Datasets:

davanstrien

/

MOH-split

like 0

53a2f7f3-3d97-49f3-ba60-11b89ec91569

The number of milk premises on the register on the 31st December was 58, and the number of visits paid to them was 210. The standard of the milk supply was satisfactory. Of 93 samples submitted for chemical analysis, none contained less than 3 per cent. of fat, and only 8 less than 3.5 per cent. Of 21 samples of pasteurised milk examined bacteriologically, only one was below the prescribed standard. The phosphotase test for adequate heat treatment and the methylene blue test for keeping quality of milk was satisfied in 179 samples and 52 samples respectively. Only 12 samples failed to satisfy; 4 the phosphotase test and 8 the methylene blue test. In each case where the sample failed to satisfy, further samples from the same sources of supply gave satisfactory results. 14 Meat Supplies. Only one slaughterhouse in the Borough was used during the year and this only on occasion under licence from the Ministry of Food.

0c1f4ed4-f8ee-4da7-8a3f-b7408bc85d95

The number of animals slaughtered and inspected at this slaughterhouse was 81. Premises where Food is Prepared or Offered for Sale. Routine visits were paid by the sanitary inspectors to all food premises in the Borough. The number of such inspections was 1,415. Food certified as unfit for human consumption, largely due to war conditions, totalled 21 tons. Most of this was used for animal feeding. Analysis of Food and Drugs. During the year the Public Analyst analysed 795 samples, including 751 informal and 44 formal. Of these, 25 informal and 3 formal samples were reported to be adulterated, giving a percentage adulteration of 3.5, compared with 3.2 in 1944.

b3da065d-6fef-4b11-a1a2-cae823420d33

The adulterated samples included semolina pudding, 2; pudding and cake flour, 6; baking powder, 1; shredded suet, 1; dried fruit, 3; spices, etc., 6; dried parsley, 2; pickle, 1; ginger beer extract, 1; and medicaments, 5. In six instances the adulteration was in the nature of infestation by insects or mites. PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Notifications. The total number of notifications received was 2,494. They relate to the following diseases - TABLE No. 5.

cb3de8aa-6c59-4749-87fa-37846868bdb2

Diphtheria 30 Malaria 5 Scarlet Fever 203 Ophthalmia Neonatorum 6 Enteric Fever (including Paratyphoid) 1 Dysentery 98 Puerperal Fever 10 Cerebrospinal Meningitis 18 Puerperal Pyrexia 22 Zymotic Enteritis 67 Erysipelas 43 Measles . 1,052 Pneumonia 207 Whooping Cough 288 Poliomyelitis 4 Scabies 440 Diphtheria. There was again a fall in the number of cases of Diphtheria, attributable, no doubt, to the high percentage of the child population which can now be considered to be immune to diphtheria. During 1945, the number of children immunised under the Council's scheme was 1,820; in addition, 244 schoolchildren were immunised by medical officers of the London County Council, and a number of schoolchildren were given a reinforcing injection.

0d319f33-408b-4af3-a142-cee47df2dabb

In Woolwich there are two methods by which parents may have their children immunised. 15 Either the parents can make arrangments directly with their own doctor, the Council supplying the prophylactic and paying the doctor's fees, or the mothers are invited to attend with the children by appointment at special sessions at welfare centres. When the course of injections is completed, every parent is encouraged to bring the child to a clinic for the Schick test. It is estimated that 78.7 per cent. of the child population of Woolwich has been immunised against Diphtheria. Whooping Cough. Immunising injections against Whooping Cough are given by means of a "family doctor" scheme. During the year, 387 children received injections, compared with 207 in 1944. Tuberculosis. The number of primary notifications of Tuberculosis received during the year was 260, compared with 248 in 1944.

6e3d9800-3929-4a1a-af54-ac386cd5a347

The number of persons examined for the first time at the dispensaries was 1,443. Of these, 241 were found to be suffering from Tuberculosis. The number of contacts who attended for examination was 332, and 12 of these proved to be tuberculous. The total number of attendances at the dispensaries was 6,502, 900 more than in 1944. The number of patients referred to the dispensaries by medical practitioners was 776, and by medical boards, 110. There were 1,216 cases on the register on the 31st December. Visits paid to the homes of patients by tuberculosis visitors totalled 3,742, and by the Tuberculosis Officer, 66. The number of X-Ray examinations made was 1843, and the number of specimens of sputum examined was 759, of which 93 were positive. Additional nourishment was granted in 99 instances.

4c09aa94-1a2c-48a9-8095-42cf67c58c7d

Seven patients received dental treatment; 394 patients were admitted to hospital, sanatoria or training colonies. In January, the artificial pneumothorax clinic was brought back to St. Nicholas Hospital from the Seamen's Hospital, where it had been accommodated whilst repairs to bomb damage were carried out at St. Nicholas Hospital. Clinics were held regularly throughout the year, on Fridays at 4.30 p.m., and the total number of attendances was 972. The following is an excerpt from the report of Dr. A. Wingfield, the Consultant in charge of the clinic:— "The routine—interview, fluoroscope and refill at each attendance— has been continued. X-Ray films and blood sedimentation rate are taken 3-monthly, or more frequently if indicated. Aspiration of pleural effusions is carried out at the clinic when necessary, and 19 such aspirations have been performed during the year."

0d87ad87-5601-4c4a-afd9-d460d0b7976f

Clinics at other London hospitals were attended by 45 patients, who received 822 refills. Although the payment of maintenance allowances has considerably increased the work of the dispensaries, the administration of the scheme was efficiently maintained. On the 1st January, 93 patients were receiving payments ; 79 were granted an allowance during the year, and at the end of the year there were 109 patients receiving an allowance. 16 The Tuberculosis Care Committee, which undertakes all the care and aftercare work of the tuberculous in the Borough, continued to meet regularly and to provide valuable assistance. This Committee helps by the provision of clothing and pocket money for necessitous patients entering institutions ; by the purchase of surgical apparatus and nursing requisites ; by supplementing financial assistance given by voluntary organisations ; by paying training fees in suitable cases ; and in many other ways. It supervises the Council's schemes for the provision of extra nourishment and of dentures. In all, during the year it dealt with 341 applications.

cdcbafad-aeac-4110-b57c-e490e971ee83

Laboratory Facilities. The bacteriological work of the Council, rendered necessary in connection with investigations into infectious diseases, food poisoning, etc., is carried out at the Woolwich War Memorial Hospital. In addition to the examinations of sputum made for the tuberculosis service, 492 throat and nasal swabs, 39 specimens of faeces and 11 specimens of food were examined. Samples of water from the public swimming baths were regularly examined and in general the results were satisfactory. Disinfection and Disinfestation. The Council's disinfecting station is situated at White Hart Road, Plumstead, but a number of articles of personal clothing are also disinfected at the two cleansing stations. In all, a total of 68,534 articles were disinfected at these three stations. The number of rooms disinfected after cases of infectious disease was 329, of which 56 had been occupied by tuberculous persons. The number of rooms disinfested of vermin was 683.

3e93de52-ab24-4594-9dfc-955c06df1ba4

Personal cleansing was continued at the temporary cleansing station at the Turkish Baths, Plumstead, and at the cleansing section of the Eltham Hill Health Centre. The number of cases of Scabies notified (440) was higher than the number notified in 1944 (390) but the actual number of persons treated decreased slightly from 2,540 to 2,360. There was also a slight decrease in the number of persons treated for verminous conditions. The following table gives details of the number of persons treated, including Scabies contacts, and the number of treatments given at the two cleansing stations. TABLE No. 6. Persons. Treatments.

9e45dc59-e19d-4e8e-a597-7476e77c6ff1

Pre-school children—Vermin 91 92 Scabies 330 661 School children— Vermin 2,090 2,096 Scabies 865 1,925 Adults— Vermin 152 152 Scabies 1,165 2,243 Totals 4,693 7,109 Regular Scabies clinic sessions were held, and attended by the Council's consultant, who continued to supervise the scheme,

83684685-c9ec-49e2-ac7d-7f64becb4e04

WOO 46 METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1946 BY T. STANDRING, M.D., B.S., D.P.H., M.R.C.S., L.R.C.P. Medical Officer of Health WOOLWICH: The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 TABLE OF CONTENTS page Health Committee 3 Maternity and Child Welfare Committee 3 Preface 4 Vital Statistics 5 General Provision of Health Services in the Area, including those for Maternity and Child Welfare 7 Sanitary Administration, including Housing 10 Inspection and Supervision of Food 12 Prevalence and Control of Infectious Diseases: Disinfestation 13 HEALTH COMMITTEE. At 31st December, 1946. THE WORSHIPFUL THE MAYOR (Councillor F. R. Moore, J.P.)

b9e7f075-3e94-44e8-92b0-facfdee914a8

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

09526c02-8529-4586-9b17-2d90a00446aa

E. L. Reeves (Chairman) Councillor Mrs. E. Brooks (Vice-Chairman) 4 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Woolwich. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Forty-sixth Annual Report on the health of the Metropolitan Borough of Woolwich which, in accordance with the instructions of the Minister of Health, is again in an abridged form. Dr. E. Virginia Saunders-Jacobs continued to act as Medical Officer of Health until my return from service with H.M. Forces in September. There were no large scale outbreaks of illness during 1946, and the number of cases of infectious diseases coming to the knowledge of the Department was comparatively low, except in the case of measles, of which there were 1,301 cases compared with 1,052 in 1945.

b7e0a62a-832c-46e4-b1ff-0114905e39c0

There was a slight increase in the number of cases of scarlet fever. There were fewer cases of diphtheria, the number of cases in which this diagnosis was confirmed being the lowest ever recorded. There was only one death from diphtheria and two deaths from whooping cough ; no deaths occurred from scarlet fever, measles, typhoid fever or Cerebrospinal fever. The Registrar General's estimate of the mid-1946 population shews an increase of 19,150 over that of 1945. The birth rate (21.6) was the highest recorded since 1921, and the death rate (11.4) was the lowest since 1939. The infant mortality rate (31) was the lowest ever recorded. There was only one maternal death. A summary of vital statistics will be found in Table No. I, and detailed causes of death are shewn in Table No. II.

