DEPT 13 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. 19 15 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. Public Health and Housing Committee. Mayo r. Councillor WILLIAM A. WAYLAND, J.P. (ex officio). Chairman. Alderman E. J. KNIGHT. Vice=Chairman. Councillor W. FALKNER. Alderman W. A. SCHULTZ, J.P. Councillor A. E. BRETT. Councillor Dr. W. H. BROOKS. Councillor W. R. CARNELL. Councillor H. CATTELL. Councillor W. H. GREEN. Councillor C. H. KIPPS. Councillor J. SHEPHERD. Councillor R. SOPER. Staff of the Public Health Department. Medical (Offcer 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. Sanitary Inspectors and health Visitors. Miss F. O'Riordan. Miss W. C. Smart. Health Visitor. Mrs. H. Davies. Chief Clerk. Charlbs A. Chapman. Clerks. *Henry J. L. Smith. George Northmore. Municipal Dispensary for the Prebention of Consumption, 78 Amersham Vale, New Cross, S.E. Administrative Tuberculosis Officer—W. H. Whitehouse, m.d. Clinical Tuberculosis Officer—Murdoch Macdonald, m.d. Dispenser Clerk—Miss G. F. Greig. Nurse—Miss Porteous. *Attendant—G. Abbott. Disinfecting Staff. C. F. Dowsett (Chief Disinfector). *T. Lyons. *F. Smith. *R. G. Gladman. Council's Shelter Mortuarp and Coroner's Court. *Attend ant~-G. W. J. Wagner. Cleansing Station. Bath Attendant—Mrs. Wagner. School Nurse—Miss Gilby. * On Service with H.M. Forces. TABLE OF CONTENTS. Page Page Vital Statistics— Tuberculosis 70 Summary of 6 Non-notifiable Diseases 88 Population 7 School Exclusions 65 Births . 12 Bacteriological Diagnoses 48 Marriages 14 Deaths 15 Sanitary Work— „ in Wards 16 Housing, Town Planning, „ Ages at 17,31 etc., Act 105-108 .. Causes of 31,36 House-to-house Inspection 106 „ from Zymotic Diseases 44 Drainage Works 98 „ Tuberculous Diseases 70 Overcrowding 101 „ of Infants 17 Smoke Nuisances 101 in Public Institutions 16 Disinfectio 82 from Respiratory Coroner's Court & Mortuary 82 Diseases 88 Summary of Male Inspectors' ,, from Influenza 88 Work 96,102 „ from Constitutional Summary of Women Inspec- Diseases 88 tors' Work 21, 22 Cancer 88, 89 Revenue Act Certificates 100 Statistics for 1915 and pre- House and Trade Refuse 105 vious years 13 Street Refuse 105 Local Government Board Legal Proceedings 119,120,123,124 Tables 29-32 Infectious Diseases— Food Supply _ , ,, Food Premises 110 Deaths from 44 Bakehouses 111 Cases notified 46 Dairies, Milkshops, etc. 111 Age periods and Wards 30 Ice Cream Premises 112 Smallpox and Vaccination 49 Cowhouses 113 Scarlet Fever 51 Slaughterhouses 113 Diphtheria 52 Unsound Food 123 Enteric Fever 54 Sale of Food and Drugs Acts Erysipelas 58 119-123 Puerperal Fever 58 Fried Fish Shops 112 Ophthalmia Neonatorum 58 Fish curers 112 Cerebro-spinal Fever 59 Polio Myelitis 59 Factories and Workshops— Plague 60 Home Office Tables 114-117 Chickenpox 60 Offensive Trades 113 Anthrax 60 Glanders 60 Tuberculosis Dispensary- Typhus Fever 61 Report of Tuberculosis Officer 75 Diarrhcea and Enteritis 61 Measles 63 Canal Boats. Whooping Cough 68 Report of Inspector 118 Metropolitan Borough of Deptford. Public Health Department, Town Hall, New Cross, S.E. To the Mayor, Aldermen and Councillors. Gentlemen, I beg to present the Annual Report on the state of the Public Health and the record of sanitary work carried out during the year 1915. This Report also gives:—An account of the work done under the Food and Drugs Acts ; a general reference to the question of Maternity and Infant Welfare; and a detailed description of our Tuberculosis Dispensary work for the year. Your attention is drawn to an increase in the death-rate which is not to be accounted for by any epidemic disease but rather to deaths attributed to old age and respiratory diseases, the latter especially in the first four or five months of the year. The large rainfall which occurred particularly in the spring and winter months, was undoubtedly the cause of the increased number of deaths from respiratory diseases. I wish to express my thanks to the members of the Council for their kind and courteous consideration in connection with matters affecting this department. 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. I am, Your obedient Servant, W. H. Whitehouse. 6 Summary of Vital anb Mortal Statistics for 1915. 1915. 1914. 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 110,299 109,182 Number of inhabited houses 16,658 16,696 Average number of persons per house 6.6 6.5 Density 70 per acre 70 per acre Length of Public Streets 53 miles approx 53 miles approx Rateable Value £636,361 £636,361 1d. Rate produces (approximately) £2,542 £2,496 Cost of administration of Public Health Department £1,718 £1,789 Marriages 1,262 857 Marriage Rate 11.4 7.8 Births 2,955 3,121 Birth Rate 26.8 28. 6 Birth Rate, average for the last 10 years 27.4 27.4 Deaths 1,962 1,598 Death Rate 17.8 14.6 Death Rate, average for the last 10 years 14.5 14.6 Infantile Mortality 132per 1,000 99per 1,000 births births Infantile Mortality, average for 117 per 1,000 122per 1,000 the last 10 years births births Zymotic Death Rate 2 07 1.69 7 AREA AND POPULATION. Acres. Estimated Population. 1563 110,299 The population of the Metropolitan Borough of Deptford at the census taken April, 1911, was 109,496. Estimate of Civil Population, 1915. The war has made it impossible to adhere to the methods of estimation of local and national populations hitherto in use. Men of military age have been largely drafted to military training centres or sent abroad with the army, and the remainder of the male adult population, as well as, to a lesser extent, the female population, has migrated on an unprecedented scale into areas other than those in which it was enumerated at the last census. Under these circumstances estimates of local populations based on the census returns were clearly inadmissible, and it became necessary to search for a substitute. Fortunately this was ready to hand in the National Register, which referred to a date only six weeks removed from that for which estimates were required, viz., the middle of the year 1915. No doubt this does not form a perfect record as it is known that a number of persons escaped registration. From investigations however which have been made in another connection it appears that the defects in the register taken as a whole are not on such a scale as to affect seriously the estimates of population based upon it. By the method described below it was possible to derive from these returns estimates of the civil population only of each administrative area on August 15th. No attempt has been made to increase these by allowance for members of the fighting forces because, apart altogether from the difficulty of ascertaining the average military population of each district during the year, experience has shown that under present circumstances only civilian deaths can be tabulated for local areas. If military deaths were to be included they would have either to be debited to the area in which they occurred, a course which would render the death-rates of districts containing large military hospitals meaningless, or to the area of residence. An attempt made to pursue the latter course has had to be abandoned owing to military authorities having been unable to furnish to the registrars the necessary information. It has been found necessary therefore to limit the tabulation of deaths by local areas to deaths of 8 civilians, and under these circumstances the civilian population is obviously the proper one to use for the calculation of death-rates. An additional advantage in the use of National Register populations is that these consist of habitual residents in each locality and not merely of the persons who happened to be present therein on a certain date. The deaths tabulated from the year 1911 onwards are also those of habitual residents only, and therefore the use hitherto of populations which in certain cases included very large institutional elements chiefly composed of non-residents introduced in these cases serious errors into the rates calculated from them, as pointed out in the "Registrar-General's Annual Reports (See page 132, Report for 1913). This source of error now of course disappears for the time being, and in such districts an unavoidable break in the continuity of the previously misleading rates will result. In any case however, the maintenance of continuity is under present circumstances obviously impossible, and it is felt that the present estimates will furnish death-rates calculated to indicate as nearly as may be the health conditions of the civil population. The method by which the estimates of civil population have been derived from the National Register returns may now be described. The ratio of the total population less the males aged 15-65 years to the number of females aged 15-65 years at the date of the census was calculated for each administrative area, and this ratio was applied to the number of the civil population of the district. A small adjustment was necessary in order to make the sum of the estimates for the several districts equal to the estimate for the country as a whole made on the same basis. Further, the population in institutions was not registered and this (taken to be the same in the aggregate for England and Wales as at census date) together with a number of persons of no fixed abode, were distributed evenly over the whole country. These two adjustments raised the original estimates by about one per cent. The question of the population to be used for the calculation of birthrates has also required consideration. The births registered are not only those of the children of civilians, and the estimates of civil population therefore form an unsuitable basis for the calculation of birth-rates. It is impossible to frame any estimate that would give reliable birthrates, and it is suggested, therefore, that the birth-rates for 1915 be based upon the existing estimates of total population for 1914. These will sometimes be seriously in error owing to extensive migration having occurred. 9 In Deptford the birth-rates are based on the new estimate of population since, from local information, I consider this to be more accurate than the population estimate for 1914. Difficulties, which will probably prove insoluble, remain as to estimation of populations in sex and age groups and the standardizing factors dependent upon them. Moreover, the present method of estimation will obviously not apply to 1916 or subsequent years unless the National Register is effectively kept up to date or further enumeration made. Nothing can at present be decided as to these matters. The estimated population to the middle of the year 1915 was 110,299. The estimated population for each of the various wards was as follows:— East 21,340 S. 12,232 N. 24,043 S.E. 12,411 N.W. 23,652 S.W. 16,621 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 1915 respectively:— Year. HOUSES. Inhabited. Uninhabited. Total. 1901 15,823 516 16,339 1911 16,102 491 16,593 1915 16,658 249 16,907 Taking the number of inhabited houses in 1915 to be 16,658 as set forth in the above table, and calculating the population to be 110,299 then the average number of persons per house would be 6'6. The following table shows the number of houses, separate occupiers, and population in 1901 and 1911, distinguishing the various kinds of 10 buildings and the population enumerated therein, and also the buildings not used as dwellings :— 1901 1911. Total. Buildings used as Dwellings. 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, Vessels. Sheds, Vagrants, etc. Separate Flats. (Included in Col. 5.) 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 4 2 16 48 6 773 Govt. & Municipal Buildings 16 Population 110,398 109,496 98,470 3,409 5,116 752 190 1,398 140 21 3,409 Shops 234 Offices 27 Uninhabited 424 640 561 1 70 1 3 – 4 – 207 Warehouses. Workshops & Factories 179 Theatres and other Being built 92 15 11 – 3 – – – 1 – – places of amusement. 7 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 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 11 Site, Sub-Soil and Drainage of Deptford. The physical features and character of the Borough have been so many times described by me that I refer you to previous reports for the sake of economy. 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. 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 1¼ acres Borough Council. 3. Hilly Fields Brockley 45½ acres L.C.C. (On South-&ast Boundary of Borough) 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 12 Births. Number of births 2955 Average number of births for previous 10 years 3113 Average birth-rate for previous 10 years 27.4 Birth-rate of Deptford per 1,000, for 1915 26.8 England and Wales 21.8 96 Great Towns 22.2 148 Smaller Towns 21.6 London 22.6 The total number of births registered in the Borough in 1915 was 2,955, as compared with 3,121 in 1914. Of these, 1,479 were boys and 1,476 were girls. The birth-rate for the Borough was equivalent to an annual rate of 26.8 per 1,000 of the population, as compared with 28.6 in 1914, 28.0 for 1913, and 26.5 for 1912. The birth-rate for London was 22.6 per 1,000, compared with 24.3 for 1914, 24.8 for 1913 and 24.7 for 1912. The popular belief that boy babies outnumber girls in war time finds some support in the fact that the numbers of male and female births in recent quarters show an increasing excess in the number of males born. Unfortunately, statisticians have shown that a continuance of this excess is no certainty, and it is a fact that during the Crimean War the ratio of males born actually declined. However, in the first quarter of this year 1,032 males were born to 1,000 females, in the second quarter (the ninth, tenth and eleventh months of the war) 1,043, in the third quarter 1,055. As regards the actual birth-rate, the decline in this country is insignificant compared with that recorded in the latest German statistics. These returns show that in twenty-four leading German cities the birth-rate decreased during April, May, June and July, 1915, by 20 per cent, as compared with the corresponding months in 1914, which is equivalent to a loss of four hundred thousand births annually throughout the German Empire. 13 The subjoined table gives the number of births for each Ward, together with the birth-rate :— Ward. Births. Birth Rate per 1,000. Males. Females. Total. East Ward 340 363 703 32.9 North Ward 377 343 720 29.9 North-West Ward 333 353 686 29.0 South Ward 103 88 191 15.6 South-East Ward 146 140 286 23.0 South-West Ward 180 189 369 22.2 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. Estimnted population. Births. Deaths. Deaths under one year. No. Rate per 1000. No. Rate per 1000. No. Mortality per 1000 births. 1905 114,512 3290 28.7 1642 14.3 411 124 1906 115,495 3260 28.2 1854 16.0 472 144 1907 116,510 3323 28.5 1641 14.0 356 107 1908 117,539 3084 26.2 1643 13.9 381 123 1909 118,583 3093 26.8 1611 13.5 321 103 1910 119,642 2959 24.7 1671 13.9 366 123 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 1914 109,182 3121 28.6 1598 14.6 309 99 Average for 10 years 113,959 3113 27.4 1656 14.5 365 117 1915 110,299 2955 26.8 1962 17.8 391 132 Illegitimate Births. The illegitimate births, which number 84, eight more than the previous year, occurred in the several Wards, as follows:— East Ward 20 South Ward 6 NorthWard 11 South-East Ward 9 North-West Ward 24 South-West Ward 14 84 14 Marriages. There were 1262 marriages in the Borough during the year, as compared with 857 in the previous year. The marriage rate for 1915 was equal to 11.4 per 1,000 of the estimated population and has not been exceeded in any year for the past ten years. The marriages were celebrated in the following places :— 776 in Churches of England. 116 in other places of worship. 370 in the Superintendent Registrar's Office. 1262 Total (of residents of Deptford). 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 3 2 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 15 The returns issued by the Registrar-General reveal several features of unusual interest inasmuch as they have special significance in war time. They show that the marriage-rate in England and Wales during the quarter ended 30th September, 1915, reached 21.8 persons married per 1,000 of the population. This is the highest rate yet recorded in any quarter since the establishment of civil registration. The next highest rate is 21.4 in the fourth quarter of 1865, in which quarter until recent years the marriage-rate as a rule considerably exceeded that in the third quarter. The nearest approach in any third quarter to the rate recorded last quarter is 18.2 in 1912, and 18.1 in 1907 and 1913. It is further noteworthy that the rate for the second quarter of the past year, viz., 20.9, is the highest in any second quarter since the establishment of civil registration. The analysis of the marriagerate statistics for the quarter ended September 30th, followed on the lines of those which characterised the report of the previous quarter, which in its turn gave the highest June quarter figures yet recorded. It was then found that the remarkable increase in the marriage-rate occurred chiefly in the industrial and more densely populated counties of England. In London, the marriages in the second quarter of 1915 were 15,065, compared with 11,218 in the corresponding period of 1914. In Middlesex, there was an increase from 2,322 to 3,054 ; and in Essex, the figures from 2,565 rose to 3,657. In Lancashire, the marriages in the June quarter of 1914 were 11,451, and in 1915 they were 13,136. The figures also rose appreciably in the West Riding of Yorkshire, in Surrey, Sussex and Hampshire. The returns bear out a general impression that the high marriage-rate is attributable partly to war weddings and partly to the prosperity of the workers in areas where war work is done. Deaths. 1915 Average for past 10 years. Number of deaths 1,962 1,656 Average death-rate for previous 5 years 14.6 14.5 Rate per 1,000 Deptford 17.8 „ „ England and Wales 15.1 „ „ 96 Large Towns 15.6 „ „ 148 Smaller Towns 14.0 „ „ County of London 16.1 The number of deaths registered within the Metropolitan Borough of Deptford from all causes during 1915 was 1,406, equal to a deathrate of 12.7 as compared with 1,145 deaths, and a death-rate of 10.5 during the previous year. Of this number 697 were males and 709 16 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.: 144, of which number 132 occurred in the Metropolitan Asylums Board's South Eastern Hospital, making 1262 deaths actually belonging to Deptford. To this number we must add 700 deaths of parishioners which occurred in public institutions outside the Borough, making a total of 1,962, of which 1,028 were males and 934 females, and upon these figures the statistics are based. The death-rate for the Borough was equal to an annual rate of 17.8 per 1,000 of the population, as compared with 14.6 for 1914, 15.5 for 1913, and 13.2 for 1912, the average for the past five years being 14.6. The 700 deaths outside the borough were distributed as follows:— Asylums 51 Poor Law Institutions :— Greenwich Union 386 Other than Greenwich 32 Hospitals :— Guy's 44 Seamen's 7 Miller 35 East London (for children) 12 St. Bartholomew's 1 St. Thomas' 11 London 1 Metropolitan Asylums Board 17 St. John's 2 Evelina 12 Other Hospitals 55 Other places 34 Total 700 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 287 263 550 25.8 North Ward 241 199 440 18.3 North-West Ward 185 165 350 14.8 South Ward 70 82 152 12.4 South-East Ward 141 104 245 19.7 South-West Ward 104 121 225 13.5 17 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 1914 and 1915 is as follows:— 1914. 1915. Under 1 year 19.3 per cent. 19'9 per cent, deaths. 1 to 2 years 5.4 „ 7.0 „ „ 2 to 5 „ 4.8 „ 6.0 „ „ 5 to 15 „ 4.0 „ 4.2 „ „ 15 to 25 „ 4.0 „ 4.2 „ „ 25 to 45 „ 13.0 „ 10.9 „ „ 45 to 65 „ 21.0 „ 22.4 „ „ 65 years and upwards 28.5 „ 25.4 „ „ Seasonal Mortality. First Quarter.—The deaths numbered 583, which is equal to an annual death rate of 21.1 per 1000. Second Quarter.—The deaths numbered 463, which is equal to an annual death rate of 16.8 per 1000. Third Quarter.—In this quarter 429 deaths were registered, equal to an annual rate of 15.6 per 1000. Fourth Quarter.—487 deaths were registered, equal to a rate of 17.7 per 1000 of the population. Note.—The figures contained in the Quarterly Reports have been corrected by the inclusion of 24 parishioners whose deaths occurred outside the Metropolitan area Infantile Mortality. Total deaths of Infants under one year, 391. Average for previous 1915. 10 years Deptford Infantile death rate per 1000 births 132 117 England and Wales ... ... 110 96 Large Towns ... ... ... 117 148 Smaller Towns... ... ... 114 County of London ... ... ... 112 Of the 1,962 deaths recorded during the year 391 were of infants under one year of age. In a previous table will be seen the infantile mortality per 1,000 births for the past ten years. 