WOO 34 Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1934 BY J. MACMILLAN, D.S.O., M.C., M.B., D.P.H. Medical Officer of Health LONDON: WIGHTMAN & CO., LTD. Regency Street, S.W.1 PUBLIC HEALTH AND HOUSING COMMITTEE. At 31st December, 1934. His Worship the Mayor (Councillor A. H. Gilder, J.P.). Councillor Miss M. Crout, J.P. (Chairman). Councillor Mrs. L. E. Driver (Vice-Chairman). Aldermen: R. T. Baillie Mrs. E. Brooks E. H. Kemp, J.P. Councillors: E. Brown C. J. Keedy C. H. Darby Mrs. E. L. Reeves J. B. Fyson Miss S. Turnbull G. Greenwood H. Vaughan H. L. Hunt Miss G. E. Walters, J.P. MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Public Health and Housing Committee. Councillor Miss G. E. Walters, J.P. (Chairman). Councillor Mrs. L. E. Driver (Vice-Chairman). 3 TABLE OF CONTENTS. page Public Health and Housing Committee 2 Maternity and Child Welfare Committee 2 Preface 6 I.—GENERAL PROVISION OF HEALTH SERVICES. Public Health Officers 10 Laboratory Facilities 13 Ambulance Facilities 13 Professional Nursing in the Home 14 Clinics and Treatment Centres 15 Hospitals 16 Midwifery and Maternity Services 17 Institutional Provision for Mothers and Children 17 Health Visiting 17 Infant Life Protection 17 Orthopaedic Treatment 17 Supply of Insulin 18 Vaccination 18 Adoptive Acts, By-laws and Regulations in Force in the District 21 II.—HEALTH PROPAGANDA. General Reference 25 Health Week 25 School Children 26 Informal Talks 27 Central Council for Health Education 27 "Better Health" 27 Posters 27 Cookery Classes 28 Bed-bug Demonstration Stall 28 Health Services Booklet 29 III.—MATERNITY AND CHILD WELFARE. General Reference 30 Staff 31 Notification of Births Acts 32 The Work of the Health Visitors 32 Infant Life Protection 33 The Work of the Welfare Centres 34 Feeding of Infants 36 Artificial Sunlight Clinic 38 Toddlers' Clinic 39 Provision of Maternity Outfits 43 Compensation of Midwives 43 Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 43 Obstetric Complications in Private Practice 43 Home Helps 43 Treatment of Minor Ailments 43 Dental Treatment 44 Orthopaedic Treatment for Children under Five Years of Age 45 Provision of Nursing Assistance 46 Day Ambulance 46 Children's Beds 46 Institutional Midwifery 46 Ante-Natal Treatment and Emergencies 47 Convalescent Home Treatment for Children 47 onvalescent Home Treatment for Mothers 47 Assisted Milk Scheme 48 Blind Persons Act, 1920 49 Widows', Orphans' and Old Age Contributory Pensions Act, 1925 49 4 IV.—SANITARY ADMINISTRATION. PAGE Staff 50 Water Supply 50 Removal and Disposal of Refuse 50 Drainage 50 Smoke Abatement 51 Fouling of Pavements by Dogs 51 The Rats and Mice (Destruction) Act. 1919 51 Complaints 52 Sanitary Inspection of the Area 52 Condition of the River Thames 54 Offensive Trades 56 Rag Flock Act 56 Mortuaries 56 Cemeteries 57 Factory and Workshop Act 57 Removal of Infirm and Diseased Persons 59 Children's Sandpits 59 Public Baths and Washhouses 59 Legal Proceedings 59 Nuisance from Pigeons 60 Shops Act, 1934 60 Pharmacy and Poisons Act, 1933 61 v.—INSPECTION AND SUPERVISION OF FOOD. Registration of Premises 62 Milk Supply 63 Artificial Cream Act 65 Meat Supply 65 Slaughter of Animals Act, 1933 66 Other Food Premises 68 Unsound Food 68 Merchandise Marks Act 68 Agricultural Produce (Grading and Marking) Acts 69 Sophistication of Food 70 Adulterated Samples—Action taken 73 Food Poisoning 74 Nutrition 76 By-laws 76 VI.—HOUSING. Statistics 77 Inspection of Houses 78 Clearance Areas 80 Eltham Hutments—Rehousing 81 Council's Housing Schemes 82 Overcrowding 84 Common Lodging Houses 84 Rent (Restrictions) Acts 85 Tents and Vans 85 Houses Let in Lodgings 85 New Houses 85 Bug Infestation of Houses 85 VII.—PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. General Reference 92 Notifications 92 Diphtheria 98 Diphtheria Immunisation 99 Scarlet Fever 103 Smallpox 106 Erysipelas, Malaria and Dysentery 106 Enteric Fever 106 5 page Anterior Poliomyelitis 106 Cerebro-Spinal Meningitis 106 Encephalitis Lethargica 107 Puerperal Fever and Puerperal Pyrexia 107 Ophthalmia Neonatorum 107 Zymotic Enteritis 108 Whooping Cough 108 Measles 108 Pneumonia 109 Tuberculosis 110 Arrangements for Disinfection and Disinfestation 122 VIII.—GENERAL STATISTICS. Population 123 Social Conditions 124 Sickness and Invalidity 127 Physical Features of the Area 127 IX.—VITAL STATISTICS. Annual Statistics (including those of Wards) 128 Births 130 Marriages 132 Deaths 132 Deaths from Cancer 136 Maternal Mortality 137 Child Mortality 138 Infant Mortality 139 APPENDIX. Meteorological Tables 143 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 the Thirty-Fourth Annual Report on the Health of the Metropolitan Borough of Woolwich. In accordance with the instructions of the Council, the report, which is an "Ordinary Report" and not a "Survey Report," follows the outline indicated by the Ministry of Health in order to ensure uniformity in the presentation of Annual Reports of Medical Officers of Health throughout the country. A precis of the Health Services of the Borough will be found in the first section and the Council's scheme of Health Propaganda is fully described in the second section. In December a general inspection of public health services in the Borough was begun by medical officers of the Ministry of Health but the inspection was not completed at the end of the year. This survey inspection is required in order that the Ministry may be satisfied from time to time that a local authority is maintaining a reasonable standard of efficiency and progress in discharging its duties relating to public health, regard being paid to the standards in other areas whose financial and other circumstances are substantially similar. The Council's Maternity and Child Welfare Scheme is comprehensive and differs substantially from what it was when the first assistant medical officer—Dr. Rachel Mackenzie—was appointed in 1918. A detailed description of the year's working is given in Section III. Dr. Mackenzie retired on superannuation towards the end of the year and the following reference to her work was presented to the Council by the Maternity and Child Welfare Committee and recorded in the Council's minutes:— "We desire to place on record our very deep appreciation of the devoted services to maternity and child welfare given by Dr. Mackenzie during her sixteen years' service with the Council. She was the first Medical Officer appointed for maternity and child welfare work, and has been, in a large measure, responsible for the development and success of the Council's Maternity and Child Welfare Scheme. Dr. Mackenzie has always taken the keenest personal interest in the care and comfort of mothers and the feeding and up-bringing of children, and has given the whole of her talent and time to the furtherance of their well being. We sincerely regret that we have to lose her services and hope that she will live long to enjoy a happy, well-earned retirement." 7 Ample evidence of the valuable work carried out by the Sanitary Section during the year will be found in those Sections dealing with Sanitary Administration, Housing, Supervision of the Food Supplies and Control of Infectious Disease. A very high standard of work has been maintained throughout. The outstanding nuisance in the Borough during the year was that caused by the condition of the River Thames. The whole of the sewage of London is discharged into the River Thames just at or below Woolwich—at the northern outfall near Barking Creek and at the southern outfall at Crossness—and the only treatment the great bulk of London sewage receives is time to settle to allow of the deposit of crude matters in suspension. The liquid sewage is then discharged direct into the river, without further treatment except during hot spells when chemicals may be added as a palliative measure. The removal of sewage from the Thames depends partly upon the tides and partly upon the supply of water from the upper reaches. Last summer, during the period of drought, the amount of such water available was very much below average, and so little was available for the aeration, dilution and removal of the sewage. The tides do not by themselves remove the sewage, and so the river at Woolwich, as the season went on, became a solution of sewage effluent. Offensive smells arose from it night and day and these were noticed not only in those parts of the town adjoining the river but in parts further away. The Thames had, in fact, arrived at a condition very little different from that described in words which were written in a government report on the sanitary condition of Woolwich in 1851:—"There is the river in front, tainted by the refuse of the Metropolis and the daily tides cause the vitiated waters to oscillate, weaving much of the same water, with any refuse it contains, backwards and forwards in front of the town for several days." The London County Council in July decided to spend something over half-a-million pounds in providing additional sewage purification plant on the north side of the river, but according to the present plan it will be five years before the plant is complete, and then it will treat by the activated sludge process approximately 20 per cent. of London sewage. It will thus only be a partial scheme, and unless there is some alteration in outlook or speeding up, Woolwich will have to endure unpleasant odours from the River Thames every dry summer, since, as it is well put in the same report referred to above, "Rivers and natural streams cannot be turned into open sewers with impunity." In housing matters much progress has been made. A general survey of the Borough has made clear what areas require to be dealt with by clearance schemes and negotiations are now in progress with the London County Council with a view to settling how much shall be undertaken by that body and how much by the Borough Council. Three representations were made by me during the year and the building 8 of 106 dwellings for re-housing the occupiers of these areas and the one represented in 1933 was commenced. Compared with 1933, the incidence of infectious disease shows an increase, mainly due to the periodicity of measles, a disease which occurs in epidemics approximately every two years, but in addition there were more cases of diphtheria (416 against 370), erysipelas (119 against 67) and pneumonia (280 against 249). The number of cases of measles was 2,392, compared with 354 in the previous year. There was a slight decrease in the number of cases of scarlet fever (989 against 1,004) and puerperal fever and puerperal pyrexia (35 against 40). There were no cases of Smallpox. Facilities for diphtheria immunisation were provided during the year by means of a family doctor scheme. Immunisation is carried out by the doctor and paid for by the Council, but Schick testing is undertaken by the Council. Full details of the scheme will be found in that section of the report dealing with the Control of Infectious Diseases. The number of primary cases of tuberculosis coming to the knowledge of the Department during the year was 269 (252 in 1933). At the end of the year there were 829 persons suffering from pulmonary tuberculosis and 219 persons from other forms of tuberculosis, i.e., in all 1,048 persons (1,035 in 1933) living in the Borough. The deaths from tuberculosis during the year numbered 146 (135 in 1933). The principal vital statistics for the year are as follows:—The birth rate was 13.7, an increase of 1.0 on that of 1933; the death rate was 11.3 compared with 11.2 in 1933; the infantile mortality rate was 63, compared with 62 in the previous year and the neo-natal mortality rate (deaths under 4 weeks per 1,000 births) was 27.5 as against 33.92. Maternal deaths numbered three, compared with six in 1933; the rate for the year per 1,000 births being 1.44. Not in any year during the last quarter of a century have there been as few as three maternal deaths. The population of the Borough is estimated by the Registrar General to be 145,520 at the middle of the year, a decrease of 680 on 1933. This is the total population and includes non-civilians. It is on this figure that the rates of the Borough are calculated, and so, when any comparison of figures in this report- is made with those during the period 1915 to 1931 (when civilians only were included) allowance must be made for this alteration in method. Since my last report the following staff changes have taken place:— Miss E. L. Little, Tuberculosis Visitor, commenced duty on 1st January. Dr. C. F. Clarke, who became a part-time public vaccinator in 1930, resigned his appointment in June on the grounds of ill-health. 9 Dr. Andrew Mair was appointed a Public Vaccinator from 1st August. Mr. Amyas Britter, Committee Clerk, who entered the service of the Plumstead Vestry in 1900, died on the 28th August. Mr. H. M. Collyer, Grade B Clerk, was promoted to Grade C from 1st October. Mr. L. Pike, Grade A Clerk, was promoted to Grade B from 1st October. Mr. A. Goad was appointed to a temporary clerkship from 30th November. Dr. Rachel Mackenzie, Medical Officer for Maternity and Child Welfare, who entered the service of the Council in 1918, retired on superannuation in December. ,Dr. Frances Smith, Assistant Medical Officer, commenced duty on 27th December. It is pleasing to place on record that the following additional qualification was obtained during the year by one of the Council's Health Visitors Diploma of Nursing, University of London— Miss Winifred Adams. I am very grateful to the Chairmen of the Health Committees, to the members of these Committees, and indeed to all the members of the Council for the interest they have taken in the work of the Department and for the kindness and consideration they have shown to me on all occasions. I thank sincerely every member of the staff for the valuable work they have done during the year and the help they gave to me personally. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. MACMILLAN, Medical Officer of Health. 10 SECTION I. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. i. Public Health Officers of the Authority. (a) In tabular form are shown 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. 1. Year appointed. Name. Qualifications. Appointment. 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. Assistant Medical Officer (General Purposes). 1934 Smith, F. E. M.B., Ch.B., D.P.H. Assistant Medical Officer (General Purposes). 1927 Lynham, J. E. A. B.A., M.D., D.M.R.E. Consultant, Artificial Sunlight. 1927 Taylor, H. G. F.R.C.S. Consultant under Puerperal Fever Regulations, 1926. Obstetric Consultant (1931). 1930 Emslie, M. M.B., Ch.B. Medical Officer, Toddlers Clinic (part-time). 1934 Smith, W. M.A., M.D., B.Ch. Medical Officer, Schick Testing Clinic. 1930 Brews, R. V. L.R.C.P.I. and L.M., L.R.C.S.I. and L.M. Public Vaccinator (parttime). 1930 Cowie, W. M.A., M.B., C.M. 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. 1934 Mair, A. M.D., D.P.H. do. The deputies for the above Public Vaccinators are respectively: Dr. N. E. Sampey, Dr. D. Wilson, Dr. E. C. Wise, Dr. W. T. Milton, Dr. R. W. Wood, Dr. R. Lewys-Lloyd, Dr. H. M. Wise. 11 (b) In tabular form are shown below the dates of appointments, names, and qualifications of the Public Analyst, Sanitary Inspectors, Health Visitors, Vaccination Officer, Tuberculosis Staff and the Clerical Staff employed by the Council at the 31st December. TABLE No. 2. Year appointed. Name. Qualifications. Appointment. 1933 Williams, H. Amphlett A.C.G.F.C., F.I.C. Public Analyst (part time). 1909 Shaw, H. Cert. Royal San. Inst.; Cert. San. Insp., Exam. Board; Cert. San. Insp. Assocn.; Cert. Meat and other foods; Cert. San. Science, R.S.I. Chief Sanitary Inspector. (1928) 1901 Tedham, W. 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. J. Cert. San. Insp., Exam. Board; Cert. Royal San. Inst.; Cert. Meat and other foods; Cert. Smoke Insp., R.S.I.; Cert. Advanced Inspectors, 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; Cert. Meat and other foods. Sanitary Inspector. 1933 Lewis, E. Cert. San. Insp., Exam. Joint Board; Cert. Meat and other foods; Cert. Smoke Insp., R.S.I.; Cert. San. Science, R.S.I. Sanitary Inspector. 12 TABLE No. 2—continued. Year appointed. Name. Qualifications. Appointment. 1904 Farrugia, Mrs. A. Cert. San. Insp., Exam. Board; Cert. Royal San. Inst. Woman Sanitary Inspector. 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 Seccombe, Miss W. Cert. General Hospital Training; C.M.B.; Health Visitors' Cert. Health Visitor. 1927 Farrell, Miss E. V. Cert. General Hospital Training; C.M.B.; Heliotherapy Cert.; Health Visitors' Cert., Board of Education. Health Visitor and Artificial Sunlight Nurse. 1930 Frederick, Miss F. E. Cert. General Hospital Training; C.M.B.; Health Visitors' Cert. Health Visitor. 1933 Carey, Miss A. Cert. General Hospital Training; Cert. Fever Training; C.M.B.; Heath Visitors' Cert. Health Visitor. 1933 Adams, Miss W. Cert. General Hospital Training; C.M.B.; Health Visitors' Cert.; Diploma in Nursing, University of London. Health Visitor. 1921 Castledine, Mrs. L. Cert. General Hospital Training Tuberculosis Visitor. 1921 Mahony, Miss N. Cert. General Hospital Training; Health Visitors' Cert. Tuberculosis Visitor. 1934 Little, Miss E. L. Cert. General Hospital Training; Cert. Fever Training; C.M.B.; Tuberculosis Cert.; Health Visitors' Cert. Tuberculosis Visitor. 1923 Smith, Mrs. M. Dispensing Certificate Dispenser and Secretary of Care mittee. 13 TABLE No. 2—continued. Clerks: 1901 Smith, H. S. Chief Clerk. 1906 Collyer, H. M. Committee Clerk. 1913 Prescott, H. T. Clerk, Grade B. 1920 Taylor, S. G. Vaccination Officer and Clerk, Grade B. 1920 Pike, L. Clerk, Grade B. 1920 Stephenson, Miss D. Maternity and Child Welfare Clerk. 1922 Edwards, Mrs. N. Maternity and Child Welfare Clerk. 1930 Crawford, Miss I. Clerk, Grade A. 1931 Allen, L. Clerk, Grade A. 1933 Biswell, Miss V. Tuberculosis Clerk. 1933 Bryant, Miss A. Temporary Clerk. 1934 Goad, A. Temporary Clerk. The Medical Officer of Health is Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme. ii. Laboratory Facilities. The bacteriological work of the Council rendered necessary by investigations into infectious diseases, food poisoning, and water control in the Council's swimming baths, is carried out at the Woolwich War Memorial Hospital. The bacteriological examination of milk samples is carried out partly at the Woolwich War Memorial Hospital and partly at the Clinical Research Laboratory. A minimum of 500 samples is purchased annually in accordance with the provisions of the Food and Drugs (Adulteration) Act, 1928, and the various Regulations and Orders in which are laid down the standards for food. They are submitted for chemical analysis to the Public Analyst whose Laboratory is situated at 1, Southwark Street, London, S.E. 1. iii. 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 diseases 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. 14 In addition to these services the Council hire ambulances of the London County Council for the conveyance of non-urgent maternity cases, between 8 a.m. and 11 p.m., to hospitals in the London area. A note on the use of this service will be found in the Maternity and Child Welfare Section. iv. Professional Nursing in the Home. During the year nursing assistance was available in all parts of the Borough. Such assistance is provided by four Nursing Associations, as follows:— Woolwich and Plumstead District Nursing Association: All Woolwich (except North Woolwich) and Plumstead. Silvertown and North Woolwich District Nursing Association: North Woolwich. Eltham Provident Nursing Association: All Eltham (except New Eltham). New Eltham District Nursing Association: New Eltham. All these Associations insist that the patient shall be under the care of a medical practitioner, and, in ordinary circumstances, only nurse non-infectious cases. On the recommendation of the Medical Officer of Health, however, they provide nursing assistance for cases of measles, whooping cough, zymotic enteritis, ophthalmia neonatorum, pneumonia, anterior poliomyelitis, tuberculosis, puerperal fever and puerperal pyrexia. For nursing assistance the Borough Council pay, in necessitous cases, in accordance with the following schedule:— Disease. Rate of Payment. Measles Ophthalmia Neonatorum 1s. 0d. per visit for one case; 6d. per visit, per Zymotic Enteritis case, for more than one case in the house at Whooping Cough the same time. Poliomyelitis Acute Primary Pneumonia Influenzal Pneumonia Puerperal Fever 1s. 3d. per visit. Puerperal Pyrexia Tuberculosis An additional grant is made yearly in respect of the nursing treatment of children suffering from threadworms. 15 v. Clinics and Treatment Centres. In tabular form is shown below a list of clinics and treatment centres in the Borough:— TABLE No. 3. 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 Doctor's Room, Ante-Natal Room, Ante-room, Weighing Room, Waiting Room, Dental Rooms do. 6 Westhorne Avenue, Eltham Doctor's Room, Ante-Natal Room, Ante-room, Weighing Room, Waiting Room, Lecture Hall, Dental Rooms do. 6 Elizabeth Street, North Woolwich Doctor's Room, Weighing Room do. 1* Wesley Hall, Timbercroft Lane, Plumstead do. do. do. 2 All Saints' Church Hall, New Eltham do. do do. 2 Holy Trinity Church Hall, Beresford Street, Woolwich do. do. do. 1 St. Luke's Hall, Westmount Road, Eltham do. do. do. 1 Sunlight Clinic. Old Town Hall, Woolwich Treatment and Waiting Rooms, etc. do. 9 Day Nurseries. Nil. School Clinics. Brewer Street, Woolwich Doctor's Rooms, Treatment Rooms, Waiting Rooms Local Medical Association Daily 236, Plumstead High Street, Plumstead Doctor's Room, Treatment Room, Waiting Rooms, Dental Rooms do. Daily Westhorne Avenue, Eltham Doctor's Room, Dental Rooms, Waiting Room, Treatment Rooms do. Daily *An Ante-Natal Clinic is held here once a month. 16 TABLE No. 3—continued. Clinics and Treatment Centres. 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, Whitehart Road, Plumstead Accommodation for cleansing of verminous children Woolwich Borough Council Daily Tuberculosis Dispensaries. Maxey Road, Plumstead Doctor's 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 Association Daily 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 have 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 the Annual Report for 1930, 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. 17 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. Midwifery and Maternity Services. There are no whole-time midwives employed by the Council. By the courtesy of the County Medical Officer of Health I have been able to ascertain that 47 midwives residing in the Borough gave notice during the year of their intention to practise. The services of a Consultant Surgeon are available for cases of obstetric emergencies and difficulties occurring at home, and for consultation and treatment in cases of puerperal fever or puerperal pyrexia. Arrangements have also been made for the home nursing of such cases and for such bacteriological investigations as are necessary. The Council's Maternity Services are fully described in the Maternity and Child Welfare Section of the report and no developments or changes took place during the year. viii. Institutional Provision for Mothers or Children. There are no special provisions for the institutional treatment of unmarried mothers, illegitimate infants or homeless children in the Borough, but in February, 1934, the Council agreed to make a grant towards the cost of maintenance of Woolwich cases admitted to Stretton House Home, Grove Park, a home maintained by the Southwark Diocesan Preventive and Rescue Work Organisation for unmarried mothers. No grant, however, was made during the year. ix. Health Visiting. The arrangements made for the visiting of children between the ages of one and five years are described in the Maternity and Child Welfare Section. x. Infant Life Protection. A third health visitor, Miss W. Adams, was appointed a part-time infant life protection visitor. A note on the administration of this service will be found in the Maternity and Child Welfare Section of the report. xi. Orthopædic Treatment. Arrangements for orthopaedic treatment of children under five years of age, were made with the local branch of the Invalid Children's Aid Association in 1925. This body has for many years maintained a remedial clinic in Thomas Street where all children requiring such treatment may be sent. The London County Council 18 make an annual grant in respect of children over five years of age. In the Maternity and Child Welfare Section of the Report there is an account of the year's working so far as children under five are concerned. xii. Supply of Insulin to Persons suffering from Diabetes. In May, 1930, the Council obtained the approval of the Ministry of Health to supply Insulin to diabetic patients, who were necessitous and unable to obtain it under the National Health Insurance Acts. A continuing approval is obtained yearly. A supply of Insulin was given under this scheme to eleven patients during the year, the total cost being £22 11s. 0d. 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. (2) A quarterly report must be furnished in respect of each patient treated, giving the following information:— (a) 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. xiii. Vaccination. Dr. C. F. Clarke, who had held the appointment of Public Vaccinator under the Woolwich Board of Guardians for the major portion of the old parish of Woolwich, for many years, resigned on the grounds of ill-health, his last day of service being 28th June, 1934. The vacancy was filled by the appointment of Dr. Andrew Mair, who commenced duty on the 1st August, 1934. During the interim Dr. H. M. Wise acted as Public Vaccinator for Dr. Clarke's district. The Council took the opportunity of making adjustments in the districts of the Public Vaccinators, as these were much overdue. The districts had not been altered for at least twenty years; many changes in the distribution of population had taken place during these years, particularly in Plumstead and Abbey Wood, and it was felt desirable that a medical practitioner resident in that part of the Borough should be appointed as Public Vaccinator for that area. The old parish of Plumstead, formerly a vaccination district, was divided into two, and Dr. Mair was appointed to the eastern portion. Dr. Wise's new district consists of the remaining portion of Plumstead and part of the old parish of Woolwich. 19 The districts of the Public Vaccinators are as set out below in the following Table No. 4, their names and hours of attendance being also shown:— TABLE No. 4. Public Vaccinator and Surgery. Surgery Hours. District. Dr. R. V. Brews, 10, High Street, North Woolwich Weekdays: 9-10 a.m. 6- 8 p.m. North Woolwich. Dr. W. Cowie, Tudor House, Charlton Road. Weekdays: 9- 10 a.m. 6- 8 p.m. Woolwich—Streets between Greenwich boundary and a line through middle of Hill Street, Frances Street, Henry Street and Chapel Street. Dr. A. Mair, 45, Lakedale Road, Plumstead Weekdays: 9-10 a.m. 6- 7 p.m. (except Tuesday evenings) Plumstead—All streets in the Borough east of a line running south down the centres of White Hart Road, Lakedale Road, The Slade, Garland Road to the junction of the Borough boundary with Shooters Hill. Dr. H. M. Wise, 23, Plumstead Road, Plumstead Weekdays: 9 a.m. 7 p.m. Woolwich and Plumstead—All streets between the above line and a line through the middle of Hill Street, Frances Street, Henry Street and Chapel Street. Dr. E. Milton, Passeys House, High Street, Eltham Weekdays: 9-10 a.m. 6.30-7.30 p.m (except Thursday evenings) Eltham—Well Hall and Sherard wards, and that part of Avery Hill ward lying west of a line through the middle of Gravel Pit Lane, Bexley Road, Southend Road, Footscray Road and Green Lane. Dr. G. Blackall, 429, Footscray Road, New Eltham. Weekdays: 2 p.m. 6-7.30 p.m. (except Thursday evenings) Eltham and New Eltham—That part of Avery Hill ward lying east of the above line. 20 I submit a return by the Vaccination Officer on the work carried out under the Vaccination Acts for the year 1933. TABLE No. 5. RETURN to be made on or before the 9th of February, 1935, 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, 1933, 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, 1933. Number of these Births duly entered by 31st January, 1935, in Columns I., II., IV. and V. of the "Vaccination Register'' (Birth List Sheets), viz.:— Col. I. Col. II. Col. IV. Number in respect of whom Statutory Declaration of Conscientious Objection has been received. Col. V. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Died Unvaccinatcd. 1. 2. 3. 4. 5. 6. 7. 1. Plumstead 501 215 — — 215 31 2. Woolwich† 1,198 591 7 — 467 46 3. Eltham 462 209 — — 189 25 Total 2,161 1,015 7 — 871 102 Number of these Births which on 31st January, 1935, remained unentered in the "Vaccination Register" on account (as shown by "Report Book ") of:— Number of these Births remaining on 31st January, 1935, 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 1934. 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 1934. . 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. 8 11 20 1 6 49 22 10 These figures are to be obtained from columns 2 and 6 of the Summary (From N.) 7 22 6 4 21 82 48 15 1,236 944 For notes on Table 5 see page 21. 21 Notes on Table No. 5. NOTE.