8f0ee933-7541-4d2d-b67b-006428a296d7

Despite staffing difficulties, the health services were well maintained and greater use than ever before was made of the maternity and child welfare centres. Difficulties in securing the repair of housing defects became more acute during the year owing to a worsening in the supply of building materials. Disputes regarding the extent of war damage as opposed to fair wear and tear gave rise to delay in carrying out repairs. Coupled with the grave shortage of houses these difficulties made the Sanitary Inspectors' task an unenviable one. Nevertheless, it proved possible to maintain a relatively reasonable standard for housing. The quality and freshness of the food supplies distributed in the Borough were on the whole satisfactory and there were no serious outbreaks of food poisoning. It will be noted that such adulterations as occurred were of a minor character and rarely of major articles of diet.

7fcff7cf-85dd-4f7d-9ef7-225e01dae586

In presenting this report I desire to express my appreciation of the continued confidence and support which I received from the members of the Council, and in particular from the Chairman and members of the Health Committees. My thanks are due to the chief officers of the Council for their help, and to the staff of the Health Department for their conscientious work and loyal assistance. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, T. STANDRING, Medical Officer of Health. 5 VITAL STATISTICS. Table No. I contains extracts from the vital statistics for the year, with comparable figures for 1945. Table No. II shows details of causes of death. Table No. I. Population (Registrar General's Estimate) 1946. 1945. 134,420 115,270 Live Births—Legitimate 2,740 1,850 Live Births—Illegitimate 163 171 2,903 2,

ae2801c3-f3c5-464e-90d6-b710ffaaccca

021 Birth Rate 21.6 17.5 Still-births 78 37 Still-births—Rate per 1,000 total births 26 18 Deaths 1,531 1,478 Death Rate 11.4 12.8 Deaths from puerperal causes:— (a) From sepsis — 2 (6) From other causes 1 2 Death rate from puerperal causes per 1,000 total births 0.34 1.94 Death Rate of Infants under one year of age:— (a) All infants 31 41 (b) Legitimate infants 31 38 (c) Illegitimate infants 36 70 Deaths from Cancer (all ages) 238 267 Deaths from Whooping Cough 2 1 Deaths from Diarrhoea (under two years of age) 6 11 6 Table No. 2.

bb7a97f2-edbd-4042-ab42-f080ffae4eff

Nett Deaths during the calendar year 1946, including non-residents in Institutions in the Borough. Causes of Death. Nett Deaths at the subjoined ages of "residents" whether occurring within or without the district. Deaths in Public Institutions. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. In Borough Outlying Institu tions. Residents. NonRsdts. All Causes 1531 91 5 8 8 18 39 56 145 261 417 483 367 65 505 Typhoid and Paratyphoid Fevers — — — — — —

54668c48-a98f-40c9-9a77-b0e68bcf4b84

— — — — — — — — — Cerebrospinal Meningitis — — — — — — — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — Whooping Cough 2 1 1 — — — — — — — — — — — 1 Diphtheria 1 — 1 — — — — — — — — — — — 1 Tuberculosis of Respiratory System 76 — — 1 1 10 16 12 16 9 6 5 6 — 32 Other Tuberculosis Diseases 7 — 1 — — 2 2 — 1 — 1 — 1 1 6 Syphilis 23 — — — — — — 1 4 7 7 4 3 1 13 Influenza 15 — — — — — — — 3 5 3 4 2 — 1 Measles —

2afe5b7d-a4ea-47f6-8695-88e56a8c20cf

— — — — — — — — — — — — — — Poliomyelitis and Polioencephalitis 1 — — — — — — — — — — — — — — Encephalitis Lethargica 1 — — — — — — — — 1 — — — — 1 Cancer 238 — — — — — 3 9 30 65 74 57 72 12 71 Diabetes 9 — — — — — — — — 3 4 2 2 — 3 Cerebral Haemorrhage, etc.

a696aded-59f1-4ed0-9ca0-da34194ea290

153 — — — — — — — 6 33 50 64 54 7 42 Heart Disease 477 — — — 1 — 3 10 30 73 155 205 101 5 126 Other Circulatory diseases 42 — — — — — 1 — 3 4 15 19 13 2 11 Bronchitis 82 2 1 1 — — — 4 6 6 27 35 7 1 18 Pneumonia 60 11 1 2 — — — 3 3 11 10 19 15 1 31 Other Respiratory diseases 18 — — 1 — — — 2 1 5 8 1 1 1 7 Peptic Ulcer 22 — — — — — — 1 5 8 7 1 9 1 10 Diarrhoea, etc.

ff470075-2cc2-468e-92bb-873dc34177ab

6 6 2 1 3 Appendicitis 7 — — 1 1 — 1 — 2 — 2 — 4 — 3 Other Digestive diseases 33 1 — — — 1 — 4 6 8 7 6 10 5 17 Acute and Chronic Nephritis 31 — — — — 1 1 — 4 7 8 10 6 2 15 Puerperal Sepsis and Post-abortive sepsis — — — — — — — — — — — — — — — Other Maternal causes 1 — — — — — — — — — — — — — 1 Premature Birth 27 27 — — — — — — — — — — 3 3 17 Congenital Malformations, etc.

32236e18-679e-409e-8c1a-2cf472432d98

36 34 — — — — 1 — 1 — — — 9 5 17 Suicide 14 — — — — — 1 3 2 4 4 — 2 3 — Road Traffic Accidents 15 — — — 3 — 4 2 2 1 1 2 5 5 3 Other Violence 38 6 — — — 2 3 1 5 3 6 12 17 — 13 All other Causes 96 3 — 2 2 2 2 4 14 8 22 37 21 9 42 7 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 1,956, and the number registered in Woolwich was 1,979. After correction for inward and outward transfer the nett number of Woolwich live births was 2,903.

a6e025a2-4d0e-4aa1-a60f-d7fad8c0283a

It is known that at least 1,999 births took place in Institutions. Clinics and Treatment Centres. The Eltham Maternity and Child Welfare Centre which had been maintained at 601, Westhorne Avenue since the destruction by enemy action in 1941 of the Eltham Health Centre at Briset Road, was transferred in April to the adapted first aid post at Lionel Road; the North Woolwich centre at Fernhill Street, which had been in use as a first aid post, was re-opened in September. At the end of the year the New Eltham Centre, which had been carried on in the Legal and General Sports Pavilion, Footscray Road, throughout the war, was transferred to the Bardhill Sports Pavilion, also in Footscray Road. With these exceptions, the clinics and treatment centres at 31st December were as listed in the Annual Report for 1945.

bf9686dc-2704-4b0a-9a18-3d6079ca5f8e

The attendances at the Centres were as follows:— Expectant mothers, 13,620; nursing mothers, 12,027; children, 57,366. These figures reflect not only the higher birth rate but the greater use now being made of the welfare centres. Toddlers' Clinics. The number of toddlers' inspections rose from 3,015 in 1945 to 3,720 in 1946. One of the Council's Assistant Medical Officers reports that in most cases the general condition and progress of the toddlers attending the clinics has been good and their diet and vitamin intake satisfactory. A substantial number of cases required dental treatment and a few cases of unusual defects such as squint and deafness were referred for special examination. Postural defects, knock knees, and flat feet, were the most common defects, but remedial exercises gave good results.

e811cf36-c5b4-41b7-b2c0-4a9cde67e115

Beheaviour complexes and habits arising in some of the toddlers were discussed with the mothers and advice was given as to the treatment of these children at home. Health Visiting. The number of visits paid by health visitors to children under five years of age was 17,146; the total number of visits paid by health visitors was 24,049. Child Life Protection. There were 21 foster mothers on the register at the end of 1946, two more than at the end of 1945, and there were 16 foster children. The number of visits paid by child life protection visitors was 199. Artificial Sunlight Clinic. A total of 10,391 treatments were given at this clinic, compared with 10,228 in 1945. 8 Dental Treatment. The numbers of mothers and of children under five attending the dental clinics were 343 and 241 respectively, and the number of tuberculous persons was 5.

a690cdba-d2c6-4acf-86e5-d875ebe5907c

The total number of attendances was 1,514. Minor Ailments. The number of children under five years of age referred to school clinics for treatment of minor ailments was 308. Issue of Fruit Juices and other Supplements. The distribution of the Government fruit juices and cod liver oil was continued throughout the year at the food offices and at certain welfare centres. Midwifery Services. No change took place during the year in the midwifery services which were dealt with fully in the Annual Report for 1945. During the year 1,304 mothers were admitted to the British Hospital for Mothers and Babies. Of these, 812 were Woolwich mothers, 311 of whom were admitted under the Council's scheme. The number of admissions to the maternity unit of the War Memorial Hospital was 296. Of these, 186 were Woolwich mothers, 70 of whom were admitted under the Council's scheme.