18 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 703 137 195 North Ward 720 92 128 North-West Ward 686 79 115 South Ward 191 20 105 South-East Ward 286 35 122 South-West Ward 369 28 76 TABLE SHEWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1915. BIRTHS 2955 DEATHS—including 700 in Outlying Public Institutions 1962 Excess of Births over Deaths 993 I submit a list of the principal causes of the 309 infantile deaths in the Borough during 1915, viz.:— Whooping Cough 23 Measles 10 Tuberculosis 16 Meningitis 6 Convulsions 18 Bronchitis and Pneumonia 88 Diarrhceal Diseases 29 Enteritis and Diseases of Digestive System 44 Gastritis 7 Syphilis 2 Suffocation in bed with parents 4 Congenital Malformation, Atelectasis, and Injury at Birth 22 Debility and Marasmus 54 Premature Birth 49 Other causes 19 391 19 In a supplement in continuation of a report of the medical officer of the Local Government Board for 1914-15, containing a report on maternity mortality in connection with child-bearing and its relation to infant mortality, Dr. Newsholme points out, that although much valuable work has been done by the Central Midwives Board, by local supervising authorities, and by many voluntary associations and hospitals, child bearing is still associated in some parts of the country with very excessive mortality, and in every part of the country with much avoidable sickness and mortality. The report is intended to draw attention to this fact, to stimulate further local inquiry on the subject, and to encourage measures which will make the occurrence of illness and disability due to child-bearing a much rarer event than at present. In the first part the national aspect of the subject is discussed. It is pointed out that there has been a remarkable decline in the national birth-rate and in the national death-rate. By the simultaneous decline of both birth-rate and death-rate a fall in the rate of natural increase of the population has been postponed. The death-rate can still be greatly reduced. A very high proportion of the deaths occurring under the age of 70 are unnecessary deaths. Of the total deaths at all ages, 44 per cent, occur under the age of 40, and 76 per cent, under the age of 70. But the fall in the death-rate cannot keep pace indefinitely with a continuous fall in the birth-rate. Already the average age of the national population and its consequent proneness to death is on the increase. Had the birth-rate of England and Wales been the same in 1914 as in 1876, 467,837 additional infants would have been born in 1914. These figures emphasize the importance of preventing, so far as is practicable, further decrease of the balance of births over deaths by measures directed to saving the lives and maintaining and improving the standard of health of mothers and of their children. In the second part of the report are displayed the local differences of mortality in child-bearing, so far as these can be shown in massed statistics. In respect of puerperal fever there is a remarkable uniformity in the experience of counties, county boroughs, and metropolitan boroughs in England and Wales, taken in the aggregate. The deathrate from conditions other than puerperal fever adversely affecting child-bearing is much lower in London than in the provinces. This difference means that over 800 mothers die each year in England and Wales, as the result of child-bearing, whose lives would be saved if the experience of the rest of England and Wales were as favourable as that of London. But the recorded experience of London in respect of 20 puerperal fever is as unfavourable as that of the provinces. If this disease were to be eliminated, as it has been substantially from the experience of many lying-in-hospitals, a further saving of 1,100 lives of mothers would be secured annually in England and Wales. The close relationship between factory work for married women and excessive mortality from child-bearing is indicated. Although dogmatism as to causation is not justified, and the need for further intensive inquiry is suggested by the facts under each heading, Dr. Newsholme says the presumption is justified that better arrangements for ante-natal care and for midwifery attendance would go far to reduce the mortality from child-bearing. In order that official action may be taken for reducing maternal mortaliy and suffering in child-bearing, measures must be adopted for ascertaining what cases need help. This condition, the report states, can be fulfilled by : (a) The provision of skilled assistance at maternity centres, which is one of the best means for obtaining such information ; (b) the notification of births, which provides essential information ; (c) the notification of puerperal fever when made more effective. Hospital provision for the treatment of puerperal fever is most valuable in itself, as well as in securing more complete notification ; (d) the collection of the statistics of hospital experience ; (e) the provision of pathological aids for diagnosis, which will lead to the better diagnosis and treatment of many cases of illness in child-bearing. Other suggestions are concerned with ante-natal work in connection with clinics and consultations, and difficulties in regard to the supply of midwives are discussed at length. The report makes a most opportune appearance at a time when it is important for the public to realise the urgent necessity for maternity and infant welfare schemes. Female Sanitary Inspectors and Health Visitors. NOTIFICATION OF BIRTHS. During the year 5989 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 2955 births registered during 1915. „ 3014 „ notified „ „ 21 The duties of the female staff as Health Visitors are, briefly:— 1. To visit systematically all the births in the poorer streets and some of the births in the better class districts. 2. To instruct the mothers, and especially young mothers, with first children or twins, in the feeding and proper care of their babies. 3. To pay revisits and to carefully watch over the child's health and progress, and to take the necessary steps by advice or by reference to medical or philanthropic agencies to safeguard the child's prospects and circumstances. 4. To improve the home conditions of the mothers domestically by help, advice and suggestion, hygienically by referring defects of structure or environment to the Public Health Department. 5. To attend and supervise their respective Centres for Infant Welfare. . 6. Deal with those notifiable infectious diseases peculiar to early infancy. 7. To make enquiries as to the cause of failures to notify births under the Notification of Births Act, 1907. 8. To inspect the homes of verminous children notified by the London County Council as required by that body. 9. To make inquiry respecting persons notified under the Tuberculosis Order, 1913, and visit dispensary cases. For the above purposes the Borough has been divided into three districts, mapped out as containing those streets in which infant deaths have chiefly occurred in recent years. One district is assigned to each Lady Health Visitor, and in the special streets so named and defined every household in which a birth occurs is visited on or about the eleventh day after the birth if the mother is up, or earlier on request, or if there is reason to believe that the mother is unattended by a doctor, midwife or nurse. It is important to notice that, in these streets referred to, every birth is visited, and not merely births in those households where the parents are ostensibly poor or dirty. In other streets only those births are supervised where the mothers are very young, careless, negligent, ill-treated, alcoholic, deserted, living in poor and domestically squalid surroundings, or are known to be the chief or sole wage-earners for their families, or where the children are first children, wasting, debilitated, ailing, illegitimate or twins. During the year 2,964 homes have been visited where children have been born. 22 The distribution of visits in the different wards was as follows:— Miss O'Kiordan Visits E. N. N.W. S. S.E. S.W. Total. 3 153 845 186 379 353 1919 Revisits 4 163 822 193 432 223 1837 Total 7 316 1667 379 811 576 3756 Miss Smart Visits 1456 15 — — 1 2 1474 Revisits 1909 14 1 5 — 2 1991 Total 3425 29 1 5 1 4 3465 Mrs. Davies Visits 2 894 132 — — 1028 Revisits 2 1419 247 — — — 1668 Total 4 2313 379 — — — 2696 Totals Visits 1461 1062 977 186 380 355 4421 Revisits 1975 1596 1070 198 432 225 5496 Total 3436 2658 2047 384 812 580 9917 The following visits are included in the above table 1st visits 2nd visits Total Births 2964 3025 5989 T ubercutosis 512 1623 2135 Verminous Children 280 693 963 Ophthalmia Neonatorum 11 45 56 Infant Deaths 345 — 345 Miscellaneous 309 120 429 4421 5496 9917 The number of births notified under the Notification of Births Act during this period was 3014. 137 parents had to be warned in respect of their failure to comply with the Act. 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 701 333 368 678 23 92 67 530 12 North 749 405 344 725 24 166 257 292 34 Nth.-west 717 350 367 701 16 272 224 173 48 South 190 108 82 187 3 104 47 18 21 Sth-East 291 152 139 281 10 110 63 99 19 Sth-West 366 176 190 355 11 195 65 88 18 Totals 3041 1524 1490 2927 87 939 723 1200 152 23 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 677 61 39 777 North 708 46 36 790 North-West 619 37 82 738 South 98 10 25 133 South-East 222 25 18 265 South-West 220 10 31 261 2544 189 231 2964 Maternity and Child Welfare. In several circulars issued by the Local Government Board during the years 1914 and 1915, the scope and intention of an organized scheme of baby culture is set forth. The following is a summary of that scheme:— It is intended that the work of each local authority should be directed along two main lines of endeavour—first, the visiting of all mothers in fact, and, in so far as may be possible, of all mothers in expectation; secondly, the establishment in every area of centres where the examination of mothers, babies and children under school age should be undertaken at regular intervals. The purpose of these visits and examinations is stated to be in the main to give advice in general on hygiene, and in particular on the difficulties of the individual mothers and children. But the possibility of some sort of simple medical treatment is held out as one of the advantages of the centres. The medical officer of health has immediate information of the birth of a child. From that notification radiates the health visitation as part of the normal public health work of the district. Within two or three days of the notification an official visitor is sent by the medical officer of health to such homes as he judges advisable. The visitor sees the mother and baby, gives advice on the care of the infant, takes a general survey of the home, the cleanliness and sanitation thereof, and in particular urges the mother to take her baby as soon as possible to the "centre," and to consider that centre as in some sort the place for the standardization of her infant; there she will know how it fares, if its height, its weight, and its health are as good as may be, and there she will receive advice on all the difficulties that occur in the upbringing of 24 the little one, and all this right on until the child is entered on the books of the local elementary school, when the record will be handed on to the school doctor. When the little one comes to learn of all this it will be able to echo in truth the words of the psalmist: "In thy book all my members were written." But the work of the centres will not be limited to the oversight of the mothers in fact and their infants. It is intended that the work should have a very definite extension to the mothers in expectation. There is no legal notification of pregnancy, so that the medical officer of health has to trust to the willing co-operation of the medical men and midwives of the district for information concerning the mothers in expectation, or to such chance knowledge as may come to him through voluntary agencies or his own health visitors. The object of obtaining this information is that the expectant mothers should be urged to attend the centres for medical examination and that the health visitors should visit them at their homes. The Health Visitors and their Work. The three most useful qualifications for non-medical health visitors are those of: (l) A trained nurse; (2) a certified midwife; and (3) a certified sanitary inspector. The first training will enable thevisitorto gain important instruction in the hygiene of child life; the second will enable her to supplement the work of the midwife even to acting as an inspector of midwives; and the knowledge of sanitary work will enable the visitor to appreciate the state of a house and its sanitary arrangements, and bring her into intimate relation to the regular sanitary officers of the district. The nature of the advice to be given to the mother in fact is not outlined: it may be presumed to depend on the individual case of mother and child. But on the visitation of the expectant mother there is an indication in some notes given in last year's report. The Centres. The main work of the centres will be with the mothers and the children. But the circulars show that a very strenuous effort is to be made to increase to the greatest possible extent their work in relation to the expectant mothers. The actual scope of work of the centres is best given in the official terms: "The chief object of the centre is to secure the medical supervision of the expectant and nursing mother and of her child. This supervision takes the form of a medical consultation, followed by the giving of hygienic advice, and by treatment, especially for minor complaints, when local circumstances indicate the need for this." 25 It would appear that the expectant mother, when persuaded to attend the clinic centre, will only be seen once in the ordinary course of events. She would be examined, and advice on the care of her general health, with particular instructions on any obvious difficulties, given. Patients found to have serious symptoms would be referred to a private practitioner; "no responsibility should be undertaken at the centre for the continuous treatment of serious illness," a record is to be kept. When the baby's turn comes to attend the centre it is natural that it should be the chief focus of attention. "Commonly, it will be desirable to secure that each infant attending the centre is seen by the doctor at least every four or six weeks. These consultations should be arranged more frequently, if the health visitor in the intervals finds that the infant is not progressing favourably. After the early months of life less frequent attendance will be needed, but the consultations should suffice to secure early recognition of rickets, etc. After the child has reached the age of two or three years, efforts should be made to secure a medical examination at quarterly or half-yearly intervals, until the child is entered on a school register." Record of the state of the infant is to be kept. Besides the records of the mother and child there is to be kept a record of the visits to the home and the conditions found there. So much for the general scope of the work. There remains to discover the medical arrangements. At the end of Dr. Newsholme's report we find the following:— "The value of a centre depends chiefly on the medical advice given in it. The late Professor Budin, the distinguished founder of infant consultations, said: 'An infant consultation is worth precisely as much as the presiding physician.' This is even more true for the antenatal work of the centre." The medical arrangements for the centres are left entirely in the hands of the local authority. Each local authority opening a centre will decide the best arrangement for medical service. An officer appointed by the local authority may undertake this. The arrangement made should, so far as practicable, be one which will receive the general approval of local medical practitioners. This may sometimes be secured by appointing a practitioner not practising in the district. It is less satisfactory to have a rota of doctors. The last-named arrangement should not be entertained unless it is provided that the same doctor will attend at consecutive consultations for not less than six months. 26 With regard to the cost the memorandum assumes that the health visitors will be officers of the sanitary authority, so that their salaries need not be reckoned as a part of the working expenses of the centre, which would comprise "the doctor's salary, rent, rates, taxes, lighting, heating, caretaking, and a few minor items, including drugs and medical appliances." The Local Government Board will pay 50 per cent of the amount spent on approved expenditure for the above purposes, but it is thought that in many instances the centre can be conducted on premises used for other purposes, so that no rent need be paid. So far, the effect of the war upon the child has received but scant attention by local authorities. Yet it is a matter of supreme importance both to us as a nation and to us as a race, that the future of the child should not be handicapped by the patriotism of the father. We must not forget that the boys and girls of to-day are the men and women of to-morrow. Heavy, then, as the national burden is, and must continue to be, the problem of the child must neither be neglected or set aside. As far as possible a solution must be found for every case of hardship or distress, either directly or indirectly, attributable to the operations of the war. It has never been the practice of the British people to stint their expenditures, and every family that possesses the means of spending money freely does not hesitate to provide itself, not only with all the necessaries it requires, but with as many comforts and luxuries as it can reasonably afford. The savings of the British people are made after all these other expenditures are provided for. Hitherto the British people have financed this great war in the same way as they would have financed a great Government building, a new county hall, or a new post office. They have assumed that expenditures for such a purpose would be met after they had supplied themselves with their necessaries, comforts and luxuries. This is the situation at the present time. The nation is spending just as much upon its necessaries, comforts and luxuries as it usually does. In fact, expenditures upon these things are greater than they have ever been. Hitherto the entire cost of the war has been financed out of normal savings and by the consumption of floating capital. The greatest reserve which the country possesses is still untouched—the power to reduce its expenditures upon comforts and luxuries, and by so doing to set free the additional money needed by the nation for war purposes. Financiers are convinced, however, that without serious difficulty thecountry can increase the annual sums it has hitherto devoted out of income to the war by about £ 400,000,000 a year. If this is so, one can readily imagine that the small amount of money required for maternity and child welfare will also be found. 27 Infant Consultations, &c. I am pleased to be able to report that there are now 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. Infant consultations Infant Weighing 1860 attendances for the year. Lecture—52 weekly lectures on Infant care (1 hour each). 4 extra lectures prior to examination (1 hour each). Average number of mothers attending each week, 35. The mothers take a great interest in lectures given and make every effort to attend regularly. An examination in Infant Care is held every December. In April, 1915, the Mayoress, Mrs. Wayland, entertained the mothers, with their babies, to tea at the Borough Hall, and also presented each mother who passed the examination with a prize. Cases requiring hospital treatment are sent to a suitable hospital. We are indebted to the Belgrave Hospital for Children for prompt treatment of cases referred to that Institution. Visits are paid to expectant mothers where known, but at present there is no systematic method of obtaining the names of such cases. No difficulty has been found in obtaining beds for suitable cases, but difficulty occasionally arises in providing for the children of the family during the absence of the mother in hospital. There are at present three lying-in homes in the Borough. These have been inspected and visits are paid to all births occurring therein. Cornbury Road Mission Hall. Total attendances for the year 247 Number of consultations 42 Average number of attendances 6 Do. do. (last half of year) 7 28 Albany Institute, Deptford Fund. Returns of Infant Consultations from January 1st to December 31st, 1915, No. of individual Babies who have attended Infant Consultations 247 „ times those Babies have been weighed 1689 „ „ „ seen by Doctor 718 Total attendance of Mothers at Lectures 1788 No. of Infant Consultations held 50 Total attendance made by Children at the Day Nursery for the year 4172 No. of Babies admitted to Babies' Home 52 Babies who have been re-admitted 4 Deptford Health Centre. The following is a summary of the work done:— Throat and nose cases (including 242 operations) 393 Skin disease cases 1333 Medical cases 3150 Dental cases (including 6423 extractions of teeth 1966 anaesthetics 3017 fillings inserted) 2642 Eye cases 724 Baby Camp—Attendances in middle of 1915 40-50 29 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 1915 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 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 1915 110,299 2,891 2,955 26.8 1,406 12.7 144 700 391 132 1,962 17.8 Area of District in acres (land and inland 1,563. water). Total population at all ages 109,496. At census Total families or separate occupiers, 25,040. 1911. 30 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 1915. Notifiable Disease Number of cases notified. Total cases notified in each Ward. Total Cases Removed to Hospital. At all Ages At Ages—Years East Ward North Ward North-West Ward South Ward South-East Ward South-West Ward Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous croup 201 3 55 109 21 9 3 l 32 43 54 19 24 29 184 Erysipelas 146 3 10 11 24 38 45 15 51 30 25 10 18 12 14 Scarlet fever 440 3 111 273 38 13 2 .. 119 104 91 37 39 50 402 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 37 .. 1 12 7 13 4 .. 3 24 1 .. 9 .. 33 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 4 .. .. .. 2 2 .. .. 1 .. 2 .. .. 1 2 Cerebro-spinal Meningitis 15 3 3 5 2 1 1 .. 4 3 3 2 3 .. 15 Poliomyelitis 2 .. 1 1 .. .. .. .. .. .. 1 1 .. .. 2 Pulmonary Tuberculosis 299 .. 8 45 57 127 57 5 98 70 47 19 33 32 205 Other forms of Tuberculosis 106 12 26 41 11 6 8 2 45 14 21 6 13 7 32 Ophthalmia Neonatorum 13 13 .. .. .. .. .. .. 4 4 2 1 .. 2 .. Chicken-pox 196 12 68 112 1 2 1 .. 44 75 25 6 13 33 .. Anthrax 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. Totals 1460 49 283 609 163 211 122 23 401 367 272 101 152 167 889 31 Table No. 3. METROPOLITAN BOROUGH OF DEPTFORD. Causes of, and Ages at Death during the Year 1915. (This Table is prepared in accordance with the requisitions of the Local Government Board.) CAUSES OF DEATH. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the Distrtct. Total Heaths whether of "Residents " or "Non-Residents" in Institutions in the District. AH 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 causes Certified 1962 391 138 118 83 82 213 440 497 155 Uncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever 5 .. .. .. 2 1 1 1 .. 4 Small Pox .. .. .. .. .. .. .. .. .. .. Measles 49 10 18 20 1 .. .. .. .. 10 Scarlet Fever 9 .. .. 1 7 .. 1 .. .. 36 Whooping Cough 61 23 23 14 1 .. .. .. .. .. Diphtheria and Croup 10 .. 3 6 1 .. .. .. .. 76 Influenza 21 .. .. .. .. .. 1 10 10 .. Erysipelas 5 2 .. .. .. .. 3 .. .. .. Phthisis (Pulmonary Tuberculosis) 172 .. .. 3 9 30 68 57 5 1 Tuberculous Meningitis 28 7 8 9 2 1 .. 1 .. .. Other Tuberculous Diseases 26 9 2 4 7 1 2 .. 1 .. Cancer, malignant disease 119 .. .. .. 3 .. 13 61 42 2 Rheumatic Fever 10 .. .. .. 3 1 8 3 .. .. Meningitis 21 6 1 4 6 1 2 1 .. 5 Organic Heart Disease 145 1 .. .. 7 5 21 57 54 3 Bronchitis 206 33 8 7 .. 3 14 57 84 .. Pneumonia (all forms) 201 55 32 27 11 6 12 37 21 8 Other diseases of Respiratory Organs 23 3 1 3 .. .. .. 10 6 1 Diarrhoea and Enteritis 116 73 21 7 1 .. 3 5 6 .. Appendicitis and Typhlitis 7 .. .. .. .. 1 1 1 1 .. Cirrhosis of Liver 10 .. .. .. .. .. 3 7 .. .. Alcoholism 6 .. .. .. .. 1 2 2 1 .. Nephritis & Bright's Disease 39 .. 1 1 .. 2 8 16 11 .. Puerperal Fever 1 .. .. .. .. .. 1 .. .. 4 Other accidents and diseases of Pregnancy and. Parturition 4 .. .. .. .. .. 4 .. .. .. Congenital Debility and Malformation, including Premature Birth 122 115 6 1 .. .. .. .. .. 1 Violent Deaths (excluding Suicides) 73 9 4 8 8 11 15 9 9 .. Suicides 10 .. .. .. 1 .. 2 4 3 .. Other defined diseases 460 44 10 8 10 17 33 101 242 4 Diseases ill-defined or unknown 3 1 .. .. .. 1 .. • • 1 .. 1962 391 138 118 83 82 213 440 497 155 32 Table No. 4. METROPOLITAN BOROUGH OF DEPTFORD This Table is prepared in accordance with the requisitions of the Local Government Board. Infantile Mortality, 1915. Nett Deaths from stated causes at various Ages under 1 year of Age. CAUSE OF DEATH. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 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 73 17 18 13 121 76 71 59 64 391 Uncertified .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 5 5 10 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. 1 1 3 4 6 9 23 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. 1 1 1 .. .. .. 2 Tuberculous Meningitis .. .. .. .. .. .. 1 5 1 7 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. 2 3 3 1 9 Meningitis (not Tuberculous) .. .. .. .. .. .. 3 2 1 6 Convulsions 3 3 .. .. 6 6 3 .. 3 18 Laryngitis .. .. .. .. .. 1 1 .. .. 2 Bronchitis .. 1 3 1 5 15 4 4 5 33 Pneumonia (all forms) .. 1 3 .. 4 10 11 9 21 55 Diarrhœa .. .. .. 1 1 5 14 5 4 29 Enteritis .. .. .. .. .. 8 14 13 9 44 Gastritis .. .. .. 2 2 2 3 .. .. 7 Syphilis .. .. .. .. .. 2 .. .. .. 2 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying 1 .. .. 1 2 1 .. .. 1 4 Injury at Birth 3 .. .. .. 3 .. .. .. .. 3 Atelectasis 5 2 .. .. 7 .. .. .. .. 7 Congenital Malformations 5 1 .. 1 7 2 2 1 .. 12 Premature Birth 37 3 4 2 46 3 .. .. .. 49 Atrophy, Debility, and Marasmus 12 6 8 3 29 12 6 6 1 54 Other Causes 7 .. .. .. 7 3 2 .. 3 15 73 17 18 13 121 76 71 59 64 391 Nett Births—Legitimate, 2871; Illegitimate, 84. Nett Deaths—Legitimate infants, 381 Illegitimate infants, 10. 33 Table No. 5. Return of Births Registered during the Year 1915. 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 1442 1449 51 2891 331 359 14 690 370 338 6 708 325 349 18 674 100 86 3 186 142 135 4 277 174 182 6 356 Births registered in Outlying Institutions 37 27 33 64 9 4 6 13 7 5 5 12 8 4 6 12 3 2 3 5 4 5 5 9 6 7 8 13 Total Births belonging to the Borough 1479 1476 84 2955 340 363 20 703 377 343 11 720 333 353 24 686 103 88 6 191 146 140 9 286 180 189 14 369 c 34 Table No. 6. Return of Deaths Registered during the year 1915. 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' H. F. M. F. Deaths registered in the Borough 697 709 328 1406 168 175 117 343 145 125 69 270 117 111 69 228 54 70 16 124 75 62 29 137 73 88 21 161 65 78 7 143 Deaths in Outlying Institutions 399 301 69 700 119 85 20 204 100 74 22 174 65 53 10 118 17 13 4 30 65 42 6 107 33 34 7 67 .. .. .. .. Total number of Deaths of Residents of the Borough 1028 934 391 1962 287 263 137 550 241 199 92 440 185 165 79 350 70 82 20 152 141 104 35 245 104 121 28 225 .. .. .. .. 144 Deaths registered in the Borough were of non-parishioners. Of these 132 occurred in the South-Eastern Hospital. In the last line of the above Table, the 11 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. 36 17 Table No.7. Deaths Registered in or Relonging to the Metropolitan Borough of Deptford during the Year 1915. Diseases. Whole Borough. All ages. 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 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. 1 Enteric Fever 3 2 5 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 2 2 4 ... ... ... ... ... ... ... ... ... ... ... ... 2 Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Small Pox— (a) Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Not Vaccinated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Doubtful ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Measles 28 21 49 7 3 8 10 12 8 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 4 11 5 4 9 11 9 20 1 1 2 4 3 7 ... ... ... 7 Scarlet Fever 4 5 9 ... ... ... ... 1 3 4 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 3 3 2 1 3 1 ... 1 ... ... ... ... 1 1 1 ... 1 8 Whooping Cough 29 32 61 11 12 14 9 4 10 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 12 22 7 8 15 4 5 9 1 2 3 4 2 6 3 3 6 9 (a) Diphtheria 7 3 10 ... ... 2 1 4 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 5 1 ... 1 2 1 1 ... ... ... ... ... ... 1 ... 1 (b)Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Influenza 11 10 21 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 1 3 2 3 3 1 2 ... 1 1 ... 1 1 2 3 2 1 3 1 2 3 2 2 4 4 3 7 11 Miliary Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Asiatic Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13 Cholera Nostras ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 Dysentery ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 81 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 15 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 Yellow Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 17 Leprosy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Erysipelas 3 2 5 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 ... ... ... ... ... ... 1 1 2 19 (a) Mumps ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... (b) German Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Varicella ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Other Epidemic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 20 (a) Pyaemia. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Septicæmia ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... (c) Vaccinia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 21 Glanders ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 22 Anthrax (Splenic Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Rabies ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Tetanus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 Mycoses ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 26 Pellagra ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 Beri-Beri ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 28 (a) Pulmonary Tuberculosis 81 52 133 ... ... ... ... ... 1 2 1 1 3 5 8 7 6 16 13 12 9 20 7 18 1 ... 2 ... 1 ... ... 20 12 32 20 17 37 16 7 23 5 3 8 13 4 17 7 9 16 (b) Phthisis (not defined as tuberculosis) 17 16 33 ... ... ... ... ... 1 1 1 ... ... ... ... 2 2 3 1 4 6 5 3 1 1 1 21 ... ... ... ... 6 7 13 5 1 26 1 7 8 2 ... 2 2 1 3 1 ... 1 29 (a) Acute Phthisis 4 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 1 ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... 1 2 1 ... 1 (b) Acute Miliary Tuberculosis 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 30 Tuberculous Meningitis 16 J2 28 3 4 6 2 5 4 1 ... ... 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 1 3 4 3 7 6 3 9 1 1 2 ... 2 2 3 2 5 31 (a) Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Other peritoneal & intestinal tubercle 3 5 8 ... 1 ... 1 2 ... ... ... 1 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 2 ... 1 1 ... ... ... ... ... ... 1 2 3 32 Tuberculosis of Spinal Column ... 2 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 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 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 1 ... 1 ... ... ... ... ... ... ... ... ... 35 Disseminated Tuberculosis 7 6 13 3 4 ... 1 2 ... ... ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 5 5 1 6 ... ... ... ... ... ... ... 2 2 ... ... ... 36 Rickets, Softening of Bones 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 37 Syphilis 3 3 6 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 ... 1 ... ... ... 1 1 2 ... 1 1 38 Other Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 39 Cancer of the buccal cavity 9 2 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 4 1 3 ... 1 ... ... ... ... 1 1 3 ... 3 1 1 2 1 ... 1 1 ... 1 3 ... 3 40 ,, stomach, liver, etc. 13 13 26 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 6 4 5 3 2 1 ... ... 1 1 2 5 5 10 2 2 4 2 ... 2 1 1 2 2 4 6 41 ,, peritoneum intestines & rectum 15 22 37 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 4 6 6 4 2 6 1 4 ... ... 2 4 6 4 2 6 2 6 8 1 3 4 3 4 7 3 3 6 42 ,, female genital organs ... 12 12 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 4 ... 3 ... 1 ... 1 ... ... ... 4 4 ... ... ... ... 5 5 ... ... ... ... 3 3 ... ... ... 43 ,, breast ... 14 14 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 4 ... 3 ... 3 ... 2 ... ... ... 4 4 ... 2 2 ... 2 2 ... 2 ... ... 1 1 ... 3 3 44 skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 45 Cancer of other or unspecified organs 11 8 19 ... ... ... ... ... ... 1 1 1 ... ... ... ... ... 1 ... ... 1 2 ... 3 2 1 1 2 3 ... ... 2 1 3 2 1 3 2 1 3 3 3 6 1 1 2 1 1 2 46 Other Tumours (situation undefined) 1 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 47 Rheumatic Fever 3 7 10 ... ... ... ... ... ... ... 1 2 ... ... 1 ... ... ... 1 ... 2 1 2 ... ... ... ... ... ... ... ... ... 2 3 1 ... 1 ... 1 1 ... 2 2 ... 1 1 1 1 2 48 (a) Chronic Rheumatism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Osteo-Arthritis 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 (c) Gout ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 49 Scurvy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 50 Diabetes 7 7 14 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... 2 4 2 ... 2 ... ... ... ... 1 2 3 2 1 3 ... 1 1 2 ... 2 2 1 3 ... 2 2 51 Exophthalmic Goitre ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 52 Addison's Disease ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...' ... ... 1 1 ... ... ... ... ... ... 38 39 Table No. 7.—continued. Diseases. Whole Borough. All ages. 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 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 Leucocythaemia I.ymphadenoma 3 ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 54 Anaemia, Chlorosis 1 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... l ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 2 ... ... ... ... 1 1 55 (a) Diabetes insipidus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Purpura ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... (c) Haemophilia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Other General Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 56 Alcoholism (acute or chronic) 4 2 6 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... 1 ... 1 ... ... 1 ... ... ... ... 1 ... 1 1 ... 1 2 ... 2 ... ... ... ... 1 1 ... 1 1 57 (a) Occupational Lead Poisoning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) 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 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 61 (a) Cerebro-spinal Fever 3 2 5 ... ... 1 ... ... 1 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 2 1 ... 1 ... ... ... ... 1 1 ... ... ... (b) Posterior Basil Meningitis ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... (c) Meningitis, other forms 5 10 15 1 4 ... ... 1 2 1 3 ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 2 1 3 1 2 3 1 1 2 ... 1 1 ... 4 4 1 1 2 62 Locomotor Ataxy 3 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 1 1 ... ... ... ... ... 1 2 3 ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 63 Other Diseases of the Spinal Cord 3 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 2 1 3 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 64 Cerebral Haemorrhage, Apoplexy 32 23 55 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 3 6 5 15 11 6 1 ... 2 7 4 11 2 3 5 8 5 13 4 6 10 4 ... 4 7 5 12 65 Softening of Brain 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 15 ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 66 Paralysis without specified cause 2 3 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... 1 ... ... ... ... 1 1 2 ... 1 1 1 ... 1 ... ... ... ... ... ... ... 1 1 67 General Paralysis of the Insane 11 2 13 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 ... 4 ... 3 1 1 ... 1 ... ... ... ... ... 3 ... 3 3 1 4 3 ... 3 ... ... ... 1 1 2 1 ... 1 68 Other forms of Mental Alienation ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 69 Epilepsy 2 9 11 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 2 ... 4 ... ... ... 1 ... 1 ... ... ... ... 2 1 3 ... 3 3 ... 2 2 ... 1 1 ... 1 1 ... 1 1 70 Convulsions (Non-puerperal) 5yrs & over ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 71 Infantile Convulsions (under 5 years) 9 14 23 7 11 2 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 5 10 1 5 6 ... 3 3 1 ... 1 2 ... 2 ... 1 1 72 Chorea ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 73 Hysteria, Neuralgia, Neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 74 Other Diseases of the Nervous System 1 6 7 ... ... ... ... ... 1 ... 3 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 1 1 1 1 2 ... 1 1 ... 2 2 ... ... ... ... 1 1 75 Diseases of the Eyes and Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 76 (a) Mastoid Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Other Diseases of the Ears 2 1 3 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... 1 ... i ... ... ... 1 ... 1 ... ... ... III.—Diseases of the Circulatory System. 77 Pericarditis 2 1 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 ... 2 ... ... ... 78 Acute Myocarditis and Endocarditis ... 7 7 ... ... ... ... ... ... ... 1 ... ... ... 2 ... 1 ... ... ... 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 2 ... 1 1 ... 3 3 79 (a) Valvular Disease 38 46 84 1 ... ... ... ... ... ... 1 2 3 ... ... ... 4 1 6 2 5 10 5 6 9 12 8 4 3 ... 1 6 11 17 10 13 23 6 7 13 2 4 6 9 5 14 5 6 11 (b) Fatty Degeneration of the Heart 10 9 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 2 3 2 3 4 2 ... ... ... 3 2 5 2 ... 2 1 1 2 ... 2 2 4 2 6 ... 2 2 (c) Other Organic Disease of the Heart 27 15 42 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 2 2 3 4 9 2 8 5 2 1 1 ... 7 5 12 10 3 13 1 1 2 ... 2 2 5 2 7 4 2 6 80 Angina Pectoris 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 ... ... ... 2 ... 2 81 (a) Aneurysm 3 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 1 ... 1 ... ... ... 1 ... 1 (b) Arterial Sclerosis 17 3 20 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 9 2 4 ... 1 ... 2 ... 2 6 2 8 3 ... 3 1 ... 1 2 1 3 3 ... 3 (c) Other Diseases of Arteries ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 82 (a) Cerebral Embolism & Thrombosis ... 5 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ......... 1 ... 3 ... ... ... 1 ... ... ... ... 1 1 ... ... ... ... 2 2 ... 1 1 ... 1 1 (b) Other Embolism and Thrombosis 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 83 Diseases of the Veins (Varices, Haemorrhoids, Phlebitis, etc ) ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 1 1 ... ... ... 84 (a) Status Lymphaticus 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 (b)Other Diseases of the Lymphatic System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 85 Haemorrhage: other Diseases of the Circulatory System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... IV —Diseases of the Respiratory System. 86 Diseases of the Nasal Fossae ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 87 Diseases of the Larynx 4 1 5 2 ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 1 ... 1 1 ... 1 ... ... ... ... 1 i 88 Diseases of the Thyroid Body ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 89 & 90 Bronchitis 106 100 206 17 16 2 6 5 2 ... ... ... ... ... 1 ... 2 2 1 7 4 8 7 22 20 29 23 11 !5 3 3 32 34 66 21 23 44 19 17 36 6 3 9 17 10 27 11 13 24 91 Broncho-pneumonia 76 47 123 27 17 18 6 13 9 1 3 ... ... ... 1 1 ... ... ... 3 1 4 ... 4 4 3 1 1 4 1 1 29 17 46 21 15 36 15 4 19 2 5 7 5 3 8 4 3 7 92 (a) Lobar Pneumonia. 15 20 35 ... 3 2 4 ... 1 ... ... 1 1 ... 1 ... 1 1 ... 3 ... 3 4 4 1 1 3 ... 1 ... ... 5 7 12 4 1 5 1 4 5 2 1 3 1 4 5 2 3 5 (b) Pneumonia (type not stated) 28 15 43 6 2 ... 2 3 1 3 ... ... 2 1 ... 1 ... 1 1 1 1 5 3 4 1 2 2 1 ... ... ... 16 7 23 3 3 6 4 1 5 2 ... 2 1 3 4 2 1 3 93 Pleurisy 5 2 7 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 1 ... ... ... ... ... 2 ... ... 2 ... 2 2 3 ... 3 ... ... ... ... ... ... ... ... ... 94 Pulmonary Congestion, Pulmonary Apoplexy 2 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 ... 1 1 95 Gangrene of the Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 96 Asthma 4 2 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... .... ... ... 2 1 3 1 ... 1 1 ... 1 ... ... ... ... 1 1 97 Pulmonary Emphysema 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ..... 1 1 ... ... ... 98 (a) Fibroid Disease of the Lung ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (b) Other Diseases of the Respiratory System ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 40 41 Table No. 7,—continued. Diseases Whole Borough. All ages. Under 1 1 to 2 2 to 5 5 to 10 10 to 15 15 to 20 20 to 25 4 25 to 35 5 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 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. V.—Diseases of the Digestive System. 99 (a) Diseases of the Teeth and Gums 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... (b) Other Diseases of the Mouth & Annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 100 Diseases of Pharynx. Tonsillitis ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 101 Disease of (Esophagus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 102 Perforating Ulcer of Stomach 6 5 11 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 2 ... 2 3 1 2 ... ... ... ... ... ... 2 2 4 2 ... 2 1 ... 1 ... 1 1 1 1 2 ... 1 1 103 (a) Inflammation of Stomach 5 8 13 4 3 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... 1 ... ... 2 4 6 1 3 4 1 ... 1 ... ... ... 1 1 2 ... ... ... (b) Other Diseases of Stomach 2 1 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 1 104 & 105 (a) Infective Enteritis 23 18 41 15 16 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 11 23 4 5 9 4 1 5 ... ... ... 2 ... 2 1 1 2 (b) Diarrhoea (not returned as infective) 6 3 5 6 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 5 1 ... 1 2 ... 2 ... ... ... 1 ... 1 ... ... ... (c) Enteritis (not returned as infective) 13 15 28 6 6 6 5 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... ... 7 10 17 4 2 6 1 2 3 ... 1 1 1 ... 1 ... ... ... (d) Gastro-Enteritis (not returned as infective) 22 12 34 13 10 2 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 1 1 2 ... ... ... 9 5 14 2 3 5 2 2 4 2 ... 2 5 1 6 2 1 3 (e) Dyspepsia (under 2 years of age) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (/) Colic ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (g) Ulceration of Intestines 2 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 ... ... ... ... 1 1 ... 1 1 (h) Duodenal Ulcer ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 106 Ankylostomiasis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 107 Other Intestinal Parasites ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 108 Appendicitis 4 3 7 ... ... ... ... ... ... ... 2 1 ... ... 1 ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 1 1 ... 1 1 ... 1 ... ... ... 1 2 3 1 ... 1 109 (a) Hernia 1 5 6 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 1 1 ... ... ... ... 1 ... 1 ... 1 1 ... 1 1 ... 1 1 ... ... ... ... 2 2 (b) Intestinal Obstruction 2 4 6 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 2 1 2 ... ... ... ... ... ... ... ... ... ... 1 1 1 2 3 ... ... ... ... 2 2 110 Other Diseases of the Intestines 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 5 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 1 2 2 ... ... ... ... ... ... 2 2 4 ... 1 1 2 2 4 ... ... ... ... ... ... ... ... ... (b) Cirrhosis of Liver (returned as alcoholic) 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Diseases formerly classed to "Other Diseases of Liver and Gall Bladder'' ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 114 Biliary Calculi 2 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... ... 1 ... 1 ... 2 2 ... ... ... 1 ... 1 ... ... ... 115 Other Diseases of the Liver 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 116 Diseases of Spleen ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 117 Peritonitis (cause unstated) 2 1 3 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 118 Other Diseases of the Digestive System ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... VI.—Non-venereal Diseases of the Genito-Urinary System and Annexa. 119 Acute Nephritis 3 1 4 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... 1 1 ... ... ... 1 ... 1 ... ... ... 120 Bright's Disease 21 14 35 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 3 2 1 7 2 6 1 2 3 3 3 ... ... 5 6 11 5 ... 