AC 4372 WOO29 Metropolitan Borough of Woolwich Annual Report of the Medical Officer of Health for WOOLWICH 1929 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 1929 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, 1929. His Worship the Mayor (Councillor T. Davis, J.P.)S Councillor Miss G. E. Walters, J.P. (Chairman). Councillor Mrs. L. E. Driver (Vice-Chairman). Alderman A. Gorman. Councillors— Miss M. Crout, J.P. H. N. Dickinson A. H. Gilder S. J. Huff E. T. Lamerton J. Lee T. G. E. Phillips Major G. H. Rayner Mrs. E. L. Reeves Miss S. Turnbull 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 13 Population 15 Sickness and Invalidity 16 II.—Vital Statistics. Annual Statistics 17 Births 19 Marriages 21 Deaths 21 Maternal Mortality 31 Child Mortality 33 Infantile Mortality 34 III.—General Provision of Health Services. Hospitals 40 Institutional Provision for Unmarried Mothers 42 Ambulance Facilities 42 Clinics and Treatment Centres 43 Staff 45 Professional Nursing in the Home 48 Midwives 49 Maternal Mortality 49 Chemical Work 49 Bacteriological Examinations 49 Adoptive Acts, By-laws and Regulations in force in the Borough 50 IV.—Health Propaganda. General Reference 51 Cinematograph Projector 51 Health Week, 1929 51 Health Talks to School Children 53 Health Talks to Adults 56 Clean Food Demonstration 56 Other Matters 58 5 V.—Sanitary Administration. page. Staff 59 Complaints 59 Closet Accommodation 59 Removal and Disposal of Refuse 59 Drainage 60 Sewer Emanations 61 Sanitary Inspection of Area 62 Rats 66 Mosquitoes 6? Rag Flock 67 Offensive Trades 68 Smoke Abatement 68 Factories and Workshops 68 Mortuaries 70 Cemeteries 71 Exhumations 72 Plumstead Churchyard 72 Removal of Infirm and Diseased Persons 75 Legal Proceedings 79 VI.—Inspection and Supervision of Food. General Reference 81 Milk Supply 82 Registration 82 Cowkeepers 82 Milk Retailed in Bottles 82 Designated Milks 83 Public Health (Condensed Milk) Regulations 86 Public Health (Dried Milk) Regulations 86 Artificial Cream Act, 1929 86 Agricultural Produce (Grading and Marking) Act, 1928 87 Merchandise Marks Act 89 Sale of Food Order, 1921 89 Meat Inspection 90 Slaughterhouses 91 Inspection of Imported Meat 91 Bakehouses 92 Fried Fish Shops 92 Ice Cream Promises 92 Other Food Premises 93 Unsound Food 93 Adulteration of Food 94 Adulterated Samples—Action Taken 97 Bacteriological Examination of Food 98 Other Legal Proceedings 99 6 VII.—Housing. page. Statistics 100 Inspection of Houses 102 Housing Act, 1925 102 Rent Restrictions Acts 104 Tents and Vans 104 Houses Let in Lodgings 104 New Houses—Water Certificates 105 Council's Housing Scheme 105 VIII.—Infectious Diseases. Notifications 107 Smallpox 114 Scarlet Fever 114 Diphtheria 117 Enteric Fever 119 Encephalitis Lethargica 119 Cerebrospinal Meningitis 120 Pneumonia 120 Erysipelas, Malaria and Dysentery 123 Puerperal Fever and Puerperal Pyrexia 123 Ophthalmia Neonatorum 124 Anterior Poliomyelitis 125 Anthrax 126 Zymotic Enteritis 126 Whooping Cough 126 Measles 126 Disinfection and Disinfestation 128 Tuberculosis 129 Notifications 129 Cases of Tuberculosis in District 132 Deaths 133 The Public Health (Prevention of Tuberculosis) Regulations, 1925 136 The Work of the Dispensary 136 Contacts 140 Co-operation with Hospitals 142 Co-operation Locally 142 Extra Nourishment 142 Dental Treatment 143 Shelters 143 Bacteriological Examinations 143 Institutional Treatment 143 Care Committee 144 7 IX.—Maternity and Child Welfare. page. Notification of Births Acts 146 The Work of the Health Visitors 146 The Work of the Welfare Centres 147 Voluntary Centre 152 Artificial Sunlight Clinic 152 Collective Instruction of Expectant and Nursing Mothers 157 Assisted Milk Scheme 157 Feeding of Infants 157 Treatment of Minor Ailments 159 Dental Treatment 159 Orthopaedic Treatment 160 Provision of Nursing Assistance 162 Home Helps 162 Convalescent Home Treatment 164 Hospital Beds for Children under Five Years 164 Institutional Midwifery 164 Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 166 Blind Persons Act, 1920 166 Widows', Orphans' and Old Ago Contributory Pensions Act, 1925 166 Local Government Act, 1929 166 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-ninth Annual Report on the health of the Metropolitan Borough of Woolwich. It is an ordinary report as the special five-yearly survey report is not due until next year. The outstanding feature of the year was the passing of the Local Government Act of 1929, which will probably have a greater influence on the health activities of local authorities than any other Act passed in the last fifty years. The Act has placed considerable additional burdens on the London County Council, and the future administration of these duties appears to be so gigantic a task that the success of the health administration of London at any rate will probably depend upon the extent to which that body will exercise its statutory powers of delegating and transferring those functions to the Metropolitan Borough Councils. Statistics. In the early months of the year the weather was abnormally cold and raw, resulting in a large increase in the incidence of cardiac and respiratory diseases, and of Influenza, a set of circumstances which re-acted very unfavourably on the young and on the aged. In consequence the death rates were higher. The general death rate was 12.6, and the infantile mortality rate 62, compared with 11.0 and 50, respectively, in 1928. The birth rate was 16 3, compared with 16.1 in the previous year. 9 The Registrar-General's estimate of the population is 141,600 civilians, and 146,800 including the military. There is, however, reason to believe that this is under-estimated and my estimate exceeds his by 7,053. Such increase as has taken place is most marked in the Eltham Wards, where the population is now estimated to be nearly 40,000. Health Services. A general reference to the health services will be found in Section III, where they are set out more or less in precis form, but in each case reference is given to the appropriate parts of the report, where the subject is dealt with in detail. Health Propaganda. Health propaganda is now a regular part of the work of the department and it has developed considerably during the year in response to public demand. During the year a cinematograph machine was purchased, and for the first time a series of monthly winter lectures, illustrated by lantern slides or cinema films, for adults was given. The monthly evening talks and display of cinema films to young children were continued. No Health Exhibition was held during the year, but the Council took the opportunity of exhibiting at the local Trades and Industry Exhibition, where two stalls were utilized for demonstrating the clean handling of food in shops and homes. There appears to be an increasing demand for health lectures at meetings of Guilds and other organizations of a like nature, particularly in outlying parts of the Borough—a demand which every endeavour should be made to meet as such meetings provide for a free and more personal discussion of health matters than is possible at large meetings. 10 Infectious Diseases. The incidence of notifiable infectious diseases was higher in 1929 than in the previous year. There were more cases of diphtheria (496) and scarlet fever (567) than there were in any year since 1921; but on the other hand, there was a decrease in the number of cases of measles (151) and enteric fever (7). Smallpox appeared in the Borough for the second year in succession, five notifications being received. The incidence of pneumonia (293) and influenzal pneumonia (90) was high. The number of notifications of puerperal fever and puerperal pyrexia rose from 48 to 53, and there were three deaths from puerperal fever, compared with eight in 1928. At the end of the year there were 932 cases of pulmonary and 278 cases of non-pulmonary tuberculosis, making a total of 1,210 cases known to be living in the Borough. Sanitary Administration. The allocation of duties of the Sanitary Inspectors was revised during the year, consequent upon the increasing demand made on the Department by the administration of the Public Health (Meat) Regulations, 1924. In 1929, the carcases of 24,885 animals were inspected at the. private slaughterhouses in the Borough, and it was necessary for one Inspector, and on occasion two, to devote their whole time to this work. In all, three Inspectors are now concerned with the supervision of the food supplies and the premises where they are prepared, or stored or sold. Although there were only five cases of smallpox notified in the Borough, the occurrence of the disease in the Metropolis placed much additional work on the Inspectors in connection with the supervision of contacts possibly infected in other Boroughs—work of the highest importance in preventing 11 the spread of the disease in these days when so large a proportion of the population is unvaccinated. In all, nearly 1,400 special visits were paid, often after office hours and occasionally on Sundays. The general work of the district Inspectors continued as in previous years, and is dealt with fully in Sections V., VII., and incidentally, in Section VIII., while that of the food Inspectors will be found in Section VI. One of the Council's disinfectors, Mr. E. G. Turner, who •entered the service of the Plumstead Vestry on the 7th October, 1886, retired on superannuation on the 1st August. Maternity and Child Welfare. During the year plans were prepared for the erection of a new Centre at Eltham to replace the existing hut at 179, Well Hall Road, which is obviously too small to deal with the increasing numbers attending there in consequence of the rapid development of Eltham. It is also well known that the overcrowded condition of this Centre prevents many mothers bringing their children there. When Plumstead Centre was erected in 1926, an arrangement was made whereby certain rooms were made available for the dental treatment of school children under arrangements with the London County Council. The scheme has worked satisfactorily and the Council felt that the principle should be extended to the new Centre. Plans have accordingly been prepared whereby there will be provided a large waiting hall, a set of maternity and child welfare rooms, dental rooms, and two further rooms for the treatment of school children. The plans have been approved by the Minister (1930). 12 This section of the work continues to increase, the attendances at the ordinary consultations being 36,697, while the number of treatments given at the Sunlight Clinic was 10,074. I wish to record my thanks to the members of the Maternity and Child Welfare and Public Health and Housing Committees, and to the other members of the Council, for their continued courtesy and consideration, and to the staff of the Department for their ready and loyal assistance during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JOHN MACMILLAN, Medical Officer of Health. 13 Twenty-ninth Annual Report on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH Year ending 31st December, 1929. SECTION I.—GENERAL STATISTICS. TABLE No. 1. Area (acres) 8,282 Population, 1929:— Total (including military) 146,800 Civilians 141,600 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, 1929) £1,096,003 Sum represented by a Penny Rate (October, 1929) £4,566 14 Social Conditions. The Metropolitan Borough of Woolwich comprises the three Civil Parishes of Woolwich, Plumstead and Eltham, and covers an area of 8,282 statute acres. The River Thames covers approximately 645 acres. The Borough is divided into the two Parliamentary Divisions of East Woolwich and West Woolwich, and is further subdivided into fourteen Wards. Much of the Borough is unbuilt on and the number of persons per acre varies from 11 in Eltham to 31 in Woolwich—the general average of the Borough being 18. The following scheme indicates the various divisions of the Borough for special purposes:— Civil Parishes. Parliamentary Divisions. Wards. Registration Districts to 1928. Present Registration Districts. Plumstead (Wards 1-7) East Woolwich (Wards 1-6) (1) Abbey Wood East Plumstead (Wards 1-3) Plumstead (Wards 1-5) (2) St. Nicholas (3) Central (4) Glyndon West Plumstead (Wards 4-7) (5) St. Margarets (6) Burrage Woolwich (Wards 6-11) West Woolwich (Wards 7-14) (7) Herbert Woolwich (Wards 8-11) (8) Dockyard Woolwich (Wards 8-11) (9) St. Marys (10) River (11) St. Georges Eltham (Wards 12-14) (12) Avery Hill Eltham (Wards 12-14) Eltham (Wards 12-14) (13) Sherard .(14) Well Hall 15 In comparing the statistics in this report with those in previous reports, it is important to note that in May, 1928, the number of wards in the Borough was increased from 11 to 14. It had been apparent for some time that Eltham Ward was too large, and so it was divided into three wards, now known as Avery Hill, Sherard and Well Hall Wards. The original St. Nicholas' Ward was for the same reason divided into two—now known as the Abbey Wood and St. Nicholas' Wards. During the year an enquiry was held by the London County Council into a proposal to unify the three civil parishes of Woolwich into one, to be known as the Parish of the Borough of Woolwich. No Order, however, had been made at the end of the year. For many years the statistics of the Borough have been presented in relation to the four registration districts of Woolwich, West Plumstead, East Plumstead and Eltham, and it is proposed to continue them in this form until accurate figures for the wards are available after the Census of 1931. Population. The Registrar General estimates the population of the Borough at the 30th June, 1929, as 146,800. 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 5,200, which is the estimated number of non-civilians. The civilian population, therefore, is estimated to be 141,600. For several years now I have been of opinion that the figure estimated by the Registrar General is below the true estimate, and my estimate of the population of the Borough at the middle of 1929 was 148,653. In the report, however, the Registrar General's figures have been accepted for comparative statistical purposes, but in sub-dividing his figures, allowances have been made for internal movements in the Borough which can be fairly accurately measured by an analysis of the 16 application forms of selected tenants for the Council's housing estate at Eltham and by an analysis of the applications made under the Small Dwellings Acquisition Acts. When these allowances have been made, the figures for the old registration 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. The incidence of the infectious diseases is referred to in the appropriate Sections of the Report, and these were present to a greater extent than in the previous few years. There was, as could only be expected from the cold character of the winter months, an increase in the amount of influenza and respiratory diseases. In January, the Minister gave a general sanction to the provision of medical assistance for poor families suffering from influenza, and in one instance, where a whole family of ten was stricken down, a home help and nursing assistance was provided under this authority. This note on sickness is necessarily incomplete because no returns are made to Medical Officers of Health which would enable a complete and accurate survey to be made. TABLE No. 2. Estimated Population. Woolwich 29,440 West Plumstead 38,112 East Plumstead 34,204 Eltham 39,844 141,600 17 SECTION II.—VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shown below:— TABLE No. 3. Births—Legitimate 2,241 ,, Illegitimate 71 • 2,312 Birth Rate 16.3 Deaths 1,780 Death Rate 12.6 Number of Women dying in, or in consequence of Child Birth:— (a) From Sepsis 3 (b) From other causes 11 Deaths of Infants under one year 144 (a) Legitimate 137 (b) Illegitimate 7 Infantile Mortality Rate 62 Deaths from Measles (all ages) 1 ,, ,, Whooping Cough (all ages) 22 ,, ,, Diarrhoea (under 2 years of age) 21 The chief Vital Statistics since 1901 are given in the following Table:— 18 TABLE No. 4. Year. Population estimated to middle of each Year. Births. Nett deaths belonging to the District. Nett. Under 1 year. At all Ages. Number Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 1901 117,652 3536 30.1 457 129 1709 14.6 1902 119,285 3734 31.3 467 125 1837 15.4 1903 117,842 3684 31.3 398 108 1638 13.9 1904 118,456 3535 29.8 477 135 1763 14.9 1905 118,589 3546 29.9 362 102 1604 13.5 1906 119,143 3549 29.8 388 109 1668 14.0 1907 119,704 3330 27.8 373 112 1616 13.5 1908 122,258 3176 26.0 300 94 1516 12.4 1909 120,227 2947 24.5 242 82 1587 13.2 1910 121,197 2842 23.6 242 85 1418 11.7 1911 121,487 2810 23 .1 272 97 1566 12.9 1912 121,932 2776 22.8 208 75 1456 11.9 1913 122,382 2833 23.1 228 80 1549 12.7 1914 122,431 2838 23.2 241 85 1706 13.9 1915 a 138,200 2839 21.9 268 94 1837 14.2 b 129,505 1916 a 141,783 3068 23.5 213 69 1704 13.1 b 130,313 1917 a 147,078 2718 20.6 216 79 1566 11.9 b 131,942 1918 a 150,650 2548 19.0 270 106 2100 15.6 b 134,453 1919 a 141,918 2737 20.1 235 86 1679 12.3 b 136,237 1920 o 140,000 3658 26.9 224 61 1487 10.9 6 135,904 1921 a 141,700 3197 23.2 197 62 1594 11.6 b 137,604 1922 a 142,350 2941 21.3 184 63 1603 11.6 b 138,254 1923 a 143,530 2867 20.5 123 43 1387 9.9 b 140,000 1924 a 144,400 2590 18.5 168 65 1543 11.0 b 139,980 1925 a 145,440 2582 18.3 141 55 1519 10.8 b 140,740 1926 a 146,200 2463 17.4 107 43 1450 10.2 b 141,900 1927 a 144,770 2242 15.9 95 42 1491 10.6 b 140,770 1928 a 146,600 2269 16.1 114 50 1554 11.0 b 141,100 1929 a 146,800 2312 16.3 144 62 1780 12.6 b 141,600 a Total population. b Civil population. 19 BIRTHS. During the year 2,392 births were registered in the Borough; 1,226 were males and 1,166 females. Corrected by outward and inward transfers, these numbers become 2,312, 1,170 and 1,142 respectively. The corrected figures for the registration districts are shown in the following Table No. 5. TABLE No. 5. Registration Districts. Males. Females. Total Births. Woolwich 303 318 621 West Plumstead 313 287 600 East Plumstead 220 248 468 Eltham 334 289 623 The Borough 1,170 1,142 2,312 The birth rate, calculated on the civilian population was 16.3, compared with 16.1 in 1928. The following Table, No. 6, shows the birth rates in each registration district, after correction for outward and inward transfers, for each year since 1925:— TABLE No. 6. Period. Woolwich. West Plumstead East Plumstead Eltham. The Borough. 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 1929 21.1 15.7 13.7 15.6 16.3 b 20 Illegitimate Births. The number of illegitimate births registered was 53. There were 22 inward transfers and 4 outward transfers, making a net figure of 71, equivalent to 31 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 ; in 1928, 715 ; and in 1929, 532. Notification of Births. During the year, 2,300 live births were notified. This is at the rate of 96.2 per cent, of registered births and compares with 98 per cent, last year. 959 notifications were received from midwives, 157 from doctors, 116 from parents, and 55 from other persons ; 566 from the British Hospital for Mothers and Babies, 190 from the Military Families' Hospital, 71 from the Plumstead and District Hospital, 129 from the Woolwich War Memorial Hospital, and 34 from the Eltham Cottage Hospital. Twenty-three births took place in midwives' homes. In addition to these, 64 notifications were received from the Medical Officer of Health of Greenwich, 52 from the Medical Officer of Health of Lewisham, and 31 from other Medical Officers of Health. 92 still births were notified. It is known that 918 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 39 66, the figures for the various districts being—Woolwich, 39 per cent. ; West Plumstead, 46 per cent. ; East Plumstead, 36 per cent.; and Eltham, 37 per cent. The following Table, No. 7, shows the number of corrected births each year since 1925; 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. 21 TABLE No. 7. Year. No. of births. No. of live births notified. No. of still births. Percentage of births notified. Birth Rate England and Wales. Woolwich. London. 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 1929 2312 2300 92 96 16.3 15.7 16.3 MARRIAGES. There were 996 marriages (1,252 in 1928). The marriage rate was 14.1, as compared with 15.06, 16 01, 13 9 and 17.7 in the four preceding years. DEATHS. The total deaths registered in the district were 1,610. This figure includes 194 non.residents who died in the district but does not include 364 residents who died outside the Borough. When allowance is made for inward and outward transfers, the net figure of 1,780 is obtained. The death rate for the year was 12 6. According to the figures published by the Registrar General for the 52 weeks ended 29th December, 1929, only one metropolitan borough had a lower rate than Woolwich. In 1929 the death rate for England and Wales was 13 4, and for London 13 8. The mean death rate for the 107 great towns was 13 7. 22 The following Table, No. 8, shows the death rates in each registration district (after correction for outward and inward transfers) for each year since 1925:— TABLE No. 8. Period. Woolwich. West Plumstead East Plumstead Eltham. The Borough. 1925 13.6 11.6 9.7 8.2 10.8 1926 11.7 11.1 10.3 7.6 10.2 1927 1.30 11.4 9.9 8.3 10.6 1928 14.4 11.9 10.4 8.1 11.0 1929 15.7 13.7 12.5 9.2 12.6 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 562 London General Hospitals 157 Special Hospitals 34 Mental Hospitals 62 Fever Hospitals.. 