—(a) The total of the figures in columns 3 to 11 should agree with the figures 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. (b) 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 1934 sent to other Vaccination Officers should be stated here:—93. †Includes the Burrage and Herbert Wards in Plumstead Parish. (Signature) S. G. TAYLOR, Date—10th February, 1935. Vaccination Officer. During the year ended 30th September, 1934, the number of persons successfully vaccinated and re-vaccinated at the cost of the rates was 1,144. This figure includes 672 primary vaccinations of persons under one year of age and 183 over one year of age, and 289 re-vaccinations. xiv. 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 369 advances to purchasers of houses in accordance with the provisions of these Acts. Transfer of Powers Order, 1933.—This Order came into operation on the 1st April, 1933, and transferred certain duties to the Borough Council from the London County Council in respect of (a) Building Lines; (b) Disused Burial Grounds; (c) Seamen's Lodging Houses; (d) Thames and other Embankments; (e) Common Lodging Houses; (f) Cowhouses and Places for the Keeping of Cows; (g) Infant Life Protection; (h) Offensive Trades; (i) Slaughterhouses and Knackers' Yards. 22 By-laws.—In tabular form below is a list of the by-laws which are in force in the district:— (a) Made by the London County Council— Subject Matter. Act. Date when By-laws were allowed or took effect. Common Lodging Houses London County Council (General Powers) Act, 1902—Sec. 53 (2) 1st October, 1903 Seamen's Lodging Houses Merchant Shipping Act, 1894— Sec. 214 1st April, 1917 Conveyance of Dead Horses London County Council (General Powers) Act, 1903—Sec. 554 21st February, 1905 Construction of new sewers Metropolis Management Act, 1855 28th March, 1906 Drainage By-laws do. 28th July, 1934 Closing and filling up of cesspools and privies and the removal and disposal of refuse Public Health (London) Act, 1891 —Sec. 16 (2) 28th June, 1893 Prescription of times for removal or carriage by road of offensive or noxious matter or liquid do. 26th November, 1901 Ashpits and receptacles for dung Public Health (London) Act, 1891 —Sec. 39 (1) 28th June, 1893 Receptacles for dung do. 3rd January, 1905 Ashpits and receptacles for dung do. 11th July, 1913 Water closets, urinals, earth closets, privies and cesspools do. and London County Council (General Powers) Act, 1928— Sec. 24 21st August, 1930 Cleansing and disinfection of lairs and vehicles and apparatus used for the conveyance of animals Foot and Mouth Disease Order 1928, Articles 22 (1) d and e 1st April, 1931 Spitting in public places Municipal Corp. Act, 1882, and Local Government Act, 1888 12th May, 1903 Waste paper and refuse in streets do. 4th July, 1906 Hairdressers' Establishments in which Massage Treatment is given London County Council (General Powers) Act, 1915—Part V 15th June, 1921 Massage establishments London County Council (General Powers) Act, 1920—Part IV 28th July, 1921 Nursing Homes Nursing Homes Registration Act, 1927—Sec. 4 1st March, 1929 23 Subject Matter. Act. Date when By-laws were allowed or took effect. Fat melter Public Health (London) Act, 1891 25th November, 1907 Knacker do. do. Gut scraper and catgut maker do. do. Glue and Size manufacturer • do. do. Tripe boiler do. do. Bone boiler, Manure manufacturer or Tallow melter do. do. Soap boiler do. do. Dresser of Fish Skins do. do. Fishmonger do. do. Dresser of Fur Skins do. 22nd March, 1922 Slaughtering of Poultry do. 22nd December, 1923 Slaughter of Cattle do. 7th December, 1923 Amended do. 31st July, 1935 Fish Curers London County Council (General Powers) Act, 1908—Sec. 9 28th February, 1914 Vendors of Fried Fish do. do. Rag and Bone Dealers do. 18th September, 1923 Slaughterhouses Slaughterhouses, etc. (Metropolis) Act, 1887, and Local Government Act, 1888 27th October, 1891 Tenement Houses Public Health (London) Act, 1891 and Housing Act, 1925 5th March, 1926 Amended do. 8th June, 1931 Smoke Emission Public Health (Smoke Abatement) Act, 1926 19th May, 1931 (b) Made by the Woolwich Borough Council— Prevention of Nuisances from:— (1) Snow, ice, salt, dust, etc., in streets Public Health (London) Act, 1891 —Sec. 16 24th June, 1903 (2) Offensive matter running out of manufactories do. do. (3) Keeping of animals do. do. 24 Subject Matter. Act. Date when By-laws were allowed or took effect. As to paving of yards and open spaces in connection with dwelling houses Public Health (London) Act, 1891 —Sec. 16 24th June, 1903 Water supply to water closets Public Health (London) Act, 1891 —Sec. 39 da Conduct of persons using Sanitary Conveniences Public Health (London) Act, 1891 —Sec. 45 do. Tanks, cisterns, etc., for storing drinking water Public Health (London) Act, 1891 —Sec. 50 do. Mortuaries Public Health (London) Act, 1891 —Sec. 88 do. Tents, vans, sheds used for human habitation Public Health (London) Act, 1891 —Sec. 95 do. Public Baths Baths and Washhouses Act, 1846 do Market Place Public Health Act, 1875 do. Street Noises on Sundays Municipal Corporations Act, 1882 and Local Government Act, 1888, as applied by the London Government Act, 1899 23rd February, 1906 Litter Municipal Corporations Act, 1882 and Local Government Act, 1888, as applied by the London Government Act, 1899 29th November, 1933 25 SECTION II.-HEALTH PROPAGANDA. For many years the Council have carried out a progressive policy in health education, making full use of the powers given to them by the London County Council (General Powers) Act, 1926. The public response has been very encouraging, and this has been shown not only by large attendances at Health Exhibitions and Health Weeks but also by an increasing demand for informal talks at meetings in private halls. Health Education is therefore an important section of the work of the Department and continuous endeavours are made not only to spread a knowledge of the laws of health, but also to bring home the personal responsibility of every individual in the matter, and so secure co-operation in health matters between the Council and the citizen. The importance of making use of the many health services now provided for the public, it need hardly be said, is always stressed. Without such use, value can never be obtained for the money spent on the pursuit of health by the State, by the County, by the Borough or by the individual. Certain special activities are set out in greater or less detail in the next few pages but much unseen, or rather unheard of, work goes on daily in the home, at the Welfare Centres and Dispensaries, and in the office. The story of health is being continually spread by the Council's health officers. Leaflets, booklets and posters are in constant circulation or use. The Health Services booklet of 20 pages is now in its third edition. The special activities of the year may be classified as follows:— (a) Health Week.—The tenth local Health Week was held in September, and the following is a copy of the report made by the Public Health Committee to the Council:— "In accordance with the Council's resolution Of the 31st January, 1934, we arranged a suitable programme for Health Week. During the week 24th-29th September, we held a Health Exhibition at the Town Hall, Woolwich. "We 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 the various national and local organisations. Trade exhibits were limited to those 26 which directly bear on our work. The Health Department's exhibits dealt with general sanitation, the control of infectious disease, bug infestation, maternity and child welfare and tuberculosis. In addition, illustrating the sub-divisions, there were exhibits from the British Legion Industries, Preston Hall; Papworth Colony; the National Association for Maternity and Child Welfare; the Child Guidance Council; the Greenwich Tuberculosis Handicraft Centre; the Woolwich Invalid Children's Aid Association and the Woolwich Nursing Associations. "The exhibits from the Woolwich War Memorial Hospital consisted of tableaux illustrating the hospital's work in connection with accident cases and an Appeal Stall in connection with the hospital extension fund organised by His Worship the Mayor. There were also exhibits from the National Institute for the Blind; the National Society for the Prevention of Cruelty to Children; the Health and Cleanliness Council; the National Milk Publicity Council; the British Social Hygiene Council and the Cremation Society. "Attractive exhibits were arranged by the following Committees of the Council:—Works, Housing, Baths, Libraries and Allotments. In the Victoria Hall the Electricity Committee arranged a very complete and pleasing exhibit illustrating the home services which this Committee has provided for the citizens of the Borough. The trade exhibit was by Cow and Gate Limited. "We acknowledge with thanks our indebtedness to the Ministry of Health; the Trustees of the British Museum (Natural History Section); the London School of Hygiene and Tropical Medicine; the London County Council; the Bermondsey Borough Council; St. Bartholomew's Hospital; the National Smoke Abatement Society and many others, for the loan of models, pictures or articles in connection with the Exhibition. "The attendances during the week are estimated at 16,500, including 1,214 school children in conducted parties. "We are grateful to the lecturers who gave their services, and to all who helped by exhibiting, by speaking, by lending and by working, to whom we have extended the sincere thanks of the Council; and we take this opportunity of placing on record once again, our appreciation of the work of the Council's staff." (b) School Children.—Prior to 1932, monthly sessions were held for the instruction of school children in matters of health, but in that year a new policy was adopted—that of combining with the Libraries Committee in the presentation of educational films—and this policy has been continued. The meetings are held on Mondays and films are shown at 9.30 and 11 a.m. and again at 3.30 p.m., to different 27 audiences. In this way some 1,500 children receive visual education each month. The health films shown were:— January 22nd ... " How we Hear." February 19th ... " The Climber." October 15th ... " How we See." November 19th ... " Almost a Tragedy." December 10th ... " Three Card Trick." (c) Informal Talks.—These talks commenced in 1929 and the demand has grown each year since then. This service, providing, as it does, health education for the people in their own meeting places, establishes a direct contact which is of great value to the department in bringing closely to the attention of the people most interested (most interested because every endeavour is made to fit the subject to the audience) details of services about which they might remain in ignorance. The scheme, commenced in 1934, for the immunisation of children against Diphtheria, may be mentioned as an instance. There were many talks on this subject: the audiences were all keenly interested and it is known that many parents were so influenced as to make immediate arrangements for their children to be tested. The talks are given by members of the staff on subjects closely associated with the work on which they are engaged. At each meeting it is the practice to show films or lantern slides, or photographs by means of an epidiascope, or to give a practical demonstration. (d) Central Council for Health Education.—This organisation is composed of representatives of health and education authorities, insurance committees, friendly societies, etc., and it co-ordinates the activities of these organisations in different aspects of health education. This body advises and assists local health and education authorities, particularly in regard to the organisation of health exhibitions and the supply of health posters; it publishes literature on health matters; it sends weekly articles to the press; it holds a Conference in London each year and is, in short, a central agency of very great value to local authorities interested in health education. The Council makes an annual contribution of three guineas to its funds. (e) Better Health.—In an effort to bring current health topics to the attention of the public, the Council purchased monthly 2,000 copies of "Better Health," a journal published by the Central Council for Health Education, and distributed them through the Welfare Centres, Libraries and Schools. A limited number were posted to residents in the Borough, selected at random, each month. This journal has met with the approval of the public and there is no difficulty in finding ready readers. (f) Posters.—The Central Council for Health Education provide a monthly service of health posters for use on the wooden poster frames originally erected by the Empire Marketing Board. The Borough Council have the use of two of 28 these frames and purchase two sets of posters monthly. The posters shown during the year were as follows:— January National Council for Maternity and Child Welfare (E.M.B. Adapted). February Food Education Society. March British Social Hygiene Council. April British Red Cross Society. May National Milk Publicity Council. June National Council for Maternity and Child Welfare. July Anti-Noise League. August Dental Board of the United Kingdom. September National Safety First Association. October Health and Cleanliness Council. November National Association for the Prevention of Tuberculosis. December National Smoke Abatement Society. (g) Cookery Classes.—Demonstrations in cookery were started at the Tuberculosis Dispensary in April, in order to provide instruction for the wives and mothers of the tuberculous in the buying and cooking of simple, cheap and nutritious articles of food and the preparation of them in an appetising, tempting and palatable way. The demonstrator is loaned by the South Metropolitan Gas Company and a demonstration meter shows how much the actual cooking has cost, in terms of pence. The cooked dishes are sold at about half cost to those attending the classes. A cup of tea and biscuits are provided by the Care Committee at each meeting. The nett cost to the Council for food for the year was £2 10s. 9d. The number attending was 21; the number of attendances was 294 and there were 31 meetings. (h) Bed-Bug Demonstration Stall.—A stall dealing with the bed-bug problem was prepared for this year's health exhibition. An article describing it was subsequently written by Mr. C. J. Couch and published in the Journal of the Royal Sanitary Institute in the November issue, 1934, and the stall was re-constructed and shown there. The article is reproduced below from part 5 of Volume 55 of the Journal, by kind permission of the Institute. "In Woolwich the Bed Bug Campaign has now been intensively pursued for over two years and the experience gained during that period has clearly shown the necessity for measures to procure the interest and active co-operation of the general public. With this end in view the Public Health Department has given the widest publicity to the subject by memoranda, literature and by practical demonstrations. A stall at the recent Health Exhibition in Woolwich was set aside for the sole purpose of focussing attention on the bed bug, its habits, life history and the methods which are being used in the Borough to exterminate it. In the past too little attention has been paid to the fact that families living in bug infested dwellings are often led 29 to conceal the presence of these insects for fear of the comments of their neighbours, though they may be well aware that the whole area is infested. It was, therefore, decided that propaganda should be used to try and dispel some of the innate prejudice which exists in the minds of many people—one of the slogans used in the propaganda campaign, "The bed bug is not a social stigma, it is a misfortune," led to many questions being asked as to the methods of eliminating these pests and their practical application. The stall was the most popular focus of interest throughout the week and has led to a considerable increase of "bug-mindedness" in the Borough. The stall itself consists of three shelves and the sides and back of the interior of the walls were used to display pictures, literature and slogans. "The first shelf was used to show the life history of the insect and live bugs were exhibited in small glass jars in the six stages of development, with separate ones for adult males and females, eggs, "Mr. and Mrs. Bug and Family" and cast skins of the insect. "On the second shelf the haunts of the bug were displayed by showing a portion of a spring mattress in a glass case infested with live bugs, a portion of the underside of a chair and of an iron bed rail, each being grossly infested, the latter clearly showing that the bug will live in an iron bedstead. Other examples were wood mouldings, skirtings, picture rails, ceiling fillets, bed ticking, and pillow casing, each showing the presence of eggs, cast skins and the filth deposited. "The third shelf was utilised to show the materials used in Woolwich to destroy the bug, but the centre of this shelf contained a model of a bug, enlarged forty-five times in a glass case. On each side were arranged the gases, solutions and implements which consisted of, tins of Cyanide, Zyklon B preparation in a glass jar, a tin opener and hammer, gas mask, a cylinder and syphon of Etox, Cyanide testing outfit, a compressed air sprayer, bottles of various solutions, sulphur cylinders, sulphur candles and a pail, soap, floor cloth and scrubbing brush on which was a card bearing the words, 'You can use soap, and water and then paraffin oil. This method is also effective but takes longer.' "The whole exhibit will be on view at the Institute on the occasion of the Sessional meeting on the 13th November when Mr. McKenny Hughes opens the discussion on 'The Bed Bug as a Housing Problem.' " (i) Health Services Booklet.—In 1931 it was decided to publish a booklet which would inform the public of the services available and also act as a reference book in case of need. A booklet was accordingly prepared giving detailed information regarding the Care of the Mother and Child; the duties of foster-mothers under the Children's Act; the Nursing Services; Ambulance facilities; Infectious and other Diseases; Disinfection; Sanitary matters; Health Education, Vaccination and the Registration of Births and Deaths. A first edition of 5,000 copies was quickly distributed during Health Week and through the Council's Centres, and since then revised editions have been similarly circulated. 30 SECTION III.—MATERNITY AND CHILD WELFARE. The Council's Maternity and Child Welfare Scheme embraces the following services:— (a) Administration of the Notification of Births Acts, 1907-15. (b) Home visits to mothers and children. (c) Infant Life Protection. (d) Establishment of Welfare Centres. (e) Establishment of an Artificial Sunlight Clinic. (f) The systematic medical inspection of toddlers. (g) Provision of maternity outfits. (h) Payment of compensation to midwives. (i) The services of a Consultant in cases of Puerperal Fever and Puerperal Pyrexia. (j) The services of a Consultant in exceptional cases of obstetric or ante-natal abnormality at home. (k) Provision of Home Helps in maternity cases. (l) An arrangement with the School Medical Treatment Committee for the treatment of minor ailments in young children. (m) An arrangement with the School Medical Treatment Committee for the provision of dental treatment to young children and to expectant and nursing mothers. (n) An arrangement with the Woolwich Invalid Children's Aid Association for orthopaedic treatment for children requiring such treatment. (o) Provision of nursing assistance for young children suffering from Measles, Ophthalmia Neonatorum, Zymotic Enteritis, Whooping Cough, Poliomyelitis, Pneumonia and Influenzal Pneumonia, and for mothers suffering from Puerperal Fever, Puerperal Pyrexia, Pneumonia arid Influenzal Pneumonia. (p) Day Ambulance service for maternity cases. (q) Reservation of twelve beds for children under 5 years of age who are suffering from such conditions as are usually treated in a general hospital, at the War Memorial Hospital. 31 (r) Provision of beds for the institutional treatment of midwifery for 144 cases per annum at the British Hospital for Mothers and Babies, and for 66 cases at the War Memorial Hospital. (s) Reservation of beds, for ante-natal treatment and emergencies of midwifery, at the War Memorial Hospital, equivalent to 18 weeks' treatment per annum. (t) An arrangement with the Woolwich Invalid Children's Aid Association for the convalescent treatment of children requiring such treatment. (u) Convalescent Home treatment for expectant and nursing mothers. (v) Arrangements for the supply and distribution to young children, expectant and nursing mothers, of milk and food-drugs at cost price, half cost or free, according to economic circumstances. In addition to these services the Council have, at the request of the London County Council, undertaken to do such work as is necessary in the case of children under five years of age:— (w) Under the Blind Persons Act, 1920. (x) Under Section 6 of the Widows', Orphans' and Old Age Contributory Pensions Act, 1925. Staff.—Three whole-time medical officers are in medical charge of the clinics. Each of these devotes eight sessions per week to Maternity and Child Welfare and three sessions per week to Tuberculosis. One part-time medical officer takes charge of the Toddlers Examination Clinic and two Consultants have been appointed— one for the Artificial Sunlight Clinic and one for consultations in connection with cases of puerperal sepsis and difficult obstetric cases at home. The dental staff— two dentists 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 now consists of eleven whole-time health visitors: two of these are part-time sanitary inspectors, three are part-time infant life protection visitors and one is the artificial sunlight clinic nurse. It is the practice of the Council to appoint additional temporary health visitors during epidemics of measles. Dr. Rachel Mackenzie, who entered the service of the Council on the 1st August, 1918, retired on the 22nd December, 1934, on superannuation. Dr. F. E. Smith, who was appointed to the vacancy so created, commenced duties on the 27th December. Miss W. Adams, a health visitor in the service of the Council, was appointed an infant life protection visitor and commenced duty as such in February. 32 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 so notified. As soon as a notification is received pamphlets dealing with the care and comfort of mothers and infants are sent by post to every mother. Subsequently, between the tenth and fourteenth day, a visit is paid to the home by the health visitor who decides on her first visit the necessity for subsequent visits. It may be stated, however, that, broadly, the general basis of visiting is as follows:—three visits during the first year and one visit in each subsequent year up to the age of five years, or until the child goes to school. The Work of the Health Visitors.—The work performed by these officers during the year, with regard to maternity and child welfare, is summarised in the following Table:— TABLE No. 6. Births—First visits 2,007 ,, Revisits 18,656 Infant deaths investigated 35 Still-births investigated 17 Expectant mothers—home visits 687 Infectious diseases:— Ophthalmia Neonatorum—First visits 7 „ ,, Revisits 64 Measles—First visits 2,264 „ Revisits 585 Puerperal fever—First visits 5 ,, ,, Revisits 5 Puerperal Pyrexia—First visits 20 ,, „ Revisits 3 Zymotic Enteritis—First visits 3 „ „ Revisits - Pneumonia 81 Anterior Poliomyelitis - Encephalitis Lethargica 1 Infant Life Protection 1,184 Visits unclassified 293 Visits unsuccessful 3,374 29,291 33 In 1934 the Council paid the class fees and expenses in connection with the visits to approved institutions of one of the health visitors who attended a refresher course for health visitors. Infant Life Protection.—The Council became responsible on the 1st April, 1933, for Infant Life Protection work in Woolwich, and forthwith appointed two of their health visitors as Infant Life Protection Visitors (part-time), and in 1934 a third was so appointed. When evasion of the law is suspected the necessary investigations are made by one of the male sanitary inspectors. The houses of all new foster-mothers are inspected by the district sanitary inspectors, who furnish in each case, a sanitary report. At the end of 1933 there were 104 foster children and 76 foster mothers on the Council's register and a year later the numbers were 93 and 68 respectively. It is the custom to report on all homes where women indicate their desire to become foster-mothers and in addition to the number of foster mothers shown above, another 45 were either temporarily without nurse children or had been noted as suitable persons. These figures do not, however, tell the whole story, as 171 foster children were added to the register and 182 foster children were removed during the year. The following Table shows the ages of the children under supervision on the 31st December, 1934:— TABLE No. 7. Under 1 year. # 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 16 12 10 12 10 9 11 2 11 The number of visits paid by the Infant Life Protection Visitors was 1,184. The number of visits made by the male inspector, in connection with infringements and kindred matters was 70, while the number of visits paid by the district sanitary inspectors was 91. The number of, and nature of the various legal infringements discovered during the year were as follows:— 34 TABLE No. 8. Nature of Infringement. No. Keeping a nurse child without giving timeous notice 15 Change of address by foster mother without giving timeous notice 2 Infant removed from care of foster mother without giving timeous notice 14 Infant kept in premises or by persons prohibited from receiving same - Infant kept in excess of number fixed 1 Cautionary letters were sent in 28 cases. No action was taken in 4 cases and there were no prosecutions. In 5 instances insanitary conditions were discovered, in 5 instances there was overcrowding and in 7 instances verminous conditions existed. In all cases appropriate action was taken to secure the abatement of the nuisances. Nurse infants who are kept under unsatisfactory conditions may be removed to a place of safety, but it was not necessary to remove any such during the year. All foster mothers are urged to attend the Council's welfare centres with the children under five years of age in their charge, and it is pleasing to record, that, with very few exceptions, every child of such age now regularly attends an infant welfare centre. Special care is taken to see that children who are weak and ailing attend the centres. During the year two nurse infants died—one from bronchitis and one from enteritis. The only institution in the Borough holding a certificate of exemption is the Woolwich War Memorial Hospital. The Work of the Welfare Centres.—These are eight in number and are all municipal. Four are in buildings belonging to the Council and four are held in church halls. Infant welfare sessions are held at all of them and ante-natal sessions are held twice weekly at three of them and once a month at one other. At the end of the year 6.25 ante-natal sessions and 21 infant consultation and weighing sessions were being held each week. \ In tabular form below are shown detailed statistics for 1934 and the consolidated statistics for the previous year:— 35 TABLE No. 9. Centre. No. on Roll of Centre. No. of Attendances. Mothers. Children. Mothers. Children. Expectant. Nursing. Expectant. Nursing. Town Hall 406 443 1,459 992 885 9,775 Plumstead 256 261 1,113 637 463 8,068 Eltham 404 201 1,127 1,073 472 6,348 Slade 4 123 445 7 200 4,093 New Eltham 2 78 414 4 175 4,486 St. Luke's 1 39 279 1 62 2,323 North Woolwich 20 43 154 36 116 1,247 Beresford Street 38 78 173 62 162 1,154 Totals, 1934 1,131 1,266 5,164 2,812 2,535 37,494 Totals, 1933 979 1,225 5,210 2,532 2,474 37,743 The next Table, No. 10, shows the number of children classified by year of birth and the number of attendances made by them during the year. TABLE No. 10. Children in Attendance At each Centre. Year of Birth. Town Hall. Plumstead. Eltham. New Eltham. Slade. St. Luke's. N. Woolwich. Beresford St. Totals. 1934 448 326 255 113 110 67 41 51 1,411 1933 418 324 276 106 126 85 36 44 1,415 1932 267 209 185 77 101 36 33 25 933 1931 195 112 165 64 50 37 24 28 675 1930 86 112 146 38 38 30 13 16 479 1929 45 30 100 16 20 24 7 9 251 1,459 1,113 1,127 414 445 279 154 173 5,164 36 Table No. 10—continued Attendances. Year of Birth Town Hall Plumstead Eltham New Eltham Slade St. Luke's N. Woolwich Beresford St. Totals 1934 3,356 2,866 2,009 1,426 1,074 749 427 338 12,245 1933 3,550 3,186 2,325 1,867 1.606 997 400 390 14,321 1932 1,652 1,114 882 671 822 204 250 160 5,755 1931 838 473 546 303 311 176 103 155 2,905 1930 285 366 417 174 217 142 37 77 1,715 1929 94 63 169 45 63 55 30 34 553 9,775 8,068 6,348 4,486 4,093 2,323 1,247 1,154 37,494 These figures, which do not include attendances at the special Toddlers' Clinic or the Sunlight Clinic, show a slight decrease over 1933. Feeding of Infants in Woolwich.