5 2 1 3 2 3 5 6 2 8 1 2 3 121 Chyluria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 122 Other Diseases of the Kidney & Annexa 1 2 3 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 123 Calculi of the Uninary Passages ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 124 Diseases of the Bladder 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 1 ... ... ... ... ... ... ... ... 2 ... 2 1 ... 1 ... ... ... 1 ... 1 ... ... ... 125 Diseases of the Urethia. Urinary Abscess, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 126 Diseases of the Prostate 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 1 ... 1 ... ... ... 127 Non-Venereal Diseases of the Male Genital Organs 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 128 Uterine Haemorrhage (non Puerperal) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 129 Uterine Tumour (non-cancerous) ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 130 Other Diseases of the Uterus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 131 Ovarian cyst. Tumor (non-cancerous) ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 132 Other Diseases of the Female Genital Organs ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 133 Nor-puerperal Diseases of the Breast (Non-cancerous) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VII.—The Puerperal State. 134 Accidents of Pregnancy ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 ... ... ... 135 Haemorrhage at Childbirth ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 136 Other Accidents of Childbirth ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 137 Perperal Fever ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 138 ,, Albuminuria & Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 ,, Phlegmasia Alba Dolens. Embolism & sudden death ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 140 ,, Insanity ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 141 ,, Diseases of the Breast ... ... ... ... ... ... ......... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... VIII.—Diseases of the Skin and of the Cellular Tissue 142 (a) Senile Gangrene 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 1 ... 1 (b) Gangrene (other types) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 143 Carbuncle, Boil 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 144 Phlegmon, Acute Abscess ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 145 Diseases of the Integumentary System 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 42 43 Table No. 7.—continued Diseases. Whole Borough. All ages 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 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. IX—Diseases of the Bones and of the Organs of Locomotion. 146 Diseases of the Bones 3 ... 3 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... 2 147 Diseases of the Joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 148 Amputations ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 149 Other Diseases of Locomotor System ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... X.—Malformations. 150 Congenital Malformations 5 9 14 4 8 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 4 4 2 ... 2 ... 4 4 l l 2 ... 1 1 ... 1 1 XI.—Diseases of Early Infancy. 151 (a) Premature birth 29 20 49 29 20 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 4 6 9 2 11 8 6 14 2 4 6 5 2 7 3 2 5 (b) Infantile Debility, Icterus, and Sclerema 34 25 59 33 21 1 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 14 11 25 7 3 10 6 8 14 1 1 2 2 1 3 4 1 5 152 Other Diseases peculiar to early Infancy 4 6 10 4 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 2 2 4 2 1 3 ... ... ... ... 1 1 ... ... ... 153 Lack of Care ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... XII.—Old Age. 154 (a) Senile Dementia 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... 1 ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 1 (b) Senile Decay 52 96 148 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 15 26 26 49 10 21 10 21 31 18 28 46 5 15 20 7 11 18 6 11 17 6 10 16 XIII.—Affections Produced by External Causes. 155 to 163 Suicides 8 2 10 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... 2 1 1 ... 2 ... ... 1 ... ... 2 1 3 1 1 2 ... ... ... ... ... ... 4 ... 4 1 ... 1 164 Poisoning by Food 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 165 Other Acute Poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 166 Conflagration 2 1 3 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 167 Burns (Conflagration excepted) ... 2 2 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 168 Absorption of Deleterious Gases (Conflagration excepted) 7 4 11 4 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... 1 3 ... 3 1 2 3 1 ... 1 ... 1 1 1 1 2 169 Accidental Drowning 7 2 9 ... ... ... ... ... 1 2 ... ... ... 1 ... 1 ... ... ... ... ... 1 ... 1 1 1 ... ... ... ... ... ... ... ... 4 1 5 2 ... 2 ... ... ... 1 ... 1 ... 1 1 170 to l76 Injuries 27 9 36 ... ... 2 ... 2 1 2 ... ... ... 2 ... 2 ... ... ... 8 ... 2 ... 1 1 2 ... ... ... ... ... 7 3 10 1 4 5 8 1 ... ... ... ... 5 ... 6 3 ... 5 177 Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 178 Excessive Cold ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 179 Effects of Heat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 180 Lightning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 181 Electricity (Lightning excepted) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 182 to 184 Homicide ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 185 Fractures (cause not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 186 Other Violence 3 7 10 ... ... ... ... ... 2 ... 1 ... ... ... 1 1 2 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 7 9 ... ... ... ... ... ... ... ... ... XIV.—Ill 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) ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... (b) Atrophy, Debility, Marasmus (aged 1 year and under 70) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (c) Teething ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (d) Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... (e) Other ill-defined deaths ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... (/) Cause not specified ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1028 934 1962 210 181 78 60 64 54 22 29 17 15 15 21 21 25 36 40 72 r 65 112 84 147 97 139 132 79 99 16 32 287 263 550 241 199 440 185 165 350 70 82 152 141 104 245 104 121 225 44 INFECTIOUS AND OTHER DISEASES. 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. Forty-four more deaths from these diseases occurred 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 228 deaths were registered during 1915. DEATH RATE. The death rate from all these diseases, calculated on the estimated population, was 2.07 per 1000 of the population, compared with an average of 1.71 for the past ten years. In 1914 the death rate was 1.69; in 1913, 1.87; and in 1912, 0.91. 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 96 4.50 North Ward 49 2.04 North-West Ward 43 1.82 South Ward 6 0.49 South-East Ward 21 1.69 South-West Ward 13 0.78 228 2.07 The following statement shows the position occupied by Deptford with respect to the Epidemic Diseases in the country and in the neighbouring Metropolitan boroughs. These rates are calculated on the 1914 population:— England and Wales Epidemic Death-rates per 1,000 inhabitants. 1.3 96 Great Towns 1.6 148 Smaller Towns 1.4 County of London 1.6 Greenwich 1.7 Camberwell 1.2 Bermondsey 2.9 Poplar 2.6 Lewisham 0.8 Deptford 2.2 45 Year Enteric Fever Small Pox Measles Scarlet Fever Whooping Cough Diphtheria •Diarrhœa and Enteritis (under 2 years) Total No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate No. of Deaths Rate 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 11 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 1914 3 0.03 – – 50 0.46 9 0.08 9 0.08 25 0.23 88 0.81 184 1.69 Average for 10 years. 4 0.04 – – 50 0.43 8 0.07 34 0.29 16 0.14 84 0.74 196 1.71 1915 5 0.05 – – 49 0.44 9 0.08 61 0.55 10 0.09 94 0.85 228 2.07 * The deaths under this heading for the years 1905 to 1910 refer only to those certified to be due to epidemic or summer diarrhoea, or epidemic, zymotic or infective enteritis. From 1911 onwards, deaths from Gastro enteritis, Gastro-intestinal Catarrh, Muco-enteritis, Colitis, &c., are also included. 46 Infectious Diseases, 1915. 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) 201 201 14 187 Erysipelas 157 146 1 145 Scarlet Fever 442 440 31 409 Typhus Fever – – – – Enteric Fever 37 37 4 33 Relapsing Fever – – – – Continued Fever – – – – Puerperal Fever 5 4 – 4 Plague – – – – Cerebro-spinal Fever 15 15 – 15 Anthrax 1 1 – 1 Hydrophobia – – – – Glanders – – – – Pulmonary Tuberculosis 766 299 – 299 Other Tubercular Diseases 163 106 – 106 Ophthalmia Neonatorum 14 13 – 13 Acute Poliomyelitis 2 2 – 2 Chicken pox 197 196 – 196 Total 2000 1460 50 1410 Previous vear 2064 1794 65 1729 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 1905 TO 1915. 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. Anthrax. Totals. Measles. Disinfections. (premises) 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 10 168 723 .. 29 .. 4 .. .. .. .. .. .. .. 1131 850 1399 1909 .. 185 9 179 373 .. 33 4 6 .. 2 172 .. .. .. .. 963 467 1232 1910 .. 125 5 138 300 .. 24 1 2 .. 1 96 .. .. .. .. 692 1114 1209 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 1914 .. 253 .. 225 866 .. 9 .. 5 .. .. 419 16 1 .. .. 1794 480 1385 Average for past 10 Yrs. .. 206 6 175 570 .. 24 1 5 13 1 204 8 1 .. .. 1217 663 1276 1915 .. 201 .. 146 440 .. 37 .. 4 196 15 405 13 2 .. 1 1460 688 1105 Chart shewing week by week the total number of cases of Infectious Disease notified during the 52 weeks ended January 1st, 1916. 47 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 1460. This shows a decrease of 334 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:— 1911 1912 1913 1914 1915 No. of cases 1233 1,254 1,738 1794 1460 Estimated population 109,475 109,377 109,280 109,182 110,299 Attack rate per 1000 of population 11.3 11.4 15.6 16.4 13.2 The decrease in notifications for 1915 was due to a considerable diminution in the cases of scarlet fever and diphtheria. There were 426 fewer cases of scarlet fever and 52 fewer cases of diphtheria than in the previous year. Discovery and Diagnosis of Infectious Diseases. It is well to know that unrecognised cases largely spread infectious diseases. 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. 48 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 408, and the results of examination, were as follows:— Bacillus found. Doubtful. Bacillus not found. Total. Diphtheria (Secretion) 61 – 167 228 Reaction obtained. Doubtful. Reaction not obtained. Total. Typhoid (Blood) 14 – 11 25 Bacillus found. Doubtful. Bacillus not found. Total. Tuberculosis (Sputum) 33 — 122 155 Total 108 — 300 408 Medical men requiring the free bacteriological examination of sputa for Tubercle should send these specimens to the Council's Tuberculosis Dispensary. Classification of Infectious Diseases. Infectious Diseases fall into several categories— (a) Permanent compulsorily certifiable diseases, including Tuberculosis, Measles, and German Measles. (b) Temporary compulsorily certifiable diseases Chicken pox when small pox is present. (c) Non-certifiable diseases— (1) Diseases notifiable by School Teachers:—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. 49 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 2883 Greenwich Union. DEPTFORD (SUB-REGISTRATION) VACCINATION DISTRICT. YEARS 1910 TO 1914. Year ending 31st December. No. of Births registered Successfully Vaccinated Insusceptible of Vaccination. Had Small Pox. Number respect of whom Certificates of Conscientious Objection have been received. Dead Unvaccinated. Postponement by Medical Certificate. Removal to districts the Vaccination Officer of which has been duly apprised. Removal to places unknown or which cannot be reached and cases not having been found. Unaccouned 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 3339 1824 10 •• 704 246 14 22 337 182 Yearly Average 3183 1956 13 •• 508 233 17 22 332 103 I am indebted to the courtesy of Mr. A. E. Rossiter, Vaccination Officer to the Guardians, for the above figures. D 50 Scarlet Fever. Average of 1915 previous 10 years. Number of cases 440 570 „ deaths . 9 8 Death rate per 1,000 in Deptford 0.08 0.07 442 notifications were received during the year 1915, relating to 440 cases. Of these, 31 cases were errors in diagnosis or cases which occurred in hospital, thus reducing the net number of cases to 409. The number of cases for 1915 was much less than in the previous year. During the previous three years 866, 639 and 406 cases were notified respectively. The deaths were 9, compared with 9, 3 and 6 in the three preceding years. The death-rate was 0.08 per 1,000, and for the three preceding years 0.08, 0.03 and 0.05 respectively. The rate for London was 0.07. During the first quarter of the year 136 cases were notified, during the second quarter 81, the third quarter 96, and during the last quarter there were 127. Over 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 of 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 the receipt of each notification to the Medical Officer of Health, as to the milk, the water supply, sanitary arrangements, drainage, school or department attended by the patient and the rest of the family, general state of the house and out-buildings, the number of persons in the house, and the means of isolation. Notices were sent to the school where children attended from infected homes, requiring exclusion of these children from school, until the house was cleansed and disinfected to the satisfaction of the Medical Officer of Health after recovery or removal of the patient. Where cases were removed tc 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, Chart shewing week by week the number of cases of Scarlet Fever notified during the 52 weeks ended January 1st, 1916. 51 Scarlet Fever. WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total. East 26 29 6 17 8 6 16 11 56 63 119 North 16 18 10 9 13 12 13 13 52 62 104 North-West 9 9 1 9 13 18 10 22 33 58 91 South 3 1 1 5 3 9 5 10 12 25 37 South-East 8 4 5 8 2 2 3 7 18 21 39 South-West 6 7 5 5 6 4 12 5 29 21 50 Total 68 68 28 53 45 51 59 68 200 240 440 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-16 15-26 25-45 45-65 65 & upwards. All Ages. 3 111 273 38 13 2 .. 440 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 D 2 52 is free from infection, therefore the difficulties of discharge of such cases from scarlet fever hospitals into homes where there are other susceptible children can be realised, especially as any eczematous condition of the mouth, nostril, or ear is known to be highly infective. In some cases a patient may be released who has escaped any of the abovenamed complications in six weeks, whereas another may have to be isolated for prolonged periods, for any one or more of these reasons, and released even then with some risk lest a "return" case be the result. Diphtheria and Membranous Croup. 1915 Average for previous 10 years Number of Cases 201 206 Number of Deaths 10 0.09 Death rate per 1,000 in Deptford 0.09 0.14 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 201, relating to 201 cases. Of the number notified, 14 were errors of diagnosis and hospital cases, reducing the number of cases to 187 compared with 224, 222, and 165 for the previous three years. Ten deaths were registered during the year, as compared with 25, 20 and 11, for the three previous years. The rate of mortality was 0'09 per 1,000, and for the three previous years 0.23, 0.18 and 0.10, respectively. The rate for London was 0.15. The cases were distributed in the various Wards as follows:— East 32, North 43, North-West 54, South 19, South-East 24, and South-West 29. 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 Chart shewing week by week the number of cases of Diphtheria notified during the 52 weeks ended January 1st, 1916. 53 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 10 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 228 specimens of membrane, of which 61 were found to be positive and 167 negative. Diphtheria. WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total. East 6 6 — 1 6 7 2 4 14 18 32 North 5 11 5 3 5 3 3 8 18 25 43 North-West 7 13 4 3 4 9 4 10 19 35 54 South 6 1 1 1 1 4 4 1 12 7 19 South-East 3 1 1 4 3 1 5 6 12 12 24 South-West 3 7 6 1 1 6 1 4 11 18 29 Total 30 39 17 13 20 30 19 33 86 115 201 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. Ail Ages. 3 55 109 21 9 3 1 201 54 Enteric Fever. 1915 Average of previous 10 years. Number of Cases 37 24 Number of Deaths 5 4 Death rate per 1,000, Deptford 0.05 0.04 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 37 cases were notified, as compared with 9 cases in 1914, and 17 cases in 1913, and 9 cases in 1912. Four of this year's number were however errors of diagnosis. It may further be pointed out that 16 of the notified cases occurred between January 1st and March 8th, which was an unusually large number, and it was more noticable because many of the cases came from the North Ward. I made special enquiries in order to ascertain the origin of the disease. In no case has the testing of the drainage system of the house revealed any defect. No shell-fish, watercress or other solid food likely to be contaminated had been eaten by any of the patients. No carrier of enteric was found in the homes. I paid special attention to the milk supply with the following results: That in no less than 16 cases the milk supply was from one dairyman. I traced the dairyman's supply of milk on March 5th, and found that he obtained his milk from a dairy farm at West Sussex, and that a girl had been ill at the farm for a fortnight, and that on this date she was notified as suffering from Enteric Fever. On further enquiry I learnt that the patient was the daughter of the proprietor of the farm. She had no connection with the dairy,but was the only member of the household who was in the habit of drinking raw milk. All the milk produced on the farm was sent to Deptford with the exception of that used in the house. It seemed fairly obvious therefore that the milk had been contaminated. About twenty cows are kept which required the services of two cowmen. One of these had been many years employed on the farm and had a clear history, but the second was taken on temporarily in November last to fill the place of a regular worker who had enlisted. This temporary milker who curiously enough was leaving to resume his normal occupation of gardener, had enteric fever in June, 1914, at Emsworth, Hants, and it seems probable that he was a carrier. 55 From the facts narrated above we were able to take the necessary steps to deal with the matter and the outbreak quickly terminated. 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. Five deaths were attributed to this disease during the year, compared with three in the preceding year. 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 0.05 per 1,000, whilst for the preceding year it was 0'03. The rate for London was 0.03 The case mortality for 1915 was 13.5 per cent, compared with 33.3 for 1914. The cases were distributed in the different wards as follows:— East 3, North 24, North-West 1, and South-East 9. Bacteriological examinations were made of 25 specimens of blood, of which 14 were found to be positive and 11 negative. The following table gives the situation in the borough of each case and the general condition of the dwellings :— 56 ENTERIC FEVER, 1915. Address. Ward. Age. Sex w.c. accommodation. Yard Paving. Sanitary Defects and Remarks. Amersham Road S.E. 24 F. 1 external Good Sink waste untrapped Heston Street S.E. 16 F. 1 ” ” No nuisance. Do. S.E. 35 F. 1 ” ” ” Do. S.E, 5 F. 1 ” ” ” Alloa Road N. 21 M. 1 ” ” No nuisance Drain tested, no result Edward Street E. 28 F. 1 ” ” No nuisance Do. E. 30 M. 1 ” ” ” Cranbrook Road S.E. 11 F 1 ” ” Defective W.C. & paving *Grove Street N. 9 F. 1 ” ” Kitchen walls dirty Defective R. W. Pipe causing dampness Drain tested, no result * Do. N. 13 M. 1 ” ” *Evelyn Street N. 12 F. 1 ” ” Gutters and main roof defective Drain tested, no result Staunton Street N. 8 F. 1 ” Defective Kitchen, scullery walls and ceilings and passage ceilings dirty, back addition room damp and verminous Drain tested, no result *Evelyn Street N. 23 F. 1 internal 1 external Good ,, No nuisance Drain tested, no result *Etta Street N. 12 F. 1 ” ” No nuisance Drain tested, no result Heston Street S.E 27 F. 1 ” ” Drain choked Defective waste pipe *Gosterwo???d St N. 11 M. 1 ” ” Defective flush apparatus Kitchen and scullery ceilings dirty Drain tested, no result *Colwick Street N. 26 M 1 ” ” Defective flush apparatus to W.C. Dampness to front room ground floor Drain tested, no result *Kempslade Street N. 32 F 1 ” ” No nuisance Drain tested, no result * Do. N. 11 F. 1 ” ” ” *Trundley's Road N. 26 F 1 ” ” Insufficient supply of water to flushing apparatus of W.C. Sink waste foul and untrapped Drain tested, no result *Do. N. 27 M. 1 ” ” ” *Childers Street N. 18 F. 1 ” ” Defective gutters to main and scullery roofs Drain tested, no result 57 EFTERIC FEVER, 1915—continued. *Evelyn Street N. 30 F. 1 internal 1 external Good Insufficient supply of water to 1st floor W.C. Dustbin deficient. Vent pipe of drain choked *Kempslade Street N. 35 F. 1 external „ No nuisance Drain tested, no result *Gosterwood St N. 20 F. 1 „ „ Back-addition room ceiling dirty, scullery walls and ceiling dirty, staircase ceiling dirty, defective dustbin. Drain tested, no result Woodpecker Rd. N.W. 11 M. 1 „ Defective Untrapped drain inlet Grove Street N. 9 F. 1 „ Good Drain choked, and W.C. pan defective Do. N. 40 M 1 „ „ „ *Alloa Road N. 35 M. 1 „ „ No nuisance Drain tested, no result Wilson Street S.E. 10 F. 1 „ „ No nuisance Do. S.E. 4 F. 1 „ „ „ Childers Street N. 60 F. 1 „ „ Scullery roof defective, washhouse requires limewashing, water tap defective (repaired) Stanley Street E. 53 M. 1 „ „ Drains tested—correct No nuisance *Milk supplied from farm as mentioned in report. The following table gives the age, ward and seasonable 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 .. 