LEW 4 BOROUGH OF LEWISHAM. Annual Report on the VITAL STATISTICS AND SANITARY CONDITION of the BOROUGH OF LEWISHAM and REPORT OF THE PUBLIC ANALYST For the Year 1902, 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, etc. Lewisham: Printed by Freame, Manning & Co., 12a, Lee High Road. 3 BOROUGH OF LEWISHAM. EPITOME OF VITAL STATISTICS, 1902. Area in acres, exclusive of area covered by water 6,991 Enumerated population (Census, 1901) 127,495 Estimated population to the middle of 1902 132,432 Average number of persons per house (Census, 1901) 5.6 Total number of Births registered in the Borough 3,491 Birth Rate per 1,000 estimated population 26.3 Total number of Deaths registered in the Borough 1,942 Total number of Deaths of residents of the Borough, after correction for non-residents dying in Public Institutions, and residents dying outside the District 1,818 Deaths of persons under 1 year of age 428 Infantile Death Kate per 1,000 Births registered 122 Total number of Deaths in Public Institutions in the Borough 568 Deaths of non-residents in Public Institutions in the Borough 241 Deaths of residents in Institutions outside the Borough 117 Corrected Death Rate per 1,000 of the estimated population 13.7 4 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham. Gentlemen, I beg to submit to you my Annual Report on the Vital Statistics and Sanitary Condition of the Borough for the year 1902. An examination of the statistical figures contained herein shows that the health of the district is highly satisfactory. The corrected death rate from all causes amounted to 13.7 per 1,000, a slight increase over that for the preceding year (13.0 per 1,000), due partly to the fact that the death rate for 1902 is calculated upon the number of deaths registered in 53 instead of 52 weeks. Compared with other Metropolitan Boroughs, Lewisham enjoys, as in previous years, one of the lowest death rates in London. (See Tables 9 and 10.) The death rates from all causes and from Zymotic Diseases and Phthisis and the Infantile Mortality compare most favourably with other London Boroughs and the principal towns of England. The year under review has been an anxious one owing to the prevalence of Small Pox in London, and the eases which occurred in the Borough. The inhabitants of the Borough were exposed to special risks owing to the large number of workmen resident in Lewisham who were exposed to infection during their employment at the Small Pox Hospitals. It is a matter for congratulation that we were able to control the threatened outbreak. Compared with other London Boroughs, Lewisham escaped with 84 cases, equal to an attack rate of 063 per 1,000, nearly the lowest in London. (See Table 9.) The occurrence of Small Pox in the district from September, 1901, to September, 1902, entailed a vast amount of work, and I cannot speak too highly of the willing co-operation of the Sanitary Inspectors, who throughout the whole period 5 worked early and late as necessity required. The work did not end with the removal of the patient and the subsequent disinfection of the premises, after the receipt of the notification certificate. Numerous suspected cases occurred in which your Medical Officer was invited to assist in the diagnosis. The names and addresses of the persons who had been in contact with patients had to be secured, information at times not easily obtainable. Between seven and eight hundred persons (contacts) were kept under daily observation at their homes. Full particulars are set out in the report. It should be noted that it was not found necessary to obtain additional assistance to meet the demands made upon the Department. I desire to take this opportunity of expressing my thanks to the Council for the cordial support given to me in my efforts to prevent the extension of the outbreak, also to the Medical Practitioners of the district for their unvarying courtesy, and to the Sanitary Staff for their willing and valuable help. A spot map, which may be examined in the Office, has been prepared showing the incidence of the various infectious diseases during the year within the Borough. During the period under review the Laboratory was completed, and I am able to append to this report details of the year's work under the Food and Drugs Acts. In my previous Annual Report I stated that the clerical staff would prove inadequate to cope with the work of the Department. Since that period the clerical work has greatly increased and I would ask your early consideration of this matter. I am also of opinion that there is a necessity for an additional Sanitary Inspector for house to house inspection. I remain, Gentlemen, Your obedient servant, A. WELLESLEY HARRIS, Medical Officer of Health and Public Analyst. June, 1903. 6 CONTENTS. Page Accidents, fatal 24 Bakehouses, regulations for 90 to 93 ,, Underground, list of 93 Birth Rate 15 „ in divisions 16 Cancer, mortality 23 Chicken Pox 66 Constitutional Diseases, mortality of 24 Customs and Inland Revenue Act 89 Deaths registered 17 ,, age periods at 18 ,, causes of, in detail 33, 34 Death Rates 17 „ zymotic 20 „ all causes 26 to 29 „ in disease groups 30 „ London sanitary districts 31 & 32 Diarrhœa, epidemic 22 Digestive Diseases, mortality of 24 Diphtheria, mortality 22 „ attack rates 42 & 43 ,, notification of 68 „ anti-toxin in 69 ,, in schools 69 Disinfection 89 Enteric Fever, mortality of 22 Erysipelas, notifications of 70 Factory and Workshop Act 88 & 90 Heart Disease, mortality of 24 House to house inspections 88 Ice Cream regulations 103 Infant mortality 19 Infectious Diseases— Attack rates of 43 Deaths in Wards 36 „ in age groups 38 Death rates 37 Errors in diagnosis 70 & 72 Notifications of 41 ,, in Wards 42 ,, London Boroughs 43 Local Government Board Tables 123 to 126 Measles, mortality 21 Midwives, registration of 104 Nervous Diseases, mortality of 24 Page Nuisances from— Fish offal 93 Gas Works 95 to 98 House refuse 98 & 99 Rivers 98 Sewage flooding 99 to 103 Smoke 94 Phthisis, mortality of 22 ,, spitting in railway carriages 103 Population, 1902 13 ,, in Wards 14 „ in Divisions 15 Puerperal Fever 70 Public Analyst, report of 109 to 120 Public Institutions outside Borough, deaths in 25 Public Institutions within Borough, deaths of residents and non-residents 35 Respiratory Diseases, mortality of 24 ,, Seasonal influence Chart A Sanitary Inspections, register of 106 Staff, disposition of 87 Scarlet Fever mortality 22 ,, attack rates 42 & 43 ,, notifications 66 ,, return cases 67 School closure 70 Seasonal mortality 19 Small Pox— Attack rates in London Boroughs 43 Cases of 44 Contacts 64 & 65 Details of cases 46 to 64 Infection from Small Pox Hospitals by labourers 44,46,47,48, 49, 52, 55&56 And laundries 50 & 51 Mortality 21 Precautions against 45 & 46 Unrecognised cases 49 & 50 Suicides 24 Street List of Infectious Diseases 73 to 83 Urinary Organs, diseases of, mortality of 24 Water certificates 89 Whooping Cough, mortality of 22 7 SYNOPSIS OF TABLES AND CHARTS. Table 1.—Population of the Borough in Wards obtained at the Census, April, 1901. Also the population estimated at the middle of the years 1901 and 1902. Table 2.—Population of the Borough in Divisions obtained at the Census, April, 1901. Also the population estimated at the middle of the years 1901 and 1902. Table 3.—Births and Birth Bates for each Division of the Borough for the years 1901 and 1902. Table 4.—Corrected Death Totals and Death Bates for the years 1901 and 1902. Table 5.—Corrected Total Deaths from all causes in Wards occurring daring the four quarters of the year 1902. Table 6. —Corrected Death Rates from all causes in Wards, Divisions and the Whole Borough for the four quarters of the year 1902. Table 7.—Deaths in Disease Groups in the three Divisions and the Whole Borough for the year 1902. Table 8.—Deaths in Disease Groups in the 10 Wards of the Borough for the year 1902. Table 9.—Death Bates of London and Metropolitan Boroughs during the year 1902, after distribution of deaths in Public Institutions. 8 Table 10.—Death Rates in London and the several Metropolitan Boroughs from all causes and from certain diseases during the year 1902, before distribution and after distribution of deaths in Public Institutions. Table 11.—Causes of, and ages at, Deaths in the Borough for the year 1902. Table 12—Residents and Non-Residents dying in Public Institutions situated in the Borough. Table 13.—Deaths trom Principal Zymotic Diseases in Wards duriftg the year 1902. Table 14.—Death Rates from Principal Zymotic Diseases and Phthisis, and Infantile Mortality, in the Borough and its Divisions in the County of London, and in the 76 Great Towns, for the year 1902. Table 15.—Deaths from Principal Zymotic Diseases arranged in Age Groups for the year 1902. Table 16.—Number of notifications of Infectious Disease in Divisions and for the Whole Borough during the Pour Quarters of the year 1902. Table 17.—Notifications of Infectious Disease in Wards and for the whole Borough during the year 1902. Table 18.—Attack Rates from the Principal Infectious Diseases per 1,000 of the population for the Ten Wards and the Whole Borough for the year 1902. Table 19.—Number of notifications of Small Pox, Scarlet Fever and Diphtheria in the Metropolitan Boroughs and the County of London during the 53 weeks of 1902. 9 Table 20.—Showing Cases of Infectious Diseases notified at various Age groups in the Borough, and its Divisions during the year 1902. Table 21.—Showing Cases of mistaken Diagnosis of Cases of Small Pox, Scarlet Fever and Diphtheria admitted to the Metropolitan Asylums Board Hospitals during the years 1899, 1900, and 1901. Table 22.—Register of Sanitary Work. Charts. Chart A.—Showing weekly total deaths from all causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 weeks ending December 27th, 1902. Chart B.—Showing weekly notifications of all Infectious Diseases, also weekly notifications of Scarlet Fever, and Diphtheria and Small Pox, during the year 1902. Appendix.—Local, Government Board Tables, Table A.—Vital Statistics of Whole District during the years 1901 and 1902. Table B.—Vital Statistics of Separate Localities in the years 1901 and 1902. Table C.—Cases of Infectious Disease notified during the year 1902. Table D.—Causes of, and Ages at, Death during the year 1902. Part 1. VITAL STATISTICS. REPORT OF THE Medical Officer of Health FOR THE YEAR 1902. VITAL STATISTICS. The Vital Statistics set out in the Report are based upon the population of the entire Borough estimated to the middle of the year 1902, which amounted to 132,482, compared with 128,480 for 1901, an increase in one year of 3,952 persons. The increase in the population by natural iucrement, i.e., the excess of births over deaths, amounted to 1,673. It may be assumed, therefore, that the difference of 2,279 between the estimated population and that shown by the natural increment is due to immigration into the district. In order to make the statistical returns iu this report comparable with other districts and with the Returns of the Registrar General, a period of 53 weeks ending January 3rd, 1903, is taken. All statistics contained in the report are based upon the figures recorded during this period. The various rates are per 1,000 persons estimated to be living in either the Ward, Division, or whole Borough, except where otherwise stated. 14 Table 1. Population of the Borough in Wards obtained at the Census, April, 1901. Also the population estimated at the middle of the years 1901 and 1902. Ward. Population at Census, April, 1901 Estimated population middle of 1801. Estimated population middle of 1902, Church 6,412 6,434 6,522 Manor 6,734 6,761 6,872 South 5,503 5,508 5,531 Lee Division 18,649 18,703 18,925 Blackheath 6,729 6,735 6,759 Lewishara Village 13,842 13,887 14,070 Lewisham Park 11,145 11,394 12,391 Brockley 10,952 10,984 11,114 Catford 23,203 23,631 25,338 Lewisham Division 65,871 66,631 69,672 Forest Hill 18,051 18,063 18,115 Sydenham 24,924 25,083 25,720 Sydenham & Forest Hill Division 42,975 43,146 43,835 15 Table 2. Population of the Borough in Divisions, obtained at the Census April, 1901, also population estimated at the middle of the years 1901 and 1902. Divisions. Population at Census, April, 1901. Estimated population middle of 1901. Estimated population middle of 1902. Lee 18,649 18,703 18,925 Lewisham 65,871 66,631 69,672 Sydenham and Forest Hill 42,975 43,146 43,835 Whole Borough 127,495 128,480 132,432 THE BIRTH RATE. The total number of Births registered in the Borough of Lewisham during the year 1902 was 3,491. Of this total 1,812 were males and 1,679 females. The birth rate for Lewisham is therefore 26 3 per 1,000 inhabitants, compared with 25.9 in the previous year. The birth rate for London was 28.5 per thousand, or 2.2 per thousand in excess of this Borough. 16 Of the total births, 481 were registered in the Lee division, 1,857 in Lewisham and 1,158 in Sydenham and Forest Hill. The birth rate in Lee was 25.4, in Lewisham 26.6, and in Sydenham and Forest Hill 26.3 per 1,000 of the inhabitants of each division. Table 3. Births and Birth Rates for each Division of the Borough for the years 1901 and 1902. Division. Toal Number of Births. 1901. Birth Rate per 1000 persons. 1901. Total Number of Births. 1902. Birth Rate per 1000 persons. 1902. Lee 398 21.2 481 25.4 Lewisham 1,882 28.2 1,857 26.6 Sydenham & Forest Hill 1,040 24.1 1,153 26.3 Whole Borough 3,320 25.9 3,491 26.3 County of London 131,278 29.0 132,810 28.5 MARRIAGE RATE. The number of Marriages registered in the Borough during the year amounted to 759, compared with 670 in 1901. The Marriage Rate was 5.7, an increase of .5 per 1,000 over 1901, while the Marriage Rate for the whole of London was equal to 17.8 per 1,000. 17 MORTALITY. The total number of Deaths registered in the Borough was 1,942; compared with 1,875 for the year 1901. After deducting the deaths of non-residents (241) dying in Public Institutions situated within the Borough, and adding those of residents (117) who died outside the district, a corrected total of 1,818 is obtained, compared with 1,668 in 1901. The corrected total deaths, 1,818, is equivalent to a Death Rate of 137 per 1,000 living at all ages, and compares most favourably with the death rate, 17.2 per 1,000 for the County of London, and 18.6 for the 76 Great Towns. Compared with other Metropolitan Boroughs, Lewisham enjoys, as in previous years, one of the lowest death rates in London. Hampstead 10.8 is the lowest, followed by Stoke Newington 13.4, Wandsworth 13.5, and Lewisham 13.7 per 1,000 of the population living at all ages. The highest death rates in London were Finsbury, 22.9, Southwark, 21.4, Holborn, 21.3. (See Tables 9 and 10). The death rate for Lewisham, 13.7, for the year 1902, shows a very slight increase over that for the preceding year 13.0 per 1,000, due partly to the fact that the figures are obtained from deaths registered in 53 weeks (371 days); only 52 weeks (364 days) were considered in the previous year. On sub-dividing the corrected deaths into the various divisions and Wards of the Borough, it will be noted that the mortality rate of the Lee Division, 11.6, was the lowest, Lewisham, 14.2 the highest, and Sydenham and Forest Hill 13.8 per 1,000 of the persons estimated to be living in each Division referred to. (See Table 4). 18 Carrying the sub-division a step farther, the death rates from all causes in the individual Wards show Lewisham Park to have suffered the highest mortality (15.7); on the other hand Brockley claims the lowest mortality for the year of 10.9 per 1,000. (See Table 6). In the Annual Report for 1901, no records of figures were available which would enable one to give the mortality rates for each Ward. The sub-division of mortality and other rates is most valuable in pointing out the unsatisfactory portions of the Borough and in investigating the various factors responsible for the difference in the various districts, and the remedial measures that may be necessary. The environment, status, age and occupation of the population of a district has considerable effect upon the mortality. The poorer and more crowded districts require the most attention of the Council by means of regular and systematic inspection. The necessity of the appointment of an additional Inspector for house-to-house duty is referred to in another portion of the Report. ANALYSIS OF DEATHS. Age Periods.—Of the 1818 corrected total deaths occurring in the Borough : Age. 428, equal to 28.5 per cent. of total deaths occurred under 1 year 200, „ 110 ,, ,, ,, ,, between 1 & 5 86, „ 4.7,, ,, ,, ,, „ 5 & 15 86, „ 4.7 ,, ,, ,, ,, „ 15 & 25 547, „ 30.0 ,, ,, ,, ,, „ 25 & 65 471, „ 25.3 ,, ,, ,, ,, over 65 years 19 Percentage of deaths under 1 year to total deaths in Wards and Divisions. Lee Division 15.9 p.c. Lewisham Division 26.9 p.c. Sydenham & Forest 21.0 p.c. Hill Division per cent. Church Ward 11.8 Manor Ward 16.4 South Ward 20.3 Blackheath Ward 14.5 Lewisham Village Ward 18.5 Lewisham Park Ward 25.1 Brockley Ward 26.2 Catford Ward 84.6 Forest Hill Ward 21.7 Sydenham Ward 20.6 Seasonal Mortality.—The highest mortality occurred during the first and last quarters of the year, the death rate from all causes being 15.9 and 15.3 per 1,000 respectively. The lowest death rate was 11.7 for the third quarter. Chart A. shows deaths from all causes recorded weekly and the seasonal effect with regard to Infantile Diarrhoea and diseases of the respiratory group. Table 7 shows the total deaths in 12 classes registered in each quarter, from which it will be seen that deaths from diseases of the respiratory organs, and the heart and bloodvessels, were the highest during the first and fourth quarters of the year. Infant Mortality.—The Infant mortality rate represents the proportion of deaths occurring among children under one year of age to the total number of births registered during the same period. Of the 1818 corrected total deaths recorded in the Borough, 428 or 23.5 per cent. of the total deaths were under one 20 year of age. The total births were 8491, therefore the infant mortality rate was 122 per thousand births (compared with 128 for 1901), England and Wales 133, 76 Great Towns 145, County of London 189. The infant mortality rate is a valuable index of the sanitary condition of a district. Compared with other districts, Lewisham is in a most satisfactory position. The rate referred to is the lowest in the ten South Metropolitan Boroughs. Of the total 29 Metropolitan Sanitary Districts four only have a lower rate, Hampstesd 87, Marylebone 107, Stoke Newington 115, and Hackney 119. (See Table 9). In the three Divisions of the Borough the infant mortality rates were Lee 72.7, Lewisham 142, and Sydenham and Forest Hill 111 per 1,000 births. An examination of the causes of death among infants under one, shows that the following diseases were the most fatal:—Whooping Cough, Epidemic Diarrhoea and Enteritis, Convulsions, Enteritis, Gastritis and other Digestive diseases, and Premature Birth. (See Table 11). Zymotic Death Rate.—The Zymotic death rate is calculated upon the total deaths occurring at all ages from the principal infectious diseases, viz.:—Small Pox, Measles, Scarlet, Typhus and Typhoid Fevers, Whooping Cough and Epidemic Diarrhoea and Enteritis. The Zymotic death rate is also a valuable test of the sanitary condition of a district, and in this respect Lewisham maintains a high position compared with other districts. 21 The Zymotic death rate for the Borough is 1.7 per 1,000 persons, compared with 2.21 for the County of London, 1.63 England and Wales, and 2.12 for the 76 Great Towns. Of the ten South Metropolitan Boroughs only two have a lower rate, Greenwich 1.59, and Wandsworth 1.62. Of the remaining Boroughs five are lower, Hampstead 0.81, City of Westminster 1.28, Stoke Newington 1.17, City of London 1.88, Kensington 1.49. (See Table 9). Of the total 227 deaths from the principal infectious diseases, Small Pox accounted for 12, Measles 27, Scarlet Fever 17, Whooping Cough 63, Diphtheria 44, Enteric Fever 9, and Epidemic Diarrhoea and Enteritis 55. (See Table 11). The death rates from the above diseases for the whole Borough, the County of London, and the 76 Great Towns, have been calculated and are set out in Table 14. The highest rates were due to Whooping Cough and Epidemic Diarrhoea. In the three Divisions of the Borough the Zymotic death rates were Lee 1.3, Lewisham l.85 (the highest), and Sydenham and Forest Hill l.66. (See Table 14). The relation of age periods to mortality from the Zymotic diseases will be found in Table 15. Of the total 227 deaths, 78 per cent. were among children under 5 years of age. For the distribution of deaths in Ward localities see Table 13. CLASS I.