BOROUGH OF LEWISHAM. Annual Report on the VITAL STATISTICS & SANITARY CONDITION of the BOROUGH OF LEWISHAM and REPORT OF THE PUBLIC ANALYST For the Year 1903, 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, 1903. Area in acres, exclusive of area covered by water 6,991 Enumerated population (Census, 1901) 127,495 Estimated population to the middle of 1903 136,405 Average number of persons per house (Census, 1901) 5.6 Total number of Births registered in the Borough 3,563 Birth Rate per 1,000 estimated population 26.1 Total number of Deaths registered in the Borough 1,566 Total number of Deaths of residents of the Borough, after correction for non-residents dying in Public Institutions, and residents dying outside the District 1,513 Deaths of persons under 1 year of age 328 Infantile Death Rate per 1,000 Births registered 92 Total number of Deaths in Public Institutions in the Borough 480 Deaths of non-residents in the Borough 152 Deaths of residents outside the Borough 99 Corrected Death Rate per 1,000 of the estimated population 11.l 4 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisliam. Gentlemen, I beg to submit to you my Annual Report on the Vital Statistics and Sanitary Condition of the Borough for tbe year 1903. 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 11.1 per 1,000, a marked decrease over that for the preceding year, 13.7 per 1,000. Compared with other Metropolitan Boroughs, Lewisham occupies a high position, and has the lowest death rate except Hampstead. In addition to the general death rate, the mortality among Infants, and the death rates from Phthisis and the principal Epidemic Diseases, offer valuable evidence in regard to the healthiness of any locality. In these respects Lewisham is most fortunate; the Infantile Mortality, 92 per 1,000 births, and the death rate from Phthisis, 0.74 per 1,000, were the second lowest in London, and the mortality from the principal Zymotic Diseases (0.82) was the lowest of the ten South Metropolitan Boroughs. Lewisham, therefore, may justly be considered one of the healthiest districts in the Metropolis. During the year special attention has been given to the subject of the Housing of the Working Classes, and from the reports contained herein, it will be seen that Lewisham has the lowest percentage of persons living in one, two, and threeroomed homes of any district in London. The percentage of of the population living in homes of less than five rooms is also the lowest. 5 It is a matter of regret that no steps have been taken by the London County Council to remedy the serious evil arising from the frequent flooding in the neighbourhood of Loampit Vale, due to the incapacity of the sewers under their control, notwithstanding the many appeals made to them by your Council. This subject was reported upon in detail in my Report for 1902. Investigations were made in regard to special nuisances arising from the pollution of the Rivers Pool and Ravensbourne by the Crystal Palace District Gas Company, to remedy which it was necessary for your Council to institute proceedings in the High Court. Representations were also made to the Local Government Board respecting the pollution of the Pool River by effluent discharged from the Sewage Farm at South Norwood. I remain, Gentlemen, Your obedient Servant, A. WELLESLEY HARRIS, Medical Officer of Health and Public Analyst. 6 CONTENTS. Page. Accidents, fatal 25 Adulteration of Food and Drugs 117, 119, 124 127, 129, 130 ,, ,, ,, forms of 119 Age Periods of Deaths 18 ,, Infectious Disease 43 All Saints Orphanage, outbreak of Diphtheria 55 Analyses of samples of water 103 Analyst, Public, report of 117 to 131 Anti-toxine in Diphtheria 51 Attack Rates, infectious disease 45, 46 Bacteriological examination of water and watercress 104 Bakehouses, underground 94 Beacon Road Board School, Scarlet Fever among scholars 60 Births, registered 15 ,, ,, in Divisions 16 Birth Rate 15 ,, in Divisions 16 Butter, samples analysed 122 & 129 ,, preservative in 122 ,, colouring matter in 122 ,, details of adulterations 130 Cancer, mortality from 24 Chicken Pox, notification of 52 Crystal Palace District Gas Bill 107 Combined Drainage 95 Communications from various local authorities 108 Constitutional Diseases, mortality from 25 Cowsheds 92 Customs and Inland Revenue Act, 1903 78 „ „ „ 1890, houses examined under 95 Dairies 92 Death, ages at 18, 34, & 35 Death, causes of in detail 34, 35 Deaths, in Divisions 27 & 30 ,, in Disease Groups 30 ,, of Infants, causes of 21 „ ,, percentage to total deaths 19 „ registered 17 ,, in Wards 28 ,, from Zymotic Diseases 37 Death Rates from all causes 29 ,, County of London 27, 29, 32, 33 ,, in Disease Groups 31 in Divisions 27, 29 ,, Infantile 38 ,, Metropolitan Boroughs 32, 33 from Phthisis 38 ,, in Wards 29 ,, from Zymotic Diseases 22 Digestive Diseases, mortality from 25 Diphtheria, age periods 44 ,, mortality from 23, 45 ,, notifications 51 Disinfection 60 Dwellings occupied by working classes 81,82, 83 Employment of Children Act, 1903 77 Enteric Fever, mortality from 23, 45 ,, notifications 52 Erysipelas, notifications 53 Expiring Laws Continuance Act, 1903 76 Generative Organs, diseases of, mortality from 25 Heart disease, mortality from 25 House-to-house inspection 90 Housing of the Working Classes Act, 1903 76 ,, „ „ premises dealt with 78 Infantile Mortality 20 ,, death rate from 38 Infected Army Blank is 91 Infectious disease, age periods of 43 ,, attack rates from 45 ,, attack rates in Metro,, politan Boroughs 49 ,, mistaken diagnosis 43 ,, notifications 43 ,, return cases 46 ,, notified by school ,, authorities 56 ,, street list Inspections, general 92 Legal Proceedings 90 Legislative measures in 1903 75 Page. Lewisham Bridge Board School, outbreak of diphtheria 57 Local Government Board Tables 135 to 138 Marriage Rate 16 Measles at Lewisham Bridge Board School 60 ,, mortality from 23 ,, notifications 53 Meteorological Table 40 Midwives Act, 1902 75 Milk, artificial colouring in 121 ,, composition of samples 128 ,, details of adulterated samples 127 number of samples analysed 121 ,, ,, ,, per 1,000 of the population 129 ,, preservatives in 121 ,, results of analysis of samples 126 Mistaken diagnosis, infectious disease 43 Mortality 17 Mortuaries 98 Mumps notified 55 Nervous diseases, mortality from 25 Non-residents dying in Public Institutions in Borough 36 Nuisances from House Refuse deposit 88 Smoke 88 Ballast Fire 88 Public Urinals 88 Gipsies 89 Fish Offal 89 Stable Litter 89 Outworkers, List of 101 Overcrowding 98 Phthisis, death rates from 38 ,, mortality 23 Street list 62 Pollution of Rivers Pool and Ravensbourne 101 ,, ,, by sewage 104 ,, ,, by Gas products 106 Population, 1903 13 ,, increase in 13 ,, in Wards 14 ,, in Divisions 15 Population residing in 1, 2, 3 and 4-roomed homes 87 Premises subject to registration 98 Prosecutions under Sale of Food and Drugs Acts 118,131 Public Analyst, report of 117 to 131 Public Institutions in Borough Non-residents dying in 36 Residents dying in 36 Public Institutions outside Borough, deaths in 26 Puerperal Fever notifications 53 Rainfall 40 Residents dying in Public Institutions in Borough 36 Residents dying in Public Institutions outside Borough 26 Respiratory Diseases, mortality from 25 Return cases, infectious disease 46 Rivers pollution 101 St. Stephen's Schools, Diphtheria at 56 Sanitary Work, register of 93 Sanitation of Schools, defective 60 Scarlet Fever, age periods 44 ,, mortality from 23,45 ,, notifications 50 Seasonal Mortality 19 School Attendance, age for 44 Schools and Infectious disease 55 Slaughterhouses 92 Slum Property 83 Small Pox notification 50 Spirits, etc , adulterations of 130 Street List of Infectious disease and Phthisis 62 Suicides 25 Underground Bakehouses 94 Urinary Organs, diseases of, mortality from 25 Watercress Beds, pollution of 106 Water Certificates 96 Whooping Cough 23, 55 Workshops, List of 97 „ defects reported by Inspector 100 ,, inspection of 99 Zymotic Death Rates 22,37 Zymotic Diseases, ages at death from 39 ,, deaths from in Wards 37 7 SYNOPSIS OF TABLES AND CHARTS. Part I.—Vital Statistics. 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, 1902 and 1903. 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, 1902 and 1903. Table 3.—Births and Birth Bates for each Division of the Borough for the years 1901, 1902 and 1903. Table 4.—Number of Deaths at various Age Periods and their Percentage to corrected Total Deaths during the years 1902 and 1903. Table 5.—Percentage of Deaths Under One Year of Age to Total Deaths in Wards and Divisions for the years 1902 and 1903. Table 6.—Analysis of Deaths Under One Year of Age during the years 1902 and 1903. Table 7.—Corrected Death Totals and Death Rates for the years 1901, 1902 and 1903. Table 8.—Corrected Total Deaths from All Causes in Wards occurring during the four quarters of the year 1903. Table 9. -Corrected Death Rates from All Causes in Wards, Divisions and the Whole Borough for the four quarters of the year 1903. Table 10.—Deaths in Disease Groups in the three Divisions and the Whole Borough for the year 1903. Table 11.—Death Rates in Disease Groups in the Wards and Divisions of the Borough for the year 1903. Table 12.—Death Rates of London and Metropolitan Boroughs during the year 1903, after distribution of deaths in Public Institutions. 8 Table 13.—Death Rates in London and the several Metropolitan Boroughs from All Causes and from Certain Diseases during the year 1903, before distribution and after distribution of deaths in Public Institutions. Table 14.—Causes of, and Ages at, Deaths in the Borough for the year 1903. Table 15—Residents and Non-Residents dying in Public Institutions situated in the Borough. Table 16.—Deaths from Principal Zymotic Diseases in Wards during the year 1903. Table 17.—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 1903. Table 18.—Deaths from Principal Zymotic Diseases arranged in Age Groups for the year 1903. Table 19.—Meteorological Table for London for the year 1903. Part II.—Infectious Diseases. Table 20.—Showing Cases of Scarlet Fever and Diphtheria at various Age Periods notified during the year 1903. Table 21.—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 22.—Attack Rates from the Principal Infectious Diseases per 1,000 of the population for the Ten Wards and the Whole Borough for the year 1903. Table 23.—Particulars of "Return Cases" of Infectious Disease during the year 1903. Table 24.—Attack Rates at All Ages from Small Pox, Scarlet Fever and Diphtheria in the Metropolitan Boroughs and the County of London for the years 1902 and 1903. 9 Part III.—General. Table 25.—Estimated Number of Dwellings in the Borough of Lewisham at rentals varying from 4s. to 13s. Table 26.—Showing distribution of Population in relation to 1, 2, 3 and 4-roomed homes compared with other London Boroughs —Census 1901. Table 27.—Register of Sanitary Work for 1903. Table 28.—Houses Examined and Certified under the Customs and Inland Revenue Act. Table 29.—Water Certificates Granted. Table 30.—Tabular detail of Workshops, Table 31.—Details of Premises subject to Registration by the Local Authority, or the London County Council. Table 32.—Details relating to Inspection of Workshops and Workplaces in the Borough. Table 33.—Defects reported by the Workshops Inspector. Table 34.—List of Outworkers. Part IV.—Report of Public Analyst. Table A.—Showing Number of Samples submitted for Analysis, with Results, for the year ended December 31st, 1903. Table B.—Summary of Samples Analysed in the Borough in each year, 1898 to 1903 (inclusive). Table C.—Showing Results of Total Samples submitted during the during the years 1902 and 1903. Table D.—Showing Results of Total Samples of Milk submitted during the years 1902 and 1903. Table E.—Details of Adulterated Samples of Milk for the year ended December 31st, 1903. Table F.—Average Composition of Milk Samples submitted in 1903 10 Table G.—Showing the Number of Samples of Milk taken per 1,000 of the Population and the Percentage of Samples Adulterated in the Metropolitan Boroughs during the year 1902. Table H.—Showing the Number of Samples of Butter submitted in the four quarters of the years 1902 and 1903. Table I.—Details of Adulterated Samples of Butter, Spirits, Lime Water, &c., for the year ended December 31st, 1903. Also details of Other Prosecutions taken under the Sale of Food and Drugs Acts. Appendix.—Local Government Board Tables. Table A.—Vital Statistics of Whole District during the years 1901, 1902 and 1903. Table B.—Vital Statistics of Separate Localities in the years 1901, 1902 and 1903. Table C.—Cases of Infectious Disease notified during the year 1903. Table D.—Causes of, and Ages at, Death during the year 1903. Charts. Chart A.—Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 weeks ended January 2nd, 1904. Chart B.—Showing Percentage of Deaths in Eleven Groups to Total Deaths during 1903. Chart C.—Showing Weekly Notifications of All Infectious Diseases, also Weekly Notifications of Scarlet Fever, and Diphtheria and Small Pox, during the year 1903. PART 1. VITAL STATISTICS. 13 report OF THE Medical Officer of Health FOR THE YEAR 1903. 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 1903, which amounted to 136,405, compared with 132,432 for 1902, an increase in one year of 3,973 persons. The increase in the population by natural increment, i.e., the excess of births over deaths, amounted to 1,997. It may be assumed, therefore, that the difference of 1,976 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 in this report comparable with other districts and with the Returns of the Registrar General, a period of 52 weeks ending January 2nd, 1904, 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, 1902 and 1903. Ward. Population at Census, April, 1901 Population estimated to the middle of 1901. 1902. 1903. Church 6,412 6,434 6,522 6,611 Manor 6,734 6,761 6,872 6,983 South 5,503 5,508 5,531 5,553 Lee Division 18,649 18,703 18,925 19,147 Blackheath 6,729 6,735 6,759 6,784 Lewisham Tillage 13,842 13,887 14,070 14,253 Lewisham Park 11,145 11,394 12,391 13,393 Brockley 10,952 10,984 11,114 11,245 Catford 23,203 23,631 25,338 27,056 Lewisham Division 65,871 66,631 69,672 72,731 Forest Hill 18,051 18,063 18,115 18,166 Sydenham 24,924 25,083 25,720 26,361 Sydenham & Forest Hill Division 42,975 43,146 43,835 44,527 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, 1902 and, 1903. Divisions. Population at Census, April, 1901. Population estimated to the middle of 1901. 1902. 1903. Lee 18,649 18,703 18,925 19,147 Lewisham 65,871 66,631 69,672 72,731 Sydenham and Forest Hill 42,975 43,146 43,835 44,527 Whole Borough 127,495 128,480 132,432 136,405 THE BIRTH RATE. The total number of Births registered in the Borough of Lewisham during the year 1903 was 3,563. Of this total 1,826 were males and 1,737 females. The birth rate for Lewisham is therefore 26.12 per 1,000 inhabitants, compared with 26.36 in the previous year. The birth rate for London was 28.4 per thousand, or 2.28 per thousand in exeess of this Borough. Of the total births, 486 were registered in the Lee division, 1,979 in Lewisham and 1,098 in Sydenham and Forest Hill division. 16 The birth rate in Lee was 25.4, in Lewisham 27.2, and in Sydenham and Forest Hill 24.7 per 1,000 of the inhabitants of each division. MARRIAGE RATE. The number of Marriages registered in the Borough during the year amounted to 891, compared with 759 in 1902. Table 3. Births and Birth Rates for each Division of the Borough for the years 1901, 1902 and 1903. Division. Total Number of Births. 1901. Birth Rate per 1000 persons. 1901. Total Number of Births. 1902. Birth Rate per 1000 persons. 1902. Total Number of Births 1903. Birth Rate per 1000 persons 1903. Lee 398 21.2 481 25.4 486 25.4 Lewisham 1,882 28.2 1,857 26.6 1,979 27.2 Sydenham & Forest Hill 1,040 24.1 1,153 26.3 1,098 24.7 Whole Borough 3,320 25.9 3,491 26.3 3,563 26.1 County of London 131,829 29.0 130,478 28.5 130,906 28.4 17 The Marriage Rate was 13.1, an increase of 1.6 per 1,000 over 1902, while the Marriage Rate for the whole of London was equal to 17.4 per 1,000. MORTALITY. The total number of Deaths registered in the Borough amounted to 1,566, compared with 1,942 for the year 1902. After deducting the deaths of non-residents (152) dying within the Borough, and adding those of residents (99) who died outside the district, a corrected total of 1,513 is obtained, compared with 1,818 in 1902. The corrected total deaths, 1,513, is equivalent to a Death Rate of 11.1 per 1,000 living at all ages, and compares most favourably with the death rate, 15.2 per 1,000 for the County of London, and 16.3 for the 76 Great Towns. Compared with other Metropolitan Boroughs, Lewisham enjoys the second lowest death rate in London. Hampstead is the lowest with 10.0, followed by Lewisham 11.1, Wandsworth 12.4, and Stoke Newington 12.6 per 1,000 of the population living at all ages. The districts having the highest death rates in London were Finsbury, 20.3, Shoreditch, 19.4 and Holborn, 18'6. (See Tables 12 and 13). The death rate for Lewisham, 11.1 per 1,000 for the year 1903, shows a marked decrease compared with 13.7 per 1,000 in 1902, and 13.0 per 1,000 in 1901. On sub-dividing the corrected deaths into the three divisions of the Borough, it will be noted that the mortality rate of the Sydenham and Forest Hill Division, 10.9, was 18 the lowest, Lewisham 11.2 the highest, and Lee Division, 11.1 per 1,000 of the persons estimated to be living in each Division referred to. (See Table 7). Carrying the sub-division a step farther, the death rates from all causes in the individual Wards show Lewisham Village to have suffered the highest mortality (13.6); on the other hand Brockley claims the lowest mortality for the year with 8.9 per 1,000. (See Table 9). 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. ANALYSIS OF DEATHS. Table 4. Number of Deaths at Various Age Periods and their Percentage to Corrected Total Deaths during the years 1902 and 1903. Age Periods. 1902. 1903 Number of Deaths. Percentage to Total Deaths. Number of Deaths Percentage to total Deaths. Deaths under 1 year 428 23.54 328 21.68 Over 1 yr.&under 5yrs. 200 11.00 142 9.39 „ 5 „ „ 15 „ 86 4.73 61 4.03 „ 15 „ „ 25 „ 86 4.73 76 5.02 „ 25 ,, ,, 65 ,, 547 30.09 478 31.59 Over 65 years 471 25.91 428 28.29 Total 1818 100.0 1513 100.0 Chart A. Showing Weekly Total Deaths from all Causes, , from Respiratory Diseases, and from IInfantile Diarrhæa, flor the 52weeks ending January 2nd 1904 19 Table 5. Percentage of Deaths under one year of age to Total Deaths in Wards and Divisions. District. 1902. 1903. Church Ward per cent. 11.8 per cent. 11.3 Manor Ward 16.4 26.4 South Ward 20.3 14.8 Lee Division 15.9 17.4 Blackheath Ward 14.5 13.8 Lewisham Village Ward 18.5 22.2 Lewisham Park Ward 25.1 20.8 Brockley Ward 26.2 20.0 Catford Ward 34.6 32.7 Lewisham Division 26.9 24.9 Forest Hill Ward 21.7 13.4 Sydenham Ward 20.6 21.4 Sydenham & Forest Hill Division 21.0 18.2 Whole Borough 21.68 23.54 Seasonal Mortality.—The highest mortality occurred during the first and last quarters of the year, the death-rates from all causes being 11.8 and ll.l per 1,000 respectively. The lowest death-rate was 10.6 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. 20 Table 10 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 1,513 corrected total deaths recorded in the Borough, 328 or 21.7 per cent. of the total deaths were under one year of age. The total births were 3,563, therefore the infant mortality rate was 92 per thousand births, compared with 122 for 1902. The Infant mortality during 1903 for England and Wales was 132, 76 Great Towns 144, and the County of London 130. The infant mortality rate is a valuable index of the sanitary condition of a district. Compared with other Metropolitan districts, Lewisham is in a most satisfactory position. The rate referred to is the lowest in the ten South Metropolitan Boroughs, and of the total 29 Metropolitan Sanitary Districts only one, Hampstead, has a lower rate, viz., 88. (See Table 12). In the three Divisions of the Borough the infant mortality rates were Lee 76, Lewisham 103, and Sydenham and Forest Hill 80 per 1,000 births. An examination of the causes of death among infants under one shows that the following diseases were the most fatal:—Epidemic Diarrhoea and Enteritis, Bronchitis and Pneumonia, Convulsions, Enteritis, Gastro-Enteritis and other Digestive diseases, and Premature Birth. (See Tables 6 and 14). 21 Table 6. Analysis of Deaths under one year of age, during the years 1902-3. Disease. 1902. 