DEPT 9 ANNUAL REPORT ON THE HEALTH OF THE Metropolitan Borough of Deptford, BY WILLIAM ?H. WHITEHOUSE, M.D., D.P.H., Of the Inner Temple, Barrister-at-Law; Fellow of the Royal Society of Medicine, &c., &c. Medical Officer of Health. 1911 Public Health Committee. Mayor. E. MUMFORD PRESTON, J.P. Chairman. Councillor EDWARD G. H. BERRYMAN. Vice=chairman. Councillor WILLIAM H. BROOKS, L.S.A. (Lond.) Alderman ERNEST GEORGE SIMMONDS, J.P. Alderman H. GARLAND WELLS. Councillor W. H. GREEN. Councillor JESSE QUAIL. Councillor ROBERT SOPER. Councillor JOHN SHEPHERD. Councillor G. TAMS. Staff of the Public Health Department. Medical Officer of Health. William H. Whitehouse, m.d., d.p.h., b.s., Barrister-at-Law. Public Analyst. Henry G. Harrison, m.a. (Cantab), f.i.c. Sanitary Inspectors. Thomas Turner. John V. Snowdon. Robert D. J. Simpson. Joshua Owner. Alfred Priest. A. G. Kemp. Philip Shelley, F. Hewett. Female Sanitary Inspectors and Health Visitors. (1) Miss E. A. McCleverty. (2) Vacant. (3) Vacant. Clerks. Charles A. Chapman. Henry J. L. Smith. Disinfector. C. F. Dowsett. Assistant Disinfectors. T. Lyons. F. Smith. Caretaker at Council's Shelter and Mortuary. G. W. J. Wagner. Metropolitan Borough of Deptford. Public Health Department, Town Hall, New Cross, S.E. To the Right Worshipful the Mayor, Aldermen and Councillors. Gentlemen, In presenting the Annual Report on the Health Administration of the Borough for the year 1911, it is impossible to deal with all aspects of the question in as full detail as they deserve, but the following pages deal, however briefly, with most of the important features. In comparing this report with previous years it is well to remember that the memorandum which is sent out by the Local Government Board at the end of each year on the preparation of annual reports has increased in size very considerably during the past few years, and its enlargement may be said to be an index of the additional duties which now devolve upon sanitary authorities. Social Conditions. Under the heading of social conditions of the district, the Medical Officer of Health is for the first time asked to state as regards his district the amount of Poor Law relief and the extent to which hospital and other forms of medical relief are utilised. 6 Treatment of Phthisis. Amongst the information asked for by the Board for the first time this year is a statement as to the amount of sanatorium and hospital accommodation which is available for early, intermediate and advanced cases of pulmonary tuberculosis. Housing of the Working Classes Acts. It may not be out of place to point out that the report of your Medical Officer must contain adequate information in regard not only to the vital statistics, sanitary circumstances and administration of the district but to the action taken under the Housing of the Working Classes Acts. If such information is not given the Medical Officer of Health of the County is required by the order of the Local Government Board of 29th July, 1910, to obtain further information on these matters. Result of Census Returns. In comparing this report with previous years great care must be shown, owing to the fact that the population of the Borough was over estimated in 1910 to the extent of 10,144 persons. This of course makes the actual death rate appear high compared with the previous year, when in fact it was only .6 per 1,000 higher. The same factor causes the birth rate also to appear 2.7 per 1,000 higher, when actually it is .4 per 1,000 higher. Infectious Diseases. There is a marked decline in the prevalence of typhoid fever, which is an indication of the sanitary progress of the Borough. Measles and scarlet fever have been prevalent during the year but fortunately they have both been of a mild type. In addition to which the order of the Local Government Board authorizing the Metropolitan Asylumns Board to utilize spare accommodation in their hospitals for the reception and 7 treatment of measles may be said to have reduced the mortality from measles; which fact shows the value of institutional care of infectious diseases especially in Poor Law cases. Deaths in Public Institutions. 585 deaths in Public Institutions outside the Borough of persons belonging to Deptford are included in estimating the vital statistics in this Report. In 1911 the number dying in these institutions was rather less than in 1910, and the fact is an interesting one, as something may be learned of the social conditions of a locality when so large a proportion in times of sickness seek refuge in public institutions, more especially in the workhouses. Generally this implies poverty and want, but it may also, and no doubt does, imply that the institutions have a good reputation, and attract sufferers to them. Infant Mortality. Every extended inquiry into the intricate subject of infant mortality brings to light the fact that parents living apparently under the same social and sanitary conditions, have varying success in rearing their childlen, and that the personal factor deserves a careful study. Poverty and riches, sanitary or insanitary conditions, occupation or the want of it, high birth-rate or low, all play their part in bringing these variations about. Infant Consultations and Depots for giving advice to mothers, which have been under my consideration, may have an active and useful future before them in the Borough, whether instituted as a private enterprise, as a Municipal undertaking, or as an extension of local medical institutions. This year's infantile mortality is considerably higher— 20 per 1000, than the previous year—but the circumstances were exceptional, and with the increased staff of Health Visitors which the Council has sanctioned I have every hope of a satisfactory infantile mortality for 1912. 8 Decline in Deaths from Drinking. It is gratifying to know that very few deaths were recorded during the year from excessive drinking. It has frequently bean pointed out in these Reports that the adverse influence upon the public health of drinking is indirect. It is reflected in high infant mortality, neglect of, and cruelty to children. The waste of money in drink which ought to be spent on the necessaries of life is, apart from actual drunkenness, a great source of injury to the public health, accentuating the miseries and suffering of poverty. Everyone who deals with mortality statistics very well understands that the registered deaths by no means represent the actual number caused by the excessive use of alcohol. It is notable, however, that while acute alcoholic poisoning, acute alcoholic mania, delirium tremens, chronic alcoholic neuritis, and alcoholic paralysis are generally ascribed in the death returns to alcoholism, yet there are many other diseases to which alcohol is the attributing cause, which are not so included, and which comprise diseases of the stomach, such as gastric catarrh, chronic dyspepsia and dilatation of the stomach ; of the liver, such as congestion, cirrhosis and fatty liver; of the kidneys, such as chronic nephritis. The results of coroner's inquests also show that alcohol is the contributing cause to other deaths. House Fly and Disease. As flies may be a source of dangerous contamination, owing to their frequenting places where filth exists, particular attention has been paid to stable refuse and manure heaps. Flies may carry an enormous number of bacteria and the danger which may arise from the transmission by these insects of filth and infection of foodstuffs cannot be over-estimated. 9 Phthisis. There is, unfortunately, no considerable lessening of the phthisis mortality, which, although not great, is an evidence that special efforts are still required to combat this disease. Those special efforts will be the outcome of the compulsory notification of all forms of tuberculosis which should result in great administrative advantages. By the notification of phthisis the experince so gained will be very valuable and greatly facilitate the work of the Health Department in connection with the organised scheme of supervision and treatment which is now before the Health Committee. The efforts of the Council have hitherto been directed with a view to bringing more closely the living places and the surroundings of the people to the requirements of sanitation. The work, needless to say, cannot be regarded as finished. There is still wanted the developed scheme mentioned in the text of this report, and more open spaces and playgrounds in the poorer quarters of the borough and other similar necessities for health. With phthisis as with other diseases prevention is better than cure, and attention must not be diverted from the preventive aspects by prospects which are held out of cure which are often illusory. In conclusion, it is pleasant to report that the Staff of the Public Health Department have carried out their duties during the year with remarkable conscientiousness and have been of the greatest assistance to me. I beg to add my sincere thanks to your Committee for their kindly and courteous consideration to the Staff and myself. To Mr. Purkis, of the Town Clerk's Department, who has furnished me with valuable information, I also tender my best thanks. I have the honour to remain, Gentlemen, Your obedient Servant, W. H. Whitehouse. 10 Summary of Vital and Mortal Statistics for 1911. 1911. 1910. Area 1,563 acres 1,563 acres Population— Census 1901 110,398 110,398 Census 1911 109,498 — Estimated to middle of 1911 109.475 119,642 Number of inhabited houses 16,466 15,823 Average number of persons per house 6.6 7 Density 70 per acre 75 per acre Length of Public Streets 53 miles approx. 53 miles approx. Rateable Value £640,807 £634,588 1d. Rate produces (approximately) £2,400 - Cost of administration of Public Health Department £1,354 — Marriages 758 716 Marriage Rate 6•9 5•9 Births 3,001 2,959 Birth Rate 27•4 24•7 27•0* Birth Rate, average for the last 10 years 28•3 27•1 Deaths 1,728 1,671 Death Rate 15•8 13•9 15•2* Death Rate, average for the last 10 years 14•9 15•1 Infantile Mortality 143 per 1,000 births 123 per 1,000 births Infantile Mortality, average for the last 10 years 130 per 1,000 births 133 per 1,000 births Zymotic Death Rate 2•72 1•71 * Calculated on Census Population of 1911. Area and Population, Births and Deaths. 13 Area and Population. Acres. Estimated Population. 1563 ... 109,475 The population of the Metropolitan Borough of Deptford at the census taken April 3rd, 1911, was 109,498. The estimated population to the middle of the year 1911, based on the results of the above census and that of 1901, was 109,475. The estimated population for each of the various wards based on the results of the Census of 1901 and that of 1911, was as follows:— East 22,272 S. 12,268 N. 24,759 S.E. 12,051 N.W. 23,835 S.W. ... 14,290 As the Borough has an area of 1563 acres, the density of the population on this estimate is 70 per acre. The following table shows the total number of dwelling houses and the number occupied and unoccupied in 1901 and 1911 respectively:— Year. HOUSES. Inhabited. Uninhabited. Building. Total Number of Dwelling Houses. In occupation. Not in occupation. 1901 15,823 229 195 92 16,339 1911 16,466 280 195 16 16,957 Taking the number of occupied houses for 1911 as set forth in the above table, viz., 16,466, and supposing the average number of persons per house to be 6.6, instead of 7 as stated in the previous reports, the population would be 109,498. With the prevention of overcrowding and the lessening of the number of families per house which we hope to bring about, 6.6 will become a more correct factor in future years. 14 The following table gives the approximate number of houses in each ward, and I have added a column showing the estimated population of each Ward :— Ward. Houses Occupied. Uninhabited Houses. Houses Building. Total number of Houses. Estimated population at 6•6 per house. In Occupation. Not in Occupation. North 3149 45 15 9 3218 20,941 South 2243 36 62 5 2346 14,916 NorthWest 3151 31 12 1 3195 20,954 SouthWest 2931 31 26 1 2989 19,491 East 2973 85 41 — 3099 19,770 SouthEast 2019 52 39 — 2110 13,426 16,466 280 195 16 16,957 109,498 Back-to-Back Houses. There are very few houses of this class in the district and practically no houses built in courts. Site, Sub-Soil and Drainage of Deptford. The physical features and character of the Borough are better described by considering the whole of London, but generally speaking we may say that the town is situated on one side of a long ridge, at the top of which ridge we find Telegraph Hill, and extending in South-East direction we have Hilly Fields. From this ridge we get a wide sweep down into the Thames valley, until in the North and East we get very low-lying land. 15 In the Southern district the soil is practically all clay, but the gradual slope forms an ideal drainage area. In the South-West we find gravel to the north of New Cross, and clay to the south of it. In the South and South-East we have all clay. So much clay has a serious effect on the houses and drains after a very dry or very wet season, in which the clay shrinks or expands, the foundations being seriously interfered with. There is also an interference with the foundations owing to the sliding movement which takes place on a big slope. Deptford is exceedingly fortunate in being connected with the finest sewage system in the world. The sewers passing through Deptford are:— Branch. Size of Barrel. Coming from. Length. Bermondsey Branch 5-ft. 6-in. Rotherhithe 7290-ft. Southern High Level Sewer 10-ft. 6-in. Wandsworth 6480-ft. Southern Low Level Sewer 7-ft. 3-in. Putney 7260-ft. Effra Branch 8-ft. 3-in. Norwood 6270-ft. Storm Relief (in Church Street) 13-ft. 6-in. by 11-ft. — 2970-ft. Storm Relief (St. George's Stairs) 13-ft. 6-in. by 11 -ft. — 1980-ft. Relief Sewer at Broadway 10-ft. Greenwich 3080-ft. Deptford to Lee Green Sewer 6-ft. Lee 1320-ft. Ravensbourne and Sydenham Sewer 6-ft. by 4-ft. Bell Green 1330-ft. New Southern High Level Sewer 8-ft. 3-in. Brockley 7920-ft. 16 Thus we have about 8.7 miles of main sewers of large bore in the Borough, all radiating towards the Deptford Pumping Station except the last mentioned, but all pass on to the Crossness Pumping Station, and from this point the sewage passes into the Thames. Open Spaces. The Borough whilst having several parks in the neighbourhood is particularly devoid of small open spaces in the congested areas. Every opportunity should be taken of acquiring small plots of land for the purpose of providing playgrounds and small gardens. By such a provision, streets would be opened up which are not only dangerous to the health of the people but a menace to public morality. The open spaces existing at present are :— Situation. Size. Maintained by 1. Deptford Park Evelyn Street 22 acres L.C.C. 2. Ravensbourne Recreation Ground Brookmill Road 1¼ acres Borough Council. 3. Hilly Fields Brockley 45½ acres L.C.C. Although the Hilly Fields are not actually within the Borough this open space is situated immediately on the SouthEastern boundary. 17 Births. Number of births 3001 Average number of births for previous 10 years 3245 Average birth-rate for previous 10 years 28.3 Birth-rate of Deptford per 1,000 27.4 England and Wales 24.4 77 Great Towns 25.6 136 Smaller Towns 23.4 London 25.0 The total number of births registered in the Borough in 1911 was 3,001, as compared with 2,959 in 1910. Of these 1,521 were boys and 1,480 were girls. The birth-rate for the Borough was equivalent to an annual rate of 27.4 per 1,000 of the population, as compared with 24.7 for 1910, 26.8 for 1909 and 26.2 for 1908. The birth-rate for London was 25.0 per 1,000, compared with 23.9 per 1,000 for 1910, 24.2 for 1909, and 25.2 for 1908. The subjoined table gives the number of births for each Ward, together with the birth-rate :— Ward. Births. Birth Rate per 1,000. Males. Females. Total. East Ward 359 367 726 32•6 North Ward 380 368 748 30•2 North-West Ward 356 369 725 30•4 South Ward 89 88 177 14•4 South-East Ward 169 111 280 23•2 South-West Ward 168 177 345 24•1 18 In the following table will be seen the number of births, deaths, and deaths of children under one year of age, which have occurred during the past ten years, with the respective rates:— Year. Estimated population. Births. Deaths. Deaths under one year. No. Rate per 1000. no. Rate per 1000. No. Mortality per 1000. births. 1901 110,398 3395 30•7 1790 16•2 510 150 1902 111,577 3315 29•7 1826 16•3 459 138 1903 112,455 3465 30•8 1740 15•4 473 136 1904 113,634 3265 28•7 1824 16•0 489 149 1905 114,512 3290 28•7 1642 14•3 411 124 1906 115,495 3260 28•2 1854 16•0 472 144 1907 116,510 3323 28•5 1641 14•0 356 107 1908 117,539 3084 26•2 1643 13•9 381 123 1909 118,583 3093 26•8 1611 13•5 321 103 1910 119,642 2959 24•7 1671 13•9 366 123 Average for 10 years 115,034 3245 28•3 1724 14•9 424 130 1911 109,475 3001 27•4 1728 15•8 428 143 It will be observed that apparently the birth-rate for the year is rather higher than that for several years previously, but we must consider the fact that the census returns show a much smaller population than that estimated by the Registrar General. If we correct these rates we find that actually the birth-rate is only slightly higher than that of 1910. The birth-rate is still very high in the old parts of the borough. The high birth-rate amongst the poorer classes no doubt partially results from very early marriage. B 2 19 Illegitimate Births. The illegitimate births, which number 88, occurred in the several Wards, as follows :— East Ward 32 NorthWard 11 North-West Ward 22 South Ward 3 South-East Ward 14 South-West Ward .6 Total 88 Marriages. There were 758 persons married in the Borough during the year, as compared with an average of 707 in the ten years preceding. The marriage-rate for 1911 was equal to 6.9 per 1,000 of the estimated population and was therefore higher than any year for the past ten year's with the exception of 1906. It is puzzling to understand how an increase in the marriage-rate is coincident with a decline which is considered to have taken place in the trade and commerce of the Borough, and with a decrease which has actually occurred in the population. The marriages were celebrated in the following places:— 510 in Churches of England. 60 in other places of worship. 188 in the Registrar's Office. 758 Total. 20 Deaths. 1911. Average for past 10 years. Number of deaths 1,728 1,724 Average death-rate for previous 5 years 14•3 14•9 Rate per 1,000 Deptford 15•8 „ „ England and Wales 14•6 ,, ,, 77 Large Towns 16•4 ,, ,, 136 Smaller Towns 14•4 „ ,, County of London 15•0 The number of deaths registered within the Metropolitan Borough of Deptford from all causes during 1911 was 1,304, equal to a death-rate of 11.9 as compared with 1,232 deaths, and a death-rate of 10.1 during the previous year. Of this number 643 were males and 661 females. The total number of deaths belonging to Deptford is obtained by deducting the number of deaths of non-parishioners registered in the Borough, viz.: 161, of which number 154 occurred in the Metropolitan Asylums Board's South Eastern Hospital, making 1,143 deaths actually belonging to Deptford. To this number we must add 585 deaths of parishioners which occurred in public institutions outside the Borough, making a total of 1,728, of which 892 were males and 836 females, and upon these figures the statistics are based. The death-rate for the Borough was equal to an annnal rate of 15.8 per 1,000 of the population, as compared with 13.9 for 1910, 13.5 for 1909 and 13.9 for 1908, the average for the past five years being 14.3. The 585 deaths outside the borough were distributed as follows:— DEATH RATES FROM ALL CAUSES IN METROPOLITAN BOROUGHS, 1911. 21 Asylums 36 Poor Law Institutions:— Greenwich Union 327 Other than Greenwich 20 Hospitals:— Guy's 39 Seamen's 13 Miller's 12 East London (for children) 11 St. Bartholomew's 7 St. Thomas' 16 London 11 Metropolitan Asylums Board 18 Other Hospitals 37 Other places 38 The following table gives the number of deaths which occurred in each Ward, and the death rates for each Ward. Ward. Deaths. Death Rate per 1,000. Males. Females. Total. East Ward 251 217 468 21•0 North Ward 198 194 392 15•8 North West Ward 171 155 326 13•7 South Ward 71 63 134 10•9 South East Ward 111 96 207 17•2 South West Ward 90 111 201 14•1 Deaths of residents occurring in outlying public institutions are allocated to their respective Wards according to the addresses of the deceased as received from the RegistrarGeneral's Department. 22 The proportion which the mortality at various ages bears to the total number of deaths during 1910 and 1911 is as follows:— 1910. 1911. Under 1 year 21.9 per cent. 24.8 per cent, deaths. 1 to 2 years 7.9 „ „ 2 to 5 ,, 13.0 „ 4.7 „ „ 5 to 15 „ 3.2 „ 4.2 „ „ 15 to 25 „ 2.7 „ 3.2 „ „ 25 to 45 „ 11.7 „ „ 45 to 65 „ 32.5 „ 20.6 „ „ 65 years and upwards 26.7 „ 22.9 „ „ Seasonal Mortality. First Quarter.—The deaths numbered 451, which is equal to an annual death rate of 16.5 per 1000. Second Quarter.—The deaths numbered 360, which is equal to an annual death rate of 13.1 per 1000. Third Quarter.—In this quarter 464 deaths were registered, equal to an annual rate of 16.9 per 1000. Fourth Quarter.—453 deaths were registered, equal to a rate of 16.5 per 1000 of the population. Infantile Mortality. Total deaths of Infants under one year, 428. 1911. Average for previous 10 years. Deptford Infantile death-rate per 1,000 births 143 130 England and Wales 130 77 Large Towns 140 136 Smaller Towns 133 County of London 128 Chart shewing Principal Causes of Death, 1911. 23 Of the 1,728 deaths recorded during the year 428 were of infants under one year of age. During the past ten years the infantile death-rate had fallen from 159 to 103 per 1,000 births registered. In 1910 there.was an increase to 123. It is disheartening to those who hoped that the lower rates which prevailed, especially in the past four years, would be maintained, for the infantile death-rate for the year 1911 suddenly rose to 143 per 1,000 births. This increased mortality was foreshadowed, and it is correct to state that the lower rates of recent years were largely dependent upon meteorological conditions. During the summer months of last year the infantile mortality rate in Deptford was as high as 251 for the 13 weeks ending the 30th of September, that is to say : one-fourth of the children born died before reaching the age of one year. This is more appalling when we consider that only a small portion of the Borough is poverty stricken. The largest number of infant deaths is found to be in those districts where the people are poor and ignorant and where the three great factors in the production of infantile mortality, of improper feeding, uncleanliness and undue exposure prevail. It is the above alarming figures which have brought home to the Council the urgent necessity for carrying out the long reiterated advice of the Public Health Committee, and for taking steps to combat this terrible sacrifice of infant life by means of the personal ministrations of more Health Visitors and other measures stated in this report. Towards the end of the year the Council sanctioned the appointment of an additional Health Visitor and also a Female Sanitary Inspector. In future years I feel certain that the Health Committee will look back with pride and satisfaction on the fact that they have taken an 24 active part in the prevention of the painful sickness and unnecessary deaths of those children whose parents were unable through lack of knowledge to do the proper thing at the proper time for them. The following is a table showing the infantile death-rate For the 13 weeks ending 30th of September, for some of the London Boroughs:— Deptford. Bermondsey. South wark. Poplar. Bethnal Green. Shoreditch. Greenwich. Deaths under 1 year per 1,000 births registered 251 281 250 273 255 266 241 In a previous table will be seen the infantile mortality per 1,000 births for the past ten years. The following table shows the infantile mortality in the various wards:— DEPTFORD. Ward. Births Registered. Deaths under 1 year of age. Infantile Mortality per 1000 Births. East Ward 726 143 197 North Ward 748 108 144 North-West Ward 725 95 131 South Ward 177 12 68 South-East Ward 280 29 104 South-West Ward 345 41 119 25 TABLE SHEWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1911. BIRTHS 3001 DEATHS (including 585 in Outlying Public Institutions 1728 Excess of Births over Deaths 1273 The value of rain as a means of removing filth and microorganisms, which cause so much of the epidemic summer diarrhoea, is evident. Scavenging by water-carts should take the place of rain in dry weather, and the dust laid by water should be swept up and removed before it has time to dry and disseminate in the atmosphere; and any attempt at scavenging in dry weather without the aid of water simply results in the more complete dissemination of dust into the atmosphere. Added to this, the proper paving of yards, and the regular swilling of the gutters of the narrow streets of the poor, would do much to lessen the incidence and death rate of diarrhoea and other diseases among the inhabitants. Among the infant population generally "wasting diseases" and "diarrhœal diseases" account, as a rule, for the greater loss of life, and one of the principal factors in their causation is without doubt the deprivation of the natural breast milk and consequent resort to artificial or hand-feeding. Unsuitable diets are often persisted in, which the infant's stomach rejects, or its tissues fail to assimilate, and many a baby's life is sacrificed through the inability of those about the child to understand that feeding and nourishing are not quite the same thing. The ill-effects of artificial feeding of infants become exagerated in hot weather on account of the greater liability to contamination of food from dust and flies, milk food often becoming acid, and developing bacteria in the course of a 26 few hours, although there be outwardly no apparent change. Since the adoption of the Notification of Births Act, 1907, the notice of the birth of a child is received within two days of the event, and enables the Lady Health Visitor to pay an early visit to the home and give advice to the mother as to the proper feeding and management of the infant, which I feel certain in the future will be attended with the most encouraging results. I submit a list of the principal causes of the 428 infantile deaths in the Borough during 1911, viz.:— Whooping Cough 16 Measles 10 Diarrhceal Diseases 106 Enteritis and Diseases of Digestive System 40 Bronchitis and Pneumonia 62 Debility and Marasmus 40 Premature Birth 55 Congenital Malformations, Atelectasis, and Injury at Birth 9 Meningitis 13 Convulsions 19 Suffocation in bed with parents 5 Other causes 53 428 The Public Health Committee in presenting the following report on Infantile Mortality to the Council in December, 1911, stated that they had now completed their consideration of the reference from the Council at its meeting on 21st November, 1911, directing the Committee to enquire and report as to the causes of the high death rate in certain wards of the borough during the past five years, especially amongst children under one year of age. The Committee have devoted a great deal of careful attention to the main object of the reference, viz., the 27 causes of infantile mortality in certain portions of the borough, and they have received the following report from Dr. Whitehouse, the Medical Officer of Health, on the subject:— In stating the chief factors which influence the death rate of infants in the borough it is necessary to consider first the causes of death. It is approximately estimated that in the past five years 9.3 per cent. died from infectious diseases, chiefly Measles and Whooping Cough, 17 per cent, died from Diarrhceal Diseases, 28 per cent, from Wasting Diseases (17 from Premature Birth and 11 from Marasmus), 2.7 per cent, from Tuberculosis Diseases, and 43 per cent, from other diseases, 20 per cent, being due to Pneumonia and Bronchitis. During 1910 there were 45 more deaths among infants than 1909, the main increases being due to the following diseases:—Diarrhoeal Diseases accounted for 32 more deaths, Bronchitis and Pneumonia 11, Accidents 3, Convulsions 7, Wasting Diseases 5, Heart and Meningitis 5. The main decreases were: Premature Births 15 less and Tubercle 4 less. The remaining causes were fairly normal and correspond with the previous year to a great extent. The factors contributing to the Diarrhoea and Chest Troubles are those mentioned in the text of this report. By far the greater number of deaths have been registered in the Central District, which comprises the whole of the East and parts of the North and North-West Wards, the first named supplying the larger number of deaths. 28 The conditions contributing to the high infantile death rate in the Central District are:— 1. Density of Buildings.—By increasing the tendency to Diarrhoea mortality. 2. Site.-—The three Wards comprising the Central District are low lying, and thus the tendency to many diseases is increased. For instance Bronchitis, Pneumonia, Diarrhoea and also Infectious Diseases tend to become endemic in such an area. 3. Lack of Ventilation and Light.—This is conducive to Diarrhoea, Rickets, Chest Troubles and Wasting Diseases. Among the common conditions that are harmful are obstructive walls and buildings, back to back houses, overcrowding, and neglect of ventilation of rooms. Light, in many of the small houses, is reduced to a minimum. 4. Lack of Cleanliness.— This has a similar effect to the above. In many houses refuse is left about in the yards, animals are kept, and the yards belonging to the smaller houses I regret to say, are only partly paved and generally filthy and damp. The floors, walls, furniture, clothing and bedding are notoriously dirty in many of the houses. 5. Foul Air.—This is produced by lack of ventilation and accumulation of filth, aided in many cases by the use of a gas stove situated frequently in the only living room, and used instead of a fireplace ; a common practice in the district referred to. 6. Drinking Water.—This can only cause Diarrhœa when the supply is insufficient, and therefore is not responsible for the ordinary epidemics of summer Diarrhoea in this borough. 29 7. Soil.—This is an important factor among the causes of infantile mortality which, fortunately, we are able to cope with to some extent by efficient paving and drainage. 8. Temperature.—The higher temperature of the air in the summer months has long been observed to be associated with high Diarrhoeal mortality, and the reverse with low air temperature. The maximum mortality by no means coincides with the highest readings of the air thermometer. The temperature of the soil being a less sensitive indicator, and more steady in its record, is on the whole a better guide. The maximum Diarrhoeal mortality is generally attained in the week in which the temperature recorded by the 4-ft. earth thermometer attained its mean weekly maximum. It is a remarkable fact that for the first half of 1911 the rate of infantile mortality for the borough was only 93, and even more striking than that, in the East Ward for the same period the rate was only 86 per 1000 births. 9. Rainfall.—Diarrhoeal diseases are greater in dry seasons and less in wet. Under the former conditions the micro-organism is capable of getting abroad from its primary home, the earth, and having become air-borne, fastens on food or other organic matter and uses it as a nidus and pabulum in undergoing various changes in its life history. From food and other organic matter it can manufacture a virulent chemical poison which is the material cause of diarrhoea. 10. Social position is a great factor in increasing infantile mortality, as is shown by the statistics. 