—Small Pox was responsible for 12 deaths, equal to a death rate of 0 09 per 1,000, the lowest mortality of the ten South Metropolitan Boroughs. Of the remaining Boroughs, only two show a lower rate, Hampstead 0.04, and Kensington 0.06. The case mortality, i.e., the percentage of deaths to attacks was 14.3 per cent. Further reference will be made to this disease in another part of the report. Measles was responsible for 27 deaths, equal to a death rate of 0.23 per thousand of the population. The mortality 22 from this disease was highest in the Sydenham and Forest Hill Division and lowest in Lee. (See Table 14). Scarlet FeYer.—17 deaths were notified in the Borough, equal to a mortality rate of 012 per thousand. On sub-division, the Lewisham Division had the highest mortality, 0.15, and Sydenham and Forest Hill the lowest, 0.09 per thousand. The case mortality was 2.6 per cent. of persons affected. Diphtheria.—There were 44 fatal cases, giving a mortality rate for the Borough of 0 33 per thousand. Of the three Borough Divisions, the disease was most fatal in Lee, and the lowest in Lewisham, the mortality being 0.47 and 0.25 per thousand respectively. The case mortality was 11.8 of the actual cases. Whooping Cough.—Of all the Zymotic diseases Whooping Cough caused the greatest number of deaths (63), equal to a death rate of 0.47. In the Sydenham and Forest Hill Division the mortality rate was 0.52 per 1,000, Lewisham 0.47, and Lee 0.36. Enteric Fever.—There were 9 fatal cases equal to a death rate of 0.06 per 1,000, and a case mortality of 15.2. Epidemic Diarrhoea and Enteritis.—Fifty-five deaths occurred, equal to a death rate of 0 41 per 1,000. The mortality was highest in the Lewisham Division, 0.54, and lowest in Lee, 0.10. (See Table 14.) Details of deaths attributed to other infective diseases will be found in Tables 7 and 11, Class I. CLASS II.—Phthisis.—This disease was responsible for 142 deaths, or 7.6 per cent. of the total 1,818 deaths from all causes. This mortality is equal to a death rate of 106 per 1,000, compared with 0.93 in 1901 for the whole Borough, the lowest rate of the ten south Metropolitan Boroughs. Of the 23 remaining London sanitary districts, only two are lower, Hampstead 0.85, and Paddington 1.05 per 1,000. The district having the highest mortality is Holborn, 3.0l per 1,000. The death rate for the County of London was 1.60. The position of Lewisham in comparison with other Boroughs is most satisfactory. Sub-dividing the deaths over the three divisions, the death rates were:—Lee 0.89, Lewisham 1.16, and Sydenham and Forest Hill TO. Phthisis is now fully recognised as an infectious disease. In 1902 it was responsible for a greater loss of life than Small Pox, Measles, Scarlet Fever, Diphtheria and Enteric Fever combined, notwithstanding the abnormal fatality from Small Pox due to the Epidemic. The total deaths from the diseases mentioned were :— Lewisham. Countyof London Small Pox 12 1314 Measles 27 2861 Scarlet Fever 17 563 Diphtheria 44 1181 Enteric Fever 9 585 Total 109 6004 Lewisham 142 Phthisis County of London 7621 These figures alone show the necessity of considering how the reduction in Phthisis mortality can be best achieved. It is my intention to submit to you a special report on this important question for your consideration. In addition to Phthisis 60 deaths are registered as due to various forms of tubercular disease. (See Table 11). GLASS III.—Cancer was the stated cause of 104 deaths, compared with 143 in 1901, equal to a mortality rate of 0.77 per 1,000. On sub-dividing these deaths, 13 were registered in Lee, 51 in Lewisham, and 40 in Sydenham and Forest Hill. For other diseases of this Class see Table 11. 24 CLASS IV.- Nervous Diseases.—This class was responsible for 144 deaths. Of this number 21 were cases of Insanity, 19 Meningitis, 65 Convulsions; of the latter 51 were children under 1 year. CLASS Y.—Diseases of Heart and Blood Vessels accounted for 224 deaths, equal to 12.3 per cent. of the total deaths. 66 deaths were due to Apoplexy. CLASS VI.—Respiratory Diseases.—This class was the cause of 275 deaths, equal to 15.1 per cent. of the total deaths from all causes. The highest number of deaths occurred during the seventh week, and corresponds with the highest weekly record of deaths from all causes. (See Chart A). Bronchitis and Pneumonia were the most fatal, particularly to children under 5 years of age. (See Table 11). CLASS VII.—Digestive Diseases.—To this class 166 deaths were assigned, 28 of which occurred to children under 1 year. CLASS VIII.—Diseases of Urinary Organs.—67 or 3.6 per cent. of the total deaths were recorded in this class. CLASS IX.—Diseases of Generative Organs.—Only 4 deaths were registered. CLASS X.—General or Constitutional Diseases.—268 or 14.1 per cent. of the total deaths were due to diseases in this class. Old Age claimed 112 of this total, and Premature Birth was the certified cause of 78 deaths. CLASS XI.—Accidents —42 fatal accidents occurred, ten of which were due to overlaying. CLASS XII.—Yiolence, Suicides, &c.—12 suicides occurred in the Borough. 25 DEATHS OF RESIDENTS belonging to the Borough occurring in Public Institutions &c., in districts outside dunng the year 1902. Number of Deaths Small Pox Hospitals:— Long Reach Hospital 6 Gore Farm Hospital 1 Ship "Castalia" 2 Ship "Atlas" 3 Fever Hospitals:— Brook Hospital 27 South Eastern Hospital 1 General Hospitals:— Guy's Hospital 11 St. Bartholomews's Hospital 5 London Hospital 4 St. Thomas' Hospital 2 St. George's Hospital 2 Charlton and Blnckheath Cottage Hospital 2 Seamens' Hospital, Greenwich 2 Brompton Hospital 2 Homœpathic Hospital 1 City of London Hospital, Stone 1 National Hospital 1 Number of Deaths General Hospitals—continued. King's College Hospital 2 Royal Free Hospital 1 University Hospital 1 Westminster Hospital 1 Clapham Maternity Hospital 1 Childrens' Hospital, Great Ormonde Street 1 Asylums:— L. C. Asylum, Dartford 8 Claybury Asylum 6 Cane Hill Asylum 6 Darenth Asylum 6 Horton Asylum 4 Leavesden Asylum 1 Caterham Asylum 1 Banstead Asylum 1 Camberwell House Asylum 1 Other Institutions:— Greenwich Infirmary 1 St. Piligia's Creche 1 50, Weymouth Street, Marylebone 1 Total 117 26 Table 4. Corrected Death Totals and Death Rates for the years 1901 and 1902. Localities. Total Number of Deaths. 1901. Death Rate per 1,000 of thepopulation. 1901. Total Number of Deaths. 1902. Death Rate per 1,000 of thepopulation 1902. Lee Division 255 13.6 220 11.6 Lewisham Division 856 12.9 991 14.2 Sydenham and Forest Hill Division 557 12.9 607 13.8 Whole Borough 1,668 130 1,818 13.7 County of London 79,924 17.1 80,105 17.2 27 Table 5. Corrected total Deaths from All Causes in Wards occurring during the four quarters of the year 1902. Localitses. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. M. F. Total M. F. Total M. F. Total M. F. Total M. F. Total Church Ward 20 20 40 6 11 17 3 3 6 6 7 13 35 41 76 Manor Ward 19 20 39 3 9 12 9 10 19 8 7 15 39 46 85 South Ward 8 8 16 9 7 16 7 10 17 4 6 10 28 31 59 Black heath Ward 14 18 32 13 9 22 11 9 20 15 15 30 53 51 104 Lewisham Village Ward 21 32 53 16 18 34 23 24 47 18 31 49 78 105 183 Lewisham Park Ward 28 35 63 21 17 38 17 19 36 30 28 58 96 99 195 Brockley Ward 15 19 34 14 15 29 12 10 22 19 18 37 60 62 122 Catford Ward 35 46 81 48 47 95 41 40 81 74 56 130 198 189 387 Forest Hill Ward 26 51 77 27 30 57 25 19 44 31 25 56 109 125 234 Sydenham Ward 40 52 92 37 37 74 37 59 96 57 54 111 171 202 373 The Whole Borough 226 301 527 194 200 394 189 203 388 262 247 509 867 951 1818 County of London — — 24291 — — 17872 — — 16833 — — 21109 — — 80105 76 Great Towns — — 73773 — — 61452 — — 56603 — — 71265 — — 263093 28 Table 6. Corrected Death Rates from All Causes in Wards, Divisions, am the Whole Borough, for the four Quarters of the Year 1902 Localities. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. Church Ward 24.5 10.4 8.6 7.9 11.6 Manor Ward 22.7 6.9 11.0 8.7 12.3 South Ward 11.5 11.6 12.2 7.2 10.6 Lee Division 20.0 9.5 8.8 8.0 11.6 Blackheath Ward 18.9 18.0 11.8 17.7 15.3 Lew. Village Ward 15.0 9.6 18.8 13.9 13.0 Lew. Park Ward 20.8 12.2 11.6 18.7 15.7 Brockley Ward 12.2 10.4 7.9 18.3 10.9 Catford Ward 12.7 14.9 12.7 20.5 15.3 Lewisham Division 15.0 12.5 11.8 17.4 14.2 Forest Hill Ward 17.0 12.5 9.7 12.3 12.9 Sydenham Ward 14.8 11.5 14.9 17.2 14.4 Sydenham & Forest Hill Division 15.4 11.9 12.7 14.1 18.8 Whole Borough 15.9 11.8 11.7 15.3 13.7 County of London 21.3 15.7 14.7 17.2 17.2 76 Great Towns 19.9 16.6 15.8 17.9 18.6 29 * Table 7. Deaths in Disease Groups in the Three Divisions and the whole Borough for the year 190'2. Disease Classes. Lee Division. Lewisham Division. Sydenham and Forest Hill Division Whole Borough 1St Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year. 1St Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year 1St Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year 1St Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year I. Infective 24 5 4 2 35 38 28 44 49 159 20 14 35 24 93 82 47 83 75 287 II. Tuberculous 11 4 7 5 27 28 30 22 25 105 13 14 17 26 70 52 48 46 56 202 III. Malignant 5 5 5 4 19 19 12 15 15 61 10 14 16 7 47 34 31 36 26 127 IV. Nervous 4 6 7 5 22 17 23 17 21 78 16 7 4 17 44 37 36 28 43 144 V. Heart and Blood Vessels 9 8 5 2 24 35 23 23 36 117 26 24 16 17 83 70 55 44 55 224 VI. Respiratory 20 6 1 7 34 62 28 10 53 153 39 16 7 26 88 121 50 18 86 275 VII. Digestive 2 4 5 4 15 19 22 25 37 103 8 13 11 16 48 29 39 41 57 166 VIII. Urinary 5 1 — — 6 9 8 8 11 36 8 6 4 7 25 22 15 12 18 67 IX. Generative Organs 1 1 — — 2 — 1 — 1 2 — — — — — 1 2 — 1 4 X. General 12 5 8 9 34 26 33 35 47 141 26 16 29 22 93 64 54 72 78 268 XI. Accidents 2 — — — 2 9 7 6 8 29 3 3 1 4 11 14 10 6 12 42 XII. Violence — — — — — 1 3 2 1 7 — 4 — 1 5 1 7 2 2 12 Totals 95 45 42 38 220 263 218 206 304 991 169 131 140 167 607 527 394 388 509 118 * For Diseases in each Class see Table II. 30 *Table 8. Deaths in Disease Groups in the Ten Wards of the Borough for the Year 1902. Disease Class Wards Deaths Whole Borough 1902 Percentage to Total Deaths 1 2 3 4 5 6 7 8 9 10 Church Manor South Blackheath Lewisham Village Lewisham Park Brockley Catford Forest Hill Sydenham I. Infective 12 12 11 15 18 27 23 76 21 72 287 15.7 II. Tuberculous 7 13 7 11 23 21 15 35 24 46 202 11.1 III. Malignant 7 8 4 11 10 11 7 22 23 24 127 6.9 IV. Nervous 4 7 11 9 11 14 9 35 19 25 144 7.9 V. Heart and Blood Vessels 8 7 9 11 30 22 17 37 45 38 224 12.3 VI. Respiratory 15 14 5 17 27 33 22 54 30 58 275 15.1 VII. Digestive 5 7 3 13 16 24 8 42 23 25 166 9.1 VIII. Urinary 4 1 1 3 7 7 1 18 8 17 67 3.6 IX. Generative Organs 1 1 — 1 — — — 1 — — 4 0.2 X. General Diseases 13 13 8 10 31 29 18 53 37 56 268 14.1 XI. Accidents — 2 — 3 7 6 3 10 2 9 42 2.3 XII. Violence — — — 1 2 — — 4 2 3 12 0.6 Total Deaths 76 85 59 105 182 194 123 387 234 373 1818 100.0 *For List of Diseases in each Class see Table 11. 31 Table 9. Showing death rates of London and Metropolitan Boroughs during the year 1902, after distribution of deaths in Public Institutions. Boroughs Per 1000 Persons Living. Deaths under 1 year to 1000 Births registered Deaths from All Causes Principal Epidemic Diseases Small-pox Measles Scarlet Fever Diphtheria Whooping.cough Enteric Fever Pyrexia* (Origin uncertain) Diarrhœa Phthisis County of London 17.2 2.21 0.28 0.51 0.12 0.25 0.40 012 0.00 0.53 1.60 139 West. Paddington 14.6 1.74 0.14 0.56 0.06 0.22 0.16 0.09 — 0.51 1.05 133 Kensington 15.3 1.49 0.06 0.52 0.12 0.11 0.12 0.11 — 0.45 1.29 149 Hammersmith 16.3 1.90 0.11 0.66 0.06 0.20 0.23 0.09 — 0.55 1.43 143 Fulham 17.1 3.13 0.09 1.16 0.13 0.35 0.45 0.06 — 0.89 1.38 148 Chelsea 18.0 2.06 0.09 0.89 0.11 0.17 0.19 0.08 — 0.53 1 45 145 City of Westminster 16.1 1.28 0.21 0.23 0.08 0.16 0.19 0.11 0.01 0.29 1.78 136 North St. Marylebone 18.3 1.98 0.18 0.72 0.10 0.20 0.17 0.11 — 0.50 1.92 107 Hampstead 10.8 0.81 0.04 0.18 0.08 0.12 0.12 0.13 — 0.14 0.85 87 St. Pancras 18.6 2.46 0.34 0.47 0.20 0.45 0.47 0.18 — 0.35 1.88 147 Islington 16.4 1.80 0.16 0.34 0.12 0.30 0.46 0.13 — 0.29 1.50 133 Stoke Newington 13.4 1.17 0.15 0.10 0.10 0.11 0.27 0.08 0.02 0.34 1.26 115 Hackney 15.0 1.98 0.31 0.35 0.07 0.27 0.41 0.14 — 0.43 1.43 119 Central Holborn 21.3 2.44 0.77 0.50 0.13 0.17 0.45 0.10 — 0.32 3.01 129 Finsbury 22.9 3.18 0.35 0.81 0.15 0.37 0.73 0.09 — 0.68 2.28 154 City of London 20.4 1.38 0.27 0.38 0.04 0.38 0.15 0.08 — 0.08 1.69 126 East. Shoreditch 20.7 3.53 0.63 0.73 0.07 0.21 0.63 0.18 — 1.08 1.81 174 Bethnal Green 20.8 2.56 0.48 0.45 0.14 0.25 0.67 0.11 — 0.46 1.97 155 Stepney 20.6 3.31 0.85 0.54 0.10 0.28 0.65 0.11 — 0.78 1.90 147 Poplar 19.3 2.77 0.54 0.40 0.12 0.33 0.58 0.16 — 0.64 1.70 154 South. Southwark 21.4 3.10 0.37 0.78 0.20 0.30 0.54 0.11 — 0.80 2.62 166 Bermondsey 20.8 3.06 0.23 1.17 0.14 0.23 0.52 0.10 — 0.67 1.88 155 Lambeth 17.4 1.86 0.19 0.27 0.15 0.17 0.38 0.12 0.00 0.58 1.70 127 Battersea 15.0 1.98 0.15 0.58 0.14 0.10 0.36 0.09 — 0.56 1.31 127 Wandsworth 13.5 1.62 0.10 0.39 0.09 0.27 0.26 0.12 — 0.39 0.90 127 Camberwell 16.3 2.23 0.24 0.45 0.15 0.31 0.41 0.12 — 0.55 1.51 138 Deptford 16.5 2.44 0.29 0.65 0.17 0.18 0.36 0.11 0.01 0.67 1.12 138 Greenwich 15.4 1.59 0.22 0.41 0.06 0.15 0.20 0.09 — 0.46 1.19 138 Lewisham 13.7 1.70 0.09 0.23 0.12 0.33 0.47 0.06 — 0 41 1.06 122 Woolwich 15.1 1.93 0.31 0.33 0.07 3.19 0.42 0.11 — 0.50 1.49 125 In this Table 0 00 indicates that the deaths were too few to give a rate of 0.005; where no death occurred, — is inserted. *Originally termed Simple Continued Fever. 32 Table 10. Death rates in London and the several Metropolitan Boroughs from All Causes, and from Certain Diseases during the year 1902 before Distribution, and after Distribution of Deaths in Public Institutions. Boroughs. Death-rates per 1000 Living. All Causes. Scarlet Fever Diphtheria Phthisis Before Distribution. After Distribution Before Distribution After Distribution Before Distribution After Distribution Before Distribution After Distribution County of London 17.7 17.2 0.12 0.12 0.25 0.25 1.64 160 West Paddington 15.7 14.6 0.01 0.06 0.15 0.22 0.99 1.05 Kensington 17.2 15.3 0.01 0.12 0.04 0.11 2.09 1.29 Hammersmith 13.8 16.3 0.01 0.06 0.11 0.20 0.86 1.43 Fulham 17.8 17.1 0.40 0.13 0.68 0.35 1.53 1.38 Chelsea 25.2 18.0 — 0.11 0.07 0.17 3.15 1.45 City of Westminster 15.8 16.1 0.03 0.08 0.05 0.16 1.25 1.78 North. St. Marylebone 15.6 18.3 — 0.10 0.10 0.20 1.14 1.92 Hampstead 14.2 10.8 1.15 0.08 1.29 0.12 1.40 0.85 St. Pancras 18.6 18.6 0.02 0.20 0.13 0.45 1.93 1.88 Islington 16.1 16.4 0.03 0.12 0.13 0.30 1.68 1.50 Stoke Newington 11.2 13.4 — 0.10 0.06 0.11 1.07 1.26 Hackney 15.6 15.0 0.05 0.07 0.55 0.27 1.43 1.43 Central. Holborn 21.6 21.3 0.02 0.13 0.39 0.17 2.27 3.01 Finsbury 14.0 22.9 0.01 0.15 0.03 0.37 1.22 2.28 City of London 36.9 20.4 0.04 0.04 0.38 0.38 1.92 1.69 East. Shoreditch 20.2 20.7 0.01 0.07 0.04 0.21 1.84 1 81 Bethnal Green 19.1 20.8 0.02 0.14 0.10 0.25 2.23 1.97 Stepney 20.4 20.6 0.01 0.10 0.19 0.28 1.64 1 90 Poplar 19.7 19.3 0.03 0.12 0.16 0.33 1.97 1.70 South. Southwark 17.9 21.4 0.01 0.20 0.12 0.30 1.42 2.62 Bermondsey 17.5 20.8 0.02 0.14 0.06 0.23 1.70 1.88 Lambeth 17.9 17.4 0.16 0.15 0.25 0.17 1.61 1.70 Battersea 14.3 15.0 0.01 0.14 0.03 0.10 1.26 1.31 Wandsworth 12.5 13.5 0.34 0.09 0.41 0.27 0.91 0.90 Camberwell 17.4 16.3 0.01 0.15 0.08 0.31 2.22 1.51 Deptford 13.4 16.5 0.34 0.17 0.76 0.18 0.71 1.12 Greenwich 20.1 15.4 0.43 0.06 0.94 0.15 1.74 1.19 Lewisham 14.6 13.7 0.54 0.12 0.59 0.33 1.03 1.06 Woolwich 13.8 15.1 — 0.07 0.03 0.19 1.39 1.49 33 * TABLE 11. Causes of, and Ages at, Death in the Borough for the year 1902. Causes of Death. Deaths Whole Borough Borough Divisions Under 1 year 1 and under 5 years 5 and under 15 years 19 and under 29 years 29 and under 69 years 69 years and over Total all Ages [ Deaths of Residents outside Borough Deaths of Non-residents in Borough Lee Lewisham Sydenham and Forest Hill Public Institutions in Borough Class I.—Infectious Diseases 1 2 3 4 5 6 7 8 9 10 11 12 13 1 Small Pox 2 — — 2 8 — 12 12 — — 11 1 — 2 Measles 4 22 — 1 — — 27 7 2 14 11 8 3 Scarlet Fever — 9 6 1 1 — 17 5 59 2 11 4 69 4 Typhus Fever — — — — — — — — — — — — — 5 Plague — — — — — — — — — — — — — 6 Influenza 4 — — 2 7 17 30 — 2 7 13 10 3 7 Whooping Cough 28 33 2 — — — 63 1 1 7 33 23 1 8 Diphtheria 1 22 17 3 1 — 44 21 55 9 18 17 68 9 Enteric Fever — — 2 4 3 — 9 — 14 3 4 2 16 10 Epidemic Diarrhœa 22 1 — — — — 23 — — 2 15 6 1 11 Epidemic Enteritis 31 1 — — — — 32 1 — — 23 9 12 12 Dysentry — — — — — — — — — — — — — 13 Venereal Diseases 3 1 — — 2 — 6 2 — — 2 4 — 14 Puerperal Septicœmia — — — — 6 — 6 — — — 3 3 2 15 Infective Endocarditis — — — 1 — — 1 1 — — 1 — — 10 Erysipelas 2 — — 1 2 4 9 — — 1 6 2 2 17 Septicœmia not Puerperal — — — — 1 — 1 — 2 — 1 — 2 Class III.— Class IV.— Malign- Class II.— Nervous ant Tuberculous Diseases Diseases Diseases 18 Pysemia — — 1 2 1 — 4 — — 2 2 — 3 19 Other Septic Diseases 2 1 — — — — 3 — — — 2 1 1 20 Phthisis 1 4 4 32 96 5 142 9 5 18 80 44 39 21 Meningitis 4 12 3 — — — 19 1 1 5 8 6 5 22 Peritonitis 1 — — — — — 1 — — 1 — — 1 23 Scrofula — — — 1 — — 1 — — 1 — — — 24 Other Tuberculous Dis. 13 8 4 7 7 — 39 3 2 2 17 20 12 25 Cancer, Carcinoma — — — — 66 38 104 6 8 13 51 40 19 26 Sarcoma — — — — 2 2 4 — — 2 1 1 1 27 Other Malignant Diseases — — — — 11 8 19 — 1 4 9 6 5 28 Meningitis (not Tuber.) 5 7 3 1 3 — 19 2 — 3 12 4 4 29 Insanity (G. P. Insane) — — — — 4 17 21 4 3 1 11 9 14 30 Epilepsy — 1 — 2 2 1 6 1 1 2 3 1 2 31 Convulsions 51 12 2 — — — 65 — — 10 34 21 1 32 Locomotor Ataxy — — — — 2 1 3 — — — 2 1 1 33 Paraplegia, Dis. of Cord — — 1 — 3 7 11 2 — 4 3 4 — 34 Other Nervous Diseases — — 2 2 10 5 19 4 1 2 14 3 7 Class V.— Diseases of Heart and Blood Vessels 35 Valvular Disease, Endocarditis 1 — 8 3 23 14 49 3 4 3 28 18 15 36 Cerebral Hœmmorrhage — — — — 25 41 66 1 16 7 30 29 27 37 Thrombosis — — — — — — — — — — — — — 38 Apoplexy, Hemiplegia — — — — 2 2 4 — — 1 1 2 1 39 Aneurysm — — — — 3 — 3 2 — — 2 1 1 40 Embolism 1 1 1 41 Thrombosis, not Cerebral — — — — 2 — 2 - — 1 1 — — 42 Other Dis. Heart and Blood Vessels 6 1 5 2 40 45 9S 5 16 12 54 33 25 * Continued on Page 34. 34 TABLE 11—continued. Causes of Death Deaths Whole Borough Borough Divisions Under 1 year 1 and under 5 years 3 and under 15 years 18 and under 23 years 23 and under 63 years 63 years and over Total all Ages Deaths of Residents outside Borough Deaths of Non-residents in Borough Lee Lewisham Sydenham and Forest Hill Public Institutions in Borough Class VI.— Respiratory Diseases 1 2 3 4 5 6 7 8 9 10 11 12 13 43 Croup (not Spasm or Membranous) 3 — — — — — 3 — — 1 — 2 — 44 Bronchitis 17 11 1 — 31 65 125 2 13 15 68 42 38 45 Pneumonia 34 27 4 4 32 16 117 6 6 13 73 31 20 46 Asthma Emphysema — — — — 3 9 5 — — — 2 3 — 47 Pleurisy — — — — 3 3 6 — — 2 1 3 — 48 Other Respiratory Dis. 7 6 1 — 5 — 19 1 — 3 9 7 3 Class VII.— Digestive Diseases 49 Enteritis (not Epidemic) 10 1 — — 3 — 14 1 2 1 8 5 2 50 Gastro Enteritis 18 1 1 — — 1 21 — — 1 17 3 4 51 Peritonitis (not Puerperal — — — — — — — — — — — — — 52 Cirrhosis of Liver — — — 1 10 7 18 2 — 3 9 6 1 53 Gastric Ulcer (Perforation of) — — 1 1 2 — 4 — — 2 2 — 2 54 Other Digestive Diseases 53 8 6 5 25 12 108 4 3 6 67 34 38 Class VIII.— Class Urinary IX. Diseases 55 Nephritis, Acute — — 1 1 12 1 15 — — 1 6 8 2 56 Brights Disease — — — — 13 11 24 1 1 3 16 5 4 57 Other Urinary Diseases 1 1 1 — 17 8 28 — 1 2 14 12 7 58 Generative Organs, Discases of — — — 1 2 1 4 1 1 2 2 — 1 59 Old Age — — — — 1 111 115 2 15 23 52 37 41 Class X.— General Diseases _i 60 Premature Birth 78 — — — — — 78 1 — 5 46 27 2 61 Chronic Rheumatism — — 1 — — 1 2 1 — — — 2 1 62 Rheumatic Fever — 1 1 — 6 — 8 — 1 1 4 3 1 63 Parturition, Diseases and Accidents of 1 — — 3 5 — 9 — — — 7 2 2 64 Alcoholism — — — — 10 — 10 — 1 — 7 3 7 65 Gout — — — — — 1 1 — — 1 — — — 66 Diabetes Melletus — — — — 4 4 8 — — — 3 5 1 31ass XI.— Accidents 67 All Other Diseases 14 4 3 1 8 10 40 2 1 4 22 14 10 68 Burning 1 1 1 — — 1 4 — — — 2 2 1 69 Overlaying 9 1 — — — — 10 — — — 7 3 — 70 Poison — 1 — — — — 1 — — — — 1 — 71 Drowning — 1 1 — — — 2 — — — 2 — — Class XII.— violence 72 Other Accidents 1 1 3 1 11 8 25 5 3 2 18 5 8 73 Homicide — — — — — — — — — — — — — 74 Suicide — — — — 11 1 12 2 — — 7 5 4 Grand Totals 428 200 86 86 547 471 1818 117 241 220 991 607 568 Note—Columns 1 to 8, and 10, 11, and 12 include deaths of Residents in the Borough, in outside Districts and in Public Institutions. 