—In midsummer the usual enquiry was made, as in previous years, as to the type of feeding adopted in the case of infants attending the welfare centres. The method used was as follows:— (a) On the card of every child under one year of age attending a welfare centre, between the 16th July and the 24th August, 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. The results of the enquiry are shown in Table No. 11, on the adjoining page. 37 TABLE No. 11. Feeding of Infants attending Welfare Centres—16th July to 24th August, 1934. 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 61 75 58 53 41 27 26 19 5 365 3 - — 368 Breast and Hand 11 14 11 10 11 5 11 17 9 99 12 3 2 116 Hand 6 19 41 35 37 30 50 47 33 298 44 48 71 461 78 108 110 98 89 62 87 83 47 762 59 51 73 945 PERCENTAGES. Breast 78.2 69.4 52.8 54.1 46.1 43.5 29.9 22.9 10.6 47.9 5.1 — — 38.9 Breast and Hand 14.1 12.9 10.0 10.2 12.4 8.1 12.6 20.5 19.1 12.9 20.3 5.9 2.7 12.3 Hand 7.6 17.6 37.3 35.7 41.6 48.4 57.5 56.6 70.2 39.1 74.6 94.1 97.3 48.8 38 Artificial Sunlight Clinic.—The artificial sunlight clinic is held in part of the Town Hall Infant Welfare Centre. The total number of patients treated during the year, including 133 whose course of treatment was not completed at the end of 1933, was 467. The total number of treatments given was 9,612 : of these, 7,546 were by carbon arc, 1,254 by mercury vapour lamp, and 812 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 figures for the Sunlight Clinic show but little change from the previous year. A smaller number was carried forward, but a larger number of new cases was treated, the total being practically the same. The group under the heading 'Anæmia, Debility, etc.,' is still the largest, and is relatively considerably larger than last year. The total number cured or improved has dropped, but this is explained by an increase in those who ceased to attend and those who were under treatment at the end of the year. It seems undeniable that the Clinic is of real assistance in a district where social conditions are lowered by unemployment." In Table No. 12, are shown below the number and types of cases treated during the year:— TABLE No. 12. Cases treated at Sunlight Clinic, 1934. Brought forward from 1933 New Cases. Total. Much Improved or Cured. Improved. I.S.Q. Ceased Treatment. Treatment not yet complete Rickets 43 72 115 28 23 9 19 36 Anaemia, Debility and Malnutrition 48 153 201 51 29 12 31 78 Catarrhal Children 14 28 42 9 5 3 11 14 Septic Conditions 1 2 3 1 — — - 2 Nervous Children 3 6 9 2 2 - 1 4 Enlarged Glands 12 27 39 15 5 — 5 14 Miscellaneous Nervous Conditions 1 2 3 — 1 1 — 1 Miscellaneous Skin Conditions 3 12 15 8 2 — — 5 Other Conditions 4 18 22 6 — 1 4 11 Mothers 4 14 18 2 3 — 6 7 133 334 467 122 70 26 77 172 39 Toddlers Clinic.—The routine medical examination of toddlers is now an integral part of the Council's Maternity and Child Welfare Scheme. Children are examined in their birthday month, aged 2 years, 3 years and 4 years. Those requiring observation are called up for review at intervals of a few months, and those requiring *treatment are told how to obtain it. All are carefully followed up by the Health Visitors. The examinations follow the lines of the school medical examinations and are recorded in the same way. The record cards, however, are slightly modified in order to deal with special points of importance to the toddler. Three sessions are held weekly—one at the Old Town Hall, Woolwich, one at Plumstead Health Centre and one at Eltham Health Centre. The clinic is under the medical charge of Dr. Margaret Emslie and she reports below on the year's working:— "The finding at routine toddlers' inspections during the year 1934 are summarised in Table, No. 13, appended. "These figures and observations include all conditions clinically considered to show variation from the normal (i.e. from perfect functional utility and health), but it should be noted that all the conditions recorded were not necessarily considered to require treatment. In this respect the Table varies from certain other Tables embodying results of routine examinations, since these in some instances appear to show only cases or conditions referred for treatment, and are not a summary of simple observations on the child. In the case of certain defects or pseudo-defects there is in fact a large difference, in the conditions referred to here, between the incidence of signs and symptoms patent to the observer, or interesting to him, that may hold some possible significance on the future or past health of the child, or that might offer some indication for a different orientation of teaching in preventive health work at an earlier age, and therefore be worth recording, and that which is held to be a true abnormality or pathological state requiring treatment. The best instance of this is the disease of rickets, in regard to which, as will be seen later, there is a suggestion that a widespread condition of latent or non-disabling rickets may possibly prevail, but a very low rate (7 per cent. actually) of children was referred to the orthopaedic clinic for treatment of deformities, of rachitic or other origin. Any suggestion that the cases recorded (on clinical evidence) as rachitic in this Table are comparable with the totals of cases of rickets referred for treatment of the acute condition, or for orthopaedic deformity solely, in the records of other clinics, would entirely falsify the impression that is intended to be given by these figures, and falsify the actually prevailing state of affairs. The observations offered in these annual records are offered as observations only, pending further investigation and 40 the accumulation of evidence as to what is and what is not important in the protective care of toddlers or in the better concentration of teaching at an earlier age. Evidence of disease, it need hardly be said, can only be based on accredited facts, not on external observation, but in the beginning it is observation simply that must determine when it is or is not likely to be worth while to pursue the effort of getting more exact evidence. "To go on to the recorded findings it will be seen that the nutrition of the children seen (as judged by height, weight and general appearance) was considered to be extremely satisfactory, the rate for actual malnutrition (marked 4 in the Table) being as low as 0.4 per cent.; and for sub-normal nutrition or simple thinness (3 in Table) 11 per cent. (The ability to make a thin child fat is of course not always a question at the disposition of the parents' goodwill, or of their resources). In 53 per cent. of cases, i.e., more than half, the general nutrition was recorded as excellent (this, however, included some children who were too fat) and in a further 35.5 per cent. as average. These figures are believed to compare well with findings elsewhere and are on a par with what has been found in previous years, always, however, showing a slight improvement. There can be no question—if these observations are just— of any suffering of the children from under-nourishment, even in difficult times. The muscle tone, still a better test than weight of the well being of the children, was put down as excellent in 70 per cent. of those seen. "Nevertheless there remains the question of possible rickets, aforementioned, and of anaemia, both commented upon in previous years. The number of cases showing external evidences of rickets (not necessarily active, in fact, in most cases, presumably non-active and healed, but the remnant of a non-healthy and unsatisfactory condition at an earlier age, on such assessment of symptoms as is here possible), amounts to 30 per cent. and that of anaemia 21 per cent. These figures are in accordance with what has been noted and annotated upon previously on the same evidence. Possibly these conditions are factitious, not to be supported by laboratory findings, but the impression recurs, and one may remember that there is actual evidence (in regard to anaemia, not rickets) of a proved high incidence of this condition in non-selected children of an earlier age investigated in a neighbouring part of London (c.f. Dr. Helen Mackay's work at the Queen's Hospital). If the miasma that rickets (of a discernible degree) and anaemia may exist somewhat widely amongst children of pre-school age, unrealised and unchecked till disclosed by routine examination, can be dispersed, all the better; until it is there remains the uncomfortable possibility that in spite of all our efforts at intelligent teaching as we understand it, all of our education of the mothers isn't going home or some of the education we give is wanting still in knowledge, in an important sense. If the condition, or conditions, are found to exist in reality, then all the more reason for our efforts to be increased and to be amplified in knowledge so far as possible. All of this waits only for research. 41 "Some of the points that suitable research would elucidate are clear and interesting. Is the anaemia, if it exists, merely a hang-over from Dr. Mackay's nutritional anaemia of infants, or is it of a separate etiological and environmental origin? (i.e. when and how must we prevent it?) Can the rickets be established by X-ray findings and biochemical reports as true rachitis arising by the same causes as in earlier infancy? Is it healed or active? At what age did it begin? Does any of it, as a result of recent difficult times, and possibly selective feeding, show evidence of having arisen as a real deprivation complex, absolute or relative, in children who have been exposed to hardship, at an age corresponding with the hardship, and possibly at an age later than rickets is usually thought to be incurred? Does it correspond with any particular social stratum or circumstance? Or is it uniform (so far as it exists) throughout the centres in the district and the grades and circumstances roughly corresponding with these? "Dental caries is a condition recorded in the Table, that elsewhere has been associated with rickets, on laboratory evidence, as being secondary to a poor formation of enamel coincident with defective calcium-phosphorus metabolism such as we know exists in rickets. This year the figures for dental caries in the children examined show a diminution at the earliest age (3.5 per cent. of children shows caries at the age of 2, i.e., at an age between their second and third birthdays, compared with the best previously recorded figure of 8 per cent.). At the next age, 3 years, the figure remains high at 27 per cent., and at the age of 4, unfortunately, still 48 per cent. The diminution at the youngest age is, however, very gratifying if it is real, but it may in fact be somewhat falsified by the fact that children now come more accurately in their birthday month for routine inspection, than at odd dates between birthdays, and at the exact age of two, one would expect to see less caries than for example, some months later, nearer 3. "Of the 45 per cent. of children showing tonsil enlargement only 3.6 per cent. were considered to require operation." TABLE No. 13. Medical Inspection of Toddlers, 1934. Disease, Defect or Condition. BOYS Age last Birthday. GIRLS. Age last Birthday. 2 3 4 2 3 4 Total Total Children Examined 224 190 158 225 182 166 1,145 Nutrition— (a) Excellent 145 85 35 167 109 62 603 (b) Normal 67 82 85 48 60 71 413 (c) Sub-normal 12 23 36 10 13 30 124 (d) Bad - - 2 - - 3 5 42 Medical Inspection of Toddlers, 1934—continued. Disease, Defect or Condition. BOYS Age last Birthday. GIRLS. Age last Birthday. 2 3 4 2 3 4 Total Muscular Tone— (a) Excellent 107 142 133 131 138 148 799 (b) Good 116 47 25 90 42 18 338 (c) Sub-Normal 1 1 — 4 2 — 8 Clothing and Footgear— (a)Satisfactory 219 186 152 223 178 162 1,120 (b) Unsatisfactory 5 4 6 2 4 4 25 Cleanliness— (a) Excellent 212 181 154 217 176 156 1,096 (b) Fair 12 9 4 8 6 10 49 (c) Dirty — — — — - - - Anæmia 38 48 32 51 41 31 241 Lungs— Bronchitis 4 8 6 3 9 10 40 Asthma —- — — — - 2 2 Nervous System— Behaviour Symptoms 81 56 37 85 45 30 334 Organic Disease 1 1 1 1 1 1 6 Alimentary System— Worms 3 - 3 2 3 4 15 Other Conditions 6 6 3 6 7 2 30 Genito-Urinary System— Enuresis and Frequency 16 10 10 22 6 3 67 Other Conditions 3 2 2 — 2 — 9 Rickets— Including Healed Cases and Early Signs 74 76 65 52 45 34 346 Skin Conditions 16 16 8 19 8 11 78 Eye Defects and Infections including Squints 6 11 8 10 10 11 56 Ears— Otorrhœa, Earache, etc. 3 10 4 2 3 7 29 Nose and Throat— Enlarged Tonsils 87 96 75 93 89 76 516 Enlarged Tonsils and Adenoids Adenoids Teeth— Caries 9 58 84 7 44 72 274 Hypoplasia 2 5 2 1 4 5 19 Malocclusion 25 11 3 29 14 3 85 Heart and Circulation— (a) Functional Hearts 39 39 48 35 35 42 238 (b) Organic Heart Disease — 1 — — — 1 2 Enlarged Glands— (a) Tonsillar 61 82 80 71 64 81 439 (b) Post-Cervical 50 48 53 39 53 45 288 Other Diseases and Defects 1 3 7 2 3 4 20 43 Provision 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. During the year 93 applications were received; 82 were supplied—51 free, 7 at half cost and 24 at cost price. Compensation of Midwives.—Whenever an assistant medical officer finds it necessary to recommend hospital treatment for expectant mothers referred to the Council's ante-natal clinics for ante-natal examination by midwives, the midwife loses her patient if the mother accepts the advice of the medical officer and is admitted to hospital. In these cases the Council make a payment of 10s. by way of compensation to the midwife subject to certain conditions, which are referred to in detail in my Annual Report for 1931, being complied with. During the year compensation was paid in 8 instances. 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 it was 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. 0d. for each such case. No case was dealt with under this scheme during the year. Home Helps.—During the year 43 applications were considered by the Committee and 40 home helps were provided. The total cost of this service was £123 2s. 0d. 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 to the Eltham and Plumstead Health Centres; to a private practitioner or to a hospital. During the year 280 children were sent to these clinics and for each case the Council paid 5s. 0d. hildren referred to them suffered from the conditions set out in the following Table, No. 14, but it is well worthy of notice that the number of children treated at the Eltham Health Centre and the Plumstead Health Centre appear out of all proportion to the number sent to Brewer Street Clinic, Woolwich. The explanation 44 does not lie in the fact that Woolwich children require less treatment; it is entirely due to the fact that facilities exist in the same building for the required treatment to be given at the time of the visit at Eltham and at Plumstead. TABLE No. 14. Brewer Street. Eltham. Plumstead. Impetigo 11 32 1 Ear Discharge 17 45 25 Eyes 19 37 34 Miscellaneous 2 40 17 49 154 77 Dental Treatment.—Mothers and children requiring dental treatment are referred from the Welfare Centres to the School Clinics at Brewer Street, Woolwich, at Westhorne Avenue, Eltham, and at Plumstead High Street. This service, which had been established at Woolwich for many years was extended to Eltham in 1932 and to Plumstead in 1933. There are three sessions per month at Woolwich, two per month at Plumstead and two per month at Eltham. The following Table, No. 15, shows the cases attending and the total attendances during the year. The number of sessions was 84 excluding anaesthetic days. TABLE No. 15. Expectant Mothers. Nursing Mothers. Children under 5. No. Attendances. No. Attendances. No. Attendances. Woolwich 90 180 44 117 143 216 Eltham — — — — 126 221 Plumstead — — — — 112 161 90 180 44 117 381 598 Dentures are provided free, at part cost, or at cost price, according to the 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 45 supplied in previous years. Twenty-five sets (complete or partial) of artificial teeth were supplied during the year at a total cost of £133 10s. 6d. Payments by mothers amounted to £72 1s. 0d. Orthopædic Treatment for Children under Five Years of Age.— Children requiring orthopaedic treatment are referred to the remedial clinic of the Woolwich Invalid Children's Aid Association. The Council pay for children under five years of age sent by their medical officers to the clinic, 2s. 0d. per attendance for cases requiring massage or electrical treatment and 1s. 6d. per attendance for any other form of treatment. The cost of these services for the year was £169 10s. 6d. 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. 16. Cases treated at Orthopaedic Clinic, 1934. Type of Case. Number remaining over from 1933. New Cases. Total Cases. Number who completed treatment by end of year. Number with treatment not completed. Talipes (Club Foot) — 12 12 10 2 „ (Flat Foot) 2 9 11 10 1 Rickets— General 5 35 40 36 4 Genu Valgum (Knock Knee) 4 31 35 32 3 Genu Varum (Bow Leg) 2 18 20 13 7 Infantile Paralysis — — — — — Erb's Paralysis — 1 1 1 — Bad Posture 1 5 6 5 1 Muscular Weakness 1 4 5 5 — Mouth Breathing 1 3 4 3 1 Torticollis — 2 2 2 — . Other Deformities 1 — 1 1 — Other Diseases 4 2 6 5 1 Constipation — 1 1 1 — 21 123 144 124 20 46 Provision of Nursing Assistance for Certain Diseases.—In Section 1 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 has been dealt with under these diseases, q.v. In February the Council considered an application from the Woolwich and District Nursing Association requesting that payments should be made in respect of the nursing of children under five years of age, suffering from diseases, other than those specified infectious diseases for which payment is made under existing agreements. The Association asked that payments should be made in respect of children suffering from threadworms, discharging eyes, otorrhœa, blepharitis and boils. As arrangements already existed at the Minor Ailments Clinic for the treatment of these conditions, except threadworms, the Council decided to make payments in respect of the nursing of cases of threadworms only and to include all the nursing associations in the arrangement. It was agreed that during the financial year ended 31st March, 1935, a payment at the rate of 1s. 0d. per visit should be made in respect of such cases, that the total expenditure should not exceed £18, and that in the event of this amount being exceeded a pro rata reduction would be made in the payment to each of the associations. During the nine months of 1934 the number of cases so treated was 46, payment being made at approximately eleven pence per visit. Day Ambulance.—In accordance with an agreement entered into with the London County Council, ambulances are hired from that body for the conveyance of mothers to maternity hospitals between the hours of 8 a.m. and 11 p.m., and, except in rare instances, the cost is recovered from the patient. During the year this service was used on 8 occasions. Children's Beds.—Twelve beds have been reserved by the Council in the Woolwich War Memorial Hospital for the treatment of children under 5 years of age suffering from such conditions as are usually admitted to general or children s hospitals. Including those remaining in hospital at the beginning of the year, the number of children who received treatment during the year was 193. Of these 167 were discharged cured or very much improved in health, 14 were discharged as improved and 5 died. No children were transferred to other hospitals, 4 others were discharged showing no improvement, and the number remaining in hospital at the end of the year was 3. The surgical conditions for which these children were admitted included:—enlarged tonsils and adenoids, phimosis, hernia, abscess, injury, pyloric stenosis, rectal prolapse, and cleft palate, etc., and those admitted for medical treatment included children suffering from prematurity, marasmus, pneumonia, bronchitis, diarrhoea, urinary infection, catarrhal jaundice, and chorea, etc. 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 47 of the Hospital, that 801 babies were born during the year. At the ante-natal clinics in connection with this hospital, 8,682 attendances were made, and at the infant clinics, 2,687 attendances. In addition there were 190 extern cases. The number of mothers admitted under the Council's scheme was 138, the nett cost to the Council being £974 3s. 0d. (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 195, and 40 mothers were admitted for ante-natal or emergency treatment. The number of attendances at the ante-natal clinic was 1,195. The number of mothers admitted under the Council's scheme was 61, the nett cost to the Council being £501 18s. 6d. Ante-Natal Treatment and Emergencies.—The number of cases admitted for ante-natal or emergency treatment under the Council's scheme was 4. The reasons for admission were: —Albuminuria, 1; Pyelitis, 1; Heart Trouble, 2. Convalescent Home Treatment for Children under 5 years of Age.— ♦ The necessary arrangements for this 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 of 70 children, the total cost of whose convalescent treatment amount to £422 16s. 4d. The Council's grants amounted to £200. The children were sent away for periods varying from 2 to 27 weeks, and payment was only made in respect of children sent to homes approved by the Medical Officer of Health. During the year at the request of the Metropolitan Boroughs' Standing Joint Committee, proposals on the subject of a scheme which has for its object the provision of a convalescent home for the reception of mothers after confinement and their babies, was considered. It appeared that money was available from a Trust for erecting and equipping such a home free of cost, but that no funds would be available for the maintenance of the home. The proposals provided for a home of thirty single rooms for mothers and babies, and nurseries for babies and toddlers. The Trustees who were responsible for the home asked whether the Metropolitan Boroughs as a whole would be responsible for 13 beds. The Council agreed to cooperate in the scheme. 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 one mother was so admitted to a convalescent home. 48 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, £1,956 0s. 9d.; Fresh milk, Nil; Dinners, Nil. In January the Council decided to co-operate with the London County Council in regard to the supply of extra nourishment to maternity cases where domiciliary relief was being granted by the County Council. The details of the scheme may be summarised as follows:— (a) Grant of extra nourishment shall be considered as additional to, and not part of, ordinary relief. (b) There shall be no material interval between the recommendation of extra nourishment, and the issue thereof, the Welfare Centre's recommendations shall be regarded as matters of urgency by Relieving Officers and District Medical Officers. (c) Women in receipt of relief who attend London County Council antenatal clinics for examination and advice prior to confinement in London County Council hospitals shall be dealt with by the London County Council, except in special cases. (d) After confinement the nursing mothers will be referred to Borough Council's clinics, with a view to any extra nourishment required being supplied through such centres. (e) Recommendations from Welfare Centres with regard to nursing mothers will be dealt with in the same way as expectant mothers. All expectant mothers in receipt of relief not attending London County Council ante-natal clinics must attend Borough Council Welfare Centres, and the procedure suggested is as follows:— (1) The medical officer of the centre will forward to the relieving officer his recommendation for any milk or special foods which may be necessary for a nursing or expectant mother. (2) The relieving officer will consult the district medical officer on each recommendation, and will satisfy himself that the applicant is unable to provide the special nourishment without further assistance. The recommendation will then be submitted to the district sub-committee. 49 (3) If the district sub-committee agree to the recommendation received from the local welfare centre, arrangements will be made by the relieving officer for the supply to be issued by the centre. In cases of sudden or urgent necessity, the relieving officer will exercise his responsibility under Section 17 of the Poor Law Act, 1930. (4) Accounts for the supplies issued by the welfare centre will be forwarded to the Chief Officer of Public Assistance for payment. In May the scheme was modified as follows (1) To extend the scheme to provide that nourishment over and above the normal diet and necessary on medical grounds may similarly be supplied for delicate children, attending the metropolitan borough councils' maternity and child welfare centres, whose parents are in receipt of out-relief. (2) To modify the scheme by the deletion of the provision that a relieving officer must consult the district medical officer upon each recommendation as to extra nourishment received from a maternity and child welfare centre before the submission of the recommendation to the district sub-committee, on the clear understanding:— (a) That the district sub-committees, and (in cases of sudden or urgent necessity) the relieving officers may consult the appropriate district medical officer whenever in any case they consider such a course desirable, and (b) That the district medical officer shall be consulted in those cases in which medical relief is being afforded to the family. In September the Council decided to accept certificates from medical officers in charge of London County Council ante-natal clinics at hospitals in the cases of expectant mothers attending such clinics who, though not in receipt of relief, are nevertheless in such financial circumstances as to be unable to bear the cost of such nourishment; reserving the right, however, of requiring a certificate from one of the Council's medical officers whenever such course is considered desirable. At the end of the year it was estimated that the amount due from the London County Council in respect of extra nourishment was £353. 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. Reports are furnished to the County Council, as the occasion arises, when the home conditions are unsuitable for blind children or it is advisable that the child should be admitted into a suitable institution. During the year no new 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. 50 SECTION IV.—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 female Inspector and two part-time female Inspectors. Water Supply—The Metropolitan Water Board is responsible for the water supply of the Borough, and no complaints were received as 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 under the control of the Works Department of the Council. Collection is made once weekly, with the exception of a small central area, where a twice-weekly collection is made. All refuse is disposed of by burning at the Council's destructor at White Hart Road, Plumstead. An opportunity of improving the present system of refuse collection was taken during the year, when the necessity arose for replacing the electric collection vehicles. These vehicles were definitely out of date, inasmuch as dust blew about during collection and transport, and the loading, line was too high. After trials of six different types of vehicles, it was decided to purchase four "Pagefield Prodigy" refuse collection vehicles of 15 cubic yards capacity each. Steps were also taken to improve the efficiency of the method of disposal of refuse at the Plumstead Destructor by a decision to provide a new hopper and refuse handling plant, together with the necessary conveyors. The cost of this improvement, including a new approach roadway and certain new buildings, was £12,000. Offensive trade refuse is removed by contractors, who remove fish waste from shops in the Borough and make their own arrangements with the shopkeepers as to the time and day of removal. The contractors provide airtight containers of a type approved by your Medical Officer of Health, the number of these supplied varying according to the individual requirements of the proprietors of the shops. Inoffensive trade refuse is removed by the Works Department at a charge of five shillings per load and 1,886 tons of such refuse were removed. Drainage.—Practically every house in the Borough is connected with the water-carriage system for the disposal of sewage. The exceptions are in out-lying parts of Eltham. 51 The inspection of new drainage and of extensive reconstruction of old systems is carried out by the Borough Engineer, but in all other cases alterations are supervised by the Sanitary Inspectors. During the year 47 complaints were received regarding the defective action of combined drains; on investigation 244 houses in all were found to be affected. In all systems, except seven, the obstruction was of a temporary character. In 17 instances choked interceptors were found. Costs recovered from the owners amounted to £3 7s. 6d. In the following 7 instances reconstruction was necessary, and the work was carried out by the owners after the service of notices :—Mast Pond Wharf and Tuff & Hoar's Wharf, Woolwich High Street; 78 Archery Road, Eltham; 5-7 Speranza Street, Plumstead; 52-72 Tuam Road, Plumstead; 38-46 Spray Street, Woolwich; 28-29 Albion Road, Woolwich; 89-91 Kingsman Street, Woolwich. Seven single private drains were cleared at the request of the owners, from whom the costs, £1 14s. 0d., were recovered. Action with Regard to Smoke Abatement.