ANNUAL REPORT ON THE HEALTH OF THE Metropolitan Borough of Deptford, BY WILLIAM H. WHITEHOUSE, M.D., D.P.H., of the Temple, Barrister-at-Law; Fellow of the royal society of medicine,&c., &c. Medical Officer of Health 1919 DEPTFORD: Gaylard & Son, 446 New Cross Road, S.E. 14. Public Health and Housing Committee. Lieut.-Col. Sir WILLIAM A. WAYLAND, J.P., F.C.S., F.S.A. Chairman. Alderman W. H. GREEN. Vice=Chairman. Alderman E. J. KNIGHT. Councillor W. R. Carnell. Councillor W. F. Marchant. Councillor J. Tiffen. Councillor E. C. Wood. Councillor Mrs. M. Charlton. Councillor Mrs. B. M. Drapper. Councillor Mrs. M. Humphries. Councillor Mrs. L. White. Councillor Miss A. M. Jacob. Staff of the Public Health Department. Medical Officer of Health WILLIAM H.WHITEHOUSE.M.D., D.P.H., B.S., Barrister-at-Law. Assistant Medical Officers of health. MURDOCH MACDONALD, M.D., D.P.H., B.ch. (Tuberculosis officer). WILLIAM SCARISBRICK, M.D., D.P.H., B.sc. (Maternity and Child Welfare officer.) public Analyst. HENRY G. HARRISON, M.A.(Cantab), F.I.C. Sanitary inspectors. THOMS TURNER. ROBERT D.J.SIMPSON. ALFRED PRIEST. PHILIP SHELLEY. JOHN V.SNOWDON. ARTHUR G.KEMP. FREDERICK HEWETT. HARRY ALLAM Health Visitors. Miss W.C. SMART (also a Sanitary inspector). Miss A.S.BAIRD Miss E. CLUBBE Miss E. HOLLAND Miss H. F. G . PIPER Miss E. T. Stowell Miss PORTEUS Chief Clerk. CHARLES A. chapman. Clerks. HENRY J.L.SMITH F.GILES Attendent-G.ABBOTT. Doroner's Court and Mortuary. Attendant — G. W. J. WAGNER. Disinfecting Station. C.F.DOWSETT (Chief Disinfector). T.LYONS F.SMITH J.TRIPLOW Cleansing Station. Bath Attendant —Mrs. WAGNER. School Nurse —Mis WYATT Mertopolitian Borongh of Deptford. PUBLIC HEALTH DEPARTMENT, TOWN HALL NEW CROSS ROAD,S.E.14. September Ist, 1920. To the Right Worshipful the Mayor, Aldermen and Councillors. LADIES AND GENTELMEN, In compliance with the order of the Ministry of Health I have pleasure in submitting the Annual Report for 1919, the ninth since I have been your Medical Officer of Health, on the vital statistics of the Borough and the work of your Public Health Department for the 53 weeks ending January 3rd, 1920. Vital Statistics. The foundation of vital statistics being the annual estimate of the population of the Borough, the correctness of such estimate is a matter of first importance. The estimated population for the middle of the year 1919 has been obtained by new methods calculated to yield nearer approximations to the truth than the formula previously employed. Such methods have given an estimated civil population of 111,205 and a total population of 115,843. Births. It will be noted in the text that the birth rate in the Borough for year 1919 was 20˙5 per 1000, which is 2 ˙ 2 per 1000 more than that for the previous year and 2˙2 per 1OOO more than that for the whole of London. Deaths. During the year 1469 deaths were registered in the Borough, being 220 less in number than in the previous year. The death rate was 13˙0 per 1000 compared with 17˙9 per 1000 for the previous year. Infantile Mortality. The infantile mortality for the year was the lowest on record and was in striking contrast with the rates recorded 10 years ago. The death rate being 85 per 1000 births compared with 97 per 1000 in 1918. 5 Infectious Diseases. During 1919 the following diseases were unduly prevalent: Diphtheria, Scarlet Fever and Measles. There were 270 cases of Diphtheria, with 16 deaths. The cases were as usual more prevalent in the North-West and North Wards. There were 517 cases of Scarlet Fever notified, and it is to be noted that this disease was generally distributed throughout the Borough, but the East and North Wards supplied by far the greater number of cases. It is satisfactory to know that there were only 9 deaths from Scarlet Fever, thus showing the value of Institutional care, and the necessity of the steps taken by the Committee and your Medical Officer to procure the same. Measles cases notified numbered 1459, and this disease was prevalent throughout the Borough, but it is fairly satisfactory to note that there were only 21 deaths. General Matters. As this will be the last report that I shall have the pleasure of making to the Council, I should like to say that the past 9 years have been years of progress, and I have marked with considerable satitisfaction a steady improvement in the general health of the borough and in the sanitary conditions generally. Staff. 1 have much pleasure in reporting that the present staff of the Public Health Department have carried out their difficult duties in a satisfactory and conscientious manner and to my entire satisfaction. Personally I beg to thank the Council for their kind and courteous consideration and support in matters affecting this department. I am, Your obedient Servant, W. H. Whitehouse. 6 Summary of vital and mortality statistics for 1918. 1919. 1918. 1,563 acres 1,563 acres Area Population— Census 1901 110,398 110,398 Census 1911 109,496 109,496 Estimated to middle of 1919 111,205 102,036 Number of inhabited houses 16,855 16,855 Average number of persons per house 6.5 6.5 Density 71 per acre 65 per acre 53 miles approx. Length of Public Streets 53 miles approx. Rateable Value £621,248 £604,686 1d. Rate produces (approximately) £2,490 £2,464 £2,617 Cost of administration of Public Health Department £1,895 Marriages 1,004 907 Marriage Rate 8.7 7.9 Births 2,426 2,093 Birth Rate 20.5 18.3 Birth Rate, average for the last 10 years 25.4 26.1 Deaths 1,469 1,827 13.0 Death Rate 17.9 Death Rate, average for the last 10 years 15.3 14.9 85 per 1,000 births Infantile Mortality 97 per 1,000 births Infantile Mortality, average for the last 10 years 109 per 1,000 births 111 per 1,000 births Zymotic Death Rate 0.7 1.08 Area and Population. Births and Deaths. 8 Area and Population. Acres. Estimated Population. 1563 111,205 The total population for Deptford has been estimated by the Registrar-General as 115,843. The civil population has been estimated as 111,205. 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 i it d population (115,843) has been used in calculating the Birth and \l ite as it includes all the elements of the population i o insists 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 (111,205) has been adopted as it excludes all the men who have joined the services from this Borough. The estimated civil population for each of the various wards was as follows: — East 21,534 South 12,777 North 24,144 South-East 11,449 North-West 24,671 South-West 16,630 As the Borough has an area of 1,563 acres, the density of the population on this estimate is 71 per acre approximately. The following table shows the total number of dwelling houses and the number inhabited and uninhabited in 1901, 1911, and 1919 respectively:— HOUSES. Year. Inhabited. Uninhabited. Total. 1901 516 15,823 16,339 491 16,102 1911 16,593 43 16,898 1919 16,855 9 Taking the number of inhabited houses in 1919 to be 16,855 as set forth in the above table, and calculating the population to be 111,205, then the average number of persons per house would be 6.5. The following table shows the number of houses, separate occupiers, and population in 1901 and 1911, distinguishing the various kinds of buildings and the population enumerated therein, and also the buildings not used as dwellings:— 1901 1911. Building used as dwellings. Vessels, Sheds, Vagrants, etc. Separate Flats. (Included in Col. 5.) Offices, Warehouses, workshops, factories. Ordinary Dwelling Houses. Hotels, Inns, and Public Houses. Buildings not used as Dwellings. Blocks of Flats. Institutions. Total. Shops. Totals (Cols. 4-11) Others. Kind of Building. No. 8 13 Cols. 1 2 3 4 5 6 7 9 10 11 12 14 Number inhabited 764 Places of Worship 15,823 16,102 14,768 75 1,049 121 40 15 34 - 48 33 Govt. & Municipal Buildings 6 773 Separate Occupiers 24,615 25,040 22,838 773 1,193 124 42 16 16 3,409 shops 234 Population 110,398 109,496 98,470 3,409 5,116 752 190 1,398 140 21 Offices 27 Warehouses, Workshops & Factories 207 179 - - Theatres and other places of amusement. Uninhabited 424 640 561 1 - 70 1 - 3 - 4 - - - Being built 92 15 11 3 1 7 Families or separate occupiers (private and other) in Deptford :— East ... ... 4,671 North ... ... 5,385 North-West ... 5,358 South ... ... 2,854 South-East... ... 2,783 South-West ... 3,979 25,040 1911 ... 25,040 1901 ... 24,615 Increase 425 * 1911 1919 Number of Private Families ... 24,275 25,728 Population in Private Families ... 107,775 111,205 Population of Deptford living in Institutions, large establishments, vessels, etc.:- Number of Institutions, etc. 22 Population 1436 Population Population. Institution. East 227 10 North 20 1 North-West 512 4 South 93 3 South-East 584 4 South-West - - 1436 22 10 Back-to-Back Houses. There are very few houses of this class in the district and practically no houses built in courts. Site, Sub-Soil and Drainage of Deptford. The physical features and character of the Borough are better described by considering the whole of London, but generally speaking we may say that the town is situated on one side of a long ridge, at the top of which ridge we find Telegraph Hill, and extending in a South-East direction we have Hilly Fields. From this ridge we get a wide sweep down into the Thames valley, until in the North and East we get very low-lying land. In the Southern district the soil is practically all clay, but the gradual slope forms an ideal drainage area. In the South-West we find gravel to the north of New Cross, and clay to the South of it. In the South and South-East we have all clay. So much clay has a serious effect on the houses and drains after a very dry or very wet season, in which the clay shrinks or expands, the foundations being seriously interfered with. There is also an interference with the foundations owing to the sliding movement which takes place on a big slope. Sewage System. The sewers passing through Deptford are: — Branch. Coming from Length. Bermondsey Branch Rotherhithe 7290-ft. Southern High Level Sewer Wandsworth 6480-ft. Southern Low Level Sewer Putney 7260-ft. Effra Branch Norwood 6270-ft. Storm Relief (in Church Street) — 2970-ft. Storm Relief (St. George's Stairs) - 1980-ft. Relief Sewer at Broadway Greenwich 3080-ft. Deptford to Lee Green Sewer Lee 1320-ft. Ravensbourne and Sydenham Sewer Bell Green 1330-ft. New Southern High Level Sewer Brockley 7920-ft. 11 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 (On South-East Boundary of Borough) Brockley 45½ acres L.C.C. 4. Telegraph Hill Recreation Ground Telegraph Hill 9¾ acres L.C.C. 5. Railways and adjoining land - 234 acres 6. Millwall Football Ground - 5½ acres 7. Canals - 8 acres 8. St. Paul's Churchyard - 2.2 acres 9. Reservoir - 1 acre Births. Number of births 2426 Average number of births for previous 10 years 2847 Average birth-rate for previous 10 years 25.4 Birth-rate of Deptford per 1000, for 1919 20.5 England and Wales 18.5 96 Great Towns 19.0 148 Smaller Towns 18.3 London 18.3 The total number of births registered in the Borough in 1919 was 2426, as compared with 2093 in 1918. Of these, 1277 were boys and 1149 were girls. This is 421 below the average for the past 10 years and 333 above the figure for 1918. The birth-rate for the Borough was equivalent to an annual rate of 20'5 per 1000 of the population, as compared with 18'3 for 1918, 20'1 for 1917, and 26'5 for 1916. 12 The birth-rate for London was 18'3 per 1000, compared with 19'1 for 1918. 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: — Births. Deaths under one year. Estimated population. No. Mortality per 1000 births. Year. Rate per 1000. No. 1909 118,583 3093 26.8 321 103 1910 119,642 2959 24.7 366 123 1911 109,475 3001 27.4 428 143 109,377 2896 258 1912 26.5 89 1913 109,280 3106 28.0 350 113 109,182 1914 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 1918 114,328 2093 18.3 205 97 Average for 10 years 112,587 2847 25.4 31 2 109 1919 115,843 2426 20.5 85 207 Illegitimate Births. The illegitimate births number 91 or 3.8 per cent. of the total births. These births occurred in the several wards as follows : — East ... ... 23 North... ... 15 North-West ... 22 South ... ... 12 South-East ... 10 South-West ... 9 91 Marriages. There were 1,004 marriages in the Borough during the year, as compared with an average of 949 in the ten years preceding. The marriage rate for 1919 was equal to 8.7 per 1,000 of the estimated population and has not been exceeded in any year for the past ten years. The rate for 1918 was 7.9 per 1,000. The marriages were celebrated in the following places : — 654 in Churches of England. 89 in other places of worship. 261 in the Superintendent Registrar's Office. 