AC 4373 GRE 32 Metropolitan Borough of Greenwich. ANNUAL REPORT . . ON THE . . HEALTH OF THE BOROUGH For the Year 1934 By M. MACDONALD M.D., D.P.H. MEDICAL OFFICER OF HEALTH. LONDON: E. G. Berryman Be Sons, Ltd. Blackheath Road S.E.10 Metropolitan Borough of Greenwich. ANNUAL REPORT . . ON THE . . HEALTH OF THE BOROUGH For the Year 1934 By M. MACDONALD m.d., d.p.h. MEDICAL OFFICER OF HEALTH LONDON: E. G. Berryman & Sons, Ltd. Blackheath Road S.E.10 CONTENTS. Pages Public Health Staff 3-4 Public Health, Maternity and Child Welfare Committee 5-8 Introductory 9-10 Section A.—Natural and Social Conditions of the Area 11 Vital Statistics 12-21 ,, B.—General Provisions of Health Services in the Area. 22-24 C.—Sanitary Circumstances of the Area 25-38 D.—Housing 39-47 ,, E.—Inspection and Supervision of Food 48-69 ,, F.—Prevalence of, and Control Over, Infectious Diseases 70-92 ,, G.—Maternity and Child Welfare 93-107 Appendix I 108-109 3 Staff of the Public Health Department. Medical Officer of Health and Administrative Medical Officer, Tuberculosis, and Maternity and Child Welfare : M. Macdonald, M.D., Ch.B., D.P.H. Tuberculosis Officer : F. R. Waldron, M.B., B.Ch., D.P.H. Maternity and Child Welfare Medical Officer : Janet M. Morton, M.B., Ch.B. (Edin.), D.P.H. Assistant Maternity and Child Welfare Medical Officers : J. G. Dathan, M.R.C.S., L.R.C.P., M.M.S.A. †gladys M. Cox, M B., B.s. (Lond.) †lsoBEL C. Johnson, M.B., Ch.B. Pathologist : †frank Standish, M.B., B.S., D.P.H. Public Vaccinators : †william Cowie, M.A., M b., C M. †joHN S. Davies, M.A., M.B., C.M. †D. Morien Thomas, M B., M.R.C.S., L.R.C.P. Gynecologist : †Victor J. F. Lack, M.B., B.S., F.R.C.S., M.R.C.P. Obstetric Consultants : †margaret Basden, M.B., B.S., F.R.C.S., M.D. †Frank Cook, B.Sc., M.B., B.S., F.R.C.S. †Arthur J. McNair, B.A., M B., B.Ch., F.R.C.S. Tumour Clinic Consultant : †Robert Davies-Colley, C.M.G., M.Ch., M.A., F.R.C.S. Dental Surgeon : †G. F. Ferris, L.D.S., R.C.S. (Eng.) Public Analyst : †A. E. Brown, B.Sc., F.I.C. Sanitary Inspectors : a E. Martin. ab W. H. Collins. abce S. A. Radford. ab Miss G. Davis. abcde W. R. Drake. be H. L. Bennett (Food). In E. Saphier. Housing Inspector : be A. E. Morgan. Vaccination Officer : †E. S. Elliott. Health Visitors .' fh Mrs. M. D. Morison. fgh Miss A. M. M. Hadfield. fgh Miss F. C. Jagot. ghk Miss M. E. Hollow. fgh Miss A. Jenkins. _ (died 30/3/34) fgh Miss E. Bailey. A Miss K. Walton. ghk Miss P. N. Steer. 4 TUBERCULOSIS DISPENSARY : Nurses : fg Miss T. I. Husbands. afgh Miss D. M. Wilkins. ghk Mrs. D. E. Shepherd. Dispenser : Caretaker : W. H. Green, M.P.S. Mrs. G. W. Vickery. ARTIFICIAL SUNLIGHT TREATMENT : Nurse-in-Charge gij Miss L. D'Oyly Watkins. Assistant Nurses : gj†Miss L. Mallett. gij †Miss C. Meikle. MATERNITY HOME : Matron : Sister : ghm Miss Q. M. Anstice. gh Miss F. A. Bonsom. CLERICAL STAFF: F. W. Foulger (Principal Clerk). aH. W. Duck. E. P. Tidman. Miss L. Merricks. Miss M. W. W. Lawson. Mrs. L. E. Wright. Miss G. Sibborn (Milk Saleswoman.) L. A. Westacott. E. W. Pike. J. Hannen. Disinfecting Staff : T. Smith. G. Hook. T. G. Griggs. A. Moore. T. Packham (Motor Driver). Caretaker at Cleansing Station : Mrs. E. Robinson. Mortuary Keeper : W. J. Lawley. a Cert. Royal Sanitary Institute. b Cert. Sanitary Inspectors' Examination Board. c Cert. R.S.I. Meat and other Foods. d Cert. Sanitary Inspectors' Association Examination Board (Prizeman). e Smoke Inspector's Certificate. / Cert. R.S.I. Health Visitors and School Nurses. g General Nursing Training (3 years). h Certified Midwife. i Bio-Physical Assistant. j Chartered Society of Massage and Medical Gymnastics. k Cert. R.S.I. Health Visitors. I Cert. R.S.I, and Sanitary Inspectors' Examination Joint Board. m Approved Teacher of Midwifery. n Cert. R.S.I. Sanitary Science. All the members of the Staff of the Department are whole time Officers with the exception of those marked †. 5 Public Health, Maternity and Child Welfare Committee during the Year, 1933-34. The Mayor t *Councillor R. J. Cummings, J.P., and 13 Members. *Alderman Mrs. P. M. Beacham (Chairman) Councillor Mrs. C. H. Thackeray (Vice-Chairman). Alderman s M. G. Byerley, J.P., F.R.C.V.S. Councillors : *W. Aylett. *Lt.-Col. M. C. Matthews, V.D. "Mrs. F. Carter. *Miss M. Sherman. J. R. Dabin. *Mrs. C. R. Turner, J.P. H. D. Hardee. G. F. Westmacott. *Mrs. A. Kennedy. D. A. Whitenstall. * Denotes Members who served on the Assistance Sub-Committee. Powers and Duties of the Public Health, Maternity and Child Welfare 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 ; Food and Drugs (Adulteration) Act, 1928 ; the sale of Horseflesh, etc., Regulation Act, 1889 ; such matters arising under the Housing of the Working Classes Acts, 1890 and 1894, and the Working Classes Dwelling Act, 1890 ; Housing and Town Planning Acts ; Parts 2 and 5 of the Housing Act, 1930, so far as they relate to the repair and demolition of insanitary houses ; the Public Health (London) Acts ; the Metropolis Management Acts relating to defective drainage ; the Canal Boat Acts ; the Factory and Workshop Acts ; Rent and Mortgage Interest Restrictions Acts, 1920—1933; the Rats and Mice (Destruction) Act, 1919 ; Merchandise Marks Act, 1926 ; Agricultural Produce (Grading and Marking) Act, 1928 ; the sanitary provisions of any other Act of Parliament ; the powers of the Council under the Orders of the Local Government Board or Ministry of Health dealing with Tuberculosis ; Milk and Dairies Order, 1926 ; 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. 6 3.—The Committee may serve and receive notices, take proceedings, and in particular cases empower any Officer of the Council to make complaints and take proceedings on their behalf under, and otherwise execute, the Public Health (London) Act, 1891, and sections 82, 83, 84 and 85 of the Metropolis Management Act, 1855, relating to the inspection of any premises, drains, sinks, traps, syphons, pipes, or other works or apparatus connected therewith, and otherwise in relation to defective drainage, except as to the recovery of expenses, and the same shall not require the approval 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. 9.—There shall be referred to the Committee such functions relating to vaccination as are transferred to the Council by Section 2, Local Government Act, 1929. 10.—There shall be referred to the Committee such functions transferred to the Council under the Transfer of Powers (London) Order, 1933, as follow : — (a) Enforcement of By-laws made by the London County Council relating to seamen's lodging houses, licensing and inspection of seamen's lodging houses and the supervision of the sanitary condition of such lodging houses in accordance with the by-laws for the time being in force. (b) Registration, licensing, inspection and regulation of common lodging houses and the enforcement of by-laws relating to such houses but exclusive of the powers of making by-laws under Section 53 of the London County Council (General Powers) Act, 1902. 7 (c) Licensing of dairymen to use premises as a cow house or place for the keeping of cows. (d) Reception of notices given by persons who undertake for reward the nursing and maintenance in a dwelling of infants and the inspection of premises by infant protection visitors or other persons appointed by the Council for that purpose. Fixing the number of infants to be kept in a dwelling house in which any infant is received for reward. Applications to a Court or Justice for an Order directing the removal of an infant to a place of safety. (e) Consideration of and decision upon applications for sanction to the establishment anew or enlargement of certain offensive businesses or imposition, modification or removal of conditions. (/) Licensing of slaughterers of cattle or horses and of knackers to use premises as a slaughter house or knacker's yard. Licensing of persons to use premises for receiving or keeping horses for slaughter or the carcases of dead horses.. 11.—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. 12.—Powers and duties mentioned in Section 6 of the Widows',. Orphans' and Old Age Contributory Pensions Act, 1925. 13.—The provision of artificial sunlight treatment for adult residents of the Borough in accordance with Section 75, Public Health (London) Act, 1891. 14-—The execution of the duty under Section 12 of the Rent and Mortgage Interest Restrictions (Amendment) Act, 1933, to issue certificates as to the state of repair of houses to which the Rent and Mortgage Interest Restrictions Acts apply. 15.—The execution of the powers and duties of the Council under the provisions of the Slaughter of Animals Act, 1933. '6-—The execution of the powers and duties of the Council under the provisions of the Pharmacy and Poisons Act, 1933 ; and that each of the Council's Sanitary Inspectors be hereby 8 appointed an Inspector under Section 25(5) of the Pharmacy and Poisons Act, 1933, for the purpose referred to therein. 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, etc., Acts. London County Council (General Powers) Acts. Rag Flock Act, 1911. Public Health (Tuberculosis) Regulations, 1930. 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 (Special Designations) Order, 1923. Milk and Dairies Order, 1926. Public Health (Condensed Milk) Regulations, 1923. „ „ (Dried Milk) „ „ ,, „ (Meat) Regulations, 1924. ,, (Imported Food) Regulations, 1925. ,, „ (Imported Milk) Regulations, 1926. „ „ (Preservatives, etc., in Food) Regulations. ,, „ (Smoke Abatement) Act, 1926. Artificial Cream Act, 1929. Public Health (Prevention of Infectious Diseases) Regulations, 1934. 9 Public Health Offices, Borough Hall, Royal Hill, Greenwich, S.E.10. May, 1935. To the Mayor, Aldermen and Councillors Metropolitan Borough of Greenwich. Ladies and Gentlemen, I have the honour to present herewith my Annual Report on the health of the Borough for the year 1934. The Report has been compiled in compliance with Circular 1417 of the Ministry of Health, dated October, 1934, and as defined in that circular is an " ordinary" report. The Ministry's programme stipulates that for each series of 5 years from 1925 onwards there shall be published one " survey" to four " ordinary" reports. Ordinary reports are expected to deal with the sanitary circumstances, the sanitary administration and the vital statistics of the district for the year under review, together with any alteration or extension of the existing services. The general improvement in the Public Health of the Borough continues to be maintained and the year may be described as a fairly healthy one. The Birth Rate is 13.71 per 1,000 of the population which is the same figure as recorded last year. The average for the last ten years is 16.40. The Birth Rate for the County of London is 13.2 and 14.8 for all England and Wales. The Crude Death Rate is 12.23 per 1,000 of the estimated population. This rate when applying the Registrar General's Comparability Factor is adjusted to 12.47. The Death Rates for the County of London and for England and Wales are 11.9 and 11.8 respectively. The average Death Rate for the Borough for the last ten years is 11.31 per 1,000 of the population. 10 The Infant Mortality Rate for the Borough measured by the number of deaths under one year to 1.000 births registered, is 87 compared with 66 last year, and 63 the average for the last ten years. The Infant Mortality Rate for the County of London is 67 ; that for 121 large towns, 63. The total number of deaths arising from the class known as the Common Infectious Diseases was 60 as compared with 43 for the previous year. This Death Rate is .61 per 1.000 of the population. There is still a considerable amount of overcrowding in spite of the number of houses erected in the Borough by the Borough Council and by private enterprise. The progress of the Council's Housing Schemes is indicated in the Report. During the year the appointment of a temporary Housing Inspector was created a permanent one and to deal more effectively with the sanitary conditions of the Borough, the Public Health Committee is considering the appointment of 2 additional Inspectors to commence duty early in 1935. Maternity and Child Welfare work has continued to grow in extent and usefulness. A new combined Infant Welfare and Artificial Sunlight Centre was completed in December and was opened early in the New Year. A weekly clinic for " toddlers " is new held at Shooter's Hill Road and Borough Hall Centres and is proving very successful. The Infant Mortality is higher this year than it has been for some time past. Fluctuations in this rate are to be expected and the causes of the increased rate this year are referred to in the body of the Report. In conclusion I would again take this opportunity of expressing my indebtedness to the Chairman and members of the Public Health, Maternity and Child Welfare Committee for the help and consideration given me, and my sincere thanks are also given to every member of the staff of the Department for their assistance and cooperation in carrying out the duties of my office. I have the honour to be Your obedient Servant. M. Macdonald. 11 SECTION A. STATISTICS 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 1,990 „ 3,858 acres Population— At Census, 1931 100,924 Estimated, 1934 97,250 Density of Population— East Greenwich 30 persons per acre West Greenwich 53 „ „ St. Nicholas, Deptford 55 „ „ Charlton and Kidbrooke 13 „ „ Average for the Borough 25 persons per acre Number of Inhabited Houses—1934 19,249 Structurally separate dwellings at Census, 1931 18,114 Number of Uninhabited Houses— At Census, 1931 250 Estimated, 1934 270 Number of Families or Separate Occupiers— At Census, 1931 25,144 Rateable Value £957,349 Sum Represented by a Id. Rate £3,872 12 SOCIAL CONDITIONS. The Metropolitan Borough of Greenwich comprises three districts, viz., Greenwich, Charlton and Kidbrooke, and St. Nicholas, Deptford, all of which are now united into one civil parish. The altitude varies from a few feet below high-water mark on the marshes, up to 249 feet above sea level on the Shooter's Hill Road by the Borough boundary. The industries and sources of employment in the Borough are to be found in close proximity to the River Thames which forms the Borough boundary on the north side. Chief among these are large Cable and Engineering Works, Gasworks, Soap and Candle Works, L.C.C. Generating Station and Tramway Car Repair Depot, The London Power Company's Works, Glass Bottle Works, Linoleum Manufacturing Works, Merryweathers' Works (Fire Engines), Cement and Stone Works, Asbestos Works, etc. POPULATION. In accordance with the usual custom, the Registrar General has submitted his estimate of the resident population of the Borough computed at mid year, 1934. The figure returned is 97,250, which shows a decrease of 580 persons since last year. The following is the local distribution : -— Estimated Population at Mid Year, 1934 East Greenwich 40,179 West Greenwich 24,059 St. Nicholas, Deptford 6,335 Charlton and Kidbrooke 26,677 97,250 *extracts from vital statistics of the year. Total M. F. Live Births ( Legitimate 1,289 671 618 } Birth Rate 13.7 (Illegitimate 48 29 19) Still-Births 33 20 13} Rate per 1,000 total Births 24.0 Deaths 1,186 633 553 Death Rate 11.9 13 Deaths from Puerperal Causes : — Rate per 1,000 total Births. Puerperal Sepsis 1 0.7 Other Puerperal Causes 2.2 Total 4 2.9 Death Rate of Infants under one year of age : — All Infants per 1,000 live births 86 Legitimate Infants per 1,000 legitimate live births 81 Illegitimate Infants per 1,000 illegitimate live births 229 Deaths from Measles (all ages) 16 „ „ Whooping Cough (all ages) 6 „ „ Diarrhoea (under 2 years of age) 30 * These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. MARRIAGES. Mr. E. A. Bale, the Superintendent-Registrar of the Greenwich Registration District, has kindly furnished me with the particulars relating to the number of marriages solemnised in the Borough of Greenwich. The following table shows these particulars giving the number of marriages in the Borough for each year since 1926 : — Year Churches of England Marriages in Superintendent - Registrar's Office of parties resident in Greenwich or outside the Registration District, and in Chapels and Roman Catholic Churches Total Approximate Population of the districts concerned Greenwich Charlton and Kidbrooke St. Nicholas J 1926 382 95 48 271 796 104500 1927 388 91 45 239 763 103700 1928 356 84 52 246 738 103900 1929 362 127 44 268 801 104430 1930 351 150 41 .321 863 104430 1931 291 138 34 309 772 100640 1932 312 152 30 265 759 101024 1933 286 136 48 331 801 97830 1934 .331 143 39 338 851 97250 14 BIRTHS. The total number of births registered in the Borough during the year was 1,847. Of this number 640 occurred in St. Alfege's Hospital, 387 in the Borough Maternity Home, and 169 at various Nursing Homes within the Borough. Of this total of 1,196 Institution births, 534 only belonged to Greenwich, the remainder being transferred to the appropriate localities. One hundred and forty-four births belonging to the Borough took place in Institutions outside the Borough area, thus the actual figure for Greenwich becomes 1,329 :—Males, 696 ; Females, 633. This figure gives a Birth Rate of 13.7 per 1,000 of the population, and once again is the lowest on record. The previous year's Birth Rate was 13.71 and the average for the last ten years 16.40. The Birth Rate for the County of London equals 13.2 per 1,000 of the population. The Birth Rate for all England and Wales was 14.8. Illegitimate births numbered 48, representing 3.6 per cent of the total births. Seventy-one illegitimate births actually were registered in the Borough. In 32 cases, however, the mothers were ordinarily resident outside the Borough and these births were consequently allocated to the correct area. Nine illegitimate births belonging to Greenwich occurred outside the Borough, thus giving the net figure of 48. Forty illegitimate births occurred in St. Alfege's Hospital. Under the Births and Deaths Registration Act, 1926, which came into operation on the 1st July, 1927, the registration of still-births became compulsory. Thirty-five such still-births were registered during the year, representing a percentage of 2.9 of the total births registered. Each of such cases is separately investigated with a view to finding out whether what is thought to have been the cause for such still-birth is of a preventable nature, and if so, an endeavour is made to take such appropriate action as will guard against a recurrence of this condition. Under the provisions of the Notification of Births Act, 1907, intimations have been received from medical men, parents and others, with respect to 1,891 births ; 60 were in respect of still-births, of which number 29 were referred to other Boroughs. 15 DEATHS. The net number of deaths registered during 1934 was 1,186 of which 637 were males and 549 females. This gives a crude Death Rate for the Borough of 12.23, which figure is slightly increased to 12.47 when the comparability factor furnished by the Registrar General for adjusting Local Deaths is taken into account. The adjusted Death Rate is in effect a "corrected" Death Rate. The Registrar General in a memorandum points out that if the populations of all areas were similarly constituted as regards the proportions of their sex and age group components their crude death rates (deaths per 1,000 population) could be accepted as valid comparative measures of the mortalities experienced by the several populations. Populations, however, are not similarly constituted and their crude Death Rates therefore fail as true comparative mortality indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution. For instance a Town with a population consisting of aged persons would register more deaths than one composed entirely of young and vigorous adults. Again a town containing a larger number of males than females records more deaths with a consequent higher Death Rate than one in which females preponderate. To overcome this difficulty the Registrar General has worked out for each area in the Country an adjusting factor which is termed the Comparability Factor and is based on the last census population figure. The Comparability Factor for Greenwich is 1.02 and may be regarded as the population handicap to be applied, which, when multiplied by the crude Death Rate for the year, modifies the latter so as to make it comparable with the Country as a whole or any other similarly adjusted area. The Death Rates for the County of London and for England and Wales are 11.9 and 11.8 respectively. The following table showing causes of death at all ages has been supplied by the Registrar-General, and is included in accordance with the request contained in the Ministry of Health's Circular No. 1,417. 16 It has been customary to include in the Report tables compiled by the Registrar General showing the comparative rates for Births, Deaths, and Infantile Mortality of the various Metropolitan Boroughs. Unfortunately at the time of going to press this information is not to hand, but through the courtesy of Dr. Allan Young, the Medical Officer of Health for Poplar, who has obtained the particulars direct from the Boroughs concerned, I am enabled to give the comparative figures in the following table. Cities and Boroughs Est. Resident Population (mid 1934) Live Births (rate) Death Rate : Infantile Mortality per 1,000 Births Crude Adjusted West Districts. Paddington 139,790 13.7 12.4 12.3 95 Kensington 179,080 12.3 13.3 12.5 93 Hammersmith 129,170 13.8 12.9 13.3 77 Fulham 145,400 13.7 12.6 12.7 59 Chelsea 58,160 10.8 13.4 11.4 65 Westminster 124,050 9.4 11.8 12.1 66 North Districts. St. Marylebone 92,320 9.0 12.7 12.6 61 Hampstead 90,000 10.4 11.3 10.6 53 St. Pancras.. 187,540 13.1 12.84 13.19 65 Islington 314,200 14.7 11.8 11.9 62 Stoke Newington 50,620 13.7 11.5 11.0 60.6 Hackney 211,120 14.2 11.7 12.2 56 Central Districts. Holborn 36,000 8.58 12.2 ? 71 Finsburv 64,970 15.1 13.4 14.6 51 City of London 9,660 6.8 10.5 11.6 121 East Districts. Shoreditch 90,630 16.1 13.1 14.4 84 Bethnal Green 102,060 14.3 11.8 13.3 72.6 Stepney 214,990 15.3 12.3 14.3 87.2 Poplar 146,370 15.5 12.3 13.7 62 South Districts. Southwark 159,930 14.9 13.5 14.4 77 Bermondsey 105,060 14.8 12.4 14.1 64 Lambeth 283,900 14.21 12.78 12.65 63.38 Battersea 150,870 14.3 12.5 12.3 61.3 Wandsworth 345,250 10.98 11.18 10.39 57 Camberwell 238,360 13.22 12.31 12.31 67 Deptford 101,380 15.8 13.1 13.6 68 GREENWICH 97,250 13.71 12.23 12.47 87 Lewisham 222,180 12.2 10.0 10.1 43 Woolwich 145,520 13.7 11.3 12.0 63 Causes of Death. Sex Deaths at Subjoined ages of " Residents," whether occurring within or without 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 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and over. All Causes M 633 64 10 7 17 30 23 47 68 98 138 131 F 563 52 9 11 19 24 28 30 47 75 93 165 Typhoid and Paratyphoid Fevers M 1 .. .. .. .. .. .. .. 1 .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Measles M 8 2 4 1 1 .. .. .. .. .. .. .. F 8 1 4 2 1 .. .. .. .. .. .. .. Scarlet Feverc M 2 .. .. 1 1 .. .. .. .. .. .. .. F 1 .. .. .. 1 .. .. .. .. .. .. .. Whooping Cough M 3 1 2 .. .. .. .. .. .. .. .. .. F 3 1 1 1 .. .. .. .. .. .. .. .. Diphtheria M 2 .. .. 1 1 .. .. .. .. .. .. .. F 3 .. .. 2 1 .. .. .. .. .. .. .. Influenza M 6 .. .. .. 1 .. .. .. .. 2 2 1 F 8 1 1 .. .. .. 1 .. 1 1 1 2 Encephalitis Lethargica M. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever M. .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of M 41 .. 1 .. .. 12 5 6 10 4 3 .. Respiratory System F 32 .. .. .. 2 10 11 .. 4 2 1 2 Other Tuberculous Diseases M 9 2 .. .. 3 .. 1 1 .. 1 1 .. F 3 .. .. 1 .. 2 .. .. .. .. .. .. Syphilis M 2 .. .. .. .. .. .. 2 .. .. .. .. F 1 .. .. .. .. .. .. .. .. .. .. 1 General Paralysis of the M 3 .. .. .. .. .. .. 2 .. 1 .. .. Insane, tabes dorsalis F .. .. .. .. .. .. .. .. .. .. .. .. Cancer, malignant disease .. M 77 .. .. .. .. .. 2 4 10 18 30 13 F 82 .. .. .. 1 .. 3 8 10 24 22 14 Diabetes M 3 .. .. .. .. 1 .. .. .. .. 2 .. F 8 .. .. .. .. .. .. 3 .. 2 2 1 Cerebral Haemorrhage, etc. M 31 .. .. .. .. .. .. 1 2 6 11 11 F 26 .. .. .. .. .. .. 1 2 5 8 10 Heart Disease M 135 .. .. .. 1 2 3 6 12 27 34 50 F 135 .. .. .. 3 4 3 4 11 23 27 60 Aneurysm M 6 .. .. .. .. .. .. 1 1 .. 3 1 F 1 .. .. .. .. 1 .. .. .. .. .. .. Other Circulatory Diseases M 13 .. .. .. .. .. .. .. 1 2 5 5 F 14 .. .. .. .. .. .. .. .. 2 3 9 Bronchitis M 44 4 .. .. .. .. .. .. 4 4 13 19 F 17 1 .. .. .. .. .. .. 1 .. 2 13 Pneumonia (all forms) M 54 14 2 2 .. 1 2 6 2 11 7 7 F 39 10 2 2 1 2 3 5 2 1 3 8 Other Respiratory Diseases M 6 .. .. 1 2 .. .. .. 1 I 1 .. F 4 .. .. .. .. .. .. .. 1 1 .. 2 Peptic Ulcer M 12 .. .. .. .. .. .. 2 4 4 2 .. F 5 .. .. .. .. .. .. .. 2 1 I 1 Diarrhoea, etc. M 14 14 .. .. .. .. .. .. .. .. .. .. F 18 15 1 .. .. .. .. 1 .. .. .. 1 Appendicitis M 5 .. .. .. 3 .. .. .. .. .. 1 1 F 2 .. .. .. .. .. .. 1 .. .. 1 .. Cirrhosis of Liver M 4 .. .. .. .. 1 .. .. 1 .. 1 1 F 1 .. .. .. .. .. .. .. .. .. 1 .. Other Diseases of Liver, etc. M 1 .. .. .. .. .. .. .. .. .. .. 1 F 7 1 .. 1 .. .. .. .. 2 2 1 .. Other Digestive Diseases M 9 2 .. .. .. .. .. 1 .. 2 3 1 F 12 .. .. 1 1 .. .. 1 2 1 3 3 A. and Cr. Nephritis M 25 .. .. .. 1 1 .. 4 6 4 4 5 F 12 .. .. .. .. .. 2 .. 1 4 1 4 Puerperal Sepsis F 1 .. .. .. .. .. 1 .. .. .. .. .. Other Puerperal Causes F 3 .. .. .. .. .. 1 2 .. .. .. .. Congenital Debility, M 20 20 .. .. .. .. .. .. .. .. .. .. ture Birth, Malformations, etc. F 18 17 .. .. .. 1 .. .. .. .. .. .. Senility M 8 .. .. .. .. .. .. .. .. .. 1 7 F 27 .. .. .. .. .. .. .. .. .. 3 24 Suicide M 11 .. .. .. .. 1 2 .. 4 2 2 .. F 4 .. .. .. .. 1 .. .. .. 1 2 .. Other Violence M 35 1 1 1 1 6 4 5 3 3 5 5 F 14 3 .. .. 1 1 .. .. 2 2 1 4 Other Defined Diseases M 43 4 .. .. 2 5 4 6 6 6 7 3 F 44 2 .. 1 7 2 3 4 6 3 10 6 Diseases ill-defined or unknown M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 17 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 1929 1,387 764 1930 1,036 602 1931 1,134 633 1932 1,194 761 1933 1,167 707 1934 1,186 723 Average 1,184 698 AGE MORTALITY. The age mortality and the distribution of the deaths between the different quarters of the year is shown by the following table: — Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 27 30 32 27 116 Between 1 and 2 years 4 8 5 2 19 Between 2 and 5 years 9 7 I 1 18 Between 5 and 15 years 10 12 9 5 36 Between 15 and 25 years .. 17 15 11 11 54 Between 25 and 45 years .. 38 25 26 42 131 Between 45 and 65 years .. 85 62 59 80 286 65 years and upwards 157 146 100 123 526 Total 347 305 243 291 1,186 18 Locally the Death Rate varied from 10.64 in Charlton and Kidbrooke, 12.17 in East Greenwich, 13.14 in St. Nicholas, Deptford, to 13.84 in West Greenwich. Of the total number of deaths, 11 were of illegitimate birth, all 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 1929 to 1933 compared with the figures for 1934 : — District 1929 1930 1931 1932 1933 Average for 5 years 1934 East Greenwich 12.94 10.01 10.90 12.88 11.67 11.68 12.17 West Greenwich 13.61 9.86 13.80 11.43 12.55 12.25 13.84 St. Nicholas Deptford 16.13 11.84 11.64 14.49 19.37 14.69 13.14 Charlton and Kidbrooke .. 