WOO 30 Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1930 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, S.E. 18. 65922 PUBLIC HEALTH AND HOUSING COMMITTEE. At 31st December, 1930. The Worshipful the Mayor (Councillor Miss G. E. Walters, J.P.). Councillor Miss M. Grout, J.P. (Chairman). Councillor Mrs. L. E. Driver (Vice.Chairman). Alderman A.Gorman. Councillors— J. T. Cotter T. G. E. Phillips H. N. Dickinson Major G. H. Rayner A. H. Gilder Mrs. E. L. Reeves S. J. Huff Miss S. Turnbull E. T. Lamerton H. J. Turner J. Lee H. Vaughan MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Public Health and Housing Committee. 3 TABLE OF CONTENTS. Page Public Health and Housing Committee 2 Maternity and Child Welfare Committee 2 Preface 6 I.—GENERAL STATISTICS. Social Conditions 9 Physical Features of the Area 10 Population 10 Sickness and Invalidity 10 II.—VITAL STATISTICS. Annual Statistics 11 Births 13 Marriages 14 Deaths 15 Deaths from Cancer 20 Maternal Mortality 22 Child Mortality 23 Infantile Mortality 24 III.—GENERAL PROVISION OF HEALTH SERVICES. Public Health Officers 29 Professional Nursing in the Home 32 Midwives 32 Laboratory Facilities 33 Adoptive Acts, By.laws and Regulations in Force in the District 33 Hospitals 35 Maternal Mortality 36 Institutional Treatment for Unmarried Mothers 36 Ambulance Facilities 36 Clinics and Treatment Centres 37 Vaccination 39 Supply of Insulin 41 IV.—HEALTH PROPAGANDA. Health Week, 1930 42 Health Talks to School Children 43 Health Talks to Adults 43 Informal Talks 44 "Better Health" 44 V.—SANITARY ADMINISTRATION. Staff 45 Water Supply 45 Removal and Disposal of Refuse 45 Water Closet Accommodation 45 Drainage 46 Smoke Abatement 46 Sanitary Inspection of the Area 47 4 page Factories and Workshops 49 Rats 50 Offensive Trades 50 Rag Flock 50 Mortuaries 51 Cemeteries 51 Exhumations 52 Removal of Infirm and Diseased Persons 52 Legal Proceedings 52 VI.—INSPECTION AND SUPERVISION OF FOOD. General Reference 53 Milk Supply:— Registration 53 Designated Milks 54 Condensed and Dried Milks 54 Agricultural Produce (Grading and Marking) Act, 1928 55 Merchandise Marks Act, 1926 56 Meat Inspection 56 Slaughterhouses 57 Inspection of Imported Meat 58 Other Food Premises 58 Unsound Food 58 Sophistication of Food 59 Adulterated Samples—Action Taken 61 Chemical and Bacteriological Examination of Food 62 Nutrition 62 Other Legal Proceedings 62 VII.—HOUSING. Statistics 63 Action under Housing Acts 65 Housing Conditions 65 Sufficiency of Supply of Houses 66 Overcrowding 67 Fitness of Houses 67 New Housing Estate 67 Houses Let in Lodgings 68 Tents and Vans 68 Rent Restrictions Acts 68 New Houses—Water Certificates 69 VIII.—INFECTIOUS DISEASES. Notifications 70 Diphtheria 75 Scarlet Fever 76 Enteric Fever 78 Puerperal Fever and Puerperal Pyrexia 78 Erysipelas, Malaria and Dysentery 78 Smallpox 78 Chicken.pox 79 Pneumonia 79 Cerebrospinal Meningitis 81 5 page Anterior Poliomyelitis 81 Zymotic Enteritis 81 Whooping Cough 81 Measles 81 Ophthalmia Neonatorum 81 Tuberculosis:— General Reference 82 Deaths 83 Administration of Tuberculosis Regulations 84 Shelters 88 Bacteriological Examinations 88 The Work of the Dispensary 88 Home Visiting 91 Work for the Ministry of Pensions 91 Contacts 91 X.Ray Examinations 91 Observation Cases 92 Co.operation with Medical Practitioners 92 Co.operation with School Medical Service 92 Supply of Extra Nourishment 92 Dental Treatment 92 Finsen Light Treatment 93 Artificial Pneumothorax 93 Tuberculosis Care Committee 93 Institutional Treatment 95 Disinfection and Disinfestation 96 IX.—MATERNITY AND CHILD WELFARE. General Reference 99 History of Scheme 100 Notification of Births Acts 103 The Work of the Health Visitors 103 The Work of the Welfare Centres 104 Feeding of Infants 106 Eltham Health Centre 107 Artificial Sunlight Clinic 110 Medical Inspection of the Toddler 112 Home Helps 118 Treatment of Minor Ailments 118 Dental Treatment 118 Orthopaedic Treatment 119 Provision of Nursing Assistance 120 Hospital Beds for Children 120 Institutional Midwifery 121 Ante.Natal and Emergency Hospital Treatment 121 Convalescent Home Treatment 121 Assisted Milk Scheme 121 Collective Instruction to Mothers 122 Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 122 Blind Persons Act, 1920 122 Widows', Orphans' and Old Age Contributory Pensions Act, 1925 122 Local Government Act, 1929—Scheme under Section 101 (6) 122 METEOROLOGY. 6 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Madam Mayor, Ladies and Gentlemen, I have the honour to submit the Thirtieth Annual Report on the health of the Metropolitan Borough of Woolwich. For some years now it has been the practice to issue ordinary reports for four years in succession, and then a more comprehensive or survey one. A survey report was due this year, but the Minister of Health has requested that a report of a simpler character should be prepared, containing however, information on certain matters in more detail than has been given in the reports for the past few years, and it is on this basis that the present report has been prepared. On the 1st April, the Local Government Act, 1929, came into force, and as a result the Boards of Guardians and the Metropolitan Asylums Board ceased to exist. In the Metropolis the County Council became responsible for most of their duties and functions, and the Borough Councils for the remainder. In the end the only addition made to the work of the Health Department was the administration of the Vaccination Acts. The Act also changed the system of Government grants.in.aid, a block grant being substituted for the percentage grants which were formerly received in respect of the maternity and child welfare and the tuberculosis services. Provision was made in the Act for the transfer or delegation of certain functions of the County Council to the Borough Councils. It is a matter of regret that, although the matter was under consideration both by the County Council and the Metropolitan Boroughs' Standing Joint Committee, no scheme had been submitted to the Minister for approval by the end of the year. A certain amount of explanation is needed regarding the vital statistics of the year. These are usually calculated on a mid.year population furnished by the Registrar.General. This year, however, he did not furnish this figure but suggested that, until the results of the 1931 Census were known, it would be better 7 to calculate rates for comparative purposes on the figures for mid 1929. Accordingly throughout the report these figures have been used, i.e., Civil Population, 141,600; Military Population, 5,200. The vital statistics of the Borough were highly satisfactory. The death.rate was 10.9 (12 6 in 1929)—the fourth lowest in the Metropolis; the infantile mortality rate was 42 (62 in 1929)—the lowest in the Administrative County; and the neo.natal mortality rate (deaths under four weeks per 1,000 births) was 20.11, the lowest in the records of the Borough. The birth.rate, 15.5, compares with 16.3 in the previous year. The incidence of infectious disease was higher in 1930 than in the previous year. This was largely accounted for by the biennial epidemic of Measles, 2,702 cases of which came to the knowledge of the Department, as compared with 151 in the previous year. The number of cases of Scarlet Fever notified was 627 (567 in 1929); Diphtheria, 497 (496 in 1929); Pneumonia, 283 (383 in 1929); Erysipelas, 77 (80 in 1929). 36 cases of Puerperal Fever and Puerperal Pyrexia were notified, compared with 53 in 1929. For the third year in succession Smallpox appeared in the Borough, 10 notifications being received. Another factor in the increase of the number of cases notified is the fact that Chicken.Pox was made notifiable from the 1st April until the end of the year, and 597 notifications were received. In comparing the figures of 1929 with those of 1930 regard should be had to this and to the epidemic of Measles. The number of new cases of Tuberculosis coming to the knowledge of the Department was 335 (324 in 1929). At the end of the year there were 940 cases of pulmonary and 277 cases of non.pulmonary tuberculosis, making a total of 1,217 cases (1,210 in 1929) known to be living in the Borough. The Department continues to carry on, as part of its daily routine, health propaganda work. Arrangements were entered into during the year whereby 2,000 copies of a local edition of "Better Health" are distributed monthly, mainly through the Council's clinics and libraries. The reports of the Sanitary Inspectors show that much work has been carried out in securing the remedying of defects and the abatement of nuisances associated with housing, and the maintenance of a desirably high standard in these matters. In the same way the reports of those inspectors engaged in the supervision of the food supplies illustrate how important it is to maintain a vigilant eye at all times. During the year Parliamentary sanction was obtained to the closure of Plumstead Churchyard. I regret to report that Mr. William Wood, Sanitary Inspector, who entered the service of the Plumstead Vestry in 1897, had to apply for superannuation on account of ill.health. He retired in September, but unfortunately his health did not improve and he died suddenly in December. 8 In maternity and child welfare work the outstanding features of the year were two in number, namely, the institution of a scheme for the medical inspection and treatment of the toddler, and the building of a new Health Centre at Eltham. This Centre is the first Municipal one in London to be built for Maternity and Child Welfare work and for the treatment of school children. The attendances at the Centres continue to increase every year, and in all numbered 52,079 during 1930. In conclusion, it is my pleasant duty to thank the members of the Health Committees, and the Council generally, for the support and kindly consideration they have given and shewn throughout the year. It delights me to say also, how much I appreciate the manner in which the staff of the Department have carried out their duties at all times during the year. I am, Madam Mayor, Ladies and Gentlemen, Your obedient Servant, JOHN MACMILLAN, Medical Officer of Health. 9 THIRTIETH ANNUAL REPORT on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH. Year ending 31st December, 1930. 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 (April, 1930) £960,210 Sum represented by a Penny Rate (October, 1930) £4,000 Social Conditions.—In 1930, the London County Council made an Order unifying the three Civil Parishes of Woolwich, Plumstead and Eltham into one parish, which is now known as the Parish of the Borough of Woolwich. The Borough is situated in the South.East of the Administrative County of London, and is bounded on the North, East and South by the County boundaries, and on the West by the Metropolitan Boroughs of Lewisham and Greenwich. It covers an area of 8,282 statute acres and includes a small area (North Woolwich) north of the Thames. The River Thames covers, within the borough, 645 acres. The Borough is divided into the two Parliamentary Divisions of East Woolwich and West Woolwich, and is further sub.divided into 14 wards. The Borough may be described as one of the suburban working.class Metropolitan Boroughs. Much of it 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 19. 10 Physical Features and General Characteristics of the Area.—In the physical configuration of the Borough the outstanding feature is Shooters Hill, which rises over 400 feet above sea level. At a little lower level on the Woolwich and Plumstead side there is the well.marked plateau of Woolwich and Plumstead Commons, due to the erosion of local clay from off the pebble beds. Lower down still is the level plain of the Thames. Southward, in Eltham and Lee, the land, after sloping downward from Shooters Hill, rises slightly again in Eltham and then falls away towards New Eltham and Lee, but rises again as it approaches Chislehurst. In the main this area is composed of London clay although there is a considerable amount of sand and gravel in Avery Hill Ward. Population.—Ever since 1919 it has been the practice to rely on the Registrar General's mid.year estimate of the population of the Borough for the purpose of calculating the birth, death and other rates, but this year the Registrar General has not supplied the estimated figure, presumably because an accurate figure will be available as soon as the Census figures of 1931 are known. It has been accordingly suggested that the population figures for 1929 should be used. It should be clearly understood, however, that this is a purely arbitrary figure and must be treated as such. It is the basis, however, upon which rates throughout the Metropolis and Country generally will be calculated for the year, and is the only figure which can be used safely for comparative purposes. For many years the statistics of the Borough have been presented for the four registration districts of Woolwich, West Plumstead, East Plumstead and Eltham, and they are being continued in this form this year. When the report for 1931 comes to be issued I propose to give the figures in Wards. Accordingly, the figures used throughout this report for calculating rates are as follows:— TABLE No. 2. Estimated Population. Woolwich 29,440 West Plumstead 38,112 East Plumstead 34,204 Eltham 39,844 Sickness and Invalidity.—It is impossible to give any accurate information on the amount of sickness in the Borough throughout the year, but so far as can be ascertained there was no undue amount of sickness or invalidity during 1930. 11 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 2,127 „ Illegitimate 61 2,188 Still.births 77 ,, Rate per 1,000 total births 35 0 Birth Rate 15.5 Deaths 1,547 Death Rate 10.9 Percentage of total deaths occurring in public institutions 52.7 Number of Women dying in, or in consequence of Child Birth:— (a) From Sepsis 4 (b) From other causes 4 Deaths of Infants under one year 91 (а) Legitimate 90 (b) Illegitimate 1 Infantile Mortality Rate 42 Deaths from Measles (all ages) 15 „ „ Whooping Cough (all ages) 1 ,, ,, Diarrhoea (under 2 years of age) 10 12 The chief Vital Statistics since 1901 are given in the following Table:— TABLE No. 4. Year. (1) Population estimated to middle of each Year. (2) Births. Nett Deaths belonging to the District. Nett. Under 1 year. At all Ages. Number. (3) Rate. (4) Number. (5) Rate per 1,000 Nett Births. (6) Number. (7) Rate. (8) 1901 117,652 3536 30.1 457 129 1709 14.6 1902 119,285 3734 31.3 467 125 1837 15.4 1903 117,842 3684 31.3 398 108 1638 13.9 1904 118,456 3535 29.8 477 135 1763 14.9 1905 118,589 3546 29.9 362 102 1604 13.5 1906 119,143 3549 29.8 388 109 1668 14.0 1907 119,704 3330 27.8 373 112 1616 13.5 1908 122,258 3176 26.0 300 94 1516 12.4 1909 120,227 2947 24.5 242 82 1587 13.2 1910 121,197 2842 23.6 242 85 1418 11.7 1911 121,487 2810 23.1 272 97 1566 12.9 1912 121,932 2776 22.8 208 75 1456 11.9 1913 122,382 2833 23.1 228 80 1549 12.7 1914 122,431 2838 23.2 241 85 1706 13.9 1915 a 138,200 2839 21.9 268 94 1837 14.2 b 129,505 1916 a 141,783 3068 23.5 213 69 1704 13.1 b 130,313 1917 a 147,078 2718 20.6 216 79 1566 11.9 b 131,942 1918 a 150,650 2548 19.0 270 106 2100 15.6 b 134,453 1919 a 141,918 2737 20.1 235 86 1679 12.3 b 136,237 1920 a 140,000 3658 26.9 224 61 1487 10.9 b 135,904 1921 a 141,700 3197 23.2 197 62 1594 11.6 b 137,604 1922 a 142,350 2941 21.3 184 63 1603 11.6 b 138,254 1923 a 143,530 2867 20.5 123 43 1387 9.9 b 140,000 1924 a 144,400 2590 18.5 168 65 1543 11.0 6 139,980 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 1930 a Not 2188 15.5 91 42 1547 10.9 b available. a Total Population. b Civil Population. 13 Births.—During the year 2,319 births were registered in the Borough, 1,189 being males, and 1,130 females. Corrected by outward (177 males and 149 females) and inward (104 males and 91 females) transfers, these numbers become 2,188, 1,116 and 1,072 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 279 292 571 West Plumstead 303 242 545 East Plumstead 216 221 437 Eltham 318 317 635 The Borough 1,116 1,072 2,188 The birth rate, calculated on the civilian population for 1929 was 155, compared with 16 3 in 1929. The following Table, No. 6, shows the birth rates in each of the old registration districts, after corrections for outward and inward transfers, for each year since 1926:— TABLE No. 6. Period. Woolwich. West Plumstead. East Plumstead. Eltham. The Borough. 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 1930 19.4 14.3 12.8 15.1 15.5 Illegitimate Births.—The number of illegitimate births registered was 44. There were 22 inward transfers and 5 outward transfers, making a net figure of 61, equivalent to 28 per 1,000 births. Natural Increase of Population.—This term means the excess of births over deaths. In 1927 it was 751, in 1928, 715, in 1929, 532, and in 1930, 641. 14 Notification of Births.—During the year 2,272 live births were notified. This is at the rate of 98'0 per cent, of the registered births and compares with 96'2 per cent. last year. The births were notified as shown in the following Table:— TABLE No. 7. Midwives 839 British Hospital for Mothers and Babies 693 Military Families' Hospital 203 War Memorial Hospital 120 Medical Practitioners 105 Parents 105 St. Nicholas Hospital 94 Eltham Cottage Hospital 41 Midwives' Homes 20 Other Persons 46 In addition to these, 35 notifications were received from the Medical Officer of Health, Greenwich, 70 from the Medical Officer of Health, Lewisham, and 32 from other Medical Officers of Health. 74 still births were notified. It is known that 1,018 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 46.59. The following Table, No. 8, shows the number of corrected births each year since 1926; 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:— TABLE No. 8. Year. No. of Births. No. of Live Births Notified. No. of Still Births. Percentage of Births Notified. Birth Rate. Woolwich. London. England and Wales. 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 1930 2188 2272 74 98 15.5 16.3 15.7 Marriages.—There were 1,082 marriages (996 in 1929). The marriage rate was 15 3 as compared with 16 01, 13 9, 17 7 and 14'1 in the four preceding years. 15 Deaths.—The total deaths registered in the district was 1,404. This figure includes 163 non.residents who died in the district, but does not include 306 residents who died outside the Borough. When allowance is made for inward and outward transfers the net figure of 1,547 is obtained. The death rate for the year, calculated on the 1929 population, was 10.9. In 1929 the corresponding rate was 12.6. According to the figures published by the Registrar General for the 53 weeks ended 3rd January, 1931, three Metropolitan Boroughs had a lower rate than Woolwich, viz., Lewisham, 9.7, Greenwich 10.3 and Poplar 10.5, while Fulham and Camberwell had the same rate. In 1930 the death rate for England and Wales was 11.4, for London 114, and the mean death rate for 107 County Boroughs and Great Towns, including London, was 11.5. The following Table, No. 9, shows the death rates in each of the old registration districts (after correction for outward and inward transfers) for each year since 1926. TABLE No. 9. Period. Woolwich. West Plumstead. East Plumstead. Eltham. The Borough. 1926 11.7 11.1 10.3 7.6 10.2 1927 13.0 11.4 9.9 8.3 10.6 1928 14.4 11.9 10.4 8.1 11.0 1929 15.7 13.7 12.5 9.2 12.6 1930 13.7 12.4 11.0 7.4 10.9 The seasonal mortality in the four Quarters of the year was as follows:— First Quarter, 13 6; Second Quarter, 9 8; Third Quarter, 8 9; Fourth Quarter, 106. 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. 10. Hospital or Institution. Number of Deaths. Public General Hospitals 552 Voluntary General Hospitals 126 Mental Hospitals 43 Special Hospitals 32 Infectious Diseases Hospitals 24 Sanatoria and Tuberculosis Institutions 18 Cottage Hospitals and Nursing Homes 20 815 The following Tables are self explanatory:— 16 TABLE No. 11. Birth.rate, Death.rate, and Analysis of Mortality during the Year 1930. 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 & Enteritis (under 2 yrs.) Total Deaths under 1 Year. Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No inquest. Uncertified Causes of Death. Live Births Still Births England and Wales 16.3 0.69 11.4 0.01 0.00 0.10 0.02 0.05 0.09 0.12 0.55 6.0 60 90.4 6.9 1.7 1.0 107 County Boroughs and Great Towns, including London. 16.6 0.71 11.5 0.01 0.00 0.15 0.02 0.05 0.10 0.11 0.50 8.3 64 90.6 6.6 2.3 0.5 159 Smaller Towns (1921 Adjusted Populations 20,000.50,000). 16.2 0.69 10.5 0.00 0.00 0.08 0.01 0.05 0.07 0.13 0.43 4.4 55 91.8 5.9 1.2 1.1 London 15.7 0.56 11.4 0.01 0.00 0.23 0.02 0.03 0.10 0.08 0.55 9.9 59 88.3 7.4 4.3 0.0 WOOLWICH 15.5 0.54 109 0.01 0.00 0.11 0.04 0.01 004 009 0.38 4.6 41 89.1 8.4 2.5 0.0 17 TABLE No. 12. Deaths of Woolwich Residents Registered during the Calendar Year, 1930, 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 1547 91 29 23 34 79 171 420 335 365 Enteric fever 1 .. .. .. .. .. .. 1 .. .. Smallpox .. .. .. .. .. .. .. .. .. .. Measles 15 .. 9 3 1 .. .. .. .. .. Scarlet fever 5 .. 1 1 2 .. .. .. .. .. Whooping cough 1 .. .. 1 .. .. .. .. .. .. Diphtheria 5 .. 1 2 2 .. .. .. .. .. Influenza 13 .. .. .. .. .. 1 4 4 2 Encephalitis lethargica 3 .. .. .. .. .. 2 1 .. .. Meningococcal meningitis 1 .. .. 1 .. .. .. .. .. .. Tuberculosis of respiratory system 150 .. .. 1 1 31 65 43 9 .. Other tuberculous diseases 15 .. .. 2 2 6 3 .. .. .. Cancer, malignant disease 201 .. .. .. 1 1 17 80 67 35 Rheumatic fever 6 .. .. .. 1 3 1 1 .. .. Diabetes 22 .. .. .. .. .. 1 9 11 1 Cerebral haemorrhage, &c. 75 .. .. .. 1 .. 1 21 19 33 Heart disease 361 .. .. .. 5 .. 10 81 116 143 Arterio-sclerosis 42 .. .. .. .. .. 1 10 16 15 Bronchitis 61 6 2 1 .. .. 1 13 8 31 Pneumonia (all forms) 101 14 7 5 4 .. 9 41 9 10 Other respiratory diseases 19 1 .. .. 1 .. 4 10 2 1 Ulcer of stomach or duodenum 18 .. .. .. .. .. 4 7 3 4 Diarrhoea, &c. 13 7 3 .. 1 .. .. .. 1 1 Appendicitis and typhlitis 11 .. .. .. 3 3 1 3 .. 1 Cirrhosis of liver 7 .. .. .. .. .. .. 4 3 .. Acute and chronic nephritis 51 .. .. .. .. 1 7 16 13 14 Puerperal sepsis 4 .. .. .. .. 1 3 .. .. .. Other accidents and diseases of pregnancy and parturition 4 .. .. .. .. .. 4 .. .. .. Congenital debility and malformation, premature birth 43 42 .. .. .. 1 .. .. .. .. ouicide 23 .. .. .. .. .. 8 11 2 2 Other deaths from violence 54 2 .. 1 1 9 7 13 11 10 Other defined diseases 221 16 3 5 8 14 21 51 41 62 Causes ill-defined or unknown . . 1 .. 1 .. .. .. .. .. .. .. 18 TABLE No. 13. 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 1930. Causes of Death. Males. Females. Woolwich. Plumstead. Eltham. Deaths in Public Institutions. In Borough. Outlying Institutions. West. East. Residents. Non. Residents. All causes 836 711 403 474 376 294 535 140 280 Enteric fever 1 ... ... 1 ... ... ... ... 1 Smallpox ... ... ... ... ... ... ... ... ... Measles 8 7 9 2 1 3 ... 12 Scarlet fever 3 2 1 ... 1 3 ... ... 5 Whooping cough 1 ... 1 ... ... ... ... ... ... Diphtheria 4 1 ... 3 ... 2 ... 1 5 Influenza 9 4 4 6 1 2 9 3 ... Encephalitis lethargica 3 ... 2 ... 1 ... 3 ... ... Meningococcal meningitis 1 ... ... 1 ... ... 1 ... ... Tuberculosis of respiratory system 87 63 42 34 40 34 52 7 38 Other tuberculous diseases 4 11 4 4 3 4 9 4 4 Cancer, malignant disease .. 107 94 40 74 41 46 67 20 45 Rheumatic fever 2 4 1 4 1 3 1 1 Diabetes 13 9 8 8 2 4 10 1 1 Cerebral haemorrhage, &c. 22 53 16 29 19 11 25 3 4 Heart disease 174 187 88 119 106 48 105 14 29 Arterio-sclerosis 25 17 9 14 6 13 2 1 15 Bronchitis 33 28 10 18 24 9 12 4 7 Pneumonia (all forms) 63 38 34 33 21 13 38 7 22 Other respiratory diseases 12 7 5 7 4 3 8 2 3 Ulcer of stomach or duodenum 17 1 2 8 3 5 8 4 7 Diarrhoea, &c. 9 4 4 3 2 4 5 ... 3 Appendicitis and typhlitis 6 5 2 3 4 2 8 4 3 Cirrhosis of liver 4 3 1 2 2 2 1 1 2 Acute and chronic nephritis 27 24 10 14 15 12 15 6 7 Puerperal sepsis 4 1 .. 1 2 2 1 2 Other accidents and diseases of pregnancy and parturition ... 4 1 1 2 ... 3 2 1 Congenital debility and malformation — premature birth 27 16 22 4 9 8 17 4 4 Suicide 16 7 10 7 2 4 5 ... Other deaths from violence 36 18 19 14 13 8 28 12 11 Other defined diseases 121 100 56 61 53 51 98 38 48 Causes ill.defined or unknown 1 ... 1 ... ... ... 1 ... ... 19 Causes of Death.—Table No. 12 shows that 361 deaths were due to heart disease, 201 to Cancer, 150 to Pulmonary Tuberculosis, 101 to Pneumonia, 75 to Cerebral Haemorrhage, and 61 to Bronchitis. There were 43 deaths from Congenital Debility and Prematurity. Only 13 deaths occurred through Influenza, and 15 through Measles. Seventy.two per cent. of all deaths occurred in persons over 45 years of age. Respiratory Diseases.—The following Table, No. 14, shows the number of deaths each year since 1912 from respiratory diseases, the annual death rate, the number of deaths under five years of age and the percentage of deaths occurring in children under five years of age. TABLE No. 14. Year. Bronchitis. Pneumonia. Other Respiratory. Total. Death Rate. Number under 5 years. Percentage under 5 years. 1912 105 93 23 221 1.8 78 35.8 1913 115 106 11 232 1.9 65 28.0 1914 118 137 11 266 2.2 91 34.2 1915 168 180 18 366 2.7 125 34.1 1916 130 130 13 273 2.1 60 21.9 1917 113 142 17 272 2.1 87 31.9 1918 108 208 5 321 2.4 112 34.9 1919 114 125 15 254 1.9 71 27.9 1920 101 97 16 214 1.5 70 32.7 1921 113 98 21 232 1.7 51 22.0 1922 123 116 5 244 1.8 64 26.2 1923 93 65 10 168 1.2 22 13.1 1924 142 95 10 247 1 • 8 65 26.3 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 1930 61 101 19 181 1.3 35 19.3 20 Cancer.