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23 Paratyphoid Fever Ulcerative colitis — 7 12/6/36 M. 13 Typhoid Fever Typhoid Fever — 8 19/7/36 F. 8 Typhoid Fever Enteric Fever — 9 11/8/36 F. 26 Typhoid Fever Gastro-enteritis — 10 25/9/36 F. 51 Paratyphoid Fever Acute Enteritis — 11 30/9/36 F. 12 Paratyphoid B. Paratyphoid B. — 12 2/10/36 F. 52 Paratyphoid B. Paratyphoid B. — Erysipelas, Malaria and Dysentery. The number of notifications of Erysipelas received was 68, compared with 78 in 1935. Four cases of Dysentery were notified. There were two notifications of Malaria (induced for therapeutic purposes).

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Anterior Poliomyelitis. Only one notification was received during the year compared with two in the previous year. The patient was admitted to the special ward reserved for such cases by the London County Council at the Western Hospital. 112 Encephalitis Lethargica. One case of this disease was notified and was removed to hospital. The diagnosis was not confirmed. Smallpox. There were no cases of smallpox. Cerebro-Spinal Meningitis. Fifteen cases were notified compared with three in 1935. There were six military cases. All the cases were admitted to hospital. Details of each case are given in the following Table No. 48. TABLE No. 48. Cerebro-spinal Meningitis, 1936. No. Date Notified. Sex. Age. Ultimate Diagnosis. Remarks. I 10/2/36 M.

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16 Cerebro-spinal Meningitis — 2 10/2/36 M. 14 Cerebro-spinal Meningitis — 3 10/2/36 M. 18 Cerebro-spinal Meningitis — 4 13/2/36 M. 15 Cerebro-spinal Meningitis — 5 18/2/36 F. 34 Cerebro-spinal Meningitis — 6 25/2/36 F. 5 Cerebro-spinal Meningitis Died 7 26/2/36 M. 18 Cerebro-spinal Meningitis Died 8 6/3/36 F. 7 Cerebro-spinal Meningitis Died 9 23/3/36 M. 19 Cerebro-spinal Meningitis Died 10 27/3/36 M. 15 Cerebro-spinal Meningitis — 11 28/3/36 M.

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23 Cerebro-spinal Meningitis — 12 31/3/36 M. 45 Pneumococcal Meningitis Died 13 16/4/36 F. 15 Cerebro-spinal Meningitis — 14 3/5/36 M. 24 Meningitis Died 15 12/8/36 M. 9 Sub-arachnoid haemorrhage . . — Whooping Cough. During the year 452 cases of Whooping Cough came to the knowledge of the Department, compared with 266 in 1935 and 253 in 1934. As this disease is not notifiable in the Borough, knowledge is usually obtained through the School Medical 113 Service, but exceptionally, cases are notified by medical practitioners and occasionally cases are discovered by the health visitors in their routine visits. Nursing.—One case was nursed under the Council's scheme, 14 visits in all being paid.

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The cost of this service was 14/-. Deaths.—-There were eight deaths certified to be due to this disease, compared with two in 1935. Ophthalmia Neonatorum. Twenty-six cases were notified, seven of which were admitted to hospital. Thirteen cases were nursed at home under the Council's scheme, 186 visits in all being paid. The cost of this service was £9 6s. Od. The following Table No. 49 gives details of each case. TABLE No. 49. Ophthalmia Neonatorum, 1936. Notified Date. Cases Treated Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hospital. 3/2/36 — Yes Yes — — — 18/2/36 Yes — Yes — — — 7/3/36 Yes — Yes — — — 21/3/36 Yes — Yes — —

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— 11/4/36 Yes Yes — — — 18/4/36 Yes — Yes — — — 22/4/36 Yes — Yes — — — 22/4/36 Yes — Yes — — — 22/4/36 — Yes Yes — — — 6/5/36 — Yes Yes — — — 7/5/36 Yes — Yes — — — 18/5/36 Yes — Yes — — — 10/6/36 Yes — Yes — — — 25/6/36 Yes — Yes — — — 26/6/36 Yes — Yes — — — 14/7/36 Yes — Yes — — — 28/7/36 Yes — Yes — — — 12/8/36 Yes — Yes — — — 15/8/36 Yes — Yes — — — 18/8/36 Yes — Yes — — — 5/9/36 Yes — Yes — — — 17/10/36 —

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Yes Yes — — — 28/11/36 — Yes Yes — — — 10/12/36 — Yes Yes — — — 16/12/36 Yes — Yes — — — 18/12/36 Yes — Yes — — — 114 Zymotic Enteritis. Sixty-three cases were notified during the year compared with five in 1935 and three in 1934. The age incidence is given in Table No. 41. Zymotic Enteritis at all ages and not limited to any particular months has been notifiable in Woolwich for many years. In recent years the number of cases notified has fallen considerably. During the year, owing to the occurrence of cases of illness sometimes diagnosed as gastric influenza, sometimes food poisoning, and sometimes diarrhoea, or diarrhoea and vomiting, a circular letter was sent to all medical practitioners in the Borough drawing their attention to the fact that Zymotic Enteritis was notifiable.

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This may account in large measure for the increase in the number of notifications. The number of deaths in children under two years certified to be due to diarrhoeal diseases was 25. Measles. The two main sources of our knowledge of the incidence of Measles in the Borough are the School Medical Service and the health visitors. Occasionally, however, information comes through the local nursing associations and from parents. During the year 2,060 cases (including 97 cases of German Measles) were discovered. In 1935 and in 1934 the corresponding figures were 656 and 2,392. Measles occurs in epidemic form every two years and usually lasts for four months.

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The incidence in each of the twelve months of the year was as follows :— January 53 February 401 March 824 April 376 May 202 June 104 July 68 August 12 September 3 October 10 November 5 December 2 From these figures it will be noted that the disease first assumed epidemic proportions in February, reached its peak in March and fell away thereafter. The Council's scheme for measles control was put in force at the beginning of the year, three temporary health visitors being appointed. They investigated every reported case of measles from whatever source information came ; they visited cases absent from school from unknown causes and every case of suspected measles. The staff health visitors made subsequent visits to cases where children were under school age, but where they were of school age the subsequent visits were made by temporary health visitors.

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115 Notices were sent to head teachers when the diagnosis of measles was not confirmed, when suspect cases were diagnosed as measles and when cases of measles in school children came to the knowledge of the department other than through the school medical service. The co-operation between the School Medical Service and the Department was excellent, visits being paid to every home where cases of measles or suspected measles were living, within 24 hours of the teacher sending the notification to the Department. The scheme worked very well in other respects. It enabled the normal routine work of the health visitors to be maintained with very little disturbance ; it ensured the early diagnosis of secondary cases and their exclusion from school in an infectious state ; it ensured the early provision of nursing assistance and it enabled arrangements to be made for the early admission of cases to hospital where necessary. Home Nursing.—In 45 cases nursing assistance was provided during the year, 499 visits in all being paid. The cost to the Council was £26 11s. 6d.

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Measles Serum,.—It was not possible to obtain a supply of Measles Serum and it was not used in any case treated at home. Hospital Treatment.—The number of children admitted to fever hospitals was 266. Deaths.—There were 13 deaths from measles during the year. Pneumonia. The number of cases notified was 249 compared with 255 in 1935. Of these 18 were influenzal. The number of deaths certified to be due to lobar or bronchial pneumonia was 97 and to acute influenzal pneumonia one. The ward incidence of the Pneumonias is shown in Table No. 40. There is misunderstanding about the notification of pneumonia. All primary pneumonias—lobar or broncho—have to be notified. Secondary pneumonias, with the single exception of acute influenzal pneumonia, are not notifiable.