12.76 9.32 9.36 10.10 11.59 10.62 10.64 Whole Borough 13.38 9.99 11.40 11.34 11.96 11.61 12.23 INFANTILE MORTALITY. The Infantile Mortality Rate measured by the deaths of children under one year of age to the number of births registered, was 87 per 1,000 births, as compared with 66 last year. The total number of deaths during the year was 116, as compared with 97, 119 and 89, the respective figures for the years 1931, 1932 and 1933. 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 67, compared with 59 in 1933, 66 in 1932, 65 in 1931 and 59 in 1930. For England and Wales the rate was 59, compared with 64 in 1933, 65 in 1932. 66 in 1931 and 60 in 1930. 19 The following table shows these figures since 1921. District Average for five vears 1921-1925 inclusive Average for five years 1926-1930 inclusive 1931 1932 1933 1934 East Greenwich 62 60 72 98 60 86 West Greenwich 80 59 76 84 71 95 St. Nicholas, Deptford 88 78 71 57 72 122 Charlton and Kidbrooke 50 42 39 59 69 73 Borough 66 57 64 80 66 87 REMARKS ON VARIOUS DEATH CAUSES. Infective Diseases. Principal Epidemic Diseases.—There were 70 deaths due to this class of disease, equalling a Death Rate of .72 per 1,000 ; the rate last year was 1.02 ; and was .48 in 1930 and 1931 respectively and .87 in 1932. Zymotic.—The class known as common infectious diseases is credited with causing a total of 60 deaths equalling a Death Rate of .61 per 1,000. Locally the Zymotic Death Rate varies from .10 in Charlton and Kidbrooke (.52 in 1933), .54 in East Greenwich (.43 in 1933), .91 in West Greenwich (.45 in 1933), to .94 in St. Nicholas, Deptford (.15 in 1933). Smallpox.—There were no deaths from Smallpox, this being the thirty-second year since a death occurred from this cause in the Borough. Measles.—There were sixteen deaths ascribed as due to this disease. This is equal to a Death Rate or .16 per 1,000. The number of deaths recorded in the years 1930, 1931, 1932 and 1933 were 21, 2, 24 and 2 respectively. 20 Scarlet Fever.—This disease occasioned 3 deaths during the year. Three deaths occurred in 1930, 1 in 1931, 1 in 1932 and 3 in 1933. Whooping Cough.—This disease was given as the cause of 6 deaths, with a Death Rate of .08 per 1,000. There were 6 deaths in the years 1931 and 1932, and 8 in 1933. Diphtheria.—There were 5 deaths during the year. This gives a Death Rate of .05 comparing with .14 for the previous year. Fourteen deaths occurred in 1933, 7 in 1932, 11 in 1931 and 12 in 1930. Three of the patients were under five years of age. Typhoid Fever.—There were no deaths ascribed to this disease during the year. There were 0 in 1933 and 1932, 1 in 1931 and 0 in 1930. Diarrhcea, Dysentery and Zymotic Enteritis.—Thirty deaths were stated to be due to these causes, equalling a Death Rate of .30 per 1,000. Last year there were 17 deaths, 24 in 1932, 16 in 1931, 7 in 1930, and 11 in 1929. Influenza.—There were 10 deaths due to this cause during the year. Four occurred in East Greenwich, 2 in West Greenwich, and 4 in Charlton and Kidbrooke. Tuberculosis. This class includes the causes of 85 deaths during the year under review, with a rate of .87. These figures compare with 115, 112, 87 and 106, the totals of the years 1930, 1931, 1932 and 1933 respectively, and the respective rates of 1.10, 1.12, .86 and 1.08. Tuberculosis of the Lungs (Consumption) is, as usual, credited with the major portion of these deaths, there being 75 attributed to the cause or a rate of .77 per 1,000 as compared with .96 for the last year. Locally the deaths were 23 in East Greenwich (Death Rate .56) ; 5 in St. Nicholas, Deptford (Death Rate .79) ; 24 in Charlton and Kidbrooke (Death Rate .89) ; 23 in West Greenwich (Death Rate .95). The remaining forms of Tuberculosis were responsible for 10 deaths, 2 of which occurred in East Greenwich, 5 in West Greenwich, 1 in St. Nicholas, and 2 in Charlton and Kidbrooke. 21 Cancer. This disease was responsible for a total of 161 deaths for the year. The number of deaths in 1933, 1932, 1931, 1930 and 1929 were 162, 155, 160, 150 and 150 respectively. The distribution of deaths were as follows:—69 in East Greenwich, 50 in West Greenwich, 29 in Charlton and Kidbrooke and 13 in St. Nicholas, Deptford. DISEASES OF THE CIRCULATORY SYSTEM. Heart Disease.—Once again the deaths from this cause occupy the principal place in the classification of diseases, there being 209 deaths under this class as compared with 193 for the year 1933. MORTUARY. The Council's Mortuary was erected in 1904, and is situate adjacent to the Coroner's Court in Lamb Lane. The number of bodies dealt with since 1920 is shown below : — Year Drowned Bodies from River Other ' Bodies Total 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 1927 9 275 284 1928 10 351 361 1929 4 317 321 1930 12 218 230 1931 17 128 145 1932 11 151 162 1933 10 130 140 1934 8 226 234 22 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. PUBLIC HEALTH STAFF. In accordance with the request contained in the Ministry of Health Circular No. 1417, the particulars relating to the Staff of the Department are set out on pages 3 and 4. The following alterations in the personnel of the Department occurred during the year. Miss Q. M. Anstice was appointed as Matron and Miss F. Bonson as Sister, at the Maternity Home. Both these ladies commenced their duties early in January. Mr. E. Saphier was appointed in June as District Sanitary Inspector owing to the resignation of Mr. A. J. Shelley who had been temporarily carrying out the duties whilst Mr. A. E. Morgan was performing special housing duties. This latter officer has now been permanently appointed as Housing Inspector. Miss P. N. Steer was appointed Health Visitor to fill the vacancy created by the death, after a painful illness, of Miss M. Hollow. Laboratory Work.—The long-standing arrangement with the Bacteriological Department of the Seamen's Hospital has been in force throughout the year, whereby that Institution carried out all necessary pathological and bacteriological work for this Department, other than under the Food and Drugs (Adulteration) Act, and in this connection, 2,540 specimens have been examined for Diphtheria, 6 for Typhoid Fever, 353 for Tuberculosis, and 49 for other various conditions. Fuller details respecting the results of the examinations of these specimens will be found under the different headings of the individual diseases. 23 Ambulance Facilities. (a) Patients suffering from Infectious Diseases are conveyed to Hospital by the ambulances of the London County Council. (b) For Non-Infectious and Accident Cases. No provision is made by the Council, but facilities are afforded by the ambulances of the London County Council, and certain local hospitals. (c) For Maternity Cases. The existing arrangements with the L.C.C. continues whereby their ambulances are available, free of charge, between the hours of 11 p.m. and 8 a.m., for all maternity patients entering the Council's Maternity Home, 78, Shooters Hill Road, S.E.3, and for urgent cases only during the day time. Representations have been made from time to time to the London County Council to extend this service so that ambulances may be available at any time during the day. The County Council are, however, owing to various difficulties, unable to fall in with our proposals, although there is reason to believe these difficulties will be overcome in the near future. Clinics.—The five Infant Welfare and Ante-Natal Centres continue to be well attended, and early in January, 1935 as foreshadowed in last year's Report, the new Centre at Charlton Road was formally opened by the Mayor (Councillor Mrs. F. Carter, J.P.). The Centre was designed by the Borough Engineer (Mr. C. H. Jennings) and built by direct labour at a cost of approximately £2,050 and provides for Doctor's Consulting Room, cubicles for Ante-natal patients, weighing room for babies, waiting rooms, milk salesroom, and covered shelters for perambulators. In addition, accommodation is provided so that artificial sunlight treatment can be given with the latest types of carbon arc and mercury vapour lamps. The increased attendances at the Centre during the year show how great was the need for a combined centre in this district. Tumour Diagnostic Clinic.—During 1934 there were 45 attendances at the Clinic. 29 new patients were seen and advised, of whom 8 only were females. Any of the non-malignant cases who needed Treatment were referred to their private doctors or hospitals. 24 No case considered to be non-malignant in previous years has returned with any evidence of malignancy developing. Of 29 new patients, 6 were referred to the Council's Consultant for diagnosis, of whom 4 were found to have malignant diseases. Unfortunately difficulty is still experienced in inducing people to attend the clinic who may have possible cause to worry over their condition. Hospitals.—Children who are in need of hospital treatment are referred by the Doctors at the Welfare Centres to St. John's Hospital, Lewisham, the Council paying the Hospital Authorities £50 per annum for such services. During the year approximately 300 cases were referred. Maternity Home.—The extension of the Home alluded to last year, was opened for the reception of patients on the 1st January, 1934. This extension provides on the ground floor 2 Isolation Wards for patients, and on the upper floor improved sleeping accommodation for the domestic staff. The extension has made the administration of the Home much easier and is much appreciated by all concerned. Fuller particulars relating to the Home and the Maternity services generally, are set out in Section G of the Report. 25 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The tables on pages 26 to 27 and 33 to 38 summarise, as far as possible, the Sanitary work of the Department; from this it will be seen that a total of 14.665 houses and premises have been inspected or re-inspected during the year; 1,249 intimation notices and 183 statutory notices have been served. There were altogether throughout the year 589 complaints registered. FACTORIES, WORKSHOPS AND WORKPLACES. The number of Factories, etc., upon the Register at the close of the year was 243 Factories, 104 Workshops, 37 Wharves and Quays. The whole of these premises were kept under systematic observation by the Inspectors, who made 353 inspections. The duties of the sanitary authorities in relation to the sanitation of factories are few and are limited mainly to the enforcement of suitable sanitary accommodation of factory employees. In certain of these trades in which female labour is mainly used, inspections are carried out by the Woman Inspector. Generally speaking the Factories and Workshops are in good condition and no evidence has been forthcoming to show that any local occupation exercises an adverse influence on the health of the workers engaged therein. Outworkers' Register.—Four lists, containing 4 names and addresses, have been received from employers within the district. In addition to this, 18 lists containing 38 names and addresses of Outworkers residing in this Borough were received from Medical Officers of Health of other Boroughs, whilst 4 lists with 8 names and addresses were forwarded to other districts, thus giving a total of 38 Outworkers in the Borough. 80 visits of inspection have been paid to these premises. 26 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES and HOMEWORK. 1.—INSPECTION. Premises. Number of Inspections Written Notices Prosecutions Factories (Including Factory Laundries) 286 1 . . Workshops (Including Workshop Laundries) 48 4 . . Workplaces (Other than Outworkers' Premises) 19 3 . . Total 353 8 2.—DEFECTS FOUND. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— Want of Cleanliness 7 7 . . . . Want of Ventilation 2 2 . . . . Overcrowding . . . . . . . . Want of Drainage of Floors 2 2 . . . . Other Nuisances 9 9 . . . . Sanitary Accommodation— Insufficient 8 8 . . . . Unsuitable or Defective 20 20 . . . . Not Separate for Sexes 2 2 . . . . Offences under the Factory and Workshops Act— Illegal Occupation of Underground Bakehouse (s. 101) . . . . . . . . Other Offences . . . . 1 . . Totals 50 50 1 . . Including those specified in Sections 2, 3, 7 and 8 of the Factory Act, 1901, as remediable under the Public Health Acts. 27 3.—WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1934. No. Bakehouses 16 Factory Bakehouses 24 Barge Builders 11 Blacksmiths 6 Boot and Shoe Makers 9 Builders' Yards 2 Carpenters and Joiners 3 Carriage Builders 2 Coopers 1 Cycle Works 4 Dress and Mantle Makers 9 Engineers 4 Electrical Engineers 3 Fuel Works 2 Furniture 1 Laundries 1 Milliners 2 Monumental Masons 1 Motor Vehicle Repairers 4 Photographers 2 Picture Frame Makers 1 Plumbers 2 Tailors 13 Others 15 137 4.—OTHER MATTERS. Class. No. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) — Other — Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (s. 5):— Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspectors 2 Underground Bakehouses (Sec. 101):— In use at end of 1934 13 Smoke Abatement.—During the year this problem was constantly before the staff and 22 observations of Factory chimneys were made for the purpose of detecting offences under the Public Health (Smoke Abatement) Act, 1926, and the Bye-laws made by the London County Council which came into force in 1931. 28 It is satisfactory to note that the improvements hoped for last year in connection with the London Power Company's Generating Station in St. Nicholas have been carried out, the Company having been successful in inducing the Admiralty and the Royal Observatory authorities to remove the embargo with regard to the height of chimneys. In September a new chimney was erected to a height of 285 feet above ground level, and 2 additional boilers, making a total of 16 connected thereto, which with the installation of gas washing apparatus of modern type, should tend to a great extent to lessen the number of complaints arising from this particular source. The other chief offender, the London Passenger Transport Board's Generating Station, East Greenwich, is still handicapped by restrictions imposed by the Royal Observatory, but are taking additional measures by gradually installing modern plant and apparatus, to prevent the occurrence of smoke nuisance. Sewer Emanations.—A large number of complaints were received during the year of offensive odours emanating from the London County Council sewers in various parts of the Borough. These complaints were forwarded to the County Council, which authority, it is understood, is conducting experiments as to the best means of ventilating sewers. The problem, however, is very difficult and so far no satisfactory solution has been found. In connection with the subject of sewers, it is rather interesting to note that a case of Weil's Disease (Spiroch. Ictero Hæmorrhagica) in a sewer worker was reported from St. Alfege's Hospital in the early autumn. Recent investigations tend to show that this disease may occur comparatively frequently amongst workers in sewers. It appears that in most cases the symptoms are mild and complicated with slight jaundice, which together with slight pains throughout the body, is often diagnosed as attacks of influenza. Infection takes place through a cut or abrasion contaminated by slime from the walls of sewers or from excreta of rats. Scavenging and Refuse Disposal.—The collection of house, etc., refuse in the Borough is under the control of the Borough Surveyor, who has kindly supplied me with the following information relating to the disposal of refuse. The amount of refuse collected in the Borough during the year ended 31st December, 1934, was approximately 20,300 tons, of which 16,232 tons were dealt with at the Council's Refuse Plant and the remainder was disposed of by barging to the controlled tips under contract. 29 The improved system of collection inaugurated in 1931, and supplemented in 1933, has been augumented by the addition of a further mechanical vehicle—a self-contained tipping lorry designed for inside loading, and 65 per cent. of all the refuse was collected under these definitely more hygienic conditions. A second incinerator for the destruction of "tailings" at the Council's Refuse Plant has been completed, which will increase the capacity of the plant to some extent, and it is anticipated, will enable a greater proportion of the refuse collected to be dealt with. Public Sanitary Conveniences, etc.—There are 7 Sanitary Conveniences provided by the Council, all of which are situated in the main arteries of traffic. During the year a new above ground Convenience has been erected at Creek Road, Deptford, in place of the old underground Convenience which has now been demolished. In addition to the above there are 6 Urinals maintained by the Council which together with 8 Drinking Fountains and 5 Horse Troughs are cleansed daily by the attendants attached to the Department. Common Lodging Houses.—The supervision of the sanitary condition of Common Lodging Houses is now carried out by the Council's Sanitary Inspectors under the Transfer of Powers (London) Order, 1933. Nine inspections were made during the year. Drainage.—During the year 89 plans of Drainage and other Sanitary works relating to existing and new buildings were examined and approved. Infringements of the Bye-laws were reported in 2 instances, in respect of failure to give notice of intention to construct drainage or to deposit plans. The Builders concerned were cautioned and no further action was considered necessary. Houses Let in Lodgings.—Under Section 6 of the Housing Act, 1925, the London County Council made Bye-laws which came into force in 1926. These Bye-laws define a house let in Lodgings as ordinary tenement houses in which the rooms or floors are let out separately, and all houses suitable to the working classes and occupied by members of more than one family are subject to registration, and in them there must be compliance with certain requirements as to Sanitation, cleanliness, etc. As stated last year only those houses which require the constant supervision of the Inspector are required 30 to be registered. The number of houses on the register is at present 104 and 150 visits were paid for inspection purposes. In no case was it necessary to institute legal proceedings. Rats and Mice (Destruction) Act, 1919.—During the year 173 complaints of the presence of rats in houses, etc., were received. These complaints were at once investigated for the purpose of discovering the source of the Rats, and advice and assistance were given where necessary. In the case where defective drains were found steps were taken to have these remedied. The usual procedure was adopted with regard to Rat Week, particulars of which have been dealt with in previous Reports, and as usual supplies of approved Rat Poison were supplied to necessitous tenants. Baths and Wash-houses.—Through the courtesy of the Baths Superintendent, Mr. A. E. Read, I am enabled to include the following report on the Public Baths. Greenwich is in the happy position of being the possessors of a most modern and up-to-date establishment of Public Baths. Fronting upon the main road, they stand upon an area of 1¼ acres and consist of three Swimming Baths, 74 Slipper Baths for males and females, Public Wash-houses, Vapour Baths, Establishment Laundry, Boiler Houses and Engineers' Workshops. The Swimming Baths are constructed of reinforced concrete and lined with white marble terazzo. Each bath is fitted with teak dressing boxes or cubicles, adequate lavatory accommodation and well supplied with Showers and Foot Baths. The first-class bath is 100ft. long, 40ft. wide, and has a depth of from 3ft. to 7ft. 9in. The Ladies' Swimming Bath is 70ft. by 36ft., and a depth from 3ft. to 6ft. 6in. The Gentlemen's Swimming Bath is 80ft. by 40ft., and has a similar depth of 3ft. to 6ft. 6in. In connection with these baths a most up-to-date filtration, aeration and chlorination plant has been provided, capable of purifying the contents of each bath every 3¼ hours, thus ensuring that 31 every bather can use the baths with the utmost confidence, and safety from any infection, as far as can be made possible. The water is treated and tested daily in respect to temperature, and to avoid any overdosing of chemicals that may cause any unpleasant reaction. A special feature is the ventilation. The establishment is fitted with the Plenum system, in which pure air is drawn through air filters, passed through air ducts, in which heaters are placed, and used when required, and distributed throughout the Baths by specially placed grids, the overheated or vitiated air being extracted by fans in ducts constructed in the roof. This system allows all windows to be closed excluding dust, grit, etc., whilst perfect ventilation of pure air is being circulated. The provision of the new Vapour Baths and the installation of the Medicated and Foam Baths have brought these baths to a level of an inland spa. Various treatments for skin diseases, neuritis, obesity, rheumatic and gouty conditions are given. The Public Wash-house is used to its utmost capacity especially in winter. Here, in a well-lighted and warm room, family washing may be done. For a charge of l¼d. per hour, the washer may have the use of a locker for private possessions, the use of washing troughs, rinsing and copper, with an unlimited supply of hot and cold water. After washing, the use of the hydro extractors, one drying horse, the mangles and folding tables are all included in this one charge. Should the washer desire to use the washing machine, an additional charge of 1/- per hour is made. In winter the First-Class Bath is covered over and used as a hall for dancing, boxing and public meetings, the remaining two baths being kept open all the year round for swimming, mixed bathing being available every day. During the year ending 31st March, 1935, the following attendances were made: — Slipper Baths 68,643 Swimming Baths 203,889 Vapour and Medicated Baths 2,293 Total 274,825 Washers 16,161 32 Verminous Premises.—As a means of assisting occupiers in the more densely populated parts of the Borough in ridding their premises of vermin, a supply of a special fluid is kept at the Borough Hall and is supplied to occupiers whose premises have been reported upon by the Sanitary Inspector. Applicants are required to bring their own bottles, and advice is given in every case as to the correct way of using the preparation. During the year 686 gallons were distributed to approximately 5,488 applicants. Rag Flock Acts, 1911 and 1928.—These Acts prohibit the sale or use for the purpose of making any article of upholstery, cushions or bedding, of unclean flock manufactured from rags. No samples of rag flock were taken during the year. Water Supply.—During the year 425 water supply certificates have been granted under Section 48 of the Public Health (London) Act, 1891. Five water supplies have been reinstated where the supply has been cut off; water fittings have been amended in 61 cases, covers to cisterns adapted in 90 cases, and extra water supply to tenement houses in 22 cases. Fouling of Footways by Dogs.—On the 4th September, 1933, the Council obtained sanction for a By-law to prevent nuisances of this nature. It was only found necessary to institute proceedings in one case. This being the first case taken under these by-laws and in view of the youth of the Defendant the Magistrate dismissed the case upon payment of costs but expressed the opinion that the Borough Council had a duty to perform in maintaining the cleanliness of its paths. 33 SUMMARY of WORK PERFORMED by the SANITARY INSPECTORS DURING THE YEAR 1934. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Inspections— Houses Inspected (House to House) . . . . . . . . . . „ ,, Complaints, Nuisances 708 698 540 534 2480 Other Premises Inspected 51 56 84 43 234 Re-Inspections, Calls Made, etc. 2627 2891 2527 2252 10297 Inspections of Huuses Let in Lodgings 39 28 31 52 150 Factories,Workshops and Workplaces 103 78 54 113 348 ,, Outworkers' Premises 13 23 17 27 80 „ Common Lodging Houses 3 2 . . 4 9 ,, Cowhouses . . . . 2 4 6 ,, Stables and Yards 18 7 6 1 32 Piggeries 1 . . . . . . 1 ,, Courts and Alleys 4 . . 6 1 11 ,, Fields, Lanes, etc. 17 5 10 15 47 ,, Urinals 29 13 21 17 80 ,, Gipsy Vans . . 1 14 5 20 „ Horse Slaughterhouses . . . . . . 4 4 ,, Soap Boilers . . . . 1 . . 1 ,, Other places where food . . . . . . . . . . is prepared or stored 189 131 162 201 683 Investigations (Rats and Mice) 42 43 48 49 182 Total 3844 3976 3523 3322 14665 Drains— Intercepting Chamber 6 2 10 6 24 Other Chambers Constructed 25 8 19 28 80 Reconstructions and Additions 101 18 61 22 202 Opened, Cleansed and Amended 87 131 44 55 317 Traps Fixed 39 11 79 54 183 New Soil Pipes 10 5 14 22 51 Soil and Vent Shafts Repaired 16 4 16 25 61 Drains Ventilated 9 1 15 7 32 Drains Sealed off, etc. 20 7 7 34 Drains Tested—by Smoke 41 29 39 72 181 by Water 43 102 98 65 308 Found Defective 11 24 21 20 76 New Covers to Manholes 16 3 9 5 33 Yards Drained 1 23 6 30 Washhouses Drained 12 12 Areas Drained 2 3 34 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Water Closets and Urinals— Closets Erected 24 6 27 36 93 W.C. Doors Repaired or Provided 116 76 131 116 439 Sanitary Conveniences or Improvements Effected to Factories, Workshops and Workplaces 15 . . 6 17 38 Flushing Apparatus Amended 115 83 58 S9 345 Pans or Traps Furnished 102 65 134 98 399 Water Supply Disconnected from Drinking Water Cistern 1 . . . . 1 2 Cleansed 34 4 6 10 54 Ventilation Improved 55 39 12 12 118 Public-house Urinals Cleansed or Repaired 5 . . 2 3 10 Other Urinals Altered or Cleansed . . . . . . 2 2 Other Urinals Constructed 16 1 3 1 21 Ashpits— Provided 114 53 59 52 278 Covers to Receptacles 1 . . . . . . 1 Pavings— Forecourts and Yards 51 38 80 49 218 Areas . . . . 2 6 8 Washhouses 1 . . 4 5 10 Mews and Stables 1 . . . . . . 1 General Water Supply— Covers to Cisterns Adapted 49 36 . . 5 90 Water Fittings Amended 11 12 19 19 61 Water Services Altered so as to draw direct from main 4 2 . . 4 10 Water Supplies Reinstated where cut off through defective fittings 3 2 . . 5 Extra Water Supply to tenement houses 5 4 8 5 22 Water Supply Certificates Granted (Section 48) 64 84 94 183 425 Other Improvements— Verminous Rooms Cleansed 12 29 76 58 175 Ventilation Improved 144 109 121 135 509 Staircases Repaired, Amended, Lighted and Ventilated 97 15 37 38 187 Leaky House Roofs and Gutters Repaired 126 71 118 135 450 35 Summary of Sanitary Work—continued. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Other Improvements—contd. Walls and Ceilings of Premises Cleansed and Repaired 538 428 571 547 2084 Stoves and Fireplaces Repaired 10 43 51 63 173 Washing Coppers Repaired 36 14 18 22 90 Sinks Provided 68 75 115 86 344 Floors Repaired 111 64 92 69 336 Provision for Storage of Food 5 . . . . . . 