C.I . Az4373 Gre 22 THE ANNUAL REPORT MADE TO THE COUNCIL OF THE Metropotitan Borough of Greenwich For the Year 1923, BY ERNEST GEORGE ANNIS, M.R.C.S., L.R.C.P., L.S.A., D.P.H. Barrister -at- Law, Fellow of the Royal Sanitary Institute, MEDICAL OFFICER OF HEALTH TO THE BOROUGH, ADMINISTRATIVE MATERNITY AND CHILD WELFARE MEDICAL OFFICER, AND EXECUTIVE TUBERCULOSIS OFFICER. woolwlch: Printed by the Pioneer Press, Ltd. (T.U. Fed.), S, New Road. — 1924 — THE ANNUAL REPORT made to THE COUNCIL of the Metropolitan borough of (Greenwich For the Year 1923, by ERNEST GEORGE ANNIS, M.R.C.S., L.R.C.P., L.S.A., D.P.H Barrister-at- Law, Fellow of the Royal Sanitary Institute, MEDICAL OFFICER OF HEALTH TO THE BOROUGH, ADMINISTRATIVE MATERNITY AND CHILD WELFARE MEDICAL OFFICER, and EXECUTIVE TUBERCULOSIS OFFICER. Woolwicl): Printed by the Pioneer Press, Ltd. (T.U. Fed.), 3, New Road. — 1924 — Contents. Pages Public Health Committee 1-2 Maternity and Child Welfare Committee 3 Introductory 4-5 Section I.—General Statistics 6-10 „ II.—Vital and Mortal Statistics, Marriages, Births, Deaths 11-21 „ III.—Infectious Diseases 21-41 „ IV.—Causes of Sickness 42 „ V.—Summary of Nursing Arrangements Hospitals and other Institutions available for the District 42-45 „ VI.—Laboratory Work 45-46 „ VII.—Sanitary Administration 46-70 „ VIII.—Public Health Staff 70-72 „ IX.—Housing 72-74 „ X.—Maternity and Child Welfare 74-85 Index 87-89 Public Health Committee during the Year, 1922-3. The Mayor— Councillor E. M. Dence, J.P., L.C.C. and 13 Members. Alderman S. A. Kelly. Councillors— A. J. Hunt (Chairman) F. W. Mander, M.A. Mrs. N. Cunis (Vice-Chairman) W. W. Middleton M. G. Byerley, F.R.C.V.S. Dr. H. B. Morgan F. S. Eason G. Redgrove Mrs. A. M. Edwards J. M. Rokes, A.M.I.E.E. Dr. W. R. Hodgkinson, C.B.E., Mrs. C. R. Turner M.A. Duties and Powers of the Public Health Committee— 1.—The Committee shall consist of thirteen 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 Horseflesh, etc., Regulation Act, 1889 ; such matters arising under the Housing of the Working Classes Act, 1890 and 1894, and the Working Classes Dwellings Act, 1890 ; Housing and Town Planning Acts ; the Public Health (London) Acts ; the Metropolis Management Acts relating to defective drainage ; the Canal Boat Acts ; the Factory and Workshop Acts ; Increase of Rent and Mortgage Interest Restrictions Act, 1920 ; the sanitary provisions of any other Act of Parliament; the Rats and Mice (Destruction) Act, 1919 ; the powers of the Council under the Orders of the Local Government Board or Ministry of Health dealing with Tuberculosis ; the Dairies, Cowsheds, and Milkshops Order of 1885 ; and the Milk (Special Designations) Order, 1923 ; the by-laws and regulations made under the above Acts, or otherwise relating to the public health and sanitary condition of the Borough, as are not within the reference to any other Committee. 2 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 on 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 to the Council. Provided that the Committee shall report their action to 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 re-drainage 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, 1919. Housing, &c., Act, 1923. London County Council (General Powers) Act, 1902, 1907, 1908, 1922. Rag Flock Act, 1911. Public Health (Tuberculosis Regulations), 1912. Public Health (Milk and Cream) Regulations, 1912, 1917. Rats and Mice (Destruction) Act, 1919. Rent and Mortgage Interest Restrictions Acts 1920 and 1923. Milk and Dairies (Amendment) Act, 1922. 3 Mtaternity and Child Welfare Committee during the Year 1922-3. The Mayor— Councillor E. M. Dence, J.P., L.C.C. and fourteen Members. Alderman S. A. Kelly (Vice-Chairman) Councillors— M. Sherman (Chairman) *Dr. W. R. Hodgkinson, C.B.E., MA. S. H. M. Carpenter, L.D.S. *M. C. Matthews, M.A. Mrs. N. Cunik W. W. Middleton A. J. Haylock Dr. H. B. Morgan T. Hearn, B.Sc., M.S.P. Mrs. C. R. Turner Co-opted Members— Mrs. M. Hamilton Mrs. R. F. A. Purkiss Mrs. H. S. Scarr Mrs. M. J. Woodnutt * Part period. Powers and Duties of the Maternity and Child Welfare Committee. 1.—The Committee shall consist of 14 members, 10 of whom shall be members of the Council, and four selected by the Council from outside that body. 2.—There shall be referred to the Committee all matters arising out of the powers and duties of the Council under the Maternity and Child Welfare Act, 1918, or any Act or Acts amending the same, or of any Orders or Regulations made under such Act or Acts, and the Committee shall make recommendations to the Council in relation to the matters aforesaid. 4 Public Health Offices, Borough Hall, Royal Hill, Greenwich, S.E.10. May, 1924. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Ladies and Gentlemen, I have the honour to submit herewith my Annual Report as Medical Officer of Health for the year 1923, on the health of the Borough, and it is very gratifying to me to be able to report that despite the continued prevalence of unemployment, the health statistics generally show a marked improvement. The Death Rate is 10.95 per 1,000 of the estimated population, which is the lowest figure recorded since the Council's inception and 1.97 lower than that for last year, and 2.92 lower than the average for the previous 5 years. The Birth Rate is 20.54 per 1,000, which figure is slightly higher than that for the County of London. The Infantile Mortality Rate for the Borough, measured by the number of deaths under one year to 1,000 births registered, is 61, which whilst slightly higher than last year's record figure is, nevertheless, very commendable. The Zymotic Death Rate of 46 per 1,000 shows an improvement on last year's figure of .86. The figures relating to the different constituent parts of the Borough are as follows:— Districts. Birth Rate. Death Rate. Infantile Mortality per 1000 Births. Zymotic Death Rate. Diarrhoea Death Rate. Consumption Death Rate. East Greenwich 21.17 10.43 66 .48 .15 .91 West Greenwich 17.29 12. 97 87 .51 .10 1.25 St. Nicholas, Deptford 26.33 12.58 68 1.03 .25 1.55 Charlton 16.64 8.74 28 15 — 1.41 Kidbrooke * 102.89 10.47 5 — — .30 †Whole Borough 22.28 10.95 56 .46 .10 1.12 * This exceptionally high Birth Rate is accounted for by the fact that in this District are the Council's and "Stonefield" Maternity Homes. †The "corrected" Birth Rate is 20.54 and the Infantile Mortality Rate 61 per 1,000 Births. 5 Attack Rates of the various notifiable diseases per 1,000 living in the several districts are as follows:— Districts. Small-pox. Diphtheria. Scarlet Fever. Erysipelas. Typhoid Fever. Puerperal Fever. East Greenwich 0.08 2.13 2.31 .49 . 19 . 13 West Greenwich 0.00 2.28 2.28 .66 .18 .07 St. Nicholas, Deptford 0.00 2.46 2. 32 1.55 .12 .00 Charlton 0.00 1.57 1.20 .10 .05 .05 Kidbrooke 0.00 3.08 3.69 .61 . 00 .00 Whole Borough 0 .03 2.12 2.14 .54 .15 .08 In conclusion, it is my privilege again to express my appreciation of the kindness and consideration which has always been shown to me by the members of the Public Health, and Maternity and Child Welfare Committees, and the whole of the members of the Council. I gladly acknowledge also the valuable assistance I have at all times received from every member of my capable and enthusiastic Staff. I am, Ladies and Gentlemen, Your obedient Servant, E. G. Annis 6 SECTION 1. General Statistics. Elevation—Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts— East Greenwich 1,300 acres West Greenwich 453 „ St. Nicholas, Deptford 115 „ Charlton and Kidbrooke 1,991 „ 3,859 acres Population— At Census, 1921 100,450 Estimated, 1923 102,460 Density of Population— East Greenwich 34.69 persons per acre West Greenwich 60.06 „ St. Nicholas, Deptford 67.25 „ Charlton and Kidbrooke 11.25 „ Average for the Borough 26.25 persons per acre Number of Inhabited Houses— Structurally separate dwellings at Census, 1921 16,526 „ „ „ 1923 17,366 Number of Uninhabited Houses— At Census, 1921 288 Estimated, 1923 137 No. of Families or Separate Occupiers— At Census, 1921 22,972 Rateable Value £768,354 Sum represented by a Id. rate £3.148 7 CENSUS 1921 Table I. Total population of the Borough shown in various age groups compared with the administrative County of London, Age Group. London. Greenwich. Number Per cent. of Total Number Per cent. of Total 0-5 376,055 8.3 9,414 9.4 5-15 809,212 18.0 20,323 20.2 15-25 796,590 17.8 17,985 17.9 25-35 722,316 16.1 15,112 15.1 35-45 643,230 14.3 13,698 13.6 45-55 532,834 11.9 11,179 11.1 55-65 344,311 7.7 7,118 7.1 65-up 259,975 5.8 5,621 5.6 Total Population 4,484,523 100.0 100,450 100.0 Table II. (a) Showing the percentage of males and females, respectively, in the total population. Males. Females. London 46.2 53.8 Greenwich 48.6 51.4 (b) Showing the percentage of persons in certain sex-age groups compared with the administrative County of London. Age. 0-5 5-15 15-25 25-35 35-45 45-55 55-65 65 up Males. London 9.2 19.5 17.2 15.2 14.0 12.1 7.7 5.1 Greenwich 9.8 21.5 17.5 14.4 13.4 11.2 6.8 5.0 Difference +.6 +2.0 +.3 —.8 —.6 —.9 —.9 —.1 Females London 7.7 16.8 18.3 16.9 14.7 11.7 7.6 6.4 Greenwich 8.9 19.0 18.3 15.7 13.8 11.0 6.9 6.3 Difference + 1.2 + 2.2 — -1.2 —.9 —.7 —.7 -.1 8 Table III. Actual number and proportion per 10,000 males and females over 12 unoccupied and employed in certain occupations as under, compared with the administrative County of London. Males. Females. London Greenwich London Greenwich Actual Per 10,000 Actual Per 10,000 Actual Per 10,000 Actual Per 10,000 Total Population 2,071,579 48,850 2,412,944 51,600 Age 12 years or over 1,600,084 37,142 1,945,828 40,169 Total occupied (employed) aged 12 years and over 1,385,701 31,741 780,511 12,578 Total unoccupied (unemployed) and retired, aged 12 years and over 214,383 1,340 5,401 1,454 1,165,317 5,988 27,591 6,870 Employed as— (1) Makers of Textile Goods. 52,909 330 289 78 113,056 580 1,014 252 (a) Tailors (24,169) (151) (66) (16) (26,594) (136) (101) (25) (b) Boot and Shoe Makers and Re pairers (12,691) (79) (109) (29) (2,938) (15) 3 - (2) Makers of Foods Drinks and Tobacco 27,187 169 391 105 19,057 97 269 67 (a) Tobacco (2,045) (12) (2) — (4,918) (25) (5) — (3) Workers in Wood and Furniture 70,143 438 1185 319 6,863 35 81 20 (4) Makers of and Workers in Paper 42,541 265 281 76 31,128 160 173 43 (a) Printers, Bookbinders, etc. (38,970) (243) (260) (70) (17,001) (87) (124) 31 (b) Stationery, CardboardBoxes (3,082) (19) (17) (13,715) (70) (41) (10) (5) Builders. Bricklayers, Stone Workers 45,565 284 1019 274 165 - 2 - (6) Painters and Decorators 36,609 228 642 173 633 - 9 (7) Transport and Communications 253,009 1581 4,465 1,202 12,848 66 220 55 (a) Railway Workers (30,145) (188) (358) (96) (183) — (1) — (b) Road Transport (104,811) (655) (1256) (338) (667) — (17) — 9  Males. Females. London Greenwich London Greenwich Actual Per 10,000 Actual Per 10,000 Actual Per 10,000 Actual Per 10,000 Transport—conid. (c) Water Transport (41,011) (256) (2011) (541) (269) - (6) - (d) Other Workers in Transport (77,042) (481) (840) (226) (11,729) (60) (196) (49) (8) Metal Workers (not Electro Plate or Precious Metals) 115,674 723 4,622 1,244 8,562 44 437 109 (9) Personal Service 77,384 483 847 228 278,747 1,433 4,325 1077 (a) Domestic Ser- vants (19,611) (122) (115) (31) (173,765) (893) (2972) (740) (b) Laundry (1762) (10) (20) — (20,573) (105) (248) (62) (c) Inn, HotelKeepers, Publicans, Beersellers, Barmen, Waiters. (20,516) (128) (255) (69) (25,038) (128) (372) (92) (10) Clerks and Draughtsmen 102,087 637 1,519 409 97,565 501 1,698 422 (11 )Commercial, Finance, Public Admint. Professinal 281,980 1,762 5,680 1,529 131,139 674 2,570 640 (xxiii-xxiv-xxv) (a) Defence (18,442) (115) (1,204) 324 - - - - (12) Other Occupations not specified 256,442 1,602 8,989 2,420 76,126 391 1,127 280 Makers and Fitters of Electrical Apparatus and Electricians. 24,171 151 1,812 487 4,622 24 653 163 10 Table IV Housing Conditions. Average number of Rooms per person— ,, ,, ,, London .96 Greenwich .99 Tenements of Number of Per cent. of Total Population Rooms Occupied Population Greenwich London 1 Room 1,548 3,050 30 5.8 2 „ 7,215 10,446 10.4 16.6 3 „ 15.873 21,043 20.9 22.5 4 „ 21,484 24,975 24.9 20.1 Over 4 47,290 34,735 34.6 29.6 Living otherwise than in Private dwellings .. 6,201 7.2 5.4 Table V. Density of Population Whole Borough—Persons per acre 26—London 60. Wards Persons per acre Wards Persons per acre Charlton and Kidbrooke 11 South 37 *Marsh 29 South East 25 * North 80 West 75 North West 83 St. Nicholas, Dept- ford 66 * Area altered during 1911-1921 intercensal period. 11 SECTION 2. VITAL AND MORTAL STATISTICS, 1923. POPULATION. The population of the Borough estimated to the middle of the year 1923 is 102,460, being an increase of 530 over that of last year, and it is upon this figure that the statistics generally in this Report are based. (The Registrar-General's estimate is 102,777). The distribution of the population throughout the Borough is as follows:— Census, 1921. (Adjusted.) Estimated Population at middle of year 1923. East Greenwich 44,647 45,098 West Greenwich 26,931 27,211 St. Nicholas, Deptford 7,646 7,734 Charlton 18,959 19,160 Kidbrooke 3,217 3,257 Total 101,400 102,460 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total. M. F. *Births Legitimate 2,055 1,053 1,002 *Birth Rate 20.8 Illegitimate 64 33 31 « *Deaths 1,119 612 507 *Death Rate 10.8 Number of women dying in, or in consequence of, childbirth From Sepsis 1 ,, other causes 4 *Deaths of Infants under one year of age per 1,000 births:— Legitimate, 54; Illegitimate, 265; Total, 60. Deaths from Measles (all ages) 2 ,, ,, Whooping Cough (all ages) 13 ,, ,, Diarrhaœa (under 2 years of age) 11 *These figures which are supplied by the Registrar-General differ slightly from those shown in other parts of the Report. 12 MARRIAGES. The Superintendent-Registrar of the Greenwich Registration District has kindly furnished me with the particulars relating to the number of marriages solemnised in the Parishes of Greenwich and St. Nicholas. The Superintendent-Registrar for the Woolwich Registration District has also kindly supplied the particulars for the parishes of Charlton and Kidbrooke, with the exception, in these latter particulars, that the marriages performed in the Woolwich Superintendent-Registrar's Office and in Chapels in Charlton and Kidbrooke, of residents in those Parishes, are not included. The following table shows these particulars, giving the number of marriages in Greenwich and St. Nicholas, etc., for each year since 1912:— Year. In Churches of England in Greenwich. In Churches of England in Charlton and Kidbrooke. 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 & Greenwich. Total. Approximate Population of the districts concerned. 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 1918 353 165 55 244 817 89939 1919 419 197 76 326 1018 102591 1920 384 105 64 3122 875 104453 1921 344 124 57 249 774 100493 1922 364 112 45 275 796 101930 1923 336 132 51 222 741 102460 BIRTHS. The total number of births registered in the Borough during the year was 2,276. Of this number 167 occurred in Greenwich and Deptford Hospital and 397 at various Nursing Homes within the Borough. Of this total of 564 Institution births, 267 only belonged to Greenwich, the remainder being transferred to the appropriate localities. One hundred and nineteen births belonging to the Borough took place in Institutions outside the Borough area, thus the actual figure for Greenwich becomes 2,098—Males, 1,078; Females, 1,020. This figure gives a Birth Rate of 20-54 per 1,000 of the population, which is 1-65 below the average for the last ten years. 13 The Birth Rate for the County of London equals 20.4 per 1,000 of the population. The Birth Rate for all England and Wales was 19.7. Illegitimate births numbered 64, representing 3.0 per cent. of the total births. One hundred and twenty nine illegitimate births were registered in the Borough. In 73 cases, however, the mothers were ordinarily resident outside the Borough, and these births were consequently allocated to the correct areas. Eight illegitimate births belonging to Greenwich occurred outside the Borough, thus giving the net figure of 64. Thirty-three illegitimate births occurred in the Greenwich and Deptford Hospital. Under the provisions of the Notification of Births Act, 1907, intimations have been received from medical men, parents and others, with respect to 2,348 births. DEATHS. The total number of deaths registered during 1923 was 1,119, of which 612 were males and 507 females. The crude Death Rate for the Borough of 10.95 per 1,000 compares favourably with 11.2, the Death Rate for the County of London, and 11.6, the Death Rate for the 105 Large Towns. It is interesting to note that the Death Rate is the lowest recorded since the inception of the Council. The Death Rate in the various Metropolitan Boroughs varied from 9.9 in Woolwich, 10.1 in Wandsworth, 10.3 in Hampstead and Lewisham, and 10.5 in Fulham up to 13.1 in Finsbury, 12.9 in Shoreditch, 12.8 in Southwark and 12.1 in Chelsea, Bermondsey and Holborn. Locally the Death Rate varied from 8.74 in Charlton, 10.43 in East Greenwich, 10.47 in Kidbrooke, 12.58 in St. Nicholas, Deptford, to 12.97 in West Greenwich. Of the total number of deaths 17 under five years of age were of illegitimate birth, 15 of whom were under one year of age. 14 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 1918 to 1922, compared with the figures for 1923:— District. 1918. 1919. 1920. 1921 1922. Average for 5 Y ears. 1923. East Greenwich 16.01 10.58 10.39 12.17 11.26 12.08 10.43 West Greenwich 2603 18.56 14.84 12.53 15.27 17.44 12.97 St. Nicholas 24.45 12.84 15.61 14.28 17.61 16.95 12.58 Charlton 20.42 13.10 9.39 11.80 11.68 13 .27 8.74 Kidbrooke 10.50 6.88 8.90 11.62 12.38 10.05 10.47 Borough 19.16 13.15 11.72 12 .41 12.92 13.87 10.95 DEATHS IN INSTITUTIONS. The following table shows the number of deaths of Greenwich ents in Public Institutions during the last six years:— Year. Total Deaths of Greenwich Resident. Total Deaths of Greenwich Residents in Public Institutions. 1918 1,718 651 1919 1,372 603 1920 1,231 535 1921 1,243 553 1922 1,313 600 1923 1,119 546 Average 1,332 581 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. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Under 1 year of age 46 30 27 26 129 Between 1 and 2 years 10 7 4 3 21 Between 2 and 5 years 14 8 5 7 34 Between 5 and 15 years 11 5 11 11 38 Between 15 and 25 years 19 30 16 16 81 Between 25 and 45 years 35 41 37 27 140 Between 45 and 65 years 81 60 49 81 271 65 years and upwards 112 98 75 117 402 Total 328 279 224 288 1,119 15 INFANTILE MORTALITY. The Infantile Mortality, measured by the deaths of children under one year of age to the number of births registered, was 61 per 1,000 births, there having been a total of 129 such deaths during the year, as compared with 195, 175 and 121, the respective figures for the years 1920, 1921, and 1922. A further reference to the Infantile Mortality Rate will be found in the Section devoted to the Maternity and Child Welfare Scheme. For the whole of London the rate was 60 in 1923, compared with 74 in 1922, 80 in 1921 and 75 in 1920. For England and Wales the rate was 69, compared with 77 in 1922, 83 in 1921 and 80 in 1920. Locally the variations were from 5 per 1,000 births in Kidbrooke, 28 in Charlton, 66 in East Greenwich, 68 in St. Nicholas to 87 in West Greenwich. The following table shows at a glance these figures since the formation of the Borough:— District. Average for five years, 1901-1905. inclusive. Average for five years, 1906-1910, inclusive. Average for five years, 1911-1915. inclusive. Average for five years, 1916-1920, inclusive. 1921. 1922. 1923. East Greenwich 129 106 96 81 61 46 66 West Greenwich 126 110 112 110 87 63 87 St. Nicholas, 179 143 167 138 91 81 68 Charlton 121 109 76 89 86 74 28 Kidbrooke 39 79 16 39 15 10 5 Borough 131 111 103 95 73 56 61 16 ANALYSIS OF DEATH CAUSES. Adopting the Registrar-General's classification of diseases, the following table shows the Death Rates for all persons belonging to the Borough per 1,000 of the population living in the Borough. 1923. 1923. Infective Diseases— Local Diseases—continued. Epidemic 0.58 Circulatory System 1.18 Sporadic — Respiratory System 1.69 Venereal 0.06 Digestive System 0.39 Septic 0.09 Lymphatic System 0.01 Malarial 0.02 Urinary System 0.40 Tuberculosis 1.30 Reproductive System 0.04 Parasitic Diseases — Parturition 0.03 Constitutional Diseases 1.39 Bones and Joints 0.03 Developmental Diseases 1.81 Integumentary System — Dietetic Diseases - External Causes— Local Diseases— Nervous System 11.3 Accidents 0.40 Homicide — Organs of Special Sense 0.07 Suicide 0.08 REMARKS ON VARIOUS DEATH CAUSES. Infective Diseases. Epidemic.—There was 60 deaths due to this class of disease, equalling a Death Rate of .58 per 1,000; the rate last year was 1.34 and was 1.53, .88 and .93 in 1919, 1920, and 1921 respectively. Zymotic.—The purely Zymotic class of epidemic diseases is credited with causing a total of 47 deaths, equalling a Death Rate of .46 per 1,000. Locally the Zymotic Death Rate varied from .00 in Kidbrooke (.30 in 1922), .15 in Charlton (.36 in 1922), .48 in East Greenwich ( 87 in 1922), .51 in West Greenwich (1.03 in 1922) and 1.03.in St. Nicholas, Deptford (1.69 in 1922). Small-Pox.—There were no deaths from Small-Pox, this being the twenty-first year since a death occurred from this cause in the Borough. Measles.—Two deaths only were ascribed as due to this disease, both being under five years of age. 17 The number of deaths recorded last year was 29, and in the years 1919, 1920 and 1921, 13, 26, and 5 respectively. One death occurred in St. Nicholas and one in Charlton. Scarlet Fever.