AC 4372 WOO 73 METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1943 BY T. STANDRING, M.D., B.S.. D.P.H., M.R.C.S., L.R.C.P.. Deputy Medical Officer of Health WOOLWICH: The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 HEALTH COMMITTEE. At 31st December, 1943. The Worshipful the Mayor (Councillor Mrs. E. L. Reeves, J.P.) Councillor C. H. Darby (Chairman) Councillor Miss G. E. Walters, J.P. (Vice-Chairman). Alderman- Mrs. K. Howlett Councillors- J. W. Andrews S. L. Collins T. W. Croft Miss M. Crout, j.p. Mrs. A. Day Mrs. L. E. Driver A. H. Gilder, j.p. D. B. Lister Mrs. K. M. Rance Rev. H. Stebbings W. T. Walden D. P. Walsh MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor C. H. Darby (Chairman) Councillor Miss G, E. Walters, j.p. (Vice-Chairman) 3 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Madam, Ladies and Gentlemen, I have the honour to submit the Forty-third Annual Report on the health of the Metropolitan Borough of Woolwich, and in doing so, I desire to record my deep regret at the death of Dr. Macmillan on the 21st November, 1043, and to acknowledge my personal indebtedness to him for the help and wise counsel he gave to me since my appointment as Deputy Medical Officer of Health. In accordance with the instructions of the Ministry of Health, the report is again an abridged one, and certain figures normally incorporated are omitted for security reasons. The Registrar General estimates that there was a slight increase in the population during 1943. There was again an increase in the number of live births allocated to Woolwich, the birth rate being the highest since 1924. The death rate was slightly higher than in 1942, as also was the infant mortality rate (35—34 in 1942) due in the main to an increase in the number of deaths from congenital conditions. The number of births was 2,174, the number of deaths under one year was 77, and the total number of deaths was 1,558. Details of caupes of death will be found in Table No. 1. Maternal deaths numbered 4 (1.79 per 1,0()0 total births), The scarcity of labour and materials continued to be a problem in the work of the sanitary section of the Department, but nevertheless satisfactory results were obtained by the sanitary inspectors. The extermination of rats claimed a considerable portion of the sanitary inspectors' time, particularly in the latter half of the year, following the specific directions of the Ministry of Food. The number of cases of scarlet fever was nearly double that of 1942. Fortunately the disease continues to be mild in character and not one death occurred. During the past five years only two deaths in Woolwich have been attributed to scarlet fever, one in 1939 and one in 1941. The incidence of measles is interesting. Prior to the War, epidemics occurred regularly every two years, but in 1940, which should have seen the start of an epidemic, the number of cases in the Borough was only 83, and in 1941 the number was 538. The winter of 1942 saw the commencement of an epidemic (723 eases being notified in that year), which continued all through 1943 (1,227 cases) with a slight decrease in the last two months, but increasing again in the early months of 1944. No wholly satisfactory explanation can be given, although the war generally, and evacuation in particular, in upsetting the habits of the people and the ratio of susceptibles to immunes, must have some bearing on the experience. 4 The increase in the incidence of tuberculosis throughout the country generally had not been felt appreciably in Woolwich prior to 1943, but in that year 292 new cases were notified, an increase over 1942 of 43 cases. The number of deaths increased also from 102 in 1942 to 112 in 1943. The death rate, however, increased by only .05. The outstanding features of the Tuberculosis Service were the institution of Maintenance Grants and the provision of Miniature Mass Radiography Units for the detection in its early stages of pulmonary tuberculosis, and of certain other conditions. The maternity and child welfare clinics operated throughout the year on a peace-time basis and were well attended. Other branches of this service, with one or two exceptions, were working on almost a pre-war level. The administration of the added war-time service, that of day nurseries, whilst considerably increasing the work of the Department, was carried on effectively. I feel that this report would be grossly incomplete without a special reference to the work of Dr. Macmillan, and the progress of the Health Services during his service with the Council. Dr. Macmillan was appointed in August, 1919, and from my own knowledge of him, over a period which was all too short, I can endorse the many stories I have heard of his energy and drive, and of the sincerity with which he devoted himself to the service of