THE ANNUAL REPORT MADE TO THE COUNCIL OF THE Metropolitan Borough of Greenwich For the Year 1917, by ERNEST GEORGE ANNIS, M.R.C.S., L.R.C.P., L.S.A., D.P.H., MEDICAL OFFICER OF HEALTH TO THE BOROUGH, and CHIEF EXECUTIVE TUBERCULOSIS OFFICER, and GEORGE HERBERT DART, M.D., M.R.C.P., D.P.H., Deputy and Acting Medical Officer of Health to the Borough, and Tuberculosis Officer. London : E. G. BERRYMAN & SONS, L.TD., PRINTERS, Blackheath Road, S.E. 1918. 3 INDEX OF CONTENTS. Page. Age Mortality 13 Analysis of Death Causes 15 Area of Borough 8 Articles and Rooms Disinfected 30 Articles Destroyed 31 Bacteriological Examinations 22, 26 Bakehouses 32 Births 8,11 Bones and Joints 20 Books Destroyed29 Cancer 18 Causes of Death 16-20 Cerebro-Spinal Fever 25 Chicken Pox 20 Circulatory System 19 Cleansing Children 47 Complaints 32, 46 Constitutional Diseases 18 Consumption 25-28 Contacts 26 Cowhouses 36 Customs and Inland Revenue Acts 37 Dairies, Cowsheds and Milkshops 36, 47 Deaths, with Age Mortality 13 Density of Population 8 Developmental Diseases 18 Diarrhæa and Zymotic Enteritis17,25 Dietic Diseases 18 Digestive System 19 Diphtheria 16,22 Diphtheria Anti-Toxin 16, 17 Disinfection 29, 30, 32 Duties and Powers of the Public Health Committee 26 Elevation of Borough 8 Enteritis 19 Epidemic Cerebro-Spinal Meningitis 25 Epidemic Diseases 16 Erysipelas 17,22 External Causes 20 Factories and Workshops 32,33 Food and Drugs—Samples of 39,40,41 Food—Premises for Preparation of, &c. 36, 37 Gonorrhæa 17 Health Centre 28 Health Visitor 13 Home Work 34 Horse Slaughterer 36 House Drainage 38 Houses Inspected for Infectious Disease 29 Houses Let in Lodgings 37, 38 Ice Cream Premises 36 Infant Consultations 28 Infant Mortality 14 Infective Endocarditis 18 Influenza 17 Inhabited Houses 8 Inland Revenue Acts 37.48 Insanitary Houses 47 Institution Deaths 12 Integumentary System 20 Introductory Review 9 Legal Proceedings 40.41,47 4 INDEX—continued. Page. Local Diseases 19 Lymphatic System 19 Malarial Diseases 18 Marriages 10 Measles 16, 23-24 Membranous Croup 22 Military Sanitary Works 32 Mortuary 20, 48 Nervous System 19 Notices, &c. 46 Notifications 14 Notification of Births Act 14 Offensive Trades 36, 42, 45 Ophthalmia Neonatorum 25 Organs of Special Sense 19 Outworkers' Register 32 Overcrowding 45 & 47 Parasitic Diseases 18 Persons Cleansed 47 Polio-encephalitis 25 Polio-myelitis 25 Population 8 Premises Cleansed 47 Public Health Committee 5 Puerperal Fever 17, 23 Pyaemia and Septicaemia 18 Refuse Removal 39 Remarks on Death Causes 16-20 Reproductive System 20 Respiratory System 19 Rheumatic Fever 18 Sale of Food and Drugs Acts 40,41 Sanitary Work—Summaries, &c.32, 42-48 Scarlet Fever 16,22,23 School Clinic 28 Septic Diseases 17 Slaughterhouses 35 Small-pox 16,20 Smoke Nuisances 39 Sporadic Diseases 17 Staff of Public Health Department 7 Statistical Summary 8 Suffocation 20 Suicide 20 Syphilis 17 Tenement Houses 48 Tubercular Diseases 18 Tuberculosis 18, 25 Tuberculosis Dispensary 26 Tuberculosis Officer's Report 26,27,28 Typhoid Fever 17,23 Underground Bakehouses 35 Underground Rooms 47 Unwholesome Food 46 Uninhabited Houses 8 Urinary System 20 Vaccination Particulars 21 Venereal Diseases 17 Verminous Premises 47 Verminous Children 47 Water Supply 39 Whooping Cough 17,25 Workshops and Factories 33,35 Workshops and Workplaces 35 Zymotic Enteritis 17,25 Zymotic Diseases 16 5 public health Committee during the year 1916-17. Charles Stone, Esq., J.P. (Mayor), and 9 Members. W. K. Soames, Esq., Chairman. C. Nixon, Esq., Vice-Chairman. Councillors— H. Baron. A. J. Hunt. E. A. Lovibond. C. Nixon. D. W. Noakes. Dr. J. Gordon Parker, D.Sc. F. Powell, R.N. W. K. Soames. F. Whatley, B.A. Duties and Powers of the Public Health Committee. 1.—The Committee shall consist of nine elected members. 2.—There shall be referred to the Committee the execution of the Food and Drugs Act, 1875-1899; the Margarine Act, 1887; the Sale of Horse-flesh, &c., 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, Cowsheds, 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. 6 3.—The Committee may serve and receive notices, take proceedings, 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. 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 sanitary 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. 7 Staff of the public health department. Sanitary Inspectors— Charles Turle Wilson. Arthur E. Bache. Charles W. Nettleton. Thomas Clark. Ebenezer Martin. Miss G. Davis. Health Visitors— Miss E. M. Millington. Miss 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 Shelter — Edward Jackson. Maria Jackson. MUNICIPAL DISPENSARY FOR THE PREVENTION OF CONSUMPTION. Administrative Medical Officer— E. G. Annis, M.R.C.S., etc., D.P.H. Tuberculosis Medical Officer— G. H. Dart, M.D. Dispenser — g. W. vickery. Nurses— L. Heastman. T. I. Husbands. Clerks— *W. H. Peters. *A. H. Sapsed. *T. D. P. Mobsby. Medical Officer of Health— *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. *On Military Service. 8 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 30.00 persons per acre. West Greenwich 72.34 ,, St. Nicholas 61.09 ,, Charlton and Kidbrooke 9.29 ,, Average for the Borough 25.25 ,, Number of Inhabited Houses— At Census, 1901 14,240 At Census, 1911 14,722 Estimated, 1917 16,299 Number of Uninhabited Houses— At Census, 1911 803 Estimated, 1917 267 Population— At Census, 1911 95,968 Estimated, 1917—For Birth Rate 100,815 „ „ For Death Rate 90,440 Birth Rate, 1917 19.36 (nett) per 1,000 Death Rate, 1915 15 96 „ (Excluding Military deaths) „ (Zymotic) 1.42 „ „ (Infantile Mortality) 105 per 1,000 Births. 9 Public Health and Housing Department, Royal Hill, Greenwich. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Gentlemen, The Annual Report of the Medical Officer of Health for the year 1917 is again in a very much abridged form. The Birth Rate is 19.57 per 1,000 for Greenwich and 17.5 for the whole of the County of London. The recorded Death Rate of 15.96 per 1,000 of the estimated population being slightly higher than 15.0 per 1,000, the Death Rate for the County of London and 14.6 per 1,000, the figure for the 96 large towns. The Infantile Mortality Rate for the Borough, measured by the number of deaths under one year to 1,000 births registered, is 105, an increase from 83, the figure for last year; the figure for all London is 103, compared with 89 in 1916, and the Borough average during the last five years, 1912-16 inclusive, is 94. The Zymotic Death Rate of 1.42 is 0.17 per 1,000 below the corresponding figure for last year. The figures relating to the different constituent parts of the Borough are as follows : — Districts. Birth Rate. Death Rate. Percentage of deaths under one year of acre. Infantile Mortality per 1,000 Births. Zymotic Death Rate. Diarrhoea Death Rate. Con□ motion Death Rate. East Greenwich 17.44 14.05 15.08 109.00 1.31 0.36 1.61 West Greenwich 20.89 19.55 12.61 106.00 1.21 0.28 3.16 St. Nicholas 26.42 26.07 13.26 114.42 3 80 0.87 . 3.07 Charlton 27.38 13.50 11.06 97.22 1.18 0.56 1.30 Kidbrooke 7.02 6.71 — — — . — .74 Whole Borough 19.36 15.96 14.06 105.38 1.42 0.42 2.01 Attack Rates of the various notifiable diseases per 1,000 living in the several districts : — Districts. Small.pox. Diphtheria. Scarlet Fever. Erysipelas. Typhoid Fever. Puerperal Fever. East Greenwich .00 4.23 1.24 0.32 0.09 — West Greenwich .00 2.37 3.91 0.51 0.23 0.04 St. Nicholas .00 4.98 2.87 2.49 0.43 0.29 Charlton .00 3.11 0.49 0.12 0.06 — Kidbrooke .00 1.11 1.11 0.75 — — Whole Borough .00 3.57 1.71 0.51 014 0.03 In conclusion, I have again 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. 