returned as genuine. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. These Regulations, which provide for the sale and labelling of dried milks, came into force in 1924. No information is available of the quantity of dried milk used in the Borough, but there is evidence that it is being used in increasing quantities. No samples were submitted to the Public Analyst during the year. The following Table, No. 44, shows the number of adulterated samples and the action taken in each case:— 102 TABLE No. 44. ADULTERATED SAMPLES. ACTION TAKEN. Sample No. Sample of Particulars of Adulteration. Action taken. 382 Coffee 30% chicory Informal. 403 Prescription Deficient in sodium bicarbonate, 26.5%. Fined £1 and 21s. costs. 409 Prescription Do. do. 21.1% Costs £2 2s. 452 Coffee 32.6% chicory Informal. 494 Milk 21.33% deficient in fat Warranty proved. Dismissed. 495 Do. Artificially coloured with annatto. Fined £2. 15 Do. 8.6% deficient in fat Cost £2 2s. 18 Do. Artificially coloured with annatto. Costs £1 10s. 59 Cream Contained .37% boric acid. . Informal. 259 Do. Do. .28% do. Do. 260 Do. Do. .52% do. Do. 261 Do. Do. .27% do. Do. 262 Do. Do. .47% do. Do. 268 Do. Do. .26% do. Fined £5 and 21s. costs. 269 Do. Do. .25% do. Explanation accepted 270 Do. Do. .32% do. Costs £2 2s. 290 Do. Do. .28% do. Informal. 291 Do. Do. .39% do. Do. 348 Butter 1.83% excess water Do. 364 Do. .81% do. No proceedings. 103 THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912-1917. During the year 215 samples of milk and 21 of cream were purchased and submitted to the Public Analyst. None of the milk samples showed any preservative. Ten samples of cream were admixed with a preservative. In tabular form, as required by the Ministry, are set out below the details of this work:— TABLE No. 45. REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912-1917, FOR THE YEAR ENDED 31ST DECEMBER, 1925. 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 215 (including 1 separated milk.) Nil. - - Cream 16 10 Boric Acid .37, .28, .52 Informal Samples. .27, .47 % .26% Fined £5 and 21s. costs. .25% Cautioned. .32% £2 2s. costs. .28% Informal. .39% Do. 104 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 5 (i) Correct statements made 5 (ii) Incorrect statements made Nil (iii) Percentage of Preservative found in each sample: Percentage stated on statutory label: .37 per cent. Not exceeding .4 per cent. .34 per cent. .24 per cent. .29 per cent. .29 per cent. (b) Determinations made of milk fat in cream sold as Preserved Cream:— (i) Above 35 per cent. 5 (ii) Below 35 per cent. Nil (c) Instances where (apart from analysis) the requirements 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 105 SECTION VII.— PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. NOTIFICATIONS. The total number of notifications, excluding duplicates, was 1,375, compared with 1,472 in 1924 and 1,187 in 1923. In addition 1,916 cases of measles, including German measles, came to the knowledge of the Department, mainly through the school medical service. Detailed statistics relating to the incidence of infectious disease, each year since 1901, will be found in Table No. 50. The following diseases are notifiable in the Borough:— Anthrax. Ophthalmia neonatorum. Cerebro-spinal meningitis. Pneumonia, Acute Primary. Cholera. Pneumonia, Acute Influenzal. Continued Fever. Poliomyelitis. Diphtheria. Plague. Dysentery. Puerperal Fever. Encephalitis Lethargica. Relapsing Fever. Erysipelas. Scarlet Fever. Enteric (or Typhoid) Fever. Small Pox. Glanders. Trench Fever. Hydrophobia. Tuberculosis. Malaria. Typhus Fever. Membranous Croup. Zymotic Enteritis. 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 disease notified during the year; the number of cases admitted to hospital or sanatorium; the total number of deaths occurring from these diseases, and the distribution and case-rate per 1,000 of the population of the various registration districts in the Borough. 106 TABLE No. 46. INFECTIOUS DISEASES. Diseases. Total cases notified. Admissions to Hospital. Total Deaths. Diphtheria 299 295 13 Scarlet Fever 364 339 4 Enteric Fever (including Paratyphoid) 16 10 4 Puerperal fever 9 7 3 Erysipelas 44 11 — Pneumonia 277 100 97 Malaria 5 — — Ophthalmia neonatorum 31 8 1 Dysentery 1 1 — Encephalitis Lethargica 10 9 3 Cerebro-spinal Meningitis 5 4 3 Poliomyelitis 1 — — Zymotic Enteritis 13 2 9 Tuberculosis Pulmonary Males 141 180 91 Females 105 133 69 Total 246 313 160 Tuberculosis N on-pulmonary Males 27 23 14 Females 27 20 13 Total 54 43 27 Measles 1916 39 9 3291 1181 333 No cases of Smallpox, Cholera, Continued fever, Relapsing fever, Typhus fever, Trench fever, Anthrax, Glanders, or Hydrophobia were notified during the year. 107 TABLE No. 47. CASES OF INFECTIOUS DISEASES NOTIFIED, 1925. Diseases. Number of Cases Notified. All Ages. Age Groups. 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 299 4 11 17 24 21 102 38 30 43 9 .. .. Scarlet Fever 364 2 6 16 25 39 165 62 18 25 4 2 .. Enteric Fever 16 .. .. .. .. .. 4 1 1 .. 5 4 1 Puerperal Fever 9 .. .. .. .. .. .. .. 1 7 1 .. .. Erysipelas 44 1 .. .. .. .. 1 2 4 7 4 21 4 Pneumonia 277 22 21 16 19 11 42 14 9 36 29 36 22 Malaria 5 .. .. .. .. .. .. .. .. 3 1 1 .. Ophthalmia Neonatorum 31 31 .. .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. .. .. .. .. 1 .. .. .. Encephalitis Lethargica 10 . . .. 1 .. .. 2 1 .. .. 3 3 .. Cerebro-spinal Meningitis 5 2 1 .. .. .. .. .. 2 .. .. .. .. Poliomyelitis 1 .. .. .. .. .. 1 .. .. .. .. .. .. Zymotic Enteritis 13 8 2 1 1 .. .. .. .. 1 .. .. .. Tuberculosis Pulmonary Males 141 1 .. 2 1 1 4 5 15 50 31 29 2 Females 105 .. 1 .. .. 1 3 4 17 55 15 8 1 Total 246 1 1 2 1 2 7 9 32 105 46 37 3 Tuberculosis Non-pulmonary Males 27 2 2 2 1 1 9 4 2 .. 1 3 .. Females 27 1 1 1 .. 1 7 3 2 8 3 .. .. Total 54 3 3 3 1 2 16 7 4 8 4 3 .. Measles (including German Measles) 1916 42 68 80 155 323 1151 78 10 9 .. .. .. 3291 116 113 136 226 398 1491 212 111 245 106 107 30 108 TABLE No. 48. Cases of Infectious Diseases Notified in the Borough and Parishes during the year 1925, shewing the Case Rate per 1,000 Population. Diseases. Borough. Total Cases notified in each locality. Case rates, per 1,000 Population. Woolwich. Plumstead. Eltham. Borough. Woolwich. Plumstead. Eltham. West. East. West. East. Diphtheria 299 109 62 77 51 2.12 3.35 1.52 2.16 1.60 Scarlet Fever 364 90 70 95 109 2.59 2.77 1.71 2.67 3.42 Enteric Fever 16 4 .. 5 7 0.11 0.12 .. 0.14 0.22 Puerperal Fever 9 2 2 4 1 0.06 0.06 0.05 0.11 0.03 Erysipelas 44 10 12 11 11 0.31 0.31 0.29 0.31 0.35 Pneumonia 277 98 74 62 43 1.97 3.02 1.81 1.74 1.35 Malaria 5 1 2 1 1 0.04 0.03 0.05 0.03 0.03 Ophthalmia Neonatorum 31 8 11 6 6 0.22 0.25 0.27 0.17 0.19 Dysentery 1 .. .. 1 .. 0.01 .. .. 0.03 .. Encephalitis Lethargica 10 2 3 2 3 0.07 0.06 0.07 0.06 0.09 Cerebro spinal Meningitis 5 3 1 1 .. 0.04 0.09 0.02 0.03 .. Poliomyelitis 1 1 .. .. .. 0.01 0.03 .. .. .. Zymotic Enteritis 13 5 4 2 2 0.09 0.15 0.10 0.06 0.06 Pulmonary Tuberculosis 246 65 79 65 37 1.75 2.00 1.93 1.83 1.16 Tuberculosis (Non-pulmonary) 54 9 12 26 7 0.38 0.28 0.29 0.73 0.22 Measles (including German Measles) 1916 386 380 476 674 13.61 11.87 9.31 13.37 21.18 3291 793 712 834 952 23.37 24.40 17.44 23.43 26.20 109 TABLE No. 49. DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES (INCLUDING MEASLES), 1925. 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 13 1 2 1 1 1 7 .. .. .. .. .. .. Scarlet Fever 4 .. .. 1 1 .. 1 1 .. .. .. .. .. Enteric Fever 4 .. .. .. .. .. .. .. .. .. 1 3 .. Puerperal Fever 3 .. .. .. .. .. .. .. .. 2 1 .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 97 18 9 3 3 .. 1 1 .. 7 7 18 30 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 1 1 .. .. .. .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 3 .. .. .. .. .. .. 1 .. 1 1 .. .. Cerebrospinal Meningitis 2 2 .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. Zymotic Enteritis 9 6 1 .. .. .. .. .. .. .. .. 1 Tuberculosis Pulmonary Males 91 .. .. .. .. .. .. .. 10 36 17 26 2 Females 69 1 .. .. .. .. .. 2 12 28 14 10 2 Total 160 1 .. .. .. .. .. 2 22 64 31 36 4 Tuberculosis Non-pulmonary Males 14 5 1 .. 1 .. 1 .. 3 2 .. .. 1 Females 13 3 2 1 .. .. 3 1 .. 2 .. 1 .. Total 27 8 3 1 1 .. 4 1 3 4 .. 1 1 Measles 9 3 3 1 1 .. 1 .. .. .. .. .. .. 332 40 18 8 7 1 14 6 25 78 41 58 36 110 TABLE No. 50. Notification of Infectious Diseases, 1901 to 1925. Year. 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 .. 1 .. .. .. 173 .. .. .. .. 519 1909 .. 268 1027 13 113 9 206 .. .. .. .. .. 149 .. .. .. .. 768 1910 1 171 524 10 89 7 196 .. 1 .. .. .. 102 .. .. .. .. 396 1911 .. 239 518 16 82 16 375 .. 1 3 .. 8 866 .. .. .. .. 801 1912 3 429 474 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 1 271 232 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 1925 .. 299 364 16 44 9 300 .. 5 1 10 31 13 .. 5 1 277 1916 *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. 111 SMALL POX. No case of small pox was notified during the year, and no action was necessary by the Medical Officer of Health under the Public Health (Small Pox Prevention) Regulations, 1919. SCARLET FEVER. Notification. During the year 364 cases of scarlet fever were notified, compared with 440 cases in 1924 and 334 cases in 1923. The case rates for the various registration districts in the Borough are given in detail in Table No. 48. The number of notifications received each quarter was as follows :— First quarter 77 Third quarter 88 Second quarter 93 Fourth quarter 106 During the quinquennium, 3,000 cases were notified compared with 1,382 in the period 1916-20. Deaths. There were four deaths. Return Cases. The following Table shows the number of return cases, the dates of admission to hospital, the dates of discharge from hospital and some observations on the condition of the primary case on discharge. 112 TABLE No. 51. No. in register. Date admitted to hospital. Date discharged. Total days in hospital. Onset of secondary case. Remarks on primary case. 1924. 390 18/11/24 23/12/24 36 14/1/25 Otorrhœa. 432 27/12/24 7/2/25 43 15/2/25 299 25/11/24 6/3/25 102 11/3/25 1925. 17 11/1/25 21/2/25 42 11/3/25 Slight nasal discharge. 69 25/3/25 1/5/25 38 16/5/25 9/6/25 71 26/3/25 27/5/25 63 31/5/25 77 31/3/25 26/5/25 57 14/6/25 88 13/4/25 26/6/25 75 8/7/25 143 14/6/25 25/7/25 42 28/7/25 Slight nasal discharge. Scarlat. inal rheumatism. 29/7/25 171 1/7/25 19/8/25 50 25/8/25 154 20/6/25 4/9/25 77 13/9/25 181 7/7/25 29 '8/25 54 27/9/25 259 7/10/25 21/11/25 46 5/12/25 234 10/9/25 25/11/25 77 10/12/25 283 20/10/25 12/12/25 54 25/12/25 Multiple Cases. The following Table shows the house distribution, by wards. The term "house" is synonymous with the term "family " except in six instances where two families are involved. TABLE No. 52. 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 10 11 23 18 15 16 11 14 14 58 61 251 251 2 cases occurred 2 .. 2 2 1 .. 3 1 .. 6 19 36 72 3 „ „ .. 1 .. 3 .. .. .. .. .. 1 2 7 21 4 „ „ .. .. 1 .. .. 1 .. .. 1 1 1 5 20 Total houses 12 12 26 23 16 17 14 15 15 66 83 299 364 113 In 13 instances a doctor notified two cases of scarlet fever in the same house simultaneously. When enquiries were made into these cases it was found that the onset of the disease of both cases had occurred within 24 hours in only eight instances. In the other five the differences in onset were 3, 4, 6, 7 and 13 days respectively. Four of these instances occurred in Eltham. Having regard to the number of simultaneous cases and the number of multiple cases which can be accounted for as return cases, there is not sufficient data available to measure the influence of domestic overcrowding upon the incidence of scarlet fever in the Borough. It has not been possible to show, for affected households, 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, namely, less than one person per room, one to two persons per room, more than two persons per room. Dick Test. The Dick test—a reference to which is made in the prefatory note of this report—has not been employed in the area so far as I am aware. Home Isolation. 