5657087e-ccbb-4d8a-9053-75ac1fdabbc5

Admissions to the Eltham Cottage Hospital numbered 59. Care of Premature Infants. The action taken in connection with the care of premature infants is in conformity with the Ministry of Health Circular No. 20/44. The number of babies born in the Borough whose birth weight was 5½ lbs. or less was 74. Of these, 44 were born in hospital and 30 in private houses. Of those born in hospital, 3 died during the first twenty-four hours and 36 survived at the end of four weeks. Of those born in private houses, 8 were admitted to hospital; 3 died during the first twenty-four hours and 25 survived at the end of four weeks. No applications for the loan of draught-proof cots or other equipment or for the services of the Consultant Paediatrician were received. Home Helps. The Council's scheme provides for domestic assistance in confinement cases and in cases of illness where the housewife is incapacitated.

d043a856-29aa-4e4e-bbab-169271a36136

The total number of cases in which domestic help was provided was 376; 241 in confinement cases and 135 in cases of illness. Whereas the home help is employed in the majority of maternity cases for two weeks, in many of the cases of illness, particularly where old people are concerned, the period of employment is of much longer duration. Care of Illegitimate Children. The only direct provision for the care of illegitimate infants is provided by a scheme for guaranteed payments to foster mothers undertaking the care of such infants. The Council, however, makes a contribution to a fund administered by the Metropolitan Boroughs' Standing Joint Committee to provide financial assistance to Moral Welfare Associations. Welfare work in this connection is carried out by each health visitor in her own area, but there is close contact between the health visitors and the welfare workers of the Moral Welfare Association working in the Borough. Only one application was received during the year for assistance under the "guaranteed payments" scheme.

4a5e90a7-b9e7-42d6-a9db-ddfaeb58d5b8

9 Convalescence for Children under Five. The Council makes an annual grant to the Invalid Children's Aid Association in respect of children under five years of age recommended for convalescence. During the year, 36 children were sent to convalescent homes. War-time Day Nurseries. At the end of 1945 the Council was still maintaining four day nurseries, but H.M. Government having decided to relinquish financial responsibility for the whole of the nett approved expenditure on 1st April, and thereafter to make a grant to Welfare Authorities of approximately 46 per cent., the Council reviewed the position and decided to close the Cyril Henry Nursery. This nursery was taken over at the end of April by the London County Council as a nursery school. Thus, three day nurseries remained providing accommodation for 180 children. These three nurseries were still open at the end of the year. The health of the children attending the day nurseries was generally good and no serious outbreaks of infection occurred.

a46e0335-ba93-4bff-9e5a-88fbcd50686f

Regular medical supervision was provided. Clinic for Physical Medicine. The year 1946 was the first complete year during which the clinic for physical medicine had been open full time, but even so, owing to staffing difficulties it is not possible to say that it was working to full capacity. Attendances totalled 12,249, compared with 10,955 in 1945. Professional Nursing in the Home. The provision of nursing assistance in the homes of patients suffering from certain infectious diseases by arrangement with the local nursing associations, as described in previous Annual Reports, was continued. The total number of visits paid by nurses on behalf of the Council was 2,056. An additional grant of £100 was made to the nursing associations for the nursing of children under the age of five years for non-infectious conditions, distributed on the basis of a percentage of the total of such cases nursed by the nurses of each nursing association. Foot Clinics.

de696cb9-cbe3-4864-aa58-a73fd6f7c0f5

Although there was an unsatisfied demand, the number of treatments given at both the Woolwich and Eltham foot clinics was lower than in 1945. This fall was partly due to staffing shortages and probably to the reintroduction of the appointments system which was in abeyance during the war. The number of attendances at the Central Health Centre was 7,826 compared with 9,148 in 1945, and at the Eltham Hill Health Centre, Sherard Road, the attendances were 5,030 compared with 5,669 in 1945. Supply of Insulin to Persons Suffering from Diabetes. The number of patients who received Insulin during the year, in accordance with the sanction of the Ministry of Health, was 26. Tuberculosis Dispensaries. The temporary premises at Maxey Road, Plumstead, and the dispensary at 11, Carnecke Gardens, Eltham, continued in use throughout the year.

cd3fac56-f81c-4357-a8ff-9b7f7fec9262

The work of the dispensaries is referred to in the section dealing with infectious diseases. Vaccination. The Vaccination Officer's return for the year shows that there were 1,466 entries in the birth lists. Of these, 796 were successfully vaccinated. The total number of successful primary vaccinations during 1946 was 1,744. 10 SANITARY ADMINISTRATION. Complaints. 4,431 complaints of nuisance were received and investigated. The necessary action was taken where defects or nuisances were discovered. Sanitary Inspection of the Area. During the year, 20,408 inspections, including re-inspections, were carried out by the Sanitary Inspectors. The nature of these inspections is shown in Table No. III, and details of nuisances abated are given in Table No. IV. The number of intimation notices served as a result was 2,334, and the number of statutory notices, 715.

eef59de8-0ef1-4e83-b624-106e85a6815a

In only 16 instances were legal proceedings instituted. TABLE No. III. Inspections. Complaints Investigated 4,431 Houses re Other Diseases 144 Complaints Re-inspections 5,592 Aged and Infirm Persons 248 Outworkers' Premises 104 Common Lodging Houses 34 Houses Let in Lodgings 11 Tents and Vans 19 Houses re Overcrowding 568 Factories 167 New Houses re Water Supply 625 Shops Act 12 Houses re Infectious Diseases 569 Food Premises 1,003 Houses re Smallpox Contacts 457 Theatres and Cinemas 10 Houses re Verminous Cases 3,601 Urinals Accessible to the Public 115 Houses re Scabies Cases 2,592 Women's Lavatories.. 106 TABLE No. IV. Nuisances Abated.

25ab569a-107a-4cbd-8983-b94bc55c5bf1

Dirty Conditions 489 Defective Paving 3 Damp Conditions 1,445 Drainage Defects 1,037 Dilapidations 1,421 Water Closet Defects 807 Verminous Rooms Cleansed 988 Dust Bins provided 196 Defective Lighting 157 Water Supply Defects 112 Defective Ventilation 218 Foul Accumulations removed 22 Water Supply. The Metropolitan Water Board is responsible for the water supply for all domestic purposes in the Borough, all dwelling houses being supplied direct from public water mains. There are a few wells in the Borough, used chiefly for trade and kindred purposes. No complaints were received as to the quality or purity of the water supply. 11 Eradication of Bed Bugs. The necessary action was taken in all cases where infestation by bed bugs was discovered, in accordance with the usual procedure adopted by the Department. This procedure has been fully described in previous Annual Reports.

1be55311-8aa1-4f7f-a705-950f5e20892e

The total number of inspections of verminous premises was 3,601. Hydrogen Cyanide was used for the disinfestation of 65 loads of furniture on removal to Council houses or flats, but no house was disinfested by this method. Rat Destruction. The work of rat destruction continued during the year. The area of each complaint received was surveyed and appropriate measures were taken where necessary. In October, in compliance with a Ministry of Food request, a special scheme for block control was adopted. The Ministry desired, in the first instance, a scheme for block control to be applied to all private dwelhngs in the Borough, but in view of the amount of work already carried out in Woolwich a modified scheme providing for block control in industrial areas only was finally approved. The staff engaged on this work was increased by four, making six in all, two of whom were trained as investigators.

a0e15096-25d8-446c-92be-8a4eab8143c6

These operated under the supervision of a sanitary inspector who deVoted the whole of his time to rat destruction and prevention. The total number of premises surveyed during the year was 3,176, and the number of inspections was 7,632. Effective preventive measures were taken in 1,553 instances, after baiting and trapping. Maintenance treatments of the sewers in the Borough were carried out in January and June, and in these two treatments 608 manholes were baited, most of them on both occasions. The results of these treatments continue to be satisfactory and indicate their worth in helping to keep the rat population of the Borough at a low level. Housing. The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 5,851, and the number found not to be in all respects reasonably fit for habitation was 2,214.

ffdefad9-3d77-4d5b-b93a-b1b652ee382c

The number rendered fit in consequence of informal action by the sanitary inspectors, including the service of intimation notices, was 1,698. Statutory notices were served in respect of 630 houses. The problems in relation to housing dealt with by the Department were aggravated by the acute housing shortage, notwithstanding the measures taken by the Council for its relief. It is noteworthy that the number of new houses erected was 726 ; of these 610 were temporary (418 under the administration of the Borough Council and 192 under the administration of the London County Council). Of the 116 permanent houses, 99 were erected by the Borough Council and 17 by private builders.

