DEPT 49 ANNUAL REPORT (ABRIDGED) 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 and M. MACDONALD, M.D., D.P.H., Tuberculous Officer and Acting Medical Officer of Health. 1917 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E, 14. Public Health and Housing Committee. Mayor. Councillor WILLIAM A. WAYLAND, Lt.-Col., J.P. {ex officio). Chairman. Councillor W. H. GREEN. Voice Chairman. Councillor Dr. W. H. BROOKS. Alderman E. J. KNIGHT. Councillor W. R. CARNELL Councillor H. CATTELL. Councillor W. FALKNER. Councillor J. G. HICKS. Councillor C. H. KIPPS. Councillor T. D. LENG. Councillor R. SOPER. Councillor C. WATSON. Staff of the Public Health Department. Medical Officer of Health. *William H. Whitehouse, m.d., d.p.h., b.s., Barrister-at-Law. Tuberculosis Officer and Acting Medical Officer of Health. 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 Inspector and Health Visitor. Miss W. C. Smart. Temporary Sanitary Inspector. Miss N. Playne. Health Visitors. Miss H. Davies. Miss Butcher. Temporary Health Visitors. Miss A. Perrett. Miss A. Mark. Chief Clerk. *Charles A. Chapman. Clerrks. *Henry J. L. Smith. Miss D. Thorogood. Miss G. Hicks, Municipal Dispensary for the prevention of Consumption, 78 Amersham Vale, New Cross, S.E. Administrative Tuberculosis Officer—W. H. Whitehouse, m.d. Clinical Tuberculosis Officer—M. Macdonald, m.d. Dispenser Clerk—Miss G. F. Greig. Nurse—Miss Porteous. *Attendants— G. Abbott. Disinfecting Staff. C. F, Dowsett (Chief Disinfector). *T. Lyons. F. Smith. *R. G. Gladman. Council's Shelter, Mortuary and Coroner's Court. *Attendant—G. W. J. Wagner. Cleansing Station. Bath Attendant—Mrs. Wagner. School Nurse—Miss Gilby. *On Service with H.M. Forces. TABLE OF CONTENTS. Page Vital Statistics— Summary of 6 Population 7 Births 7 Marriages 7 Deaths 7 ,, of Infants 8 ,, from Respiratory Diseases 13 ,, from Influenza 13 ,, from Constitutional Diseases 13 ,, Cancer 13 Local Government Board Tables 11-15 Infectious Diseases- Deaths from 16 Cases notified 16 Smallpox 16 Scarlet Fever 16 Diphtheria 16 Enteric Fever 16 Erysipelas 16 Puerperal Fever 16 Ophthalmia Neonatorum 16 Cerebro-spinal Fever 16 Diarrhoea and Enteritis 16 Measles 17 Tuberculosis 17 Page Sanitary Work- Housing, Town Planning, etc., Act 18 Drainage Works 18 Overcrowding 18 Smoke Nuisances 18 Disinfection 18 Coroner's Court & Mortuary 18 Legal Proceedings 19 Maternity and Child Welfare 10-13 Food Supply— Food Premises 18 Dairies, Milkshops, etc. 18 Ice Cream Premises 18 Slaughterhouses 19 Unsound Food 19 Sale of Food and Drugs Acts 19 Factories and Workshops— 18 Tuberculosis Dispensary— Report of Tuberculosis Officer 17 Canal Boats— Report of Inspector 20 Metropolitan Borough of Deptford. Public Health Department, Town Hall, New Cross Road, S.E. 14. June, 1918. To the Mayor, Aldermen and Councillors. Gentlemen, On behalf of Dr. Whitehouse, I have the honour of submitting the Annual Report on the health of the Borough during 1917. As in the previous year and for the same reasons, the Report is only a brief summary of the work done in respect of certain of the more important matters. The work of the Department has been rendered difficult by the further "calling up" of members of the permanent staff. Also the entire clerical staff has been replaced by temporary clerks with no previous experience of Public Health Work. These changes necessitated a complete reorganisation of the duties of the various members of the staff. The most important point in the Report and one to which I would draw your attention, is the rapid decline in the birth rate, a matter of grave public concern. In 1917 there were 749 fewer babies born in Deptford than in 1913, the last year of peace, when the rate had been already falling. I put forward these figures not with the idea of suggesting a method of promoting a recovery of the birth rate, but as showing the need for putting forth every effort to save the lives of those that are born. Along with a reduced birth rate, I have to report an increased infantile mortality rate, due principally to an outbreak of measles. From a consideration of these two facts, the Committee will see the necessity of developing and extending the Maternity and Child Welfare Work in the Borough. To the Chairman and Members of the Committee I have to acknowledge with deep thanks the encouragement and support they have always rendered me. To the Members of the Public Health Staff I have to record my appreciation of the admirable manner in which they have discharged their duties—duties which are often difficult and not always pleasant. I am, Mr. Mayor and Gentlemen, Your obedient Servant, M. Macdonald. 