AC 4372 WOO 28 Metropolitan Borough of Woolwich Annual Report OF THE Medical Officer of Health FOR WOOLWICH 1928. 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 1928. 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. 3 PUBLIC HEALTH AND HOUSING COMMITTEE. At 31st December, 1928. His Worship the Mayor (Councillor R. P. Purcell, J.P. Councillor Miss M. Crout, J.P. (Chairman). Councillor Miss G. E. Walters, J.P. (Vice.Chairman). Councillors— E. Brown J. Lee T. Davis L. J. Needham H. N. Dickinson T. G. E. Phillips Mrs. L. E. Driver Mrs. E. L. Reeves A. H. Gilder Miss S. Turnbull S. J. Huff H. J. Turner H. Vaughan. MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Public Health and Housing Committee. 4 TABLE OF CONTENTS. PAGE Public Health and Housing Committee 3 Maternity and Child Welfare Committee 3 Preface 8 I.—General Statistics. Social Conditions 4 Population 14 Sickness and Invalidity 15 II.—Vital Statistics. Annual Statistics 16 Births 18 Marriages 20 Deaths 20 Maternal Mortality 29 Child Mortality 31 Infant Mortality 32 III.—General Provision of Health Services. Hospitals 38 Institutional Provision for Unmarried Mothers 42 Ambulance Facilities 42 Clinics and Treatment Centres 42 Staff 45 Professional Nursing in the Home 48 Midwives 49 Maternal Mortality 49 Chemical Work 49 Bacteriological Examinations 50 Adoptive Acts, By.laws and Regulations in force in the Borough 50 IV.—Health Propaganda. General Reference 51 Health Exhibition, 1928 52 Health Talks to Mothers and Fathers at Welfare Centres 54 Health Talks to School Children 55 Use of Slogans 56 Other Matters 57 5 V.—Sanitary Administration. Staff 58 Complaints 58 Closet Accommodation 58 Scavenging 58 Drainage 59 Sanitary Inspection of Area 61 Rats 65 Mosquitoes 65 Rag Flock 65 Offensive Trades 66 Smoke Abatement 66 Factories and Workshops 67 Mortuaries 69 Cemeteries 69 Legal Proceedings 71 VI.—Inspection and Supervision of Food General Reference 73 Milk Supply— Registration 74 Cow keepers 75 Dairymen and Purveyors of Milk 75 Designated Milks 76 Public Health (Condensed Milk) Regulations, 1923.1927 79 Public Health (Dried Milk) Regulations, 1923.1927 80 Meat Inspection 80 Slaughterhouses 81 Bakehouses 81 Fried Fish Shops 81 Ice Cream Premises 81 Other Food Premises 82 Unsound Food 82 Food Poisoning 83 Sale of Food and Drugs Acts 83 Adulterated Samples—Action taken 86 Bacteriological Examination of Food 88 Other Legal Proceedings 88 VII.—Housing. Statistics 89 Inspection of Houses 93 6 Housing Act, 1925 95 Underground Sleeping Rooms 97 Houses Let in Lodgings 98 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920.1923 99 Tents and Vans 99 New Houses—Water Certificates 99 Council's Housing Scheme 101 VIII.—Infectious Diseases. Notifications 108 Smallpox 115 Scarlet Fever 115 Diphtheria 118 Enteric Fever 119 Encephalitis Lethargica 121 Cerebrospinal Meningitis 121 Pneumonia 122 Erysipelas, Malaria and Dysentery 124 Puerperal Fever and Puerperal Pyrexia 125 Ophthalmia Neonatorum 126 Anterior Poliomyelitis 127 Zymotic Enteritis 128 Whooping Cough 128 Measles 128 Disinfection and Disinfestation 129 Tuberculosis— Notifications 130 Deaths 133 The Public Health (Prevention of Tuberculosis) Regulations, 136 1925 Tuberculosis Dispensary—General Reference 136 The Work of the Dispensary 137 Contacts 142 Co.operation with Hospitals, etc. 143 Co.operation with Local Practitioners 144 Co.operation with School Medical Service 144 Home Nursing 144 Provision of Extra Nourishment 144 Dental Treatment 145 Shelters 145 Bacteriological Examinations 145 Institutional Treatment 146 Woolwich Tuberculosis Care Committee 147 7 IX.—Maternity and Child Welfare. General Reference 150 Notification of Births Acts 152 Work of the Health Visitors 153 Welfare Centres 155 Feeding of Infants 157 Artificial Sunlight Clinic 159 Treatment of Minor Ailments 166 Dental Treatment 166 Orthopaedic Treatment for Children under 5 Years 167 Provision of Nursing Assistance 168 Hospital Beds for Children under 5 Years 168 Institutional Midwifery 169 Supply of Milk, etc., to Necessitous Mothers and Children 172 Collective Instruction of Expectant and Nursing Mothers 174 Voluntary Centre 174 Administration of the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 175 Research Work on the Health of the Toddler 177 Blind Persons Act, 1920 177 Widows', Orphans' and Old Age Contributory Pensions Act, 1925 177 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.Eighth Annual Report on the health of the Metropolitan Borough of Woolwich. It follows, as to contents and arrangement, the outline indicated by the Ministry of Health in Circular 939, in order to ensure uniformity in the presentation of Annual Reports of Medical Officers of Health throughout the country. It is usual in the preface to refer generally, but briefly, to the chief features of the work of the Department during the year, and in the report itself to refer to the work of the other Departments of the Council where they deal with matters affecting the health and general well.being of the community. In October the registration districts were altered by the Registrar General and the number of registrars was reduced from four to three. The new areas, with the exception of Eltham, do not correspond to the parishes, and it was considered desirable for this year at least not to break the continuity of the records, but to present the usual comparative figures for registration districts in the old way. In May, the number of wards in the Borough was altered from eleven to fourteen. Eltham Ward was divided into three, now known as Avery Hill, Sherard and Well Hall, respectively. St. Nicholas' Ward was divided into two, now known as St. Nicholas' and Abbey Wood, respectively. In the report, wherever figures relating to Wards are given, they refer to the wards as now known. 9 The vital statistics of the year can be regarded as satisfactory and show that the Borough is maintaining its position as one of the healthiest London areas. Although there was an increase in the general death rate to 11.0 and also in the infantile mortality rate to 50, only two metropolitan boroughs had a lower death rate and only one a lower infantile mortality rate. The birth rate showed a slight increase, 16.1 compared with 15.9. The Registrar.General's estimate of the population is 141,100 civilians and 146.600 including the military. There is, however, reason to believe that this is under.estimated and my estimate exceeds his by 6,030. Such increase as has taken place is most marked in Eltham parish, the population of which is now estimated, on a conservative basis, to be 38,655. A general reference to the health services of the Borough will be found in Section III., where they are set out more or less in precis form, but in each case references are given to the appropriate parts of the report where the subject is dealt with in detail. Possibly one of the most outstanding features of the year's work is the realization of the important part health propaganda is now taking in the day's work of the department. Health propaganda now.a.days is not limited to those with whom we come in contact, either through attendances at Council institutions or in home visiting; efforts are being made to reach those whom we cannot reach by these means, and to interest all members of the public in matters of health. The methods followed during the year for the full development of the public conscience in relation to health matters are fully described in Section IV., and so far the results have been such as to encourage us to persevere in these matters. Endeavours have been made to 10 seminate information in a manner acceptable to the public palate and likely to appeal not only to those who are already interested, but also to those who are indifferent or even hostile. Great as has been the improvement in communal health during the last two decades, further improvement is likely to be retarded until every individual realises that he must take his share in promoting it. The incidence of infectious disease was higher in 1928 than in 1927, mainly due to the prevalence of measles. There were also a few more cases of scarlet fever and diphtheria. The incidence of enteric fever was higher than in previous years, as was the case generally in London, where, during the summer months, especially in a few West.end boroughs, there was a wide.spread outbreak of para.typhoid fever. Nine cases of a common origin to those in other parts of London occurred in Woolwich. There were fewer cases of pneumonia and tuberculosis than in 1927. The number of notifications of puerperal fever and puerperal pyrexia rose from 38 to 48, and unfortunately, there were eight deaths from puerperal fever compared with three in 1927. At the end of the year there were 944 cases of pulmonary and 278 cases of non.pulmonary tuberculosis, making a total number of 1,222 cases known to be living in the Borough. The reports of the Sanitary Inspectors shew that the sanitary state of the Borough is satisfactory and that a high level of hygiene in the handling of the food supplies is being maintained. The number of slaughterings in the Borough reached the unprecedented figure of 24,772, and the inspection of these carcases, as provided for in the Public Health (Meat) Regulations, 1924, placed much additional work on those Inspectors responsible for the examination of the meat. The difficulties in regard to housing are still considerable, but much progress was made during the year, 749 new houses being occupied. This figure includes 443 11 houses which were built by the local authority. There are now 2,034 houses on the Council's estate at Eltham and plans have been approved for the erection of a further 142, on some of which work has been started. A report on the Council's housing scheme is given at the end of Section VII. Mr. A. G. Duck, Chief Sanitary Inspector, had been in indifferent health from the beginning of the year and felt it necessary to apply for superannuation, to take effect from the 31st July. He was much esteemed by members of the Council and his colleagues and at his retirement the Council adopted the following resolution :— " (a) That the Council hereby places on record its appreciation of the long and faithful services of Mr. Albert George Duck, Chief Sanitary Inspector, formerly to the parish of Plumstead, and to the Borough since its creation in 1900, over a period of 38 years, and wishes him renewed health and happiness in his retirement. (b) That the above resolution be suitably engrossed on vellum and presented to Mr. A. G. Duck, and that the Seal of the Council be affixed thereto." To me, personally, he was a loyal and helpful colleague, ever willing to assist in the work of the Department, not only in his own section but in the work of the clinical sections as well. He designed the tuberculosis shelters now used by the department, prepared models of simple devices which could be made by fathers for making easy the domestic trials and difficulties of mothers, and he was an interesting, racy and popular lecturer at annual Health Weeks. He has well earned his retirement but it is to be hoped that from time to time we shall see and hear him again in Woolwich. The opening of the War Memorial Hospital in March marked the development of two extensions in the Maternity and Child Welfare scheme. For the first time beds became 12 available for the treatment of such medical and surgical conditions in children under 5 as are usually treated in a general or children's hospital, and the Council's provision for institutional midwifery was increased 50 per cent. The arrangements made with the Governors of the Hospital ensure that a bed is always available locally for emergencies in expectant mothers and in young children and avoid the delay and danger associated with the long journey to a London General or Special Hospital. Local medical practitioners can use these beds for emergency cases by direct application to the Hospital. The steps necessary to provide additional facilities for Maternity and Child Welfare work in Eltham will require the careful consideration of the Council during 1929. Eltham Centre was opened in 1917 and one was established at New Eltham in 1920. Since then, there has been much building in the district and the Eltham Centre is no longer conveniently situated. The attendances at the Welfare Centres during the year numbered 32,515, a slight increase on those of 1927. Gratefully, I express, once again, my indebtedness to the staff of the Department for their loyal co.operation during the year. They have risen nobly to the many and new. demands placed upon them, particularly in regard to the development of health propaganda work. My thanks are also due to those of other Departments for their help during the year, and in the compilation of this report. To the members of the Council, and particularly those of the Health Committees, my thanks are due for their many kindnesses during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JOHN MACMILLAN. 13 Twenty.eighth Annual Report on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH Year ending 31st December, 1928. SECTION I.—GENERAL STATISTICS. TABLE No. 1. Area (acres) 8,282 Population, 1928 :— Total (including military) 146,600 Civilians 141,100 Population, Census 1921 :— Total (including military) 140,389 Civilians 136,307 Number of Inhabited Houses, 1921 26,048 Number of Families or Separate Occupiers, 1921 33,647 Rateable Value (October, 1928) £1,083,035 Sum represented by a Penny Rate (October, 1928) £4,512 14 Social Conditions. Woolwich may be described as one of the suburban working.class metropolitan boroughs. It comprises the three Civil Parishes of Woolwich, Plumstead and Eltham, and its area is 8,282 statute acres. In Woolwich Parish there are 1,135 acres; in Plumstead, 3,387 acres; and in Eltham, 3,760 acres. The River Thames covers approximately an additional 645 acres. Much of the Borough is unbuilt on and the number of persons per acre varies from 10 in Eltham to 31 in Woolwich, the general average of the Borough being 17. Population. The Registrar General estimates the total population of the Borough at the 30th June, 1928, as 146,600. This is the highest estimate since the end of the war. The figures include the military, and in order to obtain the civilian population it is necessary to make a reduction of 5,500, which is the estimated number of non.civilians. The civilian population, therefore, is estimated to be 141,100. In 1926, the civilian population was estimated by the Registrar General as 141,900. Compared with 1927 the civilian population is estimated to show an increase of only 330. For the reasons which were given in my annual report for 1927, I am unable to understand these figures. To my mind the estimates thus furnished are below the true figure, and my estimate of the population of the Borough at the middle of 1928 was 147,130, but, as the practice in recent years has been to accept the figures of the Registrar.General for comparative statistical purposes, his figures have again been adopted this year, and populations of the registration districts of the Borough have been calculated. It has been necessary in these calculations to make allowance for transfers which have taken place under the Council's housing scheme from Woolwich and Plumstead to Eltham, and figures are available to shew that over 7,000 persons have moved from these districts to the Council's housing estate. Internal movement of the population in the 15 Borough can also be traced by a study of the Council's operations under the Small Dwellings Acquisition Acts. Here we can see movement not only to Eltham, but also towards East Plumstead and away from Woolwich and West Plumstead, and in the population calculations, this movement also has been taken into account. Due weight has also been given to the natural increase in each of the registration districts and to the location of new houses. When these adjustments have been made, the estimated figures for the districts are as follows :— These figures have been used throughout the report for calculating the rates in the Borough and the various registration districts. Sickness and Invalidity. There have been no causes of sickness or invalidity which have been specially noteworthy in the area during the year, nor are there any conditions of occupation or environment which appear to have a prejudicial effect on health. TABLE No. 2. Estimated population. Woolwich 29,646 West Plumstead 38,457 East Plumstead 34,342 Eltham 38,655 141,100 16 SECTION II.—VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shewn below :— TABLE No. 3. Births—Legitimate 2,208 „ Illegitimate 61 2,269 Birth Rate 161 Deaths 1,554 Death Rate 110 Number of Women dying in, or in consequence of Child Birth.. (a) From Sepsis 8 (6) From other Causes 5 Deaths of Infants under one year 114 (a) Legitimate 103 (6) Illegitimate 11 Infantile Mortality Rate 50 Deaths from Measles (all ages) 1 ,, ,, Whooping Cough (all ages) 8 ,, ,, Diarrhoea (under 2 years of age) 9 The chief Vital Statistics since 1901 are given in the following table :— 17 TABLE No. 4. Year. 1 Population estimated to middle of each Year. 2 Births. Nett deaths belonging to the District. Nett. Under 1 year. At all Ages. Number 3 Rate. 4 Number. 5 Rate per 6 1,000 Nett Births. Number. 7 Rate. 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 1616 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 b 138,200 129,505 2839 21.9 268 94 1837 14.2 J916 a b 141,783 130,313 3068 23.5 213 69 1704 13.1 1917 a b 147,078 131,942 2718 20.6 216 79 1566 11.9 1918 a b 150,650 134,453 2548 19.0 270 106 2100 15.6 1919 a b 141,918 136,237 2737 20.1 235 86 1679 12.3 1920 a b 140,000 135,904 3658 26.9 224 61 1487 10.9 4921 a b 141,700 137,604 3197 23.2 197 62 1594 11.6 1922 a b 142,350 138,254 2941 21.3 184 63 1603 11.6 1923 a b 143,530 140 000 2867 20.5 123 43 1387 9.9 1924 a b 144,400 139,980 2590 18.5 168 65 1543 11.0 1925 a b 145,440 140,740 2582 18.3 141 55 1519 10.8 1926 a b 146,200 141,900 2463 17.4 107 43 1450 10.2 1927 a b 144,770 140,770 2242 15.9 95 42 1491 10.6 1928 a b 146,600 141,100 2269 16.1 114 50 1554 11.0 a Total population. b Civil population. 18 BIRTHS. During the year 2,379 births were registered in the Borough ; 1,239 were males and 1,140 females. Corrected by outward and inward transfers, these numbers become 2,269, 1,172 and 1,097 respectively. The corrected figures for the registration districts are shewn in the following Table No. 5. TABLE No. 5. Registration Districts. Males. Females. Total Births. Woolwich 324 288 612 West Plumstead 278 286 564 East Plumstead 240 218 458 Eltham 330 305 635 The Borough 1,172 1,097 2,269 The birth rate, calculated on the civilian population was 16.1, compared with 15 9 in 1927. The following Table, No. 6, shews the birth rates in each registration district, after correction for outward and inward transfers, for each year since 1924 :— TABLE No. 6. Period. Woolwich. West Plumstead East Plumstead Eltham. The Borough. 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 1927 19.3 15.9 14.2 14.6 15.9 1928 20.6 14.7 13.3 16.4 16.1 19 Illegitimate Births. The number of illegitimate births registered was 49. There were 23 inward transfers and 11 outward transfers, making a net figure of 61, equivalent to 27 per 1,000 births. Natural Increase of Population. This term means the excess of births over deaths. In 1926 it was 1,013, in 1927, 751, and in 1928, 715. Notification of Births. During the year, 2,336 live births were notified. This is at the rate of 98 per cent of registered births, and compares with 100 per cent, last year. 1,037 notifications were received from midwives, 133 from doctors, 113 from parents, and 53 from other persons ; 645 from the British Hospital for Mothers and Babies, 160 from the Military Families' Hospital, 52 from the Plumstead and District Hospital, 87 from the Woolwich War Memorial Hospital, and 13 from the Eltham Cottage Hospital. Fifty.three births took place in midwives' homes. In addition to these, 28 notifications were received from the Medical Officer of Health of Greenwich, 53 from the Medical Officer of Health for Lewisham, and 31 from other Medical Officers of Health. 80 still births were notified. It is known that 871 Woolwich 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 38 39, the figures for the various districts being—Woolwich, 38 per cent. ; West Plumstead, 44 per cent. ; East Plumstead, 40 per cent. ; and Eltham, 32 per cent. The following Table, No. 7, shews the number of corrected births each year since 1924, the number of live and still births notified, the percentage of notified births, and the birth rates for the same period for Woolwich, London, and England and Wales. b 20 TABLE No. 7. Year. No. of births. No. of live births notified. No. of still births. Percentage of births notified. Birth Rate. Wool. wich. London. England and Wales. 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 1927 2242 2366 62 100 15.9 16.1 16.7 1928 2269 2336 80 98 16.1 15.9 16.7 MARRIAGES. There were 1,252 marriages (977 in 1927). The marriage rate was 17.7, as compared with 15.7, 15.06, 16.01 and 13.9 in the four preceding years. DEATHS. The total deaths registered in the district were 1,310. This figure includes 109 non.residents who died in the district but does not include 353 residents who died outside the Borough. When allowance is made for inward and outward transfers, the nett figure of 1,554 is obtained. The death rate for the year was 11.0. According to the figures published by the Registrar General for the 52 weeks ending 29th December, 1928, only two metropolitan boroughs had a lower rate than Woolwich. In 1927 the death rate in Woolwich was lower than in any metropolitan borough. In 1928, the death rate for England and Wales was 11 "7 and for London 1T6. The mean death rate for the 107 great towns was 116. 21 The following Table, No. 8, shows the death rates in each registration district (after correction for outward and inward transfers) for each year since 1923 :— TABLE No. 8. Period. Woolwich. West Plumstead East Plumstead Eltham. The Borough. 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 ll.I 10.3 7.6 10.2 1927 13.0 11.4 9.9 8.3 10.6 1928 14.4 11.9 10.4 8.1 11.0 Deaths in Public Institutions. In tabular form is shown below the number of deaths of Woolwich residents which took place in various institutions during the year: — TABLE No. 9. Hospitals or Institutions. Number of Deaths. Poor Law Institutions 530 London General Hospitals 131 Special Hospitals 43 Mental Hospitals 38 Fever Hospitals 37 Tuberculosis Institutions 26 Cottage Hospitals and Nursing Homes 20 825 The following Tables are self.explanatory. 22 TABLE No. 10. Birth Rate, Death Rate, and Analysis of Mortality during the year 1928. 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. Diarrhoea' and Enteritis (under Two years). Total Deaths under 1 Year. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births Still Births England and Wales . . 16.7 0.70 11.7 0.01 0.00 0.11 0.01 0.07 0.06 0.19 0.53 7.0 65 90.9 6.7 1.4 1.0 107 County Boroughs and Great Towns, including London. 16.9 0.70 11.6 0.01 0.00 0.15 0.02 0.09 0.09 0.17 0.48 9.6 70 91.0 6.5 1.9 0.6 156 Smaller Towns (1921 Adjusted Populations, 20,000.50,000). 16.6 0.73 10.6 0.01 0.00 0.08 0.01 0.06 0.08 0.21 0.41 4.8 60 92.6 5.7 0.5 1.2 London 15.9 0.53 11.6 0.01 0.00 0.30 0.02 0.09 0.09 0.13 0.55 10.2 67 88.7 7.6 3.7 0.0 WOOLWICH .. 16.1 0.57 11.0 0.01 0.00 0'06 0.04 0.11 0.10 0.09 0.38 3.9 50 83.8 10.6 0.6 0.0 23 TABLE No. 11. Deaths of Woolwich Residents Registered during the Calendar Year 1928, 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 6 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 vears. 75 and upwards. All causes 1554 114 24 27 39 70 201 396 357 326 Enteric fever 2 .. .. .. .. .. 1 1 .. .. Smallpox .. .. .. .. .. .. .. .. .. .. Measles 9 I 5 2 1 .. .. .. .. .. Scarlet fever 5 1 1 1 2 .. .. .. .. .. Whooping cough 16 8 3 1 4 .. .. .. .. .. Diphtheria 14 .. .. 8 5 .. .. 1 .. .. Influenza 12 .. .. .. .. .. 5 4 2 I Encephalitis lethargica 3 .. .. 1 .. .. 1 1 .. .. Meningococcal meningitis 1 .. 1 .. .. .. .. .. .. .. Tuberculosis of respiratory system 145 .. 1 .. 3 40 59 33 7 2 Other tuberculous diseases 20 2 1 3 3 6 . . 5 .. .. Cancer, malignant disease 209 .. .. .. 1 .. 20 81 80 27 Rheumatic fever 1 .. .. .. . . .. . . 1 .. .. Diabetes 13 .. .. .. .. .. 2 5 3 3 Cerebral hemorrhage, &c. 71 .. .. .. .. .. 1 21 29 20 TABLE No. 11.—continued. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 6 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and wilder 65 years. 65 and under 75 years. 75 and upwards. Heart disease 255 .. .. .. 2 6 19 75 79 74 Arterio-sclerosis 64 .. .. .. .. .. 1 12 26 25 Bronchitis 113 11 3 1 2 .. 2 19 26 49 Pneumonia (all forms) 71 12 3 2 2 2 9 19 12 10 Other respiratory diseases 18 .. .. .. 1 1 4 5 4 3 Ulcer of stomach or duodenum 17 .. .. .. .. .. 3 8 5 1 Diarrhoea, &c. 16 7 2 1 .. .. 1 3 .. 2 Appendicitis and typhlitis 10 .. .. .. .. 2 4 4 .. .. Cirrhosis of liver 6 .. .. .. .. .. .. 5 1 .. Acute and chronic nephritis 39 .. .. 1 3 2 8 11 9 5 Puerperal sepsis 8 .. .. .. .. .. 8 .. .. .. Other accidents and diseases of pregnancy and parturition 5 .. .. .. .. .. 4 1 .. .. Congenital debility and malformation, premature birth 48 47 1 .. .. .. .. .. .. .. Suicide 26 .. .. .. .. .. 7 9 7 3 Other deaths from violence 53 6 .. 3 6 5 10 8 5 10 Other defined diseases 284 19 3 3 4 6 32 64 62 91 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. 24 TABLE No. 12. Shewing 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 1928. Causes of Death. Males. Females. Woolwich. Plumstead. Eltham. Deaths in Public Institutions. West. East. In Borough. Outlying Institutions. Residents. NonResidents. All causes 831 723 428 457 356 313 504 90 321 Enteric fever ... 2 ... ... 1 1 1 ... 1 Smallpox ... ... ... ... ... ... ... ... ... Measles 4 5 4 1 2 2 2 ... 5 Scarlet fever 2 3 2 ... 1 2 ... ... 5 Whooping cough 8 8 4 4 3 5 3 ... 5 Diphtheria 5 9 4 5 1 4 ... ... 14 Influenza 7 5 7 1 1 3 2 ... Encephalitis lethargica 2 1 ... 