41 Tuberculosis Institutions 22 Cottage and Country Hospitals and Nursing Homes 41 919 The following Tables are self.explanatory. 23 TABLE No. 10. Birth Rate, Death Rate, and Analysis of Mortality during the year 1929. Rate per 1,000 Total Population. Annual Death-Rate per 1,000 Population. Rate per 1,000 Live 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 Mcdical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births Still Births England and Wales 16.3 0.68 13.4 0.01 0.00 0.8 0.02 0.15 0.08 0.74 0.55 8.1 74 91.5 6.1 1.5 0.9 107 County Boroughs and Great Towns, including London. 16.6 0.69 13.7 0.01 0.00 0.12 0.02 0.19 0.09 0.76 0.50 10.9 79 91.8 5.8 1.9 0.5 157 Smaller Towns (1921 Adjusted Populations, 20,000.50,000). 16.0 0.71 12.3 0.01 0.00 0.06 0.02 0.15 0.07 0.71 0.45 5.9 69 92.6 5.4 1.0 1.0 London 15.7 0.53 13.8 0.01 0.00 0.04 0.02 0.26 008 0.69 0.56 10.7 70 89.5 6.8 3.7 0.0 WOOLWICH 16.3 0.56 12.6 0.01 0.01 0.01 0.02 0.16 0.12 0.68 0.43 9.1 62 90.3 8.7 1.0 0.0 24 TABLE No. 11. Deaths of Woolwich Residents Registered during the Calendar Year 1929, Classified by Age and Cause. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 and under 75 years . 75 and upwards. All causes 1780 144 28 37 55 68 201 475 372 400 Enteric fever 1 .. .. .. .. 1 .. .. .. .. Smallpox 1 .. .. .. 1 .. .. .. .. .. Measles 1 .. .. 1 .. .. .. .. .. .. Scarlet fever 3 1 .. 1 1 .. .. .. .. .. Whooping cough 22 11 8 3 .. .. .. .. .. .. Diphtheria 17 .. 1 7 9 .. .. .. .. .. Influenza 96 5 3 5 3 4 11 28 21 16 Encephalitis lethargica 2 .. .. .. .. .. 2 .. .. .. Meningococcal meningitis 1 .. .. 1 .. .. . . .. .. .. Tuberculosis of respiratory system 143 .. .. .. 5 35 57 39 5 2 Other tuberculous diseases 16 2 1 3 4 2 1 2 1 .. Cancer, malignant disease 213 .. 1 .. .. 1 16 87 70 38 Rheumatic fever 5 .. .. 1 .. 1 .. 3 .. .. Diabetes 16 .. .. .. .. 1 l 3 6 5 Cerebral haemorrhage, &c. 76 .. .. .. .. .. .. 22 21 33 25 TABLE No. 11.—continued. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 and under 75 years. 75 and upwards. Heart disease 353 .. .. .. 3 6 18 107 108 111 Arterio-sclerosis 38 .. .. .. .. .. 2 8 10 18 Bronchitis 121 12 1 .. 1 .. 1 16 34 56 Pneumonia (all forms) 119 26 5 7 6 4 12 35 11 13 Other respiratory diseases 15 1 .. 3 4 3 4 Ulcer of stomach or duodenum 23 .. .. .. .. 1 2 14 6 .. Diarrhoea, &c. 28 18 3 1 1 1 2 1 1 Appendicitis and typhlitis 12 .. .. .. 3 1 1 3 4 • • Cirrhosis of liver 8 .. .. .. .. .. .. 3 4 1 Acute and chronic nephritis 54 .. .. .. 1 .. 11 18 10 14 Puerperal sepsis 3 .. .. .. .. .. 3 .. .. .. Other accidents and diseases of pregnancy and parturition 11 .. .. .. .. .. 11 .. .. .. Congenital debility and malformation, premature birth 44 42 1 1 .. .. .. .. .. .. Suicide 18 .. .. .. .. 1 8 9 .. .. Other deaths from violence 61 2 1 3 3 6 12 10 5 19 Other defined diseases 259 25 3 3 14 3 28 62 52 69 Causes ill-defined or unknown .. .. .. .. •• .. •• .. •• .. 26 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 1929. Causes of Death. Males. Females. Plumstead. Deaths in Publio Institutions. Woolwich. West. East. Eltham. In Borough. Outlying Institutions. Residents. NonResidents. All causes 893 887 462 525 428 365 585 173 334 Enteric fever ... 1 1 ... ... ... ... ... 1 Smallpox 1 ... ... ... ... 1 ... ... 1 Measles ... 1 1 ... ... ... ... ... 1 Scarlet fever 1 2 ... ... ... 3 ... ... 3 Whooping cough 10 12 8 3 1 10 4 ... 11 Diphtheria 10 7 3 7 1 6 ... ... 16 Influenza 50 46 27 30 19 20 41 10 11 Encephalitis lethargica 2 ... 1 1 1 ... 1 Meningococcal meningitis ... 1 .. ... .. 1 ... ... 1 Tuberculosis of respiratory system 75 68 35 46 35 27 44 13 32 Other tuberculous diseases 4 12 5 2 7 2 8 6 5 Cancer, malignant disease 93 120 47 72 41 53 68 16 46 Rheumatic fever 2 3 1 1 1 2 ••• ... 1 Diabetes 8 8 4 5 4 3 7 3 1 Cerebral haemorrhage, &c. 27 49 25 28 16 7 30 7 5 27 TABLE No. 12.—continued. Causes or Death. Male. Female. Woolwich. Plumstead. j Eltham. Deaths in Public Institutions. In Borough. Outlying Institutions. West. East. Residents. NonResidents. Heart disease 168 185 82 105 1ll 55 137 18 28 Arteriosclerosis 20 18 10 10 8 10 1 ... 12 Bronchitis 53 68 30 35 41 15 17 6 10 Pneumonia (all forms) 63 56 34 30 26 29 37 12 19 Other respiratory diseases . 8 7 5 4 3 3 3 3 1 Ulcer of stomach or duodenum 20 3 2 10 6 5 10 3 10 Diarrhoea, &c. 21 7 7 3 8 10 8 2 8 Appendicitis and typhlitis 6 6 1 6 4 1 10 4 1 Cirrhosis of liver 7 1 1 3 1 3 4 1 ... Acute and chronic nephritis 29 25 12 17 17 8 9 7 13 Puerperal sepsis ... 3 ... ... ... 3 ... ... 3 Other accidents and diseases of pregnancy and parturition ... 11 3 4 3 1 5 2 2 Congenital debility and malformation — premature birth 25 19 15 12 7 10 14 6 9 Suicide 15 3 6 4 5 3 2 ... ... Other deaths from violence 39 22 21 9 16 15 32 14 11 Other defined diseases 136 123 76 78 46 59 93 40 71 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... 28 CAUSES OF DEATH. Table No. 11 shows that there were 353 deaths from heart disease, 213 from cancer, 143 from pulmonary tuberculosis, 121 from bronchitis, 119 from pneumonia, 96 from influenza, 76 from cerebral haemorrhage and 54 from nephritis. In 1928 there were 255 deaths from heart disease, 71 from pneumonia and 39 from nephritis. The other figures differ but slightly from those of that year. 70 per cent, of all deaths occurred in persons over 45 years of age. Heart Disease. The deaths from heart disease, which numbered 211 in 1927 and 255 in 1928, numbered 353 in 1929. The large increase in diseases of the heart is due particularly to the abnormally cold weather in the first quarter of the year, but partially to more accurate certification of the cause of death in old people. Except in 27 instances, the age at death was 45 years or over. Tuberculosis and Infectious Diseases. These are referred to in the section dealing with the notifiable infectious diseases. Diarrhoea. 28 deaths were certified to be due to diarrhoeal diseases, compared with 16 in 1928 and 6 in 1927. 21 deaths occurred in children under two years of age. Respiratory Diseases. The following Table, No. 13, shows the number of deaths each year since 1925 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. The increase in the number of deaths this year was mainly due to the abnormally cold weather in February and March, and possibly also to the prevalence of influenza. 29 TABLE No. 13. Deaths from Respiratory Diseases. Year. Bronchitis. Pneumonia. Other Respiratory. Total. Death Rate. No. under 5 years. Percentage under 5 years, 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 1929 121 119 15 255 1.8 51 20.0 Violence and Suicide. 61 deaths (39 males and 22 females) occurred from violence, apart from suicide, a number somewhat in excess of previous years. 18 deaths were due to suicidal causes (15 males and 3 females). Cancer. The total deaths from cancer was 213, of which 93 occurred in males and 120 in females. Deaths certified as due to cancer or malignant disease each year since 1925 are shewn in the following Table, No. 14. 30 TABLE No. 14. Deaths from Cancer and Malignant Disease. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 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 1929 93 120 213 1.50 11.97 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 5 1 6 4 Mouth and Jaw 2 1 3 2 Pharynx — — — — (Esophagus 5 1 6 4 Stomach 18 20 38 19 Liver and Gall Bladder — 8 8 1 Intestines 17 11 28 12 Rectum 8 11 19 11 Uterus — 16 16 7 Ovary — 5 5 4 Breast — 27 27 12 Vagina and Vulva — 1 1 1 Skin 5 — 5 4 Kidney 2 1 3 I Larynx 3 3 6 5 Lung 8 1 9 6 Pancreas 3 5 8 5 Bladder 10 2 12 8 Other specified Organs 1 — 1 — Undefined 1 — 1 1 Sarcoma 5 6 11 7 93 120 213 114 31 Inquests. There were 155- inquests held on Woolwich residents during the year, compared with 165 in 1928. Maternal Mortality. The number of deaths from puerperal sepsis was 3 ; from eclampsia, 3 ; and from abortion, 2. The incidence of sepsis shows an appreciable diminution, but that of eclampsia is disappointing, as in the majority of such cases there are recognisable premonitory symptoms and signs for which active preventive measures are indicated. Throughout the year systematic enquiries have been carried out in all cases of maternal mortality and confidential reports submitted to the Ministry of Health. These investigations have emphasized the importance of medical supervision at regularintervals during the ante-natal period from as early a date as possible, and also the necessity for widespread education of the general public regarding the advisability of such examinations. Another important factor in preventive work is the co-operation of the midwives, by encouraging their patients to have regular medical attention; many abnormalities which may have reached severe degrees before serious signs of ill-health develop may be detected at an early stage by medical examination. The maternal death rate per 1,000 births was 6 06 ; in 1928 it was 5 73. The following Table shows the causes of death each year since 1912. 32 TABLE No. 16. Maternal Mortality, Woolwich, 1912-1929. 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 - i 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 1929 2 2 - - 2 1 3 1 3 14 Totals 7 12 7 15 14 4 27 14 75 175 33 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1 and 2 years of age was 28, and between 2 and 5, 37. In 1928 these figures were 24 and 27 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, 1928 and 1929. TABLE No. 17. Child Mortality (1-2 years). Death Rates per 1,000 estimated age population from stated Groups of Diseases, in quinquennial periods, etc. Period. Estimated mean Population. Infectious Fevers. Tuberculosis Respiratory Diseases. Diarrhceal Diseases. All other causes. Total Deaths. 1911-1915 2,581 7.67 2.87 8.76 2.56 4.96 26.82 1916.1920 2,536 6.86 1.42 8.28 .63 4.42 21.61 1921.1925 2,876 3.69 1.46 4.52 .49 2.99 13.15 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 1929 2,141 4.20 .47 2.80 1.40 4.20 13 07 34 TABLE No. 18. Child Mortality (2-5 years). Death Rates per 1,000 estimated age population from stated Groups of Diseases, in quinquennial periods, etc. 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 1929 6,822 1.91 .44 1.02 .14 1 . 91 5.42 INFANTILE MORTALITY. The number of deaths of infants under one year of age was 144—30 more than in 1928. The rate of infant mortality resulting from these deaths (deaths under one year per 1,000 births) was 62, compared with 50 in 1928. The lowest infantile mortality figure ever recorded in the annals of the Borough was 42, in 1927. The rate for the administrative County of London was 70, and for England and Wales, 74. In four metropolitan boroughs—Lewisham, Stoke Newington, Hampstead and Hackney—the infantile mortality rate was lower. In Hammersmith and Wandsworth, it was the same as in Woolwich. 35 The following Table, No. 19, shows the distribution of infantile mortality throughout the year, the rate being much higher in the first quarter owing to the cold weather experienced then and the high incidence of respiratory diseases. The rates shown are calculated on a varying year basis. TABLE No. 19. Deaths under Births. 1 year. Rate. First quarter 580 58 103 Second quarter 600 32 51 Third quarter 577 20 34 Fourth quarter 555 34 59 The following Table No. 20 shows the infantile mortality rate in the Borough and the registration districts for each year since 1925. TABLE No. 20. Period. Woolwich. West Plumstead. East Plumstead. Eltham. The Borough. 1925 59 42 51 69 55 1926 51 37 41 44 43 1927 53 29 42 47 42 1928 60 43 41 54 50 1929 77 45 60 66 62 Causes of Death. The causes of infant mortality are set forth in detail in Tables Nos. 22, 23 and 24, 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 causes of death were prematurity and c 36 pneumonia, 26 deaths being ascribed to both of these conditions. Thirteen deaths were due to enteritis and 5 to diarrhoea. There was one death from scarlet fever and 11 from whooping cough. The neo-natal mortality rate, i.e., deaths under 4 weeks, was 26 81, compared with 22.47 in 1928. Of 62 neo-natal deaths, 23 were certified to be due to premature birth and 7 to debility. Six children under one month died from respiratory diseases. Deaths of Illegitimate Children. The number of deaths of illegitimate children was 7, compared with 11 in 1928 and 2 in 1927. Three deaths were certified as due to want of attention at birth, 1 to prematurity, 1 to acute otitis media, 1 to suffocation by drowning and 1 to broncho pneumonia and gastro enteritis. Five of these deaths occurred in the first week of life and two at the age of 7 months. A comparison of the infantile mortality rates of legitimate and illegitimate infants shows that the rate for legitimate was 61 and for illegitimate 99. 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. 21. Hospitals or Institutions. Number of Deaths. Poor Law Institutions 21 Special Hospitals 17 London General Hospitals 16 M.A.B. Hospitals 9 Cottage Hospitals 3 66 37 TABLE No. 22. INFANT MORTALITY, 1929. 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 .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. 1 .. 1 Whooping Cough .. .. .. .. .. .. 2 4 3 11 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. 1 1 2 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions 2 1 .. .. 3 1 .. .. 1 5 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. .. 1 2 4 .. 3 3 12 Pneumonia (all forms) .. .. 3 1 4 3 5 8 6 26 Diarrhoea .. .. .. .. .. .. 3 1 1 5 Enteritis 1 .. 1 .. 2 3 5 1 2 13 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, Overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth 5 .. .. .. 5 .. .. .. .. 5 Atelectasis 3 .. 1 .. 4 .. .. .. .. 4 Congenital Malformation 5 .. .. .. 5 2 1 .. .. 8 Premature Birth 20 2 .. 1 23 3 .. .. .. 26 Atrophy, Debility and Marasmus 7 .. .. .. 7 1 .. .. .. 8 Other Causes 4 1 2 .. 7 5 2 1 3 18 48 4 7 3 62 24 18 20 20 144 Nett Births registered during the calendar year Legitimate 2241 Illegitimate 71 Nett deaths registered during the calendar year Legitimate 137 Illegitimate 7 38 TABLE No. 23. INFANT DEATHS, 1929. Causes of Death. The Borough. Woolwich. West Plumstead. East Plumstead. Eltham. M. F. M. F. M. F. M. F. M. F. Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .... Scarlet Fever .. 1 .. .. .. .. .. .. .. 1 Whooping Cough 5 6 .. .. .. .. .. .. 1 4 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis 1 1 .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. . . .. .. .. .. .. .. .. .. Convulsions 3 2 1 1 .. .. 1 1 1 .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 5 7 1 2 1 1 3 4 .. .. Pneumonia 12 14 6 4 2 2 2 3 2 5 Diarrhoea 3 2 .. .. .. .. 1 1 2 1 Enteritis 11 2 3 .. 2 .. 2 .. 4 2 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, Overlying . . .. .. .. .. .. .. .. .. .. Injury at birth 4 1 2 1 1 .. .. .. 1 .. Atelectasis 1 3 1 2 .. 1 .. .. .. .. Congenital Malformation 5 3 2 1 1 1 1 2 Premature birth 14 12 7 3 2 4 1 3 4 2 Atrophy, Debility and Marasmus 5 3 1 1 1 2 2 .. l .. Other causes 12 6 4 1 3 2 •• 1 5 2 81 63 31 17 15 12 13 15 22 19 144 48 27 28 41 39 TABLE No. 24.—INFANT DEATHS, 1929. Causes of Death. The Borough. Woolwich. West Plumstead. East Plumstead. Eltham. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks1 year. Under 4 weeks. 4 weeks1 year. Smallpox . . . . . . . . . . . . . . . . . . . . Chickenpox . . . . . . . . . . . . . . . . . . . . Measles . . . . . . . . . . . . . . . . . . . . Scarlet Fever . . 1 . . . . . . . . . . . . . . 1 Whooping Cough . . 11 . . 4 . . 1 . . 1 . . 5 Diphtheria and Croup . . . . . . . . . . . . . . . . . . . . Erysipelas . . . . . . . . . . . . . . . . . . . . Tuberculous Meningitis . . 2 . . . . . . 1 . . 1 . . . . Abdominal Tuberculosis . . . . . . . . . . . . . . . . . . . . Other Tuberculous Diseases . . . . . . . . . . . . . . . . . . . . Meningitis (not Tuberculous) . . . . . . . . . . . . . . . . . . . . Convulsions 3 2 1 1 . . . . 2 . . . . 1 Laryngitis . . . . . . . . . . . . . . . . . . . . Bronchitis 2 10 . . 3 1 1 1 6 . . . . Pneumonia 4 22 3 7 . . 4 . . 5 1 6 Diarrhoea . . 5 . . . . . . . . . . 2 . . 3 Enteritis 2 11 1 2 . . 2 1 1 . . 6 Gastritis . . . . . . . . . . . . . . . . . . . . Syphilis . . . . . . . . . . . . . . . . . . . . Rickets . . . . . . . . . . . . . . . . . . . . Suffocation, overlying . . . . . . . . . . . . . . . . . . . . Injury at Birth 5 . . 3 . . 1 . . . . . . 1 . . Atelectasis 4 . . 3 . . 1 . . . . . . . . . . Congenital Malformation 5 3 3 . . 1 . . . . 1 1 2 Premature Birth 23 3 9 1 6 . . 3 1 5 1 Atrophy, Debility & Marasmus 7 1 2 . . 3 . . 1 1 1 . . Other causes 7 11 2 3 2 3 •• 1 3 4 62 82 27 21 15 12 8 20 12 29 144 48 27 . 28 41 40 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 (6) Smallpox. These hospitals in the Metropolis are under the control of the Metropolitan Asylums Board. There are no hospitals in Woolwich. Most of the Woolwich cases are admitted to the Brook Hospital in Greenwich, the Park Hospital in Lewisham, or to the South-Eastern Hospital, New Cross. Joyce Green Hospital was closed during the year for the admission of cases other than smallpox. 41 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 summarised as follows :—a Dispensary for the examination of persons suspected to be suffering from tuberculosis is established in Maxey Road, Plumstead, where arrangements are made for the diagnosis of doubtful cases, for out-patient treatment and for institutional treatment. Briefly, the Borough Council is responsible for preventive work and for local and out-patient treatment, and the County Council is 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 has made arrangements with two local hospitals for the reservation of maternity beds : (i.) The British Hospital for Mothers and Babies and (ii.) The War Memorial Hospital. Detailed information regarding this service will be found in the Maternity and Child Welfare Section (No. IX.) of the report. (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 42 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 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 1,937 patients were admitted, and 2,097 cases of accidents and other emergencies were treated in the Casualty Department during the year. ii. Institutional Treatment for Unmarried Mothers, Illegitimate Children and Homeless Children in the Area. There are now no institutions in the Borough specially provided for the treatment of such cases. 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 other places. (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. 43 iv. Clinics and Treatment Centres. In tabular form below is shown a list of clinics and treatment centres in the Borough. 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. 25. 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. 5 179, Well Hall Road, Eltham. Do. Do. 5 Wesley Hall, Timbercroft Lane, Plumstead. Doctor's room, Weighing room. Do. 2 All Saints' Church 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. 25—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 members of the Public Health staff. During the year the Council, with the approval of the Ministry of Health, increased the number of Sanitary Inspectors doing duty in the Borough by one; and Mr. F. Hemingway was appointed to fill the position created. TABLE No. 26. Year appointed. Name. Qualifications. Appointment † 1918 Mackenzie, R. E. W. M.B., D.P.H Assistant Medical Officer of Health for Maternity and Child Welfare. † 1921 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 Purposes). 1891 Smith, Sir W. R. M.D., D.Sc., D.P.H., L.L.D., F.R.S.(Edin.) Public Analyst (Part time) †1927 Lynham, J. E. A B.A., M.D., D.M.R.E. Consultant, Artificial Sunlight. †1927 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. Assoen., Cert. Meat and other foods. Chief Sanitary Inspector. (1928) *1896 Little, W. Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. *1897 Wood, W Cert. Royal San. Inst. Sanitary Inspector. 46 TABLE No. 26—continued. Year appointed. Name. Qualifications. Appointment. *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, Cert. Meat and other foods. Sanitary Inspector. *1929 Hemingway, F. Cert. San. Insp., Exam. Joint Board, Cert. Meat and other foods. 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. Board of Education. Health Visitor. *†l918 Garside, Mrs. M. Cert. San. Insp. Exam. Board, C.M.B., Health Visitors'Cert. Health Visitor and Sanitary Inspector. †l919 Burnett, Miss W. Cert. San. Insp. Exam. Board, C.M.B., Health Visitors'Cert, Board of Education. Health Visitor. 47 TABLE No. 26—continued. Year appointed. Name. Qualifications. Appointment. †1919 Tibbits, Miss E. Cert. San. Insp. Exam. Board, Health Visitor's Cert., Board of Education. Health Visitor. *†l919 Ware, Miss C. Cert. San. Insp. Exam. Board, C.M.B., HealthVisitors'Cert., 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 Visitors' Cert., Royal San. Inst. Health Visitor. †1920 Morgan, Miss F. Cert. General Hospital Training, C.M.B., HealthVisitors'Cert., Maternity and Child Welfare Cert. Health Visitor. †l922 Seccombe, Miss W. Cert. General Hospital Training, C.M.B., HealthVisitors'Cert. Health Visitor. †1927 Farrell, Miss E. V. Cert. General Hospital Training, C.M.B., Heliotherapy Cert., HealthVisitors'Cert., Board of Education. Health Visitor and Artificial Sunlight Nurse. †1921 Castledine, Mrs. L. Cert. General Hospital Training. Tuberculosis Visitor. †1921 Prestige, Mrs. M. Cert. San. Insp. Exam. Board, C.M.B., HealthVisitors'Cert., Board of Education. Tuberculosis Visitor. †1921 Mahony, Miss N. Cert. General Hospital Training, Health Visitors' Cert. Tuberculosis Visitor. †l923 Smith, Mrs. M. Dispensing Certificate. Clerk-Dispenser. †l922 Morrison, Mrs. M. L. - Lay Organiser. CLERKS : Britter, A. Prescott, H. T. Collyer, H. M. Smith, H. S. †Edwards, Mrs. N. †Stephenson, Miss D. Pike, L. Taylor, S. G. MORTUARY KEEPER : F. Leason. The Medical Officer of Health* is Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme. * Salary contributions made under the Public Health Acts. † Salary contributions made by Exchequer Grants. 