25 cases, or 6 9 per cent. of cases, were isolated at home and in no instance did a return case occur. Each case kept at home is under the supervision of the district inspector, who makes frequent inspections at intervals in order to ensure that the proper precautions for preventing the spread of disease are being taken. The Royal Arsenal authorities require cases to be removed to hospital, or a certificate from the Medical Officer of Health of efficient home isolation, before their employees are allowed to return to work. During the year five certificates were issued. H 114 DIPHTHERIA. Notification. During the year 299 cases of diphtheria were notified, compared with 195 in 1924. The case rates of the various registration districts are given in Table No. 48. The number of notifications received each quarter was as follows:— First quarter 66 Third quarter 63 Second quarter 57 Fourth quarter 113 During the quinquennium 1,675 cases were notified compared with 1,613 in the period 1916-1920. Deaths. The number of deaths from diphtheria was 13, six of which were in children under five years of age. Return Cases. There were three return cases amongst those isolated in hospital. Multiple Cases. The following Table shows the house distribution, by wards. The term "house" is synonymous with the term "family" except in seven instances where two families were involved:— TABLE No. 53. 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 20 26 24 7 13 11 15 8 60 38 231 231 2 cases occurred 2 6 2 2 .. .. 1 2 .. 3 1 19 38 3 „ „ .. 1 1 .. .. .. 1 .. .. 1 .. 4 12 4 „ „ .. .. .. .. .. .. .. .. .. .. 1 1 4 5 „ „ .. .. .. .. .. .. .. .. .. .. .. .. .. 6 „ „ .. .. .. .. .. .. .. .. .. .. .. .. .. 7 „ „ .. .. .. .. .. .. 1 .. .. .. 1 2 14 Total houses 11 27 29 26 7 13 14 17 8 64 41 257 299 115 Five pairs and one set of three cases of diphtheria were notified simultaneously. When enquiries were made, in only one instance was it found that the origin of the disease in both persons was on the same day. In addition to these, four more cases were notified within 24 hours of each other. When allowance is made for these and for return cases, and for cases notified on more than one occasion during the year, there is, as in the case of scarlet fever, insufficient data for determining the effect of domestic overcrowding upon the incidence of diphtheria amongst susceptibles. Schick Test. The Schick test—a reference to which is made in the prefatory note of this report—has not been employed in the area so far as I am aware, and no artificial measures of immunisation against the disease have been made use of. ENTERIC FEVER. Sixteen cases of enteric fever were notified during the year. In only one case was the diagnosis not confirmed. In the following Table the details of each case are shown: TABLE No. 54. No. Date. Sex. Age. Diagnosis. Final Diagnosis. Result 1925. 1 Jan. 27 F. 40 Enteric Fever Arthritis Cured 2 Jan. 29 F. 48 Enteric Fever Enteric Fever: Pneumonia Died 3 Feb. 2 M. 8 Typhoid Fever Enteric Fever Cured 4 May 6 M. 14 Typhoid Fever Paratyphoid Cured 5 June 5 M. 44 Enteric Fever Enteric Fever Cured 6 Aug. 4 M. 62 Enteric Fever Enteric Fever: Cholecystitis Died 7 Aug. 10 F. 51 Typhoid Fever Enteric Fever Died 8 Oct. 15 F. 9 Paratyphoid Fever Paratyphoid B. Cured 9 Oct. 29 F. 6 Paratyphoid Fever Paratyphoid B. Cured 10 Nov. 2 F. 44 Paratyphoid Fever Paratyphoid B. Cured 11 Nov. 8 M. 9 Paratyphoid Fever Paratyphoid B. Cured 12 Nov. 9 F. 16 Paratyphoid Fever Paratyphoid B. Cured 13 Nov. 13 M. 38 Paratyphoid Fever Paratyphoid B. Cured 14 Nov. 19 M. 44 Enteric Fever Enteric Fever Died 15 Nov. 20 F. 55 Paratyphoid Fever Paratyphoid Fever Cured 16 Dec. 5 F. 85 Paratyphoid Fever Paratyphoid Fever Still in Hospl. 116 During the five years under survey, 62 cases of the enteric group of fevers were notified, compared with 212 in the quinquennium 1901-1905. PNEUMONIA. All acute primary pneumonias are notifiable, but no acute secondary pneumonias except influenzal are notifiable. During the year 277 notifications were received, of which 40 were influenzal. 97 deaths occurred from primary pneumonia and 13 from influenzal pneumonia. The objects of notification are twofold: (1) to enable methods of controlling the disease to be put into action; and (2) to collect data from whch measures of control can be deduced. The Regulations have now been in operation for over six years, and it may be that the time is now opportune to consider how far they have been effective. If we examine the figures published in the Annual Report of the Medical Officer of Health for London for the year 1924, we find that in London County in that year there was a notification rate of 147 per 1,000 and a death rate of 1.16 per 1,000, giving a case mortality rate of 79 per cent., a figure which every practising physician knows is ridiculous. Examined in detail the figures are even more interesting, for in fourteen London boroughs the death rates exceed the notification rates. Similarly, in England and Wales, we find that for the year 1924, 60,723 cases were notified and 38,970 deaths occurred. As it is generally accepted that the case mortality rate of pneumonias is somewhere between 20 and 30 per cent., it is obvious that many cases of pneumonia escape notification. In this way we see that methods of controlling the disease can only be put into action in a limited sort of way and the data which is being collected is inadequate and unreliable. 117 The term "acute primary pneumonia," somehow or other, suggests acute lobar pneumonia, and so primary bronchopneumonias are often not notified. A common disease of young children, known as capillary bronchitis, is now classified as a pneumonia by the Registrar General, but is still regarded by some doctors as a bronchitis—if death ensues, the terminal condition may be said to be due to the onset of a complication —a secondary pneumonia. I do not believe that the objects of notification will ever be attained until we have notification of all acute pneumonias. Secondary pneumonias were excluded from notification because it was considered that, as these were usually secondary to the infectious diseases, further notification was not needed. Unfortunately for this premise, measles and whooping cough are not notifiable in every area, and so secondary pneumonias complicating these diseases do not always get known. Similarly, a pneumonia following on an acute bronchitis is not notifiable. In any event, if the practical reason for notification is the provision of nursing, it is difficult to justify the non-inclusion of acute secondary penumonias in cases where the primary disease is not notified, when regard is paid to the fact that out of the total deaths from pneumonia in England and Wales in 1924 (38,970) all but 7,253 were of persons under 45 years of age. There were only 32,690 deaths from tuberculosis. Administrative measures for the control of pneumonia should include more efficient and wider notification, a greater use and extension of existing nursing facilities, and the provision of hospital beds where cases can be moved at an early stage of the disease—they cannot safely be removed in the later stages. When the general practitioner knows that by notification he can be helped and that his patient can be assisted by the local authority, then you will find that the 118 notifications will increase in number, and, what is more important still, the number of deaths per annum will fall. In Woolwich the notifications and deaths from pneumonia during the past seven years have been as follows:— Notifications. Deaths. 1919 123 125 1920 136 97 1921 236 98 1922 345 116 1923 242 65 1924 354 95 1925 277 97 Nursing Provision. I am informed by the Secretaries of the Nursing Associations in the Borough that the following cases of pneumonia were nursed during the year:— Woolwich and Plumstead Nursing Association 96 Eltham District Nursing Association 4 Silvertown and North Woolwich Nursing Association 2 St. Luke's Parish Nursing Association 12 The Council have a scheme whereby the various nursing associations are paid 1s. 3d. for each visit where the Medical Officer of Health asks for nursing assistance to be furnished. During the year 60 cases were nursed at a total cost of £59 1s. 3d. The number of visits paid by the nurses was 945, thus averaging approximately 16 per case. This scheme requires to be better known. The following Table No. 55 shows the number of notifications of pneumonia received each month, classified by sex and according to type incidence. It also shows the number of deaths occurring from acute pneumonia and from influenzal pneumonia. 119 TABLE No. 55. Monthly incidence of Pneumonia. Month. Male. Female. Total Type. No. of Deaths. Lobar. Broncho. Influenzal. Acute Primary (not specified). Acute Primary Pneumonia Influenzal Pneumonia January 12 13 25 6 8 6 5 13 1 February 14 12 26 5 3 16 12 8 7 March 24 8 32 7 1 17 7 6 2 April 17 9 26 13 3 2 8 7 1 May 9 4 13 6 4 1 2 7 .. June 11 4 15 5 3 1 6 6 1 July 11 8 19 9 5 .. 5 8 .. August 4 1 5 2 2 .. 1 3 .. September 12 2 14 8 5 1 .. 5 .. October 16 8 24 4 8 2 10 5 .. November 17 21 38 3 15 2 18 11 .. December 26 14 40 8 12 2 18 18 1 Total 173 104 277 76 69 40 92 97 13 The next Table, No. 56, 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. 56. Notification of Pneumonia. Ward. Lobar. Broncho. Influenzal. Acute Primary. Total. Dockyard 6 6 - 7 19 St. Mary's 8 6 3 14 31 River 14 11 5 8 38 St. George's 4 3 1 2 10 Burrage 2 7 2 7 18 Herbert 1 1 1 3 6 Glyndon 5 6 3 5 19 St. Margaret's 9 5 10 7 31 Central 4 2 2 2 10 St. Nicholas 6 18 7 21 52 Eltham 17 4 6 16 43 76 69 40 92 277 120 ENCEPHALITIS LETHARGICA. Ten cases were notified during the year, including one female who had been notified in 1924. Nine of them were admitted to hospital. Details of each case are given in the following Table No. 57. The number of notifications received during the quinquennium was 40, compared with 6 in the two years 1919 and 1920. TABLE No. 57. Date notified. Sex Age Ultimate Diagnosis. Remarks. 1925. Jan. 25 M. 40 Renal disease. Pneumonia Died January 28 May 15 M. 9 Encephalitis Lethargica May 27 M. 38 Pneumococcal Meningitis Died May 28 June 9 F. 9 Encephalitis Lethargica July 2 M. 2 Constipation July 3 M. 10 Encephalitis Lethargica Died July 5 Aug. 14 M. 46 Encephalitis Lethargica Dec. 1 F. 39 Encephalitis Lethargica Died December 21 Notified previ'sly. Dec. 7 F. 46 Encephalitis Lethargica Dec. 10 M. 60 Encephalitis Lethargica CEREBRO SPINAL MENINGITIS. Five cases were notified during the year, details of which are set out in the following Table No. 58. All the cases, with one exception, were admitted to hospital. The number of notifications received during the quinquennium was 26, compared with 63 in the previous five years. TABLE No. 58. Date notfied. Sex Age Ultimate Diagnosis. Remarks. 1925. Feb. 14 M 18 Cerebro Spinal Meningitis Military case. May 13 M 1½ Broncho-pneumonia May 18 F 1 Cerebro Spinal Meningitis Died June 9. July 11 M 15 Tuberculous Meningitis Died July 21. Aug. 11 F 3/12 Cerebro Spinal Meningitis Died August 13 121 ERYSIPELAS. The number of notifications received during the year was 44, and during the quinquennium, 225. During the five years 1916-1920, 380 cases were notified. No special comment is called for on the incidence of this disease. OTHER NOTIFIABLE INFECTIOUS DISEASES. References to the diseases which in the main affect young children—Measles, Whooping Cough, Zymotic Enteritis. Acute Poliomyelitis, and Ophthalmia Neonatorum—and to Puerperal Fever, will be found in the Maternity and Child Welfare section of the report. The incidence of Malaria and Dysentery calls for no comment. ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. Disinfection. On receipt of a notification, the district Sanitary Inspector visits the home and enquires into the circumstances of each case in order to discover, if possible, the source of infection and to make arrangements for disinfection. Practically all cases of Scarlet Fever and Diphtheria are removed to hospital, although in periods of large epidemics the existing hospital accommodation of the Metropolitan Asylums Board is sometimes taxed to such an extent that cases which should go to hospital have to be left at home. If the case is removed to hospital, infected articles, bedding, etc., are removed to the Council's Disinfecting Station at White Hart Lane and disinfected there by steam, articles which cannot be disinfected by steam being disinfected by formalin. The infected rooms are disinfected by formalin. If the case is left at home the Inspector reports the conditions to the Medical Officer of Health, who decides whether or not 122 home isolation can be permitted, making a personal visit if necessary. A printed card of instructions is given in these cases, and the process of disinfection is delayed until the medical attendant certifies that the case is free from infection. Periodical visits are paid by the district Sanitary Inspector to ensure that isolation is being carried out. Contracts are excluded from school in accordance with the regulations of the London County Council. After diphtheria the contacts attend at the Town Hall for examination and for swabbing whenever, in the opinion of the Medical Officer of Health, this is necessary. The Disinfecting Station is sometimes used for special disinfections at the request of the inhabitants. A small charge, to cover the cost of disinfection, is made in these cases, and during the year 57 such disinfections were carried out, and fees amounting to £15 7s. were paid. In tabular form below is shown the amount of disinfection which was carried out during the year. TABLE No. 59. Rooms disinfected after ordinary fevers 650 „ „ tuberculosis 293 „ ,, verminous cases 53 Rooms disinfected for other reasons 69 Total articles disinfected 24, 244 Disinfestation. The Council's Station for cleansing verminous persons adjoins the Disinfecting Station and was opened in November, 1906. It is mainly used by school children under an agreement which was originally entered into with the London County Council in August, 1911. The station is now reserved for the use of these children every 123 day, except Saturday and Sunday, between 9 and 4.30 o'clock. Under the agreement the Borough Council must cleanse children to the reasonable satisfaction of the London County Council, who pay 1s. for each cleansing. For this purpose the Borough Council employs a female attendant who acts under the supervision of a London County Council school nurse who is responsible for the treatment at the Station. Children suffering from scabies are examined weekly by one of the County Council's medical staff. This work is closely co-ordinated with that of the woman Sanitary Inspector who visits the children's homes and makes the necessary arrangements for the cleansing and disinfecting of verminous bedding and rooms. Every effort is made to ensure that the bedding is disinfected the same day the child is cleansed. Table No. 60 below shows the extent to which the Station has been used within the last five years. TABLE No. 60. Children. Adults. Grand Total. Year. Boys. Girls. Total. Males. Females. Total. 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 1925 359 2082 2441 23 6 29 2470 TUBERCULOSIS. The Council's Tuberculosis service has the following ramifications:— (a) The administration of the various Tuberculosis Regulations of 1912, 1921, 1924 and 1925. 124 (b) The supply and supervision of shelters at the homes of patients. (c) The provision of a Tuberculosis Dispensary. (d) Home visiting of Tuberculosis cases. (e) Visiting and medical examinations of cases for the Ministry of Pensions. (f) Arrangements for securing the examination and systematic supervision of home contacts. (g) An agreement with the Seamen's Hospital for X-ray examinations in doubtful cases. (h) Arrangements for following up cases where the diagnosis is doubtful. (i) Co-operation between the Tuberculosis Officer and the local medical practitioners. (j) Co-operation with the School Medical service. (k) Provision of extra-nourishment for tuberculous persons. (l) An agreement with the School Treatment Committee for the provision of dental treatment. (m) An agreement with the London Hospital for Finsen Light treatment of lupus. (n) An agreement with Brompton Hospital for the induction of artificial pneumo-thorax. (o) The formation of a Care Committee. Institutional treatment is provided and controlled by the London County Council. For these purposes the Council maintain a staff of one whole-time and one part-time Medical Officer, a Lay Organiser, three Tuberculosis Visitors and and one Clerk Dispenser. The Lay Organiser is Secretary of the Care Committee. In addition to these the School Treatment Committee appoint, subject to the Council's approval, one part-time Dentist and one part-time Anaesthetist for the dental clinics. The names and qualifications of the staff are given in Section III. 125 At the beginning of the quinquennium the Dispensary was managed by a Voluntary Committee, but in 1921, owing to the inability of the Central Fund for the Promotion of Tuberculosis Dispensaries in London to carry on, the Council took over the Dispensary and Staff as a going concern. Since that date the Dispensary has been part of the Health Department and its activities are fully co-ordinated with general health work. There were two Medical Officers on the staff at the time of the change, but in 1923, by means of a re-organisation of the medical staff, it was possible to arrange for the work to be done by one and a half medical officers, thus setting free for other medical services of the Council the half-time of one of the doctors. In 1923, the Dispenser, who was a part-time Tuberculosis Visitor, resigned, and, in considering the steps to fill the vacancy, the Council resolved to substitute for the appointment the appointment of Clerk-Dispenser. Otherwise the staff remains unchanged. During the four years the service has been amplified in the following respects:— Arrangements have been entered into with the authorities of the Brompton Hospital for the induction of artificial pneumo-thorax, and of the London Hospital for Finsen Light treatment of tuberculosis. The agreement with the Seamen's Hospital for the X-ray examination of doubtful cases has been renewed. Additional nourishment is given in necessitous cases certified by the Tuberculosis Officer as requiring this. Dental treatment is now available. A Tuberculosis Care Committee has been formed. The number of tuberculosis shelters has been increased by two. The number of attendances at the Dispensary average 7,000-8,000 a year, while the number of new cases averages 1,200. The vast majority (over 80 per cent.) of those who make a first visit are non-tuberculous. This large proportion 126 of non-tuberculous is possibly due to the fact that there is no general hospital or dispensary in Woolwich, and many cases go, in consequence, to the Dispensary, who would otherwise in the first instance attend the out-patient department of a general hospital. Fifty per cent. of approved expenditure on the Dispensary scheme is paid by the Ministry of Health and twenty-five per cent. by the London County Council. Grant is not paid for expenses incurred in administering the Tuberculosis Regulations. Details of the Council's Tuberculosis Service are given in the following pages and the various details will be found under corresponding letters to those set out above. Before dealing with them, however, it is convenient here to refer to the mortality statistics. Deaths. The deaths from pulmonary tuberculosis in Woolwich during 1925 numbered 160, giving a death-rate of 114 per 1,000 of the population, the lowest figure recorded since 1912. The corresponding figures for 1924 were 171 and 122 respectively. Deaths from other forms of tuberculosis numbered 27, as against 28 in the preceding year, the death-rate being 019 per 1,000 of the population. The decrease in mortality in 1925 under 1924 is almost entirely confined to pulmonary, but ten additional deaths were reported in the age period 25-45. Nine children under 1 year died of tuberculosis. In five instances it was definitely established that they were contacts of mothers who had positive sputum. Such facts as these lend support to the view that children of tuberculous mothers would be better removed from immediate contact with them. The deaths and death-rates from tuberculosis, classified by type of disease, annually, since 1912, have been as follows: 127 TABLE No. 61. Year. Deaths. Death-rates. All Forms. Pulmonary. NonPulmonary. All Forms. Pulmonary. Non. Pulmonary. 1912 175 129 46 1.44 1.06 0.38 1913 218 184 34 1.78 1.50 0.28 1914 229 177 52 1.87 1.45 0.42 1915 237 197 40 1.83 1.52 0.31 1916 210 169 41 1.61 1.30 0.31 1917 215 176 39 1.63 1.33 0.30 1918 231 199 32 1.72 1.48 0.24 1919 196 171 25 1.44 1.26 0.18 1920 188 161 27 1.38 1.18 0.20 1921 207 168 39 1.50 1.22 0.28 1922 190 163 27 1.37 1.18 0.19 1923 191 173 19 1.36 1.23 0.14 1924 199 172 28 1.42 1.22 0.20 1925 187 160 27 1.33 1.14 0.19 In addition to the 160 deaths stated above, 8 persons who had been notified as suffering from pulmonary tuberculosis died during the year, and information relating to these is given in the following table:— TABLE No. 62. Case No. Date notified as Tuberculosis. Cause of Death. 1 13/4/23 Cerebral tumour. 2 13/3/25 1. Mastoiditis 2. Broncho pneumonia. 3. Convulsions. 3 20/3/23 Carcinoma of R. ileum. Broncho pneumonia. 4 24/2/25 Chronic bronchitis and mitral disease. 5 1/12/24 Pernicious anaemia. 6 13/8/23 Transverse myelitis. Bedsores. 7 20/8/20 Suppurative pyelo-nephritis. 8 12/6/19 Carcinoma of stomach and liver. Cardiac failure. 128 The period which elapsed between notification and death is shewn in the following table:— TABLE No. 63. Pulmonary. Percentage. NonPulmonary. Percentage. Not Notified 14 8.75 10 37.04 0-1 month 20 12.50 11 40.74 1-3 17 10.63 2 7.41 3-6 „ 12 7.50 — — 6-12 „ 27 16.87 2 7.41 1-2 years 27 16.87 1 3.70 2-5 „ 33 20.63 1 3.70 Over 5 years 10 6.25 — — 160 100.00 27 100.00 The ratio between non-notified and the total non-notified deaths and the total Tuberculosis deaths, as will be seen from the above Table, is therefore as 1 is to 8. 129 TABLE No. 64. Tuberculosis. Summary of Notifications received during the year ended 2nd January, 1926. Age-periods— Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 & upwards. Total Primary Notifications. Under 5. 5 to 10. 10 to 15. Total Primary Notifications. Pulmonary Males 2 3 4 5 15 22 28 31 18 11 2 141 195 .. .. .. .. .. 12 121 „ Females .. 2 3 4 17 23 32 15 6 2 1 105 145 .. .. .. .. .. 3 84 Non-Pulmonary Males 2 6 9 3 2 .. .. 1 3 .. .. 26 25 .. .. 1 1 1 .. 17 „ Females 1 3 7 3 2 4 4 3 .. .. .. 27 33 .. .. .. .. .. .. 16 Total 5 14 23 15 36 49 64 50 27 13 3 299 398 .. .. 1 1 1 15 238 New Cases Not Notified. Pulmonary Males 1 .. .. .. .. 1 1 .. 3 3 1 10 .. .. .. .. .. .. .. .. „ Females 1 .. .. .. 2 3 6 .. 1 1 .. 14 .. .. .. .. .. .. .. .. Non-Pulmonary Males .. 1 1 .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. „ Females 2 1 1 .. .. .. .. .. .. .. .. 4 .. .. .. .. .. .. .. .. Grand Total 9 16 25 15 38 53 71 50 31 17 4 329 .. .. .. .. .. .. .. .. 130 (a) Administration of the Tuberculosis Regulations. Notifications. The 1912 Regulations provide for the notification of tuberculosis by general practitioners, school medical officers, and superintendents of institutions on admission and discharge of patients. During the year 399 notifications were received, but 99 of these related to cases which had been notified previously. The nett number was 300. In addition to these cases, however, the Department had knowledge of 30 other new cases from other Medical Officers of Health and from the death returns. The total number of new cases was 330. Secondary notifications, on forms C and D, are not included in these figures. In Table No. 64 will be found the age and sex distribution of the new notified cases. The distribution of disease in the various cases notified each year since 1921 was as follows:— TABLE No. 65. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 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 1925 246 9 6 9 14 6 10 300 The 1921 Regulations require the Medical Officer of Health to revise quarterly the register of notifications, and, as soon as he is aware that a notified case has removed permanently to another area, notify the Medical Officer of Health of that area of the case. In accordance with this duty 19 notifications were sent to other medical officers and 10 notifications were received. 