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The care with which he undertook this work is evidenced by the fact that after inquiry by a Ministry of Health Inspector, in only 10 instances were houses excluded from the Clearance Orders made by the Council, and these only on undertakings by the owners to re-condition the houses. A man of wide views, he early set out to educate the people of Woolwich in all matters relating to health, keeping always to the forefront the principle that 5 prevention is better than cure. Health Weeks were organised; lectures, film displays and health plays in large halls, and informal talks and film displays at the meeting places of various organisations in the Borough, were arranged. All these efforts met with instant response, the first Health Week exhibition in 1925 being attended by over 25,000 persons. Although every aspect of public health received his undivided attention when required, Dr. Macmillan had especial interest in some subjects, one of which was the eradication of bed bugs.

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With the building of the Council's estates, this problem became more urgent, in order to prevent the infestation of the new homes of families from the old and unfit houses. With the fervour of a pioneer, Dr. Macmillan studied every detail of the life history of the bed bug, from the hatching of the larva through all stages of development, using bugs bred and fed by himself. He carried out many practical experiments dealing with different aspects of infestation, until the methods now used in Woolwich, and proved the most effective, were evolved. The kindly sympathy shown by Dr. Macmillan towards all classes of the community was never more in evidence than in his endeavours to remove from the minds of occupiers of infested buildings the fixed idea that the presence of the bed bug was a social stigma. His expert practical knowledge was recognised nationally by his appointment to the Special Committee of the Medical Research Council for research into bug infestation. In the passing of Dr.

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Macmillan the people of Woolwich have lost a kindly friend and a faithful servant, but the records of his long endeavours on their behalf are set down in the Annual Reports which it was his duty and pleasure to present to the Council. In conclusion, I desire to express my sincere thanks to the Chairman and members of the Health Committee, and to members of the Council generally, for the confidence reposed in me, and for their support and consideration, and I take this opportunity of expressing my appreciation of the work of the staff of the Department, and of the help I have received from them. I am, Madam, Ladies and Gentlemen, Your obedient Servant, T. STANDR1NG, Deputy Medical Officer of Health. 6 TABLE No. 1. Nett Deaths during the calendar year 1943. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. All Ages. Under 1 year.

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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 1,558 77 13 14 173 412 869 Typhoid and paratyphoid fevers 2 . . . 1 1 . Cerebrospinal fever 1 . 1 . . . . Scarlet fever . . . . . . . Whooping cough 1 . 1 . . . . Diphtheria 1 . . 1 . . . Tuberculosis of the respiratory system 97 . . . 57 34 6 Other forms of tuberculosis 15 . 2 4 5 2 2 Syphilitic diseases 21 . . . . 7 14 Influenza 28 1 . . 4 8 15 Measles . . . . . . .

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Acute polio-myelitis and polio-encephalitis . . . . . . . Acute infective encephalitis 3 . . . 1 1 1 Cancer of buccal cavity and oesophagus (M); uterus (F) 27 . . . 1 12 14 Cancer of stomach and duodenum 32 . . . 1 14 17 Cancer of breast 27 . . . 2 12 13 Cancer of all other sites 161 . 1 . 12 56 92 Diabetes 15 . . . . 6 9 Intracranial vascular lesions 132 . . . 4 39 89 Heart disease 413 . 1 . 19 85 308 Other diseases of the circulatory system 35 . . . 2 7 26 Bronchitis 94 3 1 . 1 28 61 Pneumonia 67 9 3 .

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5 12 38 Other respiratory diseases 21 1 . 1 3 8 8 Ulcer of stomach or duodenum 20 . . . 6 8 6 Diarrhoea under 2 years 9 9 . . . . . Appendicitis 10 . . . 2 2 6 Other digestive diseases 36 1 . . 4 14 17 Nephritis 48 . . . 9 10 29 Puerperal and post-abortive sepsis 1 . . . 1 . . Other maternal causes 3 . . . 3 . . Premature birth 23 23 . . . . . Congenital malformation, birth injury, infantile diseases 27 26 . . . 1 . Suicide 12 . . . 4 5 3 Road traffic accidents 7 . . 2 .

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2 3 Other violent causes 49 3 1 4 15 8 18 All other causes 120 1 2 2 11 30 74 7 GENERAL PROVISIONS OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 1,214. The number of births registered in Woolwich was 1,202. After correction for inward and outward transfers the net number of Woolwich live births was 2,170. 955 births are known to have taken place in institutions. Maternity and Child Welfare Clinics and Treatment Centres. The arrangements in being during the year at each of the Council's maternity and child welfare clinics and treatment centres remained unchanged from those set out in the 1942 report, except for the addition of further sessions as required.

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The attendances at the Maternity and Child Welfare Centres during the year were: Expectant Mothers, 0,442; Nursing Mothers, 1,910; Children, 50,810. The number of inspections carried out at Toddlers' Clinics was 1,982. Toddlers' Clinics. One of the assistant Medical Officers engaged on the examination of toddlers has furnished the following note:— "The special sessions for toddlers only were re-started in 1942, and quickly became re-established. The objects of the regular examination of these children between the ages of two and five years are, firstly to detect in the child any deviation from the healthy state, and to take the appropriate measures for correction; and secondly, to assist the mother to bring up her children in good health, avoiding the formation of bad habits, which are often the precursors of childish disorders.. On the whole, the health of the children is good.

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The figures compare favourably with those of pre-war years. There is a noteworthy decrease in the incidence of dental caries, which in 1943 was 19.9 per cent., compared with 24.0 per cent. in 1938 and 23.9 per cent. in 1934. There was, however, some increase in clinically assessed anaemia, and in the number of children showing a weakened muscular tone. There was no case of advanced rickets. Undoubtedly the Government scheme for supplying milk and vitamins has been beneficial. Satisfactory nutrition, however, depends on many factors besides an adequate diet, such as a sufficiency of fresh air, suitable clothing and good housing conditions." Health Visiting. The number of visits paid by Health Visitors to children under five years of age was 22,091; the total number of visits paid by Health Visitors was 30,100. Infant Life Protection.

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There were 20 foster mothers on the register at the end of 1943, compared with 36 in 1942. The number of children was 26. The number of visits paid by infant life protection visitors was 358. 8 Artificial Sunlight Clinic. Artificial sunlight treatment was continued in the Town Hall shelter, but at the end of the year arrangements were being made for the transfer of the clinic to more suitable accommodation at the Old Town Hall. The number of treatments given was 13,655. Dental Treatment. The number of mothers and children attending the dental clinics was 412, and the number of tuberculous persons attending was 12. The total number of attendances was 1,270. Minor Ailments. The number of children under five years of age referred to school clinics for treatment of minor ailments during the year was 119. Meals for Children under Five Years of Age.

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To assist mothers experiencing difficulty in providing suitable meals for the under-fives, arrangements were made for demonstrations of war-time meals suitable for young children to be given at Woolwich and at Eltham. Issue of Fruit Juices, etc. When the Government scheme for the issue of fruit juices and cod liver oil for children was initiated, issues were made at the maternity and child welfare centres. This resulted in considerable congestion at some of the centres, and additional means of distribution became necessary. Arrangements were therefore made for issue at the food offices and at all first aid posts. Issue of Clothing Coupons to Expectant Mothers. In July, the responsibility for the issue of clothing coupons to expectant mothers was transferred to the Food Office. Prior to the transfer, 1,224 applications were granted, and 73,440 coupons were issued. Midwifery Services. The Domiciliary Midwifery Service in London is administered by the London County Council.

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Institutional midwifery in Woolwich was available only at the British Hospital for Mothers and Babies and at the Eltham Cottage Hospital, but beds were also available at other hospitals, notably, St. Alfege's Hospital and Lewisham Hospital, and through the evacuation scheme. During 1943, 1,288 mothers were admitted to the British Hospital for Mothers and Babies, 206 under the Council's scheme. No cases were admitted under the Council's scheme for ante-natal or emergency treatment. 69 mothers were admitted to the Eltham Cottage Hospital. Institutional maternity accommodation has never quite met the demand, and during the war years the demand has increased whilst the number of beds available locally has decreased, owing to the closure of the maternity wards of the War Memorial Hospital, St. Nicholas' Hospital and the Military Families' Hospital.

