GRE 18 THE ANNUAL REPORT MADE TO THE COUNCIL OF THE Metropolitan borough of Greenwich For the Year 1918, 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. 3 INDEX OF CONTENTS. PAGE. Age Mortality 13 Analysis of Death Causes 15 Area of Borough 8 Articles and Rooms Disinfected 32 Articles Destroyed 34 Bacteriological Examinations 22, 26 Bakehouses 35 Births 8,11 Bones and Joints 20 Books Destroyed 32 Cancer 18 Causes of Death 16-2O Cerebro-Spinal Fever 27 Chicken Pox 20 Circulatory System 19 Cleansing Children 50 Complaints 35,49 Constitutional Diseases 18 Consumption 25-28 Contacts 27 Cowhouses 39 Customs and Inland Revenue Acts 40,51 Dairies, Cowsheds and Milkshops 39,50 Deaths, with Age Mortality 13 Density of Population 8 Developmental Diseases 18 Diarrhœa and Zymotic Enteritis 17, 27 Dietic Diseases 18 Digestive System 10 Diphtheria 17,22 Diphtheria Anti-Toxin 17 Disinfection 32, 33 Duties and Powers of the Public Health Committee 5, 6 Elevation of Borough 8 Enteritis 19 Epidemic Cerebro-Spinal Meningitis 27 Epidemic Diseases 16 Erysipelas 18,23 External Causes 20 Factories and Workshops 36 Food and Drugs—Samples of 41, 42, 43 Food—Premises for Preparation of, &c. 39,40 Gonorrhœa 18 Health Centre 31 Health Visitor 14 Home Work 37 Horse Slaughterer 39 House Drainage 40 Houses Inspected for Infectious Disease 32 Houses Let in Lodgings 40 Ice Cream Premises 39 Infant Consultations 31 Infantile Mortality 15 Infective Endocarditis 18 Influenza 17 Inhabited Houses 8 Inland Revenue Acts 40,51 Insanitary Houses 50 Institution Deaths 13 Integumentary System 20 Introductory Review 9 Legal Proceedings 43,50 4 INDEX —continued. PAGE. Local Diseases 19 Lymphatic System 19 Malarial Diseases 18 Marriages 10 Measles 16, 23-24 Membranous Croup 23 Military Sanitary Works 35 Mortuary 20,51 Nervous System 10 Notices, &c. 49 Notifications 14 Notification of Births Act 14 Offensive Trades 39,42,45 Ophthalmia Neonatorum 27 Organs of Special Sense 19 Outworkers' Register 35 Overcrowding 47,50 Parasitic Diseases 18 Persons Cleansed 50 Polio-encephalitis 27 Polio-myelitis 27 Population 8 Premises Cleansed 46 Public Health Committee 5 Puerperal Fever 8, 25 Pyaemia and Septicemia 18 Refuse Removal 41 Remarks on Death Causes 16-20 Reproductive System 20 Respiratory System 19 Rheumatic Fever 18 Sale of Food and Drugs Acts 42, 43 Sanitary Work—Summaries, &c. 35,44-49 Scarlet Fever 17,23,24 School Clinic 31 Septic Diseases 18 Slaughterhouses 38 Small-pox 16,20 Smoke Nuisances 41 Sporadic Diseases 17 Staff of Public Health Department 7 Statistical Summary 8 Suffocation 20 Suicide 20 Syphilis 17 Tenement Houses 51 Tubercular Diseases 18 Tuberculosis 18,28 Tuberculosis Dispensary 28 Tuberculosis Officer's Report 28, 29, 30 Typhoid Fever 17,25 Underground Bakehouses 36 Underground Rooms 47 Unwholesome Food 48 Uninhabited Houses 8 Urinary System 19 Vaccination Particulars 21 Venereal Diseases 17 Verminous Premises 47 Verminous Children 47 Water Supply 41 Whooping Cough 17,27 Workshops and Factories 36,38 Workshops and Workplaces 36 Zymotic Enteritis 17,27 Zymotic Diseases 16 5 public health Committee During the year 1917-18. Charles Stone, Esq., J.P. (Mayor), and 9 Members. A. J. Hunt, Esq., Chairman. F. Powell, Esq., Vice-Chairman. Councillors — H. Baron. Dr. J. Gordon Parker, D.Sc F. Powell, R.N. A. J. Hunt. E. A. Lovibond. W. K. Soames. C. Nixon. F. Whatley, B.A. D. W. Noakes. 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.—A1l 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. Thomas Clark. Arthur E. Bache. Ebenezer Martin. Charles W. Nettleton. Miss G. Davis. Health Visitors- Miss E. M. Millington. Miss H. Chitty. Miss A. B. Reid. 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 Medical Officer of Health — G. H. Dart, M.D., M.R.C.P., D.P.H. *On Military Service. †On Military Service part of the year. 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 West Greenwich St. Nicholas Charlton and Kidbrooke Density of Population East Greenwich West Greenwich St. Nicholas Charlton and Kidbrooke Average for the Borough Number of Inhabited Houses — 1451.4 acres. 297.8 „ 112.1 „ 1990.4 „ 3851.7 „ 29.84 persons per acre. 71.96 60.75 „ 9.24 23.35 At Census, 1901 14,240 At Census, 1911 14,722 Estimated, 1918 16,077 Number ok Uninhabited Houses— At Census, 1911 803 Estimated, 1918 223 Population— At Census, 1911 95,968 Estimated, 1918—For Birth Rate 100,773 89,939 „ „ For Death Rate Birth Rate, 1918 16.88 per 1,000 Death Rate, 1918 19.16 „ (Zymotic) 1.70 „ (Infantile Mortality) 119 per 1,000 Births. 9 Public Health and Housing Department, Royal Hill, Greenwich. September, 1919. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Gentlemen, I have the honour to submit herewith the Annual Report of the Medical Officer of Health for the year 1918. The Birth Rate is 16.61 per 1,000 for Greenwich and 16.1 for the whole of the County of London. The mortality statistics for the year are, unfortunately, not quite of so satisfactory a character as we have been in the habit of recording during recent years, the recorded Death Rate of 19.16 per 1,000 of the estimated population being slightly higher than 18.9 per 1,000 the Death Rate for the County of London and 18.2 per 1,000, the figure for the 96 large towns, although this figure for our local Death Rate is, in my Opinion, entirely falacious, as it is based upon the Registrar-General's estimate; of our population, which, in my opinion, is considerably below the actual number of residents in the Borough. The Infantile Mortality Rate for the Borough, measured by the number of deaths under one year to 1,000 births registered, is 119, an increase from 105, the figure for last year; the figure for all London is 107, compared with 103 in 1917, and the Borough average during the last five years, 1913-17 inclusive, is 98. The Zymotic Death Rate of 1.70 is 0.28 per 1,000 above the corresponding figure for last year. The figures relating to the different constituent parts of the Borough are as follows: — Districts. Percentage of deaths under one year of age. Infantile Mortality per 1,000 Births. Zymotic Death Rate. Diarrhœa Death Rate. Consumption Death Rate. Birth Rate. Death Rate. East Greenwich 16.84 15.01 12.50 99 1.56 0.48 1.34 West Greenwich 18.76 26.03 11.87 146 2.01 0.32 2.80 St. Nicholas 22.34 24.45 12.65 123 2.06 0.58 3.09 Charlton 17.36 20.42 12.50 131 1.14 0.31 2.04 Kidbrooke 4.68 10.50 7.14 40 0.37 - - Whole Borough 16.88 19.16 12.20 119 1.70 0.41 1.90 Attack Rates of the various notifiable diseases per 1,000 living in the several districts : — Typhoid Fever. Puerperal Fever. Scarlet Fever. Districts. Small-pox. Diphtheria. Erysipelas. East Greenwich .00 2.71 1.76 0.20 0.09 - West Greenwich .00 2.48 1.73 0.65 - - St. Nicholas .00 1.91 3.68 2.06 0.29 0.14 Charlton .00 3.51 1.65 0.19 0.38 - Kidbrooke 1.12 0.37 - .00 2.25 - Whole Borough .00 2.72 1.86 0.45 0.13 0.01 10 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 Stall have performed their duties throughout the past year. I am, Gentlemen, Yours respectfully, E. G. ANNIS. VITAL AND MORTAL STATISTICS, 1917. POPULATION. The number of persons estimated to be living at the middle of 1918 was 100,773 for the Birth Rate, and 89,939 for the Death Rate. The distribution of the population throughout the Borough is as follows:— Census, 1911. Estimated Population at middle of year 1918. Calculated on Death Rate. Birth Rate. East Greenwich 45,960 43,303 48,519 West Greenwich 22,933 21,430 24,004 St. Nicholas 7,290 6,811 7,632 15,720 17,622 Charlton 16,901 Kidbrooke 2,875 2,675 2,996 95,968 89,939 100,773 Total MARRIAGES. The Superintendent-Registrar of the Greenwich Registration District has kindly furnished hie 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. 11 The following table'shows these particulars, giving the number of marriages in Greenwich and St. Nicholas, etc., for each year since 1910. 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. In Churches of England in Charlton and Kidbrooke. St. Nicholas Parish Church. Approximate Population of the districts concerned. In Churches of England in Greenwich. Year. Total. 