08b46bc7-b1a2-42af-b246-06e7b5036519

Some indication of the Council's housing problem is given by the following:— The long waiting list from 1939, despite the building of 14,667 houses in the Borough between the years 1920 and 1939; no building during the war years; 1,894 houses demolished; 35,999 houses damaged (3,788 seriously); and the higher marriage and birth rates causing a greater demand for new homes than before the war. 12 It is interesting, however, to compare the figure of 726 (above) with the average yearly rates of house building in Woolwich during the four decades, 1901-1940, which were as follows: 1901-1910, 453; 1911-1920, 533; 1921-1930, 443; 19311940, 1,039. Squatters.

7708d6fa-14ba-438a-9226-3d250e25a0b3

In September "squatters" took possession of two army camps in the Borough where, after negotiations with the War Office and the Ministry of Health, they were allowed to remain. Certain adaptations with regard to sanitary arrangements and water supply were carried out at the camps. INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 58. The standard of the milk supply was satisfactory; practically all the milk distributed in Woolwich is heat treated. Of 310 samples submitted for chemical analysis, 216 (69 per cent.) contained more than 3.5 per cent. of fat; only two contained less than 3 per cent. Of 64 samples of pasteurised milk examined bacteriologically, only one sample gave an unsatisfactory result. The phosphatase test for adequate heat treatment was satisfied in 328 samples, and the methylene blue test for the keeping quality of milk in 162 samples.

62264e22-3450-4eae-b4ad-7e9990d85e26

Only 11 samples failed to satisfy; 7 the phosphatase test and 4 the methylene blue test. In each case. where the sample failed to satisfy, further samples from the same sources of supply gave satisfactory results. Meat Supplies. Only one slaughterhouse in the Borough was used during the year and this only on occasion under licence from the Ministry of Food. The number of animals slaughtered and inspected at this slaughterhouse was 39. Premises where Food is Prepared or Offered for Sale. Routine visits were paid by the sanitary inspectors to all food premises in the Borough. The number of such inspections was 1,043. Analysis of Food and Drugs. During the year the Public Analyst analysed 734 samples, including 682 informal and 52 formal. Of these, 17 informal and 4 formal samples were reported to be adulterated, giving a percentage adulteration of 2.8, compared with 3.5 in 1945.

87b4c126-3a98-47ce-b3b8-4b2265df6f2d

The adulterated samples included mixed spice, 1; mixed herbs, 1; coffee essence, 1; canned meat, 1; canned soup, 1; pickles, 1; whole ginger, 1; vitamin capsules, 1; milk, 4; vinegar, 2; gravy preparations, 2; cake mixture, 2; mineral water, 1; lemon biscuit mixture, 1; Frutella dessert powder, 1. Unsound Food. During the year, 12½ tons of food was surrendered as unfit for human consumption. Most of this was utilised for animal feeding or for fertilisers. No seizures were made. 13 Food Poisoning. The number of notifications of food poisoning was five, but in two cases the notification was withdrawn. Ice Cream. The removal of restrictions on the manufacture of ice cream resulted in many registered sellers of this commodity recommencing operations, and in a number of fresh registrations.

2b1625ff-7884-4839-a2d1-bcbe7b695e32

Twenty-four samples of ice cream and ingredients for its manufacture were examined bacteriologically. Samples from two vendors were most unsatisfactory, and the sale of ice cream at their premises was suspended. In one case the business changed hands and a new arrangement was made whereby ice cream was obtained from a well-known manufacturer, and in the other case improved conditions were obtained and manufacture and sale later recommenced. Sale of Food in Public Places. Section 16 (1) of the Food and Drugs Act, 1938, provides that every itinerant vendor of ice cream must display his name and address legibly and conspicuously on the stall, vehicle or container used. In September, the Council, as empowered by Sub-Section (II), resolved that the provisions of Section 16 should apply within the Borough of Woolwich in relation to all kinds of food (except milk) as it applies in relation to ice cream. PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Incidence.

b6782d51-f0c5-4fca-9708-b64384c468fe

The numbers of cases of notifiable infectious diseases which occurred during the year after correction of diagnosis were as follows :— TABLE No. V. Diphtheria 8 Ophthalmia Neonatorum 4 Scarlet Fever 253 Dysentery 46 Puerperal Fever 6 Cerebrospinal Meningitis 8 Puerperal Pyrexia 19 Zymotic Enteritis 54 Erysipelas 56 Measles 1,301 Pneumonia 204 Whooping Cough 412 Poliomyelitis 1 Scabies 439 Malaria 6 Diphtheria. The number of confirmed cases of Diphtheria, 8, was the lowest ever recorded, and it seems fairly safe to say that there is a connection between this low figure and the efforts of the Department to produce a Diphtheria immune child population.

1818e9b2-1e6e-4385-acd4-1cc6454dae74

For some years after the introduction of the Council's original 14 scheme, namely, immunisation by the family doctor, there was no great fall in the incidence of the disease, but during the last five years the numbers have fallen considerably. Although the fall was originally associated with evacuation, the introduction of immunising sessions at welfare centres to supplement the "family doctor" scheme secured the immunisation of increasing numbers of children. The return of the population has caused no rise in the incidence of diphtheria. On the Registrar General's estimated mid-1946 child population (27,600) the percentage of the child population in the Borough immunised is 69.5, but it is considered that this figure is low; many children who have returned to the Borough undoubtedly were immunised whilst evacuated, of which there is no record in the Department. There was one death from Diphtheria giving a death rate of .007 per 1,000 of the population. Whooping Cough.

49a32353-a820-495c-8e01-b7cba0b74ff3

Immunisation against whooping cough is provided by means of a "family doctor" scheme, under which injections are given by the family doctor whose fees are paid by the Council. During the year, 426 children received injections, compared with 387 in 1945. Not all of these children received the full course of four injections. Tuberculosis. The work of the Tuberculosis Dispensaries is shewn below in tabular form, with figures for 1938 and 1945 for comparative purposes. It will be noted that the work of the Dispensaries has increased considerably:— 1938. 1945. 1946. Number of primary notifications 248 260 247 Number of persons examined for first time 1,312 1,443 1,

816a2dcb-59de-4a2e-ba1f-41f0f11ed383

691 Number of these found to be tuberculous 231 241 234 Number of contacts examined 512 332 403 Number of contacts found to be tuberculous 21 12 10 Total number of attendances 5,415 6,502 8,263 Number of patients referred by Medical Practitioners 437 776 926 Number of patients referred by Medical Boards — 110 91 Visits to homes of patients by Tuberculosis Visitors 4,522 3,742 3,560 Visits to homes of patients by Tuberculosis Officer 285 66 75 Number of X-ray examinations 1,156 1,843 2,494 Number of specimens of sputum examined 1,059 759 970 Number of specimens of sputum positive 157 93 118 Number of patients admitted to hospital or sanatorium 344 394 318 Number of patients given dental treatment 38 7 5 Number of cases on register at end of year 874 1,

af5d5a9b-a249-4f81-889e-1f4ed306b7fe

216 1,263 15 In the spring the Mass Radiography Unit of the London County Council was brought to Woolwich and set up in the Old Parochial Offices, Maxey Road, where it operated for a period of eight weeks. During this period the total number of persons examined was 8,438 (5,253 men and 3,185 women). Of these, 5,701 were Woolwich residents (3,798 men and 1,903 women), the remainder being persons working in, but living outside the Borough. Of the 5,701 Woolwich residents X-rayed by the miniature apparatus only 175 were referred for large films; of these 55 were referred to their own doctors as probably tuberculous, and 12 for some other abnormality. The artificial pneumo-thorax clinic at St. Nicholas' Hospital continued its work during the year. Dr.

42328268-3d12-493e-bceb-90c108e60e5f

A. Wingfield, who had been consultant in charge of the clinic since its inception, was recruited to H.M. Forces in September, and was replaced by Dr. R. Hartley. The total number of attendances at the clinic was 1,051. Clinics at other London hospitals were attended by 56 patients, who received 1,317 refills. The number of applications for maintenance allowances received during the year was 88. On the 1st January, 109 patients were receiving an allowance, 78 were granted an allowance during the year, and at the end of the year 102 patients were in receipt of an allowance. The Tuberculosis Care Committee continued its excellent" work of providing for the after-care of patients and assistance to dependants. Four quarterly meetings of the full Committee were held, and the General Purposes Sub-Committee met on 12 occasions.

d889cc94-0c6c-4979-9594-851b9dea1685

Assistance was given in many ways including the supply of pocket money, clothing, shoes, extra nourishment, beds and bedding, fares for relatives to visit patients in institutions, and fees for the training of a patient at a Secretarial College. The funds come from interest on investments; donations both from employees of firms in the Borough and from private sources; and by the sale of Christmas Seals. Laboratory Facilities. The Council's bacteriological work is carried out in the Pathological Department of the Woolwich Memorial Hospital. During the year 633 throat and nasal swabs were examined; 1,187 specimens of sputum; 110 specimens of faeces; 1 specimen of bread; and 10 specimens of ice cream and 14 of ice cream ingredients. • The practice of submitting samples of water from the public swimming baths for examination was continued. Twenty-seven such samples were submitted during the year and apart from some occasional slight over-chlorination, the results were generally satisfactory.