48 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 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. Rate of Payment. Measles Is. per visit for one case ; 6d. per visit, per case, for more than one case in the house at the same time. Ophthalmia Neonatorum Zymotic Enteritis Whooping Cough Poliomyelitis 49 Disease. Rate of Payment. Acute Primary Pneumonia 1s. 3d. per visit. and Influenzal Pneumonia Puerperal Fever Puerperal Pyrexia vii. Midwives. Through the courtesy of Dr. Menzies, the County Medical Officer of Health, I have been able to ascertain that 39 midwives gave notice during the year of their intention to practise in the Borough. viii. Maternal Mortality. During the year the Council co-operated in the general scheme throughout the country for making special investigations into maternal deaths. The information, which is treated as strictly confidential, was forwarded to the Ministry as occasion arose. 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 41, 42 and 43 in the Section dealing with the inspection and supervision of food. 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 1928 are also given. 50 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 390 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. TABLE No. 27. Disease. Positive Result. Negative Result. Total, 1929. Total, 1928. Diphtheria 266 1,796 2,062 1,553 Enteric Fever — 13 13 26 Tuberculosis 76 300 376 348 342 2,109 2,451 1,927 51 SECTION IV.—HEALTH PROPAGANDA. The ordinary routine health propaganda work of the Council through its officers and institutions has continued on more or less similar lines as in previous years, but in addition, progress has been made in reaching the general public directly. The Council's powers in this connection are contained in Section 42 of the London County Council (General Powers) Act, 1926. In September, the Council purchased a first class cinematograph projector machine and much use of this was made during the year. The machine was supplied by the Gaumont Company and was specially constructed so that it could be adapted for use with a filament lamp or with an arc. The operator is a member of the Health Department, and as more experience is gained in the use of the machine, more and more use will be made of it, not only in the Council's buildings but in field work outside. The Council's activities in health propaganda work during the year may be classified as follows :— (a) Health Week, 1929. The following is a copy of the Health Committee's report to the Council :— In accordance with the Council's resolution of the 8th May last, we made arrangements for holding the annual Health Week activities in two parts of the Borough, and fixed a programme for three days at the Eltham Parish Hall, and another one for three days at the Town Hall. D 52 We concentrated on health talks, making as much use as possible of health films, and arranged for the production of a health play, writ.ten by a member of the staff of the department. This play, 'The Sins of the Mother,' was presented by members of the Shornells Dramatic Group on four occasions, was excellently produced and acted, and proved exceedingly popular. As in 1927, it was a great asset. The lectures were on various aspects of health work and were all given by lecturers expert in their special subjects. The films which we selected shewed not only general and special aspects of public health work, but also health-producing games and exercises. Certain of these films were hired but others were kindly lent by the following :— The National Association for the Prevention of Tuberculosis ; Health and Cleanliness Council; Dental Board of the United Kingdom; Messrs. D. W. Gibbs & Co.; Community Interest Films; Anglo-American Oil Company; National Milk Publicity Council; British Social Hygiene Council, and the Corporation of the City of Glasgow. In one of the films shewn, ' Health is Wealth,' one of the sections depicts the use of the tuberculosis shelters in Woolwich. We are grateful also to many voluntary workers for their assistance in running the creches at Eltham and Woolwich; to members of the staff of other departments for assistance in the production of the play, in the presentation of the films and for organ recitals, and to the Royal Arsenal Co-operative Society for the loan of furniture necessary for the production of the play. To all of these we have extended, in accordance with the wish of the Council, our hearty thanks. 53 As in previous years, special arrangements were made for the attendance of school children over 13 years of age, one session being held at Eltham and two sessions at the Town Hall. Three films were shewn and a special talk was given by one of the assistant medical officers at each session. The attendances at Eltham were smaller, naturally enough, than at Woolwich, but there is little doubt that the experience gained there justifies a continuance of the policy of holding Health Weeks in other parts of the Borough than Woolwich, and we shall bear this point in mind when the question of the organization of the next Health Week comes to be considered. In all, the total attendances were just short of 7,000. The Council's own cinematograph machine was used for projection throughout the week and proved highly satisfactory. The success of Health Week could not have been achieved without the support of the Council, the loyal co-operation of the staff and the assistance ungrudgingly given by representatives of health and other organizations within and without the Borough. (b) Health Talks to School Children. In 1928 a series of monthly talks to school children were arranged with the co-operation of the Advisory Committee of School Teachers. The series consisted of five meetings and the place of meeting was at the Town Hall. The general arrangement was as follows : a short talk of 15-18 minutes duration on a simple health subject was given by an Assistant Medical Officer, and then three or four health films were shown. In the 54 intervals between the films, health songs, which were specially written by a member of the staff, were shown on the screen and community singing followed. As an alternative, a literary reading has been given in the interval and on one occasion a one-act health play was presented. This play was written by a member of the staff of the Health Department and presented bv members of the staff of the department. The details of the programme at the beginning of 1929 are given below :— Subject and Lecturer. Cinema Films. 21st January, 1929. " The Care of the Mouth " " The CUmber " (Dr. C. Isobel Wright). " The Care of the Teeth " " Giro, the Germ." Community Singing. 18th February, 1929. " Simple Health Principles " " Dont Wait till it Hurts '' (Dr. C. Isobel Wright). " Inside Out" " Grade ' A ' (T.T.) Milk " " A Dangerous Handicap " Story Interlude : Mr. W. Cray. 18th March, 1929. " Common Pests in the Home." " Where there's Life there's 'ope " (Dr. C. Isobel Wright). " The Tale of the Flea, the Bug and the Louse " " A Brush with the Enemy." Health Play : " Dad on the Fly Trail." This series was such a success that the Health Committee decided to arrange another series for the winter of 1929-30. This was done with certain variations. It was found that 55 there were certain disadvantages in community singing and so this was discontinued. A second play was written by the same author and presented by members of the staff. In detail, the programme was as follows, two of the lectures being given in 1929 and the remaining three in the new year. Subject and Lecturer. Cinema Films. November 18th, 1929. " Just Ourselves " " Your Mouth " (Dr. Margaret Emslie). " Drifting " " New Ways for Old." December 16th, 1929. " Keeping Fit " " Beware of the Demons " (Mr. P. H. Jones). " Physical Education in the Schools " and a Health Play, " Dad, the Germ Catcher." January 20th, 1930. " Why do we Eat ? " " Peter and the Moon Man" (Dr. C. Isobel Wright) " Bottled Health " " Clara Cleans her Teeth " February, 17th, 1930. " Fighting the Germs " " Danger Ahead " (Mr. P. H. Jones). " Handling of Milk in a City Depot." and a Health Play, " Dad on the Fly Trail." March 17th, 1930. " The House we Live In " " Ten Little Dirty Boys " (Dr. C. Isobel Wright) " A School of Health " " Delay is Dangerous." 56 (c) Health Lectures to Adults. A series of health lectures to adults at the Town Hall, Woolwich, was arranged to take place during the winter. These meetings were held at 8 p.m. One lecture was given during the year under review, the other three being given at the beginning of the new year. The programme was as follows :— Date. Subject and Lecturer. November, 18th, 1929. " Secrets of Good Health " Sir W. Arbuthnot Lane, Bart., C.B. January 20th, 1930. " Sunlight Cure and Artificial Substitutes " Dr. Percy Hall. February 17th, 1930. " The Psychology of the School Child " Dr. George Somerville. March 24th, 1930. " Common Errors in Diet " Professor R. H. A. Plimmer, D.Sc. Some of these lectures were illustrated by lantern slides and a few cinema pictures on health subjects were shewn after each lecture. (d) Clean Food Demonstration. In connection with a Trade and Industry Exhibition organised by the Woolwich Chamber of Commerce, arrangements were made for a demonstration of the slogan " Buy Clean Food and Keep it Clean." Two stalls were utilized. The one applied the first half of the slogan and was arranged as a model food shop. The public were shown, by means of hygienic counters and cases and by WTapping and transparent coverings, how food could be protected from contamination. Various methods of keeping 57 perishable food clean and wholesome were demonstrated. The adjoining stall, which applied the second half of the slogan, showed the interior of a model larder and illustrated to the housewife how the various articles of food in daily use " Buy Clean Food "— could be kept free from dust and flies. Popular features of this larder were the " Baby's Tray," which showed how baby's food should be prepared and kept, and a vegetable stand designed for keeping vegetables in a tidy and clean manner. 58 The exhibits were explained by a staff of Sanitary Inspectors and Health Visitors. The two photographs here given graphically illustrate the arrangement of the stalls. —"and Keep it Clean." (e) In addition, lectures have been given by members of the staff to Guilds and Mothers' Meetings and Associations of a like nature. 59 SECTION V.— SANITARY ADMINISTRATION. Staff. The sanitary section of the Department is under the control of the Chief Sanitary Inspector, who is assisted by ten male, one woman and two part-time women Sanitary Inspectors. In 1928 the number of male inspectors was nine, but on the 27th June, 1929, the Ministry of Health approved the appointment of an additional male sanitary inspector and Mr. F. Hemingway commenced duty on the 14th August, 1929. The Chief Sanitary Inspector is also responsible for the inspection and supervision of food and such housing matters as come within the purview of the Department. Complaints. The number of complaints received during the year was 2,277, compared with 2,102 in 1928. Most of the complaints came from occupiers of houses and dealt with alleged nuisances there. In accordance with the provisions of the Public Health (London) Act, 1891, a complaints book is kept and all complaints, both written and oral, are recorded therein. 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 15 in Plumstead and 12 in Eltham. Removal and Disposal of Refuse. House refuse is collected and disposed of by the Works Committee of the Council. Collection is once a week generally, but in certain parts of the Borough twice weekly. All house refuse is burnt at the Council's destructor, White Hart Road, Plumstead, but 60 before burning a preliminary sorting is made and tins and all iron removed. These are crushed in a hydraulic press and are sold. 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. Trade Refuse. Trade refuse also is collected by the Works Committee, but in this case a charge of 5s. 0d. per load is made. During the year approximately 2,957 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. Practically every house in the Borough is connected with the water carriage system and drainage is satisfactory. During the year 43 complaints were received with regard to the construction of combined drains. On investigation it was found that 200 houses in all were affected. In every case the drains were cleared. In all the systems except four, the obstruction was of a temporary nature, or was due to slight defects which admitted of a remedy at the time of inspection. Costs recovered from the owners amounted to £57 2s. 4d. In these four instances, however, reconstruction was necessary. After service of the notices and on receipt of the consent of the owners, the work was carried out in two cases by the Works Department of the Council, (the costs being paid by the individual owners in their proper proportions) and in the other two by the owners themselves. 61 Sewer Emanations. As a result of a serious explosion which took place in Holborn in December, 1928, the question of the ventilation of the London County Council's main sewers and manholes received the careful consideration of the Main Drainage Committee of that body, and they gave instructions that the manholes that had been covered by plates should be re-opened. When the plates were removed, a host of complaints were received from inhabitants of adjoining houses. Quite apart from any considerations as to whether the public health was likely to be endangered by these emanations there could be no doubt that an intolerable state of affairs had arisen, and it was no consolation to the complainants to be informed that the County Council had been advised that the public health was not likely to be endangered by the action taken. The complainants regarded the smell as most objectionable and abominable, and a nuisance of the worst order. At the meeting of the Woolwich Borough Council in July it was declared urgent business to deal with the following motion :— "That the London County Council be informed that the removal of the covers from certain manholes on the main sewers in Woolwich has resulted in most objectionable and offensive sewer emanations, causing serious pollution of the atmosphere, and that the Woolwich Borough Council, while appreciating the desire of the London County Council to minimise the risk of damage by explosion of sewer gases, are of opinion that the method adopted is unsatisfactory and also unfair to those who are subjected to the discomfort of these intolerable smells, and asks that immediate steps may be taken to replace these covers." The public outcry against the action of the County Council was not confined to Woolwich, and the County Council, in reply to representations, took steps to see that the discomfort and discontent complained of were removed by the replacement of most of the plates. 62 Later on the County Council stated that the matter was one of great complication and old standing, and that the ventilation of sewers had always been regarded as essential both from the point of view of safeguarding the workers and of the safety of the sewers themselves. They accordingly decided that no alteration should be made in the principle governing the ventilation of sewers under their control by means of surface ventilators, varied in special cases by the use of ventilating columns or such other methods of ventilation as may be suitable in particular circumstances, and they authorised the Main Drainage Committee to decide the method of ventilation in any particular case having regard to the circumstances involved. In September further representations were made to the County Council on the matter. Sanitary Inspection of the Area. In Table No. 28 will be found details of the inspections made in connection with the sanitary supervision of the Borough during the year. The incidence of smallpox in the London area (referred to in the appropriate section of the report) interfered considerably with the routine work of the Inspectors, as all Woolwich contacts were kept under close supervision. The number of intimation notices served was 2,551, and statutory notices, 917. The statutory notices related to 775 premises and included 727 general notices, 100 ash-pit, 61 water closet and 26 paving notices. In addition to these, three notices were served under the London County Council (General Powers) Acts and By-laws. In 180 instances the owners neglected to comply with the statutory notices, but it was only necessary to apply for seven summonses, details of which are set out in Table No. 34, as the letter from the Town Clerk to the owner as a preliminary to proceedings was sufficient in the majority of cases to get the work done. In addition to these seven summonses referred to, three other 63 summonses were taken out for failure to comply with the Magistrate's Orders. In Table No. 29 will be found a tabular statement of the type of nuisances abated during the year. TABLE No. 28. Inspections. Housing Survey—Houses Inspected 1,883 Complaints Investigated 2,277 Outworkers' Premises 756 Houses Let in Lodgings 49 Houses re Infectious Disease 1,485 Houses re Smallpox Contacts 1,333 Houses re Verminous Cases 1,092 Houses re Scabies Cases 215 Houses re Other Diseases 204 Overcrowding Investigated—Rooms 77 Underground Rooms Illegally Occupied 5 Drainage Inspections 1,008 Drains Tested by Smoke Test 125 Drains Tested by Water Test 3 New Houses 698 Tents and Vans 8 Factories 179 Workshops 735 Workplaces 75 Theatres and Cinemas 21 Rag and Bone Premises 16 Urinals Accessible to the Public 298 Women's Lavatories 449 Smoke Observations 158 Special Inspections re Rats 215 Inspections re Mosquitoes 39 Miscellaneous (Unclassified) 1,684 Re-Inspections 9,268 64 TABLE No. 29. Nuisances Abated. Cleansing— Interiors Cleansed 1,253 Rooms Cleansed 2,760 Damp Conditions— Walls 615 Sites 6 Roofs 772 Rain Water Pipes and Gutters 482 Others 27 Dilapidations— Walls 674 Ceilings 549 Floors and Hearths 262 Coppers 148 Stoves 219 Others 53 Verminous Conditions— Rooms Cleansed 216 Defective Lighting— Windows Repaired 36 ,, Enlarged — ,, Additional — Defective Ventilation— Windows Rendered Usable 439 „ Additional Provided — Other Means 2 65 Defective Paving— Yards Re-paved 95 ,, Repaired 114 Scullery Floors Re-paved or Repaired 109 House Drains— Defective Drains Repaired 147 Choked Drains Cleared 206 Vent Pipes Repaired 15 Soil Pipes Repaired 5 Gullies Fixed 42 New Drainage 3 Rain Water Tanks Repaired 1 ,, ,, Abolished 2 Sinks Repaired or Provided 113 Wastes Cleansed 93 Wastes Trapped or Repaired 120 Water Closets— Flushing Apparatus Repaired 327 Flushing Apparatus Renewed 121 New Pans 185 New Traps 153 Foul Pans Cleansed by Owner 28 Foul Pans Cleansed by Occupier 37 Additional w.c.'s Provided 2 Doors and Fastenings Remedied 111 Dust Bins Provided 394 Underground Rooms Closed — Overcrowding—Cases Remedied 16 66 Water Supply— Additional 1 Re-instated 61 Cisterns Cleansed 1 Cisterns Covered 2 Cisterns Removed 1 Foul Accumulations— Manure Removed 1 Offensive Accumulations Removed 24 Back Yards Cleansed 45 Dung Pits Provided 1 Rats— Drains Repaired in Consequence 14 Premises Rat-Proofed 2 Other Effective Measures 5 Rag and Bone Premises— Premises Cleansed — Rain-proof Premises Provided — Vermin-proof Conditions Provided — Miscellaneous 117 Rats and Mice (Destruction) Act, 1919. Each male Inspector has been authorised under this Act to act as rats officer in his own district. During the year 200 special inspections were made in this connection and six informal notices were served. In no instance was it necessary to resort to legal proceedings. In two instances rat-proofing of premises was carried out under the supervision of the Inspector, and in 14 instances investigation showed that the ingress of rats was due to defective drains which were repaired in consequence. The Council co-operated in the National Rat Week Campaign, which this year was from the 4th to the 9th November. With the assistance of the Works Department 67 8,553 baits were laid in the old sewers of Woolwich and Plumstead that were likely or known to be infested with rats. Co-operation was readily obtained from many firms in the Borough. 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, thirty-nine inspections being made. Rag Flock Acts. During the year six samples of rag flock were taken for analysis and the following Table gives the detailed results of each analysis made. All these samples complied with the Rag Flock Regulations inasmuch as the soluble chlorine in the form of chlorides did not exceed 30 parts of chlorine in 100,000 parts of flock, which is the maximum amount allowed by the Regulations. Rag flock is only manufactured on a wholesale scale at one factory in the Borough, but it is sold at several shops. TABLE No. 30. Samples of Rag Flock. Date. Parts per 100,000 of soluble chlorine in the form of chlorides. 