1903. Number of Deaths. Percentage Deaths to total Deaths under 1 year. Number of Deaths. Percentage Deaths to total Deaths under 1 year Premature Birth 78 18.2 68 20.7 Tubercular Diseases 19 4.4 13 4.0 Epidemic Diarrhœa „ Enteritis 53 12.4 29 8.8 Other Zymotic Diseases 35 8.2 10 3.0 Convulsions 51 11.9 24 7.3 Circulatory Diseases 7 1.6 7 2.1 Respiratory Diseases 61 14.3 58 17.7 Enteritis, GastroEnteritis and other Digestive Diseases 81 18.9 78 23.8 Overlaying, Drowning, other Accidents and Homicide 11 2.6 9 2.7 Classified under various other headings 32 7.5 32 9.8 Totals 428 100.0 328 100.0 22 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. The Zymotic death rate for the Borough amounted to 0.82 per 1,000 persons, compared with 1.75 for the County of London, 1.46 England and Wales, and 1.89 for the 76 Great Towns. Of the ten South Metropolitan Boroughs, Lewisham possesses the lowest rate, and of the remaining Boroughs only Hampstead, with 0.58, has a lower rate. (See Table 12). Of the total 112 deaths from the principal infectious diseases, Measles accounted for 36, Scarlet Fever 11, Whooping Cough 4, Diphtheria 20, Enteric Fever 9, and Epidemic Diarrhœa and Enteritis 32. (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 17. The highest rates in the Borough were due to Measles and Epidemic Diarrhoea. In the three Divisions of the Borough the Zymotic death rates were Lee 1.3 (the highest,) Lewisham 0.9, and Sydenham and Forest Hill 0.5. (See Table 17). The relation of age periods to mortality from the Zymotic diseases will be found in Table 18. Of the total 112 deaths, 77 per cent. were among children under 5 years of age. For the distribution of Zymotic deaths in Ward localities see Table 16. Chart B. Showing Percentage of Deaths in Eleven Groups to Total Registered Deaths druing 1903 28 ANALYSIS OF DEATHS IN RELATION TO DISEASE GROUPS. GLASS I.—Infective Diseases. Small Pox.—No deaths occurred from this disease. Measles.—Of all the Zymotic Diseases Measles caused the greatest number of deaths, 86, equal to a death rate of 0.26 per 1,000 of the population. The death rate from this disease was highest in the Lee Division and lowest in the Sydenham and Forest Hill Division. (See Table 17). Scarlet Fever.—Eleven deaths were notified in the Borough, equal to a mortality rate of 0.08 per 1,000. Lewisham Division had the highest mortality, 0.14, and Lee 0.05. No deaths were recorded in the Sydenham and Forest Hill Division. The case mortality amounted to 2.5 per cent. of the persons affected. Diphtheria.—There were 20 fatal cases, giving a mortality rate for the Borough of 0.15 per 1,000. Of the three Borough Divisions, the disease was most fatal in Sydenham and Forest Hill, and the least fatal in Lewisham, the mortality being 0.20 and 0.11 per 1,000 respectively. The case mortality was 8.0 per cent. of the actual cases. Whooping Cough.—Only four deaths occurred from Whooping Cough, equal to a death rate of 0.08. In the Sydenham and Forest Hill Division the mortality rate was 0.04 per 1,000, and Lewisham 0.08 per 1,000. No deaths occurred in the Lee Division. Enteric Fever.—There were 9 fatal cases, equal to a death rate of 0.07 per 1,000. The case mortality was equal to 20.9 per cent. of the persons affected. CLASS II.—Tuberculous—Phthisis. -This disease was responsible for 107 deaths, or 7.1 per cent. of the total 1,513 deaths from all causes. This mortality is equal to a death 24 rate of 0.78 per 1,000 (compared with 1.06 in 1902) for the whole Borough, the lowest rate of the ten Southern Metropolitan Boroughs. Of the remaining London sanitary districts, only Hampstead, 0.74, is lower. The district having the highest mortality from this cause was Holborn, with 3.14 per 1,000. The death rate for the County of London was 1.55. 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 0.52, Lewisham 0.78, and Sydenham and Forest Hill 0.90. Comparing Phthisis with other infectious diseases it was again responsible for a greater loss of life than Small Pox, Measles, Scarlet Fever, Diphtheria and Enteric Fever combined. The total deaths from the diseases mentioned were:— Lewisham. County of London Small Pox — 13 Measles 36 2046 Scarlet Fever 11 361 Diphtheria 20 740 Enteric Fever 9 368 Total 76 3528 Phthisis 107 7124 In addition to Phthisis 62 deaths were registered as due to various forms of tubercular disease. (See Table 14). CLASS III.—Malignant Diseases.—-Cancer was the stated cause of 77 deaths, compared with 104 in 1902, equal to a mortality rate of 0.56 per 1,000. On sub-dividing these deaths, 14 were registered in Lee, 35 in Lewisham, and 28 in Sydenham and Forest Hill. For other diseases of this Class See Table 14. 25 CLASS IV.—Nervous Diseases.—This class was responsible for 125 deaths, equal to 8'3 per cent. of the total deaths. Of this number 19 were cases of Insanity, 19 Meningitis, 35 Convulsions; of the latter 24 were children under 1 year. CLASS V.—Diseases of Heart and Circulation. Diseases of Heart and Blood Vessels accounted for 220 deaths, equal to 14.5 per cent. of the total deaths. Sixty-six deaths were due to Apoplexy. CLASS VI.—Respiratory Diseases.—This class was the cause of 213 deaths, equal to 14.1 per cent. of the total deaths from all causes. The highest number of deaths occurred during the. 48th week. (See Chart A). Bronchitis and Pneumonia were the most fatal, particularly to children under 5 years of age. (See Table 14). CLASS VII.—Digestive Diseases.—To this class 155 deaths, or 10.2 per cent. of the total deaths, were assigned; 78 of these occurred to children under 1 year. CLASS VIII.—Diseases of Urinary Organs.—Fifty-three or 3.5 per cent. of the total deaths were recorded in this class. CLASS IX.—Diseases of Generative Organs.—Only 5 deaths were registered in this group. CLASS X.—General or Constitutional Diseases.—Of the 256, or 16.9 per cent. of the total deaths due to disease in this class, Old Age claimed 104 of the total, and Premature Birth was the certified cause of 68. CLASS XI.—Accidents—Forty fatal accidents occurred, three of which were due to overlaying. CLASS XII.—Violence, Suicides, &c.—Fourteen suicidcs and two other violent deaths occurred in the Borough. NOTE:—Chart B. contains a diagramatic comparison of deaths occurring in various groups. 26 DEATHS OP RESIDENTS belonqinq to the Borough occurring in Public Institutions, &c., in districts outside during the year 1903. Number of Deaths Number of Deaths Fever Hospitals:— Asylums—continued. Brook Hospital 5 Camberwell House Asylum 2 South-Eastern Hospital 1 Horton Asylum 2 London Fever Hospital 1 St. Luke's Hospital (Asylum) 2 Claybury Asylum 1 Peckham House Asylum 1 General Hospitals:— City of London Asylum, Stone 1 Guy's Hospital 14 Manor Asylum, Epsom 1 St. Thomas' Hospital 7 St. Bartholomews' s Hospital 5 London Hospital 2 Other Institutions, &c.:— Seamen's Hospital, St.Peter's House, Kennington 2 wich 2 University Hospital 2 Children's Hospital, Great Ormonde Street 2 Greenwich Infirmary 2 Lambeth Infirmary 1 Bethlem Royal Hospital 2 Camberwell Workhouse 1 Brompton Hospital 1 Eoyal Hospital for Incurables 1 King's College Hospital 1 Charing Cross Hospital 1 Salvation Army Maternity Home, Hackney 1 Grosvenor Hospital 1 St. Olave's Infirmary, City 1 Eiver Thames 2 Oxygen Hospital 1 Hostel of God 1 Metropolitan Hospital 1 Tailors' Institution, St. Pancras 1 Poplar Hospital 1 Charlton Eailway Station 1 3,Chester Cottages, Eltham 1 Asylums:— 48, Friendly St., Deptford 1 Baptist Chapel, Lewisham Eoad 1 L. C. Asylum, Dartford 11 Cane Hill Asylum 3 Caterham Asylum 4 Total 99 Banstead Asylum 4 27 Table 7. Corrected Death Totals and Death Rates for the years 1901, 1902 and 1903. Locality. 1901. 1902. 1903 Total Number of Deaths. Death rate per 1,000 of the population. Total Number of Deaths. Death rate per 1,000 of the population. Total Number of Deaths. Death rate per 1,000 of the population. Lee Division 255 13.6 220 11.6 213 ll.l Lewisham Division 856 12.9 991 14.2 816 11.2 Sydenham and Forest Hill Division 557 12.9 607 13.8 484 10.9 Whole Borough 1,668 13.0 1,818 13.7 1,513 11.1 County of London 79,924 17.1 80,105 17.2 69,737 15.2 Table 8. Corrected total Deaths from All Causes in Wards occurring during the four quarters of the year 1S03. Localities. 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 10 15 25 9 13 22 12 8 20 6 7 13 37 43 80 Manor Ward 14 8 22 10 8 18 7 8 15 11 6 17 42 30 72 South Ward 8 7 15 6 9 15 9 7 16 11 4 15 34 27 61 Blackheath Ward 16 8 24 6 4 10 8 10 18 6 7 13 36 29 65 Lewisham Village Ward 32 26 58 16 23 39 21 32 53 22 22 44 91 103 194 Lewisham Park Ward 24 17 41 19 24 43 9 14 23 25 22 47 77 77 154 Brockley Ward 12 13 25 15 19 34 10 5 15 15 11 26 52 48 100 Catford Ward 33 39 72 35 28 63 51 37 88 35 45 80 154 149 303 Forest Hill Ward 30 19 49 25 30 55 24 12 36 30 24 54 109 85 194 Sydenham Ward 33 37 70 33 38 71 36 42 78 38 33 71 140 150 290 The Whole Borough 212 189 401 174 196 370 187 175 362 199 181 380 772 741 1513 County of London — — 19328 - — 16314 — — 15581 - — 18514 — — 69737 76 Great Towns — — 65150 — — 57626 — — 56761 — - 64931 — — 244468 28 29 Table 9. Corrected Death Bates from All Causes in Wards, Divisions, and the Whole Borough, for the four Quarters of the Year 1903. Localities. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Whole Year. Church Ward 15.3 13.3 12.1 7.9 12.1 Manor Ward 12.6 10.3 8.6 9.7 10.3 South Ward 10.8 10.8 11.5 10.8 11.0 Lee Division 13.0 11.5 10.7 9.4 11.1 Blackheath Ward 14.2 5.9 10.6 7.7 9.6 Lew. Village Ward 16.3 10.9 14.9 12.3 13.6 Lew. Park Ward 12.2 12.8 6.9 14.0 11.5 Brockley Ward 8.9 12.1 5.3 9.3 8.9 Catford Ward 10.6 9.3 13.0 11.8 11.2 Lewisham Division 12.1 10.4 10.8 11.5 11.2 Forest Hill Ward 10.8 12.1 7.9 11.9 10.7 Sydenham Ward 10.6 10.8 11.8 10.8 11.0 Sydenham & Forest Hill Division 10.7 11.3 10.2 11.2 10.9 Whole Borough 11.8 10.9 10.6 11.1 11.1 County of London 16.8 14.2 13.5 16.1 15.2 76 Great Towns 17.3 15.3 15.1 17.3 16.3 * Table 10. Deaths in Disease Groups in the Three Divisions and the whole Borough for the year 1903. 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 7 11 3 5 26 34 13 27 12 86 9 11 8 3 31 50 35 38 20 143 II. Tuberculous 9 3 2 3 17 27 35 18 14 94 10 14 13 21 58 46 52 33 38 169 III. Malignant 4 6 6 5 21 8 16 15 19 58 5 14 16 4 39 17 36 37 28 118 IV. Nervous 5 3 7 2 17 14 18 23 13 68 10 14 6 10 40 29 35 36 25 125 V. Heart & Blood Vessels 11 8 7 3 29 30 25 27 28 110 22 14 19 26 81 63 47 53 57 220 VI. Respiratory 11 7 3 14 35 36 25 11 42 114 21 21 8 14 64 68 53 22 70 213 VII. Digestive 2 2 5 4 13 18 17 28 27 90 12 8 15 17 52 32 27 48 48 155 VIII. Urinary 2 1 4 1 8 6 7 6 4 23 3 11 4 4 22 11 19 14 9 53 IX. Generative Organs — — — — — - 1 2 1 4 1 — — — 1 1 1 2 1 5 X. General 9 13 10 7 39 38 29 33 41 141 21 14 21 20 76 68 56 64 68 256 XI. Accidents 2 — 4 1 7 6 2 6 8 22 3 1 3 4 11 11 3 13 13 40 XII. Violence — 1 — — 1 3 1 1 1 6 2 4 1 2 9 5 6 2 3 16 Totals 62 55 81 45 213 220 189 197 210 816 119 126 114 125 484 401 370 362 380 1513 30 * For Diseases in each Class see Table 14. Table 11. Death Rates per 1,000 of the population, in Disease Groups, in the Wards and Divisions of the Borough for the year 1903 Disease Class Wards and Divisions. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Church Manor South Lee Blackheath Lewisham Village Lewisham Park Brockley Catford Lewisham Forest Hill Sydenham Sydenham and Forest Hiil Whole Borough I. Infective 1.7 1.1 1.3 1.4 1.5 1.5 1.3 0.7 1.1 1.2 0.7 0.7 0.7 1.05 II. Tuberculous 1.1 1.3 0.2 0.9 0.6 1.2 1.5 1.4 1.4 1.3 1.5 11 1.3 1.24 III. Malignant 1.1 0.9 1.4 1.1 1.5 0.6 0.8 0.9 0.7 0.8 0.8 0.9 0 9 0-87 IV. Nervous 0.8 1.0 0.9 0.9 0.6 0.9 1.3 0.9 0.9 0.9 0.7 1.0 0.9 0-92 V. Heart and Blood Vessels 2.7 1.0 0.7 1.5 1.5 1.8 1.5 1.6 1.4 1.5 2.1 1.6 1.8 1.61 VI. Bespiratory 2.3 1.4 1.8 1.8 1.2 2.9 1.3 0.9 1.4 1.6 1.5 1.4 1.4 1.56 VII.Digestive 0.3 0.7 1.1 0.7 0.6 1.8 1.1 0.9 1.3 1.2 0.8 1.4 1.2 1 '14 VHI.Urinary 0.3 0.4 0.5 0.4 0.4 0.6 0.3 0.1 0.3 0.3 0.6 0.4 05 039 IX. Generative Organs - - - - - - 01 - 01 0.1 0.1 - 00 0.04 X. General Diseases 1.7 2.1 2.3 2.0 1.3 2.0 2.1 10 2.4 20 1.4 1.9 1.7 1.88 XI. Accidents 0.3 0.1 0.7 0.4 0.1 0.4 0.2 0.4 0.3 0 3 0.1 0.3 02 0.29 XII. Violence — 0.1 — 0.1 0.3 0.1 — 0.1 0.1 01 0.3 0.1 0.2 0.12 Total Deaths 12.1 10.3 11.0 11.1 9.6 13.6 11.5 89 11.2 11.2 10.7 11.0 10.9 11.09 31 32 Table 12. Death Rates of London and Metropolitan Boroughs during the year 1903, 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 Typhus Feve Enteric Fever Pyrexia* (Origin uncertain) Diarrhoea Phthisis County of London 15.2 1.75 0.00 0.44 0.08 0.16 035 000 008 0.00 0.64 1.55 130 West. Paddington 13.2 1.31 — 0.27 0.07 0.10 0.37 — 0.05 — 0.45 1.06 119 Kensington 13.9 1.56 — 0.19 0.08 0.13 0.51 — 005 — 0.60 1'25 145 Hammersmith 14.1 1.61 — 0.23 007 015 0.26 — 0.08 001 0 81 1 47 141 Fulham 13.9 2.21 — 0.42 005 0 16 0.31 — o.io — 1.17 1.38 127 Chelsea 15.3 1.13 — 0.19 0.03 0.05 0.39 — 0.05 — 0.42 1.57 142 City of Westminster 13.6 100 002 0.27 0.05 0.08 0.19 - 0.08 — 0.31 1.69 123 North. St. Marylebone 16.4 1.61 0.28 0.13 0.20 0.43 — 0.10 0.02 0.45 183 96 Hampstead 10.0 0.58 — 0.09 0.05 0.12 0.19 — 002 — 0.11 0.74 88 St. Pancras 16.2 1.92 — 0.83 0.10 0.16 0.39 — 0.06 — 0.38 1.82 133 Islington 14.3 1.44 — 0.37 0.07 0.12 0.45 — 0.07 0.00 0.36 1.40 126 Stoke Newington 12.6 1.46 — 0.46 — 0.13 0.37 — 0.10 — 0.40 1.23 119 Hackney 13.9 1.77 — 0 51 009 0.21 0.30 — 0.16 — 0.50 1.27 119 Central. Holborn 18.6 1.44 — 0.31 0.09 0.14 0.31 — 0.09 0.50 3.14 95 Finsbury 20.3 2.31 — 0.69 0.11 0.11 0.54 — 0.10 — 0.76 2.28 135 City of London 14.6 0.85 — 0.12 0.04 0.08 0.16 — 012 — 0.33 1.59 136 East. Shoreditch 19.4 2.91 0.87 0.06 0 19 0.38 — 0.11 1.30 2.32 171 Bethnal Green 18.2 2 23 — 0.66 0.09 0.21 0.32 — 0.09 — 0.86 2.10 141 Stepney 18.0 2.36 0*01 0.57 0 07 019 0.36 — 0.09 — 1.07 2.10 138 Poplar 18.2 2.97 0.01 0.95 0.11 0.35 0.47 — 0.10 — 0.98 1.74 154 South. Southwark 18.1 1.99 0.40 0.09 0.11 0.33 0.11 0.95 2.40 148 Bermondsey 18.4 2.04 — 0.39 0.19 0.14 0.32 002 0.09 — 0 .89 1.74 158 Lambeth 15.2 1.70 0.01 0.42 007 0 09 0.41 — 0.07 0.00 0 .63 1.40 125 Battersea 14.2 1.98 — 0 62 0.04 017 0 47 — 010 — 0.58 1.29 134 Wandsworth 12 4 1 62 — 0.43 007 0.18 0.36 — 007 — 0.51 0'95 109 Camberwell 13.7 1 36 — 0.31 005 0 13 0 27 — 006 — 0.54 1.22 12.3 Deptford 14 9 219 — 0.55 0 16 0.40 040 — 004 — 0 64 1.35 134 Greenwich 13.3 1.73 — 028 009 027 037 — 001 — 071 112 127 Lewisham 111 0.82 — 0.26 0.08 0.15 0.03 — 0 07 — 0.23 0.78 92 Woolwich 13.5 1.10 — 0.21 003 0.11 022 — 0.04 0.49 1 45 108 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. 33 Table 13. Death rates in London and the several Metropolitan Boroughs from All Causes, and from Certain Diseases during the year 1903 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 15.7 15.2 0.08 0.08 0.16 0.16 1.60 1.55 West. Paddington 14.4 13.2 0.01 0.07 0.04 0.10 1.13 1.06 Kensington 15.7 13.9 0.01 0.08 0.04 0.13 2.05 1.25 Hammersmith 11.5 14.1 — 0.07 0.04 0.15 0.89 1.47 Fulham 14.7 13.9 0.24 005 0.54 0.16 1.60 1.38 Chelsea 21.3 15.3 — 0.03 0.03 0.05 2.85 1.57 City of Westminster 14.1 13.6 — 0.05 0.03 0.08 1.03 1;69 North. St. Marylebone 14.2 16.4 0.02 0.13 0.09 0.20 0.94 1.83 Hampstead 12.4 10.0 0.65 0.05 0.53 0.12 1.55 0.74 St. Pancras 16.5 16.2 — 0.10 0.03 0.16 1.90 1.82 Islington 14.1 14.3 0.01 0.07 0.05 0.12 1.66 1.40 Stoke Newington 10.1 12.6 — - 0.04 0.13 0.89 1.23 Hackney 14.7 13.9 0.13 0.09 0.40 0.21 1.40 1.27 Central. Holborn 18.9 18.6 — 0.09 0.21 0.14 1.80 3.14 Finsbury 11.7 20.3 — 0.11 0.04 0.11 1 09 2.28 City of London 36.1 14.6 — 0 04 0.33 0.08 2.49 1.59 East. Shoreditch 19.0 19.4 0.01 0.06 0 .02 0.19 2.23 2.32 Bethnal Green 17.4 18.2 0.02 0.09 0.07 0.21 2.39 2.10 Stepney 18.8 18.0 0.00 0.07 0.12 0.19 1.83 2.10 Poplar 18.9 18.2 0.02 0.11 0.11 0.35 1.98 1.74 South. South wark 15.7 18.1 0.00 0.09 0.06 0.11 1.38 2.40 Bermondsey 15.3 18.4 0.02 0.19 0.02 0.14 1.57 1.74 Lambeth 15.8 15 2 0.12 0.07 0.16 0.09 1.35 1.40 Battersea 14.0 14.2 — 0.04 0.07 0.17 1.28 1.29 Wandsworth 11.6 12.4 0.15 0.07 0.22 0.18 0.95 0.95 Camberwell 15.1 13.7 0.00 0.05 0.03 0.13 1.88 1.22 Deptford 12.2 149 0.23 0.16 0.58 040 0 96 1.35 Greenwich 17.6 13 3 0.50 0.09 0.94 0.27 1.70 1.12 Lewisham 11.5 11. 1 0.22 0.08 0.37 0.15 0.79 0.84 Woolwich 12.5 13.5 — 0.03 0.11 0.11 1.32 1.45 * Taken from Registrar General's Annual Summary. 34 Table 14. Causes of, and Ages at, Death in the Borough of Lewisham for the year 1903. Causes ok Death. Deaths Whole Borough Borough Divisions Deaths in Public Institutions in the Borough. Deaths of Residents outside the Borough. Deaths of Non-residents in the Borough Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 65 years 65 years and over Total all Ages Lee Lewisham Sydenham and Forest Hill 1 2 3 4 5 6 7 8 9 10 11 12 13 Class I.—Infective Diseases 1 Small Pox — — — — — — — — — — — - 2 Measles 7 27 2 — — — 36 12 18 6 4 1 2 3 Scarlet Fever — 7 3 1 — — 11 1 10 — 29 2 21 4 Typhus Fever — — — — — — — — — — — — — 5 Plague — — — - - - - - - - - - - 6 Influenza 2 — — — 3 7 12 1 8 3 1 - — 7 Whooping Cough 2 2 — — — — 4 — 2 2 1 — 1 8 Diphtheria 1 7 12 — — — 20 3 8 9 46 I 31 9 Enteric Fever — 1 — 2 6 — 9 2 7 — 3 5 2 10 Epidemic Diarrhoea 18 1 — — — — 19 6 12 l 3 — — 11 Epidemic Enteritis 11 2 — — — — 13 — 9 4 - — — 12 Dysentry - — — - - - - - - - - - - 13 Venereal Diseases — — — 1 1 - 2 - 2 - - 2 - 14 Puerperal SepticoemiaFev — — — — 3 — 3 — - — — — — 15 Infective Endocarditis — — — — 1 — 1 — 1 — 1 1 1 16 Erysipelas 17 Septicœmia not Puerperal — — — 6 — 6 l Z 1 — 18 Pyæmia 1 — 1 — 2 1 1 2 — 19 Other Septic Diseases — — — 6 — — 5 1 2 1 1 Class II.— Tuberculous Diseases 20 Phthisis - 3 2 20 76 6 107 10 57 40 36 5 2 21 Meningitis 8 15 8 2 2 — 35 4 21 10 13 1 2 22 Peritonitis - — — 1 1 — 2 — 1 1 1 1 — 23 Scrofula — — — — — — — — — — — — — 24 Other Tuberculous Dis 5 4 6 6 3 1 25 3 15 7 9 — 2 25 Cancer, Carcinoma — — — 1 40 36 77 14 35 28 14 4 1 Class III.— Malignant Diseases 26 Sarcoma 1 — 2 8 1 12 3 6 3 4 3 — 27 Other Malignant Diseases — — — 12 17 29 4 17 8 13 1 1 28 Meningitis (not Tuber.) 6 7 1 3 2 — 19 4 11 4 2 — — 29 Insanity (G. P. Insane) — — — 9 10 19 4 11 4 3 11 1 Class IV.— Nervous Diseases 30 Epilepsy — — 1 — 10 4 15 2 7 6 6 4 3 31 Convulsions 24 11 — — — — 35 3 21 11 2 — — 32 Locomotor Ataxy — — — — 3 — 3 — 1 2 — — — 33 Paraplegia, Dis. of Cord - 1 — — 5 1 7 1 3 3 1 — 1 34 Other Nervous Diseases 3 — 1 2 14 7 27 3 14 10 5 6 1 Class V.— Diseases of Heart and Blood Vessels 35 Valvular Disease, - — 4 4 22 20 50 9 21 20 13 3 4 carditis 36 Cerebral Hœmorrhage - — 1 — 19 17 37 3 21 13 9 3 37 Thrombosis - — — — 1 6 7 1 3 3 1 — — 38 Apoplexy, Hemiplegia - — — — 5 10 15 4 6 5 — 1 — 39 Aneurysm - — — — 6 3 9 6 3 5 1 1 40 Embolism - - — — 4 3 7 2 3 2 1 1 — 41 Thrombosis, not Cerebral — - — — — — — - — — — — 42 Other Dis. Heart and Blood Vessels 7 1 3 2 31 51 95 10 50 35 28 6 11 35 Table 14—continued. Causes of Death Deaths Whole Borough Borough Divisions Deaths in Public Institutions in Borough Deaths ot Residents outside Borough Deaths of Non-residents in Borough Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 65 years 65 years and over Total all Ages Lee Lewisham Sydenham and Forest Hill 1 2 3 4 5 6 7 8 9 10 11 12 13 Class VI.— Respiratory Diseases 43 Croup (not Spasm or Membranous) 1 — 1 — — — 2 1 — 1 — — — 44 Bronchitis 20 5 — — 25 41 91 9 55 27 39 3 15 45 Pneumonia 31 21 1 2 16 17 88 17 45 26 21 4 10 46 Asthma Emphysema — — — — 3 — 3 — 1 2 — — — 47 Pleurisy — — — 1 4 — 5 2 2 1 3 — — 48 Other Respiratory Dis. 6 3 — 1 5 9 24 6 11 7 3 — — Class VII.— Digestive Diseases 49 Enteritis (not Epidemic) 7 1 — — 4 — 12 1 5 6 1 — — 50 Gastro Enteritis 14 2 — — 1 1 18 1 12 5 — — — 51 Peritonitis (nut Puerperal 1 — — — — 1 2 — 1 1 — — — 52 Cirrhosis of Liver — - — — 10 2 12 2 8 2 3 1 2 53 Gastric Ulcer (.Perforation of) - — — 4 7 1 12 3 2 7 8 — — Class VIII.— Class Urinary IX. Diseases 54 Other Digestive Diseases 56 9 2 6 15 11 99 6 62 31 35 6 5 55 Nephritis, Acute - 1 — — 3 2 6 1 2 3 2 — — 56 Bright's Disease - — 2 — 22 12 36 7 14 15 15 — 1 57 Other Urinary Diseases 1 1 — — 4 5 11 — 7 4 8 3 3 58 Generative Organs, Diseases of 1 — — — 4 — 5 — 4 1 2 1 1 r 59 Old Age — — — — 1 103 104 17 55 32 47 4 17 Class X.— General Diseases 60 Premature Birth 68 — - — - - 68 8 40 20 4 1 1 61 Chronic Rheumatism - - - — 2 1 3 .— 1 2 1 — — 62 Rheumatic Fever — — 6 2 4 — 12 4 4 4 — — — 63 Parturition, Diseases and Accidents of — — — 2 4 - 6 1 4 1 1 — — 64 Alcoholism — — — — 6 2 8 2 3 3 4 — 1 65 Gout — — - — 2 3 5 1 2 2 2 — — 66 Diabetes Melletus — 1 2 4 6 13 2 10 1 3 — — Class XI.— Accidents ^67 All Other Diseases 19 — 2 1 10 5 37 4 22 11 8 2 1 68 Burning — 3 — 1 1 5 1 1 3 3 1 — 69 Overlaying 3 — — — — - 3 — 3 — 1 — — 70 Poison — 1 1 — 3 — 5 3 2 — — 1 — 71 Drowning 1 — — — 2 — 3 — 1 2 — 1 — 72 Other Accidents 3 3 2 4 9 3 24 3 15 6 6 5 2 Class XII.Vio lence 73 Homicide 2 — — — . .— 2 1 _ 1 — — — 74 Suicide — — - 2 10 2 14 — 6 8 1 4 1 Grand Totals 328 142 61 76 478 428 1513 213 816 484 480 99 152 Note—Columns 1 to 10 include deaths of Residents in the Borough, in outside Districts and in Public Institutions. 36 Table 15. Residents and Non-Residents dying in Public Institutions situated in the Borough. Institution. Deaths of Residents. Deaths of NonResidents. Total. The Park Hospital 25 66 91 Lewisham Infirmary 280 16 296 Lewisham Workhouse 10 1 11 St. Olave's Workhouse ... 50 50 St. John's Hospital 13 10 23 Home for Sick Children, Lower Sydenham 2 4 6 Flower House Asylum ... 2 2 Nursing Home, Dartmouth Road 1 ... 