DEPT 12 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. 1914 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. Public Health and Housing Committee. Mayor. Councillor WILLIAM A. WAYLAND, J.P., F.C.S., F.S.A. Chairman. Councillor W. H. BROOKS. Vice=Chairman. Alderman E. J. KNIGHT. Alderman E. G. H. BERRYMAN. Alderman W. A. SCHULTZ, J.P. Councillor W. BOOTH. Councillor A. E. BRETT. Councillor H. CATTELL. Councillor W. FALKNER. Councillor W. H. GREEN. Councillor C. H. KIPPS. Councillor J. SHEPHERD. Staff of the Public Health Department. Medical Officer of Health. William H. Whitehouse, m.d., d.p.h., b.s., Barrister-at-Law. Tuberculosis Officer. Murdoch Macdonald, m.d., d.p.h., b.ch. Public Analyst. Henry G. Harrison, m.a. (Cantab), f.i.c. Sanitary Inspectors. Thomas Turner. John V. Snowdon. Robert D. J. Simpson. Arthur G. Kemp. Alfred Priest. Frederick Hewett. Philip Shelley. Harry Allam. Female Sanitary Inspectors and Health Visitors. Miss F. O'Riordan. Miss W. C. Smart. Health Visitor. Miss H. Tugwell. Chief Clerk. Charles A. Chapman. Clerks. Henry J. L. Smith. George Northmore. Municipal Dispensary for the prevention of Consumption, 78 Amersham Vale, New Cross, S.E. Administrative Tuberculosis Officer—W. H. Whitehouse, m.d. Clinical Tuberculosis Officer—Murdoch Macdonald, m.d. Nurse—Miss Porteous. Attendant—G. Abbott. disinfecting Staff. C. F. Dowsett (Chief Disinfector). T. Lyons. F. Smith. R. G. Gladman. (Council's Shelter, Mortuary and Coroner's Court. Attendant, G. W. J. Wagner. Cleansing Station. Bath Attendant—Mrs. Wagner. School Nurse—Miss Gilby. Metropolitan Borough of Deptford. Public Health Department, Town Hall, New Cross, S.E. To the Right Worshipful the Mayor, Aldermen and Councillors. Gentlemen, In compliance with the order of the Local Government Board, I have pleasure in submitting to you my Report on the Vital Statistics of the Borough and the work of your Public Health Department for the 52 weeks ending January 2nd, 1915, this being the Fourth Annual Report prepared by me. Vital Statistics. The foundation of vital statistics being the annual estimate of the population of the Borough, the correctness of such estimate is a matter of first importance. The estimated population for the middle of the last year has been obtained by the use of new methods and recognized formula calculated to yield nearer approximations to the truth than the simple formula previously employed. Such methods have given an estimate of 109,182 persons, showing a decrease of 314 persons since the census in 1911. There are grounds for thinking that the population has increased slightly rather than decreased since the middle of the year. The principal argument in favour of that view is the reduction in the number of empty properties recorded. Births. It will be noted in the text that the birth-rate in the Borough for for the year 1914 was 28.6 per 1,000, which is .6 per 1,000 more than that for the previous year and 4.3 per 1,000 more than that for the whole of London. Deaths. During the year of 52 weeks the deaths registered in the Borough numbered 1,598, being 129 less in number than in the previous year.— The death rate was 14.6 per 1,000 compared with 15.5 for the previous year. . 5 Deaths in Institutions. There were 616 deaths in public institutions and in other places outside the Borough. The increased and increasing proportion of deaths recorded in institutions has been, and is, a very prominent feature in the statistics of recent years. Whether such feature is altogether satisfactory is open to question. It implies that the sick are more ready to take advantage of the opportunity afforded to them of obtaining the most skilled treatment, but, on the other hand, it is also an indication of a growing disinclination to care for the sick in their homes, the causes of which cannot be dealt with in this report. It has, however, to be recognised that there is now a tendency to urge isolation treatment for many diseases for which isolation was not thought necessary in the past. Infantile Mortality. The infantile mortality for the year was low and in striking contrast with the rates recorded ten to fifteen years ago. Diarrhœa still claims many victims amongst children, but there was some improvement in the year under consideration as will be seen by referring to other reports. The infantile death rate for 1914 was 99 per 1,000 births compared with 113 per 1,000 for the previous year. Infectious Diseases. During 1914 the following diseases were unduly prevalent, viz., Diphtheria, Scarlet Fever and Measles. There were 253 cases of Diphtheria with 25 deaths, against 247 cases and 20 deaths for the previous year, and the cases were again more prevalent in the North, North-West and East Wards. There were 866 cases of Scarlet Fever notified, which complaint was generally prevalent throughout the Borough, but there were only nine deaths, thus showing the value of institutional care, for most of these cases are treated in hospital. There were slightly fewer cases of Measles than in the previous year, 497 cases being notified to me from various sources; but there were again 50 deaths. Tuberculosis. During the past year much attention has been paid to cases of Tuberculosis among residents in the Borough, for the benefit of those affected and as a means of preventing infection to others. 419 cases have been notified during the year, being 165 less than in the previous year. 6 The Public Health Service and the War. In the autumn of last year the question which was in the mind of every medical officer of health in London was whether there was any work in which he could share which would be of use to his country; whether he could make his special knowledge available to those who direct the military forces of the British Empire in such a way as to be of value in the great undertaking upon which this country had entered. When war was declared the London medical officers of health offered their services to the Deputy Director of Medical Services of the London military district. This offer was at once accepted, and without loss of time these officers were engaged in the work of inspection of all billets and encampments, in looking into the conditions under which troops are housed, the sanitary arrangements of the buildings, the supervision of food supplies, and, indeed, all the circumstances which would have come under the notice of these officers, had their sanitary authorities statutory powers in this connection. In this work they are associated with the late county medical officer of health, a member of the deputy director's staff. It is important to note that the medical officers of health thus acting have no executive functions, but are in the position of advisers of the commanding officers whose units are in the several cities and boroughs of London. The whole intention of the introduction of sanitary thought into military life is to look to the combatant force as executive. From the private soldier who is taught to have regard to personal hygiene and to carry into effect the teaching which he receives, to the commanding officer who is responsible for the health conditions under which his men live, the duty of action remains with the combatant. The part of the medical officer is that of adviser, and this position has been carefully maintained in the London arrangements. There are other branches of work which may fall to the medical officers thus acting in London. As yet there has been no indication of introduction of disease from abroad, as the result of the return of those who come home from the seat of the war. The future only can show whether we shall remain exempt. Soldiers have returned with bowel disturbances due to exposure, and to irregularity of diet incidental to war, but true dysentery is not known to have manifested itself among them. Enteric fever has not been conspicuous, and nothing has been heard of cholera except certain occurrences of this disease in Hungary among wounded soldiers returning from Galicia, and more recently in Vienna, where, it has been stated in the press, it has appeared among 7 the wounded brought back to that city. Smallpox has not yet declared itself, but the war is not far advanced, and medical officers of health may in connection with epidemic disease yet find that they have to take part in safeguarding the troops at home. Staff. I have much pleasure in reporting that the staff of the Public Health Department have carried out their difficult duties in a satisfactory and conscientious manner and to my entire satisfaction. Personally, I beg to thank the Council for their kind and courteous consideration in connection with matters affecting this department. I am, Your obedient Servant, W. H. Whitehouse. 8 Summary of Vital and Mortal Statistics for 1914. 1914. 1913. Area 1,563 acres 1,563 acres Population— Census 1901 110,398 110,398 Census 1911 109,496 109,496 Estimated to middle of year 109,182 109,280 Number of inhabited houses 16,696 16,638 Average number of persons per house 6.5 6.6 Density 70 per acre 70 per acre Length of Public Streets 53 miles approx. 53 miles approx. Rateable Value £636,361 £641,504 1d. Rate produces (approximately) £2,496 £2,495 Cost of administration of Public Health Department £1,789 £1,754 Marriages 867 847 Marriage Rate 7.8 7.7 Births 3,121 3,106 Birth Rate 28.6 28.0 Birth Rate, average for the last 10 years 27.4 27.6 Deaths 1,598 1,727 Death Rate 14.6 15.5 Death Rate, average for the last 10 years 14.6 14.6 Infantile Mortality 99 per 1,000 births 113 per 1,000 births Infantile Mortality, average for the last 10 years 122 per 1,000 births 124 per 1,000 births Zymotic Death Rate 1.69 1.87 Area and Population. Births and Deaths. 10 Area and Population. Acres. Estimated Population. 1563 109,182 The population of the Metropolitan Borough of Deptford at the census taken April, 1911, was 109,496. The estimated population to the middle of the year 1914, based on the results of the above census and that of 1901, was 109,182. 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 21,124 N. 23,799 N.W. 23,413 S. 12,108 S.E. 12,285 S.W. 16,453 As the Borough has an area of 1563 acres, the density of the population on this estimate is 70 per acre approximately. The following table shows the total number of dwelling houses and the number inhabited and uninhabited in 1901, 1911, and 1914 respectively:— Year. HOUSES. Inhabited. Uninhabited. Total. 1901 15,823 516 16,339 1911 16,102 491 16,593 1914 16,696 202 16,898 Taking the number of inhabited houses in 1914 to be 16,696 as set forth in the above table, and calculating the population to be 109,182 then the average number of persons per house would be 6'5. The following table shows the number of houses, separate occupiers, and population in 1901 and 1911, distinguishing the various kinds of buildings and the population enumerated therein, and also the buildings not used as dwellings :— 11  1901 1911. Total. Buildings used as Dwellings. Vessels,Sheds. Vagrants, etc. Separate Flats. (Included in Col.5.) Buildings not used as Dwellings. Totals (Cols. 4-11) Ordinary Dwelling Houses. Blocks of Flats. Shops. Hotels. Inns, and Public Houses, Offices, Warehouses, Workshops,Factories. Institutions. Others, Kind of Building. No. Cols. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Number inhabited 15,823 16.102 14,768 75 1,049 121 40 15 34 - 764 Places of Worship 33 Separate Occupiers 24,615 25,040 22,838 773 1,193 124 42 16 48 6 773 Govt. & Municipal Buildings 16 Shops 234 Population 110,398 109,496 98,470 3,409 5,116 752 190 1,398 140 21 3,409 Offices 27 Warehouses,Workshops & Factories 179 Uninhabited 424 640 561 1 70 1 3 — 4 — 207 Theatres and other places of amusement. 7 Being built 92 15 11 - 3 - - - 1 - - Families or separate occupiers (private and other) in Deptford:— East ... ... 4,671 North 5,385 1911 ... 25,040 North-West ... 5,368 1901 ... 24,615 South ... ... 2,854 South-East ... 2,783 Increase 425 South-West ... 3,979 25,040 Number of Private Families ... ... 24,975 Population in Private Families ... ... 107,775 12 13 Tenements in the Occupation of Private Families. Tenements with more than two occupants per room:—Number 1966. Population, all ages, 13,185 Population under 10 years of age, 5,273 Percentage of population in " private families " living more than two in a room 12-2 No. of Rooms per tenement. No. of children under 10 years of age. Number of Persons in Private Family (or Tenement). Total No. of Private Families (or tenements). Population. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 & up Number of Private Families (or Tenements). 1 0 829 570 68 6 3 1 .. .. .. .. .. .. .. .. .. 1477 2218 1 .. 31 177 28 9 2 .. .. .. .. .. .. .. .. .. 247 762 2 .. .. 14 75 12 2 1 .. .. .. .. .. .. .. .. 104 421 3 .. . . . . 4 19 6 2 .. 1 .. .. .. .. .. .. 32 170 4 .. .. .. .. .. 6 2 .. .. .. .. .. .. .. .. 8 50 5 .. .. •• .. .. 1 .. .. .. .. .. .. .. .. .. 1 6 829 601 259 113 43 18 5 .. 1 .. .. .. .. .. .. 1869 3627 2 0 309 996 297 90 26 6 2 .. .. .. .. .. .. .. .. 1726 3732 1 .. 33 509 89 48 12 5 1 .. .. .. .. .. .. .. 697 2304 2 .. .. 17 413 65 33 13 4 2 .. .. .. .. .. .. 547 2367 3 .. .. .. 12 171 47 24 7 2 .. .. .. .. .. .. 263 1427 4 .. .. .. .. 3 09 14 11 4 1 .. .. .. .. .. 102 661 5 .. .. .. .. .. 1 11 5 1 l .. .. .. .. .. 19 142 6 .. .. .. .. •• •• .. .. .. .. .. •• .. .. .. 309 1029 823 604 313 168 69 28 9 2 .. .. .. .. .. 3354 10633 3 0 193 1259 535 307 157 71 17 7 .. .. .. .. .. .. .. 2546 6930 1 .. 26 881 227 156 58 27 9 6 2 .. .. .. .. .. 1392 5066 2 .. .. 18 564 188 115 51 28 6 1 .. .. .. .. .. 971 4585 3 .. .. .. 7 274 134 79 44 20 4 1 .. .. .. .. 563 3338 4 .. .. .. .. 4 119 74 60 21 6 3 .. .. .. .. 287 2014 5 .. .. .. .. .. 8 43 16 9 7 1 1 1 .. .. 81 634 6 .. .. .. .. .. .. .. 6 7 3 .. 1 .. .. .. 17 153 7 .. .. .. •• •• .. .. .. •• 1 .. 1 .. .. .. 2 22 193 1285 1434 1105 779 500 291 170 69 24 5 3 1 •• 5859 22742 4 0 82 955 611 486 290 129 57 19 7 .. .. .. .. .. .. 2336 8007 1 .. 6 304 250 199 115 72 25 7 1 1 .. .. .. .. 980 4397 2 .. .. 4 236 188 140 88 53 26 11 5 2 .. .. .. 753 4199 3 .. .. .. 3 159 128 123 68 46 27 8 .. 1 .. .. 563 3765 4 .. .. .. .. 1 75 72 58 42 23 11 4 .. .. .. 286 2200 5 .. .. .. .. .. 2 29 27 20 18 10 5 1 .. l 113 989 6 .. .. .. .. .. .. .. 5 3 1 4 1 .. .. l 15 148 7 .. .. .. •• •• .. •• .. .. 1 .. 1 .. .. .. 2 22 82 661 919 975 837 589 441 255 151 82 39 13 2 .. 2 5048 23727 Total. 1-4 .. 1413 8576 3435 2797 1972 1275 806 453 230 108 44 16 3 .. 2 16130 60729 5 .. 24 219 398 538 470 415 308 202 156 68 43 18 4 1 1 2865 15274 6 .. 17 209 336 374 434 343 245 159 92 65 42 18 12 5 .. 2351 12536 7 .. 14 132 235 300 302 210 158 111 62 35 21 10 4 6 2 1602 8372 8 .. 8 62 152 181 201 146 98 56 30 21 12 7 4 1 2 981 5119 9 .. 6 28 61 99 85 61 45 29 20 5 5 3 2 1 1 451 2355 lO&up .. 4 16 57 102 120 103 85 44 40 9 8 6 •• •• .. 594 3390 Totals .. 1486 4242 4674 4391 3584 2553 1745 1054 630 311 175 78 29 14 8 24974 107775 Tenements of five rooms and upwards with more than Two Persons per room. No. of rooms per tenement. No. of persons per tenement. No. of children under 10 years of age in Private Families (or tenements). Total No, of Private Families (or tenements). Population. 0 1 2 3 4 5 6 7 8 9 10 All ages. Under 10. No. of Private Families (or tenements). 5{ 11 1 3 5 14 12 6 2 .. .. .. .. 43 473 145 12 .. .. 2 6 5 3 2 .. .. .. .. 18 216 69 13 .. 1 .. .. 1 1 1 .. .. .. .. 4 52 16 14 .. .. .. .. 1 .. .. .. .. .. .. 1 14 4 15 .. .. .. 1 .. .. .. .. .. .. .. 1 15 3 6{ 13 .. .. 1 .. 5 5 .. .. 1 .. .. 12 156 55 14 .. .. .. 2 2 .. .. .. 1 .. .. 5 70 22 7 15 .. .. .. .. .. 1 .. 1 .. .. .. 2 30 12 14 Explanation.—From the above table it will be seen that of a total of 25,040 families or separate occupiers enumerated in the Metropolitan Borough of Deptford, 24,974 were private families, of which 1,869 were enumerated in tenements of one room, 3,354 in tenements of two rooms, and so on. The 1,869 families enumerated in one-roomed tenements included 829 consisting of one person each, 601 of two persons each, 259 of three persons each, and so on, and contained an aggregate population of 3,627. Again, in 1,477 of the 1,869 families in one-roomed tenements, there were no children under 10 years of age, in 247 there was one child, in 104 there were two children, and so on. The 247 families with one child under 10 included 31 of two persons of all ages, 177 of three persons, 28 of four persons, etc., etc. The lower portion of the table gives details with regard to children for those of the larger tenements only which contained more than two persons per room. It shows that there were in Deptford 67 five-roomed tenements so occupied, 43 containing 11 persons each, 18 with 12 persons and so on. Of the 43 with 11 persons each, one contained no children under 10 years of age, 3 had one child, and 5, 14, 12, 6 and 2 had 2, 3, 4, 5 and 6 children respectively, making 145 children in all. A "dwelling" or "tenement" was defined in the instructions to Census Enumerators as "a place in which any person entitled to receive a schedule usually lives," and the persons entitled to receive a schedule and therefore for census purposes regarded as heads of families, were stated to be: (a) Every head of a family occupying the whole or part of a house or flat. (b) Every separate lodger occupying a room or rooms in a house or flat (where two or more lodgers shared a room or rooms they were treated for census purposes as a single family). (c) Every resident caretaker of a house to be let, of a shop or other business premises, or of a public building. (d) Every outdoor servant (with or without family) occupying separately any building or rooms in a building, such as a lodge, gardener's cottage, rooms over coach-house or stable, etc., which is detached from the house to which it belongs or has no internal communication therewith. (e) Every resident proprietor, manager or head of a hotel, club, business establishment, school, etc. (f) The chief resident officer of every institution, (g) The master or person in charge of every boat, barge, or other vessel. 15 The families under the headings (a) to (d) have been treated as "Private Families," those under the heading (e) as "private" only when the domestic members of the occupier's family exceed the. nondomestic (i.e., trade servants, visitors, scholars, etc.), and those under headings (f) and (g) have been treated as " non-private " families. Population of Deptford living in Institutions, large establishments, vessels, etc.:- Number of Institutions, etc. 22 Population 1436 Population Institution. East 227 10 North 20 1 North-West 512 4 South 93 3 South-East 584 4 South-West - — 1436 22 The following table gives the approximate number of inhabited and uninhabited houses in each Ward at the end of the year 1914, also the number of separate occupants of tenements, and the estimated population of each Ward from the Census returns for 1911:— Ward. Inhabited Houses. Uninhabited Houses. Total Number of Houses. Houses Building. Houses in Tenements Number of Separate Occupiers in Tenements. Other Premises. Population of Census 1911. Males. Females. North 3.115 27 3,142 — 157 639 149 23,868 11,915 11,953 South 2,113 17 2,130 1 61 128 145 12,143 5,208 6,935 NorthWest 3,830 7 3,837 — 825 1,688 181 23,480 11,530 11,950 SouthWest 2,271 16 2,287 22 68 168 31 16,500 7,568 8,932 East 2,996 99 3,095 — 83 327 216 21,185 10,663 10,522 SouthEast 2,371 36 2,407 11 62 173 112 12,320 6,103 6,217 16,696 202 16,898 34 1,256 3,123 834 109,496 52,987 56,509 Back-to-Back Houses. There are very few houses of this class in the district and practically no houses built in courts. 16 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. 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. Sewage System. The sewers passing through Deptford are:— Branch. Coming from Length. Bermondsey Branch Rotherhithe 7290-ft. Southern High Level Sewer Wandsworth 6480-ft. Southern Low Level Sewer Putney 7260-ft. Effra Branch Norwood 6270-ft. Storm Relief (in Church Street) — 2970-ft. Storm Relief (St. George's Stairs) — 1980-ft. Relief Sewer at Broadway Greenwich 3080-ft. Deptford to Lee Green Sewer Lee 1320-ft. Ravensbourne and Sydenham Sewer Bell Green 1330-ft. New Southern High Level Sewer Brockley 7920-ft. 17 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 permanent open spaces existing which cannot be built upon are:— Situation. Size. Maintained by 1. Deptford Park Evelyn Street 22 acres L.C.C. 2. Ravensbourne Recreation Ground Brookmill Road 1} acres Borough Council. 3. Hillv Fields (On South-East Boundary of Borough) Brockley 45½ acres L.C.C. 4. Telegraph Hill Recreation Ground Telegraph Hill 9¾ acres L.C.C. 5. Railways and adjoining land - 234 acres 6. Millwall Football Ground 5½ acres 7. Canals — 8 acres 8. St. Paul's Churchyard — 2˙2 acres 9. Reservoir — 1 acre Births. Number of births 3121 Average number of births, for previous 10 years 3128 Average birth-rate for previous 10 years 27˙4 Birth-rate of Deptford per 1,000, for 1914 28˙6 England and Wales 23˙8 97 Great Towns 25˙0 145 Smaller Towns 23˙9 London 24˙3 The total number of births registered in the Borough in 1914 was 3,121, as compared with 3,106 in 1913. Of these, 1,596 were boys and 1,525 were girls. The birth-rate for the Borough was equivalent to an annual rate of 28˙6 per 1,000 of the population, as compared with 28˙0 for 1913, 26˙5 for 1912, and 27˙4 for 1911. The birth-rate for London was 24'3 per 1,000, compared with 24˙8 for 1913, 24˙7 for 1912, and 25˙0 for 1911. B 18 The subjoined table gives the number of births for each W together with the birth-rate:— Ward. Births. Birth Rate per 1,000. Males. Females. Total. East Ward 359 338 697 33·0 North Ward 413 396 809 34·0 North-West Ward 403 405 808 34·5 South Ward 91 87 178 14·7 South-East Ward 154 129 283 23·0 South-West Ward 176 170 346 21·0 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. 1904 113,634 3265 28·7 1824 16·0 489 149 1905 114,512 3290 28·7 1642 143 411 124 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 26v2 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 1911 109,475 3001 27·4 1728 15·8 428 143 1912 109,377 2896 26·5 1442 13·2 258 89 1913 109,280 3106 28·0 1727 15·5 350 113 Average for 10 years 114,405 3128 27·4 1678 14·6 383 122 1914 109,182 3121 28·6 1598 14·6 309 99 It will be observed that the birth-rate for the year is higher than that for the previous year. The birth-rate is still very high in the old parts of the borough, particularly the East and North Wards. Illegitimate Births. The illegitimate births, which number 76, occurred in the several Wards, as follows:— East Ward 15 South Ward 2 North Ward 13 South-East Ward 9 North-West Ward 28 South-West Ward 9 76 19 Marriages. There were 857 marriages in the Borough during the year, as compared with an average of 749 in the ten years preceding. The marriage rate for 1914 was equal to 7'8 per 1,000 of the estimated population and has not been exceeded in any year for the past ten years, except in 1912, when the rate was 8'3. The marriages were celebrated in the following places:— 511 in Churches of England. 112 in other places of worship. 234 in the Superintendent Registrar's Office. 857 Total. Condition as to Marriage and Ages in the Metropolitan Borough of Deptford At Census 1911. Ages. Unmarried. Married. Widowed. Male. Female. Male. Female. Male. Female. Under 15 years 17269 17319 - - - - 15 and under 20 years 4775 4888 10 46 - - 20 „ 25 „ 3787 3858 641 1274 2 8 25 „ 30 „ 2216 2010 2485 3135 17 34 30 „ 35 „ 1079 1038 3296 3562 50 86 35 „ 40 „ 629 720 3112 3132 70 161 40 „ 45 „ 386 535 2810 2759 106 217 45 „ 50 „ 314 436 2372 2214 138 325 50 „ 55 „ 203 297 1992 1800 205 420 55 „ 60 „ 123 202 1463 1250 196 468 60 „ 65 „ 81 155 991 849 216 547 65 ,, 70 „ 43 136 640 473 213 554 70 „ 75 „ 37 94 368 226 207 480 75 „ 80 „ 17 56 115 93 116 338 80 „ 85 „ 11 32 53 32 90 157 85 „ 90 „ 1 7 11 8 22 60 90 „ 95 „ 1 5 .— — 7 12 95 „ 100 „ — — 1 — — 1 100 years and upwards - - - - - - All ages 30972 31788 20360 20853 1655 3868 62760 41213 5523 B 2 20 Deaths. 1914 Average for past 10 years. Number of deaths 1,598 1,678 Average death-rate for previous 5 years 14·4 14·6 Rate per 1,000 Deptford 14·6 „ „ England and Wales 13·7 „ „ 97 Large Towns 15·0 „ „ 145 Smaller Towns 13·1 „ „ County of London 14·4 The number of deaths registered within the Metropolitan Borough of Deptford from all causes during 1914 was 1,145, equal to a deathrate of 10·5 as compared with 1,283 deaths, and a death-rate of 11·6 during the previous year. Of this number 583 were males and 562 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.: 163, of which number 146 occurred in the Metropolitan Asylums Board's South Eastern Hospital, making 982 deaths actually belonging to Deptford. To this number we must add 616 deaths of parishioners which occurred in public institutions outside the Borough, making a total of 1,598, of which 844 were males and 754 females, and upon these figures the statistics are based. The death-rate for the Borough was equal to an annual rate of 14·6 per 1,000 of the population, as compared with 15·5 for 1913, 13·2 for 1912, and 15·8 for 1911, the average for the past five years being 14·4. The 616 deaths outside the borough were distributed as follows:— Asylums 49 Poor Law Institutions:— Greenwich Union 340 Other than Greenwich 22 Hospitals:— Guy's 35 Seamen's 11 Miller 23 East London (for children) 8 St. Bartholomew's 3 St. Thomas' 8 London 1 Metropolitan Asylums Board 13 St. John's 8 Evelina 7 Other Hospitals 49 Other places 39 Total 616 21 The following table gives the number of deaths belonging to each Ward, and the death rates for each Ward. Ward. Deaths. Death Rate per 1,000. Males. Females. Total. East Ward 229 200 429 20·3 North Ward 189 163 352 14·8 North-West Ward 148 136 284 12·1 South Ward 72 75 147 12·1 South-East Ward 106 79 185 15·1 South-West Ward 100 101 \ 201 12·2 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 Registrar-General's Department. The proportion which the mortality at various ages bears to the total number of deaths during 1913 and 1914 is as follows:— 1913. 1914. Under 1 year 202 per cent. 19˙3 per cent. deaths. 1 to 2 years 5˙8 5˙4 „ „ 2 to 5 „ 5˙1 4 8 „ „ 5 to 15 „ 3˙6 40 „ „ 15 to 25 „ 4˙6 „ 4˙0 „ „ 25 to 45 „ 12˙1 13˙0 „ „ 45 to 65 „ 19˙4 21˙0 „ „ 65 years and upwards 29˙2 28˙5 „ „ Seasonal Mortality. First Quarter.—The deaths numbered 448, which is equal to an annual death rate of 17˙6 per 1000. Second Quarter.—The deaths numbered 334, which is equal to an annual death rate of 12˙2 per 1000. Third Quarter.—In this quarter 377 deaths were registered, equal to an annual rate of 13˙8 per 1000. Fourth Quarter.—439 deaths were registered, equal to a rate of 16˙1 per 1000 of the population. Note.—The figures contained in the Quarterly Reports have been corrected by the inclusion of 33 parishioners whose deaths occurred outside the Metropolitan area. 22 Death Registration and Vital Statistics. It may almost be said that the foundation of efficient public health work rests upon the accuracy of death registration. To secure that accuracy we are dependent upon the general practitioner, who, as a rule, expends a great deal of care upon the certificate of death, which is the initial step in the process of registration, in spite of the fact that he receives no payment for the performance of what is a most important duty on behalf of the State. Indeed, it is common knowledge among medical officers of health that a death certificate is often much more carefully filled in than a certificate notifying a case of infectious disease, although for the latter he receives a statutory fee. A study of the earliest records of death registration in this country is of considerable interest, not to say wonderment. The cause of death not infrequently found is dropsy, cough, tumour, atrophy and various other symptoms, and some years ago one very conscientious practitioner gave the cause of death as primary, syphilis, secondary, the act of God. A great deal of progress has been made in the accuracy of death registration since those early days, but there is still much room for improvement, and medical officers of health at any rate will welcome reforms in the administration of the national statistics of life and death. The first of these reforms might be with advantage the institution of a confidential system of death certification under which system the medical practitioner might transmit the death certificate to the registrar direct in a sealed envelope, and such certificate should be looked upon as a confidential document, subject to the discretion of the Registrar-General. To quote the system of death registration as carried out in Switzerland:-The practitioner is furnished by the civil authorities with a form, the upper part of which is detachable, and contains only the name of the deceased and a series number. This part is torn off and placed in a distinctive envelope by the practitioner in attendance, and must be delivered to the local registrar within forty-eight hours. The rest of the serially numbered form contains spaces for the details of the cause of death, with a space wherein the practitioner can note the sanitary and social conditions of the dwelling of the deceased. This part is placed in a separate coloured envelope and sent with the other to the local registrar, who, however, forwards this second one unopened to the Central Health Statistical Bureau. The practitioner is remunerated for his certification. Sir Victor Horsley, who has devoted much thought to the question of vital statistics generally, urges that the office of Registrar-General be completely reconstituted as a sub-office of a ministry of public health. 23 Though at the present time it is in effect a sub-office of the Local Government Board, it cannot, he contends, be looked upon as sufficiently co-ordinated with that department, indeed, it never can be an adequate part of the public health system of the country until it is an essential part of a ministry of public health, which would unite the three existing and inco-ordinate branches of public health work—namely, the Local Government branch, Public Health and Poor Law, the Board of Education branch and the Home Office (factories, etc.) branch. One very essential reform and one which has frequently been advocated, is the placing of the registration of deaths under the control of medical officers of health. This reform would be quite easy of accomplishment, for it would only be necessary to place the local registrars of deaths on the staffs of the medical officers of health, and as vacancies fell in, appointing the latter superintendent registrars. In this way there would be an expert official, who would be able to straighten out obscure entries on certificates at the very outset, and thus lessen the work at a later date of the central department, which in recent years especially has done a large amount of good through making enquiries of medical practitioners whose certificates have been capable of a double interpretation. Sickness Statistics. Whilst allowing death statistics their full value I consider it is a fallacy always to regard the death-rate as the best possible index of the health of a community. Much more useful information could sometimes be obtained as to the health of a borough by the registration of sickness apart from death. There is, of course, a great deal of preventible sickness of insufficient severity to destroy life. This is greatest among children, where the after-effects are often very serious. There is also much adult non-fatal sickness, which, by loss of wage-earning power, and by the loss of employment, and by the loss of the enjoyment of life, is of the greatest importance. Much ill-health due to insanitary environment, therefore, does not show itself upon the mortality statistics. Nevertheless, there has been a great improvement in Public Health in the last few years, and many more deaths and much more sickness would have taken place but for the following agencies:—(1) Sanitary science. (2) Advance in medical and surgical knowledge. (3) Improvement in economic position. As to which of these factors has had the greater influence, each will be acclaimed the cause alike by the sanitarian, the practitioner of medicine, and the politician, and in each case the claim will be false if the whole credit is claimed. Admitting all this, we nevertheless claim that sanitary science has herein justified every farthing spent upon its pursuit. There is only one asset of real value 24 in human existence and that is health. Health, however, is precisely the last thing that appeals to an individual in health. The appeal in this case is to his pocket. We need go no further to understand the indignation of the healthy ratepayer against the extravagance of the local authority in matters of health if we realise that the only thing appreciable by the man in the street is a dividend expressed in coin of the realm. The health department can show nothing of this sort; its dividend is health, physical fitness, and the mental value that attaches to a healthy population. The public health department's object is to fight disease-producing conditions, but it is up against two mountains of obstruction. One of these is self-interest; the other is colossal ignorance. Infantile Mortality. Total deaths of Infants under one year, 309. Average for previous 1914. 10 years. Deptford Infantile death rate per per 1000 births 99 122 England and Wales 105 97 Large Towns 114 145 Smaller Towns 104 County of London 104 Of the 1,598 deaths recorded during the year 309 were of infants under one year of age. During the past ten years the infantile death-rate has fallen from 149 to 99 per 1,000 births registered. 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 697 116 166 North Ward 809 74 91 North-West Ward 808 60 74 South Ward 178 11 62 South-East Ward 283 24 85 South-West Ward 346 24 69 Chart shewing Principal Causes of Death, 1914. 25 TABLE SHEWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1914. BIRTHS 3121 DEATHS—including 616 in Outlying Public Institutions 1598 Excess of Births over Deaths 1523 I submit a list of the principal causes of the 309 infantile deaths in the Borough during 1914, viz.:— Measles 7 Tuberculosis 11 Meningitis 4 Convulsions 8 Bronchitis and Pneumonia 43 Diarrhceal Diseases 34 Enteritis and Diseases of Digestive System 42 Gastritis 7 Syphilis 11 Suffocation in bed with parents 5 Congenital Malformation, Atelectasis, and Injury at Birth 13 Debility and Marasmus 38 Premature Birth 69 Other causes 17 309 Although the Infantile Mortality for the whole of the Borough may be this year considered very satisfactory yet I still hope to see a further reduction in one of our wards in particular. In previous reports I have given the contributing causes of the higher infantile death rate in the central district of the Borough, which contains practically the whole of the East Ward, to which I particularly refer. We found that the conditions associated with and assisting in varying degree in the production of excessive infant mortality were partly social and partly sanitary, and that it is easy, according to the point of view adopted, to magnify unduly the importance of one set of factors. The effects of unsatisfactory domestic and extra-domestic local conditions are fairly obvious, and their consequences fall most heavily on the poorer members of the community. Of the domestic forms of insanitation to be noted in Deptford, overcrowding and lack of cleanliness are probably the most important. For the infant it means exposure to a stuffy atmosphere, and the storage of milk in a contaminated and vitiated atmosphere. Outside 26 the house, refuse is frequently left about in the yards instead of being burnt. Animals are frequently kept, and the yards belonging to the smaller houses are in many cases only partly paved and therefore filthy and damp. From the number of cleansing notices we find it necessary to serve in the course of the year it will readily be understood that we find the floors, walls, furniture, clothing and bedding notoriously dirty in many of the houses. Other contributing causes are:—(1) Density of buildings. (2) Low-lying building sites. (3) Lack of ventilation and light. (4) Foul air from the accumulation of filth. (5) The geological formation of the land. (6) The feeding of the child. (7) The sex and age of the infant. 8. Temperature.