35 Table 12. Residents and Non-Residents dying in Public Institutions situated in the Borough. Institution. Deaths of Residents. Deaths of NonResidents. Total The Park Hospital 28 189 167 Lewisham Infirmary 281 20 301 St. Olave's Workhouse 1 61 62 St. John's Hospital 10 13 23 Home for Sick Children, Lower Sydenham 7 7 14 Flower House Asylum — 1 1 Totals 327 241 568 36 Table 13. Deaths from Principal Zymotic Diseases in Wards, during the year 1902. Localities Small Pox Measle Scarlet Fever Diphtheria Whooping Cough Enteric Fever Epidemic Diarrhoea Totals Death Kates Principal Zymotic Diseases. Church Ward — — 1 3 3 — — 7 1.07 Manor Ward — 1 1 5 1 1 1 10 1.4 South Ward — 1 — 1 3 2 1 8 1.4 Lee Division — 2 2 9 7 3 2 25 1.3 Blackheath Wd. — 1 — 2 6 1 2 12 1.77 Lew. Vill. Wd. — — 1 1 4 2 3 11 0.88 Lew. Pk. Wd. 2 2 2 4 5 — 6 21 1.72 Brockley Ward 2 — 2 6 1 — 6 17 1.52 Catford Ward 7 11 6 5 17 1 21 68 2.10 Lewisham Div. 11 14 11 18 33 4 38 129 1.85 Forest Hill Wd. — 3 — — 9 6 18 0.99 Sydenham Ward 1 8 4 17 14 2 9 55 2.13 Sydenham and Forest Hill Div. 1 11 4 17 23 2 15 73 1.66 Whole Borough 12 27 17 44 63 9 55 227 1.7 County of London 1314 2360 560 1159 1876 541 2470 10280 2.21 76 Great Towns 1764 7441 2870 3924 5579 2336 8108 32022 2.12 37 Table 14. Death Rates from principal Zymotic Diseases and Phthisis, ana Infantile Mortality in the Borough and its Divisions, in the County of London, and in the 76 Great Towns, for the Year 1902. Disease. Lee Division. Lewisham Division. Sydenham and Forest Hill Div. Whole Borough County of London. 76 Great Towns. Small Pox 0.15 0.02 0.09 0.28 0.12 Measles 0.10 0.20 0.25 0.23 0.51 0.49 Scarlet Fever 0.10 0.15 0.09 0.12 0.12 0.19 Diphtheria 0.47 0.25 0.38 0.33 0.25 0.26 Whooping Cough 0.36 0.47 052 0.47 0.40 0.37 Enteric Fever 0.15 0.05 0.04 0.06 0.12 0.15 Epidemic Diarrhœa and Enteritis 0.10 0.54 0.34 0.41 0.53 0.54 Total Zymotic Death Rates 1.82 1.85 1.66 1.70 2.21 2.12 Infantile Mortality Rate 72 142 111 122 139 145 Phthisis Death Rate 0.89 1.16 1.0 1.06 1.60 — Comparative Rates for other Boroughs will be found in Table 9. 38 Table 15. Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1902. Ages. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Epidemic Diarrhoea and Enteritis Totals in Age Groups. Under 1 year 2 4 — l 29 — 53 88 1 and under 5 years — 22 9 22 83 — 2 88 5 and under 15 years — — 6 17 2 2 — 27 15 and under 25 years 2 1 1 8 — 4 — 11 25 years and upwards 8 — 1 1 — 8 — 13 Total all ages 12 27 17 44 63 9 55 227 Note.—Typhus Fever should be included in the list of Principal Zymotic Diseases. It is omitted in the above table, as no cases occurred during the year. Part 2. INFECTIOUS DISEASES. 41 NOTIFIABLE INFECTIOUS DISEASE. The total number of notifications received during the year amounted to 1,316, thirty-four of which were returned from hospital as not suffering from any infectious disease. After deducting this number a corrected total of 1,282 is obtained, compared with 915 in 1901. No figures are available for correction amongst cases treated at home. The notifiable infectious diseases are Small Pox, Cholera, Diphtheria, Membraneous Croup, Erysipelas, the disease known as Scarlatina or Scarlet Fever, and the fevers known by any of the following names:—Typhus, Typhoid, Enteric, Relapsing, Continued or Puerperal. (Section 55 of the Public Health (London) Act, 1891). Table 16. Number of Notifications of Infectious Disease in Divisions of and, for the whole Borough during the four Quarters of the Year 1902. Disease. Lee Division. Lewisham Division. Sydenham and Forest Hill Div. Whole Borough. Quarters. Whole Year. Quarters. Whole Year. Quarters. Whole Year. Quarters. Whole Year. 1st. 2nd 1 3rd 4th 1 st 2nd 3rd 4th I st 2nd 3 rd 4th I st 2nd 3rd 4th Small Pox 12 2 — — 14 30 10 6 — 46 7 17 — — 24 49 29 6 — 84 Scarlet Fever 88 22 19 2H 107 64 113 59 115 351 29 49 46 55 179 131 184 124 198 637 Diphtheria&Membranous Croup 36 16 16 10 78 60 72 39 39 210 13 13 34 28 88 109 101 89 77 376 Enteric Fever 5 1 1 — 7 7 9 10 6 32 3 3 5 9 2C 15 13 16 15 59 Erysipelas 7 4 1 5 17 15 11 15 18 59 10 8 6 12 36 32 23 22 35 112 Puerperal Fever — — — — — 1 2 2 3 8 3 2 — 1 6 4 4 2 4 14 Total 98 45 39 48 223 177 217 131 181 706 65 92 91 105 353 340 354 259 329 1282 42 TABLE 17. Notifications of Infections Disease in Wards and whole Borough during the year 1902. Disease. WARDS. Whole Borough Church Manor South Blackheath Lewisham Village Lewisham Park Brockley Catford Forest Hill Sydenham Small Pox 9 4 1 4 5 12 5 20 1 23 84 Scarlet Fever 33 46 28 35 37 64 49 166 56 123 637 Diphtheria 22 35 21 16 28 39 58 69 17 71 376 Enteric Fever 2 2 3 3 6 6 7 10 3 17 59 Erysipelas 5 6 6 4 13 11 6 25 11 25 112 Puerperal Fever — — — — — — 3 5 2 4 14 Total 71 93 59 62 89 132 128 295 90 263 1282 TABLE 18. Attack rates from the Principal Infectious Diseases per 1000 of the population for the ten Wards and the Whole Borough for the year 1902. Disease. WARDS. Whole Borough Church Manor South Blackheath Lewisham Village Lewisham Park Brockley Catford Forest Hill Sydenham Small Pox 1.37 0.53 0.18 0.58 0.35 0.96 0.44 0.78 0.05 0.89 0.63 Scarlet Fever 5.05 6.69 5.06 5.17 2.62 5.16 4.40 6.55 3.09 4.78 4.81 Diphtheria 3.37 5.09 3.79 2.36 1.98 3.14 5.21 2.72 0.93 2.76 2.83 Enteric Fever 0.30 0.30 0.54 0.44 0.42 0.48 0.62 0.39 0.16 0.66 0.44 Erysipelas 0.76 0.87 1.08 0.59 0.92 0.88 0.53 0.98 0.60 0.97 0.84 Puerperal Fever — — — — — — 0.26 0.19 0.11 0.15 0.10 Total 10.87 13.53 10.66 9.16 6.32 10.65 11.51 11.6 4.96 10.22 9.68 43 Table 19. Number of Notifications of Small Pox, Scarlet Fever, and Diphtheria in the Metropolitan Boroughs and the County of London during the year 1902. Borough Small Pox. Scarlet Fever. Diphtheria. No. Attack Rate. No. Attack Rate. No. Attack Rate. Paddington 113 0.77 364 2.50 222 1.52 Kensington 99 0.55 378 2.12 186 1.04 Hammersmith 100 0.87 353 3.08 182 1.58 Fulham 94 0.65 553 3.86 429 2.99 Chelsea 39 0.52 204 2.75 133 1.79 Westminster 232 1.28 475 2.62 285 1.57 St. Marylebone 155 1.16 414 3.13 237 1.79 Hampstead 20 0.23 254 3.04 98 1.17 St. Pancras 360 1.52 1219 5.17 836 3.54 Islington 302 0.89 1379 4.09 881 2.61 Stoke Newington 51 0.98 202 3.97 99 1.91 Hackney 424 1.91 883 3.97 720 3.24 Holborn 219 3.74 203 3.46 118 1.99 Finsbury 211 2.09 392 3.89 238 2.38 City of London 39 1.52 83 3.24 97 3.78 Shoreditch 442 3.74 250 2.12 233 1.96 Bethnnl Green 515 3.96 529 4 07 323 2.49 Stepney 1387 4.58 1069 3.56 780 2.59 Poplar 630 3.72 670 3.95 470 2.77 Soutlnwark 517 2.50 1099 5.30 538 2.60 Bermondsey 224 1.72 506 3.88 283 2.17 Lambeth 362 1.18 1354 4.44 488 1.60 Battersea 189 1.10 893 5.21 294 1.71 Wandsworth 131 0.54 1080 4.46 758 3.13 Camberwell 356 1.35 1390 5.29 693 2.63 Deptford 145 1.29 648 5.81 268 2.40 Greenwich 102 1 04 463 4.72 183 1.16 Lewisham £4 0.63 637 4.88 376 2.84 Woolwich 236 1.96 279 2.32 252 2.10 County of London 7796 1.67 18252 3.98 10731 2.32 44 Small Pox.—The outbreak which occurred in 1901 continued in 1902. In the County of London 7,796 cases were notified, equal to an attack rate of 1.67 per thousand persons living. In the Borough of Lewisham only 84 cases occurred, showing an attack rate of 0.63 per thousand. Compared with other London Boroughs Lewisham was most fortunate, only four districts having a lower attack rate, i.e., Hampstead 0.28 (20 eases), Chelsea 0.52 (39 cases), Wandsworth 0.54 (131 cases), and Kensington 0.55 (99 cases). The highest attack rates were those of Stepney 4.58 (1,387 cases), Bethnal Green 3.96 (515 cases), Shoreditch 3'74 (442 cases), and Poplar 3'72 (630 cases). (See Table 19.) On sub-dividing the cases of Small Pox over the Wards of the Borough, Church Ward was most affected, having an attack rate of 1.37, and Forest Hill Ward the least, 0.05 (See Table 18). The first case in 1902 occurred on January 1st, the origin being a previous case in the same house, in Sydenham. It was not until the 26th of January that the second case occurred in the Borough. The source of infection (a new one) was traced to the Small Pox Hospitals at Long Reach, where the man had been employed up to the onset of his illness. The danger of workmen residing in our District and working at the Small Pox Hospitals soon became evident, and greatly increased our anxiety. A large number of carpenters and bricklayers, residents of the district, were employed at the Small Pox Hospitals. Eight of the men so employed contracted the disease at their work, and there is little doubt that they, on returning to their houses, conveyed infection which was responsible for many of our cases. The Hospital authorities were undoubtedly seriously pressed for accommodation for the large number of cases occurring in London, as they were not prepared with 45 sufficient hospital accommodation to meet the demands made upon them at the beginning of the outbreak. It was unfortunate for this and probably other Boroughs that the workmen were employed prior to re-vaccination. The following precautions instituted in 1901 to prevent the spread of the outbreak in Lewisham were adhered to in nearly every particular:— PRECAUTIONS INSTITUTED IN 1901. The general precautious taken to prevent the spread of Small-Pox were as follows:— (а) 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 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 inlected 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 conducted 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. (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. 46 (A) 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. (I) Contacts were kept under observation for sixteen days, and employeis 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 observation. I was prepared at any hour to visit suspected cases when desired by the various Medical Practitioners of the Borough. My opinion was invited in the majority of cases detailed in this report, and in a much greater number of cases not Small Pox, in which the medical attendant had good grounds for suspicion. In order to render the report in regard to Small Pox complete, brief details of the six cases of 1901 are repeated, in addition to the particulars of cases occurring during 1902. SMALL POX CASES, 1901. *Case A. —H. C., male, aged 15. Vaccinated. Sickened at 51, Brownhill road. Removed to Hospital September 29th. Recovered. Case B.—J. G., male, aged 22. Unvaccinated. The patient had only resided in the Borough three days; he previously lived in Camberwell. Fourteen days prior to his illness he visited his brother at the Small Pox Hospital. He was removed to Hospital from 62, Devonshire Road, October 14th. Refused vaccination at Metropolitan Asylums Board Hospital. Recovered. 47 *Case C.—P. B. S., male, aged 5. Unvaccinated. Sickened at 120, Sydenham Road. The patient recently arrived from Australia with his parents and brother. Removed to hospital December 12th. Recovered. *Case D.—C. B., male, aged 3. Brother of Case C. Vaccinated during incubation. This case was found by your Medical Officer by keeping daily observations upon the family and contacts. Origin, Case C. Recovered. *Case E.—Ch. J. C., male, aged 28. Occupation, stoker, Crystal Palace District Gas Co. Vaccinated. Sickened at 31, Holmshaw Road, Sydenham. Removed to Hospital December 23rd. Origin unknown. Recovered. All gas stokers who had been in contact were offered vaccination, but very few accepted the offer fearing they might be incapacitated from work. *Case F.—E. W., female, aged 28. Dressmaker. Vaccinated. Sickened at 122, Sydenham Road. Removed to Hospital December 25th. Source of infection, Case C. in next house. SMALL POX CASES, 1902. *Case 1.—E. P., female, aged 46. Vaccinated in infancy and during incubation. Sickened at 122, Sydenham Road. Disease contracted from Case F. Removed to Hospital January 3rd. Recovere 1. Case was discovered while under observation as a contact. *Case 2.—W. W., male, aged 57. Vaccinated. Carpenter working at Long Reach Hospital until illness. Sickened January 20th at 33, Knowles Hill Crescent. Rash appeared January 24th. Removed January 25th to Hospital. Recovered. The wife was without means and under notice to quit her lodgings. She was therefore removed to the Council's Cottage Hospital and kept under observation as contact. 48 *Case 3.—T. B., male, aged 20. No evidence of vaccination. Sickened February 7th at 36, Ladywell Park. Rash appeared February 13. Removed to Hospital February 13th. Carpenter employed until onset of illness at Small Pox Hospitals at Dartford. Result, fatal. *Case 4.—H. B., male, aged 23. Fell ill March 12th. Rash appeared March 14. Removed to Hospital same day from 5, The Pavement, Southend Lane. Was engaged as Labourer at Long Reach and Joyce Green Small Pox Hospitals. Vaccinated in infancy. Recovered. *Case 5.—W. M., male, aged 30. Vaccinated in infancy. Fell ill February 16th, at 27, Woodlands Street, Hither Green. Removed to Hospital February 19th, the date of rash. Clerk in District Messenger Office, Victoria Street. Origin unknown. Fatal. *Case 6.—M.E., female, aged 38. Vaccinated in infancy. Fell ill February 15th, at 34, Sydenham Hill. Rash appeared February 20th. Removed same day to Hospital. Cook. Origin probably Woolwich. Recovered. *Case 7.—H. W., male, aged 4 years. Unvaccinated. Fell ill at 77, Farley road, on February 16th. Rash appeared February 19th. Removed to Hospital February 20th. Origin unknown. Recovered. *Case 8.—A. C., male, aged 22. Vaccinated in infancy. Fell ill February 23rd, at 18, Maybank Cottages. Rash appeared February 24th. Removed to Hospital February 25th. Labourer employed at Small Pox Hospitals. Recovered. *Case 9.—W. R., male, aged 26. Vaccinated in infancy. Fell ill February 26th, at 28, Elthrada road. The case at time of visit was suspicious. He was removed on February 28th to the Council's Hospital to await further development and to 49 avoid risk to occupants. On March 3rd the case was sufficiently distinct to warrant his transference to the Metropolitan Asylums Board Hospital. Signalman on South-Eastern Railway. Origin unknown. Recovered. *Case 10.—G. R., male, aged 40. Vaccinated in infancy. Fell ill February 25th, at 83, Lewisham Road. Rash appeared February 28th. Removed to Hospital March 2nd. City Missionary constantly employed in the poorest part of Stepney. Origin, contact with Small Pox in Stepney. Recovered. *Case 11.—Male, aged 35. Vaccinated. Fell ill March 1st at 77, Farley Road. Occupation, Miller. Removed to Hospital March 2nd. Origin, previous case in house. Recovered. *Case 12.—B. W., male, aged 4 months. Vaccinated during incubation. Fell ill at 77, Farley Road, and removed to Hospital March 2nd. Origin, previous case in house. Fatal. Case 13.—R. T., male, aged 37. Vaccinated in infancy. Fell ill February 21st at 129, Leahurst Road. Rash February 26th. The usual Medical Attendant was away from home and the locum tenens considered the case one of influenza, and treated it as such for a week, when the principal returned and notified the case as Small Pox. The patient was employed as a carpenter at Gore Farm Small Pox Hospital up to February 22nd. A list of persons with whom he had been in contact from the earliest period of his illness was obtained. They were visited and kept under daily observation. Case 14.—W. D., male, aged 22. Vaccinated in infancy. Sickened at 32, Boone's Road. Fell ill February 23rd. He was treated for influenza by the locum tenens mentioned in Case 13. The case was not recognized until the return of the principal, who immediately certified the case. The patient was removed to Hospital March 6th, but not before he had infected other 50 persons. The patient was employed as a railway porter at Hither Green Station, and stated he was frequently brought into contact with workmen employed at the Small Pox Hospital, an incident accountable probably for the infection. W. D. resided with his mother, who carried on the business of a domestic laundry at the above address. Laundry work was carried on in the house until March 3rd, on which date all the work in hand was transferred to the next house (also a domestic laundry). This course was taken by the mother, who on this date first had suspicions as to the nature of the illness. On visiting the premises on March 6th, immediately after a telephone message from the medical attendant certifying the case, I endeavoured to obtain a list of customers from the proprietors of each laundry. This list was refused, and, on threatening proceedings, a few names wore given which did not account for the amount of work in hand. Directions were given to remove all laundry and textile materials from both houses to the disinfecting station for disinfection. This was carried out. The laundry after disinfection was purposely mixed. The proprietors of each laundry were then requested to send representatives to sort the materials according to the various owners. In this way we obtained the names and addresses of the various customers. We refused to return the articles to the laundry, and communicated the circumstances to each owner, giving them an opportunity of refusing the articles if they preferred to do so. Both laundries were stripped, disinfected and cleansed, and some of the workers re-vaccinated. Vaccination or re-vaccination was obstinately refused by members of W. D.'s family, in spite of persuasion by their doctor, the Vaccination Officer and myself, the patient's mother being chiefly responsible for the refusal. The result of this refusal was unfortunate. (See Cases 29, 38, 89, 40 and 51). None of the future cases occurring in the district were traced to the clothing referred to above. The 51 advisability of proceedings under the Factory and Workshop Act was considered, but in view of the fact that the temporary Medical Attendant did not suspect the case to be small pox, the occupiers could not be expected to be aware of the nature of the illness. This case, Lowever, illustrates the necessity of power being granted to compel the owners of laundries to supply a correct list of the names and addresses of their customers should a case of scarlet fever or small pox occur in any dwellinghouse or building occupied with the premises where any wearing apparel is made, cleansed, or repaired. The delay in the diagnosis in this case was responsible for several others. The patient recovered. *Case 15. J. S., male, aged 35. Vaccinated in infancy. Occupation, gardener. Sickened March 3rd at 20, Taunton Road. Rash, March 6th. Removed same day to Hospital. Origin of infection, probably Poplar. Recovered. *Case 16.—J. F., female, aged 30. Vaccinated in infancy. Sickened at 38, Harvard Road. Occupation, charwoman. Origin unknown. Recovered. *Case 17.—M. C., female, aged 17. Unvaccinated. Sickened at " The Vineries," Exbury Road, March 2nd. Rash appeared March 6th. Removed to Hospital March 7th. Occupation, typist in City. No members of the family had ever been vaccinated, an 1 refused all offers when this case occurred. Source of infection, possibly contact in London or train. Result, Hæmorrhagic case, fatal. *Case 18.—E. C., female, aged 36. Vaccinated in infancy. Sickened at 25, Russell Street, March 2nd. Removed to Hospital March 6th. Occupation, laundress carrying on a small business at home. Action taken was similar to Case 14. No history of contact with other cases. Result, fatal. 52 *Case 19.—S. E., female, aged 42. Vaccinated. Sickened March 3rd at 22, Burghill Road. Rash appeared March 7th. Removed to Hospital March 8th. Occupation, independent. Source of infection uncertain. Probably contact in London. Recovered. *Case 20.—J. C., male, aged 35. Vaccinated in infancy. Sickened March 6th at 52, Farley Road. Removed to Hospital March 8th. Occupation, coppersmith at Woolwich Arsenal, where he worked until March 5th. Several cases occurred in his department at Woolwich. Result, recovered. ' *Case 21.—C. H., aged 46, male. Vaccinated in infancy. Sickened, at 44 Beacon Road, March 4th. Removed to Hospital March 8th. Labourer employed at Small Pox Hospitals, Joyce Green, until March 4th. Recovered. Case 22.—E.S., female, aged 18. Vaccinated in infancy. Fell ill March 3rd at 1, Brandram Road. Removed to Hospital March 9th. Occupation, housekeeper. Had been visiting Boone's Road. Recovered. Case 23.—L. A. W., male, aged 45. Vaccinated in infancy. Sickened at 38, Lansdowne Road. Removed to Hospital March 9th. Returned to his home ill on March 3rd from 10, Victoria Road, Bexley, where he contracted the disease. Recovered. Case 24.—J. W., aged 57, male. Vaccinated in infancy. Sickened at 3, Hanover Street. Removed to Hospital March 11th. Occupation, bootmaker- Source of infection unknown. Recovered. *Case 23.