W0031 Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1931 BY J. MACMILLAN, D.S.O., M.C., M.B., D.P.H. Medical Officer of Health WOOLWICH: The KAtish Independent Printing Works (T.U.). 16, Wellington Street, S.E. 18. PUBLIC HEALTH AND HOUSING COMMITTEE. At 31st December, 1931. His Worship the Mayor (Alderman F. T. Halse, J.P., L.C.C.). Councillor H. Vaughan (Chairman). Councillor F. J. Bloomfield (Vice-Chairman). Alderman S. G. Turner. Councillors— B. A. G. Beaten Miss C. K. Lambeth W. W. Burr E. T. Lamerton P. Chinnery Mrs. E. L. Reeves Miss M. Crout, J.P. Rev. H. Stebbings Mrs. L. E. Driver Miss S. Turnbull A. H. Gilder Miss G. E. Walters, J.P. MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Public Health and Housing Committee. Councillor H. Vaughan (Chairman). Councillor Miss C. K. Lambeth (Vice-Chairman). 3 TABLE OF CONTENTS PAGE 2 Public Health and Housing Committee Maternity and Child Welfare Committee 2 Preface 6 I—GENERAL STATISTICS. 9 Census, 1931 Population 9 Sickness and Invalidity 10 Physical Features of the Area 10 Social Conditions 10 II.—VITAL STATISTICS. Annual Statistics (including those of Wards) 11 Births 13 Marriages 15 Deaths 15 Deaths from Cancer 19 Maternal Mortality 21 Child Mortality 22 Infantile Mortality 23 III. GENERAL PROVISION OF HEALTH SERVICES. Public Health Officers 26 Professional Nursing in the Home 29 Midwives 29 Laboratory Facilities 29 Adoptive Acts, By-laws and Regulations in Force in the District 29 Hospitals 30 Institutional Treatment of Unmarried Mothers 30 Ambulance Facilities 30 Clinics and Treatment Centres 31 Maternal Mortality 33 Health Visiting 34 Vaccination 35 Supply of Insulin 36 IV.—HEALTH PROPAGANDA. Health Week, 1931 37 Health Talks to School Children 38 Health Lectures to Adults 40 Informal Talks 40 "Better Health" 40 Health Services Booklet 40 4 PAGE v.—SANITARY ADMINISTRATION. Staff 41 Water Supply 41 Removal and Disposal of Refuse 41 Drainage 41 Smoke Abatement 42 Complaints 42 Sanitary Inspection of Area 42 Factory and Workshops Act 44 Rats 46 Offensive Trades 46 Rag Flock Act 46 Mortuaries 46 Cemeteries 47 Removal of Infirm and Diseased Persons 47 Legal Proceedings 48 Public Baths and Washhouses 48 VI.—INSPECTION AND SUPERVISION OF FOOD. General Reference 49 Milk Supply 49 Agricultural Produce (Grading and Marking) Acts 51 Merchandise Marks Act 51 Meat Inspection 52 Other Food Premises 53 Unsound Food 54 Sophistication of Food 54 Adulterated Samples—Action Taken 56 Chemical and Bacteriological Examination of Food 57 Nutrition 57 Other Legal Proceedings 57 VII.—HOUSING. Statistics 58 Inspection of Houses 60 Rent Restrictions Acts 61 Tents and Vans 61 Houses Let in Lodgings 61 New Houses 62 Council's Housing Scheme 63 Common Lodging Houses 63 VIII.—INFECTIOUS DISEASES. Notifications 64 Diphtheria 69 Scarlet Fever 70 Enteric Fever 71 Puerperal Fever and Puerperal Pyrexia 72 Erysipelas, Malaria and Dysentery 72 Smallpox 72 Chicken Pox 72 5 page 73 Cerebro spinal Meningitis Anterior Poliomyelitis 73 Zymotic Enteritis 73 Whooping Cough 73 Measles 73 Ophthalmia Neonatorum 74 Pneumonia 74 Tuberculosis :— Notifications 70 Deaths 78 Public Health (Tuberculosis) Regulations, 1925 8() staff 80 The Work of the Dispensaries 80 Out-Patient Hospital Treatment 83 Dental Treatment 83 Shelters 83 Sputum Examinations 83 Supply of Extra Nourishment 83 Nursing 83 Institutional Treatment 83 Tuberculosis Care Committee 85 and Disinfestation 85 IX.—maternity and child welfare. General Reference 89 Staff 89 Notification of Births Act 89 The Work of the Health Visitors 90 The Work of the Welfare Centres 90 Feeding of Infants 92 Artificial Sunlight Clinic 93 Toddlers Clinic 95 Home Helps 95 Treatment of Minor Ailments 95 Dental Treatment 95 Orthopaedic Treatment 96 Provision of Nursing Assistance 96 Institutional Midwifery 97 Ante-Natal and Emergency Hospital Treatment 97 Convalescent Home Treatment for Children 97 Assisted Milk, etc., Scheme 97 Collective Teaching to Mothers 97 Public Health (Puerperal Fever and Puerperal Pyrexia)Regulations, 19-6 98 Obstetric Complications in Private Practice 98 Maternity Outfits 98 Day Ambulance Service for Maternity Cases 98 Compensation for Midwives 98 Convalescent Home Treatment for Mothers 99 Blind Persons Act, 1920 99 Widows', Orphans', and Old Age Contributory Pensions Act, 1925 99 appendices. I. Report on the Medical Inspection of Toddlers 100 H. Meteorological Tables 110 6 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit, in accordance with the instructions of the Ministry of Health, the Thirty-First Annual Report on the Health of the Metropolitan Borough of Woolwich. The Report for 1930 was a very full report, and this year I have only dealt fully with those local conditions which were not so dealt with last year and any important changes which have taken place during the year. A Census of the population was taken during the year and in the preliminary report issued by the Registrar General the total population of the Borough was given as 146,944. These figures were subject to amendment, and in a later report the final figure was given as 146,881. The increase in the inter-censal period amounted to 4p6 per cent. At the middle of the year the Registrar General estimated the total population to be 147,400, of whom 4,800 were military. The civil figure of 142,600 is that which is used throughout the report for calculating rates, and the population of the separate Wards of the Borough will be found in the body of the Report. The birth rate was 15*1, as compared with 15'5 in 1930 ; the death rate was 116, as compared with 10"9 ; the infantile mortality rate was 59, as compared with 42, and the neo-natal mortality rate (deaths under four weeks per 1,000 births), was 28"77, as compared with 20T1. Maternal deaths numbered 8—the same as in 1930—the rate for the year being 3'7. The Council's scheme of health propaganda is fully described in Section IV. During the year a Health Services booklet, giving details of the Council's health services was issued. It may be obtained, free of charge, by any inhabitant of the Borough. 7 The incidence of infectious diseases was notably lower than in 1931. Measles was not present in epidemic form. There was a great decrease in the amount of scarlet fever (387 against 627), and diphtheria (281 against 497). The number of cases of pneumonia (all forms) rose from 283 to 371. The number of notifications received in respect of the puerperium was 49, compared with 36 in 1930. The number of primary cases of Tuberculosis coming to the knowledge of the Department during the year was 305 (335 in 1930). At the end of the year there were 944 cases of pulmonary and 264 cases of non-pulmonary tuberculosis, making a total of 1,208 cases (1,217 in 1930) known to be living in the Borough. The deaths from tuberculosis numbered 168 (165 in 1930). The work of the sanitary inspectors has been conscientiously and carefully carried out and the reports of the district and food inspectors show that a high standard has been maintained, reflecting great credit on them. It is pleasing to record that the following sanitary inspectors have obtained additional professional qualifications during 1930 and 1931 :— Laboratory Technique of Meat Inspection, Smithfield— H. M. Kersey, W. Tedham. Smoke Inspectors, Royal Sanitary Institute— C. J. Couch, H. M. Kersey, H. W. Pendrill. Advanced Inspectors, Royal Sanitary Institute— H. W. Pendrill. The report on Maternity and Child Welfare shows that this invaluable branch of the Council's work continues to grow in usefulness, and that it is becoming more and more welded in the general London health scheme. At the Eltham Health Centre, which was opened by the Minister of Health at the beginning of the year, there are clinics not only for the care and comfort of expectant and nursing mothers and children under 5 years of age, but also for the medical and dental treatment of the school child, providing an easy and definite co-ordination between the work of the School Medical Authority and the Council. An additional welfare centre, held once weekly, was opened at St. Luke's Church Hall to serve the needs of East Eltham and certain small but important additions Here made to the service generally, which are referred to in detail in Section IX. The attendances at all the Centres continued to increase, the total number being 53,115. 8 The Toddlers Examination Clinic has now become a definite part of the scheme and the initial difficulties appear to have been overcome, as mothers are now anxious to have their children examined. A very full report of the working of the scheme will be found in Appendix I, where not only routine findings but also a special report on the nervous child in its early days has been furnished by Dr. Emslie, the Medical Officer of the Clinic. Since my last report the following officers have left the Council's service :— Dr. C. Isobel Wright, who joined the staff in 1927, resigned in March on appointment as Tuberculosis Officer of the Metropolitan Borough of Finsbury. Mr. William Little, Sanitary Inspector, who entered the service of the Plumstead Vestry in 1896, applied for superannuation on account of ill-health and retired in September. I am very grateful to the members of the Health Committees and the Council generally, from whom I have received many kindnesses and the greatest possible help during the year, and I take this opportunity of expressing my appreciation. The staff have also, as usual, fulfilled in a highly satisfactory manner, the increasing demands made upon them. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. MACMILLAN. 9 THIRTY-FIRST ANNUAL REPORT on the HEALTH OF THE METROPOLITAN BOROUGH OF WOOLWICH. Year ending 31st December, 1931. SECTION I.—GENERAL STATISTICS. TABLE No. 1. Area (acres) 8,282 Population, estimated to middle of 1931 :— Total (including military) 147,400 Civilians 142,600 Population, Census 1931:— Total (including military) 146,881 Civilians 141,504 Number of inhabited houses, 1931 29,870 Number of families or separate occupiers, 1931 38,176 Rateable value (April, .1931) £1,038,277 Sum represented by a penny rate (April, 1931) £4,326 Census. The fourteenth Census of the population of England and Wales was taken on the 26th April, and a preliminary report was issued by the Registrar-General later in the year. It is interesting to note that in five year's time (and not ten years as heretofore) the next Census will be taken. The figures in the preliminary report have been obtained in advance of the main report by so organising the procedure of enumeration as to permit simple figures being abstracted locally, and are subject to confirmation in the subsequent Census reports. It is not expected that there will be any substantial discrepancy. The population of Woolwich in 1921 was 140,389; in 1931 it was 146,881. The percentage increase was 4 7. There were only two boroughs which shewed greater increases, namely, Lewisham, with 26'3, and Wandsworth, with 7*6. Only eight of the metropolitan boroughs shewed increases, the administrative County and the remaining cities and boroughs shewing decreases. Population. The population at the middle of the year was estimated by the RegistrarGeneral to be 147,400. Of these 4,800 were military, so that the civilian population was 142,600. The estimated civilian population in each of the wards of the Borough is shewn in the following Table, No. 2 :— 10 TABLE No. 2. Wards. Estimated Population Dockyard 7,148 St. Mary's 5,267 River 11,735 St. George's 5,033 Burrage 8,163 Herbert 8,516 Glyndon 8,837 St. Margaret's 12,638 Central 8,090 St. Nicholas 14,012 Abbey Wood 10,812 Well Hall 13,224 Avery Hill 11,693 Sherard 17,432 In the old parishes, the estimated populations are, therefore, as follows :— Woolwich 29,183 Plumstead 71,068 Eltham 42,349 Sickness and -Invalidity. There was no unusual or excessive mortality during the year which calls for any comment under this head. 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. Social Conditions. The Borough covers an area of 8,282 statute acres, and includes a small area north of the Thames. The River Thames covers, within the Borough, 645 acres. The Borough is divided into two Parliamentary Divisions of East Woolwich and West Woolwich, and is further sub-divided into fourteen Wards. It may be described as one of the suburban working-class Metropolitan Boroughs. The number of persons per acre varies from 6 in Avery Hill Ward to 70 in the Central Ward, the general average of the Borough being 17. 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 shewn below TABLE No. 3. Births—Legitimate 2,097 „ Illegitimate 58 2,155 Still-births 73 „ Rate per 1,000 total births 339 Birth Rate 15.1 Deaths 1,654 Death Rate 11.6 Percentage of total deaths occurring in public institutions 56.7 Number of women dying in, or in consequence of, Child Birth . (a) From Sepsis 6 (b) From other causes 2 Deaths of Infants under one year 128 (a) Legitimate 120 (6) Illegitimate 8 Infantile Mortality Rate 59 Deaths from Measles (all ages) 1 ,, ,, Whooping Cough (all ages) 9 ,, „ Diarrhoea (under 2 years of age) 6 12 The chief Vital Statistics since 1901 are given in the following Table :— TABLE No. 4. Year. Population estimated to middle of each Year. Births. Nett Deaths belonging to the District. Nett. Under 1 year. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. (1) (2) (3) (4) (5) (6) (7) (8) 1901 117,652 3536 30.1 457 129 1709 14.6 1902 119,285 3734 31.3 467 125 1837 15.4 1903 117,842 3684 31.3 398 108 1638 13.9 1904 118,456 3535 29.8 477 135 1763 14.9 1905 118,589 3546 29.9 362 102 1604 13.5 1906 119,143 3549 29.8 388 109 1668 140 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 141,783 130,313 3068 23.5 213 69 1704 13.1 b 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 110 b 139,980 1925 a 145,440 2582 18.3 141 55 1519 10.8 b 140,740 1926 a 146,200 2463 17.4 107 43 1450 10.2 b 141,900 1927 a 144,770 2242 15.9 95 42 1491 10.6 b 140,770 1928 a 146,600 2269 161 114 50 1554 11.0 b 141,100 1929 o 146,800 2312 16.3 144 62 1780 12.6 6 141,600 1930 a 146,800 2188 15.5 91 42 1547 10.9 b 141,600 1931 a 147,400 2155 151 128 59 1654 11.6 b 142,600 a Total Population. b Civil Population. 13 The chief Vital Statistics for 1931, for the Wards of the Borough, are given in the following Table:— TABLE No. 5. Wards. Population. Births. Deaths under 1. Deaths all Ages. Number. Rate. Number. Rate. Number. Rate. Dockyard 7,148 123 17.2 9 73 76 10.6 St. Mary's 5,267 107 20.3 6 56 66 12.5 River 11,735 171 14.6 12 70 163 13.9 St. George's 5,033 165 32.8 9 55 88 17.5 Woolwich 29,183 566 19.4 36 64 393 13.5 Burrage 8,163 134 16.4 7 52 112 13.7 Herbert 8,516 125 14.7 12 96 111 13.0 Glyndon 8,837 123 13.9 6 49 131 14.8 St. Margaret's 12,638 165 13.1 12 73 149 11.8 Central 8,090 104 12.9 6 58 123 15.2 St. Nicholas' 14,012 216 15.4 10 46 173 12.3 Abbey Wood 10,812 127 11.7 7 55 103 9.5 Plumstead 71,068 994 14.0 60 60 902 12.7 Well Hall 13,224 161 12.2 7 43 108 8.2 Avery Hill 11,693 191 16.3 7 37 123 10.1 Slier ard 17,432 243 13.9 18 74 128 7.3 Eltham 42,349 595 14.0 32 54 359 8.5 borough 142,600 2,155 15.1 128 59 1,654 11.6 The rates St. Mary's, River and St. George's Wards, and Woolwich Parish, are aicuiatea on the Civil population only; if the Military are included, these rates are substantially lower; the birth rates becoming, respectively, 17.1, 14 1, 19.4 and 16.6, and the death rates 10.5, 10.4 and 11.6. The infantile mortality rates remain unchanged. Births. During the year 2,333 births were registered in the Borough, 1,190 being males and 1,143 females. Corrected by outward (176 males and 195 females) and inward (92 males and 101 females) transfers, these numbers become 2,155, 1,106 and 1,049 respectively. The birth rate was 151, compared with 15 5 in 1930 and 16 3 in 1929. Illegitimate Births.—The number of illegitimate births registered was 52. ere were 16 inward transfers and 10 outward transfers, making a nett figure of 58, equivalent to 27 per 1,000 births. 14 Natural Increase of Population.—This term means the excess of births over deaths. In 1928 it was 715, in 1929, 532, in 1930, 641, and in 1931, 501. Notification of Births.—During the year 2,303 live births were notified. This is at the rate of 98'7 per cent, of the registered births and compares with 98'0 per cent, last year. The births were notified as shown in the following Table :— TABLE No. 6. Midwives 817 British Hospital for Mothers and Babies 663 Military Families' Hospital 200 St. Nicholas Hospital 184 War Memorial Hospital 144 Medical Practitioners 118 Parents 72 Eltham Cottage Hospital 36 Midwives' Homes 18 Other Persons 51 In addition to these, 44 notifications were received from the Medical Officer of Health, Greenwich, 63 from the Medical Officer of Health, Lewisham, and 35 from other Medical Officers of Health. 84 still.births were notified. It is known that 1,047 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 48.58. The following Table, No. 7, 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. 7. Year. No.of Births. No. of Live Births Notified. No. of Still Births. Percentage of Births Notified. Birth Rate. Woolwich. London. England and Wales. 1926 2463 2442 68 95 17.4 171 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 1931 2155 2303 84 99 15.1 15.0 15.8 15 Marriages. There were 1,250 marriages (1,082 in 1930). The marriage rate was 17.05, as compared with 13.9, 17.7, 14.1 and 15.3 in the four preceding years. Deaths. The total deaths registered in the Borough was 1,485. This figure includes 166 non-residents who died in the district, but does not include 335 residents who died outside the Borough. When allowance is made for inward and outward transfers the nett figure of 1,654 is obtained. The death rate for the year was 11 '6, compared with 10.9 in 1930 and 12.6 in 1929. In four of the Metropolitan boroughs lower death rates were recorded as under :— Lewisham, 10.2; Greenwich, 114; Wandsworth, 114; and Hackney 11.5. In 1931 the death rate for England and Wales was 12.3, for London 12.4, and the mean death rate for 107 County Boroughs and Great Towns (including London) was 126. The seasonal mortality in the four quarters of the year was as follows:— First Quarter, 15.2; Second Quarter, 10.4; Third Quarter, 9.4; Fourth Quarter, 11.0. Deaths in Public Institutions.—In tabular form is shewn below the number of deaths of Woolwich residents which took place in various institutions during the year:— TABLE No. 8. Hospital or Institution. Number of Deaths. Public General Hospitals 665 Voluntary General Hospitals 129 Mental Hospitals 48 Special Hospitals 35 Infectious Diseases Hospitals 18 Sanatoria and Tuberculosis Institutions 20 Cottage Hospitals and Nursing Homes 23 938 T he following Tables are self explanatory:— TABLE No. 9. Birth.rate, Death.rate, and Analysis of Mortality during the Year 1931. 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 15.8 0.67 12.3 0.01 000 0.08 001 0.06 0.07 0.36 0.54 5.9 66 91.2 6.2 1.7 0.9 107 County Boroughs and Great Towns, including London. 16.0 0.67 12.6 0.00 0.00 0.10 0.01 0.08 0.08 0.33 0.53 7.9 72 91.6 5.7 2.2 0.5 159 Smaller Towns (1921 Adjusted Populations 20,000-50,000). 15.6 0.73 12.1 0.01 0.00 0.07 0.02 0.06 0.06 0.37 0.52 4.9 66 92.7 5.1 1.2 1.0 London 15.0 0.50 12.4 0.01 0.00 0.03 0.02 0.07 0.06 0.26 0.58 9.7 65 89.5 6.2 4.2 0.0 WOOLWICH 15.1 0.51 11.6 0.00 0.00 0.01 0.03 0.06 0.04 0.24 0.37 2.8 59 90.5 6.2 3.3 0.0 16 Table no.10 Deaths registered during the calendar year 1931, and deaths in Public Institutions. Causes of Death. Nett Deaths at the subjoined ages of "Residents " whether occurring within or without the District. Deaths in Public Institutions. 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 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. In Borough. Outlying Institutions Residents. NonResidents. All Causes 1654 128 29 30 33 74 84 85 176 275 362 378 628 152 310 Typhoid and Paratyphoid Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. Scarlet Fever 5 2 .. .. 3 .. .. .. .. .. .. .. .. .. .. Whooping Cough 9 6 2 1 .. .. .. .. .. .. .. .. .. 1 4 Diphtheria 6 .. 1 3 2 .. .. .. .. .. .. .. 2 .. 3 Influenza 34 1 3 2 .. 1 .. 2 4 4. 7 10 12 1 3 Encephalitis Lethargica 2 .. .. .. .. .. .. .. 1 1 1 10 12 1 2 Cerebro-Spinal Fever 4 1 .. 1 .. .. 1 .. .. 1 .. .. 1 .. .. Tuberculosis of Respiratory System 148 .. .. 1 .. 40 34 21 29 19 4 .. .. .. 4 Other Tuberculous Diseases 20 2 3 3 7 2 .. 1 .. .. .. 2 60 4 38 Syphilis 9 3 .. .. .. .. 1 2 2 .. 1 .. 13 3 6 General Paralysis of the insane, Tabes Dorsalis 4 .. .. .. .. .. .. 2 .. 1 1 .. 5 .. 2 Cancer, malignant disease 220 .. .. .. .. .. 3 18 31 61 70 37 74 22 54 Diabetes 16 .. .. .. .. 1 2 1 1 3 6 2 9 1 1 Cerebral Haemorrhage, etc. 75 .. .. .. .. .. .. 2 3 13 25 32 24 7 6 Heart Disease 367 .. .. .. 2 5 13 10 36 62 123 116 141 21 33 Aneurism 6 .. .. .. .. .. .. 1 1 3 1 .. 2 2 1 Other Circulatory Diseases 43 .. .. .. .. .. .. .. 4 10 14 15 6 2 13 Bronchitis 91 4 1 .. 1 .. 1 .. 