WOO 40 Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1940 BY J. MACMILLAN, D.S.O., M.C., M B., Ch.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, 1940. The Worshipful the Mayor (Councillor A. Gorman, J.P.) Councillor C. H. Darby (Chairman) Councillor A. H. Gilder (Vice-Chairman). Councillors— J. W. Andrews Miss M. Grout, J.P, Mrs. L. E. Driver G. E. Greenwood H. L. Hunt E. T. Lamerton D. B. Lister S. W. Lister Mrs. K. M. Rance Mrs. E. L. Reeves E. G. Stevenson H. Vaughan Miss G. E. Walters, J.P. MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor Mrs. E. L. Reeves (Chairman) Councillor Miss G. E. Walters, J.P. (Vice-Chairman). TABLE OF CONTENTS. page Preface 3 Vital Statistics 5 General Provision of Health Services in the Area 7 Sanitary Administration 10 Housing 10 Inspection and Supervision of Food 11 Prevalence and Control of Infectious Diseases 13 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 Fortieth Annual Report on the health of the Metropolitan Borough of Woolwich. It is, on account of the war, like its immediate predecessor, shorter than usual, but it is hoped that it contains sufficient statistics and other material as is necessary to enable readers to appraise generally the health of the population and the maintenance of health services under war conditions. Since my last report the following staff changes have taken place:— Mr. C. W. V. Harris, Sanitary Inspector, died on the 21st February. Dr. F. J. C. Blackmore, Tuberculosis Officer, retired on superannuation on the 3rd April. Mr. J. S. Gibson, Sanitary Inspector, commenced duty on 4th April. Dr. M. E. Proudfoot, Assistant Medical Officer, resigned her appointment on the 7th October. Mr. F. Hemingway, Sanitary Inspector, resigned his appointment on the 30th November. Dr. F. E. Smith, Assistant Medical Officer, resigned her appointment on the 3rd December. Miss A. Klue, Health Visitor, resigned her appointment on the 31st December. In accordance with expectations, the war altered the work of the Department in many ways. Most services were maintained; some were reduced; some ceased; some were increased; new responsibilities were many. Civil defence affected the Department in the following ways:— (а) It was necessary to organise, staff and administer First Aid Posts and Gas Cleansing Stations. (b) It was necessary to organise, train and administer the Stretcher Bearer service. (c) It was necessary to provide medical and sanitary supervision of shelters and shelterers. (d) It was necessary to provide for medical supervision of the rest centres. The work of the sanitary inspectors did not diminish. The closing of private slaughterhouses and the concentration of slaughter in large slaughterhouses, brought much additional work in Woolwich, the number of animals slaughtered at the Royal Arsenal Co-operative Society's abattoir rising from 49,344 in 1939 to 89,509 in 1940. The raids damaged drains, as well as buildings, enabling sewer rats to come to the surface, and it was necessary towards the end of the year to spend more time on rat prevention work. The routine disinfestation, as a preventive measure, of blankets belonging to the various sections of civil defence personnel caused a 4 great increase in the amount of this work, but this was set off in some measure by the fall in the amount of disinfection owing to the great reduction in the number of cases of infectious disease. It was not possible to continue cyanide fumigation of furniture prior to occupancy of houses on the Council's Housing Estates, and resort had to be made to older and not so reliable methods. House to house inspection was discontinued, and slum clearance work wholly ceased. Of maternity and child welfare it can be said that the basic preventive services were maintained on a slightly reduced scale but probably little short of the pre-war standard because of the fall in the number of the population. It was only possible to continue the treatment services, however, with the exception