—The total number of deaths was 201, of which 107 occurred in males and 94 in females. The deaths certified as due to Cancer and Malignant Disease each year since 1912 are shown in the following Table:— TABLE No. 15. Deaths from Cancer and Malignant Disease. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 1912 61 63 124 1.02 8.52 1913 54 70 124 1.01 8.00 1914 63 75 138 1.13 8.09 1915 51 74 125 0.97 6.80 1916 55 78 133 1.02 7.80 1917 58 72 130 0.99 8.03 1918 81 84 165 1.23 7.86 1919 76 81 157 1.16 9.35 1920 60 95 155 1.14 10.42 1921 76 106 182 1.34 11.42 1922 72 94 166 1.20 10.36 1923 91 84 175 1.25 12.62 1924 87 94 181 1.29 11.73 1925 83 110 193 1.37 12.71 1926 93 104 197 1.39 13.59 1927 101 109 210 1.49 1408 1928 100 109 209 1.48 13.45 1929 93 120 213 1.50 11.97 1930 107 94 201 1.42 12.99 21 The following Table, No. 16, shows the seat of primary disease in all deaths from Cancer (including all other specified malignant tumours):— TABLE No. 16. Seat of Primary Disease. Males. Females. Total. Deaths in Hospital. Lip 3 — 3 2 Tongue 5 — 5 3 Mouth and Tonsil 3 3 3 Jaw 1 2 3 1 Pharynx 1 — 1 1 Oesophagus 11 2 13 12 Stomach 21 11 32 17 Liver and Gall Bladder.. 3 0 9 5 Intestines 11 18 29 14 Rectum 12 6 18 13 Ovary — 7 7 4 Uterus — 8 8 3 Breast 1 20 21 6 Skin 6 1 7 5 Larynx 1 3 4 3 Lung 2 — 2 2 Pancreas 4 — 4 3 Bladder 4 2 6 2 Prostate 8 — 8 7 Testis 2 — 2 1 Other Organs and Undefined 1 6 7 3 Sarcoma 7 2 9 2 107 94 201 112 22 Maternal Mortality.—The number of deaths from Puerperal Sepsis was 4, and from other accidents and diseases of pregnancy, 4, making a total of 8 maternal deaths. In 1928 and 1929 the numbers were 13 and 14. The maternal death rate per 1,000 births was 3'66. The following Table shows the causes of death each year since 1912:— TABLE No. 17. Maternal Mortality, Woolwich, 1912-1930. Year. Abortion. Ectopic Gestation. Placenta Praevia. Other Puerperal Haemorrhage. Other Accidents of Child Birth. Child Birth with Secondary Causes. Puerperal Eclampsia. Puerperal Phlebitis and Embolism. Puerperal Fever. Totals. 1912 1 - - - - - 1 1 1 4 1913 1 - - - 1 - 1 - 2 5 1914 1 - 1 2 - 1 1 1 4 11 1915 1 1 - - 1 2 - 3 8 1916 - 1 1 1 4 - 1 - 7 15 1917 - 1 - 2 - 1 2 1 7 14 1918 - - - 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 1930 1 - - - - 1 2 - 4 8 Totals 8 12 7 15 14 5 29 14 79 183 23 Inquests.—There were 130 inquests held on Woolwich residents during the year, compared with 155 in 1929. Deaths of Children, 1—5 Years of Age.—The number of deaths of children between 1 and 2 years of age was 29, and between 2 and 5 years, 23. In 1929 these figures were 28 and 37. The causes of death are given in detail in Table No. 12. The following Tables show the variation in rates of mortality in these age groups in the last twenty years. These rates have been calculated on the estimated populations living at these ages and in stated groups of diseases. The rates for 1930 are also given. TABLE No. 18. Child Mortality (1—2 years). Death Rates per 1,000 estimated age population from stated Groups of Diseases, in Quinquennial Periods. Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1911-1915 2,581 7.67 2.87 8.76 2.56 4.96 26.82 1916-1920 2,536 6.86 1.42 8.28 .63 4.42 21.61 1921-1925 2,876 3.69 1.46 4.52 .49 2.99 13.15 1926-1930 2,249 4.00 .89 3.38 1.07 2.05 11.39 1930 2,190 5.48 .91 4.11 1.37 1.37 13.24 TABLE No. 19. Child Mortality (2—5 years). Death Rates per 1,000 estimated age population from stated Groups of Diseases, in Quinquennial Periods. Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1911-1915 7,681 3.05 1.20 1.56 .26 1.30 7.37 1916-1920 7,547 2.70 1.09 1.54 .02 2.52 7.87 1921-1925 8,266 1.79 .61 .77 .22 1.23 4.62 1926-1930 7,149 1.45 .48 .95 .08 1.17 4.13 1930 6,534 1.39 .46 .92 .00 .76 3.53 24 Infantile Mortality.—The number of deaths of infants under one year of age was 91, compared with 144 in 1929, and 114 in 1928. The rate of infant mortality resulting from these deaths (deaths under one year per 1,000 births) was 42, compared with 62 in 1929, and 50 in 1928. The rate this year equals the lowest infantile mortality rate ever recorded in the Borough, viz., in 1927. According to a return published by the Registrar General for the 53 weeks ending 3rd January, 1931, Woolwich had a lower infantile mortality rate (41) than everyother Metropolitan Borough with the exception of Chelsea, which it equals. The rate for the administrative County of London was 59, and England and Wales, 60. The following Table, No. 20, shows the distribution of infantile mortality throughout the year calculated on a varying year basis. TABLE No. 20. Births. Deaths under 1 Year. Rate. First Quarter 538 46 81 Second Quarter 574 18 32 Third Quarter 544 13 24 Fourth Quarter 532 14 27 The following Table, No. 21, shows the infantile motality rate in the Borough and the old registration districts for each quinquennium since 1901, and for each year since 1926:— TABLE No. 21. Period. Woolwich. West Plumstead. East Plumstead. Eltham. The Borough. 1901-1905 138 99 128 97 120 1906-1910 110 89 93 91 98 1911-1915 103 76 83 68 86 1916-1920 94 70 70 81 79 1921-1925 63 46 62 59 57 1926-1930 61 36 45 48 48 1926 51 37 41 44 43 1927 53 29 42 47 42 1928 60 43 41 54 50 1929 77 45 60 66 62 1930 67 29 39 31 42 25 The five-yearly figures in the above Table show very clearly the progressive fall in infantile mortality, and if Table No. 25 be examined, it will be seen that the improvement is not merely in the totals but in every sub-division. Causes of Death.—The causes of infantile mortality are set forth in Tables Nos. 23 and 24, which show the incidence of mortality from each cause upon infants, distinguished by age, sex and registration district. It will be noted from these Tables that the chief causes of death were Premature Birth, 20; Pneumonia, 14; Congenital Malformation, 12; and Debility, 10. There were 7 deaths from Enteritis and Diarrhoea. The neo-mortality rate (deaths under 4 weeks) was 20.11, compared with 26.81 in 1929. Of the 44 neo-natal deaths, 20 were certified as due to premature birth, 7 to congenital malformation, and 6 to debility. Deaths of Illegitimate Children.—Only one illegitimate child died, compared with 7 in 1929, and 11 in 1928. 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. 10. TABLE No. 22. Hospitals or Institutions. Number of Deaths. Public General Hospitals 24 Voluntary General Hospitals 8 Fever Hospitals 2 Special Hospitals 13 Cottage Hospitals and Nursing Homes 3 50 Tables are set out in the following pages which classify in various ways the causes of death during 1930, followed by a Table which shows the death rates from stated groups of diseases in each five-yearly period since 1901:— TABLE No. 23. Infant Mortality, 1930. Nett Deaths from stated causes at various ages under one year of age. Causes of Death. Under 1 week. 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 1 month and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 1 1 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. 1 .. .. 2 3 Convulsions 1 1 1 .. 3 .. .. .. .. 3 Laryngitis .. .. .. .. .. .. .. 1 .. 1 Bronchitis .. .. .. .. .. 2 .. 2 1 5 Pneumonia .. 1 .. 1 2 3 4 4 1 14 Diarrhoea .. .. .. .. .. .. .. 1 .. 1 Enteritis .. .. .. .. .. .. 3 1 1 5 Gastritis .. .. .. .. .. .. 1 .. .. 1 Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. • • .. .. Suffocation, Overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth.. 3 .. .. .. 3 .. .. .. .. 3 Atelectasis 2 .. .. .. 2 .. .. .. .. 2 Congenital Malformation 3 2 1 1 7 4 .. 1 .. 12 Premature Birth 14 2 3 1 20 .. .. .. .. 20 Atrophy, Debility and Marasmus 3 1 1 1 6 4 1 .. .. 10 Other Causes •• .. •• 1 1 2 4 1 9 26 7 6 5 44 16 9 15 7 91 Nett Births registered during the calendar year Nett Deaths registered during the calendar year Legitimate, 2,127 ; Illegitimate, 61. Legitimate, 90 ; Illegitimate, 1. TABLE No. 24. Infant Deaths, 1930. Causes of Death. The Borough. Woolwich. West Plumstead. East Plumstead. Eltham. m. F. Under 4 weeks 4 wks.1 year m. F. Under 4 weeks 4 wks.1 year m. F. Under 4 weeks 4 wks.1 year m. F. Under 4 weeks 4 wks.1 year m. F. Under 4 weeks 4 wks.1 year Smallpox - - - - - - - - - - - - - - - - - - - - Chicken Pox - - - - - - - - - - - - - - - - - - - - Measles. . - 2 - 2 - 1 - 1 - - - - - - - - - 1 - 1 Scarlet Fever - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) 1 2 -- 3 1 - - 1 - 1 - 1 - 1 - 1 - - - - Convulsions 2 1 3 - 1 - 1 - - - - - 1 - 1 - - 1 1 - Laryngitis - 1 - 1 - 1 - 1 - — - - - - - - - - - - Bronchitis 2 3 — 5 1 2 - 3 - 1 - 1 - - - - 1 - - 1 Pneumonia 7 7 2 12 3 3 - 6 2 1 1 2 1 2 - 3 1 1 1 1 Diarrhoea 1 - - 1 - - - - - - - - - - - - 1 - - 1 Enteritis 4 1 — 5 1 _ - 1 2 - - 2 - - - - 1 1 - 2 Gastritis - 1 — 1 - 1 - 1 - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - - - - - Rickets. . - - - - - - - - - - - - - - - - - - - - Suffocation, Overlying - - - - - - - - - - - - - - - - - - - - Injury at Birth 3 — 3 — - - - - — - - - - - - - 3 - 3 - Atelectasis 1 1 2 — 1 - 1 - - 1 1 - - - - - - - - - Congenital Malformation 7 5 7 5 2 4 4 2 - — - - 2 - - 2 3 1 3 1 Premature Birth 12 8 20 — 4 6 10 - 1 — 1 - 6 2 8 - 1 - 1 - Atrophy, Debility and Marasmus 8 2 6 4 2 2 1 3 3 - 2 1 1 - 1 - 2 - 2 - Other Causes 4 5 1 8 - 2 1 1 3 1 - 4 1 - - 1 - 2 - 2 52 39 44 47 16 22 18 20 11 5 5 11 12 5 10 7 13 7 11 9 27 TABLE No. 25. Infant Mortality, 1901-1930. Rates for stated groups of diseases and for stated age periods for the quinquennial periods, 1901—1930. Period Groups. Sub-Divisions of Group "G." Death Bates. A B C D E F G H Infectious Diseases. Tuberculous Diseases. Diseases of Nervous System. Diseases of Respiratory System. Diseases of Digestive System. Syphilis Diseases of Development. All other Diseases. Total. Congenital Defects. Prematurity Debility Under 4 weeks. Over 4 weeks. 1901-1905 7.26 4.33 8.48 19.30 24.62 .94 44.14 10.76 119.83 — — — — — 1906-1910 6.75 3.41 6.81 17.50 14.39 1.58 38.50 8.58 97.52 6.81 19.95 11.74 37.50 60.02 1911-1915 5.04 2.55 4.19 17.10 13.77 1.06 31.99 10.64 86.34 3.12 18.30 10.57 32.27 54.07 1916-1920 4.08 1.09 3.53 16.30 7.74 1.29 33.67 10.92 78.62 3.19 19.96 10.52 35.44 43.18 1921-1925 3.81 1.55 2.82 10.52 6.13 .70 23.07 8.75 57.35 4.30 12.84 5.93 25.47 31.88 1926-1930 2.88 0.78 2.18 10.28 4.01 .09 19.96 7.84 48.02 3.75 12.64 3.57 22.92 25.10 The rates in each case are per 1,000 births. 28 29 SECTION III. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 1. Public Health Officers of the Authority. (a) In tabular form is shewn below the names, qualifications and appointments of all Medical Officers employed by or discharging duties for the Council, either whole or part time or in a consultative capacity, at the 31st December. 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. 1927 Wright, C. I. M.D., B.S., D.P.H. Assistant Medical Officer (General Purposes). 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. 1930 Emslie, M. M.B., Ch. B. Medical Officer, Toddlers' Clinics (part time). 1930 Brews, R. V. L.R.C.P.I. and L.M., L.R.C.S.I. and L.M. Public Vaccinator. 1930 Cowie, W. M.A., M.B., C.M. do. 1930 Clarke, C.F. M.R.C.S., L.S.A. do. 1930 Wise, H. M. M.B., M.R.C.S., L.R.C.P... do. 1930 Milton, E. F. M.D., B.S. do. 1930 Blackall, G. M.B., B.A.O., D.P.H. do. 1930 Power, Dr. F. J. L.R.C.P.I. and L.M., L.R.C.S.I. and L.M. do. The deputies for the above Public Vaccinators are respectively,:— Dr. N. E. Sampey, Dr. D. Wilson, Dr. H. M. Wise, Dr. E. C. Wise, Dr. W. T. Milton, Dr. R. W. Wood, Di. R. Lewys-Lloyd. 30 (6) In tabular form is shewn below the dates of appointment, names, and qualifications of the Public Analyst, the Sanitary Inspectors, Health Visitors, the Vaccination Officer, the Tuberculosis Staff and the Clerical Staff employed by the Council:— TABLE No. 27. Year appointed. Name. Qualifications. Appointment. 1891 Smith, Sir W. R. M.D., D.Sc., D.P.H., L.L.D., F.R.S. (Edin.). Public Analyst. (part time) 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. 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. Cert. Smoke Insp., R.S.I. 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. Cert. Smoke Insp., R.S.I. 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. 1930 Kersey, H. M. 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. 1917 Latham, Miss K. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., C.M.B., Health Visitor's Cert. Board of Education. Health Visitor. 31 TABLE No. 27—continued. Year appointed. Name. Qualifications. Appointment. 1918 Garside, Mrs. M. Cert. San. Insp. Exam. Board, C.M.B., Health Visitors' Cert. Health Visitor and Sanitary Inspector 1919 Burnett, Miss W. Cert. San. Insp. Exam. Board, C.M.B., Health Visitor's Cert., Board of Education. Health Visitor. 1919 Tibbits, Miss E. Cert. San. Insp. Exam. Board, Health Visitor's Cert., Board of Education. Health Visitor. 1919 Ware, Miss C. Cert. San. Insp. Exam. Board, C.M.B., Health Visitors' Cert., Board of Education. Health Visitor and Sanitary Inspector. 1920 Campbell, Miss M. Cert. General Hospital Training, C.M.B., Cert. San. Insp. Exam. Board; Health Visitors' Cert., Royal San. Inst. Health Visitor. 1920 Morgan, Miss F. Cert. General Hospital Training, C.M.B., Health Visitors' Cert., Maternity and Child Welfare Cert. Health Visitor. 1922 Seccombe, Miss W. Cert. General Hospital Training, C.M.B., Health Visitors' Cert. Health Visitor. 1927 Farrell, Miss E. V. Cert. General Hospital Training, C.M.B., Heliotherapy Cert., Health Visitors' Cert., Board of Education. Health Visitor and Artificial Sunlight Nurse. 1930 Frederick, Miss F. E. Cert. General Hospital Training, C.M.B., Health Visitors' Cert. Health Visitor. 1930 1921 Oughton, G. E. Castledine, Mrs. L. Cert. General Hospital Training Vaccination Officer. (part time) Tuberculosis Visitor. 1921 Prestige, Mrs. M. Cert. San. Insp. Exam. Board, C.M.B., Health Visitors' Cert., Board of Education. Tuberculosis Visitor. 1921 Mahony, Miss N. Cert. General Hospital Training, Health Visitors' Cert. Tuberculosis Visitor. 1923 Smith, Mrs. M. Dispensing Certificate Clerk-Dispenser. 1922 Morrison, Mrs. M. L. Lay Organiser. CLERKS: Britter, A. Edwards, Mrs. N. Smith, H. S. Collyer, H. M. Pike, L. Stephenson, Miss D. Crawford, Miss I. Preseott, H. T. Xaylor, S. G. The Medical Officer of Health is Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme. 32 ii. 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, Pneumonia, 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; Ophthalmia Neonatorum 6d. per visit, per case for more Zymotic Enteritis than one case in the house Whooping Cough at the same time. Poliomyelitis Acute Primary Pneumonia and Influenzal Pneumonia Puerperal Fever Is. 3d. per visit. Puerperal Pyrexia iii. Midwives. There are no whole-time midwives employed by the Council. Through the courtesy of Dr. Menzies, the County Medical Officer of Health, I have been able to ascertain that 62 midwives gave notice during the year of their intention to practise in the Borough. 33 iv. Laboratory Facilities. Arrangements have been in force for many years with the Seamen's Hospital Society for bacteriological examinations at the following charges for each examination:— s. d. Diphtheria 3 0 Enteric Fever 3 0 Tuberculosis 3 0 In addition, telegrams are paid for and 6d. is charged for each outfit provided. The bacteriological examination of milk samples is carried out by the Clinical Research Laboratory at a cost of 5s. 0d. a specimen. A minimum of 500 samples are purchased annually under the Sale of Food and Drugs Act and submitted for chemical analysis to the Public Analyst, Sir W. R. Smith, at the Royal Institute of Public Health. Details of the examinations carried out under these various heads will be found in the appropriate sections of the Report. v. 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 300 advances to purchasers of houses in accordance with the provisions of these Acts. The following is a list of By-laws and Regulations made under the various Acts, with dates of adoption:— By-laws made under:— Public Health (London) Act, 1891. Section. Date of Adoption. 16 (1) Prevention of nuisances arising from matter thrown in any street; offensive matter running into an uncovered place; keeping of animals; paving of yards and open spaces. 15th May, 1903 16 (2) Closing of cesspools and privies; removal and disposal of refuse. 28th June, 1893 Section. Date of Adoption. 16 (2) Removal of faecal and offensive matter 26th Nov., 1901 39 (1) Construction of closets, privies, ashpits, cesspools, and 28th June, 1893 dung receptacles 14th June, 1901 3rd Jan., 1905 39 (2) Keeping water closets supplied with sufficient water 24th June, 1903 45 Decent conduct of persons using public lavatories, etc. 24th June, 1903 50 Securing cleanliness and freedom from pollution of tanks, 24th June, 1903 cisterns, and other receptacles used for storing water. 88 Management of Mortuaries 24th June, 1903 95 Tents, Vans, Sheds 24th June, 1903 19 Bone boiler, Manure manufacturer or Tallow melter 25th Nov., 1907 19 Gut scraper and Catgut maker or Catgut manufacturer 25th Nov., 1907 19 Fat Melter or Fat Extractor 25th Nov., 1907 19 Fellmonger 25th Nov., 1907 19 Dresser of Fish Skins 25th Nov., 1907 19 Dresser of Fur Skins 22nd Mar., 1922 19 Glue and Size Manufacturer 25th Nov., 1907 19 Knacker 25th Nov., 1907 19 Slaughterer of Poultry 22nd Dec., 1923 19 Soap Boiler 25th Nov., 1907 19 Tripe Boiler 25th Nov., 1907 London County Council (General Powers) Act, 1902:— « 53 Common Lodging Houses 14th Aug., 1903 London County Council (General Powers) Act, 1903:— 54 Conveyance of Carcases of Dead Horses through Public Streets. 21st Feb., 1905 London County Council (General Powers) Act, 1908:— 9 Fish Curer 28th Feb., 1914 9 Vendor of Fried Fish 28th Feb., 1914 9 Rag and Bone Dealer 18th Sept., 1923 9 Rag and Bone Dealer 8th June, 1928 Metropolis Management Act. 1855:— 202 Drains, regulating dimensions of, keeping cleansing, 14th June, 1901 and repairing of. Metropolis Management Act, 1855 (Section 202) and Metropolis Management Acts (Amendment—By-laws) Act, 1899:— Plans to be deposited. Construction, reconstruction, 20th Aug., 1903 or alteration of pipes, drains, traps, and other apparatus. 34 35 Section. Date of Adoption. Slaughterhouse, etc. (Metropolis) Act, 1874, and the Local Government Act, 1888:— Slaughterer of Cattle 27th Oct., 1891 Baths and Washhouses Act. 1846:— 34 Management, Use and Regulations of Public Baths 24th June, 1903 Public Health Act, 1875:— 167 Regulating the use of the Market Place 24th June, 1903 Regulations made under:— Factories and Workshops Acts and Public Health (London) Act, 1891:— Bakehouses 31st Jan., 1902 Housing, Town Planning, etc., Act, 1909:— 17(7) Underground Rooms 9th Feb., 1911 Public Health (London) Act and Housing Act, 1925:— Houses divided into separate tenements, etc. 5th Mar., 1926 Section 55 of the Public Health (London) Act, 1891, has been applied to Zymotic Enteritis. Chickenpox was made a notifiable disease for six months from 1st April, and again for a further period of six months from 1st October. vi. Hospitals. The Medical Officer of Health is asked to specify under this heading all the hospital services, public or voluntary, within or without the area, which are used by the inhabitants of the area. In an area such as London a correct list of these is impossible because, naturally enough, the sick are not concerned with such artificial boundaries as those of administrative counties and boroughs, but are only interested in obtaining a bed in some convenient hospital. There are, for example, no fever hospitals in Woolwich, and although cases generally go to the Brook Fever Hospital in Greenwich, they may be admitted to the Park Hospital in Lewisham, to the South-Eastern Hospital in Deptford, and, occasionally, to hospitals as far afield as the Grove in Wandsworth, or the North-Eastern at Tottenham. In the same way patients requiring general hospital treatment may be admitted to any of the Metropolitan hospitals, and a study of the death returns shews that 752 deaths of Woolwich inhabitants took place in 54 Metropolitan institutions or general hospitals during the year. In these circumstances, therefore, I have thought it advisable to limit the information required by the Ministry to such hospitals as are actually situated in the area and are not under the control of any public authority, thus excluding St. Nicholas' Hospital, belonging to the London County Council, and the Military Families' Hospital. 36 (а) The Woolwich War Memorial Hospital is situated at the top of Shooters Hill. It is a general hospital which has a special ward for children and one for maternity cases. It is mainly used by Woolwich residents and under agreement with the Borough Council is bound to limit its admissions of non-residents in the Borough to not more than 40 per cent. of its total admissions. It is controlled by a voluntary Committee on which there are five representatives of the Borough Council. The total number of beds is 112, which are allocated as follows:— medical 28, surgical 38, children's 18, private beds 20, and maternity 8. There are special departments for X-ray, electric light treatment and massage. The question of appointing a Pathologist is under consideration, but at the end of the year all the pathological work was being done at outside Laboratories. (b) The British Hospital for Mothers and Babies is a maternity hospital with 42 beds, and is situated in Samuel Street, Woolwich. Over 80 per cent. of admissions are from Woolwich. It is managed by a voluntary Committee of whom two are members nominated by the Borough Council. The hospital accommodation in Woolwich is inadequate. In the War Memorial Hospital the Council reserve twelve beds for children under 5 years and sufficient accommodation as may be necessary for 66 maternity cases per annum; and, in addition, the Hospital Authorities are under contract to provide emergency treatment from time to time for such cases of midwifery as require it. In the same way, at the British Hospital for Mothers and Babies, sufficient accommodation as may be necessary for 144 confinements per amium, and for emergency and ante-natal treatment is reserved for cases sent by the Borough Council. vii. Maternal Mortality. In accordance with the Ministry of Health Circular 888, the Council conduct enquiries into every death in the Borough of women from child-birth. They have appointed a Consultant whose services are available in cases of puerperal fever or puerperal pyrexia. viii. Institutional Treatment for Unmarried Mothers, Illegitimate Infants and Homeless Children. There are no special provisions for any of these classes in the Borough. ix. Ambulance Facilities. (a) The London County Council'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. 37 (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 daytime when accompanied by a doctor or a nurse. x. 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. 28. 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 Rooms, 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. 2 St. John's Hall, North Woolwich. do. do. 1 Holy Trinity Church Hall, Beresford Street. Doctor's Room Weighing Room Waiting Room do. 1 Sunlight Clinic. Old Town Hall, Woolwich Treatment and Weighing Rooms, etc. do. 9 Day Nurseries. Nil. 38 TABLE No. 28—continued. Situation. Nature of Accommodation. By Whom Provided. Sessions weekly. School Clinics. Brewer Street, Woolwich Doctors' Rooms, Treatment Rooms, Waiting Rooms. Local Medical Association. Daily. Plumstead High Street do. do. do. Daily. Park Place, Eltham do. do. do. Daily. Cyril Henry Treatment Centre, St. Mary's 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. Notes on Table No. 29. NOTE.—(a) The total of the figures in columns 3 to 11 should agree with the figure in column 2. Any cases of children successfully vaccinated after the declaration of conscientious objection had been made should be included in column 6 above and not in column 3. The number of such cases should be inserted here :— 2. (6) The figures in columns 2 to 11 should not include re-registered births or cases of children born in other districts. *The total in this column should be the number of Certificates of successful primary vaccination of children under 14, actually received during the year, including any relating to births registered in previous years. The total thus given should include the Certificates of successful primary vaccination of which copies have been sent to the Vaccination Officers of other Districts. The total number of Certificates for the year 1930 sent to other Vaccination Officers should be stated here :— 52 †Includes the Burrage and Herbert Wards in Plumstead Parish. (Signature) S. G. TAYLOR, Date—7th February, 1931, Vaccination Officer. 39 xi. Vaccination. I submit a return by the Vaccination Officer on the work carried out under the Vaccination Acts for the year 1929. TABLE No. 29. RETURN to be made on or before the 9th of February, 1931, by Mr. S. G. Taylor, Vaccination Officer of all Sub-Districts of the Metropolitan Borough of Woolwich Registration District, respecting the Vaccination of Children whose Births were registered from 1st January to 31st December, 1929, inclusive:— Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st December, 1929. Number of these Births duly entered by 31st January, 1931, in Columns I., II., IV. and V. of the "Vaccination Register" (Birth List Sheets), viz. :— Col. I. Successfully Vaccinated. Col. II. • Col. IV. Number in respect of whom Statutory Declaration of Conscientious Objection have been received. Col. V. Died Unvaccinated. Insusceptible of Vaccination. Had Small Pox. 1. 