WOO 35 Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1935 BY J. MACMILLAN, D.S.O., M.C., M B., D.P.H. Medical Officer of Health WOOLWICH: The Kentish Independent Printing Works, (T.U.) 41 Wellington Street, S.E. 18. PUBLIC HEALTH AND HOUSING COMMITTEE. At 31st December, 1935. His Worship the Mayor (Councillor H. Berry, J.P., L.C.C.). Councillor Miss M. Crout, J.P. (Chairman). Councillor Mrs. L. E. Driver (Vice-Chairman). Aldermen: Mrs. E. Brooks E. H. Kemp, J.P. Councillors: E. Brown C. J. Keedy C. H. Darby F. R. Moore J. B. Fyson Mrs. E. L. Reeves A. H. Gilder H. Vaughan G. E. Greenwood Miss G. E. Walters, J.P. W. J. Wood MATERNITY AND CHILD WELFARE COMMITTEE Comprising the Members of the Public Health and Housing Committee. Councillor Miss G. E. Walters, J.P. (Chairman). Alderman Mrs. E. Brooks (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 14 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 18 Orthopaedic Treatment 18 Supply of Insulin 18 Vaccination 18 Adoptive Acts, By-laws and Regulations in Force in the District 20 School Medical Service (L.C.C.) 20 Survey of Health Services 23 II.—HEALTH PROPAGANDA. General Reference 24 Health Services Booklet 24 Health Week 24 Silver Jubilee Celebrations 24 School Children 25 Informal Talks 25 Films 25 Cookery Classes 25 Central Council for Health Education 26 "Better Health" 26 Posters 26 III.—MATERNITY AND CHILD WELFARE. Staff 28 Notification of Births Acts 28 The Work of the Health Visitors 28 Infant Life Protection 29 The Work of the Welfare Centres 31 Artificial Sunlight Clinic 34 Toddlers' Clinic 35 Provision of Maternity Outfits 41 Compensation to Midwives 41 Payment of Midwives' Fees 41 Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 42 obstetric Complications in Private Practice 42 Home Helps 42 Treatment of Minor Ailments 42 Dental Treatment 43 Orthopaedic Treatment for Children under Five Years of Age 43 Provision of Nursing Assistance 44 Day Ambulance 44 Children's Beds 45 Institutional Midwifery 45 Ante-natal Treatment and Emergencies 46 4 PAGE Convalescent Home Treatment for Children 46 Convalescent Home Treatment for Mothers 46 Assisted Milk Scheme 47 Blind Persons Act, 1920 47 Widows', Orphans', and Old Age Contributory Pensions Act, 1925 47 IV.—SANITARY ADMINISTRATION. Staff 48 Water Supply 48 Drainage 48 Condition of the River Thames 48 Removal and Disposal of Refuse 49 Complaints 50 Sanitary Inspection of the Area 50 Shops Act, 1934 52 Smoke Abatement 52 Public Baths and Washhouses 52 Factory and Workshop Acts 53 The Rats and Mice (Destruction) Act, 1919 54 Fouling of Footways by Dogs—By-law 55 Nuisance from Pigeons 55 Rag and Bone By-laws 55 Rag Flock Act 55 Mortuaries 56 Cemeteries 56 Offensive Trades 57 Removal of Infirm and Diseased Persons 57 Children's Sandpits 57 Pharmacy and Poisons Act, 1933 57 Legal Proceedings 58 V.—HOUSING. Statistics 59 Inspection of Houses 60 Clearance Areas 61 Re-housing of Old People Living Alone 66 Hutment Dwellings 67 Council's Housing Schemes 68 Overcrowding Survey 69 Bug Infestation of Houses 86 Common Lodging Houses 89 Increase of Rent and Mortgage Interest (Restrictions) Acts 89 Tents and Vans 89 Houses Let in Lodgings 89 New Houses 89 VI.—INSPECTION AND SUPERVISION OF FOOD. General Reference 90 Milk Supply 90 Meat Supply 94 Other Food Premises 95 Unsound Food 96 Merchandise Marks Act, 1926 96 Agricultural Produce (Grading and Marking) Acts 97 Sophistication of Food 98 Adulterated Samples—Action taken 106 Food Poisoning 107 Chemical and Bacteriological Examination of Food 110 Nutrition 110 By-laws 110 5 VII.—PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. page General Reference 111 Notifications 111 Diphtheria 117 Scarlet Fever 118 Smallpox 120 Erysipelas, Malaria and Dysentery 120 Enteric Fever 121 Anterior Poliomyelitis 121 Encephalitis Lethargica 121 Cerebro-Spinal Meningitis 121 Puerperal Fever and Puerperal pyrexia 122 Zymotic Enteritis 122 Whooping Cough 122 Ophthalmia Neonatorum 123 Measles 123 Pneumonia 124 Tuberculosis 125 Arrangements for Disinfection and Disinfestation 139 VIII.—GENERAL STATISTICS. Physical Features of the Area 141 Population 141 Social Conditions 143 Sickness and Invalidity 143 IX.—VITAL STATISTICS. Annual Statistics (including those of Wards) 144 Births 146 Marriages 148 Deaths 148 Deaths from Cancer 152 Maternal Mortality 153 Child Mortality 154 Infant Mortality 155 APPENDIX. Meteorological Table 159 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-fifth Annual Report on the Health of the Metropolitan Borough of Woolwich. This Annual Report is an "Ordinary Report" and not a "Survey Report," and it follows the outline indicated by the Ministry of Health in Circular 1492 in order to obtain uniformity in the presentation of Annual Reports of Medical Officers of Health throughout England and Wales. In the first section will be found a precis of the Health Services of the Borough, and at the end of the section will be found the official letter of the Minister of Health, setting forth his observations on the report of the Survey of the Health Services in the Borough made by his Officers at the end of 1934 and the beginning of 1935. All who have taken part in their development, or watched with interest their progress will note with pleasure and gratification that the opening runs as follows:—"The report indicates that so far as can be judged from a general survey, a reasonable, and in most respects a high standard of efficiency and progress is being maintained by the Council in the discharge of their functions relating to Public Health." The Council's scheme of Health Propaganda is fully described in the second section of the Report, and of special interest is the success which is attending the cookery classes organised in connection with the Tuberculosis Dispensary. Great interest has been taken by the wives and mothers of the tuberculous in these demonstrations which show how to make the best use, so far as food value is concerned, of the diminished income which this disease so often entails. In the third Section is recorded progress in connection with Maternity and Child Welfare during the year. The maternity services of the Borough form a comprehensive scheme whereby complete facilities are provided for hospital and domiciliary care, and no woman need be without the services of a trained midwife at her confinement. They comprise:— (a) Home visits to expectant mothers. (b) Establishment of ante-natal and post-natal clinics. (c) Provision of maternity outfits. (d) Payment of compensation to midwives. (e) Payment of midwives' fees in suitable cases. (f) The services of a Consultant in exceptional cases of obstetric or ante-natal abnormality at home. (g) The services of a Consultant in cases of puerperal fever and puerperal pyrexia. (h) Provision of home helps in maternity cases. 7 (i) An arrangement with the School Medical Treatment Committee for the provision of dental treatment to expectant and nursing mothers. (j) Provision of nursing assistance for young children suffering from ophthalmia neonatorum and for mothers suffering from puerperal fever or puerperal pyrexia. (k) Provision of beds for the institutional treatment of midwifery for 144 cases per annum in the British Hospital for Mothers and Babies, and for 66 cases in the War Memorial Hospital. (l) Reservation of beds for ante-natal treatment and emergencies of midwifery at the War Memorial Hospital, equivalent to 18 weeks' treatment per annum. (m) Convalescent Home Treatment for expectant and nursing mothers. (n) Arrangements for the supply and distribution to expectant and nursing mothers of milk and food drugs at cost price, half cost or free, according to economic circumstances. To-day all authorities regard ante-natal care as the basis of an adequate maternity service, and in this Borough there are ample ante-natal arrangements. At four Centres the Council have ante-natal clinics, and there are others in all the hospitals of this Borough with maternity beds. There is a large excess of midwives in Woolwich—sixty-one gave notice of their intention to practise. Every one of these can send her cases to the Council's ante-natal clinics for opinion and advice, and most of them do so. Their fees can be paid in necessitous cases and compensation is made to them if it is found that their cases ought to be confined in hospital. A Consultant is available to assist doctors called in by midwives in emergencies at home. There are many ancillary services and post-natal examinations are arranged for. Moreover, there are arrangements whereby cases seen at the non-hospital clinics can be referred to the hospital clinics for specialist opinion and if necessary, for treatment, and in this way the ante-natal services of the Council are fully linked up with hospital practice. The number of maternity beds in Woolwich hospitals is 84. In brief the local maternity arrangements are as complete as present day knowledge and practice can make them. At the present time a Midwives' Bill, providing for a salaried midwife serivce, is going through Parliament. It seems to me, however, in view of the increased public demand for maternity beds in London, that there is reason to doubt the necessity for a domiciliary salaried midwifery service in London. There has been a great increase in the percentage of women going into hospital for their confinements since 1919. In that year one birth in fourteen in Woolwich took place in institutions, to-day three out of every five do so. Many authorities believe that if sufficient beds were provided very few expectant mothers would refuse to use them. The hospitals are evidently providing something which the women want and believe in—whatever the obstetricians may say. The chief argument used against hospitals is the story of occasional disaster—mostly years ago. In the development of any other services disaster is the spur to greater development in safety procedure, and midwifery should be no exception. When the Bill becomes law it will be interesting to see whether the salaried midwife will change the present 8 trend towards hospital confinements in London, or whether she will find her main work in the domiciliary ante-natal and post-natal care of the hospital patient. Some six years ago the Council's Toddler Medical Inspection Scheme was started. It has now established itself in the eyes of the public as a valuable part of the Council's Child Welfare Scheme, and it would appear that the time is now ripe for its extension along present lines, but providing for more home visiting and for additional facilities for eye and dental treatment. The year has been an extremely busy one for the sanitary section of the Department, not only in routine sanitary administration, the supervision of food supplies, and control of infectious disease, but also in the matter of slum clearance. At the end of the year, 22 areas included in the five year programme had been represented as unhealthy areas and Clearance Orders had been made by the Council. The Orders have all been confirmed by the Minister, either in 1935 or early in 1936. They deal with 213 houses in all, details of which will be found in the Housing Section of the Report. The provision of re-housing accommodation is in process, and 343 persons had been re-housed in new houses by the end of the year. Officers of the London County Council have made inspections of four large areas in this Borough, but no official representations had been made by the County Medical Officer by the end of the year. It is quite clear, however, that such representations will be made in the near future. A new epoch in housing matters is foreshadowed by the recent housing survey, the first stage of which—the ascertainment of the amount of overcrowding—was completed during the year. It is dealt with in detail in the fifth section of the Report. Compared with 1934 the incidence of infectious disease showed a marked decrease, due mainly to the absence of a measles epidemic. There were fewer cases of diphtheria (313 as against 416), of scarlet fever (634 against 989), of pneumonia (255 as against 280), or erysipelas (78 as against 119). There was an increase in the number of cases of puerperal pyrexia and puerperal fever (45 as against 35), and of ophthalmia neonatorum (17 as against 7). The number of cases of measles fell from 2,392 to 656. The number of notifications of tuberculosis received during the year was 242, compared with 269 in 1934. At the end of the year there were 798 persons suffering from pulmonary tuberculosis, and 177 persons suffering from other forms of tuberculosis, that is in all 975 persons (1,048 in 1934), living in the Borough. The number of deaths from tuberculosis during the year was 136, compared with 146 in 1934. The principal vital statistics for the year are as follows: The birth rate was 14.0, an increase of 0.3 on that of 1934. The infantile mortality rate was 44 compared with 63 in the previous year, and the neo-natal mortality rate (deaths under four weeks per thousand births) was 19.5 as against 27.5. The number of maternal deaths was three, the same as in 1934, the rate for the year per thousand births being 1.46. 9 The population of the Borough is estimated by the Registrar-General to be 146,400 at the middle of the year, an increase of 880 on 1934. 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 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 I Grant was appointed to a temporary clerkship from the 13th February. Miss M. Campbell, who joined the staff as a health visitor in 1920, was appointed as a sanitary inspector and health visitor from the 1st April. Mr. T. H. Prescott, Grade B. Clerk, was promoted to Grade C from the 1st April. Miss A. Bryant, Temporary Clerk, was appointed to Grade A from the 1st April. Mr. G. R. Sumner, Sanitary Inspector, commenced duty on the 8th April. Mr. W. F. R. Wheal, Sanitary Inspector, commenced duty on the 1st May. Miss E. M. Little, who joined the staff on the 1st January, 1934, as a Tuberculosis Visitor, was appointed as a Health Visitor from the 1st May. Miss E. M. Plummer, who joined the staff as a Temporary Health Visitor on the 18th February, was appointed a Tuberculosis Visitor from the 28th July. Mrs. A. M. Farrugia, Sanitary Inspector, retired on superannuation on the 31st August. Miss M. F. Tyers, who joined the staff as a temporary Health Visitor on the 2nd September, was appointed as a Health Visitor from the 1st November. In conclusion, I desire to thank the Chairmen and members of the Health Committees, and indeed all the members of the Council for their continued confidence and support, and for the kindly and sympathetic way they have dealt with the many problems it has been my duty to bring before them. It is an additional pleasure to express my appreciation of the assistance given to me by every member of the staff without whose loyalty and co-operation it would not be possible to deal with the ever increasing duties and responsibilities placed upon the Department as the years roll on. 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, 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. (Part-time). 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 appointment, names and qualifications of the Public Analyst, Sanitary Inspectors, Health Visitors, Vaccination Officer, Tuberculosis Staff and Clerical Staff employed by the Council on 31st December. The Public Analyst, whose appointment previously had been from year to year, was appointed on a permanent basis from 1st April, 1935. Mr. H. G. Harrison, the Public Analyst for Deptford and Shoreditch, was appointed in March, 1935, to act as Public Analyst for this Borough during the temporary absence of Mr. H. Amphlett Williams, for so long a period as Mr. Williams is Public Analyst. 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. 12 TABLE No. 2—continued. Year appointed. Name. Qualifications. Appointment. 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. 1935 Sumner, G. R. Cert. San. Insp., Exam. Joint Board; Cert. Meat and other Foods. Sanitary Inspector. 1935 Wheal, W. F. R. Cert. San. Insp., Exam. Joint Board; Cert. Meat and other foods. Sanitary Inspector. — One vacancy — 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 and Sanitary Inspector. (1934). 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.; Health Visitors' Cert. Health Visitor. 13 TABLE No. 2—continued. Year appointed. Name. Qualifications. Appointment. 1933 Adams, Miss W. Cert. General Hospital Training; C.M.B.; Health Visitor's Cert; Diploma in Nursing, University of London. Health Visitor. 1934 Little, Miss E. Cert. General Hospital Training; Cert. Fever Training; C.M.B.; Tuberculosis Cert.; Health Visitors' Cert. Health Visitor. (1935). 1935 Tyers, Miss M. F. Cert. General Hospital Training; C.M.B.; Health Visitors' Cert.; Massage. 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. 1935 Plummer, Miss E. M. Cert. General Hospital Training; C.M.B.; Cert. Fever Training; Health Visitors' Cert. Tuberculosis Visitor. 1923 Smith, Mrs. M. Dispensing Certificate Dispenser and Secretary of Care Committee. Clerks: 1901 Smith, H. S Chief Clerk. 1906 Collyer, H. M. Committee Clerk. 1913 Prescott, T. H. Clerk, Grade C. 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. Clerk, Grade A. 1934 Goad, A. Temporary Clerk. 1935 Grant, Miss I. 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, etc., 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. 14 iii. Ambulance Facilities. The London County Council's ambulance service is available:— (а) 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 maternity cases throughout the day and night, but urgent maternity cases must be accompanied by a doctor or nurse. 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 Zymotic Enteritis Whooping Cough Poliomyelitis 1s. 0d. per visit for one case ; 6d. per visit, per case, for more than one case in the house at the same time. 15 Acute Primary Pneumonia Influenzal Pneumonia Puerperal Fever Puerperal Pyrexia Tuberculosis 1s. 3d. per visit. An additional grant is made yearly in respect of the nursing treatment of children suffering from threadworms. 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 Centers. Old Town Hall, Woolwich .. Doctor's Room, Weighing Rooms, Waiting Rooms, etc. Woolwich Borough Council. 9 236, Plumstead High Street Doctor's Room, Ante-Natal Room, Ante-room, Weighing Room, Waiting Room, Dental Rooms. do. 7 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 * An Ante-Natal Clinic is held here once a month. 16 TABLE No. 3—continutd. Clinics and Treatment Centres. Situation. Nature of Accommodation By Whom Provided. Sessions Weekly. Day Nurseries. Nil. School Clinics. Brewer Street, Woolwich Doctors' 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 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:— 17 (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. 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 61 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. 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, has yet been made. 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. 18 x. Infant Life Protection. A note on the administration of this service will be found in the Maternity and Child Welfare Section of the report. xi. Orthopaedic 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 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 nine patients during the year, the total cost being £17 4s. 9d. 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:— (а) The number of doses of Insulin administered; (b) Stating whether any tests were made of the urine or of the blood of the patient, and, if so, by whom and with what results ; (c) A report on the progress of the patient. xiii. Vaccination. I submit a return by the Vaccination Officer on the work carried out under the Vaccination Acts for the year 1934. 19 TABLE No. 4. RETURN to be made on or before the 9th of February, 1936, 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, 1934, 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, 1934. Number of these Births duly entered by 31st January, 1936, in Columns I., II., IV., and V. of the "Vaccination Register" (Birth List Sheets), viz.:— Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declaration of Conscientious Objection has been received. Col. V. Died Unvaccinated. Insusceptible of Vaccination. Had Small Pox. 1. 2. 3. 4. 5. 6. 7. 1. Plumstead 563 200 - - 249 46 2. Woolwich † 1321 656 11 - 496 47 3. Eltham 463 227 - - 177 18 Total 2347 1083 11 - 922 111 Number of these Births which on 31st January, 1936, remained unentered in the "Vaccination Register" on account (as shown by "Report Book'') of:— Number of these Births remaining on 31st January, 1936, 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 1935. 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 1935. 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. 11 12 37 8 These figures are to be obtained from columns 2 and 6 of the Summary (Form N.) 16 45 42 8 4 15 14 8 31 72 93 24 1171 927 Notes on Table No. 4. 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. 20 *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 1935 sent to other Vaccination Officers should be stated here:—110. *Includes the Burrage and Herbert Wards in Plumstead Parish. (Signature) S. G. TAYLOR, Date—10th February, 1936. Vaccination Officer. During the year ended 30th September, 1935, the number of persons successfully vaccinated or re-vaccinated at the cost of the rates was 2,061. This figure includes 704 primary vaccinations of persons under one year of age; 403 over one year of age, and 954 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 410 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. By-Laws and Regulations.—A complete list of the various By-laws and Regulations in force in the Borough was given in the Annual Report for 1934. One additional one, dealing with the fouling of public footways by dogs came into force during the year. xv. School Medical Service (London County Council). Through the courtesy of Sir Frederick Menzies, the School Medical Officer, I am able to give the following particulars of the routine medical examination of elementary school children in Woolwich in 1935:— 21 TABLE No. 5 (Part I.). Examination of Elementary School Children in Woolwich, 1935. Numbers Examined and Defects Found. Boys. Girls. Entrants. Age 7. Age 11. Age 14. Entrants. Age 7. Age 11. Age 14. Number examined 1,302 572 1,004 1,117 1,241 635 896 1,032 Cases * Cases * i Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 10 2 10 4 13 2 3 2 8 5 5 1 14 1 3 2 Skin Disease 6 5 5 4 6 5 6 3 11 9 2 2 4 1 9 5 Defective Teeth — 522 — 135 — 231 — 260 — 508 — 198 — 172 — 255 Enlarged Tonsils 127 36 43 10 40 11 11 6 122 33 61 10 39 13 28 14 Adenoids 29 21 6 4 3 3 2 2 37 15 8 3 4 1 1 1 Enlarged Tonsils and Adenoids 68 52 12 12 5 5 6 5 58 42 14 12 2 2 6 6 Other Nose and Throat defects 9 3 4 2 5 1 6 2 5 1 7 2 4 3 4 3 Enlarged Glands 11 1 3 — 3 — — — 9 1 2 — 3 1 — — Eye Disease 25 17 6 2 8 5 7 5 32 19 12 7 8 7 7 4 Vision defect — — — 18 — 57 — 83 — — — 28 — 63 — 73 Otorrhoea 6 3 5 2 3 — 3 3 13 5 — — 5 4 2 2 Other ear disease 2 1 1 — — — 1 1 1 — — — 2 1 — — Defective hearing 1 1 3 2 1 1 2 1 — — 1 1 1 — 3 3 Speech defects 4 — 2 1 4 — — — 2 — 3 — 1 1 — — Heart defects 15 — 6 — 5 — 9 3 16 2 8 — 16 2 14 3 Anaemia 13 4 6 — 13 2 3 1 20 7 10 1 4 — 5 2 Lung defects 24 9 5 — 6 — 7 7 15 6 8 1 5 3 3 1 Nervous defects 5 1 5 3 4 — 1 — 4 1 3 1 7 2 3 — Phthisis — — — — 1 — — — — — — — — — — — Other T.B. disease — — — — — — — — — — — — — — — Rickets 2 1 — — — — 1 — 1 — — — 1 — — — Spinal deformities — — — — 7 4 2 2 3 — 1 1 5 3 15 10 Other deformities 23 7 6 3 17 9 6 5 23 7 9 2 18 7 13 7 Other defects 43 22 21 10 31 15 10 5 42 29 28 11 34 14 16 8 Number of Children noted for treatment. . — 638 — 189 — 318 — 363 — 615 — 255 — 277 — 358 * Defects, however slight, are included under "Cases" ; those severe enough to require treatment are shown under *. 22 TABLE No. 5 (Part II.). Age Groups. Number examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Good Fair Poor Good Average Below normal Bad Clean Nits Pediculi Clean Dirty Pediculi All sound Less than 4 decayed. 4 or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either or both eyes. Entrants— Boys 1302 1020 279 3 218 1035 49 — 1293 9 — 1302 — — 745 455 102 — — — Girls 1241 932 303 6 281 918 42 — 1225 10 6 1236 5 — 694 451 96 — — — Age 7— Boys 572 439 131 2 97 443 32 — 566 6 — 570 2 — 426 131 15 355 159 52 Girls 635 504 131 — 120 485 30 — 624 9 2 633 2 — 425 191 19 363 213 55 Age 11— Boys 1004 654 343 7 137 820 47 — 994 10 — 999 4 1 761 232 11 725 172 103 Girls 896 554 341 1 166 672 58 — 875 20 1 895 1 — 719 172 5 645 138 112 Age 14— Boys 1117 731 380 6 202 880 35 — 1105 12 — 1108 9 — 856 259 2 851 139 126 Girls 1032 736 295 1 221 777 34 — 1008 21 3 1027 5 — 774 250 8 739 165 128 Total 7799 5570 2203 26 1442 6030 327 — 7690 97 12 7770 28 1 5400 2141 258 3678 986 576 Percentage 71.4 28.3 0.3 18.5 77.3 4.2 0.0 98.6 1.2 0.2 99.6 0.4 0.0 69.3 27.4 3.3 70.2 18.8 11.0 London 54.2 45.3 0.5 17.4 76.9 5.7 97.2 2.5 0.3 99.0 0.9 0.1 68.9 27.0 4.1 66.4 19.0 14.6 23 xvi. Survey of Health Services. A general inspection of Public Health Services in the Borough was begun by Medical Officers of the Ministry of Health at the end of 1934, and was completed at the beginning of 1935. This survey is required in order that the Ministry may be satisfied from time to time that the 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. In connection with the survey, the following letter was received from the Minister of Health:— "I am directed by the Minister of Health to state that he has had under consideration the report made by his officers after their recent survey of the public health services of the Borough Council. The report indicates that, so far as can be judged from a general survey, a reasonable, and in most respects, a high standard of efficiency and progress is being maintained by the Council in the discharge of their functions relating to public health. Amongst a number of satisfactory features exhibited by the services, the Minister has noted in particular the comprehensive character of the Council's maternity and child welfare service and of their anti-tuberculosis work in so far as it comes within the functions of the Borough Council; the excellent work which is being done at the 'toddlers' clinic'; the attention given to the prevention and control of infectious disease; the commendable degree of co-operation between the Council's health services and the school medical service of the London County Council; the active interest taken by the Council and their officers in health publicity and health education, and the measures promoted for the disinfestation of houses in the Borough. The following are matters connected with particular services to which the Minister thinks he may usefully direct the Borough Council's attention:— Public Cleansing.—In view of the importance of this service and the heavy annual expenditure upon it, it is considered that its supervision by a special cleansing officer would tend to the greater efficiency of the service and leave the Borough Engineer free to devote more time to other duties. In this connection attention is drawn to the section dealing with the organisation of cleansing work on page 25 of the Ministry's Annual Report for 1931-32 (issued as a separate publication with the title ' Public Cleansing—Extracts from the Annual Report of the Ministry of Health for 1931-32'). Maternity and Child Welfare.—At the War Memorial Hospital the maternity unit, although excellent in many respects, is inadequate in size for the number of patients treated, with consequent deficiency in certain arrangements, particularly in the accommodation for babies. In conclusion, I am to express the Minister's appreciation of the assistance afforded to his officers during the survey." 24 SECTION II. HEALTH PROPAGANDA. In health propaganda work there are two main objects:— (a) the broadcasting of information about the health activities of the Council, and (b) the stimulation and maintenance of public interest in matters of health. Excluding the day-byday work of the sanitary inspectors, health visitors, and tuberculosis visitors in the home and in clinics, the activities of the Council in these respects may be classified as follows:— (a) Health Services Booklet.—A booklet of twenty pages giving information regarding the Council's Health Services has been prepared and advantage is taken of every opportunity of distributing it to householders in the Borough. It can be obtained free on application at the Health Department, or at any of the Council's Welfare Centres, Dispensaries and Public Libraries. It is sent as a matter of routine to every new tenant on the Council's estates. It is now in its fourth edition. This booklet is in addition to the leaflets dealing with specific matters. (b) Health Week.—As a house-to-house distribution of the maternity services booklet had been made in connection with the Silver Jubilee Celebrations earlier in the year no Health Week was organised in the Autumn. (c) Silver Jubilee Celebrations.—The Council as a body took part in the Silver Jubilee Celebrations and the individual Committees of the Council each contributed. The Maternity and Child Welfare Committee published a booklet placing on record in a permanent form the activities of the Borough Council in maternity and child welfare work, in order that the inhabitants of the Borough might realise and appreciate what had been done and accomplished during the last 25 years The booklet which was entitled "The care of the Mother and Child during the reign of King George V." set out in full the development of the service from its start in 1906 and directed special attention in the closing paragraphs to the need for further efforts to reduce maternal mortality and the need for development of additional services for the care of the toddler. A copy of the booklet was sent by post to every house in the Borough. A feature of the Celebrations was a procession of decorated vehicles, serious and otherwise, which traversed the principal streets of Plumstead, Woolwich and Eltham and aroused much public interest. The Public Health Committee entered an exhibit in this procession. It consisted of a Welfare Centre tableau, arranged on a horse-drawn float, and attention was drawn in a simple way to the importance of prevention in the fight against disease. 