WOO 46 METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1946 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 5 General Provision of Health Services in the Area, including those for Maternity and Child Welfare 7 Sanitary Administration, including Housing 10 Inspection and Supervision of Food 12 Prevalence and Control of Infectious Diseases: Disinfestation 13 HEALTH COMMITTEE. At 31st December, 1946. THE WORSHIPFUL THE MAYOR (Councillor F. R. Moore, 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. L. R. Duff Major F. W. Beech, J.P. A. H. Gilder, m.b.e., J.P. Mrs. N. Cooper Mrs. K. Howlett Miss M. Crout, J.P. Mrs. M. E. Polley C. H. Darby Miss G. E. Walters, J.P. Mrs. L. E. Driver 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 Forty-sixth Annual Report on the health of the Metropolitan Borough of Woolwich which, in accordance with the instructions of the Minister of Health, is again in an abridged form. Dr. E. Virginia Saunders-Jacobs continued to act as Medical Officer of Health until my return from service with H.M. Forces in September. There were no large scale outbreaks of illness during 1946, and the number of cases of infectious diseases coming to the knowledge of the Department was comparatively low, except in the case of measles, of which there were 1,301 cases compared with 1,052 in 1945. There was a slight increase in the number of cases of scarlet fever. There were fewer cases of diphtheria, the number of cases in which this diagnosis was confirmed being the lowest ever recorded. There was only one death from diphtheria and two deaths from whooping cough ; no deaths occurred from scarlet fever, measles, typhoid fever or Cerebrospinal fever. The Registrar General's estimate of the mid-1946 population shews an increase of 19,150 over that of 1945. The birth rate (21.6) was the highest recorded since 1921, and the death rate (11.4) was the lowest since 1939. The infant mortality rate (31) was the lowest ever recorded. There was only one maternal death. A summary of vital statistics will be found in Table No. I, and detailed causes of death are shewn in Table No. II. Despite staffing difficulties, the health services were well maintained and greater use than ever before was made of the maternity and child welfare centres. Difficulties in securing the repair of housing defects became more acute during the year owing to a worsening in the supply of building materials. Disputes regarding the extent of war damage as opposed to fair wear and tear gave rise to delay in carrying out repairs. Coupled with the grave shortage of houses these difficulties made the Sanitary Inspectors' task an unenviable one. Nevertheless, it proved possible to maintain a relatively reasonable standard for housing. The quality and freshness of the food supplies distributed in the Borough were on the whole satisfactory and there were no serious outbreaks of food poisoning. It will be noted that such adulterations as occurred were of a minor character and rarely of major articles of diet. In presenting this report I desire to express my appreciation of the continued confidence and support which I received from the members of the Council, and in particular from the Chairman and members of the Health Committees. My thanks are due to the chief officers of the Council for their help, and to the staff of the Health Department for their conscientious work and loyal assistance. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, T. STANDRING, Medical Officer of Health. 5 VITAL STATISTICS. Table No. I contains extracts from the vital statistics for the year, with comparable figures for 1945. Table No. II shows details of causes of death. Table No. I. Population (Registrar General's Estimate) 1946. 1945. 134,420 115,270 Live Births—Legitimate 2,740 1,850 Live Births—Illegitimate 163 171 2,903 2,021 Birth Rate 21.6 17.5 Still-births 78 37 Still-births—Rate per 1,000 total births 26 18 Deaths 1,531 1,478 Death Rate 11.4 12.8 Deaths from puerperal causes:— (a) From sepsis — 2 (6) From other causes 1 2 Death rate from puerperal causes per 1,000 total births 0.34 1.94 Death Rate of Infants under one year of age:— (a) All infants 31 41 (b) Legitimate infants 31 38 (c) Illegitimate infants 36 70 Deaths from Cancer (all ages) 238 267 Deaths from Whooping Cough 2 1 Deaths from Diarrhoea (under two years of age) 6 11 6 Table No. 2. Nett Deaths during the calendar year 1946, 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 1531 91 5 8 8 18 39 56 145 261 417 483 367 65 505 Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — Cerebrospinal Meningitis — — — — — — — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — Whooping Cough 2 1 1 — — — — — — — — — — — 1 Diphtheria 1 — 1 — — — — — — — — — — — 1 Tuberculosis of Respiratory System 76 — — 1 1 10 16 12 16 9 6 5 6 — 32 Other