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 74 924 94452 324 1917 343 128 67 1191 90440 653 1918 353 165 55 244 817 89939 BIRTHS. The total number of Births registered in the Borough during the year has been 1,753, but of these, 92 occurred in the Greenwich Union Infirmary, the address of the mother being in 27 instances in Deptford, 19 in Lewisham, 17 in Woolwich and one in Croydon. Deducting these and adding seven which were transferred from Lambeth, Stepney, St. Pancras and Deptford, it will lie seen that the number of strictly Greenwich births for 1918 is 1.696, of which 872 were males and 824 females. This corrected figure gives a Birth Kate of 16.88 per 1,000 of the population, being 7.65 below the average for the last seventeen years, 1901 to 1917, the period since the formation of the Metropolitan Borough. Amongst the total number of births registered in the Borough there were 114 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. 82 of such births were registered in the East Greenwich District, which includes the Infirmary of the Greenwich Union. In 19 cases the mother was ordinarily a resident in the Borough of Deptford, 13 in Lewisham, 14 in Woolwich and one in Croydon, and accordingly this number of births have been transferred to those Boroughs. The remaining 67 were similarly allocated to the district in this Borough in which the mother ordinarily resided, making 24 of such births belonging to East Greenwich, 24 to West Greenwich, 13 to St. Nicholas, and 6 to Charlton. 12 The Birth Rate for the County of London equals 16.1 per 1,000 of the population. It varied from 7.3 in the City of London, 10.3 in the City of Westminster, to 21.7 in Lambeth. The Birth Rate for all England and Wales was 17.7. Under the provisions of the Notifications of Births Act, 1907, intimations have been received from medical men, parents, and others, with respect to 1,735 births. DEATHS. The total number of deaths registered during 1918 was 1,718, of which 895 were males and 823 females. The crude Death Rate for the Borough of 1916 per 1,000 compares with 18.9, the Death Rate for the County of London, and 18.2 the Death Rate for the large towns. Locally the Death Rate varied from 26.03 in West Greenwich, 24.45 in St. Nicholas, 20.42 in Charlton, 16.01 in East Greenwich, to 10.50 in Kidbrooke. The following table shows the variation in, and average of, the Death Rates in each of the five Districts of the Borough in the live years, 1913 to 1917, compared with the figures for 1918:— 1917. Average for Five Years. District. 1913. 1914. 1915. 1916. 13.57 12.57 13.11 East Greenwich 12.46 12.87 14.05 19.62 West „ 18.81 18.61 19.93 19.55 18.83 26.52 22.44 22.63 St. Nicholas 18.78 18.73 26.07 11.83 Charlton 12.75 17.56 13.66 13.63 13.50 27.42 19.24 Kidbrooke 6.55 43.41 8.57 6.71 14.95 17.56 Borough 14.31 15.14 15.96 15.47 13 DEATHS IN INSTITUTIONS. The following table gives the particulars showing the number of deaths of Greenwich residents in Public Institutions : Total Deaths of Greenwich Residents under 1 year of age. Total Deaths of Greenwich Residents in Public Institutions. Total Deaths of Greenwich Residents. Year. 1901 1,468 362 356 1902 1,522 387 408 1903 1,317 345 354 1,450 1904 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 1,421 488 306 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 1817 1,439 203 364 1,409 Average 284 459 1,718 210 1918 651 Age Mortality. The age mortality and the distribution of the deaths between the different quarters of the year is shown by the following table: — First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Deaths. Total. Under 1 year of age 53 64 54 39 210 87 Between 1 and 2 years 26 26 12 23 27 104 Between 2 and 5 years 23 14 40 Between 5 and 15 years 109 13 14 24 58 17 137 Between 15 and 25 years 17 24 79 48 Between 25 and 45 years 45 44 173 310 73 366 Between 45 and 65 years 95 74 124 65 years and upwards 85 395 107 79 124 Total 383 340 310 685 1,718 14 NOTIFICATION OF BIRTHS ACT, 1907. Date of adoption — l7March, 1909. Misses Millington, Chitty and Reid 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 rise in the Infantile Mortality in West Greenwich, St. Nicholas, Charlton and Kidbrooke, whilst East Greenwich lias improved in that respect. Visits paid in reference to Births 1,514 Re-visits made 1,181 Visits paid in reference to Notified Cases of Diarrhœa 149 Re-visits made in reference to Cases of Diarrhœa 114 Visits paid in reference to Cases of Measles 93 „ „ „ Whooping Cough 53 „ „ „ Ophthalmia Neonatorum 23 Re-visits „ „ „ 34 Visits paid in reference to Scabies Cases 65 „ „ Verminous Cases 37 „ „ Ante-Natal „ 51 Miscellaneous enquiries and extra visits paid by special request 296 Consultations attended 139 3,749 The following table gives the number and character of the intimations respecting births in the Borough:— 1914 1916. 1917. 1911. 1912. 1913. 1915 1918. Total Number of Births notified in each year since adoption 2,623 2,513 2,280 2,497 1,992 2,553 2,450 1,735 1,340 1,338 1,095 (a) Attended by Midwives 1,412 1,226 1,282 1,314 990 1,283 1,175 1,054 1,183 897 (b) Attended by- Doctors 1038 745 1,271 Number of Still Births notified in each year 47 71 53 42 61 24 36 44 Number of Births registered in each year 2,381 2,393 2,409 2,347 2,545 2,354 1,967 1,753 15 INFANTILE MORTALITY. The Infantile Mortality, measured by the deaths of children under one year of age to the number of births 'registered, was 119 per 1,000 births, there having been a total of 210 such deaths during the year, as compared with 238, 197, mid 203, the figures for the years 1915, 1916 and 1917. The number for the County of London was 107 per 1,000 births, the average for the past five years in Greenwich has been 103 per 1,000 births. For all London the rate was 107 in 1918, compared with 103 in 1917 and 89 in 1916. For England and Wales the rate was 97, compared with 97 in 1917, 99 in 1916 'and 110 in 1915. Locally, the variations were from 40 per 1,000 births in Kidbrooek, 99 in East Greenwich, 123 in St. Nicholas, 131 in Charlton to 146 in West Greenwich. The following table compares at a glance these figures for the years since the formation of the Borough:— Average for five Years, 1901-1905 inclusive. Average for five Years, 1906-1910 inclusive. Average for five Years, 1911-1915 inclusive. 1916. 1917. District. 1918. East Greenwich 96 99 129 106 68 109 West „ 126 110 112 92 106 146 St. Nicholas 179 143 167 156 114 123 Charlton 121 109 76 75 97 131 39 16 40 Kidbrooke 79 51 - Total 131 111 103 83 105 119 AN ANALYSIS OF DEATH CAUSES. All death causes are conveniently arranged under various headings, according to the Registrar-General's classification of diseases, and the follow ing table shows the Death Kates 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. 16 1918. Infective Diseases— Epidemic 4.86 Sporadic 0.01 Venereal 0.06 Septic 0.04 Malarial 0.01 Tuberculosis 1.90 Dietetic Diseases 0.01 Constitutional Diseases 1.41 Developmental Diseases 2.09 Local Diseases — Nervous System 0.32 1908. Local Diseases —continued. Circulatory System 1.52 Respiratory System 3.64 Digestive System 0.78 Urinary System 0.53 Reproductive System 0.06 Parturition 0.02 Bones and Joints 0.02 Integumentary System 0.06 External Causes — Accidents 0.53 Organs of Special Sense 0.03 Suicide 0.04 REMARKS ON VARIOUS DEATH CAUSES. Infective Diseases. Epidemic. There were 436 deaths due to this class of diseases, equalling a Death Rate of 4.86 per 1,000; the rate last year was 1.54, and was 2.30, 1.71 and 1.71 in 1914, 1915 and 1916 respectively. Zymotic. The purely Zymotic class of epidemic diseases is credited with causing a total of 153 deaths, equalling a Death Rate of 1.70 per 1,000. Locally, the Zymotic Death Rate varied from .37 in Kidbrooke (0.00 in 1917), 1.1 in Charlton (1.18 in 1917), 1.78 in East Greenwich (1.31 in 1917), 2.01 in West Greenwich (1.2l in 1917), up to 2.06 in St. Nicholas (3.80 in 1917). Small-Pox. There were no deaths from this disease in 1918, this being the sixteenth 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 45 which occurred in 1917; 45, 46 and 48 deaths were recorded in the years 1914, 1915 and 1916 respectively. Thirty-seven of the deaths occurred in East Greenwich, 5 in West Greenwich. 