7th January 19.25 19th February 23.75 28th February 25.00 9th April 30.00 25th April 28.90 2nd May 28.50 e 68 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 158 special observations were recorded and 24 offences were discovered. Warning letters were sent in each case. During the year the appropriate Committee of the London County Council provisionally approved the following draft bye-law :— "The emission of black smoke for a period of two minutes in the aggregate within any continuous period of 30 minutes from any one chimney or a building, other than a private dwelling house, shall, until the contrary is proved, be presumed to be a nuisance liable to be dealt with summarily under the Public Health (London) Act, 1891." Factory and Workshop Act. The Medical Officer of Health is 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 358. The number of inspections was 989, compared with 778 in 1928. The number of sanitary defects found was 98, and 95 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, 756, compares with 820 for 1928. Most of the outworkers in the 69 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. 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. TABLE No. 31. Factories, Workshops, Workplaces & Homeworkers' Premises. 1.—Inspection. Including inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written notices. Prosecutions. Factories (Including Factory Laundries). 179 10 — Workshops (Including Workshop Laundries). 735 18 — Workplaces (Othor than Outworkers' Premises) 75 1 — Homeworkers' Premises 756 3 — 70 2.—Defects Found. Description. Number of Defects. Found. Remedied. Referred to H.M. Inspect'r Number of Prosecutions. Nuisances under Public Health Act :— Want of Cleanliness 25 25 — — Want of Ventilation 3 3 — — Overcrowding 1 1 — — Want of drainage of floors — — — — Other nuisances 64 62 — — Sanitary Accommodation insufficient 3 2 — — unsuitable or defective 1 1 — — not separate for sexes 1 1 — — Offences under the Factory and Workshop Act :— Illegal occupation of underground bakehouses (s. 101) — — — — Other offences — — — — Total 98 95 — — 3.—Outworlc in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices served. Prosecutions. Wearing Apparel:—making, etc. 17 3 — Racquet and Tennis Balls 4 1 — 21 4 — Mortuaries. The Public Mortuary is in Sun Street, Woolwich, and a temporary Mortuary is provided in Eltham High Street. The following Table shows the use made of the mortuaries during the year. 71 TABLE No. 32. Sun Street Sun Street (Infectious) Eltham. All Mortuaries. 1928 1929 No of Bodies received : (a) for inquest 22 — — 31 22 (b) for custody 15 — 5 18 20 37 — 5 49 42 No. of Post - Mortem Examinations 15 — — 17 15 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 at Plumstead. At the end of 1927 the Council adopted the Burial Acts for the parish of Eltham, a condition precedent to the provision of a cemetery, but at the end of the year no suitable site had been found, although the matter has received the close attention of the appropriate Committee throughout the year. In Table No. 33 which follows, is shown 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. 33. Number of Interments. 1927. 1928. 1929. Woolwich Cemetery 554 604 657 Plumstead Cemetery 654 643 767 Eltham Churchyard 200 227 265 Plumstead Churchyard 8 8 9 72 Exhumations. During the year eight 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 the public health may be taken. At each exhumation a Sanitary Inspector was present. Plumstead Churchyard. This churchyard consists of two portions—an old portion around the church and which has been closed for many years, and a newer portion which was opened in 1860, and lies south of the other portion. In and about 1890 the sanitary condition of this churchyard was a matter which received much consideration by the Plumstead Board of Works, and representations were made to the Home Office with a view to closing it. In 1893 an enquiry was conducted by a Home Office Inspector and as a result the official Regulations in force in 1860, and modified in 1891, were again modified to read as follows :— (1)" The Burial Ground shall be effectively fenced, and, if necessary, under-drained to such a depth as will prevent water remaining in any grave or vault. (2) The area to be used for graves shall be divided in grave spaces, to be designated by convenient marks, so that the position of each may be readily determined, and a proper plan kept, upon which each grave space shall be shown. (3) No new vault or earthen grave shall be dug within two feet of any other grave. (4) A register of graves shall be kept, in which the name, age, and date of burial in each shall be duly registered. (5) No body shall be buried in any vault or walled grave unless the coffin be separately entombed in an 73 tight manner; that is by properly cemented stone or brickwork which shall never be disturbed. (6) One body only shall be buried in an unwalled grave at one time, unless the bodies be those of members of the same family. (7) No unwalled grave shall be reopened within 14 years after the burial of a person above 12 years of age, or within 8 years after the burial of a child under 12 years of age, unless to bury another member of the same family; in which case a layer of earth not less than one foot thick shall be left undisturbed above the previously-buried coffin; but if, on reopening any grave, the soil be found to be offensive, such soil shall not be disturbed, and in no case shall human remains be removed from the grave. (8) No coffin shall be buried in any unwalled grave within four feet of the ordinary level of the ground unless it contains the body of a child under 12 years, when it shall not be less than three feet below that level. (9) No new vaults or earthen grave shall be made within 20 yards of the southern boundary of the Burial ground. (10) Twenty-four hours' notice of any intended burial to be given by the sexton to the Sanitary Inspector of the District, such notice shall give the name of the person to be buried and number of the grave to be used. (11) The existing paths shall not be used for interments, and the incumbent and churchwardens of Plumstead, and all other persons to whom it may concern, are hereby required to conform to and obey the said regulations as provided by the Act." 74 According to the figures published in successive Annual Reports of the Medical Officer of Health, the burials in this Churchyard each year since 1894 have been as follows :— 1894—318 1903—115 1912—60 1921—24 1895—358 1904—123 1913—34 1922—33 1896—253 1905— 62 1914—51 1923—23 1897—177 1906— 60 1915—46 1924—27 1898—193 1907— 40 1916—38 1925—16 1899—149 1908— 22 1917—36 1926—15 1900—164 1909— 59 1918—32 1927— 8 1901—144 1910— 51 1919—37 1928— 8 1902—125 1911— 47 1920—41 1929— 9 In recent years the churchyard has assumed a very forlorn appearance and has become a wilderness. Many graves have sunk below the level of the surface of the land and others are exposed by holes in the brickwork above the ground. The graves are overcrowded and there is an entire absence of order. Generally speaking, the condition is one of dilapidation and neglect. There have been for some years many complaints about the condition of the churchyard. During the year the General Purposes Committee of the Council asked the Town Clerk to initiate the necessary steps for closing it. After considerable research and many consultations and enquiries, the General Purposes Committee reported as follows :— " We have for some time had under consideration the desirability of closing that portion of the above churchyard which is at present used for burials, with a view to the Council taking it over as an open space, and have been in negotiation with the Vicar of Plumstead thereon. 75 Section 7 of the Burials Act, 1852, excludes from the operation of the Act any burial ground added after that date, and as that portion of the Churchyard at present used for burials was added in 1860, it is not possible to close it under the provisions referred to. In a similar case, provision was obtained in one of the General Powers Acts of the London County Council deeming a cemetery to have been closed for burials within the meaning of the Open Spaces Acts applicable thereto. In view of the many complaints which have been received as to the conditions of the Churchyard, we are of opinion that similar steps should be taken in this case, subject to the Vicar of Plumstead concurring in the action proposed." The Vicar of Plumstead concurred, and in November the London County Council decided, subject to the Woolwich Borough Council agreeing to defray a proportion of the expenses for the promotion of a Bill and all expenses specially incurred, to promote legislation in Parliament in the session 1929-30 to enable the Borough Council to close that portion of Plumstead Churchyard still open for burials and provide for matters incidental thereto. The area of the newer portion is 12,127 square yards. The area of the closed portion, including the church, is 5,387 square yards, and excluding the church, 4,307 square yards. A plan of the churchyard is shown on page 76, the two portions being separately defined. Removal of Infirm and Diseased Persons in Certain Cases. The London County Council (General Powers) Act, 1928, includes a section which provides for the removal of aged, infirm or diseased persons, on the certificate of the Medical 76 ST. NICHOLAS' CHURCHYARD, PLUMSTEAD. Old Portion, 4,307 sq. yds. Newer Portion, 12,127 sq. yds. 77 Officer of Health. Such persons may be removed to a suitable hospital, infirmary, poor law institution or other suitable institution or place either within or without the district, and they may be detained and maintained there for a period not exceeding three months or such further period as may be determined by further orders. The penalty for obstructing such an Order is not exceeding £10. Procedure to be followed by Medical Officer of Health. (1) The Medical Officer of Health certifies in writing in one or other of the two following forms :— (a) That the person is aged or infirm or physically incapacitated and resides in premises in the district which are insanitary owing to any neglect on the part of the occupier thereof or under insanitary conditions. or, alternatively— (b) That the person is suffering from grave chronic disease. (2) The Medical Officer of Health further certifies that such person is unable to devote to himself or to receive from persons with whom he resides proper care and attention, and that thorough enquiry and consideration have shown the necessity, in the interest of the health of such person and for preventing injury to the health of or serious nuisance to other persons, that he should be removed from the premises in which he is residing. (3) The Medical Officer of Health gives to any person to be removed under the provisions of this section, or to some person being in charge of such person, three days' clear notice of his intention to make an application to a Petty Sessional Court. 78 (4) The Medical Officer of Health gives three days' notice to the Guardians before making any application under this section. N.B.—The consent, in writing, of the Guardians is necessary before the persons are received or retained in a poor-law hospital, and the Guardians are entitled to appear before a Petty Sessional Court to be heard upon the matter. (5) The Medical Officer of Health makes application to a Petty Sessional Court and tenders oral proof of the allegations in his certificate. Procedure at Petty Sessional Court. (6) After oral proof of the allegations in the Medical Officer's certificate the Court may order a registered medical practitioner to be nominated by them to examine the person. (7) The Court, if they think fit, may make an Order for the removal of such person to a suitable place and for the detention and maintenance of such person therein for a period not exceeding three months in the first instance. The Order may be renewed for further periods of three months each. Responsibility for Costs on Sanitary Authority. (8) The cost of removal and maintenance in a suitable place shall be borne by the Sanitary Authority. (9) The Sanitary Authority may be required to contribute towards the maintenance of any dependants 79 of that person as the sanitary authority may think fit or as they may be directed by the Court. N.B.—The Guardians may assume such obligations as may be agreed upon between them and the Sanitary Authority. Procedure to be followed regarding rescission of Order. (10) Six clear weeks after the making of the Order an application may be made to the Court, by or on behalf of the person in respect of whom the Order was made, for its rescission. (11) In this case three clear days' notice must be given to the Medical Officer. The Council at their meeting in December, 1928, passed a resolution authorising the Medical Officer of Health to put into operation the Council's powers under the Act when the occasion arose. During the year I was asked to take action in three cases of aged persons and all of them on learning that application to a Magistrate was being made agreed voluntarily to go into an infirmary or institution. 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. 34. 80 TABLE No. 34. Prosecutions under Public Health and kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1 1929. 2nd Jan. Leaky house roof 8, Collingwood St. Order to abate nuisance within 21 days. Fined £2. 2 do. Defective and leaky roof. 9, Collingwood St. Fined £2. 3 do. do. 4, Rodney Street Order to abate nuisance within 21 days. £2 2s. costs. 4 15th Jan. do. 11, Collingwood St. Fined £2. 5 30th Jan. Leaky house roof, defective and damp floor. 21, Balgowan Street Order to abate in 14 days. Costs £1. 6 30th April Defective and leaky house roof 10, Collingwood St. Order to abate in 14 days. 7 30th April Default in complying with Magistrate's Order. 4, Rodney Street .. Fined £5. 8 30th April do. 8, Collingwood St. Fined £5. 9 30th April do. 9, Collingwood St. Fined £5. 10 3rd Dec. Premises without sufficient ashpit. 30, Meadowcourt Road. Dustbin provided. Summons withdrawn. 81 SECTION VI. INSPECTION AND SUPERVISION OF FOOD. Although there are now three special food Inspectors, all the male Sanitary Inspectors in some degree or other are concerned with the inspection and supervision of the food supplies. The following Table No. 35 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. 35. Premises. On Register 31st December. Number of Legal Proceedings. Inspections. Notices. Bakehouses 38 80 — — Cowsheds 19 156 6 — Milkshops 94 466 5 — Ice Cream Premises 107 271 1 — Slaughterhouses 7 26 — — Fried Fish Shops 59 190 10 — Butchers' Shops 96 170 — — Premises whore Food is prepared (other than above) 172 371 23 Shops and Markets — 1680 — — 82 MILK SUPPLY. Registration. The number of registered dairy premises at the end of the year was 94 ; 24 of these were in Woolwich, 40 in Plumstead, and 30 in Eltham. These premises were in the occupation of 63 registered dairymen or purveyors of milk. In addition, 18 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 registers 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 19 cowsheds in all, with accommodation for 417 cows. The average number of cows kept was 335. The cowsheds were regularly inspected and it was found necessary to serve six notices. Inspections are usually made at milking time. In general, the conditions were satisfactory. Milk Retailed in Bottles. Every person delivering milk in bottles must fill and close every such bottle on registered premises and no person must remove or tamper with the disc or device for sealing the bottle at any time after leaving such premises before it is handed to the customer. Towards the end of 1928 and the beginning of 1929 there was reason to believe that the above regulation was not being complied with and so special observations were made. It was found that certain milk vendors were filling milk bottles in the streets, and in some instances this breach of the regulations was aggravated by the fact that unwashed bottles were being used. Legal proceedings in these cases may be taken either against the dairyman or the roundsman, but if the Council 83 take proceedings against the dairyman he may summons the roundsman if he alleges he is actually the offender. In only one instance did a dairyman issue a summons against the roundsman, and in this instance the Magistrate convicted the employer and dismissed the summons against the employee. Twelve summonses in all were taken out by the Council in respect of this offence, and in all instances (except one where the summons was dismissed under the Probation of Offenders Act on payment of costs) convictions were recorded. 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 " (Tuberculin Tested) ; Grade "A," and Pasteurised. The licences have to be renewed annually and all expire on the 31st December each year. Thirty-seven applications were received for Dealers' and eight for Supplementary licences, all of which were granted. The total amount received in fees was £10 Is. Od. In some instances owing to changes in ownership the licences appear duplicated in the following Table No. 36, which gives details of each licence issued. TABLE No. 36. Name and Address of Applicant. Nature of Licence. Premises to Sell at or from. Designation. The Express Dairy Co., Ltd., 26, Tavistock Place, W.C. 1. Dealers 3, Wellington Street, Woolwich. Certified. Do., do. do. do., do. Grade "A" (Tuberculin Tested). Do., do. do. do., do. Pasteurised F 84 TABLE No. 36—continued. Name and Address of Applicant. Nature of Licence. Premises to Sell at of from. Designation. The Express Dairy Co., Ltd., 26, Tavistock Place, W.C. 1 Do., do. Do., do. Dealers do. do. 397, Footscray Road, Eltham. 397, Footscray Road, Eltham. 30, Eltham High Street. Certified Pasteurised Certified Do., do. do. 30, Eltham High Street Pasteurisod Do., do. do. 82, Eltham High Street. Certified Do., do. do. do., do. Grade " A " Do., do. do. do., do. Pasteurised Do., do. Do., do. Do., do. do. do. do. do., do. 102, Westmount Road, Eltham. do., do. Grade " A " (Tuberculin tested). Certified Grade " A " Do., do. do. do., do. Pasteurised Porter, W. J., 18, Well Hall Parade, Eltham. do. 18, Well Hall Parade, Eltham. Grade "A" (Tuberculin Tested). The Eltham and Sidcup Farm Dairies, Ltd., 76, Finsbury Pavement, E.C. 2. do. 82, Eltham High Street Certified Do., do. do. 397, Footscray Road, Eltham. do. Do., do. do. 102, Westmount Road, Eltham. do. Slater, A. E. (Mrs.), 30, Eltham High Street. do. 30, Eltham High Street do. Bowyer, R., 310, High Road, Lee, S.E. 13. Cole, E. J., 18, Camrose Street. Plumstead. do. do. 40, Well Hall Road, Eltham. 18, Camrose Street, Plumstead. do. Grade " A " (Tuberculin Tested). Marshall, John, 4, Ladysmith Road, Eltham. do. 2, North Park Mews, Messiter Place, Eltham. Certified s.-> TABLE No. 36—continued. Name and Address of Applicant. Nature of Licence. Premises to Sell at or from. Designation. The United Dairies (London), Ltd., 2, Canterbury Road, Brixton, S.W. 9 Dealers 124, Westmount Road Eltham. Pasteurised Do., do. do. do., do. Certified Do., do. do. do., do. Grade " A " Do., do. do. do., do. Grade " A " (Tuberculin Do., do. do. " Ashurst," Shrewsbury Lane, Plumstead. Tested). Pasteurised Do., do. do. do., do. Certified Do., do. do. do., do. Grade " A " Do., do. do. do., do. Grade " A " (Tuberculin Tested). Do., do. do. 16, Pellipar Road, Woolwich. Pasteurised Do., do. do. 62, Plumstead Common Road, Plumstead. do. Do., do. do. 25, Eltham High Street, do. Do., do. Supplementary 74, Little Heath, Charlton. Certified Do., do. do. do., do. Grade " A " Do., do. do. do., do. Grade "A " (Tuberculin Tested). Do., do. do. do., do. Pasteurised Do., do. do. 30, Burnt Ash Road, Lee. Certified Do., do. do. do., do. Grade " A " Do., do. do. do., do. Grade " A " (Tuberculin Tested). Do., do. do. do., do. Pasteurised Do., do. Dealers 16, Lakedale Road, Plumstead. Certified Do., do. do. do., do. Grade " A " (Tuberculin tested). Do., do. do. do., do. Grade " A " Do., do. do. do., do. Pasteurised 86 During the year six 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 set out 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 centimetre." In similar circumstances a sample of pasteurised milk was taken, where the standard is not so high. The results of the examinations are shown in the following Table. TABLE No. 37. Date. Designation. Bacteria per c.c. Coliform Bacilli. 