1,004 Total 13 Deaths. ] 1919 Average for past 10 years. Number of deaths Average death-rate for previous five years 1,469 1,689 16.4 15.3 Rate per 1,000 for Deptford 13 „ „ England and Wales 13.8 „ „ 96 Large Towns 13.8 „ „ 148 Smaller Towns 12.6 „ „ County of London 13.4 The number of deaths registered within the Metropolitan Borough of Deptford from all causes during 1919 was 1,051, equal to a deathrate of 10.1 as compared with 1,361 deaths, and a death-rate of 12.6 during the previous year. The total number of deaths belonging to Deptford is obtained by deducting the number of deaths of nonparishioners registered in the Borough, viz., 230, of which a number occurred in the Metropolitan Asylums Board's South Eastern Hospital and other places, making 773 deaths actually belonging to Deptford. To this number we must add 696 deaths of parishioners which occurred in public institutions outside the Borough, making a total of 1,469, of which 790 were males and 679 females, and upon these figures the statistics are based. The death-rate for the Borough was equal to an annual rate of 13 per 1,000 of the population, as compared with 17.9 for 1918, 16.0 for 1917, and 15.1 for 1916, the average for the past live years being 16.4. The subjoined table shows the number of deaths which have occurred during the past ten years, with the respective rates. Deaths. Estimated Population. Year. No. Rate per 1000. 1909 118,583 1611 13.5 1910 119,642 1671 13.9 1911 109,475 1728 15.8 1912 109,377 1442 13.2 109,280 1913 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 1918 *102,036 17.9 1827 110,170 1689 15.3 Average for 10 years *111,205 1469 13.0 1919 Civil population. 14 The following table gives the number of deaths belonging to each Ward, and the death rates for each Ward. Deaths. Death Rate per 1,000. Total. Ward. Children under 1 year Males. Females. East Ward 204 142 70 346 15.8 North Ward 148 45 310 162 12.6 North-West Ward 118 111 36 229 9.1 South Ward 81 107 22 188 14.4 109 92 17 201 17.2 South-East Ward South-West Ward 116 79 17 195 11.5 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 1918 and 1919 is as follows:— 1918. 1919. Under 1 year 20.2 per cent. 19.3 per cent, deaths. 1 to 2 years 5.8 5.4 2 to 5 5.1 4.8 5 to 15 3.6 4.0 15 to 25 4.6 4.0 25 to 45 12.1 13.0 45 to 65 19.4 21.0 65 years and upwards 29.2 28.5 Death Registration and Vital Statistics, It may almost be said that the foundation of efficient public health work rests upon the accuracy of death registration. To secure that accuracy we are dependent upon the general practitioner, who. as a rule, expends a great deal of care upon the certificate of death, which is the initial step in the process of registration, in spite of the fact that he receives no payment for the performance of what is a most important duty on behalf of the State. Indeed, it is common knowledge among medical officers of health that a death certificate is often much more carefully filled in than a certificate notifying a case of infectious disease, although for the latter he receives a statutory fee. A study of the earliest records of death registration in this country is of considerable interest, not to say wonderment. The cause of death not infrequently 15 found is dropsy, cough, tumour, atrophy and various other symptoms, and some years ago one very conscientious practitioner gave the cause of death as primary, syphilis, secondary, the act of God. A great deal of progress has been made in the accuracy of death registration since those early days, but there is still much room for improvement, and medical officers of health at any rate will welcome reforms in the administration of the national statistics of life and death. The first of these reforms might be with advantage the institution of a confidential system of death certification, under which system the medical practitioner might transmit the death certificate to the registrar direct in a sealed envelope, and such certificate should be looked upon as a confidential document, subject to the discretion of the Registrar-General. Infantile Mortality. Total deaths of Infants under one year, 207. Average for previous 10 years. 1919 Deptford Infantile death rate per 1000 births 85 109 England and Wales 89 96 Large Towns 93 148 Smaller Towns 90 County of London 85 Of the 1469 deaths recorded during the year 207 were of infants under one year of age. During the past ten years the infantile death-rate has fallen from 149 to 85 per 1000 births registered. In a previous table will be seen the infantile mortality per 1000 births for the past ten years. Deaths of Illegitimate Infants. Of the 207 infants who died before attaining the age of one year, 14 or 6.7 per cent, were illegitimate, the mortality amongst them being in the proportion of 154 deaths per 1000 against 83 per 1000 among children born in wedlock. The mortality amongst infants in the various Wards is shown in the following table: — Deaths under 1 year of age Infantile mortality per 1000 Births. Births Registered Ward East 522 70 134 North 530 45 85 North-West 36 63 570 South 151 22 88 South-East 239 17 71 South-West 314 17 54 16 Comparative table of infantile deaths from Diarrhœa and Enteritis RATE PER 1000 BIRTHS. Diarrhœa and Enteritis under two years. Total deaths under one year. England and Wales 9.59 89 96 Great Towns 12.24 93 148 Smaller Towns 8.67 90 London 16.22 85 Deptford 11.58 85 TABLE SHEWING THE NUMBER OF BIRTHS AND DEATHS IN THE BOROUGH DURING THE YEAR 1919. Births 2426 Deaths —including those in outlying Public Institutions 1469 Excess of Births over Deaths 957 I submit a list of the principal causes of the 207 infantile deaths in the Borough during 1919, viz.: — Measles 2 Tuberculosis 3 Meningitis 3 Influenza 3 Bronchitis and Pneumonia 58 Diarrhœal Diseases Enteritis and Diseases of Digestive System 28 Scarlet Fever 1 Suffocation in bed with parents 2 Congenital Malformation, Atelectasis, and Premature Birth 80 Debility and Marasmus 38 Other causes 27 207 Although Infantile Mortality for the whole of the Borough may be this year considered very satisfactory, yet I still hope to see a further reduction in one of our wards in particular. In previous reports I have given the contributing causes of the higher infantile death rate in the central district of the Borough, which contains practically the whole of the East Ward, to which I particularly refer. We found that the conditions associated with and assisting in varying degree in the production of excessive infantile mortality were 17 partly social and partly sanitary, and that it is easy, according to the point of view adopted, to magnify unduly the importance of one set of factors. The effects of unsatisfactory domestic and war conditions are fairly obvious, and their consequences fall most heavily on the poorer members of the community. Of these domestic forms of insanitation to be noted in Deptford, overcrowding and lack of cleanliness are probably the most important. For the infant it means exposure to a stuffy atmosphere, and the storage of milk in a contaminated and vitiated atmosphere. Outside the house, refuse is frequently left about in the yards instead of being burnt. Animals are frequently kept, and the yards belonging to the smaller houses are in many cases only partly paved and therefore filthy and damp. From the number of cleansing notices we find it necessary to serve in the course of the year it will readily be understood that we find the floors, walls, furniture, clothing and bedding notoriously dirty in many of the houses. Other contributing causes are of buildings. (2) Low-lying building sites. (3) Lack of ventilation and light. (4) Foul air from the accumulation of filth. (5) The geological formation of the land. (6) The feeding of the child. (7) The sex and age of the infant. 8. Temperature. -The higher temperature of the air in the summer months has long been observed to be assoiated with high Diarrhœal mortality, and the reverse with low air temperature. The maximum mortality by no means coincides with the highest readings of the air thermometer. The temperature of the soil being a less sensitive indicator, and more steady in its record, is on the whole a better guide. The maximum Diarrhœal mortality is generally attained in the week in which the temperature recorded by the 4-ft. earth thermometer attained its mean weekly maximum. 9. Rainfall. —Diarrhœal diseases are greater in dry seasons and less in wet. Under the former conditions the micro-organism is capable of getting abroad from its primary home, the earth, and having become air-borne, fastens on food or other organic matter and uses it as a nidus and pabulum in undergoing various changes in its life history. From food and other organic matter it can manufacture a virulent chemical poison which is the material cause of diarrhœa. The value of ram. therefore, as a means of removing filth and microorganisms, which so much of the epidemic summer diarrhoea, is evident. Scavenging by water carts should take the place of rain in dry weather, and the dust laid by water should be swept up and removed 18 before it has time to dry and disseminate in the atmosphere ; and any attempt at scavenging in dry weather without the aid of water simply results in the more complete dissemination of dust into the atmosphere. 10. Industrial employment of many of our women in the borough is probably one of the important influences at work, for it is obvious that girls and young women who are employed in industrial work for many hours daily have but little time to make themselves practically familiar with the very numerous, and often apparently unimportant matters, which make all the difference between a well-ordered home and one which lacks the influence of a capable mother. Nevertheless, to what extent and in what manner the industrial employment of married women affects the infantile mortality is still a matter of discussion. Until the present improved social conditions of the bread winner the harmful effects were partly counteracted by the greater comfort and increased nourishment which such employment enabled the mother to secure. The mortality from prematurity and congenital defects is higher in the East Ward of Deptford than in the remainder of the Borough and greater than the average of some other large towns. One reason why diarrhœal diseases are excessive in the locality mentioned above may partly be put down to artificial feeding, but the disadvantages of artificial feeding are further accentuated by the absence of the mother from the home, and by carelessness and ignorance and lack of cleanliness in the preparation of the food. It is impossible, however, under normal conditions to dissociate the effects of married female labour from those of poverty, and in social questions causes and effects may occupy positions of mutual dependence and transferability. Many of the women are occupied, as much from choice, as necessity, or are widows or the wives of men whose payments to the upkeep of the home are insufficient to maintain it in comfort. The excessive mortality from bronchitis and pneumonia and premature births may also be one of the effects of married female labour. The mother has to take her baby to be cared for in the mornas she proceeds to work, and fetch him again in the evening. Under the best of conditions the child is liable to contract respiratory diseases, but in former years the mother had no option but to leave the child in charge of a neighbour. The mother used not to select the house where the baby was cared for on sanitary grounds, and the standard of cleanliness which usually obtained in a " baby-minder's house " was 19 below that of the average for the neighbourhood. In 1913, the Albany Day Nursery was opened, and it has been undoubtedly the means of improving the conditions under which the children are cared for. The Goldsmiths' College and Miss MacMillan's Home are also doing good work in this direction. Other allied conditions may also be put down as contributory causes to the wastage of child life :—(1) The unhealthy condition of the parents, particularly the mother. Young girls frequently, before being married, lead most unhealthy lives. Instead of taking as much open air exercise as possible, and eating plain and wholesome food at proper times to develop all the normal functions of the body, they prefer spending their spare time in stuffy houses, picture palaces, etc., where conditions are far from satisfactory. Especially does this apply to those employed in factories or close workshops during the day time. Again, sweets often are taken in place of a good meal, and it is noticeable, particularly when young girls go out to the factories, money so earned instead of being spent on good food, is used in finery and other trashy things. When a girl gets married, the course of training up to marriage has been so useless that the same helpless methods are carried on during the early years of married life, leading to bad nutrition and deficient staying power, with the result that when a call is made upon the system these weakly subjects either do not go to their full time, or a debilitated human being is added to the present generation, to die in a few days, or it may be months later, from failure of the mother