GRE 23 The ANNUAL REPORT « made to THE COUNCIL of the METROPOLITAN BOROUGH OF GREENWICH For the Year 1916. by ERNEST GEORGE ANNIS, M.R.C.S., L.R.G.P., L.S.A., D.P.E. Medical Officer of Health to the Borough. and GEORGE HERBERT DART, M.D., M.R.C.P., D.P.H. Deputy and Acting Medcal Officer of Health to the Borough. INDEX Of CONTESTS. Page Age Mortality 14 Analysis of Death Causes 16 Anthrax 26 Ares. of Borough 7 Articles and Rooms Disinfected 31 Articles Destroyed 31a Bacteriological Examinations 22, 27 Bakehouses 32 Births 7,12 Bones and Joints 19 Books Destroyed 30 Cancer 18 Causes of Death 16-20 Cerebro-spinal Fever 26 Chicken Pox 20 Circulatory System 19 Cleansing Children 48 Complaints 32, 46 Constitutional Diseases 18 Consumption 27, 28 Contacts 26 Conhouses 35; 48 Customs and Inland Revenue Acts 37 Dairies, Cowaheds and Milkshopa 36 48 Deaths, with Age Mortality 7, 12 Density of Population 7 Developmental Diseases 18 Diarrhoea and Zymotic Enteritis 17, 25 Dietetic Diseases 18 Digestive System 19 Diphtheria 17 22 Diphtheria Anti-Toxin 17 Disinfection 31, 32 Duties and Powers of the Public Health Committee 4,5 Elevation of Borough 7 Enteritis 19 Epidemic Cerebro-Spinal Meningitis 26 Epidemic Diseases 16 Erysipelas 18 22 External Cauaes 20 Factories and workshops 32 Food and Drugs-Samples of 40-48 Food-Premises for Preparation of etc. 36 Glanders 26 Gonorrhoea 16 Health Centre 29 Health-visitor 14 Home work 34 Horse Slaughterer 36 House Drainage 38 Houses Inspected for Infectious Disease 30 Houses let in Lodgings 37 48 Housing of the working Classes 37 Housing and Town Planning Acts 1808 42 Hydrophobia 26 Ice Cream Premises 36, 48 Infant Consultations 29 Infant Mortality 14 1 INDEX. (Continued) Page. Infective Endocarditis 18 Influenza 17 Inhabited Houses 7 Inland Revenue Acts 37, 49 Insanitary Houses 48 Institution Deaths 13 Integumentary System 20 Introductory Review 8,9 Isolation Shelter 26 Legal Proceedings 41, 42,49 Leprosy 26 Local Diseases 19 Lymphatic System 19 Malarial Diseases 18 Marriages 11 Measles 17, 24 - 25 Membranous Croup 22 Military Sanitary Works 32 Milk and Cream Regulations 39 Mortuary 20, 49 Nervous System 19 Notices, etc 48 Notifications 20-27 Notification of Births Act 15 Offensive Trades 36 38, 48 Ophthalmia Neonatorum 26 Organs of Special Sense 19 Outworkers Register 32 Overcrowding 37, 48 Parasitic Diseases 18 Persons Cleanse 48. Polio-encephalitis 26 Polio-myelitis 26 Population 7 Premises Cleansed 48 Preservatives 39 Public Health Committee 4 Public Sanitary Conveniences 38 Puerperal Fever 13,24 Pyaemia and Septicaemia 18 Rag Flock Act 38 Refuse Removal 38 Remarks on Death Causes 16-30 Reproductive System 19 Respiratory System 19 Rheumatic Fever 18 Sale of Food and Drugs Act 38-42 Sanitary work-Summaries, etc. 33,42-47 Scarlet Fever 17 , 22 -23 School Clinic 29 Septic Diseases 18 Slaughterhouses 35, 48 Small-pox and Vaccination 16, 20 Smoke Nuisances 38 Sporadic Diseases 17 Staff of Public Health Department 6 Statistical Summary 7 Suffocation 20 Suicide 20 Syphilis 17 2 INDEX (Continued) Page. Tenement Houses 49 Trade Refuse-Removal of 38 Tubercular Diseases 18,26 Tuberculosis 18,26 Tuberculosis Dispensary 27 Tuberculosis Officer's Report 27-38 Typhoid Fever 17, 24 Underground Bakehouses 35 Underground Rooms 48 Unwholesome Food 44 Uninhabited Houses 7 Urinary System 19 Vaccination Particulars 21 Venereal Diseases 17 Verminous Promises. 48 Verminous Children 48 Vital Statistics 10 Water Supply 38 Whooping Cough 17,26 Workshops and Factories 32, 33 Workshops and Workplaces 32,33,35 Zymotic Enteritis 17,25 Zymotic Diseases 16 PUBLIC HEALTH COMMITTEE DURING THE YEAH 1915-16. Charles Stone Esq., J.p. (Mayor), and 9 Members. C. Nixon, Esq. Chairman. Col. E. A. Lovibond, Vioe-Chairman. Councillors- H. Baron Dr. J. Gordon Parker, D.Sc. J. Davey, F. Powell, R.N. A. J. Hunt, W. K. Soamee, C. Nixon, E. R. Woodward. Duties and Powers of the Public Health 1. -The Committee shall consist of nine elected members. 3. - There shall be referred to the Committee the execution of the Food and Lrugs Act, l875-1899; the Margarine Act,1887; the Sale of Horse-Flesh, etc., Regulation Act, 1889; such matters arising under the Housing of the working Classes Act, 1890 and 1894, and the Working Classes Dwellings Act, 1890; the Public Health (London) Acts; the Metropolis Management Acts relating to defective drainage; the Canal Boat Acts; the Factory and workshop Acts; the sanitary provisions of any other Act of Parliament; the Dairies, Cow-sheds and Milkshops Order of 1885; the by-laws and regulations made under the above Acts, or otherwise relating to the public health and sanitary condition of the Borough, which are not within the reference to any other Committee, shall stand referred to the Committee. 3.-The Committee may serve and receive notices, take ings, and in particular cases empower any Officer of the Council to make complaints and take proceedings in their behalf under, and otherwise execute, the Public Health (London) Act, 1891, and sections 82, 83, 84 and 85 of the Metropolis Management Act, 1855, relating to the inspection of any premises, drains, sinks, traps, syphons, pipes, or other works or apparatus connected therewith, and otherwise in relation to defective drainage, except as to the recovery of expenses, and the same shall not require the approval of the Council, provided that the Committee shall report their action at the next following meeting of the Council, who may at any time determine or prohibit or otherwise vary any such notices or proceedings. 4. -All plans for drainage and redrainage of premises shall be laid before this Committee for consideration. 4. 5. -Works of drainage of houses and premises shall be carried out under the direction of. this Committee. 6.-The Committee shall have the control of Mortuaries erected or maintained by the Council, as the Sanitary Authority, and shall have control of the disinfecting staff, apparatus and plant. 7. The construction, maintenance and control of public tary conveniences, and conveniences maintained by the Council, shall be referred to this Committee. 8. Provision and maintenance of Tuberculosis Dispensary. Additional matters coming within the definition of the sanitary provisions of any other Act of Parliament:- Notification of Births Act, 1907. Housing and Town Planning Act, 1909. London County Council (General Powers) Act, 1902, 1907, 1908. Rag Flock Act, 1911. Public Health (Tuberculosis Regulations), 1912. Public Health (Milk and Cream) Regulations, 1912. STAFF of the PUBLIC HEALTH DEPARTMENT. Sanitary Inspectors Charles Turle Wilson, Thomas Clark. Arthur E. Baethe, Ebenezer Martin, Charles W. Nettleton, Miss G. Davie. Health Visitors. Miss E. M. Millington, Mies H. Gower. Public Analyst. A. E. Brown, B.Sc.,F.I.C. Disinfector. James Forrest. Assistant Disinfectors. Frank. Mears. A. Clay. Caretakers at Council's ShelterEdward Jackson. Maria Jackson. MUNICIPAL DISPENSARY FOR THE PREVENTION OF CONSUMPTION. Administrative Medical OfficerE. G. Annis, M.R.C.S., etc. D.P.H. Tuberculosis Medical OfficerG. H. Dart, M.D. DispenserG. W. Vickery. Nurses.L. Heastman. T. I. Husbands. ClerksЖ W.H Peters. Ж A. H. Sapsea. T. D.P. Mobsby. Medical Officer of Health- Ж Ernest G. Annis, M.R.C.S., L.R.C.P., D.P.H. Deputy and Acting Medical Officer of Health. G. H. Dart, M.D., M.R.C.P., D.P.H. Ж on Military Service. 6. STATISTICAL SUMMARY. Elevation-Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts- East Greenwich 1451.4 acres West Greenwich 297.8 ,, St. Nicholas 112.1 ,, Charlton and Kidbrooke 1990.4 ,, 3851.7 ,, Density of Population- Calculated on Death Rate. East Greenwich 31.33 persons per acre West Greenwich 75.55 ,, ,, ,, St. Nicholas 63.8l ,, ,, ,, Charlton and Kidbrooke 9.71 ,, ,, ,, Average for the Borough 24.52 ,, ,, ,, Number of Inhabited Houses- At Census, 1901 14,240 At Census, 1911 14,722 Estimated, 1916 16,166 Number of Uninhabited Houses- At Census, 1911 803 Population- At Census, 1911 95,968 Estimated 1918 for death rate 94,453 ,, birth ,, 102,765 Birth Kate, 1916 22.90 per 1,000 Death Rate, 1916 15.14 ,, ,, (Excluding Military deaths) ,, ,, (Zymotic) 1.57 per 1,000 ,, ,, (Infantile Mortality) 83.69 per 1000 Births. 7. PUBLIC HEALTH AND HOUSING DEPARTMENT, ROYAL HILL, GREENWICH. October, 1917. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Gentlemen, The Local Government Board request that the "Annual Report of the Medical Officer of Health" for this year ahould be typewritten and many details omitted. The Local Government Board wish suitable arrangements to be made for the careful preservation of all records in order that after the termination of the war a report can he printed dealing more fully with the period from the beginning of 1916 to the end of the last complete year, giving separate statistics for each year. At the beginning of the year Mr. Peters, the chief clerk to the Public Health Department, was called up in his group for Molitary Service, and shortly afterwards Mr. Mobsby enlisted for service, so that the office work has been carried on through the year by a temporary staff. Fortunately Miss Merricka, who has carried out the duties of temporary chief clerk since Mr.Mobsby's enlistment, has shown great ability and prevented any dislocation in the routine of the office work. The Registrar General has adopted the following estimates of population for the calculation of the death rate and birth rate:- For the death rate - 94,453 ,, ,, birth ,, - 102,765. The Registrar General states that the former is an estimate of the civilian population; the latter of the total population based on the assumption that the ratic between the total and the civilian population is the same in the Borough as in England and Wales as a whole. With a view to approximation to the population amongst which the births have occurred, the total population of England and Walea for this