woo 38 Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1938 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 HEALTH COMMITTEE. At 31st December, 1938. The Worshipful the Mayor (Councillor T. Watt, J.P.) Councillor C. H. Darby (Chairman). Councillor A. H. Gilder (Vice-Chairman). Alderman: Mrs. E. Brooks. Councillors: J. W. Andrews D. B. Lister Miss M. Crout, J.P. S. W. Lister G. S. Dean Mrs. E. L. Reeves. Mrs. L. E. Driver E. G. Stevenson G; E. Greenwood H. Vaughan C. J. Keedy Miss G. E. Walters, J.P MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee. Alderman Mrs. E. Brooks (Chairman). Councillor Miss G. E. Walters, J.P. (Vice-Chairman). 3 TABLE OF CONTENTS PAGE Health Committee 2 Maternity and Child Welfare Committee 2 Preface 6 I.—GENERAL STATISTICS. Area 9 Population 9 Inhabited Houses 10 Rateable Value, etc 10 Physical Features of the Area 10 Social Conditions 11 Sickness and Invalidity 11 II.—VITAL STATISTICS. Annual Statistics (including those of Wards) 12 Births 14 Marriages 16 Deaths 16 Deaths from Cancer 21 Maternal Mortality 21 Child Mortality 22 Infant Mortality 23 III.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Public Health Officers of the Authority 27 Clinics and Treatment Centres 32 Institutional Provision for Mothers or Children 33 Ambulance Facilities 34 Professional Nursing in the Home 34 Midwifery and Maternity Services 35 Health Visiting 35 Infant Life Protection 36 Hospitals 36 Orthopaedic Treatment 36 Dental Treatment 36 Adoptive Acts, By-laws and Regulations in force in the District 37 Laboratory Facilities 37 Vaccination 37 Supply of Insulin 39 School Medical Service (l.C.C.) 39 IV.—HEALTH PROPAGANDA. National Health Campaign 42 Health Film Displays for School Children 42 Health Film Displays for Adults 43 Informal Talks 43 Cookery Classes 43 Central Council for Health Education 44 " Better Health " 44 Health Services Booklet 44 Health and Happiness for Baby 44 Leaflets 44 Posters 45 Bookmarks 45 London County Council Midwifery Scheme 45 4 V.—SANITARY ADMINISTRATION. PAGE Staff 46 Water Supply 46 Drainage 46 Removal and Disposal of Refuse 46 Complaints 47 Sanitary Inspection of the Area 47 Shops Act, 1934 49 Smoke Abatement 49 Public Baths and Washhouses 49 Eradication of Bed-Bugs 50 Factories Act 53 The Rats and Mice (Destruction) Act, 1919 55 Fouling of Footways by Dogs 55 Nuisance from Pigeons 55 Rag and Bone By-laws 56 Rag Flock Act 56 Mortuaries 56 Cemeteries 56 Offensive Trades 57 Removal of Infirm and Diseased Persons 57 Pharmacy and Poisons Act, 1933 57 Legal Proceedings 58 VI.—HOUSING. Statistics 59 Overcrowding 61 Inspection of Houses 61 Underground Rooms 62 Re-housing of Old People 63 New Houses 63 Council's Houses 63 Increase of Rent and Mortgage Interest (Restrictions) Acts 64 Tents and Vans 64 Houses Let in Lodgings 64 Common Lodging Houses 64 Clearance Areas 64 VII.—PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. General Reference Notifications and Deaths Diphtheria 81 Scarlet Fever 82 Puerperal Fever and Puerperal Pyrexia 84 Erysipelas 85 Malaria 85 Enteric Fever 85 Dysentery 85 Anterior Poliomyelitis 85 Encephalitis Lethargica 86 Smallpox 86 Cerebro-spinal Meningitis 86 Whooping Cough 86 Zymotic Enteritis 87 Ophthalmia Neonatorum 87 Measles 88 Pneumonia 89 Tuberculosis 90 Arrangements for Disinfection and Disinfestation 103 5 VIII.—INSPECTION AND SUPERVISION OF FOOD. PAGE General Reference 105 Milk Supply 105 Meat Supply 107 Registered Premises 110 Other Food Premises 110 Unsound Food 112 Merchandise Marks Act, 1926 112 Agricultural Produce (Grading and Marking) Acts 112 Sophistication of Food 113 Adulterated Samples—Action Taken 121 Other Legal Proceedings 123 Nutrition 123 Chemical and Bacteriological Examination of Food 123 Food Poisoning 123 IX.—MATERNITY AND CHILD WELFARE. General Reference 125 Staff 126 Public Health (London) Act, Part xii 127 The Work of the Health Visitors 127 Infant Life Protection 128 The Work of the Welfare Centres 129 Toddlers' Clinics 134 Artificial Sunlight Clinic 137 Ear, Nose and Throat Clinic 139 Provision of Maternity Outfits 139 Compensation to Midwives 140 Payment of Midwives' Fees 140 Administration of the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926 140 Obstetric Complications in Private Practice 141 Home Helps 141 Boarding out of Children 141 Expenses of Mothers Breast-feeding their Babies in Hospital 14> Treatment of Minor Ailments 141 Dental Treatment 142 Orthopaedic Treatment for Children under Five years of Age 143 Provision of Nursing Assistance 144 Children's Beds 144 Institutional Midwifery 145 Ante-Natal Treatment and Emergencies 145 Convalescent Home Treatment for Children under Five years of age 145 Convalescent Home Treatment for Expectant and Nursing Mothers 145 Supply of Milk, etc., to Necessitous Mothers and Children 145 Blind Persons Act, 1920 146 Widows', Orphans' and Old Age Contributory Pensions Act, 1925 146 Salaried Midwives Scheme 146 APPENDIX. Meteorological Table 147 6 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Thirty-Eighth 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 Circular 1728, in order to ensure uniformity in the presentation of Annual Reports of Medical Officers throughout the country. The principal vital statistics for the year are as follows:—the birth rate was 13.6, a decrease of 0.6 on that of 1937 ; the infantile mortality rate was 50, compared with 40 in the previous year and 59 in 1936 ; the neo-natal mortality rate "(deaths under four weeks per thousand births) was 23.8 as against 17.41 the previous year. The number of maternal deaths was 1, the rate for the year per thousand births being 0.47, as against 1.35 in 1937. This is the lowest maternal mortality rate this Borough has ever known. The population of the Borough is estimated by the Registrar General to be 150,900, an increase of 1,500 on 1937. This is the total population and includes non-civilians, and it is on this figure that the vital statistics of the Borough are calculated. Progress in health education is reported fully in Section IV. The Council co-operated whole-heartedly in the second half of the National Health Campaign during the first three months of 1938, as they had done in the first half at the end of 1937. There is every reason to believe that the Campaign did much to stimulate public interest in the Council's health services. The Chief Sanitary Inspector and his staff have had a busy year—doing good solid work in environmental hygiene—in the improving of housing conditions, in the abatement of nuisances, in food control, and in preventing the spread of infectious disease. 7 It is now five years since the intensive policy with regard to the elimination of unhealthy dwellings began. In that time 71 areas, comprising 667 houses, have been represented by me in Woolwich. An additional four areas, comprising 538 houses, have been represented by officers of the London County Council. The number of persons rehoused or to be rehoused in all is 5,611. Detailed information with regard to each of these areas is given in this year's annual report, or has been given in reports of previous years. There remain other clearance areas to be dealt with both by the London County Council and by the Borough Council, but the housing situation is very much better than it was five years ago. It is not possible to give such definite information with regard to overcrowding. A large number of the known cases of overcrowding have been abated in diverse ways, but one cannot be sure that there is not overcrowding elsewhere. Only after another housing survey, similar to that carried out in 1936, can it be definitely stated that the overcrowding position is definitely improved. Compared with 1937, there was an increase in the incidence of scarlet fever, 507 as against 428, and a decrease in the incidence of diphtheria, 264 as against 297. There were 4 deaths from scarlet fever and 8 from diphtheria. There were fewer notifications of enteric fever, 6 compared with 17, and of dysentery, 50 compared with 81. Measles was present in epidemic form. The number of notifications of tuberculosis received during the year, including duplicates, was 248, compared with 264 in 1937. At the end of the year there were 751 persons suffering from pulmonary tuberculosis, and 152 persons suffering from non-pulmonary tuberculosis, that is in all 903 persons (928 in 1937) living in the Borough. The number of deaths from tuberculosis during the year was 128, compared with 119 in 1937. There is nothing which calls for comment in the supervision of the food supplies during the year. This work proceeded in very much its usual way. There was, however, an increase of over eight thousand in the number of animals killed at the abattoir in Shooters Hill. It is not generally known that nearly half of the private slaughterhouse work in London is done in Woolwich. A very interesting commentary on the examination of food and drugs has been prepared by the Public Analyst and will be found in Section VIII. It is pleasing to record the increased interest taken by mothers in the Council's toddlers clinics. Nearly 400 more children were examined last year than in any previous year. It is clear from what is happening that the very complete scheme of the Council for dealing with the care and comfort of the toddler is being appreciated in the Borough. The machinery for remedying defects discovered has been improved. The salaried midwives scheme of the London County Council came into operation at the beginning of the year and the Borough Council are helping as much as they can through their ante-natal clinics and through the provision of their ancillary services. 8 Since my last report, the following staff changes have taken place:— Dr. W. Cowie, public vaccinator, resigned his appointment on the 5th January, 1938. Miss A. Carey, appointed as a health visitor in 1933, resigned her appointment on the 31st January, 1938. Miss P. H. Newbury, woman sanitary inspector, commenced duty on the 1st February, 1938. Mr. W. E. McLelland, sanitary inspector, commenced duty on the 1st February, 1938. Mr. S. E. Birdsall, F.R.C.S., was appointed Consultant to the Ear, Nose and Throat Clinic on the 2nd February, 1938. Miss L. Berry, health visitor, commenced duty on the 14th February, 1938. Miss G. B. Day, health visitor, commenced duty on the 16th February, 1938. Mr. J. B. Blaikley, F.R.C.S., was appointed obstetric consultant on the 23rd February, 1938. Mr. A. L. Gunn, F.R.C.S., was appointed obstetric consultant on the 23rd February, 1938. Mr. A. L. Walker, F.R.C.S., was appointed obstetric consultant on the 23rd February, 1938. Mr. J. Lewington, temporary clerk, was appointed to Grade "A" from the 1st April, 1938. Miss M. W. Clifton, Clerk Grade "A," commenced duty on the 28th December, 1938. Air raid precautions have thrown a great deal of extra work upon the Department; representatives of all branches of the Department's work have been engaged in teaching or in organisation. During the latter half of the year the Department had to work under very great pressure, but I am very glad to be able to say that all have given their services ungrudgingly and unsparingly. In conclusion I desire to express my gratitude to the Chairman and Members of the Committees on Health, and, indeed, to all Members of the Council, for the interest they have taken in the work of the Department, and for their continued kindliness, confidence and support. I take this opportunity also of placing on record my sincere appreciation of the work of every member of the Staff and how much I owe to them personally. I am, Mr. Mayor, Ladies and Gentlemen, Your Obedient Servant, J. MACMILLAN, Medical Officer of Health. 9 SECTION I. GENERAL STATISTICS. Akea. The area of the Borough is 8,282 statute acres. Parts of the River Ward, where there were 3,529 inhabitants at the time of the Census in 1931, are situate on the North side of the River Thames. The Borough was originally divided into three parishes—Woolwich, Plumstead and Eltham. The acreage of Woolwich parish is 1,135, and of its wards as follows:—Dockyard, 139; St. Mary's, 99; River, 572; St. George's, 325. The acreage of Plumstead parish is 3,387; and its wards as follows:—Burrage, 184; Herbert, 245; Glyndon, 302; St. Margaret's, 552; Central, 115; St. Nicholas, 1,207; Abbey Wood, 782. The acreage of Eltham parish is 3,760, and its wards as follows:—Well Hall, 687; Avery Hill, 1,824 ; Sherard, 1,249. 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, 43.8; St. Mary's, 54.7; River, 16.7; St. George's, 22.1; Burrage, 37.1; Herbert, 36.3; Glyndon, 24.9; St. Margaret's, 24.7; Central, 59.7; St. Nicholas, 10.8; Abbey Wood, 16.2; Well Hall, 16.5; Avery Hill, 9.3; Sherard, 19.8. Population. The Registrar General estimates the population of the Borough at the middle of the year as 150,900, an increase of 1,500 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 1938 is shown in the following Table No. 1. 10 TABLE No. 1. Wards. Population. Dockyard 6,092 St. Mary's 5,415 River 9,538 St. George's 7,180 Burrage 6,831 Herbert 8,997 Glyndon 7,521 St. Margaret's 13,643 Central 6,862 St. Nicholas 13,060 Abbey Wood 12,701 Well Hall 11,344 Avery Hill 17,010 Sherard 24,706 In the old parishes the estimated populations are therefore:— Woolwich 28,225 Plumstead 69,615 Eltham 53,060 Inhabited Houses. The number of inhabited houses at the time of the Census in 1931 was 29,870. These were occupied by 38,176 families. At the end of 1938, according to the rate books, the number of inhabited houses was 35,023. Rateable Value, Etc. The rateable value of the Borough in October, 1938, was £1,250,133, and the sum represented by a penny rate at that date was £5,021. 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. 11 Social Conditions. In my Annual Report for 1936 I published a Table taken from the Census Returns of 1931 which set out under generalised headings the total number of males and females engaged in occupations at ages of 14 years and upwards. There was little unemployment in Woolwich during the year. 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. 12 SECTION II. VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the vital statistics of the year are shown below:— TABLE No. 2. Live Births—Legitimate 1,987 Live Births—Illegitimate 72 2,059 Birth Rate per 1,000 population 13.6 Still-births 60 Still-births—Rate per 1,000 total births 28.3 Deaths 1,576 Death Rate per 1,000 population 10.4 Deaths from puerperal causes:— (a) From Sepsis — (6) From other causes 1 Death rate from puerperal causes per 1,000 total births 0.47 Death Rate of Infants one year of age:— (a) All Infants 50 (b) Legitimate Infants 49 (c) Illegitimate Infants 69 Deaths from Cancer (all ages) 245 Deaths from Measles (all ages) 4 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 19 13 The chief Vital Statistics since 1911 are given in the following Tables. TABLE No. 3. 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) 1911 121,487 2,810 23.1 272 97 1,566 12.9 1912 121,932 2,776 22.8 208 75 1,456 11.9 1913 122,382 2,833 23.1 228 80 1,549 12.7 1914 122,431 2,838 23.2 241 85 1,706 13.9 1915 a 138,200 2,839 21.9 268 94 1,837 14.2 b 129,505 1916 a 141,783 3,068 23.5 213 69 1,704 13.1 b 130,313 1917 a 147,078 2,718 20.6 216 79 1,566 11.9 b 131,942 1918 a 150,650 2,548 19.0 270 106 2,100 15.6 b 134,453 1919 a 141,918 2,737 20.1 235 86 1,679 12.3 b 136,237 1920 a 140,000 3,658 26.9 224 61 1,487 10.9 b 135,904 1921 a 141,700 3,197 23.2 197 62 1,594 11.6 b 137,604 1922 a 142,350 2,941 21.3 184 63 1,603 11.6 b 138,254 1923 a 143,530 2,867 20.5 123 43 1,387 9.9 b 140,000 1924 a 144,400 2,590 18.5 168 65 1,543 1.0 b 139,980 1925 a 145,440 2,582 18.3 141 55 1,519 10.8 b 140,740 1926 a 146,200 2,463 17.4 107 43 1,450 10.2 b 141,900 1927 a 144,770 2,242 15.9 95 42 1,491 10.6 b 140,770 1928 a 146,600 2,269 16.1 114 50 1,554 11.0 b 141,100 1929 a 146,800 2,312 16.3 144 62 1,780 12.6 b 141,600 1930 a 146,800 2,188 15.5 91 42 1,547 10.9 b 141,600 1931 a 147,400 2,155 15.1 128 59 1,654 11.6 b 142,600 1932 a 146,400 2,054 14.0 123 60 1,635 11.1 1933 a 146,200 1,857 12.7 116 62 1,634 11.2 1934 a 145,520 2,000 13.7 127 63 1,650 11.3 1935 a 146,400 2,053 14.0 91 44 1,500 10.2 1936 a 146,500 2,017 13.8 121 59 1,649 11.2 1937 a 149,400 2,125 14.2 86 40 1,660 11.1 1938 a 150,900 2,057 13.6 102 50 1,576 10.4 a Total Population. b Civil Population. 14 The chief Vital Statistics for 1938 for the Wards of the Borough are given in the following Table— TABLE No. 4. Wards. Population. Births. Deaths under 1. Deaths at all ages Number Rate. Number Rate. Number Rate. Dockyard 6,092 99 14.6 3 30 68 11.2 St. Mary's 5,415 78 14.4 4 51 52 9.6 River 9,538 138 14.5 8 58 109 11.4 St. George's 7,180 127 17.7 6 47 47 6.5 Woolwich 28,225 442 15.7 21 48 276 9.8 Burrage 6,831 91 13.3 5 55 99 14.5 Herbert 8,997 158 17.6 8 50 106 11.8 Glyndon 7,521 107 14.2 3 28 97 12.9 St. Margaret's 13,643 191 14.0 13 68 169 12.4 Central 6,862 111 16.2 2 18 105 15.3 St. Nicholas 13,060 219 16.8 11 50 179 13.7 Abbey Wood 12,701 152 12.0 13 85 132 10.4 Plumstead 69,615 1,029 14 .8 55 53 887 12.7 Well Hall 11,344 115 10.1 4 35 96 8.5 Avery Hill 17,010 161 9.5 8 49 152 8.9 Sherard 24,706 310 12.5 14 45 165 6.7 Eltham 53,060 586 11.0 26 44 413 7.8 BOROUGH 150,900 2,057 13.6 102 50 1,576 10.4 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. The nett births for the year were 2,059, 1,032 being males and 1,027 females. In addition there were 60 still-births, 36 being males and 24 females. The nett number of illegitimate births was 74, 2 of these being still-births. The birth rate was 13.6 compared with 14.2 in 1937 and 13.8 in 1936. The birth rate for England and Wales was 15.1, for London 13.4, and the mean birth rate for the 126 great towns, including London, was 15.0. 15 Natural Increase of Population.— This term means the excess of births over deaths. In 1934 it was 350: in 1935, 553; in 1936, 368; in 1937, 465, and in 1938, 483. Notification of Births.— During the year 2,290 live births were notified. This is at the rate of 98.7 per cent, of the registered births and compares with 100.4 per cent, last year. The births were notified as shown in the following Table :— TABLE No. 5. British Hospital for Mothers and Babies 831 Midwives 532 St. Nicholas Hospital 411 Military Families Hospital 192 Woolwich War Memorial Hospital 185 Eltham Cottage Hospital 59 Medical Practitioners 39 Parents 9 Midwives Homes 6 Other Persons 26 TABLE No. 6. Year. No. of Births. No. of Live Births. Notified. No. of StillBirths Notified. Percentage of Births Notified. Birth Rate. Woolwich. London. England and Wales. 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 1937 2,125 2,423 75 100 14.2 13.4 14.9 1938 2,059 2,290 69 99 13.6 13.4 15.1 In addition to these, 152 notifications were received from the Medical Officer of Health, Lewisham; 102 from the Medical Officer of Health, Greenwich; and 60 from other Medical Officers of Health; 589 births were transferred to other areas. Sixty-nine still-births were notified; 21 of which were transferred to other areas. It is known that 1,414 Woolwich births took place in institutions, either within or without the Borough, so that the percentage of institutional midwifery for the Borough was 68.7. The following Table No. 6 shows the number of corrected births each year since 1934, 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. 16 Marriages. There were 1,576 marriages (1,496 in 1937). The marriage rate was 20.88, as compared with 20.0, 19.4, 17.9 and 18.19 in the four preceding years. Deaths. The total number of deaths registered in the Borough was 1,223. This figure includes 179 non-residents who died in the district but does not include 532 residents who died outside the Borough. When allowance is made for these inward and outward transfers, the nett figure of 1,576 is obtained. The death rate for the year was 10.4, compared with 11.1 in 1937, and 11.2 in 1936. 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. The proportion of old people to young and of men to women varies considerably in different parts of the country, and these proportions affect the crude death rate. The death rate is higher among old people and among young people than it is in the middle periods of life, and at all ages the death rate for men is higher than it is for women. The population of Woolwich differs from that of London in that it is a younger population. Death rates in Woolwich from tuberculosis are relatively higher and death rates from cancer relatively lower because of this fact, and the general death rate compares favourably with Boroughs where a large percentage of the population consists of older people. In order to obtain a proper comparison an adjusting factor has been introduced by the Registrar General and in the case of Woolwich it is higher than 1.0 because of the favourable distribution of the population as to age and sex. When the crude death rate for Woolwich (10.4) is multiplied by this adjusting factor (1.06), the adjusted death rate for 1938 is found to be 11.0, and it is this figure which should be used when comparing the death rate of Woolwich with that of other districts. In 1938 the death rate for England and Wales was 11.6, for London 11.4, and the mean death rate for the 126 County Boroughs and Great Towns, including London, was 11.7. The seasonal mortality in the four quarters of the year was as follows:— First quarter, 13.2; Second quarter, 9.5; Third quarter, 9.0; Fourth quarter, 9.9. Deaths over 45 years of Age.— The number of deaths which occurred at 45 years of age and over was 1,199 or 75.4 per cent, of the total deaths. 17 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. 7. Hospitals or Institutions. Number of Deaths. Public General Hospitals 754 St. Nicholas 446 Lewisham 135 St. Alfege's 81 Lambeth 21 St. George's in the East 18 Voluntary General Hospitals 111 War Memorial 28 Miller 18 Guys 9 Infectious Diseases Hospitals 37 Brook 20 Park 6 Mental Hospitals 33 Tooting 12 Bexley 11 Special Hospitals 12 Cottage Hospitals and Nursing Homes 41 Sanatoria and Tuberculosis Institutions 6 994 As the total number of deaths was 1,576, the percentage of institutional deaths to total deaths was 63.1. The following Tables Nos. 8 and 9, classify the nett deaths by age, by sex, and by wards. They show also the number of deaths in public institutions in the Borough of residents and non-residents and of residents in public institutions outside the Borough. 18 TABLE No. 8. Nett Deaths during the calendar year 1938, including non-residents in Institutions in the Borough. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the district. Deaths in Public Institutions. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. In Borough. Outlying Institutions. Residents. NonResid'ts. All Causes 1576 102 7 13 33 57 74 91 130 315 334 420 502 157 492 Typhoid and Paratyphoid Fevers 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Measles 4 .. 1 2 .. .. .. .. .. .. .. .. .. 3 Scarlet Fever 4 .. .. 1 2 1 .. .. .. .. .. .. .. .. 4 Whooping Cough 1 .. .. .. .. .. .. .. .. .. 1 Diphtheria 8 .. 1 3 4 .. .. .. .. .. .. .. 1 .. 7 Influenza 6 .. .. .. .. 1 1 1 1 Encephalitis Lethargica 3 .. .. .. .. .. .. 1 1 .. 1 .. 1 .. 1 Cerebrospinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of the Respiratory System 117 .. .. .. 2 23 29 14 14 26 8 1 47 23 34 Other Tuberculous diseases 11 .. 2 3 2 .. .. 1 .. .. 1 .. 9 Syphilis 3 .. .. .. .. .. .. 1 .. 2 .. .. 1 1 1 General Paralysis of the Insane, Tabes Dorsalis 5 .. .. .. .. .. .. 1 1 3 .. .. .. .. 4 Cancer 245 .. .. .. .. 5 18 36 83 55 48 86 19 75 Diabetes 22 .. .. .. .. .. 1 .. .. 5 10 6 6 3 8 Cerebral Haemorrhage, etc. 68 .. .. .. .. .. 1 .. 7 14 26 20 25 4 17 Heart Disease 456 1 3 5 11 24 78 124 210 116 21 106 Aneurysm 7 .. .. .. .. .. .. .. 2 2 3 .. 1 .. .. Other Circulatory diseases 51 .. .. .. .. .. .. I 1 15 11 23 4 2 25 Bronchitis 40 2 .. .. .. 1 .. 2 2 4 11 18 8 .. 10 Pneumonia 96 18 2 3 2 1 6 11 9 17 12 15 32 10 31 Other Respiratory diseases 21 2 .. .. .. .. .. I 2 2 6 8 7 2 7 Peptic Ulcer 21 .. .. .. .. .. 1 5 4 6 2 3 15 2 3 Diarrhoea, under 2 years 19 18 1 .. .. .. .. .. .. .. .. 3 .. 15 Appendicitis 11 .. .. .. 3 2 .. 1 2 2 i 8 6 2 Cirrhosis of Liver 2 .. .. .. .. .. .. .. .. 1 1 .. 1 1 1 Other Liver diseases 4 .. .. .. .. .. 1 .. 1 .. 1 I .. 1 3 Other Digestive diseases 39 .. .. 1 3 1 4 2 4 6 7 u 18 6 12 Acute and Chronic Nephritis 38 .. .. .. .. 1 4 6 4 8 9 6 19 2 10 Puerperal Sepsis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Puerperal Causes 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 Congenital Debility, Premature Birth, etc. 53 53 .. .. .. .. .. .. .. .. .. .. 21 11 15 Senility 22 .. .. .. .. .. .. .. 3 isj 8 1 7 Suicide 21 .. .. .. .. 2 2 1 3 8 3 2 4 2 2 Violence 58 .. .. 1 5 10 5 6 4 6 9 12 25 16 21 Other defined Diseases 118 5 2 3 7 9 8 6 11 25 28 14 44 23 55 Causes ill-defined or unknown . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 19 Nett Deaths during 1938, 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 874 702 68 52 109 47 99 106 97 169 105 179 132 96 152 165 Typhoid and Paratyphoid Fevers. . — 1 - - - - - - - - - - - - - 1 Measles 1 3 — 1 — 1 - - - - - 1 - - - 1 Scarlet Fever 1 3 — — 1 — — — — — — 2 1 — — — Whooping Cough — 1 - - - - 1 - - - - - - - - - Diphtheria 3 5 — — 1 1 3 1 1 - - - - - - 1 Influenza 2 4 — — — — 1 1 — 1 — 1 1 — 1 — Encephalitis Lethargica 2 1 - - - - - - - 2 - 1 -- - - - Cerebrospinal Meningitis — — — — — — — — — — — — — — — — Tuberculosis of Respiratory System 71 46 2 5 8 8 7 10 8 6 8 13 11 3 11 17 Other Tuberculous Diseases 7 4 — — — 1 — 1 — — — — 1 2 2 4 Syphilis 3 — — — — — . — 1 — — — 2 — — — — General Paralysis of the Insane, Tabes Dorsalis 4 1 1 1 - 1 - - - - - - 1 - 1 — Cancer 139 106 10 8 13 4 9 21 12 29 21 30 20 14 30 24 Diabetes 10 12 2 — — — 3 2 4 3 3 1 1 1 — 2 Cerebral Haemorrhage, etc. 36 32 2 — 7 — 4 6 8 5 2 9 6 3 7 9 Heart Disease 234 222 25 18 32 9 35 33 28 51 35 52 33 28 41 36 Aneurysm 4 3 1 — — — 2 — — — — 2 1 — — 1 Other Circulatory Diseases 34 17 2 2 3 1 2 1 3 9 2 6 6 4 7 3 Bronchitis 17 23 3 — 2 1 4 1 2 4 2 11 3 2 2 3 Pneumonia 58 38 3 4 10 3 4 7 7 9 4 8 8 4 8 17 Other Respiratory Diseases . . 12 9 2 — 3 — 2 — 1 1 1 1 3 3 2 2 Peptic Ulcer 19 2 — — 2 — 2 — 2 4 2 4 2 1 — 2 Diarrhoea (under 2 years) 9 10 — — 2 1 2 2 1 1 1 1 5 1 — 2 Appendicitis 9 2 — — 1 — 1 — 2 — 1 2 3 — — 1 Cirrhosis of Liver 1 1 - - - - - - - - - - — 1 1 — Other Diseases of Liver, etc. 1 3 - - - - - - - - - 1 - 2 1 — Other Digestive Diseases 21 18 1 1 4 2 1 2 4 5 3 3 4 4 2 3 Acute and Chronic Nephritis 17 21 2 — 1 — 1 2 1 4 3 6 2 4 7 5 Puerperal Sepsis - - - - - - - - - - - - - - - - Other Puerperal causes — 1 - - - - - - - - - - - - - 1 Congenital Debility, Premature Birth, etc. 28 25 2 1 1 1 1 5 2 10 1 6 6 3 8 6 Senility 11 11 1 2 5 1 — 1 — 4 1 2 2 — 2 1 Suicide 19 2 — 1 1 - 1 2 2 2 3 — 1 4 2 2 Violence 40 18 1 4 4 4 4 3 3 6 3 5 3 6 5 7 Other Defined Diseases . . 61 57 8 4 8 8 9 4 6 13 9 9 8 6 12 14 Causes ill-defined or unknown — — — — — — - - - - - - - - - 20 Causes of Death.—Table No. 8 shows that 456 deaths were due to heart disease, 245 to cancer, 128 to tuberculosis, 96 to pneumonia, 68 to cerebral haemorrhage, and 38 to nephritis. There were 53 deaths from congenital debility and prematurity. Respiratory Diseases.—The following Table No. 10 shows the number of deaths each year since 1934 from respiratory diseases, the annual death-rate, the number of deaths under five years of age, and the percentage of deaths occurring in children under five years of age:— TABLE No. 10. Year. Bronchitis. Pneumonia. Other Respiratory. Total. DeathRate. Number under 5 years. Percentage under 5 years. 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 1937 56 105 11 172 1.0 19 11.4 1938 40 96 21 157 1.0 27 17.2 Cancer.—The total number of deaths was 245 of which 139 occurred in males and 106 in females. In the following Table No. 11 is shown the number of deaths certified as due to Cancer and Malignant Disease, each year since 1934 :— TABLE No. 11. Year. Males. Females. Total. Rate. Percentage of Total Deaths. 1934 119 103 222 1.52 13.45 1935 106 107 213 1.45 14.20 1936 133 126 259 1.57 15.71 1937 123 122 245 1.64 14.75 1938 139 106 245 1.62 15.55 21 The following Table No. 12 shows the seat of primary disease in all deaths from Cancer, including all other specified malignant tumours. TABLE No. 12. Seat of Primary Disease. Males. Females. Total. Deaths in Hospital. Tongue 2 - 2 - Mouth 4 2 6 6 Jaw — — — — Pharynx 1 1 2 2 Oesophagus 8 1 9 8 Stomach 22 9 31 20 Liver and Gall Bladder 3 2 5 1 Pancreas 10 1 11 9 Intestines 14 15 29 19 Rectum 18 10 28 22 Larynx 2 3 5 2 Lung 15 7 22 12 Bronchus 3 — 3 2 Ovary — 6 6 4 Uterus — 10 10 6 Breast — 26 26 15 Kidney 1 2 3 1 Bladder 4 2 6 5 Prostate 13 — 13 10 Skin 6 2 8 3 Others and unspecified 5 3 8 5 Sarcoma 8 4 12 9 139 106 245 161 No knowledge is available as to the extent to which use is made of increased facilities now provided in National Radium Centres and no local investigations have been undertaken in pursuance of the suggestions contained in the Ministry's circulars of previous years. Investigations are not made into cancer deaths. Maternal Mortality.