2 1 3 North 5 9 2 6 1 .. .. 1 8 16 24 North-West .. .. 1 .. .. .. .. .. 1 .. 1 South .. .. .. .. .. .. .. .. .. .. .. South East .. 6 .. 2 .. .. 1 .. 1 8 9 South-West .. .. .. .. .. .. .. .. .. .. .. Total 6 16 3 8 1 .. 2 1 12 25 37 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages. .. 1 12 7 13 4 .. 37 58 Erysipelas. 1915 Average of previous 10 years. Number of Cases 146 175 Number of Deaths 5 — One hundred and forty-six cases of Erysipelas have been notified during 1915, as compared with 225 in 1914, 230 in 1913, and 188 in 1912. There were five 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. 1915 Average for previous 10 years. Number of Cases 4 5 Number of Deaths 1 — Four cases of puerperal fever were notified, compared with 5, 1 and 8, for the three years preceding. The death rate was equal to 0.009 per 1,000, compared with 0.046, 0.009, and 0.027 for the three preceding years. The case mortality was 25 per cent, compared with 40 per cent, for 1914. 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 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 59 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. Thirteen cases were notified during the year, and were visited by the Health Visitors. Four of the cases were in the East Ward, four in the North Ward, two in the North-West Ward, one in the South Ward, and two in the South-West Ward. Spotted Fever. epidemic cerebro-spinal 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: Fifteen cases of this complaint of which six were fatal, were notified in the borough, and we have received notifications from the CountyCouncil of a considerable number 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. Acute Polio-Myelitis or Polio-Encephalitis. Two cases were 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. 60 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, by an Order of the London County Council, made compulsorily notifiable during the period from 17th March to 30th June. 196 cases were notified. No deaths were ascribed to this cause. Anthrax, and Hydrophobia in Man. One case of anthrax was notified during the year. One or two somewhat disturbing cases of anthrax in man, traceable to infected shaving brushes, appeared in the Metropolis last year, including the one under review, which fortunately recovered. Suspicion fell upon a shaving brush in the first instance because at a post-mortem examination it was noted that the small local lesion came well within the individual's shaving area, which covered a larger ground than usual. The clue was followed up and the brush was bacteriologically examined, with the result that it could be definitely stated that it was infected with anthrax. Further enquiry showed that other shaving brushes were grossly infected. Subsequent experiments showed that the infection could be removed to a large extent by thorough washing, but this process would not appear to give absolute security. On the facts becoming known, prompt action was taken to secure the withdrawal of the brushes from the market. Glanders. No cases of Glanders were notified during the year. 61 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. 1915. Average of previous 10 years. Number of Deaths 116 109 Number of deaths under two years of age 94 84 Death rate per 1,000 (all ages) 1.05 0.82 Death rate per 1,000 (under two years of age) 0.85 0.74 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 116 deaths during 1915 compared with 96 for 1914. Of this number 101 were of children under five years of age, 94 of these being under two years of age. The death rate was 1.05 per 1,000 at all ages, and 0.85 for infants under two years of age. The older statistics do not give an accurate comparison with 1911-1915, because the heading of Diarrhoea did not, before these dates, include the names mentioned above, but simply cases registered as epidemic or summer diarrhœa, or epidemic, zymotic or infective enteritis. It is usual now to consider the infantile mortality in this case as being for all children under two years of age. The deaths from this disease occurred among the inhabitants of the various Wards as follows :— East 59. North 22. North-West 15. South 3. South-East 11. South-West 6. 62 The following table shows the periodsof 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 1 23 22 5 6 30 29 59 North 1 – – 1 5 6 6 3 12 10 22 North-West 3 – 2 2 4 2 1 1 10 5 15 South – – – – 2 – – 1 2 1 3 South-East 1 – – – 6 1 2 1 9 2 11 South-West 1 1 – – 2 2 – – 3 3 6 Total 6 1 4 4 42 33 14 12 66 50 116 The mean annual death rate per 1,000 from diarrhœal diseases in Deptford for the past ten years was as follows:— 1906 1.26 1911 1.72 1907 0.18 1912 0.34 1908 0.70 1913 0.95 1909 0.39 1914 0.88 1910 0.68 1915 1.05 These figures must be taken with a certain amount of reservation for the reasons stated before. Hot weather and particularly dry 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 tempera- 63 tures 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. Measles. 1915 Average for previous 10 years. Number of Deaths 49 50 Death rate per 1,000, Deptford 0.44 0.43 The number of cases of Measles dealt with during the year was 688, as compared with the previous six years as follows :— Cases. Deaths. 1915 688 49 1914 480 50 1913 497 50 1912 233 28 1911 664 67 1910 1,114 60 1909 467 66 As the disease was 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. The rate of mortality was 0.44, compared with a rate of 0.45 for 1914, 0.45 for 1913, and 0.26 for 1912. The rate for London was 0.50. The deaths occurred among the inhabitants of the various wards as follows:— East 11 North 9 North-West 20 South 2 South-West 7 South-West — 64 The following table shows the periods of the year, and the localities in which deaths from Measles occurred, the sex and ages at death. WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M F M F M F M F M F Total. East l 1 6 3 – – – – 7 4 11 North – 1 5 2 – 1 – – 5 4 9 North-West 9 3 2 5 – 1 – – 11 9 20 South – – 1 1 – – – – 1 1 2 South-East 2 2 1 1 – – 1 – 4 3 7 South-West – – – – – – – – – – – Total 12 7 15 12 – 2 l – 28 21 49 AGES AT DEATH. Under 1 1-2 2-5 5-15 15-2 5 2 5-45 45-65 65 & upwards All Ages 10 18 20 1 — – – – 49 Measles presents a problem bristling with difficulties, for infectivity is greatest at the time of the appearance of the rash. Measles is not transmitted by means of the desquamation. Terminal disinfection is probably useless and therefore unnecessary. Transmission of the disease by third persons or by fomites is exceedingly improbable. The control of measles depends upon the early recognition of cases. Notification of Measles. Cases of measles aud German measles are in future to be notified by medical practitioners and by parents or guardians. The order imposing the requirement is called the Public Health (Measles and German Measles) Regulations, 1915, and it comes into force on January 1st, 1916. This fact was made known to the Public Health Committee on 1st December, 1915. 65 It is to be hoped that the order will meet with success, but I have some doubts unless the measures tendered by the Local Government Board are also carried out. I do not, however, mean to make too much of the possibility of failure. The first step in this connection is to try to ensure success. To forget the difficulties and drawbacks and to go ahead. It is difficult to put a scheme before the Council involving additional Health Visitors, one or more nurses, not to mention a measles medical officer, when there is so much talk of economising even in public health, but I warn the Council that such things may have to come. 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 April 28th to May 14th in Classroom A ; Classroom B from May 3rd to May 21st; Classroom C from May 29th to May 14th ; Classroom F from April 19th to May 7th. Canterbury Road Unprotected children in Classroom A excluded from February 15th to March 5th and from Classroom B from February 17th to March 5th. Childeric Road Unprotected children in Classroom C excluded from May 7th to May 28th ; Classroom D from May 13th to May 28th ; Classroom E from May 4th to May 21st. Deptford R. C. Unprotected children in Classroom A excluded from May 13th to May 28th; Classroom C from May 13th to May 28th. Render Street Unprotected children in Classroom A excluded from April 29th to May 14th ; Classroom F from May 26th to June 4th. Mantle Road Unprotected children in Classroom C excluded from March 11th to March 26th and from April 22nd to May 14th; Hall class from May 3rd to May 21st; Classroom D from April 28th to May 14th. 66 Monson Road Unprotected children in Classroom A excluded from January 21st to January 29th and from July 5th to July 21st. Nynehead Srreet Unprotected children in Classroom D excluded from Decomber 8th to Decemher 23rd; Clasfroom E from May 10th to May 28th, and from November 1st to November 12th. St. James' Unprotected children in Classroom 2 excluded from May 17th to May 28th. Stanley Street Unprotected children in Classroom A excluded from May 6th to May 21st; Classroom B from May 17th to May 28th ; Classroom C from March 22nd to March 31st. Trundleys Road Unprotected children in Classroom A excluded from May 3rd to May 21st; Classroom D from April 26th to May 14th. 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:— 67 Disease. Period of exclusion of children suffering from the disease Period of exclusion of children living in houses where the disease exists. Rules in regard to flats and tenement houses. 1 2. 3. 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. Diphtheria Membranous croup (2) Until after discharge from hospital. (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 infants 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 last case in the house German measles 14 days from date of rash . Same rules as for ordinary measles, In cases where children live in tenement houses exclude as follows— 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. (a) 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 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 eczemz 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 scalp 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. E 2 68 Whooping Cough. Average for 1915. previous 10 years. Number of Deaths 61 34 Death rate per 1000, Deptford 0.55 0.29 This disease was the cause of 61 deaths compared with 9, 43 and 24 for the three preceding years. The death rate per 1000 persons living was 0.55 as compared with 0.8, 0.39 and 0.22 for the three preceding years. The deaths occurred among the inhabitants of the various Wards as follows:— East 22. North 15. North-West 9. South 3. South-East 6. South-West 6. 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 5 3 7 3 – 1 – 10 12 22 North 2 – 2 6 2 2 1 – 7 8 15 North-West 3 1 – 3 1 1 – – 4 5 9 South 1 – – 2 – – – – 1 2 3 South-East – 1 4 1 – – – – 4 2 6 South-West 2 1 1 – – – – 2 3 3 6 Total 11 8 10 19 6 3 2 2 29 32 61 AGES AT DEATH. Under l 1-2 2-5 5-15 15-25 25-45 45-65 65 & upward All Ages. 23 23 14 1 – – – – 61 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 1914, the latest year for which there are records, there were 9144 deaths from measles 69 in England and Wales. Whooping cough accounted for 8,044 deaths. The fatality from these two popularly considered mild diseases may profitably be compared with that from scarlet fever and diphtheria. The total deaths from smallpox, enteric fever, scarlet fever and diphtheria combined was 10,450. 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 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 Total Measles 71 55 33 66 60 67 28 50 50 49 529 Whooping Cough 61 35 25 47 44 35 24 43 9 61 384 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 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 Total Measles Under 5 years 64 51 32 60 50 62 27 48 48 48 490 Over 5 years 7 4 1 6 10 5 1 2 2 1 39 Total 71 55 33 66 60 67 28 50 50 49 529 Whooping Cough Under 5 years 59 34 24 45 42 34 24 42 9 60 373 Over 5 years 2 1 1 2 2 1 – 1 – 1 11 Total 61 35 25 47 44 35 24 43 9 61 384 70 Leprosy. There were no known cases of Leprosy in the Borough during the year. Pulmonary Tuberculosis, including Phthisis. Number of cases notified, 1915 299 Number of deaths 172 Death-rate per 1,000 (Deptford) 1.56 Phthisis was the cause of 172 deaths during 1915, compared with 152 for 1914. The death-rate was 1.56 per 1,000 persons, compared with 1.39, 1.33 and 1.35 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 98 47 2.2 21,340 North 70 43 1.8 24,043 North-west 47 32 1.4 23,652 South 19 10 0.8 12,232 South-east 33 22 1.8 12,411 South-west 32 18 1.1 16,621 Whole borough 299 172 1.56 110,299 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. 71 WARDS. QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F M. F Total. East 11 10 15 12 8 12 17 13 51 47 98 North 19 7 10 11 7 4 4 8 40 30 70 North-West 5 8 6 6 6 2 5 9 22 25 47 South 4 5 1 1 3 2 3 – 11 8 19 South-East 9 4 8 1 2 6 2 1 21 12 33 South-West 9 4 1 5 3 3 2 5 15 17 32 Total 57 38 41 36 29 29 33 36 160 139 299 AGES OF PATIENTS NOTIFIED. Under l 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Agea. —– 8 45 57 127 57 5 299 General Tuberculosis. Fifty-four deaths were recorded as being due to these diseases. Of these deaths 11 occurred in the East Ward, 16 in the North, 12 in the North-West, 2 in the South, 5 in the South-East, and 8 in the South-West. Twenty-eight deaths were classified as tuberculous meningitis and 26 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 7 8 • 9 2 1 – 1 – Other Tubercular Diseases 9 2 4 7 1 2 – 1 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. 72 wards QUARTERS. YEAR. March. June. Sept. Dec. M. F. M. F. M. F. M. F. M. F. Total. East 6 4 3 5 6 6 7 8 22 23 45 North 2 3 2 – 1 2 2 2 7 7 14 North-West 4 3 5 1 3 2 2 1 14 7 21 South – – 1 1 – 2 1 1 2 4 6 South-East 3 – 2 2 – 2 2 2 7 6 13 South-West 2 2 2 1 – – – – 4 3 7 Total 17 12 15 10 10 14 14 14 56 50 106 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards. All Ages. 12 26 41 11 6 8 2 106 Tuberculosis. The following is a List of Sanatoria for the Treatment of Tuberculosis by the London County Council. Beds for children from the Metropolitan area. Name of Institution. No. of authorised Beds. Age limits. Whether education is provided. Boys. Girls. Harpenden 10 Under 14 Under 16 Yes Nayland 100 „ 16 „ 16 Yes Carshalton 100 „ 16 „ 16 Yes Alexandra Hospital and Clandon Home 30 „ 12 „ 12 Yes Great Ormond Street Hospital 10 „ 12 „ 12 Yes Cromwell House, Highgate 30 „ 12 „ 12 Yes Brompton 10 „ 16 „ 16 No Fleet 10 „ 8 „ H Yes Victoria Home, Margate 5 „ 12 „ 15 Yes Ide Hill, Sevenoaks 5 „ 16 „ 16 Yes East London Hospital 12 „ 13 „ 13 Arrangements will not be complete until May 1st Bognor Sanatorium 28 73 The County Council has given authority for 231 beds to be taken for children (exclusive of those provided at Carshalton) and the balance of the authorised number is being taken as opportunity occurs. No. of beds Name of Institution. occupied on Jan. 28, 1916. Harpenden 10 Nayland 64 Carshalton 75 Brompton 10 Alexandra and Clandon 27 Great Ormond Street and Cromwell House 40 Victoria Home, Margate 5 Fleet 10 Ide Hill, Sevenoaks 4 St. Vincent's Home, Pinner 1 Royal Sea Bathing Hospital, Margate 1 Victoria Park Hospital 2 King's College Hospital 1 Total 250 Tuberculosis Care Committees. Interim arrangements pending the formulation and approval of Local Schemes. The London County Council desires to obtain local advice and assistance in connection with tuberculous child patients referred to it for residential treatment, under the scheme for the treatment of tuberculosis in London, as to:— (1) The suitability of the case for treatment by the Council under the scheme; (2) The amount, if any, which the parents or guardians of the child should be invited to contribute towards the cost of treatment; (3) The selection of a visitor to visit the home (in accordance with the provisions of clauses 4, 5, 9 and 11 of the model scheme of the Public Health Committee of the Council.) For the above-mentioned purposes the Council has instructed its officers to endeavour to obtain the co-operation and assistance of the 74 local medical officer of health, the local dispensary care committee (or, in the absence of such a committee, of the tuberculosis officer) and local social workers, representatives of local hospitals and others. The Council hopes to receive from the representatives of voluntary agencies advice as to the amount which should be paid in each case, and also as to the most suitable visitor to collect the contribution. The amounts collected will be paid in to the Comptroller of the Council. November, 1915. Tuberculosis Scheme. Interim Advisory Committee —Children. Pending the submission of Schemes for Tuberculosis Care Committee by the Borough Councils and their approval by the London County Council and Local Goverument Board, it is suggested that Interim Committees be formed in connection with each Borough or Dispensary area, and that they should be constituted as follows:— (a) Borough Medical Officer of Health. (b) Tuberculosis Dispensary Medical Officer. (c) Health Visitors. (d) London County Council Divisional Medical Officer. (e) London County Council District Organizer. (f) Invalid Children's Aid Association Representatives. (g) Hospital Almoner or Representative. Procedure proposed under the Interim Advisory Committee Scheme. (1) Forms A and B will be forwarded to the County Medical Officer of Health by the Borough Medical Officer of Health as at present. (2) Cases may be rejected or sent to the referee on purely medical grounds as hitherto. (3) Cases selected as suitable for medical reasons will be forwarded together with Form B to the London County Council District Organizer. (4) These cases will be referred to the Interim Advisory Committee concerned by the District Organizer. They will be asked to make recommendations as to the amount (if any) for which the parent should be assessed, and as to the visitor who should be attached to the case, and they will forward all such information as they possess on these matters to the County Medical Officer of Health through the District Organizer. The Committee 75 will also be asked to "classify the cases into groups," but not to take action in respect of such groups without reference to the London County Council. (5) The final decision as to assessment and all other matters will remain with the London County Council. (6) This decision will be communicated subsequently to the Interim Advisory Committee concerned by the District Organizer in each case. (7) The signature to the parents' consent form and the collection of the assessment (if any) will be done by the member of the Interim Committee in charge of the case. (8) All correspondence re patient while under institutional treatment will be conducted by the London County Council Central Office. (9) Notice of date of discharge will be sent beforehand to the District Organizer for the information of the Interim Advisory Committee and subsequent to discharge progress reports will be asked for periodically, for the information of the London County Council. (10) The London County Council reserves the right to deal with all emergency cases without reference to any committee. MUNICIPAL TUBERCULOSIS DISPENSARY. Dr. Macdonald reports as follows :—-In submitting the report of the work done at the Dispensary during the year 1915, it will be noticed that several tables shown in previous reports have been altered, one omitted and one or two added. By this rearrangement it is hoped to present a clearer and more precise account of the work accomplished than was formerly the case. The tables showing the condition of the patients on admission and the results of treatment seemed to be specially called for. With reference to the term "discharged" it is well to remember that "discharged" in the case of tubercular patients does not mean loss of connection with the Dispensary. It simply means that active or systematic treatment is no longer deemed necessary, and each patient is given fully to understand that he is expected to report at the Dispensary at stated intervals with the proviso that should urgent symptoms develop he should immediately inform the Dispensary or his own medical attendant. 