25 (d) School Children.—The practice, adopted in 1932, of co-operating with the Libraries Committee in the presentation of educational films to school children was continued during 1935. On one Monday each month during the Winter, three displays of films are given to different groups of school children. On each occasion four films are shown, three being selected by the Libraries Committee and one by the Public Health Committee. The average attendance at each session is 500. The health films shown were as follows:— January 21st "Dr. Wise on Influenza." February 18th "Tommy Tucker's Tooth." March 18th "Bottled Health." October 21st "Beware of the Demons." November 18th "Swimming." December 9th "Dirty Bertie." (e) Informal Talks.—It is a matter of common knowledge that a keen public interest is taken in health matters in this Borough. Requests for health talks at meetings of organisations are frequent and are complied with when this is possible. Certain societies and guilds apply regularly each year for such lecturettes and every year applications are received from fresh sources. The subject matter of the talks varies ; sometimes it is about the Council's health services, sometimes on preventive medicine and sometimes on disease. The lecturers are members of the staff— medical officers, sanitary inspectors, health visitors or tuberculosis visitors. At all meetings it is the practice to show films or lecture slides, or to give a practical demonstration. (f) Films.—It is difficult now-a-days to procure suitable silent 35 mm. films, the only size possible to show on the Council's full size projector, and many of the older ones are old and worn. The newer health films are of smaller size (16 mm.) and are few in number. Such films are now being made however in increasing numbers, and will be available at no distant date, but many of these have sound accompaniments. Health films are an attractive feature of our informal health talks, many of which deal with the Council's health services. It was felt that it would be useful if a film illustrating the Council's work in health services was available, and so it was decided to make one, which was partly completed at the end of the year. Consideration is being given also to the purchase of a 16 mm. cinematograph sound film projector. The provision of such apparatus is essential to-day owing to the preference of most people for this type of film. Health propaganda must always be changing and must be presented in an attractive form. (g) Cookery Classes.—Demonstrations in cookery were started at the 1 ubereulosis Dispensary in April, 1934, in order to provide instruction for the wives and mothers of the tuberculous in the buying and cooking of simple, cheap 26 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 £3 10s. 0d. The number attending was 41, the number of attendances was 577 and there were 48 meetings. (h) The Central Council For Health Education.—This organisation consisting of representatives of health authorities, educational authorities, insurance committees, friendly societies, etc., exists for the systematic development of methods of health education, and the cultivation of health mindedness in the community. It is, in the words of the Minister of Health, "a clearing house of information and experience in the best methods of stimulating general interest in making widely known the facilities which exist in the prevention and treatment of disease and in fostering a knowledge of the part which individuals can play in promoting the health of the nation." The Council provides a poster service and an exhibition service ; it publishes literature on health matters and it sends weekly articles to the press on health subjects ; it has provided a permanent exhibition of health propaganda material in London and it holds a Conference each year on health matters ; it is in short a co-ordinating central agent of great value to local authorities in their work for health education. The Council makes an annual contribution of £3 3s. Od. to its funds. (i) Better Health.—This is the official journal of the Central Council for Health Education. It is published monthly and the total monthly issue is over 200,000 copies. In it are to be found popular descriptions of standards of personal hygiene, and of advances in modern preventive medicine. The journal thus provides a simple, inexpensive and regular medium of arousing and stimulating public interest in health. The Council purchase each month 2,000 copies of this journal and these are distributed free through the Welfare Centres, Libraries, and Schools. In an endeavour to interest a wider public in health matters a small number of copies are posted each month to residents in the Borough, selected at random. "Better Health" has met with the full approval of the general public and school teachers. (j) Posters.—Posters produced by professional advertising agents are outstanding in character, variety and design. Business firms are convinced of the value of these if one judges by the space occupied by such posters on the hoardings of this country. Such displays must have a value in health propaganda work, but until recently there were few health posters which were suitable for display on public hoardings. The position is now changed and posters are available. Many of the voluntary health associations have undertaken the responsibility of producing these in accordance with a scheme organised by the Central Council for 27 Health Education. This body issues these posters at a reasonable cost to those local authorities who can display them on the wooden poster frames originally erected by the Empire Marketing Board. These posters have been widely praised both for their educational value and for the high standard of design. The Public Health Committee have arranged for the display of two sets of posters each month. The posters shown during the year were as follows;— January "Building a healthy people" (C.C.H.E.) February "Do you use the Health Services ?" (C.C.H.E.) March British Social Hygiene Council April British Red Cross Society May National Milk Publicity Council June Anti-Noise League July National Council for Maternity and Child Welfare August Dental Board of the United Kingdom September National Safety First Council October Health and Cleanliness Council November National Society for the Prevention of Tuberculosis December National Smoke Abatement Society Smaller posters—crown and double-crown-prepared by the health organisations and associations have been used extensively in the Council's Welfare Centres and Dispensaries. 28 SECTION III. MATERNITY AND CHILD WELFARE. The Council's Maternity and Child Welfare scheme is comprehensive in its arrangements for the care and comfort of expectant and nursing mothers and for children under 5 years of age. It has included since 1933 infant life protection. Staff.—Three whole-time medical officers are in medical charge of the clinics, each of whom devotes eight half-days per week to Maternity and Child Welfare, and three half-days 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 consultation in connection with cases of puerperal sepsis and difficult obstetric conditions occurring 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 thirteen whole-time health visitors: three of these are part-time sanitary inspectors, four are part-time Infant Life Protection Visitors, and one is the Artificial Sunlight Clinic nurse. Notification of Births Acts, 1907-15.—Every birth occurring in the Borough requires to be notified to the Medical Officer of Health within thirty-six hours of birth. As a matter of fact, only a very small percentage of births are not 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. 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 2,042 „ Revisits 16,802 Infant deaths investigated 28 Still-births investigated 24 Expectant mothers—home visits 761 29 Infectious diseases:— Ophthalmia Neonatorum—First visits 18 „ „ Revisits 15 Measles—First visits 469 „ Revisits 118 Puerperal fever—First visits 11 „ „ Revisits 1 Puerperal Pyrexia—First visits 25 „ „ Revisits 7 Zymotic Enteritis—First visits 4 „ „ Revisits 1 Pneumonia 75 Anterior Poliomyelitis 1 Encephalitis Lethargica 1 Infant Life Protection 1,086 Visits unclassified 509 Visits unsuccessful 3,292 25,290 The Council paid the class fees and expenses in connection with the visits to approved institutions of two health visitors who attended refresher courses for health visitors. Infant Life Protection.—The Council became responsible on the 1st April, 1933, for Infant Life Protection work in Woolwich, and have appointed four of their health visitors as Infant Life Protection Visitors (part-time). 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 1934 there were 93 foster children and 68 foster mothers on the Council's register, and a year later the numbers were 92 and 69, 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 77 were either temporarily without nurse children or had been noted as suitable persons. 30 These figures do not, however, tell the whole story, as 185 foster children were added to the register and 186 foster children were removed during the year. The following Table shows the ages of the children under supervision on the 31st December, 1935:— TABLE No. 7. Under 1 Year. 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 28 6 8 8 8 12 7 10 5 The number of visits paid by the Infant Life Protection Visitors was 1,086. The number of visits made by the male inspector, in connection with infringements and kindred matters was 78, while the number of visits paid by the district sanitary inspectors was 61. The number of, and nature of the various legal infringements discovered during the year were as follows:— TABLE No. 8. Nature of Infringement. No. Keeping a nurse child without giving timeous notice 11 Change of address by foster mother without giving timeous notice 1 Infant removed from care of foster-mother without giving timeous notice 7 Cautionary letters were sent in 19 cases. There were no prosecutions. In 7 instances insanitary conditions were discovered; in 4 instances there was overcrowding, and in 5 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, these children now regularly attend an infant welfare centre. Special care is taken to see that children who are weak and ailing attend the centres. During the year five nurse infants died—two from pneumonia, one from enteritis, one from marasmus, and one from osteomyelitis. The only institution in the Borough holding a certificate of exemption is the Woolwich War Memorial Hospital. 31 The Work of the Welfare Centres.—These are eight in number and are now all municipal. Infant welfare sessions are held at all of them; ante-natal sessions are held at four in three instances twice weekly and in one instance once a month. With the inclusion of the monthly ante-natal session at North Woolwich, at the end of the year 6.25 ante-natal sessions and 23 infant consultation and weighing sessions were being held each week. In tabular form below are shown detailed statistics for 1935 and the con solidated statistics for the previous year:- TABLE No. 9. Centre. Number on Roll of Centre. Number of Attendances. Mothers. Children. Mothers. Children. Expectant. Nursing. Expectant. Nursing. Town Hall 322 225 1,515 816 336 10,530 Plumstead 270 314 1,271 711 774 9,795 Eltham 397 179 1,019 1,048 260 6,849 Slade — 73 441 — 84 4,320 New Eltham 3 67 435 3 95 4,809 St. Luke's — 52 241 — 81 2,183 North Woolwich 14 34 160 32 47 1,411 Beresford Street 13 39 177 15 82 1,426 Totals, 1935 1,019 983 5,259 2,625 1,759 41,323 Totals, 1934 1,131 1,266 5,164 2,812 2,535 37,494 The next Table, No. 10, shows the number of children and the number of attendances made by them during the year. It should be noted that children are classified in the table by year of birth, so that the figures cannot be read as under one year, under two years and so on. They illustrate, however, quite definitely the fact that the toddler does not attend such clinics in large numbers and that as he gets older he attends still less. It was because of this and because there are no day nurseries or nursery schools in Woolwich that the toddler medical inspection scheme, reported on later, was started. If toddlers are found at the special examination clinic to require further observation most of them are brought to the infant welfare clinics for this purpose. 32 TABLE No. 10. Children in Attendance at Each Centre. Year of Birth. Town Hall. Beresford St. N. Woolwich. Plumstead. Slade. Eltham. St. Luke's. New Eltham. Totals. 1935 454 36 43 434 120 273 67 113 1,540 1934 500 55 54 378 129 256 68 123 1,563 1933 234 29 22 199 80 197 40 71 872 1932 171 29 19 141 67 137 22 61 647 1931 114 22 17 73 29 124 26 45 450 1930 42 6 5 46 16 32 18 22 187 1,515 177 160 1,271 441 1,019 241 435 5,259 Attendances Year of Birth. Town Hall. Beresford St. N. Woolwich Plumstead. Slade Eltham St. Luke's New Eltham Totals 1935 3,511 300 476 3,946 1,148 2,624 780 1,348 14,133 1934 4,458 557 522 3,761 2,032 2,291 799 2,144 16,564 1933 1,270 247 236 1,108 573 911 326 677 5,348 1932 728 186 82 622 411 503 111 404 3,047 1931 431 102 83 220 111 392 134 159 1,632 1930 132 34 12 138 45 128 33 77 599 10,530 1,426 1,411 9,795 4,320 6,849 2,183 4,809 41,323 The attendances, which do not include attendances at the Toddlers' Clinic or the Sunlight Clinic, and the number on the roll, are the highest recorded since this service commenced. 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:— (а) On the card of every child under one year of age attending a welfare centre between the 1st May and the 30th June, 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 11 on the adjoining page. 33 TABLE No. 11. Feeding of Infants attending Welfare Centres—1st May to 30th June, 1935. 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 80 98 52 37 27 29 25 15 17 380 — — — 380 Breast and Hand 6 17 21 24 17 9 7 6 20 127 19 3 2 151 Hand 11 26 25 18 51 45 48 59 39 322 47 63 73 505 97 141 98 79 95 83 80 80 76 829 66 66 75 1,036 PERCENTAGES. Breast 82.5 69.5 53.0 46.8 28.4 34.9 31.2 18.7 22.3 45.8 — — — 36.7 Breast and hand 6.1 12.0 21.4 30.3 17.8 10.8 8.7 7.5 26.3 15.3 28.8 4.5 2.0 14.6 Hand 11.3 18.4 25.5 22.8 53.8 54.3 60.0 73.7 51.3 38.8 71.2 95.5 98.0 48.7 34 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 172 whose course of treatment was not completed at the end of 1934, was 446. The total number of treatments given was 10,203: of these, 8,642 were by carbon arc, 1,185 by mercury vapour lamp, and 376 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:— "Thanks to the efficient work of the medical assistants and the staff, the Sunlight Clinic has continued to give good results in treatment. Constant touch is kept with other sections of the Health Department, and cases which seem to require a specialist are always referred for opinion and such therapeutic measures as are advised. The figures as a whole are similar to those of former years, with the gratifying exception that the numbers cured or much improved have relatively increased. The largest group is still that including general debility and malnutrition inevitable in a district where many people are poor. The improvement shown in a large majority of these is satisfactory. Cases of rickets are still seen, but these seem to come at an earlier stage and respond better, as the figures show. All cases with enlarged glands are given general as well as local treatment, and of these 23 out of 29 were much improved or cured. Improvement was noticed also in all of the expectant mothers who attended regularly." A successful issue in the treatment of children by artificial sunlight can only be obtained when there is regular attendance over a requisite period. The Old Town Hall, central though it may be for many purposes, is a long way from Eltham and still further from New Eltham. It is from the welfare centres in these areas that many patients are recommended for artificial sunlight treatment, and it has been found that the regular attendance of such children at the Woolwich clinic involves a strain on time in travelling and family purse, which many mothers are unable to bear. In consequence after the first few attendances treatment ceases. For this reason the Maternity and Child Welfare Committee have decided that as soon as a convenient site is available they will recommend the Council to provide facilities for artificial sunlight treatment at Eltham. 35 The following Table, No. 12, shows the number of cases and conditions treated during the year:— TABLE No. 12. Cases treated at Sunlight Clinic, 1935. Brought forward from 1934. New Cases. Total. Much Improved or Cured. Improved. I.S.Q. Ceased Treatment. Treatment not yet complete Rickets 36 52 88 36 26 7 19 23 Anaemia, Debility and Mulnutrition 78 162 240 87 75 13 65 69 Catarrhal Children 14 20 34 13 8 3 10 11 Septic Conditions 2 — 2 2 — — — — Nervous Children 4 5 9 3 4 — 2 1 Enlarged Glands 14 15 29 13 10 3 3 4 Miscellaneous Nervous Conditions 1 1 2 1 — — 1 — Miscellaneous Skin Conditions 5 3 8 4 — — 4 — Other Conditions 11 3 14 9 3 — 2 5 Mothers 7 13 20 8 10 1 1 3 172 274 446 176 136 27 107 116 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 those who require further observation or treatment are "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, have been slightly modified in order to deal with special points of importance in the care and comfort of the toddler. 36 Three sessions are held weekly—one at the Old Town Hall, Woolwich, one at Plumstead Health Centre, and one at Eltham Health Centre. These sessions are under the medical charge of Dr. Margaret Emslie, and she reports below on the year's working. In the year under review a slight extension of the service has taken place in that two or three toddlers are so examined each morning session at New Eltham by one of the Assistant Medical Officers. Dr. Emslie's report follows:— "The total number of full inspections is increased this year (1314 as compared with 1,145 in 1934 and 1,105 in 1933), and 505 additional attendances were made as re-inspections. Once more the figures for the nutrition of the children are satisfactory in themselves and show a continuance of the improvement gradually making itself felt in previous years. 61 per cent. were marked as of excellent nutrition; 28 percent. of good, or normal, as compared with 53 per cent. and 35.5 percent. in 1934, and 42 per cent. and 41 per cent. in 1933, the trend obviously being towards the higher standard. The rate for subnormal nutrition has declined in a corresponding manner from 16 per cent. in 1933 and 11 per cent. in 1934 to 10 per cent. this year, and for serious malnutrition the figures are almost too small to show as a percentage (0.2 per cent.). Admitting the essential weakness of such computations as evidence, and the fallibility of external observations only, the tendency towards improvement noted since the first inspections were made is nevertheless consistent and worthy of remark. Anaemia and rickets as accessory conditions relating to the nutritional state both show improvement on the figures previously noted. Anaemia (as assessed clinically) has declined from 17 per cent. (1933) and 21 per cent. (1934) to 14 per cent. and rickets from 30 per cent. (1933 and 1934) to 18 per cent., the first yielding shown in this figure since the clinic started. It is to be hoped the decline is of some significance and may mark the starting point of a falling curve. Passing to certain special symptoms that have received attention in previous reports, the figure for 'behaviour symptoms' amounts this year to the equivalent of 18 per cent. of the total children examined. But this is a total of symptoms, not of children, and more than one symptom was undoubtedly noted in a number of children and sometimes several such evidences of disturbance. For the assessing of disturbed children it would indeed be odd to assume anything less than the presence of a number of disturbed symptoms, viewed and assessed in relation to each other. Each one of these, however, 37 would have its individual interest and be worth observing at any given stage as a warning of potential significance for the future. It is from such observations of individual symptoms that the totals shown in the table are made. The figure 18 per cent. is therefore extremely generous and must not be taken to represent the number of children that at any given time might be estimated to require treatment, or even unusual lines of management. To the figure, however, should be added some proportion of the 6.5 per cent. enuresis cases, a group which has in the last two years been separately recorded (under genitourinary conditions), and which must comprise both behaviouristic and organic cases. Of this group, however, more than half again occurs amongst the two year olds, and at that age enuresis during the night while worth observing (and in individuals always worth recording) can hardly be put down as pathological. A large number of these cases (or symptoms) are simply circumstantial, seen at their best in the only child and big interval families (c.f. Annual Report, 1931), and in the course of time yield to a happier play of circumstance —as for example in the instances cited when the children go to school, acquire normal companionship, form their own social contacts and find worthy outlets for their manifold energies. The truth of this is abundantly seen in the fact that 50 per cent. of the total behaviour symptoms are noted at the age of two (a stage when they are not pathological developments, when they are nothing but fingers pointing a possible way) and by the ages of three and four, when a majority of the children now fortunately are able to go to school, the percentage has already by natural forces halved itself. Nothing could be a clearer indication of the foolishness of placing too much weight on these symptoms as pathological entities—as social tendencies and indications they are real enough—or treating them by precipitate and exaggerated methods by anything more than normalising so far as possible the surroundings and social contacts of the child than this spontaneous tendency of the problem to diminish and solve itself. Further, the marked change in the attitude of parents towards school for their pre-school age children that has occurred since the facilities were provided (in the interval since the 1931 report was written), is the best testimonial possible to the success of these provisions and the best augury for happier times for the lonely and difficult child in the future. The figures for symptoms themselves have come tumbling down in the last three years in a manner which would excite the frankest scepticism were it not that the great majority of the total toddlers' examinations are still carried out by the same observer, and she at least is certain that she has not slackened her standards nor begun to omit recording symptoms. The figures for dental caries have been recorded this year with some endeavour at precision in regard to the amount of damage present. The total figure shows a slight diminution, 22 per cent. of cases as compared with 24 per cent. last year and 25 per cent. in 1933, but the figure for caries at the age of two years has relapsed from 3.5 per cent. of cases in 1934 to 6.7 per cent. In 1933 this figure was 9 per cent. so that last year's improvement was illusory 38 or at least evanescent. At the age of three, the incidence of caries this year is 19 per cent., compared with 27 per cent. in 1934 and 28 per cent. in 1933; and at four years 44 per cent., compared with 48 per cent. in 1934 and 45 per cent. in 1933. On the whole, therefore, there is a minor improvement throughout the 2—6 period, though the high incidence at the age of four remains obstinate and is disappointing in view of the facilities for early detection of defects that are provided and of which the parents, as a rule, take willing advantage. Analysing the degree of defect now we get further disconcerting figures. Forty per cent. of all children showing caries are found to have two teeth or less involved, 8.5 per cent. have three or four, and 51 per cent. have four or more already gone when they are inspected. Even at the age of two the percentage of defective children showing extensive defect is not much less than the latter average figure for the 2—5 period. Hypoplasia as apart from caries is rioted at that age in 21 per cent.: no doubt caries already covers a number of additional cases of this. These are macroscopic observations only, but they go to show that the developmental element in caries is probably important—as some laboratory research has shown—-and that the majority of children who are going to have faulty teeth in their first dentition have the defect already well established by the age of two years. Prevention, therefore, more than ever is the watchword since it is evident that treatment cannot overtake the effects of a bad beginning. The figures for children showing enlarged tonsils and/or adenoids remains high (50 per cent.), but the operation figure is low, under 3 per cent., a figure lower than we have shown before and very much lower than the percentage of operation cases shown by certain other authorities. It must be remembered that each case is assessed individually on its merits and not from the point of view of statistics; that treatment also should be not merely therapeutic but preventive—preventive of further damage that might be incurred should diseased tonsils remain in situ or adenoids obstruct the nasal airway and invite infections of the sinuses communicating with the nose or of the ear. The small rate of operation cases would be no matter for congratulation if the same children not operated on now were to fall victim after some short interval—say soon after attendance at school—to symptoms requiring emergency treatment of the nose and throat. This point of view, naturally, has to be continually kept in mind when deciding whether enlargement of the tonsils matters or not; and it is given very earnest consideration in each case. It is to be hoped, therefore, that the freedom from symptoms and absence of secondary signs of infection (such as catarrhs, deafness and seriously enlarged glands) which has led to the great majority of cases being put down for observation only, will stand them in good stead at a later date. It should be said further in the same connection that 30 per cent. of children showed definite enlargement of anterior or posterior cervical glands, 39 often found to have partially subsided on re-examination. Each case in which the enlargement seemed suspicious—apart from frank co-existing infection of the nose and throat—was sent to the Tuberculosis Officer for examination, and many were submitted to the intradermal tuberculin test. In only two cases during the year, however, was the evidence such as to cause a diagnosis of tuberculous glands to be made. Of the cases showing deformity due to rickets or postural conditions and deformities due to other causes, 9 per cent. were referred for special advice under the Council's scheme (advice re shoes, exercises, etc.) and one-half of these were sent on further to see the orthopaedic specialist of the Invalid Children's Aid Association. Of the 42 cases in which squint was found—a condition now put under active treatment at a very early age—it was interesting to note that 4 cases had already been placed under treatment and supplied with glasses by their parents before coming under the observation of the clinic. The other matters in the report are mostly self-explanatory and do not call for special comment. The assessment of alimentary defects is not complete and cases of constipation have been set aside for more careful recording and analysis next year. With an eye to the future, it might be as well perhaps to record once more the advantages that would accrue, if an arrangement could be organised for checking up the observations made in regard to anemia and rickets (serious social scourges as these are) by suitable methods of laboratory analysis." The findings at the toddlers' inspection clinics are summarised in the following Table:— TABLE No. 13. Medical Inspection of Toddlers, 1935. Disease, Defect or Condition. BOYS. Age last Birthday. GIRLS. Age last Birthday. 2 3 4 2 3 4 Total. Total Children Examined 270 183 206 238 212 205 1,314 Nutrition— (a) Excellent 185 102 77 184 148 109 805 (b) Normal 71 58 76 46 54 68 373 (c) Sub-normal 14 22 51 8 10 28 133 (d) Bad — 1 2 — — — 3 Muscular Tone— (a) Excellent 120 119 170 131 157 157 854 (b) Good 144 64 32 103 55 47 445 (c) Poor 6 — 4 4 — 1 15 40 Medical Inspection of Toddlers, 1935—continued. Disease, Defect or Condition. BOYS. Age last Birthday. GIRLS. Age last Birthday. 