—J. A. Male, aged 37. Vaccinated in infancy. Sickened at 9, Dacre Street, March 11th. Removed to Hospital. Occupation, plumber engaged at Small Pox Hospitals, Gore Farm, until onset of illness. Recovered. 53 Case 26.—S. J. H., male, aged 3. Unvaeeinated. Sickened at 7, Dallas Road. Removed to Hospital March 11th. Origin unknown. Recovered. Case 27.—E. M. C., female, aged 16. Vaccinated in infancy. Sickened March 11th at 13, Blackheath Rise. Removed to Hospital March 11th. Occupation, domestic servant. Origin of infection unknown. Recovered. Case 28.—F. H., male, aged 22. Vaccinated in infancy. Sickened March 8th at 14, Hedgeley Street. Removed to Hospital, March 12th. Occupation, carpenter. Had been in contact with workmen employed at Gore Farm Hospital. Recovered. *Case 29.—A. D., male, aged 19. Vaccinated in infancy. Refused re-vaccination after contact with his brother (Case 14). Sickened at 32, Boone's Road. Removed to Hospital March 12th. Source of infection, brother (Case 14). Recovered. *Case 30.—E.C., female, aged 55. Vaccinated in infancy Sickened at 12, Porson Street. Occupation, laundress. Source of infection doubtful. Recovered. *Case 31.—A. D., female, aged 37. Vaccinated in infancy. Fell ill March 10th at 1, Slaithwaite Road. Removed to Hospital March 13th. Occupation, domestic servant. Visited South Street, Greenwich, a fortnight before illness. Recovered. *Case 32.—A. W., female, aged 37. Vaccinated. Fell ill March 10th at 322, Stanstead Road. Removed to Hospital March 13th. Origin doubtful. Recovered. Case 33.—W. S., male, aged 35. Vaccinated. Sickened March 10th at 5, Blackheath Vale. Removed to Hospital March 13th. Occupation, gardener. Source of infection unknown. Recovered. 54 Case 34.—A. W., male, aged 17. Vaccinated in infancy. Sickened March 11th, at 1, Sharstead Villas. Removed to Hospital March 13th. Occupation, errand boy. Source unknown. Recovered. *Case 35.—G. G., male, aged 49, Vaccinated in infancy. Sickened at 67, Elmira Street. Removed to Hospital March 14th. Occupation, bricklayer. For some weeks he had been working on buildings in the Old Kent Road. Source of infection unknown. Case 36.—J. C., male, aged 23. Unvaccinated. Sickened March 11th, at 12, The Pavement, Lady well. Removed to Hospital March 16th. Occupation, journeyman butcher. Source of infection unknown. Result, fatal. Case 37.—A. S., male, aged 29. Vaccinated in infancy. Sickened March 13th, at 144, Adelaide Road. Removed to Hospital March 15th. Occupation, Clerk at Ludgate. Travelled daily per S. E. Railway. Source of infection unknown. *Case 38.—F. D., male, aged 18. Refused vaccination as a contact of Case 14. Sickened March 13th, at 7, Royal Oak Place. Removed to Hospital March 15th. Occupation, porter, Woolwich Railway Station. Source of infection, Case 14 (brother), residing at 32, Boone's Road. Patient recovered. Case 39.—M. D., female, aged 61. Mother of previous case and Nos. 14 and 29. Refused re-vaccination as a contact. Sickened at 32, Boone's Road. Removed to Hospital March 16th. Origin, Case 14. Recovered. Case 40.—0. D., male, aged 25. Son of previous case. Refused re-vaccination as a contect of case 14. Sickened at 8, Lochaber Road, March 14. Remove! to Hospital March 16. Occupation, porter at Charing Cross Station. 55 *Case 41.—E. T., female, aged 27. Wife of Case 13. Vaccinated. Sickened March 15th. Removed to Hospital March 17th, from 129, Leahurst Road. Source of infection, previous case in house. Case 42.—H. W., male, aged 30. Vaccinated in infancy. Sickened March 16th, at 6, Chapel Yard. Removed to Hospital March 19th. Occupation, bricklayer engaged at Gore Farm Hospital, and lodging in Dartford. Returned to his home feeling ill on March 16th. Hospital infection. Case 43.—M. D., female, aged 23. Vaccinated in infancy. Sickened March 17th, at 77, Burnt Ash Hill, where she was in service Removed to Hospital March 20th. Source of infection doubtful. She had been travelling on S. E. Railway to visit friends in Plumstead. Case 44.—J. C., male, aged 50. Vaccinated in infancy. Refused re-vaccination as a contact with Case 17 (his daughter). Sickened March 22nd, at The Vineries, Exbury Road. Removed to Hospital March 24th. Daughter was removed to Hospital on March 7th. Mr. J. C. visited her a few days after her admission, and again refused re-vaccination at the Hospital. The date of onset of illness suggests that infection occurred on his visit to his daughter in Hospital. After this second case in the house tne contacts no longer refused vaccination. Result, recovered. *Case 45.—H. R., female, aged 10 years. Not vaccinated. Sickened March 21st, at 88, Glenfarg Road. Rash appeared March 23rd. This child was a member of a very poor family, and it was not until late at night, March 26th, that medical advice was called in. My opinion was immediately invited. I found the child suffering from Confluent Small Pox, in bed with her aunt. The examination of other members of the family lead to the discovery of Case 46. The child was removed to 56 the Hospital at 9 a.m. on March 27th. Source of infection: the head of the family had been in close contact with workmen employed at Gore Farm Small Pox Hospital. Recovered. *Case 46.—F. S., female, aged 26. Aunt to previous caseVaccinated in infancy. Sickened at 88, Glenfarg Road, and discovered on examining Case 45. Removed to Hospital March 27th. Close observation was kept upon contacts by personal daily visits to the house. Result, recovered. One occupant of the house, C. B., aged 68, was acting as Bailiff, and was in possession of premises in London. The Agents were communicated with, and his immediate return home effected. *Case 47.—H. M., male, aged 22. Vaccinated in infancy. Fell ill March 22nd, at 7, Springfield Park Crescent. Removed to Hospital March 27th. Occupation: This patient had up to the time of his illness been working at Gore Farm Small Pox Hospital, and returned home at night. A drapery business was carried on at his home premises. The whole stock was removed for disinfection. Result, recovered. *Case 48.—A. R. F., female, aged 80. Vaccinated in infancy. Sickened March 24th, at 188, Minard Road. Removed to Hospital March 28th. Source of infection, Mrs. A. of Loughborough Junction, who had been in contact with Small Pox cases, visited the patient on the 16th of March. Recovered. *Case 49.—A. R., female, aged 30. Sickened March 28th, at 88, Glenfarg Road. Removed to Hospital March 29th. Vaccinated as a contact after exposure to infection in Cases 45 and 46—two previous cases in the house. A. R. was discovered ill on March 8th during a personal visit to examine contacts at the address mentioned. On re-visiting the following morning the symptoms were sufficiently pronounced to order her removal to Hospital. Recovered. 57 Case 50.—A. G., female, aged 48. Vaccinated in infancy only. Refused re-vaccination. Sickened March 28th, at 67, Elmira Street. Removed to Hospital April 1st. Source of infection, previous case in house, husband—Case 35. Recovered. Case 51.—M. T., female, aged 62. Vaccinated in infancy. Refused re-vaccination as a contact. Sickened April 1st, at 30, Boone's Road. Removed to Hospital April 5th. Occupation, laundress. Source of infection, Cases in No. 32, Boone's Road. Recovered. Case 52.—J. J., male, aged 31. Vaccinated in infancy. Sickened April 1st, at 1, Gordon Terrace, Porthcawe Road. Removed to Hospital April 7th. Occupation, hawker in and about Belvedere, Bexley and Erith. Source of infection, doubtful. Recovered. *Case 53.—H. S., male, aged 6 months. Vaccinated as a contact. Sickened April 5th, at 88, Glenfarg Road. Removed to Hospital April 8th. Source of infection, three previous cases in house (45, 46, and 49). Discovered by personal daily observations of contacts. Fatal. *Case 51.—A. R., male, aged 1J years. Vaccinated as a contact. Sickened at 88, Glenfarg Road. Removed to Hospital April 8th. Discovered on visit to Case 53. Recovered. "Case 55.—L. R., male, aged 8. Vaccinated as a contact. Sickened at 88, Glenfarg Road. Removed April 8th. Five previous cases. Discovered same time as Case 53. Recovered. *Case 53.—C. B., male, aged 63. Vaccinated in infancy and re-vaccinated as a contact during incubation period. Sickened at 88, Glenfarg Road. On visiting the house on April 9th, I found C. B. who was apparently well on the previous day, in a serious condition. having severe hæmorrhages from various passages and under skin, and suffering from Hæmorrhagic 58 Small Pox. He was immediately removed to Hospital, where he died the same day. C. B. was the bailiff referred to as a contact in Case 46. This was the last person attacked at 88, Glenfarg Road. Seven cases occurred in three families, who were all related to one another. Case 57.—A. A., female, aged 34. Vaccinated. Sickened at 32, Handen Road. Removed to Hospital April 11th. Occupation, domestic servant. She entered service April 8th and fell ill on the 9th. Source of infection unknown. Nine contacts all accepted re-vaccination. Case recovered. *Case 58.—N. J., female, aged 3. Vaccinated in infancy. Re-vaccination refused. Sickened at 1, Gordon Terrace, Porthcawe Road. Removed to Hospital April 17th. Source of infection, father, Case 52. *Case 59.—K. J., female, aged 18. Vaccinated in infancy only. Sister of Case 58. Sickened at 1, Gordon Terrace, Portheawe Road. Removed to Hospital April 17th. Occupation flower seller. Source of infection, father, Case 53. Recovered. Case 60.—A. J., female, aged 40. Vaccinated in infancy. Refused re-vaccination after contact with Case 51. Sickened at 155, Ennersdale Road. Removed to Hospital April 22nd. Infection, Case 51, Boone s Road. Case 61.—E. J., male, aged 15. Vaccinated in infancy. Sickened April 20th at 155, Ennersdale Road. Removed to Hospital April 22. (See Case 60). Patient recovered. Case 62.—V. J., female, aged 9. Vaccinated in infancy. Sickened at 155, Ennersdale Road. Removed to Hospital April 22nd. (See Case 60). Recovered. *Case 63.—E. L., female, aged 28. Vaccinated in infancy. Sickened April 26th at 38, Sydenham Hill. I was invited 59 to see this case on April 29th. The symptons were in our opinion not sufficiently definite to warrant removal to Metropolitan Asylums Board Hospital. The case was taken to the Council's Cottage Hospital for observation on May 1st, and was transferred to the Metropolitan Asylums Board Hospital when all doubts were removed. Source of infection unknown. The patient, a lady of independent means, had not been out of the district for some weeks. Recovered. Case 64.—C. B., male, aged 38. Vaccinated in infancy. Fell ill April 28th at 18, Prospect Road, Sydenham. Removed to Hospital May 3rd. Occupation, compositor, Long Lane, E.C. Source of infection unknown Recovered. *Case 65.—H. J. W., male, aged 34. Vaccinated in infancy. Sickened May 2nd at 69, Hawstead road. Removed to Hospital May 5th. Occupation, printer, Chiswell Street. Source of infection unknown. Recovered. *Case 66.—T. E., male, aged 31. Vaccinated in infancy. Sickened May 1st at 85, Porthcawe Road. Removed to Hospital May 10th. This case occurred in a house occupied by several poor families. There were 15 immediate contacts, who were removed to the Council's Hospital for observation and disinfection until all risk of fresh cases occurring had ceased. The homes were disinfected and cleansed, and all filthy clothing destroyed and replaced. Result, T. E. recovered. While the contacts were at the Council's Hospital one of them developed Small Pox and was removed to the Metropolitan Asylums Board Hospital. (See Case 68). Case 67.—H. B., female, aged 33 (wife of Case 64). Vaccinated. Fell ill May 13th at 18, Prospect road. Removed to Hospital May 14. Source of infection, husband, Case 64. Recovered. 60 *Case 68.—L. E., female, aged 7. Vaccinated during incubation. Fell ill May 19th at Council's shelter. Rash appeared May 21st. Removed to Hospital same day. Source of infection, father, case 66. Recovered. *Case 69.—G. C., male, aged 20. Vaccinated. Fell ill May 18th, at 6, Mercy Terrace, Lewisham. Removed to Hospital May 21st. Occupation, gas stoker. Source of infection unknown. Recovered. *Case 70.—J. W. W., male, aged 22. Unvaeeinated. Sickened May 25th, at 10, Acacia Road. Removed to Hospital May 26th. Occupation, lamplighter. Source of infection doubtful. Recovered. Mangling work was done in the house, the last delivery home being on May 13th. The customers were advised of the case and offered re-vaccination. *Case 71.—E. T., female, aged 58. Vaccinated in infancy. Fell ill May 20th, at 13, Champion Park. Removed to Hospital May 26th. Occupation, midwife. This case was certified as chicken pox, but owing to the age of the patient I immediately applied to the medical attendant for permission to visit the case with him, which request was readily granted. We could not agree upon the diagnosis, and with his permission I took the responsibility of certifying the case as Small Pox and ordering her immediate removal to Hospital, where the diagnosis of Small Pox was confirmed. The case recovered. On interviewing other residents in the house I found a man ill in bed and without medical attendance. His symptoms were suspicious, and I visited him again on the following morning, when he showed distinct symptoms of Small Pox. (See Case 72). *Case 72.—A.P., male, aged 37. Fell ill May 23rd, at 13, Champion Park. Removed to Hospital May 27th. I discovered this case while investigating contacts with previous case. Occupation, gas stoker Crystal Palace Gas Works. This was 61 the third case among the Company's men. On the occurrence of the first case an effort was made to persuade the workers to consent to re-vaccination, and, in spite of the valued assistance and help of the Company, only one or two consented. The patient recovered. Case 73.—W. S. I., male, aged 8. Vaccinated in infancy. Fell ill at 10, Acacia Road, May 26th. Removed May 27th. Previous case in house. Recovered. Case 74.—V. I., female, aged 10. Vaccinated in infancy. Sickened at 10, Acacia road. Removed to Hospital May 28th. Previous cases in house, Nos. 70 and 73. Recovered. *Case 75.—J. H. G., male, aged 35. Vaccinated in infancy. Sickened May 28tli at 83, Trilby Road. Removed to Hospital June 2nd. Occupation, baker out of employment. He had been in all parts of London seeking employment. His wife carried on a small general business at the above address. The stock was destroyed, and the premises stripped, cleansed and disinfected. Recovered. Case 76—N. B., female, aged 24. Vaccinated in infancy. Refused re-vaccination. Removed to Hospital from 10, Acacia Road, on May 30th. (See Cases 70, 73, and 74). Recovered. Case 77.—E. P., female, aged 44. Vaccinated in infancy. Sickened at 4, Dillwyn Road, June 9th. Removed to Hospital June 11th. Source of infection, the patient frequently visited 10, Acacia Road, where Cases 70, 73, and 74 occurred. Recovered. *Case 78.—S. J. M., male, aged 15. Unvaccinated. Sickened June 24th at 31, Acacia Road. Removed to Hospital June 27th. Source of infection, probably 10, Acacia Road. Recovered. 62 *Case 79.—Mrs. M., female, aged 58. Stated vaccinated in infancy, no signs. Sickened June 23rd at 93, Hither Green Lane. Removed to Hospital June 29th. Source of infection, probably unrecognised case of daughter. The daughter was engaged at a cafe in Regent Street. At the end of May a resident charwoman was removed from the cafe, but was returned as not suffering from Small Pox. A fortnight later Miss M. had several spots, and came home for a few days, and returned to business without seeking medical advice. Twelve days after the daughter's arrival Mrs. M. was removed from Hither Green Lane to Hospital. The above facts were communicated to the Medical Officer of Health of the district referred to. The case was a severe one, terminating fatally. *Case 80.—B. E., female, aged 43. Vaccinated in infancy. Sickened May 18th at 60, Engleheart Road. Removed to Hospital July 21st. Source of infection doubtful. Fatal. *Case 81.—M. C., female, aged 54. Vaccinated in infancy only. Sickened July 18th at 50, Rushey Green. Removed to Hospital July 22nd. Source of infection doubtful. Haemorrhagic case. Fatal. Case 82.—W. P., male, aged 17. Vaccination doubtful. Sickened August 17th at 3, Howson Road, Brockley. Removed to Hospital August 22nd. Source of infection not traceable. Recovered. Case 83.—W. D. P., male, aged 47. Stated vaccination in infancy only. Refused re-vaccination. Sickened September 4th at 3, Howson Road. Removed to Hospital September 5th. Source of infection, Case 82. Hemorrhagic case. Fatal. Case 85.—E. P., female, aged 47. Wife of case 83. Removed to Hospital September 5th. Source of infection, case 82. Recovered. 63 The Diagnosis of Small Pox is often attended with the greatest difficulty, even to Medical Practitioners having had special experience in the disease, and it is satisfactory to note that the diagnosis in the 84 cases herein detailed was confirmed by the Hospital authorities. There were, however, three cases sent to Hospital which were returned as not suffering from Small Pox. The first was that of a tramp who was taken to Brockley Police Station. He was seen by a doctor, and immediately removed to Hospital. The special circumstances connected with the man's movements, the suspicious character of the rash and the difficulty of detaining the man for confirmation of the diagnosis justified, no doubt, the action taken. The second case was that of a lad who showed marked premonitary symptoms. His surroundings were such that in the interests of the business carried on by the family he was removed with the consent of his parents as a suspicious case. The third case was removed under similar circumstances to the second. Neither of these persons suffered any harm from their temporary removal. The following points are worthy of note :—The errors of diagnosis were most trivial; all cases were removed to Hospital, although not without difficulty in some instances; where the disease was recognised in its early stages, and the re-vaccination of contacts carried out, second cases in the house were rare. The effect of delayed diagnosis, due to the delay in seeking medical advice, was sometimes unfortunate, and necessitated the most careful and constant watchfulness over contacts. This is well illustrated in the cases at 88, Glenfarg Road, although the serious consequences only affected the 64 household. A less fortunate illustration is that of the mistaken diagnosis at Boone's Road, which caused so much mischief to others outside the house. (See Case 14.) The outbreak, as a whole, compared with the population of the district, was fortunately a limited one, only 6'8 persons being attacked in every ten thousand of the population residing in the Borough. That the outbreak of Small Pox was kept well in check, and did not assume the magnitude reached in many other districts, is, I think, a matter for congratulation. (See Table 19). Our good fortune in this respect was due principally to the prompt action taken by the Medical Practitioners in charge of the patients. In those cases where the disease was fairly distinct (50 per cent. of the actual cases) immediate removal to Hospital followed the receipt of the certificate. One hundred and thirteen suspected cases were, however, less easily disposed of, the symptoms or the character of the rash leading to considerable doubt. In these cases the medical attendants were good enough to invite my assistance in consultation, which resulted in my confirming their suspicions and obtaining removal to Hospital of the cases marked thus (*) in the detailed report. In 63 cases we were able to remove the suspicion. That I was able to help in the diagnosis was due to the experience gained in a former position, that of Medical Superintendent of the Southampton Small Pox and Fever Hospitals. I desire to take this opportunity of acknowledging the unvarying courtesy shown me by the Medical Practitioners who had charge of the cases referred to. CONTACTS.