1 Totals 331 149 480 There were also three deaths of non-residents occurring in the district, outside Public Institutions, as follows:— 1 at Catford Railway Station, 1 at Blackheath Railway Station, and 1 in Bromley Road. 37 Table 16. Deaths from Principal Zymotic Diseases in Wards, during the year 1903. Localities Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhus Fever Enteric Fever Pyrexia *(origin uncertain) Epidemic Diarrhoea & Epidemic Enteritis Totals Death Kates from Principal Zymotic Diseases. Church Ward — 7 — 1 — — 1 — 1 10 1.51 Manor Ward — 3 1 1 — — 1 — 2 8 1.15 South Ward — 2 — 1 - — — — 3 6 1.08 Lee Division — 12 1 3 — 2 — 6 24 1.25 Blackheath Wd. — 4 1 2 — — 1 — — 8 1.18 Lew. Vill. Wd. — 8 2 2 - — - — 3 15 1.05 Lew. Pk. Wd — 4 2 3 1 — 1 — 2 13 0.97 Brockley Ward — — 1 1 1 — 1 — 2 6 0.53 Catford Ward — 2 4 — — — 4 — 14 24 0.89 Lewisham Div. — 18 10 8 2 — 7 — 21 66 0.91 Forest Hill Wd. — 4 — 1 — — — — 3 8 0.44 Sydenham Ward — 2 - 8 2 — — — 2 14 0.53 Sydenham and Forest Hill Div. — 6 - 9 2 - — — 5 22 0.49 Whole Borough — 36 11 20 4 — 9 — 32 112 0.82 County of London 13 2054 362 752 1631 3 387 6 2958 8166 1.77 76 Great Towns 415 5486 2160 2971 4922 1742 10613 28309 1.89 * Originally Simple Continued Fever 38 Table 17. 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 1903. Disease. Lee Division. Lewisham Division. Sydenham and Forest Hill Div. Whole Borough County of London. 76 Great Towns. Small Pox — 0.00 0.03 Measles 0.63 0.25 0.13 0.26 0.45 0.36 Scarlet Fever ... 0.05 0.14 — 0.08 0.08 0.14 Diphtheria 0.16 0.11 0.20 0.15 0.16 0.20 Whooping Cough — 0.03 0.04 0.03 0.35 0.33 Enteric Fever ... 0.10 0.10 — 0.07 0.09 0.12 EpidemicDiarrhcea and Enteritis... 0.31 0.29 0.11 0.23 0.64 0.71 Total Zymotic Death Rates... 1.25 0.91 0.49 0.82 1.77 1.89 Infantile Mortality Rate 76 103 80 92 131 144 Phthisis Death Rate... 0.52 0.78 0.90 0.78 1.55 — Comparative Rates for other Boroughs will be found in Table 12. 39 Table 18. Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1903. Ages. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Epidemic Diarrhcea and Enteritis. Totals in Age Groups. Under 1 year - 7 - l 2 - 29 39 1 and under 5 years - 27 7 7 2 l 3 47 5 and under 15 years - 2 3 12 — — — 17 15 and under 25 years - — 1 — — 2 — 3 25 years and upwards - — — — — 6 — 6 Total all ages - 36 11 20 4 9 32 112 Note.—Typhus Fever should he included in the list of Principal Zymotic Diseases. It is omitted in the above table, as no cases occurred during the year. Table 19. Meteriological Table for London for the Year 1903. (Deduced from Observations at Greenwich, under the Superintendence of the Astronomer Royal.) 1903. Barometer. AIR TEMPERATURE Bright Sunshine. Rain and other forms ot Precipitation. Mean pressure at 32o F. at Station Level (Bar. 159 ft. above M.S.L.) Mean of Absolute Minimum & Maximum. Total possible. Total observed Number of Days. Total Fall. Most in a day. Month. Minimum > Maximum CO Minimum. Day of Month Maximum. Day of Month. Amount Day of Month. Ins. o o o o Hours Hours Ins. Ins. January 29.814 36.8 44.6 23.8 16 53.9 5 259 57.2 18 2.13 0.59 5 February 29.966 39.3 50.7 26.2 18 58.3 20 276 73.3 10 1.37 0.39 28 March 29.681 38.7 53.4 29.5 11 68.0 25 365 132.6 18 2.20 0.38 30 April 29.709 36.7 52.0 28.4 20 60.2 30 413 128.9 11 1.85 0.53 26 May 29.714 44.3 63.0 31.3 13 77.9 22,31 481 182.9 15 1.95 0.34 3 June 29.857 47.0 64.6 37.1 13 84.8 28 494 187.9 10 6.07 1.32 15 July 29.765 52.6 71.5 42.2 8 87.5 11 498 184.1 13 5.27 2.47 23 August 29.700 51.4 69.2 44.2 7 77.5 8 451 188.0 17 4.82 1.15 11 September 29.853 49.3 66.0 38.4 17 82.0 1 380 169.3 15 2.24 0.77 4 October 29.488 46.6 58.7 36.5 24 68.5 1 331 84.3 24 4.44 0.72 11 November 29.872 39.1 49.8 26.4 20 57.0 9 266 35.4 16 1.93 0.68 27 December 29.581 34.5 42.0 25.2 3 52.8 9 244 21.4 12 1.27 0.58 10 Year 29.750 43.0 57.1 — — — — 4458 1445.3 179 35.54 — — 40 This table is collated from the figures given in the Annual Summary of the Registrar General. PART 2. INFECTIOUS DISEASES. 43 NOTIFIABLE INFECTIOUS DISEASE. The total number of notifications received during the year amounted to 879, forty-seven of which were returned from hospital as not suffering from any infectious disease. After deducting this number a corrected total of 832 is obtained, compared with 1282 in 1902. No figures are available for correction amongst cases treated at home. The notifiable infectious diseases are Small Pox, Cholera, Diphtheria, Membranous 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). Mistaken Diagnosis.—Information on this subject is only available in regard to infectious diseases admitted to hospital, which are Small Pox, Typhoid Fever, Scarlet Fever and Diphtheria, no information being possible in regard to persons nursed at home. During the years 1899, 1900 and 1901, the percentages of errors for the County of London were 6'3, 7.9 and 9.2, and for Lewisham, 6.0, 6.5 and 9.3, respectively. Of the total cases removed to hospital during 1903 (591), the percentage of errors amounted to 7'9 per cent. Age Periods.—Young children are the most susceptible to infectious diseases. The following figures show the percentages to the total number of cases of Scarlet Fever and Diphtheria, notified during the year at different age periods :— Percentage to total notification at all ages. Scarlet Fever. Diphtheria. 4 years and under 28.0 28.0 5 ,, ,, 88.0 43.0 6 „ „ 46.0 55.0 44 Measles and Whooping Cough are also commonest amongst the younger children. These facts alone show the necessity of serious consideration being given to the immediate necessity of raising the age for school attendance, and the abolition of the practice which at present pertains of receiving into stuffy infant class-rooms children below the age of four and five years, inviting infectious disease which too often proves fatal. I referred to this evil in my report of 1901, and think it is a subject which your Council should consider and represent to the School Governing Authorities. Table 20. Age Periods of Cases of Scarlet Fever and Diphtheria, notified during the year, 1903. Age Periods. Scarlet Fever. Diphtheria. Males. Females. Total. Percentage to Total Cases. Males Females. Total. Percentage to Total Cases. Under 1 year 3 2 5 1.12 3 2 5 2.0 1 to 2 years 3 2 5 1.12 5 3 8 3.2 2 „ 3 „ 21 10 31 6.92 11 6 17 6.8 3 ,, 4 ,, 20 16 36 8.04 13 8 21 8.4 4 „ 5 „ 24 24 48 10.72 10 10 20 8.0 5 „ 10 „ 70 98 168 37.50 63 51 114 45.6 10 „ 15 „ 41 44 85 18.98 9 20 29 11.6 15 „ 25 „ 19 35 54 12.05 5 11 16 6.4 25 years and over 8 8 16 3.56 6 14 20 8.0 At all ages 209 239 448 100.00 125 125 250 100.0 Case Mortality.—The case mortality of the various infectious diseases is represented by the percentage of fatal cases to the number of persons attacked. Chart C. Showing Weekly Notifications of all Infectious Diseases. also Weekly Notifications of Scarlet Fever and Diphtheria during the Year 1903. 45 The mortality of Scarlet Fever, in 1903, equalled 2.4 per cent., compared with 2.6 in 1902 ; Diphtheria, 8 per cent. and 8.9 in 1902; Enteric Fever 20.9 per cent., and 15.1 per cent. in 1902. Attack Rates represent the number of notifications to every 1,000 persons living at all ages. The comparison of these rates are valuable, showing the districts which were most affected. The Attack Rate from all notifiable infectious diseases for the whole Borough during the year, amounted to 6.09 per 1,000, a marked improvement over that of 9.68 for 1902. Attack Rates for the various Wards will be found in Table 22. The Ward having the greatest number of cases in relation to its population was Manor Ward, and the smallest number South Ward. Table 21. 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 Fox 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 46 Table 22. Attack rates from the Principal Infectious Diseases per 1000 of the population for the ten Wards and the whole Borough for the year 1903. Disease. WARDS. Whole Borough Church Manor South Blackheath Lewiaham Village Lewisham Park Brockley Catford Forest Hill Sydenham Small Pox – – – – – – – – 0.05 – 0.00 Scarlet Fever 1.66 4.44 2.70 2.80 1.96 4.25 2.40 5.43 2.47 2.57 3.28 Diphtheria 3.02 4.44 1.08 3.39 3.64 1.12 1.42 1.25 0.99 1.32 1.83 Enteric Fever 0.15 0.43 — 0.29 0.35 0.37 0.17 0.29 0.16 0.53 0.31 Erysipelas 0.60 0.56 0.18 0.44 0.77 0.44 0.44 0.51 1.04 0.56 0.60 Puerperal Fever — — — — 0.14 — — 0.18 — 0.03 0.05 Total 5.41 9.88 3.96 6.92 6.87 6.19 4.44 7.68 4.73 5.04 6.09 Return Cases.—Of the 548 cases of Scarlet Fever and Diphtheria removed to hospital, 53 were considered "Return Cases," i.e. new cases which occurred in a house within a few days of the return of a patient from hospital. Twelve of these cases referred to Diphtheria, and 41 to Scarlet Fever. It was found on investigation that although the first patient had been retained in hospital for several weeks, there was good reason to believe that the secondary cases were due to infection conveyed by the home-coming patient. Most of our patients are received at the Park hospital, the Medical Superintendent of which has always been most willing to give me every information in regard to return cases. I have every reason to believe that the greatest possible supervision 47 and care is exercised in the examination of patients before they are discharged, that the return cases are unfortunate but unavoidable accidents, and that under existing conditions every precaution is taken to avoid them. I am still of opinion, however, that the transfer and detention of children in a separate convalescent hospital for a short period prior to their return home would be a great advantage and reduce the number of return cases. The recent theory that the peeling stage of Scarlet Fever ceases to be infectious before desquamation has ceased, may in the future be responsible for the permature discharge of patients. (See Table 28). Table 23. Particulars of Return Cases, 1903. Diphtheria. Ist Case. Discharged from Hospital. Address. New Case. Removed to Hospital. Onset of Illness. W.P. Dec. 5 Taunton Road, Lee W.G.P. Jan. 18 Jan. 11 J.R. Feb. 18 Kemble Rd., Forest Hill M.R. Feb. 23 Feb. 20 Fk.F. Fd.F. Feb. 27 Ennersdale Road S.H.F. Mar. 7 Mar. 3 C.F. Mar. 11 Mar. 7 C.A. Mar. 24 Minard Road Ed.A. Mar. 31 Mar 30 K.A. Mar. 31 Mar. 30 E.A. April 19 April 18 L.H. May 6 Aislibie Road W.H. May 12 May 10 M.R. May 9 Kemble Road K.R. May 13 May 12 Ar.J. July 1 Avenue Square Al.J. July 18 July 17 E.J. July 15 J.C. June 25 Prospect Road P.C. July 17 July 14 E.C. July 21 Aislibie Road F.C. Aug. 3 Aug. 2 48 Scarlet Fever. Ist Case Discharged from Hospital. Address. Return Case. Removed to Hospital. Onset of Illness. K.V. Dec. 17 Ennersdale Road F.V. Jan. 2 Jan. 1 W.8. Jan. 2 Malham Boad R.S. Jan. 8 Jan. 6 L.S. Jan. 19 Jan. 5 E.B. Jan. 5 Trilby Road O.B. Jan. 9 Jan. 7 lLB. Jan. 17 Jan. 16 V.B. Feb. 12 S.F. Dec. 24 Ennersdale Road F.G.F. Jan. 13 Jan. 12 F.W.F Jan. 20 Jan. 18 M.B. Jan. 12 Stanstead Road G.B. Jan. 19 Jan. 17 S.B. Jan. 19 Jan. 17 L.D.B. Jan. 21 Jan. 21 A.E.P. Feb. 13 Hedgley Street F.P. Feb. 18 Feb. 17 F.Y. Feb. 23 Ennersdale Road A.Y. Mar. 12 Mar. 9 T.I. Feb. 20 Priory Cottages, Sangley Lane L.I. Mar. 12 Mar. 10 Gs.S. Mar. 16 St. Fillan's Road H.S. Mar. 28 Mar. 27 G.S. April 1 Mar. 30 S.C. Mar. 18 Glenfarg Road M.C. April 6 April 4 C.A. Mar. 24 Minard Road L.A. April 6 E.A. C.A. Mar. 25 Mar. 27 Morena Street F.A. April12 April 11 C.W. April 21 Hedgley Street W.W. April 28 April 26 L.W. April 24 Drysdale Road F.W. May 6 May 3 G.W. May 6 May 5 A.W. May 7 May 6 A.C.W May 7 May 6 B.S. April 29 Mount Pleasant Road E.S. May 4 May 8 Ed.W. April 29 Beckenham Hill Catford E.W. May 10 May 10 L.H. May 6 Aislibie Road E.H. May 18 May 12 J.C. May 5 Ringstead Road H.E. May 23 May 21 C.B. May 6 Wildfell Road J. b. May 54 May 22 F.B. May 23 May 21 H.H. May 25 Brownhill Road L.H. May 31 May 22 R.H. June 2 May 30 E.H. June 2 May 31 D.s. May 21 Brightfield Road A.S. June 4 June 3 F.C. June 5 Perry Yale A.S. June 12 June 11 S.A. June 8 Stanton Square A.A. June 18 June 15 D.S. May 21 Brightfield Road M.S. June 14 June 12 H.W. June 10 Fernbrook Road V.W. June 17 June 16 R.C. June 15 Perry Hill H.C. July 17 July 16 c.c. July 16 July 15 M.B. Aug. 10 Ivy Lane A.B. Sep. 1 Aug. 31 49 Table 24. Attack Rates per 1,000 persons living at all ages from Small Pox, Scarlet Fever and Diphtheria in the Metropolitan Boroughs and the County of London for the years 1902 and 1903. Borough. Small Pox. Scarlet Fever. Diphtheria. *All Notifiable Infectious Diseases. 1902. 1903. 1902. 1903. 1902. 1903. 1902. 1903. Paddington 0.77 0.03 2.50 2.85 1.52 1.02 6.51 5.09 Kensington 0.55 0.02 2.12 1.87 1.04 1.00 5.37 4.31 Hammersmith 0.87 0.06 3.08 2.72 1.58 1.43 7.11 5.73 Fulham 0.65 0.07 3.86 2.74 2.99 1.98 8.95 6.27 Chelsea 0.52 0.09 2.75 2.81 1.79 1.32 6.46 5.23 City of Westminster 1.28 0.26 2.62 1.96 1.57 1.03 7.05 4.31 St. Marylebone 1.16 0.03 3.13 3.15 1.79 1.73 8.59 6.87 Hampstead 0.23 0.01 3.04 2.04 1.17 1.00 5.77 3.90 St. Pancras 1.52 0.13 5.17 2.79 3.54 2.21 12.25 6.48 Islington 0.89 0.03 4.09 2.55 2.61 2.21 9.53 5.06 Stoke Newington 0.98 0.03 3.97 1.67 1.91 0.76 8.26 3.78 Hackney 1.91 0.01 3.97 2.97 3.24 2.43 11.55 8.01 Holborn 3.74 0.03 3.46 2.48 1.99 0.89 11.48 6.02 Finsbury 2.09 0.02 3.89 2.93 2.38 1.29 10.88 5.92 City of London 1.52 — 3.24 2.97 3.78 1.10 10.43 5.09 Shoreditch 3.74 — 2.12 2.20 1.96 1.31 10.70 5.68 Bethnal Green 3.96 0.02 4.07 3.01 2.49 1.86 13.58 7.07 Stepney 4.58 0.08 3.56 2.90 2.59 1.79 13.32 6.73 Poplar 3.72 0.16 3.95 2.65 2.77 2.50 12.88 6.77 Southwark 2.50 0.19 5.30 2.46 2.60 1.70 13.19 6.17 Bermondsey 1.72 0.05 3.88 3.08 2.17 1.34 10.30 6.66 Lambeth 1.18 0.23 4.44 2.42 1.60 1.12 9.14 5.06 Battersea 1.10 0.21 5.21 2.73 1.71 1.81 9.84 6.18 Wandsworth 0.54 0.11 4.46 3.28 3.13 2.13 9.84 6.94 Lamberwell 1.35 0.07 5.29 2.50 2.63 1.37 11.07 5.25 Deptford 1.29 0.01 5.81 4.46 2.40 4.05 11.60 10.08 Greenwich 1.04 0.04 4.72 1.64 1.16 2.08 9.63 5.01 Lewisham 0.63 0.00 4.88 3.28 2.84 1.83 9.68 6.09 Woolwich 1.96 0.04 2.32 3.21 2.10 1.51 7.80 5.64 County of London 1.67 0.09 3.98 2.71 2.32 1.67 10.06 6.00 ♦Note.—Chicken Pox, which was notifiable during part of 1902, has been omitted. 50 SMALL POX.—On November 12th my opinion was invited in respect of G. D., aged 28 years, residing at Vestris Road, Forest Hill. I found the patient suffering from Small Pox and secured his immediate removal to Hospital. The patient was taken ill on the 6th, the rash appeared on the 8th November. He was a workman employed by a firm of silver refiners at Rotherhithe. The necessary precautions were taken by observation and re-vaccination of contacts, and the thorough disinfection of the infected premises and contents. Fortunately no extension of the disease occurred in this district. The above case was the only one occurring in the year, compared with 84 in 1902. SCARLET FEVER.—The total number of notification certificates received amounted to 466, compared with 651 in the previous year. Of the notified cases 347, or 74 per cent. were removed to the Metropolitan Asylums Board Hospitals. Subsequent events proved that eighteen, or 5.2 per cent. of the cases so admitted were not suffering from the disease, and were in consequence returned to their homes. Deducting this number from the total notifications a corrected total of 448 is obtained, equal to an attack rate of 3.28 per 1,000 persons living at all ages, a marked decrease compared with the attack rate of 4.81 per 1,000 for the year 1902. Compared with other London Boroughs the attack rate is high. (See Table 24.) An examination of the attack rates for the various Wards shows the highest attack rate (5.43 per 1,000), occurred in the Catford Ward, against 6.55 per 1,000 in 1902. The area least affected was Church Ward, 1.66 per 1,000, compared with 5.05 in 1902. (See Tables 21 and 22). In relation to age periods the greatest number of cases, 37 per cent., occurred between the age periods five to ten years, 28 51 per cent. amongst children under five years, 19 per cent. between 10 and 15 years, 12 per cent. from 15 to 25 years, and 3.5 per cent. among persons over the age of 25. Fatalities.—Of the 448 cases, 11 or 2.4 per cent. of the certified cases proved fatal. Return Cases.—Of the 346 cases removed to Hospital we were informed that 41 were considered "return cases." (See Table 23.) DIPHTHERIA.—This disease was responsible for 274 notifications. Of this number 192 or 70 percent., were removed to Hospital. Twenty-four cases were returned from Hospital as not suffering from any infectious disease, giving a corrected total of 250. The attack rate per 1,000 of the population living at all ages in the Borough amounted to 1.83, which shows a satisfactory diminution when compared with 2.83 for 190.2. Sub-dividing the cases over the various Wards of the Borough Manor Ward suffered most, having an attack rate of 4.44, compared with 5.09 in 1902. The Ward least affected was Forest Hill, where the attack rate was only 0.99, compared with 0.93 in 1902. Case Mortality.—Of the 250 cases, 20, or 8 per cent., proved fatal, compared with 11.8 per cent in 1902. Anti-Toxin.—The sanction of the Local Governmen Board was obtained for the gratuitous supply of Anti-Toxin to medical practioners in the district. It was felt that the value of this curative and prophylactic agent was often reduced by the delay occasioned in obtaining a supply, or that the pecuniary circumstances of the patient precluded its use. Arrangements were made whereby a supply could be obtained at the Town Hall at any hour. The following is a copy of a card supplied to all medical practioners residing in the district, many of whom 52 have expressed their appreciation of the arrangements made. Applications for supplies are generally made at night or on Saturdays and Sundays, when the supplies of business firms are not available. To the Medical Officer of Health, Town Hall, Catford, S.E. Dear Sir, I hereby certify that the parents or guardians of now residing at and suffering from Diphtheria, should receive a supply of Diphtheria Anti-Toxin without charge Kindly give bearer bottle...of the above serum. Yours truly, (Name) (Address) Date p.t.o. NOTE.—Each bottle contains 2,000 units. A free supply will also be given where it is thought desirable to give injections as a protective agent. Serum can be obtained at the Town Hall, Catford, at Room No. 20, between the hours of 9 a.m. and 5 p.m., at other hours from the Hall Porter. Medical Officer of Health. CHICKEN POX.—This disease ceased to be notifiable on January 7th. ENTERIC OR TYPHOID FEYER.—Forty-eight notifications were received, of which 27 were removed to Hospital. Five cases were returned as not suffering, thus giving a corrected total of 43 cases. 53 The attack rate for the whole Borough was 0.31 per 1,000. On sub-dividing the cases over the various Wards, the highest attack rate, occurred in Sydenham Ward, 0.53 per 1,000, and the lowest in Church Ward, 0.15 per 1,000. (See Table 22). The Case Mortality equalled 20.9 per cent. of the cases. ERYSIPELAS.—Eighty-two persons were notified as suffering from this disease, two of which proved fatal. PUERPERAL FEVER.—Eight cases were certified, seven of which were in Catford Ward. The attack rate for the whole Borough amounted to 2.2 per 1,000 Births. Of the cases notified, 3, or 37.5 per cent., proved fatal. MEASLES.—In March, 1903 the London County Council, by virtue of the powers conferred on them by the Public Health (London) Act, 1891, made an Order that from and including April 1st, 1903, Sections 65, 68, 69, 70, 72, 73 and 74 of the above Act, relating to dangerous infectious disease, should apply throughout the Administrative County of London to the disease known as Measles. The Sections of the Act, above referred to provide for :— The cleansing and disfection of infected houses. The disinfection of infected bedding, clothing or other articles. Penalties for placing infectious rubbish into ashbins, without previous disinfection; for letting bouses in which infected persons have been lodging without previously disinfecting such house or part of a house. Penalty on ceasing to occupy infected houses or parts of houses without disinfection or notice to owner of the previous existence of the 54 disease, and for the exposure of infected persons or articles or the conveyance of infected persons in public conveyances. The Order does not provide for the compulsory notificacation of the disease. Considering the special character of this disease it is extremely doubtful if the advantage to be derived by the compulsory notification would justify its expense. Then, again, measles is generally considered by the public as a mere childish ailment, simple in character, notwithstanding the fact that the disease claims many victims annually. The little importance with which the disease is treated by many parents accounts for the fact that unless the cases are severe or complications supervene, medical aid is rarely sought. Eight months have now elapsed since the regulations referred to came into force, during which period we received information of 321 cases or suspected cases of measles. In 42 instances the information was given by medical practitioners, who were under the impression that compulsory notification was required, six by parents, and 273 by head teachers of various Board Schools. I feel confident that the cases notified only represent a small proportion of the actual cases which occurred, and disinfection was in consequence incomplete. In the endeavour to prevent the extension of measles the greatest good results from the education of parents as to the necessity of treating the disease more seriously, and in controlling the movements of their children while infection is in their own houses or those of their neighbours or friends. This was attempted by issuing a special circular in districts where the disease was known to exist. The distribution of similar information in relation to other infectious diseases would, I think, be 55 of great utility. There is, however, a difficulty in the distribution, which could be considerably lessened if school children, under the direction of the various class teachers, were permitted to convey to their homes the circulars referred to. NOTIFICATION BY SCHOOL AUTHORITIES.