2 3 4 2 3 4 Total Clothing and Footgear— (a) Good 262 178 201 230 207 199 1,277 (b) Fair 8 5 5 8 5 6 37 Cleanliness— (a) Excellent 245 170 198 220 206 198 1,237 (b) Fair 25 13 8 18 6 7 77 (c) Dirty — — — — — — — Heart and Circulation— (a) Functional Conditions 52 33 43 19 37 39 223 (b) Organic Heart Disease — 1 — 1 — — 2 Anaemia 31 20 25 40 33 37 186 Respiratory System— Bronchitis 9 7 9 7 4 16 52 Asthma — 1 1 — 1 1 4 Other Diseases — — 2 — — — 2 Nervous System— Behaviour Symptoms 51 21 19 44 28 26 189 Minor Retardation 38 4 7 22 8 2 81 Mongolism — — — 1 1 — 2 Alimentary System— Worms 2 3 2 2 5 5 19 Acidosis Attacks — 2 3 — 2 1 8 Others 1 1 1 — 2 — 5 Genito-Urinary System— Enuresis and Frequency 28 8 6 19 19 5 85 Other Conditions 2 — 1 — 1 — 4 Skin Conditions— Infective Skin Conditions 4 2 2 6 5 4 23 Urticaria 3 3 — 3 3 1 13 Eczema 4 — — 3 — 1 8 Ichthyosis 3 2 2 — 1 — 8 Other Diseases 2 — — 2 2 1 7 Eye Defects and Infections— Squint 7 9 10 7 6 3 42 Blepharitis 3 1 3 3 4 — 14 Conjunctivitis — 2 — 2 1 — 5 Ear Conditions— Otorrhoea, etc. 8 1 5 4 4 8 30 Teeth— Caries 18 30 100 16 46 83 293 Malocclusion 26 6 6 21 17 — 76 Hypoplasia 4 2 7 3 2 1 19 Rickets— (Cases clinically considered as showing definite evidence of Rachitis) 60 38 47 37 23 31 236 41 Medical Inspection of Toddlers, 1935—continued. Disease, Defect or Condition. BOYS. Age last Birthday. GIRLS. Age last Birthday 2 3 4 2 3 4 Total Other Diseases and Defects Rheumatism — 2 2 2 1 1 8 Tuberculous Glands — — — — 1 1 2 Hypopituitarism — 1 — — 1 — 2 Other diseases 1 I 2 — 4 3 11 Nose and Throat— Enlarged Tonsils Enlarged Tonsils and Adenoids 147 95 105 95 107 116 665 Adenoids Enlarged Glands— Tonsillar 63 53 61 37 50 61 325 Posterior Cervical 26 17 20 17 24 27 131 Development Conditions— Umbilical Hernia 3 1 — 2 3 2 11 Inguinal Hernia — 1 — — 1 1 3 Naevus 2 1 — 4 2 — 9 Others 1 1 1 3 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 circumstances scales being used as tests of necessity. During the year 103 applications were received: 96 were supplied —66 free, 13 at half cost, and 17 at cost price. Compensation to 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 seven instances. Payment of Midwives' Fees.—During the year the appropriate Committee of the Council decided that the Maternity and Child Welfare Scheme should be enlarged by adding a provision guaranteeing the payment of midwives' fees where such appeared to be necessary or desirable, and authorised the Medical Officer of Health, if he was satisfied that the interests of an expectant mother were not prejudiced thereby, to make a payment not exceeding 25s. in respect of any one confinement, subject to the presentation of a report to the Committee. No payments were made during the year. 42 Administration of the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926.—The Council's Scheme for the diagnosis and treatment of these conditions provides for the services of a consultant—Mr. H. G. Taylor, F.R.C.S.—for the provision of nursing assistance, for hospital treatment in the County Council's hospitals, and for bacteriological examination where necessary. The extent to which it has been made use of has been reported on in that part of the Infectious Diseases Section of the Report which deals with the notification of these diseases each year since 1927. Obstetric Complications in Private Practice.—In September, 1931, the Council arranged for the services of Mr. H. G. 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 case. No case was dealt with under this scheme during the year. Home Helps.—In 1929 the Council established a scheme for the supply of home helps, in order to deal with what appears to be a very apparent need. In the early years the service was little used. It may be that there is among many mothers an unwillingness to accept someone else into their home; it may be that there is a want of mutual confidence, or a feeling of distrust. Anyhow this service grew slowly, although it was part of it that the mother in certain cases should be allowed to nominate her home help, subject to the approval of the Medical Officer of Health. In 1934 there were 40 occasions on which a home help was supplied, but in 1935 there were 86 applications, and 80 home helps were provided. The total cost of the service was £264 3s. 6d. 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 at the Eltham and Plumstead Health Centres; to a private practitioner or to a hospital. During the year 309 children were sent to these clinics and for each case the Council paid 5s. 0d. Spectacles have been provided under this scheme at an additional cost to the Council. TABLE No. 14. Brewer Street. Eltham. Plumstead. Impetigo 9 24 14 Ear Discharge 21 27 28 Eyes 50 33 28 Miscellaneous 9 49 17 89 133 87 43 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 87 including anaesthetic days. TABLE No. 15. Expectant Mothers. Nursing Mothers. Children under 5. No. Attendances. No. Attendances. No. Attendances. Woolwich 133 226 54 100 121 128 Eltham — — — — 141 228 Plumstead — — — — 120 181 133 226 54 100 382 537 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 supplied in previous years. Thirty-one sets (complete or partial) of artificial teeth were supplied during the year at a total cost of £144 2s. 0d. Payments by mothers amounted to £74 3s. 6d. Orthopaedic 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 £168 6s. 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 44 approved by him. Excluding 106 children where wedges only were necessary and 31 others where temporary splinting only was required, the children referred to the clinic required treatment for the following conditions:— TABLE No. 16. Cases Treated at Orthopaedic Clinic, 1935. Type of Case. Number remaining over from 1934. New Cases. Total Cases. Number who completed treatment by end of year. Number with treatment not completed. Talipes (Club Foot) 2 9 11 7 4 Talipes (Flat Foot) 1 6 7 7 — Rickets— General 4 11 15 12 3 Genu Valgum (Knock Knee) 3 50 53 45 8 Genu Varum (Bow Leg) 7 35 42 38 4 Infantile Paralysis — 1 1 — 1 Bad Posture 1 5 6 6 — Muscular Weakness — 7 7 5 2 Mouth Breathing 1 4 5 3 2 Torticollis — 11 11 7 4 Injuries — 1 1 1 — Other Deformities — 2 2 2 — Other Diseases 1 5 6 3 3 20 147 167 136 31 Provision of Nursing Assistance.—In Section I. of the Report the general scheme of nursing assistance is described in full. The extent to which this service has been made use of in respect of specific diseases is fully reported on in the appropriate portions of the Infectious Diseases' Section of the Report. In addition grants were made to the nursing associations in respect of 44 children treated for thread-worms at approximately tenpence per visit, amounting in all to £18. Day Ambulance.—In March of this year the London County Council decided that, as from 1st April, 1935, the London Ambulance Service would be available, without charge, throughout the day and night, for the conveyance from any address within the County of London to hospitals or municipal institutions within the County of parturient women who have made arrangements for their admission to such hospital or municipal institution. 45 The removal is undertaken subject to the following conditions:— (1) The patient must have in her possession an ambulance card issued by the Council, a supply of which will be forwarded to each hospital or institution. (2) The patient must be accompanied by a doctor, nurse or female friend. (3) The patient must be wrapped in blankets ready for her removal when the ambulance arrives. This extension of facilities which hitherto had only been available between the hours of 11 p.m. and 8 a.m., does not affect the procedure to be adopted in urgent cases, i.e., cases attended by a doctor or midwife in which hospital treatment may become a matter of urgency. In these cases an ambulance can always be obtained without charge on application by telephone, but the patient must be accompanied to hospital by a doctor or midwife. In consequence of this resolution the agreement with the London County Council by which the Council hired ambulances for this purpose during the day from the London County Council automatically terminated. In the first quarter of the year, however, the day ambulance was supplied in three cases. 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 173. Of these 158 were discharged cured or very much improved in health, 6 were discharged as improved, and 3 died. No children were transferred to other hospitals, 2 others were discharged showing no improvement, and the number remaining in hospital at the end of the year was 4. The surgical conditions for which these children were admitted included:- enlarged tonsils and adenoids, phimosis, hernia, injury, pyloric stenosis, cleft palate, dermoid cyst, cervical adenitis, etc., and those admitted for medical treatment included children suffering from prematurity, malnutrition, pneumonia, bronchitis, diarrhoea, vomiting, enuresis and pemphigus, etc. Some children were admitted for observation. Institutional Midwifery.—(1) British Hospital for Mothers and Babies.— I There are 42 beds in this hospital, and I am informed by Miss Gregory, the Secretary of the Hospital, that 794 babies were born during the year. At the ante-natal clinics in connection with this hospital, 8,669 attendances were made, and at the infant clinics, 2,773 attendances. In addition there were 180 extern cases. The number of mothers admitted under the Council's scheme was 145, the nett cost to the Council being £943 16s. 0d. 46 (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 206, and 31 mothers were admitted for ante-natal or emergency treatment. The number of attendances at the antenatal clinic was 1,433. The number of mothers admitted under the Council's scheme was 61, the nett cost to the Council being £444 14s. 6d. Ante-Natal Treatment and Emergencies.—The number of cases admitted for ante-natal or emergency treatment under the Council's scheme was 3. The reasons for admission were albuminuria 2 and vaginal prolapse 1. 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 105 children, the total cost of whose convalescent treatment amounted to £675 13s. 2d. The Council's grants amounted to £200. The children were sent away for periods varying from 3 to 24 weeks, and payment was only made in respect of children sent to homes approved by the Medical Officer of Health. 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 2 mothers were so admitted to convalescent homes. During the year the Council learned from the Association of Maternity and Child Welfare Centres that they were in treaty with a charitable Trust which has considerable funds to be applied to the building and equipment of convalescent homes, with a view to opening one at Staplehurst, Kent, for ten convalescent mothers with their babies under one year of age, and eight convalescent children without their mothers, aged one to five years. Before the Association could secure a grant they had to satisfy the Trustees that the beds would be fully occupied, and they asked if this Council would be prepared to make use of this accommodation. It was proposed that patients should be received at the following rates:- 25s. per week for a mother and breast-fed baby; 30s. per week for a mother and bottle-fed baby, and 15s. per week for a toddler. The travelling expenses for each patient would be the only extra charge. The Council agreed to co-operate in this scheme. 47 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. In the administration of this service, economic circumstances scales have been adopted by the Council and revised from time to time. In May they were revised and are now as set out below:— No. in Family. Free Per head. Half-cost Per head. s. d. s. d. 1 14 0 16 0 2 12 0 14 0 3 10 0 12 0 4 9 0 10 0 5 8 0 9 0 6 and over 7 0 8 0 after deduction of rent only. In 1934 the Council agreed to co-operate with the London County Council with regard to the supply of extra nourishment to maternity cases where domiciliary relief was being granted by the County Council. The scheme was subsequently enlarged to include delicate children whose parents were in receipt of out-relief. It was anticipated that when the Unemployment Assistance Board assumed responsibility for the grant of assistance to certain persons within the scope of Part 2 of the Unemployment Act, 1934, it would affect the scheme of co-operation to a considerable extent, but in point of fact it did not do so. At the end of the year it was estimated that the amount due from the London County Council in respect of extra nourishment was £433, compared with £353 in part of the previous year. The approximate cost of the supply of milk, etc., to necessitous mothers and children, excluding any payments due by the London County Council, was as follows :— Dried Milk, £2,000 15s. 0d.; Fresh Milk, £2 5s. 0d.; Dinners, Nil. 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 to 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. 48 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, twelve male inspectors and three part-time female inspectors. This is an increase of two. Seven male inspectors were engaged wholly on district work, two wholly on food inspection, one on inspection of shops and food premises, one in charge of disinfection and disinfestation and one on special housing work. The three part-time female inspectors were engaged partly on health visiting and partly on sanitary inspection. 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. Drainage .—Practically every house in the Borough is connected with the water carriage system for the disposal of sewage. The exceptions are in the outlying parts of Eltham. The number of cesspools at the end of the year was 18, 10 of which were in Plumstead and 8 in Eltham. 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, 59 complaints were received regarding the defective action of combined drains; on investigation, 267 houses in all were found to be affected. In all systems, except five, the obstruction was of a temporary character. In 14 instances choked interceptors were found. Costs recovered from the owners amounted to £1 19s. 0d. In the following 5 instances reconstruction was necessary, and the work was carried out by the owners after the service of notices:— 101-105, Parkdale Road; 14-32, Roydene Road; 120-124, Woolwich High Street; 70-71, Warwick Street; 312-322, Wickham Lane; 95-105, Genesta Road. Six single private drains were cleared at the request of the owners from whom the costs, amounting to £1, were recovered. Condition of the River Thames.—During the summer months the Thames was again offensive, and as in 1934, this was the subject of complaints, not only from individuals, but also from the Woolwich Chamber of Commerce. London sewage effluent is discharged into the river from two main outfalls belonging to the London County Council, one on the north side near Barking Creek, and the other at Crossness, both in close proximity to Woolwich. The odours which emanate from time to time from the River Thames are a serious nuisance, and representations in this respect were, in August, 1935, once again made to the London County Council. 49 In reply, the Borough Council were informed that the County Council had been doing what they could to prevent any cause of complaint of unpleasant smells from the River Thames so far as the effluent from the Council's main drainage outfalls affected the condition, and that for some time the Council had been giving special and costly treatment to the effluent to render it as satisfactory as possible. The County Council further pointed out that there were other factors which contributed to the state of the river, notably the drought which had adversely affected the position and which had had a prejudicial effect on the condition of the river owing to the considerable reduction of flow. Whether this is a sufficient explanation or not, it is quite certain that the Thames would not be so offensive at Woolwich were it not for the fact that the County Council pour 270 million gallons of sewage, most of it inadequately treated, into the river each day, four times as much as reaches the Thames from other authorities above London. Four years from now the County Council will be able to say that they are treating 20 per cent. of London sewage by new plant, which is now being installed, but it is regrettable that the largest public health authority in the country is at the present time discharging its sewage into the river in such a state that during hot weather it produces a serious nuisance to those who live or work in this part of the Metropolis. 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. In 1934, the Council decided to improve the efficiency of the method of disposal of refuse at the Destructor by providing a new hopper and refuse handling plant, together with the necessary conveyors, The alterations, including the erection of a new chimney shaft, were completed during the year at a cost of £18,031. In October, the Council decided to adopt a scheme for the salvage of waste paper and to install the necessary apparatus. Offensive trade refuse is removed by contractors, who make their own arrangements with the shopkeepers as to the time and day of removal. The contractors provide air-tight receptacles of a type approved by your Medical Officer of Health, the number of these supplied varying according to the individual requirements of the shop-keepers. The contractors during the year decided to raise the weekly charge for the removal of these tins, and fixed the minimum charge at 1/- per week instead of the old flat rate of 6d. per tin. Inoffensive trade refuse is removed by the Works Department at a charge of five shillings per load, and 2,211 tons of such refuse were removed. 50 Complaints.—During the year, 3,472 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 wll be found in Table No. 17. In connection therewith the number of intimation and statutory notices served was 2,459 and 539 respectively. The statutory notices related to 435 premises and included 416 general, 27 ashpit, 19 water-closet and 34 paving notices. In addition to these notices under the Public Health (London) Act, 1891, 42 notices were served under London County Council (General Powers) Acts and under By-laws, and one under the Rats and Mice (Destruction) Act, 1919. In 92 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. Two of the summonses were not heard until January, 1936. In Table No. 18 will be found a summary of the nuisances abated and defects remedied. TABLE No. 17. Inspections. Housing Survey — Houses Inspected 1,008 Drainage Inspections 1,496 Drains Tested by Smoke Test 383 Clearance Areas — Houses Surveyed 194 Drains Tested by Water Test 43 New Houses 1,279 Complaints Investigated 3,472 Tents and Vans 55 Outworkers' Premises 181 Factories 303 Houses Let in Lodgings 454 Workshops 426 Houses re Infectious Disease 1,086 Workplaces 111 Houses re Smallpox Contacts 33 Shops Act, 1934 704 Houses re Verminous Cases 6,997 Theatres and Cinemas 18 Houses re Scabies Cases 128 Rag and Bone Premises 6 Houses re Other Diseases 134 Urinals Accessible to the Public 174 Common Lodging Houses 71 Women's Lavatories 202 Overcrowding Investigated— Rooms - Smoke Observations 16 Special Inspections re Rats 268 Underground Rooms Illegally Occupied 1 Miscellaneous 1,495 Re-Inspections 9,307 51 No figures are shown under overcrowding as this, in accordance with the provisions of the Housing Act, 1935, was the subject of a special survey, the results of which are to be found in the Housing Section of the Report. TABLE No. 18. Nuisances Abated, Cleansing— Sinks Repaired or Provided 252 Interiors Cleansed 891 Wastes Cleansed 15 Rooms Cleansed 1,730 Wastes Trapped or Repaired 285 Damp Conditions— Water Closets— Walls 653 Flushing Apparatus Repaired 181 Sites 7 „ „ Renewed 53 Roofs 610 New Pans 253 Rain Water Pipes and Gutters 323 New Traps 242 Others 50 Foul Pans Cleansed by Owner 19 Dilapidations— Occupier 35 Walls 809 Additional W.C.s Provided 8 Ceilings 572 Doors and Fastenings Remedied 49 Floors and Hearths 188 Coppers 88 Dust Bins Provided 429 Stoves 185 Underground Rooms Closed 1 Others 67 Overcrowding—Cases Remedied 17 Verminous Conditions— Water Supply— Rooms Cleansed 1,481 Additional 4 Defective Lighting— Reinstated 12 Windows Repaired 211 Cisterns Cleansed — „ Enlarged 2 „ Covered 14 „ Additional 6 „ Removed 3 Defective Ventilation- Foul Accumulations— Windows Rendered Usable 418 Manure Removed 9 „ Additional Provided 7 Offensive Accumulations Removed 33 Other Means 4 Defective Paving— Back Yards Cleansed 13 Yards Re-paved 150 Dung Pits Provided — „ Repaired 110 Rats— Scullery Floors Re-paved or Repaired 54 Drains Repaired in Consequence 167 House Drains— Premises Rat-proofed 19 Defective Drains Repaired 235 Other Effective Measures 21 Choked Drains Cleared 284 Rag and Bone Premises— Vent Pipes Repaired 51 Premises Cleansed — Soil Pipes Repaired 19 Rain-proof Premises Provided Vermin-proof Conditions — Gullies Fixed 87 New Drainage 14 vided — Rain Water Tanks Repaired - Miscellaneous 18 „ „ „ Abolished 2 52 Shops Act, 1934.—The Act deals mainly with the employment of shop assistants under eighteen years of age and with the arrangements in shops and warehouses for the health and comfort of workers. The Council in their capacity as sanitary authority have to enforce some of these welfare provisions. The remainder of the Act is administered by the London County Council. The term " Shop" includes any premises where any retail trade or business is carried on, any wholesale shop and any warehouses kept for the purposes of trade by any person carrying on any retail trade or business, or by any wholesale dealer or merchant. The Council delegated all their powers, except the appointment of inspectors, to the Public Health Committee. The welfare provisions, with the enforcement of which this Council are charged, are those which deal with ventilation, heating and the provision of sanitary conveniences, and the Medical Officer of Health and all the Sanitary Inspectors were appointed inspectors for this purpose. There are approximately 2,000 shops in the Borough. During the year a start was made on their systematic inspection, and 704 were so inspected. Decisions as to the standards to be aimed at or accepted have been postponed until the shops position as a whole can be reviewed. The problems to be faced include defining the limits of a reasonable temperature in open-fronted shops, shops with open doorways and shops with closed fronts; settling what is suitable and sufficient ventilation in these types; deciding what "conveniently available" means in the case of sanitary conveniences, or what special circumstances would justify the issue of a certificate of exemption, and so on. Until the extent of the problem is known, it is, no doubt, wiser to defer these decisions. Certificates of exemption with regard to sanitary conveniences were issued in four instances. Smoke Abatement.—The problem of smoke abatement in Woolwich is not a large one. During the year, sixteen special observations were made to ascertain whether there were any breaches of the law regarding smoke emission. One nuisance was discovered and a notice was served. This resulted in the abatement of the nuisance and no legal proceedings were necessary. 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 280,437; Turkish and Russian Vapour Baths, 12,988; Slipper Baths, 174,436; and the Public Washhouse, 16,229. 53 Filtration plants have been installed at the Woolwich and Plumstead Baths, and the chemical and bacteriological content of the water is regularly examined by members of the Baths Staff. There are two open-air swimming pools in the Borough, one in Eltham Park and one in the Victoria Gardens, North Woolwich. These belong to the London County Council, and filtration plants have been installed at both. There are also paddling pools in the Borough, one belonging to the Woolwich Borough Council on their Middle Park Estate, and one in Eaglesfield, belonging to the London County Council. There are no filtration plants at either of these. Factory and Workshop Act.—The following Table is in the form adopted by the Secretary of State to provide for uniformity throughout the country in the presentation of certain particulars of this work which lend themselves to statistical treatment:— TABLE No. 19. Factories, Workshops and Workplaces. 1.—Inspection. Premises. Number of Inspections. Written Notices. Occupiers. Prosecuted. (1) (2) (3) (4) Factories (including Factory Laundries) 303 6 — Workshops (including Workshop Laundries) 426 15 — Workplaces (other than Outworkers' premises) 111 1 — Total 840 22 — 54 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 26 26 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of Floors — — — — Other Nuisances 6 6 — — Sanitary Accommodation Insufficient - - - - Unsuitable or Defective 24 24 — — Not separate for Sexes — — — — Offences under the Factory and Workshop Acts :— Illegal Occupation of Underground Bakehouses (S. 101) — — — — Other Offences — — — — Total 56 56 — — 3.—Outwork in Unwholesome Premises : Section 108. Nature of Work. Instances. Notices Served. Prosecutions. (1) (2) (3) w Wearing Apparel— Making, etc. 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 268. In 167 instances it was necessary to secure the repair of defective drains. Nineteen premises were made rat-proof, and other effective measures were taken in 21 instances. The number of statutory notices served under the Rats and Mice (Destruction) Act, 1919, was one. During the 55 National Rat Week, held from 4th to 9th November, special measures were undertaken with the co-operation of the many large firms in the Borough and the Borough Engineer. The number of baits laid in sewers in Woolwich and Plumstead was 11,553. Fouling of Footways by Dogs—By-law.—In 1934 the Council made a By-law which was sanctioned by the Home Office to come into operation from 1st January, 1935. The administration of the By-law was delegated by the Council to the Public Health Committee during the year, and officers of the Health Department make periodic observations under the By-law. Three summonses were issued during the year, particulars of which will be found in Table No. 22 at the end of this Section. 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. It is necessary, however, in the first place for the Council to obtain the consent to the measures adopted by them from the person or body in whom the building or land, upon which the birds congregate, is vested. The powers of the Council under this Section have been delegated to the Health Committee. No action was taken during the year. Rag and Bone By-laws.—One of the By-laws made by the London County Council prohibits the distribution or sale of any article of food or any balloon or any toy from any premises used for the business or from any cart, barrow or other vehicle or receptacle used for the collection or disposal of rags and bones, etc., or in any other way connected with the business. A practice has grown up whereby bills shewing no name or address are distributed outside schools inviting school children to supply old woollen articles and rags in exchange for toys. These are distributed by men who are not principals and who, when challenged, do not disclose who their principals are, and who accept rags and give toys in exchange. Five persons were caught during the year, but it was only possible to take legal proceedings in four instances. The results of these proceedings will be found in Table No. 22. Rag Flock Act.—Six 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. All the samples complied with the Regulations, as the results of analyses show, the number of parts of chlorine being, respectively, 3, 3, 6, 6, 7, and 12. 56 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. 20. Sun Street. Sun Street (Infectious). Eltham. All Mortuaries. Number of Bodies Received 1934 1935 (a) For inquest — — — — (b) For Custody 15 — 5 14 20 15 — 5 14 20 Number of Post-Mortem Examinations - — — — Cemeteries.—The Council own three cemeteries within the Borough, two in Plumstead and one in Eltham. The two in Plumstead are known respectively as the Woolwich Cemetery and the Plumstead Cemetery, the Woolwich one being divided into two portions, the Old and the New. Eltham Cemetery was opened for interments in April, 1935. Burials also take place in Eltham Churchyard, and rarely in a private burial ground within the grounds of Christchurch 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. 21. Number of Interments. 1933 1934 1935 Woolwich Cemetery 645 661 584 Plumstead Cemetery 769 755 681 Eltham Cemetery — — 66 Eltham Churchyard 252 236 166 57 Exhumations.—During the year two exhumations under Home Office Licence were carried out. Offensive Trades.—By the Transfer of Powers Order, 1933, consideration of, and decision on applications for 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. 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. Two such applications were made during 1935. Sandpits.—It is the practice of the Council to disinfect all children's sandpits under their control at regular intervals during the year. 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. The Council have appointed the Medical Officer of Health, the Chief Sanitary Inspector and two district inspectors as inspectors under the Act. The Act will come into force on the 1st May, 1936. 58 Legal Proceedings.—The particulars of the various prosecutions instituted under the various Acts are set out in detail in the following Table, No. 22:— TABLE No. 22. Prosecutions under Public Health and Kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1. 28th February Being a person having charge of a dog on lead allowed said dog to deposit its excrement on public footway. Conway Road Dismissed under Probation of Offenders' Act. 2. 11th July Insufficient ashpit 8, Ladysmith Road Dustbin supplied. Summons with drawn. 3. 24th July Did knowingly suffer to be brought on to his premises rags from a dust cart. 143, Crescent Road Fined 20s. 0d. 4. 11th July Did distribute toys from a vehicle in exchange for rags. Marmadon Road Fined 5s. 0d. 5. 7th October Did distribute toys from a vehicle in exchange for rags. Purneys Road Fined 20s. 0d. each (two defendants). 6. 