15bb3373-d3d8-4d37-97cf-341d1c90f709

16 Disinfection and Disinfestation. Infected articles of bedding, clothing, etc., and articles infested with bugs are disinfected at the Council's Disinfecting Station, White Hart Road, Plumstead; but the personal clothing of persons treated at the two Cleansing Stations is disinfected at those two stations. During the year 40,802 articles were disinfected at the three stations. The number of rooms disinfected after cases of infectious disease was 465, and of these 88 had been occupied by tuberculous persons. The number of rooms disinfested of vermin was 988. Personal Cleansing Stations are situated at the Turkish Baths, Plumstead High Street, and at the Eltham Hill Health Centre, Sherard Road.

e95c3e77-5fdd-40c8-8330-69b8313622c1

Part of the premises of the Turkish Baths was adapted as a Cleansing Station as a tempory measure after the destruction in 1941 of the former cleansing station at White Hart Road, and it has not been possible, so far, to make suitable alternative arrangements. The number of persons cleansed of vermin was 2,567 and the number of persons (including contacts) treated for scabies was 2,089. The total number of attendances was 6,026. G. 41. METROPOLITAN BOROUGH OF WOOLWICH. FROM THE MEDICAL OFFICER OF HEALTH. Health Department, Town Hall, Woolwich, S.E.18.

263c98a9-f4a8-4e19-a0b9-035ba0303618

METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1947 BY T. STANDRING, M.D., B.S., D P H., M.R.C.S., L.R.C.P. Medical Officer of Health TABLE OF CONTENTS 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 7 Sanitary Administration, including Housing 11 Inspection and Supervision of Food 13 Prevalence and Control of Infectious Diseases : Disinfestation 14 The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 2 HEALTH COMMITTEE. At 31st December, 1947. THE WORSHIPFUL THE MAYOR (Councillor J. F. Parker, j.p.) Councillor Mrs.

3739748e-8456-4727-9f01-9d2c777ffe98

E. Brooks (Chairman). Alderman Mrs. J. R. Whiting (Vice-Chairman). Aldermen— F. C. Halse, j.p. m.i.o.b. Councillors- Major F. W. Beech, j.p. Mrs. K. Howlett Miss M. Crout, j.p. E. S. W. Langton C. H. Darby Mrs. M. E. Polley Mrs. L. E. Driver Mrs. K. M. Rance Mrs. L. R. Duff Mrs. E. L. Reeves A. H. Gilder, m.b.e., j.p. Miss G. E. Walters, j.p. MATERNITY AND CHILD WELFARE COMMITTEE. Comprising the Members of the Health Committee Councillor Mrs. E. Brooks (Chairman) Alderman Mrs.

272411b2-e6c6-4f75-8d1e-2602f0083d96

J. R. Whiting (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 47th Annual Report on the health of the Metropolitan Borough of Woolwich which, in accordance with the instructions of the Minister of Health, is again in an abridged form. The health of the Borough remained good throughout the year. The incidence of infectious disease generally again remained low. For the third year in succession the notifications of measles (easily the most prevalent of the infectious diseases) were over 1,000 (1,183). Since the war the biennial periodicity of this disease has been upset. It may well be that this is due to the abnormal movements of the child population during and since the war, resulting in a variation of the usual pattern of the yearly number of susceptibles at risk.

398a1797-a254-4c54-bf68-d767cb8085f5

There was a slight increase in the number of cases of scarlet fever but the disease remained of a mild nature. The number of confirmed cases of diphtheria (7) was again the lowest ever recorded. There were no deaths from diphtheria and no deaths from whooping cough. Extraordinarily the only death from measles—one of the most serious diseases of childhood—occurred in a woman of 57 years of age. The number of scabies' notifications again showed a remarkable decrease, being less than half the number of the previous year. It appears that this disease, which was a problem of shelter life, is now receding to its pre-war level. The epidemic of poliomyelitis, which affected the whole of the country in the summer and early autumn, was also apparent in the Borough but fortunately to a lesser extent than in many other areas.

212905f1-1da9-4ed6-b836-a0880e2e40b9

The total number of confirmed cases was 23, the highest incidence occurring in the week ending 16th August during which there were 7 confirmed cases. Precautionary measures were taken and advice given through the Council's services and the local Press. Among the precautions, the attendance rules for welfare centres were relaxed and children's functions curtailed. The special film on the disease was shown to several gatherings of local doctors. Poliomyelitis is a serious disease, but it must not be assumed that an attack must automatically mean death or crippling for life. These disasters do unfortunately occur, but they are by no means inevitable. Of the 23 cases, 3 cases had serious remaining paralysis, 3 had some paralysis preventing complete participation in all activities, the remaining 17, for practical purposes, recovered completely. There were no deaths. The Registrar-General's estimate of the mid-1947 population shows an increase of 5,730 over that of 1946.

1cffdd8f-fec5-4f44-9b0e-8d1fc760379c

The total births, which for many years have been around 2,000 per annum, jumped to 2,903 in 1946 and to 3,193 in 1947. This is the first time there has been more than 3,000 births per annum since 1921. The increase is reflected in the birth rate of 22.8. This large number of births kept your maternity and baby welfare services employed to the full throughout the year ; in spite of this pressure it is most gratifying to report that the infantile mortality 4 rate (27) was again the lowest ever recorded. It is perhaps ironical that this should be achieved in the last full year before the maternity and child welfare services pass from your control. A summary of vital statistics will be found in Table No. 1 and detailed causes of death are shown in Table No. 2. The Sanitary Inspectors again had a very busy year.

a4dfa7bd-21c3-441f-b0fe-4a730c9431a6

Disputes over the extent of war damage as opposed to fair wear and tear were not so frequent but the effects of the lack of proper maintenance during the war years on the older houses in the Borough is now being felt. In spite of all the difficulties the Inspectors had considerable success in maintaining the standard of housing. The abnormal floods in March endangered the safety of the water supply to North Woolwich and adjoining areas. General precautions were supplemented in North Woolwich by advice on the spot by Sanitary Inspectors, by warning posters, and by street announcements by loud-speaker vans frequently throughout the danger period. The public co-operated well, and no disease attributable to polluted water occurred. In the abridged reports of the last few years, details of staff changes have been omitted ; nevertheless, mention must be made of the retirement in July of Mr. H. S. Smith, Chief Administrative Assistant. Mr. Smith had been in the Council's service for 46 years.

4e6b32c8-1af2-4417-9f5a-1ae8cc249d2b

During that time he had seen, and in no small measure assisted in, the growth of the health services to their present state of which you are so justly proud. His vast knowledge and help was especially valuable in keeping the services running smoothly through the war years. He left with the very best wishes of Council and staff alike. The continued confidence and encouragement of the members of the Council and particularly members of the Health Committees is much appreciated. Success is a co-operative effort and my thanks are also due to the chief officers of the Council and to the staff of the Department who have given me every support. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, T. STANDRING, Medical Officer of Health. 5 VITAL STATISTICS. Table No. 1 contains extracts from the vital statistics for the year, with comparable figures for 1946. Table No. 2 shows details of causes of death. Table No. 1. 1947.

b13bb57b-612a-41ea-832a-78cc8893921d

1946. Population (Registrar-General's Estimate) 140,150 134,420 Live Births—Legitimate 3,074 2,740 Live Births—Illegitimate 119 163 - 3,193 - 2,903 Birth Rate 22.8 21.6 Still-births 65 78 Still-births—Rate per 1,000 total births 20 26 Deaths 1,626 1,531 Death Rate 11.6 11.4 Deaths from puerperal causes :— (a) From sepsis 1 — (b) From other causes 2 1 Death rate from puerperal causes per 1,000 total births 0.92 0.34 Death rate of Infants under one year of age :— (a) All infants 27.25 31 (b) Legitimate infants 26.

d4755094-4620-4a45-81c4-e0e30cefea8b

7 31 (c) Illegitimate infants 42 36 Deaths from Cancer (all ages) 260 238 Deaths from Whooping Cough — 2 Deaths from Diarrhoea (under two years of age) 7 6 Table No. 2. Nett Deaths during the calendar year 1947, including non-residents in Institutions in tne 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 year 8. 5 and under 15 year 8. 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.

6000f52d-8c4a-49be-bff0-7db2611bbf40

In Borough Outlying Institu tions. Residents. NonRsdts. All Causes 1626 87 10 10 12 31 40 67 126 271 395 577 325 88 484 Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - - Cerebrospinal Meningitis 6 3 1 1 — — — — - 1 - - 2 - 4 Scarlet Fever 1 — — - 1 - - - - - - - - - - Whooping cough - - - - - - - - - - - - - - - Diphtheria — — — — — — — — - - - - - — — Tuberculosis of Respiratory System 89 1 — 2 — 14 19 12 14 17 7 3 7 2 43 Other Tuberculosis Diseases 12 — 2 1 2 2 1

92529137-9938-488b-b2ec-9bc9e98bb0fa

2 - 1 1 - 2 3 9 Syphilis 16 1 — — — — — - 2 4 4 5 3 - 6 Influenza 7 — 1 — — - - 1 - 2 1 2 - - 3 Measles . 1 — — - - - - - - 1 - - - - 1 Poliomyelitis and Polioencephalitis - - - - - - - - - - - - - - - Encephalitis Lethargica 1 — — — — — — — 1 - - — — — 1 Cancer 260 1 1 — 2 — 1 9 30 72 77 67 67 19 70 Diabetes 12 — — — - - - - - 2 6 4 1 1 6 Cerebral Haemorrhage, etc.