—This disease occasioned 2 deaths, both of which were under five years. One death occurred in West Greenwich, and 1 in Charlton. Six such deaths occurred both in 1921 and 1922. Diphtheria.—There were 11 deaths during the year. This gives a Death Rate of .10 comparing with .41 for the previous year. Forty-two deaths occurred in 1922, and 15, 13 and 28 in 1919, 1920, and 1921 respectively. Five of the patients were under five years of age. Typhoid Fever.—There were six deaths ascribed to this disease ; there were 2 in 1919, 2 in 1920, 1 in 1921 and 0 in 1922. Diarrhoea, Dysentery, and Zymotic Enteritis.—Thirteen deaths were said to be due to these causes, equalling a rate of .12 per 1,000. Last year there were 2 deaths and 28, 22 and 27 respectively in 1919, 1920 and 1921. Influenza.—Influenza is found to have been the responsible cause of 11 deaths in 1923; 27 was the average of the previous three years. Of the 11, 6 were over 65 years of age. Sporadic Diseases.—There were no deaths from this class of diseases during the year. Venereal. Syphilis.—Seven deaths were given as due to Syphilis, as against 2 in 1922 and 4 in 1921. One occurred in East Greenwich, 3 in West Greenwich and 3 in St. Nicholas. Five of the deceased persons were in the Greenwich and Deptford Hospital and 2 in Seamen's Hospital. There were no deaths from Gonorrhoea during the year. 18 Septic Diseases. Erysipelas.—Three deaths occurred from this cause in 1923, as compared with 1 last year. There were 6 in 1920 and 2 in 1921. Puerperal Fever.—There was one death from this disease during the year. This case occurred in East Greenwich and died in the Brook Hospital. Pæemia and Septicemia, &c.—There were 5 deaths from this disease during the year and 2 deaths from Hospital Gangrene. Malarial. Rheumatic Fever.—There were 3 deaths in 1923 as compared with 1 in 1922, with 3 in 1921 and 12 in 1920. Rheumatism of the Heart.—There were no deaths attributed to this cause. Tuberculosis. This class includes the causes of 133 deaths during the year under review, with a rate of 1.30; these figures compare with 147, 138 and 141, the totals of the years 1920, 1921 and 1922 respectively, and respective rates of 1.40, 1.37 and 1.38. Tuberculosis of the Lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 115 attributed to this cause, or a rate of 1.12 per 1,000. Locally, the deaths were 1 in Kidbrooke (giving a Death Rate of .30), 41 in East Greenwich (giving a Death Rate of .91), 34 in West Greenwich giving a Death Rate of 1.25) 27 in Charlton (giving a Death Rate of 1.41) and 12 in St. Nicholas, Deptford (giving a Death Rate of 1.55). The remaining forms of Tuberculosis were responsible for 18 deaths, being 8 in West Greenwich, 5 in East Greenwich, 3 in Charlton and 2 in St. Nicholas. Of these other forms of Tuberculosis, Tuberculosis of the Brain and its membranes were credited with 8 (7 being under five years of age), Tubercle affecting the Intestines 4, General Tuberculosis 3 and other forms of Tuberculosis 3 deaths. Parasitic Diseases.—There were no deaths from this class of disease. 19 Dietetic Diseases.—There was 1 death from this class of disease. Constitutional Diseases.—The deaths from this cause were 142 in number, which gives a rate of 1.39 per 1,000. Of these, 127 were attributed to Cancer, 5 to Diabetes, 4 to Anaemia, 3 to Rheumatoid Arthritis, 2 to Lymphadenoma and 1 to Gout. The deaths from Cancer were distributed as follows—53 occurred in East Greenwich, 43 in West Greenwich, 8 in St. Nicholas, 20 in Charlton and 3 in Kidbrooke. Developmental Diseases.—There were 185 deaths, equal to a rate of 1.81 per 1,000. These may roughly be divided into those from causes which would appear to be unavoidable, viz.:—Congenital defects, 15, and those from causes more or less preventable, viz. :—Premature birth, 20 ; Injury at birth, 1; Debility at birth, 16 ; Atrophy, Debility and Marasmus, 8 ; Atelectasis, 5 and Dentition, 1. The remaining and largest portion of these deaths from developmental diseases, 119 in number, were from Old Age: in 1922 there were 137 deaths from this cause and 94 in the previous year. Local Diseases. Nervous System.—One hundred and sixteen deaths were attri. buted to the various nervous diseases, which gives a rate of 1.13 per 1,000; last year the rate was 99 per 1,000. Convulsions were responsible for 10, all of whom were under five years of age; 9 were from Meningitis, 61 from Apoplexy, 6 from Hemiplegia or Brain Paralysis, 5 from General Paralysis of the Insane, 4 from Cerebral Tumour, 6 from Epilepsy, 2 from diseases of the Spinal Cord, 3 from Softening of the Brain, 3 from Locomotor Ataxy, and 7 from other diseases of this system. Organs of Special Sense.—There were 8 deaths from this class of causes, equal to a rate of .07 per 1,000. Circulatory System.—The Death Rate from diseases of this system was 1.18 per 1,000, there being a total of 121 such deaths. Valvular Diseases of the Heart were responsible for 108, 5 from Aneurism, 1 from Embolism, 1 from Angina Pectoris and from the remaining diseases of this system, 6. 20 Respiratory System.—One hundred and seventy-three deaths were due to diseases of the Respiratory Organs, as compared with 296 in the proceeding year. The Death Rate under this heading equals 1.69 per 1,000. Thirteen were from Acute and 62 from Chronic Bronchitis, 86 from the various forms of Pneumonia, (27 being under five years of age) 2 from Emphysema, 4 from Pleurisy, 2 from other diseases of the Larynx and Trachea and 4 from other diseases. Digestive System.—There were 61 deaths from diseases of this system, equal to a rate of .59 per 1,000. Of this number, Enteritis were responsible for 7, all of whom were under five years of age, 8 to Appendicitis, 10 to Obstruction of Intestine, and 1 to other diseases of the Intestines, 6 to Cirrhosis of Liver, and 7 to other diseases of the Liver, 1 to Peritonitis, 14 to Ulcer of Stomach and Duodenum; 1 to other diseases of the Stomach, 1 to diseases of Æophagus, and 5 to other diseases of the Digestive System. Lymphatic System.—There were 2 deaths from diseases affecting this system during the year. Urinary System.—Forty one deaths, equal to a rate of .40 per 1,000, occurred from diseases affecting this system. Twentyeight were from Bright's Disease, 7 from diseases of the Bladder and Prostate, and 6 from ill-defined causes of the Urinary system. Reproductive System.—There were only 5 deaths due to diseases of the Generative Organs. Four deaths were attributed to diseases of Parturition. Bones and Joints.—There were four deaths from diseases of bones and joints. Integumentary System.—There was 1 death from diseases of Integumentary System. External Causes.—There were 41 deaths given as due to causes grouped under this heading; 32 were the result of accident or negligence, and the remaining 9 were from Suicide. Three children died from Suffocation by being overlaid in bed (compared with 1 from this cause last year); 2 cases were from Drowning, 2 from Burns and Scalds, while accidents on railways, in vehicular traffic and in building operations, falls, etc., were responsible for 24 deaths. The Suicides were 4 from Poisoning, 2 by Cut or Stab, 2 by Hanging or Strangulation and 1 by Drowning. Ill-Defined Causes.—There were no deaths in 1923, the cause of which was not ascertained. 21 MORTUARY. The number of bodies dealt with in the Mortuary since 1912 is shown below:— Year. Drowned Bodies from River. Other Bodies. Totals. 1912 15 126 141 1913 17 114 131 1914 15 134 149 1915 15 194 209 1916 11 182 193 1917 15 209 224 1918 24 138 162 1919 12 120 132 1920 14 175 189 1921 15 152 167 1922 14 166 180 1923 12 170 182 SECTION 3. NOTIFIABLE DISEASES DURING THE YEAR 1923. Disease. Total Cases Notified.* Cases admitted to Hospital. Total Deaths.* Small Pox 4 4 — Diphtheria 217 211 11 Scarlet Fever 219 201 2 Enteric (including paratyphoid) 16 14 6 Puerperal Fever 9 8 3 Pneumonia 71 25 40 Erysipelas 56 19 3 Acute Polio Myelitis 4 2 — Cerebro Spinal Fever 5 3 3 Continued Fever 1 1 - Malaria 2 1 - Ophthalmia Neonatorum 16 4 - Dysentery 1 1 - Notifiable Locally. Measles 706 14 2 Whooping Cough 329 16 13 Chicken Pox 69 4 1 Diarrhoea 86 8 19 1,811 536 104 * For particulars as to Age Groups see Tables at end of Report. 22 TUBERCULOSIS. Age-Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M F M F M F M F 0 1 - 1 1 1 2 2 4 8 1 2 4 5 6 11 8 9 1 1 — — 10 10 6 4 7 1 — 3 15 13 10 5 4 8 9 20 16 14 1 3 12 9 4 25 20 31 3 6 14 8 2 1 35 34 16 1 2 15 8 1 — 45 17 11 — — 4 7 - — 55 13 4 — — 3 4 — — 65 and upwards 3 3 — — 5 2 — — Totals 134 108 27 39 63 51 6 13 OPHTHALMIA NEONATORUM. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. *19 13 †6 19 — — — *Includes 3 cases of inflammation of the Eyes. †2 cases attended as Out-Patients. Notifications under the Provisions of the Public Health (London) Act, 1891.—During the year 2087 cases have been notified under the above Act, as compared with 2,116, 3227 and 3,720 respectively in the preceding years 1920, 1921 and 1922. Chicken-Pox.—The Order made by the Council for a period of three months terminated on the 18th February, 1923. From the 1st January, 1923, to this date 69 notifications were received. Small-Pox.—Four cases of this disease occurred in the Borough during the year. 23 These four cases occurred in one house in the Borough, the first case having apparently contracted the infection during her journey from Blackheath to Paddington early one morning as she was proceeding into Oxfordshire for a few days' holiday. It was subsequently discovered that an unrecognised case of small-pox was travelling about the West End of London at about this period and it is presumed that they came into contact in some way. The remaining three cases were other occupants of the same house who persistently refused vaccination or re-vaccination until it was too late to prevent an attack of the disease although in two of the cases the late vaccination did materially affect the character of the disease. In the other case, which was not vaccinated at all, the illness was of a much more serious character. In due course the four patients made a good recovery with no further spread of the disease from the one house originally affected. The Council's Isolation Shelter was used for a period by some of the occupants of the premises whilst they were under observation and their rooms were cleansed and bedding etc. disinfected. Contacts.—Two intimations were received from overseas by Medical Officers of Health of the Port Sanitary Authorities respecting persons who had been in contact with Small-Pox. In every instance they were kept under observation. Details respecting vaccination in the Borough are given in the Supplemental Vaccination Reports on page 41. Diphtheria.—Two hundred and seventeen cases of Diphtheria were notified during the year, as compared with 275, 391, 595 and 707 respectively in the years 1919, 1920, 1921 and 1922. The distribution of these cases was as follows :—96 in East Greenwich, 62 in West Greenwich, 19 in St. Nicholas, 30 in Charlton and 10 in Kidbrooke. Of this total number, 211 were removed to the Hospital for treatment, amongst which number the Hospital Authorities reported that in 12 cases they considered the diagnosis incorrect. There were 11 fatalities due to this disease, which gives a case mortality of 5.0 per cent. One thousand five hundred and thirty eight specimens were forwarded by medical practitioners for bacteriological investigation from cases suspected to be diphtheria. Of this number 1,433 were reported to give negative or doubtful results, and 105 were positive in character, being dealt with accordingly. 24 The quarterly incidence of the disease for 1923 has been as follows :— lst Quarter— East Greenwich, 48 cases ; West Greenwich, 26 ; St. Nicholas, 11 ; Charlton, 3 ; Kidbrooke,8 ; a total of 96 cases. 2nd Quarter—East Greenwich, 27 cases ; West Greenwich, 9 ; St. Nicholas, 3 ; Charlton, 6 ; a total of 45 cases. 3rd Quarter—East Greenwich, 12 cases ; West Greenwich, 13 ; St. Nicholas, 4 ; Charlton, 7 ; Kidbrooke, 2 ; a total of 38 cases. 4th Quarter—East Greenwich, 9 cases ; West Greenwich, 14 ; St. Nicholas 1 ; Charlton, 14 ; a total of 38 cases. Membranous Croup.—There were no cases of Membranous Croup notified during the year. Erysipelas.—Fifty-six cases were notified during the year, 22 being in East Greenwich, 18 in West Greenwich, 12 in St. Nicholas, 2 in Charlton and 2 in Kidbrooke. Nineteen of these patients were removed to a Public Institution in the district. Scarlet Fever.—Two hundred and nineteen cases were notified during the year, as compared with 587, 958 and 599 cases respectively in the years 1920, 1921, and 1922 ; 104 cases were in East Greenwich, 62 in West Greenwich, 18 in St. Nicholas, 23 in Charlton and 12 in Kidbrooke ; 201 of these cases were removed to the Hospital for treatment, 7 of which were returned as not suffering from this disease. There were two deaths from this disease during the year as against 6 last year. There were no cases which could be described as " Return Cases," as compared with 10 in the previous year. Typhoid Fever.—There were 16 cases of Typhoid or Enteric Fever notified during the year, 9 being in East Greenwich, 5 in West Greenwich, 1 in St. Nicholas and 1 in Charlton. The ages of the patients were : 1 between one and five years, 4 between five and fifteen years, 3 between fifteen and twenty-five years, 5 between twenty-five and forty-five years and 3 between forty-five and sixtyfive years. Fourteen cases were removed to Hospital for treatment. In the years 1919, 1920, 1921 and 1922 there were 20, 15, 11, and 3 cases respectively. The average number for the previous 10 years is 13. 25 No case was traceable to the consumption of shellfish; there were 6 fatalities from this disease. Eleven specimens were forwarded by medical practitioners for bacteriological examination from cases suspected to be Typhoid Fever in character, 1 giving a positive result. Puerperal Fever.—Nine cases of this disease were notified during the year, 6 being in East Greenwich, 2 in West Greenwich and 1 in Charlton. There were 6 cases in 1922, 11 cases in 1921, 5 in 1920 and 5 in 1919. There was 1 death from this disease during the year. Measles.—This disease was made permanently notifiable by an Order of this Council, approved by the Ministry on the 1st July, 1920. Seven hundred and six cases were notified during the year, as compared with 1286 during the previous year, and 572 for the year 1921. The ages and incidence of fatality of the disease were as follows : There were 18 cases under 1 year of age, with no resultant deaths. Between the ages of one to five years there were 208 cases with 2 deaths at this age period giving a case mortality of .96 per cent., and 480 cases between five years and sixty-five with no deaths. The case mortality for the whole district works out at .28 per cent. as compared with 2.25 per cent. for the previous year. Table showing number of Measles Cases reported during the year 1923. 1st QUARTER. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. Total. East Greenwich 7 76 221 4 1 308 West Greenwich 3 3 6 - — 12 St. Nicholas, Deptford — — — - — — Charlton 2 17 52 - 1 72 Kidbrooke — 1 6 3 — 10 Total 12 96 285 7 2 402 26 2nd QUARTER. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 65. Total. East Greenwich 1 32 100 3 1 137 West Greenwich — 6 5 1 12 St. Nicholas, Deptford — 2 — — — 2 Charlton — 14 24 — _ 38 Kidbrooke — — 3 - — 4 Total 1 54 132 5 1 193 3rd QUARTER. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65 Total. East Greenwich 1 22 17 1 3 44 West Greenwich — 6 2 8 St. Nicholas, Deptford — — — — — Charlton — 1 4 1 — 6 Kidbrooke — — — — — — Total 1 29 23 2 3 58 4th QUARTER. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. Total. East Greenwich 2 11 5 - 18 West Greenwich — 6 7 - — 13 St. Nicholas, Deptford — 11 6 - — 17 Charlton 1 1 2 — 4 Kidbrooke 1 — — - — 1 Total 4 29 20 — — 53 Total cases in year = 706. Zymotic Enteritis or Summer Diarrhoea.—Eighty-six cases of Diarrhoea were notified throughout the whole of the Borough, 43 being under one year of age and 43 between one and five. Forty of such notifications related to patients in East Greenwich, 39 in West Greenwich, 2 in St. Nicholas and 5 in Charlton. There were 12 deaths ascribed to this disease. Whooping Cough.—This disease was made permanently notifiable as from 1st November, 1921. Three hundred and twenty-nine cases were notified (compared with 408 in 1922), 51 being under one year of age, 174 from one to five, 103 from five to fifteen, and 1 from 25 to 45, the districts concerned being East Greenwich, 196 ; West Greenwich, 87 ; St. Nicholas, 27; 27 Charlton, 19. Each of these cases was visited and leaflets and instructions left, together with verbal advice respecting the isolation and care of the patient. Epidemic Cerebro-Spinal Meningitis, Cerebro-Spinal Fever, or Post-Basal Meningitis.—There were 5 cases of this disease notified during the year, 3 of which occurred in East Greenwich, and 2 in Charlton. Four specimens were forwarded by medical practitioners for bacteriological examination in respect of suspected cases, each giving a negative result. Acute Polio-Myelitis or Acute Polio-Encephalitis.— There were 4 cases notified during the year, as compared with no cases in 1922, and 3 in 1921. Ophthalmia Neonatorum.—During the year 16 cases of this disease have been notified, 5 being in East Greenwich, 1 in West Greenwich, 2 in St. Nicholas, Deptford, and 8 in Charlton. Further particulars of this disease will be found on page 83. Malaria. There were 2 cases of Malaria notified during the year, 1 occurring in East Greenwich, and 1 in West Greenwich, compared with 10 last year. Encephalitis Lethargica.—There were no cases of this disease notified during the year. Glanders.—No case of Glanders has occurred within the Borough. 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 276 cases of Tuberculosis notified in the Borough, 219 being pulmonary cases, ordinarily known as Consumption, and 57 non-pulmonary, being Tuberculosis affecting other portions of the body than the lungs. Of this number of cases, 90 pulmonary and 23 non-pulmonary, occurred in East Greenwich, 64 pulmonary and 21 non-pulmonary in West Greenwich, 21 pulmonary and 6 non-pulmonary in St. Nicholas, 41 pulmonary and 7 non-pulmonary in Charlton, and 3 pulmonary and 0 non-pulmonary in Kidbrooke. The various ages of the patients were as follows Pulmonary cases under 1, none; 28 from one to five, 7 cases; five to fifteen, 30 cases; fifteen to twentyfive, 49 cases ; twenty-five to forty-five, 90 cases ; forty-five to sixtyfive, 43 cases ; and 5 cases over sixty-five ; whilst the Non-Pulmonary were : Under one year of age, 0 cases, one to five, 11 cases ; five to fifteen, 24 cases; fifteen to twenty-five, 13 cases ; and twenty-five to forty-five, 9 cases. Three hundred and ninety specimens were forwarded by medical practitioners for bacteriological investigation from patients suspected to be consumptive ; 303 were reported to be negative and 87 positive. Disinfection has been offered and carried out in 121 cases, including 165 rooms and 456 articles of bedding, etc.; disinfectant has also been supplied to patients to disinfect sputum, etc., and sputum pots where such are found necessary. 29 REPORT OF TUBERCULOSIS OFFICER. To the Medical Officer of Health. Sir, In presenting the Eleventh Annual Report on the work of the Tuberculosis Department it may be stated at the outset that there has been no alteration in the conduct of the Borough Scheme for the Campaign against Tuberculosis, the work being carried out on proved and established lines, with generally satisfactory results. For Pulmonary Tuberculosis the Incidence Rate and Death Rate are the lowest recorded in the Borough. The Notifications and Deaths from Tuberculosis in 1923 were as under :— Notifications. Deaths. Non- Non- Pulmonary Pulmonary Total Pulmonary Pulmonary Total 219 57 276 115 17 132 and the averages for the previous ten years (1913-1922) 282 122 135 24 In at least 8 instances, 6 pulmonary and 2 non-pulmonary, the diagnosis of Tuberculosis was not confirmed after a period of observation in Hospital, so that the corrected number of Notifications should read 213 Pulmonary and 55 Non-pulmonary. These figures are very satisfactory, giving an Incidence Rate as regards Pulmonary Tuberculosis of 2.08 per 1,000, the lowest ever recorded in the Borough, and showing that despite continued adverse economic and social conditions the disease is not increasing. This might be added despite the fact that Notification is becoming more efficient every year. The 8 cases referred to above comprised : 1 Cancer of the Lung (died) : 1 Aneurism of the Aorta (died) ; 1 Heart Disease (died) : 1 Gastric Ulcer (died) : 1 Pneumonia (died) and 1 case of Bronchial Catarrh following Gas Poisoning. These were all notified as suffering from Pulmonary Tuberculosis, whilst 2 cases notified as Lupus were found not tuberculous. Non-Pulmonary Tuberculosis : The 57 Notifications included : 26 cases Tuberculosis of the Glands 6 „ „ „ Spine 10 „ „ ,, Joints 5„ ,, „ ,, Abdomen 1 „ „ „Bone 6 ,, „ „ Brain 1 ,, „ Testicle 2 „ ,, „ Skin (Lupus) In connection with these Non-pulmonary Notifications affecting chiefly children, it might be mentioned here that 33 or 57 per cent. of the 57 cases notified used condensed milk almost exclusively. 