—The number of deaths from Puerperal Sepsis was nil, and from other accidents and diseases of pregnancy one, making a total of one maternal death compared with three in 1937. The maternal death rate per 1,000 births was 0.47 as against 1.35 in 1937. In the last two years there have not been any deaths from Puerperal Sepsis. 22 The Table which follows would appear to show a steady lowering of the maternal mortality rate in this Borough:— TABLE No. 13. Maternal Mortality, Woolwich, 1912-1938. Year. Abortion. Ectopic Gestation Placenta Praevia. Other Puerperal Haemorrhage. Other Accidents of ChildBirth. ChildBirth with Secondary Causes. Puerperal Eclampsia Puerperal Phlebitis and Embolism Puerperal Fever. Totals. 1912 1 - - - - - 1 1 1 4 1913 1 - - - 1 - 1 - 2 5 1914 1 - 1 2 - 1 1 1 4 11 1915 1 1 - - 1 - 2 - 3 8 1916 - 1 1 1 4 - 1 - 7 15 1917 - 1 - 2 - 1 2 1 7 14 1918 1 - - 2 1 - 1 1 9 15 1919 - 2 1 2 - - 2 1 5 13 1920 - 1 - - 1 - 1 3 5 11 1921 - - - - - - 3 2 5 10 1922 - - - 1 - - 2 - 3 6 1923 - - - - 1 - 1 - 3 5 1924 - - 2 1 1 - 3 1 2 10 1925 - - 1 2 1 1 1 - 3 9 1926 — 1 - 2 - - - 1 2 6 1927 - 1 - - - - 1 1 3 6 1928 - 2 1 - 1 - 1 - 8 13 1929 2 2 - - 2 1 3 1 3 14 1930 1 - - - - 1 2 - 4 8 1931 — - - - 1 - 1 - 6 8 1932 - - - 1 - - 1 - 4 6 1933 — 1 - - 1 1 - 1 2 6 1934 — - - - - 1 - - 2 3 1935 - - - 1 - - - 1 1 3 1936 - 1 - - - 1 - 1 2 5 1937 - - - 1 - - 1 1 - 3 1938 - - - 1 - - - - - 1 Totals 8 14 7 19 16 8 32 18 96 218 Inquests.—There were 115 inquests held on Woolwich residents in 1938, compared with 129 in 1937. An additional 111 deaths were certified by the coroner after post-mortem but without inquest. Deaths of Children, 1-5 years of age.—The number of deaths of children between 1 and 2 years of age was 7, and between 2 and 5 years, 13. In 1937 these figures were 21 and 44. The causes of death are given in detail in Table No. 8. 23 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 population at these ages and from stated groups of diseases. TABLE No. 14. 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. All Causes. 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 1937 1,902 1.05 1.05 1.52 — 1.05 4.73 1938 2,032 0.49 0.49 0.98 0.49 0.98 3.44 TABLE No. 15. Child Mortality (2—5 years). Death-rates per 1,000 estimated age population from stated Groups of Diseases. Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhoeal Diseases. All other causes. All Causes. 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 1937 5,504 0.91 0.18 0.36 — 0.73 2.18 1938 5,685 0.88 — 0.53 — 0.88 2.29 Infant Mortality. The number of deaths of infants under one year of age was 102, compared with 86 in 1937 and 121 in 1936. The rate of infant mortality (deaths under 1 year per 1,000 births) was 50, compared with 40 in 1937 and 59 in 1936. The deaths in the different Wards in the Borough are shown in Table No. 19. The rate for the Administrative County of London was 57; for England and Wales, 53; and for the 126 County Boroughs and Great Towns, including London, was 57. 24 The following Table No. 16 shows the distribution of infant mortality throughout the year, calculated on a varying year basis. TABLE No. 16. Births. Deaths under 1 year. Rate. First Quarter 534 36 69 Second Quarter 520 20 38 Third Quarter 417 19 38 Fourth Quarter 474 23 49 Causes of Death.—The causes of infant mortality are set forth in Tables Nos. 18 and 19, which show the incidence of mortality from each cause for infants classified by age, sex and wards. It will be noted from these Tables that the chief causes of death were:—Premature birth, 23; Diarrhoea, 18; Pneumonia, 18; Congenital Malformation, 14. The number of deaths occurring in the first week of life was 34. Deaths of Illegitimate Children.—Five illegitimate children died, compared with 8 in 1937 and 8 in 1936. The infant mortality rate figure for illegitimate children was 69, compared with 49 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. 7. TABLE No. 17. Hospitals or Institutions. Number of Deaths. Public General Hospitals 39 Voluntary General Hospitals 9 Special Hospitals 10 Cottage Hospitals and Nursing Homes 2 Infectious Diseases Hospitals 16 76 Tables which classify in various ways the causes of infant deaths in 1938, are set out on the following two pages. 25 TABLE No. 18. Infant Mortality, 1938. 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 ... ... ... ... ... ... 1 ... ... 1 Whooping Cough ... ... ... ... ... ... ... ... 1 1 Tuberculous Diseases ... ... ... ... ... 1 ... 1 ... 2 Bronchitis ... ... ... ... ... 2 ... ... ... 2 Pneumonia ... 1 1 ... 2 5 5 4 2 18 Diarrhoea ... 1 ... ... 1 8 5 3 1 18 Injury at Birth 5 1 ... ... 6 ... ... ... ... 6 Atelectasis 3 ... ... ... 3 1 ... ... ... 4 Congenital Malformation 2 2 2 2 8 4 2 ... ... 14 Premature Birth 21 1 1 23 ... ... ... ... 23 Icterus 2 1 1 1 5 ... ... ... ... 5 Other Causes 1 ... ... ... 1 ... 4 2 1 8 34 7 5 3 49 21 17 10 5 102 Nett Births registered during the calendar year Legitimate, 1,985 ; Illegitimate, 72. Nett Deaths registered during the calendar year Legitimate, 97 ; Illegitimate, 5. 26 TABLE No. 19. Nett Infant Deaths, classified by Sex and Wards. Causes of Death. The Borough. Woolwich. Plumstead. Eltham. Males. Females. Dockyard. St. Mary's. River. 1 St. George's. Burrage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas. Abbey Wood Well Hall. Avery Hill. Sherard. Measles - 1 - 1 - - - - - - - - - - - Whooping Cough - 1 - - - - 1 - - - - - - - - - Tuberculous Diseases 2 - - - - 1 - - - - - - - - 1 Bronchitis — 2 - - 1 - - - - - - - 1 - - - Pneumonia 9 9 - 2 4 2 - 1 - 1 - 3 1 — - 4 Diarrhoea 9 9 - - 2 1 2 2 1 1 1 1 4 1 - 2 Injury at Birth 6 — 1 — — — - - - 1 - - - 1 1 2 Atelectasis 1 3 - - - - - 1 - 1 - - - - 2 - Congenital Malformation 4 10 1 - 1 - 1 3 - 3 1 2 1 - 1 - Premature Birth 15 8 - - - 1 - 1 2 3 - 4 5 1 3 3 Other Causes 4 4 1 - - 1 1 - - 1 - 1 1 1 - 1 Icterus 2 3 — 1 — — — — — 2 — — — — 1 1 52 50 3 4 8 6 5 8 3 13 2 11 13 4 8 14 27 SECTION III. 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 and Dental 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. 20. Year appointed. Name. Qualifications. Appointment. 1921 Blackmore, F. J. C. M.R.C.S., L.R.C.P Assistant Medical Officer of Health and Tuberculosis Officer. 1931 Proudfoot, M. E. M.B., Ch.B. Assistant Medical Officer (General Purposes). 1931 Saunders-Jacobs, E. V. M.A., M.B., B.S., M.R.C.S., L.R.C.P., B.Sc., D.P.H. Assistant Medical Officer (General Purposes). 1934 Smith, F. E. M.B., Ch.B., D.P.H. Assistant Medical Officer (General Purposes). 1927 Lynham, J. E. A. B.A., M.D., D.M.R.E. Consultant, Artificial Sunlight Clinic. 1927 Taylor, H. G. .. F.R.C.S Consultant under Puerperal Fever Regulations, Obstetric Consultant (1931). 1938 Blaikley, J. B. . . F.R.C.S., M.C.O.G. Obstetric Consultant. 1938 Gunn, A. L. F.R.C.S., M.C.O.G. Obstetric Consultant. 1938 Walker, A. L. F.R.C.S., F.C.O.G. Obstetric Consultant. 1938 Birdsall S. E. F.R.C.S Consultant, Ear, Nose and Throat Clinic. 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). 1937 Alcock, O. H. M.B., B.S Medical Officer, Infant Welfare Centres (part-time). 1937 Morton, J. M. M.B., Ch.B., D.P.H. Medical Officer, Infant Welfare Centres (part-time). 28 TABLE No 20—continued.. Year appointed. Name. Qualifications. Appointment. 1937 Waghorn, K. M. M.R.C.S., L.R.C.P... Medical Officer, Infant Welfare Centres (part-time). 1937 Holmes, L. M.B., B.S., M.R.C.S., L.R.C.P. Anaesthetist, Dental Clinics. 1930 Brews, R. V. L.R.C.P.I. and L.M., L.R.C.S.I. and L.M. Public Vaccinator (parttime). 1930 Wise, H. M. M.B., M.R.C.S., L.R.C.P. do. 1930 Milton, E. F. M.D., B.S.. do. 1930 Blackall, G. M.B., B.A.O., D.P.H. do. 1930 Power, F. J. L.R.C.P.I. and L.M., L.R.C.S.I. and L.M. do. 1934 Mair, A. M.D., D.P.H. do. 1932 Elvy, D. M. L.D.S. Dental Surgeon (part-time). 1937 Jones, O. N. H. L.D.S. do. 1937 Wade, H. L.D.S. do. The deputies for the above Public Vaccinators are respectively : Dr. N. E. Sampey, Dr. E. C. Wise, Dr. W. T. Milton, Dr. R. W. Wood, Dr. R. Lewys-Lloyd, Dr. H. M. Wise. Dr. W. Cowie, a public vaccinator, gave notice to terminate his appointment on the 5th January, 1938. He was the public vaccinator for the district comprising that part of the Borough lying between the Greenwich boundary and a line drawn through the middle of Hill Street, Francis Street, Henry Street, and Chapel Street. This was a very small district and the Council decided to add it to Dr. Wise's district. This alteration received the approval of the Ministry of Health. (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. Mr. A. Edgcombe Brown, B.Sc., F.I.C., the Public Analyst for Greenwich, acts as Public Analyst for this Borough during the temporary absence of Mr. H. Amphlett Williams. 29 TABLE No. 21. Year appointed. Name. Qualifications. Appointment. 1933 Williams, H. Amphlett . . A.C.G.F.C., F.I.C. Public Analyst (part time). 1909 Shaw, H. Cert. Royal San. Inst.; Cert. San. Insp., Exam. Board; Cert. San. Insp. Assocn.; Cert. Meat and other foods; Cert. San. Science, R.S.I. Chief Sanitary Inspector. (1928) 1901 Tedham, W. Cert. Royal San. Inst., Cert. Meat and other foods. Sanitary Inspector. 1920 Pendrill, H. W. Cert. San. Insp., Exam. Board; Cert. Advanced Inspectors, R.S.I.; Cert. Meat and other foods ; Cert. Smoke Insp., R.S.I. Sanitary Inspector. 1921 Harris, C. V. Cert. San. Insp., Exam. Board; Cert. Royal San. Inst.; Cert. Meat and other foods. Sanitary Inspector. 1922 Couch, C. J. Cert. San. Insp., Exam. Board; Cert. Royal San. Inst.; Cert. Meat and other foods; Cert. Smoke Insp., R.S.I.; Cert. Advanced Inspectors, R.S.I. Sanitary Inspector. 1925 Pindar, E. B. Cert. San. Insp., Exam. Board; Cert. Royal San. Inst.; Cert. Meat and other foods. Sanitary Inspector. 1928 Andrew, F. A. Cert. San. Insp., Exam. Joint Board; Cert. Meat and other foods. Sanitary Inspector. 1929 Hemingway, F. Cert. San. Insp., Exam. Joint Board; Cert. Meat and other foods. Sanitary Inspector. 1930 Kersey, H. M. Cert. San. Insp., Exam. Joint Board ; Cert. Meat and other foods ; Cert. Smoke Insp., R.S.I. Sanitary Inspector. 1931 Hoines, F. J. Cert. San. Insp., Exam. Joint Board; Cert. Meat and other foods. Sanitary Inspector. 1933 Lewis, E. Cert. San. Insp., Exam. Joint Board; Cert. Meat and other foods; Cert. Smoke Insp., R.S.I.; Cert. San. Science, R.S.I. Sanitary Inspector. 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. 30 TABLE No. 21—continued. Year appointed. Name. Qualifications. Appointment. 1938 McLelland, W. E. Cert. San. Insp., Exam. Joint Board; Cert. Meat and other food. Sanitary Inspector. 1935 Tyers, Miss M. F. Cert. San. Insp.,Exam Joint Board; Cert. General Hospital Training; C.M.B.; Health Visitors' Cert.; C.S.M.M.G.; Diploma in Nursing, University of London. Woman Sanitary Inspector (1936). 1938 Newbury, Miss P. H. Cert. San. Insp., Exam. Joint Board. Woman Sanitary Inspector. 1918 Garsido, 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 Morgan, Miss F. Cert. General Hospital Training; C.M.B.; Health Visitors' Cert.; Maternity and Child Welfare Cert. Health Visitor. 1922 Seccombe, Miss W. Cert. General Hospital Training; C.M.B.; Health Visitors' Cert. Health Visitor. 1927 Farrell, Miss E. V. Cert. General Hospital Training; C.M.B.; Heliotherapy Cert.; Health Visitors' Cert., Board of Education. Health Visitor and Artificial Sunlight Nurse. 1930 Frederick, Miss F. E. Cert. General Hospital Training; C.M.B.; Health Visitors' Cert. Health Visitor. 1933 Adams, Miss W. Cert. General Hospital Training; C.M.B.; Health Visitors' 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). 1937 Phebey, Miss W. A. Cert. General Hospital Training; C.M.B.; Health Visitors' Cert. Health Visitor. 1938 Berry, Miss L. Cert. General Hospital Training; C.M.B.; Health Visitors' Cert. Health Visitor. 31 TABLE No. 21—continued. Year appointed. Name. Qualifications. Appointment. 1938 Day, Miss G. B. Cert. General Hospital Training; C.M.B. ; Health Visitors' Cert. Health Visitor. 1921 Castledine, Mrs. L. Cert. General Hospital Training Tuberculosis Visitor. 1921 Mahony, Miss N. Cert. General Hospital Training; Health Visitors' Cert. Tuberculosis Visitor. 1935 Plummer, Miss E. M. Cert. General Hospital Training; C.M.B.; Cert. Fever Training; Health Visitors' Cert. Tuberculosis Visitor. 1923 Smith, Mrs. M. Dispensing Certificate Dispenser and Secretary of Care Committee. Clerks: 1901 Smith, H. S Chief Clerk. 1906 Collyer, H. M. Committee Clerk. 1913 Prescott, T. H. Clerk, Grade C. 1920 Taylor, S. G. Vaccination Officer and Clerk, Grade 1920 Pike, L. J. 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 Alien, L. Clerk, Grade A. 1933 Bis well, 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. Clerk, Grade A. 1937 Lewington, J. W. Clerk, Grade A. 1938 Clifton, Miss M. W Clerk, Grade A. The Medical Officer of Health is Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme. 32 ii. Clinics and Treatment Centres. In tabular form is shown below a list of clinics and treatment centres in the Borough:— TABLE No. 22. 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. 8 Westhorne Avenue, Eltham Doctor's Room, Ante-Natal Room, Ante-room, Weighing Room, Waiting Room, Lecture Hall, Dental Rooms. do. 7 Elizabeth Street, North Woolwich Doctor's Room, Weighing Room do. 2* Wesley Hall, Timbercroft Lane, Plumstead. do. do. do. 2 All Saints' Church Hall, New Eltham. do. do. do. 3 Holy Trinity Church Hall, Beresford Street, Woolwich. do. do. do. 1 St. Luke's Hall, Westmount Road, Eltham. do. do. do. 2 Sunlight Clinic. Old Town Hall, Woolwich Treatment and Waiting Rooms, etc. do. 10 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 * An Ante-Natal Clinic is held here once fortnightly. 33 TABLE No. 22—continued. Situation. Nature of Accommodation By Whom Provided. Sessions Weekly. Cyril Henry Treatment Centre, St. Mary's Street, Woolwich, Accommodation for operating on, and detention of, cases of enlarged tonsils and adenoids London County Council Daily Borough Disinfecting Station, 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 *By arrangement with the Council two treatment sessions are held weekly in rooms at Eltham Health Centre. The building of a new Health Centre in Market Street, to replace the infant welfare centre and sunlight clinic at the Old Town Hall and the School Treatment Centre in Brewer Street, was almost completed by the end of the year. On the ground floor there have been provided a large waiting hall, a set of maternity and child welfare rooms, a clinic for physical medicine and a staff room"; and on the upper floor a dental suite, minor ailment treatment rooms, special treatment rooms, a foot clinic, and waiting and staff rooms. A description of the Centre appears in the Maternity and Child Welfare Section of this Report. iii 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. 34 iv. Ambulance Facilities. (a) Accidents and Sudden Illness.—The London County Council provide ambulances free of charges within the County of London for the conveyance of persons meeting with accidents or sudden illness in streets or public places. The ambulance may be called by private, public or police telephone. Full instructions are given in every telephone box. Where the dialling system is in operation, it is necessary to dial 999 and ask the operator for "Ambulance." No charge is made for the use of the telephone if the call is made from a public box. (b) Maternity Cases.—Maternity cases can be removed to hospital by ambulance if an ambulance card is obtained from the hospital when the bed is booked. Urgent cases, whether previously arranged for or not, can be removed when accompanied by a doctor or a nurse. Telephone No. Waterloo 6000. No charge is made for the ambulance, but the telephone call must be paid for. (c) Removal of Sick Persons.—The London County Council will arrange for the removal of sick persons by ambulance to hospitals or any place within the County of London. No charge is made for the removal of cases of infectious disease to the London County Council hospitals. Non-infectious cases removed to the London County Council hospitals are subject to assessment. Otherwise the standard charge is 12s. 6d. Full particulars and arrangements for removal can be obtained by telephoning Waterloo 3311, or writing to the Medical Officer of Health, London Ambulance Service, London County Council, The County Hall, S.E. 1. 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 puerperal pyrexia. For nursing assistance, the Borough Council pay, in necessitous cases, in accordance with the following schedule:— 35 Disease. Rate of Payment. Measles Ophthalmia Neonatorum 1s. 0d. per visit for one case; 6d. per visit, Zymotic Enteritis per case, for more than one case in the Whooping Cough house at the same time. Poliomyelitis Acute Primary Pneumonia Influenzal Pneumonia Puerperal Fever 1s. 3d. per visit. Puerperal Pyrexia Tuberculosis An additional grant is made yearly in respect of the nursing treatment of children suffering from threadworms. vi. 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 55 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. A District midwifery service is maintained by the British Hospital for Mothers and Babies in the district adjacent to the Hospital. The Council's Maternity Services are fully described in the Maternity and Child Welfare Section of the report. The County Council's scheme of Salaried Midwives came into operation on 1st January, 1938. vii. 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. 36 viii. Infant Life Protection. A note on the administration of this service will be found in the Maternity and Child Welfare Section of the report. ix. 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. x. Orthopaedic Treatment. Arrangements for the orthopaedic treatment of children under five years of age were made with the local branch of the Invalid Children's Aid Association in 1925. This body has for many years maintained a remedial clinic in Thomas Street where all children requiring such treatment may be sent. The London County Council make an annual grant in respect of children over five years of age. In the Maternity and Child Welfare Section of the Report there is an account of the year's working so far as children under five are concerned. xi. Dental Treatment. The Council's arrangements for dental treatment are described partly in the Maternity and Child Welfare section of this report and partly in that portion which deals with Tuberculosis. 37 xii. Adoptive Acts, By-Laws and Regulations Relating to Public Health in Force in the District. Adoptive Acts.—The Small Dwellings Acquisition Acts, 1899-1923, have been adopted by the Council. During the year, the Borough Treasurer tells me, the Council made 104 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. xiii. Laboratory Facilities. The bacteriological work of the Council rendered necessary by investigations into infectious diseases, food poisoning, etc., is carried out at the Woolwich War Memorial Hospital. The bacteriological examination of milk samples is carried out partly at the Woolwich War Memorial Hospital and partly at the Clinical Research Laboratory. A minimum of 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 standards for food. They are submitted for chemical analysis to the Public Analyst whose Laboratory is situated at 1, Southwark Street, London, S.E. 1. xiv. Vaccination. I submit a return by the Vaccination Officer on the work carried out under the Vaccination Acts for the year 1937. TABLE No. 23. RETURN to be made on or before 14th February, 1939, 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, 1937, inclusive :— Registration Sub-Districts comprised in Vaccination Officer's District. 1. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st December, 1937. 2. Number of these Births duly entered by 31st January, 1939, in Columns I., II., IV., and V. of the "Vaccination Register" (Birth List Sheets), viz.:— Col. I. Successfully Vaccinated. 3. Col. II. Col. IV. Number in respect of whom Statutory Declaration of Conscientious Objection has been received. 6. Col. V. Died Unvaceinated. 7. Insusceptible of Vaccination. 4. Had Small Pox. 5. 1. Plumstead 663 271 - - 291 31 2. Woolwich † 1299 600 4 - 548 33 3. Eitham 450 207 5 - 184 18 Total 2412 1078 9 - 1023 82 38 TABLE No. 23—continued. Number of these Births which on 31st January, 1939, remained unentered in the "Vaccination Register" on account (as shown by " Report Book ") of :— Number of these Births remaining on 31st January, 1939, 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). 11. *Total Number of Certificates of Successful Primary Vaccination of Children under 14 received during the Calendar Year 1938. 12. 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 1938. 13. Postponement by Medical Certificate. 8. Removal to Districts the Vaccination Officers of which have been duly apprised. 9. Removal to places unknown or which cannot be reached; and cases not having been found. 10. 15 12 34 9 These figures are to be obtained from colum ns 2 and 6 of the Summar y (Form N.) 18 54 36 6 7 14 10 5 40 80 80 20 1165 953 Notes on Table No. 23. 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:—nil. (6) The figures in columns 2 to 11 should not include re-registered births or cases of children born in other districts. *The total in this column should be the number of Certificates of successful primary vaccination of children under 14, actually received during the year, including any relating to births registered in previous years. The total thus given should include the Certificates of successful primary vaccination of which copies have been sent to the Vaccination Officers of other Districts. The total number of Certificates for the year 1937 sent to other Vaccination Officers should be stated here:—161. •(•Includes the Burrage and Herbert Wards in Plumstead Parish. (Signature) S. G. TAYLOR, Vaccination Officer. Date—13th February, 1939. During the year ended 30th September, 1938, the number of persons successfully vaccinated or re-vaccinated at the cost of the rates was 1,136. This figure includes 687 primary vaccinations of persons under one year of age, 193 over one year of age, and 256 re-vaccinations, 39 xv. 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. Insulin was supplied under this scheme to 18 patients during the year, the total coat being £35 0s. 5d. 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. xvi. 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 1938. The percentage of entrant boys requiring treatment for some defect or other was 35.4, and of girls, 35.3; the corresponding figures for London being 47.5 per cent., and 47.2 per cent. Excluding nutrition and dental defects, the percentage of entrant boys requiring treatment was 14.3, and girls, 12.3; the corresponding figures for London being 14.9 and 13.5. 40 TABLE No. 24 (Part I.). Examination of Elementary School Children in Woolwich, 1938. Numbers Examined and Defects Found. Number examined Boys. Girls. Entrants. Age 7. Age 11. Age 14. Entrants. Age 7. Age 11. Age 14. 1,150 Cases * 888 Cases * 964 Cases * 947 Cases * 1,155 Cases * 902 Cases * 940 Cases * 912 Cases * Malnutrition 21 4 17 - 16 2 13 1 14 3 28 5 11 1 5 1 Skin Disease 6 5 5 5 2 2 6 3 11 6 7 6 6 5 8 4 Defective Teeth - 285 - 154 - 160 — 157 — 295 — 166 — 137 — 166 Enlarged Tonsils 136 65 75 39 34 21 20 13 109 39 74 41 51 34 29 22 Adenoids 12 8 4 3 — — 1 1 9 4 4 3 4 4 — — Enlarged Tonsils and Adenoids 50 38 26 23 11 8 4 4 51 42 32 31 8 7 7 7 Other Nose and Throat defects 9 1 4 3 3 3 3 3 8 4 3 2 3 1 1 1 Enlarged Glands 4 1 5 2 1 — — — 5 — 7 1 4 — — — Eye Disease 21 18 8 7 5 3 11 9 23 20 14 11 12 9 3 3 Vision defect — — - 40 — 81 — 89 — — — 29 — 92 — 66 Otorrhoea 3 3 2 2 3 3 2 2 6 4 3 2 — — 3 3 Other ear disease 5 2 1 — — — 1 — 2 — 2 1 2 1 1 1 Defective hearing - — — — 3 3 1 1 2 1 1 1 — — — — Speech defects 5 — 2 — 3 2 2 2 3 - - - - - 1 — Heart defects 6 1 1 — 5 — 7 4 4 — 8 2 3 1 3 1 Anaemia 4 2 2 2 6 2 5 4 8 4 6 1 2 2 2 1 Lung defects 10 5 2 1 6 3 5 4 15 9 4 2 4 2 1 — Nervous defects 9 2 6 — 7 3 1 1 8 1 9 2 5 1 3 1 Phthisis - - - - - - - - - - - - - - - - Other T.B. disease - - - - - - - - - - - - - - - - Rickets 1 - - - - - - - - - - - - - - - Spinal deformities — — 4 3 3 3 1 1 1 - 3 3 5 4 1 - Other deformities 18 11 4 2 9 5 8 4 12 7 7 5 10 5 6 5 Other defects 22 12 18 12 17 12 11 7 24 14 17 12 24 18 11 9 Number of Children noted for treatment - 407 — 254 - 290 — 266 — 408 — 284 — 279 — 261 * Defects, however slight, are included under "Cases"; those severe enough to require treatment are shown under *. 41 TABLE No. 24 (Part II.). Age Groups. Number examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Vision. Good Fair Poor. Good Average Below normal Bad Clean Nits Pediculi Clean Dirty Pediculi All sound Less than 4 decayed. 4 or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either or both eyes. Entrants— Boys 1150 833 315 2 72 999 78 1 1141 8 1 1139 11 - 853 246 51 — — Girls 1155 848 307 - 88 1015 51 1 1137 15 3 1149 6 - 843 260 52 — — — Age 7— Boys 888 620 267 1 53 762 72 1 878 8 2 880 8 — 730 144 14 590 237 55 Girls 902 600 300 2 101 726 72 3 892 8 2 899 2 1 736 152 14 621 229 46 Age 11— Boys 964 651 312 1 64 841 59 — 962 2 — 962 1 1 798 157 9 745 113 105 Girls 940 635 304 1 70 826 44 - 923 15 2 933 7 — 808 129 3 675 150 111 Age 14— Boys 947 595 350 2 107 796 43 1 941 3 3 944 3 - 790 154 3 713 115 118 Girls 912 680 231 1 136 729 46 1 905 7 — 909 3 — 741 166 5 707 104 93 Total 7858 5462 2386 10 691 6694 465 8 7779 66 13 7815 41 2 6299 1408 151 4051 948 528 Percentage 69.5 30.4 0.1 8.8 85.2 6.0 99.0 0.8 0.2 99.5 0.5 0.0 80.2 17.9 1.9 73.3 17.2 9.5 London 54.6 45.1 0.3 16.2 77.2 6.6 97.7 2.0 0.3 98.7 1.2 0.1 70.2 26.3 3.5 67.8 19.0 13.2 42 SECTION IV. HEALTH PROPAGANDA. Apart from the normal health education work of the Council's visiting and clinic staffs, the activities of the Council in health education and health propaganda during 1938 may be classified as follows:— (a) National Health Campaign.—In last year's Annual Report, I set out fully the steps taken by the Council to assist this national effort to increase the use of the Health Services. The campaign was a wide one, and included appeals not only to use the health services of local authorities—maternity and child welfare, school medical, tuberculosis, and social hygiene—but also to use the general practitioner medical services, and the hospitals, sufficiently early to enable the best results to be obtained. In the closing month the campaign was closely associated with the work of the National Fitness Council. The campaign extended over part of two calendar years. The first two sections dealing with health services generally and with maternity and child welfare services in particular, occupied the winter months of 1937. In the spring of 1938 flie remaining services were dealt with. The propaganda material used included: a series of large posters measuring 80 inches by 120 inches for display on hoardings; double crown posters for display in windows and on notice boards; classroom posters; display showcards for counters, etc.; traffic notices; bookmarks; and three-leaf folders, all bearing similar information and the same slogan for each section of the Campaign. In Woolwich arrangements were made for display on hoardings of the large posters; the double crown posters and the classroom posters were distributed widely to the churches, clubs, guilds, employers and to the various departments of the Council. The show-cards were distributed to small shopkeepers; the bookmarks were distributed through the Libraries, and 30,000 of the three-leaf folders, with local information overprinted, were distributed house-to-house throughout the Borough each month. . (b) Health Film Displays for School Children.—Experience having demonstrated the value of the cinema film as a medium for the education of school children (particularly so with the introduction of the sound film) arrangements for monthly displays at the Town Hall and at the Plumstead Museum were continued during 1938 in co-operation with the Libraries Committee. On one Monday in each of the winter months, three separate audiences, each of approximately 400, saw a programme of educational and health films of about one hour's duration at the Town Hall; and at Plumstead Museum on one Wednesday in each of the winter months a display was given to a small audience during the afternoon and again in the evening to an audience of approximately two hundred. 43 The Health films shown in these combined programmes were:- Town Hall. January 17th "Swimming (Speed)." " Giro and His Enemies." February 14th "The Story of Milk Production." March 14th "Training in Ball Games." November 14th "Vision." December 12th "Exercises Performed with a Rhythmical Swing." Plumstead Museum. January 19th "Circulation." February 9th "Carriage." March 9th "Stand up and Breathe." October 12th "The Filter." "Swimming (Breast and Butterfly Strokes)." November 9th "Swimming (The Crawl)." December 14th "Swimming (Back Stroke)." (c) Health Film Displays for Adults.—Following the film displays to school children at Plumstead Museum the same films were displayed the same evening to an adult audience of approximately 180. (d) Informal Talks.