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The main objects underlying notification are (a) statistical evidence of the prevalence of the disease or diseases and (b) the provision of nursing assistance if required. 116 In a recent memorandum the Ministry of Health suggest that a sanitary authority should be prepared to provide facilities for bacteriological examination of sputum. Various strains of the pneumococcus can now be differentiated by use of typespecific anti-sera—a matter of importance in the use of specific serum therapy. There are four types of anti-sera : types I. and II. are seldom found in healthy individuals, but are responsible for some 60 per cent, of all cases of lobar pneumonia ; type III. and the heterogeneous collection in group IV. are normally present in throats and seldom give rise to cases of pneumonia. Felton's serum, which the Council supplies (see appropriate paragraph) is used in types I. and II. cases. The following Table No.

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50 shows the number of notifications of Pneumonia received each month, classified by sex and according to type. It also shows the number of deaths occurring from acute primary pneumonia and influenzal pneumonia. TABLE No. 50. Monthly Incidence of Pneumonia. Month. Male. Female. Total. Type. No. of Deaths. Lobar. Broncho. Influenzal. Acute Primary (not specified) Acute Primary Pneumonia. Influenzal Pneumonia. January 31 15 46 5 12 3 26 12 1 February 22 20 42 7 10 1 24 12 — March 18 17 35 10 3 1 21 10 April 13 4 17 5 — 1 11 14 — May 7 7 14 3 1 1 9

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6 — June 10 4 14 4 — — 10 2 — July 4 1 5 — — 1 4 2 — August 4 3 7 2 1 1 3 5 — September 9 3 12 6 1 5 8 — October 7 4 11 3 1 ] 6 9 — November 13 7 20 5 6 1 8 7 — December 11 15 26 5 6 7 8 13 — 149 100 249 55 41 18 135 100 1 117 Nursing.—Nursing assistance is provided by the Council for cases of pneumonia, and during the year 25 cases were nursed, 603 visits being paid by the nurses of the local nursing associations. The total cost to the Council was £37 13s. 9d.

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Anti-Pneumococcal Serum.—During the year the Council provided, free of charge, anti-pneumococcal serum (Felton's) for the treatment of persons suffering from pneumonia to those medical practitioners who considered this form of treatment suitable. The total cost to the Council was £32 8s. 0d. Tuberculosis. The Council's Tuberculosis Service, which is under the general administrative control of the Medical Officer of Health, is in charge of a whole-time tuberculosis officer. He is assisted by three assistant medical officers who are whole-time officers in the service of the Council but spend three half-days per week in tuberculosis work and eight half-days in maternity and child welfare. There are also three wholetime tuberculosis health visitors, one clerk-dispenser, who acts as secretary to the Care Committee, and one clerk. Notifications.—During the year 217 cases of pulmonary tuberculosis and 36 cases of non-pulmonary tuberculosis were notified.

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These figures exclude 37 duplicate notifications. The ward incidence of notified cases of tuberculosis was as follows. In each case the first figure is the pulmonary figure and the second, the non-pulmonary:— Dockyard, 10 and Nil; St. Mary's, 7 and 2; River, 20 and 3; St. George's, 12 and Nil; Burrage, 6 and 1; Herbert, 10 and 1; Glyndon, 13 and 3; St. Margaret's, 18 and 1; Central, 10 and 5; St. Nicholas, 31 and 8; Abbey Wood, 14 and 2; Well Hall, 16 and 2; Avery Hill, 20 and 2; Sherard, 30 and 6.

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In order that the register may be correctly maintained, it is necessary to delete from the register all those who have died, or have been lost sight of, or who have removed to other areas, or who are regarded as cured, or those in whom the diagnosis was not confirmed, and to add to it new cases, lost eases found again, cured cases who relapse and transfers from other areas. The number of transfers to Woolwich was 48 and the number from Woolwich was 75. The following Table No. 51 shows the changes which took place in the register during the year 118 TABLE No. 51. Pulmonary Non-Pulmonary Totals.

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M. F. M. F. Number on Register on 1st January, 1936 458 340 93 84 975 Number of new Cases notified 130 87 15 21 253 Number of Cases restored 5 5 2 1 13 Other additions 12 15 6 3 36 Deletions 151 112 25 21 309 Number on Register on 31st December, 1936 454 335 91 88 968 It will be noted that the total number on the register at the end of the year was 968, and, of this number, 90.4 per cent. were on the dispensary register. In 1935 the corresponding percentage was 90.25 and in 1934, 91.75. The following table shows the new cases notified during the year and the corresponding case rates classified by parishes. TABLE No. 52. Woolwich.

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Plumstead. Kltham. The Borough. Pulmonary Tuberculosis: Cases 47 106 64 217 Rates 1.58 1.54 1.33 1.48 Non-Pulmonary Tuberculosis: Cases 5 21 10 36 Rates 0.16 0.30 0.21 0.24 The following Table No. 53 summarises the number of cases coming to the knowledge of the Department in 1936 and includes notifications received from general practitioners, cases not notified but included in death returns and those transferred from other areas. It does not include any duplicate notifications or those received from Medical Superintendents of hospitals on admission or discharge of patients. Deaths occurring within the year are classified in the same Table by age and sex groups. 119 TABLE No. 53. Tuberculosis—-New Cases and Mortality, 1936. Age Periods. New Cases. Deaths.

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Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0-1 year — — — 1 — — — — 1-5 years 2 1 2 3 — — 2 2 5-10 years 3 4 — 3 — — — 1 10-15 years 7 1 5 2 2 1 — — 15-20 years 10 15 3 5 3 8 2 1 20-25 years 15 19 2 4 3 9 1 — 25-35 years 37 27 2 3 16 9 — 1 35-45 years 18 19 1 2 14 5 1 — 45-55 years 21 8 1 1 12 4 — — 55-65

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years 19 1 1 1 10 – 1 — 65 and upwards 6 3 — — 7 1 — — 138 98 17 25 67 37 7 5 The following Table, No. 54, shows the site of disease in patients notified, each year since 1932. TABLE No. 54. Year. Lungs. Meninges. Intestines and Peritoneum. Glands. Joints. Spine. Other Forms. All Causes.

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1932 235 6 6 11 8 5 12 283 1933 207 7 4 14 10 4 6 252 1934 219 8 6 12 9 2 13 269 1935 209 5 2 10 5 4 7 242 1936 217 4 10 11 4 3 4 253 120 Deaths.—The following Table No. 55 shows the number of deaths and death rates every year since 1932. TABLE No. 55. Tuberculosis—Deaths and Death.Rates. Year. Deaths. Death.rates. All Forms. Pulmonary. Non. Pulmonary. All Forms. Pulmonary. Non. Pulmonary.

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1932 154 139 15 1.05 0.95 0.10 1933 135 116 19 0.92 0.79 013 1934 146 120 26 1.00 0.82 0.18 1935 136 121 15 0.93 0.82 0.10 1936 116 104 12 0.79 0.71 0.08 In addition to those recorded in the above Table, seven persons who had been notified as suffering from pulmonary tuberculosis died during the year from other causes and detailed information as to these is given in the next Table. TABLE No. 56. Case No. Date Notified as Tuberculosis. Cause of Death. 1 20/10/35 Cachexia, Bronchiectasis. 2 16/11/28 Cardiac failure. Chronic Nephritis, Emphysema.

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3 8/2/36 Carcinoma ventriculi. 4 8/6/16 Uraemia, Duodenal ulcer. 5 25/11/35 Toxaemia, Peritonitis, Pyelitis. 6 8/4/36 Endothelioma of Lung. 7 18/1/36 Carcinoma of Stomach. 121 The period which elapsed between notification and death is shown below :— TABLE No. 57. Period between Notification and Death. Pulmonary. Percentage. Non. Pulmonary. Percentage.