the Council, and thereby to the people of Woolwich. On his appointment, maternity and child welfare was in its infancy, but from then on the Council, with the advice of Dr. Macmillan, and through schemes prepared by him, built up the extensive service which is known in Woolwich to-day, covering every phase of the care of the mother and the child up to school age. Infant welfare clinics, ante-natal clinics, toddlers' clinics, ear, nose and throat clinics, artificial sunlight treatment, dental treatment, provision of maternity beds, and the many other branches of this service grew up during Dr. Macmillan's term of office. Woolwich was one of the first Councils in the country to initiate toddlers' clinics, and the first Metropolitan Borough Council to provide municipal centres with accommodation on the same premises for both school and maternity and child welfare services. With the sanitary condition of the Borough and the housing position generally, Dr. Macmillan quickly made himself familiar. In connection with slum clearance he represented as unfit for human habitation 672 houses, and every one of these he personally inspected for the preparation of evidence, many on more than one occasion. The care with which he undertook this work is evidenced by the fact that after inquiry by a Ministry of Health Inspector, in only 10 instances were houses excluded from the Clearance Orders made by the Council, and these only on undertakings by the owners to re-condition the houses. A man of wide views, he early set out to educate the people of Woolwich in all matters relating to health, keeping always to the forefront the principle that 5 prevention is better than cure. Health Weeks were organised; lectures, film displays and health plays in large halls, and informal talks and film displays at the meeting places of various organisations in the Borough, were arranged. All these efforts met with instant response, the first Health Week exhibition in 1925 being attended by over 25,000 persons. Although every aspect of public health received his undivided attention when required, Dr. Macmillan had especial interest in some subjects, one of which was the eradication of bed bugs. With the building of the Council's estates, this problem became more urgent, in order to prevent the infestation of the new homes of families from the old and unfit houses. With the fervour of a pioneer, Dr. Macmillan studied every detail of the life history of the bed bug, from the hatching of the larva through all stages of development, using bugs bred and fed by himself. He carried out many practical experiments dealing with different aspects of infestation, until the methods now used in Woolwich, and proved the most effective, were evolved. The kindly sympathy shown by Dr. Macmillan towards all classes of the community was never more in evidence than in his endeavours to remove from the minds of occupiers of infested buildings the fixed idea that the presence of the bed bug was a social stigma. His expert practical knowledge was recognised nationally by his appointment to the Special Committee of the Medical Research Council for research into bug infestation. In the passing of Dr. Macmillan the people of Woolwich have lost a kindly friend and a faithful servant, but the records of his long endeavours on their behalf are set down in the Annual Reports which it was his duty and pleasure to present to the Council. In conclusion, I desire to express my sincere thanks to the Chairman and members of the Health Committee, and to members of the Council generally, for the confidence reposed in me, and for their support and consideration, and I take this opportunity of expressing my appreciation of the work of the staff of the Department, and of the help I have received from them. I am, Madam, Ladies and Gentlemen, Your obedient Servant, T. STANDR1NG, Deputy Medical Officer of Health. 6 TABLE No. 1. Nett Deaths during the calendar year 1943. 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 1,558 77 13 14 173 412 869 Typhoid and paratyphoid fevers 2 .. .. .. 1 1 .. Cerebrospinal fever 1 .. 1 .. .. .. .. Scarlet fever .. .. .. .. .. .. .. Whooping cough 1 .. 1 .. .. .. .. Diphtheria 1 .. .. 1 .. .. .. Tuberculosis of the respiratory system 97 .. .. .. 57 34 6 Other forms of tuberculosis 15 .. 2 4 5 2 2 Syphilitic diseases 21 .. .. .. .. 7 14 Influenza 28 1 .. .. 4 8 15 Measles .. .. .. .. .. .. .. Acute polio-myelitis and polio-encephalitis .. .. .. .. .. .. .. Acute infective encephalitis 3 .. .. .. 1 1 1 Cancer of buccal cavity and oesophagus (M); uterus (F) 27 .. .. .. 1 12 14 Cancer of stomach and duodenum 32 .. .. .. 1 14 17 Cancer of breast 27 .. .. .. 2 12 13 Cancer of all other sites 161 .. 1 .. 12 56 92 Diabetes 15 .. .. .. .. 6 9 Intracranial vascular lesions 132 .. .. .. 4 39 89 Heart disease 413 .. 