13th March Certified 6,866 Absent in 1 c.c. 28th May Certified 7,173 Absent in 1 c.c. 31st July Certified 6,933 Absent in 1 c.c. 21st August Certified 1,250 Absent in 1 c.c. 3rd September Certified 4,780 Absent in 1 c.c. 20th November . . Certified 5,743 Absent in 1 c.c. 11th December .. Pasteurised 17,833 The Public Health (Condensed Milk) Regulations, 19231927. During the year six samples were taken and were found to comply with the Regulations in every respect. The Public Health (Dried Milk) Regulations, 1923-1927. Nine samples of dried milk were submitted for analysis during the year and all were reported as genuine. Artificial Cream Act, 1929. This Act came into operation on the 1st June, 1929, and is designed to regulate the sale and manufacture of a cream substitute which has hitherto been known as reconstituted cream and is usually prepared 87 by emulsifying butter, dried skimmed milk and water. The definition in the Act is, however, drawn sufficiently wide to include any article of food resembling cream and containing nothing but the ingredients of cream. The Act provides that where any such substance is artificial cream it shall not be sold under a description or designation including the word " cream " unless that word is immediately preceded by the word " artificial." Receptacles used for conveying artificial cream or for containing it when exposed for sale, must be labelled with the words " artificial cream" in large and legible type. Provision is made for the registration with the Pood and Drugs Authority of premises where artificial cream is manufactured or sold ; and where an article having the composition of cream or artificial cream is sold on premises so registered, it shall be presumed to be artificial cream unless the contrary is proved. Any officer of the Food and Drugs Authority duly authorised in that behalf by the Authority may at all reasonable times enter and inspect any premises registered with the Authority under this Act. Agricultural Produce (Grading and Marking) Act, 1928. This Act provides for the grading and marking of agricultural produce, and the Minister of Agriculture and Fisheries may make regulations prescribing grade designations to indicate the quality of any articles as he may consider appropriate, and containing a definition of the quality indicated by every grade designation. The use of the designations is not compulsory, but if they are used the produce must conform to the standards prescribed. Special provisions are made as to eggs. The local authority in London is the Council of the Metropolitan Borough concerned, and the Medical Officer of Health, the Chief Sanitary Inspector and three Sanitary Inspectors have been appointed officers for the purposes of this Act in Woolwich. Under the Act Regulations have been made prescribing grade designations for certain articles and these are as follows :— 88 TABLE No. 38. Produce. Date of Regulations. Designations. Eggs 15th December, 1928 Special. Standard. Pullet Standard. Special (Duck). Standard (Duck). Ducklet Standard. Broccoli 27th March, 1929 First Quality or Prima Qualitat or Premiere Quality Tomatoes and Cucumbers 7th May, 1929 A. 1. Apples and Pears 19th June, 1929 Extra Fancy. Fancy. " C." Wheat Flour 12th September, 1929 All-English (Plain). All-English (Self- raising. All-English(Yeoman)) Beef 26th September, 1929 Select. Prime. Good. Malt Flour and Malt Extract. 29th November, 1929 All-English Malt Flour (White Bread) All-English Malt Flour (Brown Bread) All-English (Pharmaceutical) Malt Extract. All-English (Bakers') Malt Extract (White Bread). All-English (Bakers') Malt Extract (Brown Bread). All-English (Veterinnary) Malt Extract. Potatoes 30th November, 1929 E. and W. No. 1 Size. E. and W. No. 2 Size. E. and W. No. 3 Size. 89 Merchandise Marks Act, 1926. Under the provisions of Section 9 of the above Act, Food and Drugs Authorities have power to execute any of the provisions of the Act, other than those relating to importation, in respect of food stuffs which are subject to an Order in Council made under the Act. The orders which so far have been made are as follows :— The Merchandise Marks (Imported Honey. Goods) No. 3 Order, 1928 .. Fresh Apples. The Merchandise Marks (Imported Currants. Goods) No. 5 Order, 1928 .. Sultanas. Raisins. Eggs in shell. Dried Eggs. Oat Products. The Merchandise Marks (Imported Raw Tomatoes. Goods) No. 4 Order, 1929 These orders prohibit the sale or exposure for sale respectively, in the United Kingdom, of the products mentioned above unless the goods bear an indication of the country of origin. The term " sale " includes sale, wholesale, or sale by retail, and exposure for sale includes exposure for sale wholesale and exposure for sale retial. As a general rule imported produce does not require marking when exposed for sale or sold in quantities not exceeding 14 lbs. in weight. Sale of Food Order, 1921. During the year Article 8 of this Order, which provides that eggs imported into the United Kingdom should not be sold under any description of which the words " fresh " or " new laid " formed part unless the description includes the word " imported " or a word or words disclosing the country of origin, was revoked by the Sale of Food (Revocation) Order, 1929. 90 MEAT. The Public Health (Meat) Regulations, 1924. Notice of intention to slaughter any animal must be given to the Council. In one instance only, slaughtering took place without notice and the butcher was cautioned. The following Table shows the number of animals slaughtered in the Borough during the year :— TABLE No. 39. Month. Cattle. Sheep & Lambs. Pigs. Calves. Total. January 197 801 1,337 139 2,474 February 170 650 1,172 163 2,155 March 171 811 1,069 223 2,274 April 190 879 995 177 2,241 May 220 948 330 183 1,681 June 181 921 52 197 1,351 July 170 1,054 19 178 1,421 August 189 814 68 178 1,249 September 177 993 596 158 1,924 October 211 918 1,246 176 2,551 November 239 842 1,237 177 2,495 December 263 1,067 1,654 85 3,069 Totals .. 2,378 10,698 9,775 2,034 24,885 91 The number of whole carcases condemned on account of disease or injury was 31 (27 pigs and 4 sheep). In 857 instances partial condemnation was necessary in respect of 147 cattle, 105 sheep and 605 pigs. All shops and stalls where meat is sold are regularly inspected, and, if any insanitary conditions are discovered, measures are taken to secure their abatement. Slaughterhouses. 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. 40. 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. Inspection of Imported Meat. In Woolwich, as in other parts of the country, much imported meat is sold. In the usual way this meat comes from the London markets after inspection, and such inspection as it receives in Woolwich takes place in the butchers' shops where it is exposed for sale. Occasionally, however, the Port of London Authority allow foreign meat to be removed from the Port of London without 92 examination on the understanding that (a) the meat shall be taken to a wholesale depot; (6) none of it shall be removed without the permission of the local Medical Officer of Health ; and (c) the consignees shall give the Medical Officer of Health notice as soon as the meat is received at the depot. Guarantees are obtained by the Port of London Authority before such permission is given. During the year 122 carcases of sheep were so examined in Woolwich and in one instance a whole carcase was condemned on account of caseous lymphadenitis. OTHER FOOD PREMISES. Bakehouses. There were, on the 31st December, 38 bakehouses in the Borough, of which 24 were factory and 11 underground. Eighty inspections were made by the Sanitary Inspectors, but it was not found necessary to serve any notices. The conditions on the whole were satisfactory. Fried Fish Shops. There were 59 fried fish shops on the register at the end of the year. These premises were inspected on 190 occasions and 10 notices were served for breaches of the by-laws. Ice Cream, etc. Premises. The number of premises where ice cream was sold during the year was 107, but in many instances the sale was intermittent. 271 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 a similar commodity, shall be registered with the sanitary authority. The section concerned, 93 however, does not apply to hotels, restaurants, clubs and certain factories and workshops. The Act does not empower the sanitary authority to refuse registration—a very serious defect. Other Premises. All premises where food for human consumption is sold and/or prepared for sale and/or stored are regularly inspected in order to ensure that they are maintained in a proper sanitary condition. In addition to those referred to in the preceding paragraphs the businesses receiving attention in this connection are restaurants, eating houses, coffee stalls and canteens, butchers' shops, grocery and provision stores, places where cooked meats and sausages are prepared, and places where stallholders and street traders keep their goods. In the inspection of all such premises careful attention is paid to the condition of the interior surfaces of the walls, roofs and floors, the cleanliness of the tables, utensils, machines and cooking apparatus, and the personal hygiene of those actually handling the food. Such technical points as the position of drain inlets and water closets receive close attention. The maintenance of an ideal standard of cleanliness in food preparation rooms is only possible by the elimination of dust and filth, by adequate lighting, proper ventilation and the free use of soap and water. Any defects in technique or in structure regarded as inimicable to these principles are immediately brought to the notice of the persons responsible, and revisits are made until the inspector is satisfied that proper hygienic conditions prevail. In addition to the inspection of these premises, 1,680 visits were made to shops and stalls in the markets with a view to inspecting the food offered for sale. UNSOUND FOOD. There were 222 instances of unsound food being surrendered. These compare with 288 in 1928. Included in 94 the food surrendered were :—3 cwts. of Beef ; 2cwts. Mutton ; 2 3/4 tons Pork; 9 cwts. Pigs' Offal, Liver, etc.; l½ cwts. Sheep's Offal, Liver, etc.; 6 cwts. Ox Liver; 2½ cwts. Ox Lungs; 3½ cwts. Fish; 33 lbs. Ox Tongues; 11 qrs. Cake; 1 cwt. Christmas Pudding; 1½ cwts. Dates; 2 3/4 cwts. Apples; 3 qrs. Potatoes; 1 cwt. Brussels Sprouts; 3 qrs. Carrots, and smaller quantities of grapes, tomatoes, oranges, etc. On two occasions food was seized, but, after considering the circumstances of each case, the Committee were of opinion that the owners should be cautioned, and they instructed the Town Clerk to send a warning letter. In one instance, the food consisted of 6 lbs. Tomatoes and 5| lbs. Apples, and in the other case, 112 oranges. On another occasion, 1 -lb. of meat was brought to the office by the purchaser 20 hours after it had been purchased. The meat was then unfit for human food, but it was impossible to say whether it was in such a state when it was sold. An inspection of the shop in question the same day disclosed no unsound food, and so no further action was taken in the matter. ADULTERATION, Etc. The number of samples taken during the year was 527, of which number 23 were certified by the Public Analyst to be adulterated. The percentage, 4'3, compares with 411 in 1928. No adulterated sample of milk was obtained. The number of samples taken on Sundays was 12, none of which were adulterated. The following Table gives details of the various analyses made under the Food and Drugs (Adulteration) Act, Public Health (Condensed Milk) Regulations, the Public Health (Dried Milk) Regulations, and the Public Health (Preservatives, etc. in Food) Regulations. 95 TABLE No. 41. Article. Formal Samples. Informal Samples. Number Analysed. umber Adulterated. Milk 195 - 195 - Separated Milk 2 - 2 - Cream - 21 21 Condensed Full Cream Milk - 4 4 - Condensed Skimmed Milk 1 1 2 - Dried Full Cream Milk 3 5 8 Dried Full Cream Milk (Modified) 1 1 Butter 4 24 28 1 Bread and Butter 9 - 9 1 Coffee - 5 5 - Tea - 3 3 - Cocoa 2 - 2 - Coffee and Chicory Essence. 2 2 - Sugar - 5 5 - Lard 8 8 - Jam - 11 11 - Brawn - 10 10 - Sausages 9 3 12 1 Tripe 6 6 - Chitterlings - 2 2 - Dripping 5 4 9 - Self-Raising Flour - 5 5 - Vinegar - 5 5 - Malt Vinegar 6 5 11 2 Ground Ginger - 3 3 - Pearl Barley - 5 5 - Green Peas - 6 6 - Candied Peel - 5 5 - Sponge Cakes - 3 3 - Cordials - 5 5 - Apples - 1 1 - Whisky 21 - 21 2 96 TABLE No. 41 (continued). Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Gin 17 - 17 3 Rum 11 - 11 3 Brandy 3 - 3 - Ale 7 - 7 - Stout 3 - 3 - Olive Oil - 5 5 - Ipecacuanha Wine - 5 5 - Liniment of Turpentine - 5 5 - Goulard's Extract - 3 3 - Goulard's Lotion 1 1 2 1 Lead Subacetate Ointment. - 2 2 - Syrup of Squills 4 4 - Syrup of Figs 2 2 - Strong Tincture of Iodine 1 5 6 1 Lime Water 4 4 - Glycerin of Borax 1 9 10 1 Camphorated Oil 5 5 - Sweet Spirit of Nitre 11 7 18 7 313 214 527 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 :— TABLE No. 42. 1927. 1928. 1929. 4.5 per cent, and over 8 2 2 4% and under 4-5% 15 10 8 3.5% and under 4% 106 115 74 3% and under 3'5% 134 142 111 Below 3% 1 4 Nil 264 273 195 TABLE No. 43. Sample No. Article. Formal or Informal. Result of Analysis. Result of Proceedings or other action. 24 Goulard's Lotion. Informal 2.24 times stronger than B.P. — 77 Butter Informal 48.73 per cent. of foreign fat. — 98 Sausages Formal 263 parts per million of sulphur dioxide. Fined £5. 116 Bread and Butter Formal Bread and margarine Dismissed. £1 Is. costs. 171 Strong Tincture of Iodine Informal 75 per cent. deficient in Iodine and 54.5 per cent. deficient in Potass Iodide. 198 Whisky Formal 38.93 degress under proof. Dismissed. £2 12s. 6d. costs. 218 Rum Formal 46.07 degrees under proof. Fined £2 or 28 days. 220 Gin Formal 36.39 degrees under proof. Further sample taken. 229 Glycerin of Borax Informal 100 per cent. deficient in borax. — 251 Sweet Spirit of Nitre Informal 27.2 per cent. deficient in ethyl nitrite. — 252 Sweet Spirit of Nitre. Informal 50.6 per cent. deficient in ethyl nitrite. — 253 Sweet Spirit of Nitie. Informal 65.2 per cent. deficient in ethyl nitrite. — 254 Sweet Spirit of Nitre. Informal 20.4 per cent. deficient in ethyl nitrite. — 97 ADULTERATED SAMPLES—ACTION TAKEN. The following, Table No. 43, shows the number of adulterated samples and the action taken in each instance where the samples were formal. 98 TABLE No. 43—continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Proceedings or other action. 255 Sweet Spirit of Nitre. Informal 45.4 per cent. deficient in ethyl nitrite. — 260 Malt Vinegar Informal 28 per cent. deficient in acetic acid and made from vinegar other than malt. — 269 Sweet Spirit of Nitre. Formal 63.8 per cent. deficient in ethyl nitrite. Dismissed. 272 Malt Vinegai Formal 25 per cent. deficient in acetic acid and made from vinegar other than malt. Vendor cautioned. 273 345 Rum Sweet Spirit of Nitre. Formal Informal 22 per cent. excess water 81 per cent. deficient in ethyl nitrite. Dismissed. £2 costs. 466 Whisky Formal 36.64 degrees under proof. Vendoi cautioned. 503 Gin .. Formal 39.71 degrees under proof. Dismissed. £3 38. costs. 506 Rum Formal 38.8 degrees under proof. Dismissed. £3 3s. costs. 508 Gin Formal 49.17 degrees under proof. Dismissed. £5 5s. costs. 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 examinations of designated milks was carried out at the laboratories of the Clinical Research Association, Watergate House, York Buildings, Adelphi, W.C. 2. 99 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. TABLE No. 44. Date of Hearing. Offence. Result. 1929. 2nd January Did fail to cause bottles to be filled with milk and closed on registered premises. Fined £1. Costs £1. do. do., do. Fined £1. Costs £2. do. do., do. Dismissed. (Roundsman summoned by dairyman in previous case). do. do., do. Fined £1. Costs £1. do. do., do. Fined £1. Costs £1. do. do., do. Fined £1. 30th January do., do. Fined £5. Costs £1. do. do., do. Fined £5. Costs £1. do. do., do. Fined £5. do. do. do., do. do., do. Fined £5 or one month. Fined £2. Costs £1. 19th September do., do. Dismissed. Costs £1 1s. 0d. 16th October Did wilfully obstruct a Sampling Officer. Fined £10 or two months. 27 th November Did fail to cause bottles to be filled with milk and closed on registered premises. Fined £5. G 100 SECTION VII.—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement is shown:— TABLE No. 45. Number of new Houses erected during the year:— (a) Total 698 (6) With State assistance under the Housing Acts:— (i) By the Local Authority 160 (ii) By other bodies or persons 50 1.—Inspection of Dwelling Houses during the Year. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 5,564 (2) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 1,883 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 (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 1,399 101 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 *Includes intimation notices. 1,775 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 rendered fit after service of formal notices:— (a) By owners — (6) 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 — (6) Proceedings under the Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 775 (2) Number of dwelling houses in which defects were remedied after service of formal notices: (a) By owners 644 (6) By Local Authority in default of owners — 102 (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 7 (2) Number of dwelling houses in respect of which closing orders were made 10 (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 4 (5) Number of dwelling houses demolished in pursuance of demolition orders 4 Inspection of Houses. In accordance with the provisions of the Housing (Consolidated) Regulations, 1925, the systematic inspection of houses in the district was continued during the year. In all, 1,883 houses were surveyed house-to-house, and their condition was recorded on special survey cards. The necessary steps were taken, of course, to secure the abatement of such nuisances as were found to exist. Except in those cases where closing orders were asked for, the usual practice has been to serve notices under the Public Health (London) Act. 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 notice 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, seven representations were made with respect to dwelling houses ; ten closing orders were made and four demolition orders were served and the four houses were subsequently pulled down. Two closing orders were 103 mined; the closing order in one case was made in the same year, and in the other case the closing order was made in 1922, the premises having been used other than as a dwelling house for several years. The details with regard to each case where action was taken are shown in Table No. 46 which follows. TABLE No. 46. Action Taken under Housing Acts. Date of Representation. Premises. Date of Closing Order. Remarks. 1928. 14th November 12, Walpole Place 9th January — 12th December 7, Eleanor Road 9th January Determined on 15th May. 14th November 8, Pound Place 9th January Demolition Order, 10th July. 14th November 14, Pound Place 9th January Demolition Order, 10th July. 14th November 20a, Pound Place 9th January . . Demolition Order, 10th July. 13th June 16, Pound Place 1st August, 1928 Demolition Order, 13th March. 1929. 11th July 1, Jubilee Cottages 9th October — 11th July 2, Jubilee Cottages 9th October — 11th July 3, Ram Alley 9th October — 11th July 4, Ram Alley 9th October — 16th October 55, St. James's Place 9th November — 1922. 12th May "Harrowfield" Farm House. 5th July, 1922 Determined 4th December. 1929. 11th December 31, Vicarage Road — Action pending at end of year. 11th December 33, Vicarage Road — Action pending at end of year. 104 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1923. During the year two applications were made by the occupiers of houses for certificates that the houses in question were not in a reasonable state of repair. The condition of the houses did not justify further action under these Acts and no certificates were granted. One owner made an application for a report under the Act, but as the necessary repairs had not been completed, the owner was informed that until these were done no report could be issued. Tents and Vans. Bye-laws regulating the use of these were made by the Council in 1903. All tents and vans (which are few in number) were inspected regularly and steps taken to ensure that the bye-laws were being observed. The total number of inspections made was eight. Houses Let in Lodgings. During the year, at the request of the Metropolitan Boroughs' Standing Joint Committee, the Public Health Committee had under consideration the provisions in the bye-laws made by the London County Council with respect to such houses under which the operation of certain bye-laws is suspended until six months after the Rents Restrictions Acts shall have ceased to be in force, and the question whether the suspensory provisions should now cease to have effect as regards houses which become decontrolled under the Acts. After consideration, the Public Health Committee were of opinion: (a) That it is desirable to bring into operation the suspended bye-laws; (b) That all the suspended bye-laws or parts of bye-laws should be brought into operation; and (c) That such byelaws should be made to apply to houses wholly or partially decontrolled. The Council agreed. 