131 The 1924 Regulations require the Medical Officer of Health to furnish, quarterly, a return to the County Medical Officer of the actual number of cases on the register at the beginning and end of the quarter, the number added and the number removed, giving in the case of removals the name and address and reason for removal of each case. The Table given below shows the changes which have taken place in the register during 1925, and it will be noted that at the end of the year there were 2,156 known cases of tuberculosis in the Borough. TABLE No. 66. Pulmonary. NonPulmonary. Totals M. F. M. F. Number on Register at 1st January, 1925 1009 859 276 263 2407 Number of additions 158 119 28 33 338 Number of deletions 278 239 36 36 589 Number on Register at 31st December, 1925 889 739 268 260 2156 The 1925 Regulations provide for the compulsory discontinuance of a person, suffering from infectious respiratory tuberculosis, from employment involving the handling or treatment of milk, and are enforceable by local authorities. No action was taken under them during the year. (b) Shelters. The Council have provided 13 shelters for the use of consumptives who have been to sanatoria and who are desirous of continuing to live under open-air conditions. The shelters are of special design to allow of their easy transport and introduction into gardens through the terraced houses which are a feature of this locality. They are 132 times used for cases too advanced for sanatorium treatment, and in some cases have been effective in enabling such consumptives to resume their work. The Tuberculosis Visitors regularly visit in order to ensure that the shelters are being used to full advantage. The shelters are used generally throughout the year, but it is difficult to get some patients to continue their use during the winter months. (c) Tuberculosis Dispensary. The Tuberculosis Dispensary is in Maxey Road, Plumstead. Consultations are held there every day, but special days and times are allotted to men, women and children. Its situation is not ideally central and the Council may have to consider very shortly the provision of a branch dispensary or visiting station at Eltham. Form "R" (a return as to the work in connection with the Tuberculosis Dispensary during the year) follows as Table No. 67. If this table be compared with Table No. 64 it will be noticed that although there were 330 new cases, only 195 attended the Dispensary. Enquiries were made to ascertain the reasons why the other cases did not attend the Dispensary and the information available shows that 63 died shortly after notification, 46 were inmates of hospitals or infirmaries, 6 were inmates of asylums, while 20 were under the case of medical practitioners and did not wish to attend the Dispensary. 133 TABLE No. 67. Return as to work carried out in connection with the Maxey Road Tuberculosis Dispensary for the year 1925 (Form "R" (revised). Number of Under observation at the Dispensary on Jan. 1st pending diagnosis Examined for the first time during the year Total. Found to be Under observation at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary NonPulmonary (a) All persons (including "Contacts") Adults M. 7 350 357 96 3 236 12 10 F. 7 389 396 74 5 294 11 12 Children under 15 M. 5 314 319 9 8 295 7 — F. 2 296 298 10 6 276 5 1 Total 21 1,349 1,370 189 22 1,101 35 23 (b) "Contacts" (included in (a) Adults M. 1 90 91 11 1 75 4 - F. 2 163 165 19 - 138 6 2 Children under 15 M. 1 141 142 2 2 135 3 — F. .. 147 147 3 2 142 — — (c) Insured persons included in (a) M. 4 288 292 76 1 199 8 8 F. 5 62 67 18 2 39 3 5 134 TABLE No. 67 (continued). (1) Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 751 (2) Total number of attendances of patients at the Dispensary during the year:— Insured 3,445 Uninsured 3,186 (3) Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 349 (4) Number of cases in which the period of observation at the Dispensary exceeded two months 42 (5) Number of insured patients under domiciliary treatment on December 31st 279 (6) Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 144 (7) Number of persons referred to affiliated hospital for consultation - (8) Number of consultations with medical practitioners at the homes of patients:— Insured 23 Uninsured 16 (9) Number of other visits paid by Tuberculosis Officers to the homes of patients 471 (10) Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 3,928 (11) Number of specimens of sputum examined in connection with the work of the Dispensary 380 135 (d) Home Visiting of Tuberculous Cases. On receipt of every notification the home is visited by the Tuberculosis Visitor, who advises as to any re-arrangement that seems possible and desirable in the interests of the patient and other members of the family. In the case of patients notified by the Tuberculosis Officer a visit is also made by one of the medical staff, who thus gains a knowledge of the home circumstances of the patient. The Tuberculosis Visitor endeavours to visit each home in her district once in three months, but, in the case of patients with recent and more active disease, visits are often more frequent. (e) Work for Ministry of Pensions. The Ministry of Pensions have made arrangements to secure that tuberculous ex-service men of certain categories receive the fullest measure of residential treatment which competent medical opinion considers desirable for them, and affords them any necessary preference over the general population. In dealing with these cases the Ministry have made arrangements whereby the services of the Council's Tuberculosis Staff are available. During 1925, 119 reports were furnished by the Tuberculosis Officers, and 479 visits were paid by the Tuberculosis Visitors. An amount of, approximately, £42 per annum is paid to the Council for these services. Reports are furnished periodically on all cases in receipt of treatment allowance and such other cases as apply to the Ministry for assistance, and occasionally for other reasons. Special visits are often necessary for these purposes to the homes of the patients, and as these are often urgent—any delay in furnishing the report may mean that treatment allowance is not paid—the routine work and administration of the Dispensary is sometimes upset. (f) Contacts. On receipt of each new primary notification 136 every effort is made to induce people living in the same house as the patient to present themselves for examination. In many cases, however, it is very difficult to persuade them of the necessity for this examination. During the year under review 545 contacts were examined out of a total of 731. (g) X-Ray Examinations. An agreement was entered into with the Seamen's Hospital Society in 1921 providing for the X-ray examination of doubtful cases of Tuberculosis. Payment is made on the following basis:—For screen and report, 7s. 6d.; X-ray plate and report, 15s. No pulmonary case is sent until three negative spit examinations have been made. The number of cases referred for this examination during the year was 67. Increasing use is being made of this service. 42 cases were referred in 1923 and 65 in 1924. This service is very useful, often enabling very early cases to be diagnosed, but the maximum results will never be obtained until the apparatus and the Tuberculosis Officer are under the same roof. In this connection it may be as well to point out that the increasing use of artificial pneumothorax treatment and the necessity of refills for these patients over prolonged periods is one for serious consideration, and it may be desirable, in the near future, that refills should be undertaken by Tuberculosis Officers themselves to relieve the pressure on the hospitals concerned. Without X-ray apparatus it would be difficult, and probably undesirable, to attempt this. (h) Observation Cases. Observation cases are those in which no definite diagnosis of tuberculosis has been arrived at during the first month. A number of these fail to continue in attendance but a check is kept upon these cases by going through their case papers at the end of each month, and, if they are not attending, the Tuberculosis Visitor endeavours to get them to visit again. 137 (i) Co-operation with Local Practitioners. During the year 39 new cases were seen by the Tuberculosis Officer at the home of the patients, and 172 were referred to the Dispensary by medical practitioners in the Borough. (j) Co-operation with the School Medical Service. There is intimate relationship with the School Medical Service and the Dispensary. Many cases are referred to the Dispensary by the School Medical Officers, and the child contacts of tuberculous patients are referred to the School Medical Service for special observation and supervision. The Divisional School Medical Officer and the Tuberculosis Officer, in personal consultation, discuss these contacts and decide on the supervision desirable. Other children whose condition is unsatisfactory are referred to the School Clinic for the treatment of minor ailments end dental caries, or to the School Care Organiser with a recommendation as to the provision of milk and cod liver oil to be given at school. (k) Extra Nourishment. It is a well known fact that the income of many families, where there is a case of tuberculosis, is insufficient for their needs, and the provision of extra nourishment is regarded as an essential part of the patient's treatment. The expenditure ranking for grant on this service is limited to a maximum rate of £2 per annum per 1,000 population, and so every effort has been made to secure that the funds available are expended to the best possible advantage, and that grants of food are made only to patients who are likely to benefit materially thereby. In carrying out the administration of this work every case is certified in the first instance by the Tuberculosis Officer to be in need of such assistance, and in giving this certificate he is guided by the following conditions which are laid down in Circular 257 of the Ministry:— 138 (a) Patients who have received an adequate course of sanatorium treatment, and whose medical condition is such that, with the grant of extra nourishment, they may be expected to maintain or recover full working capacity; and (b) Patients in whose cases ultimate arrest of the disease may reasonably be anticipated, and who are waiting for admission to a sanatorium. After certification by the Tuberculosis Officer, enquiries are made into the financial circumstances of the applicant, and, when this information has been obtained, the application is reviewed by the Care Committee. On the report of the Care Committee the Medical Officer of Health issues the necessary vouchers. A report is then submitted to the next meeting of the Health Committee for the approval of the action of the Medical Officer of Health in issuing to the cases concerned. Only those articles which have been approved by the Ministry are supplied to these cases. The approved articles are as follows:—butter, eggs, milk, oatmeal, Virol and milk, and Emprote. Careful enquiry is made from time to time to ensure that the articles of food supplied are consumed by the patients for whom they are ordered. (1) Dental Treatment. Dental work is carried out at the School Clinic in Brewer Street, patients being referred there from the Dispensary. During the year 28 patients received treatment, the total number of attendances being 57. Patients receive dental treatment free, but if dentures are required patients are assessed according to their means, each case being treated on its merits. Dentures were supplied in nine cases at a cost of £38 3s., and during the year the income received under this head was £19 14s. 6d. 130 (m) Finsen Light Treatment. In 1921 the Council entered into an agreement with the London Hospital for the treatment of persons, suffering from lupus, in the Finsen Light Department of the hospital. A fee of 5s. is paid for each attendance. No case is sent there