1 .. 19 85 308 Other diseases of the circulatory system 35 .. .. .. 2 7 26 Bronchitis 94 3 1 .. 1 28 61 Pneumonia 67 9 3 .. 5 12 38 Other respiratory diseases 21 1 .. 1 3 8 8 Ulcer of stomach or duodenum 20 .. .. .. 6 8 6 Diarrhoea under 2 years 9 9 .. .. .. .. .. Appendicitis 10 .. .. .. 2 2 6 Other digestive diseases 36 1 .. .. 4 14 17 Nephritis 48 .. .. .. 9 10 29 Puerperal and post-abortive sepsis 1 .. .. .. 1 .. .. Other maternal causes 3 .. .. .. 3 .. .. Premature birth 23 23 .. .. .. .. .. Congenital malformation, birth injury, infantile diseases 27 26 .. .. .. 1 .. Suicide 12 .. .. .. 4 5 3 Road traffic accidents 7 .. .. 2 .. 2 3 Other violent causes 49 3 1 4 15 8 18 All other causes 120 1 2 2 11 30 74 7 GENERAL PROVISIONS OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 1,214. The number of births registered in Woolwich was 1,202. After correction for inward and outward transfers the net number of Woolwich live births was 2,170. 955 births are known to have taken place in institutions. Maternity and Child Welfare Clinics and Treatment Centres. The arrangements in being during the year at each of the Council's maternity and child welfare clinics and treatment centres remained unchanged from those set out in the 1942 report, except for the addition of further sessions as required. The attendances at the Maternity and Child Welfare Centres during the year were: Expectant Mothers, 0,442; Nursing Mothers, 1,910; Children, 50,810. The number of inspections carried out at Toddlers' Clinics was 1,982. Toddlers' Clinics. One of the assistant Medical Officers engaged on the examination of toddlers has furnished the following note:— "The special sessions for toddlers only were re-started in 1942, and quickly became re-established. The objects of the regular examination of these children between the ages of two and five years are, firstly to detect in the child any deviation from the healthy state, and to take the appropriate measures for correction; and secondly, to assist the mother to bring up her children in good health, avoiding the formation of bad habits, which are often the precursors of childish disorders.. On the whole, the health of the children is good. The figures compare favourably with those of pre-war years. There is a noteworthy decrease in the incidence of dental caries, which in 1943 was 19.9 per cent., compared with 24.0 per cent. in 1938 and 23.9 per cent. in 1934. There was, however, some increase in clinically assessed anaemia, and in the number of children showing a weakened muscular tone. There was no case of advanced rickets. Undoubtedly the Government scheme for supplying milk and vitamins has been beneficial. Satisfactory nutrition, however, depends on many factors besides an adequate diet, such as a sufficiency of fresh air, suitable clothing and good housing conditions." Health Visiting. The number of visits paid by Health Visitors to children under five years of age was 22,091; the total number of visits paid by Health Visitors was 30,100. Infant Life Protection. There were 20 foster mothers on the register at the end of 1943, compared with 36 in 1942. The number of children was 26. The number of visits paid by infant life protection visitors was 358. 8 Artificial Sunlight Clinic. Artificial sunlight treatment was continued in the Town Hall shelter, but at the end of the year arrangements were being made for the transfer of the clinic to more suitable accommodation at the Old Town Hall. The number of treatments given was 13,655. Dental Treatment. The number of mothers and children attending the dental clinics was 412, and the number of tuberculous persons attending was 12. The total number of attendances was 1,270. Minor Ailments. The number of children under five years of age referred to school clinics for treatment of minor ailments during the year was 119. Meals for Children under Five Years of Age. To assist mothers experiencing difficulty in providing suitable meals for the under-fives, arrangements were made for demonstrations of war-time meals suitable for young children to be given at Woolwich and at Eltham. Issue of Fruit Juices, etc. When the Government scheme for the issue of fruit juices and cod liver oil for children was initiated, issues were made at the maternity and child welfare centres. This resulted in considerable congestion at some of the centres, and additional means of distribution became necessary. Arrangements were therefore made for issue at the food offices and at all first aid posts. Issue of Clothing Coupons to Expectant Mothers. In July, the responsibility for the issue of clothing coupons to expectant mothers was transferred to the Food Office. Prior to the transfer, 1,224 applications were granted, and 73,440 coupons were issued. Midwifery Services. The Domiciliary Midwifery Service in London is administered by the London County Council. Institutional midwifery in Woolwich was available only at the British Hospital for Mothers and Babies and at the Eltham Cottage Hospital, but beds were also available at other hospitals, notably, St. Alfege's Hospital and Lewisham Hospital, and through the evacuation scheme. During 1943, 1,288 mothers were admitted to the British Hospital for Mothers and Babies, 206 under the Council's scheme. No cases were admitted under the Council's scheme for ante-natal or emergency treatment. 