LEW 3 BOROUGH OF LEWISHAM. ANNUAL REPORT ON THE VITAL STATISTICS AND SANITARY CONDITION OF THE Borough of Lewisham For the Year 1901, BY A. WELLESLEY HARRIS, M.R.C.S., D.P.H., &c. Medical Officer of Health and Public Analyst for the Borough of Lewisham. Fellow and Member of the Council of the Sanitary Institute. Fellow of the Epidemiological Society &c. London: Printed by Freame, Manning & Co., 12a, Lee High Road, Lewisham, S.E. 3 BOROUGH OF LEWISHAM. EPITOME OF VITAL STATISTICS, 1901. Area in acres exclusive of area covered by water 6,991 Enumerated population (Census, 1901) 127,495 Estimated population to the middle of 1901 128,480 Average number of persons per house 5.6 Total number of Births registered in the Borough 3,320 Birth Rate per 1,000 estimated population 25.9 Total number of Deaths registered in the Borough 1,875 Total number of Deaths registered in the Borough, after correction for non-residents dying in Public Institutions, and residents dying outside the District 1,668 Deaths of persons under 1 year of age 426 Rate per 1,000 births registered 128 Total number of Deaths in Public Institutions 613 Deaths of non-residents in Public Institutions in the Borough 289 Deaths of residents in Institutions outside the Borough 82 Corrected Death-rate per 1,000 of the estimated population 13.0 4 To the Mayor, Aldermen and Councillors of the Borough of Lewisham. Gentlemen, I beg to submit to you my first Annual Report on the Health and Sanitary Condition of the Borough of Lewisham during the year 1901. It was not until the end of August that I had the honour of commencing my duties, and in consequence of the absence of office records it has been difficult to collect the facts contained therein. The alteration of areas in the formation of the existing Borough has made it quite impossible to obtain comparative statistical figures for previous years. The time devoted to organising the Department, together with the large amount of work entailed by the threatened invasion of Small-pox, and the necessity of waiting for the issue of the Census Returns for the County of London, are mainly responsible for the delay of issue. The health of the district is highly satisfactory. The The death rate from all causes amounted to 13.0 per 1,000, the lowest in London excep Hampstead, and far below the average for England and Wales and the 33 great towns. The mortality from the principal infectious diseases, 1.62 per 1,000, compares most favourable with other Boroughs. The infantile mortality is nearly the lowest in London, only four Boroughs having a lower mortality. The mortality from Phthisis, .93 per 1,000, is, with the exception of Hampstead (.91 per 1,000,) the lowest in London, 5 The density of a population has a great effect upon the Public Health. Lewisham maintains a high position in this respect, having 18.3 persons per acre of area, the lowest number in London except Woolwich, 11.2 persons per acre. With respect to the housing of the inhabitants, Lewisham is in a better position than any other London borough. The attack rates from all infectious diseases compare favourably with other districts. In regard to small-pox we were most fortunate. Eleven notifications were received, six of which proved to be genuine. On the 4th of November, I drew the attention of the Lewisham Board of Guardians to the necessity of obtaining the vaccination or re-vaccination of school children. The communication was considered by the Board who decided to take no action. I am pleased to state, however, the Guardians re-considered the matter. While this Report was in press, I was supplied by the courtesy of the Board and Mr. Atkins, with figures showing that 2,549 children have been examined at four Schools, 121 of which were vaccinated in consequence of such examination. I am also informed that the whole of the schools in the Borough will be visited. Other figures relating to vaccination are set out in the report. So far as the Staff are concerned, I reported upon the insufficient number of Sanitary Inspectors, and your Council authorised the appointment of two additional Officers. The Clerical Staff I fear will be inadequate to cope with the work of the office. I remain, Your obedient Servant, A. WELLESLEY HARRIS, Medical Officer of Health. July 1902. 6 contents. PAGE Age period in relation to Infectious Disease 52 & 54 Area of the Borough 11 Births 26 Birth Rates 27 Civil Parishes 11 Cowsheds 59 Deaths 27 Death Rate 29 Deaths, Age Distribution of 28 Deaths in Public Institutions 29 Deaths of Residents in other Districts 30 & 31 Disinfection 58 Domestic Service 17 Houses let in Lodgings 59 Infant Mortality 35 Infectious Diseases 47 to 53 Inhabited Houses 13 Inspection of Houses 58 PAGE Marriages 36 Persons per House 13 Phthisis, Deaths from 32, 33 & 34 Population, Age Distribution of 18 Population, Enumerated, Census, 1901 12 Population, Density of 16 Population, Estimated 26 Population, Occupations of 17 Register of Sanitary Work 62 School Closure 58 Seasonal Mortality 35 Slaughter-Houses 60 Tenements 14 Vaccination Returns 53 Water Certificates 61 Wells Closed 58 Workshops 60 Zymotic Deaths 35 7 synopsis of tables and charts. Table 1. Showing the Population, Decennial Increase, Inhabited Houses, Area, and Density of population of the Borough and its Divisions : Census 1901. Table 2. Showing the distribution of Houses, Population, etc., in separate Wards: Census 1901. Table 3. Showing total number of Tenements, and Tenements of less than Five Booms in the Borough, distinguishing those occupied by various numbers of persons. Table 4. Showing the disposal of Families or separate Occupiers in Tenements of over and under five rooms in the Metropolitan Boroughs. Table 5. Showing the estimated Populations, Areas, Densities and Death Rates of the Metropolitan Boroughs, 1901, arranged in order of density. Table 6. Showing number of persons living in the Borough at the Census, 1901, at seven age periods. Table 7. Showing Births and Birth Bates for each Division of the Borough, 1901. Table 8. Showing number of Deaths and Death Bates in each Division of the Borough, for the year 1901. Table 9. Showing number of Residents and Non-residents dying in Public Institutions situated in the Borough. Table 10. Showing Death Rates calculated per 1,000 persons living at all ages in the Administrative County of London, and Metropolitan Boroughs during the 52 weeks of 1901, after distribution of Deaths in Public Institutions. 8 Table 11. Showing Quarterly distribution of Deaths for the whole Borough and its Divisions. Table 12. Showing Meteorological Records at Greenwich, total Deaths, and Deaths from three groups of Diseases in the Borough of Lewisham for each week of the year 1901. Table 13. Showing causes of, and Ages at, Deaths during the year 1901. Table 14. Showing Deaths from the principal Zymotic Diseases for the Borough and its Divisions during the year 1901. Table 15. Showing Death Rates from the principal Zymotic Diseases for the Borough and its Divisions during the year 1901. Table 16. Age distribution of Deaths from Zymotic Diseases occurring in the Borough during the year 1901. Table 17. Showing cases of Infectious Disease notified during the year 1901 in the Borough and its divisions. Table 18. Number of Cases of Infectious Diseases notified in the several Boroughs and the Administrative County of London during the 52 weeks ended 28th December, 1901. Chart A. Shewing percentage Number of Persons in Seven Groups of Occupation to Total Population. Chart B. Density of Population. Showing number of persons per acre in each Metropolitan Borough. Chart C. Showing percentage of Deaths, in Thirteen Groups, to total registered Deaths, 1901. Chart D. Showing weekly total deaths from all causes, and from Respiratory Diseases and Diarrhoea. Chart B. Showing weekly Notifications of Infectious Disease, PART I. POPULATION AREA, DENSITY, AGE DISTRIBUTION, &C. CENSUS, 1901. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1901. AREA OF THE BOROUGH. The area of the Borough given by the Registar General in his Census Returns is 7014.4 acres, including 23.1 acres of water area. The distribution of area over districts is as follows:—Lee, 1616.3, Lewisham, 3680.3 and Sydenham and Forest Hill, 1717.8 acres Compared with other Metropolitan Boroughs, Lewisham is the third largest in extent, its area being exceeded by Wandsworth, 9,129 and Woolwich, 8,276 acres. The Borough of Lewisham, constituted in November 1900, under the London Local Government Act 1899, is made up of the civil parishes:—Lee and Lewisham ; containing the following Wards:— Lee:—Church, Manor and South Wards, Lewisham :—Blackheath, Lewisham Village, Lewisham Park, Brockley, Catford, Forest Hill and Sydenham Wards. It has been customary to divide the Borough into three divisions, viz:— No. 1. Lee Manor Ward Church „ South „ No. 2. Lewisham Blackheath Ward Lewisham Village Ward „ Park „ Brockley „ ,Catford Ward „ No. 3. Sydenham Ward Sydenham and Forest Hill Forest Hill Ward Each division has its own administrative Committee. 12 Prior to November, 1900, the Lewisham District included Penge. On the formation of the existing Borough, Penge, was excluded and the Civil Parish of Lee added. The boundaries of the Lewisham District were further changed by the removal or addition of small areas :— Camberwell transferred to Lewisham an area having a population in 1901 of 90 persons. Dulwich „ „ „ „ 784 „ Greenwich „ „ „ „ 883 „ Eltham „ „ „ „ 28 „ Charlton „ „ „ „ 3 „ Total 1784 Lewisham transferred to Woolwich an area having a population in 1901 of 15 persons. „ „ Greenwich do. 1116 „ „ „ Camberwell do. 1643 „ Total 2774 Owing to the alteration of the old boundaries and areas in the formation of the new Borough, and the absence of statistical records for the old districts it is impossible to obtain accurate figures for periods prior to the present year and for this reason many comparative figures are necessarily omitted. POPULATION. The enumerated population in 1891 for the area which now constitutes the Borough amounted to 88,933 against 127,495 in 1901, showing an increase in ten years of 38,562 persons. This is equal to an increase of 431 for every 1,000 persons recorded in the Census of 1891. 13 Dealing with the divisions of Lee, Lewisham and Sydenham and Forest Hill it will be found that the per centage increase, based upon the enumerated populations of each division in 1891 and 1901, amounted to an increase in Lee of 10.3 per cent, in Lewisham 87 88 per cent and in Sydenham and Forest Hill, 25.5 per cent. (Vide Table 1.) INHABITED HOUSES. The Census returns show that the Borough contained 22,750 dwelling houses in 1901, compared with 15,377 in 1891, an increase of 7,373 or 48.0 per cent, in the decennial period, compared with an increase of 43.1 per cent. in the population. It is fortunate that buildings were erected which provided accommodation slightly in excess of the increased population thus avoiding over-crowding. As one would expect, building operations were carried out most extensively in the Lewisham division, to which is allocated 68.8 per cent. of the total new houses erected in the Borough. Sydenham and Forest Hill follows with 24.8 per cent., and Lee 6.5 per cent. Only a little more than half of the available building land has yet been covered, and there is every reason to believe that extensive building operations will continue for some years, especially in the Lewisham division. PERSONS PER HOUSE. The 22,750 houses in the District contained 27,701 separate families or occupiers while the number of persons per house, amounted to 5.6 for the whole district, (Vide Table 2.) 14 TENEMENTS. No definition of the word is given, but it appears to mean the home of a separate family or separate occupier. The total number amounted to 27,701 of which 19,140 contained five rooms and over. The balance, 8,561, were tenements or houses of less than five rooms. The proportion of families or separate occupiers in homes containing less than five rooms to total families and the percentage of the population housed in one roomed homes forms a valuable index of the social condition, wealth or poverty of a community. The same factors are useful in judging under what conditions the working classes are housed and the need for improvement, if any, in a district. The Borough of Lewisham compared with other London Boroughs stands the highest in this respect. Out of every hundred families or separate occupiers only 30.9 occupy homes of less than five rooms, the lowest proportion of any London Borough. Hampstead 42.2, is next in order, Wandsworth, 42.3, Stoke Newington, 49.1, Kensington, 55.0, Greenwich 55.2 &c. (Vide Table 4.) Of the 8,561 homes or tenements of less than five rooms there were :— 970 homes of one room containing 1,488 persons, or 1.16 per cent. of population. 1,720 homes of two rooms containing 4,552 persons, or 3.59 per cent. of population. 2,490 homes of three rooms containing 8,550 persons, or 6.7 per cent. of population. 3,381 homes of four rooms containing 14,308 persons, or 11. 22 per cent. of population. 15 ONE ROOM TENEMENTS. As these form both living and sleeping rooms it is necessary that a minimum of 400 cubic feet per head should be insisted upon, also that adequate means of ventilation are provided. The air of such rooms is usually polluted, and where they are overcrowded the health of the occupants must suffer. Of the nine hundred and seventy one-roomed homes recorded:— 631 contained 1 person. 209 „ 2 persons. 94 „ 3 „ 26 „ 4 „ 8 „ 5 „ 1 „ 6 „ 1 „ 7 „ We have in Lewisham a less number of persons living in one-roomed homes than any other London borough. The total number of persons living in one-roomed homes amounted to 1,488, or 1.16 per cent. of the entire population. Wandsworth comes next in order with 1.38 per cent. ; Hampstead, 2.21; while Holborn is credited with the highest percentage 14.41 (Vide Tables 3 and 4). Of the total one-roomed tenements in the Borough of Lewisham 65 per cent. are occupied by one person only, 21.5 per cent. by two persons, 9.7 by three persons, 2.5 per cent. by four persons, and 0.82 by five persons. In one case six persons, and in another, seven persons were returned as occupiers of a single room. The occupation of single room tenements by one and two persons requires no special comment. There may, however, be overcrowding where three and generally where four or 16 more persons occupy a single room. In many instances such occupations consist of parents and their children. In only twenty-six instances were four persons found occupying one room. The foregoing facts point to an absence of any serious overcrowding in the district. TWO-ROOMED HOMES. These number 1,720, housing 4,582 persons, or 3.59 per cent. of the total population. Two-roomed homes are not so likely to become overcrowded as those previously described. One room is most frequently used as a sitting room and kitchen. Where they are occupied by families of four persons then the second room is most probably used as a bedroom. Five persons and over to two rooms generally implies overcrowding. Analyses of two, three and four-roomed homes are set out in Table 3. DENSITY. By this term is meant the average number of persons residing in the Borough to each acre of land. The health of a district is greatly influenced by the environments and the density of its inhabitants. Overcrowding on space, accompanied as it generally is by narrow streets, high buildings, insufficient light and air and ventilation, leads to high mortality among persons so situated. The borough is most fortunate in this respect compared with other London districts. It has a good elevation and is bounded for the most part by open country, while nearly half its area is unbuilt upon. These conditions have in themselves a considerable effect on the health of its residents. The density, 17 *18.3 persons per acre, with the exception of Woolwich, is the lowest in London. (Vide Table 5 and Chart B.) OCCUPATION AND EMPLOYMENT. The following is a list of the principal occupations :— Persons. Employment. 