6 Summary of Vital and Mortality Statistics for 1917. 1917. 1916. 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 103,527 110,299 Number of inhabited houses 16,862 16,658 Average number of persons per house 61 6-6 Density 66 per acre 70 per acre Length of Public Streets 53 miles approx. 53 miles approx. Rateable Value £619,902 £617,060 1d. Rate produces (approximately) £2,423 £2,427 Cost of administration of Public Health Department £2,008 £1,961 Marriages 821 1,021 Marriage Rate 7.1 9.3 Births 2,329 2,918 Birth Rate 20.1 26.5 Birth Rate, average for the last 10 years 28.0 27.2 Deaths 1,663 1,666 Death Rate 16.0 15.1 Death Rate, average for the last 10 years 14.7 14.8 Infantile Mortality 102per 1,000 births 88 per 1,000 births Infantile Mortality, average for the last 10 years 112per 1,000 births 118 per 1,000 births Zymotic Death Rate 1.5 1.03 7 POPULATION. The total population for Deptford for 1917 has been estimated by the Registrar General as 115,403. The civil population, based on the National Register, in conjunction with the last two Census enumerations, has been calculated as 103,527. If these two estimates are correct it means that nearly 12,000 men from Deptford have joined the Forces. For the purpose of this Report, the total population (115,403) has been used in calculating the Birth and Marriage Rate since the men in the Forces have participated in it, but for the Death Rate, the estimate of the civil population (103,527) has been taken, deaths in the Forces being registered under the military authorities. Births. The number of births registered in the Borough was 2329, viz.: 1,204 boys and 1,125 girls. This is 716 below the average for the past ten years, and 589 below the figure for 1916. The birth rate was 20'1 per 1000 as compared with 26'5 for the preceding year. Illegitimate Births. The illegitimate births numbered 63, and occurred in the several Wards, as follows:— East Ward 20 South Ward 3 North Ward 15 South-East Ward 7 North-West Ward 15 South-West Ward 3 Marriages. There were 821 marriages in the Borough during the year, as against 1021 in the previous year and the marriage rate was 7.1 per 1000 of the population as compared with 9.3 in 1916. These figures have been supplied by the Superintendent Registrar. Notification of Births. Of the 2329 births registered in the Borough, 2294 or 98 per cent, were notified to the Medical Officer of Health within 36 hours. The information came in most instances from midwives. Deaths. The total number of deaths registered in Deptford was 1091, but when this figure is corrected, by the exclusion of deaths of nonparishioners occurring in the district, and the inclusion of deaths of parishioners occurring outside the district, the number is raised to 1663, equivalent to a death rate of 16'0 per 1000 as compared with an average death rate of 14.7 in the past ten years. The principal causes of death in the several age periods of life are set out in Table III. 8 Infantile Mortality. The deaths amongst infants under the age of one year numbered 239, the infantile mortality rate being equivalent to 102 per 1000 births as compared with 88 per 1000 in the previous year. This increased mortality can be chiefly traced to the severe epidemic of measles which occurred in the earlier part of the year. The deaths are not to be looked for as occurring in the course of the disease itself, but are rather to be found amongst the complications, such as Bronchitis and Pneumonia, which occur later. The following table shows the mortality among infants in the various wards:— Ward. Births Registered. Deaths under 1 year of age. Infantile Mortality per 1000 Births. East Ward 503 80 159 North Ward 557 54 96 North-West Ward 560 57 101 Southward 209 11 52 South-East Ward 229 22 96 South-West Ward 271 15 55 I submit a list of the principal