purpose has been calculated by adding to the published estimates for 1914 the natural increase up to the middle of the year 1916. The Statistics for the Borough for the year 1915 are in most particulars more satisfactory than those for 1915. The number of deaths is smaller, and the death rate as calculated from the population allocated to the Borough by the Registrar General is lower. The number of deaths from Zymotic disease and the number of notifications of infectious disease and the corresponding rates per 1,000 of the population are lower-witn the exoeption of Diphtheria, in which a considerable increase is shown, though fortunately the Borough escaped anything approaohing an epidemic. The Infantile Mortality rate, which is calculated from the number of deaths under one year of age and the number of births registered (not from the general population), shows a gratifying 8 Page 12. Death rate for Kidbrook should be 8.57 " 16. Local diseases-Circulatory system .01 " 17. Influenza Of the 26 deaths 14 were over 65 years. " 21. Total No. of removals to places unknown and cases not found = 340. " 22. Second Qtr. West Greenwich=15. " 25. Fourth Qtr. Total of ages 16-25=5. " 31 & 31A. 52 weeks 30th.December 1916. " 32. Sanitary work. Tables on pages 42-4. " 37. under the Public Health (London) Act, 1891. Cleansing =0. Districts. Birth Rate. Death Rate. Percentage of deaths under one year of age. tile Mortal ity per 1,000 births Zymotict Death rate. Diarrhœa death rate. Consump tion East Greenwich- 22.1 12.57 13.15 68 1.12 .35 1.10 West Greenwich 24.7 19.93 12.52 92 2.18 .53 2.36 St. Nicholas 28.10 22.14 21.25 156 4.34 1.68 1.82 Charlton 22.33 13.66 13.33 75 .97 .06 .91 Kidbrocke 12.7 9.20 8.33 51 .35 - .35 Whole Borough 22.90 15.14 8.36 83 1.57 .43 1.40 Attack Rates of the various notifiable diseases per 1,000 living in the several districts:- Smallpox. Dipntheria. Soarlet Fever. Erysipelas. Typhoid Fever. Puerpera Fever. East Greenwich .00 5,09 1.94 .46 .11 .11 West Greenwich .00 4.01 2.40 .52 .17 - St. Nicholas .00 2.38 1.68 .98 - - Charlton .00 1.51 2.12 .42 .24 .06 Kidbrooke .00 .35 1.42 .35 .35 - Whole Borough .00 3.86 2.05 .63 .14 .06 In conclusion, I have to thank the Public Health Committee and Council for the kindness and consideration with which they have regarded my endeavours to carry out the duties of Medical Officcr of Health and Tuberculosis Officer and I have also to express my appreciation of the manner in which the members of the Staff have performed their duties throughout the past year. I am, Genxlemen, Yours respeotfully, G. H. DART. 9. decrease from 101 to 83 per 1,000 births. There is a decrease in diarrhoeal deaths both in number and rate per 1,000 of the population, the rate for 1916 being .43 as compared with .59 for 1915. The figures relating to the different constituent part of the Borough are as follows:- Districts. Birth Rate. Death Rate. Percentage of deaths under one year of age. Infantile Mortality per 1,000 births Zymotic Death rate. Diarrhœa death rate. Consump tion East Greenwich 22.1 12.57 13.15 68 1.12 .35 1.10 West Greenwich 24.7 19.93 12.52 92 2.18 .53 2.36 St. Nicholas 28.10 22.14 21.25 156 4.34 1.68 l.82 Charlton 22.33 13.66 13.33 75 .97 .06 .91 Kidbrooke 12.7 9.20 8. 33 51 .35 — .35 Whole Borough 22.90 15.14 8.36 83 1.57 .43 1.40 Attack Rates of the various notifiable diseases per 1,000 living in the several districts:- Smallpox. Diphtheria. Scarlet Fever. Erysipelas. Typhoid Fever. Puerpera Fever. East Greenwich .00 5.09 1.94 .46 .11 .11 West Greenwich .00 4.01 2.40 .52 .17 - St. Nicholas .00 2.38 1.68 .98 - - Charlton .00 1.51 2.12 .42 .24 .06 Kidbrooke .00 .35 1.42 .35 .35 - Whole Borough .00 3.86 2.05 .63 .14 .06 In conclusion, I have to thank the Public Health Committee and Council for the kindness and consideration with which they have regarded my endeavours to carry out the duties of Medical Officer of Health and Tuberculosis Officer, and I have also to express my appreciation of the manner in which the members of the Staff have performed their duties throughout the past year. I am, Gentlemen, Yours respectfully, G. H. DART. 9. VITAL AND MORTAL STATISTICS, 1916. POPULATION. The number of persons estimated to be living at the middle of 1916 was 94,452 for the birth rate and 102,765 for the death rate. The distribution of the population throughout the Borough is as follows:- Census 1911. Estimated Population 1916 calculated on Death Rate Birth Rate. East Greenwich 45,960 45,475 49,478 West Greenwich 22,933 22,499 24,480 St. Nicholas 7,290 7,153 7, 782 Charlton 16,910 16,516 17,969 Kidbrooke 2, 875 2,809 3,056 Total 95,968 94,452 102,765. 10. MARRIAGES. The Superintendent-Registrar of the Greenwich Registration District has kindly furnished me with the particulars relating to the number of marriages solemnized in the Parishes of Greenwich and St. Nicholas. The Superintendent-Registrar for the Woolwich Registration District has also kindly supplied the particulars for the Parishes of Charlton and Kidbrooke, with the exception, in these latter particulars, that the marriages performed in the Woolwich Superintendent-Registrar's Office and in Chapels in Charlton and Kidbrooke. of residents in those Parishes, are not included. The following table shows these particulars, giving the number of marriages in Greenwich and St. Nicholas, etc., for each year since 1893. Year In Churches of England in Greenwich In Churches of England in Charlton & Kidbrooke. In St. Nicholas Parish Church. Marriages in Superintendent-Registrar's Office of parties resident in Greenwich or outside the Registration District and in Chapels & Roman Catholic Church in St. Nicholas and Greenwich. Approximate Population of Districts concerned. Total 1893 295 - 49 94 438 66489 1894 299 - 44 100 443 67507 1895 246 - 52 102 400 68525 1896 282 - 61 96 439 69543 1897 287 - 40 119 446 70561 1898 309 - 45 119 473 71569 1899 343 - 46 158 547 72597 1900 359 - 46 140 545 73615 1901 354 - 52 147 553 74636 1902 - - - - 667 75969 1903 - - - - 675 77395 1904 324 129 48 174 675 101651 1905 303 130 67 205 705 103493 1906 314 113 69 217 713 105350 1907 328 115 45 252 740 107222 1908 387 110 52 224 673 109110 1909 246 84 54 224 608 111014 1910 304 110 53 243 710 112935 1911 309 123 34 230 696 95982 1912 266 102 59 228 655 95992 1913 295 120 51 259 725 96015 1914 279 135 72 243 729 96037 1915 472 188 95 406 1161 96385 1916 381 145 74 324 924 94,452 11. BIRTHS. The total number of Births in the Borough during the year has been 2,354, but of these, 87 occurred in the Greenwich Union Infirmary, the address of the mother being in l8 instances in Deptford, Lewisham 29, Woolwich 4 and Bermondsey 1. Deducting these and adding 23 which were transferred from Lambeth, City of London, Lewisham, Deptford and Hackney, it will be seen that the number of strictly Greenwich births for 1916 is 2325, of which 1199 were males and 1126 females. This corrected figure gives a Birth Rate of 22.70 per 1,000 of the population, being 2.47 below the average for the last fifteen years, 1901 to 1915, the period since the formation of the Metropolitan Borough. Amongst the total number of births registered in the Borough there were 94 in which the name of the father was not registered and therefore not given in the return; accordingly, these births may be presumed to be of an illegitimate character. 74 of such births were registered in the East Greenwich District, which includes the Infirmary of the Greenwich Union. In 12 cases the mother was ordinarily a resident in the Borough of Deptford, 3 in Woolwich and 21 in Lewisham, and accordingly this number of births have been transferred to those Boroughs. The remaining 58 were similarly allocated to the districts in this Borough in which the mother ordinarily resided, making 23 of such births belonging to East Greenwich, 25 to West Greenwich, 4 to St. Nicholas and 6 to Charlton. The Birth Rate for the county of London equals 23 per 1,000 of the population. It varied from 8.1 in the City of London, 12.5 in the City of Westminster, to 27.4 in Shorediton. The Birth Rate for England and Wales was 21.6 Under the provisions of the Notifications of Births Act, 1907, intimations have been received from medical men, parents and others, with respect to 2,497 births, from which it will be seen that we have 143 intimations to be credited to births which were registered during the latter part of 1915, or will be registered during the early parts of 1917, as the time allowed by law for registration purposes extends up to six weeks, whereas that under the Notification of Births Act is to be within 36 hours. DEATHS. The total number of deaths registered during 1916 was 1,426, of which 781 were males and 645 females. The crude Death Rate for the Borough of 15.14 per 1,000 compares with 14.3, the Death Rate for the County of London, and 14.4 the Death Rate for the 96 large towns. In the County of London the lowest crude Death Rates amongst the various Metropolitan Boroughs were 11.7 in Wandsworth, 11.8 Lewisham, 12.3 Woolwich; whilst the highest rates were 18.7 Shoreditch, 19.3 Finsbury. Locally the Death Rate varied from 8.37 in Kidbrook, 12.57 in East Greenwich, 13.66 in Charlton, 19.93 in west Greenwich to 22.44 in St. Nicholas. The following table shows the variation in, and average of, the Death Rates in each of the five Districts of the Borough 12. in the five years, 1911 to 1915 compared with the figures for 1916- District. 1911 1912 1913 1914 1915 Average for Five Years. East Greenwich 14.04 11.99 12.46 12.87 13.57 12.98 West „ 16.15 15.03 l8.81 l8.61 19.62 17.64 St. Nicholas 22.15 22. 86 l8.78 18.73 26.52 21.81 Charlton 13.61 10.88 12.75 11.83 17.56 13.32 Kidbrooke 6.29 5.63 6.55 27.42 43.41 17.86 BOROUGH 14.86 13.20 14.31 14.95 17.56 14.97 DEATHS IN INSTITUTIONS. The following table gives the particulars showing the number of deaths of Greenwich residents in Public Institutions:- Year. Total Deaths of Greenwich Residents. Total Deaths of Greenwich Residents under 1 year of age. Total Deaths of Greenwich Residents in Public Institutions. 