1,563 National or Local Government. 3,901 Professional, legal, clerical, medical, teaching, &c. 11,352 Domestic service. 7,880 Commercial occupations, including clerks. 3,768 Conveyance of goods, &c. 3,040 Engaged in building operations. 3,135 Retired, or living on own means. 20,008 Of no occupation, including students over ten years of age. DOMESTIC SERVICE. Eleven thousand three hundred and fifty two persons were employed in domestic service. Of this number 9,502 were indoor servants in houses, not hotels, lodging-houses or restaurants. The percentage of domestic indoor servants to families or separate occupiers residing in a district is a fair guide to the social position and wealth of its inhabitants. The percentage in the Borough equals 36.2. Of the 28 boroughs only seven can claim a higher percentage. (See Table 4.) * Calculated upon the estimated population. 18 AGE DISTRIBUTION. The number of persons living in the Borough at seven age periods is set out in Table 6. PUBLIC INSTITUTIONS. The following is a list of hospitals, infirmaries and other public institutions situated within the borough and receiving persons from outside districts :- Institution. Persons. Officials. St. John's Hospital 34 21 Lewisham Workhouse 473 22 Lewisham Infirmary 232 53 St. Olave's Workhouse 311 49 Park Fever Hospital 266 209 Flower House Asylum 21 8 East London Industrial School for Boys 150 11 Home for Sick Children, Sydenham 37 13 Home for Inebriates 20 3 Chart A Showing Percentage Number of Persons in Seven groups of Occupation to Total Population. 19 Table 1. Showing the Population, Decennial Increase, Inhabited Houses, Area, and Density of Population of the Borough and its Divisions. Census 1901. District. Census Population. Increase. Percentage Kate of Increase. Inhabited Houses. Persons per House. Area in Statute Acres. Density of Population. Persons per Acre. 1891. 1901. 1891. 1901. Lee 23,097 25,490 2,393 10.3 3,917 4,400 5.7 1616.3 15.7 Lewisham 31,063 58,352 27,289 87.88 5,467 10,541 5..5 3680.3 15.8 Sydenham and Forest Hill 34,773 43,653 8,880 25.5 5,993 7,809 5.57 1717.8 25.4 Whole Borough 88,933 127,495 38,562 43..1 15,377 22,750 5.6 7014.4 18.1 20 Table 2. Showing the distribution of Houses, Population, etc., in separate Wards: Census 1901. Ward. Inhabited Houses. Uninhabited Houses. Houses Building. Persons per House. Population. In Occupation. Not in Occupation. Total. Male. Female. Lee Dvison. Church 1,147 32 77 2 5.59 6,412 2,556 3,856 Manor 1,190 25 67 — 5.6 6,734 3,008 3,726 South 892 14 36 19 6.1 5,503 2,173 3,330 Lewisham Division. Blackheath. 1,146 24 41 2 5.8 6,729 2,814 3,915 Lewisham Vill. 2,549 61 71 128 5.4 13,842 6,449 7,393 Lewisham Park 1,777 19 83 42 6.2 11,145 5,129 6,016 Brockley 1,971 17 104 59 5.5 10,952 4,982 5,970 Catford 4,404 47 262 185 5.2 23,203 10,968 12,235 Sydenham and Forest Hill Division. Forest Hill 3,325 66 212 102 5.4 18,051 7,835 10,216 Sydenham 4,349 75 264 59 5.2 24,924 10,835 14,089 The Entire Borough 22,750 380 1,217 598 5.6 127,595 56,749 70,746 21 Table 3. Showing Total Number of Tenements and Tenements of less than Five Rooms in the Borough distinguishing those occupied by various number of persons. Total No. of Tenements—27,701. Tenements of less than Five Rooms—8,561. District. Tenements of less than Five Rooms. No. of Rooms in Tenement. PERSONS PEP TENEMENT. 1 person. 2 persons. 3 persons. 4 persons. 5 persons. 6 persons. 7 persons. 8 persons. 9 persons. 10 persons. 11 persons. 12 persons. Total persons. Percentage of population. The Borough of Lewisham. 970 1 631 209 94 26 8 1 1 - - - - - 1,488 1.16 1,720 2 340 587 392 283 92 52 11 9 2 1 1 - 4,582 3.59 2,490 8 153 665 692 428 248 172 75 37 16 3 - 1 8,550 6.7 8,881 4 91 613 747 590 510 365 240 120 65 21 13 6 14,308 11.22 22 Table 4. Showing the disposal of Families or separate Occupiers in Tenements of over and under five rooms in the Metropolitan Boroughs. Name oi District. Out of every 100 Total Families or separate Occupiers, the Number occupying Tenements of fewer than 5 rooms was Out of every 100 Total Families or separate Oceupiers, the following number occupied Tenements of Total number of persons living in One.roomed Tenements. Percentage of Population living in One. roomed Tenements Percentage of Domestic indoor Servants to Families or separate Occupiers 1 room 2 rooms 3 rooms 4 rooms City of London 61.95 15 20 17 10 1,421 5.27 37.6 Battersea 61.8 9 15 20 18 6,342 3.75 13.1 Bermondsey 75.8 15 24 20 17 8,706 6.65 6.6 Bethnal Green 84.1 19 26 24 15 12,755 9.83 5.8 Camberwell 56.0 9 14 17 16 8,856 3.41 15.3 Chelsea 69.1 21 21 17 10 6,609 8.95 55.2 Deptford 56.69 8 13 16 20 4,080 3.70 15.4 Finsbury 85.13 26 33 17 9 14,416 14.20 8.2 Fulham 67.4 8 14 25 21 4,426 3.22 18.6 Greenwich 55.2 7 13 15 20 2,392 2.49 24.5 Hackney 59.6 10 15 19 16 8,943 4.07 17.9 Hammersmith 60.0 10 17 19 14 4,942 4.40 19.3 Hampstead 42.2 6 14 14 8 1,819 2.21 81.4 Holborn 78.1 27 28 16 7 8,502 14.31 22.3 Islington 70.5 16 24 18 13 25,988 7.75 15.5 Kensington 55.01 15 20 12 8 11,334 6.41 80.0 Lambeth 62.7 14 17 17 15 18,932 6.26 18.1 Lewisham 30.9 6 9 12 1,488 1.16 36.2 Paddington 64.8 15 20 20 10 9,233 6.41 50.2 Poplar 73.2 11 18 23 21 8,274 4.90 8.1 St. Marylebone 72.5 26 26 13 8 16,408 12.31 51.4 St. Pancras 78.9 24 29 16 10 27,464 11.67 16.9 Shoreditch 84.8 25 28 19 13 15,053 12.68 5.7 Southwark 82.8 21 26 21 15 20,151 9.77 7.8 Stepney 80.4 22 26 20 13 34,519 11.56 8.8 Stoke Newington 49.1 8 13 16 12 1,456 2.84 27.8 Wandsworth 42.3 4 7 15 16 3,217 1.38 35.2 Westminster 64.5 18 23 15 8 14,008 7.65 65.8 Woolwich 57 7 14 17 19 3,092 2.63 14.4 23 Table 5. Showing the estimated Populations, Areas, Densities and Death. rates of the Metropolitan Boroughs, 1901, arranged in order of density. Boroughs. Population. Area. Acres. Density. Persons per acre. Death.rate ] from all Causes. Zymotic Death.rate. Woolwich 117,619 8,276 14.2 14.6 1.51 Lewisham 128,580 7.015 18.3 13.0 1 62 Greenwich 96,188 3,852 24.9 15.3 2.17 Wandsworth 233,943 9,129 25.6 18.4 1.55 Hampstead 82,287 2,265 36.3 10.6 1.02 City of London 26,627 671 39.7 20.1 1.06 Hammersmith 112,619 2,286 49.3 17.0 2.86 Camberwell 259,897 4,480 58.0 16.5 2.44 Stoke Newington 51,238 863 59.0 18.1 1.26 Hackney 219,780 3,288 66.8 15.7 2.14 Deptford 110,732 1,562 70.8 16'5 2.48 Poplar 168,887 2,327 72.6 20.0 8.04 City of Westminister 182,502 2,502 72.9 16.0 1.34 Lambeth 302,460 4,080 74.1 17.8 2.15 Kensington 176,787 2,291 77.1 15.2 1.83 Battersea 169,364 2,160 78.4 16.4 2.76 Fulham 138,426 1,703 81.2 15.8 2.81 Bermondsey 130,348 1,500 86.9 20.9 2.90 St. Pancras 235,297 2,694 87.3 18.2 2.40 St. Marylebone 133,060 1,742 90.4 16.6 1.65 Paddington 144,154 1,356 106.4 14.8 1.72 Islington 335,325 3,092 108.4 15.9 1.87 Chelsea 73,879 660 111.9 16.6 1.31 Holborn 59,205 405 146.1 20.1 2.28 Stepney 298,884 1,765 169.3 20.9 2.54 Bethnal Green 129,700 750 171.8 20.8 2.88 Finsbury 101,623 589 172.2 21.4 2.75 Shoreditch 118,554 658 180.1 21.8 2.98 Southwark 206,219 1,131 182.3 21.5 3.02 County of London 4,544,983 74,839 60.7 17.1 2.22 24 Table 6. Showing number of Persons living in the Borough at the Census, 1901 at seven age periods. Age. Males. Females. Total. Kate per 1,000 of Population. Years. 