AC 4372 W0026 Metropolitan Borough of Woolwich. Annual Report OF THE Medical Officer Of Health FOR Woolwich. BY J. MACMILLAN, D.S.O.,M.C.,M.B.,D.P.H., Medical Officer of Health. Woolwich: The "Kentish Independent" Printing Works (T.U.) 16, Wellington Street. Metropolitan Borough of Woolwich. Annual Report OF THE Medical Officer Of Health FOR Woolwich. 1926. BY J. MACMILLAN, D.S.O., M.C.,M.B., D.P.H. Medical Officer of Health. Woolwich: The "Kentish Independent" Printing Works (T.U.) 16, Wellington Street. 2 Public Health and Housing Committee. At 31st December, 1926. 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. H. Narborough, E. Brown, T. H. Thompson, P. Chinnery, Miss S. Turnbull, T. Davis, H. J. Turner, A. H. Gilder, Miss G. E. Walters, J.P. W. G. McCartney, R. A. M. Walters. Maternity and Child Welfare Committee. Comprising the Members of the Public Health and Housing Committee. 3 SUMMARY OF STATISTICS 1926. Births:— Legitimate 2,394 Illegitimate 69 2,463 Birth Rate 17.4 Deaths 1,450 Death Bate 10.2 Number of Women dying in, or in consequence of child birth:— (a) From Sepsis 2 (b) From other causes 4 Deaths of Infants under 1 Year:— (a) Legitimate 98 (6) Illegitimate 9 Infant Mortality Rate 43 Deaths from Measles (all ages) 12 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 Years) 13 4 TABLE OF CONTENTS. page Public Health and Housing Committee 2 Maternity and Child Welfare Committee 2 Summary of Statistics 3 Preface 8 I.—Natural and Social Conditions. Social Conditions 11 Area 11 Population 11 II.—Vital Statistics. Annual Statistics 13 Births 14 Marriages 16 Deaths 16 Child Mortality 26 Infantile Mortality 27 III.—General Provisions of Health Services. Hospitals 33 Institutional Provision for Unmarried Mothers 34 Ambulance Facilities 34 Clinics and Treatment Centres 35 Staff 36 Professional Nursing in the Home 39 Midwives 40 Chemical Work 40 Bacteriological Examinations 40 Adoptive Acts, By-Laws and Regulations in force in the Borough 41 Health Week 44 5 IV.—Sanitary Administration. page Staff 46 Complaints 46 Closet Accommodation 46 Scavenging 46 Combined Drains 47 Sanitary Inspection of Area 48 Eats 51 Mosquitoes 52 Rag Flock 52 Offensive Trades 52 Smoke Abatement 52 Factories and Workshops 52 Legal Proceedings 54 Mortuaries and Cemeteries 56 V.—Inspection and Supervision of Food. General Reference 57 Milk Supply:— Registration 58 Prosecutions 59 Milk and Dairies Order, 1926 59 Cowkeepers 59 Dairymen and Purveyors of Milk 60 Designated Milks 61 Meat Supply 62 Slaughterhouses 64 Other Food Premises:— Bakehouses 64 Fried Fish Shops 64 Ice Cream 65 Other Premises 65 Unsound Food 66 Food Poisoning 66 Sale of Food and Drugs Acts 66 Public Health (Condensed Milk) Regulations, 1923 68 6 page Public Health (Dried Milk) Regulations, 1923 69 Adulteration of Food 69 Public Health (Milk and Cream) Regulations, 1912-17 70 VI.—Housing. Statistics 72 General Reference 74 Houses Let in Lodgings 75 Housing Act, 1925 75 Underground Sleeping Rooms 76 Tents and Vans 76 Increase of Rent and Mortgage Interest (Restrictions) Acts 76 New Houses—Water Certificates 76 VII.—Infectious Diseases. Notifications 79 Small Pox 85 Scarlet Fever 85 Diphtheria 87 Enteric Fever 88 Encephalitis Lethargica 88 Cerebrospinal Meningitis 89 Pneumonia 89 Erysipelas 91 Malaria, Trench Fever and Dysentery 91 Puerperal Fever and Puerperal Pyrexia 91 Ophthalmia Neonatorum 92 Zymotic Enteritis 93 Whooping Cough 93 Measles 93 Anterior Poliomyelitis 94 Disinfection and Disinfestation 96 Tuberculosis:— Staff 97 Notifications 98 Deaths 100 7 page The Public Health (Prevention of Tuberculosis) tions, 1925 102 The Work of the Dispensary 102 Contacts and Observation Cases 105 Co-operation with Hospitals, etc. 105 Co-operation with Local Practitioners 107 Co-operation with School Medical Service 107 Home Nursing 108 Provision of Extra Nourishment 108 Dental Treatment 108 Shelters 108 Bacteriological Examinations 109 Institutional Treatment 109 Woolwich Tuberculosis Care Committee 110 VIII.—Maternity and Child Welfare. Staff 111 Administrative Action 111 Welfare Centres 113 Collective Teaching 115 Treatment of Minor Ailments 115 Work of the Health Visitors 116 Orthopaedic Treatment for Children under five years of age 117 Dental Treatment 119 Institutional Midwifery 119 Institutional Provision for Unmarried Mothers 120 Home for Ailing Babies 121 Provision of Nursing Assistance 122 Research Work on the Health of the Toddler 122 Widows', Orphans', and Old Age Contributory Pensions Act, 1925 122 Supply of Milk, etc., to Necessitous, Expectant, and Nursing Mothers and Milk to Young Children 123 The Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 123 Feeding of Infants 124 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-Sixth Annual Report on the health of the Metropolitan Borough of Woolwich, which follows, as to contents and arrangement, the outline indicated by the Ministry of Health in Circular 743, in order to ensure uniformity in the presentation of Annual Reports of Medical Officers of Health throughout the country. The work of the various services of the Department is referred to in detail in the pages of the report, but it is necessary to refer briefly to a few aspects of our work. The chief vital statistics of the year are as follows. The population, as estimated by the Registrar General, is 141,900 (civil) and 146,200, including non-civilians, compared with last year's figures of 140,740 and 145,440 respectively. The birth rate, 17.4, is lower than in any previous year. The marriage rate, 16.01, shews a decrease compared with previous years. The death rate, 10.2, is the second lowest in London, and is the second lowest recorded in the history of the Borough. The infantile mortality rate, 43, equals the record figure obtained in 1923, and is also the second lowest in London. The incidence of infectious disease was lower in 1926 than in 1925, mainly due to the absence of an epidemic of measles. There were, however, increases in the prevalence of scarlet fever and diphtheria. At the end of the year there were 1,677 cases of pulmonary and 533 cases of nonpulmonary tuberculosis, making a total of 2,210 cases known to be living in the Borough. 9 In connection with the control of infectious disease, there is definite evidence of a spread throughout the country of the movement for securing the artificial immunisation of children against diphtheria. As I explained in the Annual Report for last year, it is now possible to ascertain by means of a simple test (known as the Schick test) whether a child is susceptible to this disease or not, and those who are susceptible can have conferred upon them a productive immunity by inoculation of a mixture of diphtheria toxin and anti-toxin. The procedure is very simple and causes no particular discomfort to the individual, while the results have been most encouraging and seem to justify its use by local authorities in general. The general adoption of the scheme of immunisation against diphtheria would mean the avoidance of suffering and discomfort to the child, the sparing of anxiety and worry to the parents, and the cost of maintenance of diphtheria beds to the community. In sanitary matters the department has maintained the standard of recent years. It has continued to work on similar lines as in previous years, but more attention is being paid to the supervision of food supplies and to individual hygiene rather than to environmental hygiene. Houses are being erected in increasing numbers each year, the number erected in 1926 being 203 by private enterprise and 170 by the Council—figures in excess of any previous post-war year, but still behind the average number erected yearly before 1914. The new houses are barely sufficient to accommodate the increase in the population, and they do not yet permit any action being taken with one or two small groups of houses which ought to be closed as soon as the general housing conditions will permit. Maternity and Child Welfare work develops satisfactorily. During the year one important change took place. The Plumstead Centre at 289, Plumstead High Street, was transferred in October to new premises built by the Council, and these premises will be used in 1927, not only for maternity and child welfare purposes, but also for dental treatment in connection with the London County Council scheme for the treatment of school children. This marks an 10 important phase in the unification of the health services of London, it being the first instance where municipal premises have been used for the health services of the central authority. The Council's scheme for the orthopaedic treatment of children requiring such treatment has continued to expand, works very satisfactorily, and is now regarded as one of the most important branches of the service. The attendances at the welfare centres have increased. Health propaganda work continues to be developed, and during the year the Council co-operated in the general Health Week organised throughout the country in the first week of October. No exhibition was organised, and reliance was placed entirely upon the use of the cinema picture, the lecture, and the health play for propaganda work. There is a very real desire for information of this sort in Woolwich, and the results are most encouraging. It has been sometimes said that the organisation of a Health Week leads to the disorganisation of the department for some weeks. In my opinion those who say this fail to appreciate that propaganda is an essential permanent adjunct to health work, that it is a movement which has come to stay and that its organisation is as much the work of the department as the supervision of infectious disease or any other established service. During the week the Town Hall was packed full at each session, and many had to be refused admission owing to lack of room. In conclusion, I must acknowledge the help, consideration, and kindness which has been shewn to me by members of the Council, and express my appreciation for the able and conscientious manner in which the staff of the department have carried out their work. To the Members of the Council, and particularly to those of the Health Committees, I am deeply indebted, and take this opportunity of expressing my thanks. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JOHN MACMILLAN. 11 Twenty-sixth Annual Report on the Health of the Metropolitan Borough of Woolwich Year Ending 31st December, 1926. Section 1.—Natural and Social Conditions of the Area. Social Conditions. Woolwich may be described as one of the surburban working-class metropolitan boroughs. Much of it is open space. In the parish of 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. The chief occupations of the inhabitants were set out in detail on page 17 of my Annual report for the year 1925, and it is unnecessary to repeat them this year. 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 river Thames amounts to approximately 645 acres. Population. The civilian population of the Borough is estimated by the Begistrar General to be 141,900, and the total population 146,200. On these figures the nett increase since 1921 amongst the civilian population is 5,593. I think these figures are under-estimated, for more than one reason. In the first place the natural increase in the population (i.e., the excess of births over deaths) since the time of the Census to the middle of 1926 was 6,236. In the second place much building is going on in Eltham and in East Plumstead, and 12 people are drifting towards Woolwich from the centre of London. It must be borne in mind that whatever system the Registrar General adopts for calculating inter-censal populations it must be more or less uniform for the whole country, and cannot possibly deal with the abnormal growth which has taken place in the population of Woolwich during the past fifteen years. My own estimate of the population is 144,887. However, in estimating the population for the various registration districts, I have taken the Registrar General's figures, and have made use of such information as is at my disposal with regard to internal migration within the Borough. The estimated figures for the districts are as follows:— TABLE No. 1. Estimated population Woolwich 32,277 West Plumstead 40,589 East Plumstead 35,688 Eltham 33,346 141,900 These figures have been used throughout the report in calculating the rates in the Borough and the various registration districts. 13 Section II.—Vital Statistics. An extract from the vital statistics of the year, in the form requested by the Minister of Health, will be found on page 3. The chief vital statistics since 1901 are given in the following table:— TABLE No. 2. 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 Nett Births. Number. Rate. 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 14.0 1907 119,704 3330 27.8 373 112 1616 13.5 1908 122,258 3176 26.0 300 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 23.1 228 80 1549 12.7 1914 122,431 2838 23.2 241 85 1706 13.9 1915 a 138,200 2839 21.9 268 94 1837 14.2 b 129,505 1916 a 141,783 3068 23.5 213 69 1704 13.1 b 130,313 1917 a 147,078 2718 20.6 216 79 1566 11.9 b 131,942 1918 a 150,650 2548 19.0 270 106 2100 15.6 b 134,453 1919 a 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 11.0 b 139,980 1925 a 145,440 2582 18.3 141 55 1519 10.8 b 140,740 1926 a 146,200 2463 17.4 107 43 1450 10.2 b 141,900 a Total population. b Civil population. 14 BIRTHS. During the year 2,570 births were registered in Woolwich, 1,285 being boys and 1,285 being girls. Corrected by outward and inward transfers these numbers become 2,463, 1,236, and 1,227 respectively. The corrected figures for the different registration districts are shewn in Table No. 3, which follows:— TABLE No. 3. Registration Districts. Males. Females. Total Births. Woolwich 339 366 705 West Plumstead 344 308 652 East Plumstead 292 289 581 Eltham 261 264 525 The Borough 1236 1227 2463 The birth rate calculated on the civilian population was 17.4, compared with 18.3 in 1925. This is the lowest birth rate in the history of the Borough. The following Table, No. 4, shows the birth rates in each registration district, after correction for outward and inward transfers, for each year since 1922. TABLE No. 4. Period Woolwich West Plumstead East Plumstead Eltham The Borough 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 1926 21.9 16.1 16.4 15.8 17.4 15 Illegitimate Births. The number of illegitimate births registered was 66. There were 21 inward transfers and 18 outward transfers, making a nett figure of 69, equivalent to 27 per 1,000 births. Natural Increase of Population. This term means the excess of births over deaths. In 1924 it was 1,047, in 1925 it was 1,063, and in 1926 it was 1,013. Notification of Births. During the year 2,442 live births were notified. This is at the rate of 95 per cent. of the registered births, and compares with 99 per cent. last year. 1,167 notifications were received from midwives, 154 from doctors, 163 from parents, and 51 from other persons, 602 from the British Hospital for Mothers and Babies, 195 from the Military Families Hospital, 43 from the Woolwich Infirmary, and 10 from the Woolwich and Plumstead Maternity Home. 57 births took place in midwives' homes. In addition to these, 56 notifications were received from the Medical Officer of Health of Lewisham, 32 from the Medical Officer of Health of Greenwich, and 36 from other Medical Officers of Health. 68 still births were notified. It is known that 821 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 33.3 per cent., the figures for the various districts being:—Woolwich, 35 per cent.; West Plumstead, 36 per cent.; East Plumstead, 29 per cent., and Eltham, 33 per cent. The number of maternity beds in the Borough is not yet equal to the demand, and I have little doubt that the provision of further beds would mean a further increase in the number of women entering institutions for their confinements. The following Table, No. 5, shows the number of corrected births each year since 1922, the number of live and still births notified, the percentage of notified births, and the birth rates for the same period for Woolwich, London, England, and Wales. 16 TABLE No. 5. Year. No. of births. No. of live births notified. No. of still births. Percentage of births notified. Birth rate. Woolwich. London. England and Wales. 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 1925 2582 2612 76 99 18.3 18.0 18.3 1926 2463 2442 68 95 17.4 17.1 17.8 MARRIAGES. There were 1,136 marriages (1,096 in 1925). The marriage rate was 16.01, as compared with 16.5, 16.9, 15.7, and 15.06 in the four preceding years. DEATHS. The total deaths registered in the district were 1,189. This figure includes 62 non-residents who died in the district, but does not include 323 residents who died outside the Borough. When allowance is made for inward and outward transfers, the nett figure of 1,450 is obtained. The death rate for the year was 10.2. In 1925 the corresponding rate was 10.8. The death rate, 10.2, is the second lowest in the metropolitan boroughs, Lewisham taking first place with 10.0. In 1926, the death rate for England and Wales was 11.6, and for London 11.6. The mean death rate for the 105 great towns was 11.6. The following Table, No. 6, shows the death rates in each registration district (after correction for outward and inward transfers) for each year since 1922:— 17 TABLE No. 6. Period. Woolwich West Plumstead East Plumstead Eltham The Borough 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 11.0 1925 13.6 11.6 9.7 8.2 10.8 1926 11.7 11.1 10.3 7.6 10.2 The seasonal mortality in the four quarters of the year was as follows:—First quarter, 13.0; second quarter, 9.7; third quarter, 7.7; fourth quarter, 10.2. 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. 7. Hospitals or Institutions. Number of Deaths. Poor Law Institutions 415 London General Hospitals 88 Mental Hospitals 47 Special Hospitals 41 Infectious Diseases Hospitals 34 Tuberculosis Institutions 29 Cottage Hospitals & Nursing Homes 27 681 The following Tables are self-explanatory. 18 Table No. 8.—Birth-rate, Death-rate, and Analysis of Mortality during the Year 1926. 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. Diarrhœa 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 17.8 11.6 0.01 0.00 0.09 0.02 0.10 0.07 0.22 0.47 8.7 70 91.8 7.2 1.0 105 County Boroughs and Great Towns, including London. 18.2 11.6 0.01 0.00 0.12 0.02 0.10 0.10 0.22 0.43 11.8 73 92.0 7.5 0.5 158 Smaller Towns (1921 Adjusted Populations 20,000 —50,000). 17.6 10.6 0.01 0.00 0.07 0.02 0.11 0.06 0.23 0.40 6.6 67 92.6 6.3 1.1 London 17.1 11.6 0.01 0.00 0.20 0.02 0.05 0.12 0.17 0.48 11.8 64 90.6 9.4 0.0 WOOLWICH 17.4 10.2 0.01 0.00 0.08 0.03 0.02 0.07 0.23 0.28 5.3 43 89.9 10.1 0.0 19 TABLE No. 9. Deaths of Woolwich Residents Registered during the Calendar Year 1926, 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 1450 107 26 32 47 92 173 391 269 313 Enteric fever 1 .. .. 1 .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. Measles 12 3 7 1 1 .. .. .. .. .. Scarlet fever 4 .. .. 1 3 .. .. .. .. .. Whooping cough 3 1 1 1 .. .. .. .. .. .. Diphtheria 10 .. 1 4 5 .. .. .. .. .. Influenza 33 3 .. 1 3 2 5 10 4 5 Encephalitis lethargica 6 .. .. 1 2 1 2 .. .. Meningococcal meningitis 1 .. .. 1 .. .. .. .. Tuberculosis of respiratory system 148 .. .. 2 1 42 81 37 5 .. Other tuberculous diseases 17 4 1 2 4 2 3 1 .. .. Cancer, malignant disease 197 .. .. .. .. 3 12 108 46 28 Rheumatic fever 8 .. .. .. 3 3 1 1 .. .. Diabetes 10 .. .. .. .. .. 2 2 5 1 Cerebral haemorrhage, &c. 81 .. .. .. .. .. 2 18 32 29 20 TABLE No. 9.—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 191 .. .. .. 2 8 17 63 59 42 Arterio-sclerosis 41 .. .. .. .. .. 1 10 17 13 Bronchitis 103 3 3 1 .. .. 4 19 26 47 Pneumonia (all forms) 81 16 6 6 4 3 13 14 7 12 Other respiratory diseases 13 .. .. .. .. 