Ac 4372 WOO 41 Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1941 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 I HEALTH COMMITTEE. At 31st December, 1941. The Worshipful the Mayor (Councillor H. J. Turner, J.P.) Councillor Mrs. E. L. Reeves (Chairman) Councillor C. H. Darby (Vice-Chairman) Councillors— J. W. Andrews D. B. Lister Miss M. Crout, J.P. S. W. Lister Mrs. L. E. Driver J. F. Parker A. H. Gilder Mrs. K. M. Rance G. E. Greenwood E. G. Stevenson E. T. Lamerton 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 C. H. Darby (Vice-Chairman). TABLE OF CONTENTS. page Preface 3 General Provision of Health Services in the Area 7 Sanitary Administration 11 Inspection and Supervision of Food 12 Prevalence and Control of Infectious Diseases 15 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 Forty-first Annual Report on the health of the Metropolitan Borough of Woolwich. It is much shorter than most of its predecessors, but it is hoped that although much is not published, there is yet sufficient to enable readers to assess how war conditions have affected the health environment of, and health services available for, the inhabitants of this Borough. On grounds of national security, I am requested by the Ministry of Health not to publish complete tables of local populations, but I can say that the Registrar General estimates the population to be less than it was in 1940. It is not possible also, to give both vital statistical figures and rates because from these it would be easy to calculate the estimated population, but I can say that the birth rate was lower, the death rate was higher, and the infant mortality rate (42) was higher than they were the previous year. The actual figures follow. The number of births was 1,530, the number of deaths under one year was 65, and the total number of deaths was 1,627. The detail of causes of death will be found in Table No. 1. The number of maternal deaths was 2. The sanitary administration of the Borough was satisfactorily maintained during the year, despite the many extra claims on the Department. All complaints were investigated and dealt with. The abattoir of the Royal Arsenal Co-operative Society was closed in October. The number of animals slaughtered during the period it was open in 1941 was 60,986. Two Sanitary Inspectors, with the necessary labour, were engaged throughout the whole year on the inspection of drains damaged in raids. As a result the rat nuisance did not assume any serious proportions in the Borough. It was possible to resume, on a small scale, the cyanide fumigation of furniture belonging to families allotted houses on the Council's Housing Estates. Infant welfare sessions were held in every part of the Borough, on practically the same scale as in pre-war days, as were ante-natal and post-natal sessions. Treatment sessions were limited. Eltham Health Centre, which was being used as a First Aid Post, was completely demolished by enemy action in March. The issue of clothing coupons to expectant mothers, and fruit juices and cod liver oil to children, was new work undertaken by the Maternity and Child Welfare Service. The Council's war-time programme for day nurseries was settled during the year although the first day nursery was not opened until the beginning of 1942. The 4 Council's scheme provides for the opening of three day nurseries in the Borough, i.e., one in Woolwich, one in Plumstead, and one in Eltham, and for the use of two London County Council rest centres—one in Eltham and one in Plumstead, as day nurseries. There was more infectious disease in the Borough in 1941 than there was in 1940 but the increase was almost entirely due to epidemics of measles (538 cases) and whooping cough (419 cases). There were 11 cases of enteric fever and 43 of cerebrospinal meningitis. The incidence of tuberculosis was higher than in the previous year, 226 cases of pulmonary tuberculosis and 32 cases of non-pulmonary being notified. In November the Ministry of Health in a general Circular drew attention to the increase in the incidence of tuberculosis in England and Wales as a whole. The notification figures in Woolwich for the past four years have been as follows:— Pulmonary. Non-Pulmonary. 