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The Council, therefore, readily accepted the invitation of the British Hospital for Mothers and Babies to support an application to the Ministry of Health for sanction to the building of a new block. Unfortunately, the Minister could not approve the proposal, but permission was subsequently obtained to rebuild a damaged block. 9 Towards the end of the year a scheme was formulated whereby the London County Council would, in certain circumstances, become financially responsible for extra beds in voluntary hospitals, and the whole question became a matter of negotiation between the Council, the London County Council and the British Hospital for Mothers and Babies. Negotiations were still in progress when the year closed and a proposal to re-open the maternity ward of the War Memorial Hospital was being examined. Home Helps. Home helps were supplied in 90 cases. The number of home helps on the panel has diminished considerably but suitable arrangements were made to supply help in every case where required.

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The home help scheme was under review at the end of the year with a view to attracting more women to this employment by improving the status of the home help. A recommendation that home helps should be re-graded was submitted to the Local Authorities Joint Industrial Council for Non-Trading (Manual) Workers, and early in 194-1 home helps were placed in Grade "B" of the Joint Industrial Council scheme. Supply of Milk, etc., to Necessitous Mothers and Children. The approximate cost of this service during the year was: Dried milk, £115; fresh milk, nil ; dinners, nil. Clinic for Physical Medicine. The work of this clinic was continued in an attenuated form throughout the year. The number of attendances was 5,771. War-time Nurseries.

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Up to the end of 1942, as set out in the report of that year, the Council had established three day nurseries, and in addition the London County Council had staffed and equipped two nurseries at rest centres. In 1943 the erection of two further day nurseries was commenced, one at Woolwich Common and one at Abbey Wood. They are pre-fabricated buildings supplied by the Government, each providing accommodation for 60 children. Construction of the Woolwich Common Nursery was almost complete at the end of the year. All the Council's nurseries are training schools for probationers, and are affiliated to the National Society of Children's Nurseries. Admissions to all nurseries are made through the Health Department and medical supervision is carried out by the Council. At the end of 1943 arrangements were in being for the erection of two more nurseries—one at Garland Road, Plumstead, and one at Mineral Street, Plumstead.

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One of the Assistant Medical Officers who has been engaged on the medical supervision of day nurseries has furnished the following note:— "The general condition of the children on admission is on the w hole very good. They settle quickly into their new surroundings and even the 'nervous' type of child is soon playing happily and deriving much benefit from the companionship of others. Those of the children whose general condition is not satisfactory improve noticeably due to the regular routine and the good and suitable meals provided at the nursery. Catarrh and colds are troublesome in the winter but disappear with the better weather when the children are able to remain outside most of the day. 11 The nurseries have their quota of infectious diseases, and every precaution is taken to prevent their spread. No serious epidemics occurred.

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The advice that can be given by a matron to the mother is most useful, and it is interesting to note that in the few cases where a child has initially been brought to a nursery dirty in person and clothing, the example of the other mothers and a tactful word from the matron has soon achieved the desired improvement. Immunisation against diphtheria is not a condition of admission to a nursery, but no difficulty has been experienced in obtaining the consent of parents." 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 1,244. Foot Clinics.

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The work of the foot clinics continued during the year at the Central Health Centre and at Eltham Baths. The number of attendances at Woolwich was 10,285, compared with 12,024 in 1942. At Eltham, the number of attendances was 4,348. As the Eltham Clinic was first opened in December, 1942, no comparable figures can be given. Supply of Insulin to Persons Suffering from Diabetes. The number of patients under the Council's scheme who received Insulin during the year was 22. Tuberculosis Dispensaries. The premises at Maxey Road, Plumstead, and 11, Carnecke Gardens, Eltham, continued in use throughout the year. The work of the dispensaries is referred to in the section dealing with infectious diseases. Vaccination. There were 1,090 entries in the birth lists for 1942. Of these, 571 were successfully vaccinated.

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The total number of successful primary vaccinations during 1943 was 1,217, and 12 successful re-vaccinations were carried out. SANITARY ADMINISTRATION. Complaints. 2,808 complaints of nuisance were received and the necessary action was taken where defects or nuisances were discovered. Sanitary Inspection of the Area. During the year 26,813 inspections, including re-inspections, were carried out by the sanitary inspectors. Included in this number are 2,808 primary inspections on complaint of nuisances, and 2,588 on account of infectious disease. The number of inspections of factories was GOO. Defects were found and remedied in 46 instances. 11 The number of intimation notices served was 1,504, and the number of statutory notices, 423.

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In 09 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 eight summonses as in all other cases the necessary steps were taken on receipt of a letter from the Town Clerk. Eradication of Bed Bugs. 1,592 inspections of verminous premises were carried out and appropriate action was taken in accordance with the methods adopted in Woolwich, which have been reported on very fully in previous reports. Hydrogen Cyanide was used in the disinfestation of 4 buildings, and 14 loads of furniture. Rodent Control. In the course of routine and special inspections the Sanitary Inspectors discovered 388 rat infestations, 04 of which were in food premises. The number of inspections totalled 12,004, 890 being of food premises. In 130 instances it was necessary to secure the repair of drains.

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114 premises were rat-proofed and other effective measures taken in the remainder. Following a Direction issued by the Minister of Food under the Infestation Order, 1943, a survey of the Borough was carried out and a report submitted to the Ministry on the extent of infestation in the area. A further Direction issued in October required the Council to take all necessary steps to remedy all infestation of rats and mice in any sewer, drain or culvert in or under any land in the Borough. Arrangements were made with the Borough Engineer for the carrying out of this work under the supervision of the Sanitary Inspectors, and treatment of the sewers commenced on the 6th December. As was expected, the more recently constructed Sewers, such as those on the Council's housing estates, were found in general to be free from infestation. A third Direction required the Council to proceed with all necessary action to remedy all infestation by rats and mice on land within the Borough.

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The necessary arrangements were being made at the end of the year. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 4,478, and the number found not to be in all respects reasonably fit for human habitation was 1,755. The number rendered fit in consequence of informal action by the sanitary inspectors (including the service of intimation notices) was 1,399. Statutory notices were served in respect of 350 houses. INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 60, and 261 visits were made. The milk supply in Woolwich is in the main in the hands of three large distributors and, having regard to war-time difficulties, the standard was satisfactory.

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12 Two pasteurisers' licences, 7 dealers" licences and 4 supplementary licences were issued under the provisions of the Milk (Special Designations) Regulations, for the sale of pasteurised milk, and 14 dealers' and 3 supplementary licences were issued for the sale of tuberculin tested milk. Meat Supplies. With the exception of one used occasionally under licence from the Ministry of Food, all slaughterhouses in the Borough remained closed. The number of animals slaughtered and inspected at this one slaughterhouse during the year was 100. Basement Bakehouses. In 1938, certificates of suitability were issued as required by the Factories Act, 1937, in respect of seven basement bakehouses. In 1943 the quinquennial examination was carried out and the certificates of suitability were renewed in six instances. In the remaining case the bakehouse had not been used for a period exceeding twelve months. 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 1,421. The total weight of food certified as unfit for human consumption was 11 tons 2 cwts. Very little of this food was destroyed, most of it being used for animal feeding. Analysis of Food and Drugs. During the year, 810 samples were submitted to the Public Analyst for analysis. Of these, 655 were informal and 155 formal. Thirty-one samples were reported as adulterated (five of which were formal), giving a percentage adulteration of 3.8 compared with 3.5 in 1942. Suitable action was taken in each case of adulteration. English Grown Almonds.

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Owing to the many enquiries he had, received as to the edibility of locally grown almonds, the Public Analyst carried out an investigation and submitted a report on samples obtained. His conclusions were as follows:— (1) English-grown almonds are almost entirely confined to the Common Almond, P. Amygdalus (Communis) or its closely related forms, at least in the neighbourhood of London. Poisonous varieties, if they occur, may be detected at once by their bitter taste. (2) The percentage of Hydrogen Cyanide yielded by the Common Almond is about one-twentieth of that yielded by the bitter almond. (3) This proportion would not appear to be dangerous if the nuts were used in moderate quantities for normal dessert and cooking purposes. Food Poisoning. Thirteen cases of food poisoning were notified. In each case the illness was of a mild character and confined to individual private households. 13 PREVALENCE AND CONTROL OF INFECTIOUS DISEASES.

