AC 4372 WOO 45 METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1945 BY T. STANDRING, M.D., B.S., D.P H., M.R.C.S., L.R.C.P. Medical Officer of Health WOOLWICH: The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 TABLE OF CONTENTS. PAGE Health Committee 3 Maternity and Child Welfare Committee 3 Preface 4 Vital Statistics 6 General Provision of Health Services in the Area, including those for Maternity and Child Welfare 8 Sanitary Administration, including Housing 12 Inspection and Supervision of Food 13 Prevalence and Control of Infectious Diseases: Disinfestation 14 HEALTH COMMITTEE. At 31st December, 1945. The Worshipful the Mayor (Councillor C. H. Darby, j.p.) Councillor Mrs. E. L. Reeves (Chairman). Councillor Mrs. E. Brooks (Vice-Chairman). Aldermen— F. C. Halse, m.i.o.b. S. C. C. Harris. Mrs. J. R. Whiting. Councillors— J. W. Andrews Mrs. N. Cooper Miss M. Crout, J.P. Mrs. L. E. Driver Mrs. L. R. Duff A. H. Gilder, M.B.E., J.P. Mrs. K. Howlett Mrs. M. E. Polley Miss G. E. Walters, J.P. J. F. Whitty MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor Mrs. E. L. Reeves (Chairman) Councillor Mrs. E. Brooks (Vice-Chairman) 4 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 45th Annual Report on the health of the Metropolitan Borough of Woolwich, which, in common with the reports for the years 1939-1944, is in an abridged form in accordance with the instructions of the Ministry of Health. The health services of the Borough were well maintained throughout the year and no unusual outbreaks of illness occurred. There were no epidemics of infectious diseases, except perhaps a mild one of Measles of which 1,052 cases came to the knowledge of the Department. It is interesting to note that, since the commencement of evacuation during the war, the regular biennial epidemics of Measles, which were formerly general throughout London during the winter and early spring, have been replaced by a varying number of cases each year, spread mainly over the spring and summer months, with isolated cases during the autumn and winter. There were fewer cases of Diphtheria and of Scarlet Fever than in 1944; many of the latter were nursed at home owing to staffing difficulties in the London County Council fever hospitals. There was only one death from Diphtheria, one from Whooping Cough and one from Measles; there were no deaths from Scarlet Fever. There was a slight increase in the number of notifications of Tuberculosis, but a decrease in the number of deaths. The population at the middle of 1945 as estimated by the Registrar-General showed an increase of nearly 5,000 over that of 1944. The birth rate (17.5) was lower than that of 1944 (18.3), as also was the death rate—12.8, compared with 14.5 for 1944. The infant mortality rate was 41, as compared with 40 in 1944, and the maternal death rate was slightly higher—1.94, compared with l.43 in 1944. A summary of vital statistics will be found in Table No. 1. Detailed causes of death are shown in Table No. 2. The year 1945-46 saw the end of bombing and of hostilities, both in Europe and in the Far East. Consequently, the members of the staff of the Health Department, many of whom had been engaged in Civil Defence to the final stages and later in the winding-up of the First Aid and other medical Posts, devoted the latter half of the year wholly to the health services. Although many members of the permanent staff were still away, the health services, including those of maternity and child welfare, physical medicine, and chiropody, were extended and improved as conditions allowed. 5 Premises used by this Department were reconverted for peace-time purposes; a war-time building was being adapted as a health centre to replace the one destroyed at Eltham in 1941 by enemy action. The sanitary section of the Department, although handicapped by being short-staffed, continued the work of maintaining the sanitary conditions in the area at as high a standard as possible having regard to war-time and post-war difficulties, particularly those arising from the acute lack of housing accommodation. As Deputy Medical Officer of Health, I continued to supervise the work of the Department until May, 1945, when I joined H.M. Forces; Dr. E. Virginia SaundersJacobs then returned from special service with the Ministry of Health to act as Medical Officer of Health. In presenting this report, I would like to thank the permanent and temporary members of the staff of the Health Department for the loyal, enthusiastic and efficient manner in which they have carried out their duties ; and the Chairman and members of the Health and Maternity and Child Welfare Committees for the encouragement and support they have given to the staff. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, T. STANDRING, Medical Officer of Health. 