to carry out her proper maternal functions. (2) The want of care exercised by the mother during early motherhood, tending towards or causing this general debility. (3) The irregular habits of the father before marriage. PREVENTION OF INFANT MORTALITY. Maternity and Child Welfare Work. Dr. Win. Scarisbrick's report is as follows, in which 1 concur: — As was expected, the Maternity and Child Welfare work in the Borough has developed greatly during the last twelve months, and there is every indication that it will develop further still in the near future. The field it embraces is an ever widening one. and as the tremendous import.nice of the subject to the community as a whole has become more fully realised, it easily ranks as one of the foremost social problems of the day. As a foreword it is necessary to emphasize how closely related Maternity and Child Welfare work is to other subjects embraced under B 2 20 Public Health administration, e.g., Medical Inspection and Treatment of school children, Tuberculosis, Venereal Diseases, Infectious Diseases generally, etc. In fact, there is hardly any branch of Public Health work with which the subject is not directly or indirectly connected. It is easy to see, therefore, that in order to obtain good results the closest co-operation is necessary between this and other Departments, and also between the several Committees. At present the bulk of the work in Deptford is of necessity carried out at the various Infant Welfare and Ante-Natal Clinics, supplemented by home visiting. It embraces consultations with the doctor and nurses, keeping of records, talks to mothers, clothing demonstrations, and the provision of milk, dried milk, medicines, etc., either at cost price, free, or reduced price, according to the circumstances of the mother. A lot of good work has been and is being done, as a visit to any of the Clinics will demonstrate, but much more is required if the efforts just enumerated are to be followed to a logical conclusion. Two things are urgently required, viz., a Maternity Home where expectant mothers having no facilities or accommodation at home, or whose home conditions are unsatisfactory, or where some difficulty is expected over the confinement, can be admitted and receive skilled nursing and treatment during the confinement period. Secondly, an Observation Nursery for premature, ailing, or ill-nourished babies requiring careful feeding and management is a real necessity, and could be established and worked in conjunction with the Maternity Home. The Ante-Natal Clinic could with advantage be held at the Maternity Home. A Treatment Centre, which could also be established along with the Maternity Home and Day Nursery, is a further requirement which, if provided, would be capable of doing an immense amount of good. Here babies and children suffering from minor ailments would be sent from the out-lying Welfare Clinics as out-patients for treatment of such ailments as sores, discharging ears, rickets, etc. At the present time most of these cases are only seen once a week by the doctor, and however willing the mother may be in such cases to try and get her child well, yet in the majority of cases not having had any training and not properly understanding the principles of the treatment advised, her enthusiasm soon lessens and improvement occurs only slowly. Of course, it might be urged that such cases could attend as out-patients at the General Hospitals in the neighbourhood, but it has been found that continuity of 21 treatment is essential to success, and where ailing babies and children have been prescribed for at one of the Council's Infant Welfare Centres, the cases should be followed up, daily if necessary, by the original practitioner who saw the case. Day Nurseries constitute another important branch of Infant Welfare work. At these places mothers who are compelled to leave their homes and to go out working and have no one in whose charge they can leave their babies, are allowed to leave one or more of their infants during certain hours of the day, and these children are looked after and fed by a trained staff. The following Clinics are held once a week at present Monday, 2 p.m. Gosterwood Street Mission Hall. Tuesday, 10.30 a.m Napier Street Mission Hall. Special Ante-Natal Clinic. Napier Street Mission Hall. 2 p.m. Wednesday, 2.30 p.m. Erlam Road Church Institute. Thursday, 2 p.m. Goldsmiths' College. 2 p.m. Hales Street Mission Hall. Albany Institute. 2 p.m. Friday, 2 p.m. Besson Street Mission Hall. All the Maternity and Infant Welfare Centres in Deptford, with the exception of the Albany Institute and Hales Street have been established by the Borough Council, whilst even at the latter centre one of the Council's Health Visitors attends and assists in the supervision of the work there. Of the other centres or clinics there are at present two kinds to be differentiated, viz., Maternity Centres and Infant Welfare Centres. The Maternity or Ante-Natal Centre is held once a week at Napier Street Mission Hall, and its main function is to advise expectant mothers in matters relating to their health, primarily in regard to condition directly associated with pregnancy, but also as to general ailments which indirectly affect their physical welfare. The women frequently come of their own accord, or are sent by doctors, midwives, health visitors or referred from an Infant Welfare Centre or other institution. For the establishment and maintenance of a satisfactory Maternity Centre one or two points may be detailed as most important if the work is to be successful. First, the atmosphere with which the work is conducted must be one of cheerfulness, encouragement and help. No internal examination should be conducted without the full consent of the patient, and only when necessary in her interests. 22 Ante-natal work as just referred to should be supplemented by :— (a) Home visiting, either by the midwife or with her knowledge and co-operation. (b) Educational classes in hygiene of pregnancy, mothercraft, etc.; these may be incorporated with the talks to mothers at the Infant Welfare Centres. (c) Dinners or milk for expectant and nursing mothers may be provided through the Maternity Centres. In this connection it may be stated that it is impossible to lay too great stress on the importance of adequate nourishment for expectant mothers if the child is to be born healthy and strong, and grow up healthy and strong. Shillings spent properly on the mother during the carrying period are worth pounds spent on the child afterwards. (d) Dental treatment, where necessary, is most important, as caries and septic teeth exercise a specially deleterious effect on health during pregnancy and lactation. The Ministry of Health have promised to pay a grant towards the cost of dental treatment to authorities who provide this below the cost price, or free, and where the circumstances of the case justify such a course. (e) Maternity Hospital or Home should be associated with the Ante-Natal Clinic, and admission for institutional treatment where necessary be arranged for. Treatmeant for venereal disease. Many cases of pregnancy are unfortunately complicated by venereal disease, and it may be necessary hospitto refer the case to a venereal disease hospital or a specialist venereal medical officer: With regard to the above-mentioned adjuncts of ante-natal work as conducted in Deptford, details as regards (a), (b) and (c) will be found in the paragraphs on Infant Welfare Centres. Endeavours are being made to provide dental treatment for expectant mothers by mean of a scheme which will embrace also dental treatment for persons resident in the Borough suffering from Tuberculosis. The Public Health Committee have had the question of the establishment of a Maternity Home under their earnest consideration for a considerable time, and it is to be deplored that there is no suitable building available in the Borough. Endeavours have been made for a long time to obtain the Red Cross War Depot in Lewisham High Road for this purpose, but up to the moment of writing the Borough Council, in spite of many attempts, have been unable to come to a working arrangement with the London County Council, which owns the premises. 23 Infant Welfare Centres. The kind of work carried out at these centres is now fairly well known, but mention may be made of lectures and talks to mothers both by the doctor in attendance and the Health Visitors. By selecting one branch of child welfare for each lecture certain fundamental facts and principles are explained to mothers as a whole, and it has been found possible by this means to lessen-individual teaching and so save time. This is important where, as at Deptford, the attendance at the clinics has grown so enormously. The talks include ante-natal subjects, mothercraft, clothing, preparation of food, etc. The sale of dried milk, Virol, cod-liver oil and medicines has expanded considerably, but no more than what is necessary for the benefit of mothers and children. In no case are these given or continued without the express order of the doctor. The provision of cow's milk will be referred to later. With regard to Home Visiting, the tables appended are sufficient evidence of the large amount of work done in this direction, and having paid many visits to homes myself, I can vouch for the high quality of this branch of Mother and Child Welfare work as carried out by the Health Visitors. Health Visitors. During the year it was found expedient to abolish temporary posts and make the change to a permanent staff. All this tended to consolidate the position, and as will be seen from the charts has led to greater popularity of the clinics amongst the general public. Several points emerged, which, if adopted, should lead to greatly improved results. The first one is the establishment of a special Central Clinic (if possible in conjunction with the Maternity Home) for more severe cases of illness of babies. Again, ample material could be obtained from cases attending clinics for bacteriological and other research work, and this would encourage Medical men in the Borough not only to send children, but attend themselves, if they thought the work was being carried on scientifically. For we must remember that to a very large extent the general medical practitioners have the welfare of the public in their hands, and it is only right they should have every assistance from the Local Authority and be encouraged to carry on a high standard of medical practice. In other words, all possible encouragement should be given to Medical Practitioners to carry out treatment themselves, and there should be cordial co-operation between them and the Public Health Committee through the Medical Officer of Health. 24 Voluntary Helpers. The great assistance rendered by the lady Voluntary Helpers at the Clinics is inestimable. It would be impossible for the Health Visitors alone, without seriously interfering with the Home-Visiting, to conduct the large amount of work at the Clinics, and for this reason as well as the splendid way in which voluntary help has been given, cordial appreciation of the helpers should be recorded. The names of the helpers are given later. The help of the Maternity and Child Welfare Committee and the Public Health Committee was most useful, and their support was at all times willingly granted. Thanks are tendered to the Chairman, Vice-Chairman and the Members of the two Committees. Supply of Milk. Towards the end of the year, the Maternity and Child Welfare Committee decided to follow the recommendations of the Ministry of Health with regard to the issue of free milk and milk at a reduced price to ante-natal mothers, nursing mothers, hand-fed infants and weakly children under five years old. Arrangements were made with local purveyors of milk, whereby mothers, on presentation of a milk card, obtained either at the Clinic or Town Hall and signed by the Medical Officer of Health or the Assistant Medical Officer of Health, could obtain a certified quantity of milk from their milkman, either free or at a reduced price. This free and reduced milk was only allowed in necessitous cases after enquiry into the financial circumstances of the family and where an increased amount of cow's milk was indicated for the sake of the health of the mother or child. Posters were printed and circulated throughout the Borough, and by means of this advertisement, coupled with the energies of the Health Visitors, it was not long before almost every mother in Deptford was aware of the excellent facilities thus provided by the Council. As to the beneficial results gained from supplying milk in cases where the parents are unable to purchase it there can be no doubt, but it was found necessary, in order that the health of the children should not suffer on account of lack of nourishment, that there should be as little delay as possible in providing the milk after application had been made —even at the risk of some slight abuse of the privilege, due to parents, anxious to obtain cheap milk, understating the income of the family. Instances of this latter kind were few in nilmber considering the large number of applications. 