30 11. Industrial employment of many of our women in the borough is probably one of the important influences at work, for it is obvious that girls and young women who are employed in industrial work for many hours daily have little time to make themselves practically familiar with the very numerous and often apparently unimportant matters which make all the difference between a wellordered home and one which lacks the influence of a capable mother. The fact of employment in factories after confinement obviously militates against a mother feeding her child naturally. From statistics I have collected elsewhere, I find that 75 per cent, of the mothers who were not industrially employed, and whose babies lived 12 months, fed their children naturally up to the age of 12 months, whilst only 27 per cent, of those industrially employed did so. Further, the mortality of summer diarrhoea was, in the .whole population, 30 times greater among bottle-fed children than among breast-fed children, so that factory labour by preventing breast feeding, must have a pernicious influence. 12. Food.—This is also a factor in contributing to the high rate of infantile mortality, especially Milk, which becomes contaminated by exposure to dust or filth and emanations, etc. Flies are frequently the means of conveyance, and the important part played by flies in the dissemination of disease has long been recognised. There is hardly a house in the East Ward with a proper receptacle or pantry for food, and where there is, it is insufficiently lighted and ventilated. Breast-fed children are remarkably free from disease, and those partially breast-fed come next; the mortality is much higher among children artificially fed, and especially if fed by the bottle. 31 I feel strongly that a large number of infants start life at a very great disadvantage, because during intrauterine life or during the first six months, their mothers have not been able to nourish them. We suffer greatly from these defectively nourished babies in Deptford, as is demonstrated by the fact that 28 per cent, of the infantile deaths are from wasting diseases, 11 per cent, of which are due to Marasmus, and the remaining 17 per cent, primarily to maternal conditions causing premature birth and congenital defects. The life of a mother among the poorer classes is always a strenuous one if the family is large (the birth rate for the East Ward last year was estimated as 31.9 as compared with 24.7 for the whole borough, and 23.9 per 1,000 for London), when hunger is added, and particularly when such a woman is an expectant or nursing mother, the condition is a very distressing one. 13. Maternal neglect.—The infantile mortality in the borough is higher among illegitimate children from all causes, but the excess is greatest in regard to diarrhœa. It may be noted that Illegitimate Births are highest in the East and North-West Wards. During 1910, the East Ward contributed 21, North-West 13 and the other wards averaged 7 each. I have it on the authority of the Health Visitor and from personal observation that many of the mothers live more exacting lives than any other group of the community, and that when food first comes into the house, it is given to the children or the husband, whilst the mother, even if carrying, goes on from day to day in a state of semi-starvation. 14. Sex.—It is common knowledge that the mortality in male infants is greater than that in children of the opposite sex, as also is the liability to Diarrhœa. 32 15. Age.—Infants under 1 year, and very young children, furnish nearly the whole of the deaths from diseases classed under Diarrhceal Diseases. Summary. From the above report it will be clear that there are many factors at work causing infantile mortality, some of which we can cope with now, whilst others we must leave to future legislation. Amongst the most urgent matters requiring legislation, with a view to reducing the wastage of child lives, are the following :— (a) The earlier registration of births (say within seven days), which would in my opinion, obviate the necessity for notification in addition to registration, and would be far less troublesome and confusing to the public. The shorter period for registration would also prevent the leakages due to the present long period of 42 days, in which period the parent or parents often remove from the place of birth. (b) The medical certification and registration of all stillbirths. (c) The extension of the existing legislation regarding the milk supply so as to cover dirty milk and all diseases of cows likely to affect their milk, and so as to prohibit the use of chemical preservatives in milk sold for human consumption. (d) That all preparations offered or sold as food for infants should be certified by a Government analyst as non-injurious, and that each packet should contain its analysis. 33 Insanitary damp dwellings can be remedied by damp courses and the removal of defects and nuisances. Instructions can be given so that mothers will be encouraged to breast-feed their children. This can be done by official and voluntary agencies who will also supervise the hygienic conditions of the home. Refuse from houses and street refuse can and should be removed in covered carts and not deposited in the streets for collection, as is sometimes done. The streets should be sufficiently watered, especially in the summer, and particulary in the neighbourhood of shops. Open spaces can be provided as opportunities offer, and cottage baths in the poor quarters can and should be provided by the Council at a nominal charge of 1d. per person, so as to encourage cleanliness, and supply the wants of many people. Another matter which may possibly affect the question under consideration, and which should be remedied, is the large amount of defective road channelling and curbing which allows pools of stagnant water to accumulate in the roadways. This is daily evident in the poorer streets. These are simply a few of the lines on which we can work, the details of which, and the extension of the same should be left to the Public Health Department. The Committee concur in the report above set out, and they have considered the manner in which certain of the suggestions therein contained can be brought into force. As a result they find that many of the matters assigned by the Medical 34 Officer of Health as causes of Infantile Mortality are already being grappled with, notably, lack of ventilation and light, and lack of cleanliness. There are other causes however mentioned in the report of the Medical Officer of Health, such as the use of uncovered carts for the collection of refuse, and the pools of stagnant water in the roadways caused by defective channelling and curbing, which the Committee considers could be gradually removed. The Committee are also impressed with the desirability of cottage baths being provided, especially in the north-western portion of the borough, which accommodation can be obtained, the Committee are informed, at a very small cost, by converting existing premises for this purpose. They therefore recommend : (a) That it be referred to the Baths and Washhouses Committee to consider the desirability of converting two or more houses in one of the wards in the Central District of the borough as slipper baths. (b) That it be an instruction to the Works Committee to take into consideration the paving of the streets of congested areas with a surface of jointless and impervious material, with a view to the best possible cleansing of such streets in the interests of public health. (c) That it be an instruction to the Works Committee that all vans or carts for the collection of refuse hereafter purchased be fitted with permanent covers, and that the present vans or carts be altered as opportunity arises. Below is a comparative table giving particulars showing the relationship between the temperature, rainfall and diarrhœa mortality in the summer months:— C 2 35 No. of Week in Year. Mean Weekly Temperature of Air. Mean Weekly Temperature of Earth four feet below surface. Rainfall. Deaths from Diarrhœa and Enteritis. 1910. 1911. 1910. 1911. 1910. 1911. 1910. 1911. o o o o ins. ins. 31 60.2 68.0 60.12 66.11 0.85 0.06 l 8 32 August 60.7 72.5 60.48 66.43 0.18 0.00 - 26 33 62.7 69.4 61.13 67.06 0.19 0.58 5 14 34 59.9 63.9 61.26 66.39 0.80 0.29 11 26 35 58.3 65.3 60.59 65.36 0.41 0.41 15 19 36 September 54.7 66.9 59.68 64.63 0.02 0.01 13 19 37 56.1 60.3 58.71 64.19 0.66 0.41 18 16 38 53.8 54.3 58.01 61.74 0.00 0.48 2 13 39 58.6 55.0 57.35 59.94 0.10 0.44 3 7 40 October 57.4 48.2 57.61 57.63 0.08 0.27 4 7 Weekly Average 58.2 62.4 59.49 63.95 0.33 0.29 7 15 Note.—The meteorological particulars in the above Table are the results of observations taken at the Royal Observatory, Greenwich. NURSING FACILITIES. Deptford is well provided with facilities for the nursing of the poorer inhabitants of the Borough, the chief of which are:— 1. Ranyard Nurses, Central Office, Ranyard House, 25 Russell Square, managed by a committee and superintended by a Sister. Eight of the Nurses live in different parts of the Borough and attend medical and surgical cases in the Borough and in emergency abnormal cases of midwifery. No charge is made, and med'cal men find them of great service among the sick poor. 2. Nurses of St. John the Divine in Watson Street. These are connected with the Morden Hill Hospital, Blackheath. They attend similar cases to the above. 3. Central Hall Nurses, High Street. Two in number attend any cases requiring their services. 36 4. Medical Mission Nurse. Nurse Trender attends Medical Mission cases. 5. St. John's Church Nurse. Attends similar cases to the above. Other useful institutions and organizations in the Borough are:— The Creche in Albury Street.—Hon. Medical Officer, Dr. Elmslie Crabbe. The Duchess of Albany's Deptford Fund. Charity Organization Society.— Secretary, Miss Butcher, 11 Amersham Road. Rescue workers. Mutual Registration Offices, 11 Amersham Road. Deptford Clinic.—This work is carried on at 353 Evelyn Street and at Deptford Green. The treatment of children is undertaken, including the removal of tonsils and adenoids in a properly constructed operating theatre, open air treatment, dental clinic, infant consultations and school for mothers. Much excellent work is done under the management of Miss McMillan with the help of two honorary medical officers, an honorary dental surgeon, a qualified teacher of physical culture and a trained nurse. The London County Council have recognised Miss McMillan's good work and have now given her a small grant. FLIES AND INFANTILE MORTALITY. During the summer of 1911 we have had an excess of Summer diarrhoea, and although it is recognised that flies play an important part in the dissemination of disease, it is a strange fact that although we have had an exceedingly hot summer the 37 number of flies has not been as great as usual in London. It is recognised by some that with rows of houses crowded as they are into narrow streets, comparatively few flies are sufficient to carry infection from one house to another. Although in 1911 we had only thousands of flies instead of tens of thousands, there were quite sufficient to account, if necessary, for all the cases of infantile diarrhoea which occurred. Of course it is obvious that there are other sources of infection, but we may take it that flies are the principal agents in the spread of summer diarrhœa in young children. We are absolutely dependent on outside sources for the supply of milk, and it is readily conceivable that flies contaminate some of the milk even before it arrives here, and this fly-infected milk may then give rise to infantile diarrhœa in a district which itself is comparatively free from flies. If warm weather conditions prevail the growth of the bacteria in milk is favoured, and the greater number there are of flies the greater likelihood there is that unprotected milk will be contaminated. Luckily we have taken special pains to do away with collections of manure and house refuse which are the favourite breeding grounds of the house fly. If flies are present in noticeable numbers in a crowded district it only needs the ignorance and carelessness of one mother whose child has summer diarrhoea to cause a rapid spread in the number of cases; the flies acting as carriers of germs from the infective excreta, and infecting houses where there is a free access of food. Flies may therefore be a nuisance and injurious to health by their mere numbers, or may also be a specific and dangerous nuisance by being capable of carrying all sorts of disease germs. A consumptive for instance who has not been instructed may expectorate on to the ground or into an open vessel, flies settle on it, ignest some of the tubercle bacilli, and then may 38 diately settle on to food suitable for the growth of the germ, and convert it, especially milk, from being a wholesome food into a virulent dangerous poison. Distribution of Condensed Milk. Regarding the sale of condensed milk from bulk, it has recently become a common practice in some of the poorer districts for condensed milk to be sold in small quantities from open tins; in this way it is sold from a farthingsworth upwards and is placed in the customers' own vessels, sometimes supplied in the form of a smear on paper. Such a proceeding is open to many objections, for not only is machine skimmed milk often sold for condensed milk without the necessary declaration on the vessel in contravention to sale under the Food and Drugs Acts, but it is also open to serious objection on account of the great opportunity for contamination. Rickets. Rickets is a very prevalent disease in Deptford. Many parents speak of it as a family disease, as being somewhat naturally incidental to children, and they will relate how each or several members of the family have suffered one after the other, and nothing could be done for them. The present efforts of the Health Department are directed to change entirely this attitude of mind by teaching the doctrine that rickets is a preventable disease, that it is more readily prevented than cured, and that in nearly every case it is caused by improper food and feeding. We are now circulating the following card, which we hope will be carefully read and acted on:— HINTS TO PARENTS REGARDING RICKETS IN CHILDREN. Rickets is a very serious disease for a baby to have, and it is very common. It is a disease which is easily prevented by a little care on the mother's part and easily cured when taken in time. 39 Rickets is a disease of early infancy, and generally begins during the baby's first year of life-at the time that the teeth are appearing. A mother or nurse should always think of rickets when:— (i.) The baby begins to sweat much, especially on the forehead when he is sleeping. (ii.) The baby becomes very restless and begins to toss about when sleeping and to throw off the bedclothes. (iii.) The baby dislikes to be moved, and the body and limbs are so tender that the child now cries more readily on being washed and dressed. When placed in a chair, in bed, or on the floor, he tries to keep quite still, like an old man, instead of being always on the move like a healthy child. If he has previously been walking he has now no desire to do so, and at once "goes off his feet." (iv.) The baby is suffering from digestive troubles. At one time it may have diarrhcea with slimy offensive motions, at another time constipation, and the abdomen often appears larger than in the case of a healthy child. When any or all of these conditions are present, the child is most likely suffering in the early stage of rickets. It is then the plain duty of the parents to immediately consult a medical man ; because, at this early stage, the disease, if promptly treated, is readily curable, and may pass off in a few weeks in most cases. But if the child is not properly treated, and is not prevented from standing or walking, and is not kept lying flat so as to reduce the pressure on the soft bones and muscles, then the condition becomes rapidly worse. Then:— 40 (a) The child may die in infancy, or if it lives through this stage, the bones may be bent into different shapes; producing such deformities as bow-legs, knock-knee, pigeon-breast, flat-foot, curvature of the back, etc., and the child may remain deformed for life. (b) Teething is delayed, and the teeth come in the wrong order, and one by one, instead of as usual in pairs. (c) The flesh becomes soft and flabby. (d) Growth becomes stunted. (e) The head begins to appear large in proportion to the face, and the forehead to have a characteristic square shape. (f) Thickenings appear at the ends of the bones of the arms and legs, and ribs near the breast bone. (g) The child now suffers more readily from colds, bronchitis and convulsions. CAUSES WHICH PRODUCE RICKETS. (1) Improper Diet is theChief cause.—And thisoccurs chiefly in the case of bottle-fed children either from milk not properly prepared and often not sufficient in quantity, or feeding on condensed milks and the various kinds of so-called infant foods, or by giving the child a little of the ordinary every-day meals which it cannot digest. (2) Bad Hygienic Conditions.— Living in damp, ill-ventilated houses and the want of sunlight. PREVENTIVE TREATMENT. (l) Feed with mother's milk. Very few breast-fed infants ever suffer from rickets. 41 (2) If the infant is bottle-fed then those in charge of the infant should acquaint themselves regarding the feeding and nursing of infants. Parents can have printed leaflets giving directions on infant feeding and nursing, from the Public Health Department, and if they communicate with the lady health visitors they will gladly call and explain the instructions in these leaflets. Medical advice must however be obtained from the medical attendant of the family. (3) Every child, even the most delicate, should be suitably clad and taken out a good deal every fine day. Plenty of fresh air, light and sunshine is an excellent preventive against rickets. Fireguards. Fireguards are articles of furniture which I have noticed to be singularly lacking in Deptford. It does not seem to be generally known that in view of the fact that under the Children Act of 1908, it is now incumbent upon all parents and householders, having the charge of young children, to possess fireguards to protect kitchen or room fires, so that there will be no reasonable risk of children being seriously injured by burning. There are certain points in regard to the construction of fireguards which are of primary importance (1) The fireguard should enclose the fire completely. (2) It should be capable of being attached to the fireplace, so that a young child cannot pull it over. (3) If the front of it consists of vertical bars, so open that children can easily push in paper, etc., the inside of those bars should be filled in with close wire-mesh, 42 so as to make it difficult to put paper through, or at any rate, to withdraw it in a lighted condition. (4) Another safeguard against the introduction of wisps of paper, etc., is that the fireguard should make a good semi-circle around the fire, so that young children cannot thrust anything through the grate as far as the fire. Such fireguards should be obtainable cheaply, viz., from two to four shillings each, and need be no more of a recurring expense than other items of furniture if they are used carefully. They are specially important in these days when cottages are built with such small kitchens, or where the family lives in perhaps one room only, for then the children are forced into closer contact with the fire. HEALTH VISITOR. Notification of Births. During the year 1911 three hundred and twenty nine more primary visits were made to the homes of babies than in the previous year, the total number being 2324. This increase was largely due to the fact that early notification as required by the Act has been systematically carried out, and it may be said that the Notification of Births Act is now working efficiently in the Borough. There were 3001 births registered during 1911. ,, 3028 „ notified „ „ These figures show that the compulsory notification under the Act within 36 hours is much more valuable to us than the registration of the birth which may not take place until six weeks after the birth. Your Lady Health Visitor (Miss E. A. McCleverty) reports that she has visited each home, usually about the middle 43 of the second week where the notification has been made by the midwife or responsible person, and shortly after the mother is up, where a medical practitioner has notified the birth, if your Medical Officer of Health has considered it a suitable case for visitation. Your Medical Officer considers that if visited early the mother is open to receive advicg concerning her offspring, and will frequently tell the Health Visitor of little difficulties she may have with other children and seek that advice which it is in the province of the Health Visitor to give. Miss McCleverty has reported to me that she has paid 2324 visits during the year, 1646 being first visits and 678 being re-visits. The midwives receive the visits to their patients quite cordially, and support our efforts in advising the mother in the care of herself and her offspring. Breast-feeding is generally attempted for the first two months, after which time the milk disappears or becomes of very poor quality, ft is unfortunately a fact that the child is then fed either upon boiled bread, cheap brands of condensed milk, or as an alternative skimmed milk. It is after the breast milk disappears that the real trouble commences, and in some families baby after baby suffers from rickets and wasting diseases. In the poorest of homes the milk is frequently given too greatly diluted. It is such cases as these that show the immediate necessity of providing Schools for Mothers and Infant Consultations in every suitable locality. Dummies or comforters, I regret to state, are still very general, notwithstanding every effort to teach the mother the injury they do to the health of their little ones. The puerperium is frequently too short in the case of women with large families, and results disastrous to the health of the mother may be a consequence. Many defects and nuisances in the houses which otherwise might be overlooked, 44 are discovered by these visits, which defects are reported and steps taken to remedy them. Pantry accommodation is very inadequate in many houses and the food is very frequently uncovered. Much good is done by health visiting, and much ignorance and superstition are dispelled. The immediate results may frequently be disappointing, but we are encouraged with the hope that the interest we take in the mothers' welfare may lead to the children becoming the healthy men and women of the future. The distribution of visits in the different wards was as follows :— e. n. n.w. s. s.e. s.w. Totals. Visits 802 376 206 12 147 103 1646 Re-visits 394 140 66 4 49 25 678 The number of births notified under the Notification of Births Act during this period was 3028. 234 parents had to be written to on account of the failure to comply with the Act, and in 22 of these cases a second letter was necessary. In the following table, information will be found with regard to the births notified in the different wards, together with the sex, whether born alive or dead, and by whom the birth was notified :— Ward. Births Notified. Alive. Dead. By whom Notified. Total. Males. Females Parent. Doctor. Nurse. Other Person. East 733 365 368 706 27 106 120 475 32 North 757 383 374 737 20 172 240 309 36 Nth.-west 727 364 363 714 13 206 281 181 59 South 185 98 87 178 7 110 52 21 2 Sth-East 286 173 113 277 9 84 77 109 16 Sth-West 340 168 172 329 11 140 79 112 9 Totals 3028 1551 1477 2941 87 818 849 1207 154 45 Details as to the feeding of the babies visited is given below. " Mixed feeding" means both breast and hand-fed. Wards. Breast Feeding. Mixed Feeding. Hand Feeding. Totals East 501 40 26 567 North 252 27 17 296 North-west 133 17 11 161 South 5 1 0 6 South-east 85 13 13 111 South-west 65 6 2 73 Totals 1041 104 69 1214 Deptford Clinic. As already stated, Miss McMillan has recently enlarged the scope of her work at the Deptford Clinic, and has arranged that on one afternoon a week mothers may take their babies to the clinic for examination by a qualified medical man. The babies are weighed and advice is given to the mothers with regard to treatment, feeding, clothing, etc. Acting on my instructions your Health Visitor has visited the Clinic at various times on these afternoons, and we are co-operating as far as possible with the workers there. The work should be productive of great good, and your Visitor is sanguine that the mothers in Deptford will take advantage of the instruction there given them. 46 Table No. 1. METROPOLITAN BOROUGH OF DEPTFORD. (This Table is prepared in accordance with the requisitions of the Local Government Board). VITAL STATISTICS OF WHOLE DISTRICT DURING 1911 AND PREVIOUS YEARS. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Under l year of Age. At all Ages. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 115,495 3,260 — 28.2 1,387 12.0 64 531 472 144 1,854 16.0 1907 116,510 3,276 3,323 28.5 1,336 13.1 192 497 356 107 1,641 14.0 1908 117,539 3,065 3,084 26.2 1,251 10.6 156 548 381 123 1,643 13.9 1909 118,583 3,047 3,093 26.8 1,207 10.1 119 523 321 103 1,611 13.5 1910 119,642 2.906 2,959 24.7 1,232 10.1 116 555 366 123 1,671 13.9 1911 109,475 2,921 3,001 27.4 1,304 11.9 161 585 428 143 1,728 15.8 Area of District in acres Total population at all ages 109,498 (at Census of 1911). (exclusive of area 1,563. Number of inhabited houses 15,823 (at Census of 1901). covered by water). Average number of persons per house, 6.6. 47 Table No. 2. METROPOLITAN BOROUGH OF DEPTFORD. (This Table is prepared in accordance with the requisitions of the Local Government Board). CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1911. Notifiable Disease Number of cases notified. Total cases notified in eaoh Ward. Total Cases Removed to Hospital. At all Ages At Ages—Years East Ward North Ward North-West Ward South Ward South-East Ward South-West Ward Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox 1 . . . . . . . . 1 . . . . . . . . 1 . . . . . . 1 Cholera . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Diphtheria including Membranous croup 159 4 51 83 13 7 1 . . 27 37 40 18 11 26 135 Erysipelas 177 8 9 15 26 61 46 12 54 52 33 8 16 14 16 Scarlet fever 369 2 113 223 20 11 . . . . 43 142 91 24 30 39 346 Typhus fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Enteric fever 13 . . 1 2 5 5 . . . . 3 2 4 2 2 . . 9 Relapsing fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Continued fever 4 . . 1 . . . . 3 . . . . 2 . . . . . . 1 1 . . Puerperal fever 2 . . . . . . . . 2 . . . . . . 1 . . . . . . 1 2 Plague . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Cerebro-Spinal Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anthrax . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Hydrophobia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glanders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Phthisis UnderTuberculosis Regulations, 1908 180 l 11 19 17 69 55 8 71 59 17 2 22 9 79 UnderTubercuIosis Regulations. 1911 155 .. 3 27 32 74 17 2 43 36 37 6 16 17 23 Chicken-pox 157 12 61 79 3 2 . . . . 39 16 36 14 40 12 . . Ophthalmia Neonatorum 15 15 . . . . . . . . . . . . 8 5 . . . . 1 1 1 Acute Poliomyelitis 1 . . 1 . . . . . . . . . . . . . . 1 . . . . . . . . Totals 1233 42 251 448 116 235 119 22 290 350 260 74 139 120 612 50 Table No. 4. METROPOLITAN BOROUGH OF DEPTFORD (This Table is prepared in accordance with the requisitions of the Local Government Board.) Infantile Mortality, 1911. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 1 month. 1 to 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Total Deaths under 1 year. All Causes Certified 71 14 21 16 122 71 98 68 69 428 Uncertified . . . . . . . . . . . . . . . . . . . . Small Pox . . . . . . . . . . . . . . . . . . . . Chicken Pox . . . . . . . . . . . . . . . . . . . . Measles . . . . . . . . . . . . . . 3 7 10 Scarlet Fever . . . . . . . . . . . . . . . . 1 1 Diphtheria and Croup . . . . . . . . . . . . . . . . 1 1 Whooping Cough . . . . . . . . . . 2 6 4 4 16 Diarrhœa . . . . . . 1 1 18 36 28 23 106 Enteritis . . . . 2 2 4 6 13 9 5 37 Tuberculous Meningitis . . . . . . 1 1 . . 2 2 1 6 Abdominal Tuberculosis . . . . . . . . . . 1 . . . . . . 1 Other Tuberculous Diseases . . . . . . . . . . . . . . 3 4 7 Congenital Malformations 7 . . . . . . 7 1 1 . . . . 9 Premature Birth 38 4 6 2 50 2 3 . . . . 55 Atrophy, Debility, and Marasmus 12 3 5 1 24 10 4 . . 2 40 Atelectasis . . . . . . . . . . . . . . . . . . . . Injury at Birth . . . . . . . . . . . . . . . . . . . . Erysipelas . . . . . . . . . . . . . . . . . . . . Syphilis . . 1 . . . . 1 1 3 . . . . 5 Rickets . . . . . . . . . . . . . . . . . . . . Meningitis (not Tuberculous) . . . . . . 1 1 1 2 2 1 7 Convulsions 2 2 . . 1 5 2 5 2 5 19 Gastritis . . . . . . . . . . . . 2 1 . . 3 Laryngitis . . . . . . . . . . . . 1 . . . . 1 Bronchitis 1 2 3 . . 6 9 8 7 5 35 Pneumonia (all forms) . . . . 2 . . 2 9 3 5 8 27 Suffocation, overlaying . . . . . . 2 2 1 1 1 . . 5 Other Causes 11 2 3 2 18 8 8 1 2 37 71 14 21 16 122 71 98 68 69 428 Nett Births—Legitimate, 2913; Illegitimate, 88. Nett Deaths—Legitimate infants, 411; Illegitimate infants, 16. D 2 56 DEATHS FROM 7 PRINCIPAL INFECTIOUS DISEASES. Year Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria Diarrhœa and Enteritis (under 2 years) Total No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate 1901 10 0.09 1 0.01 53 0.48 17 0.15 50 0.45 37 0.34 104 0.94 272 2.46 1902 11 0.10 30 0.26 58 0.53 18 0.17 36 0.32 18 0.17 38 0.67 209 2.22 1903 4 0.03 - - 72 0.64 23 0.20 47 0.42 45 0.40 42 0.64 233 2.33 1904 3 0.02 - - 73 0.64 11 0.09 49 0.43 16 0.14 112 0.98 264 2.30 1905 6 0.05 - - 16 0.13 9 0.07 18 0.15 9 0.07 84 0.73 142 1.20 1906 6 0.05 - - 71 0.61 16 0.13 61 0.52 18 0.15 146 1.26 318 2.72 1907 5 0.04 - - 55 0.47 13 0.11 35 0.30 26 0.22 20 0.18 154 1.32 1908 6 0.05 - - 33 0.28 6 0.05 25 0.21 10 0.08 82 0.70 162 1.37 1909 6 0.05 - - 66 0.55 13 0.11 47 0.40 16 0.13 46 0.39 194 1.63 1910 4 0.03 - - 60 0.50 3 0.03 44 0.37 12 0.10 82 0.68 205 1.71 Average for 10 years. 6 0.05 3 0.03 56 0.48 12 0.11 41 0.36 21 0.18 76 0.72 215 1.93 1911 2 0.02 - - 67 0.61 7 0.06 35 0.32 15 0.14 172 1.57 298 2.72 * The deaths under this heading for the years 1901 to 1910 refer only to those certified to be due to epidemic or summer diarrhœa, or epidemic, zymotic or infective enteritis. For 1911, deaths from Gastro enteritis, Gastro-intestinal Catarrh, Muco-enteritis, Colitis, &c., are also included 57 In the following table will be seen the number of deaths from these diseases and the epidemic death rate in each Ward:— Deaths. Epidemic Death-rate. East Ward 126 5.66 North Ward 62 2.50 North-West Ward 56 2.35 South Ward 7 0.57 South-East Ward 18 1.49 South-West Ward 29 2.03 298 2.72 The following statement shows the position occupied by Deptford with respect to the Epidemic Diseases in the country and in the neighbouring Metropolitan boroughs: — Epidemic death-rates per 1000 inhabitants England and Wales 1.8 77 Great Towns 2.3 136 Smaller Towns 2.0 Greenwich 2.4 Camberwell 1.8 Bermondsey 2 .7 Poplar 4.0 Lewisham 1.3 County of London 2.2 Deptford 2.7 West Ham 2.1 Liverpool 3.1 Manchester 2.4 Birmingham 2.7 Leeds 2.3 58 Infectious Diseases, 1911. Disease. Total number of notifications received. Relating to cases. Errors of diagnosis and cases occurring in hospital Nett number of cases. Small-Pox 1 1 — 1 Cholera — — — — Diphtheria (including Membranous Croup) 164 159 7 152 Erysipelas 202 177 — 177 Scarlet Fever 386 369 20 349 Typhus Fever — — — — Enteric Fever 15 13 — 13 Relapsing Fever — — — — Continued Fever 4 4 — 4 Puerperal Fever 3 2 — 2 Plague — — — — Cerebro-spinal Fever — — — — Anthrax — — — — Hydrophobia — — — — Glanders — — — — Phthisis 507 335 — 335 Chicken Pox 165 157 — 157 Ophthalmia Neonatorum 18 15 — 15 Acute Poliomyelitis 1 1 — 1 Total 1466 1233 27 1206 Previous Year 825 692 50 642 59 The following table shows the number of patients notified during each of the last ten years:— INFECTIOUS DISEASES NOTIFIED IN THE METROPOLITAN BOROUGH OF DEPTFORD FROM 1901 TO 1911. Year. Smallpox. Diphtheria. Membranous Croup. Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Continued Fever. Puerperal Fever. Chicken Pox. Cerebro-spinal Meningitis. Pulmonary Tuberculosis. Ophthalmia Neonatorum Acute Poliomyelitis. Totals. Measles. Disinfections, (premises) 1901 4 407 . . 78 550 8 60 . . 2 . . . . . . . . . . 1116 . . 925 1902 139 253 4 147 638 . . 73 . . 3 1119 . . . . . . . . 2450 . . 1076 1903 2 449 11 134 501 2 31 1 7 46 . . . . . . . . 1184 273 1164 1904 11 186 4 146 501 . . 29 . . 8 304 . . . . . . . . 1129 1029 1507 1905 2 143 6 152 603 . . 33 . . 7 . . . . . . . . . . 946 600 1197 1906 1 303 8 161 649 . . 40 . . 9 . . . . . . . . . . 1171 1007 1593 1907 . . 287 13 130 774 . . 34 4 4 . . 2 . . . . . . 1948 726 1495 1908 . . 197 10 168 723 . . 29 . . 4 . . . . . . . . . . 1131 850 1399 1909 . . 185 9 179 373 . . 33 4 6 . . 2 172 . . . . 963 467 1232 1910 . . 125 5 138 300 . . 24 1 2 . . 1 96 . . . . 692 1114 1209 Average for past 10 yrs. 15 253 7 143 561 1 39 1 5 147 5 27 . . . . 1204 607 1280 1911 1 152 7 177 369 . . 13 4 2 157 . . 335 15 1 1233 664 1121 Notifiable Infectious Diseases. The total number of cases of Infectious Diseases notified during the year under the provision of the Public Health (London) Act, 1891, was 1,233. This compares unfavourably with the two preceding years, showing an increase of 541 and 270 cases respectively. During the past five years the total number of cases notified and the attack rates per 1,000 of the population have been as follows:— 60  1907 1908 1909 1910 1911 No. of cases 1,248 1,131 963 692 1233 Estimated population 116,510 117,539 118,583 119,642 109,475 Attack rate per 1000 of population 107 9.6 8.1 5.8 11.3 Briefly, this increase in notifications was mainly due to the fact that Chicken Pox was made notifiable for three months dating from March 22nd, and also to an increase in the number of Tuberculosis notifications due to the Public Health (Tuberculosis in Hospitals) Regulations, 1911. Fees for Notifications. The amount paid to Medical Practitioners for notification during the period under report was:- £ s. d. First Quarter 14 8 6 Second „ 44 12 0 Third ,, 31 5 6 Fourth „ 40 13 0 £130 19 0 All fees except those for the notification of Pulmonary Tuberculosis are repaid to the Sanitary Authority by the Metfopolitan Asylums Board. Discovery and Diagnosis of Infectious Diseases. It is well to know that unrecognised cases largely spread infectious diseases. 61 Discovery.-—Mild cases of indisposition or disease excite no particular attention, or are attributed to other than the real cause by parents, guardians, or friends, and are not submitted to medical examination. In the autumn there are generally several instances of parents and guardians failing to recognise as infectious cases slight disturbances of health in children until other children become infected and dev elop typical symptoms. When cases of suspected infectious diseases occur there is sometimes considerable difficulty and delay in making an exact medical diagnosis in certain types of the diseases. Here bacteriological and additional clinical examinations are brought to bear upon doubtful types, and to check or confirm the diagnosis. The arrangements for the bacteriological examination and reports upon doubtful cases by the Council with the Clinical Research Association of Watergate House, Adelphi, W.C., were renewed. The number of specimens of secretion, blood and sputum submitted to bacteriological tests during the year in suspected cases of Diphtheria, Typhoid or Enteric Fever, and Tuberculosis, and the results of examination, were as follows:— Bacillus found. Doubtful. Bacillus not found. Total. Diphtheria (Secretion) 41 0 148 189 Reaction obtained. Doubtful. 1 Reaction not 1 obtained. Total. Typhoid (Blood) 0 3 8 11 Bacillus found. Doubtful. Bacillus not found. Total. Tuberculosis (Sputum) 1 1 4 6 It seems apparent that medical men practising in the district do not sufficiently avail themselves of the facilities offered by the Council. 62 Infectious Diseases fall into several categories— (a) Permanent compulsorily certifiable diseases, including Phthisis. (b) Temporary compulsorily certifiable diseases:—Chicken pox when small pox is present. (c) Non-certifiable diseases— (1) Diseases notifiable by School Teachers:—Measles, whooping cough, mumps, tonsilitis. (2) Communicable Disorders notifiable by School Teachers :—Ophthalmia, ringworm, impetigo, scabies, pediculosis. (3) Suspicious illness:—Sore throat, feverish cold, whooping, vomiting, diarrhœa, rash, etc. Small Pox. One case of small pox occurred, viz., J. A., 29 years of age, male, of Monson Road, notified on 27th February. The patient, a bricklayer by trade, fell ill on 21st February, and the characteristic rash appeared on the 24th. The patient was promptly removed to hospital and the premises disinfected. The patient, who was vaccinated in infancy, was revaccinated on removal to South Wharf, and has since recovered. All persons who had been in contact with the patient were kept under close observation, but I am pleased to report that no further cases occurred. It is worthy of note that no deaths have occurred from this complaint since 1902, in which year there were 30 deaths out of a total of 143 cases; in the next year only two cases were notified with no deaths. It is an important fact that owing to the further facilities afforded by the Act by which exemption from vaccination may be obtained, the decline in infant vaccination still continues, contributing a danger to the community, and there is little doubt that the sense of security now prevailing will sooner or later receive a rude shock in the form of a serious outbreak of small pox. 63 Vaccination. The number of successful vaccinations for the year 1910 was much less than for 1909 and indeed for many previous years. Again, the number of children in respect of whom certificates of conscientious objection have been received is in excess of any previous year. A sudden increase in this number during 1907 and the following years is clearly due to the Vaccination Act of 1907, which enabled the so-called conscientious objector to obtain exemption from vaccination of his child with much greater ease than hitherto; and too much stress cannot be laid of the danger to a community from invasion by small pox when there exists a large proportion of young unvaccinated persons. The number of certificates of successful primary vaccination, at all ages, received during the past two years has been as follows:— 1910 2220 1911 (half-year) 1036 Greenwich Union. DEPTFORD (SUR-REGISTRATION) VACCINATION DISTRICT. YEARS 1910 AND 1911. Year ending 31st December. No. of Births registered Successfully Vaccinated Insusceptible of Vaccination. Had Small Pox. Number respect of whom Certificates of Conscientious Objection have been received. Dead Unvaccinated. Postponement by Medical Certificate. Removal to districts the Vaccination Officer of which has been duly apprised. Removal to places unknown or which cannot be reached and cases not having been found. Unaccount ed for. 1910 3147 2220 4 .. 312 226 10 17 323 35 1911 1st half-year. 1607 1036 14 .. 183 131 37 13 161 32 Totals 4754 3256 18 495 357 47 30 484 67 I am indebted to the courtesy of Mr. A. E. Rossiter, Vaccination Officer to the Guardians, for the above figures. 64 Scarlet Fever. Average of 1911 previous 10 years. Number of cases 369 561 „ deaths 7 12 Death rate per 1,000 in Dept- ford 0.06 0.11 386 notifications were received during the year 1911, relating to 369 cases. Of these, 20 cases were errors in diagnosis and cases which occurred in hospital, thus reducing the net number of cases to 349. The number of cases for 1911 was in excess of that in the previous year, and the virulence of the type in 1911, as indicated by the number of deaths, was greater. During the past three years, 300, 362 and 723 were notified respectively. The deaths were 7, compared with 3, 13 and 6 in the three preceding years. The death-rate was 0'06 per 1,000, and for the three preceding years, 0.03, O.11 and 0.05 respectively. The rate of mortality for England and Wales was 0.05,for the 77 great towns 0.06, for the 136 smaller towns 0'06, for the County of London 0.04 per 1,000. During the first quarter of the year only 48 cases were notified, during the second quarter 59, the third quarter 93, but during the last quarter there were 169. Over 80 per cent. of these cases were removed to hospital, and previous records show that the percentage of deaths is much lower if the patient is treated in hospital than if nursed at home. Chart shewing week by week the number of cases of Scarlet Fever notified as having occurred in the Borough of Deptford during the 52 weeks ended December 30th, 1911. 65 Scarlet Fever is a variable disease, some cases being of a most malignant form, whilst others are of a mild form. Even in the latter type complications may arise. Some attacks are so mild as to escape recognition altogether, thereby acting as " carriers," and being the means whereby this complaint is spread, which partly accounts for the difficulty and often impossibility of tracing the source of infection. Contaminated milk, food, water supply, overcrowding and insanitary conditions play an important part in the spread of scarlet fever and zymotic disease generally. It is by these mild missed cases or "carriers" that infection is spread, especially in schools, although the work done by medical inspection of school children has done much to reduce one great source of infection. Complications or sequelae may follow even in the mildest of cases: such as otorrhœa, mastoiditis, nephritis, or albuminuria, rheumatism, rhinitis, and secondary glandular affections forming abscesses. As any one or more of these complications may occur in the same patient, prolonging his recovery, the uncertainty, variability, and treacherousness of this complaint can be understood. Bacteriology has not as yet been of any help in defining when a patient is free from infection, therefore the difficulties of discharge of such cases from scarlet fever hospitals into homes where there are other susceptible children can be realised, especially as any eczematous condition of the mouth, nostril, or ear is known to be highly infective. In some cases a patient may be released who has escaped any of the abovenamed complications in six weeks, whereas another may have to be isolated for prolonged periods, for any one or more of these lesions, and released even then with some risk lest a " return " case be the result. 66 Scarlet Fever. WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total. 2 5 7 5 5 11 4 4 18 25 43 North 8 5 6 6 16 18 40 43 70 72 142 North-West 3 7 6 9 6 14 17 29 32 59 91 South 1 1 5 5 6 .. 1 5 13 11 24 South-East 2 4 6 .. 2 5 4 7 14 16 30 South-West 3 7 1 3 6 4 3 12 13 26 39 Total 19 29 31 28 41 52 69 100 160 209 369 AGF.S OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. A11 Ages. 2 113 223 20 11 .. .. 369 The procedure by the Health Department for the prevention of the spread of scarlet fever in the borough has consisted of systematic weekly visits to the houses where cases were isolated at home by the Sanitary Inspector. Reports were made on receipt of each notification to the Medical Officer of Heath, as to the milk, water supply, sanitary arrangements, drainage school or department attended by the patient and rest of the family, state of the house, out-buildings, number in house, and means of isolation, these reports being entered into an Infectious Disease Register, where the results of subsequent weekly visits to enforce isolation are also recorded. Notices were sent to the school where children attended from infected E 2 67 homes, requiring exclusion of these children from school until the house was cleansed and disinfected to the satisfaction of the Medical Officer of Health after recovery or removal of the patient. Where cases were removed to hospital the usual routine followed was fumigation, the removal of infected bedding and clothing to the borough steam disinfector, and, where necessary, the stripping and limewashing of the infected house or parts thereof on the certificate of the Medical Officer of Health. Diphtheria and Membranous Croup. 1911 Average for previous 10 years. Number of Cases 159 260 Number of Deaths 15 21 Death rate per 1,000 in Dept- ford 0.14 0.18 These two diseases are grouped together, as they are symptomatic of each other, and the terms are regarded as synonymous. This method is also adopted by the RegistrarGeneral, and therefore allows of comparison. The total number of notifications received were 164 relating to 159, seven of which were notified as membranous croup. Of the number notified 7 were errors of diagnosis and hospital cases, reducing the number of cases again to 152 compared with 119, 180, and 179 for the previous three years. Fifteen deaths were registered during the year as compared with 12, 16, and 10 for the three previous years. The rate of mortality was 0.14 per 1,000, and for the three previous years 0.10, 0.13, and 0.08 respectively. The death rate for England and Wales was 0.13, for the 77 great towns 0.15, for the 136 smaller towns 0.12, and for the County of London 0.14. 68 The cases were distributed in the following Wards as follows:—East 27, North 37, North-West 40, South 18, SouthEast 11, and South-West 26. It will be seen therefore that the cases were fairly evenly scattered over the borough, but the disease showed a tendency to increase in August and December; in the latter month 23 cases were notified. It will be seen on the age table that the largest number of attacks occurred between the ages 1-15. When the patient is treated at home no other child from the same house is allowed to attend school while the patient is infectious, nor for two weeks afterwards. Contacts. The examination of the throats of diphtheria contacts whenever practicable, by bacteriological means is a most important aid to precautionary measures against the spread of diphtheria. Should a positive result be obtained in the case of children showing no evidence of diphtheria the presence of some measure of infection is assumed, and much valuable light on the origin of outbreaks is obtained. Your Medical Officer takes swabs of all contacts or suspicious cases whenever they come to his notice. Last year your Committee had under consideration the provision of diphtheria anti-toxin for the use of medical men, including Poor Law Medical Officers in cases of diphtheria, and it was decided that practitioners in the borough might obtain from the Public Health Department anti-toxin sufficient for their purposes upon sending a written order stating the name, age, and address of the patient, together with the doctor's name, and stating that it is to be used for a poor inhabitant of the borough. Chart shewing week by week the number of cases of Diphtheria and Membranous Croup notified as having occurred in the Borough of Deptford during the 52 weeks ended December 30th, 1911. 69 It is desirable that medical men should be made aware of these facilities, and emphasis should be laid on the importance of prompt treatment by anti-toxin and the saving of life which may be effected. Although this serum can be obtained from the Town Hall practically night or day very few applications have been received hithereto. Bacteriological examinations were made during the year by the Clinical Research Association of 189 specimens of membrane sent them, of which 41 were found to be positive and 148 negative. Diphtheria. WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total. East 4 5 3 2 2 3 3 5 12 15 27 North 3 4 4 2 5 5 8 6 20 17 37 North-West 2 4 7 2 8 6 4 7 21 10 40 South 1 4 .. 2 4 .. 3 4 8 10 18 South-East .. .. 2 1 3 1 1 3 6 5 11 South-West 2 7 1 5 4 1 .. 6 7 19 26 Total 12 23 17 14 26 16 19 31 74 85 159 AGES OF PATIENTS NOTIFIED. Under l 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages. 4 51 83 13 7 1 .. 159 70 Enteric Fever. 1911 Average of previous 10 years. Number of Cases 13 39 Number of Deaths 2 6 Death rate per 1,000, Deptford 0.02 0.05 This disease has been endemic in the borough for many years. There has been no serious outbreak of the disease during the last ten years, and only once in that time have we had as many as 40 cases notified in the one year. During the past year we had 13 cases notified, as compared with 24 cases in 1910, 33 in 1909. This year therefore was exceptional, as showing the lowest number on record of cases notified from this disease. The prevalence of this disease is generally considered an index of the sanitary state of a district, and such a small number of cases in so densely populated a town is an indication of a good sanitary condition as regards its water carriage system, sewage, drainage, etc. It also indicates that Deptford has a good pure water supply, which is indeed the case. Two deaths were attributed to this disease during the year, compared with 4, 6, and 6 in the preceding three years; one death was registered as having occurred outside the borough. As it is so obviously necessary in the patient's interest to secure a speedy recognition of the condition with a view to recovery, so is it necessary to avoid the terrible disabilities incurred by " carriers " when their condition becomes known. As it is in the public interest that those who are " carriers" should be recognised as such, and as there is no legal power to obtain this information we have to secure it by voluntary cooperation between the medical attendant, patient and the public health authority. Upon the recovery or removal of a patient the necessary disinfection has been carried out, consisting of the stripping and limewashing of the infected room after fumigation, and of 71 disinfecting the bedding and infected articles and clothing in the Council's steam disinfector. The death rate was equal to an annual rate of 0.02 per 1,000, whilst for the three preceding years it was 0.03, 0.05 and 0.05. The case mortality for 1911 was 15.4, compared with 16.7 for 1910. The rate of mortality for England and Wales was 0'07, for the 77 great towns 0.06, for the 136 smaller towns 0.07, and for the County of London 0.03. The following table gives the situation in the borough of each case and the general condition of the dwellings :— Address. Ward. Age. Sex w.c. accommodation. Yard Paving. Sanitary Defects and Remarks. Upcott Street N.W. 42 M. In yard Concrete No record made. St. John's Road S.E. 36 M. Outside „ No nuisance. Clifton Road S.E. 22 M. Outside ,, — Vansittart Street N. 14 F. In yard „ Defecti\e gulley, pit dug. Sandbourne Rd. S. 37 F. 1 Inside, 1 outside „ No nuisance. Woodpecker Rd. N.W. 19 M. 1 Inside, 1 outside „ No record made. Cornbury Road.. N.W, 16 M. 1 Inside, 1 outside „ Yard surface cement concreted, floor vent provided, roof up, rooms cleansed Pagnell Street E. 19 M. In yard „ No defects, drain tested, no result, house clean. Railway Grove E. 38 F In yard „ Defective drainwhich was reconstructed. Housecleansed and repaired, July 1911. March ant Street N.W. 28 M. In yard „ Kitchen dirty, (cleansed). Wickham Gdns. S. 23 M 1 Inside, 1 outside Tiled Two stack pipes direct to drain. (Gullies fixed). Watergate Street N. 13½ M. Outside Concrete defective Three rooms foul. Napier Street E. 3 F. In yard Concrete Patient died at home. Notified as the result of P.M. examination. 72 The following table gives the age distribution during the past year:— Enteric. WARD. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total. East .. .. .. .. 1 1 .. 1 1 2 3 North .. .. .. .. .. 1 1 .. 1 1 2 North-West 1 .. .. .. 3 .. .. .. 4 .. 4 South .. .. .. .. 1 1 .. .. 1 1 2 South East 1 .. .. .. 1 .. .. .. 2 .. 2 South-West .. .. .. .. .. .. .. .. .. .. .. Total 2 .. .. .. 6 3 1 1 9 4 13 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65& upwards. A11 Ages. .. 1 2 5 5 .. .. 13 The cases were distributed in the different wards as follows:—East 3, North 2, North-West 4, South 2, and SouthEast 2. Eleven bacteriological examinations were made of specimens of blood, of which 3 were found to be doubtful and 8 negative. Erysipelas. 1911 Average of previous 10 years. Number of Cases 177 143 Number of Deaths 0 — 73 One hundred and seventy seven cases of Erysipelas have been notified during 1911, as compared with 138 in 1910, 179 in 1909, and 168 in 1908. There were no deaths registered from the disease either within the borough or from outlying institutions. In each notified case the premises have been visited and enquiries made, and where necessary disinfection performed. Puerperal Fever. 1911 Average for previous 10 years. Number of Cases 2 5 Number of Deaths 1 — The two cases of puerperal fever notified have been notified in the practice of midwives, and compared with 2, 6, and 4 for the three years preceding. One death occurred as compared with 1,1, and 2 for the three preceding years. The death rate was equal to 0.009 per 1,000, compared with 0.008, 0.008, and 0.01 for the three preceding years. Such a low mortality speaks well for the midwives of the borough, who attend by far the greater number of the births. The mothers also have either followed the advice of their nurses as regards cleanliness, or have been the creatures of providence. It is a notable fact that the deaths from this disease are very often the result of gross carelessness on the part of the mothers themselves, because many of them do not trouble to prepare clean bedding for their lying-in. This is not always due to actual dirty habits, but to the fact that they do not wish to soil their bedding, not knowing in their ignorance that at the time of their confinement cleanliness is of the first importance. 74 Both cases were carefully enquired into by the Medical Officer of Health and the Health Visitor. Disinfection has been carried out and every effort made to prevent further cases. In addition to the above the following section of the rules of the Central Midwives Board was rigorously enforced :— " Whenever a midwife has been in attendance upon a patient suffering from puerperal fever or from any other illness supposed to be infectious, she must disinfect herself and all her instruments and other appliances, to the satisfaction of the local Sanitary Authority, and must have her clothing thoroughly disinfected before going to another labour. Unless otherwise directed by the supervising authority, all washable clothing should be boiled, and other clothing should be sent to be stoved (by the local Sanitary Authority), and then exposed freely to the open air for several days." Every precaution was taken to prevent the disease being conveyed to other women, and it is gratifying to remark that much greater care is now taken by midwives in cleansing themselves and their clothing and appliances than in previous years. The keeping of temperature charts during the puerperal period, as practised by the midwives, has proved of immense benefit in helping to direct the attention of the midwife to the possibility of puerperal complications, and enables her to recognise the necessity of calling in medical assistance at the earliest indication of danger. In March, 1906, the London County Council called the attention of Boards of Guardians in the Metropolis to the rules made by the Central Midwives Board under the Midwives' Act, 1902, one of which rules prohibits a midwife from attending alone upon certain cases of difficulty, and places on her the 75 duty of advising that the services of a medical practitioner be obtained, but no provision is made either in the Act or rules made thereunder for the payment of fees of medical practitioners who may be summoned in such cases, and in which the patients are too poor to pay. Upon consideration of the representations made to them on the subject, the Guardians agreed (in cases in which the patient was not in receipt of poor law relief) to pay the fee of any medical practitioner called in by a midwife under the rule of the Central Midwives Board, where the person was obviously too poor to pay. Ophthalmia Neonatorum. This is an extremely serious affection which attacks the eyes of newly-born infants. It is usually caused by the entrance of certain bacteria into the eyes at the time of birth. The symptoms, redness and swelling of the eyelids, make their appearance in about three or four days after birth, and the disease frequently runs such an acute course that if proper treatment is not applied immediately the eyes are permanently damaged and the child is rendered blind for life. The extent to which this disease is prevalent in this country is shown by the statements made by well-known authorities that over one-third of the inmates of schools for the blind lost their sight as a result of this disease. On the other hand, it is no less certain that if this disease is brought under efficient treatment when the symptoms first make their appearance the eyes can be saved from serious injury and the sight preserved. Notification of this disease was made compulsory by an Order of the London County Council, and came into operation on March 13th, 1911. 76 Fifteen cases were notified during the year, and were visited by the Health Visitor. Eight of the cases were in the East Ward and five cases in the North Ward. Pemphigus Neonatorum. Several cases of this disease came to the knowledge of this department in September as occurring in the practice of one midwife. The Health Visitor was able to trace two cases, one in Zampa Road, and the other in Bolina Road. Owing to the action of the London County Council a further spread was checked. Spotted Fever. EPIDEMIC CEREBRO-SPINAL MENINGITIS. Posterior basal meningitis is included in the term "cerebrospinal fever," but does not include meningitis due to tuberculosis, syphilis, middle ear disease, and injury. The Local Government Board on the 1st March, 1911, approved an Order of the London County Council requiring the notification of cases of Cerebro-Spinal Fever (Epidemic Cerebro-Spinal Meningitis) for a further period of twelve calendar months from and including 13th March, 1911. No cases of this complaint have been notified in the borough, but we have received notifications from the County Council of cases occurring in other Metropolitan Boroughs. Chicken Pox. March to June, 1911. Number of Cases 157 Number of Deaths 1 Death rate per 1,000, Deptford 0.0l 77 On March 14th the London County Council made the above disease compulsorily notifiable for a period of three months from and including March 22nd, 1911. During this period 157 cases were notified in Deptford. One death was attributed to this cause, making a death rate of 0.01 Acute Polio-Myelitis or Polio-Encephalitis. This disease was made compulsorily notifiable by an Order of the London County Council, for a period extending from 1st September, 1911, to 12th March, 1912. One case was notified during the period under report. This case was visited by the Health Visitor, and is referred to in the portion of my report dealing with her work. Plague. No case of plague occurred during the year. At the end of the year 1910 the Local Government Board issued an order relating to the Prevention of Epidemic Diseases —Regulations as to Plague—Destruction of Rats—Articles I., II., III. and IV. are as follows :— Article I. The expression "Local Authority" means the Common Council of the City of London, the Council of each Metropolitan Borough, the Council of each Municipal Borough or other Urban District, the Council of each Rural District and each Port Sanitary Authority. Article II.—In any district in which a representation is made to the Local Authority that rats in the district are infected or threatened with plague, or that there is an unusual mortality among rats in the district, the Local Authority shall report the matter to us, and shall take 78 measures (a) for the destruction of all rats in the district; and (6) for preventing the entrance of rats into buildings and other premises in the district. Article III.—For the purposes of these regulations the Local Authority may appoint such additional officers or servants as they may deem necessary and may delegate to such officers or servants any powers under these regulations. Article IV.—The expenses incurred by a Local Authority in the execution of these regulations shall be defrayed in the case of a Local Authority which is a Sanitary Authority for the execution of the Public Health (London) Act, 1891, as part of their expenses in the execution of that Act, and in the case of any other Local Authority as part of their general expenses in the execution of the Public Health Acts. The Medical Officer of the Local Government Board prepared a Memorandum on Plague, and recommended precautions against rats, the most important of which are as follows :— 1st. Persistently and systematically destroy all rats. 2nd. Remove and obliterate their nests, burrows and habitual haunts. 3rd. Make each dwelling as far as practicable rat-proof, and remove all known harbourage for rats in or near dwellings. 4th. At the same time do not allow waste of food (whether for human beings, chickens or other animals) to accumulate in or about the house. 79 Anthrax, Glanders and Hydrophobia in Man. No cases where notified of the above diseases during the year. Continued and Typhus Fever. Four cases of continued fever were notified during the year. We have had no case of typhus fever since 1903, when we had one case, and in 1901 we had three cases. Diarrhœa and Enteritis. 1911 Average of previous 10 years. Number of Deaths 188 76 Death rate per 1,000 (all ages) 1.72 0.72 Death rate per 1,000 (under 2 years of age) 1.57 — Under this heading are included deaths registered as due to epidemic diarrhoea, epidemic enteritis, infective enteritis, zymotic enteritis, summer diarrhœa, dysentery and dysenteric diarrhœa, choleraic diarrhoea, cholera (other than Asiatic or epidemic) and cholera nostras. Under the heading of "Enteritis" are included deaths registered as due to enteritis, muco-enteritis, gastro-enteritis, gastric catarrh, and gastro-intestinal catarrh. Gastritis is a separate disease. These diseases were the cause of 188 deaths during 1911. Of this number 178 were of children under five years of age, 143 of these being under one year of age. The death rate was 1.72 per 1,000 at all ages, and 1.57 for infants under two years of age. 80 Previous statistics do not give an accurate comparison with previous years, because the heading of Diarrhœa did not include the names mentioned above, but simply cases registered as epidemic or summer diarrhœa, or epidemic, zymotic or infective enteritis. It is usual now to consider the infantile mortality in this case as being for all children under two years of age. The deaths from this disease occurred among the inhabitants of the various Wards as follows:— East 82. North 43. North-West 26. South 5. South-East 16. South-West 16. The following table shows the periods of the year and the ocalities in which deaths from Diarrhœa and Enteritis occurred n children under two years of age, together with particulars as to sex. WARDS. March. QUARTERS. YEAR. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total. East 1 — 2 2 38 21 9 3 50 26 76 North — 1 — 1 16 13 3 5 19 20 39 North-West 1 — — — 12 11 — 1 13 12 25 South — — — — 4 1 — — 4 1 5 South-East — — — — 8 6 — — 8 6 14 South-West — — — — 9 3 1 — 10 3 13 Total 2 1 2 3 87 55 13 9 104 68 172 The following accompanying Chart shows the seasonal distribution of Diarrhœal Deaths during the summers of 1910 and 1911, and their relation to the temperature of the ground as indicated by the 4-ft. thermometer. 