2. 3. 4. 5. 6. 7. 1. Plumstead 553 210 3 269 25 2. Woolwich† 1,287 598 8 — 529 53 3. Eltham 550 244 1 — 235 14 Total 2,390 1,052 12 1,033 92 Number of these Births which on 31st January. 1931, remained unentered in the "Vaccination Register" on account (as shown by "Report Book)" of Number of these Births remaining on 31st Jan., 1931, neither duly entered in the "Vaccination Register "(Columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the " Report Book " (columns 8, 9 and 10 of this Return). Total Number of Certificates of Successful Primary Vaccination of Children under 14 received during the Calendar Year, 1930. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate, during the Calendar Year 1930. 1 Postponement by Medical Certificate. Removal to Districts the Vaccination Officers of which have been duly apprised. Removal to places unknown or which cannot be reached ; and cases not having been found. 8. 9. 10. 11. 12. 13. 4 20 10 12 These figures are to be obtained from columns 2 and 6 of the Summary (Form N.). 13 54 21 11 15 17 11 13 32 91 42 36 1,252* 865 40 The following Schedule shows the names, addresses and districts of the Public Vaccinators and Deputy Public Vaccinators appointed by the Council to carry out the work of vaccination in the Borough:— Public Vaccinator, Surgery and Deputy. Surgery Hours. District. Dr. R. V. Brews, 10, High Street, North Woolwich. (Dr. N. E. Sampey). Week-days: 9-10 a.m. 6-8 p.m. The whole of North Woolwich. Dr. W. Cowte, Tudor House, Charlton Road. (Dr. D. Wilson). 9-10 .a.m. 6-8 p.m. That part of the Parish of Woolwich lying north and west of a line drawn from a point in the Borough boundary at the centre of Hill Street along the centre of Hill Street, to its junction with Frances Street, thence along the centre of Frances Street, Henry Street and Chapel Street and continuing due north to the Borough boundary in the centre of the River Thames. Dr. C. F. Clause, 254, Burrage Road, Plumstead. (Dr. H. M. Wise). 9.30 a.m. 9 p.m. The remainder of the Parish of Woolwich south of the River Thames. Dr. H. M. Wise, 23, Plumstead Road, 9 a.m. 7 p.m. The Parish of Plumstead. (Dr. E. C. Wise). Dr. F. J. Power, St. Nicholas' Hospital, Plumstead High Street. (Dr. R. Lewys-Lloyd). — St. Nicholas' Hospital, the Plumstead Institution and "Furze Lodge" Receiving Home. Dr. G. Blackaxl, Belmont Lodge, Footscray Road, New Eltham. (Dr. R. W. Wood). 9-10 a.m. 2 p.m. 6-7.30 p.m. That part of the Parish of Eltham comprised by a line drawn from the point in the centre of Green Lane at the Borough boundary; thence northwards along the centres of Green Lane, Footscray Road and Southend Road to Bexley Road ; thence along the centre of Bexley Road to Gravel Pit Lane; thence along the centre of Gravel Pit Lane to the Bexleyheath line of the Southern Railway, along such railway line to the Borough boundary and thence southward along such boundary to the starting point. Dr. E. F. Milton, Passey's House, Eltham High Street. (Dr. W. T. Milton). 9-10 a.m. 6.30-7.30 p.m. (except Saturday evenings). The remainder of the Parish of Eltham. 41 On the 1st April the Council became responsible for the administration of the Vaccination Acts within the Borough. It so happened on this date also, that the three civil parishes of the Borough were formed into one parish, which is known as the Parish of the Metropolitan Borough of Woolwich. On the 31st March there were two Vaccination Officers, Mr. Oughton for the parishes of Woolwich and Plumstead, and Mr. Knottley for the parish of Eltham. Owing to the change in the parish boundaries, Mr. Knottley's appointment was automatically terminated, and Mr. Oughton became Vaccination Officer for the Metropolitan Borough of Woolwich. Mr. Oughton was a part-time Vaccination Officer, and in addition to these duties acted as a collector to the Woolwich Board of Guardians. In this capacity he became an officer of the London County Council. Whilst he was Vaccination Officer to the Guardians he had assistance from other clerks of the Guardians, but when the change over took place and he was no longer able to obtain this assistance it was decided to afford assistance from this Department. Mr. S. G. Taylor, of this office, accordingly spent one or two days a week as assistant to the Vaccination Officer. The position created was an unsatisfactory one, but matters had to continue in this state because the County Council were unable, before the end of the year, to arrive at a definite basis for dealing with part-time officers, but in January of 1931 it was at length decided that Mr. Oughton should, as a condition of his appointment as Collector in the London County Council's service, resign his appointment as Vaccination Officer. In consequence the Council resolved that Mr. S. G. Taylor, should be appointed a part-time Vaccination Officer, to take effect from the 1st February, at a salary of £285 per annum. xii. Supply of Insulin to Persons suffering from Diabetes. In May, the Council agreed to supply Insulin to diabetic patients who were necessitous and unable to obtain it under the National Health Insurance Acts. The Council's powers in this matter are to be found in Section 77 of the Public Health (London) Act, 1891, and are subject to the approval of the Minister of Health. The Minister approved the Council's proposals, but stated that Insulin should only be supplied to the medical practitioner undertaking the treatment of the patient, and the following information should be required :— (а) The name, address, age and sex of each patient; (б) A quarterly report in respect of each patient treated, giving the following information :— (1) The number of doses administered ; (2) Whether any tests were made of the urine or of the blood of the patient, and, if so, by whom and with what results ; (3) The progress of the patient during the period under report. A supply of Insulin was given under this scheme to one patient during the year. 42 SECTION IV.—HEALTH PROPAGANDA. Health Propaganda is now part of the routine work of the Department. Such work not only means the giving of instruction in matters concerning health to those who are willing to receive it, but also a general stimulation of interest in health matters. It is increasing in extent every year and no doubt, when public interest is more aroused, more and more efforts will be needed to sustain the interest created. The Council's powers in the matter are contained in Section 42 of the London County Council (General Powers) Act, 1926. The Council's activities in health propaganda work during the year may he classified as follows:— (a) Health Week.—The following is a copy of the report of the Public Health Committee to the Council:— "In accordance with the Council's resolution of the 9th July last, we made arrangements for holding a local Health Week at the Town Hall from the 3rd to the 8th November. "We did not arrange for an exhibition this year, but designed our programme on a sessional basis, one session being held each afternoon and one each evening. In addition, there were on each of four mornings a session for conducted parties of school children, when the general public were not admitted. At each session health films were shewn, and in addition, either a lecture or a demonstration of rhythmical and remedial exercises was given. In all, the attendances were over 7,500, but at four sessions admission had to be refused to scores. The Council's cinematograph machine and lantern were used during the week and proved very satisfactory. "We think the Health Week movement is successful in stimulating interest in public health in Woolwich and believe that there is an increasing recognition of a public health conscience in the Borough. "We are grateful to the many voluntary workers for their assistance in running the creche, and to members of the staff of other departments for the provision of organ and orchestral music. To all these we have extended, in accordance with the wish of the Council, our hearty thanks. "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 organisations within and without the Borough." 43 (6) Health Talks to School Children.—Since 1928, when the first series of these talks was inaugurated, they have been given monthly during the winter months. At first they were only given at the Town Hall, Woolwich, but in 1930 a start was made at Eltham. The general programme is as follows:—an Assistant Medical Officer talks on a suitable health subject for some 15 minutes and then two or three health cinematograph films are shown. The talks given during the year and the programme for 1930-31 are set out below:— Date. 1930. Subject and Lecturer. Cinematograph Films. January 20th "Why Do We Eat ?" Dr. C. Isobel Wright. "Peter and the Moon Man" "Bottled Health." "Clara Cleans Her Teeth." February 17th "Fighting the Germs" Mr. P. H. Jones "Danger Ahead" "Handling of Milk in a City Depot" and a Health Play, "Dad on the Fly Trail." March 17th "The House We Live In" Dr. C. Isobel Wright "Ten Little Dirty Boys" "A School of Health" "Delay is Dangerous" December 1st "Germs" Dr. Rachel Mackenzie "Dr. Wise on Influenza" "Ten Little Dirty Boys" "A Brush with the Enemy" December 15th "The Fires of Life" Dr. C. Isobel Wright "Running" "How We Hear" "Cleanliness is Happiness" 1931. January 19th "Five Good Friends" Dr. C. Isobel Wright "Foot ball" "How We Breathe" "Demons of Decay" February 16th "Our Relay Race" Dr. C. Isobel Wright "Sports in Slow Motion" "Our Wonderful Body" (Part I.) February 23rd "Pioneers in Health" Dr. Rachel Mackenzie "The Death Mystery" "Bottled Health" "Giro the Germ" "Demons of Decay" March 16th "The Swing of the Pendulum" Dr. C. Isobel Wright "Swimming" "Our Wonderful Body" (Part II.) "Clara Cleans Her Teeth" 44 (c) Health Lectures to Adults.—Three lectures were given at the Town Hall, 88 follows :— Date. 1930. Subject. Lecturer. January 20th "Sunlight Cure and Artificial Substitutes" Dr. Percy Hall February 17 th "The Psychology of the School Child" Dr. G. Somerville March 24th "Common Errors in Diet" Professor Plimmer Either in conjunction with each lecture or immediately afterwards, lantern slides or cinema films were shown. (d.) Informal Talks.—Possibly, however, the greatest development during the year took place in connection with informal talks to local organisations and associations. They were given on the usual meeting day at the premises of the organisation concerned, and it was possible on most occasions to make use of the Council's cinematograph apparatus. The speakers at the talks were all members of the staff; assistant medical officers, health visitors and sanitary inspectors taking part in this work. The subjects included:—"Mothercraft and Fathercraft," "Elementary Physiology," "Diet and Digestion," and "Food Supply." Usually the programme consisted of a twenty to thirty-minute talk, followed by question and answer, and just to stimulate further interest in matters of health, a cinematograph film on another subject was then shown. On two occasions, by the courtesy of the Libraries Committee, the Council's Epidiascope was used to illustrate points in the lectures. There is great value in such talks. The people are in their own meeting place and feel at home; they ask more questions than at public meetings and they ask them more readily. Moreover, a point of contact is made with the Council's officers —a matter of great importance in the development of health propaganda. It should be pointed out, however, that the difficulty of adequately illustrating such talks is the paucity of non-flam films. (e) "Better Health—In the early part of the year a local edition of "Better Health "was inaugurated. "Better Health "is the official organ of the Central Council for Health Education, and local editions are now published by over 120 local authorities. The journal consists of a current copy of "Better Health " by the Central Council to which are added two pages of local matter by the Medical Officer of Health. The publishers supply 2,000 copies per month free, and the Medical Officer of Health arranges for their distribution. The local "copy "has consisted of articles on various infectious diseases, the Council's health services, and general articles by members of the staff. The copies are distributed to the welfare centres, libraries, schools, and a limited number are posted each month to residents in the Borough selected at random. Contents bills are also issued by the publishers to assist in the distribution. It was found that there was a demand for this journal, especially at the welfare centres, and experience has shown the wisdom of participating in this scheme. The monthly articles published by the Central Council on personal and public health are excellent and are greatly appreciated by those who are privileged to read them. 45 SECTION V.—SANITARY ADMINISTRATION. Staff.—During the year there were, on the staff of the Sanitary Section of the Department, one Chief Sanitary Inspector, Ten Male Inspectors, one Woman Inspector, and two part-time Women Inspectors. Mr. William Wood, who joined the staff of the Plumstead Vestry in 1897, was superannuated on the 4th June through reasons of ill-health, and Mr. H. M. Kersey was appointed to the vacancy so caused and commenced duties on the 22nd September. Mr. Wood died on the 2nd December. Water Supply.—The water supply of the Borough is under the control of the Metropolitan Water Board, and no complaints were received with regard to the quality of the water supply during the year. Removal and Disposal of Refuse.—House refuse is collected and disposed of by direct labour in Woolwich, and is under the control of the Works Committee of the Council. Collection is made once weekly with the exception of a few special instances where a twice-weekly collection is made. All house refuse is disposed of by burning at the Council's Destructor, White Hart Lane. All tins are salved, treated in a hydraulic press and sold. The clinker is mixed with bitumen and is used for surfacing certain roads in the Borough. Most of the dustbins in the Borough are of the moveable pattern ; it was found necessary to take action for the renewal of 713 dustbins. Trade refuse is removed at a charge of 5s. per load, and 3,435 loads were so dealt with. Special air-tight receptacles are provided by the Council for the collection and removal of offensive trade refuse. A charge of 6d. per receptacle is made for this service, an empty bin (which has been cleansed with steam) being left each time a full one is collected. (I ater Closet Accommodation.—The number of cesspools in the Borough, which are only to be found in Plumstead and Eltham, increased in number from 27 to 31. In Plumstead the cesspools are practically all on Shooters Hill as there is no sewer for these houses on that part of Shooters Hill lying between the top of the hill and the Kent boundary. The question of the removal of sewage in this area has been a matter of serious consideration for some years past, but the matter became more acute during the year because proposals were mooted for the erection of other houses with frontages on Shooters Hill. If these houses were erected it would be necessary either to construct an expensive sewer from Shooters Hill to W ickham Lane, or to make arrangements with the West Kent Sewage Board for 46 the sewage of this area to drain into one of their sewers. Fortunately, however, the Council were able to get the proposed building land scheduled as part of London's Green Belt, and the sewerage problem in this area becomes much simpler as it only involves the construction of a sewer for dealing with the existing houses. The cesspools in Eltham are isolated, and are only to be found in outlying parts of the district. With these exceptions every house in the Borough is connected with the water carriage system. Drainage.—New drainage and extensive reconstruction of old systems is supervised by the Borough Engineer. In all other instances the sanitary inspectors are responsible. During the year 59 complaints were received with regard to the construction of combined drains. On investigation it was found that 308 houses in all were affected, and in every case the drains were cleared. In all the systems except 5 the obstruction was of a temporary nature. In 22 instances choked interceptors were found. Costs recovered from owners amounted to £8 13s. 6d. In the following 5 instances reconstruction was necessary, and the work was carried out by the owners after service of notices:— 4 and 5, Elizabeth Terrace, Eltham. 13 and 15, Court Yard, Eltham. 1 and 2, Red Lion Cottages and "Heath Cottage," Shooters Hill. 104 and 105, Woolwich High Street. 33 and 35, Wilmount Street. Action Taken with regard to Smoke Abatement.—140 observations were made of chimney shafts, and 7 notices were served. The number of offences discovered was 11, warning letters being sent in each case. No legal proceedings were instituted. At the beginning of the year the London County Council made the following By-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." Owing to objections by the Federation of British Industries, the National Union of Manufacturers, and one Metropolitan Borough Council, the By-law was amended to read as follows:— "The emission of black smoke for a period of three minutes, and after five years from the date of confirmation of this By-law for a period of two minutes in the aggregate within any continuous period of thirty minutes from any one chimney of 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. 47 "Provided that nothing in this By-law shall extend to the emission of smoke from a chimney of a building (not being a chimney of a building or part of a building mainly used for steam raising) used for the following processes, that is to say, the smelting of ores and minerals, the calcining, puddling and rolling of iron, and other metals, the conversion of pig iron into wrought iron, the reheating, annealing, hardening, forging, converting and carburising of iron and other metals, and the manufacture of glass, so as to obstruct or interfere with any of such processes respectively, or to the emission of smoke from a kiln which is fed with fuel otherwise than from above." The new By-law appeared to be more acceptable to these organisations, and the Woolwich Borough Council, when it came before them at the end of the year, offered no observations thereon. Sanitary Inspection of the Area.—The number of complaints received during the year was 3,018, and notices for the remedy or abatement of every defect or nuisance found were served. In Table No. 30 which follows will be found a summary of the inspections made by the Sanitary Inspectors during the year. The numbers of intimation and statutory notices served were 3,549 and 1,021 respectively. These latter notices related to 681 premises and included 828 general notices, 108 ash-pit, 33 water closet, and 35 paving notices. In addition to these, 11 notices were served under the London County Council (General Powers) Acts and By-laws, and 6 under the Rats and Mice (Destruction) Act, 1919. In 115 instances the owners neglected to comply with the statutory notices, but it was only necessary to apply for 5 summonses, details of which are set out in Table No. 36, as a letter from the Town Clerk as a preliminary to legal proceedings was sufficient in the vast majority of cases to get the necessary work done. In Table No. 31 will be found a summary of the nuisances abated and defects remedied. TABLE No. 30. Inspections. Housing Survey — Houses Drains Tested by Smoke Test 226 Inspected 2,351 Drains Tested by Water Test 34 Complaints Investigated 3,018 . New Houses 521 Outworkers' Premises 527 Tents and Vans 26 Houses Let in Lodgings 532 Factories 283 Houses re Infectious Disease 1,982 Workshops 707 Houses re Smallpox Contacts 2,005 Workplaces 154 Houses re Verminous Cases 1,182 Theatres and Cinemas 29 Houses re Scabies Cases 173 Rag and Bone Premises 8 Houses re Other Diseases 264 Urinals Accessible to the Public 297 Overcrowding Investigated— Women's Lavatories 485 Rooms 70 Smoke Observations 140 Underground rooms Illegally Occupied 7 Special Inspections re Rats 244 Miscellaneous 1,408 Drainage Inspections 1,151 Re-Inspections 9,428 48 TABLE No. 31. Nuisances Abated. Cleansing— Sinks Repaired or Provided 137 Interiors Cleansed 1,478 Wastes Cleansed 139 Rooms Cleansed 2,929 Wastes Trapped or Repaired 175 Damp Conditions— Water Closets- Walls 739 Flushing Apparatus Repaired 274 Sites 18 ,, ,, Renewed 126 Roofs 999 New Pans 163 Rain Water Pipes and Gutters 618 „ Traps 153 Others 133 Foul Pans Cleansed by Owner 51 Dilapidations-— „ Occupier 140 Walls 756 Additional W.C.s Provided 14 Ceilings 724 Doors and Fastenings Remedied 142 Floors and Hearths 243 Dust Bins Provided 713 Coppers 177 Underground Rooms Closed 2 Stoves 190 Overcrowding—Cases Remedied 44 Others 199 Wfl.tpt1 Knrmlv— Verminous Conditions— i » cii/vi ii yj iJi. y Additional 1 Rooms Cleansed 217 Re-instated 19 Defective Lighting— Cisterns Cleansed 2 Windows Repaired 172 „ Covered 6 „ Enlarged - „ Removed 5 „ Additional 23 Defective Ventilation— Foul Accumulations— Windows Rendered Usable 580 Manure Removed 4 „ Additional Provided 8 Offensive Accumulations Removed 56 Other Means 13 Defective Paving— Back Yards Cleansed 69 Yards Re-paved 148 Dung Pits Provided 8 „ Repaired 140 Rats— Scullery Floors Re-paved or Repaired 141 Drains Repaired in Consequence 31 House Drains— Premises Rat Proofed 11 Defective Drains Repaired 170 Other Effective Measures 7 Choked Drains Cleared 221 Rag and Bone Premises— Vent Pipes Repaired 46 Premises Cleansed — Soil Pipes Repaired 22 Rain-proof Premises Provided — Gullies Fixed 51 Vermin-proof Conditions Provided - New Drainage 3 Rain Water Tanks Repaired 1 Miscellaneous 248 „ „ „ Abolished 3 49 Factory and Workshop Act.—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. 32. Factories, Workshops, Workplaces and Homeworkers' Premises. 1—.Inspection. TABLE No. 32. Factories, Workshops, Workplaces and Homeworkers' Premises. 1—.Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written notices. Prosecutions. Factories (Including Factory Laundries). 286 21 — Workshops (Including Workshop Laundries). 712 29 Workplaces (Other than Outworkers' Premises) 132 12 — Homeworkers' Premises 527 4 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 42 41 Want of Ventilation 2 2 - - Overcrowding 1 1 — — Want of drainage of floors — — — — Other nuisances 41 36 — — Sanitary Accommodation insufficient 14 14 unsuitable or defective 16 16 - - not separate for sexes 3 3 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101) - - - - Other offences — — — — Total 119 113 — — 50 3.—Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances. Notices served. Prosecutions. Wearing Apparel:—making, etc. 9 4 — The Rats and Mice (Destruction) Act, 1919.—Each district inspector is the rats officer for his area and investigates all complaints received. The number of complaints (244) is a somewhat higher figure than 1929. In 31 instances defective drains were repaired, 11 premises were rat-proofed, and other effective measures taken in 7 instances. National Rat Week was held from the 3rd to the 8th November, and during it co-operation was obtained from the Borough Engineer and many large firms in the Borough. The number of baits laid in old sewers in Woolwich and Plumstead, which were regarded as infested, was 13,975. Offensive Trades.—There are no offensive trades in the Borough. Rag Flock Acts.—Five samples of rag flock were taken for analysis and the following Table gives the results. All these samples complied with the Rag Flock Regidations 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 prepared by one wholesale manufacturer, and is used in several workshops and sold at several shops in the Borough. TABLE No. 33. Samples of Rag Flock. Date. Parts per 100,000 of soluble chlorine in the form of chlorides. June 10th 12.5 10.0 7.5 15.0 11.2 51 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. TABLE No. 34. Sun Street. Sun Street (Infectious) Eltham. All Mortuaries. Number of Bodies received : 1929 1930 (a) For Inquest 8 - - 22 8 (b) For Custody 4 4 2 20 10 12 4 2 42 18 Number of Post-Mortem Examinations — — — 15 — Cemeteries.—There are two cemeteries in the Borough, designated respectively the Woolwich and the Plumstead Cemeteries. 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. The condition of Plumstead Churchyard was fully reported on in my Annual Report for 1929. At that time I reported that the graveyard should be closed. The Council accepted this report and asked the London County Council to promote legislation in Parliament accordingly. The County Council agreed, and in 1930 Parliamentary sanction was obtained. Section 64 of the London County Council (General Powers) Act, 1930, reads as follows:— The portion of Plumstead Churchyard in the Metropolitan Borough of Woolwich, delineated and coloured pink on the plan marked " B " and signed in triplicate by the Right Honourable the Earl of Lytton, the Chairman of the Committee of the House of Lords to whom the Bill for this Act was referred (of which plan copies have been deposited in the Committee and Private Bill Office of the House of Commons in the, Parliament Office House of Lords, and with the Town Clerk of the said Metropolitan Borough respectively), shall be deemed to be a disused burial ground within the meaning of the Open Spaces Act, 1906." The last interment in the Churchyard was on 11th August, 1930. 