Tuberculosis Diseases 7 — 1 — — 2 2 — 1 — 1 — 1 1 6 Syphilis 23 — — — — — — 1 4 7 7 4 3 1 13 Influenza 15 — — — — — — — 3 5 3 4 2 — 1 Measles — — — — — — — — — — — — — — — Poliomyelitis and Polioencephalitis 1 — — — — — — — — — — — — — — Encephalitis Lethargica 1 — — — — — — — — 1 — — — — 1 Cancer 238 — — — — — 3 9 30 65 74 57 72 12 71 Diabetes 9 — — — — — — — — 3 4 2 2 — 3 Cerebral Haemorrhage, etc. 153 — — — — — — — 6 33 50 64 54 7 42 Heart Disease 477 — — — 1 — 3 10 30 73 155 205 101 5 126 Other Circulatory diseases 42 — — — — — 1 — 3 4 15 19 13 2 11 Bronchitis 82 2 1 1 — — — 4 6 6 27 35 7 1 18 Pneumonia 60 11 1 2 — — — 3 3 11 10 19 15 1 31 Other Respiratory diseases 18 — — 1 — — — 2 1 5 8 1 1 1 7 Peptic Ulcer 22 — — — — — — 1 5 8 7 1 9 1 10 Diarrhoea, etc. 6 6 2 1 3 Appendicitis 7 — — 1 1 — 1 — 2 — 2 — 4 — 3 Other Digestive diseases 33 1 — — — 1 — 4 6 8 7 6 10 5 17 Acute and Chronic Nephritis 31 — — — — 1 1 — 4 7 8 10 6 2 15 Puerperal Sepsis and Post-abortive sepsis — — — — — — — — — — — — — — — Other Maternal causes 1 — — — — — — — — — — — — — 1 Premature Birth 27 27 — — — — — — — — — — 3 3 17 Congenital Malformations, etc. 36 34 — — — — 1 — 1 — — — 9 5 17 Suicide 14 — — — — — 1 3 2 4 4 — 2 3 — Road Traffic Accidents 15 — — — 3 — 4 2 2 1 1 2 5 5 3 Other Violence 38 6 — — — 2 3 1 5 3 6 12 17 — 13 All other Causes 96 3 — 2 2 2 2 4 14 8 22 37 21 9 42 7 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 1,956, and the number registered in Woolwich was 1,979. After correction for inward and outward transfer the nett number of Woolwich live births was 2,903. It is known that at least 1,999 births took place in Institutions. Clinics and Treatment Centres. The Eltham Maternity and Child Welfare Centre which had been maintained at 601, Westhorne Avenue since the destruction by enemy action in 1941 of the Eltham Health Centre at Briset Road, was transferred in April to the adapted first aid post at Lionel Road; the North Woolwich centre at Fernhill Street, which had been in use as a first aid post, was re-opened in September. At the end of the year the New Eltham Centre, which had been carried on in the Legal and General Sports Pavilion, Footscray Road, throughout the war, was transferred to the Bardhill Sports Pavilion, also in Footscray Road. With these exceptions, the clinics and treatment centres at 31st December were as listed in the Annual Report for 1945. The attendances at the Centres were as follows:— Expectant mothers, 13,620; nursing mothers, 12,027; children, 57,366. These figures reflect not only the higher birth rate but the greater use now being made of the welfare centres. Toddlers' Clinics. The number of toddlers' inspections rose from 3,015 in 1945 to 3,720 in 1946. One of the Council's Assistant Medical Officers reports that in most cases the general condition and progress of the toddlers attending the clinics has been good and their diet and vitamin intake satisfactory. A substantial number of cases required dental treatment and a few cases of unusual defects such as squint and deafness were referred for special examination. Postural defects, knock knees, and flat feet, were the most common defects, but remedial exercises gave good results. Beheaviour complexes and habits arising in some of the toddlers were discussed with the mothers and advice was given as to the treatment of these children at home. Health Visiting. The number of visits paid by health visitors to children under five years of age was 17,146; the total number of visits paid by health visitors was 24,049. Child Life Protection. There were 21 foster mothers on the register at the end of 1946, two more than at the end of 1945, and there were 16 foster children. The number of visits paid by child life protection visitors was 199. Artificial Sunlight Clinic. A total of 10,391 treatments were given at this clinic, compared with 10,228 in 1945. 8 Dental Treatment. The numbers of mothers and of children under five attending the dental clinics were 343 and 241 respectively, and the number of tuberculous persons was 5. The total number of attendances was 1,514. Minor Ailments. The number of children under five years of age referred to school clinics for treatment of minor ailments was 308. 