Woo 36 Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1936 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, 1936. The Worshipful the Mayor (Councillor Miss M. Crout, J.P.). Councillor Mrs. E. L. Reeves (Chairman). Councillor Mrs. L. E. Driver ( Vice-Chairman). Aldermen: Mrs. E. Brooks. Sir Ernest Kemp, J.P. E. H. Reeves. Councillors: E. Brown. C. H. Darby J. B. Fyson A. H. Gilder G. E. Greenwood C. J. Keedy F. R. Moore H. Vaughan 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 11 Laboratory Facilities 15 Clinics and Treatment Centres 15 Ambulance Facilities 16 Professional Nursing in the Home 17 Hospitals 18 Midwifery and Maternity Services 19 Institutional Provision for Mothers and Children 19 Health Visiting 19 Infant Life Protection 19 Supply of Insulin 19 Vaccination 20 Adoptive Acts, By-laws and Regulations in Force in the District 21 Orthopaedic Treatment 22 School Medical Service (L.C.C.) 22 II.—HEALTH PROPAGANDA. General Reference 25 Health Services Booklet 25 Health Week 25 The Cinema and Health Education of School Children 26 Talks to Selected Audiences 27 Cinema Projector 27 Films 27 Cookery Classes 27 Central Council for Health Education 27 "Better Health" 28 Posters 28 III.—MATERNITY AND CHILD WELFARE. General Reference 30 Staff 31 Public Health (London) Act, Part XII. 31 The Work of the Health Visitors 32 Infant Life Protection 32 The Work of the Welfare Centres 34 Artificial Sunlight Clinic 37 The Care and Comfort of the Pre-School Child 38 Toddlers' Clinic 40 Provision of Maternity Outfits 46 Compensation to Midwives 46 Payment of Midwives' Fees 46 Administration of the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 46 Obstetric Complications in Private Practice 46 Home Helps 46 Boarding-out of Children 47 Treatment of Minor Ailments 47 Dental Treatment 47 Orthopaedic Treatment for Children under Five Years of Age 48 Provision of Nursing Assistance 49 Children's Beds 49 Institutional Midwifery 50 4 page Ante-Natal Treatment and Emergencies 50 Convalescent Home Treatment for Children under Five Years of Age 50 Convalescent Home Treatment for Expectant and Nursing Mothers 50 Supply of Milk, etc., to Mothers and Children 50 Blind Persons Act, 1920 51 Widow's, Orphans' and Old Age Contributory Pensions Act, 1925 51 IV.—SANITARY ADMINISTRATION. Staff 52 Water Supply 52 Drainage 52 Removal and Disposal of Refuse 53 Complaints 53 Sanitary Inspection of the Area 53 Shops Act, 1934 55 Smoke Abatement 56 Public Baths and Washhouses 56 Eradication of Bed-Bugs 57 Factory and Workshop Acts 59 The Rats and Mice (Destruction) Act, 1919 61 Fouling of Footways by Dogs 61 Nuisance from Pigeons 61 Rag and Bone By-laws 61 Rag Flock Act 62 Mortuaries 62 Cemeteries 63 Offensive Trades 63 Removal of Infirm and Diseased Persons 63 Children's Sandpits 64 Pharmacy and Poisons Act, 1933 64 Legal Proceedings 64 v.—INSPECTION AND SUPERVISION OF FOOD. General Reference 66 Milk Supply 66 Meat Supply 69 Registered Premises 70 Other Food Premises 71 Unsound Food 71 Merchandise Marks Act, 1926 72 Agricultural Produce (Grading and Marking) Acts 72 Sophistication of Food 73 Adulterated Samples—Action taken 79 Other Legal Proceedings 81 Food Poisoning 81 Public Analyst—Alteration in Terms of Appointment 85 Chemical and Bacteriological Examination of Food 85 Nutrition 85 By-laws 85 VI.—HOUSING. Statistics 86 Overcrowding 88 Inspection of Houses 91 Clearance Areas 91 Hutment Dwellings 98 Re-housing of Old People Living Alone 99 New Houses. 99 Council's Housing Schemes 100 100 Increase of Rent and Mortgage Interest (Restrictions) Acts 100 Tents and Vans 100 Houses let in Lodgings 100 Common Lodging Houses 5 VII.—PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. page General Reference 101 Notifications and Deaths 102 Diphtheria 107 Scarlet Fever 108 Puerperal Fever and Puerperal Pyrexia 111 Enteric Fever 111 Erysipelas, Malaria and Dysentery 111 Anterior Poliomyelitis 111 Encephalitis Lethargica 112 Smallpox. 112 Cerebro-spinal Meningitis 112 Whooping Cough 112 Ophthalmia Neonatorum 113 Zymotic Enteritis 114 Measles 114 Pneumonia 115 Tuberculosis 117 Arrangements for Disinfection and Disinfestation 129 VIII.—GENERAL STATISTICS. Physical Features of the Area 131 Population 131 Social Conditions 132 Sickness and Invalidity 134 IX.—VITAL STATISTICS. Annual Statistics (including those of Wards) 135 Births 137 Marriages 139 Deaths 139 Deaths from Cancer 144 Maternal Mortality 145 Child Mortality 146 Infant Mortality 147 APPENDIX. Meteorological Table 151 6 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Madam Mayor, Ladies and Gentlemen, I have the honour to submit the Thirty-sixth Annual Report on the health of the Metropolitan Borough of Woolwich. The Report, in accordance with the instructions of the Council, follows the outline indicated by the Ministry of Health, in order to ensure uniformity in the presentation of Annual Reports of Medical Officers throughout the country. During the year much consideration was given to the needs of the toddler and it was decided to increase, from the beginning of April, 1937, the facilities already provided for his care and comfort. The number of toddlers sessions is to be doubled, following-up is to be more complete and additional provision is to be made for the treatment of defects discovered. The clinics of the school medical service are to be used for this purpose but when this is not possible other arrangements are to be made. Orthopaedic cases, for example, will continue to be sent to the Remedial Clinic of the Woolwich Invalid Children's Aid Association. A new Ear, Nose and Throat Clinic is to be established, where medical and hygenie treatment chiefly, but if necessary surgical treatment also, will be available. Parliament has decided that the salaried midwives' service to which I referred in last year's report is to be administered by the London County Council whose scheme had not been made public at the end of the year. It is not yet known to what extent, or in what ways, the existing maternity services of the Metropolitan Borough Councils are to be utilised. Progress in slum clearance still continues. An additional twelve areas were represented during the year bringing the total number of areas dealt with since the commencement of the programme up to 34. In these 34 areas were 293 houses occupied by 1,156 persons. Three official representations have been made by medical officers of the London County Council. Details will be found in the housing section of the Report. In the matter of overcrowding progress has also been made. Landlords have been provided, as a result of a systematic survey, with information as to the "permitted number" of persons who may occupy a dwelling and the position of all known overcrowded families has been investigated. It is difficult to know what is happening with regard to overcrowding. At the end of 1935, 683 families were known to be living in overcrowded dwellings in the Borough. In 414 cases 7 crowding no longer exists. It has not been possible to ascertain in what way this happened in all cases as 165 families have moved to unknown addresses. Overcrowding has been abated in the other cases partly by reduction in the size of families occasioned by marriage or death, partly by the adjustment of accommodation in the same house, and partly by transfer to municipally owned houses. The 1936 survey, however, disclosed that a further 261 families were overcrowded. At the end of a year in which there was no systematic effort at abatement there was less overcrowding. Compared with 1935, the incidence of infectious disease showed an increase, due mainly to the presence of a measles epidemic. There were fewer cases of diphtheria (176 as against 313), of scarlet fever (609 as against 634), of erysipelas (68 as against 78), and of puerperal pyrexia and puerperal fever (28 as against 45). There was an increase in the number of cases of ophthalmia neonatorum (26 as against 17), epidemic diarrhoea (63 as against 5), and enteric fever (12 as against 9). The number of cases of measles rose from 656 to 2,060. The number of notifications of tuberculosis received during the year was 253, compared with 242 in 1935. At the end of the year there were 789 persons suffering from pulmonary tuberculosis, and 179 persons suffering from other forms of tuberculosis, that is in all 968 persons (975 in 1935), living in the Borough. The number of deaths from tuberculosis during the year was 116 compared with 136 in 1935. The principal vital statistics for the year are as follows:—the birth rate was 13.8, a decrease of 0.2 on that of 1935; the infant mortality rate was 59, compared with 44 in the previous year and 63 in 1934; the neo-natal mortality rate (deaths under four weeks per thousand births) was 21.81, as against 19.5. The number of maternal deaths was 5, two more than in 1935, the rate for the year per thousand births being 2.47. The population of the Borough is estimated by the Registrar General to be 146,500 at the middle of the year, an increase of 100 on 1935. This is the total population and includes non-civilians, and it is on this figure that the rates of the Borough are calculated. For many years the Council have been very active in securing open spaces for the perpetual enjoyment of the citizens of Woolwich and numerous small areas have been acquired by them from time to time. The Council have always regarded the "Green Belt" as of the greatest importance, and when larger areas were on the market the County Council were urged to purchase these and generous financial assistance was given by the Borough Council. Because of this policy Woolwich is now more fortunate than most London Boroughs in its extent of public open spaces. The County Council own 700 acres of such space in Woolwich to-day and the Borough Council about 200 acres in no fewer than 143 areas of varying size, from a small shrubbery to extensive playing fields. 8 In all our towns, there are here and there, derelict plots of land—used only too often as convenient dumps for shooting rubbish surreptitiously. Sometimes the owner cannot be found ; often he is only too willing to sell a piece of land he cannot develop. Such areas in this Borough have been acquired by the Council as opportunity offered and have been changed from eyesores to small beauty spots at very little cost. In recent years considerable thought has been given by the Borough Council to beautifying its open spaces and to developing them in a manner most suitable for encouraging the young, the adolescent, the middle-aged and the aged, to spend more time in the open air. Such spaces when properly developed, can be used for play by those sufficiently active to enjoy it, and for providing a restful and pleasing atmosphere for those of maturer years. The Council's open spaces ma3T be divided into five classes:— (a) Large Formal Gardens. There are two of these—Well Hall Pleasaunce, opened in 1933, and one other in process of development—Rockcliff Gardens, Plumstead. In each of these the land has been laid out according to its possibilities and full advantage has been taken of the natural features in the development. To these have been added by carefully designed layouts, that beauty of ever-changing pictures of form, colour and shade, which nature gives us by trees, shrubs, flowers, and pools, and the restful atmosphere which is to be found in such pleasing surroundings. Space has been reserved in each of them for active physical recreation. St. Mary's Churchyard, Woolwich, should be included in this series. Over three acres in extent, its walks, lawns, flower beds and rock gardens in the midst of Old Woolwich provide a welcome and refreshing change of great charm from the mat'ter-of-fact atmosphere of work-a-day Woolwich in the adjoining factories and wharves. (b) Shrubberies and Greens. There are many examples of these throughout the Borough, varying in size from a few square yards to an acre and a half. In their design no routine plan has been followed, but each has been developed as the site permitted. Often special features such as rock gardens, or rose gardens, or ornamental flower beds, have been introduced. There are over a hundred such sites, and they form pleasing and attractive interludes in our network of streets and roads, providing in a simple way glimpses of natural beauty and charm. Rockcliff Gardens. The Tarn. Children's Playground, Gough Street. Well Hall Pleasaunce. 9 (c) Natural Park. The acquisition of the Tarn, at Eltham, gives Woolwich a natural park— small it may be, but one which will prove a never-ending source of delight to nature lovers. It consists of nine acres, one-third of which is water. The adjoining slopes are thickly wooded. The whole lends itself to preservation in its wild state, with fish in the lake and a bird sanctuary around. When paths have been made, resting places provided and wild flowers introduced, one more beauty spot will be available for nature study, for rest and for recreation. (d) Playing Fields. Over 90 acres of playing fields have been provided on the Council's Estates at Eltham. (e) Children's Recreation Grounds. Fifteen in all have been provided; some equipped with open-air gymnasiums ; some in open areas, some small and tucked away amidst crowded buildings, but all providing delight and exercise for active healthy youngsters, and diminishing the risk of road accidents. The beautification of the Borough is not however confined to open spaces only. In the streets, trees have been planted, the species varying from street to street. Roadside verges are to be found in the new wide roads. The unkempt appearance so often seen there has been eliminated with a fair measure of success by careful grouping of shrubs of various types. The open spaces under the control of the London County Council are larger and they are retained in their natural state as a rule, but in places formal gardens have been developed. Woolwich is fortunate in its open spaces, in possessing a Council who recognise the value of beauty, of natural calm, and of exercise in the open air amidst pleasant surroundings, in the mental and physical well-being of its citizens, and an engineer who is capable of giving practical interpretation and expression to this outlook, with such marked success, in so able, so varied, and so pleasing a fashion, and perhaps what is more important, a public deeply appreciative of the advantages they now enjoy. 10 Since my last report the following staff changes have taken place:— Miss M. F. Tyers, who joined the health visiting staff in September, 1935, was appointed as a sanitary inspector from the 27th May. Mr. A. Goad, temporary clerk, was appointed to Grade "A" from the 1st April. Miss I. Grant, temporary clerk, was appointed to Grade "A" from the 1st April. Miss J. Walters was appointed to a temporary clerkship from 20th July. It is pleasing to place on record that the following additional qualifications were obtained during the year by members of the staff :— Diploma of Nursing, University of London, with Distinction—Miss M. F. Tyers. Certificate of the Sanitary Inspectors' Examination Board—Miss W. Adams, Miss A. Carey and Miss M. F. Tyers. In conclusion, I desire to express my gratitude to the Chairmen and members of the Health Committees, and indeed, to all the members of the Council, for their continued confidence and support, for the interest they have taken in the work of the Department and for their sympathetic approach to the many problems it has been my duty to bring before them. I thank sincerely also every member of the staff for the valuable work they have done during the year, and for the help they have given to me personally. I am, Madam Mayor, Ladies and Gentlemen, Your obedient Servant, J. MACMILLAN, Medical Officer of Health. 11 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.Se., 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, 6. 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. 12 (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's appointment is now on a permanent basis. Mr. H. G. Harrison, the Public Analyst for Deptford and Shoreditch, acts as Public Analyst for this Borough during the temporary absence of Mr. H. Amphlett Williams. 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 Pondrill, 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. 13 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, £r.. 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. 1935 Tyers, Miss M. F. Cert. San. Insp.,Exam Joint Board; Cert. General Hospital Training; C.M.B.; Health Visitors' Cert.; Massage; Diploma in Nursing, University of London. Woman Sanitary Inspector (1936). 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 Seocombe, 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. 14 TABLE No. 2—continued. Year appointed. Name. Qualifications. Appointment. 1933 Carey, Miss A. Cert. General Hospital Training ; Cert. Fever Training ; C.M.B. ; Health Visitors' Cert. ; Cert. San. Insp. Exam. Joint Board. Health Visitor. 1933 Adams, Miss W. Cert. General Hospital Training; C.M.B.; Health Visitor's Cert; Diploma in Nursing, University of London.; Cert. San. Insp., Exam. Joint Board. Health Visitor. 1934 Little, Miss E. Cert. General Hospital Training; Cert. Fever Training; C.M.B.; Tuberculosis Cert.; Health Visitors' Cert. Health Visitor. (1935). 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. Clerk, Grade A. 1935 Grant, Miss I. Clerk, Grade A. 1936 Walters, Miss J. Temporary Clerk. A temporary staff of 19 measurers and clerks were employed for approximately five months in connection with the survey of working-class houses rendered necessary by the overcrowding provisions of the Housing Act, 1936. The Medical Officer of Health is Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme. 15 ii. Laboratory Facilities. The bacteriological work of the Council rendered necessary by investigations into infectious diesases, 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 800 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.I. iii. Clinics and Treatment Centres. In tabular form is shown below a list of clinics and treatment centres in the Borough:— TABLE No. 3. Clinics and Treatment Centres. Situation. Nature of Accommodation. By Whom Provided. Sessions Weekly. Maternity and Child Welfare Centres. Old Town Hall, Woolwich Doctor's Room, Weighing Rooms, Waiting Rooms, etc. Woolwich Borough Council. 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, Boresford Street, Woolwich. do. do. do. 1 Luke's Hall, Westraount 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—continued. 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 verminous children. Woolwich Borough Council Daily Tuberculosis Dispensaries. Maxey Road, Plumstead Doctor's Rooms, Waiting Rooms, Dressing Rooms, Dispensary, etc. do. Daily 11, Carnecke Gardens Doctor's Room, Waiting Room etc. do. 3 Venereal Diseases. Nil. Orthopaedic Clinics. 8, Thomas Street, Woolwich Clinic, Waiting Room, Dressing Room Woolwich Invalid Children's Aid Association Daily Christchurch Church Hall, Eltham High Street. Waiting Room do. 2 iv. Ambulance Facilities. The London County Council provide ambulances free of cost at any hour of the day or night, including Sundays and public holidays, for the conveyance to hospitals or private residences of:— (a) Persons meeting with accidents or suffering from sudden illnesses in the streets, public places, places of employment, etc.; 17 (b) Persons meeting with accidents in their homes ; (c) Persons suffering from illnesses in their homes if a medical practitioner certifies that the case is one of life or death, and that arrangements have been made for the reception of the patient in a hospital; (d) Parturient women, if the case is one of urgency whether from the home, place of business or elsewhere, on the application of a qualified medical practitioner or certified midwife, provided that either a doctor or midwife accompanies the case ; and (e) Non-urgent cases of parturition. In such cases admission to a maternity bed must have previously been arranged and a card (issued by the County Council to hospitals, maternity homes, etc.) for such admission obtained. The card must be handed to the ambulance attendant at the time of removal. The husband or a female friend must accompany the patient. (/) To the Council's hospitals and institutions. Ambulances are supplied on payment of prescribed charges for the conveyance of cases between private houses, hospitals (other than the Council's hospitals, etc.), nursing homes, and for examinations, consultations and treatment by specialists or at special establishments. The standard charge for the removal of one patient from one place to another within the County of London is 12s. 6d. This charge includes, if necessary, the services of a male attendant. A doctor and one friend is allowed to accompany the patient. For journeys extending outside the County for one or two persons in addition to the Council's staff, 1s. 6d. a mile up to 50 miles and thereafter Is. 3d. a mile is charged. v. Professional Nursing in the Home. During the year, nursing assistance was available in all parts of the Borough. Such assistance is provided by six Nursing Associations, as follows :— Woolwich and Plumstead District Nursing Association. Silvertown and North Woolwich District Nursing Association. Eltham Provident Nursing Association. New Eltham District Nursing Association. Horn Park District Nursing Association. Mottingham District Nursing Association. 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 18 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 Acute Primary Pneumonia Influenzal Pneumonia Puerperal Fever Puerperal Pyrexia Tuberculosis An additional grant is made yearly in respect of the nursing treatment of children suffering from threadworms. vi. Hospitals. The Medical Officer of Health is asked to report under this heading on the hospitals belonging to the local authority and hospitals with which the local authority have made arrangements for the admission of patients. There are no hospitals belonging to this local authority, but arrangements for the admission of patients have been made with two local hospitals :— (a) War Memorial Hospital. (b) British Hospital for Mothers and Babies. The Council's arrangements with these hospitals were fully reported on in the Annual Report for 1930, but it may be convenient to refer to them briefly here : At the War Memorial Hospital the Council reserve twelve beds for children under five years, and sufficient accommodation as may be necessary for 66 maternity cases per annum. In addition the hospital authorities are under contract to provide emergency treatment as occasion arises for such cases of midwifery as require it. 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. Proposals to provide additional maternity accommodation at both of the above hospitals were under consideration at the end of the year. Is. Od. per visit for one case ; 6d. per visit, per case, for more than one case in the house at the same time. 1s. 3d. per visit. 19 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 68 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. Maternity in-patients beds are provided in ; (a) The British Hospital for Mothers and Babies ; (6) The War Memorial Hospital ; (c) The Eltham Cottage Hospital; (d) The Military Families Hospital; (e) St. Nicholas Hospital (London County Council) and (/) a few in midwives' homes. District midwifery services are maintained by the British Hospital for Mothers and Babies in the district adjacent to the Hospital and by the Plaistow Maternity Hospital in North Woolwich. 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. 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. 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. 20 Insulin was supplied under this scheme to nine patients during the year, the total cost being £13 18s. 3d. Insulin is supplied to medical practitioners under the following conditions :— (1) The application must state the name, age, address, and sex of the patient for whom it is required. (2) A quarterly report must be furnished in respect of each patient treated, giving the following information :— (a) The number of doses of Insulin administered ; (b) Stating whether any tests were made of the urine or of the blood of the patient, and, if so, by whom and with what results ; (c) A report on the progress of the patient. xii. Vaccination. I submit a return by the Vaccination Officer on the work carried out under the Vaccination Acts for the year 1935. TABLE No. 4. RETURN to be made on or before the 13th of February, 1937, 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, 1935, 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, 1935. Number of these Births duly entered by 31st January, 1^37, in Columns I., II., IV., and V. of the " Vaccination Register (Birth List Sheets), viz. :—- Col. I. Col. II. Col. IV. Number in respect of whom Statutory Declaration of Conscientious Objection has been received. Col. V. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Died Un vaccina ted. 1. 2. 3. 4. 6. 6. 7. 1. Plum stead 677 291 1 - 274 37 2. Woolwich 1239 597 6 - 458 35 3. Eltham 497 238 1 - 195 14 Total 2413 1126 8 - 927 86 21 TABLE No. 4—continued. Number of these Births which on 31st January, 1937, remained unentered in the " Vaccination Register " on account (as shown by " Report Book ") of :— Number of these Births remaining on 31st January, 1937, 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 1936. 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 1936. Postponement by Medical Certificate. Removal to Districts the Vaccination Officers of which have been duly apprised. Removal to places unknown or which cannot be reached; and cases not having been found. 8. 9. 10. 11. 12. 13. 6 16 42 10 These figures are to be obtained from colum ns 2 and 6 of the Summar y (Form N.) 16 66 48 13 8 20 17 4 30 102 107 27 1249 952 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 :—4. (b) The figures in columns 2 to 11 should not include re-registered births or cases of children born in other districts. "The total in this column should be the number of Certificates of successful primary vaccination of children under 14, actually received during the year, including any relating to births registered in previous years. The total thus given should include the Certificates of successful primary vaccination of which copies have been sent to the Vaccination Officers of other Districts. The total number of Certificates for the year 1935 sent to other Vaccination Officers should be stated here :—131. fIncludes the Burrage and Herbert Wards in Plumstead Parish. (.Signature) S. G. TAYLOR, Vaccination Officer. Date—13th February, 1937. During the year ended 30th September, 1936, the number of persons successfully vaccinated or re-vaccinated at the cost of the rates was 2,570. This figure includes 753 primary vaccinations of persons under one year of age ; 610 over one year of age, and 1,217 re-vaccinations. xiii. 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 22 Council made 212 advances to purchasers of houses in accordance with the provisions of these Acts. 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 1935. xiv. 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. A branch clinic was opened at the Christchurch Church Hall, Eltham High Street, on the 1st April, 1936. 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. 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 1936 :— 23 TABLE No. 5 (Part I.). Examination of Elementary School Children in Woolwich, 1936. Numbers Examined and Defects Found. Boys. Girls. Entrants. Age 7. Age 11. Age 14. Entrants. Age 7. Age 11. Age 14. Number examined 989 831 1,176 971 1,027 819 1,115 1,106 Cases * Cases * Cases * Cases * Cases * Cases * Cases * Cases * Malnutrition 17 17 1 13 1 3 19 1 10 1 17 1 2 1 Skin Disease 8 7 3 3 5 5 7 5 9 7 12 11 5 3 6 3 Defective Teeth — 361 — 198 — 194 227 359 187 192 240 Enlarged Tonsils 117 56 68 22 34 26 25 17 99 55 64 34 50 31 26 16 Adenoids 17 9 4 3 5 2 26 9 8 4 Enlarged Tonsils and Adenoids 58 42 28 21 4 3 4 4 63 47 32 24 9 7 6 6 Other Nose and Throat defects 9 — 4 — 3 2 3 13 5 1 1 3 1 4 3 Enlarged Glands 5 — 5 — 1 — 1 1 4 — 3 — 5 1 — — Eye Disease 13 9 10 6 6 4 6 4 24 15 9 4 12 11 6 4 Vision defect — — — 32 74 80 _ 27 66 — 66 Otorrhoea 3 2 4 2 4 2 4 4 5 5 6 2 2 1 Other ear disease 1 1 2 1 1 1 2 . 2 1 1 Defective hearing 1 1 1 — 1 — 2 1 3 1 4 1 Speech defects 1 — 4 1 5 4 2 2 1 — 1 Heart defects 2 — 3 — 8 1 4 4 1 8 2 7 5 7 4 Anaemia 6 5 9 5 10 3 4 1 16 8 14 5 8 2 3 1 Lung defects 13 5 14 4 5 4 5 4 16 4 5 1 4 2 1 Nervous defects 3 1 3 2 5 2 3 2 8 4 5 2 3 2 3 1 Phthisis 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — Rickets 1 1 1 — — — — — — — Spinal deformities — — 3 3 2 2 3 3 1 1 1 1 7 7 7 6 Other deformities 25 9 11 3 7 2 6 3 10 3 10 4 12 5 12 6 Other defects 17 9 19 12 19 12 7 6 19 11 22 11 30 20 20 8 Number of Children noted for treatment. . — 443 — 269 — 303 — 322 451 — 277 — 318 332 * Defects, however slight, are included under " Cases " ; those severe enough to require treatment are shown under *. 