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Notifications. The total number of notifications received was 3,042. They relate to the following diseases:— Table No. II. Diphtheria 86 Ophthalmia Neonatorum 11 Scarlet Fever 533 Dysentery 70 Enteric Fever (including Paratyphoid) 2 Cerebrospinal Meningitis 19 Poliomyelitis 2 Puerperal Fever 2 Zymotic Enteritis 40 Puerperal Pyrexia 25 Measles 1,227 Erysipelas 45 Whooping Cough 482 Pneumonia 250 Scabies 245 Malaria 3 Diphtheria.

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There was a slight increase in the number of notifications received, but nevertheless, generally the incidence of diphtheria has declined, as shown by the fact that during the quinquennium 1939-43 the average number of cases notified per annum was 83 compared with an average of 375 cases per annum for the quinquennium 1929-33. In connection with the campaign to secure the immunisation of as many children between the ages of one and five as possible, special visits to these homes were made by the health visitors at the end of 1942 and at the beginning of 1943. In consequence, it was found necessary to extend the Council's scheme—a family doctor scheme. Special immunisation clinics at welfare centres, and at some first aid posts were therefore arranged, and these continued all through 1943. The number of children immunised under the Council's schemes was 2,116.

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In addition, 1,093 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 population, were 62 and 76 respectively. Refusals for various reasons and failure to keep appointments are still encountered. This is in contrast to the experience of the day nurseries, briefly referred to elsewhere, where all that is required of the parent is the necessary signature agreeing to immunisation, and refusals are virtually unknown. Whooping Cough. Whooping cough is a dangerous and distressing disease of childhood. In January, the Council formulated a scheme on the same lines as the diphtheria immunisation scheme for preventive inoculation against this disease. The scheme was brought to the notice of the medical practitioners in the Borough, and in all 119 children were given the inoculations. Influenza.

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The epidemic which occurred in the latter part of the year and in the early months of 1944 was not very severe in Woolwich. Arrangements were made, however, through the Women's Voluntary Services, the Woolwich Council 14 of Social Service, the British Red Cross Society and the St. John Ambulance Association for help in the home and with shopping, etc., and for assistance in nursing cases confined to bed. Arrangements were made also for the supply of meals from rest centres where necessary. Tuberculosis. The number of persons examined for the first time at the Dispensaries was 1,153. Of these, 197 were tuberculous. 267 contacts were examined, of whom 10 were tuberculous. The total number of attendances at the Woolwich and Eltharn Dispensaries was 5,438. There were 818 cases on the tuberculosis register on the 31st December.

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4,097 visits were made by nurses to homes of patients and 54 by the Tuberculosis Officer or by an Assistant Medical Officer. 739 cases were referred to the Dispensaries by medical practitioners and 165 by medical boards. 627 specimens of sputum were examined, of which'77 were positive. The number of X-ray examinations made was 1,769. Additional nourishment was granted in 220 instances. Twelve patients received dental treatment under the Council's scheme. 488 patients were admitted to hospitals, sanatoria, or training colonies. The artificial pneumothorax clinic at St. Nicholas' Hospital, which commenced in June, 1942, under the charge of Dr. A. Wingfield, continued throughout the year and was highly successful from all points of view. The number of patients who received treatment there was 56, and the number of refills given was 792. In addition, 36 patients attended London Hospitals and 447 refills were given.

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The Tuberculosis Care Committee continued their meetings and rendered valuable assistance in various ways to the needy tuberculous and their families. The payment of maintenance allowances under the Government scheme to encourage institutional treatment of early cases of tuberculosis commenced on the 30th June. Application forms are issued at the dispensaries and the staff give any necessary assistance in their completion. An Assessment Officer of the London County Council attends at the dispensary every week and fixes allowances. Details of the allowances payable are then forwarded to the Borough Treasurer, who arranges for the payments to be made at one of four cash offices, or by post where applicable. 110 patients were in receipt of an allowance at the end of the year, and the scheme was working smoothly. The Government, as part of the plan for extension of the tuberculosis service, made arrangements for the provision of miniature mass radiography units for the detection of symptomless pulmonary tuberculosis, and one such unit was allocated to the London County Council.

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Representations were made to the London County Council with a view to this unit being brought to Woolwich, but a visit had not been possible by the end of the year. Another unit was, however, set up in the Royal Arsenal. Laboratory Facilities. The bacteriological work of the Council is carried out at the War Memorial Hospital. Tn addition to the number of examinations 15 made for the tuberculosis service, 618 specimens were examined for diagnostic purposes in the case of diphtheria, 1 in the case of enteric fever, 10 in the case of dysentery and 4 on account of food poisoning. Disinfection and Disinfestation. The number of rooms disinfected after cases of infectious disease was 646, of which 81 had been occupied by tuberculous persons. On account of the presence of vermin, 803 rooms were disinfested. 78,455 articles were treated at the disinfecting station.

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Personal cleansing was continued at the temporary cleansing station at the Plumstead Turkish Baths and at the cleansing section of the Eltham Hill Health Centre. In July the Ministry of Health issued a circular on head infestation by lice It was suggested that the health visitors should include the examination of children's heads as part of their work. In Woolwich, it has always been the practice for the health visitors to carry out such examinations where necessary, to give advice to. the mother, and to arrange for any necessary treatment at the cleansing stations. There was a further increase in scabies, but the increase was small compared with that in 1942. The scheme for diagnosis and treatment, which commenced in May, 1942 (reported in the Annual Report for that year) continued in being. On the whole, treatment for scabies is now readily accepted by a large proportion of the contacts as well as the clinically infected cases.

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In May, the disinfestation of bedding for scabies was discontinued, except for special cases, and ironing or washing at home substituted. The objections of some of the families to treatment were removed, when it was known that "the van" would not be calling at the house. The relapse rate remained practically unaffected. The County of London (Scabies) Regulations, 1943, which came into operation on the 1st August, 1943, require the notification of cases of scabies by medical practitioners, subject to certain exceptions. 245 cases were notified. The number of persons treated (including scabies contacts), and the number of treatments given at the cleansing stations, were as follows:— TABLE No. III. Persons. Treatments.

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Pre-school children- Vermin 42 42 Scabies 640 1,283 School children— Vermin 1,970 1,975 Scabies 1,195 2,869 Adults— Vermin 80 80 Scabies 1,924 3,804 Totals 5,851 10,053

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METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1944 BY E. VIRGINIA SAUNDERS-JACOBS, M.A. (Cantab), M.D., B.S., B.Sc., M.R.C.S., L.R.C.P., D.P.H. Acting Medical Officer of Health WOOLWICH : The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 HEALTH COMMITTEE. At 31st December, 1944. The Worshipful the Mayor (Councillor E. T. Lamerton, j.p.) Councillor Mrs. E. L. Reeves (Chairman). Councillor Mrs. A. Day ( Vice-Chairman). Alderman- Mrs. K. Howlett Councillors- Mrs.

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N. Cooper T. W. Croft Miss M. Crout, j.p. C. H. Darby Mrs. L. E. Driver G. E. Edwards A. H. Gilder, m.b.e., j.p. D. B. Lister Mrs. K. M. Rance W. T. Walden D. P. Walsh Miss G. E. Walters, j.p. MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor Mrs. E. L. Reeves (Chairman) Councillor Mrs. A, Day (Vice-Chairman) 3 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the 44th Annual Report on the health of the Metropolitan Borough of Woolwich.

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It is again in an abridged form, in accordance with the instructions of the Ministry of Health and in common with those published during the war. It has, however, been possible to include certain figures for 1944 which were omitted for recent years, as restrictions previously imposed for security reasons have now been lifted. A summary of vital statistics will be found in table No. 1. The Registrar General's estimate shows a slight reduction in the population. The birth rate was a little lower, and the death rate a little higher, than in 1943. The infant mortality rate rose from 35 in 1943 to 40 in 1944, but this increase is mainly attributable to deaths from enemy action. The maternal death rate fell from 1.79 in 1943 to 1.43 in 1944. The health of the Borough remained good. There was a reduction in the number of notifications of infectious diseases and, as is shown in table No.

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2, there was only one death from Diphtheria and one from Whooping Cough, and there were no deaths from Typhoid Fever, Scarlet Fever or Measles. There were also fewer notifications of, and deaths from, Tuberculosis. There was a satisfactory reduction in the incidence of Scabies. No noteworthy outbreaks of illness occurred and the number of deaths, apart from those due to enemy action, was no more than the average for the Borough. Although many members of the staff of the Department were serving in H.M. Forces, or seconded to other duties, and a proportion of the time of those remaining continued to be devoted to Civil Defence, the Council's Health services were effectively maintained under the supervision of the Deputy Medical Officer of Health, Dr. T. Standring.