30 From careful and frequent revisions of the Registers it is estimated that the number of Tuberculous persons residing in the Borough at the close of 1923 amounted to 824 as follows : Men. Women. Children. Total. Pulmonary Tuberculosis 214 217 129 560 Non-pulmonary 20 33 211 264 The patients mentioned in last year's Report as having been struck off the Register after five or more years of apparent good health, have been under supervision during the year and have continued well. Late Notification and Non-notification: Of the total deaths from Pulmonary Tuberculosis in 87 per cent of the cases, notification had previously been made under the Regulations, whilst in the remaining 13 per cent, it had not. This latter figure is an improvement on the previous year when it was 17 per cent, and a very great improvement on 1921 when the non-notified cases reached 26 per cent. At the beginning of the year a circular was addressed to each medical practitioner in the Borough asking him to notify every case he was called upon to attend, in order that no case should escape Notification on the assumption that it had already been notified by another practitioner. The immediate result was a crop of Re-notifications showing on the one hand how Consumptive patients float about from doctor to doctor, but on the other hand it has resulted in a great reduction of the non-notified cases. It is proposed to continue the experiment and at the same time to carry on the usual practice of sending reminders to both Medical men and Institutions upon failure to notify. Of the 15 cases mentioned in the Table below, who died before notification was received, the certifying authority in 2 cases was the Coroner: in 4 cases Institutions and in 9 instances General Practitioners. As far as could be ascertained in 10 of these cases the average duration of illness was 8-5 months. The following table shows the Death notification interval of 115 patients who died in 1923 and whose deaths were ascribed to Pulmonary Tuberculosis:— Died before notification received 15 Died within one month of notification 12 „ „ one to three months 12 „ three to six months 26 „ ,, six to twelve months 19 31 Died within one to two years 16 „ two to three years 12 „ „ three to four years or over 3 Deaths : During the year 133 persons died from Tuberculosis (all forms) giving a death rate of 1.3 per 1,000 population: 115 deaths were due to the pulmonary form or a rate of 1.12 per 1,000, the lowest ever recorded in the Borough. Non-pulmonary deaths, of which there were 18, included 6 cases of meningitis in children, the eldest of whom was 11 years and the youngest 9 months of age. A table showing the Ward Distribution, sex and age period at death will be found elsewhere in the Report. The Notifications and Deaths from Pulmonary Tuberculosis with the Incidence and Death Rates for the previous five years are recorded in the following table:— Year. Notifications Incidence per 1,000 Deaths Death Rate per 1,000 1918 267 2.6 146 1.62 1919 300 2.9 141 1.35 1920 264 2.5 120 1.14 1921 263 2.6 119 1.18 1922 218 2.1 120 1.18 Occupation: There are no Industries in the Borough which have any special bearing upon the Incidence of Tuberculosis, but below is given a condensed table of the occupation of 180 cases of Pulmonary Tuberculosis notified in 1923 together with the number who presented a family history of Tuberculosis. In connection with occupation, however, it must be borne in mind that very fewtrades in themselves are injurious, it is the conditions under- which they are carried on that require consideration. Further, in connection with occupation, it is surely highly desirable for the protection of the public that power be obtained to prevent and if necessary compensate persons suffering from Pulmonary Tuberculosis from dealing with or handling food stuffs. During the year 3 persons (2 milkmen and 1 baker's roundsman) were so notified, but beyond the usual advice as regards infection, etc.,work was still carried on despite the fact that 2 of them had the Tubercle germs in their sputum. Notifications are rightly confidential but that nothing "shall be done to interfere with a man's employment," requires amendment if the public are to be protected from a possible source of Infection. 32 Occupation Number Number with Family History of Tuberculosis Labourer 48 11 Street Traders 5 2 Firemen 2 — Clerks 12 3 Factory Workers 11 4 Mechanics 22 9 Shop Assistants 12 2 Houswives 39 11 Domestics 10 3 Others 19 8 Housing : As is well known, Home conditions have a special bearing upon the spread of Tuberculosis, and unfortunately the remarks of last year under this heading, are still applicable. Gross overcrowding exists in many cases and although every effort has been made to mitigate the evil, little progress has been accomplished, owing to the housing shortage. Many examples could be given, but the following two will suffice : (a) Father, mother, and 3 children living and sleeping in the one room together with the patient aged 20. (b) Father, mother and 5 children, living and sleeping in the same room with patient aged 12. In this instance an additional room was obtained through the aid of the Care Committee and Dispensary Staff. It follows that an analysis of the sleeping arrangements reveals a serious state of affairs. Of 263 patients suffering from Pulmonary Tuberculosis, 150 were sharing a bed. 44 had a separate bed but not a separate room. 69 had a separate room and a separate bed. To endeavour to prevent infection spreading under these and other difficulties arising out of the housing shortage and unemployment, presents a very difficult problem. The four shelters provided by the Council have been in constant use, and as will be mentioned later Bedsteads and Bedding have baen lent or supplied in several instances by the Council and other agencies. 33 Dealing now with the Dispensary itself, 842 new patients were examined during the year. The sources from which these patients came are as follows:— Doctors 184 Hospitals 20 School Medical Service 22 Ministry of Pensions 8 Own Application 100 Nurses (Contacts) 508 Contacts : Arrangements were made during the year by the County Council for further co-operation between the Dispensary and the School Medical Service so as to insure that no contact of school age will remain unexamined. If for any reason examination cannot be carried out at the Dispensary, the School Medical Officers are notified and the child examined at School. Much of the nurses' time is spent endeavouring to secure the examination of every contact. This year, out of a total of 862 Contacts 683 or 79 per cent, were examined of whom 62 or 9 per cent. were found to be Tuberculous. In addition 109 contacts were examined more than once before arriving at a definite diagnosis. The work of the Dispensary is shown in the statistical table appended and explains itself. Duration of Illness : Taking 87 deaths in 1923 from Pulmonary Tuberculosis (50 men, 33 women, 4 children) whose histories were recorded at the Dispensary the average duration of illness for both sexes worked out at 38 months as against 31.6 months last year, the difference between the males and the females being 2.4 months against 1.8 months in the preceding year. In the Children the average duration was 6.2 months against 7.2 in 1922. Family History. In connection with the 87 deaths alluded to in the previous paragraph, there was a history of Tuberculosis amongst the near relatives (father, mother, brothers, sisters,) in 21 instances, and amongst remote relatives (uncles, aunts, etc.,) in 7. Sanatorium Treatment. During the year 143 patients were sent to sanatoria, 83 under the County Scheme, 45 through the Guardians and 15 through other sources. In addition 35 children are attending the Open Air Schools at Shooters Hill. The average duration of residence remains the same, and the same difficulties remain in finding suitable employment for those discharged fit for work. 34 Dental Treatment. The Dentist reports as follow — Number of Patient 120 Attendances 196 Extractions (gas) 130 Extractions (Local anaesthesia) 71 Extractions (ordinary) 15 Fillings and Scalings 11 Referred to own Dentist — Refused Treatment — Dentures were supplied in 6 instances, the Council paying part cost. The Council have resolved to determine the agreement with the British Dentists Hospisal and to appoint a part-time dentist. This arrangement will come into force in April 1924, and should prove of advantage in every way. X-ray Examinations. During the year 50 patients were examined of whom 29 were children. There were 47 examinations of the chest and 3 of other parts. Sputum Examinations. Of 235 sputum specimens bacteriologically examined at the Seamen's Hospital, 48 proved positive and the remainder negative. At the same time 300 specimens were chemically examined at the Dispensary for Albumen, with very similar results to those mentioned last year. The Interim Tuberculosis Care Committee. The Council having now agreed to form a permanent Care Committee the following Report will be the last one issued by the present Committee. In appending the Report I desire to warmly acknowledge the help which has been always willingly and freely rendered by the Committee and especially by the Honorary Secretary to the many cases referred to them by the Dispensary. Much of the assistance given has been of such a nature as cannot well be written down, but the friendly visits, the kindly advice and the interest shown in their welfare, have been much appreciated by the patients and also by the Dispensary staff. The Report is as follows and it only calls for me to endorse the Hon. Secretary's remarks regarding the difficulties in obtaining suitable Housing and Employment for Tuberculous patients. 35 REPORT OF THE HONORARY SECRETARY FOR THE YEAR ENDED 31st DECEMBER, 1923. During the year 1923, the Interim Tuberculosis Care Committee included representatives of the following bodies:—Charity Organisation Society, Invalid Children's Aid Association, London County Council (2), St. Peter's Parish, Miller Hospital, National Health Insurance, Greenwich Guardians, British Red Cross Society, Local Medical Practitioners and Labour Party. The Medical Officer of Health, Tuberculosis Officer, and Tuberculosis Health Visitors also served upon the Committee together with Miss M. N. Johnston, the Hon. Secretary. The Committee held 11 meetings, the average attendance being 9. £122 8s 0d towards the cost of treatment of patients was collected from their relations for the London County Council. This amount is somewhat less than has been collected in recent years, but more adults have sent their contributions direct to the London County Council so that the total paid for Greenwich patients in 1923 was probably larger than usual. The Winter Distress League helped with clothing for two pat'ents, 7 private donors gave clothes, the British Red Cross emergency Help Committee supplied clothes to several patients recommended to them and the Guardians to 3 patients, all of whom were going to Sanatoria. Loans were made in four cases, (3 for clothes and 1 for a mattress), 2 of which have been repaid, and 2 nearly repaid by weekly instalments. The Borough Council lent bedsteads and mattresses to 11 patients. The Vicar of Greenwich gave letters from the Northampton Charity for 2 patients, that had been under observation, for the Hanneman Convalescent Home, Bournemouth, and the Hunstanton Convalescent Home. 12 patients were helped through the S.S.H.S. and S.S.F.A. (from Naval and Regimental Funds), the United Services Fund, the British Red Cross Society, and the Society for the Relief of Distress helped with £25 4s 7d. The Charity Organisation Society helped two cases recommended to them by the Committee at a cost of £57 4s Od. Three parents saved their money by using the Secretary as their banker, while their children were in Sanatoria, to provide clothes, etc., for them on their return home. 36 It will be seen therefore that the Committee has been instrumental in securing a considerable measure of assistance in a large number of instances, but it will be appreciated that, in many cases, the shortage of housing accommodation makes it impossible to improve the homes, and often the patient loses the good obtained on his return to a crowded home. In other cases the hopelessness of getting suitable work causes the patient to lose heart owing to the lack of occupation and a consequent lack of money to get extra nourishment. Despite these difficulties, however, the members of the Committee have been much encouraged in their work, owing to the marked improvement brought about in the condition of many of the patients coming under their care. In June, the Secretary of the Royal Borough of Kensington Tuberculosis Care Committee wrote, with reference to the fixed Minimum Income Basis in Cases of Assessment, that at a meeting of representatives of the neighbouring Boroughs the following resolution was passed unanimously: "That a graduated scale based on (a) income (b) expenditure (c) number of persons in the family should be substituted as a guide for the fixed minimum income basis of £160. The Committee's views were invited and they were also asked if they would associate themselves with the above Committee in making a joint recommendation to the London County Council. After some discussion, the Committee decided to support the resolution and join in the recommendation to the London County Council. In July, the Secretary reported attending a Conference at 19, Berkeley Street, between the Secretaries of Tuberculosis Care Committees and the Representatives administering the Emergency Help Scheme in the County of London, with the object of securing a closer co-operation in dealing with ex-Service men coming within the scope of the Scheme. I should like in closing to acknowledge gratefully the help I have always received not only from the members of the Committee but also from the Medical Officer of Health, and the Tuberculosis Officer. My period of office extends over six years, M. N. JOHNSTON, Hon. Secretary. 37 Apart from the help rendered by the Care Committee, the four Shelters provided by the Borough Council have been in constant use. Extra nourishment has been granted in 25 instances. To prevent overlapping, other cases already in receipt of Poor Law Relief, have been referred to the Guardians. Nothing has been done in the way of providing accommodation for advanced cases, and such patients must either enter the Infirmary or remain at home as a possible source of infection to their families. The services of the District Nurses in attending and nursing those advanced cases referred to them from the Dispensary must be gratefully acknowledged. In concluding the Report I would once more thank the members of the Public Health and Dispensary Staff for their assistance and co-operation in carrying out the work entrusted to us. I am, Sir, Your obedient Servant, M. MACDONALD, M.D., D.P.H. 38 Return of work carried out in connection with the Maze Hill Tuberculosis Dispensary for the Year 1923. Number of Under Observat'n at the Dispensary in Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Found to be Under Observat'n at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary NonPulmonary (a) All persons (including "Contacts.") Adults. M. 4 144 148 58 6 78 5 1 F. 7 230 237 53 6 165 10 3 Children under 16. M. 5 225 230 8 9 202 6 5 F. 4 2 43 247 11 10 215 9 2 Total .. 20 842 862 130 31 660 30 11 (b) "Contacts" (included in (a)). Adults M. 1 61 82 13 2 45 1 1 F. 3 163 166 21 2 136 4 3 Children under 15. M. 1 174 175 1 3 165 4 2 F. - 189 189 7 4 173 4 1 (c) Insured persons (included in (a)). M. 2 117 119 46 4 63 5 1 F. 2 49 51 19 1 27 3 1 39 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December 424 2. Total number of attendances of patients at the Dispensary during the year—Insured 3,095 Uninsured 5,234 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 256 4. Number of cases in which the period of observation at the pensary exceeded two months 37 5. Number of insured patients under domiciliary treatment on 59 December 31st 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 7. Number of persons referred to affiliated hospital for consultation 8. Number of consultations with Medical practitioners at the homes of patients—Insured 19 Uninsured 7 9. Number of other visits paid by Tuberculosis Officer to the homes of patients .166 10. Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 4,888 11. .Number of specimens of sputum examined in connection with the work of the Dispensary 235 I have again to write in the most appreciative terms of the good work accomplished by the members of the Care Committee during the year. Every effort has been put forth to effect the greatest possible assistance to all those coming within the purview of the Committee, a special measure of praise being due to Miss M. N. Johnston, who has enthusiastically and efficiently discharged the duties of Hon. Secretary. The Committee was formed in 1918 and Miss Johnston has filled the office during the whole of the Committee's existence. Effective as has been the work of the Interim Tuberculosis Care Committee, the Ministry of Health and the London County Council had for some time urged the establishment of Permanent Committees, and this matter was considered by the Greenwich Borough Council on several occasions. The suggestion was put forward to the Ministry of Health that all matters relating to Tuberculosis in the Borough might be referred to a Committee of the Council specially 40 formed for the purpose, but it was pointed out that such delegation of duties would necessitate legislation, which the Minister could hold out no hope of promoting at the present time. The Greenwich Borough Council at their meeting on 21st November, 1923, decided to form a Permanent Tuberculosis Care Committee for the Borough, constituted as follows :— Five members of the Public Health Committee of the Greenwich Borough Council. One representative of the Local ex-Service Benevolent Committee of the United Services Fund. One representative of the Local Medical Practitioners. One representative of the British Red Cross Society. One representative of the Greenwich Guardians. One representative of the National Health Insurance. One representative of the Miller Hospital. Two representatives of the London County Council. One representative of the Invalid Children's Aid Association. One representative of the Charity Organisation Society. The Medical Officer of Health, and The Tuberculosis Officer. It was further decided that such Committee be appointed annually and that its proceedings be submitted at each meeting of the Public Health Committee. To these proposals both the Ministry of Health and the London County Council have signified their general approval. 41 Supplemental Vaccination Return for 1922. Return made on or before the 9th of February, 1924, by Mb. 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, 1921, inclusive:— Registration SubDistricts comprised in the Vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1922. Number of these Births duly entered by 3lst Jan., 1924. No. of Births which on 31st Jan., 1924, remained unentered in the Vaccination Register on account of— No of these births remaining on 31st Jan., 1924, not accounted for. Total No.of Certificates of successful Primary Vaccination at all ages received during Calendar Year 1923. No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1923. 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. South Deptford 642 314 3 — 223 31 2 18 7 44 .. .. North Deptford 1,060 513 2 — 350 28 3 6 14 144 .. .. East Deptford 1,046 390 3 — 261 61 8 9 69 245 .. .. East Greenwich 955 512 3 — 285 45 — 15 44 51 .. .. West Greenwich 490 271 1 — 140 17 1 2 11 47 .. .. Total 4,193 2,000 12 — 1,259 182 14 50 145 531 2,889 980 Dated February 1st, 1924. No. of Births entered in "Birth List Sheets" as registered from 1st January to 31st December, 1922 516 Successfully Vacoinated 309 Insusceptible of Vaccination 2 Had Small-Pox .— CHARLTON AND KIDBROOKE. Statutory Declarations of Conscientious Objection 143 Dead Unvaccinated 24 Postponed by Medical Certificate 2 Removed to Districts the Vaccination Officer of which has been duly apprised 16 A. E. Rossiter, Vaccination Officer. Removed to places unknown, or which cannot be found; and cases not traced 19 Not accounted for 1 G. E. Ouqhton. 42 SECTION 4. CAUSES OF SICKNESS. There was no cause of sickness during the year calling for special mention other than the four cases of Small-pox, particulars of which are given on page 23 dealing with Infectious Diseases. SECTION 5. SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home. (a) General. No provision is made by the Council. (b) For Infectious Diseases. Arrangements are made with the Blackheath and Charlton District Nursing Association : St. John the Divine Home, Deptford, and the Ranyard Nurses for nursing selected cases of Measles, Ophthalmia Neonatorum, Influenza, Dysentery, Epidemic Diarrhoea, Malaria and Pneumonia, upon an intimation from the Public Health Dept. The Council's Health Visitors also give advice and assist as far as possible. Midwives.—No midwives are employed or subsidised by the Council. There are 14 practising in the district. 43 Clinics and Treatment Centres. Name. Situation. Nature of Accommodation. By whom provided. Period when held. Maternity and Child Welfare Centres. Borough Hall, Royal Hill, Greenwich. 1 large waiting room. 1 large weighing room. 1 Consulting room. Local Authority. Thrice weekly. (a) Infant Consultations Conduit House, Trafalgar Rd., Greenwich. Ditto. (Portion used for Day Nursery Purposes) Ditto. Thrice weekly. 105, Shooter's Hill Road. Blackheath. Ground floor consisting of large waiting room, large weighing room and consulting room. Ditto. Twice weekly. Albany Institute, Creek Road. Deptford. Large hall and consulting room. Ditto. Once weekly. (6) Pre- Maternity. Borough Hall. (See above). Ditto. Twice weekly. 