LEWS BOROUGH OF LEWISHAM. Annual Report ON THE VITAL STATISTICS & SANITARY CONDITION OF THE BOROUGH OF LEWI SHAM AND REPORT OF THE PUBLIC ANALYST For the Year 1904, BY A. WELLESLEY HARRIS, M.R.C.S., D.P.H., &c., Medical Officer of Health and Public Analyst for the Borough of Lewi sham ; Fellow and Member of the Council of the Sanitary Institute ; Fellow of the Epidemiological Society ; Fellow of the Royal Institute of Public Health ; Formerly Medical Officer of Health for the Borough and Port of Southampton, and Medical Superintendent of the Southampton Small-Pox and Fever Hospitals, &>c. 8 BOROUGH OF LEWISHAM. EPITOME OF VITAL STATISTICS, 1904. Area in acres, exclusive of area covered by water 6,991 Enumerated population (Census, 1901) 127,495 Estimated population to the middle of 1904 140,401 Average number of persons per house (Census, 1901) 5.6 Total number of Births registered in the Borough 3,589 Birth Rate per 1,000 estimated population 25.6 Total number of Deaths registered in the Borough 1,799 Total number of Deaths of residents of the Borough, after correction for non-residents dying in Public Institutions, and residents dying outside the District 1,679 Deaths of persons under 1 year of age 440 Infantile Death Rate per 1,000 Births registered 122 Total number of Deaths in Public Institutions in the Borough 542 Deaths of non-residents in the Borough 210 Deaths of residents outside the Borough 90 Corrected Death Rate per 1,000 of the estimated population 12.0 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisliam. Gentlemen, I have the honour to submit my Annual Report on the Vital Statistics and Sanitary Condition of the Borough for the year ended December 31st, 1904, in compliance with the Order of the Local Government Board. I am pleased to report that the Borough continues to maintain a fortunate position among other London Boroughs with respect to its Death-rate, which is calculated upon the number of deaths occuring from all classes of disease to the total number of persons living at all ages, and also in regard to the Infant Mortality and the mortality due to the principal infectious diseases. With regard to the general death-rate, 12.0 per 1,000, this was the lowest death-rate but one recorded in the 29 Metropolitan Boroughs, Hampstead having the lowest, 10'2 per 1,000. The death-rate due to the principal infectious diseases, and referred to as the Zymotic Death-rate, amounted to 1.4 per 1,000. This rate is higher than that recorded in 1903, and is due largely to an increased mortality among infants from Epidemic Diarrhoea and Enteritis. The increased mortality from infectious diseases was general throughout England and Wales. Of the ten South Metropolitan Boroughs the rate recorded in Lewisham was the lowest. The infant mortality rate showed a marked increase throughout England and Wales. The recorded rate in this Borough amounted to 122 per 1,000 births, the lowest in the South Metropolitan Boroughs. The increased mortality was due to Epidemic Diarrhoea and Enteritis, diseases which must be 6 considered to a great extent evidence of the improper feeding and care of infants, and therefore preventable. Special consideration has been given to this important subject in this report. I trust that the greater facilities we now possess for obtaining information in regard to these diseases, consequent upon the appointment of Women Sanitary Inspectors and the possession of returns giving particulars of recorded births, will enable us to adopt measures which it is hoped will do much to prevent the sacrifice of infant life. The mortality in relation to consumption is also worthy of notice. In this Borough the death-rate attributable to this disease amounted to 0.84 per 1,000 persons living at all ages, the lowest rate in London with the exception of Hampstead, which was 0.83 per 1,000. The above figures are very satisfactory. They show that with the exception of Hampstead, Lewisham holds the highest position amongst the London Boroughs. If we compare the mortality figures due to consumption in Lewisham with those of the 76 Great Towns in England and Wales, we find that only four towns have a lower death-rate, viz.: Hornsey, King's Norton, Willesden, and Handsworth. Infectious disease was less frequent than in the preceding year, 552 cases occurring compared with 832 in L903. We have further evidence that of the persons attacked with Scarlet Fever the majority, 54 per cent. of the total, were children of 6 years old and under, and in Diphtheria 44 per cent. of the attacks occurred at the same age period. This furnishes an urgent reason for raising the school attendance age, the necessity for which I have frequently urged. I am pleased to report that the staff of the Department have carried out their duties most satisfactorily. A tabulated summary of the work of the Inspectors is set out in Table 28. 7 Your Council appointed Miss Irene Whitworth (B. Sc. Lond.) their first Woman Sanitary Inspector, and I am pleased to report that her services have already proved most valuable. Miss Whitworth commenced her duties in September ; details of her duties and the work she has performed are set out in the Report. Your attention is called to the important measures which have been taken to remedy serious nuisances, which were a danger to the health of the district, and a source of discomfort to many inhabitants. I refer to the pollution of the Rivers Pool and Ravensbourne by water-gas tar from the Works of the South Surburban Gas Company, which I believe has now been remedied in consequence of your Council's action and the works subsequently executed by the Company. Another danger to health was the system previously adopted for the disposal of house refuse in the Borough. The arrangements made during the year for its complete removal from the district have been attended by considerable benefit. With regard to the administration of the Sale of Food and Drugs Acts, the report of the Public Analyst shows an increase in the number of samples submitted during the year. It is satisfactory to note that adulteration was again less frequent. I remain, Gentlemen, Your obedient Servant, A. WELLE SLEY HARRIS, Medical Officer of Health and Public Analyst. March, 1905. CONTENTS. Page Accidents, deaths due to 47 Bacteriological Examinations 93 Ballast Fires 107 Birth Rate 17 Bread Act 121 Butter, samples submitted132 Cancer, deaths from 46 Circulatory diseases, deaths from 47 , . Combined drainage 98 Constitutional diseases, deaths from 47 Customs and Inland Revenue Act, houses examined under 96 Deaths, ages at 20 & 21 ,, effect of season 21 Death rate, all causes 19 ,, comparison with other boroughs 19 & 54 ,, in wards and divisions 51 ,, zymotic 43 Diarrhoea, epidemic, deaths from 45 Digestive diseases, deaths from 47 Diphtheria, deaths from 44 Disinfection 108 Enteric fever, deaths from 45 Epidemic enteritis 45 Food analysis, samples submitted 129 Homeworkers 109 Houses let in lodgings 108 ,, unfit for human habitation 108 Infant mortality 24 to 44 ,, ,, causes of 26 ,, „ relation of food supply 35 „ ,, street incidence 25 Infectious disease, Age period in relation to 65 Case mortality 67 Influence of schools 74 Notification of 65 Communication on return cases 117 Return cases 69 School closure on account of 75 Street list of 77 to 85 Legal proceedings taken 94 Marriage rate 19 Page Measles, deaths from 44 Milk, amendment of law in relation to supply of 118 ,, analysis of 129 ,, bacterioscopic examination of 93 ,, certified supplies of 40 ,, dirty 130 „ dyed 130 ,, commissions40 ,, preservatives in 121 & 130 ,, samples on delivery 130 ,, sour 130 ,, Sunday samples 129 ,, unclean 120 ,, warranty clauses 119 Model farms 38 Nervous diseases, deaths from 46 Patent foods 41 Phthisis, deaths from 45 & 46 ,, home visits 114 Population 16 Public Health (London) Act, conference on 89 to 92 Registration of births, returns of 30 to 32 Respiratory diseases, deaths from 47 Rivers Ravensbourne and Pool, pollution of 99 to 107 Sanitary Inspector,woman,work and visits of 114 Scarlet fever 44 Small Pox, communication on contacts 125 ,, and vagrants 93 Smoke nuisance 107 Trade refuse, communication on 123 Vital statistics, epitome of 5 Water certificates 97 Whooping Cough, deaths from 45 Workshops 108 ,, domestic 109 ,, insufficient sanitary conveniences 110 Workrooms 108 „ overcrowding in 110 9 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, 1903 and 1904. 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, 1903 and 1904. Table 3.—Births and Birth Rates for each Division of the Borough for the years 1901, 1902, 1903 and 1904. Table 4.—Number of Deaths at various Age Periods and their Percentage to corrected Total Deaths during the years 1902, 1903 and 1904. Table 5.—Percentage of Deaths Under One Year of Age to Total Deaths in Wards and Divisions for the years 1902, 1903 and 1904. Table 6.—Analysis of Deaths Under One Year of Age during the years 1902, 1903 and 1904. Table 7.—Corrected Death Totals and Death Rates for the years 1901, 1902, 1903 and 1904. Table 8.—Corrected Total Deaths from All Causes in Wards occurring during the four quarters of the year 1904. Table 9. —Corrected Death Rates from All Causes in Wards, Divisions and the Whole Borough for the four quarters of the year 1904. Table 10.—Deaths in Disease Groups in the three Divisions and the Whole Borough for the year 1904. Table 11.—Death Rates in Disease Groups in the Wards and Divisions of the Borough for the year 1904. 10 Table 12.