25 The following table gives the number of cases in which free milk and reduced milk was supplied to mothers attending the different Clinics up to the end of the year. Milk supplied free. Milk supplied at half-price. CLINIC Total. 6 Gosterwood Street 63 69 Napier Street 58 4 62 Eslam Road 22 11 4 33 Goldsmith's College 38 42 40 Besson Street 10 50 Hales Street 82 5 87 Grand total 343 Home Visiting. During the year, great headway was made in the direction of getting into touch with mothers and children m their own homes, and all praise is due to the Health Visitors for the hard work carried out in this direction, and for the great tact displayed in this oft-times difficult portion of their duties. The following tables give the number of visits and re-visits, etc., made by the different Health Visitors during the period under review: — Miss Smart East Ward. Miss Baird Miss Piper North-East Ward. Miss Stowell North-West Ward. Miss Clubbe South-West Ward. Miss Holland South and South-East Ward. The Assistant Medical Officer of Health made 67 home visits from the time of taking up duty to the end of the year. 26 NAPIER STREET CLINIC. No. of times Clinic opened. New Cases. New and Old Cases. Consultations with Doctor. 1919 Total New Cases Total Old Cases. Breast Fed. Mixed. Hand. Ages 1—5. January 4 10 5 3 .. 18 139 157 40 February 4 6 .. 8 .. 14 108 122 60 March 4 12 5 3 .. 20 136 156 80 April 4 17 7 3 .. 27 168 195 101 May 4 7 1 1 1 10 175 185 72 June 3 13 .. 3 8 24 107 131 71 July 5 11 11 3 .. 25 177 202 81 August 3 5 .. .. 3 8 111 119 49 September 5 8 1 2 3 14 183 197 87 October 4 12 4 3 2 21 188 209 70 November 4 17 2 1 2 22 174 196 105 December 4 12 .. 3 3 18 180 198 105 Total 48 130 36 33 22 221 1847 2067 921 ANTE-NATAL CLINIC. No. of times held 44 Total attendam es 127 LEWISHAM HIGH ROAD CLINIC. New Cases. Total New and Old Cases. No. of times Clinic opened. Total New Cases. Ante Natal Old & New Consultations with Doctor. Total Old Cases. 1919 Mixed. Hand. Breast Fed Ages 1-5 January 5 12 4 7 .. 23 8 177 208 36 February 4 4 2 11 .. 17 12 163 192 42 March 3 9 7 2 .. 18 9 111 138 .. April 4 9 4 5 .. 18 7 177 202 32 May 4 12 7 2 .. 21 7 206 234 .. June 4 6 10 1 .. 17 3 166 186 .. July 5 10 3 2 5 20 6 167 193 .. August 4 12 1 .. 2 15 7 178 200 .. September 4 22 7 4 5 38 14 250 302 31 October 5 19 3 10 4 36 10 326 372 98 November 4 14 4 4 4 26 3 270 299 113 December 3 19 1 5 5 30 - 230 260 82 Total 49 148 53 53 25 279 86 2421 2786 434 27 BESSON STREET CLINIC. New Cases. No. of times Clinic opened. Total New and Old Cases. Consultations with Doctor. Total New Cases. Total Old Cases. 1919 Breast Fed. Mixed. Hand. Ages 1—5 January 5 10 .. 2 .. 12 84 96 44 February 4 4 4 7 .. 15 124 139 23 March 4 22 5 2 .. 29 154 183 66 April 4 10 4 1 .. 15 154 169 69 May 5 14 6 5 .. 25 231 256 96 June 4 10 1 1 .. 12 162 174 69 July 5 14 14 7 .. 35 203 238 111 August 4 14 5 .. 5 24 182 206 51 September 4 17 3 6 7 33 188 221 46 October 5 17 4 7 8 36 279 315 88 November 4 17 .. 6 9 32 239 271 113 December 3 4 1 4 .. 9 140 149 50 Total 51 153 47 48 29 277 2140 2417 826 ERLAM ROAD CLINIC. New Cases. No. of times Clinic opened. Total New and Old Cases. Consultations with Doctor. Total New Cases. Total Old Cases 1919 Breast Fed. Mixed. Hand. Ages 1—5 January 4 4 2 1 .. 7 107 114 55 February 4 4 4 .. .. 8 101 109 36 March 4 9 7 .. .. 16 87 103 63 April 5 1 .. 1 .. 2 115 117 62 May 4 5 3 3 .. 11 107 118 47 June 3 4 .. .. .. 4 82 86 28 July 5 3 1 1 1 6 103 109 50 August 4 8 .. 1 .. 9 61 70 24 September 4 7 3 2 .. 12 95 107 19 October 5 5 1 3 1 10 125 135 34 November 4 11 .. .. 4 15 115 130 66 December 4 7 .. 2 .. 9 112 121 70 Total 50 68 21 14 6 109 1210 1319 554 28 GOSTERWOOD HALL CLINIC. New Cases. No. of times Clinic opened. Total New and Old Cases. Consultations with Doctor. Total New Cases. Total Old Cases. Breast Fed. Mixed. Hand. Ages 1—5 1919 January 4 8 3 5 .. 16 103 119 64 February 4 14 1 16 .. 31 157 188 106 March 5 10 5 6 .. 21 275 296 142 April 3 9 2 2 .. 13 171 184 64 May 4 11 4 10 .. 25 234 259 98 June 4 9 3 .. .. 12 224 236 73 July 3 13 3 2 2 20 146 166 61 August 3 9 5 2 1 17 143 160 50 September 5 7 4 1 6 18 258 276 76 October 4 8 10 1 5 24 209 233 69 November 4 8 .. 4 2 14 191 205 96 December 5 12 5 1 5 23 205 228 75 Total 48 118 45 50 21 234 2316 2550 974 HALES STREET CLINIC. New Cases. I No. of times Clinic opened. Total New and Old Cases. Consultations with Doctor. Total New Cases. Total Old Cases. Breast Fed. Mixed. Hand. Ages 1—5. January 5 3 2 1 47 6 92 98 9 February 4 2 3 3 32 8 67 75 17 March 4 6 1 6 37 13 79 92 38 April 4 1 1 4 21 6 81 87 23 May 5 6 7 5 28 18 115 133 28 June 4 6 1 7 20 14 64 78 16 July 5 8 1 3 19 12 105 117 23 August 4 8 1 .. 22 9 103 112 31 September 4 11 .. 2 16 13 93 106 31 October 5 11 .. 2 20 13 137 150 38 November 4 8 .. 2 16 10 133 143 33 December 3 7 1 .. 34 8 136 144 7 Total 51 77 18 36 312 130 1205 1335 294 29 NOTIFICATION OF BIRTHS ACT. The number of births notified under the Act was 2545, notifications being received as follows: —492 from doctors; 1,234 from midwives ; 712 from parents: 107 from other persons. 145 parents were warned in respect of their failure to comply with the Act. The distribution or visits in the different wards was as follows:— Ward E. N. N.W. S. S.E. S.W. Total. Miss Smart 671 856 .. .. .. .. .. .. .. .. .. .. 671 Visits Revisits 856 1527 .. .. .. .. .. 1527 Total Visits Miss Mark Jan. —July .. .. 634 .. .. .. 634 Revisits .. .. 638 .. .. .. 638 Total .. .. .. .. .. 1272 1272 Miss Playne July—Dec. 147 61 46 1 161 434 Visits 18 2 Revists 142 100 39 53 158 494 289 161 57 99 3 319 928 Total Miss Butcher Jan.—July Visits .. .. .. 336 245 .. 581 281 522 .. 803 Revisits .. .. .. .. Total .. .. 617 .. 1384 767 Miss Jones Jan.—July Visits .. .. .. .. .. 342 342 862 .. .. .. .. .. Revisits 862 Total .. .. .. .. .. 1204 1204 Miss Baird July—Dec. 610 .. .. .. .. .. 610 Visits Revisits 889 .. .. .. .. .. 889 Total 1499 .. .. .. .. .. 1499 Miss Clubbe July—Dec. .. .. .. .. 355 355 Visits .. Revisits .. .. .. .. .. 803 803 Total .. .. .. .. .. 1158 1158 .. Miss Piper July—Dec Visits 838 .. .. .. .. 838 Revisits .. 659 .. .. .. .. 659 Totals 1497 .. .. .. .. .. 1497 Miss Stowell July—Dec. .. .. 838 .. .. .. 838 Visits Revisits .. .. 948 .. .. .. 948 Totals .. .. .. .. .. 1786 1786 Miss Holland July—Dec. .. .. .. 203 .. 496 Visits 293 Revisits .. .. .. 231 637 .. 868 .. 930 1364 Total .. .. .. 434 Total 1490 585 539 516 5799 Visits 1770 899 750 Revists 2749 1626 565 1161 961 7820 Total 1658 1150 1700 1472 13619 4519 3115 30 SUMMARY OF WORK OF 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 1992 5338 7330 Still Births Infant Deaths 56 6 62 131 9 140 Expectant Mothers 140 149 289 Tuberculosis 143 191 58 334 Verminous Children 56 114 Scabies 72 65 137 22 Opthalmia Neonatorum 40 62 Measles 1572 1566 3138 2013 Miscellaneous 1615 398 Of the 1992 babies visited, 1800 were breast fed ; 124 hand fed ; while 68 were both breast and hand fed, i.e., " mixed feeding." The Committee are again indebted to the several ladies (Miss Bridges, Mrs. Green, Miss Jacob, Mrs. Rivers, the Misses Warcup) who have so regularly assisted the clinics and given valuable assistance, but more are required. Owing to increased attendance at the clinics and the small number of voluntary helpers, 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 profitably occupied in home visiting, especially as the time spent in the clinics was on work which did not call for all trained workers, e.g., the weighing of the babies, the sale of dried milk, Virol, etc. The Committee will also note with satisfaction the services of Mrs. Dorothy Fynn, C.M.B., who rendered me valuable assistance as a Health Visitor at a time when the staff of Health Visitors was greatly reduced. She has since acted as a Health Visitor and attended the clinics during the absence of members of the staff from illness, and at a time when measles was very prevalent she helped in the inspections of the homes. of Nonresidents registered in the District 8 of Residents not registered in the District. 9 Number. 6 Rate. 7 Number. 10 Rate per 1,000 Nett Births. 11 Number. 12 Rate. 13 Number. 4 Rate. 5 109,280 28.0 350 113 15.5 3,106 625 1913 3,041 1,283 11. 6 181 1,727 616 14.6 99 1914 109,182 3,071 3,121 28.6 1,145 10.5 163 309 1,598 Uncorrected Number. 3 32 Table No. 2. METROPOLITAN BOROUGH OF DEPTFORD Causes of, and Ages at Death During the Year 1919. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without 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 year. 25 and under 45 years. 45 and under 65 years. 65 and upwards. CAUSES OF DEATH. 1 2 3 4 5 6 7 8 9 10 All Certified causes 1469 207 70 162 95 136 346 396 417 Enteric Fever 2 .. .. .. .. .. 1 1 .. Small Pox .. .. .. .. .. .. .. .. .. Measles 21 2 5 9 5 .. .. .. .. Scarlet Fever 9 1 1 4 4 .. .. .. .. Whooping Cough 1 .. 1 .. .. .. .. .. .. Diphtheria and Croup 16 .. .. 7 9 .. .. .. .. Influenza 81 3 2 1 1 9 31 20 14 Erysipelas .. .. .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 133 1 .. 1 12 24 57 33 5 Tuberculous Meningitis 9 1 3 .. 3 1 .. .. .. Other Tuberculous Diseases 16 1 1 3 3 2 2 2 2 Cancer, malignant disease 126 .. .. .. .. 4 11 59 52 Rheumatic Fever 7 .. .. .. 4 2 1 .. .. Meningitis 9 3 1 .. 2 1 1 .. 58 Organic Heart Disease 114 .. .. 1 1 1 15 39 58 Bronchitis 178 23 4 2 2 1 10 44 92 Pneumonia (all forms) 154 35 19 15 4 4 28 31 18 Other diseascs of Respiratory Organs 19 2 .. 1 2 .. 2 5 7 Diarrhœa and Enteritis 40 28 5 .. .. 1 2 1 3 Appendicitis and Typhlitis 7 .. .. .. 3 1 1 2 .. Cirrhosis of Liver 4 .. .. .. .. .. .. 3 1 Alcoholism .. .. .. .. .. .. .. .. .. Nephritis & Bright's Disease 39 .. .. .. .. 2 7 13 17 Puerperal Fever 4 .. .. .. .. .. 4 .. .. Other accidents and diseases of Pregnancy and Partturition 2 .. .. .. .. .. 2 .. .. Congenital Debility and Malformation, including Premature Birth 80 80 .. .. .. .. .. .. .. Violent Deaths (excluding Suicides) 39 2 1 6 5 5 8 6 6 Suicides 6 .. .. .. .. .. .. 6 .. Other defined diseases 352 25 2 .. 14 9 37 68 197 Diseases ill-defined or unknown 1 .. 1 .. .. .. .. .. .. 1469 207 45 51 74 67 220 333 472 33 Infectious and other Diseases. c 2 36 INFECTIOUS AND OTHER DISEASES. The list of notifiable infectious diseases has been extended and now includes the following diseases, viz. : —Scarlet Fever, Diphtheria, Erysipelas, Enteric Fever, Puerperal Fever, Cerebro-Spinal Fever, Measles, German Measles, Pulmonary Tuberculosis, other Tuberculous Diseases, Smallpox, Ophthalmia Neonatorum, Poliomyelitis, Anthrax, Primary Pneumonia, Influenzal Pneumonia. Malaria, Dysentery, Trench Fever, Encephalitis lethargica and Polio-Encephalitis. Notifiable Infectious Diseases. Under the provisions of Public Health (London) Act, 1881, and the Tuberculosis Regulations, 3,087 notifications of cases of infectious diseases were received, as compared with 1,756 in 1918. This increase is chiefly due to greater prevalence of Scarlet Fever and Measles. Deaths from Epidemic Diseases. To the seven principal epidemic diseases (Small-pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Enteric Fever, Diarrhœa Diseases) 82 deaths were ascribed, and the death-rate from them was 0.7 per 1,000 of the estimated civilian population, as against 1.08 per 1,000 in the preceding year. A summary of the deaths from epidemic diseases will be found in Table 2, and a list of the cases notified in Table 4. 