6 VITAL STATISTICS. Table No. 1 contains extracts from the vital statistics for the year, with comparable figures for 1944. Table No. 2 shows details of causes of death. Table No. 1. 1945. 1944. Population 115,270 110,970 Live Births—Legitimate 1,850 1,917 Live Births—Illegitimate 171 120 — 2,021 — 2,037 Birth Rate 175 18-3 Still-births 37 48 Still-births—Rate per 1,000 total births 18 23 Deaths 1,478 1,611 Death Rate 12.8 14.5 Deaths from puerperal causes:— (a) From Sepsis 2 1 (b) From other causes 2 2 Death rate from puerperal causes per 1,000 total births 1.94 1.43 Death Rate of Infants under one year of age:— (a) All infants 41 40 (b) Legitimate infants 38 37 (c) Illegitimate infants 70 91 Deaths from Cancer (all ages) 267 223 Deaths from Whooping Cough 1 1 Deaths from Diarrhoea (under two years of age) 11 17 7 Table No. 2. Nett Deaths during the calendar year, 1945, including non-residents in Institutions in the Borough. Causes of Death. Nett Deaths at the subjoined ages of " residents " whether occurring within or without the district. Deaths in Public Institutions. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. .5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. In Borough Outlying Institu tions. Residents. NonRsdts. All Causes 1478 83 7 9 14 31 50 54 136 253 433 408 347 66 515 Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — Cerebrospinal Meningitis 1 — — — — 1 — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — Whooping Cough 1 1 — — — — — — — — — — — — 1 Diphtheria 1 1 — — — — — — — — — — — — 1 Tuberculosis of Respiratory System 79 1 — 1 — 16 19 9 16 10 7 — 9 — 42 Other Tuberculosis Diseases. . 11 1 1 1 1 3 — — — 2 1 1 3 1 4 Syphilis 16 — — — — — — — 3 6 5 2 3 2 4 Influenza 7 — — — — — — — — 3 2 2 — — 4 Measles 1 — 1 — — — — — — — — — — — 1 Poliomyelitis and Polioencephalitis — — — — — — — — — — — — — — — Encephalitis Lethargica 1 — — — — — — 1 — — — — — — 1 Cancer 267 — — — — 1 6 11 39 73 91 46 74 15 97 Diabetes 16 — — — — — — — 2 3 7 4 4 — 9 Cerebral Haemorrhage, etc. 127 — — — — — — 1 10 24 57 35 33 1 36 Heart Disease 414 — — — — 1 2 8 20 60 146 177 86 10 108 Other Circulatory diseases 41 — — — — — — — 5 — 21 15 16 2 14 Bronchitis 82 5 — 1 1 — 1 1 8 10 23 32 8 1 14 Pneumonia 65 8 2 — 1 1 1 2 3 12 17 18 21 3 30 Other Respiratory diseases 13 1 — — — 1 1 — 3 3 2 2 — 1 6 Peptic Ulcer 26 — — — — — — 2 3 11 6 4 10 2 9 Diarrhoea, etc. 11 11 — — — — — — — — — — — — 11 Appendicitis 6 — — — — — — 1 — 2 3 — 4 2 2 Other Digestive diseases 29 1 — 2 — 1 2 3 2 2 6 10 6 — 15 Acute and Chronic Nephritis 32 — — 1 — 1 — 3 3 6 8 10 9 — 9 Puerperal Sepsis and Post-abortive sepsis 2 — — — — — 2 — — — — — — — 2 Other Maternal causes 2 — — — — — 2 — — — — — — — — Premature Birth 14 14 — — — — — — — — — — 2 3 9 Congenital Malformations, etc. 31 30 1 — — — — — — — — — 12 5 12 Suicide 11 — — — — — — 1 3 5 2 — 5 1 3 Road Traffic Accidents 11 — 1 — — — 1 1 1 — 3 4 5 5 6 Other Violence 81 5 1 3 7 2 7 10 10 7 12 17 12 5 17 All other Causes 79 4 — — 4 3 6 — 5 14 14 29 25 7 48 8 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 1,472. The number of births registered in Woolwich was 1,452. After correction for inward and outward transfers the nett number of Woolwich live births was 2,021. It is known that at least 1,542 births took place in Institutions. Clinics and Treatment Centres. The war-time arrangement of sessions at the clinics and treatment centres continued during the first half of the year but with the disbanding of Civil Defence certain buildings which had been used as first aid posts were brought back into use as welfare centres. At the end of the year the following clinics and treatment centres were in use:— Woolwich Central Health Centre Child welfare and ante-natal clinics. Dental clinic. Physical medicine. Foot clinic. Plumstead Health Centre Child welfare and ante-natal clinics. 601, Westhorne Avenue Child welfare and ante-natal clinics. Wesley Hall, Timbercroft Lane Child welfare clinics. Legal and General Sports Pavilion, Footscray Road, New Eltham Child welfare clinics. St. Luke's Church Hall, Westmount Road Child welfare clinics. St. John's Church Hall, North Woolwich Child welfare clinics. 137, Alnwick Road, Horn Park Child welfare and ante-natal clinics. Old Town Hall Artificial Sunlight clinic. Turkish Baths, Plumstead High Street Personal cleansing station. Eltham Hill Health Centre, Sherard Road Personal cleansing station. Foot clinic. Maxey Road, Plumstead Tuberculosis Dispensary. 11, Carnecke Gardens, Eltham Tuberculosis Dispensary. 