—Death Rates of London and Metropolitan Boroughs during the year 1904, after distribution of deaths in Public Institutions. Table 13.—Death Rates in London and the several Metropolitan Boroughs from All Causes and from Certain Diseases during the year 1904, before distribution and after distribution of deaths in Public Institutions. Table 14.—Causes of, and Ages at, Deaths in the Borough for the year 1904. 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 1904. 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 1904. Table 18.—Deaths from Principal Zymotic Diseases arranged in Age Groups for the year 1904. Table 19.—-Meteorological Table for London for the year 1904. Part II.—Infectious Diseases. Table 20.—Showing Cases of Scarlet Fever and Diphtheria at various Age Periods notified during the year 1904. 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 years 1902, 1903 and 1904. Table 22.—Attack Rates at All Ages from Small Pox, Scarlet Fever and Diphtheria in the Metropolitan Boroughs and the County of London for the years 1903 and 1904. 11 Part III.—General. Table 23.—Houses Examined and Certified under the Customs and Inland Revenue Act. Table 24.—Water Certificates Granted. Table 25.—Details relating to Inspection of Workshops and Workplaces in the Borough. Table 26.—List of Outworkers. Table 27.—Details of Premises subject to Registration by the Local Authority, or the London County Council Table 28.—Register of Sanitary Work for 1904. Part IV.—Report of Public Analyst. Table A.—Showing Number of Samples submitted for Analysis, with Results, for the year ended December 31st, 1904. Table B.—Summary of Samples Analysed in the Borough in each year, 1898 to 1904 (inclusive). Table C.—Showing Results of Total Samples submitted during the years 1902, 1903 and 1904. Table D.—Showing Results of Total Samples of Milk submitted during the years 1902, 1903 and 1904. Table E.—Average Composition of Milk Samples submitted in 1904. Table F.—Details of Adulterated Samples of Milk for the year ended December 31st, 1904. Table G.—Samples in which Formalin was used as a Preservative. Table H.—Showing the Number of Samples of Butter submitted in the four quarters of the years 1902, 1903 and 1904. Table I.—Details of Adulterated Samples of Butter, Ac., for the year ended December 31st, 1904. Also details of Other Prosecutions taken under the Sale of Food and Drugs Acts. 12 Appendix.—Local Government Board Tables. Table A.—Vital Statistics of Whole District during the years 1901, 1902, 1903 and 1904. Table B.—Vital Statistics of Separate Localities in the years 1901, 1902, 1903 and 1904. Table C.—Cases of Infectious Disease notified during the year 1904. Table D.—Causes of, and Ages at, Death during the year 1904. Charts. Chart A.—Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 weeks ended 31st December, 1904. Chart B.—Showing Percentage of Deaths in Eleven Groups to Total Deaths during 1904. Chart C.—Showing Weekly Notifications of All Infectious Diseases, also Weekly Notifications of Scarlet Fever, and Diphtheria, during the year 1904. PART 1. VITAL STATISTICS. report OF THE Medical Officer of Health FOR THE YEAR 1904. 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 1904, which amounted to 140,401, compared with 136,405 for 1903, an increase in one year of 3,996 persons. The increase in the population by natural increment, i.e., the excess of births over deaths, amounted to 1,790. It may be assumed, therefore, that the difference of 2,'206 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 December 31st, 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. 16 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, 1903 and 1904. Ward. Population at Census, April, 1901 Population estimated to the middle of 1901. 1902. 1903. 1904. Church 6,412 6,434 6,522 6,611 6,700 Manor 6,734 6,761 6,872 6,983 7,095 South 5,503 5,508 5,531 5,553 5,575 Lee Division 18,649 18,703 18,925 19,147 19,370 Blackheath 6,729 6,735 6,759 6,784 6,807 Lewishara Village 18,842 13,887 14,070 14,253 14,437 Le wish am Park 11,145 11,394 12,391 13,393 14,402 Brockley 10,952 10,984 11,114 11,245 11,377 Catford 23,203 23,631 25,338 27,056 28,785 Lewisham Division 65,871 66,631 69,672 72,731 75,808 Forest Hill 18,051 18,063 18,115 18,166 18,218 Sydenham 24,924 25,083 25,720 26,361 27,005 Sydenham & Forest Hill Division 42,975 43,146 43,835 44,527 45,223 17 Table 2. Population oj the Borough in Divisions, obtained at the Census April, 1901, also population estimated at the middle of the years 1901, 1902, 1903 and 1904. Divisions. Population at Census, April, 1901. Population estimated to the middle of 1901. 1902. 1903. 1904. Lee 18,649 18,703 18,925 19,147 19,370 Lewisham 65,871 66,631 69,672 72,731 75,808 Sydenham and Forest Hill 42,975 43,146 43,835 44,527 45,223 Whole Borough 127,495 128,480 132,432 136,405 140,401 THE BIRTH RATE. The total number of Births registered in the Borough of Lewisham during the year 1904 was 3,589. Of this total 1,802 were males and 1,787 females. The birth rate for Lewisham is therefore 25 6 per 1,000 inhabitants, compared with 26.1 in the previous year. The birth rate for London was 27.9 per thousand, or 2.3 per thousand in excess of this Borough. Of the total births, 469 were registered in the Lee division, 1,967 in Lewisham, and 1,153 in Sydenham and Forest Hill division. The birth rate in Lee was 24.2, in Lewisham 25.9, and in Sydenham and Forest Hill 25.5 per 1,000 of the inhabitants of each division. 18 Table 3. Births and Birth Rates for each Division of the Borough for the years 1901-1904. Division. 1901 1902. 1903. 1904. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births. Birth Rate per 1000 persons. Total Number of Births Birth Rate per 1000 persons Total Number of Births Birth Rate per 1000 persons. Lee 398 21.2 481 25.4 486 25.4 469 24.2 Lewisham 1,882 28.2 1,857 26.6 1,979 27.2 1,967 25.9 Sydenham&Forest Hill 1,040 24.1 1,153 26.3 1,098 24.7 1,153 25.5 Whole Borough 3,320 25.9 3,491 26.3 3,563 26.1 3,589 25.6 County of London 131,829 29.0 130,478 28.5 130,906 28.4 129,335 27.9 19 MARRIAGE RATE. The number of Marriages registered in the Borough during the year amounted to 843, compared with 891 in 1903. The Marriage Rate was 12.0, a decrease of 1.1 per 1,000 on 1903, while the Marriage Rate for the whole of London was equal to 17.0 per 1,000. MORTALITY. The total number of Deaths registered in the Borough amounted to 1,799, compared with 1566, for the year 1903. After deducting the deaths of non-residents (210) dying within the Borough, and adding those of residents (90) who died outside the district, a corrected total of 1,679 is obtained, compared with 1,513 in 1903. The corrected total deaths, 1,679, is equivalent to a Death Rate of 12.0 per 1,000 living at all ages, and compares most favourably with the death rate, 16.1 per 1,000 for the County of London, and 17.2 for the 76 Great Towns. Compared with other Metropolitan Boroughs, Lewisham enjoys the second lowest death rate in London. Hampstead is the lowest with 10.2, followed by Lewisham 12.0, Stoke Newington 13.3, and Wandsworth 13.4 per 1,000 of the population living at all ages. The districts having the highest death rates in London were Finsbury, 21.3, Shoreditch, 20.4, Southwark, 20.l, and Bermondsey, 20"0. (See Tables 12 and 13). The death rate for Lewisham, 12.0 per 1,000 for the year 1904, shows a slight increase over the previous year. 20 On sub-dividing the corrected deaths into the three divisions of the Borough, it will be noted that the mortality rate of the Lee Division, 10.0, was the lowest, Lewisham 12.4 the highest, and Sydenham and Forest Hill Divisions 12.1 per 1,000 of the persons estimated to be living in each Division referred to. (See Table 7). Carrying the sub-division a step further, the death rates from all causes in the individual Wards show Blackheath to have suffered the highest mortality (14.8); on the other hand South claims the lowest mortality for the year with 8.L per 1,000. (See Table 9). ANALYSIS OF DEATHS. Table 4 Number of Deaths at Various Age Periods and, their Percentage to Corrected Total Deaths during the years 1902, 1903, and 1904 Age Periods. 1902. 1903. 1904 Number of Deaths. Percentage to Total Deaths. Number of Deaths. Percentage to total Deaths. Number of Deaths. Percentage to Total Deaths. Deaths under 1 year 428 28.54 328 21.68 440 26.21 Over 1 yr.& under 5 yrs. 200 11.00 142 9.39 140 8.34 „ 5 „ „ 15 „ 86 4.73 61 4.03 39 2.32 „ 15 „ „ 25 „ 86 4.73 76 5.02 85 5.06 „ 25 „ „ 65 „ 547 30.09 478 31.59 470 27.99 Over 65 years 471 25.91 428 28.29 505 30.08 Total 1818 100.0 1513 100.0 1679 100.0 Chart A. Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 Weeks ending December 31st, 1904. 21 Table 5. percentage of Deaths under one year of age to Total Deaths in Wards and Divisions. District. 1902. 1903. 1904. per cent. per cent. per cent. Church Ward 11.8 11.3 19.7 Manor Ward 16.4 26.4 26.0 South Ward 20.8 14.8 13.3 Lee Division 15.9 17.4 20.7 Blackheath Ward 14.5 13.8 13.9 Lewisham Village Ward 18.5 22.2 27.6 Lewisham Park Ward 25.1 20.8 31.5 Brockley Ward 26.2 20.0 27.2 Catford Ward 34.6 32.7 31.3 Lewisham Division 269 24.9 28.2 Forest Hill Ward 21.7 13.4 18.6 Sydenham Ward 20.6 21.4 29.1 Sydenham & Forest Hill Division 21.0 18.2 24.8 Whole Borough 21.68 23.54 26.21 Seasonal Mortality.—The highest mortality occurred during the first and last quarters of the year, the death-rates from all causes being 12.6 and 13.0 per 1,000 respectively. The lowest death-rate was 10.9 for the third quarter. 