52 In Table No. 35, which follows, is shown the number of interments in the different graveyards. The information regarding the Cemeteries is given through the courtesy of the Town Clerk, and, in the case of Eltham Churchyard, through that of the Vicar of Eltham. TABLE No. 35. Number of Interments. 1928 1929 1930 Woolwich Cemetery 604 657 562 Plumstead Cemetery 643 767 736 Eltham Churchyard 227 265 183 Plumstead Churchyard 8 9 5 Exhumations.—During the year two exhumations under Home Office Licences were made in local graveyards. Removal of Infirm and, Diseased Persons in Certain Cases.-—It was not necessary to make any application to a Magistrate during the year. 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. 36 TABLE No. 36. Prosecutions under Public Health and Kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1 17th January Dampness and Broken Flooring. 66, Maxey Road Work done, Costs, £1 1s. Od. 2 14th March Dirty Walls and Ceilings 56, Basildon Road Order to abate in 28 days. Ordered to pay £1 costs. Fined £1 or 14 days imprisonment. 3 14th March Defective Yard Paving do. 4 14th May Insufficient Ashpit 102, Sidcup Road 5 14th May Insufficient Ashpit 110, Sidcup Road . . Fined £2 and £1 costs or one month imprisonment. 53 SECTION VI. INSPECTION AND SUPERVISION OF FOOD. The food premises in the Borough are kept under observation, both as to their sanitary condition and cleanliness, by one special food inspector, but all the district sanitary inspectors are responsible for keeping them under observation as to the condition and soundness of the food stored, sold or prepared for sale. Two other inspectors are responsible for the inspection of meat at slaughterhouses and for the taking of samples under the Sale of Food and Drugs Acts. The following Table, No. 37, shows the food premises on the registers and the number of inspections made in respect of each type during the year:— TABLE No. 37. Premises. On Register 31st December. Number of Legal Proceedings. Inspections. Notices. Bakehouses 47 122 16 — Cowsheds 19 109 7 — Milkshops 94 403 5 — Ice Cream Premises 122 280 7 — Slaughterhouses 6 21 — — Fried Fish Shops 63 259 17 — Butchers' Shops 93 158 6 — Premises where Food is prepared (other than above) 222 427 70 Shops and Markets — 1689 — — Milk Supply.—The Borough Council is required to keep registers of all persons carrying on in the Borough the trade of cow keeper or dairyman, and of all premises in the Borough which are used as dairies. The following summary shows the state of the registers at the end of the year :— No. Registered dairy premises 94 Registered dairymen with premises in Borough 64 „ ,, „ „ outside Borough 19 Cowkeepers 7 Cowsheds 19 Purveyors of milk in sealed bottles 98 54 All milk premises are inspected at frequent intervals in order to ensure that the provisions of the various Regulations are being carried out. One applicant for registration as a purveyor of milk was refused, the sanitary condition of his premises being such that the public health was likely to be endangered if the applicant were enabled to sell milk. The Milk and Dairies Order, 1926, requires that the bottling of milk should be carried out on registered premises. In 1929 an active campaign against filling bottles in the street was carried out, and as a result thirteen summonses were issued for breaches of the Order. There was considerable improvement in this respect in 1930, and it was only necessary to institute proceedings in one case, in which the magistrate imposed a fine of £2. Under the Milk (Special Designations) Order, 1923, the Council are authorised to grant licences to persons other than a producer to sell milk under special designations. Each licence automatically terminates on the last day of the year in which it is issued. In tabular form is shown below certain information relating to this Order:— TABLE No. 38. Number of dealers licences issued :— (a) To use the designation "Certified" milk 6 (b) „ „ "Grade A" (Tuberculin Tested) 8 (c) „ „ "Grade A" 3 (d) „ „ "Pasteurised" 13 Number of supplementary licences issued:— (a) To sell "Certified" milk 2 (6) ,, "Grade A" (Tuberculin Tested) 2 (c) „ "Grade A" 2 (d) „ " Pasteurised " 2 Number of licences issued for bottling establishments for Pasteurised milk 1 Three samples of Pasteurised milk were bacteriologically examined during the year and the results of the examinations are shown below:— Bacteria per 1 c.c. 54,990 2,923 43,750 Samples of dried milk and condensed milk were taken under the appropriate Regulations, and in each instance it was found that the Regulations were being complied with. 55 Agricultural Produce (Grading and, Marking) Act, 1928.—This Act empowers the Minister of Agriculture and Fisheries to make Orders for the grading and marking of agricultural produce. The following Regulations have been made under the Act and are still in force. TABLE No. 39. Produce. Date of Regulations. Designations. Egos 10th March, 1930 Special Weight or Special. Standard Weight or Standard. Medium Weight or Medium. Pullet Weight or Pullet. Special Duck. Standard Duck. Medium Duck. Small Duck. Broccoli 6th January, 1930 First Quality, or Prima Qualitat, or Premiere Quality. Tomatoes and Cucumbers 14th April, 1930 A.l. A.l. Strawberries 19th May, 1930 Extra Selected. Selected. Canned Fruits, Peas and Beans 4th June, 1930 Select Dessert Plums. Select Strawberries. Select Loganberries. Select Raspberries. Select Black Currants. Select Dessert Gooseberries. Select Apples. Select Peas. Select Beans. Cherries 18th June, 1930 Extra Selected. Selected. Apples and Pears 19th June, 1929 Extra Fancy. Fancy. Beef 26th September, 1929 Select. Prime. Good. Dressed Poultry 2nd June, 1930 Poussins A.l. Asparagus Chicken, A. 1. Spring Chicken A. 1. Spring Chicken, A. Chicken A. 1. Chicken, A. Surrey Chicken, A.l. Surrey Chicken, A. Capons, A. 1. Young Hens, A. 1. Young Hens, A. Cockerels A. 1. Cockerels A. Hens, A. Ducklings, A. 1. Young Ducks A. 1. Young Ducks A. Young Geese A. 1. Young Geese A. Turkeys (Young Hens) A. 1. Turkeys (Young Cocks) A. 56 TABLE No. 39—continued. Produce. Date of Regulations. Designations. Wheat Flour 12th September, 1929 All-English (Plain). All-English (Self Raising). All-English (Yeoman). 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 (Veterinary) Malt Extract Potatoes 30th November, 1929 E. and W. No. 1 Size. E. and W. No. 2 Size. E. and W. No. 3 Size. The local authority in London is the Metropolitan Borough Council concerned, and the Medical Officer of Health, Chief Sanitary Inspector and three Sanitary Inspectors have been appointed officers for the purpose of this Act in Woolwich. 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 retail. As a general rule imported produce does not require marking when sold in quantities not exceeding 14 lbs. in weight. Meat. The Public Health (Meat) Regulations, 1924.—Notice of intention to slaughter any animal must be given to the Council. 57 The following Table shows the number of animals slaughtered in the Borough during the year:— TABLE No. 40. Month. Cattle. Sheep & Lambs. Pigs. Calves. Goats. Total. January 254 944 1,052 169 1 2,420 February 213 815 927 142 — 2,097 March 233 891 909 183 — 2,216 April 220 980 591 198 — 1,989 May 238 1,043 236 169 — 1,686 June 199 1,075 14 179 — 1,467 July 211 1,126 4 193 — 1,534 August 187 869 29 171 — 1,256 September 210 929 640 123 — 1,902 October 233 840 1,013 125 — 2,211 November 228 683 988 145 — 2,044 December 234 771 1,444 105 — 2,554 2,660 10,966 7,847 1,902 1 23,376 The number of whole carcases condemned on account of disease or injury was 19 (11 pigs, 5 sheep and 3 cattle). In 843 instances partial condemnation was necessary in respect of 588 pigs, 117 sheep and 138 cattle. 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. The licence in respect of 30, Hare Street was not renewed :— TABLE No. 41. Situation of Slaughterhouse. Owner. Bostall Farm, Abbey Wood Royal Arsenal Co-operative Society, Ltd. 14, Church Street Portlock, T. W. 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. 58 Inspection of Imported Meat.—As I explained in my Annual Report for 1929, the Port of London Authority occasionally allow foreign meat to be removed from the Port of London without examination on the understanding that the meat shall be taken to a wholesale depot and dealt with by the local authority. During the year 89 carcases of sheep were examined and all were passed as fit for the food of man. Other Food Premises. Bakehouses.—There were at the end of the year 47 bakehouses in the Borough, of which 19 were factory and 12 underground. The inspections numbered 122, and 16 notices were served. The conditions on the whole were satisfactory. Fried Fish Shops.—There were 63 premises on the Register. They were inspected on 259 occasions, and 17 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 122, but in many instances the sale was intermittent. 280 inspections were made and 7 notices served. Ice Cream premises are registered by the Council under the London County Council (General Powers) Act, 1928. Other Premises.—As a matter of routine a number of food premises, including eating houses, coffee stalls, butchers shops and restaurants, are visited each week by the Food Inspector, and immediate action is taken in regard to any insanitary condition found. In addition, 1,689 visits were made to shops and stalls in the markets. Unsound Food.—There were 183 instances of unsound food being surrendered. These compare with 222 instances in 1929. Included in the food surrendered were:—1¾ £ tons of Beef, 4 cwts. of Mutton, 2 tons of Pork, 10 cwts. of Pigs Offal, Livers, etc., 5 cwt. Sheeps Offal, 18 cwt. Ox Liver, 5 cwt. Ox Lungs, 3 cwt. Fish, 8 bushels of Mussels, 5½ tons of Potatoes, ½ cwt. Apples and Pears, 36 lbs. Jam, 132 tins of Condensed Milk, 122 tins of Salmon, 60 lbs. Dried Peas, 34 tins of Cocoa, 32 lbs. of Prunes, 30 lbs. of Prawns, 10 lbs. of Bacon and smaller quantities of Raisins, Split Peas, Tomatoes, Scarlet Runners, Loganberries, etc. The 8 bushels of mussels were surrendered in consequence of information received from the Fishmongers' Company to the effect that mussels which had been obtained from a suspected laying were being exposed for sale in Woolwich. Samples were accordingly taken from three Woolwich dealers and submitted to the Fishmongers' Company for examination. As the report was unsatisfactory the whole of the consignment was surrendered and destroyed. The mussels were obtained from the River Medway. On two occasions food was seized, nine summonses in all being required to deal with them. Particulars are given in Table No. 45. 59 Sophistication of Food.—The following Table gives details of the various analyses made under the Food and Drugs (Adulteration) Act, Public Health (Condensed Milk) Regulations, Public Health (Dried Milk) Regulations, and the Public Health (Preservatives, etc., in Food) Regulations. In accordance with custom four samples were taken on Sundays. None of these were adulterated. TABLE No. 42. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Milk 131 - 131 2 Cream 2 17 19 - Condensed Milk (Full Cream) 5 4 9 - Condensed Milk (Skimmed) 4 - 4 - Condensed Milk - 3 3 - Dried Milk (Full Cream) 1 - 1 - Infants' Food 3 - 3 - Evaporated Milk - 1 1 - Butter 25 24 49 - Cheese - 11 11 - Margarine 14 2 16 4 Lard 10 5 15 - Tea 10 15 25 - Coffee 4 15 19 - Coffee Extract - 1 1 - Coffee and Chicory 1 - 1 - Sugar 10 6 16 - Jam 12 6 18 1 Honey 5 5 10 - Sausages 30 - 30 1 Sausage Meat 2 - 2 - Breakfast Sausage 5 - 5 - Preserved Sausages 1 - I - Saveloy 1 - 1 - Polony 1 - 1 - Black Pudding 2 - 2 - Brawn 4 4 8 — Corned Beef 1 — 1 — Faggots 1 2 3 - Chicken and Ham Roll 1 - 1 - Chitterlings 1 - 1 - Mincemeat 3 5 8 — Pepper 2 6 8 - Dripping 5 - 5 - Tripe 1 - 1 - Flour 5 — 5 - 60 TABLE No. 42—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Baking Powder 1 6 7 - Golden Syrup 6 - 6 Vinegar 4 - 4 - Malt Vinegar 2 - 2 - Ground Ginger - 5 5 - Ground Almonds - 5 5 - Raisins - 4 4 - Sultanas - 4 4 - Mixed Dried Fruit 7 - 7 - Candied Peel - 5 5 - Sauces - 5 5 - Olive Oil 5 5 10 - Fish Paste 5 - 5 - Crab Paste 1 - 1 - Pate de foie gras 1 - 1 - Salmon Roll 1 - 1 - Pickles 5 - 5 - Tinned Salmon - 7 7 - Tinned Tomatoes - 1 1 - Sweets - 8 8 - Beer 8 - 8 - Whisky 7 - 7 - Rum 11 - 11 - Gin 6 - 6 1 Mercury Ointment 4 - 4 - Boric Ointment - 9 9 - Rhubarb Powder - 5 5 - Syrup of Squills - 6 6 - Camphorated Oil - 10 10 - Curry Powder 1 - 1 - Peas 1 - 1 — 379 217 596 9 61 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. 43. 1928 1929 1930 4 5 per cent. and over 2 2 2 4 per cent. and under 4.5 per cent. 10 8 1 3.5 per cent. and under 4 per cent. 115 74 68 3 per cent. and under 3.5 per cent. 142 111 60 Below 3 per cent. 4 — - 273 195 131 Adulterated Samples—Action Taken.—The following Table, No. 44, shows the number of adulterated samples and the action taken in each instance where the sample was formal. TABLE No. 44. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 475 Jam Formal 60 parts per million of of Sulphur Dioxide. Vendor cautioned. 508 Margarine Formal Sold in Unprinted Wrapper Costs, 10s. Od. 509 Margarine Formal do., do. Costs, 10s. Od. 523 Margarine Formal do., do. Fined £1 282 Margarine Formal do., do. Vendor cautioned. 310 Milk Formal 2 per cent. added water No action. 324 Milk Formal 3.53 per cent. of added water. No action. 368 Sausage Formal 108 parts per million Sulphur Dioxide. No action. 412 Gin Formal 38.93 degrees under proof Costs £2. 62 Chemical and Bacteriological Examination of Food.—In addition to the bacteriological examination of milk already referred to a few other samples of food were submitted for bacteriological examination during the year. The results of the chemical examinations are found in Tables Nos. 42, 43 and 44. Nutrition.—The dissemination of knowledge and instruction of matters affecting nutrition is part of the Council's general scheme of Health Propaganda, q.v. 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. 45. No. Date of Hearing. Offence. Result. 1 23rd April Did fail to deliver Margarine sold by retail in a paper wrapper on which was printed the word " Margarine." Ordered to pay 10s. 0d. costs. 2 23rd April do., do., do. Ordered to pay 10s. 0d. costs. 3 23rd April do., do., do. Fined £1. 4 10th July Did fail to cause bottles to be filled with Milk and closed on registered premises. Fined £2. 5 16th October Did expose for sale 28-lbs. of Apples which were unsound. Fined £2. 6 16th October Did expose for sale 3½-lbs. of Figs which were unsound. Fined £2. 7 16th October Did expose for Sale 25½-lbs. of Runner Beans which were unsound. Fined £2. 8 16th October Did expose for sale 8-lbs. of Grapes which were unsound. Fined £2. 9 16th October Did expose for sale 60-lbs. of Hard Peas which were unsound. Fined £2 and £2 2s. 0d. costs. 10 16th October Did deposit for sale 32-lbs. of Prunes which were unsound. Fined £3. 11 16th October Did expose for Sale condensed Milk which was unsound. Fined £3. 12 16th October Did deposit for Sale Condensed Milk which was unsound. Fined £3. 13 16th October Did expose for sale Tinned Salmon which was unsound. Fined £5 and £5 5s. 0d. costs. 63 SECTION VII.—HOUSING. The first part of this section is recorded under headings set out in Circular No. 1119 issued by the Ministry of Health to secure uniformity in the presentation of certain housing statistics. TABLE No. 46. Number of new houses erected during the year:— Built by the Local Authority Nil „ by other Local Authorities Nil „ by other bodies and persons 521 With State Assistance under the Housing Acts:— By the Local Authority— For the purpose of Part 2 of the Act of 1925 Nil „ „ Part 3 of the Act of 1925 Nil For other purposes Nil By other bodies or persons 2 1.—Inspection of Dwelling Houses during the Year. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts)5,824 Inspections made 14,951 (2) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 2,351 Inspections made 5,299 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (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 2,408 2.—Remedy of Defects during the Year without Service of Formal Notices.* Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 2,008 * Includes intimation notices. 64 3.—Action under Statutory Powers during the Year. (а) 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 (b) By Local Authority in default of owners (3) Number of dwelling houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close (б) Proceedings under the Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 681 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners *764 (b) By Local Authority in default of owners * Includes notices served in 1929. (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 5 (2) Number of dwelling houses in respect of which closing orders were made 5 (3) Number of dwelling houses in respect of which closing orders were determined, the dwelling houses having been rendered fit (4) Number of dwelling houses in respect of which demolition orders were made 6 (5) Number of dwelling houses demolished in pursuance of demolition orders 4 4. Houses Owned by Council. (a) Number 2,211 (b) Number built during last two years:— (1) Under Part III. of Housing Act, 1925 160 (2) Under Part II. of Housing Act, 1925 (3) Under other powers 65 Housing Acts.—In tabular form is shown below a detailed statement of the specific action taken under the Housing Acts during the year :— TABLE No. 47. Action under the Housing Acts. Premises. Action Taken during Year. Date. Glyndon Road, 60 Closing Order 1930. 12th March. Jubilee Cottages, 1 Demolition Order 12th March. Jubilee Cottages, 2 Demolition Order 12th March. Ram Alley, 3 Demolition Order 12th March. Ram Alley, 4 Demolition Order 12th March. Robert Street, 2 Closing Order 18th June. Robert Street, 4 Closing Order 18th June. St. James' Place, 55 Closing Order determined 12th February. Walpole Place, 12 Closing Order determined 14th May. Woolwich High Street, 81-82 Closing Order 12th February. Do., do. Demolition Order 12th November. Woolwich High Street, 83 Closing Order 12th February. Do., do. Demolition Order 12th November. General Observations as to Housing Conditions.—The commonest type of dwelling in London is that of six to eight rooms, whereas in Woolwich the most prevalent type is four to five rooms, and over half the houses in the Borough are of this size. There are in consequence very few large tenement houses, and so the evils associated with this type of dwelling exist only in one or two small areas in the Borough. Nevertheless, inspection of the district has shown that many of the smaller houses which were built for one family often house two or more families without being specially adapted for the purpose. It is estimated that there are over 3,000 houses so used. As one would expect in an old town like Woolwich there are a certain number of old houses which have outlived their usefulness and cannot be reconditioned except at a cost out of all proportion to their worth. As opportunity offers these are dealt with under the appropriate sections of the Housing Act. One of the least satisfactory aspects of housing in Woolwich is the continued existence of hutments which were erected as temporary dwellings in the early years of the War and which still house a large proportion of the inhabitants. It cannot be seriously contended, so long as these temporary dwellings exist, that the housing of the Borough is in a satisfactory state. 66 The great housing evil however is overcrowding. At the time of the 1921 census evidence of the increase of this evil was apparent, and when the figures for the 1931 census are published it will be found that there has been little if any diminution in this respect. It should be constantly borne in mind that Woolwich is one of the peripheral London boroughs and London is constantly transferring its inhabitants from the central boroughs to those on its borders. Sufficiency of Supply of Houses.—The only accurate figures which are available as to the conditions under which people live are those provided by the Census figures for 1921, and the following Table, which appeared in my Annual Report for 1922, illustrates the situation as it then existed. It is true that there has been considerable building in the Borough since that date, and that many occupants of the new houses are those who were living under the worst housing conditions, but it should not be forgotten that wages are lower than they were in 1921, and that there is a great temptation for many to augment their income by sub-letting rooms. TABLE No. 48. Number or Private Families Occupying the Following Number of Rooms : 1 2 3 4 5 6-7 8-9 10 and over. Total. Total Private Families 2222 4751 5484 9202 5967 5013 642 366 33,647 Private families, less "families" of only 1 person 1104 4177 5232 9015 5893 4946 628 363 31,358 Census: Percentage Living in These Units of Occupation : 1911 4. 7 9.7 16.4 23.3 20.8 20.4 2.8 1.9 100.00 1921 6.6 14.1 16.3 27.4 17.7 14.9 1.9 1.1 100.00 In spite of the fact that there is less and less work done in the Arsenal there is every reason to believe that the population of Woolwich has increased. It is becoming more and more a dormitory Borough, and it is likely to become even more so in the future. In 1921 there were living in Woolwich 16,397 people whose work was outside the Borough. Much of the Borough is unbuilt on, and a large proportion of the land is available for building purposes, so that there are no special difficulties in the way of providing suitable sites for new houses. 67 Overcrowding.—There are no accurate figures available as to the state of overcrowding in Woolwich in 1930. Such figures can only be revealed at Census times, and any method which relies on figures obtained from a limited number of inspections by Sanitary Inspectors presents many fallacies. In 1921 it was shown that there was more overcrowding than in 1911. There is every reason to believe that the number of new houses in the Borough has not kept pace with the increase in population, and for this reason and those already given I do not think that there will be any improvement in the figures for overcrowding when the Census results for 1931 are known. There are no causes operating in Woolwich which do not appertain elsewhere. It is, of course, very difficult to deal with overcrowding in its present state. Cases come to the knowledge of the Department and such steps as are possible are taken to abate the nuisance. Accommodation for some has been found on the Council's Housing Estate, but as there were no new houses built last year this remedy was limited to vacancies. In some cases applications have been referred to the London County Council for accommodation on their estates, but experience has shown that many of the applicants who live under these conditions are unable to accept a house because of the extra cost of transport. Fitness of Houses.—In Woolwich it is the practice to proceed under the Public Health Acts in order to deal with nuisances or defects found to exist in houses, and only occasionally has use been made of the powers contained in Section 3 of the Housing Act, 1925, and in the corresponding sections of earlier Acts. In the ordinary way very few difficulties are experienced in enforcing the notices. It is exceptional to find a house without an adequate internal water supply, and every house is provided with a water closet or other proper sanitary accommodation. In the houses which are used by two or more families without being specially adapted for the purpose these are shared between the families. New Housing Estate.—The Housing Committee recommended the Council at its meeting in December to acquire a further site for housing purposes and submitted the following report which was adopted by the Council:— "The Council, at their meeting on the 8th October, 1930, delegated powers to us to negotiate with the Commissioners of Crown Lands for the acquisition of the site coloured red on the plan then produced to the Council. Mr. Frank Hunt, the Valuer of the London County Council, was good enough to agree to act as Valuer for the Borough Council and to negotiate for the acquisition of the site, which covers an area of about 275 acres, and he now reports that Messrs. Glutton, the Crown Surveyors, are prepared to recommend the Commissioners of Crown Lands to accept the sum of £90,000 therefor. The site does not include the strip of land on the east side of Sidcup Road, forming part of the sports grounds of Messrs. Tillings and Messrs. Peek Frean & Co., the acquisition of which must be left open for the present. There 68 is also excluded from the sale a small triangular piece of land on the eastern boundary of the site having an area of about .87 acres. There is included in the sale a 40 ft. strip of land between the sports grounds of the two Clubs above referred to leading from Sidcup Road to the site to be purchased. Mr. Hunt advises that the sum of £90,000, representing about £327 an acre, is not an unreasonable amount to pay for this site. The Council will also be required to pay the legal costs of the Commissioners and their Surveyor's charges, estimated together at £1,200. We are of opinion that the land should be acquired by the Council for housing purposes. It will be sold subject to the present leases and tenancies, and we have asked Mr. Hunt to advise us in the settlement of tenants' claims in connection therewith. We have approved a provisional lay-out of the site, which will be displayed in the Council Chamber, but which will probably require amendment in details as various sections are developed. The lay-out provides an average density over the whole estate of 8 houses to the acre (approximately 2,200 houses), ample provision being made for Open Spaces and Schools. The Borough Treasurer, at our request, has submitted a statement shewing the revenue income and expenditure from which it appears that the deficiency to be met by the Council, after crediting Government and County Council subsidies based on the present grants, will approximate on completion of the Estate to a sum of £13,910 per annum for 40 years, equivalent to a present rate of 3½din the £. This statement is, of course, provisional, as no detailed estimates are yet available for the cost of road and sewer work, or the construction of houses, and the income being based upon similar rents to those charged on the present Estate." Houses Let in Lodgings.