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The foods examined included:— milk, 258; condensed milk, 15; cream, 8; cheese, 8; butter, 11; margarine, 17; lard, 7; baking powder, 6; rice, 8; arrowroot, 5; cornflour, 5; ground almonds, 6; dried fruit, 9; ginger, 10; dried herbs, 4; preserves, 34; vinegar, pickles, etc., 34; cocoa, 5; coffee, 9; tea, 14; meat, 9; canned soup, 4; sausages, 32; suet, 7; fish, 33; fish paste, 6; canned vegetables, 24; canned fruit, 16; confectionery, 11; beer and spirits, 6; fruit drinks, 4; ice cream, 4; iodine, 9; and 55 others.

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The following Table gives details of adulterated samples and the action taken in each case where the sample was formal. TABLE No. 4. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 514 Margarine Informal Contained water, 16.4 per cent. — 527 Margarine Informal Genuine Margarine, but incorrectly labelled. — 602 Milk Informal Contained a small proportion of added water. — 603 Milk Informal Contained 2 per cent. of added water. — 610 Beef Suet Informal Contained ground rice, 15.3 cent. — TABLE No. 4 —continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 630 Milk Informal Contained 1 per cent. of added water.

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— 640 Milk Informal Contained a small proportion of added water. — 649 Margarine Informal Genuine margarine, but incorrectly labelled. — 661 Margarine Informal Contained water, 16.5 per cent. — 710 Pork Sausages Informal Contained sulphur dioxide, 35 parts per million. — 715 Sardines, canned Informal Contained lead, 6 parts per million. — 25 Sausages Informal Contained sulphur dioxide, 260 parts per million. — 46 Strawberry Jam Informal Contained sulphur dioxide, 100 parts per million. — 54 Olive Oil Informal Contained foreign vegetable oils, not less than 40 per cent. — 64 Margarine Informal Genuine margarine, but incorrectly labelled. — 114 Olive Oil Formal Contained foreign vegetable oils, not less than 60 per cent. — 121 Strawberry Jam Formal Contained sulphur dioxide, 60 parts per million.

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Vendor cautioned. 134 Milk Formal 6 per cent. of the milk fat abstracted. Case dismissed. 152 Margarine Informal Genuine margarine, but incorrectly labelled. — 162 Milk Formal 4 per cent. of the milk fat abstracted. Re-sampled. 181 Strawberry Jam Informal Contained sulphur dioxide 80 parts per million. — 216 Sardines, canned Informal Contained lead, 7 parts per million. — 252 Milk Formal 11 per cent. of the milk fat abstracted. Summons withdrawn. 272 Tincture of Iodine Informal Iodine, 8 per cent. deficient; potassium iodide, 23 per cent. excessive. 284 Ground Rice Informal Consisted entirely of cornflour. — 297 Milk Formal Contained 21 per cent. of added water; the sample was also 16 per cent.

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deficient in milk fat, but this deficiency may have been due to the added water. Vendor fined £3. £2 2s. costs. 298 Milk Formal 5 per cent. of the milk fat abstracted. Re-sampled. 302 Milk Formal 18 per cent. of the milk fat abstracted. Defendant died after service of summons. 338 Marmalade Informal Contained soluble solids, only only 66.0 per cent. — 350 Sausages Formal Contained sulphur dioxide, 52 parts per million. Vendor cautioned. 12 13 TABLE No. 4—continued. Sample No. Article. Formal or Informal. Result of Analysis. Result of Legal Proceedings or other Action. 354 Lard Informal Contained foreign vegetable fat, not less than 50 per cent. — 397 Quinine, Ammoniated Tincture of.

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Informal Ammonia, 33 per cent. deficient. — 425 Quinine, Ammoniated Tincture of. Formal Ammonia, 30 per cent. deficient. — 440 Milk Formal Contained 1 per cent. of added water. — 444 Milk, sterilised Informal Contained 1 per cent. of added water. Food Poisoning. The number of notifications of cases of food poisoning was 27. PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 659. They relate to the following disease:— TABLE No. 5.

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Diphtheria 61 Ophthalmia Neonatorum 17 Scarlet fever 128 Encephalitis Lethargica 1 Enteric fever (including Paratyphoid) 1 Dysentery 4 Puerperal fever 5 Cerebrospinal Meningitis 32 Puerperal pyrexia 19 Poliomyelitis 2 Erysipelas 44 Polio-Encephalitis 1 Smallpox — Zymotic Enteritis 21 Pneumonia 231 Measles 83 Malaria 2 Whooping Cough 7 Diphtheria. The amount of anti-toxin supplied to medical practitioners during the year was 4,000 units. The number of children immunised during the year was 239, 14 Ophthalmia Neonatorum. Seventeen cases were notified, 3 of which were admitted to hospital. Nursing assistance was provided under the Council's scheme in 13 cases.

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Cerebrospinal Meningitis. Thirty-two cases were notified compared with 9 in 1939, and 6 in 1938. With the exception of seven in army barracks the cases were sporadic. All the cases were removed to hospital and in 10 cases the diagnosis was not confirmed. There were five deaths. Tuberculosis. The number of new cases examined was 779. Of these 151 were definitely tuberculous. 271 contacts were examined, of which 20 were definitely tuberculous. The total number of attendances at the Dispensaries was 3,224 ; 4,025 visits were made by nurses to homes of patients, and 290 domiciliary visits were paid by the Tuberculosis Officer or an Assistant Medical Officer. 344 cases were referred to the Dispensaries by medical practitioners and 81 by Medical Boards.

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507 specimens of sputum were examined, of which 104 were positive ; and 1,033 X-ray examinations were made. The number of cases on the register on the 31st December, 1940, was 962. 98 patients received artificial pneumothorax treatment. Additional nourishment was granted in 385 instances. 37 patients received dental treatment under the Council's scheme. 331 patients were admitted to hospitals, sanatoria, or training colonies. The Tuberculosis Care Committee continued their meetings and rendered valuable assistance in various ways to the needy tuberculous and their families. Laboratory Facilities. The bacteriological work of the Council is carried out at the War Memorial Hospital. In addition to the number of examinations made for the tuberculosis service, 362 specimens were examined for diagnostic purposes in the case of diphtheria, 3 in the case of enteric fever, and 1 on account of other disease. Disinfection and Disinfestation.

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The number of rooms disinfected after cases of infectious disease, etc., was 487. Of these 113 were rooms which had been occupied by tuberculous persons. 1,093 rooms were disinfected for verminous cases. 45,931 articles were disinfected at the Disinfection Station. The number of school children cleansed at the Cleansing Station, in accordance with the terms of the agreement with the London County Council was 1,276. The number of adults cleansed was 60. In addition, 35 French and Belgian refugees were cleansed. In September, the Cleansing Station at Whitehart Road was damaged by enemy action and it was necessary to form a new station for the cleansing of verminous persons. Fortunately, it was possible to do this in the Plumstead Turkish Baths building, where a limited amount of disinfection by dry heat could be arranged. 15 TABLE No. 6.

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Notification of Infectious Diseases (including Tuberculosis), 1919 to 1940. Year. Smallpox Diphtheria and Mem. Croup. Erysipelas Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. §Puerperal Pyrexia. Primary Pneumonia. Influenzal Pneumonia. Malaria. Dysentery. Anthrex. Ophthalmia Neonatorum. Encephalitis Lethargica. Cerebro-spinal Meningitis. Poliomyelitis and Polio-encephalitis. ‡Zymotic Enteritis. Pulmonary Tuberculosis. Tuberculosis Non-pulmonary. †Measles x Chicken Pox.