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 at certain welfare centres. Midwifery Services. No change took place during the year in the midwifery services which were dealt with fully in the Annual Report for 1945. During the year 1,304 mothers were admitted to the British Hospital for Mothers and Babies. Of these, 812 were Woolwich mothers, 311 of whom were admitted under the Council's scheme. The number of admissions to the maternity unit of the War Memorial Hospital was 296. Of these, 186 were Woolwich mothers, 70 of whom were admitted under the Council's scheme. Admissions to the Eltham Cottage Hospital numbered 59. Care of Premature Infants. The action taken in connection with the care of premature infants is in conformity with the Ministry of Health Circular No. 20/44. The number of babies born in the Borough whose birth weight was 5½ lbs. or less was 74. Of these, 44 were born in hospital and 30 in private houses. Of those born in hospital, 3 died during the first twenty-four hours and 36 survived at the end of four weeks. Of those born in private houses, 8 were admitted to hospital; 3 died during the first twenty-four hours and 25 survived at the end of four weeks. No applications for the loan of draught-proof cots or other equipment or for the services of the Consultant Paediatrician were received. Home Helps. The Council's scheme provides for domestic assistance in confinement cases and in cases of illness where the housewife is incapacitated. The total number of cases in which domestic help was provided was 376; 241 in confinement cases and 135 in cases of illness. Whereas the home help is employed in the majority of maternity cases for two weeks, in many of the cases of illness, particularly where old people are concerned, the period of employment is of much longer duration. Care of Illegitimate Children. The only direct provision for the care of illegitimate infants is provided by a scheme for guaranteed payments to foster mothers undertaking the care of such infants. The Council, however, makes a contribution to a 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. Only one application was received during the year for assistance under the "guaranteed payments" scheme. 9 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, 36 children were sent to convalescent homes. War-time Day Nurseries. At the end of 1945 the Council was still maintaining four day nurseries, but H.M. Government having decided to relinquish financial responsibility for the whole of the nett approved expenditure on 1st April, and thereafter to make a grant to Welfare Authorities of approximately 46 per cent., the Council reviewed the position and decided to close the Cyril Henry Nursery. This nursery was taken over at the end of April by the London County Council as a nursery school. Thus, three day nurseries remained providing accommodation for 180 children. These three nurseries were still open at the end of the year. The health of the children attending the day nurseries was generally good and no serious outbreaks of infection occurred. Regular medical supervision was provided. Clinic for Physical Medicine. The year 1946 was the first complete year during which the clinic for physical medicine had been open full time, but even so, owing to staffing difficulties it is not possible to say that it was working to full capacity. Attendances totalled 12,249, compared with 10,955 in 1945. Professional Nursing in the Home. The provision of nursing assistance in the homes of patients suffering from certain infectious diseases by arrangement with the local nursing associations, as described in previous Annual Reports, was continued. The total number of visits paid by nurses on behalf of the Council was 2,056. An additional grant of £100 was made to the nursing associations for the nursing of children under the age of five years for non-infectious conditions, distributed on the basis of a percentage of the total of such cases nursed by the nurses of each nursing association. Foot Clinics. Although there was an unsatisfied demand, the number of treatments given at both the Woolwich and Eltham foot clinics was lower than in 1945. This fall was partly due to staffing shortages and probably to the reintroduction of the appointments system which was in abeyance during the war. The number of attendances at the Central Health Centre was 7,826 compared with 9,148 in 1945, and at the Eltham Hill Health Centre, Sherard Road, the attendances were 5,030 compared with 5,669 in 1945. 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 26. Tuberculosis Dispensaries. 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 shows that there were 1,466 entries in the birth lists. Of these, 796 were successfully vaccinated. The total number of successful primary vaccinations during 1946 was 1,744. 10 SANITARY ADMINISTRATION. Complaints. 4,431 complaints of nuisance were received and investigated. The necessary action was taken where defects or nuisances were discovered. Sanitary Inspection of the Area. During the year, 20,408 inspections, including re-inspections, were carried out by the Sanitary Inspectors. The nature of these inspections is shown in Table No. III, and details of nuisances abated are given in Table No. IV. The number of intimation notices served as a result was 2,334, and the number of statutory notices, 715. In only 16 instances were legal proceedings instituted. TABLE No. III. Inspections. Complaints Investigated 4,431 Houses re Other Diseases 144 Complaints Re-inspections 5,592 Aged and Infirm Persons 248 Outworkers' Premises 104 Common Lodging Houses 34 Houses Let in Lodgings 11 Tents and Vans 19 Houses re Overcrowding 568 Factories 167 New Houses re Water Supply 625 Shops Act 12 Houses re Infectious Diseases 569 Food Premises 1,003 Houses re Smallpox Contacts 457 Theatres and Cinemas 10 Houses re Verminous Cases 3,601 Urinals Accessible to the Public 115 Houses re Scabies Cases 2,592 Women's Lavatories.. 