81 The mean annual death rate per 1,000 from diarrhœal diseases in Deptford for the past ten years was as follows:— 1902 0.67 1907 0.18 1903 0.64 1908 0.70 1904 0.98 1909 0.39 1905 0.73 1910 0.68 1906 1.26 1911 1.57 These figures must be taken with a certain amount of reservation for the reasons stated before. The chart illustrates the fact that dry hot weather is necessary for fatal diarrhœa to become prevalent. In August the number of deaths reached 74, whilst in September, the next hottest month, there were also 74 deaths. In the first week of October there were 7 deaths, but later in the month the weather became colder and there was a corresponding check in the diarrhœal mortality. On the whole, therefore, we may say that dry hot weather is requisite for fatal diarrhœa. Why meteorological conditions produce such serious results cannot altogether be explained. It may be that a hot summer lowers the resistance of infants and renders them more liable to the disease. Again, it may be that hot weather increases the number of domestic flies and consequently the risk of contamination of milk and other infant foods. I am inclined to the opinion that summer diarrhœa is due to organisms derived from human or animal filth, and that the prevalence of the complaint during hot summers is due, first to the amount of dust prevalent during a dry summer, and secondly to the opportunity afforded by high temperatures for the growth of infecting organisms in milk and other infant foods. Hand-fed infants are specially liable to fatal attacks for two reasons, first because they run more risk of infective material being introduced with their food, and secondly because hand-feeding, unless conducted with the greatest circumspection, and with F 82 the most careful adaption to the digestive capacity of the individual child, is apt to induce intestinal catarrh or other digestive disturbances, which render the bottle-fed babies unduly susceptible to diarrhceal disease. Measles. 1911 Average for previous 10 years. Number of Deaths 67 56 Death rate per 1,000, Deptford 0.61 0.48 The number of cases of Measles dealt with during the year was 664, as compared with the previous three years as follows:— Cases. Deaths. 1910 1,114 60 1909 467 66 1908 850 33 As the disease is not notifiable under the Public Health (London Act), 1891, the above figures do not represent the total number of cases which have occurred in the borough, as our only sources of information are the Divisional Superintendent of the London County Council Schools and voluntary notification by parents. The same procedure is adopted in the case of Measles with regard to disinfection as if it were notifiable. The rate of mortality was 0.61, compared with a rate of 0.50 for 1910, 0.55 for 1909 and 0.28 for 1908. The deaths occurred among the inhabitants of the various wards as follows:— East 37 North 6 North-West 10 South 1 South-West 2 South-West 11 F 2 83 The rate of mortality for England and Wales was 0.4 for the 77 great towns 0'5, for the 136 smaller towns 0.4 and for the Metropolis as a whole 0'6. The following table shows the periods of the year and the localities in which deaths from Measles occurred, the sex and ages at death. WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M F M F M F M F M F Total. East — — l — — — 16 20 17 20 37 North — — — — — — 6 — 6 — 6 North-West l 4 3 1 — — 1 — 5 5 10 South — — — — — 1 — 1 — 1 South-East — — 1 — — — — 1 1 1 2 South-West 2 3 3 2 — — — 1 5 6 11 Total 3 7 8 3 — — 24 22 35 32 67 AGES AT DEATH. Under I 1-2 2-5 5-15 15-25 25-45 45-65 65 & upwards All Ages. 10 34 18 5 — — — — 67 Schools. The following list shows the action taken during the year for the prevention of the spread of infectious disease in various schools in the Borough. With the exception of one school they were all closed for measles. 84 School. Action Taken. Disease. Ravensbourne All unprotected children under 5 Measles (late St.John's) years of age excluded from January 26th to February 17th. Childeric Road All unprotected children under 5 Measles years of age excluded from March 20th to April 4th. Hatcham, C.E. All unprotected children under 5 Measles years of age excluded from March 17th to March 31st. Clifton Hill All unprotected children excluded Measles from Class-room E (Infants' Department) from March 14th to March 24th. Kender Street. All unprotected children under 5 Measles years of age excluded from April 6th to Easter Holidays. Mantle Road All children suffering from sore Diphtheria throat excluded until certified free from infection. Canterbury Road All unprotected children from Measles Class-room A (Infants' Department) excluded from May 8th to May 12th. Monson Road All unprotected children from Measles Class-room A (Infants' Department) excluded from June 6th to June 9th. Stanley Street. All unprotected children under 5 Measles years of age excluded from June 14th to June 30th. 85 School. Action Taken. Disease. Frankham Street All unprotected children under 5 Measles years of age excluded from October 2nd to October 20th. Deptford, R.C. All unprotected children from Measles Class-rooms E & G excluded from October 9th to October 27th. Alverton Street All unprotected children from Measles Class-room C excluded on October 23rd and 24th. Monson Road All unprotected children from Measles Class-room A excluded from October 19th to October 24th. Nynehead Street All unprotected children under 5 Measles years of age excluded from Infants' Department from November 2nd to 6th. Waller Road All unprotected children under 5 Measles years of age excluded from Infants' Department from October 31st to November 10th. Clifton Hill All unprotected children excluded Measles from Class-room E of Infants' Department from November 6th to 10th. Creek Road All unprotected children under 5 Measles years of age excluded from Infants' Department from November 6th to 24th. Ravensbourne All unprotected children under 5 Measles years of age excluded from Infants' Department from November 3rd to 24th. 86 School. Action Taken. Disease. Ravensbourne Previous exclusion extended to December 8th. Do Previous exclusion extended to Christmas Holidays. Alverton Street All unprotected children under 5 Measles years of age excluded from Class-room F (Infants' Department) from November 15th to 21st. Waller Road All unprotected children under 5 Measles years of age excluded from Infants' Department from November 11th to 20th. Nynehead Road All unprotected children excluded Measles from Class-room A (Infants' Department) from November 8th to 24th. Childeric Road All unprotected children under 5 Measles years of age excluded from Infants' Department from November 24th to December 8th. Do Previous exclusion extended to Christmas Holidays. Clifton Hill All unprotected children under 5 Measles years of age from the Infants' Department from November 23rd to December 8th. Do Previous exclusion extended to Christmas Holidays. St. Josephs All unprotected children excluded Measles from Class-rooms F and G (Infants' Department). 87 Whooping Cough. Average for 1911. previous 10 years. Number of Deaths 35 41 Death rate per 1000, Deptford 0.32 0.36 This disease was the cause of 35 deaths compared with 44, 47 and 25 for the three preceding years. The death rate per 1000 persons living was 0.32 as compared with 0.37, 0.40 and 0.21 for the three preceding years. The deaths occurred among the inhabitants of the various Wards as follows:— East 6. North 11. North-West 15. South-East 1. South-West 2. South 0. The following table shows the periods of the year and the localities in which deaths from Whooping Cough occurred, the sex and ages at death. WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M, F. M. F. Total. East — — — — 3 1 — 2 3 3 6 North 3 2 3 2 1 — — — 7 4 11 North-West 2 3 2 4 — 2 1 1 5 10 15 South — — — — — — — — — — — South-East — — — 1 — — — — — 1 1 South-West — 2 — — — — — — — 2 2 Total 5 7 5 7 4 3 1 3 15 20 35 AGES AT DEATH. Under l 1-2 2-5 5-15 15-25 25-45 45-65 65 & upward All Ages. 16 9 7 3 — — — — 35 88 The following is a comparative table showing the number of deaths from measles and whooping cough during each of the past ten years:— Deaths from 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 Total Measles 58 72 73 16 71 55 33 66 60 67 571 Whooping Cough 36 47 49 18 61 35 25 47 44 35 397 I submit a table for the past ten years to show the number of deaths from measles and whooping cough below five years of age, as compared with those occurring over that age :- Disease Age 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 Total Measles Under 5 years 51 64 69 15 64 51 32 60 50 62 518 Over 5 years 7 8 4 1 7 4 1 6 10 5 63 Total 58 72 73 16 71 55 33 66 60 67 571 Whooping Cough Under 5 years 35 45 46 18 59 34 24 45 42 34 382 Over 5 years 1 2 3 — 2 1 1 2 2 1 15 Total 36 47 49 18 61 35 25 47 44 35 397 Pulmonary Tuberculosis. Number of cases notified, 1911. Under the Tuberculosis Regulations, 1908 180 „ (in Hospitals) Regulations, 1911 155 Total 335 Number of deaths 144 Death-rate per 1,000 (Deptford) 1.31 89 Phthisis was the cause of 144 deaths during 1911, compared with 151 deaths in 1910. The death-rate was 1.31 per 1,000 persons, compared with 1.26, 1.40 and 1.30 for the three preceding years. In the following table will be seen the number of cases notified, the number of deaths and the death rate in each Ward:— Wards. Fresh Patients notified during the Year. Deaths Death-rate per 1.000. Estimated Population to middle of year. Poor Law. Hospitals Totals. East 71 43 114 34 1.53 22,272 North 59 36 95 37 1.49 24,759 North-west 17 37 54 32 1.34 23,835 South 2 6 8 9 0.73 12,268 South-east 22 16 38 17 1.41 12,051 South-west 9 17 26 14 0.98 14,290 Whole borough 180 155 335 143 1.31 109,475 The compulsory notification of Pulmonary Phthisis has been progressive, and has come about in the following stages. In 1909, the Public Health (Tuberculosis) Regulations, came into operation. They require cases of pulmonary tuberculosis coming under the notice of the following Poor Law Officers in the discharge of their respective duties to be notified within 48 hours to the Medical Officer of Health:— 90 1. Medical Officer of Poor Law Institutions to notify cases occurring in their Institutions to the Medical Officers of Health of the district in which the sufferer resided previous to admission to the Institution. (Notification Form A.) 2. District Medical Officers to report cases occurring among persons visited by them under their agreement with the Guardians. (Notification Form B.) 3. Superintendent Officers of Poor Law Institutions to notify intended place of residence of persons leaving the Institution who have been certified by the Medical Officer thereof to be suffering from pulmonary tuberculosis. (Notification Form C.) 4. Relieving Officers to notify change of residence of persons who have been reported by District Medical Officers to be suffering from pulmonary tuberculosis. (Notification Form D.) On March 22nd, 1911, the Local Government Board issued the Public Health (Tuberculosis in Hospitals) Regulations, 1911, which came into operation on May 1st. Under these regulations notifications are received of all phthisical patients attending hospitals, dispensaries, or similar institutions. Finally we have at the end of 1911 an order of the Local Government Board—called "The Public Health (Tuberculosis Regulations), 1911," under which all other cases of pulmonary phthisis must be notified. This order came into force on the 1st January, 1912, and the Board advised that the arrangements which were necessary to facilitate the execution of the order should be made as soon as possible. 91 These latter regulations complete the system of notification which was inaugurated in 1908, and relate to cases in Poor Law practice, and afterwards increased by the Public Health (Tuberculosis in Hospitals) Regulations, 1911. They make it the duty of every Medical Practitioner, with certain exceptions, to notify every case of Pulmonary Tuberculosis either in his public or private practice. For each case notified the medical man is entitled to a fee of 2s. 6d. OBJECT OF NOTIFICATION. That the Council may assist in the eradication of this disease, being enabled to take action in individual cases with a view to preventing the spread of infection and removing conditions favourable to infection. FINANCE. To assist this organised scheme, the Finance and National Insurance Bill makes provision for the sanatorium treatment of insured persons, and in some cases to dependents of the insured. DUTIES OF THE MEDICAL OFFICER OF HEALTH. 1. To transmit to the proper authorities all notifications addressed to him in error, and to inform the notifying practitioner that he has done so. 2. To keep a register of all cases notified, and to enter therein the name and address, age, sex, date of notification, medical man, and the action taken by the Medical Officer of Health in regard to each patient. 3. To keep a separate record of the probable factors concerned in producing the disease, existence of disease in persons 92 in contact, action taken to obviate infection, to remove insanitary conditions, and to aid the patient himself or any additional persons who may be discovered to be suffering with the disease. From the foregoing it will be apparent that the duties of your Medical Officer are greatly increased, and it will also be apparent that some scheme is necessary for providing for the systematic seeking out and following up of each patient's case, together with the necessary medical supervision and treatment. The home conditions must receive attention, disinfection carried out when necessary, and the members of the patient's family examined so that the disease may be detected in an early stage. Under such a scheme there must be a skilled staff to see sufferers, not only at a central office but visit them at their homes, who will carefully examine, treat, and record each case. At least one trained nurse must be employed to see that the Medical Officer's instructions are carried out thoroughly. On December 4th, 1911, your Medical Officer presented the following Report to the Committee. The compulsory notification of Phthisis will bring to the knowledge of your Medical Officer of Health, the cases of Phthisis occurring in that class of the community who most need his services ; but I have to remind the Committee that they are very imperfectly provided with the opportunities which are needed for utilizing the knowledge thus gained. Notification, without the ability to ameliorate the condition of the sufferer is not calculated to effect the main object in view. 93 It appears to me to be hopeless to expect any material benefit from the order when the sufferer is compelled to live with others in one or two rooms, and the advice to sleep alone is a counsel of perfection very rarely capable of being followed. It seems desirable that my Committee should express their views very strongly that they consider it advisable that a sanatorium should be established under the direct control of the Metropolitan Asylums Board, the institution to be maintained by a charge upon the Metropolitan Boroughs according to their rateable values. A conference to representatives from the City Corporation and the Metropolitan Boroughs was held earlier in the year to consider the whole question and the conference expressed the opinion that the establishment of Tuberculosis Dispensaries in each Borough was a desirable adjunct for the treatment of Phthisis, thus endorsing the view expressed by Sir Shirley Murphy in his last annual report. The preventative measures undertaken by such an institution are detailed in the report on the value of a Tuberculosis Dispensary (see page 95). POWERS AND DUTIES OF COUNCILS. Special powers are given to the Borough Council by Article IX (1). Special Powers of Councils. Article IX.—(l) For the purposes of these Regulations and of the Poor Law Regulations and of the Hospital Regulations a Council, on the advice of their Medical Officer of Health, may supply all such medical or other assistance, and all such facilities and articles as may reasonably be required for the detection of Pulmonary Tuberculosis, and for preventing the spread of infection 94 and for removing conditions favourable to infection, and for that purpose may appoint such officers, do such acts and make such arrangements as may be necessary. Provided that nothing in this sub-division shall be deemed to authorise a Council to take any of the measures herein mentioned at any Poor Law Institution or any Hospital. (2) A Council, on the advice of their Medical Officer of Health, may provide and publish or distribute in the form of placards, handbills, or leaflets, suitable summaries of information and instruction respecting Pulmonary Tuberculosis, and the precautions to be taken against the spread of infection from that disease. From the above it is apparent to your Medical Officer that the Local Government Board have not taken this step for the mere pleasure of providing him with innumerable statistics or of filling his office with unlimited tables, but if I read the signs of the times aright we are close to the opening of a new era when perhaps loftier conceptions of civic patriotisim may prevail, and Borough Councils will awaken to their responsibilities concerning consumption. Citizens of various London Boroughs have already awakened to the fact that consumption is an infective disease and must be fought as all other infectious diseases must be fought, but the time has now arrived when we should not leave the hygiene of the homes of the people and the treatment of this infectious disease to the laity, who have to undertake these problems of health and sanitary science and undertake the work which we as a corporate body shirk. Phithisis alone caused 144 deaths last year ; this does not include deaths from other Tuberculous Diseases. 95 It is a singular coincidence that the eleven infectious diseases added together caused exactly the same number of deaths—144. We go to enormous expense in providing institutional care for small pox, scarlet fever, enteric fever, measles, diphtheria, cerebro-spinal fever, typhus fever, and yet we have hitherto done nothing for consumption, which is as fatal as them all put together and three or four other infectious deseases besides. Such an argument should appeal to those in favour of leaving the matter in the hands of a committee of amateurs to deal with. The National Insurance Act deals also with consumption, and the Health Committees attached to it have many powers to compel us to deal with the health matters of the district. After several meetings of the Public Health Committee on the subject of prov iding a municipal Institution for Consumption, a sub-committee was formed to visit similar institutions in the Metropolitan area. In addition to which your Medical Officer obtained particulars from many other Tuberculosis Dispensaries in various parts of the provinces. Late in the year the Sub-Committee presented their report as follows:— REPORT UPON THE VALUE OF A TUBERCULOUS DISPENSARY. We beg to report that, acting upon your instructions, we have visited the Dispensaries now in full working order in the Metropolitan area. We find that eight of the Boroughs have these institutions at the present time, whilst practically the whole of the others have the matter under consideration. After careful enquiry into the working of these establishments, we have come to the following definite conclusions:— 96 1. That a Tuberculosis Dispensary is a very sincere effort to deal with Consumption in the best manner known to medical science and modern reasoning. 2. That there is great scope for such an institution in Deptford. 3. That it is to the best interests of the Borough that we should have an institution of our own. 4. That, in view of the new Tuberculosis Order, 1912, making the notification of all cases of Pulmonary Tuberculosis compulsory, and a recent Order of the Local Government Board authorising Municipal Dispensaries, it is advisable that this Council should provide its own Dispensary, especially as your Medical Officer of Health may be prohibited from divulging the names of persons suffering from this complaint to any voluntary agency. In arriving at our conclusions, we have taken into consideration the fact that Dispensaries are not a new or untried undertaking, inasmuch as they have been instituted in Great Britain as long ago as 1887. Since that time there has been a marked falling off in the mortality from consumption in every town engaged in this kind of treatment. Now this method of attacking consumption has become a world-wide movement, for not only is this system carried on in many of the countries of Europe, but in America, with beneficial results. By the Dispensary System we can place treatment within the reach of every consumptive, and its final claim is the total eradication of the disease during the present century. Such an outlook places it in the first rank of social and philanthropic efforts. 97 This disease is preventable and curable, and yet it causes 50,000. deaths every year, and three times this number are disabled by it. Further, it is estimated that the charge to the State in England and Wales, in relieving the distress directly caused by consumption, is at present one million sterling. "If preventable, the reasons, why it has not hitherto been prevented, are :— Firstly, because in the past it has not been recognised that the disease is due to a minute germ called the tubercle bacillus, and that it is an extremely difficult thing to recognise consumption in the early stages, and only in the last few years has a method been devised for distinguishing the complaint at an early period. A very important reason why the disease was not recognised was because the patient did not go to a medical man as a rule until he was past cure, and because the onset of the disease was so insidious that the patient did not feel his need for advice. In the future it is proposed that all doubtful cases of consumption and all persons in contact in the home shall be examined and, if necessary, treated. Secondly, the disease could not be dealt with efficiently in the past, even after it had been recognised, there being only room for a very small number of patients in sanatoria. Supposing we could afford the enormous cost of providing sanatorium treatment for every consumptive, only a certain proportion would be suitable, and only a proportion could leave their homes, families and employment to go to these institutions, since in many cases such action would mean ruin both to the patient and his family. By means of the Dispensary we could avoid sanatorium treatment in many cases too advanced for such treatment to be of lasting value, and we could educate these patients so that they would not prove a danger to the community. G 98 Thirdly, the great majority of the early cases can be cured in their own homes without interfering with their work, so that there is only a residuum who require sanatorium treatment. By means of the Dispensary system we are much better able to follow up the cases included in the latter category, and make their home conditions more satisfactory and the workshop more healthy. THE GENERAL SCHEME. The idea is to have a central building as a clearing house which we call the Dispensary, acting in close conjunction with the Medical Officer of Health. At this centre all cases are received, and either come voluntarily or are sent by the Medical Officer of Health, medical practitioners or institutions. A diagnosis of consumption having been made, the patient is either treated at the Dispensary or at home, and afterwards, if necessary, sent to some sanatorium, or to a home for advanced cases, or to the infirmary. The buildings used for Dispensaries are usually houses which have been rendered suitable for the purpose. Perhaps the old milk depot at Woolwich has been transformed into one of the most ideal of the London Dispensaries on account of its glazed brick walls with rounded corners to admit of easy cle.ining, and floors of granolithic paving. In addition, the whole suite of rooms is on the ground floor, with separate exits and entrances. We believe that the smallest number of rooms possible for the convenient working of a Dispensary is one large waiting room, two small dressing rooms, nurses' room, consulting room, laboratory, dispenser's room and the usual offices. G 2 99 If the Council favourably receives our report, it will be necessary either to adapt an existing house, or erect a suitable building where all not already under medical care may go for treatment free of charge. In either case we shall reap the benefit of the experience of those pioneer institutions it has been our privilege to visit. Briefly, the most important measures carried out by the Dispensaries are :— 1. The visiting of consumptives in their homes for the purpose of instructing them as to the best means to be there adopted both for their own health and for the prevention of the spread of infection to other inmates. 2. The treatment at home of such cases as are unfitted to receive treatment at the Dispensary. 3. The treatment by Tuberculin. 4. The provision of outdoor shelters to be lent in certain suitable cases. 5. The searching out of contact and early cases of disease with a view to securing for them treatment before the disease has become advanced. 6. The formation of an open air school. 7. The removal to hospital of cases in need of complete rest and better food than they could otherwise obtain. 8. The bacteriological examination of the sputum of the patients of medical practitioners. 9. The supply of pocket sputum flasks or boxes, and the distribution of literature for the guidance of consumptives. 100 10. The organisation of voluntary helpers who would assist certain special cases who may need extra food, extra clothing, or other help; they also endeavour to keep the family going for a short period if the breadwinner is removed to hospital for a few weeks' treatment. We present a table of the chief points in connection with the Dispensaries we have visited, the cost of working in each case, with the exception of Paddington, being about £700 for the first year and £300 initial expenses. The first named sum may increase if the work grows to such an extent as to render an increase in the staff necessary :— THE TREATMENT. (Including Tuberculin Treatment.) The usual method of dealing with persons for treatment is as follows:— The patient is first examined by the Medical Officer and a record taken of his history, physical signs, weight, general condition, &c. He is then given a clinical thermometer (costing 8½d.) and instructed how to take his temperature, and a card is given him on which he is to record his temperature every four hours for four days. He is then told to come back to the Dispensary at a fixed time, and to bring his temperature card record with him. The day following his first appearance he is visited by the Nurse or Health Visitor who sees that he understands taking his temperature correctly. This gives her an opportunity of seeing the home conditions and giving him advice and literature on the subject of home hygiene, the necessity of the open window, the care of the sputum, &c. 101 When he comes to the Dispensary it is clear either from his physical signs or from the presence of tubercle bacilli in the sputum that he is suffering from pulmonary tuberculosis. If he is not suffering from this complaint he is not accepted for treatment but is recommended elsewhere. If his temperature is not above 100° and it is a suitable case, tuberculin treatment may be started, but if the temperature is over 100° he is made to rest in bed for a few days, and is visited by the Medical Officer, and then later the tuberculin treatment may be started at home, if such a course is considered advisable. If when a new patient presents himself at the Dispensary no definite evidence of tuberculosis can be detected he is tested by one of the diagnostic tests by tuberculin now in general use, after which if a positive reaction takes place and the case is a suitable one, the curative treatment of the disease is commenced. Tuberculin is given as a curative agency in about one-third of the cases. Drugs are supplied to a greater or lesser extent in all the Dispensaries, for the gift of a bottle of medicine is always a necessary adjunct to any medical institution. Nourishment in the form of cod liver oil and maltine is rather freely supplied at all the Dispensaries. CONCLUSIONS. In our conversations with the medical staffs of the Dispensaries we have elicited the fact that what is looked upon as one of the most important features is the visiting of the homes of consumptives and getting hold of the contact and early cases, with a view to securing treatment for them whilst in that stage in which a cure can most readily be effected. 102 Great importance is also attached to having a few really good voluntary helpers, who will act as almoners, and be the means of providing certain cases with good food and helping in other ways. The value of good nourishing food must always be borne in mind. There often arises, in the course of a case of consumption, a period when the question as to whether the patient can have a few weeks rest and good food to build up his resisting powers, and the answer to this question will decide whether or not he will be able to throw off the disease. Many of the patients in Deptford will be found in this category. In Deptford, during 1909, we received 538 notifications of phthisis relating to 172 cases. In 1910 we had 209 notifications relating to 96 cases, and during 1911 we have had 507 notifications relating to 335 cases. Under the system of compulsory notification during 1912 we may expect to receive about 1,200 notifications. It is encouraging however to note that since tuberculosis has become notifiable in poor law institutions and hospitals the death rate has already decreased in the Borough, but it is still higher than the rate for the whole of London and for England and Wales. Finally, it is generally recognized that the work in each Dispensary is proceeding satisfactorily, although there is an indication that sometimes the work is hampered by having a voluntary Committee. From what we know of public affairs, and from what we have seen concerning the institutions we have visited, we have arrived at the conclusion that the Public Health of Deptford will be better served by the Council undertaking this valuable work, and building or renting a suitable house and providing it with the necessary fittings and appliances. As regards staff, we believe that a more experienced and zealous medical man will be obtained by attaching him to the Health Department as an 103 Assistant Medical Officer of Health and Medical Officer to the Municipal institution for Tuberculosis. Your Medical Officer of Health should act as Superintendent of the institution in order to keep the work in close touch with the Health Department, and in order to be able to present every matter concerning it and its requirements to the Council. A whole time nurse must be appointed, with special knowledge of the treatment of phthisis. It will also be necessary to appoint a caretaker and wife, the duty of the former being to act as porter, in addition to his other duties. Phthisis. In the following table will be seen the number of cases notified during each of the four quarters, and the ages and sex of the patients. WARDS. QUARTERS. YEAR.  March. June. Sept. Dec. M. F. M. F. M. F. M. F. East 8 7 18 16 22 14 12 17 60 54 114 North 14 10 21 16 10 7 12 5 57 38 95 North-West 1 .. 11 6 9 9 10 8 31 23 54 South .. 1 1 2 2 .. 2 .. 5 3 8 South-East 3 .. 9 2 8 2 11 3 31 7 38 South-West .. 3 5 4 6 4 1 3 12 14 26 Total 26 21 65 46 57 36 48 36 196 139 335 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages. 1 14 46 49 143 72 10 335 104 General Tuberculosis. Forty-live deaths were recorded as being due to these diseases. Of these deaths 7 occurred in the East Ward, 10 in the North, 8 in the North-West, 4 in the South, 5 in the SouthEast, and 11 in the South-West. Twenty-three deaths were classified as tuberculous meningitis and 22 to other tuberculous diseases. The following gives the ages at which death occurred :— Cause. Under 1 1 to 2 2 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards.  