1 ... 2 ... 1 3 Meningococcal meningitis 1 ... ... ... 1 ... ... 1 ... Tuberculosis of respiratory system 88 57 54 35 28 28 38 8 46 Other tuberculous diseases 6 14 4 7 5 4 8 1 8 Cancer, malignant disease 100 109 44 69 52 44 64 6 43 Rheumatic fever 1 ... 1 ... ... ... ... ... 1 Diabetes 7 6 2 5 3 3 4 1 3 Cerebral haemorrhage, &c. 32 39 20 16 24 11 32 4 2 25 TABLE No. 12.—continued. Causes of Death. Male. Female. Woolwich. Pluinstead. Eltham. Deaths in Public Institutions. West. East. In Borough. Residents. NonResidents. Outlying Institutions. Heart disease 129 126 77 74 eo 44 92 12 22 Arterio-sclerosis 36 28 9 24 9 22 7 ... 13 Bronchitis 60 53 27 36 32 18 23 3 9 Pneumonia (all formS) 33 38 21 16 21 13 26 8 8 Other respiratory diseases 7 11 9 5 3 1 6 ... 1 Ulcer of stomach or duodenum 15 2 8 1 3 5 3 1 7 Diarrhoea, &c. 7 9 6 4 3 3 4 2 6 Appendicitis and typhlitis 6 4 3 5 2 ... 9 4 1 Cirrhosis of liver 3 3 2 2 2 ... 3 ... ... Acute and chronic nephritis 24 15 8 13 6 12 10 1 15 Puerperal sepsis 8 2 3 1 2 2 1 5 Other accidents and diseases of pregnancy and parturition 5 1 3 1 4 1 1 Congenital debility and malformation, premature birth 29 19 17 11 5 15 14 4 10 Suicide 24 2 6 7 5 8 9 1 2 Other deaths from violence 36 17 16 11 13 13 17 8 18 Other defined diseases 159 125 70 101 66 47 121 22 67 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... 26 27 CAUSES OF DEATH. Table No. 11 shows that there were 255 deaths from heart disease, 209 from cancer, 145 from pulmonary tuberculosis, 113 from bronchitis, 71 from cerebral haemorrhage, 71 from pneumonia and 39 from nephritis. These figures differ but slightly from those of 1927. The number of deaths from influenza was 12, compared with 45. 69 per cent. of all deaths occurred in persons over 45 years of age. Tuberculosis and Infectious Diseases. These are referred to in the section dealing with the notifiable infectious diseases. Heart Disease. The deaths from heart disease, which numbered 191 in 1926 and 211 in 1927, numbered 255 in 1928. Except in 27 instances, the age at death was 45 or over. Diarrhoea. 16 deaths were certified as due to diarrhoeal diseases, compared with 6 in 1927. Nine deaths occurred in children under two years of age. Respiratory Diseases. The following Table, No. 13, shows the number of deaths each year since 1924 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. 28 TABLE No. 13. Year. Bronchitis. Pneumonia. Other Respiratory. Total. Death Rate. No. under 5 years. Percentage under 5 years. 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 1927 114 94 10 218 1.5 37 17.0 1928 113 71 18 202 1.4 32 15.8 Violence and Suicide. Fifty-three deaths (36 males and 17 females) occurred from violence, apart from suicide, a number somewhat in excess of previous years. Twenty-six deaths were due to suicidal causes (24 males and 2 females). Cancer. The total deaths from cancer was 209, of which 100 occurred in males and 109 in females. Deaths certified as due to cancer or malignant disease each year since 1924 are shewn in the following Table No. 14. TABLE No. 14. Deaths from Cancer and Malignant Disease. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 1924 87 94 181 1.29 11.73 1925 83 110 193 1.37 12.71 1926 93 104 197 1.39 13.59 1927 101 109 210 1.49 14.08 1928 100 109 209 1.48 13.45 29 The following Table, No. 15, shows the seat of primary disease in all deaths from cancer (including all other specified malignant tumours). TABLE No. 15. Seat of Primary Disease. Males. Females. Total. Deaths in Hospital. Tongue 4 1 5 3 Mouth and Jaw- 7 3 10 8 Pharynx 1 — 1 — (Esophagus 11 2 13 5 Stomach 25 20 45 23 Liver and Gall Bladder 7 6 13 4 Intestines 9 16 25 12 Rectum 8 11 19 11 Uterus — 13 13 7 Ovary — 14 14 6 Breast — 12 12 4 Vagina and Vulva — 4 4 3 Skin 2 — 2 2 Larynx 5 1 6 5 Lung 3 — 3 — Pancreas 1 2 3 3 Bladder 5 — 5 2 Other specified Organs 3 — 3 2 Other and undefined — 1 1 — Sarcoma 9 3 12 7 100 109 209 107 Inquests. There were 165 inquests held on Woolwich residents during the year, compared with 154 in 1927 and 147 in 1926. Maternal Mortality. The number of deaths from puerperal sepsis was 8, and from other accidents and diseases of pregnancy, 5. In 1927, the corresponding figures were 3 and 3 respectively. This is the highest number of deaths recorded in the Borough since 1919, and, so far as sepsis is concerned, since 1918. The death rate per 1,000 births from these diseases was 5.73. 30 The following Table shows the causes of death each year since 1912. TABLE No. 16. Maternal Mortality, Woolwich, 1912-1928. Year. Abortion. Ectopic Gestation. Placenta Praevia. Other Puerperal Haemorrhage. Other Accidents of Child Birth. Child Birth with Secondary Causes. Puerperal Eclampsia. Puerperal Phlebitis and Embolism. Puerperal Fever. Totals. 1912 1 — — — — — 1 1 1 4 1913 1 — — — 1 — 1 — 2 5 1914 1 — 1 2 — 1 1 1 4 11 1915 1 1 — — 1 — 2 — 3 8 1916 — 1 1 1 4 — 1 — 7 15 1917 — 1 — 2 — 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 1 — 3 9 1926 — 1 — 2 — — — 1 2 6 1927 — 1 — — — — 1 1 3 6 1928 — 2 1 — 1 — 1 — 8 13 Totals 5 10 7 15 12 3 24 13 72 161 31 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 24, and between 2-5, 27. In 1927 these figures were 21 and 29 respectively. The causes of death are given in detail in Table No. 11. The following Tables show the variation in the rates of mortality in these age groups in five-yearly periods since 1911, and for the years 1926, 1927 and 1928. TABLE No. 17. Child Mortality (1-2 years). Death Rates per 1,000 estimated age population from stated Groups of Diseases, in quinquennial periods. Period. Estimated mean Population. Infectious Fevers. Tuberculosis Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1911–1915 2,581 7.67 2.87 8.76 2.56 4.96 26.82 1916–1920 2,536 6.86 1.42 8.28 .63 4.42 21.61 1921–1925 2,876 3.69 1.46 4.52 .49 2.99 13.15 1926 2,438 3.69 .41 3.69 1.64 1.23 10.66 1927 2,348 2.13 1.70 3.41 — 1.70 8.94 1928 2,129 4.70 .94 2.82 .94 1.88 11.27 32 TABLE No. 18. Child Mortality (2-5 years). Death Rates per 1,000 estimated age population from stated Groups of Diseases, in quinquennial periods. Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1911–1915 7,681 3.05 1.20 1.56 .26 1.30 7.37 1916–1920 7,547 2.70 1.09 1.54 .02 2.52 7.87 1921–1925 8,266 1.79 .61 .77 .22 1.23 4.62 1926 7,794 1.29 .51 .89 — 1.41 4.10 1927 7,476 .94 .54 1.47 .13 .80 3.88 1928 7,121 1.83 .42 .42 .14 .98 3.79 INFANTILE MORTALITY. The number of deaths of infants under one year of age was 114. The rate of infant mortality resulting from these deaths (deaths under one year per 1,000 births) was 50. A lower figure has only been recorded on three occasions—in 1922 and in 1926 it was 43, and in 1927 it was 42. The rate for the administrative County of London was 67, and for England and Wales, 65. In only one Metropolitan Borough —Chelsea—was there a lower rate (48) ; in Wandsworth the rate was also 50. 33 The following Table, No. 19, shows the infantile mortality rate in the Borough and the registration districts for each year since 1924. TABLE No. 19. Period. Woolwich. West Plumstead. East Plumstead. Eltham. The Borough. 1924 79 42 68 70 65 1925 59 42 51 69 55 1926 51 37 41 44 43 1927 53 29 42 47 42 1928 60 43 41 54 50 Causes of Death. The causes of infant mortality are set forth in detail in Tables Nos. 21, 22 & 23 which show the incidence of mortality from each cause upon infants, distinguished by age, sex and parish. It will be noted from these Tables that the chief cause of death was prematurity, 31 deaths being ascribed to this condition. 11 deaths were due to bronchitis, 12 to pneumonia, 9 to congenital malformation, 8 to whooping cough and 7 to debility or marasmus. There was one death from measles, one from scarlet fever and 7 from diarrhoeal diseases. The neo-natal mortality rate, i.e., deaths under 4 weeks, was 22.47, compared with 22.75 in 1927. Of 51 neo-natal deaths, 29 were certified to be due to premature birth and 5 to congenital malformations. Deaths of Illegitimate Children. The number of deaths of illegitimate children was 11, compared with 2 in 1927, which was a somewhat exceptional figure. Four deaths 34 were certified to be due to prematurity and all these occurred within the first week of life. In three cases, death was due to injury at birth, in one to marasmus, in one to acute bronchitis, in one to atelectasis and in one to status lymphaticus. The oldest of these was three months and four were males and seven females. A comparision of the infantile mortality rates of legitimate and illegitimate infants shows that the rate for legitimate was 47 and for illegitimate, 180. Institutional Deaths. In tabular form is shown below the number of deaths of Woolwich infants which took place in various institutions during the year. These figures are included in those shown in Table No. 9. TABLE No. 20. Hospitals or Institutions. Number of Deaths. Poor Law Institutions 18 Special Hospitals 17 London General Hospitals 14 M.A.B. Hospitals 6 Cottage Hospitals 3 58 35 TABLE No. 21. INFANT MORTALITY, 1928. Nett Deaths from stated Causes at various Ages under One year of age. Causes of Deaths. 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. Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 .. .. 1 Scarlet Fever .. .. .. .. .. .. .. .. 1 1 Whooping Cough .. .. .. .. .. .. 2 2 4 8 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. 2 .. .. 2 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions 2 .. .. .. 2 2 2 .. .. 6 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. 1 1 2 5 2 2 .. 11 Pneumonia (all forms) .. .. .. .. .. 2 4 3 .. 12 Diarrhoea .. .. .. .. .. .. .. 1 .. 1 Enteritis .. .. 1 .. 1 1 1 1 .. 6 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. 1 .. 1 Suffocation, Overlying .. .. .. .. .. 1 .. .. .. 1 Injury at Birth 4 .. .. .. 4 .. .. .. .. 4 Atelectasis 2 1 1 .. 4 .. .. .. .. 4 Congenital Malformation 2 .. 1 2 5 3 1 .. .. 9 Premature Birth 20 1 4 4 29 1 1 .. .. 31 Atrophy, Debility and Marasmus .. 1 1 1 3 1 1 1 1 7 Other Causes .. .. 1 .. 1 2 3 .. 6 9 30 3 10 8 51 18 20 11 14 114 Nett Births registered during Legitimate 2208 the calendar year Illegitimate 61 Nett deaths registered during Legitimate 103 the calendar year Illegitimate 11 c TABLE No. 22. INFANT DEATHS, 1928. Causes of Death. The Borough. Woolwich West Plumstead. East Plumstead. Eltham. M. F. M. F. M. F. M. F. M. F. Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. .. .. .. .. .. .. .. .. .. Measles 1 .. .. .. .. .. .. .. .. .. Scarlet Fever .. 1 .. .. .. .. .. .. .. .. Whooping Cough 6 2 .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis 1 1 1 1 .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions 4 2 2 1 1 .. .. 1 1 .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 8 3 .. 1 4 .. 2 l 2 1 Pneumonia (all forms) 4 8 .. 4 2 1 2 2 .. 1 Diarrhoea .. 1 .. 1 .. .. .. .. .. .. Enteritis 2 4 .. 2 .. .. .. 1 2 1 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets 1 .. .. .. .. .. .. .. 1 .. Suffocation, Overlying .. 1 .. .. .. .. .. .. .. 1 Injury at birth 3 1 l .. .. 1 1 .. 1 .. Atelectasis 1 3 .. 2 .. 1 1 .. .. .. Congenital Malformation 7 2 4 1 1 1 .. 1 1 Premature birth 15 16 6 4 3 4 2 1 4 7 Atrophy, Debility and Marasmus 6 1 1 .. 3 .. 1 .. 1 1 Other causes 6 3 3 •• .. 1 .. 1 3 1 65 49 19 18 15 9 12 7 19 15 114 37 24 19 34 36 TABLE No. 23.—INFANT DEATHS, 1928. Causes of Death. The Borough. Woolwich. West Plums tead. East Plumstead. Eltham. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks— 1 year. Under 4 weeks. 4 weeks1 year. Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. .. .. .. .. .. .. .. .. .. Measles .. 1 .. .. .. .. .. 1 .. .. Scarlet Fever .. 1 .. 1 .. .. .. .. .. .. Whooping Cough .. 8 .. 1 .. .. .. 1 .. 4 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. 2 .. 2 .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions 2 4 .. 3 1 .. 1 .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 2 9 .. 1 .. 4 .. 3 2 1 Pneumonia (all forms) .. 12 .. 4 .. 3 .. 4 .. 1 Diarrhoea .. 1 .. 1 .. .. .. .. .. .. Enteritis 1 5 .. 2 .. .. .. 1 1 2 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. 1 .. .. .. .. .. .. .. 1 Suffocation, overlying .. 1 .. .. .. .. .. .. .. 1 Injury at Birth 4 .. 1 .. 1 .. 1 .. 1 .. Atelectasis 4 .. 2 .. 1 .. 1 .. .. .. Congenital Malformation 5 4 2 3 1 .. 1 .. 1 1 Premature Birth 29 2 10 .. 7 .. 3 .. 9 2 Atrophy, Debility & Marasmus 3 4 .. 1 1 2 1 .. 1 1 Other causes I 8 .. 3 .. 1 .. 1 1 3 51 63 15 22 12 12 8 11 16 18 114 37 24 19 34 37 38 SECTION III.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. It is difficult, in the Metropolis, to give in the limits of the report, a precis of the health services of the area, although the mere enumeration of the health services in the area is quite a simple matter. Such an enumeration, however, would be no reflex of the use made of health services by the people of Woolwich. For instance, amongst the municipal services, cases of infectious disease are removed to hospitals, all of them outside the Borough, of the Metropolitan Asylums Board, and cases of tuberculosis requiring special forms of treatment are sent to hospitals belonging to other authorities. In the same way many residents requiring hospital treatment receive it as outdoor or resident patients in various London general hospitals. In this section a brief reference is made to many of the health services, and, where the service is dealt with subsequently in the report, a reference is given to the pages where the details are to be found. i. Hospitals Provided or Subsidised by the Local Authority or by the County Council. (a) Fever and (b) Smallpox. These hospitals in the Metropolis are under the control of the Metropolitan Asylums Board, and, although there are no hospitals in Woolwich, there are several within easy reach. Most of the Woolwich cases are admitted to the Brook Hospital in Greenwich, the Park Hospital in Lewisham, or to Joyce Green Hospital near Dartford. A few go to other hospitals of the Metropolitan Asylums Board. 39 Detailed information regarding the use made of the Asylums Board's hospitals by Woolwich residents is set out 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 or private wards. (c) Tuberculosis. The arrangements for the treatment of Tuberculosis are set out in full in Section VIII. of the report. These may be summarized as follows:—A Dispensary for the examination of persons suspected to be suffering from tuberculosis is established in Maxey Road, Plumstead. All forms of treatment for this disease in individual cases originate there. Arrangements are made for the diagnosis of doubtful cases, for out-patient treatment and for institutional treatment. Briefly, the Borough Council are responsible for preventive work and for local and out-patient treatment, and the County Council are responsible for institutional treatment. No institutional treatment is provided in Woolwich except under the Board of Guardians in the Plumstead and District Hospital. (d) Maternity. The Council have made arrangements with two local hospitals for the reservation of maternity beds: (i.) The British Hospital for Mothers and Babies; (ii.) The War Memorial Hospital. The British Hospital for Mothers and Babies, formed by the amalgamation of the British Lying-in Hospital, Endell Street, and the Home for Mothers and Babies, was established in new premises in 1922. Unfortunately, owing to lack of money, only part of the Hospital was completed at that time, and only 42 beds are available. Since then the Board of Management have been actively engaged in collecting funds and have been so far successful that they were able to 40 commence building a new ante-natal clinic, which will be opened late in 1929. At the Hospital is a school for the higher training of mid wives. From the birth returns it would appear that approximately 76 per cent. of the admissions are Woolwich cases. Detailed information regarding this institution will be found on page 170. (e) Children. There is no special hospital for children in the Borough, but there is a children's ward in the War Memorial Hospital. (f) Others. The Woolwich War Memorial Hospital, which was formally opened in November, 1927, admitted its first patient on the 5th March, 1928. It is a general hospital which has, in addition, a small maternity section and an X-ray and electro-therapeutic department. It receives private patients. Seventy-two beds are provided in the general wards, 24 beds in cubicles in the general wards, and 8 beds in the private wards. In the maternity section there are 7 beds. Its total capacity is therefore 111 beds. The Council have been keenly interested in the hospital and have shown much practical sympathy in its construction, contributing in money and by labour, and by service of certain of its members on the original Hospital Committee. In detail the contributions of the Council have been as follows, the dates being those of the appropriate resolutions :— 1921-22.—Contribution of £3,000 to general building fund. 1923.—Several applications were made by the Council to the Unemployment Grants Committee for approval of the work of levelling the site, etc., to rank as part of the Council's scheme for the relief of unemployment. Sixty per cent. of the cost of this ranked for grant, but the Council's contribution was limited to £6,000. The additional amount contributed by the Unemployment Grants Committee was £13,412. 41 1925.—Grant of £3,200 as capital contribution towards the cost of children's beds. The Ministry's Maternity and Child Welfare grant is payable in respect of the loan charges. 1926-27.—Contribution of £2,500 for strip of land required for road widening purposes and for such accommodation as is necessary for ten nominated persons requiring treatment each year. 1927.—Contribution of £1,200 for further additional accommodation. 1927.—Contribution of £30,000 to enable hospital to open free of debt, subject to accommodation at hospital to extent of 60 per cent. of the existing accommodation being always available for Woolwich residents. In addition to these capital contributions, the Council have entered into agreements for:— (a) The reservation of 12 beds for children under 5 years of age ; (b) Such accommodation as is necessary for 66 maternity cases per annum ; (c) The provision of emergency maternity treatment; (d) The provision of ante-natal treatment when necessary ; (e) Artificial sunlight treatment for cases of tuberculosis ; (f) X-ray examinations of doubtful cases ; (g) Ten direct nominations per annum ; (h) Securing the reservation of 60 per cent. of the present beds for Woolwich residents ; 42 The Council have five representatives on the Board of Governors, and the Medical Officer of Health is entitled to be present at all meetings and speak, but not vote thereat. Through the courtesy of Mr. Edwin Radford, J.P., the Secretary-Superintendent of the Hospital, I am enabled to say that 1,281 patients were admitted and 4,100 cases of accidents and other emergencies were treated in the Casualty Department up to the end of the year. ii. Institutional Treatment for Unmarried Mothers, Illegitimate Infants and Homeless Children in the Area. The Woolwich and Plumstead Maternity Home was closed at the end of 1927, and there is now no provision for this class of case in the area. iii. Ambulance Facilities. (a) The Metropolitan Asylums Board's ambulance service is available for the removal to hospital, free of charge, of persons suffering from infectious disease, and, on payment, for the removal of persons suffering from non-infectious disease to hospitals or homes. (b) The ambulance service of the London County Council is available for the removal of 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 maternity cases during the day time when accompanied by a doctor or a nurse. iv. Clinics and Treatment Centres. In tabular form below is shown a list of clinics and treatment centres in the Borough. The list differs in one 43 item only from that of last year, in that a School Clinic has been provided at Eltham by the local Medical Association. Details of the work of the Welfare centres will be found in Section IX., and of the Tuberculosis Dispensary in Section VIII. Persons requiring treatment for venereal disease can attend one of the London Hospitals, the nearest to the Borough being the Seamen's Hospital, Greenwich, and St. John's Hospital, Lewisham. TABLE No. 24. CLINICS AND TREATMENT CENTRES. Situation Nature of Accommodation. By whom provided. Sessions weekly. Maternity and Child Welfare Centres. Old Town Hall, Woolwich. Doctor's room, Weighing room, Waiting rooms, etc. Woolwich Borough Council. 7 236, Plumstead High Street. Do. Do. 4 179, Well Hall Road, Eltham. Do. Do. 5 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 Holy Trinity Church Hall, Beresford Street. Doctor's room, Weighing room, Waiting room. Voluntary Organisation 1 44 TABLE No. 24—continued. Situation Nature of Accommodation. By whom provided. Sessions weekly. Sunlight Clinic. Old Town Hall, Woolwich, Treatment and Weighing rooms, etc. Woolwich Borough Council. 9 Day Nurseries. Nil. School Clinics. Brewer Street, Woolwich. Doctors' rooms, Treatment rooms, Waiting rooms. Local Medical Association. Daily. Plumstead High Street Do. Do. Daily. Park Place, Eltham . . Do. Do. Daily. Cyril Henry Treatment Centre, St. Mary Street, Woolwich. Accommodation for operating on, and detention of, cases of enlarged tonsils and adenoids. London County Council. Daily. Borough Disinfecting Station, White Hart Road, Plumstead. Accommodation for cleansing of verminous children. Woolwich Borough Council. Daily. Tuberculosis Dispensary. Maxey Road, Plumstead. Doctors' rooms, Waiting rooms, Dressing rooms, Dispensary, etc. Do. Daily. Venereal Diseases. Nil. Orthopaedic Clinic. 8, Thomas Street, Woolwich. Clinic, Waiting Room, Dressing Room. Woolwich Invalid Children's Aid Assocn. Daily. 45 v. Public Health Officers of the Local Authority. In tabular form below are shown the names, qualifications, service and duties of the members of the Public Health staff. During the year, Mr. A. G. Duck, Chief Sanitary Inspector, applied for superannuation, and Mr. H. Shaw, one of the Council's Sanitary Inspectors, was promoted to Chief Sanitary Inspector. Mr. F. A. Andrew was appointed to fill the vacancy caused by this promotion. Two other additions have been made in that the names of the Consultants appointed by the Council in connection with Artificial Sunlight Treatment and the Puerperal Fever Regulations have been included. TABLE No. 25. Year appointed. Name. Qualifications. Appointment. †l918 Mackenzie, R. E. W. M.B., D.P.H Assistant Medical Officer of Health for Maternity and Child Welfare. †1921 Blackmore, F. J. C. M.R.C.S., L.R.C.P. Assistant Medical Officer of Health and Tuberculosis Officer. †l927 Wright, C. I. M.D., B.S., D.P.H. Assistant Medical Officer (General 1891 Smith, Sir W. R. M.D., D.Sc., D.P.H., L.L.D., F.R.S.(Edin.) poses). Public Analyst (Part time) †l927 Lynham, J. E. A. B.A., M.D., D.M.R.E. Consultant, Artificial Sunlight. †l927 Taylor, H. G. F.R.C.S. Consultant, under Puerperal Fever Regulations, 1926. *1909 Shaw, H. Cert. Royal San. Inst., Cert.San.Insp.Exam. Board, Cert. San. Insp. Assocn., Cert. Meat and other foods. Chief Sanitary Inspector. (1928). 46 TABLE No. 25—continued. Year appointed. Name. Qualifications. Appointment. *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. *1920 Pendrill, H. W. Cert. San. Insp. Exam. Board, Cert. Meat and other foods. Sanitary Inspector. *1921 Harris, C. V. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. *1922 Couch, C. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst.,Cert. Meat and other foods. Sanitary Inspector. *1925 Pindar, E. B. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. *1928 Andrew, F. A. Cert. San. Insp., Exam. Joint Board. Sanitary Inspector. *1904 Farrugia, Mrs. A. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst. Woman Sanitary Inspector. †l917 Latham, Miss K. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., C.M.B. Health Visitors' Cert., Cert approved by Board of Education. Health Visitor. *†l918 Garside, Mrs. M. Cert. San. Insp. Exam. Board,C.M.B..Health Visitors' Certificate. Health Visitor and Sanitary Inspector. †l919 Burnett, Miss W. Cert. San. Insp. Exam. Board, C.M.B. Health Visitors' Diploma, Cert approved by Board of Education. Health Visitor. 47 TABLE No. 25—continued. Year appointed. Name. Qualifications. Appointment. †1919 Tibbits, Miss E. Cert. San. Insp. Exam. Board, Health Visitors' Diploma, Cert approved by Board of Education. Health Visitor. *†1919 Ware, Miss C. Cert. San. Insp. Exam. Board, C.M.B. Cert., approved by Board of Education. Health Visitor and Sanitary Inspector. †l920 Campbell, Miss M. Cert. General Hospital Training, C.M.B., Cert.San.Insp. Exam. Board. Health Visitor. †1920 Morgan, Miss F. Cert. General Hospital Training, C.M.B., Health Visitors'Cert. Maternity and Child Welfare Cert. Health Visitor. †l922 Seeeombe, Miss W. Cert. General Hospital Training, C.M.B., Health Visitors'Cert. Health Visitor. †l927 Farrell, E. V. Cert. General Hospital Training, Cert, approved by Board of Education, C.M.B., Heliotherapy Cert. Health Visitor and Artificial Sunlight Clinic Nurse. †l921 Castledine, Mrs. L. Cert. General Hospital Training. Tuberculosis Visitor. †l921 Hunter, Miss M. Cert. San. Insp. Exam. Board,C.M.B.Health Visitors' Diploma. Tuberculosis Visitor. †l921 Mahony, Miss N. Cert. General Hospital Training, Health Visitors' Cert. Tuberculosis Visitor. †l923 Luffman, Miss M. Dispensing Certificate Clerk-Dispenser. †1922 Morrison, Mrs. M. L. — Lay Organiser. CLERKS: Britter, A. Collyer, H. M. †Edwards, Mra. E. Pike, L. Prescott, H. T. Smith, H. S. †Stephenson, Miss D. Taylor, S. G. 48 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 the Public Health Acts. f Salary contributions made by Exchequer Grants. vi. Professional Nursing in the Home. During the year nursing assistance was available in all parts of the Borough. Such assistance is provided by four Nursing Associations, as follows:— Woolwich and Plumstead District Nursing Association : All Woolwich (except North Woolwich) and Plumstead. Silvertown and North Woolwich District Nursing Association : North Woolwich. Eltham Provident Nursing Association : All Eltham (except New Eltham). New Eltham District Nursing Association : New Eltham. All these Associations insist that the patient shall be under the care of a medical practitioner, and, in ordinary circumstances, only nurse non-infectious cases. On the recommendation of the Medical Officer of Health, however, they provide nursing assistance for cases of Measles, Whooping 49 Cough, Zymotic Enteritis, Ophthalmia Neonatorum, Tuberculosis, Anterior Poliomyelitis, Puerperal Fever and Puerperal Pyrexia. For nursing assistance the Borough Council pay, in necessitous cases, in accordance with the following schedule :— Disease. Measles Ophthalmia Neonatorum Zymotic Enteritis Whooping Cough Poliomyelitis Rate of Payment. 