—No register is now kept of Houses let in Lodgings; 532 inspections of such houses were made, 46 offences were discovered and 39 notices served. Tents and Vans.—By-laws regulating the use of these were made by the Council in 1903. All tents and vans (which are few in number) were inspected regularly and steps taken to ensure that the By-laws were being observed. The total number of inspections made was 26. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1923.— During the year one application was received from the occupier of a house and 78 from occupiers of hutments for certificates that the premises were not in a reasonable state of repair. In the case of the house the certificate was granted. In the case of the hutments about half the applications were made towards the end of the year and so 24 were under consideration on 31st December. In 27 instances certificates were granted, and in the remaining 27 cases the applications were refused. 69 An application from the owner of a house for a report that the house was in a reasonable state of repair was granted. No decision was reached in six similar applications from the owners of hutments at the end of the year. New Houses.—The following Table, No. 49, shows the number of certificates of a proper and sufficient supply of water for new houses granted by the Public Health Committee at each of their meetings. All were in respect of houses built by private enterprise. TABLE No. 49. Date. of Meeting. Woolwich. Plumstead: Eltham. Total. West East 15th January - 3 - 32 35 12th February - 1 3 30 34 12th March - 2 4 33 39 9th April - 5 1 52 58 14th May - 1 3 30 34 18th June - 3 8 41 52 10th July - - 1 29 30 30th July - 7 - 29 36 16th September - 2 7 74 83 15th October - 2 3 41 46 12th November 4 2 13 25 45 10th December - 2 - 27 29 4 30 43 444 521 SECTION VIII. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. The following diseases are notifiable in the Borough:— Anthrax Ophthalmia Neonatorum Cerebrospinal Meningitis Pneumonia—Acute Primary Chicken Pox Pneumonia—Acute Influenzal Cholera Poliomyelitis Continued Fever Plague Diphtheria Puerperal Fever Dysentery Puerperal Pyrexia Encephalitis Lethargica Relapsing Fever Erysipelas Scarlet Fever Enteric (or Typhoid) Fever Smallpox Glanders Tuberculosis Hydrophobia Typhus Fever Malaria Zymotic Enteritis Membranous Croup 70 NOTIFICATION. The total number of notifications, excluding duplicates, was 2,172, compared with 1,941 in 1929 and 1,587 in 1928. This increase is more apparent than real as these figures include 597 notifications of Chicken Pox, a disease which was made notifiable from the 1st April on account of the prevalence of Smallpox in London. This disease was not notifiable in 1929. In addition, 2,702 cases of Measles, including German Measles, came to the knowledge of the Department mainly through the school medical service. The following Table, No. 50, shows the total number of cases notified, the total admissions to hospital, and the total deaths from each of the notifiable infectious diseases, except tuberculosis. The succeeding four Tables show respectively, the incidence of infectious disease each year since 1901 and for 1930, the age incidence of infectious disease, the deaths from infectious disease classified according to age groups, and the incidence and case-rates in each of the old registration districts of the Borough. TABLE No. 50. Diseases. Total Cases Notified. Admissions to Hospital. Total Deaths. Diphtheria 497 494 5 Scarlet Fever 627 596 5 Enteric Fever (including Para-Typhoid) 8 7 1 Puerperal Fever 5 4 4 Puerperal Pyrexia 31 21 — Erysipelas 77 40 5 Smallpox 10 10 — Pneumonia 283 165 101 Malaria 2 1 — Ophthalmia Neonatorum 8 3 — Encephalitis Lethargica — — 3 Dysentery 1 - — Cerebrospinal Meningitis 2 2 1 Poliomyelitis 2 2 — Zymotic Enteritis 22 13 13 Chicken Pox 597 2 1 * Measles 2,702 268 15 4,874 1,628 154 *Not Notifiable. TABLE No. 51. Notification of Infectious Diseases, 1901 to 1930. Year. Smallpox. Diphtheria and Mem. Croup Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. § Puerperal Pyrexia. Pneumonia Primary. Influenzal Pneumonia. Malaria. Dysentery. Anthrax. Ophthalmia Neonatorum. Encephalitis Lethargica. Cerebrospinal Meningitis. Poliomyelitis. ‡Zymotic Enteritis. *Pulmonary Tuberculosis. *Tuberculosis Non-pulmonary †Measles. X Chicken Pox 1901 21 216 72 311 68 1 8 .. .. .. .. .. .. .. .. .. .. .. .. .. 323 .. 1902 228 233 98 267 50 1 11 .. .. .. .. .. .. .. .. .. .. .. 189 .. 646 301 1903 6 186 58 389 42 3 2 .. .. .. .. .. .. .. .. .. .. .. 165 .. 661 .. 1904 6 163 74 472 25 1 5 .. .. .. .. .. .. .. .. .. .. .. 186 .. 1240 .. 1905 7 273 83 513 27 1 12 .. .. .. .. .. .. .. .. .. .. 212 145 .. 465 .. 1906 .. 387 97 528 40 .. 8 .. .. .. .. .. .. .. .. .. .. 366 176 .. 825 .. 1907 .. 275 110 1023 27 .. 6 .. .. .. .. .. .. .. .. 1 .. 93 150 .. 1453 .. 1908 .. 362 90 596 19 .. 6 .. .. .. .. .. .. .. .. 1 .. 173 154 .. 519 .. 1909 .. 268 113 1027 13 .. 9 .. .. .. .. .. .. .. .. .. .. 149 206 .. 768 .. 1910 1 171 89 524 10 .. 7 .. .. .. .. .. .. .. .. 1 .. 102 196 .. 396 .. 1911 .. 239 82 518 16 .. 16 .. .. .. .. .. .. 8 .. 1 3 866 375 .. 801 .. 1912 3 429 87 474 20 .. 2 .. .. .. .. .. .. 20 .. 1 3 129 689 .. 775 .. 1913 .. 321 70 626 14 .. 8 .. .. .. .. .. .. 14 .. .. 1 338 532 143 387 .. 1914 .. 416 107 714 18 .. 7 .. .. .. .. .. .. 18 .. 1 .. 199 400 98 967 .. 1915 .. 286 138 601 31 .. 6 .. .. .. .. .. .. 19 .. 50 2 173 420 69 1179 .. 1916 1 271 95 232 9 .. 16 .. .. .. .. .. .. 33 .. 17 .. 80 392 77 1590 .. 1917 .. 277 79 147 12 .. 12 .. .. .. .. .. .. 41 .. 22 1 101 448 95 1710 .. 1918 .. 240 61 222 12 .. 14 .. .. .. .. .. .. 23 .. 11 3 118 563 97 800 .. 1919 4 398 63 243 26 .. 7 .. 123 .. 61 7 1 34 3 7 1 123 394 80 1886 .. 1920 1 427 82 538 6 .. 13 .. 136 .. 29 1 .. 29 3 6 .. 31 359 69 1013 .. 1921 .. 592 59 1351 11 .. 14 .. 187 49 10 4 .. 32 9 2 .. 454 285 71 481 .. 1922 .. 437 37 511 8 1 11 .. 212 133 11 .. .. 26 3 2 4 31 245 60 2698 .. 1923 .. 152 40 334 16 .. 8 .. 196 46 4 1 .. 18 1 5 6 49 245 66 194 .. 1924 .. 195 45 440 11 .. 7 .. 249 105 3 1 .. 27 17 12 5 13 273 69 2679 .. 1925 .. 299 44 364 16 .. 9 .. 237 40 5 1 .. 31 10 5 1 13 246 54 1916 .. 1926 .. 393 46 411 8 1 4 7 259 33 5 .. .. 18 7 9 5 23 287 52 1246 .. 1927 .. 278 65 478 9 .. 8 30 280 36 3 1 .. 19 6 4 3 12 269 84 457 .. 1928 3 300 89 529 17 .. 20 28 216 14 12 1 .. 14 8 3 3 5 263 62 2418 .. 1929 5 496 80 567 7 .. 15 38 293 90 5 .. 1 17 4 9 4 8 250 52 151 .. 1930 10 497 77 627 8 .. 5 31 262 21 2 1 .. 8 .. 2 2 22 244 55 2702 597 §Notification of Puerperal Pyrexia commenced October, 1926. *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. X Chicken Pox was again made notifiable April, 1930. 72 TABLE No. 52. Cases of Infectious Diseases Notified, 1930 (excluding Tuberculosis). Number of Cases Notified. Age Groups. Diseases. 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 497 3 17 25 33 40 189 83 41 51 13 2 .. Scarlet Fever 627 3 13 39 44 44 258 131 37 47 11 .. .. Enteric Fever 8 .. .. .. .. .. .. 1 3 3 .. 1 .. Puerperal Fever 5 .. .. .. .. .. .. .. .. 5 .. .. .. Puerperal Pyrexia 31 .. .. .. .. .. .. .. .. 29 2 .. .. Erysipelas 77 2 .. .. .. 2 3 3 6 10 9 33 9 Smallpox 10 .. .. 1 .. .. 1 2 2 2 .. 2 .. Pneumonia 283 11 12 15 12 7 20 14 19 39 33 73 28 Malaria 2 .. .. .. .. .. .. .. .. 1 1 .. .. Ophthalmia Neonatorum 8 8 .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. .. .. .. .. 1 .. .. .. Cerebrospinal Meningitis 2 .. .. .. 1 .. .. .. 1 .. .. .. .. Poliomyelitis 2 .. .. .. .. 1 1 .. .. .. .. .. .. Zymotic Enteritis 22 10 6 2 1 .. 1 1 .. .. .. .. 1 Chicken Pox 597 23 32 25 43 59 334 61 9 10 1 .. .. *Measles (including German Measles) 2702 40 192 187 268 355 1481 82 61 35 1 .. .. 4874 100 272 294 402 508 2288 378 179 233 71 111 38 *Not Notifiable. 73 TABLE No. 53. Deaths from Infectious Diseases (excluding Tuberculosis), 1930. 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 5 .. 1 1 .. 1 1 1 .. .. .. .. .. Scarlet Fever 5 .. 1 .. .. 1 .. 2 1 .. .. .. .. Enteric Fever 1 .. .. .. .. .. .. .. .. .. .. 1 .. Puerperal Fever 4 .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Pyrexia .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 5 .. .. .. .. 1 .. .. .. .. .. 3 1 Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 101 14 7 4 1 .. 3 1 2 3 6 41 19 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 3 .. .. .. .. .. .. .. .. 1 1 1 .. Cerebrospinal Meningitis 1 .. .. 1 .. .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. Zymotic Enteritis 13 7 3 .. .. .. 1 .. .. .. .. .. 2 Chicken Pox 1 .. 1 .. .. .. .. .. .. .. .. .. .. Measles 15 2 9 2 1 .. l .. .. .. .. .. .. 154 23 22 8 2 3 6 4 3 7 8 46 22 74 TABLE No. 54. Cases of Infectious Diseases in the Borough and Parishes during the year 1930, shewing the Case Rates per 1,000 population. Diseases. Total Cases Notified in each locality. Case Rates per 1,000 Population. Borough. Woolwich. Plumstead. Eltham. Borough. Woolwich. Plumstead. Eltham. West. East. West. East. Diphtheria 497 158 122 91 126 3.51 5.37 3.20 2.66 3.16 Scarlet Fever 627 178 189 96 164 4.43 6.05 4.96 2.81 4.12 Enteric Fever 8 .. 5 .. 3 0.06 .. 0.13 .. 0.08 Puerperal Fever 5 1 2 1 1 0.04 0.03 0.05 0.03 0.03 Puerperal Pyrexia 31 11 4 5 11 0.22 0.37 0.10 0.15 0.28 Erysipelas 77 21 29 14 13 0.54 0.71 0.76 0.41 0.33 Smallpox 10 .. 9 1 .. 0.07 .. 0.24 0.03 .. Pneumonia 283 84 63 77 59 2.00 2.85 1.65 2.25 1.48 Malaria 2 1 .. 1 .. 0.01 0.03 .. 0.03 .. Ophthalmia Neonatorum 8 4 2 2 .. 0.06 014 0.05 0.06 .. Dysentery 1 .. 1 .. .. 0.01 .. 0.03 .. .. Cerebrospinal Meningitis 2 1 1 .. .. 0.01 0.03 0.03 .. .. Poliomyelitis 2 .. .. 1 1 0.01 .. .. 0.03 0.03 Zymotic Enteritis 22 2 2 14 4 0.16 0.07 0.05 0.41 0.10 Chicken Pox 597 159 126 167 145 4.22 5.40 3.31 4.88 3.64 Measles 2702 926 554 342 880 19.08 31.45 14.54 10.00 22.09 4874 1546 1109 812 1407 34.42 52.51 29.10 23.74 35.31 75 Diphtheria. Notification.—During the year 497 cases were notified, compared with 496 in 1929 and 300 in 1928. This is the highest number notified since 1921, when 592 were notified. The number of military cases was 28. The case-rates for the various registration districts in the Borough are given in Table No. 54. The number of notifications received each quarter was as follows:— First quarter 170 Third quarter 86 Second quarter 120 Fourth quarter 121 Deaths.—There were only five deaths from Diphtheria, compared with 17 in 1929 and 14 in 1928. Three of these deaths were in children under five, and two were in school children. Home Isolation.—Three cases were isolated at home. 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 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. Four such certificates were issued during the year. Antitoxin.—A supply of Diphtheria Antitoxin is kept 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 88,000 units. The total cost to the Council was £6 12s. 0d., £1 4s. 0d. of which was recovered. Schick Test.—There are no clinics in the area where Schick testing and immunisation are carried out. Return Cases.—Nine cases gave rise to thirteen cases. Multiple Cases.—The following Table shows the house distribution by wards. The term "house" is synonymous with the term "family," except in 13 instances where two families were involved. 76 TABLE No. 55. Diphtheria, Multiple Cases. 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 10 22 32 22 29 10 26 21 12 40 12 26 63 8 333 333 2 cases occurred 2 2 3 1 3 — 3 1 1 1 2 — 8 1 28 56 3 „ „ 1 2 — — 1 — 1 2 — 1 — — 2 — 10 30 4 „ „ — 1 — — — — — 1 1 — — — 1 — 4 16 5 „ „ — 1 1 — — — — — — 1 — — — — 3 15 6 „ „ 1 — — — — — — 1 — — — — — — 2 12 7 „ „ — — — — — — — — 1 — — — — — 1 7 Total Houses 14 28 36 23 33 10 30 26 151 43 14 26 74 9 381 469 Military — — — — — — — — — — — — — — — 28 497 Scarlet Fever. Notification.—During the year 627 cases of Scarlet Fever were notified, compared with 567 in 1929 and 529 in 1928. There were 24 military cases. The case— rates for the various old registration districts of the Borough are given in detail in Table No. 54. The number of notifications received each quarter was as follows:— First quarter 180 Third quarter 143 Second quarter 159 Fourth quarter 145 Deaths.—There were five deaths from Scarlet Fever during the year, including two in children under five years of age. In 1929 the number of deaths was three. Home Isolation.—Thirty—one cases, or 4.9 per cent., were isolated at home, and in no instance did a return case occur. The same procedure as in Diphtheria was carried out. Dick Test.—This has not been employed in the area so far as I am aware. Multiple Cases.—The following Table shows the house distribution by wards. The term "house" is synonymous with the term "family" except in 15 instances where two families were involved. 77 TABLE No. 56. Scarlet Fever, Multiple Cases. 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 17 14 42 21 34 25 21 49 14 39 20 20 71 15 402 402 2 cases occurred — 4 10 6 4 6 5 8 1 5 2 3 11 - 65 130 3 „ „ — - 2 2 1 1 - - 1 - - 3 4 - 14 42 4 „ „ 1 — - 1 - 1 - 1 1 - - - 1 - 6 24 5 „ „ - - - - - - - - - - - 1 - - 1 5 Total Houses 18 18 54 30 39 33 26 58 17 44 22 27 87 15 488 603 Military - - - - - - - - - - - - - - - 24 627 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. TABLE No. 57. Scarlet Fever, Return Cases. No. in Register Date Admitted to Hospital. Date Discharged. Total Days in Hospital. Onset of Secondary Case. Remarks on Primary Case. 1929. 466 23/11/29 1/1/30 39 7/1/30 — 511 7/12/29 21/1/30 45 31/1/30 Sore Nose. 545 24/12/29 25/2/30 63 18/3/30 — 481 28/11/29 22 /2/30 86 11/3/30 — 11/3/30 1930 9 4/1/30 7/2/30 34 10/2/30 — 13/2/30 — 56 27/1/30 27/3/30 59 4/4/30 — 80 6/2/30 29/3/30 51 22/4/30 — 110 26/2 30 25/4/30 58 1/5/30 — 114 22/2/30 17/4/30 54 21/4/30 — 116 28/2/30 3/4/30 34 9/4/30 — 12/4/30 - 128 7/3/30 16/4/30 40 26/4/30 - 160 24/3/30 2/5/30 37 24/5/30 Peeling. 188 3/4/30 23/5/30 50 4/6/30 — 199 7/4/30 12/6/30 66 1/7/30 — 200 7/4/30 17/5/30 40 10/6/30 — 210 10/4/30 23/5/30 47 27/5/30 — 2/6/30 211 18/4/30 29/5/30 41 10/6/30 — 291 23/5/30 17/10/30 147 30/10/30 — 244 3/5/30 1/7/30 59 25/7/30 — 271 15/5/30 26/6/30 42 2/7/30 — 324 15/6/30 25/7/30 40 25/8/30 — 363 7/7/30 10/9/30 65 30/9/30 — 409 5/8/30 26/9/30 52 2/10/30 — 412 7/8/30 19/9/30 43 2/10/30 — 493 5/10/30 20/11/30 46 30/11/30 Nasal Discharge. 520 16/10/30 26/11/30 41 2/12/30 Sore Throat. 555 6/11/30 17/12/30 41 30/12/30 — 78 Enteric Fever. Eight cases were notified during the year, and one death occurred. It will be noticed from the following Table, No. 58, which gives details of each case notified, that the diagnosis was not confirmed in two instances. TABLE No. 58. No. Date Notified. Sex. Age. Diagnosis. Final Diagnosis. Remarks. 1 16/1/30 M. 51 Enteric Fever Enteric Fever Died. 2 31/3/30 M. 20 Paratyphoid Fever Paratyphoid B. — 3 7/5/30 F. 24 Paratyphoid B. Paratyphoid B. — 4 26/5/30 M. 13 Paratyphoid Fever Scarlet Fever — 5 26/5/30 F. 16 Paratyphoid Fever Paratyphoid B. — 6 4/6/30 F. 18 Enteric Fever Paratyphoid B. — 7 6/6/30 F. 22 Paratyphoid Fever Paratyphoid B. — 8 30/9/30 F. 19 Typhoid Fever Tuberculous Meningitis Died. Puerperal Fever and Puerperal Pyrexia. Thirty-six cases were notified, compared with 53 in 1929 and 48 in 1928. Thirty-one women were notified as suffering from Puerperal Pyrexia and five from Puerperal Fever. In six instances the disease was a sequel to abortion. Treatment.—The Council's scheme for the diagnosis and treatment of these diseases provides for a consultant, for nursing assistance, for hospital treatment and for bacteriological examination where necessary. During the year Mr. Taylor saw two cases; nursing assistance was provided in one case, while no bacteriological examinations were carried out. All the cases except 10 received hospital treatment at some stage or other. Deaths.—There were four deaths, compared with three in 1929 and eight in 1928. Erysipelas, Malaria and Dysentery. The number of notifications of Erysipelas received was 77, compared with 80 in 1929. Two cases of Malaria, including one induced for therapeutic purposes, were notified, and one notification was received in respect of Dysentery. Smallpox. During the 53 weeks ended 3rd January, 1931, there were 5,187 cases of Smallpox in the Metropolis, compared with 1,905 in 1928. Cases of this disease occurred in every Metropolitan Borough except Chelsea, the incidence being highest in 79 Bethnal Green, Stepney, Shoreditch, Poplar, Hackney and Camberwell, in that order. In 12 Boroughs there were less than 20 cases. Ten cases were notified in Woolwich, and in every instance the diagnosis was confirmed. There were no deaths. The Smallpox Shelter was in use during the year. 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. Chicken Pox. In consequence of a letter received from the Ministry of Health, drawing attention to the recent increase in the cases of Smallpox in London, the Council, with the approval of the Ministry of Health, resolved to make Chicken Pox notifiable from the 1st April, and from that date to the end of the year 597 notifications were received. Pneumonia. The incidence of Pneumonia was much lower than in 1929, 283 cases being notified, compared with 383 in that year. There was an increase in the case mortality rate as 101 deaths were certified as due to Lobar or Broncho Pneumonia, compared with 119 in 1929, but on the other hand the deaths from Acute Influenzal Pneumonia fell from 49 to 7. Anti-Pneumococcal Serum.—During the year the Council provided, free of charge, anti-pneumococcal serum for the treatment of persons suffering from Pneumonia, to those medical practitioners who considered this form of treatment suitable. In all 2,580 c.c. were used at a total cost to the Council of £41 9s. 9d. The treatment of Lobar Pneumonia by this means is receiving a considerable amount of attention, both in this country and in America, and there appears to be little doubt that in a considerable number of cases it shortens the period of illness, Limits its severity and diminishes the case mortality rate. Cursing.—Nursing assistance is provided by the Council for cases of Pneumonia, and during the year 33 cases were nursed, 547 visits being paid by the nurses of the local nursing associations. The total cost of this service to the Council was £34 3s. 9d. The following Table, No. 59, shows the distribution of Pneumonia in each ward of the Borough, classified according to the type of Pneumonia shown on the notification certificate:— 80 TABLE No. 59. Notification of Pneumonia. Ward. Lobar. Broncho. Influenzal. Acute Primary. Total. Dockyard 5 3 - 10 18 St. Mary's 8 1 1 8 18 River 16 1 2 8 27 St. George's 12 2 - 7 21 Burrage 6 — 2 7 15 Herbert 6 - - 2 8 Glyndon 2 1 — 8 11 St. Margaret's 11 2 2 14 29 Central 4 2 2 4 12 St. Nicholas 14 6 5 17 42 Abbey Wood 6 1 2 14 23 Well Hall 7 1 1 9 18 Sherard 6 3 1 12 22 Avery Hill 1 3 3 12 19 104 26 21 132 283 The following Table, No. 60, 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. 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 25 15 40 13 2 - 25 14 - February 18 10 28 5 2 4 17 14 3 March 36 15 51 22 6 2 21 15 1 April 19 16 35 12 2 4 17 12 3 May 11 5 16 9 1 1 5 5 — June 14 5 19 11 2 1 5 — - July 5 3 8 4 1 2 1 1 - August 3 4 7 3 3 - 1 7 - September 10 4 14 6 — 1 7 1 - October 9 8 17 6 3 2 6 6 - November 22 5 27 8 1 3 15 14 - December 17 4 21 5 3 1 12 12 - 189 94 283 104 26 21 132 101 7 81 Cerebrospinal Meningitis. Two cases were notified during the year, and in both instances the diagnosis was confirmed. The following Table gives the details of each case:— TABLE No. 61. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. 2/4/30 M. 3 Cerebrospinal Fever Died. 12/12/30 M. 18 Cerebrospinal Meningitis — Anterior Poliomyelitis. Two notifications were received and in both instances the diagnosis was confirmed. Nursing assistance is provided for such cases, but was not utilised during the year. Both cases were treated in hospital. Zymotic Enteritis. Twenty-two cases of this disease were notified during the year, compared with 8 cases in 1929. The number of deaths in children under two years of age certified as due to Enteritis or Diarrhoea was 10. Whooping Cough. During the year 73 cases of Whooping Cough came to the knowledge of the Department from the School Medical Service, compared with 327 in 1929. As this disease is not notifiable in the Borough, knowledge can only be obtained of cases from this source. Nursing assistance is provided for this disease but was not utilised during the year. Deaths.—There was only one death from Whooping Cough during the year, compared with 22 in 1929. Measles. This disease is not notifiable in the Borough, but from various sources the Department learned of 2,702 cases, compared with 151 in 1929 and 2,418 in 1928. Deaths.—There were 15 deaths from Measles during the year, 14 of which were in children under 5 years of age. Home Nursing.—Nursing assistance was provided in 66 cases, the number of visits paid was 521, and the cost to the Council was £26 1s. 6d. 82 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 hundred and sixty-eight cases were admitted during the year, compared with 2 in 1929 and 56 in 1928. Measles Epidemics.—In December, 1929, the Council resolved to appoint temporary health visitors during epidemic periods for measles work. Their duties are to meet the school nurse at the school, obtain from her direct the names of children suffering from Measles, or suspected to be suffering from Measles, and also those who are absent from unknown causes, and to visit the homes as soon as possible. By such temporary appointments the routine work of the health visitors goes on as usual, and there is no delay in visiting Measles cases, a very important factor in the control of the disease. During the year two such temporary health visitors did duty for a period of approximately three months each. The experience thus gained justified the Council's policy in every way. Ophthalmia Neonatorum. During the year eight cases were notified, three of which were admitted to hospital. Two were notified in March, one in June, one in July, one in August, two in September, and one in December. Every child recovered from the disease without any impairment of vision. Home Nursing.—Two cases were nursed at home, 68 visits in all being paid. The cost of this service was £3 8s. Od. Tuberculosis. The Council's Tuberculosis service has the following ramifications:— (a) The administration of the various Tuberculosis Regulations of 1912, 1921, 1924 and 1925. (b) The supply and supervision of shelters at the homes of patients. (c) Bacteriological examination of specimens of sputum. (d) The provision of a Tuberculosis Dispensary. (e) Home visiting of Tuberculosis cases. (f) Visiting and medical examinations of cases for the Ministry of Pensions. (g) Arrangements for securing the examination and systematic supervision of home contacts. (h) An agreement with the Seamen's Hospital for X-ray examinations m doubtful cases. (i) Arrangements for following up cases where the diagnosis is doubtful. (j) Co-operation between the Tuberculosis Officer and the local medical practitioners. (k) Co-operation with the School Medical Service. (J) Provision of extra nourishment for tuberculous persons. 83 (m) An agreement with the School Treatment Committee for the provision of dental treatment. (n) An agreement with the London Hospital for Finsen light treatment of lupus. (o) An agreement with the Brompton Hospital for the induction of artificial pneumo.thorax. (p) The formation of a Care Committee. (q) Institutional treatment through the London County Council. Details of the Council's Tuberculosis service are given in the following pages under letters corresponding to those set out above. Before dealing with them, however, it is convenient to deal with the mortality statistics. Deaths.—The deaths from pulmonary tuberculosis during 1930 numbered 150, giving a death rate of 106 per 1,000 of the population. The corresponding figures for 1929 were 143 and 101 respectively. Deaths from other forms of tuberculosis numbered 15, as against 16 in the preceding year, the death rate being 0T1 per 1,000 of the population. The total number of deaths from tuberculosis during the year was 165, and the combined mortality rate 117. The deaths and death.rates from tuberculosis, classified by type of disease, annually, since 1912, have been as follows:— TABLE No. 62. Tuberculosis—Deaths and Death.rates. 