Tubercular Meningitis 6 1 8 6 1 l — — Other Tubercular Diseases 6 1 2 3 3 5 l l Human and Animal Tuberculosis. The Royal Commission appointed to inquire into the relations of human and animal tuberculosis has now issued its final report. The Commission has had the opportunity of comparing tuberculosis caused by the mammalian bacillus with tuberculosis caused by the avian bacillus, and has arrived at the following conclusions:— 1. Comparing mammalian tubercle bacilli of known human origin with mammalian tubercle bacilli of known origin from spontaneous disease in other animals, it is found that in every instance the bacilli of origin from 105 animals other than man are identical culturally, microscopically, and in their effects upon the tissues of experimental animals, with bacilli from certain cases of tuberculosis in the human subject. 2. Referring to the anatomical origins of the human viruses which have been investigated, attention is called to the fact that in all parts of the human body, and in human sputum, collected with due precautions to avoid contamination through food, tubercle bacilli have been found which culturally and in histological effects are identical in every respect with the tubercle bacillus commonly present in the bodies of tuberculous cattle and swine. 3. It is found that many of the viruses of human origin grow with greater cultural luxuriance and produce less histological damage in the organs of certain experimental animals than the bacilli commonly obtain.ed from cattle and swine. 4. In the majority of cases the examinations of the cultures and the animal tissues which have been received at different stages during a protracted series of experiments with the same virus have shown that the original characteristics of the virus were remarkably stable. 5. Hence, to such extent as it may be supposed that such series of experiments are comparable to what takes place in a human body infected with tubercle bacilli, the result supports the view that changes in the characteristics of a virus do not readily or rapidly take place in the human body. 6. But there have been examined in addition certain other viruses which in respect of the details reported on, hold an intermediate position between the viruses usually obtained from human sources, and those of common animal origin. 106 7. Owing to the existence of these intermediate viruses, it is found impossible to class all the strains of mammalian tubercle bacilli which have been investigated as belonging to one of two stable types. 8. Another significant feature of these intermediate viruses is that they serve to bridge the apparent gap between the viruses, on the one hand, which produce acute tissue destruction in the bovine and rabbit, and are of relatively scanty growth on culture media, and those viruses on the other hand, which produce less tissue damage in the bovine and rabbit and grow more luxuriantly on artificial media. A UNITY OF CHARACTERISTICS. 9. It is found that underlyingall the mammalian viruses which have been investigated there is an essential unity of characteristics, the differences observed being differences of degree, but not of kind. On artificial culture media they all grow in the same way, though they differ quantitatively in the amount of growth yielded. In the tissues of suitable experimental animals they all produce lesions histologically characteristic of mammalian tuberculosis, though they differ in the intensity of the tissue changes which they set up under similar experimental conditions. 10. Comparing the mammalian with the avian viruses, it is found that there are differences not merely of degree but of kind. 11. On appropriate culture media the growth of the avian bacillus can be distinguished without hesitation from the growth of the mammalian bacillus. 12. Comparing the results of similar experiments performed under suitable conditions upon suitable animals, 107 it is found that microscopic examination of the tissues unmistakably distinguishes infections due to avian bacilli from infections due to mammalian bacilli. 13. It is, however, not possible in the tissues of all animals under all experimental conditions, to distinguish with certainty under the microscope, lesions due to avian bacilli from lesions due to mammalian bacilli. It is sometimes found that in the tissues of mammals the avian bacillus produces tubercles of a chronic type which are indistinguishable from tubercles produced by mammalian bacilli. Respiratory Diseases. Under this heading are included bronchitis, pneumonia, pleurisy, and other diseases of the respiratory organs. The number of deaths registered was 326. Of these deaths 62 were children under one year of age, 62 over one and under live years, and 82 were persons over 65 years of age. Bronchitis was most severe near the river in the East and North Wards. Broncho-pneumonia, pneumonia of all forms were also more severe in these two wards and accounted for more deaths than any of the other wards. Influenza. This disease, which is an infectious one, accounted for 13 deaths during the year. Eleven of the deaths occurred between the ages of 25 and 65, and the North Ward accounted for six of the deaths. 108 Constitutional Diseases. These diseases form a group which are only second in importance to those known as the epidemic diseases. They include rheumatic fever, rheumatism, rickets, diabetes, gout, anæmia, and above all, tuberculosis, whether of the lungs or any part of the body. During the year they caused 904 deaths. CANCER AND MALIGNANT DISEASES. One hundred and twenty-two deaths from cancer and malignant diseases were recorded during the year. They were equal to a death rate of 11.1 per 10,000 of the population, which is 1.2 in excess of the rate recorded in the preceding year, while the actual number of deaths were 13 in excess of the same year. When comparison is made with the mean return for the preceding 10 years, it is found that they are 34 in excess. This group of diseases continues to show an uninterrupted increase, and, indeed, an examination of the figures proves that whereas there were only 482 deaths in the five years 1902 to 1906, there were 516 in the years 1907-1911, or an increase of nearly 7 per cent. This indeed is a matter of the utmost moment, and it is therefore no wonder that we hear of cancer research funds and endowments of special institutions for inquiry into the cause of this disease. 109 DEATHS FROM CANCER DURING 1911. PART AFFECTED All Ages 1-5 5-15 15-25 25-30 30-35 35-40 40-45 45-50 50-55 55-60 60-65 65-70 70-75 75 and upward M F Total. M F M F M F M F M F M F M F M F M F M F M F M F M F M F Stomach 5 3 8 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 2 .. 1 .. .. .. 2 .. .. .. .. 1 .. 1 Bowels, Intestines, &c. 8 8 16 .. .. .. .. .. 1 1 .. .. .. 1 .. .. .. 1 .. .. .. 2 *• .. 2 .. .. .. 4 .. 1 Rectum 6 7 13 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 2 1 .. 1 1 2 1 .. 1 .. 2 Female Generative Organs .. 14 14 .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 2 .. 2 •• .. 3 .. 1 .. 2 .. 1 Breast .. 13 13 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 .. l .. 2 .. .. .. 2 .. 5 Mouth, Neck, Tongue and 8 4 12 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 4 •• .. 2 3 1 1 .. .. .. Throat Bladder 3 2 5 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. 1 1 .. Kidney .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. Liver 5 9 14 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. 1 2 1 .. 3 1 .. .. 2 .. 2 Lung .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. Prostate Gland 2 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. i .. Pancreas 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Parotid 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. Pharynx Carcinoma ) 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. (part affected not stated) 6 7 13 .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 3 3 1 2 1 1 .. .. Sarcoma 2 5 7 1 .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 .. .. .. .. .. 1 48 74 122 1 .. .. .. .. 2 2 .. .. .. 2 3 2 3 5 4 3 8 9 3 7 17 13 7 2 14 2 13 110 OTHER NOTIFIABLE DISEASES. Ward. Small Pox. Chicken Pox. Erysipelas. Continued Fever. Puerperal Fever. Acute Polio Myelitis. Ophthalmia Neonatorum. Total. M F M F M F M F M F M F M F M F Total. East ... ... 18 21 29 25 ... 2 ... ... ... ... 5 3 52 51 103 North ... ... 10 6 29 23 ... ... ... i ... ... 1 4 40 34 74 North-West 1 ... 21 15 16 17 ... ... ... ... 1 ... ... ... 39 32 71 South ... ... 5 9 3 5 ... ... ... ... ... ... ... ... 8 14 22 South-East ... ... 18 22 9 7 ... 1 ... ... ... ... 1 ... 28 30 58 South-West ... ... 5 7 8 6 ... 1 ... l ... ... 1 ... 14 15 29 Total 1 ... 77 80 94 83 ... 4 ... 2 1 ... 8 7 181 176 357 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards All ages. 35 72 94 29 69 46 12 357 1ll Disinfection. The disinfection of infected clothing and bedding has been carried out at the new Disinfecting Station, Watson Street, by means of two machines of the Washington-Lyons pattern. The following shows the amount of disinfection carried out for the past three years :— 1911 5,886 articles of bedding, clothing, &c. 1910 5,193 1909 8,119 The number of rooms disinfected by the Council's staff during the year was 1,251. Disinfecting fluid is supplied gratis where required. For the removal of infected bedding, etc., and its return after disinfection an adequate staff is maintained. There are two vans employed, one used for collecting infected materials, and the other pure van for returning them after disinfection is completed. One man is employed for collection, and another for returning the sterilized materials. Cleansing and disinfection of 1,251 rooms in 1,121 houses in which infectious disease has occurred, has been carried out under the directions of your Medical Officer of Health. The infected rooms have been fumigated and when necessary the walls of the disinfected portion of the house have been stripped and the ceilings cleansed. With a view to further minimise the risk of spreading infection we have the power to destroy books belonging to a public library which come from infected houses. 112 Your Medical Officer now recommends that all books which are much worn and soiled should be destroyed. All books taken from houses in which smallpox has occurred should be destroyed. All books which have been used in the sick room, if there is a possibility, however remote, of their conveying infection, should be dealt with in the same way. With regard to volumes which, although taken from infected houses, have but a very remote likelihood of having retained infection, the following system of disinfection may be carried out. The book is placed on end and opened as far as can be, and is subjected to the vapour of formalin for three hours. This process, if necessary, can be repeated, and the books can be returned to the library none the worse for the operation with the exception of a smell of formalin, which passes off after a few days. The chamber we use for this kind of disinfection, and also for other small articles which would be injured by steam, as leather goods, furs, boots, etc., is a specially constructed, zinc lined chamber 6-ft. 11-in. by 4-ft. 4½-in. by 1-ft. 6-in., having a capacity of 45 cubic feet. An alformant lamp is used. The Medical Officer is unable to recall a single instance in which infection has been conveyed by books, notwithstanding that he has instituted inquiries in other districts of books taken from infected houses. The degree of exposure of books whilst in infected houses varies very widely, and it is not desirable to make any hard and fast rule as to how books from infected houses should be dealt with. There can be no question that the method which has stood the test of so many years in a number of great cities, such as Manchester, Bradford, Leeds, Glasgow and Edinburgh, 113 may be relied upon, whilst it is interesting to note that in America there is a growing tendency to attach relatively small importance to the role played by books in the dissemination of sickness. Table SHEWING THE NUMBER OF PREMISES, ROOMS AND BEDDING DISINFECTED DURING THE YEAR ENDING DECEMBER 30TH, 1911. 1911 Premises. Rooms. Beds. Pillows. Bolsters. Mattresses Sheets. Blankets. Odd Articles. Articles Destroyed. January 96 100 34 60 26 9 50 67 128 February 84 93 35 73 23 12 44 72 240 March 116 120 39 80 28 10 46 70 217 April 92 104 39 66 24 15 40 69 116 1 Mattress May 74 83 27 63 21 16 39 50 99 June 75 112 16 46 21 18 40 48 207 July 74 75 46 101 44 22 67 66 147 1 Bed, 2 mattresses. August 63 74 50 85 39 16 70 53 112 1 Mattress. September 82 93 56 103 36 17 67 59 143 1 Bed, 2 mattresses, 1 bolster, 1 odd article October 129 145 76 148 53 22 88 116 252 1 Bed, 2 palliasses, 1 mattress. N ovember 128 134 77 144 48 18 88 131 253 2 Beds, 1 mattress, 2 palliasses. December 108 118 45 110 35 16 52 97 175 1 Bed, 1 bolster, 1 sheet, 1 odd article. Total 1121 1251 540 1079 398 191 691 898 2089 h 114 Table SHEWING THE NUMBER OF ROOMS DISINFECTED AFTER THE FOLLOWING DISEASES. 1911 Small Pox. Scarlet Fever. Diphtheria. Enteric Fever. Membranous Croup. Erysipelas. Puerperal Fever. Measles. Pulmonary Tuberculosis Cancer. Scabies. Continued Fever. Chicken Pox. January •• 14 9 1 •• 1 •• 55 17 1 1 1 •• February 1 15 14 •• •• 1 •• 42 20 •• •• •• •• March •• 21 12 •• 1 1 •• 71 11 •• 1 April •• 17 10 •• •• 2 •• 41 11 4 •• •• 11 May •• 21 10 •• •• 2 •• 19 20 •• •• •• 9 June •• lb 10 •• •• 3 •• 18 7 2 •• •• 16 July •• 23 15 3 •• 4 •• 4 21 •• •• •• 3 August •• 30 13 •• •• 1 •• 1 22 1 •• •• •• September •• 46 12 3 •• 1 •• 9 17 1 •• •• •• October •• 78 14 1 •• 3 •• 22 14 •• •• •• •• November •• 58 18 1 •• 2 1 37 15 1 •• •• •• December •• 38 14 1 •• 2 1 45 17 •• •• •• •• Total 1 376 151 10 l 23 3 364 192 10 1 1 40 Table. SPECIAL CASES. January ist to December 30th, 1911. Jan. 3—New Cross Road. Blood poisoning. 3 pillows, 4 blankets, 3 odd articles disinfected. ,, 14—Waller Road. Cancer. 1 bed, 4 pillows, 1 bolster, 1 mattress, 1 odd article disinfected. ,, 20—Grove Street. Scabies. 1 bed, 1 bolster, 2 sheets, 2 blankets, 2 odd articles disinfected. Feb. 20—Tressillian Road. Cancer. 2 mattresses, 3 pillows, 1 bolster, 1 blanket, 13 odd articles disinfected. ,, 28—Alpha Road. Pneumonia. 3 beds, 1 bolster disinfected. March 7—Alpha Road Pneumonia. 1 bed disinfected. ,, 15—Brockley Road. Heart failure. 1 bed disinfected. April 8—Crescent Road. Cancer. 1 mattress, 1 pillow, 1 bolster, 9 odd articles disinfected. ,, 15—Giffin Street, Cancer. 1 bed, 1 bolster, 1 pillow, 2 sheets, 1 blanket, 1 odd article disinfected. h 2 115 April 19—Crescent Road. Cancer. 1 mattress, 3 pillows, 1 bolster, 5 odd articles disinfected. '29—Seymour Street. Cancer. 1 bed, 3 pillows, 1 bolster, 1 mattress, 2 blankets, 3 odd articles disinfected. ,, 29—Lewisham High Road. Bronchitis. 1 bed disinfected. May 30—Endwell Road. Blood poisoning. 1 bed disinfected. June 1—Tyrwhitt Road. Blood poisoning. 1 mattress, 1 pillow, 2 sheets, 3 blankets, 3 odd articles disinfected. ,, G—Pepys Road. Blood poisoning. 1 mattress, 1 bolster, 1 pillow, 8 sheets, 1 blanket, 16 odd articles disinfected. ,, 24—Jerningham Road. Dropsy. 2 sheets, 1 blanket, 2 mats destroyed. ,, 29—Waller Road. Cancer. 1 bed, 1 mattress destroyed. July 12—Shardeloes Road. Apoplexy. 1 bed, 1 mattress, 2 pillows, 3 blankets, 1 odd article disinfected. Aug. 21—Chubworthy Street. Cancer. 1 mattress, 2 pillows, 1 bolster, 3 sheets, 2 blankets, 1 odd article disinfected. ,, 30—Endwell Road. Senile Decay. 1 bed, 2 pillows, 1 odd article disinfected. Sept. 7—Ruddigore Road. Cancer. 1 bed, 3 pillows, 2 bolsters, 2 sheets, 3 odd articles disinfected. Oct. 6—Cranbrook Road. Cancer. 1 bed, 2 pillows, 2 bolsters, 1 sheet, 1 odd article disinfected. ,, 6—Park Road. Cancer. 1 bed, 1 mattress, 1 sheet disinfected. ,, 28—Napier Street. Bronchitis. 1 bed, 2 pillows destroyed. Nov 28—Shardeloes Road. Cancer. 1 bad, 5 pillows, 3 bolsters, 1 mattres, 2 blankets, 9 odd articles disinfected. Dec. 8—Wallbutton Road. Scabies. 1 bed, 1 pilllow, 1 bolster, 4 blankets, 1 mattress, 2 sheets, 1 odd article disinfected. MIDWIVES ACT. Disinfection of wearing apparel, etc., was carried out in 7 cases. BOOKS DISINFECTED. 92 books belonging to the Council's Public Library, collected from houses where infectious diseases had occurred, were disinfected before being put back into circulation. 116 VERMINOUS PREMISES. 26 premises consisting of 75 rooms were fumigated during the year. Table. Total number of Premises disinfected 1121 „ „ Rooms ,, 1251 ,, „ Beds ,, 540 ,, ,, Pillows ,, 1079 „ ,, Bolsters ,, 398 ,, ,, Mattresses „ 191 „ „ Sheets ,, 691 ,, „ Blankets ,, 898 „ „ Odd articles „ 2089 Total articles 5886 Total number of Beds destroyed 8 „ ,, Mattresses „ 14 ,, ,, Sheets „ 3 „ „ Blanket ,, 1 ,, ,, Bolsters ,, 2 ,, ,, Odd articles ,, 2 „ ,, Palliasses ,, 4 N.B. —The above articles were destroyed at the request of the owners. The Shelter. The Public Health (London) Act, 1891, Section 60, SubSection 4, imposes on the Sanitary Authority the duty of making provision for the temporary housing of persons who are compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected by the Sanitary Authority. The accommodation provided at the new premises in Watson Street consists of a detached building containing two separate and distinct tenements, each consisting of two bedrooms, kitchen, larder, bathroom, and w.c. The shelter was not used during the year. 117 Cleansing of Verminous Persons. Late in the year it came to the knowledge of your Medical Officer that the County Council had under consideration the question of the cleansing of school children infested with vermin, their Committee having provisionally agreed upon the general outline of the following scheme for the treatment of children throughout London :— 1. That the cleansing stations provided by the various Metropolitan Borough Councils should, as far as possible, be utilised by agreement with the Borough Councils. 2. That the treatment of children should be entirely dis- tinct from any establishment used for the isolation of suspected cases of infectious disease contacts. 3. That the exclusive use of the baths for the cleansing of children should be allowed on certain days. 4. That the cleansing station should be in a convenient position, and that the children should be efficiently supervised, with female attendance for the treatment of the girls. 5. That a uniform payment to the Borough Councils at the rate of 2s. per child, irrespective of the number of baths required before a child can be regarded as cleansed, should be arranged throughout London. 6. That this scheme be subject to the Borough Councils undertaking, where necessary, to deal with the homes for the children cleansed. Your Medical Officer considered that the upper flat of the shelter which is never used—and has a separate entrance, and is totally distinct from the lower flat, and has an entirely different entrance into the street without going into the disinfecting yard—might be used for the purpose. 118 In order to fully understand the position, it may be as well to give a short resume of the Acts of Parliament referring to the cleansing of verminous persons, and of the correspondence with the London County Council. The Cleansing of Persons Act, 1897, empowered Local Authorities to expend any reasonable sum on buildings, appliances and attendants for the purpose of the proper cleansing of persons infested with vermin. The Local Authority had the power to permit such person to have the use free of charge of the apparatus which the authority possesses, for cleansing the person and his clothing from vermin. The London County Council (General Powers) Act, 1904, empowered the Local Authorities to cleanse, purify, or destroy articles which the Medical Officer of Heath certifies are filthy, dangerous or unwholesome. On the certificate of the Medical Officer of Health that any house or part of a house is infested with vermin, the owners may be compelled to strip, cleanse rooms, houses, or part of such houses that are so infested. Section 21 of this Act applies Section 59 of the Public Health (London) Act, 1891, compelling sanitary authorities to provide means for cleansing, purifying and destroying filthy, dangerous or unwholesome articles. Under the London County Council (General Powers) Act, 1907, the following powers have been conferred on the County Council:— 1. The Medical Officer or his representative may, in any school within the County, provided or maintained by the Council as the Education Authority, examine the person and clothing of any child attending such school, and if on examination, he is of opinion that the person or clothing is infested with vermin, or is in a foul or dirty condition, the Medical Officer may give notice in writing to the parent or guardian requiring him to cleanse properly the person and clothing of such child within 24 hours after the receipt of such notice. 119 2. If on the receipt of the notice he fails to comply therewith within the prescribed time, the Medical Officer or his representative may remove the child from school to suitable premises and detain him until such cleansing is effected. Section 37 enables the Medical Officer of the County Council to enforce the cleansing of the person and clothing of the inmates of common lodging houses. Section 38 gives power to the County Council to make arrangements with sanitary authorities for the purpose of cleansing of the person and clothing of the above-mentioned cases. The Childrens Act, 1908, reproduces the clauses in the General Powers Act, 1907, and provides power for the cleansing of verminous children by the authority. Mortuary and Coroner's Court. REGISTER OF BODIES RECEIVED INTO THE MORTUARY During the year ending December 31st, 1911. Total. Males. Females. Post Mortems. Inquests. Brought in to await burial. Infectious. 92 62 30 49 80 11 1 Bodies Brought From Borough of Deptford Borough of Greenwich. Borough of Camberwell. Borough of Bermondsey. Borough of Lewisham. Croydon. 74 11 1 4 1 1 120 Mortuary Keeper. G. W. J. Wagner, appointed 31st January, 1911. Inquests. The total number of inquests held on residents of Deptford was 122. Of this number 80 were held in the borough, the remaining 42 being on residents who died outside the borough. The results of the inquests were as follow :— Natural causes 44 Accidental causes 53 Suicides 13 Misadventure 5 Open verdicts 4 Delirium Tremens 2 Alcholism 1 121 Table No. 7. METROPOLITAN BOROUGH OF DEPTFORD. Shewing the Streets in which Infectious Disease occurred during 1911. STREET. Small Pox. Diphtheria and Membranous Croup. Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Chicken Pox. Ophthalmia Neonatorum. Poliomyelitis. Pulmonary Tuberculosis. Atkinson Street 1 1 2 Albury Street 2 2 7 Achilles Street 1 1 Abinger Road 2 1 3 Avignon Road 2 1 Alvar Street 1 1 2 3 Alloa Road 5 4 Arica Road 2 1 2 Alpine Road 2 1 2 Albyn Road 1 3 2 Addey Street 5 3 Adolphus Street 1 2 Andom Terrace 1 Amersham Vale 2 1 2 Amersham Road 1 1 Ashmead Road 1 1 1 Avonley Road 1 2 Alverton Street 3 Arbuthnot Road 1 Arklow Road 1 1 Angus Street 1 Aspinall Road 1 Alfred Place 1 Alexander Street 1 Barlborough St. 2 1 Brookmill Road 1 2 2 Briant Street 2 Brocklehurst St. 2 1 1 1 Brockley Road 1 1 3 2 1 Bestwood Street 1 1 Bolina Road 1 4 Boscawen Street 3 1 Besson Street 1 1 3 Berthon Street 1 2 Blackhorse Road 1 1 3 3 Blockhouse Street 2 l Bawtree Road 4 1 Breakspears Road 1 3 Baildon Street 8 2 Bevil Street 1 Batches Cottages 1 Bolden Street 1 Batavia Road 1 Billington Road 1 1 Bronze Street 5 122 Table No. 7-Continued. Shewing the Streets in which infectious Disease occurred during 1911. STREET. 1 Small Pox Diphtheria and j Membraneous Croup Erysipelas. Scarlet Fever ! Enteric Fever. Continued Fever. puerperal Fever. Chicken Pox Ophthalmia Neonatorum Poliomyelitis Pulmonary Tubercnlosis. Carrington House 21 Cornbury Road 2 3 1 3 2 Chilton Street 1 1 Chipley Street 1 6 1 Colwick Street 2 2 Church Street 3 3 2 3 3 9 Chubworthy St. 2 4 2 1 Childeric Road 2 3 4 5 Cassella Road 2 2 2 Czar Street 1 1 1 1 Cranbrook Road 1 3 2 1 Creek Street 1 1 Comet Street 1 1 1 Cottesbrooke St. 1 1 Clifton Hill 2 1 2 Corston Street 1 1 1 3 Clandon Street 2 l Crossfield Street 1 4 1 7 Clifton Road 1 Clyde Street 2 1 Childers Street 3 4 Croft Street 4 1 Crooke Road 1 3 2 Camplin Street 1 1 1 Canterbury Road 1 Chipley Street 1 Douglas Street 1 4 2 1 2 5 Desmond Street 4 Deloraine Street 5 3 1 Deptford B'y. 1 1 Dorking Road 2 4 Drakefell Road 1 1 I Dollings Place 1 1 Dennett's Road 1 1 1 3 Dennett's Grove 3 Dundalk Road 2 1 Dugald Street 1 Erlanger Road l 1 Endwell Road 2 1 Edale Road 1 3 1 3 Evelyn Street 1 7 9 1 2 16 Evelina Road 1 Edward Street 5 3 1 2 6 Etta Street 2 1 Eugenia Road 1 1 1 3 2 123 Table No. 7 —continued. Shewing the Streets in which Infectious Disease occurred during 1911. STREET. Small Pox Diphtheria and Membraneous Croup Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever Chicken Pox Ophthalmia Neonatorum Poliomyelitis Pulmonary Tuberculosis. Edric Road 4 2 1 Eckington Gdns. 2 Edward Place 1 Evelyn Buildings 2 Egmont Street 1 Folkestone Gdns. 2 9 2 Fox well Street 1 1 1 Finland Road 1 1 1 1 Fawcett Road 2 1 4 1 1 Faulkner Street 1 2 3 Florence Street 1 8 1 Ffinch Street 3 Florence Road 1 1 Frankham Street 1 1 8 5 Florence Cottages 3 Friendly Street 1 2 Grove Street 2 2 4 2 4 Giffin Street 1 3 2 1 12 Goodwood Road 1 3 1 2 Gosterwood Street 3 1 1 Gellatly Road 1 1 1 Glenville Grove 3 1 Greenfield Street 1 Grinstead Road 2 4 Grinling Place 1 1 Hale Street 1 2 2 3 Hyde Street 1 3 1 1 Hornshay Street 1 1 1 Heston Street 3 4 1 High Street 2 2 2 5 Harton Street 1 2 Haydock Road 1 2 2 Hunsdon Road 1 2 1 Hosier Street 1 1 Hanlon Street 4 1 1 1 Hilly Fields C'snt 1 Harcourt Road 1 Hoopwick Street 1 Hatcham Pk. Rd. 1 Hathway Street 1 Hoopwick Street 1 Hood Street 1 Hereford Place 1 Hamilton Street 1 124 Table No. 7—continued. Shewing the Streets in which Infectious Disease occurred during 1911. STREET. Small Pox Diphtheria and Membraneous Croup Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Chicken Pox Ophthalmia Neonatorum Poliomyelitis Pulmonary Tuberculosis. Idonia Street 1 2 2 Ilderton Road 2 Jerningham Road 1 1 Junction Road 1 1 Kempslade Street 1 l Render Street 1 6 3 Kenwood Avenue 1 1 Knoyle Street 2 1 Kerry Road 1 1 1 l Knotts Terrace 2 1 Knott Street 5 Kentfield Place 1 Ludwick Road 2 1 Lovelinch Street 2 1 l Lee Terrace 1 2 Lewisham High Road 1 3 2 Lucas Street 1 2 Liardet Street 2 1 Lausanne Road 1 Leylang Road 1 Lubbock Street 1 1 Lind Street 1 Malpas Road 3 2 3 2 Manor Road 2 2 Mona Road 1 Monson Road 1 1 2 Milton Court Rd. 2 1 9 1 2 Mornington Road 2 2 2 l Mary Ann's Bdgs. 1 3 1 1 Martins Place 1 Martha Place 1 Marchant Street 1 Manor Cottages 1 Napier Street 2 2 1 1 3 New Cross Road 1 1 2 5 Nettleton Road 1 Nynehead Street 1 Oareboro Road 1 4 1 Oscar Street 1 2 2 1 Oldfield Road 4 1 Ommaney Road 1 125 Table No. 7.—continued. Showing the Streets in which Infectious Disease occurred during 1911. STREET. Small Pox. Diphtheria and Membranous Croup. Krysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puepeval Fever. Chicken Pox. Ophthalmia Neonatorum. Poliomyelitis Pulmonary Tuberculosis. Pepys Road 2 Payne Street 1 3 Prince Street 1 3 1 Pomeroy Street 1 1 3 Pagnell Street 1 1 1 Powers Place 1 1 Pender Street 1 1 Prospect Place 1 Queen's Road 3 2 Ruddigore Road 1 Rowley Street 1 3 3 Royal Naval PI 1 6 Rolt Street 1 4 1 4 Rectory Buildings 1 3 3 2 Railway Grove 2 2 2 1 1 1 Reginald Street 1 1 1 Reservoir Road 3 Revelon Street 1 2 Rollins Street 3 Reculver Road 3 5 1 Reginald Road 1 1 1 5 Raleigh Buildings 1 Rokeby Road 1 1 1 Rutt's Terrace 3 1 Reaston Street 2 S. E. Hospital 5 4 Speedwell Street 1 2 1 6 St Asaph Road 5 2 1 Senegal Koad 3 2 1 2 Staunton Street 1 1 Silwood Street 1 1 Summer Street 1 Senate Street 1 St. Johns' Terrace 1 Spring Street 1 Sanford Street 4 Selden Road 1 1 2 Strickland Street 1 Sylva cottages 1 Stanhope Street 1 1 1 3 Snead Street 1 Seymour Street 1 2 1 3 St. John's Road 1 1 1 2 Shardeloes Road 2 1 Sayes Street 1 1 126 Table No. 7—continued. Shewing the Streets in which Infectious Disease occurred during 1911. STREET. Small Pox Diphtheria and Membraneous Croup Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Chicken Pox Ophthalmia Nenatorum Poliomyelitis Pulmonary Tuberculosis. St. James' 2 Sprules Road 1 Sandbourne Road 1 Sharratt Street 1 1 1 1 Slowgrove cott'gs 3 St. Norbert's Rd. 1 1 Shere Road 7 Somerville Road l Simla Street 1 Ship Street 3 Scawen Road 3 Spring Street 2 Stanley Street 1 Tanners Hill 1 4 2 1 Trundleys Road 7 2 33 2 3 Tolhurst Street 1 1 Tressillian Road 1 4 Trim Street 1 Upcott Street 1 1 1 Vance Street 1 1 Vesta Road 1 Vanguard Street 1 1 7 1 2 Vansittart Street 1 1 1 1 1 Vulcan Road 1 1 Vulcan Terrace 2 Wallbutton Road 1 Windmill Lane 1 3 2 Watson Street 1 2 1 1 1 Warwick Street 2 3 Wot ton Road 1 3 2 1 Waller Road 2 1 2 Walpole Road 2 1 1 1 Wilson Street 1 Wickham Road 1 1 Watergate Street 4 1 5 1 1 12 Woodpecker Kd. 2 2 4 1 1 Whitcher Street 2 2 2 Wickham gardens 1 Walsham Street 1 Wrigglesworth St. 1 i 2 Totals 1 159 177 369 13 4 2 157 15 1 335 General Sanitary Administration. 129 District Inspection. The work performed by the District Inspectors represents, as usual, a very large number of inspections. The total inspections and visits to premises numbered 27,881 as against 20,085 for the previous year, thus showing an increased activity on the part of the sanitary staff. The figures stated above related to 5,449 houses in which 8,498 sanitary improvements of one kind and another were effected. The premises visited included stable yards, manure depots! vacant land, passages, urinals attached to public houses and premises for which certificates under the Customs and Inland Revenue Acts were required,as well as those for which certificates as to the water supply were demanded. Re-drainage. The principal drainage work for the year 1911 has been done at the following premises :— EAST WARD. No. 140 High Street; Nos. 1, 2, 3, 4 and 5 Alfred Place ; Nos. 81, 83, 129, 131, 133 and 187 Church Street; Nos. 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46 and 48 Stanhope Street; Fairground, High Street; Stable, Frankham Street; Nos. 46 and 48 Adolphus Street; Nos. 20, 28 and 30 Octavius Street ; Nos. 13, 15, 17, 19, 21, 37, 32, 34, 50, 52 Speedwell Street; Nos. 22, 23 and 24 Comet Street; Nos. 1 and 2 Sun Cottages, Speedwell Street, Nos.3, 5, 7, 32,34, 43, 59 and 61 Napier Street; Nos. 72, 74 and 76 Kerry Road; Nos. 1, 2, 3, 4, 5 and 6 Dorset Terrace, Payne Street; Nos. 103 and 105 Douglas Street. NORTH WARD. Nos. 13, 229, 231, 86, 101, 103, 105, 107 and 109 Evelyn Street; Nos. 47, 49, 51, 53 and 91 Edward Street; Nos. 12-14, 175, 219, 2^1, 223, 225, 227, 193, and 185 Childers Street; Nos. 96, 98, 100, 102, 104 and 106 Prince Street; Nos. 26, 28, 30, 32, 34, 36, 38 and 40 Czar Street; Nos. 11, 12, 13, 14 and 15 Grinstead Road ; Nos. 58, 60, 62 and 64 Boscawen 130 Street; Nos. 34 and 36 Trundleys Road; Nos. 33 and 35 Hyde Street; No. 36 Staunton Street. NORTH-WEST WARD. Nos. 325, 327, 333i, 343 and 345 New Cross Road; Nos. 2, 4, 6, 8, 12, 14 and 16 Clifton Hill ; Nos. 2 and 4 Vance Street; No. 31 Walpole Road ; Nos. 62 and 63 Railway Grove; 10, 11, 13, 15, 17, 19, 21 and 23 Fagnell Street; Nos. 1, 3 and 5 Angus Street; No. 11.Milton Court Road; Relief Station, Simla Street; Nos. 81-95 Childeric Road; Nos. 2-16 Goodwood Road; Nos. 34-40, 42-52 and 69-83 Senegal Road; Nos. 5-13 Zampa Road; No. 1 Surrey Cottage; No. 1 Achilles Street; No. 1 Pagnell Street. SOUTH AND SOUTH-EAST WARDS. Nos. 35, 37, 39, 41, 43, 45, 47 and 49 Ashmead Road; Nos. 9, 214 and Brockley Lane Station, Brockley Road; Nos. 1 and 3 Carlton Road ; No. 71 Endwell Road ; No. 59 Florence Road; No. 55 Friendly Street; No. 5 Harcourt Road ; Nos. 2, 4, 6, 8, 10, 12, 14 and 16 Lind Street; Nos. 70, 130 and 148 Lewisham High Road; Nos. 42, 83, 98, 120, 122 ond 154 Malpas Road ; Nos. 15, 17, 19, 21 and 23 St. Donatt's Road ; No. 31 St. James; No. 150 and St. John's Institute, St. John's Road; No. 60 Shardeloes Road; No. 60 Tyrwhitt Road ; Nos. 39 and 82 Wickham Road. SOUTH-WEST WARD. Nos. 32 (hall at rear), 85, 104, 145-147, 191-193, New Cross Road; Nos. 14-32 Avonley Road; 1-10 Masons Cottages; No. 101 Besson Street; 58-70 Monson Road; Nos. 218, 224-230, and 271-275 Queen's Road; Nos. 45-62 Camplin Street; Nos. 21-39 Hunsdon Road; Nos. 3-11 Martin's Place; Nos. 6-12 Briant Street; Nos. 35-39 Reaston Street; Nos. 105-113 Dennett's Road; No. 25 Erlanger Road; Nos. 55-65 Barlborough Street; Nos. 19-25 Eckington Gardens; Nos. 13-17 Selden Road; Nos. 28-34 Ventnor Road. 131 New Drainage. The following applications under the Metropolis Management Acts to build and drain were approved by the Council during the year :— No. of Application. Nature of Application. 