—The higher temperature of the air in the summer months has long been observed to be associated with high Diarrhœal 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 Diarrhceal 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, which was a particularly severe year, the rate of infantile mortality for the borough was only 93, compared with 143 for the full year; and even more striking that in the East Ward for the same period the rate was only 86 per 1,000 births, compared with 197 for the full year. 9. Rainfall.—Diarrhceal 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. The value of rain, therefore, 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. 27 Below is a comparative table giving particulars showing the relationship between the temperature, rainfall and diarrhoea mortality in the summer months:— No. of Week in Year. Mean Weekly Temperature of Air. Mean Weekly Temperature of Earth four feet below surface. Rainfall. Deaths from Diarrhoea and Enteritis. 1913. 1914. 1913. 1914. 1913. 1914. 1913. 1914. 0 0 0 0 ins. ins. 31 August 59.5 59.5 59.73 61.78 0.00 0.88 2 4 32 . * 57.1 64.0 60.24 61.80 0.09 0.02 3 — 33 60.7 62.1 60.10 62.19 0.14 0.01 3 — 34 .. 60.9 64.4 60.58 62.48 0.36 0.17 8 1 35 September 62.8 63.4 60.62 62.48 0.51 0.00 8 6 36 59.1 62.4 60.63 62.40 1.43 0.47 5 9 37 58.0 57.1 59.96 61.14 0.06 0.14 8 9 38 54.9 52.5 59.03 58.87 0.60 0.12 4 3 39 October 60.2 53.8 58.46 57.34 0.13 0.00 9 6 40 58.5 52.9 58.75 56.62 0.22 0.00 3 — Weekly Average .. 59.2 59.2 59.81 60.71 0.35 0.18 5 4 Note.—The meteorological particulars in the above Table are the results of observations taken at the Royal Observatory, Greenwich. 10. 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 but little time to make themselves practically familiar with the very numerous, and often apparently unimportant matters, which make all the difference between a well-ordered home and one which lacks the influence of a capable mother. Nevertheless, to what extent and in what manner the industrial employment of married women affects the infantile mortality is still a matter of discussion. Under present social conditions, the harmful effects are partly counteracted by the greater comfort and increased nourishment which such employment enables the mother to secure. The mortality from prematurity and congenital defects is higher in the East Ward of Deptford than in the remainder of the Borough and greater than the average of some other large towns. One reason why diarrhceal diseases are excessive in the locality mentioned above may partly be put down to artificial feeding but the disadvantages of artificial feeding are further accentuated by the absence of the mother from the home, and by carelessness and ignorance and lack of cleanliness in the preparation of the food. It is impossible, 28 however, to dissociate the effects of married female labour from those of poverty, and in social questions causes and effects may occupy positions of mutual dependence and transferability. Many of the women are occupied, not from choice, but from necessity, and are widows or the wives of men whose earnings are insufficient to maintain the home in comfort. The excessive mortality from bronchitis and pneumonia may also be one of the effects of married female labour. The mother has to take her baby to be cared for in the morning as she proceeds to work, and fetch him again in the evening. Under the best of conditions the child is liable to contract respiratory diseases, but in former years the mother had no option but to leave the child in charge of a neighbour. The mother does not select the house where the baby is cared for on sanitary grounds, and the standard of cleanliness which usually obtained in a "baby-minder's house " is below that of the average for the neighbourhood. In 1913, the Albany Day Nursery was opened, and it has been undoubtedly the means of improving the conditions under which the children are cared for. Other allied conditions may also be put down as contributory causes to the wastage of child life:—(l) The unhealthy condition of the parents, particularly the mother. Young girls frequently, before being married, lead most unhealthy lives. Instead of taking as much open air exercise as possible, and eating plain and wholesome food at proper times to develop all the normal functions of the body, they prefer spending their spare lime in stuffy houses, picture palaces, etc., where conditions are far from satisfactory. Especially does this apply to those employed in factories or close workshops during the day time. Again, sweets often are taken in place of a good meal, and it is noticeable, particularly when young girls go out to the factories, money so earned, instead of being spent on good food, is used in finery and other trashy things. When a girl gets married, the course of training up to marriage has been so useless that the same helpless methods are carried on during the early years of married life, leading to bad nutrition and deficient staying power, with the result that when a call is made upon the system these weakly subjects either do not go to their full time, or a debilitated human being is added to the present generation, to die in a few days, or it may be months later, from failure of the mother to carry out her proper maternal functions. (2) The want of care exercised by the mother during early motherhood, tending towards or causing this general debility. (3) The irregular habits of the father before marriage. 29 Economy in Food. To waste food—that which acts in giving us the inherent power of life—is against the higher nature of man, and the duty to avoid all forms of food-waste should be inculcated, as a part of the moral teaching of the public health administration, in every household and school in the Borough. It is an undoubted fact that factory life has done much to wean many of our artizan men and women from the old-fashioned form of home-life. Too frequently the woman is compelled to assist in keeping the home together by outside work. This leads to loss of pride in the home, and many become satisfied with a one or two-roomed tenement where the cooking facilities are inadequate, and it becomes an easy excuse, for the careless, to purchase their provisions already prepared. Now that food-stuffs are rising in value, it is well to remember that frequently wealth buys nothing but flavour, things which tickle the palate, and that the very cheapest foods, if wisely chosen, have all the nutritive value of the dearest. Moreover, by good cooking, cheap food can be made as tasteful and appetising as the dearest, and quite as stimulating to the digestive juices. The rich set the fashion for fancy white bread, the servant class spread the fashion, and the poor suppose that what their richer neighbours eat must be the best. Having regard to the present danger of the price of flour still increasing, and poverty spreading, the preference for the white loaf becomes of national importance. Flour is bleached wholesale to make it white, and, as a consequence, low grades of flour are oftentimes bleached and sold as white thus enhancing the profit of the miller. Economically, bleached flour is of no superior value, and, if anything, it tends to deteriorate the flour from which the miller has already taken useful active principles called " vitamines," the phosphates and a part of the protein, some of which are physiologically necessary for nutrition and others for bodily growth. As the British Medical Journal recently stated: "Let the Government once and for all forbid this bleaching and insist on the sale of a household flour of the same standard as our forbears had from the millers whose windmills ground the golden grain. The wheat then will go much further, and the cattle cease to have the best part of the food of man." It is the bleaching and faking of flour which give opportunity for the millers to form rings and force the prices up in times like these. Bread is sold legally by weight, and too often the baker slack-bakes his 30 loaf and leaves as much water in it as possible ; in consequence the bread is less digestible, more dough-like, and less nourishing. Bread ought to be sold as containing a given weight of the food principles found in wheat, not less than so much protein, so much carbohydrate, and containing all the principles which suffice to support the nutrition of pigeons when they are fed on bread and water. In three weeks pigeons fed on white bread and water mope to die. On the wholemeal wheat they live and flourish. This is the true physiological test of bread value. In the canning of foodstuffs heating to 120° destroys the vitamines. Tinned food, therefore, cannot replace fresh foods. We want the nation to have fresh foods, not faked foods. Of very high value among cheap foods is the potato. With milk and fat it forms an adequate and healthy diet. Cooked with cheese we obtain a food at once nutritious and appetizing. Waste of protein, of valuable salts and vitamines must be prevented by boiling or baking potatoes in their skins, though for boiling, just a narrow scale of skin can be removed. The ordinary habit of peeling and soaking potatoes not only wastes the good things and flavour in the peel, but allows much of the precious principles in the potato to dissolve out—to be thrown away with the water in which they are soaked and boiled. If it became necessary to add much potato to flour for the making of bread, the nutritive value of the loaf will be lowered, for potato contains a lower percentage of protein and starch than flour; the wholesomeness of the loaf, on the other hand, will not be lessened, but the children will want more slices of such a bread ; that must not be forgotten. The water in which meat, bacon, fish, or vegetables are cooked should be boiled down and become part of the stockpot into which all scraps of food, bread, meat, bones, and vegetables should go. Probably as many people again could be well fed by good cooks on the waste which is thrown away from the kitchens of poor and rich alike. The waste of food in our country is colossal. There is almost nothing in our raw foodstuffs which cannot be used. The outside leaves and peelings of vegetables, the bones, the waste of broken bread, put in the stockpot make palatable and most nutritious broth. The pig flourishes and waxes fat on the contents of the waste-pail. Children could flourish no less well on the discarded material. The servant class are often most wasteful, from a mistaken, uneducated, and snobbish view of life. 31 One of the most prevalent forms of waste is over-eating—almost all of us, whether rich or poor, eat too much under the erroneous idea that man can feed up his strength. Now what does over-feeding do? It leads to excessive bacterial decomposition in the bowel, absorption of toxins, metabolic disturbances, and lessening of health, vigour, and happiness. The amount of food required is determined by the energy output of the body, and to put in more is as useless as pouring petrol into the already filled tanks of a car. There would not be an underfed child in the land if the overfeeders yielded up their excess, and the increased number of good-tempered and happy, healthy people would be astonishing. Many of the children of the rich are nowadays really starved by over-indulgence. Four meals a day and sweets and food between meals set up in them a chronic derangement of the digestive organs which leads to malnutrition. It is as easy to starve the body by ill-feeding as by deficient feeding ; the chronically unclean tongue and disturbed nutrition are the precursors of the decay of teeth. If the immunizing mechanism of the mouth is to be efficient the stomach must be in perfect order, and long fasting periods must intervene between meals. Three meals a day is the right rule, and every man should rise from table not satiated but wishing to eat more. His appetite should be as keen and the tongue as clean as that of a well-kept dog. If we have to consider the ways and means of cheapening food our first thought should therefore be " let us eat more wisely." Home-made Bread. Although the making of bread at home is capable of effecting a great economy, the art has been for a long time on the decline in this country. Home-made bread is more nourishing and palatable, and will keep fresh much longer than the bread that is purchased from the baker. These advantages, combined with the saving of the bakers' profits, make the present an opportune time for the revival of bread-making at home. Already wheaten bread is too dear as a staple article of food, especially amongst the poor, who consume large quantities of it. It may, therefore, interest some to study the following recipes extracted from one of our health pamphlets for making bread at home :— Wheat Bread. Ingredients—1 peck of flour, 2 ozs. of compressed or distillery yeast, l½ozs. of salt, 3 quarts of water. 32 Method—Turn the flour into a clean pan, and make a "hay" or hole in the centre—let the water be about 80° Fahr. or nearly blood warm so that it feels neither hotter nor colder than the hand when placed in the water. Put the water into a bowl, add the yeast and salt, and stir up well with the hand until dissolved, then turn it into the bay and make up into rather a stiff dough ; knead well and leave dry, cover with a clean cloth, and set the pan of dough in a warm place to prove for at least 2 hours, then give it another good kneading and drying over, and leave it for another hour: turn out on to the board, divide into suitable sized pieces, make into loaves, prove and bake in a moderate oven. A 2-lb. loaf in a moderate oven will take from 20 to 40 minutes and larger loaves in proportion. Mixed Bread. Take 4 lbs. of wheat flour (households or seconds) and mix with 4 lbs. of rye flour or Indian corn or maize flour in the pan; mix one table-spoonful of salt well into the flour; add one quart of skim milk and three pints of cold water and work it well into the flour. Now add two teaspoonfuls of bicarbonate of soda dissolved in a little cold water. Now knead up thoroughly until a nice smooth dough is obtained. Now work into the dough a tablespoonful of melted lard or butter. Grease enough bread tins to hold the dough, put it into the tins and steam for two hours and then place tins in a fairly well heated oven for about one hour. If we wish to increase the nutritive value of home-made bread, maize flour, coarsely and freshly ground, may be added in the proportion of, say, one quartern of maize flour to one quartern of wheat flour, either households or seconds. Maize flour is cheaper than wheat flour, and is largely used in Europe, America and South Africa, in a variety of ways. It was also introduced into Ireland during the potato famine, and has since been much in use. As maize lacks gluten it should be mixed with wheat flour, this mixture making an excellent bread. Maize flour, by itself, will make splendid tea cakes. District Nursing. The following is a list of the chief nursing bodies where district nurses may be obtained :— 1. Ranyard Nurses, Central Office, Ranyard House, 25 Russell Square. Eight of the Nurses live in different parts of the Borough. 2. Nurses of St. John the Divine in Watson Street. These are connected with the Morden Hill Hospital, Blackheath. 3. Central Hall Nurses, High Street. Two in number. 4. St. John's Church Nurse. 33 Female Sanitary Inspectors and Health Visitors. NOTIFICATION OF BIRTHS. During the year 3986 visits were made to the homes of babies. Early notification as required by the Act has been systematically carried out, and it may be said that the Notification of Births Act is working efficiently in the Borough. There were 3121 births registered during 1914. „ 3002 „ notified „ „ Your Lady Health Visitors report that they have visited 2227 homes where children have been born. These visits have usually been made about the middle 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, should your Medical Officer of Health consider it a suitable case for visitation. Your Medical Officer considers that if visited early the mother is open to receive advice concerning her offspring, and will frequently tell the Health Visitors of little difficulties she may have with other children and seek that advice which it is in the province of a Health Visitor to give. Breast-feeding is generally attempted for the first two months, after which time the milk sometimes disappears or becomes of very poor quality. It is unfortunately a fact that the child has then frequently been fed either upon boiled bread, cheap brands of condensed milk, or as an alternative skimmed milk. It is hardly sufficiently realised that the artificial feeding of infants has only been extensively practised within quite recent times and that the feeding bottle was introduced within the memory of the present generation. Whether we shall ever return to the habits of the prefeeding bottle days or not it is difficult to say. If we do not it will not be for want of serious warnings of the risks run by the bottle-fed baby, namely—a liability to all kinds of digestive disturbances resulting in impaired digestion for life ; a liability to rickets with deformities lasting for life ; a greatly increased liability to die during the first year of life from diarrhoea ; a lack of vital resistance causing the baby to succumb more easily to the various diseases which it might contract; interference with the proper development of both the temporary and permanent teeth with effects lasting for life ; liability to scurvy; and liability to contract tuberculosis by the ingestion of tuberculous milk. c 34 The distribution of visits in the different wards was as follows:- E. N. N.W. S. S.E. S.W. Total Miss O'Riordan Visits 161 6 703 162 345 297 1674 Revisits 121 1 833 149 455 309 1868 Total 282 7 1536 311 800 606 3542 Miss Day (Jan. to July 29th) Visits 559 - - - - - 559 Revisits 787 - - - - - 787 Total 1346 - - - - - 1346 Miss Stone Visits 230 666 156 - 16 - 1068 Revisits 225 733 267 — — — 1225 Total 455 1399 423 - 16 — 2293 Miss Tug well (Dec. 21st to 31st) Visits — 51 — — — — 51 Revisits - 26 - - - - 26 Total - 77 — — - - 77 Totals 950 723 859 162 361 297 3352 Revisits 1133 760 1100 149 455 309 3906 Total 2083 1483 1959 311 816 606 7258 The following visits are included in the above table:— 1st visits 2nd visits Total Births 2227 1759 3986 Tuberculosis 433 1575 2008 Verminous Children 316 461 777 Ophthalmia Neonatorum 16 25 41 Infant Deaths 77 — 77 Miscellaneous 283 86 369 3352 3906 7258 The number of births notified under the Notification of Births Act during this period was 3002. 141 parents had to be written to on account of the failure to comply with the Act, and in one case a second letter was necessary, making a total of 142 letters sent. 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. Midwife Other Person. East 667 343 324 648 19 89 66 502 10 North 759 394 365 742 17 198 224 305 32 Nth.-west 797 393 404 777 20 323 195 , 227 52 South 178 92 86 173 5 112 43 13 10 Sth-East 268 135 133 261 7 92 56 106 14 Sth-'W est 333 174 159 322 11 140 70 101 22 Totals .. 3002 1531 1471 2923 79 954 654 1254 140 35 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 451 25 32 508 North 447 24 42 513 North-West 573 33 46 652 South 98 3 12 113 South-East 214 4 15 233 South-West 185 3 20 208 1968 92 167 2227 Maternity and Child Welfare. During the year the Local Government Board issued a circular on Maternity and Child Welfare. I understand from this and from interviews with officials of the Board that it is desired that we extend the scope of the work we are already doing in infant care, and this Council is offered every encouragement in the way of a grant in carrying out this work. The Medical Officer to the Board states in his Third Report on Infantile Mortality that the ideal condition of things " is that each mother should be able to receive medical advice during pregnancy at an ante-natal clinic ; that she should be advised during the lying-in period by the doctor or midwife, and that subsequent visits should be made by the health visitor at intervals determined by the needs of each child. These visits should be supplemented by the work of an Infant Welfare centre until the child begins to attend school." Supervision of infant welfare and health visiting in connection with the Notification of Births Act is now the routine practice in the borough. Since the details of the work are, I feel certain, insufficiently realised, it appears desirable to set forth the main features of health visiting. These have been described by Dr. Lane Claypon in a memorandum issued by the Local Government Board, as follows:— The health visitor is primarily concerned with infants, but it is important that her work should be looked at from a broad point of view and should include any features which may affect the well-being of the child before or after birth. In the first place it is desirable to emphasise the value of ante-natal work, and to indicate briefly the line which may suitably be followed at this period with a view to safeguarding the infant's life and its future welfare. c 2 36 It is hoped that maternity centres, where pregnant women may seek advice and help, will be established in many areas. Where there is a maternity institution, or failing this a children's hospital, it is probable that arrangements could be made for the municipal maternity centres to be established in direct connection with them. The centre should be available for all cases, not only for those applying to the maternity institution or hospital for aid, and it is anticipated that medical practitioners may be glad to utilise the services of the doctor or visitors of the centres for cases they will themselves attend at the confinement. Ante-natal visiting will be carried out in connection with the maternity centre, since there will be many points which may suitably be supplemented by domiciliary visits. It is assumed that where ante-natal visiting is proposed either with or without a maternity centre, satisfactory arrangements will be made for obtaining information regarding the locality of the expectant mothers. This may be accomplished by obtaining the names and addresses of pregnant women from those persons or agencies who are practising midwifery in the district. Where ante-natal visiting is already being carried out by any agency, co-operation with that agency, with a view to avoid overlapping, will be desirable. The points with which domiciliary visits will be mainly concerned will include inquiry as to the presence of any conditions in the mother which may injuriously affect the progress of her confinement and the health of the unborn infant, the feeding and clothing of the mother and the hygiene of her daily life. The health visitor should make inquiry as to the preparations the mother is proposing to make, or has made, for the birth, and should be prepared to give instruction as to the requirements for this event. The health visitor should also endeavour to secure the preparation of suitable clothing for the infant, and should give advice and instruction regarding the breast-feeding of infants. It is assumed that where a maternity centre exists the health visitors will be present during the consultations at the centre, and at their visits will endeavour to secure that the medical advice given there is carried out at home. Where no centre exists it will be advisable for the health visitors to inquire into the points above-mentioned and also into such matters as the condition of teeth and bowels, and to give advice on the care of the breasts. The health of the mother and child, although largely inter-dependent before birth, must to some extent be considered separately. 37 I.—The Health of the Mother before the Birth. Many women regard suffering during pregnancy as a natural accompaniment of this state. The condition of pregnancy should not, however, be regarded as pathological, but attention should rather be devoted to the prevention, and, if necessary, treatment of such ailments or minor departures from the normal which occur all too frequently among pregnant women. In a small percentage of cases pathological conditions must be expected to supervene, but the total sum of physical or mental disturbance or suffering in this numerous and important class of the community could undoubtedly be in great degree eliminated were due attention given to the adoption of suitable hygienic measures. The feeding of the expectant mother is clearly a point of considerable importance. She should be encouraged to provide nourishing food for herself, and directions as to the avoidance of unsuitable substances should be given; in this latter category such things as alcohol in any form, vinegar, pickles, &c., will be included. The clothing of the mother is frequently of unsuitable type. The health visitor should bear in mind that no part of the body should be constricted by clothing, more especially in cases where there is any tendency to varicosity of veins or to oedema of the feet and ankles. Constriction above or below the knee should be avoided. The presence of a septic focus or foci in any part of the mother's organism will be a source of danger to the infant. Decayed teeth or pyorrhoea alveolaris even in a mild degree will be liable to affect the child detrimentally. The habit of excessive kissing of infants is to be deprecated, but it is hardly probable that it will be eliminated. Dummy teats, which at the present time are regrettably prevalent, and the teats of the feeding bottles of artificially-fed children, are unfortunately not infrequently moistened in the mother's mouth before being put into that of the child. The danger to the infant from this revolting practice, especially if carious teeth or other septic focus be present, need hardly be emphasised. The care and condition of the breasts should be inquired into. The importance of cleanliness of the breasts is perhaps not sufficiently realised. The common practice of "hardening" the nipples with alcohol before the confinement is not desirable, and cracked nipples may best be avoided by strict attention to cleanliness and the application of some emollient or of friar's balsam. The difficulty attending breastfeeding consequent on the condition of depressed nipples may be aided by pulling them outwards during the later months of pregnancy. 38 Constipation is a common trouble among pregnant women and should be carefully dealt with. The occasional dose of castor oil, or some other powerful aperient, cannot be considered satisfactory. Efforts should first of all be made to relieve the condition by care as to the diet of the expectant mother. Fruit and vegetables (the latter mixed with oil, if necessary), a sufficient intake of fluid and moderate exercise should be advised. If these measures fail it may be necessary to resort to aperients. These should be taken in small daily doses to ensure regularity of action rather than in larger but less frequent doses. The actual drug used will vary with the individual, but it is probable that some form of saline aperient will be found applicable in the najority of cases. Sanitation.—The sanitary condition of the home, its order and cleanliness, are matters of much importance, and should on no account be neglected by the health visitor in her ante-natal visiting, as well as later. Preparation for the infant.—The continued efforts of health visitors, both municipal and voluntary, to secure more suitable clothing for infants, has undoubtedly led to considerable improvement in most areas where this work is energetically carried on. It is not unusual, however, for little preparation to be made for the clothing of the expected infant, or, if made, it may be of unsuitable type. There is a tendency to pay more attention to the clothing of the child after the early weeks of life. This is clearly erroneous, since the greatest care will be required immediately after birth. The thin cotton shirt for newly-born infants and garments leaving the arms bare still persist in many areas, as does also the heavy, but not warm, flannelette petticoat or dress with cotton bodice or lining, for children after the first weeks of life. Suitable advice as to the clothing of the infant given before birth may secure great improvements, since it is generally found that the mother is more ready to provide satisfactory clothing than to change from unsatisfactory garments to those recommended by the health visitors after the confinement. It is essential that advice as to the importance of breast-feeding should be given. The value of supplying the infant with the food designed for it by nature need hardly be pointed out. 39 It has been shown by numerous observers that the milk of the same species, while of great value throughout the whole period of suckling, is very specially so during the early days of life. Even where circumstances may render it necessary for the infant to be weaned during the early weeks of life the mother should be by all means encouraged to give the infant the breast for the longest possible period. No difficulty is experienced in the subsequent early weaning, as is sometimes supposed. The need for regular feeding should also be discussed with the expectant mother ; if possible she should be persuaded to accustom the infant from birth onwards to feeding periods which should not be less than three hours apart, and the feeding should be entirely intermitted between from 10-11 p.m. to 5-6 a.m. Those who have practised these methods of feeding have found by experience that greatly superior results are obtained than by the methods of more frequent feeding. Breast-feeding, even if difficult, should not be entirely abandoned for three or four weeks. The difficulty is frequently due to the infant, which is not sufficiently strong to supply the necessary stimulus to the mammary gland which is tequired for the adequate fulfilment of its function. Only in comparatively rare cases can the deficiency of the mammary function be attributed to a real defect on the part of the mother, unless she is suffering from an insufficiency of food. II.—Health of the Infant—Post-natal visiting. The first visit after birth is paid at varying periods. In the county boroughs the health visitors are frequently inspectors of midwives, and they visit the infants as soon as possible after the receipt of the notification in order to assist the supervision of the work of the midwives. In other areas it is usual for the first visit to be paid after the attendance of the doctor and midwife has ceased. Where the sanitary conditions and the clothing of the infant have received due care before the birth of the child, the most important matter for the first visit will be the feeding of the infant. In subsequent visits the sanitation and cleanliness of the home should be kept in view, as also any alteration in the clothing and feeding of the child, as the early months and years of life are reached. Many of the children visited will doubtless be attending the maternity centre, and it will be the duty of the health visitor to attend at the centre and secure the carrying out of the advice which is given there by subsequent home visits. 40 The frequency of the revisits to the child's home will depend upon the nature of the case. In the larger towns it has been found that the average number of visits required by an infant during the first year of life is from 8 to 10 ; on this average some have received less and others many more than the average. This figure does not include ante-natal visits; or visits between the ages of 1 and 5 years, which will also vary in frequency according to home conditions. It is essential that the medical officer of health should be in close touch with the daily work of the health visitor and should personally direct her work. Where, as will frequently be the case, the medical officer of health and the doctor at the maternity centre are different persons, it is desirable that arrangements should be made whereby all records, both of ante and post-natal visits, as also the medical records of the centre, should be on a uniform basis; and arrangements should also be made for the health visitor to visit such special cases as may be desired by the medical officer of the centre. Infant Consultations, &c. I am pleased to be able to report that there are now at least four centres in the district inaugurated for the purposes of child welfare at:— The Town Hall. Cornbury Road Mission Hall. The Albany Institute. The Deptford Health Centre and Evelyn Home. Town Hall. The work here is good but needs to be extended. It is inefficiently supported by the local authority and a grant from the Local Government Board is badly required. Nature and scope of work. Infant consultations and lectures for mothers are held each week. The mothers take an interest in the teaching and are very keen to absorb the knowledge expounded to them. Several expectant mothers have attended the classes. The annual examination for knowledge in Infant care was held in December, and was conducted by Dr. Macdonald. 41 Twelve mothers passed the examination satisfactorily and the marks obtained showed that the candidates came up to a good standard of efficiency. Infant consultations 1501 attendances for the year. Infant Weighing Lecture—51 weekly lectures on Infant care (l hour each). 7 extra lectures prior to examination (l hour each). 6 lectures on Home Nursing (l hour each). Average number of mothers attending each week, 31. Medical Treatment. Cases referred by the Superintendent are seen by the Medical Officer, and cases requiring operation or continual hospital treatment are referred to a suitable hospital. Patterns of garments are supplied to the mothers on request. It has been brought to my notice here that milk is badly required to nourish poor mothers, and thus reduce artificial feeding of infants. Help should also be given to provide artificial teeth for nursing mothers, some of whom are quite incapable of bearing the expense. Cornbury Road Mission Hall. The expenses of the Infant Consultation are partly borne by the municipality. Up to the present the attendance has not been satisfactory. Dr. Swanson kindly attends each week and gives her services, and we are much indebted to the Lady Gomme Dispensary for medicines, etc. Total attendances for the year ... ... 361 Number of consultations ... ... ... 46 Average number attending each week ... 7 Albany Institute, Deptford Fund. Returns of Infant Consultations from January 1st to December 31 st, 1914. No. of individual Babies who have attended Infant Consultations 352 „ times those Babies have been weighed 2063 „ „ „ seen by Doctor 739 Total attendance of Mothers at Lectures 2237 No. of Infant Consultations held 50 Total attendance made by Children at the Day Nursery for the year 3425 No. of Babies admitted to Babies' Home 36 Babies who have been re-admitted 5 42 The Secretary, Mrs. Lamert, reports to me as follows:— With regard to the Babies' Home, which is really the expensive part of our work, I am sorry to say that unless the Local Government Board are able to give us a substantial grant, i.e., 50 per cent. of our expenses, I fear it will no longer be possible to carry on this much needed branch of our work. For this, we must have a doctor, trained nurses, and food stuffs and chemists bills are very heavy items, but the work is urgently needed, and is doing real good as the records of the Medical Officer in charge furnish proof." Deptford Health Centre. This institution has again been of great service to the Public Health Department, and many suitable cases have been referred to it for open air and other treatment during the year by the Health Visitors and our Tuberculosis Dispensary. The centre is under the management of Miss McMillan, and the three medical officers attend on Tuesdays, Wednesdays and Fridays, at 2 p.m., and there is a nurse in attendance daily from 9 a.m. to 7 p.m. The following table gives the number of children attending the doctors:— No. of No. of attendances Disease. Children. to Doctors. Defects of vision 409 914 Eye diseases 646 1001 Ear disease 260 581 Nose and throat diseases 502 912 Skin diseases 606 1225 Spinal diseases 58 89 Various diseases (acute and chronic) 372 1143 Anaemia and malnutrition 101 184 Injuries 143 244 3,097 6,293 Dental treatment has also been given to 2943 children and nearly 10,000 extractions and stoppings have been performed by the dentist. In addition, the nurse treated 237 other children for slight troubles. 