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., Tuberculosis Officer and Acting Medical Officer of Health. 1918 (Prepared in accordance with the requisitions of the Local Government Board). DEPTFORD: Gaylard & Son, New Cross Road, S.E. 14 Public Health and Housing Committee. manor Councillor WILLIAM A. WAYLAND, Lt.-Col., .P. (ex officio). Chairman. Councillor Dr. W. H. BROOKS. Vice - Chairman Alderman E. J. KNIGHT. Councillor W. H. GREEN. Councillor W. R. CARNELL Councillor H. CATTELL. Councillor W. FALKNER. Councillor J. G. HICKS. Councillor J. TIFFEN. Councillor T. D. LENG. Councillor R. SOPER. Councillor C. WATSON. Staff of the Public Health Department. JWrtiral (Mrer of #}caltij. William H. Whitehouse, m.d., d.p.h., b.s., Barrister-at-Law (TuluTrulosts ti&ffi'rrr anti Urting ittrtiral (©ffirpv of li)ra(ti). Murdoch Macdonald, m.d., d.p.h., B.ch. [Hnalpst. Henry G. Harrison, m.a. (Cantab), f.i.c. i&anitarj) Jmgpertorg. Thomas Turner. John V. Snowdon. Robert D. J. Simpson. "Arthur G. Kemp. Alfred Priest. "Frederick Hevvktt. Philip Shelley. "Harry Allam. ioanitan) f-ngpectoi; anti 2i}ralti) Visitor. Miss W. C. Smart. 2Tcmpvaq) Sanitan) Ensprrtor. Miss N. Playne. 3i)ralt1) Visitors. Miss H. Davies. Miss Butcher. Cempoiarj) IlKaltij Visitors. . Miss A. Perrett. Miss A. Mark. Miss Jones. (iTi)irt' OTInk. "Charles A. Chapman. tf Irrfcs. Henry J. L. Smith. Miss D. Thorogood. Miss G. Hicks. /tfhiniripa; Disprnsaq) for t1)f ^DrrUmtion of (LTonsumption, 78 Amersliam 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. A ttendant— :G. Abbott. ©isinfrrting irfaff. C. F. Dovvsett (Chief I )isinfector). ;'T. Lyons. F. Smith. "R. G. Gladman. tfTounril's ^Ijrltrr, fttortuarj) anti tforonrr's (ffonrt. Attendant—"G. W. }. Wagner. (flMransmg Station. Bath Attendant—Mrs. Wagner. School Nurse—Miss Gilby. * On Service vvitli H.M. Forces. TABLE OF CONTENTS. Page Page Vital Statistics— Sanitary Work— Summary of 6 Housing 27 Population 7 Drainage Works 27 Births 7 Overcrowding 27 Marriages 8 Disinfection 27 Deaths 8 Coroner's Court & Mortuary 27 „ in Wards 9 Summary of Male Inspectors' Work 24-26 „ Ages at 11 Summary of Women InspecCauses of 11 tors' Work 16 from Zymotic Diseases 18 Legal Proceedings 31 „ Tuberculous Diseases 18 „ of Infants 12 Food Supply „ from Influenza 22 Unsound Food 28 Local Government Board Sale of Food and Drugs Acts 28-30 Tables 10-17 Factories and Workshops— Home Office Tables 31-35 Infectious Diseases— Deaths from 11 Tuberculosis Dispensary Cases notified 17 Report of Tuberculosis Officer 20 Smallpox 18 Influenza 22 Canal Boats— Tuberculosis 18 Report of Inspector 36 Metropolitan Borough of Deptford. Public Health Department, Town Hall New Cross Road, S.E. 14. June, 1919. To the Mayor, Aldermen and Councillors. Gentlemen, On behalf of Dr. Whitehouse, who was still on service during the year, I have again the honour of presenting the Annual Report on the health of the Borough during 1918. As in the two previous years, the Report is curtailed at the request of the Local Government Board, and must be regarded only as a very brief summary of the work accomplished. The only points on which the Board desire somewhat detailed information are first, Maternity and Child Welfare work and second, Influenza. Both are dealt with in the Report. Since the Armistice, several members of the Staff have been released from the Army and resumed their ordinary duties shortly before the close of the year. To the Chairman and Members of the Public Health Committee and to the various members of the Staff I have to acknowledge my indebtedness for their co-operation and assistance during the year. I am, Gentlemen, Your obedient Servant, M. Macdonald. 6 Summary of Vital and Mortalitn Statistics for 1918. 1918. 1917. Area 1,563 acres 1,563 acres Population Census 1901 110,398 110,398 Census 1911 109,496 109,496 Estimated to middle of 1918 102,036 103,527 Number of inhabited houses 16,855 10,862 Average number of persons per house 6.0 6.1 Density 65 per acre 66 per acre Length of Public Streets 53 miles approx. 53 miles approx Rateable Value . . £604,686 £619,902 1d. Rate produces (approximately) £2,464 £2,423 Cost of administration of Public Health Department £1,895 £2,008 Marriages 907 821 Marriage Rate 7.9 7.1 Births 2,093 2,329 Birth Rate 18.3 20.1 Birth Rate, average for the last 10 years 261 28.0 Deaths 1,827 1,663 Death Rate 17.9 16.0 Death Rate, average for the last 10 years 14.9 14.7 Infantile Mortality 97 per 1,000 births 102 per 1,000 births Infantile Mortality, average for the last 10 years Zymotic Death Rate 111 per 1,000 births 1.08 112 per 1,000 births 1.5 7 POPULATION. The total population for Deptford has been estimated by the Registrar-General as 114,328. The civil population has been estimated as 102,036. These estimates have been based mainly upon the rationing returns supplied to the Registrar-General by the Ministry of Food. As far as Deptford is concerned the estimate for the civil population is fairly correct, as by courtesy of the Executive Officer of the Local Food Committee, I have been able to scrutinise the number of ration books issued. For the purpose of this Report the total population (114,328) has been used in calculating the Birth and Marriage Rate as it includes all the elements of the population contributing to these rates. It consists therefore of all the non-civilians enlisted from this district whether serving at home or abroad. For the Death Rate the estimate of the civil population (102,036) has been adopted as it excludes all the men who have joined the services from this Borough. The estimated population for each of the various wards based on the number of ration books issued was as follows:— East 19,758 South 11,724 North 22,153 South-East 10,505 North-West . 22,637 South-West 15,259 BIRTHS. The number of Births registered in the Borough was 2,093, viz., 1,073 males and 1,020 females. This is 853 below the average for the past ten years and 236 below the figure for 1917. The Birth Rate was 18.3per 1,000 as compared with 20.1 per 1,000 in the previous year, and is the lowest rate recorded in Deptford. The Illegitimate Births totalled 94 or 4.5 per cent. of the total births. These births occurred in the several wards as follows: East 20 South 10 North 23 South - East 6 North-West 32 South - West 3 8 MARRIAGES. I am indebted to the Superintendent-Registrar tor Greenwich and Deptford for the following information:— There were 907 marriages in the Borough during the year celebrated in the following places:— 646 in Churches of England. 