1 1 4 2 5 Ulcer of stomach or duodenum 12 .. .. .. .. 3 9 .. .. Diarrhoea, &c. 17 9 4 .. 1 1 2 .. .. Appendicitis and typhlitis 8 .. .. 3 .. 2 2 1 .. .. Cirrhosis of liver 6 .. .. 1 .. .. 3 2 .. Acute and chronic nephritis 46 .. .. .. 2 2 5 21 9 7 Puerperal sepsis 2 .. .. .. .. 1 1 .. .. .. Other accidents and diseases of .. .. .. .. .. .. .. .. pregnancy and parturition 4 .. .. .. .. 1 3 .. .. .. Congenital debility and .. .. .. .. .. .. .. .. .. tion, premature birth 53 49 1 .. 1 2 .. .. .. Suicide 20 .. .. .. .. 3 5 9 3 .. Other deaths from violence 40 3 1 2 4 4 7 10 3 6 Other defined diseases 282 16 1 4 11 11 25 47 49 118 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. 21 TABLE No. 10. 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 1926. Causes of Death. Male. Female. Woolwich. Plums tead. Eltham. Deaths in Public Institutions. West. East. In Borough. Outlying Institutions. Residents. NonResidents. All causes 764 686 379 451 366 254 368 62 313 Enteric fever 1 .. .. .. 1 .. .. .. 1 Small-pox .. .. .. .. .. .. .. .. .. Measles 8 4 7 1 1 3 2 .. 3 Scarlet fever 2 2 .. 1 3 .. .. .. 4 Whooping cough 2 1 2 1 .. .. .. .. 2 Diphtheria 4 6 4 .. 6 .. .. .. 10 Influenza 18 15 10 7 11 5 15 2 3 Encephalitis lethargica 4 2 2 1 1 2 2 .. 1 Meningococcal meningitis 1 .. .. .. .. 1 .. .. 1 Tuberculosis of respiratory .. .. .. .. .. .. .. system 101 47 38 49 33 28 37 2 46 Other tuberculous diseases 6 11 5 4 6 2 2 .. 6 Cancer, malignant disease 93 104 39 69 57 32 44 1 53 Rheumatic fever 2 6 1 2 2 3 1 .. 3 Diabetes 6 4 4 .. 2 4 2 .. 1 Cerebral haemorrhage, &c. 43 38 17 29 23 12 30 7 5 22 TABLE] No. 10.—continued. Causes of Death. Male. Female. Plums tead. Deaths in Public Institutions. Woolwich. West. East. Eltham. In Borough. Outlying Institutions. Residents. NonResidents. Heart disease 88 103 48 63 48 32 37 9 19 Arterio-sclerosis 25 16 8 11 4 18 3 6 Bronchitis 57 46 35 31 25 12 17 4 5 Pneumonia (all forms) 38 43 26 23 14 18 18 15 Other respiratory diseases 8 5 4 2 5 2 1 i 6 Ulcer of stomach or denum 8 4 1 6 4 1 3 i 7 Diarrhoea, &c. 10 7 7 4 4 2 6 2 6 Appendicitis and typhlitis 6 2 5 2 1 2 5 Cirrhosis of liver 4 2 3 2 1 1 2 Acute and chronic nephritis 19 27 17 13 7 9 13 2 6 Puerperal sepsis .. 2 1 .. 1 .. .. 2 Other accidents and diseases .. .. .. .. .. .. .. .. of pregnancy and .. .. .. .. .. .. .. .. turition .. 4 3 1 .. .. 3 1 .. Congenital debility and .. .. .. .. .. .. .. .. formation, premature .. .. .. .. .. .. .. .. birth 31 22 9 16 14 14 12 5 9 Suicide 12 8 8 3 5 4 5 .. 2 Other deaths from violence 28 12 13 11 3 13 14 8 14 Other defined diseases 139 143 67 96 84 35 98 17 70 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. 23 CAUSES OF DEATH. Table No. 8 shows that there were 197 deaths from cancer, 191 from heart disease, 148 from pulmonary tuberculosis, 103 from bronchitis, 81 from cerebral haemorrhage, 81 from pneumonia, 53 from congenital debility, and 33 from influenza. The percentage of all deaths occurring in persons over 45 years of age was 67. Tuberculosis and Infectious Fevers. These are referred to in the section dealing with the notifiable infectious. diseases. Respiratory Diseases. The following Table, No. 11, shows the number of deaths each year since 1922 from respiratory diseases, the annual death rate, the number of deaths under 5 years, and the percentage of deaths occurring in children under 5 years of age. TABLE No. 11. Year. Bronchitis. Pneumonia. Other Respiratory. Total. Death Rate. No. under 5 years. Percentage under 5 years. 1922 123 116 5 244 1.8 64 26.2 1923 93 65 10 168 1.2 22 13.1 1924 142 95 10 247 1.8 65 26.3 1925 110 97 16 223 1.6 47 21.1 1926 103 81 13 197 1.4 35 17.8 Heart Disease. The deaths from heart disease, which numbered 197 in 1925, numbered 191 in 1926. In that year, all except 27 were in persons over 45 years of age. Diarrhoea. 17 deaths were certified as due to diarrhoeal diseases, and 13 of these occurred in children under 2 years of age. In 1925, the figures were 9 and 7 respectively. Maternal Mortality. In England and Wales the deaths of mothers from diseases primarily due to child bearing approximate to four maternal deaths to every 1,000 live births, and this figure has been more or less constant for 24 over 20 years. 1n 1926, s1x deaths 1n the Borough were due to these groups of d1seases, a f1gure below the average of the last f1ve years. The follow1ng Table shows the causes of death each year s1nce 1912. TABLE No. 12. Maternal Mortal1ty, Woolw1ch, 1912-1926. Year. Abort1on. j Ectop1c Gestat1on. Placenta Prsev1a. Other puerperal Haemorrhage. Other Acc1dents of Ch1ld B1rth. Ch1ld B1rth w1th Secondary Causes. Puerperal Eclamps1a. Puerperal Phleb1t1s and Embol1sm. 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 — 1 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 — 3 9 1926 — 1 — 2 — — 1 2 6 Total 5 7 6 15 11 3 22 12 61 142 V1olence and Su1c1de. 40 deaths, 28 males and 12 females, occurred from v1olence apart from su1c1de. 20 deaths were due to su1c1dal causes, 12 males and 8 females. Cancer. The total number of deaths was 197, of wh1ch 25 93 occurred in males and 104 in females. The deaths certified as due to cancer or malignant disease each year since 1922 are shown in Table No. 13. TABLE No. 13. Deaths from Cancer and Malignant Disease. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 1922 72 94 166 1.20 10.36 1923 91 84 175 1.25 12.62 1924 87 94 181 1.29 11.73 1925 83 110 193 1.37 12.71 1926 93 104 197 1.39 13.59 The following Table, No. 14, shows the seat of primary disease in all deaths from cancer (including all other specified malignant tumours). TABLE No. 14. Seat of Primary Disease. Males. Females. Total. Deaths in Hospital. Tongue 5 1 6 3 Mouth and Jaw — 1 1 — Pharynx 4 1 5 5 (Esophagus 6 2 8 3 Stomach 23 17 40 19 Liver and Gall Bladder 6 4 10 3 Intestines 8 13 21 9 Rectum 11 7 18 9 Uterus — 16 16 10 Ovary — 4 4 2 Breast — 21 21 12 Vagina and Vulva — 1 1 — Skin — — — — Larynx 3 2 5 2 Lung 2 3 5 4 Pancreas 4 — 4 1 Neck 1 1 2 1 Bladder 6 1 7 1 Kidney — — — — Other specified organs 4 1 6 1 Abdominal Cavity (unspecified) — — — — Other and undefined — — — — Sarcoma 10 8 18 12 93 104 197 97 26 Inquests. There were 147 inquests held on Woolwich residents during the year compared with 141 in 1925 and 141 in 1924. DEATHS OF CHILDREN 1—5 YEARS OF AGE. The number of deaths of children between 1—2 years of age was 26, and between 2—5, 32. In 1925, these figures were 32 and 34 respectively. The causes of death are given in detail in Table No. 9. Below are set out Tables showing the variation in the rates of mortality in these age groups in five.yearly periods since 1911 and for the year 1926. TABLE No. 15. 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.S2 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 1315 1926 2,438 3.69 .41 3.69 1.64 1.23 10.66 27 TABLE No. 16. 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. Diarrhoeal 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 1926 7,794 1.29 .51 .89 — 1.41 410 INFANTILE MORTALITY. The number of deaths under one year was 107, compared with 141 in 1925 and 168 in 1924. The infantile mortality rate (deaths under one year per 1,000 births) was 43. This is the second lowest rate in London, Lewisham being lowest with 40. It equals the record figure obtained in 1923. The number of deaths (107) is the smallest number yet recorded. The following Table, No. 17, shows the infantile mortality rate in the Borough and registration districts for each year since 1922:— TABLE No. 17. Period. Woolwich West Plumst.ead East Plumstead Eltham The Borough 1922 68 52 80 46 63 1923 51 37 42 39 43 1924 79 42 68 70 65 1925 59 42 51 69 55 1926 51 37 41 44 43 28 Causes of Death. The chief causes of death were as follows:—Premature birth and debility, 49; Pneumonia, 16; Bronchitis, 3; Diarrhoea, 8; Tuberculosis, 4. Three deaths occurred from Measles and 1 from Whooping Cough. In 1925, the corresponding figures were as follows:—Premature birth and debility, 58; Pneumonia, 18; Bronchitis, 10; Diarrhoea, 5; Tuberculosis, 9; Measles, 3; Whooping Cough, 7. Compared with 1925, the fall in the rate is almost wholly due to fewer deaths amongst children over four weeks. The chief causes of the neo-natal deaths (i.e., those under 4 weeks) were developmental diseases, death in 30 instances being certified as due to prematurity. 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 41 and for illegitimate 130. Tables are set out in the following pages which classify in various ways the causes of death during 1926, 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 causes of death in 1923 and 1926. 29 TABLE No. 18. INFANT MORTALITY, 1926. 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 .. .. .. .. .. .. 1 .. .. 3 Scarlet Fever .. .. .. .... .. .. .. .. .. .. Whooping-cough .. .. .. .. .. .. 1 .. .. 1 Diphtheria and Croup .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. 1 1 .. .. 3 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. .. Convulsions .. .. .. 1 .. 1 .. .. .. 3 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 .. .. .. 1 .. .. 1 3 Pneumonia (all forms) .. .. .. .. .. 7 4 .. 3 16 Diarrhoea .. .. .. .. .. 1 .. .. 1 Enteritis 1 1 1 .. 3 2 .. .. 1 7 Gastritis .. .. .. .. .. 1 .. .. 1 Syphilis .. .. .. .. .. .. .. 1 1 Rickets .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. 1 1 i .. .. .. 2 Injury at Birth 2 .. .. .. 2 .. .. .. 2 Atelectasis 4 .. .. .. 4 .. .. .. 4 Congenital Malformation 1 .. .. 1 2 4 .. .. 2 8 Premature Birth 26 3 .. 1 30 2 .. 32 Atrophy, Debility and Marasmus 4 1 .. 1 6 1 2 .. 9 Other causes 1 2 2 .. 6 2 1 2 10 39 8 3 5 55 18 15 9 10 107 Nett Births registered during the calendar vear Legitimate 2394 Illegitimate 69 Nett Deaths registered during the calendar year Legitimate 98 Illegitimate 9 30 TABLE No. 19. INFANT DEATHS, 1926. Cause of Death. The Borough. Woolwich. West Plumstead. East Plumstead. Eltham. M. F. M. F. M. F. M. F. M. F. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles 3 .. 2 .. .. .. .. .. 1 .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough 1 .. .. .. 1 .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. Tuberculous Meningitis 1 .. 1 1 .. 1 .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases 1 .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions 1 2 .. 1 .. 1 .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 2 .. .. 1 .. .. 1 .. .. .. Pneumonia (all forms) 10 6 .. 3 2. .. .. .. 3 3 Diarrhoea .. 1 .. .. .. .. .. .. .. 1 Enteritis 5 2 .. 1 2 .. 3 1 .. .. Gastritis l .. .. .. .. .. .. .. .. .. Syphilis l .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, Overlying 1 1 .. 1 .. .. .. .. .. .. Injury at Birth .. 2 .. 2 .. .. .. .. .. .. Atelectasis 3 1 .. .. 1 .. 1 1 .. .. Congenital Malformation 4 4 .. 2 I 1 1 .. 2 1 Premature Birth 17 15 .. 5 3 5 7 3 7 2 Atrophy, Debility and Marasmus 8 1 .. 1 4 .. 2 .. 2 .. Other Causes 9 1 3 .. 1 1 4 .. 1 .. 68 39 18 . 18 15 9 19 5 16 7 107 36 24 24 23 31 TABLE No. 20. INFANT DEATHS, 1926. Cause of Death. The Borough. Woolwich. West Plum stead. East Plum stead. Eltham. Under 4 weeks 4 weeks1 year Under 4 weeks 4 weeks 1 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 .. 2 .. .. .. .. .. 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. 1 .. .. .. 1 .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. 3 .. 2 .. 1 .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. 1 .. 1 .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions 1 2 1 1 .. 1 .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 2 1 1 .. .. .. 1 .. .. Pneumonia (all forms) .. 16 .. 8 .. 2 .. .. .. 6 Diarrhoea .. 1 .. .. .. .. .. .. .. 1 Enteritis 3 4 .. 1 .. 2 3 1 .. .. Gastritis .. 1 .. I .. .. .. .. .. .. Syphilis .. 1 .. I .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. Suffocation, overlying 1 1 1 1 .. .. .. .. .. .. Injury at Birth 2 .. 2 .. .. .. .. .. .. Atelectasis 4 .. 1 .. 1 .. 2 .. .. .. Congenital Malformation 2 6 1 1 1 1 .. 1 .. 3 Premature Birth 30 2 5 .. 8 .. 9 I 8 1 Atrophy,Debility & Marasmus 6 3 .. 1 4 .. 1 I 1 1 Other Causes 5 6 1 2 1 1 2 2 1 55 52 13 23 15 9 17 7 10 13 107 36 24 24 23 32 TABLE No. 21. INFANT MORTALITY, 1901—1926. Rates for stated groups of diseases and for stated age periods for the quinquennial periods 1901.1926. 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 504 2.55 419 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 1923 1.39 0.35 3.49 5.23 2.79 0.35 21.97 7.33 42.90 3.48 14.30 4.19 25.11 17.79 1926 1.62 1.62 122 7.71 3.65 0.41 19.90 7.31 43.44 3.25 12.99 3.66 22.33 21.11 The rates in each case are per 1000 births. . 33 Section 3. — General Provision of Health Services in the Area. Most of the matter which is dealt with in this section is referred to in detail in other sections of the report, and references will be found to the pages where the details are given. The information given is more or less in tabular form:— i. Hospitals provided or subsidised by the Local Authority or by the County Council. (a) Fever and (b) Small Pox. Practically all cases in Woolwich requiring hospital treatment for these diseases are admitted to one of the hospitals of the Metropolitan Asylums Board, and most of them go to one or the other of the following hospitals:— The Brook, situated in Shooters Hill Road. The Park, situated in Hither Green. The South-Eastern, situated in New Cross. Joyce Green, situated in Dartford. Detailed information regarding the use made of the Asylums Board's Hospitals by Woolwich residents is set out in Table No. 41 in the section dealing with the Prevention and Control of Infectious Diseases. A small number of infectious cases are admitted to the London Fever Hospital— an institution where fever patients are received on payment either in general wards or in private rooms. (c) Tuberculosis. The London County Council are responsible for the institutional treatment of Tuberculosis in London. They maintain no institution in Woolwich. Certain statistical information regarding the number of persons who received institutional treatment for this disease during the year will be found on page 109. (d) Maternity. There is one voluntary maternity hospital in Woolwich, viz., the British Hospital for Mothers and Babies, which has 42 beds. Detailed information regarding this institution will be found on page 119. c 34 (e) Children. The Council's Home for Ailing Babies, Eglinton Eoad, Plumstead. This home, which was taken over by the Council on the 1st April, 1919, was closed on the 24th June, 1926. Detailed information regarding this home will be found on page 121. (f) Others. At the present time there are no other hospitals in Woolwich maintained or subsidised by the Local Authority or the London County Council, but the Borough Council in 1925 made proposals to the Minister of Health to close the Council's Home for Ailing Babies and to provide equivalent accommodation in the new War Memorial Hospital, which is nearing completion, and will be opened in August, 1927. It was hoped to open this institution in September, 1926, but various delays unfortunately made this impossible. The Council's scheme provides for the maintenance of children's and maternity beds (including beds for ante-natal or pre-maternity and emergency eases) and as these proposals have been approved by the Minister of Health the scheme will shortly be put into operation. ii. Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children in the Area. Detailed information regarding the Woolwich and Plumstead Maternity Home will be found on page 120. 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 the 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, and for the removal of ordinary 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. 35 iv. Clinics and Treatment Centres. In tabular form is shown below a list of Clinics and Treatment Centres in the Borough. The list only differs in one item from that of last year, viz., the substitution of the Council's new Centre at Plumstead for the premises previously rented there. Details regarding the work of the Maternity and Child Welfare Centres will be found on pages 113—115, and with regard to Tuberculosis on pages 102—104. Persons requiring treatment for venereal diseases can 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. 22. CLINICS AND TREATMENT CENTRES. Situation. Nature of Accommodation. By whom provided. Sessions weekly. Maternity and Child We Ifare Centres. Town Hall, Woolwich Doctor's room, Weighing room, Waiting rooms, etc. Woolwich Borough Council 6 236, Plumstead High Street, 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 36 TABLE No. 22—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 Plurastead Road, Plums tead Do. Do. .. Daily Cyril Henry Treatment Centre, St. Mary Street, Woolwich Accommodation for operating on, and detention of, cases of enlarged tonsils and adenoids London County Council Daily Borough Disinfecting Station, White Hart Road, Plums tead Accommodation for cleansing of vermi nous children Woolwich Borough Council Daily Tuberculosis Dispensary. Maxey Road, Plums tead 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, 1926, are shown below in the form requested by the Minister of Health. No changes took place during the year except those consequent upon the closure of the Council's Home for Ailing Babies. the closure of the Council's Home for Ailing Babies. 37 Year appointed. Name. Qualifications. Appointment. †1918 Mackenzie, R E. W. M.B., D.P.H Assistant Medical Officer of Health for Maternity and Child Welfare †1921 Blaokmore, 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., Cli.B., D.P.H. Assistant Medical Officer (General Purposes) 1891 Smith, Sir W. R. M.D., D.Sc., D.P.H., L.L.D., F.R.S.(Edin.) Public Analyst (Part time) *1890 Duck, A. G. F.S.I.A., Cert. Royal San.Inst., Cert. Meat and other foods Chief Sanitary Inspector *1896 Little, W. Cert. Royal San. Inst., Cert. Meat and other foods Sanitary Inspector *1897 Wood, W Cert. Royal San. Inst. Sanitary Inspector *1901 Tedham, W. Cert. Royal San. Inst., Cert. Meat and other foods Sanitary Inspector *1904 Powell, T. Cert. Royal San. Inst., Cert. Meat and other foods Sanitary Inspector *1909 Shaw, H Cert. Royal San. Inst., Cert.San.Insp.Exam Board., Cert. San. Insp. Assocn., Cert. Sanitary Inspector *1920 Pendrill, H. W. Meat and other foods Cert. San. Insp. Exam. Board, Cert. Meat and other foods Sanitary Inspector *1921 Harris, C. V. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert.Meat and other foods Sanitary Inspector *1922 Couch, C. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert.Meat and other foods Sanitary Inspector *1925 Pindar, E. B. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector *1904 Farrugia, Mrs. A. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst. Woman Sanitary Inspector \ 38 Year appointed. Name. Qualifications. Appointment. 11917 Latham, Miss K. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., C.M.B. HealthV i sitors' Cert., Cert, approved by Health Visitor «tl918 Garside, Mrs. M. .. Board of Education Cert. San. Insp. Exam. Board,C.M.B.,Health Visitors' Certificate Health Visitor and Sanitary Inspector fl919 Burnett, Miss W. .. Cert. San. Insp. Exam. Board,C.M.B.Health Visitors' Diploma, Cert, approved by Board of Education Health Visitor 11919 Xibbits, Miss E. Cert. San. Insp. Exam. Board, Health Visitors' Diploma, Cert, approved by Board of Education Health Visitor *1-1919 Ware, Miss C. Cert. San. Insp. Exam. Board., C.M.B., Cert, approved by Board of Education Health Visitor and Sanitary Inspector tl920 Campbell, Miss M. . . Cert. General Hospital Training, C. M. B., Cert. San.Insp.Exam Board Health Visitor fl920 Morgan, Miss F. Cert. General Hospital Training, C. M. B., Health Visitors' Cert. Maternity and Child Welfare Cert. Health Visitor fl922 Seccombe, Miss W.. . Cert. General Hospital Training, C. M. B., Health Visitors' Cert. Health Visitor fl921 Castledine, Mrs. L. . . Cert. General Hospital Training Tuberculosis Visitor f 1921 Hunter, Miss M. Cert. San. Insp. Exam. Board, C.M.B., Health Visitors' Diploma Tuberculosis Visitor fl921 Mahony, Miss N. Cert. General Hospital Training, Health Visitors' Cert. Tuberculosis Visitor fl923 Luffman, Miss M. . . Dispensing Certificate Clerk-Dispenser fl922 Morrison, Mrs. M. L. Lay Organiser 39 CLERKS: Britter, A. Collyer, H. M. ‡Edwards, Mrs. E. Pike, L. Prescott, H. T. Smith, H. S. ‡ Stephenson, Miss D. Taylor, S. Or. MORTUARY KEEPER: F. Leason. The Medical Officer of Health* is Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme. * Salary contributions made under Public Health Acts. ‡ Salary contributions made by Exchequer Grants. vi. Professional Nursing in the Home. Practically all professional nursing in the home is carried out by one or other of the local Nursing Associations which serve various parts of the Borough. All of them insist that the patient should be under the care of a medical practitioner, and in ordinary circumstances only nurse non-infectious cases. However, on the recommendation of the Medical Officer of Health, they will nurse cases of Measles, Whooping Cough, Ophthalmia Neonatorum, Tuberculosis, Anterior Poliomyelitis, Puerperal Fever, and Puerperal Pyrexia. During the year changes in these services took place so far as Eltham was concerned. The Eltham and District Nursing Association became defunct on the 31st December, 1925, and it became necessary to re-organise St. Luke's Nursing Association on provident lines. For some months there were no nursing arrangements in the greater part of Eltham, but the Eltham Provident Nursing Association, as it is now described, spread out from St. Luke's Parish, and a second nurse was appointed for work in other parts of Eltham. The Woolwich and Plumstead Nursing Association and the Silvertown and North Woolwich Nursing Association continued to carry on their activities as in previous years. The Borough Council have entered into agreements with all the Nursing Associations whereby nursing assistance in necessitous cases is paid for by the Council for patients 40 requiring such assistance suffering from the diseases set out in the following schedule, which, in addition, shows the rates of payment:— Disease. Rate of Payment. Measles 1s. per visit for one case; 6d. per visit, per case, for more than one case in the house at the same time. Ophthalmia neonatorum Zymotic Enteritis Whooping Cough Poliomyelitis Pneumonia and Influenzal Pneumonia 1s. 3d. per visit. Puerperal Fever Puerperal Pyrexia vii. Mid wives. Through the courtesy of Dr. Menzies, the County Medical Officer of Health, I have been able to ascertain that 39 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 34 to 37 in the section dealing with the inspection and supervision of food. ix. Bacteriological Examinations. These are carried out at the Seamen's Hospital, Greenwich. In tabular form is shown below the number and result of the various examinations made during the year. For comparative purposes the figures for 1925 are also given. TABLE No. 23. Disease. Positive Result. Negative Result. Total 1926. Total 1925. Diphtheria 138 1,068 1,206 918 Enteric Fever 2 16 18 36 Tuberculosis 56 251 307 217 196 1,335 1,531 1,171 41 x. 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 1926, the Borough Treasurer tells me, the Council made 293 advances to purchasers of houses in accordance with the provisions of this Act. The following is a List of By-laws and Regulations made under the various Acts, with date of adoption:— By-laws made under:— Public Health (London) Act, 1891. Section. Date of Adoption. 16 (1) Prevention of nuisances arising from matter thrown in any street; offensive matter running into an uncovered place; keeping of animals; paving of yards and open spaces. 15th May, 1903 16 (2) Closing of cesspools and privies: Removal and disposal of refuse. 28th June, 1893 16 (2) Removal of faecal and offensive matter. 26th Nov., 1901 39 (1) Construction of closets, privies, ash-pits, cesspools, and dung receptacles. 28th June, 1893 14th June, 1901 3rd Jan., 1905 39 (2) Keeping water closets supplied with sufficient water. 24th June, 1903 45 Decent conduct of persons using public lavatories, etc. 24th June, 1903 50 Securing cleanliness and freedom from pollution of tanks, cisterns, and other receptacles used for storing water. 24th June, 1903 88 Management of Mortuaries 24th June, 1903 42 Section. Date of Adoption. 94 Houses let in lodgings (Woolwich and Plumstead Parishes only). 13th Aug., 1895 95 Tents, Vans, Sheds 24th June, 1903 19 Bone boiler, Manure manufacturer or Tallow melter 25th Nov., 1907 19 Gut scraper and Catgut maker or Catgut manufacturer. 25th Nov., 1907 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 Mar., 1922 19 Glue and Size Manufacturer 25th Nov., 1907 19 Knacker 25th Nov., 1907 19 Slaughterer of Poultry 22nd Dec., 1923 19 Soap boiler 25th Nov., 1907 19 Tripe Boiler 25th Nov., 1907 London County Council (General Powers) Act, 1908:— 9 Bag 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. 43 Section. Date of Adoption. Metropolis Management Act, 1855 (Section 202) and Metropolis Management Acts (Amendment—Bylaws) 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 Baiths and IVashhouses 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 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. 44 xi. 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 details of the week's programme. In accordance with the Council's resolution of the 9th June, 1926, we arranged a suitable programme for Health Week, 1926. We commenced the week by opening the new Maternity and Child Welfare Centre at Plumstead, and we arranged that this centre should be available for public inspection on each day after the opening, between 11 a.m. and 9 p.m. At the Town Hall, we concentrated on addresses and health talks, making as much use as possible of health films, but we also arranged for the production of two health plays, written by a member of the staff of the Health Department. One of these, "Sunshine House," was presented on two occasions by the 3rd Royal Eltham Girl Guides, and the other, "Dad's Dentures," was presented by members of the Health Department on three occasions. These plays proved very delightful, and demonstrated in a very simple way certain cardinal principles of the laws of health. The lectures and cinema pictures illustrated various aspects of health work, for example, schemes for maternity and child welfare, the dangers of tuberculosis, the general sanitary and epidemiological work of a health department, the production and handling of milk, the care of the teeth, the dangers of venereal disease, the life and habits of the fly, the rat menace, cold storage, and the dangers of the streets and of uncleanliness. Certain of these films were hired, others were kindly lent by the Ministry of Health, the Ministry of Agriculture and Fisheries, National Dental Board, Corporation of the City of Glasgow, the Health and Cleanliness Council, Junior Red Cross League, National Milk Publicity Council, Safety First Council, Messrs. Gibbs, Ltd., Nujol, Ltd., and the 45 Delco Light Co., Ltd. To all of them we have extended, in accordance with the pleasure of the Council, our hearty thanks. The talks and lectures on health work were given by experts in their special subjects. In setting out the programme, we arranged for lectures suitable for women to be given in the afternoon, while those of general interest were reserved for the evening. We have also extended our thanks to the lecturers. We take this opportunity of saying how much we are indebted to the members of the staff of other departments of the Council who assisted us in making arrangements for the opening of the Welfare Centre; for converting the Town Hall into a suitable building for cinema pictures; for the giving of organ recitals, and in many other ways. We held five afternoon sessions and six evening sessions. The general arrangement was that films were shown for the first 30 to 40 minutes, and for the last 40 minutes, with a lecture in between. The average duration of the afternoon sessions was 2J hours, and of the evening sessions 2f hours. The attendances at the Town Hall during the week were very gratifying, totalling just short of 10,000, a figure much in excess of what we had anticipated. At Plumstead Centre there was a steady stream of visitors from the time the centre was officially opened until Saturday evening, but the figures were not recorded. We are grateful to many voluntary workers for their assistance during Health Week, and particularly for their work in connection with the creche which was established every afternoon at the Town Hall, where babies could be looked after while their mothers went to the lectures, a service which had added very materially to the comfort of all concerned. Comparing this year's Health Week with last year's exhibition, it is interesting to record that many people were disappointed that there was no exhibition, but that many more appreciated the greater opportunity given them of 46 obtaining health instruction by the lecturers and the use of the film. Both methods have their uses, and must be regarded as complementary and not as alternative. The success of Health Week could not have been achieved without the united support of the Council and the keen co-operation of the staff and the voluntary workers, and we take this opportunity of thanking all who so contributed for the enthusiasm and energy with which they carried out their share. Section IV—Sanitary Administration Staff. The sanitary staff consists 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 wholly engaged in Food and Drugs work and in the supervision of food. Complaints. In accordance with the provisions of the Public Health (London) Act, a complaints book is kept, and all complaints, both written and oral, are recorded there. Inspections are then made by the District Inspectors, who take the necessary steps to ensure the abatement of such nuisances as are found to exist. During the year, 2,536 complaints were received, compared with 1,690 in the previous year. Of these, 28 related to the non-removal of house refuse—5 in Woolwich, 15 in Plumstead, and 8 in Eltham. Water Closet Accommodation. A system of sewers exists throughout the Borough, except in the outlying districts, where as a temporary expedient, cesspools and earth closets are in use. The number of cesspools regularly emptied by the Council was 31, of which 16 were in Plumstead and 15 in Eltham. Scavenging. The collection and disposal of house refuse in the Borough is carried out by the Works Department of the Council. Horse transport has now been almost entirely superseded by electric vehicles, and, as a result, the deposit 47 of refuse in shoots has ceased, all the refuse being taken either to the Woolwich or Plumstead Destructors. The Borough Engineer tells me that the special plant installed a Plumstead for utilising clinker for road material is giving very satisfactory results, and that this material, mixed with bitumen, is now regularly used for the surfacing of certain classes of roads in the Borough. Trade Refuse. The collection of trade refuse is carried out by the Works Department at a charge of five shillings per load. In order £o obtain the removal of trade refuse application must be made at the Town Hall and the charge prepaid. During the year approximately 1,300 loads were removed. This refuse is also disposed of at the Destructors. Offensive Trade Refuse. The collection of offensive trade refuse was, up to April, supervised by this Department, but is now under the control of the Works Department. Specially designed receptacles are provided by the Council for this work, and a charge of sixpence is made each time a receptacle is used, the full receptable being removed and a clean, empty one substituted. The receptacles are collected daily by means of an electric motor tractor and a closed waggon with sliding doors. The refuse is disposed of to a manufacturer of guano at Poplar, and the receptacles are cleansed by steaming and washing. Combined Drains. Twenty-five combined drains, connected with 186 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 £8 0s. Id., 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 48 serve 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 three cases, involving connections with 47 houses. Sanitary Inspection of the Area. The Sanitary Officers' Order of 1922 defines the duties of sanitary inspectors. Statistical Tables, Nos. 24 and 25 are set out below showing the number of inspections made and the character and type of the nuisances abated. 3,819 intimation notices and 1,344 statutory notices were served during the year, compared with 3,223 and 858 respectively last year. The statutory notices related to 993 premises, and included 932 general notices, 220 ash-pit, 97 water closet, and 78 paving notices served under the Public Health (London) Act. In addition to these, 16 were served under the London County Council (General Powers) Acts and Bye-laws and one under the Rats and Mice (Destruction) Act, 1919. There were 226 instances in which the owners neglected to comply with the statutory notices, and these were reported to the Town Clerk for legal proceedings. The corresponding figure last year was 140. 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 a notice, and requesting his attention forthwith. In consequence of these letters it was found necessary to issue only 18 summonses, details of which are set out in Table No. 27. TABLE No. 24. Inspections. Housing Survey—Houses Inspected 3,985 Complaints Investigated 2,536 Outworkers' Premises 1,035 Houses Let in Lodgings 374 Homes re Verminous Cases 669 Homes re Scabies Cases 74 49 Overcrowding Investigated—Rooms 278 Underground Rooihs Illegally Occupied 2 Drainage Inspections 422 Drains tested by Smoke Test 183 Drains Tested by Water Test 25 New Houses 373 Tents and Vans 19 Factories 257 Workshops 572 Work Places 48 Theatres and Cinemas 6 Rag and Bone Premises 41 Urinals Accessible to the Public 267 Women's Lavatories 187 Smoke Observations 20 Special Inspections re Rats 149 Inspections re Mosquitoes 87 Miscellaneous (Unclassified) 1,128 Re-inspections ... 13,176 TABLE No. 25. Nuisances Abated. Cleansing:— Interiors Cleansed 1,605 Rooms Cleansed 3,434 Damp Conditions:— Walls 740 Sites 8 Roofs 1,316 Rain Water Pipes and Gutters 690 Others 70 Dilapidations:— Walls 637 Ceilings 533 Floors and Hearths 333 Coppers 176 Stoves 198 50 Verminous Conditions:— Rooms Cleansed 282 Defective Lighting:— Windows Repaired 75 ,, Enlarged – ,, Additional – Defective Ventilation:— Windows Rendered Usable 652 ,, Additional Provided 4 Other Means 10 Defective Paving:— Yards Re-paved 86 ,, Repaired 187 Scullery Floors Re-paved or Repaired 82 House Drains:— Defective Drains Repaired 78 Choked Drains Cleared 239 Vent Pipes Repaired 14 Soil Pipes Repaired 11 Gullies Fixed 33 New Drainage 3 Rain Water Tanks Repaired 3 Sinks Repaired or Provided 75 Wastes Cleansed 73 Wastes Trapped or Repaired 119 Water Closets:— Flushing Apparatus Repaired 357 Flushing Apparatus Renewed 80 New Pans 140 New Traps 115 Foul Pans Cleansed by Owner 15 Foul Pans Cleansed by Occupier 214 Additional w.c.'s Provided 4 Doors and Fastenings Remedied 105 Dust Bins Provided 1,286 Overcrowding—Cases Remedied 17 51 Water Supply:— Additional 2 Re-instated 19 Cisterns Cleansed 4 Cisterns Covered 1 Foul Accumulations:— Manure Removed 12? Offensive Accumulations Removed 144 Back Yards Cleansed 126 Rats:— Drains Repaired in Consequence 10 Premises Rat-Proofed 13 Other Effective Measures 9 Rag and Bone Premises— Premises Cleansed 6 Rain-proof Premises Provided – Vermin-proof Conditions Provided – Other Matters Remedied 1 Miscellaneous 336 Rats. During the year many investigations were made under the Rats and Mice (Destruction) Act, 1919. As in previous years the Council co-operated in Rat Week as arranged by the Board of Agriculture and Fisheries in November. With the assistance of the Works Department, 6,630 baits were laid in manholes of the old sewers likely to be infested, and co-operation was sought from and readily given by the Royal Arsenal and Royal Dockyard authorities and many large firms in the Borough. Complaints regarding rat infestation in small buildings are usually accompanied by the intimation that the rats come from one or other of the adjoining gardens. The Act, however, makes the occupier of rat-infested premises the person responsible for their destruction. The complaints are investigated, suitable advice is given as to destruction and ratproofing, and notices are served on all persons responsible. During the year 20 notices were served, but in no instance was it necessary to resort to legal proceedings. 52 Mosquitoes. Investigations were again carried out in the areas that were originally badly infested with mosquitoes. These were mainly in the Plumstead and Abbey Wood district, and it was found that there was a further diminution from the previous year, which no doubt can, in a very large measure, be associated with the efforts of the Council in improving the ditches on the marsh land. Rag Flock. This Act prohibits the use of dirty flock, and the Regulations made thereunder provide for a standard of cleanliness. Six samples were taken during the year, the detailed results of which are given as follows:— Parts per No. 100,000 1. Soluble chlorine in the form of chlorides 30 00 2. do. do. 22.50 3. do. do. 60.00 4. do. do. 32.50 5. do. do. 181.00 6. do. do. 23.50 Samples No. 3, 4, and 5 did not comply with the Rag Flock Regulations, viz., that the amount of soluble chlorine in the form of chlorides must not exceed 30 parts of chlorine in 100,000 parts of flock. Cautionary letters were sent by the Town Clerk to those concerned. Offensive Trades. There are no offensive trades in the Borough. Action taken with regard to Smoke Abatement. The Sanitary Inspectors, in the ordinary course of their duties, keep ehimney shafts under observation and record any nuisance of smoke in connection therewith. During the year there were 20 special observations. 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 this district. The total number of factories, workshops, and work places on the register at the end of the year was 256. The number of inspections made was 877, which compares with 761 in 1925. 53 Sanitary defects were found in 63 instances. Bakehouses are specially reported on in the section dealing with the supervision of food. The number of inspections of outworkers' premises was 1,035, compared with 645 last year. The largest number of outworkers in the Borough are employed in the manufacture of tennis balls, and practically all the remainder are employed in making wearing apparel. Generally speaking, the homework is carried out under satisfactory conditions, but it was necessary to serve 16 notices in respect of unwholesome premises. Infectious disease occurred in ten instances in the homes of outworkers. In recent years it has been noticed that the sending of half-yearly lists to the Medical Officer of Health has been neglected by some firms. During the year the Committee instructed cautionary letters to be sent to four persons. One summons was taken out against one employer for neglecting to send a list of outworkers, and another for neglecting to keep a list of outworkers. Both summonses were withdrawn on payment of half a guinea costs in each case. The following Table is in the form adopted by the Secretary of State to provide for uniformity throughout the country in the presentation of certain particulars of this work which lend themselves to statistical treatment. TABLE No. 26. Factories Workshops Laundries, Workplaces, and Homeworkers' Premises. 