10 VITAL AND MORTAL STATISTICS, 1917. POPULATION. The number of persons estimated to be living at the middle of 1917 was for the Death Rate 90,440 and for the Birth Rate 100,815. The distribution of the population throughout the Borough is as follows:— Census, 1911. Estimated Population at middle of year 1917. Calculated on Death Rate. Birth Rate. East Greenwich 45,960 43,544 48,539 West Greenwich 22,933 21,544 24,015 St. Nicholas 7,290 6,849 7,634 Charlton 16,910 15,814 17,629 Kidbrooke 2,875 2689 2,998 Total 95,968 90,440 100,815 MARRIAGES. The Superintendent-Registrar of the Greenwich Registration District has kindly furnished the 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 Carriages 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 1910. Year. In Churches of England in Greenwich. In Churches of England in Charlton anc 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 and Roman Catholic Church in St. Nicholas and Greenwich. ce Total. Approximate Population of the districts concerned. 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 94452 1917 343 128 67 653 1191 90440 11 BIRTHS. The total number of Births in the Borough during the vear has been 1967, but of these, 97 occurred in the Greenwich Union Infirmary, the address of the mother being in 15 instances in Deptford, Lewisham 35, Woolwich 5, Croydon and Camberwell one each. Deducting these and adding 16 which were transferred from Lambeth and Lewisham, it will be seen that the number of strictly Greenwich births for 1917 is 1,926, of which 964 were males and 962 females. This corrected figure gives a Birth Rate of 19.36 per 1,000 of the population, being 5.65 below the average for the last sixteen years, 1901 to 1916, the period since the formation of the Metropolitan Borough. Amongst the total number of births registered in the Borough there were 107 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. 29 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 resident in the Borough of Deptford, 3 in Woolwich, 29 in Lewisham and one each in Croydon and Camberwell, and accordingly this number of births have been transferred to those Boroughs. The remaining 61 were similarly allocated to the districts in this Borough in which the mother ordinarily resided, making 29 of such births belonging to East Greenwich, 23 to West Greenwich, 5 to St. Nicholas, and 4 to Charlton. The Birth Rate for the County of London equals 17.5 per 1,000 of the population. The Birth Rate for all England and Wales was 17.8. Under the provisions of the Notifications of Births Act, 1907, intimations have been received from medical men, parents, and others, with respect to 1,992 births. DEATHS. The total number of deaths registered during 1917 was 1,439, of which 777 were males and 662 females. The crude Death Rate for the Borough of 15.96 per 1,000 compares with 15.0, the Death Rate for the County of London, and 14.6, the Death Rate for the 96 large towns. Locally the Death Rate varied from 6.71 in Kidbrooke, 13.50 in Charlton, 14.05 in East Greenwich, 19 55 in West Greenwich, to 26.07 in St. Nicholas. 12 The following table shows the variation in, and average of, the Death Rates in each of the five' Districts of the Borough in the five years, 1912 to 1916, compared with the figures for 1917: — District. 1912. 1913. 1914. 1915. 1916. Average for Five Years. East Greenwich 11.99 12.46 12.87 13.57 12.57 12.69 West „ 15.03 18.81 18.61 19.62 19.93 18.40 St. Nicholas 22.86 18.78 18.73 26.52 22.44 21.86 Charlton 10.88 12.75 11.83 17.56 13.66 13.34 Kidbrooke 5.63 6.55 27.42 43.41 8.57 18.31 Borough 13.20 14.31 1495 17.56 15.14 15.03 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 Institution*. 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 1,426 197 544 Average 1,407 289 447 1917 1,439 203 364 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. Second Quarter. Third Quarter. Fourth Quarter. Total. Under 1 year of age 69 36 50 48 203 Between 1 and 2 years 22 19 17 16 74 Between 2 and 5 years 22 20 11 11 64 Between 5 and 15 years 18 21 16 25 80 Between 15 and 25 years 30 25 11 15 81 Between 25 and 45 years 62 53 33 51 199 Between 45 and 65 years 96 95 56 68 314 65 years and upwards 170 112 58 87 424 Total 489 381 252 321 1,439 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 East and West Greenwich; St. Nicholas, Charlton and Kidbrooke have improved. Visits paid in reference to Birth 1,461 Re-visits made 973 Visits paid in reference to Notified Cases of Diarrhæa 318 Re-visits made in reference to Cases of Diarrhæa 229 Miscellaneous enquiries and extra visits paid by special request 86 3,067 14 The following table gives the number and character of the intimations respecting births in the Borough since the adoption of the Notification of Births Act, 1907: — NOTIFICATION OF BIRTHS ACT, 1907. Date of adoption—17th March, 1909. 1909. 1910. 1911. 1912. 1913. 1914. 1915. 1916. 1917. 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 1,992 (a) Attended by Mid wives 642 1,298 1,282 1,412 1,340 1,338 1,226 1,314 1,095 (b) Attended by Doctors 586 1,365 1,271 1,038 1,283 1,175 1,054 1,183 897 Number of Still Births notified in each year 16 51 24 71 53 36 42 61 47 Number of Births registered in each year 2,492 2,457 2,381 2,393 2,545 2,409 2,347 2,354 1,967 INFANTILE MORTALITY. The Infantile Mortality, measured by the deaths of children under one year of age to the number of births registered, was 105 per 1,000 births, there having been a total of 203 such deaths during the year, as compared with 235, 101, and 197, the figures for the three preceding years. The number for the County of London was 103 per 1,000 births, the average for the past five years in Greenwich has been 98 per 1,000 births. For all London the rate was 103 in 1917, compared with 89 in 1916 and 112 in 1915. For England and Wales the rate was 97, compared with 99 in 1916, 110 in 1915 and 105 in 1914. Locally, the variations were from Nil per 1,000 births in Kidbrooke, 97 in Charlton, 106 in West Greenwich. 109 in East Greenwich, and 114 in St. Nicholas. The following table pares at a glance these figures for the years since the formation of the Borough: — 15 District. Average for five Years, 1901-1905 inclusive. Average for five Years, 1906-1910 inclusive. Average for five Years, 1911-1915 inclusive. 1916. 1917. East Greenwich 129 106 96 68 109 West „ 126 110 112 92 106 St. Nicholas 179 143 167 156 114 Charlton 121 109 76 75 97 Kidbrooke 39 79 16 51 - Total 131 111 103 83 105 AN ANALYSIS OF DEATH CAUSES. All death causes are conveniently arranged under various headings, and the following table shows the Death Rates for 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. 1917. 