4 12 22 46 13 4 11 Pneumonia (all forms) 126 29 13 6 5 4 4 4 8 21 19 13 55 15 20 Other Respiratory Diseases 20 1 .. .. .. .. 1 .. 2 4 5 7 5 .. 5 Peptic Ulcer 15 .. .. .. .. .. 1 1 3 7 2 1 5 4 5 Diarrhoea, etc. 9 5 1 1 .. 1 .. .. .. 1 .. .. 3 1 5 Appendicitis 9 .. .. .. 2 .. .. .. 3 2 1 1 8 1 5 Cirrhosis of Liver 3 .. .. .. .. .. .. .. .. 3 1 1 8 4 .. Other diseases of Liver, etc. 7 .. .. .. .. 1 .. .. 2 3 1 .. 1 .. .. Other Digestive Diseases 34 3 .. 3 .. 1 1 .. 5 3 8 10 14 5 2 Acute and Chronic Nephritis 49 .. .. .. 1 1 2 1 7 9 17 11 14 5 12 Puerperal Sepsis 6 .. .. .. .. 1 2 3 .. .. .. .. 3 10 5 Other Puerperal Causes 2 .. .. .. .. 2 .. .. .. .. .. .. O 2 2 3 Congenital Debility, Premature Birth, Malformations, etc. 62 61 1 .. .. .. .. .. .. .. .. .. 32 10 .. Senility 56 .. .. .. .. .. .. .. .. 2 6 48 31 10 7 Suicide 14 .. .. .. .. .. 2 3 3 2 3 1 8 4 18 Other Violence 53 3 2 5 5 9 5 2 6 4 3 9 25 11 14 Other defined Diseases 128 7 2 4 4 5 11 11 21 24 23 16 63 14 29 Causes ill-defined or unknown 1 .. .. .. .. .. • • • • .. .. .. 1 1 .. .. 17 B TABLE No. 11. Nett Deaths Registered during 1931, Classified by Sex and Wards. Causes of Death. The Borough. Woolwich. Plumstead. Eltham. Males Females Dockyard St. Mary's River St. George's Burrage Herbert Glyndon St. Margaret's Central St. Nicholas' Abbey Wood Well Hall Sherard Avery Hill All Causes 848 806 76 66 163 88 112 111 131 149 123 173 103 108 128 123 Typhoid and paratyphoid fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Scarlet fever l 4 2 .. 1 .. .. .. .. .. .. 1 .. 1 .. .. Whooping Cough 2 7 .. 1 1 .. .. .. 2 1 2 1 .. 1 .. .. Diphtheria 4 2 1 .. .. .. .. .. 1 .. .. .. 1 1 2 .. Influenza 16 18 .. .. 8 1 4 4 2 4 .. 2 1 4 .. 4 Encephalitis lethargica 1 1 .. .. .. .. .. .. .. 2 .. .. .. .. .. .. Cerebro-Spinal Fever 2 2 .. 1 1 .. .. .. .. .. 1 .. 1 .. .. .. Tuberculosis of respiratory system 86 62 5 8 14 6 7 16 12 7 22 14 6 16 7 Other tuberculous diseases 13 7 .. 1 3 .. 2 1 2 1 .. 2 1 1 4 2 Syphilis 7 2 .. .. 2 .. 1 1 .. 2 1 1 1 .. .. .. General paralysis of the insane, tabes dorsalis 3 1 1 .. 1 .. 1 .. .. .. .. .. .. .. .. 1 Cancer, malignant disease 125 95 7 9 20 17 19 11 15 17 13 21 18 14 19 20 Diabetes 5 11 1 3 .. 1 1 2 1 .. 1 1 5 .. .. .. Cerebral haemorrhage, etc. 28 47 3 4 6 5 7 6 5 9 11 4 2 2 3 8 Heart disease 172 195 15 13 44 20 31 25 30 36 33 31 25 20 14 30 Aneurism 6 .. .. .. .. .. 1 .. .. .. .. 2 1 1 1 .. Other circulatory diseases 26 17 4 1 6 1 4 2 5 3 3 4 2 3 2 3 Bronchitis 44 47 6 2 6 5 3 9 7 10 11 16 3 3 5 5 Pneumonia (all forms) 63 63 7 8 10 7 7 7 8 7 8 13 12 9 16 7 Other respiratory diseases 11 9 3 o 2 .. 1 .. 2 1 4 3 .. 1 1 .. Peptic ulcer 13 2 3 .. 2 .. .. 1 2 2 .. 3 2 .. .. Diarrhoea, etc. 6 3 .. .. .. .. .. 2 1 2 .. 1 .. 1 1 1 Appendicitis 6 3 1 .. 1 .. 1 .. .. .. .. 3 2 1 .. .. Cirrhosis of liver 3 .. .. .. 1 .. l .. .. .. .. 1 .. .. .. .. Other diseases of liver, etc. 2 5 .. .. .. .. .. .. 1 .. 1 .. .. 2 1 2 Other digestive diseases 15 19 1 .. 1 1 2 5 1 7 2 3 1 2 5 3 Acute and chronic nephritis 25 24 4 1 .. 2 3 5 7 9 3 5 1 5 3 1 Puerperal sepsis .. 6 .. .. .. .. 1 .. .. 1 1 1 .. .. 1 1 Other puerperal causes .. 2 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. Congenital debility, premature birth, 25 37 2 6 7 7 3 7 1 4 2 4 2 3 10 4 formation, etc. Senility 19 37 1 .. 7 1 1 3 5 5 10 10 .. 9 1 3 Suicide 7 7 .. 1 .. .. 1 1 .. 1 1 1 .. .. 4 4 Other violence 43 io 3 2 6 5 3 5 3 1 1 5 3 6 6 4 OfcYier defined diseases Caunen ill-defined or unknown 67 1 61 6 3 13 7 8 5 12 12 7 12 7 10 13 13 18 19 Causes of Death.—Table No. 10 shews that 367 deaths were due to Heart Disease, 220 to Cancer, 168 to Tuberculosis, 126 to Pneumonia, 91 to Bronchitis, and 75 to Cerebral Haemorrhage. There were 62 deaths from Congenital Debility and Prematurity. In every instance these figures are above those of 1930. There were 34 deaths from Influenza, compared with 13 in 1930, but there was only one death from Measles, as against 15. Seventy-two per cent, of all deaths occurred in persons over 45 years of age. Respiratory Disease.—The following Table, No. 12, shews the number of deaths each year since 1927 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. 12. Year. Bronchitis. Pneumonia. Other Respiratory. Total. Death Rate. Number under 5 years. Percentage under 5 years. 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 1931 91 126 20 237 1.7 54 22.8 Cancer.—The total number of deaths was 220, of which 125 occurred in males and 95 in females. In the following Table, No. 13, is shewn the number of deaths certified as due to Cancer and Malignant Disease, each year since 1927 :— TABLE No. 13. Deaths from Cancer and Malignant Disease. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 1927 101 109 210 1.49 14.08 1928 100 109 209 1.48 13.45 1929 93 120 213 1.50 11.97 1930 107 94 201 1.42 12.99 1931 125 95 220 1.54 13.30 20 The following Table, No. 14, shews the seat of primary disease in all deaths from Cancer (including all other specified malignant tumours) :— TABLE No. 14. Seat of Primary Disease. Males. Females. Total. Deaths in Hospital. Lip — 1 1 — Tongue 7 1 8 5 Mouth and Tonsil 1 1 2 2 Jaw 3 — 3 3 Oesophagus 10 — 10 7 Stomach 25 14 39 23 Liver and Gall Bladder 5 5 10 4 Intestines 15 21 36 20 Rectum 18 7 25 13 Ovary . — 3 3 2 Uterus — 14 14 7 Breast — 17 17 7 Skin 5 1 6 6 Larynx 3 3 3 Lung 5 3 8 3 Pancreas 5 2 7 4 Kidney 2 1 3 3 Bladder 3 1 4 3 Prostate 11 — 11 7 Testis 1 — 1 1 Thyroid — 1 1 1 Abdominal Cavity — 1 1 1 Sarcoma 6 1 7 3 125 95 220 128 21 Maternal Mortality.—The number of deaths from Puerperal Sepsis was 6, and from other accidents and diseases of pregnancy, 2, making a total of 8 maternal deaths, the same number as in 1930. The maternal death rate per 1,000 births was 3.71. The following Table shews the causes of death each year since 1912 TABLE No. 15. Maternal Mortality, Woolwich, 1912-1931. Year. Abortion. Ectopic Gestation. Placenta Praevia. Other Puerperal Haemorrhage. Other Accidents of Child Birth. Child Birth with Secondary Causes. Puerperal Eclampsia. Puerperal Phlebitis and Embolism. Puerperal Fever. Totals. 1912 1 - - - - - 1 1 1 4 1913 1 - - - 1 - 1 - 2 5 1914 1 - 1 2 - 1 1 1 4 11 1915 1 1 - - 1 - 2 - 3 8 1916 - 1 1 1 4 - 1 - 7 15 1917 - 1 - 2 - 1 2 1 7 14 1918 1 - - 2 1 - 1 1 9 15 1919 - 2 1 2 - - 2 1 5 13 1920 - 1 - - 1 - 1 3 5 11 1921 - - - - - - 3 2 5 10 1922 - - - 1 - - 2 - 3 6 1923 - - - - 1 - 1 - 3 5 1924 - - 2 1 1 - 3 1 2 10 1925 - - 1 2 1 1 1 - 3 9 1926 - 1 - 2 - - - 1 2 6 1927 - 1 - - - - 1 1 3 6 1928 - 2 1 - 1 - 1 - 8 13 1929 2 2 - - 2 1 3 1 3 14 1930 1 - - - - 1 2 - 4 8 1931 — — — — 1 — 1 — 6 8 Totals 8 12 7 15 15 5 30 14 85 191 22 Inquests.—There were 103 inquests held on Woolwich residents during the year, compared with 130 in 1930. 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, 30. In 1930 these figures were 29 and 23. The causes of death are given in detail in Table No. 10. The following Tables shew the variation in rates of mortality in these ages in the last five years. These rates have been calculated on the estimated populations living at these ages and in stated groups of diseases :— TABLE No. 16. Child Mortality (1—2 years). Death Rates per 1,000 estimated age population from stated Groups of Diseases Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarr. hceal Diseases. All other causes. Total Deaths. 1927 2,348 2.13 1.70 3.41 - 1.70 8.94 1928 2,129 4.70 .94 2.82 .94 1.88 11.27 1929 2,141 4.20 .47 2.80 1.40 4.20 13.07 1930 2,190 5.48 .91 4.11 1 . 37 1.37 13.24 1931 2,071 1.45 1.45 6.76 .48 3.86 14.0 TABLE No. 17. Child Mortality (2—5 years). Death Rates per 1,000 estimated age population from stated Groups of Diseases Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrheal Diseases. All other causes. Total Deaths. 1927 7,476 .94 .54 1.47 .13 .80 3.88 1928 7,121 1.83 .42 .42 .14 .98 3.79 1929 6,822 1.91 .44 1.02 .14 1 . 91 5.42 1930 6,534 1.39 .46 .92 .00 .76 3.53 1931 6,373 .78 .62 .94 .16 2.20 4.70 23 Infantile Mortality. The number of deaths of infants under one year of age was 128, compared with 91 in 1930, and 144 in 1929. The rate of infant mortality resulting from these deaths (deaths under one year per 1,000 births) was 59, compared with 42 in 1930 and 62 in 1929. The rates for the different wards in the Borough are shewn in Table No. 5. In seven metropolitan boroughs lower rates were recorded as under:—Chelsea, 42; Lewisham, 50; Deptford, 53; Stoke Newington, 54; Camberwell, 56; Battersea, 57; and Bermondsey, 57. The rate for the administrative county was 65, and for England and Wales, 66. The following Table, No. 18, shews the distribution of infantile mortality throughout the year calculated on a varying year basis :— TABLE No. 18. Births. Deaths under 1 Year. Rate. First Quarter 580 42 73 Second Quarter 576 31 54 Third Quarter 507 26 46 Fourth Quarter 492 29 52 Causes of Death.—The causes of infantile mortality are set forth in Tables Nos. 20 and 21, which shew the incidence of mortality from each cause for infants, distinguished by age, sex and wards. It will be noted from these tables that the chief causes of death were:—Premature Birth, 31; Pneumonia, 29; Congenital Malformation, 11; Debility, 8; and Injury at Birth, 8. There were five deaths from Enteritis and Diarrhoea. The neo-natal mortality rate (deaths under 4 weeks) was 28.77, compared with 20.11 in 1930 and 26-81 in 1929. Of the 46 neo-natal deaths, 25 were certified as due to premature birth, 4 to injury at birth, 4 to congenital malformation, and 4 to debility. The deaths from pneumonia accounted for nearly half the increase in the infantile mortality rate. Deaths of Illegitimate Children.—Eight illegitimate children died, compared with 1 in 1930, and 7 in 1929. Institutional Deaths.—In tabular form is shown below the number of deaths of Woolwich infants which took nlace in various institutions durinc the vear. These figures are included in those shewn in Table No. 8:— TABLE No. 19. Hospitals or Institutions. Number of Deaths. Public General Hospitals 55 Voluntary General Hospitals 10 Fever Hospitals 6 Special Hospitals 14 ~85 Tables are set out in the following pages which classify in various ways the causes of infant death in 1931. TABLE No. 20. Infant Mortality, 1931. 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 .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. 2 2 Whooping Cough .. .. .. .. .. .. .. .. 2 6 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. • • Tuberculous Meningitis .. .. .. .. .. .. .. .. .. 2 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. Convulsions .. .. .. .. .. .. .. .. .. .. Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. 1 1 2 .. .. 4 Pneumonia .. .. .. .. 3 6 4 9 7 29 Diarrhoea .. .. .. .. .. 1 .. .. .. 1 Enteritis .. .. .. .. .. 3 .. .. .. 4 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. 1 .. .. .. .. 3 Rickets .. .. .. .. .. .. .. .. .. • • Suffocation, Overlying .. .. .. .. .. .. .. .. .. .. Injury at Birth.. 5 3 .. .. 8 .. .. .. .. 8 Atelectasis 3 .. .. .. 3 .. .. .. .. 3 Congenital Malformation 4 2 1 1 8 2 1 .. .. 11 Premature Birth 25 2 1 .. 28 1 2 .. .. 31 Atrophy, Debility and Marasmus 4 .. 2 .. 7 1 .. .. .. 8 Other Causes 3 .. .. .. 3 4 5 1 3 16 46 8 6 2 62 24 16 12 14 128 Nett Births registered during the calendar year. Legitimate, 2,097 ; Illegitimate, 58. Nett Deaths registered during the calendar year . . Legitimate, 120 ; Illegitimate, 8. 24 TABLE No. 21. Nett Infant Deaths, Classified by Sex and Wards. Causes of Death. The Borough. Woolwich. Plumstead. Eltham. Males. Females. Dockyard. St. Mary's River St. George's Burr age Herbert Glyndon St. Margaret's Central St. Nicholas' Abbey Wood Well Hall Sherard Avery Hill Smallpox - - - - - - - - - - - - - - - - Chickenpox - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - Scarlet fever 1 1 1 - 1 - - - - - - - - - - - Whooping cough 2 4 - 1 - — - - 1 — 1 1 - — Diphtheria and Croup - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - Tuberculous meningitis 2 - - — - 1 - - — — 1 — — Abdominal tuberculosis - - - - - - - - - - - - - - - Other Tuberculous diseases - - - - - - - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - - - - -Bronchitis 1 3 1 — — — — 1 — 2 — — - - ~ Pneumonia 11 18 4 - 1 1 2 1 2 2 3 2 4 - 6 1 Diarrhoea - 1 - - - - - - 1 — — - - — — Enteritis 4 - - - - - - - - - - 1 - 1 1 1 Gastritis - - - - - - - - - - - - - - - Syphilis 2 1 - - 1 — - 1 - — — - 1 - — — Rickets - - - - - - - - - - - - - - - - Suffocation, overlying - - - - - - - - - - - - - - - - Injury at Birth 4 4 - 1 1 - - 1 - - - - 1 2 2 Atelectasis 2 1 - 2 - 1 - - - - - - - - - - Congenital malformation 6 5 — — 1 2 — 1 1 1 1 — - — 3 1 Premature birth 11 20 2 1 4 4 3 4 - 1 1 3 1 3 3 1 Atrophy, Debility and Marasmus 2 6 — 1 1 — — 1 — 2 t- 1 — — 2 — Other causes 9 7 1 - 2 1 1 2 - 3 1 1 - 2 1 1 57 71 9 6 12 9 7 12 6 12 6 10 7 7 18 7 25 26 SECTION III. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. i. 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. 22. 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. 1931 Proudfoot, M. E. M.B., Ch. B. Assistant Medical Officer (General Purposes). 1931 Saunders-Jacobs, E. V. M.A., M.B., B.S., M.R.C.S., L.R.C.P., B.Sc., D.P.H. do., do. 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. Obstetric Consultant (1931). 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 (part time). 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, 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. 27 (6) In tabular form is shown 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. 23. 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) 1901 Tedham, W. Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. 1904 PoweU. T. Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. 1920 Pendrill, H. W. Cert. San. Insp. Exam. Board, Cert. Advanced Inspectors' R.S.I., 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. Cert. Smoke Insp., R.S.I. Sanitary Inspector. 1931 Hoines, F. J. Cert. San. Insp. Exam., Joint Board. 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 Visitors Cert. Board of Education. Health Visitor. 28 TABLE No. 23—continued. Year appointed. Name. Qualifications. ntment. 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 Visitors Cert., Board of Education. Health Visitor. 1919 Tibbits, Miss E. Cert. San. Insp. Exam. Board, Health Visitors 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 Seceombe, 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. 1931 Taylor, S. G. - Vaccination Officer, (part time) 1921 Castledine, Mrs. L. Cert. General Hospital Training 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: Allen, L. Britter, A. Edwards, Mrs. N. Smith, H. S. Collyer, H. M. Pike, L. Stephenson, Miss D. Crawford, Miss I. Prescott, H. T. Taylor, S. G. (part time). The Medical Officer of Health is Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme, 29 ii. Professional Nursing in the Home. The arrangements for providing nursing assistance in the home were set out fully in my annual report for 1930. No change has taken place in the constitution of the various Associations or of the areas in which they work. They are all under agreement with the Council to provide nursing assistance at the cost of the Council for cases of measles, whooping cough, zymotic enteritis, ophthalmia neonatorum, pneumonia, anterior poliomyelitis, puerperal fever and puerperal pyrexia. The rates of payment vary from 6d. to 1s. 3d. per visit. Tuberculosis was added to this list during the year, and payment is made at the rate of 1s. 3d. per visit. iii. Midwives. There are 110 whole-time midwives employed by the Council. By the courtesy of the County Medical Officer of Health, I have been able to ascertain that 52 midwives gave notice during the year of their intention to practise in the Borough. iv. Laboratory Facilities. During the year the agreement with the Seamen's Hospital for the bacteriological work of the Council was terminated and a new one entered into with the Board of Management of the Woolwich War Memorial Hospital. The change arose in this way. A pathologist and bacteriologist was appointed on the staff of the Memorial Hospital and facilities thus became available for this work to be done locally. Accordingly, the change was made on the 1st October. It meant the severance of a happy relationship of long standing with the Seamen's Hospital, but it was felt that as the Council was so intimately connected with the development and maintenance of the Woolwich War Memorial Hospital, that the bacteriological work should be carried out there, as an equally efficient service was now available. The new agreement provided for the continuance of the same rates of payment. The bacteriological examination of milk samples is carried out by the Clinical Research Laboratory at a cost of 5s. Od. per 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. 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 227 advances to purchasers of houses in accordance with the provisions of these Acts. 30 By-laws and Regulations.—A complete list of the various by-laws and regulations in force in the Borough was given in the Annual Report for 1930, and no change has taken place during the year with the exception that chicken pox, which was made notifiable on the 1st April, 1930, and continued for a further period of six months from October of that year, was again renewed until the 30th September, 1931 only. vi. Hospitals. The Medical Officer of Health is asked to report under this heading on the hospitals belonging to the local authority and hospitals with which the local authority has made arrangements for the admission of patients. There are no hospitals belonging to this local authority, but arrangements for the admission of patients have been made with two local hospitals:— (a) War Memorial Hospital; (b) British Hospital for Mothers and Babies. The Council's arrangements with these hospitals were fully reported on in last year's Annual Report, but it may be convenient to refer to them briefly here. At the War Memorial Hospital the Council reserve twelve beds for children under five years, and sufficient accommodation as may be necessary for 66 maternity cases per annum. In addition, the hospital authorities are under contract to provide emergency treatment as occasion arises for such cases of midwifery as require it. At the British Hospital for Mothers and Babies, such accommodation as may be necessary for 144 confinements per annum, and for their ante-natal treatment, is reserved for cases sent by the Borough Council. vii. Institutional Treatment for Unmarried Mothers, Illegitimate Infants and Homeless Children. There are no special provisions for any of these classes in the Borough. viii. Ambulance Facilities. The London County Council's ambulance service is available:— (a) For the removal to hospital, free of charge, of persons suffering from infectious disease; (b) For the removal, on payment, of persons suffering from non-infectious disease to hospitals or other places; (c) For the removal, free of charge, of cases of accident and sudden illness arising in the streets or public buildings, to hospitals or home. (d) For the removal, free of charge, 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 nurse. 31 During the year the Council entered into an agreement with the London County Council for the conveyance of non-urgent maternity cases between 8 a.m. and 11 p.m., on payment by the Borough Council in accordance with the rates set out in the following schedule:— For removal of a maternity case:— 5s. 0d., or at the rate of 1s. 0d. a mile, whichever is the less, with a minimum charge of 3s. 6d. Mileage to be reckoned from the ambulance station nearest to the patient's address including the return journey to that station. For the provision of a nurse to accompany the case:— 5s. 0d. for a period of up to two hours, and thereafter at an extra charge of 2s. 0d. an hour or part of an hour. For waiting:— 5s. 0d. an hour or part of an hour after 15 minutes. ix. Clinics and Treatment Centres. In tabular form below is shewn a list of clinics and treatment centres in the Borough. This list differs from the one published last year in the following respects:— Maternity and Child Welfare.—(a) The Centre at 179, Well Hall Road, Elthain, was closed and the work transferred to the Council's new Welfare Centre at Westhorne Avenue, Eltham. (b) A new Maternity and Child Welfare Centre was opened at St. Luke's Church Hall, Westmount Road, Eltham. School Clinics.—The School Clinic at Park Place, Eltham, was closed and the work transferred to the Council's Health Centre in Westhorne Avenue. Tuberculosis Dispensary.—A branch Tuberculosis Dispensary was opened at 179, Well Hall Road, Eltham. Venereal Diseases.—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. 32 TABLE No. 24. Clinics and Treatment Centres. Situation. Nature of Accommodation. By Whom Provided. Sessions weekly. Maternity and Child Welfare Centres. Old Town Hall, Woolwich Doctor's Room, Weighing Rooms, Waiting Rooms, etc. Woolwich Borough Council. 