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 1930 165 150 15 1.17 1.06 0.11 In addition to the 165 deaths mentioned above, five persons who had been notified as suffering from pulmonary tuberculosis died during the year, and detailed information as to these is given in the following Table, No. 63: 84 TABLE No. 63. Case No. Date Notified as Tuberculosis. Cause of Death. 1 8/4/22 Volvulus of Colon. Operation Resection and end to end anastomosis and appendicectomy. 2 17/4/29 Suicide, Lysol Poisoning. 3 11/6/17 Cardiac Failure. Rheumatic Myocarditis. Rheumatoid Arthritis. 4 16/1/30 Gangrene of Lung. Pneumonia (Lobar). 5 11/2/26 Emphysema. Bronchitis. Cardiac Failure. The period which elapsed between notification and death is shown in the following Table, No. 64:— TABLE No. 64. Pulmonary. Percentage. Non. Pulmonary. Percentage. Not notified 12 8.00 2 13.33 0-1 month 23 15.33 6 40.00 1-3 months 20 13.33 1 6.67 3-6 months 10 6.67 1 6.67 6-12 months 15 10.00 1 6.67 1-2 years 20 13.33 — — 2-5 years 28 18.67 3 20.00 Over 5 years 22 14.67 1 6.66 150 100.00 15 100.00 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths was as one is to 12. In 1929 it was as one is to 12, and in 1928, as one is to 11. (a) Administration of the Tuberculosis Regulations.—In July, 1930, the Minister of Health issued the Public Health (Tuberculosis) Regulations, 1930, which came into operation on the 1st January, 1931. They involve the repeal of:— The Public Health (Tuberculosis) Regulations, 1912. The Public Health (Tuberculosis) Regulations, 1921. The Public Health (Tuberculosis) Regulations, 1924. 85 Substantially these regulations are the same as those now in force, but there are certain changes:— (1) Certain of the definitions have been altered to correspond with changes introduced by the Local Government Act, 1929. (2) Notifications by School Medical Officers are not required to be made on special forms. (3) It is made clear that cases must be notified in each successive sanitary district if the patient changes his residence. (4) Primary notifications are to be made on the usual infectious diseases notification forms. (5) Minor alterations have been made in the forms to be used in respect of cases admitted to and discharged from institutions. (6) Amendments have been made in the method by which notifications are transmitted to the Medical Officer of Health. (7) Provisions are inserted to secure that the Register of Notifications kept by the Medical Officer of Health is maintained up-to-date. (8) Modifications have been made in the information to be given to the County Medical Officer. (9) The relevant provisions of the Sanitary Officers Order, 1926, have been applied to the action taken by a Medical Officer of Health under these regulations. (10) Notification is not required in cases where notification is required by Section 5 (6) of the Local Government (Emergency Provisions) Act, 1916. These regulations were brought to the notice of all medical practitioners practising in the Borough. Earlier in the year the Minister issued the County of London (Tuberculosis) Regulations, 1930, to enable the London County Council to maintain or arrange for the maintenance otherwise than in their homes, of children living in London in houses where, owing to over-crowding or otherwise, they are, in the opinion of the County Medical Officer, in danger of being infected with tuberculosis, or whose parent or parents are receiving residential treatment for tuberculosis, and for whose care adequate arrangements cannot otherwise be made. Notifications.—It happens that duplicate notifications of cases of tuberculosis are received, so that the figure for the year (392) is misleading, and for this reason the following Table, No. 65, has been prepared to show the actual number of new cases notified during the year. It shows also the numbers occurring in each of the registration districts of the Borough and the corresponding case rates. 86 TABLE No. 65. Woolwich. West Plumstead. East Plumstead. Eltham. The Borough. Pulmonary Tuberculosis- Cases 78 52 60 54 244 Rates 2.65 1.36 1.75 1.36 1.72 Non-Pulmonary Tuberculosis— Cases 22 10 8 15 55 Rates 0.77 0.36 0.23 0.38 0.39 In Table No. 66 appears a summary of the cases coming to the knowledge of the Department during the year. It includes notifications received from general practitioners on form "A," from school medical officers on form "B," 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. TABLE No. 66. Tuberculosis—New Cases and Mortality. Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 0-1 - - 1 - - - - - 1-5 1 2 3 3 - 1 1 3 5-10 4 2 6 7 - - - 1 10-15 5 4 3 8 1 - - 1 15-20 15 24 1 3 3 12 - 4 20-25 22 25 3 5 5 11 1 1 25-35 42 19 1 3 23 15 2 1 35-45 21 16 3 2 15 12 - - 45-55 35 9 1 1 21 7 - - 55-65 22 2 1 1 12 3 - - 65 and upwards 7 - 1 1 6 3 - - Totals 174 103 24 34 86 64 4 11 87 The following Table, No. 67, shows the site of the disease in patients notified each year since 1926. TABLE No. 67. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 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 1930 244 6 5 18 15 3 8 299 The Regulations of 1921 require the Medical Officer of Health to revise quarterly the register of notifications, and, as soon as he is aware that a notified case has removed permanently to another area, to notify the Medical Officer of Health of that area of the case. In accordance with these Regulations 61 notifications were sent to other medical officers, and 32 were received. The Regulations of 1924 require the Medical Officer of Health to furnish, quarterly, a return to the County Medical Officer of the number of cases of tuberculosis in the district. The usual steps were taken during the year to ensure 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; who have left the district; who have been lost sight of ; who have been cured, and those in whom the diagnosis has not been confirmed. The following Table, No. 68, shows the number on the Register at the beginning of the year, the changes which have taken place during the year, and the number remaining on the register at the end of the year. It will be seen that the total number on the register on the 31st December was 1,217, and of this number 1,079, or 88.6 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 1929 the corresponding percentage was 83.7. 88 TABLE No. 68. Pulmonary. NonPulmonary. Totals. M. F. M. F. Number on Register at 1st January, 1930 510 422 144 134 1,210 Number of additions 184 110 22 34 350 Number of Deletions 169 117 25 32 343 Number on Register at 31st December, 1930 525 415 141 136 1,217 The Regulations of 1925 provide for the compulsory discontinuance of a person suffering from infectious respiratory tuberculosis from employment involving the handling or treatment of milk, and are enforceable by local authorities. No action was taken under them during the year. (b) Shelters.—The Council maintain twelve shelters for the use of patients returning from sanatoria who are able and willing to continue this form of treatment. They are of special design to allow of their easy transport and introduction into gardens. Full use is not made of them, possibly because patients dislike being overlooked by neighbours. In many cases they are loaned free of charge, but in some instances a small rent, usually sixpence per week, is paid. (c) Bacteriological Examinations.—Any general practitioner in the Borough may send specimens of sputum from suspected cases of tuberculosis to the Seamen's Hospital, Greenwich, at the cost of the Council. During the year 2,178 specimens were examined there, 291 being positive and 1,887 negative. In addition to these arrangements, however, examinations of specimens of sputum are carried out at the laboratory attached to the Dispensary, and during the year 732 specimens were examined, 110 of which were positive and 622 negative. (d) Tuberculosis Dispensary.—The Tuberculosis Dispensary is in Maxey Road, Plumstead. Consultations are held there, special times being allotted to men, women and children. These hours are set out in tabular form below. The total number of attendances at the Dispensary during 1930 was 4,657. In this connection it is interesting to point out that 225 of the persons notified during 1930 attended the Dispensary, which is equivalent to 78.6 per cent. The corresponding percentage in 1929 was 82.78. A return of the work of the Dispensary is given in Table No. 69, 89 TABLE No. 69. Return showing the work of the Dispensary during the year 1930. 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 113 60 7 6 6 9 13 9 119 69 20 15 (b) Doubtfully tuberculous .. .. .. .. .. .. .. .. 51 41 15 16 (c) Non-tuberculous .. .. .. .. .. .. .. 149 174 160 137 B. CONTACTS examined during the year:— (a) Definitely tuberculous 1 1 .. .. .. .. .. .. 1 1 .. .. (b) Doubtfully tuberculous .. .. .. .. .. .. .. .. 4 2 1 1 (c) Non-tuberculous .. .. .. .. .. .. .. .. 57 103 71 81 C. CASES written off Dispensary register as (a) Cured 14 13 1 .. 2 3 2 1 16 16 3 1 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) .. .. .. .. .. .. .. .. 255 312 243 232 D. NUMBER OF PERSONS on Dispensary register on December 31st:— (a) Diagnosis completed 405 350 48 45 41 68 40 58 446 418 88 103 (6) Diagnosis not completed .. .. .. .. .. .. .. .. 9 10 2 3 90 (1) Number of persons on Dispensary Register on January 1st 1,013 (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"59 (4) Died during the year 96 (5) Number of observation cases under "A" (b) and "B" (b) above in which period of observation exceeded 2 months 9 (6) Number of attendances at the Dispensary (including contacts) 4,657 (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— (a) "Light" treatment 230 (b) Other special forms of treatment 173 (9) Number of patients to whom Dental treatment was given, at or in connection with the Dispensary 23 (10) Number of consultations with medical practitioners— (a) At homes of applicants 67 (b) Otherwise 829 (11) Number of other visits by Tuberculosis Officers to Homes 479 (12) Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 5,321 (13) Number of— (a) Specimens of sputum, etc., examined 732 (b) X-ray examinations made, in connection with Dispensary work 408 (14) Number of insured persons on Dispensary Register on the 31st December 524 (15) Number of insured persons under Domiciliary Treatment on the 31st December 284 (16) Number of reports received during the year in respect of insured persons—- (a) Form G.P. 17 27 (b) Form G.P. 36 162 Staff.—The Dispensary staff consists of one whole-time Tuberculosis Officer, one half-time Assistant Tuberculosis Officer, three Tuberculosis Health Visitors, one Clerk-Dispenser and one Lay-Organiser who also acts as Secretary of the Care Committee. Post-Graduate Course.—During the year the Tuberculosis Officer was offered, and, with the approval of the Council, accepted, a scholarship from the Sun Life Insurance Company of Canada, as a contribution to enable him with forty-nine others to visit and study the tuberculosis schemes of Canada. He was absent from this country for five weeks, and on his return gave his impressions of the tuberculosis schemes there at a special lecture to members of the Council and of the Woolwich Tuberculosis Care Committee. 91 In addition, one of the Tuberculosis Visitors attended a refresher course during the winter. (e) Home Visiting of Tuberculosis Cases.—On receipt of every notification the home is visited by the Tuberculosis Visitor, who advises as to any re-arrangement that seems possible and desirable in the interests of the patient and other members of the family. In the case of patients notified by the Tuberculosis Officer a visit is also made by one of the medical staff, who thus gains a knowledge of the home circumstances of the patient. The Tuberculosis Visitor endeavours to visit each home in her district once in three months, but, in the case of patients with recent and more active disease, visits are more frequent. (f) Wark for the Ministry of Pensions.—The arrangements whereby the Council's Tuberculosis Staff are available for advising the Ministry of Pensions as to the residential treatment of ex-service pensioners, the granting of treatment allowances in eligible cases, reports as to progress, etc., continue to work satisfactory. As would be anticipated, however, this work shows a definite decrease. In 1925, 70 such ex-service men were under the supervision of the Tuberculosis Officer, and in 1930 this number had declined to 45 with a consequent decrease in the number of reports furnished to the Ministry of Pensions, and a decrease in the number of visits paid by the Tuberculosis Visitors. The reports numbered 19 in 1930 as compared with 119 in 1925, and the visits were 129 as compared with 479 in 1925. The sum of £2 7s. 6d. was received in respect of these services. (g) Contacts.—On receipt of each primary notification every effort is made to induce people living in the same house as the patient to present themselves for examination. In many cases, however, it is very difficult to persuade them of the necessity for this examination. During the year under review 322 contacts were examined. (h) X-Ray Examinations.—Experience shows that X-ray examination is indispensable in a thorough examination of a patient suspected of tuberculosis. In the later stages of the disease this examination is also necessary for the efficient control of treatment by artificial pneumothorax, and is essential if surgical measures are under consideration. Greatly increased use is therefore being made of X-rays in dispensary work, and the increase is likely to continue. In this connection it has to be remembered that several institutions to which patients are sent do not possess an X-ray plant, and it is desirable to have an examination made on their return from such institutions. Whereas in 1925 the number of X-ray examinations was 67, in 1930 the figure had grown to 408. Payment for this service is made on the following basis :— s. d. For screen and report 7 6 For X-ray film and report 15 0 92 The latest analysis of the work of the London Dispensaries issued by the Ministry of Health shows that the average number of X-ray examinations per 100 "new cases" and "contacts" examined is 17, and that the Woolwich figure is 20. The original arrangement made with the Seamen's Hospital Society in 1921 has concluded, and the X-ray work is now done at the Woolwich War Memorial Hospital, which is much more convenient for patients. (i) Observation Cases.—Observation cases are those in which no definite diagnosis of tuberculosis has been arrived at during the first month. A number of these fail to continue in attendance, but a check is kept upon these cases by going through their case papers at the end of each month, and, if they are not attending, the Tuberculosis Visitor endeavours to get them to visit again. (j) Co-operation with Local Practitioners.—During the year 67 new cases were seen by the Tuberculosis Officer at the homes of the patients, and 403 were referred to the Dispensary by medical practitioners in the Borough. (k) Co-operation with the School Medical Service.—There is intimate relationship with the School Medical Service and the Dispensary. Many cases are referred to the Dispensary by the School Medical Officers, and the child contacts of tuberculous patients are referred to the School Medical Service for special observation and supervision. The Divisional School Medical Officer and the Tuberculosis Officer, in personal consultation, discuss these contacts and decide on the supervision desirable. Other children, whose condition is unsatisfactory, are referred to the School Clinic for the treatment of minor ailments and dental caries, or to the School Care Organiser with a recommendation as to the provision of milk and cod liver oil to be given at school. (l) 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. (m) Dental Treatment.—Dental treatment is carried out under the Council's scheme at the School Clinic, Brewer Street, During the year 23 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 16 cases at a cost of £62 19s. 0d., and payments by patients amounted to £27 6s. 3d. In assessing patients, due regard is given to dental benefits they may be entitled to from approved societies, 93 (n) Finsen Light Treatment.—In 1921 the Council entered into an agreement with the London Hospital for the treatment of persons suffering from Lupus in the Finsen Light Department of the hospital. A fee of 5s. is paid for each attendance. Twenty-six attendances were made during the year. (o) Artificial Pneumothorax.—This treatment consists of collapsing the diseased lung and so putting it at rest. This is done by introducing gas or air through a needle into the pleural cavity on the affected side. The air so introduced becomes absorbed, and has to be replaced at varying intervals. These refills have to be maintained over a period varying from two to five years. In 1921 the Council agreed to pay the Brompton Hospital for this work. Patients are recommended by the Tuberculosis Officer and a fee of 10s. 6d. per refill is made to the Hospital. Since 1921 twenty-five cases have been treated by this method with very satisfactory results. Of this number fifteen are alive and fit for work, six have died, three have been lost sight of, and one is alive but unfit for work. It is, however, unsatisfactory to find that so few patients have received the benefit to be expected from this form of treatment. It is true that only a proportion of patients, viz., in the main those with one-sided disease, are suitable for this treatment ; but, notwithstanding this fact, it would seem that an insufficient number of patients are being treated in this way when one considers the total number of admissions to institutions. The essential and most important factor in the treatment of tuberculosis is rest for the lung, and this must be given in a sanatorium or by means of the induction of an artificial pneumothorax, and it would seem desirable, especially in cases where the patient is a breadwinner, to use this treatment earlier and so get the patient back to work. If this is done additional facilities for re-fills will be necessary. (p) Tuberculosis Care Committee.—When it is realised that tuberculosis is a disease not of months but of years, it will be seen that the occurrence of a case of tuberculosis in any family, especially in that of an industrial worker, throws an almost intolerable strain upon the household. In the early stages of most tuberculosis schemes of Local Authorities attention was concentrated mainly on the treatment aspect, less so on the preventive aspect, and very little or not at all on the necessity for making provision for meeting these economic problems which arise of necessity in practically every family where tuberculosis has developed. This difficulty has now been recognised, but as yet Local Authorities have no power to deal with it. It has become necessary therefore to call on voluntary effort, and as a result in most places Voluntary Committees have been formed under the aegis of the Local Authority. How wide the scope of this side of the work is will be realised if we consider what happens when a member of a family is found to have tuberculosis and has been recommended for institutional treatment, and ask ourselves:— 94 (1) How are the family to carry on during the absence of the patient, especially if he be the breadwinner? This question alone frequently presents enormous difficulties. What is his National Health Insurance benefit if any? Can the wife go out to work if a job can be found? Can the children be cared for or boarded out if the wife works? Is the patient an ex-service man or the dependent of an ex-service man? (2) Has the patient sufficient suitable clothing for institutional treatment? (3) Can his wife afford fares to visit him whilst he is undergoing treatment? (4) On his return can he have a separate bed or bedroom? Ts he fit to return to his former work? If not, can suitable light work be found? Can he meet the cost of attending London hospitals for treatment such as artificial pneumothorax refills, Finsen Light or Ultra-Violet Ray treatment? (5) When the patient is at home and the children are exposed to infection can arrangements be made for them to go and stay with relatives or be boarded out? (6) Is there sufficient food and nourishment for the returned patient? (7) Can a rest or change of air be arranged for the over-worked wife? It cannot be denied that this is a most important side of the work, and these duties devolve upon the Tuberculosis Care Committee which is constituted as follows in Woolwich:— Bodies. Woolwich Borough Council Trade Unions Employers Friendly Societies London County Council London County Council (Public Assistance Committee) London Insurance Committee Panel Committee for the County of London British Red Cross Society War Pensions Committee Woolwich Invalid Children's Aid Association Late Tuberculosis Dispensary Committee United Services Fund Representatives. Councillors H. N. Dickinson, J. Lee, Major G. H. Rayner, Mrs. E. L. Reeves, H. Vaughan, Miss S. Turnbull. Mr. W. H. Fairchild, Mr. E. Ware. Miss L. Ames, Miss Fletcher, Mr. D. Mather. Mr. W. A. Lyon, Mr. A. J. Rourke, Mr. F. Smyth. Dr. H. R. Kidner, Miss E. Faulkner. Miss C. K. Lambeth, Mrs. E. M. Newman, Mrs. J. Wood. Mr. W. Edwards. Dr. H. M. Wise. Mr. J. O'Connell. Alderman A. R. Loader. Mrs. J. B. Great Rex. Mr. W. Dashwood, Mr. E. G. Dixon, JP (Vacant). Ex-Officio: Voluntary Visitors Miss L. Bloxam, Miss L. MacDermott. Tuberculosis Officer Dr. F. J. C. Blackmore. Medical Officer of Health Dr. J. MacMillan. 95 The amount of help that can be rendered by a Care Committee depends on its ability to get in touch with organisations which can assist the family, and failing such organisations, upon the funds at its disposal. These funds have to be raised by voluntary effort. This is no easy matter, and one of the prime necessities of the Woolwich Care Committee is a number of voluntary workers with some leisure who can devote themselves to this object. The following are examples of the Committee's work during 1930:— (1) A patient—the father of a family of young children, whose wife had recently died of tuberculosis—developed the disease and was recommended for sanatorium treatment. His firm were written to and they promised to keep his job open for him. Meanwhile, the eldest daughter was found to be an advanced case of pulmonary tuberculosis, and arrangements were made for her to be admitted to the same hospital as the father where they could be together until she died. Arrangements were made for the boarding-out of the three younger children, who have since been admitted to the Royal Victoria Patriotic School, where they will remain until they are 16 years of age. On the father's return from hospital he was found to be fit for light work only, but his firm could not give him any, and he had to revert to unemployment pay. Later he had an opportunity of obtaining a post as an insurance agent if a deposit of £10 could be met. By means of a Care Fund the Care Committee were able to advance this to him, and half of it has since been refunded as a gift from the British Legion. It should be pointed out that this money is a deposit and reclaimable from the Insurance Society should the man be unable to carry on. He has since been working regularly and is happy in the work. (2) A month's rest at Hastings was arranged, and paid for by the Committee, for a mother who had been nursing an advanced case, and where there were four cases of tuberculosis in the family. (q) Institutional Treatment through the London County Council.—The following Table, No. 70, shows the number of admissions to hospitals, sanatoria and training colonies. TABLE No. 70. Hospitals. Sanatoria. Poor Law Institns. Training Colonies. Insured 130 56 123 - Uninsured 49 22 50 1 Children 59 7 11 - 238 85 184 1 96 These figures refer to 391 patients, and the monthly admissions were as follows:— January 50 July 45 February 31 August 50 March 59 September 35 April 40 October 46 May 34 November 39 June 48 December 31 ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. Disinfection.