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The work of the Sanitary Section of the Department was complicated by the enemy " flying-bomb" and " ocket" air attacks occurring during the second half of the year : all food in damaged shops was examined by the Food Inspectors ; and the difficulties of the District Inspectors were increased by the necessary concentration of building labour on repairs to war-damaged property. A drive for the extermination of rats was again undertaken with vigour, and achieved satisfactory results 4 The Maternity and Child Welfare services continued to operate on a comprehensive basis under the difficult conditions created by the fresh evacuations and population movements which followed bomb-damage. It will be observed that the attendances at the Ante-Natal Clinics increased, and that seven day-nurseries were in operation.

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In presenting this Report, I wish to pay tribute to the evidence it contains of the encouragement and support given to the staff by the Chairman and members of the Health and Maternity and Child Welfare Committees, and of the co-operation and devotion to duty shown both by the permanent and the temporary members of the staff. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, E. VIRGINIA SAUNDERS-JACOBS, Acting Medical Officer of Health. 5 VITAL STATISTICS. Table No. 1 contains extracts from the vital statistics for the year. Table No. 2 shows details of causes of death. Table No. 1.

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Population 110,970 Live Births—Legitmate 1,917 Live Births—Illegitimate 120 2,037 Birth Rate 18.3 Still-births 48 Still-births—Rate per 1,000 total births 23 Deaths 1,611 Death Rate 14.5 Deaths from puerperal causes :— (a) From Sepsis 1 (b) From other causes 2 Death rate from puerperal causes per 1,000 total births 1.43 Death Rate of Infants one year of age :— (a) All infants 40 (b) Legitimate infants 37 (c) Illegitimate infants 91 Deaths from Cancer (all ages) 223 Deaths from Whooping Cough 1 Deaths from Diarrhoea (under two years of age) 17 TABLE No. 2. Nett Deaths during the calendar year 1944. Causes of Death.

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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 1,611 83 13 25 197 458 835 Typhoid and paratyphoid fevers . . . . . . . Cerebrospinal fever 2 . . . 1 1 . Scarlet fever . . . . . . . Whooping cough 1 . . . . . . Diphtheria 1 . . . . . . Tuberculosis of the respiratory system 91 . . . 50 34 6 Other forms of tuberculosis 9 l 3 1 1 Syphilitic diseases 20 1 . . 1 8 10 Influenza 4 . . . .

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1 3 Measles Acute polio-myelitis and polio-encephalitis . . . . . . . Acute infective encephalitis 1 . . . 1 Cancer of buccal cavity and oesophagus (M); uterus (F) 30 . . . l 11 is Cancer of stomach and dudenum 38 . . . 3 19 16 Cancer of breast 19 . . . . 12 7 Cancer of all other sites 136 . . . 10 58 68 Diabetes 12 . . . . 2 10 Intracranial vascular lesions 118 . . . 3 32 83 Heart disease 425 . . . 15 74 336 Other diseases of the circulatory system 43 . . . 2 10 31 Bronchitis 67 1 . .

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3 20 43 Pneumonia 64 8 3 1 1 16 35 Other respiratory diseases 15 . 1 . 4 8 2 Ulcer of stomach or duodenum 25 . . . 2 14 9 Diarrhoea under 2 years 17 17 . . . . . Appendicitis 3 . . . 1 . 1 Other digestive diseases 35 . . . 4 13 18 Nephritis 26 . . . 3 8 15 Puerperal and post-abortive sepsis 1 . . . 1 . . Other maternal causes 2 . . . 2 . . Premature birth 22 22 . . . . Congenital malformation, birth injury, infantile diseases 22 20 . 1 . . 1 Suicide 9 . . . 4 3 2 Road traffic accidents 5 . .

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1 1 1 2 Other violent causes 234 io 5 12 72 82 53 All other causes 114 3 . 7 9 30 65 6 7 GENERAL PROVISIONS OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 1,244, and the number of births registered 1,236. After correction for inward and outward transfers the net number of Woolwich live births was 2,037 ; of these, 1,282 are known to have taken place in Institutions. Maternity and Child Welfare Clinics and Treatment Centres. The general arrangements during the year at each of the Council's maternity and child welfare clinics and treatment centres were as set out in the 1942 report. The attendances at the Maternity and Child Welfare Centres were :—Expectant Mothers, 7,646 ; Nursing Mothers, 2,214 ; Children, 36,534. Toddlers' Clinics.

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The number of inspections carried out at Toddlers' Clinics was 1,957. One of the Council's Assistant Medical Officers reports that the clinics were well attended and the mothers co-operative in carrying out the advice given; that the health of the children was, on the whole, satisfactory, and that there were extremely few cases showing a marked degree of ill-health, although minor ailments were found and there was evidence of a certain lack of good health in a high proportion of the children, particidarly among those who stayed in London during the whole of the " flying bomb " and " rocket " periods. The conditions most commonly occurring were dental caries, chronic infections of the upper respiratory tract, a mild degree of anaemia, and minor orthopaedic defects. Health Visiting. The number of visits paid by Health Visitors to children under five years of age was 18,386 ; the total number of visits paid by Health Visitors was 25,420. Child Life Protection.

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There were 19 foster-mothers on the register at the end of 1944, compared with 26 in 1943, and there were 20 foster-children. The number of visits paid by child life protection visitors was 198. Artificial Sunlight Clinic. Artificial sunlight treatment was again given in the Town Hall shelter during the early part of the year, but the clinic was transferred to newly adapted rooms at the Old Town Hall on 24th April. The number of treatments was 10,784. Dental Treatment. The number of mothers and of children under five attending the dental clinics was 323 ; the number of tuberculous persons, 6 ; and the total number of attendances, 1,062. Minor Ailments. The number of children under five years of age referred to school clinics for treatment of minor ailments was 98. 8 Issue of Fruit Juices and other Supplements.

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The distribution of the Government fruit juices and cod-liver-oil was continued, throughout the year, at the food offices and all first-aid posts. Midwifery Services. The domiciliary midwifery service in London is administered by the County Council, the mid wives working in collaboration with the Borough ante-natal clinics. Institutional midwifery was available in Woolwich only at the British Hospital for Mothers and Babies and at the Eltham Cottage Hospital, the maternity wards of the Memorial Hospital and of St. Nicholas' Hospital being closed. Woolwich mothers were, however, also admitted to London County Council hospitals outside the Woolwich area, notably to St. Alfege's, and Lewisham Hospitals ; also, through the Evacuation Scheme, to the Ministry of Health Evacuation Maternity Homes and Hostels outside London.

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Under the Council's agreement with the British Hospital for Mothers and Babies, accommodation is reserved at this Hospital for 144 of the Council's cases per annum. When the maternity wards of the Memorial Hospital closed, an arrangement was made for an extra 72 cases per annum to be admitted, but this terminated at the end of the year as the maternity unit at the Memorial Hospital was to re-open on the 1st January, 1945. In addition, by arrangement with the London County Council in February, 1944, accommodation was reserved for further 168 cases per annum, the London County Council accepting financial responsibility. During 1944, 1,364 mothers were admitted to the British Hospital for Mothers and Babies, 746 of these were Woolwich mothers, 260 of whom were admitted under the Council's Scheme. 63 mothers were admitted to the Eltham Cottage Hospital. Care of Premature Infants.

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The Ministry of Health issued a circular in March, containing recommendations for the provision of special facilities for the care of premature infants. Most of the suggested facilities were already available in Woolwich, but, in addition, the Council approved the appointment of a Consultant Paediatrician, Dr. Doyne Bell, and the purchase of draughtproof cots. Home Helps. During the year 101 applications were considered and 77 Home Helps were provided. Care of Illegitimate Infants. A scheme was adopted by the Council in 1944, which included guaranteed payments to foster-mothers undertaking the care of illegitimate infants, and a contribution to a fund to provide financial assistance to Moral Welfare Associations, such contribution to be based on rateable value and paid to the Metropolitan Boroughs' Standing Joint Committee, which administers the fund. Convalescence for Children Under Five. Under the Council's arrangement with the Invalid Children's Aid Association, 23 children were sent to convalescent homes.