24 TABLE No. 5 (Part II.). Age Groups. Number examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness op 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 989 899 89 1 103 849 37 — 985 3 1 986 1 2 616 347 26 — — — Girls 1027 920 107 — 105 869 53 — 1018 8 1 1023 2 2 653 346 28 — — — Age 7— Boys 831 717 112 2 87 693 51 — 830 1 — 831 — — 612 209 10 597 173 59 Girls 819 712 105 2 120 670 29 — 800 19 — 812 7 621 190 8 596 171 49 Age 11— Boys 1176 968 207 1 121 1018 36 1 1172 4 — 1171 4 1 953 223 864 179 132 Girls 1115 1003 111 1 122 951 42 — 1103 11 1 1109 6 — 893 217 5 843 165 107 Age 14— Boys 971 860 110 1 165 787 19 — 970 1 — 970 1 — 741 227 3 719 123 126 Girls 1106 1018 88 — 162 910 34 — 1098 6 2 1105 1 — 845 260 1 849 139 114 Total 8034 7097 929 8 985 6747 301 1 7976 53 5 8007 22 5 5934 2019 81 4468 950 587 Percentage 88.3 11.6 0.1 12.2 84.0 3.8 3.8 99.2 0.7 0.1 99.6 0.3 0.1 73.9 25.1 1.0 74.4 15.8 9.8 London 56.4 43.2 0.4 16.6 77.4 6.0 6.0 97.5 2.2 0.3 99.2 0.7 0.1 70.5 26.1 3.4 66.2 19.3 14.5 25 SECTION II. HEALTH PROPAGANDA. The Council place the greatest importance on health propaganda and health education, as these mean much in progressing towards a healthier race. They cost but little—only a fraction of what health services cost—and yet no part of the services is likely to give better value for money spent. It goes without saying that the health services provided by the municipality should be used by its citizens, and little will be accomplished if the citizens know not of them, and do not appreciate how helpful they can be. Increased co-operation by the public will ensure a better environmental health service ; a more extensive use of the health clinics for laying the foundations of a healthy life ; a more efficient school medical service, which suffers much from the want of publicity—for example there are too few parents who realise how necessary dental treatment is for children with dental defects—and a better tuberculosis service, when the public appreciate that delay in securing treatment is dangerous, and that the best thing a contact of tuberculosis can do is to submit himself for medical examination. There is need for development in all these and kindred matters and much of that development will come through greater publicity and greater knowledge of the health services. The activities during 1936 can be classified as follows :— (а) Health Services Booklet.—A booklet of twenty pages giving full information regarding the Council's health services can be obtained free of charge on application at the Health Department, or at any of the Council's health centres, dispensaries and public libraries. It is sent as a matter of routine to every new tenant on the Council's estates ; copies are distributed by post from time to time to residents in the Borough, selected at random, and copies are offered at each informal talk, referred to in heading (d), to all members of the audience. It was distributed in large numbers at the Eltham Health Exhibition. In every way possible it is brought to the notice of the public so that the Council's health services may be widely known. It is now in its fifth edition and is in addition to the leaflets issued on special subjects. (б) Health Week.—The Council, as has been their practice since 1925, arranged a health week in the autumn. Despite the discouraging experience at Eltham in 1932, when a small exhibition was arranged at the Eltham Health Centre, it was decided to arrange another at the Arcade Hall. This was highly successful, as the following report of the Public Health Committee to the Council shows. It was generally recognised that it was unfortunate that it was not possible, owing to the lack of a suitable hall, to organise a larger exhibition. 26 "In accordance with the Council's resolution a Health Exhibition was held in the Arcade Hall, Eltham, from September 28th to October 3rd, 1936. The exhibition was organised by the Central Council for Health Education and consisted of exhibits arranged by the following national organisations :— The National Council for Maternity and Child Welfare ; the Dental Board of the United Kingdom ; the National Association for the Prevention of Tuberculosis ; the Eugenics Society ; the Cremation Society ; the Health and Cleanliness Council, and the British Social Hygiene Council. The Electricity Department of the Council arranged a stand and had special cookery demonstrations, etc., at their showrooms, and the Works Department attractively set out the stage as a miniature pleasaunce. Stands dealing with sanitary inspection and household pests were arranged by the Health Department. We are indebted to the following for the loan of models, pictures and articles :—The Ministry of Agriculture and Fisheries ; the Royal Sanitary Institute ; Messrs. Accles and Shelvoke, and the London Fumigation Company. The attendances during the week are estimated at 9,180, including 310 school children in conducted parties. We take this opportunity of expressing our thanks to all those who helped to make the Exhibition such a success." (c) The Cinema and Health Education of School Children.—Once a month during the winter months a combined programme of educational and health films is shown to school children. The programme is arranged by the Libraries Committee and the Public Health Committee co-operate. The average attendance at each showing is about 500, so that, with three displays in one day, some 1,500 children are interested each month. The programme lasts just under one hour and usually four films are shown, one of which, occasionally two, is a health film. The health films shown were :— January 20th February 17th March 16 th November 9th October 12th December 7th " Our Food Supply." " Trapeze Man Talks." " How we Breathe." " New Ways for Old." " The Red Army." " Breathing." " The Eyes have it." " Stand up and Breathe." 27 (d) Talks to Selected Audiences.—An extremely popular part of the Council's service is the giving of talks to selected audiences at their own place of meeting. At the beginning of each winter notices offering talks on health subjects, with or without suitable health films, are sent to Guilds, Friendly Societies, Church Societies, Clubs and other organisations of this nature. In recent years there has been an increasing demand, particularly in the number of talks to Friendly Societies, whose members are anxious and keen to be educated in health matters, in accordance with their aims. The subject matter of the talk varies. Sometimes it is about the Council's health services, sometimes it is on preventive medicine and sometimes it is on disease. The talks are given by the members of the staff-—the Medical Officers, Sanitary Inspectors, Health Visitors and Tuberculosis Visitors. (e) Cinema Projector.—The 16 mm. film is now, for all practical purposes, the standard film for education. As such health propaganda films are now available in increasing numbers, the Council decided to buy a Gaumont-British machine for showing silent and sound films of this size. It has been used on many occasions during the year and is proving a valuable addition to the Council's equipment for health education. (/) Films.—A silent 16mm. film of the Council's health services was completed during the year by the Eltham Amateur Cinematograph Society. It is in four parts and deals with Maternity and Child Welfare, Tuberculosis, Housing, and Environmental Services. It is used to illustrate talks on the Council's health services to selected audiences and has proved of great value in this respect. Two other 16 mm. films were purchased—" The Red Army," a sound film dealing with the bed bug problem, and " The Empty Bed," a silent film on Diphtheria Immunisation. Other films have been hired from time to time to illustrate lectures and talks. (g) Cookery Classes.—Cookery classes, first started in the year 1934, in connection with the Tuberculosis Dispensary, were continued during the year. To the wives and mothers of the tuberculous the provision of cheap yet nutritious meals is one of the most difficult problems they have to face, and in order to assist them m this matter demonstrations are held at the Tuberculosis Dispensary at Maxey Road every week. A demonstrator is loaned by the South Metropolitan Gas Company. A demonstration meter shows how much the actual cooking has cost in terms of pence. Advice as to the actual purchase of food, how to prepare it, cook it and serve it, is given at these meetings, and in these ways it is shown that it is unnecessary to buy expensive food in order to obtain appetising, tempting and palatable dishes. The cooked dishes are sold at about half-cost to those attending the classes. The Tuberculosis Care Committee provide cups of tea and biscuits at each meeting. The nett cost to the Council for food provided during the year was £3 4s. 2d. The number attending was 20 and the number of attendances was 272. There were 44 meetings. (h) Central Council for Health Education.—This Council exist in their own words, to " (a) promote and encourage education and research in the science 28 and art of healthy living and to promote the principles of hygiene and encourage the teaching thereof ; and (6) assist and co-ordinate the work of all statutory bodies in carrying out their powers and duties under the Public Health Acts and other statutes relating to the promotion or safeguarding of Public Health or the prevention or cure of disease in so far as such work comprises health education and propaganda." The Central Council is an incorporated body composed of representatives of Government Departments, of Local Government, of National Health Insurance, of Professional Organisations and of Voluntary Societies engaged in health propaganda work. It is able to furnish expert advice on the best methods of health education. It organises health weeks ; it provides posters for display ; it distributes films and leaflets ; it prepares press articles ; it provides an official journal, " Better Health " ; it issues a Year Book collating information relating to health propaganda ; it holds an Annual Health Education Conference and it maintains a permanent propaganda exhibition. In short it co-ordinates the work of all Bodies whose propaganda is a matter of public health. The Borough Council makes an annual contribution of three guineas to its funds. (i) Better Health.—This is the official journal of the Central Council for Health Education. It contains popular articles and memoranda on personal and public health. The Borough Council purchase each month 2,000 copies and distribute them through the welfare centres, tuberculosis dispensaries, public libraries and schools. A number are posted to residents in the Borough, selected at random. It is pleasing to note the demand each month for this medium for arousing and maintaining interest in public health news. (j) Posters.—The immense amount of space devoted to poster advertising on hoardings is a sign of the value placed thereon by commercial undertakings. The same value presumably may be placed on this type of display in connection with health propaganda work. The Council therefore have made use of the poster service of the Central Council for Health Education and arranged for the display of two sets of posters each month on wooden poster frames previously used by the Empire Marketing Board. In June and July four such sets were posted, the London County Council having given permission to the Council to use the Boards outside Plumstead Central and Plumstead High Street Schools, during these two months. The posters shown during the year were as follows :— January .. " Don't Take Chances with your Child's Life (Diphtheria) (C.C.H.E.) February .. " Building a Healthy People " (C.C.H.E.) March .. " Do you use the Health Services ? " (C.C.H.E.) 29 April " Balance your Meal." (C.C.H.E.) May Dental Board of the United Kingdom. June National Council for Maternity and Child Welfare. June Dental Board of the United Kingdom. July Eugenics Society. July " Do you use the Health Services." (C.C.H.E.) August British Social Hygiene Council. September Health and Cleanliness Council. October National Ophthalmic Treatment Board. November National Association for the Prevention of Tuberculosis December National Association for the Prevention of Tuberculosis. In order to assist the Tuberculosis Care Committee with their Christmas Seal Sale it was arranged that the poster of the National Association for the Prevention of Tuberculosis should remain on the board during December, with the small posters of the Christmas Seal Appeal over-pasted. Smaller posters, crown and double crown, prepared by voluntary health organisations and associations, and by the Central Council, have been used extensively in the Council's welfare centres and dispensaries, as have been washable show-cards of health leaflets from the same sources. 30 SECTION III. MATERNITY AND CHILD WELFARE. The Council's Maternity and Child Welfare Scheme embraces the following services :— (a) Administration of Part XII of the Public Health (London) Act, 1936. (b) Home visits to mothers and children. (c) Infant Life Protection. (d) Establishment of Welfare Centres. (e) Establishment of an Artificial Sunlight Clinic. (/) The systematic medical inspection of toddlers at stated ages. (g) Provision of maternity outfits. (h) Payment of compensation to midwives. (i) Payment of midwives' fees. (j) The services of a Consultant in cases of Puerperal Fever and Puerperal Pyrexia. (k) The services of a Consultant in exceptional cases of obstetric or ante-natal abnormality at home. (l) Provision of Home Helps in maternity cases. (m) Boarding-out of children while expectant or nursing mother is in hospital- (n) An arrangement with the School Medical Treatment Committee for the treatment of minor ailments in young children. (o) An arrangement with the School Medical Treatment Committee for the provision of dental treatment to young children and to expectant and nursing mothers. (p) An arrangement with the Woolwich Invalid Children's Aid Association for orthopaedic treatment for children requiring such treatment. (q) Provision of nursing assistance for young children suffering from Measles, Ophthalmia Neonatorum, Zymotic Enteritis, Whooping Cough, Poliomyelitis, Pneumonia and Influenzal Pneumonia, and for mothers suffering from Puerperal Fever, Puerperal Pyrexia, Pneumonia and Influenzal Pneumonia. 31 (r) Reservation of twelve beds for children under 5 years of age who are suffering from such conditions as are usually treated in a general hospital, at the War Memorial Hospital. (s) Provision of beds for the institutional treatment of midwifery for 144 cases per annum at the British Hospital for Mothers and Babies, and for 66 cases at the War Memorial Hospital. (t) Reservation of beds, for ante-natal treatment and emergencies of midwifery, at the War Memorial Hospital, equivalent to 18 weeks' treatment per annum. (u) An arrangement with the Woolwich Invalid Children's Aid Association for the Convalescent Home treatment of children requiring such treatment. (v) Convalescent Home treatment for expectant and nursing mothers. (w) Arrangements for the supply and distribution to young children, expectant and nursing mothers, of milk and food drugs at cost price, half cost or free, according to economic circumstances. In addition to these services the Council have, at the request of the London County Council, undertaken to do such work as is necessary in the case of children under five years of age :—- (x) Under the Blind Persons Act, 1920. (,y) Under Section 6 of the Widows', Orphans' and Old Age Contributory Pensions Act, 1925. Staff.—Three whole-time medical officers are in medical charge of the clinics, each of 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 twelve whole-time health visitors : three of these are part-time sanitary inspectors and all but one, who is the Artificial Sunlight Clinic Nurse, are Infant Life Protection Visitors. It is the practice of the Council to appoint additional temporary health visitors during epidemics of measles. Public Health (London) Act, Part XII.—Every birth occurring in the Borough requires to be notified to the Medical Officer of Health within thirty-six hours of birth and 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. 32 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 1,986 ,, Revisits 16,321 Infant deaths investigated 40 Still-births investigated 6 Expectant mothers—home visits 908 Infectious diseases :— Ophthalmia Neonatorum—First visits 26 ,, Revisits 11 Measles—First visits 2,281 „ Revisits 1,153 Puerperal fever—First visits .. 5 ,, „ Revisits 4 Puerperal Pyrexia—First visits 21 ,, ,, Revisits 4 Zymotic Enteritis— First visits 38 ,, ,, Revisits 11 Pneumonia 76 Anterior Poliomyelitis 1 Encephalitis Lethargica 1 Infant Life Protection 921 Visits unclassified 480 Visits unsuccessful 2,890 27,184 Following their usual practice the Council gave the necessary facilities to two health visitors to attend refresher courses, and paid their expenses. Infant Life Protection.—The Council became responsible on the 1st April, 1933, for Infant Life Protection work in Woolwich. At the beginning of the year, four of their Health Visitors acted as Infant Life Protection Visitors (part-time), but in September, all the Health Visitors were appointed Infant Life Protection Visitors for their particular districts. 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. 33 At the end of 1935 there were 92 nurse children and 69 foster mothers on the Council's register, and a year later the numbers were 75 and 59 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 12 were either temporarily without nurse children or had been noted as suitable persons. These figures do not, however, tell the whole story, as 162 nurse children were added to the register and 179 nurse children were removed during the year. The following Table No. 7 shows the ages of the children under supervision on the 31st December, 1936 :— TABLE No. 7. Under 1 Year. 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 17 10 6 8 3 5 8 7 11 The number of visits paid by the Infant Life Protection Visitors was 921. The number of visits made by the male inspector in connection with infringements and kindred matters was 91, while the number of visits paid by the district sanitary inspectors was 45. The number, 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 12 Change of address by foster mother without giving timeous notice 2 Infant removed from care of foster mother without giving timeous notice 7 Keeping nurse children in excess of permitted number 1 Cautionary letters were sent in all cases. There were no prosecutions. In nine instances insanitary conditions were discovered ; in five instances there was overcrowding, and in one instance verminous conditions existed. In all cases appropriate action was taken to secure the abatement of the nuisances. Nurse children who are kept under unsatisfactory conditions may be removed to a place of safety, but it was not necessary to take this action 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, those children who are under five regularly attend an infant welfare centre. Special care is taken to see that children who are weak and ailing attend. During the year, five nurse children died—one from pneumonia and four from enteritis. 34 The only institution in the Borough holding a certificate of exemption is the Woolwich War Memorial Hospital. The Work or the Welfare Centres.—These are eight in number and are 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 sessions 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 1936 and the consolidated 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 321 205 1,429 833 299 9,701 Plumstead 238 302 1,104 649 681 7,981 Eltham 457 172 1,087 1,327 307 6,976 Slade 3 75 457 1 111 4,456 New Eltham 3 80 452 1 137 5,187 St. Luke's — 61 265 — 89 2,459 North Woolwich 16 48 136 32 91 1,365 Beresford Street 15 42 169 14 70 1,079 Totals, 1936 1,053 985 5,099 2,857 1,785 39,204 Totals, 1935 1,019 983 5,259 2,625 1,759 41,323 The next Table No. 10 shows the number of children attending each centre 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 less. The figures in this table do not include those of the Toddlers Clinics or of the Sunlight Clinic. 35 TABLE No. 10. Children in Attendance at Each Centre. Year of Birth. Town Hall. Plumstead. Eltham. New Eltham. Slade. St. Luke's. N. Woolwich. Beresford St. Totals. 1936 409 348 278 Ill 118 66 35 33 1,398 1935 465 380 291 125 132 79 39 49 1,560 1934 270 183 187 84 84 38 32 32 910 1933 133 86 143 58 56 40 10 24 550 1932 104 74 123 48 51 29 13 18 460 1931 48 33 65 26 16 13 7 13 221 1,429 1,104 1,087 452 457 265 136 169 5,099 Attendances. Year of Birth. Town Hall. Plumstead. Eltham New Eltham Slade St. Luke's N. Woolwich Beresford St. Totals 1936 3,129 3,085 2,272 1,547 1,193 805 451 269 12,751 1935 3,985 3,440 2,710 2,342 1,783 1,087 463 363 16,173 1934 1,475 865 967 703 781 207 288 212 5,498 1933 642 287 525 336 347 230 99 103 2,569 1932 323 247 344 199 304 94 37 106 1,654 1931 147 57 158 60 48 36 27 26 559 9,701 7,981 6,976 5,187 4,456 2,459 1,365 1,079 39,204 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 ease of infants attending the welfare centres. The method used was as follows :— (a) On the card of every child under one year of age attending a welfare centre between the 18th May and the 1st July was inserted once, and once only, the terms " Breast," or " Breast and Hand," or " Hand Fed." (b) The child' s age was taken on the day on which this note was made. (c) At the end of the period the results were summarised for the whole Borough and the appropriate percentages worked out. The results of the enquiry are shown in Table No. 11 on the adjoining page. 36 TABLE No. 11. Feeding of Infants attending Welfare Centres—18th May to 1st July, 1936. 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 67 90 54 30 36 32 23 10 10 352 — — 1 353 Breast and Hand 9 16 13 11 11 18 6 12 14 110 8 6 1 125 Hand 13 26 26 30 46 40 62 50 55 348 49 61 93 551 89 132 93 71 93 90 91 72 79 810 57 67 95 1,029 PERCENTAGES. Breast 75.2 68.2 58.1 42.3 38.7 35.5 25.4 13.9 12.7 43.4 — — 1.0 34.3 Breast and hand 10.1 12.1 14.0 15.4 11.8 20.0 6.5 16.6 17.7 13.6 14.0 9.0 1.0 12.1 Hand 14.5 19.7 27.9 42.3 49.5 44.4 68.1 69.5 69.6 43.0 86.0 91.0 98.0 53.6 37 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 116 whose course of treatment was not completed at the end of 1935, was 350. The total number of treatments given was 9,479 : of these, 7,829 were by carbon arc, 945 by mercury vapour lamp, 659 by radiant heat lamp, and 46 by infra-red lamp. The infra-red lamp was purchased in June at a cost of £15 15s. Od. The clinic is open every morning and on three afternoons each week. Treatment is by appointment only and no charge is made. Patients as a rule attend twice a week. Each whole-time assistant medical officer attends on one half day each week. The clinic is under the medical supervision of Dr. J. E. A. Lynham, who has furnished the following report on the year's work :— " The total number of cases attending the Clinic in the past year is appreciably down. This can be explained partly by the smaller number carried on from the previous year, and partly, it is hoped, by the steadily increasing influence of the Public Health Department. The number presented under the heading Debility is relatively high, and it is to be noted that the more severe cases of this kind are becoming steadily fewer in number, and that the percentage of cases much improved or cured is the highest yet obtained. A majority of those with enlarged glands did extremely well with general light baths, and reported afterwards periodically for observation. The " ' nervous " cases were not so satisfactory, but in nearly all these the home influences were obviously not the best. Many of the cases marked ceased treatment had moved out of the district ; some were considered by the parents to be cured, and some had to withdraw because of cases of epidemic disease in their homes. An infra-red lamp was introduced to assist in the treatment of rheumatic pains, and has fully justified its adoption. Much of the time the Clinic is run to its full capacity, and all the staff are looking forward to a time when accommodation may be increased. The system of referring the little patients at intervals to the doctors of the Clinic who first saw them has worked excellently." Mothers living in Eltham find it difficult to attend regularly with their children at the clinic and to keep up attendance for the time considered necessary by the medical officers. From them a course of treatment demands much time in travelling and consequential expense. Because of this, the Maternity and Child Welfare Committee have accepted in principle the establishment of an artificial sunlight clinic at Eltham, and at the end of the year negotiations for the purchase of a suitable site were in progress. 38 The following Table No. 12, shows the number of cases and conditions treated during the year :— TABLE No. 12. Cases treated at Sunlight Clinic, 1936. Brought forward from 1935. New Cases. Total. Much Improved or Cured. Improved. I.S.Q. Ceased Treatment. Treatment not yet complete Rickets 23 51 74 24 24 26 31 Anaemia, Debility and Malnutrition 69 131 200 76 57 4 63 68 Catarrhal Children 11 18 29 9 7 3 10 6 Septic Conditions — 1 1 — — — 1 1 Nervous Children 1 2 3 1 1 — 1 1 Enlarged Glands 4 7 11 7 — — 4 13 Miscellaneous Nervous Conditions 4 4 2 2 1 Miscellaneous Skin Conditions 5 5 4 1 5 Other Conditions 5 9 14 4 4 1 5 5 Mothers 3 6 9 9 — — 4 116 234 350 134 96 8 112 135 The Care and Comfort of the Pre-School Child.—In May the Ministry of Health issued a circular dealing with the arrangements to be made for the Care and Comfort of Children under School Age. The Ministry drew attention to the fact that excluding children suffering from uncleanliness and dental defects, 16 per cent. of children entering school are found to require treatment for some disease or defect which could, in many cases, have been prevented from developing, or could have been quickly cured if adequate supervision of the health of the children had been exercised throughout the pre-school period. Exclusive of nursery school provision which is in London the province of the London County Council, the Ministry suggested by way of remedy :— (а) Systematic periodical health visiting to be increased ; (б) The holding of Toddlers Clinics ; 39 (c) The use of the school clinics for the treatment of minor ailments and special defects in young children ; (d) The establishment of day nurseries in areas where a considerable number of mothers are regularly employed. In London, the corresponding percentage of school entrants found to require treatment in 1935 was 13.8. The bulk of these children were suffering from enlarged tonsils and adenoids. Diseases of the eye, diseases of the skin, defects of the lung, anaemia, or discharging ears, accounted for most of the remainder. After receipt of this circular, the arrangements for the care of the toddler in Woolwich were reviewed by the Council, and from this review it appeared that in 1935 (a) The estimated number of children aged 1-5 years was 7,502 and that 3,940 of these were in attendance or on the roll of public elementary schools. (b) The average number of visits paid per annum to children aged 1-5 years was 1.6, but all children whether suitable for visiting or not, and whether or not they were in attendance at school, were included in this calculation. (c) The total average number of visits paid to children who were visited regularly during the first five years of life was 11.3 in the first five years. (d) A toddlers clinic for the routine medical inspection of toddlers aged 2, 3 and 4 years had been established in Woolwich for six years and in 1935,1,314 children were examined at this clinic. (e) Forty-seven per cent. of all children over one year attended an ordinary infant welfare centre at least once during the year. (/) The attendances of children at the ordinary infant welfare centres falls after they are one year old. This was measured in the following way. The cards of 508 children taken at random from the permanent files, were examined in order to ascertain at what period the attendances at infant welfare centres ceased. At the end of the first year the number of children had been reduced to 421 ; at 18 months to 378 ; at 2 years to 360 ; at 3 years to 270 ; at 4 years to 158, and to 48 at 5 years, and these 48 actually made attendances in their sixth year. These figures relate of course to children who have been attending the centres and one attendance in a year was regarded as attendance during the period. (g) The treatment of toddlers defects at the school clinics has been for many years an important feature of the Woolwich infant welfare scheme. In 1935, 309 children were so treated for minor ailments and 382 for dental defects. (h) Arrangements have been in force for many years with the Woolwich Invalid Children's Aid Association for orthopaedic treatment and convalescent home treatment ; with the local nursing associations for nursing assistance and the War Memorial Hospital for hospital treatment. 40 (i) The Council already have an artificial sunlight clinic, provide additional nourishment, provide facilities for diphtheria immunisation and engage additional health visiting staff during measles epidemics. After consideration of the report the Council resolved :— (а) To appoint two additional health visitors. (b) To increase the number of toddler sessions per week from three to six. (c) To appoint three part-time medical officers on a sessional basis so that the assistant medical officers would be able to carry out routine medical inspection at these additional toddlers sessions. (d) To appoint two junior clerks. (e) To establish a special ear, nose and throat clinic, under the medical charge of one of the assistant medical officers. (f) To appoint a consultant for the above clinic who would see such cases as were referred to him by the assistant medical officer and all cases in which the question of operation was raised. (g) To make increased provision for the treatment of minor ailments cases. (h) To make increased provision for the treatment of orthopaedic cases. (i) To make increased provision for the treatment of dental cases. It was decided also that all the Council's Health Visitors should be appointed as infant life protection visitors for their own districts, and to accept in principle the establishment of an artificial sunlight clinic and orthopaedic clinic in new premises to be built in Eltham. These proposals were submitted to the Minister of Health, and in reply, a letter was received stating " that the Minister notes with satisfaction that as a result of the Council's consideration of Circular 1550, it has been decided to extend the scope of the existing facilities in the manner indicated in your letter." These new services are to come into operation at the beginning of April, 1937. 