causes of the 239 infantile deaths in the Borough during 1917, viz.:— Whooping Cough 10 Measles 6 Tuberculosis 14 Meningitis, non-tuberculous 4 Convulsions 4 Bronchitis and Pneumonia 63 Diarrhceal Diseases 8 Enteritis and Diseases of.Digestive System 21 Syphilis 2 Congenital Malformation, Atelectasis, and Injury at Birth 9 Debility and Marasmus 27 Premature Birth 33 Other causes 38 239 9 The principal causes of deaths in the first four weeks and in the later months of infancy will be found in Table IV. The same table shows that the mortality amongst illegitimate infants, of whom 16 died, was equivalent to a rate of 253 per 1000, as compared with a rate of 98 per 1000 among those born in wedlock. Maternity and Child Welfare. Health Visitors. Towards the close of the year two additional (temporary) Health Visitors were appointed, the total number now being five, of whom four are whole-time visitors. During the year the following visits were paid:— 1st visits 2nd visits Total Births 1452 3555 5007 Tuberculosis 286 998 1284 Verminous Children 177 455 632 Ophthalmia Neonatorum 20 34 54 Infant Deaths 102 — 102 Miscellaneous 261 159 420 2298 5201 7,499 Infant Consultation Centres. Maternity and Child Welfare Work, the care of which at the present time is one of the most important duties devolving upon any Public Health Committee, continues to make progress, but much remains to be done. At present the Borough possesses four municipal and two voluntary centres, with four cots in the Babies' Home, Albany Institute. In December, the Committee appointed a Lady Medical Officer to take up work in January, whose duty it will be to examine the infants at the Municipal Centres as well as to treat minor ailments. This is a great step forward and a much more satisfactory arrangement than the irregular medical attendance outlined last year. The attendances at the clinics continue satisfactory. The interest in the work displayed by the Mayor (W. A. Wayland, Esq.) and Mayoress, both of whom frequently visited the clinics, was greatly appreciated by both mothers and staff. The Committee are also greatly indebted to the several ladies (Mrs. Green, Mrs. Grieve, and Miss Jacob), who voluntarily and regularly assisted at the Town Hall clinic. In July, a most successful "Baby Week" was held, concluding with a Baby Show, for which there were 500 entries. The Mayor generously provided tea for the mothers attending. 10 The cots at the Albany Institute were in constant use throughout the year. The children were admitted suffering from malnutrition, diarrhoea, &c. Of the 33 children admitted 7 died. The average period of residence in the home was 3 weeks. Epidemic diarrhoea was made compulsorily notifiable during the summer months, and proved useful in reminding the public of the seriousness of the complaint. The necessity of cleanliness in the preparation of baby's food, and the importance of breast feeding in connection with the prevention of diarrhoea were constantly brought before the mothers by the Health Visitors. In connection with the feeding of the babies the following details are of interest. "Mixed feeding" means both breast and hand-fed. Wards. Breast Feeding. Mixed Feeding. Hand Feeding. Totals. East 209 55 51 315 North 478 33 .19 530 North-West 519 18 54 591 South 120 6 21 147 South-East 151 9 13 173 South-West 143 15 14 172 1620 136 172 1928 Antenatal Work. Some 30 expectant mothers attended the Centres and received any necessary advice, but at present it is difficult to persuade them to attend, but with the New Year it is hoped to develop this part of the work. 11 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 1917 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. Under 1 year of Age. At all Ages. Uncorrected Number. Nett. 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 1916 110,299 2,838 2,918 26.5 1,126 10;.2 135 675 258 88 1,666 15.1 1917 103,527 2,262 2,329 20.1 1,091 10.5 161 733 239 102 1,663 16.0 Area of District in acres (land and inland water). 11,563. Total population at all ages 109,496. I Total families or separate occupiers, 25,040. j At census 1911. 12 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 1917. 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 268 3 86 142 23 12 2 .. 