0 in St. Nicholas, 3 in Charlton, and 0 in Kidbrooke. The quarterly incidence was 20 in the first, and 17, 7 and 1 respectively in the succeeding quarters. 17 Scarlet-Fever. This disease occasioned 1 death between the ages of two and fifteen years, which occurred in St. Nicholas. One such death occurred in 1917 and 4 in 1916. Diphtheria. There were 16 deaths from this disease during 1918. This gives a Death Rate for Diphtheria of .07 comparing with .29 the rate for 1917. Twenty-seven deaths occurred in 1917 which were attributed to this cause, and 17, 14 and 22 in 1914, 1915 and 1916 respectively. Nine of the patients were under five years of age, and 7 of the patients were over five years of age. Ten tubes of Diphtheria Anti-toxin, containing a total of 20,000 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 45 deaths in 1918, as against 43, 23 find 8 in 1915, 1916 and 1917 respectively. These deaths equal a rate of 0.50 per 1,000. Ten of the deaths occurred in East Greenwich, 24 in West Greenwich, 7 in St. Nicholas and 4 in Charlton. Typhoid Fever. There were 4 deaths ascribed as due to this disease: there were 2 in 1917, 6 in 1916, 7 in 1915, 5 in 1914, 3 in 1913, 2in 1912, 4 in 1911 and 3 in 1910. One death occurred in East Greenwich, 1 in West Greenwich, and 2 in Charlton. Diarrhœa and Zymotic Enteritis. Thirty-seven deaths were stated to be due to this cause, equalling a rate of .41 per 1,000. Last Year there were 38 deaths, and 57, 37 and 42 respectively in 1914, 1915 and 1916. The deaths were distributed as follows:— Twenty-one in East Greenwich, 7 in West Greenwich, 4 in St. Nicholas, and 5 in Charlton. Twenty-seven patients were over five years of age. The deaths in 1917 were distributed as follows: —16 in East Greenwich, 7 in 'West Greenwich, 6 in St. Nicholas, and 9 in Charlton. It is interesting to note that the deaths during the months when Diarrhoea is notifiable in Greenwich were 13 in 1916, 29 in 1917 and 24 in 1918. Influenza. Influenza is found to have been'the responsible cause of 301 deaths in 1918: 22 was the average of the previous three years. Of the 301, 25 were over sixty-five years of age. Sporadic Diseases. There was one death from this class of diseases during the year. Venereal Syphilis. Six deaths were given as due 'to Syphilis, as against 5 in 1917 and 6 in 1916. Of these 6 deaths, 4 were under five years of age. One occurred in East Greenwich, 4 in West Greenwich and 1 in Charlton. Four of the deceased persons were in the Greenwich Infirmary. 18 There were no deaths from Gonorrhœa during the year. Septic. Erysipelas. Two deaths occurred from this cause in 1918, 1 in 1917, 3 in 1916 and 4 in 1915. Puerperal Fever. There were 0 deaths from this disease during the year. Pyemia and Septicemia. There were 0 deaths from this disease during the year. Infective Endocarditis. One death was ascribed to this cause in 1918. The number was 1 in 1917, 4 in 1916 and 0 in 1913. Malarial. Rheumatic Fever. There was 1 death in 1918, as compared with 3 in 1917, 1 in 1916 and 3 in 191.5. Tuberculosis. This class includes the causes of 17.1 deaths during the year under review, with a rate of 1.90; these figures compare with 202, 170 and 219, the totals of the years 1915, 1916 and 1917 respectively, and respective rates of 2:09, 1:80 and 2:42. Tuberculosis of the lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 146 attributed to this cause, or a rate of 1.62 per 1,000. Locally, the deaths were 0 in Kidbrooke, 16 in St. Nicholas, giving a Death Rate of 2.35; 29 in Charlton, giving a Death Rale of 1.85; 47 in East Greenwich, giving a Death Rate of 1.08; and 54 in West Greenwich, giving a Death Rate of 2.52 per 1,000. The remaining forms of Tuberculosis were responsible for 25 deaths, 11 being in East Greenwich, 6 in (West Greenwich, 5 in St. Nicholas and 3 in Charlton. Of these other forms of Tuberculosis, Tuberculosis of the Brain or its Membranes was credited with 11,6 being under five years of age; Tubercle affecting the Intestines, 5 deaths (4 being under five years of age); General Tuberculosis, 7 deaths (2 under and 5 over five); and other forms, 2. Parasitic Diseases. There were no deaths from this class of disease. Dietic Diseases. There was 1 death from this class of disease, due to Acute Alcoholism in West Greenwich, Constitutional Diseases. The deaths from this cause were 127 in number, which gives a rate of 1.41 per 1,000. Of these, 115 were attributed to Cancer, 8 to Diabetes, 3 to Anaemia and 1 to Gout. The deaths from Cancer were distributed as follows: — 44 occurred in East Greenwich, 32 in West Greenwich, 10 in St. Nicholas, 27 in Charlton, and 2 in Kidbrooke. Developmental Diseases. There were 188 deaths from this class of Causes, equal to a rate of 2.09 per 1,000. 19 These may roughly be divided into those from causes which would appear to be unavoidable, viz.:—Congenital defects, 4, and those from causes more or less preventable, viz.:—Premature birth 31; Injury at birth, 1; Debility at birth, 4; Atrophy, Debility and Marasmus, 19; Atelectasis, 3; Dentition, 3; and Rickets, 10. The remaining and largest portion of these deaths from developmental diseases, 113 in number, 'were from Old Age; in 1917 there were 137 deaths from this cause, and 109 in the previous year. Local Diseases. Nervous System. One hundred and twentynine deaths were attributed to the various nervous diseases, which gives a rate of -32 per 1,000; last year the rate was 1.50 per 1,000. Convulsions were responsible for 19, 16 being under live years of age; 6 were from Meningitis, 62 from Apoplexy, 3 from Softening of the Brain, 2 from Hemiplegia or Brain Paralysis, 7 from General Paralysis of the Insane, 3 from other forms of Insanity, 8 from Cerebral Tumour, 4 from Epilepsy, 1 from Encephalitis, 3 from Locomotor Ataxy, 4 from Paraplegia, and 7 from other diseases of this system. Organs of Special Sense. There were 3 deaths from this class of causes, equal to a rate of 0.03 per 1,000. Circulatory System. The Death Rate from diseases of this system was 1.52 per 1,000, there being a total of 137 such deaths. Valvular Diseases of the heart were responsible for 89, 1 from Hypertnophy of the Heart, 8 from Aneurism, 3 from Embolism, and from the remaining diseases of this system, 36. Respiratory System. Three hundred and twenty-seven deaths were due to diseases of the respiratory organs, as compared with 249 in the preceding year. The Death Rate under this heading equals 3.64 per 1,000. Sixty were from Acute and 65 from Chronic Bronchitis; 195 from the various forms of Pneumonia, 67 being under five years of age, 3 to Emphysema, and 4 to other diseases. Digestive System. There were 70 deaths from diseases of this system, equal to ,a rate of .78 per 1,000; (of this number Enteritis was responsible for 17, 12 being under five years,of age); 6 were due to Ulcer of the Stomach and Duodenum, 6 to Appendicitis, 18 to obstruction, and 6 to other diseases of the Intestines, 6 to Cirrhosis, and 1 to other disease of the Liver', 6 to Peritonitis, 3 to other diseases of Stomach, and 1 to other disease of the Digestive System. Lymphatic System. There were no deaths from diseases affecting this system during the year. Urinary System. Forty-eight deaths, equal to a rate of .53 per 1,000, occurred from diseases affecting this system. Twenty- 20 seven were from Bright's Disease, 7 from Acute Nephritis, 2 from Calculus 9 from diseases of the Bladder and Prostate, and 3 from ill-defined causes of the urinary system. Reproductive System. Disease of the generative organs was the cause of 6 deaths, 4 deaths were attributed to diseases of Uterus and Appendages and 2to Diseases of Ovaries. There were 2 deaths attributed to diseases of Parturition. Bonks and Joints. There were 2 deaths from diseases of bones and joints. Integumentary System. There were 6 deaths from diseases of Integumentary System. External Causes. There were 53 deaths given as due to causes grouped under this heading; 49 were the result of accident or negligence, and the remaining 4 Were from Suicide. No children died of Suffocation by being overlaid in bed during 1918 (compared with 6 from this cause last year); 7 cases were from drowning, 1 by weapon or implement, while accidents on railways, in vehicular traffic and in building operations, falls, etc., were responsible for 45 deaths. The Suicides were 1 by cut or stab, 1 from Drowning, 1 by Hanging and Strangulation, and 1 from Asphyxia. Ill-Defined Causes. There was no death the cause of which was not ascertained in 1918. MORTUARY. The number of bodies dealt with in the Mortuary since 1910 is shown below: — Drowned Bodies from River. Year. Other Bodies. Totals. 