337 operations for adenoids, tonsils, &c., were performed at the Evelyn Medical Home in Evelyn Street. Children suffering from minor ailments came to the clinicin 4ways:— 1. Those provided with cards by the London County Council. 2. Those sent by the teacher. 3. Those brought by parents directly. 4. Those recommended. 43 At the Evelyn Medical Home, 251 children received breathing exercises and other treatment. 175 were treated for mouth breathing and 64 for curvature of the spine. In addition to the above good work there is a camp school for boys and girls which carries on excellent work, although it is unfortunately still unassisted by any public authority. As many as 84 children have been in camp at one time, and have gone through a course of open air treatment and education at the same time with excellent results. The feeding and sleeping arrangements are particularly good, and I consider Miss McMillan is performing a great public service to the Boroughs of Deptford and Greenwich in not only treating so many of our children but educating them to lead healthy lives. A new departure was initiated last March by the formation of a baby camp—at the end of the summer 29 children under school age were living and sleeping in the camp. There was hardly any illness even during the hot months; the children put on weight regularly. Their sleep is reported to have been most quiet; in every way they enjoyed the open space, which was large for these tiny ones. There seems to have been marked mental improvement as well as physical during the period under report. These children had all their meals in school, including dinner. This interesting experiment has been remarkably successful and has exceeded any anticipation of our own. It is one that is capable of great development and production of good to the rising generation. It has been generally recognised that the proper care of children under school age forms a serious gap in the measures that have been suggested or ought to be put in practice during recent years to ensure a healthier and more vigorous people. This open-air camp for these babies is an endeavour to bridge the gap, and it is a method of treatment and child nurture that might well be encouraged and developed. 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 1914 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 1 year of Age. At all Ages. of Nonresidents registered in the District of Residents not registered in the District. Number. Rate. Number. Rate per 1.000 Nett Births- Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1909 118,583 3,047 3,093 268 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 1912 109,377 2,807 2,896 26.5 1,045 9.6 182 579 258 89 1,442 13.2 1913 109,280 3,041 3,106 28 .0 1,283 11 6 181 625 350 113 1,727 15. 5 1914 109,182 3,071 3,121 28.6 1,145 10.5 163 616 309 99 1,598 14.6 Area of District in acres (land and inland 1,563. water). J Total population at all ages 109,496. Number of inhabited houses 16,102. Average number of persons per house, 6 8. At census 1911. 44 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 1914. Notifiable Disease Number of cases notified. Total cases notified in er.ch Ward. Total Cases Removed to Hospital. At all Ages At Ages—Year Hast Ward North Ward North-West Ward South Ward South-East Ward South-West Ward Under I 1 to 5 5 to 15 15 to 25 •25 to 45 45 to 65 65 and upwards Small-pox .. .. .. .. .. .. .. .. .. .. •• .. .. .. . . Cholera .. .. .. .. .. .. .. .. .. .. .. .. ... .. .. Diphtheria including Membranous croup 253 .. 71 137 28 15 l l 47 46 98 14 26 22 219 Erysipelas 225 4 9 18 38 80 60 16 96 42 31 13 28 15 4 Scarlet fever 866 5 225 566 49 21 .. .. 186 286 178 59 61 96 761 Tvphus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 9 .. .. 1 5 1 .. .. 1 4 1 .. 1 2 8 Relapsing fever .. .. .. .. .. .. .. .. .. . . .. .. .. . . .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 5 .. .. .. .. 5 .. .. •• 1 3 •• • • 1 4 Cerebro-Spinal Meningitis 1 .. .. .. .. .. .. .. .. .. .... .. .. .. .. Poliomyelitis 1 .. 1 .. .. .. .. .. .. .. 1 ,. .. .. 1 Pulmonary Tuberculosis 345 4 12 44 62 136 79 8 121 79 61 17 38 29 218 Other forms of Tuberculosis 74 6 19 23 12 12 2 .. 25 17 16 4 6 6 15 Ophthalmia Neonatorum 16 16 .. •• •• .. .. .. 6 6 2 1 •• 1 3 Totals 1794 35 337 789 194 270 144 25 482 481 391 108 160 172 1233 45 46 METROPOLITAN BOROUGH OF DEPTFORD. Causes of, and Ages at Death during the Year 1914. (This Table is prepared in accordance with the requisitions of the Local Government Board.) Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the Distrtct. Total Deaths whether of " Residents " or "Non-Residents" in Institutions in the District. CAUSES OF DEATH. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All Certified 1598 309 86 77 64 64 208 336 454 170 causesUncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever 3 .. .. .. .. 1 .. 2 .. 5 Small Pox .. .. .. .. .. .. .. .. .. .. Measles 50 7 23 18 2 .. .. .. .. 23 Scarlet Fever 9 .. 3 4 2 .. .. .. .. 37 Whooping Cough 9 .. 6 3 .. .. .. .. .. 10 Diphtheria and Croup 25 1 1 10 11 .. 1 .. 1 72 Influenza 22 2 1 1 .. .. 3 7 8 .. Erysipelas 4 1 .. .. .. .. .. 2 .. .. Phthisis (Pulmonary Tuberculosis) 152 1 1 2 7 33 67 34 7 1 10 2 3 6 3 2 .. .. .. .. Other Tuberculous Diseases 19 8 .. 2 2 1 3 3 .. .. Cancer, malignant disease.. 121 .. .. .. .. .. .. .. .. .. Rheumatic Fever 13 .. .. 2 6 2 1 1 1 .. Meningitis 12 4 2 3 3 .. .. .. .. 4 Organic Heart Disease 117 .. .. .. 3 6 13 36 59 1 Bronchitis 136 22 3 3 .. .. 6 33 69 1 Pneumonia (all forms) 114 21 17 11 9 2 21 15 18 4 Other diseases of Respiratory Organs 23 .. 1 1 3 2 .. 9 7 .. Diarrhoea and Enteritis 96 76 12 1 .. .. 2 1 4 1 Appendicitis and Typhlitis.. 5 .. .. 1 .. 2 .. 2 .. .. Cirrhosis of Liver 16 .. .. • • .. .. 3 11 2 .. Alcoholism 6 .. .. .. .. .. 3 2 1 .. Nephritis & Bright's Disease 41 .. 1 .. .. 1 7 23 9 2 Puerperal Fever 2 .. .. .. .. .. 2 .. .. 3 Other accidents and diseases of Pregnancy and Parturition 4 .. .. .. .. 1 3 .. .. .. Congenital Debility and Malformation, including Premature Birth 114 113 1 .. .. .. .. .. .. .. Violent Deaths (excluding Suicides) 59 5 .. 3 8 2 15 13 13 .. Suicides 10 .. .. .. .. 1 3 4 2 .. Other defined diseases 393 46 7 4 5 8 44 77 202 5 Diseases ill-defined or unknown 7 .. 4 1 .. .. 1 1 .. 1 1598 309 86 77 64 64 208 336 454 170 47 Table No. 4. METROPOLITAN BOROUGH OF DEPTFORD (This Table is prepared in accordance with the requisitions of the Local Government Board.) Infantile Mortality, 1914. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSF. OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 Weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. All Causes Certified 76 12 20 4 112 67 54 40 36 309 Uncertified .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 1 6 7 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Erysipelas .. .. .. .. .. .. .. 1 .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. 1 1 2 Abdominal Tuberculosis .. .. .. .. .. .. 1 2 .. 3 Other Tuberculous Diseases .. .. .. .. .. 4 .. 2 .. 6 Meningitis (not Tubtrculous) .. .. .. .. .. .. 2 1 1 4 Convulsions .. l 1 .. 2 2 1 1 2 8 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. 3 3 7 9 4 2 .. 22 Pneumonia (all forms) .. .. .. .. .. 5 5 4 7 21 Diarrhoea .. .. .. .. .. 9 11 9 5 34 Enteritis .. l 1 .. 2 10 11 10 9 42 Gastritis .. .. .. .. .. 1 5 1 .. 7 Syphilis 5 .. 1 .. 6 4 1 .. .. 11 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying 1 .. .. .. 1 2 1 .. .. 5 Injury at Birth 4 .. .. .. 4 .. .. .. .. 4 Atelectasis 3 .. .. .. 3 .. .. .. .. 3 Congenital Malformations 4 .. .. .. 4 1 1 .. .. 6 Premature Birth 44 7 9 .. 60 7 1 .. 1 69 Atrophy, Debility and Marasmus 11 3 4 .. 18 11 6 1 9 38 Other Causes 3 .. 1 1 5 2 4 3 1 15 76 12 20 4 112 67 54 40 36 309 Nett Births—Legitimate, 3045; Illegitimate, 76. Nett Deaths—Legitimate infants, 298; Illegitimate infants, 11 48 Table No. 5. Return of Births Registered during the Year 1914. Sex. Illegitimate. Total. East Ward. North Ward. North-West Ward. South Ward. South-East Ward South-West Ward. Sex. Illegitimate. Total. Sex. Illegitimate. Total. Sex. Illegitimate. Total. Sex. Illegitimate. Total. Sex. Illegitimate. Total. Sex. Illegitimate. Total. M F M F M F M F M F M F M F Births registered in the Borough 1571 1500 56 3071 353 332 11 685 407 390 9 797 397 399 24 796 90 86 1 176 151 126 6 277 173 167 5 340 Births registered in Outlying Institutions 25 25 20 50 6 6 4 12 6 6 4 12 6 6 4 12 1 1 1 2 3 3 3 6 3 3 4 6 Total Births belonging to the Borough 1596 1525 76 3121 359 338 15 697 413 396 13 809 403 405 28 808 91 87 2 178 154 129 9 283 176 170 9 346 Weekly Death Kates, from all causes, in Deptford and London. 49 Table No. 6. Return of Deaths Registered during the year 1914. Registration Districts. Sex. Deaths under 1 year. Total. East Ward. North Ward. North-West Ward. South Ward. South-East Ward. South-West Ward. South-Eastern Hospital. Sex. Deaths under 1 year. Total. Sex. Deaths under 1 year. Total. Sex. Deaths under 1 year. Total. Sex. Deaths under 1 year. Total. Sex. Deaths under 1 year. Total. Sex. Deaths under 1 year. Total. Sex. Deaths under 1 year. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Deaths registered in the Borough 583 562 263 1145 119 105 83 224 118 103 63 221 97 86 52 183 60 50 10 110 56 55 22 111 58 72 21 130 75 91 12 166 Deaths in Outlying Institutions 335 281 59 616 110 92 34 202 71 58 10 129 49 49 8 98 14 24 1 38 50 30 3 80 41 28 3 69 .. .. .. .. Total number of Deaths of Residents of the Borough 844 754 309 1598 229 200 116 429 189 163 74 352 148 136 60 284 72 75 11 147 106 79 24 185 100 101 24 201 .. .. .. .. 163 Deaths registered in the Borough were of non-parishioners. Of these 146 occurred in the South-Eastern Hospital. In the last line of the above Table, the 20 deaths of residents of Deptford occurring in the South-Eastern Hospital have been allocated to their respective Wards, and the deaths of all non-parishioners excluded. 50 51 Deaths Registered in or Belonging to the Metropolitan Borough of Deptford DURING THE YEAR 1914. Diseases. Whole Borough. Under 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and up WARDS All ages. 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 East North North-West South South-East South-West M F Tot. M F M F Tot. M F Tot. M F Tot. M F Tot. M F Tot. M F Tot. I.—General Diseases. 1 Enteric Fever ... 3 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 2 2 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Small Pox— ... (a) Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Not Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Measles 25 25 50 2 5 10 13 12 6 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 11 20 9 8 17 4 1 5 1 ... 1 1 3 4 1 2 3 7 Scarlet Fever 6 3 9 ... ... 2 1 3 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 2 1 3 ... ... ... 1 ... 1 ... ... ... 2 ... 2 8 Whooping Cough 5 4 9 ... ... 3 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 4 2 1 3 ... 1 1 ... ... ... ... 1 1 ... ... ... 9 (a) Diphtheria 8 17 25 1 ... ... 1 4 6 3 7 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 2 2 4 2 3 5 1 4 5 ... 3 3 1 1 2 2 4 6 (b) Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Influenza 16 6 22 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 ... 5 ... 2 4 1 ... ... 1 3 ... 3 6 2 8 1 2 3 1 2 3 ... ... 3 2 ... 2 11 Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 15 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Erysipelas 1 3 4 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... 1 2 3 ... ... ... 19 (a) Mumps ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Varicella 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... (d) Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 (a) Pyæmia 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... (b) Septicæmia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Beri-Beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 (a) Pulmonary Tuberculosis 51 43 94 ... 1 1 ... 2 ... 1 ... ... 1 6 3 5 7 12 8 13 11 3 7 5 4 3 ... ... 1 ... ... 14 17 31 16 11 27 8 4 12 2 4 6 6 3 9 5 4 9 (b) Phthisis (not defined as tuberculosis) 29 24 53 ... ... ... ... ... ... ... 2 1 1 2 5 2 3 5 4 7 4 5 2 4 3 3 ... ... ... ... ... 9 6 15 2 5 7 6 8 14 1 2 3 7 1 8 4 2 6 29 (a) Acute Phthisis 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... (b) Acute Miliary Tuberculosis 1 1 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 30 Tuberculous Meningitis 9 7 16 1 1 1 2 3 3 2 ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 3 3 6 3 1 4 ... ... ... ... 1 1 2 ... 2 31 (a) Tabes Mesenterica ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 (b) Other peritoneal & intestinal tubercle 5 2 7 2 ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 2 1 3 1 ... 1 2 ... 2 ... ... ... ... 1 1 ... ... ... 32 Tuberculosis of Spinal Column 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 33 Tuberculosis of Joints 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 34 (a) Lupus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Scrofula ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Tuberculosis of other Organs 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 35 Disseminated Tuberculosis 5 3 8 3 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 2 3 3 1 4 ... ... ... ... ... ... 1 ... 1 ... ... ... 36 Rickets, Softening of Bones ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 37 Syphilis 9 4 13 8 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 3 2 5 2 2 4 3 ... 3 ... ... ... ... ... ... 1 ... 1 38 Other Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Cancer of the buccal cavity 9 1 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 4 ... 3 1 1 ... ... ... ... ... ... 2 1 3 3 ... 3 1 ... 1 3 ... 3 ... ... ... 40 „ stomach, liver, etc. 18 17 35 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 2 4 4 10 4 1 4 ... 1 3 3 6 6 3 9 4 2 6 2 3 5 1 1 2 2 5 7 41 „ peritoneum intestines & rectum 11 15 26 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ] 3 5 3 3 5 1 2 ... ... ... ... ... 1 2 3 5 3 8 1 4 5 2 1 3 2 5 7 42 „ female genital organs ... 19 19 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 7 ... 7 ... 1 ... 1 ... ... ... 1 1 ... 3 3 ... 5 5 ... 5 5 ... ... ... ... 5 5 43 „ breast ... 11 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 6 ... 1 ... 1 ... ... ... 3 3 ... 3 3 ... 2 2 ... ... ... ... ... ... ... 3 3 44 „ skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 45 Cancer of other or unspecified organs 14 6 20 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 3 1 3 1 6 2 1 1 ... ... 2 1 3 4 ... 4 3 2 5 3 ... 3 1 1 2 1 2 3 46 Other Tumours (situation undefined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 47 Rheumatic Fever 5 8 13 ... ... ... ... 1 1 2 ... 1 3 1 1 ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 3 4 7 ... 3 3 1 ... 1 1 ... 1 ... 1 1 48 (a) Chronic Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Osteo-Arthritis ... 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... ... 2 2 ... ... ... ... ... ... ... 1 1 ... 1 1 (c) Gout 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 49 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Diabetes 5 4 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 1 1 1 ... 1 2 ... ... ... 1 1 1 ... 1 ... ... ... 1 1 2 1 ... 1 2 2 4 51 Exophthalmic Goitre ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 52 Addison's Disease ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 52 53 Deaths Registered-continued. Diseases. Whole Borough. Under 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 aud up WARDS. All ages. East North North-West South South-East boutn-west M F Tot 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 M F Tot. M F Tot. M F Tot. M F Tot. M F Tot. M F Tot. I.—General Diseases—contd.. 53 Leucocythæmia Lymphadenoma 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 54 Anaemia, Chlorosis 1 5 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... 1 ... 2 ... ... ... ... ... ... ... 2 2 ... 1 1 ... 1 1 ... 1 1 ... ... ... 1 ... 1 55 («) Diabetes insipidus ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... (bl Purpura l ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... (c) Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Other General Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 56 Alcoholism (acute or chronic) 5 1 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... 2 ... ... 1 ... ... ... ... 2 ... 2 ... ... ... ... 1 1 ... ... ... 1 ... 1 2 ... 2 57 (a) Occupational Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (6) Non-Occupational Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 58 Other Chronic Occupational Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 59 Other Chronic Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ii.—diseases of the Nervous System and of the Organs of Special Sense. 60 Encephalitis 2 ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 ... ... ... 61 (a) Cerebro-spinal Fever ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (6) Posterior Basil Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Meningitis, other forms 6 6 12 ... 1 ... 2 2 1 ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 1 5 ... 3 3 1 1 2 1 ... 1 ... ... ... ... 1 1 62 Locomotor Ataxy 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... 63 Other Diseases of the Spinal Cord 4 6 10 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 1 ... ... 2 1 2 ... 1 ... ... 1 ... 1 1 ... 1 ... ... ... ... 3 3 ... 2 2 2 1 3 64 Cerebral Haemorrhage, Apoplexy 31 23 54 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 1 4 3 6 4 14 8 4 5 ... 1 4 7 11 7 14 11 6 4 10 5 1 6 3 2 5 6 5 11 65 Softening of Brain ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 66 Paralysis without specified cause 4 7 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 1 ... 2 1 ... 1 1 2 ... 1 1 ... 2 2 1 1 2 ... 1 1 2 1 3 67 General Paralysis of the Insane 5 3 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 1 1 2 ... ... ... ... ... ... ... ... 1 2 3 1 1 2 2 ... 2 1 ... 1 ... ... ... ... ... ... 68 Other forms of Mental Alienation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 69 Epilepsy 5 3 8 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 1 ... ... 1 1 1 ... ... ... ... ... ... 2 1 3 ... ... ... 2 2 4 ... ... ... 1 ... 1 ... ... ... 70 Convulsions (Non-puerperal; 5 yrs & over ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 Infantile Convulsions (under 5 years) 7 6 13 6 3 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 6 ... ... ... 3 ... 3 ... 1 1 1 2 3 ... ... ... 72 Chorea ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 73 Hysteria, Neuralgia, Neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 74 Other Diseases of the Nervous System 5 5 10 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 2 1 ... 2 ... ... 2 ... ... 1 ... ... ... ... ] 2 3 1 ... 1 ... 2 2 1 ... 1 ... 1 1 2 ... 2 75 Diseases of the Eyes and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 (a) Mastoid Diseases ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ......... ... ... ... ... ... ... (fc) Other Diseases of the Ears 1 2 3 ... ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ...1 1 III.—diseases of the Circulatory System. 77 Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 78 Acute Myocarditis and Endocarditis 6 3 9 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 2 ... 2 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 1 3 3 1 4 1 ... 1 ... 1 1 79 (a) Valvular Disease 24 33 57 ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... 1 2 1 5 7 5 2 6 7 11 ... 3 ... ... 8 7 15 3 4 7 1 5 6 6 5 11 2 3 5 4 9 13 (6) Fatty Degeneration of the Heart 5 4 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 1 1 2 4 1 ... ... 2 2 4 1 ... 1 ... ... ... 1 ... 1 1 1 2 ... 1 1 (c) Other Organic Disease of the Heart 26 25 51 ... ... ... ... ... ... 1 ... 1 ... 2 1 1 ... ... 1 ... 3 4 ... 6 1 7 10 ... 9 2 ... 5 3 8 9 3 12 2 8 10 ... 3 3 4 2 6 6 6 12 80 Angina Pectoris ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 81 (a) Aneurysm 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... 2 3 ... 3 ... ... ... ... ... ... 1 ... 1 (6) Arterial Sclerosis 9 3 12 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 6 1 1 2 ... ... 3 1 4 ... ... ... ... 1 1 4 1 5 2 ... 2 ... ... ... (c) Other Diseases of Arteries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 82 (a) Cerebral Embolism & Thrombosis 2 3 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 ... ... ... ... ... 1 ... 1 1 ... 1 ... 2 2 ... 1 1 ... ... ... (b) Other Embolism and Thrombosis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 83 Diseases of the Veins (Varices. Haemorrhoids, Phlebitis, etc ) ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 84 (a) Status Lymphaticus ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 (b) Other Diseases of the Lymphatic System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 85 Haemorrhage: other Diseases of the Circulatory System ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV.—Diseases of the Respiratory System, 86 Diseases of the Nasal Fossas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 Diseases of the Larynx 1 1 2 ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... 1 ... ... ... ... ... ... 88 Diseases of the Thyroid Body ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 & 90 Bronchitis 71 65 136 14 8 3 ... 1 2 ... ... ... ... ... ... ... ... 1 1 ... 2 4 5 10 14 24 18 11 10 1 ••• 27 25 52 15 15 30 14 9 23 2 3 5 7 8 15 6 5 11 91 Broncho-pneumonia 28 29 57 10 8 8 5 ... 6 3 2 ... 1 1 ... ... ... ... 1 2 1 1 1 1 ... 2 1 1 1 ... 5 5 11 16 9 5 14 5 5 10 1 2 3 6 2 8 2 4 6 92 (a) Lobar Pneumonia 22 7 29 ... 1 1 ... 2 1 1 ... ... ... ... ... ... ... 7 1 1 ... 3 1 3 1 ... ... 3 1 ... 1 1 3 4 8 ... 8 3 1 4 1 ... 1 7 1 8 2 2 4 (b) Pneumcnia (type not stated) 16 12 28 1 1 1 1 1 1 1 ... ... 1 ... ... ... ... 3 2 1 2 1 ... 1 2 3 1 2 1 ... 1 3 5 8 3 5 8 2 ... 2 4 1 5 3 1 4 1 ... 1 93 Pleurisy 4 4 8 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... 2 1 2 ... ... 1 ... 1 ... ... 1 1 2 1 1 2 ... ... ... 1 ... 1 ... 2 2 1 ... 1 94 Pulmonary Congestion, Pulmonary Apoplexy 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... 1 ... 1 1 ... ... ... 1 ... 1 ... ... ... ... 1 1 ... ... ... 95 Gangrene of the Lung 1 j 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 96 Asthma 3 2 5 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... 1 ... 1 ... ... ... ... 1 1 1 1 2 1 ... 1 ... ... ... 97 Pulmonary Emphysema ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 98 (a) Fibroid Disease of the Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (6) Other Diseases of the Respiratory System 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 54 55 Deaths Registered —continued. Diseases Whole Under 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and up East North wards Borough. All ages. North-West South South-East South-West M F Tot 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 M F rot. M F rot. M F rot. M F rot. M F Tot. M F rot. v.—diseases of the Digestive System. 99 (a) Diseases of the Teeth and Glims 3 ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... (6) Other Diseases of the Mouth &Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100 Diseases of Pharynx, Tonsillitis 4 ... 4 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... l ... 1 2 ... 2 ... ... ... ... ... ... 1 ... 1 101 Disease of (Esophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 102 Perforating Ulcer of Stomach 3 4 7 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 1 ... 1 ... ... 1 ... ... ... ... 1 1 ... 1 1 1 2 3 1 ... 1 ... ... ... 1 ... 1 103 (a) Inflammation of Stomach 5 4 9 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 3 1 4 ... ... ... 1 2 3 ... ... ... ... 1 1 1 ... 1 (b) Other Diseases of Stomach 2 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 1 1 ... 1 ... ... ... 1 1 2 ... 1 1 ... ... ... ... ... ... 104 & 105 (a) Infective Enteritis 19 17 36 17 16 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 5 14 5 7 12 3 5 8 ... ... ... ... ... ... 2 ... 2 (b) Diarrhoea (not returned as infective) 8 3 U 5 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 3 ... 3 2 ... 3 2 2 4 ... ... ... 1 ... 1 ... ... ... (c) Enteritis (not returned as infective) 13 9 22 11 7 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 4 4 8 4 3 7 2 2 4 ... ... ... 2 ... 2 1 ... 1 (d) Gastro-Enteritis (not returned as infective) 12 14 26 7 10 2 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... 4 6 10 2 2 4 3 2 5 1 1 2 1 1 2 1 2 3 (e) Dyspepsia (under 2 years of age) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (f) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (g) Ulceration of Intestines ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... i ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 (h) Duodenal Ulcer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 106 Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107 Other Intestinal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 108 Appendicitis 3 2 5 ... ... ... ... ... 1 ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 1 3 ... ... ... 1 1 2 ... ... ... ... ... ... 109 (a) Hernia 4 1 5 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 ... ... ... ... ... 1 ... i 1 ... 1 1 1 2 ... ... ... 1 ... 1 ... ... ... (ft) Intestinal Obstruction ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 110 Other Diseases of the Intestines 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... 111 Acute Yellow Atrophy of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 112 Hydatid of Liver ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 113 (a) Cirrhosis of Liver (not returned as alcoholic) 4 10 14 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 5 1 2 ... 2 ... ... ... ... 2 4 6 1 2 3 ... 2 2 1 2 3 ... ... ... ... ... ... (b) Cirrhosis of Liver (returned as alcoholic 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... (c) Diseases formerly classed to ' Other Diseases of Liver and Gall Bladder ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 114 Biliary Calculi ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 115 Other Diseases of the Liver 1 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 116 Diseases of Spleen 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 117 Peritonitis (cause unstated) 1 "3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... 1 1 2 ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... 118 Other Diseases of the Digestive System 3 1 4 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... 2 1 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 VI.—non-venereal Diseases of the Genito-Urinary System and Annexa. 119 Acute Nephritis 4 3 7 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 1 1 1 ... ... ... 1 ... 1 ... 2 2 2 1 3 ... ... ... 1 ... 1 ... ... ... 120 Bright's Disease 17 17 34 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 4 1 1 8 5 3 4 2 2 1 1 ... ... 3 2 5 1 8 12 3 2 5 3 1 4 3 3 6 1 2 121 Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Other Diseases of the Kidney & Annexa ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 Calculi of the Uninary Passages 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 124 Diseases of the Bladder 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... 1 ... 1 125 Diseases of the Urethra, Urinary Abscess, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Diseases of the Prostate 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 1 ... ... ... ... ... ... ... ... ... 2 ... 2 1 ... 1 1 ... 1 1 1 127 Non-Venereal Diseases of the Male Genital Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 128 Uterine Haemorrhage (non Puerperal) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ••• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Uterine Tumour (non-cancerous) ... 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 130 Other Diseases of the Uterus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Ovarian cyst. Tumor (non-cancerous) ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ...... 1 1 ... ... ... ... ... ......... ... ... ... 132 Other Diseases of the Female Genital Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 133 Non-puerperal Diseases of the Breast (Non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VII.—the Puerperal State. 134 Accidents of Pregnancy ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 135 Hemorrhage at Childbirth ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 136 Other Accidents of Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 137 Puerperal Fever ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 138 ,, Albuminuria & Convulsions ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 ,, Phlegmasia Alba Dolens. Embolism & sudden death ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 140 ,, Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141 ,, Diseases of the Breast ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—diseases of the Skin and of the Cellular Tissue. 142 (a) Senile Gangrene 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... (6) Gangrene (other types) ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 143 Carbuncle, Boil ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 144 Phlegmon, Acute Abscess ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 145 Diseases of the Integumentary System 2 1 3 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... 56 57 Deaths Registered —continued. Diseases. Whole Borough. Under 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 to 75 75 to 85 85 and up WARDS East North North-West South South-East South West All ages. 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 M F Tot. M F Tot. M F Tot. M F Tot. M F Tot. M F Tot. M F Tot IX-—Diseases of the Bones and of the Organs of Locomotion. 146 Diseases of the Bones 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 147 Diseases of the Joints ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 148 Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Other Diseases of Locomotor System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... X.—Malformations. 150 Congenital Malformations 4 3 7 3 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 1 3 ... 1 1 ... ... ... ... ... ... 1 1 2 XI.—Diseases of Early Infancy. 151 (a) Premature birth 41 28 69 41 28 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 10 23 11 4 15 9 5 14 3 2 5 3 3 6 2 4 6 (b) Infantile Debility, Icterus, and Sclerema 23 15 38 23 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 7 17 7 5 12 2 2 4 1 1 2 2 2 1 1 152 Other Diseases peculiar to early Infancy 5 2 7 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 4 ... ... ... ... 1 1 ... ... ... ... ... ... 1 1 2 153 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... XII.—Old Age. . 154 (a) Senile Dementia ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... 1 1 ... 2 7 ... ... ... ... ... ... ... ... ... (6) Senile Decay 52 55 107 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 12 15 30 26 9 14 21 7 28 6 15 21 8 8 16 5 9 14 2 8 10 10 8 18 XIII.- Affections Produced by External Causes. 155 to 163 Suicides 6 4 10 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... l 2 ... 1 ... 3 ... ... 2 ... ... ... ... 1 1 2 ... ... ... 2 1 3 1 ... 1 1 2 3 1 ... 1 164 Poisoning by Food ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 165 Other Acute Poisonings 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 166 Conflagration 1 2 3 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 167 Burns (Conflagration exceptec ) 4 4 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 3 3 ... ... ... 168 Absorption of Deleterious Gases (Conflagration excepted) 2 4 6 2 3 ... ... ... l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 1 1 ... ... ... 1 2 3 ... ... ... 169 Accidental Drowning 6 ... 6 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 4 2 ... 2 ... ••• ... ... ... ... ••• ... ... 170 to 176 Injuries 28 ... 37 ... ... ... ... ... ... 3 ... ... ... ... ... ... ... 7 ... 3 ... 5 2 5 1 4 2 ... 2 ... 1 5 3 8 2 2 4 7 ... 7 3 4 7 5 ... 5 6 ... 6 177 Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 178 Excessive Cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 179 Effects of Heat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 180 Lig.itning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 181 Electricity (Lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 182 to 184 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 185 Fractures (cause not specified) ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 186 Other Violence 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... XIV.—III Defined Causes. 187 Dropsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 188 (a) Syncope (aged 1 year and under 70) 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 (b) Sudden death (not otherwise defined' ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 189 (a) Heart failure (aged 1 year and under 70) 2 4 6 ... ... 2 2 ... l ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 1 3 ... ... ... ... 1 1 ... 1 1 ... 1 1 ... ... ... (b) Atrophy, Debility, Marasmus (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (e) Other ill-defined deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (/) Cause not specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 844 754 1598 178 131 46 40 39 38 22 17 11 14 15 16 19 14 51 42 64 51 87 71 91 87 135 120 73 83 13 30 229 200 429 189 163 352 148 136 284 72 75 147 106 79 185 100 101 201 Infectious and other Diseases. 60 Mortality from the Principal Epidemic Diseases. The following diseases are included under this heading:—Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Fevers (that is to say, Typhus, Enteric and Continued), Diarrhœal Diseases, and Plague. DEATHS. It is satisfactory to your Medical Officer of Health to have to report that these diseases caused 24 less deaths in the year under discussion than in the previous year. In 1906 and 1911 the number of deaths was greater than in any year for the past ten years, being respectively 318 and 298. Altogether 184 deaths were registered during 1914. DEATH RATE. The death rate from all these diseases, calculated on the estimated population, was 1.69 per 1000 of the population, compared with an average of 1.77 for the past ten years. In 1913 the death rate was 1.87; in 1912, 0.91 ; and in 1911, 272. 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 62 2.93 NorthWard 52 2.18 North-West Ward 31 1.32 South Ward 7 0.58 South-East Ward 12 0.98 South-West Ward 20 1.22 184 1.69 The following statement shows the position occupied by Deptford with respect to the Epidemic Diseases in the country and in the bouring Metropolitan boroughs:— Epidemic Death-rates per 1,000 inhabitants. England and Wales 1.2 97 Great Towns F.5 145 Smaller Towns 1.2 Greenwich 1.4 Camberwell 1.2 Bermondsey 2.1 Poplar 2.1 Lewisham 0.7 County of London 1.4 Deptford 1.69 West Ham 1.9 Liverpool 2.6 Manchester 1.9 Birmingham 1.9 Leeds 1.6 Chart shewing week by week the total number of cases of Infectious Disease notified during the 52 weeks ended January 2nd, 1915. 61 DEATHS FROM 7 PRINCIPAL INFECTIOUS DISEASES. Year Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria * Diarrhcea 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 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.ll 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 1911 2 0.02 — – 67 0.61 7 0.06 35 0.32 15 0.14 172 1.57 298 2.72 1912 2 0.02 — – 28 0.26 6 0.05 24 0.22 0.10 28 0.26 99 0.91 1913 2 0.02 — – 50 0.45 3 0.03 43 0.39 20 0.18 90 0.81 208 1.87 Average for 10 years. 4 0.03 — – 52 0.45 9 0.07 38 0.33 15 0.13 86 0.76 204 1.77 1914 3 0.03 — – 50 0.46 9 0.08 9 0.08 25 0.23 88 0.81 184 1.69 * The deaths under this heading for the years 1902 to 1910 refer only to those certified to be due to epidemic or summer diarrhœa, or epidemic, zymotic or infective enteritis. From 1911 onwards, deaths from Gastro enteritis, Gastro-intestinal Catarrh, Muco-enteritis, Colitis, &c., are also included. 