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Not notified 5 4.81 3 25.0 0.1 month 20 19.23 5 41.7 1.3 months 6 5.78 — — 3.6 months 8 7.69 — — 6.12 months 13 12.50 1 8.3 1.2 years 21 20.19 1 8.3 2.5 years 15 14.42 2 16.7 Over 5 years 16 15.38 — — 104 100.00 12 100.00 The ratio of non.notified deaths to the total tuberculosis deaths was as one is to 14. In 1935 it was as one is to 19 and in 1934, as one is to 6. Each failure to notify was investigated and differing explanations were given.

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It was found that three had been notified in other areas and not transferred here, two were acute cases who died in general hospitals and two were only diagnosed after post mortem. The County of London (Tuberculosis) Regulations, 1930, enable the County Council to maintain or arrange for the maintenance, otherwise than in their homes, of children living in London in houses where, owing to overcrowding or otherwise, they are, in the opinion of the County Medical Officer, in danger of being infected with tuberculosis ; or children whose parent or parents are receiving institutional treatment for tuberculosis and for whose care adequate arrangements cannot otherwise be made, are boarded.out during the absence of the parent. During the year eight children were thus dealt with. Public Health (Prevention of Tuberculosis) Regulations, 1925, provide for the compulsory discontinuance of employment of persons engaged in the treatment or handling of milk who are suffering from tuberculosis.

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Only one case of this kind came to the notice of the Council during the year, and on the patient's discharge from sanatorium he was found other work by the employing firm. Every milk vendor in the Borough is periodically reminded that the Tuberculosis Officer is willing to examine, free of charge, all employees or candidates for employment in the milk trade, but no requests of this kind were made during the year. 122 The Work of the Dispensaries.—The Council's Dispensary is situated at Maxey Road, Plumstead, and there is a branch dispensary at 11 Carnecke Gardens, Eltham. This branch was opened on the 11th July, 1936 and replaced the one at Well Hall Road. The Eltham Branch was opened in 1931 and its usefulness increases each year. One of the Tuberculosis Officers attends at the main Dispensary every week-day, but an evening session is held instead of an afternoon session, on Thursdays.

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Eight separate sessions in all are held for men, for women and for children. The branch dispensary is open on three half-days a week:—Monday afternoons for men and Wednesday and Friday mornings for women and children. The total number of attendances at the Dispensaries during 1936 was 5,494. In this connection it is interesting to point out that 186 of the persons notified during 1936 attended the dispensaries, which is equivalent to 73.5 per cent. The corresponding percentage in 1935 was 77.2 per cent. The corresponding percentage in 1934 was 75.08 per cent, and in 1933, 68.25 per cent. A return of the work of the Dispensaries is given in Table No. 58. In accordance with the Minister of Health's instructions the Dispensary figures are shown for the Borough as a whole and not for individual dispensaries.

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Home Visiting of Tuberculosis Cases.—On receipt of every notification the home is visited by the Tuberculosis Visitor, who advises as to any re-arrangement that seems possible and desirable in the interests of the patient and other members of the family. In the case of patients notified by the Tuberculosis Officer a visit is also made by one of the medical staff, who thus gains a knowledge of the home circumstances of the patient. The Tuberculosis Visitor endeavours to visit each home in her district once in three months, but, in the case of patients with recent and more active disease, visits are more frequent. The Examination of Home Contacts.—On receipt of a primary notification every effort is made to induce people living in the same house to present themselves for medical examination. In many cases, however, it is very difficult to persuade them to do so. If the tuberculosis visitor fails to secure the attendance of the contacts, a visit is made by one of the medical staff.

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During the year, 492 contacts were examined. In dealing with children it is the usual practice to do a Mantoux intradermal test, and, where a positive result is obtained, to X-ray the patient. During the 123 TABLE No. 58. Return showing the work of the dispensaries for 1936. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children.

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M. F. M. F. M. F. M. F. M. F. M. F. A.—NEW CASES examined during the year (excluding contacts):— (a) Definitely tuberculous 101 80 6 3 7 17 10 8 108 97 16 11 232 (6) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 153 161 95 63 472 B.—CONTACTS examined during the year: (a) Definitely tuberculous 7 4 3 3 — — 2 2 7 4 5 5 21 (6) Diagnosis not completed — —- — — — — — — — — — . — — (c) Non-tuberculous — — — — — — — — 75 146 112 138 471 C.

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—CASES written off the Dispensary Register as:— (a) Recovered 28 23 — — 4 ' 7 1 1 32 30 1 1 64 (6) Nonrtuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 238 311 208 201 958 D.—NUMBER OF CASES on Dispensary Register on December 31 st:— (a) Definitely tuberculous 368 307 27 22 42 51 31 29 410 358 58 51 877 (b) Diagnosis not completed — — — . — — — — — — — — 124 TABLE No. 58—continued. Return showing the work of the dispensaries for 1936. 1. Number of cases on Dispensary Register on January 1st 881 2.

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Number of eases transferred from other areas and cases returned after discharge under Head 3 in previous years 3 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 75 4. Cases written off during the year as Dead (all causes) 106 5. Number of attendances at the Dispensary (including Contacts) 5,494 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 231 7. Number of consultations with medical practitioners:— (a) Personal 80 (b) Other 1,082 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 433 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,316 10.

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Number of:— (a) Specimens of sputum, etc., examined 462 (b) X-ray examinations made in connection with Dispensary work 815 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (6) above 5 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 337 Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment). Provided by the Council 2 Provided by Voluntary Bodies Nil 125 year 241 children were subjected to the Mantoux intradermal test, and it will again be seen that those children in contact with a notified case of tuberculosis showed a very much higher percentage of positive results than where no such contact existed. TABLE No. 59. Contacts. 0-5 year8. 5-10 years. 10-15 years. Total.

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Percentage. Positive result 14 32 31 77 49.04 Negative Result 19 29 32 80 50.95 Non-Contacts. Positive result 4 5 7 16 19.05 Negative result 27 24 17 68 80.95 X.-ray Examinations.—X-ray examinations are now recognised as being essential in the diagnosis and investigation of cases of tuberculosis. At the present time every new adult patient attending the Dispensary is X-rayed, and in the case of children, all Mantoux positive cases are so examined, furthermore, post-sanatorium cases are also X-rayed from time to time. It must be pointed out that the figures shown here do not represent the total use made of X-rays in the treatment of Tuberculosis in Woolwich, as all patients undergoing artificial pneumothorax treatment are frequently screened and X-rayed during the progress of treatment, and, in certain cases, admitted to St.

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Nicholas Hospital, the X-ray film taken at that institution is available for the use of the Tuberculosis Officer. The only alteration during the year has been that, whereas all dispensary cases were previously X-rayed at the War Memorial Hospital approximately one-third of the patients are now sent to St. Nicholas Hospital for this purpose. This new arrangement came into force 011 the 1st July, and during the year, 631 examinations were made at the War Memorial Hospital and 182 at St. Nicholas Hospital. Co-operation with St. Nicholas Hospital.—As set out in previous reports, the Tuberculosis Officer visits St. Nicholas Hospital weekly. This is in accordance with an arrangement made with the London County Council in 1933 and subsequently renewed from time to time.