105 New Houses. The following Table, No. 47, 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 shown under the Eltham Housing Estate of the Borough Council. TABLE No. 47. Date of Meeting. Woolwich. Plumstead : Eltham Eltham Hsg. Estate. Total West. East. 16th January — 3 — 22 18 43 13th February — 1 1 16 6 24 14th March — 2 2 26 — 30 17th April — 7 25 31 — 63 15th May — — — 32 — 32 19th June 1 8 2 34 44 89 11th July — — 2 16 51 69 31st July — — — 47 — 47 17th September — 2 7 94 7 110 25th September — 3 3 13 — 19 16th October — 4 1 57 24 86 13th November — 3 — 32 10 45 11th December — 2 — 39 — 41 1 35 43 459 160 698 Demolitions. The number of houses demolished during the year was 31, all of which were in Eltham. Council's Housing Scheme. In my Annual Report for 1928 I reported very fully on the development of the Council's Housing Estate at Eltham. The last house was officially 106 opened by the Minister of Health (the Rt. Hon. Arthur Greenwood, M.P.), on the 30th November, and the last house was actually occupied by a tenant on the 7th December. It will be interesting to note here, however, that the final figures of the number of houses erected are as follows:— 1,438 "A" type; 696 "B" type; and 42 "C" type. During the year the erection of all three churches was completed and work was started on an additional school. One of the houses was given to a residential doctor. Five shops were erected on the shopping site in Westhorne Avenue, in one of which a post office is established. Two clubs have been erected by two different organizations. On the southern boundary of the estate seven shops with flats above have been erected by private firms on building leases. During the year a definite site was allocated for erecting a combined infant welfare centre and school treatment centre. This site is situated in the centre of the estate at the junction of Westhorne Avenue and Briset Road. At the end of the year the Council had under consideration the purchase of additional land for the development of a further housing estate which is required to meet the heavy demands still being made. 107 SECTION VIII.—PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. 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 Membraneous 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 NOTIFICATION. The total number of notifications, excluding duplicates, was 1,941, compared with 1,587 in 1928 and 1,585 in 1927. In addition, 151 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. 108 TABLE No. 48. Notification of Infectious Diseases, 1901 to 1929. 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 1 171 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 .. 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 .. 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 1929 5 496 80 567 7 .. 15 38 293 90 5 *Notification of Puerperal Pyrexia commenced October, 1926. 109 TABLE No. 48.—continued. Notification of Infectious Diseases, 1901 to 1929. 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 1929 .. 1 17 4 9 4 8 250 52 151 *Voluntary notification to 1910; partial to 1912; all cases thereafter, †Measles notifiable from 1/1/1916 to 31/12/1919. ‡Notification of Zymotic Enteritis commenced 1913. 110 The following three Tables are published in accordance with the requirements of the Ministry of Health and show the total number of cases of infectious diseases, excluding tuberculosis, notified during the year, the number of cases admitted to hospital, the total number of deaths occurring from these diseases and the distribution and case rate per 1,000 population of the various old registration districts in the Borough. TABLE No. 49. Diseases. Total cases notified. Admissions to Hospital. Total Deaths. Diphtheria 496 492 17 Scarlet Fever 567 534 3 Enteric Fever (including Para-typhoid) 7 7 1 Puerperal Fever 15 13 3 Puerperal Pyrexia 38 33 — Erysipelas 80 41 4 Smallpox 5 5 1 Pneumonia 383 208 119 Malaria 5 2 1 Ophthalmia Neonatorum 17 5 — Anthrax 1 1 — Encephalitis Lethargica 4 3 2 Cerebro-Spinal Meningitis 9 9 — Poliomyelitis 4 4 1 Zymotic Enteritis 8 2 28 *Measles 151 2 1 1790 1361 181 *Not notifiable. Figures indicate known cases. The figures relating to tuberculosis will be found under that heading. 1ll TABLE No. 50. CASES OF INFECTIOUS DISEASES NOTIFIED, 1929 (Excluding Tuberculosis). 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 496 5 6 18 38 37 207 93 31 46 11 3 1 Scarlet Fever 567 6 12 33 28 51 229 104 42 47 13 2 .. Enteric Fever 7 .. .. .. .. .. 3 .. 1 3 .. .. .. Puerperal Fever 15 .. .. .. .. .. .. .. .. 9 5 1 .. Puerperal Pyrexia 38 .. .. .. .. .. .. .. .. 31 7 .. .. Erysipelas 80 .. 1 2 .. .. .. 3 4 7 19 28 16 Smallpox 5 .. .. .. .. .. 1 .. .. 1 2 1 .. Pneumonia 383 29 22 20 14 .. 35 7 24 61 39 82 41 Malaria 5 .. .. .. .. .. .. .. .. 3 2 .. .. Ophthalmia Neonatorum 17 17 .. .. .. .. .. .. .. .. .. .. .. Anthrax 1 .. .. .. .. .. .. .. .. 1 .. .. .. Encephalitis Lethargica 4 .. .. .. 1 .. 1 .. .. 1 .. 1 .. Cerebro-Spinal Meningitis 9 1 2 1 1 1 1 .. 1 .. 1 .. .. Poliomyelitis 4 1 .. .. .. 3 .. .. .. .. .. .. .. Zymotic Enteritis 8 5 1 1 .. .. 1 .. .. .. .. .. .. Measles (including German Measles) 151 3 2 1 8 27 78 14 6 12 .. .. .. 1790 67 46 76 90 128 556 221 109 222 99 118 58 112 TABLE No. 51. DEATHS FROM INFECTIOUS DISEASES (excluding Tuberculosis), 1929. 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 17 .. 1 2 1 4 4 5 .. .. .. .. .. Scarlet Fever 3 1 .. .. .. 1 1 .. .. .. .. .. .. Enteric Fever 1 .. .. .. .. .. .. .. .. 1 .. .. .. Puerperal Fever 3 .. .. .. .. .. .. .. .. .. 3 .. .. Puerperal Pyrexia .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 4 .. .. .. .. .. .. .. .. .. 1 2 1 Smallpox 1 .. .. .. .. .. 1 .. .. .. .. .. .. Pneumonia 119 26 5 5 2 .. 4 2 .. 10 6 35 24 Malaria 1 .. .. .. .. .. .. .. .. .. .. 1 .. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 2 .. .. .. .. .. .. .. .. 1 1 .. .. Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis 1 .. .. .. 1 .. .. .. .. .. .. .. .. Zymotic Enteritis 28 18 3 1 .. .. .. .. .. 1 1 2 2 Measles 1 .. .. .. 1 .. .. .. .. .. .. .. .. 181 45 9 8 5 5 10 7 .. 13 12 40 27 113 TABLE No. 52. Cases of Infectious Diseases in the Borough and Parishes during the year 1929, shewing the Case Rates per 1,000 population. Diseases. Borough. Total Cases Notified in each locality. Case Rates per 1,000 Population. Woolwich. Plumstead. Eltham. Borough. Woolwich. Plumstead. Eltham. West. East. West. East. Diphtheria 496 164 145 71 116 3.50 5.57 3.80 2.08 2.91 Scarlet Fever 567 127 172 114 154 4.00 4.31 4.51 3.33 3.87 Enteric Fever 7 3 1 1 2 0.05 0.10 0.03 0.03 0.05 Puerperal Fever 15 4 .. 1 10 0.11 0.14 .. 0.03 0.25 Puerperal Pyrexia 38 14 5 9 10 0.27 0.48 0.13 0.26 0.25 Erysipelas 80 15 17 22 26 0.56 0.51 0.45 0.64 0.65 Smallpox 5 .. 2 1 2 0.04 .. 0.05 0.03 0.05 Pneumonia 383 128 74 97 84 2.70 4.35 1.94 2.84 2.11 Malaria 5 5 .. .. .. 0.04 017 .. .. .. Ophthalmia Neonatorum 17 8 3 2 4 0.12 0.27 0.08 0.06 0.10 Anthrax 1 .. .. 1 .. 0.01 .. .. 0.03 .. Encephalitis Lethargica 4 .. 1 2 1 0.03 0.07 0.03 0.06 0.03 Cerebro-Spinal Meningitis 9 2 1 3 3 0.06 0.03 0.03 0.09 0.08 Poliomyelitis 4 1 1 1 1 0.03 0.03 0.03 0.03 0.03 Zymotic Enteritis 8 3 .. 4 1 0.06 0.10 .. 0.12 0.03 Measles 151 43 54 20 34 1.07 1.46 1.42 0.58 0.85 1790 517 476 349 448 12.64 17.56 12.49 10.20 11.24 114 SMALLPOX. There were more cases of Smallpox in London in 1929 than in any year since 1902, there being in all 1,905 cases. The disease occurred in every metropolitan borough except three—Chelsea, Fulham and Hampstead—the incidence being heaviest in Stepney, Poplar, Shoreditch, Bethnal Green and Southwark. In eleven boroughs there were less than 10 cases. Five cases were notified in Woolwich, but in one instance the diagnosis was not confirmed. Of the remaining four, two were of the mild type generally prevalent in the Metropolis, but the other two were of the severe type, and one of them, an unvaccinated boy of nine years, died. His mother, who had been vaccinated in infancy, had a modified attack. On one occasion the Smallpox Shelter was used to house the contacts pending disinfection of their premises. No persons were vaccinated by the Medical Officer of Health under the provisions of the Public Health (Smallpox Prevention) Regulations, 1917. In every instance, vaccination or revaccination was offered to all contacts by the local public vaccinators. SCARLET FEVER. Notification. During the year 567 cases of Scarlet Fever were notified, compared with 529 in 1928 and 478 in 1927. The incidence amongst adults was higher than in 1928 and there were 27 military cases. The case rates for the various registration districts in the Borough are given in detail in 115 Table No. 52. The number of notifications received each quarter was as follows:— First quarter 113 Third quarter 125 Second quarter 138 Fourth quarter 191 Deaths. There were three deaths from Scarlet Fever during the year, including two 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 6 instances, where two families were involved. TABLE No. 53. Dockyard. St. Mary's. River. St. George's. Burrage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas. Abbey Wood. Well Hall. Sherard. Avery Hill. Total Houses. Total Cases. Number of houses in which 1 case occurred 22 15 18 22 15 30 26 41 17 33 37 28 66 11 381 381 2 cases occurred 3 3 1 4 1 4 6 9 2 5 3 2 6 .. 49 98 3 „ .. .. .. 1 1 .. .. 3 .. 1 .. 1 4 .. 11 33 4 „ .. .. .. .. .. .. 1 1 .. 1 .. .. 4 .. 7 28 Total Houses 25 18 19 27 17 34 33 54 19 40 40 31 80 11 448 540 Military Cases .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. 27 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. H 116 TABLE No. 54. No. in register. Date admitted to hospital. Date discharged. Total days in hospital. Onset of secondary case. Remarks on primary case. 1928. 460 4/11/28 1/1/29 58 6/1/29 — 411 15/10/28 15/1/29 92 11/2/29 — 1929. 31 26/1/29 3/5/29 97 8/5/29 — 53 5/2/29 10/4/29 64 15/4/29 Home isolation. 49 5/2/29 23/3/29 46 30/3/29 — 63 14/2/29 23/3/29 37 — 122 5/4/29 26/4/29 21 7/5/29 — 155 28/4/29 21/6/29 54 3/7/29 — 182 10/5/29 13/6/29 34 18/6/29 — 186 13/5/29 21/6/29 39 29/6/29 — 195 16/5/29 12/7/29 57 24/7/29 — 213 30/5/29 6/7/29 37 23/7/29 — 262 7/7/29 21/8/29 45 24/8/29 — 27/8/29 — 277 16/7/29 29/8/29 44 10/9/29 — 10/9/29 — 323 15/8/29 28/9/29 44 12/10/29 — 326 20/8/29 4/10/29 45 19/10/29 — 328 22/8/29 27/9/29 36 2/10/29 — 360 23/9/29 25/10/29 32 29/10/29 — 364 27/9/29 15/11/29 49 22/11/29 Slight ear discharge 1/12/29 2/12/29 — 438 31/10/29 14/12/29 44 28/12/29 — 447 5/11/29 24/12/29 49 27/12/29 — 30/12/29 — 448 5/11/29 17/12/29 42 31/12/29 — Home Isolation. Thirty-three cases, or 5.9 per cent., were isolated at home, and in only one instance did a return case occur. Frequent visits are made by the district sanitary inspectors to all cases isolated at home in order to ensure that proper precautions are being taken for preventing the spread of the disease. Employees of the Royal Arsenal are 117 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 two 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 496 cases of Diphtheria were notified, compared with 300 in 1928 and 278 in 1927. This is the highest number of cases notified since 1921, when 592 were notified. The number of military cases was 27. The case-rates for the various registration districts in the Borough are given in Table No. 52. The number of notifications received each quarter was as follows First quarter 92 Third quarter 87 Second quarter 109 Fourth quarter 208 Deaths. There were 17 deaths, 8 occurring in those under school age and 9 in school children. In 1928 there were 14 deaths. Return Cases. There were 11 return cases. Multiple Cases. The following table shows the house distribution by wards. The term "house" is synonymous with the term "family," except in 11 instances where two families were involved. 118 TABLE No. 55. 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 28 23 37 9 19 14 32 29 8 32 14 26 43 15 329 329 2 cases occurred 9 1 4 1 2 1 4 7 .. 3 2 5 5 2 46 92 3 „ „ 2 .. .. .. .. 2 .. .. .. .. 1 .. .. .. 5 15 4 „ „ 1 .. .. .. 1 1 .. 1 .. .. 1 .. .. .. 5 20 5 „ „ .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 5 8 „ „ .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 8 Total Houses 40 24 41 10 23 18 36 37 8 35 18 31 49 17 387 469 Military .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 27 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 86,000 units. The total cost to the Council was £6 9s. 0d., all of which was recovered. Schick Test. There are no clinics in the area where Schick testing and immunisation are carried out. Occasionally, however, parents request that their children should be immunised, and in these instances, through the kindness of the Medical Officer of Health of Deptford, I have been able to refer them to him. 119 ENTERIC FEVER. Seven cases, including one military case, were notified during the year, and one death occurred. In the following Table details of each case are given. TABLE No. 56. No. Date notified. Sex. Age. Diagnosis. Final Diagnosis. Remarks. 1 29/ 4/29 F. 5 Typhoid Fever Enteric Fever — 2 8/ 5/29 M. 8 Typhoid Fever Paratyphoid B. — 3 27/ 7/29 F. 15 Typhoid Fever Typhoid Fever — 4 9/ 8/29 F. 24 Paratyphoid Fever Paratyhpoid B. — 5 25/ 8/29 M. 5 Paratyphoid B. Paratyphoid B. — 6 28/ 9/29 F. 24 Typhoid Fever Typhoid Fever Died 7 28/10/29 M. 23 Paratyphoid C. Paratyphoid C. Military Case. ENCEPHALITIS LETHARGICA. Pour cases were notified during the year, but in none of them was the diagnosis confirmed on admission to hospital. The following Table gives the ultimate diagnosis of each case. TABLE No. 57. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. 22/3/29 F. 4 Poliomyelitis Congenital Debility. Died. 22/6/29 F. 29 Hysteria — 20/8/29 M. 47 Not Encephalitis Lethargica. — 10/10/29 M. 9 Anaemia — 120 CEREBROSPINAL MENINGITIS. Nine cases were notified during the year, and in only one case was the diagnosis confirmed. The following table gives the details of each case. TABLE No. 58. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. 16/1/29 M. 5 Tuberculous Meningitis Died. 4/2/29 F. 1½ Whooping Cough Convulsions Died 4/2/28 F. 3 Whooping Cough Convulsions Died 17/2/29 M. 40 Influenzal Meningitis Died 25/2/29 M. 1 Tuberculous Meningitis Died 22/3/29 F. 2½ Tuberculous Meningitis Died 9/4/29 F. 4 Tuberculous Meningitis Died 2/5/29 M. 19 Cerebrospinal Meningitis Military Case 26/5/29 M. 1 No obvious disease — PNEUMONIA. All primary Pneumonias and Influenzal Pneumonias are notifiable under the Infectious Diseases (London) Regulations, 1927. During the year 293 notifications of Acute Primary Pneumonia and 90 of Acute Infleunzal Pneumonia were received. 121 119 deaths were certified as due to acute Lobar Pneumonia or acute Broncho Pneumonia, and 45 died from acute Influenzal Pneumonia. The following Table shows the distribution of Pneumonia in each Ward of the Borough, classified according to the type of Pneumonia shown on the notification certificate :— TABLE No. 59. Notification of Pneumonia. Ward. Lobar. Broncho. Influenzal. Acute Primary. Total. Dockyard 1 1 5 23 30 St. Marys 7 1 — 12 20 River 10 8 13 10 41 St. Georges 15 8 3 11 37 Burrage 3 3 6 7 19 Herbert 4 — 4 2 10 Glyndon 4 3 9 10 26 St. Margarets 2 3 6 8 19 Central 6 4 8 3 21 St. Nicholas 9 7 18 18 52 Abbey Wood 4 5 5 10 24 Well Hall 5 6 7 10 28 Sherard 9 4 6 25 44 Avery Hill 1 — — 11 12 80 53 90 160 383 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 Primary Pneumonia and Influenzal Pneumonia. 122 TABLE No. 60. 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 31 17 48 9 14 4 21 14 5 February 60 49 109 9 13 49 38 39 18 March 27 26 53 5 7 25 16 9 16 April 20 9 29 11 2 2 14 10 2 May 12 5 17 5 2 4 6 6 1 June 8 7 15 7 — 2 6 6 3 July 13 10 23 5 4 1 13 7 — August 3 3 6 2 1 1 2 3 — September 8 2 10 5 — — 5 — — October 17 2 19 8 1 2 8 6 — November 11 13 24 8 2 — 14 7 — December 19 11 30 6 7 — 17 12 — 229 154 383 80 53 90 160 119 45 Nursing. Nursing assistance is provided by the Council for cases of Pneumonia and 67 cases were nursed during the year, 1,010 visits being paid by the nurses of the local Nursing Associations. In all cases the nurse takes the instructions of the medical practitioner in attendance. The total cost of this service to the Council was £63 2s. 6d. Anti-Pneumococcal Serum. In November the Council resolved to provide, free of charge, anti-pneumococcal serum for the treatment of persons suffering from Pneumonia, where the medical practitioner in attendance considered this treatment suitable. The treatment of lobar pneumonia by this means is a recognised form of treatment which is being used in an increasing amount in this country and in America, mainly however in hospital practice. In suitable cases it 123 shortens the period of illness, limits its severity and diminishes the case mortality rate. The Ministry of Health approved the Council's proposal for the supply of serum in qualified cases for an experimental period of one year. Owing to the short time coming within the present year it is not possible to report on this service now. ERYSIPELAS, MALARIA AND DYSENTERY. The number of notifications of Erysipelas was 80, compared with 89 in 1928. Five cases of Malaria were notified compared with 12 in 1928. No cases of "therapeutic" malaria were notified, and no notifications were received with respect to Dysentery. PUERPERAL FEVER AND PUERPERAL PYREXIA. Fifty-three notifications were received, compared with 48 in 1928. Fourteen women were notified as suffering from Puerperal Fever and 39 from Puerperal Pyrexia. In one case the original diagnosis of Puerperal Pyrexia was altered to Puerperal Fever. In the following table is shown, according to diagnosis, the place of confinement in each of these cases :— TABLE No. 61. Where Confined. Puerperal Fever. Puerperal Pyrexia. At Home 9 8 Institution 3 26 Abortions 3 4 15 38 124 Treatment. The Council's scheme for the diagnosis and treatment of these conditions provides for the services of a consultant—Mr. H. G. Taylor, F.R.C.S.—for nursing assistance, for hospital treatment in the Metropolitan Asylums Board Hospitals, and for bacteriological examinations, where necessary. During the year, Mr. Taylor saw four cases in consultation. Nursing assistance was provided in one case, while no bacteriological examinations were carried out. The following Table, No. 62, shows the extent to which hospital treatment was ultimately made use of :— TABLE No. 62. Where Treated. Puerperal Fever. Puerperal Pyrexia. Maternity Hospitals — 19 General Hospitals 2 3 Poor Law Hospitals 7 7 Cottage Hospitals 1 1 Metropolitan Asylums Board's Hospitals 3 3 Midwife's Home — 1 At Home 2 4 15 38 Deaths. One death was due to sepsis following abortion, while two other deaths were due to puerperal septicaemia. In 1928 there were 8 deaths. OPHTHALMIA NEONATORUM. During the year 17 cases were notified and 5 cases were treated in hospital. In tabular form is shewn below, as required by the Ministry of Health, the result of each case:— 125 TABLE No. 63. Date Notified. Cases Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hospital. 8/ 1/29 Yes Yes — — — 1/ 2/29 Yes — Yes — — — 18/ 2/29 — Yes Yes — — — 21/ 3/29 Yes — Yes — — — 4/ 5/29 Yes — Yes — — — 24/ 5/29 Yes — Yes — — — 11/ 6/29 Yes — Yes — — — 28/ 6/29 Yes — Yes — — — 2/ 7/29 Yes — Yes — — — 27/ 7/29 — Yes Yes — — — 18/ 8/29 Yes — Yes — — — 5/ 9 29 Yes — Yes — — — 5/10/29 Yes — Yes — — — 24/10/29 Yes — Yes — — — 25/11/29 Yes — Yes — — — 12/11/29 — Yes Yes — — — 27/11/29 — Yes Yes — — — Home Nursing. Eight cases were nursed at home. The number of visits paid was 148, an average of 18 visits per case. The cost of this service was £7 8s. Od. ANTERIOR POLIOMYELITIS. Four notifications were received. In two instances the diagnosis was not confirmed. One case originally notified as Encephalitis was diagnosed in hospital as Poliomyelitis. In all, there were three cases during the year. The number of cases during 1928 was two, and during 1927, three. Nursing assistance is provided for such cases, but was not utilised during the year. In the later stages hospital treatment is available at Queen Mary's Hospital, 126 Carshalton, and locally orthopaedic treatment can be given at the Remedial Clinic of the Woolwich Invalid Children's Aid Association. ANTHRAX. One case of anthrax was notified during the year, but the diagnosis was not confirmed. ZYMOTIC ENTERITIS. Eight cases of this disease were notified during the year, compared with five cases in 1928. The notification of this disease is obviously incomplete as the deaths of 21 children under two years of age were certified as due to Diarrhoea or Enteritis. WHOOPING COUGH. During the year, 327 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 of cases from this source, or, incidentally, by casual discovery by the Health Visitors during their daily routine. Nursing assistance was provided in one case at a cost of 13s. Od. Deaths. The number of deaths was 22, compared with 16 in 1928, and 10 in 1927. All the deaths occurred in children under five years of age. MEASLES. This disease is not notifiable in the Borough but from various sources the department learned of 151 cases, compared with 2,418 in the previous year. 127 Deaths. There was only one death from Measles during the year. Home Nursing. Nursing assistance was provided for two children. The number of visits paid was 21 and the cost to the Council was £1 1s. 0d. Hospital Treatment. Children suffering from Measles are now admitted, except where there is pressure on accommodation, under the same conditions as the ordinary infectious diseases. Two cases were admitted during the year, compared with 56 in 1928. Measles Epidemics. In December, the Council resolved to make special arrangements for measles epidemics, which occur once in every two years. It had previously been the practice for the health visitors to visit every case coming to the knowledge of the department with a view to securing that the necessary treatment was provided and limiting the crop of complications, a practice which obviously interfered with their ordinary routine work for the period of the epidemic. In addition, the information which was received from the school medical service was always somewhat late. The Council accordingly resolved to appoint temporary health visitors whose duties would be to meet the school nurse at the school, obtain from her direct the names and addresses of all children suffering or suspected to be suffering from measles, and also those who were absent for unknown causes, and thereafter to visit the homes as soon as possible. The scheme thus provides that there should be no delay in visiting measles cases, a very important factor in the control of the disease. 