AC 4373 Gre 27 THE ANNUAL REPORT MADE TO THE COUNCIL OF THE Metropolitan Borough of Greenwich for the Year 1926 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. freame. manning & co., ltd., 12a, Lee High Road. Lewisham, S.E.13. THE ANNUAL REPORT MADE TO THE COUNCIL OF THE Metropolitan Borough of Greenwich for the Year 1926 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. freame. manning & co., ltd., 12a, Lee High Road, Lewisham, S.E.13. CONTENTS. Pages Public Health Committee 1-2 Maternity and Child Welfare Committee 3 Introductory 4-5 Section I.—Natural and Social Conditions of the Area 6 Vital Statistics 7-20 „ II.—General Provisions of Health Services in the Area 21-26 Laboratory Work 25 „ III.—Sanitary Circumstances of the Area 27-42 „ IV.—Housing 43-45 „ V.—Inspection and Supervision of Food 46-55 „ VI.—Prevalence of, and Control Over, Infectious Diseases 56-80 „ VII.—Maternity and Child Welfare 81-95 1 Public Health Committee during the year. 1925-6. The Mayor— Fred Thorne, J.P., and 13 Members. Councillors— G. Redgrove (Chairman) Mrs. S. H. Mills M. G. Byerley, F.R.C.V.S. Dr. H. B. Morgan (Vice-Chairman) J. H. Round Mrs. P. M. Beacham F. C. Selfe. Major R. H. Green Mrs. C. R. Turner, J.P. Dr. W. R. Hodgkinson, F. Winchcombe C.B.E., M.A. Mrs. M. Woolner Mrs. S. A. Kelly, J.P. Powers and Duties 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 Acts, 1920 and 1923; 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; 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. 3.—The Committee may serve and receive notices, take proceedings, and in particular cases empower any Officer of the Council to make complaints and take proceedings in their behalf under, and otherwise execute, the Public Health 2 (London) Act, 1891, and sections 82. 83, 84 and 85 of the Metropolis Management Act, 1855, relating to the inspection of any premises, drains, sinks, traps, syphons, pipes, or other works or apparatus connected therewith, and otherwise in relation to defective drainage, except as to the recovery of expenses, and the same shall not require the approval of the Council. Provided that the Committee shall report their action 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 the 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, ISO'S, 1922. Rag Flock Act, 1911. Public Health (Tuberculosis Regulations), 1912. Public Health (MTk and Cream) Regulations, 1912, 1917. Rats and Mice (Destruction) Act, 1919. Rent and Mortgage Interest Restrictions Acts, 1920 and 1923. Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies (Amendment) Act, 1922. Milk and Dairies Order, 1926. Public Health (Condensed Milk) Regulations, 1923. „ „ (Dried Milk) ,, „ „ ,, (Meat) Regulations, 1924. „ ,, (Imported Milk) Regulations, 1926. ,, ,, (Preservatives, &c., in Food) Amendment Regulations, 1926. „ ,, (Smoke Abatement) Act, 1926. 3 Maternity and Child Welfare Committee during the Year 1925-6. The Mayor— Fred Thorne, J.P., and 14 Members. Councillors — *Miss M. Sherman (Chairman) M. C. Matthews, M.A. *Mrs. M. Woolner *Mrs. S. H. Mills (Vice-Chairman) Col. A. C. Ralph, D.S.O. *Mrs. P. M. Beacham *Mrs. C. R. Turner, J.P. *Mrs. N. Cunis F. Winchcombe *Mrs. S. A. Kelly, J.P. Co-opted Members— *Mrs. E. C. Berry *Mrs. M. Hamilton *Mrs. A. Dence *Mrs. C. H. Thackeray *Denotes Members who served on The Assistance Sub-Committee. 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, 1927. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Greenwich. Ladies and Gentlemen, I have the honour to submit herewith the Annual Report as Medical Officer of Health for the year 1926. The Death-Rate is 10.89 per 1,000 of the estimated population. This is .93 lower than the average for the previous 5 years and compares favourably with the rates for the County of London and England and Wales which are both returned as 11.6. It is also pleasing to be able to state that the Death-Rate is the lowest recorded since the inception of the Council. The Birth Rate is 17.75 per 1,000. Last year the Birth Rate was 18.92 and the average for the last 10 years 20.06. The Birth Rate for the County of London is 17.1 and 17.8 for all England and Wales. The Infant Mortality Rate for the Borough, measured by the number of deaths under one year to 1,000 births registered is 61 compared with 69 last year. The rate for England and Wales is 70, and for the County of London 64. The Zymotic Death Rate of .40 per 1,000 is slightly lower than last year's figure of .58. 5 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 and Enteritis Death Rate (under 2 yrs.) Consumption Death Rate East Greenwich 16.78 10.82 63 .02 5.32 .80 West Greenwich 16.59 12.24 66 .14 6.66 1.03 St. Nicholas, Deptford 29.10 14.22 79 1.02 14.70 1.66 Charlton 17.97 8.89 48 .04 5.37 .77 Kidbrooke 12.13 5.45 — — — — Whole Borough 17.75 10.89 61 .40 7.06 .89 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 .00 4.90 3.45 .59 .04 . 04 West Greenwich 0.00 4.41 2.79 .82 .07. . 07 St. Nicholas, Deptford 0.00 2.69 3.58 1.28 — . 25 Charlton 0.00 5.84 4.49 .19 .09 .14 Kidbrooke 0.00 9.39 5.76 .30 .30 — Whole Borough 0.00 4.82 3.56 .62 .06 .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 support I have at all times received from every member of my capable and enthusiastic Staff, and particularly the voluntary workers of the various Maternity and Child Welfare Centres. I am, Ladies and Gentlemen, Your obedient Servant, E. G. Annis. 6 SECTION 1. NATURAL AND SOCIAL CONDITIONS OF THE AREA. 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, 1926 104,050 Density of Population— East Greenwich 34.57 persons per acre West Greenwich 60.05 „ St. Nicholas, Deptford 68.03 ,, Charlton and Kidbrooke 12.08 „ Average for the Borough 26.96 persons per acre Number of Inhabited Houses— Structurally separate dwellings at Census, 1921 16,526 „ „ „ 1926 17,837 Number of Uninhabited Houses— At Census, 1921 288 Estimated, 1926 123 7 VITAL AND MORTAL STATISTICS, 1926. POPULATION. The population of the Borough estimated to the middle of the year 1926 is 104,050, and it is upon this figure that the statistics generally in this Report are based. The Registrar-General's estimate, excluding non-civilians is 104,300 for Birth Rate and 103,300 for Death Rate). The following is the distribution of the population throughout the Borough:— Census 1921 (Adjusted) Estimated Population at middle of year 192G. East Greenwich 44,647 44,950 West Greenwich 26,931 27,206 St. Nicholas, Deptford 7,646 7,824 Charlton 18,959 20,762 Kidbrooke 3,217 3,308 Total 101,400 104,050 EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total M. F. *Births Legitimate 1,786 916 870 *Birth Rate 17.8 Illegitimate 61 33 28 Deaths 1,130 610 520 *Death Rate 10.8 Number of women dying in, or in consequence of, childbirth From Sepsis - ,, other causes 7 *Deaths of Infants under one year of age per 1,000 births:— Legitimate, 57: Illegitimate, 229. Total Rate = 63. Deaths from Measles (all ages) 13 „ ,, Whooping Cough (all ages) 4 „ ,, Diarrhœa (under 2 years of age) 13 *These figures, which are supplied by the Registrar-General, differ slightly from those shown in other parts of the Report. 8 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 parish of Charlton and Kidbrooke, with the exception, in these latter particulars, that the marriages performed in the Woolwich Superintendent-Registrar's Office of residents in that Parish are not included. It will be noticed there is an appreciable increase in the number solemnised during the year under review. The following table shows these particulars, giving the number of marriages in Greenwich and St. Nicholas, etc., for each year since 1913:— Year In Churches of England in Greenwich Charlton & 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 In Churches of England In Non-Conformist Churches 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 — 55 214 817 89939 1919 419 197 — 76 326 1018 102591 1920 384 105 — 64 322 875 104453 1921 344 124 — 57 249 774 100493 1922 361 112 — 45 275 796 101930 1923 336 132 — 51 222 741 102460 1924 299 127 10 55 200 691 102990 1925 265 132 5 48 224 674 103520 1926 382 95 11 48 260 796 104050 BIRTHS. The total number of births registered in the Borough during the year was 2,027. Of this number 309 occurred in Greenwich and Deptford Hospital and 373 at various Nursing Homes within the Borough. Of this total of 682 Institution births, 362 only belonged to Greenwich, the remainder being transferred to the appropriate localities. 9 One hundred and thirty-four births belonging to the Borough took place in Institutions outside the Borough area, thus the actual figure for Greenwich becomes 1841:- Males, 937; Females, 904. This figure gives a Birth Rate of 17.75 per 1,000 of the population, which is 2.31 below the average for the last ten years. With the exception of the year 1918—a war period year —this is the lowest rate ever recorded. The Birth Rate for the County of London equals 17.1 per 1,000 of the population. The Birth Rate for all England and Wales was 17.8 and 18.2 for the 105 large towns. Illegitimate births numbered 61, representing 3.3 per cent. of the total births. Seventy-two illegitimate births actually were registered in the Borough In 24 cases, however, the mothers were ordinarily resident outside the Borough, and these births were consequently allocated to the correct area. 13 illegitimate births belonging to Greenwich occurred outside the Borough, thus giving the net figure of 61. Twenty-seven 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 2,096 births. DEATHS. The nett number of deaths registered during 1926 was 1,130, of which 610 were males and 520 females. The crude Death Rate for the Borough, 10.89 per 1,000, is the lowest recorded since the inception of the Borough and compares favourably with 11.6 the respective Death Rates for the County of London and the 105 large towns. This greatly decreasing death rate with presumably a similarly or possibly greater diminishing sickness rate, will in my opinion, at no very distant date compel medical practitioners solely as a means of self defence, to adopt some different method of payment for medical services, and it seems to me that the earlier this question is taken into serious consideration the better, before the general death rate has fallen very much lower. I would suggest that a system of capitation fee based on a standard death rate 10 figure should be agreed upon, such capitation fee to be increased as the death rate became lower, or decreased as the death rate became higher during any period. In this way medical men would be more definitely encouraged to take advantage of all the various means at their disposal for dealing with the different classes of diseases. In my opinion the general health of the public would be materially improved because the natural desire of medical men to increase their fee would encourage them to be active disseminators of preventive health measures, and the machinery which is already provided under the Insurance Act for making backward Authorities financially responsible for insanitary conditions leading to increased sickness and ill-health would be much more likely to be put into operation. Certain suggestions on these lines have been placed before the medical profession generally in various ways, but up to the present the idea has not received much favour. Sir Arthur Newsholme, K.C.B., M.D., F.R.C.P., in an address before the Derby Medical Society said " I have said enough I trust, to make it clear that the progress of the application of preventive medicine depends predominantly on the attitude of the medical profession. It has even been said that doctors constitute a chief obstacle to this progress ; but this can only be true in those instances in each community in which there is, for instance, failure to use every available means for prompt diagnosis and for adequate treatment of, say, tuberculosis and syphilis ; when the duty of pre-natal care of every expectant mother whose name is on a doctor's list has not been realised ; and when, for instance again, the doctor fails to fulfil his duty as doctor or teacher, in respect of the prevention of rickets, the avoidance of unhygienic habits, and especially in regard to the consumption of alcoholic drinks. In view of the habit-forming risks involved, the doctor who flippantly and without serious reason prescribes alcoholic drinks to an ailing patient is definitely open to the accusation of anti-social action.'" Sir Alfred Watson, K.C.B., in a paper before the Royal Statistical Society comparing sickness experience for the vears 1921 and 1923 with 1893 and 1897 shewed that the sickness rate amongst men had fallen on the average by about 20 per cent. Lord Cozens Hardy in an address to the National Association of Insurance Committees in dealing with this question said:— " The principal burden of malady belonged to the category of preventible disease. It was in the interests of the medical faculty as much as of the approved societies that insured persons should be kept well. Long spells of sickness were not profitable to 11 the panel doctor, but they had nearly got to the sensible Chinese system of paying the doctor when in health and ceasing payment when ill. There was no reason why doctors should live on other men's diseases. Instead, let them be handsomely paid for keeping people well. It would be possible to double the incomes of the doctors if they would halve their sickness, and there might come a time when their rate of remuneration would be in direct ratio to the fewness of their calls." An article also in one of the monthly reviews dealing with this question points out that the profession are more interested in illness than in health, and though many of them are admirable, directly we are their " patients," and are definitely ill, preferably in bed, it is not among their recognised functions to keep the community fit. The familiar tag " Prevention is better than cure " makes little appeal to Medicine. Prevention is none of its business. Cure is. The urgent need is, however, research into the causes of such epidemics as Influenza and Foot-and-Mouth Disease. Unfortunately, research appeals neither to British Governments nor to the British Public, who in their wastefulness are prepared to regard slaughter as the single solution of the cattle plague, while Influenza is treated as one of the inevitable ills to which the flesh is heir that we must learn to grin and bear. From a consideration of these remarks it would appear that this question being taken up as it is, by the lay as well as medical people, will undoubtedly become one of the factors of practical medical politics at no distant date, and as I have already indicated, in my opinion, on more grounds than one, the sooner the better. The following table shows at a glance the relative position occupied by Greenwich compared with other Boroughs in London. Lewisham 10.0 Lambeth 11.5 Hampstead 10.1 Bethnal Green 11.6 Woolwich 10.1 Holborn 11.7 Wandsworth 10.4 Stepney 11.7 Hackney 10.6 Bermondsey 11.9 Fulham 10.7 Shoreditch 11.9 Greenwich 10.9 Islington 12.0 City of London 10.9 St. Pancras 12.2 Cambcrwell 11.0 Paddington 12.3 Stoke Newington 11.0 Kensington 12.4 Deptford 11.1 Chelsea 12.4 Battersea 11.2 St. Marylebone 12.6 City of Westminster 11.2 Southwark 12 .7 Hammersmith 11.3 Finsbury 12.8 Poplar 11.3 12 Locally the Death Rate varied from 5.45 in Kidbrooke, 8.89 in Charlton, 10.82 in East Greenwich, 12.24 in West Greenwich, up to 14.22 in St. Nicholas, Deptford. Of the total number of deaths, 15 under five years of age were of illegitimate birth, 14 of whom were under one year of age. 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 1921 to 1925 compared with the figures for 1926: — District. 1921 1922 1923 1924 1925 Average for 5 years. 1926 East Greenwich 1217 11.26 10.43 11.14 10.87 11.17 10.82 West Greenwich 12.53 15.27 12.97 11.84 12.45 13.01 12.24 St. Nicholas, Deptford 14.28 17.61 12.58 11.77 12.63 13.77 14.22 Charlton 11.80 11.68 8.74 12.41 11.36 11.19 8.89 Kidbrooke 11.62 12.38 10.47 6.61 6.09 9.43 5.45 Borough 12.41 12.92 10.95 11.47 11.36 11.82 10.89 DEATHS IN INSTITUTIONS. The following table shows the number of deaths of Greenwich residents in Public Institutions during the last six years:— Year Total Deaths of Greenwich Residents Total Deaths of Greenwich Residents in Public Institutions 1921 1,243 653 1922 1,313 600 1923 1,119 546 1924 1,200 565 1925 1,173 621 1926 1,130 600 Average 1.196 591 13 AGE MORTALITY. The age mortality and the distribution of the deaths between the different quarters of the year is shown by the following table:— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4 th Quarter Total Under 1 year of age 28 23 29 34 114 Between 1 and 2 years 13 7 2 7 29 Between 2 and 5 years 15 11 1 7 34 Between 5 and 15 years 8 8 11 16 43 Between 15 and 25 years 21 17 15 14 67 Between 25 and 45 years 29 29 36 32 126 Between 45 and 65 years 89 72 58 80 299 65 years and upwards 127 105 69 117 418 Total 330 272 221 307 1,130 INFANTILE MORTALITY. The Infantile Mortality Rate 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 114 such deaths during the year, as compared with 129, 154 and 135, the respective figures for the years 1923, 1924 and 1925. It is interesting to note that the figure of 114 is the lowest yet recorded. 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 64, compared with 67 in 1925, 69 in 1924, and 60 in 1923. For England and Wales the rate was 70, compared with 75 in 1925, 75 in 1924, and 69 in 1923. Locally the variations were from 48 per 1,000 births in Charlton, 63 in East Greenwich, 66 in West Greenwich, to 79 in St. Nicholas, Deptford. 14 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. Average for five years, 1921-1925, inclusive. 1926. East Greenwich 129 106 96 81 62 63 West Greenwich 126 110 112 110 80 66 St. Nicholas, Deptford 179 143 167 138 88 79 Charlton 121 109 76 89 66 48 Kidbrooke 39 79 16 39 13 — Borough 131 111 103 95 66 61 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:— 1926 1926 Infective Diseases— Local Diseases—continued. Epidemic 0.54 Circulatory System 1.26 Sporadic 0.009 Respiratory System 2.03 Venereal 0.06 Digestive System 0.62 Septic 0.12 Lymphatic System 0.04 Malarial 0.03 Urinary System 0.36 Tuberculosis 1.12 Reproductive System 0.02 Parasitic Diseases — Parturition 0.06 Constitutional Diseases 1.35 Bones and Joints 0.02 Developmental Diseases 1.65 Integumentary System 0.03 Dietetic Diseases — External Causes— Local Diseases— Accidents 0.33 Nervous System 0.97 Homicide 0.01 Organs of Special Sense 0.04 Suicide 0.10 15 REMARKS ON VARIOUS DEATH CAUSES. Infective Diseases. Epidemic.—There were 56 deaths due to this class of disease, equalling a Death Rate of .54 per 1,000; the rate last year was .71, and was 1.34, .58, and .92 in 1922, 1923 and 1924, respectively. Zymotic.—The purely Zymotic class of epidemic diseases is credited with causing a total of 42 deaths, equalling a Death Rate of .40 per 1,000. Locally the Zymotic Death Rate varied from .04 in Charlton (.62 in 1925), .08 in East Greenwich (.44 in 1925), .14 in West Greenwich (.66 in 1925), to 1.02 in St. Nicholas (1.15 in 1925). Small-Pox.—There were no deaths from Small-Pox, this being the twenty-fourth year since a death occurred from this cause in the Borough. Measles.—Thirteen deaths only were ascribed as due to this disease, all being under five years of age. The number of deaths recorded last year was 21, and in the years 1922, 1923 and 1924, 29, 2 and 28 respectively. Two deaths occurred in East Greenwich, 4 in West Greenwich, 6 in St. Nicholas, and 1 in Charlton. Scarlet Fever. — This disease occasioned 1 death and occurred in West Greenwich. Two such deaths occurred in 1924, and 3 in 1925. Whooping Cough.—This disease was given as the cause of 4 deaths with a death rate of .03 per 1,000. There were 15, 16 and 13 deaths respectively in the years 1925, 1924 and 1923. Two deaths occurred in East Greenwich, 1 in West Greenwich, and 1 in St. Nicholas. Diphtheria.—There were 12 deaths during the year. This gives a Death Rate of .11 comparing with .13 for the previous year. Fourteen deaths occurred in 1925 and 1924, and 11 in 1923. Seven of the patients were under five years of age. Typhoid Fever.—There was one death ascribed to this disease which occurred in East Greenwich, there were 0 in 1922, 6 in 1923, 1 in 1924 and 1925 respectively. 16 Diarrhoea, Dysentery, and Zymotic Enteritis.—Twelve deaths were said to be due to these causes, equalling a rate of •11 per 1,000. Last year there were 6 deaths, and 13 in 1922 and 1923 respectively, and 12 in 1924. Influenza.—Influenza is found to have been the responsible cause of 12 deaths ; 16 was the average for the previous three years. Seven cases were over 65 years of age. Four deaths occurred in East Greenwich, 5 in West Greenwich, 2 in Charlton, and 1 in Kidbrooke. Sporadic Diseases.—There was 1 death from this class of disease during the year, tetanus being the cause. Venereal. Syphilis.—Six deaths were given as due to Syphilis, as against 6 in 1925 and 3 in 1924. Two occurred in West Greenwich, 1 in St. Nicholas, Deptford, and 3 in Charlton. Of the 6 deceased persons, 3 were in the Greenwich and Deptford Hospital, and 2 were in Outside Institutions. There were no deaths from Gonorrhoea during the year. Septic Diseases. Erysipelas.—There were no deaths from this cause in 1926. There were 1 in 1922, and 3 in 1923. Puerperal Fever.—There were no deaths from this disease during the year. There were no deaths in 1925, and 2 in 1924. Pyemia and Septicæmia, &c.—There were 11 deaths from this disease during the year, 1 from Hospital Gangrene, and 1 from other Allied Diseases. Malarial. Rheumatic Fever.—There was 1 death in 1926 as compared with 7 in 1925, 3 in 1924, and 3 in 1923. Rheumatism of the Heart.—There were 3 deaths attributed to this cause. Tuberculosis. This class includes the causes of 117 deaths during the year under review, with a rate of 1.12; these figures compare with 133, 127 and 117, the totals of the years 1923, 1924, and 1925 respectively, and the respective rates of 1.30, 1.21 and 1.12. 17 Tuberculosis of the Lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 93 attributed to this cause, or a rate of .89 per 1.000. Locally the deaths were 13 in St. Nicholas, Deptford (giving a Death Rate of 1.66), 36 in East Greenwich (Death Rate .80), 16 in Charlton (Death Rate .77) and 28 in West Greenwich (Death Rate 1.03). The remaining forms of Tuberculosis were responsible for 24 deaths, 11 of which occurred in East Greenwich, 8 in West Greenwich, 4 in Charlton, and 1 in St. Nicholas. Of these other forms of Tuberculosis, Tuberculosis of the Brain and its membranes were credited with 7 (3 being under five years of age), Tubercle affecting the Intestines 7, General Tuberculosis 8, and other forms of Tuberculosis 2. Parasitic Diseases.—There were no deaths from this class of disease. Dietetic Diseases.—There were no deaths from this class of disease. Constitutional Diseases.