unless recommended by the Tuberculosis Officer, and the number of treatments authorised at any one time is limited to twelve. Thirty attendances were made during the year. (n) Artificial Pneumothorax. In 1921 the Council agreed to pay the Hospital Committee of Brompton Hospital for the supply of artificial pneumothorax refills. In the ordinary way patients receiving these refills attend as out-patients at the hospital, but, if necessary, residential treatment is available for patients presenting symptoms of illness during the refill. The artificial pneumothorax is produced by the introduction of air or nitrogen gas into the pleural cavity, i.e., the cavity surrounding the lung, and thus, by compressing the lung, hindering the progress of the tuberculous disease. Many cases of tuberculosis benefit by this treatment, particularly when one lung is extensively diseased and the other sound. A pavment of 10s. 6d. per refill is made to the Brompton Hospital, and only cases recommended by the Tuberculosis Officer are paid for. Seventy refills were given during the year. (o) Care Committee. In 1923 the Council resolved to re-constitute the Woolwich Tuberculosis Care Committee, which had existed in association with the old Tuberculosis Dispensary. prior to the War, but which had gradually ceased to function. The object of a Tuberculosis Care Committee is to increase the effectiveness of the tuberculosis scheme of the Borough Council, and much of the work it undertakes is outside the powers of the Council. The Woolwich 140 culosis Care Committee is formed of representatives of local authorities and other local organisations. In this way all available agencies can be linked up, and extra assistance, such as food, change of air, clothing, better home conditions, more suitable occupation, etc., which may be needed to enable patients to benefit to the fullest extent from the treatment provided, may often be readily secured. Its functions are:— (1) To assist the family of the tuberculous patient before admission to, during stay, and after discharge from an institution. Generally speaking, the function of a Care Committee is to deal with the family, the function of the Borough Council and the County Council to deal with the patient. Its primary duty, therefore, is to consider the economic position of the family of every patient suffering from tuberculosis, and to render such advice and assistance as circumstances dictate, with a view to enabling the family to maintain their economic independence and to derive the fullest possible advantage from the medical treatment prescribed. Before admission to an institution the family should be visited by one of the committee who should take steps to facilitate the admission of the patient to the institution, e.g., if the mother is the patient, make arrangements for the care of the children and the house during her absence. During the stay in the institution, the visitor should keep the home under regular supervision in order, e.g., to prevent, if possible, the premature discharge of a case if all that is needed is some simple adjustment of the family circumstances. After discharge from the institution she should regularly visit so as to be able to recognise early any circumstances or difficulties 141 which would render the case more liable to relapse, take such steps as are necessary to prevent this, and assist in finding suitable employment. (2) To advise the Borough Council— (a) In cases where additional nourishment should be provided for the patient, the Tuberculosis Officer having recommended the patient on medical grounds. (b) In assessing charges to be made where artificial dentures are supplied on the recommendation of the Tuberculosis Officer. (3) Assist the County Council— (a) In recommending whether the case should receive institutional treatment from the County Council, Board of Guardians, or some voluntary agency. (b) In assessing charges to be made for residential treatment. (c) In arranging for the collection of these charges for the County Council. In broad outline these are the functions and duties of a. Care Committee in London. So far as finance is concerned the Borough Council are empowered to defray the salary of the Secretary and such official expenditure on stationery and postage as may be reasonably necessary. The Ministry of Health are of opinion that provision for financial assistance for families should not be made, but, if it is necessary, the existing public or charitable organisations should be used by bringing the family in touch with such organisations. There are no local charitable organisations in Woolwich available for providing for the needs of the tuberculous, so, unless the Woolwich Care 142 mittee take steps to raise a fund, their work would be limited to giving advice, but advice, no matter how wholesome and desirable it may be, will not accomplish the aims of the Committee. The Council had this aspect under consideration, and they have made representations to the Ministry and the County Council that funds are needed for this purpose, but so far without success. In these representations the Council received the support of seven Borough Councils. At the end of the year the Committee was constituted as follows:— Bodies. Representatives. Woolwich Borough Council Alderman Mrs. E. Dormer. J.P.; Councillors P. Chinnery, W. G. McCartney 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. A. E. Welford. Friendly Societies Mr. W. A. Lyon, Mr. A. G. Rourke, Mr. F. D. Smyth. London Insurance Committee Mr. W. Edwards. Panel Committee for the County of London. Dr. J. J. O'Mullane. War Pensions Committee Mrs. E. E. Taylor. Woolwich Invalid Children's Aid Association. Mrs. J. B. Great Rex. Late Tuberculosis Dispensary Committee. Mr. E. G. Dixon, J.P., Mr. W. Dasliwood. United Services Fund Miss M. Shaw. Ex-offlcio M embers:— Voluntary Visitors Miss L. T. Bloxam, Mr. A. Dennis, Miss L. Macdermott, Miss R. C. Wild. Tuberculosis Officer Dr. F. J. C. Blackmore. Medical Officer of Health Dr. J. Macmillan. 143 The Woolwich Tuberculosis Care Committee meets once a quarter. The Committee have appointed Sub-Committees which meet as follows:—The General Purposes and Assessments Sub-Committee once a week, the Finance Sub-Committee once a month, and the Employment Sub-Committee and the Grancher Sub-Committee meet as often as may be necessary. During the year the number of meetings held by the Committee, including the Sub-Committees, was 55. It has dealt with 256 cases under the London County Council's scheme for institutional treatment, reported on 400 applications for additional nourishment, and 15 cases requiring artificial teeth. It has given financial assistance to 31 cases. Five children were sent away to the country under the Grancher scheme. From various sources during the year the sum of £150 17s. 8d. was raised and the total expenditure was £186 16s. Institutional Treatment. The following table shows the number of admissions to hospitals, sanatoria, poor law institutions and training colonies. TABLE No. 68. Hospitals. Sanatoria. Infirmary. Training Colonies. Insured 89 68 39 4 Uninsured 48 26 18 — Children 55 4 5 — 192 98 62 4 144 These numbers refer to 284 persons, and the monthly admissions from January to December were as follows:— January 32 July 29 February 18 August 31 March 41 September 19 April 34 October 31 May 21 November 42 June 39 December 19 Bacteriological Examinations. During the year 380 specimens of sputum were examined at the Dispensary, of which 83 were positive and 297 negative. These were in addition to the 217 specimens sent by medical practitioners to the Seamen's Hospital, Greenwich, for examination, of which 40 were positive and 177 negative. 145 SECTION VIII.—MATERNITY AND CHILD WELFARE. The Council's Maternity and Child Welfare scheme embraces the following services:— (a) Administration of the Notification of Births Acts, 1907-15. (b) Home visits to mothers and young children. (c) Establishment of Welfare Centres. (d) An arrangement with the School Treatment Committee for the treatment of minor ailments in young children. (e) An arrangement with the School Medical Treatment Committee for the provision of dental treatment to young children and to expectant and nursing mothers. (f) An arrangement with the Woolwich Invalid Children's Aid Association for orthopaedic treatment for children requiring such treatment. (g) Provision of nursing assistance for young children suffering from measles and ophthalmia neonatorum. (h) The provision of a Home for Ailing Babies. (i) An arrangement with the British Hospital for the provision of beds for the institutional treatment of midwifery. (j) A grant to the Woolwich and Plumstead Maternity Home for Unmarried Mothers. (k) Arrangements for the supply and distribution to young children and nursing mothers, of milk and food-drugs at cost price or free where there is inability to pay. J 146 (l) Collective instruction to expectant and nursing mothers. (m) The supply of medical and health visitor's assistance to the one voluntary centre in the Borough. (n) Research work on the health of young children of pre-school age at the request of the Ministry of Health. For these purposes the Council maintain a staff of one whole time and one part time medical officer, six whole time and two part time health visitors, two clerks, and one part time dentist and one part time anaesthetist for the dental clinics. The last two are appointed by the School Treatment Committee. The Council rent, or own, six welfare centres and one Home for Ailing Babies, details of which are set out on pages 151—157 while the names and qualifications of the staff are given in Section III. At each of the Centres voluntary helpers assist in the work weighing babies, recording weights, giving out clinic cards, etc. These ladies generally attend one session each per week, and their regularity and assistance are much appreciated. No one absents herself without some very good reason. Several of these ladies have been doing this work continuously during the last five years. During the quinquennium under review the Council's maternity and child welfare scheme has been amplified in the following respects:— The medical staff of the Council has been reorganised so that, without an increase in the number of officers, the half time services of one of them is available for maternity and child welfare purposes, so that the number of medical officers for 147 this purpose is now the equivalent of one and a half. As a set off against this, the services of a consultant medical officer at the Home for Ailing Babies has been dispensed with. The health visitors have been increased in number from seven to eight. In this connection, however, it should be noted that two of them hold the dual appointment of sanitary inspector and health visitor. The number of welfare centres has been increased by one, namely, The Slade. Institutional midwifery has been arranged for. Orthopaedic treatment of children requiring such treatment has been provided. Dental treatment is now available for expectant and nursing mothers and for young children. Research work on the health of the pre-school child has been started. Collective teaching to expectant and nursing mothers is being given. Statistically, the number of attendances at the welfare centres has increased from 23,449 in 1920, to 27,128 in 1925, with a corresponding increase in the number of persons attending. In this connection it should be noted that in 1919 the total attendances were under 8,000. The infantile mortality rate over the five years was 57 compared with a rate of 79 in the previous quinquennium. The maternal death rates were 2.82 and 4.62 respectively. These figures indicate, in some measure, the improvement which has taken place in the health of the mothers and children of this district during the last quinquennium, but they do not express fully the benefits which have accrued. There is now a much keener recognition of the part the individual plays in hygiene; a greater knowledge of how to be healthy and how simple health rules are, a greater appreciation of the practicability of the health