—On the receipt of a notification the district sanitary inspector visits the home of the patient and enquires into the circumstances of the case to discover, if possible, the source of infection, and to arrange for disinfection. Practically all cases of Diphtheria and Scarlet Fever are removed to hospital, although in epidemic periods the hospital accommodation of the London County Council is sometimes taxed to such an extent that cases which should go to hospital have to be left at home. If the case is removed to hospital, infected articles, bedding, etc., are removed to the Council's disinfecting station, Whitehart Road, and disinfected there. The infected rooms are disinfected, sometimes by formalin solution, sometimes by formalin vapour, and sometimes by washing with disinfectant solution. If the case may be isolated at home the inspector reports the conditions to the Medical Officer of Health, who decides whether or not home isolation can be permitted, making a personal visit if necessary. A printed card of instructions is given in these cases and the process of disinfection is delayed until the medical attendant certifies that the case is free from infection. Periodical visits are made by the district sanitary inspector to ensure that isolation is being carried out. Contacts are excluded from school in accordance with the regulations of the London County Council. In the case of Diphtheria, contacts attend at the Town Hall for swabbing, when, in the opinion of the Medical Officer of Health, it is necessary. The disinfecting station is sometimes used for special disinfections at the request of the inhabitants. A small charge is made for these disinfections, and during the year 57 such disinfections were carried out, and fees amounting to £15 6s. 6d. were paid. In tabular form is shown below the amount of disinfection which was carried out during the year:— TABLE No. 71. Rooms disinfected after ordinary fevers 835 „ „ „ tuberculosis 282 „ „ „ verminous cases 41 Rooms disinfected for other reasons 26 Articles disinfected 30,629 97 During the year it became apparent that repairs and additions to the apparatus at the Council's disinfecting station were necessary, in the first place owing to the age of the apparatus, and secondly on account of the additional amount of disinfection carried out consequent upon the growth of the Borough. In epidemic periods the old plant was inadequate, overtime had to be worked, and members of families where infectious disease had occurred were inconvenienced by the late return of their goods. The apparatus in use consisted of two Washington Lyon steam disinfectors, installed 27 years ago, which were used when hot for steam disinfection and when cold for formalin disinfection of articles likely to be damaged by heat. In considering what changes should be made the Council took the view that the station should be capable of dealing more speedily and effectively with the different methods of disinfection than would be possible by the provision of another high-pressure Manlove & Alliott disinfector similar to the two already installed. The disadvantage of the disinfection of certain articles by steam is that if food or medicine has been spilled on linen or clothing the stain becomes fixed by contact with steam even though it was not visible at first, and it was obviously an out-of-date method to hold certain articles in the station over night whilst waiting for the disinfectors to cool, so that they might be used as formalin chambers. After due consideration it was resolved to provide a steam pressure plant with accessories, and to provide a special chamber for formalin for disinfecting articles which are likely to be damaged by heat. In consequence of these considerations the following work was done:— (1) The two original Washington Lyon disinfectors were overhauled and modernised. (2) The following new apparatus was installed:— (а) A rotary washing machine. (b) A soap boiler. (c) A hydro-extractor. (d) A continuous drying room. (e) A mangle. (f) Accessories such as trestles, racks, etc. (3) A brick-built formalin chamber with openings into both sides of the station was provided. The total cost of these alterations was £1,457. It was necessary to close the station for two months while these alterations were being made, and the disinfection was carried out by the Greenwich Borough Council for that period, at a charge of £7 10s. 0d. per ton, the total amount paid to the Greenwich Borough Council being £100 12s. 6d. 98 The complete reconstruction of the service has increased its efficiency and the new apparatus has given excellent service and is very satisfactory, particularly in effecting quick disinfection and return of the goods. 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 Road. 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. The following Table shows the number of persons cleansed each year since 1926 TABLE No. 72. Children. Adults. Grand Total. Year. Boys. Girls. Total. Males. Females. Total. 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 1930 477 1386 1863 11 10 21 1884 99 SECTION IX.—MATERNITY AND CHILD WELFARE. The Council's Maternity and Child Welfare Scheme embraces the following services :— (а) Administration of the Notification of Births Acts, 1907-15. (b) Home visits to mothers and children. (c) Establishment of Welfare Centres. (d) Establishment of an Artificial Sunlight Clinic. (e) The systematic medical inspection of toddlers. (f) Provision of Heme Helps in maternity cases. (g) An arrangement with the School Medical Treatment Committee for the treatment of minor ailments in young children. (h) An arrangement with the School Medical Treatment Committee for the provision of dental treatment to young children and to expectant and nursing mothers. (i) An arrangement with the Woolwich Invalid Children's Aid Association for orthopaedic treatment for children requiring such treatment. (j) Provision of nursing assistance for young children suffering from Measles, Ophthalmia Neonatorum, Zymotic Enteritis, Whooping Cough, Poliomyelitis, Pneumonia and Influenzal Pneumonia, and for mothers suffering from Puerperal Fever and Puerperal Pyrexia. (k) Reservation of twelve beds for children under 5 years of age who are suffering from such conditions as are usually treated in a general hospital, at the War Memorial Hospital. (l) Provision of beds for the institutional treatment of midwifery for 144 cases per annum at the British Hospital for Mothers and Babies, and for 66 cases at the War Memorial Hospital. (m) Reservation of beds, for ante-natal treatment and emergencies of midwifery, at the War Memorial Hospital, equivalent to 18 weeks' treatment per annum. (n) An arrangement with the Woolwich Invalid Children's Aid Association for the convalescent treatment of children requiring such treatment. (o) Arrangements for the supply and distribution to young children and nursing mothers, of milk and food-drugs at cost price, half cost or free, according to economic circumstances. (p) Collective instruction to expectant and nursing mothers. (q) The appointment of a specialist medical practitioner for consultation with general medical practitioners under the Council's scheme for the control of Puerperal Fever. 100 In addition to these services the Council have, at the request of the London County Council, undertaken to do such work as is necessary in the case of children under five years of age (r) Under the Blind Persons Act, 1920; and (s) Under Section 6 of the Widows', Orphans' and Old Age Contributory Pensions Act, 1925. For these purposes the Council maintain a staff of one whole-time and two part-time medical officers, seven whole-time and two part-time health visitors, one artificial sunlight nurse, and, in addition, two members of the honorary medical staff of the Woolwich War Memorial Hospital have been appointed Consultants— one in charge of the Sunlight Clinic and the other under the Puerperal Fever Regulations. The dental staff (dentist and anaesthetist) are part-time, and are appointed by the School Treatment Committee but subject to the approval of the Council. The growth of these services over a quarter of a century is a very interesting story. The following account, which was written in connection with the opening of the Eltham Health Centre, presents it in a simple and concise manner:— "Oaks out of little acorns grow" is a truism than can be applied very aptly to this service, and the opening of this Health Centre—the latest branch of this sturdy tree—provides an opportunity for referring to the growth of the Council's activities in this very important service. The acorn may be said to have been planted in 1906, as in that year the Council's first steps in the individual care of the mother and child were taken by appointing the first health visitor (part-time) and establishing a milk depot for supplying sterilised and humanised milk to infants. Most of the babies supplied with milk were brought fortnightly to be weighed, and, on one afternoon a week, advice was given to mothers regarding their babies. This depot, therefore, was the forerunner of the present extensive welfare centre service. Growth was slow at first, but an impetus was given to it by the Notification of Births Act, which was adopted in 1907. This Act required a birth to be notified direct to the Medical Officer of Health within 36 hours of birth, thus enabling the department to get in touch with the parent soon after the birth of the child, instead of waiting, as hitherto, until the notification was received from the registrars of birth—which was any time between one and six weeks after the birth. The milk depot was closed in 1909, but the infant consultations were continued at the Town Hall, and the attendances increased gradually. From this time the health visitor was almost wholly engaged on welfare work, and later on, received help from temporary assistants. 101 In 1914, the main trunk may be said to have been established, as in that year the Local Government Board issued a memorandum, the effect of which was to place the care of the mother and child on a national basis. Authorities were urged to inaugurate complete schemes for dealing with the whole period of childlife, from birth to school age, and grants-in-aid were made available for this purpose. The Council submitted a scheme, embracing the provision of an ante-natal clinic, the appointment of a medical officer for infant consultations, and an additional health visitor, which the Board approved. Weighing Room—Eltham Health Centre. The Great War certainly checked growth, but branches began to grow. By the end of the war, an additional Centre had been established and additional sessions were being held; the first ante-natal clinic under the Council's scheme had been established, and an assistant medical officer for maternity and child welfare purposes had been appointed. Towards the end of the war, milk, etc., was being provided to necessitous expectant and nursing mothers, and to children under five years of age. 102 Relieved of the canker of war, the tree grew rapidly. In 1919, a Home for Ailing Babies, with accommodation for twenty-one cases, was taken over for the treatment of such conditions as malnutrition, marasmus and debility. Arrangements were made with the London County Council for surgical and dental treatment at the School Treatment Centre, and by the end of the year, four Centres were working. The history of the next two years is one of continued growth. Additional sessions were started, new Centres were opened, and additional staff appointed to Doctor's Room—Eltham Health Centre. deal with the greatly increased work. The year 1922 is specially noteworthy as it marks the beginning of the Council's provision of maternity beds at the British Hospital for Mothers and Babies. Mothercraft classes and simple health talks at the Centres were started in 1925, and arrangements were made with the Woolwich Invalid Children's Aid Association for the treatment of children suffering from medical or surgical conditions requiring massage and electrical treatment. During the year, the home nursing service was extended to include certain cases of infectious diseases. 103 The Home for Ailing Babies was closed in 1926, but an agreement was entered into with the War Memorial Hospital for the reservation of twelve beds, and the original scheme was enlarged to include all children under five years of age in need of hospital treatment. Arrangements were also made for the reservation of maternity beds at the Hospital. During this year, the Council made special arrangements in connection with puerperal fever, including the appointment of a consultant obstetrician. A new phase in the usefulness of welfare centres began in 1927, when an agreement was entered into with the London County Council for the dental treatment of school children at the Plumstead Centre. At the end of the year, part of the Old Town Hall was adapted as a model Centre, and a clinic for treatment by artificial light was included. The scheme for the convalescent treatment of children under 5 years of age was completed with the Woolwich Invalid Children's Aid Association during the following year, and in 1929, the Council approved a scheme for the provision of home helps to carry on the domestic duties of mothers during confinement. In May last, a Toddlers' Clinic for the medical examination and supervision of children between one year of age and the time when they begin to attend school, was established. It is hoped, by this means, to carry on the work done at the Child Welfare Centres and thus enable parents to get advice and help from the birth of the child until it reaches school age. (a) 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. (b) The Work of the Health Visitors.—At the end of the year the number of health visitors was increased by one, Miss F. E. Frederick taking up her duties on the 5th May. The duties of health visitor include the visiting of newly-born infants, children under school age, and expectant mothers who have attended at the ante-natal clinics or to whom visits are desirable; the investigation of a limited number of still births and the deaths of young children; the visiting and reporting upon all cases of Puerperal Fever and Puerperal Pyrexia; and attendance at infant welfare centres and dental clinics. Their duties are so arranged that approximately half time is devoted to visiting and half time to centre work. Each health visitor 104 attends at the centre which serves the area in which she visits. The supervision of all children under school age includes the visiting of cases of Ophthalmia Neonatorum, Measles, Zymotic Enteritis, Whooping Cough, Pneumonia and Anterior Poliomyelitis. The following Table, No. 73, shows the classification of visits paid by the Health Visitors in 1930:— TABLE No. 73. Births—First visits 2,308 „ Revisits 15,413 Infant deaths investigated 55 Still-births investigated 25 Expectant mothers—home visits 680 Infectious diseases:— Ophthalmia Neonatorum—First visits 8 „ „ Revisits 7 Measles—First visits 2,444 „ Revisits 1,766 Puerperal fever—First visits 5 „ „ Revisits — Puerperal Pyrexia—First visits 16 „ „ Revisits 2 Zymotic Enteritis—First visits 5 „ „ Revisits 2 Pneumonia 77 Anterior Poliomyelitis 2 Visits unclassified 330 Visits unsuccessful 2,614 25,759 In 1930 the Council, with the approval of the Ministry of Health, paid the class fees of two health visitors who attended a refresher course for health visitors. (c) The Work of the Welfare Centres.—Ath the beginning of the year there were six municipal centres in the Borough and one voluntary centre, but in April the Council became directly responsible for the voluntary centre. At all the centres infant consultations are held and at three of them ante-natal clinics as well. Three of the centres are held in buildings owned or rented by the Council, whilst the other four are held in church halls on one or two half days a week. At the end of the year four ante-natal sessions and 19 infant consultation and weighing sessions were being held each week. 105 In tabular form below are shown detailed statistics for 1930 and the consolidated statistics for the previous year. TABLE No. 74. Centre. No. on Roll of Centre. No. of Attendances. Mothers. Children. Mothers. Children Expectant. Nursing. Expectant. Nursing. Town Hall 493 535 1,475 1135 1216 10,669 Eltham 330 328 1,320 614 624 8,055 Plumstead 356 434 1,058 909 1128 7,686 Slade 14 109 406 17 231 3,949 New Eltham 8 55 281 13 122 3,244 North Woolwich 9 8 104 16 15 782 Beresford Street 8 44 84 10 117 835 Totals 1930 1,218 1,513 4,728 2,714 3,453 35,220 „ 1929 1,021 1,168 4,669 2,162 2,522 32,013 The next table shows the number of children classified by year of birth and the number of attendances made by them during the year. 106 TABLE No. 75. Children in Attendance at each Centre. Year of Birth. Town Hall. Eltham. Plumstead. Slade. New Eltham. North Woolch. Beresford St. Totals. 1930 443 333 315 114 97 31 27 1,360 1929 452 357 314 126 83 28 17 1,377 1928 249 209 177 70 51 25 16 797 1927 176 162 123 51 26 14 13 565 1926 111 160 96 32 15 5 9 428 1925 44 99 33 13 9 1 2 201 1,475 1,320 1,058 406 281 104 84 4,728 Attendances. 1930 3,429 3,036 2,571 1,001 1,069 272 291 11,669 1929 4,522 2,980 3,032 1,705 1,487 279 240 14,245 1928 1,360 805 1,046 630 408 158 174 4,581 1927 777 567 542 353 192 54 99 2,584 1926 463 451 386 205 65 17 28 1,615 1925 118 216 109 55 23 2 3 526 10,669 8,055 7,686 3,949 3,244 782 835 35,220 These figures, which do not include the attendances at the special Toddlers' Clinic, or at the Sunlight Clinic, shew an increase over any previous year. It is interesting to point out also, that of these attendances 24,067 were made by children under one year of age, and 11,153 by children over one year, figures which demonstrate quite clearly the relatively small attendance made by children over one year. Feeding of Infants in Woolwich. In midsummer the usual enquiry was made, as in previous years, as to the type of feeding adopted in the case of infants attending the welfare centres. The method used was as follows:— (a) On the card of every child under one year of age attending a welfare centre between 16th June and 25th July, was inserted once, and once only, the terms "Breast," or "Breast and Hand," or "Hand Fed." (b) The child's age was taken on the day on which this note was made. (c) At the end of the period the results were summarised for the whole Borough and the appropriate percentages worked out. 107 The results of the enquiry are set out in the following Table, No 76:— TABLE No. 76. Feeding of Infants attending Welfare Centres. 16th June—25th July, 1930. 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 49 103 79 50 48 45 33 21 14 442 8 2 — 452 Breast and Hand 1 9 15 16 9 7 8 5 13 83 15 11 3 112 Hand 13 23 28 38 32 34 38 33 48 287 34 47 63 431 63 135 122 104 89 86 79 59 75 812 57 60 66 995 Percentages: Breast 77.8 76.3 64.8 48.1 53.9 52.3 41.8 35.6 18.7 54.4 14.0 3.3 - 45.4 Breast and Hand 1.6 6.7 12.3 15.4 10.1 8.1 10.1 8.5 17.3 10.2 26.3 18.3 4.5 11.3 Hand 20.6 17.0 22.9 36.5 36.0 39.6 48.1 55.9 64.0 35.4 59.7 78.4 95.5 43.3 New Health Centre. It had been apparent for some time that additional provision would have to be made in Eltham, where there had been a great increase in the population. Practically all the new houses which have been built in the Borough are in Eltham, and the Council's estate of over 2,000 houses is there also. The Council had accordingly under consideration how best to make provision for the necessary health services for this part of the Borough, and ultimately decided that an effort should be made to provide a centre which would be capable of dealing with all children up to the school leaving age, and so negotiations were entered into with the London County Council, who, as the Education Authority, are responsible for the medical inspection and treatment of school children. Ultimately, with the approval of the Ministry of Health, plans were sanctioned for the erection of a combined maternity and child welfare and school treatment centre. This centre, which was practically completed at the end of the year, was opened by the Minister of Health on February 14th, 1931, and may be described as follows:— "The centre is unique in one respect: it is the first centre in London which has been specially designed and equipped to provide for the school medical service— a very desirable linking up of the medical examination and care of the pre-school and school child. 108 The centre is ideally situated in an open part of the Council's Housing Estate, the main entrances facing Westhorne Avenue, with a pleasant outlook on the Polytechnic playing fields. There are surrounding lawns with evergreens, flowering shrubs and trees. The structure is a one-storey building of the quadrangle type, having cavity walls throughout, faced externally with Kentish sand-faced, multi-coloured bricks, and the roof is covered with harmonising multi-coloured Kentish hand-made sandfaced tiles. The floors are of polished (Empire) hardwood blocks. The rooms are well lighted and ventilated by means of metal casements in wood frames, glazed with hammered glass, and cross ventilation is provided to every room. Vita glass is used in the weighing room. The building is lighted by electricity with the most modern type of fittings and the heating is provided by electric vapour radiators. Hot water, also heated by electricity, is available in most of the rooms. The sanitary fittings are of white glazed fireclay of British manufacture, and the accessories are of white metal, chromium finished. The estimated cost of the centre is £5,500. A plan of the accommodation is given on page 109, but special attention may be called to one or two points of interest. Perhaps the most important consideration in planning a centre is the correct grouping of rooms with a view to dealing efficiently and expeditiously with large numbers of persons. Careful consideration has been given to this problem, more especially to enable the rooms for the school services to be used, not only independently, but also, if necessary, for the dual purposes of the school and welfare services. By the side of the entrances, covered space is provided for prams—a great advance on the old practice, especially in bad weather, of having pram-sheds outside the building. The large hall will seat 120 persons and will be used for health lectures and demonstrations—a feature of the Council's health propaganda work. By closing the folding partition in the middle, the hall is divided into the two waiting rooms one for mothers and children and the other for school children. The first-mentioned waiting room will contain show cases for exhibiting sterilised maternity outfits, supplied under the Council's scheme, and model garments for babies and young children's clothing, instruction in the making of which is given at the Council's mothercraft sessions. The ante-natal room contains individual dressing cubicles, adding very considerably to the comfort and privacy of the mothers. 109 The most modern equipment is provided in the dental room ; and in the recovery room, to which patients pass, a special range of basins has been installed. There is a separate entrance for school children, which leads directly to the rooms allocated for their treatment. 110 The quadrangle, which is paved with crazy paving, and contains two sand-pits, will be used as a playground for children coming with their mothers. The corridor, which runs round the quadrangle, gives access to all the rooms, and is provided with wood and glass folding partitions to enable it to be entirely closed in bad weather." The Quadrangle—Eltham Health Centre. (d) Artificial Sunlight Clinic.—This clinic was opened in October, 1927. The total number of patients treated during the year, including 79 whose course of treatment was not completed at the end of 1929, was 377. The total number of treatments given was 9,328. Of these, 5,237 were by carbon arc, 2,446 by mercury vapour lamp, and 1,645 by radiant heat lamp. The clinic is under the medical supervision of Dr. J. E. A. Lynham, who has furnished the following report on the year's work. "A review of the figures in relation to the Sunlight Clinic leads to the conclusion that this Department is rendering useful service. The total number of patients in attendance has decreased, this being due chiefly to the opening of other centres. 111 Some slight alterations were made in technique, for instance, coredcarbons have been adopted, and the time of individual treatments shortened; also the number of attendances has been reduced from three to two per week in many instances, as the mothers found it difficult to bring their children so frequently. In the case of children definitely suffering from rickets Radiostol was administered at each attendance. The results as a whole compare favourably with those of previous years. The principle of endeavouring to work in conjunction with other officers in charge of the welfare centres and clinics has been maintained. Where it has seemed desirable patients have been referred for medical or surgical opinions, or for X-ray examinations. The range of cases referred to the clinic is practically the same as that of previous years, and the percentage of cures is almost identical. It is constantly borne in mind that actino-therapy is in itself but one item in the rationale of treatment in many instances. Apart from the actual figures, the parents of many of the children constantly assure the staff of the benefits derived from attendance at the clinic." In tabular form are shewn below the number and types of cases treated during the year:— TABLE No. 77. Cases Treated at Sunlight Clinic, 1930. Type of Case. Brought Forward from 1929. New Cases. Total. Much Improved or Cured. Improved. I.S.Q. Ceased Treatment. Treatment not yet complete Rickets 17 65 82 27 14 4 12 25 Anaemia, Debility and Malnutrition 36 100 136 53 25 11 25 22 Catarrhal Children 7 39 46 10 11 6 7 12 Septic Conditions — 36 36 31 2 1 2 — Nervous Children 5 7 12 4 2 2 3 1 Enlarged Glands 3 5 8 4 1 1 — 2 Miscellaneous Nervous Conditions 2 2 4 — 1 1 — 2 Miscellaneous Skins 3 22 25 10 5 3 3 4 Others 2 15 17 5 3 1 1 7 Mothers 4 7 11 4 2 — 1 4 79 298 377 148 66 30 54 79 112 (e) Care of the Toddler.