1s. per visit for one case ; 6d. per visit, per case, for more than one case in the house at the same time. Acute Primary Pneumonia and Influenzal Pneumonia Puerperal Fever Puerperal Pyrexia 1s. 3d. per visit. vii. Midwives. Through the courtesy of Dr. Menzies, the County Medical Officer of Health, I have been able to ascertain that 41 midwives gave notice during the year of their intention to practise as midwives in the Borough. viil. Maternal Mortality. At the end of the year the Council were considering a scheme for making special investigations into maternal deaths. ix. 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 will be found in Tables Nos. 37 and 38 in the Section dealing with the inspection and supervision of food. 50 x. Bacteriological Examinations. These are carried out at the Seamen's Hospital, Greenwich. In tabular form are shown below the numbers and results of the various examinations made during the year. For comparative purposes the figures for 1927 are also given. TABLE No. 26. Disease. Positive Result. Negative Result. Total, 1928. Total, 1927. Diphtheria 156 1,397 1,553 1,318 Enteric Fever 8 18 26 21 Tuberculosis 83 265 348 391 247 1,680 1,927 1,730 xi. Adoptive Acts, By-Laws and Regulations Relating to Public Health in Force in the District. Adoptive Acts. The Small Dwellings Acquisition Acts, 1899-1923, have been adopted by the Council. During the year, the Borough Treasurer tells me, the Council made 368 advances to purchasers of houses in accordance with the provisions of these Acts. In the Annual Report for 1927, a list was given of the By-laws and Regulations made under various Acts, with the dates of their adoption. As no deletions or additions were made in this list during the year, it has not been considered necessary to repeat it this year. 51 SECTION IV.—HEALTH PROPAGANDA. The education of the people in health matters is no new departure in the work of the Public Health Department, but, except for one or two spasmodic efforts, it has in the past been confined to those with whom the Department has been in direct touch, for example, mothers attending welfare centres, and no attempt had been made to get into touch with the general mass of the people. In recent years, however, a change has taken place in regard to this matter and endeavours have been made to appeal to a wider circle. The necessity for such action has been recognized by Parliament, and, so far as London is concerned, recognition is given in the London County Council (General Powers) Act, 1926, Section 42, the appropriate part of which is as follows :— " The Council within the County and the Corporation within the City of London and the Council of any Metropolitan Borough within such Metropolitan Borough may arrange for the publication of information on questions relating to health or disease and for the delivery of lectures and the display of pictures (including cinematograph displays) in which such questions are dealt with and the Council may, if they think fit, pay or contribute towards the payment of any expenses incurred by the Council of a Metropolitan Borough under this Section." D 52 In 1925, the first Woolwich Health Week was organised, and since then there has been a steady increase in this side of the Department's work. In the main it has been done by the Council's staff, but outside help has been sought and freely given not only by health organisations but by individuals. In their every-day work, the Sanitary Inspectors, Health Visitors and Tuberculosis Visitors are spreading education in health matters, not only at special centres or clinics but in the homes of the people ; but apart from this there have been a few special efforts during the year. (a) Health Exhibition. The Council co-operated in the autumn in the general scheme of health propaganda throughout the country, organized by the Health Week Committee of the Royal Sanitary Institute. The following report, presented by the Public Health Committee to the Council, gives details of the week's programme :— " We report that, in accordance with the Council's resolution of the 2nd May last, we arranged a suitable programme for Health Week, 1928, the object of which was the stimulation of public opinion in matters of health. In this we had the active and thorough co-operation of ministers of religion, employers of labour, school teachers, the local press, individual townspeople and representative associations, all of whom helped us in divers ways in making Health Week an effective force. The focus of our activities was a Health Exhibition in which we were fortunate in receiving assistance from those other Committees of the Council which deal directly or indirectly with matters which affect the public health, and from various national and local organisations. Trade exhibits were limited to those directly bearing on our work. 53 The Exhibition illustrated : (a) Certain aspects of the work of the following Committees of the Council : Public Health and Housing, Maternity and Child Welfare, Electricity, Works, Baths, Libraries and Allotments; (6) Glimpses of the every-day routine of the War Memorial Hospital, the Woolwich and Plumstead Nursing Association, the Woolwich Invalid Children's Aid Association and the Shooter's Hill Open-Air School; (c) The propaganda campaign of the British Social Hygiene Council, the Fruit Trades' Federations and the Health and Cleanliness Council. The trade exhibits were by Ambrosia Limited and Virol Limited. The arrangements included an official opening ceremony each day, in which we were fortunate in obtaining the assistance of distinguished persons ; a series of popular lectures and cinema films, and such popular features as organ recitals and the relaying of gramophone music throughout the whole exhibition by the Celestion Radio Company. We are indebted to the Minister of Agriculture and Fisheries for the loan of the model allotment and the rats exhibit ; to the Metropolitan Asylums Board for the orthopaedic exhibit ; to the Seamen's Hospital Society for the pathological exhibits ; to the Battersea Polytechnic for the model sanitary material; to the Trustees of the British Museum for the insect exhibit; to the National Baby Week Council for permission to reproduce cover page, and to many others for the loan of smaller articles. The competitions were most successful, the entries being numerous and of high merit. The articles made by fathers and the garments made or adapted by mothers gave evidence of much patience, ingenuity and skill, whilst the children's paintings demonstrated that appreciation 54 of the beautiful is a strong feature of Woolwich life. We are grateful to the various firms who contributed to the prize fund and thus enabled us to suitably reward the prize winners. The attendances during the week totalled 25,686, including 1,523 school children in conducted parties. To all who helped by exhibiting, by speaking, by lending, by giving or by working, we have extended the sincere thanks of the Council and we take this opportunity of saying that Health Week could not have been so successful without the support of the Council, the loyal co-operation of the staff and the assistance ungrudgingly given by representatives of health and other organisations within and without the Borough." (b) Health Talks to Mothers and Fathers at Welfare Centres. During January, February and March, a weekly talk was given to mothers at the Old Town Hall Centre. The last two of the talks were open to fathers as well. These talks were given by members of the Council's staff and, when it could be arranged, the subject was demonstrated practically. The average attendance was 13. The subjects and lecturers were as follows :— " The Feeding of Baby "— Miss E. Tibbitts, Health Visitor. " Preparation for Motherhood "— Mrs. M. Garside, Health Visitor. " The Clothing of Baby "— Miss K. Latham, Health Visitor. " The Nursing of the Sick Child "— Miss M. Campbell, Health Visitor. " The Feeding of the Toddler "— Miss E. Tibbits, Health Visitor. 55 " Baby's Teeth"— Dr. C. I. Wright, Assistant Medical Officer. " The Daily Bath "— Mrs. M. Garside, Health Visitor. " Common Enemies in the Home "— Dr. C. I. Wright, Assistant Medical Officer. " The Clothing of the Toddler Miss K. Latham, Health Visitor. Fathers and Mothers : " Father Assists Mother "— Mr. A. G. Duck, Chief Sanitary Inspector. " How to Guard against Tuberculosis "— Dr. F. J. C. Blackmore, Tuberculosis Officer. (c) Health Talks to School Children. In November a series of monthly talks to school children was arranged with the co-operation of the Advisory Committee of School Teachers. The series consists of five meetings and the place of meeting is the Town Hall. The general arrangement is as follows : a short talk (15-18 minutes) on a simple health subject is given by an Assistant Medical Officer and then three or four health films are shown. In the intervals between the films, health songs, specially written by a member of the staff, are shown on the screen and community singing is indulged in. Prizes are given for the best essays on one of the subjects dealt with. The details of the programme are set out below. Two talks were given in 1928 and the remaining three will be given in 1929. Subject and Lecturer. Cinema Films. "The First Law of Health- " Tommy Tucker's Tooth " Cleanliness " " Where there's Life there's (Dr. C. I. Wright) 'ope." " Food." 56 " Sunshine and Light " " Your Mouth." (Dr. C. I. Wright) " Hearts and Hands." " Sunlight is Life." " The Care of the Mouth " " The Climber." (Dr. C. I. Wright) " The Care of the Teeth." " Giro, the Germ." " Simple Health Principles " " Don't Wait until it (Dr. C. I. Wright) Hurts." " Inside Out." " Grade ' A ' (T.T.) Milk." " A Dangerous Handicap." " Common Pests in the Home " " Where there's Life there's (Dr. C. I. Wright). 'ope." " The Tale of the Flea, the Bug and the Louse." " A Brush with the Enemy." (d) Slogan Work. How to make effective use of slogans for health propaganda is not an easy matter. The words used have to be carefully chosen, must be apt, and must convey a message. They must not be in too general terms. Their effectiveness is limited to a few weeks if fixed, but if on a moving object this period is extended. In our slogan work we have made use of daylight signs of the prismatic glass type. On each of the Department's three motor vans, one of these signs is fixed, and additional stencils have been provided. The signs measure 48 ins. by 9 ins., and, without the stencil, cost just over £3 10s. 0d. each. Each stencil costs about 15s. 0d., depending upon the number of letters. The stencils used during the year were as follows :— Woolwich Health Exhibition (Date). Fresh Air and Sunshine Bring Health. Burn your Refuse and Save your Rates. Buy Clean Food at Clean Shops. The Doctor Says—Avoid Stuffy Rooms. 57 The method is a convenient one of bringing slogans to the attention of the public and is worthy of further development. It is not expensive and after the initial outlay there is no limit to the slogans that may be used at a reasonable cost. It further possesses the advantage that the message reaches all the streets in the Borough, and, if the colours are carefully chosen, people instinctively read the slogans. (e) In addition, lectures have been given by members of the staff to Guilds and Mothers' Meetings and Associations of a like nature. 58 SECTION V.—SANITARY ADMINISTRATION. Staff. This section of the Department is under the control of the Chief Sanitary Inspector, who is assisted by nine male Sanitary Inspectors, one woman Inspector and two parttime woman Inspectors. In addition to the duties reported on in this part of the report, all the male Sanitary Inspectors are engaged in some way or other in the supervision of the food supplies. Complaints. In accordance with the provisions of the Public Health (London) Act, 1891, a complaint book is kept and all complaints, both written and oral, are recorded therein ; inspections are then made and the necessary steps taken to remedy any nuisances that may be found. During the year 2,102 complaints were received, compared with 2,589 in 1927. Water Closet Accommodation. Except in the outlying parts of the Borough, where, as a temporary expedient, cesspools or earth closets are in use, every house in the Borough is connected with the water carriage system. The number of cesspools regularly emptied by the Council was 12 in Plumstead and 14 in Eltham. Scavenging. Scavenging, which includes the storage, removal and disposal of house refuse and trade refuse, is under the control of the Works Department. With very few exceptions all house refuse is deposited first of all in moveable dustbins, which are emptied once a week, and, in certain parts of the Borough, twice weekly. Electric vehicles are used for the transport of the refuse from its source to the Council's destructor at Plumstead. The refuse, before 59 burning, is subjected to a preliminary sorting whereby tins and old iron are removed. These are crushed in a hydraulic press and are sold. The remainder of the refuse is burnt. The clinker residue from the furnace is put through a special plant, mixed with bitumen, and then used for surfacing certain classes of roads in the Borough. An arrangement exists whereby the dust inspector notifies the Health Department of houses without suitable dustbins, and immediate action is taken to see that a proper one is supplied. Trade Refuse. The collection of trade refuse is carried out by the Works Department at a charge of 5s. Od. per load. In order to obtain the removal of trade refuse, application must be made at the Town Hall and the charge prepaid. During the year approximately 2,594 loads were removed. Offensive Trade Refuse. Specially designed sealed airtight metal bins are provided by the Council for this work and a charge of sixpence is made each time one is used, the full receptacle being removed and a clean empty one substituted. The bins are collected daily and are transported by means of an electric motor tractor and a closed trailer with sliding doors. The refuse is disposed of to a manufacturer of guano at Poplar and the receptacles are cleansed by steaming and washing. Drainage. The law relating to combined drains was modified to some extent during the year by the terms of the London County Council (General Powers) Act, 1928, subsection 1 of section 32, of which reads as follows :— " For the purposes of the Metropolis Management Acts, 1855 to 1893, as amended by any subsequent Act, a drain for draining any group or block of houses by a combined 60 operation shall not become or be deemed to have become a sewer or cease or be deemed to have ceased to be a drain within the meaning of the definition contained in Section 250 of the Metropolis Management Act, 1855, by reason only of the fact that the drainage of premises not included in the order relating to such combined operation has been connected with such drain either before or after the passing of this Act, and any such additional drainage shall be deemed to have been included in such order. Provided that nothing in this section shall empower a borough council to connect or authorize the connection of any sewer to any such drain." Speaking broadly, Section 32 means that combined drains cannot now become sewers surreptitiously or by accident. It is, however, much narrower in scope than Section 21 of the Woolwich Act, which lays down that in all circumstances combined drains are drains, whereas, in Plumstead and Eltham, combined drains are only such if at some time or other plans have been approved by the Council for all or part of the system. Section 21 of the Woolwich Borough Council Act, 1905, is as follows :— " In the application to the parish of Woolwich of the provisions of the Metropolis Management Acts, 1855 to 1893, and other enactments applying to London and notwithstanding anything contained therein or in any Act of Parliament in force within any part of the said parish prior to the first day of November one thousand nine hundred, the word " drain " shall include any drain constructed before the said first day of November one thousand nine hundred and draining any group or block of houses by a combined operation and the word " sewer " as defined by section 250 of the Metropolis Management Act, 1855 shall not mean or include any such drain." 61 During the year 26 complaints were received with regard to obstruction of combined drains. On investigation it was found that 125 houses in all were affected and in every case the drains were cleared. In all the systems, except two, the obstruction was of a temporary nature or was due to slight defects which admitted of a remedy at the time. Costs recovered from the owners amounted to £3 14s. 6d. In two instances, however, reconstruction was necessary. After service of the necessary notices, and on receipt of the consent of the owners, the work was carried out by the Works Department of the Council, the costs being paid by the owners in their proper proportions. Sanitary Inspection of the Area. Details of the inspections made by the Sanitary Inspectors and the types of nuisances abated during the year are shown below in Tables 27 and 28. In connection with these inspections, it was found necessary to serve 3,558 intimation and 896 statutory notices, the corresponding figures for last year being 3,513 and 863 respectively. The statutory notices related to 751 premises and included 699 general notices, 111 ashpit, 44 water closet, 31 paving and 2 others served under the Public Health (London) Act. In addition to these, 9 were served under the London County Council (General Powers) Acts. In 154 instances the owners neglected to comply with the statutory notice and in these cases the Town Clerk was requested to institute legal proceedings ; this figure compares with 182 for the previous year. It is the practice in this Borough for the Town Clerk in these circumstances to write a letter reminding the owner that he is in default in not complying with the notice and requesting immediate attention. On account of this arrangement it was found necessary to apply for only seven summonses, details of which are set out in Table No. 32. In addition, eight other summonses were taken out for failure to comply with Magistrates' Orders. 62 TABLE No. 27. Inspections. Housing Survey—Houses Inspected 3,820 Complaints Investigated 2,102 Outworkers' Premises 820 Houses Let in Lodgings 198 Homes re Verminous Cases 785 Homes re Scabies Cases 153 Overcrowding Investigated—Rooms 92 Underground Rooms Illegally Occupied 5 Drainage Inspections 557 Drains tested by Smoke Test 92 Drains Tested by Water Test 21 New Houses 749 Tents and Vans 11 Factories 187 Workshops 548 Workplaces 43 Theatres and Cinemas 25 Rag and Bone Premises 16 Urinals Accessible to the Public 318 Women's Lavatories 408 Smoke Observations 332 Special Inspections re Rats 126 Inspections re Mosquitoes 36 Miscellaneous (Unclassified) 1,799 Re-inspections 10,273 TABLE No. 28. Nuisances Abated. Cleansing- Interiors Cleansed 1,423 Rooms Cleansed 3,105 63 Damp Conditions— Walls 788 Sites 4 Roofs 1,062 Rain Water Pipes and Gutters 698 Others 21 Dilapidations— Walls 693 Ceilings 520 Floors and Hearths 321 Coppers 174 Stoves 183 Verminous Conditions— Rooms Cleansed 264 Defective Lighting— Windows Repaired 56 ,, Enlarged 6 „ Additional — Defective Ventilation— Windows Rendered Usable 543 „ Additional Provided 6 Other Means 11 Defective Paving— Yards Re-paved 106 „ Repaired 144 Scullery Floors Re-paved or Repaired 113 House Drains— Defective Drains Repaired 86 Choked Drains Cleared 249 Vent Pipes Repaired 22 Soil Pipes Repaired 13 Gullies Fixed 53 New Drainage 3 64 Rain Water Tanks Repaired 5 „ „ Abolished 7 Sinks Repaired or Provided 124 Wastes Cleansed 91 Wastes Trapped or Repaired 117 Water Closets— Flushing Apparatus Repaired 299 Flushing Apparatus Renewed 77 New Pans 173 New Traps 154 Foul Pans Cleansed by Owner 50 Foul Pans Cleansed by Occupier 60 Additional w.c.'s Provided 7 Doors and Fastenings Remedied 124 Dust Bins Provided 486 Underground Rooms Closed 1 Overcrowding—Cases Remedied 26 Water Supply— Additional — Re-instated 24 Cisterns Cleansed 1 Cisterns Covered 5 Foul Accumulations— Manure Removed 56 Offensive Accumulations Removed 74 Back Yards Cleansed 58 Dung Pits Provided 2 Rats— Drains Repaired in Consequence 4 Premises Rat-Proofed 8 Other Effective Measures 3 65 Rag and Bone Premises— Premises Cleansed — Rain-proof Premises Provided — Vermin-proof Conditions Provided — Miscellaneous 173 Rats. Every male Inspector has been authorized under the Rats and Mice (Destruction) Act, 1919, to act as Rats Officer in his own district. The Act places the responsibility for rat preventive measures upon the occupiers of premises and it is the duty of the Inspector to advise occupiers as to the best means of rat-proofing buildings and for the destruction of rats. In every case in which complaint was made of rat infestation that procedure was followed. The Council co-operated in the general scheme throughout the country during Rat Week. With the assistance of the Works Department 8,242 baits were laid in the old sewers of Woolwich and Plumstead that were likely or known to be infested with rats. Co-operation was sought and readily obtained from the many large firms in the Borough. During the year 18 informal notices were served but in no instance was it necessary to resort to legal proceedings. Mosquitoes. For some years past the number of complaints of these pests has gradually decreased, and last year none was received. The marsh ditches, except a few private ones, are now concrete inverts and the drainage of the marshes is very much improved. In addition the area was carefully supervised during the year. Rag Flock Acts, 1911 and 1928. The Rag Flock Act, 1911, was amended in 1928 in order to remove any doubts as to the meaning of the phrase " flock manufactured from rags." It is now defined as flock which has been produced wholly or partly by tearing up woven or knitted or felted 66 materials, whether old or new. It does not include flock obtained wholly in the processes of scouring and finishing of newly woven or newly knitted or newly felted fabrics. The original Act and the Regulations made thereunder prescribe a standard of cleanliness for rag flock. During the year one sample was taken for analysis and it complied with the regulations in as much as the soluble chlorine in the form of chlorides was 25 parts of chlorine in 100,000 parts of flock. The legal limit is 30 parts. Rag flock is only manufactured on a wholesale scale at one factory in the Borough, but it is sold at several shops. 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 chimney stacks under observation and record any nuisance from smoke. In addition to this, special investigations are made where complaints are received. In the course of the year, 332 special observations were recorded and 28 offences were discovered. All the offenders were warned and one written notice was served. It is not quite fair in this matter to assume that smoke pollution of the atmosphere is due entirely to the factory chimney. Indeed, many authorities on this subject say that most of the blame should be apportioned to the domestic chimney—being another illustration, if such be needed, of the result of an accumulation of little things. This aspect of this problem will be with us for many years yet, owing to the inborn preference of the inhabitants of these isles for that traditional British picture—the open fire. Efficient substitutes have been provided by the use of electricity, gas and special fuels, 67 which are being used at an increasing, if slow, rate, and their general use would solve the problem of the nuisance arising from domestic chimneys. Apart from the domestic chimney, the question of smoke abatement in Woolwich is not a serious one. Factory and Workshop Act. The Medical Officer of Health ia required to include in his Annual Report details of the administration of this Act in his district. The total number of factories, workshops and workplaces on the register was 233. The number of inspections was 778, compared with 832 in 1927. The number of sanitary defects found was 59, and 54 of these had been remedied at the end of the year. Bakehouses are specially reported on in the section dealing with the supervision of food. The number of inspections of Outworkers' premises, 820, compares with 766 for 1927. Most of the outworkers in the Borough have been employed in the manufacture of tennis balls or wearing apparel, but towards the end of the year an additional number were employed by the manufacturers of elastic products. The supervision of places where home work is carried on is done by the woman Sanitary Inspector. She finds that, generally speaking, home work is carried out under sanitary conditions, but it was necessary to serve 17 notices for minor offences. There were two cases of infectious disease in the homes of the outworkers. 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. e 68 TABLE No. 29. Factories, Workshops, Workplaces & Homeworkers' Premises. 1.