62 Infectious Diseases, 1914. Disease. Total number of notifications received. Relating to cases. Errors of diagnosis and cases occurring in hospital Nett number of cases. Small-Pox — - - - Cholera — — — — Diphtheria (including Membranous Croup) 258 253 29 224 Erysipelas 237 225 — 225 Scarlet Fever 883 866 35 831 Typhus Fever - - - - Enteric Fever 9 9 1 8 Relapsing Fever — — — — Continued Fever — — - - Puerperal Fever 6 5 - 5 Plague - — - — Cerebro-spinal Fever — — - — Anthrax — — - — Hydrophobia — — - — Glanders — - - - Pulmonary Tuberculosis 638 345 - 345 Other Tuberculosis Diseases 95 74 - 74 Ophthalmia Neonatorum 18 16 - 16 Acute Poliomyelitis 1 1 - 1 Total 2145 1794 65 1729 Previous year 2064 1738 65 1673 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 1904 TO 1914. Year. Smallpox. Diphtheria. Membranous Croup. Erysipelas. Scarlet Fever. Typhus Fever. Enteric Fever. Continued Fever. Puerperal Fever. Chicken Pox. Cerebro-spinal Meningitis. Tuberculosis. Ophthalmia Neonatorum. Acute Poliomyelitis. Glanders. Totals. Measles. Disinfections. (premises) 1904 11 180 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 .. .. .. .. 1248 726 1495 1908 .. 197 10 168 728 .. 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 1911 1 152 7 177 369 .. 13 4 2 157 .. 335 15 1 .. 1233 664 1121 1912 .. 172 .. 188 406 .. 9 1 8 .. 4 436 26 4 .. 1254 221 940 1913 .. 247 .. 230 639 .. 17 .. 1 .. .. 584 19 .. 1 1738 497 1192 Average for past 10 yrs. 1 200 6 167 534 .. 26 1 5 46 1 162 6 .. .. 1150 717 1288 1914 .. 253 .. 225 866 •• 9 .. 5 .. •• 419 16 1 .. 1794 480 1385 63 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, and the Tuberculosis Regulations was 1794. This shows an increase of 56 on the preceding year. 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:- 1910 1911 1912 1913 1914   No. of cases 692 1233 1,254 1,738 1794 Estimated population 119,642 109,475 109,377 109,280 109,182 Attack rate per 1000 of population 5.8 11.3 11.4 15.6 16.4 Briefly, this increase in notifications for 1914 was due to the number of cases of Scarlet Fever notified, which were 227 in excess of the previous year, but there were 165 fewer cases of Tuberculosis notified. Fees for Notifications. The amount paid to Medical Practitioners for notification during the period under report was:- £ s. d.   First Quarter 45 0 9 Second „ 50 9 9 Third „ 54 18 9 Fourth „ 65 8 6 £215 17 9 All fees except those for the notification of Tuberculosis are repaid to the Sanitary Authority by the Metropolitan Asylums Board. Discovery and Diagnosis of Infectious Diseases. It is well to know that unrecognised cases largely spread infectious diseases. 64 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 develop 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. Special arrangements with the Seaman's Hospital for the bacteriological examination and reports upon doubtful cases have been made by the Council. 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 was 471, and the results of examination, were as follows:— Bacillus found. Doubtful. Bacillus not found. Total.   Diphtheria (Secretion) 70 — 262 332 Reaction obtained. Doubtful. Reaction not obtained. Total. Typhoid (Blood) 2 - 4 6 Bacillus found. Doubtful. Bacillus not found. Total. Tuberculosis (Sputum) 37 - 96 133 Miscellaneous - - - — In addition to the above examinations, many bacteriological tests were made at the Council's Tuberculosis Dispensary (vide Dispensary Report.) 65 Classification of Infectious Diseases. Infectious Diseases fall into several categories— (a) Permanent compulsorily certifiable diseases, including Tuberculosis. (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, diarrhoea, rash, epidemic pneumonia, influenza, epidemic diarrhoea, etc. Incubation and Quarantine Periods. Two Weeks from Inception to Start of Eruption.— (l) Small-pox, in which the patient remains apparently well for eleven or twelve days, then becomes feverish and sick, complains of pains in the back for two or three days, when the eruption comes. Quarantine period should be at least fourteen days, though proper isolation as soon as the eruption appears usually proves efficacious.—(2) Chicken-pox, in which the patient shows no symptoms for about twelve days, and is then feverish for two or three days, the eruption appearing about the fourteenth day. Quarantine period, therefore should be at least a fortnight.—(3) Measles, in which the patient appears well for the first ten days, followed by four days of fever and catarrh, also vomiting in some cases, and then the eruption, occupying two or three days to develop fully. Quarantine period should be two weeks, the actual patient however, being infectious for three or four weeks after the appearance of the rash.—(4) Rubella, or German measles, which remains latent about thirteen days, followed by two days of feverishness, and then the rash. Quarantine period sixteen or seventeen days. Half-a-week from Inception to Initial Symptoms.— (l) Scarlatina, latent two or three days; then feverishness, headache, slight sore throat and stiffness of the neck for a day or two; finally the characteristic florid rash. Infection remains often for many weeks, but the period of quarantine for those exposed to it need not be longer than one week.—(2) Diphtheria, similar in its early stages to scarlatina, and generally first recognised by sore throat; infectious usually for five weeks; quarantine period, one week.— 66 (3) Erysipelas, no symptoms for three or five days, when inflammation of the skin appears. Infection continues from the beginning of the inflammation until desquamation is complete; quarantine period, one week.—(4) Puerperal Fever, in which the first symptom usually appears about three days after delivery in lying-in women. The midwife or nurse should not attend other cases for a short period.—(5) Epidemic Pneumonia, latent from two to five days, when rigors, pain and fever set in, often followed by diarrhoea and vomiting. Infection continues from the onset of the disease until expectoration ceases after the lung disease, about three weeks; quarantine period, one week.—(6) Influenza, latent three or four days, or occasionally less. The fever subsides after four or five days. Infectious about ten days, and sometimes three or four weeks. Quarantine period, six days.—(7) Whooping Cough, latent four or five days; catarrh from three days to a week, or even a fortnight; then the coughing or whooping stage. Infection continues from the beginning of the catarrhal stage until mucus ceases to be coughed up. Quarantine period, one week.—(8) Cholera, latent from a few hours to a week. The bacilli is usually conveyed into the system by means of the food or water swallowed.—(9) Epidemic Diarrhoea, short latent period; attack lasts from three days to a week. Three Weeks from Inception to Initial Symptoms.— (l) Typhus Fever, latent probably about twelve or thirteen days, but sometimes extending to twenty-one days; about one week elapses between first symptom of illness and appearance of eruption; fever subsides about seven days later; and ten days or a fortnight later infection ceases. These periods are, however, liable to considerable variation. Quarantine period is difficult to state definitely.—(2) Typhoid Fever, incubation period uncertain, but probably twenty-one days, followed by a similar period of fever. Infection, which commences with the first symptom, is mainly active through the media of discharges from the stomach and bowels affecting food, air or drinking water. Quarantine period, three weeks.—(3) Relapsing Fever, incubation varies from less than a day to three or four weeks. Infectious from the onset until convalescence. Quarantine period, three weeks.—(4) Mumps, incubation about three weeks; infection from the first symptom till about three weeks after the commencement of the glandular swelling. Diseases Common to Man and Some Animals.—Among these, lengthy and uncertain incubation periods occur in tubercular disease, actinomycosis, tetanus and hydrophobia. Short periods of incubation characterise anthrax and glanders. 67 Small Pox. It is satisfactory to note that no case of small pox was notified during the year. No deaths have occurred from this complaint since 1902, in which year there were 30 deaths out of a total of 139 cases; in the next year only two cases were notified, with no deaths. Vaccination. The number of successful vaccinations for the years 1913 and 1914 was much less than for 1911 and 1912 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 conscientious objector to obtain exemption from vaccination of his child with much greater ease than hitherto. The number of certificates of successful primary vaccination, at all ages, received during the past four-and-a-half years has been as follows:— 1910 2220 1911 2037 1912 1879 1913 1819 1914 (half-year) 883 Greenwich Union. DEPTFORD (SUB-REGISTRATION) VACCINATION DISTRICT. YEARS 1910 TO 1914. Year ending 31st December. No. of Births registered Successfully Vaccinated. Insusceptible or 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 3130 2037 23 .. 377 275 16 26 324 52 1912 3069 1879 11 .. 496 197 23 22 342 99 1913 3230 1819 10 .. 653 222 24 24 332 146 1914 1681 883 3 .. 383 114 28 9 173 88 1st half-year. Yearly Average 3188 1944 11 .. 521 230 26 21 333 102 I am indebted to the courtesy of Mr. A. E. Rossiter, Vaccination Officer to the Guardians, for the above figures. E 2 68 Scarlet Fever. 1914 Average of previous 10 years.   Number of cases 866 534 „ deaths 9 9 Death rate per 1,000 in Deptford 0.08 0.07 883 notifications were received during the year 1914, relating to 866 cases. Of these, 35 cases were errors in diagnosis and cases which occurred in hospital, thus reducing the net number of cases to 831. The number of cases for 1914 was in excess of that in the previous year. During the previous three years 639, 406 and 369 cases were notified respectively. The deaths were 9, compared with 3, 6 and 7 in the three preceding years. The death-rate was 0.08 per 1,000, and for the three preceding years 0.03, 0.05 and 0.06 respectively. The rate of mortality for England and Wales was 0.08, for the 97 great towns 0.09, for the 145 smaller towns 0.07, for the County of London 0.07 per 1,000. During the first quarter of the year only 165 cases were notified, during the second quarter 207, the third quarter 213, and during the last quarter there were 281. Nearly 90 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. Prevention of Scarlet Fever. The procedure by the Health Department for the prevention of the spread of scarlet fever in the borough has consisted of systematic weekly visits by the Sanitary Inspector to the houses where cases were isolated at home. Reports were made on receipt of each notification to the Medical Officer of Health, 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 homes, requiring exclusion Chart shewing week by week the number of cases of Scarlet Fever notified during the 52 weeks ended January 2nd, 1915. 69 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. 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 and 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 oi the abovenamed complications in six weeks, whereas another mav have to be isolated for prolonged periods, for any one or more of these reasons and released even then with some risk lest a "return" case be the result. 70 Scarlet Fever. WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total.   East 14 22 23 26 21 26 19 35 77 109 186 North 21 22 23 35 35 44 47 59 126 160 286 North-West 11 24 31 24 21 23 25 19 88 90 178 South 10 3 7 8 6 1 12 12 35 24 59 South-East 4 8 8 3 6 3 16 13 34 27 61 South-West 13 13 7 12 17 10 12 12 49 47 96 Total 73 92 99 108 106 107 131 150 409 457 866 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages.   5 225 566 49 21 .. •• 866 Diphtheria and Membranous Croup. 1914. Average for previous 10 years   Number of Cases 253 200 Number of Deaths 25 15 Death rate per 1,000 in Deptford 0.23 0.13 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 Registrar-General, and therefore allows of comparison. The total number of notifications received was 258, relating to 253 cases. Of the number notified, 29 were errors of diagnosis and hospital cases, reducing the number of cases to 224 compared with 222, 165, and 152 for the previous three years. Twenty-five deaths were registered during the year, as compared with 20, 11, and 15, for the three previous years. The rate of mortality was 0.23 per 1,000, and for the three previous years 0.18, 0.10, and 0.14 respectively. 71 The death rate for England and Wales was 0.15, for the 97 great towns 0.16, for the 145 smaller towns 0.16 and for the County of London 0.16. The cases were distributed in the various Wards as follows:— East 47, North 46, North-West 98, South 14, South-East 26, and South-West 22. On reference to the chart it will be seen that the disease was most prevalent during the months of October and November. It will be seen on the age table that the largest number of attacks occurred between the ages 5—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 until two weeks after the premises are disinfected. 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. The Council now provides diphtheria anti-toxin for the use of medical men, including Poor Law Medical Officers. Practitioners in the borough may 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. If the patient is able to pay, we find the medical man quite willing to pay us the actual cost of the anti-toxin which he obtains for the patient. It is desirable that medical men should be aware of these facilities, and emphasis laid on the importance of prompt treatment by anti-toxin, and the saving of life which may be effected. Bacteriological examinations were made during the year of 332 specimens of membrane, of which 70 were found to be positive and 262 negative. 72 Diphtheria. WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F Total. East 9 8 5 6 4 3 5 7 23 24 47 North 6 6 2 5 8 4 3 12 19 27 46 North-West 3 11 14 11 3 23 13 20 33 65 98 South 2 4 1 4 — — 3 - 6 8 14 South-East 4 1 1 1 5 4 7 3 17 9 26 South-West — 4 2 4 1 - 5 6 8 14 22 Total 24 34 25 31 21 34 36 48 106 147 253 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages. - 71 137 28 15 1 l 253 Enteric Fever. 1914. Average of previous 10 years. Number of Cases 9 26 Number of Deaths 3 4 Death rate per 1,000, Deptford 0•03 0•03 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 40 cases notified in the one year. During the past year we had 9 cases notified, as compared with 17 cases in 1913, 9 cases in 1912, and 13 cases in 1911. One of this year's number, however, was an error of diagnosis. 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, and good pure water supply. Three deaths were attributed to this disease during the year, compared with 2 in each of the preceding three years. Chart shewing week by week the number of cases of Diphtheria notified during the 52 weeks ended Januarv 2nd, 1915. 73 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 disinfecting the bedding and infected articles and clothing in the Council's steam disinfector. Enteric fever, or Typhoid Fever as it is also called, is slowly but surely succumbing to the measures which have been directed against it. The part played by shellfish in spreading the infection is becoming more and more obvious, and new regulations have been made for controlling the gathering and sale of mussels and other shellfish. The "carrier" problem is more difficult of solution, as a "carrier" is only discoverable after a fairly large number of cases have occurred, and it is sometimes a very difficult matter to deal with a known " carrier." The situation is this : The carrier of the germs of enteric fever may be a person who earns his or her living by preparing food for other people, and although it may have been some years since he or she had enteric fever, the person is a continual source of danger to the community, and this danger can only be removed by supplying the individual with other employment, which will offer no opportunity for the contamination of food. The death rate for Deptford was 0•03 per 1,000, whilst for each of the three preceding years it was 0•02. The case mortality for I914 was 33•3 per cent. compared with 11•8 for 1913. The rate of mortality for England and Wales was 0•05, for the 97 great towns 0•04, for the 145 smaller towns 0•05, and for the County of London 0'03. The cases were distributed in the different wards as follows:— East 1, North 4, North-West 1, South-East 1, and South-West 2. Bacteriological examinations were made of 6 specimens of blood, of which 2 were found to be positive and 4 negative. The following table gives the situation in the borough of each case and the general condition of the dwellings:— ENTERIC FEVER, 1914. Address. Ward. Age. Sex W.C.. accommodation. Yard Paving. Sanitary Defects and Remarks Gosterwood St N. 22 F. 1 external Good One room verminous Do N. 17 M. 1 „ „ „ Ventnor Road N.W. 17 M. 1 „ „ No nuisance. Ashmead Road S.E. 32 M. 1 „ „ „ Douglas Street E. 6 F. 1 „ „ „ Waller Road S.W. 56 F. 1 internal 1 external „ Sink untrapped, sash lines and walls of W.C. defective. Besson Street s.w. 64 F. 1 external ,, No nuisance. Etta Street N. 17 M. 1 „ „ 74 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 North 1 1 .. .. .. .. 2 .. 3 1 4 North-West 1 .. .. .. .. .. .. .. 1 .. 1 South .. .. .. .. .. .. .. .. .. .. .. South East 1 .. .. .. .. .. .. .. 1 .. 1 South-West .. .. .. 1 .. l .. .. .. 2 2 Total 3 1 .. 2 .. l 2 .. 5 4 9 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages. .. .. 1 5 1 2 .. 9 Antityphoid Inoculation. The Antityphoid Inoculation of our soldiers has drawn public attention to a prophylactic measure the utility of which has been proved for all minds capable of appreciating what proof is; but misrepresentations have been made concerning its value which might produce upon ignorant people impressions which are hard to remove. Evidence is accumulating in all parts of the world demonstrating the good results which have followed the adoption of inoculation against typhoid fever. The large numher of deaths which occurred in the South African war well illustrated the ravages of disease during campaigns where preventive measures were imperfect, but we got little therapeutic instruction from the tragedies which ensued. There were 57,684 cases of typhoid fever, of which 19,454 (33 per cent.) were invalided and 8,022 (13.9 per cent.) died. Although inoculation had been introduced at that time the conditions under which the treatment was employed made deduction from the results unsafe. The technique has since been considerably improved, and the experience of other nations has made clear the beneficial effects of preventive inoculation. Sir W. B. Leishman instanced the fact that about 93 per cent. of the British garrisons in India have been protected by inoculation, and the disease which used to cost the nation from 300 to 600 deaths annually was last year 75 responsible for less than 20 deaths. Again, inoculation was made compulsory in the American army in 1911, it having practically abolished the disease in American stations; in 1913 there were only three cases of typhoid fever in the entire army, and no deaths. In Japan also encouraging figures have been obtained. In short, all experience goes to prove that inoculation against typhoid fever is a most valuable adjunct to the health of an army. It must not be asserted that it is an infallible protective—that is to say, that a man who has been inoculated is proof against infection. That would be adopting a view which cannot be supported by clinical evidence, and might easily give a false impression to the general public, and so play into the hands of the enemies of research. But inoculation does confer a very considerable degree of immunity against typhoid fever, and the disease in the inoculated person is of a far milder type than in the unprotected. These two things would constitute a sufficient cause to urge the free adoption of the measure. Inoculation, however, does more than this: it greatly decreases the incidence of the malady. Medicine is regularly attacked by those quite ignorant of medicine. In regard to a knowledge of (say) physics, law, or military tactics, the public at large, as a rule, pay deference to those who have made a lifelong study of a particular profession, but towards medicine the public to some extent adopts a different attitude, and upon occasion there is a reasonable basis in this attitude, for a man has naturally a feeling towards his body that he has not towards his possessions or his civic privileges. Medical men who have devoted themselves to the study of disease, its cause, and prevention, are quite used to being contradicted by the timid, sentimental and ignorant and as a rule only resent the treatment when the general health of the community is in question. Consequently faddists are listened to and believed who have had no opportunities of studying the intricate problems of morbid processes, and their opinions are quoted seriously against those of members of the medical profession who have devoted long years to special work. If a man contracts typhoid fever he is a danger not only to himself but to those who are associated with him. Some inconvenience for a day or two is nothing as compared with an attack of typhoid fever. To undergo an infinitesimal or a negligible risk in order to help to keep an army healthy is what is required, and all that is required from any recruit. No words can be too strong in condemnation of those who seek under the guise of patriotism to exploit their own fads, founded upon ignorance, upon our prospective troops to the detriment of the future of the nation. 76 Recent opinions on Antityphoid Inoculation expressed by Sir Wm. Osier and Sir Lauder Brunton form a worthy summary of the situation and appeal to soldiers in two final questions, which as the Lancet says should have as wide a circulation as possible. The questions are— (1) Will you believe the statements of misguided cranks who are playing into the enemy's hands by purveying their misleading literature, or will you hearken to men who have devoted their lives to the service of humanity, and who have no wish in the matter other than your good ? (2) Against a transient indisposition will you put in the balance the chance of a protracted and costly illness, possibly an untimely death ? Erysipelas. 1914. Average of previous 10 years Number of Cases 225 167 Number of Deaths 4 - Two hundred and twenty-five cases of Erysipelas have been notified during 1914, as compared with 230 in 1913, 188 in 1912, and 177 in 1911. There were four deaths registered from the disease within the borough and in outlying institutions. In each notified case the premises have been visited and enquiries made, and, where necessary, disinfection performed. Puerperal Fever. 1914. Average for previous 10 years. Number of Cases 5 5 Number of Deaths 2 — Five cases of puerperal fever were notified, compared with 1, 8 and 2, for the three years preceding. The death rate was equal to 0.046 per 1,000, compared with 0.009, 0.027, and 0.009 for the three preceding years. The case mortality was 40 per cent, compared with 100.0 per cent. for 1913. Should a case of Puerperal Fever be notified it is carefully enquired into by the Medical Officer of Health and the Health Visitor. Disinfection is 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 77 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." Ophthalmia Neonatorum. This serious affection which attacks the eyes of newly-born infants is caused by the entrance of certain bacteria into the eyes usually at the time of birth, and 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. Sixteen cases were notified during the year, and were visited by the Health Visitors. Six of the cases were in the East Ward, six in the North Ward, two in the North-West Ward, one in the South Ward, and one in the South-West Ward. Spotted Fever. EPIDEMIC CEREBROSPINAL MENINGITIS. Posterior basal meningitis is included in the term "cerebro-spinal fever," but does not include meningitis due to tuberculosis, syphilis, middle ear disease, and injury. No cases of this complaint were notified in the borough, but we have received notifications from the County Council of cases occurring in other Metropolitan Boroughs. Cerebro-spinal fever and poliomyelitis are now subject to compulsory notification. Poliomyelitis shows a well-marked seasonal incidence, there being a great increase during the hot months. It is also relatively more common in the urban districts, although this may be due to the cases being frequently treated in hospitals. 78 Acute Polio-Myelitis or Polio-Encephalitis. One case was notified during the period under report and commenced on November 9th with symptons of headache, localised paralysis, drowsiness, twichings. It is to be noted that the majority of cases occur in children and young people under 15 years of age; the mortality in these is about 13 per cent. and the permanently damaged form about 50 per cent. of the total. 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 and Destruction of Rats. 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." Chicken Pox. This disease was not notifiable in 1914, and there were no deaths, although a fair number of cases occurred amongst school children. Anthrax, and Hydrophobia in Man. No cases of the above diseases were notified during the year. Glanders. No cases of Glanders were notified during the year. Continued and Typhus Fever. No 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 eight cases. Diarrhœa and Enteritis. 1914. Average of previous 10 years Number of Deaths 96 86 Death rate per 1,000 (all ages) 0•88 0•79 Death rate per 1,000 (under two years of age) 0•81 0•76 The following Chart shews the seasonal distribution of Diarrhœal Deaths during the summers of 1913 and 1914, and their relation to the temperature of the ground as indicated by the 4-ft. thermometer. 79 Under this heading are included deaths registered as due to epidemic diarrhoea, epidemic enteritis, infective enteritis, zymotic enteritis, summer diarrhoea, 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 96 deaths during 1914 compared with 106 for 1913. Of this number 89 were of children under five years of age, 88 of these being under two years of age. The death rate was 0•88 per 1,000 at all ages, and 0•81 for infants under two years of age. The older statistics do not give an accurate comparison with 1911-1914, because the heading of Diarrhoea did not, before these dates, include the names mentioned above, but simply cases registered as epidemic or summer diarrhoea, orepidemic, 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 35. North 26. North-West 21. South 2. South-East 5. South-West 7. The following table shows the periods of the year, and the localities in which deaths from Diarrhœa and Enteritis occurred, together with particulars as to sex:— WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F M. F. M. F. M F. Total. East 2 2 — - 16 9 2 4 20 15 35 North 1 1 — - 17 9 1 3 13 13 26 North-West 1 1 1 - 6 7 2 3 10 11 21 South - - 1 - - 1 - - 1 1 2 South-East 1 — — — 3 1 — — 4 1 5 South-West — — — — 4 1 — 2 4 3 7 Total 5 4 2 — 40 28 5 12 52 44 96 80 The mean annual death rate per 1,000 from diarrhoeal diseases in Deptford for the past ten years was as follows:— 1904 0•98 1910 0•68 1905 0•73 1911 1•72 1906 1•26 1912 0•34 1907 0•18 1913 0•95 1908 0•70 1914 0•88 1909 0•39 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 diarrhoea to become prevalent. 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 diarrhoea 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 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 diarrhœal disease. The Prevention of Epidemic Diarrhoea. Following up their circular letters of the 18th August, 1911, and 25th July, 1913, with reference to mortality among children in the summer and autumn months arising from epidemic diarrhoea and other infectious diseases of infants, the Local Government Board on July 10th, addressed another circular to sanitary authorities reminding them of the importance of taking all practicable measures for the prevention of such diseases and of promoting hygienic conditions in the feeding of infants. 81 The circular is in the following terms:— Notification of Births and Home Visiting in regard to The Feeding and Care of Infants. The Board desire to emphasise the value of systematic visitation of the homes of infants under the direction of the medical officer of health with a view to the removal of conditions in and about their homes which facilitate the spread of infectious and other diseases. In view of the importance of the first visit being made soon after the birth of a child, it is important that the Notification of Births Act, 1907, under the operation of which a medical officer of health receives information as to the birth of a child within 36 hours should be in force in the Council's district. The Notification of Births Act, 1907, is now in force in counties and districts representing over two-thirds of the population of England and Wales, and the authorities which have not adopted it, and are not now taking steps to adopt it, are urged to give the question serious consideration. The advantage of county administration, outside large urban communities, is that the work of visiting homes in which births have occurred and giving advice to the mother with reference to the feeding of the infant and its protection from risk of disease may be entrusted to an officer who already works in the district and visits the hemes as inspector of midwives, tuberculosis visitor, or otherwise. The Board attach much importance to special visits paid to mothers during the season in which infantile diarrhoea is likely to prevail. The records of notification of births during the previous months will enable visits and re-visits to be made to the homes where they are most likely to be useful; homes in which there are infants from three to twelve months old, and in which breast-feeding of these infants is known to have ceased, should be visited oftener than others. The Board will be glad if the Council will consider the question of increasing their visiting staff, if these more frequent visits cannot at once be made without such increase. It is desirable to obtain the assistance of voluntary visitors in this work, and to secure co-ordination with any voluntary institution for the welfare if infants in the district. Domestic Precautions. In giving advice to mothers as to the prevention of diarrhœa, stress should be laid on methods of storing milk and other food in the dwelling. Milk vessels should be properly cleansed and scalded, kept cool by being placed in water or wrapped in a damp cloth, and should be covered 82 2(e.g., with a square of butter-muslin weighted at the corners with shot or sand). The provision of a wholesome place for the storage of food, ventilated to the outside air, should be secured wherever practicable. It is important to emphasise the point that any domestic uncleanliness, and the preparation of food for the infant with unwashed hands, may lead to serious consequences. Any action that is necessary under the Public Health Act should be taken with reference to insanitary conditions in and about the house. Sanitation of Closets, Yards and Streets. Domestic attempts at cleanliness may be rendered inoperative by conditions outside the house, and it is most important that these conditions should receive attention from the Council. Unpaved streets and yards should, where necessary, be paved, and in particular all accumulations of refuse in the neighbourhood of dwellings should be promptly and efficiently removed. These accumulations provide breeding grounds for flies and are otherwise open to serious objection. It is therefore essential to the health of a district that there should be arrangements for the frequent removal of house, stable, and street refuse, etc. In the best administered districts conservancy closets and ashpits have given place to fresh water closets and movable ash-bins with covers, and house refuse is removed in properly covered carts by the Council's own workmen under the superintendence of the surveyor at regular intervals and never less frequently than once a week. If the refuse is not burnt it should be disposed of in places remote from dwellings and should be properly covered with earth. In many districts all refuse can be disposed of in a destructor. Prevention of Flies. The Board are advised that the exact share borne by flies in conveying the infection of epidemic diarrhœa cannot yet be stated. It would be a mistake, with our present knowledge, to assume that the problem of the prevention of this disease is limited to the destruction of flies. It is concerned also with the personal cleanliness of the mother who has to prepare the infant's food, and with the cleanliness of the house, the backyard, the court, and the street, from which infective material may obtain access to the infant's food, with or without the intermediation of flies. But for practical purposes the number of flies in the summer months may be regarded in town as a valuable index, under present conditions, of the possibilities of contamination of food by pathogenic microbes or by decomposing organic matter, especially in districts in which privies and pail closets persist, and in which accumulations of house refuse or stable refuse are permitted. 83 It should be remembered in this connection that the ova of the fly, when deposited on organic matter, may develop in hot weather through the varioue stages to the adult insect in little more than a week. Hence the importance of the frequent cleansing of receptacles for house refuse and manure above alluded to. For the prevention of flies it is essential to deal with their breeding places. Destruction of flies in a dwelling is, however, also an important additional measure, and may be secured by fly traps, fly-catching papers, or in other ways. An efficacious method is the use of saucers containing a solution of formalin (one teaspoonful to the half-pint of water, or milk and water) and a little sugar; a small piece of bread being placed in the saucer as a place for flies to alight on and drink. In living rooms these should be left out overnight, all other vessels containing fluid being removed or covered over. Handbills advising domestic cleanliness, destruction of refuse, etc., may usefully include directions for the destruction of flies. The Board urge local authorities to consider at an early date the question of taking such action as may be necessary and practicable in their district on the lines indicated in the preceding paragraphs. While they relate primarily to the prevention of epidemic diarrhoea and of excessive infantile mortality, the measures to which attention is directed above must in many other and important respects contribute to the health and general welfare of the district. Measles. 1914. Average for previous 10 years. Number of Deaths 50 52 Death rate per 1,000, Deptford 0•46 0•45 The number of cases of Measles dealt with during the year was 480, as compared with the previous four years as follows:— Cases. Deaths. 1914 480 50 1913 497 50 1912 233 28 1911 664 67 1910 1,114 60 1909 467 66 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 notifications of exclusions from schools by the Education Authority and voluntary notification by parents. The same procedure is adopted in the case of Measles with regard to disinfection as if it were notifiable. F 2 84 The rate of mortality was 0•46, compared with a rate of 0•45 for 1913, 0•26 for 1912, and 0•61 for 1911. The deaths occurred among the inhabitants of the various wards as follows:— East 20 North 17 North-West 5 South 1 South-West 4 South-West 3 The rate of mortality for England and Wales was 0•24, for the 97 great towns 0•35, for the 145 smaller towns 0•21, and for the Metropolis as a whole 0•31. 