75 in other places of worship. 186 in the Superintendent Registrar's Office. This gives a marriage rate equal to 7.9 per 1,000 of the estimated population as against 7.1 in the previous year. In the following table will be seen the number of births and deaths of children under one year of age which have occurred during the past ten years, with the respective rates:— Year. Estimated population. Births. Deaths under ore year. No. Rate per 1000. No. Mortality per 1000 births. 1908 117,539 3084 26.2 381 123 1909 118,583 3093 26.8 321 103 1910 119,642 2959 24.7 366 123 1911 109,475 3001 27.4 428 143 1912 109,377 2896 26.5 258 89 1913 109,280 3106 28.0 350 113 1914 109,182 3121 28.6 309 99 1915 110,299 2955 26.8 391 132 1916 110,299 2918 26.5 258 88 1917 115,403 2329 20.1 239 102 Average for 10 years 112,907 2946 26.1 330 111 1918 114,328 2093 18.3 205 97 DEATHS. During 1918 the number of deaths registered in the Borough was 1,361, but of these 230 were of persons not belonging to the Borough, while 696 inhabitants of Deptford died outside the Borough, chiefly in various public institutions. There were therefore 1,827 deaths of persons having their usual residence in Deptford, representing a death rate of 17 9 per 1,000 of the estimated civilian population, as against 16.0 per 1,000 in 1917, and 15.1 per 1,000 in 1916. 9 The subjoined table shows the number of deaths which have occurred during the past ten years, with the respective rates. Year. Estimated Population. Deaths. No. Rate per 1000. 1908 117,539 1643 13.9 1909 118,583 1611 13.5 1910 119,642 1671 13.9 1911 109,475 1728 15.8 1912 109,377 1442 13.2 1913 109,280 1727 15.5 1914 109,182 1598 14.6 1915 110,299 1962 17.8 1916 110,299 1666 15.1 1917 *103,527 1663 16.0 Average for 10 years 111,720 1671 14.9 1918 *02,036 1827 17.9 * Civil population. The next table gives the number of Deaths belonging to each Ward nd the Death Rates for each Ward:— Ward. Deaths. Death Rates per 1,000. Males. Females. Children under 1 year. Total. East 203 207 57 410 20.6 North 216 202 57 418 18.4 North-West 187 166 54 353 15.5 South 78 98 6 176 15.0 South-East 130 118 15 248 23.6 South-West 104 118 16 222 14.5 Excess of Births over Deaths. The natural increase of the population by the excess of births over deaths was 266, compared with 666, 1,252 and 993 in the preceding three years. The following table gives the statistics of the Borough during 1918 and the five previous years, in the form prescribed by the Loca Government Board: 10 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 1918 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. Kate. 1 2 3 4 5 6 7 8 9 10 11 12 13 CO r-H CT> rH 109,280 3,041 3,106 280 1,283 11.6 181 625 350 113 1,727 155 1914 109,182 3,071 3,121 286 1,145 10.5 163 616 309 99 1,598 146 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 2,918 265 1,126 10.2 135 675 258 88 1,666 151 1917 103,527 2,262 2,329 204 1,091 10.5 161 733 239 102 1,663 160 1918 102 036* 2,085 2,093 18.3 1,361 13.3 230 696 205 97 1,827 17.9 Area of District in acres (land and inland 1,563. water). *Civil population. Total population at all ages 109,496. At census Total families or separate occupiers, 25,040. 1911. 11 Table No. 2. METROPOLITAN BOROUGH OF DEPTFORD. Causes of, and Ages at Death during the Year 1918. (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. 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 1827 205 70 162 95 136 346 396 417 .. Uncertified .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. .. 1 .. 1 .. 4 Small Pox .. .. .. .. .. .. .. .. .. .. Measles 19 2 2 12 3 .. .. .. .. 44 Scarlet Fever 3 .. .. 3 .. .. .. .. .. 12 Whooping Cough 50 16 4 28 2 .. .. .. .. 4 Diphtheria and Croup 12 .. 2 10 .. .. .. .. .. 87 Influenza 338 12 10 27 29 54 130 58 18 5 Erysipelas 4 .. .. .. .. .. 2 2 .. .. Phthisis (Pulmonary Tuberculosis) 171 .. .. 4 6 36 71 49 5 58 Tuberculous Meningitis 19 1 3 7 8 .. .. .. .. .. Other Tuberculous Diseases 22 3 . . 9 5 3 2 .. .. .. Cancer, malignant disease.. 119 .. .. .. .. 1 17 55 46 1 Rheumatic Fever 2 .. .. .. 1 .. 1 .. .. .. Meningitis 7 2 .. 3 1 .. 1 .. .. 3 Organic Heart Disease 32 .. .. .. 1 5 6 10 10 .. Bronchitis 148 25 5 8 1 1 5 41 62 .. Pneumonia (all forms) 210 23 19 37 13 17 35 43 23 8 Other diseases of Respiratory Organs 20 .. .. 1 2 .. 7 6 4 .. Diarrhœa and Enteritis 25 12 8 .. .. .. 2 2 1 1 Appendicitis and Typhlitis 7 .. .. .. 3 2 .. 2 .. .. Cirrhosis of Liver 5 .. .. .. .. 1 .. 2 2 .. Alcoholism 1 .. .. .. .. .. .. 1 .. .. Nephritis & Bright's Disease 35 .. .. 1 2 .. 4 16 12 .. Puerperal Fever 1 .. .. .. .. .. 1 .. .. 2 Other accident and diseases of Pregnancy and Parturition 8 .. .. .. .. 4 3 1 .. 1 Congenital Debility anc Malformation, including Premature Birth 87 75 9 2 1 .. .. .. .. 2 Violent Deaths (excluding Suicides) 51 10 2 3 7 3 7 7 12 .. Suicides 8 .. .. .. .. .. 3 4 1 .. Other defined diseases 419 22 6 7 10 8 49 96 221 6 Diseases ill-defined or un known 2 2 .. .. .. .. .. .. .. .. 1827 205 70 162 95 136 346 396 417 241 Sub-Entries included in above 3 1 figures, Cerebro-Spinal Fever 12 INFANTILE MORTALITY. Of the 1827 deaths, 205 or 11.2 per cent. were of infants under one year of age, and the rate of infant mortality measured by the proportion of deaths under one year to births registered was 97 as compared with 102 in 1917. This is 4 per 1000 below the average rate of the preceding ten years. The infantile mortality rate of the County of London was 107 per 1000, and in the Metropolitan Boroughs the ratio ranged from 166 in Shoreditch to 89 in Wandsworth and Lambeth. The following table gives the causes of deaths at various periods under one year of age:— Table No. 3. METROPOLITAN BOROUGH OF DEPTFORD. (This Table is prepared in accordance with the requisitions of the Local Government Board.) Infantile Mortality, 1918. 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 40 12 15 8 75 34 38 24 34 205 Uncertified .. .. .. .. .. .. .. .. .. .. .. Small Pox .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 .. 1 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 5 3 8 16 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. .. .. 1 1 Abdominal Tuberculosis .. .. .. .. .. .. 1 .. 1 2 Other Tuberculous Diseases .. .. .. .. .. 1 .. .. .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. 2 .. 