—The deaths from this cause were 140 in number, which gives a rate of 135 per 1,000. Of these. 125 were attributed to Cancer, 5 to Diabetes, 9 to Anaemia, and 1 to Rheumatoid Arthritis. Cancer.—It may be recalled I stated in last year's Report that this disease as a cause of death had now usurped the place which was formerly taken by Tuberculosis, and in that way was now the premier cause of death, having contributed 125 deaths per year, while Tuberculosis in all its forms contributed 117. This is again borne out by the year under review, the respective deaths being exactly the same as last year. The distribution of the deaths were as follow :—56 occurred in East Greenwich, 41 in West Greenwich, 7 in St. Nicholas, 18 in Charlton, and 3 in Kidbrooke. During the year the Ministry of Health issued a very able circular, dealing with Cancer, which received the very serious consideration of your Medical Officer of Health and the Public Health Committee, as a result of which a scheme has been devised, approved by the Council, and submitted to the Ministry of Health for their approval. 18 The Scheme provides for the provision of a Cancer Diagnostic Consultation, at which an eminent London specialist shall be in attendance to diagnose whether or no any conditions are cancerous in patients who may be referred to the Centre by medical men, nurses or in other ways ; and, if such diagnosis is confirmed, then the usual medical attendant will be communicated wi'th and all endeavours made to obtain appropriate treatment for the case. Developmental Diseases.—There were 172 deaths, equal to a rate of 1.65 per 1,000. These may roughly be divided into those from causes which would appear to be unavoidable, viz.:—Congenital defects 5, and those from causes more or less preventable, viz.:—Premature birth, 23; Debility at birth, 10; Atrophy, Debility and Marasmus, 10; Atelectasis, 6; and Rickets, 2. The remaining and largest portion of these deaths from developmental diseases, 116 in number, were from Old Age; in 1925 there were 120 deaths from this cause, and 150 in the previous year. Local Diseases. Nervous System.—One hundred and one deaths were attributed to the various nervous diseases, which gives a rate of .97 per 1,000; last year the rate was .79 per 1,000. Convulsions were responsible for 1; 9 were from Meningitis, 59 from Apoplexy, 1 from Chorea, 4 from General Paralysis of the Insane, 3 from other forms of Insanity, 2 from Epilepsy, 3 from diseases of the Spinal Cord, 2 from Cerebral Tumour, 3 from Encephalitis Lethargica, 3 from Softening of the Brain, and 11 from other diseases of this system. Organs of Special Sense.—There were 5 deaths from this class of causes, equal to a rate of .04 per 1,000. Circulatory System. The Death Rate from diseases of this system was 1.26 per 1,000, there being a total of 131 such deaths. Valvular Diseases of the Heart were responsible for 71, 3 from Aneurism, 4 from Embolism. 4 from Angina Pectoris, and from the remaining diseases of this system, 49. Respiratory System.- Two hundred and eleven deaths were due to diseases of the Respiratory Organs, as compared with 209 in the preceding year. The Death Rate under this heading equals 2.03 per 1,000. Twenty-one were from Acute, and 98 from Chronic Bronchitis, 79 from the various forms of Pneumonia (31 19 being under five years of age), 4 from Emphysema, 3 from Pleurisy, and 6 from other diseases. Digestive System.—There were 65 deaths from diseases of this system, equal to a rate of .62 per 1,000. Of this number. Enteritis were responsible for 6, 4 of whom were under five years of age, 13 to Appendicitis, 11 to Obstruction of Intestine, and 1 to other diseases of the Intestines, 4 to Cirrhosis of the Liver, and 5 to other diseases of the Liver. 2 to Peritonitis, 13 to Ulcer of Stomach and Duodenum; 7 to other diseases of the Stomach, and 3 to other diseases of the Digestive System. Lymphatic System.—There were five deaths from diseases affecting this system during the year. Urinary System.—Thirty-eight deaths, equal to a rate of 36 per 1,000, occurred from diseases affecting this system. 23 were from Bright's Disease, 8 from diseases of the Bladder and Prostate, 3 from Acute Nephritis, 1 from Calculus, and 3 from ill-defined causes of the Urinary system. Reproductive System.—There were only 3 deaths due to diseases of the Generative Organs. Seven deaths were attributed to diseases of Parturition. Bones and Joints.— There were three deaths from diseases of bones and joints. Integumentary System.—There were 4 deaths from diseases of Integumentary System. External Causes.—There were 48 deaths given as due to causes grouped under this heading; 35 were the result of accident or negligence, 2 from Homicide, and the remaining 11 were from Suicide. Two babies died through suffocation by being overlaid in bed. 6 cases were from Drowning, 3 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 5 from Poisoning, 2 by Hanging or Strangulation, 2 by Drowning, 1 by Cut or Stab, and 1 by Precipitation from elevated places. Ill. - Defined Causes.— There were no deaths requiring inclusion under this heading in 1926. 20 MORTUARY. The Council's Mortuary was erected in 1904, and is adjacent to the Coroner's Court in Lamb Lane. The number of bodies dealt with since 1914 is shown below:— Year Drowned Bodies from River Other Bodies Total 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 1924 21 182 203 1925 17 204 221 1926 23 214 237 21 SECTION 2. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 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) Two General Wards with 9 beds each. (3) Small Ward with 2 beds. (4) Isolation Ward with 1 bed. (5) Two Labour Wards. (6) Medical Officers' Room, Laundry, etc., together with residential accommodation for Matron. (Nurses, Probationers and Domestic Staffs accommodation is at 105, Shooters Hill Road, which is opposite the Maternity Home). Extensions and alterations were made during the year, fuller particulars of which are given on page 86. (3) Children. —No hospital is provided by Council, but arrangements are made with Deptford Fund for the treatment of Greenwich Children and Grant made by the Council for this purpose. A Grant is also made to the St. John's Hospital, Lewis'ham, in respect of minor operations performed on children referred to them by the Medical Officer in charge of the Infant Consultations. (4) Feyer and (5) Small Pox.— Cases of Infectious Diseases are treated at the Hospitals of the Metropolitan Asylums Board. The only M.A.B. Hospital in the Borough is situate at Shooters Hill Road, near the Woolwich boundary. 22 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children. No provision is made by the Council, but Dr. Barnardo'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 conveyed to Hospital by the ambulances of the Metropolitan Asylums Board. (b) For Non - Infectious and Accident cases. No provision is made by the Council. Facilities afforded by the ambulances of the Metropolitan Asylums Board, London County Council and certain local Hospitals. The L.C.C. ambulances are available free of charge between the hours of 11 p.m. and 8 a.m. for all confinement cases entering the Council's Maternity Home, 78, Shooter's Hill Road, S.E.3. 23 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 Conduit House, Trafalgar Rd., E. Greenwich. Ditto Ditto Thrice weekly (a) Infant Consultations{ 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 Charlton Vale Mission Hall, Woolwich Rd., Charlton. Large Hall consisting of waiting and weighing room and consulting room Ditto Once weekly (b) Pre- Maternity Borough Hall (See above) Ditto Once weekly 105, Shooter's Hill Road, S.E. (Do.) Ditto Once weekly Conduit House, Trafalgar Rd., E Greenwich. (Do. ) Ditto Once weekly Charlton Vale Mission Hall, Woolwich Rd., Charlton. (Do.) Ditto Once weekly (c) Minor Ailments Borough Hall, 1 large room Ditto Daily (d) Artificial Sunlight Conduit House, Trafalgar Rd., E. Greenwich. 1 large room and dressing room Ditto Daily Nursery School Rachel McMillan Memorial School, 232, Church Street, Deptford, S.E. Extensive Miss Margaret McMillan Daily 24 Clinics and Treatment Centres—Continued Name Situation Nature of Accommodation By whom provided Period when held 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, Nurse's Room and Dispenser's Room Local Authority Daily Venereal Diseases Miller General Hospital, Greenwich Rd. — — Daily Seamen's Hospital, Greenwich. — — Thrice weekly St. John's Hospital, Morden Hill, Lewisham. — — Twice weekly PUBLIC HEALTH STAFF. There was no change in the personnel of the Staff during the year. Professional Nursinc; in The. Home. (a) General. No provision is made by the Council. (b) For Injections Diseases. Arrangements are made with the Blackheath and Charlton District Nursing Association: St. John the Divine Home, Deplford, 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 Department. The Council's Health Visitors also give advice and assist as far as possible. 25 Midwives.—No district midwives are employed or subsidised by the Council. There are 20 practising in the district. Laboratorv 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 2,815 specimens have been examined for Diphtheria, 12 for Typhoid Fever, 349 for Tuberculosis, and 57 for other various conditions. Fuller details respecting results of the examinations of these specimens will be found under the different "headings of the individual diseases. Twenty-five tubes of Diphtheria Anti-toxin, containing a total of 200,000 units of serum, have been supplied during the year to Medical Practitioners for the treatment of patients suffering from this disease. HOSPITAL AND OTHER FORMS OF GRATUITOUS MEDICAL RELIEF. I am again indebted to the Secretaries of the Hospitals situated in the Borough for kindly giving me information regarding gratuitous medical relief. The Seamen's Hospital have admitted, treated and maintained 405 Greenwich persons for an average of twenty-two days each, in addition to which there have been 4,280 Outpatients, making approximately 12,840 attendances of persons belonging to the Borough of Greenwich. The number of Out patients for the previous year was 3,040, which shows an increase of over 1,200, with a corresponding increase in the number of Out-patient attendances. Miller General Hospital admitted, treated and maintained 339 Greenwich persons for an average of twenty-three days as against 356 last year. 7,255 Out-patients have also been treated, the total attendances being approximately 35,643. Blackheath and Charlton Cottage Hospital admitted 202 In-patients from Greenwich, and treated 252 Casualties; and also treated 374 Out-patients who made 2,564 attendances for this purpose. 26 POOR -LAW RELIEF. The Clerks of the Greenwich and Woolwich Boards of Guardians have been good enough to furnish me with the following figures for the year ended 1st January. 1927: — Greenwich Parish St. Nicholas Deptford Charlton and Kidbrooke Parish Total number of families in receipt of out-door relief 6,872 1,681 1,807 Total amount expended in out-door relief £95,309 £25,903 £17,483 Total number of persons treated in Hospital 1,967 300 110 Total number of persons treated medically in their own homes 1,609 492 321 Total number of persons admitted to the Workhouse 530 89 18 LEGISLATION IN FORCE. 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. 27 SECTION 3. SANITARY CIRCUMSTANCES OF THE AREA. The tables on pages 28 to 30 and 33 to 40 summarise, as far as possible, the Sanitary work of the Department; from this it will be seen that a total of 22,899 houses and premises have been inspected or re-inspected during the year; 1,249 intimation notices and 69 statutory notices have been served. It is very gratifying to be able to report that only in eight instances was it found necessary to institute Police Court proceedings during the year, particulars of which are contained in the table on page 37. There were altogether throughout the year 509 complaints registered. Factories, Workshops and Workplaces.—Two hundred and fifty-one inspections have been paid to these premises within the Borough during the year. According to information kindly furnished me by the Inspector of Factories for the Woolwich District there are 220 factories, 129 workshops and 30 wharves and quays. Outworkers' Register.—Eight lists, containing 26 names and addresses have been received from employers within the district. In addition to this 52 lists containing 137 names and addresses of Outworkers residing in this Borough were received from Medical Officers of Health of other Boroughs, whilst 7 lists with 12 names and addresses were forwarded to other districts, thus giving a total of 151 Outworkers in the Borough. 173 visits of inspection have been paid to these premises. 28 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES and HOMEWORK. 1.—INSPECTION Premises Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 67 4 ... Workshops (including Workshop Laundries) 38 5 ... Workplaces (Other than Outworker's Premises) 146 9 ... Total 251 18 ... 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 47 47 ... ... Want of Ventilation 1 1 ... ... Overcrowding ... ... ... ... Want of Drainage of Floors 4 4 ... ... Other Nuisances 19 19 ... ... Sanitary Accommodation— Insufficient 5 5 ... ... Unsuitable or Defective 4 4 ... ... Not Separate for Sexes 8 8 ... ... Offences under the Factory and Work shots Act— Illegal Occupntion of Underground Bakehouse (s. 101) ... ... ... ... Other Offences 11 11 ... ... Total 39 99 ... ... * Including thou specified in Section* 2, 3, 7 and 8 of the Factory Act, as remediable under the Public Health Acts. 29 3.—HOME WORK. Nature of Work Outworker's Lists, Section 107. Outwork in unwhole- Outwork in infected presome premises. Sec. 108 mises. Sees. 109 & 110 Lists received from Employers Notices served on occupiers as to keeping or sending lists Prosecutions Instances Notices served Prosecutions Instances Orders made (Sec. 10) Prosecutions (Sees. 109 & 110) Twice in the Year Once in the Year Failing to keep or permit inspection of lists Failing to send lists Lists Outworkers Lists Outworkers Contractors Workmen Contractors Workmen Wearing Apparel (1) Making, etc. 8 ... 26 ... ... ... ... ... ... ... ... ... ... ... ... (2) Cleaning and Washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, Lace Curtains and Nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur Fulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cotton and Kit Bags ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Box Making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rackets and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 8 — 26 — — — — — — — — — — — — 30 4.—WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1926. No. Bakehouses 37 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 14 Fuel Works 11 Laundries 8 Milliners 2 Photographers 3 Picture Frame Makers 1 Printers 1 Tailors 5 Underclothing Makers 1 Others 28 159 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 - Reports (of action taken) sent to H.M. Inspectors — Other — Underground Bakehouses (sec. 101) In use at end of 1926 13 Smoke Nuisances.—Twenty-three observations have been made for smoke nuisances during the year, but only in 1 instance was it found necessary to serve a Statutory Notice. Water Supply.—During the year 61 water supply certificates have been granted under Section 48 of the Public Health (London) Act, 1891. Defective water fittings have been remedied in 33 cases; 39 water supplies have been reinstated where the supply had been cut off; water fittings have been amended in 162 cases; 8 water supplies have been, altered so as to draw direct from the main, and cleansing, repairing and covering cisterns in 34 cases. 31 House Drainage.- Nineteen drains have been constructed, 189 drainage systems have been reconstructed or repaired; 451 such systems have also been opened, cleansed and amended; 25 surface drains have been constructed; 89 drains and soil pipes have been ventilated; 320 systems have been tested by smoke, 428 by water, of which number 93 were found to be defective; 39 new soil pipes and 332 traps have been fixed, together with 43 intercepting chambers and fresh-air inlets, and 96 other chambers. Nineteen new covers to manholes have been provided. Fifty-seven systems have been sealed oil or slurried up. Five forecourts, 9 areas, and 56 yards drained; 48 water-closets have been erected; 124 cleansed and repaired; 73 w.c. doors and seats repaired or provided. A pan, trap and water supply have been furnished throughout in 68 cases; pan and traps only furnished in 266 cases; pans only in 9 cases, and other fittings provided or improved in 227 cases, whilst the water supply has been renewed in 19 instances. Public-house urinals have been cleansed and repaired in 31 instances. During the year special attention was given to the condition of the Public House Urinals in the Borough, and a Sub-Committee was appointed to view such urinals and report upon the question, with the result that it was found in many instances there was not adequate screening to secure the privacy of the users, and further the accommodation provided generally was not sufficient. Your Medical Officer of Health therefore communicated with the Brewers concerned, and plans have been submitted for enlarging and improving such urinals, and the necessary alterations either have been carried out or are in hand. Customs and Inland Revenue Acts.—No applications were received during the year for certificates under these Acts. Horse Slaughterer.—The one horse slaughtering premises in the Borough has been inspected on two occasions and the cleansing of the premises duly carried out. Scavenging and Refuse Disposal.— The new Refuse Screening and Disposal Plant and Buildings have been in use during the whole of the year and have dealt with a considerable amount of material. Unfortunately during the whole of the summer months large quantities of screened refuse material accumulated and caused great nuisance in the neighbourhood from 32 flies; so much so that persons to whom disinfected articles were returned complained of the number of dead bodies of flies included in the parcels. Public Sanitary Conveniences.— During the year an additional underground convenience was constructed at Batley Park, Blackheath. The work was carried out by the Works Department by direct labour at a cost of £3,330, and was duly opened on 6th December, 1926. The following are the underground sanitary conveniences in the Borough:— Blackwall Lane, East Greenwich; South Street, Greenwich; Creek Road, St. Nicholas, Deptford; Blackheath Hill (foot of); Batley Park, Blackheath. Houses Let in Lodgings.—The new Bye-laws made by the London County Council under Section 6 of the Housing Act, 1925, came inito operation on the 5th March, 1926. One hundred and twelve houses have been registered and 137 inspections made upon such premises. Rats and Mice (Destruction) Act, 1919.—Complaints as to rat infestation and cases coming to the notice of the Department are forthwith investigated. Advice and assistance are given where necessary. Three hundred and fifteen such investigations were made by the Council's Officers, but in no case was it necessary to serve a Notice. Verminous Premises.—The means adopted in 1925 to assist occupiers to cope with verminous conditions continues to give great satisfaction. Applicants are required to see the Inspector before 10.30 a.m., bringing with them a plain bottle; when the Inspector is satisfied as to the bona fide of the applicant, a quantity of fluid (vermicine) is given together with the loan of a sprayer. A pamphlet of instruction is also issued with the fluid. This method of self-help and instruction has undoubtedly led to greater effort on the part of the occupiers to cleanse their premises instead of relying mainly on the owner. Increase of Rent and Mortgage Interest Restrictions Acts, 1920 and 1923.—Six applications were received during the year from tenants for certificates under these Acts. In each case the Certificate was granted. 33 SUMMARY OF WORK PERFORMED BY THE SANITARY INSPECTORS DURING THE YEAR 1926. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Inspections. Houses Inspected 566 487 528 573 2144 Other Premises Inspected 177 289 130 155 751 Re-inspections, Calls Made, etc. 4269 3167 3822 5507 16765 Inspections of Houses Let in Lodgings 82 45 7 3 137 ,, Bakehouses 3 42 2 38 85 ,, Factories, Workshops and Workplaces 38 41 25 40 144 „ Outworkers' Premises 66 54 28 25 173 ,, Verminous, etc., Cases (L.C.C. Report) 36 29 12 16 93 ,, Slaughterhouses 5 3 6 8 22 ,, Cowhouses 2 1 1 4 „ Stables and Yards 17 18 9 8 52 „ Piggeries ... ... ... ... ... ,, Courts and Alleys 1 1 ... ... 2 ,, Fields, Lanes, etc. 9 7 5 6 27 Investigations (Rats and Mice) 82 62 53 118 315 Inspections of Urinals 101 21 7 4 133 ,, Gipsy Vans ... ... ... 6 6 „ Horse Slaughterhouses ... ... 1 1 2 „ Dairies, Cowsheds and Milkshops 6 49 56 5 116 „ Soap Boilers ... 2 1 2 5 ,, Other Offensive Trades ... ... 1 ... 1 „ Ice Cream places ... 137 17 ... 154 „ Other places where food is prepared or stored 532 511 337 388 1768 Total 5980 4967 5048 6904 22899 Drains. Constructed 2 5 11 1 19 Intercepting Chamber, and Fresh Air Inlet 14 11 9 9 43 Other Chambers Constructed 28 11 18 39 96 Reconstructed or Repaired 48 24 50 67 189 Opened, Cleansed and Amended 98 113 95 145 451 Surface Drains Constructed 8 6 3 8 25 Traps Fixed 99 66 78 89 332 New Soil Pipes 19 5 4 11 39 Soil and Vent Shafts Repaired 17 5 10 9 41 Drains and Soil Pipes Ventilated 26 11 7 45 89 Drains Sealed off, etc. 3 8 9 37 57 Drains tested—by Smoke 84 95 70 71 320 ,, by Water 99 98 46 185 428 Found Defective 29 28 19 17 93 New Covers to Manholes 3 4 1 11 19 Yards Drained 11 7 1 37 56 Mews and Stables Drained ... ... ... ... ... 34 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Drains—contd. Washhouses Drained ... ... ... ... ... Fort-courts Drained ... ... ... 5 5 Areas Drained 5 2 ... 2 9 Cesspools abolished ... ... ... ... ... Privies and Earth Closets abolished ... ... ... ... ... Water Closets and Urinals. Closets erected 11 10 10 17 48 W.C. doors repaired or provided 9 11 23 30 73 Sanitary Conveniences or Improvements effecteu to Factories. Workshops and Workplaces 5 5 7 7 24 Pan, Traps and Water Supply furnished 22 13 17 16 68 Pans and Traps only furnished 69 45 51 101 266 Pans only furnished 2 4 2 1 9 Water Supply Apparatus repaired or provided 68 48 48 106 270 Water Supply renewed 10 2 5 2 19 Water Supply disconnected from Drinking Water Cistern ... 2 ... ... 2 Soil Pans properly trapped ... ... ... ... ... Cleansed and Repaired 23 39 39 23 124 Newly constructed or better situated 7 6 6 6 25 Ventilation improved 13 5 ... 34 52 Public - house Urinals cleansed or repaired 18 7 4 2 31 Other Urinals altered or cleansed 7 3 3 3 16 Other Urinals constructed ... ... 2 1 3 Repaired or water laid on ... ... ... 3 3 Ashpits. Provided 91 121 66 68 346 Covers to receptacles ... 3 ... ... 