1901 1,468 362 356 1902 1,522 387 408 1903 1,317 345 354 1904 1,450 373 369 1905 1,370 318 398 1906 1,405 320 437 1907 1,341 259 418 1908 1,377 310 442 1909 1,354 251 457 1910 1,289 261 404 1911 1,421 306 488 1912 1,263 200 467 1913 1,396 263 511 1914 1,431 235 414 1915 1,690 238 690 1916 1,426 197 550 Average 1,406 295 441 13. AGE MORTALITY. The age mortality and the distribution of the deaths between the different quarters of the year is shown by the following table:- Deaths. First Quarter. Seocnd Quarter. Third Quarter. Fourth Quarter Total Under 1 year of age 34 51 56 56 197 Between 1 and 2 years 30 22 4 19 82 Between 2 and 5 years 24 24 10 26 84 Between 5 and 15 years 16 24 17 12 69 Between 15 and 25 years 17 19 15 18 69 Between 25 and 45 years 55 45 28 43 171 Between 45 and 65 years 98 67 47 103 315 65 years and upwards 137 95 77 130 439 Total 411 354 254 407 1426 Miss Millington and Miss Gower have carried out the duties of Health Visitors, making the necessary visitations under the above Act, and also have dealt with the cases of Diarrhoea occurring in their districts. There has been a slight rise in the Infantile Mortality in Charlton and Kidbrook; West Greenwich, St. Nicholas and East Greenwich have improved. Visits paid in reference to Births 1368 Re-visits made 563 Visits paid in reference to Notified Cases of Diarrhoea 217 Re-visits made in reference to Cases of Diarrhoea 104 Miscellaneous enquiries and extra visits paid by special request 123 2,375. INFANTILE MORTALITY. The Infantile Mortality, measured by the deaths of children under one year of age to the number of births registered, was 83.69 per 1,000 births, there having been a total of 197 such deaths during the year, as compared with 263, 235 and 238, the figures for the three preceding years. The number for the County of London was 89 per 1,000 births, the average for the past five years in Greenwich has been 94 per 1,000 births. The following table gives the number and character of the intimations respecting births in the Borough since the adoption of 14. the Notification of Births Act, 1907:- NOTIFICATION OF BIRTHS ACT, 1907. Date of adoptio-17th March, 1909. 1909. 1910. 1911. 1912. 1913. 1914. 1915 1916 Total Number of Births notified in each year since adoption 1, 228 2,663 2,553 2,450 2,623 2,513 2,280 2,497 (a) Attended by Midwives 642 1,298 1,282 1,412 1,340 1,338 1,226 1,314 (b) Attended by Doctors 586 1,365 1,271 1,038 1,283 1,175 1,054 1,183 Number of Still Births notified in each year 16 51 24 71 53 36 42 61 Number of Births registered in each year 2, 492 2,457 2,381 2,393 2,545 2,409 2,347 2,354 The rates of Infantile Mortality varied amongst the Metropolitan Boroughs from 70 in Woolwich to 128 at City of London. For all London the rate was 89 in 1916, compared with 112 in 1915 and 104 in 1914. For England and Wales the rate was 99, compared with 110 in 1915, 105 in 1914 and 109 in 1913. Locally, the variations were from 51 per 1.000 births in Kidbrooke, 75 in Charlton, 68 in East Greenwich, 92 in West Greenwich, and 156 in St. Nicholas. The following table compares at a glance these figures for the years since the formation of the Borough:- District Average for 5 Year s 1901-5 Inclusive Average for 5 Years 1906-10 Inclusive 1911 1912 1913 1914 1915 1916 East Greenwich 129 106 124 78 103 87 85 68 West „ 126 110 156 81 108 96 119 92 St. Nicholas 179 143 137 160 135 214 192 153 Charlton 121 109 100 65 80 63 71 75 Kidbrooke 39 79 42 - 40 — — 51 TOTAL 131 111 129 84 103 98 101 83 15. AN ANALYSIS of DEATH CAUSES. All death causes are canveniently arranged under various headings, according to the Registrar-General's classification of diseases, and the following table, a summary of the larger table in the Appendix, shows the Death Rates for residents, and in fact all persons belonging to the Borough (although some of them may have died in Institutions in other Boroughs, or even outside the County of London altogether), per 1,000 of the population living in the Borough. 1916 1916 Infective Diseases- Local Diseases -contd. Epidemic 1.71 Lymphatic .01 Sporadic .00 Urinary System .57 Venereal .03 Reproductive System .06 Septic .18 Parturition .04 Malarial .05 Bones and Joints. .01 Tuberculosis 1.8 Integumentary System .03 Dietetic Diseases .05 External Causes- Constitutional Diseases 1.37 Accidents .60 Developmental Diseases 2.01 Homicide .00 Local Diseases- Suicide .06 Nervous System 1.31 Ill-defined Causes- Organs of special senee .01 Sudden Death .00 Ciroulatory System 2.01 Respiratory System 2.79 Other ill-defined and not specified causes .02 Drgestive System .71 REMARKS ON VARIOUS DEATH CAUSES. Infective Diseases. Epidemic. There were 161 deaths due to this class of diseases, equalling a Death Rate of 1.71 per 1,000; the rate last year was 2.30 and was 1.26, 1.59 and 1.53 in 1912, 1913 and 1914 respectively. Zymotic. The purely Zymotic class of epidemic diseases is credited with causing a total of 148 deaths, equalling a Death Rate of 1.57 per 1,000. Locally the Zymotic Death Rate varied from .35 in Kidbrooke (2.10 in 1915), .97 in Charlton (1.78 in 1915), 2.18 in West Greenwich (1.96 in 1915), 1.12 in East Greenwich (1.40 in 1915), up to 4.34 in St. Nicholas (3.84 in 1915). Small-Pox. There were no deaths from this disease in 1916, this being the fourteenth year since a death occurred from this cause in the Borough. 16. in the Borough. Measles. Forty-eight deaths were ascribed as due to this disease, 43 of the patients being under five years of age, and 5 between five and fifteen years of age, compared with 46 which occurred in 1915. 47, 39 and 38 deaths were recorded in the three preceding years. Sixteen of the deaths occurred in East Greenwich, l8 in west Greenwich, 12 in St. Nicholas, 2 in Charlton and 0 in Kidbrooke. The quarterly incidence was 7 in the first, and 20, 4 and 17 respectively in the succeeding quarters. Scrlet-Fever . This disease occasioned 4 deaths, between the ages of one and fifteen years. Two of the deaths occurred in East Greenwich and one in in west Greenwich and one in Charlton. Four such deaths occurred in 1915 and seven in 1914. Diphtheria There were 22 deaths from this disease during 1916. This gives a Death Rate for Diphtheria of 0.23 comparing with 0.14, the rate for 1915. Fourteen deaths occurred in 1915 which were attributed to this cause, and 17, 12 and 16 in the three preceding years. Fifteen of the patients were under five years of age and 7 of the patients were over five years of age. Sixteen tubes of Diphtheria Anti-toxin, containing a total of 48,000 units of serum, for the treatment of patients suffering from. this disease, have been supplied by this Council during the year. Whooping Cough. This disease was given as the cause of 23 death in 1918, as against 43, 7 and 24 in the three preceding years These deaths equal a rate of 0.24 per 1,000 Eleven of the deaths occurred in East Greenwich, 1 in West Greenwich, 6 in St. Nicholas and 5 Charlton. Typhoid Fever. There wore six deaths ascribed as due to this disease; there were 7 in 1915, 5 in 1914 3 in 1913, 2 in 1912, 4 in 1911, 3 in 1910, 3 in 1909 and 9 in 1908. one death occurred in East Greenwich, 4 in West Greenwich and 1 in Charlton. Diarrhœa and Zymotic Enteritis. 42 deaths were stated to be due to this cause, equalling a rate of 0.44 per 1,000. Last year there were 50 deaths, and 57, 61 and 31 respectively in the three preceding years. The deaths were distributed as follows:- 16 in East Greenwich, 13 in West Greenwich, 12 in St. Nicholas, and 1 in Charlton. 4 patients were over 5 years of age. The deaths in 1915 were distributed as follows:- 18 in E. Greenwich, 16 in W. Greenwich, 9 in St. Nicholas and 7 in Charlton. It is interesting to note that the deaths during the months when Diarrhœa is notifiable in Greenwich were 34 in. 1914. 24 in 1915 & 13 in 1916. Influenza. Influenza is found to have been the responsible cause for 26 deaths in 1916. 18 was the average of the previous three years. Of the 26, 12 were over sixty-five years of age. Sporadic Diseases. There were no deaths from this class of diseases during the year. Venereal. Syphilis. Six deaths were given as due to Syphilis, as against 3 in 1915 and 5 in 1914. Of these six deaths 3 were 17 children under five years of age. Three occurred in East Greenwich, West Greenwich, 1 in St. Nicholas and 1 in Charlton. One of was in the Greenwioh Infirmary and one in the Cottage Hospital, There were no deaths from Gonorrhoea during the year. Septic. Erysipelas. Three deaths occurred from this cause in 1916, 4 in 1915, 4 in 1914 and 1 in 1913. Puerperal Fever. There were 3 deaths from this disease during the year. Pyaemia and Septicaemia. There were 4 deaths from this disease during the year. Infective Endocarditis. No deaths were ascribed to this cause in 1916. The number was 0 in 1915, 1 in 1914 and 0 in 1913. Malarial. Rheumatic Fever. There was 1 death in 1916 as compared with 3 in 1915, 1 in 1914 and 0 in 1913. Tuberculosis. This class includes the causes of 170 deaths during the year under review, with a rate of l.80; these figures compare with 302, 176 and 141, the totals of the preceding three years, and respective rates of 2.09, l.84 and 1.45. Tuberculosis of the lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 133 attributed to this cause, or a rate of 1.40 per 1,000. Locally, the deaths were 1 in Kidbrooke, giving a Death Rate of .35; 13 in St. Nicholas, giving a Death Rate of l.82; 15 in Charlton, giving a Death Rate of .91; 50 in East Greenwich, giving a Death Rats of 1.1; and 53 in West Greenwich, giving a Death Rate of 2.3 per 1,000. The remaining forms of Tuberculosis were responsible for 38 deaths, 23 being in East Greenwich, 10 in West