—Inspection. Including inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written notices. Prosecutions. Factories 187 21 – (Including Factory Laundries). Workshops 548 3 – (Including Workshop Laundries). Workplaces 43 – – (Other than Outworkers' Premises) Homeworkers' Premises 820 17 – 2.—Defects Found. Description. Number of Defects. Found. Remedied. Referred to H.M. Inspect'r Number of Prosecutions. Nuisances under Public Health Act :— Want of Cleanliness 19 18 — — Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 18 14 — — Sanitary Accommodation insufficient 2 2 — — unsuitable or defective 20 20 — — not separate for sexes — — — — Offences under* the Factory and Workshop Act :— Illegal occupation of underground bakehouses (s. 101] — — — — Other offences — — — — Total 59 54 — — 69 3.—Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices served. Prosecutions. Wearing Apparel :—making, etc. 11 11 — Racquet and Tennis Balls 6 6 — 17 17 — Mortuaries. The Public mortuary is in Sun Street, Woolwich, and a temporary Mortuary is provided in High Street, Eltham. The following Table shows the use made of the Mortuaries during the year. TABLE No. 30. Sun Street Sun Street (Infectious) Eltham. All Mortuaries. 1927 1928 No of Bodies received : (a) for inquest 30 1 — 48 31 (b) for custody 16 — 2 8 18 No. of Post - Mortem Examinations 46 1 2 56 49 17 — – 21 17 Cemeteries. There are two Cemeteries in the Borough, designated respectively the Woolwich and the Plumstead Cemetery. Both are owned by the Council and both are in the parish of Plumstead. In addition, there are two Churchyards, one at Eltham and one in Plumstead. Burials in Plumstead Churchyard are limited by a Home Office Order of 1893, and, in each case, 24 hours' notice must be given to the Medical Officer of Health of any proposed interment. Only a few burials take place in the Plumstead Churchyard. 70 The Woolwich Cemetery was opened in 1856 and enlarged in 1886, and its two portions are 12.73 and 19.67 acres respectively. The Plumstead Cemetery was opened in 1890 and its area is 30.43 acres. At the end of 1927, the Cemeteries Committee had under consideration the necessity for providing additional burial accommodation in the parish of Eltham, and on their recommendation the Council adopted the Burials Acts, 1852-1900 for that parish, a condition precedent to the provision of a Cemetery. At the end of 1928 no suitable site had been found, but the matter was receiving the attention of the Committee. Exhumations. During the year five exhumations under Home Office licences were made in local graveyards. Where such a licence is granted the Medical Officer of Health is notified by the Home Office in order that the necessary action in the interest of public health may be taken. At each exhumation a Sanitary Inspector was present. In Table No. 31 which follows, is shewn the number of interments in the different graveyards in the Borough. The information regarding the interments at the Cemeteries is given through the courtesy of the Town Clerk and, in the case of Eltham, through that of the Vicar of Eltham. TABLE No. 31. Number of Interments. 1926. 1927. 1928. Woolwich Cemetery 566 554 604 Plumstead Cemetery 688 654 643 Eltham Churchyard 183 200 227 Plumstead Churchyard 15 8 8 1,452 1,416 1,482 71 Legal Proceedings. The particulars of the various prosecutions instituted under the Public Health (London) Act, 1891, and kindred Acts, for offences connected with sanitary administration are set out in detail in the following Table No. 32. TABLE No. 32. Prosecutions under Public Health and kindred Acts. No. Date of Hearing. Offence. Situation. Result. I 1928. 12th Jan. Default in complying with a Nuisance Order. 2, Frederick Place. Fined £10. 2 do. do., do. 3, Frederick Place. Fined £10. 3 do. do., do. 4, Frederick Place. Fined £10. 4 do. do., do. 5, Frederick Place. Fined £10. 5 do. do., do. 6, Frederick Place. Fined £10. 6 do. do., do. 7, Frederick Place. Fined £10. 7 do. do., do. 8, Frederick Place. Fined £10. 8 do. Default in complying with a Closing Order. 31, Frederick Place. Fined £10. 9 do. Defective roof and paving; dirty condition of interior. 60, Anglesea Road. Adjourned two weeks. 26th Jan., work done. Costs 10/- 10 14th Feb. Defective guttering, roof, down-spout and paving. 10, Westdale Road. Work done. Summons withdrawn. Costs 10/-. 72 TABLE No. 32—continued. No. Date of Hearing. Offence. Situation. Result. 11 1928. 31st May Defective drain and w.c. basin ; defective ceiling. 14, Nelson Street. Order to abate in 14 days; Fined £5. 12 do. Defective yard paving do. Various adjournments to June 28th — work done. Costs £2 2s. 13 28th June Damp walls 72, Lakedale Road. Work done; Summons withdrawn. Costs £2 2s. 14 do. Damp walls 76, Lakedale Road. Work done. Summons withdrawn. 15 24th July Defective and leaky roof 8, Collingwood Street. do., do. 73 SECTION VI.—INSPECTION AND SUPERVISION OF FOOD. It has been apparent in recent years that dealers in food stuffs are recognizing in greater measure the importance, from their point of view, of preventing contamination and sophistication of the food supplies, and greater efforts are being made by the trade to deliver a pure food supply. Various factors are contributing to this. A pure food cry is one that appeals to the average housewife, if she is satisfied that the goods supplied justify the claims made. Additional legislation has been passed by Parliament and administrative Regulations have been made by the Minister of Health, and in consequence increased powers have been given to, and additional duties placed upon, local health authorities. During the year the Food and Drugs (Adulteration) Act was passed and it came into operation on the 1st January, 1929. It is a consolidating Act and repeals the series of Acts known as the Sale of Food and Drugs Acts, 1875-1927. The Public Health (Preservatives in Food) Regulations, 1925, came into force to their full extent on the 1st January, 1928. Metropolitan Borough Councils were given power to register premises where ice cream is made or sold. In brief, the work of the Sanitary Inspectors in relation to food may be classified under four heads :— (a) Inspection of food premises. (b) Supervision of food handling preparatory to sale. (c) Inspection of food as to soundness. (d) Examination of samples of food for adulteration. 74 A report on their work under these various heads during the year is given in this Section. The following Table No. 33 shows 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. All the notices were complied with. TABLE No. 33. Premises. On Register 31st December. Number of Legal Proceedings. Inspections. Notices. Bakehouses 37 76 8 — Cowsheds 20 244 4 — Milkshops 96 575 3 — Ice Cream Shops 129 317 1 — Slaughterhouses 7 25 — — Fried Fish Shops 62 238 23 — Butchers' Shops 90 346 7 — Premises where Food is prepared (other than above) 145 684 10 — Shops and Markets — 2322 — — MILK SUPPLY. Registration. The number of registered dairy premises at the end of the year was 96 ; 24 of these were in Woolwich, 41 in Plumstead, and 31 in Eltham. These premises were in the occupation of 65 registered dairymen or 75 veyors of milk. In addition, 19 dairymen were registered whose registered premises were in adjoining areas. The number of cowkeepers was 6. During the year there were several changes in the register but no person was struck off on account of danger to the public health by reason of his method of handling, storing or distributing milk. Cowkeepers. The six registered cowkeepers in the Borough hold licences for 20 cowsheds in all with accommodation for 437 cows. The average number of cows kept was 340. These cowsheds were regularly inspected and it was found necessary to serve four notices. Inspections of cowsheds are usually made at milking time, when the Inspector is thus enabled to judge whether the cows are being milked under conditions which allow for the maintenance of a reasonable standard of cleanliness at that time, and whether proper precautions are being taken against the contamination of the new milk. In general, the conditions were satisfactory. Dairymen and Purveyors of Milk. The Milk and Dairies Order, 1926, lays down general provisions for securing milk against the risk of infection or contamination, not only in dairies but in its conveyance and distribution by means of churns or other utensils. These Regulations have been extremely useful in improving the conditions under which milk is handled, particularly with regard to dairy premises, and, on the whole, it may be said that a fair standard of excellence has been reached, although a minority of the milkmen have still only an elementary idea of the principles underlying the bottled milk trade. To the ordinary member of the public, bottled milk suggests clean milk in a clean bottle, filled and sealed in a clean dairy, and delivered without any tampering to the consumer. The vast majority of bottles of milk sold in Woolwich came within this category, but there is an 70 important, if relatively small, minority of bottles sold which do not comply with the terms of the Order. Owing to the action of large firms and to the public demand, the bottled milk trade has come to stay. Unfortunately, there are individuals who are prepared to supply milk in bottles without taking the trouble to do the work entailed in a clean, proper and hygienic manner. In dairies, unclean and unsatisfactory methods of filling bottles have been detected by the Inspectors, and advice and warning have been given. Roundsmen have been caught filling and sealing dirty milk bottles in the street, and discs for sealing have been found in dirty pockets— obviously an intermediate place between the original packet and the bottle. Proceedings for such infringements of the Regulations were pending at the end of the year. It is important, however, to remember that supervision can never be so complete as to prevent their non-occurrence. The public, by refusing to deal with those who use such methods, will do more for a pure milk supply than any set of milk regulations. Whenever your milk goes wrong quickly, think whether the dairyman is not to blame before you blame the weather. The Milk (Special Designations) Order, 1923. This Order authorises the Council to grant licences for the sale of designated milks, which may be sold under any one of the following descriptions :—Certified, Grade " A," Grade " A " (Tuberculin Tested) and Pasteurised. The licences have to be renewed annually and all expire on the 31st December. Twenty-five applications were received for Dealers' and eight for Supplementary licences, all, with one exception, being granted. The total amount received in fees was £7 1s. 0d. In the following Table are given details of each licence issued. 77 TABLE No. 34. Name and Address of Applicant. Nature of Licence. Premises to Sell at or from. Designation. The Express Dairy Co., Ltd., Tavistock Place, W.C. 1. Dealer 3, Wellington Street, Woolwich. Certified. Do., do. do. do., do. Grade " A " (Tuberculin Tested). Do., do. do. do., do. Pasteurised. The United Dairies (London), Ltd., do. 124, Westmount Road, Eltham. Certified. 2-6, Canterbury Road, Brixton, S.W. 9. Grade " A " Do., do. do. do., do. (Tuberculin Tested). Do., do. do. do., do. Grade " A." Do., do. do. do., do. Pasteurised. Do.. do. do. " Ashurst," Certified. Shrewsbury Lane, Plumstead. Do., do. do. do., do. Grade " A " (Tuberculin Tested). Do. do. do. do., do. Grade " A." Do., do. do. do., do. Pasteurised. Do., do. do. 16, Pollipar Road, Woolwich. Pasteurised. Do. do. do. 125, Eltham High Street Pasteurised. Do., do. do. 62, Plumstead Common Road. Pasteurised. Do., do. Supplementary. 74, Little Heath, Charlton. Certified. Do., do. do. do., do. Grade " A " (Tuberculin Tested). Do., do. do. do., do. Grade " A." Do., do. do. do., do. Pasteurised. Do., do. do. 30, Burnt Ash Road, Lee. Certified. 78 TABLE No. 34—continued. Name and Address of Applicant. Nature of Licence. Premises to Sell at or from. Designation. The United Dairies (London), Ltd., 2-6, Canterbury Road, Brixton, S.W. 9. Supplementary- 30, Burnt Ash Road, Lee. Grade " A " (Tuberculin Tested). Do., do. do. do., do. Grade "A." Do., do. do. do., do. Pasteurised. The Eltham and Sidcup Farm Dairies, Ltd., 76, Finsbury Pavement, E.C. 2. Dealer 102, Westmount Road, Eltham. Certified. Do., do. do. 21, Princes Road, Plumstead. Certified. Do., do. do. 397, Footscray Road, Eltham. Certified. Do., do. do. 82, Eltham High Street Certified. A. E. Slater, 30, Eltham High Street. Dealer 30, Eltham High Street. Certified. H. J. Attree, 62, Plumstead Common Road. Dealer 62, Plumstead Common Road. Grade " A " (Tuberculin Tested). W. J. Porter, 18, Well Hall Parade. Dealer 18, Well Hall Parade Grade " A " (Tuberculin Tested.) R. Bowyer, 310, High Road, Lee, S.E. 13. Dealer 40, Well Hall Road Certified. E. J. Cole, 18, Camrose Street. Dealer 18, Camrose Street Certified. Do., do. do. 20, Plumstead Road Certified. During the year nine samples of these milks were taken at the request of the Ministry of Health in order to test whether the milk complied with the bacteriological standards laid down in the Order, which lays down, in the case of Certified Milk, " not more than 30,000 bacteria per cubic centimetre and no coliform bacillus in one-tenth of a cubic 79 centimetre." In similar circumstances, samples of Grade "A" (Tuberculin Tested) milk were taken, where the standard is not so high. The results of the examinations are detailed herewith:— TABLE No. 35. Date. Designation. Bacteria per c.c. Coliform Bacilli. 24th February Grade " A " (T.T.) 1,800 Absent in .01 c.c. 30th April' Certified 2,466 Absent in 1 c.c. 2nd July Certified 1,006 Absent in 1 c.c. 31st July Certified 12,000 Absent in 1 c.c. 27th August Grade " A " (T.T.) 910 Absent in .01 c.c. 4th September Certified 9,200 Absent in 1 c.c. 25th September Certified 4,666 Absent in 1 c.c. 19th October Certified 3,446 Absent in 1 c.c. 24th November Certified 1,443 Absent in 1 c.c. The Public Health (Condensed Milk) Regulations, 1923- 1927. These Regulations provide a standard for condensed milk and lay down conditions under which it may be described or sold. Towards the end of 1927 amending Regulations were passed which became fully effective on the 1st September, 1928. In effect, these amendment Regulations were made for the purpose of ensuring that the description " Unfit for Babies " was properly displayed to the public, and laid down that such words should be printed in type not less than a quarter of an inch in height and contained in a surrounding line. During the year six samples were taken and all were 80 found to be genuine. Observations were also made for the purpose of ensuring that the Regulations, so far as labelling is concerned, were being complied with. The Public Health (Dried Milk) Regulations, 1923-1927. These Regulations provide for conditions under which dried milk may be sold and labelled. For the same reason, as in the case of condensed milk, amending Regulations were made which also came into full operation on the 1st September, 1928. Five samples were taken and submitted to the Public Analyst, who certified them all to be genuine. MEAT. The Public Health (Meat) Regulations, 1924, have effected the most obvious change in recent years in the work of the Sanitary Inspectors, as one of the most important objects of these Regulations was the inspection of carcases before removal from slaughterhouses. In 1924, the number so inspected was negligible ; in 1928, it was nearly 25,000. Most of the inspections take place at the Royal Arsenal Co-operative Society's slaughterhouse at Abbey Wood, but there are six other slaughterhouses where a smaller number of killings are made. During the year 2,344 cattle, 10,993 sheep and lambs, 10,069 pigs, 1,364 calves, and 2 goats—a total of 24,772 animals—were killed in the various slaughterhouses in the Borough and all were examined. No case of slaughtering without notice was detected. The number of whole carcases condemned on account of disease was 28—1 bullock, 26 pigs, and 1 calf. In 702 instances partial condemnation was necessary in respect to 124 cattle, 106 sheep, 470 pigs, and 2 calves. 81 All shops and stalls where meat is sold are also regularly inspected, and, if any insanitary conditions are discovered, measures are taken at once to secure their abatement. There is no public slaughterhouse in the Borough. Slaughterhouses are subject to annual licence from the London County Council, and, in the Table which follows, are shown those licensed at the end of the year. TABLE No. 36. Situation of Slaughterhouse. Owner. Bostall Farm, Abbey Wood Royal Arsenal Co-operative Society, Ltd 14, Church Street Portlock, T. W. 30, Hare Street Vicars, Hedley 33, Herbert Road Anderson, F. 168, Eltham High Street Garnsey, A. S. 6, Plumstead High Street Reed, H., & Co., Ltd. 38, Plumstead Common Road Reed, H., & Co., Ltd. OTHER FOOD PREMISES. Bakehouses. The number in the Borough on the 31st December was 37, of which 17 were factory and 11 underground. The district Inspectors made 76 inspections and served 8 notices which in most instances were for cleansing of the walls and ceilings. No legal proceedings were taken. Fried Fish Shops. There were 62 fried fish shops on the register at the end of the year. These premises were inspected on 238 occasions and 23 notices were served for breaches of the by-laws. Ice Cream Premises, etc. The number of premises where Ice Cream was sold during the year was 129, but in many 82 instances the sale was intermittent. 317 inspections were made and one notice was served. The London County Council (General Powers) Act, 1928, lays down that any premises used or proposed to be used for the sale or manufacture or storage of ice cream or similar commodity shall be registered with the sanitary authority. Hotels, restaurants and clubs, and certain factories and workshops are exempt from registration. Other Premises. As all premises where food is prepared or sold should be maintained in a proper hygienic condition, they are subjected to regular inspection. During the year 1030 such inspections were made of 235 premises, including restaurants, eating-houses and butchers' shops. Ten notices were served for insanitary conditions, which were, in the main, associated with want of cleanliness in the conduct of the business. In addition, 2,322 visits were paid to shops and to stalls in the markets. UNSOUND FOOD. There were 288 instances of unsound food being surrendered. These compare with 337 in 1927. Included in the food surrendered were : Beef, 1 ton 10 lbs. ; Pork, 2 tons 11 cwts. 2 qrs. 17 lbs. ; Mutton, 2 cwts. 16 lbs. ; Pig's Liver, 6 cwts., 3 qrs., 18 lbs. ; Ox Liver, 10 cwts. 11 lbs. ; Sheep's Liver, 2 cwts. 2 qrs. 15 lbs. ; Fish, 9 cwts. 26 lbs. ; Pepper, 30 tons 10 cwts. ; Potatoes, 5 tons ; Condensed Milk, 1,872 tins; and smaller quantities of Fowls, Sausages, Fruit, Groceries, etc. Information was received on one occasion during the year of articles of condemned food coming into the Borough to be used as animal food. The necessary supervision was exercised to ensure that none of this was used for human consumption. 83 Unsound food was seized on four occasions. In three of these cases, which were concerned with the deposit of food, no proceedings were taken as the Town Clerk did not consider the evidence sufficiently strong to warrant proceedings. In the other case proceedings were taken. FOOD POISONING. No case of food poisoning was reported during the year. ADULTERATION, ETC. The year 1928 marks the passing of the Sale of Food and Drugs Acts, 1875-1927. In their place is the Food and Drugs (Adulteration) Act, 1928, which came into operation on the 1st January, 1929. The number of samples taken during the year was 559, 23 of which were certified by the Public Analyst to be adulterated. The percentage of adulterated samples, 4.11, compares with 4.5 for 1927. The number of samples taken on Sundays was 20, none of which was adulterated. The Act requires that samples purchased for analysis shall be divided into three parts and provides for the proper disposal of each part. As a matter of convenience, however, a practice has grown up of taking informal samples, and approximately two out of every five samples taken were informal. This practice enables articles to be bought in small quantities withont arousing suspicion when the sample is being taken. These samples are analysed in the usual way but if any sophistication is found, formal samples are immediately taken. The following Table gives details of the various analyses made under the Sale of Food and Drugs Acts, the Public Health (Condensed Milk) Regulations, the Public Health (Dried Milk) Regulations, and the Public Health (Preservatives, etc., in Food) Regulations. F 84 TABLE No. 37. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Milk 273 — 273 4 Separated Milk 1 — 1 — Cream 2 19 21 2 Condensed Full Cream Milk — 2 2 — Condensed Skimmed Milk — 4 4 — Dried Full Cream Milk — 3 3 — Dried Half Cream Milk — 1 1 — Dried Full Cream Milk (Modified) — 1 1 — Butter 10 14 24 3 Margarine 5 — 5 — Coffee — 4 4 — Tea — 5 5 — Jam — 11 11 — Sugar — 5 5 — Mustard — 2 2 — Lard — 8 8 — Brawn — 5 5 — Sausages 2 15 17 2 Mincemeat — 4 4 — Tripe 3 5 8 2 Faggots 5 — 5 — Meat Paste — 2 2 — Fish Paste — 3 3 — Suet 3 10 13 5 Dripping — 5 5 — Self-Raising Flour — 6 6 — Syrup — 3 3 — Baking Powder — 2 2 — Vinegar — 2 2 — Malt Vinegar — 3 3 — Ground Ginger — 2 2 — Pickles — 5 5 — 85 TABLE No. 37—continued. Article. Formal Samples. Informal Samples. Number Analysed Number Adulterated. Black Puddings — 5 5 — Green Peas 1 5 6 — Cheshire Cheese — 2 2 — Dutch Cheese — 2 2 — Lemon Cheese — 2 2 — Pearl Barley 5 — 5 — Honey — 5 5 — Powdered Rhubarb — 4 4 — Mintips — 5 5 — Crushed Linseed — 6 6 — Paregoric — 2 2 — Milk of Sulphur — 3 3 — Liniment of Turpentine 1 8 9 1 Camphorated Oil — 3 3 — Castor Oil — 2 2 — Aspirin — 3 3 — Boric Ointment — 2 2 — Strong Mercury Ointment 1 3 4 2 Olive Oil — 5 5 — Seidlitz Powders — 3 3 — Gregory's Powder — 4 4 — Easton's Syrup 1 10 11 2 Quinine Wine — 4 4 — Paraform — 1 1 — Prescriptions 6 — 6 — 319 240 559 23 The Public Analyst has furnished the following figures showing the percentages of fat found in each sample of milk submitted for analysis during the last three years:— 86 TABLE No. 38. 1926. 1927. 1928. 4 5% and over 5 8 2 4% and under 4.5% 9 15 10 3.5% and under 4% 138 106 115 3% and under 3.5% 126 134 142 Below 3% 4 1 4 282 264 273 ADULTERATED SAMPLES—ACTION TAKEN. The following Table No. 39 shows the number of adulterated samples and the action taken in each instance where the samples were formal. TABLE No. 39. Sample No. Article. Formal or Informal. Result of Analysis. Result of Proceedings or other action. 16 Milk Formal 10 per cent. deficient in fat. Summons dismissed. £5 5s. 0d. costs. 28 Milk Formal 11.66 per cent. deficient in fat. Summons dismissed. £5 5s. 0d. costs. 35 Liniment of Turpentine Informal 41 per cent. deficient in rectified oil of turpentine. — 79 Tripe Informal Contained 0.17 per cent. of boric acid. — 88 Tripe Formal Contained 0.15 per cent. boric acid. Fined £2 and £2 2s. 0d. costs. 152 Strong Mercury Ointment. Informal 20 per cent. deficient in mercury. — 168 Strong Mercury Ointment. Formal 20 per cent. deficient in mercury. Summons dismissed. £2 2s. 0d. costs. 87 TABLE No. 39—continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Proceedings or other action. 234 Cream Informal 0 07 per cent. of boric acid. — 265 Easton's Syrup Informal 34.8 per cent. deficient in iron. — 281 Gaston's Syrup Formal 34.8 per cent. deficient in iron. No action. 299 Milk Formal 10.33 per cent. deficient in fat. Fined £2 and £2 costs. 300 Milk Formal 17 per cent. deficient in in fat. Fined £10 and £2 2s. 0d. costs. 353 Suet Informal 9.75 per cent. of rice flour. — 355 Suet Informal 10.8 per cent. of rice flour. — 357 Suet Informal 19.7 per cent. of rice flour. — 363 Suet Formal 17.9 per cent. of rice flour. No action. 375 Sausages Informal 164 parts per million of sulphur dioxide. — 378 Suet Formal 9 per cent. of rice flour. No action. 412 Cream Informal 0.33 per cent. of boric acid. — 441 Butter Informal 0.1 per cent. of boric acid. — 443 Butter Informal 0 03 per cent. of boric acid. — 452 Butter Formal 0.13 per cent. of boric acid. Vendor cautioned. 537 Sausages Informal 328 parts per million sulphur dioxide. — 88 CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. No chemical analysis, other than that referred to in the preceding paragraphs, has been carried out during the year. The bacteriological work in connection with the examination of designated milks was carried out at the laboratories of the Clinical Research Association, Watergate House, York Buildings, Adelphi, W.C. 2. OTHER LEGAL PROCEEDINGS. Particulars are set out below of legal proceedings, other than those for adulteration, taken in respect of infringements of various food laws, completed during the year. In addition, five summonses for infringements of the Milk and Dairies Regulations were down for hearing on the 2nd January, 1929. TABLE No. 40. Date of Hearing. Offence. Result. 29th March Fail to cause bottles to be filled with milk and closed on registered premises. Costs £2 2s. 0d. 24th April do., do. Dismissed. 2nd May do., do. Fined 10s. 0d. 13th August Deposit for purpose of preparation for sale 13/4lbs. of pig's liver unfit for the food of man Dismissed. 13th December Fail to cause bottles to be filled with milk and closed on registered premises. Fined £1 and £1 costs. 19th December Failure to cause margarine wrapper to be marked in accordance with the Act. Fined £1. 89 SECTION VII.—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement is shown:— TABLE No. 41. Number of new houses erected during the year:— (a) Total 749 (b) With State assistance under the Housing Acts:— (i) By the Local Authority 443 (ii) By other bodies or persons 20 1.—Inspection of Dwelling Houses during the Year. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,710 (2) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 3,820 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 14 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,494 90 2.