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War-Time Day-Nurseries. By the end of 1943, five day-nurseries, providing accommodation for 207 children, were in operation in the Borough. Three were 9 established by the Borough Council and two were in London County Council rest centres. With the opening of a new day-nursery on Woolwich Common on the 15th January, and another at Abbey Wood on the 15th May, accommodation for-the daily care of children of war workers was increased to 327 places, 95 for children under two years of age and 232 for children between two and five years of age. The building of a further nursery was in progress, but the work was stopped during the fly-bomb attacks and was not re-commenced. Negotiations which were taking place for the acquisition of a site for the erection of yet another nursery, were discontinued. Clinic foe Physical Medicine.

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The work of this clinic was somewhat expanded, the number of attendances being 7,821, as compared with 5,771 in 1943. Professional Nuesing in the Home. Nursing assistance in the homes of the patients was provided by arrangement with the six nursing associations in the Borough, for cases of measles, ophthalmia neonatorum, zymotic enteritis, whooping cough, poliomyelitis, pneumonia, puerperal fever, puerperal pyrexia and tuberculosis. The total number of visits paid by the nurses on behalf of the Council was 890. Foot Clinics. Foot clinics continued to be held daily at the Central Health Centre and at the Eltham Baths. The number of attendances at Woolwich was 8,243 compared with 10,285 in 1943. At Eltham the number of attendances was 5,196 compared with 4,348.

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Supply of Insulin to Peesons Suffeeing feom Diabetes. The number of patients under the Council's Scheme who received Insulin during the year was 19. Tubeeculosis Dispensaeies. The premises at Maxey Road, Plumstead, and 11, Carnecke Gardens, Eltham, continued in use throughout the year. The work of the dispensaries is referred to in the section dealing with infectious diseases. Vaccination. There were 1,216 entries in the birth lists for 1943. Of these 662 were successfully vaccinated. The total number of successful primary vaccinations during 1944 was 1,233. SANITARY ADMINISTRATION. Complaints. 2,148 complaints of nuisance were received and investigated. The necessary action was taken where defects or nuisances were discovered. Sanitaey Inspection of the Aeea.

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During the year, 22,628 inspections, including re-inspections, were carried out by the Sanitary Inspectors. The nature of these inspections is shown in Table No. 3, and details of nuisances abated in Table No. 4. The number of intimation notices served as a result was 1,062, and the number of statutory notices, 348. In only 5 cases were legal proceedings instituted. 10 TABLE No. 3. Inspections.

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Complaints Investigated 2,148 Tents and Vans 15 Outworkers' Premises 145 Factories.. 339 Houses Let in Lodgings 99 Shops Act, 1934 170 Houses re Infectious Diseases 1,430 Theatres and Cinemas 19 Houses re Smallpox Contacts 51 Rag and Bone Premises 14 Houses re Verminous Cases 1,845 Urinals Accessible to the Public 112 Houses re Scabies Cases 5,709 Women's Lavatories 150 Houses re other Diseases 141 Inspections re Rats 6,482 Common Lodging Houses 29 Pharmacy and Poisons Act 39 Drainage Inspections 1,544 Air Raid Shelters 369 Drains Tested by Smoke Test 258 Miscellaneous 1,514 Drains Tested by Water Test 6 TABLE No. 4. Nuisances Abated.

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Dirty Conditions 512 Defective Paving 95 Damp Conditions 819 Drainage Defects 908 Dilapidations 721 Water Closet Defects 527 Verminous Rooms Cleansed 811 Dust Bins Provided 127 Defective Lighting 180 Water Supply Defects 95 Defective Ventilation 155 Foul Accumulations removed 35 Water Supply. The Metropolitan Water Board is responsible for the water supply in the Borough ; it was satisfactory in quality and quantity. So far as can be ascertained, there were 15 wells in the Borough used chiefly for trade and kindred purposes, and all dwelling houses were supplied direct from public water mains. Eradication of Bed Bugs. Appropriate action was taken in all cases of infestation coming to the knowledge of the department ; 1,845 inspections were carried out in connection therewith. Hydrogen Cyanide was used in the disinfestation of one building, and of nine loads of furniture. Rat Destruction.

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There are no large areas of rat infestation in Woolwich, nevertheless, a considerable amount of time and effort was devoted to rat extermination. A thorough investigation was made as a result of every complaint received, and baiting and trapping under the direction of the Sanitary Inspectors was carried out, where necessary, by the Council's workmen. The number of inspections made on account of rats was 6,482. The baiting of the sewers in the Borough commenced in December, 1943, and was completed during January, 1944. Baits were laid in 2,427 manholes necessitating approximately 18,000 visits. The estimated number of rats killed, based on the method of calculation adopted by the Ministry of Food, was 9,946. At the end of the year arrangements were in progress for a maintenance treatment of the sewers to be undertaken in January, 1945. 11 Housing.

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The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 2,330, and the number found not to be in all respects reasonably fit for human habitation was 942. The number rendered fit in consequence of informal action by the sanitary inspectors, including the service of intimation notices, was 714. Statutory notices were served in respect of 228 houses. INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December, was 58, and the number of visits paid to them was 157. The standard of the milk supply in Woolwich was satisfactory in view of war-time difficulties. Two pasteurisers' licences, 7 dealers' licences and 9 supplementary licences were issued under the provisions of the Milk (Special Designations) Regulations for the sale of pasteurised milk, and 10 dealers' and 8 supplementary licences were issued for the sale of tuberculin tested milk.

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Meat Supplies. Owing to regional slaughtering, all slaughterhouses in the Borough remained closed, with the exception of one used occasionally under licence from the Ministry of Food. The number of animals slaughtered and inspected at this one slaughterhouse was 104. Premises where Food is Prepared or offered for Sale. All such premises, including those registered under the provisions of the Public Health (London) Act, 1936, were kept under frequent observation. The number of inspections carried out during the year was 1,575. The total weight of food certified as unfit for human consumption was 9 tons, 13 cwts. Very little of this food was destroyed, most of it being used for animal feeding. Analysis of Food and Drugs. During the year, 772 samples, including 695 informal and 77 formal ones, were submitted to the public analyst.

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25 of them, three of which were formal, were reported to be adulterated, giving a percentage adulteration of 3.2, compared with 3.8 in 1943. Appropriate action was taken in each case of adulteration. War Damage to Food Premises. In the early months of 1944 only a small quantity of food was damaged as a result of enemy action, but during June, July and August, while Woolwich was being subjected to concentrated attacks by " flying " bombs, more than 400 food premises were damaged in varying degrees, necessitating the examination of many tons of food of all kinds by the Food Inspectors, and resulting in the condemnation of about 7f tons of rationed and unrationed goods. In addition, many hundreds of tons of foodstuffs were damaged in local warehouses.

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The co-operation of the Salvage Division of the Ministry of Food was obtained in order to effect disposal of, and find a market for, the large quantities of damaged and undamaged food involved. 12 From September onwards, owing to the destructive " rocket " bombing, another 350 food premises were damaged, rendering about 15 tons of food of all descriptions unfit for human consumption. Thus, throughout the year, nearly 800 shops and food premises were damaged, and approximately 23 tons of food made unfit for human consumption. PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 2,180. They relate to the following diseases :— Table No. 5.

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Diphtheria 55 Malaria 20 Scarlet Fever 223 Ophthalmia Neonatorum 8 Enteric Fever Dysentery 115 (including Paratyphoid) 1 Cerebrospinal Meningitis 9 Puerperal Fever 2 Zymotic Enteritis 24 Puerperal Pyrexia 8 Measles 717 Erysipelas 52 Whooping Cough 329 Pneumonia 227 Scabies 390 Diphtheria. There was a fall in the number of notifications, due partly to the evacuation of children in the latter half of the year. Efforts to secure the immunisation of as many children between the ages of 1 and 5 as possible were continued. Mothers were invited to take such children to special sessions arranged at welfare centres or first-aid posts, or to make use of the Council's " family doctor " scheme.