1.—Inspection. Including inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories 257 36 – (Including Factory Laundries) Workshops 572 11 – (Including Workshop Laundries) Workplaces 48 1 – Homeworkers' Premises 1035 16 – Total 1912 64 – 54 2.—Defects Found. Description. Number of Defects Found. Remedied. Referred to H.M. Inspector Number of Prosecutions. Niiisances under Public Health Act:— Want of Cleanliness 11 11 – – Want of Ventilation 1 1 – – Overcrowding – – – – Want of drainage of floors 1 1 – – Other nuisances 6 6 – – Sanitary Accommodation insufficient 3 3 – – unsuitable or defective 40 40 – – not separate for sexes 1 1 – – Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) – – – – Other offences – – – – Total 63 63 – – 3.—Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices served. Prosecutions. Wearing apparel-making, &c. 6 4 – Household linen 3 1 – Curtains and furniture hangings 1 1 – Racquet and tennis balls 55 10 – 65 16 – Legal Proceedings. In Table No. 27, which follows, are set out particulars of the various prosecutions instituted under the Public Health (London) Act and kindred Acts. 55 TABLE No. 27. Prosecutions under Public Health and Kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1 1926 Feb. 11 Damp walls of ground floor, front room; dirty walls and defective floor of scullery; defective & dirty walls of staircase 57, Eglinton Road Work done. Costs 10s. 2 Feb. 11 Leaky front and rear eaves gutters; damp wall of ground front room 1, Raglan Road Work done. Costs £1 1s. 0d. 3 A pi. 8 Non-provision of dustbin 35, Belson Road Work done. Withdrawn 4 May 27 Leaky house roof 56, Princes Road Fined £5. Costs 10s. 6d. Order to abate in 14 days 5 July 14 Non - compliance with Magistrate's Order made on 27th May, 1926 56, Princes Road .. Fined £1. Costs £5 6 July 14 Defective roof gutters 59, Wickham Lane Work done. Withdrawn. Costs £1 1s. 7 July 14 Defective gutters and paving round gully 61, Wickham Lane 8 July 14 Defective and dirty walls of bedroom and scullery and staircase 63, Wickham Lane 9 July 28 Overcrowding front room 18, Swetenham Place Order to abate in 28 days 10 July 29 Fail to remove offensive rags within 24 hours 1, Hartville Road Fined £1 11 July 29 Knowingly suffer to be brought upon premises rags from a dust cart Premises adjoining 74, Powis Street Fined £1 12 Aug. 18 Defective roof and gutter of house 27, Belson Road Work done. Withdrawn 13 Aug. 25 Non - compliance with Magistrate'sOrdermade 14th July, 1926 56, Princes Road Fined £10 56 No. Date of Hearing. Offence. Situation. Result. 14 Oct. 13 Defective house roof and w.c. pan 3, Frederick Place Order to abate in 21 days 15 Oct. 13 Defective house roof, sink, waste pipe, ceiling of w.c., and window sashes 40, Majendie Road Order to abate in 21 days 16 Nov. 17 Defective roof of house ... 22, Plumstead High Street Fined £1. Costs lis. Mortuaries and Cemeteries. In Tables Nos. 28 and 29, which follow, details are given with regard to the Mortuaries and Cemeteries. The information regarding the interments at the Woolwich and Plumstead Cemeteries and the Eltham Churchyard is given through the courtesy of the Town Clerk and the Vicar of Eltham. Under the terms of the Home Office Order of 1893, twenty-four hours' notice of any proposed interment in the Plumstead Churchyard has to be given to the Medical Officer of Health. The Home Office notifies the Medical Officer of Health when an exhumation licence has been granted, in order that he may be in a position to take any action necessary in the interests of public health. During the year six copies of such licences were received from the Home Office, and in each case a Sanitary Inspector was present at the exhumation. MORTUARIES. TABLE No. 28. Sun Street. Sun Street (Infectious) Eltham. All Mortuaries. No. of Bodies received : 1925 1926 (a) for inquest 74 – – 82 74 (b) for custody 12 1 5 8 18 86 1 5 90 92 No. of Post-Mortem Examinations 39 – – 56 39 57 CEMETERIES. TABLE No. 29. Number of Interments. 1924 1925 1926 Woolwich Cemetery 570 607 566 Plumstead Cemetery 656 634 688 Eltham Cemetery 196 188 183 Plumstead Churchyard 27 16 15 1,449 1,445 1,452 Section V.—Inspection and Supervision of Food. The district sanitary inspectors constantly have in mind that unsound or unfit food may be offered for sale, and that premises where food is prepared may not be maintained in a hygienic condition. For these reasons inspection of food and food premises is carried out daily as a routine measure. Bakehouses, fish shops, butchers' shops, eating houses, sausage shops, ice cream vendors, milk shops, the market places, and all premises having any association with the preparation and/or sale of food, are therefore under constant supervision. Three inspectors have special duties in connection with this part of the work, devoting regular times to the supervision of the milk supply, the examination of meat, and the sampling of food offered for sale in the markets. Our experience demonstrates that there is a definite improvement in the conditions under which food is prepared, kept and offered for sale, but that constant reminders are necessary to maintain the improvement. In tabular form is shown below, in Table No. 30, the number of premises on the registers, the number of inspections made, and the number of notices served. Most of the notices dealt with want of cleanliness on the part of the traders, their employees, premises, or utensils. 58 It was found necessary to serve 112 notices, all of which were complied with. In one instance where fruit and vegetables were deposited in a stable, lying about on the floor and contaminated by manure and other filth, proceedings were taken under the provisions of the London County Council (General Powers) Act, 1908. A penalty of 20s. was imposed. TABLE No. 30. Premises. On Register 31st December. Number of Legal Proceedings. Inspections. Notices. Bakehouses 43 137 6 – Cowsheds 9 105 8 – Milkshops 87 1061 20 – Ice Cream Shops 222 497 1 – Slaughterhouses 7 28 2 – Fried Fish Shops 70 192 12 – Butchers' Shops 92 458 10 – Premises where food is prepared (other than above) 142 1174 53 – Premises used for the storage of food – 77 – – Shops and Markets – 3233 – MILK SUPPLY. Registration. The following Table, No. 31, shows the changes which have taken place in the milk registers during the year. TABLE No. 31. Retail Whole. sale. Total. On register on 1st January 88 9 97 Removed during the year 11 2 13 Added during the year 12 1 13 On register 31st December 89 8 97 59 Prosecutions. Legal proceedings were instituted against two persons carrying on the trade of purveyor of milk without being registered with the local authority. One gave a false name and address in Dalston. The summons was not heard at the Police Court as it had not been served as the man was not to be found. Efforts were made to trace him, but were unsuccessful. He has not been seen in the Borough since. In the other case, the defendant was fined 40s. and one guinea costs. The Milk and Dairies Order, 1926. This Order, which came into force on the 1st October, 1926, revoked the Dairies, Cowsheds, and Milkshops Orders of 1885, 1886, and 1899, so far as they relate to England and Wales, and all regulations made thereunder by local authorities. The main provisions of these Orders and Regulations are replaced in the new Order by provisions similar in general purpose, but modified in accordance with the development of modern hygienic knowledge, so that greater stress is laid on cleanliness in all operations connected with the production and handling of milk, including the care of the cow, than upon the structure of buildings. Of chief importance are the new provisions relating to the health and inspection of cattle, and the handling, conveyance and distribution of milk. With the exception of Part IV., which deals with the health and inspection of cattle, the regulations are enforceable by the Borough Councils. Cowkeepers. There are nine licensed cowkeepers in the Borough holding licences for 22 cowsheds in all, and providing accommodation for 473 cows. The average number of cows kept was 426. These cowsheds are subject to regular inspection, and, as is shown in Table No. 30, 105 inspections were made and eight notices served. These inspections were usually made when milking was in progress and the inspector paid particular attention to the following points:—the general health, personal cleanliness, and clothing of the milkers; the general condition and toilet of the cow; the suitability and cleanliness of the milk utensils (including the 60 milking stool); the sanitary state of the cowsheds and dairies; the provision of suitable facilities for personal washing by the milkers; the provision of suitable apparatus for cooling and storing the milk and the cleansing of milk utensils, and the regular and systematic removal of all manure from the immediate vicinity of the cowsheds and dairies. The education of the milkers is a slow process by reason of the traditional habits and customs of farm workers, but, in spite of this, words in season, tactfully and patiently given by the inspector, are producing a very definite improvement. Dairymen and Purveyors of Milk. It will be inferred from the preceding paragraph that only a very small proportion of the milk sold in Woolwich is produced in the Borough. Most of it comes by rail, from the milk-producing countries, in churns, many of which are of an obsolete and unsuitable pattern and are not provided with proper lids with rims that overlap the top rim of the churns. In consequence, a dirt trap is formed which facilitates the contamination of the milk while in transit. Fortunately these churns, as they go out of use, are being replaced by the more efficient kind. The majority of the milk purveyors in Woolwich sell from general shops, but there are some large dairies provided with proper and suitable apparatus for dealing with large quantities of milk, and there is evidence that these will gradually replace the general shop as a milk store, except possibly in the poorer districts, where the general shop, which provides for the sale of small quantities of food, including milk, to the casual and very poor, serves a useful purpose. All the dairies are inspected monthly, and care is taken to ensure that a high standard of purity of the milk is maintained and that cleanliness is observed in connection with the utensils and the premises. Bottles are being used in increasing numbers for the distribution of milk, not only by the purveyor in a big way of business, but also by the smaller man. When proper methods are adopted this system presents many advantages to the dairyman and to the consumer, 61 but, unfortunately, the necessity for scrupulously clean bottles has not yet been fully recognised by some members of the trade who fail to realise that you cannot cleanse milk bottles in dirty water—sometimes hot, more often tepid and occasionally cold. Efficient apparatus is needed for this purpose, and fortunately there is on the market apparatus suitable for the needs of small and large businesses. The small man often sells milk in bottles because he believes his customers like it, but he doesn't provide the necessary facilities for ensuring that the bottles are clean. He postpones the provision of appliances until his business improves. The inspector is kept busy reminding the purveyors that scalding water is a very necessary adjunct to a milk business, and that a plentiful supply is needed if properly cleansed and safe utensils are to be used. Generally speaking, the results of the year's working show that a higher standard of cleanliness is now being maintained by our milk purveyors. The Milk (Special Designations) Order, 1923. This order provides for the issue of licences for the production, bottling, and sale of " designated" milks which may be sold under one of the following descriptions:—Certified, Grade A, Grade A (Tuberculin Tested), Grade A Pasteurised, and Pasteurised. Only 26 applications for dealers' and supplementary licences were received by the Council during the year, and all were granted. As will be seen from the following Table, No. 32, the total licences in force at the end of the year was 26, compared with 9 at the end of 1925. The total amount received in fees was £5. At the request of the Ministry of Health, five samples of certified milk were submitted for bacteriological examination. All were reported up to standard. 62 TABLE No. 32. Name and Address. Nature of Licence. Premises to Sell at or from. Designation. Eltham & Sidcup Farm Dairies, Ltd. Dealer 82, Eltham High Street Certified Do. Do. Do. Grade A (T.T.) Do. Do. 102, Westmount Road Grade A (T.T.) Do. Do. Do. Certified Messrs. Edwards & Sons, Ltd., Station Buildings, Forest Hill, S.E. Do. 124, Westmount Road Certified Do. Do. Do. Grade A (T.T.) Do. Do. Do. Grade A Do. Do. Do. Grade A (Pasteurised) Do. Do. Do. Pasteurised Do. Supplementary 74, Little Heath Certified Do. Do. Do. Grade A (T.T.) Do. Do. Do. Grade A Do. Do. Do. Grade A (Pasteurised) Do. Do. Do. Pasteurised Do. Do. 30, Burnt Ash Road Certified Do. Do. Do. Grade A (T.T.) Do. Do. Do. Grade A Do. Do. Do. Grade A (Pasteurised) Do. Do. Do. Pasteurised Do. Dealer Ashurst, Shrewsbury Lane Certified Do. Do. Do. Grade A Do. Do. Do. Grade A (T.T.) Do. Do. Do. Grade A (Pasteurised) Do. Do. Do. Pasteurised The Express Dairy Co., Ltd., Tavistock Place, Do. 3, Wellington Street Certified W.C. Do. Do. Do. Grade A (T.T.) MEAT. The Department has continued to give systematic attention to the meat supply of the Borough, not only at the slaughterhouses, but also in the butchers' shops and stalls. The Public Health (Meat) Regulations, 1924, are proving of great value in improving the conditions under which meat is handled, stored, and sold, and the inspectors find that they can use the regulations as a text book for the progressive education of all concerned in the handling of meat. A 63 marked improvement has taken place compared with previous years, and legal proceedings have been unnecessary. During the year 2,308 cattle, 11,283 sheep and lambs, 3,600 pigs, and 174 calves—a total of 17,365 animals—-were killed in the various slaughterhouses in the Borough, and the carcase and internal organs of every one of them were inspected by one of the Council's staff. No single instance of slaughtering without notice was detected. As slaughtering takes place at all hours of the day and on every day of the week, including Sundays, irregular hours of duty have to be worked by the special food inspectors in order to ensure the examination of every carcase. The advantage of detecting unsound meat at the source is obvious, and this part of the regulations is of immense value to the public health. The number of whole carcases condemned on account of disease or injuries was 21—3 cattle, 7 sheep, and 11 pigs. The number of instances in which partial condemnation occurred was as follows:—468 cattle, 12 sheep and lambs, and 13 pigs. The corresponding main figures for the nine months the regulations were in force in 1925 were 47 and 634 respectively, and the general improvement in the figures may mean that, cognisant of the careful inspection that takes place after death, buyers are exercising more care in the purchase of live animals. The shops and stalls were systematically inspected, and where there were any unsatisfactory conditions the appropriate regulation was applied. There is very definite evidence that greater care is now taken to prevent the contamination of meat when exposed in the shops and stalls. Butchers are now striving to make an attractive show behind a glass front, and the adoption of a system of weighing and ticketing the joints and then exhibiting them behind glass is an advance which prevents much of the handling so common a little over a year ago. New butchers' shops are now invariably provided with glass fronts and glazed internal wall surfaces, and improvements of this character have been effected in several of the older premises. Another improvement to be recorded is the increasing use of clean washable overalls by shop assistants. 64 So far as transport of meat is concerned, the improvement referred to above is not so marked, but constant pressure is being maintained on all concerned of their obligations under the regulations. The use of light motor transport for the retail transport of meat is becoming more extensive, and the once familiar sight of a boy balancing a loaded basket of meat on a bicycle is gradually disappearing and with it those accidents we used to be acquainted with. Slaughterhouses. In tabular form below is shown the number of slaughterhouses licensed in 1920, and in January and December, 1926. During the year 683 inspections of these premises (which are licensed by the London County Council) were made. There is no public slaughterhouse in the Borough. TABLE No. 33. 1920. 1926. Jan. Dec Registered — — — Licensed 9 8 7 OTHER FOOD PREMISES. Bakehouses. The number of bakehouses in the Borough at the end of the year was 43, of which 26 were factories and 9 were underground. The district inspectors made 137 inspections and found 40 offences. In the main these were associated with want of cleanliness or with carelessness in the conduct of the business. The necessary action was taken by the occupiers without resort to legal proceedings. Fried Fish Shops. There were two additions during the year to the register of fried fish shops, making a total of 70 premises where the frying of fish was carried on. 192 inspections of these premises were made, and it was only necessary to serve 12 notices for unsatisfactoiy conditions. A reasonable standard of cleanliness is now maintained at most of these premises, but in some instances the occupiers require further education in the elementary principles of preparing food for other people. 65 Ice Cream. During the year this popular commodity was sold at 222 premises, but owing to the disappointing summer the sale was intermittent. 497 inspections were made. Ice cream vendors or premises do not require to be registered, and the only specific legislation dealing with the matter is contained in the London County Council (General Powers) Act, 1902, which deals with the manufacture, storage, and sale of this commodity. The position would be improved if premises used for the manufacture of ice cream were registered, and if, in addition, power were given to remove from the register. Detailed legislation is necessary for the maintenance of utensils and appliances in a clean and wholesome condition, e.g., provision should be made for the daily scalding of all apparatus used during the day. The provisions of the General Powers Act referred to above are not sufficient because experience has shown that it is very difficult to enforce general clauses; and bye-laws, to be of practical advantage must provide for the obligations to be set out in precise detail. Registration will not render more easy the detection of the deliberate offender, but the value of an occasional prosecution for non-registration would be educational. I do not think that the registration of places where ice cream is sold is a practical proposition, as ice cream is frequently sold at open sports grounds and by itinerant vendors, and the distribution of ice cream by tricycle trolleys is increasing. Other Premises. During the year 142 premises, including restaurants and eating houses, were regularly inspected. 