1938 204 44 1939 198 30 1940 195 35 1941 226 32 These figures make it clear that there has been some slight increase in the Borough, but the increase is probably greater than these figures indicate because the population is now much reduced. So far as tuberculosis work is concerned, the local services are back on a pre-war standard except that the Tuberculosis Care Committee has not been able to continue with the occupational thereapy scheme. The following members of the staff were members of the Armed Forces of the Crown at the end of the year : Mr. L. J. Allen (Grade " B " Clerk), Mr. J. Lewington, Mr. D. Buck, Mr. R. Hillary, and Mr. A. Goad (Grade " A " Clerks). Since my last report the following changes in the permanent staff have taken place :— Mr. J. Facer, Sanitary Inspector, commenced duty on 20th January. Miss E. M. Giles, Temporary Health Visitor, appointed to permanent staff on 22nd January. Miss W. McCaffery, Temporary Health Visitor, appointed to permanent staff on 22nd January. Dr. L. A. McDowell, B.A., Assistant Medical Officer, commenced duty on 24th January. Miss W. Adams, Health Visitor, killed by enemy action on 15th March, 5 Dr. T. Standring, Deputy Medical Officer of Health, commenced duty on 28th April. Mr. E. B. Pindar, Sanitary Inspector, retired on superannuation on 12th June. Mr. J. Cook, Temporary Sanitary Inspector, appointed to permanent staff on 13th June. Miss E. W. Woods, Health Visitor, commenced duty on 7th July. Miss J. Chandler, Chiropodist, commenced duty on 6th October. Mr. J. G. Gibson, Sanitary Inspector, resigned his appointment on 25th October. Since the beginning of the War the following have joined the Council's service for whole-time duty:— Dr. C. H. Lilley, Tuberculosis Officer. Mr. E. Brunsdon, Clerk. Dr. K. Waghorn, Assistant Medical Officer. Mrs. W. Clark, Clerk. Mr. A. Aslamidis, Sanitary Inspector. Mr. K. Morgan, Clerk. Mr. E. Rees, Sanitary Inspector. Miss J. Flint, Clerk. I take this opportunity of saying once again how grateful the staff, permanent and temporary, are for the encouragement and support given by the Chairman and members of the Committees on Health, and the Chairman and members of the Emergency Committee, during the year, and on their behalf and my own, to thank all members of the Council for the continued confidence shown in the Department and myself during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. MACMILLAN, Medical Officer of Health. 6 TABLE No. 1. Nett Deaths during the calendar year 1941. 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 1,627 65 14 15 241 471 821 Typhoid and paratyphoid fevers 2 .. .. .. .. 2 .. Cerebrospinal fever 5 .. 1 .. 1 1 1 Scarlet fever 1 .. .. 1 .. .. .. Whooping cough 3 .. 2 .. .. .. .. Diphtheria .. .. .. .. .. .. .. Tuberculosis of the respiratory system 113 .. 1 .. 70 33 9 Other forms of tuberculosis 14 .. 2 5 4 1 .. Syphilitic diseases 19 .. .. .. .. 14 5 Influenza 17 .. .. .. 2 3 12 Measles 2 .. .. 1 .. .. .. Acute polio-myelitis and polio-encephalitis 1 .. .. .. .. .. 1 Acute infective encephalitis .. .. .. .. .. .. .. Cancer of buccal cavity and oesophagus (M) ; uterus (F) 35 .. .. .. 2 11 22 Cancer of stomach and duodenum 32 .. .. .. 4 8 20 Cancer of breast 13 .. .. .. .. 8 5 Cancer of all other sites 154 .. .. .. 3 67 84 Diabetes 9 .. .. .. .. 2 7 Intracranial vascular lesions 121 .. .. .. 3 31 87 Heart disease 333 .. .. .. 15 78 240 Other diseases of the circulatory system 55 .. .. .. 1 12 42 Bronchitis 107 5 .. .. 4 26 72 Pneumonia 78 8 3 .. 7 29 31 Other respiratory diseases 18 .. .. 1 3 4 10 Ulcer of stomach or duodenum 24 .. .. .. 6 12 6 Diarrhoea under 2 years 6 6 .. .. .. .. .. Appendicitis 4 .. .. .. 3 .. 1 Other digestive diseases 38 .. .. .. 2 16 20 Nephritis 31 .. .. .. 3 11 17 Puerperal and post-abortive sepsis .. .. .. .. .. .. .. Other maternal causes 2 .. .. .. 2 .. .. Premature birth 16 16 .. .. .. .. .. Congenital malformation, birth injury, infantile diseases 18 16 .. .. 2 .. .. Suicide 11 .. .. .. 2 6 3 Road traffic accidents 11 .. 1 3 1 3 3 Other violent causes 202 5 3 3 82 65 44 All other causes 132 4 1 1 19 28 79 7 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 742. The number of registered births in Woolwich was 738. After correction for inward and outward transfers the net number of Woolwich live births was 1,530. It is known that at least 719 births took place in institutions. Maternity and Child Welfare 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 In use as a first aid post but maternity and Centre. child welfare and ante-natal clinics held every week. Plumstead Health Centre In use as a first aid post. Clinics held in the Juvenile Section of the Plumstead Library, which adjoins this Centre. 