—The daily observation of contacts with our own cases, plus residents in the Borough who had been in 65 contact with cases outside, was no light task. From January 3rd to September 19th between seven and eight hundred contacts were kept under daily observation at their homes. As a result the early discovery and removal of certain secondary cases followed. The Council's Cottage Hospital was most useful for the housing of certain contacts, and also for the detention of cases requiring further observation before the nature of the suspected illness could be decided. One cannot close this section of the report without stating that the admirable arrangements made by the Metropolitan Asylums Board were of the greatest value. The despatch with which removals were carried out at any hour deserves the highest commendation. I venture to predict, however, that unless the Board are prepared to make special arrangements for the classification of their patients it will be difficult to obtain the hospital isolation of all Small Pox patients in the future. It is, I know, impossible to show any distinction in a general ward, but the provision of special wards for paying patients would, I believe, be a solution of the difficulty. If the more wealthy patients leave the luxury and comfort of their homes in order to protect their neighbours, they should be entitled to the benefits afforded by private wards when they are prepared to pay for their use. The examination of the Street List showing the incidence of certain infectious diseases is most interesting in regard to Small Pox. It shows that during the outbreak there were 59 houses attacked, or 59 centres of infection, from any one of which the disease would have spread if not promptly dealt with. 66 CHICKEN POX.—The London County Council, declared Chicken Pox a notifiable disease on May 6th, 1902, and this order remained in force until January 7th, 1903. This action was taken owing to the difficulty which sometimes exists in distinguishing between some mild cases of Small Pox and Chicken Pox. During the year 841 notifications were received. and of this number 62 referred to children under 1 year of age, 817 under 5 years, 417 between the ages of 5 and 15, 32 between 15 and 25, and 13 to persons over 25 years of age. The usefulness of this notification was exceedingly doubtful. True, in one instance (Case 71) Small Pox was discovered on investigating a case certified as Chicken Pox, and the same enquiry led to the detection of another case (No. 72) residing in the same house, but, with this exception, no discoveries were made. The notification caused a considerable amount of extra work to the Staff, who were already over-taxed In cases where the age of the patient stated on the certificate gave rise to any anxiety, the permission of the Medical Attendant was immediately sought and obtained for my personal visit. SCARLET FEVER.—The notification certificates received amounted to 651, 492 of which cases were isolated in the Metropolitan Asylums Board Hospitals. Subsequent events showed that of the 492 cases removed to Hospital 14, or 2.8 per cent. were returned home as not suffering from the disease. After deducting this number we have a corrected total of 337 cases for the year. The attack rate for the whole Borough equalled 4.88 persons for every 1,000 residents, which is above the average (3.98) for the County of London. Only 10 London Boroughs showed a higher rate. (See Table 19). Sub-dividing the cases over the various wards and examining the attack rates in each, we find Manor Ward in Lee 67 6.69 per 1,000, and Catford Ward in Lewisham 6.55 per 1000, were most affected, while Lewisham Village, 2.62 per 1,000, was the most fortunate ward. From the Street List the portions of the Borough most affected may be noted. The 637 actual cases were distributed over 466 houses. In relation to age periods the highest number of cases occurred between the ages of 5 and 15 and 1 and 5 years, while the lowest number was recorded to children under one year. Return Cases.—Of the 492 cases removed to Hospital, we were informed that 50 were considered " return cases," i.e., a patient discharged from Hospital to its home apparently well (although the child may have been several weeks in hospital), within a few days of its return other members of the family contracted the illness, and in their turn were removed. After enquiry, there appears little doubt that discharged patients conveyed the infection in several instances. No doubt every care was taken by personal disinfection and medical inspection to prevent the discharge of children still infectious. I am of opinion, however, that the chances of return cases will be reduced by the system recently adopted of placing children in a ward free from actual cases of Scarlet Fever for some days prior to their discharge. In this way the danger of leaving wards full of infection will be obviated. The detention of children in a convalescent hospital for a short period prior to their return home would be a great advantage. Of the 637 cases, 17, or 2.6 per cent. of the total proved fatal. 68 DIPHTHERIA.—This disease was responsible for 891 notifications. After deducting the errors of diagnosis (15) of cases sent to Hospital, we have a corrected total of 376 cases. Of this number 256 or 65.4 per cent, were removed to Hospital. The attack rate for the whole Borough equalled 2.84 per 1,000, compared with 2.32 for the County of London. The highest attack rates in London were, City of London, 3.7, St. Pancras 3.54, Hackney 3.24, and the lowest Kensington 1.04, Paddington 1.52 and Hammersmith 1.58. (See Table 19). Sub-dividing the cases over the Borough Wards, the highest attack rate was in Brockley, 5.21 per 1,000 of its residents, and the lowest Forest Hill, 0.93. (See Table 18). Of the actual cases 44 proved fatal, equal to a case mortality of 11.8 per cent. The disease was more prevalent in Lewisham than many of the London Boroughs. The inspection which followed the notification revealed many sanitary defects in the houses. These were remedied. A Street List appended to this report shows the localities most affected. The 376 cases were distributed over 298 houses. Personal investigation at many houses led me to believe that several cases were due to the great ignorance displayed by many parents. In several instances after the cases were notified, the healthy members of a family were allowed to mix freely with the patient awaiting removal to Hospital. A spot map which may be seen in the office, shows that the disease was prevalent not only in the poorer properties, but in comparatively new houses. In the latter instances the dampness of the house site possibly favoured the incursions of the disease. The necessity of power to insist upon efficient landdrainage before buildings are erected, is worthy of careful consideration. 69 Anti-toxin.—The immense value of Anti-toxin used either as a curative or prophylatic agent in Diphtheria has been established beyond all doubt. Its utility is greatly increased when administered in the earliest stage of the disease. In order that all cases may have the advantage of its early use a gratuitous supply may be obtained at any hour at the Town Hall. East London Industrial Schools.—In December three cases of Diphtheria occurred in the above School, which contains 150 boys. Immediate action was taken to prevent the extension of the disease. On visiting the Institution I found Mr. Cartwright, the Superintendent, desirous of a thorough investigation, and willing to give me every possible assistance. A meeting was arranged with Dr. Farmer, the Medical Adviser to the School, who, with myself, minutely examined 150 boys. Fourteen swabs were taken and submitted to bacteriological examination. Two were found to contain diphtheria, three strepto-cocci and nine pseudo-diphtheria. The diphtheria cases were removed to Hospital, and special isolation obtained at the School for the pseudo-diphtheria cases. The occurrence of fresh cases ceased from this time. The question of providing facilities for the bacteriological examination of suspected diptheria cases is an important one. Without such examination some mild cases may escape detection and become a source of infection to many. This subject will, I hope, receive your consideration during the ensuing year. In my opinion pseudo-diphtheria is highly infectious and capable of producing conditions closely allied to diphtheria. ENTERIC OR TYPHOID FEVER.—Sixty-one notifications were received. After deducting cases removed to St. John's 70 Hospital from outside districts (2) we have a corrected total of 59 cases. Twenty-five of these were removed to Hospital. The case mortality equalled 15.2 per cent, of the attacks. The attack rute for the whole Borough was 0"44 per 1,000. On sub-dividing the cases over the various Wards, the highest attack rate, 0.66, occurred in Sydenham, and the lowest in Forest Hill. (See Table 18). ERYSIPELAS.—112 persons were notified as suffering from this disease, none of which proved fatal. PUERPERAL FEVER.—Fourteen cases were certified, distributed over the Broekley, Catford, Forest Hill, and Sydenham Wards. The attack rate for the whole Borough amounted to 0.10 per 1,000. Of the cases notified, 6, or 43 per cent., proved fatal. Errors of Diagnosis.—It is most satisfactory to note, that of the total number of Small Pox, Scarlet Fever and Diphtheria patients sent to Hospitals, amounting to 864, mistaken diagnosis occurred in only 32 instances, or in 3'7 per cent, of the total cases. The figures for the year compare most favourably with those of previous years. (See Table 21). School Closure.—It became necessary to close the Church Street Schools, Lee, owing to an outbreak of diptheria and the defective condition of the drainage. During March a private College at Blackheath was closed for the same reasons. An outbreak of Measles in the Infants' Department of the Plassy Road Board School necessitated the closing of Class room D for a period of three weeks in November. 71 The St. Michael's Schools, Lower Sydenham, were closed in October in consequence of Measles. Table 20. Showing Cases of Infectious Diseases notified at various age groups in the Borough and its Divisions during the Year 1902. Disease. Notifications and Ages in Whole Borough. Lee Division. Lewisham Division. Sydenham & Forest Hill Division. Totals Borough. Under 1 Year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upward. Total Notified. Removed to Hospital. Total Notified. Removed to Hospital. Total Notified. Removed to Hospital. Notified at all Ages. Removed to Hospital. Small-pox 2 4 6 21 51 — 14 14 46 46 24 24 84 84 Scarlet Fever 7 149 385 69 27 — 107 83 351 262 179 147 637 492 Diphtheria and Membranous Croup 6 108 198 27 37 — 78 68 210 142 88 46 376 256 Enteric Fever — 1 11 14 32 1 7 2 32 18 90 5 59 25 Erysipelas 6 3 6 15 70 12 17 2 59 6 36 8 112 16 Puerperal Fever — — — 2 12 — — — 8 4 6 2 14 6 Total 21 265 606 148 219 13 223 169 706 478 353 232 1282 879 72 Table 21. Showing Cases of mistaken Diagnosis of Cases of Small Pox, Scarlet Fever and Diphtheria admitted to the Metropolitan Asylums Board Hospitals during the years 1899, 1900, and 1901. Parish or Union. No. of Cases Admitted. Percentage of Mistakes to Total Cases. 1899. 1900. 1901. 1S99. 1900. 1901. Kensington 33 51 43 5.6 8.3 6.8 Hammersmith 24 26 24 7.3 5.5 5.3 Fulham 53 70 73 4.2 6.5 6.6 Paddington 18 28 38 3.8 7.3 5.5 Chelsea 25 22 19 5.9 6.0 8.2 St. George's 16 31 30 3.4 7.8 8.7 Westminster 13 15 24 7.9 9.4 13.2 St. Marylebone 30 46 39 5.7 8.0 7.3 St. Pancras 66 70 115 5.5 6.2 7.0 Hampstead 12 15 10 4.8 6.3 4.3 Islington 131 88 112 8.0 6.8 6.7 Hackney 111 93 157 8.9 8.1 9.6 Bloomsbury 4 6 9 5.5 5.3 5.9 Strand 3 7 9 4.4 10.6 12.7 Holborn 75 37 72 8.5 6.9 7.3 City of London 14 5 13 13.4 4.5 9.3 Shoreditch 81 74 119 12.0 11.9 14.4 Bethnal Green 44 55 82 8.2 10.4 8.4 Whitechapel 49 75 82 13.6 12.4 16.1 St. George-in-the-East 17 29 36 10.4 13.2 14.0 Stepney 17 39 66 6.2 11.7 14.7 Mile End Old Town 27 36 58 6.4 8.6 12.6 Poplar 49 60 131 8.4 7.3 13.1 Southwark 126 115 173 6.5 7.7 9.8 St. Olave's 76 88 130 5.9 10.4 11.0 Lambeth 70 106 132 4.4 7.9 10.1 Wandsworth and Clapham 108 122 122 4.9 7.6 7.5 Camberwell 94 124 156 5.7 9.8 9.0 Greenwich 66 58 125 4.8 6.4 10.5 Woolwich 42 37 63 3.7 4.0 11.0 Lewisham 52 48 55 6.0 6.5 9.3 Tottenham 33 27 48 10.6 7.4 9.4 Extra-Metropolitan 4 3 — 6.0 18.2 — Totals 1583 1706 2365 6.3 7.9 9.2 73 Street List showing the incidence of certain infectious disease notifications, also deaths from Phthisis. LEE DIVISION Small-pox Scarlet Fever Diphtheria Enteric Erysipelas Phthisis No. of Cases Houses Affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases I louses affected No. of Cases Houses affected No. of Cases Houses affected Abernethy road — — — — — — — — l l — — Aislibie road — — — — 4 3 — — — — — — Baring road — — 2 l — — — — l l l 1 Belmont hill — — — — — — — — l l — — Blackheath station — — — — — — — — l l — — Boones road 4 2 — — — — l l — — — — Boone street — — 2 2 1 1 — — l l — — Boone's place 1 1 3 3 2 1 — — — — — — Brandram road 1 1 1 1 — — — — — — — Brightfield road — — 5 3 13 9 — — l l 2 2 Burnt Ash hill 1 1 1 1 — — l l — — — — Burnt Ash road — — 3 3 3 3 — — 2 2 1 1 Butterfield street — — . — — 1 1 — — — — — — Blessington road — — 2 2 — — l l — — — — Cambridge road — — 1 1 — — — — — — 1 1 Church passage 1 1 — — 2 2 — — — — 1 1 Church street — — 5 3 5 5 — — 1 1 — — Dacre park — — 2 2 2 2 — — — — — — Dacre street 1 1 6 3 5 4 — — — — — — Effingham road — — 3 3 1 1 — — 1 1 — — Glenton road — — 1 1 — — — — — — — — Grove park — — 1 1 — — l 1 1 1 1 1 Glebe, The — — 2 2 — — — — — — — — Handen road 1 1 — — — — — — — — — — Hedgley street 1 1 1 1 — — — — 1 1 1 1 High road — — 4 4 3 3 — — 1 1 2 2 Lampmead road — — 3 2 2 2 — — — — 1 1 Lansdown read 1 1 1 1 — — — — — — 1 1 74  Small–pox Scarlet Fever Diphtheria Enteric Fever Erysipelas Phthisis No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected. Lee park — — 2 l — — — — — — — — Lee road – — 1 l — — — — — — — — Lee terrace — — 2 2 l l — — — — — — Leyland road — — 7 3 3 3 — — — — — — Lochaber road 1 1 7 5 — — 1 1 2 2 — — Manor park — — 2 2 3 3 — — — — — — Manor lane — — 6 3 8 2 — — — — — — Micheldever road — — — — — — — — 1 1 — — Murillo road — — 3 1 — — — — — — l l Newstead road — — 2 1 2 1 — — — — — — Northbrook road — — 1 1 — — — — — — — — Quentin road — — 1 1 — — — — — — — — Rembrandt road — — — — 1 1 — — — — l l Ronver road — — 11 5 9 8 — — — — — — St. Mildred's road — — — — 2 2 1 1 — — — — South Vale House — — — — 1 1 — — — — — — Summerfield street — — 1 1 1 1 — — 1 1 — — Taunton road 1 1 7 5 1 1 1 1 — — 3 3 Turner road — — 3 2 2 2 — — — — — — Weardale road — — 2 2 — — — — — — — — LEWISHAM DIVISION. Adelaide road 1 1 1 1 2 2 2 1 — — — — Aitken road — — — — — — 1 1 — — 1 1 Albacore crescent — — 1 1 — — 1 1 1 1 — — Albion road — — — — — — 1 1 — — — — Algiers road — — 1 1 1 1 1 1 — — — — Algernon road — — — — 1 1 — — — — 1 1 Arabin road — — 3 3 5 5 — — — — — — Ardgowan road — — — — 3 3 — — 1 1 — — Ardmere road — — — — — — — — — — 3 3 Arngask road — — 3 3 — — — —– 2 2 — — 75  Small-pox Scarlet Fever Diphtheria Enteric Fever Erysipelas Phthisis No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected Avenue road — — l l — — — — — — — — Barmeston road — — 4 2 — — — — l l — — Beacon road 1 1 — — — — — — l l — — Beechfield road — — 1 1 — — — — l l — — Beecroft road — — 2 2 — — — — — — — — Berlin road — — 4 2 — — 1 1 — — — — Blackshaw's Alley — — 2 2 — — — — — — — — Blagdon street — — 3 2 — — — — l l — — Blackheath hill — — 3 3 — — — — l l 2 2 „ rise 1 1 2 2 — — — — — — — — „ vale 1 1 2 1 — — — — — — — — Blythe hill — — 1 1 — — — — l l — — „ vale — — 1 1 — — — — — — — — Bowness road — — 1 1 — — — — l l — — Bradgate road — — 5 4 — — 2 2 2 2 1 1 Branscombe street — — 2 1 l l — — — — — — Braxfield road — — 1 1 — — — — 1 1 2 2 Brigade street — — 1 1 — — — — — — — — Brockley grove — — 1 1 7 6 — — — — — — „ rase — — 2 1 — — — — — — — — „ road — — 3 3 — — — — — — — — Broadfield road — — 1 1 2 2 — — 1 1 — — Bromley road — — 2 2 — — — — — — — — Brookbank road — — 1 1 — — — — 1 1 1 1 Brookdale road — — 17 9 1 1 — — 1 1 — — Brownhill road — — 11 7 4 4 — — 1 1 2 2 Blashford street — — — — — — — — 1 1 — — Bonfield road — — — — 3 2 — — — — — — Catford bridge — — — — — — — — 1 1 — — „ hill — — 5 2 1 1 1 1 — — 1 1 Chalsey road — — 1 1 — — — — — — — — Chudleigh road — — — — 2 1 — — 1 1 — — Clarendon road — — 1 1 1 1 — — — — — — Collins street — — — — — — — — — — 1 1 76  Small-pox Scarlet Fever Diphtheria Enteric Fever Erysipelas Phthisis No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected Comerford road — — 2 2 l l — — — — — — Conning ton road — — — — — — 1 1 l 1 — — Court Hill road — — 1 1 l l — — — — 4 3 Creeland grove — — 7 6 l l — — l 1 — — Cressingham road — — — — — — — — l 1 — — Crofton park road — — 4 4 10 7 — — l 1 — — Dalrymple road — — — — 3 3 1 1 — — — — Darfield road — — — — 4 4 1 1 — — 2 2 Dartmouth grove — — 1 1 — — — — — — — — „ row — — 1 1 1 1 — — — — — — Davenport road — — 5 2 1 1 — — l 1 2 2 Dermody road — — — — 1 1 — — — — 1 1 Doggett road — — 8 2 4 2 — — — — 1 1 Drysdale road — — 6 4 — — — — — — — — Dunsley place — — — — — — — — — — 1 1 East London Industrial School — — 1 1 3 1 — — — — — — Eliot place — — — — 2 1 — — — — — — „ vale — — 1 1 — — — — — — — — Ellerdale street — — 2 2 — — — — — — — — Elmer road — — 1 1 1 1 — — — — — — Elmira street 2 1 — — — — — — — — — — Elswickroad — — 1 1 2 2 2 2 l 1 2 2 Elthruda road 1 1 — — — — — — l 1 — — Elverson road — — 1 1 — — — — — — — — Embleton road — — 2 2 — — — — — — — — Engleheart road 1 1 4 2 3 3 1 1 — — 3 2 Ennersdale road 3 1 17 10 1 1 1 1 2 2 — — Ermine road — — 1 1 — — — — — — — — Essex place — — 2 1 1 1 — — 1 1 — — Exbury road 2 1 — — — — 1 1 — — — — Farley road 4 2 11 9 9 5 — — — — 1 1 Faversham road — — 1 1 1 1 — — — — — — Fordel road — — — — 2 2 — — — — 1 1 77  Small-pox Scarlet Fever Diphtheria Enteric Fever Erysipelas Phthisis No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected Foxberry road — — — — — — 1 l — — — — George lane — — l l l l — — — — l l Gillian street — — — — 5 l — — — — — — Gilmore road — — 3 3 3 3 — — — — 2 2 Glenfarg road 7 1 1 1 3 3 — — l 1 1 1 Glenview road — — 4 4 4 3 1 l — — 1 1 Glenwood road — — 2 2 — — — — — — — — Granville park — — 1 1 2 2 — — — — — — Grote's place — — — — — — — — — — 1 1 Halesworth road — — 1 1 — — — — l l — — Harvard road 1 1 6 2 — — — — — — — — Hawstead road 1 1 3 2 — — — — — — — — High street — — 2 2 2 2 — — — — 2 2 Hither Green lane 1 1 3 2 2 2 — — — — — — Holdenby road — — 1 1 — — — — — — — — Honley road — — 5 5 — — — — — — — — Honor Oak park — — 1 1 — — — — — — — — Horton street — — 1 1 — — — — — — — — Howson road 3 1 2 2 4 3 — — — — 1 1 Holly Hedge terr. — — — — 2 1 — — — — — — Ilazeldon road — — — — — — — — — — 1 1 Ivy lane — — 1 1 — — — — — — — — Jutland road — — 2 2 — — — — — — 1 1 Jerrard street — — — — 1 1 — — — — 1 1 Killeam road — — 3 3 1 1 — — l l — — Knetter road — — 1 1 2 2 — — — — 1 1 Knowles hill cres 1 l — — 2 2 — — l l — — Ladywell park 1 l 1 1 3 2 — — l l — — Ladywell road 1 l — — 1 1 — — — — — Lewis'm Infirmary — — — — — — — — — — 3 3 Lewisham w'rk'se — — — — — — 2 2 2 2 — — Laleham road — — 3 3 7 4 — — 2 2 — — Leahurst road 2 l 6 5 3 3 1 1 1 1 — — Lethbridge road — — 1 1 1 1 — — — — 2 2 78  Small-pox Scarlet Fever Diphtheria Enteric Fever Erysipelas Phthisis No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected Lewis grove — — l l — — — — — — — — Lewisham hill — — l l — — — — — — — — Lewisham road 1 1 5 4 — — 1 1 — — — — Limes grove — — — — l l — — — — — — Lingard's road — — — — — — — — 1 1 — — Lloyd's place — — 1 1 — — — — — — — — Loampit vale — — — — 3 3 — — — — l l Loampit hill — — 1 1 — — — — 1 1 — — Malyons road — — 4 2 1 1 — — — — 2 2 Manor lane — — 2 1 — — — — — — — — Marnock road — — 4 3 1 1 — — — — — — Marsala road — — 5 2 2 2 1 1 1 1 — — Maybank cottages 1 1 — — 3 2 — — — — — — Mayban k villas — — 2 1 — — — — — — — — Medusa road — — 1 1 — — — — — — — — Mercy grove — — 2 2 — — — — — — — — Mercy terrace 1 1 1 1 — — — — — — 1 1 Merritt road — — 6 5 8 6 — — — — — — Molesworth street — — 1 1 1 1 — — 1 1 — — Montpelierrow — — — — 1 1 — — — — — — Minard road 1 1 1 1 1 1 — — — — 1 1 Mill road — — — — — — — — — — 1 1 Morden hill — — 2 1 1 1 — — — — — — Montague avenue — — — — — — — — — — 2 2 Morena street — — 6 4 1 1 1 1 — — — — Morlcy road — — 2 1 1 1 — — — — 1 1 Munroe cottages — — — — 2 1 — — — — — — Nelgarde road — — 4 4 2 1 — — — — — — Nightingale cotgs. — — — — 1 1 — — — — — — Nuding road — — — — — — — — — — 1 1 Park street — — 1 1 — — — — — — — — Pascoe road — — 1 1 2 2 — — 1 1 — — Plassy road — — 2 2 — — — — — — — — Pattenden road — — — — 1 1 — — — — 1 1 79  Small-pox Scarlet Fever Diphtheria Enteric Fever Erysipelas Phthisis No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected Porson street 1 l — — — — — — — — 5 5 Prospect place — — l l — — — — — — — — Radford road — — 6 3 — — — — — — — — Railway terrace — — 3 2 — — — — l l 1 1 Rathfern road — — — — 3 l — — — — — — Regent street — — — — 4 l — — — — 1 1 Retreat, The — — 1 1 — — — — — — 1 1 Ringstead road — — — — — — — — — — 1 1 Rosenthal road — — 5 3 — — — — — — — — Roxley