of the provision of maternity beds, in a reduced form. All other ancillary services have been maintained although less use has been made of them. So far as tuberculosis work is concerned, the local services are now pretty much as they were in pre-war days, with the exception of the occupational therapy scheme of the Tuberculosis Care Committee which had to be discontinued. Although the number of births in Woolwich fell from 2,133 in 1939 to 1,840 in 1940, the Registrar General estimated that the population fell from 150,800 to 124,340, and as a result the birth rate rose from 14.1 per thousand to 14.8. The number of deaths increased from 1,592 to 1,854, and as a result the death rate rose from 11.1 to 14.9. So far as causes of death are concerned, the largest increases were in the number of deaths from bronchitis and in those from violence, under which head, deaths resulting from enemy action are classified. The infantile mortality rate was 36, compared with 49 in the previous year. It is the lowest figure ever recorded in the Borough. There was little infectious disease in the Borough during the year ; there were, for example, only 61 cases of diphtheria and 128 of scarlet fever. Other notifiable diseases were similarly reduced in number with two notable exceptions ; the incidence of pneumonia was average, while the number of cases of cerebrospinal meningitis rose from 9 to 32. In conclusion, it gives me great pleasure to be able to say that the Department met more than adequately the demands made upon it, due entirely to the hard work put in and the zeal shown by every member of the permanent, temporary and war-time staffs. I desire also to acknowledge the help given to us all by the Chairmen and members of the Committees on Health and the Chairman and members of the Emergency Committee in dealing with the local medical and sanitary problems of the war, and to thank the Council and the members of these Committees for the continued confidence placed in the Department and myself during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. MACMILLAN, Medical Officer of Health. 5 VITAL STATISTICS. Table No. 1. Population. Registrar-General's Estimate of 124,340 Live Births—Legitimate 1,781 Live Births—Illegitimate 65 1,846 Birth Rate per 1,000 population 14.8 Still-births 55 Still-births—Rate per 1,000 total births 28.9 Deaths 1,854 Death Rate per 1,000 population 14.9 Deaths from puerperal causes:— (a) From Sepsis — (b) From other causes 1 Death rate from puerperal causes per 1,000 total births 0.53 Deaths of infants under one year of age 66 Death rate of Infants under one year of age:— (a) All infants 36 (b) Legitimate infants 33 (c) Illegitimate infants 111 Notification of Births. After correction by inward and outward transfers the total number of Woolwich live births notified was 1,881. Of this number it is known that 930 took place in institutions. Deaths. The total number of deaths of Woolwich residents from all causes was 1,854. The classification by age under causes of death is shown in the following Table No. 2. 6 TABLE No. 2. Nett Deaths during the calendar year 1940. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. All Ages. Under 1 year. 1 and under 5 years. 5 and under 15 years. 15 and under 45 years. 45 and under 65 years. 65 years and upwards. All Causes 1,854 66 29 27 272 493 967 Typhoid and paratyphoid fevers .. .. .. .. .. .. .. Cerebrospinal fever 5 1 1 1 1 - 1 Scarlet fever .. .. .. .. .. .. .. Whooping cough .. .. .. .. .. .. .. Diphtheria 3 .. 2 .. .. .. .. Tuberculosis of the respiratory system 103 - 2 .. 67 29 5 Other forms of tuberculosis 12 .. 2 .. 4 2 1 Syphilitic diseases 16 1 .. .. .. 8 7 Influenza 22 .. .. .. 2 9 11 Measles .. .. .. .. .. .. .. Acute polio-myelitis and polio-encephalitis 1 .. .. .. .. .. 1 Acute infective encephalitis 2 .. .. .. .. 2 .. Cancer of buccal cavity and oesophagus (M); uterus (F) 33 .. .. .. 1 15 17 Cancer of stomach and duodenum 36 .. .. .. 4 13 19 Cancer of breast 26 .. .. .. .. 