3 Dust complaints forwarded to the Surveyor ... ... ... ... ... Pavings. Yards 72 47 62 76 257 Forecourts 7 5 1 15 28 Areas ... ... 1 3 4 Washhouses 3 5 5 3 16 Mews and Stables ... 1 4 ... 5 General Water Supply. Covers to Cisterns adapted ... ... 3 30 33 Water Supply provided ... ... ... ... ... Water Fittings amended 49 41 46 26 162 Cisterns cleansed and repaired ... 1 ... ... 1 Water Services altered so as to draw direct from main 2 ... 6 ... 8 Water Supplies reinstated where cut off through defective fittings 18 7 9 5 39 35 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 13 9 4 7 33 Water Supply Certificates granted (Section 48) 8 9 7 37 61 Other Improvements. Houses generally repaired 120 114 107 69 410 Premises cleansed, lime-washed and repaired 42 81 44 37 204 Verminous Rooms cleansed 21 54 84 28 187 Ventilation improved 37 28 45 22 132 Staircases repaired, amended, lighted, and ventilated 3 6 4 9 22 Leaky House Roofs and Gutters repaired 131 125 105 136 497 Walls and Ceilings of Premises cleansed throughout 21 27 20 16 84 Ditto ditto partially 110 160 149 102 521 Stoves and Fireplaces repaired 35 35 27 18 115 Washing Coppers repaired 32 16 19 12 79 Sinks provided 22 12 1 23 58 Floors repaired 53 44 53 41 191 Cowhouses cleansed ... 3 ... 3 6 Horse Slaughterhouses cleansed ... 1 1 ... 2 Ice Cream places cleansed or improved ... 15 5 ... 20 Other places where food is stored and prepared 1 8 31 5 46 Provision for Storage of Food ... 9 ... ... 9 Other Nuisances Abated. ... ... ... ... ... Illegal use of Underground Room discontinued ... ... ... ... ... Overcrowdings abated 1 ... ... ... 1 Sink, Lavatory and Bath Waste Pipes disconnected, trapped and amended 59 51 25 42 177 Stack Pipes disconnected and amended 12 35 15 26 118 Nuisances from dampness abated 73 57 54 35 219 Animals Kept in Unfit Places discontinued or removed 3 4 8 2 17 Dung Receptacles provided 4 4 1 ... 9 Bakehouse Nuisances abated ... 6 2 3 11 Houses abolished, unfit for habitation 3 ... ... 3 6 Accumulations of Manure and other obnoxious matter removed 15 16 8 1 40 Dampness of Walls remedied 54 19 41 9 123 Inundations abated 5 ... ... 1 6 Other Nuisances, principally of dilapidations and want of underfloor ventilation 25 13 33 21 92 36 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Other Nuisances Abated—contd. Contents of Rooms cleansed 5 5 5 10 25 Breaches of By-Laws abated ... ... 1 ... 1 Rat Infestation abated 60 25 40 11 136 Smoke Nuisances. Observations 10 4 5 4 23 Statutory Notices served (Sections 23 and 24) ... ... 1 ... 1 Food and Drugs. Samples taken 136 150 105 51 442 Found Adulterated 4 2 2 1 9 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Unwholesome Food Seizures made 55 cwts. Tomatoes — — — Voluntarily surrendered 2 boxes Mackerel 1 bag Winkles 3 bags Winkles 2 trunks Skate 6 stone of Haddocks 5 boxes Kippers (56 lbs.) (12 stone) 1 trunk Haddocks (6 stone) 4 stone of Dabs 1 trunk 1 box Haddocks (21 lbs ) 3 boxes Cod (56 lbs.) Mixed Fish (5 st. 5 lbs) 6 stone Codling 14¼ cwts. Potatoes 2 Fore, quarters Beef Fat & Offal Haddocks (6 stone) 2 trunk 6 stone Haddocks (5 cwts. 1 qr. 11 lbs.) Dabs (8 stone) ¾ cwt Shell Fish (Crab) ¾ cwt Haddocks ¾ cwt. Skate 37 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) 364 348 218 319 1249 Notices served— Under Housing Acts ... ... ... ... ... Rats and Mice (Destruction) Act, 1919 ... ... ... ... ... re Verminous Rooms 1 1 ... ... 2 Under P.H. (L.) Act and Metropolis Management Act (re combined drainage) ... 18 19 17 54 W.C.'s (Factories, Workshops and Workplaces) ... ... ... ... ... Yards 1 6 2 2 11 Miscellaneous ... 2 ... ... 2 Statutory Noticcs served under Section 4 24 33 19 43 119 Statutory Notices re Ashpit provision 1 12 3 9 25 Complaints received and attended to 135 94 152 128 509 Letters written relating to abatement of Nuisances 59 56 79 66 260 Summonses applied for and issued 4 17 ... 1 22 -Magisterial Orders obtained and enforced ... ... ... ... ... Drainage Plans received and examined 24 27 29 47 127 Reports to District Surveyor ... ... ... ... ... Legal Proceedings under the Public Health (London) Act, 1891, and Bye-Laws During the Year 1926. Premises Complaint Result of Proceedings Fine Costs 7. Kirkland Place Non-compliance with Statutory Notice Withdrawn Work done. - 2/- 88, Elliscombe Road Do, Do — 10/- 99, Do. Do Do. 477, Woolwich Road (Occupier) Do. Abatement Order 10/6 Do. Do. Non-compliance with Abatement Order Penalty 34/- Do. (Owner) 25/51, Sundorne Road Do. Non-compliance with Notices served under Sec. 83, Metropolis Local Management Act, 1855. re drainage of premises (14) Withdrawn Case dismissed — — No. 1 Flat, Victoria Mews, Charlton Non-compliance with Statutory Notice Withdrawn. Work done - 10/6 38 BOROUGH OF GREENWICH. Proceedings during 1926. Premises Number of Places Number of Inspections, 1926 Number of Notices, 1926 Number of Prosecutions, 1926 On Register at end of 1925 Added in 1926 Removed in 1986 On Register at end of 1926 Dairies, Cowsheds and Milkshops 119 21 28 112 116 2 — Slaughterhouses 5 — — 5 24 — — Other Offensive Trade Premises — — — — — — — Ice Cream Premises 126 52 24 154 156 4 — Registered Houses Let in Lodgings — — — 112 137 — — Restaurants and Eating Houses 60 — — 60 64 1 — Total number of Intimation Notices served for all purposes 1,249 „ „ ,, Statutory „ „ „ 213 Overcrowding, 1926— Number of Dwelling-rooms overcrowded 47 Number remedied 1 Number of Prosecutions — Underground Rooms— Illegal occupations dealt with during year — Number of Rooms Closed — Insanitary Houses— Number closed under the Public Health (London) Act, 1891 — Number closed voluntarily under the Housing of the Working Classes Acts — dumber demolished voluntarily '3 Number repaired or Nuisances remedied under Public Health Act approx. 2,000 Houses of the Working Classes— (a) Erected during the year (Municipal) 32 (Private Enterprise) 33 (b) In course of erection 150 39 Number of Verminous Premises cleansed under Sec. 10 of the London County 'Council (General Powers) Act, 1922 187 Number of Cleansing Baths given under Cleansing of Persons Act 3 Shelter provided under Sec. 60 (4) of the Public Heath (London) Act, 1891— Number of persons accommodated during the year — Number of Tenement Houses provided with Additional Water Supply 7 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 manu factory, etc. — (c) For the prevention of keeping animals in such a manner as to be injurious to health — (d) As to paving yards, etc., of dwelling houses — (e) In connection with the removal of offensive matter, etc. — (f) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (h) With respect to water closets, earth closets, etc. 4 (i) With respect to sufficiency of water supply to water closets — 40 (j) With respect to drainage, etc. (Metropolis Management Act, Sec. 202) 14 (k) With respect to deposit of plans as to drainage, etc. (Metropolis Management Acts Amendment (By-Laws) Act, 1899) — Mortuaries— No. of Drowned Bodies 23 „ „ Other „ 214 ,, ,, Infectious ,, — — 237 „ „ Post Mortems 110 „ ,, Inquests 236 PROPOSED BATHS AND WASH-HOUSES. The question of the erection of new and up-to-date Baths and Wash-houses has been engaging the serious attention of the Council for some years past. The existing Baths in London Street, Greenwich, were erected as far back as 1850 at a cost of £13.000, and is now one of the oldest Baths in the kingdom. The present establishment has become out-of-date and the cost of maintenance, owing to the necessity for continual repair is steadily increasing. The present accommodation consists of : — 2 Swi/mning Baths. 1st Class 91-ft. x 19-ft. 2nd Class 95-ft. x 19-ft. 42 Slipper Baths. 1st Class Male 12. Female 4. 2nd Class Male 20. Female 6. This accommodation was probably sufficient for the needs of the public at the time of the erection of such Baths, for the population of the parish of Greenwich in 1851 was only 16,194, and the accommodation provided was equivalent to 1 Slipper Bath per 385 persons. The population of the Borough (comprising the parishes of Greenwich, St. Nicholas, Deptford, and Charlton and Kidbrooke) is now 104,050. equivalent to 1 Bath for 2,477 persons. 41 In 1921 the Council opened negotiations with the Greenwich Hospital Estates for the purchase of a cleared site in Trafalgar Road, which also has a frontage to Park Street and to Creed Place, with an area of approximately 1½ acres, as a site for the erection of Public Baths and Wash-houses ; and in February, 1922. the Ministry of Health formally sanctioned the raising of a loan for the purchase of the land as a Baths, etc., site. Early in October, 1923. the Council invited architects to submit designs and plans in competition for the erection of Public Baths and Washhouses. and in October, the Council appointed Messrs. Horth and Andrew, of Hull, as Architects, and Messrs. Waggett and Bradford, of 12. Regent Street, S.W.1, as Quantity Surveyors. The Ministry of Health having decided that owing to the acuteness of the Housing question and to the shortage of skilled building labour they could not allow the use of brickwork, the Council on the 21st May, 1924, applied for sanction to borrow the sum of £22,000 for the purpose of defraying the cost of constructing in concrete the foundations of the proposed buildings. This was subsequently approved, with slight modifications, by the Ministry of Health, following upon a Local Enquiry held on the 1st July, 1924. The question of the erection of a superstructure was one of great difficulty owing to the continued shortage of materials and skilled labour, and. after many interviews and deputations, the Ministry finally sanctioned the cost of erecting the superstructure in concrete with a facing of brick. Bills of Quantities were subsequently prepared and Tenders invited. The tender of Messrs. Holliday & Greenwood, Ltd., 11, Buckingham Palace Gardens, S.W., at £121,908, was accepted, and towards the end of the year the work of excavation and erection of the foundations was commenced. The accommodation to be provided in the proposed Baths is as follows : — Swimming Bath's. Men 1st Class 100-ft. x 40-ft. Men 2nd Class 80-ft. x 40-ft. Ladies 75-ft. x 36-ft. The Men's 1st and 2nd Class Swimming Baths to be used in the Winter months for Entertainments, Public Meetings, etc. 42 Slipper Baths. 1st. Class 2nd Class Total Men 30 20 50 Women 8 16 24 28 46 74 Wash-houses. 34 sets of washing compartments with necessary accessories. Establishment Laundry. Boiler House, Engine and Pump Room. Filtration Plant. Heating, Ventilation and Lighting. Superintendent's Quarter's. 43 SECTION 4. HOUSING. It was mentioned in the Report for the year 1925 that the total accommodation provided by the Council since 1920 to the end of 1925 was 471 tenements and houses. During the year under review contracts have been entered into for the erection of 100 houses on the site known as the Twenty-Acre Field and 102 houses partially on the same site and partially on the Charlton Park Site. Of the 100 houses above referred to, 32 were completed and occupied during the year covered by this Report. It is expected that the whole of the 100 will be completed by April, 1927, and the further 102 by October of the same year. Instructions have also been given for plans to be submitted for the erection of 23 houses on the Pound Park Site. The demand for houses is still very great, there being about 1,800 applications on the books of the Council which are regarded as eligible for consideration. As the houses become available these applications will be dealt with and allocations made in order of merit consistent with the suitabilitv of the applicants. The total accommodation provided by the Council since 1920 to the end of 1926 is 442 houses, 50 flats, and 12 maisonettes. HOUSING RETURN, 1926. Number of new houses erected during the year:— (a) Total 61 (b) With State assistance under the Housing Acts : — (i.) By the Local Authority 32 (ii.) By other persons — 1.—Unfit Dwelling-houses. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,700 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 No figures available (3) Number of dwelling-houses found to be in a state 44 so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,692 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 638 3.—Action under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925 (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were dered fit after service of formal notice: — (a) By owners Nil (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 (voluntary) 1 (b) Proceedings under Public Health Acts : — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied Intimations 1,249 Statutory 213 (2) Number of dwelling-houses in which defects were remedied after service of formal notice : — (a) By owners 1,036 (b) Bv Local Authorities in default of owners Nil (c) Proceedings under sections 11, 14 and 15 of the Housing Act, 1925 : — (1) Number of representations made with a view to the making of closing orders Nil 45 (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 pursuance of demolition orders Nil 46 SECTION 5. Inspection and Supervision of Food. Milk Supply.—The majority of milk supplied to this Eorough is obtained from farmers and large firms outside the district. During the year two medical men practising in the Borough directed my attention to cases of illness which they were treating. The patients were employees at a large dairy farm, such employees alleging that their illness was caused through disease of the animals on the farm. I visited the farm, which is one of a very high-class character, and found the premises in a very satisfactory condition and a certain number of the cows were being isolated because of a curious condition affecting the udder. I arranged with the Company that none of the milk should be put into general circulation. This embargo was continued for several weeks, and during the whole of this period the milk supplied by these animals was not used for general consumption. Cowhouses.—The four cowhouses in the Borough have been visited on four occasions, and the required cleansing duly enforced. Milk and Dairies (Amendment) Act, 1922.—Milk and Dairies Order, 1926.—At the commencement of the year there were 119 premises on the Register of Dairies and Milkshops. With the coming into force of the New Order on 1st October advantage was taken to revise the Registers. Twenty-one new applications have been received during the year and added to the Register, and twenty-eight names have been taken off, thus leaving a total of 112 premises now registered. During the year 116 visits of inspection have been paid to these premises ; notices were served upon the occupiers in eight cases where dairies required limewashing or were otherwise in an insanitary condition. 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. 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 vear in respect of which it is granted. 47 During the year the following licenses were granted for the sale of graded milk : — Distribution of Certified Milk 4 ,, „ Grade A (Tuberculin Tested) 5 ,, ,, Grade A (Pasteurised) 3 „ ,, Grade A 3 Supplementary Licenses 5 (Principal Licenses granted by the Lewisham Borough Council). Milk and Cream Regulations, 1912 and 1917.—Seventytwo samples of milk were taken during the year. In no case, however, was the presence of a preservative reported upon by the Public Analyst. One sample of preserved cream was taken which was reported as genuine. The amount of milk fat was 39 per cent, and preservative (Boric Acid) 0.16 per cent. The requirements as to labelling or declaration were duly observed. Milk and Dairies Order, 1926.—This Order, with the exception of certain provisions, came into operation on the 1st October, 1926, and revokes the Dairies, Cowsheds and Milkshops Orders of 1885, 1886 and 1889, so far as they relate to England and Wales, and all Regulations made thereunder by Local Authorities. The general object of the Order is to ensure Milk being produced and delivered to the consumer in a clean and pure state. In view of the fact that there are a number of small retail milk shops in this Borough the provisions enumerated in Article 14 are important and are set out hereunder : — 14.— (1) Milk shall not be deposited or kept in any place where it is liable to become contaminated or infected. In particular it shall not be deposited or kept: — (a) in any room used as a kitchen, scullery, living- room or sleeping-room; or (b) in any room or part of a building which municatcs directly by door, window or otherwise with: — (1) any water-closet, earth-closet, privy, cesspool or receptacle for ashes or other refuse; or 48 (2) any room which is used as a sleeping-room or any room which is occupied by a person suffering from an infectious disease, or which, having been so occupied, has not been subsequently properly disinfected ; or (3) in any room or part of a building in which there is any direct inlet to a drain which is not efficiently trapped. Provided that the foregoing provisions shall not be deemed to prohibit the deposit or keeping of milk intended for use in the manufacture of butter, cream or cheese in a room used as a kitchen. (2) Vessels containing milk shall be properly covered or the milk shall be otherwise effectively protected from dust, dirt, flies or other sources of contamination ; (3) No foul or noxious matter or soiled bed or body clothing shall be conveyed through any part of a building used for the keeping or storage of milk. Meat.—During the year it was not found necessary to seize any animal or meat exposed for sale, or deposited in anv place for the purpose of sale, or preparation for sale. The following were voluntarily surrendered and destroyed: —2 Forequarters Beef. Fat and Offal. (5 cwts. 1 qr. 11 lbs). The Public Health (Meat) Regulations, 1924, which came inito force on the 1st April, 1925. provide for the better regulation and supervision of slaughter-houses and protection of meat against contamination by dirt, etc. There are 109 premises where meat, bacon, etc., are either stored or exposed for sale. In order that the chief points enumerated in the above Regulations might be continually brought to the notice of those handling meat a notice, copy of which is set out hereunder, was sent to all shopkeepers coming within the provisions of the Regulations, with a request that the same be exhibited in a prominent place. As a result it was generally found that the proprietors of such premises had complied reasonably with the Regulations and in only one case was it necessary to call the attention of a firm for failure to notify the Department as to the time of slaughter. 49 Metropolitan Borough of Greenwich. Public Health Department. Requirements necessary in Sfwps owing to New Regulations made by Ministry of Health. 1. No person suffering from ail Infectious Disease to handle meat. 2. Every counter, slab, vessel, knife and everything used in connection with the meat to be thoroughly cleansed after use ; also kept at all times in a clean condition. 3. Everything possible to be done to avoid contamination of the meat by Flies. 4. All trimmings, bones, refuse and rubbish to be placed in properly covered receptacles and kept apart from the meat. 5. No refuse or filth, whether solid or liquid, to be deposited or allowed to accumulate in the shop or rooms where meat is placed. 6. Walls and ceilings of shop or rooms where the meat is placed to be whitewashed, cleansed and purified as often as necessary. 7. Meat in shops and other places must be so placed that mud, filth, etc., shall not be splashed or blown on it. 8. The inside and outside of every vehicle and van, and the receptacle in which the meat is placed, and the covers to be kept perfectly clean. 9. If the vehicle or receptacle is open at top, back or sides, the meat to be adequately protected by a clean cloth. 10. No live animal to go in same vehicle or van as the meat. 11. In handling meat, no part to come in contact with ground, and every precaution to be taken to prevent contamination. Ernest George Annis, Medical Officer of Health. Public Health Department, Royal Hill, Greenwich, S.E.10. 50 Slaughterhouses.—The number of slaughterhouses in use in the Borough are as follow: — In 1920 In January 1926 In December, 1926 Registered — — — Licensed 4 4 4 4 4 4 Twenty-two inspections were made by the Inspectors during the year. Public Health (Preservatives, etc., in Food) Regulations (1925) and Public Health (Preservatives, etc., in Food) Amendment Regulations (1926) After 1st January, 1927, the only preservatives allowable in food will be sulphur dioxide and benzioc acid, and these will be permitted only in certain specified foods and not exceeding stated quantities. A list of colouring matter which will be prohibited is also set out in the schedule referred to in the Regulations. Provision is also made in the Regulations as to labelling of articles of food containing preservative or sold as a preservative, and where this is not required, to suitable notices to be exhibited in a conspicuous place so as to be readily seen by the purchaser. The dates on which the principal Regulations will come into force are as under : — (1) All food except those specified below 1st January, 1927. (2) Bacon, ham, egg yolk and articles of food containing preservative necessarily introduced by the use in their preparation of preserved margarine 1st July, 1927. 51 (3) Butter, cream and articles of food containing preservative necessarily introduced by the use in their preparation of preserved bacon, preserved ham, preserved egg yolk or preserved cream 1st January, 1928. (4) Articles of food containing preservative necessarily introduced by the use in their preparation of preserved butter 1st July, 1928. Other Foods.—Places where food is prepared have been visited on 147 occasions, improvements being required in 9 instances as detailed below:— Class of Premises Number of Lists Number of Inspections Number of Instances where matters needed attention At end of 1925 Added 1926 Removed 1926 At end of 1926 Hotel Kitchens 6 — — 6 6 — Eating Houses 51 9 6 54 58 3 Fried Fish Shops 32 4 3 33 33 4 Pork Butchers and Sausage Manufacturers 25 - - 25 25 1 Mineral Water Manufacturers 1 — — i 1 — Others 24 - — . 24 24 1 Totals 139 13 9 143 147 9 The 9 instances where matters needed attention included 6 cases where the premises generally, or kitchen and scullery particularly, needed cleansing and lime-washing, 2 where the sanitary arrangements were defective, and 1 where the frying utensils were dirty. In addition to the periodical visits and inspections of food shops, etc., supervision is also exercised on Saturday evenings and Bank Holidays. 52 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 for man, particulars of which are set out on page Ice Cream Premises.—There were 126 premises known at the commencement of the year where the manufacture of this commodity was carried on ; 52 have been added during the year and 24 taken off, leaving a total of 154 premises. These premises were inspected on 156 occasions, improvement required by way of cleansing of the premises in 6 cases, insanitary conditions remedied in 4 instances, and 2 cases where the ice cream was improperly stored. Bakehouses.