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 in the Borough 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. In 1918 one case was notified which ended in recovery. Scarlet Fever. Average of Previous 10 years 1919 Number of cases 517 584 deaths 9 9 Dath rate per 1,000 in Deptford 0.08 0.07 541 notifications were received during the year 1919, relating to 517 cases. Of these, 124 cases were errors in diagnosis and cases which occurred in hospital, thus reducing the net number of cases to 505. The number of cases for 1919 was in excess of that in the previous year. 37 The deaths were 9, compared with 3, 6 and 7 in the 3 preceding years. The death-rate was 0.08 per 1,000, and for the three preceding years 0.03, 0.05 and 0.06 respectively. The rate of mortality for England and Wales was 0.3, for the 96 great towns 0.04, for the 148 smaller towns 0.03,for the County of London 0.03 per 1,000. Four hundred and forty-three of these cases were removed to hospital, and previous records show that the percentage of deaths is much lower if the patient is treated in. hospital than if nursed at home. Prevention of Scarlet Fever. The procedure by the Health Department for the prevention of the spread of scarlet fever in the borough has consisted of systematic weekly visits by the Sanitary Inspector to the houses where cases were isolated at home. Reports were made on receipt of each notification to the Medical Officer of Health, as to the milk, water supply, sanitary arrangements, drainage, school or department attended by the patient and rest of the family, state of the house, out-buildings, number in house, and means of isolation, these reports being entered into an Infectious Disease Register, where the results of subsequent weekly visits to enforce isolation are also recorded. Notices were sent to the school where children attended from infected homes, requiring exclusion of these children from school until the house was cleansed and disinfected to the satisfaction of the Medical Officer of Health after recovery or removal of the patient. Where cases were removed to hospital, the usual routine followed was fumigation, the removal of infected bedding and clothing to the borough steam disinfector, and, where necessary, the stripping and limewashing of the infected house or parts thereof on the certificate of the Medical Officer of Health. Scarlet Fever is a variable disease, some cases being of a most malignant form, whilst others are of a mild form. Even in the latter type complications may arise. Some attacks are so mild as to escape recognition altogether, thereby acting as " carriers," and being the means whereby this complaint is spread, which partly accounts for the difficulty and often impossibility of tracing the source of infection. Contaminated milk, food and water supply, overcrowding and insanitary conditions play an important part in the spread of scarlet fever and zymotic disease generally. It is by these mild missed cases or "carriers " that infection is spread, especially in schools, although the work done by medical inspection of school children has done much to reduce one great source 38 of infection. Complications or sequelae may follow even in the mildest of cases: such as otorrhœa, mastoiditis, nephritis, or albuminuria, rheumatism, rhinitis, and secondary glandular affections forming abscesses. As any one or more of these complications may occur in the same patient, prolonging his recovery, the uncertainty, variability, and treacherousness of this complaint can be understood. Bacteriology has not as yet been of any help in defining when a patient is free from infection, therefore the difficulties of discharge of such cases from scarlet fever hospitals into homes where there are other susceptible children can be realised, especially as any eczematous condition of the mouth, nostril, or ear is known to be highly infective. In some cases a patient may be released who has escaped any of the above-named 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 Membraneous Croup. Average for previous 10 years. 1919 Number of Cases 270 220 Number of Deaths 16 18 Death-rate per 1,000 0.14 0.16 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 276, relating to 270 cases. Of the number notified, 9 were errors of diagnosis and hospital cases, reducing the number of cases to 261, compared with 240, 195 and 182 for the previous three years. Sixteen deaths were registered during the year. The rate of mortality was 0.1 4 per 1,000 The death-rate for England and Wales was 0.13, for the 96 great towns 0.14, for the 1.48 smaller towns 0.12, and for the County of London 0.18 The disease was most prevalent in the latter part of the year. 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 39 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. Practiti tiers in the borough may obtain from the Public Health Department anti-toxin sufficient for their purposes, upon sending a written order stating the name, age and address of the patient, together with the doctor's name, and stating that it is to be used for a poor inhabitant of the borough. If the patient is able to pay, we find the medical man quite willing to pay us the actual cost of the anti-toxin which he obtains for the patient It is desirable that medical men should be aware of these facilities, and emphasis laid on the importance of prompt treatment by anti-toxin, and the saving of life which may be effected. The cases were distributed in the various wards as follows : — East 32, North 55, North-West 93, South 24, South.East 31, and South-West 35. Two hundred and fifty-three cases were removed to hospital. Enteric Fever. Average of previous 10 years 1919 Number of Cases 8 22 Number of Deaths 2 4 Death-rate per 1,000 0.01 0.03 This disease has been endemic in the borough for many years. There has been no serious outbreak of the disease during the last ten years, and only once in that time have we had 40 cases notified in the one year. During the past year we had 8 cases notified, as compared with 14 cases in 1918 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. Two deaths were attributed to the disease during the year. 40 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 have been made for controlling and gathering the 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 0.01 per 1.000. The ease mortality for 1919 was 25 per cent., compared with 33.3 per cent, four years ago. The rate of mortality for England and Wales was 0.01, for the great towns 0.01 for the 148 smaller towns 0.01, and for the County of London 0.01. The cases distributed in the different wards as follows: — East 1, North 1, North-West 4, South-East 1 and South 1, Bacteriological examinations were made of 6 specimens of blood, of which were found to be positive and 4 negative. Erysipelas. Average of previous 10 years. 1919 Number of Cases 70 167 Number of Deaths 0 - Seventy cases of Erysipelas have been notified during 1919. There were no deaths registered from the disease within the borough or in outlying institutions. In each notified case the premises have been visited and enquiries made, and, where necessary, disinfection performed. 41 Puerperal Fever. Average for previous 10 years. 1919 Number of Cases 9 5 - Number of Deaths 4 Nine cases of puerperal fever were notified, compared with 5, 3 and 6 for the three years preceding. The case mortality was 33.3 per cent, compared with 90.0 per cent. for 1918 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 nforced “ 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 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. Twenty-one cases were notified during the year, and were visited by the Health Visitors. Three of the cases were in the East Ward, five in the North Ward, four in the North-West Ward, three in the South Ward, two in the South-West Ward and four in the South-East Ward. 42 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. Two cases of this complaint were notified in the borough, and we have received notifications from the County Council of cases occurring in other Metropolitan Boroughs. Acute Polio-Myelitis or Polio-Encephalitis. Three cases were notified during the period under report, both in the North Ward. It is to be noted that the majority of cases occur in children and young people under 15 years of age ; the mortality in these is about 13 per cent. and the permanently damaged form about 50 per cent of the total. Plague. No case of plague occurred during the year. At various times orders have been issued 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 Ist. Persistently and systematically destroy all rats. 2nd. Remove and obliterate their nests, burrows and habitual haunts. 3rd. Make each dwelling as far as practicable rat-proof, and remove all known harbourage for rats in or near dwellings.4th. At the same time do not allow waste of food (whether for human beings, chickens or other animals) to accumulate in or about the house. Chicken Pox, This disease was not notifiable in 1919 and there were no deaths, although a fair number of cases occurred amongst school children. Anthrax and Hydrophobia in Man. No cases of the above diseases were notified during the year. Glanders. No cases of Glanders were notified during the year. Continued and Typhus Fever. No cases of Continued Fever were notified during the year. We have had no case of Typhus Fever since 1903, when we had one case, and in 1901 we had eight cases. 43 Diarrhœa and Enteritis. Average of previous 10 years. 1919 Number of Cases 115 - Number of Deaths 40 76 Death-rate per 1,000 (all ages) 0.36 0.49 Death-rate per 1,000 (under two years of age) 0.33 0.46 Death-rate in 1911 per 1,000 was 1.72 Under this heading are included deaths registered as due to epidemic diarrhœa, epidemic enteritis, infective enteritis, zymotic enteritis, summer diarrhœa, dysentery and dysenteric diarrhœa, choleraic diarrhœa, 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 40 deaths during 1919 Of this number 28 were of children under one year of age, 33 of the 40 being under two years of age. The death rate was 0.36 per 1,000 at all ages, and 0.33 for infants under two years of age. It is usual now to consider the infantile mortality in this case as being for all children under two years of age. The cases of this disease occurred among the inhabitants of the various Wards as follows:— East 66 North 22 North-West 13. South-. South-East 12. South-West 2. Measles. Average for previous 10 years. 1919. Number of Deaths 21 52 Death rate per 1,000, Deptford 0.18 0.45 The number of cases of Measles dealt with during the year was 1,439, as compared with 550 for the previous year with 12 deaths. The same procedure is adopted in the case of Measles with regard to disinfection, as it is notifiable. The cases occured among the inhabitants of the various wards as follows:- East 372 North 356 North-West 343 South 131 South-East 101 South-West 136 The rate of mortality for England and Wales was 0.01, for the 96 great towns 0.01, for the 148 smaller towns 0.01, and for the Metropolis as a whole 0.08 44 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 disease exists at any premises in which school children are known to reside, the following procedure is adopted : — Period of exclusion of children suffering from the disease. 2. Period of exclusion of children living in houses where the disease exists. 3. Rules in regard to flats and tenement houses. 4. Disease. 1. Smallpox Diphtheria Membranous croup Scarlet fever or scarlatina Erysipelas Typhoid fever Enteric fever Cerebro-spinal meningitis Polio-myelitis Consumption Measles German measles Mumps hooping-cough Chicken-pox Ringworm. favus. ophthal mia (“blight”) or purulent conjunctivitis. trachoma, scabies (itch) impetigo or purulent eczema Sore throat (1) Unit the medical attendant certifies, if the case is treated at home. (2) Until after discharge from hospital. (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. (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. (1) Until the medical attendant certifies, if case is treated at home. (2) Until after discharge from hospital. When accompanied coughing or spitting At least four weeks 14 days from date of rash One week from the subsidence of all swelling. As long as cough continues, but not to be readmitted until at least five weeks from the commencement of the illness. Two weeks os until every scab is off scalp or body. 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 sclap to be notified to the School nurse. (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) (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. Not to be excluded. No proceedings to be taken to enforce attendance if medical officer of health specially orders exclusion. May attend school. 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. Same rules as for ordinary measles. Infants and seniors-Not to be excluded. Teachers to 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. infants-Three weeks' exclusion from the commenccent of the illness of last case in house. Seniors-If child has had the discase. may attend school. If child has not had the disease. three weeks' exclusion from the commencement of the illness of last in house. Same exclusion periods as for whooping-cough. both infants and seniors. May attend school. 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 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 case rule (a) will apply. 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 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 Sore throat may be indicative of mild scarlet fever or diphtheria. Children suffe throat must be excluded from school, In the abseence 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. 45 Whooping Cough. Average for previous 10 years. 1919 Number of Deaths 1 38 Death-rate per 1,000, Deptford 0.01 0.33 This disease was the cause of 1 death, compared with 30, 24 and 35 for the three preceding years, which is most satisfactory. The death-rate per 1,000 persons was 0.01 In 1918 there were 30 deaths from this complaint, 16 of them being under 1 year. Leprosy. There were no known Leprosy in the borough during the year. Pulmonary Tuberculosis. Number of cases notified in 1919 292 Number of deaths 133 Death-rate per 1,000, Deptford 1.2 Phthisis was the cause of 133 deaths during 1919, compared with 151 for 1918 The death-rate was 1.2 per 1,000 persons, compared with 1.6 and 1.43 for the two preceding years. In the following table will be seen the number of cases notified in each ward:— East 79 South 19 North 73 South-east 27 North-west 52 South-west 42 Whole Borough 292 In the following table will be seen the of the patients:- AGES OF PATIENTS NOTIFIED. 