1917. Infective Diseases— Local Diseases—continued. Epidemic 1.54 Digestive System 0.54 Sporadic 0.00 Lymphatic 0.01 Venereal 0.05 Urinary System 0.59 Septic 0.06 Reproductive System 0.03 Malarial 0.03 Parturition 0.03 Tuberculosis 2.42 Bones and Joints 0.01 Parasitic 0.00 Integumentary System 0.02 Dietetic Diseases 0.00 Constitutional Diseases 1.36 External Causes— Developmental Diseases 2.35 Accidents 0.63 Homicide 0.01 Suicide 0.02 Local Diseases— Nervous System 1.50 Ill-defined Causes— Organs of Special Sense 0.04 Sudden Death 0.00 Circulatory System 1.90 Other ill-defined and not specified causes 0.00 Respiratory System 2.76 16 REMARKS ON VARIOUS DEATH CAUSES. Infective Diseases. Epidemic. There were 139 deaths due to this class of diseases, equalling a Death Rate of 1.54 per 1,000; the rate last year was 1.71, and was 1.59, 2.30 and 1.71 in 1913, 1914 and 1915 respectively. Zymotic. The purely Zymotic class of epidemic diseases is credited with causing a total of 128 deaths, equalling a Death Rate of 1.42 per 1,000. Locally, the Zymotic Death Rate varied from .00 in Kidbrooke (0.35 in 1916), 1.18 in Charlton (0.97 in 1916), 1.21 in West Greenwich (2.18 in 1916), 1.31 in East Greenwich (1.12 in 1916), up to 3.80 in St. Nicholas (4.34 in 1916). Small Pox. There were no deaths from this disease in 1917, this being the fifteenth year since a death occurred from this cause in the Borough. Measles. Forty-five deaths were ascribed as due to this disease, 42 of the patients being under five years of age, and 3 between five and fifteen years of age, compared with 48 which occurred in 1916; 43, 46 and 48 deaths were recorded in the three preceding years. Twenty-one of the deaths occurred in East Greenwich, 8 in West Greenwich, 10 in St. Nicholas, and 6 in Charlton. The quarterly incidence was 18 in the first, and 20, 5 and 2 respectively in the succeeding quarters. Scarlet Fever. This disease occasioned one death, between the ages of 25 and 45 years. The death occurred in East Greenwich. Four such deaths occurred in 1916 and 4 in 1915. Diphtheria. There were 27 deaths from this disease during 1917. This gives a Death Rate for Diphtheria of 0.29 comparing with 0.23, the rate for 1916. Twenty-two deaths occurred in 1916 which were attributed to this cause, and 18, 16 and 14 in the three preceding years. Twelve of the patients were under five years of age, and 15 of the patients were over five years of age. Twenty-four tubes of Diphtheria Anti-toxin, containing a total of 48,000 units of serum, for the treatment of patients suffering 17 from this disease, have been supplied by this Council during the year. Whooping Cough. This disease was given as the cause of 8 deaths in 1917, as against 7,43 and 23 in the three preceding years. These deaths equal a rate of 0.08 per 1,000. Five of the deaths occurred in East Greenwich, 1 in West Greenwich, 2 in St. Nicholas. Typhoid Fever, There were two deaths ascribed as due to this disease; there were 6 in 1916, 7 in 1915, 5 in 1914, 3 in 1913, 2 in 1912, 4 in 1911, 3 in 1910 and 4 in 1909. One death occurred in East Greenwich, and 1 in West Greenwich. Diarrhæa and Zymotic Enteritis. Thirty-eight deaths were stated to be due to this cause, equalling a rate of 0.42 per 1,000. Last year there were 42 deaths, and 31, 159 and 50 respectively in the three preceding years. The deaths were distributed as follows:—Sixteen in East Greenwich, 7 in West Greenwich, 6 in St. Nicholas and 9 in Charlton. Two patients were over five years of age. The deaths in 1916 were distributed as follows:—Sixteen in East Greenwich, 13 in West Greenwich, 12 in St. Nicholas, and 1 in Charlton. It is interesting to note that the deaths during the months when Diarrhoea is notifiable in Greenwich were 44 in 1913, 34 in 1914, 24 in 1915, 13 In 1916 and 29 in 1917. Influenza. Influenza is found to have been the responsible cause of 16 deaths in 1917; 21 was the average of the previous three years. Of the 16, 8 were over sixty-five years of age. Sporadic Diseases. There were no deaths from this class of diseases during the year. Venereal. Syphilis. Five deaths were given as due to Syphilis, as against 6 in 1916 and 3 in 1915. Of these 5 deaths, 1 was a child under five years of age. One occurred in East Greenwich, 3 in West Greenwich and 1 in St. Nicholas. Two were in the Seamen's Hospital. There were no deaths from Gonorrhoea during the year. Septic. Erysipelas. One death occurred from this cause in 1917, 3 in 1916, 4 in 1915 and 4 in 1914. Puerperal Fever. There was 1 death from this disease during the year. 18 * Pyæmia and Septicæmia. There was 1 death from this disease during the year. Infective Endocarditis. One death was ascribed to this cause in 1917. The number was 4 in 1916, 0 in 1915, 4 in 1914, 0 in 1913 and 2 in 1912. Malarial. Rheumatic Fever. There were 3 deaths in 1917, as compared with 1 in 1916, 3 in 1915 and 1 in1914. Tuberculosis. This class includes the causes of 219 deaths during the year under review, with a rate of 2.42; these figures compare with 141, 172 and 170, the totals of the previous three years, and respective rates of 1.45, 1.80 and 1.80. Tuberculosis of the lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 182 attributed to this cause, or a rate of 2 01 per 1,000. Locally, the deaths were 2 in Kidbrooke, giving a Death Rate of 0.74; 24 in St. Nicholas, giving a Death Rate of 3.5; 26 in Charlton, giving a Death Rate of 1.61; 83 in West Greenwich, giving a Death Rate of 3.87; and 84 in East Greenwich, giving a Death Rate of 0.55 per 1,000. The remaining forms of Tuberculosis were responsible for 37 deaths, 14 being in East Greenwich, 15 in West Greenwich, 3 in St. Nicholas and 5 in Charlton. Of these other forms of Tuberculosis, Tuberculosis of the Brain or its Membranes was credited with 16, 13 being under five years of age; Tubercle affecting the Intestines, 7 deaths (2 being under five years of age); General Tuberculosis, 10 deaths (6 under and 4 over five); and other forms, 4. Parasiitic Diseases. There were no deaths from this class of disease. Dietic Diseases. There were no deaths from this class of disease. Constitutional Diseases. The deaths from this cause were 123 in number, which gives a rate of 1.36 per 1,000. Of these, 98 were attributed to Cancer, 13 to Diabetes, 4 to Osteo-Arthritis, 4 to Gout, 4 to Anaemia. The deaths from Cancer were distributed as follows:—39 occurred in East Greenwich, 32 in West Greenwich, 8 in St. Nicholas, 15 in Charlton and 3 in Kidbrooke. Developmental Diseases. There were 212 deaths from this class of causes, equal to a rate of 2.35 per 1,000. These may roughly be divided into those from causes which would appear to be unavoidable viz.:—Congenital defects, 7, and 19 those from causes more or less preventable, viz.:—Premature birth 30; Injury at birth, 2; Debility at birth, 2; Atrophy, Debility and Marasmus, 22; Atelectasis, 4; Dentition, 3; Rickets, 4; and Want of Breast Milk, 1. The remaining and largest portion of these deaths from developmental diseases, 137 in number, were from Old Age; in 1910 there were 109 deaths from this cause, and 118 in the previous year. Local Diseases. Nervous System. One hundred and thirtysix deaths were attributed to the various nervous diseases, which gives a rate of 1.50 per 1,000; last year the rate was 1.31 per 1,000. Convulsions were responsible for 17, all being under five years of age; 10 were from Meningitis, 60 from Apoplexy, 9 from Hemiplegia or Brain Paralysis, 4 from General Paralysis of the Insane, Epilepsy, 1 from Laryngismus Stridulus, 3 from Locomotor Ataxy, 5 from Paraplegia, and 10 from other diseases of this system. Organs of Special Sense. There were 4 deaths from this class of causes, equal to a rate of 0.04 per 1,000. Circulatory System. The Death Rate from diseases of this system was 1.90 per 1,000, there being a total of 172 such deaths. Valvular Diseases of the heart were responsible for 85, 1 from Angina Pectoris, 9 from Aneurism, 11 from Embolism, and from the remaining diseases of this system, 66. Respiratory System. Two hundred and forty-nine deaths were due to diseases of the respiratory organs, as compared with 263 in the preceding year. The Death Rate under this heading equals 2.76 per 1,000. Forty-eight were from Acute and 72 from Chronic Bronchitis; 118 from the various forms of Pneumonia, 63 being under five years of age, and 1 from Pleurisy, 3 to Emphysema, 2 to Laryngitis, and 5 to other diseases. Digestive System. There were 49 deaths from diseases of this system, equal to a rate of 0.54 per 1,000; (also Enteritis was responsible for 4, 3 being under five years of age); 10 were due to Ulcer of the Stomach and Duodenum, 6 to Appendicitis, 4 to Obstruction, and 4 to other diseases of the Intestines, 4 to Cirrhosis, and 3 to other diseases of the Liver, 9 to other diseases of Stomach, and 4 to other diseases of the