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*Whooping Cough 1919 4 398 63 243 26 — 7 — 123 — 61 7 1 34 3 7 1 123 394 80 1,886 — — 1920 1 427 82 538 6 — 13 — 136 — 29 1 — 29 3 6 — 31 359 69 1,013 — — 1921 — 592 59 1,351 11 — 14 — 187 49 10 — — 32 9 2 — 454 285 71 481 — — 1922 — 437 37 511 8 1 11 — 212 133 11 — — 26 3 2 4 31 245 60 2,

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698 — — 1923 — 152 40 334 16 — 8 — 196 46 4 1 — 18 1 5 6 49 245 66 194 — — 1924 — 195 45 440 11 — 7 — 249 105 3 1 — 27 17 12 5 13 273 69 2,679 — — 1925 — 299 44 364 16 — 9 — 237 40 5 1 — 31 10 5 1 13 246 54 1,916 — — 1926 — 393 46 411 8 1 4 7 259 33 5 — — 18 7 9 5 23 287 52 1,

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246 — — 1927 — 278 65 478 9 — 8 30 280 36 3 1 — 19 6 4 3 12 269 84 457 — — 1928 3 300 89 529 17 — 20 28 216 14 12 1 — 14 8 3 3 5 263 62 2,418 — — 1929 5 496 80 567 7 — 15 38 293 90 5 — 1 17 4 9 4 8 250 52 151 — — 1930 10 497 77 627 8 — 5 31 262 21 2 1 — 8 — 2 2 22 244 55 2,

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702 597 — 1931 3 281 80 387 3 — 8 41 327 44 3 — — 7 2 12 6 3 229 51 113 672 — 1932 7 233 44 554 3 — 5 35 199 48 2 1 — 7 2 15 6 11 235 48 3,135 — — 1933 2 370 67 1,004 5 — 4 36 181 68 2 — — 9 — 9 2 5 207 45 354 — — 1934 — 416 119 989 8 — 5 30 273 7 1 — — 7 — 4 3 3 219 50 2,

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392 — — 1935 — 313 78 634 9 — 3 42 230 25 — 1 — 17 1 3 2 5 209 33 656 — — 1936 — 176 68 609 12 — 5 23 231 18 2 4 — 26 1 15 1 63 217 36 2,060 — — 1937 — 297 73 428 17 — 10 27 196 76 1 81 — 33 — 10 4 65 228 36 76 — — 1938 — 264 94 507 6 — 8 37 200 7 4 50 — 32 — 6 5 61 204 44 2,

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560 — 45 1939 — 123 51 374 8 — 6 42 244 21 2 21 — 43 1 9 4 56 198 30 43 — 998 1940 — 61 44 128 1 — 5 19 198 33 2 4 — 17 1 32 3 21 195 35 83 7 §Notification of Puerperal Pyrexia commenced October, 1926. † Measles notifiable from 1/1/1916 to 31/12/1919 and from 1/10/38. ‡ Compulsory notification of Zymotic Enteritis commenced 1913 x Chicken Pox was made notifiable from April, 1930 to 30th September, 1931. * Compulsory notification of Whooping Cough commenced 1/10/38

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Ac 4372 WOO 41 Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1941 BY J. MACMILLAN, D.S.O., M.C., M B., Ch.B., D.P.H. Medical Officer of Health WOOLWICH : The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 I HEALTH COMMITTEE. At 31st December, 1941. The Worshipful the Mayor (Councillor H. J. Turner, J.P.) Councillor Mrs. E. L. Reeves (Chairman) Councillor C. H. Darby (Vice-Chairman) Councillors— J. W. Andrews D. B. Lister Miss M. Crout, J.P. S. W. Lister Mrs. L. E. Driver J. F. Parker A. H. Gilder Mrs.

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K. M. Rance G. E. Greenwood E. G. Stevenson E. T. Lamerton H. Vaughan Miss G. E. Walters, J.P. MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor Mrs. E. L. Reeves (Chairman), Councillor C. H. Darby (Vice-Chairman). TABLE OF CONTENTS. page Preface 3 General Provision of Health Services in the Area 7 Sanitary Administration 11 Inspection and Supervision of Food 12 Prevalence and Control of Infectious Diseases 15 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-first Annual Report on the health of the Metropolitan Borough of Woolwich.

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It is much shorter than most of its predecessors, but it is hoped that although much is not published, there is yet sufficient to enable readers to assess how war conditions have affected the health environment of, and health services available for, the inhabitants of this Borough. On grounds of national security, I am requested by the Ministry of Health not to publish complete tables of local populations, but I can say that the Registrar General estimates the population to be less than it was in 1940. It is not possible also, to give both vital statistical figures and rates because from these it would be easy to calculate the estimated population, but I can say that the birth rate was lower, the death rate was higher, and the infant mortality rate (42) was higher than they were the previous year. The actual figures follow. The number of births was 1,530, the number of deaths under one year was 65, and the total number of deaths was 1,627.

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The detail of causes of death will be found in Table No. 1. The number of maternal deaths was 2. The sanitary administration of the Borough was satisfactorily maintained during the year, despite the many extra claims on the Department. All complaints were investigated and dealt with. The abattoir of the Royal Arsenal Co-operative Society was closed in October. The number of animals slaughtered during the period it was open in 1941 was 60,986. Two Sanitary Inspectors, with the necessary labour, were engaged throughout the whole year on the inspection of drains damaged in raids. As a result the rat nuisance did not assume any serious proportions in the Borough. It was possible to resume, on a small scale, the cyanide fumigation of furniture belonging to families allotted houses on the Council's Housing Estates.

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Infant welfare sessions were held in every part of the Borough, on practically the same scale as in pre-war days, as were ante-natal and post-natal sessions. Treatment sessions were limited. Eltham Health Centre, which was being used as a First Aid Post, was completely demolished by enemy action in March. The issue of clothing coupons to expectant mothers, and fruit juices and cod liver oil to children, was new work undertaken by the Maternity and Child Welfare Service. The Council's war-time programme for day nurseries was settled during the year although the first day nursery was not opened until the beginning of 1942. The 4 Council's scheme provides for the opening of three day nurseries in the Borough, i.e., one in Woolwich, one in Plumstead, and one in Eltham, and for the use of two London County Council rest centres—one in Eltham and one in Plumstead, as day nurseries.

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There was more infectious disease in the Borough in 1941 than there was in 1940 but the increase was almost entirely due to epidemics of measles (538 cases) and whooping cough (419 cases). There were 11 cases of enteric fever and 43 of cerebrospinal meningitis. The incidence of tuberculosis was higher than in the previous year, 226 cases of pulmonary tuberculosis and 32 cases of non-pulmonary being notified. In November the Ministry of Health in a general Circular drew attention to the increase in the incidence of tuberculosis in England and Wales as a whole. The notification figures in Woolwich for the past four years have been as follows:— Pulmonary. Non-Pulmonary.

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1938 204 44 1939 198 30 1940 195 35 1941 226 32 These figures make it clear that there has been some slight increase in the Borough, but the increase is probably greater than these figures indicate because the population is now much reduced. So far as tuberculosis work is concerned, the local services are back on a pre-war standard except that the Tuberculosis Care Committee has not been able to continue with the occupational thereapy scheme. The following members of the staff were members of the Armed Forces of the Crown at the end of the year : Mr. L. J. Allen (Grade " B " Clerk), Mr. J. Lewington, Mr. D. Buck, Mr. R. Hillary, and Mr. A. Goad (Grade " A " Clerks). Since my last report the following changes in the permanent staff have taken place :— Mr.

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J. Facer, Sanitary Inspector, commenced duty on 20th January. Miss E. M. Giles, Temporary Health Visitor, appointed to permanent staff on 22nd January. Miss W. McCaffery, Temporary Health Visitor, appointed to permanent staff on 22nd January. Dr. L. A. McDowell, B.A., Assistant Medical Officer, commenced duty on 24th January. Miss W. Adams, Health Visitor, killed by enemy action on 15th March, 5 Dr. T. Standring, Deputy Medical Officer of Health, commenced duty on 28th April. Mr. E. B. Pindar, Sanitary Inspector, retired on superannuation on 12th June. Mr. J. Cook, Temporary Sanitary Inspector, appointed to permanent staff on 13th June. Miss E. W. Woods, Health Visitor, commenced duty on 7th July.

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Miss J. Chandler, Chiropodist, commenced duty on 6th October. Mr. J. G. Gibson, Sanitary Inspector, resigned his appointment on 25th October. Since the beginning of the War the following have joined the Council's service for whole-time duty:— Dr. C. H. Lilley, Tuberculosis Officer. Mr. E. Brunsdon, Clerk. Dr. K. Waghorn, Assistant Medical Officer. Mrs. W. Clark, Clerk. Mr. A. Aslamidis, Sanitary Inspector. Mr. K. Morgan, Clerk. Mr. E. Rees, Sanitary Inspector. Miss J. Flint, Clerk.