15-25 65 & upwards. All Ages. 1 25-45 45-65 1-5 5-15 83 0 292 1 7 58 106 34 General Tuberculosis. Twenty-five deaths were recorded as being due to these diseases. Of these deaths 7 occurred in the East Ward, 9 in the North, 4 in the North-West, 3 in the South-East, and 2 in the South-West. Nine deaths wire classified as tuberculous meningitis and 16 as other tuberculous diseases. 46 The following gives the ages at which death occurred: — 1 to 2 2 to 5 5 to 15 65 and UPwards. Under 1 15 to 25 25 to 45 45 to 65 Cause. 1 3 3 Tubercular Meningitis 1 1 - - - 1 1 3 2 Other Tubercular Diseases 2 3 1 2 Disinfection was carried out in all cases as in previous years. Tuberculosis Dispensary. Dr. Macdonald reports as follows : — During 1919, new cases to the number of 665 were examined at the Dispensary. This includes 197 contacts and also 101 ex-service men who were referred to the Dispensary by the Ministry of Pensions. Of the total number examined 195 were insured persons. The number of attendances recorded by all patients was 5,799, being 400 more than last year. Of the new cases 224 were found to be suffering from pulmonary tuberculosis and 46 from non-pulmonary tuberculosis: 170 were doubtful and kept under observation and the remainder were discharged as non-tuberculous. The familiar complaint that patients come under treatment only when the disease is well advanced is emphasised this year by the fact that of the 224 new cases diagnosed as pulmonary tuberculosis, 186 or 83 per cent, were classified as belonging to Stages II and III. Death — Notification Interval. In amplification of the statement made last year with reference to this point, an examination of 158 deaths belonging to the Borough attributed to tuberculosis in the death returns reveals the following information :— Pulmonary Non-Pumonary Tuberculosis. Tuberculosis. Cause not notified 36 20 Cause notified at death 7 1 Cases notified one month Cases notified three months before death 17 Cases notified six months before death 7 Cases notified more than six months before death 62 47 Of the cases not notified, almost all were deaths occurring in Institutions. Whatever the condition of the patient on admission, a diagnosis of tuberculosis must have been arrived at before death and ought to have been notified. It must be borne in mind that notification is the only means of bringing the disease to the knowlege of the Public Health Department, and that the earlier the notification the more valuable the information. During the year 384 notifications (292 pulmonary and 92 nonpulmonary) were received of which 101 came from the tuberculosis officer. The distribution of the cases is shewn below':— WARD DISTRIBUTION E. N. N.W. S. S.E. S.W. Total. 79 Pulmonary Tuberculosis 73 52 19 27 42 292 38 Non-Pulmonary Tuberculosis 32 14 1 1 6 92 105 28 384 48 117 66 20 This gives an incidence figure (pulmonary tuberculosis) of 2.6 per 1,000 on an estimated population of 111,205. With regard to the patients attending the dispensary the same procedure and the same methods of treatment were carried out as have been indicated in previous reports. The lack of accommodation for advanced cases is still urgent, but this question is at present under consideration, it being suggested that a joint “ Home” might be established with the neighbouring Boroughs of Lewisham and Greenwich. The Housing Conditions of many of the patients are such as make it imperative to remove every “ open case ”as early as possible. On an investigation of the sleeping arrangements of 300 patients attending the dispensary it was found that only 91 slept alone, 121 slept with one other person and the remainder with two or mote persons. In this way infection spreads. During the year a whole time tuberculosis nurse was appointed who attends the Dispensary and visits all cases notified whether dispensary cases or not. This was formerly done by the health visitors. There is evidence that additional help will be required if revisits are to be paid at reasonable intervals. A permanent Care Committee has now been established in place of the Interim Committee of previous years. The constitution of the Committee is practically the same. The Committee is hampered by lack of funds but much more so by lack of voluntary workers. Visiting, apart from the 48 official staff, devolves almost entirely on the honorary secretary and one or two active members, who can only visit a very few oft he patients and in fact confine themselves to the children. The difficulty of finding suitable employment for male patients is practically insurmountable in this district —such employment will have to be created, it at present does not exist here. At the same time the amount of sickness benefit requires revision, and it seems a thousand pities that the great friendly societies cannot devise a scheme whereby a, patient capable of doing “light or part-time ” work could not have his sickness benefit graded according to his capacity for work. During the year 148 patients were admitted to sanatoria and 28 to poor law institutions. The latter were all advanced cases for whom no other accommodation could be obtained. The majority of the patients attending the dispensary showed distinct improvement, but as the home circumstances remain unchanged, it is feared the improvement is only temporary in too many instances. Of the 158 deaths registered in the Borough as due to tuberculosis, 29 were patients belonging to the dispensary. Full details as to the work of the dispensary will be found in the tables appended. Number of Primary Notifications. Total Notifications on Form B. Cases admitted to Age Periods. Total Notifications on Form A. Poor Law Institution. Sanatoria. Total Primary Notifications. 0-1 5-10 20-25 25-35 35-45 45-55 55-65 65 and up 5-10 10-15 Total Primary Notifications. 1-5 10-15 15-20 Under 5 ... 26 13 153 Pulmonary— 170 10 ... ... Males 3 11 11 15 39 22 3 4 4 8 15 89 1 28 16 ... 2 Females 4 10 16 30 15 10 1 ... 131 149 2 4 8 10 51 Non-Pulmonary 6 37 2 9 1 Males 10 6 4 ... 1 ... 2 ... 35 1 4 ... 11 12 2 3 ... 2 Females 1 5 2 13 8 33 39 7 6 13 17 1 ... ... ... ... ... * Re-notifications. 50 Metropolitan Borough of Deptford. Return AS TO Work carried out in connection with the Deptford Dispensary for the period from 1st January, 1919, to 31st December, 1919. Insured. Uninsured. Children under 16. Adults. Females. Males. Males. Females. 1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensary 135 60 360 10 100 (b) Number included under 1 (a) who were found to be suffering from pulmonary tuberculosis 91 28 60 3 42 (c) Number included under 1 (a) who were found to be suffering from non-pulmonary tuberculosis 4 2 39 - 1 (d) Number included under 1 (a) who were found to be non-tuberculous 8 13 163 3 38 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 32 17 98 4 19 Insured. Uninsured. 2.(a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a)) 2352 3447 (b) Number of the above attendances at which systematical physical examinations and records were made 533 768 3. Number of visits to patients at their own homes by the Dispensary medical officers in connection with the supervision of home conditions 16 64 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” 948 963 5. Number of persons suffering from or suspected to be suffering from tuberuberculosis red to the Hospital to which the Dispensary is affiliated 1 24 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 - - 79 - - 22 (c) Practitioners at the homes of patients 7. Number of written reports concerning individual patients made to (a) Public authorities 349 191 (b) Practitioners 33 7 8. Number of specimens of sputum examined 245 103 Pneumonia. There were 109 cases of Pneumonia notified as being associated with Influenza. 51 31 cases from the East-Ward, 26 from the North, 19 from the North-West, 7 from the South, 16 from the South-East, and 10 from the South-West, only 7 of the cases were under 5 years of age. The deaths from Pneumonia of all forms numbered 154, of these 35 were under one year of age, 34 under 5 years, and 18 were 65 years and upwards. Bronchitis. There were 178 deaths from Bronchitis which was most severe in the East and North Wards. Influenza. There were 81 deaths from this disease, 65 of them being adults over 25 years of age. Constitutional Diseases. These diseases form a group which is only second in importance to those known as epidemic diseases. They include : — Rheumatic Fever. Rickets. Diabetes. Gout. Anaemia and other defined diseases. During the year they caused 640 deaths. 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 with independent boilers. By means of an extension of the steam pipe from a boiler into a small bath room in the yard adjoining, it has been possible to fit up a steam D2 52 spraying chamber for the treatment of children and others who have been found to be carriers of certain infectious diseases, although otherwise healthy, or who have been excluded from school because the germs of diphtheria have been found in the nose or throat. It is found that the children quickly get rid of the germs under daily treatment for 15 minutes, and it is seldom necessary to continue it beyond five days. The steam is impregnated with Izal and saline solution, and if an astringent is required zinc sulphate solution of definite strength. The number of rooms disinfected by the Council's staff during the year was 2,380. Disinfecting fluid is supplied gratis where required For the removal of infected bedding, etc., and its return after disinfection an adequate staff is maintained. There are two vans employed, one used for collecting infected materials, and the other a pure van for returning them after disinfection is completed. One man is employed for collection, and another for returning the sterilised materials. Cleansing and disinfection of 2,380 rooms in 2,125 houses in which infectious diseases, etc., have occurred, have been carried out under the direction of your Medical Officer of Health. The infected rooms have been fumigated, and when necessary the walls of the disinfected portion of the house have been stripped and the ceilings cleansed. Table SHOWING THE NUMBER OF PREMISES, ROOMS AND BEDDING DISINFECTED DURING THE YEAR 1919. Odd articles Premises. Rooms. Beds. Pillows. Mattresses. Blankets Bolsters. Sheets. Date 1919 Articled destroyed. 117 January 89 94 56 113 45 17 68 83 1 bed February 94 107 100 52 119 41 31 53 90 127 2 palliasses, 2 mattresses March 131 44 89 32 18 106 88 241 1 bed, 1 mattress, 1 rug 154 April 144 196 72 134 53 16 76 86 184 56 119 53 81 May 217 39 15 38 196 69 36 199 June 173 37 28 11 42 July 188 200 56 107 40 22 68 68 140 1 mattress, 1 bolster, 3 pillows 302 106 99 272 August 48 42 21 48 58 September 177 97 90 170 55 42 20 44 50 185 189 156 20 167 October 83 55 66 81 November 259 289 81 180 161 55 31 60 115 December 260 289 92 37 85 132 233 3 odd articles 199 88 2125 2380 1369 560 259 754 940 1828 Total 732 53 Table SHOWING NUMBER OF ROOMS DISINFECTED AFTER THE FOLLOWING DISEASES 1919 Scarlet Fever. Diphtheria. Erysipelas. Membraneous Croup. Pueperal Fever. Pulmonary Tuberculosis. Enteric Fever. Pneumonia. Influenza. Bronchitis. Anthrax. Ophthalmia Neonatorum. Malarial Fever. Cerebro-Spinal Meningitis. Senile Decay. Gangrene. Measles. Cancer. Scabies. 29 25 2 .. .. 12 .. 3 4 1 1 1 .. .. .. .. 9 4 January 8 February 23 22 3 .. .. 19 18 .. 3 5 4 1 1 1 .. .. .. .. .. March 26 19 1 .. .. 17 29 2 1 8 7 19 .. 1 .. 1 .. .. .. April 26 27 1 1 1 27 44 2 3 31 17 3 1 2 .. .. 1 .. .. May 29 20 1 .. .. 24 108 .. 4 5 1 5 .. .. .. .. .. 1 .. June 20 9 .. .. 1 17 125 .. .. 2 3 1 .. .. .. .. .. .. .. July 43 14 .. .. .. 27 98 3 2 .. 3 1 .. .. .. .. 1 .. 2 August 36 11 11 .. .. 35 211 1 .. 1 1 .. .. .. .. .. .. .. .. September 34 15 .. .. .. 17 93 1 .. 2 .. .. .. .. .. .. .. .. 1 October 55 16 .. .. 1 29 71 2 2 4 2 .. .. .. .. .. .. .. .. November 67 15 4 .. 1 29 155 .. 2 12 2 .. .. 1 .. .. .. .. .. December 70 55 1 .. 1 10 140 .. 8 8 .. .. .. 1 .. .. .. .. .. Total 458 248 13 1 5 259 1104 11 28 182 43 31 3 7 1 1 2 1 3 VERMINOUS PREMISES. Fifty-four premises ting of 83 rooms were fumigated during the year. BOOKS. Tin red and fifty- seven Library books were disinfected during 11 CLEANSING STATION. One thousand five hundred and twelve of clothing were disinfected during the year. Table. Total number of Premises disinfected 2125 Rooms 2380 Beds 732 Pillows 1369 Bolsters 560 Mattresses 259 Sheets 754 Blankets 940 Odd Articles 1828 6442 Total articles Toatl number of Beds destroyed 2 ” ”Matrresses ” 4 ” ”Pillows ” 3 ” ”Palliasses ” 2 ” ”Bolsters ” 1 ” ” Odd Articles ” 4 Total 16 N.B the above Articles were lestroyed at the request of the owners. 