8 236, Plumstead High Street do. do. 6 Westhorne Avenue, Eltham Doctor's Room, Ante-Natal Room, Ante-Room, Weighing Room, Waiting Room, Lecture Hall. do. 6 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 St. Luke's Hall, Westmount Road. Doctor's Room Weighing Room do. 1 Sunlight Clinic. Old Town Hall, Woolwich Treatment and Weighing Rooms, etc. do. 9 Day Nurseries. Nil. School Clinics. Brewer Street, Woolwich Doctors' Rooms, Treatment Rooms, Waiting Rooms. Local Medical Association. Daily. 236, Plumstead High Street do. do. do. 4 Plumstead High Street do. do. do. Daily. Westhorne Avenue, Eltham Doctor's Room, Dentists' Room, Recovery Room, Minor Ailments Room, Waiting Room. do. Daily. 33 TABLE No. 24—continued. Situation. Nature of Accommodation. By Whom Provided. Sessions weekly. 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. 179, Well Hall Road Doctor's Room Waiting Room do. 3 Venereal Diseases. Nil. Orthopaedic Clinic. 8, Thomas Street, Woolwich Clinic Waiting Room Dressing Room Woolwich Invalid Children's Aid Assocn. Daily. The Health Centre at Westhorne Avenue was fully described in the Maternity and Child Welfare section of the Annual Report for 1930. During the year an arrangement was entered into with the local Medical Association whereby the necessary accommodation for the examination and treatment of school children was reserved at the Health Centre, Eltham, in accordance with the terms of an agreement similar to that entered into with the same Association for the use of the Council's welfare centre at Plumstead for dental sessions on two days a week, but with this difference—the dental clinics at Plumstead Centre are held on different days in the same rooms as are used for maternity and child welfare purposes, whereas at the Eltham Health Centre there are separate sets of rooms. x. Maternal Mortality. In accordance with the terms of the Ministry of Health Circular 888, confidential enquiries are made by the Council's medical officers into every maternal death, and reports are furnished to the Ministry of Health. The services of a Consultant burgeon have been made available for consultation and treatment in cases of puerperal fever or puerperal pyrexia. Arrangements have been made for bacteriological examination in such cases and for home nursing. 34 In December, 1930, a Memorandum, 156/MCW, dealing with ante-natal services, was issued by the Ministry of Health, in which certain suggestions were made to facilitate progress in dealing with the care of the expectant, the lying-in and nursing mother. This was carefully considered by the Council, and the Ministry were informed that:— (1) As the supply of midwives is adequate, it is not proposed to take any steps to provide a municipal midwife. (2) The Council already retains the services of a Consultant for cases of puerperal fever, and has reserved beds in two voluntary hospitals for emergencies occurring during pregnancy or parturition. (3) The Council provides 12 maternity beds for cases needing institutional treatment (including abnormalities), and also for patients whose home conditions are unsuitable for confinement. The extension of these services is being considered. (4) The Council has already made arrangements for the provision of sterilised maternity outfits, for home helps, for the supply of milk to expectant and nursing mothers, and for the provision of laboratory facilities for the examination of pathological material. (5) As part of the Council's health propaganda scheme, arrangements are made from time to time for lectures to women's societies on questions affecting pregnancy. In reply the Minister wrote as follows:— ". I am directed by the Minister of Health to express his appreciation of the excellent and comprehensive provision made by the Borough Council in regard to maternity services. "In connection with the arrangements indicated in paragraph 3 of your letter, the Minister assumes that the services of a Consultant would be available in an exceptional case of obstetric or ante-natal abnormality in which it was not considered practicable to remove the patient to hospital." The Council gave further consideration to the final paragraph of the above letter, and arranged for Mr. H. Taylor, F.R.C.S., the Borough Council's Consultant under the Puerperal Fever Regulations, to see any such case and to pay him a fee of five guineas on each occasion. xi. Health Visiting. The arrangements made for the visiting of children between the ages of one and five years and the general working of the Council's maternity and child welfare scheme are described in Section IX. 35 xii. Vaccination. I submit a return by the Vaccination Officer on the work carried out under the Vaccination Acts for the year 1930. TABLE No. 25. RETURN to be made on or before the 9th of February, 1932, 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, 1930, 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, 1930. Number of these Births duly entered by 31st January, 1932, 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 476 227 - - 201 18 2. Woolwich† 1,339 737 2 — 453 47 3. Eltham 508 262 2 — 190 11 Total 2,323 1,226 4 — 844 76 Number of these Births which on 31st January, 1932, remained unentered in the "Vaccination Register" on account (as shown by "Report Book") of Number of these Births remaining on 31st Jan., 1932, 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, 1931. 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 1931. 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. 6 4 14 6 These figures are to be obtained from columns 2 and 6 of the Summary (Form N.). 6 40 43 11 4 17 14 8 16 61 71 25 1,380* 913 For notes on Table 25 see page 36. 36 Notes on Table No. 25. 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:— 1. (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 1931 sent to other Vaccination Officers should be stated here:— 84. †Includes the Burrage and Herbert Wards in Plumstead Parish. (Signature) S. G. TAYLOR, Date—9th February, 1932. Vaccination Officer. The names, addresses and districts of the Public Vaccinators and their deputies were set out in detail on page 40 of my Annual Report for 1930. Mr. Oughton, who was Vaccination Officer when the Council took this service over on the 1st April, 1930, resigned as from the 31st January, 1931, on being appointed a whole time Collector in the service of the London County Council. Mr. S. G. Taylor, a clerk in the Public Health Department, was appointed part-time Vaccination Officer as from the 1st February, at a salary of £285 per annum, rising, in accordance with the terms of the Council's salaries scheme, and on the 16th April, 1931, Mr. H. S. Smith, a principal clerk in the Department, was authorised to act as deputy when occasion arose. xiii. Supply of Insulin to Persons Suffering from Diabetes. In May, 1930, the Council agreed to supply Insulin to diabetic patients who were necessitous and unable to obtain it under the National Health Insurance Acts, and obtained the Ministry's approval. A continuing approval was obtained in May, 1931. A supply of Insulin was given under this scheme to three patients during the year, the total cost being £6 18s. 3d. Insulin is supplied to medical practitioners under the following conditions : (1) The application must state the name, age, address and sex of the patient for whom it is required. (1) A quarterly report must be furnished in respect of each patient treated, giving the following information:— (а) The number of doses of Insulin administered. (b) Stating whether any tests were made of the urine or of the blood of the patient, and, if so, by whom and with what results. (c) A report on the progress of the patient. 37 SECTION IV.—HEALTH PROPAGANDA. Health propaganda and health education take a prominent part now in the work of the Department, and it can be definitely stated that the public demand for health education is increasing. For example, in field work, i.e., lectures to social educational, etc., organisations in the borough, there is an increasing demand from fresh sources and for repeat lectures. The public are interested in the prevention of disease and in the simple laws of healthy living, and are now shewing signs of seeking opportunities to acquire the necessary knowledge. The Council's activities on health propaganda work during the year may be classified as follows:— (a) Health Week.—The following is a copy of the report of the Public Health Committee to the Council:— "Health Week.—We report that, in accordance with the Council's resolution of the 29th July, 1931, we arranged a suitable programme for Health Week with the object of maintaining and further stimulating public opinion in matters of health. In this we were fortunate to obtain the co-operation of Ministers of Religion, Employers of Labour, School Teachers, the Local Press, individual townspeople, and representative associations, all of whom helped us in divers ways in making Health Week an effective force. "This year we organised a Health Exhibition, and were able to secure the co-operation of those Committees of the Council which deal directly or indirectly with matters affecting the public health, and of various national and local organisations. Trade exhibits were limited to those which directly bear on our work. The exhibition illustrated:—(a) the everyday work of the Health Department in its separate branches of general sanitation, maternity and child welfare and tuberculosis; (6) certain aspects of the work of the other Committees of the Council, viz., Allotments, Baths, Electricity, Housing, Libraries and Works; (c) glimpses of the daily routine of the following local organisations; Woolwich War Memorial Hospital, Woolwich and Plumstead Nursing Association, the Woolwich Invalid Children's Aid Association, and the Woolwich Red Cross Rheumatism Clinic; (d) the propaganda campaign of the British Social Hygiene Council, the Health and Cleanliness Council, the Dental Board of the United Kingdom, the Wesleyan and General Assurance Society, and the Cremation Society of England. The trade 38 exhibit was Messrs. Cow & Gate, who showed, in addition to their demonstration stand, two exhibits on the stage illustrating nurseries suitable for various incomes. Included in the War Memorial Hospital exhibit was a display by the Blood Transfusion Service of the British Red Cross Society in which an appeal was made for voluntary blood donors to come forward. In all 88 such donors recorded their names. In this connection we are very grateful to the Camberwell Borough Council who kindly permitted one of their officers—Mr. E. L. Oliver, O.B.E., who is the London Secretary of this organisation—to take charge of the stall during the whole period of the Exhibition. "The Exhibition arrangements included an official opening each day by distinguished speakers, to whom we are greatly indebted for their interest and help. A series of popular health lectures and cinema films were provided twice daily in the Council Chamber, and on one day, specially devoted to Electricity, Professor Chas. R. Darling gave a talk, illustrated by experiments, on 'Michael Faraday and his Discoveries.' "We are indebted to the Ministry of Agriculture and Fisheries, for the loan of the Model Allotment, the Rat Exhibit, and the National Mark Exhibit; to the London County Council for the Orthopaedic Exhibit; the National Smoke Abatement Society for Smoke Exhibits; to the Directors of the Wellcome Museum for the old blood-letting instruments; to St. Bartholomew's Hospital for the Pathological Exhibits; and to many others for the loan of smaller articles. "We were able to organise competitions both before and during the Exhibition, and are grateful to the various firms who contributed to the prize fund and enabled us to suitably reward the prize-winners. "The attendances during the week totalled 25,469, including 782 school children in conducted parties. "To all who helped by exhibiting, by speaking, by lending, by giving, and by working, we have extended the sincere thanks of the Council, and we take this opportunity of placing on record our appreciation of the work of the Council's staff." (b) 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 shewn. 39 The talks given during the year and the programme for 1931-32 are set out below:— Date. 1931. Subject and Lecturer. Cinematograph Films. January 19th "Five Good Friends " Dr. C. Isobel Wright "Football" "How We Breathe" "Demons of Decay" February 16th "Our Relay Race" Dr. C. Isobel Wright "Sports in Slow Motion" "Our Wonderful Body" (Part I.) "The Death Mystery" February 23rd "Pioneers in Health" Dr. Rachel Mackenzie "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" December 7th "How To Be Happy" Dr. E. V. Saunders-Jacobs "How We See" "Outposts of Health" "Tennis" 1932. January 18th "The Food We Eat" Dr. M. E. Proudfoot "Dirtie Bertie" "A Brush With the Enemy" "Health is Wealth" (Part I.) January 20th "Health's Helpers" Dr. R. E. W. Mackenzie "Almost a Tragedy" "Through Life's Windows" "The Care of the Teeth" February 15th "The Human Machine" Dr. R. E. W. Mackenzie "Beware of the Demons" "Swimming" "Where There's Life, There's 'Ope" February 17th "Our Teeth and How to Care for Them" Dr. M. E. Proudfoot "Outposts of Health" "The Climber" March 14th "Eyes and No Eyes" Dr. E. V. Saunders-Jacobs "Walking" "How We Breathe" "Almost a Tragedy" 40 (c) Health Lectures to Adults.—Two lectures were given at the Town Hall, as follows:— Date. 1931. Subject. Lecturer. January 26th "Sunlight and Education" Dr. R. Forgan, M.P. March 16th "How to Enjoy Life" Sir Robert Armstrong-Jones Either in conjunction with each lecture, or immediately afterwards, lantern slides or cinema films were shewn. (d) Informal Talks.—In 1929, a scheme for providing health talks to local organisations at their own meeting-place, was started, and has continued ever since. The speakers are all members of the Public Health staff, who talk on the particular work they are engaged on. The programme usually consists of a fifteen to twenty-minute talk, followed by question and answer, and then a cinema film is shewn. (e) "Better Health."—The issue of a local edition of this journal, inaugurated in 1930, was continued, and during the year 2,000 copies per month were distributed by the Medical Officer of Health through the welfare centres, libraries, schools, and to a limited number of residents in the borough selected at random. The journal is much appreciated. In the local pages, the opportunity is taken of advertising the Council's health services, and short articles are often published on matters of current interest. (f) Health Services Booklet.—A booklet of 16 pages, giving details of the Council's health services was published during the year. It may be obtained free of charge from the Health Department. 41 SECTION V.—SANITARY ADMINISTRATION. Staff.—At the end of 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. W. Little, who joined the staff of the Plumstead Vestry in 1896, was superannuated on the 7th October, on account of ill-health. Mr. F. J. Hoines was appointed to the vacancy so caused, and commenced duties on the 19th October. 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 small central area, 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 702 dustbins. Trade refuse is removed at a charge of 5s. per load, and 3159 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 by washing, followed by steam) being left each time a full one is collected. Drainage.—With relatively very few exceptions, every house in the Borough is connected with the water-carriage system. 42 New drainage and extensive reconstruction of old systems are supervised by the Borough Engineer, but in all other instances by the sanitary inspectors. During the year 62 complaints were received with regard to the defective action of combined drains. On investigation, it was found that 313 houses in all were affected. In every case the drains were cleared. In all the systems except 7 the obstruction was of a temporary nature. In 28 instances choked interceptors were found. Costs recovered from the owners amounted to £14 8s. 5d. In the following 7 instances reconstruction was necessary, and the work was carried out by the owners after service of notices:— 2 to 22, Church Manorway, and 1 to 31, Camrose Street. 196 to 214, Wickham Lane. 7 to 21, Kingsman Street, and 1, Short Street. 1a to 7, Manor Street. 62, 63, 64, Plumstead Road. 187, 189, 191, Sandy Hill Road. 15, 17, 19, Glyndon Road. Cesspools.—The number of cesspools in the Borough is 30, 20 being in Plumstead, and 10 in Eltham. This is a decrease of one on last year. The cesspools in Eltham are only to be found in isolated parts of the district. In Plumstead most of them are to be found near the top of Shooters Hill, and during the year the Council submitted a scheme for approval whereby a sewer would be constructed there and would lead ultimately to the abolition of practically all these cesspools. Action Taken with Regard to Smoke Abatement.—120 observations were made of chimney shafts, and 1 notice was served. Four offences were discovered, and warning letters were sent in each case. No legal proceedings were instituted. Complaints.—During the year 1931 there were 2,080 complaints of nuisances made to the Health Department and investigated by the Sanitary Inspectors of the Borough. Notices for the remedy or abatement of the defects or nuisances discovered were served upon the owner or person responsible under the Public Health (London) Act, 1891. Sanitary Inspection of the Area.—A summary of the inspections carried out by the Sanitary Inspectors will be found in Table No. 26. In connection, therewith, the number of Intimation and Statutory Notices served were 3,233 and 894 respectively. The Statutory Notices related to 711 premises and included 648 general, 139 ashpit, 57 water closet, and 43 paving notices. In addition to these notices under the Public Health (London) Act, 1891, 4 notices were served under the London County Council (General Powers) Acts and By-laws. 43 In 71 instances the owners did not comply with the Statutory Notices, and in each of these instances the Town Clerk sent a letter as a preliminary to legal proceedings. In all except 7 instances this was sufficient, and in these 7, summonses were issued. In Table No. 27 will be found a summary of the nuisances abated and defects remedied. TABLE No. 26. Inspections. Housing Survey—Houses Inspected 3,242 Drains Tested by Smoke Test 188 Drains Tested by Water Test 31 Complaints Investigated 2,080 New Houses 387 Outworkers' Premises 488 Tents and Vans 18 Houses Let in Lodgings 497 Factories 367 Houses re Infectious Disease 1,691 Workshops 660 Houses re Smallpox Contacts 209 Workplaces 175 Houses re Verminous Cases 1,342 Theatres and Cinemas 27 Houses re Scabies Cases 63 Rag and Bone Premises 8 Houses re Other Diseases 329 Urinals Accessible to the Public 271 Overcrowding Investigated— Rooms 70 Women's Lavatories 491 Smoke Observations 120 Underground Rooms Illegally Occupied 1 Special Inspections re Rats 349 Miscellaneous 1,437 Drainage Inspections 2,140 Re-Inspections 11,408 TABLE No. 27. Nuisances Abated. Cleansing— Dilapidations— Interiors Cleansed 1,465 Walls 988 Rooms Cleansed 3,228 Ceilings 815 Damp Conditions— Floors and Hearths 270 Coppers 213 Walls 976 Stoves 304 Sites 33 Others 130 Roofs 1,064 Verminous Conditions— Rain Water Pipes and Gutters 607 Others 227 Rooms Cleansed 247 44 TABLE No. 27—continued. Defective Lighting— Foul Pans Cleansed by Owner 43 Windows Repaired 214 „ „ „ Occupier 165 „ Enlarged 1 Additional W.C.s Provided 3 „ Additional 1 Doors and Fastenings Remedied 138 Defective Ventilation— Dust Bins Provided 702 Windows Rendered Usable 609 Underground Rooms Closed — „ Additional Provided 3 Overcrowding—Cases Remedied 42 Other Means 7 Water Supply— Defective Paving— Additional 2 Yards Re-paved 158 Re-instated 21 „ Repaired 276 Cisterns Cleansed 16 Scullery Floors Re-paved or Repaired 118 „ Covered 17 ,, Removed 16 House Drains— Foul Accumulations— Defective Drains Repaired 324 Manure Removed 18 Choked Drains Cleared 291 Offensive Accumulations Vent Pipes Repaired 84 Removed 38 Soil Pipes Repaired 21 Back Yards Cleansed 121 Gullies Fixed 111 Dung Pits Provided 7 New Drainage 4 Rats— Rain Water Tanks Repaired 6 Drains Repaired in Consequence 23 ,, „ „ Abolished 13 Sinks Repaired or Provided 299 Premises Rat Proofed 8 Wastes Cleansed 130 Other Effective Measures 22 Wastes Trapped or Repaired 314 Rag and Bone Premises— Water Closets— Premises Cleansed 1 Flushing Apparatus Repaired 353 Rain-proof Premises Provided — „ „ Renewed 166 Vermin - proof Conditions Provided - New Pans 256 ,, Traps 234 Miscellaneous 102 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. 45 TABLE No. 28. 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). 367 32 - Workshops (Including Workshop Laundries). 