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The number of children immunised under the Council's scheme was, 1,346 ; in addition, 332 school children were immunised by Medical Officers of the London County Council. Owing to re-evacuation, these figures are considerably below those for 1943. Even so it was estimated that 75 per cent, of the child population of Woolwich had been immunised by the end of the year. Whooping Cough. 207 children were immunised under the scheme established in 1943. Tuberculosis. The number of formal notifications of tuberculosis received for the year was 248, that is 44 fewer than in 1943. The number of persons examined for the first time at the Dispensaries was 1,356, of these, 164 were found to be suffering from tuberculosis. The number of contacts who attended for examination was 268, 12 of them proved to be tuberculous. The total number of attendances at the dispensaries was 5,602.

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Patients referred to the dispensaries by medical practitioners totalled 722 ; by medical boards, 103 ; and as a result of mass radiography surveys, 70. There were 1,008 cases on the Tuberculosis Register on the 31st December. 4,649 visits by nurses were made to homes of patients and 56 by the Tuberculosis Officer or by an Assistant Medical Officer. 13 The number of X-Ray examinations made was 1,721. 623 specimens of sputum were examined, of which 75 were positive. Additional nourishment was granted in 106 instances. Six patients received dental treatment under the Council's scheme. 417 patients were admitted to hospital, sanatoria or training colonies. The work of the artificial pneumothorax clinic was continued without interrup- • tion, although damage to St. Nicholas Hospital necessitated the removal of the clinic to Seamen's Hospital, Greenwich, during the latter half of the year. The following is an excerpt from the report of Dr.

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A. Wingfield, the Consultant-in charge of the clinic. " 58 patients made a total of 871 attendances in 52 sessions, an average attendance of 16.5 per session. These figures do not, however, give a complete picture of the work carried out at the clinic as sessional attendances varied from a maximum of 24 to a minimum of 11 ; some patients received bilateral refills, and in some cases aspiration of fluid and washing out of the pleural cavity were necessary. These last two manipulations consumed much more time than an uncomplicated refill. As in previous years chest X-Rays were taken every three months, or more often if considered necessary, and blood sedimentation rate tests at about the same intervals. Patients were examined on the fluorographic screen at each attendance. During the year, 21 new patients attended and at the end of the year there were 42 patients on the books of the clinic."

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Clinics at other London hospitals were attended by 36 patients who received 740 refills. The mass radiography unit allocated by the Government to the London County Council was set up in the Plumstead Baths in February and March for a period of six weeks. Employers were asked to make known to employees the facilities thus available and to submit numbers of employees, up to a certain allocation, wishing to be X-Rayed. Arrangements were then made for parties to visit the unit. The response was gratifying and the unit worked to capacity. The following is a summary of examinations carried out :— Table No. 6 Men. Women Total. Total examined 2,586 2,485 5,071 Referred for larger films 127 107 234 Probably tuberculous 27 29 56 Cardio Vascular 8 11 19 The scheme for the payment of maintenance allowances as described in the Annual Report for 1943 continued working smoothly during 1944.

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At the end of the year, 93 patients were in receipt of such allowances. 14 The Tuberculosis Care Committee continued their meetings and in various ways rendered valuable assistance to the needy tuberculous and their families. Laboratory Facilities. The bateriological work of the Council is carried out at the Memorial Hospital. In addition to the investigations made for the tuberculosis service, 400 throat and nasal swabs, 45 specimens of faeces, and 2 specimens of food were examined for diagnostic purposes. Disinfection and Disinfestation. The number of rooms disinfected after cases of infectious disease was 358, of which 81 had been occupied by tuberculous persons. 811 rooms were disinfested on account of the presence of vermin. 70,963 articles were treated at the disinfecting station. Personal cleansing was continued at the temporary cleansing station at the Turkish Baths, Plumstead, and at the cleansing section of the Eltham Hill Health Centre.

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Although the number of cases of scabies notified (390) did not necessarily reflect the true state of affairs, it is gratifying to record that the actual number of cases and contacts treated, fell from 3,759 in 1943 to 2,536 in 1944. There was, however, a slight increase in the number of treatments for verminous conditions. The number of persons treated, including scabies contacts, and the number of treatments given at the cleansing stations, were as follows :— Persons. Treatments. Pre-school children—Vermin 276 276 Scabies. 413 804 Schoolchildren— Vermin 1,843 1,853 Scabies 797 1,978 Adults— Vermi 188 188 Scabies 1,326 2,668 Totals .. 4,843 7,767 Regular Scabies Clinic sessions were held, and attended by the Council's Consultant, who continued to supervise the scheme. TABLE OF CONTENTS.

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page Health Committee 2 Maternity and Child Welfare Committee 2 Preface 3 Vital Statistics 5 General Provision of Health Services in the Area, including those for Maternity and Child Welfare V Sanitary Administration, including Housing 9 Inspection and Supervision of Food 11 Prevention and Control of Infectious Diseases: Disinfestation 12

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AC 4372 WOO 45 METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1945 BY T. STANDRING, M.D., B.S., D.P H., M.R.C.S., L.R.C.P. Medical Officer of Health WOOLWICH: The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 TABLE OF CONTENTS. PAGE Health Committee 3 Maternity and Child Welfare Committee 3 Preface 4 Vital Statistics 6 General Provision of Health Services in the Area, including those for Maternity and Child Welfare 8 Sanitary Administration, including Housing 12 Inspection and Supervision of Food 13 Prevalence and Control of Infectious Diseases: Disinfestation 14 HEALTH COMMITTEE. At 31st December, 1945. The Worshipful the Mayor (Councillor C. H. Darby, j.p.)

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Councillor Mrs. E. L. Reeves (Chairman). Councillor Mrs. E. Brooks (Vice-Chairman). Aldermen— F. C. Halse, m.i.o.b. S. C. C. Harris. Mrs. J. R. Whiting. Councillors— J. W. Andrews Mrs. N. Cooper Miss M. Crout, J.P. Mrs. L. E. Driver Mrs. L. R. Duff A. H. Gilder, M.B.E., J.P. Mrs. K. Howlett Mrs. M. E. Polley Miss G. E. Walters, J.P. J. F. Whitty MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor Mrs. E. L. Reeves (Chairman) Councillor Mrs.

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E. Brooks (Vice-Chairman) 4 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the 45th Annual Report on the health of the Metropolitan Borough of Woolwich, which, in common with the reports for the years 1939-1944, is in an abridged form in accordance with the instructions of the Ministry of Health. The health services of the Borough were well maintained throughout the year and no unusual outbreaks of illness occurred. There were no epidemics of infectious diseases, except perhaps a mild one of Measles of which 1,052 cases came to the knowledge of the Department.

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It is interesting to note that, since the commencement of evacuation during the war, the regular biennial epidemics of Measles, which were formerly general throughout London during the winter and early spring, have been replaced by a varying number of cases each year, spread mainly over the spring and summer months, with isolated cases during the autumn and winter. There were fewer cases of Diphtheria and of Scarlet Fever than in 1944; many of the latter were nursed at home owing to staffing difficulties in the London County Council fever hospitals. There was only one death from Diphtheria, one from Whooping Cough and one from Measles; there were no deaths from Scarlet Fever. There was a slight increase in the number of notifications of Tuberculosis, but a decrease in the number of deaths. The population at the middle of 1945 as estimated by the Registrar-General showed an increase of nearly 5,000 over that of 1944.

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The birth rate (17.5) was lower than that of 1944 (18.3), as also was the death rate—12.8, compared with 14.5 for 1944. The infant mortality rate was 41, as compared with 40 in 1944, and the maternal death rate was slightly higher—1.94, compared with l.43 in 1944. A summary of vital statistics will be found in Table No. 1. Detailed causes of death are shown in Table No. 2. The year 1945-46 saw the end of bombing and of hostilities, both in Europe and in the Far East. Consequently, the members of the staff of the Health Department, many of whom had been engaged in Civil Defence to the final stages and later in the winding-up of the First Aid and other medical Posts, devoted the latter half of the year wholly to the health services.

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Although many members of the permanent staff were still away, the health services, including those of maternity and child welfare, physical medicine, and chiropody, were extended and improved as conditions allowed. 5 Premises used by this Department were reconverted for peace-time purposes; a war-time building was being adapted as a health centre to replace the one destroyed at Eltham in 1941 by enemy action. The sanitary section of the Department, although handicapped by being short-staffed, continued the work of maintaining the sanitary conditions in the area at as high a standard as possible having regard to war-time and post-war difficulties, particularly those arising from the acute lack of housing accommodation. As Deputy Medical Officer of Health, I continued to supervise the work of the Department until May, 1945, when I joined H.M. Forces; Dr. E. Virginia SaundersJacobs then returned from special service with the Ministry of Health to act as Medical Officer of Health.