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. Dr. Margaret Emslie, who is in charge of these clinics attends three times weekly —once at the Old Town Hall, Woolwich, once at Plumstead Health Centre, and once at Eltham Health Centre. It was possible in addition to examine a few toddlers at morning sessions at other centres, and this was developed as much as possible during the year. 41 The examinations follow the lines of the school medical examinations and are recorded in a similar 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. The findings are summarised in the following Table No. 13 :—• TABLE No. 13. Medical Inspection of Toddlers, 1936. Disease, Defect or Condition. BOYS. Age last Birthday. GIRLS. Age last Birthday. 2 3 4 2 3 4 Total. Total Children Examined 280 209 192 257 206 214 1,358 Nutrition— (a) Excellent 206 115 71 207 144 117 860 (6) Normal 65 73 81 42 45 79 385 (c) Sub-normal 9 21 40 8 17 18 113 (d) Bad — — — — — — — Muscular Tone— (a) Excellent 131 141 143 141 150 175 881 (6) Good 135 65 46 110 53 39 448 (c) Poor 14 3 3 6 3 — 29 Clothing and Footgear— (a) Good 273 205 185 251 206 208 1,328 (b) Fair 7 4 7 6 — 6 30 Cleanliness— (a) Excellent 254 201 185 246 192 210 1,288 (b) Fair 26 8 7 11 13 4 69 (c) Dirty — — — — 1 — 1 Heart and Circulation— (a) " Functional " Conditions 58 42 65 40 34 44 283 (b) Organic Congenital Heart Disease — - — 1 — — 1 Anaemia 18 27 22 25 26 24 142 Respiratory System — Bronchitis 9 2 8 2 6 11 38 Asthma - 2 1 — — 1 4 Nervous System— Behaviour Symptoms 81 54 34 73 43 25 310 Minor Retardation 43 7 3 20 3 5 81 Organic Nervous Disease 1 — — 1 2 Mental Deficiency or Mongolism 2 — — — — 2 4 Alimentary System— Worms 1 3 2 6 Acidosis Attacks 1 1 2 3 2 2 11 Gastritis, Enteritis, etc 1 2 - - - - 3 Constipation 1 2 — 6 4 2 15 ''En-ito-Urinary System— Enuresis and Frequency 22 17 12 21 8 9 79 Other Conditions 11 6 1 — 1 1 20 42 Medical Inspection of Toddlers, 1936—continued. Disease, Defect or Condition. BOYS. Age last Birthday. GIRLS. Age last Birthday 2 3 4 2 3 4 Total Skin Conditions— Infective Skin Conditions 2 4 4 — 8 3 21 Urticaria, Eczema, etc. 10 6 4 8 7 8 43 Ichthyosis, Alopecia, or Erythema Nodosum 1 1 — — — 1 3 Eye Defects and Infections— Slight Squint 7 8 12 6 11 8 52 Blepharitis 2 4 5 — 2 2 15 Conjunctivitis 1 — 1 — 3 1 6 Ear Conditions— Otorrhoea, etc. 3 4 6 5 2 2 22 Teeth— Caries 10 52 71 4 49 84 270 Hypoplasia 3 2 — 1 3 1 10 Malocclusion 20 8 3 16 16 — 63 Rickets— (Cases clinically considered as showing definite evidence of Rachitis) 69 58 34 34 24 33 252 Nose and Throat— Enlarged Tonsils Enlarged Tonsils and Adenoids y Adenoids .. J 112 104 67 98 73 76 530 Enlarged Glands— Tonsillar 38 37 48 25 41 47 237 Posterior Cervical 20 9 13 10 17 18 87 Other Diseases and Defects Rheumatism — — 1 — 1 5 7 Hypothyroidism - - - - - 1 1 Hypopituitarism —- — — 1 -— - 1 Developmental Conditions— Umbilical Hernia 1 2 1 6 1 — 11 Inguinal Hernia — — 1 — — — 1 Naevus 1 — 1 1 2 — 5 Others 1 1 — — 1 - 3 43 30 cases was the clothing considered sub-standard and only one child was put down as in a really dirty or neglected condition. The whole of the results are closely consistent with those in past years—except the figure for anaemia, which shows a diminution-—that is somewhat astonishing in view of the remarkably sunless summer last year and rainy weather generally. Functional heart conditions, however, have not diminished (20 per cent.) but it should be noted that we include all murmurs and irregularities amongst our records for purposes of information and observation, though obviously in the great majority of cases no symptoms whatever are attached. Figures for school examinations of children have never shown anything like the percentage of murmurs we have shown each year, but it is probably useful to know that a murmur of some kind may be expected to be present in something like one child out of five in the pre-school age period, without tangible disability, in order that the murmur accidentally discovered in a single child may not be given undeserved importance. The difficulty of associating these murmurs with clinical anaemia (i.e. calling the functional murmur, as it used to be called,' haemic ') is very noticeable this year when anaemia considered clinically, has so far declined ; but it is not inconsistent with the findings published in our report of the year 1932, when we examined in detail that year's records for anaemia, pallor, functional heart conditions and their mutual bearings on each other, and found that anaemia and heart conditions did not necessarily go together. Such findings tend to increase, not diminish, the interest and possible importance of the functional heart murmur as an " original " sign with, maybe, directional significances of its own that we will appreciate better at a later date. So far as heart murmurs and rheumatism are concerned, in only seven of the total children seen were symptoms found that might be called early rheumatism, as compared with 284 " hearts " and of these seven, six cases were girls—a, sex distribution which is consistent with findings in other places. The figures for tonsil enlargement again reaches 40 per cent. (It was 45 per cent. last year) but of the total, only 4 per cent were recommended for tonsil or adenoid operation. In view of the possible bearing of unhealthy tonsils on infections of the respiratory tract, and of the high toll which respiratory disease takes on young child life (in comparison nowadays with other illness) it is interesting to find that only 3 per cent. of the 1,385 children examined showed traces of chest trouble present, of whom four were cases of asthma. The figure for behaviour symptoms has not dimished this year (23 per cent. compared with 18 per cent. in 1935), to which might be added G per cent. of cases of minor retardation and less than 3 per cent. of enuresis cases, excluding cases 44 of night enuresis present at the age of 2 years. The retardation here mentioned is not in any sense organic, merely a question of training and possibly lack of the stimulating companionship of other children. (Mental deficiency is recorded separately). The behaviour symptoms were practically always such as to yield to simple treatment, and in particular to the salutary change of circumstance which results from a child being able to go to school at the age of 3 years— a privilege which the mother of a lonely, difficult, or unduly clever child is coming more and more to appreciate and voluntarily to accept. With a view to comparison with adult conditions a really careful note was kept of all alimentary symptoms this year and it is perhaps astonishing to find that only 11 out of 1,385 children were credited with symptoms referable to acidosis, once much written up as a children's complaint, and only 15 were constipated, some of the cases very markedly so, but yielding rapidly to treatment in the form of dietary measures and improved regime. Six children only showed worms. It is obvious that the gastro-enteritis discomforts prevalent in adult life in this century have not yet punctuated the pre-school age period. The problem of rickets, past, present, or imaginary, remains with us as it will till we can submit all questionable cases for X-ray confirmation and biochemical verdict. Cases considered to be showing undoubted rickety stigmata on external appearances once more amount to 18 per cent.—a similar figure to last year—but there were a number of other cases in which a careful record of groups of deformities was kept, in which the diagnosis might well have been made, though the stage for clinical symptoms was long past. In the writer s opinion this problem of possible rickets, which has far reaching bearings on our community life—on our stature, trunk development, respiratory capacity, and therefore, surely, on our crude physical power—on our ease and grace of movement and, therefore, our skill in athletic sports—on the deaths of mothers or infants in difficult labour—not to mention possible effects in increased liability to infection in the first year or two of life—will not be solved until in some suitable mixed community, and, on a large scale, not only doubtful cases, but, for control purposes, all children of a certain period of life, are submitted to the test of X-ray and biochemical findings correlated with clinical observation. Until this happens we are all working in the dark, perhaps missing something important or perhaps going out on lost trails ; but whoever has the courage to arrange to finance such a scheme of routine examination of children in the susceptible years will be improving the point of welfare work, whether it means that some of our present efforts can be relaxed or whether we shall be called on to refocus or intensify our measures to safeguard nutrition at an earlier age or in some other way than at present. Only a few years ago (1933) we were frank enough to admit in this report that we suspected the presence of (past) rickets in about 34 per cent. of cases, in addition to the 30 per cent. we put down as definitely rachitic. These figures 45 are not extraordinary or exaggerated compared with figures published in other places* where an attempt has been made to assess the incidence of the disease, which show also that the risks are not confined to England, although on the Continent rickets is known, somewhat unpleasantly, as " the English disease." But if they are in any way correct, whatever the actual powers of the exrachitic patient in the adult period of life, it would seem it might be advantageous and a public economy to run the problem further to earth and really get at the base of rickets (or of rickety appearances) and their more certain cure. One must not forget that with the precautions taken according to our present state of knowledge, no child in this Borough attending a Welfare Centre regularly has any right to develop true rickets. Dental caries we have discussed before in the same connection since there is at least some evidence that it may be led up to by poor quality teeth, such as are encountered frequently in rickets. This year the figure for dental caries again shows 20 per cent. of the total children affected, and 57 per cent, of those showing caries at the age of 2 years already having four or more teeth affected (exactly as last year) and 36 per cent. ditto at the age of 3 years. Since at the age of 2, many children have not even cut their full first set of 20, it is obvious that physiological growth can hardly keep pace with pathology here, and that dental treatment is never going to solve the problem. Like rickets, it remains something we do not know about yet, at bottom—that resists our methods of prevention ; that awaits real, practical exploration still in the human patient, and that apparently needs earlier and different methods of prophylaxis if improvement is to be attained. These are some of the problems that in spite of the excellent showing of our records in certain respects, and the steady gratifying progress of the children towards greater apparent general well-being, remain with us to whet our appetites and our interest for further endeavours to get a child population that by comparison with others, at home or outside England, is beyond reproach. In Woolwich we are not without the means to do this, given the necessary reinforcements in knowledge and in our medical understanding. References. (1) Germany. Schmol of Dresden found unmistakable evidence of past rickets in 89 per cent. of children submitted to post-mortem examination between the years of 1901 and 1908. (2) Ferguson and Findlay (Medical Research Special Report No. 70, 1917) found well over 50 per cent. Glasgow children with definite signs of having had rickets." W United, States. Eliot (Newhaven) in 1925 found X-ray evidence suggesting an incidence of 90-96 per cent. rickets in a series of children of native American and mixed European stocks that were examined. (4) England. McGonigle in 1923 found 83 per cent. of 2,676 County Durhan school children with definite rachitic signs plus 11 per cent. " query rickets." (5) England. Of 1,638 London five year old school children examined under auspices of London ounty Council at the request of the Board of Education Committee, 87.5 per cent. found to how rickety stigmata. 46 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 83 applications were received : 86 were supplied—60 free, 10 at half cost, and 16 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 were given in detail in my Annual Report for 1931, being complied with. During the year compensation was paid in eight instances. Payment of Midwives' Fees.—Payments to midwives, not exceeding 25s. in respect of any one confinement are guaranteed where this course is necessary or desirable. Two such payments were made during the year. 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. 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. Od. for each case. No case was dealt with in this way during the year. Home Helps.—The Council's Home Help Scheme was started in 1929 and in seven years the number of Home Helps supplied each year increased from 1 to 80. In view of the experience which had been gained from the working of the Scheme, it was reviewed and subsequently enlarged to include the provision of home helps (a) where the mother is confined in hospital; (b) where the mother is suffering from a complication which necessitates lying up in bed for a period ; and (c) where a miscarriage occurs if there has been attendance at a welfare centre and proper arrangements have been made for the confinement. At the same time the scale of assessment for the supply of home helps was revised and is now as follows :—(a) in the case of those within the Council's economic circumstances scale, the amount to be paid foi 47 the fortnight is 25 per cent, of the nett weekly income per head, calculated to the nearest sixpence, after deduction of rent only and with a minimum payment of 2s. ; (6) in the case of those within the half-cost scale, the amount for the fortnight is 75 per cent, of the nett. income per head per week, calculated to the nearest sixpence, after deduction of rent only, and (c) in the case of those above the scale each application is considered on its merits, due regard being had to what has been said before. In 1936 there were 111 applications and 90 home helps were provided. The total cost of the service was £370 6s. Od. Boarding-out of Children.—While reviewing the Home Help Scheme the Council considered the possibility of providing assistance for expectant mothers in another way and decided in suitable circumstances to make arrangements for children to be boarded-out during the mother's lying-in period. This Scheme was adopted in September as an alternative to the Home Help Scheme. No cases were boarded-out during the year. 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 private practitioners, or to hospitals. During the year, 316 children were sent to these clinics, and for each case the Council paid 5s. Od. Spectacles have been provided under this scheme at an additional cost to the Council. 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. It was decided in October to provide as soon as possible weekly sessions at Plumstead and Eltham. The following Table No. 15 shows the cases attending, and the total attendances during the year. The number of sessions was 95, including anaesthetic days. TABLE No. 14. Brewer Street. Eltham. Plumstead. Impetigo 5 34 9 Ear Discharge 21 26 28 Eyes 32 60 24 Miscellaneous 12 50 15 70 170 76 48 TABLE No. 15. Expectant Mothers. Nursing Mothers. Children under 5. No. Attendances. No. Attendances. No. Attendances. Woolwich.. 137 254 40 87 62 64 Eltham — — — 153 262 Plumstead — — — — 112 218 137 254 40 87 327 544 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. Forty-eight sets (complete or partial) of artificial teeth were supplied during the year at a total cost of £198 13s. 6d. Payments by mothers amounted to £75 7s. 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. Od. per attendance for cases requiring massage or electrical treatment and Is. 6d. per attendance for any other form of treatment. The cost of these services for the year was £178 5s. Od. Only cases recommended by the Medical Officer of Health are included in this scheme, and payment is only made for the number of attendances approved by him. Excluding 87 children where wedges only were necessary and 51 others where temporary splinting only was required, the children referred to the clinic required treatment for following conditions set out under tabulated headings in Table No. 16. All children referred to this clinic are carefully " followed up either by the Voluntary Visitors of the Association or by the Council's Health Visitors. The Woolwich Invalid Children's Aid Association's main clinic is in Thomas Street, Woolwich, but arrangmeents have been made for the treatment of Eltham children on two half days a week at Christehurch Church Hall, Eltham High Street. The Association found, just as the Council did in the case of the artificial sunlight clinic, that the matter of attendances of Eltham children was a very difficult problem for Eltham mothers. The arrangement is a temporary one. The Maternity and Child Welfare Committee have accepted in principle the establishment of a municipal orthopaedic clinic at Eltham to be housed in the same building as the proposed artificial sunlight clinic. 49 TABLE No. 16. Cases Treated at Orthopaedic Clinic, 1936. Type of Case. Number remaining over from 1935. New Cases. Total Cases. Number who completed treatment by end of year. Number with treatment not completed. Talipes (Club Foot) 4 11 15 13 2 Talipes (Flat Foot) — 5 5 3 2 Rickets— General 3 10 13 11 2 Genu Valgum (Knock Knee) 8 35 43 36 7 Genu Varum (Bow Leg) 4 45 49 43 6 Infantile Paralysis 1 1 2 — 2 Erb's Paralysis — 1 1 — 1 Bad Posture — 6 6 6 — Muscular Weakness 2 16 18 14 4 Mouth Breathing 2 3 5 5 — Torticollis 4 12 16 14 2 Other Deformities — 3 3 3 — Other Diseases 3 3 6 6 — 31 151 182 154 28 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 37 children treated for threadworms at one shilling per visit, amounting in all to £17 10s. Od. 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 188. Of these, 155 were discharged cured or very much improved in health, 16 were discharged as improved, and 3 died. Three children were transferred to other hospitals, eight others were discharged showing no improvement, and the number remaining in hospital at the end of the year was 3. The surgical conditions for which these children were 50 admitted included :—enlarged tonsils and adenoids, phimosis, hernia, injury, pyloric stenosis, hare lip, abscess, fracture, etc., and those admitted for medical treatment included children suffering from prematurity, malnutrition, pneumonia, bronchitis, diarrhoea, vomiting, enuresis, dermatitis, etc. Some children were admitted for observation. Institutional Midwifery.—(1) British Hospital for Mothers and Babies.— There are 44 beds in this hospital, and I am informed by Miss Gregory, the Secretary of the Hospital, that 842 babies were born during the year, and 165 mothers were admitted for ante-natal or emergency treatment. At the ante-natal clinics in connection with this hospital, 9,525 attendances were made, and at the infant clinics, 3,070 attendances. In addition there were 180 extern cases. The number of mothers admitted under the Council's scheme was 139, the nett cost to the Council being £955 18s. 6d. (2) War Memorial Hospital.—There are 8 maternity beds in this general 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 211, and 34 mothers were admitted for antenatal or emergency treatment. The number of attendances at the ante-natal clinics was 1,811. The number of mothers admitted under the Council's scheme was 70, the nett cost to the Council being £439 19s. Od. Ante-Natal Treatment and Emergencies.—The number of cases admitted for ante-natal or emergency treatment under the Council's scheme was 6. The reasons for admission were —Albuminuria, 2 ; Pyelitis, 2 ; Rheumatoid Arthritis, 1 ; Toxaemia of Pregnancy, 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 70 children, the total cost of whose convalescent treatment amounted to £490 9s. 3d. The Council's grants amounted to £200. The children were sent away for periods varying from 4 to 16 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 includes 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 3 mothers were so admitted to convalescent homes. 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 51 the Council for necessitous expectant and nursing mothers but modified in accordance with the discretion given to the Council in Circular No. 1U72 of 1930, and children under the age of five years, under the conditions laid down in Circular 185, issued by the Ministry of Health in March, 1921. The approximate cost of these services during the year was as follows :— Dried milk, £1,648 16s. Od. ; Fresh milk, £3 7s. 4d. ; Dinners, Nil. 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. At the end of the year it was estimated that the amount due from the London County Council in respect of extra nourishment was £247, compared with £433 in the previous year. 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. 52 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 Inspector, twelve male inspectors, one woman inspector, three temporary inspectors, and three part-time women inspectors. Six male inspectors were engaged wholly on district work, one mainly on district work but partly on duties in connection with the sale of poisons by listed sellers, 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 women inspectors were engaged partly on health visiting and partly on sanitary inspection, and the woman inspector in general sanitary inspection. Three temporary inspectors were engaged on district work from August onwards, in order that the regular inspectors might supervise the measuring, by temporary assistants, of houses throughout the Borough, rendered necessary by the provisions of the Housing Act of 1935. 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 the Borough. The number of cesspools at the end of the year was 12, 5 of which were in Plumstead and 7 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 47 complaints were received regarding the defective action of combined drains ; on investigation, 299 houses in all were found to be affected. In all systems, except 7, the obstruction was of a temporary character. In 18 instances choked interceptors were found. Costs recovered from the owners amounted to £4 17s. 5d. In the following 7 instances reconstruction was necessary : 83-89, Sand Street; 33-42, Taylor Street; 1-9, High Street, North Woolwich ; and 137-147, Albert Road ; 187-195, Plumstead High Street ; 33-43, Grasdene Road ; 137, Albert Road, and 7 High Street, North Woolwich ; and 31-43, Cantwell Road. After service of the necessary notices and on receipt of the consents of the owners, the work was carried out by the Works 53 Department of the Council, the costs being paid by the owners in their proper proportions. One single private drain was cleared at the request of the owner, from whom the costs, amounting to 5s. were recovered. 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. 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 airtight receptacles of a type approved by your Medical Officer of Health, the number of these supplied varying according to the individual requirements of the shopkeepers. The minimum charge for the removal of these tins is Is. per week. Inoffensive trade refuse is removed by the Works Department at a charge of 5s. per load, and 2,476 tons of such refuse were removed. Complaints.—During the year 3,397 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. After investigation the necessary notices for the remedy or abatement of the defects or nuisances discovered were served upon the owners or other persons responsible. Sanitary Inspection of the Area.—A summary of the inspections carried out by the Sanitary Inspectors will be found in Table No. 17. In connection therewith the numbers of intimation and statutory notices served were 1,833 and 395 respectively. The statutory notices related to 327 premises, and included 333 general, 22 ashpit, 10 water-closet, and 30 paving notices. In addition to these notices under the Public Health (London) Act, 16 notices were served under the London County Council (General Powers) Acts and under By-laws, and one under the Rats and Mice (Destruction) Act, 1919. In 48 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. 54 In Table No. 18 will be found a summary of the nuisances abated and defects remedied. TABLE No. 17. Inspections. Housing Survey — Houses Drains Tested by Smoke Test 395 Inspected 384 Drains Tested by Water Test 38 Clearance Areas — Houses New Houses 1,979 Surveyed 357 Tents and Vans 28 Complaints Investigated 3,397 Factories 353 Outworkers' Premises 130 Workshops 169 Houses Let in Lodgings 237 Workplaces 114 Houses re Infectious Disease 1,110 Shops Act, 1934 1,612 Houses re Smallpox Contacts 1 Theatres and Cinemas 23 Houses re Verminous Cases 8,769 Rag and Bone Premises 18 Houses re Scabies Cases 127 Urinals Accessible to the Public 238 Houses re Other Diseases 53 Women's Lavatories 64 Common Lodging Houses 38 Smoke Observations 37 Underground Rooms Illegally Special Inspections re Rats 312 Occupied 2 Miscellaneous 1,470 Drainage Inspections 1,706 Re-Inspections 6,020 TABLE No. 18. Nuisances Abated. Cleansing— Verminous Conditions— Interiors Cleansed 759 Rooms Cleansed 1,256 Rooms Cleansed 1,387 Defective Lighting— Damp Conditions— Windows Repaired 144 Walls 824 ,, Enlarged — Sites 24 ,, Additional 1 Roofs 551 Other Means 2 Rain Water Pipes and Gutters 278 Defective Ventilation— Others 24 Windows Rendered Usable 260 Dilapidations— ,, Additional Provided — Walls 744 Other Means 4 Ceilings 560 Defective Paving— Floors and Hearths 164 Yards Re-paved 116 Coppers 82 ,, Repaired 102 Stoves 168 Scullery Floors Re-paved or 39 Others 36 Repaired 55 TABLE No. 18—continued. House Drains— Underground Rooms Closed — Defective Drains Repaired 220 Water Supply— Choked Drains Cleared 403 Additional 13 Vent Pipes Repaired 23 Reinstated 22 Soil Pipes Repaired 6 Cisterns Cleansed — Gullies Fixed 55 ,, Covered 2 New Drainage 10 ,, Removed 1 Rain Water Tanks Repaired — Foul Accumulations— ,, ,, ,, Abolished 2 Manure Removed 4 Sinks Repaired or Provided 214 Offensive Accumulations Wastes Cleansed 37 Removed 24 Wastes Trapped or Repaired 293 Back Yards Cleansed 23 Water Closets— Dung Pits Provided — Flushing Apparatus Repaired 128 Rats— ,, ,, Renewed 43 Drains Repaired in Consequence 30 New Pans 239 Premises Rat-Proofed 15 New Traps 234 Other Effective Measures .. 18 Foul Pans Cleansed by Owner 18 Rag and Bone Premises Occupier 15 Premises Cleansed 1 Additional W.C.s Provided 7 Rainproof Premises Provided — Doors and Fastenings Vermin-proof Conditions Remedied 45 vided — Dust Bins Provided 358 Miscellaneous 37 Shops Act, 1934.—The Council, in their capacity as sanitary authority have to enforce some of the provisions of this Act. 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. This definition was extended by the Shops Act, 1936, to include the business of lending books or periodicals when carried on for purposes of gain. The Council have delegated all their powers, except the appointment of inspectors, to the Public Health Committee. The 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 have been appointed inspectors for this purpose. The problem of providing separate sanitary accommodation in small shops employing a mixed staff was considered by the Public Health Committee, and it was decided that in those shops where members of both sexes are employed, separate sanitary conveniences for each sex will be required if the number of employees 56 exceeds four. If the number is four, or less than four, one sanitary convenience will be regarded as suitable and sufficient provided that the door of such convenience is fixed with an appropriate lock or fastener on the internal side and with an automatic indicator showing on the external side of the door whether the apartment is engaged or vacant. The number of Exemption Certificates issued in cases of shops where, owing to restricted accommodation or other special circumstances, a sanitary convenience could not be provided on the premises, was 14. In every case the alternative accommodation has been within 100 yards of the shop. Heating has been insisted upon in all closed shops, but the problem of heating wet fish, butchers and openfronted shops has not been solved. In the case of all closed shops means of ventilation other than the shop door has been insisted upon, and this has been met in the majority of cases by a movable fanlight over the door. The number of shops inspected during the year was 1,594, and 67 notices for offences under the Act were served. Sanitary accommodation was made suitable and sufficient in 34 cases, and suitable means of heating was provided in 14 cases. Smoke Abatement.