15 11 Cancer of all other sites 116 .. 1 1 8 36 70 Diabetes 21 .. .. .. 6 4 11 Intracranial vascular lesions 113 .. .. .. 2 26 85 Heart disease 449 .. .. 1 23 96 329 Other diseases of the circulatory system 59 .. .. .. 1 17 41 Bronchitis 142 1 1 2 5 34 99 Pneumonia 92 9 5 1 7 34 36 Other respiratory diseases 14 .. 1 .. .. 5 8 Ulcer of stomach or duodenum 32 .. .. .. 5 13 14 Diarrhoea under 2 years 6 6 .. .. .. .. .. Appendicitis 8 .. .. 1 3 1 3 Other digestive diseases 45 1 1 .. 9 17 17 Nephritis 38 .. .. .. 7 11 20 Puerperal and post-abortive sepsis .. .. .. .. .. .. .. Other maternal causes 1 .. .. .. 1 .. .. Premature birth 16 16 .. .. .. .. .. Congenital malformation, birth injury, infantile diseases 28 25 1 .. 2 .. .. Suicide 12 .. .. .. 3 8 1 Road traffic accidents 25 .. 1 1 11 3 9 Other violent causes 241 3 10 12 87 69 60 All other causes 137 3 1 3 13 26 91 7 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Clinics and Treatment Centres. In tabular form below are shown the arrangements in being during the year at each of the Council's Maternity and Child Welfare Clinics and Treatment Centres. Woolwich Central Health Centre. In use as a first aid post but maternity and child welfare and ante-natal clinics held throughout the year. Plumstead Health Centre In use as a first aid post throughout the year. Emergency arrangements made for holding clinics in the Juvenile Library of the Plumstead Library, which adjoins this Centre. Eltham Health Centre In use as a first aid post. Child welfare clinics held two days weekly during the year. Ante-natal services transferred to Horn Park Centre. Wesley Hall, Timbercroft Lane. Church Hall continued to be used as a maternity and child welfare clinic during the year. New Eltham Hall taken over for other purposes. Clinics held during the greater part of the year at the First Aid Post, Legal and General Sports Pavilion. St. Luke's Church Hall, Westmount Road. Clinics continued to be held during the year. Elizabeth Street, North Woolwich. Taken over as a first aid post but clinics held until September. Clinics were then held at the Storey Street School, by arrangement with East Ham Borough Council. Horn Park Open throughout the whole year for ante-natal and infant welfare clinics. The attendances at the maternity and child welfare centres during the year were : expectant mothers, 2,797; nursing mothers, 773; children, 24,489. Health Visiting. The arrangements made for the visiting of children between the ages of one and five are described in previous Annual Reports. The number of such visits paid during 1940 was 14,046. The total number of visits paid by health visitors was 18,693. Infant Life Protection. The fall in the number of registered foster mothers apparent since the Council took over this service continued. There were only 20 of these in 1940, compared with 36 in 1939. The number of nurse children was 21. The number of visits paid by the infant life protection visitors was 324. 8 Toddlers' Clinics. The Council's scheme for the medical inspection of toddlers was not in being during the year. Artificial Sunlight Clinic. Towards the end of the year daily sessions were instituted in the Town Hall Shelter. Midwifery Services. There are no whole-time midwives employed by the Council, the Domiciliary Midwifery Service in London being administered by the London County Council. Maternity beds are provided in the British Hospital for Mothers and Babies, the War Memorial Hospital, the Eltham Cottage Hospital, the Military Families' Hospital, St. Nicholas' Hospital, and a few in midwives' homes. At the outbreak of war, the War Memorial Hospital, the Military Families' Hospital and St. Nicholas' Hospital closed their maternity wards, and consequently a greater demand was made on the British Hospital for Mothers and Babies. Home Helps. During the year 103 applications were considered by the Committee and 109 home helps were provided. Treatment of Minor Ailments. The number of children referred to