—Remedy of Defects during the Year without Service of Formal Notices* Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 2,269 *Include8 intimation notices. 3.—Action under Statutory Powers during the Year. (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 dered fit after service of formal notices :— (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 the Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 751 (2) Number of dwelling houses in which defects were remedied after service of formal notices : (a) By owners 519 (b) By Local Authority in default of owners — 91—92 93 (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 15 (2) Number of dwelling houses in respect of which closing orders were made *11 (3) Number of dwelling houses in respect of which closing orders were determined, the dwelling houses having been rendered fit 2 (4) Number of dwelling houses in respect of which demolition orders were made 2 (5) Number of dwelling houses demolished in suance of demolition orders 2 * Including one underground room. Inspection of Houses. The Housing (Consolidated) Regulations 1925, provide for the periodic inspection of houses within the Council's area, and the procedure laid down therein is followed by the Department. Lists of houses, the early inspection of which is desirable, are submitted to the Public Health Committee from time to time, and, after approval, are allocated to the district Inspectors, who, in their inspections, follow the outline given in Sections 28 and 29 of the Regulations, recording the result of their inspections, etc. on cards. Whenever the Inspector is of opinion that the proper action to be taken with regard to any particular house is one only possible under the Housing Act, 1925, he reports to the Medical Officer, who then visits for the purpose of determining whether a representation for a closing order should be made or whether the Council should serve notices under Section 3 of the Act. As will be seen from the above Table, 3,820 houses were inspected and recorded during the year under these Regulations. 94 TYPE "A" BRICK NON-PARLOUR HOUSE, 850ft. SUPER. 95 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 power to do the work themselves and recover the cost from the owners. During the year 14 representations were made with respect to dwelling-houses and 1 with respect to underground rooms. Closing orders were made in 11 cases ; in the other five, closing orders were made at the beginning of 1929. In one case the premises were rendered fit and in the other were adapted for use as a store. Two demolition orders were made and in five other cases houses were demolished before the question of a demolition order was considered by the Committee. The details with regard to each representation are shown below in Table No. 42. TABLE No. 42. Action under the Housing Act, 1925. Date of Representation. Premises. Date of Closing Order. Remarks. In 1927 134, Plumstead High Street. 11th January Represented in 1927. 1st February 89, Plumstead High Street. 16th February Demolition Order. 1/8/28. 1st February 14, Eltham High Street 21st February Closing Order determined 9/11/28. 2nd February 3, Hallams Cottages, Eltham. 29th February Closing Order determined 13/6/28. 9th March 1, Davey Square 11th May Demolished. 9th March 2, do., do. 11th May Demolished. 96 TYPE "B" CONCRETE PARLOUR HOUSE, 850ft. SUPER. 97 TABLE No. 42—continued. Date of Representation. Premises. Date of Closing Order. Remarks. 9th March 3, Davey Square 11th May Demolished. 9th March 4, do., do. 11th May Demolished. 4th April 12, Kidd Street 11th May Underground room as a sleeping place. 11th July 11, Plumstead High Street. 19th October Demolished. 13th June 16, Pound Place, Eltham. 9th August — In 1927 91, Plumstead High Street. 1927 Demolition Order, 1/2/28. 14th November 8, Pound Place, Eltham. — Closing Order made in 1929. 14th November 14, Pound Place, Eltham — do., do. 14th November 20a, Pound Place, Eltham. — do., do. 12th December 7, Eleanor Road — do., do. 14th November 12, Walpole Place — do., do. Underground Sleeping Rooms. It will be seen from the above Table that only one underground room was represented during the year. A closing order prohibiting its use as a sleeping place was made by the Council. Houses Let in Lodgings. During 1926 new by-laws for houses let in lodgings were approved by the Minister of Health for the whole of the County of London. The full effect of these by-laws is not yet known because many of 98 TYPE "C" BRICK PARLOUR-4 BEDROOM HOUSE, 1,150ft. SUPER. 99 them only come into force after the cessation of the Rent Restrictions Acts. These by-laws define the standard of housing in houses let in lodgings, and when fully in effect will be of much value in raising the general standard of such houses. They abolish registration, and for this reason no register is now kept. The card system of records is now used entirely throughout the sanitary section, and special indicators are used for houses to which these by-laws apply, so that in making any inspection the Inspector has an automatic reminder that it is a house let in lodgings. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1923. During the year three applications were made by the occupiers of houses for certificates that the houses in question were not in a reasonable state of repair. In one case the certificate was granted; in the other two, the necessary repairs were done by the landlord and the matter was not proceeded with. Tents and Vans. By-laws regulating the use of these were made by the Council in 1903. All tents and vans (which are few in number) were regularly inspected during the year and steps were taken to ensure that the by-laws were observed. It was necessary to serve one notice. New Houses. The following table shows the number of water certificates for new houses granted by the Public Health Committee at each of their monthly meetings during the year. All were in respect of houses built by private enterprise, except those shewn under the Eltham Housing Estate of the Borough Council :— 100 101 TABLE No. 43. Date of Meeting. Woolwich. Plumstead Eltham Total Eltham Hag. Estate. West. East. 11th January - 3 - 17 107 127 8th February — 1 — 6 27 34 9th March — - — 5 57 62 4th April — - 10 27 63 100 9th May 1 4 — 18 82 105 13th June — 2 8 26 60 96 11th July _ 4 - 24 37 65 1st August — 2 — 24 — 26 18 th September — 4 3 12 2 21 17th October - 15 1 15 - 31 14 th November — 2 1 36 8 47 12th December 2 3 - 30 - 35 3 40 23 240 443 740 Demolitions. The number of houses demolished during the year was 91, of which 14 were in Woolwich, 7 in West Plumstead, 5 in East Plumstead, and 65 in Eltham. Council's Housing Scheme. In 1919 the Council purchased a site on the Page Estate at Eltham. Its area was 334 acres and at that time the Council were advised that the site would provide sufficient room for the erection of some 2,700 houses, after making allowances for open spaces and for communal buildings. Although building is not yet completed, it is sufficiently far advanced to enable one to indicate the final development of the estate. The first house was occupied in 1921, and, commencing with that year, the number erected in successive years has been as follows 197, 103, 110, 94, 131, 178, 781 and 440. At the end of 1928 plans had been approved for or there were actually being erected another 142 houses. 708 of these houses were erected by direct labour, 1,326 by contractors and the 142 outstanding will be erected by contract. G 102 It will be noted that the number of houses falls short by 524 from the number estimated in 1919, but this is almost entirely accounted for by the action of the Government in exercising their right under the Defence of the Realm Acts to purchase the freehold of that part of the estate upon which huts were already erected. KEYNSHAM GARDENS. In the beginning it was the intention of the Council to develop the estate under the Assisted Housing Scheme of 1919, but owing to changes in Government policy, this was not possible, and the houses have been erected under three different schemes. These changes have prejudiced the Council financially. Under the assisted scheme, the total cost falling on the local rates was limited to the product of a penny rate, and only the first 448 houses came within this scheme. Sixty 103 of the remaining houses were erected under the Housing Act of 1923 and the rest under the Housing Act of 1924. Government assistance in these cases was restricted to a subsidy per house each year for a term of years. In addition, subsidies are paid by the London County Council, but these are smaller in amount. It was not possible, however, to adhere to this original scheme because it was soon evident that the greatest demand was for the smaller type of house and also because it was not possible to provide the larger type under the Housing Acts of 1923 and 1924, as, under these Acts, no houses of a greater superficial area than 950 feet were allowed to rank for subsidy. As a result, no houses of "C" type were erected under these Acts, and the proportion of " A " and " B " houses was reversed, 80 per cent. of "A" houses and 20 per cent. of "B" houses being erected. When the last 142 have been completed, the final figures will be : 1,438 " A " type, 696 " B " type, and 42 " C " type. In the early stages the Council had to accept, although reluctantly, the decision of the Minister that the height of certain rooms should be only 8 feet, but after some time they were successful in obtaining an increase to 8 feet 6 inches. It was originally intended that houses of the following sizes should be erected in the proportion set out hereunder :— Class. Percentage. A. Living room, 3 bedrooms, scullery, bathroom, etc. 12½ B. Living room, parlour, 3 bedrooms, scullery, etc. (standard type) 75 C. Living room, parlour, 4 bedrooms, scullery, etc. 12½ 104 The estate lies north and south of the Bexley Heath railway. That portion which lies to the south was completed first, and, except for eight houses, is composed of brick houses ; the other portion is in the main built of Laing's " Easiform " concrete houses. As will be seen from the plan of the lay-out, on pages 91.92, most of the houses are semi-detached, but blocks of 3, 4 and 5 are seen, especially in those parts of the estate of later development. FROISSART ROAD from PRINCE JOHN ROAD. An area of approximately 80 acres has been set aside as an open space. The Quaggy river, which runs through this open space, was straightened and made into a concrete conduit and the general ground level of this area was raised. As a result the ground which in wet weather used to be waterlogged, is now above flood level and always dry, and is let 105 to clubs throughout the year for sports purposes. In the general lay-out of the estate it was possible to arrange for many small areas and one larger one to be reserved as playing grounds for children. Sites have been reserved for three churches, and two doctors' surgeries have been provided. Two schools have been erected or are in course of erection and two additional GREEN WAY. sites have been bought by the London County Council for this purpose. The question of providing an infant welfare centre was receiving the consideration of the Committee at the end of the year. A few shopping sites have been reserved on Westhorne Avenue—an arterial road running north and south through the Estate—and a shopping centre is being 106 developed in Well Hall Road on the eastern boundary of the estate. Land has been leased to two organisations for the erection of club premises. The exclusive rents for the houses are as follows :— Class " A," 10s. 6d. Class " B," 12s. Od. Class " C," 13s. 6d. When additions are made for rates, the gross rents at the end of the year were :— WENDOVER ROAD. Class " A," 14s. 1d. Class " B," 16s. 4d. Class " C," 18s. 7d. The same rents are charged throughout the Estate independent of the initial cost of building. The Metropolitan Water Board supply the water for the Estate. All the houses are lighted by electricity which is 107 supplied by the Council for this purpose, and for cooking, heating and other domestic purposes when required. There are 830 all-electric houses on the estate, but in these houses a slow combustion stove has been fixed in the scullery. Electricity is supplied on a two-part tariff system under which the tenants pay a small fixed weekly sum with their rent, and, in addition for all current consumed, at the rate of ½d. per unit through pre-payment meters. There are no gas supplies on the Estate. Two public telephone kiosks have been erected by the Postmaster General, and two more are in course of erection. In the adjoining pages are shown plans of " A," " B " and "C" houses, but it will, of course, be understood that these are merely sample plans and that there is a great variety in design throughout the Estate. The general layout is shown on pages 91-92, and there are 4 photographs showing views of the Estate. 108 SECTION VIII.—PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. NOTIFICATION. The total number of notifications, excluding duplicates, was 1,587, compared with 1,585 in 1927 and 1,578 in 1926, In addition, 2,418 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. 48. The following diseases are notifiable in the Borough :— Anthrax Cerebrospinal Meningitis Cholera Continued Fever Diphtheria Dysentery Encephalitis Lethargica Erysipelas Enteric (or Typhoid) Fever Glanders Hydrophobia Malaria Membranous Croup Ophthalmia Neonatorum Pneumonia—Acute Primary Pneumonia—Acute Influenzal Poliomyelitis Plague Puerperal Fever Puerperal Pyrexia Relapsing Fever Scarlet Fever Smallpox Tuberculosis Typhus Fever Zymotic Enteritis 109 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. Tables showing the notification of infectious disease in the Borough each year since 1901 follow on. TABLE No. 44. Diseases. Total cases notified. Admissions to Hospital or Sanator ium. Total Deaths. Diphtheria 300 296 14 Scarlet Fever 529 506 5 Enteric Fever (including Para-typhoid) 17 17 2 Puerperal Fever 20 18 8 Puerperal Pyrexia 28 21 — Erysipelas 89 41 6 Smallpox 3 3 — Pneumonia 230 118 75 Malaria 12 11 1 Ophthalmia Neonatorum 14 6 — Dysentery 1 — — Encephalitis Lethargica 8 7 3 Cerebro-Spinal Meningitis 3 3 1 Poliomyelitis 3 3 — Zymotic Enteritis 5 5 16 Tuberculosis Pulmonary Males 151 158 88 Females 112 106 57 Total 263 264 145 Tuberculosis Non-Pulmonary Males 23 18 6 Females 39 16 14 Total 62 34 20 Measles 2418 56 9 4005 1409 305 TABLE No. 45. CASES OF INFECTIOUS DISEASES NOTIFIED, 1928. Diseases. Number of Cases Notified. Age Groups. All Ages. Under 1 year. 1 and under 2 years. 2 and under 3 years. 3 and under 4 years. 4 and under 5 years. 5 and under 10 years. 10 and under 15 years. 15 and under 20 years. 20 and under 35 years. 35 and under 45 years. 45 and under 65 years. 65 and over. Diphtheria 300 3 9 18 20 34 115 50 27 21 3 .. .. Scarlet Fever 529 6 15 17 38 39 249 95 37 31 2 .. .. Enteric Fever 17 .. .. .. .. .. .. 2 2 6 2 5 .. Puerperal Fever 20 .. .. .. .. .. .. .. .. 14 6 .. .. Puerperal Pyrexia 28 .. .. .. .. .. .. .. .. 23 5 .. .. Erysipelas 89 .. .. .. .. .. 1 2 5 17 13 33 18 Smallpox 3 .. .. .. .. .. .. .. .. 1 .. 1 1 Pneumonia 230 19 13 8 12 10 33 8 22 29 20 36 20 Malaria 12 .. .. .. .. .. .. .. .. 10 1 1 .. Ophthalmia Neonatorum 14 14 .. .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. .. .. .. .. .. .. 1 .. Encephalitis Lethargica 8 .. .. .. 1 .. 2 .. .. 4 .. l .. Cerebro-Spinal Meningitis 3 • • 2 1 .. .. .. .. .. .. .. .. .. Poliomyelitis 3 .. .. 1 .. .. 1 1 .. .. .. .. .. Zymotic Enteritis 5 .. 3 1 1 .. .. .. .. .. .. .. .. Tuberculosis Pulmonary Males 151 .. • • .. .. 1 4 6 17 46 26 44 7 Females 112 .. 1 .. .. .. 3 8 18 52 15 9 6 Total 263 .. 1 .. .. 1 7 14 35 98 41 53 13 Tuberculosis Non-Pulmonary Males 23 1 2 2 .. 1 8 1 4 2 1 1 .. Females 39 1 1 3 1 .. 9 6 4 10 1 2 1 Total 62 2 3 5 1 1 17 7 8 12 2 3 1 Measles (including German Measles). 2418 24 117 142 215 359 1518 33 4 5 1 .. .. 4005 68 163 193 288 444 1943 212 140 271 96 134 53 110 TABLE No. 46. DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES (INCLUDING MEASLES), 1928. 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 14 .. .. .. 3 3 4 1 .. .. .. 1 .. Scarlet Fever 5 1 1 .. .. 1 2 .. .. .. .. .. .. Enteric Fever 2 .. .. .. .. .. .. .. .. 1 .. 1 .. Puerperal Fever 8 .. .. .. .. .. .. .. .. 5 3 .. .. Puerperal Pyrexia .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 7 .. .. .. .. .. .. .. .. 1 .. 2 4 Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 75 12 3 1 1 .. 2 .. 1 3 9 20 23 Malaria 1 .. .. .. .. .. .. .. .. .. .. .. 1 Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 3 .. .. .. 1 .. .. .. .. 1 .. 1 .. Cerebro-Spinal Meningitis 1 .. 1 .. .. .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. Zymotic Enteritis 16 7 2 1 .. .. .. .. .. 1 .. 3 2 Tuberculosis Pulmonary Males 88 .. .. .. .. .. .. .. 7 34 14 27 6 Females 57 .. 1 .. .. .. 1 2 13 21 10 6 3 Total 145 .. 1 .. .. .. 1 2 20 55 24 33 9 Tuberculosis Non-Pulmonary Males 6 1 .. 1 .. 1 1 .. .. 1 .. 1 .. Females 14 1 .. 1 .. .. 2 .. 1 5 .. 4 .. Total 20 2 .. 2 .. 1 3 .. 1 6 .. 5 .. Measles (including German Measles). 9 1 5 2 .. .. 1 .. .. .. .. .. .. 306 23 13 8 5 5 13 3 22 73 36 66 39 111 112 TABLE No. 47. Cases of Infectious Diseases Notified in the Borough and Parishes during the year 1928, shewing the Case Rate per 1,000 population. Diseases. Borough. Total Cases Notified in each locality. Case Kates per 1,000 Population. Woolwich. Plumstead. Eltham. Borough. Woolwich. Plumstead. Eltham. West. East. West. East. Diphtheria 300 95 57 52 96 2.13 3.20 1.48 1.51 2.48 Scarlet Fever 529 122 142 98 167 3.75 4.12 3.69 2.85 4.32 Enteric Fever 17 2 .. 5 10 0.12 0.07 .. 0.15 0.26 Puerperal Fever 20 3 3 4 10 0.14 0.10 0.08 0.12 0.26 Puerperal Pyrexia 28 9 6 4 9 0.20 0.30 0.16 0.12 0.23 Erysipelas 89 20 31 25 13 0.63 0.67 0.81 0.73 0.34 Smallpox 3 .. .. 3 .. 0.02 .. .. 0.09 .. Pneumonia 230 70 55 70 35 1.63 2.36 1.43 2.04 0.91 Malaria 12 10 .. 2 .. 0.09 0.34 .. 0.06 .. Ophthalmia Neonatorum 14 6 3 2 3 0.10 0.20 0.08 0.06 0.08 Dysentery 1 .. .. .. 1 0.01 .. .. .. 0.03 Encephalitis Lethargica 8 3 2 .. 3 0.06 0.10 0.05 .. 0.08 Cerebro.Spinal Meningitis 3 2 .. 1 .. 0.02 0.07 .. 0.03 .. Poliomyelitis 3 1 1 .. 1 0.02 0.03 0.03 .. 0.03 Zymotic Enteritis 5 3 1 1 .. 0.04 0.10 0.03 0.03 .. Pulmonary Tuberculosis 263 95 50 67 51 1.86 3.20 1.30 1.95 1.32 Tuberculosis (Non.pulmonary) 62 13 15 11 23 0.44 0.44 0.39 0.32 0.59 Measles (including German Measles) 2418 600 538 581 699 17.14 20.24 13.99 16.92 18.08 4005 1054 904 926 1121 28.38 35.55 23.51 26.96 29.00 113 TABLE No. 48. Notification of Infectious Diseases, 1901 to 1928. Year. Smallpox. Diphtheria and Mem. Croup Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Puerperal Pyrexia. Pneumonia Primary. Influenzal Pneumonia. Malaria. 1901 21 216 72 311 68 1 8 .. .. .. .. 1902 228 233 98 267 50 1 11 .. .. .. .. 1903 6 186 58 389 42 3 2 .. .. .. .. 1904 6 163 74 472 25 1 5 .. .. .. .. 1905 7 273 83 513 27 1 12 .. .. .. .. 1906 .. 387 97 528 40 .. 8 .. .. .. .. 1907 .. 275 110 1023 27 .. 6 .. .. .. .. 1908 .. 362 90 596 19 .. 6 .. .. .. .. 1909 .. 268 113 1027 13 .. 9 .. .. .. .. 1910 .. 171 89 524 10 .. 7 .. .. .. .. 1911 .. 239 82 518 16 .. 16 .. .. .. .. 1912 3 429 87 474 20 .. 2 .. .. .. .. 1913 .. 321 70 626 14 .. 8 .. .. .. .. 1914 .. 416 107 714 18 .. 7 .. .. .. .. 1915 .. 286 138 601 31 .. 6 .. .. .. .. 1916 1 271 95 232 9 .. 16 .. .. .. .. 1917 .. 277 79 147 12 .. 12 .. .. .. .. 1918 .. 240 61 222 12 .. 14 .. .. .. .. 1919 4 398 63 243 26 .. 7 .. 123 .. 61 1920 1 427 82 538 6 .. 13 .. 136 .. 29 1921 .. 592 59 1351 11 .. 14 .. 187 49 10 1922 .. 437 37 511 8 1 11 .. 212 133 11 1923 .. 152 40 334 16 .. 8 .. 196 46 4 1924 .. 195 45 440 11 .. 7 .. 249 105 3 1925 .. 299 44 364 16 .. 9 .. 237 40 5 1926 .. 393 46 411 8 1 4 7 259 33 5 1927 .. 278 65 478 9 .. 8 30 280 36 3 1928 3 300 89 529 17 .. 20 28 216 14 12 114 TABLE No. 48.— continued. Notification of Infectious Diseases, 1901 to 1928. Year. Dysentery. Anthrax. Ophthalmia Neonatorum. Encephalitis Lethargica. Cerebrospinal Meningitis. Poliomyelitis. Zymotic Enteritis. Pulmonary Tuberculosis. Tuberculosis Non-pulmonary Measles. 1901 .. .. .. .. .. .. .. .. .. 323 1902 .. .. .. .. .. .. .. 189 .. 646 1903 .. .. .. .. .. .. .. 165 .. 661 1904 .. .. .. .. .. .. .. 186 .. 1240 1905 .. .. .. .. .. .. 212 145 .. 465 1906 .. .. .. .. .. .. 366 176 .. 825 1907 .. .. .. .. 1 .. 93 150 .. 1453 1908 .. .. .. .. 1 .. 173 154 .. 519 1909 .. .. .. .. .. .. 149 206 .. 768 1910 .. .. .. .. 1 .. 102 196 .. 396 1911 .. .. 8 .. 1 3 866 375 .. 801 1912 .. .. 20 .. 1 3 129 689 .. 775 1913 .. .. 14 .. .. 1 338 532 143 387 1914 .. .. 18 .. 1 .. 199 400 98 967 1915 .. .. 19 .. 50 2 173 420 69 1179 1916 .. .. 33 .. 17 .. 80 392 77 1590 1917 .. .. 41 .. 22 1 101 448 95 1710 1918 .. .. 23 .. 11 3 118 563 97 800 1919 7 1 34 3 7 1 123 394 80 1886 1920 1 .. 29 3 6 .. 31 359 69 1013 1921 4 .. 32 9 2 .. 454 285 71 481 1922 .. .. 26 3 2 4 31 245 60 2698 1923 1 .. 18 1 5 6 49 245 66 194 1924 1 .. 27 17 12 5 13 273 69 2679 1925 1 .. 31 10 5 1 13 246 54 1916 1926 .. .. 18 7 9 5 23 287 52 1246 1927 1 .. 19 6 4 3 12 269 84 457 1928 1 .. 14 8 3 3 5 263 62 2418 115 SMALLPOX. Three cases of small pox were notified. They were mild in character, had no apparent connection with each other, and occurred amongst vagrants. The first case was notified by the acting Medical Superintendent of the Plumstead and District Hospital on the 16th April; the patient was unvaccinated. The second case, a man aged 55 years, vaccinated in infancy, was admitted to the Woolwich Casual Ward on the 17th April and diagnosed as suffering from smallpox on . the 18th. On the 13th May another vagrant, aged 65, vaccinated in infancy, was discovered in the casual ward with a five days' old rash. All these cases were removed to the hospitals of the Metropolitan Asylums Board. There were no secondary cases. In dealing with these cases, the Department was fortunate in receiving the thorough and complete support of the officers of the two institutions concerned, all of whom did what they could to ensure that all possible precautions were taken to prevent the spread of the disease, and the help given by them was very valuable and much appreciated. Contacts were vaccinated either by the Medical Officer of the Hospital or by the local Public Vaccinators. No persons were vaccinated by the Medical Officer of Health under the provisions of the Public Health (Smallpox Prevention) Regulations, 1917. No contacts were admitted to the Smallpox Shelter in Sun Street. SCARLET FEVER. Notification. During the year 529 cases of scarlet fever were notified, compared with 478 in 1927 and 411 in 1926. There is usually an increase in the number of notifications of this disease every seven years, but, although on this occasion this phenomenon was again noted in a very slight degree, 116 the cases were much fewer in number than in 1921, when 1,351 persons were notified. The case rates for the various registration districts in the Borough are given in detail in Table No. 47. The number of notifications received each quarter was as follows :— First quarter 106. Third quarter 155 Second quarter 104. Fourth quarter 164 Deaths. There were five deaths from scarlet fever during the year, including three in children under 5 years of age. Multiple Cases. The following Table shows the house distribution by wards. The term " house " is synonymous with the term " family," except in seven instances, where two families were involved. TABLE No. 49. Dockyard. St. Mary's. River. St. George's. Burrage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas. Abbey Wood. Well Hall. Sherard. Avery Hill. Total Houses. Total Cases. Number of houses in which 1 case occurred 18 12 24 25 27 30 32 15 24 27 28 34 59 19 374 374 2 cases occurred 3 3 6 3 3 1 3 3 1 .. 2 8 9 3 48 96 3 „ „ 1 .. 1 1 1 .. .. .. 2 1 .. 1 4 .. 12 36 4 „ „ .. .. 1 .. 2 .. .. .. .. 1 .. .. .. .. 4 16 7 „ „ .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 7 Total Houses 22 15 32 29 34 31 35 18 27 29 30 43 72 22 439 529 Return Cases. The following Table shows the number of return cases, the dates of admission to hospital, the dates of discharge from hospital, and some observations on the condition of the primary cases on discharge. 117 TABLE No. 50. No. in register. Date admitted to hospital. Date discharged. Total days in hospital. Onset of secondary case. Remarks on primary case. 1927. 403 5/11/27 31/12/27 56 3/1/28 — 4/1/28 445 1/12/27 21/1/28 51 27/1/28 — 1928. 13 8/1/28 3/3/28 45 7/3/28 — 18 12/1/28 7/3/28 45 27/3/28 Sore Nostrils. 46 9/2/28 28/3/28 48 30/3/28 — 52 16/2/28 30/3/28 43 53 16/2/28 30/3/28 43 7/4/28 Rheumatism. 55 19/2/28 30/3/28 40 47 9/2/28 4/4/28 55 8/4/28 — 16/4/28 — 51 15/2/28 7/4/28 52 16/4/28 — 20/4/28 — 84 15/3/28 2/5/28 48 16/5/28 — 85 15/3/28 2/5/28 48 15/5/28 — 2/6/28 — 108 2/4/28 14/5/28 — 17/5/28 Home isolation. 107 2/2/28 26/5/28 54 3/6/28 — 141 3/5/28 22/6/28 50 13/7/28 — 142 5/5/28 22/6/28 48 1/7/28 — 143 6/5/28 23/6/28 48 13/7/28 Ear discharge. 169 29/5/28 3/7/28 35 14/7/28 — 174 2/6/28 11/8/28 70 21/8/28 — 21/8/28 218 9/7/28 16/8/28 38 22/8/28 — 236 18/7/28 28/8/28 41 20/9/28 — 276 16/7/28 27/9/28 73 30/9/28 — 248 26/7/28 23/10/28 89 1/11/28 Ophthalmia. 2/12/28 366 1/10/28 8/11/28 38 28/11/28 — 402 11/10/28 19/11/28 39 7/12/28 — 377 6/10/28 23/11/28 48 13/12/28 — 437 23/10/28 4/12/28 42 8/12/28 Home Isolation. Twenty-three cases, or 4 2 per cent. were isolated at home and in only one instance did a return case occur. All cases isolated at home are frequently visited by the district Sanitary Inspectors in order to ensure that H 118 proper precautions are being taken for preventing the spread of the disease. 