22 Chart A shows deaths from all causes recorded weekly and the seasonal effect with regard to Infantile Diarrhoea and diseases of the Respiratory Group. Table 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, were the highest during the first and fourth quarters of the year and infective diseases during the third quarter. Mortality in relation to Age.—The periods of life in which the highest mortality occurred are shown in Table 4. The number of deaths occurring under the age of one year amounted to 26.21 per cent. of the total deaths at all ages, an analysis of which will be found under the head of Infantile Mortality. The relation of age periods to mortality from zymotic diseases are set out in Table 18. Of the 197 deaths 92.9 per cent. occurred among children under five years of age. The distribution of zymotic deaths in ward localities appears in Table 16. 23 Table 6. Analysis of Deaths under one year of age, during the years 1902-3-4. Disease. 1902. 1903. 1904 Number of Deaths. Percentage Deaths to total Deaths under 1 year. Number of Death?. 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 73 16.6 Tubercular Diseases 19 4.4 13 4.0 14 3.2 Epidemic Diarrhœa „ Enteritis 53 12.4 29 8.8 103 23.4 Other Zymotic Diseases 35 8.2 10 3.0 29 6.6 Convulsions 51 11.9 24 7.3 26 5.9 Circulatory Diseases 7 1.6 7 2.1 5 1.1 Respiratory Diseases 61 14.3 58 17.7 73 16.6 Enteritis, GastroEnteritis and other Digestive Diseases 81 18.9 78 23.8 81 18.4 Overlaying, Drowning, other Accidents 11 2.6 9 2.7 7 1.6 Classified under various other headings 32 7.5 32 9.8 29 6.6 Totals 428 100.0 328 100.0 440 100.0 24 INFANT MORTALITY.— The infant mortality rate represents the proportion of deaths occurring among children under one year of age to the total births registered during the same period. Of the 1679 corrected total deaths recorded in the Borough, 440, or 26.2 per cent., were among children under one year of age. The infant mortality rate was therefore 122 per thousand births, compared with 92 in 1903. The comparative rates for 1904 were:— England and Wales, 146; 76 Great Towns, 160; and County of London, 144. For comparison with other London Boroughs, see Table 12. This mortality rate deserves special consideration. The number of deaths recorded under one year represent more than one-fourth of the total deaths from all causes at all ages. An examination of Table 6 shows that the majority of the 440 infant deaths were due to Epidemic Diarrhoea and Enteritis, under which headings 103 deaths were registered. Eighty-one were attributed to less acute diseases of the digestive organs; 73 to Respiratory Diseases; and 73 to Premature Birth. The distribution of the principal infant deaths in Wards was as follows:— Ward. Premature Birth. Epidemic Diarrhœa. Respiratory Diseases. Digestive Diseases. Total from Special Groups. 1. Church 3 2 l 2 8 2. Manor 6 2 2 5 15 3. South l 1 — 1 3 4. Blackheath l 1 2 2 6 5. Lewisham Village 9 16 13 6 44 6. Lewisham Park 12 13 11 13 49 7. Brockley 3 5 7 5 20 8. Catford 12 31 16 21 80 9. Forest Hill 7 12 7 9 35 10. Sydenham 19 20 14 17 70 Total 73 103 73 81 330 25 The distribution of infant deaths from Epidemic Diarrhoea and Enteritis, Respiratory Diseases, Digestive Diseases, and Premature Birth shows that the mortality was highest in the Catford Ward, the next highest was in the Sydenham Division, the majority of which occurred in the Lower Sydenham portion of the division. An examination of the records and reports made after enquiry establish the important facts that a very great majority of the infantile deaths occurred in the poorer streets, and that generally the parents were of the labouring classes. The streets list appended herewith supports this statement. LIST OF STREETS in which more than one infant died under the age of 12 months, showing that the majority of infantile deaths occurred in the poorer classes. Lee Boones Place 2 Lansdowne Road 2 Romer Road 3 Brightfield Road 2 Locnaber Road 3 Stoneyard Place 2 Dacre Street 2 LonghurstRoad 2 Taunton Road 2 Hedgley Street 2 Manor Lane 2 Turner Road 3 Lewisham. Ardgowan Road 4 Craythorne Street 2 Malyon's Road 2 Beacon Road 2 Courthill Road 3 Manor Lane 2 Blashford Street 2 Drysdale Road 2 Marsala Road 5 Broadfield Road 3 Doggett Road 2 Mercia Grove 2 Brownhill Road 2 Elthruda Road 2 Mercy Terrace 2 Church Grove 1 Engleheart Road 6 Merritt Road 2 Crofton Park Road 4 Farley Road 6 Mill Road 3 Darfield Road 4 Fernbrook Road 5 Molesworth Street 6 Ellerdale Street 2 Glenfarg Road 6 Morena Street 5 Elswick Road 3 Harvard Road 2 Mount Pleasant Rd. 2 Ennersdale Road 9 Howson Road 2 Pascoe Road 2 Favetsham Road 2 Killearn Road 2 Ringstead Road 3 Fordel Road 3 Kneller Road 3 Rennell Street 2 Glenview Road 2 Knowles HillCrescnt 5 Rhyme Road 2 Hazel bank Road 2 Ladywell Road 2 Sandhurst Road 5 Jutland Road 2 Laleham Road 5 Silvermere Road 5 Blackheath Vale 2 Leahurst Road 3 Sparta Street 2 Braxfield Road 3 Lethbridge Road 2 Springbank Road 3 Bradgate Road 2 Loampit Hill 3 Thurston Road 4 Brookdale Road 6 Loampit Vale 3 Woodlands Street 2 26 Sydenham and Fohest Hill. Beadnell Road 3 Elsinore Road 2 Perry Vale 4 Bovill Road 2 Ewart Road 3 Porthcawe Road 8 Bradford Road 2 Fairlawn Park 6 Stanton Square 3 Como Road 2 Highclere Street 2 Sydenham Road 3 Champion Crescent 2 Hindpley Place 2 Trilby Road 3 Dalmain Road 4 Maddin Road 8 Woolstone Road 2 Dillwyn Road 4 Malham Road 3 Willow Walk 3 Elderton Road 3 Miall Road 4 Abandoned.— Three infants were discovered in gardens of private houses in Sydenham, and one at Upper Sydenham Station. Two who were living were taken to the Infirmary, but subsequently succumbed to Epidemic Enteritis. ANALYSIS OF INFANTS' DEATHS. Premature Births. Of the 78 cases death occurred from a few hours to a few days after the child's birth. In no case did life extend beyond one month, and only 12 cases lived over 14 days. Many women among the poorer classes are most ignorant of the care which should be taken by prospective mothers to ensure healthy offspring, to which fact these accidents are often due. Tubercular Diseases.— Of the fourteen recorded deaths seven were due to Tubercular Meningitis, four to General Tuberculosis, and three to local manifestations of the disease. The fact that all these children were artificially fed with cows' milk offers grave suspicion that the disease may have been transmitted to them by means of infected milk. Epidemic Diarrhœa and Enteritis.— This is the most fatal disease occurring in infants. One hundred and three deaths were recorded under this heading, equal to more than one-fourth of the total deaths under one year of age. The disease is usually epidemic in character and coincident with hot 27 and very dry weather. The fact that the prevalence of this disease is limited to the months of July, August and September, and the influence of season as the main factor is of considerable importance. This does not explain, however, the fact that the disease is almost entirely limited to bottle-fed children, and that the majority of deaths occur among the poorer classes. It is most probable that hot and dry seasons are conditions which encourage active changes in the milk to which harmful bacteria have gained access. That the poorer homes suffer most is probably due to the greater facilities for food contamination arising from its improper storage and the insanitary condition of the home, or to the stale and infected milk supplied by small vendors, who have not the facilities for cooling and properly storing milk which has often travelled a long distance under conditions favourable to deterioration before reaching them. Chart A shows the seasonal incidence of Epidemic Diarrhoea. Miss Whitworth visited 65 houses at which deaths had occurred from Epidemic Diarrhoea or Enteritis, and elicited the following facts with regard to the methods of feeding:— Breast-fed 0 Cows' Milk 13 Diluted Condensed Milk 21 Cows' Milk and Condensed Milk 12 Indefinite (boiled bread, tea, potatoes, &c.) 19 It was found that practically all the infants who died from this disease were artificially fed, and that the parents did not show any concern on the advent of Diarrhœa among infants during the summer months, attributing it to the fact that "it is the fruit season." Miss Whitworth says "the majority of the parents visited displayed amazing ignorance in regard to 28 the most rudimentary principles essential for the feeding and rearing of their children. In many cases the houses were in an uncleanly condition." In eleven cases the children were illegitimate. Proper means of storing food is rarely provided in the houses in the poorer parts of the Borough, and, when present, not infrequently remains unused. Other Zymotic Diseases.— Of the 29 total deaths under one year six were due to Measles, or, more correctly, to its complications Pneumonia or Bronchitis. Whooping Cough was responsible for 23 deaths, and Influenza one. Convulsions.— Under this heading 26 deaths were recorded, compared with 24 in 1903 and 51 in 1902. It is satisfactory to note that the term "Convulsions" appears less frequently upon the Register. Its use is undesirable, as it only implies a symptom and not the actual disease causing death. In several instances an addition has been made upon the certificate showing that the convulsions were due to digestive troubles. Circulatory Diseases.— Five cases were recorded, due to developmental malformations of the heart. Respiratory Diseases.