the school clinics for treatment during the year was 140. Dental Treatment. The number of mothers and children attending the dental clinics was 167, and the number of tuberculous persons attending was 14. Clinic for Physical Medicine. This clinic was not open during the year. Institutional Midwifery. The number of mothers admitted under the Council's scheme was 174. No cases were admitted for ante-natal or emergency treatment. Supply of Milk to Necessitous Mothers and Children. The approximate cost of this service during the year was: dried milk, £680 17s. Od.; fresh milk, nil; dinners, nil. Ambulance Facilities. The London County Council provide an ambulance service which continued in being during the year. Professional Nursing in the Home. The arrangements with the six nursing associations for the nursing of cases of measles, ophthalmia neonatorum, zymotic enteritis, whooping cough and poliomyelitis, in children under five, and pneumonia puerperal fever, puerperal pyrexia and tuberculosis were continued during 1940. The total number of visits paid by the nurses was 2,445. Supply of Insulin to Persons Suffering from Diabetes. The number of cases who received insulin during the year was 21. Foot Clinic. The number of attendances was 7,416. Vaccination. I submit a return by the Vaccination Officer on the work carried out under the Vaccination Acts for the year 1940. 9 TABLE No. 3. RETURN to be made on or before 14th February, 1941, 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, 1939, inclusive:— Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in the " Birth List Sheets " as registered from 1st January to 31st December, 1939. Number of these Births duly entered by 31st January, 1941, in Columns I., II., IV., and V. of the " Vaccination Register " (Birth List Sheets), viz. :— Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declaration of Conscientious Objection has been received. Col. V. Insusceptible of Vaccination. Had Small Pox. Died Unvaccinated. 1. 2. 3. 4. 5. 6. 7. 1. Plumstead 555 210 - - 228 15 2. Woolwich 1189 467 6 - 449 27 3. Eltham 397 199 1 - 144 15 Total 2141 876 7 - 821 57 Number of these Births which on 31st January, 1941 remained unentered in the "Vaccination Register" on account (as shown by "Report Book") of Number of these Births remaining on 31st January, 1941, neither duly entered in the "Vaccination Register" (Columns 3, 4, 5, 6, and 7 of this Return) nor temporarily accounted for in the "Report Book" (Columns 8, 9 and 10 of this Return). Total Number of Certificates of Successful Primary Vaccination of Children under 14 received during the Calendar Year 1940. 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 1940. Postponement by Medical Certificate. Removal to Districts the Vaccination Officers of which have been duly apprised. Removal to places unknown or which cannot be reached; and cases not having been found. 8. 9. 10. 11. 12. 13. 15 20 58 9 These figures are to be obtained from colum ns 2 and 6 of the Summar y (Form N.) 13 119 96 12 3 18 15 2 31 157 169 23 933 661 (Signature) S. G. TAYLOR, Date—12th February, 1941. Vaccination Officer. During the year ended 30th September, 1940, the number of persons successfully vaccinated or re-vaccinated at the cost of the rates was 693. This figure includes 652 primary vaccinations of persons under one year of age, 35 over one year of age, and 6 re-vaccinations. 10 SANITARY ADMINISTRATION. Complaints. During the year, 2,426 complaints of nuisance were received by the Health Department. After investigation the necessary notices for the remedy or abatement of the defects or nuisances discovered were served. Sanitary Inspection of the Area. During the year 14,113 inspections, including re-inspections, were carried out by the sanitary inspectors. Included in this number are 2,011 primary inspections on complaint of nuisances, and 326 on account of infectious disease. The number of inspections of factories, workshops and workplaces was 192. Defects were found