76 Sanatorium cases are specially requested to follow this procedure but I regret to say that they seldom see the necessity to do so until the occurrence of a severe relapse compels them to seek advice. Probably they feel so well on leaving the sanatorium that they fancy themselves cured in spite of the warning they one and all receive that care and constant medical supervision are necessary to maintain any improvement in their health. The war has indirectly affected the work in several ways. During the winter months the attendances at the Evening Dispensary suffered severely from the darkened streets, but the chief complaint is the interference with treatment caused by the long hours of overtime worked by many of the patients. At the end of a day's work they were "played out" and too tired to attend. Others, tempted by the high wages to be earned in munition and kindred works, left employment more suited to their condition of health for work which rapidly caused them to realize that the truer economy for them was to have remained at their former employment even with the lower wages. Like other dispensary officers I have to deplore the large number of patients who postpone seeking advice until they are literally compelled to do so. The belief still seems to be prevalent that consumption is something to be ashamed of and therefore hidden at all costs. The harm that such cases do to others, let alone to themselves, is incalculable, because every case of tuberculosis is liable to become at any time a potent source of infection to others. It is satisfactory to note that the Dispensary is being more generally recognised as an institution for a particular purpose, and this year there, have been fewer instances of people coming up with all sortsof complaints. In September, the Dispensary was closed for a fortnight for painting and minor repairs. Some improvement resulted, but the condition of the walls and stairways generally is such that constant attention will be necessary if the place is to retain that clean and fresh appearance that a tuberculosis dispensary should always present. Such a dispensary should be an object lesson to the patients in cleanliness and simple methods of ventilation. Before concluding this portion of the Report, I have to thank the Medical Officer of Health and all members of the staff for their cordial co-operation and assistance in carrying, out the work of the Dispensary. In July, Miss Greig was appointed Dispenser Clerk, vice Miss Jared, resigned, and I greatly regret to report the death from pneumonia of H. Hayes, the temporary caretaker, in whom the Council lost a faithful and willing worker. A successor has been appointed, otherwise the staff remains the same. * 77 The number of patients examined at the Dispensary during 1915 was 971, of whom 445 were males and 526 females. Of this number 170 were insured. Table I. shows the details of these cases together with the attendances made by all patients (both new and old). Table I. MONTHLY ATTENDANCES DURING 1915. New Cases. Contacts. Total Attendances. All Cases. January 84 16 513 February 121 44 595 March 96 38 665 April 51 22 439 May 36 24 372 June 52 8 370 July 45 37 480 August 37 28 464 September *30 9 248* October 39 21 299 November 52 20 726 December 44 17 545 687 284 5916 *Closed two weeks for repairs. Table II. shows the various sources from which patients came to the Dispensary. Table II. SOURCE OF CASES EXAMINED AT THE DISPENSARY. Diagnosed as suffering from Applied on own initiative. Sent by Doctor. Sent by Health Visitor. Sent by School or Hospital etc. Totals. (a) Pulmonary Tuberculosis 59 60 36 31 186 (b) Non-Pulmonary Tuberculosis 27 17 25 — 69 (c) No Tubercular disease 245 58 111 18 432 Totals 331 135 172 49 687 78 Table III. deals with Contacts, the examination of whom forms one of the most important functions of Dispensary work, for it is here that the earliest and therefore most hopeful cases are to be discovered. It will be noted that of the 284 contacts examined, 28 were found to be tubercular. The contacts are all requested to attend by the Health Visitor or Tuberculosis Officer, and as a rule the examinations are conducted at the Dispensary. Table III. details of contacts examined and discharged. Examined Discharged Diagnosed as Tubercular Male Female Total Male Female Total Male Female Total Insured 11 13 24 10 12 22 l l 2 Non-Insured 123 137 260 119 115 234 4 22 26 134 150 284 129 127 256 5 23 28 pulmonary tuberculosis. The three following Tables (IV. V. & VI.) give particulars relating to those cases diagnosed as suffering from Pulmonary Tuberculosis, i.e., Consumption of the Lungs. Attention is directed to Table VI. which shows that of the 186 cases admitted, 145 were in an advanced condition before presenting themselves. This is much to be regretted if only for the patients' sake. Many of these cases expect to be cured right away by admission to a Sanatorium, and are correspondingly disappointed when told that Sanatorium Treatment is only suitable for comparatively early cases. Table IV. details of patients' suffering from pulmonary tuberculosis. Carried forwd. 31 Dec., 1914. Admitted, 1915. Total treated. 1915. Discharged Died Left District, etc. Total charged Remaining ment, 1915. Improved Not Improved Male 53 98 151 39 19 2 30 90 61 Female 44 88 132 28 14 1 10 53 79 97 186 283 67 33 3* 40 143 140 * Of the three deaths, one was complicated by Cancer of the tongue; one by Nephritis (disease of the kidneys), and the third by severe haemorrhage from the lung. 79 Table V. age and sex distribution of 186 cases admitted as pulmonary tuberculosis. Under 5 Between 5-15 Between 15-25 Between 25-35 Between 35-45 Between 45-55 55 and over Totals. Males - 22 13 29 22 9 3 98 Females l 18 19 22 15 7 6 88 Totals l 40 32 51 37 16 9 186 Table VI. showing stage of disease of above patients. (turban's classification.) 1st stage 2nd stage 3rd stage Totals Male 19 49 30 98 Female 22 46 20 88 41 95 50 186 non-pulmonary tuberculosis. The particulars of patients admitted with other forms of Tuberculosis than that of the lungs will be found below. The nature of the cases admitted was as follows:— Glands—Cervical 36; Abdominal 13. Bones 7 Joints 9 Skin 4 Table VII. details of patients suffering from non-pulmonary tuberculosis. Carried forward 31.12.14 Admitted 1915 Total treated 1915 Discharged. Died Left District etc. Total Discharged Remaining under treatmen/t 31.12.15 Improved Not improved Male 7 28 35 14 7 - - 13 Female 7 41 48 17 7 2 — 22 14 69 83 31 14 3* 35 *Two of the deaths occurred in hospital to which the patients had been referred. 80 Table VIII. age and sex of 69 cases admitted as non-pulmonary tuberculosis. Under 5 Between 5-15 Between 15-25 Between 25-35 Between 35-45 Between 45-55 55 and over Totals. Males 7 16 4 1 — — — 28 Females 8 29 2 2 — — — 41 Totals 15 45 6 3 — — — 69 non-tubercular and doubtful cases. As before remarked, fewer people attended the Dispensary this year with the idea that it was open for treatment of all kinds of diseases. The great majority of the cases referred to in the following table suffering from chest complaints such as bronchitis, "colds," asthma, etc., and were directed to their family medical attendant or to Hospital as seemed advisable. Table IX. details of patients diagnosed as non-tubercular. Carried forward 31st Dec., 1914. Admitted 1915. Total examined. Discharged nontubercular. Remaining under observation, 31st Dec., 1915. Male 77 185 262 240 22 Female 79 247 326 296 30 156 432 588 536 52 Table X. Homes visited by Tuberculosis Officer and Medical Officer of Health 196 Visits by staff on first notification 531 Revisits 1550 Special cases referred to staff by Tuberculosis Officer 94 81 Diagnosis.—As in the previous year, Tuberculin was used to assist diagnosis in all doubtful cases, i.e., cases whose sputa did not show bacilli, or where the physical signs and symptoms were indefinite. The value of the negative reaction in the von Pirquet Test was very fully appreciated in those adults, cases where a correct thermometric reading could not be relied upon. During the year 256 specimens of sputa were examined in the Laboratory at the Dispensary with 56 positive results. Treatment.—Treatment by Tuberculin injections has been carried out in suitable cases, viz., about 55 per cent. of the cases diagnosed as tubercular. The results where patients attended regularly are encouraging, but there is the ever present difficulty of inducing patients to keep on attending when once they find themselves comparatively well. In 3 cases tuberculin administration was stopped, the patients gradually losing weight, or the pulmonary condition becoming worse. In several cases where patients were undergoing this treatment the course had to be abandoned in consequence of the strenuous nature of their employment rendering them physically unfit to receive injections. Routine treatment was carried out in all cases whether receiving Tuberculin or not and calls for no comment, but attention must be drawn to the treatment of those advanced cases which so constantly present themselves at the Dispensary. At present one can only offer them the Workhouse Infirmary, and naturally many are averse to entering that Institution. Now as those advanced cases are the most infectious, it is obviously hopeless to think of eradicating consumption and allow those people to go back to homes, which in many instances are quite unsuitable for their condition. While every effort is made to get hold of early cases, it is every whit as important that proper accommodation should be provided for the advanced case, which from the Public Health view is the more dangerous of the two. During the year, 84 patients from Deptford were admitted to Sanatoria under the National Insurance Scheme, and 91 to Poor Law Institutions. An extra nourishment grant from the Insurance Committee in the form of a daily supply of milk and eggs for a period varying from 2 to 4 months, was obtained for eight insured persons judged to be receiving insufficient nourishment at home. F 82 In the Interim Report of the Departmental Committee on Tuberculosis, it is recommended that a Tuberculosis Dispensary should act as— 1. A Receiving House and Centre of Diagnosis. 2. A Clearing House and Centre of Observation. 3. A Centre for Curative Treatment. 4. A Centre for Examination of Contacts. 5. A Centre for After Care. 6. An Information Bureau and Educational Centre. From the present and previous reports it will be seen that the Dispensary is fulfilling those requirements. 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:— 1915 8,232 articles of bedding, clothing, etc. 1914 11,784 ,, ,, ,, 1913 8,875 ,, ,, ,, 1912 7,577 ,, ,, ,, The number of rooms disinfected by the Council's staff during the year was 1,230. Disinfecting fluid is supplied gratis where required. For the removal of infected bedding, etc., and its return after disin fection 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 1,230 rooms in 1,105 houses in which infectious diseases, etc., have occurred, have been carried out under the 83 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. Table SHEWING THE NUMBER OF PREMISES, ROOMS AND BEDDING DISINFECTED DURING THE YEAR 1915. 1915 Premises. Rooms. Beds. Pillows. Bolsters. Mattresses Sheets. Blankets. Odd Articles. Articles Destroyed. January 97 107 65 127 50 19 49 170 222 8 mattresses, 12 odd articles February 107 119 80 160 53 33 90 131 300 2 pillows, 2 bolsters March 116 124 86 170 71 36 68 138 337 1 mattress, 30 odd articles, 1 bed. April 86 97 53 134 38 15 60 102 297 2 beds. May 69 81 41 89 31 10 44 64 210 June 80 95 52 87 33 13 44 48 214 1 mattress, 10 odd articles July 89 99 55 102 40 15 69 74 194 2 beds, 1 bolster, 1 mattress August 87 90 56 114 41 21 65 56 188 2 beds, 2 mattresses, 9 pillows, 3 bolsters, 2 odd articles September 88 97 56 97 36 16 55 209 205 2 beds, 1 mattress, 1 1 bolster, 1 pillow, 5 odd articles. October 102 127 83 160 61 39 88 107 255 1 bed. November 87 95 68 149 47 25 55 112 238 1 bed, 3 mattresses, 2 odd articles December 97 99 70 152 53 37 84 134 317 Total 1105 1230 765 1541 554 279 771 1345 2977 Table SHEWING NUMBER OF ROOMS DISINFECTED AFTER THE FOLLOWING DISEASES:— 1915 Small Pox. Scarlet Fever. Diphtheria. Erysipelas. Enteric Fever. Pulmonary Tuberculosis Measles. Puerperal Fever. Cerebrospinal Fever. Other Diseases. January .. 52 15 1 .. 22 1 1 .. 6 February .. 50 17 6 10 23 2 .. 3 .. March .. 38 23 1 10 41 .. .. 5 1 April .. 27 12 1 3 40 3 .. 4 5 May .. 22 14 .. 5 30 1 1 1 3 June .. 34 9 1 2 19 2 .. .. 6 July .. 47 11 .. .. 21 4 .. .. 3 August .. 37 18 .. .. 25 2 .. .. 2 September .. 29 16 1 1 28 .. .. 1 2 October .. 38 24 1 1 36 1 1 .. .. November .. 40 17 .. 1 26 .. 1 2 5 December .. 36 20 1 27 3 .. 1 6 Total .. 450 196 13 33 338 19 4 17 39 84 Special Cases. In 19 instances special requests were received to disinfect or destroy articles of bedding after deaths from Cancer, &c. Such disinfections were carried out. VERMINOUS PREMISES. 86 premises consisting of 121 rooms were fumigated during the year. MIDWIVES ACT. Disinfection of wearing apparel, etc., was carried out in 3 cases. BOOKS DISINFECTED. 161 Library books collected from houses where infectious diseases had occurred, were disinfected before being put back into circulation. 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. 4£-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 of books taken from infected houses. 85 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 1105 ,, ,, Rooms ,, 1230 ,, ,, Beds ,, 765 ,, ,, Pillows „ 1541 „ ,, Bolsters ,, 554 ,, ,, Mattresses ,, 279 ,, ,, Sheets ,, 771 ,, „ Blankets ,, 1345 ,, ,, Odd articles ,, 2977 Total articles 8232 Total number of Beds destroyed 11 „ ,, Mattresses „ 17 ,, ,, Odd articles ,, 61 „ ,, Pillows ,, 12 „ ,, Bolsters ,, 7 N.B.—The above articles were destroyed at the request of the owners. Cleansing of Children attending the Elementary Schools in Deptford. Three-and-a-half years ago this Council commenced 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 period that we have undertaken this work 2,817 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 5,696 baths have been given and 5,696 sets of clothing have been disinfected. 86 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 1915 711 311 218 1240 2817 1705 1174 5696 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 articles of clothing which are verminous. 5. By contact of the child's clothing with verminous clothing in a pawnshop. Mortuary and Coroner's Court. BODIES RECEIVED INTO THE MORTUARY DURING THE YEAR 1915. Total. Males. Females. Post Mortems. Inquests. Unknown. Brought in to await burial only Infectious. 139 85 54 79 125 4 8 1 87 Coroner's Court. VERDICTS IN THE 125 INQUESTS HELD. Natural causes 57 Accidental causes 39 Suicide while insane 5 Misadventure 2 Inattention at birth 2 Open verdicts 20 OTHER NOTIFIABLE DISEASES. Ward. Small Pox. Erysipelas. Cerebro-spinal Fever. Puerperal Fever. Acute Polio Myelitis. Ophthalmia Neonatorum. Anthrax Total. M F M F M F M F M F M F M F M F Total. East ... ... 20 31 1 3 ... 1 ... ... 2 2 ... ... 23 37 60 North ... ... 18 12 2 1 ... ... ... ... 1 3 ... ... 21 16 37 North-West ... ... 16 9 3 ... ... 2 1 ... ... 2 ... ... 20 13 33 South ... ... 5 5 1 1 ... ... 1 ... 1 ... ... ... 8 6 14 South-East ... ... 16 2 ... 3 ... ... ... ... ... ... 1 ... 17 5 22 South-West ... ... 6 6 ... ... ... 1 ... ... ... 2 ... ... 6 9 15 Total ... ... 81 65 7 8 ... 4 2 ... 4 9 1 ... 95 86 181 AGES OF PATIENTS NOTIFIED. Under 1 1-5 5-15 15-25 25-45 45-65 65 & upwards All ages. 19 14 17 28 41 47 15 181 88 Respiratory Diseases. Under this heading are included bronchitis, pneumonia, pleurisy, and other diseases of the respiratory organs. The number of deaths registered was 430. Of these deaths 91 were children under one year of age, 78 over one and under five years, and 111 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 21 deaths during the year compared with 22 for the year 1914. 11 of the deaths occurred between the ages of 25 and 65, and the remainder were of persons over 65. Constitutional Diseases. These diseases which form a group which are only second in importance to those known as the epidemic diseases accounted for 259 more deaths in 1915 than in 1914. They include rheumatic fever, rheumatism, rickets, diabetes, gout, anaemia, heart, arterial and other defined diseases. During the year they caused 944 deaths against 685 for the previous year. Cancer and Malignant Diseases. One hundred and nineteen deaths from cancer and malignant diseases were recorded during the year. They were equal to a death rate of 10.8 per 10,000 of the population, which is 0.3 below the rate recorded in the preceding year. When comparison is made with the mean return for the preceding ten years it is found that they are 18 in excess. 89 DEATHS FROM CANCER DURING 1915. PART AFFECTED All Ages 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75-85 85 and upward M F Total. M F M F M F M F M F M F M F M F M F M F Buccal Cavity 9 2 11 .. .. .. .. .. .. .. .. 1 •• .. 1 4 1 3 .. 1 .. .. .. Stomach, Liver, &c. 13 13 26 .. .. .. .. .. .. .. .. .. 1 .. 4 6 4 5 3 2 1 .. .. Peritoneum, Intestines and Rectum 15 22 37 .. .. .. .. .. .. .. .. 2 2 4 6 6 4 2 6 1 4 .. .. Female Generative Organs .. 12 12 .. .. .. .. .. .. .. 1 .. 2 .. 4 .. 3 .. 1 .. 1 .. .. Breast .. 14 14 .. .. .. .. .. .. .. .. .. 2 .. 4 .. 3 .. 3 .. 2 .. .. Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other or Unspecified Organs 11 8 19 .. .. 2 1 .. .. 1 •• .. 1 2 .. 3 2 .. 1 2 3 .. .. 48 71 119 .. .. 2 1 .. .. 1 1 3 8 6 19 19 17 11 14 6 11 .. .. 90 Table No. 7. METROPOLITAN BOROUGH OF DEPTFORD. Shewing the Streets in which Infectious Disease occurred during 1915. STREET. Small Pox. Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Fever. Acute Poliomyelitis. Ophthalmia Neonatorum. Pulmonary Tuberculosis. Other Tuberculosus Diseases. Anthrax. Abinger Road 1 8 1 Achilles Street 1 1 Addey Street 1 3 1 2 Adolphus Street 1 1 2 1 2 Albury Street 2 1 2 1 Albyn Road 1 1 Alexandra Street 2 4 Alloa Road 2 2 1 Alpine Road 2 2 Alvar Street 1 2 2 3 Alverton Street 2 1 Amelia Terrace Amersham Grove Amersham Road 3 1 1 1 1 1 Amersham Vale 4 4 4 Andom Terrace 1 Angus Street 2 1 Arbuthnot Road Arica Road 1 1 1 1 Arklow Road 1 Ashmead Road 1 Aspinall Road 1 Atkinson Street Avignon Road 1 Avonley Road 1 Baildon Street 1 2 1 1 5 Barlborough St. 1 2 Batavia Road 1 2 1 Bawtree Road 4 1 Benmore Street 1 1 Berthon Street 1 4 Besson Street 1 1 1 Bestwood Street Bevil Street 1 Billington Road 1 Batsford Road 1 1 Bingley Place 1 Blackhorse Road 1 4 Blockhouse Street 2 5 1 Bolden Street 1 1 Bolina Road 5 2 10 2 Boscawen Street 1 4 1 Bousfield Road 3 Breakspears Road 3 1 91 Table No. 7—continued Shewing the Streets in which Infectious Disease occurred during 1915. STREET. Small Pox Diphtheria. Erysipelas. Scarlet Fever Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Fever. Acute Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis Other Tuberculous Diseases. Anthrax. Briant Street 2 4 1 Brindley Street 1 Broadway 1 Brocklehurst St. 3 1 1 Brockley Road 4 2 3 3 Brookmill Road 1 3 1 1 1 Bronze Street 3 12 4 Camplin Street 1 1 Canterbury Road l 3 2 1 Carrington House 5 8 2 Childeric Road 1 7 2 1 Casella Road 1 Childers Street 5 2 3 2 1 3 Chipley Street 1 3 2 Chubworthy St. 1 1 Church Street 4 2 7 1 9 2 Clandon Street 1 Clifton Hill 1 3 Clifton Road 1 Clyde Street 1 1 Colwick Street 1 1 1 Comet Street 1 1 Copperas Square Copperas Street 1 Cornbury Road 1 1 2 Cottesbrooke St. 2 Cranbrook Road 1 1 Cranfield Road 1 1 1 Creek Street 1 1 Croft Street 1 4 Crook Road 2 Crossfield Street 2 3 4 1 2 Czar Street 1 2 Deloraine Street 1 Dennett's Grove 1 Dennett's Road 1 2 4 Deptford B'dway Desmond Street 1 2 1 1 1 Dollings Place Dorking Road 1 5 4 1 Douglas Street 2 2 3 3 Drakefell Road 2 2 Drake Buildings 1 Dugald Street 1 1 Dundalk Road 2 1 1 Eckington Gdns. . 1 1 Edale Road 2 1 3 92 Table No. 7 -continued. Shewing the Streets in which Infectious Disease occurred during 1915. STREET. Small Pox Diphtheria. Erysipelas Scarlet Fever. Fnteric Fever. Continued Fever. Puerperal Fever Cerebrospinal Fever. Acute Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis. Other Tuberculous Diseases. Anthrax. Edward Place 1 Edric Road 1 1 Edward Street 1 2 2 2 1 6 Egmont Street Elm Terrace 1 Endwell Road 1 1 Erlam Road Erlanger Road 1 2 1 Etta Street 2 1 2 Eugenia Road 1 Evelyn Street 2 3 2 4 1 8 1 Evelina Road 1 1 Faulkner Street 1 Fawcett Road 1 2 1 1 Ffinch Street 1 1 Finland Road 1 2 2 1 Fisher's Rents 1 Florence Road 1 1 2 1 Florence Street Florence Cottages 1 Folkestone Gdns. 3 1 3 2 1 Foxberry Road 3 1 1 Foxwell Street 1 1 Frankham Street 3 3 2 Friendly Street 1 1 2 1 1 Gellatly Road 1 1 1 Giffin Street 1 3 3 1 10 1 Glenville Grove 1 2 1 Goodwood Road Gosterwood Street 2 5 2 3 Greenfield Street 2 Grinling Place Grinstead Road 1 2 1 Grove Street 2 4 5 2 1 Harcourt Road 1 Hales Street 1 2 2 1 1 Hamilton Street 3 Hanlon Street 2 Harefield Road 2 2 1 Harton Street 2 1 3 Hatcham Pk. Rd. 1 1 1 1 Haydock Road 2 2 2 1 Heston Street 2 2 2 4 1 1 High Street 2 2 2 2 1 Hicks Street 2 1 93 Table No. 7-continued. Shewing the Streets in which Infectious Disease occurred during 1915. STREET. Small Pox Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Fever. Acute Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis. Other Tuberculous Diseases. Anthrax. Hornshay Street 1 Hornshay Place Hosier Street 2 3 2 Hunsdon Road 1 3 1 Hyde Street 5 4 3 3 1 Idonia Street 2 2 Ilderton Road 2 Jerningham Road 4 1 1 Junction Road 1 1 Kender Street 3 3 1 1 Kender Place 1 Kent Terrace 1 Kenwood Avenue 1 Kerry Road 6 4 2 Kitto Road 1 Knott Street 1 2 1 Knott's Terrace 2 1 1 Knoyle Street 1 2 Kempslade Place 1 3 1 Lausanne Road 1 6 Laurie Grove l Leonidas Street 1 1 1 Lee Terrace 1 Lewisham High Road 1 1 1 1 Liardet Grove 1 Liardet Street 2 1 Lind Street 1 Lindo Street 1 Lovelinch Street 2 4 1 Lubbock Street 1 Ludwick Road 1 1 1 2 Lucas Street 1 2 Leylang Road 2 1 Malpas Road 3 2 3 1 2 Manor Road 1 1 2 1 Marchant Street 1 Mary Ann's Bdgs. 1 Mason's Grove 2 1 Milton Court Rd. 4 1 7 5 Mitchell's Cottgs. 1 94 Table No. 7.-continued. Showing the Streets in which Infectious Disease occurred during 1915. STREET. Small Pox. Diphtheria Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Fever. Acute Poliomyelitis Ophthalmia Neonatorum. Pulmonary Tuberculosis. Other Tuberculous Diseases. Anthrax. Mona Road 1 Monson Road 3 2 2 Mornington Road 1 1 Musgrove Road 1 Napier Street 1 3 15 3 1 Nettleton Road 1 New Cross Road 5 1 6 1 1 7 2 New King Street 1 Norval Street Nynehead Street 1 1 2 Norfolk House 1 3 1 Oareboro' Road 1 1 2 Octavius Street 2 Oldfield Road Oldfield Villas 1 Ommaney Road 1 1 Oscar Street 1 3 Park Road 1 Pagnell Street 1 1 1 Payne Street l 3 1 1 Pender Street 1 Pepys Road 1 2 Pendrell Road 1 Pomeroy Street 1 1 3 1 Prince Street 1 1 3 1 Prospect Place 1 1 Providence Place 1 Queen's Road 1 1 1 1 Reservoir Road 2 1 Railway Grove 4 1 Raleigh Buildings 8 1 Reaston Street 2 2 2 1 Rectory Buildings 2 1 2 1 Reculver Road 2 3 3 1 Reginald Road 2 1 2 1 Reginald Place 1 2 Revelon Road 1 5 1 Rokeby Road 4 1 Rollins Street 1 2 1 Rolt Street 1 4 3 Ruddigore Road 1 Rudford Road 1 5 1 Rutt's Terrace Royal Naval P1. Rowley Street 95 Table No. 7-continued. Shewing the Streets in which Infectious Disease occurred during 1915. STREET. Small Pox Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever. Puerperal Fever. Cerebrospinal Fever. Acute Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis. Other Tuberculous Diseases. Anthrax, St. Asaph Road 2 3 2 St. Donatt's Road 4 St. James' 1 St. John's Road 6 1 2 St. John's Terrace St. Nicholas' St. St. Margaret's Rd. 1 St. Norbert Road 1 Sayes Street 1 Scawen Road 3 Selden Road 1 1 Senegal Road 2 2 1 Seymour Street 3 1 1 1 Shardeloes Road 1 5 4 Sharratt Street 1 1 Shere Road 1 Sandbourne Road 1 Silwood Street 3 1 1 Snead Street 1 2 3 2 Somerville Road 2 1 2 South Eastern Hospital (Staff) 8 1 9 Speedwell Street 1 3 9 3 1 Spring Street 1 1 Stanhope Street 1 6 3 Stanley Street 1 1 Staunton Street 6 1 2 1 2 1 Strickland Street 1 3 Summer Street 2 2 Sun Cottages 2 Tanner's Hill 1 3 3 1 Tolhurst Street Tressillian Crsnt. 