—During the year 561 notifications were received from Board School teachers relating to various sickness. They were divided as follows:—Measles, 273; Mumps, 111; Bingworm, 46; Chicken pox, 68; Whooping Cough, 47; Scarlet Fever, 10; Diphtheria, 3; Eczema, 3. Investigations were made at the homes of children suffering from Measles, Chicken-pox, Scarlet Fever and Diphtheria. In regard to Measles, Lewisham Bridge Board School had the greatest number of cases, 106, necessitating the exclusion of 60 children; Ennersdale Road School 65 cases, excluding 161 children, and Brockley Road School 38 cases, excluding 61 children. Mumps.—The highest number of cases, 25, occurred at Plassy Boad School. Whooping Cough.-—Ennersdale Boad School claimed 29 of the total cases. NOTIFICATIONS SENT TO SCHOOLS.—In pursuance of the Public Health (London) Act, 1891, information was sent from the Health Department to the Head Teachers of schools attended by children notified as suffering from an infectious disease, or by children residing in a house in which a case of infectious disease was known to exist. SCHOOLS AND INFECTIOUS DISEASE, 1903. All Saints' Orphanage.—During the last week in May an outbreak of Diphtheria occurred among the boys residing at the above Institution. The cases were as follows :— 56 Case 1—May 25th D. H., aged 3 years „ 2— „ 30th J. W. B. „ 3 „ „ 3— „ 30th A. W. K. „ 3 „ „ 4— „ 30th G. A. „ 4 „ ,, 5 ,, 31st J. A. ,, 5 ,, On the occurrence of these cases I visited the Orphanage and arranged for the isolation of all contacts and suspicious cases. The Orphanage at this time contained 94 boys. The patients above referred to resided in the Orphanage, and attended the St. Stephen's Schools. On June the 19th a recrudescence of the disease occurred, four boys who also attended St. Stephen's Schools contracting the disease:— Case 6—June 19th H.C., aged 8 years 7— „ 22nd A.G. „ 8 „ 8— „ 23rd R.T. „ 12 „ „ 9— „ 29th N.D. „ 9 „ On the appearance of these fresh cases I again visited the Orphanage and personally examined 89 boys. In 21 cases swabs were taken from suspicious throats and submitted to bacteriological examination. The results necessitated the isolation and observation of six boys. The drainage and sanitary fittings of the Orphanage were thoroughly examined and found to be satisfactory, except the lavatory fittings which required alterations. The investigation carried out at St. Stephen's Schools, together with the fact that only those boys who attended the schools were attacked, led one to the conclusion that the original source of infection was at the St. Stephen's Schools and not at the Orphanage. St. Stephen's Schools.—These schools were inspected, and the sanitary fittings were found to be in a foul and filthy condition, and the drainage defective. Diphtheria was 57 valent amongst the infants attending the school from various houses in the neighbourhood. The first cases notified were as follows:— Case 1.—May 28th, G.W., aged 7 years. Of Craythorne Street „ 2.— „ 30th, A. F. „ 5 „ Of Thurston Road ,, 3. June 1st, B. 3. ,, 4 ,, ,, ,, ,, „ 4.— „ 6th, W. D. „ 5 „ Of Branscombe Street Further cases occurred, and the schools were closed for a period of three weeks, and the drainage reconstructed. After the closing of the schools, further cases ceased at the Orphanage and amongst the children attending the schools. Lewisham Bridge Schools.—An outbreak of Diphtheria among the children attending the above School occurred on the 1st July:— Case 1.—July 1st R. G., aged 6 years. „ 2.— „ 4th W. C. „ 5 „ „ 3.— „ 17th A. J. „ 8 „ „ 4.— „ 20th M. B. „ 6 „ „ 5.— „ 23rd A. R. „ 4 „ „ 6.— „ 23rd E. R. „ 6 „ „ 7.— „ 24th D. B. „ 7 „ At this time the School was closed for the summer holidays, and on the re-opening fresh cases occurred as follows :— Case 8.—September 3rd ... G. G., aged 5 years. 9.— „ 13th L. S. „ 6 „ „ 10.— ,, 14th J. U. ,, 5 „ „ 11.— „ 21st ... E. T. „ 5 „ I considered this recrudescence of great importance, and came to the conclusion that there was a possibility of the School acting as the infective agent. I was desirous of adopting measures to prevent the possibility of the occurrence of an outbreak similar to that which occurred at the same Schools in 1896, when a large number of cases occurred, and when there 58 was evidence that if the class-rooms had been closed at an earlier date much good might have resulted and the outbreak have been lessened. It has been the custom to communicate the existence of infectious disease in any particular school or part of a school to the School Board Authorities, with a view of obtaining the disinfection of infected class-rooms, and where necessary, the closing of the school or part of it. This action was taken on the recrudescence of diphtheria, at the Lewisham Bridge Board School. On the 25th September, written notification was sent to the Medical Adviser of the London School Board of the cases which had occurred since the termination of the holidays. Attention was also called to the cases which occurred prior to the holidays, and I suggested that the recrudescence was possibly due to some unrecognised case, or that the class-room itself was infected. I also advised that the class-room "D" in which cases had appeared, should be closed for a period of 14 days and thorough disinfection carried out by the local authority. The School Board authorities did not consider such steps necessary, and I was informed on the 29th September, that an examination of the children in the Infants' Department had been made by one of the Board's Officers, and that he had excluded from the class-room four children whom he had found in a suspicious condition, owing to the existence in them of pseudodiphtheria, which is looked upon (for the purposes of exclusion) as diphtheria. This examination alone, to my mind, showed the necessity of closing and disinfecting the class-room referred to. I did not think for a moment that the course suggested, i.e., closing and disinfection, could possibly be objected to, otherwise direct action would have been taken in accordance with the provisions of the Code of Regulations for Public Elementary Schools, issued by the Board of Education, Section 88 of which provides as follows:— 59 "If the Sanitary Authority of the District in "which the school is situated, or any two members "thereof acting on the advice of the Medical "Officer of Health, require either the closure of "the school or the exclusion of certain children "for a specified time, with a view to preventing "the spread of disease or any danger to health "likely to arise from the condition of the school, "such requirement must at once be complied "with, but after compliance appeal may be made "to the Board if the requirement is considered " unreasonable." In order to insist upon disinfection of the class-room advantage was taken of the powers contained in Section 60 of the Public Health (London) Act. Notice was served on the Head Teacher of the School, the class-room was closed for some days, and the premises and contents thoroughly disinfected. Your Committee drew the attention of the School Board to the difficulties which had occurred, and a copy of a report from their advisers was sent, in which they stated that the extraordinary measures suggested by your Medical Officer in a letter of the 25th September to the Board seemed unnecessary. They further stated that the class-room was overhauled in the earliest possible time by their officers and that the results indicated no necessity for either closure or disinfection. This seems extraordinary in the face of the fact that the Board's officer discovered in the class-room pseudo-diphtheria bacillus in four children and excluded them from school, and showed clearly that unrecognised cases were in the school and that the class-room itself had been thoroughly infected. The temporary closure of the class-room and its thorough disinfection resulted in no further cases occurring. The question of school closure during an outbreak of infectious disease is often difficult, and one in regard to which 60 there may be some difference of opinion, but where an outbreak is limited to a certain class-room, and early information can be obtained, there can, I think, be little doubt that the closure of such class-room must be the proper course to adopt, and disinfection carried out with the least possible delay. The best results can only be obtained by closure at the commencement of the outbreak. Measles.—-During the month of January a serious outbreak of Measles occurred at the Lewisham Bridge Board Schools, necessitating the closing of class-rooms A, B, C and D. In June it was also necessary to close the Infants' Department of the Brockley Road School. The closure in each case was followed by disinfection, and the outbreak subsequently ceased. Circulars, advising measures to be adopted to prevent the spread of the disease, were freely circulated in the districts in which the school children lived. Scarlet Fever.—A number of cases of Scarlet Fever occurred amongst children attending the Beacon Road Board School in September and October, which necessitated the temporary closing of the Infants' Department and the disinfection of same. DEFECTIVE SANITATION AT SCHOOLS.—During the year, in consequence of the existence of infectious disease, the drainage of the following Schools was examined :— West Kent Grammar School, Ladywell. School for Sons of Missionaries, Blackheath. St. Stephen's Schools, Lewisham. The conditions revealed necessitated the reconstruction of the School drainage in each case. DISINFECTION.—It was found necessary during the year to re-organise the whole of the disinfecting staff. The alterations made have proved satisfactory. 61 During the year 1,069 rooms have been disinfected by formalin spray, and 19,102 articles of bedding, clothing, etc., were removed from infected houses to the Council's Disinfecting Station for treatment in the steam disinfector. 62 Street List Streets in which Cases of Infectious Disease occurred. LEE DIVISION. 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 aislib1e road 6 3 5 3 — — 1 1 — — baking road — — 1 l — — — — — — belmont hill — — 3 l — — — — — — belmont park 1 1 — — — — — — — — birch grove 1 1 — — — — — — — — blessington road — — 1 l — — — — — — blow's place — — 1 l — — — — — — boone street 3 2 — — — — — — — — brandram road — — 1 l — — — — 1 1 brightfield road 2 1 7 — — — — — — 2 burnt ash hill 1 1 — — burnt ash road 2 2 1 l — — — — — — church street — — 1 l 1 1 — — 1 1 church terrace 2 1 — — — — — — — — dacre park 1 1 3 l — — — 1 — — dacre street — — 1 l — — — — — — effingham road 4 4 2 — — — 1 1 1 1 eltham road 1 1 — — — — — — — — glebe, the — — 1 l — — — — — — glenton road 1 1 — — — — — — — — granville road — — 1 1 — — — — — — Handen road — — 1 1— — — — — — — hedgley —street 3 3 2 1 — — — — 1 1 high road, lee 1 1 1 l — — — — — — high street, lewisham (part of) — — — — — — 2 2 — — kingswood place — — 2 2 — — — — — — lampmead road 3 2 1 1 — — — — — — 63  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. ol Cases s affected. LANSDOWN ROAD — — 2 2 — — — — — — LEE ROAD 2 l — — — — — — — — LENHAM ROAD — — 3 1 — — — — — — LEYLAND ROAD 3 l — — — — — — — — LOCHABER ROAD — — 1 1 — — — — 1 1 MANOR LANE 3 3 — — l l — — — — MANOR PARK — — 2 1 — — — — — — MURILLO ROAD 5 4 1 1 l l l l — — NEWSTEAD ROAD — — 1 1 — — — — — — OSBERTON ROAD 1 1 — — — — — — — — RONVER ROAD 1 1 1 1 —- — — — — — ROYAL OAK PLACE — — 2 2 — — — — — — st. Mildred's road 2 2 — — — — — — — — ST. STEPHEN'S ROAD — — 1 1 — — — — — — SOUTHBROOK ROAD 1 1 — — — — — — — — southbrook mews 2 1 — — — — — — 1 1 SUMMERFIELD STREET — — 3 2 — — 1 1 — — TAUNTON ROAD 3 2 4 4 l l l l 2 2 TURNER ROAD — — — — — — 1 1 — — LEWISHAM DIVISION ABERDEEN TERRACE — — 1 1 — — — — — — ADELAIDE ROAD 1 1 1 1 — — l l 1 1 ALBACORE CRESCENT 2 2 — — l l — — 1 1 ALGERNON ROAD 2 2 1 1 — — l l 2 2 ALGIERS ROAD 1 1 — — — — — — — — ALL SAINTS' ORPHANAGE — — 9 1 — — — — — — ARABIN ROAD — — — — — — 1 1 — — ARDGOWAN ROAD 4 4 1 1 — — — — — — ARDMERE ROAD 1 1 1 1 — — — — — — ARNGASK ROAD 5 2 — — — — — — — — AVENUE ROAD — — — — — — 1 1 — — 64  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 AVENUE SQUARE 2 l l l — — — — — — BARHESTON ROAD — — l l — — — — 2 2 BARTRAM ROAD 2 2 — — — — — — — — BEACON ROAD 2 2 — — — — — — 1 1 BEAUFORT GARDENS — — — — — — l 1 — — BECKENHAM HILL 2 1 — — — — — — — — BEECROFT ROAD — — l l — — — — — — BENIN STREET — — l l — — — — — — BERLIN ROAD 1 1 — — — — — — — — BLACKHEATH RISE — — — — l l — — — — BLACKHEATH VALE 1 1 — — — — — — — — BLAGDON STREET 1 1 — — — — — — — — BLASIIFORD STREET — — — — l l — — — — BLYTHE HILL 1 1 — — — — — — — — BRADGATE ROAD — — l l l l — — 1 1 BRANSCOMBE STREET — — 3 2 — — — — — — BRAXFIELD ROAD 1 1 — — — — — — 1 1 BRIGADE STREET — — — — l 1 — — — — BRIGHTSIDE ROAD 3 3 1 1 — — — — — — BROADFIELD ROAD 5 3 — — — — — — 1 1 BROCKLEY GROVE 1 1 1 1 — — — — — — BROCKLEY RISK — — 1 1 — — — — — — BROCKLEY ROAD — — 1 1 — — — — — — BROMLEY ROAD 1 1 1 1 — — — — — — BROOKBANK ROAD. 2 1 — — — — — — — — BROOKDALE ROAD. 11 5 1 1 — — 1 1 — — BROWNHILL ROAD 11 5 2 2 — — 2 2 1 1 CATFORD HILL 1 1 1 1 — — — — — — CHALSEY ROAD — — 2 2 — —- — — — — CIIARSLEY ROAD — — — — 1 1 — — — — CLAREMONT TERRACE 1 1 — — — — — — — — COMERFORD ROAD. — — 1 1 1 1 — — — — COURTHILL ROAD 2 2 — — — — — — 2 2 CRAYTHORNE STREET — — 2 2 — — — — — — 65  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 CROFTON PARK ROAD — — — — — — 1 1 — — CULVERLEY ROAD 2 l — — — — — — — — DALRYMPLE ROAD — — l l — — — — — — DAVENPORT ROAD 5 4 l l — — — — 2 2 DARFIELD ROAD 1 1 — — — — — — 1 1 DARTMOUTH ROW — — l l — — — — — — DERMODY ROAD — — — — — — — — 1 1 DOGGETT ROAD 1 1 — — — — — — — — DOWANHILL ROAD. — — l l — — — — — — DRYSDALE ROAD 7 1 l l — — — — — — DUNSLEY PLACE — — 2 l — — — — — — EASTDOWN PARK 2 2 2 2 — — — — — — ELIOT HILL — — — — — — 1 1 — — ELIOT PARK — — 1 1 — — — — — — ELLERDALE STREET 2 1 1 1 — — 1 1 — — ELMER ROAD 1 1 — — — — — — — — ELMIRA STREET — — 4 4 — — — — — — ELSWICK ROAD — — — — — — — — 1 1 ELTHRUDA ROAD 1 1 1 1 1 1 — — — — EMBLETON ROAD 1 1 — — 1 1 — — — — ENGATE STREET 1 1 — — — — — — — — ENGLEHEART ROAD 4 4 — — — — — — 1 1 ENNERSDALE ROAD 10 5 1 1 — — — — — — ERMINE ROAD 1 1 — — — — — — — — EXBURY ROAD 1 1 — — 1 1 — — — — FARLEY ROAD 6 5 4 3 — — — — 2 2 FAVERSHAM ROAD — — — — — — 1 1 1 1 FERNBROOK ROAD 2 2 — — — — — — 1 1 FOIiDEL ROAD 3 3 — — 1 1 — — 1 1 FORDYCE ROAD — — — — 1 1 — — — — EOXBERRY ROAD 2 1 — — — — — — 1 1 FRANCEMARY ROAD 1 1 — — — — — — — — GILMORE ROAD 2 2 — — — — — — — — GLENFARG ROAD 8 6 1 1 — — 1 1 4 4 66  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 glenview road l 1 — — — — — — — — granville park 1 1 — — — — — — — — halesworth road — — 1 1 1 1 — — — — harvard road 8 2 — — — — — — — — iiawstead road — — — — — — — — 1 1 hazelbank road 1 1 — — l 1 — — — — hazeldon road — — l l — — — — — — high street, lewisham — — — — 1 1 — — 1 1 hither green lane — — 8 1 l 1 — — — — holbeach road — — I 1 — — 1 1 — — honley road 4 4 — — — — — — — — howson road 2 1 — — — — — — — — ivy lane 2 1 — — — — — — — — infirmary, high street 1 1 — — — — — — — — jerrard street — — 1 l — — — — — — ki.llearn road 1 1 1 1 — — 1 1 1 1 kneller road — — 1 1 — — — — 1 1 knowles hill crescent 2 2 — — — — — — — — ladywell park — — 1 1 — — 2 2 — — ladywell road 1 1 — — — — — — 1 1 laleham road 3 3 — — 1 1 l l — — leahurst road 6 4 1 1 — — — — — — lethbridge road 1 1 2 1 — — — — — — lewisham hill — — 2 2 — — — — — — lewisham park — — 2 2 — — — — — — lewisham road — — 1 1 — — — — 1 1 limes grove 1 1 1 1 — — — — 2 2 lloyd's place — — — — — — — — 1 1 loampit hill — — — — 1 1 — — — — loampit vale 1 1 2 2 — — 1 1 — — longhurst road 1 1 — — — — 1 1 — — marsala road 1 1 1 1 — — — — — — mallett road — — 1 1 — — — — — — malyon's road 1 1 1 1 — — — — 2 2 67  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 s affected MEREITT EOAD — — 3 3 — — — — 2 2 MERCIA GEOVE — — 2 2 — — — — — — MILL EOAD 3 3 2 2 — — l 1 — — MINAED EOAD 8 7 4 2 — — — — — — MOLESWOETH STREET 2 2 3 3 — — — — — — —MOEENA STEEET 2 1 — — — — — — — — MOUNT PLEASANT ROAD 3 3 — — — — l 1 1 1 NIGHTINGALE GEOVE — — — — — — 1 1 — — NUDING ROAD 1 1 — — — — — — — — PARAGON MEWS — — 1 1 — — — — — — PARK STEEET — — 1 1 — — — — — — PATEOL PLACE — — 1 1 — — — — — — PATTENDEN ROAD 1 1 — — — — — — — — POND ROAD 3 1 — — — — — — — — PORSON STREET — — 4 4 — — — — 1 1 EAVENSBOURNE PARK 5 2 2 2 — — — — — — REGENT STREET — — 1 1 — — 1 1 — — RENNELL STREET — — 1 1 1 1 — — RETREAT, THE 2 1 — — — — — — 1 1 RHYME ROAD — — — 4 — — l 1 1 1 RIDDINGTON'S YARD — — 1 1 — — — — — — RINGSTEAD ROAD 3 3 1 1 — — — — — — ROSENTHAL EOAD — — — — 1 1 — — — — RUSHEY GEEEN 1 1 — — — — — — 1 1 EYECROFTROAD 2 2 — — — — — — — — ST. FILLANS ROAD 8 3 — — — — 1 — — 1 st. Margaret's road — — — — — — l 1 — — SANDHURST GARDENS 2 2 2 2 — — — — — — SANDHURST ROAD 4 2 — — — — 1 1 1 1 SANDROCK ROAD — — 2 1 — — 1 1 1 1 SANGLEY ROAD 6 3 SILVERMERE ROAD 4 4 2 2 — — 1 1 — — SCROOBY STREET 1 1 — — — — — — — — SOUTHEND — — — — — — 1 1 1 1 68  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 SPARTA STREET 2 l l l — l l — — SPRINGBANK ROAD 7 4 l l — — — — — — STANSTEAD ROAD 1 1 — — — — — — — — STILLNESS ROAD — — — — l l — — — — STONDON PARK 2 1 — — — — — — — — TALBOT HOUSES, BLACKH'TH 1 1 — — — — — — — THEODORE ROAD — — — — — — — — l l THORNFORD ROAD — — — — — — l l — — THURSTON ROAD 1 1 5 5 — — — — 2 2 TORRIDON ROAD 1 1 — — — — — — — — TRANQUIL VALE 1 1 1 1 — — — — — — TYRWHITT ROAD 1 1 2 1 — — l l — — UNDEROLIFF ROAD. 1 1 — — — — l l — — VICAR'S HILL — — — — — — — — 1 1 WE.LLMEADOW ROAD 5 4 — — — — — — 1 1 WEMYSS ROAD — 1 1 — — — — — — WESTDOWN ROAD — — — — — 1 l — — WHITBREAD ROAD 9 4 1 1 — — — — — — WILDFE.LL ROAD 6 2 — — — — — — 1 1 WILLOW WALK — — — — — — 2 l — — WILMORE PLACE WINCHESTER ROAD (upper) 3 2 1 1 — — — — — — WISTERIA ROAD 1 1 1 1 — — — — — — WOODLANDS STREET 4 8 1 1 — — — — — — SYDENHAM AND FOREST HILL DIVISION. ACACIA ROAD 2 1 — — — — — — — — ACKROYD ROAD 1 1 — — — — — — — — ADAMSRILL ROAD — — 1 1 — — — — 1 1 AGNEW ROAD — — — — — — — — 1 1 ALLENBY ROAD — — — — 1 1 — — — — 69  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[6] BEADNELL ROAD — — 1 1 — — — — — — BOVILL ROAD 1 1 — — — — — — — — BRADFORD ROAD — — 2 2 — — — — — — BROSELEY GROVE 2 1 — — — — — — — — BURGHILL ROAD 4 2 — — — — — — — — CANONBIE ROAD — — — — — — 1 1 — — CHAMPION CRESCENT — — — — — — 1 1 — — CHAMPION PARK 1 1 — — — — — — — — CLYDE PLACE — — 2 1 — — — — — CLYDE —TERRACE — — — — — — 1 1 — — COLFE ROAD — — 1 1 — — — — — — COMO ROAD 1 1 — — — — 1 1 — — COOMBE ROAD 1 1 — — — — — — 1 1 CROFT COTTAGES — — — — — — — — 1 1 CROWN PLACE — — 1 1 — — — — — — CROWN TERRACE — — — — — — — — 1 1 DACRES ROAD — — — — 5 2 1 1 — — DALLAS ROAD 3 1 — — — — — — — — DALMAIN ROAD — — 4 4 — — — — 2 2 DARTMOUTH ROAD. — — 1 1 — — — — — — DAVIDS ROAD 1 1 — — — — 1 1 — — DEVONSHIRE ROAD 3 — — — — — 2 2 — — DILLWYN ROAD 1 1 1 1 — — — — — — DUNCOMBE HILL — — — — — — 1 1 1 1 EDNEY STREET — — 1 1 — — — — — — ELDERTON ROAD 3 2 2 1 — — — — 1 1 ELVINA ROAD 1 1 — — — — — — — — EWART ROAD 5 5 4 3 — — 4 4 2 2 FAIRLAWN PARK 1 1 — — — — — — 2 2 FERMOR ROAD — — — — — — 1 1 — — FIR STREET — — — — 3 1 — — — — GABRIEL STREET — — — — — — — — 1 1 GRAFTON ROAD 1 1 — — — — — — — — HASELTINE ROAD — — — — — — — — 1 1 70  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 HELVETIA STREET — — — — — — l l — — HILLCREST ROAD —- — l l — — — — — — HINDSLEY PLACE — — — — — — — — 3 l HOMECROFT ROAD l l — — — — — — — — HONOR OAK PARK — — l l — — — — — HOUSTON ROAD — — — — — — — 1 l KANGLEY BRIDGE ROAD l l — — — — — — — — KELVIN GROVE — — — — 1 1 — — — — KEMBLE ROAD 2 2 2 l — — — — — — KENT HOUSE ROAD 1 1 — — — — l l — — KILMORIE ROAD 8 3 — — — — — — — — KNIGHTON PARK ROAD 2 1 — — — — 2 2 — — LARKBERE ROAD 3 3 — — — — — — — — LAWRIE PARK ROAD — 1 l — — 1 1 — — LAUREL GROVE — — 1 l — — — — — — LONDON ROAD 2 2 1 l — — — — — — LONGTON AVENUE 1 1 — — — — — — — — MADDIN ROAD 1 1 — — — — 1 1 2 2 MALHAM ROAD 3 2 2 2 — — 1 1 1 1 MANOR ROAD — — — — — — 1 1 — — MAYOW ROAD 1 1 1 1 — — — — 1 1 MI ALL ROAD 1 1 2 2 1 1 1 1 — — MOUNT ASH ROAD — — 1 1 — — — — 1 1 NORTHWOOD ROAD 1 1 — — — — 1 1 — — NEUCHATELP ROAD 1 1 — — — — — — — — NEWLANDS ARK — — — — — — — — 1 1 OAKSFORD AVENUE 1 1 1 1 — — — — — — ORCHARD PLACE 1 1 — — — — — — — — PARK ROAD — — — — 1 1 — — — — PERRY HILL 5 2 1 1 — — — — 1 1 PERRY RISE 2 2 — — — — — — — — PERRY VALE 7 3 — — — — — — — — PORTHCAWE ROAD 1 1 1 1 — — 1 1 — — PROSPECT ROAD — — 2 1 — — — — — — 71  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 RAGLAN STREET l l 2 2 — — — — l l ROCKBOURNE ROAD — — 1 1 — — — — — — ROJACK ROAD l l — — — — — — — — ROSAMOND STREET — — 1 1 — — — — — — ROWLAND GROVE — — 1 1 — — — — — — RUSSELL STREET — — — — — — 1 1 2 2 SOUTH ROAD — — — — — — — — 1 1 SPRINGFIELD l l — — — — — — — — STANSTEAD ROAD (part of) 4 2 1 1 — — 2 2 2 '2 STANTON ROAD — — — — — — — — 1 1 STANTON SQUARE 1 1 1 1 — — — — — — SUNDERLAND ROAD — — — — — — 1 1 1 1 SYDENHAM HILL — — — — 1 1 — — — — SYDENHAM ROAD 1 1 1 1 — — 1 1 1 1 TREDOWN ROAD — — — — 1 l — — — — TREWSBURY ROAD 1 1 — — 1 1 — — — — TRILBY ROAD 5 3 — — — — — 1 — — VANCOUVER ROAD 1 1 — — 1 1 — — 1 1 VENNER ROAD 9 2 2 1 — — — — — — VESTRIS ROAD 2 1 — — — — — — — — WASTDALE ROAD — — — —- 1 1 1 1 — — WELLS ROAD 2 2 — — — — 1 l 1 1 WESTBOURNE ROAD — — — — — — — — 3 3 WHATMAN ROAD 2 1 — — — — — — — — WILLOW WALK 1 1 1 1 — — — — — — WOOLSTONE ROAD — — 1 1 — — — — — — YORK TERRACE 1 1 — — — — — — — — PART 3. GENERAL 75 PUBLIC HEALTH AND LEGISLATIVE MEASURES, 1903. MIDWIYES ACT, 1902.