—Twenty-six special observations were made to ascertain whether there were any breaches of the law regarding smoke emission and four nuisances were discovered, notices being served in each instance. No legal proceedings were instituted, as the action taken by the Sanitary Inspectors resulted in the abatement of the nuisances. Fouling of Pavements by Dogs—By-law.—In view of the fact that nuisance and inconvenience caused to pedestrians by the fouling of pavements by dogs appeared to be increasing, and because of representations made by ratepayers and residents in the Borough, the Council decided to make a by-law in the interests of public health. The by-law is as follows:— "(1) No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. (2) Any person offending against this By-law shall be liable on summary conviction to a fine not exceeding Forty Shillings." The by-law was adopted by the Council at their meeting on the 3rd October, 1934. The Home Secretary confirmed the by-law on the 30th November, 1934, and fixed the date upon which it was to come into operation as the 1st January, 1935. 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 381. In 50 instances defective drains were repaired, 12 premises were rat-proofed, and other effective measures were taken in 30 instances. National Rat Week was held from the 5th to the 10th 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 10,548. 52 Complaints.— During the year 3,402 complaints of nuisances were made to the Health Department or to the Sanitary Inspectors on the district, and all these were investigated by the Sanitary Inspectors. Notices for the remedy or abatement of the defects or nuisances discovered were served upon the owner or other person responsible under the provisions of the Public Health (London) Act, 1891, or the appropriate Sections of the London County Council (General Powers) Acts, or under By-laws. Sanitary Inspection of the Area.—A summary of the inspections carried out by the Sanitary Inspectors will be found in Table No. 17. In connection therewith the number of Intimation and Statutory notices served was 2,642 and 444 respectively. The Statutory notices related to 379 premises and included 315 general, 48 ashpit, 9 water-closet and 33 paving notices. In addition to these notices under the Public Health (London) Act, 1891, 39 notices were served under London County Council (General Powers) Acts and under By-laws. In 38 instances, where owners did not comply with the Statutory notices, the Town Clerk was asked to institute proceedings. It was only necessary, however, to issue summonses in three instances, as in all the other cases the necessary steps were taken on receipt of a letter from him. In Table No. 18, will be found a summary of the nuisances abated and defects remedied. TABLE No. 17. Inspections. Housing Survey — Houses Inspected 772 Drainage Inspections 1,690 Drains Tested by Smoke Test 418 Clearance Areas — Houses Surveyed 122 Drains Tested by Water Test 68 New Houses 1,627 Complaints Investigated 3,402 Tents and Vans 60 Outworkers' Premises 151 Factories 329 Houses Let in Lodgings 702 Workshops 418 Houses re Infectious Disease 1,550 Workplaces 121 Houses re Smallpox Contacts 33 Theatres and Cinemas 27 Houses re Verminous Cases 4,471 Rag and Bone Premises 5 Houses re Scabies Cases 192 Urinals Accessible to the Public 195 Houses re Other Diseases 243 Women's Lavatories 248 Common Lodging Houses 152 Smoke Observations 26 Overcrowding Investigated — Special Inspections re Rats 381 Rooms 30 Miscellaneous 1,905 Underground Rooms Illegally Occupied 5 Re-Inspections 8,196 53 TABLE No. 18. Nuisances Abated. Cleansing- Sinks Repaired or Provided 233 Interiors Cleansed 966 Wastes Cleansed 14 Rooms Cleansed 2,239 Wastes Trapped or Repaired 322 Damp Conditions— Water Closets— Walls 587 Flushing Apparatus Repaired 210 Sites 16 „ „ Renewed 83 Roofs 483 New Pans 270 Rain Water Pipes and Gutters 290 New Traps 254 Others 46 Foul Pans Cleansed by Owner 24 Dilapidations— „ „ „ Occupier 65 Walls 771 Additional W.C.s Provided 1 Ceilings 596 Doors and Fastenings Remedied 58 Floors and Hearths 239 Coppers 146 Dust Bins Provided 708 Stoves 202 Others 70 Underground Rooms Closed 8 Verminous Conditions— Overcrowding—Cases Remedied 18 Rooms Cleansed 1,391 Water Supply— Defective Lighting— Additional 5 Windows Repaired 200 Re-instated 20 „ Enlarged 10 Cisterns Cleansed 2 „ Additional — „ Covered 2 Defective Ventilation- „ Removed 1 Windows Rendered Usable 431 Foul Accumulations— „ Additional Provided 3 Manure Removed 11 Other Means 6 Offensive Accumulations Removed 29 Defective Paving— Yards Re-paved 185 Back Yards Cleansed 13 „ Repaired 162 Dung Pits Provided 7 Scullery Floors Re-paved or Repaired 92 Rats— Drains Repaired in Consequence 50 House Drains— Defective Drains Repaired 280 Premises Rat Proofed 12 Choked Drains Cleared 286 Other Effective Measures 30 Vent Pipes Repaired 22 Rag and Bone Premises— Soil Pipes Repaired 12 Premises Cleaned — Gullies Fixed 119 Rain-proof Premises Provided — New Drainage 5 Vermin-proof Conditions Provided - Rain Water Tanks Repaired — „ „ ,, Abolished 2 Miscellaneous 124 54 The Condition of the River Thames.— During the summer months there was a most offensive smell from the River Thames and this was the subject of general complaint, not only from those who worked or travelled on the river, but also from householders and shopkeepers in those areas near the River. London sewage effluent is discharged into the River from two main outfalls belonging to the London County Council, situated near Barking and Crossness, both in close proximity to Woolwich. Strong representations were made by the Council to the London County Council who were urged to take steps towards securing a permanent improvement in the state of the Thames so far as this was affected by the discharge of sewage into it. The quantity of sewage reaching the Outfalls is approaching 300 million gallons per day and most of it is discharged into the river after preliminary settlement of the sewage for removal of solid matters in suspension. A small proportion is treated with activated sludge, one large unit being installed at the Northern Outfall in 1931. In 1934 the County Council resolved to instal an additional five units and this will enable one third of the total dry weather flow at the Northern Outfall to be treated by this process, but the construction of these works will take time and will not be complete at the present rate of progress till 1940. As a temporary measure the County Council propose to use sulphate of iron, but this is only a palliative. The County Council, in November, in a letter to the Council enclosed the following statement:— "During the past summer the water of the Thames from some distance below the Council's outfalls up to the tidal limit at Teddington has been in an unusually bad condition. So far as the reaches below, say, London Bridge are concerned, this condition is no doubt mainly due to the effluent entering the river at the Council's outfalls making more demands on the self-purificatory powers of the river than can be satisfied under the unusually difficult conditions which have prevailed during the last two years and which became more difficult when the fresh water flow of the river was allowed to be reduced to about onefifth of the volume of effluent discharged from the outfalls. "It must be admitted that the progress of self-purification has at times reached the point where it has been physically impossible for the oxygen of the air to be absorbed at a rate sufficient to keep the water free from offensive smell or to oxidise fully compounds in the water which would discolour white lead paint. "Careful investigation shows, however, that the condition of the upper tidal reaches is due rather to the polluted state of water coming over Teddington weir, combined with the many discharges of effluent between Teddington and 55 the County of London. It has been realised for some years that the water of the Thames during the summer does not progressively improve from the outfalls to Teddington. The improvement which is observed on the early part of the journey does not continue, but a zone of deteriorating water is reached followed by some improvement towards Teddington. The low salt content of the bad water in these upper tidal reaches shows that it is not water which has come up with the tide from the region of the outfalls of the Council but is rather fresh water from the non-tidal reaches which has become polluted on its way to the outfalls and ultimately to the sea. It is this water only which is available for dilution of the Council's effluent and it is insufficient both in quantity and quality for this purpose. "During the summer months (June to September) of this year the flow of sewage from the Council's outfalls averaged 238.9 million gallons per day (the average for the last ten years was 273.3 million gallons per day), and it is estimated that the effluent from other sewage works discharging directly or indirectly into the Thames below Teddington weir and above the Council's outfalls averaged 65 million gallons per day, and that the flow of upland water in this length into the Thames which is not measured would be, perhaps, 15 million gallons per day. The flow of the Thames itself over Teddington weir averaged 76.7 million gallons per day (June, 129.6 million gallons per day, July, 73.8 million gallons per day, August, 54.1 million gallons per day, September, 50 (approximately) million gallons per day. "The statutory flow in the Thames under the Thames Conservancy Act, 1932, is fixed at 170 million gallons per day, but under powers provided in that Act the Minister of Health reduced the minimum to 100 million gallons per day on 22nd June and to 50 million gallons per day on 11th July. "The result is that during the last four months a quantity of sewage effluent approximating to 300 million gallons has been discharged each day into the above-mentioned length of the Thames and has been carried up and down by the tides, while the flow of upland water tending to drive it down stream was on occasions as low as 1 /15th of this quantity, while during an average year the flow of upland water was at least equal to the sewage flow and generally exceeded it two and three times. "The Thames has not received a winter scouring by flood water for two years. As far up as Twickenham at high water it is both dirty and covered with floating matter—barges are employed in collecting driftwood. The quantity and quality of the freshwater flow available or permitted do not suffice to remove all this matter, to remove and oxidise accumulation of foul mud and to purify the Council's effluent. 56 "It does not appear that there is any hope of improvement of the quality of water available for dilution—except the natural improvement due to increased freshwater flow—until the standard of purification of the sewage effluent in the upper part of the tidal portions of the river is improved. "Until the further purification plant which has been authorised is in use it will therefore be necessary to avoid bad summer periods by the use of chemical agents which will oxidise the more readily putrescible matters in the effluent as at present discharged rather than merely as heretofore to attempt to fix, without oxidising, constituents which might cause odours." Offensive Trades.—By the Transfer of Powers Order, 1933, consideration of, and decision on applications to the establishment anew or the enlargement of certain offensive businesses, or imposition, modification, or removal of conditions, was transferred from the London County Council to the Metropolitan Borough Councils. In Woolwich, however, there is only one offensive trade, namely, that of a slaughterer of poultry. The premises were approved by the London County Council in November, 1931. Rag Flock Act.—Two samples of rag flock were taken for analysis. Such material must 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. Both samples complied with the Regulations, as the results of analyses show, the number of parts of chlorine being, respectively, 3 and 4. Mortuaries.—The Public Mortuary is in Sun Street, Woolwich, and a temporary mortuary is provided in Eltham High Street. The following Table shows the use made of the mortuaries during the year:— TABLE No. 19. Sun Street. Sun Street (Infectious). Eltham. Ml Mortuaries. Number of Bodies Received :— 1933 1934 (a) For Inquest — — — — — (b) For Custody 11 — 3 16 14 11 — 3 16 14 Number of Post-Mortem Examinations — — - - - 57 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. In 1932, land at Eltham was purchased by the Council for an additional cemetery. During the year, development of the land, and the erection of a Chapel and other buildings was undertaken by direct labour, under the supervision of the Borough Engineer. Only the western half of the land is being laid out at present, and provision is being made for three Church of England, two General and one Roman Catholic Sections. These sections comprise 4, 2 and 1¼ acres respectively. Two other sections of approximately 2½ acres are in course of development. A site has been reserved in the grounds for a Crematorium and a Garden of Rest. Burials also take place in Eltham Churchyard and in a private burial ground within the grounds of Christ Church Priory in Eltham High Street. In the following Table is shown the number of interments in the different graveyards. The information in the case of the cemeteries is given through the courtesy of the Town Clerk, and, in the case of the Eltham Churchyard, through that of the Vicar of Eltham. TABLE No. 20. Number of Interments. 1932 1933 1934 Woolwich Cemetery 560 545 661 Plumstead Cemetery 765 769 755 Eltham Churchyard 232 252 236 Exhumations.— During the year one exhumation under Home Office Licence was carried out. Factory and Workshop Act.— The following Table No. 21, 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. 58 TABLE No. 21. Factories, Workshops and Workplaces. 1.—Inspection. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (Including Factory Laundries) 329 17 — Workshops (Including Workshop Laundries) 418 6 — Workplaces (Other than Outworkers' premises) 121 1 — Total 868 24 — 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of Cleanliness 24 24 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of Floors 2 2 — - Other Nuisances 12 11 1 - Sanitary Accommodation Insufficient 1 1 — — Unsuitable or Defective 27 27 — — Not separate for Sexes — — — — Offences under the Factory and Workshop Acts:— Illegal Occupation of Underground Bakehouse (S. 101) - - - - Other Offences 3 — 3 - Total 69 65 4 — 59 Table No. 21 —continued,. 3.—Outwork in Unwholesome Premises, Section 108. Nature of Work Instances. Notices Served. Prosecutions. (1) (2) (3) (4) Wearing Apparel— Making, etc. 2 2 — Removal of Infirm and Diseased Persons.— Power is given by Section 28 of the London County Council (General Powers) Act, 1928, to remove infirm and diseased persons living under insanitary conditions to institutions. Usually such persons are persuaded to enter an institution, but occasionally difficulty is experienced in this connection, and it is necessary to make application to a Magistrate for an Order. No such application was made during 1934. Sandpits.— It is the practice of the Council to disinfect all children's sandpits under their control at regular intervals during the year. Public Baths and Washhouses.— There are three bathing establishments in the Borough, one at Plumstead, one at Woolwich, and a small 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 22 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 334,070; Turkish and Russian Vapour Baths 13,335; Slipper Baths 195,159, and the Public Washhouse 18,242. Legal Proceedings.—The particulars of the various prosecutions instituted under the Public Health (London) Act, 1891, and kindred Acts are set out in detail in the following Table No. 22. 60 TABLE No. 22. Prosecutions under Public Health and Kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1 13th February An occupied dwelling-house without a proper and sufficient supply of water. "The Woodlands," Shooters Hill Closing Order made. Costs £1. 2 29th June Defective W.C. flushing apparatus, defective and dilapidated ceilings. 23, Sand Street Work done. Summons withdrawn on payment of 10s. 0d costs. 3 29th June Defective and choked rain water pipe; defective W.C. flushing apparatus. 25, Sand Street Work done. Summons withdrawn on payment of l0s. 0d. costs. 4 7th December Exchanging toys for rags contrary to the by-laws relating to Rag and Bone Dealers. - Fined 10s. 0d. Nuisance from Pigeons.— Under Section 52 of the London County Council (General Powers) Act, 1927, a Borough Council is empowered to seize and destroy, sell or otherwise dispose of house-doves or pigeons in excessive numbers, if they appear to have no owner. No action under this Section was taken during the year. Shops Act, 1934.—This Act, which came into operation on the 30th December, contains, inter alia, provisions for the health and comfort of shop workers, and it applies to retail shops, wholesale shops and warehouses. These welfare provisions deal with ventilation, temperature and lighting; with the provision of sanitary conveniences and sufficient washing facilities; and with facilities for taking meals, if these have to be taken in the shop. Metropolitan Borough Councils are responsible only for the administration of those sections which deal with ventilation, heating and the provision of sanitary conveniences. Adequate means of ventilation and of lighting must be provided and maintained, and, unless the shop be specially exempt, suitable and sufficient sanitary conveniences must be provided, not only for those employed in the shop, but also for those employed about the shop. The Medical Officer of Health and all the Sanitary Inspectors were appointed Inspectors for the purposes of the Act. 61 Pharmacy and Poisons Act, 1933.—This Act places upon Metropolitan Borough Councils the duties of enforcing the provisions of that part of the Act which relates to poisons in Part 2 of the Poisons List. Poisons in Part 1 of the Poisons List may only be sold by "authorised sellers" and those in Part 2 by authorised sellers and by persons whose names appear in a register to be kept by the local authority. "Authorised sellers," i.e., pharmacists, will be inspected by Inspectors appointed by the Pharmaceutical Society, but the Borough Council are required to arrange for the necessary inspection of all other persons. It will be necessary to appoint an inspector for this purpose and also to see that the requirements of the law relating' to the marking and storage of poisons are enforced. The Act will come into force on an appointed day. 62 SECTION V.— INSPECTION AND SUPERVISION OF FOOD. Each district sanitary inspector exercises a general supervision over all food exposed for sale and all food premises in his district. In addition three food inspectors have been appointed, two of whom are responsible for the inspection of meat at the slaughterhouses and for the taking of samples under the Food and Drugs (Adulteration) Act, 1928, while the third systematically and regularly inspects all food premises. Immediate steps are taken to secure the abatement of any insanitary condition discovered. The inspectors, in turn, are responsible for bi-weekly inspections of the markets. Registered Premises.—The London County Council (General Powers) Act, 1932, requires the registration of premises used for the following purposes:— (a) The sale, manufacture or storage of ice cream or similar commodity; (b) The manufacture of sausages; (c) The preparation or manufacture of potted, pressed, pickled, or preserved meat, fish or other food. Since the Act came into force an inspection of all food shops in the Borough has been undertaken and any structural alterations or improvements which have been regarded as necessary in such premises have been required by the Council to be carried out before registration is granted. The register of such premises is kept in five parts, and the numbers in each part at the end of the y£ar, were as set out below:— (a) Sale, manufacture or storage of Ice Cream 195 (b) Manufacture of Sausages (c) Preparation or manufacture of Potted, Pressed, Pickled or Preserved Meat 93 (d) Preparation or manufacture of Potted, Pressed, Pickled or Preserved Fish 32 (e) Preparation or manufacture of Potted, Pressed, Pickled or Preserved other foods 4 The total number of inspections made was 968. 63 Inspection of Food Premises.— In addition to the premises dealt with above registers of other food premises in the Borough are kept, and Table No. 23, shows the number of inspections made in respect of each of these during the year:— TABLE No. 23. Premises. On Register 31st December. Number of Legal Proceedings. Inspections. Notices. Bakehouses 35 93 10 — Cowsheds 8 86 3 — Dairies 77 254 2 — Slaughterhouses 4 27 5 — Fried Fish Shops 62 311 11 — Butchers' Shops 108 133 8 — Premises where food is prepared (other than above) 66 70 — — Shops and Markets — 1,312 3 — Milk Supply.— The Borough Council is required to keep registers of all persons carrying on in the Borough the trade of cowkeeper or dairyman, and of all premises in the Borough which are used as dairies. The following Table No. 24 shows the state of the registers at the end of the year:— TABLE No. 24. No. Dairy premises 77 Dairymen with premises in Borough 49 „ „ outside Borough 39 Cowkeepers 2 Cowsheds 8 Purveyors of milk in sealed bottles 145 The standard of cleanliness in cowsheds and dairies and in other premises where milk is sold has been maintained at a high level. The cowsheds in the Borough at the end of the year were as set out in the following Table No. 25. 64 TABLE No. 25. Situation of Cowhouse. No. of Sheds. No. of Cows. Licencee. Avery Hill Farm, Eltham 3 69 W. F. Fisher. Coldharbour Farm, Eltham 2 88 C. U. Fisher. Chapel Farm, Eltham 3 59 C. U. Fisher. Eleven samples of raw milk were bacteriologically examined during the year. The results are shown below. Bacillus Coli was present in all these samples except those marked with an asterisk:— Bacteria per 1 c.c. January 16,666* 17,666 February 117,666 80,000* March 17,200 May 38,333 77,000 July 8,200,000 14,800,000 September 78,666 27,666* 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:— Number of pasteurisers' licences issued 2 Number of dealers' licences issued to use the designation :— (a) "Certified" 5 (b) " rade A (Tuberculin Tested)" 7 (c) "Grade A (Pasteurised)" 13 (d) "Pasteurised" 14 Number of supplementary licences issued to sell:— (a) "Certified" milk 2 (b) "Grade A (Tuberculin Tested)" milk 3 (c) "Grade A (Pasteurised)" milk 2 (d) "Pasteurised" milk 8 65 Thirty-eight samples of pasteurised milk were bacteriologically examined during the year, including milk supplied to hospitals and schools in the Borough. The results of the examinations are shown below. Such milk must not contain more than 100,000 bacteria per cubic centimetre. Bacteria per 1 c.c. January 27,000* 1,500 — — February 15,800 2,500 — — March 15,000* 4,700 — — April 4,800 2,700 — — May 10,433 6,066 5,200 30,000* July 3,400 4,600 14,833 — September 5,200 7,000 4,200 3,700 49,000* 24,000 — — October 212,000* 2,600,000* 36,000* 124,000* November 920 730 94,000 57,000* December 16,800* 8,600* 11,200* 23,000* 222,000* 318,000* 98,000 102,000 320,000 Bacillus Coli was present in those samples marked with an asterisk. Dried and Condensed Milks.—Seven samples of condensed milk and five samples of dried milk were examined. The appropriate Regulations were being complied with in every respect. Artificial Cream Act, 1929.—This Act has for its object the regulation of the manufacture and sale of artificial cream. The Council are required to keep a register of all premises where artificial cream is manufactured, sold, exposed or kept for sale. No premises are registered in this Borough. Meat Supply.—Notice of intention to slaughter any animal must be given to the Council in accordance with the provisions of the Public Health (Meat) Regulations, 1924. Hie following Table, No. 26, shows the number of animals slaughtered and inspected in the Borough during the year. In 1933 the number was 38,763. 66 TABLE No. 26. Month. Cattle. Sheep and Lambs. Pigs. Calves. Total. January 231 1,913 2,012 — 4,156 February 199 1,258 1,774 1 3,232 March 239 1,409 1,695 — 3,343 April 201 1,637 1,328 1 3,167 May 204 1,906 439 70 2,619 June 208 1,751 94 35 2,088 July 186 1,950 30 — 2,166 August 222 1,913 237 — 2,372 September 234 1,657 1,439 1 3,331 October 266 1,750 1,923 — 3,939 November 288 1,391 1,898 — 3,577 December 246 1,259 2,099 — 3,604 2,724 19,794 14,968 108 37,594 The number of whole carcasses condemned on account of disease or injury was 54 (44 pigs, 7 sheep and 3 cattle). In 2,330 instances partial condemnation was necessary in respect of 1,965 pigs, 41 sheep and 324 cattle. Slaughter of Animals Act, 1933.—This Act, which deals with the humane slaughter of animals, came into force on the 1st January, 1934. It conferred new powers on local authorities and imposed new duties upon them as well as upon persons carrying on slaughterhouses and knackers' yards. The subject matter of the Act is not, however, new to local authorities as there is already a statutory duty to make by-laws for preventing cruelty in slaughterhouses. In London, the London County Council had, by their by-laws, required the use of mechanical stunning instruments for all animals (except in the case of animals killed according to the Jewish method of slaughtering) and this is the central requirement of the new Act. The Act requires that animals in slaughterhouses and knackers' yards are to be stunned before slaughter, and that the stunning shall be by a mechanically operated instrument which is defined to include an electrical instrument. This does not apply to sheep unless the local authority apply it by resolution, while goats 67 may be excluded by resolution. The requirement applies to pigs, but if electrical energy is not available this is a defence to proceedings unless it can be shown by the prosecution that electricity can reasonably be made available. Provision is made for slaughtering by Jews or Mohammedans for their co-religionists. In accordance with the provisions of Section 2, the Council at their meeting on the 3rd January, 1934, resolved that Section 1 should, on and from the 1st February, 1934, apply to sheep, ewes, wethers, rams and lambs, and they decided not to pass a resolution exempting goats or kids. The Act places on local authorities a new duty, that of licensing slaughtermen, and licences once granted are available throughout England and Wales. In this matter the Council decided as follows:— (a) That licences for slaughtermen be for a period not exceeding one year, and shall expire on the same day that slaughterhouse licences expire ; (b) That renewals be for a period of one year; (c) That a charge of two shillings be made for each original licence; (ii) That a charge of one shilling be made for each renewal. The number so licensed during the year was nineteen. The Act gives statutory force to requirements for slaughterhouses and knackers' yards most of which, apart from slight differences, have long been normal in the by-laws of local authorities in respect of slaughterhouses, and they also give the right of inspection to the Medical Officer of Health or Sanitary Inspector at any time when business is or appears to be in progress, or is usually carried on. Slaughterhouses.—There is no public slaughterhouse in the Borough. Slaughterhouses are subject to annual licence and in Table No. 27, which follows, are shown those licensed at the end of the year. TABLE No, 27. 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. 38, Plumstead Common Road Reed, A. J. Inspection of Imported Meat.—In Woolwich, as in other parts of the country, much imported meat is sold. In the usual way this meat comes from the London markets after inspection, and such inspection as it receives in Woolwich takes place in the butchers' shops where it is exposed for sale. Occasionally, however, the Port °f London Sanitary Authority allows foreign meat to be removed from the Port of London without examination on the understanding that:—(a) the meat shall be 68 taken to a wholesale depot; (b) none of it shall be removed without the permission of the local Medical Officer of Health; and (c) the consignees shall give the Medical Officer of Health notice as soon as the meat is received at the depot. Guarantees are obtained by the Port of London Authority before such permission is given. During the year, however, no such meat was inspected. 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, 1,312 visits were made to shops and to stalls in the markets. Bakehouses.—There were, at the end of the year, 35 bakehouses in the Borough, of which 30 were factory and 8 underground. The inspections numbered 93, and 10 notices were served. The conditions on the whole were satisfactory. Unsound Food.—There were 337 instances of unsound food being surrendered. These compare with 574 in 1933. Included in the food surrendered were 1 ton 11 cwts. Beef; 1 cwt. Mutton; 3 tons 5 cwts. Pork; 1 ton 2 cwts. Pig Offal; 19 cwts. Ox Livers; 4 cwts. Ox Lungs; 1J cwts. Sheeps' Offal; 1 cwt. Fish; 80 lbs. Veal; 1 f cwts. Sweets ; 2 cwts. Flour, and 50 Rabbits. Only one seizure was made (15 lbs. of sweets) and on the instructions of the Public Health Committee a cautionary letter was sent by the Town Clerk. 