road — — — — 1 l — — — — — — Rushey qreen 1 l 1 1 — — — — — — — — Ryecroft road — — — — — — — — l l — — St. John's Hospital — — — — — — — — — — 1 1 St. Fillan's road. — — 1 1 1 l — — l l 1 1 St. Olave's w'rk'se — — — — — — — — l l — — Sandhurst road — — 5 4 6 5 l l l l — — Sandrock road — — — — — — — — l l — — Sangley road — — 2 2 — — — — — — — — Scroohy street — — 2 1 — — — — — — — — Sharsted villas 1 l 1 1 — — — — — — — — Shell road — — 1 1 — — — — 2 l — — Shrubbery road — — — — — — — — 1 l — — Silvermere road — — 3 3 1 1 — — 1 l — — Slaithwaite road 1 l 2 1 — — l l — — — — Southend — — 1 1 — — l l — — — — South vale — — 1 1 — — — — — — 1 1 Sparta street — — 2 2 — — — — 1 l — — Springbank road — — 1 1 8 4 — — — — Springfield pk.cres 1 l — — — — — — — — — — Stanstead road 1 l 6 4 1 1 — — — — — — Stillness road — — — — — — l l — — — — Stondon park — — 3 1 — — — — — — — — Sunninghill road — — — — 1 1 — — — — — — Theodore road — — — — 1 1 — — — — — — 80  Small -pox Scarlet Fever Diphtheria Enteric Fever Erysipelas Phthisis No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected Thurston road — — l l l l l 1 — — l l Torridon road — — 3 2 l l — — — — l l Tyrwliitt road — — 2 1 l l — — — — — — Vian street — — — — — — — — — — l l Walerand road — — — — l l l 1 — — — — Wearside road — — 2 1 — — — — — — — — Wellmeadoic road — — 3 2 5 4 — — — — — — Whitbread road — — 1 1 1 1 — — — — — — Whitburn road — — 2 2 — — — — — — — — Wildfell road — — 3 1 2 1 — — — — — — Willow walk — — 1 1 — — — — — — 3 2 Winchester rd. Up. — — 4 1 — 1 — — — — — — Wisteria road — — — — — — — — l l — — Woodlands street 1 1 — — 2 1 — — l l — — SYDENHAM AND FOREST HILL DIVISION Acacia road 5 2 1 1 1 1 — — 2 2 — — Adamsrill road — — 2 1 3 2 — — — — 1 1 Adding ton grove — — 1 1 — — — — — — — — Agnew street — — — — 1 1 — — — — — — Beadnell road — — 2 1 — — — — — — — — Bell green — — 2 2 2 1 — — — — 1 1 Blythe hill — — — — 1 1 — — — — — — Bovill road — — 1 1 — — — — 2 2 — — Bradford road — — 2 2 — — — — 1 1 — — Brockley rise — — 1 1 — — — — — — 1 1 Broselcy grove — — 2 2 — — — — 1 1 — — Burghill road 1 1 1 1 — — — — — — 1 1 Byne road — — — — 1 1 — — — — — — Carholme road — — — — — — — — 1 1 — — Champion crescent — — 1 1 1 1 — — — — — — 81  Small-pox Scarlet Fever Diphtheria Enteric Fever Erysipelas Phthisis No. of Cases Houses affected No. of Cases Houses affected J No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected Champion park 2 1 2 2 — — — — l l — — Clyde terrace — — — — l l — — — — — — Colfe road — — 1 1 l l — — — — — — Colfe road upper — — 5 2 l l — — — — — — Como road — — 3 3 l l — — — — — — Coom.be road — — — — 2 l — — l l l l Cranston road — — 1 1 — — — — — — — — Dacres road — — — — — — — — — — l l Dallas road 1 1 2 2 — — — — 2 2 l l Dalmain road — — — — 1 l — — 2 2 3 2 Dartmouth road — — 1 1 2 l — 2 — — — — Davids road — — 1 1 — — — — — — 1 1 Devonshire road — — 4 4 — — — — — — 1 1 Dillwyn road 1 1 2 2 2 2 — — — — 1 1 Edney street — — — — 4 1 — — — — — — Elderton road — — 2 2 2 2 1 1 1 1 1 1 Eliot bank — — — — 3 1 — — 1 1 — — Elsinore road — 1 1 — — — 1 1 1 1 Ewart road — — 2 1 1 1 — — 1 1 — — Fairlawn park, North terrace — — 1 1 2 2 — — — — — — West terrace — — 2 2 — — — — — — 2 2 Fir street — — — — — 1 1 — — — — Fransfield grove — — — — — — — — 1 1 — — Garlics road — — — — — — 1 1 — — — — Grafton road — — 2 1 1 1 — — — — 1 1 Hanover street 1 1 — — — — — — — — 1 1 Haseltine road — — — — 2 1 — — — — — — Helvetia street — — 7 3 — — — — 1 1 — — Herschell road — — — — — — — — 1 1 — — High street — — — — — — — — — — 2 2 Hillmore grove — — 1 1 1 1 — — — — — — Honor Oak Park — — 1 1 — — — — — — — — Honor Oak road — — — — 2 2 — — — — — — Holmshaw road — — 1 1 2 2 — — — — — — 82  Small-pox Scarlet Fever Diphtheria Enteric Erysipelas Phthsis No. of Cases. Houses affected No. of Cases Houses affected No. of Cases. Houses affected No. ot Cases Houses affected No. ot Cases Houses affected No. of Cases Houses affected Houston road — — — — — — 1 1 — — — — Hurstbourne road — — — — — — 1 1 — — l l Inglemere road — — — — l l — — — — — — Kangley bridge rd. — — 5 3 — — — — — — — — Kemble road — — 1 1 — — — — — — — — Kent House lane — — — — — — 1 1 — — — — Kent Home road — — 5 2 5 3 — — 2 2 — — Kilmorie road — — 8 3 — — — — — — — — Knighton park — — 1 1 — — — — — — — — Kirkdale — — — — 1 1 — — — — l l Larkbeare road — — — — 8 5 1 1 1 1 — — Lawrie park road — — 1 1 2 2 — — — — l l Longton avenue — — 1 1 — — 1 1 — — — — Longton grove — — 1 1 — — — — — — — — Lutwyche road — — 2 1 — — — — — — — — Lowther hill — — — — 2 2 — — — — — — Aladdin road — — 6 4 — — — — — — — — Malham road — — 3 2 — 1 — — 2 2 — — Mayow road — — — — — — — — 1 1 — — Miall road — — — — 1 1 — — 4 4 — — Mount Ash road — — 1 1 1 1 — — — — l l Myrtle grove — — 1 1 — — — — — — — — Neuchatel road — — 4 3 — — — — l l Newlands park — — 4 2 4 1 — — — — — — Oaksford avenue — — 5 2 — — — — — — — — Park road — — 2 1 — — — — — — — — Peak hill — — 1 1 1 1 — — — — 2 2 Pearcefield avenue — — 1 1 — — — — — — — — Perry hill — — 2 2 — — — — 1 1 — — Perry rise — — 4 2 — — 1 1 — — 1 1 Perry vale — — 2 2 1 1 — — 1 1 1 1 Plane street — — 3 1 1 1 — — — — — — Porthcawe road 5 2 3 2 3 2 — — — — 3 3 Prospect road 2 1 4 3 1 1 — — — — — — Queenswood road — — — — 1 1 — — — — — — 83  Small Pox Scarlet Fever Diphtheria Enteric Erysipelas Phthsis No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected No. of Cases Houses affected Relinque road — — 2 2 — — — — — — — — Rosamond street — — 1 1 — — — — — — — — Russell street 1 1 — — — — — — — — — — Rutland road — — 5 1 — — — — l 1 l l St. Germain's road — — — — l l — — — — 2 2 St. Mark's road — — — — l l — — — — 1 1 Siddons road — — 1 1 — — — — — — — — Southend lane 1 1 3 3 — — — — — — 1 1 Springfield — — — — — — l l l 1 — — Stanton road — — 1 1 — — — — — — — — Stanton square — — 1 1 — — — — — — — — Stanstead road — — 7 6 — — — — — — 2 2 Sunderland road — — 1 1 — — — — — — — — Sydenham hill 2 2 — — 1 l — — — — — — Sydenham hill road — — 1 1 l l 2 l — — — — Sydenham park — — — — — — 1 l — — — — Sydenham road 1 1 7 3 2 2 — — l 1 — — Taylor's lane — — — — — — 1 l l 1 1 1 Treviso road — — — — 1 1 — — — — — — Trilhy road 1 1 1 1 — — — — — — — — Tyson road — — — — — — 1 l — — — — Vancouver road — — 1 1 1 1 — — — — — — Venner road — — 3 3 — — — — — — — — Vestris road — — 1 1 — — 1 l — — — — Watlington grove — — — — 1 1 — — — — — — Wells road — — 1 1 1 1 1 l — — — — West hill — — — — 1 1 — — — — 1 1 estwood park — — 1 1 — — — — — — — — Westwood road — — — — — — 1 l — — — — Whatman road — — 1 1 1 1 — — — — — — Willow walk — — 5 3 — — — — — — 1 1 Woolstone road — — 5 3 — — — — — — — — Wyleu street — — 1 1 — — — — — — — — Wynell road — — — — 1 1 — — — — — — Woodvale — — — — — — — — — — 1 1 Part 3. GENERAL SANITARY WORK. 87 DISPOSITION OF SANITARY STAFF.—The staff consists of five first-class and three second-class Inspectors, appointed to the following districts :— Lee Division :—Area, 1616.3 acres. Estimated number of houses 1902, 3,299. Estimated population, 18,925. Wards, Church, Manor and South. Inspector, one first-class Sanitary Inspector—Mr. R. White. Lewisham Division .—Area, 3,680.3 acres. Estimated number of houses 1902, 12,636. Estimated population, 69,672. This district, owing to its extensive area, has for administrative purposes been divided into two portions, A and B. A is formed by the Blackheath, Lewisham Village and Brockley Wards, having a population of 31,943 divided over 5,788 houses. One Inspector (1st Class), Mr. J. A. K. Cooper, has been appointed. B, the remaining portion of the Division, is formed by the Lewisham Park and Catford Wards, the estimated population of which is 37,729, distributed over 6,848 houses. The Sanitary Inspectors for this district are Mr. J. F. Charlesworth (1st Class), and Mr. R. J. Davis (2nd Class). Sydenham and Forest Hill Division:—Area, 1,717.8 acres. Estimated population 43,835, distributed over 7,842 houses. The Division contains the Sydenham and Forest Hill Wards. The Sanitary Inspectors appointed to the Division are Mr. E. T. Pidwell (1st Class), and Mr. B. A. Knappett (1st Class). The district has been divided into fairly equal parts, each Inspector having a portion of each Ward. HOUSE INSPECTION.— The inspections of houses, are, as a rule, made by the District Inspectors in consequence of special information received or following the notification of infectious 88 diseases, in addition to which one Inspector (Mr. A. H. Gray, 2nd Class) unattached to any particular district, is employed on house to house inspections in various streets as directed. FACTORY AND WORKSHOP ACT.—The inspections of workshops, workrooms, homes of outworkers, laundries, &c., throughout the whole Borough is the duty of Mr. J. Daltry (2nd class). The above inspectors report daily to your Medical Officer of Health the result of their investigations and receive the necessary instructions or his personal visits where required. During the year 1,155 complaints of nuisances were received from residents and investigated and remedied by the Department. 5,871 houses were inspected ; 1,641 intimation and 309 statutory notices were served. The inspection of work ordered by intimation or verbal notices necessitated 13,195 visits to work in hand. A summary of the general Sanitary Work receiving the attention of the Department during the year is set out in Table 22. HOUSE TO HOUSE INSPECTION was carried out in the following streets:—Railway Terrace, Ladywell Park, Porthcawe Road, Maddin Road, Miall Road, The Pavement, Southend Lane, Kirtley Road, Relinque Road, Ladywell Road (part of), Sangley Road, Sandhurst Gardens, Sandhurst Road (north side), Scrooby Street, Orchard Place, Stanton Road, Stanton Square, Laurel Grove, Myrtle Grove, Davids Road and Willow Walk, Sydenham. The number of houses examined amounted to 657. Of this number the house drainage was found defective in 104 instances, or 16 per cent. of the houses. Other nuisances existed in 434 instances principally caused by filthy premises, overcrowding, insufficient water supply or defective ashpits. 89 I am of opinion that a greater amount of house-to-house inspection is desirable, and recommend the appointment of one additional Inspector at least, for this duty. DISINFECTION.—During the year 1,148 rooms were disinfected and 32,201 articles were removed for treatment in the Steam Disinfector at Molesworth Street Depot. During the small pox outbreak it was necessary to burn 33 articles, which were replaced by your Council. WATER CERTIFICATES.—During the year 1,350 new houses were inspected and found to be in possession of a proper and sufficient water supply. Certificates were issued in accordance with the Act. FACTORY AND WORKSHOP ACT.—The principa measures under this Act are the inspection of workshops, workrooms, and the homes of outworkers. The Inspector entrusted with this duty was only engaged during a portion of the year, during which time he made 225 inspections. The provisions of the Act relating to Bakehouses has been referred to elsewhere. CUSTOMS AND INLAND REVENUE ACT, 1890.—This Act provides that the assessment to inhabited house duty of any house originally built or adapted by additions or alterations and used for the role purpose of providing separate dwellings for persons, at rents not exceeding for each dwelling the rate of seven shillings and sixpence a week, and occupied only by persons paying such rents, shall be discharged by the said Commissioners, provided that a certificate of the Medical Officer of Health for the district in which the house is situate, shall be produced to them to the effect that the house is so constructed as to afford suitable accommodation for each of the families or persons inhabiting it, and that due provision is made for their 90 sanitary requirements. The Medical Officer of Health on request by the person who would be liable to pay the house duty on any house in the district, if the duty were not discharged as aforesaid, shall examine the house for the purpose of ascertaining whether such a certificate can properly be given, and if the house be constructed so as to afford such accommodation, and due provision be made as aforesaid, shall certify the same accordingly. During the year a number of applications have been made for an inspection and certificate. Bakehouses.—The Factory and Workshop Act, 1901, contains several sections relating to Bakehouses. It enacts that after January, 1904, it will be illegal to use an underground bakehouse unless it complies with the conditions mentioned. In order to assist occupiers of these premises to bring their premises into a condition that will be satisfactory, the following regulations have been approved by your Council, who will consider all cases before refusing to issue the certificate prescribed by the Act:— STATUTORY REQUIREMENTS FOR ALL CLASSES OF BAKEHOUSES PROVIDED BY SECTIONS 97, 98, 99 and 100 OF THE FACTORY AND WORKSHOP ACT, 1901. SANITARY REGULATIONS. A water closet, earth closet, privy, or ashpit must not be within or communicate directly with the bakehouse. Every cistern for supplying water to the bakehouse must be separate and distinct from any cistern for supplying water to a water closet. A drain or pipe for carrying off fæcal or sewage matter must not have an opening within the bakehouse. If any person lets or suffers to be occupied or occupies any room or place as a bakehouse in contravention of this section he shall be liable to a fine not exceeding forty shillings, and to a further fine not exceeding five shillings for every day during which any room or place is so occupied after a conviction under this section. 91 PENALTY TOR BAKEHOUSE BEING UNFIT ON SANITARY GROUNDS. If any room or place used as a bakehouse is in such a state as to be on sanitary grounds unfit for use or occupation as a bakehouse, the occupier of the bakehouse shall be liable to a fine not exceeding, for the first offence, forty shillings, and any subsequent offence, five pounds. LIME-WASHING, PAINTING AND WASHING All the inside walls of the rooms of a bakehouse, and all the ceilings or tops of those rooms, whether those walls, ceilings or tops are plastered or not, and all the passages and staircases of a bakehouse, must either be painted with oil or varnished, or lime-washed, or be partly painted or varnished and partly limewashed . Where the bakehouse is painted with oil or varnished, there must be three coats of paint or varnish, and the paint or varnish must be renewed once at least in every seven years, and must be washed with hot water and soap once at least in every six mouths. Where the bakehouse is lime-washed, the lime-washing must be renewed at least once in every six months. AS TO SLEBPING PLACES NEAR BAKEHOUSES. A place on the same level with a bakehouse, and forming part of the same building may not be used as a sleeping place, unless it is constructed as follows, that is to say :— (a) Is effectually separated from the bakehouse by a partition extending from the floor to the ceiling ; (4) Has an external glazed window of at least nine superficial feet in area, of which at least 4½ super. feet are made to open for ventilation. SPECIAL PROVISIONS RELATING TO UNDERGROUND BAKEHOUSES. No underground bakehouse shall be used as such unless it was so used at the time of the passing of this Act (August 17th, 1901). An underground bakehouse shall mean a bakehouse, any baking room of which is so situated that the surface of the floor is more than 3 feet below the footway of the adjoining street, or of the ground adjoining, or nearest to the room. After January 1, 1904, it will not be lawful to use any underground bakehouse (whenever established) unless the Council are satisfied that it is suitable for the purpose in regard to construction, light, ventilation, and in all other respects, and a certificate of suitability has been given by the Borough Council. Where the certificate required by Section 101 cannot be obtained unless structural alterations are made, in order to bring any underground bakehouse 92 in conformity with the Act, a Court of Summary Jurisdiction may, on complaint by the occupier, make an order relating to an apportionment of the expenses between the owner and the occupier, or may, at the request of the occupier, determine the lease. In order to comply with the provisions of the Factory and Workshop Act relating to underground bakehouses the following requirements will be necessary:— The bakehouse shall be of a sufficient cubic capacity, and shall be in every part thereof at least 7 feet 6 inches in height, measured from the floor to the ceiling. The floor shall be constructed of hard, smooth, durable, and impervious material. Special precautions to be taken where adjacent ground abuts on a wall or walls for the exclusion of damp. The surface of the walls shall be faced with a hard, smooth and durable material. Every underground bakehouse shall be approached by a suitable staircase, adequately lighted and ventilated. Any opening into the shop above must be 60 covered as to prevent the entrance of dust. Light.—The underground bakehouse shall be adequately lighted with daylight throughout to the satisfaction of the Sanitary Authority, and the lighting obtained shall be such that an official copy of the Abstract of the Factory Act may be read in all parts of such bakehouse, between the hours of 11 a.m. and 3 p.m. Ventilation.—The bakehouse shall be properly and efficiently ventilated by permanent inlets and outlets, communicating directly with the open air in such a way, and at such a height above the street level, as to prevent the entrance of street dust and dirt. At least one of such outlets shall be over an oven door. If required by the Sanitary Authority, artificial means of ventilation shall be provided. All other Respects.—Dough-troughs, and all similar furniture and fittings (if any) shall be mounted on strong castors or wheels, so as to be readily moveable for cleaning purposes. Provision for the proper storage of flour shall be made elsewhere than in the underground bakehouse itself, but storage sufficient for two days' consumption of flour may be permitted in the bakehouse, provided that the required cubic capacity is not thereby reduced. Properly covered receptacles shall be provided for the storage of all refuse matters, aud such receptacles shall be emptied and cleansed at least once in every 24 hours. 98 No animal shall be kept in or allowed access to any underground bakehouse. There shall not be in direct communication with the bakehouse any coal or other cellar, room, unpaved yard, or area which may be a nuisance or may cause contamination by foul air, dust, or dirt. The water supply for the bakehouse shall, where possible, be drawn from the rising main. Conveniences for personal ablutions shall be provided in a suitable position, but not within the bakehouse, and shall include a water-tap and a sink or lavatory basin of an approved character. Proper provision shall be made for the depositing of wearing apparel outside the bakehouse. The owners or occupiers of underground bakehouses contemplating alterations with a view to meeting the above requirements, shall, when required submit to the Sanitary Authority a specification and plans of the alterations which they propose making. Approved ani adopted by the Council of the Metropolitan Borough of Lewisham. LIST OF UNDERGROUND BAKEHOUSES IN THE BOROUGH OF LEWISHAM. 2, Summerfield Place, Baring Road, Lee 122, Burnt Ash Road, Lee 225, High Road, Lee 83, High Road, Lee 5, Turner Road, Lee *23, Kent House Road, Sydenham 1, Stanstead Road, Forest Hill 55, Park Road, Forest Hill 1, Malham Road, Forest Hill 45, Wastdale Road, Forest Hill 31, Brockley Rise, Forest Hill 309, Stanstead Road, Forest Hill 122 Wood vale, Forest Hill 11, Sydenham Road, Sydenham *28, Kirkdale, Sydenham 32, High Street, Sydenham 14, London Road, Forest Hill 42, Perry Vale, Forest Hill 160, Rushey Green, Catford 90, Rushey Green, Catford 54, High Street, Lewisham 124, Hither Green Lane, Lewisham 83, Hither Green Lane, Lewisham 2, Loampit Hill, Lewisham 314, Brockley Road 294, Brockley Road 392, Stanstead Road, Catford * Not in use. SPECIAL NUISANCES :— Fish Offal.