106 TABLE No. IV. Nuisances Abated. Dirty Conditions 489 Defective Paving 3 Damp Conditions 1,445 Drainage Defects 1,037 Dilapidations 1,421 Water Closet Defects 807 Verminous Rooms Cleansed 988 Dust Bins provided 196 Defective Lighting 157 Water Supply Defects 112 Defective Ventilation 218 Foul Accumulations removed 22 Water Supply. The Metropolitan Water Board is responsible for the water supply for all domestic purposes in the Borough, all dwelling houses being supplied 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. 11 Eradication of Bed Bugs. The necessary action was taken in all cases where infestation by bed bugs was discovered, in accordance with the usual procedure adopted by the Department. This procedure has been fully described in previous Annual Reports. The total number of inspections of verminous premises was 3,601. Hydrogen Cyanide was used for the disinfestation of 65 loads of furniture on removal to Council houses or flats, but no house was disinfested by this method. Rat Destruction. The work of rat destruction continued during the year. The area of each complaint received was surveyed and appropriate measures were taken where necessary. In October, in compliance with a Ministry of Food request, a special scheme for block control was adopted. The Ministry desired, in the first instance, a scheme for block control to be applied to all private dwelhngs in the Borough, but in view of the amount of work already carried out in Woolwich a modified scheme providing for block control in industrial areas only was finally approved. The staff engaged on this work was increased by four, making six in all, two of whom were trained as investigators. These operated under the supervision of a sanitary inspector who deVoted the whole of his time to rat destruction and prevention. The total number of premises surveyed during the year was 3,176, and the number of inspections was 7,632. Effective preventive measures were taken in 1,553 instances, after baiting and trapping. Maintenance treatments of the sewers in the Borough were carried out in January and June, and in these two treatments 608 manholes were baited, most of them on both occasions. The results of these treatments continue to be satisfactory and indicate their worth in helping to keep the rat population of the Borough at a low level. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 5,851, and the number found not to be in all respects reasonably fit for habitation was 2,214. The number rendered fit in consequence of informal action by the sanitary inspectors, including the service of intimation notices, was 1,698. Statutory notices were served in respect of 630 houses. The problems in relation to housing dealt with by the Department were aggravated by the acute housing shortage, notwithstanding the measures taken by the Council for its relief. It is noteworthy that the number of new houses erected was 726 ; of these 610 were temporary (418 under the administration of the Borough Council and 192 under the administration of the London County Council). Of the 116 permanent houses, 99 were erected by the Borough Council and 17 by private builders. Some indication of the Council's housing problem is given by the following:— The long waiting list from 1939, despite the building of 14,667 houses in the Borough between the years 1920 and 1939; no building during the war years; 1,894 houses demolished; 35,999 houses damaged (3,788 seriously); and the higher marriage and birth rates causing a greater demand for new homes than before the war. 12 It is interesting, however, to compare the figure of 726 (above) with the average yearly rates of house building in Woolwich during the four decades, 1901-1940, which were as follows: 1901-1910, 453; 1911-1920, 533; 1921-1930, 443; 19311940, 1,039. Squatters. In September "squatters" took possession of two army camps in the Borough where, after negotiations with the War Office and the Ministry of Health, they were allowed to remain. Certain adaptations with regard to sanitary arrangements and water supply were carried out at the camps. INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 58. The standard of the milk supply was satisfactory; practically all the milk distributed in Woolwich is heat treated. Of 310 samples submitted for chemical analysis, 216 (69 per cent.) contained more than 3.5 per cent. of fat; only two contained less than 3 per cent. Of 64 samples of pasteurised milk examined bacteriologically, only one sample gave an unsatisfactory result. The phosphatase test for adequate heat treatment was satisfied in 328 samples, and the methylene blue test for the keeping quality of milk in 162 samples. Only 11 samples failed to satisfy; 7 the phosphatase test and 4 the methylene blue test. In each case. where the sample failed to satisfy, further samples from the same sources of supply gave satisfactory results. 