—This is an Act to secure the better training of mid wives and to regulate their practice. Except where otherwise stated the Act came into force in April, 1903, and the chief provisions are the following :— 1. From and after April 1st, 1905, no woman may use the name or title of midwife, or any name or title implying that she is certified under this Act, or is recognised by law as a midwife. 2. From and after April 1st, 1910, no woman shall habitually and for gain attend women in child-birth unless she is certified under this Act, except under the direction of a qualified medical practitioner. 3. No woman shall be certified until she has complied with the rules and regulations laid down by the Central Mid wives Board. 4. No woman certified under this Act shall employ an uncertified person as her substitute. 5. A Central Midwives Board has been appointed to regulate the issue of certificates, the course of training for midwives, the admission of women to the roll of women in practice prior to the passing of the Act, regulating within due limits the practice of midwives and the conditions under which they may be suspended. Local Supervision of Midwives.—Every Council of a County or County Borough throughout England and Wales shall, on the commencement of this Act, be the local supervision authority. 1. To exercise general supervision over midwives practising in their area. 76 2. To investigate charges of malpractice, misconduct, etc., and report thereon to the Central Board. 3. To suspend from practice any midwife where necessary in order to prevent infection or for other causes provided in the Act. 4. To supply lists of persons practising to the Central Board, also the death of any midwife, or change of address. 5. To give due notice of the effect of the Act. Delegation of Powers to District Councils.—A County Council may delegate, with or without restrictions, any powers or duties conferred or imposed upon them in pursuance of this Act. HOUSING OF THE WORKING CLASSES ACT, 1903.— An Act to amend the law relating to the housing of the working classes, August 14th, 1903. This Act contains many provisions, the most important of which are :— (a) The extension of the period for which loans may be granted for the purpose of the housing of the working classes to eighty years. (b) The greater facilities given to obtain the speedy closing of premises which in the opinion of the Local Authority are not reasonably capable of being made fit for human habitation, or in such a state that the occupation thereof should be immediately discontinued. By this Act, in such cases, an application may be made to a Justice of the Peace for a Closing Order without giving notice to the owner or occupier as prescribed in the Act of 1890. EXPIRING LAWS CONTINUANCE ACT, 1903.—By this Enactment the Vaccination Act of 1898, a temporary Act expiring on the 31st December, 1903, is continued until December 31st, 1904. 77 EMPLOYMENT OF CHILDREN ACT, 1903.—This Act gives important powers to local authorities as the following brief epitome shows:— Any local authority may make bye-laws regulating the employment of children with respect to all occupations or to any occupation:— (a) The age below which employment is illegal; (b) The hours between which employment is illegal; (c) The number of daily and weekly hours beyond which employment is illegal. Any local authority may make bye-laws with respect to street trading by persons under the age of sixteen and may make such bye-laws: (a) to prohibit such street trading except subject to such conditions as to age and sex, or otherwise as may be specified in the bye-laws, or subject to the holding of a license to trade to be granted by the local authority; (b) to regulate the conditions on which such license may be granted, suspended or revoked; (c) to determine the streets, places and hours where such trading may be carried on; (d) to require street traders to wear badges. In making these bye-laws the local authority shall have special regard to the desirability of preventing the employment of girls under 16 in streets or public places. A child under the age of 11 shall not be employed in street trading. Bye-laws must be confirmed by the Secretary of State. The expression "street trading" includes the hawking of newspapers, flowers, matches or other articles, playing, singing or performing for profit, shoe-blacking, or any like operation carried on in streets or public places. The Act shall come into operation on January 1st, 1904. 78 CUSTOMS AND INLAND REVENUE ACT, 1903.—By the Customs and Inland Revenue Act of 1890, every house used solely for providing separate dwellings at rentals not exceeding 7s. 6d. per week for each dwelling obtained exemption from Inhabited House Duty provided a certificate was obtained from the Medical Officer of Health of the district that the dwelling houses were suitable and that due provision was made for their sanitary requirements. The Act of 1903 extends the provisions of the former Act as follows :— Houses used for the sole purpose of providing separate dwellings at rentals below £20 per annum are exempt from Inhabited House Duty. Over £20 and not exceeding £40, the duty is reduced to threepence. Over £40 and not exceeding £60, reduced to sixpence in the pound. These provisions shall not take effect with regard to any such dwelling house of an annual value not exceeding £40 unless a certificate from the Medical Officer of Health as to accommodation and sanitary condition is obtained. (See page 95). HOUSING OF THE WORKING CLASSES.—During the year under review, representations were made by your Medical Officer of Health in respect of the following premises :— Nos. 1 & 2, Hollis Cottages.—Premises certified unfit for habitation, January 20th. The premises were foul, damp and dilapidated, and beyond repair. Permanently closed by owner. Hope Yard.—Six cottages, certified on February 27th as unfit for habitation, owing to foul, damp and dilapidated 79 condition, and want of light and ventilation. Notices were served on the owners, who executed the minimum amount of work necessary to temporarily improve the condition of the property, but sufficient to render the application for a closing order difficult. Paragon Mews.—Certified March 17th. Overcrowded, dilapidated and beyond repair. Permanently closed by owner. Hazeldon Road.—Two houses unfit for habitation. Certified April 16th. The premises were foul and dilapidated. The necessary repairs were carried out by the owner. Mill Road-—Two houses. Certified April 17th. Insufficient light and ventilation, also damp and dilapidated. The necessary works were carried out by the owner. Loampit Yale.—One house. Certified April 28th as foul, damp aud dilapidated. Notices served. Repairs executed by owner. Reeves Alley & 214a, High Street.—Three houses. Certified April 28th. Closing order granted by Magistrate. Wilmore Place.—Three houses. Certified April 28th. Beyond repair. Demolished by owner. No. 10, Glenwood Road.—Representation made, September 15th. The premises were in a very bad condition, due principally to the filthy habits of the tenant. The owner had considerable trouble in obtaining possession of the premises. Notices were served. The premises were put into habitable condition by the owner. Pettitt's Buildings, Elmira Street.—Three houses. Certified as unfit for human habitation September 15th. Foul 80 damp and dilapidated. Notices served, and works executed by the owner. Thornford Road.—Two houses, unoccupied for a considerable time. Certified as unfit December 1st. Required works executed by owner. The greater facilities given to obtain the speedy closing of premises unfit for habitation by the Housing of the Working Classes Act, 1903, will be of great value. It will obviate the necessity of notice where houses are not reasonably capable of being made fit for habitation, and prevent the owners on the receipt of notice executing temporary work, which although unsatisfactory, is often just sufficient to prevent the Council making application for closing orders. On the 14th December the following special report was submitted to the Housing of the Working Classes Committee "Shortly after my appointment in 1901, I was requested to prepare a report as to the number of houses let at various rentals in the Borough, together with certain information as to overcrowding, and the necessity or otherwise of further accommodation for the housing of the working classes. "At that time very little material was available, and I am glad to have had an opportunity of enlarging upon the information previously laid before the Committee. "In formulating the present report I have endeavoured as far as practicable to confine my attention to streets and houses occupied by the working classes. "With regard to rent, the average rentals of houses in various streets, have been extracted from the rate books. "From the facts I have been able to collect, it would appear that the rentals paid by the working classes (labourers, mechanics and others), range from 4s. to 12s. per week. 81 "The following table gives the estimated number of dwellings in the divisions of the Borough let at weekly rentals of sums varying from 4s. to 13s." Table 25. Estimated number of Dwellings in the Borough and its Divisions let at weekly rentals of sums varying from 4s. to 13s. Rental per week of Lee. Lewisbam. Sydenham and Forest Hill Total. 4s. 6 30 36 4s. 6d. — 17 20 37 5s. 12 35 11 58 5s. 6d. — 21 46 67 6s. — 45 166 211 6s. 6d. 12 132 120 264 7s. 60 162 123 345 7s. 6d. 64 300 48 412 8s. 165 196 575 936 8s. 6d. — 41 312 353 9s. 154 360 476 990 9s. 6d. — 280 97 377 10s. 36 333 400 769 10s. 6d. — 876 396 1272. 11s. 125 392 574 1091 11s. 6d. — 180 14 194 12s. 61 623 125 809 12s. 6d. — 830 122 952 13s. 31 628 64 723 Total at all rentals. of 13s. per week and under. * 720 5457 3719 9896 82 Analysis of Dwellings occupied by the Working Classes in the Borough of Lewisham, in the Division of Lee, Lewisham, and Sydenham and Forest Hill. Lee. Number of dwellings let at a rental of 4s. to 7s. 6d. weekly (inclusive). Houses. Flats. Total Dwellings. 84 64 148 Dwellings let at rental of 8s. to 10s. 6d. weekly (inclusive). 355 — 355 Dwellings let at rental of lis. to 14s. weekly (inclusive). 217 — 217 Totals 656 64 720 Note.—If houses with rentals of 12s. 6d. to 14s. per week inclusive are excluded from the return a total of 689 dwellings with rentals of 12s. per week and under, remains. Lewisham. Dwellings let at a rental of 4s. to 7s. 6d. per week (inclusive). Houses. Flats. Total. 480 238 718 Dwellings at a rental of 8s. to 10s. 6d. weekly (inclusive). 2002 84 2086 Dwellings let at a rental of lis. to 14s. weekly (inclusive). 2983 36 3019 Totals 5465 358 5823 Note.—If houses with rentals of 12s. 6d. to 14s. per week (inclusive) are excluded from the return a total of 3,999 dwellings with rentals of 12s. per week and under remains. 83 Sydenham and Forest Hill. Dwellings at a rental of 4s. to 7s. 6d. per week (inclusive). Houses. Flats. Total. 137 427 564 Dwellings at a rental of 8s. to 10s. 6d. per week (inclusive). 1942 314 2256 Dwellings at a rental of lis. to 14s. per week (inclusive). 949 — 949 Totals 3028 741 3769 Note—If houses with rentals of 12s. 6d. to 14s. per week (inclusive) are excluded from the return, a total of 3,533 dwellings with rentals of 12s. per week and under, remains. Note—Separate houses or flats are included in the term " dwellings." "It would appear from the foregoing figures that the labouring classes pay an average rental of 8s. per week, and mechanics 10s. 6d. or lis. "Considering the population of the three divisions of the Borough, estimated in 1902, showing Lee, 18,925; Lewisham, 69,672, and Sydenham and Forest Hill, 43,835, it would appear that the number of houses occupied by the working classes is proportionately greater in the Sydenham and Forest Hill Division. Sanitary Condition of Houses.—" The Sanitary condition of the houses occupied by the working classes is on the whole satisfactory. They require however, frequent inspection. Slums and Old Properties.—" Taking the Borough as a whole, it has less of this property than any other district in London. I have prepared a map outlining the worst property. 84 "Lee.—The streets known as Butterfield Street, Summerfield Street and Ronver Road do not bear a good reputation, although the houses are in a fair condition structurally. A small area formed by Boones Road, Church Street, Boone Street, Dacre Street and Royal Oak Place, consists of old houses which are closely crowded together, and although not satisfactory, are not bad enough to be dealt with by a scheme under Part I of the Housing of the Working Classes Act. This area requires frequent inspection. "Blackheath.—The worst properties are in Collins Street, Lethbridge Road, Sparta Street, Paragon Road, Bath Place, Brigade Street, Queen Street, Merton Place, Munroe Cottages, Essex Place, and Regent Street. In Lewisham a small block of property, probably the worst in the Borough, consists of Porson Street, Vian Street, Elmira Street, Shrubbery Road, Mill Road, Avenue Square, Engate Street, Romer Place, Hope Yard, Mount Place, Smiths Cottages, Dunsley Cottages, Patrick's Cottages, and Ward's Cottages. This old property receives frequent inspection and attention. "Lady well Park—In this road the houses are occupied by the poorest class of tenants, and many houses are registered as "houses let in lodgings," and are visited weekly. Other old properties are Ladywell Terrace, Nightingale Grove, Maybank Cottages and Maythorn Cottages. "In Catford parts of Doggett Road, Willow Walk, Wildfell Road, Sangley Road, Glenfarg Road, Sandhurst Road, Killearn Road, Morena Street and Scrooby Street are made undesirable and insanitary by the tenants. Frequent inspections are made, and notices served to remedy dirty premises. "Lower Sydenham—Kirtley Road, Portbcawe Road, 85 Maddin Road, Relinque Road, Stanton Road and Stanton Square. The defects in the houses in these roads are chiefly due to the habits of the tenants. Chaplin Street, Bird-in-Hand Cottages, Springfield and Wells Road are of a similar nature." Houses in Which More than One Family Reside.— "After examining all the streets occupied by the labouring classes it would appear that the following streets are those in which two families may be found occupying one house :— "Sydenham and Forest Hill.—Mount Ash Road, David's Road, Clyde Terrace, Bradford Road, Coombe Road, Rowland Grove, Dallas Road, Plane Street, Oaksford Avenue, Fransfield Grove, Dalmain Road, Herschell Road, Rutland Road, Bell Green, Helvetia Street, Southend Lane, Kangley Bridge Road, Hazeltine Road, Porthcawe Road, Relinque Road, Maddin Road, Fairlawn Park, Watlington Grove, Kent House Road, Kirtley Road, Champion Park, Elderton Road, Acacia Road, Myrtle Grove, Dillwyn Road, Miall Road. "Lewisham.—Ladywell Park, Ladywell Park Terrace, The Retreat, Ennersdale Road, Glenview Road, Knowles Hill Crescent, Beacon Road, Ardmere Road, Fernbrook Road, Brightside Road, Elthruda Road, Sangley Road, Engleheart Road, Bowness Road, Laleham Road, Sandhurst Road, Woodlands Street, Benin Street, Blashford Street, Houley Road, Cudham Road, Farley Road, Davenport Road, Morena Street, Scrooby Street, Blagdon Street, Willow Walk, Holbeach Road, Brookdale Road, Silvermere Road, Nelgarde Road, Doggett Road, Wildfell Road, Lower Winchester Road, Faversham Road, Rathfern Road, Pattenden Road, Creeland Grove, Paragon Road, South Vale, Collins Street, Eliot Cottages, Blackheath Vale, Drysdale Road, Sparta Street, Lethbridge Road, Essex Place, Elverston Road, Connington Road, Leathwell Road, Merton Place, Camden Row, St. German's Villas, Claremont Terrace, 8(3 Elswick Road, Jerrard Street, Horton Street, Thurston Road, Craythorne Street, Station Road, Hope Cottages, Bertrand Street, Brookbank Road, Algernon Road, Branscombe Street, Ellerdale Street, Embleton Road, Marsala Road, Loampit Yale, Loampit Hill, Porson Street, Vian Street, Shrubbery Road, Elmira Street, Pear Tree Cottages, Mill Road, Molesworth Street, Rennell Street, Rhyme Road, Avenue Road, Engate Street, Romer Place, Cressingham Road, Lewis Grove, Mercia Grove, Gilmore Road, Eastdown Park, Wisteria Road, Dermodv Road, Malyon's Road, Mercy Terrace, Railway Terrace, Prospect Place, Ladywell Road, Gillian Street, Brockley Grove, Darfield Road, Merritt Road, Arabin Road, Howson Road, Foxberry Road, Kneller Road, Comerford Road, Whitbread Road, Holdenby Road, Hazeldon Road, Eddystone Road, Crofton Park Road. "Lee.—Myron Place, Turner Road, Brightfield Road, Hedgley Street, Stoneyard Place, Taunton Road, Summerfield Street, Ronver Road, Butterfield Street." "Census Returns.—The Census Returns of 1901 show that Lewisham held the highest position of all London Boroughs in relation to the proportion of its population living in oneroomed homes. "The total number of one-roomed homes amounted to 970, in which 1.16 per cent, of its population resided. "The two-roomed homes amounted to 1,720, housing 4,582 persons, or 3.57 per cent, of its population. "There were 2,490 three-roomed homes, housing8,550, or 6'65 per cent. of its population, and 3,381 four-roomed homes, housing 14,308 persons, or 1114 per cent, of its population. "The total number of tenements of less than five rooms amounted to 8,561." 87 METROPOLITAN BOROUGHS. Total Tenements. Total 1.roomed homes. Proportion of population per 1000 living in 1.roomed homes. Total 2.roomed homes. Proportion of population per 1000 living in 2.roomed homes. Total 3.roomed homes Proportion of population per 1000 living in 3.roomed homes Total 4.roomed homes Proportion of population per 1000 living in 4.roomed homes Total Tenements of Less than 5 rooms Proportion of population per 1000 living in homes of less than 5 rooms Table 26. Shewing distribution of Population in relation to 1, 2, 3 & 4.roomed homes compared with other Metropolitan Boroughs—Census 1901. Battersea 38987 3413 37.4 5887 113 2 7934 179.3 6855 195.5 24089 525.5 Bermondgey 29073 4258 66.8 6968 188.0 5738 198.0 5100 208.4 22064 661.2 Betbnal Green 28209 5378 98.3 7264 219.3 6746 249.9 4344 193.7 23732 761.2 Camber well 56985 4906 34.1 7766 94.8 9899 152.5 9355 171.2 31926 452.7 Chelsea 17467 3812 89.5 3736 160.1 2927 159.7 1607 100.8 12082 510.1 Deptford 24615 1974 36.9 3313 92.4 3906 134.1 4763 205.0 13956 468.3 Fins bury 24097 6364 141.9 7882 309.8 4233 209.4 2036 109.9 20515 770.9 Fulham 32137 2460 32.0 4360 97.6 8309 232.0 6552 226.1 21681 587.8 Greenwich 19702 1375 24.9 2552 77.8 2990 122.8 3960 203.5 10877 429.0 Hackney 48794 4827 40.7 7211 102.9 9387 165.3 7664 168.4 29089 477.2 Hammersmith 25810 2698 43.9 4389 126.0 4919 171.1 3499 149.7 15505 490.7 Hampstead 16998 1096 22.1 2331 88.2 2331 106.1 1420 77.8 7178 294.2 Holborn 13790 3725 143.6 3834 232 9 2224 155.0 989 72.0 10772 . 603.4 Islington 79129 12955 77.5 18934 195.4 14379 172.0 9538 144.5 55801 589.3 Kensington 38349 5695 64.1 7776 157.3 4757 114.3 2887 79.6 21115 415.3 Lambeth 70887 10058 62.6 12311 132.5 12120 156.2 10006 155.1 44495 505.8 Lewisham 27701 970 11.6 1720 35.7 2490 66.5 33S1 111.4 8561 225.1 London, City of 5339 775 53.4 1123 141.8 885 120.9 524 82.6 3307 399.0 Padd ington 33661 5035 61.0 6668 156.7 6548 173.0 3564 114.3 21815 508.0 Poplar 35787 3935 49.0 6450 129.6 8270 210.2 7561 235.8 26216 642.7 St. Marylebone 31623 8312 123.3 8246 221.8 4185 133.4 2204 78.8 22947 557.3 St. Pancras 57045 13417 116.7 16827 261.6 9410 167.9 5369 159.4 45023 662.1 Shoreditch 27031 6705 127.3 7509 244.8 5102 210.0 3624 173.4 22940 755.6 South wark 47808 9896 97.7 12480 217.6 10211 220.1 7025 181.9 39612 717.3 Stepney 61113 13282 115.5 15690 221.7 11926 202.2 8284 159.8 49182 699.2 Stoke Newington 11824 894 28.4 1600 92.6 1885 123.7 1434 118.5 5813 363.2 Wandsworth 49756 2039 13.8 3591 41.6 7458 116.3 7964 154.6 21052 326.3 Westminster, City of 41244 7546 76.8 9635 166.1 6279 135 9 3208 79.3 26668 458.0 Woolwich 24585 1724 26.3 3378 83.8 4094 126.8 4821 196.6 14017 433.5 County of London 1019516 149524 67.1 201431 154.3 181542 165.5 139533 152.1 672030 539.0 88 The figures contained in the above table are most interesting, showing clearly that Lewisham bears the highest position of all London Boroughs in regard to the housing of its population. It has the smallest percentage of persons living in homes of less than five rooms, and in homes consisting of one, two and three rooms. A report on the subject of the housing of the working classes was submitted while the Annual Report was in print, and from the detailed figures contained therein it is estimated that from 20 to 25 per cent, of the population of the Borough may be considered to belong to the working class. NUISANCES. Deposit of House Refuse.