1910 12 109 121 1911 8 112 120 15 126 141 1912 1913 17 114 131 1914 15 134 149 1915 15 194 209 1916 11 182 193 1917 15 209 224 1918 24 138 162 Notifications under the Provisions of the Public Health (London) Act, 1891. During the year 2,613 cases have been notified under the above Act, as compared with 1,493, 1,906 and 1,400 respectively, in the preceding years 1915, 1916 and 1917. Small-Pox. No cases of this disease were notified during the year in persons residing in the Borough. Chicken-Pox. Two hundred and nineteen cases of this disease were notified during three months of the year in which it was notifiable. Supplemental Vaccination Return for 1917. Return made on or before the 8th of February, 1919, 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, 1917, inclusive: — No. of Births which on 31st Jan., 1918, remained unentered in the Vaccination Register on account of— No. of these Births duly entered by 31st Jan.. 1918. No. of Births from 1st Jan. to 31st Dec., 1917. Registration Sub-Districts Comprised in the Vaccination Officer's District. No. of these births remaining on 31st Jan., 1919, not accounted for. Removal to Districts, V. O. of which apprised. Removal to places unknown and case not found. Certificates of conscientious objection received. Dead Unvaccinated. Postponement by Medical Certificate, Insusceptible of Vaccination. Successfully Vaccinated. Had Small-pox. 5 7 1 2 3 4 6 8 9 10 11 South Deptford ... 7 474 241 2 ... 152 21 28 23 North Deptford 1089 537 9 280 76 10 12 55 110 ... East. Deptford 903 458 143 76 15 5 88 116 2 ... East Greenwich 925 478 4 232 76 2 31 61 41 ... West Greenwich 481 250 2 ... 140 24 5 5 26 29 60 258 Total 3872 1964 19 947 273 32 319 ... Dated February 7th, 1919. 22 Diphtheria. Two hundred and forty-four cases of Diphtheria were notified during the year, as compared with 236, 169, 364 and 322, respectively, in the years 1914, 1915, 1916 and 1917. This distribution of these cases was as follows: — 117 in East Greenwich, 53 in West Greenwich, 13 in St. Nicholas, 55 in Charlton, and 6 in Kidbrooke. Of this total number, 214 were removed to the Hospital for treatment. Amongst which number, the Hospital Authorities reported that in 3 they considered the diagnosis incorrect. There were 16 fatalities due to this disease, which gives a case mortality of 6.5 per cent. One thousand one hundred and one 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 110 were positive in character, being dealt with accordingly. The quarterly incidence of the disease for 1918 has been as follows:— 1st Quarter —East Greenwich, 43 cases; West Greenwich, 8; St. Nicholas, 7; Charlton, 21; a total of 79 cases. 2nd Quarter —East Greenwich, 26 cases; West Greenwich, 11; St. Nicholas, 2; Charlton, 17; Kidbrooke, 3; a total of 59 cases. 3rd Quarter —East Greenwich, 31 cases; West Greenwich, 21; St. Nicholas, 2; Chariton, 7; Kidbrooek, 3; a total of 64 cases. 4th Quarter —East Greenwich, 17 cases; West Greenwich, 13; St. Nicholas, 2; Charlton, 10; a total of 42 case. 23 Membranous Croup. No cases of Membranous Croup were notified during the year. Erysipelas. Forty-one cases were notified during the year, 9 being in East Greenwich, 14 in West Greenwich, 14 in St. Nicholas, 3 in Charlton, and 1 in Kidbrooke. One of these patients was removed to a Public Institution in the District. Scarlet Fever. One hundred and sixty-seven cases were notified during the year, as compared with 325, 193 and 155 cases respectively, in the years 1915, 1916 and 1917; 76 cases were in East Greenwich, 37 in West Greenwich, 25 in St. Nicholas, 26 in Charlton, and 3 in Kidbrooke; 154 of these cases were removed to the Hospital for treatment. There was 1 death from this disease during the year as against 1 last year. One of the cases removed to the Hospital as suffering from Scarlet Fever was returned as wrongly diagnosed. The following Table gives particulars of the two cases which would seem to be "return cases." There were no such cases in 1917, 6 in 1916, and 17 in 1915. Table showing Return Cases of Scarlet Fever during year 1918. Date of Removal of Primary Case. Date of Removal of Second Case. Time between Cases Date of Disinfection. Date of Discharge from Hospital. Remarks, &c. Appearance on discharge from Hospital. 16th Nov., 1917 16th Nov., 1917 3rd Jan., 1918 17 days 20th Jan., 1918 Apparently well. 12th Feb., 1918 13th Feb., 1918 5th April, 1918 23rd April, 1918 19 „ Apparently well. 25 Typhoid Fever. There were 12 cases of Typhoid Fever notified during the year, 4 being in East Greenwich, 0 in West Greenwich, 2 in St. Nicholas, 6 in Charlton, and 0 in Kidbrooke. The ages of the patients were: 5 between five and 1 fifteen years: 2 between fifteen and twenty-five years, 4 between twenty-live and forty-five years, and 1 between forty-five and sixty-five years. Of the total number of cases 7 were removed to the Hospital for treatment. Thirteen such cases occurred in 1917, 14 in 1916 and 25 in 1915; the average number for the years 1902 to 1917, inclusive, being 25. There were four fatalities from this disease during the year, 1 in East Greenwich, 1 in West Greenwich, and 2 in Kidbrooke Four specimens were forwarded for bacteriological examina- tion from cases suspected to be Typhoid Fever in character, all giving a positive result. Three of the cases removed to the Hospital as suffering from Typhoid Fever were returned as wrongly diagnosed. Puerperal Fever. One case of this disease was notified during the year, which occurred in St. Nicholas. There were 3 cases in 1917, 14 in 1916, and 4 in 1915. There were no deaths from this disease during the year. Measles. Seven hundred and ninety-four cases of Measles were notified during the year, as compared with 1,409 during the previous year, and 1,378,971, and 982 in the years 1916, 1915 and 1914 respectively. The ages and incidence of fatality of the disease were as follows —There were 458 cases under five years of age, amongst whom there were 42 deaths, giving a case mortality of 9.1 per cent. Between the ages of five to fifteen years there were 307, with 3 deaths at this age period, giving a case mortality of .98 per cent. Between fifteen.and twenty-five there were 22 cases and no deaths; between twenty-five and forty-five, 6 cases and no deaths; and one between forty-live and sixty-five, which recovered. The case mortality for the whole district works out at 5.6 per cent. 26 Table showing number of Measles Cases reported during the year 1918. 1st QUARTER. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. East Greenwich 51 4 6 64 ... West Greenwich 3 46 11 2 1 St. Nicholas 2 2 ... ... ... Charlton 2 27 20 2 1 Kidbrooke ... ... ... ... ... Total 11 139 84 2 8 Total 244. 2nd QUARTER. Under 1. 5 to 15. 15 to 25. 25 to 65. 45 to 65. 1 to 5. East Greenwich 9 161 74 7 1 1 West Greenwich 37 19 2 1 ... ... St. Nicholas 1 6 7 ... ... ... Charlton 2 35 40 2 3 ... Kidbrooke ... ... ... ... ... ... 239 11 1 Total 14 140 3 Total 408. 3rd QUARTER. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. East Greenwich 2 24 21 1 ... West Greenwich 9 6 ... 