601, Westhorne Avenue Private house taken over to replace Eltham Health Centre demolished by enemy action in March. Child welfare and ante-natal clinics held during remainder of year. Wesley Hall, Church hall continued to be used as a maternity Timbercroft Lane. and child welfare clinic. New Eltham Clinics held during the greater part of the year at the First Aid Post, Legal and General Sports Pavilion. St. Luke's Church Hall, Clinics continued to be held here. Westmount Road. St. John's Church Hall, Clinic opened in October, 1941, to replace one North Woolwich. in Storey Street School (East Ham), closed in September, 1940. 137, Alnwick Road, Ante-natal and infant welfare clinics held every Horn Park. week. 8 The attendances at the Maternity and Child Welfare Centres during the year were: expectant mothers, 2,615; nursing mothers, 682; children, 27,525. At the end of the year arrangements had been made to re-institute toddler inspection sessions in each part of the Borough. Artificial Sunlight Clinic. Artificial sunlight treatment was continued in the Town Hall shelter. 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 1941 was 14,672. The total number of visits paid by health visitors was 20,834. Infant Life Protection. There were 22 foster mothers on the register at the end of 1941, compared with 20 in 1940. The number of nurse children was 24. The number of visits paid by the infant life protection visitors was 191. 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 as a result a greater demand was made on the British Hospital for Mothers and Babies. During 1941 937 mothers were admitted to this hospital; 184 of these were admitted under the Council's scheme. No cases were admitted under the Council's scheme for antenatal or emergency treatment. Home Helps. During the year 62 applications were considered by the Committee and 37 home helps were provided. Dental Treatment. The number of mothers and children attending the dental clinics was 211, and the number of tuberculous persons attending was 8. The total number of attendances was 676. Issue ot Clothing Coupons to Expectant Mothers. In connection with clothes rationing, the Health Department is responsible for the issue of special coupons to expectant mothers residing in the Borough. During the year 904 applications were granted, and 45,200 coupons were issued. Issue of Fruit Juices, etc. The Government scheme for the issue of fruit juices and cold liver oil for children is administered through the Maternity and 9 Child Welfare Clinics. As a result there has been much more traffic to these buildings during the year, but no figures have been recorded. Supply of Milk to Necessitous Mothers and Children. The approximate cost of this service during the year was : dried milk, £180 12s. 2d.; fresh milk, nil; dinners, nil. 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 1941. The total number of visits paid by the nurses on behalf of the Council was 192(f. School Clinics. Clinics were held at the Woolwich Central Health Centre, and at 595 Westhorne Avlnue—a private house taken over when Eltham Health Centre was demolished. The number of children under 5 years of age referred to the school clinics for treatment of minor ailments during the year was 109. Ambulance Facilities. The London County Council provide an ambulance" service for four main purposes, (a) removal of persons meeting with accidents or sudden illness in the streets or public places, (6) for removal of maternity cases, (c) for removal of sick persons, (d) for removal of civil defence casualties. Clinic for Physical Medicine. This clinic was not open during the year. Foot Clinic. An additional chiropodist was appointed and she commenced duty in October. The number of treatments rose from 7,416 in 1940 to 8,945 hi 1941. Tuberculosis Dispensaries. Maxey Road, Plumstead. In use as a first aid post but temporary modation at the rear in use as a Tuberculosis Dispensary from 28th April. 11, C'arnecke Gardens, Eltham. Continued to be used as a Tuberculosis Dispensary during the year. The work of the dispensaries is referred to in the section dealing with infectious disease. Supply ot Insulin to Persons Suffering from Diabetes. The number of patients, under the Council's scheme, who received insulin during the year was 18. Vaccination. I submit a return by the Vaccination Officer on the wrork carried out under the Vaccination Acts for the year. 10 RETURN to be made on or before 14th February, 1942, 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, 1940, 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, 1940. 