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I take this opportunity of saying once again how grateful the staff, permanent and temporary, are for the encouragement and support given by the Chairman and members of the Committees on Health, and the Chairman and members of the Emergency Committee, during the year, and on their behalf and my own, to thank all members of the Council for the continued confidence shown in the Department and myself during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. MACMILLAN, Medical Officer of Health. 6 TABLE No. 1. Nett Deaths during the calendar year 1941. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. All Ages. Under 1 year. 1 and under 5 years. 5 and under 15 years. 15 and under 45 years. 45 and under 65 years. 65 years and upwards. All Causes 1,

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627 65 14 15 241 471 821 Typhoid and paratyphoid fevers 2 . . . . 2 . Cerebrospinal fever 5 . 1 . 1 1 1 Scarlet fever 1 . . 1 . . . Whooping cough 3 . 2 . . . . Diphtheria . . . . . . . Tuberculosis of the respiratory system 113 . 1 . 70 33 9 Other forms of tuberculosis 14 . 2 5 4 1 . Syphilitic diseases 19 . . . . 14 5 Influenza 17 . . . 2 3 12 Measles 2 . . 1 . . . Acute polio-myelitis and polio-encephalitis 1 . . . . . 1 Acute infective encephalitis . . . . . . .

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Cancer of buccal cavity and oesophagus (M) ; uterus (F) 35 . . . 2 11 22 Cancer of stomach and duodenum 32 . . . 4 8 20 Cancer of breast 13 . . . . 8 5 Cancer of all other sites 154 . . . 3 67 84 Diabetes 9 . . . . 2 7 Intracranial vascular lesions 121 . . . 3 31 87 Heart disease 333 . . . 15 78 240 Other diseases of the circulatory system 55 . . . 1 12 42 Bronchitis 107 5 . . 4 26 72 Pneumonia 78 8 3 . 7 29 31 Other respiratory diseases 18 . . 1 3 4 10 Ulcer of stomach or duodenum 24 . . .

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6 12 6 Diarrhoea under 2 years 6 6 . . . . . Appendicitis 4 . . . 3 . 1 Other digestive diseases 38 . . . 2 16 20 Nephritis 31 . . . 3 11 17 Puerperal and post-abortive sepsis . . . . . . . Other maternal causes 2 . . . 2 . . Premature birth 16 16 . . . . . Congenital malformation, birth injury, infantile diseases 18 16 . . 2 . . Suicide 11 . . . 2 6 3 Road traffic accidents 11 . 1 3 1 3 3 Other violent causes 202 5 3 3 82 65 44 All other causes 132 4 1 1 19 28 79 7 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Births.

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The number of notifications received was 742. The number of registered births in Woolwich was 738. After correction for inward and outward transfers the net number of Woolwich live births was 1,530. It is known that at least 719 births took place in institutions. Maternity and Child Welfare Clinics and Treatment Centres. In tabular form below are shown the arrangements in being during the year at each of the Council's maternity and child welfare clinics and treatment centres. Woolwich Central Health In use as a first aid post but maternity and Centre. child welfare and ante-natal clinics held every week. Plumstead Health Centre In use as a first aid post. Clinics held in the Juvenile Section of the Plumstead Library, which adjoins this Centre. 601, Westhorne Avenue Private house taken over to replace Eltham Health Centre demolished by enemy action in March. Child welfare and ante-natal clinics held during remainder of year.

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Wesley Hall, Church hall continued to be used as a maternity Timbercroft Lane. and child welfare clinic. New Eltham Clinics held during the greater part of the year at the First Aid Post, Legal and General Sports Pavilion. St. Luke's Church Hall, Clinics continued to be held here. Westmount Road. St. John's Church Hall, Clinic opened in October, 1941, to replace one North Woolwich. in Storey Street School (East Ham), closed in September, 1940. 137, Alnwick Road, Ante-natal and infant welfare clinics held every Horn Park. week. 8 The attendances at the Maternity and Child Welfare Centres during the year were: expectant mothers, 2,615; nursing mothers, 682; children, 27,525. At the end of the year arrangements had been made to re-institute toddler inspection sessions in each part of the Borough.

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Artificial Sunlight Clinic. Artificial sunlight treatment was continued in the Town Hall shelter. Health Visiting. The arrangements made for the visiting of children between the ages of one and five are described in previous Annual Reports. The number of such visits paid during 1941 was 14,672. The total number of visits paid by health visitors was 20,834. Infant Life Protection. There were 22 foster mothers on the register at the end of 1941, compared with 20 in 1940. The number of nurse children was 24. The number of visits paid by the infant life protection visitors was 191. Midwifery Services. There are no whole-time midwives employed by the Council, the Domiciliary Midwifery Service in London being administered by the London County Council.

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Maternity beds are provided in the British Hospital for Mothers and Babies, the War Memorial Hospital, the Eltham Cottage Hospital, the Military Families' Hospital, St. Nicholas' Hospital, and a few in midwives' homes. At the outbreak of war the War Memorial Hospital, the Military Families' Hospital and St. Nicholas' Hospital closed their maternity wards, and as a result a greater demand was made on the British Hospital for Mothers and Babies. During 1941 937 mothers were admitted to this hospital; 184 of these were admitted under the Council's scheme. No cases were admitted under the Council's scheme for antenatal or emergency treatment. Home Helps. During the year 62 applications were considered by the Committee and 37 home helps were provided. Dental Treatment. The number of mothers and children attending the dental clinics was 211, and the number of tuberculous persons attending was 8. The total number of attendances was 676.

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Issue ot Clothing Coupons to Expectant Mothers. In connection with clothes rationing, the Health Department is responsible for the issue of special coupons to expectant mothers residing in the Borough. During the year 904 applications were granted, and 45,200 coupons were issued. Issue of Fruit Juices, etc. The Government scheme for the issue of fruit juices and cold liver oil for children is administered through the Maternity and 9 Child Welfare Clinics. As a result there has been much more traffic to these buildings during the year, but no figures have been recorded. Supply of Milk to Necessitous Mothers and Children. The approximate cost of this service during the year was : dried milk, £180 12s. 2d.; fresh milk, nil; dinners, nil. Professional Nursing in the Home.

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The arrangements with the six nursing associations for the nursing of cases of measles, ophthalmia neonatorum, zymotic enteritis, whooping cough, and poliomyelitis, in children under five, and pneumonia, puerperal fever, puerperal pyrexia, and tuberculosis were continued during 1941. The total number of visits paid by the nurses on behalf of the Council was 192(f. School Clinics. Clinics were held at the Woolwich Central Health Centre, and at 595 Westhorne Avlnue—a private house taken over when Eltham Health Centre was demolished. The number of children under 5 years of age referred to the school clinics for treatment of minor ailments during the year was 109. Ambulance Facilities.

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The London County Council provide an ambulance" service for four main purposes, (a) removal of persons meeting with accidents or sudden illness in the streets or public places, (6) for removal of maternity cases, (c) for removal of sick persons, (d) for removal of civil defence casualties. Clinic for Physical Medicine. This clinic was not open during the year. Foot Clinic. An additional chiropodist was appointed and she commenced duty in October. The number of treatments rose from 7,416 in 1940 to 8,945 hi 1941. Tuberculosis Dispensaries. Maxey Road, Plumstead. In use as a first aid post but temporary modation at the rear in use as a Tuberculosis Dispensary from 28th April. 11, C'arnecke Gardens, Eltham. Continued to be used as a Tuberculosis Dispensary during the year.

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The work of the dispensaries is referred to in the section dealing with infectious disease. Supply ot Insulin to Persons Suffering from Diabetes. The number of patients, under the Council's scheme, who received insulin during the year was 18. Vaccination. I submit a return by the Vaccination Officer on the wrork carried out under the Vaccination Acts for the year. 10 RETURN to be made on or before 14th February, 1942, by Mr. S. G. Taylor, Vaccination Officer of all Sub-Districts of the Metropolitan Borough of Woolwich Registration District, respecting the Vaccination of Children whose Births were registered from 1st January, to 31st December, 1940, inclusive:— Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in the " Birth List Sheets " as registered from 1st January to 31st December, 1940.

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Number of these Births duly entered by 31st January, 1941, in Columns I., II., IV., and V. of the " Vaccination Register " (Birth List Sheets), viz. :— Col. I. Successfully Vaccinated. Col II. Col. IV. Number in respect of whom Statutory Declaration of Conscientious Objection has been received. Col. V. Died Unvaccinated Insusceptible of Vaccination. Had Small Pox. 1. 2. 3. 4. - 6. 7. J. Plumstead 261 93 1 - 114 7 2. Woolwich 1132 427 I - 407 29 3.