77d8b90f-23b4-4c8f-9d37-9df748e3a391

129 — — — — — 1 3 11 24 40 50 25 5 30 Heart Disease 505 — — — — 1 4 10 25 66 144 255 83 12 116 Other Circulatory diseases 50 — — — — — — - 4 8 15 23 13 4 12 Bronchitis 130 2 — 1 1 - 1 5 10 21 37 52 13 2 18 Pneumonia 82 21 1 1 2 - 2 1 5 10 14 25 21 4 37 Other Respiratory diseases 15 — — — — - 2 3 - 4 4 2 2 - 6 Peptic Ulcer 16 1 — — — — — 2 4 3 3 3 8 1 4 Diarrhoea, etc.

596a926a-43b8-4365-af62-b37cfb33d2bb

7 7 — — - - - - - - - - 4 3 3 Appendicitis 2 — — 1 — — — - - - 1 - 1 - 1 Other Digestive diseases 27 — — — — 1 1 - 5 3 6 11 14 1 13 Acute and Chronic Nephritis 21 — — — — — — - - 6 6 9 4 2 8 Puerperal Sepsis and Post-abortive sepsis 1 - - - - - - - - - - - - - 1 Other Maternal causes 2 — — — — 1 — 1 - - - - - - - Premature Birth 14 14 — - - - - - - - - - 3 4 10 Congenital Malformations, etc.

e4f0639b-de18-401a-baab-367817d0363e

32 23 - 1 1 1 — 1 1 4 - - 8 7 16 Suicide 17 — - - - 2 - 5 3 4 2 1 3 1 1 Road Traffic Accidents 10 — - 1 1 2 3 1 1 - 1 - 5 8 3 Other Violence 49 11 2 — 2 3 2 3 1 3 7 15 18 3 10 All other Causes 112 2 2 1 — 3 3 8 9 15 19 50 18 6 52 6 7 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Births. The number of notifications received was 2,349 and the number registered in Woolwich was 2,326. After correction for inward and outward transfer the nett number of Woolwich live births was 3,193.

4a62c649-ab5f-409d-b95a-c3fe9fcc7538

It is known that at least 1,443 births took place in Institutions. Clinics and Treatment Centres. The following clinics and treatment centres were in use throughout the year:— Woolwich Central Health Centre Child welfare and ante-natal clinic. Sunlight clinic. Physical medicineFoot clinic. Plumstead Health Centre Child welfare and ante-natal clinics. Lionel Road, Eltham Child welfare and ante-natal clinics. Wesley Hall, Timbercroft Lane Child welfare clinics. Bardhill Sports Pavilion, Footscray Road, New Eltham Child welfare and ante-natal clinics. St. Luke's Church Hall, Westmount Road Child welfare clinics. Fernhill Street, North Woolwich Child welfare and ante-natal clinics. 137, Alnwick Road, Horn Park Child welfare and ante-natal clinics. Turkish Baths, Plumstead High Street Personal cleansing station. Eltham Hill Health Centre, Sherard Road Personal cleansing station.

0c460ab3-8034-4a01-b391-fba6e7814eee

Foot clinic. Maxey Road, Plumstead Tuberculosis Dispensary. 11, Carnecke Gardens, Eltham Tuberculosis Dispensary. The attendances at the Maternity and Child Welfare Centres were as follows :— Expectant mothers, 11,017 ; nursing mothers, 15,007 ; children, 65,581. Toddlers' Clinics. The clinics were well attended and 3,725 inspections were carried out as compared with 3,720 in 1946. One of the Council's Assistant Medical Officers reports that the attendances of toddlers, especially two-year-olds, have been good and their general condition satisfactory. Postural defects, knock knees and bowed tibia are relatively common in younger children though by no means necessarily of pathological import. Advice on shoes, sunlight treatment and, if necessary, attendance at the Physical Medicine Clinic, has in most cases cured them during the pre-school period.

6f576660-af41-4416-a6b2-f518dfafbfb1

A number of toddlers have been sent for dental treatment though most of these have had adequate vitamins since infancy. This is a further illustration of our present incomplete knowledge of caries. Troubles arising from enlarged tonsils and adenoids have been investigated at the Ear, Nose and Throat Clinic. Advice, usually successful, has been given to mothers with "difficult children"—a few of these have gone to a Child Guidance Clinic for further treatment. 8 Health Visiting. The number of visits paid by health visitors to children under five years of age was 18,610 ; the total number of visits was 24,160. Child Life Protection. There were 23 foster mothers on the register at the end of 1947, two more than at the end of 1946, and there were 16 foster childrenThe number of visits paid by child life protection visitors was 113. Artificial Sunlight Clinic.

e3fdeff5-cdcd-4f97-97ce-9fac20e17930

A total of 10,007 treatments was given at this clinic, compared with 10,391 in 1946. Dental Treatment. The numbers of mothers and children under five attending the dental clinic were 282 and 371 respectively, and the number of tuberculous persons was 22. The total number of attendances was 1,900. Minor Ailments. The number of children under five years of age referred to school clinics for treatment of minor ailments was 496. Issue of Fruit Juices and other Supplements. The distribution of the Government fruit juices and cod liver oil was continued throughout the year at certain welfare centres. Midwifery Service. This is administered in London by the London County Council. No substantial change took place in the midwifery services, which were dealt with fully in the Annual Report for 1945. Arrangements were made during the year for midwives' sessions to be held at the Central Health Centre, Market Street, Woolwich.

d3f1c1a6-1e3c-41de-8ad9-cf59d93e4924

Mothers attend at these sessions for booking and ante-natal examination. The innovation has proved beneficial to patient and midwife alike. During the year 1,323 mothers were admitted to the British Hospital for Mothers and Babies. Of these, 824 were Woolwich mothers, 311 of whom were admitted under the Council's scheme. The number of admissions to the maternity unit of the Memorial Hospital was 280. Of these, 75 were Woolwich mothers, 66 of whom were admitted under the Council's scheme. Admissions to the Eltham Cottage Hospital numbered 62. Care of Premature Infants. The action taken in connection with the care of premature infants is in conformity with the Ministry of Health circular No. 20/44. The number of babies born in the Borough whose birth weight was 5J lbs. or less was 113. Of these, 42 were born in hospital and 31 in private houses.

5b51ea68-5098-4636-bc42-a1cb1d074ca0

Of those born in hospital, 2 died during the first twenty-four hours and 34 survived at the end of four weeks. Of those born in private houses, 5 were admitted to hospital; none died during the first twenty-four hours and 25 survived at the end of four weeks. No applications for the loan of draught-proof cots or other equipment or for the services of the Consultant Paediatrician were received. Home Helps. The Council's scheme provides for domestic assistance in confinement cases and in cases of illness where the housewife is incapacitated or where old people are concerned. The total number of cases in which domestic help was provided was 561 ; 309 in confinement cases and 252 in cases of illness. Whereas 9 the home help is employed in the majority of maternity cases for two weeks, in many of the cases of illness, particularly in old people, the period of employment is of much longer duration. War-time Day Nurseries.

f9c02353-71cb-430e-af56-41036bebcb9a

The three remaining nurseries were closed on the 5th April. The prefabricated buildings (including furniture and equipment) at Woolwich Common and Dahlia Road, Abbey Wood, were taken over by the London County Council as nursery schools. The County Council agreed that all day nursery children of 2 years of age and over could continue to attend the nursery schools. A Daily Guardian Service (see next paragraph) was immediately instituted to make provision for any children under 2 years displaced from the nurseries and other special cases. Daily Guardians. As nursery schools provide no accommodation for children under the age of two, the Council in April inaugurated a daily guardian scheme in order to provide for such children of mothers who, from necessity, found it essential to work. Under the scheme, which received the approval of the Ministry of Health, the mother made her own arrangements with the daily guardian, but 6s. Od. per week of the amount required by the daily guardian was guaranteed by the Council.