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 39. 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 1,043. Analysis of Food and Drugs. During the year the Public Analyst analysed 734 samples, including 682 informal and 52 formal. Of these, 17 informal and 4 formal samples were reported to be adulterated, giving a percentage adulteration of 2.8, compared with 3.5 in 1945. The adulterated samples included mixed spice, 1; mixed herbs, 1; coffee essence, 1; canned meat, 1; canned soup, 1; pickles, 1; whole ginger, 1; vitamin capsules, 1; milk, 4; vinegar, 2; gravy preparations, 2; cake mixture, 2; mineral water, 1; lemon biscuit mixture, 1; Frutella dessert powder, 1. Unsound Food. During the year, 12½ tons of food was surrendered as unfit for human consumption. Most of this was utilised for animal feeding or for fertilisers. No seizures were made. 13 Food Poisoning. The number of notifications of food poisoning was five, but in two cases the notification was withdrawn. Ice Cream. The removal of restrictions on the manufacture of ice cream resulted in many registered sellers of this commodity recommencing operations, and in a number of fresh registrations. Twenty-four samples of ice cream and ingredients for its manufacture were examined bacteriologically. Samples from two vendors were most unsatisfactory, and the sale of ice cream at their premises was suspended. In one case the business changed hands and a new arrangement was made whereby ice cream was obtained from a well-known manufacturer, and in the other case improved conditions were obtained and manufacture and sale later recommenced. Sale of Food in Public Places. Section 16 (1) of the Food and Drugs Act, 1938, provides that every itinerant vendor of ice cream must display his name and address legibly and conspicuously on the stall, vehicle or container used. In September, the Council, as empowered by Sub-Section (II), resolved that the provisions of Section 16 should apply within the Borough of Woolwich in relation to all kinds of food (except milk) as it applies in relation to ice cream. PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Incidence. The numbers of cases of notifiable infectious diseases which occurred during the year after correction of diagnosis were as follows :— TABLE No. V. Diphtheria 8 Ophthalmia Neonatorum 4 Scarlet Fever 253 Dysentery 46 Puerperal Fever 6 Cerebrospinal Meningitis 8 Puerperal Pyrexia 19 Zymotic Enteritis 54 Erysipelas 56 Measles 1,301 Pneumonia 204 Whooping Cough 412 Poliomyelitis 1 Scabies 439 Malaria 6 Diphtheria. The number of confirmed cases of Diphtheria, 8, was the lowest ever recorded, and it seems fairly safe to say that there is a connection between this low figure and the efforts of the Department to produce a Diphtheria immune child population. For some years after the introduction of the Council's original 14 scheme, namely, immunisation by the family doctor, there was no great fall in the incidence of the disease, but during the last five years the numbers have fallen considerably. Although the fall was originally associated with evacuation, the introduction of immunising sessions at welfare centres to supplement the "family doctor" scheme secured the immunisation of increasing numbers of children. The return of the population has caused no rise in the incidence of diphtheria. On the Registrar General's estimated mid-1946 child population (27,600) the percentage of the child population in the Borough immunised is 69.5, but it is considered that this figure is low; many children who have returned to the Borough undoubtedly were immunised whilst evacuated, of which there is no record in the Department. There was one death from Diphtheria giving a death rate of .007 per 1,000 of the population. Whooping Cough. Immunisation against whooping cough is provided by means of a "family doctor" scheme, under which injections are given by the family doctor whose fees are paid by the Council. During the year, 426 children received injections, compared with 387 in 1945. Not all of these children received the full course of four injections. Tuberculosis. The work of the Tuberculosis Dispensaries is shewn below in tabular form, with figures for 1938 and 1945 for comparative purposes. It will be noted that the work of the Dispensaries has increased considerably:— 1938. 