0 to 5 6,768 6,737 13,505 105.9 5 to 15 12,125 12,049 24,174 189.6 15 to 20 5,395 7,318 12,713 99.7 20 to 35 14,821 21,200 36,021 282.5 35 to 55 12,245 15,536 27,781 217.8 55 to 75 4,775 6,725 11,500 90.19 75 to 95 620 1,181 1,801 14.1 Chart B Density of Population. Showing number of persons per acre in each Metropolitan Borough. PART II. VITAL STATISTICS & INFECTIOUS DISEASES 26 VITAL STATISTICS. It is important, when comparing the vital statistics between one or more divisions of a district, or between various boroughs, that due consideration should be given to the varying conditions under which the residents of such divisions or districts live. Density of population, emigration and immigration, social position, wealth or poverty, age and sex distribution, employment or occupation, the existence of hospitals, infirmaries, asylums, &c., receiving patients from outside districts, play an important part in the comparison. The absence of such information may seriously affect the accuracy of statistical returns. In this Borough the decennial increase in population by immigration was more than 2.5 times the natural increase which accrued by the excess of births over deaths. *In the registration district of Lewisham the increase in population during the intercensal period, 1891-1901, was 41,299, of which number only 11,655 was due to the natural increase of births over deaths. ESTIMATED POPULATION. The census returns were obtained on April 1st, 1901, shewing an enumerated population of 127,495 persons. All vital statistics should be calculated upon the population of a district estimated to be living at the middle of each year. The estimated number of persons living at all ages within the borough at the middle of the year 1901 amounted to 128,480, which figure will form the basis of future calculations. BIRTHS. The total number of births registered in the borough during the year amounted to 3,320, of which 1,692 were males and 1,628 females. * The Registration District of Lewisham is not co-terminous with (he Borough. This does not, however, seriously alter the vaule of the comparison. 27 Table 7. Showing Births and Birth Rates for each Division of the Borough, 1901. Districts. Total. Males. Females. Birth Rate per 1,000 persons. Lee 398 186 212 15.5 Lewisham 1,882 964 918 31.9 Sydenham and Forest Hill 1,040 542 498 23.6 Whole Borough 3,320 1,692 1,628 259 The Birth Rate of 25.9 per thousand of the population for the whole district is below the averages:—29.0 for the whole of London, 29.5 for the 83 great towns and 29.8 for the 67 other large towns. In the Lewisham division the birth rate was higher than the average for the whole borough, due to a difference in the age of its population compared with Lee and Sydenham. MORTALITY. The number of deaths registered within the borough amounted to 1,875. After deducting the deaths of non-residents (289) dying in public institutions situated within the borough, and adding those of residents (82) who died outside the district, a corrected total of 1,668 is obtained, equivalent to an annual death rate of 13 per thousand persons living at all ages, the lowest in London except Hampstead, 10.6 (Vide Tables 5 and 10), and below that for— The County of London 17.1 England and Wales 16.9 33 Great Towns 18.6 28 Age Distribution. Of the total 1,668 deaths:— 426 or 25.5 per cent. occurred in persons under 1 year. 157 or 9.4 „ „ ,, between 1 and 5 years. 68 or 3.7 „ „ „ „ 5 „ 15 „ 77 or 4.6 „ „ „ „ 15 „ 25 „ 512 or 80.7 „ „ 25 „ 65 „ 488 or 25.9 „ „ „ „ 65 and upwards. Table 8. Showing number of Deaths and Death Rates in each Division of the Borough, for the year 1901. Division. Deaths. Death-rate per 1,000 of the population in the Division. Birth-rate per 1,000 of the population in the Division. Lee 255 10.0 15.5 Lewisham 856 14.5 81.9 Sydenham and Forest Hill 557 12.6 23.6 In considering the above table, allowance must be made for the age and sex distribution. The fact that Lewisham shows a birth-rate of double that of Lee will in itself account 29 for an increased death-rate, owing to the higher mortality general among children under one year of age. The same argument will apply, in a lesser degree, to the Sydenham and Forest Hill Division. Table 9. Showing number of Residents and Non-Residents dying in Public Institutions situated in the Borough. Public Institution. Deaths of Residents. Deaths of Non-Residents. Total The Park Hospital 25 224 249 Lewisham Infirmary 294 21 315 St. Olave's Workhouse — 28 28 St. John's Hospital 5 16 21 Totals 324 289 613 30 DEATHS of Residents belonging to the Borough occurring in Public Institutions &c., in districts outside during the year 1901. Name of Institution &c. Sex. Age. Cause of Death. Banstead Asylum male 40 years Phthisis „ female 70 „ Senile Decay Bethlem Hospital male 40 ,, Brain Disease Brook Fever Hospital male 4 „ Diphtheria „ male 2 „ Scarlet Fever „ female 4 „ Diphtheria „ male 31 „ Enteric Fever „ female 2 „ Scarlet Fever „ male 18 „ Enteric Fever „ female 2 „ Diphtheria „ female 1 „ Diphtheria „ female 2 „ Scarlet Fever „ male 9 „ Diphtheria „ male 19 „ Scarlet Fever Brompton Hospital male 23 „ Phthisis „ female 35 „ Phthisis Camberwell House Asylum male 32 „ Phthisis Cane Hill Asylum female 41 „ Phthisis „ male 36 „ Paralysis „ female 37 „ Phthisis „ male 31 „ Paralysis Caterham Asylum female 54 „ Epilepsy „ female 24 „ Phthisis „ male 60 „ Cancer Children's Hospital, Great Ormond street male 4 „ Tuberculosis City of London Asylums, Stone female 65 ,, Senile Decay Claybury Asylum male 39 „ Paralysis „ female 43 „ Brain Disease „ male 66 „ Chronic Colitis Darenth Asylum male 14 ,, Meningitis Evelina Hospital male 1„ Bronchitis „ female 14 „ Tuberculosis „ male 10 months Diarrhoea Friedenheim female 84 years Cancer German Hospital male 50 „ Diabetes Great Northern Central Hospital male 34 „ Nervous Exhaustion Guy's Hospital male 18 „ Septicaemia „ male 25 „ Cerebral Tumour 31 Guy's Hospital female 46 „ Blood Poisoning „ female 21 days Premature Birth „ male 52 years Cerebral Haemorrhage „ male 4 „ Meningitis „ male 48 „ Accident „ male 42 „ Cancer „ female 1 „ Intersussception „ male 1 „ Tuberculosis „ female 35 „ Tumour „ female 18 „ Kidney Disease „ female 66 „ Cancer „ female 3 „ Meningitis „ male 64 „ Accident „ male 68 „ Bronchitis Kings College Hospital male 38 „ Dissiminated Sclerosis „ male 38 „ Kidney Disease „ male 54 „ Phthisis „ male 31 „ Heart Disease Leavesden Asylum male 70 „ Pneumonia London County Asylum, Dartford female 32 „ Brain Disease „ female 25 „ Heart Disease „ male 46 „ Paralysis „ male 37 „ Paralysis „ female 70 „ Ulcerative Colitis „ male 41 „ Paralysis „ female 44 „ Ulcerated Colitis „ female 32 „ Phthisis London Hospital male 28 „ Accident Manor Asylum, Epsom female 39 „ Epilepsy Royal Hospital, Waterloo road male 1 „ Pneumonia St. Bartholomew's Hospital male 77 „ Cancer „ female 46 „ Cancer „ female 57 „ Septicæmia „ male 46 „ Aneurism of Aorta „ female 45 „ Phthisis St. George's Hospital female 46 „ Alcholism St. Mary's Hospital male 39 „ Accident „ male 2 months Diarrhoea St. Thomas' Hospital male 74 „ Cancer „ male 9 ,5 Accident „ male 17 „ Enteric „ male 62 „ Cancer Westminster Hospital male 65 ,, Cirrhosis of Liver Woolwich Infirmary male 27 „ Influenza 32 Relation of Environment and Occupation to Phthisis Mortality. LEWISHAM. 19 Ringstead road F No occupation 9 Algernon road M Commercial clerk 108 Howson road F No occupation 28 Lady well park F Ditto 80 Ardmere road M Journalist 75 Engleheart road M General labourer 5 Nelgarde road F No occupation 1 Lower Winchester road M Driver (Royal Horse Artillery) 11 Thurston road F No occupation 820 Brockley road F Ditto 80 Faversham road F Ditto 27 Lower Winchester road M Clerk 40 Medusa road M Scholar 60 Glenfarg road F No occupation 68 Wisteria road F Ditto 87 Sandhurst road F Ditto 8 Hazeldon road M Editor (Newspaper) 40 Honley road F No occupation 138 Laleham road M Joiner (Journeyman) 119 Ennersdale road F Domestic servant 19 Brownhill road F No occupation 150 Ardgowan road M Ditto 66 Minard road F At home 41 Courthill road M Clerk 65 Killearn road F No occupation 62 Laleham road F Ditto 52 Arngask road M Plasterer 85 Engleheart road F Domestic servant Infirmary, Lewisham M Carpenter Infirmary, Lewisham M Labourer 17 Jutland road M No occupation Infirmary, Lewisham F Domestic servant 1 Eegent street M Railway porter 2 Avenue cottages M Cab driver 83 Brockley grove M Ironmongers' assistant 48 Doggett road M Hose pipe maker 1 Eegent street M Labourer 43 Beacon road F Teacher 38 52 Silvermere road M Clerk 16 Essex place F Scholar 18a Lethbridge road M Baker Grotes place M No occupation 80 Mount Pleasant road M Baker 30 Holbeach road F No occupation 26 Glenfarg road F Scholar 64 Laleham road M „ 68 Bradgate road F No occupation 25 Montague avenue F „ 58 Catford hill M Soldier 15 Dermody road F No occupation Lewisham Infirmary M Labourer Lewisham Infirmary F Domestic servant 71 Granville park M No occupation 57 Howson road F Teacher Lewisham Infirmary F No occupation 22 High street F Servant 59 Knowles hill crescent F No occupation 17 Doggett road F „ 120 Ennersdale road F „ SYDENHAM. 