and remedied in 11 instances. The number of intimation notices served was 955 and the number of statutory notices 300. Only in 58 instances, where the owners did not comply with the statutory notices, was the Town Clerk asked to institute proceedings. It was, however, necessary to issue summonses in only two instances, as in all other cases the necessary steps were taken on receipt of a letter from the Town Clerk. Eradication of Bed Bugs. The methods adopted in Woolwich in this respect have been reported on very fully in previous reports. Cyanide, however, was not used throughout the year. During 1940, 3,016 inspections of verminous houses were carried out and the necessary action was taken. As a preventive measure all infested furniture from bombed houses taken into store was treated with contact insecticides during the process of storing and the stores were carefully inspected by an experienced inspector at regular intervals for some months. As a result the bed bug problem in these furniture stores did not arise. Rats and Mice (Destruction) Act, 1919. The number of inspections of rat infested premises made during 1940 was 535. In 96 instances it was necessary to secure the repair of defective drains. Fifty-eight premises were made rat-proof and other effective measures were taken in 60 instances. HOUSING. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 2,766, and the number found not to be in all respects reasonably fit for human habitation was 1,136. The number rendered fit in consequence of informal action by the sanitary inspectors (including the service of intimation notices) was 959. Statutory notices were served in respect of 177 houses. New Houses. Certificates of a proper and sufficient supply of water were issued for 160 new houses. Of these 23 were in respect of houses built by the Council. 11 INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 63, and 74 inspections were made. Two pasteuriser's licences, 9 dealer's licences and 6 supplementary licences were issued under the provisions of the Milk (Special Designations) Orders, for the sale of pasteurised milk, and 15 dealer's and 3 supplementary licences were issued for the sale of "Tuberculin tested" milk. The number of samples of designated milk examined bacteriologically was 4. Meat Supplies. The number of animals slaughtered and inspected at the slaughterhouses in the Borough was 89,509, compared with 49,344 in 1939. Premises where Food is Prepared or Offered for Sale. All such premises, including those registered under the provisions of the Public Health (London) Act, 1936, are kept under frequent observation. The number of inspections carried out during the year was 2,810. The total weight of food surrendered including carcases and parts of carcases found to be unsound at the slaughterhouse was 183 tons 16 cwts. Sophistication of Food. During the year 703 samples were submitted to the Public Analyst for analysis. Of these 531 were informal and 172 formal. Thirty-five samples were reported as adulterated. The foods examined included:— milk, 258; condensed milk, 15; cream, 8; cheese, 8; butter, 11; margarine, 17; lard, 7; baking powder, 6; rice, 8; arrowroot, 5; cornflour, 5; ground almonds, 6; dried fruit, 9; ginger, 10; dried herbs, 4; preserves, 34; vinegar, pickles, etc., 34; cocoa, 5; coffee, 9; tea, 14; meat, 9; canned soup, 4; sausages, 32; suet, 7; fish, 33; fish paste, 6; canned vegetables, 24; canned fruit, 16; confectionery, 11; beer and spirits, 6; fruit drinks, 4; ice cream, 4; iodine, 9; and 55 others. The following Table gives details of adulterated samples and the action taken in each case where the sample was formal. TABLE No. 4. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 514 Margarine Informal Contained water, 16.4 per cent. — 527 Margarine Informal Genuine Margarine, but incorrectly labelled. — 602 Milk Informal Contained a small proportion of added water. — 603 Milk Informal Contained 2 per cent. of added water. — 610 Beef Suet Informal Contained ground rice, 15.3 cent. — TABLE No. 4 —continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 630 Milk Informal Contained 1 per cent. of added water. — 640 Milk Informal Contained a small proportion of added water. — 649 Margarine Informal Genuine margarine, but incorrectly labelled. — 661 Margarine Informal Contained water, 16.5 per cent. — 710 Pork Sausages Informal Contained sulphur dioxide, 35 parts per million. — 715 Sardines, canned Informal Contained lead, 6 parts per million. — 25 Sausages Informal Contained sulphur dioxide, 260 parts per million. — 46 Strawberry Jam Informal Contained sulphur dioxide, 100 parts per million. — 54 Olive Oil Informal Contained foreign vegetable oils, not less than 40 per cent. — 64 Margarine Informal Genuine margarine, but incorrectly labelled. — 114 Olive Oil Formal Contained foreign vegetable oils, not less than 60 per cent. — 121 Strawberry Jam Formal Contained sulphur dioxide, 60 parts per million. Vendor cautioned. 134 Milk Formal 6 per cent. of the milk fat abstracted. Case dismissed. 152 Margarine Informal Genuine margarine, but incorrectly labelled. — 162 Milk Formal 4 per cent. of the milk fat abstracted. Re-sampled. 181 Strawberry Jam Informal Contained sulphur dioxide 80 parts per million. — 216 Sardines, canned Informal Contained lead, 7 parts per million. — 252 Milk Formal 11 per cent. of the milk fat abstracted. Summons withdrawn. 272 Tincture of Iodine Informal Iodine, 8 per cent. deficient; potassium iodide, 23 per cent. excessive. 284 Ground Rice Informal Consisted entirely of cornflour. — 297 Milk Formal Contained 21 per cent. of added water; the sample was also 16 per cent. deficient in milk fat, but this deficiency may have been due to the added water. Vendor fined £3. £2 2s. costs. 298 Milk Formal 5 per cent. of the milk fat abstracted. Re-sampled. 302 Milk Formal 18 per cent. of the milk fat abstracted. Defendant died after service of summons. 338 Marmalade Informal Contained soluble solids, only only 66.0 per cent. — 350 Sausages Formal Contained sulphur dioxide, 52 parts per million. Vendor cautioned. 12 13 TABLE No. 4—continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 354 Lard Informal Contained foreign vegetable fat, not less than 50 per cent. — 397 Quinine, Ammoniated Tincture of. Informal Ammonia, 33 per cent. deficient. — 425 Quinine, Ammoniated Tincture of. Formal Ammonia, 30 per cent. deficient. — 440 Milk Formal Contained 1 per cent. of added water. — 444 Milk, sterilised Informal Contained 1 per cent. of added water. Food Poisoning. The number of notifications of cases of food poisoning was 27. PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 659. They relate to the following disease:— TABLE No. 5. Diphtheria 61 Ophthalmia Neonatorum 17 Scarlet fever 128 Encephalitis Lethargica 1 Enteric fever (including Paratyphoid) 1 Dysentery 4 Puerperal fever 5 Cerebrospinal Meningitis 32 Puerperal pyrexia 19 Poliomyelitis 2 Erysipelas 44 Polio-Encephalitis 1 Smallpox — Zymotic Enteritis 21 Pneumonia 231 Measles 83 Malaria 2 Whooping Cough 7 Diphtheria. The amount of anti-toxin supplied to medical practitioners during the year was 4,000 units. The number of children immunised during the year was 239, 14 Ophthalmia Neonatorum. Seventeen cases were notified, 3 of which were admitted to hospital. Nursing assistance was provided under the Council's scheme in 13 cases. Cerebrospinal Meningitis. Thirty-two cases were notified compared with 9 in 1939, and 6 in 1938. With the exception of seven in army barracks the cases were sporadic. All the cases were removed to hospital and in 10 cases the diagnosis was not confirmed. There were five deaths. Tuberculosis. The number of new cases examined was 779. Of these 151 were definitely tuberculous. 271 contacts were examined, of which 20 were definitely tuberculous. The total number of attendances at the Dispensaries was 3,224 ; 4,025 visits were made by nurses to homes of patients, and 290 domiciliary visits were paid by the Tuberculosis Officer or an Assistant Medical Officer. 