—Eighty-five inspections have been made of the various Bakehouses in the Borough and 11 nuisances found therein have been abated. At the end of the year there were 5 Factory and 37 other Bakehouses on the Register, 13 of which are underground. Food and Drugs Acts.—Four hundred and forty - two samples have been purchased under the provisions of the Sale of Food and Drugs Acts and submitted to the Public Analyst for analysis, of which 433 were certified to be genuine and 9 adulterated, the adulterations thus being equivalent to 2.03 per cent, of the samples taken. Of the total number of samples purchased, 72 were milk, of which 3 were certified to be adulterated ; the remaining adulterated samples were 3 of vinegar, and 3 of camphorated oil. It was not considered necessary to take legal proceedings in respect of either of the 9 adulterated cases. An application was made by a Resident for a private analysis by the Public Analyst of a Wedding Cake. Such examination showed that the ingredients contained therein were in bad condition. The Public Analyst further gave his opinion that the cake was unfit for human consumption. 53 SALE OF FOOD AND DRUGS ACTS. Administrative Action Taken Regarding Samples reported to be NOT GENUINE. No. of Sample Description of Sample Nature of Adulteration Result of Proceedings 50 Camphorated Oil Deficient in Camphor to the extent of 3% Warning Letter 53 Do. Deficient in Camphor to the extent of 2.5% Warning Letter 55 Do Deficient in Camphor to the extent of 2% Warning Letter 96 Milk Deficient In Fat to the extent or 6% Warning Letter 141 Do. Admixed with 2% of Water Warning Letter 161 Do Admixed with 1·5% of Water Warning Letter 290 Vinegar Deficient in Acetic Acid to the extent of 4% Warning Letter 344 Do. Deficient in Acetic Acid to the extent of 9% Warning Letter 402 Do. Deficient in Acetic Acid to the extent of 8% Warning Letter 54 Sale of Food and Drugs Acts.—Number and Description of Samples purchased for Analysis under the above Acts during the Year 1926. Description of Samples Number of Samples Purchased Number Genuine Number Not Genuine Baking Powder 6 6 – Brawn 8 8 – Bread 8 8 – Butter 61 61 – Camphorated Oil 7 4 3 Cheese 19 19 — Cocoa 2 2 — Coffee 3 3 — Corned Beef 13 13 — Custard Powder 2 2 — Dripping 4 4 — Flour 8 8 — Lard 18 18 — Margarine 2 2 — Milk 72 69 3 Mustard 13 13 — Olive Oil 6 6 — Paregoric 7 7 — Pearl Barley 8 8 — Pepper 17 17 — Preserved Cream 1 1 — Rice 36 36 — Sago 7 7 — Salmon and Shrimp Paste 1 1 — Sausage (Breakfast) 18 18 — Sausages 3 3 — Self Raising Flour 12 12 — Sugar (Yellow) 1 1 — Tapioca 21 21 — Veal, Ham and Tongue 1 1 — Vinegar 57 54 3 442 433 9 Procedure under the Sale of Food and Drugs Acts, etc. The following are the principal legal provisions relating to the composition and description of food and drugs (apart from provisions to poisons and other special drugs) in force on the 1st January, 1927:— (a) The Sale of Food and Drugs Acts, 1875 to 1907, viz.:— Sale of Food and Drugs Act, 1875; Sale of Food and Drugs (Amendment) Act, 1879; Margarine Act, 1887; 55 Sale of Food and Drugs Act, 1899; Butter and Margarine Act, 1907; (b) Legislation amending and supplementing the Sale of Food and Drugs Acts, viz.:— Section 10 of the Licensing Act, 1921 (Dilution of Spirits). Milk and Dairies (Consolidation) Act, 1915. Section 4 of the Milk and Dairies (Amendment) Act, 1922. Section 23 of the Finance Act, 1921 (sending samples to Government Chemist). (c) Orders and Regulations made under the Sale of Food and Drugs Acts, viz.:— Order as to Registration of Margarine Factories, etc., 1900. Order as to Registration of Butter Factories, etc., 1907. Regulation as to Competency of Analysts, 1900. Sale of Milk Regulations, 1901 and 1912. Sale of Butter Regulations, 1902. (d) Regulations made under the Public Health (Regulations as to Food) Act, 1907:— Public Health (Milk and Cream) Regulations, 1912 and 1917.* Public Health (Condensed Milk) Regulations, 1923. Public Health (Dried Milk) Regulations, 1923. Public Health (Preservatives, &c., in Food) Regulations, 1925 and 1926. *Revoked as from 1st January, 1928 56 SECTION 6. PREVALENCE OF, AND CONTROL OVER. INFECTIOUS DISEASES. Notifications under the Provisions of the Public Health (London) Act, 1891.—During the year 2,869 cases have been notified under the above Act. The following table shows the comparison since 1921 :— No. Year. 3,227 1921 3,720 1922 2,087 1923 3,516 1924 3,555 1925 2,869 1926 Small-Pox.—No case of this disease occurred during the year. Contacts.—Seven intimations were received from Medical Officers of Health of the Port Sanitary Authorities respecting persons who had been in contact with Small-Pox whilst on board ship. In every instance they were kept under observation for the usual period. Details respecting vaccination in the Borough are given in the Supplemental Vaccination Reports on page 65. Diphtheria.—Five-hundred and three cases of Diphtheria were notified during the year, as compared with 707, 275, 319 and 434 respectively in the years 1922, 1923, 1924 and 1925. The distribution of these cases was as follows: — 220 in East Greenwich, 120 in West Greenwich. 21 in St. Nicholas, 121 in Charlton, and 21 in Kidbrooke. Of this total number, 501 were removed to the Hospital for treatment. Three cases were returned to Hospital for further treatment, after being discharged as cured. All these were examined by your Medical Officer of Health. There were 12 fatalities due to this disease, which gives a case mortality of 2.3 per cent. Two thousand eight hundred and fifteen specimens were forwarded by medical practitioners for bacteriological examination from cases suspected to be diphtheria. Of this number, 2,581 were reported to give negative or doubtful result, and 234 were positive in character, being dealt with accordingly. 57 Although from time to time I have to remind practitioners that the help which may be obtained from the examinations of the swab by a bacteriologist is merely in the nature of assistance towards making the diagnosis, yet some medical practitioners still seem to be relying on the fact of having obtained a definite positive or negative result before deciding to notify the case, and in some instances the 24 hours delay in obtaining this bacteriological result is of very serious moment to the patient. This practice was particularly brought to my notice again recently in connection with a fatal case of Diphtheria. When I called at the house for another purpose I was asked by the parents to see the suspected diphtheria case and immediately was able to diagnose the case as one of Diphtheria, although the medical practitioner concerned was patiently waiting for the bacteriological result to be communicated to him and was with a certain amount of difficulty persuaded to notify the case before such result had been obtained. The removal to hospital, however, was effected as speedily as possible; unfortunately with the fatal result within the next 48 hours. The continuous and long-continued prevalence of diphtheria in this district has caused much thought to be given to the question, and I am pleased to be able to inform the Council that there appears a strong likelihood that a definite method of attack against this disease on purely preventive lines is at last within sight, for a method has been discovered for testing persons, particularly children, to see whether they are susceptible, or not, to the attack of the Diphtheria organism. This method is called the Schick test. If the person tested is found to be susceptible, then a further step can be taken of definitely treating such person in order to set up a condition of immunity to the disease. This definite preventive method is being largely introduced in America, and is beginning to be recognised in this country. Some large centres, notably Edinburgh and Birmingham, also the Metropolitan Borough of Holborn, are acting on these lines, and I propose to bring the matter to the notice of this Council suggesting that we should set up similar machinery during the current year. Dr. E. H. Thomson, M.B., C.M., D.P.H., Medical Superintendent at the North-Eastern Hospital states:— "We too often hear about the marked reduction in the diphtheria mortality rate since the introduction of antidiphtheric serum. But it is not the extent to which the mortality has diminished that is remarkable, for every case can be cured, but that it is still so high. Much avoidable 58 loss of life is caused by this disease, and the present mortality rate is no subject for congratulation, but rather one for sorrow and regret. The time has more than come when every one should put forth the utmost effort to educate not only medical but public opinion as to the grave danger to life from diphtheria, and the comparative ease by wnich it can be averted." The quarterly incidence of the disease for 1926 has been as follows:— 1st Quarter—East Greenwich, 77 cases; West Greenwich, 46; St. Nicholas, 3; Charlton, 42; Kidbrooke, 7; a total of 175 cases. 2nd Quarter—East Greenwich, 63 cases; West Greenwich, 20; St. Nicholas, 3; Charlton, 22; Kidbrooke, 7; a total of 115 cases. 3rd Quarter—East Greenwich, 29 cases; West Greenwich, 19; St. Nicholas, 4; Charlton. 23; Kidbrooke, 4; a total of 79 cases. 4th Quarter—East Greenwich, 51 cases; West Greenwich, 35; St. Nicholas, 11; Charlton. 34; Kidbrooke, 3; a total of 134 cases. Membranous Group.—There were no cases of Membranous Croup notified during the year. Erysipelas.— Sixty-five cases were notified during the year, 27 being in East Greenwich, 23 in West Greenwich, 10 in St. Nicholas, 4 in Charlton, and 1 in Kidbrooke. Fifteen of these patients were removed to a Public Institution in the district. Scarlet Fever.—Three hundred and seventy-one cases were notified during the year, as compared with 219, 292 and and 304 cases respectively in the years 1923. 1924 and 1925. 155 cases were in East Greenwich, 76 in West Greenwich, 28 in St. Nicholas, 93 in Charlton, and 19 in Kidbrooke; 362 of these cases were removed to Hospital for treatment, 11 of which were returned as not suffering from this disease. There was 1 death from this disease during the year, compared with three the previous year. Of the 362 cases treated in Hospital, the following were certified to be suffering on discharge from Hospital with chronic disease:—Rhinitis, 2; Otorrhœa 2, and Rhinorhœa. There were no cases which could be described as "Return Cases." 59 Typhoid Fever.—There were 7 cases of Typhoid or Enteric Fever notified during the year, 2 being in East Greenwich, 2 in West Greenwich, 2 in Charlton, and 1 in Kidbrooke. The ages of the patients were: 2 between five and fifteen years, 1 between fifteen and twenty-five years, 3 between twenty-five and forty-five years, and 1 between forty-five and sixty-five years. All the cases were removed to Hospital for treatment. In the years 1922, 1923, 1924 and 1925 there were 3, 16, 10 and 8 cases respectively. The average number for the previous ten years is 12. No case was traceable to the consumption of shell fish; There was only one fatality from this disease. Twelve 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, 2 in East Greenwich. 2 in West Greenwich, 2 in St. Nicholas, and 3 in Charlton. There were 9 cases in 1925, (i cases in 1924. 9 cases in 1923, and 6 cases in 1922. In the latter part of the year the Ministry of Health issued a notable Circular and Orders respecting the notification of Puerperal Fever and Puerperal Pyrexia, under which it is now compulsory that all cases of pyrexia (temperature of 100.4 F. or more, sustained during a period of 24 hours, or if the same recurs during the puerperium period) shall be notified, at the same time giving authority for the employment of recognised Obstetric Consultants to advise with any practitioner desiring such help. This Council have accordingly selected a panel of consultants for this purpose, as follows:— Margaret Basden, M.R.C.S., L.R.C.P., 1913, M.B., B.S. (Lond.) 1913, F.R.C.S. (Eng.) 1919, M.D. (Lond.) 1921. F. Cook, B.Sc.. M.B., B.S. 1911, F.R.C.S. (Eng.) 1914, 152, Harley Street, W.l,and 14, St. Thomas Street, S.E.1. A. J. McNair. M.A., M.B., B.Ch. (Camb.,) 1913, F.R.C.S. (Eng.) 1921, Warden's House, Guy's Hospital, S.E.1. 60 The method of procedure adopted is that whenever a medical man notifies a case of Puerperal Fever, or Puerperal Pyrexia, he shall at the same time indicate on the notification form whether or no he desires the help of one of the obstetric consultants. Should he do so, then your Medical Officer of Health immediately puts him into direct communication with the consultant selected by the Medical Practitioner, an order for his attendance being issued by this department, which naturally carries with it the obligation to pay the agreed fee. On receipt from the Consultant of a short report respecting the case the fee becomes due and is paid. Should the Medical Practitioner also or alternatively desire assistance in the way of bacteriological examination, then necessary arrangements have been made and put into force in connection with our existing machinery for this purpose at the Seamen's Hospital, Bacteriological Department. These Regulations came into force on the 1st October. 1926, and during the remainder of the year we received under the regulations notification of four cases of Puerperal Fever and one case of Puerperal Pyrexia. There was no call for the assistance of the Obstetric Specialist or of the Bacteriologist. Measles.—This disease was made permanently notifiable by an Order of this Council, approved bv the Ministry on the 1st July. 1920. One thousand two hundred and ninety-nine cases were notified during the year, as compared with 1,610 during the previous year, and 1,874 for the year 1924. Forly-six such cases were removed to Hospital for treatment. The ages and incidence of fatality of the disease were as follows:— There were 60 cases under 1 year of age. Between the ages of one to five years there were 576 cases with 13 deaths at this age period, giving a case mortality of 2.2 per cent., and 663 cases between five years and sixty-five years with no deaths. The case mortality for the whole district works out at l.00 per cent. as compared with 1.3 for the previous year, and 1.4 for the year 1924. 61 Table showing number of Measles Cases reported during the year 1926. Quarter ended 3rd April, 1926. Under 1 1 to 5 5 to 15 15 to 25 25 & over Total East Greenwich 11 94 148 7 1 261 West Greenwich 11 98 88 2 1 200 St. Nicholas. Deptford 4 68 36 — — 108 Charlton 12 124 141 3 2 282 Kidbrooke — — 8 — — 8 Total 38 384 421 12 4 859 Sources of Notification:— By Medical Practitioners 563 Males. Females. ,, Parents 81 ,, Health Visitors 55 412 447 ,, L.C.C. Schools 160 859 Quarter ended 3rd July, 1926. Under 1 1 to 5 5 to 15 15 to 25 25 & over Total East Greenwich 5 61 72 2 1 141 West Greenwich 2 35 44 1 1 83 St. Nicholas, Deptford — 11 4 — — 15 Charlton 4 61 60 2 127 Kidbrooke — — 11 3 — 14 Total 11 168 191 8 2 380 Sources of Notification :— By Medical Practitioners 220 Males. Females „ Pareats 34 „ Health Visitors 44 161 219 ,, L.C.C. Schools 82 380 62 Quarter ended 2nd October, 1926. Under 1 1 to 5 5 to 15 15 to 25 '25 & over Total East Greenwich 4 8 6 — — 18 West Greenwich — 5 1 — — 6 St. Nicholas, Deptford 1 1 2 — — 4 Charlton 1 4 2 — — 7 Kidbrooke — — — — — — Total 6 18 11 — — 35 Sources of Notification:— By Medical Practitioners 31 Males Females ,, Health Visitor 1 ,, L.C.C. Schools 3 14 21 35 Quarter ended 1st January, 1927. Under 1 1 to 5 5 to 15 25 & over Total East Greenwich 3 3 5 1 12 West Greenwich — 3 5 — 8 St. Nicholas, Deptford 2 — 3 — 5 Charlton — — — — — Kidbrooke — — — — — Total 5 6 13 1 25 Sources oi Notification:— By Medical Practitioners 18 Males. Females. „ Health Visitors 3 „ L.C.C. Schools 4 12 13 25 Total Cases in Year 1,299 Zymotic Enteritis or Epidemic Diarrhœa.—One hundred and thirteen cases of diarrhoea were notified throughout the whole of the Borough, 41 being under one year of age and 72 between one and five. Sixty-one of such notifications related to patients in East Greenwich, 16 in West Greenwich, 17 in St. Nicholas, and 19 in Charlton. There were 18 deaths ascribed to Diarrhœa and Enteritis, but only 12 were certified as Zymotic or Epidemic. Whooping Cough.—This disease was made permanently notifiable as from 1st November, 1921. 63 One hundred and twenty-six rases were notified (compared with 655 in 1925), '26 being under one year of age, 70 from one to five, 29 from five to fifteen, and 1 from fifteen to twenty-five, the districts concerned being East Greenwich 75; West Greenwich, 25; St. Nicholas, 8; Charlton, 17; and Kidbrooke, 1. Each of these cases was visited and leaflets and instructions left, together with verbal advice respecting the isolation and care of the patient. Twenty-five cases were removed to Hospital for treatment. Epidemic Cerebro-Spinal Meningitis, Cerebro-Spinal Fever, or Post-Basal Meningitis.—There was only 1 case of this disease notified during the year, this being a soldier notified from the Herbert Hospital. Acute Polio-Myelitis or Acute Polio-Encephalitis.— There were 2 cases notified during the year, as compared with 4 cases in 1923, 1 in 1924, and 1 in 1925. Ophthalmia Neonatorum.—During the year 6 cases of this disease have been notified, 1 being in East Greenwich, 1 in West Greenwich, and 4 in Charlton. Further particulars of this disease will be found on page 90. Malaria.—There were 8 cases of Malaria notified during the year, 4 occurring in West Greenwich, 2 in East Greenwich, and 2 in St. Nicholas, compared with 2 last year. Encephalitis Lethargica.—There were 6 notifications of cases of this disease. Three of the cases occurred in the eastern part of the Borough, and 3 in the western. Five cases unfortunately died—a very high percentage, as shewn below :- Date Notified Sex Age Treatment— Home or Hospital Remarks 1926 Feb. 16 Mar. 6 Apl. 31 May 25 June 28 Nov. 29 M F M F M M 45 15 65 9 43 76 Various Hospitals St. John's. Lewisham Park M. A.B. & G. D. Hospital Brook M. A.B. Home Home Died Died General Paralysis Died Died Parkinson's Disease Still receiving treatment at various Hospitals. Died 64 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 231 cases of Tuberculosis notified in the Borough, 177 being pulmonary cases, ordinarily known as Consumption, and 54 non-pulmonary, being Tuberculosis affecting other portions of the body than the lungs. Of this number of cases, 71 pulmonary and 25 nonpulmonary occurred in East Greenwich, 51 pulmonary and 11 non-pulmonary in West Greenwich, 12 pulmonary and 2 nonpulmonary in St. Nicholas, 41 pulmonary and 16 non-pulmonary in Charlton, and 2 pulmonary in Kidbrooke. The various ages of the patients were as follows:—Pulmonary cases under 1 year, 1; from one to five, 3 cases; five to fifteen, 25 cases; fifteen to twenty-five, 55 cases; twentv-five to forty-five, 63 cases; forty-five to sixty-five, 25 cases; and 3 cases over sixtyfive; whilst the Non-pulmonary were:—One to five, 11 cases; five to fifteen, 18 cases; fifteen to twenty-five, 14 cases; twenty-five to forty-five, 8 cases; and forty-five to sixty-five, 3 cases. Three hundred and forty-nine specimens were forwarded by medical practitioners tor bacteriological investigation from patients suspected to be consumptive; 289 were reported to bo negative and 60 positive. Disinfection has been offered and carried out in 120 cases, including 173 rooms and 398 articles of bedding, etc.; disinfectant has also been supplied to patients to disinfect sputum, etc., and sputum pots where such are found necessary. 65 Supplemental Vaccination Returns for 1925. Return made on or before the 9th of February, 1927, by Mr. E. S. Elliott, 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, 1925, inclusive:— Registration SubDistricts comprised in the Vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1925. Number of these Births duly entered by 31st Jan., 1927. No. of Births which on 31st Jan.. 1927, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1927, not accounted for Total No. of Certificates of successful Primary Vaccination at all ages received during Calendar Year, 1926. No. of Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1926. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. 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 598 295 — — 917 17 6 16 7 40 North Deptford 747 314 3 — 261 38 22 3 5 101 East Deptford 853 315 2 — 213 31 32 6 11 243 East Greenwich 825 417 — — 228 46 18 6 23 87 West Greenwich 408 199 — — 126 17 10 5 6 45 Total 3,431 1,540 5 — 1,045 149 88 36 52 516 1,651 1,033 Dated February 7th, 1927. E. S. Elliott, Vaccination Officer. CHARLTON AND KIDBROOKE. No. of Births entered in "Birth List Sheets" as registered from 1st January to 31st December, 1925 694 Successfully Vaccinated 417 Insusceptible of Vaccination 3 Had Small-Pox — Statutory Declarations of Conscientious Objection 196 Dead Unvaccinated 24 Postponed by Medical Certificate 8 Removed to Districts the Vaccination Officer of which has been duly apprised 39 Removed to places unknown, or which cannot be found; and cases not traced 6 Not accounted for 1 G. E. OUGHTON. 66 DISINFECTION. The new Disinfecting and Cleansing premises were opened in June, 1924, and are situate at Tunnel Avenue, Blackwall Lane, East Greenwich. The following returns show in detail the amount of work performed during the year by the Disinfecting Staff:— Number of Articles and Rooms Disinfected in connection with the Undermentioned Diseases for the 52 weeks ended 1st January, 1927. Total No. Articles Disinfected — 44 2,321 1,836 35 89 398 1,088 209 359 66 11 — 6,456 *Includes—Cancer; 35 Rooms; 284 Articles. Private Books Disinfected and Returned 250. Odd Articles — 10 286 60 — 7 67 265 126 207 50 — — 1,078 Quilts — 5 193 139 8 13 21 28 6 4 1 — — 418 Cushions — — 46 36 1 1 16 37 6 6 — — — 149 Sheets — — 40 25 1 11 9 22 — 4 — — — 112 Blankets — 9 651 539 9 17 73 218 28 69 8 2 — 1,623 Pillows — 9 574 513 8 18 109 316 17 29 3 5 — 1,601 Bolsters — 4 176 177 4 7 29 30 8 8 — 2 — 445 Mattresses — 3 148 113 3 6 38 127 16 20 — 1 — 475 Palliasses — — 2 2 — 1 — 2 — 2 1 — 10 Beds — 4 205 232 1 8 36 43 2 10 3 1 — 545 Premises Entered — 6 324 378 6 9 120 60 40 11 2 3 — 959 Rooms — 6 374 437 12 9 173 76 58 22 5 5 — 1,177 Infectious Diseases Polio-Myelitis Encephalitis Lethargica Scarlet Fever Diphtheria Enteric Fever Puerperal Fever Tuberculosis Other Diseases* Measles From Verminous Premises Scabies Iufluenza and Pneumonia Cerebro-Spinal Meningitis Total 67 Number of Articles Destroyed in connection with the Undermentioned Diseases during the 52 weeks ended 1st January, 1927. Infectious Diseases. Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Pieces Total No. Articles Destroyed Scarlet Fever 3 — 2 — — — — 1 — — 6 Diphtheria 1 1 1 — — — — — — — 3 Tuberculosis 4 6 7 — — 3 2 — 1 55 78 Other Diseases 12 3 2 5 14 3 1 — — 186 226 For Verminous Premises 2 — — — — — — — — — 2 Total 22 10 12 5 14 6 3 1 1 241 315 68 HOUSES INSPECTED AND INQUIRIES MADE IN CONNECTION WITH INFECTIOUS DISEASE. Number of Houses Inspected and Inquiries made by Infectious Disease Inspector 1,063 Number of Re-visits 3,174 The Health Visitors also visited 1,689 cases, and re-visited when required. The following books belonging to the Libraries, etc., were destroyed in consequence of Infectious Disease:— Central Library 185 Branch Library 26 School Libraries 21 Total 232 CLEANSING STATION, BLACKWALL LANE. The new Cleansing Station which forms part of the Disinfecting premises was opened in June, 1924, and is situate at at Tunnel Avenue. Blackwall Lane, East Greenwich. The arrangements made with the London County Council for reserving the use of the Cleansing Station on Mondays and Thursdays for the cleansing of verminous school children continue in operation. The following table shows the number of children cleansed during the year:— 1st Quarter 226 2nd „ 165 3rd „ 177 4th „ 199 Total 767 Three adults suffering from verminous conditions were also given cleansing baths. In every case the infested clothing was disinfected. 69 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR 1926. Disease. Total Cases Notified.* Cases admitted to Hospital. Total Deaths.* Small Pox — — — Diphtheria 503 501 12 Scarlet Fever 371 362 1 Enteric (including paratyphoid) 7 7 1 Puerperal Fever 9 7 — Puerperal Pyrexia 1 1 — Pneumonia 120 40 8 Erysipelas 65 15 — Acute Polio Myelitis 2 — — Cerebro Spinal Fever 1 1 — Continued Fever — — — Malaria 8 1 — Ophthalmia Neonatorum 6 1 Encephalitis Lethargica 6 4 3 Dysentery 1 1 — Notifiable Locally. Measles 1299 46 13 Whooping Cough 126 25 4 Diarrhœa 113 5 12 * For particulars as to Age Groups see Tables at end of Report REPORT OF THE TUBERCULOSIS OFFICER. To the Medical Officer of Health. Sir, During 1926 there has been no material change in the Antituberculosis Campaign. The work has been carried out on established lines. The figures submitted are very satisfactory and are evidence that our scheme is founded on sound principles. Notifications and Deaths.—I was able to report last year that the Incidence and Death Rates were the lowest ever recorded in the Borough, and it is particularly gratifying to know that the figures for the period under review are even lower and this despite causes acting in favour of the spread of this disease, such as the widespread unemployment and lack of suitable housing accommodation. In 1926 the Notifications and Deaths were as follows:— Notifications. Pulmonary 177 NonFulmonarv 54 Total. 231 Deaths. Pulmonary 93 NonPulmonary 24 Total. 117 and the averages for the previous ten years (1916-1925):— 249 107 128 25 70 These figures give an Incidence Rate for all forms of 2.22 per 1,000 of the population (1.70 pulmonary and .52 nonpulmonary), and a Death Rate for all forms of 1.12 per 1,000 (.89 pulmonary and .18 non-pulmonary). In ten instances (7 pulmonary and 3 non-pulmonary) the diagnosis of Tuberculosis was not confirmed so that the above rates should be read at a slightly lower figure. Further improvement in the figures may be looked for if and when the unemployment and housing problems are more satisfactory. Notification.—The following table shows the Death Notification interval of 93 patients in 1926, and whose deaths were ascribed to Pulmonary Tuberculosis. Of the 13 cases where the information was derived from the Death Returns, 6 had been treated in hospitals, and 7 by general practitioners. Information from Death Returns 13 Died within One Month of Notification 9 Died within Three Months of Notification 8 Died within Six Months of Notification 11 Died with Over Six Months of Notification 52 93 Revised Diagnosis.—The 10 cases in which the diagnosis of Tuberculosis was not confirmed comprised: 1 chronic bronchitis, 2 cancer, 3 debility and 1 pleurisy. These 7 patients were notified as suffering from Pulmonary Tuberculosis. The 3 cases notified as non-pulmonary proved: 1 scarlet fever with meningitis, 1 simple glandular swelling and 1 mastoid abscess. In this connection it is very gratifying to note that the number of cases sent by general practitioners to the Dispensary (before notification) for an opinion as to diagnosis is increasing year by year. Deaths.—During the year 117 persons died from Tuberculosis (all forms) giving a death rate of 1.12 per 1,000 population, 93 were due to the Pulmonary Form equal to a rate of .89 per 1,000 of the population, which is slightly lower than last year's record figure. Several of these pulmonary deaths were notified from Mental Hospitals and concerned patients who had not resided in the Borough for many years. 71 Notifications and deaths from Pulmonary Tuberculosis, with the Incidence and Death Rates for the previous five years, are recorded below:- Year. Notifications Incidence per 1,000 Deaths Death Rate per 1,000 1921 263 2.6 119 1.18 1922 218 2.1 120 1.18 1923 213 2.08 115 1.12 1924 214 2.04 104 1.00 1925 197 1.90 104 1.00 Deaths from Non-pulmonary Tuberculosis, of which there were 24 (equal to a rate of .18 per 1,000) included 7 Meningitis, 7 of Abdominal Tuberculosis, 9 Bones and Joints, and 1 Genitourinary. The 51 (corrected) Notifications of Non-pulmonary Tuberculosis included: 3 cases of General or Miliary Tuberculosis. 19 ,, Tuberculosis of the Glands (Neck). 4 „ „ „ Spine. 9 „ „ „ Joints. 8 „ ,, ,, Abdomen. 6 „ ,, „ Brain (Meningitis). 2 „ ,, ,, Other. SUNLIGHT TREATMENT (Tuberculosis Section). A full description of the installation was given on page 66 of last year's Report. It only remains to add that following a series of tests with the Carbon Tetrachloride Actinometer the pure carbons hitherto used are being gradually replaced by Tungsten-cored Carbons which have been found to give a flame much richer in ultra-violet rays. Also as far as possible to aid reflection the walls of the Treatment Room have been white enamelled, and to try and improve the atmosphere of the room an Ozoniser was installed in December, and so far seems to answer its purpose. At the close of 1925 there were 78 patients under treatment. During the year 74 new cases were sent from the Dispensary. The total treated during 1926 therefore amounted to 152. Discharges numbered 92, leaving 60 under treatment at the close of the year. 72 The 74 new cases comprised:— 6 children under 5 years of age. 55 between 5 and 15 years and 13 others over 15 years. These patients were further classified as follow:— Tuberculous Adenitis 10 Tubercular Abdomen 6 Hilus Tuberculosis 17 Pretubercular and Malnutrition 33 Other 8 Many more would have been sent had accommodation been available, but the Clinic having been established by the Maternity and Child Welfare Committee, such patients naturally had prior claim. It was not found possible to send adult cases, except in one or two instances, when women were sent. 152 patients received 2,888 treatments, an average of nearly 19 per patient. The shortest completed course comprised 11 treatments, and the longest 33, these cases being Asthma and Hilus Tuberculosis respectively. Attendances were well maintained, except during the school holidays and the hopping season. At other times absentees were looked after by the Nurses. A few cases did not complete treatment, the alleged reason usually being that "the child caught cold after treatment," the real reason, the fact that the parent was unable or unwilling to spend the necessary time in bringing the child to and from the Clinic. As regards the actual treatment no change has been made from the procedure adopted and outlined in 1925. Each patient is examined medically at the Dispensary before commencing the course and periodically during the treatment. Owing to lack of accommodation and other circumstances it had not been found possible to carry out Blood Tests as anticipated. Blood pressure was estimated in some of the older children, but as the results did not give much information this practice has been discontinued. In 7 patients, a second course of treatment was given with marked benefit, and there is reason to believe that short repeated courses, as far as children are concerned, would be more beneficial than long continuous ones, which are apt to prove tiring to both children and parents. As regards skin reactions no attempt has been made to obtain pigmentation; rather to delay such manifestation as long as possible, but when it did appear it was taken as an indication for terminating the treatment. 73 The effect desired has been "reddening'' or slight Erythema (2nd degree) and this has been obtained in some instances, although some children did not react at all. In fact, in only one case (E.P. No. 74), a girl, aged 20, was this degree exceeded, when a fairly severe erythema followed the initial dose. As a rule patients attending the Light Centre did not receive any active medical treatment beyond "Malt and Oil" in the case of pre-tubercular and badly nourished children. It is to be recognised that Light Treatment does not do away with evil effects of bad housing and insufficient nourishment. Of the 92 patients, all did well, the gland cases especially so. In one case (D.B. No. 3), a girl of 16 years with glands involving both sides of the neck, and who had been dismissed from Hospital with several discharging sinuses, the exposure to Ultra-Violet Ray served to act almost magically, healing rapidly taking place after a few exposures so that now she is able to go back to work and is in good health. In a case of Lupus (Mrs. J.), the woman had given up attending a. City Hospital owing to the time and expense involved in travelling to and fro. Lupus was of the dry type and after a rather prolonged course at our Centre improvement gradually set in and she was discharged with instructions to attend for further treatment in two months time; her condition was much better, although not completely healed. Owing to our Centre being centrally situated she was able to continue for this furthter treatment. It should be mentioned that no local treatment was given, the whole body being exposed. In the pre-tubercular and malnutrition cases no marked increase in weight was noted, but there was a steady improvement in general health and strength, lassitude and fatigue giving way to renewed activity. This improvement was generally noted by the parents in the first instance. One or two cases of Asthma in children showed marked symptomatic improvement after exposure. In conclusion, on the whole one can look back on the year's work with satisfaction and confidence, but more and better accommodation is required, together with bathing and washing facilities, before the full benefits of Ultra-Violet Rays can be realised. Occupation.—As indicated last year, there are no industries in the Borough which have any special bearing upon the Incidence of Tuberculosis, and the occupations of notified cases in 1926 show no marked difference to those quoted last year. 74 Housing.—The Housing condition presents little improvement and much overcrowding exists, many examples continue to be brought to the notice of the Public Health Committee by the Care Committee. It follows that the sleeping arrangements continue a very serious difficulty in the problems of infection. Of 241 patients suffering from Pulmonary Tuberculosis: 129 were sharing a bed. 60 had a separate bed but not a separate room. 52 had a separate room and a separate bed. As a result of much persuasion and perseverance on the part of the Tuberculosis nurses and the Care Committee, 28 patients who were sharing a bed have now separate beds, and 10 patients, who each shared a bed with three others, have had their sleeping arrangements so altered as to have only one partner: not an ideal arrangement, but the best that could be done under the circumstances, and a great improvement on the original state as found by the nurses. Apart from overcrowding, many sanitary defects have been reported to and dealt with by the Public Health Department. The Council has now increased the number of shelters to 8, and these are in constant use. Bedsteads and bedding have been lent or supplied by the Council and other agencies. (See Report of Care Committee). At the close of 1926 the estimated number of persons suffering from Tuberculosis and residing in the Borough was as follows:— Men. Women. Children. Total. Pulmonary Tuberculosis 235 230 156 621 Non-Pulmonary 33 33 179 245 giving a total of 866 as against 804 in the previous year. Dealing with the Dispensary itself, 798 new patients were examined during the year. The sources from which these patients came were as follow:— Doctors 129 Hospitals 22 School Medical Service 38 Ministry of Pensions 6 Own Application 69 Nurses (Contacts) 534 Contacts.—Much of the nurses time is spent endeavouring to secure the examination of every contact. This year, out of a total of 668 Contacts, 505 or 75 per cent. were examined, of whom 36 were found to be Tuberculous. 75 The work of the Dispensary is shown in the statistical table on page 79 and explains itself. Sanatorium Treatment.— During the year 131 patients were sent to sanatoria, 90 under the County Scheme, 35 through the Guardians, and 6 through other sources. The average duration of residence was 4½ months, but the same difficulties remain in finding suitable employment for those discharged fit for work. In addition 87 children are attending the Open-Air Schools at Shooters Hill and Forest Hill, and are all doing remarkably well. The Open-Air School brings practically all the advantages of the Sanatorium to the immediate homes of the children without in any way breaking with the home life or interrupting their education. They are or should be the schools of the future. The children are all periodically examined at the Dispensary, in addition to the supervision of the School Medical Officer. X-Ray Examinations.—The arrangements with the Greenwich Guardians for the X-Ray examination of patients, as hinted last year, were completed and came into operation in April. Apart from every other advantage the financial gain to the Council is very considerable: for example, in 1925 under the old scheme 55 patients were examined at the Seamen's Hospital at a cost of £41, since April, under the new arrangement 208 patients were examined at a cost of only £30 at the Greenwich and Deptford Hospital. The agreement is that the Tuberculosis Officer has the use of the Guardians' X-Ray Installation, with the assistance of the Operator, on one afternoon per week for a charge of £10 per quarter, irrespective of the number of patients submitted. All patients are "screened" but in addition skiagrams are taken in the case of children and also adults where thought necessarv. During the first quarter of the year 18 patients were examined at the Seamen's Hospital, which, with the 208 examined during the remainder of the year at the Greenwich and Deptford Hospital, makes a total of 226. Of these 141 were adults and 85 children. The parts examined were Chest 119, Other 7. Sputum Examinations.—Of 148 sputum specimens bacteriologically examined at the Seamen's Hospital, 27 proved positive and 121 negative. At the same time, 138 specimens were chemically examined at the Dispensary for Albumen, with very similar results to those reported previously. 76 In closing this Section of the Report it might be mentioned that the relations with the other authorities concerned in the work (the Board of Guardians, the Ministry of Pensions, the British Red Cross Society, the School Authorities, and the Various Hospitals) have been cordial and the co-operation well maintained. Tuberculosis Care Committee.—The committee has met regularly, and below is a very brief statement supplied by Miss Johnston, the Hon. Secretary, as to its activities during 1926. Such a statement gives no real indication as to the volume of work performed, and I can only reiterate the remarks I made in my previous reports. Miss Johnston reports as follows:— "During the year assistance was obtained for patients and their families to the value of £82 by the following Societies:— Charity Organisation Society. United Services Fund (Greenwich Branch). Soldiers', Sailors' and Airmen's Families Association (Greenwich Branch). Soldiers' and Sailors' Help Society. Society for the Relief of Distress, and Voluntary Helpers. The Charlton Branches of the S. S. & A. Families Association and U. S. Fund have also assisted many cases recommended to them. The British Red Cross Emergency Help Committee assist all attributable cases when help is required. Five convalescent letters have been given by the Vicar of Greenwich for wives and children of tubercular patients, and the U. S. Fund have provided for expatients at their Bournemouth Home. The Greenwich Guardians again have been most sympathetic in providing extra nourishment, clothing, blankets, etc., in cases recommended by the Committee. A sum of £120 13s. 6d. was collected from patients and their relatives on behalf of the London County Council towards the cost of treatment." 77 The Report on Dental Treatment will be found in the succeeding pages, and I have now only to acknowledge once more my indebtedness to every member of the Public Health and Dispensary Staff for their assistance and co-operation in carrying out the work. I am, Sir, Your obedient Servant, M. MACDONALD, M.D., Ch.B., D.P.H. TUBERCULOSIS DENTAL CLINIC. Mr. G. F. Ferris, L.D.S.. R.C.S. ((Eng.), reports as follows: — The mouth is the chief channel of entrance of organisms, and is the foci of septic processes. Oral sepsis, or what is commonly called "a dirty mouth," is believed to be the forerunner of much chronic disease, resulting in disablement and premature death. The course of all diseases may be influenced by oral conditions, and the presence of oral sepsis is often the determining factor between death and recovery. Oral sepsis in children is now regarded as a possible pre-tubercular state, although no tubercle may appear to be present. Septic temporary teeth cause infection of the lymphatic glands, and lower their resisting capacity to tubercle infection. Thus the bacilli remain and flourish where Nature intended they should be resisted and killed. A septic mouth in the adult must ultimately result in lowered resistance and the possibility of tubercle infection. It follows therefore that proper dental care and adequate education in dental hygiene for children, will result in a healthy adult population. Details of treatment carried out during the year are as follow: — No. of sessions 26 ,, ,, patients 45 Attendances 156 Dentures supplied 8 Filling and scaling 33 Extractions N2O 34 Extractions (local anaesthetic) 72 Extractions 13 Advice 42 Referred 50 Sessions for gas administration 10 78 TUBERCULOSIS. Age-Periods New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F 0 1 — 1 — — — 1 — 1 2 1 12 2 — — 3 1 5 12 7 8 4 — 1 1 — 10 5 4 8 2 1 1 6 1 15 15 12 6 2 4 7 2 — 20 12 13 6 3 8 12 2 — 25 20 17 2 3 7 12 2 1 35 22 11 2 — 16 3 2 — 45 13 8 1 2 8 2 1 — 55 4 4 — 1 5 2 — 1 65 and upwards — 3 — — 2 2 — — Totals 106 80 46 19 51 42 20 4 Particulars relating to the above Table are dealt with in the Report of the Tuberculosis Officer on pages 69 to 71. 79 Return of work carried out in connection with the Maze Hill Tuberculosis Dispensary for the Year 1926. DIAGNOSIS. Pulmonary. Non-pulmonary. TOTAL. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 42 17 12 7 5 4 10 3 47 21 22 10 (b) Doubtfully tuberculous — — — — — — — — 2 3 4 5 (c) Non-tuberculous — — — — — — — — 41 73 38 38 B.—Contacts examined during the year:— (a) Definitely tuberculous 15 7 5 1 2 3 — 17 7 8 1 (b) Doubtfully tuberculous — — — — — — — — 2 — 2 3 (c) Non-tuberculous — — — — — — — — 80 129 110 126 C.—Cases written off the Dispensary Register as (a) Cured (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 121 202 148 164 D.—Number of persons on Dispensary Register on December 31st:— (a) Diagnosis completed 183 144 66 34 34 22 85 39 217 166 161 73 (b) Diagnosis not completed — — — — — — — — 4 3 6 8 80 1. Number of persons on Dispensary Register on January 1st 545 2. Number of persons transferred from other areas and of " lost sight of cases return 9 3. Number of patients transferred to other areas and cases " lost sight of 16 4. Died during the year 64 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 15 6. Number of attendances at the Dispensary (including Contacts) 6,034 7. Number of attendances of non-pulmonary cases at Orthopaedic stations for treatment or supervision — 8. Number of attendances at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light" treatment 2,888 (b) Other special forms of treatment - 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 45 10. Number of consultations with medical practitioners :— (a) At Homes of Applicants 17 (b) Otherwise 248 11. Number of other visits by Tuberculosis Officers to Homes191 12. Number of visits by Nurses or Health Visitors to Homes for sary purposes 4,404 13. Number of (a) Specimens of sputum, &c., examined 148 (b) X-ray examinations made 226 in connection with Dispensary work. 14. Number of Insured Persons on Dispensary Register on 31st December 246 15. Number of Insured Persons under Domiciliary Treatment on 31st Dec. 25 16. Number of reports received during the year in respect of Insured persons:—(a) Form G.P. 17 11 (b) Form G.P. 36 26 81 SECTION 7. Maternity and Child Welfare In my Annual Report for 1925 I dealt fully with the various activities under the Council's Maternity and Child Welfare Scheme. These have been conducted on similar lines as heretofore. Infant Welfare Consultations.—Consultations are held at two Centres on each afternoon from 2 to 5 p.m., as. follows: — Borough Hall, Royal Hill... Monday, Tuesday and Thursday Conduit House, 236, Trafalgar Road Monday, Wednesday and Friday 105, Shooters Hill Road Tuesday and Friday Albany Institute, Creek Road Thursday Charlton Vale Wesleyan School Room, Woolwich Road Wednesday The following table shows at a glance the work undertaken at the various Infant Consultation Centres during the year:— Borough Hall Conduit House 105. Shooter's Hill Rd Albany Institute Charlton Vale Total Attendances 9,068 10,009 4,496 2,269 3,712 29,554 New Cases 387 430 215 151 176 1,359 Medical Consultations 3,796 3,831 1,829 1,138 1,306 11,900 Nursing Mothers seen by Doctors 1,276 1,367 796 381 468 4,288 All babies are weighed and advice given to the mothers at every attendance. The continued popularity of the Centres is borne out by the steady increase in the number of attendances. During the last 5 years these have increased by over 7,000, as shown below: 1922 22,218 1923 24,261 1924 26,068 1925 28,584 1926 29,554 82 Pre-Maternity Clinics.—These are held at 10 a.m., as follows:— Borough Hall, Royal Hill Tuesday. Conduit House, 236, Trafalgar Road Wednesday. 