105, Shooters Hill Road, S.E. ( Do. ) Ditto. Once weekly. (c) Minor Ailments. Borough Hall. 1 large room. Ditto. Daily. Day Nurseries Conduit House 1 large Ward, Playroom, Bathroom, Matron's Offices and Residential Accommodation. Ditto Daily. Nursery School. Rachel McMillan Memorial School, 232, Church Street Deptford, S.E. Extensive. Miss Margaret McMillan. Daily. School Clinics. Park Row, Greenwich. Whole House. Local Medical Practitioners. Daily. Ditto. Health Clinic, Deptford Green, S.E. Several rooms. Miss Margaret McMillan. Daily. Tuberculosis. Dispensary, 7a, Maze Hill, Greenwich. Consulting Room and Dentist's Surgery. Separate Waiting and Cloak Rooms for Men and Women Patients, Nurses' Room and Dispenser's Room. Local Authority. Daily Venereal Diseases. Miller General Hospital, Greenwich Rd. Seamen's — — Daily. Hospital, Greenwich. - - Thrice weekly St. John's Hospital. Morden Hill. Lewisham - - Twice weekly. *Creche Closed 13th October, 1923. 44 Hospitals Provided or Subsidised by Local Authority. (1) Tuberculosis.—Sanatoria provided by London County Council. (2) Maternity.—Maternity Home, 78, Shooters Hill Road, Blackheath, S.E.3, provided by the Council. Accommodation comprises :— (1) Receiving Ward. (2) General Ward with 10 beds. (3) Small Ward with 2 beds. (4) Single Ward with 1 bed. (5) Isolation Ward. (6) Labour Ward. (7) Medical Officers' Room, Laundry, etc., together with residential accommodation for Matron, Nurses, Probationers and Domestic Staff. (3) Children.—None provided by Council but arrangements made with Deptford Fund for Greenwich Children and Grant made by the Council for this purpose. (4) Fever and (5) Small Pox.—Cases of infectious Disease are treated at the Hospitals of the Metropolitan Asylums Board whose Brook Hospital is situate at Shooters Hill Road, Blackheath. (For the last six months this Hospital has been closed.) Institutional Provision for Unmarried Mothers, Illegitimate Infants, and Homeless Children. No provision is made by the Council, but Dr. Barnado's Homes National Incorporated Association have Finchley Lodge, St. John's Park, Blackheath, used for this and similar purposes. Ambulance Facilities. (a) Patients suffering from Infectious Diseases are veyed to Hospital by the ambulances of the Metropolitan Asylums Board. (b) For Non-Infectious and Accident cases. No provision by the Council. Facilities afforded by the ambulances of the Metropolitan Asylums Board, London County Council and certain local Hospitals. 45 HOSPITAL AND OTHER FORMS OF GRATUITOUS MEDICAL RELIEF. The Seamen's Hospital have admitted, treated and maintained 256 Greenwich persons for an average of twenty-eight days each, in addition to which there have been 2,012 Out-patients, making approximately 6036 attendances of persons belonging to the Borough of Greenwich. Miller General Hospital admitted, treated and maintained 359 Greenwich persons for an average of twenty-three days. 6,563 Out-patients have also been treated, the total attendances being approximately 32,700. Blackheath and Charlton Cottage Hospital admitted 268 In-patients from Greenwich, and treated 530 Out-patients making 3,278 attendances for this purpose. Included in the number of 530 were 214 Casualty cases. POOR-LAW RELIEF. I am indebted to the Clerks of the Greenwich and Woolwich Boards of Guardians for the following figures for the year ended 29th December, 1923 Greenwich Parish. St. Nicholas Deptford Parish. Charlton and Kidbroke Parish. Total amount expended in out-door relief £80,363 £ * £15,483 Total number of persons treated in Hospital 1,203 197 120 Total number of persons treated medically in their own homes 239 * 238 Total number of persons admitted to the Workhouse 501 83 38 * Figures are unobtainable. SECTION 6. LABORATORY WORK. The long-standing arrangement with the Bacteriological Department of the Seamen's Hospital has been in force throughout the year, whereby that Institution carried out all necessary pathological and bacteriological work for this Department, other than under the Sale of Food and Drugs Act, and in this connection 1,538 specimens have been examined for Diphtheria, 11 for Typhoid Fever, 390 for Tuberculosis, and 38 for other various conditions. 46 Fuller details respecting results of the examinations of these specimens will be found under the different headings of the individual diseases. Thirty-one tubes of Diphtheria Antitoxin, containing a total of 76,000 units of serum, have been supplied during the year to Medical Practitioners for the treatment of patients suffering from this disease. SECTION 7. SANITARY ADMINISTRATION. List of Adoptive Acts, By-Laws and Local Regulations Relating to the Public Health, in Force in the District, with Date of Adoption. By-Laws made under Public Health (London) Act, 1891, Sec. 16 (1). By-Laws made under Public Health (London) Act, 1891, Sec. 16 (2). By-Laws made under Public Health (London) Act, 1891, Sec. 39 (1). By-Laws made under Public Health (London) Act, 1891, Sec. 39 (2). By-Laws made under Public Health (London) Act, 1891, Sec. 50. By-Laws made under Public Health (London) Act, 1891, Sec. 94. By-Laws made under Metropolis Local Management Act, 1855, Sec. 202 (Plans). By-Laws made under Metropolis Local Management Act, 1855, Sec. 202 (Drainage). By-Laws made under London County Council (General Powers) Act, 1903, Sec. 54. Provisions of L.C.C. (General Powers) Act, 1902, as to Ice Creams. Regulations under Dairies, Cowsheds and Milkshops Orders, 1885 and 1886. Further particulars are given under Powers and Duties of the Public Health Committee on pages 1 and 2. The tables on pages 48 to 50 and 53 to 60 summarise, as far as possible, the Sanitary work of the Department; from this it will be seen that a total of 17,976 houses and premises have been inspected or re-inspected during the year; 1223 intimation notices and 127 statutory notices have been served. 47 It was found necessary to institute Police Court proceedings in six cases only during the year, particulars of which are contained in the table on page 58. There were altogether throughout the year 595 complaints registered. Factories, Workshops and Workplaces.—Two hundred and ninety-four inspections have been paid to these premises within the Borough during the year. There were 175 workshop premises on the Register at the beginning of the year, 10 have been added and 2 taken off, leaving a total now on the Register of 183. This total includes 8 laundries, 13 dressmaking and mantle works, 9 fuel and firewood works, 3 cycle works, 2 milliners, and various others, including workplaces, such as 4 blacksmiths, 14 barge builders 4 builders' yards, etc. Outworkers' Register.—Seventeen lists, containing 46 names and addresses have been received from employers within the district. In addition to this 58 lists containing 152 names and addresses of Outworkers residing in this Borough were received from Medical Officers of Health of other Boroughs, whilst 17 lists with 23 names and addresses were forwarded to other districts, thus giving a total of 175 Outworkers in the Borough. One hundred and sixty-five visits of inspection have been paid to these premises. 48 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES and HOMEWORK. 1.—INSPECTION. Premises. Number of Inspections. Written Notices. Prosecutions Factories (Including Factory Laundries) 68 4 .. Workshops (Including Workshop Laundries) 90 18 .. Workplaces (Other than Outworkers' Premises) 136 11 .. Total 294 33 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecut's. Found. Remedied. Referred to H.M. Inspector. *Nuisances under the Public Health Acts:— Want of Cleanliness 17 17 .. .. Want of Ventilation 13 13 .. .. Overcrowding .. .. .. .. Want of Drainage of Floors 4 4 .. .. Other Nuisances 10 10 .. .. Sanitary Accommodation— Insufficient 7 7 .. .. Unsuitable or Defective 25 25 .. .. Not Separate for Sexes 1 1 .. .. Offences under the Factory and Workshops Act:— Illegal Occupation of Underground Bakehouse (s. 101) .. .. .. .. Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) 23 23 .. .. Other Offences 1 1 .. .. Total 101 101 .. .. * Including those specified in Sections 2, 3, 7 and 8 of the Factory Act, as remediable under the Public Health Acts. 49 3.—HOME WORK. Nature of Work. Outworkers' Lists, Section 107. Outwork in unwholesome premises. Sec. 108. Outwork in infected premises. Sees. 109 & 110. Lists received from Employers. Notices served on occupiersas to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 10). Prosecutions (Secs. 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. Contractors Workmen. Contractors Workmen. Wearing Apparel— (1) Making, &c. 14 16 26 .. .. .. .. .. .. .. .. .. .. .. .. (2) Cleaning & Washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Lace, Lace Curtains & Nets .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and Upholstery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fur Pulling .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Umbrellas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Paper Bags and Boxes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cotton and Kit Bags .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Brush Making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Box Making .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Rackets and Tennis Balls 2 .. 4 1 .. .. .. .. .. .. .. .. .. .. .. Stuffed Toys .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 16 16 30 1 — — — — — — — — — — — 50 4.—WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1923. No- Bakehouses 39 Factory Bakehouses 5 Barge Builders 14 Blacksmiths 4 Boot and Shoe Makers 8 Builders' Yards 4 Carpenters and Joiners 4 Carriage Builders 2 Coopers 4 Cycle Works 3 Dress and Mantle Makers 13 Fuel Works 9 Laundries 8 Milliners 2 Photographers 3 Picture Frame Makers 1 Printers 1 Tailors 5 Underclothing Makers 1 Others 53 183 5.—OTHER MATTERS. Class. No. 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 2 Reports (of action taken) sent to H.M. Inspectors .. 2 Other — Underground Bakehouses (sec. 101) :— In use at the end of 1923 13 Customs and Inland Revenue Acts.—No applications were received during the year for certificates under these Acts. Scavenging.—The Refuse Destructor forshadowed for some years past is still in course of construction. The collection of house, etc., refuse in the Borough is under the control of the Borough Surveyor, and very few complaints have been received as to non-collection. Two hundred and sixty-eight new ash receptacles have been provided. Horse Slaughterer.—The one horse slaughtering premises in the Borough has been inspected on three occasions and the cleansing of the premises duly carried out. 51 Houses let in Lodgings.—We are still waiting for the By-Laws to be made by the London County Council under Sec. 26 of the Housing and Town Planning, etc. Act, 1919, as amended by Sec. 14 of the Housing etc. Act, 1923. Rats and Mice (Destruction) Act, 1919. 424 investigations were made by the Council's Rats Officer, but as was the case last year only in one case was it found necessary to serve a notice. The usual " Rat Week " was held during the first week in November, when circulars were sent out to all business firms and factories in the Borough inviting their co-operation and concerted action towards the extermination of rats and mice. Chemists and Hardware Dealers were also circularised with a view to their laying in larger stocks of raticides. From investigations subsequently made by the Rats Officer it appeared that in most cases the efforts put forward by the various owners and occupiers of property in the Borough were carried out in an enthusiastic and consciencious manner. Increase of Rent and Mortgage Interest Restrictions Acts, 1920 and 1923. The New Act which came into force on the 31st July, 1923, amends and prolongs the duration of the Principal Act of 1920, until the 24th June 1925. A Tenant therefore who is charged the increased rent allowable by the Act is still enabled to apply to the Sanitary Authority for a Certificate as to whether or not the dwelling house occupied by him is in all respects reasonably fit for human habitation, or otherwise not in a reasonable state of repair. Twenty such applications for certificates were received. 9 certificates were granted ; in the remaining 11 cases the necessary work was done by the landlord, the certificates therefore being not necessary. Other Schedule Offensive Trades.—The Foreign Animals Wharf being still in the occupation of the Military, the Offensive Trades generally carried on therein have not yet been recommenced. Smoke Nuisances.—Twenty-three observations have been made for smoke nuisances during the year, but in no instance was it found necessary to serve a Statutory Notice. Serious complaints continue to be received respecting the emission of large volumes of smoke, together with dust and fine, gritty particles, from the chimneys of the London County Council Generating Station and the London Electric Supply Corporation 52 and although both of these authorities profess to be doing all they possibly can to deal with the matter, still it was thought that some recognised authority, having expert knowledge as to the satisfactory working of the various appliances, might be of assistance to the Department in dealing with this question. The Council have accordingly authorised the engagement of such an expert should it be found necessary. Water Supply—During the year 90 water supply certificates have been granted under Section 48 of the Public Health (London) Act 1891. This number includes 80 houses comprising the Council's Housing Estate at Charlton. Defective water fittings have been remedied in 46 cases ; 22 water supplies have been reinstated where the supply had been cut off ; water fittings have'been amended in 150 cases ; 23 water supplies have been altered so as to draw direct from the main ; water supply provided in 9 instances, and cleansing, repairing and covering cisterns in 8 cases. House Drainage.—24 drains have been constructed, 138 drainage systems have been reconstructed or repaired; 324 such systems have also been opened, cleansed and amended; 84 surface drains have been constructed ; 89 drains and soil pipes have been ventilated; 160 systems have been tested by smoke, 445 by water, of which number, 140 were found to be defective ; 35 new soil pipes and 355 traps have been fixed, together with 59 intercepting chambers and fresh air inlets, and 87 other chambers. Ventilation has been improved in 63 cases. Fifty-four new covers to manholes have been provided. Twenty systems have been sealed off or slurried up. Thirty-five forecourts 18 areas, 96 yards, 5 mews and stables drained ; 2 cesspools abolished 34 water-closets have been erected; 180 cleansed and repaired; 103 w.c. doors and seats repaired or provided. A pan, trap and water supply have been furnished throughout in 65 cases; pan and traps only furnished in 195 cases; pans only in 16 cases, and other fittings provided or improved in 255 cases, whilst the water supply has been renewed in 49 instances. Public-house urinals have been cleansed and repaired in 13 instances; 4 urinals were altered, 12 repaired or water laid on, and 9 constructed. During the year the Council continued their efforts in urging the London County Council to include in their next General Powers Bill, a clause placing the liability upon owners of property for the cost of repairing or renewing drainage systems up to the point of connection with the public sewer and in November a communication was received from the County Council stating they had decided to insert such a clause in their next Bill which would be before Parliament in 1924. 53 SUMMARY OF WORK PERFORMED BY THE SANITARY INSPECTORS DURING THE YEAR 1923. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. Inspections Houses Inspected 436 553 566 559 2114 Other Premises Inspected 63 66 73 119 321 Re-inspections Calls Made, etc. 3150 4384 2099 3133 12,766 Inspections of Houses Let in Lodgings 22 38 33 16 109 ,, Bakehouses 9 56 7 42 114 „ Factories and Workshops . 23 34 19 72 148 „ Outworkers' Premises 52 34 32 47 165 „ Slaughterhouses 2 5 9 6 22 „ Cowhouses .. .. 3 4 7 „ Stables and Yards 61 44 14 20 139 „ Piggeries 2 1 1 1 5 „ Courts and Alleys 10 .. .. 3 13 „ Fields, Lanes, etc. 43 39 6 7 95 Investigations (Rats and Mice) 140 139 78 67 424 Inspections of Urinals 6 9 3 7 25 „ Gipsy Vans .. .. .. .. .. „ Horse Slaughterhouses .. 2 1 .. 3 „ Dairies, Cowsheds and Milkshops 14 100 32 19 165 „ Soap Works 1 1 .. .. 2 „ Other Offensive Trades .. 2 1 .. 3 „ Ice Cream places .. 90 50 .. 140 ,, Other places where food is prepared 241 338 234 358 1171 „ Premises (Children Act, 1908) 3 12 6 4 25 Total 4278 5947 3267 4484 17,976 Drains. Constructed 3 6 5 10 24 Intercepting Chamber and Fresh Air Inlet 21 13 17 8 59 Other Chambers Constructed 30 17 24 16 87 Reconstructed or Repaired 39 30 46 23 138 Opened, Cleansed, and Amended 67 96 86 75 324 Surface Drains Constructed 54 18 8 4 84 Traps Fixed 114 85 89 67 355 New Soil Pipes 8 7 12 8 35 Soil and Vent Shafts Repaired 7 10 9 16 42 Drains and Soil Pipes Ventilated 21 21 36 11 89 Drains Sealed off, etc. 6 8 2 4 20 Drains tested—by Smoke 58 40 32 30 160 „ by Water 118 168 99 60 445 Found Defective 39 50 37 14 140 New Covers to Manholes 25 11 6 12 54 Yards Drained 42 10 31 13 96 Mews and Stables Drained 1 3 1 .. 5 Washhouses Drained .. .. .. .. 1 54 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. Drains—contd. Forecourts Drained 19 2 6 8 35 Areas Drained 5 5 8 .. 18 Cesspools abolished 1 .. 1 .. 2 Privies and Earth Closets abolished .. .. .. .. .. Water Closets and Urinals. Closets erected 6 11 6 11 34 W.C. doors and seats repaired or provided 32 19 22 30 103 Sanitary Conveniences or Improvements effected to Factories, Workshops and Work places 18 6 1 11 36 Pan, Traps and Water Supply furnished 26 21 5 13 65 Pans and Traps only furnished 48 31 64 52 195 Pans only furnished 4 7 2 3 16 Water Supply Apparatus repaired or provided 90 53 64 48 255 Water Supply renewed 20 15 3 11 49 Water Supply disconnected from Drinking Water Cistern 3 .. .. .. 3 Soil Pans properly trapped 3 .. .. .. 3 Cleansed and Repaired 67 45 29 39 180 Newly constructed or better situated 8 7 2 9 26 Ventilation improved 21 16 13 13 63 Public-house Urinals cleansed or repaired 4 5 2 2 13 Other Urinals altered or cleansed 2 2 .. .. 4 Other Urinals constructed 8 1 .. .. 9 Repaired or water laid on 1 11 .. .. 12 Ashpits. Provided 72 64 50 82 268 Covers to receptacles 4 1 1 .. 6 Dust complaints forwarded to the Surveyor 3 .. .. 1 4 Pavings. Yards 80 75 67 71 293 Forecourts 22 6 6 14 48 Areas 2 11 8 .. 21 Washhouses 9 1 9 12 31 Mews and Stables 2 2 1 3 8 General Water Supply. Covers to Cisterns adapted 3 3 1 2 9 Water Supply provided 1 2 6 .. 9 Water Fittings amended 65 40 22 23 150 Cisterns cleansed and repaired 3 1 2 2 8 Water Services altered so as to draw direct from main 9 6 5 3 23 Water Supplies reinstated where cut off through defective fittings 6 7 2 7 22 55 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. General Water Supply—contd. Defective Water Fittings (causing nuisance from dampness) repaired 19 4 9 14 46 Water Supply Certificates granted (Section 48) 17 36 22 15 90 Other Improvements. Houses generally repaired 123 166 129 175 593 Premises cleansed, lime-washed and repaired 50 49 20 66 185 Verminous Rooms cleansed 24 59 53 60 196 Ventilation improved 91 72 39 85 287 Staircases repaired, lighted and ventilated 39 24 24 16 103 Leaky House Roofs and Gutters repaired 151 114 93 200 ,558 Walls and Ceilings of Premises cleansed throughout 45 44 27 62 178 Ditto ditto partially 140 152 128 168 588 Stoves, Fireplaces and Flues repaired 63 72 33 49 217 Washing Coppers repaired 33 28 21 35 117 Sinks provided 29 15 5 13 62 Doors and Floors repaired 78 71 32 70 251 Cowhouses cleansed .. .. .. 3 3 Piggeries cleansed 1 .. .. .. 1 Ice Cream places cleansed or improved 1 9 5 .. 15 Other places where food is stored or prepared 3 19 22 28 72 Provision for Storage of Food 4 12 1 2 19 Other Nuisances Abated. Illegal use of Underground Room discontinued .. .. .. .. .. Overcrowdings abated 1 2 .. 1 4 Sink, Lavatory and Bath Waste Pipes disconnected, trapped and amended 62 57 41 54 214 Stack Pipes disconnected and amendec 46 50 22 43 161 Nuisances from dampness abated 69 47 36 53 205 Animals Kept in Unfit Places discontinued or removed 2 4 6 1 13 Dung Receptacles provided 2 .. .. .. 2 Bakehouse Nuisances abated 2 4 .. 17 23 Houses abolished, unfit for habitation .. 1 .. .. 1 Accumulations of Manure and other obnoxious matter removed 12 27 20 9 68 Dampness of Walls remedied 50 39 20 49 158 Inundations abated 2 2 .. .. 4 Other Nuisances, principally of dilapidations and want of underfloor ventilation 38 63 60 39 200 56 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Other Nuisances Abated.—contd. Contents of Booms cleansed 5 7 10 17 39 Breaches of By-Laws abated .. .. .. .. .. Rat Infestation abated 15 6 29 5 55 Smoke Nuisances. Observations 8 6 2 7 23 Statutory Notices served (Sections 23 and 24) .. .. .. .. .. Food and Drugs. Samples taken 120 119 96 103 438 Found Adulterated 10 2 3 4 19 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Unwholesome Food. Seizures made - - - - Voluntarily surrendered One Crate (24) of Rabbits. One Crate (6 stone) of Haddock. 2 qrs. 14 lb. of Skate. 1 Bushel of Apples. 6 Stone of Cod Fish. 14 Stone of Skate. 56 lbs. of Haddock. 57 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. Notices, Etc. Intimations served under Public Health (London) Act, 1891 (Section 3) 291 277 249 266 1083 Notices served— Under Housing, Town Planning, etc., Act, 1919 37 36 27 40 140 Bats and Mice (Destruction) Act, 1919 .. .. .. 