69 mothers were admitted to the Eltham Cottage Hospital. Institutional maternity accommodation has never quite met the demand, and during the war years the demand has increased whilst the number of beds available locally has decreased, owing to the closure of the maternity wards of the War Memorial Hospital, St. Nicholas' Hospital and the Military Families' Hospital. The Council, therefore, readily accepted the invitation of the British Hospital for Mothers and Babies to support an application to the Ministry of Health for sanction to the building of a new block. Unfortunately, the Minister could not approve the proposal, but permission was subsequently obtained to rebuild a damaged block. 9 Towards the end of the year a scheme was formulated whereby the London County Council would, in certain circumstances, become financially responsible for extra beds in voluntary hospitals, and the whole question became a matter of negotiation between the Council, the London County Council and the British Hospital for Mothers and Babies. Negotiations were still in progress when the year closed and a proposal to re-open the maternity ward of the War Memorial Hospital was being examined. Home Helps. Home helps were supplied in 90 cases. The number of home helps on the panel has diminished considerably but suitable arrangements were made to supply help in every case where required. The home help scheme was under review at the end of the year with a view to attracting more women to this employment by improving the status of the home help. A recommendation that home helps should be re-graded was submitted to the Local Authorities Joint Industrial Council for Non-Trading (Manual) Workers, and early in 194-1 home helps were placed in Grade "B" of the Joint Industrial Council scheme. Supply of Milk, etc., to Necessitous Mothers and Children. The approximate cost of this service during the year was: Dried milk, £115; fresh milk, nil ; dinners, nil. Clinic for Physical Medicine. The work of this clinic was continued in an attenuated form throughout the year. The number of attendances was 5,771. War-time Nurseries. Up to the end of 1942, as set out in the report of that year, the Council had established three day nurseries, and in addition the London County Council had staffed and equipped two nurseries at rest centres. In 1943 the erection of two further day nurseries was commenced, one at Woolwich Common and one at Abbey Wood. They are pre-fabricated buildings supplied by the Government, each providing accommodation for 60 children. Construction of the Woolwich Common Nursery was almost complete at the end of the year. All the Council's nurseries are training schools for probationers, and are affiliated to the National Society of Children's Nurseries. Admissions to all nurseries are made through the Health Department and medical supervision is carried out by the Council. At the end of 1943 arrangements were in being for the erection of two more nurseries—one at Garland Road, Plumstead, and one at Mineral Street, Plumstead. One of the Assistant Medical Officers who has been engaged on the medical supervision of day nurseries has furnished the following note:— "The general condition of the children on admission is on the w hole very good. They settle quickly into their new surroundings and even the 'nervous' type of child is soon playing happily and deriving much benefit from the companionship of others. Those of the children whose general condition is not satisfactory improve noticeably due to the regular routine and the good and suitable meals provided at the nursery. Catarrh and colds are troublesome in the winter but disappear with the better weather when the children are able to remain outside most of the day. 11 The nurseries have their quota of infectious diseases, and every precaution is taken to prevent their spread. No serious epidemics occurred. The advice that can be given by a matron to the mother is most useful, and it is interesting to note that in the few cases where a child has initially been brought to a nursery dirty in person and clothing, the example of the other mothers and a tactful word from the matron has soon achieved the desired improvement. Immunisation against diphtheria is not a condition of admission to a nursery, but no difficulty has been experienced in obtaining the consent of parents." 