—This part of the Council's health education work is decidedly popular, and many local organisations regularly request two or three of these talks each winter. It is a very convenient way of disseminating knowledge as the audience is an organised body; the talk is given on the usual meeting day and in the usual meeting place; the audience is at home and is inclined to ask more questions than at a crowded public meeting; and moreover, as most of the talks are given by members of the staff, a point of contact is made by the Council's officers with the general public—a most useful development of health education. These talks are usually illustrated by cinema films or by lantern slides, and the introduction of sound films has added greatly to the interest and value of these meetings. (e) Cookery Classes.—The weekly cookery demonstrations for the wives and mothers of the tuberculous held at the dispensary at Maxey Road continue to be appreciated. The practical advice given is of great value to these women who, for the most part, have slender purses and need all the knowledge to be gained, not only to enable them to expend their money to the greatest advantage but also to enable them to cook the food in the most nutritious way. It was for these reasons that these demonstrations were first arranged. The nett cost to the Council for food provided during the year was £2 9s. l1d. The number attending was 18, and the number of attendances was 424. There were 44 meetings. The Tuberculosis Care Committee provide cups of tea and biscuits at each meeting, and the cooked dishes are sold at about half cost to those attending the classes. 44 (f) Central Council for Health Education.—This Council is an incorporated body composed of representatives of Government Departments, Local Government, National Health Insurance, Professional Organisations and Voluntary Societies engaged in Health Propaganda work. Your medical officer was elected Chairman of the Council in November, 1938. The Council aims at (a) the organisation of Health Weeks on behalf of local authorities; (6) the production and distribution of posters; (c) the issue of "Better Health"; (d) the organisation of a Health Education Conference annually; (e) the distribution of films and leaflets; (f) the issue of a Year Book collating information relating to health propaganda; (g) the co-ordination of the work of affiliated societies in the organisation of local campaigns, etc.; (h) the maintenance of a permanent collection of Health Education material; and (i) the furnishing of expert advice on the best methods of Health Education. The Borough Council increased its annual contribution to the funds of this body from five guineas to ten guineas. (g) "Better Health."—This journal, which is the official magazine of the Central Council for Health Education, is published monthly. During the year its layout was revised in order to increase its popular appeal. Its contents include articles on personal health and hygiene from the public and personal points of view, and it is a valuable aid to public health in these matters. We know it is thoroughly appreciated by those into whose hands it comes monthly. In Woolwich we distribute some two thousand copies each month, through the welfare centres, through the public libraries, through the schools, and by post. (h) Health Services Booklet.—This booklet contains full information regarding the Council's health services and six editions have been published since it was first issued in 1931. It is distributed through the health centres, the public libraries, and the local post offices. Every new tenant in the Council's housing estates receives a copy. Any ratepayer can receive a copy on application to the Health Department. (i) Health and Happiness for Baby.—Prior to 1937 advice to expectant and nursing mothers and information on the care and management of infants was given in various leaflets. In 1937, however, these leaflets were combined and rewritten in the form of a booklet entitled "Health and Happiness for Baby." This booklet has 32 pages and was first printed in November, 1937; a second edition was printed at the end of 1938. A copy is sent to every Woolwich mother when the birth of her baby is notified and copies are obtainable at the welfare centres. In this way over 2,500 copies are distributed each year. (j) Leaflets.—A complete series of leaflets dealing with practically every branch of the Council's health services has been prepared locally or has been purchased from central sources. These are distributed as necessary and can be obtained on request at the health department and any of the health centres. 45 (k) Posters.—Posters provide a striking and effective method of appeal to the public, but the message they convey must be clear and easily appreciated. In no circumstances should they be used to convey a lengthy message. The excellent series provided by the Central Council for Health Education were displayed during the year, usually on two boards, but on four during June and July. Those shown during the year were as follows:— January "Use your School Dental Service." February "Support the National Health Campaign." March "Get Fit—Keep Fit." April "Drink Safe Milk." May "Britain's Way to Health and Fitness." June "Balance your Meal." "Holiday Fitness all the Year." July National Milk Publicity Council. Youth Hostels Association. August "Obey the Laws of Health." September National Fitness Council. October Dental Board of the United Kingdom. November National Safety First Association. December National Association for the Prevention of Tuberculosis. Other posters, crown and double crown, were in regular use in the Health Centres, Dispensaries, Public Libraries and on the hoardings. (l) Bookmarks.—Use was made of these in order to make better known throughout the Borough the need for the early diagnosis of tuberculosis. They were distributed through the Public Libraries. They indicate briefly the symptoms and signs which indicate the advisability of obtaining medical advice and they give the names and addresses of, and the times of attendance at, the tuberculosis dispensaries. (m) London County Council Midwifery Scheme.—The London County Council having expressed the hope that facilities would be given by the Borough Councils for the display of posters and leaflets drawing attention to, and giving information with regard to the domiciliary midwifery service, this Council decided to give help in every way possible. As a result leaflets and posters, prepared by the County Medical Officer, have been distributed and displayed at the Town Hall in the Maternity and Child Welfare Centres and in the Public Libraries. 46 SECTION V. SANITARY ADMINISTRATION. Staff.—The staff of the Sanitary Section at the end of 1938 consisted of one Chief Inspector, 13 male inspectors, 2 women inspectors and 2 part-time women inspectors, who are also part-time health visitors. During the year one of the male inspectors was seconded for whole-time service in connection with air raid precautions. Water Supply.—The Metropolitan Water Board is responsible for the watersupply of the Borough, and no complaints were received as to the quality of the water supply during the year. So far as can be ascertained there are eighteen wells in the Borough, used in the main for trade or kindred purposes. Drainage.—The drainage of every house in the Borough, except in 15 instances, is connected with sewers. These exceptions are to be found at Shooters Hill, Bostall Heath, Harrow Manorway and Bexley Road, and in all cesspools are used. The total number of cesspools is fourteen, seven of which are in Plumstead and seven 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 instances alterations are supervised by the Sanitary Inspectors. During the year 25 complaints were received regarding the defective action of combined drains; on investigation, 130 houses in all were found to be affected. In all systems, except 3, the obstruction was of a temporary character. In 8 instances choked interceptors were found. Costs recovered from the owners amounted to £1 9s. 2d. In the following three instances reconstruction was necessary:—2-18 (even), Owenite Street; 133-139 (odd), Abbey Wood Road; 1-12 (all), Troy Street. After service of the necessary notices and on receipt of the consents of the owners, the work was carried out by the Works Department of the Council, the costs being paid by the owners in their proper proportions. Seventeen orders for the cutting off and sealing up of drains, involving 101 houses, were made during the year as a result of slum clearance operations. 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. 47 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 1s. per week. Inoffensive trade refuse is removed by the Works Department at a charge of 5s. per load, and 2,704 tons of such refuse were removed. Complaints.—During the year 3,021 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. 25. In connection therewith the numbers of intimation and statutory notices served were 1,138 and 237 respectively. The statutory notices related to 187 premises, and included 202 general, 9 ashpit, 2 water closet and 12 paving notices. In addition to these notices under the Public Health (London) Act, 12 notices were served under the London County Council (General Powers) Acts and under By-laws. In 43 instances, where owners did not comply with the statutory notices, the Town Clerk was asked to institute proceedings. It was necessary, however, to issue summonses in only three instances, as in all the other cases the necessary steps were taken on receipt of a letter from him. In Table No. 26 will be found a summary of the nuisances abated and defects remedied:— TABLE No. 25. Inspections. Housing Survey— Houses Inspected 452 Common Lodging Houses 96 Underground Rooms Illegally Occupied 12 Clearance Areas— Houses Surveyed 287 Drainage Inspections 1,753 Complaints Investigated 3,021 Drains Tested by Smoke Test 315 Outworkers' Premises 215 Drains lested by Water Test.. 115 Houses Let in Lodgings 226 Houses re Infectious Disease 838 New Houses 1,108 Houses re Smallpox Contacts 3 Tents and Vans 25 Houses re Verminous Cases 5,351 Factories with mechanical power 278 Houses re Scabies Cases 465 Factories without mechanical power 80 Houses re Other Diseases 40 48 TABLE No. 25—continued. Other premises under Factories Act 65 Women's Lavatories 160 Smoke Observations 26 Shops Act, 1934 667 Special Inspections re Rats 291 Theatres and Cinemas 10 Pharmacy and Poisons Act . 87 Rag and Bone Premises 20 Miscellaneous 1,581 Urinals Accessible to the Public 119 Re-Inspections 7,018 TABLE No. 26. Nuisances Abated. Cleansing— Scullery Floors Re-paved or Repaired 32 Interiors Cleansed 416 Rooms Cleansed 645 House Drains— Damp Conditions— Defective Drains Repaired 159 Choked Drains Cleared 239 Walls 424 Vent Pipes Repaired 16 Sites 21 Soil Pipes Repaired 8 Roofs 324 Gullies Fixed 44 Rain Water Pipes and Gutters 138 New Drainage 15 Others 52 Rain Water Tanks Repaired — Dilapidations— „ „ „ Abolished — Walls 425 Sinks Repaired or Provided 101 Ceilings 288 Wastes Cleansed 40 Floors and Hearths 109 Wastes Trapped or Repaired 244 Coppers 43 Water Closets— Stoves 76 Flushing Apparatus Repaired 67 Others 22 „ „ Renewed 19 Verminous Conditions— New Pans 197 Rooms Cleansed 1,370 New Traps 173 Defective Lighting— Foul Pans Cleansed by Owner 7 Windows Repaired 68 Occupier 1 Additional W.C.'s Provided 5 „ Enlarged 2 „ Additional 2 Doors and Fastenings Remedied 16 Other Means 2 Dust Bins Provided 145 Defective Ventilation— Underground Rooms Closed 9 Windows Rendered Usable 143 Water Supply— „ Additional Provided 2 Additional — Other Means 7 Reinstated 11 Defective Paving— Cisterns Cleansed — Yards Re-paved 63 „ Covered — „ Repaired 83 „ Removed - 49 TABLE No. 26—continued. Foul Accumulations— Premises Rat-Proofed 17 Manure Removed 3 Other Effective Measures .. 14 Offensive Accumulations Removed 13 Rag and Bone Premises— Premises Cleansed — Back Yards Cleansed 7 Rainproof Premises Provided — Dung Pits Provided — Vermin-proof Conditions Provided - Rats— Drains Repaired in Consequence 64 Miscellaneous 179 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 number of inspections made during the year was 667 and 2 notices for offences under the Act were served. Sanitary accommodation was made suitable and sufficient in 13 cases, and suitable means of heating was provided in one case. Suitable means of ventilation was provided in one case. 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 39. Smoke Abatement.—During the year 26 smoke observations were made on factory chimneys in the Borough. In 6 cases offences were committed and 3 notices were served. In each case the nuisance was abated forthwith and no further action was taken. During the year an Inaugural Meeting of the Greater London Advisory Council for Smoke Abatement took place. The Council was represented at this meeting. The following resolution was passed:— "That this meeting of representatives of Greater London Local Authorities hereby resolves that a Greater London Advisory Council for Smoke Abatement be forthwith and hereby is established, having such objects and constitution as shall be determined by the representatives of the constituent Local Authorities." No representatives were appointed by the Borough Council during the year but the Council were in full sympathy with the proposal and no doubt will appoint representatives in the near future. Public Baths and Washhottses.—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 50 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. The construction of the new baths at Eltham—two swimming pools—was proceeded with during 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 187,246; Turkish and Russian Vapour Baths, 23,756; Slipper Baths, 194,298; and the Public Washhouse, 14,133. 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. Independent samples are taken by this Department from time to time. There are two open-air swimming pools in the Borough, one in Eltham Park and one in the Victoria Gardens, North Woolwich. These belong to the London County Council, and filtration plants have been installed at both. There are also paddling pools in the Borough, one belonging to the Woolwich Borough Council on their Middle Park Estate, and one in Eaglesfield, belonging to the London County Council. There are no filtration plants at either of these. Eradication of Bed-Bugs.—An organised effort against bed-bug infestation of the Council's Housing Estates has been in being since 1934. It includes inspection of the furniture and effects of selected applicants, inspection when opportunity offers of occupied Council houses not known to be infested, disinfestation when necessary of furniture and effects prior to occupation, disinfestation when necessary of tenanted and untenanted Council houses, and regular periodic supervision of all houses for a period of two years after a process of disinfestation has been carried out. The figures given under appropriate heads below indicate what this effort means and indicate the measure of success. It is not possible to exercise the same control over privately owned houses as over the Council's estates, but the Council help owners so far as their resources allow, by disinfesting contents of infested houses while the owners deal with the structure, by "following up" afterwards by trained women Sanitary Inspectors and by disseminating knowledge about the bed-bug amongst the populace. There is, however, no organised search for the bed bug in these houses and no disinfestation of premises or furniture before new tenants are admitted. Houses known to be bug infested, and about to be demolished, are, however, disinfested. During the year the Royal Sanitary Institute arranged a course on disinfestation for sanitary inspectors. The Council sent one woman Sanitary Inspector to this course. 51 In Circular 1728 the Ministry of Health ask that particulars of the action taken for the eradication of bed-bugs should be given under the five headings set out below:— 1. The number of (a) Council houses; (b) Other houses; (i) Found to be infested; (ii) Disinfested. 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; (6) 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 514. The number of Council Houses found to be infested during the year was 79, and all of these were successfully disinfested ; in all instances, except six, after one fumigation. The distribution of infested houses is interesting, as most of the infestation which exists in the Council's houses is in houses which were occupied prior to the institution in 1934 of the disinfestation scheme. On the Page Estate of 2,306 houses, bug infestation was found in 61 cases. On the Middle Park Estate of 1,962 houses, 14 cases were found; ten of these and all of those on the Page Estate were in houses which were built prior to 1934. Two cases of infestation were found in the North Woolwich houses built about 1902 and two in houses which came into the possession of the Council through default in payment of sums due under mortgages. No infestation has yet been found in the Timbercroft Lane Estate of 54 houses. 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 occasionally an occupier asks for help in eradicating the bed-bug. The number of such houses found to be infested during the year was 494. The scheme of co-operation described in my Annual Report for 1932, between the Council and the Landlord, was put into operation in 159 instances, while a further 103 houses in clearance areas were dealt with prior to demolition. One further house is known to have been disinfested by the occupier after advice from the department. 2. The methods employed for freeing infested houses from bed-bugs and the name of the fumigant and/or insecticide used. Different methods were used by the Department during the year, in different circumstances. (а) Sulphur dioxide, plus cleansing, as described in my Annual Reports for 1932 and 1933, was used in 84 houses, all of which, with the exception of 9, were in private ownership. In 78 instances this method of treatment was successful in one application. (b) Cyanide (Zyklon B) was used for the disinfestation of 18 occupied houses in 9 blocks. In such cases the occupiers of infested dwellings are 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 houses 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. 52 In three instances re-infestation occurred during the year, in a block of three houses, all of which became re-infested. The three families concerned were very friendly and it was found that a good deal of interchange of furniture went on between them, not an unusual practice, but one which leads to unfortunate results when one of them purchases secondhand bug-infested furniture and it also becomes the subject of exchange. Regulations, known as the Hydrogen Cyanide (Fumigation of Buildings), Regulations, and dated December, 1938, have been made by the Secretary of State and come into operation on the 1st February, 1939. All fumigation of buildings with hydrogen cyanide after that date will have to comply with these Regulations. (c) 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 106 occasions, with 4 primary failures. (d) Washed heavy naphtha was used for 33 houses, 6 of which were furnished and 24 of which belong to the Council. In four instances the primary treatment was not successful, 2 of these being furnished houses. As our knowledge of washed heavy naphtha grows it is becoming more and more clear that it will replace hydrogen cyanide as a fumigant in houses, but as yet we have not been able to work out a thoroughly satisfactory method of using this chemical in furnished houses, although the method for use in empty houses is quite efficient. (e) In addition to the above, 103 houses in Clearance Areas were disinfested with a mixture of equal parts of orthodichlorbenzene and paraffin 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 506 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 three, or in hired vans. During the year 215 removals were carried out in this way, each van load being disinfested with Zyklon B, at one of the Council's depots. As a matter of interest it may be stated that of the 506 tenants inspected during the year 252 were in slum clearance houses and 254 were in other houses. Eighty per cent. of the slum clearance houses were bug infested, compared with 52 per cent. of the others. Recent work by the London County Council and by the Enfield Urban District Council has shown that heavy naphtha can be effectively used in vans for the disinfestation of furniture in transit. It appears that at a temperature of 100ºF. 53 a saturated solution of naphtha will kill the bed-bug in six hours. The Council decided to build a suitable van for this work and it came into service towards the end of December. No opportunity for using it for naphtha work arose before the end of the year. 4. Whether the work of disinfestation is carried out by the Local Authority or by a Contractor. The work of disinfestation, including all cases where hydrogen cyanide was used, was in every instance during the year carried out by the Council's own staff. 5. The measures taken by way of supervision or education of tenants to prevent infestation or re-infestation after cleansing. In Woolwich all houses which are disinfested or where furniture is disinfested prior to the tenants' admission, are subject for a period of two years to periodical inspection by the Council's women sanitary inspectors. In this way 862 houses dealt with in earlier years were inspected. In 1938 bugs were found in 42 of these houses, eleven, in addition to those referred to in paragraph 2 (6), being on the Council's estates. In order that householders may co-operate with the Council in preventing infestation or re-infestation after cleansing, the following steps have been taken by way of supervision or education:— (а) Each new tenant on the Council's estate 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. (b) To the head of each infested family is sent after disinfestation a letter asking for co-operation, and enclosing a reprint of the article referred to above. (c) The sanitary inspector in charge of disinfestation personally explains to the housewife the precautions which must be taken after disinfestation if the house is to remain free from bugs. (d) The woman sanitary inspector pays periodic visits for a period of two years. On these visits she repeats how infestation may occur, e.g., by the exchange of bedding and cot furniture between neighbours and friends, by the purchase of secondhand furniture from neighbours and dealers, or by the purchase of infested firewood from itinerant hawkers. (e) Secondhand furniture is disinfested free of charge on request, but such requests are not common. (f) A copy of the film, "The Red Army," has been purchased and is shown frequently in connection with health lectures. It deals with the life history of the bed-bug and its dissemination. Factories 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. 54 TABLE No. 27. Factories and Workplaces. 1.—Inspection. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories with mechanical power 278 16 — Factories without mechanical power 80 1 - *Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 65 15 - Total *Electrical Stations should be reckoned as factories. 423 32 — 2.—Defects Found. Particulars. (1) Number of Defects. Number of defects in respect of which Prosecutions were Instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Want of Cleanliness (S 1) 30 30 — — Overcrowding (S. 2) — — - - Unreasonable Temperature (S. 3) 13 13 - — Inadequate Ventilation (S. 4) 1 1 — — Ineffective Drainage of Floors (S. 6) - — — — Sanitary Conveniences (S. 7) Insufficient 1 1 - - Unsuitable or Defective. . 12 12 — — Not Separate for Sexes - - — — Other Offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and reenacted in the Third Schedule to the Factories Act, 1937). - - - - Total 57 57 — — 55 3.—Outwork in Unwholesome Premises. 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.—This Act makes it obligatory for all occupiers of land to keep the land and premises thereon clear of rats and mice. Cases of rat infestation vary widely and often the correct treatment of a particular case can only be decided after an examination of the premises concerned. Each district inspector is the rats officer for his area and investigates all complaints received, giving the necessary advice to suit the particular case. During the National Rat Week, held from 7th-14th November, special measures were undertaken and the co-operation of many large firms in the Borough, and of the Borough Engineer was obtained. The number of baits laid in the sewers of Woolwich and Plumstead was 7,325. The total number of inspections made was 512. In 64 instances it was necessary to secure the repair of defective drains. Seventeen premises were made rat proof and other effective measures were taken in 14 instances. No statutory notices were served. Fouling of Footways by Dogs.—In 1934 the Council made a by-law which came into operation from the 1st January, 1935. The by-law is as follows:— "No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway." One summons was issued during the year, particulars of which will be found in Table No. 30 at the end of the Section. Nuisances 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. Action taken during the year was limited to the destruction of a considerable number of eggs. 56 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. This by-law is frequently broken. No summonses were taken out during this year. Rag Flock.—Four 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, 8; 9.6; 8; 8. At the request of the manufacturers, 98 bales of rag flock were disinfected before export, and the necessary certificates were given to enable importation into South Africa to take place. Payments in respect of this service amounted to £51 9s. 0d. Mortuaries.—The Public Mortuary is in Sunbury Street, Woolwich, but in recent years this has been little used, owing to the centralisation of Coroners' Courts in London. Inquests on Woolwich cases are held in Lewisham or Greenwich. The temporary mortuary in Eltham was closed in June, 1937. The following Table shows the use made of the mortuaries during the year:— TABLE No. 28. Sunbury Street. Sunbury Street (Infectious). All Mortuaries. 1938 1937 Number of Bodies Received:— (a) For Inquest — — — — (6) For Custody 9 - 9 11 9 - 9 11 Number of Post-Mortem Examinations - - — — Cemeteries.—The Council own three cemeteries within the Borough, two in Plumstead and one in Eltham. The two in Plumstead are known respectively as the Woolwich Cemetery and the Plumstead Cemetery, the Woolwich one being divided into two portions, the Old and the New. Eltham Cemetery was opened for interments in April, 1935. Burials also take place in Eltham Churchyard, and rarely in a private burial ground within the grounds of Christchurch Priory in Eltham High Street. 57 In the following Table are shown the numbers 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. 29. Number of Interments. 1936 1937 1938 Woolwich Cemetery 610 613 523 Plumstead Cemetery 741 719 765 Eltham Cemetery 140 148 166 Eltham Churchyard 168 161 155 Exhumations.—During the year five 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 in this Borough 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. In 1936 the Council approved an application by the Royal Arsenal Co-operative Society to establish anew the business of a slaughterer of cattle and that of a tripe boiler, subject to certain conditions. An application for the re-establishment of the business of slaughterer of poultry, referred to above, was considered by the Council in July, 1937, and was approved. 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 connection, and it is necessary to make application to a Magistrate for an Order. No such application was made during the year. Pharmacy and Poisons Act, 1933.—This Act places upon Metropolitan Borough Councils the duties of enforcing the provisions of that part of the Act which relates to poisons in Part 2 of the Poisons List. Poisons in Part 1 of the Poisons List may only be sold by "authorised sellers" and those in Part 2 by authorised sellers and by listed sellers, whose names appear in a register to be kept by the local authority. 58 "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 Medical Officer of Health, the Chief Sanitary Inspector, and two sanitary inspectors have been appointed as inspectors for this purpose. The Council decided in February, 1937, to delegate its powers under the Act to the Health Committee. The number of names entered on the Council's list at the beginning of the year was 91. Seven were added and four were deleted. The number at the end of the year was 94, and there were 93 deputies approved. Legal Proceedings.—The particulars of the various prosecutions instituted under the various Acts are set out in detail in the following Table No. 30. TABLE No. 30. Prosecutions under Public Health and Kindred Acts. No. Date of Hearing. Offence. Situation. Result. 