—Complaints were received during the year of the various refuse tips belonging to the Council situated in the Borough. The question of house refuse disposal was considered by your Council and arrangements have been made for the removal of such material out of the Borough. House refuse cannot be deposited in the Borough without causing a serious nuisance, and the method now adopted has proved highly satisfactory. Smoke Nuisances.—Complaints were received of smoke nuisances arising from the following premises:— Robertson's Preserve Factory, Bromley Road, Catford. Park Hospital, Hither Green. Crystal Palace District Electric Light Works, Sydenham. Observations were kept on these premises and notices served in accordance with the Public Health (London) Act, after which no recurrence of the nuisance occurred. Ballast Fire.—Complaint was received of a nuisance arising from a ballast fire in Brownhill Boad. After the service of a notice the nuisance was abated. Public Urinals.—Complaints were received of nuisances arising from various public urinals, principally those attached to 89 public houses. On investigation it was found that the nuisances were due principally to the fact that the urinals opened directly on to the pavement or in view of a dwelling-house, and the complaints were of annoyance and indecency, matters which could not be dealt with under the Public Health (London) Act. In some instances, however, it was necessary to serve notices owing to the uncleanly condition of the urinals, upon which the nuisances were abated. Gipsies.—Complaint was received of a nuisance caused by gipsies occupying a piece of vacant land in Hither Green Lane. On inspection, the vans were found to be without proper sanitary accommodation and sufficient water supply, and after the service of notice the occupiers removed. Fish Offal.—A serious nuisance was caused by the deposit of fish offal used for manuring land in Hither Green. The farmer of the land contended that it was necessary for his business, and that he had been allowed to manure his land with the material for many years. On inspecting the land it was found that the farmer had not taken the best known means of preventing a nuisance. The fish offal had been spread over the land and allowed to remain uncovered, thus creating a serious offence. Moreover, building operations had extended to within a short distance of the land in question. Your Council ordered proceedings, and the farmer was fined £5 and ordered to pay 10s. costs. A Prohibition Order was also made. A serious nuisance also occurred in the public thoroughfare from the carting of fish offal in improperly constructed vehicles. Two offenders were fined £1, and 2s. costs, and two £2, and 2s. costs. In another case the summons could not be served, the offender having disappeared. Offensive Litter in Stables.—Complaints were received of a nuisance arising from horse litter in stables in High Road, Lee. The nuisance was abated on the service of notice. 90 LEGAL PROCEEDINGS-—The following is a summary of the legal proceedings which were ordered by your Council:— Adulteration of food and drugs, 18 summonses, 13 convictions, resulting in the imposition of fines to the amount of £41 and £8 2s. 6d. costs. Other proceedings under the Sale of Food and Drugs Acts, four summonses, four convictions. Fines, £4 15s. Costs, £1 19s. 6d. Proceedings under the Public Health (London) Act, nine summonses, 6 convictions. Fines £11. Costs, 15s. Contravention of Bye-laws, ten summonses, nine convictions. Fines, £16. Costs, £4 11s. Proceedings under the Housing of the Working Classes Act. Three summonses, three convictions. Closing orders were granted by the Magistrate. Ice Cream Vendors.—In consequence of the bye-laws made under the London County Council (General Powers) Act, relating to the inspection of premises on which ice cream is manufactured, etc., six itinerant vendors were summoned for selling ice cream from vehicles upon which the name and address of the manufacturer did not appear, resulting in fines to the amount of £5 10s., and 12s. costs. HOUSE-TO-HOUSE INSPECTION.—House-to-house inspection was carried out in the following streets situated in the Borough:— No. of houses inspected Harvard Road 28 The Retreat, Hither Green Lane 21 Russell Street 42 Hanover Street 37 Vian Street 28 Porson Street 51 Shrubbery Road 15 Summerfield Street 100 91 No. of houses inspected Thurston Road Springfield Plane Street Fir Street Edney Street Rosamond Street Oaksford Avenue Beadnell Road Wells Road Mill Lane Rowland Grove 79 50 10 20 16 11 18 15 14 8 46 The total number of houses inspected was 609, and various nuisances were found in 548, or 90 per cent., of the houses. The drainage was found defective in 182 instances, necessitating relaying. In 302 instances the nuisances related to dirty premises, and the remaining defects were of a minor character. During the year I represented to your Council the necessity of appointing an additional Sanitary Inspector in order that this branch of the work of the Department might receive greater attention, and in December a first-class Inspector was appointed exclusively for house-to-house duty. He has unfortunately been unable to do as much as one would have wished in consequence of the indisposition of one of the district inspectors, whose place he had to fill temporarily. ' It is anticipated that during the ensuing year a large amount of this desirable work will be carried out. INFECTED ARMY BLANKETS.—During May information was received that some Contractors had purchased quantities of Army blankets, which had arrived from South Africa, and which had been proved by bacteriological examination to be infected with typhoid fever. Acting on this information it was discovered that some of the blankets had been sent to the Girls' Industrial 92 Home, Dartmouth Road, while twelve blankets had been supplied to small shopkeepers, who in their turn had disposed of them. All the blankets were traced to the purchasers, secured and disinfected. SLAUGHTERHOUSES, COWSHEDS AND DAIRIES.— There exist in the Borough 17 slaughterhouses, 14 cowsheds, and 148 dairies. These have received periodical inspection. With regard to slaughterhouses, licenses are granted by the London County Council, and in no case was it necessary to oppose their renewal. In the case of a cowshed at Beckenham Place Farm it was found necessary to oppose the renewal of the license, as the premises were in such a condition as to be unfit for use. FACTORY & WORKSHOP ACT, 1901.—There are 584 premises on our Register which contain 906 workrooms. These have received frequent visits by the Inspector specially appointed. The details of the work are set out in Table 30, from which it will be seen that (excluding those employed in domestic workplaces) 648 men are employed in workshops, 1,469 women, and 382 young persons. GENERAL INSPECTIONS.—The total number of premises inspected within the Borough by the district and other sanitary inspectors amounted to 5,653, and the re-inspections of work in progress to 13,612. 1,695 intimation notices were served, and 828 statutory notices were ordered by your Council. With regard to the latter, it was only found necessary to carry out the order in 306 instances, the necessary works being commenced or completed subsequent to your Council making the order. A detailed list of the sanitary work of the various inspectors during the year is contained in Table 27. 93 Table 27. Register of Sanitary Work for the year ended 31st December, 1903. Lee Lewisham Sydenham and Forest Hill Work shops House to House Description of Work Mr. R. White Mr. J. F. Charlesworth Mr. J. A. K. Cooper Mr. R. J. Davis Total Mr. E. T. Pidwell Mr. B. A. Knappett , Total Mr. J. Daltry Mr. A. H. Gray Total for Whole Boro. Premises inspected 584 345 491 989 1825 928 654 1582 846 816 5653 Re-inspections of Works in progress 2011 768 1087 1316 3171 1155 1190 2345 1190 4925 13642 Premises repaired, cleansed,&c 68 54 85 55 194 70 94 164 94 341 861 Defective Roofs, Stackpipes, &c. remedied 93 31 39 79 149 36 57 93 11 267 613 Drains re-constructed 141 49 135 53 237 58 86 144 7 177 706 Drains repaired 142 38 24 33 95 52 75 127 117 71 452 Drains ventilated 108 5 41 20 66 40 26 66 13 76 329 Stackpipes,Sinks, Bath Wastes, &e..disconnected from drains 121 47 58 46 151 44 25 69 19 ' 51 411 Gulley Traps provided 208 93 193 107 393 167 281 448 29 164 1242 Water Closets reconstructed 139 45 97 61 203 113 155 268 38 97 745 Water Closets repaired 101 15 25 59 99 31 51 82 65 41 388 Water Closets supplied with water ... 48 26 30 24 80 13 1 14 18 111 271 Soil Pipes reconstructed 73 22 58 18 98 39 41 80 15 2 268 Soil Pipes repaired and ventilated 82 27 15 16 58 46 22 68 3 5 216 Dustbins provided 98 4 23 53 80 39 68 107 8 133 426 Premises over-crowded — — 1 2 3 — 3 3 9 2 17 Yards paved 106 16 42 104 162 49 117 166 6 233 673 Offensive accumulations removed 54 20 17 26 63 27 24 51 3 2 173 Dung Vaults erected or repaired... 8 7 3 1 11 1 3 4 2 25 Animals improperly kept 5 1 4 2 7 1 5 6 — 6 24 Water Supply to Houses reinstated 1 1 3 9 13 6 13 19 1 2 36 Cisterns repaired, cleansed or covered 34 15 100 115 78 43 121 7 229 506 Water- Certificates issued 46 23 155 631 809 127 137 264 33 147 1299 Complaints by Residents 341 131 154 38 373 105 129 234 7 4 959 Visits to Lodging-houses •— — — — — — — — — 324 324 Visits to Bake-houses 105 47 184 — 231 115 98 213 — 549 Visits to Milk-shops 125 95 182 11 288 125 88 213 — — 626 Visits to Cow-sheds 52 24 8 4 36 24 12 36 -— — 124 Workshops visited — — — — — — — — 701 — 701 Visits to Slaughter-houses 57 17 29 1 47 52 13 65 — — 169 House-to-house inspections 31 — — 42 42 — — — — 567 640 Intimation Notices served 214 100 238 180 518 137 169 306 10;. 552 1695 Statutory Notices ordered 127 75 204 75 354 87 51 138 27 182 828 Statutory Notices served 50 5 29 40 74 49 26 75 9 96 306 Legal proceedings 1 — 2 2 4 — — — — 4 9 94 UNDERGROUND BAKEHOUSES. In pursuance of the Factory and Workshop Act, 1901, the occupiers of all underground bakehouses existing within the Borough were compelled to bring their premises into such sanitary condition as would entitle thetn to a certificate of fitness to be issued by your Council. Your Medical Officer visited each underground bakehouse, meeting the occupiers and their advisers, and agreeing upon the works which would be necessary before the bakehouse could be reported as satisfactorily complying with the conditions of the Act. Subsequent to these consultations plans and specifications were submitted, and observations kept during the progress of the work, with the result that in every case the occupiers were able to bring their premises into a satisfactory condition. In many instances the requirements entailed considerable structural alterations and expenditure. Although each baker was supplied with a copy of the regulations made by your Council which gave an idea of the standard necessary for him to attain, each case had to be considered on its individual merits, and it is satisfactory to note that we were able in every case, if not at first, finally, to agree upon the necessary works, without appeal. There can be no doubt that the passing of the Factory and Workshop Act has caused a great improvement of the premises in which bread is made. The following underground bakehouses were reported to your Council as satisfactory and the necessary certificate granted. 41 Dartmouth Road 52, Baring Road, Lee 122, Burnt Ash Road, Lee 225, High Road, Lee 83, High Road, Lee 5, Turner Road, Lee 14, London Road, Forost Hill 42, Perry Vale 160, Rushey Green 90, Rushey Green 54, High Street, Lewisham Riverdale Mills, Lewisham 32, High Street, Sydenham 55, Park Road, Forest Hill 31, Brockley Rise 309, Stanstead Road 122, Woodvale 11, Sydenham Road 124, Hither Green Lane 83, Hither Green Lane 2, Loampit Hill 294, Brookley Road 392, Stanstead Road 95 COMBINED DRAINAGE—After investigation of defective house drains and the service of notices for remedying the same, the owners in many instances claimed the drain to be a sewer repairable by the local authority. Owing to the fact that your Council possess an elaborate record of orders for combined drainage, a large majority of these claims could not be substantiated after examination of the plans. In a few cases, however, your Council were less fortunate, and orders were made for the repair of the combined drainage in the following instances: 95 to 127, Brightfield Road; 38 and 40, and 44 to 52, Ladywell Road; 1, 2 and 3, Prospect Place; 1 to 19, Railway Terrace; 1 to 7, Jerrard Street; 31 to 45, Porson Street; 79 to 85, Tyrwhitt Road and 42, Ringstead Road. Table 28. Houses Examined and Certified under the Customs and Inland Revenue Act during 1903. Name of Street, Number of Houses. Number of Dwellings. Number of Certificates Granted. Date of Inspection. Davenport Road 33 66 66 April 9th Ebsworth Street 19 38 38 June 9th Farley Road 60 120 120 May 21st and June 4th Kilmorie Road 8 16 16 March 11th Leahurst Road 3 6 6 March 9th and April 15 th Lutwyche Road 2 4 4 March 3rd and August 17th Mallett Road 5 10 10 March 26th Miall Road 9 18 18 April 24th Neuchatel Road 1 2 2 March 25th Totals 140 280 280 96 Table 29. Water Certificates Granted after inspection in accordance with Section 48 of the Public Health (London) Act, 1891, during the year 1903. Ward. Number of Water Certificates Granted. Church - Manor 17 South 30 Lee Division 47 Blackheath 5 Lewisham Village 72 Lewisham Park 159 Brockley 112 Catford 495 Lewisham Division 843 Forest Hill 199 Sydenham 210 Sydenham and Forest Hill Division 409 Whole Borough 1299 97 Table 30. Workshops, 1903. Class of Work. No. Number of Rooms. Number of Workers Allowed. Number of Workers Found. Part Time and Domestic. Day. Artificial Light Overtime. Men. Women. Young Persons Number. No. of Rooms. Dress 148 187 1286 1213 796 l 699 253 90 90 Millinery 21 21 131 125 80 l 63 31 6 6 Laundry 138 349 1549 1431 951 17 651 4 55 55 307 557 2966 2769 1827 19 1413 288 151 151 Tailor 42 46 195 183 122 85 23 8 12 12 Boot 76 77 265 247 166 126 — 13 86 86 Joiner 16 23 517 485 369 60 — 15 2 2 Smith 26 31 378 350 273 81 — 6 1 1 Furrier 3 3 15 13 8 4 2 1 — — Cycles 19 28 202 183 137 44 — 9 3 3 Coachbuilder 10 23 294 279 213 44 — 5 — — Cabinet and Upholsterer 21 28 375 357 261 58 7 6 5 5 Blindmaker 3 5 31 29 19 6 — 3 — — Photography 5 14 56 53 34 8 7 2 8 8 framer 7 9 43 39 29 10 - 5 3 3 Jeweller 12 13 65 56 39 22 — 6 13 13 Piano 2 2 9 9 6 1 — 1 — — Saddler 8 10 61 51 39 21 — 3 1 — Mason 4 5 62 60 43 16 — 2 2 — Lathrender 3 5 29 24 18 16 — ' — — — Various 20 27 172 165 111 27 17 9 14 14 Total 584 906 5735 5352 3714 648 1469 382 301 301 98 Table 31. Details of Premises Subject to Registration by the Local Authority or the London County Council. Premises. Number of Places. No. of Inspections 1903. No. of Notices 1903. No. of Prosecutions 1903 On Register at end of 1902. Added in 1903. Removed in 1903. On Register at end of 1903. Milk premises 139 85 26 148 626 - - Cow sheds 16 — 2 14 124 - - Slaughter houses 17 — — 17 169 - - Other offensive Trade premises - - - - - - - Ice cream premises — — — — - - - Registered houses Let 29 14 15 89,4 *21 - in Lodgings *For nuisances. Overcrowding, 1903— Number of dwelling rooms overcrowded - 6 „ Remedied 6 „ Notices issued . 4 „ Prosecutions Nil Mortuaries— Total number of bodies removed 116 „ „ Infectious bodies removed 2 99 Table 32. Details relating to the Inspection of Workshops and Workplaces within the Borough. Class of Work. Number of Places Number of Inspections 1903. Number of Notices 1903. Number of Prosecutions 1903. On Register at end of 1902. Added in 1903. Removed in 1903. On Register at end of 1903. Premises. Rooms. Workshops. Workshop dries 28 110 — 138 349 110 21 — Workshop Bakehouses 88 1 2 87 87 549 87 - Other Workshops 110 336 — 446 557 336 50 — Workplaces. Outworkers' Premises 67 78 10 135 135 88 11 - Places where food is prepared for sale - 28 - 28 28 28 8- Workplaces other than the above 72 229 — 301 301 229 29 — Total 365 782 12 1135 1457 1340 206 — 100 Table 33. Defects reported by Workshops Inspector. Particulars. Number of Defects. Notices Issued. Prosecutions Found. Notified by Home Office. Remedied. Notified to Home Office. Matters under the Public Health (.London) Act, 1891:— Want of Cleanliness 154 — 154 — 127 Want of Ventilation - - - - - - Want of Air-space: crowding 10 — 10 — 10 Sanitary Accommodation (S. 38.) [Insufficient 6 — 6 — 6 J Unsuitable 6 — 6 — 6 J Not separate for v sexes 2 - 2 - 2 - Want of Drainage of Floors Other Nuisances 6 82 2 8 82 2 8 47 Contraventions of Factory and Workshop Act, 1901:— Occupying Underground Bakehouse without Certificate - - - - - - Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) - - - - - - Failure as regards Lists of Outworkers (s. 107) - - - - - - Giving out work to be done in premises which are Unwholesome (s. 108) - - - - - - Infected (s. 110) - - - - - - Allowing Wearing Apparel to be made in Premises infected by Scarlet Fever or Small Pox (s. 109) - - - - - - Other Contraventions - - - - - - Total 266 2 268 2 206 101 Abstract not affixed 28 Cases reported to As to action taken in cases 2 H.M. Inspector by H.M. Inspector Other cases 19 N umber of underground bakehouses in use at the end of 1903 Certificates granted (s. 101) 23 Number of workshop rooms measured 675 Table 34. List of Outworkers. Class of Homework. 1903 Number of Lists received. 1903. Number of Addresses of Outworkers. U 0 to Feb. 1st. Up to Aug. 1st. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of out workers No. of Lists. No. of out workers Wearing Apparel— Dress. Blouses 7 9 22 31 - 36 Tailoring 20 28 9 12 30 4 Lace 1 1 — — — Cabinet making — — — — — Fur pulling — — — — — Other 8 10 9 17 6 Total 36 48 40 60 30 46 POLLUTION OF THE RIVERS POOL AND RAYENSBOURNE. During the early part of the year an examination of the rivers passing through the Borough, and their tributaries, was made with the view of ascertaining whether the same were contaminated, and also the nature and source of any pollution. The fact that there are connected with the rivers two large water-cress beds, that the Pool River passes through the works of the Crystal Palace Gas Company at Lower Sydenham, and also receives the effluent from the Croydon Corporation's Sewage Farm, were sufficient to warrant a careful enquiry. 102 The Rivers examined were:— The Pool River, which rises in the Addington Hills and passes from the Croydon boundary through Elmers End and Lower Sydenham to Catford, where it joins the River Ravensbourne. It receives in its course before joining the Ravensbourne the streams known as the Beck and the Chaffinch. For a part of its course the river passes through the works of the Crystal Palace Gas Company, entering the works near Southend Lane. The River Ravensbourne, which rises at Keston, euters the Borough near Ravensbourne Station, and continues through Southend and near the Bromley Road to Catford, where it is joined by the Pool River, and continues as the Ravensbourne through the Ladywell Recreation Ground to Lewisham, and thence into the Deptford District. Nine samples were collected for examination at the following points:— 1. Effluent from filter beds of the Croydon Sewage Farm at Elmers End. 2. From conduit conveying storm-water, and waste from South Norwood Public Baths. 3. From the River Chaffinch near Elmers End Station, before it is joined by conduit from Sewage Farm, or by conduit from South Norwood Public Baths. 4. From the River Beck at bridge in King's Hall Road, before its junction with the Chaffinch. 5. From the River Beck at its farthest point, near the " White Hart," Wickham Road. 6. From the River Chaffinch at the bridle path near its source. 7. From the Pool River at Southend boundary. 8. From the River Ravensbourne at the Borough Boundary. 9. From the River Ravensbourne, about 70 yards above its junction with the Pool River. 103 These samples were analysed, and the following results obtained:— Results of Analyses of Samples of Water, etc. Constituents. Sample No. 1 2 3 4 5 6 7 8 9 Free or Saline Ammonia .50 .53 .025 .025 .0025 .012 .480 .0025 .012 Albuminoid Ammonia .185 .09 .022 .020 .017 .022 .055 .006 .026 Chlorines as Chlorides 6.25 5.6 2.3 3.5 2.1 1.4 4.9 3.4 2.6 Nitrogen as Nitrates .35 .42 .224 .175 .126 .042 .084 .42 .42 Nitrogen as Nitrites .14 .035 Nil. Nil. Nil. Nil. .192 Trace Trace Oxygen absorbed in ten minutes at 100° C. in acid solution 2.06 1.002 .180 .334 .263 .194 1.042 .360 .251 in alkaline solution 1.68 1.029 .181 .306 .276 .253 .835 .235 .130 Total Solids 68.0 62.0 40.0 47.5 25.0 23.0 52.0 38.0 37.0 Total Hardness 21.5 21.5 21.0 19.6 15.2 13.8 19.4 14.4 19.7 Permanent Hardness 4.9 6.6 5.3 11.5 4.4 2.7 2.5 3.1 4.0 Colour Very distinct Brown. Distinct Brown. Very ' Pale Brown. Pale Brown. Very Pale Brown. Greenish Brown. Distinct Brown. Very Pale Brown. Very Pale Brown. Remarks Alkaline. Slightly Alkaline. Very slightly Alkaline. Very slightly Alkaline. Very slightly Alkaline. Very slightly Alkaline. Slightly Alkaline. Very slightly Alkaline. Very slightly Alkaline. Note.—Results of Analyses expressed in grains per gallon. 