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In presenting this report, I would like to thank the permanent and temporary members of the staff of the Health Department for the loyal, enthusiastic and efficient manner in which they have carried out their duties ; and the Chairman and members of the Health and Maternity and Child Welfare Committees for the encouragement and support they have given to the staff. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, T. STANDRING, Medical Officer of Health. 6 VITAL STATISTICS. Table No. 1 contains extracts from the vital statistics for the year, with comparable figures for 1944. Table No. 2 shows details of causes of death. Table No. 1. 1945. 1944. Population 115,270 110,970 Live Births—Legitimate 1,850 1,917 Live Births—Illegitimate 171 120 — 2,021 — 2,

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037 Birth Rate 175 18-3 Still-births 37 48 Still-births—Rate per 1,000 total births 18 23 Deaths 1,478 1,611 Death Rate 12.8 14.5 Deaths from puerperal causes:— (a) From Sepsis 2 1 (b) From other causes 2 2 Death rate from puerperal causes per 1,000 total births 1.94 1.43 Death Rate of Infants under one year of age:— (a) All infants 41 40 (b) Legitimate infants 38 37 (c) Illegitimate infants 70 91 Deaths from Cancer (all ages) 267 223 Deaths from Whooping Cough 1 1 Deaths from Diarrhoea (under two years of age) 11 17 7 Table No. 2.

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Nett Deaths during the calendar year, 1945, including non-residents in Institutions in the Borough. Causes of Death. Nett Deaths at the subjoined ages of " residents " whether occurring within or without the district. Deaths in Public Institutions. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. .5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. In Borough Outlying Institu tions. Residents. NonRsdts.

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All Causes 1478 83 7 9 14 31 50 54 136 253 433 408 347 66 515 Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — Cerebrospinal Meningitis 1 — — — — 1 — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — Whooping Cough 1 1 — — — — — — — — — — — — 1 Diphtheria 1 1 — — — — — — — — — — — — 1 Tuberculosis of Respiratory System 79 1 — 1 — 16 19 9 16 10 7 — 9 — 42 Other Tuberculosis Diseases. .

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11 1 1 1 1 3 — — — 2 1 1 3 1 4 Syphilis 16 — — — — — — — 3 6 5 2 3 2 4 Influenza 7 — — — — — — — — 3 2 2 — — 4 Measles 1 — 1 — — — — — — — — — — — 1 Poliomyelitis and Polioencephalitis — — — — — — — — — — — — — — — Encephalitis Lethargica 1 — — — — — — 1 — — — — — — 1 Cancer 267 — — — — 1 6 11 39 73 91 46 74 15 97 Diabetes 16 — — — — — — — 2 3 7 4 4 — 9 Cerebral Haemorrhage, etc.

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127 — — — — — — 1 10 24 57 35 33 1 36 Heart Disease 414 — — — — 1 2 8 20 60 146 177 86 10 108 Other Circulatory diseases 41 — — — — — — — 5 — 21 15 16 2 14 Bronchitis 82 5 — 1 1 — 1 1 8 10 23 32 8 1 14 Pneumonia 65 8 2 — 1 1 1 2 3 12 17 18 21 3 30 Other Respiratory diseases 13 1 — — — 1 1 — 3 3 2 2 — 1 6 Peptic Ulcer 26 — — — — — — 2 3 11 6 4 10 2 9 Diarrhoea, etc.

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11 11 — — — — — — — — — — — — 11 Appendicitis 6 — — — — — — 1 — 2 3 — 4 2 2 Other Digestive diseases 29 1 — 2 — 1 2 3 2 2 6 10 6 — 15 Acute and Chronic Nephritis 32 — — 1 — 1 — 3 3 6 8 10 9 — 9 Puerperal Sepsis and Post-abortive sepsis 2 — — — — — 2 — — — — — — — 2 Other Maternal causes 2 — — — — — 2 — — — — — — — — Premature Birth 14 14 — — — — — — — — — — 2 3 9 Congenital Malformations, etc.

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31 30 1 — — — — — — — — — 12 5 12 Suicide 11 — — — — — — 1 3 5 2 — 5 1 3 Road Traffic Accidents 11 — 1 — — — 1 1 1 — 3 4 5 5 6 Other Violence 81 5 1 3 7 2 7 10 10 7 12 17 12 5 17 All other Causes 79 4 — — 4 3 6 — 5 14 14 29 25 7 48 8 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 1,472. The number of births registered in Woolwich was 1,452. After correction for inward and outward transfers the nett number of Woolwich live births was 2,021.

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It is known that at least 1,542 births took place in Institutions. Clinics and Treatment Centres. The war-time arrangement of sessions at the clinics and treatment centres continued during the first half of the year but with the disbanding of Civil Defence certain buildings which had been used as first aid posts were brought back into use as welfare centres. At the end of the year the following clinics and treatment centres were in use:— Woolwich Central Health Centre Child welfare and ante-natal clinics. Dental clinic. Physical medicine. Foot clinic. Plumstead Health Centre Child welfare and ante-natal clinics. 601, Westhorne Avenue Child welfare and ante-natal clinics. Wesley Hall, Timbercroft Lane Child welfare clinics. Legal and General Sports Pavilion, Footscray Road, New Eltham Child welfare clinics. St. Luke's Church Hall, Westmount Road Child welfare clinics. St. John's Church Hall, North Woolwich Child welfare clinics.

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137, Alnwick Road, Horn Park Child welfare and ante-natal clinics. Old Town Hall Artificial Sunlight clinic. Turkish Baths, Plumstead High Street Personal cleansing station. Eltham Hill Health Centre, Sherard Road Personal cleansing station. Foot clinic. Maxey Road, Plumstead Tuberculosis Dispensary. 11, Carnecke Gardens, Eltham Tuberculosis Dispensary. 9 Sanction was obtained from the Ministry of Health for the use of an ad hoc first aid post at Lionel Road, Eltham, as a maternity and child welfare centre but the necessary work of adaptation had not been carried out at the end of the year. The attendances at the maternity and child welfare centres were as follows : expectant mothers 7,899; nursing mothers 4,604; children 47,289. Toddlers' Clinics.

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The clinics were well attended and 3,015 toddlers' inspections were carried out, as compared with 1,057 in 1944. The general standard of health was satisfactory. Again dental caries, minor anaemia, orthopaedic defects and chronic infections of the upper respiratory tract formed the majority of the conditions requiring treatment. Health Visiting. The number of visits paid by health visitors to children under five years of age was 20,643 ; the total number of visits paid by health visitors was 28,029. Child Life Protection. There were 19 foster-mothers on the register at the end of 1945—the same number as at the end of 1944—and there were 21 fosterchildren. The number of visits paid by child life protection visitors was 148. Artificial Sunlight Clinic. The artificial sunlight clinic at the old Town Hall continued its work. The number of treatments given was 10,228. Dental Treatment.

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The number of mothers and of children under five attending the dental clinics was 397; the number of tuberculous persons, 7; and the total number of attendances, 1,200. Minor Ailments. The number of children under five years of age referred to school clinics for treatment of minor ailments was 155. Issue of Fruit Juices and other Supplements. The distribution of the Government fruit juices and cod liver oil was continued at the food offices throughout the year and at all first aid posts until the disbandment of Civil Defence in May. With the closing of the first aid posts, arrangements were made for distribution at certain welfare centres, the Food Office supplying staff in some cases. Midwifery Services. The Domiciliary Midwifery Service in London is administered by the County Council, the midwives working in collaboration with the Borough ante-natal clinics.

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Institutional midwifery was available in Woolwich at the British Hospital for Mothers and Babies, at the Eltham Cottage Hospital, and at the War Memorial Hospital. The maternity ward at St. Nicholas' Hospital remained closed. Some Woolwich mothers were admitted to London County Council hospitals outside the Woolwich area, notably St. Alfege's and Lewisham Hospitals ; also, through the evacuation scheme, to the Ministry of Health evacuation maternity homes and hostels outside London. Under the Council's agreement with the British Hospital for Mothers and Babies, accommodation is 10 reserved at this hospital for 144 of the Council's cases per annum. In addition, by arrangement with the London County Council, accommodation is reserved for a further 168 cases per annum, the London County Council accepting financial responsibility. The maternity unit at the War Memorial Hospital reopened on the 1st January, and the pre-war agreement again operated, the hospital providing accommodation for 66 cases per annum referred by the Council.