5f7b2e3b-a7a5-4ed4-ba87-6d3ce5ebf528

During the year 35 daily guardians were registered and 24 remained on the register at the end of the year. The number of children cared for by these guardians during the year was 24, and at the end of the year there were 8 on the register. Care of Illegitimate Children. The only direct provision for the care of illegitimate infants is provided by a scheme for guaranteed payments to foster mothers undertaking the care of such infants. The Council, however, makes a contribution to a fund administered by the Metropolitan Boroughs' Standing Joint Committee to provide financial assistance to Moral Welfare Associations. Welfare work in this connection is carried out by each health visitor in her own area, but there is close contact between the health visitors and the welfare workers of the Moral Welfare Associations working in the Borough. No applications were received during the year for assistance under the " guaranteed payments " scheme. Convalescence for Children under Five.

c83afcd9-c64d-459c-8a42-68045f3bf6cc

The Council makes an annual grant to the Invalid Children's Aid Association in respect of children under five years of age recommended for convalescence. During the year, 74 children were sent to convalescent homes. Clinic for Physical Medicine. The attendances at this clinic totalled 11,188, compared with 12,249 in 1946. Professional Nursing in the Home. The provision of nursing assistance in the homes of patients suffering from certain infectious diseases, by arrangement with the local nursing associations as described in previous Annual Reports, was continued. The total number of visits paid by nurses on behalf of the Council was 1,474. An additional grant of £100 was made to the nursing associations for the nursing of children under the age of five years for non-infectious conditions, 10 distributed on the basis of a percentage of the total of such cases nursed by the nurses of each nursing association. Foot Clinics.

fe7824db-72ad-4efb-b2dd-ebae344cc343

The attendances at the Council's foot clinics showed a slight increase on 1946. The number at the Central Health Centre was 7,916, compared with 7,826, and at the Eltham Health Centre, Sherard Road, the number was 5,571, compared with 5,030. The staff of chiropodists was increased from five to seven in February. 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 28. Tuberculosis Dispensaries. The reinstatement from first aid post and temporary dispensary enabled the premises at Maxey Road to revert to their former use as the main Tuberculosis Dispensary as from 1st December. The dispensary and the branch at Eltham—11, Carnecke Gardens—were fully used throughout the year.

c03aee84-1582-4f6e-9141-46ccec93b134

The work of the dispensaries is referred to in the section dealing with infectious diseases. Vaccination. The Vaccination Officer's return for the year shows that there were 1,986 entries in the birth lists. Of these, 1,128 were successfully vaccinated. The total number of successful primary vaccinations during 1947 was 2,154. Health Propaganda. Apart from the normal health education work of the Council's visiting and clinic staffs, the display of posters, the distribution of leaflets and the Better Health journal, it was found possible during the 1946-47 " season " to recommence in a modified form the series of informal talks and display of cinema films. Applications from the organisers of the many religious, social and educational bodies covering church guilds and clubs, women's guilds, youth clubs, rovers, scouts, guides, etc., were received, and a system of rationing had to be adopted to ensure that each organisation had at least one show during the season.

243d2771-31fd-49ab-beb7-c59e13233855

In all, 48 shows were given to audiences totalling 1,750. The cinema films covered—personal hygiene, tuberculosis, diphtheria, food, household pests, etc. 11 SANITARY ADMINISTRATION. Complaints. 5,261 complaints of nuisance were received and investigated. The necessary action was taken where defects or nuisances were discovered. Sanitary Inspection of the Area. During the year, 26,784 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 are given in Table No. 4. The number of intimation notices served as a result was 3,084, and the number of statutory notices, 1,087. In only 23 instances were legal proceedings found to be necessary. TABLE No. 3. Inspections.

906cf765-d14c-45ef-a6f1-5ab4b8cd8594

Complaints Investigated 5,261 Aged and Infirm Persons 567 Complaints 6,450 Common Lodging Houses 38 Outworkers' Premises 127 Tents and Vans 16 Houses Let in Lodgings 320 Factories 392 Houses re Overcrowding 1,152 Shops Act 254 New Houses re Water Supply 733 Food Premises 3,234 Houses re Infectious Diseases 454 Theatres and Cinemas 22 Houses re Smallpox Contacts 2 Urinals Accessible to the public 212 Houses re Verminous Cases .. 3,493 Women's Lavatories 154 Houses re Scabies Cases 697 Miscellaneous 3,122 Houses re Other Diseases 84 TABLE No. 4. Nuisances Abated.

3b98fb0c-8f34-446b-92a0-cc27d73fc587

Dirty Conditions 614 Drainage Defects 1,363 Damp Conditions 2,143 Water Closet Defects 2,272 Dilapidations 2,330 Dust Bins provided 223 Verminous Rooms Cleansed 947 Water Supply Defects 213 Defective Lighting 232 Foul Accumulations removed 42 Defective Ventilation 269 Miscellaneous 27 Defective Paving 171 Water Supply. The Metropolitan Water Board is responsible for the water supply for all domestic purposes in the Borough, all dwelling houses being supplied direct from public water mains. There are a few wells in the Borough, used chiefly for trade and kindred purposes. No complaints were received as to the quality or purity of the water supply. Nine specimens were bacteriologically examined as a precautionary measure when the supply to North Woolwich was affected by flooding of Metropolitan Water Board pumping station. During the year a special investigation of the deep wells in the Borough was undertaken.

ab34c0f2-c8e8-4ee6-85a5-bd83ce725218

There are seven still in use, but none for ordinary domestic purposes. 12 Two are used for trade and the rest for boiler supply and kindred purposes. The chemical and bacteriological reports showed that only one well was giving water unfit for drinking. This was a riverside well situated on Crown property and subject to contamination by tidal water from the river. In view of the restricted access to the site and the use to which the water was put (storage for fire-fighting), the quality of this water was not of serious consequence. The water from one deep source, a spring, although reasonably safe for drinking purposes, was liable to pollution by animals. There was no evidence that the spring was used for drinking, but the owners of the land, at the instigation of the Council, rendered the supply inaccessible. Eradication of Bed Bugs. The necessary action was taken in all cases where infestation by bed bugs was discovered, in accordance with the usual procedure adopted by the Department.

317071f0-c3a0-4a9c-800b-951ad0897dcb

This procedure has been fully described in previous Annual Reports. The total number of inspections of verminous premises was 3,493. Hydrogen Cyanide was used for the disinfestation of 46 loads of furniture on removal to Council houses or flats, but no house was disinfested by this method. The use of D.D.T. was commenced towards the end of the year and further particulars will be included in subsequent Reports. Rat Destruction. The work of rat destruction continued during the year. The staff engaged on this work consisted of two investigators and four operators, working under the supervision of a sanitary inspector who devoted the whole of his time to rat destruction and prevention. Under the scheme one investigator and two operators work systematically through the Borough, block by block. The other investigator and two operators deal with areas of infestation arising from reports and complaints. The total number of premises surveyed during the year was 20,715, and the number of inspections was 35,405.

47740893-c249-4f06-845c-0c19ac874fc8

Effective preventive measures were taken in 1,856 instances. Maintenance treatments of the sewers in the Borough were carried out in June and December, and in these two treatments 1,057 manholes were baited. The results of these treatments continue to be satisfactory and indicate their worth in helping to keep the rat population of the Borough at a low level. In addition a test-baiting of 361 manholes was carried out in April. The Transfer of Functions (Infestation Control) Order, 1947, which came into force on 1st September, had the effect of transferring to the Ministry of Agriculture and Fisheries the main functions of the Minister of Health under the Rats and Mice (Destruction) Act, 1919, and the functions of the Minister of Food under the Rats and Mice (Destruction) Order, 1919, and the Infestation Order, 1943. Housing.

57854a06-b483-44b6-91a1-1236b53075ea

The total number of dwelling houses inspected for housing defects under the Public Health or Housing Acts was 7,302 and the number found not to be in all respects reasonably fit for habitation was 3,813. The number rendered fit in consequences of informal action by the sanitary inspectors, including the service of intimation notices, was 2,431. Statutory notices were served in respect of 910 houses. 13 The problems in relation to housing dealt with by the Department were aggravated by the acute housing shortage, notwithstanding the measures taken by the Council for its relief. During the year considerable progress was made in the provision of new houses by the Council. Some 460 permanent and temporary houses were completed, bringing the total number of dwellings erected since the war to 963. At the end of December 474 further dwellings were under construction. Building on the new Coldharbour Farm Estate commenced in February, and the first completed house was opened by the Minister of Health on the 12th July, 1947.

1f96f19d-9847-4ac1-8e64-46203d874bc1

By the end of the year 54 houses had been built and occupied on the Estate, and houses were being erected under five separate contracts, including one for 92 dwellings to be built by Direct Labour. In addition, 95 houses were built by private enterprise and 119 temporary dwellings by the London County Council. Squatters. Many of the squatters, who last year occupied two army camps, left for various reasons and at the end of the year 55 families remained. Although all reasonable adaptations and additions had been carried out, the accommodation could never have been made wholly satisfactory and as each hut became vacant it was rendered unuseable. INSPECTION AND SUPERVISION OF FOOD. Milk. The number of milk premises on the register on the 31st December was 58. The standard of the milk supply was satisfactory ; practically all the milk distributed in Woolwich is heat treated. All the 263 samples submitted for chemical analysis contained 3 per cent, or more of fat.

c0f5b801-f812-4e21-9b13-a03ebf82e5c1

The phosphatase test for adequate heat treatment was satisfied in 265 samples, and the methylene blue test for the keeping quality of milk in 144 samples. Only 1 sample failed to satisfy the methylene blue test, the phosphatase test being satisfied in all cases. Meat Supplies. The one slaughterhouse used in the Borough during the year is under contract to the Ministry of Food. Up to September these premises had only occasionally been used. From this month, however, owing to the closure of slaughterhouses in nearby Kent towns, the Ministry concentrated the slaughtering at these premises ; so much so that it was found necessary for the Council to utilise the full-time services of three inspectors for the inspection of carcases. Due to a change in the method of slaughtering, the flow of carcases is now much more rapid as compared with pre-war and the arrival of the beasts for slaughter is irregular.

df0eec7d-13f2-4bee-a9e1-5fa357e8b296

As all carcases must be inspected within a reasonable time of killing, the staff were frequently kept on duty late. This work has been further increased by the fact that the grade of bovine animals slaughtered is much below that of the pre-war quality, this necessitating an even more detailed inspection. The number of animals slaughtered and inspected at this slaughterhouse was:— cattle, 8,438; sheep, 16,010; pigs, 293; calves, 1,235. Premises where Food is Prepared or Offered for Sale. Routine visits were paid by the sanitary inspectors to all food premises in the Borough. The number of such inspections was 3,234. 14 Analysis of Food and Drugs. During the year the Public Analyst analysed 618 samples, including 562 informal and 56 formal.