104 After considering the various analyses no objection could be taken to Samples 3, 5, and 6, which were taken from the watercourses before they reach the points where the effluent and stormwater enter, nor to Samples 8 and 9 taken from the River Ravensbourne. With regard to Samples No. 1 (effluent from filter beds of the Croydon Sewage Farm), No. 2 (from conduit conveying storm-water and waste from Public Baths), No. 4 (from the River Beck before its junction with the Chaffinch), and No. 7 (from the Pool River at Southend) the analysis was unsatisfactory. The organic purity of the effluent from the sewage farm was, in my opinion, far below that of a passable effluent, and the character of the water in the Pool River was completely changed after receiving the sewage effluent and waste water from the baths. Although the river water is not used for drinking purposes, the fact that large quantities of organic putrescible matter was being admitted to the river necessitated action being taken to secure a higher standard of purity of the effluent. It must also be remembered that the river passes through the Ladywell Recreation Ground and isolated cases may occur of children or others drinking the water. The risk of admission of pathogenic bacteria, which might at any time render the consumption of water-cress grown at Southend Lane exceedingly dangerous, called for a bacteriological examination of the water in question. Samples of effluent, water, and water-cress were submitted to Professor E. Klein for examination, and he reported on the same as follows :— (Copy) St. Bartholomew's Hospital, E.C. April 27th, 1903. To the Medical Officer of Health. Sir—I beg herewith to report on the bacterioscopic analysis on the Sample of effluent, and the two samples of water received here by messenger on April 23rd, 1903. The effluent, slightly turbid, was labelled " Effluent from Sewage Farm." One sample of water was labelled "From Chaffinch, 100yards above junction from Sewage Farm." This sample was very slightly turbid. 105 One sample of water was labelled ''From 40 yards above water-cress beds." This sample was extremely turbid. For the sake of simple designation we will refer to the Effluent as "Sample No. 1;" to the first sample of water as "Sample No. 2," and to the second sample of water (the one near the water-cress beds) as "Sample No, 3." Analysis of Sample No. 1:— (а) This Sample contained about 120,000 microbes per 1 cubic centimetre. (б) It contained at least 5,000 bacillus coli communis, but less than 10,000 per 1 cubic centimetre. (l) It contained at least 50, but less than 100, spores of bacillus enteritidis sporogenes per 1 cubic centimetre. As an effluent I consider this a good deal inferior in quality to what would be considered as passable; 1,000 bacillus coli per 1 cubic centimetre, should be the extreme number; 10 spores or less per 1 cubic centimetre should be the maximum number of spores in a passable effluent. Sample No. 2:— (a) This sample contained about 450 microbes per 1 cubic centimetre. (b) It contained more than 10, but less than 20 bacillus coli communis per 1 cubic centimetre. (c) It contained the spores of bacillus enteritidis sporogenes in 10 cubic centimetres, but not in 3 cubic centimetres. Sample No. 3:— (a) This sample contained about 28,800 microbes per 1 cubic centimetre. (b) It contained at least 100 bacillus coli communis per 1 cubic metre. (c) It contained the spores of bacillus enteritidis sporogenes in 1 cubic centimetre. From this analysis it follows that there is a remarkable and striking difference between the two samples of water, the one 100 yards above the intake of the effluent of the sewage farm is of the character of surface waters such as one constantly meets everywhere, but not directly polluted. The other sample, viz., 40 yards above the water-cress beds, is strongly polluted with sewage. The number of bacteria present (28,800 per 1 cubic centimetre), the large number of bacillus coli communis (at least 100 per cubic centimetre), and spores of bacillus enteritidis in every 1 cubic centimetre, prove that such pollution must have taken place. (Signed) E. Klein. (Copy) St. Bartholomew's Hospital, E.C. May 1st, 1903. To the Medical Officer of Health. Sir—i received in a sterile bottle, well tied and secured, a sample of water-cress, brought by your Inspector. About 150 cubic centimetres of sterile distilled water were added to the total amount of water-cress, and after shaking the mixture for a few minutes, the water was poured off into a sterile flask. The fluid thus poured off was very turbid, and was used for cultivation experiments. It ought to be stated that the above bottle containing the water-cress—in fact, quite filled by it—measured about 30 ounces, or 850 cubic centimetres. 106 The results of the numerous cultivations were as follow (а) The water (150 centimetres), in which the above water-cress had been washed here in the laboratory contained above one thousand bacillus coli communis per 1 cubic centimetre. (б) It contained less than 10, but not more than 4 spores of bacillus entevitidis sporogenes per 1 cubic centimetre. From these results I consider the above water-cress strongly polluted with sewage microbes, and for this reason I think the material unsuited and (possibly) dangerous for consumption. (Signed) E. Klein. This report showed the desirability of preventing the use of any water-cress grown at Southend Lane. The growers were informed of the result of the examination, and the danger which might accrue from the consumption of the water-cress. The Council were powerless to prevent the sale of the material, but publicity was given in the press to the conditions under which it was grown. A copy of the special report submitted to your Council was forwarded to the Local Government Board and the Corporation of Croydon. Your Surveyor and myself met the Engineer and Medical Officer of Croydon at the sewage farm, and they informed us that it was proposed to construct additional filter beds in order to improve the quality of the efiluent. I have recently been informed that application has been made to the Local Government Board for sanction to borrow the necessary funds, so that we may hope in the near future that the required works will be completed and a dangerous source of pollution will be removed. Pollution by Products of Gas Manufacture.—The Crystal Palace District Gas Company carry on the manufacture of carburetted water-gas, the necessary enrichment being obtained by the use of Baku petroleum. In the course of manufacture a waste product is formed, technically termed water-gas tar, which the Company store in tanks. Large quantities of this material were permitted by the Company to escape into the Pool River several times during the year. On some occasions this material 107 covered the surface of the river and seriously fouled its bed and banks, creating a most serious and offensive nuisance in the districts through which the river flowed. Numerous complaints were received, and reports were from time to time submitted to your Council. So serious was the nuisance that your Council instituted proceedings in the High Court, and were successful. The Company having given notice of appeal on points of law, I refrain from giving a detailed report of all the circumstances while the case is sub judice. It is to be hoped that the proceedings instituted will result in the cessation of a most intolerable nuisance. CRYSTAL PALACE DISTRICT GAS BILL.—The Crystal Palace District Gas Company promoted a Bill in Parliament seeking powers to reduce the illuminating power of their gas, to be relieved of their statutory obligation to remove the sulphur and sulphur compounds from the gas, and for other matters. Your Council opposed the Bill, chiefly by reason of the clause relating to the removal of the sulphur compounds. In their application to Parliament the Company stated that they had been prosecuted by your Council for committing a nuisance in purifying the gas, and that if they obtained permission to cease the purification no further nuisance would be caused. It was shown, however, by witnesses on behalf of the Council that the burning of unpurified gas would be prejudicial to the health of the consumers. In recent years there has been a considerable increase in the number of gas stoves used in private houses of all classes, and as a rule no provision is made for an outlet for the products of combustion. The use of these stoves with pure gas must necessarily result in great vitiation of the air in rooms in which they are used, and were the Company allowed to deliver unpurified gas this vitiation would be still greater. The Company were not successful in their application. 108 COMMUNICATIONS FROM VARIOUS LOCAL AUTHORITIES CONSIDERED DURING 1903. During the year your Council received communications from various Local Authorities on public health matters as follows (which were referred to the Works Committee and reported on by your Medical Officer of Health):— 1. From tbe Kensington Borough Council (7th January) stating that owing to difficulties which had arisen in connection with proceedings under the Sale of Food and Drugs Acts through the absence of any definite standard, they had addressed communications to the Local Governmant Board and the Board of Agriculture on the matter, urging very strongly that regulations might be framed by the last-named Board, which should place both the Commissioners of Customs and the Local Authorities under the Sale of Food and Drugs Acts in a position to effectually deal with the sale of inferior butter in the future, and asking this Council to make similar representations to the Government Departments named on the subject. Your Medical Officer reported that, in his opinion, there was no necessity for any variation in the present law relating to butter, and that he failed to see that any alteration in the standard would be of any material advantage. The Council decided not to support the action taken by the Kensington Borough Council. 2. From the Battersea Borough Council f25th March) stating that they had for some time experienced great difficulty in administering the Sale of Food and Drugs Acts, owing firstly to the conflicting decisions given by the stipendiary magistrates, sometimes, in their opinion, quite against the weight of the evidence adduced, and secondly, to the system of analysis (and certificates given thereon) adopted by Somerset House, the Court of Appeal in such 109 matters; that they were of opinion that the first difficulty would be met by the appointment of a special tribunal to try disputed cases under the Act, so qualified as to be able to understand and examine the evidence brought before it, and that, with regard to Somerset House, the method of milk analysis in use there is the "maceration" process, a process, which in their opinion was almost universally condemned as antiquated and incorrect; that they had asked the Board of Agriculture to receive a deputation from them on the subject, and asking the Council, if they concurred in the above views, to support them by bringing pressure to bear upon the Board of Agriculture to promote legislation to enable disputed cases under the Acts to be tried by qualified tribunals, and to secure amendment in the method of analysis and certification adopted by Somerset House. Your Medical Officer reported that this Council have not been in conflict with the authorities at Somerset House with regard to analytical results, and the Council decided to take no action. 3. From the Westminster City Council (6th April) stating that with regard to the suggestion that some plan of combined action should be agreed upon, whereby, at the request and expense of the Council of the Borough to which milk is consigned, samples might be taken at the railway depots by the Inspectors of the Councils of the respective Boroughs in which depots are situated, they had now resolved to address a communication to the Government urging them to consider as to the desirability of inserting in the " Sale of Adulterated Butter Bill " now before Parliament a clause which would give authority to a Sanitary Inspector of any Metropolitan Borough to take samples of milk for analysis at any railway station situated in another Borough, and being the place of delivery of milk consigned to his district. The Council had already agreed to the 110 principle involved, and the Committee directed that a communication be forwarded to the Government in support of the action taken by the City of Westminster. 4. From the Camberwell Borough Council (16th April) stating that they had had under consideration a report from their Bacteriologist with reference to the bacteriological examinations of milk and butter for tuberculosis, and had decided to make a representation to the President of the Board of Agriculture with a view of obtaining the insertion of the following Clauses in the Adulterated Butter Bill, which was then before the House of Commons:— (a) The provisions of the Sale of Food ani Drugs Acts, 1875 to 1899, shall apply to samples of milk or butter which shall be proved to contain bacteria capable of producing disease in man, but no prosecution shall lie under this Section unless the seller shall have been informed at the time of purchase that such sample was, or samples were, intended for bacteriological examination, and no sanitary authority shall undertake any prosecution under this Section except upon the certificate of a bacteriologist, who shall be a registered medical practitioner, and possessed of qualifications satisfactory to the Board of Agriculture (Local Government Board). (b) In any prosecution under the preceding Section the certificate of a bacteriologist duly qualified and appointed shall be accepted as evidence in the same manner and to the same extent as if he were a public analyst appointed under the Sale of Food and Drugs Acts, 1875 to 1899. Provided always that it shall be lawful for any sanitary authority to appoint as bacteriologist its public analyst, being a registered medical practitioner, and possessed of qualifications satisfactory to the Board of Agriculture (Local Government Board). and asking your Council to support their action. The Committee concurred in the action taken by the Camberwell Borough Council, and directed that a communication be addressed to the President of the Board of Agriculture in support of such action. 5. From the Metropolitan Asylums Board (2nd April) stating that the Ambulance Committee had under consideration a proposal that the operation of the Board's Ambulance service should be extended so as to permit of the ambulance carriages being placed at the disposal of the public for the conveyance in London of medical and surgical cases, and of persons of unsound mind. The Asylums Board stated that 1ll applications for the conveyance of non-infectious sick persons were frequently made to them, but could not be complied with as it was considered that their Ambulance service could only legally be used for the infectious diseases mentioned in the Public Health (London) Act, 1891. That if it was assumed that a public ambulance service for the conveyance of the noninfectious cases was needed the Ambulance Committee con. sidered that the Metropolitan Asylums Board as a central authority was in the best position of any public body in London to provide a thoroughly efficient service with the least possible expenditure. That owing to the non-infectious character of the proposed work and to the fact that it could be distributed fairly equally over the whole day, it was believed that a very moderate fee per journey for the hire of horse, single bedded ambulance, and coachman would cover expenses, and that on the grounds of economy and efficiency it was suggested that it might be advisable that the Asylums Board should undertake the proposed work and that it was practicable for them to do so immediately, should the necessary legal authority be obtained. The Asylums Board asked, before taking any action in the matter, whether in the event of the proposal being adopted, this Council would be disposed to support an application by the Managers to the Local Government Board for the necessary legal authority for giving effect to it. The Council, having fully considered the proposal, directed that the Metropolitan Asylums Board be informed that this Council were not prepared to take any action in the matter. 6. From the Southwark Borough Council (31st October), stating that they had had under consideration reports by their analyst respecting the unsatisfactory quality of the water recently supplied by the Southwark and Yauxhall "Water Company and the Lambeth Water Company, and pointing out 112 the serious danger likely to arise to public health if the quality was not materially improved. The last named Company supply water in this Borough, and your Medical Officer reported that in his opinion the reports above referred to were serious, and that steps should be taken to prevent the recurrence, if possible, of such contamination. The Committee directed that the attention of the London County Council be called to the reports, and that they be requested to take such steps as they should consider necessary to prevent the recurrence of the contamination of the water on occasions of excessive rain and flooding of the sources from which the supply was obtained. 7. From the Bermondsey Borough Council (15th October) stating that they had had under consideration a report of their Public Health Committee with reference to the question of warranties given under Section 25 of the Sale of Food and Drugs Act, 1875, and in connection therewith the provisions in Section 20, Sub-Section 5, of the Sale of Food and Drugs Act, 1899, and that they had passed the following resolution thereon:— "That the attention of the Local Government "Board be called to the difficult and anomalous "position of local authorities in regard to the use "or abuse of warranties, and that the Board be "urged to promote legislation to put the law in a "clear and more equitable position." and asking the Council to support their action in the matter. The Town Clerk and your Medical Officer reported that the question of "warranty" in prosecutions under the Sale of Food and Drugs Acts had been a difficult one, and that they were of opinion that the subject should receive the attention of the Local Government Board, as suggested by the Bermondsey Borough Council. The Council concurred in the suggestion that legislation should be promoted to put 113 the law in a clear and more equitable position, and directed that the Local Government Board be communicated with, urging them to promote such legislation. 8. From the St. Pancras Borough Council (15th October) with reference to additional provision required for dealing with contacts in the prevention of the spread of small pox and other infectious diseases, and sending a copy of resolutions passed by them in reference thereto. The Council received a report from your Medical Officer stating that there was, in his opinion, a need for additional protective powers which, under the existing Sanitary Acts, the Council were unable to enforce, and that he thought that the following clause should receive the support of the Council:— "That it should be an offence to refuse or withhold "information, or give false information with "respect to persons living in a house in which "small pox or other infectious disease has broken "out, with regard to either name, employment or "occupation, schools attended by their children, "or as to any person living in the house or " employed therein." The Council concurred in the views expressed by your Medical Officer of Health, and directed that the London County Council be requested to insert in their next General Powers Bill a section to give effect to the proposal set out above. PART 4. REPORT OF PUBLIC ANALYST. 117 REPORT OF THE PUBLIC ANALYST FOR THE YEAR ENDED DECEMBER 31st, 1903. SAMPLES SUBMITED.—During the period under review 451 samples purchased in conformity with the Food and Drugs Acts were submitted to me for analysis, compared with 458 in the previous year. ADULTERATED SAMPLES.—Of the total number of samples submitted, 61 were found adulterated, equivalent to 13'5 per cent, in 1902, compared with 15 per cent., an improvement to the extent of 1.5 per cent, over the previous year's work, a smaller reduction in the practice of adulteration than one hoped for. The work of 1902, apparently had good effect in reducing the percentage of adulterated samples. During the third quarter of 1903, however, there was a marked rise. (See Table C.) Although the percentage of adulterations for the year 1903 is only slightly below that of 1902, it is important to note that your Council only deemed it expedient to order prosecutions in 30.1 per cent, of the adulterated samples compared with 49.1 per cent, in 1902, the vendors of other adulterated samples receiving a caution. The particulars of all adulterated samples are fully set out in Tables E. and I. 118 FINES.