29 Madden road M Scholar 46 Russell street M Labourer 2 Rojack road M Farmer 55 Brockley rise F No occupation 21 Dallas road M Scholar 7 Shaws cottages F No occupation 2a Highfield terrace, Como road M Hosiers' assistant 178 Sydenham road M Public-house manager 62 Miall road M Gas stoker 11 Kinver road F Scholar 2 Church view, Como road M Bricklayer 4 Montem road F Widow 35 Ewart road M Bootmaker Recreation road M Scholar 8 Holmshaw road M Labourer 11 Hanover street F No occupation 75 Silverdale road M Telegraphist Station house, Lwr. Sydenham F Drapers' assistant 17 Bradford road F No occupation 45 Honor Oak park M Hosiers' assistant 34 51 Miall road F No occupation 29 Siddons road F Ditto 104 Sydenham road M Printers' assistant Taylors lane M Decorator 54 Kent house road M Farmer 7 Perry vale F No occupation 131 Devonshire road M Draper 47 Dillwyn road F No occupation 15 Elderton road M Soldier 57a Dartmouth road F No occupation 33 Hanover street M Hotel porter 205 Sydenham road M Greengrocers' assistant 10 Relinque road M Labourer 27 Prospect road M Labourer 6 Dartmouth road F No occupation Willow walk M Blacksmith 22 Russell street M Labourer Fairlawn park M Labourer 93 Dalmain road M Barman 37 Larkbere road F No occupation 253 Sydenham road M Grocer 70 Porthcawe road M Carman 2 Relinque road M Labourer 17 Dallas road F No occupation 59 Wells road M Carpenter LEE. 6 Aislibie road M Omnibus conducter 12 Taunton road M Scholar 89 Burnt Ash road F No occupation 76 Burnt Ash road F Independent means 49 Effingham road F No occupation 6a Lansdown road F Teacher 26 Granville road M Dentists' assistant 17 Osberton road F No occupation 7 Corona road F Independent means 18 Belmont hill F No occupation 279 High road M Coachman 10 Eton grove M Commercial clerk Church street M Laundryman 20 Victoria houses F Scholar Belmont hill M Gardener 9 Church street M Scholar 85 SEASONAL MORTALITY. The greatest number of deaths occurred in January August and December. The least number in February, May and October. Chart D shows the January and December rise was due to the increased mortality from Respiratory Diseases (Pneumonia, Bronchitis and Pleurisy). The sudden increase in August was mainly due to the advent of Infantile Diarrhoea and Enteritis prevalent during August and September. (Vide Chart D). INFANT MORTALITY. The infantile mortality rate represents the proportion of deaths occurring among children under one year to the total number of births registered in the same period. The number of infantile deaths was 426 or 25.5 per cent. of the total deaths, equivalent to a mortality of 128 for every thousand births. This rate compares favourably with that of 168 for 33 great Towns and 148 for the County of London. Only four other London Boroughs have a lower rate —Hampstead, 104; St. Marylebone, 107; Stoke Newington, 115; and Holborn, 124. (Vide Table 10). ZYMOTIC DEATH-RATE. The rate is calculated upon the total number of deaths occurring from the seven principal infectious diseases, viz.:— Small - pox, Scarlet Fever, Measles, Diphtheria, Whooping Cough, Typhus and Enteric Fevers, and Diarrhoea. This group of diseases was responsible for 209 deaths, or a Zymotic death-rate of 1.62 per 1,000, compared with 2.05 for England and Wales and 2.68 for the 33 great Towns. It also compares most favourably with other Metropolitan 36 Boroughs. (Vide Table 5). Deaths and death·rates relating to infectious diseases are set out in Tables 13, 14, 15 and 16, and the influence of season upon the occurrence of Infantile or Zymotic Diarrhoea is demonstrated on Chart D. PHTHISIS. One hundred and twenty deaths were recorded, equivalent to a mortality of .93 per 1,000, the second lowest in London ; Hampstead being .91, and the County of London 16 per 1,000. This low rate is highly satisfactory. (Vide Table 10). RESPIRATORY DISEASES. Under this heading are included Bronchitis, Pneumonia, Pleurisy and other diseases of the respiratory organs, excluding Phthisis. The total number of deaths amounted to 260, or a death·rate of 2.0 per thousand. CANCER. Under this heading 123 deaths were registered, representing a death·rate of .93 per thousand of the population. ALCOHOLISM AND CIRRHOSIS OF THE LIVER. Only 44 deaths were recorded. SUICIDES AND ACCIDENTS. Forty·two deaths were registered, of which only two were suicides. (Vide Table 13.) MARRIAGES. The persons married during the year numbered 670, equal to a marriage rate of 5'2 per thousand of the population, Compared with 17'6 for the county of London (1900), Table 10. Showing Death Rates calculated per 1,000 persons living at all ages in the administrative County of London, and Metropolitan Boroughs during the 52 weeks of 1901, after distribution of Deaths in Public Institutions. Boroughs. All Causes. Principal Epidemic Diseases. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Typhus. Enteric. Simple Continued Fever. Diarrhoea. Phthisis. Deaths under 1 year to 1000 Births Registered County of London 17·1 2·22 0·05 0·43 0·18 0·29 0·85 o·oo o·ii 0·00 0·86 1·66 148 Paddington 14·3 173 — 0·06 0·08 0·82 0·36 — o·io — 0·81 1·10 136 Kensington 15·2 1·83 0.01 0·43 0·09 0·22 0·35 o·oi 0·06 — 066 1·37 163 Hammersmith 17·0 2·86 0·18 0·42 0·12 0·32 0·71 — 0·14 — 1·02 1·42 168 Fulham 15·8 2·81 0·02 0·28 0·14 0·35 0·56 — 0·14 o·oi 1·81 1·37 152 Chelsea 16·6 1·31 0.01 0·12 0·07 0·12 0·39 — 0·08 — 0·52 1·68 138 City of Westminster 16·0 1·84 0·09 0·32 006 0·12 0·26 — 0.11 — 0·38 1·89 185 St. Marylebone 16·6 1·65 0·05 0·07 0·14 0·25 0·80 — 0·06 — 0·78 1·89 107 Hampstead 10·6 1·02 0·02 0.01 0.05 0·24 0·29 — 0·09 — 0·32 0·91 104 St. Pancras 18·3 2·89 0·17 0·29 0·14 0·46 0·37 — 0·13 — 0·83 1·87 154 37 Islington 16·0 1·97 0·02 0·47 0·09 0·39 0·27 — 0·14 — 0·59 1·51 140 Stoke Newington 18·2 1·28 0·06 0.16 0·08 0·27 0·12 — 0.10 — 0·49 1·35 115 Hackney 15·8 2·15 0·02 0·43 0·12 0·44 0·23 — 0·09 — 0·82 1·53 185 Holborn 20·1 2·28 0·51 0·39 0·05 0·25 0·17 — 0·20 — 0·71 2·81 124 Finsbury 21·4 2·78 0·07 0·48 0·18 0·86 0·38 — 0.11 — 1·20 2·19 142 City of London 20·1 1·06 0·08 0·04 0·15 0·80 0·08 — 0.11 — 0·30 2·29 175 Shoreditch 21·9 2·99 0·04 0·63 0·17 0·25 0·51 — 0·08 — 1·81 2·23 197 Bethnal Green 20·3 2·88 0·02 0·68 0·34 0·49 0·29 — 0·15 1.01 0·90 2·16 153 Stepney 20·9 2·54 0·07 0·60 0·14 0·25 0·83 — 0·15 — 1·00 2·09 163 Poplar 20·0 3·04 0·06 0·53 0·08 0·49 0·47 — 0·15 — 1·26 1·79 165 Southwark 21·5 8·02 0·07 0·78 0·26 0·26 0·48 — 0·09 — 1·08 2·51 168 Bermondsey 20·9 2·90 0.11 0·62 0·34 0·28 0·44 — 0·17 — 0·94 1·79 169 Lambeth 17·2 2·15 0.01 0·40 0·13 0·17 0·38 — 0·08 0.01 0·97 1·65 139 Battersea 16·4 2·76 0.01 0·78 0·06 0·12 0·48 — 0.11 — 1·20 1·46 163 Wandsworth 184 1·55 0.01 0·28 0·07 0·18 0·27 — 0·07 — 0·67 1·14 132 Camberwell 16·5 2·44 0·03 0·59 0·18 0·43 0·82 — 0·10 — 0·79 1·48 142 Deptford 16·5 2·48 0.01 0·48 0'15 0·34 0·45 0·02 0·09 — 0·94 1·19 146 Greenwich 15·2 2·17 0·03 0·57 0·05 0·23 0·41 — 0·10 — 0·78 1·16 130 Lewisham 13·0 1·62 — 0'22 009 0·18 0·21 — 0·10 — 080 093 128 Woolwich 14·6 1·51 o·oi 0·18 0·04 0·17 0·17 — o·io — 0·84 1·76 129 38 Chart C Showing Percentage of Deaths, in Thirteen Groupa, to total registered Deaths, 1901. Chart d. Showing lYeel^Ly TotxJ. Deaths from aU Causes ·from Respira tory Diseases and front Diarrhoea· arid Enteritis for the 52 Weeks ending December 28^1901 . Table 11. Showing Quarterly distribution of Death for tin· whole Borough and its Divisions. Whole Borough. Lee. Lewisham. Sydenham and Forest Hill. Infantile Mortality. Quarter. Deaths. Death Rate. Deaths. Death Rate: Deaths. Death Rate. Deaths. Death Rate. Deaths under one year of age. Death Rate per 1,000 Births. First 443 13·8 77 12·0 226 15·3 140 12·7 108 130 Second 363 11·2 44 7 191 12·9 128 11·6 68 82 Third 429 13·3 57 8·9 233 15·5 139 126 166 200 Fourth 438 13·3 77 12·0 206 13·6 150 13·6 84 101 For the Year 1,668 13 255 10·0 856 14·5 557 12 6 426 128 OD CD Notk.