1 ... St. Nicholas 9 7 1 ... ... Charlton 2 10 ... ... ... Kidbrooke ... ... ... ... ... Total 2 44 44 2 1 Total 93. 4th QUARTER. 1 to 5. 5 to 15. 15 to 25. Under 1 25 to 65. East Greenwich 6 21 ... ... ... West Greenwich 1 1 ... ... ... St. Nicholas 3 ... ... ... ... Charlton 2 15 1 ... ... Kidbrooke ... 3 ... ... ... Total 9 1 39 ... ... Total 49. Total cases in year = 794. 27 Zymotic Enteritis or Summer Diarrhœa. This Council made an order requiring' the notification of cases of Zymotic Enteritis or Summer Diarrhœa during the months of July, August and September. The order was duly advertised and came into operation for the months stated. The sections included in the order were Sections 55 and 57 of the Public Health (London), Act, 1801, and under the provisions of these sections 208 cases of Diarrhoea were notified throughout the whole of the Borough, 67 being under one year of age: 105 between one and five; 34 between five and fifteen; 1 between fifteen and twenty-five and 1 between twentyfive and forty-five. One hundred and eight of such notifications related to patients in East Greenwich, 02 in West Greenwich, 14 in St. Nicholas and 24 in Charlton. There were 37 deaths ascribed to this disease, comparing with 38 in the previous year. Whooping Cough. Four hundred and ninety-seven cases were notified (compared with 136 in 1917), 59 being under one year of age, 263 from one to five and 175 from five to fifteen; the districts concerned being East Greenwich, 108: West Greenwich, 62; St. Nicholas, 14, and Charlton, 26. Each of these cases was visited and leaflets and instructions left together with verball advice respecting the isolation and care of the patient. Epidemic Cerebro-Spinal Meningitis or Cerebro-Spinal Fever. There were 2 cases of Cerebro-Spinal Meningitis noli lied during the year, 1 in St. Nicholas, 1 in Charlton. One of the cases removed to Hospital as suffering from Cerebro-Spinal Fever Mas returned wrongly diagnosed. 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. Two cases were notified during 1918. There were no cases in 1917, 2 in 1916 and none in 1915. Ophthalmia Neonatorum. During the year 23 cases of this disease have been notified, 4 being in East Greenwich, 14 in West Greenwich, 2 in St. Nicholas and 3 in Charlton. Contacts. Three intimations were received from the Medical Officer of Health of the various Port Sanitary Authorties respecting persons who had been in contact with Small-pox, and one with Plague, which were kept under observation. 28 During the year the undermentioned Military Discharges have been notified and visited: — Malaria 42 Dysentery 3 Enteric Fever 2 47 Glanders. Under the Glanders Order no notification been made to this authority during the year with respect to out- breaks 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 403 cases of Tuberculosis notified in the Borough, 267 being pulmonary cases, ordinarily known as Consumption, and 136 non-pulmonary, being Tuberculosis affecting other portions of the body than the lungs. Of this number of cases, 98 Pulmonary and 53 Non-pulmonary occurred in East Greenwich, 90 Pulmonary and 37 Non-pulmonary in West Greenwich, 20 Pulmonary and 17 Non-pulmonary in St. Nicholas, 5 Pulmonary and 29 Non-pulmonary in Charlton, and 83 Pulmonary in Kidbrooke. The various ages of the patients were as follows: — Pulmonary cases, under one year of age, no cases; from 1 to '5, three cases; 5 to 15, thirty-three Cases; 15 to 25, sixtythree cases; 25 to 4.5, one hundred and thirty-two cases; 45 to 65, thirty-five cases; and one case over 65; whilst the Non-pulmonary wen —under 1 year of age, one case; 1 to 5, twenty-three cases; 5 to 15, ninety-two cases; 15 to 25, eight cases: 25 to 45, twelve cases. Two hundred and sixty-eight specimens were forwarded by medical practitioners for bacteriological investigation from patients suspected to be consumptive; 216 were reported to be negative and 52 positive. Disinfection has been offered and carried out in 66 cases, including 87 rooms (and 360 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 1918. I have the honour to submit the sixth report upon the work carried out at the Tuberculosis Dispensary. 29 New Patients examined during 1918. Recommended by. Males. Females. Children. Total. Private Practitioners 77 50 28 155 London County Council 18 18 - - From Sanatoria - - - - Military 64 - 64 - Own accord 9 21 52 82 Contacts 11 43 286 340 Other Institutions, Hospitals, Clinics, &c. 7 19 26 - 161 121 403 685 Consultative Cases. Males. Females. Children. Total. National Insurance 52 17 69 - London County Council - - - - Private Practitioners 53 32 6 91 Military 64 - 64 - 169 49 6 224 Males. Females. Children. Totat. Contacts 11 43 286 340 Found Tuberculous 4 10 47 61 Attendances. Patients retained for Treatment. Males. Females. Children. Total. Patients 72 112 212 396 Re-attendances 722 1316 2846 4884 Patients retained for Observation. Females. Males. Children. Total. Patients 32 63 207 302 Re-attendances 140 447 2007 2594 Nurses Visits. First Visits 366 Re-visits 3327 3693 Patients Primarily Notified from Dispensary. Pulmonary 68 Other Forms 49 117 30 Sputum Examination. Negative Results 125 Positive „ 32 157 Number of Examinations Dispensary Patients referred elsewhere. Males. Females. Children. Total. Sanatorium 9 9 12 30 Infirmary 2 2 - 4 Hospital 1 6 6 13 Doctors 2 6 1 9 14 23 19 56 Suspected (Observation) Patients Discharged. Much Improved. Improved. Total. 8 Males 8 - Females 11 11 - Children 61 61 - 80 80 - Suspected (observation) Patients disposed of otherwise. Males. Females. Children. Total. Taken on as Patients) (Tuberculous) ) 10 8 21 39 Sent to Institution (Hospital Convalescent Home) 18 1 11 6 Died (Intercurrent Disease) ) - - - - Interned - - - - Enlisted - - - - 11 19 27 57 Deaths of Patients during 1918. Males. Females. Children. Total. At Home 5 1 11 5 Hospital - - - - Infirmary 1 1 2 - Sanatorium - - - - 6 6 1 13 31 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. E. G. Annis, Executive Tubetrulosis 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 Creche and Cleansing Station, Wellington Street. Albany Institute Infant Consultation, Creche 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, 230, Trafalgar Road. Greenwich Borough Council's Infant Consultation and Ante- Natal Centres. The total attendances of Babies at our Crèche has been 7,445, whilst the figures for our Infant Consultation Centre are as follows:— New Cases 446 Attendances 3,481 Medical Consultations 1,527 The Children are weighed at every attendance. The number of cases attending the Ante-Natal Clinic is 47 and the number of attendances 67. In December, 1917, owing to the difficulty of obtaining milk, the Ministry of Food purchased large stocks of Dried Milk and 32 circularised the Infant Welfare Centres as to the conditions under which this milk could be obtained for the benefit of the young infants. Under this arrangement, £750 worth of milk was distributed to the mothers attending the various Infant Welfare Centres during 1918. This milk was purchased at 1s. 10d. a lb. from the purveyors, and sold at cost price to the mother, thus no profit being made on these transactions. Undoubtedly, this was a very wise arrangement, and has been of great benefit to the young infants. During the year also, about £30 worth of Virol has been distributed; for this, the mothers bring their own jars, and Virol is dispensed at 2d. per oz., which is roughly, at cost price. HOUSES INSPECTED AND ENQUIRIES MADE IN CONNECTION WITH INFECTIOUS DISEASE. Number of Houses Inspected and Enquiries made 2,273 Number of Re-visits 4,469 Eight hundred and four of the, above were carried out by Health Visitors and revisited when required. 