1,251 inspections were made, and it was necessary to serve 53 notices for unsatisfactory conditions, which were usually due to lack of cleanliness but occasionally to faults in construction of the premises. The principal difficulty of the small eating houses is very often the limited facilities available. The small domestic kitchen is invariably taken into use for the purposes of the business, and the accommodation is so limited that there is a permanent muddle. In such cases, where additional accommodation is impossible, the inspector tries to encourage the occupiers to adopt a scheme D 66 to ensure the speedy removal of all refuse and scraps and to clean up frequently. There have been, in addition, 3,233 other inspections of shops and of the stalls in the markets. UNSOUND FOOD. There were 339 instances of unsound food being surrendered. This compares with 210 in 1925. Included in the food surrendered were:—1 ton, 8 cwts., 3 qrs., Beef; 18 cwts., 3 qrs., 22 lbs., Pork; 6 qrs., 7 lbs., Pigs' Livers; 2 tons, 7 cwts., 2 qrs., 15 lbs., Ox Livers; 3 cwts., 18 lbs., Mutton; 10 cwts., 3 qrs., Fish; 2 cwts., Ox Lungs; 2 cwts., Tomatoes; 2 lbs., Rabbit; 1½ cwts., Cocoa; 2 bushels, Winkles; 15 cwts., Apples; 5 lbs., Chicken; 312 lbs., Damsons; 12 lbs., Ox Tongues, and 4 lbs. of Ox Kidneys. No intimation was received during the year that any such food was being sent into the Borough for animal food. One seizure was made of a quantity of damsons. Two summonses were served, one for offering the damsons for sale and the other for having damsons deposited for the purpose of sale. In the first case the defendant was fined £2, and in the second £1 and £2 2s. costs. FOOD POISONING. No case of food poisoning was reported during the year. SALE OF FOOD AND DRUGS ACTS. The number of samples taken under these Acts was 547, ten of which were found by the Public Analyst to be adulterated. The percentage of adulterated samples was 1.8, which compares with 3.9 in the previous year. Seventeen samples were taken on Sundays, none of which were adulterated. Six bottles of medicine, supplied in accordance with prescriptions for panel patients under the National Health Insurance Acts were obtained and were found to be genuine. The following Table, No. 34, gives details of the analyses made. 67 TABLE No. 34. Article. Formal Samples. Informal Samples. Number Analysed Number Adultera ted. Milk 280 3 283 6 Separated Milk 2 — 2 — Cream — 2 2 — Preserved Cream — 8 8 — Butter — 61 61 — Cheese 1 — 1 — Condensed Milk — 8 8 — Lard — 7, 7 — Coffee 1 26 27 1 Cocoa — 3 3 — Dried Milk — 2 2 — Malted Milk — 1 1 — Baking Powder — 3 3 — Cream of Tartar — 3 3 — Apples — 4 4 1 Meat Paste — 2 2 — Fish Paste — 2 2 — Olive Op — 9 9 — Whisky — 4 4 — Vinegar — 4 4 — Pepper — 5 5 — Ground Ginger — 4 4 — Mustard — 8 8 — Tea — 4 4 — Self-Raising Flour — 8 8 — Zinc Ointment — 12 12 — Compound Liquorice Powder — 14 14 — Saffron 1 3 4 1 Camphorated Oil — 6 6 — Crushed Linseed — 5 5 — Gregory's Powder — 3 3 — Powdered Rhubarb — 6 6 — Aspirin Tablets '— 6 6 — 68 Sulphur Ointment ... — 5 5 — Strong Tincture of Iodine 1 4 5 1 Tincture of Iodine ... — 6 6 — Lime Water ... — 4 4 — Prescriptions 6 — 6 — 292 255 547 10 The following figures relating to the fat percentage figures of each sample of milk examined in the last three years are given below. The minimum legal standard is 3% of fats. TABLE No. 35. 1924 1925 1926 4-5% and over 1 1 5 4% and under 4.5% 14 12 9 3-5% and under 4% 121 90 138 3% and under 3.5% 96 109 126 Below 3% 3 2 4 Not given — — — 235 214 283 PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. These regulations provide a standard for condensed milk and the conditions under which it may be described and sold. Eight samples were taken during the year, and the Analyst found them to be genuine. In addition to the sampling, a number of inspections have been made of condensed milk exposed for sale in shops to ascertain whether the labelling was being properly carried out, but no contravention of the regulations was found, probably due in very large measure to the fact that condensed milk is prepared by large manufacturers who take steps to comply with the regulations. 69 PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. These regulations provide for the conditions under which dried milk may be sold and labelled. Two samples were taken during the year and submitted to the Public Analyst for analysis. They were reported upon as genuine. There are not many kinds of dried milk on sale, and they are invariably prepared by large manufacturers. ADULTERATED SAM PLES—ACTION TAKEN. The following Table, No. 36, shows the number of adulterated samples and the action taken in each instance where the samples were formal. TABLE No. 36. Sample No. Article Formal or Informal. Result of Analysis. Result of Proceedings. 383 Apples Informal l/40th grain arsenic per lb. ... — 476 Milk Formal Coloured with annatto Fined £1 and 21s. costs 480 Saffron Informal Contained 5'79% excess moisture — 217 Coffee Informal Contained 20% of chicory ... — 271 Milk Formal 24'66% deficient in fat Costs £2 2s. 285 Strong tincture of iodine Informal 75% deficient in iodine and potassium iodide — 298 Milk Formal 12% added water and 3% deficient in fat Costs £2 2s. 306 Milk Informal 9% added water and 13% deficient in fat — 371 Milk Formal 26.33% deficient in fat Fined £4 and 21s. coats 392 Milk Formal Contained 3.76% added water Costs 21s. 70 THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912-1917. During the year 285 samples of milk and 10 of cream were purchased and submitted to the Public Analyst. None of the samples showed any preservative. In tabular form, as required by the Ministry, are set out below the details of this work. TABLE No. 37. REPORT ON ADMINISTRATION IN CONNECTION WITH THE PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912-1917, FOR THE YEAR ENDED 31st DECEMBER, 1926. 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 285 (including separated milk.) Nil. — — Cream 2 Nil. — — 71 2. Cream sold as Preserved Cream. (a) Instances in which samples have been sub mitted to analysis to ascertain if the statements on the label as to preservatives were correct 8 (i) Correct statements made 8 (ii) Incorrect statements made — (iii) Percentage of Preservative Percentage found in each sample; stated on •27 per cent. statutory •34 per cent. label: •28 per cent. Not •40 per cent. exceeding •34 per cent. •4 •34 per cent. per cent. •35 per cent. •39 per cent. (b) Determinations made of milk fat in cream sold as Preserved Cream:— (i) Above 35 percent. 8 (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 (2) of the Regulations have not been observed Nil (d) Particulars of each case in which the tions have not been complied with and action taken Nil 3. Thickening substances Nil 4. Other observations (if any) Nil 72 Section VI.—Housing. In accordance with the instructions of the Ministry of Health, the following tabular statement is shown:— TABLE No. 38. Number of new houses erected during the year:— (a) Total 373 (b) With State assistance under the Housing Acts, 1919, or 1923:— (i) By the Local Authority 170 (ii) By other bodies or persons 55 1. Unfit Dwelling Houses. Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 7,199 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Consolidated Regulations, 1925 3,985 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all repects reasonably fit for human habitation 1,526 2.—Remedy of Defects without Service of Formal Notices* Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 2,809 *Includes intimation notices. 73 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 993 (2) Number of dwelling houses in which defects were remedied:— (a) By Owners 771 (b) 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 4 (2) Number of dwelling houses in respect of which closing orders were made *4 (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 — *Includes one underground room. 74 The general state of housing in the Borough was fully reported on in the Annual Report for 1925, and the conditions outlined there are substantially the same now. The housing shortage has not yet been overtaken. The number of houses erected in 1926 totalled 373, 170 being erected by the Borough Council and 203 by private enterprise. In the period 1901-10, 453 new houses were completed annually, and in the next ten years 533. Overcrowding is still observed, due, in a fair number of cases, to the economic conditions which are associated with large families and limited means, and in some cases to the regard of parents for their married children who were sheltered temporarily in their family home. The arrival of a young family makes the housing conditions worse, and the difficulty of finding accommodation later on becomes very nearly insuperable owing to the prevalence of a rooted objection to let apartments or houses to families with young children. The general standard of housing in Woolwich is good, and such difficulties as are discovered as a result of inspection are usually the type that occur in working-class dwellings. The hutments continue to be used as permanent homes, but as time progresses these require more and more attention to maintain them in a habitable condition. They are not suitable for permanent dwellings, and the general standard of housing in the Borough can never be regarded as on a really satisfactory basis until they are substituted by houses. They were erected as a temporary expedient, as a war measure, and have outlived this purpose. A small number of Woolwich residents have been allotted houses on the London County Council's estates outside the Borough, and possibly the diminution of work in the Royal Arsenal with the consequent reduction in personnel has led to men leaving this area for other localities where work can be found. The erection of the Council's houses at Eltham has meant the transfer of persons from more overcrowded portions in the Borough. It is early to feel these effects, but, after making all allowances, the housing situation in Woolwich can be summed up in four words—more houses •are required. 75 Houses Let in Lodgings. The bye-laws made by the London County Council under the Housing Act, 1925, received the approval of the Minister of Health, and now apply to the whole of London. Very little experience was gained during the year of the administration of these byelaws because they only came into effect on the 5th March, 1926, and it is too early yet to make any comment on their working. Under these new bye-laws registration was abolished, but it was found convenient to keep an unofficial register of these houses which would have been registered, and on this basis the following Table has been constructed:— TABLE No. 39. On register at beginning of year 325 On register at end of year 327 Inspections made 374 Notices served 140 Prosecutions Nil Action taken under the Housing Act, 1925. Under this Act the Council have power to secure the closing of underground rooms illegally occupied as sleeping places; to make closing and demolition orders, and to serve notices on the owners calling on them to render houses fit for human habitation, and, in default, have the power to do the work themselves and recover the cost from the owners. During the year under review four representations were made, three with respect to dwelling houses and one with respect to an underground room. Closing orders were made in all cases. The details are set out in the following Table. TABLE No. 40. Action taken under Housing Acts. Date of representation. 1926. Date of closing order. Remarks. 3rd March 69, New Road 3rd March 18th June 26, Burrage Road 7th July Underground room 15th Oct. 27, Vicarage Road 9th Nov. 15th Oct. 29, Vicarage Road 9th Nov 76 Underground Sleeping Rooms. As will be seen from the above Table one underground room was represented during the year and a closing order was made by the Council. One other room, originally used for this purpose, ceased to be so used. Tents and Vans. The bye-laws for regulating the use of these were made by the Council in 1903. All the tents and vans were regularly inspected during the year to ensure that these bye-laws were being observed. It was necessary to serve notices for three offences. Increase of Rent and Mortgage Interest (Restrictions) Acts. 1920 and 1923. During the year four applications were made by the occupiers of four houses for certificates that the houses occupied by them were not in a reasonable state of repair. One certificate was granted and one report issued, and in the other two instances the applications were withdrawn as the necessary work to put the houses in a reasonable state of repair was done. New Houses. Water certificates were granted during the year for the following new houses erected in the Borough:— Council's Housing Scheme. Eltham 40 12th February. 39 16th April. 30 9th July. 23 17th September. 26 15th October. 12 12th November. Private Enterprise. Plumstead, West— "Meopham," Cleanthus Road 15th January. "Lerryn," "Dalkusha," Cleanthus Road 12th February. 25, The Slade 18th June. " Tremlis Loe," Eaglesfield Road 17th September. 33, 35, Eaglesfield Road 10th December. 77 Plumstead, East— 100, 102, 104, 106, 108, 110, 112, 114, 116, 118, Basildon Road 12th March. 120, 122, 124, 126, 128, Basildon Rd. 16th April. 400, 402, 404, Wickham Lane 14th May 130, 132, 134, 136, 138, Basildon Rd. 18th June. 5, The Terrace, King's Highway 17th September. The Vicarage, Abbey Wood do. 6, The Terrace, King's Highway 15th October. 5, Verdun Road do. 406, Wickham Lane 12th November. I, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, Openshaw Road 10th December. Eltham— 87, Glenesk Road 15th January. "Rose Bank," Park View Road do. 51, 53, Gourock Road do. 9, 11, 14, 16, Dobell Road do. 130, Westmount Road do. 81, " Braeside," " Devona " "Malvern," Glenesk Road 12th February. "Elmslea," Bexley Road do. 68, 70, Archery Road do. Shop—" Pearks," Well Hall Road do. 11, Weigall Road 12th March. 63, 65, 165, 167, Footscray Road do. 18, 20, Dobell Road do. 1, 2, Parkview Road 16th April. 67, 408 , 410, and Sports Pavilion, Footscray Road do. 10, " Hillside View," Glenesk Road do. '" Elmthorpe," "Wayside," Bexley Road do. 21, 22, " Ravensbourne Cottage," Weigall Road do. 72, 74, Archery Road do. "The Ferns," Avery Hill Road do. 49, Gourock Road do. 78 97, Dunvegan Road ... ... ... 14th May. " Meadowcroft," " Averydene," Bexley Road ... ... ... do. 43, 45, Gourock Road ... ... do. 1, 13, Dobell Road ... ... do. 69, 75, 161, 163, Footscray Road ... 18th June. " Lyndhurst," "Zelah," Cadwallon Road ... ... ... ... do. Tudor House, Eltham High Street do. 91, 93, 95, 97, 99, 101, Glenesk Road do. " Woolacombe," Glenlea Road ... do. 15, 17, 22, 24, Dobell Road do. "Keryn," 'Trevaunance," Park View Road ... ... ... ... do. "Homeleigh," Bexley Road ... do. 19, 20, Weigall Road ... ... ... do. 100, 102, 104, Well Hall Road ... 9th July. 21, 23, Eltham High Street ... ... do. 57, 59, 63, 65, Gerda Road do. 71, 73, Footscray Road ... ... do. 12, Weigall Road do. "Arden," Bexley Road ... ... do. " Rodenhurst," Glenesk Road ... do. 8, 10, 12, 14, 16, 18, Cadwallon Road do. "Kenmore," Archery Road ... ... 17th September. 19, 26, 28, 30, 32, 34, Dobell Road ... do. 76, "Darrock," Archery Road ... do. "Earlswood," "Radnor," Bexley Road ... do. 17, 18, 19, 20, Croft Villas, Green Lane ... ... ... ... ... do. 67, Gerda Road ... ... ... do. 88, 92, 96, Well Hall Road do. 18, Weigall Road do. " Shanklin," "Ventnor," Ladysmith Road ... ... 15th October. 83, Glenesk Road ... ... ... do. 78, Archery Road ... ... ... do. 2, 4, Meadowcourt Road ... ... do. " Whycliffe," Bexley Road ... ... do. 172, 174, Footscray Road do. 17, Weigall Road ... ... ... do. 94, Well Hall Road ... ... ... do. 79 21, 23, 40, 42, Dobell Road 12th November "Elmstead," Park View Road do. "Tendine," Archery Road do. 16, Weigall Road do. 109, Dunvegan Road do. "Downes," "Terenure," Glenlea Road do. 110, "St. Michael's," Dunvegan Road do. 6, '' Dudlar,'' Glenlea Road 10th December. 54, 56, Glenesk Eoad do. " Northdown Way," Bexley Road do. 86, 90, 98, Well Hall Road do. 15, Weigall Road do. " Kenmore Villa," Park View Road do. 2, 4, 6, 8, 10, 12, Sherard Parade do. 25, 27, Dobell Road do. Section VII.—Prevalence of and Control over Infectious Diseases. NOTIFICATION. The total number of notifications, excluding duplicates, was 1,578, compared with 1,375 in 1925, and 1,472 in 1924. In addition, 1,246 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. 45. The following diseases are notifiable in the Borough:— Anthrax Pneumonia, Acute Primary Cerebro-spinal Meningitis Pneumonia, Acute Cholera Influenzal Continued Fever Poliomyelitis Diphtheria Plague Dysentery Puerperal Fever Encephalitis Lethargica Puerperal Pyrexia Erysipelas Relapsing Fever Enteric (or Typhoid) Fever Scarlet Fever Glanders Small Pox Hydrophobia Trench Fever Malaria Tuberculosis Membranous Croup Typhus Fever Ophthalmia Neonatorum Zymotic Enteritis 80 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 TABLE No. 41. INFECTIOUS DISEASES. Admissions to Hospital or Sanatorium. Total Deaths. 390 10 399 4 7 1 4 2 5 — 14 1 1 — 106 81 4 — 4 — 5 6 9 1 3 — 8 17 249 101 173 47 422 148 40 6 14 11 54 17 17 12 1452 300 No cases of Small Pox, Cholera, Relapsing Fever, Typhus Fever, Dysentery, Trench Fever, Anthrax, Glanders, or Hydrophobia were notified during the year. 81 TABLE No. 42. CASES OF INFECTIOUS DISEASES NOTIFIED, 1926. Disease 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 393 7 13 22 26 40 127 61 43 40 10 4 .. Scarlet Fever 411 3 10 24 44 46 191 42 26 16 6 3 .. Enteric Fever 8 .. .. .. 1 1 3 1 .. 1 ... 1 .. Puerperal Fever 4 .. .. .. .. .. .. .. 1 3 .. .. .. Puerperal pyrexia 7 .. .. .. .. .. • • .. .. 4 3 .. .. Erysipelas 46 1 .. .. .. .. .. 2 3 5 8 21 6 Continued fever 1 .. .. .. .. .. 1 .. .. .. ... .. .. Pneumonia 292 28 30 19 14 28 24 9 13 34 31 41 21 Malaria 5 .. .. .. .. .. .. .. .. 3 2 .. .. Ophthalmia Neonatorum 18 18 .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 7 .. .. .. .. 3 .. 1 1 .. 1 1 .. Cerebro-spinal Meningitis 9 .. 1 .. 1 .. 1 .. 3 3 .. .. .. Poliomyelitis 5 .. .. .. 1 .. ... .. 2 2 .. .. .. Zymotic Enteritis 23 7 7 5 .. 1 2 .. .. .. .. 1 ... Tuberculosis (Males 169 7 .. 7 .. .. 4 6 19 57 30 41 10 Pulmonary Females 118 .. .. .. .. 1 5 7 25 50 16 12 2 Total 287 1 .. 1 .. l 9 13 44 107 46 53 12 Tuberculosis Males 36 .. .. 3 2 ... 10 5 2 6 2 5 1 Non-pulmonary Females 26 1 .. 1 2 2 5 2 4 5 2 2 .. Total 62 1 .. 4 4 2 15 7 6 11 4 7 1 Measles (including German Measles) 1246 42 109 94 176 201 578 35 7 3 1 .. .. 2824 108 170 169 267 323 951 171 149 232 112 132 40 82 TABLE No. 43. Cases of Infectious Diseases Notified in the Borough and Parishes during the year 1926, 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 393 166 86 82 59 2.77 5.14 2.12 2.30 1.77 Scarlet Fever 411 91 97 137 86 2.90 2.82 2.39 3.84 2.58 Enteric Fever 8 .. .. 6 2 0.06 .. .. 0.17 0.06 Puerperal Fever 4 2 1 1 .. 0.03 0.06 0.02 0.03 .. Puerperal Pyrexia 7 5 .. 1 1 0.05 0.15 .. 0.03 0.03 Erysipelas 46 11 10 16 9 0.32 0.34 0.25 0.45 0.27 Continued Fever 1 .. .. .. 1 0.01 .. .. .. .03 Pneumonia 292 109 52 68 63 2.06 3.38 1.28 1.91 1.89 Malaria 5 4 1 .. .. 0.04 0.12 0.02 .. .. Ophthalmia Neonatorum 18 12 2 2 2 0.13 0.37 0.05 0.06 0. 06 Encephalitis Lethargica 7 3 .. 2 2 0.05 0.09 .. 0.06 0.06 Cerebro-spinal Meningitis 9 7 .. 1 1 0.06 0.22 .. 0.03 0.03 Poliomyelitis 5 3 1 1 .. 0.04 0.09 0.02 0.03 .. Zymotic Enteritis 23 9 1 10 3 0.16 0.28 0.02 0.28 0.09 Pulmonary Tuberculosis 287 99 77 61 50 2.02 3.07 l8.9 1.71 1.50 Tuberculosis (Non-pulmonary) 2 21 16 14 11 0.44 0.65 0.39 0.39 0.33 Measles (including German Measles) 1246 344 461 226 215 8.71 10.66 11.36 6.33 6.45 2824 886 805 628 505 19.90 27.45 19.83 17.60 15.14 83 TABLE No. 44. DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES (INCLUDING MEASLES), 1926. 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 10 .. 1 1 1 2 5 .. .. .. .. .. .. Scarlet Fever 4 .. .. 1 .. .. 3 .. .. .. .. .. .. Enteric Fever 1 .. .. .. .. 1 .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. .. .. .. 1 .. 1 .. .. Puerperal pyrexia .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 1 .. .. .. .. .. .. .. .. .. .. .. 