2 Convulsions 1 1 .. .. 2 3 .. .. .. 8 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 1 .. .. 2 7 5 5 6 25 Pneumonia (all forms) .. .. .. 1 1 3 6 6 7 23 Diarrhœa .. .. .. .. .. .. .. .. 1 1 Enteritis .. .. .. .. .. 3 4 2 2 11 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. 2 1 .. .. 3 Rickets .. .. .. .. .. 1 .. .. 1 3 Suffocation, overlaying.. l .. .. 1 2 1 2 1 .. 6 Injury at Birth .. .. .. .. .. .. .. .. .. .. Atelectasis l .. .. .. 1 .. .. .. .. 1 Congenital Malformations 1 l .. 1 3 1 .. .. .. 5 J Premature Birth 29 8 5 37 3 .. .. .. 40 Atrophy, Debility, and Marasmus 3 4 7 4 18 8 4 1 .. 31 Other Causes 4 2 2 1 9 1 4 4 6 24 40 12 15 8 75 34 38 24 34 205 Nett Births—legitimate, 1999; Illegitimate, 94. Nett Deaths—Legitimate infants, 195; Illegitimate infants, 10. 13 Deaths of Illegitimate Infants. Of the 205 infants who died before attaining the age of one year, 10 or 4.8 per cent. were illegitimate, the mortality amongst them being in the proportion of 106 deaths per 1000 against 97 per 1000 among children born in wedlock. The mortality amongst infants in the various Wards is shown in the following table:— Ward. Births Registered. Deaths under 1 year of age. Infantile mortality per 1000 Births. East 472 57 120 North 546 57 104 North-West 476 54 113 South 148 6 40 South-East 231 15 64 South-West 220 16 72 PREVENTION OF INFANT MORTALITY. MATERNITY AND CHILD WELFARE WORK. Maternity and Child Welfare work has been actively pursued during the year. By the appointment of a part-time Lady Medical Officer, who commenced duty in January, the medical examination and reexamination of every infant admitted to the Clinics is now possible. These examinations are carried out on the lines suggested by the Local Government Board in connection with the Maternity and Child Welfare Act, 1918. This Act widens the powers of local authorities and enables them to make such arrangements as may be sanctioned by the Board for attending to the health of expectant mothers and of nursing mothers and of children under the age of 5 years. The Act is administered by a Special Maternity and Child Welfare Committee, which must include at least 2 women amongst its members. The additional services for which the grant under the Act is available include hospital treatment for children under 5 years of age, lying-in homes, home helps, the provision of food for expectant and nursing mothers and for children under five years of age, creches and day nurseries, convalescent homes, homes for children of widowed and deserted mothers and for illegitimate children and their mothers, also for experimental work. A valuable item is that by which medical and nursing aid can be provided for necessitous cases. 14 Mention is also made that no Health Visitor should be expected to undertake the visiting of more than 400 births per year unless the district is a very compact one. Previously the proportion was one health visitor to every 500 births. From this brief summary of the Act, it will be seen that there is a wide field open to the Committee. The work carried out by the Committee during the past year may be shortly described. In 1918 there were four clinics situate as follows One in the North Ward (Gosterwood Street), meeting on Monday. One in the East Ward (Napier Street), meeting on Tuesday. One in theNorth-westWard(Ilderton Road), meeting on Wednesday. One in the South Ward (Laurie Hall), meeting on Thursday. These were conducted entirely by the Council's offices, the staff consisting of a part-time lady Medical Officer and six Health Visitors, all acting under the supervision of the Medical Officer of Health. In addition to the above clinics, a small Infant Consultation Centre was opened in July by the Ragged School Union, whose premises are situated in Hales Street, one of the worst areas of the East Ward, and a locality where great difficulty has always been experienced by the Health Visitors in inducing mothers to take their infants to the municipal clinic a short distance away. It was hoped that with a centre at their "very doors" some of the least lethargic might be tempted to attend. Results have been gratifying and there is every evidence that the initial success will be continued. The Institution authorities are acting in full co-operation with the Medical Officer of Health, under whose supervision the work is carried on. By permission of the Council, one of the Health Visitors conducts the clinic, assisted by several voluntary workers. It is hoped by the authorities to shortly appoint a medical officer. (This was carried out in January, when Dr. Carpenter, a local practitioner, was appointed). The other Voluntary Centre (which is, however, only partly within the Borough), is the Albany Institute, has been long established and continues to do excellent work. The Babies Home, belonging to the Institute, is entirely within the Borough and contains 10 cots, of which four belong to the Council. Statistics relating to the above are appended, but it might be mentioned here that the attendance at Laurie Hall Clinic has grown to such an extent that the Public Health Committee have decided, with the New Year, to abolish it and instead to establish two clinics, one in 15 the South-West Ward at Besson Street and one in the South Ward at Lewisham High Road (carried out in January, 1919). Other work undertaken by the Committee during the year was the provision of medical and nursing assistance to women in necessitous circumstances; the free supply of milk to nursing and expectant mothers in necessitous circumstances and the supply of dried milk at cost price to nursing mothers. Expectant mothers were seen at the Welfare Centres, but as it is not desirable to carry on ante-natal work during the progress of an Infant Consultation Session, the Committee having very properly decided to establish a Central Ante-natal Clinic which will meet weekly at the Napier Street Centre (since established). During the year the question of appointing a full-time medical officer to carry out the provisions of the Act was discussed as likely to lead to more efficient service and better supervision. The matter is still under consideration. INFANT WELFARE CENTRES—STATISTICS, 1918. Clinic. New Cases with Method of Feeding. Total Attendances. Old & new Cases. Consultations with Doctor. Expectant Mothers. Fresh Cases. Old Cases. Total. Consultations with Doctor Breast Mixed Hand. Total. Gosterwood St. 146 45 28 