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 H F M F M F M F Total. East 2 6 6 2 1 3 — — 9 11 20 North 5 6 2 2 2 — — — 9 8 17 North-West 1 — 1 1 1 — 1 — 4 1 5 South — — — — 1 — — — 1 — 1 South-East 1 2 — 1 — — — — 1 3 4 South-West 1 — — 1 — 1 — — 1 2 3 Total 10 14 9 7 5 4 1 — 25 25 50 AGES AT DEATH. Under 1 1-2 2-5 5-15 15-25 25-45 45-65 65 & upwards All Ages 7 23 18 2 — — — - 50 Measles presents a problem bristling with difficulties. Attempts to diminish its prevalence appear to be doomed to failure, therefore more attention must be directed to the treatment of the patient, and removal to hospital is strongly recommended. The special investigations into the causes of death in measles furnish additional evidence in support of this opinion, which is also held by practical medical men, that better results may be obtained by greater attention to the mouth and pharynx during the height of the disease. Notification has hitherto proved of very little value, and some authorities which have added 85 measles to the list of notifiable diseases have petitioned to have it removed. Notification must be valueless, unless during epidemic periods the local authorities take the advice tendered by the Local Government Board, and provide additional assistance, medical or otherwise. Schools. The following list shows the action taken during the year for the prevention of the spread of measles in the Infants' Departments of various schools in the Borough:— School. Action Taken Alverton Street . Unprotected children excluded from Classroom B from February 19th to March 6th; Classroom C from January 28th to February 10th; ClassF from February 13th to 27th. Canterbury Road. Unprotected children excluded from Classroom A from February 9th to March 6th; Classroom B from May 25th to June 5th; Classroom C from June 24th to July 3rd; Classroom D from March 5th to March 20th and May 27th to June 12th. Childeric Road Unprotected children excluded from Classroom C from February 9th to February 27th. Clifton Hill Unprotected children excluded from Classroom A from January 26th to February 13th; Classroom D from January 21st to January 31st; Classroom E from January 15th to January 23rd. All unprotected children under five years of age excluded from February 9th to February 27th. All unprotected children in Classroom D over five years from March 2nd to March 13th. Deptford Park Unprotected children excluded from Classroom A from June 26th to July 17th; Classroom D from June 8th to June 19th; Classroom E from June 26th to July 17th; Classroom F from June 26th to July 17th. Kender Street Unprotected children excluded from Classroom A from February 16th to March 6th. Lucas Street Unprotected children excluded from Classroom A from March 13th to April 3rd; Classroom B from March 17th to April 3rd; Classroom C from March 17th to April 3rd; Classroom D from March 13th to March 27th. Mantle Road Unprotected children excluded from Classroom A from April 27th to May 8th; Classroom B from April 27th to May 15th: Classroom C from February 18th to March 13th and April 28th to May 15th; Classroom D from April 27th to May 15th; Classroom E from April 28th to May 15th. 86 School n Taken Monson Road Nynehead Street ... Ravensbourne St. James' Stanley Street Trundleys Road ... Waller Road Unprotected children excluded from Classroom A from January 19th to February 13th; Classroom B from January 22nd to February 6th ; Classroom C from January 26th to February 13th and from June 19th to July 3rd; Classroom D from January 22nd to February 6th ; Classroom G from March 5th to March 13th. Unprotected children excluded from Classroom A from March 5th to March 13th and March 27th to April 8th, and May 13th to May 29th, and June 17th to July 3rd; Classroom B from March 11th to March 20th; Classroom C from March 9th to March 20th and April 2nd to April 8th: Classroom E from February 13th to February 27th, and March 11th to March 20th, and April 2nd to April 8th. Unprotected children excluded from Classroom A from February 18th to March 6th; Classroom B from 18th February to March 6th; Classroom C from February 16th to March 6th ; Classroom D from February 23rd to March 6th. All unprotected children under five years of age excluded from July 8th to July 22nd. Unprotected children excluded from Classrooms 1 and 2 from February 26th to March 13th. Unprotected children excluded from Classroom A from January 23rd to February 6th and March 2nd to March 27th ; Classroom B from February 11th to February 27th; Classroom C from February 18th to March 13th. Unprotected children excluded from Clsssroom B from June 3rd to June 12th; Classroom C from March 2nd to March 13th and from May 1st to May 22nd, and June 8th to June 19th, and July 6th to July 22nd ; Classroom D from March 2nd to March 13th and May 1st to May 22nd. Unprotected children excluded from Classroom A from July 9th to July 22nd; Classroom B from July 9th to July 22nd and December 11th to December 18th. RULES AND REGULATIONS IN REGARD TO INFECTIOUS DISEASES IN SCHOOL CHILDREN. When a notice has been received from the Medical Officer of Health, stating that an infectious illness exists at any premises in which school children are known to reside, the following procedure is adopted:— 87 Disease. 1 Period of exclusion of children suffering from the disease2. Period of exclusion of children living in houses where the disease exists. 3. Rules in regard to flats and tenement houses. 4. Smallpox (1) Until the medical attendant certifies, if the case is treated at home. (1) If patient is removed to hospital, until 14 days, and in case of smallpox 16 days, following date when case was certified (vide notice from local medical officer of health) In cases where children live in tenement houses exclude as follows:— (a) In the case of "model dwellings" or "trust buildings," etc only children from the same flat (or self-contained tenement) as that in which the case of infection exists. (2) Until after discharge from hospital. Diphtheria Membranous croup 1 (1) Until a fortnight after disinfection of premises, if the case is treated at home. (2) If patient is treated at home until the expiration of 14 days from date of disinfection of premises. If no disinfection notice is received it should be procured without delay from the offices of the local sanitary authority. (2) Until a fortnight after date of discharge from hospital. Scarlet fever or scarlatina (1) Until a fortnight after disinfection of premises if the case is treated at home. (2) Until a fortnight after date of discharge from hospital. Erysipelas Typhoid fever or Enteric fever Cerebro-spinal meningitis Polio-myelitis (1) Until the medical attendant certifies, if the case is treated at home. Not to be excluded, No proceedings to be taken to enforce attendance if medical officer of health specially orders exclusion. (b) In the case of an ordinary dwelling house sub-let, children from the whole house should be excluded, except in cases where the tenements are absolutely self-contained and each family has its own domestic and sanitary conveniences, in which case rule (a) will apply. (2) Until after discharge from hospital. Consumption When accompanied by coughing or spitting May attend school. Measles At least four weeks Infants — All in(ants to be excluded until Monday following 14 days from the commencement of the illness of last case in the house. Seniors—If child has had the disease may attend school. If child has not had the disease, exclude until Monday following 14 days from the commencement of the illness of List case in the house. In cases where children live in tenement houses exclude as follows— (а) In the case of "model dwellings" or "trust buildings," etc., only children from the same flat (or selfcontained tenement) as that in which the case of infection exists. (b) In the case of an ordinary dwelling-house sub-let, children from the whole house should be excluded, except in cases where the tenements are absolutely self-contained, and each family has its own domestic and sanitary conveniences, in which cases rule (a) will apply German measles 14 days from date of rash Same rules as for ordinary measles, Mumps One week from the subsidence of all swelling, Infants and seniors—Not to be excluded. Teachers to keep a list of the children in same family or house in which case has occurred. These children to be kept under observation. Any child showing symptoms to be immediately excluded. Mumps generally develops between 20 and 30 days following exposure to infection. Whooping-cough As long as cough continues, but not to be readmitted until at least five weeks from the commencement of the illness. Infants—Three weeks' exclusion from the commencement of the illness of last case in house. Seniors—If child has had the disease, may attend school. If child has not had the disease, three weeks' exclusion from the commencement of the illness of last case in house. Same exclusion periods as for whooping-cough, both infants and seniors. Chicken-pox Two weeks or until every scab is off scalp or body. Ringworm, favus.ophthalmia("blight") or purulent conjunctivitis, trachoma, scabies (itch), impetigo or purulent eczema Until the teacher is satisfied that the child is cured or until medical certificate is furnished, The return of all children after absence owing to ringworm of the soalp to be notified to the school nurse. May attend school. Sore throat Sore throat may be indicative of mild scarlet fever or diphtheria. Children suffering from sore throat must be excluded from school, In the absence of scarlet fever or diphtheria in the school, children affected with sore throat may resume attendance when a satisfactory medical certificate has been submitted or when the teacher is satisfied that they have recovered. When scarlet fever or diphtheria is prevalent special rules are to be observed. 88 Whooping Cough. 1914. Average for previous 10 years. Number of Deaths 9 38 Death rate per 1000, Deptford 0•08 0•33 This disease was the cause of 9 deaths compared with 43, 24 and 35 for the three preceding years. The death rate per 1000 persons living was 0•08 as compared with 0•39, 0•22 and 0•32 for the three preceding years. The deaths occurred among the inhabitants of the various Wards as follows:— East 4. North 3. North-West 1. South —. South-East 1. South-West —. 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 3 1 4 North — 1 - - — — 2 - 2 1 3 North-West - - - - - - - 1 — 1 1 South - - - - - - - - - - - South-East - - - - - 1 - - - 1 1 South-West - - - - - - - - - - - Total — 1 — — — 1 5 2 5 4 9 AGES AT DEATH. Under 1 1-2 2-5 5-15 15-2 5 25-45 45-65 65 & upward All Ages. — 6 3 - - - - - 9 Institutional Isolation of Measles and Whooping Cough. The continued prevalence and high rate of mortality of measles and of whooping cough are matters of grave concern. In 1913, the latest year for which there are records, the death-rate from measles 89 in England and Wales was 280 per million. From whooping cough the death-rate in 1913 was 140 per million. The fatality from these two popularly considered mild diseases may profitably be compared with that from scarlet fever and diphtheria. In 1913 the scarlet fever deathrate was 60 per million, and the diphtheria death-rate was 120 per million. Present conditions do not allow of hospital treatment of these diseases, and for most cases it appears probable that domestic treatment will continue to be necessary, and the greatest scope for saving life lies in the more complete medical treatment and in skilled nursing and supervision of patients treated at home. 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 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 Total Measles 16 71 55 33 66 60 67 28 50 50 496 Whooping Cough 18 61 35 25 47 44 35 24 43 9 341 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 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 Total Measles Under 5 years 15 64 51 32 60 50 62 27 48 48 457 Over 5 years 1 7 4 1 6 10 5 1 2 2 39 Total 16 71 55 33 66 60 67 28 50 50 496 Whooping Cough Under 5 years 18 59 34 24 45 42 34 24 42 9 331 Over 5 years — 2 1 1 2 2 1 — 1 — 10 Total 18 61 35 25 47 44 35 24 43 9 341 90 Leprosy. There were no known cases of Leprosy in the Borough during the year. Pulmonary Tuberculosis. Number of cases notified, 1914 345 Number of deaths 152 Death-rate per 1,000 (Deptford) 1•39 Phthisis was the cause of 152 deaths during 1914, compared with 148 for 1913. The death-rate was 1.39 per 1,000 persons, compared with 1.33, 1•35 and 1•31 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. East 121 48 2•3 21,124 North 79 36 1•5 23,799 North-west 61 27 1•2 23,413 South 17 9 0•7 12,108 South-east 38 17 1•4 12,285 South-west 29 15 0•9 16,453 Whole borough 345 152 1•39 109,182 Pulmonary Tuberculosis, including 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. 91 WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total. East 21 16 21 8 14 7 15 19 71 50 121 North 9 6 10 22 9 12 6 5 34 45 79 North-West 7 10 5 5 8 8 10 8 30 31 61 South 2 2 3 1 2 2 3 2 10 7 17 South-East 8 — 5 — 5 6 10 4 28 10 38 South-West 1 1 5 3 3 8 6 2 15 14 29 Total 48 35 40 39 41 43 50 40 188 157 345 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages. 4 12 44 62 136 79 8 345 General Tuberculosis. Thirty-five deaths were recorded as being due to these diseases. Of these deaths 9 occurred in the East Ward, 11 in the North, 6 in the North-West, 5 in the South-East, and 4 in the South-West. Sixteen deaths were classified as tuberculous meningitis and 19 as 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 2 3 6 3 2 - - — Other Tubercular Diseases 8 - 2 2 l 3 3 - 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. 92 WARDS QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total. East 3 2 5 5 3 2 — 5 11 14 25 North 2 8 3 1 1 1 — 1 6 11 17 North-West 3 3 2 4 2 1 l — 8 8 16 South — 1 1 1 — — l — 2 2 4 South-East 1 2 — 1 — 1 l — 2 4 6 South-West 2 2 2 — — — — — 4 2 6 Total 11 18 13 12 6 5 3 6 33 41 74 AGES OF PATIENTS NOTIFIED. Under l 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages. 6 19 23 12 12 2 — 74 Tuberculosis. Previous reports have dealt with the establishment and the value of a municipal tuberculosis dispensary, which we have had in the borough since 1911, when we had the honour of establishing the first municipal dispensary in the metropolis. I do not propose in this report to reiterate the same points, but to give you an account of the things we have learnt from the notification and supervision of those suffering from the disease. I have come to one definite conclusion, namely, that it may become physically possible for the working classes to avoid infection to at least the same extent as it is now possible for the rich. This is to be brought about by—(l) The help that social science can give to the prevention of infection by tubercle through material help, education and moral influence. (2) Improvement of housing accommodation and town planning, so that open spaces are secured and sunlight admitted to every house. (3) By adequate wages and improvement in working conditions. By educating the public we may persuade them to avail themselves of such possibilities, but all these will fail unless there also grows a 93 sense of responsibility and unselfish care for others (altruism in its finest sense) which would make compulsory measures as unnecessary as they are impracticable. The death-rate from phthisis is much higher among poor people than among rich, the difference being probably due in part at least to greater exposure to infection and re-infection, and we have to consider the reasons for this greater exposure and the extent to which it can be lessened. It depends greatly on how people live when they do not know or suspect that they are sources of infection, and partly on how they can be persuaded to live when they have become aware of it. Fortunately, cases who are infective unconsciously, do not usually distribute a large number of germs and so do not expose those around them to such massive doses of infection as is done by those in advanced disease. The ordinary habits of refined people leave so little opening for the spread of infection that they are sufficient to protect those in contact with doubtful cases unless sputum is present, when somewhat more care should be taken even if bacilli are not found. These habits could be followed in all decent working-class homes, and are quite frequently found there. The presence of tubercle bacilli in any person's sputum necessitates more rigid precautions before one could expect those in contact, particularly children or those not fully recovered from previous infection, to be safe; it must be admitted that a very large number of working-class houses do not permit of this care. Even here, however, perfectly satisfactory arrangements can be made in those cases where there is a regular income sufficient to maintain the family in decency during health, provided that the accommodation is sufficient and properly planned. It is the business of social science to show how this state of affairs could be made more usual. The slow process of obtaining control of the sources of infection may be greatly hastened by measures which aim at preventing the cases of chronic tubercle from becoming phthisical. If these cases are cured, the sources of infection are indeed cut off before they come to the surface, and it is now recognised that all subjects of active phthisis must pass through this latent, or chronic, phase before they become infective. It is also known that natural cure frequently occurs at this stage and that treatment is successful in a very large percentage of cases. Further, much chronic ill-health occurs among those who are the subjects of chronic tuberculosis, which may persist for years whether phthisis develops or not, and which may be relieved by treatment of the tuberculosis causing it, 94 Hitherto preventive medicine has been concerned with acute illnesses, and though measures employed for the control of these certainly have social bearings, they are comparatively simple and may be dictated from the strictly medical point of view, to which, in urgent illness, all else readily gives way. The case of acute phthisis, for example, will go to a sanatorium for six months without demur, and will be ready on returning to adopt the life of a valetudinarian rather than risk relapse; to accept charity, or to let the children go short while he, or she, drinks the milk they should have; to let the wife, or husband, continue overworking to keep things going, so that infection is likely to occur which might have been prevented by timely rest or medical advice; to overcrowd the rest of the family in order to sleep alone, or to use up the yard where the children should be playing, and darken the kitchen window by the erection of a sleeping shelter. The fear of such orders prevents many early cases from applying for advice. Thus we see social and sanitary sciences playing their part, each needing the co-operation of the other, and the secret of the former seeming to lie in the intimate knowledge of problems of poverty which is obtained through regular visiting combined with careful inquiry into the causes of distress in individual cases, and into the means of restoring each family to a normal social position. Municipal Tuberculosis Dispensary. Dr. Macdonald reports as follows:—The number of patients examined at the Dispensary during the year was 997, of whom 410 were males and 587 females. Of this number, 190 were insured and 807 non-insured. The total attendances made by these patients amounted to 5524. ATTENDANCES DURING THE MONTHS OF THE YEAR 1914 New Cases. Total Attendances, New and Old Cases. January 75 512 February 73 476 March 94 520 April 77 400 May 87 465 June 93 487 July 69 502 August 72 355 September 92 450 October 102 496 November 100 471 December 63 390 997 5524 95 SOURCE OF CASES EXAMINED AT THE DISPENSARY. Applied on own initiative. Sent by Doctor. Sent by Health Visitor. Sent by Tuberculosis Officer. Totals. Found to be suffering with Pulmonary Tuberculosis 65 66 33 14 178 Found to be suffering with some other Tubercular disease 10 5 7 — 22 Found to be NOT suffering with Tuberculosis 438 65 232 39 774 Contacts in which a definite diagnosis had not been arrived at — — — 23 23 Totals 513 136 272 76 997 PULMONARY TUBERCULOSIS. The ages and sex of patients diagnosed as Phthisical, are as follows:— Under 5 Between 5-15 Between 15-25 Between 25-35 Between 35-45 Between 45-55 55 and over Totals. Males 2 11 17 21 26 16 4 97 Females — 11 18 29 16 6 1 81 Totals 2 22 35 50 42 22 5 178 Of the above cases, 81 (44 M and 37 F) have ceased attending, whilst 97 (53 M and 44 F) are still receiving treatment. NON-PULMONARY TUBERCULOSIS. The ages and sex of patients found to be suffering with tuberculosis, other than pulmonary, are as follows:— 96 Under 5 Between 5-15 Bet ween 15-25 Between 25-35 Between 35^5 Between 45-55 55 and over Totals. Males 3 4 — 2 — — — 9 Females 5 7 1 — — — — 13 Totals 8 11 1 2 — — — 22 Of these cases, 8 (2 M and 6 F) have ceased attending, whilst 14 (7 M and 7 F) are still receiving treatment. NON-TUBERCULAR DISEASES AND DOUBTFUL CASES. The ages and sex of patients who have not been found to be suffering from any form of tuberculosis, are as follows:— Under 5 Between 5-15 Between 15-25 Between 25-35 Between 35-45 Between 45-55 55 & over Totals Males 78 146 28 22 12 14 10 310 Females 103 187 39 60 47 24 4 464 Totals 181 333 67 82 59 38 14 774 Of these cases, 618 (233 males and 385 females) have ceased attending, whilst 156 (77 males and 79 females) are still under observation. Home Visitation. Our scheme includes provision for home visitation of patients and examination of suspects and contacts by the Dispensary Medical Officer or the Medical Officer of Health. Homes visited by Dispensary Medical Officer and the Medical Officer of Health 326 Contacts examined by Dispensary Medical Officer and tbe Medical Officer of Health 390 * Visits of the staff of the Medical Officer of Health to the homes of patients on first notification 402 Revisits of Staff 1284 Special cases referred to the staff by the Dispensary Medical Officer 224 Total 2626 * (The staff includes 3 Health Visitors with nursing and special experience in Tuberculosis work.) 97 Owing to several changes in the medical staff during the year, the work of the Dispensary has suffered to quite an appreciable extent. This is especially seen in the administration of the special treatment by means of Tuberculin, where continuity of treatment over a prolonged period is very desirable and indeed essential, if good results are to be looked for. Following the resignation of Dr. Burton and the appointment of his successor, the work of the Dispensary was carried on by a locum tenetis, so that the treatment of the patients was in charge of three different medical officers during the past twelve months. As each officer has his own ideas as to the method and dosage of administering tuberculin, and the patients to whom it should be given, the result has been that in many cases the particular tuberculin has been changed, and in others stopped, so that it is for the most part practically impossible this year to give any accurate information as to results of treatment under this heading. It shows how little desirable such changes are in the interests of the patients. Possibly for the same reason there is a distinct tendency on the part of many patients to regard the Dispensary as a place for the dispensing of special cough mixtures. They are very surprised when asked to submit to examination. "Oh, I've just a bad cough, if you give me a bottle, I will be all right," is what one is accustomed to hear, and requests have even been received to "make up" a bottle "for a neighbour" who has a "bad cough" but who cannot be troubled to come down to the Dispensary himself. Others, in spite of the notice at the door, take the Dispensary to be something in the nature of the outdoor department of a general hospital, and patients have presented themselves with all manner of complaints bearing no relation to Tuberculosis: e.g., rickets, headaches, varicose veins, sprains, etc. These people are sometimes very annoyed when refused treatment. The above remarks show what a great deal remains to be done in the way of educating the people as to what Tuberculosis is, and a series of monthly or quarterly popular lectures is worth considering. If the ordinary consumptive patient could only be taught to realise that a clean, well-ventilated home, with reasonable attention in the matter of personal hygiene and the disposal of sputum, would do more to improving his health and preventing the spread of infection in the family than a gallon of cough mixture, then a distinct step forward would be gained. By means of lantern or other illustrated lectures to which all known tuberculous patients would be invited, the value of fresh air, of cleanliness, and the importance of careful disposal of the sputum could be explained to a large number at one time, and if periodically repeated, might in time, lead these patients to take the really simple precautions 98 which are necessary for their own well-being. Much is done by the Medical Officers and Health Visitors when visiting the homes, but it is impossible for the staff to visit each home as often as might be desirable. Contacts.—Every effort is made to get contacts to attend the Dispensary, where examination can be made as a rule, under more satisfactory conditions than obtained in the homes. Little difficulty is experienced in getting the juvenile contacts to attend, but it is to be regretted that more of the Adult contacts do not see the necessity of submitting themselves to examination. Domiciliary Cases.—During the last quarter of the year, 56 cases receiving domiciliary treatment at the hands of their panel doctors were visited and reported on by the Tuberculosis Officer at the request of the London Insurance Committee. The condition of these patients, many of whom were bedridden was as satisfactory as could be expected. The panel doctors concerned were notified beforehand by the Tuberculosis Officer. Diagnosis.—Formerly the only criterion of definite Pulmonary Tuberculosis was the finding of Tubercle Bacilli in the sputum, but in addition to this we have now in Tuberculin a very valuable and trustworthy guide in the diagnosis of consumption. During the latter part of the year where no bacilli were found in the sputa, the Tuberculin test was always applied and with satisfactory results, both by the subcutaneous method for adults and by the cutaneous (Von Pirquet) method in young children. During the year 438 specimens of sputa were examined in the Bacteriologcial Laboratory at the Dispensary, with 103 positive results. TREATMENT. (a) Routine.—There are of course many cases where treatment by Tuberculin is not admissible, and these are treated as far as possible by the familiar "Routine Method," viz., advice as to good food, fresh air, and the administration from time to time of tonic and other mixtures. Drugs should play a very minor part in the treatment of phthisis, but as the education of the patients is not sufficient for them to grasp the importance of hygienic measures in their treatment, mixtures of some sort have frequently to be prescribed in order to secure their continued attendance at the Dispensary. During the year, no fewer than 5,376 prescriptions were dispensed in the treatment of these patients. Incidentally it may be remarked that dental treatment is urgently required for all classes of patients attending the Dispensary. It is surprising to find what a large number never think it necessary to clean their teeth, and as few of them can boast of a sound set of teeth, it is evident that the health of the majority is bound to suffer from this cause 99 alone. The digestive powers of a consumptive patient is often of a very poor order and is not likely to be assisted if mastication of the food is imperfectly performed, owing to the state of the teeth. (b) Tuberculin Treatment.—Every year is proving the value of Tuberculin as a means of treating Tuberculosis. It is not to be used in every case, but generally speaking, cases suitable for Sanatorium treatment (i.e., early cases) do well with Tuberculin, especially if a full 9 or 12 months' course of treatment can be carried out. Therein lies a difficulty as patients in many instances, when they find themselves improving have a tendency to cease attending after a few months. As before remarked, it is not possible to give much information as to the results of this form of treatment this year for the reasons given, but it may be said that 44 patients received Tuberculin for a longer or shorter period and that on the whole the results were satisfactory, although in a few cases there was a loss of weight. In a few advanced cases in which Tuberculin was given, mainly as a palliative, the sedative effect was very marked, in fact so marked in one case that the patient requested "a strong dose" at each injection. Respiratory Diseases. Under this heading are included bronchitis, pneumonia, pleurisy, and other diseases of the respiratory organs. The number of deaths registered was 273. Of these deaths 43 were children under one year of age, 36 over one and under five years, and 94 were persons over 65 years of age. Bronchitis was most severe in the East and North Wards. Broncho-pneumonia and pneumonia of all forms were also more severe in these wards and accounted for more deaths than in any of the other wards. Influenza. This disease, which is an infectious one, accounted for 22 deaths during the year compared with 24 for the year 1913. Ten of the deaths occurred between the ages of 25 and 65, and sight of the deaths were of persons over 65. 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, anaemia, and other defined diseases. During the year they caused 685 deaths. G 2 100 Cancer and Malignant Diseases. One hundred and twenty-one 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 0.2 above the rate recorded in the preceding year, while the actual number of deaths was equal to that year's figure. When comparison is made with the mean return for the preceding ten years it is found that they are 19 in excess. DEATHS FROM CANCER DURING 1914. 85 and upward F  .. 1 .. .. .. .. .. 1 M .. .. .. .. •• .. .. _.. 75-85 F .. 4 2 1 1 •• 1 9 M 1 1 1 .. .. .. 1 4 65-75 F .. 4 5 1 1 .. 2 14 M 3 10 8 .. .. .. 6 22 55-65 F 4 3 7 6 •• 1 21 M .. 4 5 .. .. .. 3 16 45-55 F 2 3 T 3 1 16 M .. 3 1 .. .. •• 3 7 35-45 F .. .. 1 1 .. .. •• 4 M 1 .. 1 .. •• .. 1 3 25-35 F .. •• 1 1 •• .. 1 3 M .. .. 15-25 _F_ .. .. .. ....1 .. .. .. .. M .. ..1 .. .. .. .. .. .. 5-15 F .. •• .. .. .. .. .. .. M .. .. •• .. •• .. .. .. 1-5 F .. •• •• 1 .. .. .. 1 M .. •• .. .. .. .. .. .. All Ages Total. 10 35 26 19 11 .. 20 121 F 1 17 15 19 11 •• 6 69 M 9 18 11 .. .. .. 14 52 PART AFFECTED Buccal Cavity Stomach, Liver, &c. Peritoneum, Intestines and 1 Rectum f Female Generative Organs Breast *. Skin .. Other or Unspecified Organs 101 OTHER DISEASES NOTIFIED. Ward. Small Pox. Erysipelas. Continued Fever. Puerperal Fever. Acute Polio Myelitis. Ophthalmia Neonatorum. Glanders. Total. M F M F M F M F M F M F m F m F Total. East ... ... 58 38 ... ... ... ... ... ... 4 2 ... ... 62 40 102 North ... ... 18 24 ... ... ... 1 ... ... 4 2 ... ... 22 27 49 North-West ... ... 12 19 ... ... ... 3 ... 1 1 1 ... ... 13 24 37 South ... ... 6 7 ... ... ... ... ... ... 1 ... ... ... 7 7 14 South-East ... ... 16 12 ... ... ...... ... ... ... ... ... ... ... 16 12 28 South-West ... ... 8 7 ... ... ... 1 ... ... 1 ... ... ... 9 8 17 Total ... ... 118 107 ... ... ... 5 ... 1 11 5 ... ... 129 118 247 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards All ages. 20 10 18 38 85 60 16 247 102 The Shelter. The Public Health (London) Act, 1891, Section 60, Sub-Section 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 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. Disinfection. The disinfection of infected clothing and bedding has been carried out at the 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 four years:— 1914 11,784 articles of bedding, clothing, etc. 1913 8,875 „ „ „ 1912 7,577 „ „ ,, 1911 5,886 ,, ,, ,, The number of rooms disinfected by the Council's staff during the year was 1,582. 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 a 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 1,582 rooms in 1,385 houses in which infectious diseases, etc., have occurred, have been carried out under the direction 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. 103 Table SHEWING THE NUMBER OF PREMISES, ROOMS AND BEDDING DISINFECTED DURING THE YEAR 1914. 1914 Premises. Rooms. Beds. Pillows. Bolsters. Mattresses Sheets. Blankets. Odd Articles. Articles Destroyed. January 120 132 75 163 52 26 92 124 281 1 mattress, 4 odd articles. February 88 92 69 129 59 29 64 117 340 1 bed, 1 mattress, 1 blanket, 3 odd articles March 93 121 63 117 45 19 61 100 313 1 mattress,1 odd article April 98 105 71 135 57 23 73 105 230 1 bed, 2 pillows May 113 135 66 140 58 27 66 119 197 3 beds, 3 mattresses, 2 odd articles June 114 173 76 151 61 33 93 101 180 4 beds, 2 mattresses, 4 odd articles July 115 141 83 132 47 26 90 97 182 2 beds, 2 palliasses, 2 bolsters, 2 pillows, 2 blankets August 93 97 69 132 56 24 92 90 176 September 125 139 86 175 52 23 81 353 267 1 bed, 1 mattress October 126 137 103 193 54 25 100 377 1084 1 mattress, 1 sheet November 159 170 108 217 80 51 138 263 955 4 beds, 6 mattresses, 2 bolsters, 5 pillows, 5 odd articles December 141 140 102 207 92 35 107 195 565 1 mattress. 20 odd articles Total 1385 1582 971 1891 713 341 1057 2041 4770 Table SHEWING NUMBER OF ROOMS DISINFECTED AFTER THE FOLLOWING DISEASES:— 1914 Small Pox. Scarlet Fever. Diphtheria. Krysipelas. Membranous Croup. Enteric Fever Pulmonary Tuberculosis Measles Puerperal Fever. Cerebrospinal Fever. Other Diseases. January .. 66 17 .. 2 2 27 11 1 .. 4 February .. 47 18 .. .. 3 7 8 .. .. 1 March .. 62 12 .. .. .. 21 8 .. .. 1 April .. 59 18 1 .. .. 14 3 .. .. .. May .. 77 15 3 1 .. 13 7 1 .. .. June .. 126 21 1 .. .. 20 3 .. .. .. July .. 89 13 .. .. .. 24 3 .. .. 1 August .. 63 16 .. .. 1 l2 .. .. .. 3 September .. 78 26 1 .. .. 17 .. 1 .. 3 October .. 76 28 1 .. 1 16 .. .. .. 1 November .. 108 25 .. 1 .. 22 1 .. .. 12 December .. 93 20 2 .. 1 21 .. .. .. .. Total .. 944 229 9 4 8 214 44 3 .. 26 104 SPECIAL CASES. Jan. 5th—Billington Road. Cancer. 1 bed, 1 mattress, 6 pillows, 1 bolster, 4 blankets, 9 odd articles disinfected. ,, 6th—Seymour Street. Cancer. 2 beds, 2 pillows, 1 bolster—disinfected, ,, Sth—Col wick Street Cancer. 1 bed, 1 pillow, 1 bolster, 1 blanket, 3 odd articles —disinfected. ,, 16th—Rolt Street Cancer. 1 bed—disinfected. ,, 20th—St. John's Road. Cancer. 1 bed, 3 pillows, 1 bolster, 2 odd articles—disinfected. Feb. 2nd —Shere Road. Dropsy. 1 bed, 1 pillow, 1 bolster, 2 odd articlesdestroyed. ,, 2nd—Rolt Street, Cancer. 1 bed—disinfected. Mar. 2nd—Erlanger Road. Cancer. 1 bed, 3 pillows, 5 odd articles—disinfected. April 20th—Eckington Gardens. Cancer. 1 bed, 2 pillows—disinfected. May 20th—Manor Road. Jaundice. 1 bed, 2 pillows, 1 blanket, 6 odd articles —disinfected. June 12th—Strickland Street. Cancer. 1 bed, 3 pillows, 1 bolster—disinfected. Camplin Street, Bronchitis. 1 mattress, 1 bed—destroyed. Aug. 10th—Wickham Road. Cancer. 1 mattress, 1 bolster, 2 piliows, 3 udd articles —disinfected. ,, 15th—Trundleys Road. Cancer. 2 beds, 2 bolsters, 1 pillow, 4 sheets, 2 odd articles—disinfected. ,, 18th—Jerningham Road. Cancer. 1 bed, 1 pillow, 2 sheets, 1 blanket— disinfected. 24th— Haydock Road. Cancer. 1 bed, 2 pillows, 1 bolster, 1 mattress, 1 blanket. 14 odd articles—disinfected. Sept. 2nd—Kerry Road. Cancer. 1 bed, 3 pillows, 4 odd articles—disinfected. ,, 2nd—Amersliam Vale. Cancer. 1 bed, 4 pillows, 2 sheets, 1 bolster, 10 odd articles—disinfected. ,, 11th—Senegal Road. Cancer. 1 bed, 2 pillows, 1 bolster, 1 odd article —disinfected. ,, 25th—Jerningham Road. Heart disease. 1 bed—destroyed, Oct. 8tli—Manor Road. Gangrene. 1 bed, 4 pillows, 1 bolster—disinfected. ,, 22nd—High Street. Cancer. 2 beds, 6 pillows, 2 bolsters, 7 odd articles —disinfected. ,, 23rd—Foxberry Road. Heart disease. 1 bed, 2 pillows, 1 bolster— disinfected. Nov. 24th—Warwick Street. Cancer. 1 bed, 2 pillows, 1 bolster—disinfected. „ 28th—Childeric Road. Cancer. 1 bed, 1 mattress, 2 sheets, 2 pillows, 1 bolster, 3 blankets—disinfected, Dec. 30th—Evelyn Street. Cancer. 1 bed, 2 sheets, 3 blankets, 18 odd articles—destroyed. VERMINOUS PREMISES. Fifty premises consisting of 99 rooms were fumigated during the year. MIDWIVES ACT. Disinfection of wearing apparel, etc., was carried out in seven cases. BOOKS DISINFECTED. One hundred and fifty-two Library books collected from houses where infectious diseases had occurred, were disinfected before being put back into circulation. 105 With a view to further minimising the risk of spreading infection we have the power to destroy books belonging to the public libraries which come from infected houses. 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. Table. Total number of Premises disinfected 1385 „ „ Rooms ,, 1582 ,, ,, Beds ,, 971 ,, ,, Pillows „ 1891 ,, ,, Bolsters „ 713 ,, ,, Mattresses „ 341 ,, ,, Sheets ,, 1057 „ ,, Blankets ,, 2041 ,, ,, Odd articles ,, 4770 Total articles 11784 Total number of Beds destroyed 16 „ „ Mattresses ,, 17 ,, ,, Blankets ,, 3 ,, ,, Odd articles ,, 39 ,, ,, Pillows ,, 9 ,, ,, Palliasses „ 2 ,, ,, Sheets ,, 1 „ ,, Bolsters ,, 4 N.B.