59 101 79 15 18 16 258 Erysipelas 107 4 8 11 16 31 29 .. 50 16 13 9 11 8 .. Scarlet fever 117 1 34 70 40 1 1 13 44 17 13 8 22 106 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 10 .. 1 3 4 .. 2 .. .. 4 2 .. 3 1 8 Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. German Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 3 .. .. .. 2 1 .. .. 2 1 .. .. .. .. 3 Cerebro-Spinal Meningitis 9 .. 4 3 2 .. .. .. 3 2 2 2 .. .. 8 Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 266 1 3 33 72 114 38 5 80 51 52 17 32 34 130 Other forms of 141 6 35 69 22 7 2 .. 60 25 26 1 16 13 8 Ophthalmia Neonatorum 23 23 .. .. .. .. .. .. 6 7 5 1 1 .. 3 Anthrax .. .. .. .. •• •• •• •• .. •• •• .. •• .. .. Totals 942 38 175 331 151 166 74 12 273 251 196 58 89 94 524 13 Table No. 3. METROPOLITAN BOROUGH OF DEPTFORD. Causes of, and Ages at Death during the Year 1917. (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 District. Total Deaths whether of " Residents" or "Non-Residents" in Institutions in the District. All Ages. j 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 1663 239 81 70 63 77 201 411 521 .. Uncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. 6 Small Pox .. .. .. .. .. .. .. .. .. .. Measles 30 7 10 10 3 .. .. .. .. 71 Scarlet Fever 2 1 .. 1 .. .. .. .. .. 45 Whooping Cough 20 8 7 5 .. .. .. .. .. 4 Diphtheria and Croup 22 1 2 10 9 .. .. .. .. 84 Influenza 17 .. .. .. 1 1 2 4 9 .. Erysipelas 3 1 .. .. .. .. 1 1 .. .. Phthisis (Pulmonary Tuberculosis) 187 2 2 4 8 36 76 49 10 15 Tuberculous Meningitis 23 5 3 6 8 1 1 .. .. .. Other Tuberculous Diseases 27 8 3 3 2 5 4 2 .. .. Cancer, malignant disease 127 .. .. .. .. 1 16 64 46 .. Rheumatic Fever 2 .. .. .. 1 .. 1 .. .. .. Meningitis 9 3 2 1 2 1 .. .. .. .. Organic Heart Disease 130 .. .. .. 5 6 17 47 55 .. Bronchitis 196 28 9 3 3 1 10 39 103 .. Pneumonia (all forms) 154 36 22 12 4 3 17 40 20 .. Other diseases of Respiratory Organs 15 1 .. 1 .. .. 3 3 7 .. Diarrhcea and Enteritis 71 44 12 3 1 1 3 2 5 .. Appendicitis and Typhlitis 11 .. .. .. 6 1 2 1 1 .. Cirrhosis of Liver 9 .. .. .. .. .. 1 6 2 .. Alcoholism 1 .. .. .. .. .. .. 1 .. .. Nephritis & Bright's Disease 54 1 .. 1 1 .. 7 23 21 .. Puerperal Fever 1 .. .. .. .. 1 .. .. .. 6 Other accidents and diseases of Pregnancy and Parturition 2 .. .. .. .. .. 1 .. .. .. Congenital Debility and Malformation, including Premature Birth 64 62 .. .. 2 .. .. .. .. .. Violent Deaths (excluding Suicides) 65 7 2 6 6 7 12 16 9 .. Suicides 3 .. .. .. .. .. 1 2 .. .. Other defined diseases 416 24 5 5 1 12 25 111 233 17 Diseases ill-defined or unknown 2 .. 2 .. .. .. .. .. .. .. 1663 239 81 70 63 77 201 411 521 208 14 Table No. 4. METROPOLITAN BOROUGH OF DEPTFORD. (This Table is prepared in accordance with the requisitions of the Local Government Board.) Infantile Mortality, 1917. 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 45 3 14 2 54 45 53 32 45 239 Uncertified .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. •• .. Chicken Pox .. .. .. .. .. .. .. .. •• .. Measles .. .. .. .. .. .. .. 1 5 6 Scarlet Fever .. .. .. .. .. .. .. .. 1 1 Whooping Cough .. .. .. .. .. .. 4 2 4 10 Diphtheria and Croup .. .. .. .. .. .. .. .. 1 1 Erysipelas .. .. .. .. .. .. 1 .. •• 1 Tuberculous Meningitis .. .. .. .. .. .. 2 3 2 7 Abdominal Tuberculosis .. .. .. .. .. .. 1 2 1 4 Other Tuberculous Diseases .. .. .. .. .. .. 1 1 1 3 Meningitis (not Tuberculous) .. .. .. .. .. .. 1 1 2 4 Convulsions 1 1 .. .. 2 2 .. .. .. 4 Laryngitis .. .. .. .. .. 1 .. .. .. 1 Bronchitis 3 1 4 .. 8 6 8 1 5 28 Pneumonia (all forms) .. .. 2 .. 2 6 10 7 10 35 Diarrhœa .. .. .. .. .. 4 2 1 1 8 Enteritis 1 .. .. .. 1 2 11 4 3 21 Gastritis .. .. .. .. .. 6 4 .. 5 15 Syphilis .. .. .. .. .. 1 1 .. .. 2 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying .. .. .. 2 2 2 .. 1 .. 5 Injury at Birth .. .. .. .. .. .. .. .. .. .. Atelectasis 3 .. .. .. 3 1 .. .. .. 4 Congenital tions 4 .. .. .. 4 1 .. .. .. 5 Premature Birth 25 .. 4 .. 29 3 .. 1 .. 33 Atrophy, Debility, and Marasmus 7 1 3 .. 11 8 6 l 1 27 Other Causes 1 .. 1 .. 2 2 1 6 3 14 45 3 14 2 64 45 53 32 45 239 Nett Births-Legitimate, 2266; Illegitimate, 63. Nett Deaths—Legitimate infants, 223; Illegitimate infants, 16. 