219 1830 710 14 2 16 11 Napier Street 124 32 51 207 1713 729 37 41 78 56 Ilderton Road 95 13 23 131 1500 381 27 4 31 14 Laurie Hall 224 213 41 478 5184 804 13 72 85 20 Hales Street 17 15 11 43 330 - 37 - 37 - Milk was supplied gratuitously to 60 nursing mothers in necessitous circumstances, the average quantity supplied being one-and-a-half pints per day for an average period of seven weeks. In ten instances the Council authorised the payment of medical and nursing fees after due investigation had been made. In four cases the assistance was refused, the Committee being of opinion that the circumstances did not warrant relief. NOTIFICATION OF BIRTHS ACT. The number of births notified under the Act was 2,010, notifications being received as follows:—258 from doctors; 890 from midwives; 766 from parents; 96 from other persons. Eighty-three parents were warned in respect of their failure to comply with the Act. 16 WORK OF THE HEALTH VISITORS. A summary of the work done by the health visitors may be seen from the following table:— 1st visits 2nd visits Total Births.. 2166 7166 9332 Still Births 49 4 53 Infant Deaths .. .. . 165 12 177 Expectant Mothers.. 143 130 273 Tuberculosis 529 1360 1889 Verminous Children 105 235 400 Scabies 60 136 196 Ophthalmia Neonatorum 45 112 157 Measles 764 840 1604 Miscellaneous 1778 59 1837 Of the 2,166 babies visited, J ,774 were breast fed; 171 hand fed; while 221 were both breast and hand fed, i.e., "mixed feeding." Owing to the increasing duties falling upon the Department an additional temporary health visitor was engaged during the year. The Committee are again indebted to the several ladies (Mrs. Green, Miss Jacob, Mrs. Rivers, the Misses Warcup) who have so regularly assisted the clinics and given valuable assistance, but more are required. With the lack of voluntary workers each health visitor was called upon to attend at least two clinics per week. This took up an amount of time that might have been more profitably occupied in home visiting, especially as the time spent in the clinics was on work which did not call for trained workers, e.g., the weighing of the babies, the sale of dried milk, Virol, etc. The desirability of distributing these articles from one centre, such as the Town Hall, was discussed, but was not considered feasible at the time. INFECTIOUS AND OTHER DISEASES. The list of notifiable infectious diseases has been extended and now includes the following diseases, viz.:- Scarlet Fever, Diphtheria, Erysepilas, Enteric Fever, Puerperal Fever, Cerebro-Spinal Fever, Measles, German Measles, Pulmonary Tuberculosis, other Tuberculous Diseases, Smallpox, Ophthalmia Neonatorum, Poliomyelitis, Anthrax, Primary Pneumonia, Influeuzal Pneumonia, Malaria, Dysentery, Trench Fever, Encephalitis lethargica and Polio-Encephalitis. A uniform form of certificate or notification by medical practitioners tor all notifiable infectious diseases was prescribed by the Local Government Board early in the year and has been greatly appreciated by all concerned. The following table gives the number of cases of infectious diseases notified in the Borough, together with the number removed to hospital: 17 Table No. 4. 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 1918. 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 Chicken Pox 189 4 78 104 3 .. .. .. 46 55 27 16 26 19 Small-pox 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. 1 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria including Membranous Croup 244 4 93 118 25 4 .. .. 37 67 83 18 24 15 233 Erysipelas 69 1 4 9 8 16 24 29 12 10 3 6 9 Scarlet fever 197 4 55 112 23 2 1 40 51 44 21 23 18 186 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 14 .. .. 4 4 3 3 .. 1 7 2 .. 2 2 13 Measles 550 27 393 122 4 3 1 .. 73 145 108 73 39 112 .. German Measles 157 1 84 53 13 4 2 .. 42 35 37 10 7 26 .. Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 2 .. .. .. 2 .. .. .. .. .. .. 1 1 .. 2 Cerebro - Spinal Meningitis 3 .. 1 1 1 .. .. .. .. .. 1 .. 1 1 3 Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 204 10 26 47 89 30 2 55 48 33 10 24 34 79 Other forms of Tuberculosis 110 2 21 64 15 5 1 2 35 25 18 10 10 12 6 Ophthalmia Neonatorum 16 16 .. .. .. .. .. .. 5 5 .. 2 3 1 .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1756 59 740 614 145 127 62 11 363 451 365 164 166 249 523 18 Deaths from Epidemic Diseases. To the seven principal epidemic diseases (Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Enteric Fever, Diarrhœal Diseases) 111 deaths were ascribed, and the death-rate from them was 1.08 per 1,000 of the estimated civilian population, as against 1.5 per 1,000 in the preceding year. Notifiable Infectious Diseases. Under the provisions of Public Health (London) Act, 1891, and the Tuberculosis Regulations, 1,756 notifications of cases of infectious diseases were received, as compared with 2,313 in 1917. The deaths from these diseases will be found in Table IV. Small-Pox. An outbreak of small-pox appeared in London during the months of March and April, mainly in the East End, the first case being discovered in Stepney on 2nd March. Of the 34 cases which occurred only one belonged to Deptford, the patient, a woman residing in the North Ward, being promptly removed to hospital. Diligent investigation showed that the patient had visited a picture house in Stepney about a fortnight previous to her illness. She had been successfully vaccinated in infancy, but not re-vaccinated. She made a good recovery. Prompt measures were taken to prevent the spread of infection, and no further case occurred. Tuberculosis. 205 persons were notified for the first time as suffering from Pulmonary Tuberculosis (consumption of the lungs), and 112 as suffering from other forms of tuberculosis. 17l deaths were registered as Pulmonary Tuberculosis representing a death rate of l.6 per 1,000 against 1.8 in 1917. To other forms of tuberculous disease 41 deaths were ascribed, nearly 11.6 per cent. of the deaths from all causes being due to some form of tuberculosis. Disinfection is carried out in all cases as in previous years. The Public Health (Tuberculosis) Regulations (No. 2) 1918, dated 6th September, 1918, amended the regulations of 1912 in order to provide for the notification of all cases of tuberculosis discovered at medical examinations undertaken by the Medical Boards under control of the Ministry of National Service, to the Medical Officer of Health of the Sanitary District in which the man resides. 