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Co-operation with Local Practitioners.—During the year 80 cases were seen by the Tuberculosis Officer at the homes of the patients, and 308 were referred to the Dispensary by medical practitioners in the Borough. 126 Co-operation with School Medical Service.—This continues to work in a very satisfactory way ; many cases are referred to the dispensary by the School Medical Officers and the child contacts of tuberculous patients are referred to the School Medical Service for special observation and supervision. Certain unsatisfactory children, e.g. post-sanatorium, gland and abdominal cases are recommended for admission to the Open Air School, and such children are brought to the Dispensary periodically, by the school nurse, for supervision and examination.

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Such children as are found on examination to be non-tuberculous but to be suffering from minor ailments are referred to the School Clinic, and other children whose condition warrants are referred to the School Care Organiser wdth a recommendation for the provision of milk and cod liver oil at school, and others to the Woolwich Invalid Children's Aid Association for convalescent treatment. Extra Nourishment.—Extra nourishment in the form of milk, eggs and butter is supplied to tuberculous persons on the certificate of the Tuberculosis Officer. This is done either through the Tuberculosis Care Committee or, in the case of patients in receipt of public assistance, through the London County Council. This form of assistance is not limited to the patients themselves, but can in approved cases be extended to the contacts of such cases. The extra nourishment is not intended for advanced cases of tuberculosis where real improvement cannot be expected, but only for such ante and post-sanatorium cases in which it may make a real difference to the prospects of recovery.

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Dental Treatment.—The dental treatment of tuberculous patients is carried out at the School Clinic, Brewer Street. During the year 17 cases received treatment, the number of attendances being 37. Patients requiring dentures are assessed according to their means. These were supplied in 8 cases at a cost of £34 5s. Od., and payments by patients amounted to £17 Is. 9d. In the case of certain insured persons, help towards the cost of dentures is obtained from approved societies, and this is taken into account when making the assessment. Finsen Light Treatment.—The agreement entered into by the Council with the London Hospital in 1921 for the treatment of patients suffering from Lupus in the Finsen Light Department of the Hospital is still maintained. A fee of five shillings is paid for each treatment. No patients were so treated during the year.

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Artificial Pneumothorax.—This treatment consists of collapsing a diseased lung and so putting the diseased portion out of action. This is done by introducing gas or air through a needle into the pleural cavity of the affected side and as such air becomes absorbed it is replaced at varying intervals. Refills have to be maintained over a lengthy period, which probably averages 2½ years. The Council pays a fee of 10s. 6d. each refill, and the work is at present carried out at several 127 hospitals, both in voluntary institutions and in those belonging to the London County Council, and occasionally patients return to sanatorium for this treatment. The number of patients who received such treatment during the year was 51, and the number of refills given was 779. Patients undergoing this treatment may be recommended for simultaneous treatment by sanocrysin, and the Council have sanctioned the payment, in such cases as are approved by the Tuberculosis Officer, of 3s.

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6d. per injection. No injections were made during the year. Woolwich Tuberculosis Care Committee.—At the end of the year the Committee was constituted as follows:— Bodies. Representatives. Woolwich Borough Council. Alderman Mrs. E. Brooks, Councillors R. Campbell, S. Crown, J.P., Mrs. L. E. Driver, G. Greenwood and C. J. Keedv. Trade Unions Mr. W. H. Fairchild, Mr. E. Ware. Employers Miss L. Ames, Miss E. Fletcher, Mr. A. J. Golding. Friendly Societies Mr. W. A. Lyon, Mr. A. J. Rourke, Mr. F. D. Smytho. London County Council Miss G. M. Aves, Dr. H. R. Kidner. London County Council (Public Assistance Committee). Mr.

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R. Campbell, Mrs. B. G. Dickinson, Mr. T. Moran. London Insurance Committee Mr. S. A. Brown Panel Committee for the County of London Dr. H. M. Wise British Red Cross Society Mr. J. P. O'Connell Woolwich Invalid Children's Aid Association Mrs. J. B. Great-Rex Late Tuberculosis Dispensary Committee Mr. W. Dashwood, Mr. E. G. Dixon, J.P. United Services Fund Mrs. A. Evans Ex-Officio. Voluntary Visitors Miss D. A. Frye, Miss M. Ross Tuberculosis Officer Dr. F. J. C. Blackmore Medical Officer of Health Dr. J. MacMillan, D.S.O., M.C. The Care Committee has continued to function efficiently during the past year and has been a great help to many patients whose special needs could not be met under the Council's Tuberculosis Scheme.

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Fares have been granted in 70 instances for visiting ; clothing was provided for 34 patients ; pocket money was given to 9 in sanatoria, three cases were assisted in the matter of a holiday, and one family was assisted with moving expenses. Two beds and a pair of spectacles were purchased for patients unable to meet the cost of these. The cost of one wireless licence was defrayed. Reference was made in last year's report to the Occupational Therapy Centre which was opened on October 31st, 1935. The initial difficulties with regard to the attendance of an instructor were overcome by the help of the London County Council, and he has attended since the beginning of February, 1936, on five half days a week. The highest number of patients on the attendance register has been 128 14 and the total number of attendances put in during the year was 4,351.

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It is satisfactory to be able to note that ten patients have so benefited from this work that they have been able to pass out into normal industry. It is inevitable that in dealing with the type of patient for whom this centre caters, there should be variations in attendances, as it is found that certain patients have relapses and need further periods of sanatorium treatment or rest in bed at home, but the total attendances indicate that the centre has met a real need. Institutional Treatment.—The following Table shows the number of admissions to special hospitals, sanatoria, public general hospitals, institutions and training colonies :— TABLE No. 60. Admissions to Hospitals, etc. Special Hospitals. Sanatoria. Public General Hospitals. Training Colonies.

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Insured 108 81 109 3 Uninsured 30 29 58 Children 38 12 15 176 122 182 3 These figures refer to 347 patients and the monthly admissions were as follows: January 37 February 36 March 46 April 48 May 55 June 39 July 43 August 50 September 43 October 31 November 35 December 20 Bacteriological Examination of Sputum.—During the year 462 specimens oi sputum were examined at the dispensary, and of these 43 were positive and 419 negative. Facilities for general practitioners are provided at the Woolwich War Memorial Hospital, and 326 specimens were examined during the year, 48 being positive and 278 negative. Out-door Shelters at the Homes of Patients.—Twelve shelters are maintained by the Council for patients returning from sanatoria and who are willing to continue this form of treatment. Eight were in use during the year.

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No charge is m ade for these shelters. 129 Home Nursing.—-This is provided for certain cases of tuberculosis, in accordance with the arrangements entered into with the local Nursing Associations. The number of visits paid by nurses during the year was 1,275 and the cost to the Council was £79 13s. 9d. Arrangements for Disinfection and Disinfestation and the Extent of Their Use. Disinfection.—The Council's Disinfecting Station is situated at White Hart Road, Plumstead, where there are installed two Washington Lyon steam disinfectors, one high-pressure steam washing disinfector, and one room for disinfecting articles which cannot be subjected to heat. The heavy demand on the Station owing to the work of bug eradication continued during the year. The Station is sometimes used for special disinfection at the request of inhabitants.

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A small charge is made for these disinfections and during the year 31 such disinfections were carried out, and charges amounting to £9 9s. Od. were paid. In tabular form is shown below the amount of disinfection which was carried out during the year. TABLE No. 61. Rooms disinfected after ordinary fevers 826 ,, ,, ,, tuberculosis 164 ,, ,, „ verminous cases 1,256 ,, ,, ,, for other reasons 21 Articles disinfected 49,244 Disinfestation.—In accordance with the terms of an agreement with the London County Council, disinfestation of school children is carried out at the Cleansing Station, White Hart Road. Disinfestation of adults is carried out at times when the children are not there. The following Table, No. 62 shows the number of persons cleansed each year since 1932. 130 TABLE No. 62. Year. Children. Adults.