—-Several complaints were received of a nuisance arising from the use of fish offal as manure on culti- 94 vated land in the vicinity of Whitefoot Lane. The land has been farmed for many years. Recently a large number of houses have been erected upon the borders of the farm. The owners have been called upon to conform with the London County Council bye-laws, which prohibit the deposit of any offensive matter within 300 yards of any dwelling house, and further, to take the necessary measures to remedy the nuisance. The nuisance caused by this form of manure is most offensive. Since this report has been in preparation penalties have been recovered for a breach of the bye-laws against the carters of the manure, and the farmer has for a time, if not permanently, ceased to use the material. Unenclosed Land.—Offensive matter is frequently deposited upon unenclosed land, giving rise to complaint. Such accumulations are, as a rule, removed by the Council's men, there being very great difficulty in finding the owners of such property. Smoke Nuisances.—In consequence of complaint the following observations were made :— Date. July 2nd, 2.30 p.m. to 5.10 p.m. July 3rd, 2.10 p.m. to 5.0 p.m. Premises. Messrs. Whitbread's Lewisham Road, Messrs. Guilt's, Algernon Road, The Cambrial Laundry, Morden Hill, Stanton's Silk Mills, Lewisham, Messrs. Jerrard & Sons, Loampit Vale, Robinson's Flour Mills, Mill Road, Messrs. Whitbread's, Lewisham Road, Messrs. Guilt's, Algernon Road, The Cambrian Laundry, Morden Hill, Stanton's Silk Mills, Lewisham. Messrs. Jerrard's, Loampit Vale, Robinson's Flour Mills, Mill Road, Result. No Black Smoke, do. do. do. Black Smoke, 1 min., 15 sees. Black Smoke, 4 mins., 30 sees. No Black Smoke, do. do. do. Black Smoke, 2 mins., 30 sees. Black Smoke, 1 min., 15 sees. July 7th, 1.50 p.m. to 5.15 p.m. Messrs. Jerrard's, Loampit Vale, Black Smoke, 3 mins., 50 sees. The evidence was not sufficient for action. The nuisances were abated after notice. 95 Smoke nuisances were reported, occasioned by dense black smoke issuing from L.B. & S.C. Railway engines while approaching and after remaining at Sydenham station. A similar offence was caused by a S.E. Railway engine between Forest Hill and Sydenham stations ; reported July 24th. A like nuisance was caused by a S.E. Railway engine between Ladywell and Catford stations; reported July 22nd. A nuisance caused by smoke from the chimney shaft at St. Olave's Union Workhouse was reported on July 22nd. A caution was sent in each of the above cases. CRYSTAL PALACE GAS COMPANY'S WORKS.— On many occasions complaints were received of a nuisance arising from the Company's Works at Lower Sydenham, due to the escape of large quantities of sulphuretted hydrogen into the neighbourhood. Memorials and complaints were presented to your Council and proceedings initiated in the early part of 1901 prior to my appointment as your Medical Officer of Health. In order to place an epitome of the facts before you I submit the following brief history of complaints received and action taken since January, 1901, to obtain the abatement of the nuisance. In January, 1901, several complaints were received of a nuisance caused by an offensive odour emanating from the Company's Works at Lower Sydenham. Your Committee directed that these complaints be communicated to the Company and that they be requested to take steps to abate the nuisance. In consequence of renewed complaints in May, 1901, set out in a memorial to your Council and in accordance with your instructions, six summonses were issued against the Gas Company on the 31st May, upon complaints that on six different dates the Company carried on their business as Gas Manufacturers 96 and caused effluvia which was a nuisance. The summonses came before Mr. d'Eyncourt at Greenwich Police Court, on the 2nd July, 1901, and from the evidence given by your Council's witnesses, the Magistrate came to the conclusion that a nuisance had been proved and he adjourned the case until the 13th July, to enable the Company to call evidence in answer to the complaint, it being necessary in pursuance of Section 21 of the Public Health (London) Act, 1891, for the person causing the nuisance to satisfy the Magistrate that the best practical means have been used for preventing or counteracting the effluvia causing the nuisance. At the adjourned hearing Mr. A. H. Stevenson, the Council's expert, gave evidence that in his opinion the nuisance was caused entirely by the insufficiency of area of the purifying boxes. After hearing expert evidence on both sides the magistrate adjourned the summonses sine die, in order that the experts might confer. He also expressed his opinion that the Company should adopt Mr. Stevenson's suggestion, and increase the number of purifiers. The Company agreed that in the event of the experts agreeing as to the necessary work to be carried out to abate the nuisance, they, the Company, would carry out that work, and in the event of the experts failing to agree, the summonses should go back to the Magistrate to give his decision, but in any event, the matter should be mentioned to the Magistrate at a later date, with a view of costs being awarded to your Council. Mr. A. H. Stevenson conferred with the Company's Engineer, and submitted the following report to your Council on 25th October, 1901 :— "I have to-day had an interview with Mr. Livesay, the Chairman of the Crystal Palace Gas Company; Mr. Jones, who, you remember, was their Expert Engineer at the Police Court Enquiry, and Mr. Shoubridge, Resident Engineer. After some conversation, Mr. Livesay informed me that the Company had ceased to make carburetted water gas, that is putting the oil into water gas 97 for purposes of illumination, and that they intend to carry on their water gas plant in this manner, except in cases of emergency. This is very satisfactory, as apparently the greater part of the nuisance came from this apparatus; but without the use of petroleum there will be no nuisance from the water gas apparatus. They also informed me that they will rearrange their purifiers so as to be able to work them in a manner which will, in all probability, do away with all nuisance, and in accordance with a new system which has been very recently successfully used. Of course this rearrangement of the purifiers cannot be carried out in its entirety, and probably not to any extent until the great press of winter business is somewhat relieved, but in the meantime the Company will do their utmost to minimise or prevent any nuisance. I trust these arrangements will be satisfactory to your clients. It appears to me that if they are carried out in good faith, and I have no doubt whatever that this will be so, the nuisance which was complained of will be abated." In May, 1902, further complaints were received of the offensive emanations from the Company's Works, and your Committee ordered notice to be sent to the Company requiring the abatement of the nuisance. In July, 1902, further complaints were received from residents. Acting upon instructions I visited the Company's Works, in company with Mr. A. H. Stevenson and Mr. Van Putten, on the 3rd July. It appeared to us that the Company had taken no steps to abate or minimise the nuisance in regard to which the first proceedings were taken. On the 10th July your Council decided that the former proceedings against the Company should be re-opened. An application was then made to the Magistrate to restore the summonses to the list, in order that the case might be proceeded with. The case was re-opened on the 14th of November. The Magistrate went through the evidence, and said he was satisfied that the Company had done what they could towards abating the nuisance, and he referred to the evidence of Messrs. Pratt, 98 Earner and Besant which was to the effect that, since the beginning of August, 1902, there had been no appreciable nuisance, and he stated that, while he thought the proceedings were completely justified, the Council's object had been attained, and that under the circumstances the summonses should be withdrawn, and he thought the defendant Company should pay a substantial amount towards the Council's costs. Counsel for the defendants pressed the Magistrate to find as a fact that the Company had adopted the best practical means of carrying on their business so as not to create a nuisance, but this the Magistrate declined to do, stating that he did not come to that conclusion, but on the evidence before him declined to convict the Company. On reviewing the Magistrate's decision at the first hearing on the 2nd July and 13th July, 1901, it is difficult to understand the decision arrived at on the 14th November, 1902. RIVERS POOL AND RAVENSBOURNE.—Towards the end of the year an enquiry was commenced in order to ascertai whether any pollution of these rivers inimical to the Public health was present. The facts that we have two large watercress beds in our rivers, and that one river receives the effluent from the Croydon Sewage Farm, and subsequently passes through the works of the Crystal Palace Gas Company at Lower Sydenham, were sufficient to warrant a careful examination. The observations and analyses occupied my attention for a long period and it was not until March of the present year that it was possible to place a detailed report before you. HOUSE REFUSE.—Several complaints have been received during the year of nuisances emanating from house refuse tips. Your Surveyor and myself presented a report on this subject, in which we stated as follows:— "The existing house refuse tips for the Borough are; 1. East side of Hither Green Lane. 99 2. South side of Killearn Road, Catford. 3. West side of Bromley Road, and east side of Exbury Road. House refuse contains a large proportion of vegetable and organic matter, and when subject to moisture and heat, rapidly ferments, creating an unmistakeable nuisance, which would certainly be prejudical to the health of persons living in the vicinity. Collections such as we have are likely to become a public danger during the summer months. At the time of our visits to the above, we failed to detect any nuisance arising from the deposited heaps of house refuse. We feel it our duty to advise you to substitute as quickly as possible more efficient and sanitary methods for the disposal of this material. At the present moment we are of opinion that the existing heap at the rear of Exbury Road should be covered with lime and ploughed into the land if possible, and fresh deliveries treated on arrival in a similar manner. This is not ideal, but would minimise the danger until you are able to adopt such means for the removal or destruction of house refuse as will make refuse heaps unnecessary. We also draw your attention to Section 10 of the L.C.C. Bye-Laws specifying the distance within which such deposits as this report refers to is prohibited. The rapid growth of buildings near existing tips is important. The house refuse collected and deposited at various tips within the Borough during the year 1902 amounted to 35,653 tons. FLOODING FROM L. C. C. SEWERS. During the year under review repeated flooding has occurred in the Lewisham Village Ward in consequence of the insufficiency of the London County Council sewers, resulting in the overflow of sewage after heavy rains. The nuisance caused by these frequent floodings is, in addition to the great damage and inconvenience caused thereby, a serious menace to the health of the inhabitants of the locality affected. The conditions found in the affected district on September 10th illustrates the grave danger caused by these repeated floodings from the overcharged sewers. The roadways and many houses in the vicinity of the London County Council sewers were flooded with sewage. Some 100 of the affected houses consisted of a ground floor only, consequently the occupants had to sleep in the rooms that were flooded with sewage. About 80 houses were known to be affected in this particular locality; no doubt there were many others. The whole of the flooding is directly attributable to the insufficiency of the outlets of the sewers under the control of the London County Council. The following is a brief resume of the several reports presented to your Committee in consequence of the repeated floodings, and the frequent appeals by your Council to the London County Council. During the evening of Sunday, June 30th, 1901, serious flooding occurred from the over-charged sewer in the neighbourhood of Loampit Yale. A petition relating to this matter from the residents and traders in the district was presented to your Council on July 3rd. On the 9th July, 1901, the Lewisham Committee considered a petition from the owners and residents in the affected locality complaining that the streets were impassable after a heavy rain, in consequence of the sewers overflowing. A report was presented to the Committee, stating that the evil arose through the insufficiency of the London County Council sewers. A communication was sent to the County Council asking them to take the necessary steps to remedy the nuisance comcomplained of. A reply was received from the County Council stating that the level of certain ventilating and side entrance shafts had been raised three feet with a view of obviating any further cause of complaint. Your Committee were informed that the work executed might have the effect of preventing the overflow from the street gratings, but would not on the occasion of heavy rains prevent sewage rising up the water closets of the houses in the neighbourhood. Further flooding occurred with the result predicted. 101 Your Surveyor reported on the 29th October that in his opinion it was absolutely necessary that the County Council should construct a new sewer from the point where the new Lewisham Sewer joins the old Ravensbourne and Sydenham Sewer near Horton Street, to the main outfall. Your Medical Officer reported at the same time that it was imperative in order to protect the health of the public residing in the district, and to prevent the recurrence of conditions inviting to infectious disease, that the London County Council should be urged to take immediate steps to remedy the existing defects. Your Committee recommended that a copy of the reports referred to be forwarded to the London County Council, and further, that they be requested to receive a deputation from the Committee. On November 6th a further petition relating to recent flooding was received from residents. On the 13th of February, 1902, a deputation from the Lewisham Committee was received by the Main Drainage Committee of the London County Council, who as a result, promised to give the matter their careful consideration. Your Surveyor reported that on the 10th of July, 1902, in consequence of a heavy fall of rain he visited the locality and found that the sewer had again overflowed. Several letters had been addressed to the London County Council, urging them to take the necessary steps for remedying the evil. Your Committee recommended that a letter be addressed . to the London County Council informing them of the further flooding and urging them to at once take the necesssary steps for preventing the recurrence of the same. On the 16th of September, the Lewisham Committee received a report of further flooding in consequence of the overflow of the sewer which occurred on the 10th September. 102 The attention of the County Council was also drawn to the flooding with sewage of certain houses caused by defects in the sewer. In view of the serious nature of the complaints and the great danger to public health caused by the periodical floodings, further urgent letters were addressed to the County Council pressing them to take immediate action, and asking them to receive a further deputation. Since July, 1901, constant appeals have been made to the London County Council to take the necessary steps to remedy the serious danger arising from the overflow of sewage into dwelling houses and streets in consequence of the insufficiency of their sewers. Two years have elapsed and it is lamentable to find that the London County Council have taken no action to remedy the conditions which are inimical to the public health and comfort of the inhabitants of the district affected. SPECIAL COMMUNICATIONS.— The Works Committee at their meeting on 31st January considered a letter from the Islington Borough Council, forwarding copy of a report by their Medical Officer of Health, and a resolution passed by them to the effect that the Local Government Board be approached with a view to promoting legislation which would make it a punishable offence to refuse or withhold information, or to give misleading information with respect to the number of persons residing in an infected house, their names, employment, occupation, or schools attended by them, or as to any trade, business, employment, or manufactory . that may be carried on in the premises, and expressing a hope that this Council would take similar action. A letter in the same terms was received from the Wandsworth Borough Council. The Committee, on my recommendation, decided to concur in the action taken by the Islington and Wandsworth 103 Borough Councils, and resolved that a communication be addressed to the Local Government Board accordingly. PHTHISIS AND RAILWAY CARRIAGES. On the 24th October the Works Committee considered a letter from the Woolwich Borough Council, forwarding for the consideration of the Council a copy of a report by their Medical Officer of Health, on Phthisis and Railway Carriages, stating that the South-Eastern and Chatham Railway have been asked to give their favourable consideration to recommendations contained therein as follows:— 1. To post and enforce regulations forbidding spitting in every compartment of their railway carriages. 2. To use washable materials in upholstering their compartments, and 3. To adopt a system of cleansing by washing the woodwork and using wet cloths for the seats, which will obviate the risk of scattering the germs of disease in the air and requesting that if this Council agree with these recommendations they would be good enough to communicate with the Railway Company. I reported to the Committee that in my opinion, although there is no statutory obligation at the present time, it would be well for the Council to support the recommendations of the Woolwich Borough Council. The Committee directed that a letter be addressed to the South-Eastern and Chatham Railway Company in support of the recommendations made by the Woolwich Borough Council. ORDERS, REGULATIONS, &c.— Regulations Affecting the Manufacture and Sale of Ice Creams.—The following regulations have been issued by the London County Council in pursuance of their General Powers 104 Act of 1902 for regulating the manufacture and sale of ice creams:— Any person being a manufacturer of or merchant or dealer in ice creams or other similar commodity who within the County— (a) Causes or permits ice creams or any similar commodity to be manufactured, sold or stored in any cellar shed or room in which there is any inlet or opening to a drain or which is used as a living room or sleeping room. (b) In the manufacture, sale or storage of any such commodity does any act or thing likely to expose such commodity to infection or contamination or omits to take any proper precaution for the due protection of such commodity from infection or contamination; or (c) Omits on the outbreak of any infectious disease amongst the persons employed in his business or living or working in, on or about the premises, in, or on any part of which any such commodity as aforesaid is manufactured, sold or stored to give notice thereof forthwith to the Medical Officer of the Sanitary District in which such business is carried on or such premises are situate; shall be liable for every such offence on conviction in a Court of Summary Jurisdiction to a penalty not exceeding Forty Shillings. Every itinerant vendor of any such commodity as aforesaid shall if not himself the manufacturer thereof exhibit in a legible manner on a conspicuous part of his barrow a notice stating the name and address of the person from whom he obtains such commodity and if such vendor is himself the manufacturer of such commodity he shall in the same manner exhibit his own name and address. Every such itinerant vendor who shall fail to comply with the provisions of this Section shall be liable for each offence on conviction as aforesaid to a penalty not exceeding Forty Shillings. Proceedings for the recovery of the penalties shall be instituted by the Sanitary Authority for the District in which the offence was commitfed or of the District to the Medical Officer of which such notification as aforesaid ought to have been made or in which such itinerant vendor as aforesaid shall offer any such commodity as aforesaid for sale as the case may be. As these regulations only came into force in November, 1902, no action has been taken in this Borough at present. MIDWIYES ACT.