METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1944 BY E. VIRGINIA SAUNDERS-JACOBS, M.A. (Cantab), M.D., B.S., B.Sc., M.R.C.S., L.R.C.P., D.P.H. Acting Medical Officer of Health WOOLWICH : The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 HEALTH COMMITTEE. At 31st December, 1944. The Worshipful the Mayor (Councillor E. T. Lamerton, j.p.) Councillor Mrs. E. L. Reeves (Chairman). Councillor Mrs. A. Day ( Vice-Chairman). Alderman- Mrs. K. Howlett Councillors- Mrs. N. Cooper T. W. Croft Miss M. Crout, j.p. C. H. Darby Mrs. L. E. Driver G. E. Edwards A. H. Gilder, m.b.e., j.p. D. B. Lister Mrs. K. M. Rance W. T. Walden D. P. Walsh 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 Mrs. A, Day (Vice-Chairman) 3 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 44th Annual Report on the health of the Metropolitan Borough of Woolwich. It is again in an abridged form, in accordance with the instructions of the Ministry of Health and in common with those published during the war. It has, however, been possible to include certain figures for 1944 which were omitted for recent years, as restrictions previously imposed for security reasons have now been lifted. A summary of vital statistics will be found in table No. 1. The Registrar General's estimate shows a slight reduction in the population. The birth rate was a little lower, and the death rate a little higher, than in 1943. The infant mortality rate rose from 35 in 1943 to 40 in 1944, but this increase is mainly attributable to deaths from enemy action. The maternal death rate fell from 1.79 in 1943 to 1.43 in 1944. The health of the Borough remained good. There was a reduction in the number of notifications of infectious diseases and, as is shown in table No. 2, there was only one death from Diphtheria and one from Whooping Cough, and there were no deaths from Typhoid Fever, Scarlet Fever or Measles. There were also fewer notifications of, and deaths from, Tuberculosis. There was a satisfactory reduction in the incidence of Scabies. No noteworthy outbreaks of illness occurred and the number of deaths, apart from those due to enemy action, was no more than the average for the Borough. Although many members of the staff of the Department were serving in H.M. Forces, or seconded to other duties, and a proportion of the time of those remaining continued to be devoted to Civil Defence, the Council's Health services were effectively maintained under the supervision of the Deputy Medical Officer of Health, Dr. T. Standring. The work of the Sanitary Section of the Department was complicated by the enemy " flying-bomb" and " ocket" air attacks occurring during the second half of the year : all food in damaged shops was examined by the Food Inspectors ; and the difficulties of the District Inspectors were increased by the necessary concentration of building labour on repairs to war-damaged property. A drive for the extermination of rats was again undertaken with vigour, and achieved satisfactory results 4 The Maternity and Child Welfare services continued to operate on a comprehensive basis under the difficult conditions created by the fresh evacuations and population movements which followed bomb-damage. It will be observed that the attendances at the Ante-Natal Clinics increased, and that seven day-nurseries were in operation. In presenting this Report, I wish to pay tribute to the evidence it contains of the encouragement and support given to the staff by the Chairman and members of the Health and Maternity and Child Welfare Committees, and of the co-operation and devotion to duty shown both by the permanent and the temporary members of the staff. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, E. VIRGINIA SAUNDERS-JACOBS, Acting Medical Officer of Health. 5 VITAL STATISTICS. Table No. 1 contains extracts from the vital statistics for the year. Table No. 2 shows details of causes of death. Table No. 1. Population 110,970 Live Births—Legitmate 1,917 Live Births—Illegitimate 120 2,037 Birth Rate 18.3 Still-births 48 Still-births—Rate per 1,000 total births 23 Deaths 1,611 Death Rate 14.5 Deaths from puerperal causes :— (a) From Sepsis 1 (b) From other causes 2 Death rate from puerperal causes per 1,000 total births 1.43 Death Rate of Infants one year of age :— (a) All infants 40 (b) Legitimate infants 37 (c) Illegitimate infants 91 Deaths from Cancer (all ages) 223 Deaths from Whooping Cough 1 Deaths from Diarrhoea (under two years of age) 17 TABLE No. 2. Nett Deaths during the calendar year 1944. 