Greenwich, 4 in St. Nicholas, 3 in Charlton and 0 in Kidbrooke. Of these other forma of Tuberculosis, Tuberculosis of the Brain or its Membranes was credited with 31, 10 being under five years of age; Tubercle affecting the Intestines, 4 deaths (3 being under five years of age); General Tuberculosis, 13 deaths (7 under and 5 over five); and other forms 1. Parasitic Diseases. There were no deaths from this class of disease. Dietetic Discuses. There were 5 deaths from this class of disease, 1 due to Acute Alcoholism in Charlton, 4 to Chronic Alcoholism, 1 in West Greenwich, 2 in St. Nicholas and 1 in Charlton. Constitutional Diseases. The deaths from this cause were 139 in number, which gives a rate of 1.37 per 1,000. Of these, 104 were attributed to Cancer, 14 to Diabetes, 5 to Osteo-Arthritis, 1 to Purpura Haemorrhagica and 5 to Anaemia. The deaths from Camcer were distributed as follows:- 49 occurre in East Greenwich, 27 in West Greenwich, 6 in St. Nicholas, 19 in Charlton and 3 in. Kidbrooke. Developmental Diseases. There were 190 deaths from this 18 class of disease equal to a rate of 3.01 per 1,000. These may roughly be divided into those from causes which would appear to be unavoicable, viz:- Congenital dcfocts, 19. and rhose from causcs more or lcse preventable, viz:- Premature birth, 23; Injury at birth, 1 Debolity at birth, 5; Atrophy, Debility and Marasmus, 22; Atelectasis, 5; Dentition, 3, and Rickets, 3. The remaining and largest portion of these deaths from developmental diseases, 109 in number, were from Old Age; in 1315 thers were 118 deaths from this cause, and 118 in the previous year. Local Diseases. Nervous System. One hundred and twenty four deaths were attributed to the various nervous diseases, which gives a rate of 1.31 per 1,000; last year the rate was 1.31 per 1,000. Convulsions were responsible for 9, all being under five years of age; 5 were from Meningitis, 68 from Apoplexy, 3 from Softening of the Brain, 2 from Hemiplegia or Brain Paralysis, 5 from General Paralysis of the Insane, 7 from other forms of Insanity, 1 from Cerebral Tumour, 10 from Epilepsy, 3 from Locomotor Ataxy, 2 from Paraplegia, and 9 from other diseases of this system. Organs of Special Sense. There was 1 death from this class of causes, equal to a rate of 0.01 per 1,000. Circulatory System. The Death Rate from diseases of this system was 1.64 per 1,000, there being a total of 155 such deaths. Valvular Diseases of the heart were responsible for 85, 6 from Aneurism, 2 from Pericarditis, 9 from Embolism and from the remaining diseases of this system, 53. Respiratory System. Two hundred and sixty three deaths were due to diseases of the respiratory organs, as compared with 301 in the preceding year. The Death Rate under this heading equals 2.79 per 1,000. Forty-five were from Acute and 87 from Chronic Bronchitis; 111 from the various forms of Pneumonia, 49 being under five years of age, and 5 from Pleurisy, 7 to Emphysema, 3 to Laryngitis, 1 to Croup and 4 to other diseases. Digestive System. There were 67 deaths from diseases of this system, equal to a rate of .71 per 1,000; (also Enteritis was responsible for 10, 9 being under five years of age); 8 were due to Ulcer of the Stomach and Duodenum, 5 to Appendicitis, 14 to obstruction, 10 to Cirrhosis, and 4 to other diseases of the Liver, 2 to Peritonitis, 8 to other diseases of Stomach, and 4 to other diseases of the Digestive System, and 3 to diseases of Mouth and Annexa. Lymphatic System. There were 4 deaths from diseases affecting this system during the year. Urinary System. Fifty-four deaths, equal to a rate of .57 per 1,000, occurred from diseases affecting this system. Forty were from Brights Disease, 6 from Acute Nephritis and 8 from diseases of the Bladder and Prostate. Reproductive System. Disease of the generative organs was the cause of 2 deaths, one death was attributed to diseases of Uterus and Appendages and one to disease of Ovaries. There were 4 deaths attributed to diseases of Parturition. Bones and Joints. There was one death from disease of bones 19 and joints. Integumentary System. There were 3 deaths from. other diseases of Integmentary System. External Causes. There were 65 deaths given as due to causes grouped under this heading; 57 were the result of accident or negligence, 6 were from Suicide, and the remaining 2 due to ill-defined causes. Suffocation, by being overlaid in bed, was the cause of death of 5 children under five years of age (cmpared with 3 free. this cause last year); 6 cases were from drowning, 1 by weapon or implement, while accidents on railways, in vehicular traffic and in building operations, falls, etc., were respcnsiole for 45 deaths. The Suicides "ere by poison in 3 cases, 3 by cut or stab, and 1 by other and unspecified £.etncd. Ill-defines Causes. There were 2 deaths tne cause of which was not ascertained in 1916. MORTUARY. The number of bodies death witn in tne Mortuary since 1896 is shown below:- Year Drowned Bodies from River. Other Bodies. Totals. 1896 11 33 44 1897 11 47 58 1898 15 32 47 1899 17 45 62 1800 7 66 73 1901 13 126 139 1902 13 95 108 1903 20 118 138 1904 15 155 170 1905 10 137. 147 1906 10 124 134 1907 11 145 156 1908 20 125 145 1909 7 134 131 1910 12 109 121 1911 8 112 120 1912 15 126 141 1913 17 114 131 1914 15 134 149 1915 15 194 209 1916 11 182 193 Notifications under the Previsions of the Public Health (London) Act 1891. During the year. 1906 cases have been notified under the above Act, as compared with 1483, 1773 and 3104 respectively." tne preceding years 151!?, 181-i and 1913. Small-Pox. No cases cf this disease were notified during the year in pereons residing in tne Borough. Chicken-Pox. No cases of this disease were notified during the year. Cholera. No cases. 20. 21 SUPPLEMENTAL VACCINATION RETURN for 1915. Return made on or before the 15th of February 1917, by Mr. A. E. Roasiter, Vaooination Offioer of the several Districts of the Greenwich Union, respecting the vaccination of children whose births were registered in his District from 1st January to 31at December, 1915, inclusive Registration Sub-Districts comprised in the Vecoinantion Officer's District. No. of Births from 1st Jan. to 31st December 1915. No. of-these Births duly entered by 31st Jan., 1916. No. of Births which on 31st Jan. 1916, remained unentered in the Vaccination Register on account of - No.of these births remaining on 31at Jan/16 not accounted for. Success fully Vacoinated. Insusceptible of Vaccination. Had Smallpox. Certificates of Deadooi? sot ev ticuo objection received. Dead Hpvaccinated. Postponement by Medical Ceitifioate. Removal to Districts, V 0 of which apprised. Rsmoval to plaeeca unknown & cases not found. 1. 3 3 4 5 6 7 3 9 10 11 South Deptford 833 431 1 «•» 330 51 3 17 5 b 51 North Deptford 1388 837 4 374 105 1 13 86 79 East Deptford 934 536 1 - 111 107 8 4 38 79 East Greenwioh 1099 631 *»• - 350 83 1 33 73 33 T'eso Greenwich 570 343 3 119 37 3 . - 36 3* Total .. 4813 3748 8 — 974 383 15 71 360 373 Diphtheria. Three hundred and sixty-four cases of Diphtheria were notified during the year, as compared with 169, 236, 261 and 354 respectively, in the four previous years. This distribution of these cases was as fellows:- 231 in East Greenwich, 90 in West Greenwich, 17 in St. Nicholas, 35 in Charlton and 1 in Kidbrcoke. Of this total number, 347 were removed to the Hospital for treatment. Amongst which number, the Hospital Authorities reported that in 1 case they considered the diagnosis incorrect. There were 33 fatalities due to this disease, which gives a case mortality of 6.0 per cent.- One thousand four hundred and eighty-four specimens were forwarded by Medical Practitioners for bacteriological investigation from cases suspected to be Diphtheria. Of this number,1319 were reported to give negative or doubtful results, and 365 were positive in character, being dealt with accordingly. The quarterly incidence of the disease for 1916 has been as follows:- 1st.Quarter - East Greenwich, 35 cases; West Greenwich, 31; St. Nicholas, 3; Charlton, 8; Kidbrooke, 1; a total of 5b cases. 3nd Quarter - East Greenwich, 3b cases; West Greenwich, 31; St. Nicholas, 5; Charlton, 7; a total of 55 cases. 3rd Quarter - East Greenwich, 55 cases; West Greenwich, 19; 8t. Nicholas, 3; Charlton, 6; a total of 63 cases. 4th Quarter - East Greenwich, 133 oases; West Greenwich, 35; St. Nicholas, 6; Charlton, 4; a total of 166 oases. Membranous Croup. Five cases of Membranous Croup were notified during the year. Erysipelas. Sixty cases were notified during the year, 31 being in East Greenwich, 24 in West Greenwioh, 7 in St. Nicholas, 7 in Charlton and 1 in Kidbrooke. Ten of these patients were removed to Public Institutions in the District. Scarlet Fever. One hundred and ninety-three cases were notified during the year, as compared with 525, 556 and 32c oases respectively in the three preceding years; 88 cases were in East Greenwich, 54 in West Greenwich, 13 in St. Nicholas, 35 in Charlton and 4 in Kidbrooke; 166 of these cases were removed to the Hospital for treatment. There were 4 deaths from this disease during the year as against 4 last year. Nine of the cases removed to the Hospital as suffering from Scarlet Fever were returned as wrongly diagnosed, i.e. 1 stated to be German Measles, 3 Rhinorrhoea, 3 Otorrhœs, no alternative disease being stated in the remaining 4 oases. The following Table gives particulars of the six oases which would seem to be "return oases". There were 4 auch oases in 1915 5 in 1913, 7 in 1911 and 4 in 1918. 33. 33 • TABLE SHOWING RETURN CASES OF SCARLET FEVER DURING YEAR 1916. No. Of Case Date of Removal of Primary Case. Date of Disinfection Date of Discharge from; Hospital. Date of Removal of Second Case. Time between Cases. Remarks, &c. Appearance; on Discharge from Hospital. 1 9th Nov., 1915. 11th Nov.1915 13 th Jan. 1916 24th Jan. , 1916. 