— See Table 8. \ Table 12. i Showing Meteorological Records at Greenwich, Total Deaths, and Deaths from three (/roups of ' Diseases in the Borough of Lewisham for each week of the year, 1901. No. of W eek. "Week ended. Total Deaths. Deaths from Mean Temper· ture of the Air. Mean of the Mean Temperature 3 feet below Earth. Fall of Rain in inches. Sun above Horizon in hours. Registered Sunshine in hours. Respiratory Diseases. Notifiable Zymotic Diseases. Diarrhoea and Enteritis. Highest Readings of the Thermometer. Lowest Readings of the Thermometer. l Jan. 5 27 10 l _ O 37·8 O 41·7 O 33·1 46·20 0·56 55·1 1·7 2 99 12 38 12 — l 34·6 39·0 29·3 43·56 0·23 56·5 8·7 3 99 19 35 13 — l 40·2 45·3 34·1 42·97 0·22 58·3 13·3 4 99 26 46 10 2 — 44·2 49·0 39·3 43·91 0·18 60·3 12·6 5 Feb. 2 38 5 5 l 36·9 41·5 31·8 43·44 0.10 62·9 6·9 6 99 9 33 8 2 2 34·3 38·2 29·6 41·36 0·47 65'6 2·2 7 99 16 20 3 — 1 32·6 37·5 26·7 40·50 0·03 68·6 11·9 8 99 23 41 11 1 1 35·1 39·1 31·7 39·26 0·15 71·6 6·6 9 March 2 39 11 1 1 43·9 49·1 38·7 40·39 0·57 74·8 15·7 10 99 9 41 12 — 3 42·0 48·0 37·1 41·96 0·76 77·9 11·4 11 99 16 31 5 — 3 39·0 44·6 33·7 41·91 0·09 81·3 5·4 12 99 23 31 7 1 1 38·3 43·1 34·2 41·78 0·31 84·6 13·2 13 99 30 26 4 1 1 34·2 41·1 28·4 40·53 0·44 87·7 21·2 14 April 6 34 10 3 — 44·4 53·2 36·1 41·23 0·97 91·0 27·4 15 99 13 31 5 2 — 46·2 54·1 41·0 43·57 0·71 94·0 29·0 16 99 20 24 4 — — 47·3 56·7 38·2 44·02 0·33 97·3 48·6 17 99 27 27 5 1 — 54·7 66·2 43·3 46·63 0·02 100·1 77·2 18 May 4 33 8 — 1 49·3 61·0 39·0 47·99 0.00 103·3 45·6 19 >» 11 38 6 2 — 47·1 55·3 41·2 48·75 1·56 10·59 17·3 20 99 18 26 4 — — 51·7 62·9 41·4 49·32 0.00 10·87 69·7 40 21 25 32 2 56·3 66·8 44·8 51·26 0.00 110·8 80·9 22 June 1 18 3 2 — 60·0 71·6 49·0 54·06 0·27 112·8 51·2 28 8 27 2 1 — 58·8 69·9 48·6 56·64 0·03 114·5 52·3 24 15 28 2 1 — 56·8 67·6 47·0 57·79 0.10 115·4 63·7 25 22 26 1 — 1 58·0 67·8 50·1 57·30 0·43 116·0 36·4 26 29 23 1 1 — 61·0 71·8 50·9 58·84 0.00 115·9 69·5 27 July 6 24 4 1 — 64·1 73·9 56·1 60·30 1·05 115·2 46·1 28 13 30 1 — 2 64·5 77·2 52·2 61·87 0.00 114·1 60·2 29 20 26 — 1 2 68·4 81·6 54·4 63·45 0.00 112·5 75·5 80 27 26 2 — 3 61·6 71·7 54·5 64·40 1·3 110·4 18·4 31 Augus· t 3 32 1 — 6 65·1 75·8 54·9 63·29 0·38 108·0 49·2 32 10 34 1 — 9 64·6 76·8 55·3 63·42 0·08 105·5 49·0 83 17 34 5 — 12 61·0 72·2 52·1 63·54 0·5 102·6 49·3 34 24 36 2 1 13 63·9 76·6 50·5 63·28 0.00 99·7 77·4 35 31 51 1 — 19 58·6 68·5 51·5 62·44 1·36 96·7 39·2 36 Sept. 7 48 1 2 17 56·4 65·1 47·8 60·99 0.00 93·6 52·3 37 14 30 3 1 8 59·4 68·2 53·5 60·44 0·25 90·5 17·0 38 21 32 1 2 6 56·8 65'6 48·9 59·87 1·10 87·3 19·8 39 28 32 1 1 6 58·7 68·3 50·5 59·53 0.00 84·1 21·3 40 Oct. 5 22 3 2 2 57·8 67·0 49·3 59·21 1·24 81·0 27·8 41 12 33 3 5 2 50·7 57·9 43·6 57·12 0·19 77·6 20·3 42 19 26 1 — — 51·5 59·0 43·9 55·63 1·10 74·5 26·0 43 26 27 — 1 1 44·6 53·6 36·4 54·00 0·03 71·3 12·8 44 Nov. 2 20 8 — — 49·0 55·3 42·6 52·34 0·02 68·4 38·4 45 9 31 7 1 — 39·5 46·4 33·8 50·27 0.00 65·3 7·3 46 16 33 6 3 1 41·6 45·9 37·6 49·54 0·39 62·7 5·4 47 23 38 8 1 1 48·7 48·5 37·7 47·49 0·24 60·4 10·3 48 30 42 8 2 1 39·2 44·3 33·7 46·60 0·03 58·1 9·6 49 Dec. 7 48 12 1 — 44·4 48·4 38·6 45·89 0·03 56·4 6·8 50 14 38 10 1 2 41·5 45·1 37·0 45·89 1·37 55·1 6·0 51 21 33 6 1 — 33·4 38·2 28·5 42·08 0·07 54·6 15·6 52 28 43 7 — — 36·3 41·2 30·2 43·91 1·00 54·6 6·1 41 Table 13. Showing causes of, and Ages at, Death during the Year 1901. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all Ages.) Total Deaths in Public Institutions in the District. Total All ages. Under 1 year. 1 and under 5. 5 and under )5. 15 and under 25. 25 and under 65. 65 and upwards. Blackheath and Lewisham. Sydenham and Forest Hill. Lee. Small-pox Measles 29 8 17 4 14 13 2 6 Scarlet fever 12 — 6 4 l l 4 6 2 97 Whooping-cough 28 10 14 3 l 11 14 3 – Diphtheria and membraneous croup 23 1 16 5 l 12 4 7 115 Croup — — — — Fever Typhus Enteric 14 — 1 — 5 8 9 5 27 Other continued Epidemic influenza 17 5 — 1 1 3 7 3 12 2 1 Cholera — — — Plague — — — — – – – Diarrhoea 103 95 8 64 32 7 11 Enteritis 28 17 5 – – 4 2 15 10 3 7 Puerperal fever — – – – – – – 42 Erysipelas 5 2 — — — 1 2 5 — — — Other septic diseases 7 — — — — 1 5 1 3 3 3 Phthisis 120 2 5 1 23 78 11 55 49 16 36 Other tubercular diseases 49 17 12 9 2 7 2 22 18 1 9 6 Cancer, malignant di sease 123 2 1 2 63 55 49 48 27 24 Bronchitis 124 21 11 4 — 27 61 64 45 15 26 Pneumonia 119 30 26 5 37 18 63 49 17 18 Pleurisy 3 — — — — 2 1 2 — 1 1 Other diseases of Respiratory organs 14 3 — — 1 6 4 7 4 8 5 Alcoholism Cirrhosis of liver 44 — — — — 36 8 26 14 4 7 Venereal diseases 1 1 — — 1 — — Premature birth 54 54 — — — — — 32 17 5 2 Diseases and accidents of parturition 13 7 — — 1 5 _ 8 2 3 2 Heart diseases 139 5 3 8 9 56 58 74 41 24 45 Accidents 40 9 2 2 — 17 10 23 11 6 18 Suicides 2 — — 1 1 1 1 — — \11 other causes Apoplexy 75 1 — 2 22 50 34 29 12 20 Brain diseases 41 2 5 1 1 23 9 19 6 6 10 Kidney diseases 45 — — 1 1 26 17 21 18 6 12 All other causes 396 136 24 16 18 82 19 214 110 72 113 Total all causes 1668 426 157 65 75 512 433 866 557 255 613 43 Table 14. Showing Deaths from the principal Zymotic Diseases for the Borough and its Divisions during the year 1901. Division of the Borough. Small·pox. Measles Scarlet Fever. Whooping Cough. Diphtheria. Typhoid Fever. Diarrhoeal Diseases. Total. Lee 2 2 3 7 — 7 21 Lewisham 14 4 11 12 9 64 114 Sydenham and Forest Hill 13 6 14 4 5 32 74 The whole Borough — 29 12 28 23 14 103 209 44 *Table 15. Showing fDeath-rates from the principal Zymotic Diseases for the Borough and its Divisions during the year 1901. Division. Small-pox. Measles. Scarlet Fever. "Whooping Cough. Diphtheria Typhoid Fever. Diarrhooal Diseases. Total Zymotic Death-rate. Lee — ·07 ·07 ·11 ·27 — ·27 ·82 Lewisham — ·23 ·06 ·18 ·20 ·15 1·08 1·91 Sydenham and Forest Hill — ·29 ·13 ·31 ·09 ·11 ·72 1·67 The Whole Borough — ·22 ·09 ·21 ·18 ·10 ·80 1·62 45 * Comparative Rates for other Boroughs will be found in Table 10. † The Death ·rates are per 1000 persons in each Division and in the whole Borough. 46 Table 16. Age distribution of Deaths from Zymotic Diseases occurring in the Borough during the year 1901. Disease. Ages at Death. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. d upwards. Measles 29 8 17 4 —' — Scarlet Fever 12 — 6 4 l l Whooping Cough 28 10 14 3 l — Diphtheria 23 1 16 5 — l Typhoid Fever 14 — 1 — 5 8 Diarrhoeal Diseases 103 95 8 — — – Total for the Borough 209 114 62 16 7 10 47 ATTACK RATES FROM THE PRINCIPAL INFECTIOUS DISEASES PER 1,000 OF THE POPULATION FOR EACH BOROUGH IN LONDON. Paddington 7·72 Kensington 5·8 Hammersmith 7·23 Fulham 11·07 Chelsea 5·33 Westminster 3·82 Holborn 13·3 Finsbury 10·87 City 8·30 St. Marylebone 7·5 Hampstead 5·87 St. Pancras 11·23 Islington 8·50 Stoke Newington 7·9 Hackney ll·32 Shoreditch 9 ·74 Bethnal Green 12·85 Stepney 9·5 Poplar 9·56 South war k 11·3 Bermondsey 12·9 Lambeth 6·67 Battersea 6·77 Wandsworth 6·57 Camberwell 10·7 Deptford 10·55 Greenwich 8·34 Lewisham 7·1 Woolwich 5·94 SMALL POX. During the year, 1,700 cases of Small Pox occurred within the administrative County of London. The first case occurred in January. The person was attacked shortly after arrival from Paris, where the disease was prevalent. In February a sailor was attacked shortly after his arrival home. In May, a lady on her return home from Egypt was notified in Highbury. In June a case was notified in Bethnal Green, and one in Marylebone; the latter, a recent arrival from Paris. In the same month cases occurred in Wandsworth, two of which were due to laundry infection. During the week ending August 24th there were 16 cases. From this date the disease spread, chiefly in the Boroughs north of the Thames. The Borough of Lewisham enjoyed complete immunity until the 29th September, when the first case occurred. From 48 this date until the end of the year eleven cases were notified, only six of which were genuine. Case 1. September the 29th.