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. The total number of visits paid by the nurses on behalf of the Council was 1,244. Foot Clinics. The work of the foot clinics continued during the year at the Central Health Centre and at Eltham Baths. The number of attendances at Woolwich was 10,285, compared with 12,024 in 1942. At Eltham, the number of attendances was 4,348. As the Eltham Clinic was first opened in December, 1942, no comparable figures can be given. Supply of Insulin to Persons Suffering from Diabetes. The number of patients under the Council's scheme who received Insulin during the year was 22. Tuberculosis Dispensaries. The premises at Maxey Road, Plumstead, and 11, Carnecke Gardens, Eltham, continued in use throughout the year. The work of the dispensaries is referred to in the section dealing with infectious diseases. Vaccination. There were 1,090 entries in the birth lists for 1942. Of these, 571 were successfully vaccinated. The total number of successful primary vaccinations during 1943 was 1,217, and 12 successful re-vaccinations were carried out. SANITARY ADMINISTRATION. Complaints. 2,808 complaints of nuisance were received and the necessary action was taken where defects or nuisances were discovered. Sanitary Inspection of the Area. During the year 26,813 inspections, including re-inspections, were carried out by the sanitary inspectors. Included in this number are 2,808 primary inspections on complaint of nuisances, and 2,588 on account of infectious disease. The number of inspections of factories was GOO. Defects were found and remedied in 46 instances. 11 The number of intimation notices served was 1,504, and the number of statutory notices, 423. In 09 instances, where the owners did not comply with the statutory notices, the Town Clerk was asked to institute proceedings, but it was necessary to issue only eight summonses as in all other cases the necessary steps were taken on receipt of a letter from the Town Clerk. Eradication of Bed Bugs. 1,592 inspections of verminous premises were carried out and appropriate action was taken in accordance with the methods adopted in Woolwich, which have been reported on very fully in previous reports. Hydrogen Cyanide was used in the disinfestation of 4 buildings, and 14 loads of furniture. Rodent Control. In the course of routine and special inspections the Sanitary Inspectors discovered 388 rat infestations, 04 of which were in food premises. The number of inspections totalled 12,004, 890 being of food premises. In 130 instances it was necessary to secure the repair of drains. 114 premises were rat-proofed and other effective measures taken in the remainder. Following a Direction issued by the Minister of Food under the Infestation Order, 1943, a survey of the Borough was carried out and a report submitted to the Ministry on the extent of infestation in the area. A further Direction issued in October required the Council to take all necessary steps to remedy all infestation of rats and mice in any sewer, drain or culvert in or under any land in the Borough. Arrangements were made with the Borough Engineer for the carrying out of this work under the supervision of the Sanitary Inspectors, and treatment of the sewers commenced on the 6th December. As was expected, the more recently constructed Sewers, such as those on the Council's housing estates, were found in general to be free from infestation. A third Direction required the Council to proceed with all necessary action to remedy all infestation by rats and mice on land within the Borough. The necessary arrangements were being made at the end of the year. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 4,478, and the number found not to be in all respects reasonably fit for human habitation was 1,755. The number rendered fit in consequence of informal action by the sanitary inspectors (including the service of intimation notices) was 1,399. Statutory notices were served in respect of 350 houses. INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 60, and 261 visits were made. The milk supply in Woolwich is in the main in the hands of three large distributors and, having regard to war-time difficulties, the standard was satisfactory. 12 Two pasteurisers' licences, 7 dealers" licences and 4 supplementary licences were issued under the provisions of the Milk (Special Designations) Regulations, for the sale of pasteurised milk, and 14 dealers' and 3 supplementary licences were issued for the sale of tuberculin tested milk. Meat Supplies. With the exception of one used occasionally under licence from the Ministry of Food, all slaughterhouses in the Borough remained closed. The number of animals slaughtered and inspected at this one slaughterhouse during the year was 100. Basement Bakehouses. In 1938, certificates of suitability were issued as required by the Factories Act, 1937, in respect of seven basement bakehouses. In 1943 the quinquennial examination was carried out and the certificates of suitability were renewed in six instances. In the remaining case the bakehouse had not been used for a period exceeding twelve months. 