5 Other Nuisances Abated— Sink, Lavatory and Bath Waste Pipes Disconnected, Trapped or Amended 91 92 111 113 407 Stack Pipes Amended 39 21 36 25 121 Nuisances from Dampness Abated 66 47 49 70 232 Animals kept in Unfit Places Discontinued or Removed 1 . . 23 1 25 Dung Receptacles Provided 1 . . 1 2 4 Houses Abolished, unfit for habitation 3 . . . . 3 6 Accumulations of Manure and other Obnoxious Matter Removed 7 6 8 5 26 Inundations Abated 1 1 Contents of Rooms Cleansed 1 6 3 3 13 Rat Infestation Abated 19 8 8 10 45 Smoke Nuisances— Observations 19 1 1 1 22 Statutory Notices Served (Sections 23 and 24) . . . . . . . . . . Notices, etc.— Intimations served under Public Health (London) Act, 1891 (Section 3) 279 343 269 358 1249 Notices served— Under Housing Acts 8 . . . . . . 8 Rats and Mice (Destruction) Act, 1919 . . . . . . . . . . re Verminous Rooms 1 1 . . 1 3 Under P.H. (L.) Act and Metropolis Management Act (re combined drainage) . . 3 . . 6 9 W.C.'s (Factories, Workshops and Workplaces) . . . . . . . . . . Yards . . 1 . . . . 1 Miscellaneous . . . . . . . . . . Statutory Notices served under Section 4 31 38 40 39 148 Statutory Notices (re Ashpit provision) 8 . . 5 1 14 Complaints received and attended to 164 103 137 180 589 Letters written relating to abatement of Nuisances 41 29 22 52 144 Summonses applied for and issued 3 2 . . 2 7 Magisterial Orders obtained and enforced 3 1 . . . . 4 Drainage Plans received and examined 21 15 30 23 89 36 Return Made to London County Council. Proceedings during 1934. Premises Number of Places Number of Inspections, 1934 Number of Notices, 1934 Number of Prosecutions, 1934 On Register at end of 1933 Added in 1934 Removed in 1934 On Register at end of 1934 Cowsheds 3 . . . . 3 3 . . . . ,, (Licensees) 1 . . . . 1 . . . . . . Dairies and Milkshops 173 30 26 177 251 . . . . Slaughterhouses 2 . . . . 2 242 . . . . Other Offensive Trade Premises 2 . . . . 2 . . . . . . Ice Cream Premises 154 16 35 135 178 . . . . Registered Houses Let in Lodgings 102 2 . . 104 150 8 . . Restaurants and Eating Houses 73 1 3 71 111 . . . . Legal Proceedings under the Public Health (London) Act 1891 and Bye-Laws, etc., during the year 1934. Premises. Complaint. Result of Proceedings. Fine. Costs. £ s. d. 59, Creek Road, Deptford, S.E.8 Non-compliance with Sanitary Notice re Overcrowding. Abatement Order 3 3 0 202, High Street, Deptford, S.E.8 Contravention of Public Health (Meat) Regulations. Case dismissed upon payment of costs. 1 1 0 37 Total Number of Intimation Notices served for all purposes 1249 ,, „ „ Statutory „ „ „ 183 Overcrowding, 1934— Number of Dwelling-rooms overcrowded 81 Number remedied 70 Number of Prosecutions 1 Underground Rooms— Illegal occupations found during year 6 Number of Rooms closed or illegal occupation discontinued 6 Insanitary Houses— Number closed under the Public Health (London) Act, 1891 Number of Closing Orders made — Number demolished in pursuance of Orders — Number demolished voluntarily 19 Number repaired or Nuisances remedied under Public Health Act 1,688 Housing of the Working Classes— (a) Erected during the year :— Municipal 85 Private Enterprise 340 (b) In course of erection 120 Number of Verminous Premises cleansed under Section 10 of the London County Council (General Powers) Act, 1922 175 Number of Cleansing Baths given under Cleansing of Persons Act 16 Number of Children Cleansed 961 Shelter provided under Section 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year — Number of Tenement Houses provided with Additional Water Supply 22 Number of Prosecutions ditto — 38 Number of Houses in the Borough 19,291 Number of Houses occupied by the working classes 14,468 Number of Houses inspected:— (a) On account of complaints 589 (b) Illness (P.H. Act) 700 (c) Nuisances 1,191 2,480 Number of Houses repaired (Section 17, Housing Act, 1930) 18 Number of representations by Medical Officer of Health 2 Number of Houses included in such representations 562 Number of closing orders made 5 Number of closing orders determined — Number of demolition orders — Number of Houses demolished:— In pursuance of Orders — Voluntarily 19 19 39 SECTION D. HOUSING. In common with most other Authorities, great activity has been displayed in regard to housing. During the year, the Thames Street, Greenwich (Nos. 1 and 2) areas were confirmed. These areas embrace 149 houses with a population of 732 persons. The premises are situate as follow: — Thames Street, Greenwich (No. 1) Order, 1933. Nos. 20, 22 and 24, Norway Street. Nos. 1 to 4, Norway Place, and private street, Norway Place. Nos. 5 to 65 (odd) and 75 to 93 (odd), Thames Street and part passageway adjoining Nos. 69 and 69a, Thames Street. Nos. 1, 2 and 3, Lake's Cottages and private street, Lake's Cottages. Nos. 1 to 4, Burlington Buildings and water closets and private street, Burlington Buildings. Nos. 3 to 27 (odd), Horseferry Road. Nos. 12, 14 and 16, Horseferry Road. Nos. 1 to 8, Ferry Place and water closets and private street, Ferry Place. Nos. 1, 2 and 3, Devonport Cottages, Devonport Place and water closets and part private street, Devonport Place. House, Heath Cottages in rear of No. 51, Thames Street and Nos 1 and 2. Heath Cottages and private street, Heath Cottages. Nos. 1 to 5, Sarah's Buildings and Rose Cottage, Sarah's Buildings, and private street, Sarah's Buildings. Nos. 1 to 31, Little Thames Street. Nos. 1 to 4, Welland Street. Nos. 1, 2 and 3, Townsend Cottages and land, washhouse, water closet and private street, Townsend Cottages. Nos. 6 to 18 (even), Norway Street. Nos. 69, 69a, 73 and 73a, Thames Street and part passageway adjoining Nos. 69 and 69a, Thames Street. Nos. 2, 4, 6, 8, 10, 18 and 18a, Horseferry Road. No. 67, Thames Street. Part private street, Devonport Place. Nos. 5 and 6, Welland Street. 40 Timber stores, land, etc., next to No. 5, Thames Street and stables, yard, etc., adjoining thereto. Thames Street, Greenwich (No. 2) Order, 1933. Nos. 1 to 10, Aboukir Cottages and water closets and private street, Aboukir Cottages. These areas were confirmed in March, 1934, and in April I made an official representation of the Lamb Lane area, comprising 82 houses and 448 persons. The buildings involved were : — Lamb Lane—3, 5, 7, 9, 11, 13, 15, 17, 19, 21a, 21b, 23, 25, 27a, 27b, 29 and 31. Haddo Street—52, 50, 48, 48a, 48b, 48c, 46, 44, 42, 40, 38, 36, 34, 32, 30, 26, 24, 22, 20, 18. Bell Street—1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20 and Bell Cottage. Clive Place—1, 2, 3, 4, 5. Bardsley Street—1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 14, 16. Mary Ann Place—1, 2, 3, 4. Sexton Buildings—1, 2, 3, 4, 5, 6, 7, 8. The local enquiry ordered by the Minister of Health was held at the Town Hall in November, 1934. In nearly every instance appeals were lodged by owners against the demolition of their property. A large proportion of the houses were old and of faulty construction and lacking in adequate provision for food storage and washing facilities. At the close of the year the decision of the Minister had not come to hand (since confirmed, March, 1935). During the year consultations were held from time to time with officials of the London County Council in connection with the question of small insanitary areas, many of which were suitable for demolition, but owing to the size were unsuitable for housing sites, and with which the Borough Council propose to deal systematically as clearance areas during the next few years. The areas in question contain 413 houses with a population of 1,712. This plan is based upon the assumption that the L.C.C. will deal with the larger areas. The following Tables show in detail particulars relating to the proposed areas. 41 (a) Definite Sites for Clearance and Rebuilding. Area 1. Houses. Families. Persons. Pommel's Court 4 4 16 Richardson's Place 13 14 42 Church Passage 4 5 18 21 23 76 Area 2. 1, 3, 5, Woodland Place 3 3 10 116-140, Trafalgar Road 15 11 34 4-20, Miles Street 9 10 40 1-5, Fenton Street 5 5 12 32 29 96 Area 3. 90-114, Norman Road 13 17 53 119-129, Greenwich Road 5 5 26 Capella Place 8 9 36 26 31 115 Area 4. 91-103, Royal Hill 7 13 35 1-la, Renbold Place 2 1 2 2-41, Point Hill 21 22 80 Winforton St., Atlas St., etc 44 45 174 74 81 291 Area 5. 1-40, Claremont Street 37 40 152 3-21, Haddo Street 10 11 39 90-126, Roan Street 19 20 107 Frederick Cottages 3 3 17 Purvis Terrace 9 10 37 Skinner's Buildings 7 7 27 Cottage Place 4 4 26 89 95 405 Area 6. Gonson Place 24 34 129 Cross Street 2 3 16 24-60, Stowage 19 38 142 45 75 287 42 Houses. Families. Persons. Area 7. Bury Cottages 3 3 9 Glaisher Street 19 19 48 22 22 57 Area 8. a Kirkland Place (flats) 13 11 43 b Kirkland Place (3-10) 8 11 37 21 22 80 Area 9. Dutton Cottages 4 4 10 Blackheath Hill (vacant ground) — — — 4 4 10 b Possible Sites for Rebuilding. Houses. Families. Persons. (1) 192-236, Church Street 13 18 65 (2) Duncan Cottages 10 10 37 33-36, Airy Street 4 4 10 30-44, Coldbath Street 8 10 31 22 24 78 (3) Brigade Place 6 6 18 c Areas not Suitable for Rebuilding. Houses. Families. Persons. Felma Court 3 3 16 Prince of Wales Cottages 4 4 19 Prince of Orange Lane 5 5 11 Rentarn Cottages 5 6 13 Laurel Gardens 2 4 12 Collington Street 6 7 18 Roan Street, 5-11 4 4 15 Chittenden Cottages 3 3 10 Haddo Place 2 2 7 Woods Cottages 4 4 13 38 42 134 43 TOTALS. Houses. Families. Persons. Clearance Areas 334 382 1417 Possible Building Sites 41 48 161 No Building Sites 38 42 134 413 472 1712 In addition to those mentioned, the London County Council is at present dealing with Plume Place (20 houses and 45 population), and the Eastney Street area (67 houses with a population of 440). The provision of new dwellings for rehousing persons who will be displaced is proceeding on an increasing scale and towards this end the Borough Council have erected 85 Houses (3 bedroom nonparlour type) in Victoria Road, and a block of 16 flats sufficient to accommodate 430 people are rapidly nearing completion in Azof Street (opened by the Mayor, March, 1935). Private enterprise has provided a further 340 houses. As slum clearance goes on, it is becoming very evident that an increasing number of families will require cheaper accommodation than that at present provided by the Borough Council, and it is hoped that attention will be given to the needs of the poorer citizen. The question also of small 2-bedroom houses for old people or people without families and who are not in a position to afford rent for larger houses, calls for consideration. It has been well said that the question of slum clearance is one of rent. With regard to individual houses, the procedure detailed last year of inviting owners or agents to informal consultations in respect of their property, and which has proved so successful, has been adhered to, and during the year a considerable amount of work has thus been accomplished. Many difficulties which arise in practice are overcome by such interviews. As examples of the work done by this co-operation between the owners, agents, and the Public Health Department, it may be noted that 70 informal notices were served under Section 17 of the Housing Act, 1930, requiring owners to effect repairs, and in no instance was it necessary to take further official action, as follows: — Ransom Road—7-21, 7-26, and 30-32 (23 houses). Commerell Street—48-70 (12 houses). Creek Road—141-159 (11 houses). Woodland Place—5-13, 21-23, 27-29 (9 houses). Eastney Street—2, 4, 6 and 8, 1 and 3 (6 houses). 44 Reeces Place—9 and 10 (2 houses). Church Street, Greenwich, 81 and 83 (2 houses). Billingsgate Street—2 and 4 (2 houses). Floyd Road—No. 81. Nevada Street—No. 7. Crane Street—No. 9. In addition to reconditioning (Section 17) there is a considerable number of houses in the Borough which can be dealt with under Section 19, Housing Act, 1930 (demolition) but until much more alternative accommodation is available no useful purpose would be served by making demolition orders. Further details of the work done under Part 2 of the Housing Act, 1930, will be found in the following table supplied by the Housing Inspector, whose appointment was made permanent in July, 1934. Houses Surveyed.— Houses or parts closed 5 Houses reconditioned 79 Houses in hand (in progress) 44 Houses in hand (not actually commenced) 5 Underground rooms recommended for action 7 Notices served requiring work— Informal Agreements to recondition 70 Notice of intention to survey 245 Total visits made in connection with work under the Housing Acts 3,146 Overcrowding.—Overcrowding is common and the worst instances of gross overcrowding continue to be reported to the Public Health Committee and forwarded to the Housing Committee for preferential treatment, but owing to the already long waiting list of applicants for Council houses little can be done. In addition I have during the year recommended on health grounds 10 cases to the London County Council and 20 cases to the Borough Council. The number of instances known officially to have been overcrowded was 81, of which 70 were remedied. The grossly overcrowded house is generally occupied by a very poor type of tenant who neither attempts nor desires to obtain other accommodation. A record is kept of these overcrowded houses and as soon as any particular case is relieved, a cautionary letter is sent and the owner notified that the house or rooms must not be 45 let in such a manner as to cause overcrowding in future. To ensure that these instructions are carried out, periodical visits are paid to the premises by the District Sanitary Inspectors. Underground Rooms.—Regulations in connection with underground rooms were passed by the Council and approved by the Ministry of Health on 26th September, 1933, and rooms of this nature must comply with certain standards as regards ventilation and lighting and also for protection against dampness, etc. During 1934, five Closing Orders were made as regards basement rooms used for sleeping purposes, viz., 105, Bridge Street; 33, Burney Street; 8, Nevada Street; 7, Crooms Hill; and 6, The Circus. In the opinion of many Medical Officers, including myself, underground rooms should be prohibited whether used for living or sleeping purposes. There are many illegally occupied underground rooms in the Borough, but for want of alternative accommodation, little can be done at present. Rent and Mortgage Interest (Restrictions) Acts, 1920-33.— Eight applications for certificates were made all of which were granted and in six instances reports were subsequently issued to the owner of the premises under Sec. 5 (2) of the 1923 Act on completion of the necessary repairs. Rent and Mortgage Interest Restrictions (Amendment) Act,. 1933.—Broadly the effect of this Act so far as London is concerned is that premises of a rateable value of more than £45, shall be decontrolled, those of rateable value between £20 and £45, are to remain subject to present legislation and those at present controlled having a rateable value of less than £20 are to remain controlled, even though under past legislation the premises would have become decontrolled when vacated. The Act also provides that the Rent and Mortgage Interest (Restriction) Acts shall continue for a period of 5 years and no longer. HOUSING RETURN, 1934. 1. Inspection of Dwelling-houses during the year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,797 (5) Number of inspections made for the purpose 8,660 46 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 104 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,688 2. Remedy of Defects during the year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 512 3. Action under Statutory Powers during the year:— (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 8 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 18 (b) By local authority in default of owners — (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied Notices served: Intimations 1,249 Statutory 175 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 1,063 (b) By local authority in default of owners — (c) Proceedings under Sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders were made — 47 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders (d) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 5 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — Number of houses erected during the year :— By Borough Council 85 By Private Enterprise 340 48 SECTION E. Inspection and Supervision of Food. The food premises of the Borough have been kept under constant observation by the Food Inspector assisted by the District Sanitary Inspectors, both as to their sanitary condition and cleanliness, as well as the condition and soundness of the food stored or prepared for sale. The Food Inspector is primarily responsible for the purity of the food. The Traders of the Borough have on the whole shown every desire to co-operate in the task of providing the public with pure, wholesome food, and have frequently asked the advice of the Department when in doubt as to the quality or soundness of some particular supply. The Householder, however, can help considerably in attaining the highest standard by purchasing clean food and by insisting that it has not been handled by unauthorised persons or exposed to contamination by dust, flies, etc. From observations during inspections for housing purposes it is often noticed that the storage of food in the home leaves much to be desired and housewives should realise that, as far as health is concerned, it is much better for them to buy food in small quantities and keep it in a clean ventilated food cupboard, rather than to buy larger quantities for which they have no proper storage accommodation. Additional legislation continues to impose more and more work on the Inspectorate. In addition to the actual examination of all foodstuffs the Inspectors have also to observe if the marking of the foodstuffs required by the various Acts and Orders is being complied with. Unsound Food.—Under the provisions of the Public Health (London) Act, 1891, the Medical Officer of Health and the Sanitary Inspectors are authorised to inspect, at all reasonable times, all articles intended for the purpose of sale for the food of man. 49 During the year 1934 the following diseased and unsound articles of food were surrendered : — Cwts. Stones lbs. Beef, Pork, Mutton, Lamb, Offals, etc. 14 — — Fish — — 12 Fruit 5 — — Total 19 — 12 On no occasion was it found necessary to seize any articles of unsound or unwholesome food. The Public Health (Meat) Regulations, 1924.—The above, which came into force on the 1st April, 1925, provided for the better regulation and supervision of slaughter-houses, butchers' shops, stalls ; and the protection of meat against contamination by dirt and flies, etc., in transport and handling. The annual routine inspections were made as a result of which it was found necessary to send a warning letter to a slaughterman for a minor infringement against the Regulations. A summons was also instituted against a butcher for wilfully exposing meat to dust and flies after due warning from the Meat Inspector. The Magistrate, however, dismissed the case upon payment of £1 1s. Od. costs. SLAUGHTER OF ANIMALS ACT, 1933. This Act, which came into force on the 1st January, 1934, had for its object the licensing of fit and proper persons who alone are authorised to slaughter, and the humane slaughtering of animals by firstly stunning them with a mechanically or electrically operated instrument. The Greenwich Borough Council have not resolved to exempt sheep and goats from such humane treatment, by exercising that right invested in them by the Act, but have included all animals slaughtered in both slaughter-houses and knackers-yards. The use of the humane killer has been general in this Borough for many years and the provisions of this Act will not alter materially the existing mode of slaughter. The licensing of slaughtermen, however, ensures that all animals are painlessly despatched by experienced men, who can be held responsible for the cleanliness of the dressed carcases while in their keeping. The 9 licences granted to slaughtermen in 1934 are still in force. Slaughter-houses and Knackers Yards. — There were 2 slaughterhouses and 1 knackers yard in the Borough at the end of 1934, all of which are annually licensed, and were duly visited. 50 Meat Inspection (Slaughter-houses).—During the year the Meat Inspector examined the following animals after slaughter : — Oxen 155 Calves 3 Sheep 1,028 pigs 195 Total 1,381 The increase of the number of animals slaughtered over that of last year is 63. This increase in largely due to the slaughter of 85 pigs moved from an "infected area" under the provisions of the Diseases of Animals Act, 1894. They were swine fever contacts and were moved under license from the Borough of Lewisham. Each animal was duly examined (P.M.) by the Meat Inspector and in no instance was symptomatic evidence of infection discovered. They were therefore passed as fit for human consumption. PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1925. These and subsequent regulations were made under powers granted to the Minister of Health by "the provisions of the Public Health (Regulations) as to Food Act, 1907, and certain other principal Acts. These regulations were fully explained in last year's report as well as the method of inspection of all imported food adopted at the wharves in this Borough. The regulations were amended by the Public Health (Imported Food) Amendment Regulations, 1933, which came into force on September 1st, 1933, the principal purpose being the extension of the system of certification of meat exported to England in the country of origin, from edible parts of pigs to that of cattle, sheep and goats. These regulations have been issued only to Port and Riparian Authorities. The completion of the cold store in Butchers Row, Deptford, owned by Messrs. Borthwick and Sons, Ltd., has added 950,000 cubic feet to the available cold storage space at the wharves. The cold storage chambers in the Deptford Cattle Market have also been increased from 400,000 cubic feet to 600,000 cubic feet, making a total of 1,550,000 cubic feet to be used for the storage of imported meat. The tonnage of meat landed in this Borough is expected to increase very considerably in 1935. 51 The following tables serve to illustrate the types of foods landed at the wharves in the Borough during 1934, their tonnage and country of origin. Australia— Tons Hind-quarters of Beef 30,073 2,313 Crops 21,453 1,071 Lambs 310,057 5,618 Sheep 47,598 1,058 Offal (Bags or Boxes) 5,715 143 Rabbits (Cases) 19,968 499 Beef (Bags) 6,627 221 Pigs 4,096 205 Hind-quarters Mutton (pairs) 8,076 80 Packs of Mutton 2,023 101 Veal (Bags) 115 6 Total Tonnage 11,315 Argentine— Hind-quarters of Beef 3,067 236 Fore-quarters Beef 2,515 193 Lambs 101,119 1,669 Sheep 7,523 172 Offal (Bags or Boxes) 20,642 516 Beef (Bags) 1,622 45 Pigs 5,141 257 Packs of Mutton 413 20 Packs of Lamb 101 5 Sides of Veal 72 2 Pork (Bags) 109 6 Total Tonnage 3,121 52  Tons New Zealand— Hind-quarters Beef 13,117 1,009 Fore-quarters Beef 12,978 921 Lambs 162,448 2,708 Sheep 40,180 921 Rabbits (Cases) 4,451 112 Pigs 31,409 2,571 Pork (Sides) 460 13 Veal (Bags) 1,743 88 Veal (Sides) 310 8 Total Tonnage . 8,351 U.S.A.— Offal (Bags or Cases) 20,562 343 Pigs 1,149 58 Pork 1,095 54 Chickens 363 5 Total Tonnage 460 China— Cases of Eggs 12,511 313 Iceland— Lambs 5,970 100 Canada— Cases of Offal 1,325 33 Latvia— Butter (Casks) 4,528 276 Tons 8 Cwts. (Boxes) 2,000 „ (Firkins) 132 Lithuania— Butter (Casks) 3,745 244 Tons 15 Cwts. „ (Boxes) 2,302 „ (Firkins) . 132 Estonia— Butter (Casks) 3,000 250 Tons „ (Boxes) 4,000 Poland— 2,200 111 Tons Butter (Casks) 53 Norway— Cheese 368 Cases Margarine 6 Cases Parsnips 137 Bags Mustard 4 Cases Crisp-bread 133 Cartons Conserves 48 Cases Provisions and Stores 70 Packages Canned Goods 281 Cases Ships' Stores 191 Packages Brisling 350 Cases Fish Preserves 1,070 Cases Sild in Oil 200 Cases Iced Prawns 977 Cases Skate-wings 13 Cases Tinned Shrimps 350 Boxes Iced Mackerel 409 Cases Fresh Fish 91 Cases Beers 285 Cases Whisky 18 Cases Gin 20 Cases Pilsener Beer 12 Cases Wine 5 Cases Total Tonnage 147 Tons Imported Food Surrendered.—During the year 1934 the following unsound and diseased imported foods were surrendered and sent by the importer, on instruction of the Food Inspector, to firms duly authorised to use such material for non-edible refining purposes:- Tons cwts. stones lbs. 37 Bags of Boneless Beef (Decomposed) — 19 4 0 36 Hind-quarters of Beef (Bone taint) 4 14 4 7 1 Fore-quarter of Beef (Bone taint) 9 Carcases of Lamb (Mould) — 1 1 4 17 Carcases of Mutton and Lamb — (Caseous Lymphadenitis) — 7 7 4 2 Sides of Mutton (Ditto) — — 4 3 30 Pairs of Hinds and Ends Mutton (Ditto) 6 10 4 21 Legs and Shoulders Mutton (Ditto) — 1 0 2 Total Weight 6 10 5 0 (The above weights are calculated in Smithfield Stones — 8 lbs.). Total Tonnage from all Countries ... 24,722 Tons. 54 AGRICULTURAL PRODUCTS (GRADING and MARKING) ACT, 1928. Various Regulations have been made from time to time by the Minister of Agriculture and Fisheries under the above Act relating to the use of grade designations applied by means of a national mark. The application is entirely voluntary and is intended to set up a specific standard of quality, but where traders elect to adopt the national mark they must comply with the provisions set out in the regulations. There were only a few cases calling for the attention of the Inspectors during the year. MERCHANDISE MARKS ACT, 1926. Under the powers conferred by the Act, Orders in Council have been made dealing with, amongst other imported articles, various foodstuffs. The goods must not be sold unless the name of the country of origin is clearly marked. The policy underlying the administration of such orders is to give the purchaser the opportunity of choosing between home, empire or foreign goods. With the appointment of a Sanitary Inspector solely concentrating on foodstuffs, a closer watch was kept on shops, etc., to ensure that the various Orders were being strictly complied with. In all no less than 82 infringements were detected. The traders in question were duly cautioned. In one instance a warning letter was necessary. During the year the following leaflets concerning the marking of Imported Meat, etc., were distributed to all dealers and shopkeepers likely to be affected by the Orders : — Metropolitan Borough of Greenwich. The Merchandise Marks (Imported Goods) No. 7 Order, 1934. MARKING OF IMPORTED MEAT. NOTICE TO BUTCHERS. Sale and Exposure for Sale. On sale and exposure for sale of imported meat whether wholesale or by retail, the meat must bear an indication of origin. 1. In the case of Chilled Beef, Frozen Mutton, Frozen Lamb, and Frozen Pork, where any joint or cut did not on importation or does not by reason of the method of preparation in the ordinary course of trade bear any marking, the indication of origin shall be applied by means of a Ticket or Label placed on each portion of Meat. 2. In the case of Boneless Beef, Boneless Veal, Salted Beef, Salted Pork, Loins of Frozen Pork from which the skin has been removed prior to Importation, and Edible Offals, the Ticket or Label must be placed on 55 each portion of meat or each Container or Package of Meat unless the meat is marked as on importation. 