105, Shooters Hill Road Friday. Charlton Vale Mission Hall, Woolwich Road Wednesday. Each of these Centres is attended by a Medical Officer together with a Health Visitor in charge, and a clerk, either a lady working voluntarily, or a member of the staff. It will be recollected that owing to the congestion at the Conduit House Clinic, sanction was given by the Ministry of Health to hold an additional Centre at Charlton. This Centre, which is held at the Charlton Vale Mission Hall in Woolwich Road, was opened on the 10th March, 1926. The attendances for the year were as follows:— Borough Hall 606 Conduit House 582 Shooters Hill Road 565 Charlton Vale 111 1,864 This figure of 1,864 compares favourably with last year's total of 2,057, having regard to the smaller number of Births registered during the year. The following talbles show (a) the number of visits made by the Health Visitors during the year in connection with Births and cases of Infectious Diseases, and (b) number of Infant Consultations and Pre-Maternity Clinics attended. Health Visitors' Visits, &c., 1926. Table A. Visits Re-Visits Total Infants under 1 year 2,239 3,562 5,801 Children, 1—5 years 212 4,919 5,131 Measles 1,360 257 1,617 Whooping Cough 147 40 187 Pneumonia 44 46 90 Puerperal Fever 9 18 27 Ophthalmia Neonatorum 13 40 53 Diarrhoea 116 64 180 4,140 8,946 13,086 Table B. Dental Treatment 79 5 84 Milk Scheme 126 15 141 Pre-Maternity Cases 349 53 402 Infant Consultations attended — — 1,025 Pre-Maternity Clinics attended — — 209 Miscellaneous — — 84 83 In addition to the above, 1,364 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. Convalescent Home Treatment.—Cases of mothers and children who, in the opinion of the Medical Officer, would materially benefit by a course of convalescent treatment, are dealt with by the Committee and then referred either to the Invalid Children's Aid Association, The Soldiers', Sailors' and Airmen's Families Association), or the Guardians. During the year 69 children have been sent away for treatment for periods varying from 3 weeks to 6 months. Minor Ailments.—Quite trilling minor ailments are dealt with by the Health Visitor. Other cases requiring hospital attention are dealt with by arrangement with St. John's Hospital, Lewisham, to which Hospital the Council makes a contribution of £50 per annum for this service. Home Nursing.—Children found by the Health Visitors to be in need of special nursing at their homes, are dealt with by the various Nursing Associations in the Borough to whom the Counci 1 make appropriate payment for such services. Artificial Sunlight Treatment Centre.—This Centre which was opened on the 24th September, 1925, at Conduit House, 236, Trafalgar Road, is in use every day from 10 to 12.30, and 1.30 to 5 p.m., for cases referred to the Centre by the Medical Officers attending the Infant Welfare Consultations. The treatment is given by a fully trained and specially certificated nurse. A full description of the installation was given in my Report last year, and particulars of improvements are recorded by Dr. Macdonald in the Tuberculosis Section of the Report on page 71. The conditions treated were as follows:— Rickets 165 Malnutrition and Underweight 88 Anaemia and Debility 75 Convalescent from Infectious Diseases 15 Catarrh and Bronchial Conditions 11 Premature Babies 5 Enlarged Glands 7 Other Cases 21 387 84 The routine dosage for children commence from three minutes, increasing approximately by one minute per week according to the reaction. For adults, e.g., nursing and expectant mothers, an initial dosage of six minutes, increasing by three minutes per week according to re-action. The average duration of treatment is as follows:— Rickets 9—12 months. Malnutrition 6—9 ,, Convalescent 3 ,, Bronchial condition During Winter Months. The temperature is taken as a routine measure before and after treatment. Noticeable improvement in the weights of children has been observed, particularly in those who were under-weight or not gaining weight. The following four cases are typical of many:— (a) Child of 10 months, weighing 15-lbs. 7-ozs., after 5 month's treatment weighed 22-lbs. 3-ozs. (b) Child of 14 months, weighing 20-lbs. 4-ozs.. had not gained for three months. A gain of 1½-lbs. was obtained in two months. (c) Child of 5 months, weighing 13½-lbs. and not gaining, increased 2-lbs. in a month. (d) Child of 8 months, weighing 18-lbs., not gaining, increased to 20-lbs. 2-ozs. in five weeks. In children with Rickets and other conditions not associated with underweight, the increase in weight is not necessarily greater than would have been the natural increase in weight of the growing child. Occasionally after some length of treatment, the elder children begin to lose weight and the mothers complain that the child is too active and does not rest enough. The child is then taken off treatment for a time and resumes later. As the general health of the child improves with the treatment, the increase in the brightness and activity is much noticed, particularly so in the cases of malnutrition and premature babies. The mental condition of the nervous child also improves. 85 Fair complexion children re-act quickly; erythema and irritation being produced by small exposures. Pigmentation in these cases is slight. Dark complexion children do not show signs of erythema easily, but usually show signs of slight pigmentation early, and then deep pigmentation is produced. There is not so much irritation as in cases of fair complexioned children. Several cases of red-haired children have been treated during the year, and it has been found that by increasing the dose more slowly than in the ordinary case, and by keeping the child at a greater distance from the light, the skin can take the light quite well. Greater care is needed in the case of the sandy-haired, white-eyebrow type, than with the dark red-haired child. Irritation and dryness of the skin of the face after treatment in cold or windy weather is a common feature. To overcome this, pieces of cardboard are placed in front of the child's face to protect it from the rays and vaseline is used on the skin before going out into the cold. The reaction of the skin when a child resumes treatment after being absent for a time varies. If the child himself has been well, but has been kept away on account of illness at home or other reasons, it has been noticed that the skin can almost take the same length of dosage as before the absence without skin reaction. If the child has been ill, when resuming treatment, erythema is usually produced at a much reduced exposure. Three cases have been treated in which no pigmentation occurred, although the treatment extended for months. Two of the cases were mother and daughter. All had very white, rather greasy skins ; erythema was frequently produced, also irritation, but no pigmentation resulted. It was observed in cases of Rickets where the teething was backward, that after treatment, the teeth appeared to cut quickly. One child of 14 months had only 5 teeth on commencing treatment ; after 3 weeks 4 more teeth had been out. and a further 2 during the next two weeks. At the end of 3 month's treatment the child had 14 teeth. Another child of 11 months had no teeth, but cut 4 during the first month's treatment. 86 Chronic Catarrhal Conditions.—Several of these cases showed very definite improvement and remained free from colds for a longer period than ever before. Two or three with exposure to phthisis in their homes remained well throughout the winter and were particularly satisfactory. Anæemia, Retarded Development, &c.— A few cases showed much improvement in their general conditions, but on the other hand cases were encountered where no progress could be seen. Rickets and Malnutrition.—In families above the poverty line (or with more intelligent general hygiene in spite of poverty) there was a general improvement, and arrest of onset of signs and symptoms of Rickets. Where home and nutrition factors were satisfactory and no obvious cause could be found for Rickets, the light treatment had definite curative effects, but it did not appear to counteract the depressing influences of poverty and inherited constitutional feebleness. Deprivation of Light.—Remarkable results were obtained in the case of a child who had spent his early months in an underground room and was waxy, feeble and undersized. Improvement was marked from his first treatment, and another child in the same family who suffered from Anæmia and Catarrh, also received great benefit. During the year 387 patients were treated and 6,891 treatments given. MATERNITY HOME. In my Report for the year 1925, I was able to state that the extension which had become necessary had been approved 'by the Ministry of Health and that the work would be commenced, it was hoped, early in the year 1926. As a matter of fact, the actual work was begun in March, 1926, and proceeded almost continuously up to the month of September, so that, for about six months out of the year, the activities of the staff of the Maternity Home were considerably handicapped bv building operations. The extensions were available from 1st October, 1926, from which date the accommodation consisted of two General 87 Wards each with nine beds and a Private Ward with two beds, making a total of 20 beds. In addition there is an Isolation Ward with one bed, and two Labour Wards. Prior to the extension, the accommodation consisted of one General Ward with nine beds, a Private Ward with two Beds, and Isolation Bed, and one Labour Ward. Apart from the Greenwich Maternity Home there are six Municipal Maternity Homes in London, only one of which, namely, Battersea, now has a larger number of beds than at our Maternity Home, and taking the usual capacity figure of 75%, and allowing a fortnight's stay for each patient, one arrives at the capacity figure for the year of 390 patients. I feel sure that, greatly appreciated as the Maternity Home has been in the past, it has a long period of immense usefulness before it and will play a very big part in the future in the saving of infant life and in enabling the mothers of the Borough to have comfortable and satisfactory confinements so that the impairment of the health which so often follows confinements where skilled care and attention is wanting, will be reduced to a minimum. The actual number of cases admitted during 1926 was 256, and as the average duration of stay of each patient was fourteen days, this gives an average number of patients throughout the year of just under ten. The fact that extensions were in progress influenced somewhat, in my opinion, the number of applications received for accommodation, and made it easier to ensure that, in spite of the difficulties under which the staff were handicapped, no patient had reasonable cause for complaint as to the care and attention received. Of these 256 patients, 17 were delivered by doctors, the remaining 239 being delivered by the Matron and midwives at the Home. Five infants were not entirely breast-fed while in the Home for the following reasons:—(1) prolonged convalescence, (1) family tuberculosis, (1) mother had grown-up sons living at home, (1) insufficient milk, and in the remaining case the mother, unfortunately, died through adherent placenta with post-partum hemorrhage. It is with profound regret that one has to report this first maternal death in the Home since it was opened in March, 1922. The condition with which the Medical Officer in charge of the case had to contend, however, could not possibly have 88 been anticipated, and when discovered, it is hardly necessary to add that every possible endeavour was made to avoid1 a fatal issue. Considering that this is the first maternal fatality in over 1,000 confinements and bearing in mind the fact that many cases are referred to our Maternity Home because unusual circumstances are likely to be encountered and difficulties met with, I cannot help feeling that the record is an exceedingly satisfactory one. One sometimes hears the argument that more deaths occur in Institutions proportionately than elsewhere. It is, however, always well to bear in mind the fact that an Institution, and particularly one like the Council's Maternity Home, which is available for the reception, not only of the normal case, but also of cases which essentially need Institutional treatment, is always likely to have cases which may terminate fatally in spite of the best medical and surgical skill. Ten babies were stillborn, and eight died within ten days of birth. The following table shows the total number of admissions since the Home was opened in February, 1922:— 1922 (part of) 121 1923 228 1924 220 1925 295 1926 256 1,120 The following continue their good work in the Borough: — Local Medical Practitioners' School Clinic. Health Centre, Deptford Green. Rachel McMillan Memorial Nursery School. 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 (debility and dietetic disorders). During the year 13 babies were admitted of which 3 were discharged cured, 7 relieved, 1 was sent to Evelina Hospital for operation, whilst 2 unfortunately died. 89 NOTIFICATION OF BIRTHS ACTS, 1907. The following table gives the number and character of the intimations received respecting births in the Borough:— 1918 1919 1920 1921 1922 1923 1924 1925 1926 Total Number of Births notified in each year 1,735 2,085 2,714 2,564 2,257 2,348 2,245 2,257 2,096 (a) Attended by Midwives 990 1,159 1,494 1,452 1,494 1,591 1,563 1,668 1,660 (b) Attended by Doctors 745 926 1,220 1.112 773 757 649 589 436 Numbers of Still Births notified in each year 44 59 78 52 53 50 32 32 49 Number of Births registered in each year 1,753 1,968 2,648 2,366 2,185 2,276 2,258 2,108 2,027 Puerperal Fever and Puerperal Pyrexia Regulations, 1926.—These Regulations came into force on the 1st October, 1926, and all medical practitioners practising in the Borough were notified as to the general conditions of the Regulations. Fuller details describing the arrangements made by the Council are given under Section 6 of this Report. Nine cases of Puerperal Fever were notified during the year, one of which unfortunately proved fatal. There did not appear to be any common source of infection amongst these oases, as they occurred in different districts and at different times. Since the 1st October there was only 1 case of Puerperal Pyrexia notified. Ophthalmia Neonatorum.—Under the 1914 Regulations an obligation rested upon certified midwives to notify any cases in which they were in attendance and which they had reasonable grounds for supposing were suffering from Ophthalmia Neonatorum, unless such cases had been notified already by a medical practitioner. On the 1st October, 1926, new Regulations came into force, the obligation for notifying all cases of Ophthalmia Neonatorum resting solely upon the medical practitioner in attendance upon the case, midwives not being required to notify any such cases. 90 Under the rules of the Central Midwives Board, midwives are still required to summon medical assistance in all cases of inflammation of, or discharge from, the eyes of a child, and also to send notice immediately, to the Local Supervising Authority that such assistance has been sought. Seven cases of this disease were notified during the year, and in addition there were six cases of slight inflammation of the eyes reported; 1 case was removed to hospital. Both eyes were affected in 6 cases, and one eye only in the remaining case. At the end of the year 2 of the cases were still under treatment as 'out-patients' at local hospitals. OPHTHALMIA NEONATORUM. Cases. Vision Unimpaired Vision impaired Total Blindness Deaths Notified T reated At Home In Hospital 7 6 1 5 2 — — Measles.—See pages 60 to 62. Milk, Virol, &c., Supplied to Nursing and Expectant Mothers and Young Children.—In accordance with Circular 185 of the Ministry of Health, where the income falls within the Council's scale, milk may be granted either free or at reduced cost to:— (a) Nursing Mothers; (b) Expectant Mothers in the last 3 months of pregnancy; (c) Children up to 3 years of age. In addition dinners may also be given to Nursing and Expectant Mothers who are in necessitous circumstances. The whole of the milk supplied at our Centres is Full Cream Dried Milk, and the same procedure has been adopted with regard to the distribution as in previous years. The total amount of such Milk sold or distributed free to Nursing and Expectant Mothers and Young Children during the year was 51,228 lbs. (22 tons, 17 cwt. 44 lbs.) The following tables show (a) the amount of milk, etc., given away and number of applicants receiving same, and (b) quantities sold each quarter. 91 (a) Milk, Virol, &c., Distributed Free. Quarter ended Milk Virol Emulsion Malt & Oil Cod Liver Oil lbs No. of Applicants lbs. No. of Applicants lbs No. of Applicants lbs. No. of Applicants lbs. No. of Applicants March, 1926 8,318 4,444 353 706 5 10 1,736 1,736 6 12 J une, „ 9,495 5,265 280½ 561 — — 1,429 1,429 6 12 Sept., ,, 8,706 4,165 286½ 573 — — 1,126 1,126 3 6 Dec., ,, 8,647 4,642 286½ 573 — — 1,706 1,706 6½ 13 Totals 35,161 18,516 1,206½ 2,413 5 10 5,997 5,997 21½ 43 (b) Milk, Virol, &c., Sold at Full or Reduced Prices. Quarter ended Milk Virol Emulsion Oil & Malt Cod Liver Oil Total Amount Received lbs lbs. lbs. lbs. lbs. March, 1926 4,392 307 7 350 54 £317 0 6 June., ,, 3,483 1951½ — 241 14 258 6 2½ Sept., ,, 4,135 272 — 255 19 292 19 9 Dec., ,, 4,057 287½ — 458 19 354 18 11 Totals 16,067 1,062 7 1,304 106 £1,223 5 4½ 92 Dental Treatment.—The Council's Dentist, Mr. G. F. Ferris, L.D.S., R.C.S. (Eng.), attends at the Tuberculosis Dispensary, Maze Hill, once a fortnight to deal with cases under the purview of the Maternity and Child Welfare Committee, which are referred to him by the Medical Officers of the Clinics. Extractions, scalings and such minor conditions are dealt with free, but when the provision of teeth is necessary, the Dentist draws up an estimate, the patient is assessed a certain amount, and assistance from outside sources is obtained as far as possible. The matter is then brought to the notice of the Assistance Sub-Committee to decide how much the Council shall give towards making up this amount, and for this purpose the sum of £60 per annum is set aside in this Committee's estimates. The Dentist reports as follows:— In submitting my Report for the year 1925-1926, I would again urge the necessity of a clean mouth during pregnancy, as this has a far-reaching effect upon the organs of the mother and baby. Obstetricians believe it not only possible, but highly probable that complications such as still-birth, deformity and hæmorrhagic disease of the newborn, can be traced to a septic mouth. It has been proved that bacteria can pass from the mother to the baby before birth (e.g. Spirochæto Pallida) and if this is possible with one kind of bacteria, surely other varieties may gain access to the child provided that there is lack of resistance and a virulent organism present. Correct dental treatment and careful observation during the pre-natal period will do much to reduce the heavy death-rate in mothers and babies. Extreme care both in discovering the foci of infection and in the method used for their eradication is also required. It is very necessary that the mother should attend the dentist in the early months of pregnancy so that he can keep her gums in good condition and prevent the advance of caries and pyorrhoea, which are so much aggravated by the pregnant state. But while agreeing that no septic teeth should be in the mother's head during confinement, I would point out that if the mother attends the Maternity Centre during the last two months of pregnancy, it is far better to leave a dormant infection undisturbed. The danger of lighting up an acute infection is too great at this stage. I would therefore suggest that when possible, patients presenting themselves for treatment during the last months of pregnancy, should have their treatment left until 93 after the confinement. The safest period for dental treatment of the expectant mother is between the fourth and seventh month of pregnancy. Gum treatment, for the most part, can be practised safely throughout pregnancy. With regard to conservative treatment, I have to report that the majority of patients requiring fillings still object to having them done. Indeed when appointments are made for fillings such patients fail to attend the Clinics further. It would be helpful if there were some means by which these patients could be made to understand that filling and scaling the teeth are of such vital importance. The following table shows the work performed during the year:— Sessions 26 Patients 140 Dentures supplied 34 Extractions N2o 389 Patients for Extractions 75 Extractions (local anaesthetic) 329 Patients for local anaesthetic 113 Impressions 29 Bite 18 Try in 21 Scaling and Polishing 19 Advice 42 Attendances 482 Baby Week Celebrations.—The celebrations took the form of Teas and Entertainment to the Mothers and Children attending the various Centres. A Special Committee, consisting of the whole of the members of the Maternity and Child Welfare Committee, together with prominent local voluntary helpers, made the necessary arrangements for the functions which took place at the Borough Hall, Greenwich, on Tuesday, July 13th to Thursday, July 15th, inclusive. Altogether some 1000 mothers and 1500 babies and children participated in the tea and entertainment which comprised musical drill and dancing displays, solo dances by tiny tots. A feature of the proceedings was the community singing of old English songs, etc. The cost of the tea and entertainment was largely borne by the Special Committee and other interested friends. 94 Review of Maternity and Child Welfare Scheme. Towards the end of the year under review, the National League for Health, Maternity and Child Welfare, which is a voluntary Society engaged in connection with Maternity and Child Welfare work throughout the Country, sent out a questionnaire in connection with the activities of local authorities during the twenty-five years from 1901—1925 with a view to ascertaining, if possible, whether any particular forms of child welfare work had had more influence than others on the reduction of infantile mortality during this particular period. The Council will, of course, be familiar with the many activities which now comprise the Council's Maternity and Child Welfare Scheme, and from a perusal of my reports during these twenty-five years it is possible to obtain interesting records of the manner in which the present Maternity and Child Welfare Scheme has gradually come into being. Shortly after my appointment twenty-five years ago, I was greatly impressed by the very high infantile mortality rate in certain parts of the Borough, and in my 1902 report, the appointment of Health Visitors, to combat this high infantile mortality rate, was urged. No definite steps in this connection were, however, taken until 1909 when the "Notification of Births Act" was adopted, and three consultation centres were opened in the Borough under the control of a voluntary society which was formed for the purpose. The activities of the Health Society were, however, handicapped by the difficulty to obtain suitable voluntary visitors and during the year 1911, the Health Society disbanded and the Council's first Health Visitor (part time) was engaged. In the following year further health visiting was carried out by the Woman Sanitary Inspector. In 1915 arrangements were made for the distribution of dried milk, etc., and a voluntary Centre was taken over by the Council. In 1916 an extra Health Visitor was appointed, and I was able to report that the centres were increasing in popularity. Further Centres were opened in 1917, and in 1918 there were three Health Visitors on the permanent staff. From this date onwards, rapid extension of the Council's Maternity and Child Welfare Scheme was witnessed. Arrangements were made for dental work, and in 1920 the staff of Health Visitors was increased to seven and a Maternity and Child Welfare Committee formed. In 1921 the Council's 95 first full-time Maternity Medical Officer was appointed and two Ante-natal Clinics were established. 