Digestive System, and 1 to diseases of Mouth and Annexa. Lymphatic System. There was 1 death from a disease affecting this system during the year. 20 Urinary System. Fifty-four deaths, equal to a rate of 0.59 per 1,000, occurred from diseases affecting this system. Thirtynine were from Bright's Disease, 5 from Acute Nephritis, 7 from diseases of the Bladder and Prostate, and 3 from other and ill-defined causes of the urinary system. Reproductive System. Disease of the generative organs was the cause of 3 deaths, 2 deaths were attributed to diseases of Uterus and Appendages and 1 to Testis and Penis. There were 3 deaths attributed to diseases of Parturition. Bones and Joints. There was 1 death from Arthritis. Integumentary System. Theire were 2 deaths from diseases of the Integumentary System. External Causes. There were 60 deaths given as due to causes grouped under this heading; 57 were the result of accident or negligence, 2 were from Suicide, and 1 Homicide. Suffocation, by being overlaid in bed, was the cause of death of 6 children under five years of age (compared with 5 from this cause last year); 7 cases were from drowning, while accidents on railways, in vehicular traffic and in building operations, falls, etc., were responsible for 44 deaths. Ill-Defined Causes. There was no death the cause of which was not ascertained in 1917. MORTUARY. The number of bodies dealt with in the Mortuary since 1910 is shown below: — Year. Drowned Bodies from River. Other Bodies. Totals. 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 1917 IS 209 224 Notifications under the Provisions of the Public Health (London) Act, 1891. During the year 1,400 cases have been notified under the above Act, as compared with 1,906, 1,493, and 1,778 respectively, in the preceding years 1916, 1915, and 1914. Small-Pox. No cases of this disease were notified during the year in persons residing in the Borough. Chicken Pox. This disease was not notifiable this year. 21 Supplemental Vaccination Return for 1916. Return made on or before the 8th of February, 1918, by Mr. A. E. Rossiter, Vaccination Officer of the several Districts of the Greenwich Union, respecting the vaccination of children whose births were registered in his District from 1st January to 31st December, 1916, inclusive :— Registration Sub-Districts comprised in the Vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1916. No. of these Births duly entered by 31st Jan., 1918. No. of Births which on 31st Jan., 1918, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1918, not accounted for. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. Certificates of conscientious objection received. Dead, Unvaccinated. Postponement by Medical Certificate. Removal to Districts, V.O. of which apprised. Removal to places unknown and cases not found. 1 2 3 4 5 6 7 8 9 10 11 South Deptford 678 388 ... ... 179 30 5 7 43 26 North Deptford 1341 794 2 ... 317 84 6 14 84 40 East Deptford 1040 540 1 ... 150 85 35 5 144 80 East Greenwich 1101 606 3 ... 293 67 5 29 71 27 West Greenwich 601 320 3 ... 177 35 6 1 37 22 Total 4761 2648 9 ... 1116 301 57 56 379 195 Dated February 8th, 1918. 22 Diphtheria. Three hundred and twenty-two cases of Diphtheria were notified during the year, as compared with 364, 169, 236 and 261 respectively, in the four previous years. The distribution of these cases was as follows:—184 in East Greenwich, 51 in West Greenwich, 34 in St. Nicholas, 50 in Charlton, and 3 in Kidbrooke. Of this total number, 289 were removed to the Hospital for treatment. Amongst which number, the Hospital Authorities reported that in 1 case they considered the diagnosis incorrect; disease not stated. There were 27 fatalities due to this disease, which gives a case mortality of 8.4 per cent. One thousand one hundred and sixty-six specimens were forwarded by Medical Practitioners For bacteriological investigation from cases suspected to be Diphtheria. Of this number, 991 were reported to give negative or doubtful results, and 175 were positive in character, being dealt with accordingly. The quarterly incidence of the disease for 1917 has been as follows: — 1st Quarter—East Greenwich, 40 cases; West Greenwich, 19; St. Nicholas, 6; Charlton, 4; a total of 69 cases. 2nd Quarter—East Greenwich, 39 cases; West Greenwich, 8; St. Nicholas, 10; Charlton, 2; a total of 59 cases. 3rd Quarter—East Greenwich, 46 cases; West Greenwich, 11; St. Nicholas, 5; Charlton, 4; Kidbrooke, 1; a total of 67 cases. 4th Quarter—East Greenwich, 59 cases; West Greenwich, 13; St. Nicholas, 13; Charlton, 40; Kidbrooke, 2; a total of 127 cases. Membranous Croup. No cases of Membranous Croup were notified during the year. Erysipelas. Forty-six cases were notified during the year, 14 being in East Greenwich, 11 in West Greenwich, 17 in St. Nicholas, 2 in Charlton, and 2 in Kidbrooke. Two of these patients were removed to Public Institutions. Scarlet Fever. One hundred and fifty-five cases were notified during the year, as compared with 193, 525 and 556 cases respectively, in the three preceding years; 54 cases were in East Greenwich, 84 in West Greenwich, 6 in St. Nicholas, 8 in Charlton,. 23 and 3 in Kidbrooke; 147 of these cases were removed to the Hospital for treatment. There was 1 death from this disease during the year, as against 4 last year. Five of the cases removed to the Hospital as suffering from Scarlet Fever were returned as wrongly diagnosed, i.e., 1 stated to be Consumption, 2 Chronic Otorrhoea, no alternative disease being stated in the remaining 2 cases. There were no "return eases" this vear. There were 6 in 1916, 4 in 1915, 5 in 1912, 7 in 1911, 4 in 1910. Typhoid Fever. There were 13 cases of Typhoid Fever notified during the year, 4 being in East Greenwich, 5 in West Greenwich, 3 in St. Nicholas, 1 in Charlton. The ages of the patients were: 5 between five and fifteen years; 3 between fifteen and twenty-five years and 3 between twenty-five and fortv-five years, 1 between forty-five and sixty-five and 1 over sixty-five*. Of the total number of cases, 12 were removed to the Hopital for treatment. Fourteen such cases occurred in 1916, twenty-five in 1915 and seventeen in 1914; the average number for the years 1901 to 1916, inclusive, being 31. There were two fatalities from this disease during the year, 1 in East Greenwich and 1 in West Greenwich. Sixteen specimens were forwarded for bacteriological examination from cases suspected to be Typhoid Fever in character, and of this number, 9 gave a negative result, and 7 were positive. Puerperal Fever. Three cases of this disease were notified during the year, 1 in West Greenwich and 2 in St. Nicholas. There were 14 cases in 1916, 4 in 1915, and 4 in 1914; 3 of these patients were removed to Hospital. There was 1 death from this disease during the year. Measles. This disease was made notifiable on January 1st, 1916; 1,469 cases of Measles were notified by school teachers and others during the year, as compared with 1,378 during the previous year, 971, 982 and 344 in the years 1915, 1914 and 1913 respectively. The ages and incidence of fatality of the disease were as follows:—There were o90 cases under five years of age, amongst whom there were 42 deaths, giving a case mortality of 71 per cent. Between the ages of five to fifteen years there were 730, with 3 deaths at this age period, giving a case mortality of 0.41 per cent. The case mortality for the whole district works out at 3.06 per cent. 24 Table showing number of Measles Cases reported during the year 1917. 1st QUARTER. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. East Greenwich 15 120 230 19 9 West Greenwich ... 12 30 11 5 St. Nicholas 1 12 ... ... ... Charlton 7 44 75 12 9 Kidbrooke ... 5 17 6 5 Total 23 195 352 48 28 Total 646. 