7th October Did distribute toys from a vehicle in exchange for rags. Kingsholm Gardens Fined 20s. 0d. or five days. 7. 18th October Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. Eltham High Street Fined 5s. 0d. 8. 18th October Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. Wellington Street Fined 2s. 6d. 9. 5th November Did permit a newly erected house to be occupied without having first obtained a water certificate. Well Hall Road Ordered to pay £2 2s. costs. 10. 11th December Did distribute toys from a barrow in exchange for rags. Elizabeth Street School. Fined 2s. 6d. 59 SECTION V. HOUSING The following Table shows the main housing figures for the year set out under the headings given in Circular 1492 issued by the Ministry of Health for securing uniformity in the presentation of these statistics. TABLE No. 23. 1.—Inspection of Dwelling Houses during the Year. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,091 Inspections made 15,521 (2) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 1,008 Inspections made 2,067 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 207 (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 2,296 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 1,923 * 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 10 (2) Number of dwelling houses which were rendered fit after service of formal notice:— (a) By Owners 5 (6) By Local Authority in default of owners 1 (b) Proceedings under the Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 435 60 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 373 (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 10 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 7 (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 1 (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 1,008 houses were so surveyed. These figures, although greater in number than those of the previous year, are less than the average owing to the fact that the time of the Sanitary Inspectors was taken up in dealing with unhealthy areas and with the overcrowding census, referred to later in the report. In tabular form, in Table No. 24, is shown a detailed statement of specific action (except action taken in respect of clearance areas) taken under the Housing Acts during the year. TABLE No. 24. Action under the Housing Acts. Premises. Action Taken. Date. Ann Street, 39 Notice under Section 17 11th January. do., 3 Demolition Order 30th January. do., 5 do. do. do., 7 do. do. do., 9 do. do. Dumblane Road, 13 do. do. Katrine Terrace, 2 do. do. 61 Clearance Areas.—During the year much progress has been made in the Council's programme. The steps taken and the situation at the end of the year in each area represented are set out in the following pages :— (1) Shepherds Farm Hutments.—The Clearance Order in this case was confirmed by the Minister, without modification, under date 24th April, 1934, and re-housing was provided partly on the site of the hutments and partly on an adjoining portion of the Page Estate. TABLE No. 24—continued. Premises. Action Taken. Date. Footscray Road, 153 Notice under Section 17 5th March. Ann Street, 8 do. 2nd April. Salutation Alley, 4 do. 3rd April. do., 5 do. do. Cottage rear of 19, Nightingale Vale. Demolition Order 1st May. St. Mary Street, 24 Notice under Section 17 18th May. The Avenue, 1 Demolition Order 29th May. Avenue Cottage, Shooters Hill. do. do. Saunders Road, 29 Closing Order 24th July. Whitworth Road, 54 Undertaking that house will not be used for human habitation accepted. do. do., 54a do., do. do. do., 56a do., do. do. The Grove, 15 Notice under Section 17 1st August. Jackson Street, 32 do. do. Prospect Row, 24 Undertaking that house will not be used for human habitation accepted. 2nd October. The Cottage, Mortgrammit Square. Representation 9th October. Armstrong Place, 12 do. 6th November. do., 13 do. do. Elm Terrace, 12 Undertaking that house will not be used for human habitation accepted. 4th December. Woolwich High Street, 130 Demolition Order do. Ordnance Road, 57 Notice under Section 17 9th December. do., 58 do. do. 62 At the end of the year 66 out of 67 hutments had been demolished, 307 persons being displaced. (2) Prospect Row and Kidd Street.—The Clearance Order was confirmed by the Minister, without modification, under date 9th January. At the end of the year all the cottages had been demolished, 36 persons being displaced. Re-housing was provided in the same scheme as for area No. 1. (3) St. Thomas' Cottages, Princes Road.—The Clearance Order was confirmed by the Minister, without modification, under date 9th January. Re-housing was provided in the same scheme as for area No. 1. At the end of the year all the cottages had been demolished, 13 persons being displaced. (4) Eltham High Street.—This area consisting of 14 houses was represented by me to the Council as an unhealthy area on 14th June, 1934. The houses included in the area are as follows :— Eltham High Street Nos. 8, 10, 12, 14, 16, 18, 20. Kirks Yard Nos. 1, 2, 3, 4a. Halams Cottages Nos. 1, 2, 3. The number of occupants was 46. The Council made a Clearance Order on the 12th June, 1935 ; a Ministry of Health Inquiry was held on the 20th August, and the order was confirmed by the Minister without modification, on the 12th October. Re-housing is to be provided in the same Scheme as for Area No. 1. (5) Keemor Street.—On the 5th March, 1935, I represented this area consisting of six cottages as an unhealthy area. The cottages in question are known as Brickfield Cottages, Nos. 1, 2, 3, 4 and 5, and Keemor Street, No. 13. The number of occupants was 20. The Council made a Clearance Order on the 12th June, 1935 ; a Ministry of Health Inquiry was held on 20th August, and the Clearance Order was confirmed by the Minister, without modification, under date 12th October. Re-housing is to be provided in the same Scheme as for Area No. 1. (6) Bell Water Gate.—On the 10th May, 1935, I represented this area consisting of five houses as an unhealthy area. The houses in question are known as Bell Water Gate, Nos. 2, 3, 4, 5 and 6. The number of occupants was 26. 63 The Council made a Clearance Order on the 2nd October, 1935. No Inquiry had been held at the end of the year. Re-housing is to be provided on the Horn Park Estate. (7) Timbercroft Lane (No. 1).—On the 6th June, 1935, I represented this area consisting of two cottages as an unhealthy area. The cottages in question are known as Timbercroft Lane, Nos. 3 and 5. The number of occupants was 6. The Council made a Clearance Order on the 25th September; there was no local Inquiry ; but after inspection the Minister confirmed the Order, without modification, under date 25th January, 1936. Re-housing is to be provided on the Timbercroft Lane Estate. (8) Timbercroft Lane (No. 2).—On the 6th June, 1935, I represented this area consisting of six cottages as an unhealthy area. The cottages in question are known as Timbercroft Lane. Nos. 9, 11, 13, 15, 17 and 19. The number of occupants was 21. The Council made a Clearance Order on the 25th September; there was no local Inquiry; but after inspection the Minister confirmed the Order, without modification, under date 25th January, 1936. Re-housing is to be provided on the Timbercroft Lane Estate. (9) Timbercroft Lane (No. 3).—On the 6th June, 1935, I represented this area consisting of eight cottages as an unhealthy area. The cottages in question are known as Timbercroft Lane, Nos. 21. 23. 25. 27. 35. 37. 39 and 41. The number of occupants was 34. The Council decided to purchase the area by agreement, and the Minister has intimated that he is prepared to regard it as a Clearance Area for re-housing purposes. Re-housing is to be provided on the Timbercroft Lane Estate. (10) Hulk Cottages.—On the 6th June, 1935, I represented this area consisting of five houses as an unhealthy area. The houses in question are known as Hulk Cottages, Nos. 1, 2, 3, 4 and 5. The number of occupants was 35. The Council made a Clearance Order on 3rd September; a Ministry of Health Inquiry was held on 26th November, and the Order was confirmed by the Minister, without modification, under date 25th January, 1936. Re-housing is to be provided on the Horn Park Estate. 64 (11) The Orove.—On the 6th June, 1935, I represented this area consisting of two cottages as an unhealthy area. The cottages in question are known as 16 and 17, The Grove. The number of occupants was 7. The Council made a Clearance Order on the 29th October ; no Inquiry had been held by the end of the year. Re-housing is to be provided on the Horn Park Estate. (12) Nightingale Vale and Montague Cottages.—On the 11th July, 1935, I represented this area consisting of eight houses. The cottages in question are known as Nightingale Vale, Nos. 23, 25, 27 and 29; and Montague Cottages, Nos. 1, 2, 3 and 4. The number of occupants was 27. The Council made a Clearance Order on the 3rd September; a Ministry of Health Inquiry was held on the 26th November, and the Order was confirmed by the Minister, without modification, under date 25th January, 1936. Re-housing is to be provided on the Horn Park Estate. (13) Belmont Place, Nightingale Vale.—On the 11th July, 1935, I represented this area consisting of four cottages, as an unhealthy area. The cottages in question are known as Belmont Place, Nos. 2, 3, 4 and 5. The number of occupants was 17. The Council made a Clearance Order on 3rd September; a Ministry of Health Inquiry was held on 26th November, and the Order was confirmed by the Minister, without modification, under date 25th January, 1936. Re-housing is to be provided on the Horn Park Estate. (14) Waverley Cottages, Ogilby Street.—On the 11th July, 1935, I represented this area consisting of two cottages as an unhealthy area. The cottages in question are known as Waverley Cottages, Nos. 1 and 2. The number of occupants was 24. The Council made a Clearance Order on the 3rd September; a Ministry of Health Inquiry was held on the 26th November; and the Order was confirmed by the Minister, without modification, under date 25th January, 1936. Re-housing is to be provided on the Horn Park Estate. (15) Nile Cottages and Glass Yard.—On the 11th July, 1935, I represented this area consisting of eleven cottages as an unhealthy area. The cottages in question are known as Nile Cottages, Nos. 1, 2, 3, 4 and 5, and Glass \ard, Nos. 1, 2, 3, 4, 5 and 6. The number of occupants was 34. 65 The Council made a Clearance Order on the 2nd October ; no Inquiry had been held by the end of the year. Re-housing is to be provided on the Horn Park Estate. (16) Davey Square.—On the 12th September, 1935, I represented this area consisting of seven houses as an unhealthy area. The houses in question are known as Davey Square, Nos. 5, 6, 7, 8, 9, 10 and 11. The number of occupants was 31. The Council made a Clearance Order on 29th October; no Inquiry had been held by the end of the year. Re-housing is to be provided on the Timbercroft Lane Estate. (17) Albert Road and Woodman's Cottages.—On the 12th September, 1935, I represented this area consisting of six houses as an unhealthy area. The houses in question are known as Albert Road, Nos. 140 and 142, and Woodman's Cottages, Nos. 1, 2, 3 and 4. The number of occupants was 27. The Council made a Clearance Order on the 29th October; no Inquiry had been held by the end of the year. Re-housing is to be provided on the Timbercroft Lane Estate. (18) Dock Street and Kent Cottages.—On the 12th September, 1935, I represented this area consisting of nine houses as an unhealthy area. The houses in question are known as Dock Street, Nos. 2, 4, 6, 8, 10 and 12, and Kent Cottages, Nos. 3, 4 and 4a. The number of occupants was 30. The Council made a Clearance Order on the 29th October ; no Inquiry had been held by the end of the year. Re-housing is to be provided on the Timbercroft Lane Estate. (19) Kates Place and Albert Road.—On the 12th September, 1935, 1 represented this area consisting of twenty-one houses as an unhealthy area. The houses in question are known as Kates Place, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 and 18, and Albert Road, Nos. 208, 210 and 212. The number of occupants was 76. The Council made a Clearance Order on 29th October; no Inquiry had been held by the end of the year. Re-housing is to be provided on the Timbercroft Lane Estate. 66 (20) Anne's Place.—On the 12th September, 1935, I represented this area consisting of four houses as an unhealthy area. The houses in question are known as Anne's Place, Nos. 5, 6, 7 and 8. The number of occupants was 24. A Clearance Order was made by the Council on the 29th October ; no Inquiry had been held by the end of the year. Re-housing is to be provided on the Timbercroft Lane Estate. (21) Lewis Place.—On the 7th November, 1935, I represented this area consisting of three houses as an unhealthy area. The houses in question are known as Lewis Place, Nos. 1, 2 and 3. The number of occupants was 9. The Council made a Clearance Order on the 29th November; no Inquiry had been held by the end of the year. Re-housing is to be provided on the Horn Park Estate. (22) Messeter Place.—On the 7th November, 1935, I represented this area consisting of six cottages as an unhealthy area. The cottages in question are known as Messeter Place, Nos. 2, 3, 4, 5, 6 and 7. The number of occupants was 6. The Council made a Clearance Order on the 29th November ; no Inquiry had been held by the end of the year. Re-housing is to be provided on the Horn Park Estate. Surveys of several larger areas have been carried out by officers of the London County Council during the year, and these will no doubt be dealt with by that body at no distant date. There are other smaller areas in the Borough which will require to be dealt with by the Borough Council in the course of 1936. Re-Housing of Old People Living Alone.—An entirely new problem has arisen in connection with the re-housing of persons from Clearance Areas. The Council are required to re-house all the occupants of clearance areas whatever the number in family, or their circumstances, and so it becomes necessary to consider what should be done where aged or infirm persons living alone were re-housed. The Public Health Committee decided that their women sanitary inspectors should pay periodic visits to all such cases, in order to promote their general welfare and prevent the development of insanitary conditions. This is now being carried out. 67 Hutments.—In my Annual Report for 1934 I reported on an agreed threeparty Scheme between the owners of certain hutments, the London County Council and the Council, for the re-housing of the tenants of Eltham hutments and for the demolition of the hutments. The first of the dwellings were ready for occupation on the 1st September of that year, and at the end of 1935, the total number of hutment families so re-housed was 350. Other hutments in Eltham and Plumstead are being demolished, and it may be said that they are now rapidly disappearing. They were originally put up as temporary dwellings for the duration of the war, but they continued to be used as such much longer than anybody expected. It has been said that these hutments were healthy and sanitary dwellings, but they have always been subject far too much to extremes of temperature and to daily intermittent dampness (condensation). In recent years they have not been wind and weather proof, and extensive disrepair and settlement have been apparent. Two years ago I investigated the vital statistics of these dwellings over a period of ten years, and the following rates are not without interest in this connection. There were originally just under two thousand hutments in the Borough. The population has never been known because they were never grouped as census units by the Registrar-General. In the absence of accurate estimates of the hut population it was necessary in order to study the vital statistics to consider the ratios of each cause of death to the total deaths, a method which is occasionally used, particularly in studying mortality of olden times. When the statistics were so examined it was found, as will be seen from Table No. 25, that the percentage of deaths from tuberculosis in the huts was nearly 40 per cent. higher than in the houses, and it will be noted in Table No. 26 that, from all diseases, people died at earlier ages in the huts than in the houses. TABLE No. 25. Deaths from Pulmonary Tuberculosis, 1923-1932. No. of deaths from tuberculosis. Total deaths. Percentage of tuberculosis deaths. In houses 1,436 14,899 9.64 In huts 88 661 13.31 68 TABLE No. 26. Age incidence at death, 1923-1932. Age Periods. Houses. Huts. Number of Deaths. Per 100. Number of Deaths. Per 100. 0—1 1,140 7.65 94 14.22 1—5 525 3.53 43 6.50 6—15 393 2.64 26 3.93 15—25 713 4.79 47 7.11 25—45 1,723 11.56 99 14.98 45—05 3,931 26.38 189 28.60 65—75 3,183 21.36 92 13.92 75 and over 3,291 22.09 71 10.74 14,899 100.00 661 100.00 In the case of infant mortality, however, it has been possible to calculate definite rates because these are based upon the proportion of deaths under one year to the number of births in the particular year, and the actual numbers of births and deaths of children under one year in the huts are known. It will be seen from Table No. 27 that the infant mortality rate is considerably higher in the ten-year period among the hut population than it was in the house population. TABLE No. 27. Infant Mortality, 1923-1932. Number of Births. Number of Deaths under 1 year. Rate. In houses 22,364 1,140 51 In huts 1,358 94 69 Having regard to these variations in the different rates it is difficult to believe that it is wrong to describe the hutments as unhealthy dwellings, at any rate as we knew them in recent years. Council's Houses.—During the year the Council erected 76 houses and flats on the Page Estate, Shepherds Farm, and 346 on the Middle Park Estate. 69 At the end of the year 8 houses were in course of erection on the Page Estate and 142 on the Middle Park Estate; the total number of occupied dwellings on these two estates at the end of the year was 3,538. Overcrowding Survey.—It became necessary, during the year, to carry out, in accordance with the provisions of the Housing Act, 1935, a systematic survey of the houses in the Borough, in order to ascertain what dwellings were overcrowded according to a standard defined in the Act. The standard is complex: it includes a measure of capacity based on the number, size and user of rooms; it regards persons of different ages in terms of equivalent persons, and it provides that the accommodation must be such that no two persons over 10 years of age of opposite sexes, not living as husband and wife, must sleep in the same room. The following Tables A and B, taken from the first Schedule of the Act, define the standards of capacity:— TABLE A. Where a house consists of— The permitted number of persons is— (a) One room 2 (b) Two rooms 3 (c) Three rooms 5 (d) Four rooms 7½ (c) Five rooms or more 10 with an additional 2 in respect of each room in excess of five. In the application of these tables account is only to be taken of rooms which are normally used in the locality either as living rooms or bedrooms, and a room of less than 50 square feet is to be ignored. Rooms occupied by a sub-tenant constitute a separate dwelling; children under one year are not counted and children between 1 and 10 years count as half a person. TABLE B. Where a room in a house has a floor area of— The permitted number of persons is— (a) 110 square feet or more 2 (b) 90 square feet or more, but less than 110 1½ (c) 70 square feet or more, but less than 90 1 (d) 50 square feet or more, but less than 70 ½ (e) Under 50 square feet Nil. 70 TABLE 28—THE BOROUGH Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. ½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 14 25 1106 203 707 147 2 429 9 43 1 304 6 4 13 206 2 1 84 57 14 3349 3363 1½ - — 4 14 26 11 - 20 - 3 - 21 - - - 7 - 1 - - 107 107 2 5 5 32 177 1328 408 2 1875 40 202 2 2088 16 27 46 2172 4 5 640 407 42 9439 9481 2½ — 1 5 45 8 533 — 834 17 83 2 771 6 11 14 824 4 1 140 62 51 3310 3361 3 — - 1 19 9 289 - 1210 27 170 5 2479 24 25 87 2572 7 8 926 620 29 8449 8478 3½ - - - 7 3 51 - 317 14 74 1 691 9 13 22 613 4 3 171 85 61 2017 2078 4 — — — 3 — 52 5 16 29 301 4 1652 10 29 67 1874 5 13 779 525 60 5304 5364 4½ — — — 3 — 24 3 2 9 77 2 456 3 11 22 419 — 1 148 88 32 1236 1268 5 — — — 1 — 20 1 2 10 118 5 786 13 25 31 965 3 6 456 353 34 2761 2795 5½ — — — 1 — 5 1 — 4 38 4 274 8 18 22 205 1 1 104 73 49 710 759 6 - - - - - 9 — 1 3 41 14 42 33 49 67 428 5 4 224 201 68 1053 1121 6½ — — — — — 1 — — 1 25 5 34 18 25 31 131 3 5 52 51 66 316 382 7 - - - 1 - 2 1 - 1 16 2 17 12 38 31 174 10 5 97 107 52 462 514 7½ - - - - - - - - 1 6 - 9 5 7 18 61 1 6 29 20 28 135 163 8 - - - - - 1 - - - 1 3 8 4 19 5 13 14 13 56 60 41 156 197 8½ - - - - - - - - - 2 - 3 2 6 3 4 1 9 18 17 20 45 65 9 - - - - - - - - - 1 - 1 - 3 5 4 1 7 25 27 15 59 74 9½ - - - - - - - - - - - - 1 2 2 2 - - - 11 7 11 18 10 - - - - - - - - - - - - - - 2 1 4 - 1 10 8 10 18 10½ - - - - - - - - - - - - - - - - 2 - - 5 2 5 7 11 - - - - - - - - - - - - - 1 - 1 - - - 1 2 1 3 11½ & over - - - - - - - - - - - - - - 1 1 — — — 3 2 3 5 [Totals of Dwellings Overcrowded. 19 6 38 80 12 165 11 5 20 130 24 72 24 38 18 13 7 - 1 - 683 - - Not overcrowded. — 25 1110 394 2069 1388 4 4701 145 1071 26 9564 146 275 471 10664 64 88 3950 2783 — 38938 — Total 19 31 1148 474 2081 1553 15 4706 165 1201 50 9636 170 313 489 10677 71 88 3951 2783 — — 39621 71 TABLE 29—DOCKYARD WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. 1 1½ 2 2½ 3 3 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 1 49 19 34 12 - 31 l 7 - 12 1 - 1 6 - 1 2 - 177 177 1½ — — 2 3 — — 1 — — — — — — — 1 — — - - - 7 7 2 1 — 11 71 46 — 86 3 14 — 113 4 1 7 35 - - 12 11 1 414 415 2½ — — 2 — 59 — 32 1 7 — 35 1 1 4 14 1 1 5 1 2 161 163 3 — — 2 — 27 — 52 1 10 — 118 — 1 12 46 2 1 26 13 2 309 311 3½ — — — — 7 — 8 — 4 — 19 1 — — 8 1 — 7 2 7 50 57 4 — — — — 6 — 3 2 20 — 81 1 2 9 42 1 1 34 10 6 206 212 4½ — — — — 1 — — 2 3 — 20 — — 4 9 - - 4 5 1 47 48 5 — — — — 2 — — 2 15 — 44 — — 4 30 — 1 18 10 4 122 126 5½ — — — — 1 — — 1 5 — 9 — 1 11 8 2 7 31 38 6 — — — — 1 — — — 4 — 1 1 1 5 9 1 8 7 5 33 38 6½ — — — — — — — — 1 — 1 — 1 — 4 — — 5 4 2 14 16 7 - - - - - - - - - - 1 1 3 3 9 2 4 10 2 31 33 7½ - - - - - - - - 1 - - - - 1 2 - - 2, 3 1 8 9 8 - - - - 1 - - - - - - - - 1 - 2 1 3 3 2 9 11 8½ - - - - - - - - - - - - - - - - - 1 1 - 2 2 9 - - - - - - - - - - - - - 2 - 1 - 3 4 3 7 10 9½ - - - - - - - - - - - - - 1 - - - - 1 1 1 2 10 - - - - - - - - - - - - - - - - - - 1 - 1 1 10½ - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - - - - - - - - - - - - - - - - - 11½ & over - - - - - - - - - - - - - - - - - - - - - - 1 Totals of Dwellings Overcrowded. 1 4 19 3 11 2 1 4 1 - - - 46 - - Not overcrowded. 1 49 32 108 144 — 213 10 79 — 452 9 10 51 226 7 9 142 88 — 1630 - Total 2 49 36 108 163 — 213 13 90 — 454 10 10 55 226 8 9 142 88 — — 1676 TABLE 30—ST. MARY'S WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 1 71 18 30 9 19 7 8 2 7 2 174 174 1½ — — — — 1 — — — — — 1 — — — — — - — — — 2 2 2 - 2 16 72 28 — 57 — 6 — 66 — 3 3 21 — - 10 7 2 289 291 2½ 1 - 2 — 35 — 29 1 7 — 22 1 — — 5 — - 3 — 3 103 106 3 — — 1 1 32 — 38 1 11 2 81 1 1 8 46 1 - 15 9 2 246 248 3½ — — — 1 6 — 16 2 7 — 19 1 — 1 13 — - 3 — 7 62 69 4 - - 6 2 14 — 60 1 1 5 37 — - 13 10 6 143 149 4½ — — — — 3 1 — 1 6 1 18 1 — 1 13 — — 6 — 4 47 51 5 - - 2 — — 2 6 2 30 1 — 2 18 1 1 14 5 4 80 84 5½ - - - - 1 - - - 1 - 8 - - 3 6 — - 4 4 2 25 27 6 — — — — — — 1 — 4 2 — — 1 6 10 — - 5 5 7 27 34 6½ - - - - - - - - 4 1 1 — — 3 7 1 - 2 3 6 16 22 7 - - - - - - - - - - - - - 1 4 1 - 4 1 - 11 11 7½ - - - - - - - - - - - - - - - - - - 1 - 2 2 8 - - - - - - - - - - - - - 1 - - - 3 2 1 5 6 8½ - - - - - - - - - - - - - 1 - - - - 2 1 2 3 9 - - - - - - - - - - - - - 1 1 — - — 4 2 4 6 9½ - - - - - - - - - - - - - - - - - - - - - — 10 - - - - - - - - - - - - - - - - - - - - - — 10½ - - - - - - - - - - - - - - - - - - 1 — 1 1 11 - - - - - - - - - - - - - - - - --- - - - — — 11½ & over - - - - - - - - - - - - - - - - - - - - - - Totals of Dwellings Overcrowded. 1 2 3 2 18 1 1 2 9 3 1 — — 3 1 — - — — 47 Not overcrowded. 1 71 34 102 105 — 159 7 64 5 313 6 6 36 187 4 1 84 54 1239 Total 2 73 37 104 123 1 160 9 73 8 314 6 6 39 188 4 1 84 54 — — 1286 72 73 TABLE 31—RIVER WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. ½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded Total. 1 1 1 73 50 66 27 - 40 - 3 - 14 - - 1 6 - - 4 2 1 287 288 1½ — - — 3 1 1 — 2 — 1 — — — — — — — - - - - 8 8 2 — 1 6 48 110 47 — 184 1 26 — 116 2 — 2 40 — 1 33 11 7 621 628 2½ - — — 18 2 50 — 79 1 10 — 32 — — 1 8 — - 4 2 18 189 207 3 - - - 8 - 38 - 150 3 22 - 141 3 2 8 75 - 2 41 14 8 499 507 3½ — — — 3 — 14 — 49 — 8 1 36 — 2 4 21 — 2 8 2 17 133 150 4 — — — 2 — 14 1 1 4 47 — 82 2 3 14 75 — 50 26 16 304 320 4½ — — — 1 — 11 — — 1 16 — 14 — 2 — 13 — — 13 6 12 65 77 5 — — — — — 8 — — 1 23 1 51 4 4 1 33 — 1 26 26 9 170 179 5½ - — - — — 2 — — 1 10 1 9 1 - 1 9 - - 5 4 13 30 43 6 — — — — — 4 — — 1 11 — 2 1 3 3 23 1 — 20 14 16 67 83 6½ — — — — — 1 — — 1 5 — 1 1 1 3 7 — — 3 6 8 21 29 7 - - - 1 — 2 — — — 4 - 1 - 2 4 11 - - 10 17 8 44 52 7½ — — — - — — — — 1 3 — — 1 3 6 — - 4 2 5 15 20 8 - - - - - - - - - - 1 — 1 4 1 — — — 7 10 7 17 24 8½ - - - - - - - - - 1 - - 1 - - - - - 4 - 2 4 6 9 - - - - - - - - - 1 - - - - 1 - - - 2 4 2 6 8 9½ - - - - - - - - - - - - - - 1 - - - - 5 1 5 6 10 - - - - - - - - - - - - - - - - 1 - 1 2 2 2 4 10½ - - - - - - - - - - - - - - - - - - - 1 - 1 1 11 - - - - - - - - - - - - - - - - - - - - - - - 11½ & over - - - - - - - - - - - - - - 1 - - - - 2 1 2 3 I Totals of Dwellings Overcrowded. 1 1 6 33 — 56 1 — 5 35 1 2 2 5 4 — 1 — 1 — 154 — - Not overcrowded. — 1 73 101 179 163 — 505 10 156 3 497 14 19 45 327 1 6 234 156 — 2490 - Total 1 2 79 134 179 219 1 505 15 191 4 499 16 24 49 327 2 6 235 156 — — 2644 TABLE 32—ST. GEORGE'S WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 1 44 12 23 10 - 10 - 5 - 7 2 - - 5 - - 3 1 - 123 123 1½ — — 1 1 2 — — — — — 1 — — — — — — — — — 5 5 2 — 1 13 76 35 — 46 — 11 — 58 3 5 1 23 — 2 14 7 1 294 295 2½ — — 4 — 45 — 31 — 4 — 23 — 1 2 4 — — 3 3 4 116 120 3 — — 2 — 30 — 34 1 16 — 59 4 2 9 37 — 1 24 14 2 231 233 3½ — — — — 2 — 6 — 3 — 17 — — 3 11 — — 3 2 2 45 47 4 — — — 3 - - 1 11 - 33 — 4 2 29 1 — 24 3 3 108 111 4½ — — — — 1 — — — 4 — 13 — — 2 5 — — 8 4 1 36 37 5 — — — - 2 - - - 6 — 19 2 — 5 26 - 2 15 12 2 87 89 5½ - - - - - - - - 1 - 7 - 1 1 7 — — 8 2 1 26 27 6 - - - - 1 - - - - - 1 - 1 5 16 - - 12 5 1 40 41 6½ - - - - - - - - 1 - - - 1 1 6 - - 4 1 1 13 14 7 - - - - - - - - - - - - - 3 8 — — 5 3 — 19 19 7½ - - - - - - - - - - - - - 2 4 1 — 3 3 — 13 13 8 - - - - - - - - - - - - - - - 1 - 4 2 — 7 7 8½ - - - - - - - - - - - - - - - - - - 1 - 1 1 9 - - - - - - - - - - - - - - - - - 2 2 - 4 4 9½ - - - - - - - - - - - - - - - - - - - - - - 10 - - - - - - - - - - - - - - - - - - 2 - 2 2 10½ - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - - - - - - - - - - - - - - - - - 11½ & over - - - - - - - - - - - - - - - - - - - - - - Itotals of Dwellings Overcrowded. — 1 6 - 9 - - - 2 - - - - - - - - - - 18 - - Not overcrowded. 1 44 26 100 122 — 127 2 59 — 238 11 15 36 181 3 5 132 67 — 1170 — Total 1 45 32 100 131 — 127 2 61 — 238 11 15 36 181 3 5 132 67 — — 1188 74 75 TABLE 33—BURRAGE WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. ½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 1 2 156 26 97 11 - 39 1 7 - 32 - 2 1 10 1 - 14 4 1 403 404 1½ - - - 2 4 2 - 1 - 1 - 1 - - - - — — — — — 11 11 2 — — 1 24 159 38 — 150 3 23 — 116 2 2 6 68 1 1 56 21 1 670 671 2½ — — 1 3 — 49 — 46 — 7 2 40 — — 1 18 — — 14 1 4 178 182 3 — — — — 2 26 — 57 2 10 1 122 1 3 8 81 2 — 87 29 2 429 431 3½ - - - 1 — 3 — 14 1 6 — 23 — 2 1 20 — — 16 5 4 88 92 4 - - - - - 1 — 1 2 14 2 61 1 2 7 51 - 2 76 18 1 237 238 4½ - - - - - 1 - — — 3 — 23 - 1 2 8 — 1 13 3 1 54 55 5 - — — — — 1 — 1 — 3 1 29 — — 2 32 — — 43 15 2 125 127 5½ - — - — — — — — — 1 — 7 — — 1 3 — — 11 6 1 28 29 6 - - - - - - - - - - 1 - - 2 2 10 — — 19 11 1 44 45 6½ - - - - - - - - - 1 - - - 1 - 2 1 1 4 1 1 10 11 7 - - - - - - - - 1 1 - - 2 2 2 4 2 - 7 6 4 23 27 7½ - - - - - - - - - - - - - - - - - - 3 1 — 5 5 8 - - - - - - - - - - - - - - - - - - 7 6 — — 13 8½ - - - - - - - - - - - - - - - - - - - - - 1 1 9 - - - - - - - - - - - - - - - - - 1 2 — — 3 3 9½ - - - - - - - - - - - - - - - - - - - 2 — 2 2 10 - - - - - - - - - - - - - - - - - - - - - - - 10½ - - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - - - - - - - - - - - - - - - - - - 11½ & over - - - - - - - - - - - - - - - - - - - - - - - Totals of Dwellings Overcrowded. 1 — 2 4 2 6 — 1 1 3 1 — 2 — — — — — — 23 — — Not overcrowded. — 2 156 52 260 126 — 308 9 74 6 454 4 17 34 307 7 6 373 129 — 2324 — Total 1 2 158 56 262 132 — 309 10 77 7 454 6 17 34 307 7 6 373 129 — — 2347 76 TABLE 34—HERBERT WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 - 31 11 41 5 1 33 2 1 - 13 - 1 5 7 - - 7 12 - 170 170 1½ — 2 — 1 1 — 1 — — — — — — — — — — — — — 5 5 2 — — 6 87 22 — 159 — 17 — 120 1 — 11 165 — — 108 70 — 766 766 2½ — 2 4 2 39 — 57 2 3 — 36 — 2 1 72 — — 15 4 6 233 239 3 — — 1 — 20 — 53 3 7 — 108 1 3 9 162 — — 155 109 1 630 631 3½ - - - 1 3 - 9 1 3 - 24 - — 1 36 1 — 24 11 4 110 114 4 - - - - 3 - - 1 16 - 44 - 4 2 91 — 1 110 86 3 355 358 4½ — — — — 1 — — — 3 — 10 — 1 1 30 — — 19 14 1 78 79 5 — — — — 1 — — — 4 — 26 — 1 3 47 — — 55 57 1 193 194 5½ — — — — - — — — 1 — 5 — 1 — 7 — — 4 11 1 28 29 6 — — — — — — — — 2 — — — — 3 18 — — 21 34 2 76 78 6½ - - - - - - - - 1 - - - - 1 2 — 1 4 4 1 12 13 7 - - - - - - - - - - - - - 3 7 — — 8 8 — 26 26 7½ - - - - — — — - 1 - - — — 1 2 — — 4 1 1 8 9 8 - - - - - - - - - - - - - - - 1 - 2 7 - 10 10 8½ - - - - - - - - - - - - - - - - 1 1 1 - 3 3 9 - - - - - - - - - - - - - - - - - 2 - - 2 2 9½ - - - - - - - - - - - - - - - - - - - - - - 10 - - - - - - - - - - - - - - - - - - 1 — 1 1 10½ - - - - - - - - - - - - - - - - - - 2 — 2 2 11 - - - - - - - - - - - - - - - - - - - - - - 11½ & over - - - - - - - - - - - - - - - - - - - - - - 1 Totals of Dwellings Overcrowded. 