1 1 Trim Street 1 2 Trundleys Road 1 4 3 2 1 4 Tyrwhitt Road 1 Troutbeck Road 1 Upcott Street 2 2 Vance Street 1 3 1 Vanguard Street 3 2 Vansittart Street 1 4 Ventnor Road 1 2 Vesta Road 3 Vulcan Road 1 Vulcan Terrace 1 96 Table No. 7-continued. Shewing the Streets in which Infectious Disease occurred during 1915. STREET. Small Pox. Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Continued Fever, Puerperal Fever. Cerebrospinal Fever. Acute Poliomyelitis Ophthalmia Neonatorum Pulmonary Tuberculosis. Other Tuberculous Diseases. Anthrax. Wallbutton Road 1 1 Wagner Street Waller Road 1 3 2 Walpole Road 1 2 Walsham Road 1 Warwick Street 1 2 Watergate Street 3 3 Watson Street 3 1 Whitcher Street 3 5 1 Wickham Road 1 Wilson Street 2 2 1 Windmill Lane 2 4 2 Woodpecker Rd. 2 2 6 1 2 Wotton Road 1 2 Wrigglesworth St 1 Totals 201 146 440 37 4 15 2 13 299 106 1 GENERAL SANITARY ADMINISTRATION. Work of Sanitary Inspectors. The work performed by these inspectors, of whom there are eight, including one on military service, is of a varied character, and is increasing year by year, as Public Health legislation increases. Their principal duties are set out in the following statement:— 1. To make a house to house inspection of their district as required by the Housing and Town Planning Act, 1909. 2. To inquire into complaints made to the Sanitary Authority. 3. To supervise the work required to be done for the abatement of the nuisances which they have discovered. 4. To inspect ice cream factories. 5. To inspect dairies and mikshops. 6. To inspect stables, yards, manure pits, passages, courts and vacant plots of land. 97 7. To inspect urinals attached to public houses. 8. To inspect houses for which certificates are required under the Customs and Inland Revenue Acts. 9. To inspect premises for which water certificates are required. 10. To make observations of smoke nuisances. 11. To inspect the shops, stalls and markets where food is sold on Saturday evenings and Sunday mornings. 12. To inquire respecting infectious diseases notified under the Public Health (London) Act, 1891, and under Orders of the Local Government Board. 13. To make inquiries respecting the infectious diseases (measles, etc.) notified. 14. To supervise the disinfection of rooms, schools, etc., after the occurrence of an infectious disease in them. 15. To inspect Workshops and Factories. 16. To inspect Canal Boats. 17. To inspect the homes of outworkers. This is a long tale of work, which, to do thoroughly, would require a considerable increase in the staff; nevertheless, as much of it is done as can possibly be expected. There are certain inquiries or visits which must be made day by day, that is to say, those relating to the cases of infectious diseases that are notified by the medical profession, as well as those which are notified by the teachers of the schools and by other persons. One part of the work presents difficulties—not confined to this Borough only—namely, that it is not possible to make house to house inspections to the extent the Housing and Town Planning Act authorises, and which the Local Government Board anticipate should be done. The Medical Officer of Health has no fault to find with the amount of work performed by District Inspectors, but he cannot close his eyes to the fact that they cannot do all the work devolving on them, especially that relating to house to house inspection as required by the Housing and Town Planning Act, 1910. Altogether 5013 premises were inspected, and 18,311 re-inspections, calls, &c., were made by the District Inspectors. The details of the work performed by the District Inspectors (six in number), is set out in the following pages. 98 Re-drainage. The principal redrainage work during 1915 has been carried out at the following premises :— Addey Street, Nos. 46, 48, 50 and 52. Albert Road, Nos. 7 and 9. Amersham Vale, No. 41. Brockley Road, No. 85. Czar Street, No. 49. Erlanger Road, No. 7. Florence Cottages, Nos. 6, 7 and 8. Lewisham High Road, No. 51. Monson Road, Nos. 54 and 56. Ommaney Road, No. 40. Pomeroy Street, Nos. 7, 9, 11, 13, 15, 17, 19 and 123. St. James', No. 15. St. John's Road, Nos. 51 and 51a. Sandbourne Road, No. 38. Shardeloes Road, No. 3. Tressillian Road, No. 44. Wickham Road, Nos. 25 and 62. New Drainage. The following applications under the Metropolis Management Acts to build and drain were approved by the Council during the year:— nature of work. No. of Application. 1565 To build additions and drain into existing system, at Ida Works, Grinstead Road. 1566 To build Slipper Baths and drain by a separate system on the East side of Ilderton Road, at the corner of Stockholm Road. 1567 To build addition to St. Mary's Church and Parish Hall, Erlam Road, and drain into existing system. 1569 To build new premises situate at 147, 149, 151 and 153 High Street, and drain by a combined system. 1574 To build two w.c.'s and drain into existing combined system at 182 New Cross Road. 1575 To build two w.c.'s and drain into existing combined system at 62a New Cross Road. 1576 To build eleven houses in Wallbutton Road, and drain the same by a combined system. 99 No. of Application 1577 To build and drain into existing combined system a .w.c. at the "Crown and Anchor" P.H., New Cross Road. 1578 To build w.c. and bathroom at the "Telegraph" P.H., Evelyn Street, and drain the same into existing combined system. 1580 To build w.c.'s, urinal, &c., in Martin's Yard, Endwell Road, and drain into existing combined system. 1582 For the drainage of New Relief Station, and No. 32 Watson Street, by a combined system. 1583 To build w.c.'s at 203 and 211 Lewisham High Road, and drain into existing combined system. 1584 To build w.c.'s, etc., at No. 2 Evelyn Street, and drain into existing combined system. 1588 To build additions and drain into existing system at No. 3 High Street, Deptford. 1589 To build additions and drain into existing combined system at 223 High Street, Deptford. 1590 To build W.C.'S. at 16 Evelyn Street, and drain into existing system. 1594 To build additions at rear of 110 High Street and drain into existing combined system. 1595 To build latrines at Archangel Wharf, Cold Blow Lane, and drain by a separate system. 1599 To build w.c. and lavatory at Deptford Bridge and drain into existing system. 1600 To build w.c. at rear of 211 Lewisham High Road and drain into existing combined system. 1601 To build and drain by a separate system w.c's. and urinal at box factory in Blackhorse Road. 1602 To build and drain w.c. at Railway Arches, Trundleys Road, occupied by the London Spinning Co. 1603 To build additions at 78 Wickham Road and drain into existing system. 1604 To build additional w.c's. at 2 Evelyn Street and drain into existing combined system. 1605 To build block of offices at Messrs. Stone's works, Arklow Road, and drain by a separate system. 1606 To build w.c's and urinals at 2 Evelyn Street and drain into existing combined system. 100 No, of Application 1607 To build w.c's at Victoria Works, Grove Street and drain into existing system. 1608 To build and drain w.c. on premises occupied by the London Spinning Co., on the Canal Bank. 1609 To build additions to office and drain into existing combined system at New Cross Station, S. E. & C. Railway. 1610 To build addition to Saw Mills, Reginald Place, and drain into existing system. 1611 To build w.c. at workshop in Briant Street and at rear of 92 New Cross Road, and drain into existing system. 1615 To build w.c. at mews, rear of 25 New Cross Road, and drain into existing system. 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:— Tenements. Notes. Houses during the Year 1915. No. comprised therein. No. for which Certificates were Granted. Refused Deferred. 47 94 94 — — — 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. In inspecting a common lodging house for such a certificate weight is attached to the following matters:— 1. The provision of two rooms for the occupation of the keeper or of his deputy. 2. A sufficient supply of lockers, or other receptacles, with suitable means of fastening, for clothes and for food storage. 3. A sufficient supply of kitchen utensils for cooking, for eating, and for drinking. 4. The provision of lavatory basins, of facilities for washing clothes, shirts and socks, and for foot-washing. 101 5. A sufficient supply of hand towels and roller towels, their number, and their actual cleanliness and condition at the time of inspection. 6. The provision on the premises of a bath available for use as such, and not kept as a storage receptacle for coal, boots and odds and ends. 7. The provision of a room with some degree of privacy for repairing clothes. 8. Hooks for coats and hats. 9. The height of the rooms. 10. A supply of hot water. Overcrowding. Overcrowding was abated in 12 cases without having to take legal proceedings. Smoke Nuisances. During the year 10 observations of chimneys were made. 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 102 METROPOLITAN BOROUGH OF DEPTFORD. Table. REPORT OF SANITARY INSPECTORS FOR THE 52 WEEKS ENDED JANUARY 1st, 1916. Number of District. 1 2 3 4 5 6 7 Totals. Complaints Received ... 39 25 27 25 46 24 186 Total Premises Inspected ... 783 901 952 836 808 733 5013 Re-Inspections, Calls, Service of Notices, &c., &c. ... 3375 2949 2856 2794 2883 3454 18311 Inspections under notice from tractors, per Bye-Laws ... 74 7 20 29 24 30 184 Number of Cases in which Proceedings have been taken ... ... ... ... ... ... ... ... " Intimations " Served ... 202 396 417 541 461 655 2672 " Statutory Notices" Served ... 4 17 15 66 15 13 130 Houses closed (Housing, Town Planning, etc., Act) ... ... ... ... ... 3 ... 3 ,, voluntarily ... ... ... ... ... ... 2 2 Water Closets- Old Closets abolished ... 2 ... ... ... ... 2 4 New Closets provided ... ... ... ... ... 2 2 4 ,, ,, ,, in Workshops ... ... ... ... ... ... ... ... Basin and Trap provided ... 53 16 26 60 is 33 201 Water Supply provided ... 10 24 10 44 Water Supply Apparatus provided ... 3 15 40 36 6 100 Limewashed ... 10 ... ... 14 28 22 74 Walls Repaired ... 3 8 1 6 12 6 36 Floors Repaired ... 4 ... 3 1 ... 2 10 Doors provided ... 1 3 ... 17 3 22 46 Ventilated ... 1 11 ... ... ... ... 12 Seats provided ... 1 4 1 5 1 12 Basins Cleansed ... ... 21 10 10 13 10 64 Sealed off from Scullery ... ... ... ... ... 9 ... 9 Drains- Drains Re-ccnstructed ... 19 8 7 29 ... 7 70 Surface Drains provided ... 5 2 ... ... 6 ... 13 Cleansed and Amended ... 103 24 44 67 59 54 351 Gully Traps fixed ... 42 18 11 56 16 12 155 New Soil Pipes and Vent Pipes fixed ... 27 5 2 26 11 5 76 Chambers built and Interceptors provided ... 11 3 1 16 1 5 37 Interceptors only fixed ... ... 1 ... ... ... ... 1 Ventilated ... 7 ... 11 18 5 2 43 Provided to Stables ... ... ... ... ... ... ... ... Clearing Eyes ... 11 ... 3 13 3 6 36 Sinks, Bath& Lavatory Wastes, and Rain Water Pipes- Disconnected from drains, trap ped and ventilated ... 24 17 49 34 27 3 154 103 REPORT OF SANITARY INSPECTORS FOR THE 52 WEEKS ENDED JANUARY 1st, 1916—continued. Table —continued. Number of District. 1 2 3 4 5 6 7 Totals Cesspools— Abolished ... ... ... ... ... ... ... ... Dustbins- Provided ... 74 100 61 59 117 103 514 Repaired ... ... ... 1 ... 1 ... 2 Yards- Paved ... 4 24 29 8 25 39 129 Surface Repaired ... 12 9 5 33 39 ... 98 Urinals- Provided ... ... ... ... ... ... ... ... Repaired ... ... ... ... 1 ... ... 1 Cleansed ... 4 ... ... 1 ... ... 5 Sculleries and Wash-houses- Floors paved ... 7 12 7 4 14 10 54 Coppers provided or repaired ... ... ... 10 ... 12 ... 10 New sinks provided ... ... ... .... ... ... 12 Forecourts- Paved ... ... 5 12 4 5 ... 26 Surface Repaired ... ... 3 2 7 1 ... 13 Gutters and Rain Water Pipes Provided and Repaired ... 74 45 54 124 82 39 418 Water Supply- Store Cisterns provided ... ... ... ... ... ... ... 3 „ „ Covers provided ... ... ... ... ... 3 ... „ „ Cleansed ... ... ... ... 2 ... 2 „ ,, abolished ... 6 ... 2 ... 2 ... 10 Supply Reinstated ... 2 ... 2 ... 1 ... 5 Fittings Repaired ... 23 ... 12 23 56 67 181 New Houses Inspected for Certificates before Occupation ... ... 1 ... 12 ... ... 13 Potable Water provided from Service ... 9 ... 2 1 1 13 Cleansing and Repairs- Houses Cleansed and Limewashed ... 92 129 222 156 214 250 1063 Houses repaired and Ventilation improved ... 50 28 48 144 113 80 463 House roofs repaired ... 51 41 66 109 60 82 409 Dampness abated ... ... ... 14 ... 50 16 80 Staircases, &c., lighted ... ... ... ... ... ... ... ... Stoves repaired or new ones pro- vided ... ... ... 4 ... ... ... 4 Window frames, sashes, or doors repaired, and fastenings provided ... ... ... 3 ... ... ... 3 Handrails fixed or repaired ... ... ... ... ... ... 14 14 Miscellaneous ... ... ... 3 11 9 ... 23 104 REPORT OF SANITARY INSPECTORS FOR THE 52 WEEKS ENDED JANUARY 1st, 1916—continued. T able— 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 ... ... ... ... ... 4 ... 4 Overcrowding- Cases Abated ... ... 3 1 5 1 2 12 Accumulations - Removed ... 6 19 3 2 4 4 38 Animals— Ceased keeping as a Nuisance ... ... 2 ... 1 ... 1 4 Smoke Nuisances— Cases Abated ... ... ... ... ... ... ... ... Observations ... ... ... ... ... 9 1 10 Rooms occupied in such a manner as to be a nuisance ... ... ... ... ... ... ... ... Inland Revenue Act- Houses inspected for Certificates ... ... ... ... ... ... 47 47 Number of Tenements ... ... ... ... ... ... 94 94 Number of Certificates granted ... ... ... ... ... ... 94 94 Number of Certificates refused ... ... ... ... ... ... ... ... District No. 1.—Inspector Simpson (on military service). 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 Allah. 105 Street Refuse. 7,719 loads of street refuse were collected and disposed of as compared with 8,230½ loads for the previous year. House and Trade Refuse. During 1915, 17,659½ loads of house and trade refuse were collected and disposed of, as compared with 20,234 loads for the previous year. Artizan 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. 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 2243 Number of houses represented as unfit for habitation 3 Number of houses represented as unfit for habitation, and not capable of being made fit— Number of houses closed 3 Number of underground sleeping rooms upon which Closing Orders were made 2 Number of houses demolished 2 Number of houses made habitable — Number of back-to-back houses converted to through houses — Number of closing orders made 5 Number of demolition orders made 5 Houses closed voluntarily 2 Houses dealt with under Section 15 — 106 House to House Inspection. In the following list will be seen the streets, the houses of which were systematically inspected during 1915 :— Inspector Shelley. Name of Street. No of premises inspected. No. of premises where defects existed. No. of premises found in fair condition (i.e.. where no defects were found.) Achilles Street 42 10 32 Baildon Street 56 44 12 Clifton Hill 29 7 22 Mornington Road 34 12 22 Comet Place 21 7 14 Glenville Grove 26 7 19 Providence Place 12 3 9 Pagnell Street 39 13 26 Payne Street 44 16 28 Royal Naval Place 15 4 11 Speedwell Street 60 32 28 Trim Street 34 17 17 Walpole Road 23 7 16 Wybourne Cottages 5 2 3 440 181 259 Inspector Snowdon. Alexandra Street 39 13 26 Alpine Road 1 1 — Batavia Road 49 28 21 Canterbury Road 23 8 15 Childeric Road 41 39 2 Cold Blow Cottages 7 1 6 Cornbury Road 78 51 27 Desmond Street 35 17 18 Edale Road 15 15 — Edward Street 30 12 18 Folkestone Gardens 64 13 51 Liardet Street 2 1 1 Trundleys Road 32 16 16 Vansittart Street 36 19 17 Whitcher Street 55 24 31 Woodpecker Road 79 39 40 586 297 289 107 Inspector Kemp. Avonley Road 6 5 1 Briant Street 31 26 5 Dennetts Grove 25 20 5 Eckington Gardens 29 14 15 Evelyn Buildings 13 13 — Faulkner Street 1 1 — Hath way Street 13 7 6 Franklin's Grove 6 5 1 Kender Place 7 6 1 Render Street 114 68 46 Renwood Avenue 11 10 1 Lindo Street 5 4 1- Lubbock Street 2 1 1 Mona Road 13 5 8 Martha place 11 11 — Mason's Grove 13 13 — Mason's Cottages 9 4 5 Monson Road 33 13 20 Pomeroy Street 58 43 15 Rose Cottages 3 — 3 Somerville Road 1 — 1 Selden Road 29 25 4 Senate Street 8 4 4 441 298 143 Inspector Hewett. Grinstead Road 68 24 44 Junction Road 39 24 15 Hood Street 11 5 6 Blackhorse Road 49 42 7 Grove Street 38 31 7 Bingley Place 8 7 1 Greenfield Street 18 14 4 Boscawen Street 46 29 17 Scawen Road 43 13 30 Gosterwood Street 23 14 9 Chilton Street 1 1 0 344 204 140 108 Inspector Allam. Addey Street 43 36 7 Alfred Place 5 5 — Andom Terrace 5 5 — Benmore Street 14 9 5 Church Street 104 78 26 Creek Street 34 30 4 Crossfield Street 50 38 12 Dugald Street 4 4 — Giffin Street 64 49 15 Hosier Street 55 44 11 Knott Street 29 23 6 Leonidas Street 13 12 1 Norval Street 3 2 1 Pender Street 9 9 — 432 344 88 The following is a list of the houses in respect of which Closing Orders were made :— north ward. 35 Watergate Street. 16 and 18 New King Street. 41 and 45 New King Street (underground sleeping rooms). FACTORY AND WORKSHOP ACT, 1901. Factories, Workshops, Workplaces and Outworkers. These premises were regularly visited during- the year. Special attention was paid to sanitary accommodation for persons employed. In two instances the w.c. accommodation was found to be insufficient for the persons employed, and in 42 cases the accommodation was unsuitable or defective. In all but four 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. 109 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 133, involving 268 rooms. 92 inspections were made and 21 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 252 (including bakehouses and laundries and domestic workshops) with 361 rooms. There is no industry peculiar to Deptford. The list of trades carried on in the 252 workshops is as follows:— Bakers 55 Dressmakers 64 Laundries 7 Milliners 12 Shirtmakers 2 Tailors 18 Wheelwrights, Smiths, etc. 17 Miscellaneous Workshops 77 252 The number of inspections was 317. There were twenty notices served for defects and insanitary conditions found. 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. 110 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 195 (including food premises, kitchens, etc.) with 321 rooms. Inspections for the year numbered 260 and 16 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 767, using 812 rooms. The number added during the year was 72 and cancelled 55. The number of inspections for the year was 151 and 5 notices were served. The lists received from employers in the borough numbered 75, giving the names and addresses of 445 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 18 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. 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. Premises where Food is Prepared for Sale. These premises were kept under supervision during the year. The number of inspections was 232, 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. 111 The premises added to the register during the year numbered 4, and removals 5, leaving 125 premises on the register. 9 notices were served for amendment of various defects and for cleansing, and these were complied with. Bakehouses. The number on the register at the end of the year 1915 was 63—55 as "workshops" and 8 as "factories." During the year 2 bakehouses were closed and removed from the register. The number of Underground premises in use at the end of the year was 20. 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 263, and in 11 cases notices were served. No legal proceedings were necessary. The bakehouses throughout the borough are kept in a satisfactory condition. 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 252. During this period 41 were added and 8 cancelled. The inspections numbered 401, 10 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:—Diphtheria 1 case and Chicken pox 1 case. 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. The Employment of Women. The present position of mixed staffs in various trades in the Borough is an unusual one, and there are several points that might with advantage be brought to the notice of traders who have not hitherto employed female assistants. Clause 3 of the Shops Act, 1912, provides that "(l) In all rooms of a shop where female shop assistants are employed in the serving of 112 customers the occupier of the shop shall provide seats behind the counter or in such other position as may be suitable for the purpose, and such seats shall be in proportion of not less than one seat to every three female shop assistants employed in each room. (2) Any person failing to comply with the provisions of this section shall be guilty of an offence against this Act, and liable for a first offence to a fine not exceeding £3, and for a second or subsequent offence to a fine of not less than £1 and not exceeding £5." There can be no misunderstanding as to the effect of this provision, and even in the case of the employment of a single assistant a seat has to be provided behind the counter or some other suitable position. The Public Health Act lays the obligation upon employers of providing separate accommodation for each sex. This is a serious difficulty in small establishments and it has already occupied the attention of the Local Government Board. The Board have advised the local authorities that the requirements of the Act cannot be dispensed with, but they suggest that in order to obviate the incurring of serious additional expense it may be found possible to make arrangements for the free use of a convenience in a neighbouring house or of a public convenience near by. The Board has suggested to local authorities that they should instruct their officers to ascertain whether temporary arrangements of the kind indicated can be made in any case in which the difficulty is likely to arise in the borough, and so facilitate the action of any shopkeeper who has permitted his male assistants to join the army. It will be noted that traders who are in difficulty in this matter are entitled to ask the local authority for assistance, and we advise that this course should be adopted rather than any contravention of the law should be permitted. Fried Fish Shops. There are 30 fried fish shops in the Borough. 