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Eltham 245 92 1 - 91 5 Total 1638 612 3 - 612 41 Number of these Births which on 31st January, 1942, remained unentered in the "Vaccination Register" on account (as shown by "Report Book ") of :— Number of these Births remaining on 31st January, 1942, neither duly entered in the "Vaccination Register" (Columns 3, 4, 5, 6, and 7 of this Return) nor temporarily accounted for in the " Report Book " (Columns 8, 9 and 10 of this Return). Total Number of Certificates of Successful Primary Vaccination of Children under 14 received during the Calendar Year 1941. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate, during the Calendar Year 1941.

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Postponement by Medical Certificate. Removal to Districts the Vaccination Officers of which have been duly apprised. Removal to places unknown or which cannot be reached ; and cases not having been found. 8. 9. 10. 11. 12. 13. 4 39 3 These figures are to be obtained from colum ns 2 and 6 of the Summar y (Form N.) 12 122 123 11 5 12 30 9 • 17 138 192 23 583 271 Date—1 3th February, 1942. (Signature) IS. U. LAY LUK, Vaccination Officer. During the year ended 30th September, 1941, the number of persons successfully vaccinated or re-vaccinated at the cost of the rates was 375.

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This figure includes 350 primary vaccinations of persons under one year of age, 14 over one year of age, and 11 re-vaccinations. 11 SANITARY ADMINISTRATION. Complaints. 1,763 complaints of nuisance were received. After investigation the necessary notices for the remedy, or abatement, of the defects, or nuisances, discovered were served. Sanitary Inspection of the Area. During the year 25,209 inspections, including re-inspections, were carried out by the sanitary inspectors. Included in this number are 1,763 primary inspections on complaint of nuisances, and 368 on account of infectious disease. The number of inspections of factories, workshops and workplaces was 282. Defects were found and remedied in 21 instances. The number of intimation notices served was 1,163, and the number of statutory notices, 194.

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In 16 instances, where the owners did not comply with the statutory notices, the Town Clerk was asked to institute proceedings, but it was not necessary to issue any summonses as in all cases the necessary steps were taken on receipt of a letter from the Town Clerk. Eradication of Bed Bugs. The methods adopted in Woolwich in this respect have been reported on very fully in previous reports. Cyanide was used for the disinfestation of seven loads of furniture. During 1941, 2,139 inspections of verminous houses were carried out and the necessary action was taken. As a preventive measure all infested furniture taken into store from bombed houses, was treated with contact insecticides as the goods were moved in. The stores were carefully inspected by an experienced inspector at regular intervals for some months. As a result a bed bug problem in these furniture stores did not arise. Rats and Mice (Destruction) Act, 1919.

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The number of inspections of rat infested premises made during 1941 was 4,788, compared with 535 in 1940. In 175 instances it was necessary to secure the repair of defective drains. Ninety premises were made rat-proof and other effective measures were taken in 571 instances. War conditions have made things easy for rats. There is much new harbourage —around factories, salvage dumps and similar collections. Broken sewers and drains provide easy exit for the sewer rat. Although much has been done to make things difficult for the rat, much more remains to be done. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 2,018, and the number found not to be in all respects reasonably fit for human habitation was 1,112. The number rendered fit in consequence of informal action by the sanitary inspectors (including the service of intimation notices) was 921.

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Statutory notices were served in respect of 147 houses. New Houses. Only one certificate of a proper and sufficient supply of water was issued. 12 INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 63, and 169 inspections were made. Two pasteuriser's licences, 9 dealer's licences and 5 supplementary licences were issued under the provisions of the Milk (Special Designations) Orders, for the sale of pasteurised milk, and 15 dealer's and 3 supplementary licences were issued for the sale of tuberculin tested milk. Meat Supplies. The one remaining slaughterhouse in the Borough was closed in October. The number of animals slaughtered and inspected at this slaughterhouse up to date of closure was 60,986, compared with 89,509 in 1940. Premises where Food is Prepared or Offered for Sale.

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All such premises, including those registered under the provisions of the Public Health (London) Act, 1936, are kept under frequent observation. The number of inspections carried out during the year was. 3,943. The total weight of food surrendered including carcases and parts of carcases found to be unsound at the slaughterhouse was 24 tons 13 cwts. Sophistication of Food. During the year 924 samples were submitted to the Public Analyst for analysis. Of these 574 were informal and 350 formal. Fifty-eight samples were reported as adulterated. The foods and drugs examined included:— -* Milk, 307; cheese, 5; butter, 4; margarine, 14; lard, 5; bread and cakes, 10; rice, 8; arrowroot, 5; pearl barley, 5; tapioca, 6; flour, 10; cornflour, 8; custard powder, 11;

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dried fruit, 5; ginger, 8; dried herbs, 6; preserves, 16; vinegar, pickles, etc. 63; cocoa, 5; coffee, 22; tea, 8; meat, 29; canned soup, 8; sausages, 42; suet, 4; fish, 35; meat paste, 13; fish paste, 4; canned vegetables, 18; canned fruit, 6; confectionery, 14; beer and spirits, 36; fruit drinks, 7; iodine, 5; mineral waters, 5; sugar, 5; saccharin, 8; food substitues, 47; ointments and medicines, 46; and 61 others. * The following Table No. 3 gives details of formal adulterated samples and shows the results of legal proceedings where these were taken. 13 TABLE No. 3. Sample No. Article.

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Result of Analysis. Result of Legal Proceedings. 490 Milk 10 per cent. of added water Fined £3. 567 Milk Small proportion of added water — 568 Milk 5 per cent. of added water Fined £1. 570 Milk Small proportion of added water — 574 Meat Pie Boric Acid, 0.014 per cent. — 592 Whisky Excessive water, 5.2 per cent. — 1 Milk Small proportion of water — 127 86 Egg Substitute Butter Consisted of coloured baking powder, made from cornflour, rice flour, potato starch, yellow colouring and a bicarbonate-phosphate raising mixture. The articles were described as a "Perfect Substitute" for eggs. Since they did not contain the nutritious qualities of eggs and were unsuitable for many of the purposes for which eggs are used, this description is misleading. Water, 16.9 per cent. 109 Steak and Kidney Pie 1 per cent.

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of steak and no kidney — 121 do., do. 3 per cent. of steak and no kidney — 142 Gin 2.4 per cent. excess water — 198 Meat Pie Filled with paste made from flour and potatoes, flavoured with meat extract. — 192 Tinned Roast Pork Pork, 2 per cent.; cereal filling, 80 per cent. Fined £2; Costs, £1 Is. Od. 197 Milk 1 per cent. of added water 219 Sterilised Milk.. 1 per cent. of added water — 220 Sterilised Milk.. 1 per cent. of added water — 221 Sterilised Milk.. 1 per cent. of added water — 258 Milk 1 per cent.

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of added water — 393 Lemon Substitute Contained citric acid, 1.46 gms ; Vitamin "C," 72 units; with lemon flavouring and colouring matter, dissolved in water, in one teaspoonful of the sample. The label claimed that one teaspoonful with five of water was equal to the juice of one lemon. The juice of one fresh lemon of aversize normally contains citric acid, 3 gms.; Vitamin "C," 450 units; with sugars, mineral salts and other constituents. 14 TABLE No. 3—continued. Sample No. Article. Result of Analysis. Result of Legal Proceedings. 394 395 Lemon Substitute Tomato Sauce Contained only 7.3 milligrams of Vitamin "C" in one teaspoonful of the sample. The label stated that one teaspoonful with six teaspoonsful of cold water was equivalent to one lemon. One fresh lemon of average size normally contains 22.5 milligrams of Vitamin "C."

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Sulphur dioxide, 210 parts per million 396 Lemon Substitute Contained tartaric acid, 3.7 per cent.; and lemon flavouring and colouring matter, dissolved in viator. No citric acid or Vitamin ''T3" could be detected. The samples contained a considerable growth of fungus. The label made the following claims, "The perfect substitute for fresh lemons." "Containing Vitamin 'C'.'' "Contains the natural acid of lemon juice." 431 Egg Substitute Samples were described as "The Perfect Substitute for Eggs." In each case they consisted of a weak solution of gum, sodium bicarbonate, soap and yellow colouring matter in water; as this mixture has nrfappreciable nutritive value and is unsuitable for many of the purposes for which eggs are used the description may be misleading. Case dismissed on on production of warranty. 432 Egg Substitute do., do.. do. do.