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 1,611 83 13 25 197 458 835 Typhoid and paratyphoid fevers .. .. .. .. .. .. .. Cerebrospinal fever 2 .. .. .. 1 1 .. Scarlet fever .. .. .. .. .. .. .. Whooping cough 1 .. .. .. .. .. .. Diphtheria 1 .. .. .. .. .. .. Tuberculosis of the respiratory system 91 .. .. .. 50 34 6 Other forms of tuberculosis 9 l 3 1 1 Syphilitic diseases 20 1 .. .. 1 8 10 Influenza 4 .. .. .. .. 1 3 Measles Acute polio-myelitis and polio-encephalitis .. .. .. .. .. .. .. Acute infective encephalitis 1 .. .. .. 1 Cancer of buccal cavity and oesophagus (M); uterus (F) 30 .. .. .. l 11 is Cancer of stomach and dudenum 38 .. .. .. 3 19 16 Cancer of breast 19 .. .. .. .. 12 7 Cancer of all other sites 136 .. .. .. 10 58 68 Diabetes 12 .. .. .. .. 2 10 Intracranial vascular lesions 118 .. .. .. 3 32 83 Heart disease 425 .. .. .. 15 74 336 Other diseases of the circulatory system 43 .. .. .. 2 10 31 Bronchitis 67 1 .. .. 3 20 43 Pneumonia 64 8 3 1 1 16 35 Other respiratory diseases 15 .. 1 .. 4 8 2 Ulcer of stomach or duodenum 25 .. .. .. 2 14 9 Diarrhoea under 2 years 17 17 .. .. .. .. .. Appendicitis 3 .. .. .. 1 .. 1 Other digestive diseases 35 .. .. .. 4 13 18 Nephritis 26 .. .. .. 3 8 15 Puerperal and post-abortive sepsis 1 .. .. .. 1 .. .. Other maternal causes 2 .. .. .. 2 .. .. Premature birth 22 22 .. .. .. .. Congenital malformation, birth injury, infantile diseases 22 20 .. 1 .. .. 1 Suicide 9 .. .. .. 4 3 2 Road traffic accidents 5 .. .. 1 1 1 2 Other violent causes 234 io 5 12 72 82 53 All other causes 114 3 .. 7 9 30 65 6 7 GENERAL PROVISIONS OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 1,244, and the number of births registered 1,236. After correction for inward and outward transfers the net number of Woolwich live births was 2,037 ; of these, 1,282 are known to have taken place in Institutions. Maternity and Child Welfare Clinics and Treatment Centres. The general arrangements during the year at each of the Council's maternity and child welfare clinics and treatment centres were as set out in the 1942 report. The attendances at the Maternity and Child Welfare Centres were :—Expectant Mothers, 7,646 ; Nursing Mothers, 2,214 ; Children, 36,534. Toddlers' Clinics. The number of inspections carried out at Toddlers' Clinics was 1,957. One of the Council's Assistant Medical Officers reports that the clinics were well attended and the mothers co-operative in carrying out the advice given; that the health of the children was, on the whole, satisfactory, and that there were extremely few cases showing a marked degree of ill-health, although minor ailments were found and there was evidence of a certain lack of good health in a high proportion of the children, particidarly among those who stayed in London during the whole of the " flying bomb " and " rocket " periods. The conditions most commonly occurring were dental caries, chronic infections of the upper respiratory tract, a mild degree of anaemia, and minor orthopaedic defects. Health Visiting. The number of visits paid by Health Visitors to children under five years of age was 18,386 ; the total number of visits paid by Health Visitors was 25,420. Child Life Protection. There were 19 foster-mothers on the register at the end of 1944, compared with 26 in 1943, and there were 20 foster-children. The number of visits paid by child life protection visitors was 198. Artificial Sunlight Clinic. Artificial sunlight treatment was again given in the Town Hall shelter during the early part of the year, but the clinic was transferred to newly adapted rooms at the Old Town Hall on 24th April. The number of treatments was 10,784. Dental Treatment. The number of mothers and of children under five attending the dental clinics was 323 ; the number of tuberculous persons, 6 ; and the total number of attendances, 1,062. Minor Ailments. The number of children under five years of age referred to school clinics for treatment of minor ailments was 98. 