—The above articles were destroyed at the request of the owners. 106 Cleansing of Children attending the Elementary Schools in Deptford. In July, 1912, this Council began the systematic cleansing of verminous children attending the County Council Elementary Schools in the Borough. An agreement was made with the County Council whereby the Borough Council is paid for each child cleansed. The municipal cleansing station is therefore self-supporting and is situate in Watson Street, adjoining the disinfecting station. The chief form of vermin found have been head and body lice. In conjunction with body cleansing, the staff of the Public Health Department have been engaged in cleansing the clothes, bedding and rooms in connection with these children. During the two-and-a-half years that we have undertaken this work 2,106 children have been cleansed, a large proportion of these only once, but many others twice, and some three times in the same month. In all 4,456 baths have been given and 4,456 sets of clothing have been disinfected. The following table shows the number of children who have been cleansed and the number who have required the process a second and third time:— Year. Children cleansed once. Children cleansed twice in the same month. Children cleansed three times in the same month. Total. 1912 (half-year) 344 250 179 773 1913 877 637 461 1975 1914 885 507 316 1708 2106 1394 956 4456 From a consideration of the above, it is evident that a great deal of re-infection takes place. Re-infection may be brought about in several ways:— 1. The home itself, the walls, floors and woodwork being suitable breeding places for the breeding of vermin, &c. 2. By contact with some other verminous member of the family above or below school age. 3. By contact with some article of bedding or clothing which has escaped disinfection. 4. By the use of second-hand verminous articles of clothing which are verminous. 107 5. By contact of the child's clothing with verminous clothing in a pawnshop. Amongst the children cleansed it may be taken for granted that about 80 per cent, of the parents either make use of pawnshops, the contents of which are not subject to any form of disinfection, or buy second-hand clothing either from second-hand clothing shops, stalls or ragshops. In none of these cases are the clothes disinfected before being sold. We have the causes of re-infection of verminous children before us. We can deal and are dealing with the home, the bedding, and the clothing, actually present in the home at the time of inspection, but as regards the other causes more powers are required. Those in the home under school age should be examined by the school nurse when there is repeated infection amongst scholars coming from that home. Those over school age should be subjected to a medical examination if there is the same repeated infection. As regards clothing in pawnbrokers' shops and the sale of secondhand clothing, it seems to me that legislation might easily help us in the matter by prohibiting the sale or storing of verminous or filthy clothing. The following table gives the number of children bathed and treated by the bath attendant and school nurse during the year 1914:— Week ended. 1914. 1st Bath. 2nd Bath. 3rd Bath. January 10th 42 2 6 ,, 17th 28 29 1 ,, 24th 19 13 17 „ 31st 28 15 12 February 7th 29 15 12 ,, 14th 31 23 8 ,, 21st 13 17 19 „ 28 th 27 8 14 March 7th 21 11 5 „ 14th 24 13 7 „ 21st 18 18 5 „ 28th 18 17 12 April 4th 16 7 14 „ 11th 6 6 6 „ 18th — — - „ 25th 6 5 3 May 2nd 13 — 2 ,, 9th 10 5 — ,, 16th 21 7 4 ,, 23rd 25 13 3 „ 30th 15 20 5 June 6th — — — ,, 13 th 18 8 3 „ 20th 19 13 4 27th 15 15 8 108 Week ended 1914 1st Bath. 2nd Bath. 3rd Bath. July 4th 23 14 11 ,, 11th 17 17 8 ,, 18th 32 10 10 ,, 25th (School holidays) 9 7 — August 22nd 11 3 — ,, 29th 10 1 3 September 5 th 23 10 1 ,, 12th 22 14 7 ,, 19th 25 22 9 „ 26th 24 15 19 October 3rd 23 22 11 „ 10th 27 8 11 „ 17th 19 16 7 „ 24th 24 13 12 „ 31st — — — November 7th 10 5 3 ,, 14th 13 7 2 ,, 21st 24 4 6 ,, 28th 7 14 2 December 5th 20 5 12 ,, 12th 21 6 5 ,, 19th 34 8 6 ,, 26th 5 6 1 Totals 885 507 316 The number of baths given for the year 1914 was 1,708. In addition to the above, numerous adults received baths and had their clothing and bedding disinfected. These numbered 157. Mortuary and Coroner's Court. BODIES RECEIVED INTO THE MORTUARY DURING THE YEAR 1914. . Males. Females. Post Mortems. Inquests. Unknown. Brought in to await burial only Infectious. 85 46 39 61 78 ... 6 3 Coroner's Court. VERDICTS IN THE 78 INQUESTS HELD. Natural causes 48 Alcoholism 1 Suicide while insane 4 Accidental causes 23 Open verdicts 2 109 Table No. 7. METROPOLITAN BOROUGH OF DEPTFORD. Shewing the Streets in which Infectious Disease occurred during 1914. STREET. Small Pox. Diphtheria. Krygipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Meningitis. Poliomyelitis. Ophthalmia Neonatorum. Pulmonary Tuberculosis. Other Tuberculosis Diseases. Glanders. Abinger Road 1 7 1 Achilles Street 2 1 4 1 Addey Street 2 2 6 Adolphus Street 4 2 8 1 Albury Street 1 2 2 5 1 Albyn Road 6 1 Alexandra Street 8 1 2 Alloa Road 4 1 2 Alpine Road 2 2 1 Alvar Street 2 1 5 2 1 Alverton Street 4 2 Amelia Terrace 1 Amersham Grove 2 8 Amersham Road 2 1 1 1 Amersham Vale 2 1 3 2 Andom Terrace 2 Angus Street 1 Arbuthnot Road 1 Arica Road 2 5 Arklow Road 1 1 Ashmead Road 1 2 1 1 Aspinall Road 5 2 Atkinson Street 2 Avignon Road 3 Avonley Road 1 Baildon Street 3 6 1 7 1 Barlborough St. 4 1 1 Batavia Road 1 3 1 Bawtree Road 3 2 1 1 Benmore Street 1 Berthon Street 1 3 1 3 Besson Street 2 3 3 1 Bestwood Street 1 Bevil Street 1 Billington Road 4 Batsford Road 1 Bingley Place 2 Blackhorse Road 1 5 5 1 Blockhouse Street 7 10 1 4 Bolden Street 1 Bolina Road 6 7 2 1 Boscawen Street 2 9 3 Bousfield Road 4 Breakspears Road 1 4 1 110 Table No. 7—continued. Shewing the Streets in which Infectious Disease occurred during 1914. STREET. Small Pox Diphtheria. Erysipelas. Scarlet Fever Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Meningitis. Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis Other Tuberculous Diseases- Glanders. Briant Street 1 1 1 Brindley Street 1 Broadway Chambers 1 Brocklehurst St. 1 5 1 Brockley Road 4 3 5 5 Brookmill Road 2 6 5 1 Bronze Street 1 1 1 1 Camplin Street 1 1 1 Canterbury Road 4 1 Carrington House 1 5 Childeric Road 2 4 5 1 3 Casella Road 2 Childers Street l 10 1 3 Chipley Street 1 1 9 1 2 Chubworthy St. 1 2 1 Church Street 8 10 12 3 Clandon Street 2 Clifton Hill 2 4 7 2 Clyde Street 5 1 Colwick Street 1 1 3 1 Comet Street 2 Copperas Square 1 Cornbury Road 1 3 3 1 Corston Street 1 7 Cottesbrooke St. 2 Cranbrook Road 1 3 7 Cranfield Road 2 Creek Street 1 Crook Road 5 5 Crossfield Street 1 4 5 Czar Street 4 2 Deloraine Street 1 Dennett's Grove 1 Dennett's Road 1 7 Deptford B'dway 1 1 5 Desmond Street 1 1 1 2 1 Dollings Place 1 Dorking Road 2 12 1 1 1 Douglas Street 16 22 1 5 2 Drakefell Road 1 5 3 Drake Buildings 7 2 Dugald Street 1 Dundalk Road 2 1 Eckington Gdns. 2 2 Edale Road 2 2 2 111 Table No. 7 —continued. Shewing the Streets in which Infectious Disease occurred during; 1914. STREET. Small Pox Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever Cerebrospinal Meningitis. Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis. Other Tube culous Diseases. Glanders. Edward Place 1 Edric Road 6 Edward Street 2 14 2 2 Egmont Street 2 2 Elm Terrace 2 1 2 Endwell Road 3 Erlanger Road 3 3 1 Erlam Road 2 Etta Street 1 11 1 1 Eugenia Road 3 1 Evelyn Street 5 4 22 1 2 Faulkner Street 1 Fawcett Road 1 3 2 Ffinch Street 1 1 Finland Road 5 1 Fisher's Rents 1 Florence Road 2 1 1 3 Florence Street 3 1 Florence Cottages 1 Folkestone Gdns. 2 1 14 1 Foxberry Road 2 Foxwell Street 2 2 Frankham Street 2 2 1 2 1 Friendly Street 7 1 Gellatly Road 1 2 1 Giffin Street 11 4 1 13 2 Glenville Grove 1 2 1 Goodwood Road 2 2 Gosterwood Street 2 1 17 2 2 1 Greenfield Street 1 Grinling Place 1 1 1 Grinstead Road 3 1 Grove Street 2 1 14 1 9 Hales Street 1 1 2 1 Hamilton Street 2 2 1 1 Hanlon Street 2 12 1 Harton Street 1 1 1 Hatcham Pk. Rd. 1 1 1 2 1 Hathway Street 2 Hay dock Road 3 9 1 Heald Street 1 Hereford Place 9 Heston Street 1 2 2 High Street 1 1 6 1 3 1 Hicks Street 1 112 Table No. 7—continual. Shewing the Streets in which Infectious Disease occurred during 1914. STREET. Small Pox Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Meningitis. Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis. Other Tuberculous Diseases. Glanders. Hilly Fields C'snt 2 1 1 Hood Street 1 4 Hornshay Street 2 1 1 Hornshay Place 1 Hosier Street 1 1 3 3 Hunsdon Road 1 2 2 2 Hyde Street 3 2 14 1 Idonia Street 3 1 Ilderton Road 1 1 1 Jerningham Road 2 8 2 1 Junction Road 8 1 Kender Street 1 2 1 Kent Terrace 1 Kenwood Avenue 1 Kerry Road 2 1 6 Kitto Road 1 1 1 2 Knott Street 1 1 2 Knott's Terrace 2 Knoyle Street 3 1 3 1 Lausanne Road 4 Laurie Grove 1 Leonidas Street 1 Lee Terrace 1 Lewisham High Road 3 3 4 1 Liardet Grove 1 1 Liardet Street 1 2 1 Lind Street 2 3 1 Lovelinch Street 5 8 1 1 Lubbock Street 1 1 Ludwick Road 3 4 1 Lucas Street 1 5 Luxmore Street 1 1 Malpas Road 1 1 10 1 2 Manor Road 1 7 1 Marchant Street 2 Martha Place 1 Martin's Place 1 Mantle Road 1 Mary Ann's Bdgs. 2 1 1 Mason's Grove 1 Milton Court Rd. 2 2 11 3 1 Mitchell's Cottgs. 1 113 Table No. 7.—continued. Showing the Streets in which Infectious Disease occurred during 1914. STREET. Small Pox. Diphtheria Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Meningitis. Poliomyelitis Ophthalmia Neonatorum. Pulmonary Tuberculosis. Other Tuberculous Diseases. Glanders. Mona Road 1 Midway Place 1 \ Monson Road 1 1 1 Mornington Road 2 2 2 Musgrove Road 1 1 Napier Street 1 4 4 Nettleton Road 1 New Cross Road 1 1 12 1 4 1 New King Street 2 1 1 Norval Street 1 Nynehead Street 1 2 Oareboro' Road 2 1 4 1 1 Octavius Street 1 1 3 Oldfield Road 1 Ommaney Road 3 2 Oscar Street 2 1 3 1 Pagnell Street 3 4 1 3 1 Payne Street 2 1 6 1 1 Pender Street 1 1 Pepys Road 1 1 2 Pendrell Road 1 1 Pomeroy Street 1 1 Power's Place 1 Prince Street 1 Prospect Place 2 Providence Place 2 Queen's Road 4 5 1 Railway Grove 2 5 3 Raleigh Buildings 2 1 Reaston Street 1 1 1 4 Rectory Buildings 1 2 2 1 2 1 Reculver Road 1 1 4 1 Reginald Road 1 2 1 4 1 Reginald Street 1 1 1 1 Revelon Road 4 Rokeby Road 1 Rollins Street 2 7 Rolt Street 2 11 1 5 Ruddigore Road 1 2 Rudford Road 1 2 Rutt's Terrace 1 Royal Naval Pl. 1 1 Rowley Street 1 114 Table No. 7—continued. Shewing the Streets in which Infectious Disease occurred during 1914. STREET. Small Pox Diphtheria. Krysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Meningitis. Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis. Other Tuberculous Diseases. Glanders. St. Asaph Road 2 2 St. Donatt's Road 3 2 1 1 St. James' 3 1 1 St. John's Road 1 5 St. John's Terrace 1 St. Nicholas' St. 1 1 Sayes Street 1 4 1 Scawen Road 2 3 1 Sanford Street 6 1 Selden Road Senegal Koad 1 5 2 6 3 Seymour Street 1 2 Shardeloes Road 1 2 4 1 Sharratt Street 2 9 1 2 Shere Road 2 1 8 Ship Street 2 Silwood Street 2 Simla Street 2 Snead Street 3 2 Somerville Road 8 2 South Eastern (Staff) Hospital 10 1 2 Speedwell Street 2 2 1 Spring Street 1 1 Sprules Road 1 Stanhope Street 2 3 2 Stanley Street 4 Staunton Street 2 5 1 Stockholm Road 1 Strickland Street 1 Tanner's Hill Tolhurst Street 2 1 3 5 1 Tressillian Road 1 Trim Street 1 1 Trundleys Road 8 1 8 3 Tyrwhitt Road 1 Upcott Street 5 3 1 Vance Street 1 1 Vanguard Street 8 1 2 Vansittart Street 1 1 Ventnor Road 1 Vesta Road 1 Vulcan Road 1 1 Vulcan Terrace 1 115 Table No. 7—continued. Shewing the Streets in which Infectious Disease occurred during 1914. STREET. Small Pox. Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Meningitis. Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis. Other Tuberculous Dieases. Glanders. Wallbutton Road 1 Wagner Street 1 Waller Road 2 3 1 2 1 Walpole Road 1 1 2 1 Walsham Road 1 1 Warwick Street 4 1 10 Watergate Street 2 3 2 1 2 Watson Street 1 2 3 1 Whitcher Street 4 1 Wickham Road 1 3 Wickham Gdns. 1 Wilson Street 1 1 1 Windmill Lane 4 7 2 1 Woodpecker Rd. 2 5 5 2 1 Wotton Road 8 6 Wrigglesworth St. 1 1 Wybourne Ctgs. 1 Yeoman Street Zampa Road 2 Totals 253 225 866 9 5 1 16 345 74 General Sanitary Administration. 118 Work of Sanitary Inspectors. The work performed by the District Inspectors represents, as usual, a very large number of inspections. The total inspections and visits to premises numbered 26,684 as against 27,739 for the previous year. The figures stated above related to 6,025 houses in which 7,039 sanitary improvements of one kind and another were effected. The premises visited included stable yards, manure depots, vacant land, passages, public urinals, 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 re-drainage work for the year 1914 has been carried out at the following premises. To redrain:— By a combined operation in connection with the existing system, No. 2 Eckington Gardens Do. No. 234 Lewisham High Road Do. Nos. 46 and 48 Hatcham Park Road Do. Nos. 68, 70 and 72 Kender Street To fix a new stoneware gully and pipes to building at the rear of 196 Lewisham High Road To redrain, by a combined operation in connection with the existing system, No. 4 Wickham Road Do. No. 87 Wickham Road Do. Nos. 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39 and 40 Colwick Street, and the Evelyn Saw Mills in that street. Do. Nos. 15, 17 and 21 Monson Road Do. Nos. 1 and 3 Evelyn Street Do. No. 4 Eckington Gardens Do. Nos. 18 and 20 Amersham Vale To redrain, in connection with the existing system, the "Crown and Sceptre" Public House, 92 Friendly Street To redrain, by a combined operation in connection with the existing system, Nos. 353 and 355 New Cross Road Do. No. 102 Manor Road Do. No. 185 Church Street Do. Nos. 70, 72 and 74 Tanner's Hill Do. No. 79 Gosterwood Street Do. Nos. 9 and 10 Brindley Street Do. Nos. 156 and 158 New Cross Road Do. No. 120 Lewisham High Road 119 To redrain, in connection with the existing system, No. 20 Albury Street To redrain, by a combined operation in connection with the existing system, No. 52 Ashmead Road Do. No. 162 Lewisham High Road Do. No. 2 Albury Street Do. No. 253 New Cross Road Do. No. 255 New Cross Road Do. No. 48 Breakspears Road Do. No. 153 Breakspears Road Do. No. 17 Evelina Road Do. Nos. 152 and 154 Lewisham High Road Do. No. 160 Lewisham High Road Do. Nos. 30, 32, 34, 36, 38 and 40 Barlborough Street Do. No. 151 Breakspears Road Do. Nos. 2 and 4 Albyn Road Do. Nos. 16, 22, 24 and 26 Amersham Vale Do. No. 20 Clandon Street Do. No. 16 St. James', New Cross Do. Nos. 123 and 125 Shardeloes Road Do. Nos. 6 and 7 Eckington Gardens Do. No. 53 Seymour Street Do. No. 42 Rokeby Road Do. No. 89 Drakefell Road Do. Nos. 165, 167 and 169 Edward Street Do. No. 484 New Cross Road Do. Nos. 32, 34, 36, 38 and 40 Windmill Lane Do. No. 2 Hereford Place Do. No. 405 Evelyn Street 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. 1458 To build additions at 76 Wickham Road, and drain the same partly into the existing separate system, and partly into the existing combined system, at present taking the drainage of Nos. 72 & 74 Wickham Road. 1472 To build and drain additions to Factory adjoining Knoyle Street, and to drain into existing system. 1473 To build and drain by separate system new premises at Blackhorse Road. 120 1475 To build Picture Palace at 277-281 Queen's Road, and drain by a separate system. 1460 To build and drain by a combined operation in connection with the existing system, additions to No. 38 Broadway. Approved on condition that the existing system of drainage is made to comply with the bylaws. 1476 To build addition and drain the same into the existing com- bined drain at Nos. 11 & 12 Broadway. 1481 To build w.c.'s and drain into existing system at No. 53 Broadway. 1488 To build, coal order office at the Brighton Railway Bridge, New Cross Road, and drain into the existing combined system. Approved subject to the existing system being made to comply with the bylaws. 1492 To rebuild w.c. at 94 Tanner's Hill, and drain into existing combined system. 1495 To build and drain in connection with the existing system a w.c. at Mantle Road Schools. 1496 To build and drain in connection with the existing system an addition to the Mazawattee Tea Company's premises in Trundleys Road. 1482 To build and drain by a combined operation in connection with the existing system, premises in Endwell Road. 1494 To build three W.C.'S. and drain into the existing combined system at 15 Yeoman Street. 1495 To build and drain by a separate system, premises in Ashby Road. 1496 To build and drain by a combined operation two houses in Cranbrook Road, and nine in Harton Street. 1493 To build and drain into existing combined sytem, additions at 175 High Street. 1502 To build and drain into existing combined system, a garage on land at rear of 48 & 50 Breakspears Road, such drain being connected to the combined drain at No. 44 Breakspears Road. 1503 To build and drain into existing system, additions at 209 High Street. 1504 To build and drain by a separate system, offices in Arklow Road. 1508 To build and drain by a combined system, a factory, work- shop and caretaker's cottage on the northern side of Ashby Road, between Brockley Road and Manor Road. 1509 To build additions to the Key Glass Works, Archangel Wharf, Cold Blow, S.E., and drain into existing combined system. 121 1510 To build and drain into existing combined system a bathroom at 19 Tressillian Road. 1518 To build and drain by a combined operation St. Paul's Clergy House, High Street. 1526 To connect drainage of new bowling green Pavilion on Hilly Fields to sewer in Hilly Fields Crescent. 1527 To build and drain into existing system an office at Roger's Factory, Bolina Road. 1535 To build two W.C.'s., urinal and lavatory, and drain into existing system. (F. Braby & Co., Ida Works.) 1528 To build and drain into existing combined system, a W.C. at 164 Evelyn Street. 1534 To lay additional drainage into existing combined system at 56 New Cross Road. 1545 To build and drain two w.C.'s. at the rear of 10 Creek Street. 1546 To build a urinal and drain into existing combined system at the rear of the "White Swan," High Street. 1547 To build flue adjoining Railway Arch, 346 Blackhorse Road. 1548 Temporary application for drainage of new additions to Clyde Street school. 1551 To build additions to London County Council School, and drain into existing system on the South-Side of Clyde Street. 1552 To build additions to London County Council School, and drain into existing system on the North Side of Clyde Street. The Inland Revenue Act, 1903. The following table shows the number of applications for certificates granted under the above Act for exemption or abatement from Inhabited House Duty:— Houses during the Year 1914. Tenements. Notes. No. comprised therein. No. for which Certificates were Granted. Refused Deferred. 13 20 12 8 — — 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. 122 METROPOLITAN BOROUGH OF DEPTFORD. Table. REPORT OF SANITARY INPECTORS FOR THE 52 WEEKS ENDED JANUARY 2nd, 1915. Number of District. 1 2 3 4 5 6 7 Totals. Complaints Received 14 22 20 25 34 25 9 149 Total Premises Inspected 554 863 1056 1077 875 852 748 6025 Re-Inspections, Calls, Service of Notices, &c., &c 2611 2857 3136 3025 2743 2603 3684 20659 Inspections under notice from Contractors, per Bye-Laws 14 118 15 36 33 38 9 263 Number of Cases in which Proceedings have been taken ... ... ... 1 ... 3 ... 4 "Intimations" Served 356 154 306 491 587 479 425 2798 "Statutory Notices" Served 38 5 23 10 27 22 18 143 Houses closed by Magistrate's Order ... ... ... ... ... ... ... ... ,, voluntarily ... ... ... ... ... ... ... ... Water Closets- Old Closets abolished ... 7 ... ... 1 ... 1 9 New Closets provided 3 10 ... 1 ... 2 ... 16 ,, ,, ,, in Workshops ... ... ... ... 1 ... ... 1 Basin and Trap provided 11 69 35 39 65 30 39 288 Water Supply provided 9 5 14 ... 30 2 ... 60 Water Supply Apparatus provided 36 8 15 35 27 20 ... 141 Limewashed 61 3 7 ... 22 23 17 133 Walls Repaired 43 1 ... 5 13 15 13 90 Floors Repaired 40 1 ... ... 2 1 5 49 Doors provided 15 ... ... ... 12 3 7 37 Ventilated ... ... 2 ... ... 1 2 5 Seats provided 15 ... ... 8 7 5 4 39 Basins Cleansed ... 1 9 6 3 15 1 35 Sealed off from Scullery ... ... ... ... ... 4 19 23 Drains- Drains Re-constructed 3 34 22 15 30 8 13 125 Surface Drains provided 3 ... ... ... ... 2 1 6 Cleansed and Amended 12 133 21 35 51 61 14 327 Gully Traps fixed 7 68 31 14 65 20 13 218 New Soil Pipes and Vent Pipes fixed 1 26 9 27 44 15 18 140 Chambers built and Interceptors provided 2 12 8 ... 6 6 ... 34 Interceptors only fixed ... ... ... ... ... ... ... ... Ventilated 2 11 28 1 22 4 6 74 Provided to Stables ... 1 ... ... ... ... 1 2 Clearing Eyes ... 12 2 6 21 6 3 50 Sinks, Bath & Lavatory Wastes, and Rain Water Pipes— Disconnected from drains, trapped and ventilated ... 30 26 56 52 59 22 245 123 REPORT OF SANITARY INSPECTORS FOR THE 52 WEEKS ENDED JANUARY 2nd, 1915—continued. Table—continued. Number of District. 1 2 3 4 5 6 7 Totals Cesspools— Abolished ... ... ... ... ... ... ... ... Dustbins- Provided 80 122 74 102 181 123 121 803 Repaired ... 3 ... ... 2 ... 1 6 Yards- Paved 93 7 25 22 8 25 75 255 Surface Repaired ... 7 11 16 48 35 15 132 Urinals— Provided ... ... ... ... ... ... ... ... Repaired ... ... ... ... 3 ... ... 3 Cleansed ... ... ... ... 4 ... ... 4 Sculleries and Wash-houses— Floors paved 29 2 5 4 14 9 36 99 Coppers provided or repaired ... ... ... 5 4 ... 8 17 New sinks provided ... ... ... ... 10 9 9 28 Forecourts— Paved 6 3 3 41 14 5 16 88 Surface Repaired 6 ... ... ... 1 1 ... 8 Gutters and Rain Water Pipes Provided and Repaired 91 36 33 59 82 60 50 411 Water Supply- Store Cisterns provided ... ... ... ... ... ... ... ... „ „ Covers provided 2 ... ... ... 1 6 1 10 ,, „ Cleansed ... ... ... ... ... 3 ... 3 „ ,, abolished ... 1 1 12 ... 3 3 20 Supply Reinstated ... 5 ... 3 5 ... ... 13 Fittings Repaired 12 10 3 20 33 73 67 218 New Houses Inspected for Certificates before Occupation 1 8 ... ... 14 ... ... 23 Potable Water provided from Service ... 2 ... 8 1 2 ... 13 Cleansing: and Repairs— Houses Cleansed and Limewashed 265 34 126 222 176 186 296 1305 Houses repaired and Ventilation improved 257 23 57 54 205 68 85 749 House roofs repaired 83 13 40 24 76 58 51 345 Dampness abated ... ... ... 36 ... 47 31 114 Staircases, &c., lighted ... ... ... ... ... ... 9 9 Stoves repaired or new ones provided ... ... ... 9 3 ... ... 12 Window frames, sashes, or doors repaired, and fastenings provided ... ... ... 1 7 ... ... 8 Handrails fixed or repaired ... ... ... 1 ... ... 30 31 Miscellaneous ... ... ... ... 3 1 ... 4 124 REPORT OF SANITARY INSPECTORS FOR THE 52 WEEKS ENDED JANUARY 2nd, 1915—continued. Table—continued. Number of District. 1 2 3 4 5 6 7 Totals. Dung Receptacles— Abolished ... ... ... ... ... ... ... ... Repaired ... ... ... ... ... ... ... ... Provided ... 1 ... ... ... ... ... 1 Underground Rooms— Used as dwellings abolished ... ... ... ... ... ... ... ... Overcrowding— Cases Abated 6 1 6 6 5 4 ... 28 Accumulations Removed 4 4 9 1 7 3 1 29 Animals— Ceased keeping as a Nuisance ... 1 ... 4 2 3 ... 10 Smoke Nuisances— Cases Abated 1 1 ... 2 ... 10 ... 14 Observations 6 ... 4 14 ... 43 ... 67 Rooms occupied in such a manner as to be a nuisance ... ... 2 ... ... ... ... 2 Inland Revenue Act— Houses inspected for Certificates ... 6 ... 1 ... 6 ... 13 Number of Tenements ... 12 ... 2 ... 6 ... 20 Number of Certificates granted ... 10 ... 2 ... ... ... 12 Number of Certificates refused ... 2 ... ... ... 6 ... 8 District No. 1.—Inspector Simpson (on military service since Sept.) District No. 2.—Inspector Priest. District No. 3.—Inspector Shelley. District No. 4.—Inspector Snowdon. District No. 5.—Inspector Kemp. District No. 6.—Inspector Hewett. District No. 7.—Inspector Allam. 125 Overcrowding. Overcrowding was abated in 28 cases without having to take legal proceedings. Smoke Nuisances. During the year 67 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. The nuisance was abated in every instance but one which is still under observation. 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. Authorized 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 Longinotto 13 Wickham-road 35 Baildon-street 27 M 22nd April, 1885 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 101 M Barnard Jaffa 112 High-street 112 do. 80 W do. 112 do. 124 Tanner's-hill 68 M 15th Feb. 1897 James Webster 38 Wickham road 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, 126 (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 289, the whole of which were inspected at least twice during the year with a view to seeing that they comply with the bylaws as regards cleanliness, overcrowding, etc. The inspections reveal a number of very unsatisfactory conditions. For years only a small per centage of sub-let houses have been registered as such. Another point is the difficulty in separating the sexes, which is so desirable from a moral point of view, for promiscuous sleeping together of persons of opposite sex may be a greater evil than overcrowding. In the central district we have insisted upon a proper water supply to each floor of a tenement house, but we still have houses of this description in the borough with only one water tap for the use of the various families. This tap is, as a rule, fixed in the scullery on the ground floor, therefore all tenants, except those on this floor, are obliged to carry pails of water upstairs to their rooms. This leads to the water for cooking and drinking purposes being often stored in undesirable places where it is liable to contamination. Seeing that all the water for drinking and domestic purposes has to be carried and stored in this way it follows, as an inevitable result, that very little water is used, and this does not conduce to habits of cleanliness. Usually the only sink accommodation is on the ground floor. All waste water from the sub-let rooms above has to be carried to the ground floor and pou.ed down the sink in the scullery. This, besides being inconvenient, is a source of annoyance to the other tenants, especially to the occupier of the kitchen or other room through which the waste water has to be carried. Under these circumstances it is a very difficult matter for personal clothing to be properly washed, or for washing of any kind to be efficiently done. The rooms above the ground floor having been built for use as bedrooms are not provided with a proper place for the storage of provisions. This results in such foods as milk, meat and fish deteriorating much more rapidly than would be the case under proper conditions of storage, and permits 127 of these and other foods being contaminated by flies and dust. Further, the small bedroom fireplaces found in such rooms are quite unsuitable for cooking purposes, and in many cases the grates are so small that a frying pan cannot be put on the fire. The byelaws with respect to houses let in lodgings, or occupied by members of more than one family, do not even demand one water-closet to be provided for every twelve persons occupying the house. Whatever the number of persons in a sub-let house a water-closet on each floor is, in many cases, necessary. This would obviate the necessity of carrying chamber utensils down the stairs and through a room possibly occupied by another family, and would prevent the nuisance sometimes caused by tenants throwing filth through the window into the street, yard, or passage below. I urge that if the bylaws relating to houses let in lodgings were amended, so as to deal satisfactorily with the conditions just enumerated, it would result in a distinct improvement in Deptford housing. During the year, New Regulations under Section 17 (2) of the Housing, Town Planning, &c., Act, 1909, have been prescribed by the Council concerning underground rooms used as sleeping places. Every room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room shall comply with the following regulations, namely:— 1. The subsoil of the site of the room shall be effectually drained by means of a properly trapped and ventilated subsoil drain wherever the dampness of the site renders such a precaution necessary. 2. Every drain passing under the room other than a drain for the drainage of the subsoil of the site of the room shall be gas-tight and water-tight. 3. The room shall be effectually protected against the rising of any effluvium or exhalation by being properly asphalted or by being covered with a layer of good cement concrete at least six inches thick or four inches thick if properly grouted laid upon the ground of the site of the entire room or in some equally effectual manner. 4. The space if any beneath the floor of the room shall be provided with adequate means of ventilation. 5. (i.) Every wall of the room shall be provided with an efficient horizontal damp-proof course which shall be composed of materials impervious to moisture, and shall, if the floor of the room be formed 128 of woodwork, be beneath the level of the lowest timbers or woodwork of such floor, and shall in every other case be not less than one inch below the level of the upper surface of such floor. (ii.) No part of any wall of the room shall where it is practicable to avoid it be in contact with the ground or earth. Provided that where any wall of the room is in contact with the ground or earth, such wall or such part thereof as is so in contact shall unless constructed as a hollow wall have an efficient vertical damp-proof course extending from the lowest horizontal damp-proof course therein to a height of at least six inches above the surface of the contiguous ground or earth. 6. Unless the room is provided with a fireplace and a flue properly constructed and properly connected with such fireplace, it shall be provided with special and adequate means of ventilation by one or more suitably placed apertures or air-shafts. 7. An area or open space properly paved with impervious material and effectually drained by means of a properly trapped gully shall adjoin the room and shall extend either (a) throughout the entire length of one side thereof ; or (b) at least throughout the entire width of any window or windows required by these regulations and (except where the area of such window or windows shall be not less than one-seventh of the floor area of the room) for three feet on each side of such window or windows. Any such area shall be not less than two feet wide in every part thereof and shall be open upwards from a level three inches below the level of the damp-proof course in the adjoining wall of the room. Provided (a) that where a bay window in the room having side lights overlooks such an area, the width thereof in front of such window may be one foot at the least; and (b) that any steps necessary for access to any part of the building comprising the room may be placed in or over such an area or open space if they are so placed as not to be over or across any window of the room required by the regulation in that behalf. 8. (i.) The room shall be effectually lighted by means of one or more windows opening directly into the external air. (ii.) Every such window shall be so constructed that one-half at the least may be opened and that the opening may extend to the top of the window. 129 (iii.) The total area of such window or windows clear of the sash frames shall be equal at the least to one-eighth of the floor area of the room and a portion of such total area equal in extent to at least one-tenth of such floor area shall be so situated that a line making an angle of thirty degrees with a horizontal plane can be drawn upwards from any point thereon in a vertical plane at right angles to the plane of the window so as not to intersect within a distance of ten feet measured horizontally from the window any wall of any area adjoining the room or any other wall or any kerb or other obstruction except an open fence. For the purposes of this paragraph a bay window having side lights shall be assumed to be equivalent to a flat window of the same area and of the same height in relation to the room and situated at a distance from the outside area wall equal to the mean width of the area. (iv.) In estimating the area of a window or windows for the purpose of this regulation no account shall be taken of any part of any such window which is above the mean level of the ceiling of the room. (v.) Any such window or windows shall overlook the area or open space provided in pursuance of the regulation in that behalf. Underground Workrooms. Whilst speaking of underground sleeping rooms it would not be out of place to mention underground workrooms, which may be as unhealthy from a public health point of view as any underground sleeping room. There are a number of facts laid bare in the inspection of the homes of outworkers which are of the greatest importance. Sometimes in these home-workrooms the most unsatisfactory conditions under which industrial employment is maintained are to be found, and our existing powers are insufficient in some respects to bring about the necessary improvements. The lighting, for instance, is often most unsatisfactory where basement rooms are used. It is true that we rarely find more than one or two engaged as out-workers in any one room, but when these work close to the window of a small basement room, and thus obtain sufficient light for working purposes, the rest of the room, sometimes occupied by children and others, is very poorly lighted, and this may be bad for them both from the standpoint of vision and of general health. Moreover, the available light, which is little enough, is often reduced on account of the windows being dull glazed or covered for privacy, and they are sometimes further obstructed by articles being hung by the side or front of them. On these and other grounds it is strongly urged by several London medical officers that the requirements of the Public Health (London) Act, 1891, with reference to j 130 underground rooms which are separately occupied, should be made to apply to underground workrooms. Public Washhouses. It is of vital interest to many residents of the Borough that the Council has decided to provide a further supply of public washhouses for the north part of the Borough. This I have always believed to be a most important step. When one considers the unfitness from a sanitary point of view of a small house for carrying on washing and drying operations, the amount of dampness to the house and general discomfort which it must cause to the children and other occupants of the small kitchens in which the processes are carried on, it will be seen at once what an enormous boon a public washhouse offers to the smaller householders. The gain from an economic point of view is also considerable. The amount charged for the use of a small compartment, such as will be provided in these places, with the necessary hot water, steam boiling pan, drainer, washtub, scrubbing board and draw-out drying horse, must be much less than the cost of washing at home, besides being infinitely more clean and healthy. It thus enables a very deserving class of women to make ends meet more easily; whilst the children get a home free from the steam and wet attendant on the house washing, and thus infinitely more comfortable. Street Refuse. The following is the amount of the street refuse collected during the year 1914, and the manner in which it has been disposed of:— 1914. No. of Loads Collected. DISPOSAL. Barges. Osman. Edale Road. West. Dung Pit- Sundry Shoots. January 750 169½ 299 113 168½ February 643½ 160 270 131 82½ March 706½ 304 278 33½ 91 April 657 210½ 283 39 124½ May 684 233 299 59 93 June 609½ 206½ 237 80 86 July 720 250½ 323 120½ 26 August 660½ 211½ 261 159 29 September 782 215 350 183 34 October 819½ 314½ 342 127½ 35½ November 646 349 243 30 24 December 552 376 153 18 5 Total 8230½ 3000 3338 1093½ 799 131 Street Paving. On presenting a report of your Medical Officer of Health on Infantile Mortality to the Council in December, 1911, the Public Health Committee made several recommendations, one of which was as follows:— "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." The Works Committee is certainly to be congratulated upon the way this recommendation is being carried out. The following streets in the East Ward have now been asphalted :— High Street Addey Street Bronze Street Speedwell Street Bevil Street Frankham Street Hales Street Blank Street Norval Street Stanhope Street Hosier Street The advantages of having roads paved with asphalt presenting a smooth, impervious surface—easily cleansed by rain, water cart and hosepipe—are particularly noticeable in narrow streets. The absence of puddles, after rain and the freedom from dust in the dry weather are all important where the street has frequently to be the playing ground of the children. The Works Committee deserves every encouragement to continue this kind of paving, especially in narrow streets, from a public health standpoint. House and Trade Refuse. Table showing the number of loads of house and trade refuse collected during the year and where deposited:— 1914. Number of Loads. DISPOSAL. 