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473 Sausages, Beef Boric Acid, 0-012 per cent. — In addition to these, 32 informal samples as set out in Table No. 4, were found to be adulterated. TABLE No. 4. Article. No. of Samples adulterated. Article. No. of Samples adulterated. Milk 7 Lemon Substitute 3 Tapioca 1 Tomato Ketchup 1 Meat Pie 3 Saccharin Tablets 4 Sausages 1 Zinc Ointment 1 Suet .. 1 Glauber's Salts 2 Raisins 1 Aspirin Tablets 1 Egg Substitute 3 Bleaching Powder 1 Sugar Substitute 1 Tincture of Iodine 1 Food Poisoning. The number of notifications of food poisoning was 46. 15 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications.

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The total number of notifications received was 1,523. They relate to the following diseases :— TABLE No. 5. Diphtheria 68 Ophthalmia Neonatorum 18 Scarlet fever 88 Encephalitis Lethargica 3 Enteric fever (including Paratyphoid) 11 Dysentery 25 Cerebrospinal Meningitis 43 Puerperal fever 1 Poliomyelitis 2 Puerperal pyrexia 11 Polio-Encephalitis — Erysipelas 35 Zymotic Enteritis 22 Smallpox — Measles 538 Pneumonia 238 Whooping Cough 419 Malaria 1 Diphtheria. The amount of anti-toxin supplied to medical practitioners during the year was 8,000 units. The number of children immunised under the Council's scheme was 1,441.

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In addition, 1,278 school children were immunised by medical officers of the London County Council. Ophthalmia Neonatorum. Eighteen cases were notified, 6 of whom were admitted to hospital. Nursing assistance was provided under the Council's scheme in 12 cases. Cerebrospinal Meningitis. Forty-three cases were notified compared with 32 in 1940 and 9 in 1939. Four of these were military. All the cases were removed to hospital, and in 11 cases the diagnosis was not confirmed. There were 5 deaths. Tuberculosis. The number of new cases examined was 889. Of these 166 were definitely tuberculous. 259 contacts were examined, of whom 18 were definitely tuberculous. Sessions were resumed at Maxey Road Dispensary in April, temporary accommodation being found there in premises previously used by the Tuberculosis Care Committee.

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The total number of attendances at the Woolwich and Eltham Dispensaries was 3,475. 3,167 visits were made by nurses to homes of patients, and 270 domiciliary visits were paid by the Tuberculosis Officer or an Assistant Medical Officer. 360 cases were referred to the Dispensaries by medical practitioners and 108 by medical boards. 1,449 specimens of sputum were examined, of which 204 were positive. The number of X-ray examinations made was 1,175. There were 763 cases on the tuberculosis register on the 31st December. 81 patients received artificial pneumothorax treatment. Additional nourishment was granted in 121 instances. Eight patients received dental treatment under the Council's scheme. 323 patients were admitted to hospitals, sanatoria, or training colonies:- The Tuberculosis Care Committee continued their meetings and rendered valuable assistance in various way to the needy tuberculous and their families. 16 Laboratory Facilities.

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The bacteriological work of the Council is carried out at the War Memorial Hospital. In addition to the number of examinations made for the tuberculosis service, 398 specimens were examined for diagnostic purposes in the case of diphtheria, 3 in the case of enteric fever, and 2 on account of other diseases. Disinfection and Disinfestation. The number of rooms disinfected after cases of infectious disease was 1,022. Fifty of these were rooms which had been occupied by tuberculous persons. On account of the presence of vermin, 753 rooms were disinfested. 40,315 articles were disinfected at the Disinfecting Station. In March the Cleansing Station at White Hart Marsh was obliterated by a bomb. At the same time considerable damage was done to the Disinfecting Station, but fortunately most of the plant escaped serious damage, and it was possible after a few weeks to have the Disinfecting Station working again.

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Nothing could be done to the Cleansing Station except re-building, and as a matter of policy it was decided not to re-build on this site. It had ceased to be used as a Cleansing Station from 1940, owing to earlier damage. In the circumstances the Cleansing Station set up at the Plumstead Turkish Baths is being continued for an indefinite period. This building has been used since the beginning of the War as a First Aid Post and could be used almost immediately for its new purpose. The number of school children treated at the Cleansing Station in accordance with the terms of the agreement with the London County Council, was 1,772; many (454) of these children were suffering from scabies. The number of adults cleansed was 389, and of these 271 were scabietic. The number of cases of scabies treated at the Cleansing Station in recent years has greatly increased.

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Each year, from 1941 backwards, the number of cases treated has been as follows : 725, 99, 111, 199, 144, 100, 64. The Council had pressed for the completion of the Eltham Hill Cleansing Station and the necessary sanctions were received during the summer. Towards the end of the year, proposals for extended facilities for the treatment and control of scabies were being considered.

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Metropolitan Borough of Woolwich ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR WOOLWICH 1942 BY J. MACMILLAN, D.S.O., M.C., M B., Ch.B., D.P.H. Medical Officer of Health WOOLWICH : The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 HEALTH COMMITTEE. At 31st December, 1942. The Worshipful the Mayor (Councillor E. Brown, J.P.) Councillor Mrs. E. L. Reeves (Chairman) Councillor Miss G. E. Walters, J.P. (Vice-Chairman). Councillors— J. W. Andrews Miss M. Crout, j.p. C. H. Darby Mrs. L. E. Driver A. H. Gilder, j.p.

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G. E. Greenwood D. B. Lister S. W. Lister J. F. Parker Mrs. K. M. Rance Rev. H. Stebbings E. G. Stevenson W. T. Walden MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor Mrs. E. L. Reeves (Chairman) Councillor Miss G. E. Walters, J.P. (Vice-Chairman). 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-second Annual Report on the health of the Metropolitan Borough of Woolwich. Owing to war-time restrictions, it is again an abridged report but the material published will, it is hoped, give a general appreciation of the work of the department and the health of the inhabitants of the Borough during the year.

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The restrictions on the publication of figures relating to local populations still apply and I am unable to publish the usual statistical information, but it is permissible to say that the Registrar General estimates the population to be greater than it was in 1941 : that the birth rate was the highest since 1924 ; the death rate lower than in 1941 and little higher than the mean for the five years before the war, and the infant mortality rate (34) the lowest ever recorded. The number of births was 2,036, the number of deaths under one year was 71, and the total number of deaths was 1,410. The detail of causes of death will be found in Table No. 1. The number of maternal deaths was 3. The work of the sanitary section of the Department was carried on to the usual high standard, despite the difficulties which have arisen owing to the war.

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Maternity and child welfare services were operating on practically a pre-war level, including the medical supervision of toddlers, which it was found possible to re-institute at the beginning of the year. The initial programme for the provision of war-time day nurseries was completed with the opening of the Eltham Nursery and provided places for 187 children. There was a further rise in the incidence of infectious disease in 1942, due to a continuance of the epidemics of measles and whooping cough and to an increase in the number of cases of scarlet fever and dysentery. There was a decrease in cerebrospinal meningitis and in enteric fever. Having regard to the rising tendency in the incidence of tuberculosis throughout the country, to which the Minister of Health called attention in 1941, it is pleasing to record that the number of cases of tuberculosis notified in Woolwich (249) was lower than in 1941: indeed, it was only one more than in 1938.

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The number of deaths from this disease in 1942 (102) was the lowest ever recorded. In assessing these figures regard must of course be had to the size of the population which, although greater than in 1941, was smaller than in 1938. The need for new measures in the treatment of Scabies was evident from the continued rise in this disease and a scheme of control was formulated and put into 4 effect in May. Details of the scheme are given in the body of the report under the heading Disinfection and Disinfestation. Since my last report, the following changes in the staff have taken place :— Mr. K. Morgan, Temporary Clerk, resigned his appointment on 14th February. Miss M. J. Harold, Temporary Clerk, commenced duty on 20th February (resigned, 9th May). Miss E. M. Giles, Health Visitor, resigned her appointment on 18th April. Dr.