8 Issue of Fruit Juices and other Supplements. The distribution of the Government fruit juices and cod-liver-oil was continued, throughout the year, at the food offices and all first-aid posts. Midwifery Services. The domiciliary midwifery service in London is administered by the County Council, the mid wives working in collaboration with the Borough ante-natal clinics. Institutional midwifery was available in Woolwich only at the British Hospital for Mothers and Babies and at the Eltham Cottage Hospital, the maternity wards of the Memorial Hospital and of St. Nicholas' Hospital being closed. Woolwich mothers were, however, also admitted to London County Council hospitals outside the Woolwich area, notably to St. Alfege's, and Lewisham Hospitals ; also, through the Evacuation Scheme, to the Ministry of Health Evacuation Maternity Homes and Hostels outside London. Under the Council's agreement with the British Hospital for Mothers and Babies, accommodation is reserved at this Hospital for 144 of the Council's cases per annum. When the maternity wards of the Memorial Hospital closed, an arrangement was made for an extra 72 cases per annum to be admitted, but this terminated at the end of the year as the maternity unit at the Memorial Hospital was to re-open on the 1st January, 1945. In addition, by arrangement with the London County Council in February, 1944, accommodation was reserved for further 168 cases per annum, the London County Council accepting financial responsibility. During 1944, 1,364 mothers were admitted to the British Hospital for Mothers and Babies, 746 of these were Woolwich mothers, 260 of whom were admitted under the Council's Scheme. 63 mothers were admitted to the Eltham Cottage Hospital. Care of Premature Infants. The Ministry of Health issued a circular in March, containing recommendations for the provision of special facilities for the care of premature infants. Most of the suggested facilities were already available in Woolwich, but, in addition, the Council approved the appointment of a Consultant Paediatrician, Dr. Doyne Bell, and the purchase of draughtproof cots. Home Helps. During the year 101 applications were considered and 77 Home Helps were provided. Care of Illegitimate Infants. A scheme was adopted by the Council in 1944, which included guaranteed payments to foster-mothers undertaking the care of illegitimate infants, and a contribution to a fund to provide financial assistance to Moral Welfare Associations, such contribution to be based on rateable value and paid to the Metropolitan Boroughs' Standing Joint Committee, which administers the fund. Convalescence for Children Under Five. Under the Council's arrangement with the Invalid Children's Aid Association, 23 children were sent to convalescent homes. War-Time Day-Nurseries. By the end of 1943, five day-nurseries, providing accommodation for 207 children, were in operation in the Borough. Three were 9 established by the Borough Council and two were in London County Council rest centres. With the opening of a new day-nursery on Woolwich Common on the 15th January, and another at Abbey Wood on the 15th May, accommodation for-the daily care of children of war workers was increased to 327 places, 95 for children under two years of age and 232 for children between two and five years of age. The building of a further nursery was in progress, but the work was stopped during the fly-bomb attacks and was not re-commenced. Negotiations which were taking place for the acquisition of a site for the erection of yet another nursery, were discontinued. Clinic foe Physical Medicine. The work of this clinic was somewhat expanded, the number of attendances being 7,821, as compared with 5,771 in 1943. Professional Nuesing in the Home. Nursing assistance in the homes of the patients was provided by arrangement with the six nursing associations in the Borough, for cases of measles, ophthalmia neonatorum, zymotic enteritis, whooping cough, poliomyelitis, pneumonia, puerperal fever, puerperal pyrexia and tuberculosis. The total number of visits paid by the nurses on behalf of the Council was 890. Foot Clinics. Foot clinics continued to be held daily at the Central Health Centre and at the Eltham Baths. The number of attendances at Woolwich was 8,243 compared with 10,285 in 1943. At Eltham the number of attendances was 5,196 compared with 4,348. Supply of Insulin to Peesons Suffeeing feom Diabetes. The number of patients under the Council's Scheme who received Insulin during the year was 19. Tubeeculosis Dispensaeies. 