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. Died Unvaccinated Insusceptible of Vaccination. Had Small Pox. 1. 2. 3. 4. - 6. 7. J. Plumstead 261 93 1 - 114 7 2. Woolwich 1132 427 I - 407 29 3. Eltham 245 92 1 - 91 5 Total 1638 612 3 - 612 41 Number of these Births which on 31st January, 1942, remained unentered in the "Vaccination Register" on account (as shown by "Report Book ") of :— Number of these Births remaining on 31st January, 1942, 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 1941. 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 1941. 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. 4 39 3 These figures are to be obtained from colum ns 2 and 6 of the Summar y (Form N.) 12 122 123 11 5 12 30 9 • 17 138 192 23 583 271 Date—1 3th February, 1942. (Signature) IS. U. LAY LUK, Vaccination Officer. During the year ended 30th September, 1941, the number of persons successfully vaccinated or re-vaccinated at the cost of the rates was 375. This figure includes 350 primary vaccinations of persons under one year of age, 14 over one year of age, and 11 re-vaccinations. 11 SANITARY ADMINISTRATION. Complaints. 1,763 complaints of nuisance were received. 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 25,209 inspections, including re-inspections, were carried out by the sanitary inspectors. Included in this number are 1,763 primary inspections on complaint of nuisances, and 368 on account of infectious disease. The number of inspections of factories, workshops and workplaces was 282. Defects were found and remedied in 21 instances. The number of intimation notices served was 1,163, and the number of statutory notices, 194. In 16 instances, where the owners did not comply with the statutory notices, the Town Clerk was asked to institute proceedings, but it was not necessary to issue any summonses as in all 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 was used for the disinfestation of seven loads of furniture. During 1941, 2,139 inspections of verminous houses were carried out and the necessary action was taken. As a preventive measure all infested furniture taken into store from bombed houses, was treated with contact insecticides as the goods were moved in. The stores were carefully inspected by an experienced inspector at regular intervals for some months. As a result a 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 1941 was 4,788, compared with 535 in 1940. In 175 instances it was necessary to secure the repair of defective drains. Ninety premises were made rat-proof and other effective measures were taken in 571 instances. War conditions have made things easy for rats. There is much new harbourage —around factories, salvage dumps and similar collections. Broken sewers and drains provide easy exit for the sewer rat. Although much has been done to make things difficult for the rat, much more remains to be done. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 2,018, and the number found not to be in all respects reasonably fit for human habitation was 1,112. The number rendered fit in consequence of informal action by the sanitary inspectors (including the service of intimation notices) was 921. Statutory notices were served in respect of 147 houses. New Houses. Only one certificate of a proper and sufficient supply of water was issued. 12 INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 63, and 169 inspections were made. Two pasteuriser's licences, 9 dealer's licences and 5 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. Meat Supplies. The one remaining slaughterhouse in the Borough was closed in October. The number of animals slaughtered and inspected at this slaughterhouse up to date of closure was 60,986, compared with 89,509 in 1940. 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. 