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, 22; School Libraries, 3; Total, 25. The following special disinfections were carried out during the year: — April —Cold Storage Vaults, Reserve Supply Depot, Deptford. June —Maze Hill Schools, Boys' and Girls' Departments. October—Halstow Road Girls' School, six Class Rooms. November —Workshops for the Blind of Kent, six Work Rooms. Roan Girls' School, 30 Rooms (whole School). Blackheath and Charlton Cottage Hospital. Number of Articles and Rooms Disinfected in connection with the Undermentioned Diseases for the 52 weeks ending 28th December, 1918. 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 3 2 1 1 4 9 3 ... ... 1 ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... 155 169 100 2 50 222 262 25 33 1101 Scarlet Fever 92 103 212 44 52 227 244 25 2 Diphtheria 1 8 18 21 7 178 ... Enteric Fever 11 10 1 9 14 12 9 2 11 10 2 69 ... Puerperal Fever 1 1 ... 2 1 1 7 1 ... 2 ... ... ... Tuberculosis 50 17 3 21 41 76 8 66 87 3 38 103 360 Other Diseases 25 24 30 44 12 11 257 31 29 33 1 62 501 1 2 5 11 10 Scabies 1 22 3 87 12 1 17 4 4 7 7 11 12 72 From Verminous Premises 5 14 12 5 149 3 8 Polio Myelitis 1 1 1 ... 2 2 1 ... 7 ... 1 ... ... Measles 11 11 ... ... ... ... ... ... ... ... ... ... ... 20 Influenza 29 80 10 1 12 9 22 11 9 7 25 126 534 648 240 13 127 507 498 102 77 191 2594 Total 215 624 Number of Articles Destroyed in connection with the Undermentioned Diseases during the 52 weeks ending 28th December, 1918. 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 1 ... 8 2 ... ... ... ... ... Other Diseases 5 3 2 4 ... ... ... 66 ... ... 80 For Verminous Premises 1 3 2 59 2 4 5 3 12 5 22 Influenza 3 1 ... 4 1 2 ... ... ... 11 ... Total 3 12 5 12 5 8 11 2 158 12 88 35 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. SANITARY WORK. The tables on pages 36 to 51 summarise, as far as possible, the Sanitary work of the Department; from this it will be seen that a total of 9,416 houses and premises have been inspected or reinspected during the year; 664 intimation notices have been served, and 81 statutory notices. With the exception of prosecutions in connection with the Sale of Food and Drugs Act, it was only found necessary to institute Police Court proceedings in one case during the year. There were altogether throughout the year 488 complaints entered in the Public Complaints Register of the Department. Bakehouses. One hundred and thirty-seven inspections have been made of the various Bakehouses in the Borough, and 43 nuisances found therein have been abated as the result. Factories and Workshops. Three hundred and thirty-three inspections have been paid to these premises within the Borough during the year. There were 203 workshop premises on the Register at the beginning of the year, 3 have been added during the year, and 6 have been taken off, leaving a total now on the Register of 200. This total includes 16 laundries, 29 dressmaking and mantle works, 7 fuel and firewood works, 3 cycle works, 9 milliners, and various others, including workplaces, such as 4 blacksmiths, 14 barge builders, 3 builders' yards, etc. Information has been sent to H.M. Inspector of Factories with respect to 2 workshops converted into factories. Outworkers' Register. Fifty-two Lists of Outworkers containing 162 names and addresses, have been received during the year from the Medical Officers of Health for other Districts; 21 lists, containing 80 names, haw been received from employers within the District; 43 names have been forwarded to other Districts, thus giving a total of 199 names and addresses of outworkers within the Borough. One hundred and five visits of inspection have been paid to these premises. 36 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES and HOMEWORK. 1.—INSPECTION. Premises. Number of Written Notices. Inspections. Prosecutions. 113 Factories (Including Factory Laundries) ... ... Workshops (Including Workshop Laundries) 188 ... ... ... Workplaces (Other than Outworkers' Premises) 156 10 Total 10 ... 457 2.—DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. *Nuisances under the Public Health Acts : — ' Want of Cleanliness 74 74 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of Drainage of Floors 2 2 ... ... Other Nuisances 18 18 ... ... Sanitary Accommodation — Insufficient 10 ... 10 ... 3 Unsuitable or defective 3 ... ... Not Separate for Sexes 4 4 ... ... Offences under the Factory and Workshop Act : — Illegal Occupation of Underground Bakehouse (s. 101) ... ... ... ... Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) ... ... ... ... Other Offences ... ... ... Total 111 ... ... 111 * Including those specified in Sections 2, 3, 7 and 8 of the Factory Act, as remediable under the Public Health Acts. 3.—HOME WORK. Nature of Work. Outwork in unwholesome premises. Sec. 108. Outwork in infected premises. Secs. 109 & 110. Outworkers' Lists. Section 107. Lists received from Employers. Numbers of addresses of outworkers received from other Councils. Numbers of addresses of outworkers forwarded to other Councils. Prosecutions. Number of inspections of outworkers' premises. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 110). Prosecutions (Secs. 109 & 110). Failing to keep or permit inspection of lists. Twice in the year. Once in the year. Failing to send lists. Out- workers Lists. Outworkers Lists. Wearing Apparel — 15 73 5 6 91 40 ... (1) Making, &c. 34 ... ... ... ... ... ... ... (2) Cleaning & Washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace,LaceCurtains & Nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur Pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cotton and Kit Bags ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush Making ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Box Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rackets & Tennis Balls ... ... 70 2 ... 70 ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ... 15 73 6 7 162 43 ... 105 ... ... ... ... ... ... 38 4.—WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1918 No. Bakehouses 42 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 16 Milliners 9 Photographers 3 Picture Frame Makers 1 Printers 1 Tailors 5 Underclothing Makers 1 Others 44 - 200 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 1917 12 Certificates granted in 1917 In use at the end of 1918 12 Slaughter Houses. The slaughter houses in the Borough have been inspected on 71 occasions by the Inspectors. 39 Cowhouses. The four cowhouses in the Borough have been visited on 20 occasions, and the required cleansing has been duly enforced on 10 occasions. Horse Slaughterer. The one horse-slaughtering house in the Borough has been visited by the Inspector on 12 occasions, and cleansing of the premises was required on 4 of these visits. Other Scheduled Offensive Trades. The premises where these offensive trades were carried on within the precincts of the Foreign Animals Wharf have now been taken over by the War Office and are now in use as a barracks and Army Service Depot. Dairies, Cowsheds and Milkshops Order. At the commencement of the year there were 127 premises on the Register of Dairies and Milkshops; 10 new applications have been received during the year and added to the Register, and 8 names have been taken off, thus leaving a total of 129 premises now registered. During the year 172 visits of inspection have been paid to these premises; notice was served upon the occupier in one case for dairy requiring limewashing. 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, no registration has been refused on the grounds of the unsuitability of the premises. Ice Cream Premises. There were 103 premises known at the commencement of the year where the manufacture of this commodity was carried on; 1 has been added during the year and 1 taken off, leaving a total of 103 premises. These premises were inspected on 72 occasions, and improvement required by way of cleansing of the premises in 1 case. Food Preparation. Places where food is prepared have been visited on 102 occasions, improvements being required in 12 instances, as detailed below: — 40 Number of Inspections Number on Lists. Number of instances where matters needed attention. Class of Premises. At end of 1917. Added 1918. Removed 1918. At end of 1918. Hotel Kitchens 4 ... ... 