15 Table No. 5. Return of Births Registered during the Year 1917. 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 1171 1091 49 2262 244 241 17 485 284 256 7 540 283 264 14 547 117 89 3 206 106 114 5 220 137 127 3 264 Births registered in Outlying Institutions 33 34 14 67 9 9 3 18 8 9 8 17 7 6 1 13 1 2 .. 3 4 5 2 9 4 3 •• 7 Total Births belonging to the Borough 1204 1125 63 2329 253 250 20 503 292 265 15 557 290 270 15 560 118 91 3 209 110 119 7 229 141 130 3 271 16 INFECTIOUS AND OTHER DISEASES. The following Table shows the number of notifications of Infectious disease, and the number of deaths:— Disease. Total number of notifications received. Errors of diagnosis and cases in hospital Nett number of cases. Number of Deaths. Diphtheria (including Membranous Croup) 268 6 262 22 Erysipelas 107 — 107 3 Scarlet Fever 117 1 116 2 Enteric Fever 10 — 10 — Puerperal Fever 3 — 3 — Cerebro-spinal Fever 9 — 9 — Pulmonary Tuberculosis 266 — 266 187 Other Tubercular Diseases 141 — 141 50 Ophthalmia Neonatorum 23 — 23 — Measles 1215 — 1215 30 German Measles 154 — 154 — The age period of deaths will be found in Table III. Diarrhoea. Seventy-one deaths were registered as due to diarrhcea or enteritis, 29 of which occurred during the first year of life. As previously stated, epidemic diarrhcea was made notifiable during the summer months. The number of deaths registered under this heading in 1916 was 58, of which 40 died in the first year of life. Small Pox. No case of small pox occurred in the Borough during the year. Puerperal Fever. Only 3 cases were reported all of whom recovered. Ophthalmia Neonatorum. Twenty-three cases occurred, 5 less than last year. All were promptly visited by the Health Visitors who saw that treatment was properly carried out. All made a good recovery. Provision is now made for the treatment and nursing of necessitous cases, 17 Measles and German Measles. There was a considerable prevalence of measles throughout London, which was shared by Deptford, the number of cases notified amounting to 1369 (measles 1215, German measles 154), with 30 deaths. It was not found necessary to use any large part of the grant allowed by the Council for the nursing of urgent cases, as the majority of the serious cases were removed to hospital. Tuberculosis. Two hundred and sixty six persons were notified for the first time as suffering from tuberculosis of the lungs, and 141 as suffering from other forms of tuberculosis. Pulmonary Tuberculosis death rate was 1.86 per 1000 against 1.55 in 1916. In all cases notified, or in which death occurred, the premises were at once inspected, and after death disinfection of the rooms, bedding, &c., were carried out. In every case of Pulmonary Tuberculosis, printed instructions are left as to the course that should be adopted for the prevention of Consumption. Contacts are advised to attend the Municipal Dispensary or be examined by the family medical attendant. Tuberculosis Dispensary. During 1917, new cases to the number of 683 were examined at the Dispensary. This number included 180 contacts. Of the total number examined 246 were insured. The number of attendances recorded by all patients was 5242. Of the 683 new cases, 263 were found to be suffering from Pulmonary Tuberculosis, and 49 from other forms of Tuberculosis, chiefly glandular. 257 patients were discharged improved, 34 died, the remainder being still under treatment. During the year 76 patients were admitted to Sanatoria and 61 to Poor Law Institutions. In connection with the Dispensary, the Interim Tuberculosis Care Committee has been active throughout the year. Although at present dealing mainly with child patients, efforts are being made to do something for the after care of the Adult Consumptive, a problem of great difficulty. The main obstacle is the finding of suitable employment, and even when found, the way is not easy. Employers however keen for labour are not disposed to give the standard wage to men obviously unfit to do an ordinary day's work, and the men on the other hand, decline to accept a lower wage. The problem still remains. 