9 Sanction was obtained from the Ministry of Health for the use of an ad hoc first aid post at Lionel Road, Eltham, as a maternity and child welfare centre but the necessary work of adaptation had not been carried out at the end of the year. The attendances at the maternity and child welfare centres were as follows : expectant mothers 7,899; nursing mothers 4,604; children 47,289. Toddlers' Clinics. The clinics were well attended and 3,015 toddlers' inspections were carried out, as compared with 1,057 in 1944. The general standard of health was satisfactory. Again dental caries, minor anaemia, orthopaedic defects and chronic infections of the upper respiratory tract formed the majority of the conditions requiring treatment. Health Visiting. The number of visits paid by health visitors to children under five years of age was 20,643 ; the total number of visits paid by health visitors was 28,029. Child Life Protection. There were 19 foster-mothers on the register at the end of 1945—the same number as at the end of 1944—and there were 21 fosterchildren. The number of visits paid by child life protection visitors was 148. Artificial Sunlight Clinic. The artificial sunlight clinic at the old Town Hall continued its work. The number of treatments given was 10,228. Dental Treatment. The number of mothers and of children under five attending the dental clinics was 397; the number of tuberculous persons, 7; and the total number of attendances, 1,200. Minor Ailments. The number of children under five years of age referred to school clinics for treatment of minor ailments was 155. Issue of Fruit Juices and other Supplements. The distribution of the Government fruit juices and cod liver oil was continued at the food offices throughout the year and at all first aid posts until the disbandment of Civil Defence in May. With the closing of the first aid posts, arrangements were made for distribution at certain welfare centres, the Food Office supplying staff in some cases. Midwifery Services. The Domiciliary Midwifery Service in London is administered by the County Council, the midwives working in collaboration with the Borough ante-natal clinics. Institutional midwifery was available in Woolwich at the British Hospital for Mothers and Babies, at the Eltham Cottage Hospital, and at the War Memorial Hospital. The maternity ward at St. Nicholas' Hospital remained closed. Some Woolwich mothers were admitted to London County Council hospitals outside the Woolwich area, notably 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 10 reserved at this hospital for 144 of the Council's cases per annum. In addition, by arrangement with the London County Council, accommodation is reserved for a further 168 cases per annum, the London County Council accepting financial responsibility. The maternity unit at the War Memorial Hospital reopened on the 1st January, and the pre-war agreement again operated, the hospital providing accommodation for 66 cases per annum referred by the Council. With the reopening of this unit, the war-time arrangement with the British Hospital for Mothers and Babies for the acceptance of an extra 72 Council cases was discontinued. During 1945, 1,272 mothers were admitted to the British Hospital for Mothers and Babies. 807 of these were Woolwich mothers, 297 of whom were admitted under the Council's scheme. 211 mothers were admitted to the War Memorial Hospital, 66 of them being Woolwich mothers, 62 of whom were Borough Council cases. 56 mothers were admitted to the Eltham Cottage Hospital. Care of Premature Infants. The number of babies born in the Borough whose birth weight was 5½ lbs. or less was 72. Of these, 58 were born in hospital and 14 in private houses. Of those born in hospital, 4 died during the first twentyfour hours and 48 survived at the end of four weeks. Of those born in private houses, 3 were admitted to hospital; 2 died during the first twenty-four hours, and 11 survived at the end of four weeks. No applications for the loan of draft-proof cots or other equipment, or for the services of the Consultant Paediatrician were received. Home Helps. During the year, 104 applications were considered and 82 home helps were provided in confinement cases. An extension of the home help scheme to provide domestic help in cases where the housewife is incapacitated was put into force at the beginning of the year, in accordance with the Ministry of Health circular. This new scheme is run on the same lines as the old home help scheme, the workers being allocated to cases under either service, the same rates of wages being paid and the same scale being used for assessment. The periods of employment, however, were in most cases of longer duration. From the time of the inauguration of this service to the end of the year, 36 applications were received, and in 29 cases domestic help was provided. Care of Illegitimate Children. The only direct provision for the care of illegitimate infants is provided by the scheme for "guaranteed payments" to fostermothers undertaking the care of such infants. The Council, however, makes a contribution to the fund administered by the Metropolitan Boroughs' Standing Joint Committee to provide financial assistance to Moral Welfare Associations. Welfare work in this connection is carried out by each health visitor in her own area, but there is close contact between the health visitors and the welfare workers of the Moral Welfare Association working in the Borough. No applications were received during 1945 for assistance under the "guaranteed payments" scheme. Convalescence for Children Under Five. The Council makes an annual grant to the Invalid Children's Aid Association in respect of children under five years of age recommended for convalescence. During the year, 48 children were sent to convalescent homes. 