2 5 1 8 5 — 21 - Not overcrowded. — 33 17 131 87 1 312 9 54 — 386 2 13 41 646 2 3 539 432 — 2708 — Total — 35 22 132 95 1 312 9 59 — 386 2 13 41 646 2 3 539 432 — — 2729 TABLE 35—GLYNDON WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. ½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 - - 104 13 52 20 - 22 1 4 - 22 - - - 5 1 - 3 - - 247 247 1½ — — — 1 5 1 — — — — — 1 - - - - - - - - - 8 8 2 1 — 1 7 93 35 1 92 8 10 — 162 — 2 3 45 1 1 45 6 2 511 513 2½ — — — 1 1 48 — 36 - 4 — 65 - 1 2 27 - - 13 - 1 197 198 3 - - 1 1 3 25 - 71 3 15 1 169 5 6 3 86 - - 65 9 5 458 463 3½ - - - 1 1 2 - 25 3 4 - 43 2 3 2 24 - - 26 4 4 136 140 4 — — — — — 4 — 2 — 19 — 116 — 1 4 67 — — 65 3 4 277 281 4½ — — — 1 — — — 1 1 1 — 23 — 1 2 19 — — 16 2 2 66 68 5 - - - - - 1 — 1 1 8 1 43 1 — 1 40 — — 51 5 3 150 153 5½ — — — — — — — — — 2 — 16 — 3 1 12 — — 13 1 2 46 48 6 - - — — — 1 — - - 4 — 2 1 7 5 20 - - 23 6 5 64 69 6½ - - - - - - - - - 4 - - - 1 2 5 - - 9 2 4 19 23 7 - - - - - - - - - - 1 2 2 2 5 10 1 - 14 5 5 37 42 7½ - - - - - - - - - - - 1 1 2 - 2 - - 3 1 4 6 10 8 - - - - - - - - - - - - - 1 - - - 3 6 1 1 10 11 8½ - - - - - - - - - - - - - - 1 - - 2 1 2 1 5 6 9 - - - - - - - - - - - - - - - - - - 3 - - 3 3 9½ - - - - - - - - - - - - - - - - - - - - - - - 10 - - - - - - - - - - - - - - 2 - - - - - 2 — 2 10½ - - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - - - - - - - - - - - - - - - - - - 11½ & over - - - - - - - - - - - - - - - - - - - - - - - |Totals of Dwellings Overcrowded. 1 — 2 4 4 8 — 2 1 10 1 3 3 3 3 - - - - - 45 — — Not overcrowded. — — 104 21 151 129 1 248 16 65 2 662 9 27 30 362 3 6 356 47 — 2240 — Total 1 — 106 25 155 137 1 250 17 75 3 665 12 30 33 362 3 6 356 47 — — 2285 77 TABLE 36—ST. MARGARET'S WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 1 113 6 106 13 - 53 2 3 - 39 1 - 1 22 - - 13 12 - 385 385 1½ - - 1 4 2 - 2 - 1 - 2 - - - 1 - - 1 - - 14 14 2 1 13 149 29 - 196 6 13 1 239 3 2 3 217 - - 104 38 1 1013 1014 2½ - — 2 — 52 - 67 — 9 — 73 1 1 — 62 1 — 27 5 2 298 300 3 - — — — 18 - 93 — 11 — 254 2 1 4 267 — 2 147 53 — 852 852 3½ - — — —. 2 - 16 1 7 — 48 2 1 3 44 — 1 25 8 2 156 158 4 - - - - - - - - 23 — 124 1 1 5 176 1 5 119 42 - 497 497 4½ - — — — 1 - — - 4 - 25 - - 2 38 - - 18 2 1 89 90 5 - - - - 1 - - - 6 - 30 - 3 3 72 - - 60 30 2 204 206 5½ - — - — — - — — 1 - 9 1 2 14 1 - 13 1 1 41 42 6 - - - - - - - - 3 1 - - 1 5 36 - - 27 13 4 82 86 6½ - - - - - - - - 1 - 1 - 1 1 9 - 1 4 2 2 18 20 7 - - - - - - - - 2 — 1 1 1 — 7 - - 11 4 4 23 27 7½ - — — — - — — — — — 1 — 1 — 3 — — 2 1 2 6 8 8 - - - - - - - - - - - - - - - 1 1 5 7 — 14 14 8½ - - - - - - - - - - - - - - - - - 1 1 — 2 2 9 - - - - - - - - - - - - - - - - - 1 — — 1 1 9½ - - - - - - - - - - - - - - - - - - - - - — 10 - - - - - - - - - - - - - - - - - - - - - - 10½ - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - - - - - - - - - - - - - - - - - 11½ & over - - - - - - - - - - - - - - - - - - - - - - 1 Totals of Dwellings Overcrowded. - 1 2 — 4 - — 1 7 1 3 1 1 - - - - - - 21 - - Not overcrowded. 1 113 20 259 114 — 427 9 77 1 843 11 12 29 968 4 10 578 219 — 3695 - Total 1 114 22 259 118 — 427 10 84 2 846 12 13 29 968 4 10 578 219 — - 3716 78 TABLE 37—CENTRAL WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 - 70 4 64 10 - 53 - 3 1 21 - - - 14 - - 7 2 - 249 249 1½ — — — — — — 7 — — — 2 — — — — — — — — — 9 9 2 - 1 - 118 16 1 183 1 17 1 147 - - 4 119 - - 64 17 1 690 691 2½ — - - — 32 — 95 1 6 - 43 2 - - 36 1 - 14 2 - 232 232 3 - - 1 1 10 - 93 3 9 - 138 1 - 8 149 - - 86 25 2 522 524 3½ - - - - - - 20 - 1 - 29 2 2 2 39 - - 11 4 - 110 110 4 - - - - 3 - - 2 11 - 55 1 1 4 92 - - 78 18 3 262 265 4½ — — — — 1 — — 1 1 1 14 — — 1 23 — — 16 4 1 61 62 5 — — — — — — — — — — 23 — — 1 52 — — 39 13 — 128 128 5½ — — — — — — — — — — 3 — — — 11 — 1 9 4 — 28 28 6 — — — — — — — — 2 — — — — 5 8 1 — 27 15 2 56 58 6½ - - - - - - - - 1 - - - - - 2 - - 4 — 1 6 7 7 - - - - - - - - - - - - - - 3 2 2 9 8 — 24 24 7½ — — — — — — — — — — 1 1 — 1 1 — — 1 — 2 3 6 8 - - - - - - - - - - - - 1 - 1 - 2 1 1 1 5 6 8½ - - - - - - - - - - - - - - - - - 1 1 — 2 2 9 - - - - - - - - - - - - - - - - 1 1 2 - 4 4 9½ - - - - - - - - - - - - - - - - - - 1 — 1 1 10 - - - - - - - - - - - - - - - - - - - - - - 10½ - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - - - - - - - - - - - - - - - - - 11½ & over - - - - - - - - - - - - - - - - - - - - - - ["Totals of Dwellings Overcrowded. — 1 1 1 4 — - - 3 - 1 1 1 - - - - - - 13 - Not overcrowded. — 70 4 182 68 1 451 8 48 3 475 6 5 26 550 4 6 368 117 — 2392 — Total — 71 5 183 72 1 451 8 51 3 476 7 6 26 550 4 6 368 117 — — 2405 79 80 TABLE 38—ST. NICHOLAS WARD Equivalent number of persons n family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. ½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 1 1 103 9 78 16 1 49 - 2 - 21 - - - 14 - - 9 4 1 307 308 1½ — — 1 1 4 — — 1 — — — 1 — — — — — — — — — 8 8 2 — — 5 7 147 48 — 256 4 26 — 164 — 6 4 179 1 — 23 19 5 884 889 2½ — — 2 2 — 62 — 121 2 4 — 45 — 3 1 62 — — 5 3 4 308 312 3 - - - - - 27 — 180 4 19 — 184 1 5 14 217 — 1 49 17 — 718 718 3½ - — — 1 — 8 — 39 4 10 — 34 — 2 2 42 — — 5 1 9 139 148 4 - - - - - 7 3 - 7 51 1 121 - 5 4 186 1 4 36 17 10 433 443 4½ - - - - - 3 2 1 2 16 - 28 1 1 2 43 — - 11 4 6 108 114 5 — — — 1 — 2 1 — 3 20 — 53 2 3 5 116 1 1 35 10 7 246 253 5½ — — — 1 — 1 — — — 10 — 10 — — 3 21 — — 6 3 12 43 55 6 - - - - - 1 - - 2 5 - 2 1 6 11 55 - - 11 9 8 95 103 6½ - - - - - - — - - 2 - — — — 2 11 — 1 3 2 2 19 21 7 - - - - - - 1 - - 2 - - - 5 3 31 1 - 4 4 3 48 51 7½ - - - - - - - - - - - - - - 2 8 — — 1 — — 11 11 8 - - - - - - - - - 1 - - - - 1 2 2 1 4 4 2 13 15 8½ - - - - - - - - - 1 - - - 1 - 1 - 2 2 4 3 8 11 9 - - - - - - - - - - - - - - - 1 — 2 3 3 1 8 9 9½ - - - - - - - - - - - - - - - - - - - - - - - 10 - - - - - - - - - - - - - - - - 1 - - 1 1 1 2 10½ - - - - - - - - - - - - - - - - - - - 1 - 1 1 11 - - - - - - - - - - - - - 1 - - - - - - 1 — 1 11½ and over - - - - - - - - - - - - - - - - - - - - - - - 1 Totals of Dwellings Overcrowded. 1 — 7 5 — 22 7 1 5 21 — — — 2 1 2 1 — — 75 — — Not overcrowded. — 1 104 17 229 153 1 646 23 148 1 663 5 36 53 987 6 12 207 106 — 3398 — Total 1 1 111 22 229 175 8 647 28 169 1 663 5 38 54 989 7 12 207 106 - — 3473 TABLE 39—ABBEY WOOD WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 5 75 8 64 1 - 34 - 2 - 35 2 - 1 30 - - 4 3 - 264 264 1½ — — — 1 1 — 2 — — — 3 — — — 2 — — — — - 9 9 2 1 1 4 126 29 — 122 9 18 — 272 1 2 — 270 1 — 11 11 2 876 878 2½ — — — 2 31 — 56 2 11 — 97 — 2 1 158 1 — 4 3 — 368 368 3 — — 1 1 19 — 89 1 12 — 273 5 — 1 375 1 1 35 22 2 834 836 3½ — — — — 2 — 20 — 11 — 42 — — 1 85 1 — 3 3 2 166 168 4 — — — — 2 — — 4 17 — 156 1 — 4 289 1 — 19 23 2 514 516 4½ - - - - - - - - 3 — 19 1 1 1 58 — — 4 3 — 90 90 5 — — — — — — — — 6 — 69 — 5 — 126 — — 23 13 — 242 242 5½ - - - - - 1 - - 3 — 20 2 6 2 35 — — 3 4 4 72 76 6 - - - - - - - - 2 - - 1 1 3 58 1 1 9 7 2 81 83 6½ - - - - - - - - - - - - 5 1 13 — — 3 4 — 26 26 7 - - - - - - - - 2 - - 1 5 1 20 1 — 1 3 3 31 34 7½ - - - - - - - - - - - 1 - - - - - - - 1 5 6 8 - - - - - - - - - - - - 5 — 1 2 1 3 1 5 8 13 8½ - - - - - - - - - - - - - - - - - - - - 1 1 9 - - - - - - - - - - - - - 1 - - - - 1 1 1 2 9½ - - - - - - - - - - - - - - - - - - - - - - 10 - - - - - - - - - - - - - - - 1 - - 1 1 1 2 10½ - - - - - - - - - - - - - - - - - - - - - — 11 - - - - - - - - - - - - - - - - - - - - - — 11½ & over - - - - - - - - - - - - - - - - - - - - - - Totals of Dwellings Overcrowded. 1 1 1 1 4 1 - - 7 - - 2 5 1 - 1 - - — 25 - — Not overcrowded. 5 75 12 193 81 — 323 16 80 — 986 13 27 16 1524 9 5 122 102 — 3589 — Total 6 76 13 194 85 1 323 16 87 — 986 15 32 17 1524 10 5 122 102 — — 3614 81 TABLE 40—WELL HALL WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. ½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 1 2 41 1 20 6 - 21 - 1 - 19 - - - 32 - - 6 4 1 153 154 1½ — — — — 1 — — 2 — - - 2 - - - - - - - - - 5 5 2 — — 1 1 45 12 — 118 3 6 - 149 - 2 - 291 - - 12 41 1 680 681 2½ — — — 2 — 11 — 27 3 1 - 61 - - - 61 - - 4 6 2 174 176 3 - - - - - 3 — 82 1 3 - 194 — - - 308 - - 18 46 - 655 655 3½ - - - - - - - 15 — 2 - 40 - - - 76 - - 6 9 - 148 148 4 - - - - - - - - 1 26 - 138 - - 4 228 - - 23 33 - 453 453 4½ - - - - - - - - 1 7 - 36 — - - 32 - - - 6 - 84 84 5 - - - - - - - -— — 8 - 72 — 1 - 98 - - 17 30 - 226 226 5½ — — — — - - - - - 1 2 35 - 1 1 15 - - 4 - - 62 63 6 - - - - - - - - - 2 1 6 3 13 - 43 - 1 7 10 1 83 63 6½ - - - - - - - - - - - 7 2 6 1 12 - - 7 10 3 83 86 7 - - - - - - - - - - 1 2 - 10 - 7 - — 3 5 7 29 36 7½ - - - - - - - - - - - 1 - 2 - 7 — — 4 4 3 25 28 8 - - - - - - - - - - - 1 — 2 1 4 — — 1 — 3 6 9 8½ - - - - - - - - - - - 1 1 7 — 1 — — 2 — 9 3 12 9 - - - - - - - - - - - 1 - 2 - - - 2 2 — 3 5 8 9½ - - - - - - - - - - - - - 2 - - - - 1 1 4 2 6 10 - - - - - - - - - - - - - - - - - - - - 3 — 3 10½ - - - - - - - - - - - - - - - - - - - - — — — 11 - - - - - - - - - - - - - - - - - - - - — — — 11½ & over - - - - - - - - - - - - - - - - - - - - — - - Totals of Dwellings Over crowed 1 — 1 2 — — — — — 3 2 12 2 16 - 1 - - - - 40 - - Not crowed — 2 41 2 66 32 — 265 9 54 2 752 5 33 7 1208 1 3 112 199 - 2793 - Total 1 2 42 4 66 32 — 265 9 57 4 764 7 49 7 1209 1 3 112 199 - - 2833 82 TABLE 41—AVERY HILL WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 - 17 2 23 2 - 10 1 - - 33 - 1 1 35 - - 6 11 - 142 142 1½ - - - 1 — — — — — — 4 — — — 2 - — — — - 7 7 2 — — 3 44 7 — 119 1 6 — 181 — — — 533 - — 115 124 - 1133 1133 2½ — — — — 5 — 45 3 5 — 59 — — — 248 - — 24 22 - 411 411 3 — — — — 3 — 37 — 5 — 130 — — 1 489 1 — 121 207 - 994 994 3½ — — — — 1 — 3 — — — 29 — — — 115 - — 27 25 1 199 200 4 — — — — — 1 — — 2 — 51 — 1 — 247 - — 89 187 1 577 578 4½ — — — — 1 — — — 6 — 3 — 1 — 65 - — 16 28 1 119 120 5 - - — — — — — — 5 — 16 — — 2 109 - — 37 88 - 257 257 5½ - - - - - - - - - - 4 - - - 14 - - 6 23 - 47 47 6 - - - - - - - - - 1 - - - 1 31 - 1 15 39 1 87 88 6½ - - - - - - - - - - - - 1 - - - - 1 14 - 25 25 7 - - - - - - - - - - - - - - - - - 7 21 - 32 32 7½ - - - - - - - - - - - - - - - - - 2 6 - 9 9 8 - - - - - - - - - - - - - - - - - 1 7 - 8 8 8½ - - - - - - - - - - - - - - - - - 1 2 1 3 4 9 - - - - - - - - - - - - - - - - - 1 3 1 4 5 9½ - - - - - - - - - - - - - - - - - - 1 - 1 1 10 - - - - - - - - - - - - - - - - - - 1 1 1 2 10½ - - - - - - - - - - - - - - - - - - - 1 — 1 11 - - - - - - - - - - - - - - - - - - 1 - 1 1 11½ & over - - - - - - - - - - - - - - - - - - - - - - | Totals of Dwellings Overcrowded. — — — — 2 1 — — — 1 — — — 1 2 1 - — — 8 — - Not overcrowded. — 17 5 68 17 — 214 5 29 — 510 — 4 5 1902 1 1 469 810 — 4057 — Total — 17 5 68 19 1 214 5 29 1 510 — 4 6 1904 2 1 469 810 — — 4065 83 TABLE 42—SHERARD WARD Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. ½ 1 l½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 10 10 159 23 9 5 - 15 1 - - 28 - - - 13 - - 4 2 10 269 279 1½ — — 2 3 - - - 1 - - - 3 - - - 1 - - - - - 10 10 2 4 2 12 24 31 16 - 107 1 9 - 185 - - 2 166 - - 33 24 18 598 616 2½ — — — 5 1 15 - 144 1 5 140 1 - 1 49 - - 5 3 5 365 370 3 —, 2 11 185 4 ?0 1 508 2 2 234 53 3 1077 1080 3½ — 1 1 49 f. 6 288 1 1 2 79 1 - 7 9 2 445 447 4 I 3 2 530 2 4 3 264 - - 43 48 4 931 935 4½ — — — 1 - - - - - 4 - 210 3 4 63 43 2 48 11 4 931 935 5 - - - - - - - - - 8 - 281 3 8 2 166 1 - 23 39 1 531 298 5½ - - - - - - - - 2 2 1 132 4 6 6 40 - - 10 4 4 203 207 6 — — — — — 1 — — — 2 8 28 25 13 13 91 2 20 ?6 11 218 229 6½ - - - - - - - - - 4 4 23 15 7 16 42 1 1 3 3 31 88 119 7 - - - - - - - - - 5 - 10 5 7 6 49 2 1 9 14 20 88 108 7½ - - - - - - - - - 1 - 5 2 1 5 24 - 5 3 2 9 39 48 8 - - - - - - - - - - 2 7 2 1 1 8 5 4 8 13 34 48 8½ - - - - - - - - - - - 3 1 2 - 1 - 1 3 2 7 6 47 9 - - - - - - - - - - - - - - - 2 - - 4 3 11 13 9½ - - - - - - - - - - - - - - - 2 - - 1 3 1 14 10 - - - - - - - - - - - - - - - - - - 2 1 3 10½ - - - - - - - - - - - - - - - - - - 1 - 2 11 - - - - - - - - - - - - - - - 1 - - 1 - 1 11½ & over - - - - - - - - - - - - - - - 1 - - - 1 1 1 2 1 Totals of Dwellings Overcrowded. 14 2 12 10 1 5 — 2 14 14 48 10 5 1 7 2 - - - 147 - - Not overcrowded. — 10 161 50 41 47 — 503 12 83 3 2333 51 51 62 1289 12 15 234 256 — 5213 - Total 14 12 173 60 42 52 — 503 14 97 17 2381 61 56 63 1296 14 15 234 256 — — 5360 TABLE 43—BOROUGH COUNCIL HOUSES Equivalent number of persons in family. Number of families containing the equivalent number of persons in the first column occupying dwellings with the permitted number shown at the head of this column. Totals of Families. ½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 and over Overcrowded. Not overcrowded. Total. 1 10 10 132 20 6 2 - 11 - - - 11 - - - 1 - - - - 10 193 203 1½ — — 2 3 — — — 1 — - - 2 - - - 1 - - - - - 9 9 2 4 2 12 23 14 13 - 64 1 7 - 92 - - 2 27 - - 3 4 18 250 268 2½ — — — 3 1 8 - 138 - 4 - 116 1 - - 7 - - - 2 3 277 280 3 - - - 1 1 4 - 164 3 17 1 411 - - 2 84 - - 2 6 3 694 697 3½ - - - - - - - 46 2 6 - 263 1 1 2 45 1 — 1 1 - 369 369 4 — — — 1 — 1 — 1 3 28 1 465 2 1 1 141 - — 4 6 2 653 655 4½ — — — 1 — — — — — 4 — 194 — 1 4 46 - — 2 1 1 252 253 5 - - - - - - - - - 8 - 249 3 5 2 122 - - 6 5 - 400 400 5½ - - - - - - - - 2 2 1 128 4 4 6 30 - — 3 1 4 177 181 6 — — — — — 1 — — — 2 7 28 20 6 13 73 2 — 14 3 10 159 169 6½ - - - - - - - - - 4 4 23 15 3 16 37 — — 3 — 3 74 105 7 - - - - - - - - - 5 - 10 5 5 6 44 9, 1 5 - 20 63 83 7½ - - - - - - - - - 1 — 5 2 1 5 22 5 1 1 9 34 43 8 - - - - - - - - - - 1 7 1 1 - 8 5 4 6 2 10 25 35 8½ — — — — — — — — — — - 3 1 - — 1 - 1 1 - 5 2 7 9 - - - - - - - - - - - - - - - 2 — 3 4 1 2 8 10 9½ - - - - - - - - - - - - - - - 2 - - - - 2 - 2 10 - - - - - - - - - - - - - - - - - - - - - - - 10½ - - - - - - - - - - - - - - - - 1 - - - 1 — 1 11 - - - - - - - - - - - - - - - 1 - - - - 1 — 1 11½ & over - - - - - - - - - - - - - - - - - - - - - - - | Totals of Dwellings Overcrowded 14 2 12 7 1 2 — — 2 14 12 48 9 2 — 6 1 — - - 132 - - Not overcrowded — 10 134 46 21 27 — 425 9 74 3 1959 46 26 59 688 10 14 55 33 — 3639 — Total 14 12 146 53 22 29 — 425 11 88 15 2007 55 28 59 694 11 14 55 33 — — 3771 85 86 Certain offences in relation to overcrowding have been created. Overcrowding standards may, however, be temporarily modified by the Minister of Health and overcrowding licences may be issued by local authorities in exceptional circumstances. In order to ensure that the survey of the County of London should be carried out on a strictly comparable basis the necessary forms were prepared by the London County Council, and the survey was started in all the Boroughs simultaneously as far as possible. In Woolwich a temporary staff consisting of 5 clerks, 20 enumerators and 10 survey assistants were engaged, and were employed for the equivalent of 229 unit-weeks at a total cost of £807 3s. 4d., half of which is payable by the London County Council. The survey was carried out in two stages. The first stage consisted of a door-to-door enquiry as to the number of rooms and number of persons occupying these rooms. As a result certain houses were found in which there was definite overcrowding and others were found in which there might be overcrowding if regard were paid to the size of the rooms. The second stage consisted of a further inspection and measurement of all the rooms of all the doubtful cases. It was then possible to say which houses in Woolwich were overcrowded partially and otherwise. The results were then summarised, and are set out in the foregoing Tables, Nos. 28 to 43, which show the figures for the Borough as a whole, for each Ward, and for the Council's housing estates. The figures for the Council's houses— Gossage Road, North Woolwich, Page Estate and Middle Park Estate, are shown in Table No. 43. The overcrowding on these Estates is entirely confined to the Eltham houses and may be explained as follows:— No. of families. Family too large for house occupied — 92 Occupation by lodgers or two families 40 It will be noted that, in the figures relating to the Council's Housing Estates, in 55 instances there is half a person in excess. In some cases this is due to the size of the rooms included in the calculations, e.g., a room just under 110 square feet in area, as many are, provides for one and a half persons only, while one of 110 square feet and over provides for two persons. Proposals for dealing with the overcrowding discovered were being considered at the end of the year. Bug Infestation or Houses.—In the annual reports of the last three years I have reported very fully on the Council's Disinfestation Scheme for the Council's 87 own houses and for those in private ownership. It may be said that the methods therein described have been adhered to except in so far as experience has demanded improvements. We have continued to rely on sulphur dioxide for occupied houses; orthodichlorbenzene, almost entirely, for empty houses, and for the disinfestation of vacated houses in clearance areas; but we have made more use of cyanide for van disinfestation work and for infested blocks of Council houses. When using cyanide in blocks of houses, temporary accommodation has been provided for two nights on each occasion in the block of six houses set apart for this purpose. An important addition has been the purchase of a pantechnicon, which is used not only for furniture removals but also for general disinfection work. It differs from the usual type in two respects (a) an extractor fan has been fitted, and (b) it is wired so that electric radiators may be used when necessary. The extractor fan is at the inner side of a tunnel in the Luton body space; the tunnel is closed at the front end by a wooden flap and inside the tunnel is a wooden diaphragm which permits of easy sealing and easy opening. The electricity supply for the radiators and fan is obtained through a lead when the van is standing at Sun Yard Depot. This van has been a successful innovation; cyanide is extracted from the van by means of the fan and ventilation is thus greatly accelerated. This is of great importance working as we do against time in this disinfestation process. The year's work may be summarised as follows. Sulphur dioxide was used in respect of 414 houses, practically all in private ownership, and in 362 instances it was successful in one application. Orthodichlorbenzene was used on 59 occasions in empty houses and on 36 occasions in occupied houses. Except in four instances it was only used once on each occasion. In four cases there was re-infestation at the end of the year. Cyanide (Zyklon B) was used for disinfestation of furniture in transit in vans on 130 occasions ; for disinfestation of furniture in 24 new houses in 7 blocks, and for the disinfestation of 34 occupied houses in 10 infested blocks. In no instance was there any re-infestation discovered during the year. Other fumigants or contact sprays were used on 16 occasions, in most cases experimentally. Forty-one houses in clearance areas were disinfested with orthodichlorbenzene before being demolished. Excluding these slum houses, the total number of rooms subjected to a process of disinfestation was 1,612. Valuable assistance in the skilled observation and scientific control of the processes has been given by officers of Government departments and specialists in this work. Supervision of all houses, subjected to disinfestation or where furniture is disinfested prior to the tenant's admission, is maintained for two years by periodic inspections. In this way 785 houses dealt with in earlier years were inspected. In exactly 100 of these (94 of which had been treated by sulphur) were bugs found. In not a single house on the Council's Estate from which the bed-bug had been eliminated, did re-infestation occur. It can now be said that the Middle Park 88 Estate is practically free from bed-bug infestation, and that there is very little infestation on the Page Estate. Such infestation as exists is in houses occupied prior to the institution of the scheme in 1934. This situation has not been reached without much effort. Special visits are paid to the Council's houses (a) when a tenant gives notice that he intends to vacate the premises, and before he does so ; (b) when a tenant asks for a transfer to another Council house, and (c) at the request of the Estate Office, when bugs are suspected. The number of such visits during the year was 365. The Sanitary Inspector in charge of this work inspects the furniture of all persons provisionally selected as tenants for the Council's houses, decides when disinfestation is necessary and makes the necessary arrangements. During the year he visited 701 houses in this connection. He satisfies himself in all cases when cyanide is used that the furniture is free from gas before it is allowed to be used, and that the occupiers understand the precautions necessary the first night of occupation. When blocks are being fumigated he is present when houses are being sealed and opened. His work involves irregular hours and much travelling. In supervision afterwards he is assisted by two part-time women inspectors. 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 71. The following Table, No. 44, shows details of the accommodation available in each common lodging house in the Borough:— TABLE No. 44. 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 89 Increase of Rent and Mortgage Interest (Restriction) Acts.—No applications for certificates under the provisions of the above were received. 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 55. 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 454 inspections of such houses were made. New Houses.—The following Table No. 45, 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, 314 were in respect of houses built by the Council. TABLE No. 45. Date of Meeting. Woolwich. Plums tead. Eltham. Total. West. East. 9th January — 41 13 36 90 6th February — 7 2 67 76 6th March — 19 13 56 88 3rd April — 39 13 29 81 8th May 2 26 18 123 169 5th June — 35 25 117 177 4th July — 6 12 98 116 24th July — 17 5 55 77 11th September — 19 30 71 120 9th October — 8 27 102 137 6th November — 57 30 78 165 3rd December — 37 — 31 68 2 311 188 863 1,364 90 SECTION VI. INSPECTION AND SUPERVISION OF FOOD. Three Sanitary Inspectors have been specifically appointed for the inspection and supervision of food and food premises. Two of these are responsible for the inspection of meat at the slaughter-houses, and for the taking of samples under the Food and Drugs (Adulteration) Act, 1928, and the various Regulations dealing with food standards. The third regularly and systematically inspects all food premises, especially those so used for the first time, paying particular regard to the sanitary regulations for premises used for the sale, etc., of food, as laid down in the London County Council (General Powers) Acts. In addition, each district inspector exercises a general supervision over all food exposed for sale and all food premises in his district, and in turn is responsible for the bi-weekly inspections of the market. Milk Supply.—The Borough Council is required to keep registers of all persons carrying on in the Borough the trade of cowkeepers, dairymen or purveyors of milk. The register of retail purveyors of milk is to be kept separate from the other. All dairies have to be registered also. Information on these matters is set out below in tabular form. The number of inspections of these premises was 276, and a high standard of cleanliness in cowsheds and dairies and in other premises where milk is sold has been maintained. The cowsheds in the Borough at the end of the year were as set out in the following Table No. 47 :— TABLE No. 46. No. Cowkeepers 2 Cowsheds 8 Dairies 74 Dairymen with premises in the Borough 50 „ „ outside the Borough 36 Purveyors of milk in sealed bottles 142 91 TABLE No. 47. 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 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 the 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 1 Number of dealers' licences issued to use the designation :— (a) "Certified" 5 (b) "Grade A (Tuberculin Tested)" 7 (c) "Grade A" 1 (d) "Grade A (Pasteurised)" 14 (f) "Pasteurised" 30 Number of supplementary licences issued to sell:— (a) "Certified" milk 2 (b) "Grade A (Tuberculin Tested)" milk 5 (c) "Grade A (Pasteurised)" milk 2 (d) "Pasteurised" milk 8 Bacteriological Examination of Milk.—During the year two samples of raw milk, three of Certified milk, four of Grade A (Tuberculin Tested) milk, two of Grade A (Pasteurised) milk and forty-six of Pasteurised Milk were bacteriologically examined, in all instances except two, in order to ascertain whether they complied with the standards prescribed by the Milk (Special Designations) Order, which are as follows :— Certified Milk Not more than 30,000 bacteria per c.c. Bacillus coli not found in one-tenth c.c. Grade A (Tuberculin Tested) Not more than 200,000 bacteria per c.c. Milk. Bacillus coli not found in one-hundredth c.c. Grade A (Pasteurised) Milk Nor more than 30,000 bacteria per c.c. Bacillus coli not found in one-tenth c.c. Pasteurised Milk Not more than 100,000 bacteria per c.c. There are no standards for raw milk. 92 The results are set out in the following Table: TABLE No. 48. Mouth. Type of Milk. Number of bacteria per c.c. Bacillus coli per 1/10 c.c. Remarks. January Pasteurised 38,000 — — do. 28,000 — — do. 6,800 — — do. 5,400 — — do. 8,700 — — Raw — — Tubercle bacillus not found. Raw 2,900,000 Present Or. delivery. February Pasteurised 8,400 — — do. 3,300 — — do. 8,200 — — do. 17,500 — — do. 13,700 — — March Pasteurised 12,400 Present — do. 6,800 — — do. 18,700 Present — do. 9,500 - — do. 4,100 — — May Pasteurised 12,400 — — do. 39,000 — — do. 23,000 — — do. 16,700 — — do. 10,600 — — June Pasteurised 6,200 — — do. 11,900 — — do. 4,800 — — do. 16,700 — — do. 9,600 — — do. 16,000 — — do. 274,000 Present — do. 87,500 Present — do. 44,000 Present — July Pasteurised 9,200 — — do. 4,600 — — do. 3,400 93 It will be noted that in only four instances was there a count in excess of the prescribed standards. Dried and Condensed Milks.—Three 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 (with certain exceptions) where artificial cream is manufactured, sold, exposed or kept for sale. One shop was placed on the register during the year. Month. Type of Milk. Number of bacteria per c.c. Bacillus coli per 1/10 c.c. Remarks. July Pasteurised 15,300 — — do. 95,000 Present — August Certified 5,200 — — Grade " A" (Tuberculin Tested). 2,600,000 Present — Grade " A" (Pasteurised) 800 — — September Certified 14,200 — do. 25,000 Present — Grade "A" (Tuberculin Tested) 19,400 — — do. 3,800 — — do. 38,000 Present — Grade "A" (Pasteurised) 6,200 — — Pasteurised 18,000 — — do. 11,000 — — do. 5,400 — — do. 29,500 Present — do. 27,000 Present — do. 41,000 Present — do. 644,000 Present — October Pasteurised 149,000 — — do. 4,100 — — do. 16,000 — — do. 99,500 Present — do. 4,560 — — 94 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. The following Table, No. 49, shows the number of animals slaughtered and inspected in the Borough during the year. In 1934 the number was 37,594. TABLE No. 49. Month. Cattle. Sheep and Lambs. Pigs. Calves. Total. January 287 1576 1967 — 3830 February 248 1081 1499 80 2908 March 278 1183 1398 80 2939 April 252 1222 1292 164 2930 May 287 1633 676 117 2713 June 242 1923 278 70 2513 July 239 2116 7 101 2463 August 242 1803 216 60 2321 September 269 1733 1587 — 3589 October 295 1990 2230 1 4516 November 299 1792 2097 — 4188 December 313 1359 2447 — 4119 3251 19411 15694 673 39029 The number of whole carcases condemned on account of disease or injury was 35 (31 pigs, 1 calf and 3 cattle). In 3,051 instances partial condemnation was necessary in respect of 2,676 pigs, 43 sheep, and 332 cattle. Licensing of Slaughtermen.—The Slaughter of Animals Act, 1933, requires that all slaughtermen shall be licensed. During the year 19 licences were renewed and 2 new licences issued, making a total of 21. Slaughterhouses.—There is no public slaughterhouse in the Borough. Slaughterhouses are subject to annual licence and in Table No. 50 which follows, are shown those licences in force at the end of the year. 95 TABLE No. 50. 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 Registered Premises.—The London County Council (General lowers) 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. The register of such premises which is now complete is kept in five parts, and the numbers in each part at the end of the year were as set out below:- (a) Sale, manufacture or storage of Ice Cream 205 (b) Manufacture of Sausages 86 (c) Preparation or manufacture of Potted, Pressed, Pickled, or Preserved Meat 105 (d) Preparation or manufacture of Potted, Pressed, Pickled, or Preserved Fish 42 (e) Preparation or Manufacture of Potted, Pressed, Pickeld, or Preserved other foods 4 The total number of inspections made was 942. Other Food Premises.—As a matter of routine a number of food premises, including eating houses, coffee stalls, and restaurants, are visited frequently by the Food Inspector, and immediate action is taken in regard to any insanitary condition found. In addition, 2,695 visits were made to shops and to stalls in the markets. 96 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 71, and 2 notices were served. The conditions on the whole were satisfactory. The number of inspections made in respect of all food premises, other than those referred to above as registered premises, is shown in the following Table :— Table No. 51. Premises. On Register 31st December Number of Legal Proceedings. Inspections. Notices. Bakehouses 35 71 2 — Cowsheds 8 65 4 — Dairies 74 211 5 — Slaughterhouses 4 16 — — Premises where food is prepared (other than above 160 360 4 — Shops and Markets — 2695 — — Unsound Food.