2ND QUARTER. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. East Greenwich 3 79 156 21 8 West Greenwich 8 108 90 9 3 St. Nicholas 6 51 18 ... ... Charlton ... 44 45 13 2 Kidbrooke ... 4 16 5 7 Total 17 785 325 48 20 Total 696. 3rd QUARTER. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. East Greenwich ... 9 23 1 2 West Greenwich 3 40 13 ... ... St. Nicholas 2 3 8 ... ... Charlton ... 2 5 ... ... Kidbrooke ... ... ... ... ... Total 5 54 49 1 2 Total 111. 4th QUARTER. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. East Greenwich 1 1 1 1 ... West, Greenwich ... 5 2 ... 1 St. Nicholas ... 1 ... ... ... Charlton ... 1 1 ... ... Kidbrooke ... 1 ... .... ... Total 1 9 4 1 1 Total 16. Total cases in year = 1469. 25 Zymotic Enteritis or Summer Diarrhæa. This Council made the usual order requiring the notification of cases of Zymotic Enteritis or Summer Diarrhoea, and 321 cases were notified throughout the whole of the Borough, 121 being under one year of age; 157 between one and five; 30 between five and fifteen; 2 between fifteen and twenty-five; 4 between twenty- five and fortyfive; 3 between forty-five and sixty-five, and 4 over sixty-five. One hundred and fifteen of such notifications related to patients in East Greenwich, 119 in West Greenwich, 37 in St. Nicholas and 50 in Charlton. There were 38 deaths ascribed to this disease, comparing with 42 in the previous year. Whooping Cough. One hundred and thirty-six cases were notified (compared with 241 in 1916), 11 being under one year of age, 84 from one to five, 40 from five to fifteen and 1 from fifteen to twenty-five; the districts concerned being East Greenwich, 86; West Greenwich, 30; St. Nicholas, 17, and Charlton, 3 (of which total number 1 was treated in an Institution 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. Epidemic Cerebro-Spinal Meningitis or Cerebro-Spinal, Fever. There were 8 cases of Cerebro-Spinal Meningitis notified during the year, 2 in East Greenwich, 3 in West Greenwich, 1 in St. Nicholas, 1 in Charlton and 1 in Kidbrooke. Acute Polio-Myelitis or Acute Polio-Encephalitis. No case was notified during 1917. There were 2 cases notified in 1916, no cases in 1915, 1914 and 1913, and 2 in 1912. Ophthalmia Neonatorum. During the year 13 cases of this disease have been notified, 4 being in East Greenwich, 6 in West Greenwich, 2 in St. Nicholas and 1 in Charlton, Tuberculosis. During the year there were 383 cases of Tuberculosis notified in the Borough, 268 being pulmonary cases, ordinarily known as Consumption, and 115 non-pulmonary, being Tuberculosis affecting other portions of the body than the lungs. Of this number of cases, 100 Pulmonary, and 37 Non-pulmonary occurred in East Greenwich, 85 Pulmonary and 37 Non-pulmonary in West Greenwich, 31 Pulmonary and 27 Non-pulmonary in St. Nicholas, 42 Pulmonary and 13 Non-pulmonary in Charlton, and 10 Pulmonary and 1 Non-pulmonary in Kidbrooke. The various ages of the patients were as follows:—Pulmonary cases, from 1 to 5, 26 nine cases; 5 to 15, twenty cases; 15 to 25, sixty-seven cases; 25 to 45, one hundred and twenty-one cases; 45 to 65, forty-five cases; and 65 and upwards, six cases; whilst the Non-pulmonary were— under 1 year of age, 4 cases; 1 to 5, twenty-two cases; 5 to 15, sixty-six cases; 15 to 25, seventeen cases; 25 to 45, two cases; and 45 to 65, four cases. Two hunderd and eighty-one specimens were forwarded by medical practitioners for bacteriological investigation from patients suspected to be consumptive; 230 were reported to be negative and 51 positive. Disinfection has been offered and carried out in 84 oases, including 89 rooms and 285 articles of bedding, etc. TUBERCULOSIS DISPENSARY. Report of Tuberculosis Officer on the Working of the Dispensary for the Year 1917. I have the honour to submit the fifth report upon the work carried out at the Tuberculosis Dispensary. New Patients examined during 1917. Recommended by. Males. Females. Children. Total. Private Practitioners 48 24 28 100 London County Council - 1 18 19 From Sanatoria 3 2 3 8 Military 71 — — 71 Own accord 10 36 82 128 Contacts 13 57 295 365 Other Institutions, Hospitals, Clinics, &c. 4 8 25 37 149 128 451 728 Consultative Cases. Males. Females. Children. Total. National Insurance 39 16 — 55 London County Council — 1 18 19 Private Practitioners 48 18 4 70 Military 71 — — 71 158 35 22 215 Males. Females. Children. Total. Contacts 13 57 295 365 Found Tuberculous 4 9 21 34 27 Attendances. Patients retained for Treatment. Males. Females. Children. Total. Patients 44 95 178 317 Re-attendances 560 1350 2798 4698 Patients retained for Observation. Males. Females. Children. Total. Patients 8 38 187 233 Re-attendances 32 250 1638 1920 Nurses Visits. First Visits 389 Re-visits 3804 4,193 Patients Primarily Notified from Dispensary. Pulmonary 42 Other Forms 8 50 Sputum Examination. Negative Results 134 Positive „ 18 Number of Examinations 152 Dispensary Patients referred elsewhere. Males. Females. Children. Total. Sanatorium 7 5 5 17 Infirmary 3 1 1 5 Hospital 2 9 11 22 12 15 17 44 Patients Discharged from Treatment. Much Improved. Improved. Total. Males — 3 3 Females 9 13 22 Children 15 23 38 24 39 63 28 Suspected (observation) Patients Discharged. Much Improved. Improved. Total. Males l — 1 Females 2 — 2 Children 4 l 5 7 l 8 Suspected (observation) Patients disposed of otherwise. Males. Females. Children. Total. Taken on as Patients (Tuberculous) — 3 1 4 Sent to Institution (Hospital Convalescent Home) l 3 7 11 Died (Intercurrent Dis- ease) — — — — Interned — — — — Enlisted — — — — l 6 8 15 Deaths of Patients during 1917. Males. Females. Children. Total. At Home 7 6 2 15 Hospital — — — — Infirmary 2 — — 2 Sanatorium — — — — 9 6 2 17 Insured : 9 Males, 2 Females. The Treatment of Advanced Cases. The weakest point in the present scheme is still the lack of adequate institutional accommodation for advanced and failing cases. G. H. Dart, Tuberculosis Officer. SCHOOL CLINICS, HEALTH CENTRES AND INFANT CONSULTATIONS. The following Institutions are still doing very good work in the Borough: — L.C.C. Clinics. Health Centre, Deptford Green. Miss McMillan's Infant Cr&che and Cleansing Station, Wellington Street. 29 Albany Institute Infant Consultation, Cr&che and Babies Home. The Dockyard Creche, Woolwich Road, Charlton, which was opened in the Autumn of 1917 specially for the children of Munition Workers in the Arsenal. Greenwich Borough Council's Creche at Conduit House, 236, Trafalgar Road, opened in September last. Greenwich Borough Council's Infant Consultation and AnteNatal Centre. The total attendances of Babies at our Creche has been 644, whilst the figures for our Infant Consultation Centre are as follows: — New Cases 330 Attendances 1,544 Medical Consultations 1,212 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 2,197 Number of Re-visits 6,133 Twenty-five rooms have been cleansed after disinfection by the Department. During the year, when premises have been entered for the purpose of carrying out disinfection after cases of Infectious Disease, the following books belonging to the Libraries, etc., were destroyed: — Central Library, 6; Branch Library, 2; School Libraries, 1; Total, 9. 30 Number of Articles and Rooms Disinfected in connection with the Undermentioned Diseases for the 52 weeks ending 29th December, 1917. Infectious Diseases. 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. | Cerebro-Spinal Meningitis 6 6 3 ... 2 4 10 6 9 ... 5 24 63 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 96 104 61 3 43 54 156 147 12 22 63 68 629 Diphtheria 292 301 19 ... 6 17 34 29 4 ... 17 3 129 Enteric Fever 8 8 5 ... 4 8 16 11 2 ... 6 2 54 Paerperal Fever 1 1 2 ... ... 1 ... 1 2 ... 1 ... 