18 General Sanitary Administration. To economise space the usual returns showing the work of the Sanitary Inspectors have been omitted this year. All the information however is available for reference in the books of the Public Health Department. Building operations much restricted last year were further curtailed during 1917, when only 8 plans, all concerning re-drainage, were submitted and approved. Overcrowding occurred in 5 instances, which were remedied without taking legal proceedings. Smoke Nuisances. Six cases occurred and abatement obtained without trouble. Cleansing and Disinfecting Station. Number of premises disinfected 1798 Number of rooms disinfected 2181 Bedding, clothing, &c., disinfected 6784 Verminous clothing disinfected 6692 Number of baths administered 1708 Mortuary and Coroner's Court. Number of bodies received 106 Number of inquests held 95 Housing and Town Planning, Act, 1909. Under this Act 288 houses were inspected. Offensive Businesses Of which there are only 2 in the Borough were inspected on 18 occasions and gave rise to no complaints. Food Supply. Milksliops. At the end of the year there remained on the Council's Registers 247 premises where milk was sold. These were inspected on 353 occasions. Ice Cream Premises were subjected to 174 inspections, the number of premises being 136. 19 Slaughter houses. The 2 slaughter houses were kept under constant supervision, the inspections numbering 55. Other Premises used for the Sale of Food number 117, and include Restaurants, Fried Fish Shops, &c., which were inspected 222 times and found to comply with the regulations. In 7 instances, cases of Infectious disease occurred in the above premises, 5 measles and 2 diphtheria. Prompt action was taken under the Dairy, Cowshed and Milkshop Orders. Food Control. By permission of the Council, the services of the Sanitary Inspectors and Health Visitors have been lent to the Food Control Committee. Numerous inspections have been made and results reported to that Committee. Unsound Food. The amount condemned during the year is shown below:— 3 doz. tins Condensed Milk 5 stone Haddock. 22 cwts. Potatoes. 3 barrels Herring. 1 box Bloaters 53 Rabbits 7 boxes Mackerel. 96 lbs. Cheese 1 box Cod. 222 lbs. Tomatoes 1 box Sprats. 3 lbs. Bacon. Sale of Food and Drugs Act. During the year the Sanitary Inspectors collected 427 samples under the above Acts and submitted them to the Public Analyst for analysis. Of the samples submitted 34 or 7'9 per cent, were [reported as adulterated. Proceedings were taken in 24 cases, the fines and costs inflicted amounting to £\9 Os. 6d. Factory and Workshop Act, 1901. Factories, workshops and workplaces have been frequently inspected, but in view of the present emergency, the usual Statistical Tables have been omitted. These tables are however available for reference in the Registers of the Department. All the places concerned, as also home workers' premises have been kept under regular supervision. 20 Canal Boats Acts. The following is the report of Inspector Turner, the Sanitary Inspector to whom is assigned the performance of the duties under the above Acts:— Gentlemen, I have the honour to present my report under the Canal Boats Acts for the year ended 31st December, 1917, as follows: For the purposes of inspection during the year, visits were made on the following dates:—January 18th, March 2nd, 6th and 15th, May 2nd and 30th, July 5th and 21st, September 21st, and December 20th. Boats were found and inspected on the following dates:— January 8th, March 6th and 15th (two boats), May 2nd Number of visits 10 Number of boats inspected 5 Infringements. No contraventions were found on inspections. Children on Boats. No children found on boats. Very few boats were plying on the canal during the year owing to War conditions. The boats inspected were found in a clean and habitable condition, and no cases of sickness on board. The arrangements made for inspection of boats are:— Periodical inspection by Sanitary Inspector duly appointed under the Canal Boats Acts, jointly with other duties as Inspector of Workshops, Dairies and Milkshops, &c., &c. Name and Address of Inspector:—Thos. Turner, 161 St. Asaph Road, Brockley. Remuneration of Inspector £2 per annum, part of Salary as Sanitary Inspector apportioned to these duties. I am, Gentlemen, Your obedient Servant, (Signed) Thos. Turner, Canal Boats Inspector.