660 8 — Workplaces (Other than Outworkers Premises) 175 6 — Homeworkers' Premises 488 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 37 37 - - Want of Ventilation — — — — Overcrowding — — — — Want of drainage of floors 4 4 — — Other nuisances 32 32 — — Sanitary Accommodation insufficient 1 1 — — unsuitable or defective 19 18 - - not separate for sexes 1 1 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouses (s. 101 ) - - - - Other offences - — — — Total 94 93 — — 46 3.—Outwork in Unwholesome Premises, Section 108. Nature of Work. Instances Notices served. Prosecutions. Wearing Apparel:—Making, etc. 2 2 - Racquet and Tennis Balls 2 2 - The Rats and Mice (Destruction) Act, 1919.—Each district inspector is the rats officer for his area and investigates all complaints received. The total number of inspections made was 349. In 23 instances defective drains were repaired, 8 premises were rat-proofed, and other effective measures taken in 22 instances. National Rat Week was held from the 2nd to the 7th 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 8,187. Offensive Trades.—There is only one offensive trade in the Borough, namely, a slaughterer of poultry. The premises were approved by the London County Council in November, 1931. Rag Flock Act.—Four samples of rag flock were taken for analysis. Such material has to comply with the Rag Flock Regulations, in which it is laid down that the soluble chlorine in the form of chlorides must not exceed 30 parts of chlorine in 100,000 parts of flock. In three instances the samples complied with the regulations as the parts of chlorine were, respectively, 8'9, 71, 71, but in the other instance 142 parts of chlorine were found. It appeared that this sample was purchased from a firm in the provinces under a warranty. After considering the matter, the Public Health Committee decided not to prosecute but to send a cautionary letter informing the seller that in the event of any future breach of these regulations, proceedings would be commenced, and to ask the provincial authority to deal with the matter at the source. 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. 47 TABLE No. 29. Sun Street. Sun Street (Infectious) Eltham. All Mortuaries. 1930 1931 Number of Bodies received: (a) For Inquest - - - 8 - (b) For Custody 15 1 1 10 17 15 1 1 18 17 Number of Post-Mortem Examinations — — — — — Cemeteries.—There are two cemeteries in the Borough, known as the Woolwich Cemetery and the Plumstead Cemetery, the Woolwich one being divided into two parts, the old and the new. Both are owned by the Council, and both are in the Parish of Plumstead. There is also a Churchyard at Eltham. The Plumstead Churchyard was closed in 1930. For some years now the Council have been endeavouring to acquire ground to form a cemetery at Eltham, but so far have been unsuccessful, all the sites which were examined being turned down on sanitary or other grounds. At the end of the year, however, it seemed likely that a site would shortly be obtained suitable for the purpose. In Table No. 30, 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. 30. Number of Interments. 1929 1930 1931 Woolwich Cemetery 657 562 597 Plumstead Cemetery 767 736 792 Eltham Churchyard 265 183 304 Plumstead Churchyard 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. 48 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. 31:— TABLE No. 31. Prosecutions under Public Health and Kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1 26th February An occupied dwelling house without a proper supply of water. 65, Avery Hill Road Costs, £1. Closing Order made. 2 12th March Defective stove 18, Novar Road Fined £1. 3 12th March Dampness 24, Novar Road do. 4 12th March do. 5, Novar Road do. 5 12th March Defective Yard paving 18, Novar Road do. 6 22nd May Defective Roof 9, Elm Street Work done. Costs, 10s. 6d. 7 22nd May Dirty walls and ceilings; defective windows; defective stove. 98a, Woolwich High Street. Order to abate in 28 days. Rooms evacuated. Public Baths and Washhouses.—There are two main bathing Establishments in the Borough, one at Plumstead and the other at Woolwich, and there is a smaller one at North Woolwich. At Plumstead there is a First Class Swimming Bath (capacity 120,000 gallons); a Second Class Swimming Bath (capacity 80,000 gallons); 64 Slipper Baths; and a separate building for Turkish and Russian Vapour Baths. There is also a Public Washhouse. At Woolwich there is a First Class Swimming Bath (capacity 120,000 gallons); a Second Class Swimming Bath (capacity 90,000 gallons), and 60 Slipper Baths. At North Woolwich there are 14 Slipper Baths. Through the courtesy of the Baths Superintendent I am able to say that the total number using the Swimming Baths during the year was 192,231; Turkish and Russian Vapour Baths, 14,447; Slipper Baths, 206,329; and the Public Washhouse, 22,399. 49 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. 32, shows the food premises on the registers and the number of inspections made in respect of each type during the year:— TABLE No. 32. Premises. On Register 31st December. Number of Legal Proceedings. Inspections. Notices. Bakehouses 37 102 7 — Cowsheds 13 161 3 — Milkshops 94 303 7 — Ice Cream Premises 166 272 4 — Slaughterhouses 5 20 — — Fried Fish Shops 63 245 20 — Butchers' Shops 98 196 5 — Premises where Food is prepared (other than above) 249 493 6 - Shops and Markets — 1751 — — 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 68 „ ,, „ „ outside Borough 21 Cowkeepers 5 Cowsheds 13 Purveyors of milk in sealed bottles 102 D 50 The standard of cleanliness in cowsheds and dairies and in other premises where milk is sold has been well maintained, as is evidenced from the periodic reports of the Inspectors. Designated Milks.—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. 33. Number of dealers licences issued:— (a) To use the designation "Certified" milk 7 (b) „ ,, "Grade A" (Tuberculin Tested) 4 (c) ,, „ "Grade A" 7 (d) „ ,, "Pasteurised" 7 Number of supplementary licences issued:— (a) To sell "Certified" milk 2 (b) ,, "Grade A" (Tuberculin Tested) 2 (c) „ "Grade A" 2 (d) „ "Pasteurised" 2 Number of licences issued for bottling establishments for Pasteurised milk . 1 Nineteen samples of Pasteurised milk were bacteriologically examined during the year, including milk supplied to hospitals in the Borough. The results of the examinations are shewn below. Such milk must not contain more than 100,000 bacteria per cubic centimetre. Bacteria per 1 c.c. 75,950 15,000 5,863 31,850 3,290 6,913 35,900 8,653 13,800 7,726 1,720 45,950 6,846 6,796 9,850 1,447 9,586 15,723 8,013 Dried and Condensed Milks.—Samples of these milks were taken under the appropriate Regulations, and in each instance it was found that the Regulations were being complied with. 51 Agricultural Produce (Grading and Marking) Acts.— These Acts empower the Minister of Agriculture and Fisheries to make Orders for the grading and marking of agricultural produce. In the Annual Report for 1930 a complete list was given of the Regulations which have been made under the Acts up to that date. During 1931, the following additional Regulations were made:— TABLE No. 34. Produce. Date of Regulations. Designation. Cider March 23rd Select Cider (Champagne Process) or Select Cyder (Champagne Process). Select Cider or Select Cyder. Canned Vegetables May 28th Select Whole Stringless Beans or Select Beans. Select Sliced Stringless Beans or Select Beans. Select Sliced Runner Beans or Select Beans. Select Beetroots (Whole). Select Carrots (Whole). Select Celery (Hearts). Select Fresh Picked Peas or Select Peas. Select New Potatoes. Select Spinach. Select Turnips (Whole). Macedoine of Select Vegetables. Canned Fruits May 27th Select Dessert Plums. Select Dessert Cherries. Select Morello Cherries. Select Dessert Gooseberries. Select Strawberries. Select Loganberries. Select Cultivated Blackberries. Select Raspberries. Select Redcurrants. Select Blackcurrants. Select Raspberries and Redcurrants. Select Apples. Beef July 20th Select. Prime. Good. The Regulations affecting Canned Fruits, Peas, Beans (1930), and Beef (1929) were revoked from the date of these new Regulations. 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 these Acts 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:— 52 The Merchandise Marks (Imported Goods) Honey. No. 3 Order, 1928 Fresh Apples. The Merchandise Marks (Imported Goods) Currants. No. 5 Order, 1928 Sultanas. Raisins. Eggs in shell. Dried eggs. Oat Products. The Merchandise Marks (Imported Goods) Raw Tomatoes. No. 4 Order, 1929. The Merchandise Marks (Imported Goods) Salmon and No. 8 Order, 1931 Trout. 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. The Public Health (Meat) Regulations, 1924.—Notice of intention to slaughter any animal must be given to the Council. The following Table No. 35 shows the number of animals slaughtered, and inspected, during the year. TABLE No. 35. Month. Cattle. Sheep & Lambs. Pigs. Calves. Total. January 237 764 982 130 2,113 February 198 709 767 97 1,771 March 225 938 971 206 2,340 April 208 873 794 155 2,030 May 185 819 246 185 1,435 June 203 958 72 124 1,357 July 186 985 6 159 1,336 August 185 1,072 58 141 1,456 September 199 1,053 1,194 82 2,528 October 221 952 1,745 59 2,977 November 195 1,010 1,431 16 2,652 December 231 1,217 2,043 5 3,496 2,473 11,350 10,309 1,359 25,491 53 The number of whole carcases condemned on account of disease or injury was 26 (19 pigs, 5 sheep, 2 cattle). In 1,152 instances partial condemnation was necessary in respect of 882 pigs, 77 sheep, and 193 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 168, Eltham High Street was not renewed:— TABLE No. 36. 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. 6, Plumstead High Street Reed, H., & Co., Ltd. 38, Plumstead Common Road Reed, H., & Co., Ltd. Inspection of Imported Meat.— As I explained in my Annual Report for 1929, the Port of London Authority occasionally allow imported 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 650 carcases of sheep were examined and all were passed as fit for the food of man, with the exception of 4, which were found to be affected with caseous lymphadenitis. Bakehouses.—There were at the end of the year 37 bakehouses in the Borough, of which 22 were factory and 9 underground. The inspections numbered 102, and 7 notices were served. The conditions on the whole were satisfactory. Fried Fish Shops.—There were 63 premises on the Register. They were inspected on 245 occasions, and 20 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 166, but in many instances the sale was intermittent. 272 inspections were made and 4 notices served. Ice Cream premises are registered by the Council under the London County Council (General Powers) Act, 1928. Other Food 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, 1751 visits were made to shops and stalls in the markets. 54 Unsound Food. There were 281 instances of unsound food being surrendered. These compare with 183 instances in 1930. No food was seized. Included in the food surrendered were:— 1½ tons of Beef; 1 cwt. Mutton; 3 tons of Pork; 18 cwts. Ox Livers; 4 cwts. Ox Lungs; 2 cwts. Sheeps' Offal; 11 cwts. Pigs' Offal; 1 cwt. Fish; 2 cwts. Potatoes; and smaller quantities of Fruit, Rabbits, etc. Sophistication of Food.— The following Table, No. 37, 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. Four samples were taken on Sundays or public holidays, and these were found to be genuine. TABLE No. 37. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Milk *184 10 194 8 Cream 15 6 21 - Condensed Milk (Full Cream) 3 3 6 - Condensed Milk (Skimmed) 2 7 9 - Dried Milk (Full Cream) - 4 4 - Butter 11 28 39 - Margarine 5 - 5 - Lard 5 15 20 - Tea 7 18 25 - Coffee 6 5 11 - Cocoa 9 - 9 - Jam 3 5 8 - Honey 5 - 5 - Golden Syrup - 5 5 - Lemon Curd 1 - 1 - Sugar 4 - 4 - Cheese - 10 10 - Dripping 2 - 2 - Shredded Suet - 4 4 - Dried Fruit 2 - 2 - Sultanas 4 - 4 - Dried Apricots 1 - 1 - Candied Peel 5 4 9 - Mincemeat 1 5 6 - Baking Powder - 6 6 - Mustard 6 - 6 - * This includes 3 taken at West Mailing. 55 Table No. 37.— continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Olive Oil - 9 9 - Tinned Peas - 7 7 - Lettuce - 1 1 - Sweets 3 - 3 - Vinegar 3 3 6 - Malt Vinegar 2 2 4 - Ground Cinnamon 2 - 2 — Sausages 15 - 15 3 Sausage Meat 2 - 2 1 Liver Sausage 1 - 1 — Saveloy 3 - 3 1 Polony 1 - 1 1 Breakfast Sausage 1 1 2 — Preserved Sausages 4 - 4 — Faggots 3 - 3 1 Pressed Beef 3 - 3 - Cooked Beef 3 - 3 - Cooked Pork 1 - 1 - Cooked Meat 2 - 2 - Minced Beef 1 - 1 - Jellied Veal 1 - 1 - Corned Beef 4 - 4 - Brawn 5 2 7 - Chicken and Ham Roll 1 - 1 - Luncheon Sausage 1 - 1 - Sausage Patties 1 - 1 1 Tripe 4 - 4 - Fish Paste 4 - 4 - Potted Shrimps 1 - 1 - Beer 10 - 10 - Whisky 9 4 13 - Gin 1 - 1 - Weak Tincture of Iodine 1 4 5 1 Strong Tincture of Iodine - 1 1 - Almond Oil - 8 8 1 Syrup of Squills - 4 4 - Epsom Salts - 5 5 - Camphorated Oil - 1 1 - Boric Ointment - 3 3 - Seidlitz Powders - 4 4 - 374 194 568 18 56 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. 38. 1929 1930 1931 4.5 per cent. and over 2 2 1 4 per cent. and under 4.5 per cent. 8 1 19 3.5 per cent. and under 4 per cent. 74 68 112 3 per cent. and under 3.5 per cent. 111 60 57 Below 3 per cent. — — 5 195 131 194 Adulterated Samples— Action Taken.— The following Table, No. 39, shews the number of adulterated samples and the action taken in each instance where the sample was formal. On one occasion, where three samples (Nos. 92, 93 and 95) taken in course of delivery were certified by the Public Analyst as containing varying percentages of added water, a notice was served on the Inspector to procure a sample from a corresponding milking of the cows at West Mailing. This was done, but on analysis it was found that there was a 15 per cent. fat deficiency. In the circumstances the summonses were withdrawn. TABLE No. 39. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or Other Action. 441 Almond Oil Informal 67 per cent. Apricot Kernel Oil. — 447 Sausages Formal 175 parts per million Sulphur Dioxide. Vendor cautioned. 450 Saveloy Formal 66 parts per million Sulphur Dioxide. Vendor cautioned. 451 Faggots Formal 33 parts per million Sulphur Dioxide. Vendor cautioned. 458 Polony Formal 60.3 parts per million Sulphur Dioxide. Vendor cautioned. 563 Milk Formal 8.7 per cent. of added Water Dismissed on payment of £2 2s. 0d. costs. 57 TABLE No. 39— continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or Other Action. 92 Milk Formal 2.7 per cent. of added Water and 12.66 per cent. deficient in fat. Summons withdrawn. 93 Milk Formal 8.58 per cent. of added Water and 17.33 per cent. deficient in fat. Summons withdrawn. 95 Milk Formal 15.29 per cent. of added Water. Summons withdrawn. 174 Milk Formal 4.07 per cent. of added Water. No action. 179 Weak Tincture of Iodine. Informal 30 per cent. deficient in Alcohol. — 184 Milk Formal 14.66 per cent. deficient in fat No action. 195 Milk Informal 54.33 per cent. deficient in fat — 295 Sausage Meat Formal 487 parts per million Sulphur Dioxide. Dismissed on payment of £2 2s. 0d. costs. 364 Sausages Formal 411 parts per million Sulphur Dioxide. Dismissed on payment of £2 2s. 0d. costs. 389 Sausages Formal 93 parts per million Sulphur Dioxide. Vendor cautioned. 388 Sausage Patties Formal 77 parts per million Sulphur Dioxide. Vendor cautioned. *23 Milk Formal 15 per cent. deficient in fat See Nos. 92, 93, 95. * Sample taken at West. Mailing. 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. 37, 38 and 39. Nutrition.— The dissemination of knowledge and instruction on matters affecting nutrition is part of the Council's general scheme of Health Propaganda, q.v. Other Legal Proceedings.— No legal proceedings other than those for adulteration were taken in respect of infringements of various food laws. 58 SECTION VII.— HOUSING. The housing conditions of the Borough were fully described in my Annual Report for 1930, and it is unnecessary to repeat them here. The Census figures, when published, however, will throw much light on the changes in the housing conditions in the last ten years, particularly with regard to the extent of overcrowding. These figures should be available in 1932. The following Table shews the main housing statistics of the year, and is set out under the headings given in Circular No. 1206 issued by the Ministry of Health for securing uniformity in the presentation of these statistics. TABLE No. 40. 1.— Inspection of Dwelling Houses during the Year. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,065 Inspections made 17,473 (2) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 3,242 Inspections made 7,965 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 25 (4) Number of dwelling houses (exclusive of those referred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 2,259 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 2,578 * Includes intimation notices. 59 3.— Action under Statutory Powers during the Year. (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (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 notice:— (a) By owners — (b) By Local Authority in default of owners — (b) Proceedings under the Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 711 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 640 (b) By Local Authority in default of owners — (c) Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made 25 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 2 (d) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — (e) Proceedings under Section 3 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which notices were served 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 — 60 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (f) Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which Closing Orders were made - (2) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling house having been rendered fit 1 (3) Number of dwelling houses in respect of which Demolition Orders were made - (4) Number of dwelling houses demolished in pursuance of Demolition Orders - Inspection of Houses.— In accordance with the provisions of the Housing (Consolidated) Regulations, 1925, the systematic inspection of houses in the district was continued during the year. In all 3,242 houses were surveyed house-to-house, and their condition was recorded on special survey cards. It is the practice to secure the abatement of such nuisances as are found to exist by serving notices under the provisions of the Public Health (London) Act, 1891, but in a certain number of instances demolition orders were applied for. In tabular form is shewn below a detailed statement of the specific action taken under the Housing Acts during the year. TABLE No. 41. Action under the Housing Acts. Premises. Action Taken. Date. Robert Street, 2 Demolition Order 4th February. do. 4 do. do. Coopers Place, 1 do. 9th March. do. 2 do. do. do. 3 do. do. do. 4 do. do. do. 5 do. do. do. 6 do. do. do. 7 do. do. do. 8 do. do. 61 TABLE No. 41.— continued. Premises. Action Taken. Date. Friths Buildings, 1 Demolition Order 9th March. do. 2 do. do. do. 3 do. do. do. 4 do. do. do. 5 do. do. do. 7 do. do. do. 8 do. do. do. 9 do. do. do. 10 do. do. do. 11 do. do. Cock Yard, 1 do. do. do. 2 do. do. do. 3 do. do. Woolwich High Street, 138a do. 1st April. Glyndon Road, 60 Closing Order determined 6th May. Woolwich High Street, 137 Demolition Order 7th October. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1923.—At the end of 1930, decisions had not been reached in the case of 24 applications (hutments) made during that year. During 1931, 10 additional applications were received, only three of which were in respect of hutments. In 23 instances the certificate was granted, and in 9 instances the applications were refused. One application was withdrawn, and one was still under consideration at the end of the year. Twenty-five applications (including those under consideration at the end of 1930) were received from owners of houses for report that the house was in a reasonable state of repair. In 22 instances the report was issued. 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 18. Houses Let in Lodgings.— No register is now kept of Houses Let in Lodgings. 497 inspections of such houses were made, 24 offences were discovered and 19 notices served. 62 By-laws with respect to such houses were made by the London County Council in 1925, but certain of them were postponed until six months after the Rents Restrictions Acts ceased to operate. In 1929 this matter was under consideration by the Metropolitan Boroughs Standing Joint Committee, and in response to a request from that body the Woolwich Borough Council were of opinion:— (a) That it was desirable to bring into operation the suspended by-laws. (b) That all suspended by-laws or parts of by-laws should be brought into operation. (c) That such by-laws should be made to apply to houses wholly or partially decontrolled. In 1931, the County Council came to a decision on the matter, and resolved that those four by-laws which dealt with sanitary and hygienic requirements, ventilation, lighting, etc., should be brought fully into operation in respect of wholly decontrolled houses. At the same time they took the opportunity of repealing the by-law dealing with cases of definite instability, and of revising the new by-law dealing with the permissible number of occupants as based on a standard of cubic feet of air space. These by-laws received the approval of the Ministry of Health on the 20th March, 1931. New Houses.