1913. 1914. Barges. Rail. Sundry Free Shoots. January 1781½ 1903½ 1608½ 273 22 February 1556½ 1620½ 1394½ 215 11 March 1714 1791½ 1563½ 220 8 April 1762½ 1856 1603 248 5 May 1850½ 1737½ 1478½ 257 2 June 1706½ 1710 1505 200 5 July 1811½ 1775½ 1491½ 281 3 August 1570 1436 1231 200 5 September 1615 1541½ 1315½ 226 — October 1784 1589½ 1320½ 268 1 November 1649½ 1582½ 1381½ 195 6 December 1819½ 1690 1476 212 2 Total 20621 20234 17369 2795 70 J 2 132 House Refuse. I wish again to emphasize the importance of sufficient and suitable dustbin accommodation. Dustbins should be uniform in size, and must possess tightly fitting covers. In a thickly populated district it is important that they should be emptied frequently and at regular intervals. I am strongly of the opinion that a bi-weekly collection should be made in the hot months of the year. Under the present circumstances it does not appear possible to collect the whole of the refuse once a week, and I regret to know that the circular issued to the householders by the Council last September did not meet with great success. The circular stated "it is to be hoped that all occupiers will confine the accumulation of refuse to its lowest limits, and that they will, where possible, employ other means of destroying, by burning, etc., all combustible matter, and all decomposing organic matter, such as vegetable and flesh waste, so that, should the present service of collection be unfortunately cut down, there will be less likelihood of inconvenience and ill-health amongst the community. Occupiers should avoid resorting to the dustbin with such otherwise easily disposed of articles as waste paper, old clothes, cloths, garden cuttings, etc., which are found in large quantities in the dustbins of the Borough, and which constitute in bulk a very heavy charge on the rates for collection and disposal. The estimates for the current year for removal of house refuse amount to £7,800, a sum which, by improved habits of the people could be greatly reduced." This was followed by another circular, which I give in full:— COLLECTION AND DISPOSAL OF REFUSE. The Deptford Borough Council regrets being under the necessity of again cautioning the occupiers of premises within the Borough on the matter of the disposal of House Refuse ("Dust") and Trade Refuse. Occupiers will remember that a notice was served to them on this subject dated September last, and though some diminution in the volume of combustible waste thrown in the dustbin has since been observable, the extent to which compliance has been made to the request has been very slight. Since the date of the notice referred to the difficulties of the position have increased, and, unless the volume of refuse is very considerably reduced, the Borough Council has reason to fear that with the restriction of navigation on the river, owing to Admiralty orders, the very small number of barges and river craft now available for the work owing to Government requirements, and 133 also the scarcity of men, the difficulty of continuing the service may increase to an extent they are unable to cope with, and it is even conceivable that it may be necessary to suspend the collection of refuse for the time being, and in that case it will be necessary for every occupier to find his own means of disposal. How occupiers of premises in general and householders in particular can greatly assist the authorities in coping with the situation by burning all combustible material is pointed out in the previous circular, and the Borough Council hereby warns all occupiers for a second time to give the strictest attention to this matter, so that if possible the undesirable predicament may be avoided. I hope that householders will, for their own health and the health of the public generally, see that the directions above are carried out. I urge this not only as a sanitary measure but from an economic standpoint. At the same time I ask the Council to give great consideration to the disposal of refuse, and ask them to consider whether the system now in vogue is the best. May be because Deptford is on the river the present system is the most economical, the most healthy and the quickest way of disposal. But the question as to whether a destructor would be better is worthy of consideration. Refuse and Destructors. The composition of ashbin refuse varies considerably: but according to Hutton the following is a representative example of what is obtained in towns:— Weight per cent. Breeze and cinder 50.0 Paper, straw, fibrous and vegetable refuse 13.0 Coal 0.7 Bones and offal 0.6 Rags 0.4 Coke 0.3 Ash 12.0 Dust and dirt 20.0 Bottles, 1 per cent.; tins, 0.7 per cent.; metals, 0.2 per cent.; crockery, 0.6 per cent.; broken glass 0.5 per cent. 3.0 100.0 The quantity .of ashbin refuse produced varies very largely in different districts. It usually ranges from about 4 cwt. to 7 cwt. per head per annum. 134 From this table the average calorific power of a pound of ordinary ashbin refuse, when dry, is 3,696 units of heat, and if fully utilized would evaporate 3.826 lb. of water from and at 212° Fah.:- Evaporative power of— Calorific power, or units of heat per pound of the combustible— When dry. When containing the average amount of moisture. Coal 14,000 9,334 Coke 12,000 8,000 Bones and offal 8,000 5,334 Breeze and cinder 6,000 4,000 Rags 5,000 3,334 Paper, straw, fibrous material and vegetable refuse 3,800 2,534 The combustion of town's refuse and the utilization of the heat generated for power-producing purposes have now become firmly established, and very satisfactory results are obtained. The problem of dealing with large quantities of dry and wet refuse is a very pressing one, and the refuse destructor provides not only a means of meeting the difficulty, but of meeting it in a commercial manner. The quality of refuse from a combustion point of view naturally varies very much, but the methods of dealing with same have much in common, combustion being assisted by hot air delivered into the furnace ashpit The furnace is of ordinary construction, having movable firebars. From 1.8 lb. to 2 lb. of water are usually evaporated from and at 212° Fah. per pound of refuse, and about 50 lb. to 70 lb. of refuse are-consumed per square foot of grate area per hour. It will, of course, be understood that, owing to the large varieties of refuse and the particular conditions as to transport, etc., to be met, it is a difficult matter to lay down any rules as to refuse destruction, or to draw any comparisons between different types of destructors. The clinker remaining after combustion is completed may be used for making mortar, paving blocks, etc. Antizan Dwellings. The County Council dwellings existing in the district are in :— Armada Street (Greenwich)—consisting of 2 to 4 rooms, and let at a rental of 5s. to 7s. per week. 135 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. The Housing, Town Planning, &c., Act, 1 909. The following is a tabular statement of the work carried out during the year:— Number of houses inspected 2496 Number of houses represented as unfit for habitation 5 Number of houses represented as unfit for habitation, and not capable of being made fit Number of houses closed 5 Number of houses demolished 6 Number of houses made habitable 4 Number of back-to-back houses converted to through houses - Number of closing orders made 5 Number of demolition orders made — Houses closed voluntarily — Houses dealt with under Section 15 — House to House Inspection. In the following list will be seen the streets, the houses of which were systematically inspected during 1914:— Inspector Simpson. No. of premises inspected. No. of premises where defects existed. No. of premises found in fair condition (i.e., where no defects were found.) Name of Street. Alvar Street 33 32 l Berthon Street 30 30 — Bronze Street 46 46 — Church Street 1 1 — Crossfield Street 47 45 2 Hale Street 26 21 5 Hosier Street 6 6 — Knott Street 10 10 — Mary Ann's Buildings 29 25 4 Pender Street 10 10 — Reginald Road 30 24 6 Stanhope Street 36 36 — 304 286 18 136 Inspector Shelley. Adolphus Street 19 — 19 Arklow Road 27 4 23 Angus Street 32 6 26 Edward Street 79 21 58 Idonia Street 56 24 32 Kerry Road 54 15 39 Liardet Grove 13 1 12 Octavius Street 31 5 26 Railway Grove 125 33 92 Stanley Street 22 10 12 Watson Street 60 17 43 518 136 382 Inspector Snowdon. Bawtree Road 45 29 16 Childeric Road 23 11 12 Chipley Street 16 13 3 Chubworthy Street 59 30 29 F awcett Road 82 40 42 Folkestone Gardens 128 29 99 Goodwood Road 52 26 26 Knoyle Street 52 41 11 Ludwick Road 50 32 18 Nynehead Street 17 9 8 Oareboro Road 13 5 8 Reculver Road 7 7 — Ruddigore Road 25 18 7 Sanford Street 25 5 20 594 295 299 Inspector Kemp. Besson Street 77 54 23 Dennetts Grove 26 23 3 Dennetts Road 113 77 36 Dollings Place 8 8 — Faulkner Street 35 32 3 Lubbock Street 20 15 5 Masons Cottages 9 8 1 Monson Road 36 15 21 Powers Place 12 12 — Rutts Terrace 20 11 9 Somerville Road 59 24 35 415 279 136 137 Inspector Hewett. Alloa Road 68 20 48 Bestwood Street 14 12 2 Crook Road 56 40 16 Grove Street 95 62 33 Hoopwick Street 16 3 13 Kempslade Street 25 10 15 Yeoman Street 10 10 — Windmill Lane 5 4 1 Hicks Street 17 5 12 Scawen Road 20 15 5 326 181 145 Inspector Allam. Alpha Road 21 11 10 Amersham Road 11 7 4 Ashmead Road 70 23 47 Brookmill Road 2 2 — Bolden Street 22 6 16 Fishers Rents 11 11 — Florence Road 93 55 38 Heald Street 2 2 — Lind Street 30 11 19 New Cross Road 73 34 39 Pearsons Avenue 2 2 — Strickland Street 1 1 — Thornville Street 1 1 — 339 166 173 The following is a list of the houses in respect of which Closing Orders were made:— east ward. 75 Alvar Street north ward. 31 and 33 Watergate Street. 61 „ 63 Do. The Housing Act: Demolition of Condemned Houses. The provisions contained in the Housing, etc., Act, 1909, Sec. 18, with regard to houses which have been condemned as unfit for human habitation and their demolition ordered by the Local Authority appears to be in many cases imperfectly understood. Instances occur where 138 owners pull down the building after the order has been served by the Local Authority, but leave the material upon the site in all its ungainliness. It may perhaps be useful to point out that the Authority are enabled, not only to secure the demolition of the building, but also the absolute clearance of the site. For Sec. 34 of the principal Act, i.e., the Housing of the Working Classes Act, 1890, which is in force, provides that "the owner shall, within three months after the order for the demolition of a building becomes operative, proceed to take down and remove the building and, if the owner fails therein, the Local Authority shall proceed to take down and remove the building and shall sell the materials, and after deducting the expenses incident to such taking down and removal, pay the balance of money (if any) to the owner." Factory and Workshop Act, 1901. 140 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 83 cases the accommodation was unsuitable or defective. In all but two instances the defect was remedied before the expiration of the year. 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 131, involving 277 rooms. 106 inspections were made and 14 notices 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 access or control. The number of workshops on the register at the end of the year was 251 (including bakehouses and laundries and domestic workshops) with 395 rooms. There is no industry peculiar to Deptford. The list of trades carried on in the 251 workshops is as follows:— Bakers 57 Dressmakers 62 Laundries 8 Milliners 13 Shirtmakers 3 Tailors 18 Wheelwrights, Smiths, etc. 18 Miscellaneous Workshops 72 251 The number of inspections was 283. There were thirteen notices served for defects and insanitary conditions found. 141 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 197 (including food premises, kitchens, etc.) with 336 rooms. Inspections for the year numbered 462 and 36 notices were served. These premises include stables, builders' yards, restaurants, kitchens, cinema theatres, etc. OUTWORKERS. The number of premises on the register at the end of the year was 750, using 867 rooms. The number added during the year was 103 and cancelled 57. The number of inspections for the year was 188 and 5 notices were served. The lists received from employers in the borough numbered 76, giving the names and addresses of 496 persons employed. In no case was it necessary to take legal proceedings against employers for failing to make the necessary return of outworkers employed by them. In 24 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 out-worker's rooms, and when necessary, cleansing was carried out. 142 Premises where Food is Prepared for Sale. These premises were kept under supervision during the year. The number of inspections was 392, 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, etc., 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 11, and removals 6, leaving 126 premises on the register. 27 notices were served for amendment of various defects and for cleansing, and these were complied with. 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 1914 was 65—57 as "workshops" and 8 as "factories." During the year 2 were added to the register and 5 removed. UNDERGROUND BAKEHOUSES. The number of Underground premises in use at the end of the year was 22. CLEANSING AND LIMEWASHING. 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 243, and in 2 cases notices were served. 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 circular is sent to the occupier of each bakehouse when such cleansing is due to be carried out to the effect that:— "All the inside walls of the rooms of a bakehouse, and all the ceilings or tops of those rooms (whether those walls, 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; 143 and (a) Where the bakehouse is painted with oil or varnished, 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." 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 219. During this period 39 were added and 34 cancelled. The inspections numbered 412,9 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 14 cases, Diphtheria 6 cases and Erysipelas 2 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. In one instance a summons was taken out against a purveyor for selling milk in an unclean receptacle. The summons was withdrawn after an explanation and an apology by the dairyman upon payment of costs. Fried Fish Shops. The fried fish shops, together with the fish used, were regularly inspected during the year. Hitherto fried fish shoos have been difficult to deal with under the ordinary definition of a nuisance, which must be 'an inconvenience more than fanciful, and more than one of mere delicacy or fastidiousness—an inconvenience materially interfering with the ordinary comfort physically of human existence not merely according to elegant or dainty modes and habits of living, but according to plain and sober and simple notions among the English people." It may be said by some that all fried fish shops commit a nuisance, and the London County Council have this year issued bylaws to be observed by the owners of fried fish shops. (See "Legislation.") 144 These bylaws have considerably strengthened our hands in dealing with the premises themselves, the persons employed, the utensils and the removal of refuse, and during the year we were able to serve notices upon nearly all these businesses to remedy certain defects in the carrying on of the trade. There are 33 fried fish shops in the Borough. 225 inspections were made to the same, including 91 evening inspections. 21 notices were served. Fish-curing Premises. There are 17 fish-curing premises in the Borough, 28 inspections were made and 4 notices served. 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. The number of premises on the register at the end of the period under report was 145; 25 being added and 18 removed. The number of inspections was 237; 4 notices being served. In two instances summonses were applied for against vendors for failing to exhibit their names and addresses on the barrows. One defendant was fined 2s. and 2s. costs, and the other 5s. and 2s. costs. 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. Railway Arches, Edward Street 17 cows. 42 cows. 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 33 Slaughter Houses. The following are the slaughter houses in the borough at present licensed by the London County Council (1) 180 Brockley Road. (2) 13a High Street. 145 The premises were cleansed and limewashed every quarter as required by the bylaws. Number of slaughter houses in the borough 2 Number of inspections for the year 61 The Nutritional Value of Frozen Meat. The domestic economies are of so much importance at the present time that the value of chilled and frozen meat is worthy of mention. Many experiments have been made to show that frozen meat properly thawed presents very little change in the tissue. As regards the nutritive qualities of such meat, various observers have studied the subject both at home and abroad. Parkes and Kenwood, say refrigeration is by far the best, as the freshness and nutritive value of the meat remain unaltered. Richardson, in America, as a result of many chemical analyses, concluded—after the examination of 12 samples of fresh meat and 13 of frozen meat—that "a general inspection of the tables shows very little difference between the analyses of fresh and frozen samples; the variations in the individual fresh samples are hardly greater than would be expected in material of this kind, into whose composition so many factors enter, and the differences between maxima and minima in fresh and frozen samples are of the same order; in general the variations do not tend definitely in one direction in the frozen samples, the ammoniacal nitrogen, the coagulable nitrogen, and the albuminous nitrogen figures do not show a progressive tendency to increase or decrease." Rideal, in this country, after investigating the digestibility of frozen meat, states that "the amount of digestion in these experiments is, therefore, very nearly the same for each kind of meat (fresh and frozen), and is proportional to the amount of matter capable of digestion as measured by the quantity of nitrogen existing in each kind." Martel, in France, stated, "when meat is preserved long enongh at temperature below 0°C. (freezing point) the alterations which still take place are not of such a kind as to lessen its nutritive value." In process of freezing, the fluid constituents of the meat expand, causing a rupture of the cells of the animal's body, with a result that the haemaglobin permeates the tissues, giving the meat a diffuse red or pink colour. On being thawed, the surface of the carcase becomes moist, and drops of liquid fall to the ground. This moisture is probably partly due to fluids which exude from the tissues, but must also be accounted for by the condensation of aqueous vapour of the surrounding warmer air upon the cold surfaces of the meat. The liquids, exuding from frozen meat on thawing, are of less nutritive value than the meat 146 substance remaining weight for weight. Hence the value of a joint of frozen meat bought atter thawing and which has presumably lost a certain amount of liquid is not less than it was originally. The liquids exuded after purchase should be made use of in the cooking. If liquids exuded from meat during cooking are excessive, whether it be from fresh meat or frozen meat, it is due to bad cooking, but in any case they need not be wasted, but are still available for food. 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 & Sons, Ltd., 1 Frankham Street. Number of inspections during the year 23 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. 147 Table. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDINGS DURING 1914. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of proceedings On register at end of 1913 Added 1914 Removed 1914 On register at end of 1914 Milk premises 214 39 34 219 412 9 .. Cowsheds 2 .. .. 2 33 .. .. Slaughter-houses 3 •• 1 2 61 .. .. Other offensive trade premises 2 .. .. 2 23 .. .. Ice cream premises 138 25 18 145 237 2 2 Registered houses let in lodgings 289 .. .. 289 578{ (a)*(b)*201 {(a)*- (b)*- * (a) For overcrowding. * (b) For other conditions. 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 FACTORY, WORKSHOPS, AND WORKPLACES, during 1914. CLASS OF WORK. Number of Places Number of Inspections. Number of Number of Prosecutions. On Register at end of 1913. Added 1914. Re moved 1914. On Register at end of 1914. Written Intimations. Notices. Under Factory Acts- Under Public Health Acts. Premises. Rooms Factories Factory Laundries 7 7 31 8 4 Factory Bakehouses 6 2 8 12 15 Other Factories 119 5 8 116 234 83 7 3 Workshops Workshop Laundries 8 8 30 9 9 Workshop Bakehouses 62 5 57 60 228 1 1 Other Workshops 179 9 2 186 305 46 6 3 Workplaces Places where Food is prepared for Sale 121 11 6 126 256 392 23 4 Workplaces other than the above 60 11 71 80 70 7 2 Home-workers' Premises 704 103 57 750 867 188 4 1 Total 1266 141 78 1329 1875 1039 54 14 148 Table. METROPOLITAN BOROUGH OF DEPTFORD This Table is by request of the Secretary of State. Annual Report of Medical Officer of Health for the your 1914. On the Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. 1. INSPECTION. Including Inspection made by Sanitary Inspection on Inspection of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 106 14 Workshops (including Workshop Laundries) 283 13 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 462 36 Total 851 63 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 285 284 Want of Ventilation 3 3 Overcrowding 1 1 Want of Drainage of Floors 1 1 Other Nuisances 150 146 Sanitary Accommodation Insufficient Unsuitable or defective Not Separate for Sexes 3 3 83 81 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 526 519 149 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. Notices 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. Lists. Outworkers. Outworkers. Failing to keep or permit inspection of lists. Failing to send lists. Conractors. Workmen. Lists. Conractors. Workmen. 1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing Apparel— (1) making, &c. 72 43 436 2 .. 11 73 .. .. .. .. .. 24 (2) cleaning and washing Household linen Lace, lace curtains and nets Curtains and furniture hangings Furniture and Upholstery 2 .. 6 .. .. .. 2 Electro Plate File making Brass and brass articles Fur pulling Cables and Chains Anchors and Grapnels Cart Gear Locks, Latches and Keys Umbrellas, &c. Artificial flowers Nets, other than wire nets Tents Sacks Racquet and tennis balls Paper, etc., boxes, paper bags Brush making Pea picking Feather sorting Carding, &c., of buttons, &c. Stuffed Toys Basket making Chocolates and Sweetmeats Cosaques, Christmas Crackers, Christmas Stockings, etc. Textile Weaving Total 74 43 442 2 11 75 24 150 Table-continued. 4.-REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year. Number. Bakehouses 57 Dressmaking 62 Laundries 8 Millinery 13 Shirtmaking 3 Tailoring 18 Wheelwrights (Smiths, &c.) 18 Others 72 Total number of Workshops on Register 251 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, 1901) 10 • Action taken in matters referred {Notified by H.M. by H.M. Inspector as remedi{Inspector able under the Public Health Acts, but not under the {Reports (of action Factory and Workshops Act taken) sent to (s. 5, 1901) H.M. Inspector 6 7 Other 5 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 22 151 Canal Boats. For the year ended 31st December, 1914, the report of Inspector Turner, respecting the inspection of registered canal boats and nonregistered canal boats, was as follows:— For the purposes of inspection during the year, visits were made on the following dates, viz.:—January 15th, February 19th, March 13th, May 6th and 29th, June 25th and 30th, July 23rd and 30th, September 7th, 16th and 25th, October 7th and 28th, and November 7th. No. of visits 15 „ boats inspected 12 INFRINGEMENTS. The following matter was found requiring attention:— September 7th, boat "Mab" 244, registered at Brierly Hill, cabin roof defective and leaking. Notice served—Certificate not to hand. CHILDREN ON BOATS. During the year, children of school age were found on six boats. In each case information was forwarded to the Local Education Authority for 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 arrangements made for the inspection of boats are:— Periodical inspection by Sanitary Inspector duly appointed as Inspector under the Canal Boats Acts, jointly with other duties as Inspector of Workshops, Dairies, Cowsheds, Milkshops, &c. Foods and Drugs and Legal Proceedings. 154 Legal Proceedings. A summary of the cases heard at the Police Court follows this. Happily only a very small proportion of the matters dealt with by the Department lead to summonses. The bulk of the nuisances and defects coming to the knowledge of the Department are remedied after service of a written intimation. The fines and costs imposed last year amounted to £87 3s. 6d., and the amounts during the past three years are shown below. FINES AND COSTS. "Health" Cases. "Adulteration" Cases. Total. £ s. d. £ s. d. £ s. d. 1914 10 0 0 77 3 6 87 3 6 1913 3 4 0 20 17 0 24 1 0 1912 5 19 6 25 12 0 31 11 6 155 Sale of Food and Drugs Acts. The total number of samples purchased during the year and examined by the Public Analyst was 562. The following is a list of the articles purchased, with the results of the analyses. Article. Number Genuine. Number Adulterated. Total. Percentage of Adulteration. Arrowroot 3 .. 3 .. Baking Powder 1 .. 1 .. Bloater Paste 1 .. 1 .. Bread and Butter 1 1 2 50.0 Butter 71 5 76 6.6 Cocoa 14 .. 14 .. Coffee 5 .. 5 .. Capers (French) 1 .. 1 .. Camphorated Oil 1 .. 1 .. Corned Beef 1 .. 1 .. Cream 2 1 3 33.3 „ Preserved 3 .. 3 .. Dripping 2 .. 2 .. Ginger, Ground 3 .. 3 .. Gregory's powder 1 .. 1 .. Glycerine 2 .. 2 .. Honey 2 .. 2 .. Lard 16 .. 16 .. Margarine 2 .. 2 .. Milk 299 31 330 9.4 ,, Separated 11 2 13 15.4 Machine Skimmed Condensed Milk 2 .. 2 .. Mustard 17 .. 17 .. Olive Oil 1 .. 1 .. Pepper 16 .. 16 .. Pork Sausages .. 1 1 100.0 Quinine tablets 1 .. 1 .. Rice 4 .. 4 .. Rice, Ground 4 .. 4 .. Sausages 1 1 2 50.0 Tomato Ketchup 1 .. 1 .. Malt Vinegar 2 3 5 60.0 Vinegar 3 .. 3 .. Syrup of violets 1 .. 1 .. Black Currant Wine 2 .. 2 .. Elder Wine 1 .. 1 .. Ginger Wine 4 1 5 20.0 Orange Wine 4 3 7 42.9 Raisin Wine 2 2 4 50.0 Raspberry Wine 1 1 2 50.0 Zinc Ointment 1 .. 1 .. Total 510 52 562 9.3 156 Proceedings taken with regard to Sample Purchased during the year. Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. 2 S Bread and Butter A mixture substituted for butter the fat of which contained at least 77 per cent. of foreign fats £ s. d. £ s. d. 0 5 0 0 2 0 8 A Butter Foreign fats 62 5 per cent. 3 0 0 1 3 0 14 A „ Foreign fats 36 0 per cent. 2 0 0 1 3 0 7 S „ Foreign fats 53.5 per cent. 5 0 0 3 2 0 21 A Milk 1 per cent. milk fat abstracted — — Vendor cautioned 3 P „ 4 „ „ „ „ — — Warranty proved 8 P „ 3 „ „ „ „ 0 10 0 1 3 0 8 S „ 1 per cent. added water — — Vendor cautioned 25 S „ 21 per cent. milk fat abstracted 0 10 0 1 3 0 1 SY „ 6 per cent. added water Dismissed. 2 SY „ 1„ „ — — Warranty proved Vendor cautioned 13 SY „ l0 percent. milkfat abstracted 4 0 0 2 12 6 Warranty unsuccessfully pleaded 24 A Separated Milk 7 per cent. added water 10 0 0 1 3 0 Or one month's imprisonment 3 SY „ 1„ „ „ „ — — Vendor cautioned 33 K Butter Foreign fats 83 6 per cent. — — do. 25 A Milk 12 percent, milk fat abstracted 1 0 0 1 3 0 Warranty unsuccessfully pleaded 27 h „ 3 „ „ „ „ — — Dismissed. 40 K „ 4 ,, ,, ,, „ — — Warranty proved do. 21 P „ 7 „„„ „ 2 0 0 3 3 0 Warranty unsuccessfully pleaded 23 p „ 9 „ „ „ „ 1 0 0 1 3 0 24 P 11 „ „ „ „ 1 0 0 0 12 6 do. 30 P „ 11 „ „ „ „ Dismissed. 25 SY „ 3 „ „ „ „ 1 0 0 0 12 6 Warranty proved Warranty unsuccessfully pleaded 42 SY „ 8 „ „ „ „ — — Dismissed. 44 SY „ 12 „ „ „ „ — — Warranty proved do. 41 t „ 11 „ „ „ „ — — do. 44 S Pork Sausages Boric acid 12.6 grains per lb. — — Vendor cautioned 157 Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. 19 K Malt Vinegar 12 per cent. excessive water and 78 per cent. artificial vinegar £ s. d. £ s. d. 1 0 0 1 3 0 20 K „ .. 90 per cent. artificial vinegar 0 10 0 1 3 0 43 S „ .. 90 „ „ „ „ 0 2 6 1 3 0 '26 S Ginger Wine Salicylic acid 3·64 grs. per pt. — — Withdrawn 27 S Orange Wine „ 3·47 „ — — do. 32 S „ .. „ 3·71 „ — — do. 23 SY „ .. „ 3·67 „ — — do. 41 S Raisin Wine „ 3·83 „ — — Dismissed 24 SY „ .. „ 4·06 „ — — Withdrawn 38 T Raspberry Wine „ 8·31 „ — — do. 51 P Butter 0 5 per cent. excess of water — — Vendor cautioned 34 A Milk 21 percent. milk fat abstracted 1 0 0 0 12 6 49 H „ .. 10 per cent. of added water — — Dismissed. Warranty proved 54 S „ .. 3 ,, abstraction of fat — — Vendor cautioned 50 T „ .. 9 „ „ „ „ — — Dismissed. Warranty proved 67 K „ .. 5 „ „ „ „ — — do. 74 SY „ .. 7 ,, of added water — 1 3 0 Fined the costs. Warranty unsuccessfully pleaded 86 SY „ .. 6 „ „ „ „ 13 7 0 1 13 0 72 P „ .. 1 „ „ „ „ — — Vendor cautioned. 74 S Sausage Boric acid 25·2 per lb. — do. Milk and Cream Regulations, 1912. 6 S Cream Boric acid 0 078 per cent. or 5·4 grains per lb. No label on receptacle £ s. d. £ s. d. Vendor cautioned - - 5 T „ .. Boric acid 0·13 per cent. No label on receptaclele - — do. 77 S Milk Boric acid 0 35 gr. per pint. — — do. 79 S „ .. „ 0·14 gr. ,, — — do. 68 SY „ .. „ 0·87 gr. „ 0 10 0 1 13 0 53 P „ .. „ 1·9 gr. „ 0 10 0 2 3 0 SUMMARY. Fines £48 4 6 Costs 28 19 0 Total £77 3 6 158 The Regulation of Preservatives in Food. It is pleasing to note that the Local Government Board is at last moving in the matter of the use of preservatives in food, but it has so far confined the resulting legislation to the purity of two articles of food only, namely, milk and cream. In view of this movement on the part of the Local Government Board, it is interesting to note the following regulations in force in the Dominion of Canada governing the employment of preservatives in food intended for human consumption, and it is to be hoped that similar regulations may be adopted in this country. CANADIAN REGULATIONS. Foods intended for export may contain preservatives, provided that, both in specific character and in amount, such preservatives do not conflict with regulations in force in the country to which export is made. It is forbidden to add any preservative whatever to milk, or any other preservatives than those named in Class I. to foods especially intended for the use of infants or invalids. Class I. consists of preservatives which may be used without declaration of their presence, provided that such use does not conflict with any other statutory regulations, namely, common salt, sugar, saltpetre, wood smoke, vinegar, acetic acid, spices, alcohol. In Class II. are preservatives which may be used until further notice, provided that no more than one kind of preservative substance, named in the list, shall be added to any one kind of food, or to any mixture of two or more kinds of foods; that the amount of preservative shall not exceed the maximum amount herein named, and that the presence of the preservative shall be declared on the label. Regarding this class of preservatives, it is to be noted that toleration of their use is dependent upon the fact that available evidence concerning their physiological action is not considered sufficient to prove that under the prescribed regulations they are harmful to health in such a degree as to bring them under Section 3 (f) of the Adulteration Act, which reads as follows:—"Food shall be deemed to be adulterated within the meaning of this Act if it contains any added poisonous ingredient, or any ingredient which may render such an article injurious to the health of the persons or cattle consuming it." Should satisfactory evidence of the harmfulness to health of any of the preservatives named in Class II. be forthcoming, such preservatives would immediately fall under the condemnation of the Adulteration Act, and foods containing such preservatives would be declared to be adulterated. The preservatives 159 named in Class II. are:—1. Boric acid (boracic acid) or borax—limit, 1 part in 400 in cream, 1 part in 200 in butter and other foods: 2. Benzoic acid (benzoate of soda)—limit, 1 part in 1000 parts; 3. Salicylic acid —limit, 1 part in 5000 parts; 4. Sulphurous acid (bisulphite of soda, potash or lime)—limit, 1 part in 10,000 parts in beverages, 1 part in 2000 parts in solid foods; 5. Saccharin—limit, 1 part in 1500 parts in beverages, 1 part in 700 parts in solid foods. Saccharin must not be used to take the place of sugar in any food in which sugar is employed as a source of nutriment, or for its feeding value. Where sugar is used only as a sweetener, saccharin may replace it under the conditions defined above. Class III. consists of preservative substances which are prohibited from use in foods: Formaldehyde (formalin), Betanaphtholabrastol (asaprol), hydrofluoric acid, fluorides, fluoborates, fluo-silicates or other fluorine compounds. The method of dealing with the preservatives named in Class II. is distinctly interesting, and it will be noted that "on satisfactory evidence of the harmfulness to health" any of the preservatives named "would immediately fall under the condemnation of the Adulteration Act." water in dripping. In a recent Local Government Board report on the working of the Sale of Food and Drugs Acts, there were quite a number of specimens of dripping. In March last my attention was directed to a case in which proceedings were instituted against a vendor who sold dripping certified by the Public Analyst to contain over 15 per cent. of water. As it presents some interesting features the case is one worthy of notice. The contention of the prosecution and of the Public Analyst on their behalf, was that there should be no water in dripping, but that it should be the fat as it came from the cooked meat. The defendant's point was that it was practically impossible to avoid having water present. If the dripping came from roasting meat, water was usually placed in the pan to prevent burning and was taken up along with the fat: when obtained from meat that had been boiled, there was still greater risk of getting water as well as fat. In any case the water appeared in the jelly adhering to the dripping and the public liked it. On this, the prosecution stated that there was no necessity to have water at all, and it was very objectionable, inasmuch as dripping containing water went mouldy very quickly. The Bench in imposing a penalty of £1, including costs, gave it as their view that the term dripping has no special trade meaning attached to it. It means what the dictionaries say it means, viz.," that which falls in drops, as fat, from meat in 160 roasting." A person asking for dripping expects to get that, and not a mixture of fat and water. Dripping is largely used by the poor, and it is a serious matter if it is going to be adulterated. The Bench in this case, I think, did well to impose a penalty. EGGS. The question of good and bad eggs has always presented a certain amount of difficulty to the Public Health Department. It is well known that eggs are variously classified by the shopkeeper as "New Laid Eggs," "Country Eggs," "Fresh Eggs," and "Eggs." But he does not, however, give any definition, leaving his customers to imagine the condition of the members of each of the classes named. In a recent case under the Merchandise Marks Act, we have gained a little useful information with regard to eggs. Experts who were called to give evidence held divergent views as to the date at which an egg ceased to be "new laid." One went the length of saying that after seven or eight days the term "new laid" could not be applied, and another that to warrant the description the new laid egg must be English. All agreed that Russian eggs—which, by the way, are always packed in two layers in "flats," and bear a very high number—could not be described as "new laid." They took too long to reach this country. The magistrate, in imposing a penalty, stated that to the man in the street the new laid egg meant one produced in the neighbourhood of where it was purchased. The proceedings in this case, it should be noted, were taken under the Merchandise Marks Act, not the Sale of Food and Drugs Acts. These latter, the stipendiary was of opinion, did not apply in the case of eggs, but only to foods to which some foreign substance had been added, or from which some natural ingredient had been abstracted. Because of this limitation quite a number of articles of food are left untouched, and the Merchandise Marks Act helps considerably by increasing the number of substances regarding which action can be taken. Drugs. THE SCHEDULE OF POISONS. The law relating to the sale of poisons is continually a source of disquiet to the public conscience. Upon the occurrence of a fatality due to a poison, whether the result of accident or design, in all probability the scope of inquiry will include considerations of purchase. As the law stands poisons are divided into two groups, Part I. and Part II. of the schedule, and the restrictions imposed in the case of any particular drug 161 or poisons depend upon the place assigned to it in the schedule. The obstacles in the way of sale to the public are greatest with regard to all poisons included in Part I. of the schedule. Frequently complaint is made that these regulations are unduly troublesome to the vendor, and protests are raised when any additions are made to the list, even though the need of such additions has been emphasised by repeated misadventures, as is notable in connexion with veronal and hypnotics of allied chemical composition. It is generally assumed, when there has been delay in the inclusion of new poisons in the schedule, that the fault lies in the intricacy of the steps by which the change is to be effected. This is not strictly true, though the recommendations have to receive the approval of certain public officers after they have been transmitted from the Pharmaceutical Society. To judge from recent pronouncements it would seem that the reasons for delay are more intimately connected with an amiable desire to meet the demand for the articles. The alteration in the strength of the official tincture of opium has had the effect of bringing it automatically within the scope of Part I. of the schedule, which includes opium and all preparations or admixtures containing 1 or more per cent. of morphine. While no objection has been taken to the alteration in strength, there has been an outcry against the retention of the synonym "laudanum," since it appears that under this name the drug has hitherto been freely sold in small or large quantities. The matter has been deemed of sufficient importance for the Pharmaceutical Society to seek the advice of its Law Committee, and it has received and adopted the following report:— That the policy to be advocated by the Council in regard to the sale of laudanum should be that when "laudanum" is asked for, the 1914 preparation should be supplied, and the poison book signed; but where the 1898 preparation is demanded care should be taken to label accordingly, and the attention of the purchaser should be called to the fact that it is the 1898 preparation. It would be interesting to know how often we are likely to meet with a member of the public who has any notion of the difference. Probably the majority will ask for what they have been in the habit of using, and if tinctures of both strengths are kept, the one will be reserved for the emissary from the local inspector, the other, with a few words of explanation, will be supplied to the public as before. There is always danger in keeping preparations of different strengths with similar names, and it is to be hoped that this suggested system of meeting the demand for the sale of a remedy which may become a poison if improperly employed, will speedily be rescinded. 