—H. C., aged 15, of 51 Brownhill Road. In this case the Medical Attendant was good enough to seek my assistance. I was able to confirm his suspicions and the patient was removed. The origin of infection was due to contact with gipsies in Kent. All necessary precautions were taken and no further cases occurred from this source. Case 2. J. G., male, aged 22, of 62 Devonshire Road, Forest Hill, notified on the 14th of October. The patient had only been a resident in the district for three days, coming from Camberwell. A fortnight before his illness he visited his brother (who was dying) at the Small·Pox Hospitals. Case 3. December the 12th.—P. B. S., of 120 Sydenham Road, aged 5. I was invited by the Medical Attendant to see this child, who was suffering from severe Confluent Smallpox. The patient had previously lived in Australia. Neither the patient or his brother had ever been vaccinated. The patient was removed and all contacts immediately vaccinated. The family were kept under daily observation by your Medical Officer. Case 4. On the 17th of December I found C. B., aged 3 (a brother), suffering from modified Small·pox. The patient was removed in the early stage. The origin of the former case could not be ascertained. Case 5. December the 23rd.—Ch. J. C., aged 28, stoker employed in Gas Works. Origin untraceable. Case 6. December the 25th.—E. W., female, aged 28, of 122 Sydenham Road. Source of infection, case at 120. I saw this case with the Medical Attendant. The case was quickly removed and contacts kept under observation. 49 GENERAL PRECAUTIONS. The general precautions taken to prevent the spread of Small·Pox were as follows :— (a) Circulars were distributed in the district calling attention of the public to the necessity of vaccination or re–vaccination. (b) The names and addresses of Public Vaccinators appointed for each district were appended. (c) A special circular letter was sent to all tradesmen advising the vaccination or re·vaccination of their staff. (d) Personal visits were made to large drapery establishments and arrangements made for the visit of the Public Vaccinator. (e) The whole staff of the Health Department was available at any hour, including Sundays, which arrangement permitted the immediate removal of cases and the subsequent disinfection of infected premises. (f) The ceilings, walls, floors, skirtings and furniture of all infected premises were sprayed with a solution of Formalin (1 in 80) by the aid of specially constructed force pumps. The walls were subsequently stripped. (g) All articles of clothing, bedding and all textile fabrics such as curtains, carpets, etc., likely to retain infection were removed to the Council's central disinfection station, and submitted to the action of superheated steam in the disinfecting machine. (h) Immediate notification of the case was sent to the Public Vaccinator, 50 (i) The Health Department kept a fresh supply of calf lymph in stock for the use of Medical Practitioners requiring immediate supplies for the re·vaccination of contacts—an arrangement which frequently secured immediate vaccination of persons exposed to infection. (j) All children from infected houses were prevented from attending schools. (k) The name of the school attended by children of the house was obtained from the parents, and the head teacher immediately communicated with. In order to guard against inaccurate information in this respect a private circular was despatched daily to the head teacher of all schools in the district giving particulars of cases notified. (1) Contacts were kept under observation for sixteen days and employers of persons exposed to infection were informed of the fact. (m) Information was sent to Medical Officers of other Districts where any of their residents had been in contact with infected persons in Lewisham. Similar action was taken by Medical Officers of Health with respect to the contact of any resident of Lewisham in outside districts. On the receipt of such information the persons mentioned were advised re·vaccination, and were kept under obser· , vation. The necessity of dealing promptly with the first cases is all important, and I believe the action taken, did, to a great extent prevent the extension of this disease in the district. I desire to express my thanks for the great help and courtesy which I received from the Medical Practitioners of the District • 51 and to the Sanitary Staff who worked cheerfully and well irrespective of the hour that the emergency demanded their attendance. The result of the action taken to protect the district will be given in a special report on Small Pox which I hope to place before you after the vacation. SCARLET FEVER.—Four hundred and fifty-five cases were notified during the year in the whole Borough, only 12, or 2'6 per cent., of which number proved fatal. Of the total cases, 332 were removed to hospital. DIPHTHERIA.—The notifications were 292, of which 23, or 7.8 per cent., died. One hundred and ninety-four cases were removed to hospital. TYPHOID FEVER.—Sixty-one cases occurred, 14, or 23 per cent., were fatal. The removals to hospital amounted to 36. ERYSIPELAS.—Of eighty-eight cases, five were fatal. Ten persons suffering from this disease were removed to hospital. TYPHUS FEYER.—On the 22nd of October a medical practitioner communicated with the London County Council's expert that he was attending a man, W.K., aged 20, residing in Kneller Road, Brockley, whom he suspected to be suffering from Bubonic Plague. Dr. Shirley Murphy, the County Medical Officer of Health, informed me by telephone that he had arranged to see the case with Dr. James Cantlie, the Council's expert on Plague, and invited me to attend. After examining the patient we agreed he was suffering from Typhus Fever. I arranged for his immediade removal to hospital. 52 The man some days previous to his illness had resided in lodgings at Portsmouth, the Medical Officer of which town assisted me in making inquiries. The origin of infection could not be traced. PUERPERAL FEYER.—Seven cases occurred, none of which were registered as fatal. PREVALENCE OF SCARLET FEYER AND DIPHTHERIA IN RELATION TO AGE PERIODS IN LONDON. On examination of the returns of notification for the whole of the County of London, it appears that the age period of ten years and under, are credited with the largest percentage of attacks of Scarlet Fever and Diphtheria. During the year under review, 18,381 persons were attacked with Scarlet Fever, and 12,156 Diphtheria in the County of London. Of the Scarlet Fever cases, 5,328 or 28.4 per cent. occurred amongst children between the ages of one and five years, and 6,913 or 30.7 per cent. at ages varying from five to ten years. Of the Diphtheria cases, 4,438 or 36.5 per cent. were among children between one and five, and 3,832 or 31.6 per cent. between the ages of five and ten years. The consideration of these figures suggest the advisability of an enquiry as to the necessity of raising the age limit of compulsory school attendance, with a view of reducing the extension of these diseases. The existing regulations provide that children must commence their school attendance at the age of five years. 53 Parents are frequently encouraged to send them earlier. If the age period were extended to six years, and children prohibited from attendance under that age, I believe the number of cases of infectious disease prevalent among young children, would be considerably reduced. The age periods of attacks in Lewisham are shown in Table 17. The effect of School Holidays upon infectious disease notifications is shown in Chart E. * VACCINATION RETURNS FOR THE YEAR 1902. During the year 2,659 primary vaccinations were carried out by the Public Vaccinators:— 1st Quarter 526 2nd Quarter 676 3rd Quarter 607 4th Quarter 850 2,659 Vaccination postponed on Medical Certificate 396 Infants dying unvaccinated 304 Untraceable 354 Unsuccessful vaccinations 13 * I am indebted to the courtesy of the Lewisham Board of Guardians and Mr. Chas. Atkins for the above figures. 