1 1 re Verminous Rooms .. .. 4 .. 4 Under P.H. (L.) Act and Metropolis Management Act (re combined drainage) 1 12 1 .. 14 W.C.'s (Factories, Workshops and Workplaces) .. .. .. .. .. Yards 2 1 .. .. 3 Miscellaneous 1 1 .. 4 6 Statutory Notices served under Section 4 32 13 28 7 80 Statutory Notices re Ashpit provision 9 6 3 1 19 Complaints received and attended to 149 146 171 129 595 Letters written relating to abatement of Nuisances 130 106 128 74 438 Summonses applied for and issued 1 4 .. 3 8 Magisterial Orders obtained and enforced 1 2 .. .. 3 Drainage Plans received and examined 40 29 29 21 119 58 Legal Proceedings under the Public Health (London) Act, 1891, and By-Laws during the year 1923. Premises. Complaint. Result of Proceedings. Fine Costs. Rubbish Shoot rear of Nos. 369-471 Woolwich Road Non compliance with Abatement and Prohibition Order Defendant Fined 40/- 27/6 86, Church Street Non - deposit of drainage plans Adjourned for 14 days (plans deposited) — 10/- Rubbish Shoot rear of Nos. 369-471, Woolwich Road Non Compliance with Abatement and Prohibition Order Adjourned sine die (Defendant adjudged Bankrupt morning of hearing) - 30, West Street Non Compliance with Statutory Notice Abatement Order 28 days 5/- 95, Church Lane Ditto Ditto - 9/6 630, Woolwich Rd. No proper and sufficient watercloset, etc, and water supply, and premises occupied before issue of water Certificate. (3 Summonses). Adjourned for 2 months - 6/- 59 BOROUGH OF GREENWICH. Proceedings during 1923. Premises. Number of Places. Number of Inspections, 1923. Number of Notices. 1923. Number of Prosecutions, 1923. On Register at end of 1922. Added in 1923. Bemoved in 1923. On Register at end of 1923. Dairies, Cowsheds and Milkshops 90 19 6 103 165 6 — Slaughterhouses 5 — — 5 25 — — Other Offensive Trade Premises — — — — — - Ice Cream Premises 121 27 15 133 140 14 — Registered Houses Let in Lodgings 247 - — 247 109 - - Total number of Intimation Notices served for all purposes 1236 Overcrowding, 1923— Number of Dwelling-rooms overcrowded 4 Number remedied 4 Number of Prosecutions — Underground Rooms— Illegal occupations dealt with during year 1 Number of Rooms Closed - Insanitary Houses— Number Closed voluntarily under the Public Health (London) Act, 1891 1 Number closed voluntarily under the Housing of the Working Classes Acts — Number of Verminous Premises cleansed under Sec. 10 of the London County Council (General Powers) Act, 1922 196 Number of Cleansing Baths given under Cleansing of Persons Act 21 Shelter provided under Sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year 1 60 Number of Tenement Houses provided with Additional Water Supply 1 Number of Prosecutions ditto — Inland Revenue Acts— Number of Houses for which applications were received during the 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, etc. — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping animals in such a manner as to be injurious to health (d) As to paving of yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter', etc. — (/) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (h) With respect to water closets, earth closets, etc. 1 (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, etc, (Metropolis Management Act, Sec. 202) — (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-Laws) Act, 1899) 1 Mortuaries- Total number of bodies removed 1811 Total number of infectious bodies removed 1 61 LEGAL PROCEEDINGS. Apart from the proceedings under the sale of Food and Drugs Act, it became necessary to take Police Court proceedings in 6 cases. FOOD. Cowhouses.—The four cowhouses in the Borough have been visited on 7 occasions, and the required cleansing duly enforced in 3 instances. Dairies, Cowsheds and Milkshofs Order.—At the commencement of the year there were 90 premises on the Register of Dairies and Milkshops ; 19 new applications have been received during the year and added to the Register, and 6 names have been taken off, thus leaving a total of 103 premises now registered. During the year 165 visits of inspection have been paid to these premises ; notices were served upon the occupiers in 6 cases where dairies required limewashing or were otherwise in an insanitary condition. No registration was refused on the ground of unsuitability of the premises. Milk Supply.—The majority of milk supplied to this Borough is obtained from farmers and large firms outside the district. Milk (Special Designations) Order, 1923.—This Order was made by the Minister of Health under the powers conferred on him by Section 3 of the Milk and Dairies (Amendment) Act, 1922, and revokes the Milk (Special Designations) Order, 1922, which had previously been in operation since the 1st January 1922. The new Order which came into force on the 1st July 1923, provides for some relaxation of conditions under which licenses may be granted for the sale of " Grade A" and " Pasteurised " Milk. Under the Order, the Council, as the local authority, may grant licenses to distributors such licenses to be valid only for a period ending on the 31st December in the year in respect of which it is granted. During the year 4 Dealers' licenses were granted for the sale of " Certified " Milk and 1 license for the sale of " Grade A " (Tuberculin Tested.) No applications were received for licenses to sell " Grade A" or " Pasteurised " Milk. Public Health (Condensed) Milk Regulations, 1923.— These regulations which came into force on the 1st October, 1923 62 prescribe the conditions as to labelling and composition of condensed milk, and are set out in the Schedules to the Regulations. Provision is made for the enforcement of Part II of the Regulations, which relates to the sale of condensed milk in this country, on lines following as near as possible to the procedure laid down under the Sale of Food and Drugs Acts. Milk and Cream Regulations, 1912 and 1917.—During the year no special samples were taken under these regulations, but by arrangement with the Public Analyst all samples of milk analysed by him were reported upon as to the presence or absence of preservatives. No samples of cream were taken, either preserved or fresh, for this article is used to a very limited extent Milk For Expectant and Nursing Mothers and Young Children.—During the year 61,229 lbs. of dried milk of various kinds have been supplied to mothers and children attending our Infant Consultation Centres. Meat.—During the year it was not found necessary to seize any animal or meat exposed for sale, or deposited in any place for the purpose of sale, or preparation for sale. The following was voluntarily surrendered and destroyed :— 1 Crate (24) Rabbits. Slaughterhouses.—The number of slaughterhouses in use in the Borough are as under :— In 1914. In January, 1923. In December, 1923. Registered — — - Licensed 4 4 4 4 4 4 Twenty-two inspections were made by the Inspectors during the year. 63 Other Foods.—Places where food is prepared have been visited on 132 occasions, improvements being required in 20 instances as detailed below :— Class of Premises. Number of Lists. Number of Inepections. Number of instances where matters needed attention. At end of 1922. Added 1923. Removed 1923. At end of 1923. Hotel Kitchens 5 1 — 6 6 2 Eating Houses 50 10 10 50 51 9 Fried-Fish Shops 29 6 4 31 31 6 Pork Butchers and Sausage Manufacturers 23 1 _ 24 27 3 Mineral Water Manufacturers — — — 1 1 — Others 14 2 — 16 16 — Totals 122 20 14 128 132 20 The 20 instances where matters needed attention included 12 cases where the premises generally, or kitchen and scullery particularly, needed cleansing and lime-washing, 4 where the sanitary arrangements were defective and 4 for want of ashpit. In addition to the periodical visits and inspections of food shops, etc., supervision is also exercised on Saturday evenings and Bank Holidays. No seizures of unsound food were made during the year, but a number of tradesmen voluntarily surrendered certain articles of food as unwholesome or unfit for the food of man in addition to the meat already referred to, particulars of which are set out on page 56. Ice Cream Premises.—There were 121 premises known at the commencement of the year where the manufacture of this commodity was carried on ; 27 have been added during the year and 15 taken off, leaving a total of 133 premises. These premises were inspected on 140 occasions, improvement required by way of cleansing of the premises in 8 cases, and insanitary conditions remedied in four instances. In 2 cases the sale of ice cream was discontinued owing to the unsuitability of the storage arrangements. 64 Bakehouses.—One hundred and fourteen inspections have been made of the various Bakehouses in the Borough and 23 nuisances found therein have been abated. At the end of the year there were 5 Factory and 39 other Bakehouses on the Register, 13 of which are underground. Food and Drugs Acts.—Four hundred and thirty eight samples havs been purchased under the provisions of the Sale of Food and Drugs Acts and submitted to the Public Analyst for analysis, of which 419 were certified to be genuine and 19 adulterated, the adulterations thus being equivalent to 4.33 per cent. of the samples taken. Of the total number of samples purchased, 109 were milk, of which 7 were certified to be adulterated ; the remaining adulterated samples were 8 of vinegar, 2 of rice, 1 of butter and 1 of medicine. Proceedings were taken in 8 cases, resulting in fines and costs being imposed in 6 instances. The remaining two cases were dismissed, one on account of warranty proved, and the other the Magistrate taking the view that the case was not proved. The summons in this latter instance was taken under the Milk and Dairies (Amendment) Act 1922 against a milk vendor whose sample was found upon analysis to contain 7.7 per cent. addition of water. 65 Sale of Food and Drugs Acts. Administrative Action regarding Samples reported to be NOT GENUINE. No. of Sample Description of Sample. Nature of Adulteration. Result of Proceedings. 21 Butter Admixed with 20% of margarine Fine £3 3s. ; Costs 31/— 6 Milk Admixed with 1 % of water Warning letter 24 ,, Do. do. 4% do. do. 77 ,, Do. do. 2% do. do. 83 ,, Do. do. 2% do. do. 92 ,, Do. do. 3% do. do. 298 » Do. do. 10% do. Case dismissed. Warranty proved 376 ,, Do. do. 7.7% do. do. (Taken under Milk and Dairies (Amendment) Act, 1922) 5 Rice Contained 0.74% of extraneous mineral matter Warning letter 227 ,, Do. do. 0.61% do. do. 16 Vinegar Deficient in Acetic Acid to extent of 7% Fine 21/- ; Costs 31/— 93 ,, Do. 15% do. Fine 42/- including costs 115 ,, Do. 24% do. Fine 42/- including costs 221 ,, Do. 3% do. Warning letter 251 ,, Do. 7% do. do. 262 ,, Do. 4% do. do. 409 ,, Do. 72% do. Fine 40/- ; Costs 31/- 413 ,, Do. 33% do. Dismissed on payment of costs 31/— 345 Medicine Deficient in Potassium Bromide to the extent of 16% Warning letter 66 Sale of Food and Drugs Acts.—Number and Description of Samples purchased for Analysis under the above Acts during the Year 1923. Description of Samples Number of Samples Purchased. Number Genuine. Number Not Genuine. Baking Powder 12 12 Breakfast Sausage 3 3 — Butter 114 113 1 Chicory and Coffee 1 1 — Coffee 3 3 — Camphorated Oil 1 1 — Medicine 10 9 1 Milk 109 102 7 Mustard 5 5 — Pearl Barley. . 27 27 — Pepperr 17 17 — Rice 47 45 2 Sausages 10 10 — Vinegar 77 69 8 White Precipitate Ointment 1 1 — Zinc Ointment 1 1 ,— 438 419 19 DISINFECTION. It had been hoped to report upon the opening of the new Disinfection premises, but unfortunately the building was still uncompleted at the close of the year under review. The following tables summarise the work carried out by the Disinfecting Staff during the year :— 67 Number of Articles and Rooms Disinfected in connection with the Undermentioned Diseases for the 52 weeks ended 29th December, 1923. Infectious Diseases. Rooms. Premises Entered. Beds. Palliasses. Mattresses. Bolsters. Pillows. Blankets. Sheets. Cushions. Quilts. Odd Articles. Total No. Articles Disinfected. Polio-Myelitis 1 1 .. .. .. .. .. .. .. .. .. .. .. Small-pox 19 2 9 1 3 3 13 11 8 11 7 276 342 Scarlet Fever 258 210 140 .. 80 117 325 402 58 39 110 668 1939 Diphtheria 206 182 114 .. 40 83 218 236 25 6 65 35 822 Enteric Fever 9 9 6 .. 3 8 19 23 .. 1 7 14 81 Puerperal Fever 15 8 6 2 4 5 18 15 6 2 5 5 68 Tuberculosis 145 121 56 3 40 48 133 60 24 11 23 58 456 Other Diseases 188 111 39 4 254 66 346 325 48 36 35 745 1898 Measles 10 10 .. .. .. .. .. .. .. .. .. .. .. From Verminous Premises 11 6 9 3 6 6 11 6 2 .. 1 71 115 Scabies .. .. 4 .. 5 1 8 5 1 .. 8 2 34 Influenza and Pneumonia 6 6 2 .. 5 2 6 6 .. .. 1 6 28 Cerebro-Spinal Meningitis 6 2 1 .. 2 3 7 7 2 .. 3 1 26 Total 894 668 386 13 442 342 1104 1096 174 106 265 1881 5809 68 Number of Articles Destroyed in connection with the Undermentioned Diseases during the 52 weeks ended 29th December, 1923. Infectious Diseases. Beds. Palliasses. Mattresses. Bolsters. Pillows. Blankets. Sheets. Cushions. Quilts. Odd Pieces. Total No. Articles Destroyed. Small-pox .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 1 .. .. .. .. .. .. .. .. .. 1 Diphtheria .. .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. .. •• Puerperal Fever .. .. .. .. .. •• •• .. .. .. •• Tuberculosis 3 2 6 2 4 1 .. .. 1 1 20 Other Diseases 5 .. 2 6 14 2 11 7 3 17 67 For Verminous Premises.. 1 1 .. •• 1 .. .. .. •• 60 53 Influenza .. .. 1 .. .. .. .. •• .. 11 12 Total 10 3 9 8 19 3 11 7 4 79 153 69 HOUSES INSPECTED AND INQUIRIES MADE IN CONNECTION WITH INFECTIOUS DISEASE. Number of Houses Inspected and Inquiries made by Infectious Disease Inspector 665 Number of Re-visits 1,873 The Health Visitors also visited 1,301 cases, and re-visited when required. The following books belonging to the Libraries, etc., were destroyed in consequence of Infectious Disease :— Central Libraries, 85 ; School Libraries, 6 ; Total, 91. CLEANSING STATION, BLACKWALL LANE. The arrangements made with the London County Council for reserving the use of the Council's Cleansing Station on Mondays and Thursday for the cleansing of verminous school children continue in operation. The following table shows the number of children cleansed during the year :— 1st quarter 232 2nd „ 243 3rd 146 4th 247 Total 868 Nine adults suffering from vermin were also given cleansing baths. In every case the infested clothing was disinfected. Public Sanitary Conveniences.—During the year the Council had under consideration the question of providing additional sanitary accommodation for both sexes. There are at present 3 underground sanitary conveniences in the Borough, situated at:— Blackwall Lane, East Greenwich, South Street, West Greenwich, and Creek Road, St. Nicholas, Deptford. A Sub-Committee was appointed to view and select suitable sites and, after due consideration, the Council decided to proceed with the construction of 3 additional underground conveniences, one of which would be erected in place of the urinal at present 70 existing at Blackheath Hill, and another on the open space known as " Batley Park " at the junction of Westcombe Hill and Charlton Road. Owing to the fact that the latter site was scheduled as an open space and included in the London Squares and Enclosures (Preservation) Act, 1906, it became necessary for the Council to ask the London County Council to insert a clause in their next General Powers Bill with a view to obtaining Parliamentary Powers to erect such convenience. With regard to the third convenience, which it is proposed to erect in place of the existing aboveground Urinal near the corner of King William Street and Romney Road, the site has not yet been definitely decided upon. Negotiations are still pending between H.M. Office of Works with reference to a site at the entrance to Greenwich Park, or alternately, which in my opinion is the better situation, a site adjacent to the existing structure, which matter is under negotiation with the Admiralty and Seamen's Hospital. SECTION 8. PUBLIC HEALTH STAFF. There was very little change in the constitution of the Public Health Staff during the past year. Dr. V. J. F. Lack who had been responsible for the Maternity and Child Welfare work for just over twelve months resigned in February and was succeeded by Dr. G. J. Sophian. I regret to report the death which occurred in June last, of Mr. D. Gilbert who had been in charge of the dental work of the Department since October, 1919. As foreshadowed in my annual Report last year owing chiefly to the continued state of Unemployment among the working classes, it became necessary to close the Municipal Creche at East Greenwich necessitating the dispersal of the staff. Medical Officer of Health and Administrative Medical Officer, Tuberculosis, and Maternity and Child Welfare— *Ernest G. Annis, M.R.C.S., L.R.C.P., D.P.H. (Barrister-at-Law) Assistant Medical Officer of Health and Tuberculosis Officer— *M. Macdonald, M.D., Ch.B., D.P.H. Maternity and Child Welfare Medical Officer— *G. J. Sophian, M.R.C.P. (Lond.) M.R.C.S., L.R.C.P. 71 Public Analyst—E. Brown, B.Sc., F.I.C. Bacteriologist—IArthur Davies, M.D., M.R.C.P. Dentist†*D. Gilbert, L.D.S., R.C.S. (Eng.) (Died June 1924) †*GEO. F. Ferris. L.D.S., R.C.S. (Eng.). Sanitary Inspectors— *A. E. Baohe. *W. R. Drake. *S. A. Radford. *Miss G. Davis. *A. E. Morgan. Infectious Diseases Inspector *E. Martin. Health Visitors— *Miss M. Molloy. *Miss E. Bailey. *Mrs. M. Donald-Morison. *Miss A. M. M. Hadfield. *Miss F. C. Jagot. *†Miss H. Foley. TUBERCULOSIS DISPENSARY. Nurses— *Miss L. Heastman. *Miss T. I. Husbands. *Miss D. M. Wilkins. Dispenser— Caretaker— *E. E. Burrows. *Mrs. Vickery. MATERNITY HOME Matron— *Miss N. G. Beeham. CRECHE. Sister-in-Charge— *Miss L. Wright (Resigned October, 1923. Creche Closed). Clerical Staff— *F. W. Foulger (Principal Clerk). H. W. Duck. A. G. Thomas W. H. Collins. E. P. Tidman (Temporary). Miss L. Merricks. F. Jennings do. *Mrs. L. E. Wright. *Mrs. N. Furbank (Milk Saleswoman) 72 Disinfecting Staff— J. Forrest. A. Clay F. Mears. T. Packham. F. Stevens (Motor Driver). Caretaker at Cleansing Station— Mrs. E. Robinson. Mortuary Keeper— G. W. Moss. The whole of the Staff of the Department are whole time Officers, with the exception of those marked †. Full particulars as to qualifications of the Staff are given in the Annual Report for 1922. *Contributions made in respect of salaries of above Officers, under Public Health Acts or by Exchequer Grants. SECTION 9. HOUSING. In the report for the year ended 1922 it was stated that accommodation had been provided for 282 families. A contract for the erection of 80 houses on No. 4 section of the Council's Housing Site has since been completed, making a total accommodation for 362 families. The Council is considering the question of the erection of an additional 98 houses on the No. 3 section of the Council's Housing Estate at the rear of Little Heath and Kinveachy Gardens. Such houses will probably be mostly of the A2 and A3 types, which will attract the class of tenant who would probably find it difficult to pay the rent of houses with larger accommodation. The houses on No. 3 site will be erected under the provisions of tha Housing etc., Act, 1923 and under the same Act it is also proposed to erect 22 additional houses on the remainder of the Pound Park Site as soon as the terms upon which the Ministry of Health will release the land from the Assisted Housing Scheme have been arranged. The Council further propose to erect 6 houses containing 12 Maisonettes, with accommodation similar to an A3 house, on a site acquired by the Council at the corner of Coombedale Road and Westerdale Road, Greenwich. 73 HOUSING RETURN, 1923. Number of new houses erected during the year :— (a) Total 90 (b) With State assistance under the Housing Acts, 1919 or 1923 :— (i) By the Local Authority 80 (ii) By other Bodies or Persons Nil I.—Unfit Dwelling-houses. Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,114 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 No figures available (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling houses (exclusive of those re- ferred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,642 2.—Remedy of Defects Without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 490 3.—Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919— (1) Number of dwelling-houses in respect of which notices were served requiring repairs *140 (2) Number of dwelling-houses which were ren- dered fit— (a) By owners 140 (b) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close Nil *Provisional Notices. 74 (b) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied Intimations 1,083 Statutory 99 (2) Number of dwelling houses in which defects were remedied— (a) By owners 1,641 (b) By Local Authority in default of owners 1 (c) Proceedings under sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909— (1) Number of representations made with a view to the making of closing orders Nil (2) Number of dwelling-houses in respect of which closing orders were made Nil (3) Number of dwelling-houses in respect of which closing orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which demolition orders were made Nil (5) Number of dwelling-houses demolished in pur- suance of demolition orders Nil Unhealthy Areas.