1922 witnessed the opening of the Maternity Home and a greatly increased demand for dried milk, etc. By 1923 the number of consultations held weekly had increased to nine. Visiting in connection with foster children, etc., was being performed and the Maternity Home was making excellent progress. In 1924 an Artificial Sunlight Centre was suggested, which was opened in the following year. Other arrangements which had been made during the past few years had been provision for home nursing, facilities for minor operations, arrangements made for use of Babies' Home, convalescent treatment provision as well as the extension of the Welfare Centres and Ante-natal Clinics. Twenty years ago the average infantile mortality rate was 132. During the following five years the figure had fallen to 112, and in 1914 the figure had fallen still further to just over 100. 1920 witnessed the first very marked drop in the infantile mortality rate, the figure that year being 75. the lowest recorded figure was 56 in 1922, the average for the years 1920—1925 being 68. As to the particular form of child welfare work which has had more influence than others on the lower infantile mortality rate, I am afraid an answer cannot be expressed in terms of any special phase of the work. There is no question of doubt that, particularly in recent years, an enormous step forward has been taken in connection with the education of parents and particularly mothers in the rearing of healthy children, in which connection, regular attendance at our Welfare Centres where the infants are weighed and where the mother has the advantage of the Medical Officers' and Health Visitors' advice, have undoubtedly combined very largely to this satisfactory condition of affairs. One feels one ought to add, however, that examples of almost unbelievable ignorance are still encountered from time to time, and there should, therefore, be no slackening of our efforts to reach the irreducible minimum in connection with the infantile mortality rate. 96 Index of Contents. Page. Adoptive Acts, By-laws and Local Regulations 1-3, 26 Age Mortality 13 Ambulance Facilities 22 Analysis of Death Causes 14 Anthrax 64 Area of Borough 6 Articles and Rooms Disinfected 66 Articles Destroyed 67 Artificial Sunlight Treatment 23, 71-73, 83-86 Baby Week Competitions 93 Bacteriological Examinations 25 Bakehouses 52 Baths and Washhouses 40-42 Births 8, 9 Blackheath and Charlton Cottage Hospital 25 Bones and Joints 14, 19 Books Destroyed 68 Cancer 17, 18 Causes of Sickness 15-19 Clinics and Centres 23, 24, 81, 82 Cerebro-Spinal Fever 63 Circulatory System 14, 18 Cleansing Children 68 Complaints 27 Constitutional Diseases 14, 17 Consumption 5, 17 Contacts 56 Convalescent Treatment 83 Cowhouses 46 Customs and Inland Revenue Acts 31 Dairies, Cowsheds and Milkshops . 38 Deaths, Tables showing Causes of and Ages at Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Deaths, with Age Mortality 13 Deptford Fund Babies' Hospital 21, 28 Density of Population 6 Dental Work 77, 92, 93 Developmental Diseases 14, 18 Diarrhoea and Zymotic Enteritis 16, 62 Dietetic Diseases 14, 17 Digestive System 14, 19 Diphtheria 15, 56-58 Diphtheria Anti-Toxin 25 Disinfection 66, 67 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 91 Encephalitis Lethargica 18 Enteritis 16, 62 Epidemic Cerebro-Spinal Meningitis 63 Epidemic Diseases 14, 15 Erysipelas 16 97 INDEX—continued. External Causes 19 Factories and Workshops 27-30 Food and Drugs—Samples of 52, 54 Food—Premises for Preparation of, etc. 51 Glanders 64 Gonorrhoea 16 Health Centres 23 Health Visitors, Visits, etc. 82 Home Work 29 Horse Slaughterer 31 Hospital and other forms of Gratuitous Medical Relief 25 House Drainage 31 Houses Inspected re Infectious Diseases 68 Houses Let in Lodgings 32 Housing 43-45 Hydrophobia 64 Ice Cream Premises 38 I11 defined Causes 19 Increase of Rent and Mortgage Interest (Restriction) Acts, 1920 and 1923 32 Infant Consultations 23 Infantile Mortality 13, 14 Influenza 16 Inhabited Houses 6 Inland Revenue Acts 31 Insanitary Areas 44 Institution Deaths 12 Integumentary System 14, 19 Introductory Review 4, 5 Laboratory Work 25 Legal Proceedings 37 Local Diseases 14, 18 Lymphatic System 14, 19 Malarial Diseases 14, 16, 63 Marriages 8 Maternity and Child Welfare 81, 95 Maternity Home 86-88 Measles15, 60-62 Meat 48, 49 Milk and Cream Regulations 47 Milk and Dairies (Amendment) Act, 1922 46 Milk and Dairies (Order), 1926 47, 48 Milk Supply 46 Milk Supply for Expectant and Nursing Mothers 90, 91 Milk (Special Designations) Order, 1923 46 Miller General Hospital 25 Minor Ailment Centre 23 Mortuary 20, 40 Nervous System 14, 18 Notices, etc 37 Notifications 56-64 Notification of Births Act 89 Nursing Arrangements 24 Offensive Trades 33 Ophthalmia Neonatorum 63, 89, 90 Organs of Special Sense 14, 18 98 INDEX—continued. Outworkers' Register 27 Overcrowding 38 Parasitic Diseases 14, 17 Persons Cleansed 39, 68 Polio-encephalitis 63 Polio-myelitis 63 Poor Law Relief 26 Population 7 Public Health Committee 1,2 Public Health (Meat) Regulations, 1924 48, 49 Public Health (Preservatives, &c., in Food) Regulations 50 Public Sanitary Conveniences 32 Puerperal Fever 16, 59, 60, 89 Pyaemia and Septicaemia 16 Rats and Mice (Destruction) Act, 1919 32 Remarks on Death Causes 15-19 Reproductive System 14, 15, 19 Respiratory System 14, 18 Rheumatic Fever 16 Sale of Food and Drugs Act 50-55 Sanitary Work—Summaries, etc. 28- 40 Scarlet Fever 15, 59 Scavenging and Refuse Removal 31, 32 School Clinic 24 Seamen's Hospital 25 Septic Diseases 14, 16 Slaughterhouses 38, 50 Small-pox 16, 56 Smoke Nuisances 30 Sporadic Diseases 14, 16 Staff of Public Health Department 24 Statistical Tables 6, 7 and Appendix Suffocation 19 Suicide 19 Syphilis 16 Tuberculosis 14, 16, 17, 64 Tuberculosis Dispensary—Return of Attendances 79, 80 Tuberculosis Care Committee 76 Tuberculosis Officer's Report 69-77 Typhoid Fever 15, 59 Underground Bakehouses 30 Underground Rooms 38 Unwholesome Food 36 Uninhabited Houses 6 Urinary System 14, 19 Vaccination Particulars 65 Venereal Diseases 14, 16 Verminous Premises 32, 39 Verminous Children 68 Virol 90, 91 Vital Statistics 6, 7 and Appendix Water Supply 30 Whooping Cough 15, 62, 63 Workshops and Factories 27-30 Zymotic Enteritis 16, 63 Zymotic Diseases 15 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks ended 3rd April, 1926. districts Census Population, 1921. Estimated Population at the middle of the Year 1926. Births Registered during the 13 weeks ended 3rd April, 1926. Deaths Registered during the 13 weeks ended 3rd April, 1926. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Phthisis. All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate ok 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 Diarrhoea and Dysentery. All Causes. Seven Zymotics. Typhoid. Other. During the correspond ing period year previous. During the 13 weeks ended 3rd April, 1926. During the corresponding period year previous. During the 13 weeks ended 3rd April. 1926. M. F. M. F. Greenwich East 44213 44950 97 90 58 63 13 6 48 ... 1 ... 2 ... ... ... 1 12 2 29 4 10 60 13.10 10.80 .53 .35 Do. West 26677 27206 55 48 70 37 4 12 38 ... 4 ... ... ... ... ... 1 9 2 24 9 14 44 14.68 15.77 .74 .73 St. Nicholas, Deptford 7582 7824 26 27 30 16 7 7 10 ... 6 ... 1 ... ... ... 1 4 ... 13 2 3 16 12.89 23.59 ... 4.09 Charlton 18785 20762 53 54 25 26 4 3 27 ... 1 ... ... ... ... ... ... 3 2 6 2 6 31 14.37 9.85 .97 .19 Kidbrooke 3193 3308 6 4 3 2 ... ... 4 ... ... ... ... ... ... ... ... ... ... 3 ... 1 1 7.31 6.06 ... ... Miller Hospital— Resident ... ... ... 4 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 ... ... ... ... Non-Resident ... ... ... 24 4 6 1 1 ... ... ... ... ... ... ... 1 ... ... 3 1 2 21 ... ... ... ... Seamen's Hospital— Resident ... ... ... 10 1 ... 1 ... ... 1 ... ... ... ... ... ... 1 ... 1 1 1 6 ... ... ... ... Non-Resident ... ... ... 25 ... ... ... 1 ... ... ... ... ... ... ... ... 3 ... 6 2 2 12 ... ... ... ... Greenwich & Deptford Hospital— Resident ... ... ... 54 30 7 6 28 ... 2 ... ... ... ... ... 3 10 ... 18 2 7 42 ... ... ... ... Non-Resident ... ... ... 70 52 7 10 34 ... 6 ... ... ... ... ... 2 5 1 33 4 18 53 ... ... ... ... Herbert Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... M.A.B. Brook Hospital— Resident ... ... ... 3 2 ... 5 ... ... 2 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 20 16 5 15 ... ... 9 1 24 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... Cottage Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Institutions— Resident ... ... ... ... 10 2 ... 7 ... ... ... ... ... ... ... ... ... ... 3 ... 1 6 ... ... ... ... Non-Resident ... ... ... 2 3 ... ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... 4 ... ... ... ... Outside Institutions ... ... ... 42 28 5 5 26 ... 1 ... ... ... ... ... ... 2 2 8 3 9 45 ... ... ... ... 237 223 186 144 Borough 100450 104050 *460 330 28 28 127 ... 12 ... 3 ... ... ... 3 28 6 75 17 34 152 ... ... ... ... Rate per 1,000 of Estimated Population ... ... ... ... ... ... ... ... .46 ... .11 ... ... ... .11 1.08 .22 2.88 .65 1.30 5.84 13.56 12.72 .62 .69 Deaths of Children under 1 Year per 1,000 births. 60 Death Rate of 105 large English Towns, 13.7 ; of the County of London, 13.5. *Gross Births Registered, 531 previous (20.17 per 1000). ,, ,, „ corresponding 75 period „ County of London 71 Birth Rate ,, 18.7 ,, ,, 18.0 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks ended 3rd April, 1926. DISTRICTS | Census Population, 1921. Estimated Population at the middle of the Year 1926. Births Registered during :he 13 weeks ended 3rd July, 1926. Deaths Registered during the 13 weeks ended 3rd July, 1926. 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 Diarrhoea and Dysentery. All Causes. Seven Zymotics. Typhoid. Other. During the corresponding period year previous. During the 13 weeks ended 3rd July 1926. During the corresponding period year previous. During the 13 weeks ended 3rd July, 1926. M. F. M. F. Greenwich East 44213 44950 90 97 50 63 12 11 47 ... 1 ... 2 ... ... ... ... 5 2 24 4 16 59 9.24 10.07 .53 .26 Do. West 26677 27206 68 52 41 43 7 5 28 ... ... 1 ... ... ... ... ... 8 3 12 9 9 42 10.82 12.39 .44 .14 St. Nicholas, Deptford 7582 7824 26 37 14 10 2 2 4 ... ... ... ... ... ... ... ... 3 1 5 2 2 11 9.79 12.30 .51 ... Charlton 18785 20762 47 41 21 24 2 ... 23 ... ... ... ... ... ... ... ... 4 1 6 3 4 27 9.70 8.69 .38 ... Kidbrooke 3193 3308 2 5 ... 6 ... ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... 1 4 6.09 7.27 ... ... Miller Hospital— Resident ... ... ... 2 4 ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 4 ... ... ... ... Non-Resident ... ... ... 11 5 1 1 3 ... ... ... ... ... ... ... ... ... 1 ... 1 5 9 ... ... ... ... Seamen's Hospital— Resident ... ... ... 10 ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 2 1 1 5 ... ... ... ... Non-Resident ... ... ... 12 ... ... ... 2 ... ... ... ... ... ... ... ... ... 1 ... 2 4 5 ... ... ... ... Greenwich & Deptford Hospital— Resident ... ... ... 31 23 2 5 21 ... ... ... ... ... ... ... ... 3 2 11 4 7 27 ... ... ... ... Non-Resident ... ... ... 59 34 2 3 37 ... ... ... ... ... ... ... ... 10 1 22 2 11 47 ... ... ... ... Herbert Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... M.A.B. Brook Hospital— Resident ... ... ... 1 2 ... 1 ... ... ... ... 1 1 ... ...... ... ... ... ... ... ... 1 ... ... ... ... Non-Resident ... ... ... 7 10 1 9 ... ... 3 ... 9 1 ... ... ... ... ... 1 ... ... 3 ... ... ... ... Cottage Hospital— Resident ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Non-Resident ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... Other Institutions— Resident ... ... ... 2 3 1 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 4 ... ... ... ... Non-Resident ... ... ... 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... Outside Institutions ... ... ... 23 28 3 4 11 ... ... 1 ... ... ... ... ... 4 1 4 3 3 35 ... ... ... ... 233 232 126 146 Borough 100450 104050 465 272 23 18 105 ... 1 1 2 ... ... ... ... 20 7 48 18 32 143 ... ... ... ... Rate per 1,000 of Estimated Population ... ... 17.93 10.49 ... ... ... ... .03 03 .07 ... ... ... ... .77 .26 1.19 .70 1.22 5.51 9.06 10.49 .46 .15 Deaths of Children under 1 Year per 1,000 births, 49 Death Rate of 105 large English Towns, 11.5; of the County of London, 11.1. previous Gross Births Registered, 535 „ „ „ corresponding 63 (20 63 per 1000). period „ „ „ County of London 50 Birth Rate „ „ 19 .4 ,, ,, ,, 18.5. BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks 3rd April, 1926. DISTRICTS Census Population, 1921. Estimated Population at the middle of the Year 1926. Births Registered during the 13 weeks ended 2nd October, 1926. Deaths Registered during the 13 weeks ended 2nd October, 1926. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Phthisis. All other Forms of Tuberculosis Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortalitv 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 Diarrhoea and Dysentery. ah Causes. Seven Zymotics. Typhoid. Other. During the corresponding period year previous. During the 13 weeks ended 2nd October, 1926. During the corresponding period year previous. During the 13 weeks ended 2nd October, 1926. M. F. M. F. Greenwich East 44213 44950 84 98 63 49 13 2 35 ... ... ... 1 1 1 ... 3 9 6 8 8 15 60 9.23 9.99 .26 .53 Do. West 26677 27206 66 55 39 15 7 1 18 ... ... ... ... ... ... ... ... 5 2 7 1 11 28 10.22 8.96 ... ... St. Nicholas, Deptford 7582 7824 24 28 8 5 3 ... 2 ... ... ... ... ... ... ... 1 2 ... 1 1 2 6 12.37 6.66 .51 .51 Charlton 18785 20762 57 39 27 13 6 ... 12 ... ... ... ... ... ... ... 1 6 ... 2 2 5 24 8.34 7.73 .38 .19 Kidbrooke 3193 3308 7 4 2 ... ... ... 2 ... ... ... ... ... ... ... ...... ... ... ... 1 ... 1 7.31 2 .42 ... Miller Hospital— Resident ... ... ... 6 ... 3 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... 4 ... ... ... ... Non-Resident ... ... ... 11 12 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 6 14 ... ... ... ... Seamen's Hospital— Resident ... ... ... 7 ... ... ... 1 ... ... ... ... ... ... ... ... 2 ... 1 ... 1 3 ... ... ... ... Non-Resident ... ... ... 16 ... ... ... 4 ... ... ... ... ... ... ... ... 1 ... 3 2 1 9 ... ... ... ... Greenwich & Deptford Hospital— Resident ... ... ... 38 26 3 1 21 ... ... ... ... 1 1 ... 3 4 3 9 2 14 27 ... ... ... ... Non-Resident ... ... ... 50 37 3 2 25 ... ... ... ... ... ... ... ... 7 3 10 6 18 43 ... ... ... ... Herbert Hospital— Resident ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... M..A.B. Brook Hospital— Resident ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... ...... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 4 4 1 2 ... ... ... ... 3 ... ... ... ... 3 ... ... ... ... ... ... ... ... Cottage Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Institutions— Resident ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Non-Resident ... ... ... ... 3 ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... ... ... Outside Institutions ... ... ... 29 13 2 2 6 ... ... ... ... ... ... ... ... 6 3 2 3 3 25 ... ... ... ... 238 224 139 82 Borough 100450 104050 462 221 29 3 69 ... ... ... 1 1 1 ... 5 22 8 18 13 33 119 ... ... ... ... Kate per 1,000 ot Estimated Population ... ... 17.86 8.52 ... ... ... ... ... ... .03 .03 .03 ... .19 .84 .30 .69 .47 1.17 4.62 9 .41 8.52 .23 .30 Deaths of Children under 1 Year per 1,000 births, 62 Death Rate of 105 large English Towns, 9.1 ; of the County of London, 8.8. previous Gross Births Registered, 481 ,, ,, „ corresponding 53 (18.55 per 1000). period ,, ,, „ County of London 53 Birth Rate ,, 18.3 ,, ,, 17.3. BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 13 weeks ended 1st January, 1927. DISTRICTS Census Population, 1921. Estimated Population at the middle of the Year 1926. Births Registered during the 13 weeks ended 1st January, 1927. Deaths Registered during the 13 weeks ended 1st January, 1927. 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 Diarrhoea and Dysentery. All Causes. Seven Zymotics Typhoid. Other. During the corresponding period year previous. During the 13 weeks ended 1st January, 1927. During the corresponding period year previous. During the 13 weeks ended 1st January, 1927. M. F. M. F. Greenwich East 44213 44950 101 95 77 62 10 6 60 ... ... ... 5 1 ... ... ... 10 1 22 12 15 73 12.10 12.40 .44 .53 Do. West 26677 27206 49 57 41 46 12 6 29 ... ... ... ... 1 ... ... 1 6 1 19 2 7 50 14.07 12.83 1.48 .29 St. Nicholas, Deptford 7582 7824 36 23 15 13 6 1 6 ... ... ... ... 1 ... ... 2 4 ... 7 6 ... 8 15.46 14.35 3.60 1.53 Charlton 18785 20762 37 44 24 24 6 1 20 ... ... ... 1 ... ... ... ... 3 1 9 3 3 28 13.01 9.28 .77 .19 Kidbrooke 3193 3308 6 6 2 3 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 4 3.65 6.06 ... ... Mii.ler Hospital— Resident ... ... ... 7 3 2 2 2 ... ... ... ... ... ... ... ... ... ... 2 ... 3 5 ... ... ... ... Non-Resident ... ... ... 19 10 5 4 3 ... ... ... ... ... ... ... 4 1 1 ... 3 8 12 ... ... ... ... Seamen's Hospital— Resident ... ... ... 10 1 ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 1 1 5 ... ... ... ... Non-Resident ... ... ... 16 ... ... ... 3 ... ... ... ... ... ... ... ... 4 1 1 ... 2 8 ... ... ... ... Greenwich & Deptford Hospital— Resident ... ... ... 38 38 7 4 29 ... ... ... ... 1 ... ... 1 5 ... 12 3 3 51 ... ... ... ... Non-Resident ... ... ... 47 48 9 3 37 ... ... ... ... 3 ... ... ... 5 ... 21 ... 7 59 ... ... ... ... Herbert Hospital— Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... M.A.B. Brook Hospital— Resident ... ... ... 3 3 2 ... ... ... ... ... 5 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 5 7 ... 9 ... ... ... 1 4 4 ... ... ... ... ... ... ... ... 3 ... ... ... ... Cottage Hospital— Resident ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... ... ... ... Non-Resident ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Other Institutions— Resident ... ... ... 3 6 3 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 9 ... ... ... ... Non-Resident ... ... ... 1 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... Outside Institutions ... ... ... 26 21 4 2 13 ... ... ... 1 ... ... ... 1 5 1 5 5 3 26 ... ... ... ... 229 225 159 148 Borough 100450 104050 454 307 34 14 117 ... ... ... 6 3 ... ... 3 23 3 57 23 26 163 ... ... ... ... Rate per 1,000 of Estimated Population ... ... 17.51 11-83 ... ... ... ... ... ... .22 .11 ... ... .11 .88 .11 2.19 .88 .99 6.27 12.77 11.83 1.00 .46 Deaths of Children under 1 Year per 1,000 births, 74 Death Rate of 105 large English Towns, 12.3; of the County of London, 16.7. previous Gross Births Registered, 516 ,, ,, „ corresponding 65 (19 9 per 1000). period „ „ „ County of London 74 Birth Rate „ 17.1 ,, ,, ,, 16.7. BOROUGH OF GREENWICH. Return of Births and Deaths registered during the 52 weeks ended 1st January, 1927. DISTRICTS 1 Census Population, 1921. | Estimated Population at the middle of the Year 1926. Births Registered during the 52 weeks ended 1st January, 1927. Deaths Registered during the 52 weeks ended 1st January, 1927. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. 1 Phthisis. All other Forms ot Tuberculosis Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate or 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. Diarrhoea and Dysenter>- During the corresponding period year previous. During the 52 weeks 1 ended 1st January, 1927. Duiing the corresponding period year previous. During the 52 weeVs ended 1st January, 1927. M. F. M. F. Greenwich East 44213 44950 372 380 248 237 48 25 190 ... 2 10 2 1 ... 4 36 11 83 28 56 252 10.87 10.82 .44 .02 Do. West 26677 27206 238 212 191 141 30 24 113 ... 4 1 ... 1 ... ... 2 28 8 62 21 41 164 12.45 12.24 .66 .14 St. Nicholas, Depteord 7582 7824 112 115 67 44 18 10 22 ... 6 ... 1 1 ... ... 4 13 1 26 11 7 41 12.63 14.22 1.15 1.02 Charlton 18785 20762 194 178 97 87 18 4 82 ... 1 ... 1 ... ... ... 1 16 4 23 10 18 110 11.36 8.89 .63 .04 Kidbrooke 3193 3308 21 19 7 11 ... ... 11 ... ... ... ... ... ... ... ... ... ... 4 1 3 10 6.09 5.45 ... ... Mii.ler Hospital— Resident ... ... ... 19 8 5 5 5 ... ... ... ... ... ... ... 1 ... 1 3 ... 6 16 ... ... ... ... Non-Resident ... ... ... 65 31 13 6 8 ... ... ... ... ... ... ... 6 1 2 3 7 21 56 ... ... ... ... Seamen's Hospital— Resident ... ... ... 37 2 1 1 2 ... 1 ... ... ... ... ... 1 3 2 6 3 4 19 ... ... ... ... Non-Resident ... ... ... 69 ... ... ... 10 ... ... ... ... ... ... ... ... 8 2 10 6 9 34 ... ... ... ... Greenwich & Deptford Hospital— Resident ... ... ... 161 117 19 16 99 ... 2 ... ... 2 1 ... 7 22 5 50 11 31 147 ... ... ... ... Non-Resident ... ... ... 226 171 21 18 133 ... 6 ... ... 3 ... ... 2 27 5 86 12 54 202 ... ... ... ... Herbert Hospital— Resident ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... M.A.B. Brook Hospital— Resident ... ... ... 8 7 3 6 ... ... 2 10 2 ... ... ... ... ... ... ... ... 1 ... ... ... ... Non-Resident ... ... ... 36 37 2 35 ... ... 12 2 40 7 ... ... ... ... 3 1 ... ... 8 ... ... ... ... Cottage Hospital— Resident ... ... ... 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 ... ... ... ... Non-Resident ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... ... ... ... Other Institutions— Resident ... ... ... 5 21 6 ... 12 ... ... ... ... ... ... ... ... ... ... 3 ... 3 20 ... ... ... ... Non-Resident ... ... ... 4 11 2 ... 4 ... ... ... ... ... ... ... ... ... ... 3 ... ... 12 ... ... ... ... Outside Institutions ... ... ... 120 90 14 13 56 ... 1 1 1 ... ... ... 1 17 7 19 14 18 131 ... ... ... ... 937 904 610 520 Borough 100450 104050 1541 1130 114 63 418 ... 13 1 12 4 1 ... 11 93 24 198 71 125 577 ... ... ... ... Kate per 1,000 of Estimated Population ... ... 