949b8310-c2b7-4d22-943b-00a632259cd6

Of these, 25 informal and 3 formal samples were reported to be adulterated, giving a percentage adulteration of 4-5, compared with 2.8 in 1946. The adulterated samples included chillies, 1 ; coffee and chicory essence, 1; milk, 7; patent medicines, 4; sardines, 5; anchovy paste, 1 ; dried thyme, 1; jam, 1; lard, 1; meat cubes, 1 ; meat extract, 1 ; salad dressing, 1; sausages, 3. Unsound Food. During the year 123 tons of food was surrendered as unfit for human consumption. Most of this was utilised for animal feeding or for fertilisers. No seizures were made. Food Poisoning. The number of notifications of food poisoning was 10. Ice Cream.

9ed545df-983d-4fd6-b633-8fd94d76abaa

49 samples of ice cream and ingredients for manufacture were examined by the methylene blue test; in those cases where the grading was low repeat samples were taken and the manufacturing methods investigated and advice given as necessary. The Ice Cream (Heat Treatment, etc.) Regulations, 1947, came into force on the 1st May. These Regulations made under the provisions of the Food and Drugs Act, 193i, provide, inter alia, that ice cream mixtures intended for sale for human consumption shall be raised to and kept at a temperature of 150° F. for 30 minutes or, alternatively, of not less than 160° F. for 10 minutes before freezing. The Regulation does not apply to a " complete cold mix " which is a product capable of being manufactured into ice cream with no addition except that of water. Owing to grave difficulties in supply of certain essential recording instruments, the Regulations were not in full operation during the year.

f0ac1ac3-d39b-4613-ad72-31d3a927b8d7

PREVALENCE AND CONTROL OF INFECTIOUS DISEASES. Incidence. The numbers of cases of notifiable infectious diseases which occurred during the year after correction of diagnosis were as follows :— TABLE No. 5. Diphtheria 7 Ophthalmia Neonatorum 9 Scarlet Fever 297 Dysentery 30 Puerperal Fever 2 Cerebrospinal Meningitis 11 Puerperal Pyrexia 27 Zymotic Enteritis 61 Erysipelas 30 Measles 1,183 Pneumonia 194 Whooping Cough 546 Poliomyelitis 23 Scabies 189 Malaria 5 15 Diphtheria. The number of confirmed cases of Diphtheria, 7, was again the lowest ever recorded. There were no deaths. The causes of the waxing and waning of infectious diseases are often obscure.

8b9e4a51-e111-4324-a52b-81410d040ce0

Caution must be observed, but even so, there must at least be some connection between this gratifying position and the sustained efforts of the department to secure immunity of the population. The family doctor scheme and clinic immunisation sessions continued throughout the year. On the Register-General's estimated mid-1947 child population (29,400) the percentage of the child population in the Borough immunised is 74-6, but for reasons given in last year's report it is considered that this figure is low. Whooping Cough. Immunisation against whooping cough is provided by means of a " family doctor " scheme, under which injections are given by the family doctor whose fees are paid by the Council. During the year 816 children received injections compared with 426 in 1946. Not all of these children received the full course of four injections. Tuberculosis.

5d3b84b4-b7cc-48ca-806a-db80bd113a84

The work of the Tuberculosis Dispensaries is shewn below in tabular form, with figures for 1938 and 1946 for comparative purposes. It will be noted that the work of the Dispensaries has increased considerably :— 1938. 1946. 1947. Number of primary notifications 248 247 297 Number of persons examined for first time 1,312 1,691 1,968 Number of these found to be tuberculous 231 234 161 Number of contacts examined 512 403 505 Number of contacts found to be tuberculous 21 10 14 Total number of attendances 5,415 8,263 9,472 Number of patients referred by Medical Practitioners 437 926 1,118 Number of patients referred by Medical Boards — 91 46 Visits to homes of patients by Tuberculosis Visitors 4,522 3,560 4,

65b35ec6-8987-4fcc-b5e7-5d6d62ddae56

242 Visits to homes of patients by Tuberculosis Officer 285 75 92 Number of X-ray examinations 1,156 2,494 2,983 Number of specimens of sputum examined . 1,059 970 1,191 Number of specimens of sputum positive 157 118 134 Number of patients admitted to hospital or sanatorium 344 318 300 Number of patients given dental treatment 38 5 22 Number of cases on register at end of year 874 1,263 1,438 Notifications include a number of Service and other personnel, some recently returned from abroad, who are now receiving treatment in this country but who have not yet returned to their homes in Woolwich, or had an opportunity of attending the Dispensary. In addition a number have been diagnosed during routine X-ray investigations. 16 The artificial pneumo-thorax clinic at St. Nicholas' Hospital continued its work during the year.

58fd678a-e436-4af2-b567-8258ce88fa63

The total number of attendances at the clinic was 2,912. Clinics at other London hospitals were attended by 83 patients, who received 2,110 refills. The number of applications for maintenance allowances received during the year was 121. On the 1st January, 102 patients were receiving an allowance, 115 were granted an allowance during the year, and at the end of the year 108 patients were in receipt of an allowance. The Tuberculosis Care Committee continued its excellent work of providing for the after-care of patients and assistance to dependants. Four quarterly meetings of the full Committee were held, and the General Purposes Sub-Committee met on 8 occasions. Assistance was given in many ways including the supply of pocket money, clothing, shoes, extra nourishment, beds and bedding, and fares for relatives to visit patients in institutions.

48786342-dc3d-42fc-bf72-15a93684b2ef

The funds come from interest on investments ; donations both from employees of firms in the Borough and from private sources ; and by the sale of Christmas Seals. Laboratory Facilities. The Council's bacteriological work is carried out in the Pathological Department of the Woolwich Memorial Hospital. During the year 621 throat and nasal swabs were examined ; 1,191 specimens of sputum ; 26 specimens of faeces ; 10 specimens of urine ; 25 specimens of blood ; 8 specimens of various foodstuffs and 9 specimens of water. The practice of submitting samples of water from the public swimming baths for examination was continued. Fifty-eight such samples were submitted during the year and apart from some occasional slight over-chlorination, the results were generally satisfactory. Disinfection and Disinfestation.

21ed5c57-6a61-4a80-9e3f-3459d85431c6

Infected articles of bedding, clothing, etc., and articles infested with bugs are disinfected at the Council's Disinfecting Station, White Hart Road, Plumstead ; but the personal clothing of persons treated at the two Cleansing Stations is disinfected at those two stations. During the year 15,475 articles were disinfected at the three stations. The number of rooms disinfected after cases of infectious disease was 502, and of these, 89 had been occupied by tuberculous persons. The number of rooms disinfested of vermin was 947. Personal Cleansing Stations are situated at the Turkish Baths, Plumstead High Street, and at the Eltham Hill Health Centre, Sherard Road. Part of the premises of the Turkish Baths was adapted as a Cleansing Station as a temporary measure after the destruction in 1941 of the former cleansing station at White Hart Road.

33de7f1e-30c0-4cc0-a75b-7ee72867a17c

Pending fruition of a plan for the erection of a combined cleansing and disinfecting station the premises at the Turkish Baths were structurally altered, enabling the service to be more permanent and efficient. The number of persons cleansed of vermin was 2,108 and the number of persons (including contacts) treated for scabies was 969. The total number of attendances was 3,739.

55dc32e1-343b-4d93-ae0c-b194e7003ff1

W0048 AC14372 METROPOLITAN BOROUGH OF WOOLWICH ANNUAL REPORT on the Health of the Metropolitan Borough of Woolwich for the Year 1948 BY T. STANDRING, M.D., B.S., D.P.H., M.R.C.S., L.R.C.P. Medical Officer of Health TABLE OF CONTENTS page Health Committee 2 Maternity and Child Welfare Committee 2 Preface 3 Staff 5 Vital Statistics 6 General Statistics 9 General Provision of Health Services in the Area, including those for Maternity and Child Welfare 10 Sanitary Administration, including Housing 13 Inspection and Supervision of Food 21 Prevalence and Control of Infectious Diseases : Disinfestation 24 Appendix 27 The Kentish Independent Printing Works (T.U.) 41, Wellington Street, S.E.18 2 HEALTH COMMITTEE. At 31st December, 1948.