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Grand Total. Boys. Girls. Total. Males. Females. Total. 1932 560 1,613 2,173 8 4 12 2,185 1933 550 1,579 2,129 7 11 18 2,147 1394 611 1,715 2,326 6 1 7 2,333 1935 603 1,818 2,421 10 3 13 2,434 1936 632 1,747 2,379 4 3 7 2,386 Scabies.—The number of cases of scabies coming to tlie knowledge of the Department during the year was 100, a considerable increase on the figures of previous years.

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In 1935 the corresponding figure was 64, in 1934 it was 77, in 1933 it was 57 and in 1932 it was 50. Thirty-nine of this year's cases occurred in Eltham and 61 in the rest of the Borough. The incidence of the disease per thousand population is much higher, therefore, in Eltham. It would appear as if the excessive proportion of children on new housing estates is now producing an increase in the incidence of scabies in the same way, as has been noted on many occasions in the past, the incidence of the common infectious diseases was increased. On the other hand undetected and untreated cases in adults present a great difficulty in the satisfactory control of scabies. It is not so easy to cure an Eltham child, two main difficulties standing in the way.

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From the middle of Eltham to the cleansing station at Plumstead is over 3 miles each way, so that the cost of transport of an infected family is considerable and each journey takes much more time. For these reasons the treatment is irregular and often inadequate. Arrangements for the establishment of a branch cleansing station at Eltham for the treatment of verminous conditions, including scabies, were under consideration at the end of the year. Bed-bug Infestation.—A report on the disinfestation of bug-infested premises and furniture and the methods adopted to prevent the infestation of new prennsts will be found in Section IV. 131 SECTION VIII. GENERAL STATISTICS. TABLE No. 63.

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Area (acres) 8,282 Population estimated to middle of 1936 146,500 Population, Census 1931:— Total (including military) 146,881 Civilians 141,504 Number of inhabited houses, 1931 29,870 Number of families or separate occupiers, 1931 38,176 Rateable value (April, 1936) £1,167,845 Sum represented by a penny rate (April, 1936) £4,774 Physical Features and General Characteristics of the Area. In the physical configuration of the Borough the outstanding feature is Shooters Hill, which rises over 400 feet above sea-level. At a little lower level, on the Woolwich and Plumstead side, there is the well-marked plateau of Woolwich and Plumstead Commons, due to the erosion of local clay from off the pebble beds. Lower down still is the level plain of the Thames.

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Southward, in Eltham and Lee, the land, after sloping downwards from Shooters Hill, rises slightly again in Eltham and then falls away towards New Eltham and Lee, but rises again as it approaches Chislehurst. In the main this area is composed of London clay although there is a considerable amount of sand and gravel in Avery Hill Ward. Population. The Registrar General estimates the population of the Borough at the middle of the year as 146,500, an increase of 100 on the previous year. This figure has been used in calculating rates for the purposes of this report. It should be noted that it includes non-civilians, the pre-war practice in this respect having been returned to from the beginning of 1932.

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In estimating the population of the wards of the Borough regard has been had to such information as is available from the records of the Housing Department so far as occupants of new Council houses are concerned and from the records of the Treasurer's Department if advances have been made under the Small Dwellings Acquisition Acts. The estimated population of each of the wards of the Borough at the middle of 1936 is shown in the following Table, No. 64. 132 TABLE No. 64. Wards. Population. Dockyard 6,249 St. Mary's 5,533 River 10,361 St. George's 7,551 Burrage 7,059 Herbert 8,816 Glyndon 7,773 St. Margaret's 12,343 Central 7,117 St.

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Nicholas 12,983 Abbey Wood 12,753 Avery Hill 14,816 Well Hall 10,904 Sherard 22,242 In the old parishes the estimated populations are therefore:— Woolwich 29,694 Plumstead 68,844 Eltham 47,962 These figures show very little variation from those of last year. The number of persons per acre, in 1931, was 17.7; in the Administrative County of London the corresponding figure was 58.7. The present figures for each of the wards in the borough are as follows:—Dockyard, 44.9; St. Mary's 55.9; River, 18.1; St. George's, 23.2; Burrage, 38.4; Herbert, 35.9; Glyndon, 25.7; St. Margaret's, 22.3; Central, 61.9; St.

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Nicholas, 10.8; Abbey Wood, 16.3; Avery Hill, 8.1; Well Hall, 15.8; Sherard, 17.8. Social Conditions. The following Table No. 65 sets out under generalised headings the total number of males and females engaged in occupations at ages of 14 years and upwards as shown by the Census of 1931. 133 TABLE No. 65. Occupations of Woolwich Inhabitants (over 14 years). Occupations. Males. Females. I. Fishermen — — II. Agricultural occupations 426 11 III. Mining and quarrying occupations 13 — IV. Workers in non-metalliferous mine and quarry products 74 1 V. Makers of bricks, pottery and glass 168 51 VI. Workers in chemicals, paints, etc. 926 13 VII.

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Metal workers 6,471 237 VIII. Workers in precious metals 69 9 IX. Electrical apparatus makers, fitters, etc. 1,696 1,086 X. Makers of watches, clocks, etc. 162 6 XI. Workers in skins and leather 135 34 XII. Textile Workers 22 48 XIII. Makers of textile goods 597 1,633 XIV. Makers of foods, drinks and tobacco 480 114 XV. Workers in wood and furniture 1,696 44 XVI. Workers in paper and cardboard 32 48 XVII. Printers and photographers 505 110 XVIII. Builders, bricklayers, etc. 2,485 2 XIX. Painters and decorators 1,182 46 XX. Workers in other materials 124 80 XXI. Workers in mixed or undefined materials (not enumerated elsewhere) 156 181 XXII.

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Transport Workers 5,547 463 XXIII. Commercial and financial occupations 5,221 1,926 XXIV. Public administration and defence 5,129 12 XXV. Professional occupations 1,432 1,358 XXVI. Persons employed in entertainment, etc. 326 61 XXVII. Persons employed in personal service 1,876 5,057 XXVIII. Clerks and draughtsmen 5,130 3,985 134 Table No. 65—continued. Occupations. Males. Females. XXIX. Warehousemen, storekeepers and packers 1,258 430 XXX. Stationary Engine Drivers, etc. 625 1 XXXI. Other and undefined workers 7,519 704 XXXII.

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Total Occupied 51,482 17,751 Total Unoccupied 5,313 39,963 Total Occupied and Unoccupied 56,795 57,714 Sickness and Invalidity. There have been no causes of sickness or invalidity which have been specially noteworthy in the area during the year. I am unacquainted with any conditions of occupation which appear to have had a prejudicial effect on health and I have no evidence, statistically or otherwise, that unemployment has exercised any significant influence on the health or physique of children or adults. 135 SECTION IX. VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the vital statistics of the year are shown below :— TABLE No. 66. Live Births—Legitimate 1,959 Live Births—Illegitimate 58 . 2,017 Birth Rate . 13.8 Still-births . 56 Still-births—Rate per 1,

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000 total births . 27.8 Deaths . 1,649 Death Rate . 11.2 Percentage of total deaths occurring in public institutions . 61.6 Number of women dying in, or in consequence of, Child Birth (a) From Sepsis . 2 (b) From other causes . 3 Death rate of Infants under one year of age :— . (a) All infants . 59 (b) Legitimate infants . 58 (c) Illegitimate infants . 138 Deaths from Cancer (all ages) . 259 Deaths from Measles (all ages) . 13 Deaths from Whooping Cough (all ages) . 8 Deaths from Diarrhoea (under 2 years of age) . 25 136 The chief Vital Statistics since 1901 are given in the following Table TABLE No. 67. Year. Population estimated to middle of each Year. Births. Nett Deaths belonging to the District. Nett.