11 War-Time Day-Nurseries. At the end of 1944, seven day-nurseries, providing accommodation for 327 children were in operation in the Borough. Five were established by the Borough Council, and two were in London County Council rest centres. With the end of the war in Europe and the return of evacuated schoolchildren, the London County Council asked for the return of Bloomfield Road School for educational purposes and the day-nursery there was closed at the end of July. The Rest Centre service, in common with Civil Defence, having been disbanded, the day-nursery at Roper Hall, Eltham, was closed in May, and the nursery at Earl Rise School in July. Thus, at the end of the year, there remained in use four day-nurseries, providing places for 217 children. Clinic for Physical Medicine. In the latter half of the year the work of this clinic was brought back to its full capacity, the number of attendances rising to 10,955, as compared with 7,821 in 1944. Professional Nursing in the Home. The arrangements with the local nursing associations in force for many years were continued, provision being made for nursing assistance in the homes of patients suffering from 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 2,075. In addition, a grant of £100 was made to the nursing associations for the nursing of children under the age of five years for conditions other than those above-mentioned, distributed on the basis of the percentage of the total of cases nursed by the nurses of each nursing association. Foot Clinics. The demand for foot treatment continues to grow ; increases in the attendances at both clinics were recorded. The number of attendances at the clinic at the Central Health Centre was 9,148 compared with 8,243 in 1944. At Eltham, the number of attendances was 5,669, compared with 5,196. In May the accommodation at the uncompleted Eltham Hill Health Centre, Sherard Road, used as a gas cleansing station, was vacated and after some adaptation the Eltham Foot Clinic was transferred from Eltham Baths to that building on the 5th October. Supply of Insulin to Persons Suffering from Diabetes. The number of patients who received Insulin during the year, in accordance with the sanction of the Ministry of Health, was 22. Tuberculosis Dispensary. The temporary premises at Maxey Road, Plumstead, and the dispensary at 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. The Vaccination Officer's return for the year 1944 shows that there were 1,234 entries in the birth lists. Of these, 612 were successfully vaccinated. The total number of successful primary vaccinations during 1945 was 1,243. 12 SANITARY ADMINISTRATION. Complaints. 3,032 complaints of nuisance were received and investigated. The necessary action was taken where defects or nuisances were discovered. Sanitary Inspection in the Area. During the year, 17,813 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 1,166, and the number of statutory notices, 297. In only one case were legal proceedings instituted. TABLE No. 3. Inspections. Complaints Investigated 3,032 Tents and Vans 11 Outworkers' Premises 127 Factories 178 Houses Let in Lodgings 18 Shops Act 30 Houses re Infectious Diseases 564 Theatres and Cinemas 11 Houses re Smallpox Contacts 87 Rag and Bone Premises 10 Houses re Verminous Cases 1,548 Urinals Accessible to the Public 88 Houses re Scabies Cases 5,403 Women's Lavatories 174 Houses re Other Diseases 248 Inspections re Rats 3,592 Common Lodging Houses 32 Pharmacy and Poisons Act 2 Drainage Inspections 1,301 Air Raid Shelters 8 Drains Tested by Smoke Test 228 Miscellaneous 1,115 TABLE No. 4. Nuisances Abated. Dirty Conditions 238 Defective Paving 43 Damp Conditions 725 Drainage Defects 828 Dilapidations 685 Water Closet Defects 542 Verminous Rooms Cleansed 811 Dust Bins Provided 106 Defective Lighting 183 Water Supply Defects 81 Defective Ventilation 40 Foul Accumulations removed 21 Water Supply. The Metropolitan Water Board is responsible for the water supply for all domestic purposes in the Borough, all dwelling houses being supplied 13 direct from public water mains. There are a few wells in the Borough, used chiefly for trade and kindred purposes. No complaints were received as to the quality or purity of the water supply. Eradication of Bed Bugs. The number of inspections of verminous premises was 1,548. Appropriate action was taken in all cases where infestation was discovered. The