19 METROPOLITAN BOROUGH OF DEPTFORD. Public Health (Tuberculosis) Regulations, 1912 and Public Health (Tuberculosis) Regulations (No. 2), 1918. Summary of Notifications for the period from 30th December, 1917 to 28th December, 1918. Notifications on Form A. Notifications on Form B. Number of Notifications on Form C. Age Periods. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Cases admitted to 0-3 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and up Total Primary Notifications. Poor Law Institutions. Sanatoria, Under 5 5-10 10-15 Total Primary Notifications, Pulmonary— Males ... 6 6 3 8 12 19 28 13 5 3 103 122 ... 2 ... 2 2 6 50 Females 2 10 5 10 18 27 14 12 1 99 114 ... 1 ... 1 1 2 21 Non-Pulmonary Males 1 10 91 11 4 5 1 1 ... 1 ... 55 58 ... 1 1 1 .. 2 Females 1 10 23 9 1 2 2 1 ... ... 2 54 57 ... ... 1 1 2 ... 4 * Re-notifications. 20 TUBERCULOSIS DISPENSARY. During 1918 new cases to the number of 652 were examined at the Dispensary. This included 129 contacts. Of the total number examined, 191 were insured. The number of attendances recorded by all patients was 5400. Of the new cases, 190 were found to be suffering from Pulmonary Tuberculosis, and 45 from other forms of the same disease. During the year, 236 were discharged improved, whilst 26 died, the remainder being still under treatment. As regards Institutional treatment, 77 were admitted to Sanatoria and 8 to Poor Law Institutions. There is still urgent need for providing accommodation for advanced cases. At present little exists except the workhouse. The danger of allowing these cases to remain at home has been pointed out in previous reports. The failure to deal adequately with advanced cases combined with the existing housing conditions contribute to neutralise all efforts to prevent the spread of infection. In connection with housing, the question of sub-letting should not be lost sight of. This condition often leads to gross overcrowding and hence to the spread of infection. License should be required to sub-let, such license only being granted after full investigation. It is hopeless to look for improvement when such advanced cases are allowed to live and come in intimate contact with young children. Again, with regard to notification, quite a number of cases are never notified at all and only found out when the death certificates are received. Knowledge of several cases only came to hand when applications for extra rations were received at the Town Hall. All this tends to the spread of infection. The Interim Care Committee has been doing good work during the year, but it still requires to develop and extend the scope of its functions. Attention might be drawn to the importance of allowing patients who are able to do light work to be so employed without prejudicing their Sickness Benefit. At present the Friendly Societies do not permit this. At the same time the amount of benefit might be increased in view of present conditions. A word might be said about the Dispensary itself. The premises while sufficient as a temporary measure, are ill adapted, inadequate, badly equipped, and too unsuitable to be regarded as a permanent institution dealing with the prevention of Tuberculosis. The accommodation is limited, patients frequently have to sit on the stairs, there are no dressing rooms, no proper facilities for the examination of the throat, &c. The internal walls are unsound and cannot be kept clean despite frequent washing down. Now that the war is over, the Committee might possibly consider those points. 21 I append a tabular statement in the form designed by the Local Government Board to show the work carried out at the Dispensary during the year. TUBERCULOSIS DISPENSARIES IN LONDON. Metropolitan Boroogh of Deptford, Return as to Work carried out in connection with the Tuberculosis Dispensary for the period from 1st January, 1918, to 31st December, 1918. (The return should relate only to persons residing in the area served by the Dispensary in accordance with the scheme of the Metropolitan Korough Council). Insured. Uninsured. Males. Females. Children under 16. Adults. Males. Females. 1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensary 152 39 300 34 127 •(b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 79 '28 50 20 39 (c) Number included under 1 (a) who were found to be suffering from non-pulmonary tuberculosis 5 2 31 1 5 (d) Number included under 1 (a) who were found to be non-tuberculous 50 5 156 10 57 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful .. 18 4 63 3 31 Insured. Uninsured. 2. (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a) ) 1509 3891 (b) Number of the above attendances at which systematical physical examinations and records were made 458 736 3. Number of visits to patients at their own homes by the Dispensary medical officers in connection with the supervision of home conditions .. 10 15 4. Number of visits to patients at their own homes by the Dispensary nurses in connection with the supervision of home conditions and "following up" 1300 2371 5. Number of persons suffering from or suspected to be suffering from tuberculosis referred to the Hospital to which the Dispensary is affiliated 3 17 6. Number of consultations with the— (a) Medical Adviser of the Insurance Committee (b) Consulting Physicians at the Hospital to which the Dispensary is affiliated (c) Practitioners at the homes of patients 5G 28 7. Number of written reports concerning individual patients made to— (a) Public authorities 162 130 (b) Practitioners 28 12 8. Number of specimens of sputum examined .. 207 137 M. MACDONALD, Medical Officcv of the Dispensary. 22 INFLUENZA. A serious epidemic occurred throughout the Borough, especially during the third and fourth quarters of the year, as shown by a total of 338 deaths certified as due to this disease. Arranged quarterly, the mortality figures are:—1st quarter, 3; 2nd quarter, 7; 3rd quarter, 12; 4th quarter, 316 ; total, 338. Details as to the age and sex distribution are shown as follows :— Age Period. Males. Females. Total Under 1 yr. 7 5 12 1-2 4 6 10 2-5 14 13 27 5-10 10 8 18 10-15 4 7 11 15-20 5 14 19 20-25 8 27 35 25-35 33 51 84 35-45 21 25 46 45-55 22 9 31 55-65 12 15 27 65-75 9 5 . 14 75-85 1 2 3 85 & over 1 ... 