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 1,216 entries in the birth lists for 1943. Of these 662 were successfully vaccinated. The total number of successful primary vaccinations during 1944 was 1,233. SANITARY ADMINISTRATION. Complaints. 2,148 complaints of nuisance were received and investigated. The necessary action was taken where defects or nuisances were discovered. Sanitaey Inspection of the Aeea. During the year, 22,628 inspections, including re-inspections, were carried out by the Sanitary Inspectors. The nature of these inspections is shown in Table No. 3, and details of nuisances abated in Table No. 4. The number of intimation notices served as a result was 1,062, and the number of statutory notices, 348. In only 5 cases were legal proceedings instituted. 10 TABLE No. 3. Inspections. Complaints Investigated 2,148 Tents and Vans 15 Outworkers' Premises 145 Factories.. 339 Houses Let in Lodgings 99 Shops Act, 1934 170 Houses re Infectious Diseases 1,430 Theatres and Cinemas 19 Houses re Smallpox Contacts 51 Rag and Bone Premises 14 Houses re Verminous Cases 1,845 Urinals Accessible to the Public 112 Houses re Scabies Cases 5,709 Women's Lavatories 150 Houses re other Diseases 141 Inspections re Rats 6,482 Common Lodging Houses 29 Pharmacy and Poisons Act 39 Drainage Inspections 1,544 Air Raid Shelters 369 Drains Tested by Smoke Test 258 Miscellaneous 1,514 Drains Tested by Water Test 6 TABLE No. 4. Nuisances Abated. Dirty Conditions 512 Defective Paving 95 Damp Conditions 819 Drainage Defects 908 Dilapidations 721 Water Closet Defects 527 Verminous Rooms Cleansed 811 Dust Bins Provided 127 Defective Lighting 180 Water Supply Defects 95 Defective Ventilation 155 Foul Accumulations removed 35 Water Supply. The Metropolitan Water Board is responsible for the water supply in the Borough ; it was satisfactory in quality and quantity. So far as can be ascertained, there were 15 wells in the Borough used chiefly for trade and kindred purposes, and all dwelling houses were supplied direct from public water mains. Eradication of Bed Bugs. Appropriate action was taken in all cases of infestation coming to the knowledge of the department ; 1,845 inspections were carried out in connection therewith. Hydrogen Cyanide was used in the disinfestation of one building, and of nine loads of furniture. Rat Destruction. There are no large areas of rat infestation in Woolwich, nevertheless, a considerable amount of time and effort was devoted to rat extermination. A thorough investigation was made as a result of every complaint received, and baiting and trapping under the direction of the Sanitary Inspectors was carried out, where necessary, by the Council's workmen. The number of inspections made on account of rats was 6,482. The baiting of the sewers in the Borough commenced in December, 1943, and was completed during January, 1944. Baits were laid in 2,427 manholes necessitating approximately 18,000 visits. The estimated number of rats killed, based on the method of calculation adopted by the Ministry of Food, was 9,946. At the end of the year arrangements were in progress for a maintenance treatment of the sewers to be undertaken in January, 1945. 11 Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 2,330, and the number found not to be in all respects reasonably fit for human habitation was 942. The number rendered fit in consequence of informal action by the sanitary inspectors, including the service of intimation notices, was 714. Statutory notices were served in respect of 228 houses. INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December, was 58, and the number of visits paid to them was 157. The standard of the milk supply in Woolwich was satisfactory in view of war-time difficulties. Two pasteurisers' licences, 7 dealers' licences and 9 supplementary licences were issued under the provisions of the Milk (Special Designations) Regulations for the sale of pasteurised milk, and 10 dealers' and 8 supplementary licences were issued for the sale of tuberculin tested milk. Meat Supplies. Owing to regional slaughtering, all slaughterhouses in the Borough remained closed, with the exception of one used occasionally under licence from the Ministry of Food. The number of animals slaughtered and inspected at this one slaughterhouse was 104. 