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E. V. Saunders-Jacobs was seconded to the Ministry of Health as from 4th May. Dr. M. Belton, Temporary Assistant Medical Officer, commenced duty on 4th May. Miss S. Sanders, Temporary Clerk, commenced duty on 11th May. Miss M. D. Jones, Health Visitor, commenced duty on 28th May. Dr. K. Dowling, Temporary Assistant Medical Officer, commenced duty on Kith November. Miss A. G. Smith, Temporary Clerk, commenced duty on 4th December. Miss B. Loveland, Temporary Clerk, commenced duty on 4th December. Mr. J. G. Simpson, Sanitary Inspector, resigned his appointment on 28th December. At the end of the year the following members of the staff were serving with H.M. Forces : Dr. L. A. McDowell (Assistant Medical Officer) ; Mr.

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L. J. Allen (Grade " B " Clerk) ; Mr. J. Lewington, Mr. A. Goad, Mr. D. Buck, and Mr. R. Hillary (Grade " A " Clerks). Miss D. O'Connor, Grade " A " Clerk, was called up for national service and entered hospital as a probationer on the 28th December. In conclusion, 1 desire to thank the Chairman and members of the Health Committee and members of the Council generally, for the support and consideration given to me during the year, and I take this opportunity of expressing my appreciation of the work of the staff of the department. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, J. MACMILLAN, Medical Officer of Health, 5 TABLE No. 1. Nett Deaths during the calendar year 1942. Causes of Death.

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Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District. All Ages. Under 1 year. 1 and under 5 years. 5 and under 15 years. 15 and under 45 years. 45 and under 65 years. 65 years and upwards. All Causes 1,410 71 10 14 169 378 768 Typhoid and paratyphoid fevers . . . . . . . Cerebrospinal fever 2 . 1 . . 1 . Scarlet fever . . . . . . . Whooping cough 7 5 2 . . . . Diphtheria 2 . 1 1 . . . Tuberculosis of the respiratory system 91 . . 2 62 21 6 Other forms of tuberculosis 11 1 1 1 4 3 1 Syphilitic diseases 17 . . .

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2 5 10 Influenza 7 1 . . . 2 4 Measles 2 . 1 1 . . . Acute polio-myelitis and polio-encephalitis 1 . . . 1 . . Acute infective encephalitis . . . . . . . Cancer of buccal cavity and oesophagus (M) ; uterus (F) 35 . . . 1 12 22 Cancer of stomach and duodenum 43 . . . 2 23 18 Cancer of breast 23 . . . 2 14 7 Cancer of all other sites 144 . . . 11 56 77 Diabetes 17 . . . 5 3 9 Intracranial vascular lesions 129 . . . 3 36 90 Heart disease 366 . . . 20 74 272 Other diseases of the circulatory system 55 . . . .

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9 46 Bronchitis 85 3 . . 5 28 49 Pneumonia 69 12 3 1 8 18 27 Other respiratory diseases 9 1 . . 1 4 3 Ulcer of stomach or duodenum 17 . . . 3 7 7 Diarrhoea under 2 years 5 5 . . . . . Appendicitis 2 . . . 1 . 1 Other digestive diseases 31 . . 2 3 8 18 Nephritis 47 . . . 7 17 23 Puerperal and post-abortive sepsis . . . . . . . Other maternal causes 3 . . . 3 . . Premature birth 22 22 . . . . . Congenital malformation, birth injury, infantile diseases 14 13 . . . 1 . Suicide 11 . . . 1 7 3 Road traffic accidents 5 . .

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2 2 . 1 Other violent causes 34 3 1 . 5 7 18 All other causes 104 5 . 4 17 22 56 6 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 982. The number of births registered in Woolwich was 1,090. After correction for inward and outward transfers the nett number of Woolwich live births was 2,036. It is known that at least 1,185 births took place in Institutions. Maternity and Child Welfare Clinics and Treatment Centres. In tabular form below are shown the arrangements in being during the year at each of the Council's maternity and child welfare clinics and treatment centres. Woolwich Central Health Centre. In use as a first aid post but child welfare and ante-natal clinics held every week. Physical medicine clinics held two whole days a week.

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Plumstead Health Centre In use as a first aid post but an ante-natal clinic is held every week. Child welfare clinics held in the Juvenile Section of the Plumstead Library, which adjoins this Centre. 601, Westhorne Avenue . Child welfare and ante-natal clinics held every week. Wesley Hall, Timbercroft Lane Church Hall continued to be used for child welfare clinics. New Eltham Clinics held throughout the year at the First Aid Post, Legal & General Sports Pavilion. St. Luke's Church Hall, . Westmount Road. Clinics continued to be held here. Elizabeth Street, North Woolwich. In use as a first aid post. Clinics held in St. John's Church Hall. 137, Alnwick Road, Horn Park. Ante-natal and child welfare clinics held every week.

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The attendances at the Maternity and Child Welfare Centres during the year were: expectant mothers, 5,152; nursing mothers, 1,192; children, 39,919. In January, toddler inspection sessions were re-instituted. The number of inspections carried out was 1,668. Artificial Sunlight Clinic. Artificial sunlight treatment was continued in the Town Hall shelter. The number of treatments given was 11,620. Health Visiting. The arrangements made for the visiting of children between the ages of one and five are described in previous Annual Reports. The number of such visits paid during 1942 was 19,497. The total number of visits paid by health visitors was 27,780. Infant Life Protection. There were 36 foster mothers on the register at the end of 1942, compared with 22 in 1941. The number of nurse children was 39.

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The number of visits paid by the infant life protection visitors was 306. 7 Midwifery Services. There are no whole-time midwives employed by the Council, the Domiciliary Midwifery Service in London being administered by the London County Council. Maternity beds are normally provided in the British Hospital for Mothers and Babies, the War Memorial Hospital, the Eltham Cottage Hospital, the Military Families' Hospital, St. Nicholas' Hospital, and a few in midwives' homes. At the outbreak of war the War Memorial Hospital, the Military Families' Hospital and St. Nicholas' Hospital closed their maternity wards, and as a result a greater demand was made on the British Hospital for Mothers and Babies, During 1942, 1,231 mothers were admitted to this hospital; 195 of these were admitted under the Council's scheme. No cases were admitted under the Council's scheme for ante-natal or emergency treatment. Home Helps.

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During the year 95 applications were considered by the Committee and 57 home helps were provided. Dental Treatment. The number of mothers and children attending the dental clinics was 393, and the number of tuberculous persons attending was 10. The total number of attendances was 1,045. Issue of Clothing Coupons to Expectant Mothers. In connection with clothes rationing, the Health Department is responsible for the issue of special coupons to expectant mothers residing in the Borough. During the year, 2,282 applications were granted, and 127,800 coupons were issued. Issue of Fruit Juices, etc. The Government scheme for the issue of fruit juices and cod liver oil for children is administered through the Maternity and Child Welfare Clinics. This resulted in considerable congestion at the Centres and at the end of the year consideration was being given to an alternative method of distribution. Supply of Milk to Necessitous Mothers and Children.

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The approximate cost of this service during the year was : Dried milk, £158 17s. 6d. ; fresh milk, nil; dinners, nil. War-time Nurseries. The first war-time day nursery was opened in Bloomfield Road London County Council School on the 9th February. It provided places for 40 children and was later extended to accommodate 60 children. The second nursery was established in the London County Council's Cyril Henry Treatment Centre, St. Mary's Street, Woolwich, which was erected for use as a day nursery during the last war. It now accommodates 37 children and was opened on the 18th May. The last nursery included in the Council's initial programme was opened on the 10th August. It was established in the Woolwich Borough Council Sports Pavilion, Harrow Meadow, Eltham Road, and provides places for 60 children.

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In addition to the Council's nurseries, the London County Council Rest Centres at Earl Rise School, Plumstead and Roper Hall, Eltham, were adapted for use as day nurseries for children betw een the ages of 2 and 5 years only. These nurseries are staffed and equipped by the London County Council but the children are admitted through the Health Department and medical supervision is provided by the Council. The provision of further nurseries was under consideration at the end of theyear. 8 All three of the Council's nurseries are affiliated to the National Society of Children's Nurseries and are training schools for probationers. The following shows in tabular form the day nurseries open in the Borough on the 31st December, and the accommodation available at each :— TABLE No. 2 Nursery Children between the ages of 1 and 2 years. Children between the ages of 2 and 5 years. London County Council School, Bloomfield Road, Plumstead.