3. In the case of Frozen Beef and Frozen Veal, the requirement is similar to that last mentioned. Tray, Slab or Rail.—Where a tray, slab or rail contains either only joints or cuts of imported meat of Empire origin or only joints or cuts of imported meat of foreign origin, the following is sufficient : — A ticket or label bearing the indication of origin prominently displayed on such tray, slab or rail, clearly visible to intending purchasers and adequately identifying the meat to which it applies. Where only Imported Meat is Sold.—Where only imported meat of Empire origin is sold in a shop, the Order may be complied with by displaying prominently in the shop two notices each not less than two feet square clearly visible to intending purchasers and adequately identifying the meat, bearing the words: "All meat in this shop is imported meat of Empire origin," in letters not less than two inches in height. Similarly, if only imported meat of foreign origin is sold then the Order may be complied with by two like size notices bearing the words: "All Meat in this shop is imported meat of Foreign origin," in letters of not less than two inches in height. Delivery.—In the case of meat sent out for delivery which when exposed for sale would need labelling as above mentioned, the indication of origin must be clearly and conspicuously stated on an invoice or delivery note attached to or accompanying the meat. This is not necessary where meat is sold to a purchaser who is present at the time of the sale at the shop, provided the meat was properly marked when exposed for sale. Edible Offals.—Edible Offals, whether fresh, chilled or frozen, of carcases of cattle, sheep and pigs, means livers, lungs, melts or spleen, skirts, tails, hearts, kidneys, sweetbreads, tongues, tripe and heads (including cheeks and brains). Note.—This notice does not purport to deal with the whole effect of the above Orders or the Act, but is intended as a guide to those responsible to observe their requirements. For any further information required apply to: — The Medical Officer of Health, Borough Hall, Royal Hill, Greenwich, S.E.10. 56 Metropolitan Borough of Greenwich. MARKING OF IMPORTED BACON AND HAM. - NOTICE TO SHOPKEEPERS AND OTHERS. The attention of grocers, butchers, dealers and others is called to the Order in Council, made under the Merchandise Marks Act, 1926, requiring the marking of imported bacon and ham with an indication of origin. The order applies to imported bacon and ham on importation and also on sale and exposure for sale either wholesale or by retail. Failure to comply with the provisions of the order may result in prosecution. Indication of Origin. The order requires such bacon or ham to be marked either with a definite indication of the country in which it was made or produced (e.g., Danish), or, alternatively, if imported from foreign countries, with the word „ Foreign," or, if imported from His Majesty's Dominions, with the word „ Empire." Imported Bacon and Ham with the Rind upon it. To be marked :— Method of Marking. On importation ; on (1) By means of branding or stamping durably exposure for sale and conspicuously on the rind in block letters wholesale and by not less than three-quarters of an inch in retail ; and on sale height and not more than one-twelfth of an wholesale and by inch apart, in two lines of letters joining on retail. the gammon hock and extending from the gammon hock to (a) the end of the fore-hock and (b) the end of the top collar, in positions corresponding to the positions of the two lines A to B and C to D shown in the diagram in the Schedule to the Order ; so that the indication of origin shall appear on all the standard joints or cuts. (2) Each ham or separate portion of a ham or of a side of bacon shall be marked on the rind in the manner prescribed above, and in the same relative positions as if such ham or portion of a ham or of a side of bacon had formed part of a complete side of bacon which had been so marked. Note.—Marking on exposure for sale or on sale of any separate portion of a ham or of a side of bacon shall not apply to any piece of imported bacon or ham with the rind upon it, which, owing to the manner in which the piece was cut from the joint, does not bear an indication of origin. Bacon and Ham from which the Rind has Been Removed Before Importation. To be marked:— Method of Marking, (a) On importation ; By means of branding or stamping on the bacon on exposure for sale or ham in the manner prescribed in the case wholesale ; and on of bacon or ham with the rind upon it ; or sale wholesale and by printing, stencilling, stamping or branding by retail. on each container, wrapper, or other covering in block letters not less than one-half of an inch in height. 57 To be marked :— (b) On exposure for sale by retail. Method of Marking. By means of one of the methods prescribed above in the case of marking at the time of importation, etc. ; or by means of a label or show ticket prominently displayed on or in close proximity to the bacon or ham to which it relates so as to be clearly visible to the intending purchaser, bearing the indication of origin in letters not less than one-half of an inch in height. Bacon and Ham from which the Rind has Been Removed After Importation. To be marked :— (a) On exposure for sale wholesale ; and on sale wholesale and by retail. (b) On exposure for sale by retail. Method of Marking. By means of branding or stamping on the bacon or ham in the manner prescribed in the case of bacon or ham with the rind upon it ; or by printing, stencilling, stamping or branding on each container, wrapper, or other covering in block letters not less than one-half of an inch in height. By means of one of the methods prescribed in the preceding paragraph ; or by means of a label or show ticket prominently displayed on or in close proximity to the bacon or ham to which it relates so as to be clearly visible to the intending purchaser, bearing the indication of origin in letters not less than one-half of an inch in height. Note.—The requirement of marking bacon or ham from which the rind has been removed either before or after importation shall not apply: — (a) On sale, either wholesale or by retail, in any case in which the indication of origin is clearly and conspicuously stated on an invoice or delivery note accompanying the goods ; and (b) In the case of a sale of bacon or ham which is marked on exposure for sale by retail by means of a label or show ticket to a purchaser who is present at the time of sale at the shop, place or premises on which the bacon or ham is exposed for sale. The Order does not apply to bacon or ham which has been cooked, canned or potted prior to importation. NOTE. This notice does not purport to deal with the whole effect of the Order or the Act, but is intended as a guide to those responsible to observe their requirements. For any further information required apply to: — The Medical Officer of Health, Borouch Hall, Royal Hill, Greenwich, S.E.10. 58 Metropolitan Borough of Greenwich. MARKING OF IMPORTED FOODSTUFFS. NOTICE TO SHOPKEEPERS AND OTHERS. The attention of greengrocers, grocers, poulterers, dealers and others concerned is called to the Orders in Council made under the Merchandise Marks Act, 1926, relating to the marking of the following imported produce:— 1. Fresh apples. 2. Raw tomatoes. 3. Eggs in shell (i.e., hen and duck eggs). 4. Dried eggs. 5. Currants, sultanas and raisins. 6. Oat products (i.e., oatmeal, rolled oats, oat flour and groats). 7. Honey. 8. Frozen or Chilled Salmon or Sea Trout. 9. Butter. 10. Dead Poultry (i.e., ducks, fowls (excluding guinea fowl), geese or turkeys, whether dressed or undressed). 11. Bacon and Ham. The Orders apply to these goods on sale and exposure for sale wholesale, as well as by retail, and generally on importation also ; but this notice refers to sale and exposure for sale by retail only, and in particular to the goods numbered 1 to 10 inclusive as above. For the requirements as to marking imported Bacon and Ham (with or without rind) all persons concerned are referred to a separate Notice which may be obtained on application to the address indicated at the foot of page 55. Indication of Origin. These Orders require the above goods to be marked, if imported from foreign countries, with the word "Foreign" ; or, if imported from His Majesty's Dominions, with the word " Empire." In either case, however, the goods may, at the option of the seller, be marked with a definite indication of the country in which they were made or produced (e.g., "Danish," "Produce of Canada," etc.), instead of with the words " Foreign " or " Empire." Show Tickets. On exposure for sale by retail the following goods are required to be marked with a show ticket, clearly visible to intending purchasers, bearing the indication of origin in letters not less than half an inch in height: — Fresh apples. Raw tomatoes. Currants, sultanas and raisins (not pre-packed). Oat products (not pre-packed). Butter in bulk. 59 Label or Show Ticket. Frozen or chilled salmon and sea trout are required, on exposure for sale by retail, to be marked with a label or show ticket placed on or in close proximity to each fish or portion of fish bearing the indication of origin in letters of not less than half an inch in height. Pre-Packed Goods. The following goods are required to bear the indication of origin on the container when pre-packed (i.e., made up in packages ready for retail sale) before reaching the retailer, but not otherwise: — Currants, sultanas, and raisins. Dried eggs. The following goods are always required to be marked with the indication of origin when packed ready for retail sale: — Honey. Oat products (either on the container or by means of a show ticket as above). Butter (if wrapped or packed ready for retail sale). The marking on containers of currants, sultanas and raisins, dried eggs, honey or oat products is required to be in plain block letters not less than one-twelfth of an inch in height when the greatest dimension of the packages does not exceed six inches and in letters one-eighth of an inch in height when the greatest dimension of the package exceeds six inches. In the case of butter the marking on the packages or wrappers or visible through the wrapper, is required to be in plain block letters not less than one-twelfth of an inch in height. Sales from Bulk. The following goods, when not pre-packed, must be marked with the indication of origin at the time of retail sale in quantities of more than 14 1b.: — Fresh apples. Raw tomatoes. Currants, sultanas and raisins. Oat products. Honey if sold from bulk by retail must be marked with the indication of origin whatever the quantity sold. Blends or Mixtures. Blends or mixtures of oat products and blends or mixtures of honey must be marked in one of the following ways: — (a) if derived entirely from within the Empire, by the word "Empire" ; if derived entirely from foreign countries, by the word " Foreign " ; or (b) a definite indication of the countries of origin of the goods forming the blend or mixture ; or (c) "Blended Imported." This expression is applicable even though the blend or mixture contains among its constituents some produce of the United Kingdom. 60 Blends or mixtures consisting of or containing imported butter must be marked in one of the following ways: — (a) the word "Empire" if derived entirely from within the Empire (whether or not some part of it was produced in the United Kingdom), or the word " Foreign" if derived entirely from foreign countries ; or (b) the expression " Partly Empire and partly foreign" if derived partly from within the Empire and partly from foreign countries, whether or not the blend contains also butter produced in the United Kingdom ; or (c) the expression " Partly foreign " if the blend consists of foreign butter and butter produced in the United Kingdom ; or (d) a definite indication of all the countries of origin of the butters forming the blend ; or (e) the words " Including imported butter." Eggs in Shell. Imported hen or duck eggs in shell must be marked conspicuously and durably on the shell of each egg in letters not less than 2 millimetres (approximately one-twelfth of an inch) in height. Dead Poultry. (i.e., ducks, fowls (excluding guinea fowl), geese or turkeys (whether dressed or undressed). Each imported bird must bear an indication of origin, which must be marked legibly and durably in a conspicuous manner on a seal or disc of a permanent character and not less than two centimetres in diameter, securely attached to one of the wings of each bird by a durable attachment passing through a circular hole not less than one centimetre in diameter punched or stamped through the web of the wing. The indication of origin in each case must be printed, stamped or embossed on such seal or disc in letters not less than one and a half millimetres in height. Imported Goods Generally. Apart from the above Orders, the Act of 1926 requires that all imported goods must be marked with the indication of origin at the time of exposure for sale and sale if they bear any name or trade mark of any manufacturer, dealer or trader, or the name of any place or district in the United Kingdom. The orders described above apply irrespective of whether the goods bear a United Kingdom name or trade mark. Failure to comply with them may result in prosecution. NOTE. This notice does not purport to deal with the whole effect of the above Orders or the Act, but is intended as a guide to those responsible to observe their requirements. For any further information required apply to: — The Medical Officer of Health, Borough Hall, Royal Hill, Greenwich, S.E.10. 61 Milk Supply.—The majority of milk supplied to this Borough is obtained from farmers and large firms outside the district. There is, however, one farm in the Kidbrooke area where 100 cows are kept, which is under constant supervision of the Inspector. Cowhouses.—The three cowhouses in the Borough have been visited on eight 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 173 purveyors of milk on the Register of Dairies and Milkshops. Thirty new applications have been received during the year and added to the Register, and 26 names have been taken off, thus leaving a total of 177 purveyors of milk now registered. The number of premises registered at the end of the year was 66. Two hundred and fifty-one visits of inspection of dairies, and shops where milk is sold in sealed bottles, have been made ; as a result of which lime-washing, cleansing or painting was carried out in nine cases. At the end of the year there were ten wholesale purveyors of milk on the Register. 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 licences to distributors, such licences to be valid only for a period ending on the 31st December in the year in respect of which it is granted. During the year the following licences were granted for the sale of graded milk : — Distribution of Certified Milk 2 „ „ Grade A (Tuberculin Tested) 3 „ „ Pasteurised 18 „ „ Grade A (Pasteurised) 2 *Supplementary Licences 2 * Principal Licences granted by the Bermondsey and Deptford Borough Councils. Milk.—Result of Analytical Examinations.—One hundred and sixty samples of milk were taken during the year, of which only seven were found to be adulterated or below the standard 62 fixed by the Ministry of Agriculture and Fisheries. Of the 160 samples, 48 were taken from handcarts in the streets and also 41 from local Hospitals and Schools. Milk for School Children.—During September a Circular was issued by the Board of Education with regard to the Milk Marketing Board's Scheme for the provision of milk for School children, which aims to popularise the demand for milk by reducing the price of milk consumed in approved schools. Medical Officers of Health were asked to co-operate by approving the source and quality of the milk to be supplied. By arrangement with the School Medical Officer (Dr. Kay Menzies) it was decided that only pasteurised milk should be accepted, and in order that Head Teachers would know where to obtain supplies they were furnished by the Public Health Department with names of Dairymen who were authorised to sell pasteurised milk. Samples of milk are taken in course of transit from each Department of the Schools concerned and submitted for chemical and bacteriological examination, and reports sent to the School Medical Officer. Dried Milk.—Three samples were taken in course of delivery and were found to comply with the standard laid down by the Public Health-(Dried Milk) Regulations, 1923 and 1927. Condensed Full Cream Milk.—Nine samples were taken during the year and were found upon analysis to comply with the standard laid down under the Public Health (Condensed Milk) Regulations, 1923 and 1927. In every instance the rules regarding proper labelling were observed. Bacteriological Examination.—At the request of the London County Council samples of milk were taken on arrival at the Brook Hospital (12 samples) and St. Alfege's Hospital (9), the milk being supplied under contract as Pasteurised. Two of the samples taken from St. Alfege's Hospital failed to pass the standard laid down by the Milk (Special Designations) Order, 1923, which is that bacteria per c.c. shall not exceed 100,000. Copies of the Reports of the Council's Pathologist were furnished to the London County Council in order that they could take appropriate action. Street Traders.—There are 114 Street Traders who are engaged in selling articles of food. Generally speaking, it was found that the premises where such articles of food were stored, were in all respects reasonably clean. 63 Preserved Food Premises.—In accordance with the provisions of the London County Council (General Powers) Act, 1932, all premises with the exception of clubs, hotels or restaurants used : — (a) for the sale or the manufacture for the purpose of sale of ice-cream or other similar commodity, or the storage of ice-cream or other similar commodity intended for sale ; or (b) for the preparation or manufacture of sausages or potted, pressed, pickled, or preserved meat, fish, or other food intended for sale ; are required to be registered by the owner or occupier with the sanitary authority. Ice-Cream Premises.—At the end of the year 135 premises were duly registered. These premises were inspected on 178 occasions and insanitary conditions remedied in four instances. Preserved Meat, etc., Premises.—At the end of the year 116 premises were on the register and were visited on 52 occasions. As a result of such inspections insanitary conditions were detected and remedied in eight cases. There was no instance found which necessitated the cancellation of premises already registered. Bakehouses.—One hundred and sixty-eight inspections have been made of the various bakehouses in the Borough, and forty nuisances found therein have been abated. At the end of the year there were 24 factory and 16 other bakehouses on the Register, 13 of which were underground. Food and Drugs Acts.—Altogether 448 samples have been taken under the provisions of the Food and Drugs (Adulteration) Act, 1928, and submitted to the Public Analyst for analysis of which number 155 were formal samples. Ten of these samples were certified to be not genuine, the adulterations thus being equivalent to 6-4 per cent of the samples taken as compared with 1.7 last year. Police Court proceedings were instituted in 3 instances. In one case the Vendor was fined £4 and £2 2s. 0d. costs, whilst the remaining two cases were dismissed on payment of £1 1s. 0d. costs. 64 Public Health (Preservatives, etc., in Food) Regulations. —Of the total samples submitted to the Public Analyst, there were only 5 infringements reported upon. Four were in respect of Tomato Sauce. Each sample contained a proportion of benzoic acid but they were not labelled in accordance with the Regulations. Police Court proceedings were taken in regard to a sample taken in course of delivery but the magistrate dismissed the case owing to a technical informality. It is interesting to note that since the case was heard, a further sample was taken of the same brand which proved upon analysis to be free from all preservatives. The remaining sample adversely reported upon, referred to Sausages which contained 360 parts per million of sulphur dioxide, which would have been permissible under the Regulations, had a notice declaring the existence of such preservative been exhibited in the shop. The Vendor was duly warned. Wholesale Margarine Dealers.—The following premises are registered under the Food and Drugs (Adulteration) Act, 1928, where the business of a Wholesale Dealer in Margarine is carried on in the Borough : — 21, London Street. 144, Trafalgar Road. 42, Old Dover Road. Margarine is a food used largely by the poorer classes and also for culinary purposes and care is taken to see that there is no substitution for butter and also that it is hygienically handled. Numerous samples were taken during the year. Artificial Cream Act, 1929.—For the first time since the passing of the above Act an application was received for registration. The premises, being suitable, were duly registered. 65 ANALYSIS OF IMPROVEMENTS EFFECTED ON FOOD PREMISES. The following Table shows the number of instances improvements were effected as a result of the Food Inspector's inspections. Food Premises. Work Done. Slaughterhouses and Knackers' Yards Cleansing and Limewashing 12 Eating Houses, Hotel Extension of latrine accommodation 1 Kitchens, etc. Food Kitchens cleansed and renovated 16 Sink waste-pipe fixed 1 Drain and gully laid 1 Yard paving repaired 1 Butchers' Shops Sausage-rooms cleansed and renovated 7 Premises cleansed and renovated 1 Sink waste-pipe fixed 1 Machinery cleansed 1 Cold-store cleansed of moulds 1 New Refrigerator fixed 1 Dairies and Milkshops .. Dairies cleansed, limewashed or painted 9 Yard paving repaired 2 Store-room distempered 1 Dustbin supplied 1 Steam sterilising plant installed 1 Bottle-washing machine repaired 1 Ice-Cream Shops Cleansed and limewashed 3 Cleansed and ceiling repaired 1 Cleansed and painted 1 Bakehouses Painting or limewashing 45 Eaves-gutters and rain-water pipe fixed 3 W.C. Pan and Trap fixed 2 Staircase and floor repaired 4 Dustbins supplied . 2 Flushing cistern repaired 1 Yard gully fixed 1 Pastry benches fixed 2 Premises rat-proofed 1 Sink fixed 1 Fried Fish Shops Staff-room wall repaired 1 Frying rooms cleansed, limewashed or painted 5 Rainwater pipe repaired 1 Frying ranges fixed 2 Yard paved 1 Roofs repaired 2 Eel-pie Shops Eaves-gutters renewed 2 Bench covered with zinc 1 Pie-room cleansed and limewashed .. 1 Wharves and Cold-Stores Cutting-bench re-covered with galvaniset plate 1 Sweet Factory Cutting and Packing room limewashed 1 Dust-screen erected 1 66 FOOD AND DRUGS (ADULTERATION) ACT, 1928. Number and Description of Samples Submitted for Analysis under the above Act during the Year 1934. FORMAL SAMPLES Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Bicarbonate of Soda 1 1 — Milk 154 148 6 Tomato. Sauce 3 — 3 Vinegar 3 2 1 Whisky 4 4 — 165 155 10 INFORMAL SAMPLES. The following samples were taken from Vendors and submitted to the Public Analyst, by the Food Inspector or his agent without recourse to the usual provisions as required by the Food and Drugs (Adulteration) Act, 1928. Description of Samples Number of Samples Submitted Number Genuine Number Not Genuine Almonds (Ground) 2 2 — Arrowroot 6 6 — Aspirin Tablets 3 3 — Baking Powder 3 3 — Borax 1 1 — Brawn 2 2 — Butter 22 22 — Cakes 3 3 — Castor Oil 2 2 — Cayenne Pepper 3 3 — Cheese 6 6 — Cocoa 1 1 — Cod Liver Oil and Malt 3 3 — Coffee 2 2 — Corn Flour 3 3 — Cream 1 1 — 67 Description of Samples. Number of Samples Submitted Number Genuine Number Not Genuine Curry Powder 1 1 — Custard Powder 1 1 — Dripping 4 4 — Egg Substitute 1 1 — Fish dressing 1 1 — Fish paste 9 9 — Flour 4 4 — Flour, Self-raising 2 2 — Fruit, Dried 3 3 — Ginger, Ground " Gravo Thik " (gravy powder) 8 7 1 2 2 — Gravylets (gravy tablets) 1 1 — Gravy Salt 1 1 — Herbs (mixed) 1 1 — Ice-Cream 8 8 — Jam 4 4 — Lard 22 22 — Lemon Squash 1 1 — Lemon Curd 1 1 — Margarine 19 19 — Milk 6 5 1 Mineral Water 3 3 — Mint 7 7 — Mustard 5 5 — Milk (condensed, skimmed, sweetened) 9 9 — Milk (Dried) 3 3 — Mincemeat 2 2 — Oatmeal 3 3 — Olive Oil 3 3 — Pearl Barley 9 9 — Peas, Green 2 2 — Pepper 5 5 — Rice 4 4 — Rubbing Oils 1 1 — Sardines 5 5 — Sauce 6 6 — Sausages 14 13 1 Seidlitz Powder 2 2 —- Sild 1 1 — Sodium Bicarbonate 3 2 1 Suet 5 5 — Sage and Onion Stuffing 1 1 — Sugar 1 1 — Sultanas 1 1 — Table Jelly 9 9 — Tapioca 3 3 — Thyme 1 1 — Vinegar 8 6 2 Veal Stuffing 1 1 — Wines, Non-alcoholic 3 3 — 283 277 6 68 Administrative Action Taken Regarding Samples reported to be NOT GENUINE. No. of Sample Description of Sample Nature of Adulteration Action taken 11 Milk Addition of 3% of water Summons taken out Fine £2 Costs £2 2s. 0d. H. 20 Ground Ginger Contained 3% of rice No Action taken H. 40 Milk Abstraction of 6% of fat Formal Sample taken H. 74 Sodium Bicarbonate Contained 25 parts per million of lead Formal Sample taken 47 Milk Addition of 1.5% of water Warning Letter 60 Milk Slightly deficient in solids-not-fat No Action taken H. 128 Tomato Sauce Contained 250 parts per million of benzoic acid Formal Sample taken 85 Tomato Sauce Contained 240 parts per million of benzoic acid Transit Sample requested 86 Tomato Sauce Contained 220 parts per million of benzoic acid Transit Sample requested 87 Tomato Sauce Contained 240 parts per million of benzoic acid Summons. Case dismissed. Costs awarded against Council, £1 1s. 117 Milk Addition of 9% of water Summons. Costs, £1 1s. 118 Milk Addition of 9% of water H. 225 Vinegar Deficient in acetic acid to the extent of 5% Formal Sample taken 135 Milk Addition of 7% of water Summons. Costs, £1 1s. 143 Vinegar Deficient in acetic acid to the extent of 16% Residue of stock destroyed and manufacturer warned re presence of vinegar eels and acid deficiency H. 255 Sausages Contained 360 parts per million of sulphur dioxide Manufacturer duly warned 69 OTHER PROCEEDINGS. MILK AND DAIRIES ORDER 1926. Date of Hearing Description of Sample Offence Result of Proceedings 6th Feb., 1934 No. 11—Milk Failure to comply with article 6 of the Milk and Dairies Order, 1926, re registration. Vendor fined £2 NOTIFICATION OF FOOD POISONING. Under the provisions of the London County Council (General Powers) Act, 1932, every registered medical practitioner attending on any person shall, if he suspects or becomes aware that such person is suffering from food poisoning forthwith notify such case to the Medical Officer of Health. There was only 1 case notified during the year as compared with 10 for the previous year. In this instance the illness was only slight and the suspected cause was attributed to consuming mushrooms. The patient soon recovered necessitating no further action on the part of the Officers of the Public Health Department. What might have been a serious outbreak of Food Poisoning occurred during September amongst the employees of a large Gas Works. About 275 men had partaken of dinner in the work's canteen, a large number subsequently complained of abdominal pains. Immediate investigation was made into the cause but no tangible evidence was obtainable. Fortunately, the majority of the men recovered quickly. Incidentally no official notification was received from any medical practitioner in the district. A report which was sent to the Ministry of Health concerning the case appears in the Appendix at the end of this Report. 