1 Totals 151 187 338 It will be noticed that the highest mortality was in the age-period 25 to 45 years, and also that infants under one year suffered severely. The disease was not confined to any one district. All observations pointed to the fact that the less crowded and more sanitary areas suffered as much as the more congested districts. The death-rate for the different wards was as follows :—East, 2*7 ; North, 3-0; North-west 3'5; South, 3'8; South-east 4-0; South-west, 3'2. The death-rate for the whole borough was 3'3 per 1,000 of the estimated population. The disease not being compulsorily notifiable no statistics as to the total number of cases of influenza are available, but judging from the number of deaths the number must have been very large. From interviews with the general practitioners the incubation period seems to be very short (not more than 48 hours), and infection spreads very rapidly, numerous instances being quoted of whole families or groups of people being attacked at the same time. 23 The disease most commonly began with symptoms of a " slight cold in the head " rapidly followed in most cases with pains throughout the body, and extreme prostration. Pneumonia was a frequent complication and figured largely as the secondary cause of death in the fatal cases. Recovery was slow in all cases, and in a certain number, pulmonary tuberculosis appeared as a sequel to the disease. The extreme suddenness of onset and the short incubation period rendered all attempts at preventive treatment very difficult. The Local Government Board issued Orders, known as the Public Health (Influenza) Regulations, 1918, providing for the ventilation of all places of public entertainment (especially cinematograph exhibitions) at stated intervals. The utmost that Local authorities could do was to urge the public to avoid appearing in crowded places; to take simple precautionary measures against infection, etc. All this was carried out in the Borough by means of the public press and by posters and leaflets, while disinfectants were offered to all who cared to apply, and disinfection of premises, ere., was carried out on request. The Regulations came into force in November, 1918, and continue in force until revoked by Order of the Board. Power, however, is given to a public authority to relax the Regulations, on the written advice of the Medical Officer of Health. VENEREAL REGULATIONS. These Regulations are administered by the London County Council, and the Local Authority plays only a small part in the campaign against these diseases. During the year, however, a series of lectures was arranged by the Committee for both men and women, but although every step was taken to advertise them widely, the resulting attendances were disappointing. Apart from these lectures the LocalAuthority is only called upon to make public the literature and posters provided by the County Council. Only seven persons applied to this Department during 1918 for informatiou as to where and how to obtain treatment. GENERAL SANITARY ADMINISTRATION. To economise space, the usual returns showing the work of the Sanitary Inspectors have been much curtailed, but all the information is available in the books of the Department. 24 METROPOLITAN BOROUGH OF HERTFORD. ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR ENDING 28th DECEMBER, 1918. Table No. 1. Number of District. 1 2 3 4 5 Totals. Complaints Received... 14 26 21 95 5 161 Total Premises Inspected 570 780 659 920 72 3001 Re-Inspections, Calls, Service of Notices, &c., &c. •2357 2601 2106 2602 140 9806 Inspections under notice from Contractors, per Bye-Laws 5'2 24 6 34 116 Number of Cases in which Proceedings have been taken ... 1 1 " Intimations " Served 113 185 238 329 40 905 " Statutory Notices" Served 3 4 7 ... 14 Water Closets— Old Closets abolished 1 , , . ... • • . ... 1 New Closets provided '2 . . • ... ... ... 2 ,, ,, ,, in Workshops . . . ... . . • ... ... Basin and Trap provided ... 38 27 16 13 "■2 96 Water Supply provided ... , . . 5 35 ... 40 Water Supply Apparatus provided . . • 28 16 20 2 66 Limewashed 1 ... 1 1 3 Walls Repaired 2 2 2 1 7 Floors Repaired 1 ... 2 * * * i 3 Doors provided ... 4 2 6 Ventilated ... ... 3 ... ... 3 Seats provided ... • . • 2 1 3 Basins Cleansed 3 ... 9 2 1 15 Drains- Drains Re-construcled 2 ... ... ... • . . 2 Surface Drains provided . .. 5 ... ... ... 5 Cleansed and Amended 70 61 22 29 7 189 Gully Traps fixed ... 15 5 7 5 1 33 New Soil Pipes and Vent Pipes fixed 17 • • • ... 2 2 ! 21 Chambers built and Interceptors provided 2 2 Interceptors only fixed • • • ... • •• 1 • •• 1 Ventilated ... 2 ... 3 ... 5 Provided to Stables ... • • • ... ... ... Clearing Eyes 1 2 | ... 5 1 9 Sinks, Bath& Lavatory Wastes, and Rain Water Pipes Disconnected from drains, trapped and ventilated 18 16 7 12 4 57 25 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR ENDING 28th DECEMBER, 1918—continued. T able—continued. Number of District. 1 2 3 4 5 Totals Cesspools— Abolished ... 21 ... ... ... 21 Dustbins— Provided 21 ... 27 G7 7 122 Repaired ... ... ... ... ... ... Yards- Paved 13 ... ... 13 Surface Repaired ... *8 9 ... 3 5 25 Scullery&Wash=house Floors— Paved ... ... G 1 7 Forecourts- Paved • • • . . . ... 2 ... 2 Surface Repaired ... ... ... 1 ... 1 Gutters and Rain Water Pipes Provided and Repaired 30 40 31 22 16 145 Water Supply— Store Cisterns provided ... . . • . . . ... ... ,, ,, Covers provided ... ... . . . ,, ,, Cleansed ... ... . . . ... ... ,, ,, abolished ... ... . . . ... Supply Reinstated ... 17 12 3 32 L L J Fittings Repaired ... 41 19 15 19 r kj 100 New Houses Inspected for Certificates before Occupation Potable Water provided from Service ... ... ... Cleansing and Repairs- Houses Cleansed and Limewashed 58 99 87 129 29 402 Houses repaired and Ventilation improved 45 82 f> 10 143 House roofs repaired 59 81 52 50 5 247 Dung Receptacles— Abolished • . • . . . ... ... ... Repaired ... ... ... ... Provided 26 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR ENDING 28th DECEMBER, 1918—continued. Table—continued. Number of District. 1 2 3 4 5 Totals. Underground Rooms— Used as dwellings abolished ... ... ... ... ... Overcrowding - Cases Abated ... 4 4 1 ... 9 Accumulations < Removed 2 2 ... 2 1 Animals— Ceased keeping as a Nuisance ... • • • 3 ... ... 3 Smoke Nuisances- Cases Abated Observations ... ... ... ... ... Rooms occupied in such a manner as to be a nuisance ... 2 ... <2 Unsound Food Destroyed ... District No. 1.—Inspector Priest. District No. 2.—Inspector Simpson. District No 3.—Inspector Shelley. District No. 4.