1 Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 81 16 6 2 1 ..3 3 1 3 4 9 14 19 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 6 .. .. .. .. 1 1 1 1 .. .. .. .. Cerebrospinal Meningitis 1 .. .. .. 1 .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. Zymotic Enteritis 17 9 4 .. .. .. 1 .. 1 .. .. 2 .. Tuberculosis Males 101 .. .. 1 .. .. .. .. 8 36 20 32 4 Pulmonary Females 47 .. .. .. .. 1 l .. 7 25 7 5 1 Total 148 .. .. 1 .. 1 1 .. 15 61 27 37 5 Tuberculosis Males 6 2 .. 1 .. .. l .. 1 1 .. .. .. Non-pulmonary Females 11 2 1 .. .. 1 2 1 1 1 1 1 Total 17 4 1 1 .. 1 3 1 2 2 1 1 .. Measles 12 3 7 1 .. .. 1 .. .. .. .. .. •• 300 32 19 7 3 9 18 3 23 67 38 56 25 84 Table no. 45. Notification of Infectious Diseases, 1901 to 1926. Year. Smallpox. . 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 ..- l 3 .. 8 866 .. .. .. .. 801 1912 3 429 474 20 87 2 689 .. l 3 .. 20 129 .. .. .. .. 775 1913 .. 321 626 14 70 8 675 .. .. 1 .. 14 338 .. .. .. .. 387 1914 .. 416 714 18 107 7 498 .. 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 1926 .. 393 411 8 11 349 1 9 5 7 18 23 .. 5 .. 292 1246 *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. 85 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 411 cases of scarlet fever were notified, compared with 364 in 1925 and 440 in 1924. The case rates for the various registration districts in the Borough are given in detail in Table No. 43. The number of notifications received each quarter was as follows:— First quarter 111 Third quarter 94 Second quarter 105 Fourth quarter 101 Deaths. There were four deaths, three in children of school age and one of a child under five years. Multiple Cases. The following Table shows the house distribution by wards. The term " house " is synonymous with the term " family," except in five instances, where two families are involved. TABLE No. 46. 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 17 11 19 29 15 20 18 19 34 76 60 318 318 2 cases occurred 2 , . 2 1 4 1 1 3 2 10 8 34 68 3 „ „ .. 2 .. .. .. .. 1 1 .. 1 2 7 21 4 „ „ .. .. .. .. .. .. .. .. .. .. 1 1 4 Total houses 19 13 21 30 19 21 20 23 36 87 71 360 411 86 Return Cases. The following Table show 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. TABLE No. 47. No. in register. Date admitted to hospital. Date discharged. Total days in hospital. Onset of secondary case. Remarks on primary case. 1925. 324 27/11/25 1/3/26 95 14/3/26 Ear discharge 309 14/11/25 19/12/25 36 11/1/26 11/1/26 283 20/10/25 12/12/25 54 2/1/26 323 25/11/25 4/2/26 72 14/3/26 330 28/11/25 25/2/26 90 1926. 19 11/1/26 22/2/26 43 13/4/26 61 17/2/26 18/5/26 91 7/8/26 86 9/3/26 1/6/26 84 15/6/26 Ear discharge 94 16/3/26 15/5/26 61 19/5/26 Second case in another family 102 19/3/26 28/4/26 41 14/5/26 Nasal discharge 115 2/4/26 16/7/26 106 27/7/26 Nasal discharge tonsils 148 1/5/26 14/7/26 75 21/7/26 145 28/4/26 9/6/26 43 13/6/26 27/6/26 277 2/9/26 20/10/26 49 7/11/26 Second case in another family 324 11/10/26 24/11/26 45 28/11/26 Nasal discharge 331 17/10/26 26/11/26 41 8/12/26 Sores on Nostrils Home Isolation. Twelve cases, or 2.9%, were isolated at home, and in no instance did a return case occur. When cases are isolated at home, frequent inspections, at irregular intervals, are made by the District Sanitary Inspectors, in order to ensure that proper precautions for preventing the spread of the disease are being taken. Employees of the Royal Arsenal are not allowed to remain at work unless cases are removed to hospital or a certificate of efficient home isolation is issued by the Medical Officer of Health. During the year four such certificates were issued. Dick Test. This has not been employed in the area so far as I am aware. 87 DIPHTHERIA. Notification. During the year 393 cases of diphtheria were notified, compared with 299 in 1925 and 195 in 1924. The case rates for the various registration districts in the Borough are given in detail in Table No. 43. The number of notifications received each quarter was as follows:— First quarter 131 Third quarter 63 Second quarter 104 Fourth quarter 95 Deaths. There were 10 deaths, five occurring in school children and five in those under 5 years of age. Return Cases. There were four 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 instances where two families are involved. TABLE No. 48. 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 15 15 32 48 18 18 11 23 12 47 43 282 282 2 cases occurred 3 1 4 12 1 3 .. 2 2 5 3 36 72 3 „ „ 2 2 .. .. .. .. 1 2 .. 7 21 4 „ „ .. 1 .. .. .. .. 1 .. .. .. 1 3 12 5 „ „ .. .. .. .. .. .. .. .. .. .. .. .. .. 6 „ „ .. .. .. .. .. .. .. .. .. .. 1 1 6 Total houses 18 19 36 62 19 21 12 25 15 54 48 329 393 88 Antitoxin. Diphtheria antitoxin is kept at the Town Hall, the Plumstead Library, and the Eltham Library, and is supplied to medical practitioners on application, at cost price, or free where there is inability to pay. The amount supplied during the year was 56,000 units. No antitoxin was issued free. The total cost to the Council was £4 4s., all of which was recovered. The corresponding figures in 1925 were as follows:—22,000 units, none issued free; total cost £1 13s. Schick Test. This 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. Home Isolation. Three cases were isolated at home. The same routine was carried out as in the case of Scarlet Fever. ENTERIC FEVER. Eight cases were notified during the year. One death occurred. In the following Table details of each case are given: TABLE No. 49. No. Date. Sex. Age. Diagnosis. Final Diagnosis. 1 1926. April 21 M. 5 Typhoid Fever Paratyphoid: Broncho Pneumonia 2 April 27 M. 47 Typhoid Fever Tuberculosis of lung 3 June 9 M. 4 Paratyphoid Fever Paratyphoid B. 4 June 15 M. 6 Paratyphoid B. Paratyphoid B. 6 Sept. 27 M. 21 Enteric Fever Paratyphoid B. .. 6 Nov. 18 M. 5 Typhoid Fever No obvious disease 7 Nov. 18 F. 11 Typhoid Fever No obvious disease 8 Nov. 18 M. 3 Typhoid Fever No obvious disease ENCEPHALITIS LETHARGICA. Seven cases were notified during the year, and five of them were admitted to hospital. In addition, the death of a notified cerebro spinal meningitis case was certified as due 89 to encephalitis lethargica, and one other death occurred without notification. The details of each case are given in the following Table: TABLE No. 50. Date notified. Sex Age Ultimate Diagnosis. Remarks. 1926. Feb. 3 M. 56 Encephalitis Lethargica Died 4/2/26 Apr. 20 M. 19 Encephalitis Lethargica May 10 M. 40 Stomatitis June 22 M. 11 Encephalitis Lethargica Died 23/6/26 June 26 M. 4 Pyrexia of unknown origin . . Sept. 5 F. 4 Meningitis, probably Tuberoulous Died 8/9/26 Sept. 8 M. 4 Encephalitis Lethargica Died 16/9/26 CEREBROSPINAL MENINGITIS. Nine cases were notified during the year, details of which are set out in the following Table. All the cases were admitted to hospital. Only one death was certified as due to this disease. The ultimate diagnosis in each case is given in the following Table: TABLE No. 51. Date notified. Sex Age Ultimate Diagnosis. Remarks. 1926. Feb. 6 M 20 Cerebrospinal Meningitis Military case. Mar. 16 M 21 Cerebrospinal Meningitis Military case Mar. 22 M 16 Tubercular Meningitis Mar. 25 M 18 Cerebrospinal Meningitis Military case Apr. 6 M 20 Cerebrospinal Meningitis Military case June 6 F 17 Encephalitis Lethargica Died June 17. June 12 M 6 Tubercular Meningitis Died August 13 Oct. 5 M 3¾ Cerebrospinal Meningitis Died October 2. Dec. 4 F 1 Broncho pneumonia PNEUMONIA. During the year 292 notifications were received, of which 33 were influenzal. Eighty-one deaths occurred from primary pneumonia and 22 from influenzal pneumonia. The notifica- 90 tions and deaths from pneumonia during the past five years have been as follows:— Year. Notifications. Deaths. 1922 345 116 1923 242 65 1924 354 95 1925 277 97 1926 292 81 The next Table 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. 52. Notification of Pneumonia. Ward. Lobar. Broncho. Influenzal. Acute Primary. Total. Dockyard 1 16 1 14 32 St. Mary's 2 7 — 10 19 River 7 12 5 10 34 St. George's 4 9 6 5 24 Burrage 3 5 — 10 18 Herbert 2 5 1 1 9 Glyndon — 3 3 5 11 St. Margaret's 3 2 3 6 14 Central 2 4 2 6 14 St. Nicholas 17 16 8 13 54 Eltham 13 14 4 32 63 54 93 33 112 292 The following Table, No. 53, 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. 91 TABLE No. 53. Monthly incidence of Pneumonia. Month. Male. Female. Total Type. No. of Deaths. Lobar. Broncho. Influenzal. .4 cute Primary (not specified). , A cute Primary Pneumonia Influenzal Pneumonia January 21 11 32 7 12 .. 13 11 .. February 17 12 29 13 4 4 8 4 2 March 15 17 32 8 7 5 12 13 5 April 26 17 43 3 7 17 16 8 12 May 10 6 16 3 4 .. 9 6 2 June 3 7 10 2 4 2 2 4 .. July 7 2 9 3 1 .. 5 2 .. August 2 3 5 1 1 .. 3 2 .. September 2 3 6 1 3 1 .. 3 1 October 15 14 29 6 10 3 10 7 .. November 20 [???] 31 1 12 1 17 2 .. December 30 21 51 6 28 .. 17 19 .. Total 168 124 292 54 93 33 112 81 22 ERYSIPELAS. The number of notifications received during the year was 46, compared with 44 in 1925. No special comment is called for on the incidence of this disease. MALARIA. TRENCH FEVER, AND DYSENTERY. Five cases of Malaria were notified, and none of Trench Fever or Dysentery. The incidence of Malaria calls for no comment. PUERPERAL FEVER AND PUERPERAL PYREXIA. Four cases of Puerperal Fever and seven cases of Puerperal Pyrexia were notified during the year, and nine of them were treated in hospital, four being in hospitals of the Metropolitan Asylums Board, four in Maternity Hospitals, and one in a Poor Law Institution. Only two deaths occurred amongst the notified cases. The Council's scheme for the 92 administration of the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, is referred to in detail in Section VIII. OPHTHALMIA NEONATORUM. During the year 18 cases of Ophthalmia Neonatorum were notified, and 4 cases were treated in hospital. In tabular form is shown below, as required by the Ministry of Health, the result of each case. TABLE No. 54. Ophthalmia Neonatorum. No. Notified. Cases. Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hospital. 18 14 4 16 — — — Two cases treated in hospital left the Borough, and I have been unable to ascertain their subsequent history. Nursing. During 1926, 10 cases were nursed at home at a total cost to the Council of £7 2s. The number of visits paid by nurses was 142, thus averaging 14 visits per case. During the year the Public Health (Ophthalmia Neonatorum) Regulations, 1914, were revoked, and new regulations, the Public Health (Ophthalmia Neonatorum) Regulations, 1926, became operative. These regulations differ from the old ones in that no obligation is now laid upon the midwife to notify this disease and make it obligatory on the Medical Officer of Health to send a copy of every notification he receives to the Metropolitan Asylums Board. 93 ZYMOTIC ENTERITIS. Twenty-three cases of Zymotic Enteritis were notified, compared with 13 in 1925. The number of cases notified and the number of deaths certified to be due to diarrhceal diseases in each quarter are shown below. Nine deaths were in infants under one year of age. Quarter. Cases. Deaths. First — 1 Second 1 3 Third 17 7 Fourth 5 6 Nursing assistance was provided by the Council in one case, three visits being paid. WHOOPING COUGH. During the year 219 cases of Whooping Cough came to the knowledge of the Department from the School Medical Service. As this disease is not notifiable in Woolwich, knowledge can only be obtained by the Department from this service, or, incidentally, by casual discovery by the health visitors during their daily routine. Deaths. The number of deaths was 3, compared with 17 in 1925 and 12 in 1924. All the deaths occurred in children under five years of age. MEASLES. 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 of its prevalence—an index which must be considerably below the true number. By these methods we obtained knowledge during the year of 1,246 cases, of which 53 were German Measles; 622 of these were children under 5 years of age. The number of cases discovered by health visitors was 412—less than 33 per cent. 94 Deaths. The number of deaths was 12, 11 of which were children under 5 years of age. Home Nursing. During the year 12 cases were nursed at home, at a total cost to the Council of £5 4s. The number of visits paid by nurses was 108, thus averaging 9 visits per case. Removal to Hospital. Children suffering from Measles are admitted to the hospitals of the Metropolian Asylums Board on the certificate of the Medical Officer of Health. During the year 17 such cases were admitted, compared with 39 in the previous year. ANTERIOR POLIOMYELITIS. Five notifications were received during the year, compared with one in 1925. The following Table shows the condition at the end of 1926 of each case notified (excluding deaths) in the last four years. It is the practice of the Department to keep these cases under observation until the children come under the School Medical Service, but, unfortunately, during the year two cases were lost sight of owing to change of address. 95 TABLE No. 55. POLIOMYELITIS. Date notified. Sex Age Condition on 31st December, 1926. Remarks. 1923 Mar. 18 F 8 Can walk well; splint on right leg ; general condition good ; goes to school Attending I. C. A. A. clinic for supervision May 25 F 3 Leg thinner and weaker Receiving massage at I.C.A.A.'s clinic July 7 F 6 Arm improving ; general condition good Electrical treatment and massage at Miller Hospital July 27 F 2½ In good health — Aug. 16 F 3 Splint on left leg; condition fair Under supervision at Guy's Hospital Aug. 31 F 3 General improvement Under supervision at Guy's Hospital 1924 July 19 F 1 Removed : address not known — July 23 F 2 Splint to right leg ; turns left foot in Attending I. C. A. A. clinic for supervision Aug. 24 M 8 Can walk well; wears spinal jacket; general improvement in condition Discharged from Carshalton; attending I.C.A.A. for supervision Oct. 25 F 24 Right arm almost recovered ; leg is better but still drags ; general condition good No treatment now Nov. 19 1925 F 3½ Removed : address unknown ; — — — — 1926 Aug. 16 F 3 Has had several heart attacks recently; still in bed Being treated by general practitioner Nov. 6 M 19 — R.M. Academy case Nov. 15 F 21 Well Final diagnosis: '' facial paresis'' Nov. 24 M 19 — R.M. Academy case Nov. 29 M 20 — R.M. Academy case 96 ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. The procedure in regard to these matters was fully described in last year's report, and as no change has taken place during the year it is not considered necessary to repeat this matter this year. Disinfection. The Disinfection Station is sometimes used for special disinfection at the request of inhabitants. A small charge, to cover the cost of disinfection, is made in these cases, and during the year 73 such disinfections were carried out, and fees amounting to £20 6s. were paid. In tabular form below is shown the amount of disinfection which was carried out during the year. TABLE No. 56. Rooms disinfected after ordinary fevers 720 ,, ,, tuberculosis 308 ,, ,, verminous cases 51 Rooms disinfected for other reasons 73 Total articles disinfected 23,051 Disinfestation. As in previous years children have been sent to the Cleansing Station for disinfestation under an arrangement made with the London County Council. The following Table, No. 57, shows the extent to which this Station has been used during the last five years. TABLE No. 57. Children. Adults. Grand Total. Year. Boys. Girls. Total. Males. Females. Total. 1922 394 1493 1887 9 7 16 1903 1923 280 1731 2011 18 1 19 2030 1924 337 1924 2261 17 10 27 2288 1925 359 2082 2441 23 6 29 2470 1926 427 1934 2361 24 2 26 2387 97 TUBERCULOSIS. This section of the report deals with the work of the Department under the Public Health (Tuberculosis) Regulations, 1912, and under the Dispensary Scheme as approved by the Ministry of Health and the London County Council, who contribute 50 per cent. and 25 per cent. respectively of the net expenditure of that scheme. Staff. The staff of the Dispensary is set out in detail in Section III. No change has taken place during the year. Appointment of Tuberculosis Officer as Consultant to the Woolwich Infirmary. During the year arrangements were made with the Woolwich Guardians whereby authority was given to the Tuberculosis Officer to visit tuberculous cases in the Infirmary as a Consultant and to confer with the Medical Superintendent from time to time. Under this scheme the Tuberculosis Officer visits the Infirmary at regular intervals. Post-Graduate Courses. In July, 1923, the London County Council submitted proposals to the Metropolitan Borough Councils approving the principle of Tuberculosis Officers being offered special facilities by the authorities by whom they were appointed enabling them to attend, not less than one month every three years, post-graduate instruction. In July, the Tuberculosis Officer, under this scheme, attended a study tour in Norway which the Joint Tuberculosis Council arranged for. The tour was most instructive, enabling the Tuberculosis Officer to study, clinically and administratively, the tuberculosis schemes in that country. After his return he submitted a report to the Council on what he had seen, and gave a public lecture on the differences between the administration of tuberculosis in Norway and in this country. In December, one of the Tuberculosis Visitors attended the Sixth Winter School organized by the Women Sanitary Inspectors' and Health Visitors' Association. The course extended over two weeks. 98 TABLE No. 58. Tuberculosis. Summary of Notifications received during the year ended 1st January, 1927. Age-periods— Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. 0 to 1. 1 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 25. 25 to 35. 35 to 45. 45 to 55. 55 to 65. 65 & upwards. Total Primary Notifications. Under 5. 5 to 10. [ 10 to 15. Total Primary Notifications. Poor Law Institutions. Sanatoria. Pulmonary Males 1 1 4 6 19 15 42 30 33 8 10 169 202 .. .. .. .. .. 15 166 „ Females .. 1 5 7 25 19 31 16 8 4 2 118 140 .. .. .. .. .. 14 82 Non-Pulmonary Males .. 5 10 5 2 2 4 2 2 3 1 36 39 .. .. .. .. .. 1 24 „ Females 1 6 5 2 4 1 4 2 1 1 .. 26 32 .. •• .. .. .. .. 9 Total 2 12 24 20 50 37 81 50 44 16 13 349 413 .. .. .. .. .. 30 281 New Cases Not Notified. Pulmonary Males .. 1 .. .. 1 1 1 2 4 1 .. 11 .. .. .. .. .. .. .. .. „ Females .. .. .. .. .. 1 1 .. .. .. 1 3 .. .. .. .. .. .. .. .. Non-Pulmonary Males 1 .. 1 .. 1 .. 1 .. .. .. .. 4 .. .. .. .. .. .. .. .. „ Females 2 1 1 .. .. .. .. .. .. .. .. 4 .. .. .. .. .. .. .. .. Grand Total 5 14 26 20 52 39 84 52 48 17 14 371 .. .. .. .. .. .. .. .. 99 Notifications. The total number of notifications received was 413, but 64 of these related to cases which had been previously notified, so that the total number of new notifications was 349, an increase of 49 over the previous year. Twentytwo cases died before notification. The notifications received on forms C and D, i.e., notifications from institutions regarding admission and discharge, are not included in the above figures. In Table No. 58 detailed figures are shown regarding all notifications received during the year. The distribution of the disease in the various cases notified each year since 1922 was as shown in the following Table, No. 59. TABLE No. 59. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 1922 245 8 5 16 20 5 6 305 1923 245 9 6 21 8 10 12 311 1924 273 8 6 16 22 6 11 342 1925 246 9 6 9 14 6 10 300 1926 287 8 6 14 11 7 16 349 Cases of Tuberculosis in the district. The number of Tuberculosis cases known to be living in the district at the end of the year was 2,210, an increase of 54 on the previous year. The following Table, No. 60, shows the number of cases on the register at the beginning of 1926, the changes which have taken place during the year and the number at the end. Every effort is made to keep this Table as accurate as possible. 