70 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Under the compulsory notification Section of the Public Health (London) Act, 1891, and the Orders and Regulations made thereunder, 3,226 cases of Infectious Disease were reported during the year. The following table shows the comparison since 1929. No. Year. 2,387 929 3,572 1930 1.645 1931 3,497 1932 3,267 1933 3.226 1934 Particulars relating to age groups and districts are shown in the tables at the end of the Report. Small-Pox.—There were no cases reported during the year. Public Health (Small-pox Prevention), Regulations, 1917. It was not found necessary for your Medical Officer of Health to undertake any vaccinations during the year. Details respecting vaccination in the Borough are given in the Supplementary Vaccination Report on page —. Whooping-Cough.—Whooping-Cough is only notifiable in a few London Boroughs of which Greenwich is one. Altogether 290 cases were notified compared with 571 for the previous year. One hundred and sixty-one occurred in East Greenwich. 62 in West Greenwich, 21 in St. Nicholas and 46 in Charlton and Kidbrooke. Fifteen cases were removed to Hospital for treatment. Diphtheria.—The number of patients notified as suffering from Diphtheria during the year was 422 as compared with 396 and 235 for the years 1933 and 1932. Four hundred and nineteen cases were 71 removed to Hospital, of which 12 were found necessary to receive further hospital treatment after discharge. Twenty-two of such cases were reported by the Hospital authorities as not suffering from this disease, whilst 4 were notified as suffering from Tonsillitis. In accordance with the Antitoxin Order, 1910, a supply of Diphtheria Antitoxin is provided by the Council for the use of general practitioners in emergency cases. Forty-one tubes of Antitoxin, containing a total of 408,000 units of serum, have been supplied during the year. As in previous years many enquiries from parents were received asking if their children could be protected from Diphtheria. They were reluctantly referred to other Boroughs where immunisation existed. There were 5 fatalities due to Diphtheria which gives a case mortality of 1.1 per cent. Two thousand five hundred and forty specimens were forwarded by medical practitioners for bacteriological examination from cases suspected to be diphtheria. Of this number, 2,148 were reported to give negative or doubtful results, and 392 were positive in character, being dealt with accordingly. Measles.—The same procedure has been continued in dealing with epidemics as they arise and the closest co-operation exists between the School Organisation and the Public Health Staff in securing the earliest possible information of cases and the prompt removal to hospital of those children suffering from complications and living in overcrowded and insanitary conditions. Owing to the admission of cases of measles to Hospital for treatment and the high incidence of infectious diseases generally, the London County Council were compelled to limit the admission of cases of Scarlet Fever for several months during the year. One thousand four hundred and fifty-five cases of Measles were notified during the year as compared with 1,135 for the previous year; 613 cases occurred in East Greenwich, 432 in West Greenwich, 141 in St. Nicholas, and 269 in Charlton and Kidbrooke. One hundred and fifty of such cases were removal to Hospital. 72 The case mortality for the whole Borough works out at 1.1 per cent, as compared with 0.17 per cent, for the year 1933, and 1.2 per cent, for the year 1932. Zymotic Enteritis or Epidemic Diarrhcea.—Forty-one cases of these diseases were notified throughout the whole of the Borough, 31 being under one year of age and ten, 1 to 5. Fourteen of such notifications related to patients in East Greenwich, 15 in West Greenwich, 7 in St. Nicholas, Deptford, and 5 in Charlton and Kidbrooke. There were 30 deaths ascribed to Diarrhoea and Enteritis. Although the number of notifications received was comparatively small, there was a considerable number of cases of illness arising from Diarrhoea and Vomiting, a number of whom were eventually removed to Hospital for treatment. During the month of September no less than 10 of such cases died, the cause being attributed to Enteritis ; no notification was received in any of these cases. Ophthalmia Neonatorum.—During the year 10 cases of this disease had been notified compared with 18 for the previous year. Three occurred in East Greenwich, 4 in West Greenwich, and 3 in Charlton and Kidbrooke. Four of such cases were removed to hospital for treatment. One case was returned by the hospital authorities as not suffering from this disease. Scarlet Fever.—The number of notifications of this disease was slightly less than last year, viz., 627 against 671, and fortunately the disease maintained the rather mild character which has been observed during recent years, as owing to the prevalence of measles, hospital treatment for scarlet fever was somewhat restricted. Of the 627 cases, 306 were in East Greenwich, 139 in West Greenwich, 24 in St. Nicholas and 158 in Charlton and Kidbrooke. Five hundred and twelve of these cases were removed to hospital for treatment, of which 16 were returned by the hospital authorities as not suffering from this disease. There were 3 deaths from this cause which is the same as that returned last year. Typhoid Fever. — There were only 2 cases of Typhoid or Enteric Fever notified during the year, 1 case being in St. Nicholas, Deptford, and the other in Charlton and Kidbrooke. Both were removed to hospital for treatment. Six specimens were forwarded by medical practitioners for bacteriological examination from cases suspected to be Typhoid Fever in character, all of which gave a negative result. 73 Puerperal Fever.—Five cases of this disease were notified during the year as compared with one last year. Two occurred in East Greenwich, 2 in West Greenwich and 1 in St. Nicholas, Deptford. Three of the cases were removed to hospital for treatment, of whom one died. Puerperal Pyrexia.—There were 9 cases attributed to this cause during the year as compared with 10 for the previous year. Three occurred in East Greenwich, 1 in St. Nicholas and S in Charlton and Kidbrooke. Five of such cases were removed to hospital. Epidemic Cerebro-Spinal Meningitis, Cerebro-Spinal Fever or Post-Basal Meningitis.—There were only two cases of this disease during the year. One occurred in East Greenwich and the other in West Greenwich. Both were removed to Hospital for treatment. Acute Polio-Myelitis.—Three cases were notified during the year as compared with one case for the previous year. Influenzal Pneumonia and Acute Primary Pneumonia.— During the year 154 cases of Influenzal Pneumonia and Primary Pneumonia were notified, of which more than half (82) occurred in East Greenwich, one of the low-lying districts of the Borough. As provided in the regulations where nursing was inadequate a district nurse was sent in accordance with an arrangement with the local Nursing Association. Influenza, unless accompanied by pneumonia is not notifiable. Leprosy.—A somewhat unusual experience in Greenwich as Medical Officer of Health was to see a case of Leprosy which was admitted to the Dreadnought Hospital. The patient, an Asiatic seaman, developed the disease on a voyage from the East, and on arrival in London and pending his return home was isolated in Hospital for three days. The disease was of the form known as Lepra Nodosa, hard nodules slightly larger than a pea, and were mostly confined to the face with a few on the arms and legs. The man otherwise seemed perfectly well. Infectious Diseases.—In connection with infectious diseases, it has occasionally happened that residents of Greenwich whilst on holiday or otherwise have contracted infectious disease in the district in which they are temporarily residing. In certain cases the authorities 74 concerned have refused treatment and actually sent the cases home stating that they were not liable for either hospital or other treatment. In other instances cases have been admitted to the Isolation Hospital and the amount charged to this Borough. This has led to much discussion but by the Public Health (Treatment of Infectious Diseases) Regulations, 1934, which came into operation on the 1st July, 1934, it has now been definitely stated that the district in which the disease is discovered is liable for the hospital or other treatment of the patient. DISINFECTION OF PREMISES. The disinfection of rooms from which patients suffering from notifiable infectious diseases have been removed is carried out by means of the formaldehyde spray. For other than notifiable conditions disinfection is carried out on request, and a charge made according to the circumstances of the case. Bedding and wearing material are removed to the Disinfecting Station, Tunnel Avenue, and are there submitted to steam disinfection. Books are now treated with Formalin. The following returns show in detail the amount of work performed during the year by the Disinfecting Staff : — 75 Rooms and Articles Disinfected, Year 1934. Diseases, etc. Premises Entered Rooms Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Disinfected Scarlet Fever 590 685 322 — 262 321 1,002 1,165 795 57 772 772 5,468 Diphtheria 386 499 207 — 168 192 630 755 471 29 484 1,570 4,506 Small—pox 1 3 1 — 2 1 4 3 3 — 3 16 33 Tuberculosis 79 98 11 — 9 8 47 16 11 8 8 242 360 Cancer 25 25 15 — 9 13 44 24 13 8 16 30 172 Measles 25 58 — — 9 — 13 18 10 — 6 51 107 Cerebro—Spinal Fever 2 2 1 — 2 2 — — 1 2 8 Puerperal Fever 4 5 1 — 2 2 11 1 2 — 1 10 30 Erysipelas 4 3 — — 1 1 1 4 — — 2 16 25 Chickenpox 3 3 1 — — — — 1 — — — — 2 Enteric Fever 1 3 1 — — — 2 3 — — 1 4 11 Scabies 7 6 8 — 7 8 14 22 11 — 16 76 162 Polio Meningitis 1 2 — 1 1 1 1 1 10 15 Other Diseases 62 70 13 65 4 151 18 22 7 11 94 385 Verminous Premises 48 50 41 — 48 13 53 113 7 11 12 79 377 Verminous (Housing G.B.C.) 79 — 116 — 140 11 17 15 7 6 17 2 331 Verminous (Housing L.C.C.) 24 — 48 10 '31 36 118 91 37 9 49 353 782 Total 1,341 1,512 785 10 755 610 2,110 2,252 1,390 135 1,400 3,327 12,774 76 Articles Destroyed, Year 1934. Diseases, etc. 1 Beds Palliasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Destroyed Scarlet Fever 2 — 6 — — 2 2 3 — 8 23 Diphtheria 2 — 2 — — — — — — — 4 Tuberculosis 4 — 6 6 0 5 2 1 — 8 38 Cancer 4 — 8 3 13 1 — 3 2 157 191 Other Diseases 10 16 6 2 14 — 6 2 — 270 326 Verminous Premises 8 — 7 1 4 — — 4 — 9 33 Verminous (Housing G.B.C.) 3 2 4 2 6 — 3 — — 50 70 Total 33 18 39 14 43 8 13 13 2 502 685 77 Supplemental Vaccination Return for 1933. Return made on or before the 9th of February, 1935, by Mr. E. S. Elliott, Vaccination Officer of the several Districts of the Borough of Greenwich, respecting the vaccination of children whose births were registered in his District from 1st January to 31st December, 1933, inclusive:— Registration SubDistricts comprised in tde Vaccination Officer's District. No. of Births from 1st Jan. to 31st Dec., 1933. Number of these Births duly entered by 31st Jan., 1935. No. of Births which on 31st Jan., 1935, remained unentered in the Vaccination Register on account of— No. of these births remaining on 31st Jan., 1935, not accounted for Total No. of Certificates of successful Primary Vaccination of children under 14 received during B Calendar Year 1934 No. or Declarations of Conscientious Objection actually received by Vaccination Officer during the Calendar Year 1934. 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. East Greenwich 807 426 3 — 217 39 4 % 38 74 — — *West Greenwich 245 105 — — 74 17 6 i 15 27 — — Charlton and Kidbrooke 604 290 4 225 26 9 19 13 18 — — Total 1,656 821 7 — 516 82 19 26 66 119 783 625 •Includes St. Nicholas District. Dated 4th February, 1935. E. S. Elliott, Vaccination Officer. 78 HOUSES VISITED AND ENQUIRIES MADE IN CONNECTION WITH INFECTIOUS DISEASE. Number of Houses Visited and enquiries made by Infectious Disease Inspector 1,284 Number of Re-visits 2,875 The Health Visitors also visited 1,670 cases, and re-visited when required. The following books belonging to the Libraries, etc., were disinfected in consequence of Infectious Disease : — Council Libraries 611 School Libraries 239 850 CLEANSING STATION, BLACKWALL LANE. The cleansing of persons and the disinfection of clothing,etc., in a verminous state are carried out by the Disinfecting staff.The arrangements made with the London County Council for the cleansing of verminous school-children continue in operation.The total number of children cleansed was 976. Health Propaganda.—The arrangements made with the Proprietors of " Better Health," whereby they supply us with 2,000 copies of their journal each month, continue to be in force. Copies are distributed to all members of the Greenwich Borough Council, local medical men, midwives, dentists, head-masters and head-mistresses of the various schools, boy scout organisations, to large firms for the issue to their employees, and also, of course, there are copies available at the various Welfare Centres and Tuberculosis Dispensary. Health Week.—As a means of focussing attention on health matters generally, the usual Tea and Entertainment was provided for the mothers and children attending the Welfare Centres. Through the courtesy of the British Social Hygiene Council a series of Lectures on Venereal Diseases, illustrated by Films, were given to crowded audiences. 79 REPORT OF THE TUBERCULOSIS OFFICER. To the Medical Officer of Health. Sir, In presenting this, my first, report on the work of the Tuberculosis Department, it is gratifying to be able to state that co-operation with other departments, practitioners, charitable bodies, and the Public Assistance Committee has been well maintained during the year under review. The declining incidence of, and mortality from, tuberculosis referred to in previous reports is again apparent, when comparisons are made to average figures for a number of years. Comments on the work of the Dispensary are made later in this Report under various headings. The Notifications and Deaths, are as follow:— Tabel A.- Notifications. Deaths. Pulmonary NonPulmonary Total Pulmonary NonPulmonary Total 113 23 136 75 10 85 and the averages for the previous ten years : — 128 41 96 15 These figures give an Incidence Rate for all forms of the disease of 1.40 per 1,000 of the population (1.16 pulmonary and .23 non-pulmonary). Table B.—The Death Notification Interval of 73 patients who died of Pulmonary Tuberculosis in 1934 is shown below : — Information from Death Returns 2 Died within one month of notification 7 Died within three months of notification 4 Died within six months of notification 4 Died over six months of notification 56 In two cases where death occurred before notification the reasons were as follow : — (1) Case transferred in previous year and removed from the register, returned to live in the Borough, shortly before death, without the knowledge of the department. (2) Tuberculosis discovered as contributory cause of death on post-mortem examination. 80 Deaths.—During the year 85 persons died from Tuberculosis (all forms), giving a Death Rate of .87 per 1,000 population ; 75 were due to the pulmonary form (equal to a rate of .77 per 1,000). Table C.—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 1929 152 1.46 108 1.04 1930 124 1.19 100 .96 1931 124 1.24 96 .96 1932 101 1.0 76 .75 1933 114 1.16 94 .93 Table D.—Non-Pulmonary Tuberculosis.—The 23 nonpulmonary notifications included : — 3 cases of Tuberculosis of Peripheral Glands. 6 „ „ „ Abdominal Glands. 8 „ „ „ Bones and Joints. 6 „ „ „ Other organs. Non-pulmonary deaths were 10, including 2 of bones and joint tuberculosis, 1 of abdominal, and 5 of meningitis and 2 of other organs. Table E.—At the end of 1934 the estimated number of persons suffering from Tuberculosis in the Borough was as follows : — Men Women Children Total Pulmonary 241 190 69 500 Non-pulmonary 30 40 107 177 giving a total of 677 as compared with 717 in 1933. Public Health Tuberculosis Regulations, 1925.—During the year no case arose which required action under these Regulations. Occupations.—As in previous years a consideration of this question does not reveal any influence of occupation in the incidence of tuberculosis in the Borough. Housing.—This continues to be a major problem. During the year several outstanding cases were reported to the Public Health Committee. Five cases were the subject of special recommendations 81 to the L.C.C. In these cases the families were provided with suitable accommodation in the Council's Estates, or were receiving preferential consideration at the year end. Families occasionally come to the notice of this department to whom no assistance can be given in the way of abating existing overcrowding because of absence of room internally for a bed, or externally for a sleeping shelter. Of 62 definitely infectious cases who became known to the Dispensary Staff in 1934, 28 were sharing beds 9 „ „ rooms In 23 other cases it was possible to arrange separate sleeping accommodation. In 11 of the worst cases suitable improvement was effected through the efforts of the nurses. The seven sleeping shelters belonging to the Council were in constant use during the year. Gifts of bedding and clothing from several donors were distributed by the nurses to necessitous cases. In one or two instances it was found possible to isolate an infectious case at home by supplying a bed. As in previous years ordinary Sanitary defects were notified to the Public Health Department for necessary action. Dispensary.—665 new patients including 26 transfers were seen in connection with the Dispensary during the year. The sources from which these patients came were as follows : — Doctors 245 Hospitals 16 School Medical Service 10 Nurses 270 Own application 124 Contacts.—The number examined during the year was 207. This is a very satisfactory index of the success which follows the endeavours of the nurses. Contacts are notoriously difficult to examine, because, feeling well, they do not realise the importance of the procedure. Eight of those examined were considered definitely tuberculous, and in 2 cases the diagnosis at the year end was not completed. In connection with contact examination, attention is directed to the results of a series of tuberculin tests carried out during the year and commented on in another part of this Report. 82 Dispensary Tables.—The work of the Dispensary is illustrated in tabular form on pages 87 to 92. Residential Treatment.—245 recommendations were made in 1934. The average length of stay in sanatoria remains about 4 months. It is to be regretted that greater effort to induce patients to continue residential treatment is not made. Some cases are discharged because " no further material benefit can be expected " when they would be quite willing to remain. The material benefit to contacts at home by extending the period of in-patient treatment in infectious cases, is a point meriting closer consideration. During 1934, 20 children were recommended for admission to the open-air school at Charlton. About 50 children from this Borough are in attendance, and are seen at regular intervals during the year by the Tuberculosis Officer. Special mention must be made of the remarkable improvement noted in these children after a period of attendance at the school. It would seem to be an ideal method of dealing with contact children, or quiescent cases of tuberculosis as well as the poorly developed undernourished child. 34 children were recommended for varying periods of convalescent treatment to the Invalid Children's Aid Association. Very satisfactory improvement was noted in the majority of children on their return. X-Ray Examinations.—In June, 1934, an agreement was reached with the London County Council whereby the Tuberculosis Officer would have the use of the X-Ray apparatus at St. Alfege's Hospital on one afternoon per week. 387 examinations were carried •out during the year. Some of these were done at the Seamen's Hospital under arrangements existing prior to above. Visits to St. Alfege's Hospital.—During the year your Tuberculosis Officer was appointed Visiting Consultant jointly with the Deptford Tuberculosis Officer. Visits are made on alternate weeks. In this way close contact is maintained with cases admitted from the Borough and doubtful cases are seen for the Resident Medical Staff. It is gratifying to be able to report that up to the present the relations between the Dispensary and Hospital staff has been very satisfactory. It is to be hoped that this arrangement will be extended indefinitely. In 1934, the arrangements for continuation of Artificial Pneumothorax treatment which existed with Voluntary Hospitals was discontinued. All cases discharged since May, 1934, and needing this 83 treatment now attend as out-patients at St. Alfege's Hospital, your Tuberculosis Officer visiting one afternoon per week to carry out this work. Sputum Examinations, Etc.—These examinations have been carried out at the Seamen's Hospital Laboratory as in previous years. 213 specimens were sent in connection with Dispensary patients of which number 36 were positive. In addition other examinations were made including blood, urine and pleural fluids. Blood sedimentation tests were carried out at the Dispensary on 16 patients. This gives a useful indication of the progress of some patients. It is unfortunate that more time could not be given to carrying out serial examinations in special cases. One patient was being given gold treatment at the year end. The treatment was commenced in sanatorium and continued at the request of the Medical Superintendent. It is a useful form of therapy in certain types of the disease, but does not lend itself to wide application, because close supervision is necessary on account of frequency of reactions. • Tuberculin.—Tuberculin has been used during the year as an aid to diagnosis only, Mantoux tests were carried out on 121 cases. Ill of these were children and 75 were under 10 years of age. The children were either contacts to known cases and examined for this reason, or were sent in the ordinary way by practitioners, School Medical Officers, Maternity and Child Welfare Departments, etc. Of 33 children who gave definitely positive reactions, 29 were contacts to known infectious cases. In only 4 was the source of infection in doubt. The majority reacted strongly to the weakest dilutions, i.e., 1/10,000 O.T. In only one case were the concommitant X-Ray or physical signs definite enough to warrant a diagnosis of active tuberculosis at the time of investigation. One of these cases, in which the only physical abnormality, discovered in January, 1934, was the positive tuberculin reaction, died of broncho-pneumonic Tuberculosis in October. The father of this child was found to have " open " tuberculosis in January, 1934, and was sent to Hospital. He took his discharge in May, although still expectorating large quantities of sputum containing tubercle bacilli. It is probable that this child had completely arrested the primary infection but could not resist the massive doses received between June and October. In this case efforts to isolate the infective member of the family were only partially successful. For a time during the summer months the patient was sharing a bed with the child in question. 84 When one considers the definite response given by the contact children to the test doses referred to, one must admit that only Providence prevents disaster in the case of many who day by day receive large doses of live germs in infected homes. It is in these cases that boarding out of contacts is successful in preventing manifest disease. Of the 80 children who showed negative reactions, in only 12 could contact with tuberculous cases be admitted, and this was of indefinite character. In 20 only were the full series of tests made as it is assumed that a negative reaction to a test dose of 1/1,000 O.T. excludes infection in children under S years. Out of some 300 intradermal injections made, in only one case could the reaction be regarded as excessive. This occurred in a child aged 4 who in addition to the local reaction developed slight swelling of the arm tested, and was " feverish " for a few days. Only general conclusions can be drawn from a small series of tests as that carried out. The usefulness of the reaction in discovering infected children is confirmed. It is apparent also that a great number of children are now growing up without being infected by tuberculosis until adolescence at any rate. Ultra Violet Light Treatment.—74 cases were referred for courses of Ultra Violet Light Treatment during the year. The number in 1933 was 75. The types of cases included debilitated and " pre-tuberculous " children, with chronic bronchitis, enlarged glands of neck, etc. The majority of cases given the treatment showed marked improvement. In only one or two cases could it be said that no benefit was received. All cases are examined at the beginning and completion of courses and treatment is supervised twice a week bv the Medical Officer. Dental.—Mr. Ferris, the Council's Dentist, submits the following report on cases referred from the Dispensary in 1934 : — Sessions 26 Filling and Scalings 2 New Patients 32 Advice 28 Attendances 149 Referred 26 Dentures 9 X-Ray 2 Extractions : — Gas 43 Ordinary 2 Local 101 Care Committee.—During 1934 the formation of a Care Committee for tuberculosis was considered on several occasions following representations from the London County Council. As, however, the system of " assessments " was discontinued it was not thought necessary to proceed further with the matter. 85 The difficulty patients find in accepting or continuing institutional treatment for want of clothes, etc., is a serious problem facing the dispensary staff always. By the efforts of the nurses and through voluntary gifts received, many are assisted. The isolation of patients undergoing domiciliary treatment or on return from sanatorium, is a difficult task in most cases. The Public Assistance Committees and Local Charitable Organisations dealt with many cases referred during the year. When " extra nourishment" was thought desirable for a patient or his contacts, the Public Assistance Committees were always found to give the matter sympathetic consideration. Handicraft Class.