4 4 1 Eating Houses 50 2 9 43 57 5 Fried Fish Shops 22 26 22 3 3 2 Pork Butchers 17 4 13 13 ... ... Mineral Water Manufacturers 1 ... ... 1 1 ... Ice do. 2 2 1 ... ... ... 3 Sausage do. 15 12 15 1 ... Others 6 1 2 5 6 3 Totals 117 6 21 102 123 12 These 12 instances were premises which required cleansing. Customs and Inland Revenue Acts. —No application was received during the year for certificates under these Acts. Houses Let in Lodgings. There was no change in the Register of Houses during 1918, so that the number of premises on the Register of Houses Let in Lodgings is still 247 as at the end of last year. Twenty-eight inspections were paid to these houses during the year, which brought to light the fact that under the Public Health (London) Act, 1891, Ash-bins were required in 7 cases. House Drainage. Three drains have been constructed, 145 drainage systems have been reconstructed or repaired; 204 such systems have also been opened, cleansed and amended; 37 surface drains have been constructed; 28 drains and soil pipes have been ventilated, 77 systems have been tested by smoke, 84 by water and 60 by chemicals, of which number 87 were found to be defective; 13 new soil pipes and 96 traps have been fixed, together with 6 intercepting chambers and fresh-air inlets; 5 areas, 19 yards, and 1 41 forecourt have been thoroughly drained. Twelve water-closets have been erected; a pan, trap and water supply have been furnished throughout in 47 cases; pan and traps only furnished in 78 cases; pans only in, 15 cases, and other fittings provided or improved in 168 cases, whilst the water supply has been renewed in 117 instances. The water supply for lavatory purposes has been disconnected from the drinking water system in 1 instance. Publichouse urinals have been cleansed and repaired in 37 instances, 10 urinals were altered, and 14 repaired or water laid on. Refuse Removal. New ash receptacles have been provided in 217 cases. Water Supply. During the year no water supply certificates have been granted under Section 48 of the Public Health (London) Act, 1891. Defective water fittings have been remedied in 131 case; 19 water supplies have been reinstated where the supply had been cut off: water fittings have been amended in 172 cases; 2 water supplier have been altered so as to draw direct from the main; water supply provided in 8 instances and 1 cover to cistern adapted. Smoke Nuisances. Twenty-five observations have been taken for smoke nuisancer during the year, but on no occasion was it found necessary to issue Statutory Notices for the abatement of any nuisance which was found. Food and Drugs Act. Four hundred and eight 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 360 were certified to be genuine and 48 adulterated, the adulterations thus being equivalent to 11.7 per cent. of the samples taken. Of the total number of samples purchased, 190 were milk, of which 38 were certified to be adulterated; the remaining- adulterated samples were 1 of margarine, 3 mustard, 5 vinegar and 1 dripping. In addition, 9 samples were taken on behalf of the Food Control Committee. Proceedings were taken in 23 cases, resulting in lines and costs being imposed in 15 cases; in 2 cases conviction (no penalty) and costs; in 4 cases warranty was proved; in 1 case the summons was dismissed; in 1 case the proceedings are not yet finished. A warning letter was sent in 16 cases. 42 Sale of Food and Drugs Acts.—Number and Description of Samples purchased for Analysis under the above Acts during the Year 1918. Number of Samples Purchased. Number Adulterated. Number Genuine. Remarks as to Action taken. Description of Samples. 17 17 - Baking Powder ... Bird's Custard Powder 1 1 - ... Butter 16 16 - ... Cocoa 27 27 ... - Coffee 57 57 ... - Police Court proceedings in 1 case. Dripping 17 16 1 - Egg Powder 6 6 ... Egg Substitute 3 3 ... - 1 - Gravy Salt 1 ... Ground Ginger 2 2 - ... Margarine 11 10 1 Police Court proceedings in 1 case. Not labelled as required by Margarine Act. 14 warning letters sent. Police Court proceedings in 17 cases, no action in 7 cases. Milk 190 152 38 Mustard 10 7 3 Police Court proceedings in 1 case, warning letter was sent in 1 case, and no action taken in 1 case. Pepper 11 11 ... - Self-Raising Flour 18 18 - ... 5 Vinegar 21 16 Police Court proceedings in 3 cases, 1 warning letter was sent, and no action was taken in 1 case. 360 48 Total 408 43 Sale of Food and Drugs Acts, 1918. Legal Proceedings, Particulars of Samples adulterated and result of action taken. Description of Sample Margarine Milk „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ Mustard Milk „ „ „ „ Vinegar „ Milk „ „ „ „ „ Mustard „ Vinegar Dripping Milk Vinegar „ Milk Nature of Adulteration. Not labelled as required by the Margarine Act Addition of 3 per cent, of water „ 19 „ 19 „ „ 2 3 „ 7 „ „ „ Slightly deficient in solids, not fat „ „ „ „ „ „ „ Addition of 3.5 per cent. of water Slightly deficient in solids, not fat Addition 2 percent, of water, abstraction 5 per cent, of fat Addition of 23 per cent, of water 2 4 „ „ 3 „ 3 „ „ 11 „ „ „ 2 „ „ Extraction of 36 per cent, of fat Addition of 5 per cent, of water „ 7 „ „ Slightly deficient in solids, not fat Abstraction of 3 per cent. of fat „ 2 „ „ Admixed 20 per cent, flour coloured with Turmeric Addition of 2 per cent. of water Abstraction of 24 per cent, of fat Addition of 18 per cent, of water Abstraction of 21 per cent, of fat Slightly deficient in solids, not fat Admixed with 49 per cent, of water 49 Addition of 15 per cent, of water 5 „ „ 3 „ „ „ 3 „ „ „ 7 „ „ Abstraction of 12 per cent. of fat 35 per cent, flour coloured with Turmeric. Contained very small mixture of flour and Turmeric Addition of 32 per cent, of water 22 per cent. of water Addition of 10 pet cent, of water 15 „ 48 per cent, of Acetic Acid short Addition of 16 per cent, of water Result of Proceedings. Fine £3, Costs, £3. Warning letter. Still before Court. Costs 23s. Warning letter. „ „ Fine £2, Costs £2 2s. No action taken. „ „ „ „ Warning letter. No action taken Fine £1, Costs 10s. Fine £4, Costs 21s. Warning letter. „ „ „ „ „ „ Fine 20s., Costs 21s. Warning letter. Fine £5, Costs 21s. Warranty proved. Fine £1, Costs 21s. No action taken. Warning letter. „ „ Summons dismissed. Warning letter. Warranty proved. „ „ Fine 38s., Costs 22s. No action taken. „ „ Fine 8s., Costs 12s. Costs £2. 2s. Fine 20s., Costs 25s. Warning letter. „ „ Fine £3, Costs £2 5s. Fine £1, Costs £1 5s. Under special circumstances no proceedings taken. Warning letter. Fine 20s., Costs 32s. 6d. Fine 20s., Costs 22s. 6d. Warranty proved, summons dismissed. Fine £10, Costs 37s. 6d. Warning letter. Proceedings not taken owing to technical difficulties. (44) Summary of Sanitary Work performed during the Year 1918. - First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Inspections. Houses Inspected under Public Health (London) Act, 1891, &c. 682 561 354 422 2019 Houses let in Lodgings 3 8 8 9 28 Re-Inspections, Calls made, &c. 1023 1779 1668 1434 5904 Inspections of Bakehouses 25 15 52 45 137 „ Factories and Workshops 85 67 72 109 333 „ Outworkers' Premises 45 60 105 ... ... „ Slaughterhouses 16 16 19 20 71 „ Cowhouses 2 2 2 4 10 27 „ Stables and Yards 66 21 158 41 10 „ Piggeries 15 6 31 ... 15 „ Courts and Alleys 35 26 15 91 „ Fields, Lanes, &c. 10 23 ... 4 37 „ Urinals 19 13 ... 9 41 „ Fish Curer 6 2 1 9 ... „ Gipsy Vans ... ... ... ... ... „ Horse Slaughterhouses 3 3 3 3 12 „ Dairies, Cowsheds, and Milkshops 18 56 39 59 172 „ Tar Works 3 3 ... ... ... „ Soap Boilers ... ... ... ... ... „ Other Offensive Trades ... ... ... ... ... „ Ice Works ... ... 2 ... 2 „ Ice Cream Places 15 57 ... 72 ... „ Other places where Food is prepared 48 22 7 102 25 8 „ Troops' Quarters 18 7 8 41 „ Munition Works 3 6 ... 9 ... „ Military Depot 14 ... 5 19 ... „ Cinema ... ... 10 10 ... 9416 2810 Total 2720 1696 2190 45 SUMMARY OF SANITARY WORK —continued. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Drains. I 2 1 ... 