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With the reopening of this unit, the war-time arrangement with the British Hospital for Mothers and Babies for the acceptance of an extra 72 Council cases was discontinued. During 1945, 1,272 mothers were admitted to the British Hospital for Mothers and Babies. 807 of these were Woolwich mothers, 297 of whom were admitted under the Council's scheme. 211 mothers were admitted to the War Memorial Hospital, 66 of them being Woolwich mothers, 62 of whom were Borough Council cases. 56 mothers were admitted to the Eltham Cottage Hospital. Care of Premature Infants. The number of babies born in the Borough whose birth weight was 5½ lbs. or less was 72. Of these, 58 were born in hospital and 14 in private houses. Of those born in hospital, 4 died during the first twentyfour hours and 48 survived at the end of four weeks.

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Of those born in private houses, 3 were admitted to hospital; 2 died during the first twenty-four hours, and 11 survived at the end of four weeks. No applications for the loan of draft-proof cots or other equipment, or for the services of the Consultant Paediatrician were received. Home Helps. During the year, 104 applications were considered and 82 home helps were provided in confinement cases. An extension of the home help scheme to provide domestic help in cases where the housewife is incapacitated was put into force at the beginning of the year, in accordance with the Ministry of Health circular. This new scheme is run on the same lines as the old home help scheme, the workers being allocated to cases under either service, the same rates of wages being paid and the same scale being used for assessment. The periods of employment, however, were in most cases of longer duration.

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From the time of the inauguration of this service to the end of the year, 36 applications were received, and in 29 cases domestic help was provided. Care of Illegitimate Children. The only direct provision for the care of illegitimate infants is provided by the scheme for "guaranteed payments" to fostermothers undertaking the care of such infants. The Council, however, makes a contribution to the fund administered by the Metropolitan Boroughs' Standing Joint Committee to provide financial assistance to Moral Welfare Associations. Welfare work in this connection is carried out by each health visitor in her own area, but there is close contact between the health visitors and the welfare workers of the Moral Welfare Association working in the Borough. No applications were received during 1945 for assistance under the "guaranteed payments" scheme. Convalescence for Children Under Five. The Council makes an annual grant to the Invalid Children's Aid Association in respect of children under five years of age recommended for convalescence.

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During the year, 48 children were sent to convalescent homes. 11 War-Time Day-Nurseries. At the end of 1944, seven day-nurseries, providing accommodation for 327 children were in operation in the Borough. Five were established by the Borough Council, and two were in London County Council rest centres. With the end of the war in Europe and the return of evacuated schoolchildren, the London County Council asked for the return of Bloomfield Road School for educational purposes and the day-nursery there was closed at the end of July. The Rest Centre service, in common with Civil Defence, having been disbanded, the day-nursery at Roper Hall, Eltham, was closed in May, and the nursery at Earl Rise School in July. Thus, at the end of the year, there remained in use four day-nurseries, providing places for 217 children. Clinic for Physical Medicine.

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In the latter half of the year the work of this clinic was brought back to its full capacity, the number of attendances rising to 10,955, as compared with 7,821 in 1944. Professional Nursing in the Home. The arrangements with the local nursing associations in force for many years were continued, provision being made for nursing assistance in the homes of patients suffering from Measles, Ophthalmia Neonatorum, Zymotic Enteritis, Whooping Cough, Poliomyelitis, Pneumonia, Puerperal Fever, Puerperal Pyrexia and Tuberculosis. The total number of visits paid by the nurses on behalf of the Council was 2,075. In addition, a grant of £100 was made to the nursing associations for the nursing of children under the age of five years for conditions other than those above-mentioned, distributed on the basis of the percentage of the total of cases nursed by the nurses of each nursing association. Foot Clinics.

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The demand for foot treatment continues to grow ; increases in the attendances at both clinics were recorded. The number of attendances at the clinic at the Central Health Centre was 9,148 compared with 8,243 in 1944. At Eltham, the number of attendances was 5,669, compared with 5,196. In May the accommodation at the uncompleted Eltham Hill Health Centre, Sherard Road, used as a gas cleansing station, was vacated and after some adaptation the Eltham Foot Clinic was transferred from Eltham Baths to that building on the 5th October. Supply of Insulin to Persons Suffering from Diabetes. The number of patients who received Insulin during the year, in accordance with the sanction of the Ministry of Health, was 22. Tuberculosis Dispensary.

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The temporary premises at Maxey Road, Plumstead, and the dispensary at 11, Carnecke Gardens, Eltham, continued in use throughout the year. The work of the dispensaries is referred to in the section dealing with infectious diseases. Vaccination. The Vaccination Officer's return for the year 1944 shows that there were 1,234 entries in the birth lists. Of these, 612 were successfully vaccinated. The total number of successful primary vaccinations during 1945 was 1,243. 12 SANITARY ADMINISTRATION. Complaints. 3,032 complaints of nuisance were received and investigated. The necessary action was taken where defects or nuisances were discovered. Sanitary Inspection in the Area. During the year, 17,813 inspections, including re-inspections, were carried out by the Sanitary Inspectors. The nature of these inspections is shown in Table No. 3, and details of nuisances abated in Table No.

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4. The number of intimation notices served as a result was 1,166, and the number of statutory notices, 297. In only one case were legal proceedings instituted. TABLE No. 3. Inspections. Complaints Investigated 3,032 Tents and Vans 11 Outworkers' Premises 127 Factories 178 Houses Let in Lodgings 18 Shops Act 30 Houses re Infectious Diseases 564 Theatres and Cinemas 11 Houses re Smallpox Contacts 87 Rag and Bone Premises 10 Houses re Verminous Cases 1,548 Urinals Accessible to the Public 88 Houses re Scabies Cases 5,403 Women's Lavatories 174 Houses re Other Diseases 248 Inspections re Rats 3,592 Common Lodging Houses 32 Pharmacy and Poisons Act 2 Drainage Inspections 1,301 Air Raid Shelters 8 Drains Tested by Smoke Test 228 Miscellaneous 1,115 TABLE No. 4.

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Nuisances Abated. Dirty Conditions 238 Defective Paving 43 Damp Conditions 725 Drainage Defects 828 Dilapidations 685 Water Closet Defects 542 Verminous Rooms Cleansed 811 Dust Bins Provided 106 Defective Lighting 183 Water Supply Defects 81 Defective Ventilation 40 Foul Accumulations removed 21 Water Supply. The Metropolitan Water Board is responsible for the water supply for all domestic purposes in the Borough, all dwelling houses being supplied 13 direct from public water mains. There are a few wells in the Borough, used chiefly for trade and kindred purposes. No complaints were received as to the quality or purity of the water supply. Eradication of Bed Bugs. The number of inspections of verminous premises was 1,548. Appropriate action was taken in all cases where infestation was discovered.

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The houses and furniture of all tenants allocated houses or flats by the Council were examined, and where necessary disinfestation of the furniture was carried out in the process of removal; the vacated accommodation being dealt with at the same time. Hydrogen cyanide was used in this connection for the disinfestation of 34 loads of furniture. Rat Destruction. Although there are no large areas of rat infestation in Woolwich, a number of complaints were received and a thorough investigation was made in each case. These investigations, together with the supervision of baiting and trapping where necessary, occupied a considerable amount of the sanitary inspectors' time; 3,592 inspections being made. Maintenance treatments of the sewers in the Borough were carried out in January and June, in accordance with the scheme of control initiated by the Ministry of Food. In these two treatments, 697 manholes were baited, most of them on both occasions.

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A total of 567 "takes" was recorded, 144 being small "takes," suggesting the visit of one rat only. The results of these treatments were very satisfactory and indicate that the rat population in the sewers of the Borough is being kept at a very low level. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts, was 3,295, and the number found not to be in all respects reasonably fit for habitation was 1,310. The number rendered fit in consequence of informal action by the sanitary inspectors, including the service of intimation notices, was 829. Statutory notices were served in respect of 182 houses. The number of new houses for which water certificates were issued during the year was 304, most of these were temporary houses. INSPECTION AND SUPERVISION OF FOOD. Milk.