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 1,421. The total weight of food certified as unfit for human consumption was 11 tons 2 cwts. Very little of this food was destroyed, most of it being used for animal feeding. Analysis of Food and Drugs. During the year, 810 samples were submitted to the Public Analyst for analysis. Of these, 655 were informal and 155 formal. Thirty-one samples were reported as adulterated (five of which were formal), giving a percentage adulteration of 3.8 compared with 3.5 in 1942. Suitable action was taken in each case of adulteration. English Grown Almonds. Owing to the many enquiries he had, received as to the edibility of locally grown almonds, the Public Analyst carried out an investigation and submitted a report on samples obtained. His conclusions were as follows:— (1) English-grown almonds are almost entirely confined to the Common Almond, P. Amygdalus (Communis) or its closely related forms, at least in the neighbourhood of London. Poisonous varieties, if they occur, may be detected at once by their bitter taste. (2) The percentage of Hydrogen Cyanide yielded by the Common Almond is about one-twentieth of that yielded by the bitter almond. (3) This proportion would not appear to be dangerous if the nuts were used in moderate quantities for normal dessert and cooking purposes. Food Poisoning. Thirteen cases of food poisoning were notified. In each case the illness was of a mild character and confined to individual private households. 13 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 3,042. They relate to the following diseases:— Table No. II. Diphtheria 86 Ophthalmia Neonatorum 11 Scarlet Fever 533 Dysentery 70 Enteric Fever (including Paratyphoid) 2 Cerebrospinal Meningitis 19 Poliomyelitis 2 Puerperal Fever 2 Zymotic Enteritis 40 Puerperal Pyrexia 25 Measles 1,227 Erysipelas 45 Whooping Cough 482 Pneumonia 250 Scabies 245 Malaria 3 Diphtheria. There was a slight increase in the number of notifications received, but nevertheless, generally the incidence of diphtheria has declined, as shown by the fact that during the quinquennium 1939-43 the average number of cases notified per annum was 83 compared with an average of 375 cases per annum for the quinquennium 1929-33. In connection with the campaign to secure the immunisation of as many children between the ages of one and five as possible, special visits to these homes were made by the health visitors at the end of 1942 and at the beginning of 1943. In consequence, it was found necessary to extend the Council's scheme—a family doctor scheme. Special immunisation clinics at welfare centres, and at some first aid posts were therefore arranged, and these continued all through 1943. The number of children immunised under the Council's schemes was 2,116. In addition, 1,093 school children were immunised by medical officers of the London County Council. The percentages of the child population immunised for the two age groups 0-5 and 5-15, based on estimated population, were 62 and 76 respectively. Refusals for various reasons and failure to keep appointments are still encountered. This is in contrast to the experience of the day nurseries, briefly referred to elsewhere, where all that is required of the parent is the necessary signature agreeing to immunisation, and refusals are virtually unknown. Whooping Cough. Whooping cough is a dangerous and distressing disease of childhood. In January, the Council formulated a scheme on the same lines as the diphtheria immunisation scheme for preventive inoculation against this disease. The scheme was brought to the notice of the medical practitioners in the Borough, and in all 119 children were given the inoculations. Influenza. The epidemic which occurred in the latter part of the year and in the early months of 1944 was not very severe in Woolwich. Arrangements were made, however, through the Women's Voluntary Services, the Woolwich Council 14 of Social Service, the British Red Cross Society and the St. John Ambulance Association for help in the home and with shopping, etc., and for assistance in nursing cases confined to bed. Arrangements were made also for the supply of meals from rest centres where necessary. Tuberculosis. The number of persons examined for the first time at the Dispensaries was 1,153. Of these, 197 were tuberculous. 