1 3 Constructed ... Intercepter Chamber, and Fresh Air Inlet 5 ... 1 6 ... ... 1 1 Other Chambers 65 ... ... 14 6 145 Reconstructed or Repaired 60 61 57 33 204 Opened, Cleansed and Amended 53 8 7 11 11 37 Surface Drains Constructed 96 Traps Fixed 23 32 30 11 New Soil Pipes 2 7 2 2 13 28 14 8 3 3 Drains and Soil Pipes Ventilated Drains Tested-by Smoke 23 11 25 18 77 25 31 15 13 84 „ „ by Water „ by Chemicals 19 38 3 60 ... 34 29 13 11 87 19 Found Defective 7 9 Yards Drained 2 1 Mews and Stables Drained ... ... ... ... ... Washhouses Drained ... ... ... ... ... Forecourts Drained ... ... ... ... ... Areas Drained 2 3 ... 1 ... Cesspools Abolished ... ... ... ... ... Water Closets and Urinals. 3 4 Closets Erected 5 12 ... Sanitary Conveniences or improvements effected to Factories and Workshops 12 10 5 2 29 Pan, Traps and Water Supply furnished 14 9 6 47 18 23 37 11 7 78 Pans and Traps only furnished 4 6 1 4 15 Pans only furnished 4 Water Supply Apparatus provided 9 ... 5 ... 49 10 28 30 117 Water Supply renewed 1 1 Water Supply disconnected from Drinking Water Cistern ... ... 20 Soil Pans properly Trapped 12 ... ... 32 87 21 20 34 12 Cleansed and Repaired ... 3 5 2 Newly constructed or better situated ... 5 15 Ventilation Improved 3 3 4 37 Public-house Urinals Cleansed or Repaired 11 8 2 16 7 2 Other Urinals Altered 1 10 ... 10 ... Repaired or Water laid on 4 14 ... 46 SUMMARY OF SANITARY WORK —continued. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Ashpits. 31 59 217 Provided 77 50 Covers to Receptacles ... ... ... ... ... Dust Complaints forwarded to the Surveyor ... ... ... ... ... Pavings. 16 106 Yards 38 37 15 ... Forecourts 2 10 Areas 5 1 2 Washhouses 4 1 5 ... ... Mews and Stables ... ... ... ... ... General Water Supply. Covers to Cisterns Adapted 1 ... 1 ... ... Water Supply Provided 1 3 ... 8 4 Water Fittings Amended 81 24 39 28 172 Cisterns Cleansed and Repaired ... ... ... ... ... Water Services Altered so as to draw direct from main ... 2 2 ... ... Water Supplies Reinstated where cut off through defective fittings 3 7 19 8 1 Water Supplies cut off ... ... ... ... ... Defective Water Fittings (causing nuisance from dampness) repaired 24 131 41 41 25 Water Supply Certificates granted (Section 48) ... ... ... ... ... Other Improvements. 4 17 129 Houses Generally Repaired 40 68 Premises Cleansed, Limewashed and Repaired 20 52 168 57 39 Ventilation Improved 2 2 1 5 10 Leaky House Roofs and Gutters Repaired 106 52 379 128 93 16 30 159 Walls and Ceilings of Premises Cleansed throughout 46 67 Ditto, ditto, partially 96 49 30 1 14 189 Cowhouses cleansed 2 5 2 10 Milkshops „ 5 ... 5 ... ... Horse Slaughterhouses cleansed Ice Cream Places cleansed or improved 1 1 1 1 4 ... 6 6 ... ... Other Places where Food is prepared 61 3 12 7 39 ... ... ... ... 47 SUMMARY OF SANITARY WORK-continued. Other Nuisances Abated. Illegal use of Underground Room Discontinued Overcrowdings Abated Sink, Lavatory and Bath Waste Pipes Disconnected, Trapped and Amended Stack Pipes Disconnected and Amended Nuisances from Dampness Abated Animals kept in Unfit Places Discontinued or Removed Dung Receptacles Provided ... ... Bakehouse Nuisances Abated Accumulations of Manure and other obnoxious matter Removed Dampness of Walls Remedied Other Nuisances, principally of Dilapidations and want of Under-floor Ventilation Breaches of By-laws Abated Inundations Smoke Nuisances. Observations Statutory Notices served (Secs. 23 and 24) Food and Drugs. Samples taken Found Adulterate For Food Control Committee First Quarter. 1 7 20 2 36 8 1 26 45 10 ... ... ... ... 100 24 ... Second Quarter. ... 5 13 9 54 2 13 17 17 44 ... ... 25 ... 84 10 3 Third Quarter. ... ... 8 3 22 5 12 12 7 22 ... ... ... ... 123 12 1 Fourth Quarter. ... 1 9 25 52 ... 17 14 13 30 ... ... ... ... 101 2 5 Total. 1 13 50 39 164 15 ... 43 69 82 106 ... ... 25 ... 408 48 9 ... ... 48 SUMMARY OF SANITARY WORK—continued. Third Quarter. Fourth Quarter. Second Quarter. First Quarter. Total. 56 lbs. jelly cuttings. 56 lbs. jelly cuttings. 12 lbs. corned beef. 2916 6-lb. tins, corned beef 7½ doz. tins condensed milk. 245 salted herrings. 245 salted herrings. 36 lbs. canned beef. 10 lbs. beef. 1 oxtripe, melt and liver. 32 bags figs. 1 ox liver, heart, ox tongue and skirt 32 bags figs. 6 lbs. tinned sausage. 8 st. frozen skate. 40 boxes kippered mack'rel. 8 st. frozen skate. 28 14lb. baskets figs. 5½ lbs. bacon. 15 lbs. beef. 39 st. beef. 28 14-lb. baskets 2 ox livers. 14 14-lb. boxes dried peaches. 7 lbs. tinned milk. 6 lb. corned beef. 317 tins vegetable rations. 14 14-lb. boxes dried peaches 1 ox tripe. 3½ bushels winkles. 14 st. fish. 27 tins pork and beans. 1 liver. 80¼ bags currants. 3½ bushels winkles. 90 tons rice. 2 boxes, kippers. 17 6-lb. tins corned beef. 342 cases ditto. Unwholesome Food. Voluntarily surrendered 2 calves heads. 2 lbs. bacon. 18 lbs. corned beef. 342 cases currants. 6 2-lb. tins ditto 80¼ bags currants. ½ ox head. 36 lbs. canned beef. 312½cwt. damaged wheat unfit for human food, and used for dog biscuits. 179 12oz. tins ditto 6 lbs. tinned sausages. 120 lbs. rice. 7½ lbs. bacon. 1 goose. ¾ cwt. fruit salad. 7 lbs. tinned milk. 2 4 lbs. beef. 136 lbs. beef. ox tripe, 5 ox livers. 85 lbs. offal. 1 ox tongue, heart, 56 lbs. mack'rel. 172 lbs. pilchards melt and skirt. 49 SUMMARY OF SANITARY WORK—continued. Unwholsome Food Voluntarily Surrendered Total—continued. 90 ton 120 lbs. rice. 2 calves heads. ½ox head. 2,933 6-lb. tins corned beef. 50st. 11 lb. beef. 14 st. fish. 2 boxes kippers. 312½ cwt. damaged wheat unfit for human food and used for dog biscuits. 7½ doz. tins condensed milk. 317 tins vegetable rations. 27 tins pork and beans. 6 2-lb. tins corned beef. 179 12-oz. tins corned beef. 1 goose. ¾cwt. fruit salad. 85 lbs. offal. 56 lbs. mackerel. 172 lbs. pilchards. 40 boxes kippered mackerel. Second Quarter. Third Quarter. Fourth Quarter. First Quarter. Total. Notices, &c. Intimations Served under Public Health (London) Act, 1891 (Section 3) 180 108 141 664 235 Houses let in lodgings ... ... ... ... ... 130 Complaints Received 123 117 118 488 130 118 Complaints Attended to 123 117 488 Statutory Notices Served under Section 4 28 34 34 23 119 Ditto Others 4 2 4 7 17 Statutory Notices re Ashpit provision 24 13 59 16 6 Statutory Notices re Yard Paving ... ... ... ... ... Letters Written relating to Abatement of Nuisances 106 104 140 124 474 Summonses Applied for and Issued 1 ... ... 1 ... Magisterial Orders Obtained and Enforced 1 ... ... 1 ... Drainage Plans received and examined 1 4 ... 7 2 50 BOROUGH OF GREENWICH. Proceedings during 1918. Number of Places— Number of Notices, 1918. Number of Inspections, 1918. Number of Prosecutions, 1918. On Register at end of 1917. Added in 1918. Removed in 1918. On Register at end of 1918. Premises. Dairies— Cowsheds and Milkshops 127 10 8 129 172 ... ... Slaughterhouses 5 5 ... ... 71 ... ... ... Other Offensive Trade Premises ... ... ... ... ... ... Ice Cream Premises 1 103 1 103 ... 93 ... Registered Houses Let in Lodgings 247 247 ... ... 28 ... ... Total number of Intimation Notices served for all purposes 664 Overcrowding, 1918 Number of Dwelling-rooms Overcrowded 13 Number Remedied 13 Number of Prosecutions Underground Rooms Illegal Occupation dealt with during year 1 Number of Rooms Closed 1 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 Rooms Fumigated 7 Number of Cleansing Baths given under Cleansing of Persons Act 1064 51 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 Number of Tenements comprised therein Number of Tenements for which Certificates were granted Number of Prosecutions under By-laws under Public Health Act, 1891 (a) 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, &c. (Metropolis Management Acts Amendment (By-laws) Act, 1899) ... ... ... ... — Mortuaries Total Number of Bodies Removed 162 Total Number of Infectious Bodies Removed 0 162 LEGAL PROCEEDINGS, 1918. It is a matter for satisfaction that, apart from the proceedings under the Sale of Food and Drugs Act, only one other summons was needed.