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 foodstuffs which are subject to an Order in Council made under the Act. The Orders which so far have been made are as follows:— The Merchandise Marks (Imported Goods) No. 3 Order, 1928 Honey; Fresh Apples. The Merchandise Marks (Imported Goods) No. 5 Order, 1928 Currants; Sultanas; Raisins; Eggs in Shell; Dried Eggs; Oat Products. The Merchandise Marks (Imported Goods) No. 4 Order, 1929 Raw Tomatoes. The Merchandise Marks (Imported Goods) No. 5 Order, 1930 Malt Products. The Merchandise Marks (Imported Goods) No. 8 Order, 1931 Salmon and Trout. 69 The Merchandise Marks (Imported Goods) No. 1 Order, 1932 Butter. The Merchandise Marks (Imported Goods) No. 3 Order, 1934 Bacon and Ham. The Merchandise Marks (Imported Goods) No. 5 Order, 1934 Dead Poultry. The Merchandise Marks (Imported Goods) No. 6 Order, 1934 Maize Starch. The Merchandise Marks (Imported Goods) No. 7 Order, 1934 Meat. 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 by retail. As a general rule imported produce does not require marking when sold in quantities not exceeding 14 lbs. in weight. 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. One mark—the National Mark—is used, or will be used, for all graded produce of England and Wales, and by law it conveys a guarantee that the produce is of the grade stated. It is not compulsory for all such food stuffs to be so marked, but, if marked, they must conform to the standard. In London the local authority is the Metropolitan Borough Council concerned, and in Woolwich the Medical Officer of Health, the Chief Sanitary Inspector and three Sanitary Inspectors have been appointed Officers under the Act. 1 he following is a list of products regarding which Regulations were in force on the 31st December, 1934:— Date of Regulations. Produce. 1929 Potatoes. 1930 Eggs; Glass-house grown Tomatoes and Cucumbers ; Strawberries; Cherries. 1931 Beef. 1932 Cider; Bottled Vegetables ; Plums. 1933 Apples; Wheat Flour; Malt Extract and Malt Flour; Dressed Poultry; Bottled Fruits; Cabbage Lettuce; Blackcurrants; Gooseberries; Loganberries; Raspberries; Red Currants; Cheshire Cheese; Green Peas; Brussels Sprouts; Celery; Pears. 70 Date of Regulations. Produce. 1934 Cauliflower and Broccoli; Canned Fruits ; Canned Vegetables; Honey; Asparagus; Jam; Carrots; Leeks; Radishes; Red Beet; Cabbage Greens and Cabbage; Salad (Spring) Onions; Parsnips; Ripe Onions and Shallots; Turnips and Swedes; Watercress; Horseradish; Kidney and Runner Beans; Mushrooms; Forced Rhubarb; Natural Rhubarb; Stilton Cheese; Hot House Grapes. During the year Regulations affecting Canned Vegetables (1931), Honey (1932), Cauliflower and Broccoli, Canned Fruits, Asparagus, Jam, and Bunched Carrots (1933), were revoked and the Regulations affecting Bottled Fruits were amended. No offences were discovered during the year. Sophistication of Food.— The following Table No. 28, 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. TABLE No. 28. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Milk 203 34 237 7 Separated Milk 1 — 1 — Cream — 12 12 — Condensed Milk — 7 7 — Dried Milk 5 — 5 — Butter 3 14 17 1 Margarine — 3 3 — Lard — 3 3 — Suet — 4 4 — Tea — 2 2 — Cocoa — 2 2 — Coffee — 3 3 — Flour — 1 1 — Baking Powder — 3 3 - Cornflour — 1 1 — 71 TABLE No. 28—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Custard Powder — 3 3 — Rice — 3 3 — Sago — 3 3 — Sage — 2 2 — Seasoning — 1 1 — Dried Fruit — 6 6 — Currants — 1 1 — Sultanas — 6 6 — Raisins — 5 5 — Prunes — 4 4 — Glace Cherries — 2 2 — Candied Peel — 4 4 — Ground Almonds — 4 4 — Almond Essence — 2 2 — Sugar — 7 7 — Jam 4 19 23 3 Ginger — 2 2 — Preserved Ginger — 2 2 — Mincemeat — 3 3 — Mace — 1 1 — Dried Mint — 5 5 — Sauce — 8 8 — Pickles — 5 5 — Vinegar — 13 13 — Salad Cream — 4 4 — Tinned Beans — 1 1 — „ Peas — 1 1 — „ Potatoes — 1 1 — „ Tomatoes — 3 3 — „ Beetroot — 1 1 — „ Cherries — 1 1 — 72 TABLE No. 28—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Tinned Figs — 1 1 - „ Grape Fruit — 1 1 - „ Logan berries — 1 1 - „ Plums — 2 2 - „ Pears — 2 2 - „ Gooseberries — 2 2 - „ Fruit Salad — 1 1 - „ Fish 1 13 14 4 Ox Tongue — 1 1 — Minced Beef 5 4 9 2 Minced Meat 4 — 4 — Meat Roll — 1 1 — Sausages 4 3 7 — Steak and Kidney — 2 2 — Fish 10 — 10 — Confectionery — 13 13 — Ice Cream 4 2 6 — Lemonade Crystals — 4 4 — Sherbert — 1 1 1 Lemon Gin 1 — 1 — Lime Juice Cordial — 1 1 — Mineral Waters — 4 4 — Cream Filled Pastries — 2 2 1 Non-alcoholic Wines — 2 2 — Beer — 7 7 — Brandy 5 — 5 — Gin 5 — 5 — Whisky 11 — 11 2 Solution of Hydrogen Peroxide — 3 3 — Ammoniated Tincture of Quinine — 2 2 - Cod Liver Oil — 3 3 — 73 TABLE No. 28—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Camphorated Oil — 3 3 — Formalin — 3 3 — Lime Water — 2 2 1 Phenacetin Tablets — 2 2 — Seidlitz Powders — 3 3 — Tincture of Iodine — 6 6 — 266 310 576 22 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. 29. 1932 1933 1934 4.5 per cent. and over 3 4 7 4 per cent. and under 4.5 per cent. 12 8 9 3.5 per cent. and under 4 per cent. 121 116 88 3 per cent. and under 3.5 per cent. 68 124 128 Below 3 per cent. 7 3 5 211 255 237 Adulterated Samples—Action Taken.— The following Table No. 30, shows the number of adulterated samples and the action taken in each instance where the sample was formal:— TABLE No. 30. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 451 Blackcurrant Jam Informal Contained only 14 per cent. fruit instead of 30 per cent. — 453 Blackcurrant Jam Informal Contained about 23 per cent. fruit instead of 30 per cent. — 74 TABLE No. 30—continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 480 Milk Formal Contained 1 per cent. added water — 508 Milk Formal 8 per cent. deficient in fat Fined £3 and £6 6s. costs. 513 Milk Formal 31 per cent. added water Fined £1 and 10s. 6d costs. 514 Milk Formal 1 per cent. added water - 515 Milk Formal Small percentage water — 524 Sardines Informal Contained lead 43 parts per million — 545 Sardines Formal Contained lead 20 parts per million - 565 Milk Formal 1 per cent. deficient in fat — 591 Whisky Formal 2.3 per cent. excess water — 1 Milk Informal 11 per cent. deficient in fat — 44 Strawberry Jam Informal Contained only 25 per cent. fruit instead of 42 per cent. — 64 Minced Beef Formal Contained sulphur dioxide 260 parts per million Vendor cautioned. 131 Whisky Formal Contained 3 per cent. excess water Vendor cautioned. 133 Sardines Informal Contained lead 15 parts per million — 135 Sardines Informal Contained lead 16 parts per million — 194 Cream Pastry Informal Contained no cream — 200 Sherbert Informal Only tartaric acid and sugar — 243 Butter Informal Contained 16.3 per cent. water — 248 Minced Beef Formal Contained sulphur dioxide 95 parts per million — 406 Lime Water Informal Contained chlorides .0033 per cent. — Food Poisoning.— The London County Council (General Powers) Act, 1932, requires every medical practitioner in London to notify to the Medical Officer of Health every person whom he suspects or finds to be suffering from food poisoning. 75 In his certificate he must state the name, age and sex of the person, the full postal address and particulars of the food poisoning from which the person is suffering or suspected to be suffering. The number of notifications received during the year was 37. With two exceptions, where two persons and three persons respectively were involved, these were all single cases. The age and sex distribution of the cases notified is shown in the following Table, No. 31 :— TABLE No. 31. Cases of Food Poisoning Notified during 1934:— Age Periods. Male. Female. Total. Under 1 - - - 1 and under 5 3 — 3 5 and under 10 2 — 2 10 and under 15 2 1 3 15 and under 20 2 1 3 20 and under 35 7 7 14 35 and under 45 3 1 4 45 and under 65 3 5 8 65 and over — — — 22 15 37 The medical practitioner notifying is required to state on his certificate the food he suspects. In 14 instances meat, in one or other form— pork, rabbit, sausage, beef, minced ham, meat pie, etc.— was suspected; in 11 instances fish— fresh, fried or tinned; in 6 instances fruit—fresh or tinned; in 3 instances ice cream; in 1 instance cream; in 1 instance fried chip potatoes, and in 1 instance mincemeat. Most of the cases were slight in character and there were no deaths. 76 Nutrition.— Dissemination of knowledge and instruction on matters affecting nutrition is part of the Council's general scheme of health propaganda, q.v. As part of the Council's scheme for Health Propaganda, cookery demonstration classes were arranged at the Tuberculosis Dispensary for the instruction of the wives and mothers of the tuberculous in the buying and cooking of simple, cheap and nutritious articles of food and the preparation of suitable dishes. These classes were well attended. The scheme is more fully reported on in the Health Propaganda Section. By-laws.—The power was given to the London County Council in the General Powers Act, 1932, to make by-laws with regard to food premises. Draft by-laws have been prepared by that Council and have been considered by the Metropolitan Borough Councils, who have submitted observations thereon, but there the matter rests at present. 77 SECTION VI.— HOUSING. The following Table shows the main housing figures for the year set out under the headings given in Circular 1,417, issued by the Ministry of Health for securing uniformity in the presentation of these statistics. TABLE No. 32. 1.—Inspection of Dwelling Houses during the Year. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 5,873 Inspections made 13,816 (2) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 772 Inspections made 2,218 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 54 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,434 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 1,988 * Includes intimation notices. 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 78 (2) Number of dwelling houses which were rendered fit after service of formal notice:— (a) By Owners 1 (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 379 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 356 (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 5 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 4 (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 8 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement, or room having been rendered fit - Inspection of Houses.— The systematic inspection of houses in the district in accordance with the provisions of the Housing (Consolidated) Regulations, 1925, was carried on during the year and 772 houses were so surveyed. These figures are smaller than in previous years owing to the fact that one Sanitary Inspector was seconded for special survey of the Borough in connection with unhealthy areas and in systematically reporting on houses which might be so dealt with. In tabular form, Table No. 33, is shown a detailed statement of specific action (except action taken in respect of clearance areas) taken under the Housing Acts during the year. 79 TABLE No. 33. Action under the Housing Acts. Premises. Action Taken. Date. *Woolwich Common, 35 Closing Order 3rd January. *Rectory Place, 21 do. 31st January. Church Street, 30 Undertaking to recondition house accepted 19th April. Elibank Road, 49a Demolition Order 2nd May. *Woolwich Common, 25 Closing Order 6th June. * do. 27 do. 5th July. * do. 43 do. do. * do. 48 do. do. Woolwich High Street, 54 Representation 12th September. do. 55 do. do. do. 56 do. do. do. 56 a do. do. do. 80 Demolition Order 7th November. *Woolwich Common, 1 Closing Order do. do. 1 do. do. †Nightingale Place, 1 do. do. Eltham High Street, 26 Demolition Order do. do. 28 do. do. Anglesea Avenue, 5 Notice under Section 17 do. do. 6 Demolition Order 5th December. Ann Street, 3 Representation do. do. 5 do. do. do. 7 do. do. do. 9 do. do. do. 39 do. do. Dumblane Road, 13 do. do. Katrine Terrace, 2 do. do. Prospect Row, 24 do. do. Brookhill Road, 52 Notice under Section 17 do. * Underground rooms. † Part of a house. 80 Clearance Areas.— The following unhealthy areas were dealt with as clearance areas by the Council during the year :— (1) Shepherds Farm. Hutments.—These hutments were represented by me as an unhealthy area in November, 1933. There were 67 dwelling houses and the number of occupants was 311. There was no local inquiry and the Clearance Order was confirmed by the Minister on the 24th April, 1934. At the end of the year 20 hutments had been demolished, 108 persons being displaced. Re-housing is being provided partly on the site of the hutments and partly on an adjoining portion of the Page Estate. The hutments included in the representation were as follows :— Ashwood Road Nos. 1 and 3. Barleycorn Street Nos. 3a, 5, 5a, 7, 7a, 9, 9a. Nos. 8, 10 and 12. Bilberry Road Nos. 4, 6, 8, 10, 14, 16. Nos. 1, 3, 5, 9, 11, 15, 17, 19, 21, 23, 25 and 27. Elderberry Road Nos. 1, 3, 5. Nos. 2, 4, 6, 8, 10 and 12. Elmbrook Street Nos. 1, 3, 5a, 7, 9, 11, 13 and 15. Nos. 2, 4, 6, 8, 10 and 12. Marlfield Road Nos. 2, 4, 9, 11. Rochester Way Nos. 449, 451, 453 and 455. Well Hall Road Nos. 87, 89, 91, 93, 95 and 97. (2) Prospect Row and Kidd Street Clearance Area.—On the 14th June, 1934, I represented this area, consisting of nine cottages, as an unhealthy area. The cottages in question are known as Prospect Row Cottages, Nos. 1, 2, 3, 4, 5 and 6, and Kidd Street, Nos. 45, 47 and 49. The number of occupants was 36. The Council made a Clearance Order on the 25th September; a Ministry of Health inquiry was held on the 6th November and the Clearance Order was confirmed by the Minister, without modification, under date 9th January, 1935. Re-housing is to be provided in the same area as for No. 1. (3) St. Thomas' Cottages.—On the 14th June, 1934, I represented this area, consisting of eight cottages, as an unhealthy area. The number of occupants was 13. The Council made a Clearance Order on the 25th September; a Ministry of Health 81 inquiry was held on the 6th November and the order was confirmed by the Minister, without modification, under date, 9th January, 1935. Re-housing is to be provided in the same area as for No. 1. (4) Kirks Yard and Eltham High Street Area.— This area, consisting of 14 houses, was represented by me to the Council as an unhealthy area on the 14th June, 1934. The houses included in the area were as follows:— Eltham High Street Nos. 8, 10, 12, 14, 16, 18 and 20. Kirks Yard Nos. 1, 2, 3 and 4a. Halams Cottages Nos. 1, 2 and 3. The number of occupants was 46. No inquiry had been made at the end of the year. Re-housing is to be provided in the same scheme as for Area No. 1. There are several other smaller areas which will be required to be dealt with in a similar way as part of the five years programme and there are larger areas in the Borough which no doubt will be dealt with by the London County Council in the course of a year or two. Eltham Hutments—Scheme for Re-housing of Tenants.—For a long time the Borough Council have been seriously concerned with the position of the hutments in Eltham which were erected by the Government in the early part of the war for the purpose of housing munition workers in Woolwich Arsenal, and consultations were held with the London County Council as to the best method of dealing with these hutments, which were fast becoming unfit for human habitation, and the rehousing of the tenants. After conference with the London County Council and the owners of the hutment areas to whom the Government had sold, and also with the Tenants' Association, a scheme was agreed under which the Borough Council are to erect on a portion of their Middle Park Estate houses and flats for the re-housing of the hutment tenants, the owners agreeing to pay to the Borough Council a sum of £10 per hutment where the occupier was re-housed by the Council. The London County Council agreed to contribute a sum of £1 17s. 6d. per dwelling per annum for 40 years and the Borough Council agreed to make a like contribution, this involving both the London County Council and the Borough Council in an estimated contribution of £858 15s. Od. per annum for 40 years. At the meeting on the 28th March, 1934, the Borough Council considered a full report from the Housing Committee, and they approved the scheme and decided to 82 erect as a first instalment 458 dwellings (houses and flats) at an estimated cost of £155,300, the necessary road and sewer work in connection with the scheme being estimated to cost £22,430; the dwellings and the roads and sewers were to be constructed by direct labour under the supervision of the Borough Engineer. The first of the dwellings were ready for occupation on the 1st September, 1934. It is confidently expected that the scheme now in operation will prove a satisfactory solution of the difficulty. Council's Houses.—During the year the Council erected 360 houses, 20 on the Page Estate and 340 on the Middle Park Estate. At the end of the year 246 houses were in course of erection on the Middle Park Estate, and 32 on the Page Estate. Overcrowding.—Early in 1935 the Registrar General issued a special report on housing conditions compiled from information obtained by the Census of 1931. It is particularly opportune at the present time in view of the Housing (Overcrowding) Bill now before Parliament. I have extracted from this report information which is likely to be of interest to the Council as it sets out to some extent the problem of the less favourably housed sections of the community. (a) Dwellings originally intended, for one family which are noiv shared. The following tabular statement shows to what extent dwellings originally intended for one family are now occupied by two or more :— Number of dwellings in England and Wales occupied by private families 9,123,279 Number of these shared by two or more families 838,695 Percentage so shared 9*19 Number of dwellings in London occupied by private families 730,628 Number of these shared by two or more families 293,303 Percentage so shared 40.14 Number of dwellings in Woolwich occupied by private families 29,870 Number of these shared by two or more families 7,303 Percentage so shared 24.45 Expressed in another way, there were approximately ten and a quarter million families in England and Wales; the number of families in excess of separate dwellings was just over eleven hundred thousand. In London there were 1,190,030 private families or 459,402 families in excess of separate dwellings. In Woolwich there were 38,176 private families and 8,306 families in excess of separate dwellings. 83 In considering these figures it is important to remember that, for Census purposes, a family is a person or group of persons included in a Census schedule so that it includes such persons as lodgers or caretakers. In Woolwich there were 2,930 families consisting of one person and a deduction should be made in this respect. (b) Density of Population. For many years one of the accepted standards of overcrowding has been what is known as the Registrar General's Standard of more than two persons per room. It has never been looked on as an absolute standard but merely as a convenient measure for comparing density of population in a neighbourhood. The following tabular statement shows to what extent certain densities of persons per room exist :— Number of persons living more than three persons per room in England and Wales 565,869 Percentage so living 1.48 Number of persons living more than three persons per room in London 150,130 Percentage so living 3.64 Number of persons living more than three persons per room in Woolwich 1,431 Percentage so living 1.04 Number of persons living at a density of three and over two persons per room in England and Wales 2,074,325 Percentage so living 5.45 Number of persons living at a density of three and over two persons in London 391,222 Percentage so living 9.49 Number of persons living at a density of three and over two persons per room in Woolwich 6,378 Percentage so living 4.62 Number of persons living at a density of two and over one and a half persons per room in England and Wales 4,446,940 Percentage so living 11.68 Number of persons living at a density of two and over one and a half persons per room in London 665,542 Percentage so living 16.14 Number of persons living at a density of two and over one and a half persons per room in Woolwich 16,210 Percentage so living 11.75 84 It is more useful to consider this in terms of families rather than of individuals. In Woolwich 237 families were living at a greater density than three persons per room; 1,010 families at more than two but not more than three persons per room, and 2,928 families at more than one-and-a-half but not more than two per room. A further 6,398 families were living at more than one but not more than one-and-ahalf per room. Expressed per thousand private families, these figures become 6, 26, 77 and 168 respectively. The corresponding figures for London Administrative County are 20, 56, 119 and 162. Common Lodging Houses.—These are licensed annually by the Borough Council in accordance with the provisions of the Transfer of Powers Order, 1933. The number of inspections made during the year was 152. The following Table No. 34, shows details of the accommodation available in each common lodging house in the Borough :— TABLE No. 34. 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 Increase of Rent and Mortgage Interest (Restriction) Acts.— Only one application for a certificate under these Acts was received during the year, and this was subsequently withdrawn, the landlord having carried out the necessary work. 85 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 were taken to ensure that the by-laws were being observed. The total number of inspections made was 60. Houses Let in Lodgings.—No register is now kept of houses let in lodgings but as the records of this Department in respect of individual houses are kept on cards, such houses are kept prominently before the district sanitary inspectors by means of "signals" on the cards which serve as reminders to the inspectors that they are dealing with houses that would formerly have been registered. During the year 702 inspections of such houses were made. New Houses.—The following Table No. 35, shows the number of certificates of a proper and sufficient supply of water for new houses granted by the Public Health Committee at each of their meetings. Of these, 386 were in respect of houses built by the Council. TABLE No. 35. Date of Meeting. Woolwich. Plumstead. Eltham. Total. West. East. 10th January — 4 23 75 102 7th February — 54 25 30 109 1st March — 42 24 93 159 11th April — 70 34 83 187 9th May — 39 28 115 182 13th June 4 66 29 90 189 5th July — 54 26 26 106 25th July — 1 13 16 30 12th September — 28 72 125 225 10th October 2 12 27 30 71 6th November — 5 22 48 75 5th December — 15 34 143 192 6 390 357 874 1,627 Bug Infestation of Houses.— The Council's obligations with regard to buginfested premises and the experience they have gained in their new housing estates in dealing with the problem, have already been dealt with in my last two Annual 86 Reports. How the campaign against the beg-bug progressed during 1934 may be conveniently considered now under several heads :— (I) Variations in Routine Methods— (a) The Disinfestation of Occupied Houses in Private Ownership.—The routine method of disinfestation by sulphur dioxide followed in these cases was described fully in my Annual Report for 1932 and no modification other than those referred to in my Annual Report for 1933 took place during the year. The number of rooms so disinfested during the year was 736. (b) Occupied Houses belonging to the Council.—The same method of disinfestation was followed in practically all cases but in one particularly intractable infestation of a block of four houses temporary shelter was found for the occupiers for two nights while the whole block was successfully treated with Cyanide (Zyklon B). Excluding this block the number of rooms so disinfested during the year was 220. (c) Unoccupied Houses belonging to the Council.—The routine method followed in these cases was spraying with orthodichlorbenzine. At the beginning of the year this chemical was used undiluted but latterly mixtures of orthodichlorbenzine and other chemicals of different strengths were experimented with, e.g., carbon tetrachloride, methylated spirit and paraffin, in half and quarter strengths. The number of rooms so treated was 415. (d) Transfer of Bug-infested Tenants to New Houses on the Council's Estates. —From the beginning of April the routine method of disinfestation was by means of cyanide (Zyklon B), in hired furniture vans, but in a few instances bug infested furniture was permitted to be taken to new houses, where it was treated the same night with sulphur dioxide. This method gave satisfactory insecticidal results but unfortunately the effect of sulphur in rooms where the plaster was new caused damage to metal articles, looking glasses and marble slabs, as well as to the plaster itself. For that reason this method which was only used as a temporary expedient was discontinued. The number of instances where cyanide disinfestation was carried out in hired vans was 57 and the number of instances where sulphur was used in new houses was 14. (e) Bug Infested Houses in Slum Areas.—Only a portion of one area was dealt with by the Council during the year. In 1933 I represented an area of some 67 hutments as unfit for human habitation. A Clearance Order was made by the Council and subsequently confirmed by the Minister of Health. As these huts became empty, those which were bug-infested were sprayed 87 out with a mixture of othodichlorbenzine and carbon tetrachloride, with results which appeared to be highly satisfactory. Any gasesous disinfectant is unlikely to be satisfactory for use in the disinfestation of a timber framed hut, when the timbers are warped and the inside lining is broken, and it was for that reason that this mixture was used, carbon tetrachloride being extremely toxic to the bed-bug. The number of huts so treated was 7. (II) Procedure in Routine Disinfestations— (a) Sulphur Dioxide.—More use has been made of this chemical than any other, and the methods used, which briefly can be described as gaseous disinfection plus cleansing, have been successful with one treatment only in 84 per cent. of all cases. (b) Orthodichlorbenzine.—In the report for 1933 I referred to experimental work carried out with this chemical which promised well. Briefly its fumes are so irritating to the bed-bug that it leaves its resting places much in the same way as rabbits are bolted by ferrets. Further experience has shown that ODCB is a valuable adjunct to our armamentarium against the bed-bug. Our knowledge of its efficiency justifies a more detailed scientific investigation of its action as it has been used only in an empirical manner up to now. So far we have only used it in empty houses but it has been used in other areas in occupied rooms as well. The method we have followed is as under :— (1) Space between floor and skirting, and wall and skirting, are cleared of dust and dirt by putty knife or similar tool; (2) Visible openings at architraves and mouldings are enlarged with same knife; (3) Built in cupboards especially those next to fireplaces, are carefully inspected and a similar procedure is carried out where this is possible. (4) Openings are made into any obvious cavities such as window frame pulley boxes, and other cavities such as are sometimes found around chimney breasts between the latter and the trimming and trimmer joists. (5) The room is now ready for spraying. In doing so the general idea is to endeavour to dislodge the bed-bug from his hiding places by means of the fumes and then to drive him on to an open surface, where he is accessible to orthodichlorbenzine concentration. Following out this idea, the cupboards, the obvious and other cavities, the edges of the architraves and all mouldings, and the floor next the skirtings are sprayed with orthodichlorbenzine. When 88 bed-bugs are noticed leaving their resting places the disinfectors (who always work in pairs and wear masks), now spray again and finish by spraying the floors, walls and ceilings from below upwards. The room is then sealed up and remains so until the next morning. The amount used has been varied during the year, but on an average one gallon of a mixture has been used for every 700 cubic feet. Failures were recorded in 5 per cent. of all rooms treated. (c) Hydrocyanic Acid.