1042 To build and drain new Club premises on the site of Nos. 367-9 Queen's Road, amending the application before the Council on the 12th July, 1910 (Min. Vol. X., p. 382). Approval, subject to the old connection to the server to which it is proposed to connect the new drainage system, being found in a satisfactory condition. 1113 To build and drain by a combined operation in connection with the existing system an extension to the back addition of 74 Pagnell Street. 1114 To make an entry into the sewer under this Council's control in. Eugenia Road for the purpose of draining a dwelling house in the Borough of Bermondsey, situated between the St. Catherine's Chutch and Mission in Eugenia Road. 1116 To drain into a cesspit certain premises known as " " Surrey Cottage," situated on the north side of the Grand Surrey Canal, east of the L.B. & S. C. Railway Co.'s main line. The applicants have given an undertaking that they will not at any time call upon the Council to empty or clear the cesspit. 1115 To build and drain by a combined operation in connection with the existing system, additions to Nos. 161 and 163 Lewisham High Road. 132 No. of Application, Nature of Application. 1128 To build and drain in connection with the existing system additions to factory, 75aTrundleys Road. 1129 To construct and drain a roadway in a coal depot on the west side of Endwell Road. 1139 To demolish existing premises known as Nos. 22 and 22a The Broadway and to build on the site and drain by a combined operation an Electric Picture Playhouse. 1140 To build and drain a dwelling house No. 30 Cross- field Street and to abolish the drains of No. 32 Crossfield Street, which form part of the combined drainage system for these two premises. 1072 To build and drain by a combined operation 5 application,. houses on the east side of Czar Street and to build and drain, by a combined operation, 3 houses on the west side of New King Street, amending application approved by Council on the 18th October, 1910 (Min. Vol. X., p. 520). 1143 To build and drain 5 blocks of flats, numbered 1 to 5 on the old Deptford Brewery site in Brookmill Road. 1152 To build and drain by a combined operation warehouses in Creek street on the site formerly occupied by Hills' Chemical Works. Approval as a drainage scheme only. 1162 To build and drain in connection with the existing system the flat roof over the bar of the " Montague Arms " public house, Queen's Road. 133 No. of Application. Nature of Application. 1165 To build and drain by a combined operation in connection with the existing system, an addition at at the rear of 53 Manor Road. 1142 To build and drain by a combined operation in connection with the existing system, an addition at the rear of 129 Lewisham High Road. Approved on condition that the works are carried out in conformity with the plan attached to the application, and on the further condition that the lessee of the premises undertakes to indemnify the Council against any and all costs which may now or in the future be incurred by it in relaying or in the repair of the lineof drainage pipes under or upon the said premises and the adjoining premises No. 127 Lewisham High Road, and that it be referred to the Council's Solicitor to prepare the necessary documents in the matter at the expense of the lessee of the property. 1169 To build and drain by a combined operation in connection with the existing system a w.c. at the rear of lA Cornbury Road. 1172 To build and drain in connection with the existing system, three w.c's. at a tea warehouse, 52 Trundleys Road. 1189 To build and drain in connection with the existing system, three w.c's at office and works in Glenville Grove. 134 No. of Application. Nature of Application. 1190 To build and drain in connection with the existing system, three w.e's at Archangel Wharf, New Cross. 1205 To build and drain in connection with the existing system, a lavatory, w.c. and urinal at the Ludwick Road Hall. 1206 To enlarge the school at the Salvation Army Hall, Mary Ann's Buildings, and to drain the surface water by means of a rainwater conductor across the footpath. Approval on condition that the rainwater conductor is constructed by the Council at the cost of the applicant. 1207 To build and drain by a combined operation in connection with the existing system, a timber shed at the rear of 120-2 Tanner's Hill. 1210 To build and drain w.c's and urinals at the works of the Hygienic Construction Company, Stockholm Road. 1209 To redrain and to build and drain by a combined operation in connection with the existing system an addition at No. 103 Douglas Srreet. 1211 To build and drain the new Police Station in Amersham Vale. 1215 To build and drain in connection with the existing system, additions at the Key Glass Works, Cold Blow Lane. 135 Property acquired by the London County Council. During the year the London County Council have acquired property in Kender Street, Nos. 1-8 Esther Cottages, for the purpose of extending the area of the existing schools. The inland Revenue Act, 1903. The following table shows the number of certificates granted under the above Act for exemption from Inhabited House Duty:— Houses during the Year 19ll. Tenement. Notes. No. comprised therein. No. for which Certificates were Granted. Refused Deferred. 7 14 1 6 — - The Housing and Town Planning Act, 1909, now provides also for the exemption of common lodging-houses for the working classes from inhabited house duty by Section 35. 136 METROPOLITAN BOROUGH OF DEPTFORD. Table. ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR ENDING DECEMBER 30, 1911. Number of District. 1 2 3 4 5 6 7 Totals. Complaints Received 163 34 24 42 18 41 2 324 Total Premises Inspected 778 798 772 913 870 837 481 5449 Re-Inspections, Calls, Service of Notices, &c., &c 4109 3549 3302 2839 3993 3003 1637 22432 Inspections under notice from Contractors, per Bye-Laws 24 117 3 42 20 56 2 264 Number of Cases in which Proceedings have been taken 1 ... ... 1 ... ... ... 2 " Intimations " Served 329 244 468 493 527 445 313 2819 " Statutory Notices " Served 83 4 26 42 178 67 5 405 Houses closed by Magistrate's Order ... ... ... ... ... ... ... ... „ „ Voluntarily 1 ... 2 ... 5 ... ... 8 Water Closets- Old Closets abolished ... 3 4 1 ... 1 1 10 New Closets provided 1 4 4 1 3 ... ... 13 Basin and Trap provided 100 112 55 96 65 167 7 602 Water Supply provided 67 3 39 3 3 30 ... 145 Water Supply Apparatus provided 8 27 13 23 44 19 1 135 Limewashed 47 2 30 16 5 19 4 123 Walls Repaired 5 15 9 24 31 25 ... 109 Floors Repaired 7 7 5 21 3 11 1 55 Roofs Repaired 11 ... ... ... ... ... ... 11 Doors provided ... 5 10 1 16 5 ... 37 Ventilated 9 ... 4 ... 11 ... 1 25 Seats provided 1 2 6 16 5 8 6 44 Basins Cleansed ... 2 23 4 3 8 3 43 W.C.'s sealed off from living rooms ... ... ... ... 96 ... ... 96 Drains- Drains Re-constructed 31 43 32 42 53 106 11 318 Surface Drains provided 1 3 ... 13 3 ... ... 20 Cleansed and Amended 43 116 '26 46 28 52 4 315 Gully Traps fixed 33 105 40 57 65 192 12 504 New Soil Pipes and VentPipesfixed 4 37 9 2 6 86 6 150 Chambers built and Interceptors provided 10 21 7 14 3 54 4 113 New Manhole Covers provided ... ... ... ... 3 ... ... ... 3 Interceptors only fixed ... ... 3 1 ... ... ... 4 Ventilated 11 12 25 37 10 ... 2 97 Provided to Stables ... ... ... ... ... ... ... ... Clearing Eyes ... 46 ... 20 6 24 6 102 Mica Valves fixed ... ... ... 9 ... ... ... 9 137 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR ENDING DECEMBER 30, 1911—continued. Table—continued. Number of District. 1 2 3 4 5 6 7 Totals Sinks, Bath& Lavatory Wastes, and Rain Water Pipes Disconnected from drains, trapped and ventilated 17 33 27 35 39 69 ... 220 Sink Troughs provided ... ... ... ... 8 ... ... 8 Cesspools— Abolished ... ... ... ... ... ... ... ... Dustbins- Provided 51 64 53 72 48 55 27 370 Repaired ... ... ... ... ... ... ... ... Yards — Paved 6 20 61 73 86 34 21 301 Surface Repaired 232 38 29 50 59 96 16 520 New Fire Orates and Stoves provided ... ... ... 22 ... ... ... 22 Coppers repaired ... ... ... 20 ... ... ... 20 Sash Cords fixed ... ... ... 7 ... ... ... 7 Bedding cleansed 2 ... 2 Scullery and Wash-house— Floors paved 48 4 16 13 37 37 12 167 Washhouses provided ... ... ... ... 4 ... ... 4 Coppers repaired ... ... ... ... 6 ... ... 6 Forecourts— Paved 1 4 12 21 38 35 6 117 Surface Repaired 1 3 ... ... ... 1 ... 5 Gutters and Rain Water Pipes — Provided and Repaired 118 46 68 31 68 79 19 429 Water Supply— Store Cisterns provided ... ... ... 1 ... ... ... 1 ,, ,, Covers provided ... 6 ... ... ... 2 1 9 „ „ Cleansed ... ... ... ... ... 2 1 3 ,, ,, abolished 4 l ... 2 7 3 ... 17 Supply Reinstated 1 2 .. 4 4 ... 1 12 Fittings Repaired 12 24 10 16 10 17 25 114 New Houses Inspected for Certificates before Occupation 1 ... ... ... 8 2 ... 11 Potable Water provided from Service ... ... 2 1 6 3 ... 12 138 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR ENDING DECEMBER 30, 1911—continued. Table-continued. Number of District 1 2 3 4 5 6 7 Totals. Cleansing: and Repairs— Houses Cleansed and Limewashed 408 95 204 271 246 124 10 1448 Houses repaired and Ventilation improved 272 42 114 62 76 183 27 776 House roofs repaired 124 36 77 53 83 87 22 482 Dung Receptacles— Abolished ... ... ... ... ... ... ... ... Provided ... ... ... ... ... 2 ... 2 Repaired 1 ... ... ... ... ... ... 1 Underground Rooms- Used as dwellings abolished 3 ... ... ... ... ... ... 3 Overcrowding Cases Abated 8 2 2 12 3 6 ... 33 Accumulations Removed 6 3 2 1 3 6 ... 21 Animals— Ceased keeping as a Nuisance 2 ... ... 4 1 1 ... 8 Smoke Nuisances- Cases Abated 1 6 ... 2 1 4 ... 14 Observations ... ... 6 2 19 4 ... 31 Rooms occupied in such a manner as to be a nuisance 2 ... ... ... ... ... ... 2 Inland Revenue Act Houses inspected for Certificates ... 6 1 ... ... ... ... 7 Number of Tenements ... 12 2 ... ... ... ... 14 Number of Certificates granted ... ... 1 ... ... ... ... 1 Number of Certificates refused ... 6 ... ... ... ... ... 6 Dampness abated ... ... ... ... 35 ... 18 53 Urinals— Springs provided to doors ... 2 ... ... ... 2 ... 4 Urinals cleansed ... 1 ... 1 ... 2 ... 4 District No. 1.—Inspector Simpson. District No. 2.—Inspector Priest. District No. 3.—Inspector Shelley. District No. 4.—Inspector Snowden. District No. 5.—Inspector Owner. District No 6.—Inspector Kemp. District No. 7.—Inspector Hewett. 139 Overcrowding. Overcrowding was abated in 33 cases without having to take legal proceedings. Smoke Nuisances. During the year 31 observations were made, and in 14 cases where black smoke was emitted in such a quantity as to be a nuisance notices were served to abate the nuisance. Common Lodging House Acts, 1851 and 1853- The Secretary of State, by a Provisional Order which came into operation on the 1st November, 1894, transferred to the London County Council the powers of the Commissioner of Metropolitan Police in respect of Common Lodging Houses. The following is a list of Common Lodging Houses registered in this district, providing accommodation for 437 persons; in addition to which there is Carrington House, Brookmill Road, which provides for 802 lodgers. Common Lodging Houses. Situation of the Common Lodging House. Author- ized No. of Lodgers. Sex of lodgers. M. Men. WWomen. MC Married Couples. Date of Approval of premises. Name and Residence of Licensee. Street or Place. Name. Street or Place. 1 Church-street... 43 M 19th March,1887 Letitia Catherine Longinotto 13 Wickham-road 146 Church-street ... 39 M 26th Feb., 1887 Letitia Catherine 13 Wickham-road 35 Baildon-street... 27 M 22nd April, 1885 Longinotto Sarah Ann Flight 110 Malpas road 42 Albury-street ... 48 M 22nd Sept., 1894 Ellen McCarthy 88 Douglas-street 27 Watergate street 31 M 27th Nov., 1889 Letitia Catherine Longinotto 13 Wickham-road 112 High-street 112 do. 101 80 M W Barnard Jaffa do. 112 High-street 112 do. 124 Tanner's-hill ... 68 M 15th Feb, 1897 James Webster 38 Wickham road 140 Houses Let in Lodgings. Bylaws relating to houses let in lodgings, or occupied by members of more than one family, have been made by the Council pursuant to Sec. 94 of the Public Health (London) Act, 1891:— (a) For fixing the number of persons who may occupy a house or part of a house which is let in lodgings or occupied by members of more than one family, and for the separation of the sexes in a house so let or occupied. (b) For the registration of houses so let or occupied. (c) For the inspection of such houses. (d) For enforcing drainage for such houses, and for promoting cleanliness and ventilation in such houses. (e) For the cleansing and lime-washing at stated times of the premises. (f) For the taking of precautions in case of infectious disease. The number of such houses on the register is 273, the whole of which were regularly inspected with a view to seeing that they comply with the bylaws as regards cleanliness, overcrowding, etc. Mention should be made in dealing with systematic inspection of the work of the Lady Health Visitor, as far as her duties carry her in this connection. She systematically visits certain portions of the district and encourages tenants to observe the principles of domestic sanitation, and reports any nuisance coming to her knowledge. 47 visits were made in this way in 1911. House Refuse Removal. The removal and disposal of house refuse is undertaken free of charge by the Council. 141 Street Refuse. The following is the amount of the street refuse for the year 1911, and the manner in which it has been disposed of:— 1911. No. of loads collected DISPOSAL. Barges. Nonhead Trucks. Brockley Trucks. On Wharf. Free Shoots. January 1232 1037 ... ... 3 192 February 984 731 ... ... 6 247 March 1201 1178 ... ... ... 23 April 717 702 ... ... ... 15 May 783 769 ... ... ... 14 June 723 696 ... ... ... 27 July 652 592 ... ... ... 60 August 735 719 ... ... ... 16 Sept. 935 864 ... ... 5 66 October 943 889 ... ... ... 54 Nov. 659 631 ... ... ... 28 Dec. 843 842 ... ... ... 1 Total 10407 9650 ... ... 14 743 House and Trade Refuse. Table showing the number of loads of house and trade refuse collected during the year and where deposited:- 1911 Number of Loads. Horses employed. 1911. DISPOSAL. 1911. 1910. Barges. Nunhead Trucks. Brockley Trucks. Wharf, &c. January 1755 1604 573 1520 209 ... 26 February 1539 1495 498 1301 219 ... 19 March 1754 1778 540 1434 260 45 15 April 1625 1704 512 1241 182 187 15 May 1869 1679 584 1493 154 214 6 June 1665 1592 544 1397 251 ... 17 July 1613 1538 515 1404 201 ... 8 August 1555 1554 506 1323 228 ... 4 Sept. 1456 1556 468 1235 210 ... 4 October 1619 1623 513 1424 185 ... 20 Nov. 1663 1624 551 1329 193 120 21 Dec. 1589 1628 534 1292 188 91 18 Total 19702 19375 6338 16393 2480 657 173 142 House Accommodation for the Working Classes. The houses in the borough are so varied in character that it is impossible to class them as belonging to any one group. The South Ward is almost devoid of houses for the working classes, as it consists chiefly of substantial family residences of a type above the average suburban residence. The houses are situated on high ground and in wide and well-kept roads, making the neighbourhood a most desirable one. The South-East and South-West Wards also possess good houses, but there is a fair sprinkling of houses suitable for the working class, many of which are tenement houses let to two or more families. The North-West and North are well constructed Wards, consisting of broad thoroughfares with many rows of well constructed houses letting at about £30 a year; about 10 to 15 per cent, of these being tenement houses. The East Ward is the most densely populated district, and every effort is being made to cope with poverty and ignorance in its worst forms. Buildings which in former days were probably the residences of a better class are now the swarming grounds of a wretched population. The carelessness in this area with regard to health, and the ignorance displayed of the most elementary laws of hygiene, show clearly that if we are to gradually rid ourselves of any considerable proportion of these unfortunate people, we must rigorously enforce the legal remedies at our command for clearing insanitary areas and houses, and for instilling into the landlords a true sense of their responsibilities. The time has now arrived when we should insist upon a higher standard of personal cleanliness. Hitherto, men and women with filthy clothing, often in a verminous condition, 143 and living in houses in which dirt is everywhere prevalent, have been tolerated and even pitied. With the exception of children and those persons living in " houses let in lodgings," there is no law to punish the offender, and yet the elementary principle on which nearly every advance in public health has been made is on lines of greater cleanliness. Sanitary science of to-day is the inevitable result of a most remarkable evolution. As it has developed, and its principles have become firmly established, it has been more and more clearly perceived that its art and philosophy extended beyond the individual, beyond groups or classes, over artificial limitations, and included in its wide domain all that made for the betterment of humanity. When we consider the housing of the working classes we perceive that the old days and old conceptions of disease and health are passing away. The beliefs, selfish and ignorant, that human beings could be crowded into humble houses destitute of light and air, reeking with filth and swarming like vermin, to die like vermin ; that men and women working hard must come home to such conditions; that children should be dwarfed and maimed by their cruel surroundings ; that the distressed and destitute must be left to protect themselves against not only want, but against the fatal diseases caused by man's ignorance, greed and inhumanity; these beliefs are passing away. In new situations, vigour and enthusiasm construct higher ethics, the practice of which elevates the plane of living, and now the drift of scientific opinion, and to a very appreciable degree also popular opinion, means but one thing. It means that sanitary science has in its process of development become a practical science and is now recognised as such. We have learned that if we allow our neighbour to wallow in filth we must expect to suffer some of the consequences. 144 Much good work has already been done in the East Ward, and the County Council have already built dwellings of the artisan class type for the people we are gradually displacing. In:— Armada Street (Greenwich)—consisting of 2 to 4 rooms, and let at a rental of 5s. to 7s. per week. New King Street—consisting of 2 to 4 rooms, and let at a rental of 5s. to 7s. per week. Brookmill Road-—consisting of 3 rooms, and let at a rental of 7s. 6d. per week. HOUSING, TOWN PLANNING, &C. ACT, 1909. As stated in last year's report considerable and important amendments to the law relating to the housing of the working classes have been made, and are included in the Housing and Town Planning Act, 1909, but it is only this year that we have brought our procedure under the Act into thorough working order. The sections which more immediately relate to unhealthy houses are sections 14, 15, 17, 18. Section 14 provides that in any contract made after the passing of this Act for letting for habitation a house or part of a house at a rent not exceeding in London ^40 a year, there shall be implied a condition that the house is at the commencement of the holding in all respects fit for human habitation; and by- Section 15 there is included an undertaking that the house shall, during the holding, be kept by the landlord in all respects reasonably fit for human habitation. This section does not apply to a house let for a term of not less than three years upon the terms that it be put by the lessee .into a condition reasonably fit for occupation, and the lease is not determinable before the expiration of that term. Housing, Town Planning, &c. Act, 1909. types of houses being dealt with under the act. Rowley Street—Insanitary Area. Watergate Street—Insanitary Area. Photo., E. C. Seare. Watergate Street—Insanitary Area. Kentfield Place- Insanitary Area. Photo., K. C. Scare. 145 Section 15 also only applies to houses which have undergone a change of tenancy since the passing of the Act, but it is held that if the rent has been raised or lowered this is sufficient to create a new tenancy. closing order. Section 17 states that it imposes upon every Local Authority the duty of causing to be made from time to time an inspection of their district with a view of ascertaining whether any dwelling-house therein is in a state so dangerous or injurious to health as to be unfit for human habitation, and if on representation being made, any dwelling-house appears to be in such a state, the Local Authority shall themselves make a closing order until in their judgment the dwelling-house is rendered fit for habitation. cellar dwellings. Sub-section 7 of this Section relates to cellar dwellings, and provides that a room habitually used as a sleeping place, the floor of which is more than 3 feet below the surface of the street adjoining, or nearest to such room, is to be deemed a dwelling house so dangerous or injurious to health as to be unfit for human habitation if the room either— (a) is not on an average at least 7 ft. in height from floor to ceiling; or (b) does not comply with such regulations as the Local Authority with the consent of the Local Government Board may prescribe for securing the proper ventilation and lighting of such rooms, and the protection thereof against dampness, effluvia, or exhalation. demolition order. Section 18 provides for demolition. Where a closing order has remained operative for three months, the Local Authority shall take into consideration the question of demolition of the 146 dwelling house, and shall give the owner notice of the time (not less than one month after service of the notice) and place at which the question will be considered, and the owner of the dwelling-house shall be entitled to be heard when the question is so taken into consideration. The Local Authority under this Section shall order the demolition of a building if upon such consideration they are of opinion— (1) That the dwelling house has not been rendered fit for human habitation ; and (2) That the necessary steps are not being taken to render it fit; or (3) That the continuance of any building, being or beingpart of a dwelling house, is a nuisance or dangerous or injurious to the health of the public or of the inhabitants of the neighbouring dwelling houses. The Local Authority may postpone the operation of the demolition order for a time, not exceeding six months, if they consider that the house can be rendered fit for human habitation, and the owner undertakes to execute forthwith the works necessary to render the dwelling house fit for human habitation. Under the Housing Regulations, 1910, the inspection for the purposes of Section 17 of the Act of 1909, shall include an examination of the state of the dwelling house in relation to the following matters :— (1) The arrangements for preventing contamination of water supply. (2) Closet accommodation. (3) Drainage. (4) The condition of the dwelling house in regard to light, free circulation of air, dampness and cleanh'ness. J 2 147 (5) Paving, drainage, and sanitary condition of any yard or outhouse belonging to or occupied with the dwelling house. (6) The arrangement for the deposit of refuse and ashes. (7) The existence of cellar dwellings and rooms unfit for habitation. (8) Any defects (general) which may tend to render the dwelling house dangerous or injurious to the health of an inhabitant. BACK-TO-BACK HOUSE. Section 43 makes the erection of back-to-back houses intended to be used as dwelling houses unlawful, but provides that nothing is to prevent the erection or use of a house containing several tenements in which the tenements are placed back-to-back, if the Medical Officer of Health certifies that the several tenements are so constructed and arranged as to secure effective ventilation of all habitable rooms in every tenement. This section does not apply in cases where the plans have been approved by the Local Authority before the 1st of May, 1909. As there seems to be no provision in the Act to meet the case of an owner who desires to use the house for some other purpose than for human habitation, such, for example, as for stabling or for a barn, or for some purpose which would neither be a nuisance nor injurious to health, it is therefore suggested that before a closing order is made, the owner of the house should be informed that if he desires to utilize the house for purposes other than those of a dwelling house, he should do so before the order is made. This suggestion is an admirable one for getting out of the difficulty which has been created, although in actual practice it will be found that it will be necessary 148 stantly to keep watch upon such buildings in order to prevent them reverting to dwelling houses. When the Act is amended, as it will have to be very shortly, the sanitary authority should be required to demolish a house only if they deem it expedient to do so. The work carried out by the Committee during 1911 has far exceeded the amount done in any previous year, and the Committee has in every case given the matter very careful consideration before deciding what action should be taken with respect to the property. The Medical Officer of Health in all instances advises the owners concerning the wishes of the Committee, and an opportunity of meeting the Committee and hearing their views on the matter is open to each owner. Any objection which they have to the action of the Committee is taken into consideration. It is also open for the owners to lay an improvement scheme before the Committee to present to the Council. Where the owner wishes for a specification of the work to be done under Section 15, to render his property fit for habitation, these specifications are prepared by your Inspector, and after approval by the Committee are supplied as a matter of courtesy only and without prejudice, and all work is supervised by the Inspector. There are a large number of houses within the borough which, though structurally good, are allowed to fall into a state of internal disrepair, and become insanitary owing to neglect. It is hoped that Section 14 of the Housing and Town Planning Act, which implies fitness for habitation on letting, and the maintenance of this condition, will cause more careful supervision of the interior as well as the exterior of the property. Your Medical Officer wishes to draw attention to the undesirable 149 habit when houses are internally decorated, of putting new papers over the old and dirty papers, so that not infrequently five or six layers of old and dirty wall-papers are covered with a new one. More attention should also be paid by owners to the dilapidated and dangerous condition of the ceilings. It is very desirable that when a house is cleaned the walls should be stripped before new paper is put on, and thus foul emanations which are liable to arise from layers of dirt, paste, and old wall-paper may be avoided, as this condition cannot but be unhealthy and unhygienic for the inmates of the dwellinghouses. The following is a tabular statement of the work carried out during the year :— work done under the housing, town planning, &c. act, 1909. Number of houses inspected 2154 Number of houses represented as unfit for habitation 44 Number of houses represented as unfit for habitation, and not capable of being made fit - Number of houses closed 44 Number of houses demolished — Number of houses made habitable — Number of back-to-back houses converted to through houses - Number of closing orders made 44 Number of demolition orders made — Houses closed voluntarily 2 Houses dealt with under Sec. 15 50 150 House to House Inspection. In the following list will be seen the streets, the houses of which were systematically inspected during 1911:— INSPECTOR SIMPSON Name of Road. No. of Premises Inspected. No. of Premise where defects existed. No. of Premises found in fair condition, (i.e. where no defects were found). Addey Street 73 70 3 Alfred Place 5 5 Nil Bronze Street 59 59 „ Creek Street 37 37 „ Church Street 49 49 „ Copperas Square 6 6 „ Crossfield Street 45 44 l Frankham Street 35 35 Nil Giffin Street 39 39 „ Hale Street 62 62 „ Hosier Street 54 54 „ Leonidas Street 13 13 „ Reginald Street 24 24 „ Reginald Place 21 21 „ Stanhope Street 11 11 „ 533 529 4 inspector priest. Brookmill Road 7 7 Nil Deloraine Street 33 13 20 Foxwell Street 39 11 28 Harton Street 6 6 Nil Heston Street 9 5 4 Knott's Terrace 19 16 3 Spring Street 11 7 4 Tanners Hill 58 36 22 Summer Street 16 10 6 198 111 87 151 inspector shelley. Baildon Street 50 50 Nil Comet Street 19 14 5 Glenville Grove 19 19 Nil Idonia Street 16 14 2 Kerry Road 19 19 Nil Napier Street 100 67 33 Octavius Street 31 15 16 Payne Street 46 26 20 Dorset Terrace (Payne Street) 6 6 Nil Stanley Street 23 21 2 Speedwell Street 68 53 15 Watson Street 52 47 5 Cockles Cottages Speedwell Street 4 4 Nil Slowgrove „ 4 4 „ Sun „ 2 2 „ Batches „ 2 2 „ Providence Place 7 7 „ Wybourn C'tt'ges 5 5 „ 473 375 98 inspector snowdon. Fawcett Road— 2 to 48 42 29 13 3 to 75 39 29 10 Cornbury Road— 3 to 75 39 34 5 2 to 78 39 29 10 Senegal Road— 34 to 40, 42 to 52, 73 to 83 16 16 Nil Edale Road— 43 to 49 4 4 , (completion of street) Pagnell Street— 32 to 44 7 7 „ 152 Railway Grove— 81 to 90 10 10 Nil Silwood Street— 97 to 143 24 21 3 Chipley Street— 2 to 64 24 21 3 244 200 44 inspector owner. Blackhorse Road 33 31 2 Greenfield Street 20 17 3 Czar Street 7 7 Nil Hood Street 12 10 2 Boscawen Street 43 39 4 Junction Road 13 11 2 Prince Street 13 8 5 Bestwood Street 13 13 Nil Shere Road 68 59 9 Dorking Road 42 38 4 Edward Street 34 28 6 Hoopwick Street 10 10 Nil 308 271 37 inspector kemp. Hunsdon Road— 21 to 57 19 10 9 Render Street— 1 & 2 Albert Cottages 2 2 Nil 1 Bacon's Cotts. 1 1 )) Pomeroy Street— 1 to 4 Rose Cottages 4 4 „ 1-3 Render Place 3 3 „ la-4a „ „ 4 4 „ 1-11 Martin's Place 11 9 2 50-56 Dennett's Rd. 4 2 2 153 2-5 Esther Cottages 4 4 Nil 1-20 Rutt's Terrace 20 12 8 2-6 Besson Street 3 2 1 Briant Street 31 21 10 194-200 Queen's Rd. 4 4 Nil 1-23 Lubbock St. 22 17 5 1-15 Prospect Place 15 13 2 1-12 Kenwood Av. 12 8 4 1-27 Dennett'sGrove 27 19 8 Martha Place— 1-7, la-7a 14 12 1-15 Evelyn Bdgs. 15 flats 8 7 2-36 Faulkner St. 18 13 5 1-57 Selden Road 29 25 4 1-5 Lindo Street 5 5 Nil 267 198 69 inspector hewett. Achilles Street 26 22 4 Railway Grove 26 15 11 Angus Street 6 4 2 Pagnell Street 5 4 1 Clifton Hill 3 3 Nil Edward Street 40 33 7 Liardet Grove 10 2 8 Milton Court Rd. 15 9 6 131 92 39 totals 2,154 1,776 378 154 The following is a list of the houses in respect of which Closing Orders were made:— east ward. Bevil Street, No. 1. Frankham Street, No. 15. Providence Place, Nos. 1, 2, 3, 4, 5, 6, 7. Speedwell Street, Nos. 20, 22, 26, 26a. Wybourne Cottages, Nos. 1, 2, 3, 4, 5. north ward. Rowley Street, Nos. 1, 2, 3, 4, 5, 6, 7, 14, 15, 16, 17. 