128 ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. Disinfection. Rooms from which persons suffering from notifiable infectious diseases have been removed are disinfected in different ways according to the circumstances of the case. The vast majority of cases are disinfected by means of formalin vapour, but occasionally spraying with Izal is used and sometimes simple washing and scrubbing is regarded as sufficient. Bedding and wearing apparel are removed to the Disinfecting Station and submitted to steam disinfection. The process of disinfection was fully reported on in the Annual Report of 1925. For various reasons, disinfections are sometimes arranged for at the request of individuals, and in such cases a small charge is made according to the circumstances of the case. In 1929, 40 such disinfections were carried out and fees amounting to £11 1s. 0d. were paid. The following Table shows the use made of this service during the year:— TABLE No. 64. Rooms disinfected on account of— Infectious disease 1,097 Tuberculosis 306 Verminous conditions 29 Other reasons 20 Articles disinfected 30,464 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. In recent years the number of children so sent has fallen considerably. Disinfestation of adults is carried out at times when the children are not there. 129 The following Table shows the number of persons cleansed each year since 1925:— TABLE No. 65. Children. Adults. Grand Total. Year. Boys. Girls. Total. Males. Females. Total. 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 1929 416 1451 1867 26 32 58 1925 The London County Council (General Powers) Act, 1928, enables sanitary authorities to remove verminous persons to a cleansing station and to detain them until they are free from vermin. No action was taken under this section during the year. TUBERCULOSIS. Notifications. During the year, excluding duplicates, 250 cases of pulmonary tuberculosis and 52 cases of nonpulmonary tuberculosis were notified. Cases of tuberculosis are frequently notified more than once, and during the year 71 duplicate notifications were received. 130 The following Table shows the distribution of notifications in the various registration districts in the Borough and the corresponding case-rates. TABLE No. 66. Woolwich. West Plumstead. East Plumstead. Eltham. The Borough. Pulmonary Tuberculosis— Cases 91 51 69 39 250 Rates 3.09 1.34 2.02 0.98 1.76 Non-Pulmonary Tuberculosis— Cases 20 12 7 13 52 Rates 0.68 0.58 0.20 0.33 0.37 In Table No. 67 appears a summary of cases coming to the knowledge of the Department in 1929. It includes notifications received from general practitioners on Form "A," from school medical officers on Form "B," and cases not notified but included in the death returns, and cases transferred from other areas. It does not include notifications on Form "C" or "D," i.e., from medical superintendents of hospitals, nor any duplicate notifications. Deaths during the year are classified in the same table by age and sex groups. 131 TABLE No. 67. Tuberculosis—New Cases and Mortality, 1929. Age Periods. New Cases. Deaths. Pulmonary Non. Pulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 0-1 - - 1 2 - - 1 1 1-5 - 1 5 9 - - - 4 6-10 4 2 8 7 - 2 1 1 10-15 2 7 4 5 - 3 1 1 15-20 14 21 3 2 7 9 - 2 20-25 18 27 1 1 11 8 - - 25-35 26 37 - 4 8 16 - 1 35-45 27 16 - 1 14 19 - - 45-55 23 10 1 - 21 6 - - 55-65 16 3 - 2 11 1 - 2 65 and upwards 8 3 1 2 3 4 1 - Totals 138 127 24 35 75 68 4 12 I 132 In the following Table, No. 68, is shown the site of the disease in patients notified each year since 1925. TABLE No. 68. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 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 1929 250 7 7 16 11 6 5 302 Cases of Tuberculosis in the District. As in recent years, every endeavour has been made to see that the notification register correctly represents the number of cases of tuberculosis in the district. Deletions from the register have been made in the case of patients who have died or have left the district, or have been lost sight of, or who may be regarded as cured. 133 The following Table, No. 69, shows the changes Which have taken place during the year and the number remaining on the register at the end of the year. TABLE No. 69. Pulmonary. NonPulmonary. Totals. M. F. M. F. Number on Register at 1st January, 1929 523 421 146 132 1,222 Number of additions 143 133 29 39 344 Number of Deletions 156 132 31 37 356 Number on Register at 31st December, 1929 510 422 144 134 1,210 It will be seen that the total number on the register on the 31st December was 1,210, and of this number 1,013, or 83.7 per cent., were on the dispensary register, i.e., had been dealt with in connection with the Public Health scheme for the treatment of tuberculosis. In 1928 the corresponding percentage was 80.4. Deaths. The number of deaths from Tuberculosis was 159, 143 being certified to be due to pulmonary tuberculosis and 16 to other forms. These figures compare with 165, 145 and 20 in 1928. The death rate from all forms was 112. 134 The following Table, No. 70, shows the number of deaths and the death rates from all forms of tuberculosis each year since 1912. TABLE No. 70. 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 1929 159 143 16 1.12 1.01 0.11 In addition to the deaths recorded in the above Table, 12 persons who have 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. 71. 135 TABLE No. 71. Case No. Date Notified as Tuberculosis. Cause of Death. 1 3/ 2/26 Diabetes mellitus. Vomiting. Coma. 2 21/ 6/23 Chronic bronchitis. Heart failure. 3 18/ 1/29 Acute bronchitis. Myocarditis. 4 20/12/21 Acute influenzal pneumonia. 5 17/ 6/29 Myocarditis. Chronic bronchitis. 6 28/ 1/25 Myocarditis. Acute bronchitis. 7 2/ 2/26 Cardiac failure. Mitral stenosis. Pregnancy—Induction of labour. 8 29/ 8/29 Carcinoma of lung. 9 5/11/23 Broncho-pneumonia. Gangrene of right arm. Thrombosis of right arm. Right hemiplegia. Arterio sclerosis. 10 1/ 6/27 Syncope. Lobar pneumonia. Hydronephrosis. Sarcoma of neck. 11 27/10/29 Broncho-pneumonia. Measles. 12 23/ 5/29 Asphyxia. Pressure on trachea. Carcinoma of lung. 136 The period which elapsed between notification and death was as shown below :— TABLE No. 72. Pulmonary. Percentage. NonPulmonary. Percentage. Not notified 9 6.29 5 31.25 0— 1 month 17 11.90 7 43.75 1-3 months 14 9.79 1 6.25 3-6 months 13 9.09 1 6.25 6-12 months 24 16.78 — — 1-2 years 27 18.88 2 12.50 2-5 years 28 19.58 — — Over 5 years 11 7.69 — — 143 100.00 16 100.00 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths was as one is to twelve. In 1927 it was as one is to twelve, and in 1928 as one is to eleven. The Public Health (Prevention of Tuberculosis) Regulations, 1925. These Regulations provide for the compulsory discontinuance of employment of persons engaged in the handling or treatment of milk, who are suffering from tuberculosis. No case of this kind came to the notice of the Council during the year. Every milk vendor in the Borough 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 examinations, however, were made during the year. The Work of the Dispensary. The Tuberculosis Dispensary is situated in Maxey Road, Plumstead. Consultations are held there, special times being allotted to men, women 137 and children. These hours are set out in tabular form below:— Hours of Attendance. Day. Men. Women. Children. 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 Tuberculosis Officer is always glad to consult with practitioners regarding their patients, either in the patient's home or at the Dispensary. The total number of attendances at the Dispensary during 1929 was 4,996. In this connection it is interesting to point out that 250 of the persons notified during 1929 attended the Dispensary, which is equivalent to 82.78 per cent. The corresponding percentage in 1928 was 7354. A return of the work done in connection with the Dispensary is given in Table No. 73. Staff. The staff of the Dispensary consists of one whole time Tuberculosis Officer, one half time Assistant Tuberculosis Officer, three Tuberculosis Health Visitors, one ClerkDispenser and one Lay Organiser, who also acts as Secretary of the Care Committee. Post-Graduate Course. In accordance with the practice in recent years, one Tuberculosis Visitor attended a refresher course of two weeks during the winter. 138 TABLE No. 73. Return showing the work of the Dispensary during the year 1929. 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 97 90 7 7 9 10 16 14 106 100 23 21 (6) Doubtfully tuberculous .. .. .. .. .. .. .. .. 17 35 14 22 (c) Non-tuberculous .. .. .. .. .. .. .. .. 189 185 147 134 B. CONTACTS examined during the year :— (a) Definitely tuberculous .. 3 .. 1 .. .. .. 1 .. 3 .. 2 (6) Doubtfully tuberculous .. .. .. .. .. .. .. .. .. .. 1 3 (c) Non-tuberculous .. .. .. .. .. .. .. .. 72 104 98 91 C. CASES written off Dispensary register as (a) Cured 24 16 2 .. 1 3 5 3 25 19 7 3 (6) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) .. .. .. .. .. .. .. .. 286 328 264 253 D. NUMBER OF PERSONS on Dispensary register on December 31st :— (a) Diagnosis completed 386 359 42 39 39 62 30 53 425 421 72 92 (6) Diagnosis not completed .. .. .... .. .. .. .. .. 2 1 .. .. 139 (1) Number of persons on Dispensary register on January 1st 997 (2) Number of patients transferred from other areas and of "lost sight of " cases returned 11 (3) Number of patients transferred to other areas and cases "lost sight of " 63 (4) Died during the year 114 (5) Number of observation cases under "A" (b) and "B" (b) above in which period of observation exceeded 2 months 24 (6) Number of attendances at the Dispensary cluding contacts) 4,996 (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 88 (б) Other special forms of treatment 98 (9) Number of patients to whom Dental treatment was given at or in connection with the Dispensary 26 (10) Number of consultations with medical tioners— (а) At homes of applicants 49 (б) Otherwise 568 (11) Number of other visits by Tuberculosis Officers to homes 472 (12) Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,988 (13) Number of— (a) Specimens of sputum, etc., examined 755 (b) X-Ray examinations made in connection with Dispensary work 268 140 (14) Number of Insured Persons on Dispensary register on the 31st December 480 (15) Number of insured persons under domiciliary treatment on the 31st December 278 (16) Number of reports received during the year in respect of insured persons— (a) Form G.P. 17 17 (b) Form G.P. 36 209 Contacts. Every endeavour has been made during the past year to examine the contacts of every notified case, but it becomes clearer and clearer every year in the examination of contacts that a feeling of false security may be engendered when no evidence of tuberculosis is found. As in many other paths of medicine, a negative result should only be interpreted as the non-discovery of the disease. Over and over again experience has shown that a negative result obtained at any time has had to be reversed a few months later, and so this contact problem is much more difficult than it appears on the surface. It would seem, therefore, that to be of value, examination of contacts classed as negative should take place at intervals. The contact differs from the original case in that he is probably exposed not only to the primary source of infection but also to the original case; and it may be, with a careless patient, the risk of infection is greater some years later. One very real difficulty is that adult contacts usually refuse to be examined unless they feel ill, and those who are merely seedy very often fight shy of an examination: The number of contacts examined during the year was 374. Co-operation with Hospitals. In 1928, arrangements were made for the X-Ray examination of tuberculous patients at the War Memorial Hospital, and at the same time similar arrangements were entered into for the provision of 141 violet ray treatment there. The London County Council, however, later withdrew their approval of this treatment at out-patient departments of London hospitals. In the case of children the daily attendances at the hospitals seriously interfered with their education, and later in the year children requiring such treatment were admitted to special institutions, where, in addition to their treatment, education is provided for. These difficulties, however, do not arise in the case of adults for whom no special arrangements now exist, and it would seem desirable that these facilities should be renewed in the case of adult patients. Patients requiring Finsen Light treatment for lupus are referred to the London Hospital, or occasionally to other general hospitals in London; and similarly, patients requiring Artificial Pneumothorax Refills are referred to the Brompton Hospital. In tabular form is shown below the extent of co-operation with London hospitals for special purposes. TABLE No. 74. Service and Hospital. Number of Persons. Number of Treatments. X-Ray Examinations— War Memorial Hospital 268 — Ultra-Violet Ray Treatment— War Memorial Hospital 1 42 Finsen Light Treatment— London Hospital 4 46 Artificial Pneumo-Thorax Refills— Brompton Hospital 9 98 142 Co-operation Locally. The Tuberculosis Officer works in close co-operation with the local medical profession, with the School Medical Service and the local Nursing Associations. Forty-nine consultations took place at the homes of patients and 568 other forms of consultation were held with the local medical practitioners. The children who attend the Open Air School are brought at regular intervals to the Tuberculosis Dispensary for examination. Many children are referred to the School Medical Service for treatment at the Minor Ailments Clinic, and advanced cases of Tuberculosis who require nursing assistance readily receive it through the good offices of the local Nursing Associations. 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 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, 27 cases received treatment, the number of attendances being 50. 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 eight cases at a cost of £33 7s. 6d., and payments by patients amounted to £16 6s. 9d. In assessing patients, due regard is given to dental benefits they may be entitled to from approved societies. 143 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, 890 specimens of sputum were examined at the Dispensary. Of these, 156 were positive and 734 negative. Facilities for general practitioners are provided at the Seamen's Hospital, Greenwich, and 376 specimens were examined there during the year, 76 being positive and 300 negative. Institutional Treatment. The following Table, No. 75, shows the number of admissions to hospitals, sanatoria, Poor Law Institutions and training colonies. TABLE No. 75. Hospitals. Sanatoria. Poor Law Institns. Training Colonies. Insured 108 61 72 2 Uninsured 39 21 56 - Children 61 2 15 - 208 84 143 2 144 These figures refer to 343 patients and the monthly admissions were as follows:— January 43 July 39 February 27 August 41 March 37 September 23 April 33 October 46 May 42 November 34 June 42 December 30 Woolwich Tuberculosis Care Committee. At the end of the year the Committee was constituted as follows:— Bodies. Representatives. Woolwich Borough Council Councillors H. N. Dickinson, J. Lec, Major G. H. Rayner, Mrs. E. L. Reeves, H. Vaughan, Miss G. E. Walters. J.P. Woolwich Board of Guardians Lewisham Board of Guardians Mrs. A. R. New, Mrs. E. M. Newman. Count Rivarola. Trade Unions Mr. W. H. Fairchild, Mr. T. R. Goy, 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 Alderman A. R. Loader. Woolwich Invalid Children's Aid Association. Mrs. J. B. Great Rex. Late Tuberculosis Dispensary Committee. Mr. W. Dashwood, Mr. E. G. Dixon, J.P. United Services Fund . Miss M. Shaw. Ex-Officio— Voluntary Visitors Miss L. Bloxam, Miss L. Mac Dermott. Tuberculosis Officer Medical Officer of Hoalth Dr. F. J. C. Blackmore. Dr. J. MacMillan. 145 The Care Committee, on behalf of the Borough Council, undertake the making of assessments for contributions in respect of dental treatment, and on behalf of the London County Council in respect of hospital or sanatorium treatment. They also deal with applications for grants of extra nourishment. They deal with every new case attending the Dispensary and do their best to ensure that he will receive during his illness such care, medical and social, as will give him the best chance of recovery. When necessary, they help him to find employment after discharge from an institution. The Committee works by means of its sub-committees, the principal one of which—the General Purposes and Assessment Sub-Committee—meets every Wednesday at 11.30 o'clock. The other sub-committees meet as required, and all of them make special reports at the full meeting of the Committee, which takes place quarterly. The income of the Committee, including £4 17s. Od. refunded by patients or their friends, amounted to £298 3s. Id., and the expenditure to £250 10s. 2d. In addition, a successful Pound Day was organized at Christmas time and approximately £127 in kind was distributed to tuberculous families. During the year, the Committee dealt with 706 cases in various ways, e.g., by the provision of clothing for necessitous patients entering institutions; for the purchase of surgical apparatus and nursing requisites; by supplementing financial assistance given by the voluntary organizations for in-patient treatment; by paying fares for varying periods in the case of patients going to and from hospital for out-patient treatment, and in many other ways. 146 SECTION IX.—MATERNITY AND CHILD WELFARE. The Council's Maternity and Child Welfare Scheme was fully described in last year's report. Notification of Births Acts, 1907-15. Every birth occurring in the Borough requires to be notified to the Medical Officer of Health within thirty-six hours of birth. As a matter of fact, only a very small percentage of births are not so notified. As soon as a notification is received pamphlets dealing with the care and comfort of mothers and infants are sent by post to every mother. Subsequently, between the tenth and fourteenth day, a visit is paid to the home by the Health Visitor who decides on her first visit the necessity for subsequent visits. It may be stated, however, that, broadly, the general basis of visiting is as follows :—three visits during the first year and one visit in each subsequent year up to the age of five years, or until the child goes to school. The Work of the Health Visitors. The following Table shows the classification of visits paid by the Health Visitors in 1929. TABLE No. 76. Births—First visits 2,143 „ Revisits 16,066 Infant deaths investigated 69 Still-births investigated 31 Expectant mothers—home visits 659 147 Infectious diseases:— Ophthalmia Neonatorum—First visits 17 ,, ,, Revisits 22 Measles—First visits 88 ,, Revisits 33 Puerperal fever—First visits 15 ,, „ Revisits 6 Puerperal pyrexia—First visits 29 ,, „ Revisits 2 Zymotic Enteritis—First visits 2 ,, ,, Revisits — Tuberculosis 13 Pneumonia 111 Anterior Poliomyelitis 9 Encephalitis Lethargica 9 Sunlight Clinic visits 87 Visits unclassified 205 Visits unsuccessful 2,128 21,744 In 1929, the Council, with the approval of the Minister of Health, paid the class fees of two Health Visitors at a refresher course for Health Visitors. The Work of the Welfare Centres. The Council rent or own six welfare centres and one artificial sunlight clinic. Ante-natal clinics are held at three of the centres. At the end of the year four ante-natal and seventeen infant consultations and weighing sessions were being held each week. At each of the Centres a panel of voluntary workers render valuable assistance. They undertake such tasks as J 148 TODDLERS AT NEW ELTHAM. 149 weighing the babies, recording the weights, giving out record cards, looking after toddlers, etc. The help given by them is invaluable, and is much appreciated by the mothers and by the staff. To them is due much of the credit of the successful, smooth, and harmonious working of the Centres. New Centre. During the year plans were prepared for the construction of a new infant welfare centre at Eltham. Reference to the principles guiding the Council in the matter will be found in the preface, and a full report on the new centre will appear in next year's annual report. The site chosen is on the Council's Housing Estate at the junction of Westhorne Avenue and Briset Road. The following Table No. 77 shews the numbers attending each Centre, and the attendances made there, together with comparative figures for 1928. TABLE No. 77. Centre. No. on Roll of Centre. No. of Attendances. Mothers. Children. Mothers. Children Expectant. Nursing. Expectant. Nursing. Town Hall 407 382 1,512 986 880 9,892 Eltham 334 328 1,285 629 539 7,139 Plumstead 259 303 1,014 510 784 7,042 Slade 6 111 395 7 198 3,844 New Eltham 6 14 210 17 73 2,242 North Woolwich 1 . 