— Of the 73 deaths, 23 were recorded as Bronchitis, 37 Pneumonia, and 10 other affections of the respiratory organs. Their seasonal distribution was as follows:— 26 occurred in the first quarter of the year, 15 in the second, 9 in the third, and 28 in the fourth. There is reason to believe that several of these deaths were due to pneumonia supervening upon malnutrition, due to unsuccessful artificial feeding. Enteritis, Gastro Enteritis, and other Digestive Diseases.— The deaths which are credited to this group were due generally to improper feeding. Of the 81 registered deaths, Inflammation of the stomach and intestines accounted for 10. Of the remaining 71 Wasting accounted for seven. Malnutrition 29 was the assigned cause of 11 cases, all of which had been sent to the Poor Law Infirmary too late for beneficial treatment: none of them were over six months old. Inanition.— This term, like Malnutrition, is further evidence of failure in feeding. To this cause eight deaths were attributed, each under the age of six months. Debility was the certified cause of nine deaths of children six months old and under. Marasmus, or failure of nutrition, caused 23 deaths. In six instances cases were removed to the Infirmary, and one to the Salvation Army Maternity Home. The remaining deaths grouped under the heading of Digestive Diseases were Rickets, Over-distention of stomach with undigested food, Jaundice, Stomatitis. Overlaying and other Accidents.— Seven deaths were recorded, three due to suffocation while in bed with parents, and four to other accidents. It may be fairly assumed from information collected that a large proportion of the infantile deaths are due to improper feeding, and consequently preventable. The fact that so much life is wasted through ignorance is lamentable in itself, but one cannot estimate the baneful effect upon the children who survive, showing deformities due to Rickets, or various forms of mental and nervous diseases resulting from improper nutrition and care during infancy. Until the end of the year we were seriously handicapped in any attempt to improve the unhealthy conditions under which many infants exist. To begin with it is absolutely essential that we should be in possession of the knowledge of every birth that occurs in the Borough with the least possible delay. Repeated 30 attempts have been made to obtain this information, and in January, 1904, I applied upon your authority to the Local Registrars of Births for the necessary returns, upon the payment of suitable fees. The Registrars were, I believe, willing to supply the information provided they received permission from the Registrar-General, but this permission was withheld, the Registrar-General stating that he saw "grave objection to the proposal that Registrars should furnish a detailed return of births to the local authority, and that he had uniformly declined to approve such an application." In consequence of this decision we were unable to adopt any useful and direct measures towards reducing the mortality from preventable disease amongst infants, but could only revert to the useless action of making enquiries and giving advice after a death had been recorded. Even supposing that the advice proved useful in future births it was absurd to advise parents of their errors after their loss. A further attempt to obtain-the information was made in a letter sent by your Council, as follows, a copy of which was sent to the Local Government Board:— 22nd September, 1904. To the Registrar-General. Sir, I beg to inform you that this Council have received a report from their Medical Officer of Health upon the question of infantile mortality, iu which he points out that the Council is powerless to exercise any successful preventative measures in the absence of detailed information in regard to births registered in the district. He further states that he is of opinion from information obtained from homes where deaths have unfortunately occurred through epidemic diarrhoea that their exists an astonishing amount of ignorance among the poorer classes of the district of the elementary principles of feeding their offspring, which can only be remedied by instruction and visits from the "Woman Sanitary Inspector within a reasonable time after the births have taken place, and he thinks that such action may diminish the mortality from this cause to a marked extent. This Council concur in this view and for the purpose of effecting same I have been directed to ask that you will be 81 good enough to instruct the Local Registrars to supply the Medical Officer of Health with weekly returns giving details of the births that are registered in the Borough, for which the Council would be prepared to pay the Registrars the same fee as that prescribed for returns of deaths. I am, Sir, Your obedient servant, Edward Wright, Town Clerk. The following reply was received to this letter:— Somerset House, London, W.C. Sir, I am directed by the Registrar-General to acknowledge the receipt of your letter on the 22nd instant, and in reply to state for the information of your Council, that the matter dealt with therein has been under correspondence between him and the Local Government Board for some time, and that he now hopes to be able to issue instructions to the local Registrars authorizing them to furnish to all Sanitary Authorities who desire them, detailed returns of births on forms to be supplied by him for the purpose, on payment of similar fees to which registrars are entitled for detailed returns of deaths. I am, Sir, Your obedient servant, Noel A. Humphreys, Chief Clerk. Ed. Wright, Esq., Town Clerk, Town Hall, Catford. The difficulties having been surmounted we were enabled to obtain the required returns. A pamphlet on infant feeding and management, written in popular style was distributed to homes in which births have been recorded. The birth lists were examined every Monday morning, the day on which they were received, and a selection of homes made by your Medical Officer of Health in which it was thought 32 desirable a visit should be made by Miss Whitworth, the newlyappointed Woman Sanitary Inspector. On November 29th I received a telephonic message from the London County Council requesting to be informed if Miss Whitworth was visiting homes where births had occurred. M^ attention was directed to the fact that such work was not included among the duties approved at the time of her appointment, and if carried out would necessitate the London County Council refusing to pay their contribution to her salary. I had an interview with the Medical Officer of Health to the London County Council, who, while agreeing that the work proposed was desirable, adhered to the opinion that inasmuch as the duty of visiting homes where births had occurred was not included in the list of duties approved when the Inspector was appointed, if such duty was performed, the London County Council would be unable to allow the usual contribution to the Inspector's salary. Dr. Shirley Murphy promised to report the matter to his Committee and requested me to send particulars in writing. The following letter was sent on December 1st;— Health Department, Town Hall, Catford. The Medical Officer of Health, London County Council. Dear Sir, Re Female Sanitary Inspector. On Tuesday last I had a communication from your Department by telephone asking if Miss Whitworth, our Woman Sanitary Inspector, was visiting homes where births had occurred and giving information in regard to infant feeding. Your representative pointed out that you had before you a declaration signed by our Town Clerk to the effect that Miss Whitworth was carrying out the duties approved by the Local Government Board, and that it was necessary to approve of this declaration before the proportion of her salary payable by the London County Council could be sent to the Lewisham Borough Council. 33 Your representative stated that he had information that Miss Whitworth was carrying out this work, but I failed to elicit who your informant was. I was in a position to state that up to the present Miss "Whitworth has not visited homes where births have occurred, but I frankly pointed out that it was my intention that she should do so in the near future when we had made the necessary arrangements. I desire now to point out that for over a year we have been endeavouring to obtain details of births which take place in the Borough, in order that my Council might take preventive measures in regard to infant mortality, which I hold has been a blot upon sanitary administration, it being principally due to the lamentable ignorance of parents in the feeding of their offspring, and I hold further that it is the duty of all Sanitary Authorities to take preventive measures. It is far better for them to take steps to reduce the mortality rather than cause visits to be made to homes where deaths, preventable deaths, have taken place. The Local Government Board sanctioned the appointment of Miss Whitworth, and among the list of duties which they approved was the investigation of infant mortality. I submit that the duties we propose that Miss Whitworth should carry out in visiting a selected number of homes where births have occurred, with a view of giving information in regard to the feeding of children, may be held to be preventive measures in regard to infant mortality, and may be considered to be within the duties above referred to. Of course Miss Whitworth is only visiting such homes as the Medical Officer of Health may select from the list of births registered, and if it is found that a woman sanitary inspector can carry out these