3,943. The total weight of food surrendered including carcases and parts of carcases found to be unsound at the slaughterhouse was 24 tons 13 cwts. Sophistication of Food. During the year 924 samples were submitted to the Public Analyst for analysis. Of these 574 were informal and 350 formal. Fifty-eight samples were reported as adulterated. The foods and drugs examined included:— -* Milk, 307; cheese, 5; butter, 4; margarine, 14; lard, 5; bread and cakes, 10; rice, 8; arrowroot, 5; pearl barley, 5; tapioca, 6; flour, 10; cornflour, 8; custard powder, 11; dried fruit, 5; ginger, 8; dried herbs, 6; preserves, 16; vinegar, pickles, etc., 63; cocoa, 5; coffee, 22; tea, 8; meat, 29; canned soup, 8; sausages, 42; suet, 4; fish, 35; meat paste, 13; fish paste, 4; canned vegetables, 18; canned fruit, 6; confectionery, 14; beer and spirits, 36; fruit drinks, 7; iodine, 5; mineral waters, 5; sugar, 5; saccharin, 8; food substitues, 47; ointments and medicines, 46; and 61 others. * The following Table No. 3 gives details of formal adulterated samples and shows the results of legal proceedings where these were taken. 13 TABLE No. 3. Sample No. Article. Result of Analysis. Result of Legal Proceedings. 490 Milk 10 per cent. of added water Fined £3. 567 Milk Small proportion of added water — 568 Milk 5 per cent. of added water Fined £1. 570 Milk Small proportion of added water — 574 Meat Pie Boric Acid, 0.014 per cent. — 592 Whisky Excessive water, 5.2 per cent. — 1 Milk Small proportion of water — 127 86 Egg Substitute Butter Consisted of coloured baking powder, made from cornflour, rice flour, potato starch, yellow colouring and a bicarbonate-phosphate raising mixture. The articles were described as a "Perfect Substitute" for eggs. Since they did not contain the nutritious qualities of eggs and were unsuitable for many of the purposes for which eggs are used, this description is misleading. Water, 16.9 per cent. 109 Steak and Kidney Pie 1 per cent. of steak and no kidney — 121 do., do. 3 per cent. of steak and no kidney — 142 Gin 2.4 per cent. excess water — 198 Meat Pie Filled with paste made from flour and potatoes, flavoured with meat extract. — 192 Tinned Roast Pork Pork, 2 per cent.; cereal filling, 80 per cent. Fined £2; Costs, £1 Is. Od. 197 Milk 1 per cent. of added water 219 Sterilised Milk.. 1 per cent. of added water — 220 Sterilised Milk.. 1 per cent. of added water — 221 Sterilised Milk.. 1 per cent. of added water — 258 Milk 1 per cent. of added water — 393 Lemon Substitute Contained citric acid, 1.46 gms ; Vitamin "C," 72 units; with lemon flavouring and colouring matter, dissolved in water, in one teaspoonful of the sample. The label claimed that one teaspoonful with five of water was equal to the juice of one lemon. The juice of one fresh lemon of aversize normally contains citric acid, 3 gms.; Vitamin "C," 450 units; with sugars, mineral salts and other constituents. 14 TABLE No. 3—continued. Sample No. Article. Result of Analysis. Result of Legal Proceedings. 394 395 Lemon Substitute Tomato Sauce Contained only 7.3 milligrams of Vitamin "C" in one teaspoonful of the sample. The label stated that one teaspoonful with six teaspoonsful of cold water was equivalent to one lemon. One fresh lemon of average size normally contains 22.5 milligrams of Vitamin "C." Sulphur dioxide, 210 parts per million 396 Lemon Substitute Contained tartaric acid, 3.7 per cent.; and lemon flavouring and colouring matter, dissolved in viator. No citric acid or Vitamin ''T3" could be detected. The samples contained a considerable growth of fungus. The label made the following claims, "The perfect substitute for fresh lemons." "Containing Vitamin 'C'.'' "Contains the natural acid of lemon juice." 431 Egg Substitute Samples were described as "The Perfect Substitute for Eggs." In each case they consisted of a weak solution of gum, sodium bicarbonate, soap and yellow colouring matter in water; as this mixture has nrfappreciable nutritive value and is unsuitable for many of the purposes for which eggs are used the description may be misleading. Case dismissed on on production of warranty. 432 Egg Substitute do., do.. do. do. 473 Sausages, Beef Boric Acid, 0-012 per cent. — In addition to these, 32 informal samples as set out in Table No. 4, were found to be adulterated. TABLE No. 4. Article. No. of Samples adulterated. Article. No. of Samples adulterated. Milk 7 Lemon Substitute 3 Tapioca 1 Tomato Ketchup 1 Meat Pie 3 Saccharin Tablets 4 Sausages 1 Zinc Ointment 1 Suet .. 1 Glauber's Salts 2 Raisins 1 Aspirin Tablets 1 Egg Substitute 3 Bleaching Powder 1 Sugar Substitute 1 Tincture of Iodine 1 Food Poisoning. The number of notifications of food poisoning was 46. 