—Inspector Snowoon. District No. 5.—Inspector Hewett (from Dec. '2nd to '28th only). 27 Building Operations were further restricted during the year and only five plans concerning re-drainage were submitted and approved. Overcrowding. Numerous instances came under the notice of the department, but with the existing shortage of houses it was felt that little could be done to obviate the evil until a sufficient number of houses was provided to accommodate the people dehoused. In nine cases where the overcrowding was serious, repeated efforts were successful in finding other accommodation, but in several instances the people had to go outside the Borough. Cleansing and Disinfecting Station. Number of premises disinfected ... ... ... 1492 Number of rooms disinfected ... ... ... ... 1745 Bedding, clothing, etc., disinfected ... ... ... 5912 Verminous clothing disinfected ... ... ... 5086 Number of Baths administered ... ... ... 2178 Mortuary and Coroner's Court. Number of Bodies received ... ... ... ... 118 Number of Inquests held ... ... ... ... 104 Number of Post Mortem Examinations ... ... 73 HOUSING. This question came prominently before the Committee during the year. With the exception of a small area (about 2\ acres) in the Brockley district, there is no available land in Deptford suitable for building purposes. Any extension will require to be outside the Borough boundaries. With this object in view, the London County Council, who have been constituted the Housing Authority for Greater London, are arranging a Conference with the neighbouring boroughs. New houses can only be built in Deptford by demolishing the old insanitary properties which exist in certain parts of the East and SouthEast Wards. These buildings are well known, to the Committee and would have already been dealt with but for the war and the shortage of houses which renders the problem of finding accommodation for the people to be dehoused very difficult. Whatever scheme is adopted in Deptford there is a great opportunity before the Council of building model houses fulfilling modern requirements. Flats and tenements will not solve the housing problem. 28 More especially for people with families, ample bedroom accommodation is required and a garden or allotment should be considered a necessity. The improved health resulting from the additional open space alone, would amply repay the extra cost. Another consideration which the Council might bear in mind in connection with this question is the " no children barrier " which many private owners and some few public authorities adopt in refusing to let their houses to peopie with families. Houses built by the Municipality should certainly go by preference to such people, and the question of sub-letting already referred to should not be overlooked. FOOD CONTROL. By permission of the Council, the services of the Sanitary Inspectors and Health Visitors were lent to the Food Control Committee as last year. Numerous inspections were carried out and the results reported to that Committee. UNSOUND FOOD. The following quantities of food were, upon examination by the Officers of the Department, found to be unsound, unwholesome and unlit for human consumption :— Beef ... ... 1244 lbs. Mutton ... ... 148 „ Bacon ... ... 1033 ,, Ham ... ... 673 ,, Herrings ... 14 brls. 9 boxes Mackerel ... 25 ,, Kippers ... ... 3 ,, Bloaters... ... 8 ,, Fish ... ... 98 lbs. Winkles ... ... 4 bags Fowls... ... ... 6 Butter ... ... 7 lbs. 'Cheese ... ... 43 ,, Sugar ... ... 174 ,, Eggs ... ... ... 1 case Brussel sprouts ... 10 bags Rabbits ... ... 128 Condensed Milk ... 153 tins These were all voluntarily surrendered. The conditions imposed by the Ministry of Food and the establishment of fixed prices removed the temptation to which some traders are exposed, of endeavouring to sell unsound food. The greater part of the bacon and cheese was returned under precautions to the wholesalers. The remainder of the foods were destroyed. SALE OF FOOD AND DRUGS ACTS. During the year the Sanitary Inspectors collected 415 samples under the above Acts, and submitted them to the Public Analyst for analysis. Of the number submitted 42 or 10 per c ent, were reported as adulterated. 29 The following is a list of the articles purchased with the results of the analyses:— Description of Article No. of Samples Analysed Result of Analysis. Baking Powder 2 Genuine (free from Arsenic within Royal Commission limit) Coffee 1 Genuine Ground Ginger 1 Genuine Milk 64 Genuine Do. (1 P) 2 per cent. added water Do. (5 P) 13 „ „ Do. (13 S) 2 „ „ Do. (9 SY) 8 „ „ Do. (12 SY) 4 „ „ Do. (22 SY) 1 „ „ Do. (8 T) 2 „ „ Do. (Condensed) 2 Genuine Do. (Separated) 2 Genuine Mustard 2 Genuine Olive Oil 1 Genuine, of B.P. Standard Pepper 2 Genuine Ground Rice 1 Genuine Vinegar 7 Genuine Do. (21 T) 29 per cent. excessive water Do. (22 T) 1 „ „ Do. (34 T) 12 „ „ Total number of samples analysed during quarter ending 31st March 95 Number aduldterated 10 Description of Article. No. of Samples Analysed. Result of Analysis. Butter 3 Genuine Do. (45 SY) 17 per cent. water Coffee 1 Genuine Milk 76 Genuine Do. (22 P) 2 per cent. milk fat abstracted Do. (23 P) 6 ,, ,, ,, Do. (24 P) 29 ,, ,, ,, Do. (34 P) 10 ,, ,, ,, Do. (26 S) 37 ,, ,, ,, Do. (27 S) 10 ,, ,, ,, Do. (36 S) 8 ,, ,, ,, Do. (41 S) 5 2 ,, „ and 1 per cent. added water Do. (49 S) 5 per cent. milk fat abstracted Do. (27 SY) 5 per cent. added water Do. (29 SY) 20 per cent. milk fat abstracted Do. (32 SY) 16 „ „ „ Do. (47 SY) 2 ,, ,, ,, and 1 per cent. added water Do. (36 T) 17 per cent. milk fat abstracted Mustard 1 Genuine Olive Oil 1 Genuine, B.P. Standard Pepper 1 Genuine Vinegar 6 Genuine Do. (52 T) 1 per cent. excessive water Total number of samples analysed during quarter ending 30th June 105 Number adulterated 16 30 Description of Article. No. of Samples Analysed Result of Analysis. Baking Powder 1 Genuine (free from Arsenic within Royal Commission limit) Cocoa 2 Genuine Ground Ginger 1 Genuine Milk 74 Genuine Do. (53 P) 13 per cent. milk fat abstracted Do. (60 S) 6 Do. (82 S) .. 