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 three such certificates were issued. Dick Test. This has not been employed in the area so far as I am aware. DIPHTHERIA. Notification. During the year 300 cases of diphtheria were notified, compared with 278 in 1927 and 393 in 1926. The case rates for the various registration districts in the Borough are given in detail in Table No. 47. The number of notifications received each quarter was as follows :— First quarter 102. Third quarter 67 Second quarter 61. Fourth quarter 70 Deaths. There were 14 deaths, 5 occurring in school children, and 8 in those under school age. One adult, aged 60, died. Return Cases. There were three return cases amongst those isolated in hospital. Multiple Cases. The following Table shows the house distribution by wards. The term " house " is synonymous with the term " family " except in seven instances, where two families were involved. 119 TABLE No. 51. Dockyard. St. Mary's. River. St. George's. Burrage. Herbert Glyndon. St. Margaret's Central. St. Nicholas. Abbey Wood. Well Hall. Sherard. Avery Hill. Total Houses. Total Cases. Number of Houses in which 1 case occurred 25 14 21 13 8 12 11 18 9 22 14 21 22 18 228 228 2 cases occurred .. 3 2 .. 1 .. 2 1 .. .. 2 1 5 3 20 40 3 „ „ .. .. .. .. .. .. .. .. 1 .. 1 .. .. 3 9 4 „ „ 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. 2 8 5 „ „ .. 1 .. .. .. .. .. .. .. .. .. .. .. 2 3 15 Total Houses 26 18 24 13 9 12 13 19 9 23 16 23 28 23 256 300 Home Isolation. Only four cases were isolated at home. The same administrative procedure as in scarlet fever was followed out. Antitoxin. A supply of Diphtheria antitoxin is stored at the Town Hall, the Plumstead Library, and the Eltham Library, and is available to medical practitioners on application, at cost price, or free where there is inability to pay. The amount supplied during the year was 52,000 units. The total cost to the Council was £3 18s. 0d., all of which was recovered. 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. ENTERIC FEVER. During the summer months there was a large number of cases of paratyphoid fever in London and the Home 120 Counties. So far as London was concerned, the outbreak was mainly in Boroughs situated in the West and South-West, the brunt of the attack falling in Kensington, Fulham and Wandsworth. With very few exceptions, however, there were cases in every London Borough. The number of notified cases in Woolwich during the year (17) was slightly greater than in recent years, but this is largely due to the epidemic referred to above. All the cases were removed to hospital. Two deaths occurred. The diagnosis was not confirmed in three instances. The following Table gives details of each case notified. TABLE No. 52. No. Date notified. Sex. Age. Diagnosis. Final Diagnosis. Remarks. 1 3/2/28 F. 20 Enteric Fever No obvious disease 2 11/4/28 M. 52 Typhoid Fever Typhoid Fever Died. 3 29/5/28 M. 35 Typhoid Fever Typhoid Fever 4 11/6/28 M. 53 Enteric Fever Influenza 5 30/7/28 F. 45 Paratyphoid 13. Paratyphoid B. 6 1/8/28 F. 10 Paratyphoid 13. Paratyphoid B. 7 5/8/28 M. 26 Paratyphoid B. Paratyphoid B. 8 5/8/28 M. 45 Paratyphoid B. Paratyphoid B. 9 5/8/28 F. 10 Paratyphoid B. Paratyphoid B. 10 6/8/28 M. 15 Paratyphoid Fever Paratyphoid B. 11 10/8/28 M. 26 Typhoid Fever Paratyphoid B. 12 13/8/28 F. 45 Typhoid Fever Paratyphoid B. 13 13/8/28 F. 33 Paratyphoid Fever Paratyphoid B. Died. 14 3/9/28 M. 27 Typhoid Fever Typhoid Fever 15 21/9/28 F. 41 Typhoid Fever Acute Lobar Pneumonia Died. 16 12/11/28 M. 19 Enteric Fever Typhoid Fever 17 15/11/28 F. 26 Enteric Fever Typhoid Fever 121 ENCEPHALITIS LETHARGICA. Eight cases were notified during the year. The ultimate diagnosis of each case is set out in Table No. 53 below. All the cases, except one, were admitted to hospital. In 1927 there were six cases notified. TABLE No. 53. Date. Notified. Sex. Age. Ultimate Diagnosis. Remarks. 17/ 3/28 M. 24 Encephalitis Lethargica - 3/ 5/28 M. 7 No obvious disease - 12/ 8/28 M. 24 Tumour of Brain Died. 31/ 8/28 M. 3 Encephalitis Lethargica Died. 26/10/28 F. 31 Encephalitis Lethargica Died. 29/11/28 F. 9 Encephalitis Lethargica — 6/12/28 M. 25 Encephalitis Lethargica — 24/12/28 M. 53 Encephalitis Lethargica Died. CEREBROSPINAL MENINGITIS. Three cases were notified during the year. The ultimate diagnosis of each case is set out in the following Table. All the cases received hospital treatment. TABLE No. 54. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. 7/ 2/28 M. 1 Lobar Pneumonia - 14/ 3/28 M. 1¼ Cerebrospinal Meningitis Died. 16/ 3/28 F. 2 Measles - 122 PNEUMONIA. The Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919, were revoked at the end of 1927, and in their place was substituted the Infectious Diseases (London) Regulations, 1927. So far as Pneumonia is concerned, these Regulations are practically the same as those revoked. During the year 216 notifications of acute primary pneumonia and 14 of acute influenzal pneumonia were received. Seventy-one deaths were certified as due to acute lobar pneumonia or to acute broncho-pneumonia. Four persons died from acute influenzal pneumonia. Nursing. Under the Council's scheme for the provision of nursing assistance, 18 cases were nursed during the year, 267 visits being made by the nurses of the local nursing associations. The total cost of this service to the Council was £16 13s. 9d. In tabular form is given below the number of notifications of, and deaths from, the pneumonias each year since 1923 TABLE No. 55. Year. Notifications. Deaths. 1923 242 65 1924 354 95 1925 277 97 1926 292 81 1927 316 94 1928 230 71 123 The following 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. 56. Notification of Pneumonia. Ward. Lobar. Broncho. Influenzal. Acute Primary. Total. Dockyard 2 4 1 11 18 St. Mary's 2 2 — 10 14 River 1 5 3 8 17 St. George's 7 8 2 4 21 Burrage 2 5 1 7 15 Herbert 3 3 1 1 8 Glyndon 4 7 1 14 26 St. Margaret's 1 1 1 3 6 Central 5 3 1 7 16 St. Nicholas 16 5 1 18 40 Abbey Wood 4 2 - 8 14 Well Hall 2 1 2 4 9 Sherard 5 2 - 10 17 Avery Hill 1 2 - 6 9 55 50 14 111 230 The following Table 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. 124 TABLE No. 57. Monthly Incidence of Pneumonia. Month. Male. Female. Total. Type. No. of Deaths Lobar. Broncho. Influen zal. Acute Primary (not specified). Acute Primary Pneumonia Influenzal Pneumonia January 22 11 33 8 3 1 21 9 — February 21 4 35 8 13 2 12 8 1 March 20 15 35 11 12 2 10 11 2 April 15 13 28 12 9 3 4 7 — May 9 2 11 2 — 2 7 7 — June 10 5 15 2 — 1 12 4 — July 9 2 11 3 3 — 5 4 — August 4 1 5 2 — — 3 5 — September 5 2 7 — 1 1 5 3 — October 11 9 20 3 3 — 14 7 1 November 5 6 11 2 2 1 6 4 — December 11 8 19 2 4 1 12 2 — 142 88 230 55 50 14 111 71 4 ERYSIPELAS, MALARIA AND DYSENTERY. The number of notifications of Erysipelas was 89, compared with 65 in 1927. Twelve cases of Malaria and one case of Dysentery were notified. Trench Fever ceased to be notifiable on the 31st December, 1927. No special comment is called for on the incidence of these diseases. The induction of malaria for therapeutic purposes is now a recognized method of treating general paralysis of the insane in Asylum practice. Malaria so induced is not notifiable except in so much as it is incumbent upon the medical practitioner in charge of the patient, if he is of opinion 125 that a patient so treated may be liable to relapses of malaria, to notify the case to the Medical Officer of Health of the district in which the patient proposes to reside four days before his discharge. One such notification was received during the year. PUERPERAL FEVER AND PUERPERAL PYREXIA. Notification. Forty.eight notifications were received in respect of these diseases. Seventeen women were notified as suffering from puerperal fever, 28 from puerperal pyrexia and, in the other three, the original diagnosis of puerperal pyrexia was altered to puerperal fever. In 1927 the total notifications were 38. In Table No. 58 below is shown, divided according to diagnosis, the place of confinement in each of these cases. TABLE No. 58. Where Confined. Puerperal Fever. Puerperal Pyrexia. At Home 12 14 Institution 4 10 Abortions 4 4 20 28 Treatment. The Council's scheme for the diagnosis and treatment of these conditions is described in the Maternity and Child Welfare Section of the report, but in the next Table, No. 59, is shown the extent to which hospital treatment was ultimately made use of. 126 TABLE No. 59. Where Treated. Puerperal Fever. Puerperal Pyrexia. Maternity Hospitals 1 4 General Hospitals 4 3 Poor Law Hospitals 5 5 Cottage Hospitals — 1 Metropolitan Asylums Board' Hospitals 8 8 Midwife's Home 1 — At Home 1 7 20 28 Deaths. Three deaths were due to sepsis, following abortion. One death—a Greenwich case—took place in a midwife's home 43 hours after confinement. Four deaths occurred amongst those confined at home. One of these was treated at home and the remainder in institutions. One woman notified as puerperal pyrexia died from fibrosis of lung. One woman not notified, died in an institution in another administrative area. The total number of Woolwich deaths due to sepsis was eight. OPHTHALMIA NEONATORUM. During the year 14 cases of this disease were notified and 6 cases were treated in hospital. In tabular form is shown below, as required by the Ministry of Health, the result of each case. 127 TABLE No. 60. Date Notified. Cases Treated. Vision Unimpaired. Vision impaired. Total Blindness. Deaths. At Home. In Hospital. 23/ 1/28 Yes — Yes — — — 13/ 4/28 — Yes Yes — — — 8/ 5/28 Yes — Yes — — — 15/ 5/28 Yes — Yes — — — 22/ 5/28 Yes — Yes — — — 16/ 6/28 — Yes Yes — — — 5/ 7/28 — Yes Yes — — — 12/ 7/28 Yes — Yes — — — 30/ 9/28 — Yes Yes — — — 1/10/28 Yes — Yes — — — 2/10/28 — Yes Yes — — — 15/10/28 Yes — Yes — — — 13/11/28 Yes — Yes — — — 6/12/28 — Yes Yes — — — Home Nursing. Five cases were nursed at home. The number of visits paid was 93, an average of 19 visits per case. The cost of this service was £4 13s. Od. ANTERIOR POLIOMYELITIS. Three notifications were received. In one instance the diagnosis was not confirmed; the child died from tuberculous meningitis. The ages of the other two were 2 and 14 years, respectively. Both were admitted to hospital. The number of notifications in 1927 was three and in 1926 it was five. Nursing assistance is provided for such cases. Under this scheme 41 visits were paid by a district nurse to one case notified in 1927. In the later stages hospital treatment is available at Queen Mary Hospital, Carshalton, and locally, orthopaedic treatment can be given at the Remedial Clinic of the Woolwich Invalid Children's Aid Association. 128 ZYMOTIC ENTERITIS. Five cases of Zymotic Enteritis were notified, compared with 12 in 1927. Seven deaths occurred in infants under one year of age. WHOOPING COUGH. During the year 433 cases of Whooping Cough came to the knowledge of the Department from the School Medical Service. As this disease is not notifiable in the Borough, knowledge can only be obtained by the Department from this source, or, incidentally, by casual discovery by the Health Visitors during their daily routine. Deaths. The number of deaths was 16, compared with 10 in 1927 and 3 in 1926. Twelve of these deaths occurred in children under five years of age. MEASLES. Incidence. Measles is not notifiable in Woolwich; neither is German Measles. Information as to its prevalence reaches the Department in two main ways : (1) through the School Service; (2) through visits paid by the Health Visitors. Occasionally a case is notified in error by a medical practitioner and not infrequently information comes from the local Nursing Associations. It is admitted that our knowledge of the prevalence of measles is always incomplete. The total number of cases which came to the knowledge of the Department during the year was 2,418, which number included 11 cases of German Measles. Over 80 per cent. of the cases were notified by school teachers. Deaths. There were nine deaths, eight of which occurred in children under five years of age. 129 Home Nursing. Nursing assistance was provided for eleven children. The number of visits paid was 142 and the cost to the Council was £7 2s. 0d. Hospital Treatment. Children suffering from Measles are now admitted, except when there is pressure on accommodation, under the same conditions as the ordinary infectious diseases. In consequence, there was a large increase in the number admitted, 56, compared with 4 in 1927. ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. Disinfection. This was fully reported on in the Annual Report for 1925. As no change has taken place during the year, it is unnecessary to present this matter again in this report. For various reasons, disinfections are sometimes arranged for at the request of individuals and in such cases a small charge to cover the cost is made. In 1928, fifty.eight such disinfections were carried out and fees amounting to £20 4s. Od. were paid. The following Table shows the use made of this service during the year. TABLE No. 61. Rooms disinfected on account of— Infectious disease 745 Tuberculosis 303 Verminous conditions 40 Other reasons 30 Articles disinfected 25,329 Disinfestation. In accordance with the terms of an agreement with the London County Council, disinfestation of school children has been arranged for at the Cleansing Station, White Hart Lane. Disinfestation of adults is carried out at times when the children are not there. 130 The following Table shows the number of persons cleansed each year since 1924. TABLE No. 62. Children. Adults. Grand Total. Year. Boys. Girls. Total. Males. Females. Total. 1924 337 1924 2261 17 10 27 2288 1925 359 2082 2441 23 6 29 2470 1926 427 1934 2361 24 2 26 2387 1927 379 1852 2231 34 20 54 2285 1928 377 1584 1961 22 17 39 2000 Sanitary Authorities have now powers enabling them to remove verminous persons to a cleansing station, and for their detention there, until they are free from vermin. TUBERCULOSIS. Notifications. During 1928, 263 cases of pulmonary tuberculosis and 62 cases of non.pulmonary tuberculosis were notified. The case rates for the various registration districts in the borough are given in detail in Table No. 47. The notification of tuberculosis differs from that of other diseases in that duplicate notifications are frequent, and 408 notifications were received in all. In Table No. 63 appears a summary of the notifications received during the year. It should be explained that form " A " is used by general medical practitioners, form " B " by school medical officers, and form " C " by medical superintendents of institutions for the purpose of indicating admissions •of patients to institutions. 131 TABLE No. 63. Tuberculosis.—Summary of Notifications received during the year ended 31st December, 1928. 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 4 6 17 20 26 26 27 17 7 151 196 •• •• •• •• •• 9 149 „ Females •• 1 3 7 18 22 30 15 6 3 6 111 142 •• •• 1 1 1 16 90 Non.Pulmonary Males 1 5 8 1 4 1 1 1 •• 1 •• 23 27 •• •• •• •• •• •• 18 „ Females 1 5 7 6 4 6 4 1 2 •• 1 37 40 •• 2 •• 2 2 •• 16 Total 2 12 22 20 43 49 61 43 35 21 14 322 405 •• 2 1 3 3 25 273 New Cases not Notified. Pulmonary Males •• •• •• •• 1 3 2 •• 1 1 •• 8 •• •• •• •• •• •• •• •• „ Females •• •• •• •• 1 1 2 2 1 1 •• 8 •• •• •• •• •• •• •• •• Non.pulmonary •• •• Males •• •• 2 •• •• •• •• •• •• •• •• 2 •• •• •• •• •• •• •• „ Females •• 1 2 1 •• •• 1 1 •• •• 6 •• •• •• •• •• •• •• Grand Total 2 13 26 21 45 53 66 45 38 23 14 346 405 •• 2 1 3 3 25 273 132 New cases come to the knowledge of the Medical Officer of Health other than by notification, and so to these figures must be added 16 pulmonary and 8 non.pulmonary cases, about which information was obtained from the death returns from the Registrar General, or as transfers from other areas. In the following Table is shown the number of cases notified each year since 1924, classified by sites of lesions :— TABLE No. 64. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 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 1927 269 10 18 20 18 5 13 353 1928 263 10 8 17 11 5 11 325 Cases of Tuberculosis in the District. Constant changes take place in the register of cases of tuberculosis in the district owing to the necessity of revising the register from time to time so as to delete the names of those who have died, or who have left the district, or who have been lost sight of, or who may be regarded as cured. It is also necessary to remove from the register the names of persons who have been wrongly diagnosed. In continuance of the practice of the previous two years, a careful survey has been made of all cases on the register, and as a result there have been deletions under each of the above heads. The following Table, No. 65, shows the changes which have taken place during the year :— 133 TABLE No. 65. Pulmonary. Non. Pulmonary. Totals. M. F. M. F. Number on Register at 1st January, 1928 633 503 186 174 1,496 Number of additions 174 132 27 43 376 Number of Deletions 284 214 67 85 650 Number on Register at 31st December, 1928 523 421 146 132 1,222 It will be noted that the number of cases of tuberculosis living in the district at the end of the year was 1,222, and from Table No. 69, that 982, or 80.4 per cent. were on the register of the Tuberculosis Dispensary. Deaths. The number of deaths from tuberculosis was 165, 145 being certified as due to pulmonary tuberculosis and 20 to other forms. These figures compare with 178, 148, and 30 in 1927. The death rate for all forms was 1*17. The following Table, No. 66, shows the number of deaths and death rates from all forms of tuberculosis each year since 1012. 134 TABLE No. 66. Year. Deaths. Death.rates. All Forms. Pulmonary. Non. Pulmonary. All Forms. Pulmonary. Non. Pulmonary. 1912 175 129 46 1.44 1.06 0.38 1913 218 184 34 1.78 1.50 0.28 1914 229 177 52 1.87 1.45 0.42 1915 237 197 40 1.83 1.52 0.31 1916 210 169 41 1.61 1.30 0.31 1917 215 176 39 1.63 1.33 0.30 1918 231 199 32 1.72 1.48 0.24 1919 196 171 25 1.44 1.26 0.18 1920 188 161 27 1.38 1.18 0.20 1921 207 168 39 1.50 1.22 0.28 1922 190 163 27 1.37 1.18 0.19 1923 191 172 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 1927 178 148 30 1.26 1.05 0.21 1928 165 145 20 1.17 1.03 0.14 In addition to the deaths recorded in the above Table, twelve persons who had been notified as suffering from tuberculosis died during the year from other causes, and detailed information as to these is given in the following Table No. 67. 135 TABLE No. 67. Case No. Date notified as Tuberculosis. Cause of Death. 1 31/12/26 Chronic bronchitis. Myocardial degeneration. Diaphragmatic hernia. 2 3/ 7/27 Chronic parenchymatous nephritis. Lardaceous disease. 3 3/ 5/23 Cancer of stomach. 4 16/ 1/25 Bronchitis. Oedema of lung. 5 20/ 3/24 Influenza. Nephritis. 6 3/ 7/26 Uraemic convulsions. Acute nephritis. 7 28/ 2/24 Senility. Extravasation of urine. Stricture of urethra. 8 17/ 2/26 Cardiac and respiratory failure. Chronic parenchymatous nephritis. Fibroid lung. Uraemia. 9 14/ 7/21 Cancer of tongue. 10 2/12/16 Actinomycosis of left thoracic wall. 11 17/ 3/28 Haemoptysis. Neoplasm of lung. 12 31/12/26 Acute bronchitis. The period which elapsed between notification and death was as shown below :— TABLE No. 68. Pulmonary. Percentage. Non. Pulmonary. Percentage. Not notified 10 6.90 5 25.0 0.1 month 24 16.55 11 55.0 1.3 months 18 12.41 — — 3-6 months 26 17.93 — — 6.12 months 14 9.66 1 5.0 1-2 years 23 15.86 1 5.0 2-5 years 17 11.72 1 5.0 Over 5 years 13 8.97 1 5.0 145 100.00 20 100.0 136 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths was as one is to eleven. In 1926 it was as one is to eight, and in 1927 as one is to twelve. The Public Health (Prevention of Tuberculosis) Regulations, 1925. These Regulations provide for the compulsory discontinuance of employment of persons, engaged in handling or the treatment of milk, who are suffering from tuberculosis. During the year no case occurred which required the attention of the Council. Although every milk vendor in the Brough is periodically reminded that the Tuberculosis Officer is willing to examine, free of charge, all employees or candidates for employment in the milk trade, no persons presented themselves for examination during the year. Tuberculosis Dispensary. The Tuberculosis Dispensary is situated in Maxey Road, Plumstead, and consultations are held there, special times being allotted to men, women and children. These are given in tabular form below These are given in tabular form below. The Tuberculosis Officer, in addition to the clinics held at the Dispensary, is always willing and anxious to consult with practitioners at the homes of patients. Day. Horn's of Attendance. Children. Men. Women. Tuesday — 9.12 9.12 Wednesday — 2.4 4.5.30 (Schools) Thursday 4.7.30 — — Friday 9.11 4.5 2.4 Saturday — — 9.11 The Ministry of Health and the London County Council pay 50 per cent. and 25 per cent., respectively, of the approved expenditure on the Dispensary scheme. 137 Staff. The staff of the Dispensary consists of one whole. time Tuberculosis Officer, one half.time Assistant Medical Officer, three Tuberculosis Visitors, one Clerk.Dispenser and one Lay.Organiser, who also acts as Secretary of the Care Committee. Post.Graduate Courses. For several years now the Council have allowed members of the staff to attend postgraduate courses, the Council paying fees and reasonable expenses. The course selected for Tuberculosis Visitors is the Winter School, organised by the Women Sanitary Inspectors' and Health Visitors' Association. The course lasts two weeks and opportunities are given for those attending to become acquainted with fresh knowledge and new methods regarding their everyday work. The Work of the Dispensary. The total number of attendances at the Dispensary during 1928 was 4,930, figures slightly smaller than in 1927. In this connection it is interesting to point out that 239 of the persons notified during 1928 attended the Dispensary, which is equivalent to 73.54 per cent. This is a high figure, but 100 per cent. can never be reached because the number of persons notified include those who are notified very near to death ; those who are inmates of hospitals, infirmaries and asylums, and, of course, there are a few who do not wish to avail themselves of the facilities offered. A return as to the work in connection with the Tuberculosis Dispensary is given in the following Table, but there are one or two points in the Table which call for special mention. (a) Examination of Sputum. The number of specimens of sputa examined during the year was 960, compared with 598 in the previous year. In relation to the 1,416 new cases 138 and contacts, this gives the very low figure of 68 per cent., a figure below the London average, which, in 1927, was only 75. It is not fair, however, to make this comparison because in Woolwich the circumstances are somewhat exceptional in that owing to the absence of an out.patient department of a hospital, many cases are referred to the Dispensary who normally would be sent to a general hospital. In this way a high percentage of negative cases results. Even after making allowance for this it is obvious that the sputa of a large number of new cases are not examined. There are several explanations of this. In the first place it is very difficult to get specimens of sputum from children ; secondly, a large number of new cases, especially those coming to the Dispensary on their own initiative, have no sputum, and, thirdly, it would be a waste of time to examine sputum already found to be positive through the general scheme arranged in the Borough. In this connection it is as well to bear in mind that 348 specimens of sputum were sent by private practitioners for examination at the Seamen's Hospital. (6) X-Ray Examinations. The number of X.ray examinations has risen from 78 to 235. If these patients had sputum, negative results were obtained before an X.ray examination was made. X.ray examination is, of course, valuable, both for confirming suspicious physical signs where the disease is suspected and as a means of excluding a diagnosis of tuberculosis. If the number of examinations continues to increase in this manner it would be well for the Council to consider the advisability of providing an X.Ray outfit at the Dispensary. (c) Reports on Insured Persons. Only 13 copies of form G.P. 17 were received, and 337 of form G.P. 36. Under the National Health Insurance Acts there is an obligation on medical practitioners to complete these forms. The former should be completed by panel practitioners when first 139 ing a case or when they suspect an insured person is suffering from tuberculosis, and the latter is a quarterly report on patients receiving domiciliary benefit. The extent to which these Regulations are complied with may be gauged by the fact that approximately 1,200 reports should have been received. The marked difference in the number of the two forms returned is probably due to the fact that copies of G.P. 36 are sent out from the Dispensary each quarter, whereas G.P. 17 is supplied from Insurance sources to practitioners direct. As a letter offering the services of the Tuberculosis Officer is sent to each medical practitioner whenever a notification is received, from the Dispensary point of view little is lost by the non.completion of G.P. 17. 140 TABLE No. 69. Return showing the work of the Dispensary during the year 1928. 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 (excluding contacts) :— (a) Definitely tuberculous 99 78 7 11 7 10 10 13 106 88 17 24 (b) Doubtfully tuberculous .. .. .. .. .. .. .. .. 24 22 14 8 (c) Non.tuberculous .. .. .. .. .. .. .. .. 178 182 201 168 B. CONTACTS examined during the year :— (a) Definitely tuberculous 2 2 .. .. .. .. .. .. 2 2 .. .. (b) Doubtfully tuberculous .. .. .. .. .. .. .. .. 1 2 3 2 (c) Non.tuberculous .. .. .. .. .. .. .. .. 72 98 97 105 C. CASES written off Dispensary register as (a) Cured 73 68 3 7 19 8 24 8 92 76 27 15 (b) Diagnosis not confirmed or non. tuberculous (including cancellation of cases notified in error) .. .. .. .. .. .. .. .. 271 306 315 284 D. NUMBER OF PERSONS on Dispensary register on December 31st :— (a) Diagnosis completed 395 351 39 34 38 59 23 43 433 410 62 77 (b) Diagnosis not completed .. .. .. .. .. .. .. .. 