344 cases were referred to the Dispensaries by medical practitioners and 81 by Medical Boards. 507 specimens of sputum were examined, of which 104 were positive ; and 1,033 X-ray examinations were made. The number of cases on the register on the 31st December, 1940, was 962. 98 patients received artificial pneumothorax treatment. Additional nourishment was granted in 385 instances. 37 patients received dental treatment under the Council's scheme. 331 patients were admitted to hospitals, sanatoria, or training colonies. The Tuberculosis Care Committee continued their meetings and rendered valuable assistance in various ways to the needy tuberculous and their families. Laboratory Facilities. The bacteriological work of the Council is carried out at the War Memorial Hospital. In addition to the number of examinations made for the tuberculosis service, 362 specimens were examined for diagnostic purposes in the case of diphtheria, 3 in the case of enteric fever, and 1 on account of other disease. Disinfection and Disinfestation. The number of rooms disinfected after cases of infectious disease, etc., was 487. Of these 113 were rooms which had been occupied by tuberculous persons. 1,093 rooms were disinfected for verminous cases. 45,931 articles were disinfected at the Disinfection Station. The number of school children cleansed at the Cleansing Station, in accordance with the terms of the agreement with the London County Council was 1,276. The number of adults cleansed was 60. In addition, 35 French and Belgian refugees were cleansed. In September, the Cleansing Station at Whitehart Road was damaged by enemy action and it was necessary to form a new station for the cleansing of verminous persons. Fortunately, it was possible to do this in the Plumstead Turkish Baths building, where a limited amount of disinfection by dry heat could be arranged. 15 TABLE No. 6. Notification of Infectious Diseases (including Tuberculosis), 1919 to 1940. Year. Smallpox Diphtheria and Mem. Croup. Erysipelas Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. §Puerperal Pyrexia. Primary Pneumonia. Influenzal Pneumonia. Malaria. Dysentery. Anthrex. Ophthalmia Neonatorum. Encephalitis Lethargica. Cerebro-spinal Meningitis. Poliomyelitis and Polio-encephalitis. ‡Zymotic Enteritis. Pulmonary Tuberculosis. Tuberculosis Non-pulmonary. †Measles x Chicken Pox. *Whooping Cough 1919 4 398 63 243 26 — 7 — 123 — 61 7 1 34 3 7 1 123 394 80 1,886 — — 1920 1 427 82 538 6 — 13 — 136 — 29 1 — 29 3 6 — 31 359 69 1,013 — — 1921 — 592 59 1,351 11 — 14 — 187 49 10 — — 32 9 2 — 454 285 71 481 — — 1922 — 437 37 511 8 1 11 — 212 133 11 — — 26 3 2 4 31 245 60 2,698 — — 1923 — 152 40 334 16 — 8 — 196 46 4 1 — 18 1 5 6 49 245 66 194 — — 1924 — 195 45 440 11 — 7 — 249 105 3 1 — 27 17 12 5 13 273 69 2,679 — — 1925 — 299 44 364 16 — 9 — 237 40 5 1 — 31 10 5 1 13 246 54 1,916 — — 1926 — 393 46 411 8 1 4 7 259 33 5 — — 18 7 9 5 23 287 52 1,246 — — 1927 — 278 65 478 9 — 8 30 280 36 3 1 — 19 6 4 3 12 269 84 457 — — 1928 3 300 89 529 17 — 20 28 216 14 12 1 — 14 8 3 3 5 263 62 2,418 — — 1929 5 496 80 567 7 — 15 38 293 90 5 — 1 17 4 9 4 8 250 52 151 — — 1930 10 497 77 627 8 — 5 31 262 21 2 1 — 8 — 2 2 22 244 55 2,702 597 — 1931 3 281 80 387 3 — 8 41 327 44 3 — — 7 2 12 6 3 229 51 113 672 — 1932 7 233 44 554 3 — 5 35 199 48 2 1 — 7 2 15 6 11 235 48 3,135 — — 1933 2 370 67 1,004 5 — 4 36 181 68 2 — — 9 — 9 2 5 207 45 354 — — 1934 — 416 119 989 8 — 5 30 273 7 1 — — 7 — 4 3 3 219 50 2,392 — — 1935 — 313 78 634 9 — 3 42 230 25 — 1 — 17 1 3 2 5 209 33 656 — — 1936 — 176 68 609 12 — 5 23 231 18 2 4 — 26 1 15 1 63 217 36 2,060 — — 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 — 45 1939 — 123 51 374 8 — 6 42 244 21 2 21 — 43 1 9 4 56 198 30 43 — 998 1940 — 61 44 128 1 — 5 19 198 33 2 4 — 17 1 32 3 21 195 35 83 7 §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. * Compulsory notification of Whooping Cough commenced 1/10/38