— In December, 1933, Mr. Couch, one of the Council's Sanitary Inspectors, went to Manchester to study the methods of disinfestation followed there and after consideration of his report the Council decided to adopt the following scheme so far as the transfer of bug-infested tenants to the Council's Estates was concerned, since experience had shown that some 40 per cent. of all new tenants selected for transfer to the Council's houses were living in buginfested premises. The details are as follows :— (1) The homes of selected tenants are inspected by Mr. Couch who submits one of the following reports to the Housing Department:—(1) Free from bugs; (2) Bugs suspected or very slight infestation; (3) Bug infested. (2) No further action is taken by this Department with regard to those in the first category. Those in the second category are shown how thoroughly to clean their furniture and kill bugs in the structure of the home. They are subsequently re-inspected to see whether they are free from infestation or not: if they are clean no further action is taken by this Department, if not, they are dealt with as in the next class. With regard to the third category, however, the Housing Department notifies the Health Department the date upon which the tenants are being given a new house and arrangements are then made by the Health Department with a contractor for the hire of a pantechnicon and with another contractor for cyanide disinfestation. The cost of removal varies with the number of families moved on a particular day but a uniform payment of 10s. Od. is made by each tenant towards the cost of removal. (3) The routine procedure then is as follows:— The furniture van and disinfecting van arrive at the old house at 7.30 a.m.; all the bedding is taken away by the disinfecting van and treated by steam. Everything else, except food, which the people take themselves, is put into the pantechnicon. The latter is then driven to the Borough Engineer's Yard at Eltham and parked underneath a Dutch barn. The inside of the pantechnicon is then heated to a temperature of between 65° F. and 90° F. by means of electric radiators and the van is then charged with cyanide (Zyklon B). The concentration is between one and two per cent. and the gas is allowed to remain in contact with the furniture for 3½-4 hours. At the end of that time the van is opened and a certain amount of the furniture is taken out, underneath the barn, and steps are taken 89 to free the articles from Cyanide. Tests are made to ensure that the furniture is free from gas before being removed from the yard. Between 4.30 and 5.0 the same evening the furniture is driven to the new house and the bedding is delivered about the same time. All the hopper windows, ventilators and access doors to roof space are fixed so that they cannot be closed during the first night of occupation. Mr. Couch, in every instance, is satisfied by further tests that the house is safe for occupation before he leaves it. Cyanide was also used on one occasion for the disinfestation of a block of four houses on the Council's estate and the story of one of these illustrates how difficult disinfestation may be on occasion. This house was treated, either wholly or partially, with sulphur dioxide on six occasions and with orthodichlorbenzine on two occasions. Within 48 hours the bed-bug was seen again after each treatment. Obvious and concealed cavities were exposed and treated but in spite of all these efforts the bed-bug still remained. It became necessary to consider the question of the use of cyanide and as the other three tenants in the block were also infested with bugs in greater or less degree, it was decided to disinfest the whole block. With the co-operation of the Housing Sub-Committee the four families in the block were accommodated for two nights in four flats, the bedding, etc., being supplied by the Council from existing stores. The premises were sealed up late in the afternoon and were opened about 1.0 o'clock the next morning. On this occasion a successful issue was obtained. (4) At different times during the year experiments were made with other disinfestants—proprietory and otherwise—with greater or less success. Nothing however, was discovered which justified extensive use. It is becoming more and more clear that until someone discovers something simpler to use than any of the three mentioned above, consideration must be given to improving the technique in each instance, or reducing the cost. In this connection towards the end of the year the Council decided to establish a Clearing House on the new housing estate in order to deal with blocks already infested from which the bug could not be eradicated by other methods and also to reduce the cost of cyanide disinfestation by eliminating the cost of removals. Under this scheme the prospective tenants who will occupy a complete block of four or six dwellings make their own arrangements for furniture removal to the new houses on a day fixed by the Department. Their furniture is then placed in two rooms in each of the new dwellings in the same block. These rooms are sealed up and used as containers for cyanide. The tenants sleep for two nights in the clearing house where they are provided with bedding, furnishing, light and heating. 90 (III) Following up after Disinfestations— No scheme of disinfestation can be regarded as satisfactory until arrangements are made for following up in order to prevent re-infestation arising from any cause, e.g., second-hand furniture; incomplete success in the first instance; or sub-letting to a bug-infested family, etc. As the number of houses requiring supervision was greater than the existing staff of the Council could deal with, the Council decided to appoint an additional woman sanitary inspector for this purpose. The appointment had not been made at the end of the year. (IV) Limitation of Harbourage- Ordinary methods of house construction provide much harbourage for the bed-bug and in some designs of houses it is impossible to eliminate the bedbug except by using a gas like cyanide, the use of which is cumbersome and troublesome in occupied properties. Consideration was given to this aspect of the problem by the Housing Committee who decided that in the case of cottage flats the first floor should be constructed on the hollow tile principle screeded up in concrete and plastered on the underside according to the method of the Kleine Company; that concrete skirting with wood beading (threequarters of an inch), at the joint of the floors and concrete skirting be substituted for the usual wood skirting. They decided also not to have picture rails except in the living rooms, and also to do away with all forms of board construction except where this was floated over with plaster on the under side. So far as applicable this construction is followed also in cottages. (V) Propaganda against the Bed-bug— (a) The Council's Health Services booklet contains an article on The Bedbug and this booklet is given to every tenant entering into occupation of one of the Council's houses. (b) To every tenant whose furniture is disinfested a letter is sent, incorporating this article which is as follows:— "You are now occupying a new house and my Council have done everything in their power to prevent it becoming infested with bugs, which are very prevalent. They have adopted similar precautions with all the other tenants in the area, and are also doing everything they can to keep the houses free from bugs in future. They ask for your co-operation in this matter. Bugs may be brought into houses in various ways, of which the following are some of the most usual:— 91 (a) In furniture and pictures. (b) In trunks, boxes and suitcases which have been stored for a time in buggy houses. (c) In old wood from a bug-infested building which has been bought for firewood or for other domestic purposes. (d) Very rarely by someone having the misfortune to pick up a bug on his or her clothes. If you are considering buying or accepting furniture for your new house let us know beforehand and we will inspect it and if necessary disinfest it free of charge. No doubt you are already taking precautions to see that bugs are not introduced into your house, but should you find them or suspect their presence, let us know at once, and we will advise you as to the best means of getting rid of them and will assist you in taking the necessary steps. Remember that bugs dislike cleanliness, and you should therefore keep all parts of your house thoroughly clean. We will do all we can to Help You and we ask You to Help Us." On the Council's estates the percentage of recurrence is about six, which is about one-third that found in the rest of the Borough, but it is an interesting commentary that not on one occasion were we asked to disinfest any second-hand furniture. (c) Talks on the bed-bug have been included in the series of lectures to organisations. (d) At the Health Exhibition a bug stall was shown. It is fully described in the Health Propaganda section of the report. 92 SECTION VII. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. In addition to food poisoning (which is reported on in Section V) the following diseases are notifiable in the Borough:— Anthrax Ophthalmia Neonatorum Cerebro-spinal Meningitis Pneumonia—Acute Primary Cholera Pneumonia—Acute Influenzal Continued Fever Poliomyelitis Diphtheria Polio-encephalitis Dysentery Plague Encephalitis Lethargica Puerperal Fever Erysipelas Puerperal Pyrexia Enteric (or Typhoid) Fever Relapsing Fever Glanders Scarlet Fever Hydrophobia Smallpox Malaria Tuberculosis Membraneous Croup Typhus Fever Zymotic Enteritis Although notification of an infectious disease in a house is incumbent not only upon the medical practitioner in attendance, but upon the head of the family, or the nearest relative or person in charge of the patient, in actual fact it is a rare thing for a lay notification to be received. If the patient is an inmate of a hospital in most cases the certificate is sent to the Medical Officer of Health of the district in which the normal residence of the patient is situate, but notifications of malaria, dysentery and the acute pneumonias, are always notifiable to the Medical Officer of Health of the District in which the patient is residing at the time he is notified. In London, the London County Council maintain institutions for the isolation and treatment of the sick suffering from infectious diseases. Cases from Woolwich are usually admitted to the Brook Hospital, Greenwich, or to the Park Hospital, Lewisham, but during times of pressure cases are sent to Joyce Green Hospital, Dartford, or indeed, to any other of the fever hospitals belonging to the London County Council in the County of London. 93 The less common infectious diseases are admitted to any of the London County Council's infectious disease hospitals, but it is the practice of the County Council to select certain of their hospitals for the treatment of such diseases as puerperal fever, or anterior poliomyelitis, so that special facilities and experience may be available for such cases. The total number of notifications, excluding cases of tuberculosis, which are dealt with later in this Section, was 1,865, compared with 1,764 in 1933. In tabular form are shown in the next five Tables, statistics relating to the incidence of infectious disease in the Borough in 1934 and previous years. TABLE No. 36. Notification of Infectious Disease (excluding Tuberculosis), 1934. Diseases. Total Cases Notified. Admissions to Hospital. Total Deaths. Diphtheria 416 411 11 Scarlet Fever 989 918 3 Enteric Fever (including Para-Typhoid Fever) 8 7 — Puerperal Fever 5 5 2 Puerperal Pyrexia 30 29 — Erysipelas 119 62 6 Smallpox — — — Pneumonia 280 167 126 Malaria 1 1 — Ophthalmia Neonatorum 7 2 — Encephalitis Lethargica — — — Dysentery — — — Cerebro spinal Meningitis 4 4 1 Polio-encephalitis 1 1 1 Poliomyelitis 2 2 — Zymotic Enteritis 3 2 — * Measles (including German Measles) 2,392 188 10 4,257 1,799 160 * Not notifiable. 94 TABLE No. 37. Ward Incidence of Infectious Diseases (excluding Tuberculosis), 1934. Diseases. Borough. Dockyard. St. Mary's. River. St. George's. Burrage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas. Abbey Wood. Well Hall. Avery Hill. Sherard. Diphtheria 416 21 14 14 12 13 9 22 26 18 32 17 25 24 169 Scarlet Fever 989 36 41 51 62 43 26 58 69 38 97 70 56 50 292 Enteric Fever (including Paratyphoid Fever) 8 - - 1 - 1 1 1 - - 2 1 1 - - Puerperal Fever 5 2 - - - - - - - - - 1 - 2 - Puerperal Pyrexia 30 4 1 3 2 1 1 1 1 2 7 1 2 3 1 Erysipelas 119 6 11 8 8 6 3 4 9 7 20 6 8 4 19 Smallpox - - - - - - - - - - - - - - - Pneumonia 280 16 16 33 12 18 12 13 14 8 49 23 7 21 38 Malaria 1 - - - 1 - - - - - - - - - - Ophthalmia Neonatorum 7 1 - - - - - 1 1 1 1 - - 1 1 Encephalitis Lethargica - - - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - — — Cerebro-spinal Meningitis 4 - 1 - - - - - - - 1 2 - — — Poliomyelitis 2 - - - - - - - - 1 - 1 - — — Polio-encephalitis 1 - - - - - 1 - - - - - - — — Zymotic Enteritis 3 1 - - - - - - - - - - - — 1 * Measles (including German Measles) 2,392 111 150 292 224 104 155 127 200 121 197 1 161 82 151 317 4,257 198 234 402 321 186 208 227 320 196 406 284 181 256 838 * Not notifiable. 95 TABLE No. 38. Cases of Infectious Diseases Notified 1934 (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 416 3 12 12 31 35 158 84 22 42 10 7 - Scarlet Fever 989 3 17 54 79 94 390 212 49 63 23 5 - Enteric Fever (including Para-typhoid Fever) 8 - - - 1 - 1 - - 4 1 1 - Puerperal Fever 5 — — — - - - - - 5 - - - Puerperal Pyrexia 30 — — — - - - - 2 24 4 - - Erysipelas 119 2 1 3 2 3 2 5 6 14 17 50 14 Smallpox — — — — - - - - - - - - - Pneumonia 280 37 16 15 20 13 41 8 6 17 26 52 29 Malaria 1 - - - - - - - - 1 - - - Ophthalmia Neonatorum 7 7 — - - - - - - - - - - Encephalitis Lethargica — — — — - - - - - - - - - Dysentery — — — - - - - - - - - - - Cerebro-spinal Meningitis 4 - - - 1 - 1 1 - 1 - - - Polio-encephalitis 1 — — - - - 1 - - - - - - Poliomyelitis 2 1 — - - - 1 - - - - - - Zymotic Enteritis 3 2 — 1 - - - - - - - - - *Measles (including German Measles) 2,392 61 166 218 307 418 1,152 51 13 6 — — • — 4,257 116 212 303 441 563 1,747 361 98 177 81 115 43 * Not notifiable. 96 TABLE No. 39. Notification of Infectious Diseases (including Tuberculosis), 1901 to 1934. 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. Cerebro-spinal Meningitis. Poliomyelitis and Polio-encephalitis. ‡ 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 - 1,240 - 1905 7 273 83 513 27 1 12 - - - - - - - - - - 212 145 - 465 - 1906 — 387 97 528 40 - 8 - - - - - - - - - - 366 176 - 825 - 1907 — 275 110 1,023 27 - 6 - - - - - - - - 1 - 93 150 - 1,453 - 1908 - 362 90 596 19 - 6 - - - - - - - - 1 - 173 154 - 519 - 1909 — 268 113 1,027 13 - 9 - - - - - - - - - - 149 206 - 768 - 1910 1 171 89 524 10 - 7 - - - - - - - - 1 - 102 196 - 396 - 1911 - 239 82 518 16 - 16 - - - - - - 8 - 1 3 866 375 - 801 — 1912 3 429 87 474 20 - 2 - - - - - - 20 - 1 3 129 689 - 775 — 1913 - 321 70 626 14 - 8 - - - - - - 14 - - 1 338 532 143 387 — 1914 - 416 107 714 18 - 7 - - - - - - 18 - 1 - 199 400 98 967 — 1915 — 286 138 601 31 - 6 - - - - - - 19 - 50 2 173 420 69 1,179 - 1916 1 271 95 232 9 - 16 - - - - - - 33 - 17 - 80 392 77 1,590 - 1917 - 277 79 147 12 - 12 - - - - - - 41 - 22 1 101 448 95 1,710 - 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 1,886 - 1920 1 427 82 538 6 - 13 - 136 - 29 1 - 29 3 6 - 31 359 69 1,013 — 1921 - 592 59 1,351 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 2,698 - 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 2,679 - 1925 - 299 44 364 16 - 9 - 237 40 5 1 - 31 10 5 1 13 246 54 1,916 - 1926 - 393 46 411 8 1 4 7 259 33 5 - - 18 7 9 5 23 287 52 1,246 — 1927 — 278 65 478 9 - 8 30 280 36 3 1 - 19 6 4 3 12 169 84 457 — 1928 3 300 89 529 17 - 20 28 216 14 12 1 - 14 8 3 3 5 263 62 2,418 - 1929 5 496 80 567 7 - 15 38 293 90 5 - 1 17 4 9 4 8 250 52 151 — 1930 10 497 77 627 8 - 5 31 262 21 2 1 - 8 - 2 2 22 244 55 2,702 597 1931 3 281 80 387 3 - 8 41 327 44 3 - - 7 2 12 6 3 229 51 113 672 1932 7 233 44 554 3 - 5 35 199 48 2 1 - 7 2 15 6 11 235 48 3,135 - 1933 2 370 67 1,004 5 - 4 36 181 68 2 - - 9 - 9 2 5 207 45 354 — 1934 - 416 119 989 8 - 5 30 273 7 1 - - 7 - 4 3 3 219 50 2,392 - § Notification of Puerperal Pyrexia commenced October, 1926. * Voluntary notification to 1910: partial †Measles notifiable from 1/1/1916 to 31/12/1919. ×Chicken Pox was again made notifiable from April, 1930 to30th September. ‡Compulsory notification of Zymotic Enteritis commenced 1913. 97 TABLE No. 40. Deaths from Infectious Diseases (excluding Tuberculosis), 1934. Diseases. Number of Deaths. All Ages. Age Groups. Under 1 1- 2- 5— 15- 25- 35- 45- 55- 65- 75- Diphtheria 11 1 2 2 6 - - - - - - - Scarlet Fever 3 - — — 2 1 — — — — — — Enteric Fever (inc. Para-typhoid Fever) - - - - - - - - - - - - Puerperal Fever 2 — — — — 1 1 — — — — — Puerperal Pyrexia — — — — — — — — — — — — Erysipelas 6 1 — - — — 1 — 1 1 2 — Smallpox - - - - - - - - - - - - Pneumonia 126 32 7 2 3 1 3 14 15 25 15 9 Malaria - - - - - - - - - - - - Ophthalmia Neonatorum — - — — — — — — — — — — Encephalitis Lethargica — - — — — — — — — — — — Dysentery — - — — — — — — — — — — Derebro-spinal Meningitis 1 - — — — 1 — — — — — — Poliomyelitis — - — — — — — — — — — — Polio-encephalitis 1 - — — 1 — — — — — — — Zymotic Enteritis - - - - - - — — — — — — * Measles (including German Measles) 10 4 1 2 3 - - - - - - - 160 38 10 6 15 4 5 14 16 26 17 9 * Not Notifiable. 98 Diphtheria. Notification.—During the year 416 cases were notified, compared with 370 in 1933 and 233 in 1932. The number of military cases was five. The number of notifications received each quarter was as follows:— First quarter 146 Second quarter 93 Third quarter 67 Fourth quarter 110 Multiple cases.—The following Table No. 41, shows the house distribution in wards. The term "house" is synonymous with the term "family" except in one case, where two families were involved. TABLE No. 41. Diphtheria—Multiple Cases. Dockyard. St. Mary's. River. St. George's. Burrage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas. Abbey Wood. Well Hall. Avery Hill. Sherard. Total Houses. Total Cases. Number of houses in which 1 case occurred 19 11 8 9 13 7 13 17 12 24 10 21 18 115 297 297 2 cases occurred 1 — 1 1 — 1 1 1 3 4 2 2 3 19 39 78 3 „ „ — 1 - — — — 1 1 — — 1 — — 4 8 24 4 „ „ — — 1 — — — 1 1 — — — — — 1 3 12 Total houses 20 12 10 10 13 8 16 20 15 28 13 23 21 139 347 411 Military cases - - - 5 - - - - - - - - - - - 5 416 Return cases.—Five cases gave rise to six return cases. Deaths.—There were 11 deaths from Diphtheria, compared with 15 in 1933 and 8 in 1932. Five of these deaths were in children under five years of age and 6 were in school children. 99 Home Isolation.—Five cases were isolated at home. Frequent visits are made by the district sanitary inspectors to all cases isolated at home, in order to ensure that proper precautions are being taken for preventing the spread of the disease. Employees of the Royal Arsenal are not allowed to remain at work unless cases are removed to hospital, or a certificate of efficient home isolation is issued by the Medical Officer of Health. No certificates were issued during the year. Antitoxin.—A supply of Diphtheria Antitoxin is kept at the Town Hall, the Plumstead Library and the Eltham Library, and is available for medical practitioners on application, at cost price, or free where there is inability to pay. The amount supplied during the year was 118,000 units. The total cost to the Council was £7 3s. 0d., of which, £4 16s. Od. was recovered. Diphtheria Immunisation. In June the Council considered the need of introducing a scheme for the active immunisation of children against diphtheria, and after negotiations with the Woolwich Division of the British Medical Association a scheme was agreed upon, by which children living in the Borough would be immunised by local medical practitioners on behalf of the Council, the Council undertaking to appoint an expert for diphtheria immunisation work who would prescribe the technique to be followed in all cases, and who would undertake all Schick Testing which might be necessary. The Council appointed as their expert Dr. William Smith. The scheme is fully described in a Circular which was sent to all medical practitioners in the Borough. It reads as follows:— "Subject to the conditions mentioned below, the Council of the Metropolitan Borough of Woolwich have agreed to pay a fee of 10s. Od. to medical practitioners who undertake immunisation for a Woolwich child against diphtheria. (a) The medical practitioner's name must be on a panel prepared by the Medical Officer of Health. (b) The Council will not pay a fee in respect of any child under the ageof one year or over the age of twelve years. (c) Before immunising a child, the medical practitioner must obtain the written consent of the parent or guardian. (d) The child must be given a prescribed course of immunisation. (e) The diphtheria prophylactic selected by the medical practitioner must be approved by the Medical Officer of Health and obtained from a firm licensed under the Therapeutic Substances Acts. 100 (f) Each dose of the prophylactic must be contained in a separate sealed glass ampoule. In no circumstances will the Council pay a fee in respect of the immunisation of a child by a preparation from a container holding more than one dose. (g) The medical practitioner will enter the particulars of each immunising dose on a record card provided by the Council. When this record card is completed and returned to the Public Health Department, the Medical Officer of Health will, in appropriate cases, forward particulars of the case to the Borough Treasurer, in order that the fees due may be paid each quarter. (h) In every case the medical practitioner must place before the parent or guardian the significance of the Schick test and advise that this should be applied to children over five years of age. If the parent or guardian decides to forego the Schick test before immunisation, it may be omitted. The medical practitioner must urge in every case that the Schick test should be applied three months after the immunising injections have been given. (i) If the parent or guardian desires the Schick test to be performed before immunisation the medical practitioner must refer the child to the Council's immunisation expert. The medical practitioner will also endeavour to arrange for every child to visit the immunisation expert three months after the last injection. (j) The technique to be employed in connection with diphtheria immunisation work must be that prescribed by the Council's immunisation expert. (k) The fee of ten shillings to be paid by the Council in respect of each child immunised in accordance with these rules will be the limit of the Councils liability in connection with diphtheria immunisation, and the cost of purchasing the diphtheria prophylactic must be borne by the medical practitioner, who will also be responsible for any subsequent medical attention necessary and for any other liability which may result. (I) A fee of 2s. 6d. will be paid by the Council in respect of each child over five years of age referred to the Council's immunisation expert and found to be Schick negative and therefore not requiring immunisation. (m) The Medical Officer of Health may examine any child before, during or after the administration of the immunising doses, and all records kept by the medical practitioner in respect of diphtheria immunisation must be open to his inspection. The Council have appointed an expert in diphtheria immunisation work who will prescribe the technique to be followed in respect of these cases for which 101 the Council are prepared to pay a fee. He will also undertake all Schick testing that may be necessary or desired. He will attend at the Old Town Hall Children's Welfare Centre, Woolwich, from 2.0 to 3.0 p.m., and at the Eltham Health Centre, Westhorne Avenue, from 3.30 to 4.30 p.m., on the first and second Tuesday in each alternate month of the year, that is to say:—January, March, May, July, September and November. When a medical practitioner or a parent wishes a child to be Schick tested the patient should be sent to the expert on the first Tuesday of the alternate month when the test will be performed. The interpretation of the test will be undertaken on the second Tuesday of the month. Medical practitioners may consult the expert at his clinic when he is in attendance, or privately at any other time by appointment. Most children under one year of age are immune from diphtheria, and it is therefore not considered necessary to immunise them. After the age of twelve years the risk of contracting diphtheria diminishes rapidly, and the Council do not propose at present to pay fees in respect of persons over this age. In these circumstances, if a medical practitioner desires to immunise infants under twelve months or persons over twelve years of age, it will be necessary for him to arrange for a private fee to be paid for his services and for the services of the immunisation expert, if desired. As the majority of children between the ages of one and five years are susceptible to diphtheria, there is no need to apply the Schick test, and immunisation can be recommended immediately (except in the case of those who have had diphtheria). A medical practitioner should not undertake immunisation until the appropriate facts have been placed before the parent or guardian. If the Schick test after the immunising injections have been given proves positive, the expert will advise the medical practitioner to give further injections, and on evidence being produced that these have been given, the Council will agree to pay an additional fee of 10s. Od. subject, however, to the limitation of liability indicated under (k) above. The Council, by means of the usual health propaganda channels, will bring to the notice of Woolwich residents the fact that diphtheria can be prevented and that those who desire security for their children should apply to their own family doctor." The first Schick Testing Clinics at Eltham and Woolwich were held on the 6th November but it was soon apparent that the proposal to hold these clinics twice in 102 every two months would have to be altered, and indeed it was necessary to hold two clinics in December. At the time of writing the Schick Testing Clinics are being held weekly and in consequence the procedure has been modified, as it become necessary to have all appointments made by the Department instead of by the doctors in order to regulate the numbers at the Clinics. By an arrangement with the London County Council, a list of all attendances of school children is sent monthly to that body so that they do not lose their attendance marks while attending the clinic. At the end of the year 131 children (34 of whom were under 5 years of age), had been given immunising injections by their doctor and were awaiting the Schick Test. Two children immunised previously were Schick Tested. In tabular form is shown below details of the work done under the scheme, but each afternoon is regarded as one clinic only TABLE No. 42. Woolwich and Eltham. No. of Schick Testing Clinics held 4 Preliminary Schick Tests— No. of children tested— Positive 53 Negative 24 Final Schick Tests— No. of children tested— Positive — Negative 2 No. of children immunised during the period by general medical practitioners 131 Fees paid to medical practitioners— Positive cases at 10s. 0d. (103) £51 10s. 0d. Negative cases at 2s. 6d. (21) £2 12s. 6d. The propaganda leaflet issued by the Council is as follows:— Protection against Diphtheria. "One of the most serious diseases which attack children is diphtheria, both in the severity of the illness and in the after effects which it leaves with the sufferer. Not every child, of course, is attacked by diphtheria, but the risk is always present, especially amongst young children and school children. The fact that anyone can be protected against the disease has been abundantly proved. Owing to the nature of their work, fever hospital nurses are greatly exposed to the infection of diphtheria, but when protected by immunisation, 103 they do not contract the disease. Children in large numbers in Great Britain have been similarly treated and protected against the disease. The Council of the Metropolitan Borough of Woolwich have now made arrangements with medical practitioners to pay the doctor's fee for the protection of children between the ages of one and twelve years. The treatment involves three injections, which usually cause no disturbance to the child ; there is no sore at the point of injection and no scar or mark is left. The protection does not develop fully until about three or four months after the three injections. After this time, it will generally last over that period of the child's life when it is most likely to contract diphtheria, and may indeed last throughout life. If any parent or guardian wishes to have his children protected against diphtheria, or to have any further advice on the matter, he should consult his own doctor, or, if he has no family doctor, he should consult the Health Visitor at the nearest Infant Welfare Centre, or visit the Public Health Department at the Town Hall. P.S.—Although your child, if protected, is extremely unlikely to contract diphtheria, it must not be assumed that such a thing is impossible. A very few cases of diphtheria have occurred amongst immunised children, but it must be pointed out that such attacks are nearly always slight." Scarlet Fever. Notification.—During the year 989 cases were notified, compared with 1,004 in 1933 and 554 in 1932. There were 33 military cases. The number of notifications received each quarter was as follows:— First quarter 251 Second quarter 238 Third quarter 210 Fourth quarter 290 Multiple Cases.—The following Table No. 43, shows the house distribution by wards. The term "house" is synonymous with the term "family" except in two instances, where two families were involved. 104 TABLE No. 43. 