162 Unsound Food. The following quantities of food were, upon examination by officers of the Public Health Department, found to be unsound, unwholesome, and unfit for the food of man, and were destroyed:- Inspector. Description of Food. Remarks. Mr. Simpson 1 box Mackerel Voluntarily surrendered. ,, ,, 1 box Kippers ,, ,, ,, ,, 1 box Sardines ,, ,, ,, Shelley 1 bag Mussels ,, ,, ,, ,, 2 boxes Bloaters ,, ,, ,, ,, 1 box Herrings ,, ,, ,, ,, 300 lbs. Peaches } Seized. Fined £2 and £& 3s. costs. ,, ,, 6 lbs. Plums ,, Snowdon 3 bags Winkles Voluntarily surrendered ,, ,, ½cwt. Potatoes ,, ,, ,, ,, 2 doz. lemons ,, ,, ,, ,, 4 stone Cod's Roe . ,, ,, ,, ,, 2 lbs. Cherries ,, ,, ,, ,, 8 stone Hake ,, ,, ,, ,, 4 trunks Haddock ,, ,, ,, ,, 2 trunks Skate ,, ,, ,, ,, 1 barrel Conger Eels ,, ,, ,, ,, 2 lbs. Raspberries ,, ,, ,, ,, 4 boxes Kippers ,, ,, ,, Kemp 5 lbs. of Apples ,, ,, ,, Hewett 42 lbs. Skate ,, ,, ,, ,, 1 trunk Whiting ,, ,, ,, ,, 1 case Whiting ,, ,, ,, ,, 1 bag Whelks ,, ,, ,, ,, 5 Turkeys ,, ,, „ Allam 48 Rabbits ,, ,, „ Priest 1 bag Winkles ,, ,, ,, Allam ,, Turner 126 6-lb. tins Corned Beef Returned to wholesale dealers and sorted under supervision of the Sanitary Authority for that district. Legal Proceedings. Jan. 7th, 1914. Caroline Hart, 42 Keetons Road, Bermondsey. Neglecting to execute the required works for the abatement of a nuisance arising at 82 Chilton Street. Necessary works carried out. Fined the costs, 21 s. April 29th, 1914. Mrs. Manning, 58 Weltje Road, Hammersmith. Neglecting to execute the required works for the abatement of a nuisance arising at 23 Alverton Street. Necessary works carried out. Fined 5s. and 2s. costs. 163 April 29th, 1914. George J. Briggs, 3 Hillingdon Chambers, Walworth Road. Neglecting to execute the required works for the abatement of a nuisance arising at Nos. 24 and 25 Alverton Street. Necessary works carried out. Two summonses. Fined 5s. and 2s. costs in respect of each summons. April 30th, 1914. George Crutcher, 195-201 Queen's Road. Selling milk in an unclean receptacle. Summons withdrawn upon payment of 23s. costs. May 21st, 1914. Mrs. Simmonds, 491a New Cross Road. Unsound peaches and plums. Fined £2 and £3 3s. costs. May 22nd, 1914. Walter Madden (carman), 24 Beale Street, Plaistow. Removing fish offal during prohibited hours. Fined 5s. and 2s. costs. May 22nd, 1914. Walter Madden (as above). Removing fish offal in an unsuitable receptacle. 2s. costs. May 22nd, 1914. Wm. G. Hawkins, 24 and 26 Beale Street, Plaistow. (Owner.) 2 summonses withdrawn upon conviction of carman (see above). June 11th, 1914. Salvatore Pariso, 61 Church Street. No name on ice-cream barrow. Fined 2s. and 2s. costs. June 11th, 1914. Joseph Jannece, 14 Batchelor's Hall Place, Peckham. No name on ice-cream barrow. Fined 5s. and 2s. costs. June 11th, 1914. Anna Bray, 71 Crofton Road, Peckham. Neglecting to execute the required works for the abatement of a nuisance arising at 23 Chubworthy Street. Magistrate made Order for works to be carried out within 10 days. 6s. costs. The necessary works were subsequently carried out. July 9th, 1914. G. N. Harling and Son, 79 Brockley Road. Improper construction of soilpipe at Messrs. Peppercorn's Premises, Broadway. The necessary works were executed after service of summons. Summons withdrawn on payment of 2s. costs. 164 July 9th, 1914. G. N. Harling and Son (as above). Constructing W.C. in direct communication with food premises. The necessary works were executed after service of summons. Summons withdrawn on payment of 2s. costs. Oct. 8th, 1914. Thomas Wilson, 420a Old Kent Road. Neglecting to execute the required works for the abatement of a nuisance arising at 114 Dennetts Road. The necessary works were executed after service of summons. Summons withdrawn on payment of 2s. costs. (For particulars of proceedings taken under the Sale of Food and Drugs Acts, see separate table.) Sanitary Legislation. 166 Recent Municipal and Sanitary Legislation. The principal legislation during 1914, affecting Local Governing and Sanitary Authorities, is embodied in the following Acts, of which I give a summary:— education (provision of meals) act. This Act enables a Local Education Authority, without any application to the Board of Education, to spend out of the rates such sums as may be necessary to meet the cost of the provision of food under Sec. 3 of the Education (Provision of Meals) Act, 1906. elementary education (defective and epileptic children) act. Under this Act the duty devolves upon a Local Education Authority to provide for the education of mentally defective children over seven years of age. Such Authority, however, is not obliged to provide board and lodging unless the Board of Education are satisfied that suitable provision for a child's education cannot be made in any other way, and unless the Exchequer pay not less than one-half the cost of conveying such child to and from school and of educating, boarding and lodging and medically attending and treating it (including interest on or repayment of capital raised), nor to establish a certified school for boarding and lodging mentally defective children unless there are at least fortyfive children in the area who cannot be otherwise dealt with. the milk and dairies act, 1914. Section 1.—Prohibits the sale of milk of any cow which is giving tuberculous milk, or which is suffering from emaciation due to tuberculosis, or from tuberculosis of the udder, or from acute inflammation of the udder, or from any disease liable to infect or contaminate the milk. The owner shall not be guilty of any offence unless it is proved that he did not know, and had no reason to suspect that the milk so sold or exposed for sale was the milk of such a cow. Section 2.—Gives power to the Local Government Board with the concurrence of the Board of Agriculture to make Milk and Dairies Orders for:— (a) the registration with local authorities of dairies; (b) the inspection of dairies and persons employed; (c) the prevention of the sale for human consumption or for use in the manufacture of products for human consumption, of infected, contaminated, or dirty milk or the milk of a diseased cow; (d) the prohibition of the addition of colouring matter and the prohibition or regulation of the addition of skimmed milk, or separated milk or water, or any other substance, to milk intended for sale for human consumption, and the prohibition or regulaticn of the sale for human consumption of milk to which such an addition has been made; 167 (e) the regulation of the cooling and conveyance of milk intended for sale for human consumption; (f) the labelling or marking of receptacles of milk for sale for human consumption and the identification of churns and vessels used. (g) Authorizes the designation “certified milk” under certain conditions. Section 3.—Gives powers to the medical officer of health of a county or county borough to stop the supply of milk likely to cause tuberculosis. Section 4.—Gives powers to the medical officer of health of any local authority if he has reason to suspect that tuberculosis is caused by the consumption of milk which is sold in his district. He shall endeavour to ascertain the source of the supply, and shall forthwith give notice to the medical officer of health of the county or county borough in which the cows from which the milk is obtained is kept, whether the dairy where they are kept is within or without the area of the local authority, unless the local authority are themselves the council of that county or county borough. The medical officer of health of the county shall cause the cattle in the dairy, and the persons employed therein, to be inspected, and make such investigations as may be necessary. Notice of such inspection shall be given to the local authority whose medical officer of health gave the notice, in order that that officer, or that a veterinary surgeon appointed by that authority, may be present at the inspection if so desired. The council of the county or county borough on whose medical officer of health the notice is served shall send to the medical officer of health of the local authority who gave the notice, copies of any reports which may have been made by the medical officer of health making the inspection, and of any veterinary or bacteriological reports which may have been furnished to him, and shall give information as to whether any action has been taken upon these reports and the nature of such action. Section 5.—Gives power to the medical officer of health, or any person provided with an authority from the local authority to take samples of milk at any time before it is delivered to the consumer within the area of the local authority. The result of an analysis or bacteriological examination of a sample of milk taken under this section, shall not be admissible as evidence in proceedings under this Act, unless the sample has been divided into three parts according to the provisions of the Food and Drugs Acts. No proceedings shall be taken against any person unless at the same time the sample was taken the milk was in his custody or control or in a churn or receptacle which had been sealed or closed in accordance with a Milk and Dairies Order. The medical officer of health or any other officer of any local authority may be requested to take milk for analysis within his area which is in the course of transit or delivery, to premises within the area of the officer requiring such analysis. The authority requiring the samples to be taken shall be liable to defray any reasonable expenses incurred, but for the purpose of proceedings the sample shall be deemed to have been taken by the officer who gave the notice, and the police court proceedings may be taken either before a court having jurisdiction within the district for which that officer acts, or before a court having jurisdiction in the place where the sample was taken. Section 6.—(1) The provisions of the sale of Food and Drugs Acts, 1875 to 1907, in reference to the taking of samples of Milk, and any proceedings in connection therewith, shall be amended in accordance with the provisions contained in the Third Schedule to this Act. 168 (2) So much of any Coutract, made after the passing of this Act, as requires a purveyor of Milk on a sample of his milk being taken under the sale of Food and Drugs Act, 1875 to 1907, to send to the person from whom he procured the Milk any part of such sample or to give such person notice that a sample has been so taken, shall be null and void. Section 7.—Gives power to the local authority to appoint veterinary inspectors and to provide or arrange for the provision of such facilities for bacteriological examinations of milk, as may be approved by the Local Government Board. Section 8.—Gives power to make regulations for the prevention of danger arising to public health from the importation of milk intended for sale for human consumption. Section 9.—Gives power to sanitary authorities to establish and maintain depots for the sale of milk specially prepared for consumption by infants under two years of age. Section 10.--Deals with the enforcement of duties of the local authorities. The Local Government Board may, after holding a local inquiry, make such order as they think necessary for the purpose of compelling the authority to fulfil their duties under this Act. Section 11.—Deals with the penalties incurred for the obstruction of any officer of a local authority in the execution of his duty under this Act. Section 12.—Gives power to a local authority to delegate to the Public Health Committee any of their powers or duties under this Act. Section 15.—If any person commits an offence against this Act, he shall be liable on summary conviction to a fine not exceeding £5 for the first offence, and £50 for a second or subsequent offence. Where the occupier of a dairy is charged with an offence against this Act, he shall be entitled, upon information duly laid by him, to have any other person whom he charges as the actual offender, brought before the court at the time appointed for the hearing of the charge, and if the commission of the offence has been proved, and the occupier of the dairy proved to the satisfaction of the court: (a) That he has used due diligence to enforce the execution of this Act and the Milk and Dairies Orders, and (b) That the said other person had committed the offence in question without his knowledge, consent or connivance, that other person shall be summarily convicted of the offence, The occupier shall be exempt from any fine. When it is made to appear to the satisfaction of the local authority by, or on whose hehalf, proceedings are to be taken : (а) That the actual occupier of the dairy has used all due abilities to enforce the execution of this Act, and the Milk and Dairies Orders; and (b) by what person the offence has been committed ; and (c) that it has been committed without the knowledge, consent, or connivance of the occupier of the dairy, and in contravention of his orders, proceedings shall be taken against the person, who is believed to be the actual offender, without first proceeding against the occupier of the dairy. Section 16.—Gives the interpretation of terms, such as dairy, dairymen, milk, &c. Three Schedules are included in the Act, and deal with : 1. Diseases of cows. 2. Procedure for stopping supply of milk. 3. Amendment of Sale of Foods and Drugs Acts. 169 Summary of Bylaws made by the London County Council under the General Powers Act, 1908. FISH CURER. 1. Prevents assistance by any person suffering with infectious disease. 2. Premises must have rainproof roof, be adequately lighted and ventilated. Walls and floor must be of suitable smooth, impervious material, and the floor drained. 8, There must be no effluvia at any time. 4. No poultry or animals must be kept in any place communicating with the business part of the premises. 5. Boxes, etc., which have contained fish must be removed within 24 hours. 6. Must provide means for securing personal cleanliness of those employed. 7. Suitable iron or non-absorbent receptacles with covers must* be provided, all refuse, etc., placed in them, and removed at least once every 24 hours, and thoroughly cleansed. 8. Premises and appliances must be kept in proper order and repair. 9. Premises must be limewashed four times a year. 10. Kilns must be of fireproof materia] and capable of conveying away the vapour or smoke without noxious and injurious effects. 11 & 12. Gutting slabs to be of slate, glazed earthenware or smooth impervious material, also the tanks and vats. 13. Yard to be properly paved and drained. 14. Penalty for offending, £5, and £2 a day for continuing offence. VENDOR OF FRIED FISH. 1. Relates to infectious disease. 2. Suitable premises. 8. Effluvia. 4. The keeping of animals, &c. 5. Boxes, &c., to be removed. 6. Personal cleanliness. 7. All fish to be thoroughly gutted and cleansed before being fried. 8. Suitable receptacles for offal, &c., removal and cleansing of same. 9. Premises and appliances to be in good repair. 10. Premises to be limewashed 4 times a year. 11. Deals with the construction of the furnace and the efficient carrying away and consuming of noxious gases and vapour. 12. Adequate impervious gutting slabs. 13. Yard to be properly paved and sloped and drained, and yard drain inlet trapped. 14. Penalty (as under Fish Curer). APPENDIX. Tables. 172 173 Analysis of the Vital Statistics of the Metropolitan Boroughs and of the City of London for 1914. Boroughs. Estimated Population middle of 1914. Births. All Causes. Deaths from Enteric Fever. Deaths from Small Pox. Deaths from Measles. Deaths from Scarlet Fever. Deaths from Whooping Cough. Deaths from Diphtheria. Deaths from Diarrhoea and Enteritis (under 2 years). Deaths from Pulmonary Tuberculosis. Deaths under one year of age. County of London 4,518,021 109,667 64,994 147 - 1,385 316 9l8 706 3,031 6,28l 11395 West. Paddington 142,193 2,965 1,846 3 - 4 8 25 20 79 145 281 Kensington 171,234 3,210 2,242 1 - 15 17 7 13 63 187 302 Hammersmith 123,853 2,935 1,717 5 - 41 5 21 l6 67 170 275 Fulham 157,303 4,154 2,101 9 - 31 21 42 22 126 205 468 Chelsea 64,511 1,299 870 5 - 3 5 6 8 21 87 87 City of Westminster 154,544 2,155 1,936 9 — 6 10 21 15 35 205 173 North. St. Marylebone 114,355 2,132 1,5577 6 - 2 9 20 18 59 146 208 Hampstead 86,388 1,273 893 4 - 2 2 16 10 11 55 102 St. Pancras 214,133 5,223 3,334 4 - 56 18 51 30 121 379 481 Islington 325,496 8,171 4,923 4 - 97 24 84 43 228 470 857 Stoke Newington 50,511 1,045 661 - - 1 3 6 4 16 58 81 Hackney 223,393 5,460 3,099 8 — 106 9 53 39 127 303 502 Central. Holborn 46,837. 764 754 5 - 11 2 9 4 13 92 69 Finsbury 84,521 2,541 I,652 2 - 76 6 45 9 88 167 312 City of London 17,831 181 239 1 — 1 1 3 2 1 20 17 East. Shoreditch 109,569 3,511 2,075 2 - 112 5 55 20 148 234 496 Bethnal Green 127,807 3,786 2,034 4 - 68 7 48 28 174 210 518 Stepney 275,081 8,058 4,539 8 - 182 28 72 70 268 465 997 Poplar 160,839 5,073 2,743 6 — 66 10 31 34 195 268 590 South. Southwark 188,321 5,604 3,350 2 - 95 22 59 37 207 330 693 Bermondsey 124,683 3,849 2,1615 3 - 81 8 14 18 140 203 482 Lambeth 297,094 7,022 4,319 16 - 58 16 40 50 202 422 728 Battersea 167,451 4,303 2,220 3 - 50 11 26 17 122 210 402 Wandsworth 331,321 6,675 3,617 5 - 26 13 56 41 148 298 591 Camberwell 261,828 6,580 3,589 5 - 65 23 47 39 143 373 653 Deptford 109,182 3,121 1,598 3 - 50 9 9 25 88 152 309 Greenwich 96,018 2,408 1,412 5 - 47 7 6 16 53 132 235 Lewisham 169,211 3,336 1,836 6 - 7 8 19 24 55 126 247 Woolwich 122,431 2,839 1,679 3 — 25 9 27 34 30 171 240 174 175 Analysis of the Vital Statistics of Ninety-seven of the Largest English Towns during 1914. Towns. Estimated Population middle of 1914. Births. Deaths. The Deaths Registered include The Deaths Registered include Deaths from Measles. Deaths from Scarlet Fever. Deaths from Whooping-cough Deaths from Diphtheria. Deaths from Diarrhoea and Enteritis (under two years). Deaths from Violence. Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. Deaths of Infants under 1 year. Deaths of Persons aged 65 years and upwards. Deaths from Enteric Fever. Deaths from Small-pox. 97 Towns 17,980,576 447,783 263,656 50,956 69,353 780 2 6,226 1,620 4,551 2,939 11,684 9,758 20,591 75,963 2,123 Londan 4,518,021 109.667 64,994 11,395 18,442 147 - 1,385 316 918 706 3,031 2,671 6,670 29,715 55 Croydon 178,511 4,001 1,971 321 755 6 — 11 5 23 17 65 72 201 548 - Wimbledon 58,312 1,078 599 78 262 — — 3 2 5 7 24 29 55 157 - Ealing 68,306 1,197 667 78 273 1 — 8 2 5 1 13 28 51 143 3 Action 62,461 1,468 687 144 185 1 — 9 1 6 9 27 31 41 213 - Willesden 161,115 3,947 1,722 341 501 3 — 9 5 34 21 80 45 115 546 2 Hornsey 87,742 1,477 775 84 317 — — 1 2 4 6 19 23 45 174 - Tottenham 146,141 3.794 1,675 348 458 4 - 17 9 27 38 64 43 173 559 - Edmonton 69,294 1,934 741 162 183 3 — 14 3 16 16 54 18 73 248 - Enfield 59,755 1,301 595 105 178 2 — 8 4 8 14 30 13 33 179 - West Ham 294,476 8,936 4,367 948 985 13 — 13 13 113 49 235 169 363 1590 6 East Ham 142,905 3,411 1,466 266 412 4 — 16 7 21 28 45 44 114 448 - Leyton 181,224 2,738 1,335 218 429 4 — 17 2 22 29 46 47 106 426 - Walthamstow 131,980 3,072 1,389 245 384 4 - 20 7 17 28 52 48 126 474 - Ilford 87,471 1,485 702 91 259 — — 2 - 6 4 9 28 49 172 - Gillingham 54,641 1,266 644 113 193 5 — 6 1 13 12 10 28 42 128 16 Hastings 60,044 833 814 54 430 1 — - - 4 - 7 24 49 163 2 Eastbourne 54,796 830 478 47 209 1 — - 1 5 8 11 8 17 120 2 Brighton 133,186 2,346 1,771 194 707 1 — 15 8 10 12 32 44 162 512 1 Portsmouth 241,748 5,714 3,051 485 979 30 — 39 5 49 78 71 135 261 827 27 Bournemouth 83,426 1,107 865 80 389 — — 11 - 3 14 6 28 52 182 1 Southampton 122,577 2,942 1,701 265 552 4 - 9 10 10 38 50 71 144 540 4 Reading 89,419 1,792 1,050 161 398 3 — 3 - 4 2 18 28 47 237 19 Oxford 53,980 908 646 62 279 — — 5 - 8 38 11 28 56 137 - Northampton 90,829 1,888 1,242 165 413 — — 18 1 7 23 34 31 64 222 10 Cambridge 57,159 986 711 79 273 2 — 3 - 2 4 8 25 55 147 2 Southend-on-Sea 80,234 1,454 798 95 277 5 — - 2 9 4 8 32 42 104 33 Ipswich 75,767 1,791 1,042 186 358 1 — 14 13 21 28 24 38 62 231 — Great Yarmouth 57,058 1,319 918 152 348 2 — 10 2 17 29 31 36 75 188 - Norwich 123,377 2,509 1,690 278 635 5 - 14 9 9 7 62 74 117 384 3 Swindon 52,195 1,180 599 88 194 1 — - - 2 3 10 18 35 82 1 Exeter 60,317 1,188 802 101 311 2 - - 1 17 27 13 30 70 137 1 Plymouth 113,134 2,646 1,929 332 641 5 - 38 2 38 23 62 49 158 327 - Decenport 84,503 2,027 938 163 275 12 - 14 5 9 7 31 31 75 146 - Bath 69,981 1,078 890 63 430 3 — 2 2 1 36 4 29 65 225 2 Bristol 361,573 7,777 4,820 778 1,627 8 — 93 21 68 10 124 167 455 1311 - Gloucester 50,558 1,127 701 117 261 2 — - 2 7 80 330 26 37 160 17 S'oke-on-Trent 239,515 7,647 4,208 1,102 780 17 — 84 1 85 18 77 140 255 699 63 Wolverhampton 95,615 2,585 1,484 295 414 2 — 11 5 17 15 83 57 123 342 1 Walsall 93,543 2,695 1,368 318 328 1 — 9 2 33 18 58 46 104 250 1 West Bromwich 69,125 2,191 1,069 237 286 1 — 23 16 23 4 31 50 71 183 28 Dudly 51,668 1,503 832 206 203 2 — 42 7 16 256 639 18 40 102 19 Birmingham 860,591 23,268 12,889 2,840 3,088 13 - 311 137 301 12 46 442 556 3311 439 Smethwick 74,754 1,994 999 211 262 1 - 26 14 17 13 34 23 57 131 6 Coventry 115,489 3,133 1,378 270 351 2 — 23 6 13 15 109 51 82 324 32 Leicester 231,152 5,075 3,211 611 938 5 - 102 5 74 8 19 94 213 725 22 Lincoln 59, 421 1,329 737 122 270 — - 4 - 1 4 69 20 34 98 5 Grimsby 77,554 2,118 1,132 275 264 4 - 50 1 19 35 108 34 76 166 12 Nottingham 264,970 6,192 4,042 898 1,074 5 - 145 12 62 12 44 138 268 897 22 Derby 125,662 3,011 1,609 278 524 1 19 4 23 10 77 54 158 436 - Stockport 124,326 2,716 1,726 336 456 6 - 24 6 5 15 123 50 99 341 10 Birkenhead 135,789 3,777 2,061 452 438 4 66 6 48 11 32 69 135 490 6 Wallasey 84,767 1,815 1,058 169 308 1 - 19 121 22 109 940 30 75 174 - Liverpool 763,926 23,141 14,843 3,217 2,961 43 - 521 3 249 8 87 511 994 5273 355 Bootle 72,298 2,257 1,177 276 244 1 - 40 13 42 61 273 54 176 177 Analysis of the Vital Statistics of Ninety-seven of the Largest English Towns during 1914 (continued). Towns Estimated Population middle of 1914. Births. Deaths. The Deaths Registered include The Deaths Registered include Deaths of Infants under 1 year. Deaths of Persons aged 65 years and upwards. Deaths from Enteric Fever. Deaths from Small-pox. Deaths from Measles. Deaths from Scarlet Fever. Deaths from Whooping-cough Deaths from Diphtheria. Deaths from DiarrhceS. and Enteritis (under two years). Deaths from Violence. Inquest Cases. Deaths in Public Institutions. Uncertified Causes of Death. St. Helens 99,601 3,319 1,675 457 290 4 - 29 5 25 8 93 60 67 356 58 Southport 71,163 1 016 986 97 440 1 - 10 1 7 4 4 21 29 157 21 Wigan 90,842 2,703 1,587 380 299 16 - 87 1 15 6 118 63 118 244 - Warrington 74,157 2,227 1,184 251 224 8 - 32 24 28 12 57 46 56 251 39 Bolton 184,026 4 071 2 673 485 672 12 - 62 3 51 43 174 73 178 450 5 Bury 59,165 1 ,167 937 144 282 1 - 2 8 16 5 30 43 54 173 22 Manchester 731,830 18,917 12,222 2,398 2,610 38 - 298 157 281 101 508 525 957 3870 23 Salford 233,970 6,236 3,864 782 792 19 - 111 78 77 38 165 124 312 986 4 Oldham 150,055 3,479 2,663 479 563 5 - 171 48 57 41 79 67 164 460 - Rochdale 93,517 1,857 1,493 237 383 7 1 58 1 43 22 27 35 72 259 30 Burnley 109,131 2,599 1,762 409 374 4 125 9 46 15 84 55 108 290 8 Blackburn 134,015 2,803 1, 957 322 492 7 - 21 11 11 7 49 73 119 348 32 Preston 118,118 2, 817 1,849 401 493 10 - 47 42 26 26 94 60 74 306 47 Blackpool 61,141 945 901 108 285 2 - 8 1 6 2 9 28 34 109 30 Barrow-in-Furness 65,324 1,958 934 210 197 5 - 1 6 27 9 14 33 49 138 23 Huddersfield 111,031 2 031 1 633 227 487 6 - 49 3 22 3 18 52 103 255 14 Halifax 100,701 1 778 1 477 181 463 13 - 9 4 20 13 27 50 107 304 4 Bradford 290,642 5 704 4 524 701 1 313 20 - 115 6 94 34 83 149 421 1059 7 Leeds 457,507 10 749 6 784 1,326 1,685 20 - 214 29 138 54 286 313 620 1565 3 Dewsbury 53,880 1,296 829 146 229 3 1 9 2 7 6 30 41 72 119 - Wakefield 52,329 1,196 736 123 188 7 - 15 5 4 17 31 27 58 159 3 Barnsley 53,088 1,641 935 255 188 4 - 55 5 30 2 53 47 74 112 3 Sheffield 472,234 12,962 7,717 1,706 1,608 25 - 370 86 229 66 409 270 489 1901 48 Rotherham 64,527 1,969 996 235 228 3 - 29 12 23 7 41 42 59 175 16 York 83,380 1 884 1,107 220 345 6 - 21 2 17 16 41 34 78 242 - Hull 287,472 7,928 4,403 957 1,101 43 - 98 7 53 50 256 189 396 1,014 23 Middlesborough 124,635 4,080 2,389 612 362 5 - 59 35 58 53 157 68 157 405 14 Darlington 58,425 1,615 798 159 201 3 - 3 10 23 18 25 25 30 131 36 Stockton-on-Tees 58,092 1,795 1,030 220 239 2 - 27 10 20 10 50 38 67 123 7 West Hartlepool 64,248 1,892 995 201 231 4 - 8 9 23 4 34 86 110 138 8 Sunderland 152,436 4,941 2,575 664 553 7 - 18 24 61 26 197 101 191 498 44 South Shields 110,604 3,505 1,918 475 353 16 - 31 23 55 16 105 58 71 256 63 Gateshead 118,684 3,738 2,145 553 388 9 - 61 17 45 7 170 70 88 344 108 Newcastle-on-Tyae 271,523 7,564 4,623 1,027 985 17 - 215 44 75 25 238 136 346 888 19 Tvnemouth 60,688 1,742 957 225 211 8 - 8 5 10 12 53 37 55 149 31 Carlise 52,650 1,202 787 147 254 - - - 8 6 4 19 40 48 151 25 Newport (Mon.) 87,617 2,277 1,163 267 239 4 - 19 18 36 13 37 36 80 217 1 Cardiff 186,763 4,795 2,604 526 611 7 - 61 19 74 41 95 119 277 515 - Rhondda 162,592 5,528 2,350 754 330 5 - 84 10 43 32 162 112 156 117 4 Merdry Tydfil 83,946 2,355 1,300 281 256 3 - 42 3 19 22 52 64 107 209 4 Aberdare 52,706 1,580 701 152 164 2 - — 1 3 14 28 37 45 58 4 Swansea 119,/20 3,261 1,885 461 404 5 — 81 10 85 13 74 53 141 265 5 Greater London 7,419,704 175,504 96,153 16,722 28,464 222 - 1,704 418 1,380 1,139 4,154 3,787 9,151 38,690 103 Outer Ring 2,901,683 65,837 31,159 5,327 10,022 75 - 319 102 462 433 11,23 1,116 2,481 8,975 48 14 Great Towns in Outer Ring. 1,682,693 39,839 18,691 3,429 5,581 45 - 265 62 307 267 763 638 1,545 5,757 11 Remainder of Outer Ring. 1,218,990 25,998 12,468 1,898 4,441 30 - 54 40 155 166 360 478 936 3,218 37 Edmburgh 324,618 6,466 5,027 710 1,642 11 - 109 43 13 97 94 186 ? ? ? Glasgow 1,053,926 29,462 17,514 3,912 3,510 81 - 491 227 523 162 684 703 ? ? ? Dublin(Registrati on Area) 406,000 10,926 8,456 1,584 1,923 62 — 385 39 58 72 364 197 239 3,347 244 Belfast 399,000 11,109 7,527 1,587 1,413 25 — 205 167 201 31 386 109 248 1,913 95 M 178 Meteorology for 1914 (Greenwich Record). Month. Barometer at 32° F, Lat. 45°. Air Temperature. Earth Temperature at 3ft. 2in. depth. Rainfall. Station Level. M.S.L. A Maximum B Minimum. Mean of A and B. ins. ins. °F °F °F °F ins. January 29.989 301.67 42.5 34.3 38 4 42.7 0.50 February 29.602 29.779 51.7 38.2 44.9 44.0 2.46 March 29.476 29.653 51.0 37.4 44.2 43.9 3.91 April 29.934 301.09 61.1 40.0 50.5 47.2 1.11 May 29.932 80.106 63.7 43.8 53.7 51.8 1.63 June 29.876 30.048 71.5 49.2 60.4 56.5 1.34 July 29 7.22 29.893 74.5 53.9 64.2 62.2 1.41 August 29.876 30.047 74.4 53.6 64.0 62.1 1.17 September 29.921 30.094 68.9 47.6 58.3 60.7 0.73 October 29.845 30.019 59.4 44.7 52.0 55.7 0.96 November 29.726 29.9 03 51.1 40.0 45.5 50.8 2.67 December 29.448 29.626 47.0 37.3 42.1 46.5 5.96 Means 29.779 29.954 59.7 43.3 51.5 52.0 23.85 sum INDEX. 180 INDEX. PAGE Acute Polio-Myelitis 78 Adulteration of Food 154-161 Ages at Death 21 Albany Institute 41 Annual Birth and Death-rates,and Death-rates of Children 18 Anti-toxin Serum, free distribution of 71 Anti-typhoid inoculation 74 Anthrax 78 Area of Borough 10 Back-to-back houses 15 Bacteriological Diagnoses 64 Bakehouses 142 Births 17 „ Illegitimate 18 „ Notification of 33 Bread, home-made 31 Butchers' Shops and Shops where Food is sold 142 Canal Boats 151 Cancer 100 Census Figures 11-15 Chicken Pox 78 Child welfare 35-40 Cleansing Station 106 Cleansing of Children 106 Common Lodging Houses 125 181 PAGE Constitutional Diseases 99 Consumption 90 Cost of Notification of Infectious Diseases 63 Continued Fever 78 Cowsheds 144 Dairies, Milkshops, &c. 143 Deaths 20 „ from Classified Causes 50-57 „ „ (short list) 46 „ at different age periods 21 „ in the Wards 21 „ of Parishioners occurring outside the Borough 20 „ from Epidemic Diseases 60,61 Death Registration and Vital Statistics 22 Deaths registered from all causes during the Year 20 „ „ „ „ „ Quarters 21 Deaths in Metropolitan Boroughs 172 „ Provincial Towns 174 Density of Borough 10 Deptford Health Centre 42 Diarrhoea and Enteritis 78-83 Diphtheria and Croup 70-72 „ Contacts 71 Disinfectant supplied free 102 Disinfecting Station 102 Disinfection Work 102-105 District Inspection 118 Drainage Works 118 Dust, Removal of 132 Enteric Fever 72-76 182 PAGE Enteric Fever, Inoculation against 74 Epidemic Diseases 60 „ Cerebro-Spinal Meningitis 77 Erysipelas 76 Factories and Workshops 140-150 Fatality from Infectious Diseases 60 Feeding of Infants 35 Flies and disease 80,82 Food, Adulteration of 154-161 „ unsound 162 „ Premises 142 ,, Economy in 29-31 Fried Fish Shops 143 Fish-curing Premises 144 Frozen Meat, Nutritional Value of 145 Glanders 78 Health Visitors and Female Inspectors 33-35 Houses Let in Lodgings 125-128 House and Trade Refuse 131 House Refuse and the Dust Bin 132 Housing, Town Planning, &c., Act, 1909 135-138 House to House Inspections ... 135 Home Workers, Inspection of 141 House Flies 80,82 Hydrophobia 78 Ice Cream Premises, Inspection of 144 Illegitimate Births 18 Infantile Mortality 24 „ „ Stated Causes 47 Infant Consultations 40-42 183 PAGE Infants, feeding of -35 Infectious Diseases 60-9 Infectious Diseases on Milk Premises 143 „ ,, in Streets 109-112 „ „ in Schools 85-87 „ „ Classification of 65 „ „ Discovery and Diagnosis of 63 „ „ Cases notified 45 Incubation and Quarantine Periods 65 Infectious Sickness in several Wards 45 Influenza 99 Inhabited House Duty, Certificates for Exemption from 121 Inspections—House-to-House, &c. 135 Inspection of Kitchens of Restaurants 142 ,, of Slaughter Houses and Cow Houses 144 „ of Houses Let in Lodgings 125-128 Inquests 108 Legal Proceedings 162 Legislation 166 Leprosy 90 Local Government Board Table 44-47 Marriages 19 Maternity and Child Welfare 35-40 Measles 83-86 „ Number of cases dealt with 83 „ Institutional Isolation of 88,89 Meteorology for 1914 178 Milkshops and Dairies 143 Milk and Dairies Act, 1914 166 Mortuary and Coroner's Court 108 184 PAGE New Drainage 119 Notification of Infectious Diseases 60-69 „ „ „ since 1904 62 „ „ „ in the Wards 45 „ „ „ Fees for Notification 63 „ of Pulmonary Tuberculosis 90 „ of Births Act 33 Nursing facilities 32 Overcrowding, Cases of 125 Offensive Trades 146 Open Spaces 17 Ophthalmia Neonatorum 77 Outworkers' Premises 141 Paving of Streets 131 Persons to an Acre 10 Phthisis 90 „ Notification of 90 „ Mortality 90 Places where Food is Prepared 142 Plague 78 Population—Estimated in 1914 10 „ Sub-Districts 10 Population and Inhabited Houses 10 Post-mortems, Number of 108 Prosecutions, Food and Drugs Act 156 Prosecutions, Public Health Act, &c 162 Public Health Committee „ „ Staff 3 Public Washhouses 130 185 PAGE Puerperal Fever 76 Pulmonary Tuberculosis 90 Re-drainage 118 Refuse Destructors 133 Respiratory Diseases 99 Samples Analysed in 1914 154 Sanitary Inspectors' Work, Summary of 122-124 „ Legislation 166 Scarlet Fever 68-70 Seasonal Morality 21 Sewage System of Borough 16 Sickness Statistics 23 Shelter 102 Site, Subsoil and Drainage of the Borough 16 Slaughter Houses 144 Small Pox 67 Smoke Nuisances 125 Spotted Fever Staff 3 Street Paving 131 Street Refuse 130 Streets where Infectious Diseases occurred 109-112 Summary of Sanitary Work 122-124 „ Vital and Mortal Statistics 8 Tubercular Diseases 90-99 Tuberculosis Dispensary 94-99 ,, Treatment by Tuberculin 99 „ Home Visitation 96 Typhoid (Enteric) Fever 72-76 186 Typhus Fever 78 Underground Sleeping Rooms 127 Underground Workrooms 129 Unsound Food 162 Vaccination 67 Vital Statistics for the whole Borough 44 „ „ „ Metropolitan Boroughs 172, 173 „ „ „ Provincial Towns 174-177 „ „ „ Summary of 8 Verminous Children, Cleansing of 106-108 „ Premises Disinfected 104 Washhouses, Public 130 Whooping Cough 88 „ „ Institutional Isolation of 88-89 Workshops and Factories, Inspection of 140-150 Work of Sanitary Inspectors, Summary of 122-124 Workrooms, Underground 129 Metropolitan Borough of Deptford MAP SHEWING THE LOCALITIES OF INFECTIOUS DISEASES NOTIFIED DURING THE YEAR 1914. I