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Under 1 year. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. (1) (2) (3) (4) (5) (6) (7) (8) 1901 117,652 3,536 30.1 457 129 1,709 14.6 1902 119,285 3,734 31.3 467 125 1,837 15.4 1903 117,842 3,684 31.3 398 108 1,638 13.9 1904 118,456 3,535 29.8 477 135 1,763 14.9 1905 118,589 3,546 29.9 362 102 1,604 13.5 1906 119,143 3,549 29.

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8 388 109 1,668 14.0 1907 119,704 3,330 27.8 373 112 1,616 13.5 1908 122,258 3,176 26.0 300 94 1,516 12.4 1909 120,227 2,947 24.5 242 82 1,587 13.2 1910 121,197 2,842 23.6 242 85 1,418 11.7 1911 121,487 2,810 23.1 272 97 1,566 12.9 1912 121,932 2,776 22.8 208 75 1,456 11.9 1913 122,382 2,833 23.1 228 80 1,549 12.7 1914 122,

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431 2,838 23.2 241 85 1,706 13.9 1915 a 138,200 2,839 21.9 268 94 1,837 14.2 b 129,505 1916 a 141,783 3,068 23.5 213 69 1,704 131 b 130,313 1917 a 147,078 2,718 20.6 216 79 1,566 11.9 b 131,942 1918 a 150,650 2,548 190 270 106 2,100 15.6 b 134,453 1919 a 141,918 2,737 20.1 235 86 1,679 12.3 b 136,237 1920 a 140,000 3,658 26.9 224 61 1,487 10.

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9 b 135,904 1921 a 141,700 3,197 23.2 197 62 1,594 11.6 b 137,604 1922 a 142,350 2,941 21.3 184 63 1,603 11.6 b 138,254 1923 a 143,530 2,867 20.5 123 43 1,387 9.9 b 140,000 1924 a 144,400 2,590 18.5 168 65 1,543 11.0 b 139,980 1925 a 145,440 2,582 18.3 141 55 1,519 10.8 b 140,740 1926 a 146,200 2,463 17.4 107 43 1,450 10.2 b 141,900 1927 a 144,

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770 2,242 15.9 95 42 1,491 10.6 b 140,770 1928 a 146,600 2,269 16.1 114 50 1,554 11.0 b 141,100 1929 a 146,800 2,312 16.3 144 62 1,780 12.6 b 141,600 1930 a 146,800 2,188 15.5 91 42 1,547 10.9 b 141,600 1931 a 147,400 2,155 15.1 128 59 1,654 11.6 b 142,600 1932 a 146,400 2,054 140 123 60 1,635 11.1 1933 a 146,200 1,857 12.7 116 62 1,634 11.

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2 1934 a 145,520 2,000 13.7 127 63 1,650 11 .o 1935 a 146,400 2,053 14.0 91 44 1,500 10.2 1936 a 146,500 2,017 13.8 121 59 1,649 11.2 a Total Population. b Civil Population. 137 The chief Vital Statistics for 193(5 for the Wards of the Borough are given in the following Table:— TABLE No. 68. Wards. Population. Births. Deaths under 1. Deaths at all ages Number Rate. Number Rate. Number Rate. Dockyard 6,249 116 18.5 5 43 68 10.9 St.

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Mary's 5,533 82 14.8 6 73 76 13.7 River 10,361 149 14.3 13 87 152 14.6 St. George's 7,551 124 16.4 7 56 76 10.1 Woolwich 29,694 471 15.9 31 66 372 12.5 Burrage 7,059 97 13.7 8 82 89 12.6 Herbert 8,816 126 14.3 9 71 117 13.2 Glyndon 7,773 118 15.2 9 76 119 15.3 St. Margaret's 12,343 171 13.8 4 23 144 11.7 Central 7,117 101 14.2 5 49 96 13.5 St.

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Nicholas 12,983 181 13.9 18 99 191 14.8 Abbey Wood 12,753 190 14.9 16 84 137 10.7 Plumstead 68,844 984 14.3 69 70 893 12.9 Well Hall 10,904 102 9.4 3 29 87 7.9 Avery Hill 14,816 164 11.1 2 12 126 8.5 Sherard 22,242 296 13.3 16 54 171 7.7 Eltham 47,962 562 11.7 21 37 384 8.0 BOROUGH 146,500 2,017 13.8 121 59 1,649 11.2 If the rates in St. Mary's, River and St.

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George's Wards and in Woolwich parish are compared with those of previous years, it must be borne in mind that from 1915 to 1931, these rates were calculated on the civilian population and not on the total population. Births. During the year 2,362 births were registered in the Borough, 1,257 being males and 1,105 females. Corrected by outward (327 males and 297 females) and inward (158 males and 121 females) transfers, these numbers become 2,017, 1,088 and 929 respectively. The birth-rate was 13.8 compared with 14.0 in 1935 and 13.7 in 1934. 138 Illegitimate Births.—The number of illegitimate births registered was 43. There were 21 inward transfers and 6 outward transfers, making a nett figure of 58, equivalent to 29 per 1,000 births.

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Natural Increase of Population.—This term means the excess of births over deaths. In 1932 it was 419; in 1933, 223; in 1934, 350; in 1935,553, and in 1936, 368. Notification of Births.—During the year 2,349 live births were notified. This is at the rate of 99.4 per cent, of the registered births and compares with 99.6 per cent, last year. The births were notified as shown in the following Table :— TABLE No. 69. British Hospital for Mothers and Babies 818 Midwives 546 St.

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Nicholas Hospital 400 War Memorial Hospital 210 Military Families Hospital 197 Medical Practitioners 58 Eltham Cottage Hospital 39 Parents 31 Midwives' Homes 23 Other persons 27 In addition to these, 112 notifications were received from the Medical Officer of Health, Lewisham; 96 from the Medical Officer of Health, Greenwich, and 44 from other Medical Officers of Health ; 601 births were transferred to other areas. Seventy-three still-births were notified, 18 of which were transferred to other areas. It is known that 1,350 Woolwich births took place in institutions, either within or without the Borough, so that the percentage of institutional midwifery for the Borough was 66.9. The following Table No.

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70 shows the number of corrected births each year since 1932; the number of live and still-births notified; the percentage of notified births and the birth rates for the same period for Woolwich, London, and England and Wales. 139 TABLE No. 70. Year. No. of Births. No. of Live Births. Notified. No. of StillBirths Notified. Percentage of Births Notified. Birth Rate. Woolwich. London. England and Wales.

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1932 2,054 2,209 78 98 14.0 14.3 15.3 1933 1,857 2,154 59 99 12.7 13.2 14.4 1934 2,000 2,334 75 99 13.7 13.2 14.8 1935 2,053 2,405 81 99 14.0 13.3 14.7 1936 2,017 2,349 55 99 13.8 13.6 14.8 Marriages. There were 1,422 marriages (1,315 in 1935). The marriage rate was 19.4 as compared with 17.9, 18.19, 17.70 and 15.79 in the four preceding years. Deaths. The total number of deaths registered in the Borough was 1,288.

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This figure includes 155 non-residents who died in the district but does not include 516 residents who died outside the Borough. When allowance is made for inward and outward transfers, the nett figure of 1,649 is obtained. The death-rate for the year was 11.2 compared with 10.2 in 1935 and 11.3 in 1934. In order to make the local death-rate comparable from a mortality point of view with the crude death-rate of the country as a whole or with the mortality of any other area, the Registrar General supplies a factor by which the crude death-rate should be multiplied, based upon the age and sex constitution of the population. This adjusting factor for Woolwich is 1.06, so that the adjusted death-rate for 1936 is 11.8.