—Nothing has yet been done to deal with areas officially represented to the London County Council under the Housing Acts. SECTION 10. MATERNITY AND CHILD WELFARE. No substantial change was made during the year in connection with the activities under the Council's Maternity and Child Welfare Scheme. The Infant Consultations held at the various Centres continue to be greatly appreciated by the mothers and chiefly owing to this fact it was found necessary to hold additional sessions at the Borough Hall on Mondays, Shooters Hill Road on Tuesdays and Conduit House on Fridays, for weighing purposes. This arrangement undoubtedly has had the effect of relieving the congestion at these centres, which are now held as follows :— 75 Centre. Day Time. Remarks. Borough Hall Monday 2-4.30 p.m. Attended by Mothers liv- Tuesday „ ing in West Greenwich Thursday „ area Conduit House Monday „ Do. East Greenwich and Wednesday „ portion of Charlton area Friday 105, Shooters Hill Tuesday ,, Do. Charlton and Black- Road Friday „ heath area. Albany Institute Thursday „ Do. St. Nicholas Deptford Area The following tables show (a) the number of visits made by the Health Visitors during the year in connection with Births and cases of Infectious Diseases, etc., and (b) number of Infant Consultations and Pre-Maternity Clinics attended and also visits of a miscellaneous nature. Health Visitors Visits, 1923. Table A. Visits Re-Visits Total Infants under 1 year 2281 2122 4403 Children, 1-5 years 186 2810 2996 Measles 755 88 843 Whooping Cough 405 149 554 Pneumonia 16 15 31 Puerperal Fever 9 12 21 Ophthalmia Neonatorum 29 41 70 Diarrhœa 87 35 122 Scabies 3 5 8 Verminous 4 1 5 3775 5278 9053 Table B. Children Act, 1908 274 128 402 Dental Treatment 31 3 34 Dinners 17 – 17 Milk Scheme 278 27 305 Pre-Maternity Cases 289 35 324 Infant Consultations attended 690 – 690 Pre-Maternity Clinics attended 118 – 118 Miscellaneous 36 1 37 1733 194 1927 In addition to the above, 2,290 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. 76 The following table shows at a glance the work undertaken at the various Infant Consultation Centres during the year:— Borough Hall. Conduit House. 105, Shooters Hill Rd. Albany Institute. Total. Attendances 8,105 9,084 4,336 2,706 24,261 New Cases 414 506 239 185 1,344 Medical Consultations 3,517 3,506 1,445 1,469 9,937 Nursing Mothers seen by Doctors 1,318 1,324 483 434 3,559 As in previous years the children are weighed and advice given to the Mothers at every attendance. It will be noticed that there were 24,261 attendances during the year, as compared with 22,218 for the previous period. Minor Ailment Centre, Borough Hall.—Facilities arc afforded at this Centre for the treatment of children suffering from minor ailments arising from ear, nose or throat trouble, eczema, etc. Only a comparatively small number of cases however, were dealt with during the year. The following continue their good work in the Borough:— Local Medical Practitioners' School Clinic. Health Centre, Deptford Green. Rachel McMillan Memorial Nursery School. Albany Institute Infant Consultation and Babies' Home. Deptford Fund—Babies' Hospital.—The arrangement made with the Deptford Fund still operates whereby they receive in their Hospital such Greenwich cases as are recommended by the Medical Officer for treatment. During the year 64 babies were admitted of which 38 were discharged cured, 17 relieved, 1 transferred to a M. A. B. Hospital owing to infection, whilst 8 unfortunately died. Although this would appear at first glance to be a high case mortality, it must be remembered that not only "wasting" cases, but all kinds of Medical cases are dealt with. Baby Week Competitions.—In order to make a change from the Baby Shows which had been held in former years it was decided, this year, to invite all the Mothers attending the Infant Consultations to submit specimens of their work for Exhibition and Competition. 77 The Exhibitions took place at the Borough Hall on Monday 16th July for those mothers attending Shooters Hill Road and Conduit House Consultations, and on Thursday, 19th July for the Borough Hall and Albany Institute Mothers and on each day there was a very large attendance, not only of competitors and those who regularly take advantage of the instruction and care given under the Council's Maternity and Child Welfare Scheme, but also of Members of the Council and other interested friends. There were about 200 entrants for the competitions which were divided into six classes as follows:— i. Knitted or Crochet garments. ii. Garments made from material. iii. Garments adapted from some other garment. iv. Essay on the subject of " What I have learned from attending the Infant Welfare Centre." v. Articles made by fathers. vi. Three laundered garments. Owing to the very high standard of work attained by the majority of the Competitors the Judges had considerable difficulty in deciding as to the Prize winners. Most meritorious work was submitted in all Classes, particularly in the Knitted Section. The essays showed a very comprehensive grasp on the part of the Competitors of the principles instilled at the centres, whilst the Fathers' contributions included most workmenlike cots, chairs, etc., despite, in most cases, an entire lack of skilled training. The Exhibitions clearly proved marked ability on the part of the Competitors and at the same time served to indicate clearly what can be accomplished despite the possible handicap, in some cases, of limited means and housing accommodation. The Committee were again indebted to the many influential ladies of the Borough for the ready assistance and co-operation which largely contributed towards the success of the whole proceedings. Maternity Home. It will be recollected that the Council's Maternity Home, Kidbrooke House, 78, Shooters Hill Road, received its first patient on 2nd March, 1922, and the period now under review represents therefore the first complete calender year of the Home's history. During the year 1923, 228 patients were admitted which, compared with the figure of 121 for the 10 months of 1922, represents a proportional increased admission rate of well over 50 per cent. The average duration of stay in the Home per patient was 14.3 days, giving an average number of patients accommodated per week throughout the whole year of 9. Bearing in mind the fact that the 78 Home has a nominal capacity of 12 beds, this figure must be regarded as exceedingly satisfactory, demonstrating beyond any question of doubt the fact that the Council's Home has supplied a very real need in the Borough. It is of course impossible to forecast the exact date upon which a patient will require accommodation and for this reason it is unwise to accept more cases than are represented by about 85 per cent. of the available accommodation; the Council may therefore congratulate itself that within less than two years of establishing their home the accommodation available was almost fully taken up; as a matter of fact, more than 12 patients had to be accommodated in the Home during no less than 10 weeks of the year, the highest point being reached the first week in October, when the average reached almost 16. Of the 228 cases admitted, the following brief details are submitted:— Number of cases delivered by Midwives 205 „ „ „ Doctors „ 23 Medical assistance was sought in five instances under the following conditions:— Ante-Natal 1 During Labour 1 After Labour 2 For Infant 1 One case only of Puerperal Sepsis has to be reported, and this was of a patient in connection with whom the Septic conditions were present prior to Admission. The case was transferred to the Metropolitan Asylums Board as soon as removal was considered possible. There were no notified cases of Ophthalmia Neonatorum. The number of Infants Still-born was 6, whilst 4 infants died within 10 days of birth, the particulars of which are as follows:— Congenital Malformation of Heart (1½ hrs.) 1 Imperforate Oesophagus and other Malformations (3rd day) 1 Melaenae Neonatorum (Hæmaphiliac) (5th day) 1 Congenital Heart Disease (4th day) 1 Of the 218 living Infants it is gratifying to be able to report that all but six were breast fed. Pre-Maternity Clinics.—The attendances for the year were 807, which compared with last year's figure of 609 indicates the steadily increasing popularity of the Council's Ante-Natal Clinics. 79 All prospective Maternity Home patients are, of course, strongly urged to attend these clinics and owing to the increasing numbers at the Borough Hall Centre an additional clinic was opened at the Shooters Hill Road centre which is immediately opposite the Maternity Home. During the year not a single patient developed any severe signs of toxaemias of pregnancy though quite a number attended the clinics with minor symptoms in the earlier stages. This demonstrates clearly that provided treatment is instituted early the prognosis in this type of case is certainly good. Thus the useful function the Ante-Natal Clinics served has been the predetermination of those cases needing surgical assistance. As will be seen 23 patients (about 10 per cent.) needed such surgical assistance, but from this group must be taken out 5 cases which were accidents in pregnancy and childbirth which naturally could neither be anticipated nor obviated. The majority of the cases comprised those for whom examination proved that induction of labour was necessary in the interest of both mother and child, and those who exhibited lack of muscular tone militating against a normal course of delivery. The remainder comprise those patients, who, unfortunately, did not take advantage of Ante-Natal facilities—some of whom presented themselves for admission to the Maternity Home with severe obstetrical difficulties to be overcome—despite the fact that they had booked accommodation months before. The Pre-Natal facilities have been taken advantage of by many expectant mothers other than prospective Maternity Home patients. Every patient who has attended the clinics has had her general health supervised in addition to the special care exercised in regard to her anticipated confinement ; for example, dental treatment has been provided, digestive difficulties corrected, and any conditions found likely to be inimical to her general health remedied. Such care, it need scarcely be pointed out, cannot fail to have far reaching beneficial effects on both the mothers' health and the infants' welfare, particularly during the first and most critical year of life. The policy outlined in last year's Annual Report as to admitting any case that books before labour, whether likely to be a normal case or otherwise, has been continued and I gratefully acknowledge the friendly co-operation of local doctors and midwives. Ante-Natal Work Generally.—Reports continue to be received from time to time indicating that there is still a considerable amount of real injury to the health of the mother as well as the the serious disability caused by the lack of sufficiently skilled 80 attention during the confinement. There appears to be a certain amount of disinclination on the part of Midwives to call in medical aid as frequently as it is directed under the Regulations. It has been suggested that this disinclination is possibly caused by the not unnatural desire of the Midwife to make these calls for special assistance as few as possible. It will be appreciated that whenever such a call is made there is a possibility that the patient may be asked to contribute something towards the payment of the Medical Practitioner's fee, which quite apart from the added expense, might raise doubts in the patient's mind as to the competency of the Midwife engaged. Such cases of neglect to call in medical aid are of course distinct breaches of the regulations, but it is difficult to suggest how they can be overcome or obviated under the present dual system of control in London, under which the supervising authority is divorced from all local knowledge and actual contact with the cases. Children Act, 1908. Part I of the Children Act, 1908, provides for the Local Authority appointing one or more persons to be Infant Protection Visitors, whose duty it shall be from time to time to visit any infants referred to in any notice given under Part I of the Act, and the premises in which they are kept, in order to ensure the proper nursing and maintenance of such infants. The Act enforces registration as to a foster mother of any person who undertakes for reward the nursing and maintenance of one or more infants under the age of seven years apart from their parents for a longer period than 48 hours. In June, 1920, the Greenwich Borough Council made application to the London County Council in regard to the appropriate officers of the Greenwich Borough Council being authorised to exercise the powers of Infant Protection Visitors, and at the meeting of the Greenwich Borough Council on 6th April, 1921, it was reported that the London County Council were prepared to authorise the the officers of the Greenwich Borough Council to exercise the powers in question for a period of one year (renewed annually), in the place of the visitors who had formerly been working under the direct supervision of the London County Council. Greenwich was the only Metropolitan Borough to which these powers were delegated, but the London County Council communicated with the other City and Metropolitan Borough Councils inviting their views as to undertaking the duties on lines generally similar to those obtaining in Greenwich. 81 In September, 1923, the London County Council gave special consideration to the reports received and paid a warm tribute to the manner in which the duties had been carried out by the Greenwich Borough Council's Officers. The following advantages which had been evident were enumerated :— (i) The Officers of the Greenwich Borough Council were in personal touch with the welfare centres and could thereby be of material assistance to the fostermothers; (ii) the Officers of the Greenwich Borough Council had a local knowledge of the district, and were in close touch with the general public health work of the Borough; and (iii) the travelling expenses of such officers should be less owing to the smaller area necessarily covered. Against these advantages however, the following disadvantages were mentioned:— (i) Possible lack of uniformity of standard; (ii) Inability of officers of the Borough Council to follow up cases outside the Borough; and (iii) Possible delay in urgent cases. It was, however, found impracticable to formulate a Scheme which would be acceptable to the whole of the City and Metropolitan Borough Councils and the London County Council consequently resolved to terminate the arrangement with Greenwich on 31st, December, 1923. The Council sent a resolution of regret to the London County Council at their decision and considered that in the interests of of economy and with a view to securing efficient administration these powers of the County Council should be permanently transferred to the Borough Councils. The numbers of foster-mothers and nurse children at the end of 1923 were exactly the same as was the case at the end of 1922, viz, 43 foster-mothers and 61 nurse-children. The following changes have taken place during the year:— Foster Mothers. New foster-mothers registered 13 Foster mothers giving up voluntarily or removing from the Borough 13 82 Nurse Infants. New cases notified:— Under 1 year 13 Over 1 year 13 26 Deaths: (both under 1 year) 2 Removals: Voluntarily 19 By Order under Sec. 5 1 20 Reached 7 years of age and thus ceased to come within the province of Act 4 26 From the table on page 75 it will be seen that the visits paid to foster-mothers by the Council's Health Visitors total 402 giving an average per foster-mother of 9 visits per year; these visits made a relatively small demand upon the Health Visitors' time because, except in special cases, they were carried out when the Health Visitor had occasion also to visit other houses in the same neighbourhood. Well over half the foster-mothers are in the habit of attending the Infant Welfare Centres regularly with their charges which, in itself, is a strong reason why this work should be entirely under the control of the Local Authority. The small number of deaths (2) which have occurred during the year must be regarded as satisfactory; these deaths were due to congenital weakness, and Marasmus, and an inquest was held in regard to the first mentioned case. The one infant compulsorily removed had been placed in the care of a foster-mother who was suffering from tuberculosis and whose housing accommodation was inadequate. A relative of the infant was found who was prepared to look after it and thus the difficulty was satisfactorily overcome. 83 NOTIFICATION OF BIRTHS ACT, 1907 The following table gives the number and character of the intimations received respecting births in the Borough:— 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923. Total Number of Births notified in each year 2,280 2,497 1,992 1,735 2,085 2,714 2,564 2,257 2,348 (a) Attended by Midwives 1,226 1,314 1,095 990 1,159 1,494 1,452 1,484 1,591 (b) Attended by Doctors 1,054 1,183 897 745 926 1,220 1,112 773 757 Number of Still Births notified in each year 42 61 47 44 59 78 52 53 50 Number of Births registered in each year 2,347 2,354 1,967 1,753 1,968 2,648 2,366 2,185 2,276 Dental Work.—Arrangements are made with the British Dentists' Hospital that they should provide a qualified dental surgeon to attend on one half-day per fortnight to give dental attention to any patient certified by the Maternity and Child Welfare Medical officer as requiring such, with a view to an improvement in their physical condition. Ninety-two patients have been attended by the dental surgeon and 10 dentures have been provided, the total cost of the dentures being £33 15s. 0d., of which amount the Maternity and Child Welfare Committee have decided, and the patients have paid £18 5s. 0d. The total number of patients' attendances was 327, which is more than twice last year's figure. Puerperal Fever.—Nine cases of this disease were notified during the year, three of which unfortunately proved fatal. There did not appear to be any common source of infection amongst these cases, as they occurred in different districts and at different times all over the Borough. Ophthalmia Neonatorum.—Sixteen cases of this disease were notified during the year, and in addition there were 3 cases of slight inflammation of the eyes reported. Both eyes were affected in 8 cases, and one eye only in the remaining 11 cases. Subsequently, from enquiries made, it was found that in no case was the vision impaired. 84 Of the total number of cases, 5 occurred in East Greenwich, 1 in West Greenwich, 4 in St. Nicholas, and 9 in Charlton. Measles—See pages 25 and 26. Milk, &c., Supplied to Nursing and Expectant Mothers and Young Children.—As last years Report dealt fully with the method adopted in regard to the distribution of milk, etc. it is not considered necessary to amplify such remarks. In August last year the Council were called upon by the Ministry of Health to make a reduction in the expenditure in respect of the provision of milk and meals. In order to obviate unnecessary hardship a special Sub-Committee was appointed to investigate the whole matter. As a result of their deliberations it was decided to make a slightly increased charge for milk sold at the various Centres and further to adopt the Ministry's scale of income in lieu of the existing scale. By this means it is hoped to keep the expenditure within the limit suggested by the Ministry. The following tables shows (a) the amount of milk etc., given away and number of applicants receiving same, and (b) quantities sold each quarter. It will be noticed from a perusal of these tables that since the revised scale was adopted (15th October, 1923) a marked decrease is shown in the amount of milk distributed free with a corresponding increase in the amount sold. 85 (a) Milk, Virol, Etc., Distributed Free. Quarter ended. Milk Virol Emulsion Oil and Malt Marylebone Cream. lbs. No. of Applicants lbs. No. of Applicants lbs. No. of Applicants lbs. No. of Applicants lbs. No. of Applicants March 1923 10845 6648 140½ 287 193¾ 371 282 282 – – June ,, 10862 6768 85 170 98¾ 197 281½ 282 51½ 104 Sept. ,, 10400 6974 28½ 57 46 92 201 201 89¼ 183 Dec ,, 5890 4835 78½ 157 88½ 177 382 382 107 214 37997 25225 332½ 671 427 837 1146½ 1147 247¾ 501 (b) Milk, Virol, Etc., Sold at Cost or Reduced Prices. Quarter ended Milk Virol Emulsion Oil and Malt Marylebone Cream Total amount Received lbs. lbs. lbs. lbs. lbs. £ s. d. March 1923 5920 453 167½ 243½ – 599 2 3 June „ 5161 322½ 71 204 42 489 1 6 Sept. „ 5665 212 16½ 95 91½ 500 3 4 Dec. ,, 6486 301 55 300 100½ 561 7 9 23232 1288½ 310 842½ 234 2149 14 10 87 Index of Contents. Page Adoptive Acts, By-laws and Local Regulations 46 Age Mortality 14 Ambulance Facilities 44 Analysis of Death (Causes 16 Anthrax 27 Area of Borough 6 Articles and Rooms Disinfected 67 Articles Destroyed 68 Baby Week Competitions 76 Bacteriological Examinations 45 Bakehouses 64 Births 12,13 Blackheath and Charlton Cottage Hospital 45 Bones and Joints 20 Books Destroyed 69 Cancer 19 Causes of Death 16-20 Causes of Sickness 42 Census Tables 7—10 Cerebro-Spinal Fever 27 Chicken Pox 22 Children Act, 1908 80-82 Circulatory System 19 Cleansing Children 69 Complaints 47 Constitutional Diseases 19 Consumption 18 Contacts 23,33 Cowhouses 61 Creche 70,71 Customs and Inland Revenue Acts 50 Dairies, Cowsheds and Milkshops 59, 61 Deaths, Tables showing Causes of and Ages at Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Deaths, with Age Mortality 13,14 Deptford Fund Babies' Hospital 76 Density of Population 6,10 Dental Work 34,83 Developmental Diseases 19 Diarrhoea and Zymotic Enteritis 17,26 Dietetic Diseases 19 Digestive System 20 Diphtheria 17,23,24 Diphtheria Anti-Toxin 46 Disinfection 66-68 Duties and Powers of the Public Health Committee 1,2 Duties and Powers of the Maternity and Child Welfare Committee 3 Elevation of Borough 6 Emulsion 85 Encephalitis Lethargica 27 Enteritis 26 Epidemic Cerebro-Spinal Meningitis 27 88 INDEX—continued. Page Epidemic Diseases 16 Erysipelas 18 External Causes 20 Factories and Workshops 47-50 Food and Drugs—Samples of 64-66 Food—Premises for Preparation of, etc 63 Glanders 27 Gonorrhoea 17 Health Centres 43,75 Health Visitors, Visits, etc 69, 75 Home Work 49 Horse Slaughterer 50 Hospital and other forms of Gratuitous Medical Relief 45 House Drainage 52 Houses Inspected re Infectious Diseases 69 Houses Let in Lodgings 51 Housing 72-74 Hydrophobia 27 Ice Cream Premises 63 Ill-defined Causes 20 Increase of Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923 51 Infant Consultations 74—75 Infantile Mortality 15 Influenza 17 Inhabited Houses 6 Inland Revenue Acts 50 Insanitary Areas 74 Institution Deaths 14 Integumentary System 20 Interim Tuberculosis Care Committee 34-36 Introductory Review 4-5 Legal Proceedings 58-65 Local Diseases 19-20 Lymphatic System 20 Malarial Diseases 18 Marriages 12 Maternity and Child Welfare 74-85 Maternity Home 77, 78 Measles 16-17,25-26 Meat 62 Membranous Croup 24 Milk and Cream Regulations 62 Milk Supply 61 Milk Supply for Expectant and Nursing Mothers 62, 84, 85 Milk (Special Designations) Order 1923 61 Miller General Hospital 43, 45 Minor Ailment Centre 76 Mortuary 21,60 Nervous System 19 Notices, etc 57 Notifications 21-28 Notification of Births Act 83 Nursing Arrangements 42 Offensive Trades 51 Ophthalmia Neonatorum 22, 27, 83 Organs of Special Sense 19 89 INDEX—continued. Page Outworkers'Register 47 Overcrowding 59 Parasitic Diseases 18 Persons Cleansed 69 Polio-encephalitis 27 Polio-myelitis 27 Poor Law Relief 45 Population 11 Public Health Committee 1 Public Health (Condensed) Milk Regulations, 1923 61, 62 Public Sanitary Conveniences 69,70 Puerperal Fever 18,25,83 Pyaemia and Septicaemia 18 Rats and Mice (Destruction) Act, 1919 51 Remarks on Death Causes 16—20 Reproductive System 20 Respiratory System 20 Rheumatic Fever 18 Sale of Food and Drugs Act 64-66 Sanitary Work—Summaries, etc. 53-60 Scarlet Fever 17,24 Scavenging and Refuse Removal 50 School Clinic 43 Seamen's Hospital 45 Septic Diseases 18 Slaughterhouses 62 Small-pox 10,22,23 Smoke Nuisances 51,52 Sporadic Diseases 17 Staff of Public Health Department 70-72 Statistical Tables 7-10 and Appendix Suffocation 20 Suicide Syphilis 17 Tuberculosis 18,22,27,28 Tuberculosis Dispensary—Return of Attendances 38,39 Tuberculosis—Interim Care Committee 35-36 39,40 Tuberculosis Officer's Report 29-37 Typhoid Fever 17-24 Underground Bakehouses 64 Underground Rooms 59 Unwholesome Food 56 Uninhabited Houses Urinary System 20 Vaccination Particulars 41 Venereal Diseases 17 Verminous Premises 59 Verminous Children 69 Virol 85 Vital Statistics11-21 and Appendix Water Supply 62 Whooping Cough 26, 27 Workshops and Factories 47—.50 Zymotic Enteritis 17,26 Zymotic Diseases 16 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks ended 31st March 1923. DISTRICTS. Census Population, 1921. Estimated Population at the middle of the Year 1923. Births Registered during the 13 weeks ended 31st March, 1923. Deaths Registered during the 13 weeks ended 31st March, 1923. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Phthisis. All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1,000. Under 1 year. Over 1 and under 5 Years. Persons aged 65 Years and upwards. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. All Causes. Seven Zymotics. Typhoid. Other. Diarrhœa and Dysentery. During the corresponding period year previous. During the 13 weeks ended 31st March, 1923. During the corresponding period year previous. During the 13 weeks ended 31st March, 1923. M. F. M. F. Greenwich East 44213 45098 130 120 72 72 26 11 46 .. .. .. 2 5 .. .. .. 12 2 34 15 12 62 16.27 12.81 1.60 .61 Do. West 26677 27211 66 56 68 35 14 5 38 .. .. .. 1 .. .. .. .. 10 3 15 8 17 49 23.12 15.19 1.4 .14 St. Nicholas, Deptford 7582 7734 25 26 15 11 3 3 8 .. .. .. .. .. .. .. 1 2 .. 6 1 3 13 29.23 13.49 5.21 .51 Charlton 18785 19160 54 47 30 19 3 5 15 .. 1 .. .. 1 .. .. .. 6 2 14 6 4 15 14.95 10.26 .42 .41 Kidbrooke 3193 3257 26 31 4 2 .. .. 5 .. .. .. .. .. .. .. .. .. .. .. .. 1 5 9.9 7.39 .. .. Miller Hospital— Resident .. .. .. .. 7 2 .. 2 1 .. .. .. .. .. .. .. .. .. 2 2 1 1 3 .. .. .. .. Non-Resident .. .. .. .. 13 7 .. 1 1 .. .. .. .. .. .. .. .. 1 1 2 .. 4 12 .. .. .. .. Seamen's Hospital— Resident .. .. .. .. 15 .. .. 1 .. .. .. .. .. .. .. .. .. 1 1 2 2 4 5 .. .. .. .. Non-Resident .. .. .. .. 15 .. .. .. 3 .. .. .. .. .. .. .. .. .. .. 2 3 2 8 .. .. .. .. Greenwich & Deptford Hospital— Resident .. .. .. .. 38 27 3 5 22 .. .. .. .. 3 .. .. .. 7 1 6 3 11 34 .. .. .. .. Non-Resident .. .. .. .. 51 43 5 4 31 .. .. .. .. .. .. .. .. 15 .. 11 6 7 55 .. .. .. .. Herbert Hospital— Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Non-Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. M.A.B. Brook Hospital— Resident .. .. .. .. 3 .. .. 2 .. .. .. .. 3 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Non-Resident .. .. .. .. 16 10 .. .. .. .. .. .. 23 .. .. .. .. .. .. 1 .. .. 2 .. .. .. .. Cottage Hospital— Resident .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Non-Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Institutions— Resident .. .. .. .. 1 3 .. .. 3 .. .. .. .. .. .. .. .. .. .. 1 .. 1 2 .. .. .. .. Non-Resident .. .. .. .. 1 5 1 .. 4 .. .. .. .. .. .. .. .. .. .. .. .. 2 4 .. .. .. .. Outside Institutions .. .. .. .. 34 14 7 5 12 .. 1 .. .. .. .. .. 1 3 1 9 2 6 25 .. .. .. .. 301 280 189 139 Borough 100450 102460 581 328 46 24 112 .. 1 .. 3 6 .. 1 30 7 69 30 37 145 .. .. .. .. Rate per 1,000 of Estimated Population .. .. 22.79 12.84 .. .. .. .. .03 .. .11 .23 .. .03 1.17 .28 2.69 1.17 1.45 5.66 18.62 12.84 1.53 .42 Deaths of Children under 1 Year per 1,000 births, 79 Death Rate of 105 large English Towns, 13.1; of the County of London, 13.1. previous" ,, ,, ,, corresponding 77 period ,, ,, ,, County of London 85 Birth Rate „ ,, 21.2 „ 21.2. BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks ended 30th June, 1923. DISTRICTS. Census Population, 1921. Estimated Population at the middle of the Year 1923. Births Registered during the 13 weeks ended with June, 1923. Deaths Registered during the 13 weeks with June, 1923. AGE MORTALITY SEVEN ZYMOTIC DISEASES. Phthisis. All other Forms of culosis. Bronchitis, Pneumonia. Heart Diseases. Cancer. All other Diseases. Rate of Mortality per 1,000. Under 1 year. Over 1 and under 5 Years. Persons aged 65 Years and upwards. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. Diarrhœa and Dysentery. All Causes. Seven Zymotics. Typhoid. Other. During the corresponding period year previous. During the 13 weeks ended 31st March, 1923. During the corresponding period year previous. During the 13 weeks ended 31st March, 1923. M. F. M. F. Greebwich East 441)31 4000N 187 124 an n7 11 0 37 *» 3 • • #» 1 10 i 0 11 % » I vm ■at Do. West atmao 27'JI 1 ne IIS no in 14 3 39 •« 1 2 I H i 13 *A M J 4-23 i'4& •o* St. Nicholas, Deptford 7 tui 4 77!H 21 20 10 14 3 3 3 .» 1 2 4 2 2 i 12 Z\W i&4$> 141 ISA Charlton 1 NO til HII (10 41 4S 27 II •J 3 13 i .. . H 1 " 4 % 7 m J V-7X 7-M m -2* Kidbrooke. .1224 M2S7 4N 411 0 n 6 , , 1 2 WW in Miller Hospital— Resident , , i l ,, 1 ,, 1 t ** Non-Resident , , 8 ii « . . 1 3 .< t 9 Seamen's Hospital— Resident 0 l , . , , ., 1 , , 2 2 1 1 % Non-RMident In 4 , t 1 4 2 t » Oukknwioh A DRI'ttorh Hospital Resident , , 36 35 4 n 211 1 1 I 6 4 . 10 S *> Vi Non- Resident 53 39 4 l 32 ,, 1 ,. 6 1 15 7 $4 Mkhhiciit Hospital— Resident , , ,, • • * # Non■ Resident. . , , ,. .. M.A.B. Rkook Hospital Resident , , 4 1 2 J 3 1 Non-RMident.. 4 3 2 1 It Oottaok Hospital — Resident 2 .. 1 11 Non-Resident.. 1 , , -- I Othkk Institutions— Resident 3 2 .. 1 -- -- -- Non-Resident.. 2 4 3 1 # « , . « -- -- -- Otjtsiok Institutions 30 21 4 1 12 1 1 - - io t ft DM 293 315 147 132 Borough 101400 102460 608 279 30 15 98 1 5 4 3 -- 1 35 4 2b 32 25 340 Rate per 1.000 of Estimated Population 23-81 10-92 •03 •19 •15 -11 •• ■03 1-37 •15 1-14 1 23 i-47 35*63 l«t2 M Deaths of Children under 1 Year per 1,000 births, 49 Death RaIc of 105 !ar_<- English Towns. 11 *9 ; of tJ - oumtT off Lcffidac. !•+ previous^ „ .. ,, corresponding 59 period ) County of London 51 Birth R*t* _ .. 21-4 21 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks ended 29th September, 1923. DISTRICTS. Census Population, 1921. Estimated Population at the middle of the Year 1923. Births Registered during the 13 weeks ended 29th September, 1923. Deaths Registered during the 13 weeks endc 1 29th September, 1923. Age Mortality seven zymotic diseases. Phthisis. All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1,000. Under 1 year. Over 1 and under 5 Years. Persons aged 05 Years and upwards. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. All Causes. Seven Zymotics. Typhoid. Other. Diarrhoea and Dysentery. During the corresponding period year previous. During the 13 weeks ended 29th September, 1923. During the corresponding period year previous. During the 13 weeks ended 29th September,, 1923. m. f. m. F. Greenwich East 44631 45098 115 135 57 32 12 5 33 .. .. .. .. .. 1 • 3 8 1 7 11 14 44 8.85 7.91 •62 .35 Do. West 26930 2721 1 58 58 35 31 7 2 20 .. .. .. .. .. 1 2 8 2 9 8 8 28 10.97 9.73 .88 .4 St. Nicholas, Deptford 7654 7734 31 23 15 10 6 1 4 .. .. .. .. 1 .. • • 2 5 .. 2 3 2 10 9.91 12.97 .. 1.53 Charlton 18961 19160 40 37 17 20 2 1 12 .. .. .. .. .. .. •• .. 8 •• •• 2 3 24 9 .05 7 .75> .. .. Kidbrooke 3224 3257 49 45 5 2 .. .. 6 .. .. .. .. .. .. .. 1 .. 1 .. .. 5 11.14 8.62 .. .. Miller Hospital- Resident .. .. .. .. 6 .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 1 1 3 •• .. .. .. Non-Resident .. .. .. .. 14 7 .. 1 1 .. .. .. .. .. .. .. 1 .. 2 2 4 12 .. .. .. .. Seamen's Hospital— 2 resident .. .. .. .. 13 1 .. .. 1 .. .. .. .. .. 1 .. 3 .. 1 1 3 6 .. .. .. .. Non-Resident .. .. .. .. 18 1 1 .. 4 .. .. .. .. .. .. .. .. 2 .. .. 1 3 13 .. .. .. .. Greenwich & Deptford Hospital— 7 Resident .. .. .. .. 21 25 5 1 15 .. .. .. .. 1 1 1 7 .. 1 5 14 23 .. .. .. .. Non-Resident .. .. .. .. 44 39 5 3 37 .. 1 .. .. 1 .. 1 2 .. 6 6 52 .. .. .. .. Herbert Hospital— Resident .. .. .. .. .. .. .. .. .. .. .. .. ..•• .. .. .. .. .. .. .. .. .. .. .. .. .. Non-Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. M.A.B. Brook Hospital— .. .. Resident .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. Non-Resident .. .. .. .. .. 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Cottage Hospital— Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• .. .. .. .. .. .. 1 .. .. .. .. Non-Resident .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Institutions— 2 .. .. .. .. Resident .. .. .. .. 2 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 8 .. .. .. .. Non-Resident. . .. .. .. .. 5 4 3 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. Outside Institutions .. .. .. .. 29 17 5 3 10 .. .. .. .. .. .. 1 6 1 1 6 10 21 .. .. .. .. 293 298 129 95 Borough 101400 102460 591 224 27 9 75 .. .. .. .. 1 2 7 30 3 19 24 27 111 .. .. .. •• Rate per 1,000 of Estimated Population .. .. 23.15 8.77 .. .. .. .. .. .. .. •03 •07 •27 1.17 •11 •74 .94 1.05 4.34 9.60 8.77 •41 •39 Deaths of Children under 1 Year per 1,000 births, 45 Death Kate of 105 large English Towns, 9-4 ; of tho County of London, 9 4. previous^ „ >• tt corresponding > 37 period) on. 4 ,, ,, County of London 58 Birth Rate .. .. 20 5 BOROUGH OF GREENWICH, Return of Births and Deaths registered during the 13 weeks ended 29th December, 1923. DISTRICTS. Census Population, 1921. (Adjusted Figures.) Estimated Population at the middle of the Year 1923. Births Registered during the 13 weeks ended 29th December, 1923. Deaths Registered during the 13 weeks ended 29th December, 1923. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Phthisis. All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per l,000 Under 1 year. Over 1 and under 5 Years. Persons aged 65 Years and upwards. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. All Causes. Seven Zvmotics. Typhoid. Other. Diarrhoea and Dysentery. During the corresponding period year previous. During the 13 weeks ended 29th December, 1923. During the corresponding period year previous. During the 13 weeks ended 29th December, 1923. M. F. M. F Greenwich East 44631 45098 106 95 63 61 14 3 50 .. .. .. 1 1 .. .. 3 6 1 21 9 19 63 9.29 11.03 •53 •44 Do. West 26930 27211 62 45 45 43 6 3 34 .. .. 1 2 1 1 .. 1 8 2 13 5 9 45 12.75 12.98 •44 •88 St. Nicholas, Deptford 7654 7734 20 28 11 11 2 1 10 .. 1 .. .. .. .. .. .. 1 ... 6 2 2 10 9.39 11.41 .. •51 Charlton 18961 19160 27 24 23 20 2 3 17 .. .. .. .. .. .. .. .. 5 1 4 4 6 23 12.00 9 .00 .42 .. Kidbrooke Miller Hospital— 3224 3257 50 39 5 6 2 .. 6 .. .. .. .. •• .. .. .. .. .. .. 2 2 7 12.38 13.55 .. .. Resident .. .. .. .. 6 1 .. 2 1 .. .. .. .. .. .. .. .. .. .. 3 .. 2 2 .. .. .. .. Non-Resident .. .. .. .. 14 6 3 2 1 .. .. .. .. .. .. .. .. .. 1 3 2 1 13 .. .. .. .. Seamen's Hospital— Resident .. .. .. .. 15 2 .. .. 3 .. .. .. .. .. 1 .. .. 1 .. 2 4 .. 9 .. .. .. .. Non-Resident .. .. .. .. 18 .. .. .. 2 .. .. .. .. .. .. .. .. 1 1 1 3 1 11 .. .. .. .. Greenwich & Deptford Hospital— Resident .. .. .. .. 30 27 9 .. 20 .. .. .. .. .. .. .. 4 2 1 10 2 7 31 .. .. .. .. Non-Resident .. .. .. .. 50 53 14 2 34 .. .. .. .. 2 1 .. 4 3 2 12 4 15 60 .. .. .. .. Herbert Hospital— Resident .. .. .. .. .. .. .. .. .. .. .. .. ..• • .. .. .. .. ..• • ..• • .. .. .. .. .. .. .. .. Non-Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. M.A.B. Brook Hospital— Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Non-Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. .. .. Cottage Hospital— Resident .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. 1 .. .. .. .. Non-Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Institutions— Resident .. .. .. .. 4 1 .. 1 .. .. .. .. .. .... .. .. .. .. .. .. 1 4 .. .. .. .. Non-Resident .. .. .. .. 1 3 .. .. 2 .. .. .. .. .. .. .. .. .. 1 .... .. .. 3 .. .. .. .. Outside Institutions .. .. .. .. 28 27 4 5 15 .. .. 1 3 1 .. .. .. 3 3 4 2 9 29 .. .. .. .. 265 231 147 141 - Borough 101400 102460 496 288 26 10 117 .. 1 l 3 2 l .. 4 20 4 44 22 38 148 .. .. .. •• Rate per 1,000 of Estimated Population .. .. 19.42 11.28 .. .. .. .. •03 •03 •11 •07 •03 .. •15 •78 •15 1.72 .86 1.48 5.79 10.82 11.28 .43 •46 Deaths of Children under 1 Year per 1,000 births, 52 Death Rate of 105 large English Towns, 11.8; of the County of London, 12.1. previous . corresponding 45 period . „ County of London 67 Birth Rate „ 18.9 18.7 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 52 weeks ended 29th December 1923. [####]DISTRICTS. Census Population, 1921. (Adjusted Figures.) Estimated Population at the middle of the Year 1923. Births Registered during the 52 weeks ended 29th December, 1923. Deaths Registered during the 52 weeks ended 29th December, 1923. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Phthisis. All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1.000. Under 1 year. Over 1 and under 5 Years. Persons aged 65 Years and upwards. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. All Causes. Seven Z.ymotics. Typhoid. Other. Diarrhoea and Dysentery. During the corresponding period year previous. During the 52 weeks ended 29th December, 1923. During the corresponding period year previous. During the 52 weeks ended 29th December, 1923.[/####] M. F. M. F Greenwich East 44631 45098 478 474 247 222 63 25 166 .. .. .. 6 6 3 .. 7 41 5 71 53 53 224 11.20 10.43 •87 •48 Do. West 26930 27211 242 227 198 154 41 13 131 .. • • 1 4 3 3 .. 3 34 8 50 30 43 173 15.27 12.97 1.03 •51 St. Nicholas, Deptford 7654 7734 97 106 51 46 14 8 25 .. 1 .. 1 3 .. .. 3 12 2 16 6 8 45 17.61 12.58 1.69 1.03 Charlton 18961 19160 162 156 97 70 9 12 57 .. 1 1 .. 1 .. .. .. 27 3 22 15 20 77 11. 68 8.74 •36 •15 Kidbrooke 3224 3257 173 161 19 15 2 .. 23 .. .. .. .. .. .. .. .. 1 .. 2 4 3 24 12.38 10.47 •30 .. Miller Hospital— Resident .. .. .. .. 20 4 .. 6 2 .. .. .. .. .. .. .. .. .. 2 7 2 4 9 .... .. .. .. Non-Resident .. .. .. .. 49 26 9 4 4 .. .. .. .. .. .. .. .. 2 2 10 4 11 46 .. .. .. .. Seamen's Hospital— Resident .. .. .. .. 52 4 .. 1 4 .. .. .. .. .. 3 .. .. 7 1 7 8 7 23 .. .. .. .. Non-Resident .. .. .. .. 69 1 1 1 13 .. .. .. .. .. .. .. .. 4 1 7 9 8 41 .. .. .. .. Greenwich & Deptford Hospital— Resident .. .. .. .. 125 114 21 11 83 .. .. .. 1 5 2 .. 5 22 2 27 18 31 126 .. .. .. .. Non-Resident .. .. .. .. 198 174 28 10 134 .. 1 .. .. 4 1 .. 6 26 3 44 23 43 221 .. .. .. .. Herbert Hospital— Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Non-Resident .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. M.A.B. Brook Hospital— Resident .. .. .. .. 7 2 .. 4 .. .. .. 1 6 .. .. .. .. .. .. .. .. .. 2 .. .. .. .. Non-Resident .. .. .. .. 20 14 .. .. .. .. .. 1 30 .. .. .. .. .. .. 1 .. .. 2 .. .. .. Cottage Hospital— Resident .. .. .. .. 3 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 2 .. 1 .. .. .. .. Non-Resident .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. Other Institutions— Resident .. .. .. .. 10 4 6 .. 4 .. .. .. .. .. .. .. .. .. .. 2 .. 2 10 .. .. .. .. Non-Resident .. .. .. .. 9 16 7 .. 9 .. .. .. .. .. .. .. .. .. 1 .. .. 3 21 .. .. .. .. Outside Institutions .. .. .. .. 121 79 20 14 49 .. 1 1 4 1 1 .. 2 22 5 15 12 31 105 .. .. .. .. 1152 1124 612 507 Borough 101400 102460 2276 1119 129 58 402 .. 2 2 11 13 6 .. 13 115 18 161 108 127 543 .. .. .. .. Rate per 1,000 of Estimated Population .. .. 22.28 10.95 .. .. .. .. •01 •01 •10 •12 •05 .. •12 1.12 .17 1.57 1.05 1.25 5.31 12.92 10.95 •86 •46 Deaths of Children under 1 Year per 1,000 births, 61 Death Rate of 105 large English Towns, 11.6; of the County of London, 11.2. previous ,, corresponding 56 period „ County of London 60 Birth Rate „ „ 20.4 „ 20.2. BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 31st March, 1923. Causes of Death. Deaths in Whole District at Subjoined Ages. Deaths in Localities at all Ages. Deaths in Public Institutions. Total Deaths in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton Kidbrooke Gr'n'ch & Deptford Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital M..A. B. Cottage Hospital Other Institutions Outside Institutions All Certified Causes Uncertified 328 46 10 14 11 19 35 81. 112 144 103 26 49 6 65 15 9 .. 3 .. 5 48 258 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 6 2 1 2 1 .. .. .. .. 5 .... .. 1 .. 3 .. .. .. .. .. .. .. 3 Diphtheria and Croup 3 .. .. 2 1 .. .. .. .. 2 1 .. .. .. .. .. .. .. 3 • • .. .. 26 Influenza 3 .. .. .. .. .. .. .. 3 1 1 .. .. 1 .. .. .. .. .. .. .. .. .. Erysipelas 1 1 .. ..• .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-Spinal Fever 1 .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. Dysentery 1 .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. 1 I Ophthalmia 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. Phthisis (Pul. Tuberculosis) 30 .. .. .. 1 8 13 6 2 12 10 2 6 .. 7 1 .. .. .. .. .. 3 25 Tuberculous Meningitis 2 1 .. 1 .. .. .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. .. .. 1 Other Tuberculous Diseases 5 .. .. .. 2 .. 3 .. .. 1 2 .. 2 .. .. 1 2 .. .. .. .. 1 4 Rheumatic Fever 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Cancer, Malignant Disease 37 .. .. 1 .. .. 5 13 18 12 17 3 4 1 11 3 1 .. .. .. 1 6 31 Bronchitis 31 3 .. .. .. .. 2 8 18 12 7 3 9 .... 2 .. .. .. .. .. 1 4 9 Broncho-Pneumonia 21 7 5 3 .. .. .. 3 3 12 1 5 2 2 .. 2 2 1 .. .. .. .. 3 10 Pneumonia (all other forms) Other Diseases of Respira- 17 .. .. 1 2 2 2 7 3 10 3 1 3 .. 2 .. 2 .. .. .. 1 2 10 tory Organs 5 1 .. .. .. 1 .. 3 .. 3 1 .. .. 1 2 .. .. .. .. .. .. .. 4 Diarrhoea and Enteritis 2 2 .. .. .. .. .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. .. .. 2 Appendicitis and Typhlitis 1 .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. 4 Alcoholism 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 2 Cirrhosis of Liver 1 .. .. .. .. .. .. l .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 2 Nephritis and Bright's Disease 12 .. .. 2 .. 1 .. 6 3 3 3 2 4 .. 2 .. .. .. .. .. .. 4 5 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Other Accidents and Diseases of Pregnancy and Parturition .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Congenital Debility and Malformation, including Premature Birth 20 17 1 1 1 .. .. .. .. 12 4 2 2 .. 4 .. .. .. .. .. .. 4 10 Violent Deaths, excluding Suicide 3 1 .. .. .. .. .. 1 1 1 2 .. .. .. .. .. 1 .. .. .. .. 1 8 Suicides 3 .. .. .. .. .. 2 1 .. 2 .. .. 1 .. .. .. .. .. .. .. .. 1 1 Heart Disease 30 .. .. .. 1 2 5 10 12 15 8 1 6 .. 3 3 .. .. .. .. .. 2 13 Other Defined Diseases 89 10 2 1 .. 5 3 20 48 38 35 8 5 3 25 5 .. .. .. .. 2 12 84 Diseases ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 328 46 10 14 11 19 35 81 112 144 103 26 49 6 65 15 9 .. 3 .. 5 48 258 BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 30th June, 1923. Causes of Death. Deaths in Whole District at Subjoined Ages Deaths in Localities at all ages Deaths is Pdbi.ic Institutions. Total Deaths in Public Institutions in the District All Apes Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton Kidbrooke Gr'n'ch & Deptford Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital M.A.B. Cottn ge Hospital Other Institutions Outside Institutions All Certified Cause. Uncertified 279 30 7 8 5 30 41 60 98 112 95 24 38 10 71 10 2 .. 5 2 3 51 231 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 3 .. .. .. 1 1 1 .. .. 2 1 .. .. .. 1 1 .. .. .. .. .. 1 2 Small-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 1 .. .. 1 .. .. .. .. .. .... .. .. 1 .. .. .. .. .. 1 .. .. .. 2 Whooping Cough 4 4 .. .. .. .. .. .. .. .. 2 .. .. 1 .. .. .. .. .. .. .. 2 Diphtheria and Croup 5 .. 1 2 1 1 .. .. .. 3 1 1 .. .. 1 .. .. .. 3 .. ..•• 1 10 Influenza 3 .. .. .. 1 ..•• 1 i .. .. 1 .. 2 .. 1 .. .. .. .. .. .. 1 3 Erysipelas 1 .. .. .. .. .. .. .. 