18. Watergate Street, Nos. 5, 11, 13, 15, 25, 41, 43. south-east ward. Kentfield Place, Nos. 1, 2, 3, 4, 5, 6. Summer Street, No. 5. The following houses were voluntarily closed by the owner:— Speedwell Street, Nos. 19 and 21. Notices under Section 15 to carry out works necessary to render the premises fit for habitation were served in respect of the following houses:— east ward. Baildon Street, Nos. 8, 10, 12, 14, 16, 18, 20, 22, 24,26. Berthon Street, Nos. 29, 39. Church Street, No. 83. Giffin Street, Nos. 22, 67, 71, 73, 75, 77, 79. Hale Street, Nos. 10, 12, 14, 16, 18, 19, 20, 21, 22, 24, 25, 26, 49, 51. Knott Street, No. 27. Crossfield Street, No. 40. north ward. Watergate Street, Nos. 3, 11, 15, 17, 29, 31, 35, 41. Rowley Street, Nos. 8, 15, 16, 19, 20, 21. Note.—In the case of Nos. 11, 15 and 41 Watergate Street, and 15 and 16 Rowley Street, the necessary works as per notices were not put in hand, and the premises were subsequently dealt with under Section 17. Factory and Workshop Act, 1901. 157 Factories, Workshops, Workplaces and Outworkers. These premises were regularly visited during the year. Special attention was paid to sanitary accommodation for persons employed. In three instances the w.c. accommodation was found to be insufficient for the persons employed, and in 77 cases the accommodation was unsuitable or defective. In each instance the defect has been remedied. The registers dealing with the above have been kept well up-to-date, as will be gathered by the perusal of the following paragraphs relating to the various classes of premises coming within the scope of the Factory and Workshop Act. factories. Factories include all places in which mechanical power is used in aid of the manufacturing processes. The number of factories on the register at the end of the year, including bakehouses and laundries, was 127, involving 280 rooms. 148 inspections were made and three written intimations served. workshops. Workshops include any premises (not being factories) in which manual labour is exercised by way of trade, or for purposes of gain in, or incidental to, the making, altering, repairing, finishing or adapting for sale of any article, and to or over which the employer of the persons working there has the right of accessor control. The number of workshops on the register at the end of the year was 273 (including bakehouses and laundries and domestic workshops) with 421 rooms. 158 There is no industry peculiar to Deptford. The list of trades carried on in the 273 workshops is as follows:— Bakers 70 Dressmakers 60 Laundries 9 Milliners 13 Shirtmakers 4 Tailors 18 Wheelwrights 10 Cycle and Motor Building 9 Blouse Makers 11 Miscellaneous Workshops 69 273 The number of inspections was 379. There were fifteen written intimations served for defects and insanitary conditions found. In this connection some interest attaches to the latest regulations regarding the cleansing of factories and workshops issued by the Minister for Labour and Industry in the Government of New South Wales. These provide that—(a) The floors and windows of every factory shall, when so ordered by an inspector, be washed with hot water and soap once at least every four weeks, provided that the occupier of any factory may appeal from such order to the Minister, whose decision shall be final. (b) The seats and floors of every closet, lavatory and dressing room used by the employees in any factory or shop shall be thoroughly scrubbed with water and soap once at least every week, (c) Each urinal and the floor adjacent to to such urinal, and all sinks and washbasins in-any factory or shop, shall be thoroughly cleansed with water every day. The regulations add that in all the above washings and cleanings the water used must have a disinfectant mixed with it. 159 The standard of sanitary accommodation adopted in the borough is that laid down in the Secretary of State's Order for February 4th, 1903, viz. : One sanitary convenience for every 25 persons (with modifications where more than one hundred persons are employed), and with separate accommodation for the sexes where both sexes are employed. workplaces. Workplaces include any place where work is done permanently, and where people assemble together to do work permanently of some kind or other. The kitchens of restaurants, etc., though they are not workshops, come within the meaning of the term " workplace." The number of workplaces on the register at the end of the year was 174 (including food premises, kitchens, etc.) with 308 rooms. Inspections for the year numbered 283, and 40 intimations were served. These premises include stables, builders' yards, restaurants, kitchens, etc. outworkers. The number of premises on the register at the end of the year was 661, using 673 rooms. The number added during the year was 157 and cancelled 61. The number of inspections for the year was 194 and 5 intimations were served. The lists received from employers in the borough numbered 76, giving the names and addresses of 535 persons employed. The references received from other authorities were 663, and forwarded to other authorities 331. 160 In four instances work was found in connection with infected premises, and in each case the necessary disinfection of the materials on hand was carried out before being returned to the employers of the outworkers in question. As pointed out in previous reports this work is of a varied and fluctuating character, causing continual alteration of the registers. This branch of Public Health Administration is an extremely important one, and frequent inspections are necessary, both with a view to remedying sanitary defects and also to ensure against the possibility of disease being spread by the transmission of infected work from one place to another. Special attention was paid to the condition of the outworker's rooms, and when necessary, cleansing was carried out. Inspection of Home Workers. During the year, 194 visits were paid to the homes of outworkers. Special instructions regarding cleanliness and ventilation were given where necessary, and all structural defects were dealt with. Generally speaking the majority of these homes, belonging to the more industrious section of the poorer classes, are kept in a satisfactory state by the occupants. Frequently they are more cleanly than houses kept by women who are not home workers. Home work has no attraction for the indolent sloven, and a woman who is energetic enough to add to the family finances by her personal industry, will make the additional effort of keeping the home and inmates clean and comfortable. Unfortunately when the husband is out of work or dead and the woman becomes the sole bread winner other conditions prevail. Having to work excessively long hours for so small a pay she is handicapped and therefore unable to keep her 161 house in a satisfactory condition, and the good effects of the health inspector's visits are nullified. Any legislation whereby the payment of the worker would be placed on a fair and less precarious basis would be welcomed by all seeking for economy in administration as well as improvement in the health of the people. The overwrought physique of the sweated worker, with underfed body and weakened constitution, and consequent lack of resistance to the inroads of disease, must be one of the causes of an increased death rate. Obviously all sweated labour will be ultimately paid for to the full by the State, when the prematurely incapacitated worker finds his or her inevitable place in the Infirmary or Hospital, or is kept alive by timely but limited payments from some source of Insurance. Street Tpading. So much street trading is carried on by many of the poorer and more sordid inhabitants of the East Ward, that although their trading is by no means confined to this borough, it is incumbent upon me to point out the importance of this form of hawking on the social conditions of the people. Fortunately, religious and other bodies .are taking an increasing interest in social welfare, which fact may be considered as one of the most encouraging and hopeful signs of the times. Street trading commences in childhood, and although no immediate ill effects seem to accrue, yet the more remote effects are in many cases disastrous. From an industrial point of view street trading appears to be a most harmful form of employment for a boy over 14 years of age, for it leads to nothing and offers no prospect of any kind. The employment may be attractive in that the wages 162 seem to be comparatively high and are earned from hour to hour, added to which there is excitement in the work and an absence of definite control. Only a few boys and girls engage in street trade on reaching the age of 14, as their main occupation, but unemployment comes along, and before many months they drift into it. Many boys change readily from one job to another, and fill in the interval by street trading until it becomes an ingrained habit. If, as a result of the evil consequences which follow the practice, boys and girls under 18 were prohibited from trading in the streets, much good would follow. By that time a good idea of a trade would be learnt, and the discipline of the shop would have an elevating influence. An influential committee formed to consider the subject were of the opinion and advised that no girl under 18, and no boy under 11 should be allowed to trade in the street; that boys between 14 and 18 should be prohibited, and that to prevent the employment of boys selling betting papers, they should not be allowed to trade on any day before 4.30 p.m. or after 8 p.m. Premises where Food is Prepared for Sale. These premises were kept under supervision during the year. The number of inspections was 224, and include hotel kitchens, restaurant kitchens, coffee shops, eating houses, fried fish shops, eel pie shops, oyster bars, ham and beef cooking, sausage making, meat chopping, &c., or any place where food is cooked or prepared for sale to the public, or intended for human consumption. The premises added to the register during the year numbered 10, and removals 12, leaving 117 premises on the register. Twenty-five notices were served for amendment of various defects and for cleansing, and these were complied with. k 2 163 The premises were found generally well kept and in good condition, and the occupier always ready to comply with any request as to amendment or cleanliness of the premises. Bakehouses. The number on the register at the end of the year 1910 was 72, 69 as "workshops" and 3 as "factories." During the year one was added to the register, making a total of 73 at the end of the year under report. underground premises. The number of Underground premises in use at the end of the year was 23. cleansing and li me washing. The cleansing and limewashing was regularly done in accordance with the regulations, and any defect or insanitary conditions immediately remedied on discovery. The number of inspections was 249, and in only one case was it necessary to serve a written notice. No legal proceedings were necessary. The bakehouses throughout the borough are kept in a satisfactory condition. With a view to ensuring that the cleansing of bakehouses is carried out periodically as required by the Factory Act, and to avoid the necessity of repeated visits by the Inspector, a copy of the following circular is sent to the occupier of each bakehouse when such cleansing is due to be carried out. To the Occupier of the Bakehouse situate at— No. Dear Sir (or Madam), Section 99, sub-section 1 of the above Act, provides:— "All the inside walls of the rooms of a bakehouse, and all the ceilings or tops of those rooms (whether those walls, 164 ceilings, or tops are plastered or not), and all the passages and staircases of a bakehouse, must either be painted with oil or varnished, or be limewashed, or be partly painted or varnished and partly limewashed ; and (a) Where the bakehouse is painted withoil orvarnished, there must be three coats of paint or varnish, and the paint or varnish must be renewed once at least in every seven years, and must be washed with hot water and soap once at least in every six months ; and (b) Where the bakehouse is limewashed, the limewashing must be renewed once at least in every six months. Sub-section 2 provides :— "A bakehouse in which there is a contravention of this section shall be deemed not to be kept in conformity with this Act." In pursuance of the above, I hereby require you to wash, cleanse or limewash the bakehouse and the passages and staircases thereof in your occupation, and situate at No. during the last week of 19 previous to inspection by me during the first week of 19 And also to carry out such work and do such things as may be necessary for compliance with the said sections of the Act. Dated this day of 19 W. H. White house, Medical Officer of Health. 165 Dairies, Milkshops and Purveyors of Milk. These premises were kept under constant supervision during the year. The number on the register at the end of the period under report was 206. During this period 57 were added and 57 cancelled. The inspections numbered 559, 22 notices being served. The cleansing and limewashing of these premises were carried out as hitherto, and any repairs found necessary were duly enforced. Corroded cans and measures were prohibited. The following cases of infectious disease occurred in connection with these premises:— Scarlet Fever 3 cases. Chicken Pox 1 case. Diphtheria 2 cases. 6 cases. In each instance action was taken in accordance with the Dairies, Cowsheds and Milkshops Orders, the sale of milk being prohibited until after disinfection and certification of the premises by the Medical Officer of Health. Ice Cream. These premises received the usual attention during the season of the year in which the business is carried on, and where necessary, cleansing, etc., were carried out. In the case of street barrows, every effort is made to make the vendor carry a supply of clean water on the barrow ; but, as remarked in previous reports, the Italian itinerant vendor cannot be accused of over care in the matter of cleanliness. I am pleased to report, however, that the number of these barrows shows a tendency to decrease. The number of premises on the register at the end of the period under report was 129; 22 being added and 15 removed. The number of inspections was 197; 19 notices being served. 166 One prosecution was recommended during the period under report, viz. :—Breach of regulations in using a street barrow without name and address thereon. The offender in this case disappeared before the summons could be served. Cowsheds. The following are the cowsheds in the borough at present licensed by the London County Council:— Weston, J. & Sons, 33 Octavius Street 25 cows Do. 211 Railway Arches, Edward Street 17 cows Total 42 cows One cowshed at 178-182 Grove Street was closed during the year, and no further license applied for. The periodical cleansing and limewashing was regularly carried out in accordance with the bylaws. Number of cowsheds in the borough 2 Number of cows allowed 42 Number of inspections for the year 27 Slaughter Houses. The following are the slaughter houses in the borough at present licensed by the London County Council:— Wellbeloved, Alfred, 180 Brockley Road. Lane, Frank, and Wellbeloved, Sidney John, 13a High Street. Williams, William, Friendly Mews, Friendly Street. The premises were cleansed and limewashed every quarter as required by the bylaws. Number of slaughter houses in the borough 3 Number of inspections for the year 46 167 Offensive Businesses. There are still two premises in the borough of offensive businesses under the offensive trade regulations of the London County Council, viz.:— Messrs. Wheen & Sons, Ltd., Copperas Street. Messrs. Hill 6c Sons, Ltd., 1 Frankham Street. Number of inspections during the year 35 The offensive trade at 6 Edward Street was discontinued during the year. The premises were periodically cleansed and limewashed in accordance with the regulations. I am pleased to report that very few complaints were received in reference to these premises, and that they were well supervised. Table. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDINGS DURING 1911. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of prosecutions On register at end ol 1010 Added l'Jll Removed 1911 On register at end of 1911 Milk premises 20G 57 57 206 559 22 1 Cowsheds 2 .. .. 2 27 1 .. Slaughter-houses 3 .. .. 3 46 .. .. Other offensive trade 3 .. 1 2 35 .. .. premises Ice cream premises ... 122 22 15 129 197 19 1 Registered houses let in lodgings '273 .. •• 273 273 (a)* (b)*9 (a)* (b)* *(a) For overcrowding. * (b) For other conditions. 168 Table. METROPOLITAN BOROUGH OF DEPTFORD. PUBLIC HEALTH DEPARTMENT. TABULATION OF REPORT AS REQUIRED BY S. 131 OF THE FACTORY AND WORKSHOP ACT, 1901. INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES, during 1911. CLASS OF WORK. Number of Places Number of Inspections. Number of N umbeij of Prosecutions. On Register at end of 1910. Addec 1911. Removed 1911. On Register at end of 1911. Written Intimations. Notices. L' nder Factory Acts. L'nder Public Hea It h Acts. Premises. Rooms Factories Factory Laundries 8 8 38 19 Factory Bakehouses 3 3 5 9 Other Factories 112 6 2 116 237 120 2 Workshops Workshop Laundries 9 9 31 18 8 WorkshopBakehouses 09 1 70 75 240 1 Other Workshops 186 34 26 194 315 121 8 Workplaces Places where Food is prepared for Sale Workplaces other than 119 10 12 117 247 224 7 18 the above 51 8 2 57 61 59 15 Home-workers Premises 565 157 61 661 673 194 5 Total 1122 216 103 1235 1682 1004 271 32 169 Table. METROPOLITAN BOROUGH OF DEPTFORD This Table is by request of the Secretary of State. Annual Report of Medical Officer of Health for the year 1911. On the Administration of the Factory and Workshop Act, igoi, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. i.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 149 3 Workshops (including Workshop Laundries) 379 15 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 283 40 Total 810 58 2 —DEFECTS FOUND. PARTICULARS. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts. Want of Cleanliness 167 167 Want of Ventilation 2 2 Overcrowding Want of Drainage of Hoors Other Nuisances 181 181 Sanitary Accommodation Insufficient 3 3 Unsuitable or defective Not Separate for Sexes 77 77 Offences under the Factory and Workshop Act. Illegal Occupation of Underground Bakehouse (s. 101) Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) Other Offences (excluding offences relating to outwork which are included in Part 3 of this Report) Total 430 430 170 Table—continued. 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS. SECTION 107. OUTWORK IN UNWHOLESOME PREMISES. SECTION 108 OUTWORK IN INFECTED PREMISES. SECTIONS 109. 110. Lists received from Employers. Addresses of Outworkers. Notion served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made »S. 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Inspections of Outworkers' premises. Lists. Outworkers. Lists. Outworkers. Received from other Councils. Forwarded to other Councils. tractors. men tractors men 1 2 3 4 5 6 7 R 10 11 12 13 14 15 18 17 IS 19 Wearing Apparel— (1) making, &c. 69 16 504 5 .. 13 651 330 77 .. .. 194 .. .. .. 4 (2) cleaning and washing Lace, lace curtains and nets '2 Artificial flowers Nets, other than wire nets Tents . Sacks 6 Furniture and Upholstery 2 .. 2 .. .. •• 2 2 Fur pulling 1 1 Feather sorting \ Umbrellas, &c. Carding, &c., of buttons, &c. Paper Bags and Boxes Basket making Brush making .. .. .. .. .. .. 1 Racquet and tennis balls Stuffed Toys File making Electro Plate Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Pea picking Total 71 16 506 5 18 663 331 79 194 4 171 Table-continual. 4.—REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year Number. Bakehouses 70 Dressmaking 60 Laundries 9 Millinery 13 Shirtmaking 4 Tailoring 18 Wheelwrights (Smiths, &c.) 19 Blouse-making 11 Others 69 Total number of Workshops on Register 273 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 20 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5) ( Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 4 Other 20 Underground Bakehouses (s. 101) :— Certificates granted during the year In use at the end of the year 23 172 Canal Boats. For the year ended 31st December, 1911, the report of Inspector Turner respecting the inspection of registered canal boats and non-registered canal boats was as follows : — For the purposes of Inspection during the year, 25 visits were made on the following dates, viz :— January 6 ; February 4, 6 and 21 ; March 6 and 23 ; April 8, 10 and 22; May 9, 10, 15 and 24; June 6, 21 and 27; July 21; August 23; September 8, 15 and 22; November 11 and 25; December 11 and 16. Boats were found and inspected on the following dates, viz.:— January 6; February 4, 6 and 21 (2 boats) ; March 6 and 23; April 8 and 10; May 10, 15 (3 boats) and 24; June 6, 21 (2 boats) and 27 (2 boats) ; September 8, 15 (2 boats) and 22 (2 boats); December 11 and 16. Number of visits 25 Number of boats inspected 26 INFRINGEMENTS. The following matters were found requiring attention:— February 21. Boat "Vulture," No. 399. Carrying wrong registration papers. Proper papers provided on service of notice, and certified. May 3. Boat " Dauntless," No. —. Carrying wrong registration papers and no number painted on boat. Notice served. Certificate not to hand. 173 CHILDREN ON BOATS. During the year children of school age were found in seven boats ; in each case information was forwarded to the local education authority for their attention. No cases of sickness were found on the boats during the year. The boats inspected were found in a clean and habitable condition. The canal under the jurisdiction of this authority is very little used, but the report shows a slight increase in the number of boats inspected during this year. This Borough is not a Registration Authority. The arrangements made for the Inspection of boats are:— Periodical inspection by Sanitary Inspector, duly appointed an Inspector under the Canal Boats Acts, jointly with other duties as Inspector of Workshops, Dairies, Cowsheds, and Milkshops, etc. Sale of Food and Drugs Acts. The total number of samples purchased during the year and examined by the Public Analyst was 430. The following is a list of the articles purchased, with the result of analysis:— 174 Article. Number Genuine. Number Adulterated. Total. Percentage of Adulterations. Arrowroot 2 0 2 0 Butter 84 1 85 1.18 „ Milk-blended 6 0 6 0 Cocoa 2 0 2 0 Coffee 3 0 3 0 Lard 14 0 14 0 Margarine 1 0 1 0 *Milk 229 36 265 13.58 „ Separated 16 6 22 27.27 „ Skimmed 3 1 4 25.0 Mustard 10 0 10 0 Pepper 16 0 16 0 Total 386 44 430 10.23 *Warranties.—It is the practice of the Food Inspectors when sampling to inquire whether a warranty in any form is held by the vendor, and if there be a warranty and the sample prove to be adulterated, to take a sample of the milk of the guarantor upon delivery at the vendor's premises. The control sample is not a sample of the suspected milk, but it affords evidence in some degree of the kind of milk supplied by the guarantor. The Board of Agriculture point out that the repeal of the Warranty Clauses as demanded by those who desire to strengthen the law as to fraudulent adulteration as well as those who desire to protect the farmer. It is alleged that certain dealers and milk-sellers are adulterating milk and selling the milk which they know to be adulterated, relying on those clauses to afford an almost certain way of escape in case they are prosecuted. Deterioration of Milk in Transit.—At the last meeting of the Gloucester Chamber of Agriculture the County and City Analyst, Mr. George Embrey, related the results of investigations into the problem of preventing the deterioration of milk in transit from the farm to the wholesale depot in London. Mr. Embrey had consignments of milk from Gloucester to London kept under close observation, and yet the milk, which contained 4-3 per cent, at the farm, showed only 3*5 per cent, when it reached the depot. In the unloading of the milk at London it was discovered that there were considerable leakages as the result of the tilting and rough handling of ihe churns. The shaking on the railway aids the rising of the cream to the surface, so that the milk that is lost is the richest, and this is suggested as the explanation of the extent of the deterioration. Mr. Embrey has been giving attention to the perfecting of a churn which will make leakages impossible, and hopes by means of indiarubber rings to solve the problem. The loss of 0 8 per cent, on the railway journey is serious both for producers and distributors in that the average milk is unable to bear so great a reduction and comply with the Government standard of 3 per cent, butter fat.— The Times, February 11, 1911. 175 Particulars of Action taken with regard to Samples found to be Adulterated. Sample. Fine. Costs. Totals. Remarks. £ s. d. £ s. d. £ s. d. Milk 66 O 1 0 0 0 19 6 1 19 6 „ 69 O .. 0 12 0 0 12 0 „ 66 S 25 0 0 0 2 0 25 2 0 „ 67 S 0 10 0 0 2 0 0 12 0 Milk, separated „ 55 P 2 0 0 1 2 0 3 2 0 The above samples were taken during 1910, but summonses were not heard until the period covered by this report. Milk 9 K .. .. Summons dismissed (warranty). „ 3 O .. 0 12 0 0 12 0 „ 8 O .. 0 12 0 0 12 0 „ 18 S .. 1 7 0 1 7 0 „ 2 SY .. 0 12 0 0 12 0 „ 1 T .. 1 0 0 1 0 0 „ 4 T .. .. .. Summons dismissed (warranty). „ 8 T .. .. .. Do. „ 17 K .. .. .. Vendor cautioned. „ 32 K 5 0 0 0 12 0 5 12 0 „ 15 O .. .. .. Vendor cautioned. „ 28 O .. 0 12 0 0 12 0 „ 19 P .. .. .. Vendor cautioned. „ 24 S .. .. .. Do. „ 35 S 2 0 0 0 14 0 2 14 0 „ 36 S .. 0 14 0 0 14 0 „ 37 S .. 0 14 0 0 14 0 „ 38 S 1 0 0 0 13 6 1 13 6 „ 24 SY .. .. .. Summons dismissed (warranty). „ 26 SY .. .. .. Do. „ 24 T .. .. .. Vendor cautioned. „ 41 K .. .. .. Do. „ 36 O 1 0 0 0 12 0 1 12 0 „ 38 O .. .. .. Summons dismissed (warranty). „ 40 O 1 0 0 0 12 0 1 12 0 „ 41 P .. .. .. Summons dismissed. (warranty). „ 41 S .. .. .. Do. „ 42 S .. .. .. Summons dismissed. Council to pay 10s. 6d. costs. „ 45 S .. .. .. Summons dismissed (warranty). „ 38 SY 2 0 0 0 12 0 2 12 0 „ 40 SY .. .. .. Vendor cautioned. Milk, separated 1 O 2 0 0 0 12 0 2 12 0 2 O 3 0 0 0 12 0 3 12 0 ,, 21 SY .. .. .. Vendor cautioned. 39 S .. .. .. Do. 42 P 1 0 0 1 0 0 2 0 0 Skimmed Milk 10 P 1 10 0 1 3 0 2 13 0 Totals £48 0 0 £16 3 0 £64 3 0 176 Legal Proceedings. 22nd March and 5th April, 1911. William Knight, 31 Blackheath Hill, Greenwich. Making default in complying with a notice requiring him to abate a nuisance arising at No. 187 Church Street, Deptford, by reason of defective w.c. drain. Work executed. 8s. costs paid. Summons withdrawn. July 20th, 1911. Thos. Lacey, 29 Billingsgate Street, Greenwich. Not exhibiting on his barrow the name and address of the person from whom he obtained the ice cream he was selling. Summons not served. August 31st, 1911. John McMenemy, 120 Camberwell Road. Selling from a can on which his name and address ' were not inscribed. Fined 5s. and 2s. costs. September 27th, 1911. Mrs. Ann Bray, 71 Crofton Road, Peckham. Fixing in connection with the w.c. at 11 Chubworthy Street a basin and trap, without giving notice in writing to the Sanitary Authority as required by the bylaws. Fined 10s. and 2s. costs. November 29th and December 13th, 1911. Benjamin Gale, 34 Pepys Road, New Cross. Fixing at 27 Wagner Street in connection with the w.c., certain apparatus, without giving notice to the Sanitary Authority as required by the bylaws. Fined 2s. and 2s. costs. Unsound Food Destroyed. 1 lb. ham rashers—Inspector Simpson. 1 box whiting— „ Priest. 1 box coddling, 3 barrels of grapes— „ Shelley. 24 rabbits— „ Snowden 1 box cod roes— „ Owner. 7 gallons shrimps— „ Hewett. 3 tins canned fish— ,, Turner. 177 Canned Fish. Concerning canned salmon the following is the description a firm of cannersgave to Dr. A. E. Harris with full particulars as to the methods they adopt at their Vancouver cannery in preparing the salmon for sale. They are as follows :— 1. The salmon are caught in nets, seines and traps and are brought to the canneries in boats or steamers. 2. They are raised from these vessels by elevators to the fish dock. 3. They are given a thorough external washing. 4. They are butchered and cleansed by machinery. 5. They are critically examined and passed into the brine tanks for a final cleansing. 6. They are passed into the dripping tank, where all the water is drained off from them. 7. The fish are conveyed by endless chain carriers to the cutting machine, where the salmon is divided into pieces the length of a can by rapidly revolving circular knives. 8. In the case of the flat and oval 1 lb. and i lb. cans, the salmon is packed by hand, as no practical machines for dealing with these cans can be devised, but over 80 per cent, of all salmon is packed by machinery in the tall cans, as a machine does not get tired and neglectful. These tall cans are fed with salmon from large hoppers, which are attached to the cutting 178 machines. The salmon having been first cut into cylindrical pieces, the pressure of a piston presses it into the cans. 9. To each can is added, before being filled with fish, one- quarter of an ounce of table salt. 10. From the filling machines the cans are transferred to tables where they are thoroughly inspected, weighed, and any deficiency supplied. 11. Endless belts convey the cans to cleansing machines, where the exterior is subjected to a jet of hot air under high pressure and then polished with rapidly rotating wire brushes. 12. The tops are placed on the cans and soldered, after which they pass over runways under numerous jets of cold water which cools the solder. 13. The central vents of the tops, which are open until this stage of the process, are sealed. 14. The cans are placed in open steel trays, or coolers, as they are called, which are immersed in tanks of hot water; air bubbles, escaping, call attention to leaking tins, which are removed and passed on to the leak menders for immediate repair. The contents of a mended can are as good as any other. 15. The trays containing the cans are then placed one upon another on cars and run into a track into steel retorts, where the salmon is subjected to the first cooking. This requires about 50 minutes under steam pressure of 6 lbs., equal to a temperature of 220° Fahrenheit. 179 16. The cans are withdrawn and vented by piercing the tops with small brads to allow the hot air to escape. After this the second vent holes are soldered. 17. The cans are placed in another retort for the second cooking under steam pressure of 12 lbs., or at a temperature of 240° Fahrenheit. 18. After the second cooking the cans are cleansed by scouring them in a tank of strong lye and then washing in boiling water and lastly in cold water, after which they are allowed to stand for several weeks, during which time they are repeatedly tested and examined for defects. AH such cans are removed. 19. Finally they are dipped into lacquer to prevent rust and are then cased. It will be noticed that the cans are pierced twice, and consequently such a fact in this method of canning is not the suspicious circumstance, which writers on tinned goods usually hold double piercing to be. Conference of Metropolitan Cities and Boroughs on matters relating to Public Health, convened by the London County Council, at Spring Gardens, S.W., Thursday, 6th April, 1911. HOUSES LET IN LODGINGS. That the efficient administration of Section 95 of the Public Health (London) Act, 1891, relating to the registration and regulation of houses let in lodgings is a matter of extreme importance to the public health of London. 