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In 1936 the death-rate for England and Wales was 12.1, for London 12.3 and the mean death-rate for 122 County Boroughs and Great Towns (including London) was 12.3. The seasonal mortality in the four quarters of the year was as follows :— First quarter, 13.6; Second quarter, 11.6; Third quarter, 8.4; Fourth quarter, 11. 140 Deaths over 45 years of age.—The number of deaths which occurred at 45 years of age and over was 1,225, or 74.2 per cent of the total deaths. The chief causes of these deaths were as follows:—heart disease, 404; cancer, 241; cerebral haemorrhage, 69; bronchitis, 65; pneumonia, 53 other circulatory diseases, 53 and tuberculosis, 35.

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Deaths in Public Institutions.—In tabular form is shown below the number of deaths of Woolwich residents which took place in various institutions during the year :— TABLE No. 71. Hospitals or Institutions. Number of Deaths. Public General Hospitals 770 Voluntary General Hospitals 133 Infectious Diseases Hospitals 57 Mental Hospitals 51 Special Hospitals 50 Cottage Hospitals and Nursing Homes 45 Sanatoria and Tuberculosis Institutions 8 1,114 As the total number of deaths was 1,649, the percentage of institutional deaths to total deaths was therefore 61.6. The following tables show the Birth Rates, Death Rates and Analysis of Mortality, the Nett Deaths (including non-residents in institutions in the Borough) and the Nett Deaths classified by sex and wards. 141 TABLE No. 72. Birth Rates, Death Rates and Analysis of Mortality in the Year 1936. Rate per 1,000 Population. Annual Death-rate per 1,000 Population.

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Rate per 1,000 Live Births. Percentage of Total Deaths. All Causes Typhoid and Paratyphoid Fevers. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under 2 yrs.1 Total Deaths under 1 year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. Live Births. Still - Births.

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England and Wales 14.8 0.61 12.1 0.01 – 0.07 0.01 0.05 0.08 0.15 0.55 5.7 59 90.4 6.2 2.4 1.0 122 County Boroughs and Great Towns, including London. 14.9 0.59 12.3 0.01 – 0.10 0.01 0.06 0.09 0.13 0.54 7.8 63 90.9 5.6 3.0 0.5 143 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931).

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15.0 0.64 11.6 0.01 – 0.05 0.01 0.04 0.07 0.16 0.54 4.6 56 92.0 5.0 1.9 1.1 London 13.6 0.45 12.3 0.01 – 0.14 0.01 0.07 0.05 0.13 0.56 14.5 66 87.9 5.9 6.1 0.1 WOOLWICH 13.8 0.31 11.2 0.01 – 0.08 0.03 0.05 0.05 0.13 0.53 12.4 59 87.1 8.8 4.1 – 142 TABLE No. 73.

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Nett Deaths during the calendar year 1936, including non-residents in Institutions in the Borough. 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 Instit utions Residents. NonResid'ts. All Causes 1649 121 23 21 28 64 73 94 168 284 372 401 513 137 503 Typhoid and Paratyphoid Fevers 1 . . . . . .

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. . . 1 . . . 1 Measles 13 2 4 5 2 . . . . . . . 1 . 9 Scarlet Fever 4 . . 2 2 . . . . . . . . . 4 Whooping Cough 8 3 2 3 . . . . . . . . . . 7 Diphtheria 7 1 . 2 4 . . . . . . . . . 7 Influenza 19 . . . . 2 2 3 2 4 3 3 6 1 3 Encephalitis Lethargica 4 . . . . . 1 1 1 1 . . 2 . 2 Cerebro-Spinal Meningitis 6 . 1 1 2 2 . . . . . . . . 6 Tuberculosis of Respiratory System 104 . . .

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3 23 25 19 16 10 5 3 46 13 20 Other Tuberculous Diseases 12 . 3 1 1 4 1 1 . 1 . . 4 1 5 Syphilis 3 1 . . . . . . 1 . 1 . 2 . 1 General Paralysis of the Insane, Tabes Dorsalis 5 . . . . . . 2 2 l . . . . 5 Cancer 259 . . . . 2 3 13 48 63 86 44 77 12 75 Diabetes 30 . . . 1 . . . 2 8 14 5 7 2 13 Cerebral Haemorrhage, etc. 71 . . . . . . 2 4 13 22 30 16 2 28 Heart Disease 423 . . . .

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5 4 10 29 70 143 162 123 15 86 Aneurysm 8 . . . . . . . . 5 3 . 1 . . Other Circulatory diseases 55 . . . . . 1 1 2 12 19 20 11 2 25 Bronchitis 72 2 . 1 . . l 3 6 14 11 34 4 2 16 Pneumonia 101 27 6 4 1 . 4 6 14 23 10 6 35 7 31 Other Respiratory diseases 21 . 1 . . 1 2 1 2 3 2 9 7 2 4 Peptic Ulcer 20 . . . . 2 1 3 4 6 3 1 14 4 5 Diarrhoea, etc.

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30 25 .. .. 2 .. .. .. 1 1 1 .. 6 6 19 Appendicitis 7 .. .. 1 1 2 .. 1 1 1 .. .. 4 1 3 Cirrhosis of Liver 3 .. .. .. .. .. .. .. .. 1 2 .. 2 1 1 Other diseases of Liver, etc.

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9 .. .. .. .. .. 1 1 1 3 3 .. 4 .. 4 Other Digestive diseases 20 2 .. .. .. .. 1 2 4 3 4 4 12 7 6 Acute and Chronic Nephritis 34 .. .. .. .. 2 3 4 5 6 6 8 11 2 5 Puerperal Sepsis 2 .. .. .. .. 1 1 .. .. .. .. .. 1 1 .. Other Puerperal Causes 3 .. .. .. .. .. 3 .. .. .. .. .. 2 .. 1 Congenital Debility, Premature Birth, Malformations, etc.

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49 48 .. .. .. .. 1 .. .. .. .. .. 22 16 18 Senility 37 .. .. .. .. .. .. .. .. .. 4 33 12 1 14 Suicide 18 .. .. .. .. .. 7 6 1 4 .. .. 2 3 6 Violence 60 2 2 1 3 4 2 6 8 8 9 15 36 14 10 Other defined Diseases 131 8 4 .. 6 14 9 9 14 23 20 24 43 22 63 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 143 TABLE No. 74 Nett Deaths during 1936, classified by Sex and Wards. Causes of Death. the Borough. Woolwich. Plumstead. Eltham. Males. Females. Dockyard.