organisation. Mothers bring 148 healthy babies to the centres to get them weighed and to learn how to keep them healthy. They bring difficult and ailing babies in order to get assistance in putting them right. Sick children come who require treatment by a practitioner or at a hospital, and these are referred to them at an earlier stage than used to be the case. Expectant mothers come to get advice about their own health and about the preparations for baby. More rational methods of clothing and feeding baby are gradually being brought into use. It is, in the main, to these causes, which are not entirely local but part of a general movement throughout the country, that the improvement in infant health is to be attributed. Details of the maternity and child welfare scheme under appropriate heads are given in the following pages. (a) Notification of Births Acts, 1907-1915. These Acts place an obligation on the parents, the midwife or the doctor attending, to notify a birth to the Medical Officer of Health within 36 hours of birth. In this way over 97 per cent. of births occurring in this Borough come to the knowledge of the Department within that time. Each morning, as soon as these notifications are received, as a matter of routine, literature dealing with the care and comfort of mothers and infants is sent by post to every mother. The health visitor makes her first visit to such homes as it is deemed desirable, between the tenth and fourteenth day and is guided by her experience, then gained, as to the necessity for subsequent visits, but as a general rule she works to the following standard: three visits during the first year, one visit in each subsequent year up to the age of five years. In the case of infants who are born in the Borough whose usual address is elsewhere, copies of the 149 notifications of birth are sent to the Medical Officer of Health concerned, and in the same way notifications from other Medical Officers of Health reach this Department. (b) The Work of the Health Visitors. No change has taken place in the personnel of the Health Visitors during the year. Their duties comprise the visiting of births and of children under school age in the district needing this attention; the visiting of expectant mothers who have attended at an antenatal centre or to whom visits are desirable; enquiry into still births and the deaths of young children; and attendance at the centre to the women and children including those whom she visits in the homes who come for medical and surgical advice. The supervision of all children under school age in the district includes the visiting of cases of ophthalmia neonatorum, measles, zymotic enteritis, pneumonia and anterior poliomyelitis (infantile paralysis). Arrangements have been made whereby, so far as is practicable, the health visitor attends at the centre which is most convenient to the women residing in her district. It is not many years ago since the health visitors' visits were misunderstood and in many cases unwelcomed; nowadays this has changed and mothers now expect the health visitors to call, and feel disappointed if they do not. In the first four years of the quinquennium the number of visits paid by the health visitors was as follows:—1921,16,836; 1922, 18,152; 1923, 21,073; 1924, 22,148. The following table shows the classification of visits paid by the health visitors in 1925:— 150 TABLE No. 69. Births—First Visits 2,203 „ Re-visits 12,471 Infant deaths investigated 85 Still-births investigated 10 Expectant mothers—home visits 395 Infectious diseases:— Ophthalmia Neonatorum—First Visits 30 ,, „ Re-visits 41 Measles—First visits 1,413 „ Re-visits 454 Puerperal fever—First visits 8 „ Re-visits 4 Zymotic enteritis—First visits 12 „ Re-visits 4 Tuberculosis 58 Pneumonia 140 Anter ior poliomyelitis 12 Visits unclassified 420 Visits unsuccessful 1,783 19,543 In 1925, the Council, with the approval of the Ministry of Health, paid the class fees of two health visitors at a refresher course for health visitors. These refresher courses have been attended by the health visitors in the last four years with beneficent results to this Council. At these courses not only do the health visitors learn about the modem advances in infant hygiene but they meet health visitors from other districts, and in talking over their experiences they learn much that is of mutual benefit to them in their work. They come back from this course refreshed and with added zeal and zest for their work. 151 (c) Welfare Centres. The welfare centres are set out in detail on page 44, and can be divided into two groups—a group at which ante-natal, post-natal and infant clinics are held each week, and a group at which only infant clinics are held, but where, for convenience, an occasional mother is given advice concerning herself. In the last group are included the New Eltham, North Woolwich and the Slade Centres; in the former the Town Hall, Eltham, and Plumstead Centres, The Beresford Street Centre is a voluntary centre belonging to the second group. At the end of the year three ante-natal and eighteen infant consultations and weighing sessions were being held each week. In tabular form are shown below statistics for the year 1925 and consolidated statistics for the previous four years. TABLE No. 70. Centre. No. on Roll of Centre. No. of Attendances. Mothers. Children. Mothers. Children. Expectant. Nursing. Expectant. Nursing. Town Hall 281 369 1,486 367 610 7,743 Eltham 188 75 1,058 349 132 5,748 Plumstead 172 245 923 287 285 4,967 Slade 4 66 420 4 108 3,391 New Eltham 11 4 189 26 19 1,554 North Woolwich 2 16 127 2 20 760 Beresford Street (Voluntrary). 7 41 115 9 76 671 Totals 1925 665 816 4,318 1,044 1,250 24,834 „ 1924 661 659 5,715 1,127 1,256 26,233 „ 1923 513 701 4,204 827 1,368 24,511 „ 1922 520 590 4,240 860 1,123 21,968 „ 1921 489 588 4,150 943 1,046 23,156 152 It would appear from these statistics that a fairly constant figure has now been arrived at, and any further increase is not likely to take place unless some change occurs in the organisation and work carried out at these centres. The next Table, No. 71 shows the number of children and number of attendances made by them during the year. If this table is compared with similar tables published in the annual reports of previous years, it will be noticed that the attendance of children of two years and over shows a steady increase—a matter for congratulation when it is remembered that, although theoretically the health of the young child is cared for up to the age of 5 under maternity and child welfare schemes, in actual fact past experience has shown that the care provided has been mainly limited to children under one year. TABLE No. 71. Children in attendance at each Centre. Year of Birth. Town Hall. Eltham. Plumstead. Slade. New Eltham. North Woolwich. Beresford St. (Voluntary). Totals. 1925 461 251 279 113 61 47 32 1,244 1924 462 256 274 124 49 45 44 1,254 1923 234 216 170 71 34 21 15 761 1922 196 140 116 51 22 11 14 550 1921 100 115 58 38 10 2 8 331 1920 33 80 26 23 13 1 2 178 1,486 1,058 923 420 189 127 115 4,318 Attendances of Children at each Centre. 1925 2,598 1,945 1,787 839 589 270 225 8,253 1924 3,136 2,019 1,862 1,409 589 355 303 9,673 1923 972 792 733 607 214 93 77 3,488 1922 639 481 368 263 112 31 50 1,944 1921 302 315 154 177 26 9 14 997 1920 96 196 63 96 24 2 2 479 7,743 5,748 4,967 3,391 1,554 760 671 24,834 153 (d) Treatment of Minor Ailments. Children requiring medical or surgical treatment for certain minor ailments are referred to the School Clinic, Brewer Street, to a private practitioner, or to a hospital. During the year 22 were sent to this Clinic, and for each case the Council paid 5s. The children referred there suffered from the following conditions— Impetigo 7 Ear discharge 6 Conjunctivitis 3 Squint 2 Enlarged tonsils 2 Corneal ulcer 1 Inflamed gums 1 22 (e) Dental Treatment. The dental work is carried out at the School Clinic, Brewer Street, mothers and children being referred there from the welfare centres. The following Table, No. 72, shows the number of cases attending and the number of attendances during the year. The number of sessions was, excluding anaesthetic days, 25. TABLE No. 72. First Attendances. Total Attendances. Children 114 168 Nursing mothers 57 207 Expectant mothers 48 81 219 456 Dentures are provided free, at part cost, or at cost price, according to ability to pay, but the payment is spread over many weeks. In consequence the income during the year 154 includes money received in respect of dentures supplied in 1924. Twenty-five sets (complete or partial) of false teeth were supplied during the year at a total cost of £96 15s. Payments by patients amounted to £85 18s. 6d. (f) Orthopaedic Treatment for Children under Five Years of Age. At the end of 1924 a letter was received by the Council from the Woolwich Invalid Children's Aid Association asking for a grant-in-aid for their Remedial Clinic in respect to the treatment of children under 5 years of age. This clinic was established in 1911 and deals with children requiring massage, electrical treatment and remedial gymnastics. It fulfilled a need in the Borough, did very good work and prevented many children from becoming cripples. Up till 1924 it had been entirely supported by voluntary funds with the exception of a yearly contribution of £40 from the London County Council. This voluntary support, practically all from one donor, was withdrawn at Christmas, 1924, and in these circumstances the Association asked for the support of the Council. In consequence of this letter enquiries were made and a scheme was submitted to the Ministry, approval of which was received on the 2nd April, 1925. The Council then entered into an arrangement with the Association whereby children under five years of age sent by the Medical Officer of Health to the Clinic, were paid for at 2s. per attendance for cases receiving massage or electrical treatment, and 1s. 6d. per attendance for any other form of treatment. The estimated cost of these services was between £150 and £170 per annum. Only cases recommended by the Medical Officer of Health are included in the scheme and payment is only made for the number of attendances approved by him. The Ministry approved this scheme, but limited the expenditure in the first instance to £100 per annum, on the understanding that an application for further expenditure 155 would be entertained. On this basis the scheme was inaugurated. The Ministry, in addition, insisted that a Consulting Orthopaedic Surgeon should be appointed by the Committee of the Association, and Mr. P. B. Roth, Orthopaedic Surgeon, Miller Hospital, consented to act in this capacity. For these services the Association gives an annual honorarium of 25 guineas. The scheme works as follows. Children requiring treatment are seen by one of the assistant medical officers in consultation with the Medical Officer of the Remedial Clinic, and a course of treatment is decided upon. At the end of each quarter the case is reviewed and an authorisation is issued for a further period in each case. In detail, the children referred to the Clinic required treatment for the following conditions:— Type of Case Number referred to Clinic. Number who completed treatment by end of year. Talipes (Club foot) 4 2 „ (Flat foot) 5 2 Rickets: General 7 3 Genu Valgum (knock-knee) 4 2 Genu Varus (bow-leg) 5 3 Injuries: Old dislocated knee 1 1 Injured ligament knee 1 — Deformed finger 1 — Paralyses: Infant, etc. 4 — Erb's 1 — Muscular wasting 5 4 156 Miscellaneous: Deformity of tibia 3 — Ventral hernia 1 - Defective pulmonary aeration 1 — 43 17 In all, these 43 children made 1129 attendances from the 1st April till the 31st December. With the exception of eight, all these attendances were paid for at the rate of 2s. per attendance. The total cost to the Council was £113 10s., 50 per cent. of which is recoverable from the Ministry. The average number of treatments received by the completed cases was 20, and by the uncompleted 31. During the five years under review the number of children under five years attending the Remedial Clinic increased from 18 in 1921 to 51 in 1925, the figures for each successive year being as follows; 1921, 18; 1922, 25; 1923, 48; 1924, 40. The Council, by its action, has secured the maintenance of the Woolwich Remedial Clinic, which was in very serious danger of ceasing to function because of want of funds. At this Clinic children are seen and treated at regular intervals by the Consulting Orthopaedic Surgeon and the masseuses. Their attendances are regular, and so far as can be obtained, the utmost co-ordination of parents, members of the Public Health Staff, and the Remedial Clinic is provided. The earlier a child suffering from a condition which may lead to crippling receives treatment, the less likely does permanent damage result, particularly in the case of muscular weakness associated with infantile paralysis, and in addition, if suitable treatment is easily available, more cases requiring such treatment will be detected and will receive it. 157 (g) Provision of Nursing Assistance for Children Suffering from Measles and Ophthalmia Neonatorum.