duties it is my intention, if necessary, to ask my Council to increase the staff of such Inspectors. Unfortunately, at the time of Miss Whitworth's appointment we had not overcome the obstacles raised by the RegistrarGeneral's Department to our being supplied with a list of the births registered in the Borough. The Inspector's visits, therefore, could only be made after the deaths occurred. The obstruction has now been removed, we are supplied with a list of births, and we are anxious to take preventive measures. I am somewhat surprised to find that further difficulties will be raised by the London County Council in regard to what I consider a mere technicality. My Committee are meeting on Tuesday next, and I shall be glad to hear whether in the event of Miss Whitworth being 34 requested to carry out the work mentioned, the London County Council would consider it necessary to refuse to allow the proportion of her salary. Yours faithfully, A. Welle sley Harris, Medical Officer of Health. A full report was placed before your Health Committee, who directed a communication to be sent to the Local Government Board upon the subject. As a result the Board suggested a course by which the technical difficulty might be overcome, and I hope that arrangements will be made which will enable us to have Miss Whitworth's assistance in adopting preventive measures during the ensuing year in the hope of reducing the appalling waste of infant life. It may be fairly assumed that from 40 to 50 per cent. of the infantile deaths recorded in the Borough during the year were due directly or indirectly to diseases following improper feeding. Summarising the information collected it would appear that the following causes are in a great measure responsible for the high infantile mortality:— The increasing unwillingness of mothers to suckle their offspring; Inability to suckle child when mother is the bread-winner; Ignorance of mothers in the elementary principles necessary for successful artificial feeding in regard to suitable foods, the methods of preparing same, frequency of feeding, and the amount required; Absence of cleanliness in the home; Uncleanly personal habits. 35 Unhealthy environment of infants, due to overcrowded, badly-lighted and badly-ventilated rooms; Absence of food storage accommodation; The inability of the poorer classes during temporary lack of employment to purchase the necessary milk supplies; The difficulty, particularly among the poorer classes of obtaining pure and fresh milk; The difficulty of preparing cows' milk in a form suitable for infants; The use of patent foods, which are largely advertised as substitutes for milk; The perverseness of parents who prefer to adhere to the traditional methods adopted by their mothers and grandmothers rather than listen, and much less act, upon advice offered to them by skilled observers, which they are pleased to designate "doctors' fads" or "new-fangled ideas." The failure to recognise the danger of Diarrhoea in infants, and to obtain immediate medical advice. MILK SUPPLY. Although great reforms have been carried out in regard to sanitation, by improvements in housing and drainage, and in securing a pure water supply for the community, the milk supply, which is all-important, especially to that portion of the population under two years of age, is still uncontrolled. A pure milk supply is as essential as a pure water supply. We have only to consider the number of epidemics of Typhoid Fever, Diphtheria, and Scarlet Fever which have occurred in the country from infected milk, to see the importance of this fact. 36 Add to these considerations the fact that the high infant mortality is largely due to contaminated milk produced under insanitary conditions. Then again consider the danger of tuberculous diseases being transmitted, especially to infants, by the consumption of milk taken from cows affected by the disease. Finally the milk is often reduced in quality by the addition of water, or unsweetened condensed milk and water, and also by the addition of chemicals as preservatives. This Borough differs from any other London Borough in having a large number of farms within its area, and this is a great advantage to a portion of the residents. The supply, however, from this source forms only a very small proportion of the milk consumed. The bulk is obtained from farms situated in various parts of Berkshire, Dorset, Kent, Somerset, Surrey, Sussex, and Wiltshire; in all 108 farms in different parts of the country send milk into the Borough. In addition, 13 wholesale dealers send supplies, the original source of which is unknown. Thus the bulk of the milk supplied to the Borough is produced on farms some distance away, where it may be contaminated, perhaps by carelessness, or for the want of sufficient supervision, or more usually complete absence of supervision by the Authorities (the rural authorities in whose district the farms are situated) entrusted with the duty. Again in the delivery by railway, there are further chances of pollution. The milk subsequently reaches the wholesale dealer, where it is again manipulated, and finally the retailer; by this time its condition is often greatly altered. The legislative measures adopted for safe-guarding the public in relation to the conditions under which milk may be supplied are contained in the Dairies, Cowsheds and Milkshops Orders, 1885-1899, and have proved wholly insufficient; in many districts they are a dead letter. 37 Suggested Measures for the Prevention of Infantile Mortality. Every means should be taken to encourage breast-feeding, and information given to all mothers of its advantages. Mothers should receive instructions from competent persons in regard to the measures to be adopted for successful artificial feeding when breast-feeding is impossible. Pamphlets and cards should be issued by the Council to every house in which a birth occurs, followed in the poorer districts at homes selected by the Medical Officer of Health by a visit from one of the Woman Sanitary Inspectors. That objections should not be raised by other governing bodies to this valuable work by Woman Sanitary Inspectors who may be considered competent to give information under the direction of the Medical Officer of Health. In the event of parents, by reason of destitution, being unable to procure milk, Local Authorities should have power to grant from time to time temporary supplies on satisfactory evidence that the recipient is without means. No person should be registered to follow the trade of cowkeeper, dairyman, or purveyor of milk, unless it be first ascertained that his premises are fit for such business. Fresh legislative measures should be enacted and enforced throughout the country for the better protection of milk supplies. Dr. Edmund Cantley, in a recent paper, offered a suggestion by which a pure supply could be obtained. His suggestion is "that milk companies should amalgamate and obtain Parlia- "mentary powers, somewhat similar to those which the old "water companies possessed"; that Parliament should "grant, "to each milk company of a certain size, or, better still, to an "amalgamation of several companies, an area of distribution, 38 "such as a parish or borough, with certain definite restrictions, "viz.—that the milk must be the undiluted product of the cow, "uncontaminated by preservatives, filtered and bottled at the "farm or local depot, cooled down to 40° F., containing 3.0 to "3.5 per cent. of fat and not more than 100,000 micro-organisms "per cubic centimetre and at a price not exceeding 2d. a pint." I think such a scheme is unpracticable. It would create a monopoly, which sooner or later municipalities would be compelled to purchase. It has also been suggested that the only satisfactory solution is that of municipalization of the milk supplies. Such a system could only be carried out by establishing municipal farms where the milk could be produced under scientific conditions. There can be no doubt of the urgent need which exists for reform in the milk supply. Cows' milk, owing to the conditions of civilisation has become an essential for the growth, development and maintenance of human life. The growth of cities forces the source of supply further and further away from their centres, and render the supply of fresh milk more and more difficult. The complete control by municipalities, is, I think, impracticable. Those who favour it, use as an argument that municipalities have controlled water, gas, and electricity, and therefore could control milk supply. The most superficial consideration of the character of milk raises at once an insurmountable barrier to the suggestion. There are in London a few high-class dairies, the owners of which have established model farms close to London. The animals are carefully groomed and fed, the milk is cooled immediately after it is obtained, to 45 degrees Fahr, and every precaution is taken to prevent 39 contamination. Unfortunately this supply goes to the wealthier portions of the community. Pure Milk Supply Companies have been formed in this country, in Paris, and in Copenhagen, and have proved a great success. Why should not a similar enterprise succeed in Lewisham, which is in my opinion particularly suited for such a venture. I believe if a model farm were started in which the milk was produced under scientific principles and with scrupulous cleanliness, it would soon gain public appreciation and support. Care of course has to be taken that the supply can be sold at the ordinary