— The following Table, No. 42, shews 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, except two—which were built by the Council. TABLE No. 42. Date of Meeting. Plumstead: Eltham. Total. Woolwich. West East 14th January - 2 12 24 38 11th February 1 3 - 9 13 11th March - 5 18 14 37 16th April - 12 2 30 44 13th May - - - 29 29 17th June 1 3 - 32 36 2nd July - - - 8 8 29th July - 4 1 36 41 16th September - 4 1 23 28 14th October 4 3 23 20 50 11th November - - - 22 22 9th December - - 27 21 48 6 36 84 268 394 63 Council's Houses.— Between 1919 and 1929 the Council developed a housing estate of 2,186 houses, now known as the Page Estate. In December, 1931, the Council decided to purchase a further estate, now known as the Middle Park Estate, which would provide for approximately another 2,200 houses. In July, 1931, the erection of 400 houses on the first section of this estate was approved by the Council and subsequently the approval of the Ministry of Health and the London County Council was obtained. Of these 400 houses it was decided that 320 should be of the non-parlour type and 80 of the parlour type house, both types having three bedrooms. The houses will be erected in blocks of 2, 4, 6, and 8, and the average estimated cost is £380 for the non-parlour type, and £420 for the parlour type. A children's playing field, measuring nearly 4 acres, is to be formed on the Page Estate. Common Lodging Houses.— The following Table, No. 43, shows the details of accommodation available in each of the common lodging houses in the Borough. Each is licensed by the London County Council. TABLE No. 43. Premises. Accommodation. Men. 60, Beresford Street 50 50, Woolwich High Street 22 93, Woolwich High Street 24 102, Woolwich High Street 22 4, Rope Yard Rails 15 7, Rope Yard Rails 24 10, Rope Yard Rails 51 10a and 11, Rope Yard Rails 62 21 and 21a, Rope Yard Rails 42 312 64 SECTION VIII. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. The only change which took place in the number of diseases compulsorily notifiable in the Borough was in respect to chicken pox. Owing to the presence of small pox in London this disease was made notifiable from the 1st April, 1930, to the 30th September, 1931. A complete list of the notifiable diseases will be found in last year's Annual Report. The total number of primary notifications, excluding cases of tuberculosis, which are referred to in a separate sub-section of the report, was 1,879, compared with 2,172 in 1930 and 1,639 in 1929; but as 672 notifications were included in respect of chicken pox in 1930 and 597 in 1929, the incidence of infectious disease must be regarded as less than in the two previous years. Measles, which is not notifiable, was not present in epidemic form during the year, and only 113 cases came to the knowledge of the department. The following Table, No. 44, shews the number of cases of each disease notified, the number of admissions to hospital and the total deaths, and on the four succeeding pages will be found tables shewing the incidence of infectious disease in the Borough each year since 1901, the ward incidence, the age incidence and the number of deaths from these diseases in 1931. TABLE No. 44. Diseases. Total Cases Notified. Admissions to Hospital. Total Deaths. Diphtheria 281 277 6 Scarlet Fever 387 375 5 Typhoid Fever 3 3 — Puerperal Fever 8 6 6 Puerperal Pyrexia 41 34 — Erysipelas 80 32 6 Smallpox 3 3 — Pneumonia 371 213 126 Malaria 3 2 — Ophthalmia Neonatorum 7 2 — Dysentery — — — Cerebrospinal Meningitis 12 12 4 Poliomyelitis 6 5 — Zymotic Enteritis 3 — — Encephalitis Lethargica 2 1 2 †Chicken Pox 672 5 — *Measles 113 10 1 1,992 978 156 † Notifiable up to 30th September. * Not Notifiable. 65 TABLE No 44. Notification of Infectious Diseases (Including Tuberculosis), 1901 to 1931. 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 .. l 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 .. 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 l .. 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 l .. 8 .. 2 2 22 244 55 2702 597 1931 3 281 80 387 3 .. 8 41 327 44 3 • • .. 7 2 12 6 3 229 51 113 672 §Notification of Puerperal Pyrexia commenced October, 1926. †Measles notifiable from 1/1/1916 to 31/12/1919. *Voluntary notification to 1910; partial to 1912; all cases thereafter. ‡Compulsory Notification of Zymotic Enteritis commenced 1913. x Chicken Pox was again made notifiable from April, 1930, to 30th September, 1931. 66 TABLE No. 46. Ward Incidence of Infectious Diseases (excluding Tuberculosis) 1931. Disease. Borough Dockyard St. Mary's River St. George's Burrage Herbert Glyndon St. Margaret's Central St. Nicholas' Abbey Wood Well Hall Sherard Avery Hill Diphtheria 281 16 14 42 23 19 7 20 6 10 14 12 15 73 10 Scarlet Fever 387 19 24 46 67 23 11 16 11 12 25 23 35 55 20 Enteric Fever (including ParaTyphoid) 3 — — — — — — — 2 — — - — 1 — Puerperal Fever 8 — 1 — — 1 — — 1 — 1 - — 3 1 Puerperal Pyrexia 41 6 1 4 2 — — 4 7 1 5 2 1 2 6 Erysipelas 80 4 5 7 3 3 1 6 7 6 10 7 5 8 8 Small Pox 3 — — 1 1 — — — — — 1 — — — — Pneumonia 371 14 27 43 23 12 17 21 18 20 63 25 32 30 26 Malaria 3 — — — 2 — - 1 - — - — — - — Ophthalmia Neonatorum 7 2 1 — 2 — — - - — 1 — — 1 — Encephalitis Lethargica 2 — — — 1 — — — 1 — — — — — — Dysentery - - - - - - - - - - - - - - - Cerebrospinal Meningitis 12 — 1 1 5 — — — — 1 — 2 — 2 — Poliomyelitis 6 1 — — 3 1 — 1 — — — — — — — Zymotic Enteritis 3 2 — — — — — — — — — — — 1 — *Chicken Pox 672 15 19 65 57 44 40 54 58 32 58 72 23 60 75 †Measles 113 3 3 12 56 — 2 2 5 — 24 5 1 - - 1992 82 96 221 245 103 78 125 116 82 202 148 112 236 146 *Notifiable up to 30th September. †Not notifiable. 67 TABLE No. 47. Cases of Infectious Diseases Notified, 1931 (excluding Tuberculosis). Diseases. Number of Cases Notified. Age Groups. All Ages. Under 1 year. 1 and under 2 years. 2 and under 3 years. 3 and under 4 years. 4 and under 5 years. 5 and under 10 years. 10 and under 15 years. 15 and under 20 years. 20 and under 35 years. 35 and under 45 years. 45 and under 65 years. 65 and over. Diphtheria 281 5 10 17 22 16 103 53 14 29 7 4 1 Scarlet Fever 387 4 10 22 28 31 143 63 44 35 7 .. .. Enteric Fever 3 .. .. .. .. .. .. .. .. 1 1 1 .. Puerperal Fever 8 .. .. .. .. .. .. .. .. 6 2 .. .. Puerperal Pyrexia 41 .. .. .. .. .. .. .. 2 29 10 .. .. Erysipelas 80 .. 1 1 1 .. .. 1 3 14 5 40 14 Smallpox 3 .. .. .. .. .. .. 2 1 .. .. .. .. Pneumonia 371 40 33 16 16 13 38 13 16 47 36 66 37 Malaria 3 .. .. .. .. .. .. .. .. 2 1 .. .. Ophthalmia Neonatorum 7 7 .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 2 .. .. .. .. .. .. .. 1 .. .. 1 .. Cerebrospinal Meningitis 12 2 1 .. 1 .. 2 .. 2 3 .. l .. Poliomyelitis 6 .. 1 2 l .. 2 .. .. .. .. .. .. Zymotic Enteritis 3 .. 2 .. .. 1 .. .. .. .. .. .. .. †Chicken Pox 672 18 34 34 60 58 337 93 19 14 4 1 .. *Measles (including German Measles) 113 7 2 7 6 9 31 6 33 12 .. .. .. 1992 83 94 99 135 128 656 231 135 192 73 114 52 † Notifiable up to 30th September 1931. * Not Notifiable. 68 TABLE No. 48. Deaths from Infectious Diseases (excluding Tuberculosis), 1931. Diseases. Number of Deaths. All Ages. Age Groups. Under 1 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- Diphtheria 6 .. 1 3 2 .. .. .. .. .. .. .. Scarlet Fever 5 2 .. .. 3 .. .. .. .. .. .. .. Typhoid Fever .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 6 .. .. .. .. 1 2 3 .. .. .. .. Puerperal Pyrexia .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 6 .. .. .. .. .. 1 .. 2 2 .. 1 Smallpox .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 126 29 13 6 5 4 4 4 8 21 19 13 Malaria .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum .. .. .. .. .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 2 .. .. .. .. .. .. .. 1 1 .. .. Cerebrospinal Meningitis 4 1 .. 1 .. .. 1 .. .. 1 .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. Zymotic Enteritis .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 .. .. .. 1 .. .. .. .. .. .. .. 156 32 14 10 11 5 8 7 11 25 19 14 69 Diphtheria. Notification. During the year 281 cases were notified, compared with 497 in 1930 and 496 in 1929. The number of military cases was 9. The number of notifications received each quarter was as follows: First quarter, 84; Second quarter, 75; Third quarter, 66; Fourth quarter, 56. Multiple Cases. The following Table, No. 49, shews the house distribution by Wards. The term "house" is synonymous with the term "family," except in six instances, where two families were involved. TABLE No. 49. 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 14 12 24 10 10 7 18 6 10 11 12 13 50 8 205 205 2 cases occurred 1 1 - 2 3 - 1 - - - - 1 8 1 18 36 3 „ „ - - 2 - 1 - - - - 1 - - 1 - 5 15 4 „ „ - - - - - - - - - - - - 1 - 1 4 12* „ „ - - 1 - - - - - - - - - - - 1 12 Total Houses 15 13 27 12 14 7 19 6 10 12 12 14 60 9 230 272 Military - - - 9 - - - - - - - - - - 9 9 281 * A hostel for women and children. Return Cases. Four cases gave rise to 4 return cases. In a hostel for women and children there was an outbreak of 12 cases, some of which were return caess. Deaths. There were six deaths from Diphtheria, compared with 5 in 1930 and 17 in 1929. Four of these deaths were in children under 5 and two were in school children. Home Isolation. Two cases were isolated at home. Frequent visits are made by the district sanitary inspectors to all cases isolated at home in order to secure that proper precuations 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. No certificates were issued during the year. 70 Antitoxin. A supply of Diphtheria Antitoxin is kept at the Town Hall, the Plumstead Library and the Eltham Library, and is available for medical practitioners on application, at cost price, or free where there is inability to pay. The amount supplied during the year was 34,000 units. The total cost to the Council was £2 11s. 0d., all of which was recovered. Schick Test. There are no clinics in the area where Schick testing and immunisation are carried out. Scarlet Fever. Notification. During the year 387 cases of Scarlet Fever were notified, compared with 627 in 1930 and 567 in 1929. There were 52 military cases. The number of notifications received each quarter was as follows: First quarter, 88; second quarter, 128; third quarter, 84; fourth quarter, 87. Multiple Cases. The following Table shows the house distribution by Wards. The term "house" is synonymous with the term "family" except in five instances, where two families were involved. TABLE No. 50. 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 9 10 29 10 19 7 12 11 12 23 10 25 30 20 227 227 2 cases occurred 5 3 5 1 2 2 2 — - 1 2 3 5 - 31 62 3 „ „ - - 1 2 - - - - - - 3 - 2 - 8 24 4 „ „ - - 1 - - - - - - - - 1 1 - 3 12 5 „ „ - 1 - - - - - - - - - - 1 - 2 10 Total Houses 14 14 36 13 21 9 14 11 12 24 15 29 39 20 271 335 Military - 3 - 49 - - - - - - - - - - - 52 387 Deaths. There were five deaths from Scarlet Fever during the year, including two in children under five years of age. In 1930 the number of deaths was five. Home Isolation. Twelve cases, or 31 per cent., were isolated at home, and in no instance did a return case occur. The same procedure as in Diphtheria was carried out. 71 Dick Test. This has not been employed in the neighbourhood so far as I am aware. Return Cases. The following Table shews the number of return cases, the dates of admission to hospital, the dates of discharge from hospital, and some observations on the condition of the primary case on discharge. TABLE No. 51. 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. 1930. 615 17/12/30 2/4/31 108 6/4/31 - 1931. 9 5/1/31 8/5/31 123 29/5/31 - 8/6/31 — 13 10/1/31 5/3/31 54 10/3/31 — 21 19/1/31 17/3/31 57 14/4/31 — 19/4/31 — 23/4/31 — 5/5/31 — 35 31/1/31 6/3/31 34 9/3/31 - 57 24/2/31 30/3/31 34 13/4/31 - 176 1/6/31 18/7/31 47 27/7/31 Nasal discharge 199 18/6/31 28/7/31 40 31/7/31 Nasal discharge. 216 7/8/31 — 29/6/31 27/8/31 59 29/8/31 — 269 31/8/31 — 11/8/31 4/12/31 118 15/12/31 — 309 5/10/31 6/11/31 32 17/11/31 Nasal Discharge. 21/11/31 — 2/12/31 - 308 5/10/31 17/10/31 12 20/10/31 - 325 14/10/31 27/11/31 44 9/12/31 — Enteric Fever. Three cases were notified during the year. There were no deaths from this disease. It will be noticed from the following Table, No. 52, which gives details of each case notified, that the diagnosis was not confirmed in one instance. TABLE No. 52. No. Date Notified. Diagnosis. Final Diagnosis. Remarks. 1 9/7/1931 Enteric Fever Carcinoma Vulvae - 2 4/8/1931 Paratyphoid "B" Paratyphoid "B" - 3 17/9/1931 Enteric Fever Enteric Fever — 72 Puerperal Fever and Puerperal Pyrexia . Forty-nine cases were notified, compared with 36 in 1930 and 53 in 1929. In 41 instances the notification was Puerperal Pyrexia. In four 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. Harold Taylor saw two cases. Nursing assistance was provided in one case and no bacteriological examinations were carried out. Only seven cases did not receive hospital treatment. Deaths. There were six deaths, compared with four in 1930 and three in 1929. Erysipelas, Malaria and Dysentery. The number of notifications of Erysipelas received was 80, compared with 77 in 1930. Three cases of Malaria, including one induced for therapeutic purposes, were notified. No notification was received in respect of Dysentery. Small Pox During 1931 there was a great decrease in the number of cases of this disease in the Metropolis. In all, only 1,452 were notified, as compared with 5,152 in 1930. Cases were notified in all the Metropolitan Boroughs, except Chelsea, Hampstead and Paddington. In fourteen others, however, there were less than 10 cases. The incidence was heaviest in Stepney (352), Lambeth (256), Bethnal Green (144), and Shoreditch (122). Three cases were notified in Woolwich, but in two instances the diagnosis was not confirmed. There were no deaths. The smallpox shelter was not 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. This disease was made compulsorily notifiable in April, 1930, and continued so until the 30th September, 1931. During the first nine months of the year, 672 notifications were received. 73 Cerebrospinal Meningitis. Twelve cases were notified during the year but in two instances the diagnosis was not confirmed. The following Table gives details of each case:— Table No. 53. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. 16th January M. 5 Cerebrospinal Meningitis - 4th February F. 3 Cerebrospinal Meningitis Died. 4th February M. 18 Cerebrospinal Meningitis — 28th March M. 26 Cerebrospinal Meningitis Died. 17th April M. 10/12 Cerebrospinal Meningitis Died. 21st April F. 1 Cerebrospinal Meningitis — 5th June M. 18 Cerebrospinal Meningitis — 15th June F. 6 No obvious disease — 16th June M. 20 Cerebrospinal Meningitis — 1st July M. 34 Acute Septic Meningitis — 17th August F. 58 Cerebrospinal Meningitis Died. 4th November F. 10/12 Cerebrospinal Meningitis - Anterior Poliomyelitis. Six notifications were received and in all the cases the diagnosis was confirmed. Nursing assistance is provided for such cases but was not utilised during the year. Five of the cases were admitted to hospital. Zymotic Enteritis. Three cases of this disease were notified during the year, compared with 22 cases in 1930. The number of deaths in children under two years of age, certified as due to diarrhoeal diseases was six. Whooping Cough. During the year 492 cases of Whooping Cough came to the knowledge of the Department from the School Medical Service, compared with 73 last year and 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. No death was certified as due to this disease, compared with 1 in the previous year. Measles. This disease is not notifiable in the Borough, but from various sources the Department learned of 113 cases, compared with 2,702 in 1930 and 151 in 1929, 74 Deaths. There was only one death from this disease, compared with 15 in 1930. Home Nursing. No application for nursing assistance was received during the year. 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. Ten cases were admitted during the year, compared with 268 in 1930 and 2 in 1929. Ophthalmia Neonatorum. During the year seven cases were notified, two of which were admitted to hospital. The following Table gives details of each case. TABLE No. 54. Date Notified. Cases Treated: Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Home. Hospital. 18 th March Yes — Yes — — — 16th April Yes — Yes — — — 31st July Yes — Yes — — — 27 th August — Yes Yes — — — 31st August Yes — Yes — — — 28th September — Yes Yes — — — 3rd December Yes - Yes — - - Home Nursing. Four cases were nursed at home, under the Council's scheme, 85 visits in all being paid. The cost of this service was £4 5s. Od. Pneumonia. The incidence of Pneumonia was much higher than in 1930, 371 cases being notified as compared with 283 in that year. Of these 44 were influenzal, as compared with 21 in the previous year. The number of deaths certified to be due to lobar or broncho pneumonia was 126, and to acute influenzal pneumonia, 10. The ward incidence of the pneumonias is shewn in Table No. 46. 75 The following Table, No. 55, shews the number of notifications of pneumonia received each month, classified by sex and according to type. It also shews the number of deaths occurring from acute primary pneumonia and influenzal pneumonia. TABLE No. 55. Monthly Incidence of Pneumonia. Month. Male. Female. Total. Type. No. of Deaths Lobar. Broncho. Influen zal. Acute Primary (not specified). Acute Primary Pneumonia Influenzal 1 Pneumonia January 27 30 57 12 12 3 30 23 - February 32 29 61 10 6 12 33 18 3 March 32 26 58 7 17 19 15 13 7 April 19 14 33 10 7 4 12 7 — May 21 4 25 12 3 2 8 8 — June 10 6 16 6 1 2 7 3 — July 8 7 15 2 3 - 10 4 — August 6 4 10 3 1 - 6 6 — September 3 2 5 2 1 — 2 7 — October 6 11 16 4 5 1 6 4 — November 14 7 21 7 4 - 10 11 - December 30 24 54 6 12 1 35 22 — 207 164 371 81 72 44 174 126 10 Nursing. Nursing assistance is provided by the Council for cases of Pneumonia and during the year 43 cases were nursed, 920 visits being paid by the nurses of the local nursing associations. The total cost of this service to the Council was £57 10s. 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. The total cost to the Council was £69 7s. 6d. The treatment of lobar pneumonia by this means is becoming more popular and throughout the country skilled observers are carefully studying the results obtained by such treatment. It is now generally agreed that the evidence, so far as it goes, indicates that the serum is of value and that the earlier this specific treatment is begun the better chance there is of success. 76 Tuberculosis. The Council's tuberculosis scheme was set out very fully in the Annual Report for 1930 and no substantial change took place during 1931. Notifications. During the year, excluding duplicates, 229 cases of pulmonary tuberculosis and 51 cases of non-pulmonary tuberculosis were notified. Cases of tuberculosis are often notified more than once, and in this way during the year 96 duplicate notifications were received. The number of cases notified from each of the different wards of the Borough is shewn in Table No. 56. TABLE No. 56. Ward Incidence of Tuberculosis, 1931. Ward. Pulmonary. Non-Pulmonary. Dockyard 8 5 St. Mary's 8 — River 20 3 St. George's 18 3 Burrage 15 2 Herbert 9 — Glyndon 20 6 St. Margaret's 18 4 Central 9 1 St. Nicholas' 29 9 Abbey Wood 20 3 Well Hall 13 4 Sherard 25 6 Avery Hill 17 5 Total 229 51 In the following Table appears a summary of cases coming to the knowledge of the Department in 1931. It includes notifications received from general practitioners, cases not notified but included in the death returns and cases transferred from other areas. It does not include notifications received from Medical Superintendents of hospitals on admission or discharge of patients or any duplicate notifications. Deaths occurring within the year are classified in the same Table by age and sex groups. 77 TABLE No. 57. Tuberculosis—New Cases and Mortality, 1931. Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary non- pulmonary M. F. M. F. M. F. M. F. 0-1 - - 2 - - - 2 - 1-5 - 1 6 5 - 1 3 3 5-10 2 1 9 5 - - 3 1 10-15 2 4 3 4 - - 1 2 15-20 21 12 6 3 7 7 2 - 20-25 24 17 1 1 16 10 - - 25-35 33 29 1 3 17 17 - 1 35-45 31 15 1 1 20 10 - - 45-55 18 11 1 2 9 11 - - 55-65 19 5 — — 15 4 — — 65 and upwards 2 3 1 - 2 2 2 - Totals 152 98 31 24 86 62 13 7 The following Table, No. 58, shows the site of the disease in patients notified each year since 1927. TABLE No. 58. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 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 1931 229 11 5 18 8 2 7 280 78 Cases of Tuberculosis in the District. The usual steps were taken during the year to ensure that the tuberculosis register correctly represented the number of cases of tuberculosis in the district, and the following Table, No. 59, shews the changes which have taken place during the year. TABLE No. 59. Pulmonary. Non-Pulmonary. Totals. M. F. M. F. Number on Register on 1st January, 1931 625 415 141 136 1,217 Number of New Cases notified 135 94 28 23 280 Number of Cases restored 8 4 1 1 14 Other additions 17 11 5 1 34 Deletions 145 120 46 26 337 Number on Register on 31st December, 1931 540 404 129 135 1,208 Of the total number on the register on the 31st December, 86.5 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 1930 the corresponding percentage was 88.6, and in 1929, 83.7 per cent. Deaths. The following Table, No. 60, shews the number of deaths and death rates each year since 1927. TABLE No. 60. Tuberculosis—Deaths and Death-rates. Year. Deaths. Death-Rates. All Forms. Pulmonary. NonPulmonary. All Forms. Pulmonary. NonPulmonary. 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 1.17 106 0.11 1931 168 148 20 1.14 1.00 0.14 79 In addition to the deaths recorded in the above Table, 8 persons who had been notified as suffering from pulmonary tuberculosis, died during the year from other causes and detailed information as to this is given in the following Table, No. 61. TABLE No. 61. Case No. Date Notified as Tuberculosis. Cause of Death. 1 14/ 1/19 Acute Bronchitis. Chronic Bronchitis. Valvular Disease of Heart. 2 21/ 2/17 Cardiac Valvular Disease. 3 15/11/29 Myocarditis. Senile Decay. 4 21/ 1/26 Hemiplegia. Cerebral Thrombosis. Chronic Bronchitis. 5 28/ 1/20 Mitral Regurgitation. 6 2/12/12 Heart Failure. Chronic Bronchitis. 7 3/ 9/31 Congestion. Myocarditis. Mitral Regurgitation. 8 18/ 2/31 Neoplasm of Lung. The period which elapsed between notification and death is shewn below:— TABLE No. 62. Pulmonary. Percentage. NonPulmonary. Percentage. Not notified 17 11.49 5 25.00 0-1 month 22 14.87 11 55.00 1-3 months 12 8.10 2 10.00 3-6 months 20 13.51 - - 6-12 months 14 9.46 — — 1-2 years 13 8.79 — — 2-5 years 29 19.59 1 5.00 Over 5 years 21 14.19 1 5.00 148 100.00 20 100.00 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths was as one is to eight. In 1930 and 1929 it was as one is to twelve. 80 Public Health (Prevention of Tuberculosis) Regulations, 1925. These Regulations provide for the compulsory discontinuance of employment of persons engaged in the handling or treatment of milk, who are suffering from tuberculosis. No case of this kind came to the notice of the Council during the year. Every milk vendor in the Borough is periodically reminded that the Tuberculosis Officer is willing to examine, free of charge, all employees or candidates for employment in the milk trade. No examinations, however, were made during the year. Staff. This consists of one whole-time Tuberculosis Officer, two part-time Assistant Tuberculosis Officers, three Tuberculosis Health Visitors, one ClerkDispenser, and one Lay Organiser, who also acts as Secretary of the Care Committee. In accordance with the practice in recent years, one Tuberculosis Visitor attended a refresher course of two weeks during the winter. The Work of the Dispensaries. The Council's main Dispensary is situated in Maxey Road, Plumstead, but in April a branch Dispensary was opened at 179, Well Hall Road, Eltham. It might be misleading if separate figures were shown for each of these dispensaries, as most of the Eltham patients attended the Plumstead Dispensary at some time during the year, and so in all the Tables the figures given are for the service as a whole. , One of the Tuberculosis Officers attends at the main Dispensary every week-day, but an evening session is held, instead of an afternoon one, on Thursdays. Eight separate clinical sessions in all are held for men, for women, and for children. The branch Dispensary is open on three half-days a week—Monday afternoons for men, and Wednesday and Friday mornings for women and children. The total number of attendances at the Dispensaries during 1931 was 4,416. In this connection it is interesting to point out that 221 of the persons notified during 1931 attended the Dispensaries, which is equivalent to 78 93%. Th ecorresponding percentage in 1930 was 78.6, and in 1929, 82'78. A return of the work of the Dispensaries is given in Table No. 63. 81 TABLE No. 63. Return showing the work of the Dispensaries for 1931. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 106 60 5 6 6 6 9 10 112 66 14 16 208 (B) Diagnosis not completed — — — — — — — — 1 4 3 3 11 (c) Non-tuberculous - - - - - - - - 173 192 131 129 625 B.— CONTACTS examined during the year:— (a) Definitely tuberculous 5 6 1 - - - 1 5 6 2 13 (b) Diagnosis nut completed — — — — — — — 3 2 — — 5 78 126 108 140 452 C.— CASES written off the Dispensary Register as : (a) Recovered 19 19 1 3 8 4 9 5 27 23 10 8 68 (B) non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 265 332 243 273 1,113 D.— NUMBER OF CASES on Dispensary Register on December 31st:— (a) Definitely tuberculous 407 330 50 48 36 63 33 63 443 393 83 111 1,030 (b) Diagnosis not completed - - - - - - - - 4 6 3 3 16 82 (1) Number of Cases on Dispensary Register on January 1st 1,079 (2) Number of Cases transferred from other areas and cases returned after discharge under Head 3 in previous years 6 (3) Number of Cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 43 (4) Cases written off during the year as Dead (all causes) 129 (5) Number of attendances at the Dispensary (including Contacts) 4,416 (6) Number of Insured Persons under Domiciliary Treatment on the 31st December 293 (7) Number of consultations with medical practitioners :— (a) Personal 51 (b) Other 789 (8) Number of visits by Tuberculosis Officers to homes (including personal consultations) 471 (9) Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 5,181 (10) Number of (a) Specimens of Sputum, etc. examined 677 (b) X-ray examinations made 525 in connection with Dispensary work (11) Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above 11 (12) Number of " T.B. plus " cases on Dispensary Register on December 31st 351 Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) Provided by Council Provided by Voluntary Bodies , Nil The above Table shews, inter alia, the number of contacts examined during the year and the extent of co-operation locally with medical practitioners. Other co-operation took place, however, between the staff of the Dispensary and the School Medical Officers with regard to delicate children. 83 Out Patient Hospital Treatment. Arrangements exist with different London Hospitals for special forms of treatment. During the year 29 Finsen Light treatments and 126 Ultra Violet Ray treatments were given, and 146 Pseudo-thorax Refills were carried out. All the X-Ray examinations were carried out at the War Memorial Hospital. Denial Treatment. Dental treatment is carried out under the Council's scheme at the School Clinic, Brewer Street. During the year 25 cases received treatment, the number of attendances being 56. 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 14 cases at a cost of £60 18s. 6d., and payments by patients amounted to £24 Is. 9d. In assessing patients, due regard is given to dental' benefits they may be entitled to from approved societies. Shelters. Twelve shelters are maintained by the Council for patients returning from sanatoria who are able and willing to continue this form of treatment. Sputum Examinations. During the year 677 specimens of sputum were examined at the Dispensary. Of these 114 were positive and 563 negative. Facilities for general practitioners are provided at the Woolwich War Memorial Hospital and 347 specimens were examined during the year, 48 being positive and 299 negative. 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. Nursing. During the year arrangements were made with the local Nursing Associations for the nursing of cases of tuberculosis, this disease being added to the list of those already approved under other aspects of the Council's work. Payment is made at the rate of Is. 3d. per approved visit, but the London County Council limited the amount ranking for grant for the year 1930-31 to £50. Institutional Treatment. The following Table shews the number of admissions to special hospitals, sanatoria, public general hospitals, institutions and training colonies :— TABLE No. 64. Special Hospitals. Sanatoria. Public General Hospitals. Training Colonies. Insured 113 76 120 10 Uninsured 42 39 50 4 Children 50 22 18 — 205 137 188 14 QO 85 These figures refer to 398 patients and the monthly admissions were as follows : January 46 July 53 February 54 August 40 March 32 September 46 April 57 October 44 May 45 November 51 June 33 December 43 The Committee undertakes all the care and after-care work of the Borough in regard to the tuberculous. It helps by the provision of clothing for necessitous patients entering institutions; for the purchase of surgical apparatus and nursing requisites; by supplementing financial assistance given by the voluntary organisations for in-patient treatment; by paying fares for varying periods in the case of patients going to and from hospital for out-patient treatment, and in many other ways. It assesses patients' payments for admission to London County Council institutions and for dentures under the Borough Council scheme. It supervises the provision of extra nourishment under the Council's scheme. In all, during the year, it dealt with 943 applications. ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. Disinfection. The methods followed by the Department in disinfection and disinfestation were fully described in last year's report and, in addition, a description was given of the alterations which had been made at the disinfecting Woolwich Tuberculosis Care Committee. At the end of the year the Committee was constituted as follows :— Bodies. Representatives. Woolwich Borough Council Councillors B. A. G. Beaten, W. W. Burr, Mrs. L. E. Driver, Miss C. K. Lambeth, Mrs. E. L. Reeves, Miss G. E. Walters, J.P. Trade Unions Mr. W. H. Fairchild, Mr. E. Ware. Employers Miss L. Ames, Miss Fletcher, Mr. C. N. McLaren. Friendly Societies Mr. W. A. Lyon, Mr. A. J. Rourke, Mr. F. Smyth. London County Council Dr. H. R. Kidner, Miss E. Faulkner. London County Council (Public Assistance Committee) Miss C. K. Lambeth, Mrs. E. M. Newman, Mrs. J. Wood. London Insurance Committee Mr. D. Roseberry. Panel Committee for the County of London Dr. H. M. Wise. British Red Cross Society Mr. J. O'Connell. War Pensions Committee Mr. A. R. Loader. Woolwich Invalid Children's Aid Association Mrs. J. B. Great Rex. Late Tuberculosis Dispensary Committee. . Mr. W. Dashwood, Mr. E. G. Dixon, J.P. United Services Fund Captain W\ A. Hesketh. Ex-Officio. Voluntary Visitors Miss L. Bloxam, Mr. G. F. Brazier, Miss D. A. Frye, Miss L. MacDermott. Tuberculosis Officer Dr. F. J. C. Blackmore. Medical Officer of Health Dr. J. MacMillan. co 00 87 station in order to bring it up to date. Briefly, in cases of infectious disease, infected articles, bedding, etc., are removed to the Council's disinfecting station, White Hart Road, and disinfected there. The infected rooms are disinfected, sometimes by Formalin solution or vapour, and sometimes by washing with a disinfecting solution. When cases are left at home, the process of disinfection is delayed until the medical attendant certifies that the case is free from infection. Contacts are excluded from school in accordance with the regulations of the London County Council. The disinfecting station is sometimes used for special disinfection at the request of the inhabitants. A small charge is made for these disinfections and during the year 40 such disinfections were carried out and fees amounting to £10 8s. od. were paid. In tabular form below is shewn the amount of disinfection which was carried out during the year :— TABLE No. 65. Rooms disinfected after ordinary fevers 630 „ ,, ,, tuberculosis 265 „ „ „ verminous cases 49 Rooms disinfected for other reasons 7 Articles disinfected .. 29,814 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 1927 :— TABLE No. 66. Year. Children. Adults. Grand Total. Boys. Girls. Total. Males. Females. Total. 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 1931 483 1543 2026 14 4 18 2044 Photographs of the infected and clean sides of the disinfecting station, and a plan of the station are shewn on the adjoining pages. go go 89 SECTION IX. MATERNITY AND CHILD WELFARE. The Council's Maternity and Child Welfare scheme makes comprehensive arrangements for the care and comfort of expectant and nursing mothers, and for children under five years of age. Its various ramifications were set out in detail on page 99 of my Annual Report for 1930, but, in addition to the services contained in that list, the following services are now reported on for the first time. The services of a Consultant in exceptional cases of obstetric or ante-natal abnormality at home. Provision of Maternity Outfits. Day Ambulance Service for maternity cases. Payment of compensation to mid wives. Convalescent Home treatment for expectant and nursing mothers. Staff. The medical staff consists of one whole time and two part time Medical Officers for general work and one part time Medical Officer for the Toddlers, examination clinic. In addition, the services of two Consultants are available, one for the Artificial Sunlight Clinic and one for consultation in connection with cases of Puerperal Sepsis and difficult obstetrical conditions. The dental staff— a dentist and an anaesthetist—are part time and are appointed by the School Treatment Committee, subject to the approval of the Council. The health visiting staff consists of seven whole time and two part time health visitors and one artificial sunlight nurse. 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. 90 The Work of the Health Visitors. The Council's Health Visitors divide their time between home visiting and attendance at the Centres. They are responsible for the visiting of all children under school age in their respective areas, including visits to cases of ophthalmia neonatorum, measles, zymotic enteritis, whooping cough, pneumonia and anterior poliomyelitis, but in measles epidemic periods it has been the practice to engage temporary Health Visitors for these particular visits. The following Table No. 67, shows the classification of visits paid by the Health Visitors in 1931:— TABLE No. 67. Births—First visits 1,893 „ Revisits 12,993 Infant deaths investigated 49 Still-births investigated 26 Expectant mothers—home visits 795 Infectious diseases :— Ophthalmia Neonatorum—First visits 7 ,, ,, Revisits 5 Measles—First visits 31 ,, Revisits 15 Puerperal fever—First visits 8 ,, ,, Revisits 2 Puerperal Pyrexia—First vists 29 ,, ,, Revisits 12 Zymotic Enteritis—First visits 3 „ ,, Revisits — Pneumonia 113 Anterior Poliomyelitis 1 Encephalitis Lethargica 1 Visits unclassified 242 Visits unsuccessful 2,000 18,225 In 1931 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. The Work of the Welfare Centres. These are eight in number and are now all municipal. Infant welfare sessions are held at all of them and at three of them ante-natal sessions are held twice weekly. At the end of the year 6 antenatal sessions and 21 infant consultation and weighing sessions were being held each week. 91 The new Health Centre was opened at Eltham by the Minister of Health in February, replacing the one held for many years in the hut at 179, Well Hall Road. This Centre is a combined School Treatment Centre and Infant Consultation Centre and during the year an agreement was entered into with the School Treatment Committee for the use of rooms there for the medical and dental treatment of school children. A photograph of the new Centre appears as an inset. A Centre was established at St. Luke's Church Hall in April, 1931, in order to meet the needs of the mothers in that part of Eltham which lies east of the Well Hall Road. Sessions are held once weekly, on Wednesday afternoon, one of the Council's medical officers attending at each session. In tabular form below are shewn detailed statistics for 1931 and the consolidated statistics for the previous year. TABLE No. 68. Centre. No. on Roll of Centre. No. of Attendances. Mothers. Children. Mothers. Children. Expectant. Nursing. Expectant. Nursing. Town Hall 468 426 1,640 1110 935 10,540 Plumstead 311 371 1,090 856 824 8,028 Eltham 344 193 1,024 715 351 5,869 Slade 6 86 427 9 200 3,745 New Eltham 5 70 365 17 111 4,223 St. Luke's — 38 323 — 49 2,048 North Woolwich 1 25 133 2 42 762 Beresford Street 28 50 126 48 127 888 Totals 1931 1,163 1,259 5,128 2,757 2,639 36,103 ,, 1930 1,218 1,513 4,728 2,714 3,453 35,220 The next Table shews the number of children classified by year of birth and the number of attendances made by them during the year. 92 TABLE No. 69. Children in Attendance at each Centre. Year of Birth. Town Hall. Plum stead. Eltham. Slade. New Eltham. St. Luke's. North Woolch. Beresford St. Totals. 1931 501 345 222 112 123 95 32 31 1,461 1930 501 328 324 118 99 90 39 36 1,535 1929 287 169 176 88 62 55 28 25 890 1928 188 126 140 57 38 36 17 22 624 1927 115 75 108 35 35 34 15 7 424 1926 48 47 54 17 8 13 2 5 194 1,640 1,090 1,024 427 365 323 133 126 5,128 Attendances. 1931 3,518 2,759 1,698 1,046 1,512 843 219 172 11,767 1930 4,343 3,375 2,572 1,468 1,815 715 332 369 14,989 1929 1,369 916 780 645 457 237 109 198 4,711 1928 790 606 449 316 238 102 66 116 2,683 1927 401 254 266 193 162 120 34 26 1,456 1926 119 118 104 77 39 31 2 7 497 10,540 8,028 5,869 3,745 4,223 2,048 762 888 36,103 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, the highest previous figure being 35,220, recorded in 1930. Of these attendances, 23,135 were made by children under one year of age, and 12,968 by children over that age. As the estimated number of children under one at the middle of the year was 2,063, and over one year of age 8,444, these figures demonstrate quite clearly the relatively small number of attendances made by children over one year of age. 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:— 93 (а) On the card of every child under one year of age attending a welfare centre between 15th 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. TABLE No. 70. Feeding of Infants attending Welfare Centres—15th June to 25th July, 1931. 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 36 85 75 49 42 30 31 20 15 383 5 1 - 389 Breast and Hand 3 7 12 11 9 10 4 15 17 88 13 7 1 109 Hand 10 11 38 32 23 36 38 28 41 257 49 54 65 425 49 103 125 92 74 76 73 63 73 728 67 62 66 923 Percentages: Breast 73.5 82.5 60.0 53.3 56.7 39.5 42.5 31.8 20.5 52.6 7.5 16 . 42 1 Breast and Hand 6.1 6.8 9.6 11.9 12.2 131 5.5 23.8 23.3 12.1 19.4 11.3 1.5 11.8 Hand 20.4 10.7 30.4 34.8 31 1 47.4 520 44.4 56.2 35.3 731 87.1 98.5 46.1 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 1930, was 437. The total number of treatments given was 9,976. Of these, 7,370 were by carbon arc, 2,215 by mercury vapour lamp, and 391 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:— " The number of patients referred for treatment was larger, the increase being mostly in the class of patient who was suffering from general debility. A considerable number of these responded rapidly to treatment, but in many instances improvement was slow, and it was found necessary to continue treatment over a prolonged period. There was also a greater number of new cases of rickets than in previous years. A majority of the patients responded extremely well, and many were rapidly cured, but there have been a few who proved refractory. Where bone deformities were seen the children were invariably referred to the remedial clinic of the Invalid Children's Aid Association. 94 Amongst catarrhal children, there were a few failures, but the greater proportion of these were found to respond to gradually increasing doses maintained over several months, and it seems reasonable to infer that much benefit can result if attendance is regular and kept up until the child is seen to be in thoroughly sound health. In several instances enlarged glands disappeared during the treatment, but though local and more intense treatment was applied in some of these cases, it is felt that the improvement was a secondary effect associated with the general improvement in health. In several skin conditions satisfactory results were obtained. It was found that by a moderate intensity of dosage, given on several successive days, coupled with other treatment, impetigo of long duration was made to disappear. In some cases of herpes, accompanied by pain, the treatment was followed by rapid relief and healing of the skin eruption. A number of refractory cases were sent away for varying periods to Convalescent Homes. Their rapid improvement leads to the conclusion that home conditions were partly responsible for the state of health which the sunlight alone was not adequate to combat. It is beyond dispute that, in a district where there is a considerable poor population, the Artificial Sunlight Clinic is of practical service to the community." In tabular form below are shewn the number and types of cases treated during the year:— TABLE No. 71.