8 4 1 2 141 (1) Number of persons on Dispensary Register on January 1st 1,174 (2) Number of patients transferred from other areas and of " lost sight of " cases returned 10 (3) Number of patients transferred to other areas and cases "lost sight of" 110 (4) Died during the year 107 (5) Number of observation cases under A (6) and B (6) above in which period of observation exceeded 2 months 23 (6) Number of attendances at the Dispensary cluding Contacts) 4,930 (7) Number of attendances of non.pulmonary cases at Orthopaedic Out.stations for treatment or supervision Nil (8) Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for— (а) " Light " treatment 232 (б) Other special forms of treatment 108 (b) Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 26 (10) Number of consultations with medical practitioners— (а) At Homes of Applicants 61 (b) Otherwise 867 142 (11) Number of other visits by Tuberculosis Officers to Homes 483 (12) Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 5,023 (13) Number of— (а) Specimens of sputum, etc., examined 960 (b) X-ray examinations made in connection with Dispensary work 235 (14) Number of Insured Persons on Dispensary Register on the 31st December 385 (15) Number of Insured Persons under Domiciliary Treatment on the 31st December 263 (16) Number of reports received during the year in respect of Insured Persons— (а) Form G.P. 17 13 (b) Form G.P. 36 337 Contacts. Contacts are those persons who are examined because they have recently been, or still are, living in contact with a Dispensary patient or other notified case, and who are examined as a direct consequence of action taken by the Dispensary. The definition is the official one of the Ministry of Health. Of necessity it limits the numbers who would be regarded by the medical profession as contacts. All other persons who are contacts in the medical and popular sense are classified as new cases. The number of "contacts" examined this year was 384, a gratifying improvement compared with 1927, when only 288 were seen. 143 Co.operation with Hospitals, etc. The arrangements for X.ray examination for diagnostic purposes and for ultraviolet ray treatment of certain tuberculous patients were changed during the year because for the first time facilities for these special services became available in the Borough with the opening of the Woolwich War Memorial Hospital. The Council felt that the claims of Woolwich people for these services locally were justified and so the Managers of the War Memorial Hospital were approached and agreements were entered into on the same terms and conditions as in the past. Splendid work has been done by the Miller and by the Seamens hospitals on the Council's behalf for many years, and the Council instructed the Town Clerk to convey to the respective Boards the Council's appreciation of this and their regret that the time had come to terminate so happy and successful working arrangements. The new agreements operated from the 1st October, 1928. In tabular form is show below the extent of co.operation with London hospitals for special purposes. TABLE No. 70. Service and Hospital. Number of Persons. Number of Treatments. X.Ray Examinations— At Seamen's Hospital 186 - At War Memorial Hospital 49 - Ultra-Violet Ray Treatment— At Miller Hospital 6 216 At War Memorial Hospital 1 6 Finson Light Treatment— At the London Hospital 1 10 Artificial Pneumo-Thorax Refills— At Brompton Hospital 7 108 144 It is of interest to note that out of 1,416 new cases, 440 were children under ten years of age. Examination of these children frequently revealed the fact that, though not suffering from tuberculosis, they were in need of treatment for other conditions, and such children were referred to the appropriate institution. In this connection valuable help was rendered by the Woolwich Invalid Children's Aid Association in getting children away to convalescent homes or by treatment at their remedial clinic. Co.operation with Local Practitioners. As mentioned in previous reports, the Tuberculosis Officer works in close consultation with practitioners and on receipt of a new notification the practitioner in charge of the case is written to with an offer of such assistance as can be rendered under the public tuberculosis scheme. It will be noted from Table No. 69 that 61 patients were seen in consultation at their homes and 867 other forms of consultation were held. Co.operation with School Medical Service. This continues to work satisfactorily. Special attention is paid to children who are contacts of tuberculous patients with tubercle bacilli in their sputum. These children are kept under close supervision by the School Medical Officer and referred again, if necessary, to the Dispensary. Other children are referred to the School Medical Service for treatment at the Minor Ailment Clinic. Home Nursing. Advanced cases of tuberculosis who are confined to bed require much nursing attention and through the good offices of the local nursing associations this is readily available. 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 object of this 145 measure is to help the ex.sanatorium patient and other suitable cases by the provision of such extra nourishment as will make the difference between progress and relapse. It is not intended for advanced cases of tuberculosis where real improvement cannot be expected. The expenditure on this service is limited to £2 per 1,000 population. Dental Treatment. Dental treatment is carried out under the Council's scheme at the School Clinic, Brewer Street. During the year, 26 cases received treatment, the number of attendances being 41. The only charge made to patients is in connection with the supply of dentures and then patients are assessed according to their means. Dentures were supplied in seven cases at a cost of £30 1s. 6d., and payments by patients amounted to £13 9s. Od. In assessing patients due regard is given to dental benefits they may be entitled to from approved societies. Shelters. Thirteen shelters are maintained by the Council for the use of patients returning from sanatoria who are able and willing to continue this form of treatment. Many patients are unwilling to make use of the shelters, possibly because they dislike being overlooked by neighbours. The shelters are lent by the Council in many cases free of charge, but in some instances a small rent, not exceeding sixpence per week, is charged. Bacteriological Examinations. During the year 960 specimens of sputum were examined at the Dispensary. Of these, 193 were positive and 767 negative. Facilities for general practitioners are provided at the Seamen's Hospital, Greenwich, and 348 specimens were examined there during the year, 83 being positive and 265 negative. 146 Institutional Treatment. The following Table, No. 71, shows the number of admissions to hospitals, sanatoria, Poor Law Institutions and training colonies. TABLE No. 71. Hospitals. Sanatoria. Poor Law Institns. Training Colonies. Insured 138 69 72 2 Uninsured 58 24 26 - Children 74 4 12 - 270 97 110 2 These numbers refer to 371 patients and the monthly admissions from January to December were as follows :— January 27 July 42 February 33 August 55 March 42 September 34 April 52 October 30 May 56 November 42 June 32 December 34 It has become evident that there is a good deal of misunderstanding as to the place which training colonies and village settlements occupy in the institutional scheme. It must be realised that village settlements offer no solution of the whole problem of employment for tuberculous patients. The number admitted as colonists to these institutions is extremely small, usually less than 10 per institution per 147 annum. These admissions are governed by several factors, e.g., suitability of patients ; ability of the industry to absorb new workers, and financial ability of the colony to provide houses for new colonists and their families. Woolwich Tuberculosis Care Committee. At the end of the year the Committee was constituted as follows :— Bodies. Representatives. Woolwich Borough Council Councillors Miss M. Crout, J.P., H. N. Dickinson, L. J. Needham, Mrs. E. L. Reeves, H. Vaughan, Miss G. E. Walters, J.P. Woolwich Board of Guardians Mrs. A. R. New, Mrs. E. M. Newman. Lewisham Board of Guardians Mr. S. C. Haines. Trade Unions Mr. W. H. Fairchild, Mr. T. R. Gov, Mrs. Jennings. Employers Miss L. Ames, Miss Fletcher, Mr. A. E. Welford. Friendly Societies Mr. W. A. Lyon, Mr. A. J. Rourke, Mr. F. Smyth. London Insurance Committee Mr. W. Edwards. Panel Committee for the County of London. Dr. H. M. Wise. War Pensions Committee Mr. E. J. Cole. Woolwich Invalid Children's Aid Association. Mrs. J. B. Great Rex. Late Tuberculosis Dispensary Committee. Mr. W. Dashwood, Mr. E. G. Dixon. United Services Fund Miss M. Shaw. Ex-Officio— Voluntary Visitors Miss L. Bloxam, Miss L. MacDermott Tuberculosis Officer Dr. F. J. C. Blackmore. Medical Officer of Health Dr. J. MacMillan. The main object of every sound anti-tuberculosis scheme is to attempt to ensure that every tuberculous patient is 148 receiving throughout the whole of his sick life such care, medical and social, as will give him the best chance of recovery, and which, whether recovery be possible or not, will secure comfort for him and protection against infection of all who are associated with him. The Care Committee is able to render very great assistance in attaining these objects and during the year patients and their families have been helped by the provision of clothing which every patient requires to possess on admission to hospital and sanatorium ; by the purchase of nursing requisites; by assistance in obtaining expensive surgical apparatus; by supplementing financial assistance given by a voluntary organisation for in.patient treatment; or by boarding out non.tuberculous children who are living in infected homes and who do not come within the general county scheme, or in many other smaller ways. During the year the Committee dealt with 694 cases. The full Committee meets four times a year, but it operates by means of sub.committees which meet periodically. The principal sub.committee (the General Purposes and Assessment Sub.Committee) meets weekly, on Wednesday, at 11.30 a.m., and the other sub.committees as required. The Council is only able to assist the Committee by the provision of secretarial assistance and stationery, and it is therefore necessary to appeal for voluntary aid to carry on its very necessary work. The income of the Committee, including £31 0s. 4d. refunded by patients or their friends, amounted to £233 6s. 11d. and the expenditure to £238 6s. 1d. In addition, a successful Pound Day was organised at Christmas time and approximately £120 in kind was distributed to tuberculous families. The work of the Committee may be further illustrated by the two following cases :— 149 " A.B." had an amputation of the leg for tuberculous disease of the foot, and after having a temporary leg for twelve months wished to replace this worn out instrument by a better and more efficient one, costing £22 10s. 0d., which would materially assist him in obtaining employment. The Committee considered that this was a case where a patient should do his utmost to assist himself and advised A.B. accordingly. He succeeded in getting a grant from the Hospital Savings Association and collected some Surgical Aid Society letters. He also approached the Lady Almoner of Guy's Hospital, who obtained other letters for him. Through the kindness of His Worship the Mayor (Councillor C. H. Langham, J.P.) £6 was obtained, and the Guardians kindly made up the balance. " Mrs. X " was recently left a widow with four children and with no means of support beyond a widows' and orphans' pension. She was examined at the Dispensary and found to be a rather advanced case of tuberculosis. She was recommended for sanatorium treatment which made it necessary to provide for the children during her absence, and it was felt that in all the circumstances of the case it was desirable to make some permanent provision for the children. The eldest child, a boy aged 13 years, was placed in the care of an aunt. Application was made to the Royal Patriotic Fund Corporation in connection with the two girls and eventually they were admitted to the Royal Victoria School, where they will remain until able to start work. The younger boy was boarded out by the Care Committee for many months, with assistance from the Royal Patriotic Fund Corporation, and is shortly to be admitted to the Royal Alexandra Orphanage as a permanent scholar. The mother was admitted to a sanatorium and returned much improved. It will, therefore, be seen that the action of the Care Committee has resulted in improved prospects of health for the mother and the permanent benefit of the children. J 150 SECTION IX.—MATERNITY AND CHILD WELFARE. The Council's Maternity and Child Welfare scheme embraces the following services:— (а) Administration of the Notification of Births Acts, 1907-15. (b) Home visits to mothers and young children. (c) Establishment of Welfare Centres. (d) Establishment of an Artificial Sunlight Clinic. (e) An arrangement with the School Medical Treatment Committee for the treatment of minor ailments in young children. (f) An arrangement with the School Medical Treatment Committee for the provision of dental treatment to young children and to expectant and nursing mothers. (g) An arrangement with the Woolwich Invalid Children's Aid Association for orthopaedic treatment for children requiring such treatment. (h) Provision of nursing assistance for young children suffering from Measles, Ophthalmia Neonatorum, Zymotic Enteritis, Whooping Cough, Poliomyelitis, Pneumonia and Influenzal Pneumonia, and for mothers suffering from puerperal fever and peurperal pyrexia. 151 (i) Reservation of twelve beds for children under 5 years of age who are suffering from such conditions as are usually treated in a general hospital, at the War Memorial Hospital. (j) Provision of beds for the institutional treatment of midwifery for 144 cases per annum at the British Hospital for Mothers and Babies, and for 66 cases at the War Memorial Hospital. (k) Reservation of beds, for ante-natal treatment and emergencies of midwifery, at the War Memorial Hospital, equivalent to 18 weeks treatment per annum. (l) Arrangements for the supply and distribution to young children and nursing mothers, of milk and food-drugs at cost price, or free where there is inability to pay. (m) Collective instruction to expectant and nursing mothers. (n) The supply of medical and health visitor assistance to the one voluntary centre in the Borough. (o) The appointment of a specialist medical practitioner for consultation with general medical practitioners under the Puerperal Fever Regulations. In addition to these services, the Council have, at the request of the Ministry— (p) Carried out a three-year research enquiry into the health of the toddler ; and at the request of the London County Council, undertaken 152 to do such work as is necessary in the case of children under five years of age— (q) Under the Blind Persons Act, 1920 ; and (r) Under Section 6 of the Widows', Orphans' and Old Age Contributory Pensions Act, 1925. For these purposes the Council maintain a staff of one whole time and one part time medical officer, six whole time and two part time health visitors, one artificial sunlight nurse, two clerks ; and one part time dentist and one part time anaesthetist for the dental clinics. The last two were appointed by the School Medical Treatment Committee. In addition, two members of the honorary medical staff of the Woolwich War Memorial Hospital have been appointed Consultants—one in charge of the Sunlight Clinic and the other under the Puerperal Fever Regulations. The Council rent or own six welfare centres and one artificial sunlight clinic, details of which are set out on pages 43 and 44, while the names and qualifications of the staff are set out in Section III. At each of the welfare centres, voluntary helpers assist in the work of weighing babies, recording weights, giving out clinic cards, etc. These ladies attend very regularly and their assistance is much appreciated. No one absents herself without some very good reason and much of the credit of the smooth and harmonious working of these services must be given to the voluntary helpers. (a) Notification of Births Acts, 1907-15. These Acts place an obligation on the parents, the midwife, or the doctor attending, to notify a birth to the Medical Officer of Health within 36 hours of birth. In this way over 98 per cent. of 153 births in the Borough come to the knowledge of the Department. In the case of Woolwich infants born outside the Borough, such notifications are usually transferred from the Medical Officers of Health concerned, and it is the practice here, in the case of infants born in Woolwich and the addresses of whose parents are outside the Borough to send copies of the notifications of births to the Medical Officer of Health concerned. Each morning, on receipt of these notifications, as a matter of routine, pamphlets dealing with the care and comfort of mothers and infants are sent by post to every mother. It is the duty of the health visitor to visit such homes as is deemed desirable between the tenth and fourteenth day. From her first visit she gauges the necessity for subsequent visits, but, as a general rule, works up to the following standard:—three visits during the first year and one visit in each subsequent year up to the age of five years. (b) The Work of the Health Visitors. No change has taken place in the personnel of the Health Visitors during the year. Their duties comprise the visiting of births and of children under school age ; the visiting of expectant mothers who have attended at an ante-natal centre or to whom visits are desirable ; the investigation of a limited number of still births and the deaths of young children ; the visiting and reporting upon all cases of Puerperal Fever and Puerperal Pyrexia ; and attendance at the infant welfare centres. The supervision of all children under school age includes the visiting of cases of Ophthalmia Neonatorum, Measles, Zymotic Enteritis, Pneumonia and Anterior Poliomyelitis. Arrangements have been made whereby, so far as is practicable, the health visitor attends at the welfare centre which is most convenient to the women residing in her district. 154 The following Table shows the classification of visits paid by the Health Visitors in 1928. TABLE No. 72. Births—First visits 1,971 ,, Revisits 13,540 Infant deaths investigated 46 Still-births investigated 25 Expectant mothers—home visits 448 Infectious diseases:— Ophthalmia Neonatorum—First visit 13 ,, ,, Revisits 16 Measles—First visits 1,896 ,, Revisits 603 Puerperal fever—First visits 14 ,, „ Revisits 19 Puerperal Pyrexia—First visits 23 ,, ,, Revisits 3 Zymotic Enteritis—First visits 1 „ ,, Revisits — Tuberculosis 43 Pneumonia 70 Anterior Poliomyelitis 4 Encephalitis Lethargica 18 Sunlight Clinic visits 68 Visits unclassified 305 Visits unsuccessful 1,665 20,791 In 1928, the Council, with the approval of the Ministry of Health, paid the class fees of two health visitors at a refresher course for Health Visitors. Since 1921, the Council's Health Visitors have, in turn, attended these refresher courses. At these courses Health Visitors not only learn about the modern advances in infant hygiene but have an opportunity of 155 changing experiences with other health visitors, and so they learn much that is of mutual benefit. They come back from the course with added zeal for their work. (c) The Work of the Welfare Centres. The Council's welfare centres are six in number and are of two types. In one type, arrangements have been made for the supervision of children under five years of age, in the other, ante- and postnatal clinics are held in addition. In the first type, a mother is occasionally given advice concerning herself as a matter of convenience. In this group are included the New Eltham, North Woolwich and the Slade Centres ; in the latter group are the Town Hall, Eltham and Plumstead Centres. Beresford Street Centre is a voluntary one belonging to the first group. It will be noted that in each of the three parishes which comprise this Borough there is one Centre of each type. At the end of the year 4 ante-natal and 17 infant consultation and weighing sessions were being held each week. In tabular form below are shown detailed statistics for 1928, and the consolidated statistics for the previous year. TABLE No. 73. Centre. No. on Roll of Centre. No. of Attendances. Mothers. Children. Mothers. Children.  Expectant. Nursing. Expectant. Nursing. Town Hall 368 315 1,533 687 727 8,256 Eltham 295 237 1,307 621 468 7,487 Plumstead 210 230 958 355 496 6,317 Slade 8 73 338 10 148 2,918 New Eltham 14 16 204 16 23 1,810 North Woolwich 8 30 138 10 49 1,123 Beresford Street (Voluntary) 12 28 155 24 57 913 Totals 1928 915 929 4,633 1,723 1,968 28,824 „ 1927 787 768 4,680 1,273 1,443 28,104 156 The next Table, No. 74, shows the number of children and the number of attendances made by them during the year. The attendances at the welfare centres during 1928 were more than in the previous year. It will be noted from this Table that the vast majority of attendances are made by children under the age of eighteen months. After that age is reached there is a marked falling off in the number of attendances. Mothers find difficulties in bringing toddlers to the centres, and there appears to be little doubt that, if the toddler is to be supervised, some method of periodical medical examination, on similar lines to school medical examinations, should be instituted. TABLE No. 74. Children in Attendance at each Centre. Year of Birth. Town Hall Eltham. Plumstead. Slade New Eltham. North Woolwich. Voluntary. Totals.  1928 421 323 268 83 55 44 38 1,232 1927 486 302 281 105 61 50 44 1,329 1926 283 212 180 54 33 21 29 812 1925 184 178 112 46 27 13 21 581 1924 112 169 86 32 20 6 18 443 1923 47 123 31 18 8 4 5 236 1,533 1,307 958 338 204 138 155 4,633 157 TABLE No. 74—continued. Attendances. Year of Birth. Town Hall. Eltham. Plumstead. Slade. New Eltham. North Woolwich. Voluntary. Totals.  1928 2,536 2,483 2,126 889 463 371 214 9,082 1927 3,618 2,814 2,441 1,237 834 543 379 11,866 1926 1,166 940 985 368 287 130 166 4,042 1925 563 577 435 217 144 50 95 2,081 1924 265 432 243 158 63 24 52 1,237 1923 108 241 87 49 19 5 7 516 8,256 7,487 6,317 2,918 1,810 1,123 913 28,824 Feeding of Infants in Woolwich. The usual enquiry was carried out in the months of June and July, and the results were very similar to those obtained in previous years. The following Table, No. 75, shows the results of the enquiry. TABLE No. 75. Feeding of Infants, 4th June to 14th July, 1928 (All Centres). Method of Feeding. Age in Months. 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. Grand Total.  Breast 51 76 59 34 27 30 37 23 22 359 14 13 386 Breast and Hand 1 10 13 7 5 8 17 3 6 68 14 10 7 99 Hand 4 12 17 32 19 20 41 31 34 210 35 40 55 340 Total 56 98 89 73 51 58 95 57 62 637 63 63 62 825 Percentages. Breast 911 77.6 66.3 46.6 52.9 51.7 38.9 40.3 35.5 56.4 22.2 20.6 — 46.8 Breast and Hand 1.8 10.2 14.6 9.6 9.8 13.8 17.9 5.3 9.7 10.7 22.2 15.9 11.3 12.0 Hand 7.1 12.2 19.1 43.8 37.3 34.5 43.2 54.4 54.8 32.9 55.6 63.5 88.7 41.2 158 159 (d) Artificial Sunlight Clinic. This clinic was opened in 1927. It is situated in rooms on the ground floor of the Old Town Hall. The accommodation includes a dressing room, treatment room, bath room and the usual offices. Accommodation for prams is provided in the pram room of the welfare centre. The Medical Officer in charge of the clinic is Dr. J. E. A. Lynham, who is the officer in charge of the electrotherapeutic section of the War Memorial Hospital. He attends fortnightly and generally supervises the treatment which is carried out by the Council's staff. The nurse in charge is Miss E. V. Farrell, who is a registered nurse and who, before coming to Woolwich, had experience at the Bethnal Green and Greenwich artificial sunlight clinics. Since the clinic was opened, three health visitors have been instructed in the methods of using artificial sunlight treatment and are now able to take charge of the clinic whenever the necessity arises. Three types of lamps are in use:— one carbon-arc, 30 amps., one mercury vapour, 9 amps., and one radiant heat lamp. The current is direct and the voltage is 210. As a general routine, children undergoing carbon-arc treatment start with five minutes' exposure at 36 inches and receive treatment three times a week, the exposure being increased by one minute at each treatment up to a maximum of twenty minutes, back and front being exposed alternately. Children receiving mercury-vapour treatment start at minutes back and front at 36 inches, receive treatment three times a week, and the exposure is increased by half a minute each time up to a maximum of twenty minutes, i.e., ten minutes back and front. Radiant heat is sometimes used separately but more often in conjunction with the other lamps. The temperature and pulse are taken before each treatment and if the temperature exceeds 99 degrees F., no treatment is given. If it is between 98.4 and 99 degrees, the temperature is taken after treatment. The weights are recorded every four weeks, and, towards the end of the year, photographs were being 160 taken before and after treatment. In certain cases, X-ray examinations are arranged for at the Woolwich War Memorial Hospital. The cost per treatment is estimated to be less than 1s. 0d. The current is supplied on a two part tariff system— a fixed annual charge being made and energy charged for at id. per unit. In tabular form below is shown the number and types of cases treated from the date of opening in October, 1927, to the end of 1928. TABLE No. 76. Type of Case. Much Improved or Cured. Improved. I.S.Q. Ceased Treatment. Treatment not yet complete. Total.  