rate. In my opinion, there is no doubt that urgent need exists for better control over milk supplies, and I think the more rational and possible methods to be adopted will be found in the following suggestions:— The establishment by municipalities of a model farm and dairy to produce milk under scientific conditions, and to supply carefully prepared modified milk for infants for whom breast feeding is impossible. The modified milk mixtures should be supplied on medical orders. Its gratuitous supply tends to relieve mothers of their responsibilities and to encourage artificial feeding. I believe such a farm would be a financial success if support were obtained from the managers of public institutions in the Borough, such as the Infirmary, Workhouse, and Fever Hospitals, to whom the supply of milk from scientifically managed farms would be invaluable. It would be a great benefit to the poorer classes who at present suffer from the nefarious practices of the itinerant milk-seller, and the polluted milk obtained from small shop-keepers. It would cause private individuals and companies who desired to retain the trade to imitate the model conditions under which the municipality produced their milk. 40 The cost of distribution in the poorer districts would be saved by the establishment of branch offices where milk could be sent in sealed bottles, and fetched by the consumers. In the better-class districts delivery would no doubt be required. Model farms of the character proposed have been established by private Societies in York, Paris, and Copenhagen, and have proved a great financial success. As an alternative to the above suggestion, the American system of certified milk might be adopted. This consists in the formation of a Milk Commission by the Medical Society of New York. The commission invites the co-operation of all milk dealers and farmers, and fixes a bacteriological standard and a standard of quality under which the commission is willing to certify as to the purity of the milk and the general conditions under which it is produced. Facilities are also given to milk dealers complying with the requirements of the commission to use caps on the milk bottles stamped and certified by the Medical Commission of the County of New York, when it is produced under the required conditions and of the standard of quality and purity. Briefly the required conditions are as follows:— The maintained cleanly and sanitary condition of farmyards and cowsheds. The supply to all premises of a pure water supply free from any danger of pollution. The cows to be examined at least twice a year by a Veterinary Surgeon approved by the commission. The immediate separation of cows showing signs of ill- health. The cows to be groomed entirely daily. 41 The udder to be cleansed before milking. Rejection of milk 60 days before and 10 days after calving. Regulations are made for the personal cleanliness of milkers and their clothing; for the methods of feeding; for the cooling of the milk to 45 degrees Fahr, directly after milking; and the cleansing of milk vessels. The Commission reserves the right to enter certified farms at any time to take samples for chemical and bacteriological examination, and to vary their standards. Similar Commissions exist in Baltimore, Buffalo and Philadelphia. Why should not municipalities adopt a similar course, and frame regulations agreeing to certify milk produced by any dealer or farmer under the required conditions. Considering the large amount of land situated within the Borough suitable for a model farm, an excellent opportunity exists for the successful establishment of "Certified Milk" system by private persons who are willing to comply with regulations similar to those which work so well in America. Patent Foods, are widely advertised, many accompanied by photographs of fat babies, together with the statement that they are entire foods and do not require the addition of milk. The so-called milk-foods are mainly prepared from milk evaporated to dryness and mixed with flour partly dextrinized. Other foods contain barley malt in addition. The ordinary infants' foods are prepared from cereals, with the addition of malt and pancreatic ferment to convert the starch into soluble substances. Others, again, are merely baked flour in which no attempt is made to alter the starch contained in them. They are entirely unsuitable for infants, at least for infants under 42 nine months old, and their use is largely responsible for disastrous results. Condensed Milk is entirely unsuited for feeding infants. From enquiries made it appears that the use of this material is widespread amongst the poorer classes. The public should be warned against the use of these foods. It is very difficult to convince some mothers of the essential details for success in artificial feeding. The teaching in Schools of the elementary principles of growth and nutrition, and the value of various food materials, would be greatly beneficial to the present generation. Action Already Taken in Lewisham. A pamphlet containing simple advice on the feeding of infants was prepared by your Medical Officer of Health, and your Council directed a copy of the same to be sent to all houses in which births occurred. A copy of this pamphlet will be found in the Appendix. Women's Health Society. A Women's Health Society has been formed in the Borough, with the following objects:— The delivery of popular lectures to mothers on Infant Feeding and management. These lectures are given regularly in various parts of the Borough, and have been well attended. The Society are arranging for tuition in Domestic Hygiene for ladies whom it is hoped will act as Voluntary Health Visitors. 43 Popular lectures are also given upon General Hygiene. The Society has the support of your Council, and it is believed their work has already been greatly appreciated. The Society has promised to give any assistance possible to the Health Department, and has assisted us in distributing pamphlets in the poorer homes. 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, Epidemic Diarrhoea, Enteritis and Dysentery. 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. The Zymotic death rate for the Borough for the year under review amounted to 1.40 per 1,000 persons, compared with 2.14 for the County of London, 1.94 England and Wales, and 2.49 for the 76 Great Towns. Of the ten South Metropolitan Boroughs, Lewisham possesses the lowest rate. This Borough shows an increase in the Zymotic death rate over that of the previous year, for which Epidemic Diarrhoea among children under one year is largely responsible. The increased mortality from Zymotic diseases was general throughout London as well as England and Wales. (See Tables 12 and 17). Of the total 197 deaths from the principal infectious diseases, Measles accounted for 23, Scarlet Fever 7, Whooping 44 Cough 38, Diphtheria 13, Enteric Fever 2, Epidemic Diarrhoea and Enteritis 112, and Dysentery 2. (See Table 14). 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 Epidemic Diarrhœa and Whooping Cough. In the three Divisions of the Borough the Zymotic death rates were Lee 0.67, Lewisham 1.62 (the highest), and Sydenham and Forest Hill 1.35. (See Table 17). ANALYSIS OF DEATHS IN RELATION TO DISEASE GROUPS. CLASS I.—All Infective Diseases (230). Small-Pox.— No deaths occurred from this disease. Measles.— Measles was the cause of 23 deaths, equal to a death rate of 0.16 per 1,000 of the population. The prevalence of this disease was most marked in the fourth quarter of the year in Sydenham and Forest Hill, and out of 15 deaths during that period 14 were in this division. (See Table 17). Scarlet Fever.— Seven deaths were notified in the Borough, equal to a mortality rate of 0.05 per 1,000. Lewisham Division had the highest mortality, 0.07, the rates for Lee and Sydenham and Forest Hill Divisions being 0.05 and 0.02 respectively. The case mortality amounted to 2.2 per cent. of the persons affected. Diphtheria.— There were 13 fatal cases, giving a mortality rate for the Borough of 0.09 per 1,000. Of the three Divisions the greatest number of deaths occurred in Lee, the mortality being 0.10. The case mortality was 11.1 per cent. of the actual cases. Chart B. Showing Percentage of Deaths in Eleven Groups to Total Registered Deaths during 1904. 45 Whooping Cough.— Thirty-eight deaths occurred from Whooping Cough, equal to a death rate of 0.27. Most of these deaths took place in the first and second quarters of the year, and of the 34 deaths registered during that period 30 were in the Lewisham Division. Enteric Fever.— There were only two fatal cases, equal to a death rate of 0.01 per 1,000. The case mortality was equal to 8.7 per cent. of the persons affected, compared with 20.9 for the previous year. Epidemic Diarrhœa and Epidemic Enteritis.— Of all the Zymotic Diseases Diarrhœa was by far the most fatal in the Borough, accounting for more deaths than all the other Zymotic Diseases combined, the respective figures being:—Epidemic Diarrhœa, 40; Epidemic Enteritis, 72; Dysentery, 2; total, 114. All other Zymotic Diseases, 83. The death rate from Diarrhœa in Lewisham was 0*81 per 1,000, this being the lowest rate of the ten South Metropolitan Boroughs. Of the 114 deaths due to this disease 103 were of children under one year of age, or 23.4 per cent. of the deaths of infants. Other Infective Diseases were:— Influenza, 14; Puerperal Fever, 5; Infective Endocarditis, 3; Erysipelas, 3; Venereal Disease, 1; Septicœmia not Puerperal, 1; Pyaemia, 1; and other Septic Diseases, 5. CLASS II.