100 TABLE No. 60. Pulmonary. Non. Pulmonary. Totals M. F. M. F. Number on Register at 1st January, 1926 889 739 268 260 2156 Number of additions 195 134 35 26 390 Number of deletions 165 115 27 29 336 Number on Register at 31st December, 1926 919 758 276 257 2210 Deaths. The number of deaths from tuberculosis was 165, 148 being certified as due to pulmonary tuberculosis and 17 to other forms. These are the lowest figures recorded since the notification of this disease became compulsory, and the rates correspondingly are also the lowest. The following Table, No. 61, shows the number of deaths and the death rates from all forms of tuberculosis each year since 1912: TABLE No. 61. Deaths. Death.rates. Year. All Forms. Pulmonary. Non. Pulmonary. All Forms. P ulmonary. 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 191 172 19 1.36 1.22 0.14 1924 199 171 28 1.42 1.22 0.20 1925 187 160 27 1.33 1.14 0.19 1926 165 148 17 1.16 1.04 0.12 101 In addition to the deaths recorded in the above Table, 9 persons who had been notified as suffering from tuberculosis died during the year from other causes, and information relating to these is given in detail in the following Table: TABLE No. 62. Case No. Date notified as Tuberculosis. Cause of Death. 1 3/1/26 Mediastinal new growth 2 8/3/26 Gangrene of lung 3 11/6/26 Lymphadenoma 4 9/10/25 Actinomycosis of lungs 5 6/3/23 Epithelioma of cervical and bronchial glands 6 9/3/12 Chronic nephritis. Anasarca 7 20/10/14 Bronchitis 8 24/8/26 Aortic disease 9 10/10/26 Bronchitis and heart failure The period which elapsed between notification and death was as shown below:— TABLE No. 63. Pulmonary. Percentage. Non. Pulmonary. Percentage. Not Notified 14 9.46 8 47.06 0-1 month 20 13.51 4 23.53 1-3 „ 16 10.81 1 5.88 3-6 „ 11 7.43 — — 6-12 „ 24 16.22 3 17.65 1-2 years 24 16.22 — — 2-5 „ 29 19.59 1 5.88 Over 5 years 10 6.76 — — 148 10000 17 10000 102 The ratio between non-notified and the total tuberculosis deaths, as will be seen from the above Table, is therefore as 1 is to 8. The Public Health (Prevention of Tuberculosis) Regulations, 1925. These Regulations enable the Council to prohibit any persons suffering from tuberculosis in an active form to engage in the milk trade. No direct action was taken on them during the year, but the Council caused a letter to be sent to every milk vendor in the Borough notifying him that arrangements could be made for the medical examination, free of charge, by the Tuberculosis Officer, of all persons who applied to him for employment. This letter was sympathetically received by the trade, but no candidates for employment were submitted for examination during the year. The Work of the Dispensary. The Tuberculosis Dispensary is situated in Maxey Road, Plumstead, and consultations are held there, special days and times being allotted to men, women and children. These are given in tabular form below:— Hours of Attendance. Day. Men. Women. Children. Monday — — — Tuesday — 9—12 9—12 Wednesday — 2—4 4—5.30 Thursday 4—7.30 — — Friday 9—11 4—5 2—4 Saturday — — 9—11 A return as to the work in connection with the Tuberculosis Dispensary during the year is given in the following Table, No. 64:— 103 TABLE No. 64. Return showing the work of the Dispensary during the year 1926. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults Children Adults Children Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A. NEW CASES examined during the year (exluding contacts):— (a) Definitely tuberculous 122 82 10 14 5 9 12 8 127 91 22 22 (b) Doubtfully tuberculous ... ... ... ... ... ... ... ... 34 46 29 12 (c) Non-tuberculous ... ... ... ... ... ... ... ... 173 214 221 187 B. CONTACTS examined during the year:— (a) Definitely tuberculous 3 2 2 ... ... ... ... 1 3 2 2 1 (b) Doubtfully tuberculous ... ... ... ... ... ... ... ... 1 2 2 3 (c) Non-tuberculous ... ... ... ... ... ... ... ... 61 83 97 87 C. CASES written off the Dispensary register as (a) Cured 35 39 4 3 7 13 4 1 42 45 8 4 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) ... ... ... ... ... ... ... ... 262 307 318 275 D. NUMBER OP PERSONS on Dispensary register on December 31st:— (a) Diagnosis completed 734 195 57 54 101 105 84 58 835 700 141 112 (b) Diagnosis not completed ... ... ... ... ... ... ... ... 7 8 5 1 104 (1) Number of persons on Dispensary register on January 1st 1,734 (2) Number of patients transferred from other areas and of "lost sight of" cases returned 12 (3) Number of patients transferred to other areas and cases "lost sight of" 49 (4) Died during the year 149 (5) Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 27 (6) Number of attendances at the Dispensary cluding contacts) 7,314 (7) Number of attendances of non-pulmonary cases at Orthopaedic Out-Stations for treatment or supervision — (8) Number of attendances at General Hospitals or other Institutions approved for the purpose, of patients for— (a) Finsen light treatment 46 (b) Artificial sunlight treatment 91 (c) Other special forms of treatment 49 (9) Number of patients to whom dental treatment was given, at or in connection with the Dispensary 25 (10) Number of consultations with medical practitioners: (a) At homes of applicants 55 (b) Otherwise — (11) Number of other visits by Tuberculosis Officers to homes 511 (12) Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,624 (13) Number of (a) Specimens of sputum, etc., examined 412 (b) X-ray examinations made in nection with Dispensary work 112 (14) Number of insured persons on Dispensary register on the 31st December — 105 (15) Number of insured persons under domiciliary treatment on the 31st December 297 (16) Number of reports received during the year in respect of insured persons:— (a) Form G.P. 17 27 (b) Form G.P. 36 — Contacts and Observation Cases. The number of home contacts of tuberculous patients examined at the Dispensary during the year was 344, but this figure is not entirely comparable with that of previous years, as the accepted definition of a "contact" has been altered by the Ministry of Health. There is still some difficulty in impressing upon patients the necessity for such examination of contacts, but the following incident shows how valuable such examinations may be:— In one family a small child died of tuberculous meningitis, and an endeavour was made to trace the source of this infection. With some difficulty other members of the family were examined, with the exception of the father, but after considerable pressure he also was examined and found to be suffering from pulmonary tuberculosis with a positive sputum. There can be little doubt that the infection in the case of the child and that of a sister who had previously died from the same cause were due to pulmonary disease in the father. The observation cases are those in which no definite diagnosis of tuberculosis had been arrived at during the first month. Many of these cases cease to attend, being evidently satisfied when the Tuberculosis Officer is unable to diagnose tuberculosis at the first examination. An endeavour, however, is made to secure their attendance until a definite diagnosis has been made. Co-operation with Hospitals, etc. The previous arrangements for special hospital examination and treatment have been continued during the year. These consist of agreements with the Seamen's Hospital for the X-ray examination of difficult cases; with the London Hospital for the treatment 106 of lupus, and with the Brompton Hospital for the provision of artificial pneumo-thorax refills. 112 cases were referred to the Seamen's Hospital; one case, involving 46 attendances, to the London Hospital, and four cases, involving 49 attendances, to the Brompton Hospital. During the year arrangements were entered into with the Miller Hospital for the treatment of certain cases of tuberculosis by artificial sunlight (or ultra-violet rays). This form of treatment is most suitable for the non-pulmonary type of cases, and the general conditions governing the scheme are as follows:— (1) Payment to be made only in respect of treatment of patients recommended by the Tuberculosis Officer. (2) Payment to be made in respect of not more than 30 exposures a case, at a rate not exceeding Is. an exposure, subject to special consideration of cases in which treatment is not then completed. (3) Treatment to be by appointment, and, if possible, at evening sessions when desired. (4) A maximum sum to be apportioned to each pital in respect of each Metropolitan Borough Council entering into the scheme, and notice to be given by the hospital to the Borough Council when such sum is being approached. (5) Facilities to be afforded for the County Council's Medical Officer or one of his representatives to visit the centre at any time for the purpose of conferring with the staff carrying out the work and of examining records, and such information to be given as may be reasonably required with a view to a report being made to the Council on the result of the experiment at the end of twelve months. Under these arrangements five cases, involving 138 attendances, were referred. 107 During routine examinations many new cases, though non-tuberculous, are found to require medical treatment for other conditions, and such persons are advised as to the best means available for them to obtain suitable advice or assistance to enable them to be restored to health. During the year, 98 children, who were suffering from anaemia, malnutrition, and various other conditions, discovered on examination, were referred to the Woolwich branch of the Invalid Children's Aid Association for treatment at convalescent homes or at the remedial clinic conducted by the Association. This side of the work conducted at the Dispensary is of very great value in maintaining the health of the child population and prevents more serious diseases from developing. Co-operation with local practitioners. During the year 55 cases were seen by the Tuberculosis Officer at the homes of patients, and 420 were referred to the Dispensary by medical practitioners in the Borough. In addition to these, many cases seen at the Dispensary were advised to seek advice from their own medical practitioners, and in this connection 597 letters were written to doctors by the Tuberculosis Officers. Under the National Insurance Acts, medical practitioners dealing with insured persons are required to furnish certain reports on discovering that the insured person is tuberculous and also quarterly reports (G.P. 17) on such patients who are receiving domiciliary treatment. These reports are not always furnished, and, indeed, there is room for much improvement in this particular matter when regard is paid to the fact that the general practitioner is responsible for the treatment of these cases. Co-operation with the School Medical Service. There is also close co-operation between the School Medical Service and the Tuberculosis Dispensary, by means of which the School Medical Officers can refer ailing children to the Tuberculosis Dispensary, and the Tuberculosis Officer can refer cases to the School Medical Service for supervision. Under 108 this arrangement special attention is paid to children who are contacts of tuberculous patients who have tubercle bacilli in their sputum. These children are periodically examined by the School Medical Officer, and at intervals the Tuberculosis Officer and the Divisional School Medical Officer discuss what other steps, if any, are necessary. Other children are referred to the School Medical Service for the treatment of minor ailments and dental caries. Home Nursing. The various local Nursing Associations have rendered valuable help in nursing patients at home who are suffering from advanced disease or other active disease necessitating rest in bed. Extra Nourishment. Extra nourishment, in the form of butter, eggs, and milk, is supplied to tuberculous patients on the certificate of the Tuberculosis Officer. The expenditure on this service is limited to £2 per 1,000 population. These recommendations by the Tuberculosis Officer are approved by a special committee of the Tuberculosis Care Committee and reported to the Public Health Committee of the Council. Any nourishment ordered is only sanctioned for four weeks at any one time. The total number of applications (affecting 80 persons) was 301, the total cost to the Council being £263 11s. 1d. Dental Treatment. Dental work is carried out at the School Clinic in Brewer Street, patients being referred there from the Dispensary. During the year 25 patients received treatment, the number of attendances being 51. The treatment is free except where dentures are required, and then patients are assessed according to their means, each case being treated on its merits. Dentures were supplied in 17 instances at a cost of £74 lis., and during the year the income received under this head was £15 17s. Shelters. Thirteen shelters are maintained by the Council for the use of patients returning from sanatoria who 109 are able to continue this form of open-air treatment. They are lent by the Council in many cases free, but in some instances at rents not exceeding 6d. a week. Bacteriological Examinations. During the year 412 specimens of sputum were examined at the Dispensary, of which 81 were positive and 331 negative. Facilities for general practitioners are provided at the Seamen's Hospital, and 307 specimens were examined there during the year, 56 being positive and 251 negative. Institutional Treatment. The following Table, No. 65, shows the number of admissions to hospitals, sanatoria, Poor Law Institutions, and training colonies. TABLE No. 65. Hospitals. Sanatoria. Infirmary. Training Colonies. Insured 140 76 36 2 Uninsured 71 41 26 1 Children 72 6 5 — 283 123 67 3 These numbers refer to 369 persons, and the monthly admissions from January to December were as follows:— J anuary 38 July 48 February 39 August 29 March 51 September 42 April 26 October 37 May 40 November 42 June 41 December 43 110 Woolwich Tuberculosis Care Committee. At the end of the year the Committee was constituted as follows:— Bodies. Representatives. Woolwich Borough Council Alderman Mrs. E. Dormer, J.P., Councillors R. Campbell. P. Chinnery, Miss M. Crout, J.P., W. G. McCartnev, and Miss G. E. Walters, J.P. Woolwich Board of Guardians Captain W. T. Cusheon, Mrs. E. M. Newman. Lewisham Board of Guardians Mrs. A. Burrell. London County Council Miss E. E. Faulkner, Dr. H. B. Kidner. Trade Unions Mr. W. H. Fairchild, Mr. T. B. Goy, Mr. J. M. Sherwood. Employers Miss L. Ames, 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 Mr. E. J. Cole. Woolwich Invalid Children's Aid Association Mrs. J. B. Great Rex. Late Tuberculosis Dispensary Committee Mr. E. G. Dixon, J.P., Mr. W. Dashwood. United Services Fund Miss M. Shaw. Ex-officio Members:— Voluntary Visitors Miss L. T. Bloxam, Miss L. Macdermott, Miss R. C. Wild. Tuberculosis Officer Dr. F. J. C. Blackmore. Medical Officer of Health Dr. J. MacMillan The Committee meets four times a year, and has various Sub-Committees for dealing with different aspects of the work. The General Purposes and Assessment Sub-Committee meets once a week, the Finance Sub-Committee once a month, and the Grancher Sub-Committee as often as necessary. During the year the number of meetings held, including Sub-Committees, was 52. The Committee dealt with 324 cases. From various sources during the year the total sum of £303 14s. 2d. was raised, the total expenditure being £275 4s. Under the Grancher Scheme, 14 children, who were non-tuberculous contacts of tuberculous persons, were boarded out in the country for varying periods and derived considerable benefit. The number of cases considered for institutional treatment under the London County Council 111 scheme was 324. The number of applications for extra nourishment reported on was 301, and the number of applicants for dental treatment dealt with was 25. Much of the work the Care Committee undertakes is outside the powers of the Council. Its object is to increase the effectiveness of the tuberculosis scheme of the Council, and it links up all available agencies and tries to assist the tuberculous in the way of extra assistance, food, change of air, clothing, better home conditions, more suitable occupation, etc., and thus enable them to benefit to the fullest extent by the treatment provided. Section VIII.—Maternity and Child Welfare. Staff. The staff at the end of the year is shown in detail in Section III. No changes took place during the year. Valuable help is given in all the centres by voluntary helpers who attend regularly each week and assist the medical officers and health visitors. Their services are much appreciated. Administrative Action in Connection with the Notification Of Births. As in previous years a routine practice was followed, in sending suitable literature by post to the mother when a notification of birth is received. These notifications are received by me in accordance with the terms of the Notification of Births Acts, 1907-1915. As soon as the midwife or doctor has ceased attendance, a visit is made by the health visitors, usually between the tenth and fourteenth day, in all cases where such visits are considered necessary or desirable. Re-visits are made in accordance with the impressions gained by the health visitor on her first visit, but, as a general rule, the following standard has been laid down— three visits during the first year and one vieit in each subsequent year up till the age of 5 years. Notifications of births are sometimes transferred from other Medical Officers of Health to me, and the same procedure is followed with regard to these children. In the same way notifications of children bom in Woolwich, but whose parents normally reside else- 112 METROPOLITAN – BOROUGH OF WOOLWICH. INFANT WELFARE CENTRE, PLUMSTEAD HIGH STREET, PLUM5TEAD. SE.18. PLUMSTEAD HIGH ST/tCST 113 where, are passed on to the Medical Officer of Health concerned . Welfare Centres. These are set out in detail in Table No. 66, and only one change took place during the year under the following circumstances. In June, 1925, the Council were given legal notice to terminate their occupancy of 289, Plumstead High Street, premises which had been used as a welfare centre since 1918, first of all by the American Red Cross Society and later on by the Council. Owing to the lack of suitable buildings in this neighbourhood it was necessary to build, and the Ministry agreed to this on condition that arrangements were made for this building to be used for some other purpose in addition to maternity and child welfare. In consequence the London County Council were approached, and an arrangment was made whereby this centre will be used on two whole days a week as a dental clinic for school children, in addition to the present clinic in Brewer Street, Woolwich. When the dental clinic is in full swing, approximately 1,400 children per annum, will receive the necessary treatment, and it will be the first Metropolitan Municipal Welfare Centre to be used for the purposes of the School Medical Services. It thus marks a stage in the co-ordination of health services in London. The centre was opened on the 4th October, during Health Week, by Mr. H. Snell, M.P., and the general public were admitted during the week. It began to function as a centre on the 11th October, and arrangements have been made to open the dental section at the beginning of April, 1927. The plan of the centre is shown on page No. 112, and it will be seen that the treatment rooms are interchangeable. At the end of the year 3 ante-natal and 18 infant welfare sessions were being held each week. The Work of the Centres. Tables Nos. 66 and 67, which follow, give detailed statistics for the year 1926, and consolidated statistics for the year 1925. The number of attendances of children recorded at the centres is the highest ever noted in the annals of this work, the previous best figure being in 1924, when there were 26,233. The attendances of both expectant and nursing mothers also show an increase. 