—In 1916 the Council entered into an arrangement with the local Nursing Associations for the provision of home nursing services in respect of measles. In 1920 the arrangement was extended to include the nursing of ophthalmia neonatorum. Cases of these diseases which come to the notice of the Medical Officer of Health are visited by the health visitor, and on her report the Medical Officer of Health decides whether nursing is required. The Council do not pay a retaining fee to the District Nursing Associations, for the purposes of securing that a nurse is always available, but they pay a fee per visit, the rate being as follows: 1s. per visit for one case, 6d. a visit per case for more than one case in the house at the same time. These nursing services should be extended to include provision for the nursing of cases of zymotic enteritis, puerperal fever, poliomyelitis and whooping cough. (h) The Home for Ailing Babies, Eglinton Road, Plumstead, was taken over by the Council from a voluntary association in 1919. Children suffering from debility, marasmus and malnutrition, constitute the large bulk of the admissions, but occasionally cases of bronchitis, pneumonia, diarrhoea and rickets are admitted. The available accommodation is 21 beds. The following table shows certain statistical information for the vear 1925:— Table No. 73. Number of beds 21 (1) (i.) Number of cases in hospital on the 1st January, 1925 13 (ii.) Number of cases admitted during the year 85 (iii) Number remaining in on the 31st December 13 158 (2) Average duration of stay 51 days. (3) Reasons for admission:— Malnutrition, Marasmus and Debility 40 Vomiting, Dyspepsia and Constipation 26 Bronchitis 4 Rickets 3 Diarrhœa 2 Pneumonia 1 Miscellaneous 9 85 (4) Number of cases discharged (a) In good health 60 (b) Improved 8 (c) No improvement 8 76 (5) Number of cases of infectious disease:— (a) Measles — (b) Whooping Cough — (c) Epidemic Diarrhoea — (d) Other infectious conditions 2 (6) Number of deaths 9 (i) Institutional Midwifery. The British Lying-in Hospital was established in 1749 in Endell Street, Long Acre, but in 1915 certain circumstances rendered it necessary for this institution to find another home. Fortunately, the Home for Mothers and Babies, which was established in 1905 in Wood Street, Woolwich, was available for this purpose and so the amalgamation of these two institutions came about, and the new name—The British Hospital for Mothers and Babies—was adopted. The Hospital does excellent work in 159 the neighbourhood, providing as it does an intern and extern midwifery service. It had always a reputation for a high standard of training for midwives and now even demands that its pupils shall study there longer than the Central Midwives Board requires. It must be a source of satisfaction to its Committee that the standard they set for the last twenty-one years—six months' training for a certificated nurse and twelve months for any other person—will, after April, 1926, be compulsory for all pupil midwives in every training school in the country. In 1922 new buildings were opened in Samuel Street, but unfortunately sufficient funds were not available to enable the Management to provide a complete hospital and training school on one site, and so it has been necessary to keep the old hospital in Wood Street as an ante-natal clinic. The new building has been so constructed to allow for further extension. I am indebted to Miss Gregory, the Secretary of the Hospital, for the following information, which shows statistically the cases dealt with during the year. Mothers admitted during the year 648 „ „ for observation and temporarily discharged 175 Number of children bom 656 Maternal deaths 4 Infant deaths 5 Extern cases 218 Ante-natal Clinic: Mothers attending 1,295 Total attendances 4,093 Post-natal Clinic: Mothers attending 10 Total attendances 11 Infant Clinic: Infants attending 432 Total attendances 1,125 160 In 1922 the Council entered into an agreement with the Hospital authorities whereby sufficient accommodation for 144 confinements per annum is reserved for cases sent by the Medical Officer of Health. The Hospital has undertaken to provide such accommodation as may be necessary for the purpose and to provide ante-natal supervision for these cases and bed accommodation for those cases who require it. The Council for these services pays the Hospital £1,500 per annum, and it requires each patient admitted to pay fees according to the earnings of her husband. The minimum fee has been fixed at £3 for confinement in the case of multipara and £4 in the case of primiparse. In certain cases this fee is reduced by the Maternity and Child Welfare Committee. The charge is based on a normal residence of 14 days, but an additional charge is made after this period of 3s. per day. The amount recovered in patients' fees during the year was £559 1s., making the nett cost £940 19s., 50 per cent. of which is recoverable from the Ministry of Health. The opening of this Hospital in Woolwich has brought about a very marked change in the outlook of the expectant mother with regard to institutional midwifery. In the last six years the percentage of institutional births in Woolwich has risen from 7.8 in 1919 to 32.6 in 1925. (j) Institutional Provision for Unmarried Mothers. There is one such Home in the Borough. It is situated at 23, Vicarage Park, Plumstead, and provides accommodation for eight mothers and babies. As is to be expected very few Woolwich mothers enter this Home, the girls being drawn from other parts of London. The number admitted to the Home during the year was about average, and, through the courtesy of the Superintendent, I am able to give the following information regarding this work:— 161 Mothers in the Home on the 1st January, 1925 2 Babies do. do. 2 Mothers admitted during 1925 13 Babies do. None. Births 12 Deaths 1 maternal, 1 infant. Average duration of stay of each completed case 5 months. Mothers who attended ante-natal clinics of the Borough Council 11 The Management Committee of this Home works under the Southwark Diocese and is anxious to help girls who have made a first slip and only such girls are admitted. These girls are encouraged to stay at the Home for six months, and while there carry out ordinary household work. When they leave a situation is found for them, if possible, where the child can be taken. As in previous years, a grant of £50 was made by the Borough Council towards the funds of this Home. (k) Supply of Milk, etc., to Necessitous Mothers and Children. The cost of milk and dinners supplied to nursing and expectant mothers and to young children during the year was as follows:— Dried milk, £1,093 8s. 2d. Fresh milk, Nil. Dinners, Nil. This service is administered strictly in accordance with the provisions of Circular 185, under which milk may be supplied at less than cost price, in necessitous cases only, to (a) Nursing mothers. (b) Expectant mothers in the last three months of nancy. (c) Children up to three years of age, and, exceptionally, to children between 3 and 5 years of age on a special medical certificate. K 162 The quantity of milk must not exceed one pint per day, but in exceptional circumstances, infants between three and eighteen months may receive 1½ pints per day. A suitable scale of income must be adopted. The scale of income at present in force is as follows:— Free. Half Cost. No. in Family. Per Head. No. in Family. Per Head. s. d. s. d. 1 13 0 1 15 0 2 10 6 2 12 6 3 8 6 3 10 0 4 7 6 4 8 6 5 7 0 5 8 0 6 or more 6 6 6 or more 7 6 Per head, after deduction of rent. During the five years under review these services cost most in 1921, since which date the cost has been steadily falling, chiefly owing to the adoption of lower scales of income as a test of necessity and partly to an improvement in the employment state of the Borough. No case was found during the year where milk was being obtained by false pretences. (1) Collective Teaching. In 1924 the Minister of Health wrote that, although he could congratulate the Council on its Maternity and Child Welfare work as a whole, Collective Teaching was defective, and so this aspect of maternity welfare work was considered by the Council. Collective teaching embraces classes for sewing, home nursing, first aid, general and personal hygiene and infant care. The Council had previous experience of collective teaching, about the years 1919-1920, but the classes were not popular, possibly because of domestic difficulties and lack of interest on the part of the 163 mothers. In addition, the number of health visitors at that time was insufficient to enable them to give adequate time to this branch of the work. However, in view of the Minister's criticism it was resolved to restart, in a tentative way, in 1925, and so two sewing classes were instituted, one at New Eltham and one at Woolwich. The object of these classes is to help mothers to make suitable clothing for themselves and for baby in an economical manner, to give facilities for procuring proper materials, and to give the necessary instruction. Accordingly materials have been bought by the Council in bulk and are sold in small quantities at cost price. The mothers are encouraged to bring old garments and instructions are given in adapting these for children's use. Designs for model clothing have been provided, and advice is given in cutting out and making up the material. The actual sewing is carried out either at the classes or at home. Knitting is also encouraged. These classes take up a large amount of the health visitor's time, and as the attendances are not large, it must be said that the results of these classes have been somewhat disappointing, measured by their popularity. It may be that they will increase in popularity as time goes on, but this is a matter which the future will disclose. In addition to these classes special attention is given at the morning clinics, where the attendances are relatively small, to teaching mothercraft and baby hygiene. (m) The Voluntary Centre, which was established by the Victory Club in Beresford Street, continues to do good work. It serves one of the most difficult areas in the Borough and meets once a week (on Monday afternoons). The number of children attending the Centre during the year was 115, and the total number of attendances, including mothers, was 756. As in previous years, one of the Council's assistant medical officers has attended at this centre every alternate Monday, 164 and a health visitor attended every session. The Council do not make a grant towards the expenses of this Centre. (n) Research Work on the Health of the Toddler. At the request of the Ministry of Health, arrangements have been made to keep under observation, for a period of three years, a certain number of children between the ages of one and five years in the three following groups:— 1. Unselected children in attendance at an infant welfare centre. 2. Catarrhal children in attendance at an infant welfare centre. 