54 Table 17 Showing Cases of Infectious Disease notified during the Year 1901 in the Borough and its divisions. NOTIFIABLE DISEASE Cases notified in whole District. Total Cases notified in each locality at all ages No. of Cases removed to Hospital from each locality At all ages Under 1 At Ages—Years Lee Lewisham Sydenham and Forest Hill Lee Lewisham Sydenham and Forest Hill 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwards Small-pox 11 - 3 4 4 - - l 3 7 — l 5 Cholera - - - - - - - - - - - - - Diphtheria 292 6 78 148 32 28 - 72 177 43 59 109 26 Membranous croup - - - - - - - - - - - - - Erysipelas 88 7 — 8 12 57 4 11 37 40 1 2 7 Scarlet fever 455 5 99 261 59 31 — 45 263 147 29 188 115 Typhus fever 1 — — — 1 — — — 1 — — 1 — Enteric fever 61 — 2 8 26 25 — 6 34 21 5 21 10 Relapsing fever - - - - - - - - - - - - - Continued fever - - - - - - - - - - - - - Puerperal fever 7 — — — — 7 — — 6 1 — 1 — Plague - - - - - - - - - - - - - Totals 915 18 182 429 134 178 4 135 521 259 94 323 163 55 Table 18. Number of Cases of Infectious Diseases notified in the several Boroughs and the Administrative County of London, during the 52 weeks ended 28th December, 1901. BOROUGHS. Estimated Population in the middle of 1001. Small-Pox. Scarlet Fever. Diphtheria (including Membraneous Croup). Typhus. Enteric Fever. Continued Fever. Cholera. Erysipelas. Puerperal Fever. Administrative County of London 4,544,983 1,700 18,381 12,156 20 3,194 48 3 4,604 253 Paddington 144,200 21 505 340 — 92 ' — — 141 13 Kensington 176,821 14 475 251 2 99 8 — 171 10 Hammersmith 112,631 45 346 226 — 77 2 — 116 3 Fulham 138,448 16 600 644 — 133 1 1 132 7 Chelsea 73,876 5 190 107 — 41 — — 47 4 Westminster 182,567 100 478 255 — 105 2 — 117 6 St. Marylebone 133,053 79 397 259 — 82 — — 183 4 Hampstead 82,300 7 218 153 — 50 1 — 48 5 56 St. Pancras 235,369 256 991 941 — 186 2 — 253 13 Islington 335,441 62 1,290 915 2 281 4 — 287 34 Stoke Newington 51,336 19 172 144 — 26 — — 41 4 Hackney 219,800 41 933 979 1 193 1 1 326 16 Holborn 59,231 216 259 167 1 39 — — 89 2 Finsbury 101,266 93 502 297 — 68 1 — 135 5 City of London 26,657 8 110 68 — 21 — 13 1 Shoreditch 118,504 18 556 326 — 97 10 142 6 Bethnal Green 129,720 32 841 463 1 108 2 — 211 8 Stepney 298,985 161 1,177 845 2 267 — 372 16 Poplar 168,898 71 560 619 — 172 - — 187 6 South wark 206,306 89 1,301 558 — 135 - — 241 5 Bermondsey 130,650 107 932 329 1 150 - 155 5 Lambeth 302,533 50 1,037 527 — 144 6 1 238 15 Battersea 169,403 53 602 267 — 91 — - 126 8 Wandsworth 233,985 32 689 478 — 99 1 - 225 14 Camberwell 260,022 54 1,472 867 — 154 1 — 228 19 Deptford 110,632 4 549 427 9 63 2 — 111 2 Greenwich 96,217 11 419 188 — 68 — — 110 6 Lewisham 128,480 11 455 292 1 61 — — 88 7 Woolwich 117,652 23 310 217 — 69 1 — 70 8 PART III. DISINFECTION. INSPECTIONS OF WORKSHOPS. HOUSES LET IN LODGINGS. DISTRICT INSPECTIONS, &C. 58 DISINFECTION.—During the year, 13,982 articles were disinfected at the Council's Central Station. SCHOOL CLOSURE.—It was necessary to close one private school in Lewisham, owing to the prevalence of Diphtheria among the scholars. WELLS. Analyses were made of Water from the following wells:— Situation. Result. Action. 161 Rushey Green Polluted Closed Nursery, Woodlands Polluted Closed 1, 2, 3, 4 Queen's Bench, Rushey Green Polluted Closed 93 Hither Green Lane Polluted Closed 104, 106, 108 Rushey Green Polluted Closed 140, 142, 144, 146 Rushey Green — Still in use 17 Ladywell Park — Still in use HOUSE TO HOUSE INSPECTIONS were made in the following streets:— Lewisham Division. No. of Houses Inspected. No. of Houses in which Nuisances existed. Rushey Green 35 31 Comerford Road 75 71 Courthill Road 117 89 Wildfell Road 34 32 Ardmere Road 37 37 Braxfield Road 75 73 Essex Place 27 3 Queen Street 12 nil Regent Street 9 5 Sparta Street 58 37 59 Sydenham Division. Chaplin Street 30 24 Hindsley Place 22 17 Kent House Road 30 23 HOUSES LET IN LODGINGS—REGISTERED IN THE BOROUGH, To which periodical visits have been made. 5 Rennell Street 55 Ladywell Park 5 Ladywell Park 67 „ „ 23 " " 1 Ladywell Park Terrace 25 " " 2 " " " 31 7 " " " 39 „ „ 9 " " " 43 " " 10 " " " 45 " " 62 Ladywell Park 47 " " 64 „ „ 49 " " 7 Rennell Street 51 " " 13 „ „ 53 " " 8 " " LICENSED COWSHEDS. Lewisham Division. Beckenham Place Bellingham Farm, Southend Holloway Farm, Southend White House Farm, Southend 147 Rushey Green 110 Courthill Road Shrofields Farm, Hither Green Lane 87 Loampit Vale, Lewisham 60 Sydenham and Forest Hill Division. 110 High Street 296 Sydenham Road 82 Wells Road Lee Division. Burnt Ash Farm Butterfield Dairy, Butterfield Street College Farm, 168 Burnt Ash Hill Durham Farm, Burnt Ash Lane Spicer's Meadow, Claypit Lane WORKSHOPS. The following is a list of Workshops upon the Register, Laundries 80 Milliners 14 Saddlers 5 Upholsterers 5 Joiners 23 Dressmakers 61 Watch-repairers 9 Tailors 16 Boot-repairers 49 Cycle 13 Various 18 Total 290 1901. SLAUGHTER-HOUSES. Lewisham Division. 36 High Street, Lewisham 114 " " " 245 " " " 61 69 Loampit Vale, Lewisham 12 Montpelier Road, Blackheath 13 Eushey Green, Catford 158 Eushey Green, Catford Sydenham Division. 9 Perry Vale, Forest Hill Havelock Street, Forest Hill 16 Wastdale Eoad, Forest Hill 18 High Street, Sydenham 94 " " " Lee Division. 182 High Road, Lee 187 " " " 272 „ „ „ Mayron Place 1 Weardale road 1901. WATER CERTIFICATES Granted in accordance with Section 48 of the Public Health (London) Act, 1891. The following number of certificates were granted: Lee Division 15 Lewisham 851 Sydenham and Forest Hill 318 62 Register of Sanitary Work For the Year 1901. Description of Work. Lewisham Division. Sydenham and Forest Hill Division. Lee Division. Total for Whole Borough. Mr. J. F. Charlesworth. Mr. J. Daltry. Mr. A. H. Gray. Total. Mr. E. T. Pidwell. Mr. B. A. Knappett. Total. Mr. R. White. Complaints by Residents 348 39 126 508 177 152 329 398 1235 Premises inspected 702 1177 605 2484 953 639 1592 576 4652 Re-inspections of Works in progress 1236 1730 5825 8791 1459 1882 8341 1187 13319 Intimation Notices served 248 221 548 1017 234 283 517 299 1833 Statutory Notices ordered 276 49 149 474 154 239 893 75 942 Statutory Notices served 51 30 51 132 71 63 134 34 300 Premises repaired, cleansed, &c... 128 44 159 331 66 105 171 48 550 Defective Roofs, Stackpipes, &c., remedied 92 31 80 203 51 64 115 28 346 Drains reconstructed 81 10 250 341 105 83 188 94 623 Drains repaired 106 21 91 218 101 66 167 129 514 Drains ventilated 49 6 40 95 32 39 71 53 219 Stackpipes, Sinks, Bath-wastes, &c., disconnected from Drains 122 7 191 320 103 61 164 161 545 63 Gulley Traps provided 184 35 315 534 342 318 660 166 1360 Water Closets reconstructed 103 26 284 413 168 192 360 133 906 Water Closets repaired 39 60 22 121 36 58 94 78 293 Water Closets supplied with water 117 23 41 181 57 — 57 23 261 Soil Pipes reconstructed 73 12 114 199 71 62 133 85 417 Soil Pipes repaired and ventilated 80 119 17 216 54 32 86 98 400 Dustbins provided 49 104 83 236 31 87 118 70 424 0Water Supply to Houses reinstated 16 4 5 25 15 13 28 9 62 Cisterns repaired, cleansed or covered 3 136 90 229 114 55 169 26 424 Water Certificates issued - 851 — 851 318 — 318 15 1184 Premises over-crowded 3 — 3 6 1 1 2 — 8 Yards paved 122 97 239 458 52 147 199 69 726 Removal of offensive accumulations 45 32 20 97 24 34 58 25 180 Dung Vaults erected or repaired 4 12 5 21 4 4 8 4 33 Animals improperly kept— Nuisances abated 2 2 7 11 3 8 11 6 28 Lodging Houses registered — — 24 24 — — — — 24 Bake Houses visited — 36 - 36 — — 40 13 89 Milk Shops visited — 61 — 61 — — 42 17 120 Cow Sheds visited 8 — - 8 — — 3 5 16 Workshops visited — 290 — 290 — — — — 290 Slaughter Houses visited 7 — — 7 — — 6 5 18 House-to-house inspections — — 479 479 — — 82 — 561 Legal proceedings - - - - - - - 1 1