—There were 483 instances of unsound food being surrendered. These compare with 337 in 1934. Included in the food surrendered were : 3 tons 9 cwts. Pork; 2 tons 9 cwts Beef; ½cwt. Mutton; 1 cwt. Veal; 19 lbs. Ham; 17½ cwts Ox Liver; 4 cwts Ox Lungs; 1 ton 2 cwt. Pig Offal; 2¼ cwts. Sheep Offal; 25 lbs. Rabbits; 2¼ cwts. Fish; 14 lbs. Cabbage; ½ cwt. Fruit; 6 cwts. Peas and Beans. Three seizures were made : 12 lbs. Tomatoes; 26 lbs. Prunes; 10 lbs. Sweets. On the instructions of the Public Health Committee a cautionary letter was sent by the Town Clerk in each instance. 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) Honey; Fresh Apples. No. 3 Order, 1928. 97 The Merchandise Marks (Imported Goods) Currants; Sultanas; Raisins; No. 5 Order, 1928. Eggs in Shell; Dried Eggs; Oat Products. The Merchandise Marks (Imported Goods) Raw Tomatoes. No. 4 Order, 1929. The Merchandise Marks (Imported Goods) Malt Products. No. 5 Order, 1930. The Merchandise Marks (Imported Goods) Frozen or Chilled Salmon or No. 8 Order, 1931. Sea Trout. The Merchandise Marks (Imported Goods) Butter. No. 1 Order, 1932. The Merchandise Marks (Imported Goods) Bacon and Ham. No. 3 Order, 1934. The Merchandise Marks (Imported Goods) Dead Poultry. No. 5 Order, 1934. The Merchandise Marks (Imported Goods) Meat. No. 7 Order, 1934. 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. 98 The following is a list of products regarding which Regulations were in force on the 31st December, 1935:— Date of Regulations. Produce. 1929 Potatoes. 1930 Eggs; Strawberries; Cherries. 1931 Beef. 1932 Cider. 1933 Wheat Flour; Malt Extract and Malt Flour; Gooseberries; Loganberries; Raspberries; Red Currants; Cheshire Cheese; Pears. 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; Watercress; Horseradish; Kidney and Runner Beans; Mushrooms; Forced Rhubarb; Natural Rhubarb; Stilton Cheese; Hot-house Grapes. 1935 Blackcurrants; Glasshouse-grown Tomatoes and Cucumbers; Creamery Butter; Vegetables; Perry; Canned Fruits; Plums; Wheat Flour; Bottled Fruits; Bottled Vegetables; Caerphilly Cheese; Apples; Cheddar Cheese; Cream Cheese; Dressed Poultry. During the year Regulations affecting Glasshouse-grown Tomatoes and Cucumbers (1930), Plums and Bottled Vegetables (1932), Blackcurrants, Brussels Sprouts, Celery, Green Peas, Cabbage, Lettuce, Bottled Fruits, Plums, Apples, and Dressed Poultry (1933,) Turnips and Swedes (1934), were revoked, and the Regulations affecting Canned Fruits (1934) were amended. No offences were discovered during the year. Sophistication ok Food.—The following Table, No. 52, 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. 52. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Milk 239 36 275 15 Cream - 14 14 - Dried Milk - 5 5 - Condensed Milk - 3 3 - Butter 3 7 10 - Cheese - 6 6 - Margarine 4 - 4 - Lard - 3 3 - Suet - 5 5 - Cooking Fat - 1 1 - Tea - 3 3 - Coffee - 4 4 - Cocoa - 5 5 - Sugar 2 4 6 - Flour - 3 3 - Baking Powder - 4 4 - Rice - 4 4 - Sago - 3 3 - Pearl Barley - 1 1 - Macaroni - 1 1 - Blanc Mange Powder - 1 1 - Soups 1 7 8 - Sultanas - 4 4 - Currants - 1 1 - Raisins - 2 2 - Nuts and Raisins - 1 1 - Cake and Fruit - 1 1 - Candied Peel - 3 3 - Ground Almonds - 4 4 - Ground Cinnamon - 2 2 - 99 100 TABLE No. 52—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Pepper - 3 3 - Dried Mint - 3 3 - Dried Fruits - 5 5 - Sage - 2 2 - Mincemeat - 3 3 - Jams and Jellies 19 19 1 Glace Fruits - 4 4 - Sauces - 3 3 - Mint Sauce - 3 3 - Preserved Ginger - 3 3 - Honey- - 2 2 - Cakes - 4 4 - Biscuits - 4 4 - Sweets and Confectionery - 11 11 - Ice Cream - 1 1 - Lemon Squash - 3 3 - Pickles - 8 8 1 Vinegar - 3 3 - Malt Vinegar - 5 5 - Lemonade Powder - 3 3 - Meat Minced 6 - 6 1 Meat Paste - 2 2 - Brawn - 6 6 - Saveloy 1 - 1 1 Sausages 14 2 16 1 Sausages, Preserved 7 - 7 - Sausage Rolls - 1 1 - Meat Pies - 4 4 - Faggots 1 - 1 - Chicken and Ham 1 1 2 2 101 TABLE No. 52—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Fish Paste - 1 1 - Brandy 4 - 4 - Whisky 8 - 8 - Gin 3 - 3 1 Rectified Spirit - 1 1 - Non-Alcoholic Wine - 3 3 - Ginger Wine Essence - 1 1 - Ale - 2 2 - Canned Fruits - 17 17 - Canned Anchovies - 1 1 - Canned Asparagus - 12 12 1 Canned Macaroni - 1 1 - Canned Potatoes - 1 1 - Canned Peas - 4 4 - Canned Salmon - 1 1 - Canned Sardines 1 9 10 3 Canned Sild - 14 14 5 Canned Tongue - 3 3 - Canned Oysters - 1 1 - Canned Hoes. - 1 1 - Canned Herrings and Pilchards - 5 5 - Canned Beans and Peas - 3 3 - Canned Tomatoes - 5 5 - Canned Spaghetti - 3 3 - Lime Water 3 2 5 5 Camphorated Oil - 2 2 - Mercurial Ointment - 7 7 1 Peroxide of Hydrogen 2 2 4 4 Spirit Sal Volatile - 3 3 - Tincture of Iodine 1 4 5 1 301 355 656 43 102 The Public Analyst has furnished the following figures showing the percentage of fat found in each sample of milk submitted for analysis during the last three years:— TABLE No. 53. 1933 1934 1935 4.5 per cent. and over 4 7 8 4 per cent. and under 4.5 per cent. 8 9 11 3.5 per cent. and under 4 per cent. 116 88 102 3 per cent. and under 3.5 per cent. 124 128 146 Below 3 per cent. 3 5 8 255 237 275 The following observations by the Public Analyst, Mr. H. Amphlett Williams, on the results of certain examinations during the year, are full of interest:— "The analyses made during the year raised some matters of unusual importance regarding the purity of food sold in this district. Tinned Sardines.—Following the detection of appreciable amounts of lead in sardines last year, further samples were taken, and the presence of lead in certain brands was again revealed. In the two years, 20 samples of various brands have been analysed, out of which 7 were found to contain more than one tenth of a grain per pound, or 14 parts per million of lead. There is no legal limit for lead in foods; it is, however, obvious that any comtamination of food intended for human consumption with a poisonous metal such as lead should be entirely prevented. For administrative purposes, a figure of one tenth of a grain per pound has been recommended as a maximum to be permitted. Above this proportion there would appear to be a definite danger of cases of lead poisoning arising and it seems quite unnecessary with efficient canning for the lead content to exceed such a figure. It is noteworthy that all the samples of sardines containing excessive amounts of lead were of Portuguese origin; in this connection, recent investigation has shown that the lead is derived, not from corrosion of the soldered cans, as was formerly supposed, but from the process of cooking. 103 Of the two different processes which may be adopted for cooking, the Portuguese consists of placing the salted fish on grills, made of inclined wire struts, cooking in steam and then canning in oil and processing; whilst the French process, which gives a darker product, consists of frying the fish on the grills in oil before canning. In some Portuguese factories, the grills were found on investigation to be tinned with impure tin containing lead, or with solder, with the result that some of the lead, attacked by the steam and salt, was absorbed in varying degrees by the fish. No doubt the action taken in preventing the further sale of these brands of sardines will eventually have the desired effect of avoiding the contamination at the source by the replacement of the lead-containing cooking grills. All samples of sardines, etc., are carefully examined as to their identity so as to ensure that fish of an inferior flavour, such as sild (small herrings) and brisling (sprats) are not substituted for sardines; it is of interest to note that young Horse Mackerel or Scad, a fish not usually sold for consumption in this country on account of its coarse flavour and spiny scales, were found on sale in tins as ' sardines ' in a neighbouring Borough this year. Tinned Sild.—Five samples out of the fourteen analysed during the year were found to contain excessive amounts of tin, and were accordingly reported against, and the further sale of those particular brands suspended. Whilst the ingestion of small amounts of tin with food would not appear to be dangerous to the same degree as lead, a limit of 2 grains per pound has been officially recognised as a maximum proportion, not only avoidable and unnecessary, but also potentially deleterious to health. In common with the experience of neighbouring Boroughs, the samples contaminated with tin were found to be cheap brands, of Norwegian origin, and the presence of this impurity appeared to be due to corrosion of the can, arising from the age of the stock or from careless canning, as for example, using insufficient oil or including salt water. Five samples of tinned herrings and pilchards in tomato sauce were free from excessive amounts of tin or lead. 104 Hot Milk.—Seven samples of hot milk, as served in restaurants, cafes, etc., were submitted for analysis during the year, and of these no less than five were found to be not genuine, either by reason of the abstraction of fat or the addition of water. Four prosecutions were successfully taken against the vendors of the adulterated samples, and the attention of other vendors should be called to the fact that milk may not be skimmed or contain water when sold as hot milk, any more than when it is sold as cold milk. It is, of course, well known that some of the fat in milk may be removed in the form of skin when the milk is heated and poured off into a glass; but the proportion that may unavoidably be removed in this way is comparatively small, and would be taken into consideration before condemning a sample of heated milk. If a method of heating is adopted whereby a large amount of fat rises and is separated as a skin, as, for example, if the milk is kept hot for some hours in an urn without mixing and then drawn off from the bottom for serving, the customer is obviously prejudiced by getting an article not of the quantity demanded, and the method of heating should be improved. Apart from the question of cream, added water was found in some of the samples of heated milk, and in this connection a point of considerable scientific interest arose. It is widely known that natural variations occur in the composition of milk and that the percentage of solids-not-fat in the milk from individual cows and sometimes even from herds of certain breeds may occasionally fall below 8.5; in such a case added water would be presumed under the Sale of Milk Regulations to be present, and a prosecution might be taken against a person who had sold poor but genuine milk. Now, it has been shown that the secretion of fluids in the body of an animal depends upon a factor known as their "osmotic pressure" and the osmotic pressure of a particular fluid secreted by a particular animal must accordingly, for physiological reasons, be a constant. As the freezing and boiling points of solutions are related to their osmotic pressures, these properties are also practically constant for a particular secretion, as, for example, cows' milk; the exact determination of the freezing point of a sample of milk has in the past been an extremely difficult matter, but the introduction in the last few years of the Hortvet Cryoscope and the general adoption of a standard technique, has made the accurate determination of a freezing point possible for any qualified analyst. 105 The freezing point of genuine milk is 0.55° centigrade and, as that of pure water is 0°, a proportion of added water in a sample of ' milk ' can be estimated quite independently of the percentage of solids-not-fat. This test is, therefore, performed where possible on all samples of milk showing low figures for solidsnot-fat, and the possibility of a genuine milk being condemned as watered is thereby avoided. An interesting result of the adoption of this test as a criterion has been the detection of small amounts of added water in milks which would have been passed as genuine under the standard of the Sale of Milk Regulations. The inference from the freezing point of a sample of milk therefore becomes a matter of great importance; and, as the presence of added water was indicated by this test in one of the samples of hot milk which contained only slightly less solids-not-fat than the minimum limit of 8.5 per cent., a question arose as to whether the freezing point might not have been affected by the process of heating. Series of experiments were therefore carried out in which varying quantities of milk were heated in the laboratory to various temperatures, and kept at such temperatures for varying times, in open and closed saucepans. Furthermore, samples of milk that had been heated and kept hot for periods of up to three hours in different kinds of urns in local cafes, restaurants, buffets, snack bars, etc., were taken by the Public Analyst, with the co-operation of the respective managements, and tested. The freezing points and the compositions of the samples were determined in each case, the corresponding unheated milks being analysed for comparison side by side with the heated samples. Over 130 tests were made on the various samples, and in no case was the freezing point found to be raised as a result of the heating, although in several instances, as where the milk had been kept hot in an open pan, the freezing point was slightly lowered, owing no doubt to concentration by evaporation. It was thus established that the deduction of added water from the freezing point can be relied upon when a milk has been heated in any of the ways usual in places where hot milk is sold." 106 Adulterated Samples—Action Taken.—The following Table, No. 54, shows the number of adulterated samples and the action taken in each instance where the sample was formal:— TABLE No. 54. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 424 Lime Water Formal Chlorine in excess of B.P. limit Vendor cautioned. 441 Milk Formal 16 per cent deficient in fat Fine £1. Costs £1. 446 Lime Water Informal Chlorine in excess of B.P. limit — 447 Lime Water Informal Chlorine in excess of B.P. limit — 475 Lime Water Formal Chlorine in excess of B.P. limit Vendor cautioned. 476 Lime Water Formal Chlorine in excess of B.P. limit Vendor cautioned. 486 Milk Formal 1 per cent excess of water — 487 Milk Formal 1 per cent deficient in fat — 488 Milk Formal 2 per cent excess of water — 542 Sausages Informal Contained 200 parts per million of sulphur dioxide — 568 Chicken and Ham Informal Contained 32.2 per cent boiled rice — 581 Chicken and Ham Formal Contained 30.9 per cent boiled rice Vendor cautioned. 588 Milk Formal 1 per cent of added water — 596 Saveloy Formal Contained 40 parts per million sulphur dioxide Vendor cautioned. 15 Milk Formal 6 per cent deficient in fat Fine £2. Costs 30s. 47 Asparagus, canned Informal Contained tin 2.1 grs. per lb. — 114 Milk Formal 7 per cent. deficient in fat Farm sample 147 Mercury Ointment Informal Contained mercury 33.5 per cent. instead of 30 per cent. — 149 Minced Beef Formal Contained sulphur dioxide 12 parts per million. Vendor cautioned. 166 Sild, canned Informal Contained tin 4.9 grs. per lb. Stock withdrawn from sale. 193 Sardines, canned Informal Contained lead 21 parts per million. — 223 Sardines, canned Formal Contained lead 15 parts per million. — 225 Milk Formal Slightly deficient in fat (contained 2.98 per cent.). — 107 TABLE No. 54—continned. Sample No. Article. Formal or Informal. Result of Analysis Result of Legal Proceedings or other Action. 231 Milk Formal 12 per cent. added water and 5 per cent. deficient in fat. Fined £1 and 21/costs. 238 Milk Formal 1 per cent. added water — 251 Milk Formal 17 per cent. added water and 11 per cent. deficient in fat. Fined £1 and 21/costs. 256 Milk Formal 5 per cent. added water £1 1s. costs. 257 Milk Formal 26 per cent. deficient in fat Fined £1 and 21/costs. 264 Pickles Informal Contained fragments of glass — 304 Gin Formal 3 per cent. excess water Vendor cautioned. 324 Tincture Iodine Informal 55 per cent. deficient in iodine and potassium iodide. — 326 Peroxide of Hydrogen. Informal 25 per cent. excess hydrogen peroxide. — 327 Peroxide of Hydrogen. Informal 32 per cent. excess hydrogen peroxide. — 353 Milk Formal 15 per cent. deficient in fat . . Fined £1 and 21/costs. 356 Milk Formal 4 per cent. added water — 360 Solution Hydrogen Peroxide. Formal 15 per cent. deficient in hydrogen peroxide. Vendor cautioned 361 Solution Hydrogen Peroxide. Formal 33 per cent. excess hydrogen peroxide. Vendor cautioned. 364 Sild, canned Informal Contained tin 3.7 grs. per lb. Stock withdrawn from sale. 384 Sild, canned Informal Contained tin 3.8 grs. per lb. 385 Sild, canned Informal Contained tin 4.3 grs. per lb. 386 Sild, canned Informal Contained tin 3.15 grs. per lb. 423 Blackcurrant Jam Informal Contained only 20 per cent. fruit instead of 30 per cent. Vendor cautioned. 427 Sardines, canned Informal Contained lead 15 parts per million. Vendor cautioned. 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. 108 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 total number of notifications received was 68, sixteen of which related to an outbreak in a hostel. In five other instances two persons were involved. The age and sex distribution of the cases notified is shown in the following Table, No. 55:— TABLE No. 55. Cases of Food Poisoning Notified during 1935. Age Periods. Male. Female. Total. Under 1 — — — 1 and under 5 — 1 — 6 and under 10 3 2 5 10 and under 15 3 1 4 15 and under 20 — 15 15 20 and under 35 3 11 14 35 and under 45 4 4 8 45 and under 65 11 8 19 65 and over — 2 2 24 44 68 The medical practitioner notifying is required to state on his certificate the food he suspects. In 20 households, fish, in one or other form—fresh, fried, tinned, shell or paste—was suspected; in 16 households, meat—pork, ham, rabbit, lamb, sausage, curry or meat paste; in 6 households, fruit—fresh or tinned; and in six other instances other foods were suspect. Most of the cases were slight in character, and two only were admitted to hospital where the diagnosis was not confirmed. Some cases were investigated bacteriologically (a) Two adults had boiled ham for supper. In eleven hours and nineteen hours, respectively, both were suffering from diarrhoea and sickness and abdominal 109 pain. A specimen of the ham was secured and examined. The bacteriologist reported as follows:— "The specimen received consisted of the bones of a fore-leg of ham to which was attached a fair amount of meat, especially at the knuckle end. No marked odour was apparently coming from the specimen, but it appeared to be what might be called ' Stale.' Portions of fat, lean and tissue near the bone were examined bacteriologically. The specimens were placed in broth and allowed to grow until turbidity was evident. Sub-cultivation was then performed using blood agar and litmus lactose agar media. Further cultures were also prepared using brilliant green as a restrainer. From the culture a copious growth of varied organisms was obtained. The organisms present definitely identified were:— 1. Bacillus coli (in very large numbers). 2. Bacillus proteus. 3. Staphylococcus Albus. 4. Streptococcus Haemolyticus. 5. Monilia (Yeast). No non-lactose fermenting organisms of the salmonella or typhoid groups were identified, but the numbers of Bacillus Coli present were so large that it is possible that an occasional bacillus of either of these groups would not be obtained in culture or alternatively that the correct portions of the meat were not selected for investigation. The ham was definitely very badly contaminated by many organisms of human or animal origin." As a result of further investigations it was subsequently shown that the ham was infected with Bacillus Gaertner and that one of the patients was infected with the same organism. (b) A man aged 51 years ate some ham and was diagnosed to be suffering from enteritis. He was not formally notified as suspect food poisoning. A specimen of the ham was bacteriologically examined, and reported on as follows:— "Cultures have been made from the lean and fat of the specimen. Lean.—From the lean have been found on culture:— 1. Streptococcus Salivarius. 2. Bacillus Subtilis. These organisms are of no pathogenical importance. Fat.—From the fat have been found:— 1. Coliform bacillus. 2. Another type of coliform bacillus. 3. Bacillus proteus. 110 The first organism was found to be an aberrant form of bacillus coli, whilst the second is a delayed lactose fermenting type of coliform bacillus. Opinion.—It is possible that the presence of these aberrant strains of coliform bacilli were capable of acting as pathogenic agents." (c) In a family consisting of six persons, two persons, one of whom was admitted to hospital as an emergency, became ill. In hospital a diagnosis of food poisoning was made, and later the second case was notified by the practitioner in attendance. In both instances the notification was three days after the onset. It was not possible to get an accurate history of the onset, and no food specimens were available, but stool and blood specimens were submitted for examination. Ultimately the bacteriologist reported the identification of organisms as follows:— Mother—Bacillus Gaertner "0" form. Daughter—Bacillus Aertrycke. A double infection is curious, but there is at least one similar instance on record, and in that case the double infection was proved to be due to contamination by rats or mice. (d) In March, in a hostel, sixteen cases of food poisoning were notified within two days. There were fourteen other cases not notified. The suspected food was lamb, but it was not possible to get any specimens for bacteriological examination. Four stool and serum specimens, however, were examined. In three patients a haemolytic coliform bacillus was found. Agglutination occurred to a slight degree. This is evidence that these organisms are of a toxic character, and that they were the causal agents of the outbreak. Chemical and Bacteriological Examination of Food.—The laboratories at which work is carried out, and the nature of the work done is reported on fully in that Section of the report which deals generally with the provision of health services in the Borough. 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 are held 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 during 1935. The scheme is more fully reported on in the Health Propaganda Section. By-Laws.—The County Council have prepared draft by-laws in regard to food premises in accordance with their powers under Section 6 of the London County Council (General Powers) Act, 1932. These have been submitted to the Metropolitan Borough Councils for their observations, but have not yet been adopted. 111 SECTION VII. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. In addition to food poisoning, which is reported on in the preceding Section, 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 W oolwich 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, Lartford, or indeed, to any other of the fever hospitals belonging to the London County Council in the County of London. ihe 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 112 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 1,363, compared with 1,865 in 1934. In tabular form are shown in the next five Tables statistics relating to the incidence of infectious disease in the Borough in 1935 and previous years. TABLE No. 56. Notification of Infectious Disease (excluding Tuberculosis), 1935. Diseases. Total Cases Notified. Admissions to Hospital. Total Deaths. Diphtheria 313 313 13 Scarlet Fever 634 595 2 Enteric Fever (including Para-Typhoid Fever) 9 7 — Puerperal Fever 3 3 3 Puerperal Pyrexia 42 40 — Erysipelas 78 42 3 Smallpox — — — Pneumonia 255 167 84 Malaria — — — Ophthalmia Neonatorum 17 3 — Encephalitis Lethargica 1 1 1 Dysentery 1 1 — Cerebro-Spinal Meningitis 3 3 1 Poliomyelitis 2 2 — Polio-encephalitis — — — Zymotic Enteritis 5 2 21 *Measles (including German Measles) 656 34 1 * Not notifiable. 2,019 1,213 129 113 TABLE No. 57. Ward Incidence of Infectious Diseases (excluding Tuberculosis), 1935. Disease. 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 313 20 46 22 10 10 11 11 11 10 46 24 11 11 70 Scarlet Fever 634 18 19 50 25 14 38 23 73 30 40 35 41 55 173 Enteric Fever (including Paratyphoid Fever) 9 — — 1 — — — — 1 — — 2 2 2 1 Puerperal Fever 3 — — — 1 — — — — — — 1 — — 1 Puerperal Pyrexia 42 2 3 3 4 2 7 2 3 4 5 — 1 1 5 Erysipelas 78 1 3 5 3 6 6 4 5 10 10 7 6 4 8 Smallpox — — — — — — — — — — — — — — — Pneumonia 255 16 27 25 12 14 10 14 14 9 38 31 13 12 20 Malaria — — — — — — — — — — — — — — — Ophthalmia Neonatorum 17 — 2 — — 1 — 1 2 1 — 3 — 2 5 Encephalitis Lethargica 1 — — — — — — — — — 1 — — — — Dysentery 1 — — — — 1 — — — — — — — — — Cerebro-Spinal Meningitis 3 — — — — — — 1 — — — 1 — — 1 Poliomyelitis 2 — — — — — — — — — — 2 — — — Polio-encephalitis — — — — — — — — — — — — — — — Zymotic Enteritis 5 1 — — 1 — — 1 — — — — — 1 1 *Measles (including German Measles) 656 11 1 3 11 8 15 11 73 14 23 6 128 21 331 * Not notifiable. 2,019 69 101 109 67 56 87 68 182 78 163 112 202 109 616 114 TABLE No. 58. Cases of Infectious Diseases Notified, 1935 (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 313 5 11 11 25 34 140 38 20 20 4 5 — Scarlet Fever 634 1 13 25 44 65 279 120 27 44 7 8 1 Enteric Fever (including Paratyphoid Fever) 9 — — 1 — 1 — 1 3 2 — 1 — Puerperal Fever 3 — — — — — — — — 1 2 — — Puerperal Pyrexia 42 — — — — — — — 2 36 4 — — Erysipelas 78 1 2 1 — — 4 3 1 4 9 36 17 Smallpox — — — — — — — — — — — — — Pneumonia 255 23 22 15 10 9 16 11 8 34 25 60 22 Malaria — — — — — — — — — — — — — Ophthalmia Neonatorum 17 17 — — — — — — — — — — — Encephalitis Lethargica 1 — — — — — — 1 — — — — — Dysentery 1 — — — — — — — — 1 — — — Cerebro-spinal Meningitis 3 1 — — — — 1 1 — — — — — Poliomyelitis 2 — — 1 — — — — 1 — — — — Polio-encephalitis — — — — — — — — — — — — — Zymotic Enteritis 5 5 — — — — — — — — — — — *Measles {including German Measles) 656 14 36 38 47 86 382 51 — 2 — — — * Not notifiable. 2,019 67 84 92 126 195 822 226 62 144 51 110 40 115 TABLE No. 59. Notification of Infectious Diseases (including Tuberculosis), 1901 to 1935. Year. Smallpox Diphtheria and Mem. Croup. Erysipelas Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. § Puerperal Pyrexia. Primary Pneumonia. 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 — — — — — — — — — 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 — — 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 12 269 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 44 564 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 — 1935 — 313 78 634 9 — 3 42 230 25 — 1 — 17 1 3 2 5 209 33 656 — §Notification of Puerperal Pyrexia commenced October, 1926. † Measles notifiable from 1/1/1916 to 31/12/1919. *Voluntary notification to 1910; partial to 1912; all cases thereafter. ‡Compulsory notification of Zymotic Enteritis commenced 1913. X Chicken Pox was again made notifiable from April, 1930 to 30th September, 1931. 116 TABLE No. 60. Deaths from Infectious Diseases (excluding Tuberculosis), 1935. Diseases. Number of Deaths. All Ages. Age Groups. Under 1 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- Diphtheria 13 — 2 3 8 — — — — — — — Scarlet Fever 2 — — 1 1 — — — — — — —— Enteric Fever (including Para-typhoid Fever) — — — — — — — — — — — — Puerperal Fever 3 — — — — — 1 2 — — — — Puerperal Pyrexia — — — — — — — — — — — — Erysipelas 3 — — — — — — — — 1 1 1 Smallpox — — — — — — — — — — — — Pneumonia 84 20 3 5 1 — 4 5 15 11 9 11 Malaria — — — — — — — — — — — — Ophthalmia Neonatorum — — — — — — — — — — — — Encephalitis Lethargica 1 — — — — — — — — 1 — — Dysentery — — — — — — — — — — — — Cerebro-spinal Meningitis 1 — — — — 1 — — — — — — Poliomyelitis — — — — — — — — — — — — Polio-encephalitis — — — — — — — — — — — — Zymotic Enteritis 21 14 1 — — — 2 — — — 3 1 *Measles (including German Measles) 1 — — 1 — — — — — — — — * Not notifiable. 129 34 6 10 10 1 7 7 15 13 13 13 117 Diphtheria. Notification.—During the year 313 cases were notified, compared with 416 in 1934 and 370 in 1933. There were five military cases. The number of notifications received each quarter was as follows:— First quarter 122 Second quarter 68 Third quarter 56 Fourth quarter 67 Multiple Cases.—The following Table, No. 61, shows the house distribution in wards. The term " house " is synonymous with the term family except in five cases where two families were involved. TABLE No. 61. 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 13 19 19 5 10 9 9 9 10 34 18 6 7 47 215 215 2 cases occurred 2 8 - - - 1 1 1 - 3 3 1 2 5 27 54 3 „ „ 1 1 1 - - - - - - 2 - 1 - 3 9 27 4 „ „ - 2 - - - - - - - - - - - 1 3 12 Total houses 16 30 20 5 10 10 10 10 10 39 21 8 9 56 254 308 Military Cases - - - - - - - - - - - - - - - 5 313 Return Cases.—Five cases gave rise to six return cases. Deaths.—There were 13 deaths from Diphtheria, compared with 11 in 1934 and 15 in 1933. Five of these deaths were of children under five years of age and eight were of school children. Antitoxin.—A supply of Diphtheria Antitoxin is kept at the Town Hall, the Plumstead Library and the Eltham Library, and is available for medical 118 titioners on application, at cost price, or free where there is inability to pay. The amount supplied during the year was 110,000 units. The total cost to the Council was £7 5s. 0d., of which £5 5s. Od. was recovered. Immunisation.