—On the 5th December, 1929, the Minister of Health and the President of the Board of Education issued a combined circular on the care of the toddler. It was pointed out in this circular that considerable provision had been made for the supervision of the health of babies during the first year or two of life under the provisions of the Maternity and Child Welfare Act, 1918, and that under the Education Acts provision is made for the medical inspection and treatment of school children; but although, theoretically, provision is made for the toddler, there is a very definite hiatus in the supervision of these children. Local Authorities were earnestly urged to make a new effort to deal with the problem of the start of child life, as it was obviously grossly uneconomic to allow the health and stamina of infants to deteriorate until they are five years of age, and then to spend large sums of money in trying to cure them between the ages of 5 and 15. The main aspects of the problem were, therefore, the discovery of defects which existed and the securing of treatment when necessary. In the circular it was suggested that more Nursery Schools might be provided by Education Authorities and more Day Nurseries by Maternity and Child Welfare Authorities. Woolwich had had experience of day nurseries. They were established during the war and extensively used, but immediately after the war they were closed because nobody wanted to use them—no doubt due to the fact that there are relatively fewer married women employed in Woolwich than in any other Borough in London. With this avenue closed, it was necessary to find some other means of approaching the problem, and ultimately it was decided to institute a scheme to provide for the medical inspection of the toddler on similar lines to the medical examination of school children, but making provision for such examination in the third, fourth and fifth year of life. By such a scheme it is hoped to discover defects at least a year or two earlier than they would be discovered by the School Medical Service. With regard to treatment, the Council was in a very fortunate position, because experience has shown that parents were very ready to take their children to medical practitioners for such treatment as was necessary when it became known to them, and under the Council's Maternity and Child Welfare scheme the channel is already established whereby treatment can be provided for those unable to pay doctor's fees. As this was a new venture which would take time for the general public to become acquainted with its necessity and its routine, it was decided to make provision in the first instance for a special toddlers' medical inspection clinic on two half days a week. In March, Dr. Margaret Emslie was appointed to do this work, and she has furnished the following observations dealing with the period of eight months ending 31st December. "The clinic opened in May, 1930, and in the period between May and December of that year, 256 boys and 216 girls were examined, a total of 472. The method of procedure at the Clinic was as follows:—After registering, weighing, and measuring, the child was brought to the Medical Officer, who enquired of the mother regarding its previous history, illnesses and the health of the family. 113 The ages of walking, talking, cleanliness as regards habits, hours of sleep, digestion and appetite were recorded. The child was then seen standing undressed, and a note made of general physical development and of any deformities present. Heart, lungs, mouth, teeth, throat, and ears were then examined in turn, and an attempt was made to engage the child in conversation so as to obtain some idea of its intelligence and speech development, reaction to strangers, obedience to mother, etc. The diet was then enquired into in detail, and advice given on this and on general matters of management. If time allowed, the child was seen walking and its shoes were examined for proper fit and shape. Following the examination, children with certain abnormalities were referred for observation and others for treatment. The health visitor advised the mother regarding clothing during the dressing and undressing of the child, and, when necessary, she visited the home. In Table No. 78 are shewn the results of the examination. TABLE No. 78. Medical Inspection of Toddlers, 1930. Disease, Defect or Condition. Boys. Girls. Total. Age last Birthday Age last Birthday. 1 2 3 4 1 2 3 4 Nutrition— (a) Excellent 2 41 10 2 - 29 14 2 100 (b) Normal 7 80 46 7 10 56 30 15 251 (c) Sub-normal 2 26 18 9 3 23 23 7 111 (d) Bad - 2 4 — — 2 — 2 10 Muscular Tone— (a) Excellent 1 68 43 10 4 43 44 17 230 (b) Good 9 78 34 8 9 64 23 9 234 (c) Sub-normal 1 3 1 — — 3 — — 8 Clothing and Footgear— (a) Satisfactory 8 109 59 13 9 84 54 21 357 (b) Unsatisfactory 1 17 10 5 2 13 7 3 58 (c) Not recorded 2 23 9 — 2 13 6 2 57 Cleanliness— (a) Excellent 9 116 62 14 11 82 55 22 371 (b) Fair 2 28 15 4 2 27 11 4 93 (c) Dirty - 5 1 — — 1 1 — 8 Skin— Impetigo - 4 2 - - 4 1 - 11 Urticaria - 10 5 - 1 11 6 1 34 Other Skin Conditions — - - 1 - 3 - — 4 Era- External Diseases 1 - 2 - - 3 2 - 8 Squint - 7 2 2 — 1 1 1 14 Ear— Otitis Media — 4 5 1 — 3 — 2 15 114 TABLE No. 78—continued. Medical Inspection of Toddlers, 1930. Disease, Defect or Condition. Boys. Girls. Total. Age last Birthday. Age last Birthday. 1 2 3 4 1 2 3 4 Nose and Throat— Enlarged Tonsils 5 87 33 9 3 49 36 12 234 Enlarged Tonsils and Adenoids Adenoids Enlarged Cervical Glands — 5 9 2 — 3 4 3 26 Teeth— Caries 1 12 27 8 — 10 18 13 89 Hypoplasia — 3 — — 1 — 1 — 5 Heart and Circulation— Heart Disease—Organic and Functional 1 16 9 2 2 9 9 3 51 Anaemia 1 23 18 3 5 21 17 7 95 Lungs— Bronchitis 1 8 2 — 1 6 4 — 22 Other Diseases — — 1 — — — — — 1 Nervous System- "Nervous" Children 1 19 7 4 2 7 8 2 50 Chorea — 1 — — — — — — 1 Other Defects & Diseases 104 Rickets—Past or Present 4 41 16 4 2 27 5 5 Rheumatism — — 1 1 — 1 1 1 5 Deformities — 4 — 1 — 2 1 — 8 8 Defective Speech — 1 4 1 — 1 — 1 Others — 3 — — — 3 1 — 7 Total Children Examined 11 149 78 18 13 110 67 26 472 The numbers examined do not permit of more than a very general survey. Nutrition.—The nutrition of the children appeared, on the whole, satisfactory, especially having regard to present economic conditions. In fact, the figures for 'below average' cases were Dot greater than those for 'malnutrition' in many previous investigations published, chiefly in America, where most of the specialised 'nutrition' work has been carried out. Including cases of thinness as well as true malnutrition, of which there were few, the percentages of 'below average' cases were 24 in the case of boys, and 28 in the case of girls. The figures do not indicate ill-health, and are not to be considered incompatible with the London County Council's figures, namely, 6 per cent. 'malnutrition' amongst school children, as these would appear to be Fourth Grade cases according to the London County Council's classification, in which under-nourishment was considerable. 115 Anaemia was noted in similar proportions, 15 per cent. boys, 19 per cent. girls, at the age of 2 years, but in 24 per cent. of both at the age of 3 years. These figures are high, but they may indicate such circumstantial factors as undue confinement* rather than nutritional fault, since the figures for anaemia during school life show an abrupt diminution (1 per cent. from entrants' age onwards, in London County Council reports). Rickets.—Rickets must also be considered as a general nutritional condition. Evidence of rickets was commoner in boys than in girls, 25 per cent. as compared with 18 per cent., but these must not be taken to be active cases at the moment of examination since all definitely rachitic, though minor, deformities, were included ; e.g., deformities of head, chest and teeth, as well as more obvious deformities of the limbs. Muscle Tone.—This was specially noted in all cases as providing a very good indication of health. It was most satisfactory to note that in only 16 per cent. of all the cases examined was there real softness. A few cases of minor spasticity on the other hand gave the clue to unexplained delays in walking. Dental Conditions.—Dental caries, often rachitic in origin, is a sign that has been widely complained of in this country in children entering school. The Report of the School Medical Officer of the London County Council for the year 1929 shews dental defects in 68 per cent. of children of all ages examined, and notes ' the appalling onset of caries among all children during the fourth year.' Of the children examined in the Toddlers' Clinic, 31 per cent. showed signs of caries between the ages of 3 and 4, and 48 per cent. between the ages of 4 and 5. 8.5 per cent. of cases already showed caries between the ages of 2 and 3. These figures are much smaller than the figures for London as a whole, but they would seem to indicate two things:—(a) that further work is necessary in instructing parents as to the manner of development of, and the measures necessary for, conserving the teeth, and (b) that periodic dental examination of children before school age, starting, if possible, in the third year, is a useful prophylactic that might be expected to limit the incidence of caries by correcting it in its early stages, and so also prevent the serious secondary effects of untreated dental disease. As a further index of nutrition, sound and unsound, throughout the infant period, these figures for dental caries are also of considerable interest. Respiratory Conditions.—In Dame Janet Campbell's latest Report on Infant Mortality, respiratory disease is shown to have succeeded gastro-enteric disease as the chief cause of deaths amongst young children. In view of this a history of * Compare paragraph on "Hours of Sleep." 116 respiratory disease of any sort was carefully recorded in all cases examined, and a special look-out was kept for intercurrent conditions of disease, e.g., tonsils and adenoids, naso-pharygeal catarrh, or bronchitis, etc., since a high rate of mortality would appear to indicate the likelihood of an even higher rate of disability amongst children below school age. Amongst the cases examined, 25 per cent. gave a history of respiratory disease, chiefly bronchitis, and signs of bronchitis were found in 4 per cent. Tonsils and adenoids or catarrhs or otorrhoea associated with enlarged tonsils, were found, however, in 49.5 per cent. of the total cases examined. Only 2.5 per cent. of the total cases were referred for operative treatment, a figure comparable with 7 per cent. of the total number of children so referred from L.C.C. Schools, and the much higher percentage of those examined at the school entrants' age, namely, 10 per cent. Fifteen otorrhoea cases were referred to the minor ailments clinic of the London County Council for treatment. Nervous Conditions.—Another type of defect was sufficiently evident to call for some remark. Signs of undue nervousness, such as screaming, fighting, negativism, enuresis, night terrors, stammer, thumb-sucking, masturbation, cyclic vomiting and acidosis attacks, were observed in 20 per cent. of all cases between the age of 2 and 4 years. No less than two-thirds of this amount occurred at the earliest age examined, namely, between 2 and 3 years. In a majority of the cases in which the symptoms occurred, the child was an only child or appeared after a long interval, say five, seven, or more years after the rest of the family were born, and the nervousness seemed to be definitely related to these particular circumstances. Nervous symptoms were noted in 46 per cent. of only children, and in 68 per cert. of "big space" children (children separated from the last child by an interval of more than 4 years were considered as belonging to this group) compared with the figure of 20 per cent. for the total cases already quoted. On the other hand, there was evidence that a good deal of the difficulty was associated with tiredness, over-excitement and lack of sleep. For that reason the figures that follow for the hours of sleep are of great interest. Hours of Sleep.—The variation in regard to sleep management was marked. There was a good deal of too late going to bed, spending too many hours in bed during the day, and very late getting up. The two latter were often found in conjunction, so that some children seemed to be spending as little as a couple of hours of the total daylight period out of bed. The fault of too long mid-day lying in bed was, curiously enough, noted chiefly in the case of children over 2 years, and very often in cases where management was otherwise good. If the habit had once been 117 formed of giving the child rest during the day, there seemed to be an inclination to prolong this habit unduly and at the expense of the night sleep. The fact that children of the age of 3 to 4 years, were found to receive an average total of 13½ hours' sleep, and at the age of 4 years, an average of 12 hours' sleep per day, compared with an average of only 10 hours at the age of 2 years, bears out this observation. In the case of the younger children the loss of at least four hours' necessary sleep per day might be enough to account for the greater incidence of nervous conditions and 'temper' found at this age. Deformities.—Deformities were not found to be sufficiently serious to warrant much remark. Most of the cases noted were minor rachitic deformities of the chest that might be expected to improve with better nutrition and hygienic treatment. Deformities of knees and feet were fairly common, but in many cases were due to excessive weight or to unsuitable, and particularly too short, shoes rather than to manifest rickets. Where such deformity was obvious, advice was given on walking, simple exercises and the correction of shoes, while a few cases were referred for plastic operation, or for massage and remedial treatment at the Invalid Children's Aid Association's Clinic. Numbers per Session.—The number of cases examined per session was not large, 8 to 10 being found to be about as many as could be managed with the full examination described, and allowing also some time for talk with the parent. After the first few sessions, for which appointments were not necessarily kept, the attendances generally were steady, and parents showed a willingness to avail themselves of the services provided, and to return for further conferences on request or when new symptoms became evident. Percentage Requiring Treatment.—The percentage of children referred for treatment, including dental treatment, was 35. Conclusions.—In conclusion, the purposes served by the Toddlers' Clinic may perhaps be said to have evolved as follows:— (1) As a purely inspection clinic providing information as to general physique and fitness of children at the ages chosen for examination. (2) As a means of providing a certain amount of general instruction in matters of diet, hygiene and management that prevent or lessen illness. (3) As a clearing house for the treatment of established defects, cases being referred to suitable centres, private practitioners, convalescent homes and hospitals, and to different types of clinics. (4) As a place of observation for minor conditions of ill-health or physical defect not yet requiring treatment. (5) As a means of bringing under notice certain cases of abnormality, often unsuspected or ill-defined, for which suitable provision, short of treatment, must be made, and the parent guided as to management. 118 Amongst these were several cases of cerebral diplegia associated with minor "backwardness," a case of brain tumour, a number of cases of mongolism and definite amentia, and others of endocrine deficiency or congenital heart diesase, in which the conditions had hitherto not been noticed. Cases of this sort were not amongst those for which, prima facie, treatment could always be arranged, but at least, recognition at the clinic served to lessen the difficulties that might occur through misunderstanding of certain symptoms or defects, or from a failure to appreciate the need for certain special types of training in abnormal cases." (f) Home Helps.—A scheme for the provision of home helps was put into operation in 1929. During the year 1930, four applications were considered by the Committee, and 2 home helps were provided. (g) Treatment of Minor Ailments.—Children requiring medical or surgical treatment for certain minor ailments are referred to the School Clinics at Brewer Street, Woolwich, or Park Place, Eltham, to a private practitioner, or to a hospital. During the year, 109 were sent to these clinics, and for each case the Council paid 5s. Children referred to them suffered from the following conditions :— TABLE No. 79. Brewer Street. Park Place Impetigo 7 10 Ear Discharge 32 16 Eyes 24 11 Miscellaneous 2 7 65 44 (h) Dental Treatment.—Dental work is carried out at the School Cinic, Brewer Street. Mothers and children are referred there from the centres. The following Table, No. 80, shows the cases attending, and the total attendances during the year. The number of sessions was 37, excluding anaesthetic days. TABLE No. 80. No. Attendances. Expectant mothers 82 155 Nursing mothers 41 113 Children under 5 216 273 339 541 119 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. 39 sets (complete or partial) of artificial teeth were supplied during the year at a total cost of £186 5s. Od. Payments by mothers amounted to £91 10s. 9d. Dentist's Room—Eltham Health Centre. (i) 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 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 £145 15s. 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;— 120 TABLE No. 81. Cases Treated at Orthopaedic Clinic, 1930. Type of Case. Number remaining over from 1929. New Cases. Total Cases. Number who completed treatment by end of year. Number with treatment not completed. Talipes (Club Foot) 5 7 12 10 2 „ (Flat Foot) 2 4 6 5 1 Rickets— General 1 13 14 10 4 Genu Valgum (Knock Knee) 3 11 14 9 5 Genu Varum (Bow Leg) 1 3 4 3 1 Paralysis, etc.— Infantile — 1 1 - 1 Erb's 1 2 3 1 2 Muscular Weakness 2 5 7 2 5 Congenital 1 1 2 1 1 Miscellaneous— Injuries — 1 1 1 - Torticollis 1 — 1 1 - Constipation 1 1 2 2 - Mouth Breathers — 5 5 1 4 Flat Chest — 2 2 2 — 18 56 74 48 26 (j) Provision of Nursing Assistance for Certain Diseases.—In Section III. of the report the general scheme of nursing assistance is described in full. The extent to which these services have been made use of in respect of specific diseases is dealt with under these diseases, q.v. (k) 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 £70 17s. 9d., and there were arrears of payments amounting to £7 18s. 6d. outstanding at the end of the year. Including those remaining in hospital at the beginning of the year, the number of children who received treatment during the year was 155; 129 of these were discharged cured or very much improved in health, 12 as improved, and 7 died. Three children were transferred to other hospitals, two others were discharged 121 shewing no improvement, and the number remaining in hospital at the end of the year was two. The surgical conditions for which these children were admitted included enlarged tonsils and adenoids, phimosis, intussusception, pyloric stenosis, hernia and injury ; and those admitted for medical treatment included children suffering from pneumonia, malnutrition, enteritis and rickets. (l) Institutional Midwifery. (1) British Hospital for Mothers and Babies.— There are 42 beds in this hospital, and I am informed by Miss Gregory, the Secretary of the Hospital, that 714 babies were born during the year. At the antenatal clinics in connection with this hospital 5,957 attendances were made, and at the Infant Clinics 2,320 attendances. In addition, there were 190 extern cases. The number of mothers admitted under the Council's scheme was 141, the nett cost to the Council being £936 9s. 6d. (2) War Memorial Hospital—Seven 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 134, and 14 mothers were admitted for ante-natal or emergency treatment. The number of attendances made at the ante-natal clinic was 772. The number of cases admitted under the Council's scheme was 60, the nett cost to the Council being £492 lis. 6d. (m) Ante-Natal Treatment and Emergencies.—The number of cases admitted for ante-natal or emergency treatment under the Council's scheme was six. The reasons for admission were:—one each of threatened abortion, varicose veins, haemorrhage, and albuminuria, and two on account of tuberculosis. (n) Convalescent Home Treatment for Children under Five Years of Age.—In 1928, the Council resolved to give grants-in-aid to the Woolwich Invalid Children's Aid Association for the purpose of providing convalescent home treatment for children imder five years of age. During the year such grants were made in respect of 43 children, the total cost of whose convalescent treatment amounted to £276 15s. lOd. The Council's grants amounted to £125 7s. Od. Payment is only made in respect of children sent to homes approved by the Medical Officer of Health. (o) 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, £1,256 Is. 4d. Fresh milk, lis. 6d. Dinners, nil. 122 (p) 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. The total attendances at the class during the year was 577. (q) 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 Disease Section of the report which deals with the notification of these diseases. (r) 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 case came to the knowledge of the department. (g) 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 the Annual Report for 1929 I reported on the draft scheme under Section 101 (6) of the above Act. This scheme provided in its application to Woolwich for a payment of £1,500 a year to the British Hospital for Mothers and Babies by this Council, and for payment to the Voluntary Centre in Beresford Street of a sum of £14 per annum. In its final form these were omitted from the schedule, the Council assuming the responsibility for the maintenance of the voluntary centre, and payment of £1,500 per annum to the hospital was recognised as payment under an agreement for work done. The Council were desirous that they should be the supervising authority for the infant welfare centre at the British Hospital for Mothers and Babies, but the Minister of Health was of opinion that, as this centre is attached to a maternity hospital and its work intimately related to the work of the hospital, it would be undesirable to provide for the supervision of the hospital by the County Council and for the supervision of the centre by the Borough Council. There are two schedules to the scheme, the first defining the associations to which the London County Council shall contribute, and the second, those to which 123 the metropolitan borough councils shall contribute. In tabular form is set out below the reference to Woolwich in the scheme. FIRST SCHEDULE. Name of Association. Services in respect of which contribution is payable. Amount of annual contribution to be paid by the London County Council. British Hospital for Mothers and Babies. (a) Maternity Hospital £1,070 (b) District Midwifery and Maternity Nursing. £54 (c) Infant Welfare Centre. £230 SECOND SCHEDULE. Nil. 124 METEOROLOGY. Meteorological Observations taken at the Royal Observatory, Greenwich, during the year 1930. 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. 4 53.9 32.0 45.4 + 6.8 45.2 4 0.60 „ 11 48.7 31.6 42.4 + 4.4 45.3 5 0.97 „ 18 55.4 33.0 46.0 + 7.8 45.0 3 0.30 „ 25 58.6 28.4 44.8 + 5.9 45.0 3 0.40 Feb. 1 50.6 30.8 41.0 + 1.4 45.0 5 0.90 „ 8 46.0 31.8 38.9 - 0.6 44.5 3 0.29 „ 15 47.3 31.1 37.7 — 1.3 43.8 2 0.19 ,, 22 43.8 30.8 36.1 — 3.5 43.2 — — Mar. 1 51.9 31.3 39.6 — 06 42.8 - - „ 8 42.9 33.2 45.6 + 4.8 43.1 1 0.12 „ 15 53.6 29.0 40.5 — 0.7 43.5 6 0.75 „ 22 51.0 25.4 40.2 — 1.8 43.4 4 0.46 „ 29 62.5 28.0 46.2 + 3.2 43.4 1 0.11 April 5 65.4 39.1 48.4 + 2.8 44.4 4 0.67 „ 12 62.2 35.6 46.9 + 0.8 45.1 3 0.10 „ 19 54.9 36.1 43.6 — 3.6 45.5 6 0.51 „ 26 71.9 30.1 49.1 + 0.5 45.6 3 0.10 May 3 67.9 39.1 51.5 + 2.3 46.8 2 0.19 „ 10 68.7 38.7 49.8 — 0.9 45.0 5 0.69 „ 17 69.2 44.0 55.0 + 2.4 48.5 4 0.32 „ 24 66.4 42.1 52.5 — 1.7 49.5 5 0.38 „ 31 74.3 44.0 57.6 + 1.4 50.4 4 1.28 June 7 76.3 47.7 59.2 + 1.1 51.6 2 0.55 „ 14 76.2 40.5 59.4 + 1.2 52.8 — — „ 21 82.9 50.2 64.1 + 4.8 54.0 2 2.85 „ 28 76.2 45.2 61.6 + 0.3 55.3 3 0.35 July 5 83.0 46.6 66.2 + 4.4 56.0 1 0.01 ,, 12 83.9 51.1 64.0 + 1.5 56.9 — — „ 19 76.5 47.5 60.5 — 2.8 57.0 4 0.73 „ 26 68.7 47.6 57.0 — 6.0 56.8 5 0.68 Aug. 2 „ 9 75.4 51.7 61.9 — 0.3 56.8 4 0.40 71.5 49.0 58.7 — 3.5 57.1 6 0.80 „ 16 72.1 48.7 60.7 — 1.7 57.4 5 0.44 „ 23 76.1 47.7 60.2 — 1.3 57.6 3 0.64 „ 30 92.2 47.7 70.6 + 10.1 57.9 2 0.89 Sept. 6 81.5 44.0 61.7 + 2.1 58.8 2 0.50 „ 13 73.3 50.7 60.1 + 1.8 58.5 5 0.62 „ 20 66.4 44.7 56.9 — 0.2 58.1 6 0.91 „ 27 70.3 47.2 56.9 + 1.5 57.8 5 0.59 125 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. Oct. 4 66.9 44.8 54.5 + 0.4 57.1 4 0.59 „ 11 62.6 36.1 51.0 — 0.9 56.3 3 0.19 „ 18 69.9 37.2 57.0 + 7.1 55.2 2 0.24 „ 25 63.1 39.5 49.2 + 0.9 54.8 3 0.39 Nov. 1 63.7 30.2 50.7 + 3.4 53.4 3 0.14 ,, 8 57.1 26.3 43.7 — 2.3 52.7 5 1.05 „ 15 58.0 30.0 47.1 + 3.4 51.3 3 0.20 „ 22 58.8 23.0 44.5 + 2.2 50.2 5 1.44 „ 29 55.9 33.6 45.2 + 3.4 49.6 5 1.60 Dec. 6 48.7 27.8 41.1 — 0.1 49.0 2 0.02 „13 50.1 29.8 39.4 — 1.2 48.2 4 0.69 ., 20 50.4 29.0 40.6 + 0.4 47.1 1 0.02 „ 27 52.8 39.8 40.0 + 1.5 46.6 5 0.60 Jan. 3 (1931). 49.8 29.5 40.3 + 1.6 46.1 4 0.45