54 Special Cases. Jan. 5th —Thurston Road. Cancer. 1 bed, 2 pillows, 1 bolster, 1 mattress —disinfected. Feb. 3rd —Oareboro Road. Cancer. 1 bed, 4 pillows, 1 bolster, 2 sheets —disinfected. 11th—Foxberry Road. Senile Decay. 1 bed, 2 bolsters, 2 blankets—disinfected. 2 palliasses destroyed. 22nd—Rokeby Road. Cnncer. 1 bed, 2 pillows, 1 bolster, 2 sheets, 3 blankets, 2 odd articles—disinfected. Mar. 25th—Gosterwood Street. Cancer. 1 bed, 3 pillows, 3 blankets—disinfected. April 14th—Stanhope Street. Cancer 1 bed, 2 pillows, 1 blanket, 2 odd articles—disinfected. 15th—Reginald Road Cancer 1 bed—disinfected. 19th—Pepys Road. Cancer. 1 bed, 1 holster, 4 sheets, 1 blanket, 9 odd articles—disinfected. May Ist-Finland Road. Cancer. 1 mattress, 3 pillows, 1 bolster, 3 Sheets, 2 blankets, 1 odd article—disinfected 15th—Casella Road. Cancer 1 bed, 2 blankets—disinfected July 9th—Finland Road. Cancer. 1 matress, 1 bolster, 2 pillows—disinfected 14th —Wickham Road. Cancer. 1 mattress—Destroyed. Sept. 13th mattresses, 4 pillows, 1 bolster—disinfected. Oct. 15th —Pepys Road. Cancer. 1 bed, 3 pillows, 1 bolster—disinfected. 16th—Florence Road. Cancer. 1 bed, 1 pillow, 1 bolster, 3 mattresses, 2 odd articles—disinfected. Nov. 18th—St. Donatt's Road. Heart Disease. 1 bed, 1 bolster, 1 pillow—disinfected. Dec. 3rd —Waller Road. Cancer. 3 beds, 2 pillows, 2 bolsters —disinfected. 16th —Etta Street. Cancer. 2 beds, 1 bolster, 1 pillow—disinfected. Mortuary Report for the year ending 51st December, 1919. Bodies Received, etc. Male. Female. Inquests. Postmortems. Under 1 year of age. Deposited to await burial only. Infectious. Unknown. Total. Remarks. 174 108 65 171 116 33 2 2 1 See below One case was human skulls found in Amersham Vale and was buried by the Coroner's order, no inquest being necessary. 20 inquests were held on bodies which were viewed by the Coroner, witnesses, etc., at the Seamen's Hospital, Miller Hospital, Greenwich Infirmary, Bermondsey Infirmary, and at Lewisham, and were not removed to th? Mortuary, the Inquests only being held at the Court. 55 6 bodies were detained after inquests to await burial, and 10 bodies were left on deposit to await burial after inquests owing to advanced decomposition. Verdicts of Cause of Death, etc. Natural causes 108 Suicide whilst insane 10 Accidental causes 47 Open verdicts 3 Misadventure 2 Wilful Murder 1 Deposits (Natural causes) 2 Total 174 Case of human skull 1 Boroughs of which Deceased Persons were Residents. Deptford 95 Poplar 2 Greenwich 21 Bromley 1 Lewisham 25 Eltham 1 Rotherhithe and Bermondsey 9 Balham 2 Woolwich 8 Camberwell 3 Sydenham 1 Charlton 1 Gillingham, Kent 1 Herne Hill 1 Catford 1 Total 174 Crayford, Kent 1 Forest Hill 1 Enteric fever 8 .. .. 1 3 4 .. 1 1 4 1 1 .. 7 .. Measles 1439 42 746 630 11 7 3 .. 372 356 343 131 101 136 6 General Sanitary Administration. 58 Work of Sanitary Inspectors. The work performed by the District Inspectors represents, as usual, a very large number of inspections. The total inspections and visits to premises numbered 17,051. The figures stated above related to 5,449 houses in which 6,039 sanitary improvements of one kind and another were effected. The premises visited included stable yards, manure depots, vacant land, passages, public urinals, urinals attached to public houses and premises for which certificates under the Customs and Inland Revenue Acts were required, as well as those for which certificates as to the water supply were demanded. 59 METROPOLITAN BOROUGH OF DEPTFORD. ANNUAL REPORT 01 SANITARY INSPECTORS FOR THE YEAR 1919. Table No. 1. Number of District. 1 2 3 4 5 6 7 Totals Complaints Received 9 59 37 77 48 56 22 308 Total Premises Inspected 850 782 792 926 740 765 594 5449 Re-Inspections, Calls, Service Notices, &c., &c. 2300 2005 2772 2806 2381 2899 1894 17057 Inspections under notice from tractors, per Bye-Laws 8 55 ... 17 ... 5 4 89 Number of cases in which Prc ceedings have been taken ... 2 ... ... ... 9 ... 11 “Intimations” Served 382 285 342 474 510 484 380 2857 “Statutory Notices” Served 32 5 15 30 78 10 15 185 Houses closed by Magistrate's Order ... ... ... ... ... ... ... ... voluntarily ... ... ... ... ... ... ... ... Water . Old Closets abolished ... 1 ... ... 1 ... ... ... New Closets provided ... ... ... ... 1 ... 1 ... in Workshops ... ... ... ... ... ... ... ... Basin and Trap provided 20 45 6 11 38 26 7 153 Water Supply provided 10 11 35 9 ... 65 ... ... Water Supply Apparatus provided 48 ... 2 30 41 28 ... 149 Limewashed ... 8 ... 5 34 19 20 86 Walls Repaired 4 5 ... 9 19 18 60 Floors Repaired 4 ... ... 4 2 2 1 13 Doors privided or repaired and fastening provided ... 5 1 5 4 18 33 66 Ventilated ... ... ... ... ... 2 2 ... ... 10 ... 1 5 6 22 ... ... Basins Cleansed ... 2 ... ... 1 7 ... 10 Drains Re-constructed ... 1 ... 3 12 16 ... 32 Surface Drains provided ... 5 ... ... 1 1 3 ... Cleansed and Amended 72 76 15 30 42 47 46 328 Gully Traps Fixed 6 16 ... 3 13 22 ... 60 New Soil Pipes and Vent Pipes fixed ... 15 1 ... 13 13 42 ... Chambers built and Interceptors provided ... 2 5 7 ... 14 ... ... New Covers provided ... ... ... ... ... 1 1 Interceptors only fixed ... ... ... ... ... ... ... ... Ventilated ... 1 ... 3 3 12 ... 19 Provided to Stables ... ... ... ... ... ... ... ... Clearing Eyes 1 ... ... 1 9 7 ... 18 Sinks, Bath & Lavatory Wastes, and Rain Water Disconnected from drains, trapped and ventilated ... 12 ... 7 13 3 27 62 60 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1919 continued. Table — continued. Number of District. 1 2 3 4 5 6 7 Totals Cesspools— Abolished ... ... ... ... ... ... ... ... Dustbins — Provided 40 117 72 146 123 119 60 677 Repaired ... ... ... ... ... ... ... ... _ Paved ... ... 4 1 1 8 23 37 Surface Repaired 18 19 16 6 32 21 ... 112 Urinals — Cleansed and Tarred ... ... ... ... 3 ... ... 3 Doors provided or repaired ... ... ... ... 2 ... ... 2 Scullery & J .. Floors paved or repaired 3 4 6 8 25 9 1 56 Coppers repaired ... ... ... 8 45 22 ... 75 Paved ... ... 1 1 ... 1 ... 3 Surface Repaired ... 6 ... ... 1 3 ... 10 Gutters and Rain Water Pipes r* a 1 oo m I AC ... Provided and Repaired 40 64 57 33 61 104 25 384 Water Supply— Store Cisterns provided ... ... ... ... ... ... ... ... Covers provided ... ... ... ... ... ... ... ... Cleansed ... ... ... ... ... ... ... ... abolished ... ... ... ... ... ... ... ... Supply Reinstated ... 6 1 ... 1 1 ... 9 Fittings Repaired 18 63 8 14 48 36 21 208 New Houses Inspected for Certificates before Occupation ... ... ... ... ... ... ... ... Potable Water provided from Service ... 1 ... ... ... ... ... 1 Cleansing and Repairs— J J... J 1 J IJ I... Houses Cleansed and Limewashed 105 140 141 207 216 252 163 1224 Houses repaired and Ventilation improved 90 138 8 61 63 89 83 532 House roofs repaired 78 70 67 36 131 82 62 526 Locks and fastenings to doors, etc., provided or repaired ... ... ... ... 14 ... ... 14 Reveals, window and doorsteps repairs ... ... ... ... 23 ... ... 23 Hearths, repaired, etc. ... ... ... ... 10 ... ... 10 Stoves and Mantels repaired or provided ... ... ... 3 45 16 ... 64 61 ANNUAL REPORT OF SANITARY INSPECTORS FOR THE YEAR 1919-continued. Number of District. Totals. 1 2 3 4 5 6 7 Table -continued. Cleansing and Repairs contd. Handrails balusters and stairs repaired ... ... ... 17 ... 17 ... ... Window sashes,lines an d glazing repaired, etc. ... ... ... 5 118 30 ... 153 Floors repaired ... 1 52 ... ... 53 ... ... Doors repaired or re-hung 16 ... ... 16 ... ... ... ... Dampness abated ... 4 ... 16 20 ... ... ... Dung Abolished ... ... ... ... ... ... ... ... ... ... ... Repaired ... ... ... ... ... Provided ... ... ... ... ... ... ... ... Underground I I Used as dwelings abolished ... ... ... ... ... ... ... ... ! J I ; Cases Abated 5 1 ... 1 2 ... ... 9 Accumulations . I Removed 11 3 ... 8 2 29 4 1 3 Ceased keeping as a Nuisance ... 2 1 ... 3 ... ... ... Smoke % ... Cases Abated ... 1 ... ... 1 3 ... Observations ... 3 ... ... ... ... ... ... Rats abolished ... ... ... 2 ... ... ... 2 Fences erected 4 4 ... ... ... ... ... ... District No 1 —Inspector Simpson District No. 2-Inspector Priest District No 3.-Inspector Shelley District No.4- Inspector Snowdon. District No.5-Inspector Kemp District No. 6.—lnspector Hewett. District No. 7.—lnspector Allam. 62 HOUSING. Recent housing legislation is contained in the Housing and Town Planning Act, 1919, and the Housing (Additional Powers) Act. By these Acts Local Authorities now find themselves under compulsion to make a complete survey of the housing accommodation of their districts, which will bring to light not only the number of new houses which are needed, but the number and condition of the old houses which, though still in habitation, have fallen below modern standards of decency and comfort. The Acts largely increase the powers and duties of the Local Authority to " tune up " the existing property in its district. It may make by-laws in respect of overcrowding, sanitary accommodation, water supply, and all other matters affecting the convenience, comfort and safety of the different tenements into which a single house has been divided, and may restore a neglected property at the expense of the owner. It is given the power, further, in a proper case to advance money to the owner of a property who is unable for want of means to put it into repair. It has been said that the difficulty about housing is probably greater in London than in any place in the world, due to the magnitude and complexity of the vast province of houses, and to the freedom from all control with which the older parts of it were built. Deptford may be considered a good sample amongst the Metropolitan Boroughs, but it cannot be denied that the general conditions stated above prevail even in this borough, and that much remains to be done by the new Medical Officer of Health and his increased staff of medical assistants. Your Public Health Committee, zealous from the first, has now become acquainted with the more complex details of the Department, and I am sure it only remains for the Medical Officer to put forward a clearly defined and definite plan of campaign in order to achieve the greatest benefit to the borough on the question of Housing. For years past it has been the practice of the Committee to insist upon at least 3,500 “house-to-house” inspections per annum, so that the whole of. the borough is inspected once in five years, apart from general inspections. Amongst the archives of the Ministry of Health is a map showing that, in my opinion, a large portion of Deptford, including the whole of the East Ward, needs various forms of treatment, either of reconstruction, improvement or demolition. I hope the day will not be far distant when the schemes will be put into operation. 63 Re-housing. The heart of the whole problem is how the poorer classes in Deptford are to be re-housed in decently roomy and sanitary dwellings, and yet be enabled to live not too far from their work. Of course the ideal thing would be that where a slum area is cleared, part of it at least should be made into an open space, with a much smaller number of houses than before, around it. But then where is the displaced population to live ? In London the answer is difficult. In provincial boroughs the answer is easy ; you can provide new homes in the suburbs within a mile or so, and in easy reach by tram and road of their working places. In this district you have to go miles before you can find spaces on which to build houses. The people of the poorest classes, especially the women, cannot spend time and money in daily travelling to or from the borders of Kent or Surrey, and are therefore unable or unwilling to go so far out. If the factories, workshops and docks could be moved with the population it would be a solution, but this is not practicable, although a law might fairly be passed to prevent the erection of new factories in congested areas. The ideal for future industrial expansion is that it should be rural ; in the place of so-called " garden cities " it would be preferable to have industrial villages, whence the factory worker could reach and be a real sharer in the true country ; in his spare time he could be a producer from the soil instead of a consumer of cheap luxuries in the towns. Hitherto, the only solution has either been to drive displaced poor families into other central districts already overcrowded, or to erect tenement buildings on cleared sites, or to blend these two methods. Clearance of Slum Areas. During the past nine years there has been a steady demolition of the worst houses in Deptford, but it has been left to the London County Council to clear slum areas of considerable extent, and it may be said that for 20 years it has been the policy of the London County Council to clear the worst slums