—In 1934, the Council, with the co-operation of the local medical profession, started a scheme for the immunisation of children against diphtheria. The scheme is one in which the immunisation is carried out by general practitioners and it was set out in full in my Annual Report for 1934. It was necessary, however, to modify it slightly during the year as it came to notice that cases had occurred where Doctors had given one or two injections, but were unable to give the second or third as a result of the removal of the patient to some other district or for some other reason. As the scheme stood the doctor was not entitled to any payment. It seemed unfair, however, that he should be out of pocket in his efforts to co-operate with the Council in this branch of preventive medicine, and in such circumstances the Council decided to repay the cost of the diphtheria prophylactic used by him. During 1935, 1,004 children were immunised and a further 148 were found not to require immunisation. Since the scheme started in November, 1934, 1,135 children in all have been immunised. In order to ascertain whether the child is susceptible to diphtheria or not, use is made of the Schick test. This may be done before immunisation; but it must be carried out after immunisation in order to ascertain that the desired result has been obtained. Schick testing clinics have been held periodically as often as was necessary. The figures for the year are as follows. Before the course of immunisation, 471 children were found to be Schick positive and 148 Schick negative, and after immunisation, including children immunised in 1934, 779 were found to be negative and 38 positive; 61 children failed to attend. The remaining children were waiting until the requisite period of time had passed to enable immunity to be developed. The total amount of fees paid to general practitioners for immunisation during the year was £537 10s. Od. The other costs amounted to £136 1s. 9d. Scarlet Fever. Notification.—During the year 634 cases were notified, compared with 989 in 1934 and 1,004 in 1933. There were 8 military cases. The number of notifications received each quarter was as follows:— First quarter 189 Second quarter 153 Third quarter 109 Fourth quarter 183 Multiple Cases.—The following Table, No. 62, shows the house distribution by wards. The term "house" is synonymous with the term "family" except in six instances, where two families were involved. 119 TABLE No. 62. 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 10 17 41 11 10 29 23 53 24 36 33 30 55 116 488 488 2 cases occurred 4 1 3 3 2 3 - 6 3 2 1 4 - 24 56 112 3 „ „ - - 1 - - 1 - 1 - - - 1 - 3 7 21 4 „ „ - - - - - - - - - - - - - - - - 5 „ „ - - - - - - - 1 - - - - - - 1 5 Total houses 14 18 45 14 12 33 23 61 27 38 34 35 55 143 552 626 Military Cases - - - 8 - - - - - - - - - - - 8 634 Return Cases.—The following Table, No. 63, 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. The period of detention in hospital of cases of scarlet fever has diminished much in recent years, possibly because more use is now made of anti-streptococcal serum in the treatment of such cases. A still more recent practice is to add a small amount of diphtheria anti-toxin in view of the well known complication of diphtheritic discharge from the nose which used to be responsible for long periods of detention in hospital of individual cases. The number of return cases, as set out in the following table, and the number of multiple cases in households, as shewn in Table 62, are not more than the average yearly figures. Most Medical Superintendents of infectious diseases hospitals speak highly of this serum therapy and it is evident that this method of treatment has come to stay and to shorten the period of isolation in hospital of most cases of scarlet fever. 120 TABLE No. 63. Scarlet Fever—Return Cases, 1935. No in Register. Date admitted to Hospital. Date Discharged. Total Days in Hospital. Onset of Secondary Case. Remarks on Primary Case. 1935. 1935. 1935. 30 January 14th February 6th 24 February 14th Thick nasal discharge. 61 January 30th February 26th 28 March 13th — 87 February 9th March 16th 36 March 29th — 97 February 14th March 7th 21 March 27th — 134 March 4th March 28th 25 April 17 th Discharging ear. April 19th 147 March 12th April 19th 38 April 30th — 204 April 5th April 20th 16 April 27 th — 214 April 12th June 10th 60 June 14th — 217 April 13th May 11th 29 May 13th Slight eye discharge. 262 May 10th June 13th 35 June 22nd — 286 May 22nd June 15th 25 June 23rd Nasal discharge. 352 July 9th August 3rd 26 August 8th Nasal discharge. August 14th 361 July 15th August 24th 40 September 14th — 372 July 26th September 8th 45 September 12th — 425 September 6th October 24th 49 October 31st — November 3rd 426 September 6th October 3rd 28 October 17th — 456 October 3rd October 23rd 21 October 28th — 458 October 3rd October 22nd 20 October 28th — 554 November 22nd December 16th 25 December 22nd — December 28th Deaths.—There were two deaths from scarlet fever during the year, compared with 3 in 1934. Home Isolation.—Thirty-nine cases, or 6.1 per cent., were isolated at home and in no instance did a return case occur. Frequent visits are made by the District Sanitary Inspectors to all cases isolated at home in order to ensure that proper precautions are being taken to prevent 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. Seven certificates were issued during the year. Dick Test.—This has not been employed in the neighbourhood so far as I am aware. Smallpox. There were no cases of smallpox. Erysipelas, Malaria and Dysentery. The number of notifications of Erysipelas received was 78, compared with 119 in 1934. One case of Dysentery was notified. There were no notifications of Malaria. 121 Enteric Fever. Nine cases were notified, seven of whom were treated in hospital. There were no deaths. The following Table. No. 64, gives details of each case notified. TABLE No. 64. Enteric Fever, 1935. No. Date Notified. Sex. Age. Diagnosis. Final Diagnosis. Remarks. 1 2/ 2/35 M. 4 Enteric Fever Lobar Pneumonia — 2 20/ 2/35 F. 11 Paratyphoid B. Paratyphoid B. — 3 1/ 6/35 M. 23 Typhoid Fever Typhoid Fever — 4 3/ 6/35 M. 59 Typhoid Fever Typhoid Fever — 5 18/ 7/35 F. 17 Typhoid Fever Paratyphoid Fever — 6 9/ 8/35 F. 15 Paratyphoid B. Paratyphoid B. — 7 17/ 8/35 M. 19 Paratyphoid B. Paratyphoid B. — 8 13/ 9/35 F. 2 Paratyphoid B. Paratyphoid B. — 9 11/11/35 F. 32 Paratyphoid Fever Paratyphoid Fever — Anterior Poliomyelitis. Two notifications were received and both patients were admitted to hospital to the special wards reserved for such cases by the London County Council at the Western Hospital. The diagnosis of one case was confirmed, but in the other, a boy of 15, the ultimate diagnosis was Acute Myelitis. Encephalitis Lethargica. One case of this disease was notified and was removed to hospital. The diagnosis was not confirmed. One case, which was admiited to a mental hospital after an attack of Encephalitis Lethargica some years previously, died during the year. Cerebro-spinal Meningitis. Three cases were notified, all of which were admitted to hospital. The diagnosis was confirmed in each case. One case, which was not notified, died. The following Table, No. 65, gives details of each case. 122 TABLE No. 65. Cerebro-spinal Meningitis, 1935. No. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. 1 9/1/35 M. 8 Cerebro-spinal Meningitis — 2 14/5/35 F. 12 Cerebro-spinal Meningitis (Type 1) — — — M. 20 Cerebro-spinal Meningitis Died. 3 30/12/35 F. 6/12 Cerebro-spinal Meningitis — Puerperal Fever and Puerperal Pyrexia. Forty-five cases were notified compared with 35 in 1934 and 40 in 1933. In 42 instances notification was in respect of Puerperal Pyrexia, but in at least six of these the notification should have been Puerperal Fever. In one instance the disease was a sequel to abortion. All except two cases received hospital treatment. Deaths.—There was one death compared with two in 1934 and two in 1933. Zymotic Enteritis. Five cases were notified during the year, compared with three cases in 1934 and five in 1933. The number of deaths in children under 2 years of age certified to be due to diarrhoeal diseases was fifteen. Three of the notified cases died. Whooping Cough. During the year 266 cases of Whooping Cough came to the knowledge of the Department, compared with 253 in 1934 and 514 in 1933. 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.—Three cases were nursed under the Council's scheme, 12 visits in all being paid. The cost of this service was 12s. Deaths.—There were two deaths certified to be due to this disease, compared with 13 in 1934. 123 Ophthalmia Neonatorum. Seventeen cases were notified, three of which were admitted to hospital. Ten cases were nursed at home under the Council's scheme, 256 visits in all being paid. The cost of this service was £12 16s. Od. The following Table, No. 66, gives details of each case:— TABLE No. 66. Ophthalmia Neonatorum, 1935. Notified. Date Cases Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hospital. 1/1/35 — Yes Yes — — — 4/1/35 Yes — Yes — — — 18/2/35 Yes — Yes — — — 15/3/35 Yea — Yes — — — 19/3/35 Yes — Yes — — — 28/3/35 Yes — Yes — — — 29/4/35 Yes — Yes — — — 16/5/35 Yes — Yes — — — 27/6/35 — Yes — — — Died (Prematurity). 16/7/35 Yes — Yes — — — 20/7/35 Yes — Yes — — — 22/8/35 Yes — Yes — — — 12/9/35 Yes — Yes — — — 17/9/35 Yes — Yes — — — 17/10/35 Yes — Yes — — — 19/11/35 — Yes Yes — — — 26/11/35 Yes — Yes — — — 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 656 cases (including 159 cases of German Measles) were discovered. In 1934 and 1933 the corresponding figures were 2,392 and 354. 124 The incidence in each of the twelve months of the year was as follows:— January 70 February 131 March 157 April 83 May 94 June 74 July 25 August 9 September 3 October 2 November 3 December 5 Home Nursing.—In six cases nursing assistance was provided, 52 visits in all being paid. The cost to the Council was £2 12s. Od. Hospital Treatment.—The number of children admitted to fever hospitals was 34 Deaths.—There was only one death. Pneumonia. The number of cases notified was 255, compared with 280 in 1934. Of these, 25 were influenzal. The number of deaths certified to be due to lobar or broncho pneumonia was 84, and to acute influenzal pneumonia 16. The ward incidence of the Pneumonias is shown in Table No. 57. There is misunderstanding about the notification of pneumonia. All primary pneumonias—lobar or broncho—have to be notified. Secondary pneumonias, with the single exception of Acute Influenzal Pneumonia, are not notifiable. The main objects underlying notification are (a) statistical evidence of the prevalence of the disease or diseases and (b) the provision of nursing assistance if required. In a recent memorandum the Ministry of Health suggest that a sanitary authority should be prepared to provide facilities for the bacteriological examination of sputum. Various strains of the pneumococcus can now be differentiated by use of typespecific antisera—a matter of importance in the use of specific serum therapy. There are four types of anti-sera:types I. and II. are seldom found in healthy individuals but are responsible for some 60 per cent. of all cases of lobar pneumonia; type III. and the hetrogeneous collection in group IV. are normally present in throats and seldom give rise to cases of pnemonia. Felton's serum, which the Council supplies (see appropriate paragraph) is used in types I. and II. cases. The following Table, No. 67, 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. 125 TABLE No. 67. 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 14 15 29 6 5 2 16 12 — February 15 13 28 7 3 1 17 4 — March 28 24 52 9 3 11 29 16 5 April 14 18 32 6 1 7 18 10 8 May 6 10 16 3 2 1 10 4 1 June 12 5 17 — 2 1 14 • 7 — July 4 3 7 — — — 7 4 — August 2 6 8 5 — — 3 6 — September 4 3 7 1 2 — 4 5 — October 13 6 19 3 1 1 14 4 1 November 11 5 16 4 5 1 6 2 1 December 17 7 24 3 8 — 13 10 — 140 115 255 47 32 25 151 84 16 Nursing.—Nursing assistance is provided by the Council for cases of Pneumonia and during the year 23 cases were nursed, 452 visits being paid by the nurses of the local nursing associations. The total cost to the Council was £28 5s. Od. Anti-Pneumococcal Serum.—During the year the Council provided, free of charge, anti-pneumococcal serum (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 £34 2s. Od. Tuberculosis. The Council's Tuberculosis Service, which is under the general administrative control of the Medical Officer of Health, is in charge of a whole-time tuberculosis officer. He is assisted by three assistant medical officers who are whole-time officers in the service of the Council, but spend three half-days per week in tuberculosis work and eight half-days in maternity and child welfare. There are also three whole-time tuberculosis health visitors, one clerk-dispenser, who acts as secretary to the Care Committee, and one clerk. 126 Only one change in the personnel took place during the year. Miss E. Little, who was appointed a tuberculosis health visitor in 1934 was transferred to the maternity and child welfare section to fill a vacancy. Miss E. M. Plummer was appointed a tuberculosis health visitor in July. The service embraces the following ramifications:— (a) The administration of the Tuberculosis Regulations of 1925 and 1930. (b) Bacteriological examination of sputum. (c) The provision of outdoor shelters at the homes of patients. (d) The provision of two Tuberculosis Dispensaries. (e) Home visiting of tuberculous cases. (/) Arrangements for following up cases where diagnosis is doubtful. (g) Arrangements for securing the examination and systematic supervision of home contacts. (h) Visiting and medical examination of cases for the Ministry of Pensions. (i) Provision of extra nourishment. (j) An agreement with the War Memorial Hospital for X-ray examinations in doubtful cases. (k) Co-operation with the medical staff of the local London County Council General Hospital, the Tuberculosis Officer acting as consultant for tuberculous patients. (l) An agreement with the London Hospital for Finsen Light treatment of lupus. (m) Agreements with Brompton and other Hospitals for the induction of artificial pneumothorax. (n) An agreement with the School Treatment Committee for the provision of dental treatment. (o) Provision of nursing assistance in certain cases. (p) Co-operation with the School Medical Service, (q) Co-operation between the Tuberculosis Officer and the local medical practitioners. (r) A Tuberculosis Care Committee. (s) Institutional treatment through the London County Council. 127 A detailed account of the year's working is given in the following pages, but it is convenient to deal first with the mortality statistics of the year. Deaths.—The deaths from pulmonary tuberculosis during 1935 numbered 121, giving a death rate of 0.82 per 1,000 of the population. The corresponding figures for 1934 were 120 and 0.82 respectively. Deaths from other forms of tuberculosis numbered 15, as against 26 of the preceding year, the death rate being 0.10 per 1,000 of the population. The total number of deaths from tuberculosis, i.e., pulmonary and non-pulmonary was 136, and the combined mortality rate was 0.93. During the last five years there has been a tendency for the death rate from this disease to fall, as will be noted from the following table which shews the number of deaths from tuberculosis, classified according to the type of disease, each year since 1931. TABLE No. 68. Tuberculosis—Deaths and Death-Rates. Year. Deaths. Death-rates. All Forms. Pulmonary. NonPulmonary. All Forms. Pulmonary. NonPulmonary. 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 1935 136 121 15 0.93 0.82 0.10 In addition to the 136 deaths mentioned above, five persons who had been notified as suffering from pulmonary tuberculosis died during the year from other causes, and detailed information as to these is given in the following table:— TABLE No. 69. Case No. Date Notified as Tuberculosis. Cause of Death. 1 27/ 6/31 Congestion of Lungs. Myocardial Degeneration. 2 7/ 3/24 Cardiac Failure. Pulmonary Stenosis. 3 17/ 2/28 Cardiac Failure, Broncho-pneumonia. 4 20/ 8/35 Uraemia. Chronic Nephritis. 5 21/ 6/35 Streptococcal Empyaema. 128 The period which elapsed between notification of the disease and death was investigated in the case of each death, and the results are given in Table No. 70. It will be seen there that six pulmonary cases and one non-pulmonary case were not notified. These are low figures, and the ratio of non-notified deaths to the total tuberculous deaths was as 1 is to 19. In the previous two years the corresponding ratios were as 1 is to 8 and 1 is to 6 respectively. The explanations given of these failures to notify are as follows—two died in mental hospitals, three were acute cases who died in general hospitals, and in two instances the diagnosis was only made on post-mortem examination. TABLE No. 70. Period between Notification and Death. Pulmonary. Percentage. Non. Pulmonary. Percentage. Not notified 6 4.96 1 6.67 0.1 month 19 15.70 5 33.33 1.3 months 12 9.92 2 13.33 3.6 months 8 6.60 — — 6.12 months 11 9.09 1 6.67 1.2 years 18 14.88 — — 2.5 years 30 24.80 3 20.00 Over 5 years 17 14.05 3 20.00 121 100.00 15 100.00 (a) Administration of the Tuberculosis Regulations.—The Regulations of 1930 provide for the notification of cases of tuberculosis, for the correct maintenance of the tuberculosis register, and for the preparation and dispatch of periodic returns. to the County Medical Officer. (1) The following Table, No. 71, gives a summary of cases coming to the knowledge of the Department in 1935, and includes notifications received from general practitioners, cases not notified but included in death returns, and cases transferred from other areas. It does not include notifications received from Medical Superintendents of hospitals on admission and discharge of patients, nor any duplicate notifications. Deaths during the year are classified in the same table by age and sex groups. 129 TABLE No. 71. Tuberculosis—New Cases and Mortality, 1935. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0-1 year — — — 1 — — — 1 1-5 years 2 1 1 3 — — — 2 5-10 years — 2 2 1 — — — 1 10-15 years 3 3 2 3 1 — — 1 15-20 years 11 18 1 1 3 6 1 — 20-25 years 12 19 2 3 9 8 2 — 25-35 years 28 31 4 5 18 9 2 1 35-45 years 31 17 — 1 16 10 — 1 45-55 years 17 3 3 1 14 3 1 — 55-65 years 16 2 1 — 13 3 2 — 65 and upwards 9 — — 1 8 1 — — 129 96 16 20 81 40 8 7 Excluding duplicates, 209 cases of pulmonary tuberculosis and 33 cases of non-pulmonary tuberculosis were notified. Cases of tuberculosis are often notified more than once, and this fact accounts for 55 duplicate notifications received during the year. The following table shows the actual number of new cases notified during the year and the corresponding case rates. TABLE No. 72. Woolwich. Plumstead. Eltham. The Borough. Pulmonary Tuberculosis: Cases 46 101 62 209 Rates 1.52 1.47 1.29 1.36 Non-Pulmonary Tuberculosis: Cases 11 18 4 33 Kates 0.36 0.26 0.08 0.22 130 The following Table, No. 73, shows the site of disease in patients notifiec since 1923. TABLE No. 73. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 1923 245 9 6 21 8 10 12 311 1924 273 8 6 16 22 6 11 342 1925 246 9 6 9 14 6 10 300 1926 287 8 6 14 11 7 16 349 1927 269 10 18 20 18 5 13 353 1928 263 10 8 17 11 5 11 325 1929 250 7 7 16 11 6 5 302 1930 244 6 5 18 15 3 8 299 1931 229 11 5 18 8 2 7 280 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 1935 209 5 2 10 5 4 7 242 The ward incidence of notified cases of tuberculosis was as follows. In each case the first figure is the pulmonary figure and the second the non-pulmonary one:— Dockyard, 6 and 1; St. Mary's, 6 and 2; River, 19 and 4; St. George's, 15 and 4; Burrage, 12 and 0; Herbert, 8 and 2; Glyndon, 12 and 1; St. Margaret's, 16 and 3; Central, 10 and 3; St. Nicholas, 31 and 5; Abbey Wood, 12 and 4; Well Hall, 17 and 2; Avery Hill, 18 and 0; and Sherard, 27 and 2. (2) In order that the register may be correctly maintained, it is necessary to delete from the register all those who have died, or have been lost sight of, or who have removed to other areas, or who are regarded as cured, or those in whom the diagnosis was not confirmed, and to add to it new cases, lost cases found again, cured cases who relapse, and transfers from other areas. The number of transfers to Woolwich was 35, and the number from Woolwich was 53. The following Table, No. 74, shows the changes which took place in the register during the year. It will be noted from this table that the total number on the register at the end of the year was 975, and of this number 90.25 per cent. were on the dispensary register. In 1934 the corresponding percentage was 91.75. 131 TABLE No. 74. Pulmonary. Non-Pulmonary. Totals. M. F. M. F. Number on Register on 1st January, 1935 477 352 109 110 1,048 Number of new Cases notified 118 88 17 15 238 Number of Cases restored 2 1 — — 3 Other additions 19 12 1 4 36 Deletions 158 113 34 45 350 Number on Register on 31st December, 1935 458 340 93 84 975 (3) Weekly and quarterly returns were furnished during the year to the County Medical Officer. The County of London (Tuberculosis) Regulations, 1930, 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 17 children. The Regulations of 1925 provide for the compulsory discontinuance of a person suffering from infectious respiratory tuberculosis from employment involving the handling or treatment of milk, and are enforceable by the local authority. No action was taken under them during the year. (b) Bacteriological Examination of Sputum.—During the year 555 specimens of sputum were examined at the dispensary, and of these 110 were positive and 445 negative. Facilities for general practitioners are provided at the Woolwich War Memorial Hospital, and 502 specimens were examined during the year, 75 being positive and 427 negative. (c) Out-door Shelters at the Homes of Patients.—Twelve shelters are maintained by the Council for patients returning from sanatoria and who are willing to continue this form of treatment. Eight were in use during the year. No charge is now made for these shelters. (d) The Work of the Dispensaries.—The main dispensary is at Maxey Road, Humstead. It was re-constructed during the year, and is now a really up-to-date, well-lighted and ventilated building with increased accommodation for work. As will be seen from the plan on an adjoining page, it now consists of a waiting room, dressing room with cubicles, consulting rooms, laboratory, demonstration room, dispensary, general office, Care Committee office, and nurses' room. A feature of the scheme is the panelling of the dressing room and cubicles and one consulting 132 133 room. This was supplied by Preston Hall Industries, Ltd., and is the work of tuberculous settlers in the colony. The demonstration room is used for talks and cookery lectures. Most of the furniture and equipment required replacement, and this was done. The Eltham branch dispensary was opened in 1931, and increased use is being made of this centre. In view of the replacement of the hutments and the large increase in the Eltham population it will become necessary to provide another and more centrally placed centre for this area. 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. 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. The total number of attendances at the dispensaries during 1935 was 5,270. In this connection it is interesting to point out that 187 of the persons notified during 1935 attended the dispensaries, which is equivalent to 77.2 per cent. The corresponding percentage in 1934 was 75.08 and in 1933 it was 68.25. A return of the work of the dispensaries is given in Table No. 75. (e) Home Visiting of Tuberculosis Cases.—On receipt of every notification the home is visited by the tuberculosis visitor who advises as to any re-arrangement of sleeping and other accommodation that is desirable and possible in the interests of the family as a whole. 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 first hand knowledge of the home circumstances. For the purpose of visitation the Borough is divided into three areas, each tuberculosis visitor being responsible for approximately three hundred patients. These are visited as a routine measure once in three months, but in the case of patients with recent or more active disease, and where the circumstances warrant it, home visits are made more frequently. (/) Cases of Doubtful Diagnosis.—These are known as observation cases if no definite diagnosis has been arrived at during the first month. A number of these unfortunately fail to continue in attendance, but a control is kept upon these cases by a review of all the case papers at the end of each month, and the tuberculosis visitors endeavour to get the backsliders to return. 134 TABLE No. 75. Return showing the work of the dispensaries for 1935. 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 87 73 5 4 10 8 1 3 97 81 6 7 191 (b) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 148 179 98 89 514 B.—CONTACTS examined during the year:— (a) Definitely tuberculous 9 6 2 4 — 4 1 — 9 10 3 4 26 (b) Diagnosis not completed — — — — — — — — — 1 — — 1 (c) Non-tuberculous — — — — — — — — 98 139 91 104 432 C.—CASES written off the Dispensary Register as:— (a) Recovered 29 17 1 — 7 21 3 3 36 38 4 3 81 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 248 330 190 196 964 D.—NUMBER OF CASES on Dispensary Register on December 31st:— (a) Definitely tuberculous 389 312 18 18 46 47 26 24 435 359 44 42 880 (b) Diagnosis not completed — — — — — — — — — 1 — — 1 135 Table No. 75—continued. Return showing the work of the dispensaries for 1935. 1. Number of cases on Dispensary Register on January 1st 969 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years Nil 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of 87 4. Cases written off during the year as Dead (all causes) 120 5. Number of attendances at the Dispensary (including Contacts) 5,276 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 233 7. Number of consultations with medical practitioners:— (a) Personal 84 (b) Other 1,095 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 401 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,941 10. Number of:— (a) Specimens of sputum, etc., examined 555 (b) X-ray examinations made in connection with Dispensary work. 681 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above 1 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 330 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 (g) The Examination of Home Contacts.—On receipt of a primary notification every effort is made to induce people living in the same house to present themselves for medical examination. In many cases, however, it is very difficult to persuade them to do so. If the tuberculosis visitor fails to secure the attendance of the contacts a visit is made by one of the medical staff. During the year 431 contacts were examined. The importance of such examinations may be illustrated as follows:— 136 (а) Of the 242 newly notified patients for the year, 39 or 16.1 per cent. showed contact within the family circle at the time of notification or within the previous five years. (b) During the year 259 children were tested by means of the Mantoux intradermal test, and as will be seen from the following table, those children in contact with notified cases showed a very much higher percentage of positive results than where no such contact existed. TABLE No. 76. Contacts. 0—5 years. 5—10 years. 10—15 years. Total. Percentage. Positive result 17 39 39 95 61.2 Negative result 12 35 13 60 28.8 Non-contacts. Positive result 2 10 8 20 19.2 Negative result 29 38 17 84 80.8 (h) Work for the Ministry of Pensions.—This work has practically ceased, only one report having been asked for and supplied during the year. (i) Extra N ourishment.—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. (j) X-ray Examinations.—The past two years have shown a very marked increase in the use of X-ray examinations in connection with the diagnosis and treatment of tuberculosis. This has been general throughout the whole country, and indicates the very great importance, indeed the absolute necessity, of the procedure if the diagnosis and treatment of tuberculosis are to be carried out efficiently. The increasing use of major surgery in the treatment of the disease necessitates the examination of post-sanatorium patients at more frequent intervals. The number of examinations in 1935 was 681. The patients referred by the tuberculosis officer are X-rayed at the War Memorial Hospital. In addition patients admitted to St. Nicholas Hospital are X-rayed and on discharge the films are sent to the tuberculosis officer for filing with the patients' case records. X-ray figures in London are not strictly comparable with other parts of the country as screening and films are also undertaken at the hospitals where patients receive their artificial pneumothorax refills. 137 (k) Co-operation with London County Council Local Hospital.—The Tuberculosis Officer is deemed to be an Honorary Consultant for tuberculosis at St. Nicholas Hospital. The appointment still continues to be subject to review each year. He attends at the hospital once weekly and sees there all cases in the tuberculosis wards and such cases in other wards as may be referred to him for an opinion by the medical staff. Nowadays patients in all stages of the disease are admitted to hospital in the first instance, and the Tuberculosis Officer's advice is sought as to whether a particular case should be transferred to a sanatorium or remain in hospital, or be sent to a colony. It can confidently be said that it is a good thing for the Service that the Tuberculosis Officer should act in this capacity at the local hospital. (I) Finsen Light Treatment.—In 1921 the Council entered into an agreement with the London Hospital for the treatment of persons suffering from lupus, in the Finsen Light Department of the Hospital. A fee of 5s. 0d. is paid for each attendance. No such treatment was given during 1935. (m) Artificial Pneumothorax.—This treatment consists of collapsing the diseased lung, or portion of the lung and so resting it. This is done by introducing 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. The lung is kept collapsed for a period varying from 2 to 5 years. In 1921 the Council agreed to pay 10s. 6d. for refills at Brompton Hospital in the case of patients recommended by the tuberculosis officer for this treatment, but since that date payments have been made in respect of patients treated at other voluntary hospitals and at London County Council general hospitals. The number of patients who received this particular treatment during the year was 45, and the number of refills given was 621. (n) Dental Treatment.