12 days Naval discharge general desquanation. 3 5th Jan. , 1916 5th Jan.1916 4th Feb. 1916 15 th Feb. , 1916 11 days Apparently well. 3 5th Jan., 1916 5th Jan.1916 4th Feb. 1916 35th Feb. , 1916 31 days ,, ,, 4 16th Dec. 1915 17th Dec.1915 16th Feb. 1916 36 th Feb. , 1916 10 days Feet desquanating. 5 ?th April 1916 8th April/16 14th June 1916 3nd July, 1916 16 days Heavy naval discharge feefc desquamating. 6 11th July 1916 13th July /l6 19th Oot. 1916 31at Oct. , 1916 9 days Sore Nose. Typhoid Fever. There were 14 cases of Typhoid Fever notified during the year, 5 being in East Greenwich, 4 in West Greenwich, 4 in Charlton and 1 in Kidbrooke. The ages of the patients were: 3 between one and five; 6 between five and fifteen years; 1 between fifteen and twenty-five years and 1 between twenty-five and fortyfive, one between forty-five and sixty-five and one over 65 years. Of the total number of cases, 10 were removed to the Hospital for treatment. Twenty-five such cases occurred in 1915, 17 in 1914 and 6 in 1913; the average number for the years 1901 to 1915 inclusive being 31. There were six fatalities from this disease during the year, one in East Greenwich, four in West Greenwioh and one in Eidbrooke. Eight specimens were forwarded for bacteriological examination from cases suspeoted to be Typhoid Fever in character,and all were positive. Puerperal Fever. Six cases of this disease were notified during the year, 5 in East Greenwich and one in Charlton. There were 4 cases in 1915 and 4 in 1914; 3 of these patients were removed to Hospital. Measles. One thousand three hundred and seventy eight cases were notified by school teachers and others during the year, as compared with 971 during the previous year, and 962, 344 and 565 in the years 1914, 1513 and 1913 respectively. The ages and incidence of fatality of the disease were as follows:- There were 63b cases under five years of age, amongst whom there were 43 deaths, giving a case mortality of 6.7 per cent. Between the ages of five to fifteen years there were 615, with 5 deaths at this age period, giving a case mortality of 0.81 per cent. Tne case mortality for tne wnole distriot works out at 3.4 per cent. Table showing number of Meaales Cases reported during the year 1316. lst QUARTER. Under 1. 1-5 5-15 15-25 25-65 East Greenwich 3 31 78 18 12 West Greenwich 15 111 126 3 3 St. Nicholas 4 25 21 1 1 Charlten 1 4 21 1 1 Kidbrooke - 1 8 3 3 Total 23 172 254 26 19 Total-494. 2nd QUARTER. East Greenwich 2 55 59 18 15 West, Greenwich 6 64 73 6 2 St. Nioholas 6 37 16 1 1 Charlton - l8 29 11 5 Kidbrooke - — 4 5 2 Total 14 174 181 41 25 Total-435. 34. Table showing number of Measles Cases reported during the year 1916 - Contd. 3rd QUARTER. Under 1 1-5 5-15 15-35 25-65 East Greenwich 4 31 37 1 2 West Greenwich 2 4 3 - — St. Nicholas 3 31 7 - — Charlton — 3 4 3 1 Kidbrocke 1 1 3 - 1 Total 10 69 54 4 4 Total 141. 4th QUARTER. Under 1 1-5 5-15 15-35 35 - 65 East Greenwich 7 113 75 2 — West Greenwich - 6 1 1 - St. Nicholas — 2 1 — - Charlton — 41 49 3 - Kidbrocke 1 1 1 - - Total 8 168 37 4 - Total 308 Total oases in year - 1,378. Zymotic Enteritis or Simmer Diarrhoea. This Council made an order requiring the notification of cases of Zygotic Enteritis or Suiter Diarrhoea during the months of June, July, August and September. The order was duly advertised and came into operation for the monthe stated. The sections included in the order were Sections 55 and 57 of the Public Health (London ) Act, 1891, and under the provisions of these sections 319 cases of Diarrhoea were notified throughout the whole of the Borough, 80 being under one year of age; 117 between one and five; 7 between five and fifteen; 7 between fifteen and twenty-five, 3 between twenty-five and forty-five; 3 between forty-five and sixty-five and 2 sixty-five years and over. One hundred and five of such notifications related to patients in East Greenwich, 79 in West Greenwich, 23 in. St. Nicholas and 13 in Charlton. Instructions are given by the Female Sanitary Inspector and Health Visitors to the mothers with a view to lessening the mortality among the children already infected and preventing the infection of other members of the family. The importance of cleanliness with regard to the milk and other food supply is pointed out, and a leaflet is left for the general guidance of the parents in dealing witn the sick children. Ignorance and improper feeding are the causes of many deaths from this disease. 25. The fact that Diarrhoea is infectious cornea as a surprise to many mothore. The number of notifications for Greenwich in 1916 shows a decrease in every district. There were 43 deaths ascribed to this disease, comparing with 50 in the previous year. Whooping Cough. Two hundred and forty-one oaees were notified (compared with 303 in 1915), 37 being under one year of age, 109 from one to five; 99 from five to fifteen and 4 from 15 to 35; the districts concerned being East Greenwich, 139; West Greenwich, 9; St. Nicholas 31, Charlton, "5; and Kidbrooke, 7; (of which total number 3 were treated in Institutions in the district). Each of these cases was visited and leaflets and instructions left together with verbal advice respecting the isolation and care of the patient, and at the conclusion of the illness the usual disinfection was carried out. Leprosy. The Local Government Board has not yet agreed to the notification of cases of this disease. Epidemic Cerebro-Spinal Meningitis or Cerebro-Spinal Fever. There were 6 cases of Cerebro-Spinal Meningitie notified during the year - 3 in East Greenwich and 4 in Charlton. Acute Polio-Myelitis or Acute Polio-Encephalitis. This disease was permanently added to the list of notifiable infectious diseases during 1914, on an order of the London County Council, approved by the Local Government Board. 3 cases were notified during 1916. There were no cases in 1915 and 1914 or 1913. Ophthalmia Neonatorum. During the year 19 cases of this disease have been notified, 8 being in East Greenwich and 7 in West Greenwich, 3 in St. Nicholas and 1 in Charlton, and have been dealt with by the nurses at the patient 8 homes, or in come cases as Out-patients at the Miller Hospital. Contacts. Small-pox, Plague and Yellow Fever. A notification from a Port Medical Officer respecting a contact of suspected Plague was received, and the person was kept under observation. » Glanders. Under the Glanders Order no notification has been made to this authority during the year with respect to outbreaks of Glanders. Glanders, Anthrax and Hydrophobia. No notification of any case of these diseases in man has been received during the year. Tuberculosis. During the year there were 399 cases of Tuberculosis notified in the Borough, 360 being pulmonary ca8es, ordinarily known as Consumption, and 119 non-pulmonary, being Tuberculosis affecting other portions of the body than the lungs Of this number of cases, 116 Pulmonary and 47 Non-pulmonary occurred in East Greenwich, 83 Pulmonary and 32 Non-pulmonary in West Greenwich, 43 Pulmonary and 35 Non-pulmonary in St. Nicholas , 37 Pulmonary and 15 Non-pulmonary in Charlton, and 1 Pulmonary in Kidbrooke. The various age8 of the patients were as follows:- Pulmonary cases, under one year of age, three oases; from 1 to 5, ten cases; 5 to 15 forty-four cases; 15 to 25, 73 cases; 35 to 45, 94 cases; 45 to 65 53 cases; and 65 and upwards 3 cases; whilst the Non-pulmonary were - 26. under 1 year of age, 4 cases; 1 to 5, 31 cases; 5 to 15, 56 cases; 15 to 35, 33 cases; 35 to 45, five cases, and 45 to 65 one case. Three hundred and ten specimens were forwarded by medical practitioners for bacteriological investigation from patients suspected to be consumptive; 251 were reported to be negative and 58 positive. Disinfection has been offered and carried out in 64 cases, including 71 rooms and 180 articles of bedding, etc.; disinfectant has also been supplied to patients to disinfect sputum, etc., and sputum pots where such are found necessary. TUBERCULOSIS DISPENSARY. Report of Tuberculosis Officer on the Working of the Dispensary for the year 1916. I have the honour to submit the fourth report upon the work carried out at the Tuberculosis Dispensary. New Patients examined during 1916: Recommended by Males. Females Children Total Private Practitioners 54 31 38 123 London County Council 1 — 3 4 From Sanatoria 1 3 2 6 Staff 2 9 1 12 Own accord 14 54 101 169 Old patients 4 22 57 83 Contacts 27 97 378 502 Other Institutions - Hospitals, Clinics, etc. 2 5 17 24 105 221 597 923 Consultative Cases: national Insurance 39 17 — 56 London County Council 3 8 29 39 Private Practitioners 43 22 5 70 Military 39 — — 39 123 47 34 204. Contacts 27 97 378 502 Found Tuberculous 5 13 41 59 ATTENDANCES: Patients retained for Treatment: patents 45 116 173 334 Re-attendances 497 1686 2562 4745 Patients Retained for Observation Patients 9 60 178 247 Re-attendances 19 282 1715 2016 27. Nurses Visits. First Visits 391 Re—visits 4064. Patients Primarily Notified from Dispensary. 4455. Pulmonary 78 Other Forms 41 Sputum Examinations. 119 Negative Results 158 Positive 31 189 - Dispensary Patients referred elsewhere. Males. Females. Children Total Sanatorium 6 3 12 21 Infirmary 1 3 2 6 Hospital 1 6 - 7 8 12 14 34 Patients Discharged from Treatment. Much Improved. Improved. Total. Males 10 — 10 Females 16 3 19 Children 51 6 57 77 9 86 Suspected (Observation) Patients Discharged. Much Improved. Improved. Total. Males — — — Females 9 2 11 Children 20 9 29 29 11 40 Suspected (Observation) Patients Disposed of Otherwise. Males. Females. Children. Total Taken on as Patients Tuberculous 6 13 45 64 Sent to Institution, Hospital, Convalescent Home 1 2 6 9 Died (Intercurrent Disease) - - 1 1 7 15 52 74. These tables refer, of course, only to those observation patients who received treatment at the Dispensary, Deaths of Patients during 1916. Males. Females. Children. Total. At Home 3 1 — 4 Hospital — 1 1 2 Infirmary 2 1 1 4 5 3 2 10 Insured - 3 Males, 2 Females. The Treatment of Advanced Cases. The weakest point in the present scheme is the lack of adequate institutional accommodation for advanced and bailing cases. G. H. DART. Tuberculosis Medical Officer. 