10 126 2 14 1,022 Beresford Street (Voluntary) 8 20 127 11 34 832 Totals 1929 1021 1168 4,669 2,162 2,522 32,013 „ 1928 915 929 4,633 1,273 1,968 28,824 150 The next Table, No. 78, shows classified according to year of birth the number of children attending and the number of attendances made by them during the year. There is one point in the table which calls for special mention. The percentage of infants attending may be regarded as very good, but the number of attendances made by toddlers is very small, and becomes less as the toddler advances in years. In theory the Council's scheme purports to deal with all children until they reach the age of five years or until they go to school at an earlier age. In actual fact, as the table shows, relatively few toddlers attend the centres, i.e., there is a very definite hiatus between the supervision of the infant and that of the school child. This is unfortunate because much of the benefit which accrues from the supervision of the infant is often lost before the child goes to school, where on entry it may be discovered to be suffering from preventable defects. The matter is one which causes concern to the Ministry of Health and the Board of Education, and towards the end of the year a Circular was issued drawing the attention of local authorities to this hiatus and suggesting ways whereby it may be bridged over. The matter has also had careful consideration by the Maternity and Child Welfare Committee of the Council, and at the end of the year proposals were being considered for the annual medical inspection of toddlers. 151 TABLE No. 78. Children in Attendance at each Centre. Year of Birth. Town Hall Eltham. Plums tead. Slade New Eltham. North Woolwich. Voluntary. Totals. 1929 475 352 300 128 74 39 33 1,401 1928 447 337 309 110 66 39 34 1,342 1927 254 218 164 74 31 28 26 795 1926 176 164 135 38 16 12 17 558 1925 117 135 66 26 19 5 9 377 1924 43 79 40 19 4 3 8 196 1,512 1,285 1,014 395 210 126 127 4,669 • Attendances. Year of Birth. Town Hall. Eltham. Plums tead. Slade. New Eltham. North Woolwich. Voluntary. Totals. 1929 3,459 2,461 2,318 1,185 803 365 204 10,885 1928 3,901 2,629 2,832 1,599 939 487 361 12,748 1927 1,250 939 800 636 258 94 164 4,141 1926 697 522 691 246 95 53 76 2,380 1925 358 419 291 116 99 17 18 1,318 1924 137 169 110 62 48 6 9 541 9,892 7,139 7,042 3,844 2,242 1,022 832 32,013 152 Voluntary Centre. The only voluntary centre in the Borough is held in the Hall of 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 127, and the total attendances, including mothers, was 877. The Council do not make a grant towards the working of this centre, but, as an approved centre, it receives the Ministry's grant direct. Artificial Sunlight Clinic. The clinic was opened in 1927. The total number of patients treated during the year was 415, of whom 322 were new cases. The number of treatments given was 10,074, being made up of 7,364 carbonarc, 1,703 mercury-vapour, and 1,007 radiant heat. The clinic is in charge of Dr. J. E. A. Lynham, who has kindly provided the following report on the work of the clinic during the year. "The Sunlight Clinic has been carried on during the past year as heretofore, and the results obtained appear to prove its usefulness in dealing with a number of diseased conditions in children. In dosage, the same principle has been followed beginning with a dose which is decidedly short of an erythema dose and working up gradually to the latter, the children attending two or three times per week. It has been found, on the whole, unsatisfactory to provoke any severe skin reactions, and where these have been recorded it has been the practice to discontinue treatment for a few days and begin again with a shorter exposure. 153 Several points of minor interest have been noticed, for instance, under carbon-are treatment, if the child is found to be losing weight, a change over to the mercuryvapour lamp is often followed by improvement. In very young children the radiant heat lamp is given at first, and if the child responds satisfactorily this form of treatment is continued, and often found sufficient. Most of the cases of rickets which are seen in their early stages have responded well, but in older children and where advanced changes have already occurred in the bones, less definite improvement has been recorded. It must be borne in mind that some of these children are living in adverse conditions. The great majority of those suffering from anaemia, debility, malnutrition and those subject to frequently recurrent catarrhal attacks show very great improvement, but it has been found as a rule necessary to continue the treatment for three or four months to produce satisfactory results. Such cases are afterwards kept under observation at monthly intervals, and the treatment given again if necessary. Children suffering from various septic conditions have appeared from time to time. They have also responded extremely well. A few of those described as nervous, children who are difficult, with poor appetites, restless in their sleep and inclined to be fretful, have shown decided benefit, but in a number where no obvious benefit follows it seems fairly certain that home conditions are partly responsible. 154 Various skin conditions are seen from time to time, e.g., impetigo, intertrigo, keloid following burns, and multiple papillomata. Cure has been obtained in nearly every instance. In the case of children with enlarged glands, all that can be recorded is a degree of general improvement, any reduction in the size of the glands being attributable to this rather than to any specific action. A number of mothers or expectant mothers have attended, suffering from general debility or from local disease. As a general rule improvement has followed, and some have been apparently restored to sound health. In assessing the value of the clinic there is no desire to over estimate the value of the ultra-violet rays as a therapeutic agent. Every effort is made to work in conjunction with the officers in control of the welfare centres. Such matters as diet, clothing, and other forms of treatment are supervised, and other forms of medical treatment are employed where it is thought desirable. Consultations are held with the medical officers from time to time, and children are referred to special clinics, e.g., orthopaedic, neurological, or ophthalmological when necessary. But the basic fact remains that many children who have been treated beforehand without the rays have been found to improve enormously after their courses of treatment. Some of these, in the weeks following the termination of the treatments, show some degree of failure in their general health, but improve again when their regular attendance at the light clinic is resumed." In tabular form are shown below the number and types of cases treated during the year. 155 TABLE No. 79. Type of Case. Brought Forward from 1928. New Cases. Total. Much Improved or Cured. Improved. I.S.Q. Ceased Treatment. Treatment not yet Complete. Rickets 23 58 81 27 13 11 13 17 Anaemia, Debility and Malnutrition 30 126 156 45 38 9 28 36 Catarrhal Children 13 29 42 11 12 2 10 7 Septic Conditions — 48 48 42 1 — 5 — Nervous Children 7 8 15 5 2 3 — 5 Enlarged Glands 1 10 11 - 3 1 4 3 Miscellaneous Nervous Conditions 4 9 13 — 4 3 4 2 Miscellaneous Skins 7 14 21 11 1 1 5 3 Others 3 10 13 3 5 2 1 2 Mothers 5 10 15 3 5 2 1 4 93 322 415 147 84 34 71 79 150 A CORNER OF THE SEWING CLASS. 157 Collective Teaching of Expectant and Nursing Mothers. As in previous years a special class in mothercraft has been held every Wednesday afternoon at the Plumstead Welfare 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. The total attendances at the class during the year were 754. Supply of Milk, etc., to Necessitous Mothers and Children. Under the provisions of the Maternity and Child Welfare Act, 1918, milk, etc., is provided by the Council for necessitous expectant and nursing mothers, and children under the age of five years, under the conditions laid down in Circular 185, issued by the Ministry of Health in March, 1921. The approximate cost of these services during the year was as follows :— Dried milk, £1,177 15s. 2d. Fresh milk, Nil. Dinners, Nil. Feeding of Infants. The usual enquiry was carried out during the six weeks ending 3rd August and is summarised in the following Table, No. 80. The results are very similar to those obtained in previous years. This year there appears to be a slight decrease in the amount of breast feeding, especially in the early months of life. 158 TABLE No. 80. Feeding of Infants attending Welfare Centres—24th June to 3rd August, 1929. 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 47 98 57 49 34 42 37 32 21 417 10 2 429 Breast and Hand 5 10 12 12 9 5 12 15 8 88 8 10 11 117 Hand 10 19 21 22 22 35 37 38 34 238 25 35 43 341 Total 62 127 90 83 65 82 86 85 63 743 43 47 54 887 Percentages. Breast 75.8 77.2 63.3 59.0 52.3 51.2 43.0 37.6 33.3 56.1 23.3 4.2 — 48.4 Breast and Hand 81 7.9 13.4 14.5 13.9 61 140 17.7 12.7 11.8 18.6 21.2 20.4 13.2 Hand 161 14.9 23.3 26.5 33.8 42.7 43.0 44.7 54.0 32.1 58.1 74.6 79.6 38.4 159 Treatment of Minor Ailments. Children requiring medical or surgical treatment for certain minor ailments are referred to the School Clinics at Brewer Street, Woolwich, and Park Place, Eltham, to a private practitioner, or to a hospital. During the year 81 were sent to these clinics and for each case the Council paid 5s. Od. Children referred to them suffered from the following conditions:— TABLE No. 81. Brewer Street. Park Place. Impetigo 6 15 Ear discharge 13 15 Eyes 12 4 Miscellaneous 6 10 37 44 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. 82, shows the cases attending and the total attendances during the year. The number of sessions was 24, excluding anaesthetic days. TABLE No. 82. No. Attendances. Expectant mothers 78 156 Nursing mothers 46 135 Children under 5 140 173 264 464 160 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. 31 sets (complete or partial) of artificial teeth were supplied during the year at a total cost of £145 8s. 6d. Payments by mothers amounted to £96 7s. 9d. 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 their 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 £103 8s. 0d. 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:— 161 THE REMEDIAL CLINIC. 162 TABLE No. 83. Type of Case. Number remaining over from 1928. New Cases. Total Cases. No. who completed treatment by end of year. Talipes (Club Foot) 2 9 11 6 „ (Flat Foot) 3 4 7 5 Rickets— General 8 6 14 13 Genu Valgum (Knock Knee) 3 9 12 9 Genu Varum (Bow leg) — 10 10 9 Paralysis, etc.— Infantile 1 1 2 2 Erb's 1 — 1 — Muscular Weakness 3 1 4 2 Congenital 1 1 2 1 Miscellaneous— Injuries — — — — Hernia — — — - Constipation - 3 3 2 Flat Chest 2 4 6 6 Rheumatism — — — — Torticollis 1 - 1 - 25 48 73 55 Provision of Nursing Assistance for Certain Infectious Diseases. The general scheme of nursing assistance is described in full in Section III. of the report. The extent to which these services have been made use of in respect to specific diseases is dealt with under these diseases, q.v. Home Helps. During the year the Council approved a scheme for the provision of home helps in maternity cases. Before the scheme was formulated information was obtained from all the Metropolitan Borough Councils as to the extent 163 to which the services of home helps were used. It appears that little use is made of this provision although the need is very apparent. It may be that there is among many mothers unwillingness to accept someone else into the home, or there may be a want of mutual confidence or a feeling of distrust. The home help may not be allowed to do the full work of the home and friction may ensue. The Council gave consideration to this aspect and ultimately resolved that not only should a panel of home helps be formed, but that in certain cases the mother should be allowed to nominate her own home help. It is clearly laid down, however, that any nominee need not be accepted, and that the Medical Officer of Health is to be satisfied in every case that the nominee is a person clean, capable and trustworthy, and able to do the work properly. With regard to the fees payable, the Council resolved that in every case a booking fee should be charged, and that the fees payable for this service should be collected in advance. In the case of those who fall within the Council's Economic Circumstances Scale the fee has been fixed at 2s., and those who come under the half cost scale, 4s. In the case of those above these scales each application is considered on its merits. The rate of wages paid to the home help is 1s. per hour with the following reservations:— (1) The maximum payment for attendance immediately prior to confinement to be 5s. (2) The maximum payment per week to be £2. The scheme came into operation in the second half of the year, and during the year one application was considered by the Committee and a home help provided. K 164 Convalescent Home Treatment for Children under Five Years of Age. In 1928, the Council resolved to give grantsin-aid to the Woolwich Invalid Children's Aid Association for the purpose of providing convalescent home treatment for children under five years of age. During the year such grants were made in respect of 29 children, the total cost of whose convalescent treatment amounted to £149 10s. 0d. The Council's grants amounted to £57 8s. l0d. Payment is only made in respect of children sent to homes approved by the Medical Officer of Health. Hospital Beds for Children under Five Years of Age. Twelve beds have been reserved by the Council in the Woolwich War Memorial Hospital for the treatment of children under five years of age suffering from such conditions as are usually admitted to general or children's hospitals. The Council pay the Governors of the Hospital £1,524 per annum for the use of these beds but they deduct the hospital fees received for these cases. During the year the income received, including the arrears from the previous year, was £57 14s. 6d., and there were arrears of payments amounting to £3 4s. 0d. outstanding at the end of the year. 116 children in all were under treatment during the year; 86 of these were discharged cured, 8 were improved in health, and in 6 cases there was no change. Nine children died. The number remaining in hospital at the end of the year was seven. Children were admitted suffering from bronchitis and pneumonia, marasmus, enteritis, and from other medical conditions, whilst others were admitted for operation for tonsils and adenoids, hernia, appendicitis and pyloric stenosis. Institutional Midwifery. The Council's scheme for the provision of maternity beds in Institutions was fully reported upon in last year's report. 165 (a) British Hospital for Mothers and Babies. During the year the Managing Committee of the hospital were able to complete the new Administration Block and to sever the connection with the old hospital in Wood Street, used first as a hospital and latterly as the Nurses' Home and Clinic Department. The Clinics have been transferred, and adequate kitchens, dining, sitting and bedrooms for the staff have been built. A dental clinic has also been provided. There are still outstanding, however, the second Ward Block, with additional quarters for Student Midwives, and the permanent Isolation Block. These are urgently needed, not only for the purposes of a training school for the higher training of midwives, but also in response for the increasing demands for institution beds by expectant mothers in this neighbourhood. The hospital was closed on account of these operations for nearly two months and in consequence the numbers admitted were smaller than the average of the last few years. Miss Gregory, the Secretary of the Hospital, tells me, however, that during the year the number of babies born was 582, that 4,952 attendances were made at the Ante-natal Clinics, and 1909 at the Infant Clinics. In addition there were 234 extern cases. The number of mothers admitted under the Council's scheme was 133, the nett cost to the Council being £947 6s. 4d. (b) War Memorial Hospital—7 maternity beds. I am indebted to Mr. Edwin Radford, J.P., the Secretary Superintendent of the Hospital, for the following information regarding the admissions to the maternity unit during the year. The number of children born in the hospital was 147, and 26 mothers were admitted for ante-natal or emergency treatment. The number of attendances made at the antenatal clinic was 720. 166 In consequence of the closing of the British Hospital for Mothers and Babies, during alterations, the number of Council's cases admitted—72—was above the average, all the maternity beds being reserved for the Council for a period of two months. The nett cost to the Council was £547 6s. 6d. Administration of the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. The Council's scheme under these Regulations was fully described in the Annual Report for 1928. The extent to which they were made use of is reported on fully in that part of the Infectious Diseases Section of the report which deals with the notification of these diseases. Blind Persons Act, 1920. The Council, at the request of the London County Council, have arranged that home visiting of blind children under five years of age should be carried out by the Council's health visitors, and reports are furnished to the County Council, as the occasion arises, when the home conditions are unsuitable for blind children or it is advisable that the child should be admitted into a suitable institution. During the year no fresh cases came to the knowledge of the department. Widows', Orphans' and Old Age Contributory Pensions Act, 1925. The local authority may, in case of desertion of a child who is an orphan, administer the payments on behalf of the child. No case under the provisions of this Act was dealt with during the year. Local Government Act, 1929. In September the Minister of Health published a draft scheme under Section 101 (6) of the above Act 167 (а) to determine in relation to voluntary associations providing maternity and child welfare services, which of these services are to be treated as services in respect of which the London County Council are to contribute, and which are services in respect of which the Councils of the Metropolitan Boroughs are to contribute. (b) providing for the payment of contributions to those associations by the several Councils. The proposed scheme divided Maternity and Child Welfare institutions in London into two classes and provided that the London County Council should be the Authority to be satisfied as to the efficiency of the services of those in the first class, and that the Metropolitan Borough Councils should be the Authorities for this under the second class. Representations were made to the Minister of Health and the Metropolitan Borough's Standing Joint Committee upon the scheme asking that it should be amended so as to make the Borough Councils the Authorities to be satisfied . as to the efficiency of the services provided. The decision of the Minister on the matter had not been received at the end of the year. 168 METEOROLOGY. Meteorological Observations taken at the Royal Observatory, Greenwich, during the year 1929. Week ending. Temperature of the Air. Departure from average mean air temperature for 65 years. Average Temperature 4 feet below ground. Number of days on which rain fell. Rainfall in inches. Highest during Week. Lowest during Week. Mean Temperature. Jan. 5 40.1 29.1 35.3 — 3.2 45.0 3 0.43 12 37.9 28.4 32.3 — 5.6 44.0 1 0.30 19 46.3 23.3 34.7 — 3.6 43.1 4 0.10 26 45.9 26.3 35.2 — 3.7 42.2 3 0.06 Feb. 2 52.7 23.0 40.9 + 1.3 42.0 5 0.53 9 43.8 22.9 34.9 — 4.5 42.1 2 0.09 16 41.2 12.0 24.7 —14.4 41.4 2 0.05 23 53.2 16.0 33.1 — 6.5 40.1 1 0.03 March 2 44.8 23.1 31.6 — 8.6 39.2 1 0.07 9 67.7 20.6 38.9 — 2.0 39.9 - - 16 65.1 29.1 40.5 — 0.9 39.4 - - 23 690 280 45.1 + 3.1 40.1 1 0.02 30 70.3 33.4 51.3 + 7.9 41.5 1 0.01 April 6 58.9 25.4 43.6 — 2.2 42.4 3 0.23 13 31.7 330 35.8 — 3.2 42.8 4 0.35 20 74.1 29.7 49.0 + 1.6 43.1 - 0.00 27 59.6 31.0 43.6 — 5.1 43.9 1 0.03 May 4 61.8 29.1 44.7 — 4.6 44.1 4 0.56 11 67.8 40.3 51.3 + 0.3 44.9 5 0.89 18 65.8 41.2 52.5 — 0.2 46.3 3 0.38 25 83.2 37.4 60.0 + 5.5 47.7 1 0.55 June 1 78.4 43.9 57.7 + 1.2 49.4 - - 8 71.2 43.2 55.6 — 2.6 50.4 7 0.84 15 730 44.0 59.3 + 0.9 61.1 3 0.35 22 82.7 44.6 61.5 + 1.9 52.2 2 0.05 29 73.0 44.3 56.4 — 5.0 52.9 — — 169 METEOROLOGY—continued. Week ending. Temperature of the Air. Departure from average mean air temperature for 65 years. Average Temperature 4 feet below ground. Number of days on which rain fell. Rainfall in inches. Highest during Week. Lowest during Week. Mean Temperature. July 6 76.1 48.3 58.1 — 3.8 53.0 4 1.05 13 88.1 45.9 62.9 + 0.3 53.5 - - 20 90.3 46.2 68.7 + 5.4 54.5 2 0.24 27 83.8 47.9 65.0 + 2.1 55.6 2 0.03 Aug. 3 75.1 48.3 59.8 — 2.4 56.0 4 0.97 10 78.7 50.3 60.6 — 1.6 56.0 4 0.72 17 76.4 45.4 62.2 — 0.2 56.1 2 0.79 24 80.0 49.9 62.0 + 0.7 56.2 4 0.13 31 90.5 48.7 65.5 + 5.1 56.9 - - Sept. 7 89.1 53.1 67.3 + 7.9 57.1 1 0.05 14 88.0 52.0 66.0 + 8.4 57.4 _ - 21 74.7 46.7 60.6 + 3.8 57.2 1 0.01 28 78.2 39.9 59.8 + 4.6 56.9 - - Oct. 5 73.3 41.7 55.9 + 2.2 56.1 5 0.59 12 66.9 40.1 53.1 + 1.5 55.4 5 0.98 19 67.1 33.8 52.8 + 3.1 54.9 1 0.01 26 59.6 33.0 46.8 — 1.3 53.8 3 1.05 Nov. 2 56.3 29.0 45.2 — 2.0 52.3 3 0.09 9 60.0 33.1 47.1 + 1.4 51.3 3 0.48 16 56.9 25.9 39.9 — 3.6 50.4 5 1.91 23 60.0 31.0 46.5 + 4.2 48.9 4 0.55 30 56.5 39.2 49.6 + 8.0 48.6 7 1.77 Dec. 7 54.0 36.2 47.3 + 6.0 48.6 6 2.28 14 57.0 36.2 47.7 + 7.2 47.9 5 1.09 21 56.1 26.1 36.6 — 3.3 47.3 2 0.43 28 53.9 31.9 42.6 + 4.1 45.8 6 1.05