1 .. 1 .. .. .. 1 .. .. .. .. .. .. .. 1 Cerebro-Spinal Fever 1 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 Chicken Pox 1 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. 1 Phthisis (Pul. Tuberculosis) 35 .. .. .. .. 17 9 6 3 15 8 4 8 .. 6 2 .. .. .. .. .. 10 15 Tuberculous Meningitis 3 .. 1 2 .. .. .. .. .. 1 .. 2 .. .. .. .. .. .. .. .. .. .. .. Other 'Tuberc ulous Diseases 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 Rheumatic Fever 1 .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. Cancer, Malignant Disease 25 .. .. .. .. 1 3 11 10 8 9 .1 7 .. 6 1 .. .. .. .. .. 6 18 Bronchitis 15 .. 1 .. .. .. .. 3 11 4 7 .. 4 .. 3 .. .. .. .. .. 1 .. 9 Broncho-Pneumonia 6 .. 3 .. .. 1 ' .. 1 1 3 2 1 .. .. 4 1 1 .. .. .. .. .. 12 Pneumonia (all other forms) Other Diseases of Respira 8 .. .. .. .. 1 2 3 2 2 4 1 .. 1 3 1 .. .. .. .. .. 1 15 tory Organs 6 .. .. 1 .. 1 1 1 2 1 2 .. 2 1 1 .. .. .. .. .. .. 1 1 Diarrhoea and Enteritis 3 2 1 .. .. .. .. .. .. 3 .. .. .. .. .. .. .. .. .. .. .. .. 3 Appendicitis and Typhlitis 2 .. .. .. .. .. .. .. 2 .. .. .. .. 2 .. .. .. .. .. .. .. .. 2 Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Cirrhosis of Liver 2 .. .. .. .. .. .. 2 .. 2 .. .. .. .. 2 .. .. .. .. .. .. .. 3 Nephritis and Bright's Disease 7 . .. .. .. .. .. 1 4 2 2 4 1 .... .. 1 .. .. .. .. .. .. 4 7 Puerpera.1 Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Accidents and Diseases of Pregnancy and Parturition 2 .. .. .. .. .. 2 .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 1 Congenital Debility and Malformation, including Premature Birth 16 16 .. .. .. .. .. .. .. 6 7 1 2 .. 2 .. .. .. .. .. 1 3 7 Violent Deaths, excluding Suicide 9 3 .. 2 1 1 1 .. 1 7 .. .. 2 .. 2 1 .. .. .. 1 1 1 8 Suicides 2 .. .. .. .. .. 1 1 .. .. 1 1 .. .. .. .. .." .. .. .. .. 1 .. Heart Disease 32 .. .. .. .. 3 7 11 11 18 9 .. 3 2 8 1 .. .. .. 1 .. 2 19 Other Defined Diseases . 85 4 .. .. .. 2 12 16 51 33 32 9 7 4 27 9 1 .. .. .. .. 18 87 Diseases ill-defined or unknown .. .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 279 30 7 8 5 30 41 60 98 112 95 24 38 10 71 10 2 .. 5 2 3 51 231 BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 29th September, 1923. Causes of Death. Deaths in Whole Distriot at Subjoined Aoes. Deaths in Localities at all Ages. Deaths in Pum.ic Institutions Total Deaths in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton Kidbrooke Gr'n'ch & Deptford Hospital Seamen's Hospital Miller Hospital ...... j Herbert Military 1 Hospital Brook Hospital M.A.B. Cottage Hospital Other Institutions Outside Institutions All Causes Certified 224 27 4 5 ii 16 37 4fi 75 89 66 25 37 7 46 14 G .. 1 2 46 203 UnCertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. .. .. 2 .. .. 1 1 .. .. .. 1 1 .. .. .. .. .. .. 2 Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Whooping Cough 1 .. 1 .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. 2 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Cerebro-Spinal Fever 1 .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. • • Phthisis (Pul. Tuberculosis) 30 1 .. .. 3 7 14 4 1 8 8 5 8 1 7 2 .. .. .. .. .. 6 14 Tuberculous Meningitis 2 .. 2 .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 •• Other Tuberculous Diseases 1 .. .. .. .. .. 1 •• .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 Rheumatic Fever 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 3 Cancer, Malignant Disease 27 .. .. 1 .. 1 3 9 13 14 8 2 3 .. 7 2 1 .. .. .. .. 10 32 Bronchitis 8 1 .. .. .. .. .. .. 7 2 5 1 .. .. .. .. .. .. .. .. .. .. 1 Broncho-Pneumonia 5 1 1 1 1 .. .. .. 1 3 1 .. .. 1 1 .. .. .. .. .. .. 1 5 Pneumonia (all other forms) 6 .. .. .. .. 1 1 1 3 2 3 1 .. .. .. 1 1 .. .. .. .. .. 5 Other Diseases of Respiratory Organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Diarrhoea and Enteritis 7 6 .. 1 .. .. .. .. .. 3 2 2 .. .. 1 .. .. .. .. .. .. 1 3 Appendicitis and Typhlitis 1 .. .. .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. 3 Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. •• Cirrhosis of Liver 1 .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 Nephritis and Bright's Disease 2 .. .. .. .. .. .. 2 .. .. 1 .. 1 .. .. .. .. .. .. .. .. 2 1 Puerperal Fever 3 .. .. .. 1 2 .. .. 2 .. .. 1 .. .. .. .. .. 1 .. .. 1 1 Other Accidents and Diseases of Pregnancy and Parturition 2 .. .. .. .. 1 .. 1 .. .. 1 1 .. .. 1 .. .. .. .. .. .. .. 1 Congenital Debility and Malformation, including Premature Birth 10 10 .. .. .. .. .. .. .. 4 2 2 2 .. 3 .. 1 .. .. .. 2 2 9 Violent Deaths, excluding Suicide 9 1 .. .. 1 2 3 2 .. 3 2 2 2 .. 1 1 .. .. .. .. .. 4 12 Suicides 3 .. .. .. .. .. .. 2 1 1 1 1 .. .. .. .. .. .. .. .. .. 1 1 Heart Disease 24 .. .. .. 4 1 5 8 6 11 8 3 2 .. 5 1 .. .. .. .. .. 6 15 Other Detined Diseases 78 7 .. 1 1 2 5 20 42 33 19 4 17 5 16 5 3 .. .. .. .. 11 85 Diseases ill-defined or known .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 224 27 4 5 11 16 37 49 75 89 66 25 37 7 46 14 6 .. 1 .. 2 46 203 BOROUGH OF GREENWICH. Causes of and Ages at, Death during the 13 weeks ended 29th December, 1923. Causes of Death. Deaths in Whole District at Subjoined Ages. Deaths in Localities at all Ages. Deaths in Public Institutions. Total Deaths in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton Kidbrooke Gr'n'ch & Deptford Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital M.A.B. Cottage Hospital Other Institutions Outside Institutions All Causes Certified 288 26 3 7 11 16 27 81 117 124 88 22 43 11 57 17 7 .. .. 1 5 55 232 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 2 Small-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. Whooping Cough 2 .. 2 .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. Diphtheria and Croup 3 .. .. .. 3 .. .. .. .. 1 2 .. .. .. .. .. .. .. .. .. 3 .. Influenza 5 .. .. .. 1 .. .. 1 3 1 2 .. 1 1 .. .. .. .. .. 1 .. 1 1 Erysipelas 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. 2 Cerebrospinal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis (Pul. Tuberculosis) 20 .. .. 1 1 7 6 4 1 6 8 1 5 .. 2 1 .. .. .. .. .. 3 7 Tuberculous Meningitis 1 .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 2 Other Tuberculous Diseases 3 .. .. .. .. 3 .. .. .. 1 1 .. 1 .. I .. .. .. .. .. .. 2 4 Rheumatic Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cancer, Malignant Disease 38 .. .. 1 .. 1 2 19 15 19 9 2 6 2 7 .. 2 .. .. .. 1 9 27 Bronchitis 21 .. .. .. .. .. 2 2 17 11 7 1 2 .. 2 .. .. .. .. .. .. 2 12 Broncho-Pneumonia 15 2 .. 3 .. 1 2 2 5 6 4 3 2 .. 4 2 2 .. .. .. .. 2 10 Pneumonia (all other forms) 8 .. .. .. .. .. 3 3 2 4 2 2 .. .. 4 .. 1 .. .. .. .. .. 10 Other Disees of Respiratory Organs 1 .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea and Enteritis 7 7 .. .. .. .. .. .. .. 5 1 .. 1 .. 4 .. .. .. .. .. .. 3 8 Appendicitis and Typhlitis 4 .. .. .. 1 1 .. 1 1 3 .. .. .. 1 2 .. .. .. .. .. .. 1 3 Alcoholism .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cirrhosis of Liver 2 .. .. .. .. .. .. 1 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. Nephritis and Bright's Disease 7 .. .. .. 1 .. .. 5 1 3 2 1 1 .. 1 .. 1 .. .. .. .. .. 10 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Accidents and Diseases of Pregnancy and Parturition .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Congenital Debility and Malformation, including Premature Birth 14 13 .. 1 .. .. .. .. .. 8 3 1 .. 2 5 .. .. .. .. .. 1 1 11 Violent Deaths, excluding Suicide 11 2 .. .. 1 .. 2 4 2 4 4 1 2 .. 1 .. .. .. .. .. 1 3 14 Suicides 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. Heart Disease 22 .. .. .. .. .. 1 9 12 9 5 2 4 2 2 4 .. .. .. .. .. 2 15 Other Defined Diseases . 99 2 .. .. 2 2 8 29 56 39 32 7 18 3 21 9 1 .. .. .. 2 20 87 Diseases ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 288 26 3 7 11 16 27 81 117 124 88 22 43 11 57 17 7 .. .. 1 5 55 232 BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 52 weeks ended 29th December, 1923. Causes of Death. Deaths in Whole District at Subjoined Ages. Deaths in Localities at all Ages. Deaths in Public Institutions. Total Deaths in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton Kidbrooke Gr'n'ch & Deptford Hospital Seamen's Hospitnl Miller Hospital Herbert Military Hospital Brook Hospital M.A.B. Cottage Hospital Other Institutions Outside Institutions All Causes Certified 1119 129 24 34 38 81 140 271 402 469 352 97 167 34 239 56 24 .. 9 3 15 200 924 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 6 .. .. .. 1 1 4 .. .. 3 3 .. .. .. 2 3 .. .. .. .. .. 1 6 Measles 2 .. .. 1 .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 1 2 Scarlet Fever 2 .. 1 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 .. .. 1 3 Whooping Cough 13 6 4 2 1 .. .. .. .. 6 3 3 1 .. 5 .. .. .. .. .. .. 1 9 Diphtheria 11 .. 1 4 5 1 .. .. .. 6 4 1 .. .. 1 .. .. .. 6 .. .. 4 36 Influenza 11 .. .. .. 2 .. 1 2 6 2 4 .. 3 2 1 .. .. .. .. 1 .. 2 4 Erysipelas 3 1 .. .. .. 1 .. .. 1 .. 3 .. .. .. 2 .. .. .. .. .. .. .. 5 Cerebro-Spinal Fever 3 .. .. 1 2 .. .. .. .. 1 .. .. 2 .. .. .. .. .. 1 .. .. 1 1 Chicken Pox 1 1 .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 1 2 Dysentery 1 .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. 1 •• Ophthalmia 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. Phthisis (Pul. Tuberculosis) 115 1 .. 1 5 39 42 20 7 41 34 12 27 1 22 6 .. .. .. .. .. 90 61 Tuberculous Meningitis 8 1 3 3 1 .. .. .. .. 3 3 2 .. .. 1 .. .. .. .. .. .. 2 3 Other Tuberculous Diseases 10 .. .. .. 2 4 4 .. .. 2 5 .. 3 .. 1 2 2 .. .. .. .. 3 10 Rheumatic Fever 3 .. .. .. .. .. 1 1 1 1 2 .. .. .. 1 .. .. .. .. .. .. .. 3 Cancer, Malignant Disease 127 .. .. 3 .. 3 13 52 56 53 43 8 20 3 31 6 4 .. .. .. 2 31 108 Bronchitis 75 4 1 .. .. .. 4 13 53 29 26 5 15 .. 7 .. .. .. .. .. 2 6 31 Broncho-Pneumonia 47 10 9 7 1 2 2 6 10 24 12 6 4 1 11 5 4 .. .. .. .. 6 37 Pneumonia (all other forms) 39 .. .. 1 2 4 8 14 10 18 12 5 3 1 9 2 4 .. .. .. 1 3 40 Other Diseases tory Organs 12 1 .. 1 .. .. 1 4 3 5 3 .. 2 2 3 .. .. .. .. .. .. 1 6 Diarrhæa and Enteritis 19 17 1 1 .. .. .. .. .. 12 4 2 1 .. 6 .. .. .. .. .. .. 4 16 Appendicitis and Typhlitis 8 .. .. .. 3 1 .. 1 3 3 1 1 .. .. 3 .. 1 .. .. .. .. 1 12 Alcoholism 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 3 Cirrhosis of Liver 6 .. .. .. .. .. .. 4 2 5 .. .. 1 .. 2 .. .. .. .. .. .. 1 6 Nephritis and Bright's Disease 28 .. .. 2 1 1 1 17 6 8 10 4 6 .. 4 .. 1 .. .. .. .. 10 23 Puerperal Fever 3 .. .. .. .. 1 2 .. .. 2 .. .. 1 .. .. .. .. .. 1 .. .. 1 3 Other Accidents and Diseases of Pregnancy and Parturition 4 .. .. .. .. 1 2 1 .. 1 2 1 .. .. 1 .. .. .. .. .. .. 1 8 Congenital Debility and Malformation, including Premature Birth 60 56 1 2 1 .. .. .. .. 30 16 6 6 2 14 .. 1 .. .. .. 4 10 37 Violent Deaths, excluding Suicide 32 7 .. 2 3 .. 6 7 4 15 8 3 6 .. 4 2 1 .. .. 1 2 9 42 Suicides 9 .. .. .. .. .. .. 5 1 3 3 2 1 .. .. .. .. .. .. .. .. 3 2 Heart Disease 108 .. .. .. 5 .. 18 38 41 53 30 6 15 4 18 9 .. .. .. 1 .. 12 62 Other Defined Diseases . 351 23 2 2 3 11 28 85 197 143 118 28 47 15 89 21 5 .. .. .. 4 61 343 Diseases ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1119 129 24 34 38 81 140 271 402 469 352 97 167 34 239 56 24 .. 9 3 15 200 924 BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 13 weeks ended 31 sf March, 1923. Notifiable Diseases. Cases Notified in Whole District. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. Greenwich East. Greenwich West. St. Nicholas, Deptford. Charlton. Kidbrooke.* Greenwich East. Greenwich West. St. Nicholas, Deptford. Charlton. Kidbrooke* Total. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upward Polio Myelitis 2 .. 1 1 .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. Small-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-Pox 69 4 17 44 4 .. .. .. 26 31 .. 8 4 2 1 .. 1 .. 4 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 96 2 22 53 14 4 1 .. 48 26 11 3 8 44 26 11 3 8 92 Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 19 2 1 1 3 6 4 2 11 2 3 2 1 3 .. 2 1 1 7 Scarlet Fever 94 .. 19 59 13 3 .. .. 51 21 8 7 7 47 20 8 .. 7 88 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. 1 Continued Fever 1 .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. .. .. .. 1 Puerperal Fever 2 .. .. .. 1 1 .. .. 1 1 .. .. .. 1 1 .. .. .. 2 Cerebro-Spinal Fever 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 402 12 96 285 7 1 1 .. 308 12 .. 72 10 4 .. .. .. .. 7 Whooping Cough 172 28 92 52 .. .. .. .. 114 45 .. 13 .. 3 1 .. .. .. 4 Diarrhœa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. .. .. 1 Ophthalmia Neonatorum 4 4 .. .. .. .. .. .. 2 1 .. 1 .. 1 .. .. .. .. 1 Tuberculosis, Pulmonary 61 .. 2 9 11 26 11 2 24 18 .. 11 2 .. 2 .. 1 .. 3 „ Non-Pulmonary 9 .. 2 6 .. 1 .. .. 7 2 .. .. .. .. .. .. .. .. .. Pneumonia, Acute Primary, or Acute Influenzal 26 1 3 7 4 4 7 .. 17 5 .. 4 .. 4 1 .. 1 .. 6 Totals 960 53 255 519 57 47 25 4 610 166 28 124 32 110 54 21 16 17 218 * Cases of Infectious Disease are treated in the Hospitals of the Metropolitan Asylums Board, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 13 weeks ended 30th June, 1923. Notifiable Diseases. Cases Notified in Whole District. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from each locality. At all Ages. At Ages—Years. Greenwich East. Greenwich West. St. Nicholas, Deptford. Charlton. Kidbrooke. Greenwich East. Greenwich West. St. Nicholas. Deptford. Charlton. Kidbrooke* Total. Under 1 1 to 6 5 to 16 15 to 26 25 to 45 45 to 65 65 and upwards Acute Polio Myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 45 .. 14 25 5 1 .. .. 27 9 3 6 .. 26 8 3 6 .. 44 Mem. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 10 1 .. 1 3 1 3 1 3 4 3 .. .. 2 1 .. .. .. 3 Scarlet Fever 46 2 20 16 4 2 1 1 21 16 1 4 4 19 14 1 5 1 40 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 4 .. .. 2 .. .. 2 .. 3 1 .. .. .. 3 1 .. .. .. 4 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 3 .. .. .. 1 2 .. .. 3 .. .. .. .. 3 .. .. .. .. 3 Cerebro-Spinal Fever 2 .. .. ] .. .. .. .. 2 .. .. .. .. 2 .. .. .. .. 2 Measles 193 1 54 132 5 1 .. .. 137 12 2 38 4 .. 1 .. .. 1 2 Whooping Cough 81 12 40 28 .. 1 .. .. 41 22 13 5 .. 2 4 .. .. .. 6 Diarrhæa 7 3 4 .. .. .. .. .. 1 5 .. 1 .. .. .. .. .. .. .. Ophthalmia Neonatorum 6 6 .. .. .. .. .. .. 2 .. .. 4 .. 2 .. .. 1 .. 3 Tuberculosis, Pulmonary 60 .. .. 8 12 28 10 2 25 19 7 8 1 4 .. 1 2 1 8 „ Non-Pulmonary 10 .. 3 2 5 .. .. .. 4 2 2 2 .. .. .. .. .. .. .. Pneumonia, Acute Primary, or Influenzal 26 .. 1 3 1 10 7 4 10 7 3 4 2 3 3 3 1 1 11 Totals 493 25 136 218 36 46 24 8 279 97 34 72 11 66 33 8 15 4 126 * Cases of Infectious Disease are treated in the Hospitals of the Metropolitan Asylums Board, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 13 weeks ended 29th September, 1923. Notifiable Diseases. Cases Notified is Whole District. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. Greenwich East. Greenwich West. St. Nicholas, Deptford. Chariton. Kidbrooke.* Greenwich East. Greenwich West. St. Nicholas, Deptford. Charlton. Kidbrooke* Total. Under 1 1 to 5 5 to 15 13 to 25 25 to 45 45 to 65 65 and upwards Acute Polio Myelitis 2 .. 2 .. .. .. .. .. .. 2 .. .. .. .. 2 .. .. .. 2 Small-Pox 4 .. .. 1 1 1 .. 1 4 .. .. .. .. 4 .. .. .. .. 4 Chicken-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 38 .. 8 20 6 4 .. .. 12 13 4 7 2 12 13 .. 7 2 38 Mem. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 15 .. 1 1 3 4 .. .. 6 6 2 .. 1 3 .. .. .. 1 4 Scarlet Fever 31 .. 8 15 5 3 .. .. 11 12 1 6 1 10 .. .. 5 1 29 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 3 .. .. 1 1 1 .. .. 3 .. .. .. .. 2 .. .. .. .. 2 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 4 .. .. .. 3 1 .. .. 2 1 .. 1 .. 2 1 .. .. .. 3 Cerebro-Spinal Fever 2 .. 1 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. Measles 58 1 29 23 2 2 1 .. 44 8 .. 6 .. .. .. .. .. .. .. Whooping Cough 35 8 15 12 .. .. .. .. 9 12 13 1 .. 1 2 .. .. .. 4 Diarrhoea 62 26 36 .. .. .. .. .. 27 29 2 4 .. .. .. .. .. .. .. Ophthalmia Neonatorum 5 5 .. .. .. .. .. .. 1 .. 2 2 .. .. .. .. .. .. .. Tuber-culosis, Pulmonary 43 .. .. 8 13 12 9 1 18 14 2 9 .. 14 1 1 2 .. 18 „ Non-Pulmonary 22 .. 4 7 5 6 .. .. 5 12 1 4 .. .. .. 1 .. .. 1 Pneumonia, Acute Primary, or Influenzal 7 .. 2 .. 2 1 1 1 4 2 1 .. .. .. .. .. .. .. .. Totals 331 40 106 89 41 35 15 5 147 111 28 41 4 48 31 8 14 4 105 * Cases of Infectious Disease are treated in the Hospitals of the Metropolitan Asylums Board, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 13 weeks ended 29th December, 1923. Notifiable diseases. Cases Notified in Whole District. Total Cases Notified is each Locality. Number of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. Greenwich East. Greenwich West. St. Nicholas, Deptford. Charlton. Kidbrooke.* Greenwich East. Greenwich West. St. Nicholas, Deptford. Charlton. Kidbrooke* Total. Under 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Acute Polio Myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Small-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 38 1 15 16 5 1 .. .. 9 14 1 14 .. 8 14 1 14 .. 37 Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 12 1 1 2 2 2 3 1 2 6 4 .. .. .. 4 1 .. .. 5 Scarlet Fever 48 .. 10 34 3 1 .. .. 21 13 8 6 .. 18 12 8 6 .. 44 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 8 .. 1 .. .. 4 .. .. 3 3 1 1 .. 2 3 1 1 .. 7 Malaria 2 .. .. .. .. 2 .. .. 1 1 .. .. .. 1 .. .. .. .. 1 Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-Spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 53 4 29 20 .. .. .. .. 18 13 17 4 .. .. 1 4 .. .. 5 Whooping Cough 41 3 27 11 .. .. .. .. 32 8 1 .. .. 1 1 .. .. .. 2 Diarrhæa 17 14 3 .. .. .. .. .. 12 5 .. .. .. 6 2 .. .. .. 8 Ophthalmia Neonatorum 1 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. Tuberculosis, Pulmonary 55 .. .. 5 13 24 13 .. 23 13 6 13 .. 3 3 1 1 .. 8 ,, Non-Pulmonary 16 .. 2 9 3 2 .. .. 7 5 3 1 .. 1 .. 1 .. .. 2 Pneumonia, Acute Primary, or Acute Influenzal 12 .. 1 4 2 4 1 .. 8 3 .. 1 .. 4 2 1 1 .. 8 Totals 303 24 89 101 30 40 18 1 136 84 41 41 1 44 42 18 23 .. 127 * Cases of Infectious Disease are treated in the Hospitals of the Metropolitan Asylums Board, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 52 weeks ended 29th December, 1923, Notifiable Diseases. Cases Notified in Whole District. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from each locality. At all Ages. At Ages—Years. Greenwich East. Greenwich West. St. Nicholas, Deptford. Charlton. Kidbrooke.* Greenwich East. Greenwich West. St. Nicholas, Deptford. Charlton. Kidbrooke* Total. Under 1 1 to 5 5 to 15 15 to 25 35 to 45 45 to 65 65 and upwards Acute Polio Myelitis 4 .. 3 1 .. .. .. .. .. 2 .. 2 .. .. 2 .. .. .. 2 Small-Pox 4 .. .. 1 1 1 .. 1 4 .. .. .. .. 4 .. .. .. .. 4 Chicken-Pox 69 4 17 44 4 .. .. .. 26 31 .. 8 4 2 1 .. 1 .. 4 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 217 3 59 114 30 10 1 .. 96 62 19 30 10 90 62 19 30 10 211 Mem. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 56 4 3 5 11 13 14 6 22 18 12 2 2 8 5 3 1 2 19 Scarlet Fever 219 2 57 124 25 9 1 1 104 62 18 23 12 94 58 18 22 9 201 Malaria 2 .. .. .. .. 2 .. .. 1 1 .. .. .. 1 .. .. .. .. 1 Dysentery 1 .. .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. .. .. 1 Enteric Fever 16 .. 1 4 3 5 3 .. 9 5 1 1 .. 7 5 1 1 .. 14 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever 1 .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. .. .. .. 1 Puerperal Fever 9 .. .. .. 5 4 .. .. 6 2 .. 1 .. 6 2 .. .. .. 8 Cerebro-Spina! Fever 5 .. 1 3 .. .. 1 .. 3 .. .. 2 .. 2 .. .. 1 .. 3 Measles 706 18 208 460 14 4 2 .. 507 45 19 120 15 4 2 4 2 2 14 Whooping Cough 329 51 174 103 .. 1 .. .. 196 87 27 19 .. 7 8 1 .. .. 16 Diarrhæa 86 43 43 .. .. .. .. .. 40 39 2 5 .. 6 2 .. .. .. 8 Ophthalmia Neonatorum 16 16 .. .. .. .. .. .. 5 1 2 8 .. 3 .. .. 1 .. 4 Tuberculosis, Pulmonary 219 .. 2 30 49 90 43 5 90 64 21 41 3 21 6 3 6 1 37 „ Non-Pulmonary 57 .. 11 24 13 9 .. .. 23 21 6 7 .. 1 .. 2 .. .. 3 Pneumonia, Acute Primary, or Acute Influenzal 71 1 7 14 9 19 16 5 39 17 4 9 2 11 6 4 3 1 25 Totals 2087 142 586 927 164 168 82 18 1172 458 131 278 48 268 160 55 68 25 576 *Cases of Infectious Disease are treated in the Hospitals of the Metropolitan Asylums Board, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. INFANTILE MORTALITY DURING THE YEAR 1923. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 Week 1—2 Weeks 2—8 Weeks 3—4 Weeks Total under 1 Month 1—3 Months 3—6 Months 6—9 Months 9—12 Months Total Deaths under 1 Year All Causes. Certified 46 5 3 9 63 18 16 21 11 129 Uncertified .. .. .. .. .. .. .. .. .. .. Common Infectious Diseases. Small-Pox .. .. .. .. .. .. .. .. .. .. Chicken-Pox .. .. .. .. .. .. .. .. 1 1 Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. 2 1 3 6 Diphtheria—Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. 1 .. 1 .. .. .. .. 1 Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. .. 1 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. 1 .. .. 1 Meningitis (not Tuberculous) .. .. 1 .. 1 .. 1 1 .. 3 Convulsions 3 1 .. .. 4 .. 1 1 2 8 Diseases of Trachea .. .. .. .. .. .. 1 .. .. 1 Bronchitis .. .. .. 1 1 2 .. 1 .. 4 Pneumonia, all forms .. .. .. 1 2 3 2 2 1 10 Diarrhœal Diseases. Diarrhæa, all forms .. .. .. .. .. .. 4 1 2 7 Enteritis .. .. .. .. .. 2 2 4 1 9 Gastritis 1 .. .. .. 1 .. .. .. .. 1 Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlaying 1 .. .. 1 2 1 .. .. .. 3 ,, otherwise 2 .. .. .. 2 .. 1 .. .. 3 Injury at Birth 1 .. .. .. 1 .. • • .. .. 1 Actelectasis 3 .. .. 1 4 .. .. 1 .. 5 Congenital Malformations 7 .. .. 1 8 4 .. 1 .. 13 Premature Birth 15 1 .. 1 17 3 .. .. .. 20 Atrophy, Debility and Marasmus 11 2 .. 3 16 1 1 5 .. 23 Other Causes 2 1 .. .. 3 2 .. 3 .. 8 Totals 46 5 3 9 63 18 16 21 11 129 Boys 86 Girls 43 129