—During the year 37 smoke observations were made on factory chimneys in the Borough. In 5 cases offences were committed and notices were served. In each case the nuisance was abated forthwith and no further action was taken. 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. Proposals for the establishment of swimming baths at Eltham were approved by the Council during the year. An inquiry was held by the Minister of Health on the 9th October, 1936, and the matter was still under consideration at the end of the year. Through the courtesy of the Baths Superintendent I am able to say that the total number using the Swimming Baths during the year was 260,361 ; Turkish and Russian Vapour Baths, 12,339 ; Slipper Baths, 187,650 ; and the Public Washhouse, 16,095. 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 57 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. Eradication of Bed Bugs.—In the Circular dealing with the contents and arrangement of Annual Reports of Medical Officers of Health, this heading appears for the first time. The Ministry ask for information under the four heads as set out below :— 1. The number of (a) Council Houses, (b) Other Houses, (i.) Found to be infested, (ii.) Disinfested.—Such infestation as exists in Council houses is in houses occupied prior to the institution in 1934 of the Disinfestation Scheme. 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 the presence of bed-bugs is suspected. The number of such visits made during the year was 428. The number of Council houses found to be infested during the year was 104, and all of these were successfully disinfested. Houses other than those in Council ownership are found to be infested on house-to-house inspection, on inspection following investigation of a complaint, or on enquiry into the occurrence of infectious disease, and not infrequently an occupier asks for help in eradicating the bed-bug. The number of such houses found to be infested during the year was 305, and the number in which the scheme of co-operation described in my Annual Report for 1932, between the Council and the landlord, was put into operation was 240. A further nineteen houses were known to be disinfested by owners. 2. The Methods Employed for Freeing Infested Houses from Bed-bugs.—The methods used by the Department during the year have varied:— (a) Sulphur dioxide, plus cleansing, as described in my Annual Reports for 1932 and 1933, was used in 221 houses, all of which, with the exception of 33, were in private ownership. In 194 instances this method of treatment was successful in one application. (b) Orthodichlorbenzene, the use of which in occupied houses was deprecated by the Ministry in a Circular dated 22nd May, was used on nine occasions in empty houses and on one occasion in an occupied house. It was only applied once on each occasion and was successful in each instance. (c) Cyanide (Zyklon B) was used for the disinfestation of 32 occupied houses in 17 blocks. It was also used in 22 new houses in 7 blocks, on the day the tenants 58 put their furniture into the houses. In each of these cases the occupiers of infested dwellings were accommodated for two nights in a block of empty houses on the Council's Estate, reserved for this purpose. The occupiers of the non-infested dwellings in the blocks were offered accommodation for one night, but allowed to return to their own dwellings the same evening if they so desired, as soon as the premises had been certified as safe. In no instance was any re-infestation discovered during the year. (d) In cases of light infestation, or where for any reason it was not practicable to seal off a room, other fumigants or contact sprays were used on 56 occasions, with three failures. (e) Experimentally 25 houses were disinfested with new fumigants, either by pseudo cumene, or by washed heavy naphtha. The technique for using these fumigants had to be worked out, and it can be said now that the work done promises well. The substances are non-toxic to humans. On every occasion, in each case, after one or more treatments, & successful result was finally obtained. In dealing with new substances it is necessary to find out how to use them. In these cases the method in use at the end of the year included the heating of the rooms by means of primus stoves to a temperature of over 65° F., the covering of the windows with brown paper to prevent loss of heat, and to darken the rooms, and the production of a saturated atmosphere at the elevated temperature. The rooms were left sealed up over night. Tf the results in the ensuing summer are as successful as these early experiments have been, it may be that a convenient method of eradicating the bed-bug in occupied houses has at last been found. (/) In addition to the above, 21 houses in Clearance Areas were disinfested with orthodichlorbenzene and 11 with other fumigants, before demolition. 3. The Methods Employed for Ensuring that the Belongings of Tenants are free from Vermin before Removal to Council Houses.—The Sanitary Inspector in charge of disinfestation 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 709 houses in this connection. In all cases where vermin are found, the removal is carried out under the supervision of the Health Department, either in the Council's special pantechnicons, of which there are now two, or in hired vans. During the year 203 removals were carried out in this way, each vanload being disinfested with Zyklon B, at the Council's depot. Occasionally disinfestation is carried out after infested furniture has arrived in the new house, but this is only done when the number of removals at the week-end is greater than can be dealt with by vans. 59 4. Whether the Work of Disinfestation is Carried out by the Local Authority or by a Contractor.—The work of disinfestation with hydrogen cyanide during the year was, in every instance, carried out by contractors, but at the end of the year arrangements were made for the training of the Council's own personnel in the use of Zyklon for this purpose, and from the beginning of 1937 it has been agreed that the work shall be done direct by the Council, so far as vans are concerned. At a later date, as soon as the necessary experience has been gained, the disinfestation of Council houses by this method will also be carried out direct by the Council as is all other disinfestation. A further question in my judgment might with advantage have been added namely, whether there is supervision of premises after disinfestation and if so, to what extent. To my mind this is as important as the actual disinfestation. Education as to the way the bed-bug is spread is important particularly amongst those members of the public who regard it as an inevitable accompaniment of a working class dwelling. Even now, after five years' intensive work here against the bed-bug, there is too much exchange of bedding and cot furniture between neighbours and friends; too much thoughtless purchase of infested second-hand furniture from neighbours and dealers; and a too sympathetic readiness to buy infested firewood from itinerant hawkers. Too often infested premises in private ownership are occupied after disinfestation by new tenants with infested belongings. In Woolwich all houses which are disinfested or where furniture is disinfested prior to the tenant's admission, are subject for a period of two years to periodicinspection by the Council's Women Sanitary Inspectors. In this way 615 houses dealt with in earlier years were inspected. Bugs were found in 1936 in 104 of those treated in 1935. All of these were in private ownership and sulphur dioxide was the fumigant used in the great majority (88) of them. On the other hand, in not a single house in the Council's Estates from which the bed-bug had been eliminated did re-infestation occur. Each new tenant receives by post a copy of the Council's Health Services booklet which contains a short article on the bed-bug and how it spreads; the tenant of each infested house after disinfestation is given a reprint of this article, and an Inspector personally explains the precautions which must be taken if the house is to remain free from bugs. As in previous years, greatly appreciated assistance in skilled observation and scientific control of the processes used, has been given by officers of Government departments and specialists in this work. 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. 60 TABLE No. 19. Factories, Workshops and Workplaces. 1.—Inspection. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers. Prosecuted. (4) Factories (including Factory Laundries) 353 22 — Workshops (including Workshop Laundries) 169 13 — Workplaces (other than Outworkers' premises) 114 5 — Homeworkers' Premises 130 — — Total 766 40 — 2.—Defects Found. Particulars. (i) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts: Want of Cleanliness 80 80 — — Want of Ventilation 1 1 — — Overcrowding — — — — Want of Drainage of Floors 2 2 — — Other Nuisances — — — — Sanitary Accommodation Insufficient 4 4 — — Unsuitable or Defective 66 66 — — Not separate for Sexes — — — — Offences under the Factory and Workshop Acts:— Illegal Occupation of Underground Bakehouses (S. 101) — — — — Other Offences — — — — Total 153 153 — — 61 3.—Outwork in Unwholesome Premises : Section 108. Nature of Work. (1) Instances. (2) Notices Served. (3) Prosecutions. (4) Making of Wearing Apparel — — — Making of Lamp Shades — — — Covering of racquet balls — — — 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 203. In 30 instances it was necessary to secure the repair of defective drains. Fifteen premises were made rat-proof, and other effective measures were taken in 18 instances. The number of statutory notices served under the Rats and Mice (Destruction) Act, 1919, was one. During the National Rat Week, held from 2nd—7th 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 8,820. Fouling of Footways by Dogs.—In 1934 the Council made a By-law which was sanctioned by the Home Office to come into operation from the 1st January, 1935. In November, 1936, a communication was received from the Home Office suggesting that the Borough Council should cause notices to be exhibited in the streets drawing attention to the provisions of this By-law, and it was decided that notices as to the provisions of the By-law should be exhibited in various prominent places throughout the Borough. Nine summonses were issued during the year, particulars of which will be found in Table No. 22 at the end of the Section. Nuisance from Pigeons.—Under Section 121 of the Public Health (London) Act, 1936, 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 persons 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 other 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. 62 These By-laws do not appear to be wide enough. Numerous complaints have been received of persons giving children, in exchange for rags, etc., articles —for example, goldfish, which do not fall within the definition of "any article of food or balloon or any toy." A further difficulty has been experienced in tracing persons responsible. In recent years it has been noted that bills bearing no name and address have been distributed outside schools inviting school-children to supply old woollen articles and rags in exchange for toys. These bills were distributed by men who were not principals. They accepted rags and gave toys in exchange but, when challenged, did not disclose who their principals were. It has been suggested that it should be made obligatory for a rag and bone dealer to affix his name and address to any vehicle used by him in the conduct of his business. During the year representations were made to the London County Council that these matters should receive consideration. The County Council in a letter expressed themselves sympathetic to these proposals so far as children under 14 years are concerned, and suggested that the Council should communicate these views to the Metropolitan Boroughs' Standing Joint Committee for consideration as the question is one which affects all boroughs. Three summonses were taken out during the year. 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 result of analyses show, the number of parts of chlorine being, respectively, 9, 8, 6, 3, 5, 6. 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:- 1935 1936 (a) For Inquest — — — (6) For Custody 8 — 2 20 10 8 — 2 20 10 Number of Post-Mortem Examinations — — — — — 63 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. 1934 1935 1936 Woolwich Cemetery 661 584 610 Plumstead Cemetery 755 681 741 Eltham Cemetery — 56 140 Eltham Churchyard 236 166 168 Exhumations.— During the year three exhumations under Home Office licences 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. At that time there was only one offensive trade, namely, that of a slaughterer of poultry, the premises at which this was carried on being approved by the London County Council in November, 1931. An application by the Royal Arsenal Co-operative Society to establish anew the business of a slaughterer of cattle and of a tripe boiler was considered by the Council in July, 1936, and was approved subject to the conditions which are set out under slaughterhouses in the food section of the report. Removal of Infirm and Diseased Persons.—Power is given by Section 224 of the Public Health (London) Act, 1936, 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 64 connection, and it is necessary to make application to a Magistrate for an Order. No such applications were made during the year. 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 he sold by "authorised sellers" and those in Part 2 by authorised sellers and by listed sellers, whose names appear in a register to be kept by the local authority. "Authorised sellers," i.e., pharmacists, are inspected by Inspectors appointed by the Pharmaceutical Society, but the Borough Council are required to arrange for the necessary inspection of all listed sellers. The Council have appointed as inspectors for this purpose, the Medical Officer of Health, the Chief Sanitary Inspector, and two sanitary inspectors. The Act came into force on the 1st May, 1936, and 84 names were entered on the Council's list during the year. 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 3rd January Foul decaying match lining in back lobby and absence of eaves guttering on washhouse and water closet. 15, Dock Street Order to abate in 21 days. 2 3rd January Failed to cleanse and free from vermin the walls of the ground floor front and back rooms and the first floor front room. 15, Dock Street Fined Is. Od., and £2 2s. costs. 3 8th May Damp walls and defective roof. 1, Halons Road Magistrate's Order and 2s. costs. 4 8th May Did distribute toys from a vehicle in exchange for rags. Fuchsia Street Ordered to pay 2s. costs. 5 8th May Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. Court Road Adjourned sine die. 65 TABLE No. 22—continued. No. Date of Heating. Offence. Situation. Result. 6 8th May Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. Shooters Hill Dismissed under Probation of Offenders Act. 7 28th May Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. Footscray Road Fined 10s. Od. 8 19th June 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. Od. 9 19th June Did distribute toys from a vehicle in exchange for rags. Elizabeth Street Fined 7s. 6d. 10 28th July Did distribute toys from a vehicle in exchange for rags. Ann Street Fined 2s. 6d. 11 20th August Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. Eltham Hill Fined 7s. 6d. 12 29th September Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. Plumstead Common Road. Fined 2s. 6d. 13 29th September Broken leaky downpipe on west side of house. 98a, Woolwich High Street. Work done. Summons withdrawn. 14 27 th October Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. Wrottesley Road Fined 2s. 6d. 15 27th October Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. McLeod Road Fined 2s. 6d. 16 27th October Being a person having charge of a dog on lead, allowed said dog to deposit its excrement on public footway. Woolwich Road Fined 2s. 6d. 17 11th November Insufficient ashpit 26, Dumbreck Road Dustbin supplied. Summons with drawn. 66 SECTION V. 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 hygiene of premises used for the sale, etc., of food, as provided for in the Public Health (London) Act, 1936. 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 for all persons carrying on in the Borough the trade of cowkeeper, dairyman or purveyor 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. TABLE No. 23. No. Cowkeepers 2 Cowsheds 5 Dairies 73 Dairymen with premises in the Borough 51 Dairymen with premises outside the Borough 35 Purveyors of milk in sealed bottles 163 The number of inspections of these premises was 357, 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 are fast disappearing. At the end of the year they were as set out in the following Table, No. 24:— TABLE No. 24. 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 67 Designated Milks.—Until the 30th May, 1936, the Council were authorised, under the Milk (Special Designations) Order, 1923, to grant licences to persons other than producers to sell milk under special designations. Each licence automatically terminates on the last day of the year on which it is issued. In tabular form is shown below the number of licences so issued during the period:— 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)" 13 (e) "Pasteurised" 33 Number of supplementary licences issued to sell:— (a) "Certified" Milk 2 (b) "Grade A (Tuberculin Tested)" Milk 4 (c) "Grade A (Pasteurised)" Milk 2 (d) "Pasteurised" Milk 7 A new Order, the Milk (Special Designations) Order, 1936, came into operation on the 1st June, 1936. This Order revoked the previous Order and prescribes the following special designations:—(a) "Tuberculin Tested"; (b) "Accredited"; and (c) "Pasteurised." If Tuberculin Tested milk is pasteurised and sold as Tuberculin Tested Milk (Pasteurised) two licences are required. If Tuberculin Tested Milk has been bottled at the place of production the word "Certified" may be added. The new Order like the old, prescribes maximum fees and authorises Licensing Authorities to charge lower fees or to dispense with them altogether. In this connection the Council decided that they would charge maximum fees for the whole year or any period exceeding six months and half fees for any shorter period. In London all licences can now be granted by Metropolitan Borough Councils. No licences were issued under the new Order. Bacteriological Examination of Milk.—During the year forty-five samples of pasteurised milk were bacteriologically examined in order to ascertain whether they complied with the standards prescribed by the Milk (Special Designations) Orders, 1923 or 1936. The results are set out in Table No. 25. following. In every instance the prescribed standard was complied with. Three samples of raw milk, taken at farms in the district, were examined for the presence of the tubercle bacillus. In one case this bacillus was found. The London County Council were informed and a veterinary examination of the cows in the cowsheds followed. 68 TABLE No. 25. Month. Type of Milk. Number of Bacteria per c.c. Bacillus coli per 1/10 c.c. January Pasteurised 7,800 — do. 15,000 — do. 21,000 Present do. 13,500 — do. 10,730 — February Pasteurised 5,100 — do. 21,000 — do. 14,200 — do. 9,530 — do. 4,700 — March Pasteurised 52,000 — do. 48,000 — do. 31,000 — do. 16,400 — do. 13,060 — April Pasteurised 8,000 — do. 6,800 — do. 19,000 — do. 13,600 — do. 10,600 — May Pasteurised 32,000 — do. 4,200 — do. 46,000 — do. 7,630 — do. 7,400 — June Pasteurised 28,500 — do. 6,400 — do. 16,400 — do. 17,300 — do. 19,800 — July Pasteurised 5,800 — do. 24,000 — do. 54,000 — do. 10,530 — do. 13,160 — October Pasteurised 18,000 — do. 37,000 — do. 52,000 — do. 16,360 — do. 18,700 — November Pasteurised 37,000 — do. 61,000 — do. 49,000 — do. 8,400 — do. 9,260 — Dried and Condensed Milks.—Two samples of condensed milk and one 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 where artificial cream is sold, has been placed on the register. 69 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. No meat marking scheme under Part III. of these regulations is in force in the Borough. The following Table, No. 26, shows the number of animals slaughtered and inspected in the Borough during the year. In 1935 the number was 39,029. TABLE No. 26. Month. Cattle. Sheep and Lambs. Pigs. Calves. Total. January 320 1,391 1,832 — 3,543 February 290 1,566 1,929 — 3,785 March 283 1,543 1,671 1 3,498 April 274 1,544 1,588 132 3,538 May 292 1,760 514 170 2,736 June 258 1,853 180 172 2,463 July 284 2,210 99 153 2,746 August 257 1,797 177 120 2,351 September 275 1,725 1,562 20 3,582 October 308 1,366 2,170 1 3,845 November 297 1,459 2,229 — 3,985 December 308 1,322 2,639 — 4,269 3,446 19,536 16,590 769 40,341 The number of whole carcases condemned on account of disease or injury was 42 (2 cattle, 6 sheep and 34 pigs). In 2,521 instances partial condemnation was necessary in respect of 390 cattle, 143 sheep, 1.986 pigs and 2 calves. Licensing of Slaughtermen.—The Slaughter of Animals Act, 1933, requires that all slaughtermen shall be licensed. During the year no new licences were issued, but 21 were renewed. Slaughterhouses.—There is no public slaughterhouse in the Borough. Slaughterhouses are subject to annual licence, and in Table No. 27 which follows, are shown those licences in force at the end of the year. 70 TABLE No. 27. Situation of Slaughterhouse. Owner. Bostall Farm, Abbey Wood Royal Arsenal Co-operative Society, Ltd. 14, Church Street Portlock, T. W. 33, Herbert Road Anderson, F. 38, Plumstead Common Road Reed, A. J. In July the Council considered an application from the Royal Arsenal Co-operative Society, Ltd., for the establishment anew of the business of a slaughterer of cattle and of a tripe boiler, at premises to be situated at Clothworkers Wood, Woodlands Farm, Plumstead. A Public Inquiry was held by the Public Health Committee, and after listening to the various objections put forward and considering the evidence given the Public Health Committee reported that they were not satisfied that the objectors had proved that the proposed businesses would be a nuisance or affect injuriously the residents of the neighbouring houses, and that they were of opinion that the proposed businesses were necessary, and the proposed site was suitable. They therefore decided to recommend the Council as follows:— "That the application of the Royal Arsenal Co-operative Society, Limited, to establish anew the businesses of Slaughterer of Cattle and that of Tripe Boiler at Clothworkers Wood be granted, subject to the following conditions:— (1) That no dwelling house shall be erected within 100 feet of the proposed slaughterhouse. (2) That the existing licence operating at Abbey Wood slaughterhouse be discontinued when a new licence is issued. (3) That all appropriate by-laws and statutory provisions be strictly observed. (4) That the screen of trees proposed, be maintained effectively during the period of operation of the licence." The Council adopted the recommendations. Registered Premises.—The Public Health (London) Act, 1936, requires the registration of premises used for the following purposes:— (а) The sale, manufacture or storage of ice cream or similar commodity; (б) 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 221 (b) Manufacture of Sausages 92 71 (c) Preparation or manufacture of Potted, Pressed, Pickled, or Preserved Meat 125 (d) Preparation or manufacture of Potted, Pressed, Pickled or Preserved Fish 45 (e) Preparation or manufacture of Potted, Pressed, Pickled or Preserved other foods 4 The total number of inspections made was 826. Other Food Premises.—As a matter of routine the food inspector made 477 visits to other food premises, including eating houses, coffee stalls, and restaurants, and immediate- action was taken in regard to any insanitary condition found. In addition, 2,456 visits were made to shops and to stalls in the markets. Bakehouses.—There were, at the end of the year, 35 bakehouses in the Borough, of which 33 were factory and 8 underground. The inspections numbered 90, and 6 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. 28. Premises. On Register 31st December Number of Legal Proceedings. Inspections. Notices. Bakehouses 35 90 6 Cowsheds 5 79 2 — Dairies 73 278 2 — Slaughterhouses 4 16 — — Premises where food is prepared (other than above 170 477 35 — Shops and Markets — 2,456 4 — Unsound Food.—There were 464 instances of unsound food being surrendered. These compare with 483 in 1935. Included in the food surrendered were: 2 tons 19 cwts. Pork; 2 tons 6 cwts. Beef; 3 cwts. 1 qr. Mutton; 2 tons 1 cwt. Ox Liver; 6 cwts. 3 qrs. Ox Lungs; 17 cwts. 3 qrs. Pig Offal; 3 cwts. 3 qrs. Sheep Offal; 6 qrs. Fish; 3 cwts. Broccoli; 2 cwts. Prunes; 1 qr. Sugar; 24 lbs. Corned Beef; 1 case of Turkeys; 50 cases of Tomatoes. 72 Six seizures were made. Included in these were 4£ lbs. Tomatoes; 2 lbs. Cooked Beetroot; 4| lbs. Apples; 9 Oranges; 104 lbs. Cherries; 3 Pineapples; 5 Pig's Heads. Merchandise Marks Act, 1926.—Under the provisions of Section 9 of the above Act, Food and Drug Authorities have power to execute any of the provisions of the Act, other than those relating to importation, in respect of foodstuffs which are subject to an Order in Council made under the Act. The Orders which so far have been made are as follows :— The Merchandise Marks (Imported Goods) No. 3 Order, 1928. The Merchandise Marks (Imported Goods) No. 5 Order, 1928. The Merchandise Marks No. 4 Order, 1929. The Merchandise Marks No. 5 Order, 1930. The Merchandise Marks No. 8 Order, 1931. The Merchandise Marks No. 1 Order, 1932. The Merchandise Marks No. 3 Order, 1934. The Merchandise Marks No. 5 Order, 1934. The Merchandise Marks No. 7 Order, 1934. The Merchandise Marks Amendment Order, (Imported Goods) (Imported Goods) (Imported Goods) (Imported Goods) (Imported Goods) (Imported Goods) (Imported Goods) (Imported Goods) 1936. Honey; Apples. Currants; Sultanas and Raisins; Eggs in Shell; Dried Eggs; Oat Products. Raw Tomatoes. Malt Products. Frozen or Chilled Salmon or Sea Trout. Butter. Bacon and Ham. Dead Poultry. Meat. Meat. These Orders prohibit the sale, or exposure for sale, respectively, in the United Kingdom, of the products mentioned above, unless the goods bear an indication of the country of origin. The term "sale" includes sale, wholesale, or sale by retail; and exposure for sale includes exposure for sale, wholesale, and exposure for sale by retail. As a general rule imported produce does not require marking when sold in quantities not exceeding 14 lbs. in weight. Agricultural Produce (Grading and Marking) Acts.—These Acts empower the Minister of Agriculture and Fisheries to make Orders for the grading and marking of agricultural produce. One mark—the National Mark—is used, or will be used, for all graded produce of England and Wales, and by law it conveys a 73 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. The following is a list of products regarding which Regulations were in force on the 31st December, 1936:— Date of Regulations. Produce. 1929 Potatoes. 1930 Strawberries; Cherries. 1931 Beef. 1932 Cider. 1933 Wheat Flour; Gooseberries; Loganberries ; berries; Red Currants; Cheshire Cheese; Pears. 1934 Cauliflower and Broccoli; Canned Fruits; Honey; Asparagus; Jam; Carrots; Leeks; Radishes; Red Beet; Cabbage Greens and Cabbages; 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 Apples; Glasshouse-grown Tomatoes ; Cucumbers; Wheat Flower (Amendment); Dressed Poultry; Canned Fruits (Amendment); Bottled Fruits; Bottled Vegetables; Blackcurrants; Creamery Butter; Vegetables; Perry; Caerphilly Cheese; Cheddar Cheese; Cream Cheese. 1936 Eggs; Malt Extract and Malt Flour; Canned Vegetables; Plums; Leicester Cheese; Lancashire Cheese; Wensleydale Cheese; Fruit Juice Syrup. During the year Regulations affecting Eggs (1930), Malt Extract and Malt Flour (1933), Canned Vegetables (1934), Plums (1935), were revoked. No offences were discovered during the year. Sophistication of Food.—The following Table, No. 29, gives details of the various analyses made under the Food and Drugs (Adulteration) Act, Public Health (Condensed Milk) Regulations, Public Health (Dried Milk) Regidations, and the Public Health (Preservatives, etc., in Food) Regulations. 74 TABLE No. 29. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Milk 241 36 277 6 Cream — 7 7 — Dried Milk — 1 1 — Condensed Milk — 2 2 — Butter 1 25 26 1 Cheese — 5 5 — Margarine — 4 4 — Lard — 3 3 — Suet 1 5 6 1 Dripping — 3 3 — Cream Cheese — 3 3 2 Vitacream — 2 2 1 Tea — 7 7 — Coffee — 6 6 — Sugar — 10 10 2 Flour — 5 5 — Cornflour — 5 5 — Rice — 6 6 — Sago — 4 4 — Pearl Barley — 5 5 — Oatmeal — 1 1 — Sultanas — 3 3 — Currants — 3 3 — Raisins — 3 3 — Nuts and Raisins — 1 1 — Cake and Fruit — 4 4 — Ground Almonds — 1 1 — Pepper — 5 5 — Dried Mint — 4 4 — Mustard — 4 4 — Bread — 3 3 — 75 TABLE No. 29—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Tapioca — 3 3 — Dried Fruits — 5 5 — Mincemeat — 3 3 — Jams and Jellies — 18 18 — Salad Dressing — 4 4 — Tomato Cream — 1 1 — Black Treacle — 1 1 — Preserved Ginger — 1 1 — Ground Ginger — 1 1 — Sandwich Cheese and Crab — 2 2 — Sweets and Confectionery — 14 14 — Ice Cream — 3 3 — Lemon Squash — 3 3 — Grape Fruit Squash — 2 2 — Lemon Cheese — 6 6 — Junket Powder — 1 1 — Pickles — 3 3 — Vinegar 1 13 14 2 Pectin, Fruit — 1 1 — Peppercorns 8 1 9 1 Orange Squash — 2 2 1 Meat, Minced 14 — 14 — Meat Paste — 3 3 — Brawn — 3 3 — Saveloys — 1 1 — Sausages 12 4 16 — Sausages Preserved 1 3 4 — Tripe 4 — 4 — Corned Beef — 1 1 1 Ham Sandwich — 1 1 — Beef Extract — 1 1 — 76 TABLE No. 29—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Fish Paste — 2 2 — Fish 3 1 4 — Rum 6 — 6 — Whisky 8 — 8 — Gin 8 — 8 1 Non-alcoholic Wine — 2 2 — Ginger Wine — 1 1 — Ale — 5 5 — Mineral Water — 1 1 — Canned Fruits — 23 23 8 Canned Salmon — 1 1 — Canned Sardines — 10 10 — Canned Sild — 20 20 7 Apples — 3 3 — Soup Mixture — 2 2 — Canned Roes — 2 2 — Canned Herrings and Pilchards . . — 2 2 — Canned Beans and Peas — 9 9 — Canned Spaghetti — 2 2 — Canned Crab — 2 2 — Canned Kipper Snacks — 2 2 — Canned Lobster — 1 1 — Sulphur Ointment — 3 3 — Salicylic Acid Ointment — 3 3 — Salicylic Acid — 1 1 — Cream of Magnesia — 6 6 1 Saline Lemon Flavour — 1. 1 — Ammonia (dilute solution) — 3 3 1 Arrowroot — 4 4 — Chlorinated Lime — 1 1 — Proprietary Foods — 2 2 — 77 TABLE No. 29—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Seidlitz Powder - 4 4 1 Glucose Syrup - 1 1 - Barley Water - 1 1 - 308 402 710 37 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. 30. 1934 1935 1936 4.5 per cent. and over 7 8 4 4 per cent. and under 4.5 per cent. 9 11 11 3.5 per cent. and under 4 per cent. 88 102 145 3 per cent. and under 3.5 per cent. 128 146 113 Below 3 per cent. 5 8 4 237 275 277 Mr. Amphlett Williams makes the following observations on his analyses during the year:— "The average percentages of fat and of solids-not-fat found in the samples of milk analysed during the past three years are given below: the averages have been calculated for each quarter as well as for the whole year, and thus show the regular seasonable variations in the quality of the milk. All the samples analysed have been included excepting those definitely adulterated, of which particulars will be found elsewhere. Percentage of Fat. Quarter. 1934 1935 1936 January—March 3.52 3.51 3.60 April—June 3.41 3.50 3.43 July—August 3.53 3.59 3.56 September—December 3.69 3.92 3.81 Whole Year 3.54 3.59 3.59 78 Percentage of Solids-not-fat. Quarter. 1934 1935 1936 January—March 8.80 8.85 8.76 April—June 8.86 8.85 8.78 July—August 8.69 8.67 8.70 September—December 8.97 8.86 8.81 Whole Year 8.83 8.81 8.77 The results are typical of the milk supply in the Metropolitan area and show that a satisfactory standard, considerably above the minimum of the Sale of Milk Regulations, 1901, has been maintained in Woolwich. In connection with the experimental work carried out in this laboratory during 1935 on the application of certain methods of analysis to heated milks, six further samples of 'hot milk' were taken from various cafes, etc., during this year. Two of these were found to be deficient in fat, to the extent of 10 and 37 per cent., respectively; prosecutions were taken against the vendors concerned, and after a warning, each of the cases was dismissed under the Probation of Offenders Act on payment of £5 5s. Od. costs. Of 20 samples of canned sild and brisling, seven were contaminated with excessive amounts of tin, derived apparently from imperfect canning and over-long storing. Where an excess of tin was detected in a sample, further samples were taken from the same consignment, and where contamination was confirmed in other cans also, the consignment was surrendered by the vendor and destroyed. The Local Authority acting for the district in which the wholesalers or importers were situated was also informed, so that further supplies of the same brand might be examined at the source. Ten samples of canned sardines, in addition to the samples of sild, etc., were also examined for lead, but no further instance occurred of the contamination by this metal which was detected in the previous year. Eight samples of canned prunes, imported from Australia, all of the same brand, were found to be contaminated with tin. The wholesalers surrendered the whole consignment and it was destroyed. It may be said here that the attitude of the wholesalers concerned has been entirely helpful to the administration. In the case of the Barbadoes Raw Sugar it was at their suggestion that samples from a shipment which had been condemned elsewhere were taken and analysed. These were found to contain an excessive amount of tin and sulphur dioxide and, as with the other articles the consignment was voluntarily surrendered for destruction. It is believed that the excessive amounts of tin which have been found from time to time in brown sugar, are derived from a special process of manufacture, 79 where stannous chloride is added to fix the natural colour of the brown "Denierara" type of sugar, which would otherwise be removed in the refining. The finished brown sugar should not, of course, contain tin, and it is probable that the crude, dark sugar analysed was obtained by evaporating the mother liquor containing the stannous chloride, etc., from which the brown sugar had been previously crystallised and separated. A sample of Orange Squash contained an excessive amount of bright red coal-tar dye—presumably added to suggest that the 'Squash' was made from blood oranges. Pure orange squash is only slightly deeper in colour than lemon squash, and after the dye had been extracted from this sample by wool, the squash returned to its natural colour. There was no evidence, however, that the dye was injurious to health, and in the absence of any legal standard for such drinks, no further action was taken." Adulterated Samples—Action Taken.—The following Table, No. 31, shows the number of adulterated samples and the action taken in each instance where the sample was formal:— TABLE No. 31. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 465 Cream Cheese Informal Contained only 49.0 per cent. of milk fat. Prepared from whole milk but not from cream. — 466 Cream Cheese Informal Contained only 51.4 per cent. of milk fat. Prepared from whole milk but not from cream. – 509 Cream of Magnesia Informal 16 per cent. deficient in magnesium hydroxide. — 527 Prunes, canned Informal Contained tin, 2.59 grains per lb. Stock surrendered and destroyed. 532 Milk Informal 10 per cent. of the fat abstracted. — 549 Prunes, canned Informal Contained tin, 2.38 grains per lb. Stock surrendered and destroyed. 550 Prunes. canned Informal Contained tin, 2.24 grains per lb. Stock surrendered and destroyed. 551 Prunes, canned Informal Contained tin, 2.52 grains per lb. Stock surrendered and destroyed. 552 Prunes, canned Informal Contained tin, 2.38 grains per lb. Stock surrendered and destroyed. 570 Prunes, canned Informal Contained tin, 2.24 grains per lb. Stock surrendered and destroyed. 80 TABLE No. 31—continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 572 Prunes, canned Informal Contained tin, 2.66 grains per lb. Stock surrendered and destroyed. 573 Prunes, canned Informal Contained tin, 2.03 grains per lb. Stock surrendered and destroyed. 596 Gin Formal 1.5 per cent. excessive water Vendor cautioned. 599 Vitacream Informal The composition was hot in accordance with the label. — 76 Peppercorns Formal Contained 99.0 per cent. Pimento. Vendor cautioned. 114 Barbadoes Raw Sugar Informal Contained tin, 2.38 grains per lb. Stock surrendered and destroyed. 115 Barbadoes Raw Sugar Informal Contained tin, 3.85 grains per lb. and sulphur dioxide 190 parts per million. Stock surrendered and destroyed. 118 Dilute Solution of Ammonia. Informal Ammonia 17.0 per cent. ex- excessive. — 127 Milk Formal 10.0 per cent. of the fat abstracted. Ordered to pay £5 5s. costs. 128 • Milk Formal 37.0 per cent. of the fat abstracted. Ordered to pay £5 5s. costs. 134 Milk Formal 3.0 per cent. added water — 135 Corned Beef Informal Meat contaminated with rust Four tins surrendered. 180 Seidlitz Powders Informal 1.07 grammes deficient in sodium potassium tartrate and 1.12 grammes excessive in sodium bicarbonate. — 220 Milk Formal 1.0 per cent. of the fat abstracted. — 228 Butter Informal Contained 16.5 per cent. of water. — 333 Orange Squash Informal Contained a red coal-tar dye, 0.015 per cent. — 417 Shredded Suet Informal Contained ground rice, 17.6 per cent. — 472 Sild, canned Informal Contained tin 2.52 grains per lb. Stock surrendered and destroyed. 494 Sild, canned Formal Contained tin 2.73 grains per lb. Stock surrendered and destroyed. 525 Malt Vinegar Informal Consisted entirely of artificial vinegar. — 81 TABLE No. 31—continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 529 Brisling, canned Informal Contained tin 2.31 grains per lb. — 530 Sild, canned Informal Contained tin 2.24 grains per lb. — 546 Milk Formal 3.0 per cent. of added water — 551 Malt Vinegar Formal 70.0 per cent. deficient in Acetic acid. Vendor cautioned. 560 Sild, canned Informal Contained tin 6.37 grains per lb. Stock surrendered and destroyed. 569 Sild, canned Informal Contained tin 2.17 grains per lb. Stock surrendered and destroyed. 570 Sild, canned Informal Contained tin 2.87 grains per lb. Stock surrendered and destroyed. Other Legal Proceedings.—Particulars are set out below of legal proceedings other than those for adulteration, taken in respect of infringements of various food laws, during the year. TABLE No. 32. No. Date of Hearing. Offence. Result. 1 21st May Did expose for sale 2 lbs. cooked beetroot which were unsound and unfit for human food. Case dismissed. 2 21st May Did expose for sale 4½lbs. apples; 1lb. tomatoes and 9 oranges which were unsound and unfit for human food. Adjourned sine die. 3 20th August Did expose for sale 50 lbs. cherries which were unsound and unfit for human food. Fined 20s. Food Poisoning.—The Public Health (London) Act, 1936, 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. 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. 82 The total number of notifications received was 97, 58 of which related to an outbreak in a hostel. In other instances 39 persons were involved. The age and sex distribution of the cases notified is shown in the following Table, No. 33:— TABLE No. 33. Cases of Food Poisoning Notified during 1936. Age Periods. Male. Female. Total. Under 1 — — — 1 and under 5 — — — 5 and under 10 1 3 4 10 and under 15 1 3 4 15 and under 20 — 48 48 20 and under 35 4 19 23 35 and under 45 1 5 6 45 and under 65 7 5 12 65 and over — — — 14 83 97 The medical practitioner notifying usually states on his certificate the food he suspects. In twelve households the food under suspicion was meat ; in eleven it was fish, and in four other instances, it was other foods, while in seven instances no particular food was regarded as the cause. Most of the cases were slight in character, and one only was admitted to hospital. Some cases were investigated bacteriologically (a) Two adult women, aged 43, ate some slices of cooked meat early one afternoon. After eight hours both were suffering from diarrhoea and faintness. The illness was not notified for three days, and then a specimen of the cooked meat was obtained. The bacteriologist reported as follows:— "The odour of the specimen was extremely objectionable. The fat of the meat appeared to be undergoing liquefaction. Gram Films were prepared by taking portions of the material and shaking them up with sterile water. These showed large masses of bacteria of mixed type, gram positive and gram negative. Cultures were prepared from the fat and lean portions of the meat, aerobically and anaerobically with and without the addition of brilliant green. The cultures obtained were profuse in all cases; these were sub-cultured on to agar plates. The cultures yielded a copious growth of: (a) Bacillus Coli; (b) Diphtheroids ; (c) Pneumococci, 83 (d) Streptococci; (e) Bacillus Proteus. The identification of other organisms was not practicable owing to the difficulties associated with the presence of the 'Swarmer' bacillus proteus. The fact, however, that such organisms as bacillus coli and pneumococci were identified as being present in such very large numbers makes it quite possible that a definite pathological entity may also have been present. The cultures, as obtained, make it certain that these specimens were bad and not fit for human consumption, and the facts would appear to show that contamination either by animal or human means has been severe." (b) Three adults had pork sausages for lunch about 1 p.m. About midnight all three were suffering from diarrhoea and vomiting. One sausage was examined by the bacteriologist who reported as follows:— "Portions of the skin and contents were each cultured. The cultures were aerobic and anaerobic and also with brilliant green as a restrainer. A profuse growth resulted from all methods of culture. Those from the aerobic and brilliant green were sub-cultivated on to plates and yielded a growth of : (a) Pneumococci; (b) Bacillus subtilis; (c) Coliform baccilli. The anaerobic culture did not appear to yield any definite organisms than those found with aerobic. The brilliant green culture in addition showed the presence of a non-lactose fermenting form of coliform bacillus. The latter organism was put up on carbohydrate media and at the commencement only fermented glucose, it was also sluggishly motile. Agglutination tests were made in an attempt to identify this organism, the emulsions used being those of Bacillus Dysenteriae (Shiga and Sonne), Typhoid and Salmonella group. No agglutination of any kind occurred as a result of these tests. Through leaving the carbohydrate test for a further period acid production occurred in lactose and mannite in addition to glucose, but without any gas formation. These findings indicate that the organism was bacillus coli anaerogenes. The organisms thus identified as being present both in the skin and the interior of the sausage were: (a) Pneumococci; (b) Bacillus subtilis; (c) Bacillus coli ; (d) Bacillus coli anaerogenes. None of these organisms identified should normally be pathogenic. The fact that so many were obtained and the large numbers present of each, indicate that: (1) Contamination must have occurred, and (2) that the cooking was probably insufficient." (c) A man aged 27 was diagnosed as suffering from Enteritis, but later was formally notified as suffering from food poisoning. After bacteriological examination of a stool had been made the bacteriologist reported as follows:— "Rather a liquid stool. Direct cultures yielded a growth of: (a) Bacillus Coli; (b) Streptococcus Faecalis. Cultures using brilliant green as a restrainer, yielded a growth of: (a) Bacillus Coli; (b) Non-lactose fermenting coliform bacillus. 84 Two colonies of the latter type of organism were examined and were found to be aberrant coliform bacilli. The original brilliant green cultures were then re-examined and a further non-lactose fermenting organism was tested, and as a result of chemical and serological tests has been proved to be Bacillus Newport. This organism is one of the salmonella (food poisoning) group and usually obtains access to humans as a result of eating pork." (d) In October, from a hostel, fifty-eight cases of food poisoning were notified within a few days. The outbreak was investigated by officers of the London County Council, and it is understood that a coliform organism was found which might account for the outbreak. In this connection it is interesting to recall that when a similar outbreak at this hostel was investigated by me last year a haemolytic coliform organism was regarded as the cause on that occasion. Other cases of food poisoning which were not notified came to the notice of the department. (1) In May, two adults had macaroni pudding for dinner. A few hours afterwards they became ill with stomach pain, diarrhoea and vomiting. The pudding was bacteriologically examined and the bacteriologist reported as under :— "The macaroni pudding yielded a growth of: (a) Pneumococci; (b) Bacillus Subtilis ; (c) Coliform Bacillus. Pneumococci predominated. In the macaroni pudding, organisms were found which were also identified as being present in the milk received, and the macaroni. This finding tends to show that the cooking of the article must have been inadequate. The finding of Coliform Bacillus indicates that contamination occurred either before, or subsequent to cooking. None of the organisms identified is of such a character as normally to cause intestinal upset, excepting the Coliform Bacillus. This organism may be of a type which might give rise to the symptoms complained of by the individuals who partook of the pudding, but this particular organism has not been identified as being originally present in the material from which the pudding was prepared. In these circumstances, therefore, it would seem that the only possible explanation of the occurrence is that this Coliform organism obtained access to the pudding during, or after, preparation, and thus caused the contamination and affected the individuals who became ill." (2) In September a young child was taken ill with acute diarrhoea and vomiting. Some days later, when she had recovered, her father came to the conclusion that she was poisoned by some cheap sweets, and brought a sample with him to the office. An investigation was made and the Bacillus Aertrycke was recovered from the child's stools on two occasions. Bacteriological examination was then made of the sweets, but the organism was not recovered from them. (3) At the beginning of November thirty members of a local Sports Club took a simple tea together, consisting of bread, butter, cheese, ham sandwiches and 85 tea. Within the course of 48 hours, fourteen of them were suffering from sickness and diarrhoea. Subsequent enquiries showed that the attendant who prepared the meal suffered from diarrhoea the previous day, but had apparently recovered that morning. No bacteriological investigation was made. Public Analyst—-Alteration in Terms of Appointment.—The Public Analyst was appointed in 1932 at a salary of £300 per annum for 500 samples, with a payment of 10s. 6d. for each sample taken in excess of that number. In March, the Council decided that from the 1st April the minimum number of samples to be analysed each year should be increased to 800 and a salary of £500 per annum paid, with a payment of 10s. 6d. for each sample in excess of that number. 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 1936. The scheme is more fully reported on in the Health Propaganda Section. By-Laws for the Protection of Food.—The County Council at their meeting on the 28th July, 1936, made By-laws for promoting sanitary and cleanly conditions in the manufacture, preparation, storage, transport, or exposure for sale of any article intended to be sold for food. The By-laws slightly modified were confirmed by the Minister of Health and they came into operation on the 1st day of January, 1937. 86 SECTION VI. HOUSING. The following Table shows the main housing figures for the year set out under the headings given in Circular 1561 issued by the Ministry of Health for securing uniformity in the presentation of these statistics. TABLE No. 34. 1.—Inspection of Dwelling Houses during the Year. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 4,608 Number of inspections made for the purpose 10,909 (2) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 384 Number of inspections made for the purpose 706 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 357 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,946 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 1,534 *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 — 87 ($$$)(2) Number of dwelling houses which were rendered fit after service of formal notice:— (a) By Owners 2 (b) By Local Authority in default of owners — (6) Proceedings under the Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 327 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 307 (b) By Local Authority in default of owners — (c) Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made 6 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 5 (d) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in which Closing Orders were determined, the tenement, or room having been rendered fit — 4.—Housing Act, 1935—Overcrowding * (a) (i) Number of dwellings overcrowded at the end of the year. 530 (ii) Number of families dwelling therein 530 (in) Number of persons dwelling therein 3,126 (b) Number of new cases of overcrowding reported during the year 261 (c) (i) Number of cases of overcrowding relieved during the year 414 (ii) Number of persons concerned in such eases 2,017 (d) Particulars of any cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding 88 ($$$)(e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report * *See paragraph on overcrowding below. Overcrowding.—The overcrowding provisions of the Housing Act did not take effect until the 1st January, 1937, and it is impossible to furnish a normal return under the heading "Overcrowding" above. In the second half of 1935, a survey of housing in the Borough revealed that there were then 683 families living under overcrowded conditions according to the standards laid down in the Housing Act. In the latter half of 1936 to enable "permitted numbers" to be supplied to landlords there was a more detailed survey from which overcrowded houses already measured were excluded. Two hundred and sixty one new cases of overcrowding were discovered, but in order to ascertain what the position was with regard to the first 683, a special inspection was made of all these families in the first quarter of 1937. It was found that 414 of those cases were no longer overcrowded. Overcrowding had been reduced in various ways, without any organised effort on the part of the authorities. It was found that seventy-nine families had become sufficiently reduced in number, either through persons leaving to get married and taking up house on their own, or through death. Additional accommodation for overcrowded families was found by re-arrangement of lettings in the same houses in seventy-nine instances. In twelve cases where the "permitted number" was wrong, a correction showed that there was no overcrowding. Fifty-four families were re-housed by the Woolwich Borough Council, either as part of their general housing policy, or through slum clearance. Three were re-housed by the London County Council as part of their abatement of overcrowding policy. Twenty-two were dealt with in other ways. One hundred and sixty five families had removed to other unknown addresses. This experience would seem to indicate that there is normally a large amount of movement amongst overcrowded families, and certainly foreshadows the difficulties which the future holds in the detection and elimination of overcrowding. It cannot be assumed that the 165 families whose present addresses are unknown are not living in overcrowded conditions. Investigations are proceeding to ascertain whether any of them are amongst the 261 new cases of overcrowding. Estimate of new houses required.—In the latter half of 1935 a survey of all working class houses in the Borough was carried out, and 683 houses were found to be overcrowded within the meaning of the Housing Act, 1935. The London County Council as the Authority responsible for the provision of new houses required to abate overcrowding in the Metropolis, early in the year asked that Borough Councils should estimate their requirements on a uniform basis which they submitted. The process of calculation, which took into account such accommodation as was found to be vacant during the course of the survey, the amount 89 of accommodation rendered vacant by the transfer of families, and the number of families for whom accommodation had to be provided on account of slum clearance schemes, gave the following results for Woolwich:— TABLE No. 35. Additional Dwellings required on the Standard of Table I. in the First Schedule to the 1935 Act. Additional Dwellings required on the standard of 1½ persons a room. Size. Number. 3 rooms. 4 rooms. 5 rooms. 6 rooms. 7 rooms. 8 rooms. 3 rooms 51 40 8 3 — — — 4 room 71 — 28 39 4 — — 5 rooms 25 — — 5 9 10 1 6 rooms 2 — — — — — 2 7 rooms — — — — — — — Totals 149 40 36 47 13 10 3 Following on this the Borough Council resolved that they would not provide any of these 149 houses for the abatement of overcrowding, as the duty of so doing is placed by the Act on the London County Council, unless a Borough Council or other body, decide to provide it or any portion of it, themselves. The London County Council were so informed in July, 1936. Accommodation for this purpose will be ready about March, 1937, on sites at Bellingham, Mottingham, Park Lane, Charlton, and Whitefoot Lane, Lewisham. Fixing of appointed days.—In order to bring into operation the overcrowding provisions of the Housing Act of 1935, it was necessary for the Minister of Health to fix appointed days for different purposes and for different localities. The Minister fixed, so far as Woolwich was concerned, the 1st July, 1936, as the appointed day under Section 6 of the Act and the 1st January, 1937, as the appointed day under Sections 3, 4, 8 and 68. The effect of fixing such days meant that on the 1st January, 1937, the notice prescribed by the Act as to "permitted numbers," etc., must be inserted in every rent book, that after that date overcrowding might constitute an offence, and that certain housing by-laws ceased to have effect. The fixing of appointed days added considerably to the work of the department. It became necessary to measure the rooms of all working class houses, and the Ministry of Health, in a Circular, pointed out that it would be more advantageous to undertake systematic measurement of the bulk, if not all, of the working class houses 90 in their area, than to delay measuring until the owner asked for the information. As this work had to be completed within less than six months, it became necessary to appoint temporary staff for this purpose. The estimated number of "dwellings" in the Borough is in round figures, 40,000. After deducting from this total (a) the number of owner-occupied houses, approximately 12,500; (6) the number of dwellings measured the previous year 3,400; and (c) the number of Council houses for which plans are available, 3,600; it was estimated that some 20,000 "dwellings" would require to be measured. It was subsequently found necessary to measure a proportion of the owner-occupied houses which had been sub-let. In dealing with this problem the Council took the view that the primary responsibility for the correct measuring of rooms in each district should rest on the district sanitary inspector, that he should be supplied with such temporary assistance as was necessary, in order that the work might be completed within the specified period, and that such clerical work as could be done in the office should be under the immediate supervision of a senior clerk. To enable the district inspectors to concentrate on this work and to free them from routine duties, three temporary sanitary inspectors were appointed, and these were responsible for the districts of the inspectors supervising the measuring of rooms. Each district inspector was on an average off his district for two months. The other staff engaged included six temporary survey assistants, nine temporary assistants to these and to the inspectors ; and four temporary clerks. A measuring unit consisted of one regular district inspector, two survey assistants, three assistants, and one clerk. Three such units were employed for the period. In this way the inspector could supervise the work of his team and they could consult him at once on any difficulties they encountered. Clerks started preparing the necessary cards on the 13th July, 1936, the measuring units began work on the 4th August, and except for clearing up, which was considerable, and the measuring of the sub-let owner-occupied houses, the work of measuring was completed at the end of the year. The number of " permitted number " notices supplied to landlords was 15,651. A certain amount of information is given in the statutory notice which must be inserted in rent books, but this notice could not by its very nature deal with difficult points which may arise. To overcome any misunderstanding, a pamphlet was prepared covering the chief points of the overcrowding code and explaining fully points on which difficulty might arise. One of these pamphlets was enclosed with each notice to the occupier of intention to measure, and with each series of " permitted number " notices to owners and agents. 