15 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 1,523. They relate to the following diseases :— TABLE No. 5. Diphtheria 68 Ophthalmia Neonatorum 18 Scarlet fever 88 Encephalitis Lethargica 3 Enteric fever (including Paratyphoid) 11 Dysentery 25 Cerebrospinal Meningitis 43 Puerperal fever 1 Poliomyelitis 2 Puerperal pyrexia 11 Polio-Encephalitis — Erysipelas 35 Zymotic Enteritis 22 Smallpox — Measles 538 Pneumonia 238 Whooping Cough 419 Malaria 1 Diphtheria. The amount of anti-toxin supplied to medical practitioners during the year was 8,000 units. The number of children immunised under the Council's scheme was 1,441. In addition, 1,278 school children were immunised by medical officers of the London County Council. Ophthalmia Neonatorum. Eighteen cases were notified, 6 of whom were admitted to hospital. Nursing assistance was provided under the Council's scheme in 12 cases. Cerebrospinal Meningitis. Forty-three cases were notified compared with 32 in 1940 and 9 in 1939. Four of these were military. All the cases were removed to hospital, and in 11 cases the diagnosis was not confirmed. There were 5 deaths. Tuberculosis. The number of new cases examined was 889. Of these 166 were definitely tuberculous. 259 contacts were examined, of whom 18 were definitely tuberculous. Sessions were resumed at Maxey Road Dispensary in April, temporary accommodation being found there in premises previously used by the Tuberculosis Care Committee. The total number of attendances at the Woolwich and Eltham Dispensaries was 3,475. 3,167 visits were made by nurses to homes of patients, and 270 domiciliary visits were paid by the Tuberculosis Officer or an Assistant Medical Officer. 360 cases were referred to the Dispensaries by medical practitioners and 108 by medical boards. 1,449 specimens of sputum were examined, of which 204 were positive. The number of X-ray examinations made was 1,175. There were 763 cases on the tuberculosis register on the 31st December. 81 patients received artificial pneumothorax treatment. Additional nourishment was granted in 121 instances. Eight patients received dental treatment under the Council's scheme. 323 patients were admitted to hospitals, sanatoria, or training colonies:- The Tuberculosis Care Committee continued their meetings and rendered valuable assistance in various way to the needy tuberculous and their families. 16 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, 398 specimens were examined for diagnostic purposes in the case of diphtheria, 3 in the case of enteric fever, and 2 on account of other diseases. Disinfection and Disinfestation. The number of rooms disinfected after cases of infectious disease was 1,022. Fifty of these were rooms which had been occupied by tuberculous persons. On account of the presence of vermin, 753 rooms were disinfested. 40,315 articles were disinfected at the Disinfecting Station. In March the Cleansing Station at White Hart Marsh was obliterated by a bomb. At the same time considerable damage was done to the Disinfecting Station, but fortunately most of the plant escaped serious damage, and it was possible after a few weeks to have the Disinfecting Station working again. Nothing could be done to the Cleansing Station except re-building, and as a matter of policy it was decided not to re-build on this site. It had ceased to be used as a Cleansing Station from 1940, owing to earlier damage. In the circumstances the Cleansing Station set up at the Plumstead Turkish Baths is being continued for an indefinite period. This building has been used since the beginning of the War as a First Aid Post and could be used almost immediately for its new purpose. The number of school children treated at the Cleansing Station in accordance with the terms of the agreement with the London County Council, was 1,772; many (454) of these children were suffering from scabies. The number of adults cleansed was 389, and of these 271 were scabietic. The number of cases of scabies treated at the Cleansing Station in recent years has greatly increased. Each year, from 1941 backwards, the number of cases treated has been as follows : 725, 99, 111, 199, 144, 100, 64. The Council had pressed for the completion of the Eltham Hill Cleansing Station and the necessary sanctions were received during the summer. Towards the end of the year, proposals for extended facilities for the treatment and control of scabies were being considered.