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20 40 Cyril Henry Centre, St. Mary's Street, Woolwich. 15 22 Woolwich Borough Council Sports Pavilion, Harrow Meadow, Eltham. 20 40 London County Council School, Earl Rise, Plumstead (Rest Centre). — 30 London County Council Hostel, Roper Hall, — 20 Avery Hill, Eltham (Rest Centre). 55 152 Professional Nursing in the Home. The arrangements with the six Nursing Associations for the nursing of cases of measles, ophthalmia neonatorum, zymotic enteritis, whooping cough, and poliomyelitis, in children under five, and pneumonia, puerperal fever, puerperal pyrexia, and tuberculosis were continued. The total number of visits paid by the nurses on behalf of the Council was 1,483. School Clinics.

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Clinics were held at the Woolwich Central Health Centre, anc) at 595, Westhorne Avenue—a Council house taken over by the London County Council when Eltham Health Centre was demolished. The number of children under 5 years of age referred to the school clinics for treatment of minor ailments during the year was 81. Ambulance Facilities. The London County Council provide an ambulance service for four main purposes, (a) removal of persons meeting with accidents or sudden illness in the streets or public places, (b) removal of maternity cases, (c) removal of sick persons, (d) removal of civil defence casualties. Clinic por Physical Medicine. This clinic was re-opened in March for two whole days a week. The number of attendances was 3,163. Foot Clinics. The first foot clinic was established with the opening of the Central Health Centre in 1939.

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On 1st December, 1942, a second clinic was opened in temporary accommodation at Eltham Baths, the number of treatments there during that month being 164. The total number of treatments rose from 8,945 in 1941 to 12,188 in 1942. Supply of Insulin to Persons Suffering from Diabetes. The number of patients, under the Council's scheme, who received insulin during the year was 19. 9 Tuberculosis Dispensaries. Maxey Road, Plumstead In use as a first aid post but temporary accommodation at the rear in use as a Tuberculosis Dispensary. 11, Carnecke Gardens, Eltham . Continued to be used as a Tuberculosis Dispensary during the year. The work of the dispensaries is referred to in the section dealing with infectious disease. Vaccination. There were 742 entries in the birth lists for 1941. Of these, 324 were successfully vaccinated.

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The total number of successful primary vaccinations during 1942 was 755, and 33 successful re-vaccinations were carried out. SANITARY ADMINISTRATION. Complaints. 2,436 complaints of nuisance were received. After investigation any necessary notices for the remedy or abatement of the defects or nuisances discovered were served. Sanitary Inspection of the Area. During the year 32,950 inspections, including re-inspections, were carried out by the sanitary inspectors. Included in this number are 2,436 primary inspections on complaint of nuisances, and 571 on account of infectious disease. The number of inspections of factories was 324. Defects were found and remedied in 38 instances. The number of intimation notices served was 1,426, and the number of statutory notices, 388.

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In 69 instances, where the owners did not comply with the statutory notices, the Town Clerk was asked to institute proceedings, but it was necessary to issue only five summonses as in all other cases the necessary steps were taken on receipt of a letter from the Town Clerk. Eradication of Bed Bugs. The methods adopted in Woolwich in this respect have been reported on very fully in previous reports. Cyanide was used for the disinfestation of seventeen loads of furniture and nine buildings. During 1942, 1,767 inspections were carried out and the necessary action was taken. Rats and Mice (Destruction) Act, 1919. In addition to inspections carried out specifically in connection with rat infestation, the sanitary inspectors look for signs of the presence of rats at every inspection. Thus, infestation was discovered in 400 premises, including 27 food premises.

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In 152 instances it was necessary to secure the repair of defective drains, 65 premises were rat proofed, and other effective measures were taken in the remainder. Infestation has not assumed any great proportions in the Borough, but constant endeavour is necessary on the part of everyone concerned to combat the menace of these rodents. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 2,433, and the number found not to be in all respects reasonably fit for human habitation was 1,218. The number rendered fit in consequence of informal action by the sanitary inspectors (including the service of intimation notices) was 896. Statutory notices were served in respect of 322 houses. 10 INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 60, and 93 inspections were made.

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Two pasteurisers' licences, 7 dealers' licences and 4 supplementary licences were issued under the provisions of the Milk (Special Designations) Orders, for the sale of pasteurised milk, and 14 dealers' and 3 supplementary licences were issued for the sale of tuberculin tested milk. Meat Supplies. All slaughterhouses in the Borough remained closed, but one was used occasionally under licence from the Ministry of Food. The number of animals slaughtered and inspected at this slaughterhouse during the year was 240. Premises where Food is Prepared or Offered for Sale. All such premises, including those registered under the provisions of the Public Health (London) Act, 1936, are kept under frequent observation. The number of inspections carried out during the year was 2,863. The total weight of food certified as unfit for human consumption was 10 tons 3 cwts. Very little of this food was destroyed, most of it being used for animal feeding.

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Sophistication of Food. During the year 826 samples were submitted to the Public Analyst for analysis. Of these, 616 were informal and 210 formal. Twenty-nine samples were reported as adulterated, only four of which were formal samples. No legal proceedings were instituted. The food and drugs examined included :— Milk, 212; condensed milk, 10; dried milk, 7; butter, 7; margarine, 7: lard, 7; arrowroot, 8; rice, sago, etc. 28; flour, 17; custard powder, pudding powder, etc. 29; baking powder, 9; biscuits, 4; dried egg and egg substitute, 23; fruit juice and fruit juice substitute, 12; dried fruit, 30; dried vegetables, 23; canned fruit and vegetables, 25; soup powder, 11; canned soup, 24; sausage, 24; cooked meats, 7; meat pie,

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8; canned meat, 12; meat paste, 8; meat and vegetable extracts, 5; canned fish, 29; fish paste, 14; coffee, 14; cocoa, 9; preserves, 15; vinegar, pickles, etc. 48; condiments, 22; spices, curry powder, etc. 25: cordials, mineral waters, etc. 21; confectionery, 10; alcoholic beverages, 9; medicaments, 33; others, 20. The adulterated samples were as follows :— Formal. Lemon substitute, 1; orange substitute, 1; condiment mustard, 1; ginger wine cordial, 1. Informal.

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Milk, 1; canned meat stock and vegetable soup, 1: forcemeat, 1; pepper, 1; mustard, 2; mixed spice, 2; non-alcoholic beverages, 7; lemon substitute, 1; orange substitute, 1; sauce, 1; Glauber's salts, 4; bleach ointment, 1 ; pudding powder, 2. Food Poisoning. The number of notifications of food poisoning was 205, mainly due to an outbreak at Woolwich Institution. Bacteriological examinations in connection with this outbreak disclosed no evidence of the presence of bacteria of the food poisoning groups. 11 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 1,931. They relate to the following diseases :— TABLE No. 3.

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Diphtheria 76 Malaria 7 Scarlet fever 278 Ophthalmia Neonatorum 13 Enteric fever (including Paratyphoid) 2 Dysentery 117 Cerebrospinal Meningitis 26 Puerperal fever 4 Poliomyelitis 3 Puerperal Pyrexia 13 Zymotic Enteritis 48 Erysipelas 40 Measles 723 Pneumonia 263 Whooping Cough 318 Diphtheria. The amount of anti-toxin supplied to medical practitioners during the year was 8,000 units. The number of children immunised under the Council's scheme was 2,088. In addition, 2,195 school children were immunised by medical officers of the London County Council. The percentages of the child population immunised for the two age groups 0-5 and 5-15, based on estimated populations, were 42 and 68.6 respectively.

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Ophthalmia Neonatorum. Thirteen cases were notified, five of whom were admitted to hospital. Nursing assistance was provided under the Council's scheme in 8 cases. Cerebrospinal Meningitis. Twenty-six cases were notified compared with 43 in 1941 and 42 in 1940. Two of these were military. All the cases were removed to hospital, and in 12 the diagnosis was not confirmed. There were 2 deaths. Typhus Fever. All the necessary arrangements were made for dealing with an outbreak of Typhus Fever should such occur. Special protective clothing was obtained for the use of the staff who would be engaged on this work and the sanitary inspectors and the disinfectors were given special training.

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Agreement has been reached w ith Lewisham for mutual assistance with Woolwich ; the first borough having an outbreak will deal with the Typhus cases, whilst the other borough will deal with non-typhus verminous cases. Tuberculosis. The number of persons examined for the first time at the Dispensaries was 1,129. Of these 175 were tuberculous. 280 contacts were examined, of whom 11 were tuberculous. The total number of attendances at the Woolwich and Eltham Dispensaries was 4,378. There were 767 cases on the tuberculosis register on the 31st December. 3,622 visits were made by nurses to homes of patients and 53 domiciliary visits were paid by the Tuberculosis Officer or an Assistant Medical Officer. 551 cases were referred to the Dispensaries by medical practitioners and 59 by medical boards. 607 specimens of sputum were examined, of which 94 were positive.