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, were kept under frequent observation. The number of inspections carried out during the year was 1,575. The total weight of food certified as unfit for human consumption was 9 tons, 13 cwts. Very little of this food was destroyed, most of it being used for animal feeding. Analysis of Food and Drugs. During the year, 772 samples, including 695 informal and 77 formal ones, were submitted to the public analyst. 25 of them, three of which were formal, were reported to be adulterated, giving a percentage adulteration of 3.2, compared with 3.8 in 1943. Appropriate action was taken in each case of adulteration. War Damage to Food Premises. In the early months of 1944 only a small quantity of food was damaged as a result of enemy action, but during June, July and August, while Woolwich was being subjected to concentrated attacks by " flying " bombs, more than 400 food premises were damaged in varying degrees, necessitating the examination of many tons of food of all kinds by the Food Inspectors, and resulting in the condemnation of about 7f tons of rationed and unrationed goods. In addition, many hundreds of tons of foodstuffs were damaged in local warehouses. The co-operation of the Salvage Division of the Ministry of Food was obtained in order to effect disposal of, and find a market for, the large quantities of damaged and undamaged food involved. 12 From September onwards, owing to the destructive " rocket " bombing, another 350 food premises were damaged, rendering about 15 tons of food of all descriptions unfit for human consumption. Thus, throughout the year, nearly 800 shops and food premises were damaged, and approximately 23 tons of food made unfit for human consumption. PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 2,180. They relate to the following diseases :— Table No. 5. Diphtheria 55 Malaria 20 Scarlet Fever 223 Ophthalmia Neonatorum 8 Enteric Fever Dysentery 115 (including Paratyphoid) 1 Cerebrospinal Meningitis 9 Puerperal Fever 2 Zymotic Enteritis 24 Puerperal Pyrexia 8 Measles 717 Erysipelas 52 Whooping Cough 329 Pneumonia 227 Scabies 390 Diphtheria. There was a fall in the number of notifications, due partly to the evacuation of children in the latter half of the year. Efforts to secure the immunisation of as many children between the ages of 1 and 5 as possible were continued. Mothers were invited to take such children to special sessions arranged at welfare centres or first-aid posts, or to make use of the Council's " family doctor " scheme. The number of children immunised under the Council's scheme was, 1,346 ; in addition, 332 school children were immunised by Medical Officers of the London County Council. Owing to re-evacuation, these figures are considerably below those for 1943. Even so it was estimated that 75 per cent, of the child population of Woolwich had been immunised by the end of the year. Whooping Cough. 207 children were immunised under the scheme established in 1943. Tuberculosis. The number of formal notifications of tuberculosis received for the year was 248, that is 44 fewer than in 1943. The number of persons examined for the first time at the Dispensaries was 1,356, of these, 164 were found to be suffering from tuberculosis. The number of contacts who attended for examination was 268, 12 of them proved to be tuberculous. The total number of attendances at the dispensaries was 5,602. Patients referred to the dispensaries by medical practitioners totalled 722 ; by medical boards, 103 ; and as a result of mass radiography surveys, 70. There were 1,008 cases on the Tuberculosis Register on the 31st December. 4,649 visits by nurses were made to homes of patients and 56 by the Tuberculosis Officer or by an Assistant Medical Officer. 13 The number of X-Ray examinations made was 1,721. 623 specimens of sputum were examined, of which 75 were positive. Additional nourishment was granted in 106 instances. Six patients received dental treatment under the Council's scheme. 