17.75 10.89 ... ... ... ... .12 .009 .11 .03 .009 ... .09 .89 .23 1.91 68 1.20 5.56 11.36 10.89 .58 .40 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, 116. previous Gross Births Registered, 2027 „ „ „ corresponding' 69 (19 45 per 1000). period „ „ County of London 64 Birth Rate „ tl 18 2 ,, „ „ 171. BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 3rd April, 1926. Causes of Death. Deaths at Subjoined ages of " Residents " whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District. Deaths of " Residents " in Public Institutions Total Deaths whether of "Residents" or "NonResidents" 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 12 ... 5 7 ... ... ... ... ... 1 4 6 1 ... 2 1 ... ... 2 ... ... 1 19 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup 3 ... 1 2 ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... 3 ... ... ... 27 Influenza 3 ... ... 1 ... ... ... 1 1 1 2 ... ... ... ... ... ... ... ... ... ... ... 2 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Chicken Pox 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post Basic Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pul. Tuberculosis) 28 ... ... ... 1 9 8 8 2 12 9 4 3 ... 10 1 ... ... ... ... ... 2 19 Tuberculous Meningitis 2 ... 1 ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 ... Other Tuberculous Diseases 4 ... 1 ... 2 1 ... ... ... 2 1 ... 1 ... ... ... ... ... ... ... ... 1 1 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer, Malignant Disease 34 ... ... ... ... ... 5 20 9 10 14 3 6 1 7 1 1 ... ... ... 1 9 31 Bronchitis 48 3 1 ... 1 ... 1 11 31 19 15 7 4 3 12 ... ... ... ... ... 3 4 38 Broncho-Pneumonia 17 4 2 4 ... ... 1 1 5 6 6 4 1 ... 4 ... 1 ... ... ... ... 1 16 Pneumonia (all other forms) 10 1 ... ... ... 1 ... 3 5 4 3 2 1 ... 2 1 ... ... ... ... ... 3 13 Other Diseases of Respiratory Organs 4 ... ... 1 ... 2 ... 1 ... 3 1 ... ... ... 2 ... ... ... ... ... ... ... 2 Diarrhœa and Enteritis 4 3 1 ... ... ... ... ... ... 1 2 1 ... ... 3 ... ... ... ... ... ... 1 6 Appendicitis and Typhlitis 2 ... ... ... ... 1 ... 1 ... ... ... ... 2 ... ... ... ... ... ... ... ... 2 4 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 Nephritis and Blight's Disease 5 ... ... ... ... ... 1 1 3 ... 1 2 2 ... 1 ... ... ... ... ... ... 1 3 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 2 ... ... ... ... 2 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 2 1 Congenital Debility and Malfortnation, including Premature Birth 9 9 ... ... ... ... ... ... ... 3 1 2 3 ... 2 ... ... ... ... ... ... 3 8 Violent Deaths, excluding Suicide 10 1 ... ... 1 ... 3 4 1 5 4 1 ... ... 1 1 ... ... ... ... ... 5 12 Suicides 2 ... ... ... ... ... ... 2 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 Heart Disease 17 ... ... ... ... 1 1 7 8 4 9 2 2 ... 2 1 ... ... ... ... ... 3 8 Other Defined Diseases 111 6 1 ... 3 3 9 27 62 44 32 11 23 1 35 5 3 ... ... ... 6 30 109 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 330 28 13 15 8 21 29 89 127 121 107 46 51 5 84 11 5 ... 5 ... 10 70 322 Note.— All "Transferable Deaths" of residents, i.e.. persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded. BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 3rd July, 1926. Causes of Death. Deaths at Subjoined ages of " Residents " whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District. Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents" 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 A11 Causes Certified 272 23 7 11 8 17 29 72 105 113 84 24 45 6 54 10 6 ... 3 1 5 51 223 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 3 Scarlet Fever 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria and Croup 2 ... ... 2 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 2 ... ... ... 11 Influenza 5 ... ... ... 1 ... ... 2 2 1 2 ... 2 ... 1 ... ... ... ... 1 ... 1 3 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Chicken Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post Basic Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pul. Tuberculosis) 20 ... ... ... 1 9 5 4 1 5 8 3 4 ... 3 ... ... ... ... ... ... 4 12 Tuberculous Meningitis 2 ... 1 ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 3 Other Tuberculous Diseases 5 ... ... ... ... 2 2 1 ... 2 2 ... 1 ... 1 1 ... ... ... ... ... 1 3 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer, Malignant Disease 32 ... ... ... ... ... 6 12 14 16 9 2 4 1 7 1 2 ... ... ... 1 3 31 Bronchitis 28 ... ... ... ... ... 1 9 18 15 6 3 4 ... 6 ... ... ... ... ... ... ... 18 Broncho-Pneumonia 10 1 2 3 ... ... ... ... 4 4 3 1 1 1 3 1 ... ... ... ... ... 1 9 Pnuemonia (all other forms) 10 ... 1 ... 1 ... 3 3 2 5 3 1 1 ... 2 1 ... ... ... ... ... 3 9 Other Diseases of tory Organs 3 ... ... ... ... ... 1 2 ... 1 1 ... 1 ... ... ... ... ... ... ... ... 1 ... Diarrhoea and Enteritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Appendicitis and Typhlitis 4 ... ... 1 1 1 ... ... 1 3 1 ... ... ... 2 ... ... ... ... ... ... 1 4 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis and Blight's Disease 5 ... ... ... ... ... 1 2 2 1 4 ... ... ... 1 ... ... ... ... ... ... ... 5 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... Congenital Debility and Malformation, including Premature Birth 16 16 ... ... ... ... ... ... ... 8 6 1 1 ... ... ... ... ... ... ... 1 2 3 Violent Deaths, excluding Suicide 6 ... 1 1 ... ... 1 1 2 4 2 ... ... ... 1 ... 1 ... ... ... ... 3 10 Suicides 5 ... ... ... ... ... ... 5 ... ... 3 1 1 ... 1 ... ... ... ... ... ... 1 2 Heart Disease 18 ... ... ... 1 ... 2 10 5 4 9 2 3 ... 4 1 ... ... ... ... ... 3 9 Other Defined Diseases 98 6 2 2 3 5 5 21 54 41 23 8 22 4 21 5 3 ... 1 ... 3 25 85 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... 272 23 7 11 8 17 29 72 105 113 84 24 45 6 54 10 6 ... 3 1 5 51 223 Note.— All "'Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded. BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 2nd October, 1926. Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents" 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 A11 Causes Certified 221 29 2 1 11 15 36 58 69 112 54 13 40 2 64 7 6 1 1 ... 2 42 218 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough l 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 3 Diphtheria and Croup l 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... 4 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Encephalitis Lethargica 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 Chicken Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post Basic Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pul. Tuberculosis) 22 ... ... ... 1 7 9 4 1 9 5 2 6 ... 4 2 ... ... ... ... ... 6 14 Tuberculous Meningitis 2 ... ... 1 1 ... ... ... ... 1 1 ... ... ... 2 ... ... ... ... ... ... ... 7 Other Tuberculous Diseases 6 1 ... ... 3 1 1 ... ... 5 1 ... ... ... 1 ... 1 ... ... ... ... 3 3 Rheumatic Fever 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Cancer, Malignant Disease 33 ... ... ... ... ... 2 18 13 15 11 2 5 ... 14 1 ... ... ... ... 1 3 40 Bronchitis 8 1 ... ... ... ... ... 2 5 4 3 ... 1 ... 6 ... ... ... ... ... ... ... 17 Broncho-Pneumonia 4 ... 1 ... ... ... ... 2 1 2 2 ... ... ... 3 ... ... ... ... ... ... ... 4 Pneumonia (all other forms) 6 ... ... ... ... 1 2 2 1 2 2 1 1 ... 1 1 ... ... ... ... ... 2 5 Other Diseases of Respiratory Organs 2 ... ... ... ... 1 ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 Diarrhoea and Enteritis 9 6 ... ... 1 ... 1 ... 1 4 ... 2 ... 3 ... 1 ... ... ... ... 1 5 Appendicitis and Typhlitis 4 ... ... ... 1 ... 2 1 ... 2 2 ... ... ... 2 ... ... ... ... ... ... 2 2 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver 3 ... ... ... ... ... 1 2 ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... 1 Nephritis and Bright's Disease 9 ... ... ... ... ... 3 2 4 3 3 1 2 ... 3 ... ... ... ... ... ... 3 4 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 4 Congenital Debility and Malformation, including Premature Birth 9 9 ... ... ... ... ... ... ... 3 4 1 1 ... ... ... ... ... ... ... ... 1 2 Violent Deaths, excluding Suicide 12 1 ... ... 1 2 2 3 3 6 4 1 1 ... 4 1 1 ... ... ... ... 3 16 Suicides 3 ... ... ... ... 1 2 ... ... 1 ... ... 2 ... 1 ... ... ... ... ... ... 1 3 Homicide 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Heart Disease 13 ... ... ... ... 1 ... 4 8 8 1 1 2 1 2 ... ... ... ... ... ... 3 12 Other Defined Diseases 69 8 1 ... 2 1 ... 17 31 40 14 1 13 1 14 2 3 1 ... ... ... 14 67 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 221 29 2 1 11 15 36 58 69 112 54 13 40 2 64 7 6 1 1 ... 2 42 218 Note.—All "Transferable Deaths" of residents, i.e.,persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded. BOROUGH OF GREENWICH. Causes of, and Ages at, Death during the 13 weeks ended 1st January, 1927. Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents" 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 j 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 307 34 7 7 16 14 32 80 117 139 87 28 48 5 76 11 10 ... 6 4 9 47 272 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Whooping Cough 3 2 1 ... ... ... ... ... ... 1 1 1 ... ... 1 ... ... ... 1 ... ... ... 7 Diphtheria and Croup 6 ... ... 1 5 ... ... ... ... 5 ... ... 1 ... ... ... ... ... 5 ... ... 1 9 Influenza 4 ... ... ... ... ... 1 1 2 2 1 ... ... 1 ... ... ... ... ... 1 ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post Basic Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pul. Tuberculosis) 23 ... ... ... 1 5 14 ... ... 10 6 4 3 ... 5 ... ... ... ... ... ... 5 15 Tuberculous Meningitis 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 2 Other Tuberculous Diseases 2 ... ... ... 1 ... 1 ... ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Rheumatic Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer, Malignant Disease 26 ... ... ... ... ... 1 13 12 15 7 ... 3 1 3 1 3 ... ... 1 ... 3 26 Bronchitis 35 4 ... ... ... ... 1 8 22 15 9 3 8 ... 4 ... ... ... ... ... ... 3 15 Broncho-Pneumonia 15 5 4 1 ... 1 ... 2 2 6 6 2 1 ... 8 ... 1 ... ... ... ... 1 16 Pneumonia (all other forms) 7 1 1 ... ... ... ... 4 l 1 4 2 ... ... ... 2 1 ... ... ... ... 1 7 Other Diseases of Respiratory Organs 4 ... ... ... ... ... 1 3 ... 1 2 ... 1 ... ... 1 ... ... ... ... 1 ... 6 Diarrhoea and Enteritis 4 3 ... 1 ... ... ... ... ... ... 1 2 1 ... 1 1 ... ... ... ... ... 1 6 Appendicitis and Typhlitis 3 ... ... ... 1 ... 1 1 ... 1 1 ... 1 ... 3 ... ... ... ... ... ... ... 5 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 7 ... ... ... ... 1 ... 3 3 2 2 2 1 ... 3 ... 1 ... ... ... ... 1 5 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 3 ... ... ... ... 2 1 ... ... 2 1 ... ... ... 3 ... ... ... ... ... ... ... 3 Congenital Debility and Malformation, including Premature Birth 13 12 ... ... 1 ... ... ... ... 5 6 1 1 ... 4 ... 1 ... ... ... 2 ... 9 Violent Deaths, excluding Suicide 7 ... ... 2 1 ... 2 1 1 3 3 1 ... ... 1 1 2 ... ... ... ... 2 8 Suicides 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Homicide 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Heart Disease 23 ... ... ... 3 1 2 8 9 12 2 6 3 ... 3 1 ... ... ... ... ... 5 7 Other Defined Diseases 118 6 1 2 2 4 7 32 64 56 33 4 22 3 37 3 1 ... ... 2 6 22 122 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 307 34 7 7 16 14 32 80 117 139 87 28 48 5 76 11 10 ... 6 4 9 47 272 Note.—All "Transferable Deaths'' of residents, i.e.. persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded. BOROUGH OF GREENWICH. Causes of, and Ages at. Death during the 52 weeks ended 1st January, 1927. Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents" 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 1130 114 29 34 43 67 126 299 418 485 332 111 184 18 278 39 26 1 15 5 26 210 1035 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 13 ... 5 8 ... ... ... ... ... 2 4 6 1 ... 2 1 ... ... 2 ... ... 1 22 Scarlet Fever 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 2 Whooping Cough 4 3 1 ... ... ... ... ... ... 2 1 1 ... ... 2 ... ... ... 1 ... ... ... 10 Diphtheria and Croup 12 1 1 5 5 ... ... ... ... 10 ... 1 1 ... ... ... ... ... 11 ... ... 1 51 Influenza 12 ... ... 1 1 ... 1 4 5 4 5 ... 2 1 1 ... ... ... ... 2 ... 2 6 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Encephalitis Lethargica 3 ... ... ... ... 1 ... ... 2 2 1 ... ... ... 1 ... ... ... ... ... ... 1 2 Chicken Pox 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post Basic Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pul. Tuberculosis) 93 ... ... ... 4 30 36 19 4 36 28 13 16 ... 22 3 ... ... ... ... ... 17 16 Tuberculous Meningitis 7 ... 2 1 2 ... 1 1 ... 1 3 1 2 ... 3 ... ... ... ... ... ... 2 12 Other Tuberculous Diseases 17 1 1 ... 6 4 4 1 ... 10 5 ... 2 ... 2 2 1 ... ... ... ... 5 8 Rheumatic Fever 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Cancer, Malignant Disease 125 ... ... ... ... ... 14 63 48 56 41 7 18 3 31 4 6 ... ... 1 3 18 128 Bronchitis 119 8 1 ... 1 ... 3 30 76 53 33 13 17 3 28 ... ... ... ... ... 3 7 88 Broncho-Pneumonia 46 10 9 8 ... 1 1 5 12 18 17 7 3 1 18 1 2 ... ... ... ... 3 45 Pneumonia (all other forms) 33 2 2 ... 1 2 5 12 9 12 12 6 3 ... 5 5 1 ... ... ... ... 9 34 Other Diseases of Respiratory Organs 13 ... ... 1 ... 3 2 7 ... 7 4 ... 2 ... 2 1 ... ... ... ... 1 1 10 Diarrhoea and Enteritis 17 12 1 1 1 ... 1 ... 1 5 3 5 4 ... 7 1 1 ... ... ... ... 3 17 Appendicitis and Typhlitis 13 ... ... 1 3 2 3 3 1 6 4 ... 3 ... 7 ... ... ... ... ... ... 5 15 Alcoholism ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Cirrhosis of Liver 4 ... ... ... ... ... 1 3 ... 2 ... 1 1 ... 1 ... ... ... ... ... ... ... 2 Nephritis and Bright's Disease 26 ... ... ... ... 1 5 8 12 6 10 5 5 ... 8 ... ... ... ... ... ... 5 17 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Diseases of Pregnancy and Parturition 7 ... ... ... ... 4 3 ... ... 2 2 1 2 ... 3 ... ... ... ... ... 1 3 8 Congenital Debility and Malformation, including Premature Birth 47 46 ... ... 1 ... ... ... ... 19 17 5 6 ... 6 ... 1 ... ... ... 3 6 22 Violent Deaths, excluding Suicide 35 2 1 3 3 2 8 9 7 18 13 3 1 ... 7 3 4 ... ... ... ... 13 46 Suicides 11 ... ... ... ... 1 2 8 ... 2 5 1 3 ... 2 ... ... ... ... ... ... 2 7 Heart Disease 71 ... ... ... 4 3 5 29 30 28 21 11 10 1 11 3 ... ... ... ... ... 14 36 Homicide 2 2 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... Other Defined Diseases 396 26 5 4 10 13 30 97 211 181 102 24 80 9 107 15 10 1 1 2 15 91 383 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1130 114 29 34 43 67 126 299 418 485 332 111 184 18 278 39 26 1 15 5 26 210 1035 Note.— All "Transferable Deaths" of residents, i.e.. persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded. BOROUGH OF GREENWICH. 4 Cases of Infectious Disease notified during the 13 weeks ended 3rd April, 1926. Notifiable Diseases. Cases Notified in Whole District. Total Casks 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 05 65 and upwards Polio Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 175 7 49 97 16 6 ... ... 77 46 3 42 7 77 46 3 42 7 175 Encephalitis Lethargica 2 ... ... ... 1 1 ... ... 1 1 ... ... ... 1 1 ... ... ... 2 Erysipelas 21 1 2 ... ... 6 9 3 5 12 1 2 1 1 4 1 ... 1 7 Scarlet Fever 96 1 36 50 4 5 ... ... 45 20 5 21 5 42 20 5 20 5 92 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 ... ... ... ... 3 ... ... 1 1 ... 1 ... ... 1 ... 1 ... 2 Cerebro-Spinal Fever *1 ... ... ... *1 ... ... ... ... ... ... ... *1 ... ... ... ... *1 *1 Malaria 2 ... ... ... 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 859 38 384 421 12 4 ... ... 261 200 108 282 8 8 14 12 3 ... 37 Whooping Cough 20 6 13 1 ... ... ... ... 13 3 2 2 ... ... 1 ... ... ... 1 Diarrhœa 2 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis, Pulmonary 54 ... 1 11 14 20 7 1 17 16 4 17 ... 2 3 ... 1 ... 6 ,, Non-Pulmonary 14 ... '2 3 3 3 3 ... 5 2 ... 7 ... 1 1 ... 1 ... 3 Pneumonia, Acute Primary, or Acute Influenzal 26 1 7 4 2 3 7 2 9 6 4 7 ... 2 1 2 1 ... 6 Totals 1275 55 495 587 54 52 26 6 436 308 128 381 22 134 92 23 69 14 332 •Military Case BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 13 weeks ended 3rd July, 1926. 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 IS 15 to 25 25 to 45 45 to 65 65 and upwards Polio Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 115 2 31 59 15 8 ... 63 20 8 22 7 63 20 3 22 7 115 Encephalitis Lethargica 3 ... ... 1 ... 1 ... 1 1 2 ... ... ... 1 1 ... ... ... 2 Erysipelas 19 1 1 ... 1 1 10 5 11 4 8 1 ... 2 ... ... ... ... 2 Scarlet Fever 79 1 26 47 5 ... ... ... 28 16 9 21 5 26 16 9 21 5 77 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... 1 1 ... ... ... 1 ... ... ... 1 1 ... ... ... 1 2 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria 3 ... ... ... ... 2 ... ... 1 2 ... ... ... 1 ... ... ... ... 1 Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 380 11 168 191 8 2 ... ... 141 83 15 127 14 4 3 ... 2 ... 9 Whooping Cough 10 3 5 2 ... ... ... ... 5 3 ... 2 ... 1 ... ... ... ... 1 Diarrhœa 5 1 4 ... ... ... ... ... 3 1 ... 1 ... ... ... ... ... ... ... Ophthalmia Neonatorum 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Tuberculosis, Pulmonary 40 1 ... 7 7 17 7 1 15 12 4 8 1 3 4 1 ... ... 8 „ Non-Pulmonary 13 ... 1 5 3 4 ... ... 5 i 1 3 ... 3 2 1 1 ... 7 Pneumonia, Acute Primary, or Acute Influenzal 44 3 7 8 4 13 6 3 14 15 2 12 1 5 7 ... 7 ... 19 Totals 714 24 243 321 44 48 24 10 288 162 37 198 29 110 53 14 53 13 243 BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 13 weeks ended 2nd October, 1926. 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 upwards Polio Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 79 ... 21 46 5 6 1 ... 29 19 4 23 4 29 19 4 23 4 79 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 9 ... 1 1 1 2 1 3 3 4 2 ... ... 1 2 ... ... ... 3 Scarlet Fever 60 1 15 36 6 2 ... ... 22 15 5 16 2 22 15 5 14 2 58 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... ... ... 1 1 ... 1 1 ... ... ... 1 1 ... ... ... 2 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 2 ... ... ... ... 2 ... ... ... 1 1 ... ... ... 1 1 ... ... 2 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 35 6 18 11 ... ... ... ... 18 6 4 7 ... ... ... ... ... ... ... Whooping Cough 22 3 17 2 ... ... ... ... 14 6 1 ... 1 1 1 ... ... ... 2 Diarrhœa 72 25 47 ... ... ... ... ... 38 9 13 12 ... 2 ... 2 ... ... 4 Ophthalmia Neonatorum 5 5 ... ... ... ... ... ... 1 1 ... 3 ... 1 ... ... ... ... 1 Tuberculosis, Pulmonary 37 ... ... 1 20 9 ... 1 18 12 1 6 ... 4 ... ... ... ... 4 ,, Non-Pulmonary 10 ... 3 ... 3 ... ... ... 5 3 1 1 ... 2 ... 1 ... ... 3 Pneumonia, Acute Primary, or Acute Influenzal 8 1 3 1 1 ... 2 ... 3 1 ... 4 ... 1 1 ... 3 ... 5 Totals 341 41 125 102 36 22 11 4 152 78 32 72 7 64 40 13 40 6 163 BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the 13 weeks ended 1st January, 1927. 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 upwards Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 134 1 21 88 15 8 1 ... 51 35 11 34 3 49 35 11 34 3 132 Dysentery 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 Encephalitis Lethargica 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... Erysipelas 16 1 ... 3 1 2 6 3 8 3 4 1 ... 2 ... 1 ... ... 3 Scarlet Fever 136 ... 40 80 10 5 1 ... 60 25 9 35 7 59 25 9 35 7 135 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 3 ... ... 1 ... 2 ... ... ... 1 ... 2 ... ... 1 ... 2 ... 3 Puerperal Fever 4 ... ... ... 1 3 ... ... 1 ... 1 2 ... 1 ... 1 1 ... 3 ,, Pyrexia 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... 1 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Malaria 3 ... ... ... ... 2 1 ... ... 2 1 ... ... ... ... ... ... ... ... Measles 25 5 6 13 1 ... ... ... 12 8 5 ... ... ... ... ... ... ... ... Whooping Cough 74 14 35 24 l ... ... ... 43 13 5 13 ... 9 7 4 1 ... 21 Diarrhoea 34 14 20 ... ... ... ... ... 19 5 4 6 ... ... ... 1 ... ... 1 Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Polio Myelitis 2 ... 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... Tuberculosis, Pulmonary 46 ... 2 8 14 17 5 ... 21 11 3 10 1 5 2 ... ... 1 8 ,, Non-Pulmonary 17 ... 5 6 5 1 ... ... 10 2 ... 5 ... 3 ... ... 3 ... 6 Pneumonia, Acute Primary, or Acute Influenzal 42 2 17 7 5 4 4 ... 8 14 8 11 1 ... 5 2 3 ... 10 Totals 539 37 147 232 53 45 18 7 234 122 51 120 12 128 77 29 79 11 324 BOROUGH OF GREENWICH. Cases of infectious Disease notified during the 52 weeks ended 1st January, 1927. 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 upwards Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 503 10 122 290 51 28 2 ... 220 120 21 121 21 218 120 21 121 21 501 Dysentery 1 ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 Encephalitis Lethargica 6 ... ... 1 1 2 ... 2 3 3 ... ... ... 2 2 ... ... ... 4 Erysipelas 65 3 4 4 3 11 26 14 27 23 10 4 1 6 6 2 ... 1 15 Scarlet Fever 371 3 117 213 25 12 1 ... 155 76 28 93 19 149 76 28 90 19 362 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 7 ... ... 2 1 3 1 ... 2 2 ... 2 1 2 2 ... 2 1 7 Puerperal Fever 9 ... ... ... 1 8 ... ... 2 2 2 3 ... 1 2 2 2 ... 7 ,, Pyrexia 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... 1 Cerebro-Spinal Fever *1 ... ... ... *1 ... ... ... ... ... ... ... *1 ... ... ... ... *1 *1 Malaria 8 ... ... ... 1 5 2 ... 2 4 2 ... ... 1 ... ... ... ... 1 Measles 1299 60 576 636 21 6 ... ... 432 297 132 416 22 12 17 12 5 ... 46 Whooping Cough 126 26 70 29 1 ... ... ... 75 25 8 17 1 11 9 4 1 ... 25 Diarrhœa 113 41 72 ... ... ... ... ... 61 16 17 19 ... 2 ... 3 ... ... 5 Ophthalmia Neonatorum 6 6 ... ... ... ... ... ... 1 1 ... 4 ... 1 ... ... ... ... 1 Polio Myelitis 2 ... 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... Tuberculosis, Pulmonary 177 1 3 27 55 63 25 3 71 51 12 41 2 14 9 1 1 1 26 „ Non-Pulmonary 54 ... 11 18 14 8 3 ... 25 11 2 16 ... 9 3 2 5 ... 19 Pneumonia, Acute Primary, or Acute Influenzal 120 7 34 20 12 20 19 8 34 36 14 34 2 8 14 4 14 ... 40 Totals 2869 157 1010 1242 187 167 79 27 1110 670 248 771 70 436 262 79 241 44 1062 BOROUGH OF GREENWICH. INFANTILE MORTALITY DURING THE YEAR 1926 Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 Week 1—2 Weeks 2—3 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 33 9 4 1 47 26 17 13 11 114 Uncertified ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small-Pox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... 1 ... ... ... 1 Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 1 ... 1 3 Diphtheria—Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Diseases. Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... 1 Meningitis (not Tuberculous) ... 1 ... ... 1 1 ... 2 ... 4 Convulsions ... ... ... ... ... ... ... ... ... ... Diseases of Trachea ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 2 1 3 3 1 1 ... 8 Pneumonia, all forms ... ... ... ... ... 3 2 2 5 12 Diarrhœal Diseases. Diarrhœa, all forms ... ... ... ... ... 1 3 3 1 8 Enteritis ... ... ... ... ... 1 1 2 ... 4 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis 1 ... ... ... 1 1 1 ... 1 4 Rickets ... ... ... ... ... ... ... 1 1 Suffocation, overlaying ... ... ... ... ... 2 ... ... ... 2 ,, otherwise ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Actelectasis 6 ... ... ... 6 ... ... ... ... 6 Congenital Malformations ... 1 ... ... 1 1 1 ... 3 Premature Birth 16 5 ... ... 21 1 1 ... ... 23 Atrophy, Debility and Marasmus 7 1 ... ... 8 6 5 1 1 21 Other Causes 3 1 3 ... 6 4 1 1 ... 12 Totals 33 9 4 1 47 26 17 13 11 114 Boys 64 Girls 50 114