1 17th March Being a person having charge of a dog on a lead, did allow said dog to deposit excrement upon the footway. Footscray Road Dismissed under Probation of Offenders Act. 2 17th March Leaking roof of house causing dampness. Leaking roof over ground floor back room. Absence of proper eaves gutter to same ; leaking sink waste drain. 10, Chapel Street . . Order to abate within fourteen days. 3 29th December Broken and dilapidated ceiling of first floor back room. Leaking roof over first floor back and back addition rooms causing dampness. 1, Oak Street Work done. Summons withdrawn on payment of ten and six costs. 4 29th December Leaking roof over first floor front room causing dampness. 3, Oak Street Work done. Summons withdrawn on payment of ten and six costs. 59 SECTION VI. HOUSING. The following Table shows the main housing figures for the year set out under the headings given in Circular 1728 issued by the Ministry of Health for securing uniformity in the presentation of these statistics. TABLE No. 31. 1.—Inspection of Dwelling Houses during the Year. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3,659 Number of inspections made for the purpose 8,570 (2) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 and 1932 452 Number of inspections made for the purpose 664 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 225 (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 1,288 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 1,016 Includes intimation notices. 3.—Action under Statutory Powers during the Year. (a) Proceedings under Section 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which notices were served requiring repairs — (2) Number of dwelling houses which were rendered fit after service of formal notice:— (a) By Owners — (b) By Local Authority in default of owners — 60 (b) Proceedings under the Public Health Acts (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 165 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By Owners 187 (b) By Local Authority in default of owners — (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made 5 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 7 (d) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 10 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement, or room having been rendered fit — 4.—Housing Act, 1936—Part IV.—Overcrowding.* (a) (i) Number of dwellings overcrowded at the end of the year 230 (ii) Number of families dwelling therein 230 (iii) Number of persons dwelling therein 1,675 (b) Number of new cases of overcrowding reported during the year 51 (c) (i) Number of cases of overcrowding relieved during the year 211 (ii) Number of persons concerned in such cases 1,057 (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 - *See paragraph on overcrowding on opposite page. 61 Overcrowding.—The Council are under obligation on the application of either the landlord or the occupier to give in writing the permitted number of persons in respect of any dwelling. In order to do so it is necessary to measure the house. The number of houses measured during the year was 679. The number of permitted number notices supplied to landlords and occupiers was 1,096. At the end of 1937 the number of dwellings overcrowded was 390. During the year 51 new cases of overcrowding were discovered and 211 cases were relieved. The number of families living in overcrowded conditions at the end of the year was 230. This figure is given with reserve and it is best to regard it simply as the number of families known to be living under overcrowded conditions. The figure 211 above has been arrived at in the following way:—additional accommodation for overcrowded families was found by re-arrangement of lettings in the same house in 34 instances ; in four instances where the permitted number was wrong a correction showed that there was no overcrowding; it was found that 38 families had become sufficiently reduced in number through persons leaving to get married and setting up house of their own or through death, and that 98 families had removed to other unknown addresses. The number of cases re-housed by the Woolwich Borough Council as part of their general housing policy or through slum clearance was 17, and by the London County Council as part of their abatement of overcrowding policy, 6. Fourteen cases were dealt with in other ways. Knowledge of fresh overcrowding came to the department in different ways. In 26 instances an overcrowded occupier applied for re-housing; on 2 occasions the owner complained, on one occasion the occupier, while 22 cases were discovered by the sanitary inspectors. No legal proceedings were instituted in respect of overcrowding during the year. Inspection of Houses.—The number of houses inspected in accordance with the provisions of the Housing (Consolidated) Regulations, 1925 and 1932, was 452. The action taken in regard to individual houses during the year is as set out in the following Table No. 32. TABLE No. 32. Action under the Housing Acts. Premises. Action Taken.  16, Delvan Street Closing Order 26th January 70, Court Road Demolition Order do. 11, Globe Lane do. do. H, Old Mill Road do. 23rd February Prospect House, Heathfield Terrace do. do. 62 TABLE No. 32—continued. Premises. Action Taken. Date. 1, Nightingale Vale Demolition Order. 27 th April 20, Samuel Street. . Closing Order do. 73, Brookhill Road do. 25th May 21, Rectory Place do. do. 94, Eltham Road do. 29th June Nightingale Maple, Swingate Lane Owners undertaking accepted. do. 5, Taylor s Buildings do. 20th July 6, Taylor's Buildings do. do. 225, Bexley Road. . Demolition Order do. 86, Eltham Road.. Closing Order do. 57, Elmley Street do. 28th September 1, Scotts Place Demolition Order do. 1a, Courtlands Avenue Representation 14th October 9. Passey Place Closing Order 23rd November 17, Brewery Road Representation 13 th December 10, Eltham Green. . Closing Order 21st December Underground Rooms.—Section 12 (2) of the Housing Act, 1936, states that a room, the surface of the floor of which is more than 3 feet below the surface of the street adjoining or more than 3 feet below the surface of any ground within 9 feet of the room, shall be deemed to be unfit for human habitation if either:— (a) The average height of the room from floor to ceiling is not at least 7 feet ; or (b) the room does not comply with regulations made by the local authority for securing proper ventilation and lighting, and protection against dampness, effluvia or exhalation. In 1936 the Council submitted a revised set of Underground Room Regulations to the Minister of Health. Later the Ministry indicated that in consequence of the new legislation they were revising their Model Regulations. In these circumstances the Town Clerk agreed that it would be advisable to defer consideration of the proposed new Regulations until such time as the Model Regulations of the Ministry were revised. The draft Regulations had not been approved by the Minister by the end of 1938. 63 Re-Housing of Old People.—It was decided by the Council in 1935 that where aged or infirm persons were re-housed from clearance areas 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. This practice was continued during the year with satisfactory results. New Houses.—The following Table No. 33 shows the number of certificates of a proper and sufficient supply of water for new houses granted by the Health Committee at each of their meetings. Of these 166 were in respect of houses built by the Council. TABLE No. 33. Date of Meeting. Woolwich. Plumstead : Eltham. Total. West. East. 5th January - — — — — 2nd February 1 13 4 23 41 2nd March 4 11 4 33 52 30th March — 21 3 33 57 4th May — 27 — 167 194 1st June — 19 1 63 83 30th June — 30 4 69 103 19th July — 14 1 38 53 7 th September — 15 2 124 141 12th October 1 17 1 72 91 2nd November — 15 1 59 75 30th November — 17 3 86 106 6 199 24 767 996 Council's Houses.—During the year the Council erected 178 houses and flats on the Middle Park Estate. A further 102 houses were in course of erection there. The total number of dwellings on the Council's new estates at the end of the year was 4,322. This figure is made up as follows:— Number of Houses. Page Estate 2,306 Middle Park Estate (including Horn Park) 1,962 Timbercroft Lane 54 4,322 64 Increase of Rent and Mortgage Interest (Restrictions) Acts.—No applications for certificates under the provisions of the above were received. Tents and Vans.—By-laws regulating the use of these were made by the Council in 1903. All tents and vans (which are few in number) were inspected regularly, and steps were taken to ensure that the by-laws were being observed. The total number of inspections made was 25. 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 226 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 96. The following Table No. 34 shows details of the accommodation available in each common lodging house in the Borough. TABLE No. 34. Premises. Accommodation Men. 60, Beresford Street 50 50, Woolwich High Street 22 93, Woolwich High Street 24 102, Woolwich High Street 22 4, Rope Yard Rails 15 7, Rope Yard Rails 24 10, Rope Yard Rails 51 10a and 11, Rope Yard Rails 62 21 and 21a, Rope Yard Rails 42 312 Clearance Areas.—The first representation in the present campaign against unhealthy areas was made by me in 1933, and up to the end of 1938, 71 representations in all had been made. At the end of 1937 all stages, including demolition, had been completed in the case of 26 areas. All of these have been reported on in previous annual reports. 65 The steps taken by the Borough Council and the situation at the end of the year in each of the remaining 45 areas represented by me since 1933 are 8e^ ou^ in the following pages. They are arranged in two sections:—(a) these dealt with by clearance order only, or by clearance order in the first instance, and (ty those dealt with by compulsory purchase order. The numbers indicate the seqence of the representations. (a) The first section includes the following areas:— (19). Kates Place and Albert Road.—A Clearance Order in respect of this area of 21 houses was confirmed in 1936. At the end of 1937 all the houses had been demolished. The Council subsequently decided to purchase the land comprised in the area and were able to do so by agreement with the exception of the site of Nos. 1.9, Kates Place, where it was not possible to agree terms with the freeholder. In December, 1937, the Council decided to acquire this site by means of a Compulsory Purchase Order in accordance with the powers contained in Section 32 of the Housing Act, 1936. A Ministry of Health Inquiry was held on the 21st March, 1938, and the Compulsory Purchase Order was confirmed by the Minister without modification on the 25th June, 1938. (20) Anne's Place.—A Clearance Order in respect of this area of 4 houses was confirmed in 1936. As the owner did not take any steps to demolish, the Council decided in 1938 to proceed on his default. Subsequently they acquired the site by agreement. At the end of 1938 all the houses had been demolished. (24) Salisbury Cottages, Plumstead High Street.—A Clearance Order in respect of this area of 6 houses was confirmed in 1936. At the end of 1938 all the houses had been demolished. (27) Pound Place.—A Clearance Order in respect of this area of 8 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. (30) Wilmount Street (No. 3).—A Clearance Order in respect of this area of 4 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. (32) Beaconsfield Cottages and Majendie Road.—A Clearance Order in respect of this area of 3 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. (33) Brookhill Road (No. 1).—A Clearance Order in respect of this area of 3 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. (34) Brookhill Road (No. 2).—A Clearance Order in respect of this area of 11 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. 66 (35) Charlotte Place (now Evins Place).—A Clearance Order in respect of this area of 6 houses v-as confirmed in 1937. At the end of 1938 all the houses had been demolish (9J) Godfrey Road and Woodrow.—A Clearance Order in respect of this area o# i7 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. In December, 1937, the Council resolved to purchase the land comprised in the area together with certain adjoining land and in July, 1938, decided to utilise a portion of the site for the erection of six non-parlour type houses for the rehousing of occupiers of unfit houses. (37) Churchfield Estate (No. 1).-—A Clearance Order in respect of this area of 14 houses was confirmed in 1937, one house being excluded from the Order. At the end of 1938 all the houses had been demolished. (38) Elizabeth Terrace.—A Clearance Order in respect of this area of 6 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. (39) Lakedale Road.—A Clearance Order in respect of this area of 3 houses was confirmed in 1937. At the end of 1938 all the houses had been vacated. (40) Jackson Street (No. 1).—A Clearance Order in respect of this area of 6 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. (41) Jackson Street (No. 2).—A Clearance Order in respect of this area of 7 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. (42) Graydon Street.—A Clearance Order in respect of this area of 5 houses was confirmed in 1937. At the end of 1938 all the houses had been demolished. (43) Court Yard.—This area consisting of 11 houses was represented by me to the Council as an unhealthy area on the 8th July, 1937, and the Council made a Clearance Order on the 28th September, 1937. The Order was unopposed, and after inspection the Minister confirmed the Order without modification on the 27th June, 1938. At the end of 1938 all the houses had been demolished. (44) Sandy Hill Avenue.—This area consisting of 19 houses was represented by me to the Council as an unhealthy area on the 8th July, 1937, and the Council made a Clearance Order on the 28th September, 1937. A Ministry of Health Inquiry was held on the 14th December, 1937, and the Clearance Order was confirmed by the Minister, without modification, on the 27th June, 1938. The Minister directed payments to be made in respect of two of the houses as being well-maintained houses. At the end of the year 9 houses had been vacated. 67 (45) Walmer Terrace.—This area consisting of 15 houses was represented by me to the Council as an unhealthy area on the 8th July, 1937, and the Council made a Clearance Order on the 28th September, 1937. A Ministry of Health Inquiry was held on the 14th December, 1937, and the Order was confirmed by the Minister on the 25th November, 1938, modified by the exclusion of 4 houses known as Walmer Terrace, Nos. 11, 12, 13 and 14. on undertakings offered by the owners to carry out to the satisfaction of the Council such works as are necessary for re-conditioning the property. The Minister directed a payment to be made in respect of one house in the confirmed order as being a well-maintained house. (46) Spray Street.—This area consisting of 2 houses was represented by me to the Council as an unhealthy area on the 8th July, 1937. The Council made a Clearance Order on the 28th September, 1937. A Ministry of Health Inquiry was held on the 14th December, 1937, and the Clearance Order was confirmed by the Minister without modification on the 27th June, 1938. At the end of 1938 both houses had been demolished. (47) Albert Road (No. 1).—This area consisting of 2 houses was represented by me to the Council as an unhealthy area on the 8th July, 1937, and the Council made a Clearance Order on the 28th September, 1937. The Order was unopposed and after inspection the Minister confirmed the Order without modification on the 27th June, 1938. At the end of 1938 both houses had been vacated. (48) Taylors Buildings.—This area consisting of 2 houses was represented by me to the Council as an unhealthy area on the 8th July, 1937, and the Council made a Clearance Order on the 28th September, 1937. A Ministry of Health Inquiry was to have been held on the 14th December, 1937. The owners submitted a scheme for the different user of the buildings and in order that this might be considered fully the Inquiry was adjourned by the Minister on the application of the Council. Subsequently the Council decided to deal with these houses as separate dwellings and to accept undertakings from the owners that they would not be used for human habitation. These undertakings were accepted on the 20th July, 1938. (49) Joseph Street (now Glenalvon Place).—This area consisting of 16 houses was represented by me to the Council as an unhealthy area on the 9th September, 1937, and the Council made a Clearance Order on the 16th November, 1937. A Ministry of Health Inquiry was held on the 8th February, 1938, and the Clearance Order was confirmed by the Minister, without modification, on the 24th June, 1938. The Minister directed payments to be made in respect of three houses as being well-maintained houses. At the end of 1938, 11 houses had been vacated. (50) Hill Street (now Hillreach).—This area consisting of 4 houses was represented by me to the Council as an unhealthy area on the 9th September, 1937, and the Council made a Clearance Order on the 16th November, 1937. The Order was unopposed and after inspection the Minister confirmed the Order without modification on the 24th June, 1938. At the end of 1938, 2 houses had been vacated. 68 (51) Old Mill Road.—This area consisting of 4 houses was represented by me to the Council as an unhealthy area on the 9th September, 1937, and the Council made a Clearance Order on the 16th November, 1937. The Order was unopposed and after inspection the Minister confirmed the Order without modification on the 24th June, 1938. At the end of 1938, 2 houses had been vacated. (52) Churchfield Estate (No. 2).—This area consisting of 42 hutments was represented by me to the Council as an unhealthy area on the 7th October, 1937, and the Council made a Clearance Order on the 16th November, 1937. The Order was unopposed and after inspection the Minister confirmed the Order without modification on the 24th February, 1938. At the end of 1938, 38 houses had been vacated, 31 of which had been demolished. (53) Churchfield Estate (No. 3).—This area consisting of four hutments was represented by me to the Council as an unhealthy area on the 7th October, 1937, and the Council made a Clearance Order on the 16th November, 1937. The Order was unopposed and after inspection the Minister confirmed the Order without modification on the 24th February, 1938. At the end of the year all the hutments had been demolished. (54) Anglesea Avenue.—This area consisting of 3 houses was represented by me to the Council as an unhealthy area on the 7th October, 1937, and the Council made a Clearance Order on the 16th November, 1937. A Ministry of Health Inquiry was held on the 8th February, 1938, and the Order was confirmed by the Minister without modification on the 24th June, 1938. At the end of 1938 all the houses had been vacated. (55) Bloomfield Road and Cave Cottages.—On the 6th January, 1938, I represented this area, consisting of 3 houses as an unhealthy area. The houses in question are known as Bloomfield Road No. 136 and Cave Cottages Nos. 1 and 2. The number of occupants was 15. The Council made a Clearance Order on the 16th March, and a Ministry of Health Inquiry was held on the 13th June. The Order was confirmed by the Minister, without modification, on the 25th November, 1938. Re-housing is to be provided on the Horn Park Estate. (56) Kidd Cottages.—On the 6th January, 1938,1 represented this area, consisting of 2 houses, as an unhealthy area. The houses in question are known as Kidd Cottages, Nos. 1 and 2. The number of occupants was 8. The Council made a Clearance Order on the 16th March, and a Ministry of Health Inquiry was held on the 13th June. The Order was confirmed by the Minister without modification on the 25th November, 1938. Re-housing is to be provided on the Horn Park Estate. 69 (59) Dairy Lane.—On the 3rd February, 1938,1 represented this area, consisting of 4 houses, as an unhealthy area. The houses in question are known as Dairy Lane, Nos. 1, 2, 3 and 4. The number of occupants was 20. The Council made a Clearance Order on the 16th March, and a Ministry of Health Inquiry was held on the 13th June. The Order was confirmed by the Minister without modification on the 25th November, 1938. Re-housing is to be provided on the Horn Park Estate. (60) Rideout Street.—On the 3rd February, 1938, I represented this area, consisting of 4 houses, as an unhealthy area. The houses in question are known as Rideout Street, Nos. 1, 2, 3 and 4. The number of occupants was 25. The Council made a Clearance Order on the 16th March, and a Ministry of Health Inquiry was held on the 13th June. The Order was confirmed by the Minister without modification on the 25th November, 1938. Re-housing is to be provided on the Horn Park Estate. (61) The Slade.—On the 3rd February, 1938, I represented this area, consisting of 5 houses, as an unhealthy area. The houses in question are known as The Slade, Nos. 29, 30, 31, 32 and 33. The number of occupants was 11. The Council made a Clearance Order on the 16th March. The Order was unopposed, an objection thereto having been withdrawn. The Order was confirmed by the Minister without modification on the 25th November, 1938. Re-housing is to be provided on the Horn Park Estate. (62) Shipmans Cottages.—On the 10th March, 1938, I represented this area, consisting of 2 houses, as an unhealthy area. The houses in question are known as Shipmans Cottages Nos. 1 and 2. The number of occupants was 7. The Council made a Clearance Order on the 27th April, and a Ministry of Health Inquiry was held on the 18th July. The Order was confirmed by the Minister without modification on the 22nd November, 1938. Re-housing is to be provided on the Horn Park Estate. (63) Leon Street.—On the 10th March, 1938, I represented this area, consisting of 6 houses, as an unhealthy area. The houses in question are known as Leon Street, Nos. 3, 4, 5, 6, 7 and 8. The number of occupants was 17. The Council made a Clearance Order on the 27th April, and a Ministry of Health Inquiry was held on the 18th July, 1938. The Minister did not confirm the Order, having decided to accept the undertaking offered by the owner to re-condition these properties. (64) Rectory Place and Leon Street.—On the 10th March, 1938, I represented this area, consisting of 15 houses, as an unhealthy area. The houses in question are known as Rectory Place, Nos. 15, 17, 19, 25, 26, 28, 30, 36, 38, 40, 42, 44 and 46, and Leon Street, Nos. 1 and 2. The number of occupants was 78. The Council made a Clearance Order on the 27th April, and a Ministry of Health Inquiry was held on the 18th July. The Order was confirmed by the Minister, without modification, on the 22nd November, 1938. Re-housing is to be provided on the Horn Park Estate. 70 (65) Sidney Cottages, Reidhaven Road.—On the 7th July, 1938, I represented this area, consisting of 2 houses, as an unhealthy area. The houses in question are known as Sidney Cottages, Nos. 1 and 2. The number of occupants was 7. The Council made a Clearance Order on the 13th September, 1938. No Inquiry had been held by the end of the year. Re-housing is to be provided on the Horn Park Estate. (66) Foreland Street (No. 1).—On the 7th July, 1938, I represented this area, consisting of 8 houses as an unhealthy area. The houses in question are known as Foreland Street, Nos. 2, 4, 6, 8, 10, 12, 14 and 16. The number of occupants was 37. The Council made a Clearance Order on the 13th September, 1938. No Inquiry had been held by the end of the year. Re-housing is to be provided on the Horn Park Estate. (67) Foreland Street (No. 2).—On the 7th July, 1938, I represented this area, consisting of 7 houses as an unhealthy area. The houses in question are known as Foreland Street, Nos. 13, 15, 17, 19, 21, 23 and 25. The number of occupants was 30. The Council made a Clearance Order on the 13th September, 1938. No Inquiry had been held by the end of the year. Re-housing is to be provided on the Horn Park Estate. (68) Inverary Place.—On the 7th July, 1938, I represented this area, consisting of 8 houses as an unhealthy area. The houses in question are known as Inverary Place, Nos. 1, 2, 3, 4, 5, 6, 7 and 8. The number of occupants was 23. The Council made a Clearance Order on the 13th September, 1938. The Order was unopposed but had not been confirmed by the Minister by the end of the year. Re-housing is to be provided on the Horn Park Estate. (69) Frances Street.—On the 8th September, 1938, I represented this area, consisting of 3 houses as an unhealthy area. The houses in question are known as Frances Street, Nos. 153, 155 and 157. The number of occupants was 11. The Council made a Clearance Order on the 15th November, 1938. No Inquiry had been held at the end of the year. Re-housing is to be provided on the Horn Park Estate. (b) The second section consists of the clearance areas dealt with by means of Compulsory Purchase Orders. (57) Brickfield Cottages.—On the 6th January, 1938, I represented this area, consisting of 7 houses, as an unhealthy area. The houses in question are known as Brickfield Cottages, Nos. 1, 2, 3, 4, 5, 6 and 7. The number of occupants was 21. The Council decided to secure the clearance of the area by purchasing the land comprised in the area and a Compulsory Purchase Order was made on the 16th March. A Ministry of Health Inquiry was held on the 13th June. The Order was confirmed by the Minister without modification on the 25th November, 1938. The Minister directed payments to be made in respect of two of the houses as being well-maintained houses. Re-housing is to be provided on the Horn Park Estate. 71 (58) Surgeon Street.—On the 6th January, 1938, I represented this area, consisting of 3 houses, as an unhealthy area. The houses in question are known as Surgeon Street, Nos. 5, 6 and 7. The number of occupants was 16. The Council decided to secure the clearance of the area by purchasing the land comprised in the area. The Council made a Compulsory Purchase Order on the 16th March, and a Ministry of Health Inquiry was held on the 13th June, 1938. The Order was confirmed by the Minister without modification on the 25th November, 1938. Re-housing is to be provided on the Horn Park Estate. (70) Albert Road (No. 2).—On the 8th September, 1938, I represented this area consisting of 26 houses, as an unhealthy area. The houses in question are known as :— Albert Road, Nos. 152, 154, 156, 158, 160, 162, 164, 166, 168, 170, 172, 174, 176, 178, 180, 182, 184, 186, 188, 190, 192, 194, 196, 198, 200 and 202. The Council decided to secure the clearance of this area by purchasing the land comprised in the area and also to acquire certain adjoining lands which are reasonably necessary for the satisfactory development or user of the cleared area. The total number of occupants was 151, of whom 143 were in occupation of houses in the clearance area and 8 in occupation of houses on the additional lands. The Council made a Compulsory Purchase Order on the 15th November, 1938. No Inquiry had been held at the end of the year. Re-housing is to be provided on the Woodlands Estate, Flaxton Road, Plumstead. (71) Garland Road and Pendrell Street.—On the 8th September, 1938, I represented this area, consisting of 81 houses as an unhealthy area. The houses in question are known as :— Garland Road, Nos. 6, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 43, 45, 47, 49, 51, 53 and 55. Pendrell Street, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39 and 40. The Council decided to secure the clearance of the area by purchasing the land comprised in the area and also to acquire certain adjoining lands which are reasonably necessary for the satisfactory development or user of the cleared area. The total number of occupants was 278 of whom 276 were in occupation of houses in the clearance area and 2 in occupation of houses in the additional lands. The Order had not been made at the end of the year. Re-housing is to be provided on the Woodlands Estate, Flaxton Road, Plumstead. The total number of houses included in these 71 areas is 667 the corresponding figures at the end of 1937 being 54 and 481 respectively. The Clearance Area programme of the Borough Council is not yet complete. 72 The London County Council have taken action in Woolwich in respect of the under-mentioned unhealthy areas :— (а) Parlcdale Road Area.—A Clearance Order in respect of this area of 8 houses was confirmed in 1936. At the end of 1937 all the houses had been demolished. (б) Rope Yard 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 a clearance area. In July, 1937, however, the Council decided to deal with three of these areas and part of three others by means of Compulsory Purchase Orders, including therein certain additional lands. Orders with respect to areas Nos. 1 and 8 were made on the 17th June, 1938. No Inquiry had been held at the end of the year. The houses included in the Clearance Areas 1 and 8 are as follows :— No 1 Order. Woolwich High Street, Nos. 50, 51, 52, 54, 55, 56, 56a. Meeting House Lane, Nos. 1, 2, 3, 4, 5, 6, 7, 8. Collingwood Place, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 13. Nelson Street, Nos. 7, 8, 9, 10, 11, 14. Globe Lane, No. 14. Rodney Street, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13. No. 8 Order. Woolwich High Street, Stanley House, Sidney House, Albert House, Fore House and Nos. 42, 43, 44, 45, 46. Nelson Street, No. 1. (c) Barnfield Road Areas.