—Dental treatment is carried out under the Council's scheme at the School Clinic, Brewer Street. During the year 24 cases received treatment, the number of attendances being 40. The only charge made to patients is in connection with the supply of dentures, and then patients are assesged according to their means. Dentures were supplied in ten cases at a cost of £31 17s. 0d., and payments by patients amounted to £13 6s. Od. In assessing patients due regard is given to dental benefits they may be entitled to from approved societies. (o) Home Nursing.—Arrangements have been made with all the local nursing associations whereby the cost of home nursing of patients certified by the tuberculosis officer to require it, is defrayed by the Borough Council. During the year 1,962 such visits were made, and the cost to the Council was £122 12s. 6d. (p) 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 138 culous patients are referred to the school medical service for special observation and supervision. The divisional school medical officer and the tuberculosis officer, in personal consultation, discuss these contacts and decide on the supervision desirable. Other children, whose condition is unsatisfactory, are referred to the School Clinic for the treatment of minor ailments and dental caries, or to the School Care Organiser, with a recommendation as to the provision of milk and cod liver oil to be given at school. (q) Co-operation ivith Local Practitioners.—During the year the tuberculosis officer saw at home in consultation with general practitioners 84 persons in whom the question of diagnosis of tuberculosis was raised, and a further 321 at the dispensary at the request of local practitioners. (r) 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, and C. J. Keedy. 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. T. Moran. London Insurance Committee Mr. S. H. Brown. Panel Committee for the County of London Dr. H. M. Wise. British Red Cross Society Mr. J. O'Connell. War Pensions Committee. Mr. A. R. Loader. Woolwich Invalid Children's Aid Association Mrs. J. B. Great Rex. Late Tuberculosis Dispensary Committee. . Mr. W. Dashwood, Mr. E. G. Dixon, J.P. United Services Fund 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. The Committee undertakes all care and after-care work in the Borough with regard to tuberculosis, and helps by the provision of clothing to necessitous patients entering institutions; by aiding in the purchase of surgical apparatus and nursing requisites; by assisting patients' relatives to visit them whilst in institutions, and in many other ways. It also assesses patients under the Council's Dental Scheme, and supervises the provision of additional nourishment. For many years the members have felt it desirable to provide occupation for patients discharged from sanatoria, and who are either unfit for work, or unable to obtain employment. Many of these patients have been doing a certain amount 139 of work in the workshops attached to the sanatoria, and it seemed very desirable to provide some means for continuing this occupational therapy. The opportunity came their way when the Council placed at the disposal of the Committee two workshops adjoining the dispensary. These were fitted up as carpentry shops by the Committee. This occupational therapy centre was opened on October 31st, but there were initial difficulties to be overcome, and it is very satisfactory to record that the few patients who began on October 31st have shown the keenest interest in the project, and have attended with great regularity. (s) Institutional Treatment.—The following Table, No. 77, shows the number of admissions to special hospitals, sanatoria, public general hospitals, institutions and training colonies. TABLE No. 77. Admissions to Hospitals, etc. Special Hospitals. Sanatoria. Public General Hospitals. Training Colonies. Insured 116 71 99 9 Uninsured 45 25 52 1 Children 28 7 4 — 189 103 155 10 These figures refer to 328 patients and the monthly admissions were as follows:— January 37 May 51 September 47 February 32 June 28 October 37 March 33 July 45 November 40 April 46 August 32 December 29 It is now the practice of the London County Council to pay the travelling expenses of necessitous patients suffering from tuberculosis, admitted to certain hospitals; and the Woolwich Borough Council agreed to advance any such monies to such patients, the amounts so advanced to be re-imbursed in due course by the County Council. 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. 140 The heavy demand on the Station owing to the work of bug eradication continued 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 42 such disinfections were carried out, and charges amounting to £10 4s. 0d. were paid. In tabular form is shown below the amount of disinfection which was carried out during the year. TABLE No. 78. Rooms disinfected after ordinary fevers 932 „ ,, ,, tuberculosis 177 ,, „ „ verminous cases 1,481 ,, „ „ for other reasons 13 Articles disinfected 51,975 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. 79, shows the number of persons cleansed each year since 1931. TABLE No. 79. Year. Children. Adults. Grand Total. Boys. Girls. Total. Males. Females. Total. 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 1935 603 1,818 2,421 10 3 13 2,434 A report on the disinfestation of bug-infested premises will be found in the Housing Section. 141 SECTION VIII. GENERAL STATISTICS. TABLE No. 80. Area (acres) 8,282 Population estimated to middle of 1935 146,400 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, 1935) £1,122,197 Sum represented by a penny rate (April, 1935) £4,575 Physical Features and General Characteristics of the Area. In the physical configuration of the Borough the outstanding feature is Shooters Hill, which rises over 400 feet above sea-level. At a little lower level, on the Woolwich and Plumstead side, there is the well-marked plateau of Woolwich and Plumstead Commons, due to the erosion of local clay from off the pebble beds. Lower down still is the level plain of the Thames. Southward, in Eltham and Lee, the land, after sloping 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. Population. The Registrar General estimates the population of the Borough at the middle of the year as 146,400, an increase of 880 on the previous year. This figure has been used in calculating rates for the purposes of this report. It should be noted that it includes non-civilians, the pre-war practice in this respect having been 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 from the records of the Treasurer's Department if 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 1935 is shown in the following Table, No. 81. 142 TABLE No. 81. Wards. Population. Dockyard 6,351 St. Mary's 5,574 River 10,491 St. George's 7,656 Burrage 7,135 Herbert 8,802 Glyndon 7,880 St. Margaret's 12,069 Central 7,188 St. Nicholas 13,125 Abbey Wood 12,429 Well Hall 11,783 Avery Hill 14,167 Sherard 21,749 In the old parishes the estimated populations are therefore:— Woolwich 30,072 Plumstead 68,629 Eltham 47,699 Compared with last year these figures shew substantial increases in Eltham, particularly in Avery Hill and Sherard Wards, and smaller increases in Abbey Wood, Herbert and St. Margaret's Wards. The number of persons per acre, in 1931, was 17.7; it is now estimated to be slightly less: in the Administrative County of London the corresponding figure was 58.7. The present figures for each of the wards in the borough are as under: Dockyard, 45.7; St. Mary's, 56.3; River, 18.3; St. George's, 23.5; Burrage, 38.7; Herbert, 35.9; Glyndon, 26.1; St. Margaret's, 21.8; Central, 62.5; St. Nicholas, 10.8; Abbey Wood, 15.8; Well Hall, 17.1; Avery Hill, 7.7; Sherard, 17.4. 143 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. A similar Table taken from the Industry Table Report of the Registrar General was prepared and printed in my Annual Report for 1934. Briefly, in round figures, 12,000 male persons are engaged in the manufacture of metals, machines, etc.; 11,000 males in public administration and defence; 8,000 males in commerce and finance; 3,000 in building and decorating, and 2,000 in the manufacture of chemicals, dyes, etc. Nearly 4,000 women are employed in personal service, nearly 4,000 in commerce and finance, and 2,500 in the manufacture of metals, machines, etc. Most of the inhabitants of Woolwich work, the proportion of those unoccupied and retired being relatively very small. Sickness and Invalidity. There was no unusual or excessive mortality during the year which calls for any comment under this head. 144 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. 82. Births—Legitimate 1,989 Births—Illegitimate 64 2,053 Still-births 85 Still-births—Rate per 1,000 total births 41.4 Birth Rate 14.0 Deaths 1,500 Death Rate 10.2 Percentage of total deaths occurring in public institutions 60.9 Number of women dying in, or in consequence of, Child Birth:— (a) From Sepsis 1 (b) From other causes 2 Deaths of Infants under one year:— (a) Legitimate 82 (b) Illegitimate 9 Infantile Mortality Rate 44 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) 21 145 The chief Vital Statistics since 1901 are given in the following Table :—• TABLE No. 83. Year. Population estimated to middle of each Year. Births. Nett Deaths belonging to the District. Nett. Under 1 year. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. (1) (2) (3) (4) (5) (b) (7) (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 o 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 16.1 114 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 1935 a 146,400 2,053 14.0 91 44 1,500 10.2 a Total Population. b Civil Population. 146 The chief Vital Statistics for 1935 for the Wards of the Borough are given in the following Table :— TABLE No. 84. Wards. Population. Births. Deaths under 1. Deaths at all ages Number. Rate. Number. Rate. Number. Rate. Dockyard 6,351 117 18.4 7 60 76 12.0 St. Mary's 5,574 81 14.6 8 98 79 14.2 River 10,491 152 14.5 9 59 151 14.4 St. George's 7,656 141 18.5 4 28 74 9.7 Woolwich 30,072 491 16.3 28 57 380 12.6 Burrage 7,135 101 14.2 3 30 102 14.3 Herbert 8,802 129 14.7 4 31 88 10.0 Glyndon 7,880 120 15.3 3 25 124 15.8 St. Margaret's 12,069 137 11.4 2 14 129 10.7 Central 7,188 135 18.9 5 37 103 14.4 St. Nicholas 13,125 168 12.8 14 83 155 11.8 Abbey Wood 12,429 221 17.8 11 49 105 8.4 Plumstead 68,629 1,011 14.9 42 41 806 11.7 Well Hall 11,783 116 9.9 4 34 76 6.4 Avery Hill 14,167 136 9.6 7 51 107 7.6 Sherard 21,749 299 13.7 10 33 131 6.0 Eltham 47,699 551 11.5 21 38 314 6.6 BOROUGH 146,400 2,053 14.0 91 44 1,500 10.2 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 2,414 births were registered in the Borough, 1,242 being males and 1,172 females. Corrected by outward (292 males and 302 females) and inward (129 males and 104 females) transfers, these numbers become 2,053, 1,079 and 974 respectively. The birth rate was 14.0, compared with 13.7 in 1934 and 12.7 in 1933. 147 Illegitimate Births.—The number of illegitimate births registered was 59. There were 15 inward transfers and 10 outward transfers, making a nett figure of 64, equivalent to 31 per 1,000 births. Natural Increase of Population.—This term means the excess of births over deaths. In 1931 it was 501; in 1932, 419; in 1933, 223; in 1934, 350; and in 1935, 553. Notification of Births.—During the year 2,405 live births were notified. This is at the rate of 99.6 per cent. of the registered births and compares with 99.4 per cent. last year. The births were notified as shown in the following Table:— TABLE No. 85. British Hospital for Mothers and Babies 794 Midwives 531 St. Nicholas Hospital 447 Military Families' Hospital 231 War Memorial Hospital 206 Medical Practitioners 63 Parents 59 Eltham Cottage Hospital 30 Midwives' Homes 25 Other persons 19 In addition to these, 102 notifications were received from the Medical Officer of Health, Lewisham; 73 from the Medical Officer of Health, Greenwich; and 32 from other Medical Officers of Health; 552 births were transferred to other areas. One hundred and two still-births were notified, 21 of which were transferred to other areas. It is known that 1,388 Woolwich births took place in institutions either within or without the Borough, so that the percentage of institutional midwifery for the Borough was 67.6. The following Table, No. 86, shows the number of corrected births each year since 1931; 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. 86. Year. No. of Births. No. of Live Births. Notified. No. of StillBirths Notified. Percentage of Births Notified. Birth Rate. Woolwich. London. England and Wales. 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 1935 2,053 2,405 81 99 14.0 13.3 14.7 148 Marriages. There were 1,315 marriages (1,324 in 1934). The marriage rate was 17.9 as compared with 18.19, 17.70, 15.79 and 17.7 in the four preceding years. Deaths. The total number of deaths registered in the Borough was 1,238. This figure includes 156 non-residents who died in the district but does not include 418 residents who died outside the Borough. When allowance is made for inward and outward transfers, the nett figure of 1,500 is obtained. The death-rate for the year was 10.2, compared with 11.3 in 1934 and 11.2 in 1933. 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 the age and sex constitution of the population. This adjusting factor for Woolwich is 1.06 so that the adjusted death rate for 1935 is 10.8. In 1935 the death-rate for England and Wales was 11.7, for London, 11.4, 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, 11.9; Second quarter, 10.7; Third quarter, 8.6; Fourth quarter, 9.8. 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. 87. Hospitals or Institutions Number of Deaths. 1. Public General Hospitals 663 2. Voluntary General Hospitals 115 3. Mental Hospitals 55 4. Cottage Hospitals and Nursing Homes 31 5. Special Hospitals 23 6. Infectious Diseases Hospitals 18 7. Sanatoria and Tuberculosis Institutions 9 914 The percentage of institutional deaths to total deaths was therefore 60.9. The following Tables are self-explanatory:— 149 TABLE No. 88. Birth Rates, Death Rates and Analysis of Mortality in the Year 1935. 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 1 under 1 year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. Still. Births. England and Wales 14.7 0.63 11.7 0.00 — 0.03 0.01 0.04 0.09 0.18 0.54 5.6 57 90.4 6.4 2.2 10 121 County Boroughs and Great Towns, including London. 14.8 0.61 11.8 0.00 — 0.04 0.01 0 .05 0.09 0.16 0.52 7.6 62 90.9 5.8 2.8 0.5 140 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931).. 14.8 0.64 11.2 0.00 — 0.03 0.01 0.03 0.09 0.18 0.53 4.8 55 91.9 5.5 1.6 1.0 London 13.3 0.44 11.4 0.00 — 0.00 0.01 0.04 0.06 0.11 0.55 11.3 58 87.7 6.3 5.9 0.1 WOOLWICH 14.0 0.57 10.2 — — 0.00 0.01 0.01 0.08 0.16 0.46 8.7 44 85.8 8.6 5.6 — 150 TABLE No. 89. Nett Deaths during the Calendar Year 1935, 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. Nondents. All Causes 1,500 91 10 13 34 63 83 83 136 264 347 376 530 137 384 Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — Measles 1 — — 1 — — — — — — — — — — 1 Scarlet Fever 2 — — 1 1 — — — — — — — — — 2 Whooping Cough 2 1 1 — — — — — — — — — — — 2 Diphtheria 13 — 2 3 8 — — — — — — — — — 11 Influenza 23 — — — — 2 2 2 3 5 5 4 8 3 2 Encephalitis Lethargica 1 — — — — — — — — 1 — — — — 1 Cerebro-Spinal Fever 1 — — — — 1 — — — — — — — 1 1 Tuberculosis of Respiratory System 121 — — — 1 26 26 25 17 16 7 3 49 11 31 Other Tuberculous Diseases 15 1 — 2 2 3 3 1 1 2 — — 7 3 5 Syphilis 5 — — — — — — — 2 2 1 — 2 1 1 General Paralysis of the Insane, Tabes Dorsalis 7 — — — — — 1 1 3 2 — — — — 5 Cancer, Malignant Disease 213 — — — 2 3 5 14 25 52 74 38 82 19 51 Diabetes 15 — — — — 1 1 — — 3 10 — 8 1 3 Cerebral Haemorrhage, etc. 76 — — — — — — 1 4 24 25 22 28 1 17 Heart Disease 362 — — — 2 3 8 12 19 63 108 147 98 12 57 Aneurvsm 10 — — — — — — — 3 3 3 1 4 — 2 Other Circulatory Diseases 43 — — — — — — — 1 6 14 22 6 3 19 Bronchitis 45 1 — 1 — 1 — — 3 8 14 17 9 3 9 Pneumonia (all forms) 84 20 3 5 1 — 4 5 15 11 9 11 38 11 19 Other Respiratory Diseases 15 1 — — — — — 2 2 1 3 6 6 1 4 Peptic Ulcer 18 — — — — — 2 — 2 7 7 — 4 4 9 Diarrhoea, etc. 21 14 1 — — — 2 — — — 3 1 10 3 6 Appendicitis 7 — — — 1 1 2 — 1 1 — 1 4 5 3 Cirrhosis of Liver 2 — — — — — 1 — — — — 1 2 — — Other Diseases of Liver, etc. 7 — — — — — 1 — 1 2 1 2 4 — 2 Other Digestive Diseases 39 1 1 — 1 2 1 2 6 9 7 9 21 6 11 Acute and Chronic Nephritis 48 — — — — 2 3 3 10 10 12 8 14 7 13 Puerperal Sepsis 1 — — — — — — 1 — — — — — — 1 Other Puerperal Causes 2 — — — — — 1 1 — — — — — 2 1 Congenital Debility, Premature Birth, Malformation, etc. 42 41 — — — — — 1 — — — — 19 13 6 Senility 51 — — — — — — — — — 9 42 19 — 26 Suicide 9 — — — — 1 2 3 1 1 — 1 3 — 2 Other Violence 68 5 — — 5 8 11 3 6 7 8 15 24 8 21 Other Defined Diseases 130 6 2 — 10 9 7 6 11 28 27 24 61 19 40 Causes III-Defined, or Unknown 1 — — — — — — — — — — 1 — — — 151 TABLE No. 90. Nett Deaths during 1935, 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 791 709 76 79 151 74 102 88 124 129 103 155 105 76 107 131 Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - - - Measles — 1 - - - - - - - - - - - - - 1 Scarlet Fever — 2 - - - - - - - - - - 1 1 — — Whooping Cough 2 - - - - - - - - - - - 1 — — 1 Diphtheria 4 9 1 3 1 — — — 2 — 1 1 1 — — 3 Influenza 9 14 1 3 1 1 3 1 1 2 1 1 4 1 2 1 Encephalitis Lethargica 1 — — — — — — — — — — — — 1 — — Cerebro-Spinal Meningitis 1 — — — — 1 — — — — — — — — — — Tuberculosis of Respiratory Systems 81 40 3 9 21 10 5 1 16 4 8 8 10 4 4 18 Other Tuberculous Diseases 8 7 2 1 — 1 1 1 — — 2 2 — 1 — 4 Syphilis 4 1 — — — — — 1 1 — — 1 — 2 — — General Paralysis of Insane, Tabes Dorsalis 7 - - - - - - - - 3 2 1 1 — — — Cancer 106 107 9 5 24 11 14 6 28 22 15 24 6 14 19 16 Diabetes 7 8 1 — 1 1 — 2 1 3 1 2 2 — — 1 Cerebral Haemorrhage, etc. 30 46 4 7 6 2 5 12 4 4 5 12 4 3 4 4 Heart Disease 173 189 21 21 33 16 32 24 28 38 24 30 24 18 31 22 Aneurysm 6 4 — — — — 3 — 1 2 1 — — 2 1 - Other Circulatory Diseases 19 24 2 1 3 1 4 1 2 5 4 4 3 6 6 1 Bronchitis 24 21 2 2 8 2 2 1 3 4 8 9 2 1 — 1 Pneumonia 54 30 6 6 10 5 3 3 8 4 2 11 7 4 5 10 Other Respiratory Diseases 10 5 1 1 2 — 2 — 1 3 — 2 — 2 — 1 Peptic Ulcer 17 1 1 1 2 1 1 — — 5 1 — 2 1 — 3 Diarrhoea, etc. 11 10 2 1 4 1 — 1 3 3 1 1 1 — — 3 Appendicitis 2 5 - - - - - 1 — 2 — 1 1 1 — 1 Cirrhosis of Liver 2 — — — 1 — — 1 — — — — — — — - Other Diseases of Liver, etc. 1 6 — 1 — — — 2 — 2 — 2 — — — — Other Digestive Diseases 21 18 1 1 3 1 5 5 6 3 1 3 2 1 4 3 Acute and Chronic Nephritis 28 20 2 1 4 — 3 8 — 4 5 1 4 4 7 5 Puerperal Sepsis — 1 1 — — — — — — — — — — — - — Other Puerperal causes — 2 - - - - - - - - - - - - 1 1 Congenital Debility, Premature Birth, Malformations, etc. 21 21 2 4 2 3 1 4 1 1 2 8 4 2 6 2 Senility 27 24 4 2 3 2 6 2 2 5 2 11 2 1 5 4 Suicide 5 4 — 1 2 — 1 — 2 — 2 — — — — 1 Violence 43 25 5 2 7 7 4 2 3 5 2 8 8 3 4 8 Other Defined Diseases 66 64 5 6 12 8 7 9 11 5 13 12 15 3 8 16 Causes ill-defined or unknown 1 — — — 1 — — — — - - - - - - - 152 Causes of Death.— Table No. 89 shows that 362 deaths were due to Heart Disease, 213 to Cancer, 136 to Tuberculosis, 76 to Cerebral Haemorrhage, and 43 to diseases of circulation. There were 42 deaths from Congenital Debility and Prematurity. These figures differ but little from those of 1934, in some instances being slightly higher and in some instances slightly lower. There were 84 deaths from Pneumonia compared with 126 in 1934. Seventy-four per cent, of all deaths occurred in persons over 45 years of age. Respiratory Disease.— The following Table, No. 91, shows the number of deaths each year since 1931 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. 91. Year. Bronchitis. Pneumonia. Other Respiratory. Total. DeathRate. Number under 5 years. Percentage under 5 years. 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 13.6 1934 58 126 14 198 1.3 47 23.7 1935 45 84 15 144 0.98 31 21.5 Cancer.— The total number of deaths was 213 of which 106 occurred in males and 107 in females. In the following Table, No. 92, is shown the number of deaths certified as due to Cancer and Malignant Disease, each year since 1931:— TABLE No. 92. Deaths from Cancer and Malignant Disease. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 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 1935 106 107 213 1.45 14.20 153 The following Table, No. 93, shows the seat of primary disease in all deaths from Cancer, including all other specified malignant tumours. TABLE No. 93. Deaths from Malignant Disease. Seat of Primary Disease. Males. Females. Total. Deaths in Hospital. Lip - - - - Tongue 5 — 5 4 Mouth 3 1 4 2 Jaw 2 1 3 2 Oesphagus 15 3 18 11 Stomach 15 10 25 15 Liver and Gall Bladder 7 4 11 6 Pancreas 1 4 5 4 Intestines 10 20 30 18 Rectum 13 6 19 15 Ovary — 5 5 3 Uterus — 11 11 7 Breast - 25 25 14 Skin 1 1 2 2 Thyroid 1 1 2 1 Larynx 1 — 1 — Pharynx 2 — 2 1 Lung 7 7 14 9 Bladder 2 1 3 1 Prostate 9 - 9 8 Others and unspecified 5 5 10 5 Sarcoma 7 2 9 6 106 107 213 134 No knowledge is available as to the extent to which use is made of increased facilities now provided in National Radium Centres and no local investigations have been undertaken in pursuance of the suggestions contained in the Ministry's circulars of previous years. Investigations are not made into cancer deaths. Maternal Mortality.— The number of deaths from Puerperal Sepsis was 1, and from other accidents and diseases of pregnancy, 2, making a total of 3 maternal deaths, compared with three in 1934. The maternal death rate per 1,000 births was 1.46 as against 1.44 in 1934. 154 The Table which follows would appear to show a steady lowering of the maternal mortality rate in this Borough:— TABLE No. 94. Maternal Mortality, Woolwich, 1912-1935. Year. Abortion. Ectopic Gestation Placenta Praevia. Other Puerperal Haemorrhage. Other Accidents of Child Birth. Child Birth with Secondary Causes. Puerperal Eclampsia Puerperal Phlebitis and Embolism Puerperal Fever. Totals. 1912 1 - - - - - 1 1 1 4 1913 1 - - — 1 — 1 - 2 5 1914 1 - 1 2 — 1 1 1 4 11 1915 1 1 - - 1 — 2 - 3 8 1916 - 1 1 1 4 — 1 - 7 15 1917 - 1 - 2 - 1 2 1 7 14 1918 1 - - 2 1 - 1 1 9 15 1919 - 2 1 2 - - 2 1 5 13 1920 - 1 - - 1 - 1 3 5 11 1921 - - - - - - 3 2 5 10 1922 - - - 1 - - 2 - 3 6 1923 - - - - 1 - 1 - 3 5 1924 - - 2 1 1 — 3 1 2 10 1925 - - 1 2 1 1 1 — 3 9 1926 - 1 - 2 - - — 1 2 6 1927 - 1 - - - - 1 1 3 6 1928 - 2 1 - 1 - 1 - 8 13 1929 2 2 - - 2 1 3 1 3 14 1930 1 - - — - 1 2 — 4 8 1931 - - - - 1 - 1 - 6 8 1932 - - - 1 - - 1 - 4 6 1933 - 1 - - 1 1 - 1 2 6 1934 - - - - - 1 - - 2 3 1935 - - - 1 - - - 1 1 3 Totals 8 13 7 17 16 7 31 16 94 209 Inquests.— There were 129 inquests held on Woolwich residents during the year, compared with 152 in 1934. Deaths of Children, 1—5 Years of Age.— The number of deaths of children between 1 and 2 years of age was 10, and between 2 and 5 years, 13. In 1934 these figures were 23 and 21. The causes of death are given in detail in Table No. 89. The following Tables show the variation in the rate of mortality at 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. 155 TABLE No. 95. 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. Diarrhoeal Diseases. All other Causes. Total Deaths. 1931 2,071 1.45 1.45 6.76 0.48 3.86 14.0 1932 2,010 6.45 — 1.99 0.49 2.48 11.41 1933 1,927 2.07 — 3.11 1.55 — 6.75 1934 1,726 5.21 — 4.63 — 3.47 13.32 1935 1,879 1.59 — 1.59 0.53 1.59 5.30 TABLE No. 96. 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. Diarrhoeal Diseases. All other causes. Total Deaths. 1931 6,373 0.78 0.62 0.94 0.16 2.20 4.70 1932 6,294 0.79 0.48 0.79 — 1.43 3.49 1933 6,188 0.97 0.80 0.48 — 1.62 3.88 1934 5,953 1.01 0.67 0.50 — 1.34 3.52 1935 5,623 0.88 0.35 1.06 — — 2.29 Infant Mortality. The number of deaths of infants under one year of age was 91, compared with 127 in 1934 and 116 in 1933. The rate of infant mortality resulting from these deaths (deaths under 1 year per 1,000 births) was 44, compared with 63 in 1934 and 62 in 1933. The rates for the different Wards in the Borough are shown in Table No. 84. The rate for the Administrative County of London was 58, and for England and Wales, 57. The following Table, No. 97, shows the distribution of infant mortality throughout the year, calculated on a varying year basis. 156 TABLE No. 97. Births. Deaths under 1 year. Rate. First Quarter 532 31 59 Second Quarter 538 27 50 Third Quarter 510 12 26 Fourth Quarter 473 21 44 Causes of Death.— The causes of infant mortality are set forth in Tables Nos. 99 and 100, 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: Pneumonia, 20; Premature Birth, 18; Diarrhoea, 14; and Debility and Marasmus, 7. The number of deaths occurring in the first week of life was 40. Deaths of Illegitimate Children.— Nine illegitimate children died, compared with 14 in 1934 and 13 in 1933. The infant mortality rate figure for illegitimate children was 140, compared with 44 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. 87. TABLE No. 98. Hospitals or Institutions. Number of Deaths. Public General Hospitals 41 Voluntary General Hospitals 4 Special Hospitals 11 Infectious Diseases Hospitals 2 Cottage Hospitals and Nursing Homes 4 62 Tables are set out in the following pages which classify in various ways the causes of infant deaths during 1935. 157 TABLE No. 99. Infant Mortality, 1935. 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 .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. 1 .. 1 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Meningococcal Meningitis .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. 1 .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 1 .. .. .. 1 Pneumonia .. 2 1 1 4 7 6 3 .. 20 Diarrhoea .. 1 .. 1 2 6 5 1 .. 14 Injury at Birth 3 .. .. .. 3 .. .. .. .. 3 Icterus Neonatorum 4 1 .. .. 5 .. .. .. .. 5 Atelectasis 2 .. .. .. 2 .. .. .. .. 2 Congenital Malformation 1 .. .. 1 2 4 .. .. .. 6 Premature Birth 13 3 .. 1 17 .. 1 .. .. 18 Atrophy, Debility and Marasmus 1 1 .. .. 2 3 1 1 .. 7 Violence 3 .. .. .. 3 1 1 .. .. 5 Convulsions .. .. .. .. .. .. .. .. .. .. Other Causes .. .. .. .. .. 2 5 .. 1 8 27 8 1 4 40 24 19 7 l 91 Nett Births registered during the calendar year Legitimate, 1,989; Illegitimate, 64. Nett Deaths registered during the calendar year Legitimate, 82; Illegitimate, 9. 158 TABLE No. 100. 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 - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - Whooping Cough 1 - - - - - - - - - - - 1 - - - Diphtheria and Croup - - - - - - - - - - - - - - - - Meningococcal Meningitis - - - - - - - - - - - - - - - - Tuberculous Meningitis - 1 - - - - - - - - - - - - - 1 Abdominal Tuberculosis - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - Bronchitis - 1 - - - - 1 - - - - - - - - - Pneumonia 12 8 2 3 3 - - - - - - 6 1 1 1 3 Diarrhoea 7 7 1 1 3 1 - - 2 1 1 1 1 - - 2 Injury at Birth 2 1 — - - - - 1 - - - - - - 2 - Icterus Neonatorum 4 1 - - 1 - - - - - - 2 - - 1 1 Atelectasis - 2 - - - - 1 - - - - 1 - - - - Congenital Malformation 1 5 1 1 1 2 1 Premature Birth 9 9 2 3 - 1 - 2 1 - 1 2 - 2 3 1 Atrophy, Debility and Marasmus 5 2 - 1 - 1 - - - 1 1 - 3 - - - Violence 3 2 1 - 1 - 1 - - - - - 1 1 - - Convulsions - - - - - - - - - - - - - - - - Other Causes 6 2 1 — — — — — — — 2 — 3 - — 2 50 41 7 8 9 4 3 4 3 2 5 14 11 4 7 10 159 APPENDIX. METEOROLOGICAL OBSERVATIONS TAKEN AT THE ROYAL OBSERVATORY, GREENWICH, DURING THE YEAR 1935. Week ending. Temperature of the Air. Departure from average mean air temperature for 65 years. Average temperature 4 feet below ground. Number of days on which rain fell. Rainfall in inches' Highest during week. Lowest during week. Mean temperature. Jan. 5 53.7 37.9 48.3 +9.8 48.5 4 0.42 „ 12 46.1 26.8 36.7 -1.3 47.6 4 0.32 „ 19 52.0 31.7 42.4 +4.1 46.4 2 0.07 „ 26 49.8 32.6 41.8 +2.9 46.0 5 0.32 Feb. 2 56.8 25.4 38.6 —1.0 45.1 4 0.29 „ 9 52.8 28.3 39.5 +0.1 44.9 3 0.27 „ 16 56.0 32.9 45.7 +6.6 44.3 4 0.38 „ 23 52.1 31.1 45.1 +5.5 45.1 3 0.44 Mar. 2 51.6 29.9 40.6 +0.4 45.0 4 1.02 „ 9 52.6 29.1 39.4 —1.5 44.5 3 0.22 „ 16 56.8 31.2 39.9 —1.5 43.7 - 0.00 „ 23 67.0 33.7 49.8 +7.8 44.3 3 0.37 „ 30 60.8 36.3 48.0 +4.6 45.7 1 0.01 Apr. 6 56.9 30.7 42.0 -3.8 46.1 6 0.39 „ 13 60.0 32.8 48.4 +2.4 46.1 6 1.49 „ 20 63.2 34.2 48.3 +0.7 47.1 7 0.66 „ 27 63.6 39.6 48.7 +0.0 48.0 2 0.37 May 4 67.0 35.2 50.9 +1.5 48.4 1 0.07 „ 11 75.7 43.6 55.0 +4.0 49.7 — 0.00 „ 18 55.9 28.2 43.5 -9.3 50.2 4 0.39 „ 25 69.0 33.9 51.3 —3.2 49.9 4 1.00 June 1 71.2 44.4 55.2 —1.3 51.0 2 0.18 „ 8 70.0 47.1 56.4 —1.7 52.3 6 0.81 „ 15 75.8 40.1 57.3 —1.0 53.4 6 0.99 „ 22 82.7 49.3 61.6 +1.9 54.6 5 0.57 „ 29 83.9 50.6 68.4 +7.0 56.9 1 0.39 July 6 78.5 55.3 66.6 +4.7 58.5 1 0.33 „ 13 87.1 47.4 67.7 +5.0 59.3 1 0.01 „ 20 86.6 51.1 66.5 +3.2 59.9 3 0.21 „ 27 82.8 54.0 66.3 +3.5 59.9 - 0.00 Aug. 3 81.2 45.6 62.0 -0.2 60.3 - 0.00 „ 10 87.7 48.9 68.6 +6.4 60.2 — 0.00 „ 17 84.0 45.1 63.1 +0.7 60.5 1 0.08 „ 24 90.9 54.1 67.9 +6.5 60.5 3 1.17 „ 31 76.4 42.0 59.1 —1.2 60.4 3 0.93 Sep. 7 74.4 45.5 60.0 +0.5 59.9 4 0.85 „ 14 76.7 42.4 58.8 +0.6 59.2 1 0.03 „ 21 73.4 49.1 59.5 +2.7 58.8 6 0.50 „ 28 73.6 38.1 56.3 +1.0 58.4 4 0.86 160 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. 5 60.7 42.0 52.2 -1.5 57.7 7 1.67 „ 12 61.6 39.0 50.8 -0.8 56.3 4 1.03 „ 19 63.2 40.9 54.3 +4.6 55.2 3 0.07 „ 26 54.5 28.0 43.0 —5.1 54.3 1 0.04 Nov. 2 62.4 41.1 54.3 +7.1 53.0 5 0.55 „ 9 62.8 34.6 47.3 +1.6 52.8 6 0.98 „ 16 54.3 38.1 45.8 +2.2 51.4 6 1.08 „ 23 51.9 34.5 44.9 +2.7 50.3 5 1.03 „ 30 56.0 29.4 43.1 +1.6 49.2 2 0.34 Dec. 7 48.5 30.4 38.3 —2.9 47.9 5 0.30 „ 14 46.5 29.5 39.3 —1.3 46.5 4 0.18 „ 21 45.1 27.0 34.9 —5.0 45.5 3 0.17 „ 28 52.0 20.2 40.5 +2.0 44.1 5 0.95