417 patients were admitted to hospital, sanatoria or training colonies. The work of the artificial pneumothorax clinic was continued without interrup- • tion, although damage to St. Nicholas Hospital necessitated the removal of the clinic to Seamen's Hospital, Greenwich, during the latter half of the year. The following is an excerpt from the report of Dr. A. Wingfield, the Consultant-in charge of the clinic. " 58 patients made a total of 871 attendances in 52 sessions, an average attendance of 16.5 per session. These figures do not, however, give a complete picture of the work carried out at the clinic as sessional attendances varied from a maximum of 24 to a minimum of 11 ; some patients received bilateral refills, and in some cases aspiration of fluid and washing out of the pleural cavity were necessary. These last two manipulations consumed much more time than an uncomplicated refill. As in previous years chest X-Rays were taken every three months, or more often if considered necessary, and blood sedimentation rate tests at about the same intervals. Patients were examined on the fluorographic screen at each attendance. During the year, 21 new patients attended and at the end of the year there were 42 patients on the books of the clinic." Clinics at other London hospitals were attended by 36 patients who received 740 refills. The mass radiography unit allocated by the Government to the London County Council was set up in the Plumstead Baths in February and March for a period of six weeks. Employers were asked to make known to employees the facilities thus available and to submit numbers of employees, up to a certain allocation, wishing to be X-Rayed. Arrangements were then made for parties to visit the unit. The response was gratifying and the unit worked to capacity. The following is a summary of examinations carried out :— Table No. 6 Men. Women Total. Total examined 2,586 2,485 5,071 Referred for larger films 127 107 234 Probably tuberculous 27 29 56 Cardio Vascular 8 11 19 The scheme for the payment of maintenance allowances as described in the Annual Report for 1943 continued working smoothly during 1944. At the end of the year, 93 patients were in receipt of such allowances. 14 The Tuberculosis Care Committee continued their meetings and in various ways rendered valuable assistance to the needy tuberculous and their families. Laboratory Facilities. The bateriological work of the Council is carried out at the Memorial Hospital. In addition to the investigations made for the tuberculosis service, 400 throat and nasal swabs, 45 specimens of faeces, and 2 specimens of food were examined for diagnostic purposes. Disinfection and Disinfestation. The number of rooms disinfected after cases of infectious disease was 358, of which 81 had been occupied by tuberculous persons. 811 rooms were disinfested on account of the presence of vermin. 70,963 articles were treated at the disinfecting station. Personal cleansing was continued at the temporary cleansing station at the Turkish Baths, Plumstead, and at the cleansing section of the Eltham Hill Health Centre. Although the number of cases of scabies notified (390) did not necessarily reflect the true state of affairs, it is gratifying to record that the actual number of cases and contacts treated, fell from 3,759 in 1943 to 2,536 in 1944. There was, however, a slight increase in the number of treatments for verminous conditions. The number of persons treated, including scabies contacts, and the number of treatments given at the cleansing stations, were as follows :— Persons. Treatments. Pre-school children—Vermin 276 276 Scabies. 413 804 Schoolchildren— Vermin 1,843 1,853 Scabies 797 1,978 Adults— Vermi 188 188 Scabies 1,326 2,668 Totals .. 4,843 7,767 Regular Scabies Clinic sessions were held, and attended by the Council's Consultant, who continued to supervise the scheme. TABLE OF CONTENTS. page Health Committee 2 Maternity and Child Welfare Committee 2 Preface 3 Vital Statistics 5 General Provision of Health Services in the Area, including those for Maternity and Child Welfare V Sanitary Administration, including Housing 9 Inspection and Supervision of Food 11 Prevention and Control of Infectious Diseases: Disinfestation 12