—Nineteen prosecutions were ordered for adulteration. Fines were imposed in fifteen cases, amounting to £50 15s., and £11 7s. costs. These fines are paid into the Borough Fund. In one case (Sample 608, Tincture of Bark deficient in Akaloids), a technical objection raised by the defendant was allowed by the Magistrate and the case dismissed. In the case of Samples Nos. 649 and 709, Milk, the summonses were withdrawn owing to the bottles bursting in consequence of fermentation, and also in the case of No. 604, Mustard, containing 20 per cent, of added flour, the legal advisers of the Council considering the evidence insufficient for successful action. It will be seen therefore that of the nineteen prosecutions ordered, only sixteen were heard, convictions being obtained in fifteen. PURCHASE OF SAMPLES.—An attempt was made as far as possible to purchase samples in a manner similar to that adopted by members of the public, the object of the Food and Drugs Acts being often defeated by the recognition of the Inspectors by the vendors. To obviate this difficulty 52"7 per cent, of the samples taken were purchased by an agent. PRELIMINARY TEST SAMPLES.—During the third and fourth quarters of the year, twenty-five preliminary samples were purchased by an agent informally. On examination, nine were found to be adulterated. In five of these cases the vendors had protected themselves by label, and in the remaining four cases a formal purchase was made and a conviction obtained in each case. This method of purchase gives the Inspectors an 119 opportunity of buying articles of food in small quantities and in the same way as the public are supplied. It also indicates the persons who are regularly selling adulterated foods. OBTAINING SAMPLES IN COURSE OF DELIVERY.— By Section 3 of the Sale of Food and Drugs Act (Amendment Act) 1879, local authorities are empowered to direct their Inspectors to procure samples of milk in course of delivery. So far, samples have only been taken in course of delivery where a request has been made by a dairyman who had reason to suspect the quality of his supply. In the case of milk, such samples may be taken without the request of the purchaser or consignee. Section 14 of the Sale of Food and Drugs Act, 1899, extends the powers relating to the taking of samples of milk in course of delivery to every other article of food, provided a request has been made or consent given for taking the sample by the purchaser or consignee. By virtue of this Section, householders may apparently request that samples be taken on delivery of any article of food. So far, this right has not been exercised by any inhabitant of this District. FORMS OF ADULTERATION.—The adulterations practised by the retailer, are limited to the addition of water to milk, or the abstraction of its cream; the substitution of margarine for butter; the addition of chicory to coffee; and the substitution of low-priced and inferior oils for olive oil. Sophistication of food in these days is carried on mainly by the manufacturers, who are able to command scientific and legal advice to assist them in their practices, and are able to pay the fines inflicted upon the retailers of their goods. I have extracted a few examples from reported cases adjudicated upon in various parts of England during the year 1903 120 Articles of Food. Sophistication. Baking Powder Alum. Butter Rechurning with water or milk to increase proportion of water. Colouration with Annato or Aniline Dyes to improve appearance. The addition of Boracie Acid as preservative. The substitution in part or entirely of foreign fats. Cheese Manufacture from Skimmed Milk or the addition of foreign fats. Cocoa The addition of Starch, Sugar and Oxide of Iron. Coffee Chicory, in some cases as much as 80 per cent. Demerara Sugar Inferior Sugar dyed with Aniline colour. Dripping 50 per cent, of Cotton-seed Oil. Golden Syrup Glucose. Honey The addition of Glucose. Jams The addition of Salicylic Acid, Glucose. Substitution of cheaper fruits or vegetable material, and the addition of Aniline Dyes. Lard Addition of from 50 to 80 per cent, of Cotton-seed Oil. Mustard Addition of Flour and Turmeric. Olive Oil Ootton-seed Oil. Pepper Mixed with ground Olive Stones. Ground Rice. Preserved Peas Copper added. Spices Ground Vegetable matter. Spirits Added water and Methylated Spirit. Sugar Admixture of 33 per cent, of Starch. Sweets The addition of doubtful flavouring matters and Aniline colours, Arsenic. Tinned Meats The addition of Boracic or Salicylic Acid. Yinegar Pyroligneous Acid. Wines Artificial manufacture, producing a liquid that was never acquainted with the grape. Addition of Dyes, Glycerine, Salicylic Acid, and other chemical preservatives. The respectable retailer welcomes the enforcement of the Food and Drugs Acts in a district, because it is a check to the 121 unfair competition which dealers in unadulterated articles have to contend with. It is to be hoped that the next Annual Report for this Borough will show a still greater improvement. Of the 451 samples taken in the Borough during the year in review, 270 were Milk, 76 Butter, 28 Coffee, 9 Spirits, 42 Drugs, 26 Sundries. (See Tables A and B.) MILK.—This is the most important article of food, and it is also the one most easily and most frequently adulterated. For this reason alone it is important that it should form the larger proportion of samples obtained. During the year 270 samples were submitted, 17.41 per cent, of which were adulterated, compared with 20.61 per cent. in 1902. Compared with other London Boroughs the percentage of adulterations is high. (See Table G.) The average composition of the samples submitted shows a slight improvement over those submitted in the previous year. (See Table F.) Dyed Milks.—Sixty per cent, of the milks examined were artificially coloured, either by annato or aniline. This practice is adopted to give the article a rich yellow appearance with the object too often of masking its inferior quality. Preservatives.—Boracic acid and formalin were present in several samples. The drugging of milk by these articles is regrettable, the operation frequently being carried out by several dealers before it reaches the consumer. The farmer puts a little in to preserve the milk, and the wholesale dealer not knowing it adds a little more, and finally the retailer repeats the operation. 122 A Departmental Committee issued a report in 1902 on the use of preservatives and colouring matters in food. So far the recommendations contained therein have not yet become obligatory. Regulations, are greatly needed in this respect. Twenty-four samples were taken in the course of delivery at the request of retailers, five of which were below standard, Nos. 513, 524, 598, 798, and 907. (See Table E.) BUTTER.—Seventy-six samples were submitted, only two, or 2.63 per cent. of which were adulterated, compared with 10 per cent, in 1902. These contained 92 and 94 per cent, of foreign fat respectively. (See Nos. 801 and 836). Boracic acid preservative was present in most samples. There was evidence of a marked increase in the use of Azo-dye colouring matter. COFFEE—Twenty-eight samples were submitted and proved to be genuine. COCOA.—Of the two samples submitted, one contained added starch and sugar. (See Vo. 585). MUSTARD.—Of eleven samples, one contained 20 per cent, of flour. The legal advisers of the Council did not consider the evidence sufficient for prosecution. (See No. 604). GIN.—One sample was submitted and found to be below standard. The vendor was protected by label. LIME WATER.—Of eight samples submitted, six were found to be not in accordance with the British Pharmacopoeia. One contained 171 per cent, of lime in excess, and another 34 per cent, deficiency. (See Nos. 866 and 881). 123 TINCTURE OF BARK.—Of the six samples submitted, three were deficient in Alkaloids. Proceedings instituted in case 608 were dismissed on a legal technicality. Various other samples were submitted as follows:—bread, pepper, rum, whisky, beer, porter, tincture of quinine, tincture of iodine, tincture of guaiacum, sal volatile, sweet nitre, camphorated oil, cod liver oil, paregoric, olive oil, lucca oil. The foregoing were genuine. (See Table A). 124 Table A. Showing number of Samples submitted for Analysis, with Results for the year ended December 31st, 1903. Article. No. of Samples. Genuine. Adulterated. Percentage Adulterated. Milk 270 223 47 17.41 Butter 76 74 2 2.63 Margarine 7 7 — — Lard 2 2 — — Coffee 28 28 — — Cocoa 2 1 1 50.00 Bread 3 3 — — Mustard 11 10 1 9.09 Pepper 2 2 — — Rum 4 4 — — Whiskey 2 2 — — Gin 3 2 1 33.33 Beer 5 5 — — Porter 1 1 — — Lime Water 8 2 6* 75.00 Tincture of Bark 6 3 3 50.00 Tincture of Quinine 2 2 — Ammoniated Tincture of Quinine 2 2 — Tincture of Iodine 1 1 — — Tincture of Guaiacum 1 1 — — Tincture of Iron 1 1 — — Sal Volatile 1 1 — — Spirit of Sweet Nitre 1 1 — — Camphorated Oil 2 2 — — Cod Liver Oil 2 2 — — Olive Oil 4 4 — — Salad Oil 2 2 — — Lucca Oil 1 1 — — Paregoric 1 1 — —- Totals 451 390 61 13.53 * Not in accordance with the standard fixed by the British Pharmacopceia. 125 Year No. of Samples Genuine Adulterated Percentage Adulterated No. of Prosecutions Fines and Costs imposed Summary of Samples Analysed in the Borough in each Year, 1898-1903 (inclusive). 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 1 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 — 3 100.00 2 Fines £5, costs £1 Is. 1902 Milk 228 458 389 69 15.07 34 Fines £123, costs £24 18s. 6d. Butter 149 Coffee 33 Spirits 10 Drugs 19 Sundries 19 1903 Milk 270 451 390 61 13.53 19 Fines £50 15s., costs £11 7s. Butter 76 Coffee 28 Spirits 9 Drugs 42 Sundries 26 126 Table C. Showing results of Total Samples submitted during the years 1902-8. Quarter. No. of Samples. Adulterated. Percentage Adulterated. 1902 1903 1902 1903 1902 1903 First 115 111 27 12 23.48 10.81 Second 167 72 22 4 13.17 5.55 Third 108 152 14 30 12.96 19.74 Fourth 68 116 6 15 8.82 12.93 Total for Year 458 451 69 61 15.07 13.53 Table D. Showing results of Total Samples of Milk submitted during the years 1902-3. Quarter. No. of Samples. Adulterated. Percentage Adulterated. 1902 1903 1902 1903 1902 1903 First 60 70 15 11 25.00 15.71 Second 70 31 15 1 21.43 3.23 Third 54 124 12 30 22.22 24.19 Fourth 44 45 5 5 11.36 11.11 Total for Year 228 270 47 47 20.61 17.41 127 Table E. Details of Adulterated Samples of Milk for the year ended December 31st, 1903. No. Adulteration. Remarks. 462 L. 4.8 per cent. of added water Cautioned 470 S.F. 20 per cent. of added water Fined £3 and 12s. 6d. costs 472 B.L. 3.6 per cent. of added water Cautioned 473 B.L. 3 per cent. of added water Cautioned 478 B.L. 4.5 per cent. milk fat abstracted Fined £2 and 12s. 6d. costs 481 B.L. 7 per cent. of added water Fined £2 and 12s, 6d. costs 489 L. 4.5 per cent. of added water Cautioned 513 L. 6 per cent. milk fat abstracted Cautioned 524 B.L. 5 per ccnt. milk fat abstracted Evidence not sufficient for prosecution 530 L. 20 per cent. milk fat abstracted Fined £5 and 12s. 6d. costs 560 B.L. 8 per cent. milk fat abstracted Fined £3 and 12s. (id. costs 598 S.F. 2 per cent. of added water — 641 L. 3 per cent. of added water Cautioned 643 L. 3 per cent. of added water Cautioned 649 S.F. 7.5 per cent. of added water Summons issued but withdrawn; bot tie burst 656 B.L. 5 per cent. of added water Cautioned 662 S.F. 15 per cent. milk fat abstracted Fined 10s. and 12s. 6d. costs 670 S.F. 5 per cent. milk fat abstracted No action; bottle burst 686 B.L. 4.5 per cent. of added water Cautioned 698 S.F. 96.7 percent. milkfatabstracted Fined £6 and 12s. 6d. costs 699 S.F. 3 per cent. milk fat abtracted Cautioned 702 B.L. 3 per cent. of added water Cautioned 704 B.L. 4.9 per cent. of added water Cautioned 709 S.F. 3 per cent. of added water Summons issued but withdrawn; bottle burst 710 S.F. 4.7 per cent. of added water Cautioned 715 S.F. 3 per cent. of added water No action 726 B.L. 22 per cent. of added water Fined £6 and 12s. 6d. costs 740 B.L 2 per cent of added water Cautioned 743 B.L. 2.5 per cent. of added water Cautioned 750 B.L. 2 per cent. of added water Cautioned 752 B.L. 3.5 per cent. of added water Cautioned 753 B.L 5 per cent. of added water Cautioned 760 B.L. 3 per cent. of added water No action 763 B L. 3 per cent. of added water Cautioned 764 B.L. 4 per cent. of added water Caulioned 766 B.L. 3.5 per cent. of added water Cautioned 767 B.L. 35 per cent. deficient in milk fat Fined £1 and 12s. 6d. co.-ts 773 B.L. 18 per cent. deficient in milk fat, 6 per cent. of added water Fined 10s. and 12s. 6d. costs 778 L. 4 per cent. added water Cautioned 780 L. 8 per cent. deficient in milk fat. 3 per cent. of.added water Fined £2 and 12s. 6d. costs 789 B.L. 3 per cent. of added water Proceedings re sample 773 B.L. 793 L. 2 per cent. of added water Cautioned 798 B.L. 3 per cent. of added water Cautioned 816 B.L. 2 per cent. of added water Cautioned 907 B.L. 2 per cent. of added water Cautioned 911 L. S per cent. of added water Cautioned 912 L. 1 per cent. of added water Caulioned The letters "B.L.," "SF," or "L, following each number refer to the Division of the Borough in which the Sample was procured, "B.L." being Lewisham, "S.F." Sydenham and and F, orest Hilland "L" Lee Division. 128 Table F. Average Composition of Milk Samples submitted in 1903. Average Composition of all samples submitted genuine and adulterated. Average Composition of genuine samples. 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 iat. First Quarter 3.74 8.66 3.91 8.75 3.0 8.5 Second „ 3.63 8.73 3.62 8.75 Third „ 3.59 8.55 3.78 8.66 Fourth „ 3.80 8.72 3.88 8.77 Total for Year 3.67 8.63 3.81 8.72 129 TABLE G. Showing the number of samples of Milk taken per 1,000 of population, and the percentage of samples adulterated in the Metropolitan Boroughs, during the Year 1902. District. No. of Samples per 1,000 of the population. Percentage of the Samples Adulterated District. No. of Samples per 1,000 ol the population. Percentage of the Samples Adulterated Battersea 0.93 17.83 Lambeth 1.03 7.74 Bermondsey 2.97 7.97 Lewisham 1.81 19.91 Bethnal Green 1.58 16.10 London, City 22.47 18.22 Camberwell 1.23 12.26 Paddington 2.22 10 94 Chelsea 1.27 11.70 Poplar 0.89 22.52 Deptford 1.42 10.19 St. Marylebone 1.52 6 93 Finsbury 2 70 21.17 St. Pan eras 1.11 32.06 Fulbam 1.08 1419 Shoreditch 1.30 29.87 Greenwich 1.40 17.16 Southwark 5.13 16.08 Hackney 1.41 33.23 Stepney 1.84 30.36 Hammersmith 1.24 5.04 Stoke Newington 0.86 18.18 Hampstead 0.82 4.48 Wandsworth 0.93 10.70 Holborn 2.98 15.82 Westminster, City 3.14 14.98 Islington 1.75 9.37 Woolwich 3.19 4.81 Kensington 117 11.17 Table H. Shotting number oj samples of Butter submitted in the FourQuarters of the years 1902-3. Quarter. No. of Samples. Adulterated. Percentage Adulterated. 1902 1903 1902 1903 1902 1903 First 44 22 9 — 20.45 — Second 63 13 4 — 6.35 — Third 26 15 1 — 3.85 — Fourth 16 26 1 2 6.25 7.69 Total for year 149 76 15 2 10.07 2.63 130 Table I. Details of Adulterated Samples of Butter for the Year ended December 31s#, 1903. No. Adulteration. Remarks. 801 S.F. 836 S.F. 92 per cent, of foreign fat— Margarine 94 per cent, of foreign fat— Margarine Fined £5, 12s. 6d. costs Fined £o, 12s. 6d. costs Details of Adulterated Samples of Spirits, Lime Water, &c. for the year ended December 31st, 1903. No. Article. Adulteration. Remarks. 483 S.F. Gin 115 degrees below standard Protected by label; cautioned 585 B.L. Cocoa Added Starch and Sugar Protected by label 604 S.F. Mustard 20 per cent, added Flour Proceedings ordered but not taken in consequent of the evidence being considered insufficient 608 S.F. Tincture of Bark 15 per cent, deficient in alkaloids Proceedings taken but case dropped through legal technicality 755 B.L. Tincture of Bark 16 per cent, deficient in alkaloids Cautioned 866 S.F. Lime Water 171 per cent, excess of Lime Fined £3 and 12s. 6d. costs 871 S.F. Lime Water 27'5 per cent, excess of Lime Cautioned 872 S.F. Lime Water 27 '5 per cent, excess of Lime Cautioned 879 B.L. Lime Water 155 per cent, excess of Lime Cautioned 881 S.F. Lime Water 34 per cent, deficiency of Lime Fined £2 and 12s. 6d. costs 905 S.F. Tincture of Bark 20 per cent, deficiency of Alkaloids Cautioned 914 S.F. Lime Water 15 per cent, excess of Lime Cautioned 131 Table I—continued. Other Prosecutions taken tinder The Sale of Food & Drugs' Acts No. Article. Offence. Result. 462 L. Milk Can without name and address (Sec. 9) Fined 10s. and 12s. 6d. costs 551 S.F. Skimmed Milk Not labelled Skimmed Milk (Sec. 11) Fined £3 and 12s. Sd. costs 783 L. Milk Eefusal to sell (Sec. 17) Fined £1 and 12s. 6d. costs 801 S.F. Butter Margarine, not labelled (Sec. 6) Fined 5s. and 2s. costs APPENDIX. LOCAL GOVERNMENT BOARD TABLES. 135 Table A. Vital Statistics of Whole District during the Years 1901, 1902 and 1903. Year Population estimated to Middle of each Year. Births. Total Deaths Register]) 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 i Year of Age At all Ages. Number. Rate.* Number. Rate per iooo 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 130 1902 132432 3491 26 3 438 125 1942 13 9 568 241 117 1818 137 1903 136405 3563 261 330 93 1566 11-5 480 152 99 1513 111 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; Nursing Home, Dartmouth Koad. Other Institutions.—The deaths of residents which have been distributed among the several localities in the District: Brook Hospital, South-Eastern Hospital, London Fever Hospital, 136 Guy's Hospital, St. Thomas' Hospital, St. Bartholomew's Hospital, London Hospital, Seamen's Hospital, University Hospital, Children's Hospital, Gt. Ormonde Street, Bethlem Royal Hospital, Brompton Hospital, King's College Hospital, Charing Cross Hospital, Grosvenor Hospital, St. Olave's Infirmary (City), Oxygen Hospital, Metropolitan Hospital, Poplar Hospital, London County Asylum (Hartford) Cane Hill Asylum, Caterham Asylum, Banstead Asylum, Camberwell House Asylum, Horton Asylum, St. Luke's Hospital (Asylum), Claybury Asylum, Peckham House Asylum, City of London Asylum (Stone), Manor Asylum (Epsom), St. Peter's House (Kennington), Greenwich Infirmary, Lambeth Workhouse, Camberwell Workhouse, Royal Hospital for Incurables, Salvation Army Maternity Home (Hackney). Also deaths of residents of this district which occurred in the River Thames, Hostel of God, Tailor's Institution (St. Pancras), Charlton Railway Station, Chester Cottages (Eltham), Friendly Street (Deptford), Baptist Chapel (Lewisham Road). Table B. Vital Statistics of Separate Localities in the Years 1901, 1902 and 1903 Names or Localities. LEE. LEWISHAM. SYDENHAM & FOREST HILL. WHOLE BOROUGH. Year. Population estimated to middle of each Year. Births registered. Deaths at all ages. Deaths under i 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 i Year Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under i year. 1901 18703 398 255 — 66631 1882 856 — 43146 11140 557 — 128480 3320 1668 — 1902 18925 481 220 37 69672 1857 991 261 43835 1153 607 130 132432 3491 1818 428 1903 19147 486 213 37 72731 1979 816 203 44527 1098 484 88 136405 3563 1513 328 Note:—Figures for years prior to 1901 are -unobtainable, 137 Table C. Cases of Infectious Disease Notified during the Year 1903. Notifiable Disease. Cases notified in whole district. Total Cases Notifikd in each Locality at all Ages. No. of Casks Removed to Hospital from each Locality. At all Ages Under 1 At Ages—Years. 65 and upwards Lee. Lewisham. Sydenham and Forest Hill. Lee. Lewisham. Sydenham and Forest Hill. 1 to 5. 5 to 15 15 to 25 25 to 65 Small-pox 1 — — — — 1 — — — 1 — — 1 Cholera — — — — — — — — — — — — — Diphtheria Membranous croup 250 5 66 143 16 20 — 57 140 53 48 106 38 Erysipelas 82 — 2 5 7 60 8 9 39 34 1 7 4 Scarlet fever 448 5 120 253 54 16 — 57 278 113 47 193 89 Typhus fever — — — — — — — — — — — — — Enteric fever 43 — 4 8 12 19 — 4 22 17 2 11 9 Relapsing fever — — — — — — — — — — — — — Continued fever — — — — — — — — — — — — — Puerperal fever 8 — — — — 8 — — 7 1 — 2 1 Plague — — — — — — — — — — — — — Totals 832 10 192 409 89 124 8 127 486 219 98 319 142 138 Table D. Causes of, and Ages at, Death during the Year 1903. 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 — — — — — — — — — — — Measles 36 7 27 2 — — — 12 18 6 4 Scarlet fever 11 — 7 3 1 — — 1 10 — 29 Whooping-cough 4 2 2 — — — — — 2 2 1 Diptheria and membranous croup 20 1 7 12 — — — 3 8 9 46 Croup 2 1 — 1 — — — 1 — 1 — Fever Typhus — — — — — — — — — — — Enteric 9 — 1 — 2 6 — 2 7 — 3 Other continued — — — — — — — — — — — Epidemic influenza 12 2 — — — 3 7 1 8 3 1 Cholera — — — — — — — — — — — Flague — — — — — — — — — — — Diarrhœa 32 29 3 — — — — 6 21 5 3 Enteritis 30 21 3 — — 5 1 2 17 11 1 Puerperal iever 3 — — — — 3 — — 3 — — Erysipelas 2 — — — — 2 — — — 2 1 Other septic diseases 12 — 1 — 1 10 — 1 7 4 5 phthisis 107 — 3 2 20 76 6 10 57 40 36 Other tubercular diseases. 62 13 19 14 9 6 1 7 37 18 23 Cancer, malignant disease. 118 — 1 — 3 60 54 21 58 39 31 Bronchitis 91 20 5 — — 25 41 9 55 27 39 Pneumonia 88 31 21 1 2 16 17 17 45 26 21 Pleurisy S — — — 1 4 — 2 2 1 3 Other diseases of Respiratory organs. 27 6 3 — 1 8 9 6 12 9 3 Alcoholism 20 — — — — 16 4 4 11 5 7 Cirrhosis of liver Venereal diseases 2 — — — 1 1 — — 2 — — Premature birth 68 68 — — — — — 8 40 20 4 Diseases and accidents of parturition. 6 — — — 2 4 — 1 4 1 1 Heart diseases 220 7 1 8 6 88 110 29 110 81 57 Accidents 40 7 7 3 5 14 4 7 22 11 10 Suicides 14 — — — 2 10 2 — 6 8 1 All other causes 472 113 31 15 20 121 172 63 254 155 150 All causes 1513 328 142 61 76 478 428 213 816 484 480