—These areas, details of which were given in my report for 1936, were represented to the Council on the 11th December, 1935, by Dr. J. Bruce Low. The Council subsequently made compulsory purchase orders in respect of the unfit areas and also certain adjoining houses and lands. On the 25th October, 1937, a Ministry of Health Inquiry was held. The Orders were confirmed by the Minister, with modifications, on the 13th April, 1938. Blocks of flats are being erected on the sites. 73 (d) Warwick Street Areas.—On the 15th May, 1936, Dr. W. E. Roper Saunders, a Medical Officer of Health appointed by the London County Council for the purpose of carrying into effect Part III of the Housing Act, 1936, made an official representation with respect to a group of areas known as the Warwick Street Nos. 1-11 Areas. The County Council at their meeting on the 17th May, 1938, resolved to deal with all these areas; with some of them and certain additional lands reasonably necessary for redevelopment purposes by means of Compulsory Purchase Orders and with the remainder by means of Clearance Orders. These Orders were made on 17th March, 1939. The clearance areas comprise 318 dwellings. The displacement of 1,616 persons, including 276 living in houses on the additional lands, is involved. The houses included in the clearance areas are as follows:— Area No. 1. Woolwich Church Street, Nos. 232, 234, 236, 238, 240, 242, 244. Martyr's Passage, Nos. 3, 4, 5, 6, 7, 8, 9, 16. Kingsman Street, Nos. 22, 24, 26, 28, 29, 31, 32, 34, 36, 38, 40, 41, 42, 43, 44, 45, 46, 47, 48, 50, 52, 54, 56, 62, 64, 66, 68. Warwick Street, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 12a, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35., 36, 37, 38, 39, 41, 42, 43, 44, 45, 46, 62, 63, 64, 66, 67, 68, 69, 70, 71, 72 Paradise Place, Nos. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14, 15, 16, 17, 17a, 19 and The Villa. Chapel Hill, Nos. 12, 13, 14, 40a, 41, 42 and St. Francis Flats, No. 2. Marybank, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Elgin Terrace, Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. Samuel Street, Nos. 7, 9. Area No. 2. North Kent Grove, No. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21. North Kent Place, Nos. 1, 2, 3, 4, 5. Area No. 3. Limbreys Buildings, Nos. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Area No. 4. Frances Street, Nos. 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62, 83, 85, 87, 89, 91, 93, 95, 97, 99, 101, 103, 105, 107. Thrift Cottages, Nos. 1 and 2, 3, 4. Eustace Place, Nos. 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37 and 38. Borgard Road, Nos. 17, 18, 19. 74 Area No. 5. Chapel Hill, Nos. 15, 16. Belson Road, No. 1. Sims Buildings, Nos. 6, 7, 8, 9, 10. Area No. 6. Frances Street, Nos. 66, 68, 70, 74, 76, 78, 80, 82, 84, 86, 88, 90. Harrington Buildings, Nos. 2, 3, 4, 5, 6. Railway Court, Nos. 5, 6, 7, 8 ; 1, 2, 3, 4. Samuel Street, Nos. 15, 17, 19, 21, 23, 25, 27, 29, 31. Chapel Hill, Nos. 19, 20, 21, 22, 23, 25, 26, 27, 28, 29, 30, 34, 35, 36. Sims Buildings, Nos. 1, 2, 3, 4, 5. Area No. 7. Chapel Hill, No. 7, 8, 9, 10. Area No. 8. Woolwich Church Street, Nos. 218, 220, 222, 224, 226. Areas No. 9 and 9a. Kingsman Street, Nos. 8, 10, 12, 14. Woolwich Church Street, Nos. 268, 270. Area No. 10. Woolwich Church Street, No. 198, 200. Area No. 11. Woolwich Church Street, Nos. 254, 256, 258, 260. The London County Council programme, like that of the Borough Council, is not yet complete. 75 SECTION VII. PREVALENCE AND CONTROL OF INFECTIOUS DISEASE. In addition to food poisoning, which is reported on in Section VIII, the following diseases are notifiable in the Borough :— Anthrax Ophthalmia Neonatorum Cerebro-spinal Meningitis Pneumonia—Acute Primary Cholera Pneumonia—Acute Influenzal Continued Fever Poliomyelitis Diphtheria Polio-encephalitis Dysentery Plague Encephalitis Lethargica Puerperal Fever Erysipelas Puerperal Pyrexia Enteric (or Typhoid) Fever Relapsing Fever Glanders Scarlet Fever (or Scarlatina) Hydrophobia Smallpox Malaria Tuberculosis Measles Typhus Fever Membraneous Croup Whooping Cough Zymotic Enteritis Included in the above list are measles and whooping cough. These diseases became notifiable on 1st October, 1938. No notification, however, is required if a previous case in the household has been notified within the past two months. German measles is not notifiable. Although notification of an infectious disease in a house is incumbent not only upon the medical practitioner in attendance but also 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 to be sent to the Medical Officer of Health of the district in which the usual 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, Shooters Hill, or to the Park Hospital, Hither Green, 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. 76 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 these cases. The total number of notifications, excluding cases of tuberculosis, which are dealt with later in this Section, was 1,324, compared with 1,318 in 1937. In tabular form are shown in the next five Tables statistics relating to the incidence of infectious disease in the Borough in 1938 and previous years. The incidence of measles and whooping cough was higher than this table indicates because they were only notifiable during the last quarter of the year. TABLE No. 35. Notifications of Infectious Disease (excluding Tuberculosis), 1938. Diseases. Total Cases Notified. Admissions to Hospital. Total Deaths. Diphtheria 264 264 8 Scarlet Fever 507 473 4 Enteric Fever (including Para-Typhoid Fever) 6 6 1 Puerperal Fever 8 8 — Puerperal Pyrexia 37 31 — Erysipelas 94 55 1 Smallpox — — Pneumonia 207 150 96 Malaria 4 4 — Ophthalmia Neonatorum 32 6 — Encephalitis Lethargica — — 3 Dysentery 50 20 — Cerebro-Spinal Meningitis 6 6 3 Poliomyelitis 5 5 1 Polio-encephalitis — — — Zymotic Enteritis 61 56 19 *Measles 8 †235 †4 *Whooping Cough 35 †14 1 1,324 1,319 140 *These diseases became notifiable on 1st October, 1938. †Includes non-notified cases. 77 TABLE No. 36. Notification of Infectious Diseases (excluding Tuberculosis), 1938. Diseases. Number of Cases Notified. All Ages. Age Groups. 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 264 10 9 18 19 20 118 31 9 27 1 1 1 Scarlet Fever 507 1 13 18 34 36 173 72 99 51 5 5 — Enteric Fever (including Paratyphoid Fever) 6 - - - - - - 1 1 2 2 - - Puerperal Fever 8 — — — — — — — 1 6 1 - — Puerperal Pyrexia 37 — — — — — — — 1 30 6 - — Erysipelas 94 1 1 — 1 — 4 3 6 15 10 43 10 Smallpox — — — — — — — — — — — — — Pneumonia 207 19 8 12 12 7 17 8 12 22 21 44 25 Malaria 4 — — — — — 3 — — 1 — — — Ophthalmia Neonatorum 32 32 — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — Dysentery 50 1 3 1 2 2 8 6 1 11 5 9 1 Cerebro-spinal Meningitis 6 2 — — — — 1 — 1 1 — 1 — Poliomyelitis 5 — 1 1 — — 2 — 1 — — — — Polio-encephalitis — — — — - — — — — — — — — Zymotic Enteritis 61 40 8 6 1 3 1 — — 1 1 — — *Measles 2,560 65 155 188 378 418 1,289 51 9 6 1 — — *Whooping Cough 45 6 3 2 4 7 21 — — — 2 — — 3,886 177 201 246 451 493 1,637 172 141 173 55 103 37 *Includes all known cases, whether notified or not. 78 TABLE No. 37. Ward Incidence of Infectious Diseases (excluding Tuberculosis), 1938. Disease. Borough Dockyard. St. Mary's. River. St. George's, Bur rage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas. Abbey Wood. Well Hall. Avery Hill. Sherard. Diphtheria 263 14 9 20 25 17 25 34 25 17 25 21 5 9 18 Scarlet Fever 507 22 52 26 82 10 22 20 36 30 67 51 16 18 55 Enteric Fever (including Paratyphoid Fever) 6 - - 1 - 1 _ 1 - - - - - - 3 Puerperal Fever 8 — — 1 1 1 1 — — — 1 2 — — 1 Puerperal Pyrexia 37 1 1 5 — 1 1 2 8 1 2 6 1 2 6 Erysipelas 94 — 7 7 9 7 5 6 8 4 9 4 5 7 16 Smallpox — — — — — — — — — — — — — — — Pneumonia 207 8 5 14 10 17 5 22 12 11 35 17 6 16 29 Malaria 4 — — — 4 — — — — — — — — — — Ophthalmia Neonatorum 32 2 1 1 — 1 1 3 3 1 7 5 — 1 6 Encephalitis Lethargiea — — — — — — — — — — — — — — — Dysentery 50 1 — 5 2 2 1 2 3 2 12 3 1 10 6 Cerebro-spinal Meningitis 6 — — — 1 — — 1 1 — 2 — 1 — — Poliomyelitis 5 — — — 1 1 — — — — 1 — 2 — — Polio-encephalitis - - - - - - - - - - - - - - - Zymotic Enteritis 61 1 1 7 4 1 3 4 3 — 8 12 1 5 11 *Measles 2560 136 86 167 204 98 131 122 193 54 129 177 202 127 734 *Whooping Cough 45 — 2 6 2 — — 1 1 — 3 2 — 24 4 3.886 185 164 260 345 157 195 218 293 120 301 300 240 219 889 •Includes all known cases whether notified or not. 79 TABLE No. 38. Deaths from Infectious Diseases (excluding Tuberculosis), 1938. Diseases. Number of Deaths. All Ages. Age Groups. Under 1 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- Diphtheria 8 - 1 3 4 - - - - - - - Scarlet Fever 4 — — 1 2 1 - - - - - - Enteric Fever (including Para-typhoid Fever) 1 - - - - - - 1 - - - - Puerperal Fever - - - - - - - - - - - - Puerperal Pyrexia 1 - - - - - - 1 - - - - Erysipelas 1 - - - - - - - - 1 - - Smallpox — — — — — — — — — — — — Pneumonia 96 18 2 3 2 1 6 11 9 17 12 15 Malaria — — — — — — — — — — — — Ophthalmia Neonatorum — — — — — — — — — — — — Encephalitis Lethargica 3 — — — — — — 1 1 — 1 — Dysentery — — — — — — — — — — — — Cerebro-spinal Meningitis 3 1 — — 1 — — — 1 — — — Poliomyelitis 1 — — — — 1 — — — — — — Polio-encephalitis — — — — — — — — — — — — Zymotic Enteritis 26 18 1 — 1 — 1 — — — 1 4 Measles 4 1 — 1 1 1 — — — — — — Whooping Cough. 1 1 — — — — — — — — — — 149 39 4 8 11 4 7 14 11 18 14 19 80 TABLE No. 39. Notification of Infectious Diseases (including Tuberculosis), 1916 to 1938. 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 -encephal it is. ‡ Zymotic Enteritis. Pulmonary Tuberculosis. Tuberculosis Non-pulmonary. †Measles x Chicken Pox. 1916 1 271 95 232 9 - 16 - - - - - - 33 - 17 - 80 392 77 1,590 - 1917 277 79 147 12 - 12 - - - - - - 41 — 22 i 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 — 26 1 15 1 63 217 36 2,060 — 1937 — 297 73 428 17 - 10 27 196 76 1 81 — 33 — 10 4 65 228 36 76 — 1938 - 264 94 507 6 - 8 37 200 7 4 50 - 32 - 6 5 61 204 44 2,560 §Notification of Puerperal Pyrexia commenced October, 1926. †Measles notifiable from 1/1/1916 to 31/12/1919 and from 1/10/38. ‡Compulsory notification of Zymotic Enteritis commenced 1913 x Chicken Pox was made notifiable from April, 1930 to 30th September, 1931. 81 Diphtheria. Notification.—During the year 264 cases were notified compared with 297 in 1937 and 176 in 1936. There were 10 military cases. The number of notifications received each quarter was as follows— First quarter 78 Second quarter 61 Third quarter 70 Fourth quarter 55 Multiple Cases.—The following Table No. 40 shows the house distribution in wards. The term "house" is synonymous with the term "family," except in two instances where two and three families respectively were involved. TABLE No. 40. Diphtheria—Multiple Cases, 1938. 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 12 3 14 17 14 16 27 21 12 21 19 3 7 18 204 204 2 cases occurred 1 2 3 - - 2 2 2 1 2 1 1 1 - 18 36 3 „ ,, - - - - 1 - 1 - 1 - - - - - 3 9 4 ,, ,, - - - - - - - - - - - - - - - - 6 „ „ - - - - - 1 - - - - - - - - 1 5 Total houses 13 5 17 17 15 19 30 23 14 23 20 4 8 18 226 254 Military Cases - 2 - 8 - - - - - - - - - - - 10 264 Return Cases.—There were no return cases. Deaths.—There were 8 deaths from diphtheria compared with 10 in 1937 and 7 in 1936. Four of these were of children under five years of age and 4 were school children. 82 Antitoxin.—A supply of antitoxin is kept at the Town Hall and at 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 80,000 units. The total cost to the Council was £4 8s. 0d., all of which was recovered, with the exception of five shillings. 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 aie referred to in my Annual Report for 1935 were made during that year. The basis of payment to general practitioners was altered during the year. Every medical practitioner is now paid at the rate of 2s. 6d. per injection and the Council provides the prophylactic. The number of injections per child may be two or three, never one. During 1938, 647 children were immunised and a further 32 were found not to require immunisation. Since the scheme started in November, 1934, 3,010 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 as often as was necessary. The figures for the year follow. Before a course of immunisation 143 children were found to be Schick positive and 32 Schick negative; after immunisation, including children immunised in 1937, 598 were found to be negative and 61 positive. The total amount of fees paid to general practitioners for immunisation during the year was £283 8s. lid. The other costs amounted to £102 3s. 9d. Bacteriological Examinations.—The number of throat or nose swabs examined at the War Memorial Hospital during the year was 1,630 and 106 of these showed the presence of the diphtheria bacillus. Scarlet Fever. Notification.-—-During the year 507 case6 were notified compared with 428 in 1937 and 609 in 1936. There were 118 military cases. The number of notifications received each quarter was as follows :— First quarter 179 Second quarter 151 Third quarter. 98 Fourth quarter 79 83 Multiple Cases.—The following Table No. 41 shows the house distribution by wards. The term "house" is synonymous with the term "family" except in three instances where two families were involved. TABLE No. 41. Scarlet Fever—Multiple Cases, 1938. 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 20 8 15 6 10 18 14 21 23 46 40 14 18 55 308 308 2 cases occurred 1 1 2 - - 2 1 6 2 6 4 1 - - 26 52 3 „ ,, - - 1 - - - - 1 1 - 1 - - - 4 12 4 „ ,, - - 1 - - - 1 - - 1 - - - - 3 12 5 „ „ - - - - - - - - - 1 - - - - 1 5 Total houses .. 21 9 19 6 10 20 16 28 26 54 45 15 18 55 342 389 Military Cases . . - 42 - 76 - - - - - - - - - - - 118 507 Return Cases.—The following Table No. 42 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 four weeks in hospital. TABLE No. 42. Scarlet Fever—Return Cases, 1938. No in Register. Date Admitted to Hospital. Date Discharged. Total Days in Hospital. Onset of Secondary Case. Remarks on Primary Case. 8 — — — February 4th Home isolation. Disinfection, 28/1/39. 52 February 20th.. March 17th 25 April 6th — 107 February 28th April 2nd 33 April 23rd — 84 TABLE No. 42—continued. No in Register. Date Admitted to Hospital. Date Discharged. Total Days in Hospital. Onset of Secondary Case. Remarks on Primary Case. 118 March 6th April 2nd 27 April 15th Nasal Discharge. 230 April 26th May 21st 26 May 23rd - 180 March 31st May 2nd 33 C May 5th - May 6th May 15th 198 April 10th May 21st 42 May 31st - 221 April 23rd May 14th 22 May 24th - May 28th 240 May 3rd May 26th 24 June 1st - June 13th June 14th June 16th 246 May 7th May 24th 18 June 4th - 259 May 14 th July 22nd 70 July 24th - July 25th 319 June 17th July 9th 23 July 24th - 452 October 26th November 19th 25 November 24th - Deaths.—There were four deaths from scarlet fever during the year; there were not any in 1937. Home Isolation.—Thirty-four cases, or 6.7 per cent, were isolated at home and in one instance a return case occurred. 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. Two such certificates were issued during the year. Puerperal Fever and Puerperal Pyrexia. Forty-five cases were notified during the year, compared with 37 in 1937 and 28 in 1936. In 37 instances notification was in respect of puerperal pyrexia, but at least three of these notifications should have been puerperal fever. One other case originally notified as puerperal pyrexia was subsequently notified as puerperal fever. In two instances the disease was a sequel to abortion. Thirty-nine cases received hospital treatment. Two cases were nursed under the Council's scheme and one bacteriological examination was made. Mr. Harold Taylor, F.R.C.S., the Council's Consultant, in consultation with the doctor in attendance, saw one patient. 85 Deaths.—There were no deaths from puerperal fever in 1937 and 1938. There were two in 1936. Erysipelas. The number of notifications of erysipelas was 94, compared with 73 in 1937 and 68 in 1936. There was one death. Malaria. Four cases of this disease—all military cases, either soldiers or members of their families—were notified. Enteric Fever. Six cases were notified, all of whom were treated in hospital. There was one death. The following Table No. 43 gives details of each case notified. TABLE No. 43. Enteric Fever, 1938. No. Date Notified. Sex. Age. Diagnosis. Final Diagnosis. Remarks. 1 13/6/38 M. 32 Enteric Fever Typhoid Fever — 2 29/7/38 F. 16 Paratyphoid Fever Pleural Effusion — 3 13/9/38 M. 42 Typhoid Fever Lymphangitis and Inguinal adenitis. — 4 7/10/38 M. 10 Typhoid Fever Typhoid Fever — 5 11/10/38 F. 23 Typhoid Fever Pleurisy with Effusion 6 11/10/38 F. 35 Enteric Fever Typhoid Fever Died 14/10/38 Bacteriological Examinations.—The number of blood specimens examined at the War Memorial Hospital was 7, and 1 of these was positive. The number of specimens of stools or urine examined was 8 and of these, none was positive. Dysentery. The number of cases notified during the year was 50. Steps were not taken to confirm the diagnoses bacteriologically except in a few instances. One case was so confirmed. The disease was mild. The number of cases of Dysentery notified in 1937 was 81. Anterior Poliomyelitis. Five notifications of anterior poliomyelitis were received during the year, compared with four in 1937 and one in 1936. All these cases were admitted to the special ward reserved for such cases by the London County Council at the Western Hospital, 86 Encephalitis Lethargica. No case was notified during the year. Three deaths were certified as due to this disease. Smallpox. There were no cases of smallpox. Cerebro-Spinal Meningitis. Six cases were notified, compared with 10 in 1937 and 15 in 1936. There was one military case. All the cases were removed to hospital. Details of each are given in the following Table No. 44. TABLE No. 44. Cerebro-Spinal Meningitis, 1938. No. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. 1 21/3/38 M. 29 Cerebro-spinal Meningitis — 2 16/6/38 M. 18 Cerebro-spinal Meningitis Military case. 3 22/10/38 F. 1/12 Cerebro-spinal Meningitis — 4 3/11/38 F. 5 Pneumococcal Meningitis Died 7/11/38 5 14/11/38 M. 8/12 Pneumococcal Meningitis Died 16/11/38 6 5/12/38 M. 54 Chronic Mastoiditis Died 4/12/38. Whooping Cough. Prior to the 1st October this disease was not notifiable in the Borough, and the two main sources of our knowledge of its incidence were through the School Medical Services and the health visitors. Occasionally, however, information came to us through the local nursing associations and through parents. During the year 45 cases of whooping cough came to the knowledge of the Department, compared with 249 in 1937 and 452 in 1936. The number notified from the 1st October, was 35. Nursing.—One case was nursed under the Council's scheme, 47 visits in all being paid. The cost of this service was £27s. 0d. Deaths.—There was one death, compared with 5 in 1937. 87 Zymotic Enteritis. Sixty-one cases were notified during the year compared with 65 in 1937 and 63 in 1936. The age incidence is given in Table No. 36. Zymotic enteritis at all ages and not limited to any particular months has been notifiable in Woolwich for many years. The number of deaths in children under two years of age certified to be due to diarrhoeal diseases was 19. Ophthalmia Neonatorum. Thirty-two cases were notified, six of which were admitted to hospital. Nursing assistance in accordance with the Council's scheme was given in the remaining twenty-six cases, 617 visits in all being paid. The cost of this service was £30 17s. Od. The following Table No. 45 gives details of each case. TABLE No. 45. Ophthalmia Neonatorum, 1938. Notified Date. Cases Treated Vision Impaired. Vision Unimpaired. Total Blindness. Deaths. At Home. In Hospital. 24/1/38 - Yes - Yes - - 15/1/38 Yes — — Yes — — 26/1/38 Yes — — Yes — — 7/2/38 Yes -— — Yes — — 17/3/38 — Yes — Yes — — 18/3/38 Yes — — Yes — — 23/3/38 Yes — — Yes — — 25/3/38 — Yes — Yes — — 30/3/38 Yes — — Yes — — 28/4/38 Yes — — Yes — — 14/5/38 Yes — — Yes — — 14/5/38 Yes — — Yes — — 27/5/38 Yes — — Yes — — 10/6/38 — Yes — Yes — — 15/6/38 Yes — Moved from district—Ad dress unknow n. 25/6/38 Yes — — Yes — — 30/6/38 Yes — — Yes — — 12/7/38 Yes — — Yes — — 21/7/38 Yes — — Yes — — 30/7/38 Yes — — Yes — — 6/8/38 Yes — — Yes — — 12/8/38 Yes — — Yes — — 14/9/38 Yes — — Yes — — 15/10/38 Yes — — Yes — — 8/11/38 Yes — — Yes — — 10/11/38 Yes — — Yes — — 12/11/38 Yes — — Yes — — 15/11/38 Yes — — Yes — — 22/11/38 Yes — — Yes — — 23/11/38 — Yes — Yes — — 15/12/38 — Yes — Yes — — 15/12/38 Yes — - Yes - - 88 Measles. Prior to the 1st October this disease was not notifiable in the Borough and the two main sources of our knowledge of its incidence were through the school medical services and the health visitors. Occasionally, however, information came to us through the local nursing associations or from parents. During the year 2,560 cases, including 51 cases of German Meales, were discovered. In 1937 and 1936, the corresponding figures were 76 and 2,060. The number of cases notified from the 1st October to the end of the year was 8. Measles occurs in epidemic form every two years, usually for four months. The incidence in each of the twelve months of the year was as follows :— January 37 February 152 March 643 April 735 May 624 June 287 July 59 August 8 September 4 October 2 November 7 December 2 From these figures it will be noted that the disease first assumed epidemic proportions in February, reached its peak in April and fell away thereafter. The Council's scheme for measles control was put in force at the beginning of February, two 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. 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 48 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 59 cases nursing assistance was provided, 469 visits in all being paid. The cost to the Council was £22 5s. 6d, 89 Hospital Treatment.—The number of children admitted to Fever Hospitals was 235. Deaths.—There were four deaths. Pneumonia. The following Table No. 46 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. 46. Monthly Incidence of Pneumonia, 1938. Month. Male. Female. Total. Type. No. of Deaths. Lobar. Broncho. Influenzal. Acute Primary (not specified) Acute Primary Pneumonia. Influenzal Pneumonia. January 23 14 37 8 8 1 20 20 — February 11 8 19 8 2 — 9 13 — March 15 18 33 17 4 — 12 15 1 April 10 8 18 9 1 1 7 7 - May 12 12 24 14 — 1 9 5 1 June 7 2 9 3 — 1 5 2 — July 6 4 10 3 3 — 4 S — August 2 3 5 2 3 — - 5 — September 6 1 7 3 — 1 3 1 — October 10 3 13 10 1 — 2 1 — November 9 2 11 3 3 — 5 5 — December 10 11 21 8 5 2 6 14 — 121 86 207 88 30 7 82 96 2 The number of cases notified was 207, compared with 272 in 1937. Of these 7 were influenzal. The number of deaths certified to be due to lobar or bronchial pneumonia was 96 and to acute influenzal pneumonia 2. The ward incidence of the pneumonias is shown in Table No. 37. 90 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 to provide (a) statistical evidence of the prevalence of the disease or diseases and (b) nursing assistance if required. Nursing.—Nursing assistance is provided by the Council for cases of pneumonia, and during the year 23 cases were nursed, 517 visits being paid by the nurses of the local nursing associations. The total cost to the Council was £32 7s. 6d. Anti- Pneumococcal Serum.—During the year the Council provided free of charge to medical practitioners, anti-pneumococcal serum (Felton's) for the treatment of persons suffering from pneumonia. The total cost to the Council was £27 10s. 0d. Tuberculosis. The Council's Tuberculosis Service is under the general administrative control of the Medical Officer of Health and is in charge of a whole-time Tuberculosis Officer. Three assistant Medical Officers, who are whole-time Officers in the service of the Council, spend three half days per week each on tuberculosis work and eight half days on maternity and child welfare work. There are three whole-time tuberculosis visitors, one clerk-dispenser who acts as Secretary to the Tuberculosis Care Committee and one clerk. Deaths.—The following Table No. 47 shows the number of deaths and death rates every year since 1934. Ninety-one or 71 per cent, of the deaths occurred while patients were undergoing residential treatment. TABLE No. 47. Tuberculosis—Deaths and Death Rates. Year. Deaths. Death-rates. All Forms. Pulmonary. NonPulmonary. All Forms. Pulmonary. NonPulmonary. 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 1937 119 105 14 0.79 0.70 0.09 1938 128 117 11 0.85 0.78 0.07 In addition to the above, four cases, who had been notified as suffering from pulmonary tuberculosis, died during the year from other causes which are set out in the following Table No. 48. 91 TABLE No. 48. Case No. Date Notified as Tuberculosis. Cause of Death. 1 25/9/37 Acute Endocarditis and Myocarditis. Septicaemia. 2 18/4/35 General Peritonitis. Perforated Duodenal Ulcer. 3 29/12/37 Malignant neoplasm of omentum. 4 26/10/38 Myelocytic Leukaemia. The period which elapsed between notification and death is shown below in Table No. 49. TABLE No. 49. Period between Notification and Death. Pulmonary. Percentage. NonPulmonary. Percentage. Not notified 10 8.5 7 63.6 0-1 month 18 15.4 3 27.3 1-3 months 15 12.8 — — 3-6 months 13 11.1 - — 6-12 months 12 10.2 - — 1-2 yeafs 16 13.7 1 9.1 2-5 years 17 14.6 — — Over 5 years 16 13.7 — — 117 100.0 11 100'00 The ratio of non-notified deaths to the total notified deaths was as 1 is to 8. In 1937 it was as 1 is to 8 and in 1936, as 1 is to 14. Notifications.—During the year 204 cases of pulmonary tuberculosis and 44 cases of non-pulmonary tuberculosis were notified. These figures do not include 40 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, non-pulmonary. Dockyard, 7 and nil; St. Mary's, 5 and 1; River, 19 and 3; St. George's, 9 and 1; Burrage, 14 and 3; Herbert, 16 and 5; Glyndon, 11 and 5; St. Margaret's, 12 and 1; Central, 6 and nil; St. Nicholas, 28 and 6; Abbey Wood, 11 and 2; Well Hall, 14 and 5; Avery Hill, 16 and 7; Sherard, 36 and 5. 92 The responsibility for maintaining a correct register of all cases of tuberculosis in the Borough is placed on the Medical Officer of Health by the Public Health (Tuberculosis) Regulations, 1930. To do so it is necessary to delete from the register the names of all those who have died, or have been lost sight of, or have removed to other areas; those patients regarded as cured, and those in whom the diagnosis was not confirmed. It is necessary also to add the names of new cases, lost cases who have been traced, cured cases who have relapsed and those coming to live in the district from elsewhere. The number of inward transfers was 46 and the number of transfers from the borough was 69. The following Table No. 50 shows the changes which have taken place in the register during the year. TABLE No. 50. Pulmonary Non-Pulmonary Totals. M. F. M. F. Number on Register on 1st January, 1938 431 341 83 73 928 Number of new Cases notified 126 77 23 22 248 Number of Cases restored 3 6 1 2 12 Other additions 18 15 5 5 43 Deletions 145 121 31 31 328 Number on Register on 31st December, 1938 433 318 81 71 903 At the end of the year the total number on the register was 903 and of this number 96 per cent, were on the dispensary register. In 1937 the corresponding percentage was 94 and in 1936 it was 90.4. Only those patients receiving public medical treatment and supervision are entered on the dispensary register. The following Table No. 51 shows, allocated to district of usual residence, the new cases notified during the year and corresponding case rates. TABLE No. 51. Woolwich. Plumstead. Eltham. The Borough. Pulmonary Tuberculosis : Cases 40 98 66 204 Rates 1.4 1.4 1.2 1.4 Non-Pulmonary Tuberculosis : Cases 5 22 17 44 Rates 0.2 0.3 0.3 0.3 Table No. 52 which follows, summarises the number of cases coming to the knowledge of the department in 1938 and includes notifications received from 93 practitioners, cases not notified but included in death returns, and inward transfers 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 during the year are classified in the same table by age and sex groups. TABLE No. 52. Tuberculosis—New Cases and Mortality, 1938. Age Periods. New Casks. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0—1 year 1 — 1 — — — 2 — 1—5 years 1 1 1 2 — — 1 — 5—15 years 5 6 8 1 1 1 1 15—26 years 25 39 7 6 7 16 1 2 25—35 years 37 31 7 5 16 13 1 1 35—45 years 26 8 - 2 8 6 — — 45—55 years 16 3 1 2 12 2 — — 55—65 years 23 4 1 — 21 5 1 — 65 and upwards 8 1 2 — 6 3 — — Totals 142 93 25 25 71 46 7 4 The following Table No. 53 shows the site of disease in patients notified each year since 1934. TABLE No. 53. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes. 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 1937 228 5 4 9 8 2 8 264 1938 204 4 6 8 9 6 11 248 94 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. During the year six children were thus dealt with on the recommendation of the Tuberculosis Officer. 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. It was not necessary to take any such action during the year. Every milk vendor in the Borough is periodically reminded that the Tuberculosis Officer is willing to examine, free of charge, all employees or candidates for employment in the milk trade. No persons submitted themselves for examination. The Work of the Dispensaries.—The Council's main dispensary is situated at Maxey Road, Plumstead, and the branch dispensary at 11, Carnecke Gardens, Eltham. The general supervision of anti-tuberculosis work in the Borough is however controlled from Maxey Road. During the year plans were approved for a new Dispensary at Eltham, as part of a new Health Centre which will be built in Sherard Road. It is hoped that the transfer will take place towards the end of 1939. The Tuberculosis Officer or one of the assistant medical officers is in attendance at Maxey Road every weekday, morning and afternoon, except Thursday, when an evening session replaces the afternoon one to meet the needs of those patients who are at work. Eight sessions in all are held for men, women and 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 1938 was 5,415. Of the 248 persons notified during the year 213 attended the dispensaries; that is 85.8 per cent. The corresponding percentages for 1937, 1936 and 1935 were 79.7, 73.5 and 77.2 respectively. Table No. 54 shows the work of the dispensaries during the year, and in accordance with the Ministry of Health instructions the figures are shown for the borough as a whole and not for individual dispensaries. Home Visiting of Tuberculous Cases.—Every notified case is visited by one of the Council's tuberculosis visitors unless the family doctor specially requests that this be not done. In the home she gives general and particular advice. She does what she can to ensure that the family make the best of their circumstances. She tells how infection is spread and what should be done to limit this risk. She endeavours to get all home contacts to come to the dispensary for examination. 95 In short she does everything possible to help the patient and 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 and sees whether the advice given by the tuberculosis visitor is being followed. The tuberculosis visitor endeavours to visit each home in her district once in three months but when necessary visits are paid at shorter intervals. Outdoor Shelters.—Twelve open air shelters are available for the use of patients in their own gardens. Nine were in use during the year. No charge is made for the loan of these. Home Nursing.—Under arrangements made by the Council cases of tuberculosis requiring nursing services in their own homes are attended by nurses from the local Nursing Associations. The Council takes financial responsibility for this service and the cost during the year was £62 lis. 3d. The number of visits paid was 1,001. This service is greatly appreciated. Examination of Home Contacts.—A medical examination is most important in the case of all contacts either at home or at work and every endeavour is made to persuade them to submit themselves for this examination. It is unfortunately often very difficult, but the effort is well worth while and tuberculosis visitors, when visiting, and the Tuberculosis Officers, when opportunity offers, stress the importance of this examination. During the year 512 contacts were examined. In dealing with children, in addition to the clinical examination a Mantoux Intradermal test is done and if a positive result is obtained the patient is X-rayed. During the year 238 children had a Mantoux test and the figures show, as in previous years, that children in contact with a notified case of tuberculosis are much more subject to infection than where no such contact exists. co o* TABLE No. 54. Return showing the work of the dispensaries for 1938. Diagnosis. pulmonaby. non -pulmon ary. 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 99 54 11 6 20 8 8 4 119 62 19 10 210 (6) Diagnosis not completed — — — — — — — — 2 1 1 — 4 (c) Non-tuberculous - - - - - - - - 237 211 69 70 58 / B.—CONTACTS examined during the year :— (a) Definitely tuberculous 12 4 3 — — — 2 — 12 4 5 — 21 (6) Diagnosis not completed - — — — - - - - — - 1 — 1 (c) Non-tuberculous - - - - - - - - 105 179 93 113 490 C.—CASES written off the Dispensary Register as:— (a) Recovered 17 26 3 1 8 5 2 3 25 31 5 4 65 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 347 397 166 185 1095 D.—NUMBER OF CASES on Dispensary Register on December 31st :— (a) Definitely tuberculous 383 282 37 26 45 44 30 22 428 326 67 48 869 (6) Diagnosis not completed - - - - - - - - 2 1 2 - 5 97 TABLE No. 54—continued. Return showing the work of the Dispensaries for 1938. 1. Number of cases on Dispensary Register on January 1st 879 2. Number of cases 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 tuberculosis scheme, and cases " lost sight of " 85 4. Cases written off during the year as Dead (all causes) 76 5. Number of attendances at the Dispensary (including Contacts) 5,415 6. Number of Insured Persons under Domiciliary Treatment on 31st December 260 7. Number of consultations with medical practitioners :— (a) Personal 82 (6) Other 1,017 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 285 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,522 10. Number of :— (a) Specimens of sputum, etc., examined 598 (b) X-ray examinations made in connection with Dispensary work 1,156 11. Number of " Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 8 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 309 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 98 TABLE No. 55. Contacts. 0-5 years. 5-10 years. 10-15 years. Total. Percentage. Positive result 8 24 24 56 38.89 Negative result 34 27 27 88 61.11 Non-Contacts. Positive result 2 6 12 20 21.28 Negative result 34 27 13 74 78.72 Extra Nourishment.—The sum of £302, that is to say, two pounds per thousand of the population, is available for the supply of extra nourishment to tuberculous persons, but under this scheme such nourishment is not available for advanced cases of tuberculosis where real and lasting improvement cannot be expected but only for ante- and post-sanatorium cases in which it may make a real difference to the prospects of recovery. Under arrangements made with the London County Council Public Assistance Committee the responsibility of recommending extra nourishment for patients who are being assisted by that Committee rests with the Tuberculosis Officer, and it is gratifying to record the smoothness with which these arrangements work and the cordial relations which exist between the Tuberculosis Service and the Public Assistance Service, and the officers of both services. X-Ray Examinations.—It is a commonplace, nowadays, to regard X-ray examinations as absolutely essential for the diagnosis and investigation of cases of tuberculosis. Every new adult patient attending the dispensary is X-rayed. Every positive Mantoux child is. Post-sanatorium cases are so examined from time to time. Nearly 1,200 examinations were recorded last year but X-rays are used more frequently than this figure indicates. All patients undergoing artificial pneumothorax treatment are frequently screened and X-rayed during the progress of this treatment. Local patients admitted to St. Nicholas Hospital are X-rayed in hospital and the skiagrams are forwarded to the dispensary on the patient's discharge. Patients are sent for these examinations to the War Memorial Hospital and to St. Nicholas Hospital. In the majority of cases the film is available at the Dispensary the following day. The number of patients X-rayed at the War Memorial Hospital was 306 and at St. Nicholas Hospital, 850. Dental Treatment.—Tuberculous patients requiring dental treatment are referred to the Borough Council clinic at Brewer Street. During the year 38 cases received treatment. The number of attendances was 156. Patients requiring dentures are assessed according to their income, each case being considered on its merits by the Tuberculosis Care Committee, which submits a suitable recommendation to the Health Committee. Dentures were supplied in 18 cases at a cost of £84 5s. 2d., and payments by patients amounted to £31 0s. lOd. 99 Finaen Light Treatment.—This form of treament is available for patients suffering from lupus and is carried out at the London Hospital under an arrangement made in 1921. A fee of 5s. Od. is paid for Finsen Light Treatment. For other forms of light treatment the fee is Is. Od. Two patients were so treated during the year. Artificial Pneumothorax.—This treatment is at present the most satisfactory form of putting a diseased lung at rest. Air is introduced through a needle into the pleural cavity of the affected side or sides and as it becomes absorbed it is replaced at varying intervals. These refills have to be maintained over a lengthy period— two or three years. The Council pays a fee of 10s. 6d. for every refill. This charge includes the necessary X-ray work in connection therewith. At the present time refills are carried out at various hospitals, both voluntary and public. Sometimes the patient continues to attend a sanatorium as an out-patient. The growth of this method of treatment in recent years is shown by the following Table No. 56. TABLE No. 56. Pneumothorax Refills. Year. Patients. Refills. 1935 45 621 1936 51 779 1937 61 977 1938 77 1,181 Occasionally patients undergoing this treatment are also recommended for a simultaneous course of Sanocrysin. The cost to the Council for each injection given to patients recommended for it by the Tuberculosis Officer is 3s. 6d. No such injections were given during the year. Institutional Treatment.—The following Table shows the number of admissions to special hospitals, sanatoria, public general hospitals, institutions and training colonies :— TABLE No. 57. Admissions to Hospitals, etc. Special Hospitals. Sanatoria. Public General Hospitals. Training Colonies. Insured 109 98 101 9 Uninsured 26 23 42 2 Children. 27 2 5 — 162 123 148 11 100 These figures refer to 344 patients and the monthly admissions were as follows :— January 54 May 34 September 38 February 29 June 27 October 43 March 53 July 38 November 27 April 31 August 41 December 29 Co-operation with Maternity and Child Welfare Service.—Interchange of information between the two departments is constantly taking place. Any nontuberculous but debilitated or ailing child under five years of age is referred to the Maternity and Child Welfare department, and vice versa, the Tuberculosis Dispensary is informed of any child attending the Health Centres whose condition suggests that there is a possibility of a tuberculous infection. Co-operation with School Medical Service.—Contact between the two services is close, many children being referred to the dispensary by the School Medical Officer, and the child contacts of tuberculous persons are referred to the School service for special observation and supervision. Some unsatisfactory children are recommended for admission to the Open Air School and these children are brought to the dispensary by the school nurse for supervision and examination. Nontuberculous children found to be suffering from other complaints of a minor kind are referred to the School Clinic and others whose condition, or home circumstances warrant it, are referred to the School Care Organiser, so that the need for the provision of school dinners, milk or Cod Liver Oil and Malt at school can be considered. During the year 19 children were referred to the London County Council for prolonged convalescent treatment. Other children needing such treatment are referred to the Woolwich Invalid Children's Aid Association. Co-operation with Local Practitioners.—During the year 82 cases were seen by the Tuberculosis Officer at the homes of patients and the number referred by local practitioners was 437. Co-operation with St. Nicholas Hospital.—In accordance with arrangements made with the London County Council in 1933 the Tuberculosis Officer continues to visit the hospital weekly, and in addition to visiting the wards is responsible for every recommendation for sanatorium treatment forwarded by the hospital. Woolwich Tuberculosis Care Committee.—At the end of the year the Committee was constituted as follows :— Bodies. Representatives. Woolwich Borough Council. Alderman Mrs. E. Brooks ; Councillors R- Campbell, Mrs. L. E. Driver, G. Greenwood, C. J. Keedy and S. W. Lister. Trade Unions. Mr. W. H. Fairchild, Mr. E. Ware. Employers Miss L. E. Ames, Mrs. D. B. Baldwick, Mr. A. J. Golding. Friendly Societies Mr. W. A. Lyon, Mr. A. J. Rourke, Mr. L. R- Williams. \ 101 B0dies. Representatives. London County Council Dr. H. R. Kidner, Miss C. F. Aves. London County Council (Public Assistance Mrs. R. Ashfield, Mr. R. Campbell, Mrs. B. G. Committee) Dickinson. London Insurance Committee Mr. S. H. Brown. Panel Committee for the County of London Dr. H. M. Wise. British Red Cross Society Mr. J. O'Connell. Woolwich Invalid Children's Aid Association Mrs. J. B. Great-Rex, M.B.E. Late Tuberculosis Dispensary Committee Mr. E. G. Dixon, O.B.E., J.P. United Services Fund Mrs. A. Evans. Ex-Officio. Voluntary Visitors Miss E. Fletcher, 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 following extract from the Annual Report of the Tuberculosis Care Committee for 1938 tells how this Committee works for the benefit of the patient and his household:— "The general aim of the Committee may be stated as follows:—To look after every family in the Borough in which there is a tuberculous patient, and to advise and assist as far as in their power lies, so that nothing may be lacking to supplement the medical treatment which is provided by the public authorities. The means by which we seek to attain the above objective may be enumerated as follows:— (а) The Patient. (1) The provision of clothes to enable the patient to go to an institution. (2) The provision of pocket money while he is away from home. It will be readily understo0d that in institutions patients require small sums of money to meet the cost of postages, newspapers, toilet requisites, etc. (3) Necessary nursing requisites when the patient is at home, e.g., air beds, bed rings, back rests, hot water bottles, bed pans, etc., and surgical aids and instruments in orthopaedic cases. (4) National Health Insurance.—It is found that the National Health Insurance affairs of many patients are not in order. This may be due to indifference, carelessness or unfortunate circumstances which have put the patient in arrears. The Committee endeavours to straighten out these matters so that the patient may derive all the benefit to which he is entitled. In some cases money is advanced to pay up the arrears, which may immediately put the patient into financial benefit and in such cases is expected to refund this amount from the monies received if the circumstances justify this course. (5) The interest of the employer is sought to keep the patient's job open and in other cases endeavour is made to find suitable employment for patients who have lost their posts as a result of their illness. (б) By putting the patient in touch with other organisations which may help, e.g., British Legion, British Red Cross, United Services Fund, Public Assistance, etc. 102 (7) Occupational Therapy.-—-This is dealt with more fully later in the Report. (8) Assistance at Christmas time. See under " Pound Day " later. (9) Wireless licences for lone patients. (b) The Patient's Household. (1) By providing extra beds and bedding where necessary to enable the patient to sleep alone on return from sanatorium. (2) Fares are allowed to relatives to visit the patient at intervals. (3) Financial assistance in special cases may take the form of assistance with moving expenses, redeeming Goods from pawn, furniture debts, rent arrears, etc. (4) Clothes are provided, either new or from store, for needy members of the patient's family. (5) Where the mother of a family has to receive sanatorium treatment " Home Helps " are sent in. (6) Arrangements are made for the boarding out of children. (7) Cookery and Needlework Classes for the womenfolk. (8) Extra nourishment for contacts through other agencies. (c) Extra Assistance. The Care Committee acts as agent for the Borough Council in providing extra nourishment, dental treatment, and advising as to alternative housing." A copy of this report can be obtained from the Secretary of the Committee, The Dispensary, Maxey Road, Plumstead. The Occupational Therapy Centre for men continues to work satisfactorily and is open for 5½ days a week. The number of patients on the attendance register at the end of the year was 15. The number of attendances recorded during the year was 4,250. Two patients have passed out into normal industry and for others the centre has met a real need in catering for the advanced ambulant patient who would otherwise be moping about at home. Bacteriological Examination of Sputum.—During the year 598 specimens were examined at the Dispensary and of these 102 were positive and 496 negative. Specimens sent by general practitioners are dealt with at the Woolwich War Memorial Hospital and 461 specimens were so examined during the year, 55 being positive and 406 negative. 103 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 Station is used for the disinfection of articles after the ordinary infectious fevers and for the disinfestation of bedding and kindred articles infested with vermin. 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 39 such disinfections were carried out, and charges amounting to £10 4s. 0d. were paid. Occasionally rag flock is disinfected prior to export. In tabular form is shown below the amount of disinfection which was carried out during the year:— TABLE No. 58. Rooms disinfected after ordinary fever 707 Rooms disinfected after tuberculosis 243 Rooms disinfected after verminous cases 1,370 Rooms disinfected for other reasons 12 Articles disinfected 42,067 Disinfestation.—In accordance with the terms of an agreement with the London County Council, disinfestation of school children is carried out at the Cleansing Station, White Hart Road. Disinfestation of adults is carried out at times when the children are not there. The following Table No. 59 shows the number of persons cleansed each year since 1934. TABLE No. 59. Year. Children. Adults. Grand Total. Boys. Girls. Total. Males. Females. Total. 1934 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 1937 660 2,047 2,707 9 17 26 2,733 1938 924 1,892 2,816 19 30 49 28,65 104 Scabies.—The number of cases of scabies coming to the knowledge of the Department during the year was 199. In 1937 the corresponding figure was 144, in 1936 it was 100, and in 1935 it was 64. Seventy-four of these cases occurred in Eltham and 125 in the rest of the Borough. The incidence of the disease per thousand of the population is much higher, in Eltham, as it has been consistently, in recent years. This indicates the necessity for the early establishment of a Cleansing Station in this part of the Borough and it is expected that one will be opened in the Sherard Road building some time in 1939. Bed Bug Infestation.—A report on the disinfestation of bug infested premises and furniture and the meth0ds adopted to prevent the infestation of new premises will be found in Section V. 105 SECTION VIII. INSPECTION AND SUPERVISION OF food. Four sanitary inspectors are now engaged in the inspection and supervision of food and food premises; three of them on meat inspection and in the taking of samples under the food and Drugs (Adulteration) Act, 1938, and the various Regulations and Orders dealing with food standards, and the fourth in the systematic inspection of food premises. In addition, each district inspector exercises a general supervision over all food exposed for sale in the market place and in all food premises in his own district. Milk Supply.—The Borough Council is required to keep registers of all persons carrying on in the Borough the trade of cowkeeper, dairyman, or purveyor of milk. The register of retail purveyors of milk must 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. 60. No. Cowkeepers 2 Cowsheds 5 Dairies 63 Dairymen with premises in the Borough 39 Dairymen with premises outside the Borough 33 Purveyors of milk in sealed bottles 179 The number of inspections of dairy premises was 239, and a high standard of cleanliness in cowsheds and dairies and in other premises where milk is sold has been maintained. At the end of the year the licensed cowsheds in the Borough were as set out in the following Table No. 61. TABLE No. 61. Situation of Cowhouse. No. of Sheds. No. of Cows. Licencee. Avery Hill Farm, Eltham . 3 — W. F. Fisher. Coldharbour Farm, Eltham 2 88 C. U. Fisher. Designated Milks.—Under the Milk (Special Designations) Order, 1936, all licences for designated milks can now be granted by Metropolitan Borough Councils. This order revokes that of 1923 and reduces the number of designated milks to three, namely (a) "Tuberculin Tested," (b) "Accredited," and (c) "Pasteurised." Milk may also be sold as " Tuberculin Tested (Pasteurised)," if two licences are 106 granted, and where "Tuberculin Tested" milk has been bottled at the place of pr0duction the word "Certified" may be added. Each licence automatically terminates on the last day of the year in which it is issued. In tabular form is shown below the number of licences so issued during the period:— TABLE No. 62. Number of pasteurisers' licences issued 2 Number of dealers' licences issued to use the designation:— (a) "Accredited" — (b) "Tuberculin Tested" 17 (c) "Pasteurised" 32 Number of supplementary licences issued to sell:— (a) "Accredited" milk — (b) "Tuberculin Tested" milk 7 (c) "Pasteurised" milk 7 Bacteriological Examination of Milk.—The number of samples of milk examined bacteriologically during the year was 42. One sample of raw milk was examined for the presence of tubercle bacillus and the remaining 41 were examined in order to ascertain whether they complied with the bacteriological standards laid down for pasteurised milk. Table No. 63 which follows gives details of the examination of these samples of pasteurised milk. TABLE No. 63. Month. Type of Milk. Number of Bacteria per m.l. January Pasteurised 61,000 do. 19,000 do. 39,000 do. 39,000 do. 16,730 do. 22,500 do. 107,000 do. 105,000 February Pasteurised 176,000 do. 37,200 do. 104,000 do. 369,000 do. 8,200 do. 23,500 March Pasteurised 101,000 do. 88,000 do. 67,000 do. 98,000 do. 6,500 do. 12,300 May Pasteurised 1,700 do. 2,200 do. 2,800 do. 2,600 do. 12,400 do. 25,600 do. 156,000 107 Month. Type of Milk. Number of Bacteria per m.l. May Pasteurised 216,000 do. 56,000 do. 17,300 do. 19,460 June Pasteurised 41,600 do. 86,000 do. 60,000 do. 39,400 do. 25,200 October Pasteurised 14,200 do. 510,000 do. 11,000 do. 25,500 do. 14,430 It will be noted that in nine instances the prescribed standard was not complied with. Washed bottles were also examined in order to test the degree of sterilisation. The following results, expressed in number of bacteria per millilitre, were obtained:— Sterile, 210, 260, 430, 680, 20, 40, 56, 90, 160, 210, 260, 430, 680. Dried and Condensed Milks.—Eight samples of condensed milk, all genuine, were examined. No samples of dried milk were submitted for analysis. 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. Two shops where artificial cream is sold have been placed on the register. 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. 64 shows the number of animals slaughtered and inspected in the Borough during the year, and the numbers and percentages condemned on account of tuberculosis and on account of other diseases. In 1937 the number of animals slaughtered was 34,934. 108 TABLE No. 64. Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Calves. Sheeps and Lambs. Pigs. Number killed (if known) 3,060 15 328 22,969 16,916 Number Inspected 3,060 15 328 22,969 16,916 All diseases except Tuberculosis. Whole carcases condemned — — — 5 17 Carcases of which some part or organ was condemned 352 - 1 282 242 Percentage of the number inspected affected with disease other than tuberculosis 11.5 - 0.3 1.2 1.5 Tuberculosis only. Whole carcases condemned 9 — 1 — 46 Carcases of which some part or organ was condemned 524 — 1 _ 1,173 Percentage of the number inspected affected with tuberculosis 17.4 0.6 — 7.2 109 The figures for each month are shewn in the following Table No. 65. TABLE No. 65. Monthly returns of inspections of carcases. Month. Cattle. Sheep and Lambs. Pigs. Calves. Total. January 278 1,377 1,775 - 3,430 February 250 1,100 1,708 - 3,058 March 270 1,044 1,590 - 2,904 April 240 1,315 1,392 1 2,948 May 264 1,700 703 20 2,687 June 210 1,942 155 155 2,462 July 247 1,979 4 122 2,352 August 209 2,575 191 30 3,005 September 260 2,324 1,624 - 4,208 October 250 2,858 2,358 - 5,466 November 288 2,775 2,584 - 5,647 December 309 1.980 2,832 — 5,121 3,075 22,969 16,916 328 43,288 Licensing of Slaughtermen.—The Slaughter of Animals Act, 1933, requires that all slaughtermen shall be licensed. During the year three new licences were issued and 18 were renewed. Slaughterhouses.—There is no public slaughterhouse in the Borough. Slaughterhouses are subject to annual licence and in Table No. 66 which follows, are shown those licences in force at the end of the year. TABLE No. 66. Situation of Slaughterhouse. Owner. Clothworkers' Wood, Woodlands Farm Royal Arsenal Co-operative Society, Ltd. 14, Church Street Westhorp and Bartlett. 33, Herbert Road Anderson, F. 38, Plumstead Common Road Reed, A. J. 110 Registered Premises.—The Public Health (London) Act, 1936, requires the registration of premises used for the following purposes:— (a) The sale, manufacture or storage of ice cream or similar comm0dity; (b) The manufacture of sausages; (c) The preparation or manufacture of potted, pressed, pickled or preserved meat, fish or other food. The register of such premises is kept in five parts, and the numbers in each part at the end of the year were as set out below:— (а) Sale, manufacture or storage of Ice Cream 278 (b) Manufacture of Sausages 96 (c) Preparation or manufacture of Potted, Pressed, Pickled or Preserved Meat 144 (d) Preparation or manufacture of Potted, Pressed, Pickled or Preserved Fish 50 (e) Preparation or manufacture of Potted, Pressed, Pickled or preserved other foods 4 The total number of inspections made was 740, and the number of notices served was 19. Other food Premises—As a matter of routine the food inspector made 443 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, 1,591 visits were made to shops and to stalls in the markets. Bakehouses.—There were, at the end of the year, 34 bakehouses in the Borough of which 33 were factory and 7 underground. The inspections numbered 95 and 5 notices were served. The conditions on the whole were satisfactory. Section 54 of the Factories Act, 1937, provides:— (1) That a basement bakehouse shall not be used as a bakehouse unless it was so used at the date of the passing of this Act and a certificate of suitability had been issued by the district council under an enactment repealed by this Act in respect thereof, and any basement bakehouse which, for a period exceeding twelve months, is not used as a bakehouse shall not be so used again. (2) It shall be the duty of every district council to carry out, in the year beginning at the date of the commencement of this Act and in every fifth succeeding year after that year, an examination of every basement bakehouse in respect of which a certificate of suitability has been issued, and— (a) if as the result of the examination the Council are not satisfied that the bakehouse is suitable for use as such as regards construction, height, light, ventilation and any hygienic respect, they shall give notice in writing that the certificate shall cease to have effect after the expiration of such period, 111 being not less than one month, as may be specified in the notice, and the basement bakehouse shall not be used as a bakehouse after the expiration of that period; or (6) if the Council are satisfied that the bakehouse is suitable as regards the matters aforesaid, they shall give notice in writing that the certificate shall continue to operate so long as the bakehouse may otherwise lawfully be used, but without prejudice to the power of the Council to revoke the certificate as the result of a subsequent examination under this sub-section. Special inspections of basement bakehouses were carried out during the year and all the necessary alterations were carried out. The Town Clerk was authorised to give the necessary notice in writing to the occupiers of the following premises set out below:— Premises. Occupier. 