—Tuberculous (169).—Phthisis. -This disease was responsible for 118 deaths, or 7.0 per cent. of the total 1,679 deaths from all causes. This mortality is equal to a death rate of 0.84 per 1,000 (compared with 0.78 in 1903) for the whole Borough, the lowest rate of the ten Southern Metropolitan Boroughs. Of the remaining London sanitary districts, only Hampstead, 0.83, is lower. The district having the highest 46 mortality from this cause was Holborn, with 2.86 per 1,000. The death rate for the County of London was 1.62. 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 0.72, Lewisham 0.92, and Sydenham and Forest Hill 0.75. 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 — 25 Measles 23 2256 Scarlet Fever 7 365 Diphtheria 13 723 Enteric Fever 2 286 Total 45 3655 Phthisis 118 7526 In addition to Phthisis 51 deaths were registered as due to various forms of tubercular disease. (See Table 14). CLASS III.—Malignant Diseases (115).—Cancer was the stated cause of 92 deaths, compared with 77 in 190B, equal to a mortality rate of 0.66 per 1,000. On sub-dividing these deaths, 12 were registered in Lee, 43 in Lewisham, and 37 in Sydenham and Forest Hill. For other diseases of this Class see Table 14. CLASS IY.—Nervous Diseases (107). — This class was responsible for 107 deaths, equal to 6.4 per cent. of the total deaths. 47 Of this number 17 were cases of Insanity, 20 Meningitis, 30 Convulsions; of the latter 26 were children under 1 year. CLASS V.—Diseases of Heart and Circulation (219). Diseases of Heart and Blood Vessels accounted for 219 deaths, equal to 13.0 per cent. of the total deaths. Sixty-four deaths were due to Valvular Heart Disease and Endocarditis. CLASS VI.—Respiratory Diseases (264).—This class was the cause of 264 deaths, equal to 15.7 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 (171).—To this class 171 deaths, or 10.2 per cent. of the total deaths, were assigned; 81 of these occurred to children under 1 year. CLASS VIII.—Diseases of Urinary Organs (65).—Sixtyfive, or 3.9 per cent. of the total deaths were recorded in this class. CLASS IX.—Diseases of Generative Organs (2).—Only 2 deaths were registered in this group. CLASS X.—General or Constitutional Diseases (294).—Of the 294, or 17.5 per cent. of the total deaths due to disease in this class, Old Age claimed 137 of the total, and Premature Birth was the certified cause of 73. CLASS XI.—Accidents (34).—Thirty-four fatal accidents occurred, three of which were due to overlaying. CLASS XII.—Violence, Suicides, &c (9).—Eight suicides and one other violent death occurred in the Borough. NOTE:—Chart B contains a diagramatic comparison of deaths occurring in various groups. 48 DEATHS OF RESIDENTS belonging to the Borough occurring in Public Institutions, &c., in districts outside during the year 1904. Number of Deaths Number of Deaths Fever Hospitals:— Asylums-Continued. Brook Hospital 1 Horton Asylum, Epsom 2 Colney Hatch Asylum 1 General Hospitals:— Friern Barnett Asylum 1 Guy's Hospital 16 Ilford Asylum 1 Tooting Bee Asylum 1 St. Thomas' Hospital 6 Miller Hospital, Greenwich 3 Other Institutions, &c.:— Evelina Hospital 2 University College Hospital 2 Bermondsey Infirmary 1 Westminster Hospital 2 Epileptic Colony, Epsom 1 Belgrave Children's Hospital, Kennington 1 Islington Infirmary 1 St. Luke's House, 14, Pembridge Square 1 Bolingbroke Hospital, Battersea 1 St. Peter's Home, Kilburn 1 Cancer Hospital, Chelsea 1 Salvation Army Maternity Home, Hackney 1 Central London Throat & Ear Hospital 1 Female Protection Society, 157, Marylebone Road 1 Charing Cross Hospital 1 Children's Hospital, Great Ormonde Street 1 Railway Station, Woolwich Arsenal 1 King's College Hospital 1 Earls Court District Bailway 1 London Hospital 1 London Temperance Hospital 1 East Dulwich Railway Station 1 Orthopaedic Hospital, Hatton Gardens 1 Euston (L.N.W.R.) Station 1 L.C.C. Electric Generating Station, Greenwich 1 St. George's Hospital 1 Asylums:— Artillery Mansions, Westsminster 1 River Thames, Charlton 1 Dartford Asylum 10 Great Western Hotel, Birmingham 1 Cane Hill Asylum 6 Banstead Asylum 3 9, Whitehall Place 1 Caterham Asylum 2 Camberwell House Asylum 2 Total 90 Darenth Imbecile Asylum 2 49 Table 7. Corrected Death Totals and Death Rates for the years 1901, 1902, 1903 and 1904. Locality. 1901. 1902. 1903. 1904. 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. Total Number of Deaths. Death rate per 1,000 of the population. Lee Division 255 13.6 220 11.6 213 11.1 193 10.0 Lewisham Division 856 12.9 991 14.2 816 11.2 941 12.4 Sydenham & Forest Hill Division 557 12.9 607 13.8 484 10.9 545 12.1 Whole Borough 1,668 13.0 1,818 13.7 1,513 11.1 1,679 12.0 County of London' 79,924 17.1 80,105 17.2 69,737 15.2 74,556 16.1 50 Table 8. Corrected total Deaths from All Causes in Wards occurring during the four quarters of the year 1904. 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 6 10 16 6 15 21 7 11 18 5 11 16 24 47 71 Manor Ward 13 13 26 6 10 16 8 4 12 9 14 23 36 41 77 South Ward 7 6 13 4 10 14 6 5 11 5 2 7 22 23 45 Blackheath Ward 9 15 24 18 12 30 8 10 18 9 20 29 44 57 101 Lewisham Village Ward 24 29 53 21 23 44 28 25 53 22 27 49 95 104 199 Lewisham Park Ward 30 19 49 21 29 50 23 22 45 24 24 48 98 94 192 Brock ley Ward 17 14 31 10 12 22 10 11 21 22 18 40 59 55 114 Cat ford Ward 52 38 90 38 41 79 44 40 84 44 38 82 178 157 335 Forest Hill Ward 22 35 57 15 32 47 28 26 54 31 37 68 96 130 226 Sydenham Ward 39 46 85 34 38 72 35 32 67 43 52 95 151 168 319 The Whole Borough 219 225 444 173 222 395 197 186 383 214 243 457 | 803 876 1679 County of London - - 20604 - — 16546 - — 18352 — — 19054 — - 74556 76 Great Towns — — 71202 — — 58411 — — 66504 — — 66442 — — 262559 51 Table 9. Corrected Death Rates from All Causes in Wards, Divisions, and the Whole Borough, for the four Quarters of the Year 1904. Localities. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. 1904. Church Ward 9.6 12.5 10.7 9.6 106 Manor Ward 14.7 9.0 6.8 13.0 10.9 South Ward 9.3 10.0 7.9 5.0 8.1 Lee Division 11.4 10.5 8..5 9.5 10.0 Blackheath Ward 14.1 17.6 10.6 17.0 14.8 Lew. Village Ward 14.7 12.2 14.7 13.6 13.8 Lew. Park Ward 13.6 13.9 12.5 13.3 13.3 Brockley Ward 10.9 7.7 7.1 14.1 10.0 Catford Ward 12.5 11.0 11.7 11.4 11.6 Lewisham Division 13.0 11.9 11.7 13.1 12.4 Forest Hill Ward 12.5 10.3 11.9 14.9 12.4 Sydenham Ward 12.6 10.7 9.9 14.1 11.8 Sydenham & Forest Hill Division 12.6 10.5 10.7 14.4 12.1 Whole Borough 12.6 11.3 10.9 13.0 12.0 County of London 17.8 14.3 15.8 16.4 16.1 76 Great Towns 18.7 15.3 17.5 17.5 17.2 52 Table 10. Deaths in Disease Groups in the Three Divisions and the whole Borough for the year 1904. Disease Classes. Lee Division. Lewisham Division. Sydenham and Forest Hill Division Whole Borough Istt Qr. 2nd Qr. 3rd Qr. 4th Qr- Whole Year. Ist Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year ISt Qr 2nd Qr. 3rd Qr. 4th Qr. Whole Year Ist Qr 2nd Qr. 3rd Qr. 4th Qr. Whole Year I. Infective 5 3 7 2 17 30 21 72 17 140 8 6 35 24 73 43 30 114 43 230 II. Tuberculous 7 3 6 7 23 23 29 20 22 94 13 15 13 11 52 43 47 39 40 169 III. Malignant 4 4 3 4 15 9 12 15 17 53 12 16 10 9 47 25 32 28 30 115 IV. Nervous 4 4 6 3 17 18 18 13 17 66 3 11 3 7 24 25 33 22 27 107 V. Heart & Blood Vessels 2 6 4 8 20 32 27 22 38 119 21 27 11 21 80 55 60 37 67 219 VI. Respiratory 12 6 5 4 27 49 39 19 50 157 26 14 7 33 80 87 59 31 87 264 VII. Digestive 6 3 4 5 18 25 22 25 27 99 19 10 14 11 54 50 35 43 43 171 VIII. Urinary 6 2 1 2 11 11 6 7 6 30 6 6 5 7 24 23 14 13 15 65 IX. Generative Organs - — — — — 1 - — 1 2 — — — — — 1 1 — 1 2 X. General 8 17 5 11 41 38 45 25 48 156 30 12 20 35 97 76 74 50 94 294 XI. Accidents 1 3 — - 4 9 3 3 4 19 3 2 1 5 11 13 8 4 9 34 XII. Violence — — — — — 2 3 — 1 6 1 — 2 — 3 3 3 2 1 9 Totals 55 81 41 46 193 247 225 221 248 941 142 119 121 163 545 444 395 383 457 1679 For Diseases in each Class see Table 1. 53 Table 11. Death Rates per 1,000 of the population, in Disease Groups, in the Wards and Divisions of the Borough for the year 1904 Disease Class Wards and Divisions. Church 1 Manor 2 South 3 Lee 4 Blackheath 5 Lewisham Village 6 Lewisham 7 park Brockley 8 Catford9 Lewisham 10 Forest Hill 11 Sydenham 12 Sydenham and 13 Forest Hill Whole 14 Borough I. Infective 1.6 0.4 0.5 0.9 1.2 2.3 1.7 1.5 2.0 1.8 1.3 1.8 1.6 1.64 II. Tuberculous 0.7 1.4 1.4 1.2 1.6 11 1.5 1.3 1.1 1.2 1.2 1.1 1.1 1.20 III. Malignant 0.7 1.1 0.4 0.8 0.4 1.2 0.3 0.8 0.7 0.7 0.9 1.1 1.0 0.82 IV. Nervous 0.7 0.8 1.1 0.9 0. 6 0.6 1.5 1.0 0.7 0.9 0.5 0.6 0.5 0.76 V. Heart and Blood Vessels 1.3 0.8 0.9 1.0 2.6 1.9 1.7 1.3 1.2 1.6 2.4 1.4 1.8 1.56 VI. Respiratory 2.1 1.3 0.7 1.4 3.1 2.5 2.2 1.1 1.9 2.1 1.9 1.7 1.8 1.88 VII.Digestive 0.4 1.3 1.1 0.9 1.0 1.0 1.5 1.2 1.5 1.3 1.3 1.1 1.2 1.22 VII. Urinary 0.8 0.8 0.5 0.6 0.6 0.3 0.6 0.4 0.3 0.4 0.5 0.6 0.5 0.46 IX. Generative Organs - - - - - 0.1 - - 0.0 0.0 - - - 0.01 X. General Diseases 2.4 2.5 1.3 2.1 3.2 2.5 2.2 1.8 1.8 2.1 2.4 2 .0 2.1 2.09 XI. Accidents 0.1 0.3 0.2 0.2 0.1 0.3 0.2 0.1 0.3 0.3 0.1 0.3 0.2 0.24 XII. Violence — — — — 0.3 0.1 — — 0.1 0.1 0.1 0.1 0.1 0.06 Total Deaths 10.6 10.9 8.1 10.0 14.8 13.8 13.3 10.0 11.6 12.4 12.4 11.8 12.1 12.0 54 Table 12. Death Bates of London and Metropolitan Boroughs during the year 1904, after distribution of deaths in Public Institutions. Boroughs Per 1000 Persons Living. Deaths under 1 year to 1000 Girths registered Deaths from All Causes Principal Epidemic Diseases Small.Pox Measles Scarlet Fever Diphtheria Whooping.Cough Typhus Fever Enteric Fever Pyrexia (Origin uncertain) Diarrhoea Phthisis County of London 16.1 214 o.o1 0.49 008 0.16 0.32 0 06 000 102 1.62 144 West. Paddington 13.8 1.56 001 0.27 0.07 0.13 0.11 0.07 0 .90 1.20 136 Kensington 14.3 1. 