—This class continues its excellent work, Miss Forth, the instructor, attending each Friday. The attendance is usually in the neighbourhood of 20. Owing to leaving the district Miss Annis, the " Business Manager " of the class, had to resign in August, 1934. Her departure was felt with regret by all who knew her and realised her keen interest in, and her unsparing efforts on behalf of, the class. The breach created by this loss was ably filled by Mr. Worlock, who now acts as Honorary Business Manager, Secretary and Treasurer, and Chairman of the Handicrafts Aid Society. Mr. Worlock's amiable personality and inspiring enthusiasm receives the unqualified admiration of all who are associated with him. Receipts on behalf of the Society from Sales and Donations were rather lower than in the previous year because in 1933 substantial sales took place during the Greenwich Industrial Fair. The equipment of the Hut is up to date, and the standard of the work produced by members of the class is evidenced by awards obtained at exhibitions during the year. Seven 1st class and four 2nd class prizes were won and also one high commendation. The usual Summer Outing and Christmas Party were arranged for the class and friends through the effort of members of the Handicraft Aid Society. A balance sheet for the year under review is appended. I am, Sir, Yours faithfully, (Signed) F. R. Waldron, Tuberculosis Officer. 86 GREENWICH TUBERCULOSIS HANDICRAFT CENTRE. GENERAL ACCOUNT. YEAR ENDED 31st DECEMBER, 1934. RECEIPTS. £ s. d. £ s. d. PAYMENTS. £ s. d. To Balance b/f. 159 17 5 By Materials 28 7 2 ,, Donations :— Alexandra Day Committee 20 0 0 ,, Light, Heating and Insurance 5 13 11 ,, Maintenance .. 14 18 0 Collection, Charlton Athletic F.C. 6 8 1 ,, Students' Awards 33 15 1 Handicraft Competition Prize . . 1 7 6 „ Students' Fees 2 10 0 Randall's Charity 6 0 0 „ Exhibition Expenses .. 4 14 1 ,, Sales :— Handicraft Centre .13 15 7 „ Students' Outing 2 4 0 35 14 9 ,, Sundry Expenses 14 10 3 ,, Balance in hand 144 3 1 Imperial Institute 2 14 0 Carpenter's Hall 6 10 6 Woolwich Health Exhibition .. 9 19 7 54 18 10 ,, Sundry Receipts 2 3 9 £250 15 7 £250 15 7 87 Return of work carried out in connection with the Maze Hill Tuberculosis Dispensary for the Year 1934. DIAGNOSIS. Pulmonary. Non-pulmonary. Total Grand 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 40 35 4 4 3 4 4 2 43 39 8 6 96 (b) Diagnosis not completed — — — — — — — — 2 5 2 8 17 (c) Non-tuberculous — — — — — — — — 72 96 76 69 313 13.—Contacts examined during the year :— (a) Definitely tuberculous 1 4 1 — 1 — — 1 2 4 1 1 8 (b) Diagnosis not completed . . — — — — — — — — 1 1 — — 2 (c) Non-tuberculous — — — — — — — — 33 56 65 43 197 C.—Cases written oft the Dispensary Register as (a) Recovered 12 24 17 20 5 3 12 7 17 27 29 27 100 (b) Non - tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 105 152 141 112 510 D.—Number of Cases on Dispensary Register on 31st December :— (a) Definitely tuberculous 207 165 39 11 25 31 55 25 232 196 94 36 558 (b) Diagnosis not completed — — — — — — — — 3 6 2 8 19 88 1. Number of persons on Dispensary Register on 1st January, 1934 683 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 32 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 122 4. Cases written off during the year as Dead (all causes) 59 5. Number of attendances at the Dispensary (including Contacts) 2,987 6. Number of Insured Persons under Domiciliary Treatment on 31st December 32 7. Number of consultations with medical practitioners :— (а) Personal 36 (б) Other. 243 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 115 9. Number of visits by Nurses or Health Visitors to homes for Dispensary Purposes 2,787 10. Number of :— (а) Specimens of sputum, etc., examined 213 (б) X-ray examinations made 387 11. Number of " T.B. plus " cases on Dispensary Register on 31st December 238 TUBERCULOSIS. NEW CASES and MORTALITY—Year 1934. Age-Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M •F M F 0 — 2 — — 2 1 1 2 — — 1 1 — — 5 1 2 3 2 1 1 2 — 10 3 4 6 — 1 — 15 11 8 2 5 4 5 1 — 20 15 11 1 5 9 — 25 15 22 2 1 4 9 — 35 11 11 1 — 8 2 2 — 45 8 5 1 2 11 1 — — 55 3 2 1 4 3 1 — 65 and upwards 4 — — — 3 3 — 1 Totals 72 67 19 10 41 34 9 1 Particulars relating to the above Table are dealt with in the Report of the Tuberculosis Officer on pages 79 to 88. 89 PULMONaRY tuberculosis. -Supplementary Annual Return showing in summary (a) the condition at end of 1034 of all patients remainiBK on the Dispensary Register ; and (b) the reasons for the removal ot all cases written on the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Registe as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates Previous to 1926 1926 1927 1928 1929 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus J Class T.B. minus Class T.B. plus | Class T.B. minus Class T.B. plus { Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) GrDup i Group 2 Group 3 Total (Class T.B. plus) j Group 1 J Group 2 Group 3 1 Total (Class T.B. plus) Group 1 j Group 2 Group 3 1 Total (Class T.B. plus) Group 1 Group 2 J Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M 11 5 3 1 9 5 1 1 3 2 2 4 4 6 2 2 F. 10 4 4 8 5 1 1 4 2 2 5 1 1 5 1 1 Children .. 6 8 3 10 5 Disease not Arrested Adults M. 5 4 2 11 1 2 3 i 1 3 4 1 1 4 5 1 5 6 11 F. 3 3 1 4 1 1 1 2 1 1 2 4 2 6 Children 1 1 Condition not ascertained during the year Total on Dispensary Register at 31st December 31 17 12 3 32 19 1 4 5 12 G 6 12 20 2 5 7 19 12 8 20 (fe) Not now on Dispensary 1 Register and reasons for removal 1 therefrom Discharged as Recovered Adults M. G6 12 4 10 F. 101 14 2 1 17 2 2 Children 193 1 1 14 7 Lost sight of, or otherwise removed from Dispensary Register 328 7G 44 14 134 25 4 4 4 12 12 8 11 2 21 11 7 8 15 16 12 7 2 21 Dead Adults M. 90 28 118 153 299 5 6 16 13 35 1 9 11 13 33 3 6 14 15 35 2 11 16 6 33 F. 57 35 72 104 211 3 1 3 5 9 3 4 9 5 18 7 3 8 7 18 2 6 4 5 15 Children 52 1 5 G 1 1 1 1 2 Total written off Dispensary Register 887 165 242 277 684 50 12 23 22 57 26 21 31 20 72 21 16 30 22 68 26 29 27 13 69 Grand Totals 918 182 254 280 71C 69 13 27 22 38 27 37 20 84 41 18 35 22 75 45 41 35 13 89 90 PULMONARY TUBERCULOSIS.—Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at tlie time of the last record made during the year to which the return relates Class T.B. minus 1930 Class T.B. minus 1931 Class T.B. minus 1932 Class T.B. minus 1933 j Class T.B. minus 1934 Class T.B. plus Class T.B. plus Class T.B. plus Class T.B. plus Class T.B. plus j Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 |Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group I Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M 6 1 1 1 F. 3 4 Children 2 3 Disease not Arrested Adults M. 2 7 6 13 8 7 15 2 5 6 1 12 5 16 9 2 27 12 5 18 6 29 F. 2 / 2 9 2 7 2 1 10 r. 4 1 1 6 7 10 7 1 18 18 3 12 5 20 Children .. 3 1 1 2 4 1 1 Condition not ascertained during the year Total on Dispensary Register at 31st December 15 14 8 21 13 17 9 1 27 9 9 7 2 18 12 26 16 3 45 34 8 31 11 50 (b) Not row on Dispensary Register , nd reasons for removal therefrom Discharged as Recovered Adults M. F. Children Lost sight of, or otherwise removed from Dispensary Register 6 12 4 1 17 8 8 0 4 18 6 8 3 3 14 2 5 2 1 8 6 2 2 Adults M. 6 9 13 4 26 2 5 12 7 24 6 6 4 16 1 3 12 5 20 2 3 3 Dead F. 5 4 6 5 15 5 5 5 4 14 4 4 2 10 2 6 2 2 . 10 2 2 Children 3 o 2 1 2 Total written off Dispensary Register 20 25 23 10 58 16 18 23 15 56 6 18 15 9 42 6 14 16 8 38 10 2 5 7 Grand Totals 35 39 31 10 80 29 35 32 10 83 .5 27 22 11 60 .8 40 32 11 83 44 8 33 16 57 91 NON-PULMONARY TUBERCULOSIS-Supplement Annual Return showing in summary form (a.) tlie condition at tlie end of 1934 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. Condition at the time ot the last record made during the year to which the return relates Previous to 1926 1926 1927 1928 1929 | Bones and Joints Abdominal Other Organs J Peripheral Glands | Total J Bones and Joints Abdominal Other Organs J Peripheral Glands j Total ' Bones and Joints Abdominal Other Organs Peripheral Glands Total | Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total 1 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 3 3 2 2 1 1 2 1 1 F. 1 2 3 6 1 1 1 1 1 2 3 Children .. 5 1 1 2 9 3 1 4 3 1 2 6 3 6 9 2 2 1 2 6 Disease not Arrested Adults M. 2 2 F. 1 1 1 1 Children 2 2 1 1 1 1 Condition not ascertained during the year Total on Dispensary Register at 31st December 10 1 6 5 22 3 1 4 6 2 10 10 6 1 6 13 3 2 3 4 12 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 10 6 10 2 2 1 1 F. 8 1 1 10 20 1 1 1 1 Children 34 13 8 454 509 2 5 7 2 2 2 6 1 1 Lost sight of, or otherwise removed from Dispensary Register 23 3 5 122 153 3 4 2 9 0 2 2 10 2 3 1 3 9 1 1 3 3 8 Dead Adults M. 11 O 13 1 1 1 3 1 1 2 1 1 F. 4 4 3 11 1 1 Children 0 4 8 13 31 1 1 2 1 1 Total written off D Register ispensary 90 21 20 610 753 9 1 5 8 23 10 3 2 4 19 3 3 1 5 12 3 1 4 3 11 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary). 100 22 32 615 775 12 1 5 9 27 16 5 2 6 29 9 3 o 11 25 6 3 7 7 23 92 NON-PULMONARY TUBERCULOSIS.—Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates 1930 1931 1932 1933 1934 Bones and Joints Abdominal Other Organs Peripheral Glands Total JBones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total JBones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints JAbdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 1 1 2 2 1 1 1 1 1 1 1 1 3 Children .. 4 2 6 12 2 3 3 8 1 1 1 1 2 Disease not Arrested Adults M. 2 1 3 1 1 2 1 3 3 1 4 F. 2 2 1 1 1 1 2 1 2 5 4 1 5 Children 2 1 3 2 1 3 4 1 5 3 1 4 2 1 1 4 Condition not ascertained during the year. Total on Dispensary Register at 31st December. 8 3 2 6 19 9 4 3 4 20 6 2 8 7 2 2 2 13 10 3 1 1 15 Transferred to Pulmonary (b) Not now on Dispensary 1 Register and reasons for removal therefrom. Discharged as Recovered Adults M. F. Children Lost sight of, or otherwise removed from Dispensary Register 2 2 2 6 4 3 6 13 4 2 6 4 1 5 2 1 3 Dead Adults M. 1 1 2 1 1 3 1 1 5 1 1 F. Children 1 1 1 1 1 3 1 1 Total written off Dispensary Register 3 1 2 3 9 5 1 5 6 17 7 2 1 2 12 5 1 6 2 1 3 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 11 4 4 9 28 14 14 8 10 37 13 1 4 20 12 2 3 2 19 12 3 1 2 18 93 SECTION G. MATERNITY AND CHILD WELFARE. The various activities under the Maternity and Child Welfare Scheme continue to be utilised and appreciated by the Mothers attending the Centres and Clinics. During the last few years the Council has received an increasing number of non-residents in the Maternity Home and in many instances the mothers, after confinement, have expressed a wish to be allowed to attend the Welfare Centres. Such cases have been generally referred to attend the Centres in their own area. It was felt however, that the additional number of cases could be easily dealt with by the existing staff, and towards the end of the year the Council decided to grant such facilities. Infant Welfare Consultations.—These consultations are held each afternoon as set out hereunder, and there has been no change in any particular from that described last year. Borough Hall, Royal Hill Monday, Tuesday and Thursday Chevening Road Wednesday and Friday 105, Shooter's Hill Road Tuesday and Friday Armada Street, Deptford Thursday Charlton Vale Wesleyan School Room, Woolwich Road Wednesday Morning sessions are also held on Wednesdays at Chevening Road and Charlton Vale. The following table shows at a glance the work undertaken at the various Infant Consultation Centres during the year : — Borough Hall Chevening Road 105 Shooter's Hill Rd. Armada Street Charlton Vale Total No. of Clinics 151 152 102 51 102 558 No. of attendances : Babies under 1 vear 5,322 4,604 4,486 1,192 1,381 16,985 Children 1-5 years 6,938 6,537 4,078 2,460 3,621 23,634 New Cases 346 301 261 120 107 1,135 Medical Consultations :— Babies 2,164 1,569 1,655 701 682 6,771 Children 1-5 vears 2,249 2,117 1,392 1,061 1,439 8,258 Nursing Mothers 1,561 1,102 1,121 559 472 4,815 All babies are weighed and advice given to the mothers at every attendance. 94 Toddlers' Clinic.—During the year a Toddlers' Clinic was established at the Borough Hall Centre and another at Shooter's Hill Road Centre. They are proving very successful and have relieved pressure at the ordinary Infant Welfare Sessions. At first some difficulty was experienced in inducing mothers with several children to attend the Toddlers' Session as it was contemplated she would have to visit the Centre on two occasions, viz., one for the infant child and the other for the toddlers. This has been overcome by allowing such mothers to bring the baby and toddler, so avoiding the extra attendance. The few babies so attending do not inconvenience the general routine of toddlers' examinations. It is hoped to give a full description of the work and result in the next Report. The following Table shows the number of Toddlers examined during the year : — Borough Hall Shooter's Hill Road No. of Clinics 16 32 No. of Attendances 386 645 Medical Consultations 210 348 Ante-Natal Clinics.—These are held as follows : — Borough Hall, Royal Hill Tuesday, 10 a.m., Wednesday, 2 p.m. Chevening Road Monday, 2 p.m. 105, Shooter's Hill Road Thursday, 2 p.m., Friday, 10 a.m. Charlton Vale Mission Hall, Woolwich Road Wednesday, 10 a.m. Armada Street Mission Hall, Deptford First and Third Thursdays in each month, 10 a.m. The number of new cases together with total attendances for the year were as follows : — No. Clinics New Cases Total Attendances Borough Hall 101 248 1,497 Chevening Road 50 101 597 105, Shooter's Hill Road 104 238 1,675 Charlton Vale 47 25 160 Armada Street 23 53 170 325 665 4,099 95 The following tables show (a) the number of visits made by the Health Visitors during the year in connection with Births and cases of Infectious Diseases, and (b) number of Infant Consultations and Ante-Natal Clinics attended and miscellaneous visits : — Health Visitors' Visits, &c., 1934. Table A. Visits Re-Visits Total Infants under 1 year 1,395 3,719 5,114 Children 1—5 years 275 5,659 5,934 Measles 1,419 118 1,537 Whooping Cough 305 45 350 Pneumonia 26 13 39 Puerperal Pyrexia and Fever 7 5 12 Diarrhoea 35 16 51 Ophthalmia Neonatorum 10 15 25 Inflammation of Eyes 4 6 10 Pemphigus — 3 3 Table B. 3,476 9,599 13,075 34 11 45 Dental Treatment Milk Scheme 119 20 139 Ante-Natal Cases 703 111 814 Infant Consultations Attended — — 1,108 Ante-Natal Clinics Attended — 334 Children Act 79 96 175 Miscellaneous 446 — 446 In addition to the above, 1,258 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. Infantile Mortality.—The total number of deaths under 1 year of age was 116, as compared with 89 for the previous year. The Infantile Mortality Rate is thus equal to 87 per 1,000 Births. The rate for the previous year was 66, and the average for the last ten years 63. Ihe Infantile Mortality Rate for the County of London is 67 and that for the 121 large towns 63. The following are the local rates : — Charlton and Kidbrooke 73 East Greenwich 86 West Greenwich 95 St. Nicholas, Deptford 122 Of the total of 116 deaths, 42 died before attaining the age of 1 month (34 being in the first week). 96 The chief causes of death were : — Premature Birth 19 Diarrhoea and Enteritis 28 Bronchitis and Pneumonia 29 Atrophy, Debility and Marasmus 8 Congenital Malformations 8 Atelectasis 4 Tuberculous Meningitis 2 Whooping Cough 2 Other causes 13 Measles 3 116 Of the above number, 64 were boys and 52 girls. The Infantile Mortality Rate is higher than has been recorded for some years past, and on an investigation of the causes of death, is was found that 34 cases were attributed to prematurity, atelectasis, malformations, and pneumonia within a few days of birth. Of the remaining 82, 4 did attend the Welfare Clinics once or twice, but not regularly, and not within a month of their death, whilst no less than 22 did not attend the Welfare Clinics at all. This leaves 56 to be accounted for, all of whom attended the Centres within a month of their deaths. It may be recalled that last summer was exceptionally hot and dry and may have been a contributory cause to the epidemic of Diarrhoea and Enteritis which occurred in the autumn, and incidentally according to the Reg^trar-General's Returns, the mortality from this cause was higher in Greenwich than in any other Metropolitan Borough. During this period 34 notifications of Zymotic Enteritis or Epidemic Diarrhoea were received and only 2 cases proved fatal, whereas 22 deaths were ascribed as due to the Diarrhoeal Diseases. Four of these cases which had been admitted to hospital on account of diarrhoea but were not notified as such, were fed on a Dried Milk which they had obtained from the Welfare Centre, and the suggestion arose that the cause of illness might be found in that preparation. Arising from this, a part of the preparation which had been partly used was secured from one of the mothers and submitted to both chemical and bacteriological examination with negative results, the bacteriologist reporting that bacilli coli were absent and that no food poisoning organisms were found. 97 The firm concerned were also communicated with and made similar examination from a packet from the same consignment with similar results. It should be mentioned however, that many other children were supplied from the same consignment and remained perfectly well. It is safe to assume that had it not been for this epidemic of Diarrhoea and Enteritis, the Infantile Mortality Rate recorded would have been more comparable with that of recent years. Deaths of Children 1 to 5 Years of Age. The number of deaths of children between the ages of 1 and 2 years was 19, and between 2 and 5 years, 18. The previous year the figures were 17 and 20 respectively. Birth Control.—The question of the establishment of a Clinic whereby women suffering from gynæcological conditions could obtain advice on contraceptive methods has received the serious attention of the Council from time to time. The question as to whether Clinics of this nature should be provided by Local Authorities is one which has caused a good deal of controversy, not only amongst the Public but amongst religious and other bodies. A Circular, however, issued by the Ministry of Health states that Clinics may be provided on the understanding that the following conditions are strictly complied with:— (1) That the Clinics will be available only for women who are in need of medical advice and treatment for gynaecological conditions. (2) That advice on contraceptive methods will be given only to married women who attend the clinics for such medical advice or treatment, and in whose case pregnancy would be detrimental to health or who are suffering from other forms of sickness, physical or mental, such as those mentioned in the Report of the Departmental Committee on Maternal Mortality and Morbidity. As it appeared from the reports of the Medical Officers in charge of our various Ante-Natal and Welfare Centres that it was desirable that information should be available for married women attending the Centres, the Council made arrangements with the Authorities of the Walworth Women's Welfare Centre who have been conducting a Birth Control Clinic for some time. Cases are referred to the Birth Control Clinic on medical grounds alone, the Council paying a fee of 7s. 6d. per patient. Such cases are assessed by the Assistance Sub-Committee in the same way as the milk applications are dealt with. Since the scheme has been in operation (November 23rd, 1934,) twelve cases have been so referred. 98 Notification of Births Acts, (1907 and 1915). All live births and all still births after 28th week of pregnancy must be notified within 36 hours. Early knowledge enables the Health Visitors to begin early visiting. Still-births must be certified either by the Doctor or by the Midwife or by declaration on a prescribed form, if no doctor or midwife was present. In these latter cases the Minister of Health requires the Medical Officer of Health to submit a special report in order that he may be satisfied that the child was really still-born. The following Table gives the number and character of the intimations received respecting births in the Borough : — 1927 1928 1929 1930 1931 1932 1933 1934 Total Number of Births notified in each year 1,995 2,063 2,115 2,004 1,913 1,949 1,705 1,891 (a) Attended by Midwives 1,592 1,727 1,812 1,712 1,633 1,699 1,490 1,667 (b) Attended by Doctors 403 336 303 292 280 250 215 224 Numbers of Still Births notified each year 82 71 50 42 40 65 39 60 Number of Births registered in each year 1,912 1,939 2,042 1,951 1,838 1,862 1,652 1,847 Milk, &c., Scheme. The Council has continued to supply milk, etc., to necessitous cases, each case being investigated especially as to its financial condition before a supply is granted. The milk may be granted free or at a 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 where the family income falls within the Council's scale. It is a condition that these dinners must not be taken home, but must be consumed by the mother herself on the premises. Particulars of the amount of milk, etc., distributed will be found in the following tables. The approximate cost to the Council under this heading during the year was £6,500. 99 (a) Milk, Virol, &c., Distributed Free. Quarter ended Milk Virol Roboleine Malt & Oil Cod Liver Oil lbs. lbs. lbs. lbs. Bottles March, 1934 16,248 1,023½ 186 2,738 180 June, ,, 14,921 l,224½ 127½ 1,855 145 Sept., ,, 12,729 913½ 139 987 146 Dec., ,, 12,489 1,006 176½ 1,702 245 Totals 56,387 4,167½ 629 7,282 716 (b) Milk, Virol, &c., Sold at Full or Reduced Prices. Quarter ended Milk Virol Roboleine Malt & Oil Cod Liver Oil Total Amount Received[ lbs. lbs. lbs. lbs. Bottles £ s. d. March, 1934 . . 4,644 165i 104 233 90 334 7 1 June, 4,173 146 51 86 82 298 3 3 Sept., ,, 4,123 93 37 51 94 281 3 5 Dec., ,, 4,324 155J 71 173 141 292 2 6 Totals 17,264 560 263 543 407 £1,?05 16 3 100 Milk, Etc., Scheme.—In March, 1934, the Public Assistance Department of the London County Council informed the Borough Council that in connection with the supply of extra nourishments under the Maternity and Child Welfare Scheme, arrangements have now been completed:— (1) To extend the scheme to provide that nourishment over and above the normal diet and necessary on medical grounds may similarly be supplied for delicate children, attending the Metropolitan Borough Councils' Maternity and Child Welfare Centres, whose parents are in receipt of out-relief. (2) To modify the scheme by the deletion of the provision that a Relieving Officer must consult the District Medical Officer upon each recommendation as to extra nourishment received from a Maternity and Child Welfare Centre before the submission of the recommendation to the district sub-committee, on the clear understanding (a) that the district sub-committees and (in cases of sudden or urgent necessity) the Relieving Officers may consult the appropriate District Medical Officers * whenever in any case they consider such a course desirable, and (b) that the District Medical Officer shall be consulted in those cases in which medical relief is being afforded to the family. This concession has removed a long-standing grievance and has been greatly appreciated because formerly poor persons in receipt of extra nourishment from the Borough Maternity and Child Welfare Committee had this fact taken into consideration when they applied to the Local Public Assistance Committee for relief. Convalescent Home Treatment.—The arrangements for the provision of Convalescent Home Treatment continue as before, the mothers and children being recommended by the Medical Officers of the various Centres and after investigation by the Committee are referred to the I.C.A.A. or to the Public Assistance Committee according to circumstances. During the year 78 children were sent away for periods varying from four weeks to three months, also 9 mothers with their babies were provided with a month's convalescence at Littlestone-on-Sea. Sterilised Maternity Outfits.—The same arrangements as last year hold good and during the year 15 outfits were sold and 38 given free. Ophthalmia Neonatorum.—This is a preventable disease, and even when it occurs its serious effects can be avoided by prompt treatment. Immediately on receipt of a notification the case is visited by the Health Visitor who continues to visit frequently to ensure that 101 the child receives proper treatment. If necessary arrangements are made for the District Nurse to carry out the treatment, or if the condition is severe, mother and child are removed to St. Margaret's Hospital, Hampstead, a special Institution set apart by the London County Council for the treatment of this disease. Ten cases were notified and cured without impairment of sight, with the exception of one case who subsequently died from Pneumonia. Of the 10 cases 5 were treated at home and visited by the District Nurse, 2 of whom were afterwards reported to have left the district, and 4 were removed to Hospital. The remaining case was resident in an Institution. In addition to notified cases of Ophthalmia Neonatorum 9 babies with slight discharge from the eyes were referred by the London County Council to the Public Health Department for supervision. Minor Ailments.—The arrangements with St. John's Hospital for the treatment of minor ailments continues and during the year 300 cases were referred chiefly on account of tonsils and adenoids, circumcision, etc. Home Nursing.—Children attending the various Centres who are found to be in such a condition as to require special nursing at home are referred to the various Nursing Associations operating in the Borough, the Council paying 1s. per visit to the Queen's Nursing Association and £50 per annum to the Ranyard Mission. Other Health Activities.—The following continue their good work in the Borough:— Local Medical Practitioners' School Clinic. The Health Centre, Deptford Green. Rachael McMillan Memorial Nursery School. Charlton Park Open Air School. Maternal Mortality.—The number of deaths from Puerperal Sepsis and other accidents and diseases of pregnancy was 4. All died in Public Institutions. This gives a maternal death rate of 2.9 per 1,000 total births. In the years 1931, 1932 and 1933 there were 12, 4, and 4 deaths respectively. The Maternal Mortality Rate for England and Wales was 4.41 per 1,000 total births. Puerperal Fever and Puerperal Pyrexia Regulations, 1926.— I he arrangements made by the Council under the provisions of the Puerperal Fever and Puerperal Pyrexia Regulations, 1926, whereby obstetric consultants are available to assist local medical practitioners, continue in force. This service was provided on one occasion. 102 Five cases of Puerperal Fever were notified, 2 of which occurred in Hospitals and 2 in the Council's Maternity Home. One of the latter proved fatal. Nine cases of Puerperal Pyrexia were notified, 3 occurring in East Greenwich, 1 in St. Nicholas, Deptford, and 5 in Charlton and Kidbrooke. Health Week, etc.