15, New Road, S.E. 18 A. Walkling, Ltd., 101-107, Chats- worth Road, E. 5. 24, St. James' Place, S.E. 18 J. A. Miles, 24, St. James' Place, S.E.18. 10, Woolwich Church Street, W. E. and E. A. Clothier, 10, Woolwich S.E. 18 Church Street, S.E. 18. 31, Eton Road, S.E. 18 A. Walkling, Ltd., 101-107, Chatsworth Road, E. 5. 38-40, Frances Street, S.E. 18 J. Rickman, 38-40, Frances Street, S.E. 18. 1, Waverley Road, S.E. 18 A. Werner, 1, Waverley Road, S.E. 18. 46, Hudson Road, S.E. 18 H. G. Meckiff, 46, Hudson Road, S.E. 18. The numbers of inspections made in respect of all food premises, other than those referred to above as registered premises, are shown in the following Table:— TABLE No. 67. Inspection of food Premises. Premises. On Register 31st December Number of Legal Proceedings. Inspections. Notices. Bakehouses 34 95 5 — Cowsheds 5 30 — — Dairies 63 239 3 — Slaughterhouses 4 16 — — Premises where food is prepared (other than above) 198 443 — — Shops and Markets — 1,591 — — 112 Unsound food.—Included in the food surrendered were: 3 tons, 4 cwts., Beef: 1 ton, 10 cwt., Pork; 4 cwts., Mutton; 54 lbs., Veal; 16 lbs., Ham; 84 lbs. Fish; 10 cwts. Rabbits; 1 ton, 6 cwts., Ox Heads; 2 tons 3 cwts., Pigs Heads; 5 tons, 14 cwts., Ox Offal; 1 ton, 16 cwts., Pig Offal; 6 cwts., Sheep Offal. There was one seizure—a small quantity of sweets. No proceedings followed. 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 food stuffs which are subject to an Order in Council made under the Act. The Orders which so far have been made are as follows:— The Merchandise Marks (Imported Goods) Honey; Apples. No. 3 Order, 1928. The Merchandise Marks (Imported Goods) Currants; Sultanas and Raisins; No. 5 Order, 1928. Eggs in Shell; Dried Eggs; Oat Pr0ducts. The Merchandise Marks (Imported Goods) Raw Tomatoes. No. 4 Order, 1929. The Merchandise Marks (Imported Goods) Malt Pr0ducts. No. 5 Order, 1930. The Merchandise Marks (Imported Goods) Frozen or Chilled Salmon or No. 8 Order, 1931. Sea Trout. The Merchandise Marks (Imported Goods) Butter. No. 1 Order, 1932. The Merchandise Marks (Imported Goods) Bacon and Ham. No. 3 Order, 1934. The Merchandise Marks (Imported Goods) Dead Poultry. No. 5 Order, 1934. The Merchandise Marks (Goods Imported) Meat. No. 7 Order, 1934. The Merchandise Marks (Imported Goods) Meat. Amendment Order, 1936. These Orders prohibit the sale, or exposure for sale, respectively, in the United Kingdom, of the pr0ducts 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 pr0duce does not require marking when sold in quantities not exceeding 14 lbs. in weight. Agricultural Pr0duce (Grading and Marking) Acts.—These Acts empower the Minister of Agriculture and Fisheries to make Orders for the grading and marking of agricultural pr0duce. One mark—the National Mark—is used, or will be used, for all graded pr0duce of England and Wales, and by law it conveys a guarantee that the pr0duce is of the grade stated. It is not compulsory for all such foodstuffs to be so marked, but, if marked, they must conform to the standard. 113 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 pr0ducts regarding which Regulations were in force on the 31st December, 1938:— Date of Regulations. Pr0duce. 1929 Potatoes. 1930 Strawberries; Cherries. 1932 Cider. 1933 Gooseberries; Loganberries; Raspberries; Red Currants; Cheshire Cheese; Pears. 1934 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; Dressed Poultry; Canned Fruits (Amendment); Bottled Fruits; Bottled Vegetables; Black Currants; Creamery Butter; Vegetables; Perry; Caerphilly Cheese; Cheddar Cheese. 1936 Eggs; Malt Extract and Malt Flour. 1937 Wheat Flour; Eggs (Amendment); Canned tables; Plums; Leicester Cheese; Lancashire Cheese; Wensleydale Cheese; Derby Cheese; Fruit Pr0ducts; Cabbage Greens and Cabbages (Amendment). 1938 Beef; Cauliflower and Broccoli; Cream Cheese. During the year Regulations affecting Beef (1931), Cauliflower and Broccoli (1934) and Cream Cheese (1935) were revoked. No offences were discovered during the year. Sophistication of food.—The following Table No. 68 gives details of the various analyses made under the food and Drugs (Adulteration) Act, Public Health (Condensed Milk) Regulations, Public Health (Dried Milk) Regulations, and the Public Health (Preservatives, etc., in food) Regulations. 114 TABLE No. 68. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Milk 262 26 288 14 Condensed Milk — 8 8 - Cream — 4 4 - Cream, Canned — 5 5 — Butter — 27 27 — Bread and Butter — 6 6 1 Margarine — 5 5 — Cheese 1 11 12 4 Lard — 9 9 — Lard Substitute — 3 3 — Dripping — 3 3 — Suet — 2 2 — Beef, minced 4 3 7 — Meat, fresh 9 — 9 1 Beef, corned — 1 1 — Meat Pies — 4 4 1 Tripe 3 2 5 — Sausages 23 4 27 — Meat Paste — 3 3 — Sild — 9 9 2 Fish, Canned — 24 24 5 Fish, bottled — 1 1 - Fish Paste — 13 13 - Arrowroot — 3 3 - Barley, pearl — 8 8 — Cornflour — 4 4 - Flour — 4 4 - Ginger, ground — 12 12 1 Ginger, crystallized — 1 1 - Peas, split — 2 2 - Peel, candied 2 2 - 115 TABLE No. 68—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Sago - 4 4 — Rice - 4 4 — Tapioca - 3 3 — Spaghetti - 1 1 — Tea - 8 8 — Vegetables, canned — 8 8 — Almonds and Ground Almonds — 4 4 — Cherries, Glace — 3 3 — Currants and Raisins — 3 3 — Fruit, dried — 16 16 — Fruit, canned — 24 24 — Pickles — 6 6 — Vinegar — 16 16 1 Spice — 4 4 — Sauce — 6 6 — Mint, dried — 4 4 — Pepper — 7 7 — Mustard — 2 2 — Salt — 3 3 — Salad Cream and Mayonnaise - 1 1 — Syrup and Treacle — 2 2 — Mincemeat — 5 5 — Jelly — 11 11 — Jam — 20 20 1 Lemon Curd — 5 5 — Honey — 3 3 — Bread — 3 3 — Biscuits — 1 1 Cakes — 9 9 — Soup, canned - 4 4 — Soup, dried 1 1 116 TABLE No. 68—continued. Article. Formal Samples. Informal Samples. Number Analysed. Number Adulterated. Coffee - 6 6 - Coffee and Chicory — 1 1 - Coffee and Chicory Essence - 2 2 - Cocoa — 5 5 - Sherbet — 1 1 - Mineral Waters - 7 7 - Lemonade — 1 1 - Lemonade, powder and crystals - 5 5 - Sugar — 3 3 - Baking Powder — 3 3 - Custard Powder — 3 3 - Egg Substitute — 3 3 - Sweets — 13 13 - Gelatine — 2 2 - Wine, Alcoholic — 4 4 - Wine, Non-alcoholic - 4 4 - Ale - 4 4 - Brandy 3 — 3 - Gin 6 - 6 - Rum 6 - 6 - Whisky 9 — 9 - Aspirin Tablets — 5 5 - Boric Ointment — 4 4 - Epsom Salts — 3 3 - Olive Oil — 7 7 - Quinine, Ammoniated Tincture — 3 3 1 Medicine — 1 1 1 Liquorice Powder - 3 3 — I0dine Tincture — 9 9 2 Tartaric Acid - 4 4 — Yellow Mercuric Oxide Ointment 1 — 1 — . 327 506 833 35 117 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. 69. 1936 1937 1938 4.5 per cent. and over 4 4 9 4 per cent. and under 4.5 per cent. 11 11 9 3.5 per cent. and under 4 per cent. 145 125 90 3 per cent. and under 3.5 per cent. 113 153 173 Below 3 per cent. 4 1 7 277 294 288 Mr. Amphlett Williams makes the following observations on this analyses during the year:— "Adulterated Samples.—The percentages of samples which were reported as adulterated, not up to standard or improperly labelled, during the last five years are given below:— 1934 1935 1936 1937 1938 Percentage adulterated 3.8 6.6 5.2 9.1 4.2 The very high percentage in 1937 was largely influenced by the number of samples of canned sild which were contaminated with tin, 31 samples having been condemned, of which 24 were of one particular brand. In 1938, only 7 samples were condemned on this account and the percentage of other adulterated samples accords closely with the general average of other Metropolitan Boroughs. Composition of Milks.—The average percentages of fat and of solids-not-fat found in the samples of milk analysed during the past five 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 1937 1938 January-March 3.52 3.51 3.60 3.56 3.56 April-June 3.41 3.50 3.43 3.41 3.38 July-September 3.53 3.59 3.56 3.45 3.41 October - December 3.69 3.92 3.81 3.76 3.78 Whole Year 3.54 3.59 3.59 3.56 3.54 118 Percentage of Solids-not-Fat. Quarter. 1934 1935 1936 1937 1938 January-March 8.80 8.85 8.76 8.70 8.72 April-June 8.86 8.85 8.78 8.68 8.73 July-September 8.69 8.67 8.70 8.61 8.63 October - December 8.97 8.86 8.81 8.79 8.76 Whole Year 8.83 8.81 8.77 8.71 8.72 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. It will be noticed that the similarity in composition of the milk obtained in corresponding seasons is remarkable. In solids-not-fat, the greatest variation in the five years is 1 per cent; in fat content the variations are greater, and it is probable that weather conditions may have had some effect on these figures. A prolonged dry period adversely affects the available pasture and the low fats of October-December, 1934, July-September, 1937, and April-June, 1938, were found in Quarters where the rainfall was considerably below normal. Similarly, the meteorological records show high rainfalls in April-June, 1935, and OctoberDecember, 1935. It will also be noticed that the fat content regularly rises with the onset of cold, the early winter figures being the highest; probably by design of nature to supply the greater needs of the calf. The very cold months of May in 1935 and January and February in 1936 may thus have influenced the high fats in the Quarterly averages. The freezing point test for added water in milk, the applications of which were explained in the analytical notes in the 1935 Report, was again proved to be of value. A number of samples submitted in the early part of the year showed borderline figures for solids-not-fat, and the milks would have been passed as " possibly genuine " before the adoption of this test; they were found, however, to have freezing points which definitely indicated small amount of added water and they were accordingly reported against. In every instance, the sample was traced back to the same source of supply, a large dairy delivering milk in Woolwich; but on communicating the results of the analyses, the presence of any added water was strenuously denied by the management. The company nevertheless agreed to have check analyses made at various stages in the dairy by an independent firm of analytical chemists, and in some instances quantities of added water up to 15 per cent. were discovered in these samples; it eventually appeared that water was being intr0duced into the milk at certain times when the supply pipes were rinsed out, through careless handling of the cocks. 119 Samples from this source are now yielding normal freezing points and satisfactory solids-not-fat figures. Hot Milk.—Of 16 samples of hot milk, taken from various cafes in the Borough during the year, 6 were found to be adulterated; two of these samples rank among the worst cases of adulterated milk in recent years; one containing 42 per cent. of added water and the other not being milk, but a fluid prepared from machineskimmed milk powder and water. The latter case was of considerable interest, since as far as I am aware, it is the first time it has been possible to prove conclusively that dried milk had been used instead of fresh milk in a sample of this kind. The percentage of fat was no less than 93 per cent. deficient, and the specific gravity, freezing point and 5 other constituents were outside the normal range for fresh milk; in addition, certain other impurities, which are known to occur in tap water but not in milk, were found and on determination of the proportion of these in the sample and in a separate sample of water obtained from the supply at the premises where the " milk " was purchased, a close agreement was found, thus confirming the actual amount of tap water added to the dried milk. On being summonsed, the defendant admitted the offence and was fined £1 with £1 1s. 0d. costs. Cheese.—Exception was taken to three samples of cheese which were being sold as "Cheddar Cheese." Cheddar cheese is an old established description of a recognised type of hard cheese made from full-cream milk, and it usually contains from 27 to 34 per cent. of water. The samples submitted contained from 43 to 51 per cent. of water and had been made from partly skimmed milk, with a citrate emulsifier added to hold the extra water and milk sugar to correct the taste, the mixture being wrapped in tin foil and pasteurised. In view of the evident preference for this type of "prepared" cheese, it is doubtful whether the general public realises that owing to the high water content, which may reach 60 or 70 per cent., it has a much lower food value. In my opinion, the sale of such a substance under the famous names of "Cheddar," "Cheshire," " Gruyere," " Gorgonzola," etc., amounts to a gross misrepresentation. In one curious instance, a variation in the quantities of ingredients used in the manufacture of this substance—which was not in this case sold as cheese, but under a fancy name—led to a complaint that it contained broken glass. Analysis showed that the small particles found, which certainly resembled glass in their clear, sharp, brittle, tasteless fragments, were actually crystals of hydrated lactose, or milksugar, which presumably had gradually formed as the " cheese " slowly lost water through evaporation. Correspondence with the manufacturers confirmed that an excessive amount of lactose had been used in that particular batch and that the water content had fallen from 55 per cent. to 45 per cent. ] 20 Ground, Ginger.—A sample of ground ginger was found to yield only 8 per cent. of water-soluble extractive and 1.1 per cent. of water-soluble ash compared with average figures of 14 and 2.8 per cent. respectively; these figures are abnormally low and, in the absence of any foreign ingredient, indicated that the ginger had been partly exhausted by water. The presumption was therefore raised that the ginger might consist of or might contain waste ginger, as for example, from a ginger ale manufacturer; but in view of some information that certain consignments of ginger from Nigeria had given low figures for water-soluble constituents when imported, enquiries were made by the sampling officer as to the source of this ginger, before considering a prosecution. Eventually, with the help of the London Wholesale Spice and Rice Dealers' Association, the actual importers were traced and it was found that the ginger was originally part of a consignment which had in fact been imported from Nigeria about three years ago. The matter was then taken up with the Colonial Empire Marketing Board and it was found that an extensive investigation was being carried out by the Imperial Institute in collaboration with the Director of Agriculture in Nigeria regarding the causes of this deficiency. The investigation revealed quite clearly that there was nothing inherently deficient in West African ginger as grown, but that in its preparation for market a practice of prolonging the soaking and bleaching of the rhizomes had grown amongst the natives, in order to meet the demand in the trade for a nearly white ginger. With the cause of the deficiency revealed, active steps could be taken to avoid it and the information that progressive improvements have occurred in the 1937 and 1938 crops compared with those of 1935 and 1936 indicates that the propaganda undertaken by the Department of Agriculture among the growers has taken effect. I am informed that the dealers in this country are now well aware of the position and that a careful watch is being kept on West African supplies; and, with regard to the stocks of deficient ginger already purchased, that as far as practicable these have been withdrawn for re-export or for use where water-soluble constituents are unnecessary. In these circumstances, and as no question of fraud or injury to health arises, no legal action was recommended in connection with the sample analysed. In the foregoing remarks, much of the information regarding action taken, etc., has been kindly furnished by the Inspectors, and I beg to acknowledge with thanks their general co-operation." 121 Adulterated Samples.—Action Taken.—The following Table No. 70 shows the number of adulterated samples and the action taken in each instance where the sample was formal:— TABLE No. 70. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 24 Milk Formal Contained 1 per cent, of added water. - 68 Milk Formal Contained 3 per cent, of added water. — 87 Cheese, Cheddar Informal Was made from skimmed milk Correspondence with Wholesaler. 108 Milk Formal Contained small proportion of added water. — 181 Strong Tincture of Iodine. Informal Iodine 7 per cent, excess, and Potassium Iodide 10 per cent, excess. — 182 Strong Tincture of Iodine. Informal Iodine 10 per cent, excess, and Potassium Iodide 13 per cent, excess. — 186 Milk Formal Contained 1 per cent, of added water. — 190 Cheese, Cheddar Formal Was made from skimmed milk Correspondence with Wholesaler. 234 Fresh Meat Formal Contained boric acid, 0.042 per cent. 40s. 0d. costs. 244 Cheese, Cheddar Informal Fat deficiency, 41.4 per cent. - 257 Canned Fish, Sild Informal Contained tin, 2.45 grains per lb. Stock surrendered. 289 Canned Fish, Sild Informal Contained tin, 4.13 grains per lb. Stock surrendered. 291 Canned Fish, Sild Informal Contained tin, 3.64 grains per lb. Stock surrendered. 292 Canned Fish, Sild Informal Contained tin, 2.59 grains per lb. Stock surrendered. 293 Canned Fish, Sild Informal Contained tin, 3.36 grains per lb. Stock surrendered. 300 Milk Formal Contained small proportion of added water. — 303 Quinine, Ammoniated Tincture. Informal 25 per cent, deficient in Ammonia. — 312 Blackcurrant Jam— Full Fruit Standard. Informal Contained not more than 15 per cent, of fruit. — 122 TABLE No. 70—continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 316 Milk Formal Contained 1 per cent, of added water. - 397 Ground Ginger Informal Soluble constituents about 30 per cent, below normal. Correspondence with Wholesaler. 449 Steak and Kidney Pie. Informal Contained no kidney Correspondence with Wholesaler. 535 English Spirit Vinegar Informal Contained at least 40 per cent. Malt Vinegar. Correspondence with Wholesaler. 592 Milk Formal 4 per cent, deficient in fat — 676 Milk Formal Contained 4 per cent, of added water, and 16 per cent, deficient in fat. Fined 20/-. 708 Medicine Informal 20 per cent, deficient in yellow mercuric oxide. — 738 Canned Fish, Sild Informal Contained tin, 3.36 grains per lb. — 746 Bread, Butter and Cheese. Informal Contained crystals of Lactose Hydrate. - 752 Canned Fish, Sild Informal Contained tin, 2.73 grains per lb. — 757 Cheese Informal Contained crystals of Lactose Hydrate. — 779 Milk Formal A liquid in which dried milk had been used. Was 93 per cent, deficient in milk fat. Fine £2 10s. 0d 21/- costs. 784 Milk Formal Contained 1 per cent, added water. — 800 Milk Formal 4 per cent, fat abstracted — 802 Milk Formal 4 per cent, fat abstracted — 807 Milk Formal Contained 42 per cent, added water. Fine £3. 811 Milk Formal 11 per cent, fat abstracted Costs £1. 123 Other Legal Proceedings.—In addition to the legal proceedings included in the above Table, proceedings were instituted against a retail purveyor of milk for filling bottles with milk other than on registered premises. The case was dismissed, under the Probation of Offenders Act. 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. This is fully reported on in the section dealing with Health Propaganda. 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. 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. The total number of notifications received was 36. The age and sex distribution of the cases notified is shown in the following Table No. 71. TABLE No. 71. Food Poisoning, 1938. Age Periods. Male. Female. Total. Under 1 — 1 1 1 and under 5 2 1 3 5 and under 10 — 2 2 10 and under 15 - — — 15 and under 20 — 1 1 20 and under 35 5 12 17 35 and under 45 5 3 8 45 and under 65 2 1 3 65 and over 1 — 1 15 21 36 124 The medical practitioner notifying is required to state on his certificate the food he suspects. In 12 instances the food under suspicion was meat ; in 8 instances it was fish ; in 5 instances it was tinned fish ; in 6 instances it was fruit and in 3 instances it was eggs. In 2 instances no particular food was regarded as the cause. Most of the cases were slight in character, but one man, who was admitted to hospital, died. In three instances a bacteriological examination was made. In two instances Bacillus Aertrycke was isolated, one of the cases being fatal. The notified food in the fatal case was believed to be duck eggs, but this could not be proved. The third investigation was negative. 125 SECTION IX. 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) The systematic medical inspection of toddlers at stated ages. (f) Establishment of an Artificial Sunlight Clinic. (g) Establishment of an Ear, Nose and Throat Clinic. (h) Provision of maternity outfits. (i) Payment of compensation to mid wives. (j) Payment of midwives' fees. (k) The services of a Consultant in cases of Puerperal Fever and Puerperal Pyrexia. (l) The services of a Consultant in exceptional cases of obstetric or antenatal abnormality at home. (m) Provision of Home Helps in maternity cases. (n) Boarding-out of children while expectant or nursing mother is in hospital, (o) Payment of expenses of mothers breast-feeding their babies in hospital. (p) An arrangement with the School Medical Treatment Committee for the treatment of minor ailments in young children. (q) An arrangement with the School Medical Treatment Committee for the provision of dental treatment to young children and to expectant and nursing mothers. (r) An arrangement with the Woolwich Invalid Children's Aid Association for orthopaedic treatment for children requiring such treatment, (s) 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. (t) 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. (u) 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. (v) Reservation of beds, for ante-natal treatment and emergencies of midwifery, at the War Memorial Hospital, equivalent to 18 weeks' treatment per annum. 126 (w) An arrangement with the Woolwich Invalid Children's Aid Association for the Convalescent Home treatment of children requiring such treatment. (x) Convalescent Home treatment for expectant and nursing mothers. (y) 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. (z) 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:— (1) Under the Blind Persons Act, 1920. (2) Under Section 6 of the Widows', Orphans' and Old Age Contributory Pensions Act, 1925. Staffing.—Three whole-time medical officers are in medical charge of the clinics, each devoting, per week, eight half-days to Maternity and Child Welfare and three half-days to Tuberculosis. Four part-time medical officers are also employed : one on three half-days, one on two half-days and two on one half-day each, three of them for general work and one for the systematic examination of toddlers. Six consultants have been appointed, one for the artificial sunlight clinic, one for consultation in comiection with cases of puerperal sepsis and difficult obstetric conditions occurring at home, three for difficult obstetric conditions occurring at home, and one for the Ear, Nose and Throat Clinic. The dental staff—three dentists and an anaesthetist—are part-time and are appointed by the School Treatment Committee subject to the approval of the Council. The health visiting staff now consists of thirteen health visitors ; two 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. The London County Council felt that it would be to the advantage of the maternity and child welfare services of London if a closer link could be established between maternity and child welfare clinics and the County Council's general hospitals, and suggested that if medical officers in charge of the maternity and child welfare clinics were permitted to be associated in an honorary capacity with the maternity departments and ante-natal clinics at the County Council's hospitals, it would be to the advantage of the service generally. It was suggested that there should be no fixed visiting days and times for the medical officers in charge, but that they should be at liberty to visit hospitals at any time convenient to them in order to maintain contact with the medical staff of the hospital and especially with patients known to them. The arrangements are, of course, subject to the general supervision of the medical superintendent of the hospital, and in no way affect the responsibility of the Council's medical staff for the treatment of patients. The Borough Council agreed to co-operate in this way and subsequently Dr. Proudfoot and Dr. Saunders-Jacobs were associated in this way at St. Nicholas Hospital and Dr. Smith at Lewisham Hospital. 127 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, a booklet—Health and Happiness for Baby— dealing with the care and comfort of mothers and infants, is 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. Children are visited at least once a year until they go to school and special attention is paid at such visits to the toddler to the early recognition of physical defects. The Work of the Health Visitors.—The importance of home visiting and the supervision of the health of the mother and child is now fully recognised and the influence of the health visitor is greater to-day than it has ever been. As an agent for teaching hygiene in the home her work is of enormous importance. The varied nature of the work can be seen from Table No. 72. The number of visits paid by the Council's Health Visitors during the year is summarised in the following Table TABLE No. 72. Births—First visits 2,096 Births—Revisits 19,069 Infant deaths investigated 21 Still-births investigated 14 Expectant mothers—home visits 1,002 Infectious diseases:— Opthalmia Neonatorum—First visits 29 Opthalmia Neonatorum—Revisits 9 Measles—First visits 2,896 Measles—Revisits 949 Puerperal Fever—First visits 13 Puerperal Fever—Revisits 6 Puerperal Pyrexia— First visits 16 Puerperal Pyrexia— Revisits 8 Zymotic Enteritis—First visits 41 Zymotic Enteritis—Revisits 28 Pneumonia 63 Infant Life Protection 733 Visits unclassified 732 Visits unsuccessful 4,401 32,162 Following their usual practice the Council gave the necessary facilities to two health visitors to attend refresher courses and paid their expenses. 128 Infant Life Protection.—The Council are responsible for Infant Life Protection work and all the Health Visitors have been appointed Infant Life Protection Visitors for their particular districts. When evasion of the law is suspected any necessary investigations are made by one of the male sanitary inspectors. The homes of all new foster mothers are inspected by the district sanitary inspectors, who furnish in each case a sanitary report. At the end of 1937 there were 70 nurse children and 54 foster mothers on the Council's register, and a year later the numbers were 67 and 53. 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 9 were either temporarily without nurse children or had been noted as suitable persons. These figures do not, however, tell the whole story, as 148 nurse children were added to the register, • and 151 nurse children were removed during the year. The following Table No. 73 shows the ages of the children under supervision on the 31st December, 1938:— TABLE No. 73. Under 1 year. 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 16 9 11 6 4 8 4 4 5 The number of visits paid by Infant Life Protection Visitors was 733. The number of visits made by the male inspector in connection with infringements and kindred matters was 35, while the number of visits paid by the district sanitary inspectors was 21. The number, and nature, of the various legal infringements discovered during the year, were as follows:— TABLE No. 74. Nature of Infringement. No. Keeping a nurse child without giving timeous notice 12 Change of address by foster mother without giving timeous notice 1 Infant removed from care of foster mothing without giving timeous notice 1 Keeping nurse children in excess of permitted number 1 Cautionary letters either from the Medical Officer of Health or from the Town Clerk were sent in all cases. There were no prosecutions. In three instances dirty and overcrowded conditions were discovered. In all appropriate action was taken. 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. 129 All foster mothers are urged to attend the Council's welfare centres with the children under five years of age in their charge, and special care is taken to see that children who are weak and ailing attend. Three nurse children died during the year. The only institution in the Borough holding a certificate of exemption is the Woolwich War Memorial Hospital. The Work of the Welfare Centres.—These are eight in number and are all municipal. Infant Welfare sessions are held at all of them ; ante-natal sessions are held at four—in two instances twice weekly, in one instance thrice weekly, and in one instance once a month. With the inclusion of the fortnightly antenatal sessions at North Woolwich, at the end of the year 75 ante-natal sessions and 26.5 infant consultation and weighing sessions were being held each week. In tabular form below are shown detailed statistics for 1938 and the consolidated statistics for the previous year:— TABLE No. 75. Centre. Number on Roll of Centre. Number of Attendances. Mothers. Children. Mothers. Children. Expectant. Nursing. Expectant. Nursing. Town Hall 470 200 1,289 1,023 340 9,355 Plumstead 347 370 1,172 914 702 7,835 Eltham 541 188 1,034 1,735 313 7,217 Slade — 136 564 — 193 5,377 New Eltham — 48 561 — 58 6,647 St. Luke's — 60 370 — 61 4,169 North Woolwich 35 20 132 142 29 1,280 Beresford Street 34 80 84 16 99 758 Totals, 1938 1,427 1,102 5,206 3,830 1,795 42,638 Totals, 1937 1,188 1,037 5,074 2,919 1,775 39,383 The next Table No. 76, 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. 