—Cases Treated at Sunlight Clinic, 1931. Type of Case. Brought Forward from 1930. New Cases. Total. Much Improved or Cured. Improved. I.S.Q. Ceased Treatment. Treatment not yet complete Rickets 25 89 114 36 20 8 26 24 Anaemia, Debility and Malnutrition 22 151 173 39 42 8 35 49 Catarrhal Children 12 33 45 15 8 2 10 10 Septic Conditions — 20 20 18 — 1 - 1 Nervous Children 1 4 5 1 1 1 2 Enlarged Glands 2 16 18 5 5 1 1 6 Miscellaneous Nervous Conditions 2 2 1 1 - — — Miscellaneous Skins 4 15 19 8 3 5 — 3 Others 7 14 21 7 4 2 5 3 Mothers 4 16 20 8 6 — 4 2 79 358 437 138 90 27 82 100 95 Toddlers Clinic. The special Toddlers Clinic, which was opened in May 1930, has been very successful, and no difficulty is now experienced in getting the mothers to bring their children for regular yearly examination. During 1930 two sessions were held weekly and from the 1st April, 1931, the number was increased to three, one at Woolwich, one at Plum stead, and one at Eltham. The clinic is under the medical charge of Dr. Margaret Emslie and she has furnished a very complete report of the year's work. This appears at the end of this report as Appendix I. Home Helps. A scheme for the provision of home helps was put into operation in 1929. During the year, ten applications were considered by the Committee, and seven home helps were provided. 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 the Eltham Health Centre, to a private practitioner, or to a hospital. During the year 135 were sent to these clinics, and for each case the Council paid 5s. Od. Children referred to them suffered from the following conditions:— TABLE No. 72. Brewer Street. Eltham Health Centre. Impetigo 4 33 Ear Discharge 13 19 Eyes 22 22 Miscellaneous 3 19 42 93 Dental Treatment.— Dental work is carried out at the School Clinic. Brewer Street. Mothers and children are referred there from the centres. The following Table, No. 73, shows the cases attending, and the total attendances during the year. The number of sessions was 44, excluding anaesthetic days. TABLE No. 73. No. Attendances. Expectant mothers 91 159 Nursing mothers 29 74 Children under 5 293 336 413 569 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. Thirty sets (complete or partial) of artificial teeth were supplied during the year at a total cost of £131 2s. 6d. Payments by mothers amounted to £67 2s. 5d. 96 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 Is. 6d. per attendance for any other form of treatment. The cost of these services for the year was £214 15s. Od. Only cases recommended by the Medical Officer of Health are included in this scheme, and payment is only made for the number of attendances approved by him. In detail, the children referred to the Clinic required treatment for the following conditions :— TABLE No. 74. Cases Treated at Orthopaedic Clinic, 1931. Type of Case. Number remaining over from 1930. New Cases. Total Cases. Number who completed treatment by end of year. Number with treatment not completed. Talipes (Club Foot) 2 7 9 9 — „ (Flat Foot) 1 8 9 9 - Rickets— General 4 24 28 19 9 Genu Valgum (Knock lknee) 5 35 40 31 9 Genu Varum (Bow Leg) 1 26 27 13 14 Infantile Paralysis 1 1 2 2 — Erb's Paralysis 2 2 4 3 1 Bad Posture 1 8 9 7 2 Muscular Weakness 4 9 13 11 2 Mouth Breathers 4 — 4 4 — Injuries — 1 1 1 — Other Deformities 1 3 4 3 1 Other Diseases - 4 4 2 2 26 128 154 114 40 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. :— 97 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 698 babies were born during the year. At the ante-natal clinics in connection with this Hospital, 5,583 attendances were made, and at the infant clinics 2,340 attendances. In addition there were 223 extern cases. The number of mothers admitted under the Council's scheme was 140, the nett cost to the Council being £949 17s. Od. (2) War Memorial Hospital. There are 7 maternity beds in this Hospital and I am indebted to Mr. R. S. G. Hutchings, the Secretary, for the following information regarding the admissions to the maternity unit during the year. The number of children born in the Hospital was 155, and 28 mothers were admitted for ante-natal or emergency treatment. The number of attendances made at the ante-natal clinic was 1,000. The number of cases admitted under the Council's scheme was 62, the nett cost to the Council being £529 18s. Od. Ante-Natal Treatment and Emergencies. The number of cases admitted for ante-natal or emergency treatment under the Council's scheme was 10. The reasons for admission were: Varicose veins, 3; haemorrhage, 1; albuminuria, 3; cardiac symptoms, 2; and pneumonia, 1. Convalescent Home Treatment for Children under 5 years of Age. The necessary arrangements for this treatment are made by the Woolwich Invalid Children's Aid Association, to whom the Council give grants-in-aid for this purpose. During the year such grants were made in respect to 43 children, the total cost of whose convalescent treatment amounted to £397 10s. Od. The Council's grants amounted to £160 12s. Od. The children were sent away for periods varying from 3 to 36 weeks, and payment was only made in respect of children sent to homes approved by the Medical Officer of Health. 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, £1,448 5s. 8d. Fresh milk, £1. Dinners, nil. Collective Teaching of Expectant and Nursing Mothers.— In April, the special class in mothercraft which had been held every Wednesday afternoon at the Plumstead Welfare Centre was transferred to the Old Town Hall, Woolwich, on every Tuesday afternoon. 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 461. 98 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. Obstetric Complications in Private Practice. In September, 1931, the Council arranged for the services of Mr. Harold Taylor, F.R.C.S., the Council's Consultant under the Puerperal Fever and Puerperal Pyrexia Regulations, to be available in such exceptional cases, and to pay him a fee of £5 5s. Od. for each such case. No cases were dealt with under this scheme during the year. Supply of Maternity Outfits. In 1930 the Council agreed to supply sterilised maternity outfits for the use of necessitous mothers in order to ensure the necessary cleanliness in domestic midwifery and with a view to minimising the risks of maternity. They are supplied free, half cost, or cost price, according to the family income, the Council's economic scales being used as tests of necessity. The local midwives speak very highly of these services. During the year 76 applications were received ; 71 were supplied —29 free, 8 at half cost, and 34 at cost price. Day Ambulance Service for Maternity Cases. The Council's arrangements with the London County Council for the use of ambulances for the removal of non-urgent cases during the day between 8 a.m. and 11 p.m., are set out in Section III. During the year this service was used on one occasion. Compensation for Midwives. It is a growing practice for midwives to refer maternity cases to the Council's ante-natal clinics for examination, and from time to time the assistant medical officers find it necessary to recommend such cases for confinement in hospital. The midwive accordingly loses her fee if the patient accepts the advice of the clinic doctor. The Council thought that it would be advisable in these circumstances to make a payment by way of compensation to the midwife and fixed this at 10s. Od., subject to the following conditions being complied with :— (1) That the medical officer of the clinic certifies that he or she has advised the patient to be confined in a maternity hospital; (2) That the midwife submits the ante-natal clinic medical officer's report, (3) That the patient confirms the fact that she has engaged a midwife to attend in her confinement and has been referred by the midwife to the clinic ; (4) That the birth takes place in hospital; and (5) That if a booking fee has already been paid to the midwife, this fee be returned to the patient before compensation is paid to the midwife. During the year compensation was paid in 2 instances. 99 Convalescent Home Treatment for Expectant and Nursing Mothers. In June, 1931, the Council decided to make provision under their maternity and child welfare scheme for the convalescent treatment of expectant and nursing mothers. The scheme included payment of railway fares where necessary. It was resolved also to recover some of the cost from patients after consideration of each case on its merits. During the year two mothers were sent away. 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 two cases came to the knowledge of the department. Widows', Orphans,' and Old Age Contributory Pensions Act, 1925. The local authority may, in case of desertion of a child who is an orphan, administer the payments on behalf of the child. No case under the provisions of this Act was dealt with during the year. 100 APPENDIX I. REPORT ON THE MEDICAL INSPECTION OF TODDLERS BY MARGARET EMSLIE, M.B., CH.B. The number of cases seen at the Toddlers Clinic in the year ending December, 1931, amounted to 418 boys and 429 girls, full inspections, and 362 re-visits, making a total of 1,209 consultations. This compares with a total of 472 cases in the eight months ending December, 1930. There was an increase both in the number of cases seen per session and in the proportion of parents accepting consultation when asked. There was noted, also, a tendency to make use of the Clinic for re-inspection purposes, within the period of time suggested by the medical officer, but cases requiring frequent observation were, wherever possible, referred to the ordinary child welfare sessions. The response in regard to treatment, where recommended, was good. The type of consultation that has become identified with these inspections deserves perhaps some remark. The clinic is not intended to be a purely inspection clinic for note-taking purposes ; it is intended to be of constructive benefit to the health and progress of the child. For this reason, though it includes a routine examination (like school medical inspection), it attempts to touch much more generally the questions of home management in the pre-school child and to supply what may be wanting, or can be corrected in each case, through domestic means, i.e., diet, exercise, hygiene, sleep, disciplinary training, etc., without impinging on the sphere of medical treatment. The reasons for which patients attend the clinic are diverse, and have to be considered, but the initial questions put in each case are framed so as to give information of a general and accurate character bearing on the child's life and environment, without impressing the mother that she is being asked for more than the usual "facts," or that she is supplying a picture that, in reality, conveys much more than does its simple physique. In the same way the advice that has to be administered is very often given under a cloak since it is desirable not to disturb those mothers who come (very definitely) not for advice, but for information, i.e., for a straightforward "vetting" or for the treatment of some acknowledged defect that they would see no point in discussing in its wider aspects. Opposed to these, but equally "coy," are the hyper-conscious women visiting a centre for the first time, who, once having crossed its threshold, arm themselves for a lengthy, intimate, unhurried conversation about the child that will cover the whole gamut of its life history at a swoop, taking heed of all qualities, virtues and idiosyncrasies, and will fend the mother with comprehensive and infallible advice to meet safely every possible event or accident till the "occasion" for consultation arises again. Intermediately there are those mothers who have attended a centre from time to time and who know, more or less, what to expect from the consultation, only, this time, "more so." To reduce all these groups to a common denominator, cover the ground, secure the information, and supply helpful advice is the basis of the work. Just in so far, moreover, as one consultation eventually resembles another, whatever the approach, is it likely that they are successful. The child obviously cannot be considered usefully in parts, nor is prevention likely to succeed if it is applied under one or two headings only, of possible defects, that leave aside the larger questions of environment. The procedure with regard to the arrangement of examinations was as described last year. The birthday month was chosen for the routine examinations, apart from special cases referred in emergency by the health visitors, and invitations were sent to mothers to attend in that month. The particular inducements offered to non-centre mothers varied with the case as has been inferred, and were left to the health visitors who knew the conditions in the home. He visits were arranged for at intervals suggested to the mother at the first examination, and patients were called up by letter when a reminding home visit by the health visitor was not possible. The first Table shows the results of the examinations. 101 Table I. MEDICAL INSPECTION OF TODDLERS, 1931. Disease, Defect or Condition. Boys: Age last Birthday Girls: Age last Birthday Total 1 2 3 4 1 2 3 4 Nutrition— (a) Excellent 2 68 18 3 2 65 14 8 180 (b) Normal 6 102 69 38 3 109 72 31 430 (c) Sub-normal — 31 48 30 4 29 46 41 229 (d) Bad — 2 — 1 — 1 2 2 8 Muscular Tone— (a) Excellent 2 75 57 42 3 69 53 44 345 (b) Good 5 121 77 29 5 125 77 38 477 (c) Sub-normal 1 7 1 1 1 10 4 — 25 Clothing and Footgear— (a) Satisfactory 7 180 119 66 8 182 120 74 756 (6) Unsatisfactory — 11 9 3 1 13 13 7 57 (c) Not recorded 1 12 7 3 — 9 1 1 34 Cleanliness— (a) Excellent 7 179 112 60 8 171 113 73 723 (b) Fair 1 24 23 11 1 31 20 9 120 (c) Dirty — — — 1 — 2 1 — 4 Skin— Impetigo - 3 2 1 - 1 3 1 11 Urticaria 1 12 12 3 - 17 7 - 52 Other skin conditions — 2 1 3 Eye— External diseases - 2 2 - - 7 7 1 19 Squint - 5 4 5 - 5 1 1 21 Other defects — 1 — — — — 1 — 2 Ear— Otitis Media - 4 2 3 1 5 2 2 19 Congenital deafness 1 — 1 Nose and Throat— Enlarged Tonsils| 4 86 68 32 3 94 66 35 388 Enlarged Tonsils and Adenoids Adenoids Teeth— Caries - 21 30 29 1 21 39 40 181 Hypoplasia - 5 2 1 - 6 3 1 18 Malocclusion - 5 2 1 1 8 6 2 25 Oral sepsis - I 2 — - 1 1 - 5 Heart and Circulation— Heart disease— (a) Functional - 18 19 12 3 18 24 12 106 (b) Organic - 1 1 2 - 1 2 - 7 Anaemia 1 58 31 22 3 51 35 24 225 Lungs— Bronchitis 1 11 7 2 - 10 8 5 44 Asthma — — — — — — 1 — 1 102 MEDICAL INSPECTION OF TODDLERS, 1931—continued. Disease, Defect or Condition. Boys : Age last Birthday Girls : Age last Birthday Total 1 2 3 4 1 2 3 4 Nervous System— Mongolian idiocy - - - - - - 2 2 4 Minor retardation (speech, etc.) — 7 4 — — 6 4 — 21 Minor epilepsy — 1 — — — 2 3 - 6 Cerebral diplegia — — — — — 1 - - 1 Anterior poliomyelitis — 1 - - - - - - 1 Chorea — 1 - - — - 2 - 3 Behaviour symptoms 1 67 39 21 4 46 42 15 235 Alimentary System— Worms - 3 5 3 - 4 3 5 23 Constipation — 3 5 6 — 9 12 4 39 Colitis - 1 - - - - - - 1 Acidosis - 4 2 1 - 1 4 3 15 Coeliac disease — 1 - — — — — — 1 Genito-urinary System— Enuresis (non-behaviour) - - 1 - - 6 1 - 8 Pyelitis — — 1 — — 2 2 — 5 Rickets— Past or Present 4 66 37 16 4 57 36 11 231 Deformities— Postural 2 42 36 24 2 30 27 13 176 Congenital dislocation — — — — — 1 — — 1 General— Tuberculosis (bone or gland) 1 1 - 2 - 2 - - 6 Rheumatic symptoms — — 1 1 — 3 2 2 9 Scurvy — 2 — - - - - — 2 Haemophilia — — 1 - — - - — 1 Acrocyanosis — — — - - - 1 — 1 Pituitary dystrophy — — 1 - — 1 1 — 3 Albinism - - 1 - - - - - 1 Umbilical hernia — — — - — 1 1 — 2 Total Children Examined 8 203 135 72 9 204 134 82 847 These results show, in regard to the majority of defects, no striking variation from the figures last year. Conditions that might roughly be associated with poor feeding show a minor increase; e.g., sub-normal nutrition was noted in 28 percent, of cases in 1931, as compared with 26 percent, in 1930; anaemia in 26.5 percent., as compared with 20 ; rickets in 27 per cent., as compared with 22 (total cases). This variation, however, may be apparent rather than real since the total winter months were included in the 1931 figures and only part of the winter months in the previous year (May to December). Apart from this, the weather returns for the year 1931 would almost tend to suggest an increased risk of anaemia and rickets in the latter period, owing to the lack of sunshine. There is nothing to indicate a general falling off in nutrition, even of a mild kind, due to feeding conditions alone. The figures for anaemia and rickets, however, separately analysed, show some interesting variations as compared with 1930. The incidence of anaemia is much higher this year at the age of the earliest inspection, namely, 2 years, in both boys and girls, but it is practically 103 unchanged at the age of 3, the peak period last year. The figures for the age of 4, again, show an apparent increase although the small numbers examined at this age vitiate any real comparison with other ages. The figures for rickets show the same general direction, namely, the total figures for 1931 show an increase, while the sex variation shown in 1930 is maintained, 30 per cent, boys showing rickets compared with 25 per cent, girls, the respective figures last year being 25 and 18 per cent. The highest incidence of rickets was found at the age of two, diminishing towards school age. It should also be noted that the incidence of dental defects at the age of 2 this year was doubled (16.3 per cent., as compared with 8), while remaining identically the same amongst the older groups. The standard adopted for the diagnosis of rickets was the presence of two of the generally recognised early bony signs, namely, enlarged wrist epiphyses, palpable rosary, Harrison's sulcus, depressed sternum, narrowed rib angle, crowded hypoplastic teeth, combined with constitutional symptoms. In many cases the signs were obviously indicative of old but healed rickets. In other cases signs of past rickets, bossed forehead, pigeon chest, rickety knock knees, lordosis, bent femora, etc., were present along with signs suggestive of a new early lesion (rosary, etc.) in children beyond the usual age for the development of rickets; i.e., already in their fourth or fifth year. While the exact significance of these findings cannot be assessed solely by clinical examination, the impression gained of the prevalence of anaemia and rickets and the rates shown for dental caries amongst the groups examined, under varying social conditions, would seem to point to an operating cause of a very general character (such as climate or weather) rather than a special or temporarily operating one (such as lack of food and means in families hit by unemployment). At the same time the findings would suggest that there is room for further propaganda on the inter-relation of the factors governing nutrition—air, cleanliness, exercise, light, etc., in addition to dietetic factors per se—and the relative value of inexpensive foods, at a moment when many families, in all classes, are bound to be budgeting below their normal expenditure on actual supplies. Apart from conditions reflecting nutrition, "nervous" phenomena of various sorts accounted again this year for a high proportion of the cases referred for observation. As these conditions do not necessarily end in the pre-school years, nor even when their outward symptoms are (apparently) successfully submerged, an attempt was made to submit them to analysis with a view to discovering (a) the situations in which such nervous conditions tended to occur, and (b) the extent to which they might be expected to yield spontaneously to "time" or, untreated, to become a definite charge on the community. For nervousness has its immediate bearing on health, but an equally important, if more remote, bearing on the capabilities (efficiency and enterprise) of the individual in later life. Such a factor must enter into the general calculations if it is found recurring with palpable frequency in a group of cases representative of a community, even at the child stage. It should also, if it resembles other pathological processes, be most amenable to treatment at this stage, when first able to be recognised, even if still somewhat ill-defined in character and not sharply to be removed from " normal " behaviour. It is, as a matter of fact, accepted that it is at this moment, in the whole of life, that nervousness, as experienced in adult life in all its many-coloured guises, is created. It is also known that the creating factors are mostly ignorance, a failure to appreciate the vital forces playing on the childs mind in evolution, in the actual infant years. The longer these are allowed to act adversely, the more fixed the "nervous" symptom, the longer and more stormy the road the individual must face before the evil influence can be outdone. So little, in fact, does life of itself solve these troubles that the nervous adult is, as a rule, just so much further from happy release as the years of unsuccess that divide him from the inharmonious child. No apology is needed, therefore, for examining nervousness present in the pre-school years, even slight in amount, since it is here most interesting to the observer, most accessible to treatment, and a much less costly proposition for all concerned if it can somehow be prevented from becoming an established "defect." In this instance nervous symptoms of all sorts, and some only nervous by inference, but that are sometimes physical (e.g., enuresis), provided only they were sufficient to attract attention at examination, were included in the observation. The causative jnfluences were obviously beyond the scope of the enquiry, but certain major factors likely to e involved were open for consideration. For this reason the total cases examined were first grouped in certain (family) classes or "situations" held to have special significances for the mental development of children during the pre-school years. All cases examined in the two years 1930 and 1931 were included in these groups, excluding only certain North Woolwich cases for whom such regular inspection and classification was not practicable. The classification 18 as follows:- 104 "Only Children" Cases.