91 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 384 houses were so surveyed. These figures are less than the average yearly number, owing to the demands referred to above, on the time of the sanitary inspectors. TABLE No. 36. Action under the Housing Acts. Premises. Action Taken. Date. The Cottage, Mortgrammit Square Demolition Order 1st January 12, Armstrong Place do. 29th January 13, Armstrong Place do. 29th January 152, Maxey Road do. 1st July 23, Southwood Road do. 1st July 25, Southwood Road do. 1st July 97, Brookhill Road Representation 2nd December There was an appeal against a notice served by the Council under Section 17 of the Housing Act, 1930, relating to the house, No. 15, The Grove, Eltham, which I had represented as being unfit for human habitation. It was capable of being rendered fit at a reasonable cost, and the Council resolved to serve a notice under Section 17. This notice was served on the 1st August, 1935, and notice of appeal to the County Court was given on the 21st August of that year. The case was set down for hearing at the County Court on the 20th November, 1935. There were several hearings and adjournments, and it was not until 8th July, 1936, that the County Court Judge gave his decision. He held that although the Borough Council were justified in serving the notice under Section 17, the works required by the notice to be executed were unreasonable and that the appellant was aggrieved by the action of the Borough Council. He allowed the appeal and ordered the Borough Council to pay two thirds of the costs of the appellant. It became necessary to agree an amended specification of the works to be done, and it was decided to include this amended specification in the Order. There was a further delay in this connection, and it was not until 23rd December that the draft Order embodying this amended specification was settled by the Registrar of the County Court and so at the end of 1936 the work of repair had not been completed. Clearance Aears.—During the year, the Council's programme was advanced. The steps taken, and the situation at the end of the year in each area represented since 1934 are set out in the following pages:— 92 (1) Shepherds Farm Hutments.—The Clearance Order in respect of this area of 67 hutments was confirmed in 1934. At the end of 1936 all the hutments had been demolished. (2) Prospect Row and Kidd Street.—The Clearance Order in respect of this area of 9 houses was confirmed in 1935. At the end of that year all the houses had been demolished. (3) St. Thomas's Cottages, Princes Road.—The Clearance Order in respect of this area of 8 houses was confirmed in 1935. At the end of that year all the houses had been demolished. (4) Eltham High Street.—The Clearance Order in respect of this area of 14 houses was confirmed in 1935. At the end of 1936 all the houses had been demolished. (5) Keemor Street.—The Clearance Order in respect of this area of 6 houses was confirmed in 1935. At the end of 1936 all the houses had been demolished. (6) Bell Water Gate.—This area consisting of 5 houses was represented by me to the Council as an unhealthy area on the 10th May, 1935, and the Council made a Clearance Order on the 2nd October of that year. The Clearance Order was confirmed by the Minister without modification on the 9th April, 1936. At the end of the year all the houses had been demolished. (7) Timbercroft Lane (No.1).—This area consisting of 2 houses was represented by me to the Council as an unhealthy area on the 6th June, 1935, and the Council made a Clearance Order on the 3rd September of that year. The Clearance Order was confirmed by the Minister without modification under date 25th January, 1936. At the end of the year all the houses had been demolished. (8) Timbercroft Lane (No.2).—This area consisting of 6 houses, was represented by me to the Council as an unhealthy area on the 6th June, 1935, and the Council made a Clearance Order on the 3rd September of that year. The Clearance Order was confirmed by the Minister without modification on the 25th January, 1936. At the end of the year all the houses had been demolished. (9) Timbercroft Lane (No.3).—This area, consisting of 8 houses, was represented by me to the Council as an unhealthy area on the 6th June, 1935, and the Council on the 3rd July, 1935, declared the area to be a Clearance area and resolved to purchase it by agreement. The purchase was duly completed, and at the end of 1936 all the houses had been demolished. 93 (10) Hulk Cottages.—This area, consisting of 5 houses, was represented by me to the Council as an unhealthy area on the 6th June, 1935, and the Council made a Clearance Order on the 3rd September of that year. The Clearance Order was confirmed by the Minister without modification, on the 25th January, 1936. At the end of the year all the houses had been demolished. (11) The Grove, Eltham.—This area, consisting of 2 houses, was represented by me to the Council as an unhealthy area on the 6th June, 1935, and the Council made a Clearance Order on the 29th October of that year. A Ministry of Health Inquiry was held on the 14th January, 1936, and the Clearance Order was confirmed by the Minister without modification on the 9th April, 1936. At the end of the year both houses had been demolished. (12) Nightingale Vale and Montague Cottages.—This area consisting of 8 houses was represented by me to the Council as an unhealthy area on the 11th July, 1935, and the Council made a Clearance Order on the 3rd September of that year. The Clearance Order was confirmed by the Minister without modification on the 25th January, 1936. At the end of the year all the houses had been vacated and four had been demolished. (13) Belmont Place, Nightingale Vale.—This area consisting of 4 houses was represented by me to the Council as an unhealthy area on the 11th July, 1935, and the Council made a Clearance Order on the 3rd September of that year. The Clearance Order was confirmed by the Minister without modification on the 25th January, 1936. At the end of the year all the houses had been vacated. (14) Waverley Cottages, Ogilby Street.—This area, consisting of 2 houses, was represented by me to the Council as an unhealthy area on the 11th July, 1935, and the Council made a Clearance Order on the 3rd September. The Clearance Order was confirmed by the Minister without modification under date 25th January, 1936. At the end of the year both houses had been vacated. (15) Nile Cottages and Glass Yard.—This area, consisting of 11 houses, was represented by me to the Council as an unhealthy area on the 11th July, 1935, and the Council made a Clearance Order on the 2nd October of that year. A Ministry of Health Inquiry was held on the 14th January, 1936, and the Clearance Order was confirmed by the Minister without modification on the 9th April, 1936. At the end of the year one house was occupied and seven had been demolished. (16) Davey Square.—This area, consisting of 7 houses, was represented by me to the Council as an unhealthy area on the 12th September, 1935, and the Council made a Clearance Order on the 29th October of that year. A Ministry of Health Inquiry was held on the 14th January, 1936, and the Clearance Order was confirmed by the Minister without modification on the 9th April, 1936. At the end of the year three houses were still occupied. 94 (17) Albert Road and Woodman's Cottages.—This area, consisting of 6 houses, was represented by me to the Council as an unhealthy area on the 12th September, 1935, and the Council made a Clearance Order on the 29th October of that year. A Ministry of Health Inquiry was held on the 14th January, 1936, and the Clearance Order was confirmed by the Minister without modification on the 9th April, 1936. The Minister directed in respect of one house, No. 4, Woodman's Cottages, that payment of compensation for a well maintained house was to be made in accordance with the provisions of Section 64 of the Housing Act, 1935. At the end of the year two houses were still occupied. No houses had been demolished. (18) Dock Street and Kent Cottages.—This area, consisting of 9 houses, was represented by me to the Council as an unhealthy area on the 12th September, 1935, and the Council made a Clearance Order on the 29th October of that year. A Ministry of Health Inquiry was held on the 14th January, 1936, and the Clearance Order was confirmed by the Minister on the 9th April, 1936. No. 2 Dock Street was excluded presumably, because it was no longer used as a dwelling house and was occupied as a store for business purposes. At the end of the year all the houses had been vacated, and two had been demolished. (19) Kates Place and Albert Road.—This area, consisting of 21 houses, was represented by me to the Council as an unhealthy area on the 12th September, 1935, and the Council made a Clearance Order on the 29th October of that year. A Ministry of Health Inquiry was held on the 14th January, 1936, and the Clearance Order was confirmed by the Minister without modification on the 9th April, 1936. At the end of the year twelve houses were still occupied. (20) Anne's Place.—This area, consisting of 4 houses, was represented by me to the Council as an unhealthy area on the 12th September, 1935, and the Council made a Clearance Order on the 29th October of that year. The Order being unopposed, there was no local Inquiry, and after inspection, the Minister confirmed the order without modification on the 9th April, 1936. At the end of the year all the houses were still occupied. (21) Lewis Place.—This area, consisting of 3 houses, was represented by me to the Council as an unhealthy area on the 7th November, 1935, and the Council made a Clearance Order on the 21st January, 1936. A Ministry of Health Inquiry was held on the 5th March, 1936, and the Clearance Order was confirmed by the Minister without modification on the 2nd May, 1936. At the end of the year all the houses had been demolished. (22) Messiter Place.—This area, consisting of 6 houses was represented by me to the Council as an unhealthy area on the 7th November, 1935, and the Council made a Clearance Order on the 21st January, 1936. As the order was unopposed, no local Inquiry was held, and, after inspection, the Minister confirmed the Order without modification on the 2nd May, 1936. At the end of the year all the houses had been demolished. 95 (23) Dingle Cottages and Harrow Manorway—On the 11th June, 1936,1 represented this area consisting of 8 houses as an unhealthy area. The houses in question are known as Dingle Cottages 1, 2, 3, 4, and Harrow Manorway Nos. 23, 25, 27, and 29. The number of occupants was 22. A Clearance Order was made by the Council on the 2nd September, 1936. As the Order was unopposed, there was no local Inquiry. After inspection, the Minister confirmed the Order on the 31st December, 1936, and directed that payment of compensation in accordance with the provisions of Section 64 of the Housing Act, 1935, should be made in respect of the following houses:— Dingle Cottages 1, 3 and 4: Harrow Manorway 23, 25, 27 and 29. Rehousing is to be provided on the Horn Park Estate. (24) Salisbury Cottages, Plurnstead High Street.—On the 11th June, 1936, I represented this area, consisting of 6 houses as an unhealthy area. The houses in question are known as Salisbury Cottages 1, 2, 3, 4, 5, and 6. The number of occupants was 15. A Clearance Order was made by the Council on the 2nd September, 1936, and a Ministry of Health Inquiry was held on the 27th October. The Order was confirmed by the Minister without modification on the 31st December, 1936. Rehousing is to be provided on the Horn Park Estate. (25) Fennell Stfeet.—On the 9th day of July, 1936, I represented this area consisting of 14 houses, as an unhealthy area. The houses in question are known as Fennell Street 29, 30, 31, 32,33, 34, 35, 36, 37, 38, 39, 40, 41, and 42. The number of occupants was 64. The Council made a Clearance Order on the 2nd September, 1936, and a Ministry of Health Inquiry was held on the 27th October. The Minister confirmed the Order on the 31st December, 1936, and directed that payment of compensation in accordance with the provisions of Section 64 of the Housing Act, 1935, should be made in respect of the following houses:—Fennell Street, Nos. 33, 38, and 39. Rehousing is to be provided on the Horn Park Estate. (26) Elm Terrace.—On the 8th October, 1936, I represented this area, consisting of 11 houses as an unhealthy area. The houses in question are known as Elm Terrace 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, and 11. The number of occupants was 33. The Council made a Clearance Order on the 24th day of November, 1936. No Inquiry had been held by the end of the year. Rehousing is to be provided on the Horn Park Estate. (27) Pound Place.—On the 8th of October, 1936, I represented this area, consisting of 8 houses, as an unhealthy area. The houses in question are known as Pound Place 1, 3, 5, 7, 9, 11, 13, and 15. The number of occupants was 21. The Council made a Clearance Order on the 24th November, 1936; no Inquiry had been held by the end of the year. Rehousing is to be provided on the Horn Park Estate (28) Wilmount Street (No. 1 Area).—On the 8th day of October, 1936, I represented this area, consisting of 7 houses, as an unhealthy area. The houses in question are known as Wilmount Street Nos. 1, 3, 5, 7, 9, 11, and 13. The number of occupants was 33. The Council made a Clearance Order on the 24th November, 1936; no Inquiry had been held by the end of the year. Rehousing is to be provided on the Horn Park Estate. 96 (29) Wilmount Street (No. 2 Area).—On the 8th day of October, I represented this area, consisting of two houses, as an unhealthy area. The houses in question are known as Wilmount Street Nos. 15 and 17. The number of occupants was 10. The Council made a Clearance Order on the 24th November, 1936: no Inquiry had been held by the end of the year. Rehousing is to be provided on the Horn Park Estate. (30) Wilmount Street (No. 3 Area).—On the 8th day of October, I represented this area, consisting of 1 houses, as an unhealthy area. The houses in question are known as Wilmount Street Nos. 10, 12, 14, and 16. The number of occupants was 15. The Council made a Clearance Order on the 24th November, 1936; no Inquiry had been held by the end of the year. Rehousing is to be provided on the Horn Park Estate. (31) Kempt Cottages.—On the 11th day of December, 1936, I represented this area, consisting of 3 houses, as an unhealthy area. The houses in question are known as Kempt Cottages, Nos. 1, la and 2. The number of occupants was 7. The Council decided at their meeting on the 30th December, 1936, to deal with the area by means of a Clearance Order. Rehousing is to be provided on the Horn Park Estate. (32) Majendie Road and Beaconsfield Cottages.—On the 11th day of December, 1936, I represented this area, consisting of 3 houses, as an unhealthy area. The houses in question are known as Beaconsfield Cottages, Nos. 1 and 2, and Majendie Road No. 4. The number of occupants was 11. The Council decided at their meeting on the 30th December, 1936, to deal with the area by means of a Clearance Order. Rehousing is to be provided on the Horn Park Estate. (33) Brookhill Road (No. 1).—On the 11th day of December, 1936,1 represented this area, consisting of 3 houses, as an unhealthy area. The houses in question are known as Brookhill Road, Nos. 90, 91 and 92. The number of occupants was 24. The Council decided at their meeting on the 30th December, 1936, to deal with this area by means of a Clearance Order. Rehousing is to be provided on the Horn Park Estate. (34) Brookhill Road (No. 2).—On the 11th day of December, 1936,1 represented this area, consisting of 11 houses, as an unhealthy area. The houses in question are known as Brookhill Road, Nos. 100, 100a, 100b, 101, 102, 103, 104, 105, 106, 107 and 108. The number of occupants was 41. The Council decided at their meeting on the 30th December, 1936, to deal with this area by means of a Clearance Order. Rehousing is to be provided on the Horn Park Estate. The London County Council programme for the clearance of slum areas in Woolwich, included action taken with respect to the undermentioned areas: 97 (а) Ropeyard Rails Areas. On the 26th November, 1935, Dr. W. E. Roper Saunders, a medical officer of health appointed by the London County Council for the purpose of carrying into effect Part I of the Housing Act, 1930, made an official representation with respect to a group of areas known as Ropeyard Rails Areas (Nos. 1 to 8). They comprise 125 houses, including 4 tenement houses with 38 flats. The displacement of 1,021 persons is involved. At their meeting on the 21st July, 1936, the London County Council declared each of these areas to be Clearance Areas. (b) Barnfield Road Areas.—On the 11th December, 1935, Dr. J. Bruce Low, a medical officer of health appointed by the London County Council for the purpose of carrying into effect Part I of the Housing Act, 1930, made an official representation with respect to a group of areas known as the Barnfield Road (Nos. 1 to 8) areas. The County Council, at their meeting on the 12th May, 1936, resolved to deal with six of these areas and to acquire these areas and certain additional lands for redevelopment purposes by means of compulsory purchase orders. These Orders were made on the 7th December, 1936. The six Clearance Areas comprise 87 houses and t he displacement of 330 persons of the working classes is involved. The houses included in the Clearance Areas are as follows :— No. 1. Barnfield Road— Nos. 1, 2, 3, 5, 7 and 9. Barnfield Place— Nos. 4 and 5. No. 2. Barnfield Road— Nos. 6, 8, 12, 13, 15, 17 and 19. Princes Road— Nos. 3. 5, 7, 8, 9, 11, 13, 15, 17 and 19. No. 4. Princes Road— Nos. 22, 24, 26, 28, 29, 30, 31, 33, 35 and 37. No. 5. Princes Road— Nos. 34, 36, 38, 40, 41, 42, 43, 45, 47, 49, 51 and 53. Barnfield Road— Nos. 42 and 44. No. 6. Barnfield Road— No. 74. Princes Road— Nos. 68, 70, 73, 74, 75, 77, 79, 81, 83, 85, 87, 89, 91, 93, 95, 97 and 99. Cumberland Cottages — Nos. 1, 2 and 3. Brookhill Row- Nos. 1, 2, 3, 4, 5 and 6. No. 7. Princes Road— Nos. 103, 107 and 109. Portland Place— Nos. 1, 3, 5, 7, 9, 11, 13 and 15. 98 In the additional lands outside the Clearance Areas there are 54 houses, and the displacement of 221 additional persons is involved. In the remaining two areas are two unoccupied houses and one single house respectively, and these are included in the properties which the Council decided to acquire under Part III of the Housing Act, 1935. With a view to enlarging the site available for redevelopment and for the purpose of linking up the areas to be dealt with, the County Council propose to acquire compulsorily, two additional sites situated in Princes Road. The houses in these sites are occupied by 156 persons. Additional adjoining land, approximately 2.8 acres, is being acquired by the County Council under a compulsory Purchase Order made earlier in the year. (c) Parkdale Road Area.—On the 9th January, 1936, Dr. J. Bruce Low, a medical officer of health appointed by the London County Council for the purpose of carrying into effect Part I of the Housing Act, 1935, made an official representation with respect to an area containing eight dwelling houses. The houses in question are known as Nos. 27, 29, 31, 33, 35, 37, 39, and 41 Parkdale Road. The number of occupants was 22. The London County Council made a Clearance Order known as the London County Council (Parkdale Road, Woolwich) Clearance Order on the 28th May, 1936 ; a Ministry of Health Inquiry was held on the 29th July, and the Order was confirmed without modification by the Minister on the 16th October, 1936. At the end of the year none of the houses had been vacated. The clearance area programme is not yet completed. There are many other small areas which will require to be dealt with by the Borough Council as soon as rehousing can be provided. Surveys of other large areas have been carried out by officers of the London County Council during the year. These, no doubt, will be dealt with by that body in due course. 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 rehousing 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 1936, the total number of hutment families so rehoused was 737. 99 Other hutments in Eltham and Plumstead are being demolished, and it may be said that they are rapidly disappearing. They were originally put up as temporary dwellings for the duration of the war, but they have continued to be used as such much longer than anybody expected. Re-housing of Old People Living Alone.—It was decided by the Council in 1935 that where aged or infirm persons living alone were rehoused the 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. These visits have been much appreciated, but of course, some tenants require more visits than others. New Houses.—The following Table No. 37 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 361 were in respect of houses built by the Council. TABLE No. 37. Date of Meeting. Woolwich. Plumstead. Eltham. Total. West. East. 8th January — 20 10 70 100 5th February 6 29 12 70 117 4th March — 9 33 102 144 1st April — 9 13 77 99 6th May — 22 21 131 174 10th June 1 52 44 197 294 2nd July — 8 31 115 154 22nd July — 19 4 78 101 9th September 1 66 19 211 297 7th October 1 27 18 125 171 4th November — 39 19 48 106 2nd December 18 11 88 117 9 318 235 1,312 1,874 Council's Houses.—During the year the Council erected 8 houses and flats on the Page Estate, Shepherds Farm, 296 on the Middle Park Estate and 34 on the Timbercroft Lane Estate. 100 At the end of the year 10 houses were in course of erection on the Page Estate, 150 on the Middle Park Estate and 20 on the Timbercroft Lane Estate. The total number of occupied dwellings on the Council's estates at the end of the year was 3,876. Increase of Rent and Mortgage Interest (Restriction) Acts.—Two applications for certificates under the provisions of the above were received, but only one certificate was granted. 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 28. 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, 237 inspections of such houses were made. Common Lodging Houses.—These are licensed annually by the Borough Council in accordance with the provisions of the Public Health (London) Act, 1936. The number of inspections made during the year was 38. The following Table No. 38 shows details of the accommodation available in each common lodging house in the Borough. TABLE No. 38. 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 42 312 101 SECTION VII. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. In addition to food poisoning, which is reported on in Section V., the following diseases are notifiable in the Borough : Anthrax Cerebro-spinal Meningitis Cholera Continued Fever Diphtheria Dysentery Encephalitis Lethargica Erysipelas Enteric (or Typhoid) Fever Glanders Hydrophobia Malaria Membraneous Croup Ophthalmia Neonatorum Pneumonia—Acute Primary Pneumonia—Acute Influenzal Poliomyelitis Polio-encephalitis Plague Puerperal Fever Puerperal Pyrexia Relapsing Fever Scarlet Fever Smallpox Tuberculosis 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 cases of malaria, dysentery and the acute pneumonias, are always notifiable to the Medical Officer of Health of the district in which the patient is residing at the time he is notified. In London, the London County Council maintain institutions for the isolation and treatment of the sick suffering from infectious diseases. Cases from Woolwich are usually admitted to the Brook Hospital, Greenwich, or to the Park Hospital, Lewisham, but during times of pressure cases are sent to Joyce Green Hospital, Dartford, or indeed, to any of the fever hospitals belonging to the London County Council in the County of London. 102 The less common infectious diseases are admitted to any of the London County Council's infectious disease hospitals, but it is the practice of the County Council to select certain of their hospitals for the treatment of such diseases as puerperal fever, or anterior poliomyelitis, so that special facilities and experience may be available for such cases. The total number of notifications, excluding cases of tuberculosis, which are dealt with later in this Section, was 1,254, compared with 1,363 in 1935. In tabular form are shown in the next five Tables statistics relating to the incidence of infectious disease in the Borough in 1936 and previous years. TABLE No. 39. Notification of Infectious Diseases (excluding Tuberculosis), 1936. Diseases. Total Cases Notified. Admissions to Hospital. Total Deaths. Diphtheria 176 175 7 Scarlet Fever 609 581 4 Puerperal Fever 5 5 2 Puerperal Pyrexia 23 22 — Enteric Fever (including Para-Typhoid Fever) 12 11 1 Erysipelas 68 30 2 Malaria 2 2 — Dysentery 4 2 — Poliomyelitis 1 1 — Encephalitis Lethargica 1 1 4 Smallpox — — — Cerebro-Spinal Meningitis 15 15 6 Ophthalmia Neonatorum 26 8 — Zymotic Enteritis 63 53 30 Pneumonia 249 131 101 Polio-encephalitis — — — *Measles (including German Measles) 2,060 266 13 3,314 1,303 170 * Not notifiable. 103 TABLE No. 40. Ward Incidence of Infectious Diseases (excluding Tuberculosis), 1936. 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 176 1 8 16 10 5 12 21 10 8 16 18 8 9 34 Scarlet Fever 609 24 12 34 38 21 65 25 84 30 53 34 33 53 103 Puerperal Fever 5 1 1 1 — — — 1 — — — — — — 1 Puerperal Pyrexia 23 3 3 1 3 — 2 1 2 1 3 1 1 1 1 Enteric Fever (including Paratyphoid Fever) 12 — — — 1 3 3 — — 1 — 2 — 1 1 Erysipelas 68 2 5 1 2 5 2 7 9 5 7 6 5 9 3 Malaria 2 — — — 1 — 1 — — — — — — — — Dysentery 4 1 — — — — — 1 — 1 — — 1 — — Poliomyelitis 1 — 1 — — — — — — — — — — — — Encephalitis Lethargica 1 — — — — — — — — — 1 — — — — Smallpox — — — — — — — — — — — — — — — Cerebro-Spinal Meningitis 15 1 1 1 6 1 — — 1 1 1 1 — — 1 Ophthalmia Neonatorum 26 — — — 2 — 1 1 — — 3 5 — 4 10 Zymotic Enteritis 63 1 2 4 — 3 1 3 9 1 20 10 — 6 3 Pneumonia 249 13 15 20 7 11 10 24 18 10 44 18 12 11 36 Polio-encephalitis — — — — — — — — — — — — — — — *Measles (including German Measles) 2,060 76 144 127 245 135 139 151 149 94 193 246 57 195 109 * Not notifiable. 3,314 123 192 205 315 184 236 235 282 152 341 341 117 289 302 104 TABLE No. 41. Cases of Infectious Diseases Notified 1936 (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 176 7 4 7 17 18 57 26 15 15 4 6 — Scarlet Fever 609 5 24 38 43 67 242 84 34 53 15 4 — Puerperal Fever 5 — — — — — — — — 4 1 — — Puerperal Pyrexia 23 — — — — — — — 2 17 4 — — Enteric Fever (including Paratyphoid Fever) 12 — — — — — 3 3 1 2 — 2 1 Erysipelas 68 2 — — — — — 1 — 14 9 27 15 Malaria 2 — — — — — — — — — 2 — — Dysentery 4 — 1 — — — 2 — — — 1 — — Poliomyelitis 1 — — — 1 — — — — — — — — Encephalitis Lethargica 1 — — — — — — — 1 — — — — Smallpox — — — — — — — — — — — — — Cerebro-spinal Meningitis 15 — — — — — 3 1 7 3 — 1 — Ophthalmia Neonatorum 26 26 — — — — — — — — — — — Zymotic Enteritis 63 32 17 2 2 1 1 — 1 1 3 3 — Pneumonia 249 29 30 14 11 6 24 8 8 21 24 51 23 Polio- encephalitis — — — — — — — — — — — — — *Measles (including German Measles) 2,060 61 182 167 259 359 916 38 52 24 2 — — * Not notifiable. 3,314 162 258 228 333 451 1,248 161 121 154 65 94 39 105 TABLE No. 42. Notification of Infectious Diseases (including Tuberculosis), 1901 to 1936. 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 — — — — — — 14 — — 1 338 532 143 387 — 1914 — 416 107 714 18 — 7 — — — — — — 18 — 1 — 199 400 98 967 — 1915 — 286 138 601 31 — 6 — — — — — — 19 — 50 2 173 420 69 1,179 — 1916 1 271 95 232 9 — 16 — — — — — — 33 — 17 — 80 392 77 1,590 — 1917 — 277 79 147 12 — 12 — — — — — — 41 — 22 1 101 448 95 1,710 — 1918 — 240 61 222 12 — 14 — — — — — — 23 — 11 3 118 563 97 800 — 1919 4 398 63 243 26 — 7 — 123 — 61 7 1 34 3 7 1 123 394 80 1,886 — 1920 1 427 82 538 6 — 13 — 136 — 29 1 — 29 3 6 — 31 359 69 1,013 — 1921 — 592 59 1,351 11 — 14 — 187 49 10 4 — 32 9 2 — 454 285 71 481 — 1922 — 437 37 511 8 1 11 — 212 133 11 — — 26 3 2 4 31 245 60 2,698 — 1923 — 152 40 334 16 — 8 — 196 46 4 1 — 18 1 5 6 49 245 66 194 — 1924 — 195 45 440 11 — 7 — 249 105 3 1 — 27 17 12 5 13 273 69 2,679 — 1925 — 299 44 364 16 — 9 — 237 40 5 1 — 31 10 5 1 13 246 54 1,916 — 1926 — 393 46 411 8 1 4 7 259 33 5 — — 18 7 9 5 23 287 52 1,246 — 1927 — 278 65 478 9 — 8 30 280 36 3 1 — 19 6 4 3 12 269 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 44 554 3 — 5 35 199 48 2 1 — 7 2 15 6 11 235 48 3,135 — 1933 2 370 67 1,004 5 — 4 36 181 68 2 — — 9 — 9 2 5 207 45 354 — 1934 — 416 119 989 8 — 5 30 273 7 1 — — 7 — 4 3 3 219 50 2,392 — 1935 — 313 78 634 9 — 3 42 230 25 — 1 — 17 1 3 2 5 209 33 656 — 1936 — 176 68 609 12 — 5 23 231 18 2 4 26 1 15 1 63 217 36 2,060 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. 106 TABLE No. 43. Deaths from Infectious Diseases (excluding Tuberculosis), 1936. Diseases. Number of Deaths. Age Groups. All Ages. Under 1 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- Diphtheria 7 1 — 2 4 — — — — — — — Scarlet Fever 4 — — 2 2 — — — — — — — Enteric Fever (including Para-typhoid Fever) 1 — — — — — — — — — 1 — Puerperal Fever 2 — — — — 1 1 — — — — — Puerperal Pyrexia — — — — — — — — — — — — Erysipelas 2 — — — — — — — — 1 1 — Smallpox — — — — — — — — — — — — Pneumonia 101 27 6 4 1 — 4 6 14 23 10 6 Malaria — — — — — — — — — — — — Ophthalmia Neonatorum — — — — — — — — — — — — Encephalitis Lethargica 4 — — — — — 1 1 1 1 — — Dysentery — — — — — — — — — — — — Cerebro-spinal Meningitis 6 — 1 1 2 2 — — — — — — Poliomyelitis — — — — — — — — — — — — Polio-encephalitis — — — — — — — — 1 1 1 — Zymotic Enteritis 30 25 — — — — — — — * Measles (including German Measles) 13 2 4 5 2 — — — — — — — * Not notifiable. 170 55 11 14 13 3 6 7 16 26 13 6 107 Diphtheria. Notification.—During the year 176 cases were notified, compared with 313 in 1935 and 416 in 1934. There were seven military cases. The number of notifications received each quarter was as follows First quarter .. 60 Second quarter .. 38 Third quarter .. 33 Fourth quarter .. 45 Multiple Cases.—The following Table No. 44 shows the house distribution in wards. The term " house " is synonymous with the term " family " in all cases. TABLE No. 44. 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 1 3 11 6 5 10 16 6 6 16 16 8 9 30 143 143 2 cases occurred - 1 1 - - 1 1 2 1 - 1 - - 2 10 20 3 „ „ - - 1 - - - 1 - - - - - - - 2 6 4 „ „ - - - - - - - - - - - - - - - - Total houses 1 4 13 6 5 11 18 8 7 16 17 8 9 32 155 169 Military Cases - 3 - 4 - - - - - - - - - - - 7 176 Return Cases.—Two cases gave rise to two return cases. Deaths.—There were 7 deaths from Diphtheria, compared with 13 in 1935 and 11 in 1934. Three of these were of children under five years of age and four were of school children. 