130 TABLE No. 76. Children in Attendance at Each Centre. Year of Birth. Town Hall. Beresford St. N. Woolwich. Plumstead. Slade. Eltham. St. Luke's. New Eltham. Totals. 1938 395 20 41 395 180 255 104 137 1,527 1937 449 21 48 376 164 293 114 156 1,621 1936 220 16 21 205 94 212 74 109 951 1935 111 15 11 114 58 137 35 76 557 1934 82 9 9 58 46 87 26 51 368 1933 32 3 2 24 22 50 17 32 182 Totals 1,289 84 132 1,172 564 1,034 370 561 5,206 Attendances. Year of Birth. Town Hall. Beresford St. N. Woolwich Plumstead. Slade Eltham St. Luke's New Eltham Totals 1938 3,365 134 246 3,216 2,046 2,425 1,337 1,810 14,579 1937 4,267 302 819 3,294 2,075 2,816 1,888 2,956 18,417 1936 1,066 126 150 857 707 1,046 577 1,016 5,545 1935 382 145 41 284 318 564 213 559 2,506 1934 201 45 22 123 183 263 95 228 1,160 1933 74 6 2 61 48 103 59 78 431 Totals 9,355 758 1,280 7,835 5,377 7,217 4,169 6,647 42,638 Year 1937 8589 735 1109 8750 4307 7057 3065 5771 39,383 Feeding of Infants in Woolwich. —In raid-summer the usual enquiry was made, as in previous years, as to the type of feeding adopted in the case of infants attending the welfare centres. The method used was as follows:— (a) On the card of every child under one year of age attending a welfare centre between the 20th June and the 13th August, was inserted once, and once only, the terms "Breast" or "Breast and Hand," or "Hand Fed." (b) The child's age was taken on the day on which this note was made. (c) At the end of the period the results were summarised for the whole Borough and the appropriate percentage worked out. The results of the enquiry are shown in Table No. 77 on the adjoining page. 131 TABLE No. 77. Feeding of Infants attending Welfare Centres—20th June to 13th August, 1938. Method of Feeding. AGE IN MONTHS. Grand Total. 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 Breast 78 90 60 38 33 43 22 8 8 380 — — — 380 Breast and Hand 5 15 15 8 11 13 8 17 16 108 8 4 1 121 Hand 17 33 39 35 55 44 77 48 73 421 58 85 83 647 100 138 114 81 99 100 107 73 97 909 66 89 84 1,148 PERCENTAGES. Breast 78.0 65.2 52.6 46.9 33.3 43.0 20.6 11.0 8.2 41.8 — — — 33.1 Breast and hand 5.0 10.9 13.2 9.9 11.1 13.0 7.5 23 .3 16.5 11.9 12.1 4.4 1.2 10.5 Hand 17.0 23.9 34.2 43.2 55.6 44.0 71.9 65.7 75.3 46.3 87.9 95.6 98.8 56.4 132 The new Centre at Market Street, Woolwich, to be known as the Woolwich Central Health Centre, was completed during the year and was opened on the 14th January, 1939, by Lord Horder. It replaces the Old Town Hall Infant Welfare Centre and Artificial Sunlight Clinic and the School Treatment Centre at Brewer Street. The following is taken from the Booklet prepared for the opening ceremony : "In 1931 the Woolwich Borough Council opened, at Eltham, the first municipal centre in London which provided accommodation on the same premises for school medical and maternity and child welfare services. A year later the maternity and child welfare centre at Plumstead was enlarged, providing additional accommodation for this purpose and also rooms for the school medical service. Now in the old parish of Woolwich the third combined centre in the Borough has been erected. 133 But the Woolwich centre goes further than its predecessors for in it have been established for the first time clinics for orthopaedic treatment, massage, electrotherapy, and chiropody, in addition to the maternity and child welfare and school medical services. The building is centrally situated, forming one of the group of civic buildings round the Town Hall. A solid building in keeping with its predecessors, yet thoroughly modern and up-to-date in its planning, it is one which is eminently suitable for the ever-increasing health services of a metropolitan borough. The forecourt, protected by a dwarf wall and iron railings, affords a pleasing approach to its entrances. 134 The corridors lead to the main waiting hall which has two direct entrances near the pram sheds. The upper floor is reached by means of the main staircase from the entrance hall. On the left of the staircase are arranged the school treatment rooms consisting of a minor ailments room, a waiting room, a doctor's room, an eye room, a record room and a clinic room. All these rooms inter-communicate and can be used as waiting, treatment, or consulting rooms, according to the needs of the moment, an arrangement which will make for easy working. On the right of the staircase are sited the rooms of the foot clinic and of the dental suite in which there are two dental surgeries, a rinsing room and two waiting rooms. Modern equipment is provided in the dental rooms, and in the rinsing room which serves both, a range of specially designed basins at varying heights has been installed. There are two staff rooms, one on each floor. The upper and lower corridors which run round the building give access to all the rooms and to the flat roof court. It will be possible on occasion to use the flat roof as an open air solarium. Two pram sheds have been provided at the rear of the building, one on each side. There is accommodation for the parking of cars on entrance-ways at each side of the building. Underneath these, air raid shelters, entered from the pram sheds, are provided in the form of two 3 ft. 6 ins. wide trenches, constructed of re-inforced concrete." Toddlers Clinics.-—Toddlers clinics have been a well-established part of the Council's health services for many years and there is certainly no occasion in Woolwich for the often heard complaint of the neglect of the child between the ages of two and five. Two sessions a week are held at each of the Council's main centres and frequent sessions at New Eltham, The Slade and North Woolwich. Examinations are made in the birthday months. The number of annual inspections made during the year was 1920, an increase of 300 upon the number made during the previous year, which perhaps justifies one in hoping that, ultimately, the large majority of Woolwich mothers will take advantage of this service. The findings at these examinations are summarised in the following Table No. 78. They do not differ materially from those of previous years. Dental caries remain the most prevalent serious defect found and the defect for which it is most difficult to persuade the mothers to accept the treatment offered. 135 It is planned round, a central court. In front and at the sides it is of two storeys, but at the rear, where a lofty main waiting hall is provided, it is but one storey high ; use has been made of these features to provide a pleasant roof court approached by short staircases from the upper corridors. The central court is paved with York stone laid in random fashion and an ornamental pond has been provided. The Centre is soundly constructed of stock brickwork, the front and end elevations being faced with hand-made, sand-faced, red facing bricks, relieved with stone dressings. The main roof is of timber-framed construction covered with red sand-faced cross-cambered concrete tiles. The flat roof over the main hall is covered with "Paropa" patent roofing. The first floor, staircases, and flat roof are of fireproof construction, consisting of hollow tile and reinforced concrete. The floors with the exception of the entrance hall, stairs and lavatories, are covered with ¼-inch rubber flooring. In planning the building care has been taken to ensure that every room and every passageway is not only well lighted and ventilated, but also easily cleaned. The windows are of the hospital type and consist of metal casements in hardwood frames, and cross ventilation is provided to every room. The building is lighted by electricity with the most modern type of fittings and the heating is provided by electric vapour radiators; hot water is supplied by electric unit water heaters. The sanitary fittings are of white glazed fireclay of British manufacture, and the accessories are of white metal. An internal telephone system has been installed. The estimated cost of the Centre, which has been erected by direct labour under Mr. H. W. Tee, the Borough Engineer and Architect, is £18,066. The building has been designed to provide (a) a maternity and child welfare section, (b) an orthopaedic clinic, a massage clinic and an electro-therapy clinic, (c) a school clinic, (d) a dental clinic and (e) a foot clinic. On the ground floor are the maternity and child welfare rooms and the orthopaedic, massage, and electro-therapy clinics. The maternity and child welfare rooms, comprising a weighing room, an ante-room, a doctor's room, an ante-natal room, and a dispensary with serving hatch to the main hall, are arranged on the left of the main entrance. The ante-natal room contains individual dressing cubicles which add very considerably to the comfort and privacy of the mothers. Opening from this room is a test room and lavatory. The special treatment rooms, five in number—an orthopaedic room, two for electro-therapy and massage, one dressing room and one bathroom—are on the right of the entrance. It has been necessary to construct a Faraday cage in the walls, ceiling and floor of one of these rooms in order to prevent intereference with television and wireless sets in the neighbourhood through the use of short wave machines. 136 TABLE No. 78. Medical Inspection of Toddlers, 1938. Disease, Defect or Condition. BOYS. Age last Birthday. GIRLS. Age last Birthday. 2 3 4 2 3 4 Total. Total Children Examined 404 295 262 413 291 255 1,920 Nutrition— (a) Excellent 274 185 100 305 170 128 1,162 (6) Normal 117 94 122 105 101 101 640 (c) Sub-normal 13 16 40 3 20 25 117 (d) Bad — - - - - 1 1 Muscular Tone (a) Excellent 231 225 186 263 201 202 1,308 (6) Good 164 64 76 143 87 50 584 (c) Poor 9 6 - 7 3 3 28 Clothing and Footgear— (a) Good 380 278 252 388 276 248 1,822 (b) Fair 24 17 10 25 15 7 98 Cleanliness— (a) Excellent 366 274 241 384 271 249 1,785 (b) Fair 38 21 21 28 20 6 134 (c) Dirty — - — 1 — — 1 Heart and Circulation— (a) " Functional " Conditions 69 51 45 55 82 52 354 (b) Organic and Congenital Heart Disease 1 2 - - 2 1 6 Anaemia 59 40 38 68 35 31 271 Respiratory System— Bronchitis 3 8 8 1 15 6 41 Asthma - 1 2 - — 1 4 Nervous System— Behaviour Symptoms 69 54 41 84 51 29 328 Minor Retardation 39 7 3 25 6 5 85 Organic Nervous Disease — 1 - - 1 2 4 Mental Deficiency 3 2 1 1 - — 7 Alimentary System— Worms 3 3 2 5 4 4 21 Acidosis Attacks - - 1 2 - 1 4 Gastritis, Enteritis, etc. 1 1 2 1 - — 5 Constipation 4 4 1 4 2 3 18 Genito-Urinary System— Enuresis and Frequency 18 25 7 14 18 12 94 Other Conditions 16 13 1 1 — — 31 Skin Conditions— Infective Skin Conditions 16 4 10 6 4 7 47 Urticaria, Eczema, etc 21 12 5 38 16 6 98 Ichthyosis — 1 1 - 2 — 4 137 Medical Inspection of Toddlers, 1938—continued. Disease, Defect or Condition. BOYS. Age last Birthday. GIRLS. Age last Birthday 2 3 4 2 3 4 Total Eye Defects and Infections— Slight Squint 7 2 2 4 6 8 29 Blepharitis 1 4 — 5 4 4 18 Conjunctivitis — 3 3 1 1 1 9 Ear Conditions— Otorrhoea, etc. 4 7 2 4 8 6 31 Teeth— Caries 21 85 133 26 92 117 474 Extractions or Fillings 3 14 54 1 15 50 137 Hypoplasia 14 4 1 4 2 — 25 Malocclusion 25 14 5 31 1 7 83 Dental Abscess — — 2 1 — — 3 Rickets— (Cases clinically considered as showing definite evidence of Rachitis) 68 32 15 44 22 6 187 Nose and Throat— Enlarged Tonsils 67 40 41 56 49 47 300 Enlarged Tonsils and Adenoids Adenoids Enlarged Glands— Tonsillar 44 39 52 34 32 41 242 Posterior Cervical 12 12 22 12 9 14 81 Others 1 — 1 — — — 2 Other Diseases and Defects Rheumatism 2 3 3 1 5 5 19 Jaundice - — — — 1 — 1 Fractured Tuberculous Ankle 1 — — — 1 Abscess — — — — 1 — 1 Developmental Conditions— Umbilical and Inguinal Hernia 4 1 2 4 3 1 15 Naevus 4 1 1 5 4 2 17 Other conditions — 1 1 1 — — 3 Artificial Sunlight Clinic.— An artificial sunlight clinic is held in part of the Town Hall Infant Welfare Centre. The total number of patients treated during the year, including 161 whose course of treatment was not completed at the end of 1937, was 686. The total number of treatments given was 13,109, of these 10,354 were by carbon arc, 1,774 by mercury vapour lamp, 731 by radiant heat lamp, and 250 by infra-red lamp. The clinic is open every morning and on four afternoons each week. Treatment is by appointment only and no charge is made. Patients as a rule attend twice a week. An assistant medical officer attends on two half-days each week. The 138 clinic is under the medical supervision of Dr. J. E. A. Lynham, who has furnished the following report on the year's work:— "There has been a striking increase in the number of children attending the Sunlight Clinic during the past year. It is noteworthy that this increase has been mainly in the group "Debility and Malnutrition" and it is becoming accepted that these children derive great benefit from artificial sunlight. The number of cases of rickets is considerably reduced, whilst the proportion of those cured or improved has relatively increased. The totals in other groups do not show much alteration, but the total number of cases improved has gone up considerably. On the whole, attendances have been more regular, but the percentage who ceased attending remains about the same. The infra-red lamp proved valuable in cases with painful joints. It is anticipated that, with the improved facilities in the new Clinic, much better results will be achieved." Mothers living in Eltham find it difficult to attend regularly at the clinic with their children 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. In the Sherard Road Health Centre at Eltham a sunlight treatment clinic is to be provided. The following Table No. 79 shows the number of cases and conditions treated during the year:— TABLE No. 79. Cases treated at Sunlight Clinic during 1938. Brought forward from 1937. New Cases. Total. Much Improved or Cured. Improved. I.S.Q. Ceased Attending. Treatment not yet completed Rickets 26 95 121 37 37 4 25 18 Anaemia, Debility and Malnutrition 74 254 328 113 88 11 72 44 Catarrhal Children 22 76 98 29 26 4 20 19 Septic Conditions 2 6 8 1 4 — 2 1 Nervous Conditions 4 14 18 3 7 — 6 2 Enlarged Glands 10 24 34 9 11 2 8 4 Miscellaneous Nervous Conditions 7 7 1 - 1 4 1 Miscellaneous Skin Conditions 5 9 14 9 2 — 1 2 Other Conditions 14 26 40 8 15 1 3 13 Mothers 4 14 18 8 5 1 — 4 161 525 686 218 195 24 141 108 139 Ear, Nose and Throat Clinic.—The Ear, Nose and Throat Clinic was started in May, 1937, under the charge of Mr. Myles Formby, Consultant and Laryngologist to the Woolwich War Memorial Hospital, as Consultant. Dr. F. Smith, one of the Council's assistant medical officers, took charge of the routine work of the clinic. The total number of sessions held during the year was 52, the total number of attendances was 1,217. Mr. Myles Formby resigned on giving up his appointment at the War Memorial Hospital, and his successor, Mr. S. E. Birdsall, agreed to act as Consultant. I am indebted to Mr. Birdsall for the following observations on the year's working:— "As Table No. 80 shows, there has been an increase of new cases from 218 to 358. Many of the children seen with enlarged tonsils and adenoids were considered, on examination, to be suffering from infection in the nasal sinuses, and are now classified under the heading of Caterrhal sinusitis. The Table illustrates the great importance of careful examination of the whole of the upper respiratory tract before deciding on the removal of tonsils and adenoids in children. Out of a total of 364 cases with upper respiratory tract infections, it was considered advisable to remove the tonsils and adenoids in only 85." Provision of Maternity Outfits.—Since 1930 sterilised maternity outfits have been supplied free, half cost or at cost price to expectant mothers, on application by a midwife or a doctor. The cost of the service each year has varied between £13 and £22. The London County Council as part of their salaried midwives scheme arranged to provide such outfits free of charge to all patients employing L.C.C. midwives. In these circumstances the Borough Council decided at the end of January that such outfits should be provided free of charge to all expectant mothers in the borough, who required them and who were not being attended by L.C.C. midwives. During the year 120 applications were received and 119 outfits were supplied The total cost to the Council was £35 14s. Od. 140 TABLE No. 80. Condition. No. of Cases. Treatment Discharged. Still attending. Ceased attending. Broug't forward New Conservative. Operation. None requir'd Cured. Much improved. Improved. I.S.Q. Enlarged tonsils and adenoids 65 149 122 85 7 44 20 5 7 84 54 Catarrhal Sinusitis 31 119 139 11 - 35 9 4 - 60 42 Chronic tonsillitis 5 13 14 4 - 2 2 - — 9 5 Otorrhœa 8 51 58 1 — 33 — - - 15 11 Earache — 5 4 - 1 1 - - 1 2 1 Epistaxis - 6 6 - — 2 - - - 4 - Asthma - 2 2 - - - 1 - — 1 - Injury — 1 1 - - 1 - - - - - Laryngeal stridor 1 1 1 - 1 1 — - 1 - - Furunculosis - 1 1 - — 1 — — — - - Cervical Lymphadenitis — 4 4 - - - - - - - 4 Wax in ea 1 6 7 — — 5 1 — - — 1 TOTAL 111 358 359 101 9 125 33 9 9 175 118 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 1937, being complied with. During the year no compensation was paid. Payment of Midwives' Fees.—Following on the establishment of the London County Council Salaried Midwives Service, the Council decided to omit from their scheme payments to midwives of twenty five shillings per case, when patients were unable to pay their fees. 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, 141 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. When the detailed arrangements of the County Council scheme for salaried midwives was under consideration, it was suggested that the panel of consultants should be enlarged to include all the consultants for all the boroughs in S.E. London, or Area E of the L.C.C. Scheme, if they were agreeable to be so included. All were agreeable and so a panel of consultants is now available. Those who have agreed to act in addition to Mr. Harold Taylor are:—Mr. J. B. Blaikley, F.R.C.S.; Mr. A. L. Gunn, F.R.C.S.; Mr. A. L. Walker, F.R.C.S. In one ease only during the year were the services of a Consultant Obstetrician necessary. Home Helps.—During the year 133 applications were considered by the Committee and 84 home helps were provided. The total cost of this service was £391 15s. 5d. and payments by mothers amounted to £48 2s. Od. Certain amendments were made in the Council's Home Help scheme during the year. Boarding out of Children.—In appropriate circumstances, instead of providing a home help, the Council arranges for the boarding out of children with suitable foster mothers, at the Council's expense. Children were boarded out on four occasions during the year. Expenses of Mothers Breast-Feeding Their Babies in Hospital.—In appropriate circumstances, where hardship is imposed upon breast fed babies by the inability of mothers to visit the babies frequently enough in hospital to ensure normal breast feeding, the Council will pay the travelling expenses incurred by mothers. No such payments were made 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 357 children were sent to the clinics and for each case the Council paid 5s. Spectacles have been provided on occasion at an additional cost to the Council, 142 TABLE No. 81. Brewer Street. Eltham. Plumstead. Impetigo 30 50 51 Ear Discharge 7 16 28 Eyes 26 50 47 Miscellaneous 9 16 27 72 132 153 The corresponding totals for 1937 were respectively 65, 122 and 145. 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. Weekly sessions are held at all three centres. The following Table No. 82 shows the number of cases attending and the total attendances during the year. The number of sessions was 189, including anaesthetic days. TABLE No. 82. Expectant Mothers. Nursing Mothers. Children under 5. No. Attendances. No. Attendances. No. Attendances. Woolwich.. 129 362 21 88 23 24 Plumstead 121 226 20 51 298 628 Eltham — — — — 177 421 250 588 41 139 498 1,073 All Centres, 1937 167 374 39 118 395 768 The figures of the toddler clinics in this connection are full of interest. In 1938 47 children aged 2 had defective teeth, 177 aged 3, and 250 aged 4. These figures correspond at 2 years to 5.7 per cent., at 3 years to 30.2 per cent., and at 4 years to 48.3 per cent., of the children examined; 137 children or 7.1 per cent. had already had teeth extracted or filled. 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 143 supplied in previous years. Fifty sets (complete or partial) of artificial teeth were supplied during the year at a total cost of £241 4s. Od. Payments by mothers amounted to £132 10s. Od. Arrangements were made with the London County Council for an X-ray examination in dental cases whenever the dental surgeon considered this necessary, at the cost of 7s. 6d. per attendance. No such cases were referred during the year. 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 £223 2s. 6d. Only cases recommended by the Medical Officer of Health are included in this scheme, and payment is only made for the number of attendances approved by him. Including children where wedges only were necessary, and others where temporary splinting only was required, the children referred to the clinic required treatment for the conditions set out under tabulated headings in Table No. 83, which is set out below. 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 arrangements were made during the year for the treatment of Eltham children on two half days per week at the Health Centre, Westhorne Avenue. The Association found that the attendance of Eltham children at Woolwich was a very difficult problem for Eltham mothers and thought it would be desirable if temporary arrangements were made with the Council, pending the building of a new orthopaedic centre at Eltham, to be housed in the new Health Centre in Sherard Road. 144 TABLE No. 83. Cases treated at Orthopaedic Clinic, 1938. Type of Case. Number remaining over from 1937. New Cases. Total Cases. Number who completed treatment by end of year. Number with treatment not completed. Talipes (Club Foot) 1 11 12 12 Talipes (Flat Foot) 2 22 24 17 7 Rickets— General 1 11 12 10 2 Genu Valgum (Knock Knee) 9 110 119 112 7 Genu Varum (Bow Leg) 10 122 132 120 12 Infantile Paralysis 1 5 6 4 2 Erb's Paralysis 1 1 1 Bad Posture 2 7 9 6 3 Muscular Weakness 7 28 35 33 2 Mouth Breathing 1 1 2 2 Torticollis I 8 9 8 1 Other Deformities 1 7 8 7 1 Other Diseases 3 3 3 40 332 372 335 37 Provision of Nursing Assistance.—In Section III 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 50 children treated for threadworms at one shilling per visit, amounting in all to £17 16s. 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 201 ; of these 188 were discharged cured or very much improved in health, 6 were discharged as improved and one died. Two children were transferred to another hospital, three others were discharged showing no improvement, and the number remaining in hospital at the end of the year was one. The surgical conditions for which these children were treated included:—phimosis, prolapse of rectum, enlarged tonsils 145 and adenoids, umbilical hernia, hypospadias, mastoiditis, inguinal hernia, pyloric stenosis, vulvo-vaginitis, otitis media, cervical abscess. Those admitted for medical treatment included children suffering from persistent diarrhoea, enteritis, malnutrition. Several cases 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 846 babies were born during the year and 125 mothers were admitted for ante-natal or emergency treatment. At the ante-natal clinics in connection with this hospital, 10,323 attendances were made, and at the infant clinics, 2,712 attendances. In addition there were 206 extern cases. The number of mothers admitted under the Council's scheme was 142, the nett cost to the Council being £887 9s. Od. (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 175, and 15 mothers were admitted for ante-natal or emergency treatment. The number of attendances at the ante-natal clinics was 2,004. The number of mothers admitted under the Council's scheme was 67, the nett cost to the Council being £404 2s. Od. Ante-Natal Treatment and Emergencies.—The number of cases admitted for ante-natal or emergency treatment under the Council's scheme was five. One was on account of tubal mole and the other four on account of albuminuria. Convalescent Home Treatment for Children under Five 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 grants totalling £330 were made in respect of 119 children. The children were sent away for periods varying from 4 days to 6 months, 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 5 mothers were so admitted to convalescent homes. Supply of Milk, etc., to Necessitous Mothers and Children. The approximate cost of this service during the year was as follows :—Dried milk, £1,161 6s. 9d.; Fresh milk, nil ; Dinners, nil. 146 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 £160 0s. Od. compared with £150 in the previous year. Services for London County Council.—(1) Blind Persons Act, 1920.— 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. (2) 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 Aot was dealt with during the year. Salaried Midwives Scheme.—The scheme of the London County Council for the provision of a whole time midwifery service came into being at the beginning of the year. The names and addresses of the London County Council midwives resident in Woolwich at the end of 1938 were as follows :— Telephone No. Ford, Mrs. A. R. E., 402, Well Hall Road, Eltham, S.E. 9 .. .. .. .. Eltham 1618 Hulf, Miss N., 125, Benares Road, S.E. 18 .. Woolwich 2918 Vaughan, Mrs. L., 24, The Slade, S.E. 18 .. Woolwich 2926 Weeks, Mrs. M., 105, Gregory Crescent, Eltham, S.E. 9 .. .. .. .. Eltham 2313 Woods, Mrs. E. J., 10, Openshaw Road, S.E. 2 Woolwich 2922 The Borough Council agreed to co-operate whole-heartedly with the County Council in this matter and the Borough Council ante-natal and post-natal clinics are to be used to the greatest possible extent. Mothers from adjoining Boroughs are to be seen at Council clinics if these are more convenient for them. The consultants for Woolwich and four adjoining Boroughs have agreed to act in any of the five Boroughs and midwives may call in a consultant in the case of an emergency arising. Ancillary services will be supplied by the Borough Council, the Borough Council accepting any medical certificate as to pregnancy. Midwives are authorised to obtain nursing assistance from the district nursing associations at the expense of the Borough Council. 147 APPENDIX. METEOROLOGICAL OBSERVATIONS TAKEN AT THE ROYAL OBSERVATORY, GREENWICH, DURING THE YEAR 1938. 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. 8 46.1 32.3 39.8 + 1.7 44.9 6 0.13 ,, 15 53.9 32.0 44.4 + 6.4 44.7 7 1.06 „ 22 53.6 34.2 45.7 + 7.1 45.1 4 0.28 ,, 29 54.8 33.7 44.5 + 5.2 45.3 4 0.60 Feb. 5 53.9 36.9 45.0 + 5.4 45.0 3 0.35 ,, 12 51.8 33.6 42.2 + 30 44.8 2 0.10 ,, 19 49.5 30.7 35.6 —3.8 44.1 5 0.31 „ 26 55.7 30.5 39.9 + 01 43.1 1 0.16 Mar. 5 61.8 34.6 47.2 + 6.7 43.7 3 008 ,, 12 64.4 31.7 48.1 + 7.1 44.1 - 0.00 ,, 19 64.0 34.5 48.9 + 7.2 44.9 - 000 ,, 26 66.4 36.5 49.6 + 7.3 45.9 3 0.28 Apr. 2 66.6 41 . 7 53.4 + 8.9 47.0 1 002 ,, 9 63.2 31.8 46.9 + 0.8 47.7 1 0.08 ,, 16 60.9 28.9 45.7 —0.6 47.8 - 0.00 ,, 23 53.9 33.0 45.0 — 3.4 47.9 — 0.00 , „ 30 56.7 37.1 46.0 —2.8 47.9 2 0.02 May 7 59.5 37.1 47.6 —2.4 48.0 3 0.35 14 76.1 32.1 53.9 + 2.1 48.8 1 0.19 ,, 21 66.9 40.5 51.6 — 1.7 50.1 4 0.39 ,, 28 70.3 41.2 53.5 —2.0 51.0 4 0.54 Juae 4 69.2 44.2 54.6 —2.8 51.5 4 0.32 ,, 11 72.2 47.1 59.6 + 1.4 52.7 1 0.02 ,, 18 78.4 47.0 61.6 + 2.8 54.0 - 0..00 ,, 25 80.9 48.9 65.9 + 5.3 55.4 1 0.01 July 2 74..1 45.7 59.0 — 2.6 56.5 5 0.30 ,, 9 74.9 47.2 57.5 —4.7 56.6 6 0.99 ,, 16 74.4 50.8 60.4 — 2.7 56.8 2 0.08 ,, 23 77..4 54.0 64.0 + 0.8 57.4 1 0.01 ,, 30 78.7 51.2 64.0 + 1.5 58.4 2 0.21 Aug. 6 84.0 55.5 58.9 + 7.6 59.2 1 0.01 ,, 13 81.6 55.6 59.0 + 2.8 60.2 4 1.69 ,, 20 74.4 52.5 61.4 —0.7 60.3 2 0.07 ,, 27 78.3 46.1 60.3 -0.5 59.9 3 0.12 Sep. 3 67.6 40.0 55.3 —4.7 59.3 4 0.32 ,, 10 65.7 43.9 56.7 —2.3 58.5 3 0.26 ,, 17 79.4 430 60.6 + 2.9 58.3 2 0.06 „ 24 79.7 50.9 61.3 + 5.3 58.4 6 1.47 148 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. 1 68.4 47.0 56.8 + 20 58.3 6 1.14 ,, 8 59.8 43.0 52.3 -0.5 57.4 5 0.05 ,, 15 64.7 44.2 54.8 + 4.1 56.3 3 0.34 ,, 22 63.7 38.7 52.6 + 3.6 55.7 2 0.48 ,, 29 56.1 31.0 44.3 —3.4 54.1 2 0.29 Nov. 5 68.1 39.3 52.4 + 5.7 52.8 3 0.17 ,, 12 62.3 40.4 53.5 + 8.9 52.9 2 0.13 ,, 19 61.9 43.2 52.3 + 9.5 53.1 5 0.45 ,, 26 57.1 35.5 45.0 + 3.0 52.2 5 2.11 Dec. 3 520 30.1 43.2 + 2.0 50.6 5 0.48 ,, 10 55.1 29.7 45.8 + 4.7 49.2 5 0.56 ,, 17 55.2 27.7 46.3 + 5.8 48.9 6 0.63 ,, 24 34.0 20.4 27.8 — 11.0 47.6 5 0.43 „ 31 47.2 28.0 37.9 —0.8 45.6 4 0.56 -