—The usual teas and entertainment given to the mothers and children attending the Welfare Centres were continued. Lectures and talks were given by various members of the staff. Maternity Home. The number of patients admitted during the year was 397 patients, of whom 54 were admitted to the Home for several days' ante-natal treatment. The number of cases delivered by the midwives of the Home was 376, the remainder by the Medical Staff. In 43 instances medical assistance was sought by the midwives. There was one Caesarian section, 21 instrumental deliveries, and 13 surgical inductions. Twenty-seven infants were not entirely breast fed whilst in the Home. No cases of Ophthalmia Neonatorum occurred in the Home. The number of infant deaths, within ten days of birth was nine, the causes being attributed to:— Premature 5 Diaphragmatic Hernia 1 Congenital Heart Disease 2 Atelectasis 1 There were 12 still births. Two cases of Puerperal Fever were notified under the Puerperal Fever and Pyrexia Regulations. In one case, which unfortunately terminated fatally, the patient had severe toxaemia pregnancy. Surgical induction was performed and subsequently the services of the Council's Consultant was found necessary and a macerated foetus delivered by forceps. In connection with the investigation into the cause of death it was elicited from relatives that the patient had two bad attacks of diphtheria when 16 years of age and severe small-pox only 3 years ago. A sister had also died in childbirth, the cause being attributed to toxaemia. These particulars were not divulged by the patient when she booked to go into the Home. The other case made good recovery. There were also 4 cases of Puerperal Pyrexia reported in the Home during the month of October. The first case was suspected to be scarlet fever as it transpired that the patient previous to admission 103 had been in contact with a child who was afterwards removed to Hospital with that disease. The woman was promptly isolated, but was followed by three other cases at intervals of 3 days. All the cases were removed to the isolation block and the whole medical and surgical staff swabbed. On the results of the bacteriological examination coming to hand, they all proved negative to hæmolytic streptococci, although streptococci veredins were present in every culture. None of the patients complained of feeling ill however, and all made good recovery. The last three patients were all lying in adjoining beds, but no two patients were delivered by the same nurse. The Home is a recognised training institute for pupil midwives and the Central Midwives Board have now given their approval to receive 8 pupils instead of 6 per year. The scheme of instruction was outlined in last year's report. The new extension was ready for occupation early in January, and the Home may now be regarded as one of the best equipped and modern Institutions in the country. The adjoining house which was purchased by the Council has been adapted to provide for 2 Isolation Wards on the ground floor and the upper floors are utilised for the domestic staff. Children Acts, 1908 and 1932.—The duties under these Acts were transferred by the London County Council to the Borough Council on 1st April, 1933. Under Part 1 of the 1908 Act the supervision of Foster-children and of the homes of foster-mothers is carried out by the Health Visitors. Applications for registration as a Foster-mother under the Act is sanctioned by the Borough Council on the recommendation of the Public Health, Maternity and Child Welfare Committee. During the year 175 visits were made by the Health Visitors. The following particulars are taken from the Register:— Number of Foster-mothers on Register at end of 1933 37 Number of Applicants refused 1 Number of Foster-children 32 Number of Foster-children who died during the year 1 Number of cases legal proceedings taken - Dental Clinic.—The Council's Dentist, Mr. G. F. Ferris, L.D.S., R.C.S. (Eng.), attends at the Dispensary, Maze Hill, Greenwich, once a fortnight to deal with cases referred to him by the Medical Officers of the Welfare Centres and Clinics. 104 The following Return shows the work performed during the year in detail:— Number of Sessions 25 Number of Patients:— Women 97 Children 93 190 Number of Re-Attendances: — Women 206 Children 102 308 Local Anaesthetic Extractions 129 Gas Extractions 079 Advice given 103 Dentures and Repairs 34 Fillings and Scalings 7 X-Ray 2 Referred to Hospital re Gas:— Children 18 ARTIFICIAL SUNLIGHT TREATMENT. The work at the three Centres has been conducted on similar lines to previous years. Cases referred by doctors at the various Welfare Centres continue to show a definite improvement. The number of patients treated at each Centre is given in the following table:— BOROUGH HALL CENTRE. Under 5 5—15 Over 15 Total Number under treatment at end of previous year 136 42 33 211 Number of New Patients 286 59 74 419 Discharges 334 78 93 505 Number under treatment at end of 1934 78 23 14 115 Number of treatments given 5,420 822 1,612 7,854 105 SHOOTERS HILL ROAD CENTRE. Under 5 5—15 Over 15 Total Number under treatment at end of previous year 59 6 65 Number of New Patients 171 — 22 193 Discharges 169 — 24 193 Number under treatment at end of 1934 61 — 4 65 Number of treatments given 3,472 — 403 3,875 CHEVENING ROAD CENTRE. Under 5 5—15 Over 15 Total Number under treatment at end of previous year 74 — 11 85 Number of New Patients 264 — 34 298 Discharges 254 — 38 292 Number under treatment at end of 1934 84 — 7 91 Number of treatments given 4,390 — 504 4,894 106 The following cases were treated during the year:— Rickets 150 Underweight 155 Convalescent from Infectious Disease 97 Ante-Natal Cases 82 Debility 76 Bronchitis 65 Anaemia 56 Frequent Colds 39 Post-Natal Cases 35 Sore Buttocks 24 Nervous Debility 19 Malnutrition 15 Enlarged Tonsils 12 Insomnia 11 Rheumatism 9 Enlarged Cervical Glands 9 Muscular Debility 5 Asthma 4 Nasal Catarrh 3 Neuritis 3 Boils 3 Psoriasis 2 Backward 2 Otorrhœa 2 Constipation 2 Overweight 2 Impetigo 2 Quinseys 2 Diphtheria Carriers 2 Other Conditions 13 901 In addition to the treatment of mothers and children coming under the Maternity and Child Welfare Scheme, facilities are available during the winter months on two evenings a week for paying 107 patients. The fees charged are 12s. for six treatments or 20s. for 12 treatments. During the year 25 patients were given 384 treatments, the fees received totalling £34 7s. 0d. The arrangements made with the Head Master and Head Mistress of the Roan Schools in 1933, continue to be in force, whereby selected cases are sent to the Borough Hall Centre for treatment. Dr. B. Tchaykovsky in her report as School Medical Officer to the School Governors, states as follows:— "I would again lay stress on the enormous benefit of sunlight—natural when obtainable, artificial by default—for increasing the calcium content of the growing body. "During 1934, 35 girls have attended the Greenwich Borough Centre for various reasons—underweight, frequent colds, debility, anaemia, rheumatism, chilblains—with excellent results, so much so that girls on leaving school are anxious to continue attendance at evening sessions. "We are deeply grateful to the Medical Officer of Health, for making this valuable treatment available for the Roan Schools." 108 APPENDIX I. REPORT OF MEDICAL OFFICER OF HEALTH TO MINISTRY OF HEALTH ON OUTBREAK OF FOOD POISONING. Late in the afternoon of Friday, 21st September, I received a message from the Medical Officer in charge of a large gas works at East Greenwich that a number of employees had been taken ill complaining of abdominal pains, extreme flatulence, and severe diarrhœa, but no vomiting. On investigating the matter I ascertained that on the previous day (Thursday, 20th September) the mid-day dinner was served in the Work's Canteen to some 295 employees, embracing men from all departments including the clerical staff. Of this number some 275 partook of boiled leg of pork, pease pudding, carrots and potatoes followed by apple tart. The remainder had chops or steak and potatoes, and were not affected. No complaint was made during dinner, but on Friday morning the men began to complain of the above symptoms, the total number affected being 51, of whom six were so ill that they had to be sent home. The remainder kept at work and on Saturday morning had quite recovered. The other six were still away on Saturday morning, but so far I have not received any notification of food poisoning from any general practitioner. In the meantime, with the exception of the apple tart, I secured samples of the food stuff concerned, and submitted the same for bacteriological examination. No uncooked portions of meat were available for inspection, but the cook informed me that " the meat looked splendid." Enquiries and examination as to the health of the kitchen staff revealed no case of recent illness, and I have no reason to suspect anyone as being a carrier of infection, bacterial or otherwise. The food was prepared in the kitchen and cooked by gas. The meat was cut into appropriate portions, of which one portion was cooked in a tin boiler with enamel plates at the bottom. The remainder was cooked in an iron pot. The enamel plates were in good condition, free from chips or cracks. Altogether there were about 95 lbs. cooked. 109 There was no possibility of ascertaining as to which portion the affected men were served from, i.e., from the tin boiler, or iron pot. The sanitary conditions and the cleanliness of the kitchen were excellent, and the water supply above suspicion. Bacteriological Report on samples of Ham, Carrots and Split Peas forming part of dinner referred to in above report:— Ham Cultures, McConkey, Agar A gram negative coliform bacillus. and Broth A gram positive coccus and a sarcinæ. Anarobic. — Gram positive cocci only. Carrots, Cultures as above Very scanty growth of a gram. Negative coliform type, and gram positive cocci. Anarobic.—No growth. Split Peas, Cultures as above Gram negative coliform bacilli. Gram positive cocci. Anarobic. — Gram positive cocci only. Animal experiments were carried out in all samples. Rats were fed daily for 3 days—alive and well after 5 days. In all cases the cultures referred to above were made ærobically and anærobically. Commentary.—Cultures of ham, carrots and split peas show no growth of organisms belonging to the food poisoning type. In view of the result the Ministry of Health suggested the desirability of taking blood tests from three or four of the men most seriously ill. Accordingly representations were made to the Works Medical Officer and all facilities were placed at his disposal but it is regretted that the offer of assistance was not accepted, the Works Management being of opinion that no useful purpose would be served in prolonging the enquiry. Only three men were sufficiently indisposed to be away from work for a week. 110 Index of Contents. A. Page Adoptive Acts, By-laws and Local Regulations 5-8 Age Mortality 17 Agricultural Products (Grading and Marking) Act, 1928 54 Ambulance Facilities 23 Ante-Natal Clinics 23, 94 Area of Borough 11 Articles and Rooms Disinfected 75 Articles Destroyed 76 Artificial Cream Act, 1929 64 Artificial Sunlight Treatment 84, 104-107 B. Baby Week Celebrations 78 Bacteriological Examinations 22, 62, 71, 72, 83 Bakehouses 63 "Better Health" 78 Birth Control 97 Births 14, 98 Books Disinfected 78 C. Cancer 21, 23, 24 Cerebro-Spinal Fever 75 Cleansing Children 78 Clearance Areas 39-44 Clinics and Centres 23, 93, 94, 104 Common Lodging Houses Complaints 25 Condensed Milk 62 Consumption 20, 79 Contacts 80 Convalescent Treatment 82, 100 Cowhouses 61 D. Dairies, Cowsheds and Milkshops 61 Deaths, Tables showing Causes of and Ages at Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Deaths, with Age Mortality Density of Population 11 Dental Work 84, 104 Diarrhoea and Zymotic Enteritis 20, 72, 96 Diphtheria 20, 70 Diphtheria Anti-Toxin 71 Disinfection 74-78 Drainage Work 29 Dried Milk 62, 96 99 Duties and Powers of the Public Health, Maternity and Child Welfare Committee 5-8 111 INDEX—continued. Page E. Elevation of Borough 11 Enteritis 20, 72, 96 Epidemic Diseases Erysipelas 75 Extracts from Vital Statistics 12, 13 F. Factories and Workshops 25, 26 Food and Drugs—Samples of 03-68 Food Poisoning—Notification of 69 Food—Premises for Preparation of, etc. 62, 63, 65 Food—Inspection of 48-65 Footway—Fouling of 32 G. General Statistics 11-21 & Appendix H. Handicraft Centre 85, 86 Health Centres 93, 94 Health Propaganda 78 Health Visitors, Visits, etc. 95 Heart Diseases 21 Home Nursing 101 Horse Slaughterer 49 Hospital Treatment 24 House Drainage 29 Houses Inspected re Infectious Diseases 78 Houses Let in Lodgings 29 Housing 39-47 I. Ice-Cream Premises 36, 63 Imported Food Surrendered 53 Increase of Rent and Mortgage Interest (Restriction) Acts, 1920—1933 45 Infant Consultations 93 Infantile Mortality 18, 95, 96 Influenza 20, 73 Inhabited Houses 11 Insanitary Areas 39, 44 Institution Deaths 17 Introductory Review 9, 10 L. Laboratory Work 22 Leprosy 73 112 INDEX—continued. Page M. Margarine Dealers 13 Marriages 101 Maternal Mortality 93-107 Maternity and Child Welfare 24, 102 Maternity Home 100 Maternity Outfits 19, 71 Measles 49, 57 Meat 54 Merchandise Marks Act, 1926 61 Milk, Analysis of 61 Milk and Dairies (Amendment) Act, 1922, etc. 62 Milk for School Children 61 Milk Supply 98 Milk Supply for Expectant and Nursing Mothers 61 Milk (Special Designations) Order, 1923 61 Minor Ailments 101 Mortuary 21 N. Notices, etc. 25, 35 Notifications 70-74 Notification of Births Act 98 Notification of Food Poisoning 69 O. Offensive Trades 36, 49 Open-Air School 82 Ophthalmia Neonatorum 72,100 Outworkers' Register 25 Overcrowding 44 P. Persons Cleansed 37, 78 Polio-myelitis 73 Population 12 Preserved Food Premises 63 Public Health (Imported Food) Regulations, 1925 50-53 Public Health (Meat) Regulations, 1924 49 Public Health (Preservatives, etc., in Food) Regulations 64 Public Health (Prevention of I. D.) Regulations, 1934 Public Health, Maternity and Child Welfare Committee 5 Public Sanitary Conveniences 29 Puerperal Fever, etc. 73, 101 R. Rag Flock Acts 32 Rateable Value 11 Rats and Mice (Destruction) Act, 1919 30 Remarks on Death Causes 19-21 Rent and Mortgage, &c., Acts 45 113 INDEX—continued. Page S. St. Alfege's Hospital 82 Sanitary Work—Summaries, etc. 25-38 Scarlet Fever 20, 72 Scavenging and Refuse Removal 28 School Clinic 101 Sewer Emanations 28 Slaughterhouses 49, 50 Smallpox 19, 70 Smoke Nuisances 27 Social Conditions 12 Staff of Public Health Department 3, 4 Statistical Tables 11-21 & Appendix Street Traders 62 Swimming Baths 30, 31 T. Toddlers Clinic 94 Tuberculosis 20,79,92 Tuberculosis Care Committee 84 Tuberculosis Dispensary—Returns 87, 92 Tuberculosis Officer's Report 79, 92 Tumour Diagnostic Clinic 23, 24 Typhoid Fever 20, 72 U. Underground Bakehouses 27 Underground Rooms 45 Uninhabited Houses 11 Unwholesome Food 48 V. Vaccination 77 Verminous Children 79 Verminous Premises 32 Virol 99 Vital Statistics 11-13 & Appendix W. Water Supply 32 Whooping Cough 20, 70 Workshops and Factories 25-27 X. X-Ray Examinations 82 Z. Zymotic Diseases 19, 72 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the Quarter enied April 1st, 1933. DISTRICTS. Census Population, 1931. Estimated Population at the middle of the year 1933. Births registered during the Quarter ended 1st April, 193 Deaths registered during the Quarter ended 1st April, 1933. age mortality. seven zymotic diseases. Tuberculosis, Pulmonary. All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1,000. All Causes. Seven Zymotics. Under 1 year. Over 1 and under 5 years. Persons aged 65 years and upwards. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. Diarrhœa. During the corresponding period year previous. During the Quarter ended 1st April, 1933. During the corresponding period year previous. During the Quarter ended 1st April. 1933. Typhoid. Others. M. F. M. F. Greenwich East 41697 40419 51 84 77 79 13 7 74 ... ... l l 3 ... ... l 9 1 21 32 8 79 14.99 15.48 .38 .59 Do. West 24967 24202 53 44 55 44 5 5 48 ... ... ... ... 1 ... ... 2 9 1 1.2 16 16 42 14.93 16.42 .80 .49 St. Nicholas, Deptford 6573 6372 10 8 13 16 2 ... 9 ... ... ... ... ... ... ... ... 5 ... 6 6 ... 12 21.35 18.27 1.22 ... Charlton & Kidbrooke 27687 26837 52 42 57 57 7 7 54 ... ... ... 6 ... ... ... ... 7 2 25 17 7 50 12.75 17.03 .28 .89 S. Alfege's Hospital Resident ... ... ... ... 67 50 9 8 34 ... ... ... ... ... ... ... 1 8 1 24 11 10 62 ... ... ... ... Non-Resident ... ... ... ... 95 75 7 3 83 ... ... ... ... ... ... ... 3 11 1 26 22 13 94 ... ... ... ... Seamen's Hospital Resident ... ... ... ... 8 2 ... 1 ... ... ... ... ... ... ... ... ... 2 ... 1 ... 1 6 ... ... ... ... Non-Resident ... ... ... ... 23 ... ... ... 3 ... ... ... ... ... ... ... ... 3 ... 3 2 7 8 ... ... ... ... Miller Hospital Resident ... ... ... ... 5 4 1 ... -2 ... ... ... ... ... ... ... ... 1 1 1 ... 1 5 ... ... ... ... Non-Resident ... ... ... ... 2.5 20 2 1 10 ... ... ... ... ... ... ... ... 1 1 8 ... 6 .29 ... ... ... ... Herbert Hospital Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... 13 ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 2 ... ... 7 ... ... ... ... L.C.C. Brook Hospital Resident ... ... ... ... 5 1 ... 3 ... ... ... ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... 7 16 5 9 ... ... ... 1 9 7 ... ... ... ... ... 3 ... ... 3 ... ... ... ... Cottage Hospital Resident ... ... ... ... 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... ... ... Non-Resident ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... Other Institutions Resident ... ... ... ... 2 5 3 ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... 6 ... ... ... ... Non-Resident ... ... ... ... ... 6 ... ... 3 ... ... ... ... ... ... ... ... 1 ... ... 2 ... 3 ... ... ... ... Outside Institutions Resident ... ... ... ... 31 33 5 4 19 ... ... l 1 ... ... ... 1 5 2 8 14 5 27 ... ... ... ... Borough 100924 97830 166 178 202 196 27 16 181 ... ... l 7 4 ... ... 3 30 4 64 71 31 183 ... ... ... ... 344 398 Rate per 1,000 of Estimated Population ... ... 139 16.32 ... ... ... ... ... .04 .28 .16 ... ... .12 1.23 .16 2.62 2.90 1.27 7.5 14.76 16.32 .50 .63 Deaths of Children under one year per 1,000 births 78 „ „ „ (previous corresponding period) 100 „ „ „ County of London 71 Death Rate of 118 large English Towns 17'3; of the County of London 17.3 Birth Rate „ „ „ 150; „ „ 13.8 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the Quarter ended 1st July, 1933. DISTRICTS. Census Population, 1931. Estimated Population at the middle of the year 1933. Births registered during the Quarter ended 1st July, 1933. Deaths registered during the Quarter ended 1st July, 1933. age mortality. seven zymotic diseases. Tuberculosis, Pulmonary. 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. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. Diarrhœa. All Causes. Seven Zymotics. During the corre*ponding period year previous. During the Quarter ended 1st July, 1933. During the corresponding period year previous. During the Quarter ended 1st July. 1933. Typhoid. Others. M. F. M. F. Greenwich East 41697 40419 83 64 54 45 5 ... 53 ... ... ... 2 ... ... ... ... 12 2 10 15 16 42 15.17 9.83 1.44 .19 Do. West 24967 24202 38 47 34 39 11 2 28 ... ... ... 1 1 ... ... ... 7 1 9 11 7 36 11.88 12.10 .64 .08 St. Nicholas, Deptford 6573 6372 18 13 9 9 1 ... 6 ... ... ... ... ... ... ... ... 1 ... 2 4 5 6 1403 11.34 2.44 ... Charlton & Kidbrooke 27687 26837 54 52 36 41 6 1 35 ... ... ... ... 1 ... ... 1 5 ... 7 9 14 40 911 11.50 .53 .29 S. Alfege's Hospital Resident ... ... ... 35 45 4 ... 64 ... ... ... ... 1 ... ... ... 8 1 10 13 11 36 ... ... ... ... Non-Resident ... ... ... 69 62 5 ... 69 ... ... ... ... ... ... ... ... 13 ... 11 20 15 72 ... ... ... ... Seamen's Hospital Resident ... ... ... 8 ... ... ... 4 ... ... ... ... ... ... ... ... 1 ... 2 ... 2 3 ... ... ... ... Non-Resident ... ... ... 18 ... ... ... 4 ... ... ... ... ... ... ... ... ... ... 2 5 3 8 ... ... ... ... Miller Hospital Resident ... ... ... 11 5 ... ... 5 ... ... ... ... ... ... ... ... 1 2 2 2 1 8 ... ... ... ... Non-Resident ... ... ... 23 1/ ... 1 9 ... ... ... ... ... ... ... ... 2 1 2 2 9 •24 ... ... ... ... Herbert Hospital Resident ... ... ... ... ... ... ... ... ... ... ... ......... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 6 ... ... ... ... L.C.C. Brook Hospital Resident ... ... ... 2 1 ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 10 12 ... 10 ... ... 2 ... 11 4 ... ... ... ... ... ... 1 ... 3 ... ... ... ... Cottage Hospital Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Institutions Resident ... ... ... 2 5 ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... 2 5 ... ... ... ... Non-Resident ... ... ... 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 6 ... ... ... ... Outside Institutions Resident ... ... ... 28 22 3 1 28 ... ... ... ... ... ... ... 1 7 1 6 5 7 23 ... ... ... ... Borough 100924 97830 193 176 133 134 23 3 122 ... ... ... 3 2 ... ... 1 25 3 28 39 42 124 ... ... ... ... 369 267 Rate per 1,000 of Estimated Population ... ... 15.02 10.94 ... ... ... ... ... ... .12 .08 ... ... •04 1.02 .12 1.14 1.60 1.72 5.08 12.63 10.94 1.03 .24 Deaths of Children under one year per 1,000 births 62 „ „ „ previous corresponding period 70 „ „ „ County of London 49 Death Rate of 118 large English Towns 10.6; of the County of London 10.2 Birth Rate „ „ 15.3; „ „ 13.8 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the Quarter ended 30th September, 1933. districts. Census Population, 1931. Estimated Population at the middle of the year 1933. Births registered during the Quarter ended 30th September, 1933. Deaths registered during the Quarter ended 30th September, 1933. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Tuberculosis, Pulmonary. All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1,000. Seven Zvmotics. Under 1 year. Over 1 and under 5 years. Persons aged 65 years and upwards. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. During the corresponding period year previous. During the Quarter ended 30th Septembe , 1933. During the corresponding period year previous. During the Quarter ended 39th September. 1933. Typhoid. Others. Diarrhoea. M. F. M. F. Greenwich East 41697 40419 91 71 55 44 5 3 44 ... ... l ... 1 ... ... ... 6 3 7 11 24 46 8.85 9.53 .48 .19 Do. West 24967 24202 40 39 35 21 4 1 20 ... ... ... ... ... ... ... 2 4 ... 5 12 12 21 8.52 9.28 .16 .33 St. Nicholas, Deptford 6573 6372 4 13 11 6 2 2 2 ... ... ... ... ... ... ... ... 1 1 2 3 3 7 14.03 10.71 .61 ... Charlton & Kidbrooke 27687 •26837 37 49 22 31 2 2 27 ... ... ... ... ... ... ... 2 4 ... 3 10 10 24 10.13 7.91 .14 .29 S. Alfege's Hospital Resident ... ... ... 44 32 5 4 29 ... ... ... ... ... ... ... 3 4 3 4 11 20 31 ... ... ... ... Non-Resident ... ... ... 69 63 8 2 68 ... ... ... ... ... 1 ... 7 11 4 11 21 11 66 ... ... ... ... Seamen's Hospital Resident ... ... ... 6 ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 3 ... ... ... ... 20 2 3 1 9 12 Miller Hospital Resident ... ... ... 5 2 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 4 ... ... ... ... Non-Resident ... ... ... 29 12 ... 1 3 ... ... ... ... ... ... ... ... 2 ... 1 2 7 29 ... ... ... ... Herbert Hospital Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 3 ... ... ... ... L.C.C. Brook Hospital Resident ... ... ... ... 2 ... 1 ... ... ... l ... l ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 12 12 5 10 ... ... 3 l 5 7 ... ... ... ... 1 4 ... ... 3 ... ... ... ... Cottage Hospital Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Institutions Resident ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Non-Resident ... ... ... 2 4 ... ... 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... 5 ... ... ... ... Outside Institutions Resident ... ... ... 26 26 3 ... 16 ... ... ... ... ... ... ... ... 2 ... 5 9 8 28 ... ... ... Borough 100924 97830 172 172 123 102 13 8 93 ... ... l ... 1 ... ... 4 15 4 17 36 49 98 ... ... ... ... 344 225 Rate per 1,000 of Estimated Population ... ... 13.69 9.22 ... ... ... ... ... .04 ... .04 ... ... 16 .60 .16 .68 1.47 2.01 4.02 9.32 9.22 .44 .24 Deaths of Children under one year per 1,000 births 37 ,, ,, ,, previous corresponding period 54 ,, ,, ,, County of London 49 Death Rate of 118 large English Towns 91; of the County of London 8.9 Birth Rate „ „ 146 ,, ,, 13.2 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the Quarter ended 30th December, 1933. • districts. Census Population, 1931. Estimated Population at the middle of the year 1933. Births registered during the Quarter ended 30th December, 1933. Deaths registered during the Quarter ended 30th December, 1933. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. j Tuberculosis. Pulmonary. j All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. | Cancer. All other Diseases. Rath of Mortality per 1,000. All Causes. Seven Zvmotics. Under 1 year. Over 1 and under 5 years. Persons aged (»5 years and upwards. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fevers. Diarrhoea. During the corresponding period year previous. During the Quarter ended 30th December, 1933. During the corresponding period year previous. During the Quarter ended 30th December, 1933. Typhoid. Others. M. F. M. F. Greenwich East- 41697 40419 43 57 65 51 10 3 52 ... 1 1 2 ... ... ... 4 7 ... 14 18 15 54 12.68 11.51 .81 .79 Do. West 24967 24202 55 33 38 37 5 2 26 ... 1 ... ... ... ... ... 2 10 ... 7 17 11 27 10.43 12.43 .32 .49 St. Nicholas, Deptford 6573 6372 8 9 8 12 1 1 6 ... ... ... 1 ... ... ... ... 1 ... ... 3 6 9 8.54 12.59 .61 .62 Charlton & Kidbrooke 27687 26837 36 39 40 26 10 1 23 ... ... ... 1 ... ... ... 3 6 1 10 9 8 28 839 9.86 .44 .59 S. Alfege's Hospital Resident ... ... ... 58 39 16 1 38 ... ... ... ... ... ... ... 7 5 ... 8 13 19 45 ... ... ... ... Non-Resident ... ... ... 81 59 ... 6 74 ... ... ... ... ... ... ... 4 6 ... 24 20 20 65 ... ... ... ... Seamen's Hospital Resident ... ... ... 12 1 ... ... 3 ... ... ... ... ... ... ... ... 1 ... 1 1 3 7 ... ... ... ... Non-Resident ... ... ... 20 2 ... ... 7 ... ... ... ... ... ... ... ... ... ... 2 1 6 13 ... ... ... ... Miller Hospital Resident ... ... ... 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 5 ... ... ... ... Non-Resident ... ... ... 22 14 5 2 6 ... ... ... ... ... ... ... ... ... 1 3 2 6 24 ... ... ... ... Herbert Hospital Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... L.C.C. Brook Hospital Resident ... ... ... 2 5 2 3 ... ... 2 1 3 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Non-Resident ... ... ... 7 9 ... 7 ... ... 4 ... 5 5 1 ... ... ... ... 1 ... ... ... ... ... ... ... Cottage Hospital Resident ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Non-Resident ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Other Institutions Resident ... ... ... 4 3 3 ... 3 ... ... ... ... ... ... ... 1 ... ... ... 1 ... 5 ... ... ... ... Non-Resident ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... Outside Institutions Resident ... ... ... 30 20 3 1 14 ... ... ... 1 ... ... ... ... 11 ... 2 6 4 26 ... ... ... ... Borough 100924 97830 142 138 151 1.26 26 7 107 ... 2 1 4 ... ... ... 