7 Tubercolosis 84 89 43 3 25 40 123 60 15 20 19 53 401 Other Diseases 24 44 44 9 55 28 121 92 36 29 22 181 617 From Verminous Premises 22 5 32 14 6 16 57 32 18 4 21 56 256 Scabies 12 3 16 5 1 12 21 27 16 ... 15 21 134 Measles 50 70 ... ... 5 3 6 6 2 ... ... 90 112 Army ... ... ... ... ... ... ... 418 ... ... ... ... 418 Total 604 631 225 34 147 183 544 829 116 75 169 498 2820 31 Number of Articles Destroyed in connection with the Undermentioned Diseases during the 52 weeks ending 29th December, 1917. Infectious Diseases. Beds Destroyed. Palliasses Destroyed. Mattresses Destroyed. Bolsters Destroyed. Pillows Destroyed. Blankets Destroyed. Sheets Destroyed. Cushions Destroyed. Quilts Destroyed. Odd Pieces Destroyed. Total No. Articles Destroyed. Small-pox ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... Tuberculosis 3 ... 2 ... 2 ... ... ... ... 10 17 Other Diseases 2 ... 0 2 7 ... 2 ... ... 2 21 For Verminous Premises ... 1 1 ... 5 ... ... 1 ... ... 8 Total 5 1 9 2 14 ... 2 1 ... 12 46 32 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. DISINFECTION. A total of 418 articles were disinfected for the military during this period. A detailed statement will be found on page 30. SANITARY WORK. The tables on pages 42 to 48 summarise, as far as possible, the Sanitary work of the Department; from this it will be seen that a total of 11,614 houses and premises have been inspected or reinspected during the year; 989 intimation notices have-been served, and 211 statutory notices. With the exception of prosecutions in connection with the Sale of Food and Drugs Act, it was found necessary to institute Police Court proceedings in two cases during the year. There were altogether throughout the year 254 complaints entered in the Public Complaints Register of the Department. Bakehouses. One hundred and ninety-nine inspections have been made of the various Bakehouses in the Borough, and 52 nuisances found therein have been abated as the result. Factories and Workshops. Four hundred and seventeen inspections have been paid to these premises within the Borough during the year. There were 185 workshop premises on the Register at the beginning of the year, 21 have been added during the year, and 3 have been taken off, leaving a total now on the Register of 203. This total includes 15 laundries, 29 dressmaking and mantle works, 7 fuel and firewood works, 3 cycle works, 10 milliners, and various others, including workplaces, such as 4 blacksmiths, 14 bargebuilders, 3 builders' yards, etc. Five complaints have been received from H.M. Inspector of Factories. Outworkers' Register. Forty lists of Outworkers containing 129 names and addresses, have been received during the year from the Medical Officers of Health for other Districts; 11 lists, containing 18 names, have been received from employers within the District; 30 names have been forwarded to other Districts, thus giving a total of 117 names and addresses of outworkers within the Borough. One hundred and fifty-nine visits of inspection have been paid to these premises. 33 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES and HOMEWORK. 1.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries.) 69 ... ... Workshops (Including Workshop Laundries.) 269 6 ... Workplaces (Other than Outworkers' Premises) 83 24 ... Total 421 30 ... 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. *Nuisance8 under the Public Health Acts :— Want of Cleanliness 40 40 ... ... Want of Ventilation ... ... ... ... Overcrowding ... 3 ... ... Want of Drainage of Floors 1 1 ... ... Other Nuisances 11 11 ... ... Sanitary Accommodation— Insufficient 39 39 ... ... Unsuitable or defective 8 3 ... ... Not Separate for Sexes — ... ... ... ... Offences under the Factory and Workshop Act :— Illegal Occupation of Underground Bakehouse (s. 101) ... ... ... ... Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) 27 27 ... ... Other Offences ... ... ... ... Total 121 121 Nil Nil *Including those specified in Sections 2, 3, 7 and 8 of the Factory Act, as remediable under the Public Health Acts. 34 3.—HOME WORK. Nature of Work Outworkers' Lists, Section 107. Number of inspections of outworkers' premises. Outwork in unwholesome premises. Sec. 108. Outwork in infected premises. Sees. 109 & 110 Lists received from Employers. Numbers of addresses of outworkers received from other Councils. Numbers of addresses of outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 110). Prosecutions (Sees. 109 & 110). Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers Lists. Outworkers Wearing Apparel— (1) Making, &c. 4 8 7 10 68 28 ... ... 120 ... ... ... ... ... ... (2) Cleaning & Washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace,Lace Curtains & Nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur Palling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cotton and Kit Bags ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush Making ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... Box Making ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Rackets & Tennis Balls ... ... ... ... 59 2 ... ... 38 ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 4 8 7 10 129 30 ... ... 159 ... ... ... ... ... ... 35 4.—WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1917. No. Bakehouses 45 Factory Bakehouses 3 Barge Builders 14 Blacksmiths 4 Boot and Shoe Makers 7 Builders' Yards 3 Carpenters and Joiners 2 Carriage Builders 2 Coopers 4 Cycle Works 3 Dress and Mantle Makers 29 Fuel Works 7 Laundries 15 Milliners 10 Photographers 3 Picture Frame Makers 1 Printers 1 Tailors 5 Underclothing Makers 1 Others 44 203 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) ... Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (s. 5) :— Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspectors Other ... Underground Bakehouses (s. 101) :— In use during 1916 12 Certificates granted in 1917 ... In use at the end of 1917 12 Slaughter Houses. The slaughter houses in the Borough have been inspected on 10 occasions by the Inspectors. 36 Cowhouses. The four cowhouses in the Borough have been visited on 8 occasions, and The required cleansing has been duly enforced on "7 occasions. Horse Slaughterer. The one horse-slaughtering house in the Borough has been visited by the Inspector on 24 occasions, and cleansing of the premises was not required on any of these visits. Other Scheduled Offensive Trades. The premises where these offensive trades were carried on within the precincts of the Foreign Animals Wharf are now taken over by the War Office and in use as a Barracks and Army Bervice Depot. Dairies, Cowsheds and Milks hops Order. At the commencement of the year there were 142 premises on the Register of Dairies and Milkshops; 5 new applications have been received during the year and added to the (Register, and 20 names have been taken off, thus leaving a total of 127 premises now registered. During the year 153 visits of inspection have been paid to these premises; notices were served upon the occupiers in 10 cases, 6 of which were for dairy requiring limewashing, 3 for no cover to milk pan and 1 for sanitary defect. Under the powers conferred by the London County Council (General) Powers Act, 1908, Section 5, with respect to the registration of premises unsuitable for the sale of milk, such registration has been refused on the grounds of the unsuitability of the premises in 1 case. Ice Cream Premises. There were 108 premises known at the commencement of the year where the manufacture of this commodity was carried on; none have been addbd during the year and 5 taken off, leaving a total of 103 premises. These premises were inspected on 61 occasions, and improvements required either by way of cleansing of the premises in 3 cases and remedying of sanitary defects in 3 cases. This trade is not however now carried on owing to War conditions. Food Preparation. Places where food is prepared have been visited on 138 occasions, improvements being required in 28 instances, as detailed below: — 37 Class of Premises. Number on Lists. Number of I nspections Number of instances where matters needed attention. At end of 1916. Added 1915. Removed 1915. At end of 1917. Hotel Kitchens 4 ... ... 