114 TABLE No. 66. Centre. No. on Roll of Centre. No. of Attendances. Mothers. Children. Mothers. Children. Expectant. Nursing. Expectant. Nursing. Town Hall 328 353 1,671 485 651 8,899 Eltham 236 77 1,245 444 163 6,737 Plumstead 160 186 1025 283 308 6,451 Slade 8 77 458 10 119 3,376 New Eltham 10 8 221 10 10 1,901 North Woolwich 2 31 133 3 47 958 Beresford Street (Voluntary). 7 48 131 10 105 881 Totals 1926 751 680 4,884 1,245 1,403 29,205 „ 1925 665 816 4,318 1,044 1,250 24,834 TABLE No. 67. Children in attendance at each Centre. Year of Birth. Town Hall. Eltham. Plumstead. Slade. New Eltham. North Woolwich. Beresford St. (Voluntary). Totals. 1926 530 281 318 114 51 43 35 1,372 1925 526 330 322 144 66 36 41 1,465 1924 278 226 152 83 40 25 30 834 1923 164 190 122 56 29 20 14 595 1922 115 134 77 47 21 8 8 410 1921 58 84 34 14 14 1 3 208 1,671 1,245 1,025 458 221 133 131 4,884 Attendances of Children at each Centre. 1926 3,241 1,960 2,348 1,026 592 388 206 9,761 1925 3,564 2,631 2,769 1,223 879 337 389 11,792 1924 1,159 829 711 576 211 146 196 3,828 1923 463 677 374 322 109 65 48 2,058 1922 355 475 196 190 80 19 34 1,349 1921 117 167 53 39 30 3 8 417 8,899 6,739 6,451 3,376 1,901 958 881 29,205 115 Voluntary Centre. There is only one voluntary centre in Woolwich. It is established at the Victory Club in Beresford Street, and serves one of the most difficult areas in the Borough. The Centre is held once a week—on Monday afternoon—and continues to do excellent work. The number of children attending the centre during the year was 131. The total number of attendances, including mothers, was 996. As in previous years, one of the Council's assistant medical officers has attended at this centre every alternate Monday, and a health visitor attended every session. The Council do not make a grant towards the expenses of this centre. Collective Teaching. In 1925, sewing classes were started at the Town Hall and New Eltham centres. During that year the results were disappointing, especially at Woolwich. It was thought that possibly the room provided at the old Town Hall, Woolwich, for the purpose was unsuitable, and it was resolved, as this class had only been started in a tentative way, to discontinue it and start again at Plumstead in the new centre, where the rooms were new, suitably warmed and furnished. It was found that much more interest was taken in the class there, that there was a gradual increase in the numbers attending, and more interest was taken in the work and in the model garments shown at each session. Materials for sale were much appreciated. In these classes collective and individual teaching has been given so that every mother could make the garment she chose and use any materials she already had. More than one toddler has a warm coat now owing to old materials being remade. Planning and cutting out has been done at the centre, and also most of the sewing, but in some cases work has been taken home to finish. Knitting has been very popular, and several frocks have been made. It was resolved, towards the end of the year, to start a weekly lecture at Plumstead centre on suitable subjects, commencing on the first Friday in the New Year. Treatment of Minor Ailments. Children requiring medical or surgical treatment for certain minor ailments are 116 referred to the School Clinic, Brewer Street, to a private practitioner, or to a hospital. During the year 36 were sent to this clinic, and for each case the Council paid 5s. Children referred there suffered from the following conditions:— TABLE No. 68. Impetigo 7 Ear discharge 5 Eyes—squint 9 Corneal ulcer 2 Burns and scalds 3 Miscellaneous 10 36 The Work of the Health Visitors. No change has taken place in the personnel during the year. There are eight health visitors, two of whom hold the combined appointments of sanitary inspector and health visitor. The extensive nature of their work can be seen from a study of Table No. 69, which shows in detail the number of visits paid by them during the years 1925-1926. In addition to paying these visits, they attend centres at which women and children come for medical and hygienic advice, and arrangements have been made whereby the health visitor is in attendance at the centres serving the district in which she works. Their visits are welcomed in the homes. In 1926, the Council, with the approval of the Ministry of Health, paid the class fees and expenses of two health visitors attending a refresher course for health visitors. The following Table, No. 69, shows the classification of visits paid by the health visitors, and it will be noted that there is a considerable increase in the number. There is much variation in the type of visits paid from year to year according to whether diseases are prevalent in epidemc form or not. During these epidemic periods the health visitors discontinue the re-visiting of births, except in urgent cases, and concentrate on cases suffering from the epidemic disease. 117 TABLE No. 69. 1925. 1926. Births—First visits 2,203 2,360 ,, Re-visits 12,4471 14,818 Infant deaths investigated 85 63 Still-births investigated 10 38 Expectant mothers—home visits 395 435 Infectious diseases:— Ophthalmia neonatorum—First visits 30 17 Ophthalmia neonatorum — Revisits 41 18 Measles—First visits 1,413 997 ,, Re-visits 454 461 Puerperal fever—First visits 8 7 ,, Re-visits 4 5 Zymotic enteritis—First visits 12 18 ,, Re-visits 4 10 Tuberculosis 58 27 Pneumonia 140 169 Anterior poliomyelitis 12 12 Encephalitis lethargica — 23 Visits unclassified 420 332 Visits unsuccessful 1,783 2,337 19,543 22,147 Orthopaedic Treatment for Children under five years of age. Children requiring orthopaedic treatment are sent to the remedial clinic of the Woolwich Invalid Children's Aid Association in accordance with a scheme entered into in 1925. The Council pay for children under 5 years of age, sent by the medical officers to the clinic, 2s. per attendance for cases requiring massage or electrical treatment, and 1s. 6d. per attendance for any other form of treatment. The cost of these services for the year was £191 4s. 6d. Only cases recommended by the Medical Officer of Health are included 118 in this scheme, and payment is only made for the number of attendances approved by him. In detail, the children referred to the clinic required treatment for the following conditions:— Type of case. Number remaining over from 1925. New cases. Total cases. Number who completed treatment by end of year. Talipes (Club foot) 2 23 25 17 ,, (Flat foot) 3 3 6 4 Rickets— General 4 23 27 22 Genu Valgum (Knockknee) 2 1 3 1 Genu Varus (Bow-leg) 2 11 13 12 Paralysis, etc.— Infant 4 2 6 4 Erbs 1 1 2 — Facial — 1 1 1 Muscular weakness 1 8 9 8 Miscellaneous— Injuries — 1 1 — Deformities 5 3 8 8 Hernia 1 — 1 1 Constipation — 4 4 4 Flat chest 1 6 7 6 Rheumatism — 1 1 — 26 88 114 88 In all, these 114 children made 1,960 attendances during the year. With the exception of 135, all these attendances were paid for at the rate of 2s. per attendance. The average number of treatments given to each completed case was 14, and to each uncompleted one was 30. It is interesting to record that only 18 children under 5 years of age attended this clinic during 1921, compared with 51 in 1925 and 103 In 1926. This service is probably the most important of the 119 Council's ancillary services in connection with maternity and child welfare, and it is gradually moulding public opinion to the necessity for the early treatment of these children. Dental Treatment. Dental work is carried on at the School Clinic, Brewer Street. Mothers and children are referred there from the centres. The following Table, No. 70, shows the cases attending and the total attendances during the year. The number of sessions was 24, excluding anaesthetic days:— TABLE No. 70. No. Attendances. Expectant mothers 35 64 Nursing mothers 60 162 Children under 5 139 204 234 430 Dentures are provided free, at part cost, or at cost price, according to ability to pay, and payment is spread over many weeks. In consequence, the income received during the year includes money received in respect of dentures supplied in 1925. 30 sets (complete or partial) of false teeth were supplied during the year at a total cost of £116 2s. Payments by patients amounted to £90 18s. 6d. Institutional Midwifery. The Council do not maintain a maternity hospital, but they have made arrangements with the British Hospital for Mothers and Babies whereby 144 cases, recommended by the Medical Officer of Health, are confined there per annum. For this service the Council pays £1,500 a year. In addition, the hospital has undertaken to provide accommodation for such cases as require ante-natal treatment. Each patient admitted is required to pay fees according to the earnings of her husband, and a minimum fee has been fixed at £3 per confinement in the case of multiparae and £4 per confinement in the case of primiparae. The charge is based on a normal residence of fourteen days, but an additional fee of 3s. per day is charged if this period is exceeded. The amount recovered in patients' fees during the year was £595 3s., making a net cost of £992 7s., 50 per cent. 120 of which is recoverable from the Ministry of Health. I am indebted to Miss Gregory, the Secretary of the Hospital, for the following information, which shows statistically the number of cases dealt with during the year:— Mothers admitted during the year 795* Number of children born 634 Maternal deaths 2 Infant deaths 4 Extern cases 190 Ante-natal Clinic— Mothers attending 960 Total attendances 3,457 Post-natal Clinic— Mothers attending 27 Total attendances 1,306 Infant Clinic— Infants attending 443 Total attendances 1,306 *Includes those for observation and temporarily discharged. Institutional Provision for Unmarried Mothers. Woolwich and Plumstead Maternity Home. This is a small home for unmarried mothers, situated at 23, Vicarage Park, Plumstead, which provides accommodation for eight mothers and babies. Through the courtesy of the Superintendent, I am able to give the following information:— Mothers in the Home on 1st January, 1926 5 Babies do. do. 3 Mothers admitted during the year 13 Births 12 Deaths — Average duration of stay of each completed case 23.6 weeks Mothers who attended ante-natal clinics of the Borough Council 12 The function of the Home is to give illegitimate children a chance of survival, and the mothers are kept in the Home 121 doing the light work of the Home for about six months. When they leave, situations are found for them, if possible, where the child can be taken. For some years now the Council has made a grant of £50 towards the funds of the Home. This grant was made again in 1926. Home for Ailing Babies. This Home was closed in June, 1926, in accordance with a resolution of the Council. Arrangements have been made for the treatment of these cases in the Woolwich War Memorial Hospital whenever it is opened. It was anticipated that the Hospital would be opened in September last, but unfortunately delays occurred, and for the rest of the year no accommodation was available for this type of case. The following Table shows certain statistical information for the period it was occupied in 1926. TABLE No. 71. N umber of beds 21 (1) Number of cases in hospital on the 1st January, 1926 13 (2) Number of cases admitted during the period 28 (3) Average duration of stay 72.8 days (4) Reasons for admission— Malnutrition, Marasmus, Debility 16 Vomiting and Dyspepsia 9 Miscellaneous 3 (5) Number of cases discharged— (a) in good health 33 (b) Improved 5 (c) No improvement 2 (6) Number of cases of infectious disease— (a) Measles — (b) Whooping cough — (c) Epidemic diarrhoea — (d) Other infectious conditions 1 (7) Number of deaths 1 122 Nursing Assistance. Previous to 1926, nursing assistance was only provided by the Council under this scheme for cases of measles and ophthalmia neonatorum. In 1926, these services were extended to include cases of zymotic enteritis, puerperal fever, acute poliomyelitis, and whooping cough, and in October, 1926, to puerperal pyrexia. Cases of these diseases which come to the notice of the Medical Officer of Health are visited by the health visitor, and the Medical Officer of Health decides whether nursing is required. The Council do not pay a retaining fee to the District Nursing Association, but they pay a fee per visit, the rate being as follows:—In the case of all these diseases, except puerperal fever and puerperal pyrexia, Is. per visit for one case, and 6d. a case for more than one case in the house at the same time. For puerperal fever and puerperal pyrexia, a uniform fee of Is. 3d. is paid. Research Work on the Health of the Toddler. At the request of the Ministry of Health, arrangements were made to keep under observation, for a period of three years, a certain number of children between the ages of one and five years coming within 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 work, which has been done by Dr. N. MacLennan, was carried on throughout the year. Widows', Orphans' and Old Age Contributory Pensions Act, 1925. In March, 1926, the Council resolved to inform the London County Council that it was prepared to undertake the powers and duties of a local authority under the provisions of Section 6 of this Act. Section 6 of this Act provides that in certain circumstances, e.g., desertion or abandonment of a child, the Ministry may direct that the 123 additional allowance payable in respect of a child may be paid to the local authority to be administered for the benefit of the child, and prescribes a similar procedure in respect of an orphan pension where the Minister is satisfied that it will be in the interests of the child for the local authority to administer the pension. In such cases the local authority may make representations to the Minister. The local authority for the County of London under the Act is the London County Council, but this body was of opinion that this work should be delegated to the Metropolitan Borough Councils as the authorities dealing with Maternity and Child Welfare. Any expense incurred is defrayed as expenses under the Maternity and Child Welfare Scheme. No cases under the provisions of this Act were dealt with during the year. Supply of Milk, etc., to Necessitous, Expectant and Nursing Mothers and Milk to Young Children. The approximate cost of this service during the year was as follows:— Dried milk, £1,293 15s. 9d. Fresh milk, 19s. 4d. Dinners, nil. A scale of income approved by the Ministry of Health is used as a test of necessity, and the details of this scale will be found in the annual report for 1925. In one instance an applicant made a false statement as to income. The circumstances of the case were fully reported on by the Town Clerk and considered by the Committee, and a cautionary letter was sent to the applicant. Administration of the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. These regulations came into force on the 1st October, 1926, and made notifiable, in addition to puerperal fever, puerperal pyrexia, which is defined as follows:— " Any febrile condition (other than a condition which is required to be notified as puerperal fever under the Infectious Disease (Notification Acts) occurring in women within 21 days after child-birth or mis-carriage 124 in which a temperature of 100.4 deg. Fahrenheit (38 deg. Centigrade) or more has been sustained during a period of 24 hours, or has recurred during that period." Their object is to ensure the organisation of proper measures for the prompt and effective treatment of a septic puerperium. It was recognised that the number of notifications would increase, and would include many cases relatively trivial in degree, but the great importance of securing adequate treatment in the early stages of puerperal infection was regarded as outweighing any objection to the notification of a certain amount of minor illness which gives no cause for anxiety. A copy of these regulations was sent to all medical practitioners in the Borough with a supply of appropriate forms, and the Council drew up a scheme for dealing with the conditions which might arise and submitted it to the Ministry for approval. At the end of the year the matter was still being considered by the Ministry. As the Metropolitan Asylums Board arranged to admit cases of puerperal pyrexia into their hospitals, it was not necessary to consider hospital provision for these cases, and so the scheme only includes the following provisions:— (a) The appointment of an obstetric specialist; (b) Arrangements for the bacteriological examination of lochia and blood; and (c) The provision of nursing assistance. The statistics relating to the incidence of puerperal fever and of puerperal pyrexia are given in that part of the report dealing with the prevalence and control of infectious diseases. Feeding of Infants in Woolwich. The usual enquiry was carried out in the month of June, and the results are very similar to those obtained in the five previous years. Table No. 72 shows the results of the enquiry. 125 TABLE No. 72. Feeding of Infants Attending Welfare Centres, 31st May to 10th July, 1926. 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 47 81 57 51 44 46 28 19 17 390 6 2 1 399 Breast and Hand 3 13 10 8 9 10 9 10 12 84 14 17 12 127 Hand 6 9 25 26 34 31 41 32 46 250 30 38 68 386 Total 56 103 92 85 87 87 78 61 75 724 50 57 81 912 Percentages. Breast 83.9 78.7 61.9 60.0 50.6 52.9 35.9 31.1 22.7 53.9 12. 0 3.5 1.2 43.8 Breast and hand 5.4 12.6 10.9 9.4 10.3 11.5 11.5 16.4 160 11.6 28.0 29.8 14.8 13 9 Hand 10.7 8.7 27.2 30.6 39.1 35.6 52.6 52.5 61.3 34.5 60.0 66.7 84.0 42.3 126 METEOROLOGY. Meteorological Observations taken at the Royal Observatory, Greenwich, during the year 1926. 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. 9 54.2 33.6 44.6 + 6.5 44.5 4 0.59 16 51.6 160 32.8 — 5.2 43.8 3 0.20 23 50.9 16.5 371 — 1.6 42.3 4 0.39 30 55.6 36.8 46.1 + 6.7 42.4 4 0.44 Feb. 6 56.6 37.3 46.9 + 7.3 43.4 7 1.14 13 520 29.6 39.4 + 0.4 44.0 3 0.52 20 56.0 260 460 + 6.5 43.7 5 0.94 27 55.3 39.3 500 + 10.0 44.4 4 0.13 March 6 60.5 33.2 45.6 + 50 450 4 0.11 13 57.0 36.6 48.4 + 7.3 45.1 — — 20 53.3 341 42.2 + 0.4 45.2 — — 27 56.5 32.1 41.3 — 1.2 44.7 2 0.02 April 3 73.2 29.4 49.4 + 4.5 44.8 . — 10 70.7 38.2 52.3 + 61 46.1 4 1.00 17 67.8 34.7 47.6 + 10 47.0 3 0.87 24 60.9 361 45.5 — 3.0 47.1 5 0.97 May 1 64.9 39.3 50.1 + 1.2 47.2 6 108 8 59.0 36.0 46.9 — 3.4 48.0 2 0.27 15 62.0 32.8 48.5 — 3.5 48.3 5 0.86 22 70.5 36.6 49.9 — 3.7 48.6 4 0.37 29 78.2 42.4 59.8 + 4.1 49.9 3 006 June 5 67.4 450 54.7 — 3.0 51.5 4 1.21 12 74.7 46.4 57.3 — 0.9 52.4 5 0.80 19 76.6 450 58.2 — 0.8 53.4 3 0.80 26 78.4 41.2 58.6 — 2.3 54.5 2 0.23 July 3 77.2 45.2 61.1 — 0.5 55.0 3 0.34 127 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 10 77.5 50.1 60.5 — 1.9 55.7 4 0.25 17 86.7 49.5 67.9 + 4.7 56.7 — — 24 83.8 51.0 64.3 + 11 57.7 5 0.98 31 78.8 47.2 59.6 — 2.8 57.9 6 0.85 Aug. 7 78.2 44.2 59.9 — 2.2 57.9 2 0.23 14 78.7 50.6 62.3 — 0.1 57.8 4 1.63 21 79.6 50.3 64.5 + 2.6 58.1 5 0.29 28 80.8 45.2 63.9 + 31 58.7 — — Sept. 4 83.9 50.0 64.9 + 5.0 58.9 3 1.88 11 83.8 55.4 65.1 + 6.3 59.3 2 0.23 18 820 48.1 62.4 + 4.8 59.3 — — 25 88.2 391 58.7 + 2.9 590 2 0.09 Oct. 2 66.9 380 51.4 — 31 57.6 1 0.18 9 73.0 44.1 57.3 + 4.8 56.6 2 0.09 16 64.9 38.5 51.3 + 0.9 55.9 6 1.42 23 54.0 24.2 40.3 — 8.5 54.5 3 0.18 30 53.9 27.1 41.7 — 5.9 52.4 5 0.96 Nov. 6 590 271 44.2 — 2.3 50.8 2 0.38 13 56.5 37.0 46.9 + 2.6 50.2 6 2.08 20 560 39.6 490 4. 6.3 49.9 7 1.00 27 40.6 30.6 391 — 1.1 49.5 3 0.39 Dec. 4 45.8 27.8 400 — 1.1 48.2 2 0.90 11 48.4 290 40.7 — 0.3 47.0 3 0.20 18 47.9 29.4 40.4 — 01 46.4 3 0.11 25 45.8 32.1 37.6 — 1.0 45.7 2 0.04 1927. Jan. 1 49.9 27.0 40.8 + 2.0 44.8 2 0.03