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St. Mary's River. St. George's Burrage. Herbert. Glyndon. St. Margaret's. Central. St. Nicholas. Abbey Wood Well Hall. Avery Hill. Sherard. All Causes 891 758 68 76 152 76 89 117 119 144 96 191 137 87 126 171 Typhoid and Paratyphoid Fevers. . 1 – – – – – – – – 1 – – – – – – Measles 7 6 – 2 2 2 1 – 1 1 – 1 2 – – 1 Scarlet Fever 3 1 – 1 – – – – – 1 – 1 – – – 1 Whooping Cough 2 6 – – – 1 1 – 1 – – 1 1 – 1 2

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Diphtheria 3 4 – 1 – – – – 2 – – 1 1 – 1 1 Influenza 10 9 1 – – 2 1 2 2 3 – – 3 2 2 1 Encephalitis Lethargica 2 2 – – 1 1 – – – – – 2 – – – – Cerebro-Spinal Meningitis 3 3 – – 1 3 – – – – – – 1 – – 1 Tuberculosis of Respiratory System 67 37 4 3 12 3 6 4 13 7 5 14 5 4 8 16 Other Tuberculous Diseases 7 5 – – 1 – – – – 3 1 – 1 – – 6 Syphilis 2 1 – – 1 – – – 1 – – 1 – – – – General

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Paralysis of the Insane Tabes Dorsalis 3 2 – – 1 1 – 2 – – – – 1 – – – Cancer 133 126 12 9 29 13 12 19 15 19 15 29 22 14 24 27 Diabetes 14 16 1 2 1 – 2 – 1 4 3 5 4 1 2 4 Cerebral Haemorrhage, etc. 31 40 5 2 8 – 7 4 4 7 – 9 4 8 4 9 Heart Disease 223 200 18 21 37 9 29 32 34 34 34 48 38 22 31 36 Aneurysm 4 4 – 1 – 2 – – – 3 – 1 – – – 1 Other Circulatory Diseases 29 26 3 4

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2 1 2 7 1 7 2 4 3 3 10 6 Bronchitis 41 31 1 2 7 3 8 5 6 10 2 11 7 5 – 5 Pneumonia 59 42 5 3 16 3 5 7 9 6 5 12 6 9 8 7 Other Respiratory Diseases 9 12 1 – 2 – 1 3 1 – – 4 6 – 3 – Peptic Ulcer 17 3 – 1 2 1 2 1 4 1 1 4 – – 2 1 Diarrhoea, etc.

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15 15 1 1 6 1 3 – – 2 2 5 8 – – 1 Appendicitis 3 4 – 1 1 1 – – – 3 – 1 – – – – Cirrhosis of Liver 3 – – – – – – – – – 1 1 – – 1 – Other Diseases of Liver, etc.

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4 5 – 1 – – – 1 – 1 1 2 1 – 2 – Other Digestive Diseases 14 6 – 1 – 1 1 2 2 – 3 1 2 1 3 3 Acute and Chronic Nephritis 14 20 1 2 3 1 – 3 1 4 1 1 1 6 5 5 Puerperal Sepsis – 2 – – 1 – – – – – – – – – – 1 Other Puerperal causes – 3 – – – – – – – 2 – – – – 1 – Congenital Debility, Premature Birth, Malformations, etc.

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29 20 2 1 4 4 2 6 1 4 1 6 5 3 1 9 Senility 13 24 2 3 6 1 – 5 1 4 5 2 2 – 3 3 Suicide 14 4 1 1 – 3 – 1 1 – 1 2 2 – 4 2 Violence 38 22 4 6 2 5 2 4 3 8 5 6 2 2 2 9 Other Defined Diseases 74 57 6 7 6 14 4 9 15 9 8 16 9 7 8 13 Causes ill-defined or unknown – – – – – – – – – – – – – – – – 144 Causes of Death.—-Table No.

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73 shows that 423 deaths were due to heart disease, 259 to cancer, 116 to tuberculosis, 101 to pneumonia, 72 to bronchitis, 71 to cerebral haemorrhage and 55 to diseases of circulation. There were 49 deaths from congenital debility and prematurity. Seventy-four per cent, of all deaths occurred in persons over 45 years of age. Respiratory Diseases.—The following Table No. 75 shows the number of deaths each year since 1932 from respiratory diseases, the amiual death-rate, the number of deaths under five years of age, and the percentage of deaths occurring in children under five years of age :— TABLE No. 75. Year. Bronchitis. Pneumonia. Other Respiratory. Total. DeathRate. Number under 5 years. Percentage under 5 years.

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1932 67 81 21 169 1.2 40 23.6 1933 52 86 16 154 1.0 21 13.6 1934 58 126 14 198 1.3 47 23.7 1935 45 84 15 144 0.98 31 21.5 1936 72 101 21 194 1.1 41 21.1 Cancer.—The total number of deaths was 259, of which 133 occurred in males and 126 in females. In the following Table No. 76 is shown the number of deaths certified as due to Cancer and Malignant Disease, each year since 1932:— TABLE No. 76. Males. Females. Total. Rate. Percentage of Total Deaths.

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1932 108 102 210 1.43 12.84 1933 105 103 208 1.42 12.72 1934 119 103 222 1.52 13.45 1935 106 107 213 1.45 14.20 1936 133 126 259 1.57 15.71 145 The following Table No. 77 shows the seat of primary disease in all deaths from Cancer, including all other specified malignant tumours. TABLE No. 77. Seat of Primary Disease Males. Females. Total. Deaths in Hospital. Lip 1 – 1 1 Tongue 4 – 4 3 Mouth and Tonsil 4 1 5 4 Jaw 1 – 1 – Pharynx 3 – 3 3 Oesophagus 10 4 14 8 Stomach 25 21 46

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26 Liver and Gall Bladder 2 7 9 1 Intestines 15 18 33 19 Rectum 14 12 26 16 Ovary – 8 8 7 Uterus – 9 9 5 Breast – 26 26 15 Skin 1 2 3 2 Larynx 6 1 7 6 Lung 9 4 13 7 Bronchus 3 – 3 3 Pancreas 5 1 6 5 Kidney – 1 1 1 Bladder 7 – 7 5 Prostate 12 – 12 5 Others and unspecified 6 5 11 4 Sarcoma 5 6 11 6 133 126 259 152 146 The Table which follows would appear to show a steady lowering of the maternal mortality rate in this Borough TABLE No. 78.

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Maternal Mortality, Woolwich, 1912-1936. Year. Abortion. Ectopic Gestation Placenta Praevia. Other Puerperal Haemorrhage. Other Accidents of Child Birth. Child Birth with Secondary Causes. Puerperal Eclampsia Puerperal Phlebitis and Embolism Puerperal Fever. Totals. 1912 1 – – – – – 1 1 1 4 1913 1 – – – 1 – 1 – 2 5 1914 1 – 1 2 – 1 1 1 4 11 1915 1 1 – – 1 – 2 – 3 8 1916 – 1 1 1 4 – 1 – 7 15 1917 – 1 – 2 – 1 2 1 7 14 1918

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1 – – 2 1 – 1 1 9 15 1919 – 2 1 2 – – 2 1 5 13 1920 – 1 – – 1 – 1 3 5 11 1921 – – – – – – 3 2 5 10 1922 – – – 1 – – 2 – 3 6 1923 – – – – 1 – 1 – 3 5 1924 – – 2 1 1 – 3 1 2 10 1925 – – 1 2 1 1 1 – 3 9 1920 – 1 _ 2 – – – 1 2 6 1927 – 1 — – – – 1 1 3 6 1928 – 2 1 – 1 – 1 – 8 13 1929 2 2 – –

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2 1 3 1 3 14 1930 1 – – – – 1 2 – 4 8 1931 – – – – 1 – 1 – 6 8 1932 – – – 1 – – 1 – 4 6 1933 – 1 – – 1 1 – 1 2 6 1934 – – – – – 1 – – 2 3 1935 – – – 1 – – – 1 1 3 1936 – 1 – – – 1 – 1 2 5 Totals 8 14 7 17 16 8 31 17 96 214 Inquests.—There were 145 inquests held on Woolwich residents during the year, compared with 129 in 1935.

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Deaths of Children, 1-5 Years of Age.—The number of deaths of children between 1 and 2 years of age was 23, and between 2 and 5 years, 21. In 1935 these figures were 10 and 13. The causes of death are given in detail in Table No. 73. The following Tables show the variation in the rate of mortality at these ages in the last five years. These rates have been calculated on the estimated populations at these ages and in stated groups of diseases. 147 TABLE No. 79. Child Mortality (1—2 years). Death-rates per 1,000 estimated age population from stated Groups of Diseases. Period. Estimated mean Population. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhoeal Diseases. All other Causes. Total Deaths.