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. Avery Hill. Sherard. Total Houses. Total Cases. Number of Houses in which 1 case occurred 32 27 41 24 35 16 50 53 32 69 42 44 42 190 697 697 2 cases occurred 2 2 5 6 4 5 1 8 3 7 5 6 4 33 91 182 3 ,, ,, — — — 1 — — 2 — — 2 4 — — 6 15 45 4 „ ,, - - - - - - - - - 2 - - - 3 5 20 5 „ ,, - - - - - - - - - - - - - - - - 6 ,, ,, - - - - - - - - - - 1 - - 1 2 12 Total houses 34 29 46 31 39 21 53 61 35 80 52 50 46 233 810 956 Military - 5 - 28 - - - - - - - - - - - 33 989 Return Cases.—The following Table No. 44, shows the number of return cases, the dates of admission to hospital, and the dates of discharge from hospital. It will be noted that in most of these cases the primary case was less than five weeks in hospital. 105 TABLE No. 44. 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. 1934 1934 1934 60 15th January 13th February 29 24th February — 24th do. 102 27th do. 27th do. 31 10th March - 112 30th do. 22nd do. 23 17th do. — 125 5th February 14th March 37 23rd do. — 23rd do. 185 3rd March 31st do. 28 5th April — 232 24th do. 21st April 28 3rd May — 239 26th do. 26th do. 31 29th April — 9th May 288 4th April 8th May 26 15th do. — 294 14th do. 25th do. 41 4th June — 314 24th do. 18th do. 22 21st May — 322 26th do. 18th July 85 26th July — 357 10th May 10th June 31 15th June — 17 th do. 405 31st do. 25th July 55 12th August — 440 20th do. 19th do. 60 23rd July 24th do. — 31st do. 482 28th June 25th do. 27 2nd August — 529 13th July 7th August 25 24th do. — 560 24th do. 18th do. 25 7th September — 13th do. 571 28th do. 17th September 51 27th do. — 648 6th September 6th October 30 18th October — 675 17th do. 29th do. 42 16th November — 696 26th do. 19th do. 23 1st do. — 6th do. 727 3rd October 7th November 34 11th do. — 732 5th do. 7th do. 32 11th do. — 773 16th do. 13th do. 27 26th do. — 788 22nd do. 16th do. 25 20th do. 21st do. — 25th do. 803 26th do. 24th do. 28 2nd December — 807 27th do. 23rd do. 26 14th do. - 873 13th November 24th December 41 29th do. — Deaths.—There were three deaths from scarlet fever during the year. In 1933 there were none. Home Isolation.—Seventy-one cases, or 7.17 per cent., were isolated at home, and in one instance a return case occurred. The same procedure as in Diphtheria was carried out. Five certificates of efficient home isolation were issued. Dick Test.—This has not been employed in the neighbourhood so far as I am aware. 106 Smallpox. There were no cases of Smallpox. Erysipelas, Malaria and Dysentery. The number of notifications of Erysipelas received was 119, compared with 67 in 1933, and one case of Malaria was notified. No case of Dysentery was notified. Enteric Fever. Eight cases were notified, seven of which were treated in hospital. There were no deaths. The following Table No. 45, gives details of each case notified. TABLE No. 45. Enteric. No. Date Notified. Sex. Age. Diagnosis. Final Diagnosis. Remarks. 1 11/1/34 M. 30 Typhoid Fever Typhoid Fever — 2 17/3/34 F. 50 Typhoid Fever Paratyphoid Fever — 3 30/4/34 M. 23 Paratyphoid Fever Paratyphoid Fever — 4 2/5/34 M. 24 Typhoid Fever Paratyphoid Fever — 5 6/6/34 F. 29 Enteric Fever Bacterial Endocarditis Died 6 30/7/34 M. 41 Typhoid Fever Typhoid Fever — 7 13/9/34 F. 8 Typhoid Fever Typhoid Fever — 8 22/10/34 M. 3 Typhoid Fever Typhoid Fever — Anterior Poliomyelitis. Three notifications including one of polio-encephalitis were received and all patients were admitted to hospital, but the diagnosis was not confirmed in one instance. The case of polio-encephalitis died. Cerebro-Spinal Meningitis. Four cases were notified, all of which were admitted to hospital. In one instance the diagnosis was not confirmed. There was one death. The following Table No. 46, gives details of each case:— 107 TABLE No. 46. Cerebro-spinal Meningitis. No. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. I 19/2/34 F. 14 Cerebro-spinal Meningitis — 2 21/2/34 M. 5 Pyrexia of unknown origin — 3 1/11/34 F. 3 Cerebro-spinal Meningitis — 4 28/11/34 M. 23 do. do. Died Encephalitis Lethargica. As in 1933, no cases of this disease were notified. Puerperal Fever and Puerperal Pyrexia. Thirty-five cases were notified, compared with 40 in 1933, and 40 in 1932. In 30 instances the notification was in respect of Puerperal Pyrexia, but in four of these instances the notification should have been Puerperal Fever. In four instances the disease was a sequel to abortion. Treatment.—The Council's scheme for the treatment of these diseases provides for a Consultant, for hospital treatment, for bacteriological examination where necessary, and for nursing assistance. Specific sera may also be supplied. No cases were seen by Mr. Harold Taylor during the year. It was not necessary to provide nursing assistance and no bacteriological examinations were carried out. Only one case did not receive hospital treatment. Deaths.—There were two deaths, compared with two in 1933 and four in 1932. Ophthalmia Neonatorum. Seven cases were notified, two of which were admitted to hospital. Three cases were nursed at home under the Council's scheme, 111 visits in all being paid. The cost of this service was £5 11s. 0d. The following Table No. 47, gives details of each case. 108 TABLE No. 47. Date Notified. Cases Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Home. Hospital. 1934 15th January Yes — Yes — — — 20th January Yes — Yes — — — 11th March Yes — Yes — — — 28th March Yes — Yes — — — 18th April Yes — Yes — — — 26th July — Yes Yes — — — 29th October — Yes Yes — — — Zymotic Enteritis. Three cases were notified during the year, compared with five cases in 1933 and eleven in 1932. The number of deaths in children under two years of age, certified to be due to diarrhoeal diseases, was nine. None of the notified cases died. Whooping Cough. During the year 253 cases of Whooping Cough came to the knowledge of the Department, compared with 514 in 1933 and 233 in 1932. As this disease is not notifiable in the Borough, knowledge is usually obtained through the School Medical Service, but, exceptionally, cases are notified by medical practitioners and occasionally cases are discovered by the health visitors in their routine visits. Nursing.—Two cases were nursed under the Council's scheme, 69 visits in all being paid. The cost of this service was £3 9s. 0d. Deaths.—There were 13 deaths certified to be due to this disease, compared with 9 in 1933. Measles. The two main sources of our knowledge of the incidence of Measles in the Borough are the School Medical Service and the health visitors. Occasionally, however, information comes through the local nursing associations and from parents. During the year 2,392 cases (including 55 cases of German Measles) were discovered. In 1933 and 1932 the corresponding figures were 354 and 3,135. 109 Measles occurs in epidemic form every two years and usually lasts for four months. The incidence in each of the twelve months of the year was as follows:— January 168 February 367 March 350 April 353 May 614 June 381 July 62 August 3 September 20 October 50 November 12 December 12 From these figures it will be noted that the disease first assumed epidemic proportions in January, reached its peak in May, and fell away thereafter. The Council's scheme for dealing with Measles epidemics was put in force at the beginning of the year, two temporary health visitors being appointed for Measles work. They investigated every reported case of Measles from whatever source information came ; they visited cases absent from school from unknown causes and every case of suspected Measles. The staff health visitors made subsequent visits to cases where children were under school age, but where they were of school age the subsequent visits were made by the temporary health visitors. Notices were sent to head teachers when the diagnosis of Measles was not confirmed and when suspect cases were diagnosed as Measles. The co-operation between the School Medical Service and the Department was excellent, visits being paid to every home where cases of Measles or suspected Measles were living, within 24 hours of the teacher sending the notification to the Department. The scheme worked very well in other respects. It enabled the normal routine work of the health visitors to be maintained with very little disturbance ; it ensured the early diagnosis of secondary cases and their exclusion from school in an infectious state; it ensured the early provision of nursing assistance and it enabled arrangements to be made for the early admission of cases to hospital where necessary. In every way the Council's policy was justified. Home Nursing.—In 33 cases nursing assistance was provided during the year, 410 visits in all being paid. The cost to the Council was £20. Hospital Treatment.—The number of children admitted to fever hospitals was 188. Deaths.—There were 10 deaths from Measles during the year. Pneumonia. The number of cases notified was 280, compared with 249 in 1933. Of these, 7 were influenzal. The number of deaths certified to be due to lobar or broncho pneumonia was 126 and to acute influenzal pneumonia 6. The ward incidence of the Pneumonias is shown in Table No. 37. 110 The following Table No. 48, shows the number of notifications of Pneumonia received each month, classified by sex and according to type. It also shows the number of deaths occurring from acute primary pneumonia and influenzal pneumonia. TABLE No. 48. Monthly Incidence of Pneumonia. Month. Male. Female. Total. Type. No. of Deaths. Lobar. Broncho. Influenzal. Acute Primary (not specified) Acute Primary Pneumonia. Influenzal Pneumonia. January 25 17 42 5 7 2 28 18 1 February 18 14 32 4 8 - 20 9 2 March 15 16 31 6 4 1 20 17 2 April 20 7 27 2 1 — 24 13 — May 10 5 15 — 1 — 14 7 — June 9 10 19 3 2 — 14 3 — July 7 2 9 3 — 1 5 3 — August 4 4 8 3 1 — 4 8 — September 11 2 13 4 1 — 8 3 — October 8 5 13 — 2 1 10 8 — November 23 17 40 9 9 1 21 17 — December 19 12 31 2 9 1 19 20 1 169 111 280 41 45 7 187 126 6 Nursing.—Nursing assistance is provided by the Council for cases of Pneumonia and during the year 24 cases were nursed, 431 visits being paid by the nurses of the local nursing associations. The total cost to the Council was £26 18s. 9d. Anti-Pneumococcal Serum.—During the year the Council provided, free of charge, anti-pneumococcal serum (mainly Felton's) 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 £102 10s. 4d. Tuberculosis. The Council's tuberculosis scheme was set out fully in the Annual Report for 1933 and no substantial change took place during 1934. 111 Notifications.—During the year, excluding duplicates, 219 cases of pulmonary tuberculosis and 50 cases of non-pulmonary tuberculosis were notified. Cases of tuberculosis are often notified more than once, and in this way during the year 56 duplicate notifications were received. The number of cases notified from each of the different wards of the Borough is shown in Table No. 49. TABLE No. 49. Ward Incidence of Tuberculosis, 1934. Ward. Pulmonary. Non-Pulmonary. Dockyard 14 2 St. Mary's 8 2 River 19 4 St. George's 22 3 Burrage 11 2 Herbert 10 4 Glyndon 12 4 St. Margaret's 12 4 Central 14 1 St. Nicholas 23 5 Abbey Wood 14 3 Well Hall 17 4 Avery Hill 24 7 Sherard 19 5 Total 219 50 In the following Table No. 50, appears a summary of cases coming to the knowledge of the Department in 1934. 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, nor any duplicate notifications. Deaths occurring within the year are classified in the same Table by age and sex groups. 112 TABLE No. 50. Tuberculosis—New Cases and Mortality, 1934. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0-1 year — 1 — 1 — — — 2 1-5 years 1 1 4 3 — — 4 — 5-10 years 3 4 7 1 — — 1 1 10-15 years 7 4 6 1 3 — 1 1 15-20 years 6 19 6 1 4 8 2 1 20-25 years 16 20 5 3 6 5 2 1 25-35 years 34 24 6 3 13 9 4 — 35-45 years 23 14 1 5 19 11 — 1 45-55 years 22 9 1 1 13 6 — 1 55-65 years 17 4 3 1 10 3 — 2 65 and upwards 9 4 2 — 8 2 1 1 Totals 138 104 41 20 76 44 15 11 The following Table No. 51, shows the site of the disease in patients notified each year since 1930. TABLE No. 51. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Forms. 1930 244 6 5 18 15 3 8 299 1931 229 11 5 18 8 2 7 280 1932 235 6 6 11 8 5 12 283 1933 207 7 4 14 10 4 6 252 1934 219 8 6 12 9 2 13 269 113 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. 52, shows the changes which have taken place during the year. TABLE No. 52. Pulmonary. Non-Pulmonary. Totals. M. F. M. F. Number on register on 1st January, 1934 471 356 95 113 1,035 Number of new cases notified 117 95 33 17 262 Number of cases restored 11 6 1 — 18 Other additions 13 8 5 4 30 Deletions 135 113 25 24 297 Number on register on 31st December, 1934 477 352 109 110 1,048 Of the total number on the register on the 31st December, 91.75 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 1933 the corresponding percentage was 86.66 and in 1932, 92.91. Deaths.—The following Table No. 53, shows the number of deaths and the death rates each year since 1930. TABLE No. 53. Tuberculosis—Deaths and Death-Rates. Year. Deaths. Death-rates. All Forms. Pulmonary. NonPulmonary. All Forms. Pulmonary. NonPulmonary. 1930 165 150 15 1.17 1.06 0.11 1931 168 148 20 1.14 1.00 0.14 1932 154 139 15 1.05 0.95 0.10 1933 135 116 19 0.92 0.79 0.13 1934 146 120 26 1.00 0.82 0.18 114 In addition to the deaths recorded in the above Table, seven persons who had been notified as suffering from tuberculosis died during the year from other causes, and detailed information as to these is given in the following Table No. 54. TABLE No. 54. Case No. Date notified as Tuberculosis. Cause of Death. 1 4/10/1933 Ulcerative Endocarditis. 2 3/1/1917 Hypostatic Pneumonia. Myocarditis. 3 3/4/1930 Cerebral Haemorrhage. Cerebral Tumour. 4 16/2/1934 Oxalic Acid Poisoning. 5 12/5/1919 Broncho-pneumonia. Auricular Fibrillation and Cardiac engorgement. 6 17/11/1932 Pelvic Abscess. Perforative Diverticulitis. Operation, secondary abscess, liver. 7 31/1/1932 Chronic Bronchitis. The period which elapsed between notification and death is shown below:— TABLE No. 55. Pulmonary. Percentage. NonPulmonary. Percentage. Not notified 14 11.67 10 38.50 0-1 month 18 15.00 12 46.11 1-3 months 9 7.50 - — 3-6 months 13 10.83 1 3.85 6-12 months 16 13.33 - — 1-2 years 17 14.17 — — 2-5 years 22 18.33 — — Over 5 years 11 9.17 3 11.54 120 100.00 26 100.00 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths was as 1 is to 6. In 1933 it was as 1 is to 8, and in 1932 it was as 1 is to 12. 115 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. One such examination was made during the year. The County of London (Tuberculosis) Regulations, 1930.—These Regulations enable the County Council to maintain or arrange for the maintenance, otherwise than in their homes, of children living in London in houses where, owing to overcrowding or otherwise, they are, in the opinion of the County Medical Officer, in danger of being infected with tuberculosis ; or whose parent or parents are receiving institutional treatment for tuberculosis and for whose care adequate arrangements cannot otherwise be made. During the year such arrangements were made for four children. Staff.—There is one whole-time Tuberculosis Officer and the other three assistant medical officers devote three half-days per week to Tuberculosis and eight half-days per week to Maternity and Child Welfare. There are three Tuberculosis Health Visitors; one Clerk-Dispenser, who also acts as Secretary to the Care Committee, and one Clerk. The Work of the Dispensaries.—The Council's Dispensary is situated at Maxey Road, Plumstead, and there is a branch Dispensary at 179, Well Hall Road, Eltham. The Eltham branch was opened in 1931 and more use of it is being made now than in that year. In accordance with the Minister of Health's instructions the Dispensary figures are shown for the Borough as a whole and not for individual dispensaries. 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 1934 was 4,833. In this connection it is interesting to point out that 202 of the persons notified during '934 attended the Dispensaries, which is equivalent to 75.08 per cent. The corresponding percentage in 1933 was 68.25, and in 1932 it was 89.7. 116 A return of the work of the Dispensaries is given in Table No. 56. Alterations at Maxey Road Dispensary.—During the year the Council had under consideration the question of modernising the Council's Tuberculosis Dispensary, as an opportunity was afforded by the fact that other services of the Council were no longer maintained in the existing building. It was possible by using the existing rooms, by adding the Caretaker's office and the office formerly used for rate collection and a portion of the yard and buildings previously used by the Works Department, to make such alterations as would provide a modern and convenient dispensary. The Council decided to carry out this work at an estimated cost of £760 and the plans were approved by the Ministry of Health and by the London County Council. The work was started before the end of the year. Home Visiting of Tuberculosis Cases.—On receipt of every notification the home is visited by the Tuberculosis Visitor, who advises as to any re-arrangement that seems possible and desirable in the interests of the patient and other members of the family. In the case of patients notified by the Tuberculosis Officer a visit is also made by one of the medical staff, who thus gains a knowledge of the home circumstances of the patient. The Tuberculosis Visitor endeavours to visit each home in her district once in three months, but, in the case of patients with recent and more active disease, visits are more frequent. Work for the Ministry of Pensions.—The amount of work done under this heading has practically come to an end. In 1933 only 4 reports were made ; during 1934 no reports were made. Examination of Home Contacts.—On receipt of each primary notification every effort is made to induce people living in the same house as the patient to present themselves for examination. In many cases, however, it is very difficult to persuade them of the necessity for examination. During the year under review 477 contacts were examined. 117 TABLE No. 56. Return showing the Work of the Dispensaries for 1934. 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 124 104 7 7 14 12 16 10 138 116 23 17 294 (b) Diagnosis not completed — — - - - - - - - 1 - - 1 (c) Non-tuberculous - - - - - - - - 126 151 94 68 439 B.—CONTACTS examined during the year:— (a) Definitely tuberculous 8 7 3 3 1 - - 1 9 7 3 4 23 (b) Diagnosis not completed — — — — - — — — — — — — — (c) Non-tuberculous - - - - - - - - 82 144 103 125 454 C.—CASES written off the Dispensary Register as:— (a) Recovered 15 23 1 3 1 3 4 2 16 26 5 5 52 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 219 301 198 196 914 D.—NUMBER OF CASES on Dispensary Register on December 31st:— (a) Definitely tuberculous 405 331 24 18 51 53 38 48 456 384 62 66 968 (b) Diagnosis not completed — - — — — — — - - 1 - - 1 118 Return showing the Work of the Dispensaries for 1934—continued. 1. Number of cases on Dispensary Register on January 1st 897 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 7 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 68 4. Cases written off during the year as Dead (all causes) 112 5. Number of attendances at the Dispensary (including Contacts) 4,833 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 223 7. Number of consultations with medical practitioners:— (a) Personal 72 (b) Other 1,157 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 457 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,654 10. Number of:— (a) Specimens of sputum, etc., examined 538 (b) X-ray examinations made in connection with Dispensary work 411 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 365 Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment). Provided by the Council 2 Provided by Voluntary Bodies Nil X-Ray Examinations.—More and more use is being made of X-rays in the investigation of cases of Tuberculosis. They are used to diagnose the disease in its early stages; they are used in the efficient control of the treatment of tuberculosis; and more and more use is being made of them in the clinical investigation of contacts previously found to be positive to the Mantoux test—an intradermal tuberculin test. 119 The figures now presented do not show the total use made of X-rays by the Tuberculosis Officer, because when cases are sent into St. Nicholas Hospital for institutional treatment he is able to make use of the X-ray apparatus there for diagnosis and control. The Council's arrangements for X-ray examinations are made with the War Memorial Hospital, and during the year 411 such examinations were carried out. Co-operation with St. Nicholas Hospital (L.C.C.).—Since July, 1926, the Tuberculosis Officer has visited St. Nicholas Hospital weekly in accordance with an arrangement made with the late Board of Guardians. In 1933 the London County Council, in pursuance of their policy of uniformity throughout London, terminated the appointment of all Consultants in their service and subsequently made re-appointments. Included in these appointments were Tuberculosis Officers as Consultants at the Poor Law Hospitals for their respective areas. In July, the London County Council decided to continue these appointments subject to review at a later date. Co-operation with Local Practitioners.—During the year 72 new cases were seen by the Tuberculosis Officer at the homes of the patients, and 280 were referred to the Dispensary by medical practitioners in the Borough. Co-operation with the School Medical Service.—There is intimate relationship between the School Medical Service and the Dispensary. Many cases are referred to the Dispensary by the School Medical Officers, and the child contacts of tuberculous patients are referred to the School Medical Service for special observation and supervision. The Divisional School Medical Officer and the Tuberculosis Officer in personal consultation, discuss these contacts and decide on the supervision desirable. Other children, whose condition is unsatisfactory, are referred to the School Clinic for the treatment of minor ailments and dental caries; to the School Care Organiser, with a recommendation as to the provision of milk and cod-liver oil to be given at school, or to the Woolwich Invalid Children's Aid Association. 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 of the population. Dental Treatment.—Dental treatment is carried out under the Council's scheme at the School Clinic, Brewer Street. During the year 21 cases received treatment the number of attendances being 40. The only charge made to patients is in 120 connection with the supply of dentures, and then patients are assessed according to their means. Dentures were supplied in 5 cases at a cost of £23 0s. 0d. and payments by patients amounted to £10 7s. 6d. In assessing patients due regard is given to dental benefits they may be entitled to from approved societies. Finscn Light Treatment.—In 1921 the Council entered into an agreement with the London Hospital for the treatment of persons suffering from Lupus in the Finsen Light Department of the Hospital. A fee of 5s. is paid for each attendance. During the year 14 attendances were made. Artificial Pneumo-thorax.—This treatment consists of collapsing the diseased lung and so putting it at rest. This is done by introducing gas or air through a needle into the pleural cavity of the affected side. The air so introduced becomes absorbed and has to be replaced at varying intervals. These refills have to be maintained over a period varying from two to five years. In 1921 the Council agreed to pay 10s. 6d. a refill to the Brompton Hospital, where this work was carried out, in the case of patients recommended by the Tuberculosis Officer, but since that date payments have been made in respect of patients so treated at other special hospitals and at hospitals belonging to the London County Council. The number of patients who received such treatment during the year was 38, and the number of refills was 368. Woolwich Tuberculosis Care Committee.—At the end of the year the Committee was constituted as follows:— Bodies. Representatives. Woolwich Borough Council Alderman Mrs. E. Brooks, Councillors R. Campbell, Mrs. L. E. Driver, S. Crown, J.P., G. Greenwood, Mrs. E. L. Reeves. 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 C. F. Aves. London County Council (Public Assistance Committee) Mr. R. Campbell, Mrs. B. G. Dickinson, Mr. 1. Moran. London Insurance Committee Mr. S. H. Brown. Panel Committee for the County of London British Red Cross Society Dr. H. M. Wise. 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 Mrs. A. Evans. Ex-Officio. Voluntary Visitors Miss D. A. Frye, Miss M. Ross. Tuberculosis Officer Dr. F. J. C. Blackmore. Medical Officer of Health Dr. J. MacMillan, D.S.O., M.C. 121 The After-Care Committee continued to do excellent work during the year, and the assistance rendered to necessitous cases makes the Council's Tuberculosis Scheme more effective. They assist in many ways. They help by the provision of clothing to necessitous patients entering an institution; by aiding in the purchase of surgical apparatus and nursing requisites; by paying fares for varying periods in the case of patients going to and from hospital for out-patient treatment, and in many other smaller ways. Prior to September, the Committee assessed patients' payments for institutional treatment, but when the London County Council resolved to make all institutional treatment free of charge, this work ceased. The Committee assessed patients' payments under the Council's Dental Scheme, and supervised the provision of additional nourishment. Institutional Treatment.—Institutional treatment for the tuberculous became free in London in September, but when the County Council adopted this modification of their scheme, they decided to accept voluntary contributions from patients. The following Table No. 57, shows the number of admissions to special hospitals, sanatoria, public general hospitals, institutions and training colonies:— TABLE No. 57. Admissions to Hospitals, etc. Special Hospitals. Sanatoria. Public General Hospitals. Training Colonies. Insured 108 78 122 3 Uninsured 59 23 48 1 Children 17 14 34 — 184 115 204 4 These figures refer to 374 patients and the monthly admissions were as follows:— January 32 May 51 September 42 February 32 June 53 October 27 March 57 July 35 November 54 April 55 August 39 December 30 Shelters.—Thirteen shelters are maintained by the Council for patients returning from sanatoria who are able and willing to continue this form of treatment. A ursing.—Home nursing is provided for certain cases of tuberculosis, and in accordance with the arrangements entered into with the local Nursing Associations the number of visits paid by nurses during the year was 1,203, and the cost to the Council was £75 3s. 9d. 122 ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. Disinfection.—The Council's Disinfecting Station is situated at White Hart Road, Plumstead, where there are installed two Washington Lyon steam disinfectors, one high-pressure steam washing disinfector, and one room for disinfecting articles which cannot be subjected to heat. The heavy demand on the resources of the Station owing to the work of bug eradication was again apparent during the year. The Station is sometimes used for special disinfection at the request of inhabitants. A small charge is made for these disinfections and during the year 35 such disinfections were carried out, and charges amounting to £8 13s. 6d. were paid. In tabular form is shown below the amount of disinfection which was carried out during the year. TABLE No. 58. Rooms disinfected after ordinary fevers 1,394 „ „ „ tuberculosis 180 „ „ „ verminous cases 1,391 ,, ,, for other reasons 13 Articles disinfected 62,029 Disinfestation.—In accordance with the terms of an agreement with the London County Council, disinfestation of school children is carried out at the Cleansing Station, White Hart Road. Disinfestation of adults is carried out at times when the children are not there. The following Table No. 59, shows the number of persons cleansed each year since 1930. TABLE No. 59. Year. Children. Adults. Grand Total. Boys. Girls. Total. Males. Females. Total. 1930 477 1,386 1,863 11 10 21 1,884 1931 483 1,543 2,026 14 4 18 2,044 1932 560 1,613 2,173 8 4 12 2,185 1933 550 1,579 2,129 7 11 18 2,147 1934 611 1,715 2,326 6 1 7 2,333 A report on disinfestation of bug-infested premises will be found in the Housing Section. 123 SECTION VIII.—GENERAL STATISTICS. TABLE No. 60. Area (acres) 8,282 Population, estimated to middle of 1934 145,520 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, 1934) £1,089,801 Sum represented by a penny rate (April, 1934) £4,541 Population. The Registrar General estimates the population of the Borough at the middle of the year as 145,520, a decrease of 680 on the previous year. Each year since 1931 he has shown a decrease on the previous year. It is difficult to believe that this is correct because there is much new building going on in the Borough and it is definitely known that many of the new occupiers come from outside the Borough, and in addition, each year, there is a natural increase in the population. As the figures of the Registrar General are used generally throughout the country they are the only safe basis for comparison and so his total has been used in calculating rates for the purposes of this report. It should be noted, also, that this figure includes non-civilians and that the pre-war practice in this respect was returned to from the beginning of 1932. In estimating the population of the wards of the Borough regard has been had to such information as is available from the records of the Housing Department so far as occupants of new Council houses are concerned, and of the records of the Treasurer's Department when advances have been made under the Small Dwellings Acquisition Acts. The estimated population of each of the wards of the Borough at the middle of 1934, is shown in the following Table No. 61. 