1945. 1946. Number of primary notifications 248 260 247 Number of persons examined for first time 1,312 1,443 1,691 Number of these found to be tuberculous 231 241 234 Number of contacts examined 512 332 403 Number of contacts found to be tuberculous 21 12 10 Total number of attendances 5,415 6,502 8,263 Number of patients referred by Medical Practitioners 437 776 926 Number of patients referred by Medical Boards — 110 91 Visits to homes of patients by Tuberculosis Visitors 4,522 3,742 3,560 Visits to homes of patients by Tuberculosis Officer 285 66 75 Number of X-ray examinations 1,156 1,843 2,494 Number of specimens of sputum examined 1,059 759 970 Number of specimens of sputum positive 157 93 118 Number of patients admitted to hospital or sanatorium 344 394 318 Number of patients given dental treatment 38 7 5 Number of cases on register at end of year 874 1,216 1,263 15 In the spring the Mass Radiography Unit of the London County Council was brought to Woolwich and set up in the Old Parochial Offices, Maxey Road, where it operated for a period of eight weeks. During this period the total number of persons examined was 8,438 (5,253 men and 3,185 women). Of these, 5,701 were Woolwich residents (3,798 men and 1,903 women), the remainder being persons working in, but living outside the Borough. Of the 5,701 Woolwich residents X-rayed by the miniature apparatus only 175 were referred for large films; of these 55 were referred to their own doctors as probably tuberculous, and 12 for some other abnormality. The artificial pneumo-thorax clinic at St. Nicholas' Hospital continued its work during the year. Dr. A. Wingfield, who had been consultant in charge of the clinic since its inception, was recruited to H.M. Forces in September, and was replaced by Dr. R. Hartley. The total number of attendances at the clinic was 1,051. Clinics at other London hospitals were attended by 56 patients, who received 1,317 refills. The number of applications for maintenance allowances received during the year was 88. On the 1st January, 109 patients were receiving an allowance, 78 were granted an allowance during the year, and at the end of the year 102 patients were in receipt of an allowance. The Tuberculosis Care Committee continued its excellent" work of providing for the after-care of patients and assistance to dependants. Four quarterly meetings of the full Committee were held, and the General Purposes Sub-Committee met on 12 occasions. Assistance was given in many ways including the supply of pocket money, clothing, shoes, extra nourishment, beds and bedding, fares for relatives to visit patients in institutions, and fees for the training of a patient at a Secretarial College. The funds come from interest on investments; donations both from employees of firms in the Borough and from private sources; and by the sale of Christmas Seals. Laboratory Facilities. The Council's bacteriological work is carried out in the Pathological Department of the Woolwich Memorial Hospital. During the year 633 throat and nasal swabs were examined; 1,187 specimens of sputum; 110 specimens of faeces; 1 specimen of bread; and 10 specimens of ice cream and 14 of ice cream ingredients. • The practice of submitting samples of water from the public swimming baths for examination was continued. Twenty-seven such samples were submitted during the year and apart from some occasional slight over-chlorination, the results were generally satisfactory. 16 Disinfection and Disinfestation. Infected articles of bedding, clothing, etc., and articles infested with bugs are disinfected at the Council's Disinfecting Station, White Hart Road, Plumstead; but the personal clothing of persons treated at the two Cleansing Stations is disinfected at those two stations. During the year 40,802 articles were disinfected at the three stations. The number of rooms disinfected after cases of infectious disease was 465, and of these 88 had been occupied by tuberculous persons. The number of rooms disinfested of vermin was 988. Personal Cleansing Stations are situated at the Turkish Baths, Plumstead High Street, and at the Eltham Hill Health Centre, Sherard Road. Part of the premises of the Turkish Baths was adapted as a Cleansing Station as a tempory measure after the destruction in 1941 of the former cleansing station at White Hart Road, and it has not been possible, so far, to make suitable alternative arrangements. The number of persons cleansed of vermin was 2,567 and the number of persons (including contacts) treated for scabies was 2,089. The total number of attendances was 6,026. G. 41. METROPOLITAN BOROUGH OF WOOLWICH. FROM THE MEDICAL OFFICER OF HEALTH. Health Department, Town Hall, Woolwich, S.E.18.