houses and furniture of all tenants allocated houses or flats by the Council were examined, and where necessary disinfestation of the furniture was carried out in the process of removal; the vacated accommodation being dealt with at the same time. Hydrogen cyanide was used in this connection for the disinfestation of 34 loads of furniture. Rat Destruction. Although there are no large areas of rat infestation in Woolwich, a number of complaints were received and a thorough investigation was made in each case. These investigations, together with the supervision of baiting and trapping where necessary, occupied a considerable amount of the sanitary inspectors' time; 3,592 inspections being made. Maintenance treatments of the sewers in the Borough were carried out in January and June, in accordance with the scheme of control initiated by the Ministry of Food. In these two treatments, 697 manholes were baited, most of them on both occasions. A total of 567 "takes" was recorded, 144 being small "takes," suggesting the visit of one rat only. The results of these treatments were very satisfactory and indicate that the rat population in the sewers of the Borough is being kept at a very low level. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts, was 3,295, and the number found not to be in all respects reasonably fit for habitation was 1,310. The number rendered fit in consequence of informal action by the sanitary inspectors, including the service of intimation notices, was 829. Statutory notices were served in respect of 182 houses. The number of new houses for which water certificates were issued during the year was 304, most of these were temporary 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 210. The standard of the milk supply was satisfactory. Of 93 samples submitted for chemical analysis, none contained less than 3 per cent. of fat, and only 8 less than 3.5 per cent. Of 21 samples of pasteurised milk examined bacteriologically, only one was below the prescribed standard. The phosphotase test for adequate heat treatment and the methylene blue test for keeping quality of milk was satisfied in 179 samples and 52 samples respectively. Only 12 samples failed to satisfy; 4 the phosphotase test and 8 the methylene blue test. In each case where the sample failed to satisfy, further samples from the same sources of supply gave satisfactory results. 14 Meat Supplies. Only one slaughterhouse in the Borough was used during the year and this only on occasion under licence from the Ministry of Food. The number of animals slaughtered and inspected at this slaughterhouse was 81. Premises where Food is Prepared or Offered for Sale. Routine visits were paid by the sanitary inspectors to all food premises in the Borough. The number of such inspections was 1,415. Food certified as unfit for human consumption, largely due to war conditions, totalled 21 tons. Most of this was used for animal feeding. Analysis of Food and Drugs. During the year the Public Analyst analysed 795 samples, including 751 informal and 44 formal. Of these, 25 informal and 3 formal samples were reported to be adulterated, giving a percentage adulteration of 3.5, compared with 3.2 in 1944. The adulterated samples included semolina pudding, 2; pudding and cake flour, 6; baking powder, 1; shredded suet, 1; dried fruit, 3; spices, etc., 6; dried parsley, 2; pickle, 1; ginger beer extract, 1; and medicaments, 5. In six instances the adulteration was in the nature of infestation by insects or mites. PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 2,494. They relate to the following diseases - TABLE No. 5. Diphtheria 30 Malaria 5 Scarlet Fever 203 Ophthalmia Neonatorum 6 Enteric Fever (including Paratyphoid) 1 Dysentery 98 Puerperal Fever 10 Cerebrospinal Meningitis 18 Puerperal Pyrexia 22 Zymotic Enteritis 67 Erysipelas 43 Measles . 1,052 Pneumonia 207 Whooping Cough 288 Poliomyelitis 4 Scabies 440 Diphtheria. There was again a fall in the number of cases of Diphtheria, attributable, no doubt, to the high percentage of the child population which can now be considered to be immune to diphtheria. During 1945, the number of children immunised under the Council's scheme was 1,820; in addition, 244 schoolchildren were immunised by medical officers of the London County Council, and a number of schoolchildren were given a reinforcing injection. In Woolwich there are two methods by which parents may have their children immunised. 