108 Antitoxin.—A supply of Diphtheria Antitoxin is kept at the Town Hall, the Plumstead Library and the Eltham Library, and is available for medical practitioners on application, at cost price, or free, where there is inability to pay. The amount supplied during the year was 52,000 units. The total cost to the Council was £2 10s. 0d., all of which 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 immunisation is carried out by general practitioners and it was set out in full in my Annual Report for 1934. Slight modifications which are referred to in my Annual Report for 1935 were made during that year. During 1936, 676 children were immunised and a further 48 were found not to require immunisation. Since the scheme started in November, 1934, 1,811 children in all have been immunised. In order to ascertain whether a 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 whether the desired result has been obtained. Schick testing clinics have been held periodically as often as was necessary. The figures for the year follow. Before a course of immunisation, 130 children were found to be Schick positive and 48 Schick negative ; after immunisation, including children immunised in 1935, 510 were found to be negative and 24 positive ; 12 children failed to attend. The remaining children were waiting until the requisite time had passed to enable immunity to be developed. The total amount of fees paid to general practioners for immunisation during the year was £327 17s. 6d. The other costs amounted to £66 1s. 7d. Scarlet Fever. Notification.—During the year 609 cases were notified compared with 634 in 1935 and 989 in 1934. There were 18 military cases. The number of notifications received each quarter was as follows :— First quarter 182 Second quarter 144 Third quarter 125 Fourth quarter 158 Multiple Cases.—The following Table No. 45 shows the house distribution by wards. The term " house " is synonymous with the term " family " except in five instances where two families were involved. 109 TABLE No. 45. 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 14 7 26 15 16 32 19 57 26 46 28 27 41 78 432 432 2 cases occurred 5 - 4 5 1 7 3 9 2 2 3 3 4 11 59 118 3 „ „ - - - - 1 5 - 3 - 1 - - 1 11 33 4 „ „ 1 1 - 2 8 Total houses 19 7 30 20 18 45 22 69 28 49 31 30 46 90 504 591 Military Cases - 5 - 13 - - - - - - - - - - - 18 609 Return Cases.—The following Table No. 46 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 TABLE No. 46. Scarlet Fever—Return Cases, 1936. No. in Register. Date Admitted to Hospital. Date Discharged. Total Days in Hospital. Onset of Secondary Case. Remarks on Primary Case. 1936. 1936. 1936. 89 February 13th March 14tli 31 April 2nd Nasal discharge. 151 March 14th April 10th 28 May 7 th — 162 March 22nd April 30th 39 May 4th — 178 March 29th June 13th 77 June 20th — 209 April 15th July 19th 96 July 26th — 223 April 28th May 19 th 22 June 13 th July 2nd — 250 May 11th June 6th 26 June 25th — 257 May 15 th July 15th 62 July 30th — 110 TABLE No. 46—continued. No. in Register. Date Admitted to Hospital. Date Discharged. Total Days in Hospital. Onset of Secondary Case. Remarks on Primary Case. 1936 1936 1936 290 June 8th July 25th 48 August 12th — 295 June 13th July 4th 22 July 6th — 317 June 26th August 14th 50 August 18th Nasal discharge 336 July 6th July 29th 24 August 2nd Nasal discharge. 338 July 8th July 29th 22 August 21st — 342 July 12th August 4th 24 August 25th August 12th Otorrhoea August 17th 343 378 July 12th August 22nd . . 42 September 6th — August 12th September 2nd 22 344 July 13th August 6th 25 August 27th — 435 September 22nd October 15th . . 24 October 21st — October 25th 452 October 2nd October 27th . . 26 October 30th . . — 473 October 15th November 5th . . 22 November 11th — 475 October 16th November 12th 28 November 17th — 493 October 25th November 17th 24 December 2nd. . — 503 October 29th November 20th 23 November 28th — 532 November 15th December 7 th 23 December 13th — Deaths.—-There were 4 deaths from scarlet fever during the year, compared with two in 1935. Home Isolation.—Twenty-eight cases, or 4.6 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 a case 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. No such certificates were issued during the year. 1ll Puerperal Fever and Puerperal Pyrexia. Twenty-eight cases were notified compared with 45 in 1935 and 35 in 1934. In 23 instances notification was in respect of puerperal pyrexia, but in at least three of these, notification should have been puerperal fever. In one instance the disease was a sequel to abortion. All except one case received hospital treatment. Deaths.—There were two deaths from puerperal fever compared with one in 1935 and two in 1934. Enteric Fever. Twelve cases were notified, eleven of whom were treated in hospital. There was one death. The following Table No. 47 gives details of each case notified. TABLE No. 47. Enteric Fever, 1936. No. Date Notified. Sex. Age. Diagnosis. Final Diagnosis. Remarks. 1 1/1/36 M. 72 Paratyphoid Fever Enteric Fever Died. 2 3/2/36 M. 6 Typhoid Fever Measles and Whooping Cough. — 3 4/2/36 F. 19 Paratyphoid Fever Paratyphoid Fever — 4 3/4/36 F. 14 Typhoid Fever Typhoid Fever — 5 10/5/36 F. 6 Typhoid Fever Urinary Infection (B. Coli) — 6 10/6/36 F. 23 Paratyphoid Fever Ulcerative colitis — 7 12/6/36 M. 13 Typhoid Fever Typhoid Fever — 8 19/7/36 F. 8 Typhoid Fever Enteric Fever — 9 11/8/36 F. 26 Typhoid Fever Gastro-enteritis — 10 25/9/36 F. 51 Paratyphoid Fever Acute Enteritis — 11 30/9/36 F. 12 Paratyphoid B. Paratyphoid B. — 12 2/10/36 F. 52 Paratyphoid B. Paratyphoid B. — Erysipelas, Malaria and Dysentery. The number of notifications of Erysipelas received was 68, compared with 78 in 1935. Four cases of Dysentery were notified. There were two notifications of Malaria (induced for therapeutic purposes). Anterior Poliomyelitis. Only one notification was received during the year compared with two in the previous year. The patient was admitted to the special ward reserved for such cases by the London County Council at the Western Hospital. 112 Encephalitis Lethargica. One case of this disease was notified and was removed to hospital. The diagnosis was not confirmed. Smallpox. There were no cases of smallpox. Cerebro-Spinal Meningitis. Fifteen cases were notified compared with three in 1935. There were six military cases. All the cases were admitted to hospital. Details of each case are given in the following Table No. 48. TABLE No. 48. Cerebro-spinal Meningitis, 1936. No. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. I 10/2/36 M. 16 Cerebro-spinal Meningitis — 2 10/2/36 M. 14 Cerebro-spinal Meningitis — 3 10/2/36 M. 18 Cerebro-spinal Meningitis — 4 13/2/36 M. 15 Cerebro-spinal Meningitis — 5 18/2/36 F. 34 Cerebro-spinal Meningitis — 6 25/2/36 F. 5 Cerebro-spinal Meningitis Died 7 26/2/36 M. 18 Cerebro-spinal Meningitis Died 8 6/3/36 F. 7 Cerebro-spinal Meningitis Died 9 23/3/36 M. 19 Cerebro-spinal Meningitis Died 10 27/3/36 M. 15 Cerebro-spinal Meningitis — 11 28/3/36 M. 23 Cerebro-spinal Meningitis — 12 31/3/36 M. 45 Pneumococcal Meningitis Died 13 16/4/36 F. 15 Cerebro-spinal Meningitis — 14 3/5/36 M. 24 Meningitis Died 15 12/8/36 M. 9 Sub-arachnoid haemorrhage . . — Whooping Cough. During the year 452 cases of Whooping Cough came to the knowledge of the Department, compared with 266 in 1935 and 253 in 1934. As this disease is not notifiable in the Borough, knowledge is usually obtained through the School Medical 113 Service, but exceptionally, cases are notified by medical practitioners and occasionally cases are discovered by the health visitors in their routine visits. Nursing.—One case was nursed under the Council's scheme, 14 visits in all being paid. The cost of this service was 14/-. Deaths.—-There were eight deaths certified to be due to this disease, compared with two in 1935. Ophthalmia Neonatorum. Twenty-six cases were notified, seven of which were admitted to hospital. Thirteen cases were nursed at home under the Council's scheme, 186 visits in all being paid. The cost of this service was £9 6s. Od. The following Table No. 49 gives details of each case. TABLE No. 49. Ophthalmia Neonatorum, 1936. Notified Date. Cases Treated Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hospital. 3/2/36 — Yes Yes — — — 18/2/36 Yes — Yes — — — 7/3/36 Yes — Yes — — — 21/3/36 Yes — Yes — — — 11/4/36 Yes Yes — — — 18/4/36 Yes — Yes — — — 22/4/36 Yes — Yes — — — 22/4/36 Yes — Yes — — — 22/4/36 — Yes Yes — — — 6/5/36 — Yes Yes — — — 7/5/36 Yes — Yes — — — 18/5/36 Yes — Yes — — — 10/6/36 Yes — Yes — — — 25/6/36 Yes — Yes — — — 26/6/36 Yes — Yes — — — 14/7/36 Yes — Yes — — — 28/7/36 Yes — Yes — — — 12/8/36 Yes — Yes — — — 15/8/36 Yes — Yes — — — 18/8/36 Yes — Yes — — — 5/9/36 Yes — Yes — — — 17/10/36 — Yes Yes — — — 28/11/36 — Yes Yes — — — 10/12/36 — Yes Yes — — — 16/12/36 Yes — Yes — — — 18/12/36 Yes — Yes — — — 114 Zymotic Enteritis. Sixty-three cases were notified during the year compared with five in 1935 and three in 1934. The age incidence is given in Table No. 41. Zymotic Enteritis at all ages and not limited to any particular months has been notifiable in Woolwich for many years. In recent years the number of cases notified has fallen considerably. During the year, owing to the occurrence of cases of illness sometimes diagnosed as gastric influenza, sometimes food poisoning, and sometimes diarrhoea, or diarrhoea and vomiting, a circular letter was sent to all medical practitioners in the Borough drawing their attention to the fact that Zymotic Enteritis was notifiable. This may account in large measure for the increase in the number of notifications. The number of deaths in children under two years certified to be due to diarrhoeal diseases was 25. Measles. The two main sources of our knowledge of the incidence of Measles in the Borough are the School Medical Service and the health visitors. Occasionally, however, information comes through the local nursing associations and from parents. During the year 2,060 cases (including 97 cases of German Measles) were discovered. In 1935 and in 1934 the corresponding figures were 656 and 2,392. Measles occurs in epidemic form every two years and usually lasts for four months. The incidence in each of the twelve months of the year was as follows :— January 53 February 401 March 824 April 376 May 202 June 104 July 68 August 12 September 3 October 10 November 5 December 2 From these figures it will be noted that the disease first assumed epidemic proportions in February, reached its peak in March and fell away thereafter. The Council's scheme for measles control was put in force at the beginning of the year, three temporary health visitors being appointed. They investigated every reported case of measles from whatever source information came ; they visited cases absent from school from unknown causes and every case of suspected measles. The staff health visitors made subsequent visits to cases where children were under school age, but where they were of school age the subsequent visits were made by temporary health visitors. 115 Notices were sent to head teachers when the diagnosis of measles was not confirmed, when suspect cases were diagnosed as measles and when cases of measles in school children came to the knowledge of the department other than through the school medical service. The co-operation between the School Medical Service and the Department was excellent, visits being paid to every home where cases of measles or suspected measles were living, within 24 hours of the teacher sending the notification to the Department. The scheme worked very well in other respects. It enabled the normal routine work of the health visitors to be maintained with very little disturbance ; it ensured the early diagnosis of secondary cases and their exclusion from school in an infectious state ; it ensured the early provision of nursing assistance and it enabled arrangements to be made for the early admission of cases to hospital where necessary. Home Nursing.—In 45 cases nursing assistance was provided during the year, 499 visits in all being paid. The cost to the Council was £26 11s. 6d. Measles Serum,.—It was not possible to obtain a supply of Measles Serum and it was not used in any case treated at home. Hospital Treatment.—The number of children admitted to fever hospitals was 266. Deaths.—There were 13 deaths from measles during the year. Pneumonia. The number of cases notified was 249 compared with 255 in 1935. Of these 18 were influenzal. The number of deaths certified to be due to lobar or bronchial pneumonia was 97 and to acute influenzal pneumonia one. The ward incidence of the Pneumonias is shown in Table No. 40. 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. 116 In a recent memorandum the Ministry of Health suggest that a sanitary authority should be prepared to provide facilities for bacteriological examination of sputum. Various strains of the pneumococcus can now be differentiated by use of typespecific anti-sera—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 heterogeneous collection in group IV. are normally present in throats and seldom give rise to cases of pneumonia. Felton's serum, which the Council supplies (see appropriate paragraph) is used in types I. and II. cases. The following Table No. 50 shows the number of notifications of Pneumonia received each month, classified by sex and according to type. It also shows the number of deaths occurring from acute primary pneumonia and influenzal pneumonia. TABLE No. 50. 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 31 15 46 5 12 3 26 12 1 February 22 20 42 7 10 1 24 12 — March 18 17 35 10 3 1 21 10 April 13 4 17 5 — 1 11 14 — May 7 7 14 3 1 1 9 6 — June 10 4 14 4 — — 10 2 — July 4 1 5 — — 1 4 2 — August 4 3 7 2 1 1 3 5 — September 9 3 12 6 1 5 8 — October 7 4 11 3 1 ] 6 9 — November 13 7 20 5 6 1 8 7 — December 11 15 26 5 6 7 8 13 — 149 100 249 55 41 18 135 100 1 117 Nursing.—Nursing assistance is provided by the Council for cases of pneumonia, and during the year 25 cases were nursed, 603 visits being paid by the nurses of the local nursing associations. The total cost to the Council was £37 13s. 9d. 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 £32 8s. 0d. 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 wholetime tuberculosis health visitors, one clerk-dispenser, who acts as secretary to the Care Committee, and one clerk. Notifications.—During the year 217 cases of pulmonary tuberculosis and 36 cases of non-pulmonary tuberculosis were notified. These figures exclude 37 duplicate notifications. 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:— Dockyard, 10 and Nil; St. Mary's, 7 and 2; River, 20 and 3; St. George's, 12 and Nil; Burrage, 6 and 1; Herbert, 10 and 1; Glyndon, 13 and 3; St. Margaret's, 18 and 1; Central, 10 and 5; St. Nicholas, 31 and 8; Abbey Wood, 14 and 2; Well Hall, 16 and 2; Avery Hill, 20 and 2; Sherard, 30 and 6. 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 eases found again, cured cases who relapse and transfers from other areas. The number of transfers to Woolwich was 48 and the number from Woolwich was 75. The following Table No. 51 shows the changes which took place in the register during the year 118 TABLE No. 51. Pulmonary Non-Pulmonary Totals. M. F. M. F. Number on Register on 1st January, 1936 458 340 93 84 975 Number of new Cases notified 130 87 15 21 253 Number of Cases restored 5 5 2 1 13 Other additions 12 15 6 3 36 Deletions 151 112 25 21 309 Number on Register on 31st December, 1936 454 335 91 88 968 It will be noted that the total number on the register at the end of the year was 968, and, of this number, 90.4 per cent. were on the dispensary register. In 1935 the corresponding percentage was 90.25 and in 1934, 91.75. The following table shows the new cases notified during the year and the corresponding case rates classified by parishes. TABLE No. 52. Woolwich. Plumstead. Kltham. The Borough. Pulmonary Tuberculosis: Cases 47 106 64 217 Rates 1.58 1.54 1.33 1.48 Non-Pulmonary Tuberculosis: Cases 5 21 10 36 Rates 0.16 0.30 0.21 0.24 The following Table No. 53 summarises the number of cases coming to the knowledge of the Department in 1936 and includes notifications received from general practitioners, cases not notified but included in death returns and those transferred from other areas. It does not include any duplicate notifications or those received from Medical Superintendents of hospitals on admission or discharge of patients. Deaths occurring within the year are classified in the same Table by age and sex groups. 119 TABLE No. 53. Tuberculosis—-New Cases and Mortality, 1936. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0-1 year — — — 1 — — — — 1-5 years 2 1 2 3 — — 2 2 5-10 years 3 4 — 3 — — — 1 10-15 years 7 1 5 2 2 1 — — 15-20 years 10 15 3 5 3 8 2 1 20-25 years 15 19 2 4 3 9 1 — 25-35 years 37 27 2 3 16 9 — 1 35-45 years 18 19 1 2 14 5 1 — 45-55 years 21 8 1 1 12 4 — — 55-65 years 19 1 1 1 10 – 1 — 65 and upwards 6 3 — — 7 1 — — 138 98 17 25 67 37 7 5 The following Table, No. 54, shows the site of disease in patients notified, each year since 1932. TABLE No. 54. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 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 1936 217 4 10 11 4 3 4 253 120 Deaths.—The following Table No. 55 shows the number of deaths and death rates every year since 1932. TABLE No. 55. Tuberculosis—Deaths and Death.Rates. Year. Deaths. Death.rates. All Forms. Pulmonary. Non. Pulmonary. All Forms. Pulmonary. Non. Pulmonary. 1932 154 139 15 1.05 0.95 0.10 1933 135 116 19 0.92 0.79 013 1934 146 120 26 1.00 0.82 0.18 1935 136 121 15 0.93 0.82 0.10 1936 116 104 12 0.79 0.71 0.08 In addition to those recorded in the above Table, seven 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 next Table. TABLE No. 56. Case No. Date Notified as Tuberculosis. Cause of Death. 1 20/10/35 Cachexia, Bronchiectasis. 2 16/11/28 Cardiac failure. Chronic Nephritis, Emphysema. 3 8/2/36 Carcinoma ventriculi. 4 8/6/16 Uraemia, Duodenal ulcer. 5 25/11/35 Toxaemia, Peritonitis, Pyelitis. 6 8/4/36 Endothelioma of Lung. 7 18/1/36 Carcinoma of Stomach. 121 The period which elapsed between notification and death is shown below :— TABLE No. 57. Period between Notification and Death. Pulmonary. Percentage. Non. Pulmonary. Percentage. Not notified 5 4.81 3 25.0 0.1 month 20 19.23 5 41.7 1.3 months 6 5.78 — — 3.6 months 8 7.69 — — 6.12 months 13 12.50 1 8.3 1.2 years 21 20.19 1 8.3 2.5 years 15 14.42 2 16.7 Over 5 years 16 15.38 — — 104 100.00 12 100.00 The ratio of non.notified deaths to the total tuberculosis deaths was as one is to 14. In 1935 it was as one is to 19 and in 1934, as one is to 6. Each failure to notify was investigated and differing explanations were given. It was found that three had been notified in other areas and not transferred here, two were acute cases who died in general hospitals and two were only diagnosed after post mortem. 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 children whose parent or parents are receiving institutional treatment for tuberculosis and for whose care adequate arrangements cannot otherwise be made, are boarded.out during the absence of the parent. During the year eight children were thus dealt with. Public Health (Prevention of Tuberculosis) Regulations, 1925, provide for the compulsory discontinuance of employment of persons engaged in the treatment or handling of milk who are suffering from tuberculosis. Only one case of this kind came to the notice of the Council during the year, and on the patient's discharge from sanatorium he was found other work by the employing firm. Every milk vendor in the Borough is periodically reminded that the Tuberculosis Officer is willing to examine, free of charge, all employees or candidates for employment in the milk trade, but no requests of this kind were made during the year. 122 The Work of the Dispensaries.—The Council's Dispensary is situated at Maxey Road, Plumstead, and there is a branch dispensary at 11 Carnecke Gardens, Eltham. This branch was opened on the 11th July, 1936 and replaced the one at Well Hall Road. The Eltham Branch was opened in 1931 and its usefulness increases each year. One of the Tuberculosis Officers attends at the main Dispensary every week-day, but an evening session is held instead of an afternoon session, on Thursdays. Eight separate sessions in all are held for men, for women and for children. The branch dispensary is open on three half-days a week:—Monday afternoons for men and Wednesday and Friday mornings for women and children. The total number of attendances at the Dispensaries during 1936 was 5,494. In this connection it is interesting to point out that 186 of the persons notified during 1936 attended the dispensaries, which is equivalent to 73.5 per cent. The corresponding percentage in 1935 was 77.2 per cent. The corresponding percentage in 1934 was 75.08 per cent, and in 1933, 68.25 per cent. A return of the work of the Dispensaries is given in Table No. 58. 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. Home Visiting of Tuberculosis Cases.—On receipt of every notification the home is visited by the Tuberculosis Visitor, who advises as to any re-arrangement that seems possible and desirable in the interests of the patient and other members of the family. In the case of patients notified by the Tuberculosis Officer a visit is also made by one of the medical staff, who thus gains a knowledge of the home circumstances of the patient. The Tuberculosis Visitor endeavours to visit each home in her district once in three months, but, in the case of patients with recent and more active disease, visits are more frequent. 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, 492 contacts were examined. In dealing with children it is the usual practice to do a Mantoux intradermal test, and, where a positive result is obtained, to X-ray the patient. During the 123 TABLE No. 58. Return showing the work of the dispensaries for 1936. 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 101 80 6 3 7 17 10 8 108 97 16 11 232 (6) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 153 161 95 63 472 B.—CONTACTS examined during the year: (a) Definitely tuberculous 7 4 3 3 — — 2 2 7 4 5 5 21 (6) Diagnosis not completed — —- — — — — — — — — — . — — (c) Non-tuberculous — — — — — — — — 75 146 112 138 471 C. —CASES written off the Dispensary Register as:— (a) Recovered 28 23 — — 4 ' 7 1 1 32 30 1 1 64 (6) Nonrtuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 238 311 208 201 958 D.—NUMBER OF CASES on Dispensary Register on December 31 st:— (a) Definitely tuberculous 368 307 27 22 42 51 31 29 410 358 58 51 877 (b) Diagnosis not completed — — — . — — — — — — — — 124 TABLE No. 58—continued. Return showing the work of the dispensaries for 1936. 1. Number of cases on Dispensary Register on January 1st 881 2. Number of eases transferred from other areas and cases returned after discharge under Head 3 in previous years 3 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 75 4. Cases written off during the year as Dead (all causes) 106 5. Number of attendances at the Dispensary (including Contacts) 5,494 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 231 7. Number of consultations with medical practitioners:— (a) Personal 80 (b) Other 1,082 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 433 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,316 10. Number of:— (a) Specimens of sputum, etc., examined 462 (b) X-ray examinations made in connection with Dispensary work 815 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (6) above 5 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 337 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 125 year 241 children were subjected to the Mantoux intradermal test, and it will again be seen that those children in contact with a notified case of tuberculosis showed a very much higher percentage of positive results than where no such contact existed. TABLE No. 59. Contacts. 0-5 year8. 5-10 years. 10-15 years. Total. Percentage. Positive result 14 32 31 77 49.04 Negative Result 19 29 32 80 50.95 Non-Contacts. Positive result 4 5 7 16 19.05 Negative result 27 24 17 68 80.95 X.-ray Examinations.—X-ray examinations are now recognised as being essential in the diagnosis and investigation of cases of tuberculosis. At the present time every new adult patient attending the Dispensary is X-rayed, and in the case of children, all Mantoux positive cases are so examined, furthermore, post-sanatorium cases are also X-rayed from time to time. It must be pointed out that the figures shown here do not represent the total use made of X-rays in the treatment of Tuberculosis in Woolwich, as all patients undergoing artificial pneumothorax treatment are frequently screened and X-rayed during the progress of treatment, and, in certain cases, admitted to St. Nicholas Hospital, the X-ray film taken at that institution is available for the use of the Tuberculosis Officer. The only alteration during the year has been that, whereas all dispensary cases were previously X-rayed at the War Memorial Hospital approximately one-third of the patients are now sent to St. Nicholas Hospital for this purpose. This new arrangement came into force 011 the 1st July, and during the year, 631 examinations were made at the War Memorial Hospital and 182 at St. Nicholas Hospital. Co-operation with St. Nicholas Hospital.—As set out in previous reports, the Tuberculosis Officer visits St. Nicholas Hospital weekly. This is in accordance with an arrangement made with the London County Council in 1933 and subsequently renewed from time to time. Co-operation with Local Practitioners.—During the year 80 cases were seen by the Tuberculosis Officer at the homes of the patients, and 308 were referred to the Dispensary by medical practitioners in the Borough. 126 Co-operation with School Medical Service.—This continues to work in a very satisfactory way ; many cases are referred to the dispensary by the School Medical Officers and the child contacts of tuberculous patients are referred to the School Medical Service for special observation and supervision. Certain unsatisfactory children, e.g. post-sanatorium, gland and abdominal cases are recommended for admission to the Open Air School, and such children are brought to the Dispensary periodically, by the school nurse, for supervision and examination. Such children as are found on examination to be non-tuberculous but to be suffering from minor ailments are referred to the School Clinic, and other children whose condition warrants are referred to the School Care Organiser wdth a recommendation for the provision of milk and cod liver oil at school, and others to the Woolwich Invalid Children's Aid Association for convalescent treatment. Extra Nourishment.—Extra nourishment in the form of milk, eggs and butter is supplied to tuberculous persons on the certificate of the Tuberculosis Officer. This is done either through the Tuberculosis Care Committee or, in the case of patients in receipt of public assistance, through the London County Council. This form of assistance is not limited to the patients themselves, but can in approved cases be extended to the contacts of such cases. The extra nourishment is not intended for advanced cases of tuberculosis where real improvement cannot be expected, but only for such ante and post-sanatorium cases in which it may make a real difference to the prospects of recovery. Dental Treatment.—The dental treatment of tuberculous patients is carried out at the School Clinic, Brewer Street. During the year 17 cases received treatment, the number of attendances being 37. Patients requiring dentures are assessed according to their means. These were supplied in 8 cases at a cost of £34 5s. Od., and payments by patients amounted to £17 Is. 9d. In the case of certain insured persons, help towards the cost of dentures is obtained from approved societies, and this is taken into account when making the assessment. Finsen Light Treatment.—The agreement entered into by the Council with the London Hospital in 1921 for the treatment of patients suffering from Lupus in the Finsen Light Department of the Hospital is still maintained. A fee of five shillings is paid for each treatment. No patients were so treated during the year. Artificial Pneumothorax.—This treatment consists of collapsing a diseased lung and so putting the diseased portion out of action. This is done by introducing gas or air through a needle into the pleural cavity of the affected side and as such air becomes absorbed it is replaced at varying intervals. Refills have to be maintained over a lengthy period, which probably averages 2½ years. The Council pays a fee of 10s. 6d. each refill, and the work is at present carried out at several 127 hospitals, both in voluntary institutions and in those belonging to the London County Council, and occasionally patients return to sanatorium for this treatment. The number of patients who received such treatment during the year was 51, and the number of refills given was 779. Patients undergoing this treatment may be recommended for simultaneous treatment by sanocrysin, and the Council have sanctioned the payment, in such cases as are approved by the Tuberculosis Officer, of 3s. 6d. per injection. No injections were made during the year. 