28. SCHOOL CLINICS, HEALTH CENTRES AND INFANT CONSULTATIONS. These Institutions, as enumerated last year, still continue their activities in the Borough, and the Council have now taken over the responsibility of administering Conduit House Consultation Centre, and the antenatal clinic which is now at work in connection with the Consultation Centre should prevent much suffering and loss of infant life in the Borough. Infant Consultation,Conduit House The Consultation at Conduit House, East Greenwich, was started in June, 1913, by the Medical Officer of Health and a number of ladies living in the Borough. The Centre has recently become a Municipal Institution and is administered by the Public Health Committee of the Council. Matters connected with the Clinical working of the Centre have been left in the hands of the former voluntary committee. The Committee has appointed Dr. Helen Pickard, Clinical Assistant at Great Ormond Street Children's Hospital, to carry on the medical work of the Institution. The Doctor advises the mothers on questions of diet, etc. and gives treatment for minor ailments. When necessary, mothers are directed to outside medical aid or hospital treatment. Help is given to the mothers as regards hospital letters, Surgical Aid Society letters, etc., and debilitated mothers are sent with their babies to Convalescent Homes. Medicines, Virol and other necessaries are supplied. Statistics for the year 1916- New Cases 329 Attendances 3345 Medical Consultations 1453 The Children are weighed at every attendance. Houses Inspected and Enquiries made in connection with infectious disease. Excluding Measles. Number of Houses Inspected and Enquiries made 2,130 Number of Re-visits 3,673. Twenty three rooms have been cleansed after disinfection by the Department. The undermentioned schools have been disinfected, owing to the prevalence of Infectious Disease:- Roan Girls' School-5 rooms-Scarlet Fever, Old Woolwich Road School-All departments-Diphtheria. 29 During the year, when premises have been entered for the purpose of carrying cut disinfection after cases of Infectious Disease, the following books belonging to the Libraries, etc. were destroyed:- Central Library 15; Branch Library, 4; School Libraries, 1; Total, 20. 30. 31 NUMBER OF ARTICLES AND ROOMS DISINFECTED IN CONNECTION WITH THE UNDERMENTIONED DISEASES FOR THE 53 WEEKS ENDING 2nd JANUARY, 1916. Infectious Disease. Premises Entered. Rooms Disinfected. Beds Disinfected. Palliasses Disinfected. Mattresses Disinfected. Bolsters Disinfected. Pillows Disinfected. Blankets Disinfected. Sheets Disinfected. Cushions Disinfected. Quilts disinfected. Odd Articles disinfected Total No Articles Disinfected. Small-pox - - - - - - - - - - - - - Scarlet Fever 154 171 93 1 56 86 197 201 41 14 106 169 964 Diphtheria 308 333 103 2 24 62 163 174 61 15 77 295 976 Enteric Fever 12 13 4 - 1 3 9 14 - 3 5 3 43 Puerperal Fever 3 3 4 - 2 3 4 4 - - 3 2 22 Tuberculosis 64 72 26 2 13 22 52 27 5 11 12 10 180 Other Diseases 38 32 47 18 121 45 230 580 34 11 116 354 1556 From Verminous Premises - - 23 4 4 15 35 17 24 2 11 63 188 Pertussis 20 24 - - - - - - - - - - - Measles 23 25 - - - - - - - - - - - Total 622 672 300 27 221 236 690 1017 155 56 330 996 3928. 31a. NUMBER OF ARTICLES DESTROYED IN CONNECTION WITH THE UNDERMENTIONED DISEASES DURING THE 52 WEEKS ENDING 1st JANUARY, 1917. Infectious Diseases. Beds Destroyed. Palliasses destroyed Mattresses destroyed Bolsters destroyed Pill- ows destroyed Blankets destroyed Sheets destroyed ion des- troyed Quilts troyed Odd Pieces Destroyed Total No of Articles destroyed Small-pox - - - - - - - - - - - Scarlet Fever 1 - 2 - - - - - - - 3 Diphtheria - - - - - - - 3 - - 3 Enteric Fever 1 - - 1 2 - - - - - 4 Puerperal Fever - - - - - - - - - - - Tuberculosis 2 1 3 - 3 - - - - - 9 Other Diseases 7 7 2 3 3 2 3 - 3 4 34 For Verminous Premises 1 - - - - - - - - - 1 Total 12 8 7 4 8 2 3 3 3 4 54 CO-OPERATION WITH THE MILITARY SANITARY SERVICE. The Public Health Staff have continued to help the Military Authorities in every possible way on the lines laid down by the Local Government Board in various letters and memoranda. The sanitary arrangements of the important Military camps formed in the Borough during the past year have been put into a satisfactory condition; the work of the Sanitary Inspectors in this direction has undoubtedly been of the first importance in bringing about this desirable state of affairs. SANITARY WORK. The Tables on pages 65 to 69 summarise, as far as possible, the Sanitary work of the Department; from his it will be seen that a total of 11,173 houses and premises have been inspected or re-inspected during the year; 856 intimation notices have been served, and 173 statutory notices. With the exception of prosecutions in connection with the Sale of Food and Drugs Act, it was not found necessary to institute Police Court Proceedings in any case during the year. There were altogether throughout the year 423 complaints entered in the Public Complaints Register of the Department; these were in each case carefully investigated, and any necessary action immediately taken; thus there are none of these matters left outstanding or unattended to. Bakehouses. One hundred and thirty-one inspections have been made of the various Bakehouses in the Borough, and 49 nuisances found therein have been abated as the result. Factories and Workshops. Two hundred and thirty-nine inspections have been paid to these premises within the Borough during the year. There were 212 workshop premises on the Register at the beginning of the year, 3 have been added during the year, and 30 have been taken off, leaving a total now on the Register of 185. This total includes 15 laundries, 31 dressmaking and mantle works, 7 fuel and firewood works, 3 cycle works, 8 milliners and various others, including workplaces, such as 4 blacksmiths, 14 barge builders, 3 builders' yards, etc. One complaint has been received from H.M. Inspector. Outworkers' Register. Seventy lists of Outworkers, containing 208 names and addresses, have been received during the year from the Medical Officers of Health for other Districts; 34 lists, containing 112 names, have been received from employers within the District; 63 names have been for warded to other Districts, thus giving a total of 257 names and addresses of outworkers within the Borough. One hundred and fifty-two visits of inspection have been paid to these premises. 32. FACTORIES, WORKSHOPS, LAUNDRIES, WORK-PLACES and HOMEWORK. 1. Inspection Premises. Number of Inspections Written Notices. Prosecutions. Factories (including Factory Laundries) 46 ... ... Workshops (including Workshop „) 201 13 ... Workplaces (Other than Ourworkers' Premises) 139 13 ... Total 276 25 ... 2. Defects Found. Number of Defects. Number of Brosecutione Found. Remedied Referred to H.M. Inspector *Nuisances under the Public Health Acts:- Want of Cleanliness 41 41 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of Drainage of Floors ... ... ... ... Other Nuisances 1 1 ... ... Sanitary Accommodation- Insufficient 12 12 ... ... Unsuitable or defective 8 8 ... ... Not Separate for Sexes ... ... ... ... Offences under the Factory and Workshop Act- Illegal Occupation of Underground Bakehouse (s.101) ... ... ... ... Breach of Special Sanitary Requirements for Bakehouses (se.57 to 100) 5 5 ... ... Other Nuisances 5 5 ... ... Total 72 72 Nil Nil Including those specified in Sections 2, 3, 7 and 8 of the Factory Act, as remediable under the Public Health Acts. 33. 34 3. HOME WORK. Nature of Work. Outworkers' Lists, Section 107. No. of Inspections of outworkers premises. Outwork in unwholesome premises. Sec. 108. Outwork in infected premises. Secs. 109 & 100 Lists received from Employers. Numbers of addresses of outworkers received from other Councils Numbers of addresses of outworkers forwarded to other Councils Prosecutions. Twice in the year Once in the year Failing to keep or permit inspection of lists Failing to send liste Instances. Notices Served. Prosecutions Instances Orders made (Sec. 110) Prosecutions (Secs.109 & 110) Lists Outwork ers. Lists Outwork ers. Wearing Apparel- (1) Making, &c. 11 106 2 3 136 63 ... ... 112 ... ... ... ... ... ... (2) Cleaning and Washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur Pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas 1 3 ... ... 2 ... ... ... ... ... ... ... ... ... ... Paper Bags & Boxes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cotton & Kit Bags ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... Brush Making ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... Box Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rackets & Tennis Balls ... ... ... ... 66 ... ... ... 40 ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TOTALS 12 109 3 3 308 63 ... ... 153 ... ... ... ... ... ... 4. WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END of 1915. No. Bakehouses 39 Factory Bakehouse 3 Barge Builders 14 Blacksmiths 4 Boot and Shoe Makers 7 Builders' Yards 3 Carpenters and Joiners 3 Carriage Builders 2 Coopers 4 Cycle Works 3 Dress and Mantle Makers 31 Fuel Works 7 Laundries 15 Milliners 8 Photographers 3 Picture Frame Maker 1 Printers 1 Tailors 5 Underclothing Makers 1 Others 41 185. 5. OTHER MATTERS. Number Underground Bakehouses (s.101):- In use during 1915 13 Certificates granted in 1916 ... In use at the end of 1916 13 Not in use during 1914, but are now ... Slaughter Houses. The slaughter houses in the Borough nave been inspected on 30 occasions by the Inspectors. Cowhouses. The four cowhouses in the Borough have been visited on 14 occasions, and the required cleansing has been duly enforced on 10 occasions. 