—This Act comes into force on the 1st April, 1904, and provides inter alia, for the registration of persons acting as midwives, and for the constitution of a central 105 administrative Midwives Board who will satisfy themselves as to the efficiency of persons to act as midwives and grant the necessary certificates. The chief object of the Act is to protect and safeguard the health of women and to prevent ignorant and undesirable persons acting in the capacity of midwives. The duty of carrying into effect the provisions of the Act devolves upon the London County Council, who, however, have power to delegate such duties to the Metropolitan Borough Councils. Your Council have already expressed an opinion that the Borough Councils should be entrusted with the carrying out of the provisions of the Act. 106 Table 22. REGISTER OF SANITARY WORK For the year ended 31st December, 1902. Description or Work Lewisham Division Sydenham and Forest Hill Division Lee Dive Workshops House to House Total for Whole Boro. Mr. J. P. Charlesworth Mr. J. A. K. Cooper* Mr. R. J. Davis* Total Mr. E. T. Pidwell Mr. B. A. Knappett Total Mr. R. White Mr. J. Daltry Mr. A. H. Gray Complaints by Residents 297 7 5 309 122 188 310 427 66 43 1155 Premises inspected 663 62 85 810 926 962 1888 747 1549 877 5871 Re-inspections of Works in progress 2295 88 155 2538 1102 1398 2500 1718 1010 5429 13195 Intimation Notices served 220 8 31 259 140 195 335 265 189 593 1641 Statutory Notices ordered 263 4 12 279 87 112 199 64 105 248 895 Statutory Notices served 20 – 5 25 30 32 62 42 40 140 309 Premises repaired, cleansed,&c 113 – 9 122 52 114 166 83 108 341 820 Defective Roofs, Stackpipes, &c., remedied 50 1 5 56 29 56 85 51 33 194 419 Drains re-constructed 96 7 18 121 65 60 125 80 15 59 400 Drains repaired 92 – 2 94 81 75 156 78 32 85 445 Drains ventilated 62 3 3 68 25 10 35 69 9 25 206 Stackpipes,Sinks, Bath Wastes, &c.,disconnected from drains 106 1 7 114 55 37 92 115 14 33 368 Gulley Traps provided 200 10 18 228 172 212 384 229 67 77 985 Water Closets reconstructed 99 4 9 112 130 135 265 147 44 67 635 Water Closets repaired 25 – 2 27 28 56 84 36 62 52 261 Water Closets supplied with water 66 4 3 73 22 12 34 56 18 147 328 Soil Pipes reconstructed 77 4 5 86 30 42 72 83 40 12 293 Soil Pipes repaired and ventilated 83 4 2 89 33 37 70 53 72 22 306 Dustbins provided 36 1 4 41 35 64 99 103 46 137 426 Water Supply to Houses reinstated 25 – – 25 5 22 27 3 6 3 64 Cisterns repaired, cleansed or covered 7 1 10 18 75 45 120 17 94 160 409 Water Certificates issued – 19 64 83 213 89 302 43 793 129 1350 Premises over-crowded – – – – – – – – 7 6 13 Yards paved 99 4 10 113 29 115 144 65 49 185 556 Removal of offensive accumulations 40 – 2 42 22 21 43 15 11 5 116 Dung Vaults erected or re paired 2 – 1 3 3 2 5 1 5 4 18 Animals improperly kept 1 – 1 2 7 7 14 8 3 5 32 Lodging-houses registered – – – – – – – – – 29 29 Bake-houses visited – – – – 15 23 38 13 39 – 90 Milk-shops visited – – – – 24 22 46 20 67 – 133 Cow-sheds visited 8 – – 8 2 1 3 5 – – 16 Workshops visited – – – – – – – – 225 – 225 Slaughter-houses visited 7 – – 7 5 1 6 5 – 7 25 House-to-house inspections – – 6 6 – – – – – 651 657 Legal proceedings 2 – – 2 – – – 5 – 1 8 * Mr. Cooper and Mr. Davis commenced duty in November, 1902. Part 4. REPORT OF PUBLIC ANALYST. 109 REPORT OF THE PUBLIC ANALYST FOR THE YEAR ENDED DECEMBER 31st, 1902. Table A. Showing Articles submitted for Analysis, with Results, for the year ended December 31st, 1902. Article. No. of Samples. Genuine. Adulterated. Percentage Adulterated. Milk 228 181 47 20.61 Butter 149 134 15 10.0 Coffee 83 31 2 6.06 Cheese 7 7 – – Cocoa 6 5 1 16.6 Flour 3 3 – – Condensed Milk 3 3 – – Pepper 2 2 – – Mustard 2 2 – – Vinegar 2 2 – – Margarne 1 1 – – Whiskey 8 6 2 25.0 Gin 2 1 1 50.0 Camphorated Oil 5 5 – – Compound Tinc- 3 2 1 33.3 ture of Benzoin Castor Oil 2 2 – – Sweet Spirits of 1 1 – – Nitre Citric Acid 1 1 – – Totals 458 389 69 15.0 110 Table B. Summary of Samples Analysed in the Borough in each Year, 1898 to 1902 (inclusive). Year No. of Samples Genuine Adulterated Percentage Adulterated No. of Prosecutions Amount of Fines and Costs imposed 1898 Milk 25 36 31 5 13.88 2 Fines £3, costs 15s. 6d. Butter 8 Sundries 3 1899 Milk 27 41 37 4 9.75 l Fines £5, costs 14s. 6d. Butter 4 Sundries 10 1900 Milk 24 68 61 7 10.29 7 Fines £14 15s., costs £2 13s. 6d. Butter 26 Coffee 1 Drugs 2 Sundries 15 1901 Milk 3 3 – 3 100.0 2 Fines £5, costs £1 1s. 1902 Milk 228 458 389 69 15.0 34 Fines £123, costs £24 18s. 6d. Butter 149 Coffee 33 Spirits 10 Drugs 19 Sundries 19 111 During the year under review 458 samples were examined. See Table A). Sixty-nine, or 15.0 per cent. of the 458 samples submitted were adulterated. This must be considered a high percentage, and is possibly due to the small number of samples taken in previous years. (See Table B.) The consideration of Table C. emphasizes this opinion. It shows that the highest percentage of adulteration (23.4 per cent.) occurred during the first quarter, and diminished as the work progressed, only 8.8 per cent. being recorded in the fourth quarter- Table C. Showing results of total samples submitted during the year ended December 31st, 1902. Quarter. No. of Samples. Adulterated. Percentage Adulterated. First 115 27 23.4 Second 167 22 13.7 Third 108 14 12.96 Fourth 68 6 8.8 Total for Year 458 69 15.0 112 MILK. Inasmuch as milk forms the most important article of food, the number of samples submitted has been greater in proportion to any other articles. During the year 228 samples were secured, 47 or 20.61 per cent. of which were adulterated. The greater number of offences occurred during the first, second and third quarters, and I am pleased to record the fact that the action taken by your Council, and fines inflicted by the Justices, have, as I predicted, reduced adulteration. This improvement was most marked during the fourth quarter. Table D. Quarter. No. of Samples. Adulterated. Percentage Adulterated. First 60 15 25.0 Second 70 15 21.4 Third 54 12 22.2 Fourth 44 5 11.3 Total for Year 228 47 20.61 Details of the adulterated milk samples, together with the action taken, are set out in the following Table:— 113 Table E. Details of Adulterated Samples of Milk Jor the year ended December 31st, 1902. No. Adulteration. Remarks. 6 L.B. 11 per cent. milk fat abstracted Fined £5, 12s. 6d costs 7 L.B. 13 per cent. of added water Fined £5, £1 4s. costs 8 L.B. 12 per cent. of added water Fined £5, £1 4s. costs 9 L.B. 14 per cent. of added water Fined £5, £1 4s. costs 10 L.B. 14 7 per cent. of added water Fined £5, £1 4s. costs 17 S.F. 17 per cent. of fat abstracted Fined £2, 12s. 6d. costs 40 L.B. 3 per cent. of fat abstracted Cautioned 42 L.B. 12 per cent. of fat abstracted Warranty proved, case dismissed 51 L.B. 6 per cent. of fat abstracted Fined £1, 12s. 6d. costs 53 S.F. 16 per cent. of fat abstracted, 13 per cent. added water 12s. 6d. costs 56 S.F. 3.6 per cent added water Cautioned 59 L. 4.4 per cent. added water Cautioned 91 S.F. 6 per cent. of fat abstracted Fined £5, 12s. 6d. costs. Taken in course of delivery 106 L.B. 3.6 per cent. of added water Cautioned 112 L.B. 4.5 per cent. of fat abstracted Cautioned 126 S.F. 2.36 per cent. of added water Cautioned 134 L. 3.6 per cent. of added water Cautioned 135 L.B. 43 per cent. of fat abtracted Fined £20, £1 costs 136 L.B. 15 per cent. of fat abstracted Fined £5, £1 costs 137 L.B. 12 per cent. of fat abstracted Fined £5, £1 costs 167 L.B. 3.4 per cent. of fat abstracted Cautioned 216 S.F. 4.7 per cent. of added water Cautioned 223 L.B 3 per cent. of added water Cautioned 225 L.B. 8 per cent. of added water Fined £4, 12s 6d. costs 233 S.F. 4 per cent. of added water Cautioned 239 S.F. 3 4 per cent. of fat abstracted Cautioned 254 S.F. 12 per cent. of added water Cautioned 257 S.F 3.5 per cent. of added water Cautioned 270 L. 5 per cent. of added water Cautioned 273 L. 10.5 per cent. of fat abstracted Fined £1, £1 1s. costs 299 S.F. 3 per cent. of added water Cautioned 309 L. 3 per cent. of added water Cautioned 310 L. 5 per cent. of added water Cautioned 312 L. 13 per cent. of added water Fined £5, 12s. 6d. costs 313 L. 3 per cent. of added water Cautioned 314 L. 3 per cent. of added water Cautioned 320 S.F. 3 per cent. of added water Cautioned 321 S.F. 2.5 per cent. of added water Cautioned 322 S.F. 1.8 per cent. of added water Cautioned 330 L.B 3 per cent. of added water Cautioned 342 L.B. 2 4 per cent. of added water Cautioned 395 L.B. 10 per cent of added water Owingto a technical irregularity in the collection of the sample, no proceeding's were taken 423 L. 2 per cent. of added water Cautioned 425 L.B. 3.5 per cent. of added water Cautioned 428 L.B. 3.5 per cent. of added water Cautioned 429 L.B. 3.5 per cent. of added water Cautioned 436 L. 2.3 per cent. of added water Cautioned The letters "L.B.," "S F" or "L" following each number refer to the Division of the Borough in which the Sample was procured, "L.B." being Lewisham, "S.F." Sydenham and and Forest Hill, and "L" Lee Division. 114 Samples Nos. 7, 8, 9 & 10 relate to milk supplied by a Contractor to the Park Fever Hospital and were taken in course of delivery. The proceedings before the Court in these particular cases were interesting. After the service of Summonses upon the Vendors, notice was given to the Inspector that they relied upon a warranty for their defence. As a rule such defence is successful. In this case, however, a new point was raised. The Metropolitan Asylums Board in their contract specified that the milk delivered by the vendors was to be of a particular standard, as laid down by the Board in their contract. The Magistrate decided that the usual warranty of "new milk" was not a warranty to supply milk of the standard the vendors had contracted to supply, and consequently the warranty possessed by the vendors could not be allowed. The vendors were fined on all four summonses. Sample 91. In this case a sample was taken in course of delivery at Forest Hill Station at the request of the consignee who had previously received a caution relative to a sample containing 3.6 per cent. of added water. Samples 135, 136 and 137 were obtained in course of delivery at the Park Hospital, and were supplied by the defendant in cases numbered 7, 8, 9 and 10, previously referred to. The fines were increased owing to the previous conviction. Sample No. 42. In this case notice of warranty was given and substantiated in Court. In the absence of instructions 115 no action was taken against the guarantor. The Committee have given instructions for further proceedings to be taken in similar cases in the future. Milk Standard. We have now had a year's experience in regard to the working of the regulations issued by the Board of Agriculture in August, 1901, wherein a Standard was fixed for Genuine Milk, and Skimmed or Separated Milk. The average compositions were well above the standard fixed. Average Composition of the 228 Milk Samples submitted in 1902. Milk Fat. olids not Fat. 3.55 per cent. 8.62 per cent. 116 Table F. Average Composition of Milk Samples submitted in 1902. Average Composition of all samples submitted genuine and adulterated. Average Composition of genuine samples submitted. Board of Agriculture Standard. Percentage of Milk fat. Percentage of Solids not fat. Percentage of Milk fat. Percentage of Solids not fat. Percentage of Milk fat. Percentage of Solids not fat. First Quarter 3.32 8.57 3.52 8.73 3.0 8.5 Second „ 3.43 8.67 3.58 8.75 Third „ 3.59 8.54 3.63 8.63 Fourth „ 3.87 8.7 3.93 8.76 Total for Year 3.55 8.62 3.66 8.71 117 BUTTER. Of the 149 samples submitted, 15 or 10 per cent. were adulterated. More than half the adulterated samples were submitted during the first quarter. Table G. Showing number of samples of Butter submitted in the Four Quarters of the year 1902. Quarter. No. of Sample. Adulterated. Percentage Adulterated. First 44 9 20.4 Second 63 4 6.34 Third 26 1 3.82 Fourth 16 1 6.25 Total for year 149 15 10.0 Prosecutions were successfully instituted in each of the adulteration cases. The Sale of Butter Regulations issued by the Board of Agriculture provide that where the proportion of water in a sample of butter exceeds 16 per cent. it shall be presumed for the purposes of the Sale of Food and Drugs Acts, 1875 to 1899 118 until the contrary is proved, that the butter is not genuine by reason of the excessive amount of water therein. These regulations came into operation on the 15th of May, 1902, since which time it has not been necessary to take action against any person for the contravention of this order. Table H. Details of Adulterated Samples of Butter for the Year ended December 31st, 1902. No. Adulteration. Remarks. 22 S.F. 100 per cent. of foreign fat Fined £3, 12s. 6d. costs 25 L.B. 77.5 per cent. of foreign fat Fined £2, 12s. 6d. costs 26 S.F. 90.5 per cent. of foreign fat 12s. 6d. costs. 27 S.F. 78 per cent. of foreign fat Fined £3, 12s. 6d. costs 29 S.F. 90.5 per cent. of foreign fat Fined £3, 12s. 6d. costs 43 S.F. 90 per cent. of foreign fat Fined £5, 12s. 6d. costs 58 S.F. 95 per cent. of foreign fat Fined £5, 12s. 6d. costs 100 L.B. 97 per cent. of foreign fat Fined £5, 12s. 6d. costs 115 S.F. 85 per cent. of foreign fat Fined £2, 12s. 6d costs 151 L.B. 98 per cent. of foreign fat Fined £5, 12s. 6d. costs 154 L.B. 96.05 per cent. of foreign fat Fined £5, 12s. 6d costs 185 L.B. 98 per cent. of foreign fat Fined £5, 12s. 6d. costs 191 L.B. 95 per cent. of foreign fat Fined £5, 12s. 6d. costs 356 S.F. 97.3 per cent. of foreign fat. Fined £5, 12s. 6d. costs 437 S.F. 30 per cent. of foreign fat. Fined £3, 12s 6d. costs 119 COFFEE. Of the 33 samples submitted, only two were found adulterated. Sample No. 249 L. contained 38 per cent. of Chicory. The Vendor produced evidence that the stock cannister from which the sample was served bore a label stating that the contents was a mixture. The summons was dismissed. Sample No. 264 L.B. contained 65 per cent. of Chicory The tin in which it was sold bore a label denoting that the contents was a mixture. No action was taken. SPIRITS. Ten samples of spirits were examined for adulteration and the detection of sulphuric acid and poisonous metals. Two samples of whiskey and one of gin were found to be below standard. In two of these cases the Vendors were protected by notices exhibited, and in the third case your Committee directed that a caution be given. DRUGS, &c. Samples of Drugs and various other articles were submitted. These are fully set out in Table A. 120 Table I. Details of Adulterated Samples of Coffee, Spirits, &c., for the year ended December 31st, 1902. No. Article. Adulteration. Remarks. *80 S.F. Whiskey 27 degrees under proof Protected by notices exhibited in Bar. *85 L.B. „ 28.73 degrees under proof Protected by notices exhibited in Bar. 307 S.F. Gin 3 degrees below standard Cautioned. 249 L. Coffee 38 per cent. of chicory Summons dismissed. 2/costs. 264 L.B. „ 65 per cent. of Chicory Protected by label on packet. 210 L. Cocoa Added Sugar, 25 per cent., added Starch, 13 per cent. Fined £3 12s. 6d. costs. •The legal standard is 25 degrees under proof. A. Wellesley Habbis, Medical Officer of Health and Public Analyst. Appendix. LOCAL GOVERNMENT BOARD TABLES. 123 TABLE A. Vital Statistics of Whole District during the Years 1901 and 1902. LOCAL GOVERNMENT BOARD. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non-residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age At all Ages. Number. Rate.* Number. Rate per 1000 Births registered. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1901 128480 3320 25.9 426 128 1875 14.5 613 289 82 1668 13.0 1902 132432 3491 26.3 438 125 1942 13.9 568 241 117 1818 13.7 Note.—Figures for years prior to 1901 are unobtainable. *Rates in Columns 4, 8 and 13 calculated per 1,000 of estimated population. Area of District in Acres (exclusive of area covered by water) 6,991 At Census of 1901—Total population of all ages — 127,495 „ „ Number of inhabited houses — 22,750 „ „ Average number of persons per house 5.6 Institutions within the District receiving sick and infirm persons from outside the District:—Lewisham Union Infirmary; Lewisham Union Workhouse; Park Fever Hospital; St. Olave's Union Workhouse; St. John's Hospital, Morden Hill ; Home for Sick Children, Lower Sydenham ; Flower House Asylum, Beckenham Hill. Other Institutions, the deaths in which have been distributed among the several localities in the District:—Brook Fever Hospital; South Eastern Fever Hospital: Long Reach 124 Small Pox Hospital; Gore Farm Small Pox Hospital; Small Pox Ship, "Castalia"; Small Pox Ship, "Atlas"; Guy's Hospital; St. Bartholomew's Hospital; London Hospital; St. Thomas's Hospital; St. George's Hospital; Charlton and Blackheath Cottage Hospital; Seamen's Hospital, Greenwich; Brompton Hospital; King's College Hospital; Homœpathic Hospital; City of London Hospital, Stone; National Hospital; Royal Free Hospital; University Hospital; Westminster Hospital ; Clapham Maternity Hospital; Childrens' Hospital, Great Ormonde Street; London County Asylum, Dartford ; Claybury Asylum; Cane Hill Asylum; Darenth Asylum; Horton Asylum ; Leavesden Asylum; Caterham Asylum; Banstead Asylum; Camberwell House Asylum; Greenwich Infirmary; St. Piligias Creche, 50, Weymouth Street, Marylebone. TABLE B. Vital Statistics of Separate Localities in the Years 1901 and 1902. LOCAL, GOVERNMENT BOARD. Names of Localities. LEE. LEWISHAM. SYDENHAM & FOREST HILL. WHOLE BOROUGH. Year. Population estimated to' middle of eaeh Year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each Year. Births registered. Deaths at all ages. Deaths under 1 Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 1901 18703 398 255 — 66631 1882 856 — 43146 1040 557 - 128480 3320 1668 — 1902 18925 481 220 37 69672 1857 991 261 43835 1153 607 130 132432 3491 1818 428 Note :—Figures for years prior to 1901 are unobtainable. 125 Table C. Cases of Infectious Disease Notified during the Year 1902. LOCAL GOVERNMENT BOARD. Notifiable Disease Cases notified in whole district. Total Casks Notified in each Locality at all Ages. No. of Cases Removed to Hospital from each Locality. At all Ages At Ages—Years. Lee. Lewisham. Sydenham and Forest Hill. Lee. Lewisham. Sydenham and Forest Hill. Under 1 1 to 5. 5 to 15 15 to 25 25 to 65 65 and upwards Small-pox 84 2 4 6 21 51 — 14 46 24 14 46 24 Cholera — — — — — — — — — — — — — Diphtheria Membranous croup 376 6 108 198 27 37 — 78 210 88 68 142 46 Erysipelas 112 6 3 6 15 70 12 17 59 36 2 6 8 Scarlet fever 637 7 149 385 69 27 — 107 351 179 83 262 147 Typhus fever — — — — — — — — — — — — — Enteric fever 59 — 1 11 14 32 1 7 39 20 2 18 5 Relapsing fever — — — — — — — — — — — — — Continued fever — — — — — — — — — — — — — Puerperal fever 14 — — — 2 12 — — 8 6 — 4 2 Plague — — — — — — — — — — — — — Totals 1282 21 265 606 148 229 13 223 706 53 169 478 232 126 Table D. Causes of, and Ages at, Death during the Year 1902. LOCAL GOVERNMENT BOARD. 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. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Lee Division. Lewisham Division. Sydenham & Forest Hill Division. 1 2 3 4 5 6 7 8 9 10 11 12 Small-pox 12 2 — — 2 8 — — 11 — — Measles 27 4 22 — 1 — — 2 14 11 8 Scarlet fever 17 — 9 6 1 1 — 2 11 4 69 Whooping-cough 63 28 33 2 — — — 7 33 23 1 Diptheria and membranous croup 44 1 22 17 3 1 — 9 18 17 68 Croup — — — — — — — — — — — Fever Typhus — — — — — — — — — — — Enteric 9 — — 2 4 3 — 3 4 2 16 Other continued — — — — — — — — — — — Epidemic influenza 30 4 — — 2 7 17 7 13 10 3 Cholera — — — — — — — — — — — Plague — — — — — — — — — — — Diarrhœa 55 53 2 — — — — 2 38 15 13 Enteritis 35 28 2 1 — 3 1 2 25 8 6 Puerperal fever 6 — — — — 6 — — 3 3 2 Erysipelas 9 2 — — 1 2 4 1 6 2 2 Other septic diseases 9 2 1 1 3 2 — 2 6 1 6 Phthisis 142 1 4 4 32 96 5 18 80 44 39 Other tubercular diseases. 60 18 20 7 8 7 — 9 26 25 18 Cancer, malignant disease 127 — — — — 79 48 19 61 47 25 Bronchitis 125 17 11 1 — 31 65 15 68 42 38 Pneumonia 117 34 27 4 4 32 16 13 73 31 20 Pleurisy 6 — — — — 3 3 2 1 3 — Other diseases of Respiratory organs 27 10 6 1 — 8 2 4 11 12 3 Alcoholism Cirrhosis of liver 28 — — — 1 20 7 3 16 9 8 Venereal diseases 6 3 1 — — 2 — — 2 4 — Premature birth 78 78 — — — — — 5 46 27 2 Diseases and accidents ol parturition. 9 1 — — 3 5 — — 7 _2 2 Heart diseases 224 7 1 13 6 95 102 24 117 83 69 Accidents 42 11 5 5 1 11 9 2 29 11 9 Suicides 12 — — — — 11 1 — 7 5 4 All other causes 499 124 34 22 14 114 191 69 266 164 137 All causes 1818 428 200 86 86 547 471 220 992 606 568