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The number of X-ray examinations made was 1,439. 73 patients received artificial pneumothorax treatment. Additional nourishment was granted in 208 instances. Ten patients received dental treatment under the Council's scheme. 284 patients were admitted to hospitals, sanatoria, or training colonies. The Tuberculosis Care Committee continued their meetings and rendered valuable assistance in various ways to the needy tuberculous and their families. 12 Laboratory Facilities. The bacteriological work of the Council is carried out at the War Memorial Hospital. In addition to the number of examinations made for the tuberculosis service, 746 specimens were examined for diagnostic purposes in the case of diphtheria, 5 in the case of enteric fever, 2 in the case of dysentery, and 17 on account of food poisoning. Disinfection and Disinfestation. The number of rooms disinfected after cases of infectious disease was 529. Seventy-six of these rooms had been occupied by tuberculous persons.

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On account of the presence of vermin, 566 rooms were disinfested. 59,686 articles were disinfected at the Disinfecting Station. This figure is much higher than usual, due to the increase in Scabies. Personal cleansing was continued at the temporary cleansing station in Plumstead Turkish Baths (established there when the cleansing station at White Hart Road was damaged by enemy action in 1940), and in the cleansing section of the Eltham Hill Health Centre which was opened on the 1st June. The increasing incidence of Scabies during the war has been a matter of concern and a scheme for extended facilities for its treatment and control was adopted in 1942. The scheme included diagnostic skin clinics; preliminary visits to the homes by women sanitary inspectors ; disinfestation of bedding and personal clothing ; treatment of persons at cleansing stations (family contacts to be included in those treated) ; following up after treatment and propaganda work in factories and shops. A consultant dermatologist (Dr.

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D. Erskine, Physician for Diseases of the Skin at Seamen's and St. John's Hospitals) was appointed, his duties being, inter alia :— To define the method of treatment and the administrative procedure to be followed ; To pay a fortnightly visit to Woolwich to inspect the scheme in being ; To see at his hospital clinic any doubtful cases sent there for diagnosis ; To see such cases under the Scabies Order, 1941, as may be referred to him and give evidence in Court if necessary. The scheme came into effect at the end of May and worked smoothly and efficiently. The method of treatment used generally requires two visits only to the cleansing station and involves absence from work only for the time taken to attend the cleansing station and receive the treatment. As was anticipated, the introduction of this scheme resulted in an increase in the number of cases of Scabies coming to the knowledge of the department.

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This increase, however, was more apparent than real and meant, in effect, that cases which might have remained undiscovered so far as the Department was concerned, were brought to light and induced to have the necessary treatment. The Scabies Orderv 1941, referred to above, gives power to the Medical Officer of Health to examine any person who is or has recently been accommodated in premises which he is satisfied are in a verminous condition, and to require that person, if necessary, to submit to cleansing treatment. The Order extends the existing powers with regard to verminous premises and articles. The number of school children treated at the Cleansing Stations in accordance with the terms of the agreement with the London County Council, was 2,388 ; 935 of these children were treated for scabies. In addition, 438 pre-school children were treated (411 for scabies). The cleansed was 1,775 and of these 1,703 were scabietic.

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AC 4372 WOO 73 METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1943 BY T. STANDRING, M.D., B.S.. D.P.H., M.R.C.S., L.R.C.P.. Deputy Medical Officer of Health WOOLWICH: The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 HEALTH COMMITTEE. At 31st December, 1943. The Worshipful the Mayor (Councillor Mrs. E. L. Reeves, J.P.) Councillor C. H. Darby (Chairman) Councillor Miss G. E. Walters, J.P. (Vice-Chairman). Alderman- Mrs.

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K. Howlett Councillors- J. W. Andrews S. L. Collins T. W. Croft Miss M. Crout, j.p. Mrs. A. Day Mrs. L. E. Driver A. H. Gilder, j.p. D. B. Lister Mrs. K. M. Rance Rev. H. Stebbings W. T. Walden D. P. Walsh MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor C. H. Darby (Chairman) Councillor Miss G, E. Walters, j.p. (Vice-Chairman) 3 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich.

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Madam, Ladies and Gentlemen, I have the honour to submit the Forty-third Annual Report on the health of the Metropolitan Borough of Woolwich, and in doing so, I desire to record my deep regret at the death of Dr. Macmillan on the 21st November, 1043, and to acknowledge my personal indebtedness to him for the help and wise counsel he gave to me since my appointment as Deputy Medical Officer of Health. In accordance with the instructions of the Ministry of Health, the report is again an abridged one, and certain figures normally incorporated are omitted for security reasons. The Registrar General estimates that there was a slight increase in the population during 1943. There was again an increase in the number of live births allocated to Woolwich, the birth rate being the highest since 1924.

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The death rate was slightly higher than in 1942, as also was the infant mortality rate (35—34 in 1942) due in the main to an increase in the number of deaths from congenital conditions. The number of births was 2,174, the number of deaths under one year was 77, and the total number of deaths was 1,558. Details of caupes of death will be found in Table No. 1. Maternal deaths numbered 4 (1.79 per 1,0()0 total births), The scarcity of labour and materials continued to be a problem in the work of the sanitary section of the Department, but nevertheless satisfactory results were obtained by the sanitary inspectors. The extermination of rats claimed a considerable portion of the sanitary inspectors' time, particularly in the latter half of the year, following the specific directions of the Ministry of Food. The number of cases of scarlet fever was nearly double that of 1942.

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Fortunately the disease continues to be mild in character and not one death occurred. During the past five years only two deaths in Woolwich have been attributed to scarlet fever, one in 1939 and one in 1941. The incidence of measles is interesting. Prior to the War, epidemics occurred regularly every two years, but in 1940, which should have seen the start of an epidemic, the number of cases in the Borough was only 83, and in 1941 the number was 538. The winter of 1942 saw the commencement of an epidemic (723 eases being notified in that year), which continued all through 1943 (1,227 cases) with a slight decrease in the last two months, but increasing again in the early months of 1944. No wholly satisfactory explanation can be given, although the war generally, and evacuation in particular, in upsetting the habits of the people and the ratio of susceptibles to immunes, must have some bearing on the experience.

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4 The increase in the incidence of tuberculosis throughout the country generally had not been felt appreciably in Woolwich prior to 1943, but in that year 292 new cases were notified, an increase over 1942 of 43 cases. The number of deaths increased also from 102 in 1942 to 112 in 1943. The death rate, however, increased by only .05. The outstanding features of the Tuberculosis Service were the institution of Maintenance Grants and the provision of Miniature Mass Radiography Units for the detection in its early stages of pulmonary tuberculosis, and of certain other conditions. The maternity and child welfare clinics operated throughout the year on a peace-time basis and were well attended. Other branches of this service, with one or two exceptions, were working on almost a pre-war level. The administration of the added war-time service, that of day nurseries, whilst considerably increasing the work of the Department, was carried on effectively.

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I feel that this report would be grossly incomplete without a special reference to the work of Dr. Macmillan, and the progress of the Health Services during his service with the Council. Dr. Macmillan was appointed in August, 1919, and from my own knowledge of him, over a period which was all too short, I can endorse the many stories I have heard of his energy and drive, and of the sincerity with which he devoted himself to the service of the Council, and thereby to the people of Woolwich. On his appointment, maternity and child welfare was in its infancy, but from then on the Council, with the advice of Dr. Macmillan, and through schemes prepared by him, built up the extensive service which is known in Woolwich to-day, covering every phase of the care of the mother and the child up to school age.

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Infant welfare clinics, ante-natal clinics, toddlers' clinics, ear, nose and throat clinics, artificial sunlight treatment, dental treatment, provision of maternity beds, and the many other branches of this service grew up during Dr. Macmillan's term of office. Woolwich was one of the first Councils in the country to initiate toddlers' clinics, and the first Metropolitan Borough Council to provide municipal centres with accommodation on the same premises for both school and maternity and child welfare services. With the sanitary condition of the Borough and the housing position generally, Dr. Macmillan quickly made himself familiar. In connection with slum clearance he represented as unfit for human habitation 672 houses, and every one of these he personally inspected for the preparation of evidence, many on more than one occasion.