4 4 l Eating Houses 47 3 ... 50 50 14 Fried Fish Shops 24 ... 2 22 24 7 Pork Butchers 11 5 ... 17 17 4 Mineral Water Manufacturers 1 ... ... 1 1 ... Ice do. 2 ... ... 2 2 ... Sausage do. 14 1 ... 15 18 ... Others 6 ... ... 6 6 2 Totals 109 9 2 117 122 28 The 28 instances where matters needed attention included 22 cases where the premises generally, or kitchen and scullery particularly, needed cleansing and limewashing, 3 where the sanitary arrangement was defective, 3 for want of ashpit. Customs and Inland Revenue Acts. One application was received during the year for a certificate under these Acts, and a certificate was granted. Houses Let in Lodgings. There was no change in the Register of Houses during 1917, 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 two 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, in 96 cases, whilst under the Public Health (London) Act, 1891, cleansing, etc., was required in 93 cases, as set out below: — 38 Number of notices served for cleansing of houses under the By-laws: — Rooms Cleansed 82 Staircases and Passages Cleansed 5 Water Closets Cleansed 9 Overcrowding — Washhouses Cleansed — Areas and Yards Cleansed — 96 Under the Public Health (London) Act, 1891: — Cleansing — Without Ash Bin 13 Water Closets Blocked and Water Fittings Defective 8 Water Closets Dirty Sink Waste Defective and Blocked 3 Roof Defective 9 Insufficient Ventilation — Defective Guttering, etc. 5 Verminous Rooms Walls Defective 55 Yard Paving Defective — Animals Improperly Kept — 93 Number of Inspections and Re-inspections of Registered Houses 202 Other matters referred to Inspectors — Intimation Notices By-laws 29 Ditto Public Health Act 17 House Drainage. One hundred and seventy house drainage systems have-been reconstructed; 258 such systems have also been opened, cleansed and amended; 52 surface drains have been constructed; 33 drains and soil pipes have been ventilated, 130 systems have been tested by smoke and 101 by water, and 31 by chemicals, of which number 192 were found to be defective; 19 new soil pipes and 159 traps have been fixed, together with 18 intercepting chambers and 14 other chambers; 15 areas and 21 yards. Sixty 39 water-closets have been erected; a pan, trap and water supply have been furnished throughout in 125 cases, and other fittings in 130 cases, whilst the water supply has been renewed in 69 instances. The water supply for lavatory purposes has been disconnected from the drinking water system in 2 instances. Public-house urinals have been cleansed and repaired in 52 instances, 2 urinals were altered, 3 erected, and 4 repaired or water laid on. Refuse Removal. New ash receptacles have been provided in 249 cases. Water Supply. During the year 18 water supply certificates have been granted under Section 48 of the Public Health (London) Act, 1891. Defective water fittings have been renewed in 123 cases; 22 water supplies have been reinstated where the supply had been cut off; water fittings have been amended in 140 cases; 3 water supplies have been altered so as to draw direct from the main. Smoke Nuisances. Ninety-three observations have been taken for smoke nuisances during the year, but on no occasion was itfound necessary to issue Statutory Notices for the abatement of any nuisance which was found. Food and Drugs Act. Four hundred and four 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 372 were certified to be genuine and 32 adulterated, the adulterations thus being equivalent to 7.9 per cent. of the samples taken. Of the total number of samples purchased, 146 were milk, of which 31 were certified to be adulterated; the remaining adulterated sample was 1 of mustard. Proceedings were taken in 15 cases, and in the 10 other cases a warning letter was sent, no action was taken in 7 cases. The proceedings resulted in fines and costs being imposed in 9 cases; in 6 cases conviction (no penalty) and costs; in 10 cases a warning letter was sent. 1 bottle exploded. 40 Sale of Food and Drugs Acts.—Number and Description of Samples purchased for Analysis under the above Acts during the Year 1917. Description of Samples. Number of Samples Purchased. Number Genuine. Number Adulterated. Remarks as to Action taken. Baking Powder 18 18 ... — Butter 106 106 ... — Cocoa 36 36 ... — Coffee 23 23 ... — Cream Tartar 1 1 ... — Egg Substitute 1 1 ... — Egg Powder 15 15 ... — Ground Ginger 1 1 ... — Lard 8 8 ... — Margarine 7 7 ... — Milk 146 115 31 10 warning letters sent. Police Court proceedings in 14 cases, no action in 6 cases. Separated Milk 2 2 ... Skimmed Milk 1 1 ... — Mustard 12 11 1 Police Court proceeding in 1 case. Oatmeal 1 1 ... — Pearl Barley 3 3 ... — Mustard Condiment 1 1 ... — Pepper 15 15 ... — „ Cayenne 2 2 ... — Self-Raising Flour 5 6 ... — Total 404 372 32 41 Sale of Food and Drugs Acts, 1917.—Legal Proceedings, Particulars of Samples adulterated and result of action taken. Description of Sample Nature of Adulteration. Result of Proceedings Milk 2 per cent. of water added Warning letter sent. „ 2.5 „ „ „ „ „ „ „ Slightly deficient in solids, not fat No action taken. „ „ „ „ „ „ „ „ Addition thereto of 6 per cent. of water Costs, 20s. „ „ „ 16 „ „ Fined 38s., Costs, 22s. „ „ „ 7 „ „ and abstraction therefrom of 18 per cent. of fat Costs 20s. „ Addition of. 4J per cent. of water Fine, 30s., Costs, 15s. „ Abstraction of 5 per cent. of fat Warning letter sent. „ Addition of 5 per cent. of water Costs, 20s. „ „ 23 „ „ Fined £5, Costs, 20s. „ „ 8.5 „ „ Costs, 20s. „ Slightly deficient in solids, not fat No action taken. „ „ „ „ „ „ „ „ Addition of 2 per cent. of water Warning letter sent. „ „ 3 „ „ „ „ „ „ 17 „ „ Costs, 20s. „ „ 7 „ „ Fined £3 18s., Costs, 27s. „ „ 3 „ „ Warning letter sent. „ „ 3 „ „ „ „ 4 „ „ „ Slightly deficient in solids, not fat No action taken „ „ „ „ „ „ „ „ 14 per cent. of added water Fined £2, Costs 10s. „ 12 „ „ „ (bottle exploded) „ 12 „ „ „ Costs, £1. „ 32 „ „ „ Fined £19, Costs, £1. Mustard 35 per cent. flour coloured with Turmeric „ 26s., „ 14s. Milk 19 per cent. of water added „ 40s., „ 10s. „ 2 „ „ „ Warning letter sent. „ 6 „ „ „ Fined £3, Costs, 30s. „ Abstraction of 3 per cent. of fat Warning letter sent. 42 Summary of Sanitary Work performed during the Year 1917. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Inspections. Houses Inspected under Public Health (London) Act, 1891, &c. 630 678 656 576 2540 Houses let in Lodgings ... 10 14 5 29 Re-Inspections, Calls made, &c. 2072 2003 1943 1868 7886 Inspections of Bakehouses 6 55 79 59 199 „ Factories and Workshops 92 100 101 124 417 „ Outworkers Premises 25 42 37 15 159 „ Slaughterhouses 1 4 3 2 10 „ Cowhouses 1 2 3 2 8 „ Stables and Yards 42 49 4 1 45 176 „ Piggeries 1 1 5 7 „ Courts and Alleys 28 20 25 35 108 „ Fields, Lanes, Ac 18 16 22 12 68 „ Urinals 16 14 20 20 70 „ Gipsy Vans ... ... ... ... ... „ Horse Slaughterhouses 3 5 10 6 24 „ Dairies, Cowsheds, and Milkshops 9 21 34 89 153 „ Soap Boilers ... ... ... ... ... ,, Other Offensive Trades ... ... ... ... ... „ Ice Cream Places ... 52 9 ... 61 „ Other places where Food is prepared 7 65 42 24 138 „ MiLtary Quarters 2 ... 7 11 20 „ Air Raid Shelters... ... ... ... 18 18 Total 2953 3137 3045 2916 12091 43 SUMMARY OP SANITARY WORK—continued. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Drains. Constructed 6 ... ... 