124 TABLE No. 61. Wards. Population Dockyard 6,547 St. Mary's 5,797 River 10,834 St. George's 7,853 Burrage 7,394 Herbert 8,375 Glyndon 8,144 St. Margaret's 11,944 Central 7,422 St. Nicholas 13,454 Abbey Wood 11,672 Well Hall 12,278 Avery Hill 13,268 Sherard 20,538 In the old parishes the estimated populations are therefore:— Woolwich 31,031 Plumstead 68,405 Eltham 46,084 Social Conditions. A Table showing the occupations of all Woolwich inhabitants, aged 14 years and over, compiled from the Occupation Tables Report of the Registrar General on the Census of 1931, was prepared and printed in my annual report for 1933. An Industry Table report was issued by the Registrar General in 1934 and from it a similar table has been prepared. It appears below as Table No. 62. It should be noted, however, that it is Woolwich residents who are enumerated in industries and not the number of persons employed in these industries in Woolwich. The Table sets out in generalised headings those actually engaged in industries at the time of the Census and therefore those "out-of-work" are excluded. TABLE No. 62. Industries—Males and Females aged 14 years and over, exclusive of "Out-of-Work.' Industry. Males. Females. I. Fishing 1 — II. Agriculture 240 9 III. Mining and Quarrying, and Treatment of Non-Metalliferous Mine and Quarry Products 97 12 Iv. Manufacture of Bricks, Pottery, Glass, etc. 513 103 125 TABLE No. 62—continued. Industry. Males. Females. v. Manufacture of Chemicals, Dyes, Explosives, Paints, Oils, Grease 1,716 146 VI. Manufacture of Metals, Machines, Implements, Conveyances, Jewellery, Watches 11,958 2,578 VII. Manufacture of Textiles and Textile Goods (not dress); Cellulose 114 173 VIII. Preparation of Skins and Leather, and Manufacture of Goods of Leather and Leather Substitute (not clothing or footwear) 78 32 IX. Manufacture of Clothing (not knitted) 600 1,457 x. Manufacture of Food, Drink, Tobacco 1,263 567 XI. Wood Working: Manufacture of Cane and Basket Ware, Furniture, Fittings (not elsewhere enumerated) 354 31 XII. Paper Making: Manufacture of Stationery and Stationery Requisites; Printing, Bookbinding and Photography 686 305 XIII. Building, Decorating, Stone and Slate Cutting and Dressing and Contracting 3,300 37 XIV. Other Manufacturing Industries 583 478 XV. Gas, Water, Electricity 882 42 XVI. Transport and Communication 3,402 160 XVII. Commerce and Finance 7,632 3,600 XVIII. Public Administration and Defence 10,458 2,012 XIX. Professions 839 902 XX. Entertainments and Sport 360 167 XXI. Personal Service (including Hotels and Catering but excluding Government and Local Authority) 1,466 3,644 XXII. Other Industries, or Industry not stated 45 31 Total in Industries 46,587 16,486 Unoccupied and Retired 5,313 39,963 Out of Work 4,895 1,265 Total population aged 14 years and over 56,795 57,714 The following Table No. 63, shows those employed in different industries, classified by Industrial Status, viz., Managerial, Operative, Working on Own Account and Out-of-Work. The Managerial group consists of employers, directors, managers, 126 superintendents and persons of like status. The figures in column one indicate the same industries as set out in the previous table. TABLE No. 63. Industry Managerial. Operative. Own Account. Out-of-Work. M. F. M. F. M. F. M. F. I. - - 1 - - - - - II. 32 — 139 8 69 1 40 3 III. 3 — 94 12 — — 31 — IV. 5 1 508 102 — — 47 7 v. 29 1 1,086 145 1 — 91 12 VI. 158 4 11,714 2,570 86 4 1,482 258 VII. 10 — 102 169 2 4 12 18 VIII. 11 — 58 31 9 1 9 6 IX. 75 16 410 1,313 115 128 55 53 X. 70 14 1,179 551 14 2 126 33 XI. 21 1 284 24 49 6 52 5 XII. 57 3 608 300 21 2 51 17 XIII. 193 2 2,973 35 134 — 748 2 XIV. 32 2 526 474 25 2 60 28 XV. 5 1 877 41 — — 61 — XVI. 68 1 3,261 159 73 — 468 7 XVII. 902 119 5,848 3,223 882 258 551 184 XVIII. 35 13 10,423 1,999 - — 453 44 XIX. 87 21 622 721 130 160 34 36 XX. 30 — 300 152 30 15 77 34 XXI. 267 106 1,001 3,422 198 116 220 416 XXII. 2 3 41 28 2 — 227 102 Totals 2,092 308 42,655 15,479 1,840 699 4,895 1,265 127 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 a 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 downwards 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. 128 SECTION IX.—VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the vital statistics of the year are shown below:— TABLE No. 64. Births—Legitimate 1,927 Births—Illegitimate 73 2,000 Still-births 75 Still-births—Rate per 1,000 total births 36.1 Birth Rate 13.7 Deaths 1,650 Death Rate 11.3 Percentage of total deaths occurring in public institutions 60.18 Number of women dying in, or in consequence of, Child Birth:— (a) From Sepsis 2 (b) From other causes 1 Deaths of Infants under one year:— (a) Legitimate 113 (b) Illegitimate 14 Infantile Mortality Rate 63 Deaths from Measles (all ages) 10 Deaths from Whooping Cough (all ages) 13 Deaths from Diarrhoea (under 2 years of age) 9 The chief Vital Statistics since 1901 are given in the following Table 129 TABLE No. 65. Year. (1) Population estimated to middle of each Year. (2) Births. Nett Deaths belonging to the District. Nett. Under 1 year. At all Ages. Number. (3) Rate. (4) Number. (5) Rate per 1,000 Nett Births. (6) Number. (7) Rate. (8) 1901 117,652 3,536 30.1 457 129 1,709 14.6 1902 119,285 3,734 31.3 467 125 1,837 15.4 1903 117,842 3,684 31.3 398 108 1,638 13.9 1904 118,456 3,535 29.8 477 135 1,763 14.9 1905 118,589 3,546 29.9 362 102 1,604 13.5 1906 119,143 3,549 29.8 388 109 1,668 14.0 1907 119,704 3,330 27.8 373 112 1,616 13.5 1908 122,258 3,176 26.0 300 94 1,516 12.4 1909 120,227 2,947 24.5 242 82 1,587 13.2 1910 121,197 2,842 23.6 242 85 1,418 11.7 1911 121,487 2,810 23.1 272 97 1,566 12.9 1912 121,932 2,776 22.8 208 75 1,456 11.9 1913 122,382 2,833 23.1 228 80 1,549 12.7 1914 122,431 2,838 23.2 241 85 1,706 13.9 1915 a 138,200 2,839 21.9 268 94 1,837 14.2 b 129,505 1916 a 141,783 3,068 23.5 213 69 1,704 13.1 b 130,313 1917 a 147,078 2,718 20.6 216 79 1,566 11.9 b 131,942 1918 a 150,650 2,548 19.0 270 106 2,100 15.6 b 134,453 1919 a 141,918 2,737 20.1 235 86 1,679 12.3 b 136,237 1920 a 140,000 3,658 26.9 224 61 1,487 10.9 b 135,904 1921 a 141,700 3,197 23.2 197 62 1,594 11.6 b 137,604 1922 a 142,350 2,941 21.3 184 63 1,603 11.6 b 138,254 1923 a 143,530 2,867 20.5 123 43 1,387 9.9 b 140,000 1924 a 144,400 2,590 18.5 168 65 1,543 11.0 b 139,980 1925 a 145,440 2,582 18.3 141 55 1,519 10.8 b 140,740 1926 a 146,200 2,463 17.4 107 43 1,450 10.2 b 141,900 1927 a 144,770 2,242 15.9 95 42 1,491 10.6 b 140,770 1928 a 146,600 2,269 161 114 50 1,554 11.0 b 141,100 1929 a 146,800 2,312 16.3 144 62 1,780 12.6 b 141,600 1930 a 146,800 2,188 15.5 91 42 1,547 10.9 b 141,600 1931 a 147,400 2,155 15.1 128 59 1,654 11.6 b 142,600 1932 a 146,400 2,054 14.0 123 60 1,635 11.1 1933 a 146,200 1,857 12.7 116 62 1,634 11.2 1934 a 145,520 2,000 13.7 127 63 1,650 11.3 a Total Population. b Civil Population, 130 The chief Vital Statistics for 1934 for the Wards of the Borough are given in the following Table:— TABLE No. 66. Wards. Population. Births. Deaths under 1. Deaths at all Ages Number. Rate. Number. Rate. Number. Rate. Dockyard 6,547 112 7.1 9 80 93 14.2 St. Mary's 5,797 97 16.7 4 41 80 13.8 River 10,834 166 15.3 13 78 174 16.06 St. George's 7,853 155 19.7 9 57 83 10.6 Woolwich 31,031 530 17.0 35 66 430 13.9 Burrage 7,394 109 14.7 4 37 103 13.9 Herbert 8,375 122 14.7 2 16 101 12.1 Glyndon 8,144 116 14.2 7 60 111 13.6 St. Margaret's 11,944 144 12.0 9 62 126 10.5 Central 7,422 102 13.7 8 78 126 16.9 St. Nicholas 13,454 202 15.0 22 108 159 11.8 Abbey Wood 11,672 140 12.0 5 35 116 9.9 Plumstead 68,405 935 13 7 57 60 842 12 3 Well Hall 12,278 113 9.2 9 79 94 7.6 Avery Hill 13,268 148 11.1 3 20 130 9.8 Sherard 20,538 274 13.3 23 84 154 7.5 Eltham 46,084 535 11.6 35 65 378 8.2 BOROUGH 145,520 2,000 13.7 127 63 1,650 11.3 If the rates in St. Mary's, River and St. George's Wards and in Woolwich parish are compared with those of previous years, it must be borne in mind that from 1915 to 1931 these rates were calculated on the civilian population and not on the total population. Births. During the year, 2,349 births were registered in the Borough, 1,177 being males and 1,172 females. Corrected by outward (254 males and 292 females) and inward (96 males and 101 females) transfers, these numbers become 2,000, 1,019 and 981 respectively. The birth rate was 13.7, compared with 12.7 in 1933 and 14.0 in 1932. 131 Illegitimate Births.—The number of illegitimate births registered was 64. There were 16 inward transfers and 7 outward transfers, making a nett figure of 73, equivalent to 36 per 1,000 births. Natural Increase of Population.—This term means the excess of births over deaths. In 1930 it was 641; in 1931 it was 501; in 1932, 419; in 1933, 223, and in 1934, 350. Notification of Births.—During the year 2,334 births were notified. This is at the rate of 99.4 per cent. of the registered births and compares with 99.6 per cent. last year. The births were notified as shown in the following Table:— TABLE No. 67. British Hospital for Mothers and Babies 786 Midwives 570 St. Nicholas Hospital 345 Military Families' Hospital 260 War Memorial Hospital 183 Medical Practitioners 62 Parents 51 Eltham Cottage Hospital 35 Midwives' Homes 9 Other persons 33 In addition to these, 87 notifications were received from the Medical Officer of Health, Lewisham, 44 from the Medical Officer of Health, Greenwich, and 35 from other Medical Officers of Health. Ninety-six still-births were notified. It is known that 1,273 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 63.6. The following Table No. 68, shows the number of corrected births each year since 1930; 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. 68. Year. No. of Births. No. of Live Births Notified. No. of StillBirths. Percentage of Births Notified. Birth Rate. Woolwich. London. England and Wales. 1930 2,188 2,272 74 98 15.5 16.3 15.7 1931 2,155 2,303 84 99 15.1 15.0 15.8 1932 2,054 2,209 78 98 14.0 14.3 15.3 1933 1,857 2,154 59 99 12.7 13.2 14.4 1934 2,000 2,334 75 99 13.7 13.2 14.8 132 Marriages. There were 1,324 marriages (1,248 in 1933). The marriage rate was 18.19 as compared with 17.70, 15.79, 17.7 and 14.1 in the four preceding years. Deaths. The total number of deaths registered in the Borough was 1,364. This figure includes 167 non.residents who died in the district, but does not include 453 residents who died outside the Borough. When allowance is made for inward and outward transfers the nett figure of 1,650 is obtained. The death.rate for the year was 11.3, compared with 11.2 in 1933 and 11.1 in 1932. In order to make the local death rate comparable from a mortality point of view with the crude death rate of the country as a whole or with the mortality of any other area, the Registrar General supplies a factor by which the crude death rate should be multiplied, based upon age and sex constitution of the population. This adjusting factor for Woolwich is 1.06, so that the adjusted death rate for 1934 is 12.0. In 1934 the death.rate for England and Wales was 11.8, for London, 11.9, and the mean death.rate for 121 County Boroughs and Great Towns (including London) was 11.8. The seasonal mortality in the four quarters of the year was as follows:—First quarter, 13.7; Second quarter, 10.1; Third quarter, 9.2; Fourth quarter, 11.8. Deaths in Public Institutions.—In tabular form is shown below the number of deaths of Woolwich residents which took place in various institutions during the year. TABLE No. 69. Hospitals or Institutions. Number of Deaths Public General Hospitals 694 Voluntary General Hospitals 120 Mental Hospitals 68 Special Hospitals 29 Infectious Diseases Hospitals 35 Sanatoria and Tuberculosis Institutions 15 Cottage Hospitals and Nursing Homes 32 993 The percentage of institutional deaths to total deaths was therefore 60.18. The following Tables are self-explanatory. 133 TABLE No. 70. Birth Rates, Death Rates and Analysis of Mortality in the Year 1934. Rate per 1,000 Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Live Births. Percentage of Total Deaths. All Causes Typhoid and Paratyphoid Fevers. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and 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 I Death. Live Births. StillBirths. England and Wales 14.8 0.62 11.8 0.00 0.00 0.09 0.02 0.05 0.10 0.14 0.54 5.5 59 90.4 6.5 2.1 1.0 121 County Boroughs and Great Towns, including London 14.7 0.66 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 0.47 7.4 63 90.5 6.1 2.9 0.5 140 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931). 15.0 0.67 11.3 0.00 - 0.07 0.02 0.04 0.09 0.14 0.42 3.6 53 91.2 6.1 1.6 1.1 London 13.2 0.50 11.9 0.00 0.00 0.20 0.02 0.07 0.11 0.12 0.56 12.6 67 87.7 6.3 6.0 0.0 WOOLWICH 13 7 0 51 11.3 — — 0.07 0.02 0.08 0.07 0.08 0.62 4.5 63 86.7 9.2 4.1 — 134 TABLE No. 71. Nett Deaths during the Calendar Year 1934, including Non-Residents in Institutions in the Borough. 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. NonResi dents. All Causes 1,650 127 23 21 58 69 64 105 153 288 368 374 562 150 431 Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - - Measles 10 4 1 2 3 - - - - - - - - - 8 Scarlet Fever 3 — - — 2 1 - - - - - - - 1 3 Whooping Cough 13 3 6 2 2 - - - - - - - 2 - 10 Diphtheria 11 1 2 2 6 - - - - - - - - - 11 Influenza 12 — - - - - - 1 1 4 4 2 1 1 1 Encephalitis Lethargica — — - - - - - - - - - - - - - Cerebro-spinal Fever 1 — - - - 1 - - - - - - - 1 1 Tuberculosis of Respiratory System 120 — — - 2 24 22 30 19 13 10 - 57 20 26 Other Tuberculous Diseases 26 2 — 4 4 6 4 1 1 2 9 - 11 1 9 Syphilis 9 1 - - - - - - 1 6 1 - 5 - 3 General Paralysis of the Insane, Tabes Dorsalis 5 - - - - - - 1 3 1 - - 1 - 4 Cancer, Malignant Disease 222 1 - 1 - - 1 11 36 60 66 46 74 20 47 Diabetes 17 - - - - 1 1 - 2 4 8 1 8 1 6 Cerebral Haemorrhage, etc. 67 — — — - - - 3 6 18 16 24 22 5 9 Heart Disease 391 — — — 4 6 11 12 27 68 121 142 97 14 73 Aneurysm 11 — — - - - 1 - 2 2 6 - 3 1 2 Other Circulatory Diseases 55 1 — — - - - 1 4 14 20 15 8 3 18 Bronchitis 58 4 1 — 1 - - 2 1 8 8 33 6 9 17 Pneumonia (all forms) 126 32 7 2 3 1 3 14 15 25 15 9 40 11 47 Other Respiratory Diseases 14 — — 1 1 1 1 2 3 1 2 2 4 1 4 Peptic Ulcer 18 — - - - - 1 2 5 6 3 1 9 4 7 Diarrhoea, etc 14 9 — - 2 - - - - 2 1 - 6 7 4 Appendicitis 9 — - 1 2 1 - 1 1 1 1 1 3 1 5 Cirrhosis of Liver 4 - - - - - - - 1 l 2 - 1 - 3 Other Diseases of Liver, etc 7 - - - - - - - 2 3 2 - 4 4 2 Other Digestive Diseases 31 2 1 3 3 2 - 3 2 4 7 4 16 5 11 Acute and Chronic Nephritis 45 — 1 - 1 2 2 2 2 9 17 9 12 1 10 Puerperal Sepsis 2 — - - - 1 1 - - - - - 1 1 1 Other Puerperal Causes 1 - - - - - - 1 - - - - 1 1 - Congenital Debility, Premature Birth, Malformations, etc 61 58 2 - 1 - - - - - - - 29 14 14 Senility 55 - - - - - - - - - 11 44 30 3 115 Suicide 23 - - - - 2 - 4 4 10 2 1 3 1 13 Other Violence 68 3 1 2 5 13 7 5 7 3 9 13 29 13 25 Other defined Diseases 141 6 1 1 16 7 9 3 8 23 34 27 79 13 32 Causes ill.defined or unknown - - - - - - - - - - - - - - - 135 TABLE No. 72. Nett Deaths during 1934, 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. Avery Hill. Sherard. All Causes 908 742 93 80 174 83 103 101 1ll 126 126 159 116 94 130 154 Typhoid and Paratyphoid Fever - - - - - - - - - - - - - - - - Measles 6 4 - - - - - - - 1 1 4 2 1 — 1 Scarlet Fever 1 2 1 - - - - - - - - 1 1 — — — Whooping Cough 5 8 — 2 — — 1 2 1 — 1 4 — — — 2 Diphtheria 6 5 — 1 — — - — 1 3 1 1 — — 2 2 Influenza 6 6 - - - - - 1 — 2 1 2 — — — 6 Encephalitis Lethargica — — — — — — — — — — — — — — — — Cerebro-spinal Meningitis 1 — — 1 — — — — — — — — — — — — Pulmonary Tuberculosis 76 44 7 5 13 14 11 2 7 6 10 6 12 7 9 11 Non-Pulmonary Tuberculosis 15 11 — 3 — 2 1 1 3 1 1 2 2 2 4 4 Syphilis 8 1 2 — 3 — 1 1 1 — 1 — — — — — General Paralysis of the Insane, Tabes Dorsalis 5 - - - 1 - 1 - - - 1 - - 1 1 — Cancer 119 103 14 10 27 12 12 15 15 16 20 17 18 18 13 15 Diabetes 8 9 — 1 1 — 1 1 2 4 — 1 1 1 2 2 Cerebral Haemorrhage, etc. 30 37 10 4 7 4 7 5 7 2 4 4 3 5 2 3 Heart Disease 191 200 19 22 47 18 23 28 28 26 31 28 21 25 42 33 Aneurysm 6 5 1 — — — 1 1 4 1 1 1 — — 1 — Other Circulatory Diseases 31 24 1 2 3 1 1 8 3 7 4 4 — 5 12 4 Bronchitis 30 28 2 1 6 1 4 2 4 6 8 8 2 3 3 8 Pneumonia 77 49 6 1 18 8 12 4 7 11 9 11 9 7 10 13 Other Respiratory Diseases 9 5 1 2 2 — — — I 1 1 1 2 1 1 1 Peptic Ulcer 15 3 — 1 2 1 1 3 — — — 1 3 1 3 2 Diarrhoea, etc. 8 6 2 — 1 — — 1 2 1 — 2 1 — — 4 Appendicitis 4 5 1 — — 1 1 — — 2 1 — 2 1 — — Cirrhosis of Liver 3 1 -— 1 — — — — — — 1 1 — 1 — — Other Diseases of Liver, etc 3 4 1 — 1 — — 2 — — — 2 — — — 1 Other Digestive Diseases 19 12 2 2 3 2 — — 1 1 2 6 2 1 4 5 Acute and Chronic Nephritis 22 23 4 4 1 2 4 4 4 5 2 6 4 — 4 1 Puerperal Sepsis — 2 — — — 1 — — — — — — — — 1 — Other Puerperal causes — 1 - - - - - - - - - - - - 1 — Congenital Debility, Premature Birth, Malformations, etc. 27 34 2 1 5 7 3 1 1 7 4 10 1 5 1 13 Senility 24 31 1 2 13 2 2 3 6 4 3 7 4 2 4 2 Suicide 21 2 1 2 2 1 I 3 2 3 4 — 2 1 — 1 Violence 42 26 6 4 5 4 6 1 2 4 5 11 5 1 3 11 Other Defined Diseases 90 51 9 8 13 2 9 12 9 12 10 17 19 5 7 9 Causes ill-defined or unknown — — — — — - — — — — — — — — — — 136 Causes of Death.—Table No. 71 shows that 391 deaths were due to Heart Disease, 222 to Cancer, 146 to Tuberculosis, 67 to Cerebral Haemorrhage and 55 to diseases of circulation. There were 61 deaths from Congenital Debility and Prematurity. These figures differ but little from those of 1933, in some instances being slightly higher and in some instances slightly lower. There were 126 deaths from Pneumonia compared with 86 in 1933. There were 12 deaths from Influenza, compared with 40 in 1933 and 10 deaths from Measles as against one in 1933. Seventyone per cent. of all deaths occurred in persons over 45 years of age. Respiratory Disease.—The following Table No. 73 shows the number of deaths each year since 1930 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. 73. Year. Bronchitis. Pneumonia. Other Respiratory. Total. DeathRate. Number under 5 years. Percentage under 5 years. 1930 61 101 19 181 1.3 35 19.3 1931 91 126 20 237 1.7 54 22.8 1932 67 81 21 169 1.2 40 23'6 1933 52 86 16 154 1.0 21 136 1934 58 126 14 198 1.3 47 23.7 Cancer.—The total number of deaths was 222 of which 119 occurred in males and 103 in females. In the following Table No. 74 is shown the number of deaths certified as due to Cancer and Malignant Disease, each year since 1930:— TABLE No. 74. Deaths from Cancer and Malignant Disease. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 1930 107 94 201 1. 42 12.99 1931 125 95 220 1.54 13.30 1932 108 102 210 1.43 12.84 1933 105 103 208 1.42 12.72 1934 119 103 222 1.52 13.45 137 The following Table No. 75, shows the seat of primary disease in all deaths from Cancer (including all other specified malignant tumours). TABLE No. 75. Deaths from Malignant Disease. Seat of Primary Disease. Males. Females. Total. Deaths in Hospital. Lip 1 - 1 1 Tongue 9 2 11 7 Mouth and Tonsil 5 — 5 3 Jaw — 1 1 — Oesophagus 8 1 9 7 Stomach 22 21 43 18 Liver and Gall Bladder 7 5 12 6 Intestines 9 12 21 12 Rectum 12 6 18 10 Ovary — 4 4 1 Uterus — 15 15 8 Breast 1 20 21 10 Skin 2 3 5 3 Larynx 3 1 4 2 Lung 10 — 10 7 Bronchus 6 - 6 6 Pancreas 3 - 3 1 Kidney 1 — 1 — Bladder 9 2 11 6 Prostate 6 - 6 4 Abdominal Cavity — 3 3 1 Others and unspecified 2 3 5 3 Sarcoma 3 4 7 5 119 103 222 121 Maternal Mortality.—The Council appointed two delegates to attend the Autumn Conference of the Maternal Mortality Committee held at the Friends' Hall, Euston Road, in November, and agreed to support the following resolutions:— "This Conference welcomes such encouragement to Local Authorities to maintain and develop the Maternity and Child Welfare Services for which they are responsible as is given by Circular 1433, dated October 10th, 1934. This Conference, however, is deeply impressed by the reports it has received of malnutrition among married women especially in areas where prolonged unemployment persists ; it is not satisfied that all Local Authorities are exercising or can exercise, their present powers so as to prevent continuous and increasing deterioration in health among such women; and it therefore urges the Ministry of Health and H.M. Government to consider what additional measures, either administrative or financial, are necessary to correct a growing evil. Further, in view of the reported deterioration in health among women in certain areas, the Conference calls upon Local Authorities to make special 138 arrangements for the setting up of Women's Clinics under the Public Health Acts for the supervision of post-natal and associated ailments." The number of deaths from Puerperal Sepsis was 2, and from other accidents and diseases of pregnancy, 1, making a total of 3 maternal deaths, compared with 6 in 1933. The maternal death rate per 1,000 births was 1.44 as against 3.29 in 1933. The following Table shows the causes of death each year since 1912:— TABLE No. 76. Maternal Mortality, Woolwich, 1912-1934. Year. Abortion. Ectopic Gestation Placenta Previa. 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 - - I 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 1932 - — - 1 - - 1 - 4 6 1933 - 1 - - 1 1 - 1 2 6 1934 - - - - - 1 - - 2 3 Totals 8 13 7 16 16 7 31 15 93 206 Inquests.—There were 152 inquests held on Woolwich residents during the year, compared with 121 in 1933. Deaths of Children, 1-5 years of age.—The number of deaths of children between 1 and 2 years of age was 23, and between 2 and 5 years, 21. In 1933 these figures were 13 and 24. The causes of death are given in detail in Table No. 71. The following Tables, show the variation in the rate of mortality in these ages in the last five years. These rates have been calculated on the estimated populations at these ages and in stated groups of diseases. 139 TABLE No. 77. 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- hœal Diseases. All other causes. Total Deaths. 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 1932 2,016 6.45 — 1.99 .49 2.48 11.41 1933 1,927 207 — 3.11 1.55 — 6.75 1934 1,726 5.21 — 4.63 — 3.47 13.32 TABLE No. 78. 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. Diarrhœal Diseases. All other causes. Total. Deaths 1930 6,534 1.39 .46 .92 .00 .76 3.53 1931 6,373 .78 .62 .94 .16 2.20 4.70 1932 6,294 .79 .48 .79 — 1.43 3.49 1933 6,188 .97 .80 .48 — 1.62 3.88 1934 5,953 101 .67 •50 — 1.34 3.52 Infant Mortality. The number of deaths of infants under one year of age was 127, compared with 116 in 1933 and 123 in 1932. The rate of infant mortality resulting from these deaths (deaths under 1 year per 1,000 births) was 63, compared with 62 in 1933 and 60 in 1932. The rates for the different Wards in the Borough are shown in Table No. 66. The rate for the Administrative County of London was 67, and for England and Wales, 59. The following Table No. 79, shows the distribution of infant mortality throughout the year, calculated on a varying year basis. 140 TABLE No. 79. Births. Deaths under 1 year. Rate. First Quarter 499 32 67 Second Quarter 518 31 64 Third Quarter 510 20 40 Fourth Quarter 473 44 88 Causes of Death.—The causes of infant mortality are set forth in Tables Nos. 81 and 82, which show the incidence of mortality from each cause for infants, classified by age, sex and wards. It will be noted from these Tables that the chief causes of death were:—Premature Birth, 36; Pneumonia, 32; Diarrhceal Diseases, 9; Congenital Malformation, 9; and injury at birth, 5. The neo-natal mortality rate (deaths under 4 weeks) was 27.5, compared with 33.92 in 1933 and 24.82 in 1932. Of the 55 neo-natal deaths, 34 were certified to be due to Premature Birth; 5 to Injury at Birth; 7 to Atelectasis; 4 to Congenital Malformation and 2 to Pneumonia. The number of deaths occurring in the first week of life was 39. Deaths of Illegitimate Children.—Fourteen illegitimate children died, compared with 13 in 1933 and 12 in 1932. The infant mortality rate figure for illegitimate children was 191, compared with 63 for legitimate children. Institutional Deaths.—In tabular form is shown below the number of deaths of Woolwich infants which took place in various institutions during the year. These figures are included in those shown in Table No. 69. TABLE No. 80. Hospitals or Institutions. Number of Deaths Public General Hospitals 54 Voluntary General Hospitals 11 Special Hospitals 12 Infectious Diseases Hospitals 6 Cottage Hospitals and Nursing Homes 8 91 Tables are set out in the following pages which classify in various ways causes of infant deaths during 1934. 141 TABLE No. 81. Infant Mortality, 1934. 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. Measles - - - - - - 2 1 1 4 Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - 1 - 1 1 3 Diphtheria and Croup - - - - - - - 1 1 1 Meningococcal Meningitis - - - - - - - - - - Tuberculous Meningitis - - - - - - - 1 - - Abdominal Tuberculosis - - - - - 1 - - - 1 Other Tuberculous Diseases - - - - - - - - - - Syphilis - - - - - - - 1 - 1 Bronchitis - - - - - 2 1 - 1 l Pneumonia - 1 - 1 2 10 10 8 2 4 Laryngitis - - - - - - - - - 32 Diarrhoea - - - - - 5 2 2 - 9 Injury at Birth 5 - - - 5 - - - - 5 Atelectasis 7 - - - 7 - - - - 7 Congenital Malformation 1 1 1 1 4 3 - 2 - 9 Premature Birth 24 5 3 2 34 1 1 - - 36 Atrophy, Debility and Marasmus - - - 1 1 2 1 - - 4 Erysipelas - - - - - - - 1 - 1 Convulsions - - - - - - - - - - Other Causes 2 - - - 2 2 4 1 - 9 39 7 4 5 55 27 21 19 5 127 Nett Births registered during the calendar year Legitimate, 1,927; Illegitimate, 73. Nett Deaths registered during the calendar year Legitimate, 113; Illegitimate, 14. 143 TABLE No. 82. 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. Burrage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas. Abbey Wood. Well Hall. Avery Hill. Sherard. Measles 2 2 - - - - - - - - - 3 1 - - - Scarlet Fever - - - - - - - - - - - - - - - - Whooping Cough - 3 - - - - - 1 - - 1 - - - - - Diphtheria and Croup 1 - - - - - - - - - 1 - - - - - Meningococcal Meningitis - - - - - - - - - - - - - - - - Tuberculous Meningitis - 1 - - - - - - - - - - - - 1 - Abdominal Tuberculosis - 1 - - - - - - - - - - - 1 - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - Syphilis - 1 1 - - - - - - - - - - - - - Bronchitis 2 2 - 1 1 - - - 1 - - 1 - - - - Pneumonia 17 15 2 1 4 2 2 - 2 2 1 5 1 3 1 6 Diarrhoea 6 3 1 - 1 - - - 1 - - 1 1 - - 4 Injury at Birth 2 3 1 1 - - - - 1 - 1 - 1 - - - Atelectasis 2 5 - - - 1 - - - 2 - - - - - 4 Congenital Malformation 2 7 1 - 1 9 - - - - 1 2 - 1 - 1 Premature Birth 19 17 1 1 3 4 1 1 1 3 2 5 1 4 1 8 Atrophy,Debility and Marasmus 2 2 - - 1 - - - - 1 1 1 - - - - Erysipelas - 1 - - - - - - - 1 - - - - - - Convulsions - - - - - - - - - - - - - - - - Other Causes 5 4 2 - 2 - 1 - 1 - - 3 - - - - 60 67 9 4 13 9 4 2 7 9 8 22 5 9 3 23 143 APPENDIX. METEOROLOGICAL OBSERVATIONS TAKEN AT THE ROYAL OBSERVATORY, GREENWICH, DURING THE YEAR 1934. 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. 6 50.4 27.3 39.1 + 0.8 43.9 3 0.14 „ 13 49.7 27.8 41.4 + 3.5 43.9 5 0.37 „ 20 55.0 26.6 43.6 + 51 440 6 0.64 „ 27 50.0 23.8 34.8 - 4.2 43.1 2 0.11 Feb. 3 42.9 22.5 36.2 — 3.5 42.0 4 0.19 „ 10 49.5 31.9 41.4 + 20 41 .7 - - „ 17 51.2 30.6 38.1 - 11 41.6 - - „ 24 49.8 27.5 38.3 -1.4 41.3 - - Mar. 3 49.5 28.1 37.6 -2.8 41.3 4 0.22 „ 10 54.8 30.8 42.0 + 1.1 41.5 3 0.55 „ 17 52.0 36.9 42.5 + 1.1 42.0 6 1.05 „ 24 53.5 31.5 41 .8 -0.3 42.4 3 0.42 „ 31 57.5 30.7 42.6 -11 42.9 2 0.03 Apr. 7 58.4 32.4 42.5 -3.5 43.4 3 0.24 „ 14 66.2 29.3 47.8 + 1.8 43.9 3 0.15 „ 21 77.6 41.9 53.2 + 5.3 45.7 4 0.47 „ 28 60.8 37.1 46.9 -1.7 46.7 6 1 .29 May 5 697 36.6 52.9 + 3.3 47.5 1 0.04 „ 12 79.1 39.3 55.7 + 4.3 48.7 4 0.29 „ 19 68.9 35.7 51 .6 -1.4 50.3 2 0.07 „ 26 72.8 40.7 56.7 + 1.8 51.3 - — June 2 77.6 41.9 58.1 + 1.3 52.3 - - ,, 9 75.6 44.1 55.8 -2.4 53.2 3 0.12 „ 16 87.3 42.6 63.2 + 4.7 54.2 - - „ 23 90.6 49.8 64.2 + 4.3 55.7 3 0.26 „ 30 78.1 48.2 60.9 -0.6 56.2 5 1.11 July 7 82.4 48.8 66.3 + 4.3 57.2 - - „ 14 84.0 50.5 66.4 + 3.6 58.5 2 0.32 „ 21 88.4 51.4 67.7 + 4.4 50.6 2 0.22 „ 28 83.6 51 .7 65.4 + 2.7 59.6 1 0.32 Aug. 4 82.0 47.6 64.8 + 2.6 59.9 4 0.26 ,, 11 77.8 49.9 62.9 + 0.7 59.8 3 0.17 ,, 18 81.6 48.9 62.7 + 0.4 59.4 2 0.36 ,, 25 76.8 48.1 62.3 + 1.2 59.5 2 0.26 Sept. 1 77.2 411 57.9 -2.4 59.4 3 0.67 ,, 8 82.7 43.1 62.4 + 3.1 58.8 3 0.64 ,, 15 82.4 43.9 63.7 + 5.7 59.0 2 0 05 22 74.7 41.9 58.9 + 2.4 59.1 2 0.27 ,, 29 81.3 44.0 58.1 + 3.0 58.4 3 0.23 144 APPENDIX—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. 6 69.0 44.1 55.4 + 2.0 57.9 5 0.62 „ 13 66.9 42.9 56.9 + 5.6 57.2 4 0.23 „ 20 61.2 36.0 50.4 + 0.9 56.4 3 0.11 ,, 27 65.3 40.2 54.2 + 6.3 55.6 2 0.11 Nov. 3 55.9 28.2 42.1 - 50 54.5 1 0.07 „ 10 51.7 31.1 42.5 -2.9 52.4 5 1.74 ,, 17 511 32.0 44.2 + 0.9 51.2 4 0.39 ,, 24 51.3 32 .0 43.3 + 1.1 50.5 — — Dec. 1 55.0 38.0 48.0 + 6.6 50.1 2 0.06 ,, 8 56.9 45.6 52.1 + 10.9 50.4 6 1.67 ,, 15 53.8 40.1 47.3 + 6.8 50.4 7 1.24 ,, 22 53.6 32.3 44.7 + 5.1 49.6 5 0.62 „ 29 51.4 36.0 44.6 + 6.0 48.5 7 0.83