Rickets 22 21 10 13 23 89 Anaemia, Debility and Malnutrition 48 38 6 35 30 157 Catarrhal Children 4 9 5 7 13 38 Septic Conditions 83 2 4 10 - 99 Nervous Children 4 4 — 2 7 17 Enlarged Glands — 1 2 1 1 5 Miscellaneous Nervous Conditions 3 2 3 4 12 Miscellaneous Skins 8 1 1 2 7 19 Others 3 2 2 — 3 10 Mothers 5 8 7 — 5 25 177 89 39 73 93 471 161 The total number of treatments given was 13,581, being made up of 9,575 carbon-arc, 2,789 mercury-vapour, and 1,217 radiant heat. The following clinical notes by Dr. Lynham will be read with interest in view of the wide-spread attention given to this form of treatment at the present time. " It was considered advisable to begin treatment on conservative lines, and, as the number of attendances was large in proportion to the staff, a definite procedure was arranged for all cases when first admitted to the clinic, variations in time and distance being made in special cases after their reactions to the routine treatment had been observed. With the times and distances chosen, there was no discolouration of the skin other than a faint bronzing which persisted for months. By reducing the distance to 30 inches with the carbon-arc, pronounced pigmentation was easily produced. The criterion for the full dose in any child was the appearance of an erythema which persisted over-night. Debility, etc. In the early days of the Clinic, the great majority of the children seen were fair complexioned and appeared to suffer from want of tone and general listlessness, rather than from any definite disease. They were pale, with poor appetites, fretful by day, and restless at night. These children responded quickly, the first evidence of improvement being more restful sleep. In the first weeks almost all of them lost weight, but if they kept up their attendances this was steadily regained. They presented an obvious change in appearance, their pale flabby aspect being replaced by one of firmness, with pink cheeks. After three months' attendance many of these were given a month's intermission, when they resumed treatment if desired. Where further 162 treatment did not seem necessary, appointments were given for periodic inspection. A number of these seemed to lose ground after a few months, but resumed treatment with satisfactory results. It was found that pale, dark-haired children, with long eye-lashes did not respond well to full doses, and it proved more satisfactory to reduce the time of their exposures. Approximately two-thirds of these children were treated by carbon-arc and one-third by mercury-vapour ; in 16 instances both lamps were used. In the case of marasmic babies, it became the practice to start the treatment with the radiant-heat lamp, and one or two cases were treated entirely by this means. This method was found very satisfactory and the results obtained suggest a more extended use of this lamp. Rickets. The cases included both early and advanced types, some being acute and some sub-acute. The majority of these showed very decided improvement, many being apparently cured. X-ray examinations were arranged in several cases at the War Memorial Hospital. Even in advanced cases with bony deformities, sunlight treatment proved beneficial in improving the general condition. Later on, such cases were referred to an orthopaedic surgeon for opinion, and operation, if necessary. Catarrhal Children. Most of these cases were subjected to carbon-arc treatment, but, specially in the later months, radiant-heat was combined with it. They varied considerably in their response. A number improved with great rapidity, the mothers reporting that the children ceased almost at once to " catch colds." After one or two months' intermission, these children usually 163 were brought for further treatment. Others showed very little response, continuing with recurrent attacks of bronchitis and broncho-pneumonia and remaining in poor or indifferent health with unstable temperatures. It seemed probable that home conditions were partly responsible, but it is possible that these children were suffering from some specific pathological condition, e.g., hilar lymphadenitis. Septic Conditions. Ninety-nine children suffering from impetigo and allied infections of the skin were treated, and of these 83 were cured. All these were treated by the mercury-vapour lamp at 18 inches, the average number of treatments per case being five. Chronic Eczema. Several cases of eczema attended the Clinic and various forms of treatment were tried. The most satisfactory results were obtained by giving general light baths to the body whilst the affected areas of the skin were screened from the rays. Cicatrices. A number of cases of extensive cicatrices following burns, with pain and tenderness or keloid were seen. These all responded well to localised treatment with the mercury-vapour lamp. General light baths were usually given as a tonic. Enlarged Glands. Five children presenting enlarged glands were treated. In only one instance did the glands disappear. Nervous Instability. Seventeen children suffering from pronounced nervousness were brought for treatment. There was decided improvement in about half this number. It seemed probable that domestic conditions contributed to failure in several instances. 164 WOOLWICH SUNLIGHT CLINIC. 165 Diseases of Central Nervous System. Amongst those brought to the Clinic were a number of cases of infantile paralysis, spastic paraplegia, etc., some of which had not been recognised. These children were referred to a specialist for opinion and appropriate treatment, whilst sunlight treatment was given, not as a specific, but in the hope of contributing to the general well-being of the patient. Other Diseases. A number of cases of congenital heart disease, Mongolism, Xerodermia, and other constitutional conditions were recognised. These were submitted to treatment without the hope of securing any tangible beneift. In a number of these cases, however, the parents were so satisfied that improvement was obtained that they went to considerable inconvenience to maintain a regular attendance of the children at the Clinic over long periods. Mothers. Twenty-five nursing and expectant mothers received treatment, practically all by means of the mercury-vapour lamp and a few by the carbon-arc lamp. An improvement in their general physical condition was noted in 13 instances; in 7 there was no change, and 5 others were receiving treatment at the end of the year. A curious feature of the statistics is the number in which treatment was abandoned. There are several explanations of this. At the beginning, sunlight treatment was in demand. Mothers had heard about it and some of them believed that it could effect miracles in a very few treatments ; on being disillusioned they found it inconvenient to attend. Those mothers living at a distance, particularly those in Abbey Wood, in Eltham and New Eltham, found it difficult to give the necessary time. There were indeed 25 who attended for 166 sultation and never appeared for treatment. Some expectant mothers found it hard to bring their toddlers. In a few instances an outbreak of infectious disease caused a hiatus which no attempt was made to bridge over. It must be pointed out, however, that this feature of backsliding is not infrequently seen in any form of treatment demanding a number of attendances over a long period and is not confined to Artificial Sunlight Clinics." (e) Treatment of Minor Ailments. Children requiring medical or surgical treatment for certain minor ailments are referred to the School Clinic, Brewer Street, to a private practitioner, or to a hospital. During the year 37 were sent to this clinic and for each case the Council paid 5s. Children referred there suffered from the following conditions:— TABLE No. 77. Impetigo 11 Ear discharge 10 Eyes 7 Miscellaneous 9 37 (/) Dental Treatment. Dental work is carried out at the School Clinic, Brewer Street. Mothers and children are referred there from the centres. The following Table, No. 78, shows the cases attending and the total attendances during the year. The number of sessions was 24 excluding anaesthetic days. 167 TABLE No. 78. No. Attendances.  Expectant mothers 77 136 Nursing mothers 53 153 Children under 5 170 221 300 510 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 previous years. 38 sets (complete or partial) of artificial teeth were supplied during the year at a total cost of £155 7s. Payments by mothers amounted to £96 7s. 3d. (g) 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 the scheme adopted in 1925. The Council pay for children under five years of age, sent by the medical officers to the clinic, 2s. Od. 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 £179 9s. Od. Only cases recommended by the Medical Officer of Health are included 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:— 168 TABLE No. 79. Type of Case. Number remaining over from 1927. New Cases. Total Cases. No. who completed treatment by end of year.  Talipes (Club Foot) 3 5 8 6 „ (Flat Foot) — 7 7 4 Rickets— General 1 15 16 8 Genu Valgum (Knock Knee) 4 4 8 5 Genu Varum (Bow leg) 12 8 20 20 Paralysis, etc.— Infantile 3 1 4 3 Erb's 2 _ 2 _ Muscular Weakness 1 3 4 1 MiscellaneousInjuries - 2 2 2 Hernia - _ _ _ Constipation 1 2 3 3 Flat Chest 1 2 3 1 Rheumatism _ _ _ _ Torticollis - 2 2 1 28 51 79 54 (h) Provision of Nursing Assistance for certain Infectious Diseases. In Section III. of the Report, the general scheme of nursing assistance is described in full. The extent to which these services have been made use of in respect to specific diseases is dealt with under these diseases, q.v. (i) Hospital Beds for Children under Five Years of Age. In the children's ward of the Woolwich War Memorial Hospital, twelve beds have been reserved by the Council for the use of children under five years of age suffering from such conditions as are usually treated in a general hospital. In the ordinary way such children are sent in by an assistant medical officer of the Council, but the scheme is wider in its 169 application than this, and the beds are available for children under the care of general medical practitioners on application to the Medical Officer of Health during office hours, or to the Hospital at other times. The Council pay the Hospital £1,524 per annum but they retain the hospital fees for these cases. The fees are moderate and the scale in use is the one used by the Invalid Children's Aid Association for convalescent home purposes. It is based on the number of " units " in a family, each adult counting as two units and each of the family counting as one unit. Certain deductions are made from the family gross income. These deductions include the charges which would go on whether the child is in hospital or not, for example, such items as rent, heating, travelling expenses, etc. In this way the hospital charge is based as near as possible on the actual cost of the child in the home. For the ten months during which the scheme was in operation the total income amounted to £34 1s. 3d. In addition there were £4 10s. 6d. arrears outstanding at the end of the year, some of which are accounted for by children still undergoing treatment. Sixty-seven children were admitted during the year, 46 were discharged cured, 6 were improved in health and in 3 cases there was no change. Three children died. (j) & (k) Institutional Midwifery. The Council has an arrangement with two voluntary hospitals in the Borough for the reservation of beds for institutional midwifery. (1) British Hospital for Mothers and Babies. This is a voluntary hospital with 42 beds. It has an intern and extern midwifery service, and is an instructional centre for midwives. Its present premises were opened in 1922, in which year the Council entered into an agreement with the Managers whereby sufficient accommodation for 144 confinements per annum is reserved for cases sent by the Medical Officer of Health. Ante-natal supervision is given to all cases, and ante-natal 170 beds are provided when necessary. The Council for these services pays an annual amount of £1,500 and it requires each patient admitted to pay fees according to the earnings of her husband. The minimum fee has been fixed at £3 for confinement in the case of multiparae, and £4 in the case of primiparae. In certain cases this fee is reduced by the Maternity and Child Welfare Committee. The charge is based on a normal residence of fourteen days, but an additional charge is made after this period of 3s. per day. The amount recovered in patients' fees during the year was £571 12s. 5d., making the net cost £945 7s. 7d. The cost of accommodation for antenatal cases was £17. 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 749 Number of children born 674 Maternal deaths Nil. Infant deaths 5 Extern cases 196 Ante-natal Clinic— Mothers attending 989 Total attendances 5,170 Post-natal Clinic- Mothers attending 29 Total attendances 57 Infant Clinic— Infants attending 476 Total attendances 1,983 171 (2) War Memorial Hospital. There is a small maternity section of seven beds at this hospital and similar arrangements have been made with the Managers whereby sufficient accommodation for 66 confinements per annum is reserved for cases sent by the Medical Officer of Health. The fees payable by the patients are exactly the same as in the case of admissions to the British Hospital for Mothers and Babies. Since the hospital opened on the 5th March, 53 cases have been admitted under the Council's scheme. In addition to these ordinary beds the hospital authorities have undertaken to receive such maternity cases as require ante-natal or other emergency treatment, reserving for this purpose the bed accommodation equivalent to 18 weeks' treatment per annum. During the period the hospital was open two ante-natal cases and one emergency case were admitted. The fees payable per annum to the hospital for the reservation of these beds amount to £687 10s., and 9s. Od. per day is payable for each day of approved ante-natal treatment. The actual cost for the ten months was £578 2s. 6d. for maternity beds, and £28 1s. Od. for ante-natal beds, but from this remains to be deducted the fees paid by patients amounting to £205 l1s. Od. The net cost to the Council was £400 12s. 6d. I am indebted to Mr. E. Radford, J.P., the Secretary-Superintendent of the Hospital for the following information, which shows, statistically, the number of cases dealt with by the maternity section during the period. Mothers admitted (a) for confinement 91 (b) for ante-natal or emergency treatment 3 Children born 87 Maternal deaths 1 Infant deaths 5 172 Ante-natal Clinic Mothers attending 117 Total attendances 439 (l) Supply of Milk, etc., to Necessitous Mothers and Children. The cost of milk and dinners supplied to nursing and expectant mothers and to young children during the year was as follows:— Dried milk, £1,246 0s. 5d. Fresh milk, £1 16s. 4d. Dinners, Nil. This service is administered strictly in accordance with the provisions of Circular 185, under which milk may be supplied at less than cost price, in necessitous cases only, to— (a) Nursing mothers ; (6) Expectant mothers in the last three months of pregnancy ; (c) Children up to three years of age ; and, exceptionally, to children between three and five years of age on a special medical certificate. The quantity of milk must not exceed one pint per day, but, in exceptional circumstances, infants between three and eighteen months may receive 1½ pints per day. A suitable scale of income must be adopted. The scale of income in force is as follows:— Free. Half Cost.  No. in family Per Head No. in family Per Head 8. d. s. d. 1 13 0 1 15 0 2 10 6 2 12 6 3 8 6 3 10 0 4 7 6 4 8 6 5 7 0 5 8 0 6 or more 6 6 6 or more 7 6 Per head, after deduction of rent. 173 Circular letters issued by the Ministry of Health on the 30th March, 1928 and the 6th June, 1928, suggesting additional limiting conditions in regard to this service, were carefully considered by the Council. A deduction of £142 was made by the Minister from the estimate submitted by the Council. The second letter made it clear that, although the adoption of these conditions was optional on the part of the Council, only the reduced estimate would rank for grant. The Council decided not to adopt the new conditions, which were as follows:— (1) Milk should be supplied by the Council at less than cost price solely on medical grounds, and should not be supplied to applicants who are already in receipt of Poor Law Relief. Applicants whose circumstances are such that they can only be dealt with adequately through the machinery of the Poor Law should be referred to the Guardians. (2) Every applicant for milk should be seen, in the first instance, by the Medical Officer of Health or the medical officer of a centre, and no application for milk should be considered by the Council, or the appropriate Committee of the Council, unless the medical officer furnishes a certificate that a supply is essential on grounds of health. Such a certificate should be given only in those cases in which the Medical Officer is satisfied that the health of the mother or child will suffer unless a supply of milk is provided by the Council. (3) The scale of income adopted by the Council for the supply of milk at less than cost price should be revised in order to bring it into accord with the fall in the index figure of the cost of living since the scale was framed. 174 (4) The Council should satisfy themselves that they are obtaining their supplies of milk, whether liquid or dried, at prices which bear adequate relation to the quantities of milk distributed by them. (m) Collective Instruction of Expectant and Nursing Mothers. In Section III. of this Report reference is made to general health propaganda work amongst the mothers attending centres and to the special course of lectures organised for mothers at the beginning of the year. In addition to these a special class in mothercraft has been held every Wednesday afternoon at the Plumstead Welfare Centre. It is pleasing to record that, after the disappointments and trials of the previous three years, there has been a more gratifying response on the part of the mothers towards this work, so much so that at the end of the year the Council decided to open a similar centre early in the new year at the Old Town Hall Centre. The object of this class is to demonstrate to mothers suitable articles of attire for baby and to provide facilities for making them under expert supervision. Collective and individual teaching is given and the best methods of adapting old garments are taught. Planning and cutting out are done at the Centre and most of the sewing, but in some cases work is taken home to finish. The total attendances at the Mothercraft Class during the year were 831. (n) Voluntary Centre. The only voluntary centre in the Borough is held in the Hall of the Holy Trinity Church, Beresford Street, every Monday afternoon, and does excellent work in a very difficult area of the Borough. It is staffed by voluntary workers from St. Francis Mission, but the Council supply one health visitor every session and an assistant medical officer every alternate week. The number of children attending the centre during the year was 155, and the total number of attendances, including mothers, was 994. The Council do not make a grant towards the working of 175 this centre, but, as an approved centre, it receives the Ministry's grant direct. (o) 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 in which a temperature of 100-4 degrees Fahrenheit (38 degrees 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 sepsis in the 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. In his Annual Report on the State of the Public Health in England for the year 1927, Sir George Newman, the Chief Medical Officer of the Ministry of Health, makes the following observation:— "I desire to impress again the importance of notifying all cases of puerperal pyrexia. It is true that the pyrexia is not always of septic origin, but the only safe rule is to regard the case as septic until the contrary has been proved." 176 Although the details of the Council's scheme were reported in full in the Annual Report for 1927, the matter is of such importance that they are repeated again this year. The Council's scheme is as follows:— (а) Mr. H. G. Taylor, F.R.C.S., has been appointed as Consultant at a fee of £3 3s. Od. per consultation, with the addition of £1 Is. Od. for the time spent in travelling, and a further fee of £1 Is. Od. if treatment is carried out, with a minimum annual payment of 20 guineas; (б) Arrangements have been entered into with the Seamen's Hospital Society for carrying out the bacteriological work under the regulations at a fee of half-a-guinea per examination, the fee to cover the supply of the necessary outfits. If the bacteriologist is required to attend at the home of the patient, an additional fee of one guinea is charged. (c) Under the general nursing arrangements in force, provision has been made for the nursing of cases of puerperal fever, and it was only necessary to extend these arrangements for the nursing of cases of puerperal pyrexia. A fee of is. 3d. per visit is paid for each approved visit. Hospital provision for these cases is provided in the hospitals of the Metropolitan Asylums Board. During the year, Mr. Taylor was asked to see two cases in consultation. One bacteriological examination was made. Nursing assistance was provided in two cases. The statistics relating to the incidence of puerperal fever are given in that part of the report dealing with the prevalence and control of infectious diseases. 177 (p) Research Work on the Health of the Toddler. For three years, ending May, 1928, a certain number of children between the ages of 2 and 5 years, coming within the three following groups were kept under observation at the request of the Ministry of Health : (a) Unselected children ; (b) Catarrhal children; (c) Good and Bad families. The work was carried out at the Eltham Centre and during the period systematic observations were made. The reports on these cases have been sent to the Ministry and in due course will be published by him along with the results obtained in other areas where the work was also carried out. (q) Blind Persons Act, 1920. It is the duty of the London County Council to make arrangements to the satisfaction of the Ministry of Health for promoting the welfare of blind persons ordinarily resident within the County. In September, 1921, the County Council asked that, where children under five years of age were concerned, such arrangements should be made in connection with the Council's child welfare scheme, and that home visiting should be carried out by the Council's health visitors. The County Council further asked to be informed of any cases in which the home conditions are unsuitable for blind children, or of any arrangements necessary for the reception of a blind child into a suitable institution. In October, 1921, the Council agreed to comply with this request. During the year three cases came to the knowledge of the department, all of whom were receiving suitable treatment in special London hospitals or homes. (r) Widows', Orphans' & 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. This Section provides 178 that in certain circumstances, e.g., desertion or abandonment of a child, the Ministry may direct that the 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 expense under the maternity and child welfare scheme. No cases under the provisions of this Act were dealt with during the year. CONVALESCENT HOME TREATMENT FOR CHILDREN UNDER FIVE YEARS OF AGE. In January, the Council resolved, as from 1st April, to accept responsibility for any deficit incurred by the Woolwich Invalid Children's Aid Association in providing convalescent home treatment for children under five years of age. The expenditure under this head is limited by the Minister of Health to £70 per annum. Up to the end of the year, nineteen children had been sent away under this scheme and the total deficit was £41 3s. Od. Payment is only made in respect of children sent to homes approved by the Medical Officer of Health, and parents' assessments are made in accordance with a scale which is used by all Invalid Children's Aid Associations in London. 179 METEOROLOGY. Meteorological Observations taken at the Royal Observatory, Greenwich, during the year 1928. Week ending. Temperature of the Air. Departure from aver. 1 age 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. 7 55.9 31.8 420 + 3.8 43.4 4 0.75 14 52.1 29.9 43.9 + 6.0 43.6 6 0.41 21 52.3 27.5 41.9 + 3.3 43.7 1 0.10 28 53.6 29.0 41.4 + 2.2 43.7 7 106 Feb. 4 50.2 31.0 41.0 + 1.4 43.5 6 0.62 1 1 51.7 34.3 44.1 + 4.9 43.2 4 0.32 18 55.9 36.1 46.3 + 7.0 43.7 6 0.39 25 56.5 28.2 41.0 + 1.3 43.9 - - March 3 61.3 310 46.4 + 6.0 43.5 2 013 10 68.0 26.5 42.4 + 1.4 43.0 5 0.33 17 57.2 24.8 37.7 — 3.8 40.4 2 003 24 61.3 39.5 49.0 + 7.0 44.0 4 0.36 31 60.4 32.2 45.7 + 1.9 44.5 4 0.78 April 7 60.2 32.3 45.7 — 0.3 44.8 5 0.40 14 S7.9 40.1 511 + 51 47.2 4 0.39 21 51.8 28.3 39.9 — 8.0 44.5 4 0.61 28 73.3 34.0 530 + 4.3 45.7 — - May 5 72.9 45.6 55.3 + 5.7 47.1 3 0.38 12 70.2 34.9 57.0 — 1.5 48.3 — — 19 60.2 36.9 47.1 — 5.9 48.4 6 1.52 26 70.3 40.0 49.8 — 51 48.5 3 0.67 June 2 79.6 44.9 59.3 + 2.5 49.5 - - 9 76.3 40.0 57.4 — 0.8 50.6 4 0.68 16 77.6 41.2 55.5 — 3.0 51.6 4 1.30 23 74.1 37.0 57.4 — 2.5 52.1 3 012 30 76.8 48.2 59.8 — 1.7 52.9 3 019 180 METEOROLOGY—continued. Week ending. Tomperature 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 7 14 21 28 75.9 49.7 61.3 — 0.8 53.7 3 0.53 89.1 50.2 68.4 + 5.6 54.6 1 0.02 91.1 48.4 68.4 + 5.0 55.7 - - 92.0 51.0 68.5 + 5.8 56.5 2 0.69 Aug. 4 11 18 25 73.6 48.6 59.3 — 2.9 56.9 6 2.27 83.7 45.9 63.8 + 1.5 57.0 2 0.14 75.6 47.4 60.9 — 1.4 57.1 3 0.15 77.2 45.0 62.2 + 1.0 57.2 3 0.35 Sept. 1 8 15 22 29 74.5 46.2 60.1 — 0.1 57.3 3 0.73 83.0 44.0 62.7 + 3.4 57.1 - - 72.9 44.1 58.9 + 0.9 570 2 0.33 74.0 36.7 55.0 j.5 56.5 - - 65.1 34.0 51.5 — 3.6 55.5 4 0.35 Oct. 6 13 20 27 67.0 34.0 50.2 — 3.2 54.6 1 002 68.0 33.9 52.9 + 1.6 54.0 3 0.27 66.1 29.3 52.6 + 3.0 53.4 7 1.42 62.0 41.0 51.5 + 3.5 53.0 6 1.63 Nov. 3 10 17 24 60.0 39.7 48.3 + 1.2 52.3 4 0.11 57.0 27.5 42.8 — 2.5 51.4 2 0.09 60.1 41.7 52.2 + 8.9 50. 7 7 0.79 58.2 41.4 50.9 + 8.8 50.5 4 0.53 Dec. 1 8 15 22 29 55.6 32.9 44.9 + 3.5 50.0 2 0.34 50.9 26.6 40.1 — 1.1 49.0 2 0.16 39.7 23.9 33.6 — 6.9 47.4 3 0.30 48.0 28.5 39.7 + 0.2 46.1 5 0.40 54.7 34.1 41.7 + 31 45.7 6 116