2 8 Interceptor Chamber, and Fresh Air Inlet 6 7 3 2 18 Other Chambers 4 5 5 14 Reconstructed or Repaired 36 70 32 32 170 Opened, Cleansed and Amended 43 113 64 38 258 Surface Drains Constructed 16 9 12 15 52 Traps Fixed 53 44 32 30 159 New Soil Pipes 3 8 6 2 19 Drains and Soil Pipes Ventilated 8 19 4 2 33 Drains Tested—by Smoke 22 43 36 29 130 „ „ by Water 26 16 34 25 101 ,, „ by Chemicals 23 ... 8 31 Found Defective 48 59 46 39 192 Yards Drained 7 5 8 1 21 Mews and Stables Drained ... ... ... ... ... Washhonses Drained ... ... ... ... ... Forecourts Drained 6 ... ... ... 6 Areas Drained 4 6 3 2 15 Cesspools Abolished ... ... ... 1 1 Water Closets and Urinals. Closets Erected 19 37 4 ... 60 Sanitary Conveniences or improvements effected to Factories and Workshops 21 39 14 ... 74 W.C.s and Lavatory Basins ... ... ... ... ... Pan, Traps and Water Supply furnished 31 41 8 45 125 Pans and Traps only furnished 16 32 22 19 89 Pans only furnished 4 16 12 9 41 Water Supply Apparatus provided 2 8 5 5 20 Water Supply renewed 14 22 13 20 69 Water Supply disconnected from Drinking Water Cisteru 1 1 ... ... 2 Soil Pans properly Trapped 17 17 21 13 68 Cleansed and Repaired 46 15 51 35 147 Newly constructed or better situated ... ... ... ... ... Ventilation Improved 2 4 1 1 8 Public-house Urinals Cleansed or Repaired 12 13 16 11 52 Other Urinals Altered ... 1 ... 1 2 Repaired or Water laid on ... 4 ... ... 4 Urinals Erected 3 ... ... ... 3 44 SUMMARY OF SANITARY W 0 RK—continued. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Ashpits. Provided 55 55 72 67 249 Covers to Receptacles ... ... ... ... ... Dust Complaints forwarded to the Surveyor ... ... ... ... ... Pavings. Yards 43 50 29 21 143 Forecourts 7 ... ... ... 7 Areas 4 6 3 2 15 Washhouses ... ... ... ... ... Mews and Stables ... ... ... ... ... General Water Supply. Covers to Cisterns Adapted 3 ... ... 1 4 Water Supply Provided 1 ... ... 1 2 Water Fittings Amended 35 29 37 39 140 Cisterns Cleansed and Repaired 2 1 ... 2 5 Water Services Altered so as to draw direct from main 1 1 1 ... 3 Water Supplies Reinstated where cut off through defective fittings 4 7 5 6 22 Water Supplies cut off ... ... ... ... ... Defective Water Fittings (causing nuisance from dampness) repaired 42 21 24 36 123 Water Supply Certificates granted (Section 48) 1 1 4 2 8 Other Improvements. Houses Generally Repaired 38 72 65 42 217 Promises Cleansed, Limewashed and Repaired 29 160 46 38 273 Verminous Houses Cleansed 2 4 7 4 17 Staircases and Passages ditto ... ... ... ... ... Ventilation Improved 13 13 4 1 31 Staircases Lighted & Ventilated ... ... ... ... ... Leaky House Roofs and Gutters Repaired 99 135 138 74 446 Walls and Ceilings of Premises Cleansed throughout 47 41 61 69 218 Ditto, ditto, partially 57 71 62 105 295 Cowhouses cleansed 1 4 5 4 14 Horse Slaughterhouses cleansed 1 1 I 1 4 Ice Cream Places cleansed or improved ... 17 11 ... 28 Other Places where Food is prepared 6 23 9 7 45 45 SUMMARY OF SANITARY W ORK—continued. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Other Nuisances Abated. Illegal use of Underground Room Discontinued 1 1 3 5 Overcrowdings Abated 1 12 3 2 18 Sink, Lavatory and Bath Waste Pipes Disconnected, Trapped and Amended 32 37 14 10 93 Stack Pipes Disconnected and Amended 6 17 16 7 46 Nuisances from Dampness Abated 48 27 56 27 158 Animals kept in Unfit Places Discontinued or Removed ... 4 ... ... 4 Dung Receptacles Provided ... ... ... ... ... Bakehouse Nuisances Abated 4 20 16 12 52 Accumulations of Manure and other obnoxious matter Removed 29 43 26 12 120 Dampness of Walls Remedied 41 19 28 21 109 Other Nuisances, principally of Dilapidations and want of Under-floor Ventilation 134 44 64 6 248 Breaches of By-laws Abated ... ... ... ... ... Inundations ... ... ... ... ... Smoke Nuisances. Observations 33 26 19 15 93 Statutory Notices served (Sees. 23 and 24) ... ... ... ... ... Food and Drugs. Samples taken 71 112 74 99 356 Found Adulterated 4 4 6 4 18 46 SUMMARY OF SANITARY WORK—continued. First Qnarter. Second. Quarter Third Quarter. Fourth Quarter. Total. Unwholesome Food. Voluntarily surrendered 168 cases currants. 3064 cases of dates. 40 pkts. baking powder. 460 cases of dates. 30 bags ditto. 632 lbs. of damaged wheat. ½ bushel of apples. 87 cases of dates. 98 tons haricot beans. 994 cases of dates. 12 bags of onions. 31 tons seed pearl tapioca. 134 qtrs. damaged wheat. 23½ bags ditto 6 qtrs. ditto. Notices, &c. Intimations Served under Public Health (London) Act, 1891 (Section 3) 228 292 258 211 989 Houses let in lodgings 1 1 ... ... 2 Complaints Received 39 137 45 33 254 Complaints Attended to 39 137 45 33 254 Verminous Houses ... 1 ... ... 1 Statutory Notices Served under Section 4 35 43 40 42 160 Ditto Others ... ... ... ... ... Statutory Notices re Ashpit provision 14 9 5 21 49 Statutory Notices re Yard Paving ... ... ... 2 2 Noti es re Combined Drainage ... ... ... ... ... Ditto Houses let in lodgings ... ... ... ... ... Letters Written relating to Abatement of Nuisances 55 109 52 47 263 Summonses Applied for and Issued 1 1 ... ... 2 Magisterial Orders Obtained and Enforced 1 1 ... ... 2 Drainage Plans received and examined 6 17 9 4 36 L.C.C. General Powers Act 1 ... ... ... 1 47 BOROUGH OF GREENWICH. Proceedings during 1917. Premises. Number of Places— Number of Inspections, 1917. Number of Notices, 1917. N umber of Prosecutions, 1917. On Register at end of 1916. Added in 1917. Removed in 1917. On Register at end of 1917. Milk premises 142 5 20 127 153 10 ... Cowsheds 4 ... ... 4 10 ... ... Slaughterhouses ... ... ... 5 25 ... ... Other Offensive Trade Premises ... ... ... ... ... ... ... Ice Cream Premises 108 ... 4 103 61 ... ... Registered Houses Let in Lodgings 247 ... ... 247 202 (a) *... (a)*... (b) *10 (b)*... *(a) For Overcrowding. *(b) For other conditio is. Total number of Intimation Notices served for all purposes 989 Overcrowding, 1917— Number of Dwelling-rooms Overcrowded 18 Number Remedied 18 Number of Prosecutions Underground Rooms— Illegal Occupation dealt with during year 5 Number of Rooms Closed 5 Insanitary Houses— Number Closed voluntarily under the Public Health (London) Act, 1891 Number Closed voluntarily under the Housing of the Working Classes Acts .. Number of Verminous Premises Cleansed under sec. 20 of the L.C.C. (General Powers) Act, 1904 17 Number of Baths given to School Children under Cleansing of Persons Act 1,033 48 Shelter provided under sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year — Number of Tenement Houses provided with Additional Water Supply — Number of Prosecutions ditto — Inland Revenue Acts— Number of Houses for which applications were received during year 1 Number of Tenements comprised therein — Number of Tenements for which Certificates were granted — Number of Prosecutions under By-laws under Public Health Act, 1891— (а) For prevention of nuisance arising from snow, ice, salt, filth, &c. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, &c. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, &c., of dwelling houses — (e) In connection with the removal of offensive matter, &c. — (f) As to cesspools and privies, removal and disposal of refuse, &c. — (g) For securing the cleanliness of tanks, cisterns, &c. — (h) With respect to water closets, earth closets, &c. — (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, &c. (Metropolis Management Act, sec. 202) — (k) With respect to deposit of plans as to drainage, &e. (Metropolis Management Acts Amendment (By-laws) Act, 1899) — Mortuaries — Total Number of Bodies Removed 223 Total Number of Infectious Bodies Removed 1 224 LEGAL PROCEEDINGS, 1917. Apart from the proceedings under the Sale of Food and Drugs Act, 2 other summonses were needed.