35. Horse Slaughterer. The one horse-slaughtering house in the Borough has been visited by the Inspector on 13 occasions, and cleansing of the premises was required on 4 of these visits. Other Scheduled Offensive Trades. The premises where these offensive trades were osrieed on within the precincts of the Foreign. Animals Wharf have no been taken over by the War Office and are not in use as a barracks and Army Service Depot. Dairies, Cowsheds and Milkshops Order. At the commencement of the year there were 140 premises on the Register of Dairies and Milkshops; 6 new applications nave been received during the year and added to the Register, and 4 names have been taken off, thus leaving a total of 143 premises no. registered. During the year 178 visits of inspection have been paid to these premises; notices were served upon the occupiers in 5 cases, 1 for no cover to milk pan and 4 for sanitary defects. Under the powers conferred by the London Councy Council (General) Powers Act, 190c, Section 5 with, respect to the registration of premises unsuitable for the sale of milk, no registration has been refused on the grounds of the unsuitability of the premises. Ice Cream Premises. There were 104 premises known at the commencement of the year where the manufacture of this commodity was carried on; 6 have been added during the year and 2 taken off, leaving a total of 108 premises. These premises were inspected on 107 occasions, and improvements required by remedying of sanitary defects in 2 cases. Food Preparation. Places where food is prepared have been visited on 88 occasions, improvements being required in 85 instances, as detailed below:- Class of Premises. Number on Lists. No. of Inspections No.of instances where matters needed attention At end of 1915. Added 1916 Removed 1916. At end of 1916 Hotel Kitchens 4 ... ... 4 9 3 Eating Houses 54 ... 7 47 68 16 Fried Fish Shops 26 ... 2 ' 34 58 6 Pork Butchers 12 ... 1 11 27 7 Mineral Water Mnfrs. 2 ... 1 1 1 1 Ice Manufacturers 3 ... ... 2 4 1 Sausage do. 6 8 ... 14 40 7 Others 8 ... 2 6 2 3 Totals 114 , 8 13 109 209 43 36. The 43 instances where matters needed attention included 39 cases where the premises generally, or kitchen and scullery particularly, needed cleansing and lime-washing, 3 where the sanitary arrangement was defective, 3 for want of ashpit. Customs ana Inland Revenue Acts. No applications were received during the year for certificates under these Acts. HOUSES LET IN LODGINGS. There was no change in the Register of Houses during 1916, so that the number of premises on the Register of Houses Let in Lodgings is still 247 as at the end of last year. Two hundred and thirty four visits of inspection were paid to these houses during the year, which brought to light the necessity of cleansing, etc. as set out below, as required by the By-Laws, under the Public Health (London) Act, l891, cleansing, etc., was required in 23 cases, as set cut below:- Houses closed,- Number of notice served for cleansing of houses under the By-laws:- Rooms Cleansed 23 Staircases and Passages Cleansed 4 Water Closets Cleansed 4 Overcrowding - Washhouses Cleansed 2 Areas and Yards Cleansed - 33 Under the Public Health (London) Act, 1891:- Cleansing 9 Without Ash Bin 9 Water Closets Blocks and Water Fittings Defective 4 Water Closets Dirty - Sink Waste Defective and Blocked 3 Roof Defective 3 Floors Defective 4 Defective Guttering, etc. 3 Verminous Rooms 1 Walls and Ceilings Defective 8 Yard Paving Defective - Animals Improperly Kept - Deposit of Refuse 2 34 Number of Inspections and Inspections of Registered Houses 82 Number of Notices Served - Re Particulars of Registration - Re Registration - Other matters referred to Inspectors - Intimation Notices By-laws 6 Ditto Public Health Act 13 37. House Drainage. Forty-five house drainage systems have been reconstructed; 157 such systems have also been opened cleansed and amended. 53 surface drains-have been constructed; 42 drains and soil pipes have been ventilated, 126 systems have been tested by smoke and 115 by water, of which number 127 were found to be defeotive; 23 new soil pipes and 127 traps have been fixed, together with 10 intercepting chambers and 1 other chamber; 32 yards have been thoroughly drained. Twenty eight water-closets have been arected; a pan, trap and Water supply have been furnished throughout in 76 cases, and other fittings in 126 cases, whilst the water supply has been newed in 43 instances. The water supply for lavatory purposes has been disconnected from the drinking water system. in 5 instances. Public-house urinals have been cleansed and repaired in 65 instances, 8 urinals were altered, and 2 repaired or water laid on. Refuse Removal. New ash receptacles have been provided in 395 cases, and no complaints on this subject have been forwarded to the Surveyor for his attention. Offensive Trade Refuse. The arrangements entered into with Messrs. Hempleman & Co. of West Ham, still continue to work very satisfactorily. Public Sanitary Conveniences. The Public Sanitary Conveniences, Urinals, Fountains and Horse Troughs situated within the Borough are the same as last year. Water Supply. The water supplied throughout the whole of the district by the Metropolitan Water Board still maintains its high standard of purity. During the year 6 water supply certificates have been granted under Section 48 of the Public Health (London) Act, 1891; these certificates stating that the new houses to which they refer are supplied with a proper water supply in accordance with the Act. Defective water fittings have been renewed in 94 oases; 6 water supplies have been reinstated where the supply had been cut off; water fittings have been amended in 84 cases; 11 water supplies have been altered 80 as to draw direct from the main. Smoke Nuisances. Eighty-five observations have been taken for smoke nuisances during the year, but on no occasion was it found necessary to issue Statutory Notices for the abatement of any nuisance which was found. The Rag Flock Act, 1911, came into operation on July 1st, 1912 and under its previsions samples of rag or flock used in the various branches of upholstering work are to be taken to see that they do not contain more than 30 parts chlorine, in the form of chlorides, in 100,000 parts of flock, as set out in the Regulations made under Section 1 of that Act. No samples have been taken under the provisions of this Act during the year. Food and Drugs Act. Four hundred and ten samples have been purchased under the provisions of the Sale of Food and Drugs Act and submitted to the Public Analyst for analysis, of which 389 were certified to be genuine and 21 adulterated, the adulterations thus being equivalent to 3.4 par cent. of the samples taken. 38. Of the total number of samples purchased, 146 were butter, of which 1 was certified to be adulterated; 140 were milk, of which 12 were certified to be adulterated; the remaining adulterated samples were 1 of Cocoa, 1 Coffee, 1 Egg Powder, 5 Separated Milk. There were also 3 cases of margarine not being labelled in the bulk. Milk and Cream Regulations. No special sample has been taken under the express provisions of these Regulations, but all samples of milk taken during the year under the provision of the Sale of Food and Drugs Act have been examined for preservatives, which have not been found up to the present on any occasion. As required by the Local Government Board, the following Schedule is appended:- REPORT for the YEAR ended 31st DECEMBER,1916. 1. Milk and Cream not sold as Preserved Cream. (a) (b) No. of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 140 Nil Cream - - Nature of preservative in each case in column (b),and action taken under the Regulations in regard to it. 3. Cream sold as Preserved Cream. (a) Instances in which sample have been aubsitted for analysis to ascertain if the statement on the label as to preservative was correct. (l) Cor. ect statements made 0 (3) Statements incorrect 0 0 V (b) Determinations made of milk fat in cream sold as Preserved Cream. (l) Above 35 per cent Nil (2) Below 35 per cent Nil Nil (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article 5 (3) of the Regulations have not been observed. (d) Particulars of each case in which the Regulations have not been complied with, and action taken. 3. Thickening Substances. Any evidence of their addition to cream or to preserved cream. (39) 4. Other observations (if any). Proceedings were taken in 15 cases, and in 4 cases a warning letter was sent. The proceedings resulted in fines and costs being imposed in 14 cases; in 1 case the summons was withdrawn on payment of costs; and in 4 cases a warning letter was sent. Sale of Food and Drugs Acts. - Number and Description of Samples purchased for Analysis under the above Acts during the Year 1915. Description of Samples. No. of Sam ples purchased. Number Genuine Number ated. Remarks as to Action Taken. Baking Powder. 17 17 Butter 146 145 1 Police Court proceedings in 1 case Cocoa 33 32 1 Police Court proceedings in 1 case. Coffee l8 17 1 No proceedings taken Egg Powder 16 15 1 „ „ „ Lard 3 3 - - - Margarine 7 7 - Police Court proceedings taken in 3 cases for not labelling. i Milk. 140 128 12 3 Warning letters sent. Police Court proceedings in 6 cases, no action in 1 case and warranty proved in 2 cases. Separated Milk. 7 2 5 Police Court proceedings in 5 cases. Sugar - Demerara. 