and erect high tenement dwellings on the sites to house a population equal to part of that displaced, and for the remainder a number of new houses have been built on the outskirts of London. Other slums have been cleared by private enterprise for commercial purposes, either without any attempt to provide new houses or for the purpose of building blocks of tenements. It is the experience of the London County Council that when they have cleared an ancient slum and put up new buildings their tenants are not the displaced population, but people of a somewhat higher class. The displaced persons 64 have been unable to pay the slightly increased rents necessary to make the new buildings self-supporting, or they greatly dislike the regulations and the control and limitation of overcrowding exercised by a selfrespecting public authority. Such persons infinitely prefer to live in their narrow streets of squalid houses. For this reason I believe it is true that the displaced families occupy the older houses, somewhat better than those cleared away, vacated by families slightly better off, who do prefer the nice new and clean buildings just erected. In this way there is a general move upwards, but the theory I find is only partly true because the situation is still complicated by fresh overcrowding. The London County Council, since the passing of the Housing Act, 1919, have begun to make a great effort to relieve the housing problem. Having examined the situation they have come to the conclusion that something like 200,000 persons in the County are living in grossly overcrowded habitations, frequently so small and dilapidated that they require rebuilding. The scheme now adopted by the London County Council, by which Deptford should benefit, provides for the erection within five years of 29,000 new houses to lodge 145,000 persons, round the outskirts, and also for the clearance of a number of the most insanitary and crowded areas in the interior regions with a population of some 40,000, and the rebuilding to a large extent on their sites. It is to be hoped that the East Ward of this borough is included in this scheme. Reconstruction Scheme. During the year 1919, your Medical Officer has reported on several areas in the East, North and South-East Wards for the purposes of early action,and lias definitely represented to the Council for demolition — the Benmore Street area as being an insanitary site of 49 houses with a population of 300 persons, viz., 215 adults and 85 children under 10 years of age. At the time of representation there were 23 cases of Tuberculosis in the 49 houses. Improvement Scheme. Speedwell Street area —this includes the east side of Speedwell Street, the north side of Comet Street as far east as the footpath running from Comet Street to Douglas Street. The whole of this site requires re-arrangement, insanitary houses demolished and new houses built on the re-arranged land. There is a fair amount of vacant land on this site and the whole is ripe for immediate action, and if done piecemeal no great number of persons need be displaced. 65 Building Scheme. By far the greatest venture the Council has yet attempted is the building scheme on the Arica Road Site, which is partly in Deptford and partly in Lewisham. The scheme has been sanctioned and approval obtained from the Ministry of Health for the erection of — 78 Type A houses 160 (parlour houses) 238 Total The work is now well in hand. Conversion of Houses into Flats. The Borough does not abound in houses suitable for conversion into flats, but in the 12 cases in which houses have been so converted they have been eagerly sought after, and there has been no difficulty in obtaining fair rents. The Council has during the year converted two houses-into four self-contained dwellings, and these have also readily let at economic rents. The trouble in these converted houses seems to be the difficulty in finding decently behaved and moderately quiet families for the separate dwellings. These houses not being built with sound-proof walls and floors, one family can be, and frequently is, a great nuisance to a neighbour with finer instincts and a proper sense of the fitness of things. FOOD CONTROL. By permission of the Council, the services of the Sanitary Inspectors 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 unfit for human consumption:— Beef 589 lbs. Liver 30 lbs. Mutton 4 „ Jam 870 „ Bacon 6132 „ Pears 5 brls. Ham 29 „ Sausage 60 lbs. Herrings 3 brls., 1 box Apples 36 „ Mackerel 1 brl., 6 boxes Kidneys 3 boxes Kippers 3 „ Skate 1 box Haddock 17 stone Cod 1 ” Fish 2 boxes, 140 lbs. Butter 168 lbs. Tomatoes 1 case, 16 boxes Cheese 266 „ Carrots 9688 lbs. Rabbits 844 „ Potatoes 7 tons, 50 bags Condensed Milk 174 tins Dates 2 boxes, 890 lbs. 66 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. Part of the butter and bacon was returned under precautions to the wholesalers. The remainder of the foods was destroyed. SALE OF FOOD AND DRUGS ACTS. During the year the Sanitary Inspectors collected 593 samples under the above Acts, and submitted them to the Public Analyst for analysis Of the number submitted 32 or 5 per cent, were reported as adulterated. Samples taken during 1919. Articles. Number Genuine. Number Adulterated. Percentage of Adulteration. Total. Almonds, Ground 3 .. 3 .. Arrowroot 5 .. 5 .. Baking Powder 7 .. 7 .. Butter 14 1 15 6.7 Cocoa 16 .. 16 .. Camphorated Oil 1 1 2 50 Coffee 4 1 5 20 Custard Powder 9 .. 9 .. Cocoanut, Desiccated 1 .. 1 .. Dripping 1 .. 1 .. Epsom salts 1 .. 1 .. Egg Powder 2 2 .. .. Ground Ginger 2 2 .. .. Lard 25 25 .. .. Lard Compound 1 .. 1 .. Margarine 9 .. 9 .. Milk 361 21 382 5.5 Mustard 21 .. 21 .. Pepper 36 .. 36 .. Vinegar 41 6 47 12.8 Ground Rice 1 1 .. .. Chopped Suet .. 1 1 100 Butter, informal sample .. 1 1 100 Totals 593 5.4 561 32 * 67 Proceedings Taken with regard to Samples Purchased during the year. Sample No. Particulars of Adulteration or Infringement. Article. Fine. Costs. Remarks. I I £ s. d. £ s. d. - 24 S Milk 5 per cent. abstraction of fat - Vendor warned - - 1 per cent. added water Vendor warned 18 SY „ 21 T 14 per cent. abstraction of fat - 1 13 0 Dismissed on payment of costs „ - - Vendor warned 28 T „ 2 per cent. added water Vendor warned 42 S Camphorated Oil Mineral Oil substitued for Olive Oil - - - - Milk Vendor warned 8 A 6 per cent. added water 11 A „ 3 per cent. abstraction of fat - - Vendor warned Vendor warned 25 H 1 per cent. added water - - „ Vendor warned 15 K „ 1 „ „ - - - Vendor warned 17 K 1 „ „ - „ 23 P „ 3 per cent. abstraction of fat - 1 11 6 Dismissed on payment of costs Vendor warned 28 P „ 11 „ „ 1 0 0 2 12 6 - 34 S „ 1 „ „ - 3 0 0 3 3 0 0 Master and servant both fined 50 S Vinegar 53 per cent. excessive water 2 0 0 1 1 - 47 T „ 5 „ „ „ - - - Vendor warned 71 SY Coffee Starch, 1 per cent. - - No proceedings 3rd portion lost (bottle burst) 23 A Milk 17 per cent abstraction of fat „ - - Dlismissed Warranty proved 39 P 4 - Dlismissed Warranty proved 80 S „ 10½ per cent. added water - - - - Vendor warned 75 SY „ 1 - Vendor warned 64 T „ 2 Vendor warned Boric Acid, 4.02 grains per pint - - 66 T „ - Vendor warned 68 T Vinegar 3 per cent. excessive water - - Dlismissed on payment of costs 72 T „ 7 1 11 0 0 Dlismissed on payment of costs 93 S Butter 16.9 per cent. foreign fats - 3 3 Milk 1 per cent. added water - - Vendor warned 65 K 10 per cent. abstraction of fat 104 S „ 1 0 0 1 11 0 96 T „ 4 0 9 0 1 1 0 68 Proceedings— continued. Sample No. Article. Particulars of Adulteration or Infringement. Fine. Costs. Remarks. - 56 A Chopped Suet Water 2.9 per cent., Ground Rice 31.0 per cent. - Vendor warned 88 S Vinegar 22 per cent. excessive water - 1 13 0 Dismissed on payment of costs „ 3 „ „ „ - - Vendor warned 76 T - - 108 S Butter 21.6 per cent. foreign fats Informal sample no proceedings SUMMARY £ s. d. Fines 7 9 0 Costs 19 0 0 26 9 0 Factory and Workshop Act. 70 Table. METROPOLITAN BOROUGH OF DEPTFORD. PROCEEDING DURING 1919. PREMISES. NUMBER OF PLACES— Number of inspections Number of notices Number of proceedings On register at end of 1918 Added 1919 Removed 1919 On register at end of 1919 Milk premises 227 27 229 306 4 .. 25 Cowsheds .. .. .. .. .. .. .. 2 .. .. 2 48 .. .. Slaughter-houses Other offensive trade premises 2 .. .. .. .. 20 2 17 185 16 .. 134 13 130 Ice cream premises Registered houses let in lodgings 289 .. .. 289 578 189 .. 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 1919. CLASS OF WORK. Number of Places Number of Inspections. Number of Number of Prosecutions. On Register at end of 1918 Added 1919. Removed 1918. On Register at end of 1919. Written Intimations. Notices. Under Factory Acts. Under Public Health Acts. Premises. Rooms Factories 4 4 Factory Laundries 22 5 LI Factory Bakehouses 11 1 1 11 26 51 2 Other Factories 128 6 134 258 51 8 1 Workshops Workshop Laundries 5 5 17 5 I 1. I I I Workshop Bakehouses 45 45 48 201 3 I I I Other Workshops 177 176 234 46 5 ■ I 8 9 Workplaces Places where Food is prepared for Sale 113 8 3 118 230 221 23 1 Workplaces other than the above 62 62 2 2 63 8 2 I I I I I Home-workers' Premises 699 68 241 526 530 392 2 1428 980 2 Total 1244 93 256 1081 45 71 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 1919. 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) 11 107 Workshops (including Workshop Laundries) 8 252 Workplaces (other than Outworkers' premises included in Part 3 of this Report) 25 229 588 Total 44 2 DEFECTS FOUND. PARTICULARS. Number of Defects. Number of Prosecutions Found. Referred to H.M. Inspector. Remedied. Nuisances under the Public Health Acts. I ... I I ! Want of Cleanliness 258 258 Want of Ventilation Overcrowding Want of Drainage of Floors Other Nuisances 109 108 Sanitary Accommodation Insufficient Unsuitable or defective Not Separate for Sexes 71 71 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 438 437 NATURE OF WORK. 1 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. Instances 11 Notices served. 12 Prosecutions. 13 Intances. 14 Orders made (S. 110). 15 Prosecution (Sections 109, 110) 16 Twice in the year. Once in the year. Lists. 2 Outworkers. Lists. 5 Outworkers. Falling to keep or permit inspection of lists. 9 Falling to send lists. 10 Contrauctors. 3 Workmen. 4 Contractors. 7 Workmen. 7 72 73 Table — continued. 4—REGISTERED WORKSHOPS. Workshops on Register (s. 131) at the end of year. Number. Bakehouses 45 Dressmaking 59 Laundries 5 Millinery 12 Shirtmaking 2 Tailoring 14 Wheelwrights (Smiths, &c.) 15 Others 74 Total number of workshop on Register 226 5.- OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories Failure to and Workshop Act (s. 133) 4 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory Workshop Act (s.5) Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Other - Underground Bakehouses (s. 101):- Certicates granted during the year - In use at the end of the year 16 74 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. I have the honour to present my Report under the Canal Boats Acts for the year ended 31st December, 1919, as follows :— For the purposes of inspection during the year, visits were made on the following dates, viz.:— May 7th, June 17th, July 8th, August 2nd and 12th, September 23rd, October 28th and December 16th. Three boats were found and inspected on the following dates: — July 8th (2 boats), October 28th (1 boat). Number of visits 8 Number of boats inspected 5 Infringements. The following matters were found requiring attention: JULY 8TH Boat " Leslie 229," registered at Brierly Hill. No pump on board. Boat leaky. Notice served and certificate received. July 8th Boat " Nora 239," registered at Brierley Hill. No pump on board. No registration papers produced. Notice served and certificate received. Oct. 28th.—Boat "Frank 252," registered at Brierley Hill. No pump on board. No registration papers produced. Notice served. Certificate not to hand. Children on Boats. No children were found on boats. The arrangements for inspection are : — Periodical inspection by Sanitary Inspector, duly appointed under the Canal Boats Acts jointly with the duties as Inspector of Workshops, Dairies, Milkshops, &c. 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. INDEX Vital Statistics- Summary of Population 8 Births 11 Marriages 12 Deaths 13 in Wards 14 Ages at 32 Causes of 16 from Zymotic Diseases 36 Tuberculous Diseases 45 of Infants 15 Local Government Board Tables 31-33 Infectious Diseases- Deaths from 36 Cases notified Puerperal Fever 41 Scarlet Fever 36 Tuberculosis 45 Page Sanitary Work Housing 62-65 Drainag Works 59 Overcrowding 61 Disinfection 51-54 Coroner's Court & Mortuary 55 Summary of Male Inspectors' Work 58-61 Summary of Women Inspectors' Work 29 Legal Proceedings 67 Food Supply Unsound Food 65 Sale of Food and Drugs Acts 66 Factories and Workshops— Home Office Tables 70-73 Maternity and Child Welfare 19-30 Tuberculosis Dispensary— Report of Tuberculosis Officer 46-48 Canal Boats — Report of Inspector 7