9 24 1 31 47 40 118 ... ... ... ... 280 277 Rate per 1,000 of Estimated Population ... ... 11.48 11.36 ... ... ... ... .08 .04 .16 ... ... ... .36 .98 .04 1.26 1.98 1.64 4.83 10.68 11.35 .58 .64 Deaths of Children under one vear oer 1.000 births 93 II t> it ( previous corresponding ) period 105 ,, „ „ County of London 69 Death Rate of 118 large English Towns ... 12' 1 ; of the County of London ... 12 0 Birth Rate „ „ ... 12'7; „ „ 11'5 BOROUGH OF GREENWICH. Return of Births and Deaths registered during the Year ended 3lst December, 1933. districts. Census Population, 1931. Estimated Population at the middle of the year 1933. Births registered during the Year ended 31st December, 1933. Deaths registered during the Year ended 31st December, 1933. AGE MORTALITY. SEVEN ZYMOTIC DISEASES. Tuberculosis, Pulmonary. All other Forms of Tuberculosis. Bronchitis, Pneumonia. Heart Disease. Cancer. All other Diseases. Rate of Mortality per 1,000. All Causes. Seven Zymotics. Under 1 year. Over 1 and under 5 years. Persons aged 65 years and upwards. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. fevers. Diarrhœa. During the corresponding period year previous. During the Year ended 31st December. 1933. During the corresponding period year previous. During the Year ended 31st December. 1933. Typhoid. Others. M. F. M. F. Greenwich East 41697 40419 268 276 251 219 33 13 223 ... 1 3 5 4 ... ... 5 34 6 52 76 63 221 12.88 11.67 .79 .44 Do. West 24967 24202 186 163 162 141 25 10 122 ... 1 ... 1 3 ... ...... 6 30 2 33 56 46 126 11.43 12.55 .48 .40 St. Nicholas, Deptford 6573 6372 40 43 41 43 6 3 23 ... ... ... 1 ... ... ... ... 8 1 10 16 14 34 14.49 19.37 1.21 .15 Charlton & Kidbrooke 27687 26837 179 182 155 155 25 11 139 ... ... ... 7 1 ... ... 6 22 3 45 45 39 142 10.10 11.59 .32 .49 S. Alfege's Hospital Resident ... ... ... 204 166 34 13 165 ... ... ... ... 1 ... ... 11 25 5 46 48 60 174 ... ... ... ... Non-Resident ... ... ... 314 259 20 11 294 ... ... ... ... ... 1 ... 14 41 6 72 83 59 297 ... ... ... ... Seamen's Hospital Resident ... ... ... 34 3 ... 2 7 ... ... ... ... ... ... ... ... 5 ... 5 2 6 19 ... ... ... ... Non-Resident ... ... ... 81 4 ... ... 17 ... ... ... ... ... ... ... ... 3 ... 8 8 25 41 ... ... ... ... Miller Hospital Resident ... ... ... 26 14 5 ... 7 ... ... ... ... ... ... ... ... 2 4 3 4 5 22 ... ... ... ... Non-Resident ... ... ... 99 63 10 5 28 ... ... ... ... ... ... ... ... 5 3 14 6 28 106 ... ... ... ... Herbert Hospital Resident ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Non-Resident ... ... ... 27 ... ... ... ... ... ... ... ... ... ... ... ... 6 ... 4 ... ... 17 ... ... ... ... L.C.C. Brook Hospital Resident ... ... ... 9 9 2 7 ... ... 2 2 12 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Non-Resident ... ... ... 36 49 15 36 ... ... 9 3 30 23 1 ... ... ... ... 4 1 ... 6 ... ... ... ... Cottage Hospital Resident ... ... ... 3 1 ... ... 1 ... ... ... ... ... ... ... ... ... 1 6 ... ... 2 ... ... ... ... Non-Resident ... ... ... 2 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... Other Institutions Resident ... ... ... 9 13 6 ... 10 ... ... ... ... ... ... ... 1 ... ... 1 1 2 17 ... ... ... ... Non-Resident ... ... ... 7 15 ... ... 6 ... ... ... ... ... ... ... ... 1 ... 1 3 2 15 ... ... ... ... Outside Institutions Resident ... ... ... 115 101 14 6 77 ... ... 1 2 ... ... ... 2 25 3 21 34 24 104 ... ... ... ... Borough 100924 97830 673 664 609 558 89 37 507 ... 2 3 .14 8 ... ... 17 94 12 140 193 162 523 ... ... ... ... 1337 1167 Rate per 1,000 of Estimated Population ... ... 13.70 11.96 ... ... ... ... .02 .03 .14 .08 ... ... .18 .96 .12 1.43 1.98 1.66 5.36 11.85 11.96 .61 .42 Deaths of Children under one year per 1,000 births 66 previous corresponding 80 ,, ,, ,, period ,, „ „ County of London 60 Death Rate of 118 large English Towns 12.6; of the County of London 12.5 Birth Rate „ „ 14.4; „ „ 13.2 BOROUGH OF GREENWICH. Causes of, and Ages at, Death, during the Quarter ended 1st April, 1933. 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 C5 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital L.C.C. Cottage Hospital Other Institutions Outside Institutions Typhoid and Paratyphoid Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 1 .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 1 Whooping Cough 4 2 .. 2 .. .. .. .. .. 3 1 .. .. .. .. .. .. .. .. .. .. 7 Diphtheria 7 .. .. 3 4 .. .. .. .. 1 .. .. 6 .. .. .. .. 6 .. .. 1 15 Influenza 53 1 2 1 .. 2 4 24 19 26 12 4 11 19 1 .. .. .. 1 .. 4 45 Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebrospinal Fever 1 .. .. .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 5 Tuberculosis of Respiratory System 30 .. .. .. 1 5 15 8 1 9 9 5 7 8 2 1 .. .. .. .. 5 31 Other Tuberculous Diseases 4 1 .. .. 1 1 1 .. .. 1 1 .. 2 1 .. 1 .. .. .. .. 2 4 Syphilis 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. 1 .. .. .. .. .. .. 2 General Paralysis of the Insane, tabes dorsalis 2 .. .. .. .. .. .. 1 1 1 1 .. .. 2 .. .. .. .. .. .. .. 2 Cancer 31 .. .. .. 1 1 1 10 18 8 16 .. 7 10 1 1 .. .. .. .. 5 38 Diabetes 2 .. .. .. .. 1 .. 1 .. 2 .. .. .. 2 .. .. .. .. .. .. .. 6 Cerebral Haemorrhage 12 .. .. .. .. .. .. 2 10 4 7 .. 1 5 .. .. .. .. .. .. .. 15 Heart Disease 71 .. .. .. 4 .. 7 11 49 32 16 6 17 11 .. .. .. .. .. .. 14 38 Aneurysm 3 .. .. .. .. .. .. 2 1 1 .. .. 2 1 .. .. .. .. .. .. 1 2 Other Circulatory Diseases 25 .. .. .. .. .. .. 5 20 13 6 1 5 8 .. .. .. .. .. .. 4 34 Bronchitis 35 .. .. .. .. .. 2 5 28 7 9 4 15 8 1 .. .. .. 1 .. 3 16 Pneumonia (all forms) 29 4 4 2 .. .. 5 8 6 14 3 2 10 16 .. 2 .. .. 1 1 5 55 Other Respiratory Diseases 4 .. .. .. .. 1 1 1 1 2 1 .. 1 .. .. .. .. .. .. .. 1 1 Peptic Ulcer 3 .. .. .. .. .. .. 2 1 .. 1 .. 2 1 .. .. .. .. .. .. 2 5 Diarrhœa 3 2 .. .. .. 1 •.. • .. .. 1 2 .. .. 1 .. .. .. .. .. .. 1 4 Appendicitis 2 .. .. .. 1 .. 1 .. .. 1 .. 1 .. 1 .. 1 .. .. .. .. .. 6 Cirrhosis of Liver 2 .. .. .. .. .. 1 1 .. 2 .. .. .. 2 .. .. .. .. .. .. .. 3 Other Diseases of Liver, etc. 3 .. .. .. .. .. .. 1 2 .. .. .. 3 .. .. 1 .. .. .. 1 1 2 Other Digestive Diseases 4 .. .. 2 1 .. .. .. 1 1 1 .. 2 2 .. .. .. .. .. .. 1 11 Ac. & Cr. Nephritis 12 .. .. .. .. .. .. 2 10 7 2 1 2 4 .. 1 .. .. .. .. 1 12 Puerperal Sepsis 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 Other Puerperal Causes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Congenital Debility, Premature Birth, Malformations, etc. 16 16 .. .. .. .. .. .. .. 5 3 2 6 4 .. .. .. .. .. 3 4 9 Senility 3 .. .. .. .. .. .. .. 3 1 .. .. 2 .. .. .. .. .. .. 1 1 15 Suicide 1 .. .. .. .. .. 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 2 Other Violence 12 1 .. 1 1 .. 1 1 7 5 2 1 4 5 1 1 .. .. .. .. 3 20 Other Defined Causes 21 .. .. 1 .. 1 2 10 7 8 4 2 7 5 2 .. .. .. .. .. 4 26 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 398 27 6 13 15 13 43 96 185 156 99 29 114 117 10 9 .. 6 3 7 64 434 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 Quarter ended 1st July, 1933. 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 and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital L.C.C. Cottage Hospital Other Institutions Outside Institutions Typhoid and Paratyphoid Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Whooping Cough 2 2 .. .. .. .. .. .. .. .. 1 .. 1 1 .. .. .. .. .. .. .. 5 Diphtheria 3 .. .. .. 3 .. .. .. .. 2 1 .. .. .. .. .. .. 3 .. .. .. 14 Influenza 1 .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Tuberculosis of Respiratory System 25 2 .. .. .. 8 12 3 .. 12 7 1 5 8 1 1 .. .. .. .. 8 25 Other Tuberculous Diseases 3 .. .. .. 1 .. 1 .. 1 2 1 .. .. 1 .. 2 .. .. .. .. .. 4 Syphilis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 General Paralysis of the Insane, tabes dorsalis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cancer 42 .. .. .. .. .. 3 20 19 16 7 5 14 11 2 1 .. .. .. 2 7 44 Diabetes 3 .. .. .. .. .. .. .. 3 .. .. .. 3 1 .. .. .. .. .. .. 1 1 Cerebral Haemorrhage 9 .. .. .. .. .. .. 2 7 4 2 .. 3 4 .. .. .. .. .. .. .. 13 Heart Disease 39 .. .. .. .. .. 3 7 29 15 11 4 9 13 .. 2 .. .. .. .. 5 44 Aneurysm 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. Other Circulatory Diseases 20 .. .. .. .. .. .. 4 16 10 4 1 5 4 .. .. .. .. .. 2 3 15 Bronchitis 10 .. .. .. .. .. .. 2 8 4 4 2 .. 2 1 .. .. .. .. .. .. 10 Pneumonia (all forms) 18 2 3 .. 2 .. 2 3 6 6 5 .. 7 8 1 2 .. .. .. .. 6 20 Other Respiratory Diseases 5 .. .. .. 1 .. 1 3 .. 1 1 .. 3 1 .. 1 .. .. .. .. 2 6 Peptic Ulcer 8 .. .. .. .. 1 2 2 3 3 3 1 1 2 1 .. .. .. .. .. 3 8 Diarrhoea 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. Appendicitis 3 .. .. .. .. 1 1 1 .. .. 3 .. .. 2 .. 1 .. .. .. .. .. 9 Cirrhosis of Liver 2 .. .. .. .. .. .. 1 1 2 .. .. .. .. 1 .. .. .. .. .. .. 3 Other Diseases of Liver, etc. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 1 .. 3 Other Digestive Diseases 4 .. .. .. 1 .. 1 1 1 1 .. .. 3 1 .. .. .. .. .. .. 2 7 Ac. & Cr. Nephritis 7 .. .. .. .. .. 1 1 5 2 1 1 3 2 1 1 .. .. .. .. .. 9 Puerperal Sepsis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Puerperal Causes 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 2 Congenital Debility, Premature Birth, Malformations, etc. 15 15 .. .. .. .. .. .. .. 4 10 .. 1 .. .. .. .. .. .. 2 3 7 Senility 10 .. .. .. .. .. .. .. 10 1 5 .. 4 5 .. .. .. .. .. .. 1 17 Suicide 7 .. .. .. .. 1 .. 4 2 4 1 1 1 4 .. 1 .. .. .. .. .. 9 Other Violence 11 .. .. .. 1 2 1 3 4 4 .. 1 6 4 2 .. .. .. .. 1 20 Other Defined Causes 16 1 .. .. 1 1 3 5 5 5 6 1 5 6 2 .. .. .. .. 6 38 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 267 23 3 10 14 32 63 122 99 73 18 77 80 8 16 .. 3 .. 7 50 340 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 Quarter ended 30th September, 1933. 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 G5 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital L.C.C. Cottage Hospital Other Institutions Outside Institutions Typhoid and Paratyphoid Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Scarlet Fever 1 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. 2 Whooping Cough 1 .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. 8 Diphtheria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Influenza 2 .. .. .. .. .. 1 1 .. .. 2 .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Tuberculosis of Respiratory System 15 .. .. .. .. 1 10 3 1 6 4 1 4 5 1 .. .. .. .. .. 2 19 Other Tuberculous Diseases 4 1 1 1 1 .. .. .. .. 3 .. 1 .. 3 .. 1 .. .. .. .. .. 9 Syphilis 2 .. .. .. .. .. .. 1 1 1 1 .. .. 1 .. .. .. .. .. .. .. 2 General Paralysis of the Insane, tabes dorsalis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cancer 49 .. .. .. .. .. 1 26 22 24 12 3 10 20 .. 1 .. .. .. .. 8 48 Diabetes 1 .. .. .. .. .. .. .. 1 1 .. .. .. 1 .. .. .. .. .. .. .. 2 Cerebral Haemorrhage 16 .. .. .. .. .. 1 4 11 7 3 .. 6 6 .. .. .. .. .. .. 4 18 Heart Disease 36 .. .. .. 1 2 1 13 19 11 12 3 10 11 1 1 .. .. .. .. 9 36 Aneurysm .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Circulatory Diseases 13 .. .. .. .. .. .. 4 9 6 2 2 3 3 .. .. .. .. .. 1 4 20 Bronchitis 5 .. .. .. .. .. 1 .. 4 1 1 1 2 .. .. .. .. .. .. .. .. 9 Pneumonia (all forms) 12 3 .. 1 .. .. 3 2 3 6 4 1 1 4 1 .. .. .. .. .. 4 14 Other Respiratory Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Peptic Ulcer 5 .. .. .. .. .. .. 4 1 1 4 .. .. 2 1 .. .. .. .. .. .. 10 Diarrhoea 4 2 2 .. .. .. .. .. .. .. 2 .. 2 3 .. .. .. .. .. .. .. 10 Appendicitis 5 .. .. .. 1 .. 1 2 1 2 1 1 1 .. .. 2 .. .. .. .. 3 4 Cirrhosis of Liver 1 .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. 2 Other Diseases of Liver, etc 2 .. .. .. .. .. 1 1 .. 1 1 .. .. 1 .. .. .. .. .. .. 1 7 Other Digestive Diseases 3 .. .. .. .. .. .. 3 .. 3 .. .. .. 2 .. .. .. .. .. .. 1 8 Ac. & Cr. Nephritis 10 .. .. .. .. .. .. 2 8 3 1 1 5 3 .. .. .. .. .. .. 3 13 Puerperal Sepsis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Puerperal Causes .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 Congenital Debility, Premature Birth, Malformations, etc. 7 7 .. .. .. .. .. .. .. 4 1 1 1 2 .. .. .. .. .. .. 3 8 Senility 1 .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 8 Suicide 2 .. .. .. .. .. 1 .. 1 1 .. .. 1 2 .. .. .. .. .. .. .. 5 Other Violence 10 .. .. .. .. 3 3 2 2 6 1 1 2 1 .. .. .. .. .. .. 8 13 Other Defined Causes 18 .. .. 2 1 .. 1 7 7 9 4 1 4 6 2 2 .. .. .. .. 2 29 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 225 13 4 4 5 6 25 75 93 99 56 17 53 76 6 7 .. 2 .. 1 52 321 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 Quarter ended 30th December, 1933. Causes of Death. Deaths at Subjoined Ages of " Residents " whether occurring within cr 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 and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital L.C.C. Cottage Hospital Other Institutions Outside Institutions Typhoid and Paratyphoid Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Measles 2 1 .. 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. 2 .. .. .. 6 Scarlet Fever 1 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Diphtheria 4 .. .. 2 2 .. .. .. .. 2 .. 1 1 .. .. .. .. 3 .. .. 1 8 Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever 1 1 .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. 2 Tuberculosis of Respiratory System 24 .. .. .. .. 4 12 6 2 7 10 1 6 5 1 .. .. .. .. .. 11 13 Other Tuberculous Diseases 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 2 Syphilis 1 .. .. .. .. .. .. .. 1 1 .. .. .. .. 1 .. .. .. .. .. .. 5 General Paralysis of the Insane, tabes dorsalis 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. Cancer 40 .. .. .. .. 1 2 20 17 15 11 6 8 19 3 2 .. .. .. .. 4 57 Diabetes 4 .. .. .. .. .. 1 .. 3 4 .. .. .. 2 .. .. .. .. 1 .. .. 3 Cerebral Hasmorrhage 17 2 .. .. .. 1 2 4 8 3 8 1 5 7 1 .. .. .. .. 2 4 21 Heart Disease 47 .. .. .. .. 3 3 11 30 18 17 3 9 13 1 1 .. .. .. 1 6 39 Aneurysm 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. Other Circulatory Diseases 16 .. .. .. .. .. 1 2 13 10 3 1. 2 4 1 1 .. .. .. .. 1 14 Bronchitis 15 .. .. .. .. .. .. 6 9 8 4 .. 3 3 1 .. .. .. .. .. 1 14 Pneumonia (all forms) 16 2 1 .. 1 1 5 6 .. 6 3 .. 7 5 .. .. .. 1 .. .. 1 27 Other Respiratory Diseases 4 .. 2 .. .. .. .. 1 1 3 1 .. 1 1 .. .. .. .. .. 1 4 Peptic Ulcer 2 .. .. .. .. .. .. 1 1 1 .. .. 1 2 .. .. .. .. .. .. .. 6 Diarrhoea . . 9 8 1 .. .. .. .. .. .. 4 2 .. 3 7 .. .. .. .. .. 1 .. 12 Appendicitis 2 .. .. .. .. .. 2 .. .. .. .. .. 1 1 .. 1 .. .. .. .. .. .. Cirrhosis of liver 3 .. .. .. .. .. .. 2 1 2 .. .. 1 .. 1 .. .. .. .. .. 1 1 Other Diseases of Liver, etc. 2 .. .. .. .. .. .. 1 1 2 .. .. .. .. .. .. .. .. .. .. .. 1 Other Digestive Diseases 5 .. .. .. .. .. 1 2 1 2 2 .. 1 3 .. 2 .. .. .. .. 2 16 Ac. & Cr. Nephritis 15 .. .. .. .. .. 4 6 5 6 4 2 3 5 1 .. .. .. .. 1 4 11 Puerperal Sepsis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other Puerperal Causes 2 .. .. .. .. .. 1 1 .. 1 .. 1 .. 1 .. .. .. .. .. .. .. 1 Congenital Debility, Premature Birth, Malformations, etc. 9 9 .. .. .. .. .. .. .. 3 3 .. 3 6 .. .. .. .. .. 1 1 9 Senility 4 .. .. .. .. .. .. .. 4 1 1 .. 2 2 .. .. .. .. .. .. 1 15 Suicide 3 .. .. .. .. .. 1 2 .. 1 .. .. 2 .. .. .. .. .. .. .. .. 2 Other Violence 7 .. .. .. .. 2 2 1 2 1 2 .. 4 1 1 1 .. .. .. .. 2 15 Other Defined Causes 19 1 .. .. 2 2 3 3 8 10 4 2 3 9 .. .. .. .. .. 1 8 36 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 277 26 4 3 6 14 40 77 107 116 75 20 66 97 13 8 .. 7 1 7 50 353 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 Year ended 31st December, 1933. 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 and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital L.C.C. Cottage Hospital Other Institutions Outside Institutions Typhoid and Paratyphoid Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles 2 1 .. 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. 2 .. .. .. 11 Scarlet Fever 3 .. .. 1 2 .. .. .. .. 3 .. .. .. .. .. .. .. .. .. .. 1 5 Whooping Cough 7 4 1 2 .. .. .. .. .. 4 2 .. 1 1 .. .. .. 1 .. .. .. 25 Diphtheria 14 .. .. 5 9 .. .. .. .. 5 1 1 7 .. .. .. .. 12 .. .. 2 42 Influenza 56 1 2 1 .. 2 5 25 20 27 14 4 11 19 1 .. .. .. 1 .. 4 45 Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Fever 2 1 .. .. 1 .. .. .. .. 1 1 .. .. 1 1 .. .. .. .. .. .. 12 Tuberculosis of Respiratory System 94 2 .. .. 1 18 49 20 4 34 30 8 22 26 3 2 .. .. .. .. 26 88 Other Tuberculous Diseases 12 3 1 1 3 1 2 .. 1 6 2 1 3 5 .. 4 .. .. .. .. 2 19 Syphilis 4 .. .. .. .. .. .. 2 2 2 2 .. .. 1 2 .. .. .. .. .. .. 10 General Paralysis of the Insane, tabes dorsalis 3 .. .. .. .. .. .. 2 1 1 1 1 .. 2 .. .. .. .. .. .. 1 2 Cancer 162 .. .. .. 1 2 7 76 76 63 46 14 39 60 6 5 .. .. .. 2 24 187 Diabetes 10 .. .. .. .. 1 1 1 7 7 .. .. 3 6 .. .. .. .. 1 .. 1 12 Cerebral Haemorrhage 54 2 .. .. .. 1 3 12 36 18 20 1 15 22 1 .. .. .. .. 2 8 67 Heart Disease 193 .. .. .. 5 5 14 42 127 76 56 16 45 48 2 4 .. .. .. 1 34 157 Aneurysm 5 .. .. .. .. .. .. 4 1 2 1 .. 2 1 .. .. .. .. .. .. 1 2 Other Circulatory Diseases 74 .. .. .. .. .. 1 15 58 39 15 5 15 19 1 1 .. .. .. 3 12 83 Bronchitis 65 .. .. .. .. .. .. .. 49 20 18 7 20 13 3 .. .. .. 1 .. 4 49 Pneumonia (all forms) 75 11 8 3 3 1 15 19 15 32 15 3 25 33 2 4 .. 1 1 1 16 116 Other Respiratory Diseases 13 .. 2 .. 1 1 2 5 2 6 2 1 4 2 1 1 .. .. .. .. 4 13 Peptic Ulcer 18 .. .. .. .. 1 2 9 6 5 8 1 4 7 2 .. .. .. .. .. 5 29 Diarrhoea 17 13 3 .. .. 1 .. .. .. 5 6 .. 6 11 .. .. .. .. .. 1 2 26 Appendicitis 12 .. .. .. 2 1 5 3 1 4 4 2 2 4 .. 5 .. .. .. .. 3 25 Cirrhosis of Liver 8 .. .. .. .. .. 1 4 3 6 .. .. 2 2 2 .. .. .. .. .. 1 9 Other Diseases of Liver, etc... 8 .. .. .. .. .. 1 3 4 3 1 .. 4 1 .. 1 .. .. .. 2 2 13 Other Digestive Diseases 16 1 .. 2 2 .. 2 6 3 7 3 .. 6 .. .. 2 .. .. .. .. 6 42 Ac. & Cr. Nephritis 44 .. .. .. .. .. 5 11 28 18 8 5 13 14 2 2 .. .. .. 1 8 45 Puerperal Sepsis 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 Other Puerperal Causes 3 .. .. .. .. .. 2 1 .. 1 .. 1 1 1 .. .. .. .. .. .. 1 7 Congenital Debility, Premature Birth, Malformations, etc. 47 47 .. .. .. .. .. .. .. 16 17 3 11 12 .. .. .. .. .. 6 11 33 Senility 18 .. .. .. .. .. .. .. 18 4 6 .. 8 7 .. .. .. .. .. 1 3 55 Suicide 13 .. .. .. .. 1 3 6 3 6 1 1 5 7 .. 1 .. .. .. .. .. 18 Other Violence 40 1 .. 1 2 7 7 7 15 10 5 3 16 11 2 4 .. .. .. .. 14 68 Other Defined Causes 74 2 .. 3 4 4 9 25 27 32 17 6 19 26 4 4 .. .. .. 1 20 130 Causes ill-defined or unknown .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1167 89 17 20 36 47 140 311 507 470 303 84 310 370 37 40 .. 18 4 22 216 1448 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. Cases of Infectious Disease notified during the Quarter ended 1st April, 1933. Notifiable Disease. Cases Notified in Whole District. Total Casks Notified in each Locality. No. 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. ^ to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 103 3 21 63 13 3 ... ... 21 12 10 60 21 12 10 58 101 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 17 ... 1 1 1 2 8 ... 9 2 2 4 5 ... 1 2 8 Acute Polio-Myelitis 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Scarlet Fever 152 ... 42 86 15 8 1 ... 78 42 9 23 74 38 9 23 144 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 1 ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... 1 Cerebro-Spinal Fever 2 ... ... 2 ... ... ... ... ... 2 ... ... ... 2 ... ... 2 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 309 18 79 185 22 5 ... ... 134 101 46 28 50 11 2 1 64 Whooping Cough 181 19 110 52 ... ... ... ... 131 19 1 30 9 1 ... 2 12 Diarrhoea 10 6 4 ... ... ... ... ... 7 ... 2 1 ... ... ... ... ... Ophthalmia Neonatorum 6 6 ... ... ... ... ... ... 2 1 ... 3 1 ... ... ... 1 Tuberculosis, Pulmonary 37 ... ... 2 4 19 10 2 7 17 2 11 5 6 1 6 18 ,, Non-Pulmonary 6 ... ... 2 3 1 ... ... 3 2 ... 1 2 2 ... 1 5 Pneumonia, Acute Primary or Acute Influenzal 100 1 11 10 9 28 31 10 54 20 10 16 29 11 6 9 55 Totals 925 54 268 403 67 67 50 16 446 220 82 177 196 84 29 102 411 * Cases of Infectious Disease are treated in the Hospitals of the London County Council, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the Quarter ended 1st July, 1933. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 61 ... 20 32 7 2 ... ... 23 16 9 13 23 16 9 13 61 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 19 ... 1 1 2 7 4 4 6 4 2 7 2 3 2 4 11 Acute Polio-Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 138 ... 44 77 10 5 ... ... 51 34 25 28 48 34 25 27 134 Enteric Fever 1 ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 3 ... ... ... ... 3 ... ... 1 2 ... ... 1 1 ... ... 2 Cerebro-Spinal Fever 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 1 Malaria (Induced) 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... Measles 360 13 101 220 19 7 ... ... 156 137 10 57 4 5 1 1 11 Whooping Cough 184 15 97 72 ... ... ... ... 81 30 4 69 2 1 1 2 6 Diarrhoea 14 7 7 ... ... ... ... ... 7 ... 2 5 ... ... ... ... ... Ophthalmia Neonatorum 4 4 ... ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... Tuberculosis, Pulmonary 32 ... ... 2 10 13 7 ... 14 10 1 7 5 3 ... ... 8 ,, Non-Pulmonary 10 1 ... 3 4 2 ... ... 6 1 2 1 3 1 ... ... 4 Pneumonia, Acute Primary or Acute Influenza 11 ... 1 2 1 3 1 3 5 ... ... 6 3 ... ... 3 6 Totals 839 42 271 409 54 43 13 7 352 236 55 196 92 64 38 51 245 * Cases of Infectious Disease are treated in the Hospitals of the London County Council, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the Quarter ended 30th September, 1933. Notifiable Disease. Casks Notified in Whole District. Total Casks Notified in each Locality. No. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 71 ... 22 43 3 2 1 ... 21 21 23 6 19 20 23 5 67 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 21 ... ... 1 2 7 8 3 11 5 ... 5 4 1 ... 2 7 Acute Polio-Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 123 2 35 78 4 4 ... ... 53 40 18 12 53 40 18 12 123 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 4 ... ... ... 1 3 ... ... 2 ... ... 2 1 ... ... 1 2 Cerebro-Spinal Fever 2 1 1 ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 2 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 66 10 26 30 ... ... ... ... 48 10 ... 8 ... ... ... ... ... Whooping Cough 178 20 97 60 1 ... ... ... 52 37 3 86 2 2 ... 4 9 Diarrhoea 28 12 16 ... ... ... ... ... 16 3 3 6 ... ... ... ... ... Ophthalmia Neonatorum 5 5 ... ... ... ... ... ... 1 3 ... 1 ... 1 ... ... 1 Tuberculosis, Pulmonary 26 ... ... 2 7 12 3 2 17 4 1 4 7 3 1 2 13 „ Non-Pulmonary 5 ... 1 3 1 ... ... ... 2 1 1 1 2 ... ... 1 3 Pneumonia, Acute Primary or Acute Influenzal 24 1 2 4 3 7 3 4 12 7 2 3 6 2 2 1 11 Totals 553 51 200 221 22 35 15 9 235 132 51 135 94 70 45 29 238 * Cases of Infectious Disease are treated in the Hospitals of the London County Council, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the Quarter ended 30th December, 1933. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. No. 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. 05 and upwards. Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 161 ... 35 96 22 8 ... ... 82 32 13 34 81 31 13 34 159 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 26 ... ... 3 3 8 10 ... 11 3 3 9 5 2 2 6 15 Acute Polio-Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 258 3 70 162 20 3 ... ... 84 100 31 43 82 99 31 42 254 Enteric Fever 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... 1 Puerperal Pyrexia 2 ... ... ... 1 1 ... ... 1 ... ... 1 1 ... ... ... 1 Cerebro-Spinal Fever 3 1 ... 1 ... 1 ... ... 1 ... 1 1 1 ... 1 1 3 Malaria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 400 14 201 183 2 ... ... ... 337 22 2 39 3 1 ... ... 4 Whooping Cough 28 4 18 6 ... ... ... ... 16 9 ... 3 1 1 ... 2 4 Diarrhoea 11 7 4 ... ... ... ... ... 6 1 2 ... ... ... ... ... ... Ophthalmia Neonatorum 3 3 ... ... ... ... ... ... 1 1 ... 1 1 1 ... ... 2 Tuberculosis, Pulmonary 21 1 ... 1 6 8 5 ... 12 9 ... 7 1 ... ... 1 2 „ Non-Pulmonary 6 ... ... 4 1 1 ... ... 1 2 2 1 ... 1 1 1 3 Pneumonia, Acute Primary or Acute Influenzal 29 ... 2 3 3 10 5 6 9 9 2 9 6 8 1 6 21 Totals 950 33 330 460 58 41 20 8 562 181 56 151 183 144 49 93 469 * Cases of Infectious Disease are treated in the Hospitals of the London County Council, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. Cases of Infectious Disease notified during the Year ended 31st December, 1933. Notifiable: Disease. Casks Notified in Whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. Greenwich East Greenwich West. St. Nicholas, Deptford. Charlton & Kidrrookh.* 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 396 3 98 234 45 15 1 ... 147 81 55 113 144 79 55 110 388 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 83 ... 2 6 8 24 30 13 37 14 7 25 16 6 5 14 41 Acute Polio-Myelitis 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Scarlet Fever 671 7 191 403 49 20 1 ... 266 216 83 106 257 211 83 104 655 Enteric Fever 2 ... ... 1 ... 1 ... ... 1 ... ... 1 1 ... ... ... 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ... ... 1 Puerperal Pyrexia 10 ... ... ... 2 8 ... ... 4 3 ... 3 3 2 ... 1 6 Cerebro-Spinal Fever 8 2 1 3 1 1 ... ... 1 3 1 3 1 3 1 3 8 Malaria 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... Measles 1135 55 407 618 43 12 ... ... 675 270 58 134 57 17 3 2 79 Whooping Cough 571 58 322 190 1 ... ... ... 280 95 8 188 14 5 2 10 31 Diarrhoea 63 32 31 ... ... ... ... ... 36 4 9 14 ... ... ... ... ... Ophthalmia Neonatorum 18 18 ... ... ... ... ... ... 4 7 ... 7 2 2 ... ... 4 Tuberculosis, Pulmonary 116 1 ... 7 27 52 25 4 50 33 4 29 18 12 2 9 42 ,, Non-Pulmonary 27 1 1 12 9 4 ... ... 12 6 5 4 7 4 1 3 15 Pneumonia, Acute Primary or Acute Influenzal 164 2 16 19 16 48 40 23 80 36 14 34 44 21 9 19 93 Totals 3267 180 1069 1493 201 186 98 40 1595 769 244 659 565 362 161 275 1363 * Cases of Infectious Disease are treated in the Hospitals of the London County Council, whose Brook Hospital is situated in Kidbrooke. BOROUGH OF GREENWICH. INFANTILE MORTALITY DURING THE YEAR 1933. 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 One Year. Common Infectious Diseases. Small-Pox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 1 ... 2 4 Diphtheria—Croup ... ... ... ... ... ... ... ...... ... ... Influenza ... ... ... ... ... 1 ... ... ... 1 Tuberculous Diseases. Pulmonary Tuberculosis ... ... ... ... ... ... 2 ... ... 2 Tuberculous Meningitis ... ... ... ... ... ... ... ... 2 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... 1 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculotts) ... ... ... ... ... ... ... 1 ... 1 Convulsions ... 1 ... ... 1 ... ... ... ... 1 Diseases of Trachea ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 1 ... ... 1 Pneumonia, all forms ... ... ... 1 1 ... 6 2 1 10 Diarrhœal Diseases. Diarrhoea, all forms ... ... ... 1 1 3 3 3 1 11 Enteritis ... ... ... ... ... ... 1 1 ... 2 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... otherwise 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 5 ... ... ... 5 ... ... ... ... 5 Congenital Malformations 2 1 ... ... 3 2 2 1 1 9 Premature Birth 19 ... ... 1 20 ... 1 ... ... 21 Atrophy, Debility and Marasmus 2 ... 1 ... 3 3 3 ... ... 9 Other Causes 2 ... ... ... 2 2 1 2 ... 7 Totals 31 2 1 3 37 12 21 10 9 89 Boys 50 Girls 39 89