1 1 - — - Mustard 4 4 - - - Pearl Barley 1 1 - - - Pepper 5 5 - - - Self-raising Flour 11 11 - - - Cream of Tartar 1 1 - - - 410 389 21 (40) Sale of Food and Drugs Acts, 1916. - Legal Proceedings, Particulars of Samples adulterated and result of action taken. Description of Nature of Adulteration. Result of ceedings Cocoa. Admixed with 40% Sugar and 30% of added starch. Fined 5/Costs 25/- Margarine Not labelled as required by the Margarine Act. Fined 15/Costs 2/- Separated Milk Admixed with 32% of water Fined 8/Costs 22/6 Margarine Not labelled as required by the Margarine Act. Fined 2/6 Costs 20/6 Separated Milk Admixed with 2.4% of water Fined 20/- „ „ Admixed with 25% of water Fined £5. Milk Deficient in Milk-fat to the extent of 6% Fined 20/- „ Admixed with 10% of water Fined 18/Coste 2/- „ Deficient in Milk-fat to the extent of 23% Fined l8/Costs 22/- Butter Admixed with 40% of sugar and 20% of added Starch. Fined 8/Costs 27/- Milk Admixed with 11% of water Warranty proved. „ Deficient in Milk-fat to the extent of 3%. Warning letter sent. „ Deficient in Milk-fat to the extent of 12% Fined 10/Costs 20/- „ Deficient in Milk-fat to the extent of 12% Fined 10/Coste 20/- Margarine Not labelled as required by the Margarine Act. No action taken Milk Deficient in Milk-fat to the extent of 33% Fined £3 Costs 20/- „ Slightly deficient in Solids not fat. No action taken „ Admixed with 5% of water. Warning letter sent. „ Admixed with 3% of water Warning letter sent. Margarine Not labelled as required by the Margarine Act. Summons withdrawn on payment of costs 4/- Separated Milk Admixed with 13% of water Fined £4.8.0. Costs 12/- „ „ Admixed with 12.5% of water (41) Description of sample. Nature of Adulteration. t of Proceedings . Milk. Deficient in milk-fat to the extent of 11% Warranty proved. Egg Powder Contained arsenic to the extent of l/6th of a grain per lb. No proceedings taken Coffee Coffee put in wrapper marked coffee and chicory. Warning letter sent. Summary of Sanitary Works performed during the year 191. Frirst Quartet Second Quarter Third Quarter. Fourth Quarter Total. Inspections - Houses Inspected under Housing & Town Planning Act 1909 • • • • • • • • • • • • • « « Houses Inspected under Public Health (London) Act l891, etc. 526 588 521 708 2343 Houses let in Lodgings • • • • • • • • • • • • • • • Re-Inspections, Calls made etc. 1678 2022 1697 1916 7313 Inspections of Bakehouses 13 56 6 56 131 " Factories and Workshops 64 48 35 92 239 " Outworkers' Premises 46 54 22 35 157 " Slaughterhouses 2 2 7 9 20 " Cowhouses 3 3 3 5 14 " Stables & Yards 45 74 54 41 314 " Piggeries 1 4 1 - 6 " Courts & Alleys 28 26 26 26 106 " Fields, Lanes,&c. 20 17 21 17 75 " Urinals 21 25 18 19 83 " Gipsy Vans 1 - - - 1 " Horse Slaughterhouses 2 4 4 3 13 " Dairies, Cowsheds and Milkshops 18 57 30 73 178 " Soap Boilers • • • • • • • • • • • • • • • " Other Offensive Trades • • • • • • • • • • • • • • • " Ice Cream Places • • • 66 19 • • • 107 " Other places where Food is prepare 7 37 24 20 88 " Military Guards' Quarters 23 21 28 12 84 Total 2498 3126 2516 3032 11172 (42) Summary of Sanitary Work - Continued. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Drains. Constructed 2 10 2 - 14 Interceptor Chamber, and Fresh Air Inlet 1 6 3 1 10 Other Chambers • • • • • • 1 2 3 Reconstructed or Repaired 21 22 27 30 100 Opened,Cleansed & Amended 72 61 58 44 235 Surface Drains Constructed 1 25 16 11 53 Traps fixed 20 38 46 28 132 New Soil Pipes 7 8 5 3 23 Drains & Soil Pipes Ventilated 9 20 9 4 42 Drains Tested - by Smoke 6 7 6 - 19 " " by Water 33 22 33 27 125 " " by Chemicals. 9 29 42 47 127 Found Defective 40 16 35 38 129 Yards Drained - 16 8 2 26 Mews & Stables Drained • • • • • • 1 • • • 1 Washhouses Drained • • • • • • • • • • • • • • • Forecourts Drained • • • • • • • • • • • • • • • Areas Drained • • • • • • 1 • • • 1 Cesspools Abolished • • • • • • 2 • • • 2 Water Closets & Urinals. Closets Erected 14 1 6 8 29 Sanitary Conveniences or improvements effected to Factories & Workshops 3 2 2 8 15 W.C.'s and Lavatory Basins 2 5 - 7 Pan, Traps and Water Supply furnished 16 21 17 10 64 Pans & Traps only furnished 21. 15 20 19 25 Pans only furnished 8 4 10 4 26 Water Supply Apparatus provided ll - 6 3 20 Water Supply renewed 1 9 14 9 33 Water Supply disconnected from Drinking Water Cistern • • • * • • 2 • • • 2 Soil Pans properly Trapped 12 14 14 15 55 Cleansed and Repaired 33 32 36 32 133 Newly constructed or better situated 6 • • • • • • • • • 6 Summary of Sanitary Work - Continued. Firet Quarter. Second Quarter. Third Quarter Fourth Quarter. Total Water Closets & Urinals (Ctd.) Ventilation Improved 20 13 11 3 46 Public-house Urinals cleansed or Repaired 13 14 15 13 55 Other Urinals Altered 1 2 - - 3 Repaired or Water laid on 1 - 1 - 2 Public House Urinals reconstructed 4 — 2 — 6 Ashpits. Provided 61 94 78 62 295 Covers to Receptacles - - 4 - 4 Dust Complaints forwarded to the Surveyor — — — — - Pavings. Yards 35 67 41 33 175 Forecourts 5 13 15 6 39 Areas - 2 - - 2 Washhouses 1 9 1 1 12 Mews and Stables - - - - - General Water Supply. Covers to Cisterns Adapted 3 1 4 - 8 Water Supply Provided 1 - - 2 3 Water Fittings Amended 23 25 22 14 84 Cisterns Cleanaei & Repaired 3 1 - - 4 Water Services Altered so as to draw direct from main 3 5 4 - 11 Water Supplies Reinstated where cut off through defective fittings - 1 5 - 6 Water Supplies cut off - - - — - Defective Water Fittings (causing nuisance from dampness) repaired 20 29 25 20 94 Water Supply Certificates granted (Section 48) 1 1 4 - 6 Other Improvements. Houses Generally Repaired 50 53 35 38 176 Premises Cleansed, Limewashed and Repaired 42 42 32 36 152 Staircases & Passages do. 10 4 3 - 17 Ventilation Improved 5 3 7 8 23 44. Summary of Sanitary Work - Continued. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total Staircases Lighted and Ventilated - - - - - Leaky House Roofe & Gutters Repaired 136 66 78 100 380 Walls and Ceilings of Premises Cleansed throughout 42 43 38 35 158 Ditto, ditto, partially 59 69 88 94 310 Cowhouses cleansed 1 3 1 5 10 Horse Slaughterhouses cleansed 1 1 1 1 4 Ice Cream Places cleansed or improved - 20 9 - 29 Other Places where Food is prepared 6 46 22 11 85 Other Nuisances Abated, Illegal use of Underground Room Discontinued - - - 2 2 Overcrowdings Abated 7 3 6 4 20 Sink, Lavatory and Bath Waste Pipes Disconnected, Trapped and Amended 21 34 26 18 99 Stack Pipes Disconnected and Amended 5 4 4 1 14 Nuisances from Dampness Abated 44 16 31 40 131 Animals kept in Unfit places Distintinued or Removed 2 3 5 2 12 Dung Receptacles Provided - - - - - Bakehouse Nuisances Abated - 31 - 14 45 Accumulations of Manure and other obnoxious matter Removed 16 28 29 27 100 Dampness of Walls Remedied 40 14 23 21 98 Other Nuisances, principally of Dilapidations and want of Under-floor Ventilation - 10 18 10 38 Breaches of By-Laws Abated — - — — - Inundations - - - - - Smoke Nuisances. Observations Statutory Notices served 26 23 15. 21 85 (Secs. 23 and 24) - - - - - Food and Drugs. Samples taken 108 139 60 103 410 Found Adulterated 6 8 5 2 21 45. Summary of Sanitary Work - Continued. First Quarter. Second Quarter. Third Quaiter. Fourth Quarter. Total Unwholesome Food. 14 lbs. Apples 4 16/469 Outrs. "heat. 300 cases of dates. 1 box Mackerel. 368 bags currents. 377 cases of currants. 160 lbs. damaged wheat. 148 bags of currants. Voluntarily surrendered 60 Cases of currants. 7 lbs. of Apples 484 cases of currants 3 cases of sultanas. 3 bags of sultanas. 5 oases of currants. 102 Pkts Baking Powder. 1 Barrel of Apples 1 Qtr. damaged Wheat. 1 Cwt. 18 lbs. damaged Wheat. 382 lbs. damaged Wheat. 1 Box Dabs. Notices, &c. Intimations Served under Public Health (London) Act 1891,(Section 3) 174 210 217 255 856 Houses let in lodgings - - - - - Complaints Received 112 99 95 117 423 Complaints Attended to 112 99 95 117 423 Verminous Houses 2 1 3 - 6 Statutory Notices Served under Section 4 32 7 26 20 85 Ditto Others - - - - - Statutory Notices re Ashpit provision 1 6 7 4 18 Statutory Notices re Yard Paving - - - 5 6 Notices re Combined Drainage - 6 - - - 46. Summary of Sanitary Work - Continued. First Quarter. Second barter. Third charter. Fourth garter. Total Notices, &c. Notices re Houses let in Lodgings — - - - - Letters Written relating to Abatement of Nuisances 161 39 81 75 356 Summonses Applied for and Issued 1 1 1 — 3 Magisterial Orders obtained and Enforced 1 1 - - 2 Drainage Plans received and examined 7 1 - 4 1 BOROUGH OF GREENWICH. Proceedinga during 1916. Number of Places No. of Inspections 1916. No. Notices 1916 >No. of Prosecutions 1916 Premises. On Register at end of 1915. Added in 1916 Removed in 1916 On Register at end of 1916. Milk Premises 140 6 4 142 178 5 - Cowsheds 4 - - 4 14 - - Slaughterhcuses 1 - • - 13 ~ - Other Offensive Trade Premises - - - - - - - Ice Cream Premises 104 6 3 104 107 - - Registered Houses Let in Lodgings 347 - - 247 234 (a)ж ж (b)116 (a)ж (b)ж 48. Number of Tenement Houses provided with Additional Water Supply - Number of Prosecutions ditto - Inland Revenue Acta - Number of Reuses for which applications were received during year - Number of Tenements comprised therein - Number of Tenements, for which Certificares were granted - Number of Prosecutions under By-laws under Public Health Act, 1891 - (a) For prevention of nuisance arising from sncs, ice, salt, filth, etc. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. - (c) For the prevention of keeping of animals in such a manner as to be injurious to health - (d) As to paving of yards, etc. of iwelling houses - (e) In connection with the removal of offensive matter, etc. - (f) As to cesspools and privies, removal and disposal of refuse, etc. - (g) For securing the cleanliness of tanks, cisterns, &c. - (h) With respect to water closets, earth closets, etc. - (i) With respect to sufficiency of water supply to Water Closeted - (j) with respect to drainage, etc. (Metropolis Management Act, sec. 303) - (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Ameniment (By-laws) Act, 1899) - Mortuaries - Total Number of Bodies removed 189 193. Total Number of Infectious Bodies Removed 4 LEGAL PROCEEDINGS, 1915. It is a matter for satisfaction that, apart from the proceedings under the Sale of Food and Drugs Act, no other summonses were needed. 49.