267 contacts were examined, of whom 10 were tuberculous. The total number of attendances at the Woolwich and Eltharn Dispensaries was 5,438. There were 818 cases on the tuberculosis register on the 31st December. 4,097 visits were made by nurses to homes of patients and 54 by the Tuberculosis Officer or by an Assistant Medical Officer. 739 cases were referred to the Dispensaries by medical practitioners and 165 by medical boards. 627 specimens of sputum were examined, of which'77 were positive. The number of X-ray examinations made was 1,769. Additional nourishment was granted in 220 instances. Twelve patients received dental treatment under the Council's scheme. 488 patients were admitted to hospitals, sanatoria, or training colonies. The artificial pneumothorax clinic at St. Nicholas' Hospital, which commenced in June, 1942, under the charge of Dr. A. Wingfield, continued throughout the year and was highly successful from all points of view. The number of patients who received treatment there was 56, and the number of refills given was 792. In addition, 36 patients attended London Hospitals and 447 refills were given. The Tuberculosis Care Committee continued their meetings and rendered valuable assistance in various ways to the needy tuberculous and their families. The payment of maintenance allowances under the Government scheme to encourage institutional treatment of early cases of tuberculosis commenced on the 30th June. Application forms are issued at the dispensaries and the staff give any necessary assistance in their completion. An Assessment Officer of the London County Council attends at the dispensary every week and fixes allowances. Details of the allowances payable are then forwarded to the Borough Treasurer, who arranges for the payments to be made at one of four cash offices, or by post where applicable. 110 patients were in receipt of an allowance at the end of the year, and the scheme was working smoothly. The Government, as part of the plan for extension of the tuberculosis service, made arrangements for the provision of miniature mass radiography units for the detection of symptomless pulmonary tuberculosis, and one such unit was allocated to the London County Council. Representations were made to the London County Council with a view to this unit being brought to Woolwich, but a visit had not been possible by the end of the year. Another unit was, however, set up in the Royal Arsenal. Laboratory Facilities. The bacteriological work of the Council is carried out at the War Memorial Hospital. Tn addition to the number of examinations 15 made for the tuberculosis service, 618 specimens were examined for diagnostic purposes in the case of diphtheria, 1 in the case of enteric fever, 10 in the case of dysentery and 4 on account of food poisoning. Disinfection and Disinfestation. The number of rooms disinfected after cases of infectious disease was 646, of which 81 had been occupied by tuberculous persons. On account of the presence of vermin, 803 rooms were disinfested. 78,455 articles were treated at the disinfecting station. Personal cleansing was continued at the temporary cleansing station at the Plumstead Turkish Baths and at the cleansing section of the Eltham Hill Health Centre. In July the Ministry of Health issued a circular on head infestation by lice It was suggested that the health visitors should include the examination of children's heads as part of their work. In Woolwich, it has always been the practice for the health visitors to carry out such examinations where necessary, to give advice to. the mother, and to arrange for any necessary treatment at the cleansing stations. There was a further increase in scabies, but the increase was small compared with that in 1942. The scheme for diagnosis and treatment, which commenced in May, 1942 (reported in the Annual Report for that year) continued in being. On the whole, treatment for scabies is now readily accepted by a large proportion of the contacts as well as the clinically infected cases. In May, the disinfestation of bedding for scabies was discontinued, except for special cases, and ironing or washing at home substituted. The objections of some of the families to treatment were removed, when it was known that "the van" would not be calling at the house. The relapse rate remained practically unaffected. The County of London (Scabies) Regulations, 1943, which came into operation on the 1st August, 1943, require the notification of cases of scabies by medical practitioners, subject to certain exceptions. 245 cases were notified. The number of persons treated (including scabies contacts), and the number of treatments given at the cleansing stations, were as follows:— TABLE No. III. Persons. Treatments. Pre-school children- Vermin 42 42 Scabies 640 1,283 School children— Vermin 1,970 1,975 Scabies 1,195 2,869 Adults— Vermin 80 80 Scabies 1,924 3,804 Totals 5,851 10,053