15 Either the parents can make arrangments directly with their own doctor, the Council supplying the prophylactic and paying the doctor's fees, or the mothers are invited to attend with the children by appointment at special sessions at welfare centres. When the course of injections is completed, every parent is encouraged to bring the child to a clinic for the Schick test. It is estimated that 78.7 per cent. of the child population of Woolwich has been immunised against Diphtheria. Whooping Cough. Immunising injections against Whooping Cough are given by means of a "family doctor" scheme. During the year, 387 children received injections, compared with 207 in 1944. Tuberculosis. The number of primary notifications of Tuberculosis received during the year was 260, compared with 248 in 1944. The number of persons examined for the first time at the dispensaries was 1,443. Of these, 241 were found to be suffering from Tuberculosis. The number of contacts who attended for examination was 332, and 12 of these proved to be tuberculous. The total number of attendances at the dispensaries was 6,502, 900 more than in 1944. The number of patients referred to the dispensaries by medical practitioners was 776, and by medical boards, 110. There were 1,216 cases on the register on the 31st December. Visits paid to the homes of patients by tuberculosis visitors totalled 3,742, and by the Tuberculosis Officer, 66. The number of X-Ray examinations made was 1843, and the number of specimens of sputum examined was 759, of which 93 were positive. Additional nourishment was granted in 99 instances. Seven patients received dental treatment; 394 patients were admitted to hospital, sanatoria or training colonies. In January, the artificial pneumothorax clinic was brought back to St. Nicholas Hospital from the Seamen's Hospital, where it had been accommodated whilst repairs to bomb damage were carried out at St. Nicholas Hospital. Clinics were held regularly throughout the year, on Fridays at 4.30 p.m., and the total number of attendances was 972. The following is an excerpt from the report of Dr. A. Wingfield, the Consultant in charge of the clinic:— "The routine—interview, fluoroscope and refill at each attendance— has been continued. X-Ray films and blood sedimentation rate are taken 3-monthly, or more frequently if indicated. Aspiration of pleural effusions is carried out at the clinic when necessary, and 19 such aspirations have been performed during the year." Clinics at other London hospitals were attended by 45 patients, who received 822 refills. Although the payment of maintenance allowances has considerably increased the work of the dispensaries, the administration of the scheme was efficiently maintained. On the 1st January, 93 patients were receiving payments ; 79 were granted an allowance during the year, and at the end of the year there were 109 patients receiving an allowance. 16 The Tuberculosis Care Committee, which undertakes all the care and aftercare work of the tuberculous in the Borough, continued to meet regularly and to provide valuable assistance. This Committee helps by the provision of clothing and pocket money for necessitous patients entering institutions ; by the purchase of surgical apparatus and nursing requisites ; by supplementing financial assistance given by voluntary organisations ; by paying training fees in suitable cases ; and in many other ways. It supervises the Council's schemes for the provision of extra nourishment and of dentures. In all, during the year it dealt with 341 applications. Laboratory Facilities. The bacteriological work of the Council, rendered necessary in connection with investigations into infectious diseases, food poisoning, etc., is carried out at the Woolwich War Memorial Hospital. In addition to the examinations of sputum made for the tuberculosis service, 492 throat and nasal swabs, 39 specimens of faeces and 11 specimens of food were examined. Samples of water from the public swimming baths were regularly examined and in general the results were satisfactory. Disinfection and Disinfestation. The Council's disinfecting station is situated at White Hart Road, Plumstead, but a number of articles of personal clothing are also disinfected at the two cleansing stations. In all, a total of 68,534 articles were disinfected at these three stations. The number of rooms disinfected after cases of infectious disease was 329, of which 56 had been occupied by tuberculous persons. The number of rooms disinfested of vermin was 683. 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. The number of cases of Scabies notified (440) was higher than the number notified in 1944 (390) but the actual number of persons treated decreased slightly from 2,540 to 2,360. There was also a slight decrease in the number of persons treated for verminous conditions. The following table gives details of the number of persons treated, including Scabies contacts, and the number of treatments given at the two cleansing stations. TABLE No. 6. Persons. Treatments. Pre-school children—Vermin 91 92 Scabies 330 661 School children— Vermin 2,090 2,096 Scabies 865 1,925 Adults— Vermin 152 152 Scabies 1,165 2,243 Totals 4,693 7,109 Regular Scabies clinic sessions were held, and attended by the Council's consultant, who continued to supervise the scheme,