26 ,, ,, ,, Do. (69 T) 1 per cent. added water Pepper 2 Genuine Vinegar (65 T) 38 per cent. excessive water Do. (66 T) 8 ,, ,, ,, Do. (69 T) 9 ,, ,, ,, Total number of samples analysed during quarter ending 30th Sept. 87 Number adulterated 7 Description of Article. No. of Samples Analysed Result of Analysis. Butter 3 Genuine Baking Powder 2 Genuine Coffee 1 Genuine Dripping 2 Genuine Ground Ginger 1 Genuine Lard 3 Genuine Milk 89 Genuine Do. (2 H) 1 10 per cent. milk fat abstracted Do. (95 S) 1 3 per cent. added water Do. (79 T) 1 11 percent. milk fat abstracted Do. (80 T) 1 1 ,, ,, ,, Do. (89 T) 1 8 ,, ,, ,, Mustard 5 Genuine Pepper 4 Genuine Sausage Meat 1 Genuine Vinegar 7 Genuine Do. (63 P) 1 3 per cent. excessive water Do. (75 P) 1 2 ,, ,, ,, Do. (74 T) 1 43 ,, ,, ,, Do. (96 T) 1 4 ,, ,, ,, Informal sample Milk 1 Genuine Total number of samples analysed during quarter ending 31st Dec. 128 Number adulterated 9 31 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. 1 p Milk 2 per cent. added water — — Summons withdrawn 5 P „ 13 „ „ „ 20 0 0 3 3 0 9 sy „ 8 „ „ „ 20 0 0 3 3 0 12 sy „ 4 „ „ „ — 2 2 0 Summons withdrawn on payment of costs 21 T Vinegar 29 per cent. excessive water .. 1 0 0 2 2 0 22 T „ 1 „ „ „ — — Vendor cautioned 34 T „ 12 „ „ „ 0 10 0 1 11 6 23 p Milk 6 per cent. milk fat abstracted 10 0 0 1 13 6 24 p „ 29 „ „ „ 2 0 0 1 13 6 34 P „ 10 „ „ „ — — Summons dismissed Warranty proved 26 S „ 37 „ „ „ 3 0 0 2 12 6 27 S „ 10 „ „ „ 0 10 0 1 11 6 41 S „ 5 per cent. milk fat abstracted and 1 per cent. added water 1 0 0 3 10 0 49 S „ 5 per cent. added water — - Summons dismissed Warranty proved 27 SY „ 5 „ „ „ — - Summons dismissed Warranty proved 29 sy „ 20 per cent. milk fat abstracted 1 0 0 2 12 6 3'^ sy „ 16 „ „ „ 0 10 0 1 11 6 47 SY „ 5 per cent. milk fat abstracted and 1 per cent. added water — 2 12 6 Summons dismissed on payment of costs 36 T „ 17 per cent. milk fat abstracted — 2 12 6 Summons dismissed on payment of costs 53 p „ 13 5 0 0 1 16 0 60 S „ 6 „ „ „ — — Summons not served Defendant in the Army 82 S „ 26 „ „ „ 3 0 0 including costs 65 T Vinegar 38 per cent. excessive water 0 10 0 1 10 0 66 T „ 8 „ „ „ 1 0 0 0 10 0 67 T „ 9 „ „ „ 3 0 0 1 10 0 74 T „ 46 „ „ „ 3 0 0 1 11 6 79 t Milk 11 per cent. milk fat abstracted — — Summons dismissed Warranty proved FACTORY AND WORKSHOP ACT, 1901. The usual statistical tables are appended. All factories, workshops and workplaces were kept under regular supervision, as also were home workers' premises. 32 Table. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDING DURING 1918. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of proceedings On register at end of 1917 Added 1918 Removed 1918 On register at end of 1918 Milk premises 247 7 27 227 269 4 .. Cowsheds .. .. .. .. .. .. .. Slaughter-houses 2 .. .. 2 47 .. .. Other offensive trade premises 2 .. .. 2 21 .. .. Ice cream premises (a) 136 .. '2 134 3 .. .. Registered houses let in lodgings .. .. .. .. .. .. .. (a) Prohibited D.O.R.O. 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 1918. CLASS OF WORK. Number ok Places Number of Inspections. Number of Number] of Proposcutions. On Register at end of 1917 Added 1918. Removed 1918. On Register at end of 1918. Written. Intimations. Notices. Under Factory Acts. Under Public Health Acts. Premises. Rooms Factories- Factory Laundries 4 4 22 4 Factory Bakehouses 10 1 11 26 33 Other Factories 128 1 1 128 246 36 1 Workshop Laundries Workshop Laundries 6 I 5 17 5 Workshop Bakehouses 51 6 45 48 159 1 Other Workshops 189 3 15 177 232 26 Workplaces- Places where Food is prepared for Sale 117 2 6 113 220 168 7 Workplaces other than the above 64 1 3 62 63 30 4 Home-workers' Premises 848 60 209 699 702 313 1 Total 1417 68 241 1244 1576 774 14 33 Table. METROPOLITAN BOROUGH OF DEPTFORD This Table is by request of the Secretary of State. Annual Report op Medical Officer of Health for the year 1918. On the Administration of the Factory and Workshop Act, 1901 in connection with FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 73 1 Workshops (including Workshop Laundries) 190 1 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 198 11 Total 461 13 2.—DEFECTS FOUND. PARTICULARS. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health lets. Want of Cleanliness 175 175 Want of Ventilation Overcrowding Want of Drainage of Floors 2 2 Other Nuisances 47 42 Sanitary Accommodation Insufficient 36 36 Unsuitable or defective Not Separate for Sexes Offences under the Factory and Workshop Act. Illegal Occupation of Underground Bakehouse (s. 101) \ / Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) Other Offences (excluding offences relating to outwork which are included in Part 3 of this Report) Total 260 255 34 Table-continued. 3.-HOME WORK. NATURE OF WORK. OUTWORKERS LISTS. SECTION 107 OUTWORK IN UNWHOLESOME PREMISES. SECTION 108. OUTWORK ININFECTED PREMISES. SECTIONS 109. 110 Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Twice in the year. Once in the year. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110) Prosecutions (Sections 109, 110) Lists. Outworkers. Lists. Outworkers. Failing to keep or permit inspection of lists. Failing to send lists. Confactors. Work- men Contactors. Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing apparel— 1. Making, etc. 58 9 343 2 1 3 63 2 1. Cleaning & Washing 35 Table—continued. 4.—REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year. Number. Bakehouses 45 Dressmaking 61 Laundries 5 Millinery 10 Shirtmaking 3 Tailoring 14 Wheelwrights (Smiths, &c.) 15 Others 74 Total number of Workshops on Register 227 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) 1 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector 1 Other 3 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 16 36 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, 1918, as follows:— For the purposes of inspection during the year, visits were made on the following dates:—January 4th, February 14th, April 11th, June 5th, July 8th, August 16th, October 30th and November 29th. One boat was found and inspected on the following date:—April 11th. Number of visits 8 Number of boats inspected 1 Infringements. No contraventions were found on inspection. Children on Boats. No children found on boats. Very few boats were plying on the canal during the year owing to war conditions. The boat inspected was found in a clean and habitable condition, and no case of sickness on board. The arrangement 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, etc. Name and Address of Inspector:—Thomas Turner, 161 St. Asaph Road, Brockley, S.E. 4. Remuneration of Inspector £2 per annum, part of salary as Sanitary Inspector apportioned to these duties. I am, Gentlemen, Your obedient servant, (Signed) THOMAS TURNER, Canal Boat Inspector.