3. Two or more children in the same family—"good "and "bad" families. This is part of a general system of observations being carried out in some ten or twelve areas throughout the country, and it is hoped that valuable information may be collected from this enquiry, and as a result measures may be elaborated for improving the health of the toddler. This work is being carried out at the Eltham and New Eltham Centres. (o) Feeding of Infants in Woolwich. In midsummer the usual enquiry was made as to the type of feeding adopted in the case of infants attending the welfare centres. The method used was as follows:— (a) On the card of every child onder one year of age attending a Welfare Centre between the 1st June and 11th July, was inserted once, and once only, the terms "Breast," or " Breast and Hand," or "Hand fed." (b) The child's age was taken on the day on which this note was made. (c) At the end of the period the results were summarised for the whole Borough and the appropriate percentages were worked out. The results of the enquiry are set out if the following table No. 74:— 165 TABLE No. 74. Feeding of Infants, 1st June to 11th July, 1925 (all Centres). 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 45 69 44 43 21 23 21 25 13 304 7 2 1 314 Breast and Hand 7 10 17 20 14 10 3 8 12 101 13 17 6 137 Hand ]] 6 12 12 27 26 34 34 28 36 215 32 37 57 341 Total 58 91 73 90 61 67 58 61 61 620 52 56 64 792 Percentages. Breast 77.6 75.8 60.3 47.8 34.4 34.3 36.2 40.9 21.3 49.0 13.5 3.6 1.5 39.6 Breast and hand 12.1 11.0 23.3 22.2 23.0 14.9 5.2 131 19.7 10.3 25.0 30.4 9.4 17.3 Hand 10.3 13.2 16.4 30.0 42.6 50.8 58.6 46.0 59.0 34.7 61.5 66.0 89.1 43.1 166 In Table No. 75 which follows, the percentages of children of varying ages, hand fed, are shown in comparative form for each of the last five years. It will be noted that there is a very definite diminution in the number of children entirely hand fed in the first four months of life, an indication that the efforts of the staff to encourage and maintain breast feeding are meeting with some measure of success. TABLE No. 75. Percentages of Hand Fed Children. Age in Months. 1921. 1922. 1923. 1924. 1925. 0-1 15.4 5.1 6.7 9.3 10.3 1-2 16.5 14.8 18.6 17.1 13.2 2-3 25.6 29.2 26.8 17.8 16.4 3-4 32.8 31.6 29.7 37.1 30.0 4-5 36.7 38.6 43.7 43.3 42.6 5-6 42.2 42.8 44.7 53.7 50.8 6-7 48.4 43.1 51.4 35.4 58.6 7-8 48.7 46.2 58.0 50.8 45.9 8-9 47.8 55.0 50.0 44.0 59.0 9-10 67.7 57.7 55.9 59.7 61.5 10-11 71.0 60.9 63.0 73.9 66.0 11-12 83.8 70.2 71.1 63.8 73.1 (p) Maternal Mortality. In England and Wales the deaths of mothers, from conditions primarily due to child bearing, approximate to four maternal deaths to every 1000 live births, and this figure has been more or less constant for over 20 years. In Woolwich, over a period of 14 years, 136 mothers 167 died from these causes, a death rate of 3.38 per 1000 births. In the quinquennium under review the maternal death-rate was 2.82, compared with 4 62 in the previous five years. For purposes of record I give below a table classifying the maternal deaths each year, for the period 1912 to 1925. TABLE No. 76. Maternal Mortality, Woolwich, 1912-1925. Year. Abortion. Ectopic Gestation. Placenta Prsevia. Other puerperal Hemorrhage. Other Accidents of Child Birth. Child Birth with Secondary Causes. Puerperal Eclampsia. Puerperal Phlebitis and Embolism. Puerperal Fever. Totals. 1912 1 — - — - — 1 1 1 4 1913 1 — — - 1 — 1 — 2 5 1914 1 - 1 2 — 1 1 1 4 11 1915 1 1 — 1 — 2 — 3 8 1916 — 1 1 1 4 — 1 — 7 15 1917 — 1 — 2 — 2 1 7 14 1918 1 — — 2 1 — 1 1 9 15 1919 - 2 1 2 — — 2 1 5 13 1920 — 1 - — 1 — 1 3 5 11 1921 - - - - - - 3 2 5 10 1922 — — — 1 — — 2 — 3 6 1923 — — — — 1 — 1 - 3 5 1924 - - 2 1 1 — 3 1 2 10 1925 - — 1 2 1 1 1 — 3 9 Total 5 6 6 13 11 3 22 11 59 136 168 INFECTIOUS DISEASES IN RELATION TO THIS WORK. Puerperal Fever.—Nine cases of puerperal fever were notified during the year, and seven of them were treated in hospital, three being in hospitals of the Metropolitan Asylums Board and four in Poor Law institutions. Only one death occurred among the notified cases. This case was notified on the eighth day after confinement; the patient was then too ill for removal to hospital, and she died two days later, the death being certified as due to Puerperal Septicaemia— cardiac failure. Two cases were notified on the third day after confinement, one on the fourth and one on the fifth, two on the sixth, two on the eighth and one on the 14th. Two deaths occurred which had not been notified previously. In each case every endeavour is made to secure hospital treatment. Ophthalmia Neonatorum. During the year 31 cases of ophthalmia neonatorum were notified and 8 cases were treated in hospital. In tabular form is shewn below, as required by the Ministry of Health, the result of each case:— TABLE No. 77. Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. No. Notified. Treated. At Home. In Hospital. 31 23 8 28 - - 2 One of the hospital cases was discharged to another address and was untraced. It will be noticed that there were two deaths among the notified cases—one from ophthalmia 169 neonatorum and pyaemia (i.e., general infection) and one from prematurity. Nursing. During 1925, 9 cases were nursed at home at a total cost to the Council of £8. The number of visits paid by nurses was 160. Measles. Notification Statistics. Measles is not a notifiable disease in Woolwich and, consequently, we depend on the notifications received from the school medical service and cases discovered by the health visitors as an index to its prevalence—an index which must be considerably below the true number. By these methods we obtained knowledge during the year of 1,916 cases of which 308 were German measles. 668 of these were children under five years of age. 323 cases were discovered by the health visitors who, particularly in the last quarter of the year, spent much time in visiting children suffering from this disease and giving advice as to the precautions necessary to be taken to avoid the onset of serious complications. Deaths. The number of deaths was nine, eight of which were of children under five years of age. Home Nursing. During the year 27 cases were nursed at home at a total cost to the Council of £9 15s. The number of visits paid by nurses was 206, thus averaging 8 visits per case. Removal to Hospital. Children suffering from measles are admitted to the hospitals of the Metropolitan Asylums Board on the certificate of the Medical Officer of Health. During the year 39 such cases were admitted. The provision of hospital accommodation for the treatment of measles cases was considerably amplified during the year by the Board, a much needed and greatly appreciated improvement. 170 School Closure. 16 departments were closed by the London County Council during the year. Whooping Cough. During the year 508 cases of whooping cough came to the knowledge of the department through the school medical service. As this disease is not notifiable a knowledge of its incidence can only be obtained by the department in the above way or, incidentally, by casual discovery by the health visitors during their daily routine. Deaths. The number of deaths was 17, as compared with 12 in 1924 and 4 in 1923. 16 deaths occurred in children under five years of age. Zymotic Enteritis. Thirteen cases of zymotic enteritis were notified, compared with the same number in 1924. The number of cases notified and the number of deaths certified to be due to diarrhoeal diseases in each quarter are shown below. Six of the deaths were of infants under one year. Quarter. Cases. Deaths. First 2 1 Second 1 3 Third 9 4 Fourth 1 1 13 9 Anterior Poliomyelitis. Only one case of this disease— which may be desribed as the acute stage of infantile paralysis —was notified during the year. It was characterised by a very sudden acute onset and death took place within 72 hours. The following table, No. 78, shows the condition at the end of 1925 of each case notified in the last three years. Four of 171 these children are now receiving treatment at the Remedial Clinic of the Invalid Children's Aid Association, one of these will be able to walk with the aid of an instrument, one will always have a slight limp, while the other two, both severe cases originally, will always be cripples. 172 TABLE No. 78. Poliomyelitis. Date notified. Sex Age Condition on 31st December, 1925. Treatment obtained. 1923. Mar. 18 F. 8 Gradual improvement in right leg; splint from thigh to heel; general condition good. Beceiving massage at I.C.A.A. three times a week. Under Miller Hospital. May 25 F. 3 Gradual improvement in right leg; has splint from thigh to heel; general condition good, and is attending school; a cripple. Beceiving massage at I.C.A.A. twice a week until recently; is to continue attending there. Under Guy's Hospital until Aug., 1925. July F. 7 Arm much improved; also general condition. Beceiving massage as out-patient at Miller Hospital. July 27 F. 2½ In good health — Aug. 16 F. 3 Discharged from Carshalton in May, 1925; left leg much better; has a splint and night shoe; attending school. No treatment now. Aug. 31 F. 3 Discharged from Carshalton, May, 1925. Began walking several months ago. Has no splint, but wears a night shoe. General condition fairly good. Under Guy's Hospital. Beceiving massage and electrical treatment at I.C.A.A. 1924. July 19 F. 1 Slight improvement. Still unable to crawl or walk. Left leg shorter than right. Under private doctor. Has massage twice a week. July 23 F. 2 Improvement in both legs. Has splint to right leg. Can stand. Does not walk alone. General condition good. Attended Great Ormond Street Hospital till recently. Beceiving massage at I.C.A.A. Aug. 24 M. 8 Began to walk in May, 1925. Bight leg said to be recovered. Left leg partially paralysed from hip to knee. General condition good. In-patient at Carshalton. Oct. 25 F. 24 Bight arm almost completely recovered. Leg is better, but still drags. General condition good. No treatment now. Nov. 19 F. 3½ Present address unknown — 1925. Nov. 28 M. 6 Died 30th November - 173 METEOROLOGY. Meteorological Observations taken at the Royal Observatory, Greenwich, during the year 1925. Week ending 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. 10 53.4 28.1 40.8 + 2.8 45.8 2 0.08 17 54.0 27.0 40.3 + 2.2 44.6 2 0.26 24 51.3 33.7 40.6 + 1.8 44.5 0 0.00 31 54.3 34.1 43.1 + 3.6 44.2 6 0.60 Feb. 7 54.2 33.1 49.9 + 4.5 44.4 2 0.42 14 55.1 35.2 45.3 + 6.2 44.8 6 1.28 21 41.4 30.8 38.7 — 0.8 44.4 4 0.08 28 54.2 28.8 40.0 — 0.0 43.4 4 0.08 March 7 54.2 35.5 43.7 + 3.0 43.2 3 0.12 14 53.0 24.0 37.6 — 3.5 43.3 4 0.25 21 55.3 26.9 41.9 — 0.0 43.1 2 0.12 28 51.0 27.3 39.2 — 3.6 43.1 3 0.16 April 4 55.6 28.1 42.5 - 2.7 43.0 3 0.27 April 11 62.6 35.4 48.8 + 2.7 43.9 5 0.57 18 61.4 35.3 47.6 + 0.7 45.0 4 0.23 25 61.1 30.8 45.7 — 2.9 45.6 2 0.20 May 2 59.1 34.1 45.2 — 3.8 45.9 5 0.78 9 61.2 39.5 49.4 — 1.1 46.4 6 0.47 16 80.3 39.1 57.0 + 4.7 47.8 1 0.05 23 75.1 43.0 59.5 + 5.6 49.8 2 0.24 30 70.7 43.5 55.6 — 0.4 51.0 5 0.51 June 6 83.7 42.1 59.9 + 2.0 51.9 1 0.06 13 87.1 49.9 67.2 + 9.0 53.1 0 0.00 20 83.9 41.9 62.2 + 3.0 54.8 0 0.00 27 70.5 48.1 54.2 — 6.8 54.4 2 0.12 July 4 81.8 42.8 62.8 — 1.1 54.5 1 0.02 174 METEOROLOGY—continued. Week ending 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 11 81.5 51.0 62.3 — 0.1 55.1 1 0.41 „ 18 87.8 49.9 68.1 + 4.8 56.1 0 0.00 „ 25 89.5 52.0 67.4 + 4.4 57.5 6 2.21 Aug. 1 71.3 50.0 58.0 — 4.3 58.1 5 1.12 „ 8 74.3 41.1 60.6 — 1.5 57.9 3 0.53 „ 15 76.4 50.2 61.6 — 0.8 58.3 5 0.37 „ 22 83.1 48.9 61.7 + 0.0 58.8 2 0.44 „ 29 75.3 46.7 60.5 — 0.1 58.6 3 0.88 Sept. 5 80.6 40.5 57.2 — 2.5 58.7 4 0.27 „ 12 64.5 42.8 52.7 — 5.9 57.7 3 0.26 „ 19 67.5 39.1 54.2 — 3.1 56.5 2 0.41 „ 26 63.3 38.2 52.5 - 3.0 56.0 5 1.04 Oct. 3 70.6 41.1 57.1 + 2.8 55.4 1 0.04 Oct. 10 70.0 36.9 52.9 + 6.7 55.7 2 0.02 „ 17 65.7 33.4 47.1 — 3.0 54.5 4 0.48 „ 24 66.1 38.1 53.8 + 5.2 53.5 7 1.76 „ 31 63.9 38.1 52.8 + 5.4 53.3 1 0.16 Nov. 7 61.4 40.3 51.3 + 5.0 52.8 6 1.08 „ 14 48.6 26.6 37.6 — 6.5 51.3 2 0.13 „ 21 47.4 29.1 40.6 — 1.9 49.0 0 0.00 „ 28 46.0 24.9 35.7 — 6.1 47.7 2 0.15 Dec. 5 42.0 21.4 33.0 — 8.2 46.0 3 0.08 „ 12 50.9 23.5 40.9 + 0.2 44.6 2 0.11 „ 19 45.8 23.7 34.9 — 5.5 43.7 1 0.02 „ 26 51.8 31.0 38.1 — 0.4 43.2 1 0.08 1926. Jan. 2 56.6 34.8 48.5 + 9.7 43.6 7 1.65