137 inspections were made to the same. Fish-curing Premises. There are 6 fish-curing premises in the Borough. 28 inspections of these premises were made. 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. 113 The number of premises on the register at the end of the period under report was 143; 9 being added and 11 removed. The number of inspections was 217; 5 notices being served. Cowsheds. The following are the cowsheds in the borough at present licensed by the London County Council:— Weston, J. & Sons, 33 Octavius Street 25 cows. Do. 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 31 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. 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 51 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 25 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. 114 Table. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDINGS DURING 1915. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of proceedings On register at end of 1914 Added 1915 Re moved 1915 on register at end of 1915 Milk premises 219 41 8 252 401 10 .. Cowsheds 2 .. .. 2 31 .. .. Slaughter-houses 2 .. .. 2 51 .. .. Other offensive trade 2 .. .. 2 25 .. .. Ice cream premises 145 9 11 143 217 5 .. Registered houses let in lodgings 289 .. •• 289 578 (a) — (4)187 .. (a) For overcrowding. (4) 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 FACTORIES, WORKSHOPS, AND WORKPLACES, during 1915. CLASS OF WORK. Number of Places Number of Inspections. Number of Number of Prosecutions. On Register at end of 1914. Added 1915. Removed 1915. On Register at end of 1915. Written Intimations. Notices. Under Factory Acts.l Under Public Health Acts. Premises. Rooms Factories Factory Laundries 7 7 31 Factory Bakehouses 8 8 12 21 1 Other Factories 116 6 4 118 225 71 16 4 1 Work shops Workshop Laundries 8 1 7 27 WorkshopBakehouses 57 2 55 58 242 9 1 Other Workshops 186 13 9 190 276 75 7 3 Workplaces Places where Food is prepared for Sale 126 4 5 125 245 232 8 1 Workplaces other than the above 71 3 4 70 76 28 5 9 Home-workers' Premises 750 72 55 767 812 151 3 2 Total 1329 98 80 1347 1762 820 49 13 1 115 Table. METROPOLITAN BOROUGH OF DEPTFORD This Table is by request of the Secretary of State. Annual Report of Medical Officer of Health for the year 1915. On the Administration of the Factory and Workshop Act, 1901, in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. i.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 92 21 1 Workshops (including Workshop laundries) 317 20 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 260 16 Total 669 57 1 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 239 238 Want of Ventilation 2 2 Overcrowding 1 1 Want of Drainage of Floors 104 100 Other Nuisances Sanitary Accommodation Insufficient 2 Unsuitable or defective 42 40 Not Separate for Sexes Offences under the Factory and Workshop Act. Illegal Occupationof Underground Bakehouse (s. 101) Breach of Special Sanitary Requirements for Bakehouses (ss. 97to 100) Other Offences (excluding offences relating to outwork which are included in Part 3 of this Report) Total 390 381 Table—continued. 3.—HOME WORK. NATURE OF W 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. 8 Prosecutions. Twice in the year. Once in the year. 9 Failing to keep or permit inspection of lists. 10 Failing to send lists. 11 Instances. 12 Notices served. 13 Prosecutions. 14 Instances. 15 Orders made (S. 110). 16 Prosecutions (Sections 109, 110) Outworkers. Outworkers. 1 Lists. 2 3 Contractors. 4 Workmen. Lists. 5 6 Contractors. 7 Workmen. Wearing Apparel— (1) making, &c. 68 17 392 5 .. 32 77 .. .. .. .. .. 18 (2) cleaning and washing Household linen Lace, lace curtains and nets Curtains and furniture hangings Furniture and Upholstery 2 .. 4 .. .. .. 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 70 17 396 5 32 79 18 116 117 T able— continued. 4.—REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year. N umber. Bakehouses 55 Dressmaking 64 Laundries 7 Millinery 12 Shirtmaking 2 Tailoring 18 Wheelwrights (Smiths, &c.) 17 Others 77 Total number of Workshops on Register 252 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) Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5, 1901) Notified by H.M. Inspector 6 Reports (of action taken) sent to H.M. Inspector 6 Other 6 U nderground Bakehouses (s. 101):— Certificates granted during the year 6 In use at the end of the year 20 118 Canal Boats. For the year ended 31st December, 1915, the report of Inspector Turner, respecting the inspection of registered canal boats and nonregistered canal boats, was as follows:— During the year 26 visits for the purposes of inspection have been made on the following dates, viz., January 6th, February 10th, March 3rd and 8th, April 1st, 19th and 29th, May 10th, 21st and 26th, June 25th, July 9th, 20th, 29th and 30th, August 9th, 13th, 16th and 24th, September 1st, 9th, 15th and 17th, October 7th, 18th and 25th. Boats were inspected on 17 occasions as follows;—January 6th, March 3rd, March 8th (two boats), May 26th, June 25th (two boats), July 9th, July 20th (two boats), July 30th, August 9th, August 13th (two boats), August 16th, August 24th (two boats), September 1st (three boats), September 9th (two boats), September 15th (four boats), October 7th and October 18th. Number of visits 26 Boats inspected 28 Infringements. The following matters calling for attention were found:— January 6th—Boat "Clent" 996, Registered at Wolverhampton. No pump on board. Pump provided on service of notice, and certified. September 1st—Beat "Paris" 965, Registered at Wolverhampton. Register not produced. Notice served. Register papers provided and certified. September 1st—Boat "Warwick" 917, Registered at Wolverhampton. Register not produced Notice served. Register papers provided and certified. Children on Boats. During the year children of school age were found on eight boats. In each case information was forwarded to the local education authority for their attention. General. No cases of sickness were found on the boats during the year. This Borough is not a Registration Authority under the Canal Boats Acts. The arrangements for the inspection of the boats are—Periodical inspection by a Sanitary Inspector duly appointed an inspector under the Canal Boats Acts, jointly with other duties as Inspector of Workshops, Dairies, Cowsheds and Milkshops, etc., etc. 119 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 £50 6s. 0d., and the amounts during the past four years are shown below. FINES AND COSTS. " Health " Cases. " Adulteration " Cases. Total. £ s d. £ s. d. £ s. d. 1915 15 1 0 35 5 0 50 6 0 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 Sale of Food and Drugs Acts. The total number of samples purchased during the year and examined by the Public Analyst was 511. 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 1 .. 1 .. Baking Powder 3 .. 3 .. Barley, pearl 1 .. 1 .. Beef, pressed .. 1 1 100 Beef, spiced 1 .. 1 .. Brawn 1 1 2 5.0 Butter 82 5 87 5.7 Cocoa 14 .. 14 .. Camphorated oil 1 .. 1 .. Coffee 4 .. 5 20 Coffee essence 1 .. 1 .. Cream, preserved 2 .. 2 .. Cheese 1 .. 1 .. Dripping 2 .. 3 33.8 Ginger, Ground 4 .. 4 .. Honey 1 .. 1 .. Jelly, table 2 .. 2 .. Lard 5 .. 5 .. Margarine 3 .. 3 .. Milk 298 28 326 8.6 ,, Separated 10 4 14 28.6 Mustard 7 .. 7 .. Olive Oil 2 .. 2 .. Pepper 16 .. 16 .. Sausages 1 2 3 66.6 Tartar, cream of 1 .. 1 .. Vinegar 4 .. 4 .. Total 468 43 511 8.4 120 Proceedings taken with regard to Samples Purchased during the year. Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ s. d £ s. d. 7 P Butter,, Foreign fats 75 8 per cent (A sample of Margarine) 4 0 0 1 2 0 10 SY ,, Foreign fats 77 2 per cent. (A sample of Margarine) 3 0 0 1 2 0 3 a Milk 14 percent, milk fat abstracted — — Summons dismissed Warranty proved Summons dismissed Warranty proved Summons dismissed Warranty proved Summons withdrawn on payment of costs Summons dismissed Warranty proved Vendor cautioned 3 h ,, 5 per cent, added water — — 1 K ,, 8 per cent, milk fat abstracted — — 8 k ,, 6 percent milk fat abstracted and 1 per cent. added water 2 per cent. added water 1 2 0 12 K ,, — — 13 k ,, 2 — — 11 P ,, 1 — — do. 13 s ,, 8 per cent, milk fat abstracted 1 1 0 — 14 s ,, 9 per cent, added water 1 1 0 — 17 S ,, 2 ,, ,, ,, 0 10 6 — 3 SY ,, 3 ,, ,, ,, — — Summons dismissed Warranty proved Vendor cautioned 12 T ,, 1 ,, ,, ,, — — 17 SY Separated Milk 26 ,, ,, ,, — — Summons dismissed Defendant proved he was not the owner of the milk Vendor cautioned — — 4 t Sausages Boric acid 9 9 grains per lb. — — 6 T ,, Boric acid 9 5 grains per lb. — — do. — Butter Foreign fats 77 4 per cent. (A sample of Margarine) — — Informal sample 10 S Pressed Beef Brawn Boric acid 8.1 grains per lb. — — Vendor cautioned 7 T Boric acid 3.6 grains per lb. — — do. 36 H Butter Foreign fats 42.9 per cent. 4 5 0 0 15 0 25 P Coffee Chicory 40 per cent. 4 0 0 1 0 0 31 a Milk 9 per cent. milk fat abstracted — — Summons dismissed Warranty proved 25 h ,, 4 ,, ,, ,, 0 3 6 1 1 0 30 H ,, 13 per cent. milk fat abstracted and 5 per cent. added water 1 10 0 0 10 0 Warranty unsuccessfully pleaded Vendor cautioned 24 K ,, 2 per cent. added water — — 37 P „ 8 per cent milk fat abstracted — — Sample sour when received by Analyst Vendor cautioned Summons dismissed Warranty proved 25 SY ,, 4 per cent milk fat abstracted and 2 per cent. added water — — 121 Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. £ s. d. £ s. d. 18 T Butter 6 per cent, of added water .. 0 11 0 0 10 0 Sample taken in course of delivery. Warranty unsuccessfully pleaded. Vendor cautioned. 21 T ,, 4 percent. milk fat abstracted 0 11 0 0 10 0 47 T Dripping 2 per cent. water — — 55 P Milk 10 per cent. milk fat abstracted — — Summons dismissed Warranty proved Informal sample 58 S ,, An artificially prepared milk — containing fat 2 94 per cent.. solids, not fat 8 84 per cent., the solid ingredients did not possess the character of milk solids. Deficiency in fat 2 per cent. 49 T ,, 4 percent. milk fat abstracted — Summons dismissed. 53 T ,, 11 ,, ,, ,, — — Warranty proved do. 5 Butter Water 1 per cent.in excess Vendor cautioned 71 H Milk of legal maximum. Boric acid 0 20 per cent. 3 per cent. milk fat abstracted - - Summons dismissed Warranty proved Vendor cautioned 69 S ,, 1 ,, ,, ,, — — 73 S ,, 3 per cent. added water — — do. 66 SY ,, 90 per cent. milk fat abstracted 1 0 0 0 10 0 or 21 days' imprisonment 50 H Separated Milk Boric acid 0.16 grains per pint — — Vendor cautioned 69 H ,, 5 per cent. added water 1 0 0 0 10 0 73 K ,, 2 ,, ,, ,, — — do. — Milk Obstruction of inspector 4 0 0 — or 28 days' imprisonment SUMMARY. Fines £26 13 0 Costs 8 12 0 Total £35 5 0 The Board of Agriculture and Milk Prosecutions. The Board have recently sent a circular to local authorities suggesting "that before proceedings are instituted under the Sale of Food and Drugs Acts on analytical evidence in respect of the sale of a sample of milk, there should be a preliminary investigation by an officer of the local authority, or that the milk producer should be given an opportunity of making any explanation or representation which he may desire to offer," this suggestion is not of recent origin, as suggestions similar to 122 those embodied in the Board's communication were conveyed in circular letters issued by the Board on 28th December, 1901, and 27th March, 1905. Apart from the inconvenience which must occasionally be caused owing to the time limit of 28 days imposed by the Sale of Food and Drugs Act, 1899, it would be unfair to impose upon local authorities the duty of conducting a preliminary judicial investigation in every case of milk adulteration, and any suggestion having this end in view must reflect upon the soundness of the basis upon which the Sale of Milk Regulations rest. Moreover, each case in which legal proceedings were eventually instituted would, under the suggested regime, be carried to the court prejudiced, the local authority having been allotted the double role of judge and prosecutor. The Board of Agriculture have had their attention drawn to the Board's circular letter of 1901, in which it was stated that "the limits below which a presumption is raised that the milk is not genuine were necessarily fixed at figures lower than those which are usually afforded by genuine milk," and further that "the evidence given before the Milk Regulations Committee tended to show that the practice of fraudulently mixing separated milk with new milk has become increasingly prevalent," a statement which makes the Board's suggestion still more inexplicable. In addition to this it may be said that the present standard is below that of milk from an average normal, healthy herd of cows. On account of the use of milk for the feeding of infants, children and invalids, it is most important that no milk below this standard should be allowed to be sold for human consumption, especially as, even in milk containing 3 per cent. of milk fat as required by the regulations, the amount of fat is insufficient for the proper nourishment of infants. The physiological estimate of fat in cow's milk is 4.5 per cent., and the average quality of 545 samples taken in four years in one borough was 3.6 per cent., notwithstanding that this included 43 adulterated samples. Moreover, it has been pointed out to the Board that on account of the war the employment of married women has very largely increased, and therefore, the number of artificially fed children will tend largely to increase, and, in addition, there has been an enormous increase in the number of sick and wounded for whose dietary milk is largely used. If the Board's suggestions are generally adopted, milk producers, especially in view of the higher prices of food stuff for cattle, will tend to feed their cattle even less well than formerly, and the result will be a large number of cows producing poor milk, and an increase of tuberculosis amongst cows. For the benefit of the uninitiated it may be said that milk may be adulterated or injuriously affected:— 123 (l) By the addition of water, thereby reducing the percentage of all valuable ingredients. (2) By skimming or removing cream, wholly or in part, thereby abstracting one of the most valuable constituents, the butter-fat. (3) By both skimming and watering, which is a double fraud. (4) By milking of cows too close to, or too soon after calving, thereby making the milk unwholesome. (5) By drawing milk from cows which have been fed upon improper or unwholesome food. (6) By using milk from cows which are kept under insanitary conditions. (7) If milk is produced under insanitary conditions, either by unclean hands, in milking from manure bespattered udders, or collected, kept, held, or shipped in unclean receptacles, or if not properly cooled after milking, or if not kept at a proper temperature, thus causing an unusually large number of bacteria to be developed. (8) If milk is drawn from cows which are not in a healthy condition, but suffer from diseases, such as tuberculosis, foot-and-mouth disease, actinomycosis, etc. (9) By irregular milking. 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. Snowdon 1 trunk of Haddock Voluntarily surrendered. „ .. .. 5 bags of Potatoes „ „ ,, Priest 1 box of Kippers „ „ ,, ,, ,, 1 box of Mackerel „ „ „ Turner 3 tons of Corned Beef in tins (By Military Authorities.) Legal Proceedings. Feb. 18th, 1915. H. F. Green, 63 Pepys Road. (а) W.C. pan and trap fixed without notice. Fined 10s. and 2s. costs. (б) Pan and trap improperly fixed. Fitted 10s. and 2s. costs. Feb. 18th, 1915. T. Wilmot, 57 Rodney Road, Walworth. W.C. pan and trap fixed without notice at 35 Pepys Road. Fined 10s. and 2s. costs. 124 Feb. 18th, 1915. F. Fothergill, 38 Rockbourne Road, Forest Hill. Defective drains at 173 New Cross Road. Fitted, £5 and 2s. costs. Feb. 18th, 1915. H. J. Ley, 75 Brockley Road. No water to bakehouse premises. Fined £3 and 2s. costs. Feb. 25th, 1915. J. G. Saxton, 401 Queen's Road. Neglecting to abate nuisance at 31 Kitto Road. Necessary works carried out before hearing of summons. Fined the costs, 2s. Feb- 25th, 1915. R. Soper & Son, Tanner's Hill. Neglecting to abate nuisance at 125 Arica Road. Necessary works carried out before hearing of summons. Summons withdrawn on payment of the costs, 2s. April 15th, 1915. Wiltshire & Co., Lewisham. Drain at 86 New Cross Road, opened up and closed without notice. Summons withdrawn upon payment of 2s. costs. July 22nd, 1915. Premier Fish Meal Co., Ltd., 28 Monument Street, E.C. (a) Removal of offensive matter during prohibited hours. Fined 20s. and 10s. costs. William Andrews (Carman). Fined 8s. and 2s. costs, or 7 days' imprisonment. (b) Removing offensive matter in unsuitable receptacle. William Andrews (Carman). Fined 13s. and 2s. costs. The summons against the Firm on this second charge was dismissed as it was proved that the carman had not exercised due diligence in selecting sound receptacles for this purpose. Nov. 30th, 1915. Thomas Selby, 124 Camberwell Road. Nonregistration as purveyor of milk. Fined 40s. or 10 days' imprisonment. Public Health Administration and Legislation. Among the more important legal enactments which have come into force during the year may be mentioned the Public Health (Shell-fish) Regulations, 1915. Machinery is proyided by these Regulations for 125 the closing of shell-fish layings where there is evidence to show that the shell-fish from such layings have actually caused disease, or are likely to be a source of danger to the public health. Legislation of this nature was long overdue, and it is satisfactory that the local authorities have at last obtained further powers for dealing with the matter. The Notification of Births (Extension) Act, 1915, was passed with the object of making universal throughout the country the system of the adoptive Act of 1907, under which early notification concerning all births is required to be given to the medical officer of health, and also to enable local authorities to make arrangements for the care of mothers, including expectant mothers, and young children. In this connexion an important circular letter on maternity and infant welfare was issued to local authorities by the Local Government Board on July 30th, indicating the scope of the work which they consider should be undertaken. The Government have agreed to provide, by means of annual grants to be distributed by the Local Government Board one-half of the cost of the whole or any part of schemes for maternity and child welfare approved by the Board, and Regulations under which grants are payable were issued on July 7th. The Local Government Board will not, however, pay grants under these Regulations in respect of expenditure on "schools for mothers," which are eligible for aid under the Regulations of the Board of Education of July 6th. The Local Government Board regard the saving of lives of young children suffering from measles as forming an important part of childwelfare work, and to enable local authorities to adopt administrative measures with this end in view the Board made an Order, entitled "The Public Health (Measlesand German Measles) Regulations, 1915," by which a system of notification of these diseases is put into force throughout England and Wales. In February, a memorandum on cerebro-spinal fever was issued by the Local Government Board for the guidance of medical officers of health. Special emphasis was laid upon the importance of sanitary authorities making arrangements for assisting medical practitioners to obtain an immediate diagnosis in suspected cases of the disease, for isolating patients suffering from it, for disinfection, and for the supervision of contacts. In view of the difficulty connected with the accurate diagnosis of the malady, the Board expressed their willingness to undertake the examination in their pathological laboratory of cerebrospinal fluid sent to them for this purpose. Local authorities were also 126 advised to make local arrangements with a competent bacteriologist for 'the examination of swabs taken from persons who had been in intimate contact with a patient suffering from the disease. Co-operation of Civil and Military Authorities. It is satisfactory to know that the work done by the civil health authority under a scheme of co-operation with the military authorities has proved beneficial, and has met with the approval of the Army Council, who sent a letter to the Local Government Board dated March 25th, which was published for the information of local authorities by the Board. In this letter the opinion is expressed that "the assistance of the local public health authorities under the guidance of the Local Government Board, in the unexampled circumstances of the last eight months, has been invaluable in safeguarding the health of the forces and in preventing the spread of infectious disease to an extent which would have been otherwise impracticable. The work in this Borough has been chiefly the supervision of military contacts with infectious disease. When it has been a soldier or sailor home on leave your Medical Officer of Health has communicated -with the Commanding Officers throughout the country and has decided the date when the man may safely rejoin his regiment or ship. In addition to the above, there has been a considerable amount of personal bathing and disinfecting of military clothing. Commanding Officers have been advised on sanitary matters connected with billets and encampments. When required, food has been 1inspected, and if condemned, dealt with by this department.