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, S. Crown, J.P., Mrs. L. E. Driver, G. Greenwood and C. J. Keedv. Trade Unions Mr. W. H. Fairchild, Mr. E. Ware. Employers Miss L. Ames, Miss E. Fletcher, Mr. A. J. Golding. Friendly Societies Mr. W. A. Lyon, Mr. A. J. Rourke, Mr. F. D. Smytho. London County Council Miss G. M. Aves, Dr. H. R. Kidner. London County Council (Public Assistance Committee). Mr. R. Campbell, Mrs. B. G. Dickinson, Mr. T. Moran. London Insurance Committee Mr. S. A. Brown Panel Committee for the County of London Dr. H. M. Wise British Red Cross Society Mr. J. P. O'Connell 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 Care Committee has continued to function efficiently during the past year and has been a great help to many patients whose special needs could not be met under the Council's Tuberculosis Scheme. Fares have been granted in 70 instances for visiting ; clothing was provided for 34 patients ; pocket money was given to 9 in sanatoria, three cases were assisted in the matter of a holiday, and one family was assisted with moving expenses. Two beds and a pair of spectacles were purchased for patients unable to meet the cost of these. The cost of one wireless licence was defrayed. Reference was made in last year's report to the Occupational Therapy Centre which was opened on October 31st, 1935. The initial difficulties with regard to the attendance of an instructor were overcome by the help of the London County Council, and he has attended since the beginning of February, 1936, on five half days a week. The highest number of patients on the attendance register has been 128 14 and the total number of attendances put in during the year was 4,351. It is satisfactory to be able to note that ten patients have so benefited from this work that they have been able to pass out into normal industry. It is inevitable that in dealing with the type of patient for whom this centre caters, there should be variations in attendances, as it is found that certain patients have relapses and need further periods of sanatorium treatment or rest in bed at home, but the total attendances indicate that the centre has met a real need. Institutional Treatment.—The following Table shows the number of admissions to special hospitals, sanatoria, public general hospitals, institutions and training colonies :— TABLE No. 60. Admissions to Hospitals, etc. Special Hospitals. Sanatoria. Public General Hospitals. Training Colonies. Insured 108 81 109 3 Uninsured 30 29 58 Children 38 12 15 176 122 182 3 These figures refer to 347 patients and the monthly admissions were as follows: January 37 February 36 March 46 April 48 May 55 June 39 July 43 August 50 September 43 October 31 November 35 December 20 Bacteriological Examination of Sputum.—During the year 462 specimens oi sputum were examined at the dispensary, and of these 43 were positive and 419 negative. Facilities for general practitioners are provided at the Woolwich War Memorial Hospital, and 326 specimens were examined during the year, 48 being positive and 278 negative. 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 m ade for these shelters. 129 Home Nursing.—-This is provided for certain cases of tuberculosis, in accordance with the arrangements entered into with the local Nursing Associations. The number of visits paid by nurses during the year was 1,275 and the cost to the Council was £79 13s. 9d. Arrangements for Disinfection and Disinfestation and the Extent of Their Use. Disinfection.—The Council's Disinfecting Station is situated at White Hart Road, Plumstead, where there are installed two Washington Lyon steam disinfectors, one high-pressure steam washing disinfector, and one room for disinfecting articles which cannot be subjected to heat. The heavy demand on the 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 31 such disinfections were carried out, and charges amounting to £9 9s. Od. were paid. In tabular form is shown below the amount of disinfection which was carried out during the year. TABLE No. 61. Rooms disinfected after ordinary fevers 826 ,, ,, ,, tuberculosis 164 ,, ,, „ verminous cases 1,256 ,, ,, ,, for other reasons 21 Articles disinfected 49,244 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. 62 shows the number of persons cleansed each year since 1932. 130 TABLE No. 62. Year. Children. Adults. Grand Total. Boys. Girls. Total. Males. Females. Total. 1932 560 1,613 2,173 8 4 12 2,185 1933 550 1,579 2,129 7 11 18 2,147 1394 611 1,715 2,326 6 1 7 2,333 1935 603 1,818 2,421 10 3 13 2,434 1936 632 1,747 2,379 4 3 7 2,386 Scabies.—The number of cases of scabies coming to tlie knowledge of the Department during the year was 100, a considerable increase on the figures of previous years. In 1935 the corresponding figure was 64, in 1934 it was 77, in 1933 it was 57 and in 1932 it was 50. Thirty-nine of this year's cases occurred in Eltham and 61 in the rest of the Borough. The incidence of the disease per thousand population is much higher, therefore, in Eltham. It would appear as if the excessive proportion of children on new housing estates is now producing an increase in the incidence of scabies in the same way, as has been noted on many occasions in the past, the incidence of the common infectious diseases was increased. On the other hand undetected and untreated cases in adults present a great difficulty in the satisfactory control of scabies. It is not so easy to cure an Eltham child, two main difficulties standing in the way. From the middle of Eltham to the cleansing station at Plumstead is over 3 miles each way, so that the cost of transport of an infected family is considerable and each journey takes much more time. For these reasons the treatment is irregular and often inadequate. Arrangements for the establishment of a branch cleansing station at Eltham for the treatment of verminous conditions, including scabies, were under consideration at the end of the year. Bed-bug Infestation.—A report on the disinfestation of bug-infested premises and furniture and the methods adopted to prevent the infestation of new prennsts will be found in Section IV. 131 SECTION VIII. GENERAL STATISTICS. TABLE No. 63. Area (acres) 8,282 Population estimated to middle of 1936 146,500 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, 1936) £1,167,845 Sum represented by a penny rate (April, 1936) £4,774 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 146,500, an increase of 100 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 1936 is shown in the following Table, No. 64. 132 TABLE No. 64. Wards. Population. Dockyard 6,249 St. Mary's 5,533 River 10,361 St. George's 7,551 Burrage 7,059 Herbert 8,816 Glyndon 7,773 St. Margaret's 12,343 Central 7,117 St. Nicholas 12,983 Abbey Wood 12,753 Avery Hill 14,816 Well Hall 10,904 Sherard 22,242 In the old parishes the estimated populations are therefore:— Woolwich 29,694 Plumstead 68,844 Eltham 47,962 These figures show very little variation from those of last year. The number of persons per acre, in 1931, was 17.7; 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 follows:—Dockyard, 44.9; St. Mary's 55.9; River, 18.1; St. George's, 23.2; Burrage, 38.4; Herbert, 35.9; Glyndon, 25.7; St. Margaret's, 22.3; Central, 61.9; St. Nicholas, 10.8; Abbey Wood, 16.3; Avery Hill, 8.1; Well Hall, 15.8; Sherard, 17.8. Social Conditions. The following Table No. 65 sets out under generalised headings the total number of males and females engaged in occupations at ages of 14 years and upwards as shown by the Census of 1931. 133 TABLE No. 65. Occupations of Woolwich Inhabitants (over 14 years). Occupations. Males. Females. I. Fishermen — — II. Agricultural occupations 426 11 III. Mining and quarrying occupations 13 — IV. Workers in non-metalliferous mine and quarry products 74 1 V. Makers of bricks, pottery and glass 168 51 VI. Workers in chemicals, paints, etc. 926 13 VII. Metal workers 6,471 237 VIII. Workers in precious metals 69 9 IX. Electrical apparatus makers, fitters, etc. 1,696 1,086 X. Makers of watches, clocks, etc. 162 6 XI. Workers in skins and leather 135 34 XII. Textile Workers 22 48 XIII. Makers of textile goods 597 1,633 XIV. Makers of foods, drinks and tobacco 480 114 XV. Workers in wood and furniture 1,696 44 XVI. Workers in paper and cardboard 32 48 XVII. Printers and photographers 505 110 XVIII. Builders, bricklayers, etc. 2,485 2 XIX. Painters and decorators 1,182 46 XX. Workers in other materials 124 80 XXI. Workers in mixed or undefined materials (not enumerated elsewhere) 156 181 XXII. Transport Workers 5,547 463 XXIII. Commercial and financial occupations 5,221 1,926 XXIV. Public administration and defence 5,129 12 XXV. Professional occupations 1,432 1,358 XXVI. Persons employed in entertainment, etc. 326 61 XXVII. Persons employed in personal service 1,876 5,057 XXVIII. Clerks and draughtsmen 5,130 3,985 134 Table No. 65—continued. Occupations. Males. Females. XXIX. Warehousemen, storekeepers and packers 1,258 430 XXX. Stationary Engine Drivers, etc. 625 1 XXXI. Other and undefined workers 7,519 704 XXXII. Total Occupied 51,482 17,751 Total Unoccupied 5,313 39,963 Total Occupied and Unoccupied 56,795 57,714 Sickness and Invalidity. There have been no causes of sickness or invalidity which have been specially noteworthy in the area during the year. I am unacquainted with any conditions of occupation which appear to have had a prejudicial effect on health and I have no evidence, statistically or otherwise, that unemployment has exercised any significant influence on the health or physique of children or adults. 135 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. 66. Live Births—Legitimate 1,959 Live Births—Illegitimate 58 .. 2,017 Birth Rate .. 13.8 Still-births .. 56 Still-births—Rate per 1,000 total births .. 27.8 Deaths .. 1,649 Death Rate .. 11.2 Percentage of total deaths occurring in public institutions .. 61.6 Number of women dying in, or in consequence of, Child Birth (a) From Sepsis .. 2 (b) From other causes .. 3 Death rate of Infants under one year of age :— .. (a) All infants .. 59 (b) Legitimate infants .. 58 (c) Illegitimate infants .. 138 Deaths from Cancer (all ages) .. 259 Deaths from Measles (all ages) .. 13 Deaths from Whooping Cough (all ages) .. 8 Deaths from Diarrhoea (under 2 years of age) .. 25 136 The chief Vital Statistics since 1901 are given in the following Table TABLE No. 67. Year. Population estimated to middle of each Year. Births. Nett Deaths belonging to the District. Nett. Under 1 year. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. (1) (2) (3) (4) (5) (6) (7) (8) 1901 117,652 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 1,704 131 b 130,313 1917 a 147,078 2,718 20.6 216 79 1,566 11.9 b 131,942 1918 a 150,650 2,548 190 270 106 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 2,054 140 123 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 .o 1935 a 146,400 2,053 14.0 91 44 1,500 10.2 1936 a 146,500 2,017 13.8 121 59 1,649 11.2 a Total Population. b Civil Population. 137 The chief Vital Statistics for 193(5 for the Wards of the Borough are given in the following Table:— TABLE No. 68. Wards. Population. Births. Deaths under 1. Deaths at all ages Number Rate. Number Rate. Number Rate. Dockyard 6,249 116 18.5 5 43 68 10.9 St. Mary's 5,533 82 14.8 6 73 76 13.7 River 10,361 149 14.3 13 87 152 14.6 St. George's 7,551 124 16.4 7 56 76 10.1 Woolwich 29,694 471 15.9 31 66 372 12.5 Burrage 7,059 97 13.7 8 82 89 12.6 Herbert 8,816 126 14.3 9 71 117 13.2 Glyndon 7,773 118 15.2 9 76 119 15.3 St. Margaret's 12,343 171 13.8 4 23 144 11.7 Central 7,117 101 14.2 5 49 96 13.5 St. Nicholas 12,983 181 13.9 18 99 191 14.8 Abbey Wood 12,753 190 14.9 16 84 137 10.7 Plumstead 68,844 984 14.3 69 70 893 12.9 Well Hall 10,904 102 9.4 3 29 87 7.9 Avery Hill 14,816 164 11.1 2 12 126 8.5 Sherard 22,242 296 13.3 16 54 171 7.7 Eltham 47,962 562 11.7 21 37 384 8.0 BOROUGH 146,500 2,017 13.8 121 59 1,649 11.2 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 2,362 births were registered in the Borough, 1,257 being males and 1,105 females. Corrected by outward (327 males and 297 females) and inward (158 males and 121 females) transfers, these numbers become 2,017, 1,088 and 929 respectively. The birth-rate was 13.8 compared with 14.0 in 1935 and 13.7 in 1934. 138 Illegitimate Births.—The number of illegitimate births registered was 43. There were 21 inward transfers and 6 outward transfers, making a nett figure of 58, equivalent to 29 per 1,000 births. Natural Increase of Population.—This term means the excess of births over deaths. In 1932 it was 419; in 1933, 223; in 1934, 350; in 1935,553, and in 1936, 368. Notification of Births.—During the year 2,349 live births were notified. This is at the rate of 99.4 per cent, of the registered births and compares with 99.6 per cent, last year. The births were notified as shown in the following Table :— TABLE No. 69. British Hospital for Mothers and Babies 818 Midwives 546 St. Nicholas Hospital 400 War Memorial Hospital 210 Military Families Hospital 197 Medical Practitioners 58 Eltham Cottage Hospital 39 Parents 31 Midwives' Homes 23 Other persons 27 In addition to these, 112 notifications were received from the Medical Officer of Health, Lewisham; 96 from the Medical Officer of Health, Greenwich, and 44 from other Medical Officers of Health ; 601 births were transferred to other areas. Seventy-three still-births were notified, 18 of which were transferred to other areas. It is known that 1,350 Woolwich births took place in institutions, either within or without the Borough, so that the percentage of institutional midwifery for the Borough was 66.9. The following Table No. 70 shows the number of corrected births each year since 1932; 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. 139 TABLE No. 70. Year. No. of Births. No. of Live Births. Notified. No. of StillBirths Notified. Percentage of Births Notified. Birth Rate. Woolwich. London. England and Wales. 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 1936 2,017 2,349 55 99 13.8 13.6 14.8 Marriages. There were 1,422 marriages (1,315 in 1935). The marriage rate was 19.4 as compared with 17.9, 18.19, 17.70 and 15.79 in the four preceding years. Deaths. The total number of deaths registered in the Borough was 1,288. This figure includes 155 non-residents who died in the district but does not include 516 residents who died outside the Borough. When allowance is made for inward and outward transfers, the nett figure of 1,649 is obtained. The death-rate for the year was 11.2 compared with 10.2 in 1935 and 11.3 in 1934. 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 1936 is 11.8. In 1936 the death-rate for England and Wales was 12.1, for London 12.3 and the mean death-rate for 122 County Boroughs and Great Towns (including London) was 12.3. The seasonal mortality in the four quarters of the year was as follows :— First quarter, 13.6; Second quarter, 11.6; Third quarter, 8.4; Fourth quarter, 11. 140 Deaths over 45 years of age.—The number of deaths which occurred at 45 years of age and over was 1,225, or 74.2 per cent of the total deaths. The chief causes of these deaths were as follows:—heart disease, 404; cancer, 241; cerebral haemorrhage, 69; bronchitis, 65; pneumonia, 53 other circulatory diseases, 53 and tuberculosis, 35. 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. 71. Hospitals or Institutions. Number of Deaths. Public General Hospitals 770 Voluntary General Hospitals 133 Infectious Diseases Hospitals 57 Mental Hospitals 51 Special Hospitals 50 Cottage Hospitals and Nursing Homes 45 Sanatoria and Tuberculosis Institutions 8 1,114 As the total number of deaths was 1,649, the percentage of institutional deaths to total deaths was therefore 61.6. The following tables show the Birth Rates, Death Rates and Analysis of Mortality, the Nett Deaths (including non-residents in institutions in the Borough) and the Nett Deaths classified by sex and wards. 141 TABLE No. 72. Birth Rates, Death Rates and Analysis of Mortality in the Year 1936. 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.1 Total Deaths under 1 year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. Still - Births. England and Wales 14.8 0.61 12.1 0.01 – 0.07 0.01 0.05 0.08 0.15 0.55 5.7 59 90.4 6.2 2.4 1.0 122 County Boroughs and Great Towns, including London. 14.9 0.59 12.3 0.01 – 0.10 0.01 0.06 0.09 0.13 0.54 7.8 63 90.9 5.6 3.0 0.5 143 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931). 15.0 0.64 11.6 0.01 – 0.05 0.01 0.04 0.07 0.16 0.54 4.6 56 92.0 5.0 1.9 1.1 London 13.6 0.45 12.3 0.01 – 0.14 0.01 0.07 0.05 0.13 0.56 14.5 66 87.9 5.9 6.1 0.1 WOOLWICH 13.8 0.31 11.2 0.01 – 0.08 0.03 0.05 0.05 0.13 0.53 12.4 59 87.1 8.8 4.1 – 142 TABLE No. 73. Nett Deaths during the calendar year 1936, including non-residents in Institutions in the Borough. 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 Instit utions Residents. NonResid'ts. All Causes 1649 121 23 21 28 64 73 94 168 284 372 401 513 137 503 Typhoid and Paratyphoid Fevers 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 Measles 13 2 4 5 2 .. .. .. .. .. .. .. 1 .. 9 Scarlet Fever 4 .. .. 2 2 .. .. .. .. .. .. .. .. .. 4 Whooping Cough 8 3 2 3 .. .. .. .. .. .. .. .. .. .. 7 Diphtheria 7 1 .. 2 4 .. .. .. .. .. .. .. .. .. 7 Influenza 19 .. .. .. .. 2 2 3 2 4 3 3 6 1 3 Encephalitis Lethargica 4 .. .. .. .. .. 1 1 1 1 .. .. 2 .. 2 Cerebro-Spinal Meningitis 6 .. 1 1 2 2 .. .. .. .. .. .. .. .. 6 Tuberculosis of Respiratory System 104 .. .. .. 3 23 25 19 16 10 5 3 46 13 20 Other Tuberculous Diseases 12 .. 3 1 1 4 1 1 .. 1 .. .. 4 1 5 Syphilis 3 1 .. .. .. .. .. .. 1 .. 1 .. 2 .. 1 General Paralysis of the Insane, Tabes Dorsalis 5 .. .. .. .. .. .. 2 2 l .. .. .. .. 5 Cancer 259 .. .. .. .. 2 3 13 48 63 86 44 77 12 75 Diabetes 30 .. .. .. 1 .. .. .. 2 8 14 5 7 2 13 Cerebral Haemorrhage, etc. 71 .. .. .. .. .. .. 2 4 13 22 30 16 2 28 Heart Disease 423 .. .. .. .. 5 4 10 29 70 143 162 123 15 86 Aneurysm 8 .. .. .. .. .. .. .. .. 5 3 .. 1 .. .. Other Circulatory diseases 55 .. .. .. .. .. 1 1 2 12 19 20 11 2 25 Bronchitis 72 2 .. 1 .. .. l 3 6 14 11 34 4 2 16 Pneumonia 101 27 6 4 1 .. 4 6 14 23 10 6 35 7 31 Other Respiratory diseases 21 .. 1 .. .. 1 2 1 2 3 2 9 7 2 4 Peptic Ulcer 20 .. .. .. .. 2 1 3 4 6 3 1 14 4 5 Diarrhoea, etc. 30 25 .. .. 2 .. .. .. 1 1 1 .. 6 6 19 Appendicitis 7 .. .. 1 1 2 .. 1 1 1 .. .. 4 1 3 Cirrhosis of Liver 3 .. .. .. .. .. .. .. .. 1 2 .. 2 1 1 Other diseases of Liver, etc. 9 .. .. .. .. .. 1 1 1 3 3 .. 4 .. 4 Other Digestive diseases 20 2 .. .. .. .. 1 2 4 3 4 4 12 7 6 Acute and Chronic Nephritis 34 .. .. .. .. 2 3 4 5 6 6 8 11 2 5 Puerperal Sepsis 2 .. .. .. .. 1 1 .. .. .. .. .. 1 1 .. Other Puerperal Causes 3 .. .. .. .. .. 3 .. .. .. .. .. 2 .. 1 Congenital Debility, Premature Birth, Malformations, etc. 49 48 .. .. .. .. 1 .. .. .. .. .. 22 16 18 Senility 37 .. .. .. .. .. .. .. .. .. 4 33 12 1 14 Suicide 18 .. .. .. .. .. 7 6 1 4 .. .. 2 3 6 Violence 60 2 2 1 3 4 2 6 8 8 9 15 36 14 10 Other defined Diseases 131 8 4 .. 6 14 9 9 14 23 20 24 43 22 63 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 143 TABLE No. 74 Nett Deaths during 1936, 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 891 758 68 76 152 76 89 117 119 144 96 191 137 87 126 171 Typhoid and Paratyphoid Fevers. . 1 – – – – – – – – 1 – – – – – – Measles 7 6 – 2 2 2 1 – 1 1 – 1 2 – – 1 Scarlet Fever 3 1 – 1 – – – – – 1 – 1 – – – 1 Whooping Cough 2 6 – – – 1 1 – 1 – – 1 1 – 1 2 Diphtheria 3 4 – 1 – – – – 2 – – 1 1 – 1 1 Influenza 10 9 1 – – 2 1 2 2 3 – – 3 2 2 1 Encephalitis Lethargica 2 2 – – 1 1 – – – – – 2 – – – – Cerebro-Spinal Meningitis 3 3 – – 1 3 – – – – – – 1 – – 1 Tuberculosis of Respiratory System 67 37 4 3 12 3 6 4 13 7 5 14 5 4 8 16 Other Tuberculous Diseases 7 5 – – 1 – – – – 3 1 – 1 – – 6 Syphilis 2 1 – – 1 – – – 1 – – 1 – – – – General Paralysis of the Insane Tabes Dorsalis 3 2 – – 1 1 – 2 – – – – 1 – – – Cancer 133 126 12 9 29 13 12 19 15 19 15 29 22 14 24 27 Diabetes 14 16 1 2 1 – 2 – 1 4 3 5 4 1 2 4 Cerebral Haemorrhage, etc. 31 40 5 2 8 – 7 4 4 7 – 9 4 8 4 9 Heart Disease 223 200 18 21 37 9 29 32 34 34 34 48 38 22 31 36 Aneurysm 4 4 – 1 – 2 – – – 3 – 1 – – – 1 Other Circulatory Diseases 29 26 3 4 2 1 2 7 1 7 2 4 3 3 10 6 Bronchitis 41 31 1 2 7 3 8 5 6 10 2 11 7 5 – 5 Pneumonia 59 42 5 3 16 3 5 7 9 6 5 12 6 9 8 7 Other Respiratory Diseases 9 12 1 – 2 – 1 3 1 – – 4 6 – 3 – Peptic Ulcer 17 3 – 1 2 1 2 1 4 1 1 4 – – 2 1 Diarrhoea, etc. 15 15 1 1 6 1 3 – – 2 2 5 8 – – 1 Appendicitis 3 4 – 1 1 1 – – – 3 – 1 – – – – Cirrhosis of Liver 3 – – – – – – – – – 1 1 – – 1 – Other Diseases of Liver, etc. 4 5 – 1 – – – 1 – 1 1 2 1 – 2 – Other Digestive Diseases 14 6 – 1 – 1 1 2 2 – 3 1 2 1 3 3 Acute and Chronic Nephritis 14 20 1 2 3 1 – 3 1 4 1 1 1 6 5 5 Puerperal Sepsis – 2 – – 1 – – – – – – – – – – 1 Other Puerperal causes – 3 – – – – – – – 2 – – – – 1 – Congenital Debility, Premature Birth, Malformations, etc. 29 20 2 1 4 4 2 6 1 4 1 6 5 3 1 9 Senility 13 24 2 3 6 1 – 5 1 4 5 2 2 – 3 3 Suicide 14 4 1 1 – 3 – 1 1 – 1 2 2 – 4 2 Violence 38 22 4 6 2 5 2 4 3 8 5 6 2 2 2 9 Other Defined Diseases 74 57 6 7 6 14 4 9 15 9 8 16 9 7 8 13 Causes ill-defined or unknown – – – – – – – – – – – – – – – – 144 Causes of Death.—-Table No. 73 shows that 423 deaths were due to heart disease, 259 to cancer, 116 to tuberculosis, 101 to pneumonia, 72 to bronchitis, 71 to cerebral haemorrhage and 55 to diseases of circulation. There were 49 deaths from congenital debility and prematurity. Seventy-four per cent, of all deaths occurred in persons over 45 years of age. Respiratory Diseases.—The following Table No. 75 shows the number of deaths each year since 1932 from respiratory diseases, the amiual 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. 75. Year. Bronchitis. Pneumonia. Other Respiratory. Total. DeathRate. Number under 5 years. Percentage under 5 years. 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 1936 72 101 21 194 1.1 41 21.1 Cancer.—The total number of deaths was 259, of which 133 occurred in males and 126 in females. In the following Table No. 76 is shown the number of deaths certified as due to Cancer and Malignant Disease, each year since 1932:— TABLE No. 76. Males. Females. Total. Rate. Percentage of Total Deaths. 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 1936 133 126 259 1.57 15.71 145 The following Table No. 77 shows the seat of primary disease in all deaths from Cancer, including all other specified malignant tumours. TABLE No. 77. Seat of Primary Disease Males. Females. Total. Deaths in Hospital. Lip 1 – 1 1 Tongue 4 – 4 3 Mouth and Tonsil 4 1 5 4 Jaw 1 – 1 – Pharynx 3 – 3 3 Oesophagus 10 4 14 8 Stomach 25 21 46 26 Liver and Gall Bladder 2 7 9 1 Intestines 15 18 33 19 Rectum 14 12 26 16 Ovary – 8 8 7 Uterus – 9 9 5 Breast – 26 26 15 Skin 1 2 3 2 Larynx 6 1 7 6 Lung 9 4 13 7 Bronchus 3 – 3 3 Pancreas 5 1 6 5 Kidney – 1 1 1 Bladder 7 – 7 5 Prostate 12 – 12 5 Others and unspecified 6 5 11 4 Sarcoma 5 6 11 6 133 126 259 152 146 The Table which follows would appear to show a steady lowering of the maternal mortality rate in this Borough TABLE No. 78. Maternal Mortality, Woolwich, 1912-1936. 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 1920 – 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 1936 – 1 – – – 1 – 1 2 5 Totals 8 14 7 17 16 8 31 17 96 214 Inquests.—There were 145 inquests held on Woolwich residents during the year, compared with 129 in 1935. Deaths of Children, 1-5 Years of Age.—The number of deaths of children between 1 and 2 years of age was 23, and between 2 and 5 years, 21. In 1935 these figures were 10 and 13. The causes of death are given in detail in Table No. 73. 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. 147 TABLE No. 79. 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. 1932 2,016 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 1936 1,942 2.58 1.54 3.09 – 4.63 11.84 TABLE No. 80. Child Mortality (2—5 years). Death-rates per 1,000 estimated age population from stated Groups of Diseases. d. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhoeal Diseases. All other causes. Total Deaths. 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 1936 5,478 1.83 0.18 0.91 – 0.91 3.83 Infant Mortality. The number of deaths of infants under one year of age was 121, compared with 91 in 1935 and 127 in 1934. The rate of infant mortality resulting from these deaths (deaths under 1 year per 1,000 births) was 59, compared with 44 in 1935 and 63 in 1934. The rates for the different Wards in the Borough are shown in Table No. 68. The rate for the Administrative County of London was 66, and for England and Wales, 59. The following Table No. 81 shows the distribution of infant mortality throughout the year, calculated on a varying year basis. 148 TABLE No. 81. Births. Deaths under 1 year. Rate. First Quarter 446 30 67 Second Quarter 521 32 61 Third Quarter 497 27 54 Fourth Quarter 553 32 58 Causes of Death.—The causes of infant mortality are set forth in Tables Nos. 83 and 84, 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, 27; Diarrhoea, 25; Premature birth, 20; Congenital malformation, 14, and Atelectasis, 7. The number of deaths occurring in the first week of life was 29. Deaths of Illegitimate Children.—Eight illegitimate children died, compared with 9 in 1935 and 14 in 1934. The infant mortality rate figure for illegitimate children was 138, compared with 58 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. 71. TABLE No. 82. Hospitals or Institutions. Number of Deaths. Public General Hospitals 60 Voluntary General Hospitals 11 Special Hospitals 13 Infectious Diseases Hospitals 14 98 Tables are set out in the following pages which classify in various ways the causes of infant deaths during 1936. 149 TABLE No. 83. Infant Mortality, 1936. Nett deaths from stated causes at various ages under one year of age. Causes of Death. Under 1 week. 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 1 month and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Measles .. .. .. .. .. .. .. 2 .. 2 Whooping Cough .. .. .. .. .. 3 .. .. .. 3 Diphtheria and Croup .. .. .. .. .. 1 .. .. .. 1 Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. 1 .. .. 1 Bronchitis .. .. .. .. .. 1 1 .. .. 2 Pneumonia .. .. .. .. .. 5 7 12 3 27 Diarrhoea .. .. .. .. .. 6 10 8 1 25 Rickets .. .. .. .. .. .. .. .. 1 1 Injury at Birth 2 .. .. 1 3 .. .. .. .. 3 Atelectasis 7 .. .. .. 7 .. .. .. .. 7 Congenital Malformation 4 1 1 2 8 1 1 4 .. 14 Premature Birth 15 2 1 .. 18 2 .. .. .. 20 Atrophy, Debility and Marasmus .. .. 2 .. 2 .. .. .. .. 2 Convulsions 1 .. .. .. 1 . .. 1 .. .. 2 Other Causes .. 1 1 2 4 2 2 3 .. 11 29 4 5 5 43 21 23 29 5 121 Nett Births registered during the calendar year Legitimate, 1,959; Illegitimate, 58. Nett Deaths registered during the calendar year Legitimate 113; Illegitimate 8. 150 TABLE No. 84. 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 1 1 – 1 – – – – – – – – 1 – – – Whooping Cough 1 2 – – – – – – – – – – 1 – 1 1 Diphtheria and Croup – 1 – – – – – – – – – 1 – – – – Syphilis 1 – – – – – – – – – – 1 – – – – Bronchitis 1 1 – – – – – – 1 – – – – – – 1 Pneumonia 17 10 3 1 4 1 2 1 6 – 1 4 1 – – 3 Diarrhoea 13 12 – 1 5 1 3 – – 1 2 4 7 – – 1 Rickets – 1 – 1 – – – – – – – – – – – – Injury at Birth 1 2 – – – – – – – – – – – 1 – 2 Atelectasis 4 3 – – – 1 1 1 1 1 – 1 – 1 – – Congenital Malformation 9 5 – – 1 1 – 1 – 1 – 3 4 1 – 2 Premature Birth 12 8 2 1 1 2 1 2 – 1 1 2 1 – 1 5 Atrophy, Debilitv and Marasmus 1 1 – – 2 – – – – – – – – – – – Convulsions 1 1 – – – – – 1 – – – – – – – 1 Other Causes 7 4 – 1 – 1 1 3 1 – 1 2 1 – – – 69 52 5 6 13 7 8 9 9 4 5 18 16 3 2 16 151 APPENDIX. METEOROLOGICAL OBSERVATIONS TAKEN AT THE ROYAL OBSERVATORY, GREENWICH, DURING THE YEAR 1936. Week ending. Temperature of the Air. Departure from average mean air temperature for 65 years. Average temperature 4 feet below ground. Number of days on which rain fell. Rainfall in inches' Highest during week. Lowest during week. Mean temperature. Jan. 4 50.9 35.2 44.6 + 6.0 44.8 6 1.18 „ 11 56.1 34.1 45.8 + 7.8 45.2 6 0.99 „ 18 410 24.8 33.4 —4.8 44.6 3 0.48 „ 25 49.0 25.1 38.7 —0.1 43.0 5 0.58 Feb. 1 52 .1 36.9 45.6 + 6.0 43.1 7 1.26 „ 8 45.5 24.6 34.7 —4.8 43.4 1 0.10 „ 15 42.8 19.4 33.2 —5.8 41.7 1 0.12 „ 22 54.3 29.8 42.2 + 2.6 41.0 5 0.89 „ 29 47.4 29.4 37.6 —2.6 41.7 5 0.26 Mar. 7 51.6 28.0 38.7 —2.0 41.7 5 0.19 „ 14 60.4 32.3 43.4 + 2.3 42.3 3 0.10 „ 21 65.3 31.3 38.9 + 3.9 42.9 - 0.00 „ 28 65.3 38.8 50.8 + 8.1 44.1 3 0.41 Apr. 4 63.8 35.5 48.4 + 3.2 45.8 5 0.66 „ 11 52.2 34.3 41.7 —4.4 45.7 1 0.03 „ 18 53.8 29.2 40.7 —6.2 45.2 2 0.13 „ 25 62.0 28.3 44.6 —4.0 45.1 5 0.72 May 2 63.1 36.7 49.9 + 0.9 46.4 2 0.26 „ 9 79.6 41.7 53.9 + 3.4 48.0 - 0.00 „ 16 75.0 42.1 57.7 + 5.4 49.7 1 0.07 „ 23 74.6 39.0 55.1 + 1.2 51.4 4 0.26 „ 30 67.9 33.7 52.8 —3.2 52.1 1 0.04 June 6 68.4 40.0 51.0 -6.9 52.2 6 0.89 „ 13 75.4 51.0 59.1 +0.9 52.9 2 0.48 „ 20 85.3 48.3 64.0 + 4.9 54.5 2 0.87 ,, 27 87.8 55.1 67.4 + 6.3 56.8 4 0.81 July 4 76.3 56.1 62.9 + 1.2 58.0 5 0.54 „ 11 76.9 51.3 62.0 —0.5 58.7 4 0.93 „ 18 77.8 52.2 61.9 — 1.4 58.9 6 0.71 „ 25 71. 2 47.7 59.7 —3.3 59.0 5 0.56 Aug. l 73.0 46.6 58.7 —3.6 58.9 5 0.55 „ 8 70.1 50.4 59.0 —3.1 58.8 4 0.13 „ 15 81.5 47.7 61.2 — 1.2 58.9 3 0.35 „ 22 82.9 51.3 64.7 + 3.0 59.5 1 0.06 „ 29 84.6 46.0 63.9 + 3.3 60.0 - 0.00 Sep. 5 82.8 54.2 63.6 + 3.9 60.0 3 0.71 „ 12 76.9 52.3 60.6 —2.0 59.8 4 0.39 „ 19 72.0 47.5 58.5 + 1.2 59.5 3 0.40 „ 26 72.3 48.8 59.7 + 4.1 59.2 5 1.46 152 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. 3 58.9 36.1 50.1 —4.2 58.4 2 0.20 „ 10 62.6 34.0 45.8 — 6.4 56.4 3 0.05 „ 17 67.2 36.0 51.9 + 1.8 54.9 2 0.06 „ 24 61.7 42.0 51.3 + 2.7 54.3 3 0.14 „ 31 63.1 30.3 48.8 + 1.4 53.7 6 1.55 Nov. 7 53.9 34.8 45.6 —0.7 52.2 6 0.76 „ 14 55.0 31.9 46.1 + 2.0 51.5 6 1.52 „ 21 56.1 35.7 46.0 + 3.5 50.5 5 0.65 „ 28 45.8 32.9 38.0 —3.8 49.7 1 0.02 Dec. 5 54.6 32.4 45.8 + 4.7 48.9 3 0.30 „ 12 45.0 25.7 35.9 —4.9 47.9 3 0.37 „ 19 55.2 28.0 45.6 + 5.3 46.9 6 1.09 „ 26 51.9 30.8 42.6 + 4.1 47.0 3 0.08