— Under 3 years of age. Over 3 years of age. "Big Interval" Cases.— Where the child observed came at an interval of more than four years after the birth of the last child. "Special Circumstances" Cases.— Such as foster children and step-children. "Replacement" Cases.— Where nervous symptoms were to be associated with the appearance of a younger child in the family. "Others."— Including all cases not already recorded; i.e., cases where there was more than one child in the family and where an interval not greater than four years had elapsed since the birth of the previous child. This includes naturally, many cases where replacement occurred, as it does in the "ordinary" family without symptoms, i.e., cases where children were born at shortish intervals but where the division of attention was not sudden or such as to produce a particular sense of loss in any one individual. The "Replacement" group, it may be said, was differentiated solely for the interest of the observer, who was anxious to determine the type of symptoms evidenced in certain circumstances, when a re-action was present, and when this was at the same time open to clear differentiation from other re-actions examined. Its size is no indication of the numbers of cases examined in which replacement was not accompanied by untoward effect, or where it was open to be confounded with other factors, and has, therefore, no bearing on the symptoms or lack of symptoms shown by the young child growing up as a member of a rapidly increasing family, which some would call the aggravated condition of " replacement." The following Table shows the total cases grouped according to the classifications mentioned above:— Table II. District. Only Children Big Interval Children. Replacement cases with symptoms. Special Cases. Others. Total. Under 3 Over 3 Town Hall 80 45 41 38 5 158 367 Eltham 48 34 53 29 7 329 500 Plumstead 21 16 17 13 3 39 109 New Eltham 40 18 9 15 - 40 122 189 113 120 95 15 566 1,098 The type of symptoms seen was classified as follows:— Thumb-sucking. Enuresis. Temper; fright on examination; general shyness; nervousness. Depression, "misery," noticed at home. Backwardness (generally in speech, sometimes habits). Over-dependence on mother; mother anxiety. Sleep difficulties (refusal to go to bed, wakefulness, night terrors, persistent desire to sleep with parents, etc.). Child still on breast, bottle or dummy over the age of 2 years. Frank mismanagement as seen at examination (obvious spoiling, threatening, deceiving, spanking, etc.). Lack of appetite, vomiting attacks, constipation—the "acidosis" syndrome. Stammering, stuttering. "Bad habits," self-abuse. 105 The following Table, III., shows the nervous symptoms noted, classified according to these groups, but it should be noted that the number of symptoms shown is larger than the number of nervous cases, as in many instances more than one symptom was present in a child :— Table III. Town Hall. Eltham. Plumstead. New Eltham. Total. Fright—temper complex 27 73 8 21 129 Backwardness (speech, habits, etc.) 33 55 16 17 121 Acidosis syndrome 30 56 18 12 116 Enuresis 21 32 4 13 70 Frank mismanagement 34 22 3 6 65 Sleeping difficulties 30 15 3 4 52 Thumb-sucking 13 23 5 6 47 Misery complex 15 7 3 6 31 Over-dependence; mother anxiety 14 8 2 3 27 Stammering, stuttering 4 5 2 2 13 Still on breast, bottle, dummy 2 8 — — 10 Bad habits 2 3 — 1 6 The first observation to be made in relation to Table II. is the variation in the type of case (family) shown in different districts : figures here denote percentages. Table IV. District. Only Children Big Interval Children. Others. Under 3 Over 3 Town Hall 21.8 12.2 11.l 54.9 Eltham 9.4 6.8 10.6 73.2 Plum stead 18.3 13.7 14.7 53.3 New Eltham 34.4 14.7 9.0 41.9 All districts 17.0 10.2 110 61.8 Further reference is made to this point later. The cases showing nervous symptoms may now be examined in relation to district incidence:— Table V. District. Only Children Big Interval Children Replacement Cases. Special Cases : (Foster children, etc.) Others. Totals. Under 3 Over 3 Town Hall 47 24 26 37 4 44 182 Eltham 30 21 36 29 5 101 222 Plum stead 8 8 7 13 2 13 51 New Eltham 24 12 7 15 7 65 Totals 109 65 76 94 11 165 520 106 The percentage of cases showing nervous symptoms in different districts therefore varies as follows (Tables II. and V.):— Table VI. District. Percentage of Total Cases Showing Symptoms. Town Hall 50 Eltham 44 Plum stead 47 New Eltham 53 The Borough 47 Examining further the symptoms in their order of frequency in different districts, 1, 2 and 3 in the following Table represent respectively the most frequent symptoms (in that order) seen in each case:— Table VII. District. Acidosis Syndrome. Mismanage ment. Sleep difficulties. Fright : Temper Complex Enuresis. Backward ness. "Misery" Complex. Thumb sucking. Town Hall 3—4 1 3—4 - - 2 - - Eltham 2—3 — — 1 - 2—3 - - Plum stead 1 — — 3 - 2 - - New Eltham - — — 1 3 2 — — Observing next the frequency of symptoms according to type of family :— Table VIII. Only Children: Big Interval Children Replacement Cases. Others. Totals. Under 3 Over 3 Fright—temper complex 26 12 22 14 55 129 Backwardness (speech, habits, etc.) 28 6 17 18 52 121 Acidosis syndrome 19 27 16 25 29 116 Enuresis 16 6 6 16 26 70 Frank mismanagement 17 11 16 9 12 65 Sleep difficulties 14 9 6 10 13 52 Thumb-sucking 7 7 4 10 19 47 Misery complex 1 1 3 19 7 31 Over-dependence: mother anxiety . . 10 8 5 — 4 27 Stammering, stuttering 3 — 2 3 5 13 Still on breast, bottle, dummy 3 — 1 1 5 10 Bad habits 1 1 1 — 3 6 145 88 99 125 230 687 From these Tables it is evident that "nervousness,” as indicated by fright, shyness, temper on examination, minor retardation (backwardness) and the acidosis (no appetite, constipation, vomiting, etc.) syndrome, are the commonest types of nervous symptoms found, but that special variations are found in relation to the circumstances in which the child is placed in the family. Taking the only child separately, for example, it is found that backwardness and nervousness are more evident than the other symptoms in the only child below the age of 3 years ; after that age the reactions grouped somewhat loosely as " acidosis " become the more striking. In the child separated by an interval of more than 4 years from the preceding 107 child, general nervousness comes higher than backwardness and acidosis, but the symptoms of parental mismanagement (spoiling, disobedience, etc.) are equally prominent. This is the only group amongst the groups considered (apart from the only children over 3) where what might be called gross mismanagement comes in as a serious factor, and certain inferences will almost inevitably be drawn from this. In the "replacement" cases, reactions typified in the form of "acidosis" are very noticeable, closely followed by frank symptoms of misery and by nocturnal enuresis, a sequence that will have significance for any one familiar with neurological events. The rationale of the acidosis in these cases and in that of the "only children" should perhaps be considered. In the general group, i.e., families where the interval between the children is small, nervousness, backwardness, and acidosis appear again in that order, but enuresis once more appears high on the list. Here the factor of replacement, as has already been suggested, must very often come in, though it cannot be observed very directly, and there are also the difficulties of training in the larger family where the children are all young at once. The occurrence of sleep difficulties, again, is much commoner amongst the only children, in proportion, than in the other groups (as Freud would say, " the eternal triangle.") A survey of symptoms taken now in relation to their incidence rate in different districts bears out the importance of general " nervousness " as the most frequent type of symptom in all districts. There is no outstanding indication of any direct relation between the type of district and the occurrence of any special type of symptoms, apart from the question of the type of family occurring in different districts, but confirmatory observations may be made on this point by further reference to Table IV. 1. The Only Child. The type of symptoms commonest in the only child under and over 3 years of age has already been observed. What is the incidence rate of nervous symptoms in only children as compared with the rest of the community of pre-school age ? The following figures show the evidence amongst these cases for or against special difficulties attaching to the only child family. (a) Only Child under 3 Years. The percentage total of only children under 3 showing nervous symptoms equals 57. Percentage of total other children examined showing nervous symptoms equals 45. But, excluding the only and big interval children special groups, the percentage of total cases showing nervous symptoms equals 40: and, excluding all the special groups, the percentage equals 30, so that the incidence rate of symptoms in the only children under 3 as compared with the " ordinary " child is, approximately, double. (b) Only Children over 3 Years. Percentage of only children over 3 with nervous symptoms equals 57'5. Percentage of total other children examined showing nervous symptoms equals 46. But, comparing the only child with the " ordinary " child, the incidence rate of symptoms is again as 57 5 to 30—again approximately double. (c) Only Children over and under the age of 3 compared. 57% only children under 3 showed nervous symptoms. 57-5% only children over 3 showed nervous symptoms. Therefore, the risk of nervous difficulties with the only child shows no increase after the age of 3, amongst the cases examined up to school age. 2. The Big Interval Child. (a) Nervous symptoms incidence. The percentage of " big interval " children showing nervous symptoms equals 63.3. Percentage of all other children examined showing nervous symptoms equals 45.6. But the percentage of " ordinary " children (c.f. above) showing nervous symptoms equals only therefore the incidence rate amongst the big interval group is, again, more than doubled as compared with the " ordinary " family; or, compared with all other groups, 1½ times as great, 108 (b) Age interval. Average interval (over 4 years) shown between births in "big interval" cases equals 6.2 years. Average interval shown in " big interval " cases with nervous symptoms equals 6.7 years, i.e., no direct relation is shown by these figures between the length of interval and risk of nervous defect developing, but compare further below. (c) Big interval child compared with only child. The incidence rate of nervous symptoms in "big interval" as compared with only children is as 63.3 compared with 57. The "big interval" child appears, therefore, to be labouring under still greater difficulties than the only child, in respect of nervous conditions. This point is again further developed in the ensuing paragraphs. (d) The "4 years and upwards " interval. The choice of 4 years and upwards as a standard for the "big interval" child is open to possible comment. Some would call it too generous a standard since it must include many cases where the interval between pregnancies is simply accidental or due to illness or other unavoidable cause, and therefore cannot be used to differentiate the effects, if any, of deliberate spacing of the family. The longer the interval chosen the less this factor of accident or actual lack of fertility comes in. Others, on the other hand, would no doubt defend 4 years as the minimum interval suitable between children in these days of stress, on grounds of health and economy, while admitting themselves fully alive to the dangers of too wide spacing. Four years has been chosen to delineate the "big interval" ease here because it represents, at any rate, a favourite spacing, because it is believed to denote a definite stage in the developmental cycle of the infant mind, and because it marks probably the earliest period at which the effects of spacing per see can safely be differentiated from the other elements present in the family life and relationships of the child in its first years, as now under observation. The first four years as a critical phase in the mind development of the child, comes into question here, not in regard to the nervous children we have been considering, but to those others, equally important, who go before them and who have not previously come under our attention because they have gone to school by the time their younger brothers and sisters became eligible for inspection. These children it will be seen were "only children" for at least the four first vital years of their lives, in the majority of cases, or, if our "nervous child" came at the end of a larger family, were at least peculiarly open to the difficulties of "replacement" when their place was usurped, finally, after such a long interval, by the younger infant. It is only reasonable to suppose that they would be as susceptible to the risks of the " only child " situation, and the child " replaced," as the general cases in the groups examined, so that the effects of spacing cannot be held to be limited to the effects on the aftercoming child, as measured in the statistics above. "Spacing" is, in fact, literally a two-edged weapon, and these considerations must be borne in mind in comparing the results shown, in case-numbers, with the evidences of difficulty represented in the other family groups. To proceed further and accurately it is necessary to take intervals longer than 4 years amongst the total 120 "big interval" cases with symptoms and study the effects of the increasing interml on the incidence rate of nervous symptoms. This is done in the following Table:— Table IX. Interval. Number of Cases. Number showing nervous symptoms. Percentage of Cases showing nervous symptoms. 4 years and upwards 120 76 63.3 6 „ „ 72 47 65 8 „ „ 38 28 74 10 „ „ 17 14 82.5 109 From this it is clear that the risk of nervous defect, as seen in the cases examined, increases progressively with the length of interval between births. With the longer intervals the incidence rate of symptoms is very clearly in excess of that shown by any other group of cases, including that of the only child. It should, however, be repeated that these figures do not represent the sum-total of the risks within the "big interval" family. The elder children affected by the "big interval" cannot be excluded from the reckoning, and if they could be brought directly under review would no doubt bring the total in case numbers much higher than the figures of " nervous cases" shown here. 3. The Special Circumstances Child (Foster children, step-children, adopted children, etc). The total number of these cases examined was 16, the total number showing nervous symptoms was 11. The figures are too small to allow of any general deductions but they suggest that children placed in the abnormal surroundings of a foster home, deprived of the advantages of the family " unit," or placed by circumstances in an unusual relation to either parent, show a predisposition to the development of nervous defect. 4. Other Cases. Percentage of children in "other cases" group showing nervous defects equals 30. Percentage of total children examined showing nervous defects equals 47.4. Therefore, incidence of nervous defects in type of family here classified equals less than average for all families, including "only" and "big interval" children. But the smaller average figure is more striking when the incidence of nervous defect ill these children is compared, not with the total cases figure, but with the average figure for all the "special" groups taken together, namely 67. This would appear to show that symptoms occur to less than half the extent in what might be called the "normal" family as compared with the special cases that have been analysed, representing situations in which opportunities for maladjustment are commonly believed to occur. The types of symptom, also, that represent no less than half of the total here—bad reaction to strangers ("nervousness") plus backwardness—are types for which nature may be expected to find its own cure in the larger family, with its special opportunities for comradeship. There is nothing to suggest that the same can be said for the groups of symptoms suggesting over-dependence, over-anxiety and solitariness that bulk so much larger in proportion amongst the "only" and "big interval" children (typically enuresis, mismanagement, acidosis), and that constitute at the ages as examined much clearer evidence of imperfect adjustment. As this report cannot be a symposium on "the family," and includes only one small aspect of the difficulties of its planning, and states nothing on the other side, it will be better if the subject is now left with this single remark—that nothing probably could be more difficult for the conscientious parent than the problem how, with all the knowledge available, to arrange his children so that they shall come with greatest advantage to the family unit, least hurt to themselves, justice to their mother, and, in mental growth at least, the best chance of flowering as happy and independent individuals of real solace to themselves and the race. 110 APPENDIX II. Meteorological Observations taken at the Royal Observatory, Greenwich, during the year 1931. Week ending. Temperature of the Air. Departure from average mean air temperature for 65 years. Average temperature 4 feet below ground. Number of days on which rain fell. Rainfall in inches. Highest during week. Lowest during week. Mean temperature. Jan. 10 39.1 26.1 33.2 — 4.8 44.9 1 001 „ 17 52.0 29.5 40.9 + 2.8 44.0 4 0.12 „ 24 51.0 30.9 44.1 + 5.3 44.0 5 0.34 „ 31 45.1 25.6 390 — 0.5 44.2 6 0.44 Feb. 7 46.5 26.5 36.3 — 3.3 43.5 6 0.35 „ 14 52.4 28.1 41.0 + 2.1 43.2 6 0.38 „ 21 48.1 30.1 38.1 — 1.5 42.9 4 0.24 „ 28 55.2 28.0 41.5 + 1.5 42.8 3 0.44 Mar. 7 43.6 23.9 34.4 — 6.3 42.6 2 0.11 „ 14 54.9 210 33.9 — 7.2 41.8 1 0.05 „ 21 68.9 29.0 470 + 51 41.7 1 0.01 28 61.7 33.6 45.3 + 2.6 43.2 2 0.15 April 4 550 30.9 42.8 — 2.5 43.7 4 1.14 April 11 66.3 37.1 490 + 2.9 44.3 3 0.32 „ 18 69.4 33.0 47.1 + 0.2 45.5 5 0.62 ,, 25 62.1 36.0 45.5 — 30 45.8 6 1.27 May 2 64.7 37.7 49.3 †0.3 46.3 3 0.52 9 68.1 39.1 51.0 + 0.5 47.1 4 1.10 „ 16 70.2 41.2 55.2 + 2.9 48.4 2 0.48 „ 23 68.3 40.6 50.2 — 3.8 493 5 0.88 „ 30 73.2 42.6 58.6 + 2.6 50.2 5 0.41 June 6 73.1 47.0 59.1 + 1.1 51.7 3 0.50 „ 13 77.6 5.10 61.2 + 3.0 53.0 3 0.28 „ 20 79.9 46.6 58.6 — 0.5 54.2 3 0.35 „ 27 79.5 41.4 60.2 — 0.9 54.8 1 0.09 July 4 79.7 47.2 630 + 1.4 55.2 1 0.01 July 11 78.9 49.1 62.8 + 0.4 55.9 1 002 „ 18 81.2 53.5 61.5 — 1.8 56.4 5 0.91 „ 25 79.9 47.7 61.0 — 2.0 56.5 3 0.67 Aug. 1 75.0 50.2 60.2 — 21 57.0 4 0.86 8 79.2 50.1 63.8 + 1.6 57.4 6 3.01 „ 15 73.9 45.9 58.2 — 4.2 57.9 6 1.60 „ 22 74.7 49.3 59.7 — 20 58.0 5 1.54 „ 29 69.0 41.7 55.2 — 5.4 57.6 1 0.06 Sept. 5 70.1 50.7 57.9 — 1.8 570 6 0.77 „ 12 64.9 35.1 500 — 8.6 56.7 1 0.43 „ 19 71.5 40.7 55.9 — 1.4 55.7 3 0.19 „ 26 63.9 43.3 52.3 — 3.2 55.5 5 0.18 Oct. 3 68.7 45.8 54.9 + 0.6 55.0 2 0.04 11l APPENDIX II.— 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. 10 66.4 44.2 56.6 + 4.4 55.1 3 0.40 „ 17 67.9 36.7 52.1 + 1.9 54.9 1 0.01 24 59.4 27.0 45.2 — 3.4 53.9 — — „ 31 52.6 240 40.8 — 6.6 52.1 2 0.29 Nov. 7 61.3 36.9 51.5 + 5.2 51.1 2 0.52 „ 14 57.9 370 48.0 + 4.0 50.7 4 0.96 „ 21 50.0 29.2 43.2 + 0.7 50.0 4 0.45 „ 28 56.8 341 46.3 + 4.4 490 6 0.48 Dec. 5 60.0 33.0 44.5 + 3.4 48.8 2 0.35 „ 12 54.6 33.1 45.2 + 4.5 48.1 2 0.03 „ 19 49.0 26.1 40.0 — 0.4 47.9 2 0.09 „ 26 54.8 29.3 42.1 + 3.6 47.0 — — Jan. 2 (1932). 54.4 20.6 39.8 + 11 46.7 4 0.21