180 PULMONARY TUBERCULOSIS. {a) That the principle of compulsory notification should be extended to all cases of pulmonary tuberculosis. (h) That the establishment of tuberculosis dispensaries throughout London is urgently required. MEASLES. (a) 1. That the better organization is desirable in London for the control of measles in schools. 2. That during a serious outbreak of measles children under five years of age should be excluded from school attendance. 3. That compulsory notification of measles is desirable. 4. That the cleansing of infants' departments and of the furniture, lower walls, and floors thereof shall take place once a week. 5. That accommodation should be provided in the Metropolitan Asylums Board Hospitals for urgent non-pauper cases of measles. (b) That in the interests of public health the school regulations should provide that all children from houses infected with measles should be prohibited from school attendance. WATER SUPPI.Y TO TENEMENT HOUSES. That houses of three or more stories occupied by more than one family of the working class should have at least one water supply and a sink placed on a landing convenient for the occupants of the second and third stories. 181 PLACES WHERE FOOD IS PREPARED AND EXPOSED FOR SALE. (a) That it is desirable that regulations should be made to limit the pollution resulting from exposure in an improper manner in public places or adjacent to the public way of food and food receptacles. (b) That it is desirable that all places where food is prepared for sale should be regulated by bylaws made by the London County Council and administered by the Sanitary Authorities, and should be subject to annual licensing by the Sanitary Authority. NOTIFICATION OF BIRTHS ACT, 1907. That in view of the adoption of the Notification of Births Act, 1907, throughout London, and the provisions of the recent Orders of the Local Government Board with regard to the compulsory notification of consumption, the appointment of one or more women health visitors or women sanitary inspectors in each metropolitan borough is eminently desirable. CHAPELS OF REST. That it is desirable that chapels of rest, apart from mortuaries for bodies awaiting inquest, should be established by Sanitary Authorities. That all private mortuaries should be registered and regulated. 182 Recommendations for Future Consideration. In his Annual Report the Medical Officer of Health is requested by the Local Government Board to indicate directions for further consideration and action. While many points for consideration are included in the body of the report, I would recommend that the following further matters should receive attention (.1) The opening up of certain blind streets and the making of open thoroughfares. (2) The formation of an Anti-Tuberculosis Dispensary. (3) The provision, when required, of two or three beds in a Sanatorium for suitable cases of Pulmonary Phthisis, and the provision of shelters for the homes in necessitous cases of Consumption. (4) The formation of a voluntary ladies' health society. Sanitary Legislation. 185 National Insurance Act. The most important measure considered by Parliament during 1911 was the National Insurance Bill; apart from this Act but little time has been devoted to sanitary legislation. But the far-reaching influence which such a measure is destined to have on the public health of this country is sufficient justification of any expenditure of labour, if the result be a satisfactory and workable scheme. A general sketch of its aims from the point of view of public health adminstration is all that can be attempted. It will be the details, to be framed by the Insurance Commissioners, which will be of chief practical interest from the point of view of local sanitary administration. The Act is one to " provide for insurance against loss of health, and for the prevention and cure of sickness, and for insurance against unemployment, and for purposes incidental thereto." It consists of 115 clauses and 10 schedules, divided into three parts. Part I. deals with National Health Insurance, Part II. with Unemployment Insurance, and Part III. contains some general provisions. The benefits conferred by Part I. (affecting us) of the Act are enumerated in Clause 8, as follows:— (b) Treatment in sanatoria or other institutions or otherwise when suffering from tuberculosis, or such other diseases as the Local Government Board with the approval of the Treasury may appoint (in this Act called "sanatorium benefit"). By Clause 14 sickness benefit, disablement benefit, and maternity benefit shall be administered, in the case of insured persons who are members of an approved society by and 186 through the society, or a branch thereof, and in other cases by and through the Local Health Committees; medical and sanatorium benefits shall in all cases be administered by and through the Local Health Committees. From the point of view of the Local Sanitary Authorities Clause 16, which deals with the administration of sanatorium benefit, is perhaps one of the most important. It provides that for the purpose of administering sanatorium benefit Local Health Committees shall make arrangements to the satisfaction of the Insurance Commissioners:— (a) With a view to providing treatment for insured persons suffering from tuberculosis or any other such diseases as aforesaid in sanatoria and other institutions, with persons or local authorities (other than poor law authorities), having the management of sanatoria or other institutions approved by the Local Government Board, which treatment it shall be lawful for a local authority to provide as respects insured persons resident outside as well as respects those resident within their area; and (b) With a view to providing treatment for such persons otherwise than in sanatoria or other institutions, with persons and local authorities other than Poor Law Authorities undertaking such treatment in a manner approved by the Local Government Board, which treatment (including the appointment of officers for the purpose) it shall be lawful for a local authority, if so authorised by the Local Government Board, to undertake. And under Clause 17:— (l) The Local Health Committee for any county or county borough may if it thinks fit, extend sanatorium benefit to the dependants of the insured persons 187 resident in the county, or any part of the county, or in the county borough, or any class of such dependants, and in such case the arrangements to be made by the committee shall include arrangements for the treatment of such dependants, and the sums available for sanatorium benefit shall be applicable to the purpose. Approved societies or Local Health Committees are to be empowered (Clause 20) to subscribe to hospitals and other charitable institutions, and to the support of district nurses, and to appoint and pay nurses to visit and nurse insured persons. And by Clause 21 town councils and district councils are to be empowered to contribute to certain expenditures on medical and sanatorium benefits. One of the most drastic of the clauses of the Act is the sixty-second, which provides that, where it is alleged by the Insurance Commissioners or by any approved society or local Health Committee that the sickness which has taken place among any insured persons being, in the case where the allegation is made by a society or committee, persons for the administration of whose sickness and disablement benefits the society or committee is responsible, is excessive, and that such excess is due to the conditions or nature of employment of such persons, or to bad housing or insanitary conditions in any locality, or to an insufficient or contaminated water supply, or to the neglect on the part of any person or authority to observe or enforce the provisions of any Act relating to the health of workers in factories, workshops, mines, quarries, or other industries, or relating to public health, or the housing of the working classes, or any regulations made under any such Act, or to observe or enforce any public health precautions, the Commissioners or the society or committee making such allegation may send to the person or authority alleged to be in default a claim for the payment of the amount or any extra expenditure alleged to have been incurred by reason of such 188 cause as aforesaid, and if the Commissioners, society, or committee and such person or authority fail to arrive at any agreement on the subject, may apply to the Secretary of State or the Local Government Board, as the case may require, for an inquiry, and thereupon the Secretary of State or Local Government Board may appoint a competent person to hold an inquiry. If upon such inquiry being held it is proved to the satisfaction of the person holding the inquiry that the amount of such sickness has— (i.) during a period of not less than three years before the date of the inquiry; or (ii) if there has been an outbreak of any epidemic, endemic, or infectious disease during any less period ; been in excess of the average expectation of sickness by more than ten per cent., and that such excess was, in whole or in part, due to any such cause as aforesaid, the amount of any extra expenditure found by the person holding the inquiry to have been incurred under this part of this Act by any societies or committees where the allegation is made by the Insurance Commissioners, or if the allegation is made by a society or committee by the society or committee in question by reason of such cause shall be ordered by him to be made good in accordance with certain provisions. From the decision of the person holding this inquiry there is no appeal. The provision of means for the sanatorium treatment of tuberculosis is one of the best features of this measure. Under the Finance Act a large sum is made available for the provisions of sanatoria and other institutions "for the treatment of tuberculosis or such other diseases as the Local Government 189 Board with the approval of the Treasury, after consultation with the Insurance Commissioners, may appoint" (Clause 63). This sum is to he distributed by the Local Government Board, with the consent of the Treasury, in making grants. When a grant is made to a county council the Board may authorise the council to provide the requisite institution and erect the necessary buildings, and manage and maintain the institution, any expenses of the council not covered by the grant being defrayed out of the county fund. Provision is also made for the constitution by the Local Government Board of joint committees, joint boards, etc., for the joint exercise of these powers by county councils, county borough councils, and other local authorities. The second part of the Bill, relating to "Unemployment Insurance," only indirectly affects sanitary administration. Rag Flock Act, 1911. A source of real danger to health will it may be hoped, be neutralised by the Rag Flock Act, 1911, which prohibits the use in the manufacture of upholstery, cushions, bedding, etc., of rag flock, unless it has satisfied the standard of cleanliness which the Local Government Board are empowered to set up. In order to allow manufacturers a reasonable interval in which to dispose of their present stocks, and provide suitable cleansing apparatus, the operation of the Act has been postponed until 1st October, 1912. In the meantime, regulations fixing the standard of cleanliness will be carefully considered, and be issued by the Local Government Board. Health Visitors' Bill. Amongst the Bills thrown out at the end of the session had to be included the Health Visitors' Bill, which had been introduced with the view of supplementing the Notification of Births Act, 1907. At present Local Authorities outside London 190 are at a disadvantage in this matter, as they have no legal power to pay health visitors. The Bill would have empowered Local Authorities to appoint and pay suitable women as health visitors " for the purpose of giving to persons advice as to the proper nurture, care, and management of children under five years of age, including the promotion of cleanliness." Pollution of Rivers. Legislation dealing with the Pollution of Rivers has had to be postponed once more. This matter cannot be indefinitely postponed, and it is hoped that time for its consideration may be found in an early session. Consolidation of the Public Health Acts. The necessary Consolidation of the Public Health Acts seems farther off than ever, but that also is a matter which cannot be indefinitely put aside. Public Health (Tuberculosis) Regulations, 1911. During the past year the Local Government Board have taken a long step in connection with the crusade against consumption by providing by means of regulations under Section 130, Public Health Act, 1875, for the compulsory notification of cases of pulmonary tuberculosis. Regulations requiring the notification of cases occurring in hospitals, sanatoria, and institutions of that kind came into operation on 1st May, 1911; the regulation dated 15th November, 1911, requiring medical practitioners to notify every case of pulmonary tuberculosis occurring in the course of their public or their private practices, conies into operation on 1st January, 1912. It is to be hoped that the campaign against this disease may eventually meet with great success. 191 New London County Council By-Law with respect to Deposition of Plans. The following is an outcome of the case of Kershaw v. Brooks, in which the Divisional Court held that the obligation of giving notices and depositing plans under the London County Council By-laws relating to drainage was not binding upon builders. In view of the unexpected difficulty thus encountered representations were made to the London County Council, with the result that new By-laws were made by the London County Council in July last, and same have since been approved by the Local Government Board. The new By-laws are :— 1. Notwithstanding anything contained in the By-laws made by the London County Council in pursuance of the provisions of Section 202 of the Metropolis Management Act, 1855, and the Metropolis Management Acts Amendment (By-laws) Act, 1899, in the case of any work done to or in any pipe, drain, or other means of communicating with sewers and traps and apparatus connected therewith, such plans, sections, and particulars relating to such work as are required to be deposited by the said By-laws shall be deposited by the builder, and he shall be the person liable to the penalties provided in the said By-laws for the failure to deposit such plans, sections, and particulars. Such builder shall in carrying out any such work as aforesaid, observe all the requirements contained in the By-laws made by the London County Council under the provisions of Section 202 of the Metropolis Management Act, 1855, and H E shall be liable to the penalties provided for a breach of the said By-laws. 2. In these By-laws "builder" means the builder, tractor, or person actually carrying out the work, but does not include a workman in the employ of such builder, contractor, or person. APPENDIX. Tables. 195 Meteorology for 1911 (Greenwich Record). Month. Barometer Air Temperature. Earth Temperature at 4ft depth. Rainfall. A Maximum B Minimum. Mean of A and B. ins. 0 0 0 0 ins. January 30.147 42.0 34.2 38.1 42.8 1.23 February 30.009 46.0 35.3 40.7 41.7 1.38 March 29.738 48.4 35.8 42.1 43.2 1.66 April 29.846 55.3 88.6 46.9 44.7 1.73 May 29.815 68.1 46.3 57.2 51.7 1.88 June 29.827 70.9 50.3 60.6 58.6 2.10 July 29.990 81.1 55.0 68.0 62.7 0.27 August 29.845 81.1 57.0 69.0 66.4 1.34 September 29.892 72.1 47.9 60.0 62.8 1.34 October 29.742 57.4 43.9 50.7 56.0 3.30 November 29.569 49.2 38.4 43.8 50.1 3.42 December 29.577 48.6 39.7 44.1 46.3 4.02 Means 29.833 60.0 43.5 51.8 52.2 23.67 sum 196 197 Analysis of the Vital Statistics of the Metropolitan Boroughs and of the City of London after Distribution of Deaths occurring in Public Institutions during 1911. Boroughs. Estimated Population middle of 1911. Births. Deaths. Annual Kate per 1000 Living. Deaths from Principal Infectious Diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea and Enteritis (under 2 years). Phthisis. Deaths of Children under 1 year of age to 1,000 Registered Births. Births. Deaths. Principal Infectious Diseases. County of London 4,522,628 112,793 67,826 25.0 15.0 2.2 9,858 9 2,570 172 612 1,038 144 5,313 6,084 128 Paddington 142,541 2,815 1,897 19.8 13.3 1.7 245 – 48 3 11 44 5 134 173 137 Kensington 172,296 3,040 2.349 17.7 13.7 1.9 318 – 94 2 18 44 4 134 159 142 Hammersmith 121,837 2,806 1,891 23 1 15 6 2.4 289 – 36 5 28 54 7 146 153 153 Fulham 153.726 4,012 2,203 26.2 14.4 2.3 347 – 64 7 27 35 8 178 224 129 Chelsea 66,218 1,187 1,020 18.0 15.5 1.5 101 – 30 1 5 10 – 213 96 116 City of Westminster 159,709 2,109 1,983 13.2 12.5 0.8 133 – 23 3 14 26 4 55 193 116 St. Marylebone 117,844 4.075 1.772 34.7 15.1 1.6 191 – 66 7 5 28 2 63 172 63 Hampstead 85,599 1,198 823 14.0 9.6 0.7 58 – 14 – 17 3 2 83 52 83 St. Pancras 218,031 5,132 3,371 236 15.5 1.9 420 – 108 12 37 55 7 22 342 122 Islington 327.234 7.728 4,853 23.7 14.9 2.0 649 – 130 21 51 70 12 201 405 134 Stoke Newington 50,669 958 658 19.8 13.0 1.6 81 – 28 3 3 18 1 365 55 107 Hackney 222,674 5,378 3,185 24.2 14.3 2.0 440 – 148 11 20 58 8 28 311 115 Holborn 49,084 1,272 768 26.0 15.7 1.2 61 – 15 3 3 3 3 195 102 86 Finsbury 87,639 3,253 1,728 373 19.8 3.2 276 – 79 6 17 24 8 34 163 128 City of London 19,475 410 293 21.1 15.1 0.7 14 – 1 1 1 1 – 142 31 68 Shoreditch 111,284 3,399 2,226 30.7 20.1 3.7 413 – 128 6 24 32 1 10 204 177 Bethnal Green 128,247 3,866 2,320 30.3 18.2 3.6 455 – 130 5 21 49 3 248 208 158 Stepney 279,560 9,076 4,833 32.6 17.4 3.1 872 7 303 7 32 49 6 468 493 139 Poplar 162,290 4,877 3,354 30.1 18.9 4.0 655 2 225 10 44 44 14 316 213 161 Southwark 191,.595 5,408 3,509 28.3 18.4 2.7 523 – 120 6 30 64 5 298 326 151 Bermondsey 125,840 3,827 2,311 30.5 18.4 2.7 341 55 6 13 50 5 212 223 159 Lambeth 298,032 8,4O4 4,430 28.3 14.9 1.9 578 – 112 8 43 67 12 336 419 107 Battersea 167,765 4, 154 2,39' 24.8 14.3 2.4 397 – 112 4 20 36 3 222 223 130 Wandsworth 313,389 6,584 3,743 21.1 12.0 2.1 645 – 2 30 10 33 70 9 293 277 125 Camberwell 261,407 6,246 3,724 24.0 14. 3 l.8 470 – 112 7 25 45 5 276 350 111 Deptford 109,475 3,001 1,728 27.4 15.8 2.7 298 – 67 7 15 35 2 172 144 143 Greenwich 95,982 2,381 1,409 24.9 14. 7 2.4 229 – 41 3 16 14 3 152 112 123 Lewisham 161,677 3,397 1,821 21.1 11.3 1.3 205 – 21 5 28 18 5 128 104 104 Woolwich 121,509 2,842 1,555 23.5 12.8 1.2 150 ' – 28 3 11 6 – 102 162 96 198 199 Analysis of the Vital Statistics of Seventy-seven of the Largest English Towns during 1911. Towns, Estimated Population middle of 1911. Births. Deaths. Annual Kate per 1,000 Living Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough Enteric Fever. Diarrhœa and Enteritis (under two years of age) i Deaths of Children under one year of age to 1,000 Births. Kate per cent. of Uncertified Deaths. Births. Deaths 77 Towns 16,157,797 412,723 249,385 25.6 15.5 12 7,563 1,025 2,443 3,839 983 21,120 140 0.8 76 Provincial Towns 11,635,169 299,928 181,559 25.8 15.6 3 4,993 853 1,831 2,801 839 15,807 145 1.0 London 4,522,628 112,795 67,826 24.8 15.0 9 2,570 172 612 1,038 144 5,313 128 0.1 Croydon 170,451 3,760 2,012 22.1 11.8 — 30 7 36 39 4 198 106 — Willesden 155,253 3,864 1,821 25.0 11.8 — 50 5 12 86 1 36 128 0.2 Hornsey 84,916 1,453 805 17.2 9.5 — 20 1 5 14 3 153 80 — Tottenham 138,326 3,78I 1,807 27.4 13.1 — 74 1 14 20 26 513 125 0.1 West Ham 289,646 8,658 4,554 30.0 15.8 — 229 7 49 67 8 197 144 0.1 Kast Ham 134,441 3,448 1,628 25.7 12.1 71 2 11 13 6 108 121 0.1 I.eyton 125,382 3,061 1,512 24.5 12.1 — 76 7 15 18 3 115 109 0.1 Walthamstcw 125,334 3,106 1,451 24.8 11.6 — 32 4 30 4 — 38 110 0.1 Hastings 61,036 953 827 15.7 13 .6 — 12 3 1 16 2 89 105 0.4 Brighton 131,444 2,583 1,802 19.7 13.8 — 7 9 10 40 26 276 98 — Portsmouth 232,221 5,787 3,255 25.0 14.1 — 28 21 6 3 1 47 126 0.6 Bournemouth 79,150 1,202 901 15.2 11.4 — 19 — 22 18 3 154 102 0.3 Southampton 119,394 2,850 1,808 23.9 15.2 — 10 5 18 20 8 39 134 — Reading 75,289 1,601 889 21.3 11.8 — 9 3 13 7 11 101 99 2.5 Northampton 90,152 1,926 1,185 21.4 13.2 — — — 11 2 1 68 128 0.8 Ipswich 74,122 1,769 921 23.9 12.5 — — — 2 16 2 61 101 — Great Yarmouth 55,920 1,357 799 24.3 14.3 — 24 — 20 40 8 107 123 — Norwich 121,682 2,716 1,717 22.4 14.1 — 43 25 16 53 7 114 135 0.3 Plymouth 112,152 2,607 1,919 23.3 17.2 90 — 18 5 13 73 145 — Devonport 81,975 2,101 1,094 25.7 13.4 — 105 2 40 3 15 344 114 — Bristol 357,509 7,756 5,389 21.8 15.1 — 164 15 89 143 26 614 141 0.1 Stoke-on-Trent 235,049 7,383 4,663 31.5 19.9 — 93 62 — 72 — 43 202 1.7 Burton-on-Trent 48,222 1,063 636 22.1 13.2 — 1 3 5 8 1 136 107 2.4 Wolverhampton 95,362 2,399 1,504 25.2 15.8 — 66 5 11 9 6 167 135 0.1 Walsall 92,273 2,650 1,94 28.8 16 .2 — 21 3 9 40 1 32 160 0.3 Handsworth 69,010 1,442 708 20.9 10.3 — 17 5 6 3 1 112 101 1.1 West Bromwich 68,424 2,038 1,075 29.9 15.8 — 31 1 64 2 3 881 138 1.7 Birmingham 526,030 14,749 8,800 28.1 16.8 1 18 63 10 8 30 63 164 3.5 King's Norton 81,764 1,805 741 22.1 9.1 — 22 4 6 11 — 87 101 2.2 Smethwick 71,085 1,950 1,011 27.5 14.3 — 34 3 6 16 3 157 141 0.7 Aston Manor 74,985 2,026 1,59 27.1 15.5 — 65 9 17 30 3 78 167 0.3 Coventry 107,287 2,886 1,404 27.0 13.1 — 70 31 20 42 10 202 107 2.1 Leicester 227,634 5,160 3.018 22.7 13.3 — 34 9 9 2 18 151 132 0.9 Grimsby 74,951 2,142 1,077 28.7 14.4 — 96 1 31 40 28 410 154 1.6 Nottingham 260,447 6,367 4,171 24.5 16.1 — 55 2 24 23 8 84 162 0.4 Derby 123,648 2,945 1,766 23.9 14.3 — 123 — 200 201 Analysis of the Vital Statistics of Seventy-seven of the Largest English Towns during 1911. (continued) Towns Estimated Population middle of 1911. Births. Deaths. Annual Rate per 1,000 Living. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping-cough. Enteric Fever. Diarrhoea and Enteritis (under two years of age). Deaths of Children under one year of age to 1,000 Births. Rate per cent, of Uncertified Deaths Births. Deaths. Stockport 109,090 2,550 1,712 23.4 15.7 35 4 9 10 10 179 170 0.5 Birkenhead 131,33° 3,748 2,048 28.6 15.6 — 23 4 25 31 9 215 134 0.7 Wallasey 79,137 1,735 974 22.0 12.3 1 6 2 14 7 2 80 108 0.4 Liverpool 747,627 22,506 14,882 30.2 20.0 — 311 128 123 235 32 1,458 154 2.1 Bootle 70,122 2,093 1,233 29.9 17.6 1 22 4 10 25 3 128 148 3.8 St. Helens 96,870 3,204 1,755 33.2 18.2 69 14 7 37 23 207 160 3.6 Wigan 89,340 2,434 1,592 27.3 17.9 — 60 4 11 35 33 208 193 0.1 Warrington 72,376 2,041 1,117 28.3 15.5 — 13 4 10 32 5 127 146 3.8 Bolton 181,202 4,126 2,865 22.8 15.9 — 62 22 42 15 23 338 163 o.5 Bury 58,665 1,204 928 20.6 15.9 — 25 10 4 12 — 56 164 2.2 Manchester 716,166 18,738 12,132 26.2 17.0 — 337 43 84 142 51 1,090 154 0.4 Salford 231,641 6,281 3,847 27.2 16.7 — 98 20 54 37 18 348 149 0.3 Oldham 147,751 3,49I 2,596 23.7 17.6 — 66 5 11 13 3 229 160 0.2 Rochdale 91,645 1,896 1,379 20.7 15.1 — 30 10 3 17 3 92 139 2.4 Burnley 106,569 2,479 1,910 23.3 18.0 — 68 4 21 31 9 259 210 1.8 Blackburn 133,160 2,857 2,140 21.5 16.1 — 30 28 54 9 195 188 1.4 Preston 117,216 2,726 1,971 23.3 16.9 — 5 19 31 21 20 163 172 2.1 Barrow-in-Furness 63,930 1,698 798 26.6 12.5 — 3 4 19 10 4 40 111 3.8 Huddersfield 108,144 2,126 1,618 19.7 15.0 — 17 15 22 11 8 89 132 0.6 Halifax 101,471 1.874 1,534 18.5 15.2 7 8 22 26 11 56 123 0.6 Bradford 288,723 5,477 4,288 19 .0 14.9 — 11 9 50 96 44 195 138 0.1 Leeds 445.983 10,597 7,280 23.8 16 .4 — 78 45 151 147 22 568 158 0.1 Dewsbury 53,411 1,167 919 21.9 17.3 — 25 6 7 15 7 6l 155 — Sheffield 455,793 12,656 7,328 27.8 16.1 — 791 26 44 62 31 534 140 1.0 Rotherham 62,711 1,818 1,016 29.1 16.3 — 56 3 2 15 13 112 157 1.5 York 82,407 1.953 1,100 23.8 13.4 — 9 4 7 25 6 67 113 0.1 Hull 278,968 7,965 4,639 28.6 16.7 — 101 14 21 100 63 55o 155 0.7 Middlesborough 105,124 3,260 2,036 31.1 .9.4 — 79 7 27 78 8 146 169 0.7 Stockton-on-Tees 52,175 1,539 861 29.6 16.5 — 26 4 8 26 6 55 133 0.7 West Hartlepool 63,965 1,849 998 29.0 15.6 — 5 — 16 26 1 86 120 0.7 Sunderland 15,289 4,509 2,708 29.9 17.9 — 49 7 20 93 7 170 151 2.0 South Shields 108,844 3,280 1,854 30.2 17.1 — 40 1 10 23 3 146 147 3.8 Gateshead 117,104 3,562 1,879 30.5 16.1 — 78 4 29 28 2 137 136 4.9 Newcastle-on-T yne 267,162 7,089 4,291 26.6 16.1 — 125 14 37 127 10 225 136 0.3 Tynemouth 59,oc8 1,671 908 28.4 15.4 — 11 — 6 18 5 46 122 1.8 Newport (Mon.) 84,111 2,315 1,120 27.6 13.4 — 16 7 7 11 10 91 121 0.4 Cardiff 182,729 4,740 2,555 26.0 14.0 — 7 15 37 53 6 247 135 0.0 Rhondda 153,775 5,463 2,305 35.6 15.0 — 143 19 20 20 18 3510 164 0.5 Merthyr Tydfil 81,293 2,519 1,260 31.1 15.5 — 7 4 7 7 8 150 152 0.4 Swansea 115,176 3,348 1,860 29.1 16.2 — 32 2 47 16 1 140 136 0.8 203 INDEX. PAGE Acute Polio-Myelitis 77 Adulteration of Food 173-175 Ages at Death 48 Alcoholism 8 Annual Birth and Death rates,and Death-rates of Children 18 Anti-toxin Serum, free distribution of 68 Anthrax 79 Area of Borough 13 Bacteriological Diagnoses 61 Bakehouses 163 Births 17 ,, Illegitimate 19 ,, Notification of 42 Butcher's Shops and Shops where Food is sold 162 Canal Boats 172 Canned Fish 177 Cancer 108 Chicken Pox 76 Common Lodging Houses 139 Condensed Milk, Distribution of 38 Constitutional Diseases 108 Consumption 88 Cost of Notification of Infectious Diseases 60 Conference on matters relating to Public Health 179 Continued Fever 79 204 PAGE Cow Houses 166 Dairies, Milkshops, &c. 165 Deaths 20 „ from Classified Causes 48 „ at different age periods 48 „ in the Wards 21 ,, of Parishioners occurring outside the Borough 20 „ from Epidemic Diseases 55 Deaths registered from all causes during the Year 20 „ „ „ „ Quarter 22 Death rates of Metropolitan Boroughs 196 „ ,, Provincial Towns 198 Density of Borough 13 Deptford Clinic 45 Diarrhoea and Enteritis 79 Dirty Milk Vessels 165 Diphtheria and Croup 67 „ Contacts 68 Disinfectant supplied 1ll Disinfecting Station 1ll Disinfection Work 1ll District Inspection 129 Drainage Works 130-134 Dust, Removal of 140 Enteric Fever 70 Epidemic Diseases 55 ,, Cerebro-Spinal Meningitis 76 Erysipelas 72 Factories and Workshops 157-171 Fireguards 41 Fatality from Infectious Diseases 56 205 PAGE Flies and Infantile Mortality 36 Food, Adulteration of 173-175 ,, Premises 162 Fish, Canned 177 Glanders 79 Health Visitor 42 Health Visitors' Bill 189 House Accommodation for Working Classes 142 Houses Let in Lodgings 140 House and Trade Refuse 140,141 Housing, Town Planning, &c., Act, 1909 144-154 House to House Inspections 150 Home Workers, Inspection of 160 Hydrophobia 79 Ice Cream Premises, Inspection of 165 Illegitimate Births 19 Infantile Mortality 22-42 Infectious Diseases on Milk Premises 165 „ „ in Streets 121 „ „ in Schools 83 „ „ Discovery and diagnoses of 60 Infectious Sickness in the several Wards 47 Influenza 107 Inhabited House Duty, Certificates for Exemption from 135 Inspections-—House-to-House, &c. 129 Inspection of Kitchens of Restaurants 162 „ Slaughter Houses and Cow Houses 166 „ Houses let in Lodgings 140 Inquests 120 Institutions, List of Outlying 21 Legal Proceedings 176 206 PAGE Local Government Board Returns 46-50 London County Council, Property acquired by 135 „ New Drainage By-law 191 Marriages 19 Measles 82 „ Number of cases dealt with 82 Milkshops, Registration of 165 Milkshops and Dairies 165 Mortuary and Coroner's Court 119 National Insurance Act 185 N ew Drainage 131 Notification of Infectious Diseases 58 „ „ „ since 1901 59 „ ,, ,, in the Wards 47 „ „ „ Fees for Notification 60 „ of Phthisis 88 ,, of Births Act 42 Nursing facilities 35 Overcrowding, Cases of 139 Offensive Trades 167 Open Spaces 16 Ophthalmia Neonatorum 75 Outworkers' Premises 159 Pemphigus Neonatorum 76 Persons to an Acre 13 Phthisis 88 „ Prevention of (Proposed Dispensary) 95 ,, Notification of 88 ,, Mortality 89 Places where Food is Prepared 162 Plague 77 207 PAGE Plans, Deposit of, New By-law 191 Population—Estimated in 1911 13 „ Sub-Districts 13 Population and Inhabited Houses 14 Post-mortems, Number of 119 Prosecutions, Summary of 175,176 Public Health Committee 3 Public Health Staff 4 Puerperal Fever 73 Public Health, Conference on matters relating to 179 Pulmonary Consumption 88 Re-drainage 129 Registered Lodging Houses 140 Recommendations for future consideration 182 Respiratory Diseases 107 Rag Flock Act 189 Rickets 38 Salmon, Canned 177 Samples Analysed in 1911 174 Sanitary Inspectors' Work 136 ,, Legislation 185 Scarlet Fever 64 Seasonal Mortality 22 Shelter 116 Site, Subsoil and Drainage of the Borough 14 Slaughter Houses 166 Small Pox 62 Smoke Nuisances 139 Spotted Fever 76 Street Trading 161 Street Refuse 141 208 PAGE Streets where Infectious Diseases occurred 121 Summary of Sanitary Work 136 „ Vital Mortal Statistics 10 Tuberculosis Regulations 190 Tubercular Diseases 104 Tuberculosis Dispensary 95 „ Royal Commission 104 Typhus Fever 79 Unsound Food 176 Vaccination 63 Vital Statistics for the whole Borough 46 „ „ ,, Metropolitan Boroughs 196 „ ,, „ Provincial Towns 198 Verminous Persons, Cleansing of 117 „ Premises Disinfected 116 Whooping Cough 87 Workshops and Factories, Inspection of 157 Work of Sanitary Inspectors. Summary of 136 Metropolitan Borough of Deptford MAP SHEWING THE LOCALITIES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1911. 48 49 Table No. 3. METROPOLITAN BOROUGH OF DEPTFORD. This Table is prepared in accordance with the requisitions of the Local Government Board. Causes of, and Ages at Death during the Year ending December 30th, 1911. Causes of Death. Nett deaths at the Subjoined Ages oF " Residents," whether occurring within or without the District. Deaths in or belonging to Localities (at all Ages.) Total Deaths whether of " Residents " or " NonResidents " in Institutions in the District. Deaths of Residents Registered in Public Institutions beyond the District. Years. wards. All ages Under 1 1 to 2 2 to 5 5 to 15 15to 25 25 to 45 45 to 65 63 upwards E. N N.W. s. S.E. s.w. All { causes { Certified 1728 428 136 81 72 55 203 357 396 468 392 326 134 207 201 166 585 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. 1 .. 1 .. .. .. 1 .. .. .. 1 .. 7 1 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 67 10 34 18 5 .. .. .. .. 37 6 10 1 2 11 45 5 Scarlet Fever 7 1 2 3 1 .. .. .. .. 2 2 2 .. .. 1 20 6 Whooping-cough 35 16 9 7 3 .. .. .. .. 6 11 15 .. 1 2 32 1 Diphtheria and croup 15 1 5 4 4 1 .. .. .. 4 4 4 1 .. 2 44 8 Influenza 13 .. .. 1 .. .. 4 7 1 2 6 1 1 1 2 .. .. Erysipelas 3 .. .. .. .. 1 .. 1 l 2 .. .. .. 1 .. .. 2 Cerebro-Spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Phthisis (Pulmonary Tuberculosis) 144 2 .. 2 10 21 67 41 1 34 38 32 9 17 14 2 74 Tuberculous Meningitis 23 6 1 8 6 1 1 .. .. 5 5 4 1 3 5 1 10 Other tuberculous diseases 22 6 1 2 3 3 5 1 1 2 5 4 3 2 6 .. 10 Rheumatic Fever 3 .. .. .. .. .. 1 2 .. .. .. 2 .. 1 .. .. .. Cancer, malignant disease 122 .. .. 1 .. 2 12 56 51 25 22 24 16 15 20 .. 50 Bronchitis 155 35 10 5 2 1 7 31 64 38 33 23 15 31 15 .. 38 Broncho-Pneumonia 80 20 26 9 4 2 .. 11 8 20 21 18 4 10 7 2 19 Pneumonia (all other forms) 82 7 8 2 10 2 18 27 8 23 19 9 6 14 11 6 29 Other diseases of Respiratory organs 9 .. 1 1 1 .. 1 3 2 1 2 3 .. 2 1 1 4 Diarrhœa and Enteritis 188 143 29 6 1 1 2 3 3 82 43 26 5 16 16 1 36 Appendicitis and Typhlitis 5 .. .. .. 2 .. 3 .. .. 3 1 .. .. .. 1 .. 5 Alcoholism 3 .. .. .. .. .. 2 1 .. 2 1 .. .. .. .. .. 2 Cirrhosis of Liver 13 .. .. .. .. .. 1 10 2 4 3 1 2 2 1 .. 5 Nephritis and Bright's Disease 45 .. .. .. .. 1 4 28 12 9 13 7 6 4 6 1 15 Puerperal Fever 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 1 Other accidents and diseases of Pregnancy and Parturition 11 .. .. .. .. 2 9 .. .. 3 3 3 .. 1 1 1 6 Congenital Debility and Malformation, including Premature Birth 105 104 .. 1 .. .. .. .. .. 23 29 29 5 6 13 1 10 Violent Deaths (excluding Suicides) 56 8 1 6 3 4 10 15 9 12 15 18 3 3 5 .. 31 Suicides 13 .. .. .. .. 1 6 5 1 2 4 3 1 3 .. .. 4 Heart Diseases 105 4 .. .. 3 6 18 35 39 24 24 14 14 17 12 1 36 Old Age 138 .. .. .. .. .. .. 9 129 30 32 29 13 21 13 .. 74 Other defined diseases 196 44 7 3 13 3 20 59 47 56 40 29 22 21 28 1 79 Diseases ill-defined or unknown 66 21 1 1 1 2 11 12 17 16 9 16 6 12 7 .. 24 1728 428 136 81 72 55 203 357 396 468 392 326 134 207 201 166 585