45 0.01 0.38 0.03 0.10 0.11 0.03 0.01 0.78 1.44 150 Hammersmith 15.7 2.53 — 0.91 0.05 0.19 0.31 — 0.04 — 1.03 1.38 152 Fulham 15.4 2.49 0.42 0.03 0.15 0.38 0.04 — 1.47 1.43 153 Chelsea 16.5 1.49 0.34 0.08 0.07 0.35 0.03 0.62 1.82 156 City of Westminster 13.5 0.87 — 0.13 0.05 0.04 0.10 — 0.06 0.01 0.48 1.52 125 North. St. Marylebone 16.2 1.51 — 0 .38 0.07 0.11 0.10 — 0.02 — 0.83 1.68 94 Hampstead 10.2 0.66 — 0 .20 0.02 0.05 0.09 — 0.06 — 0.24 0.83 113 St. Panoras 17.4 2.01 — 0.54 0.11 0.16 0.35 — 0.07 — 0.78 1.88 150 Islington 15.4 1.75 0.00 0.53 0.10 0.09 0.25 — 0.05 — 0.73 1.55 129 Stoke Newington 13.3 1.13 — 0.13 0.06 0.15 0.23 — 0.06 — 0.50 1.72 114 Hackney 14.9 2.13 — 0.34 0.09 0.24 0.24 — 0.12 — 1.10 1.39 142 Central. Holborn 18.5 1.80 0.04 0.74 — 0.07 0.16 — 0.07 — 0.72 2.86 109 Finsbury 21.3 2.57 0.03 0. 59 0.17 0.16 0.28 — 0.09 — 1.25 2.39 140 City of London 16.7 0.60 — — 0.04 0.09 0.30 — — — 0.17 1.58 104 East. Shoreditch 20.4 3.20 0.02 0.69 0.11 0.15 0.54 0.07 — 1.62 2.18 188 Bethnal Green 19.3 2.95 0.05 0.69 0.14 0.36 0.40 — 0.05 0.01 1.25 2.16 157 Stepney 19.4 2.84 0.01 0.57 0.11 0.30 0.42 — 0.10 — 1.33 2.12 155 Poplar 18.6 3.37 0.02 0.54 0.14 0.50 0.48 — 0.08 — 1.61 1.74 154 South. Southwark 20.1 3.13 0.00 0.92 0.06 0.13 0.57 0.09 0.00 1.36 2.36 174 Bermondsey 20.0 3.52 — 1.05 0.14 0.12 0.53 — 0.12 0.01 1.55 2.12 172 Lambeth. 15.8 2.10 0.53 0.05 0.11 0.35 0.04 1.02 1.45 138 Battersea 1.45 2.02 — 0.34 0.06 008 0.34 — 0.07 —. 1.13 1. 42 147 Wandsworth 134 1.73 0. 41 0.05 0.16 0.19 0.04 0.88 1.12 1.22 Camberwell 14.9 1.90 0.41 0.06 0.08 0.37 - 0.06 0.92 1.37 144 Deptford 16.1 2. 46 0.67 009 014 043 003 1.10 1.42 145 Greenwich 14. 4 2.26 0.39 0.03 0.11 0.55 0.09 1.09 1.33 142 Lewisham 12.0 1.40 — 0.16 0.05 0.09 0.27 — 0.01 — 0.81 0.84 122 Woolwich 14.3 2. 40 0.24 0.13 0.24 0.45 — 0.05 1.29 1.67 135 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. 55 Table 13. Death rates during 1904 in London and the several Metropolitan Boroughs, from All Causes, and from Certain Diseases (1) before Distribution, and (2) after Distribution of Deaths in Public Institutions. Boroughs. Death-rates per 1000 Living. All Causes. Scarlet Fever. Diphtheria Enteric Fever Phthisis. Before Distribution After Distribution Before Distribution After Distribution Before Distribution After Distribution Before Distribution After Distribution Before Distribution After Distribution County of London 16.6 16.1 0.08 0.08 0 16 0. 16 0.06 0.06 1.67 1.62 West. - Paddington 15.2 13.8 - 0.07 0 06 0.13 0.06 0.07 1.19 1.20 Kensington 16.3 14.3 — 0.03 001 0.10 0.03 0.03 2.22 1.44 Hammersmith 13.9 15.7 — 0.05 0 04 0.19 0.02 0 .04 0.99 1.38 Fulham 15.3 15.4 0.22 0.03 0.40 0.15 0 .06 0.04 1.54 1.43 Chelsea 22.7 16.5 — 0.08 003 0.07 0.03 3.13 1.82 City of Westm'r. 14.9 13.5 0.01 0 .05 0.04 0.04 0 .05 0 .06 0.95 1.52 North. - St. Marylebone 14.1 16.2 0.01 0.07 004 0.11 0.02 0.02 0.99 1.68 Hampstead 13.0 10.2 0.53 0.02 0.56 0.05 0.28 0.06 1.76 0 .83 St. Pancras 17.8 17.4 0.00 0.11 0.07 0.16 0 .04 0 .07 1.93 1.88 Islington 15.5 15.4 0.01 0.10 0.04 0.09 0.04 0.05 1.84 1.55 Stoke Newington 11.1 13.3 — 0.06 0.08 0.15 0.04 0.06 1.38 1.72 Hackney 15.7 14.9 0.13 0.09 0.48 0 .24 0 .12 0.12 1.43 1 .39 Central. Holborn 19.9 18.5 0.02 — 0.12 0.07 0 .05 0.07 1.81 2 .86 Finsbury 11.9 21.3 0.01 0.17 0.02 0 .16 0.09 1.08 2.39 City of London 39 .7 16.7 -— 0.04 0.38 0.09 0 .47 1.92 1.58 East. - Shoreditch 19.7 20 .4 0.11 0.03 0.15 0.03 0.07 2.17 2.18 Bethnal Green 18.4 19.3 0.01 0.14 0.12 0.36 0.02 0.05 2.40 2 .16 Stepney 19.9 19.4 0.01 0.11 0.17 0.30 0.07 0.10 1.82 2.12 Poplar 19.3 18.6 0.02 0.14 0.15 0.50 0.05 0.08 2.05 1.74 South. Southwark 18.1 20 .1 0.06 0.11 0 .13 0.06 0.09 1.45 2.36 Bermondsey 16.6 20 .0 0.01 0 .14 0.01 0 .12 0.03 0.12 1.97 2.12 Lambeth 16.7 15 .8 0.10 0.05 0.19 0.11 0.07 0.04 1.35 1.45 Battersea 14.4 14 .5 0.01 0 .06 0. 02 0.08 0.02 0.07 1.41 1.42 Wandsworth 12.4 13 .4 0.11 0 .05 0.22 0 .16 0.09 0.04 1.06 1.12 Camberwell 16.3 14 .9 0.01 0.06 0.01 0.08 0.03 0.06 1.94 1.73 Deptford 11.8 16.1 0.01 0.09 0 04 0 .14 - 0.03 0.87 1042 Greenwich 19.3 14 .4 0.54 0.03 0 76 0.11 0.25 0.09 2 .04 1.33 Lewisham 12 .9 12 .0 0.34 0 .05 0 40 0 .09 0 .11 0 .01 0 .86 0 .84 Woolwich 13.3 14.3 0.02 0.13 0 06 0 .24 0.02 0 .05 1.58 1.67 Taken from Registrar-General's Summary. 56 Table 14. Causes of, and Ages at, Death in the Borough of Lewisham for the near 1904. Causes of 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 18 years 15 and under 29 years 25 and under 68 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 6 17 — — - — 23 — 7 16 7 - 7 3 Scarlet Fever - 6 1 — 7 1 5 1 45 - 39 4 Typhus Fever — - - — — — - - - - - - - 5 Plague - -— — — - — — — — — — - — 6 Influenza 1 3 - 1 6 3 14 2 7 5 — - — 7 Whooping Cough 23 14 1 — — — 38 3 32 3 1 1 1 8 Diphtheria - 7 5 1 — — 13 2 7 4 53 — 42 9 Enteric Fever — — 2 — 2 1 — 1 13 — 13 10 Epidemic Diarrhoea 35 4 — 1 — 40 2 25 13 4 — 1 11 Epidemic Enteritis 68 3 — 1 — 72 3 47 22 27 - 12 Dysentry — — 1 1 2 1 - 1 — 1 — 13 Venereal Diseases 1 - — 1 1 - 14 Puerperal Septicœmia Fev — 2 3 — 5 1 2 2 1 — — 15 Infective Endocarditis — 1 2 — 3 — 2 1 3 — 2 16 Erysipelas 1 — 2 3 1 2 1 2 - 17 Septiccemia not Puerperal 1 1 1 1 - 18 Pyasmia - 1 — 1 1 — 1 — - 19 Other Septic Diseases 2 1 1 1 5 — 4 1 2 1 1 Class II.Tuberculous Diseases 20 Phthisis 1 3 31 73 10 118 14 70 34 32 7 5 21 Meningitis 7 9 1 — — — 17 4 7 6 7 — 4 22 Peritonitis 1 2 1 .— — 4 1 1 2 3 1 2 23 Scrofula — — — — — — — — — — 24 Other Tuberculous Dis 6 10 4 2 8 — 30 4 16 10 12 4 3 Class III.Malign ant Diseases 25 Cancer, Carcinoma — — — 56 36 92 12 43 37 16 6 1 26 Sarcoma - - 1 — 3 2 6 1 4 1 3 — — 27 Other Malignant Diseases - - — — 8 9 17 2 6 9 9 2 3 Class IV.— Nervous Diseases I 28 Meningitis (not Tuber.) 6 6 5 3 — 20 3 13 4 4 4 1 29 Insanity (G. P. Insane) - - 1 8 8 17 2 13 2 2 10 30 Epilepsy - 1 1 4 7 2 15 1 7 7 4 4 2 31 Convulsions 26 4 — — — 30 7 17 6 — — — 32 Locomotor Ataxy — 1 — 1 1 — — — 33 Paraplegia, Dis. of Cord - - 1 2 1 3 7 6 1 1 — 34 Other Nervous Diseases 3 1 — 8 5 17 3 10 4 3 1 — Class V.— Diseases of Heart and Blood Vessels 35 Valvular Disease, Endocarditis - — 3 11 30 20 64 3 42 19 16 4 2 36 Cerebral Hemorrhage 1 18 23 42 2 21 19 20 - 6 37 Thrombosis 1 5 6 2 3 1 2 1 38 Apoplexy, Hemiplegia — 11 19 30 4 15 11 1 39 Aneurysm 2 2 4 1 1 2 1 40 Embolism 1 1 1 41 Thrombosis, not Cerebral 1 1 1 42 Other Dis. Heart and Blood Vessels 5 1 24 41 71 7 36 28 12 3 8 57 Table 14—Continued. Causes of Death Heaths Whole Borough Borough Divisions Deaths In Public Institutions in Borough Deaths of Residents outside Borough Deaths of non-residents ion Borough Under 1 year 1 and under 8 years 5 and under 13 years 19 and under 25 years 1 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) — 2 - - - - 2 - - 2 - - - 44 Bronchitis 26 6 — — 17 78 127 17 68 42 37 2 12 45 Pneumonia 37 18 3 5 24 22 109 8 77 24 22 3 9 46 Asthma Emphysema — — — — 3 2 5 2 3 — — — — 47 Pleurisy — 2 - — 2 — 4 — 3 1 — — — 48 Other Respiratory Dis. 10 3 1 — 2 1 17 — 6 11 5 - 2 Class VII.— Digestive Diseases 49 Enteritis (not Epidemic) 7 1 — — 1 1 10 — 5 5 1 — 1 50 Gastro Enteritis 3 1 — — — — 4 — 4 — — — — 51 Peritonitis (not Puerperal) — — 3 3 6 — 12 3 8 1 9 2 3 52 Cirrhosis of Liver — — - 1 13 3 17 3 9 5 2 — 2 53 Gastric Ulcer (Perforation of) — — — 3 4 1 8 2 4 2 4 2 1 54 Other Digestive Diseases 71 11 1 5 16 16 120 10 69 41 41 9 9 Class VIII - Urinary Diseases 55 Nephritis, Acute — — 1 — 3 — 4 — 1 3 2 1 — 56 Bright's Disease — — - 1 28 18 47 8 23 16 18 2 — 57 Other Urinary Diseases.. 1 — — — 5 8 14 3 6 5 4 1 — Class IX 58 Generative Organs, Diseases of — — — — — 2 2 — 2 — 1 — - Class X.— Ch Gener&l Diseases 1 _* — ( 59 Old Age — — — — 2 135 137 18 72 47 60 2 20 60 Premature Birth 73 — — — — — 73 10 37 26 1 — — 61 Chronic Rheumatism — — — — 2 2 4 1 3 — — — — 62 Rheumatic Fever — — — — 4 1 5 1 3 1 — — — 63 Parturition, Diseases and Accidents of — — — 1 7 8 2 5 1 3 64 Alcoholism — — — — 7 1 8 1 2 5 4 — — 65 Gout — — — — — 2 2 — 1 1 2 — 2 66 Diabetes Melletus — — — 1 14 7 22 3 13 6 2 2 — 67 All Other Diseases 19 2 — 1 10 3 35 5 20 10 5 2 — Class XI.Accidents 68 Burning — 2 — — — 1 3 1 1 1 3 1 1 69 Overlaying 3 — — — — — 3 — 2 1 — — — 70 Poison — — — — 1 — 1 — — 1 1 — — 71 Drowning — — — — 2 — 2 — 2 - — 1 — 72 Other Accidents 4 — 2 2 11 6 25 3 14 8 8 6 3 Class XII.Vio lence 73 Homicide _ - — 1 — — 1 — — 1 1 — — 74 Suicide — — — 1 6 1 8 — 6 2 2 — 1 Grand Totals 440 140 39 85 470 505 1679 193 941 545 542 90 210 Note—Columns i to 10 include deaths of Residents in the Borough in outside Districts and in Public Institutions, 58 Table 15. Residents and NON-RESIDENTS dying in Public Institutions situated in the Borough. Institution. Deaths of Residents. Deaths of Non- residents. Total. The Park Hospital 18 112 130 Lewisham Infirmary 296 28 324 Lewisham Workhouse 9 1 10 Bermondsey (St. Olave's) Workhouse ... 50 50 St. John's Hospital 9 14 23 Home for Sick Children, Lower Sydenham ... 3 All Saints' Boys' Orphanage, Lewisham ... 1 1 Totals 332 209 541 In addition to the above a death of a non-resident occurred on the London, Brighton & South Coast Railway, Honor Oak Park. 59 Table 16. Deaths from Principal Zymotic Diseases in Wards, during the year 1904. Localities Small-Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhus Fever Enteric Fever Pyrexia *(origin uncertain) Epidemic Diarrhoea& Epidemic Enteritis Dysentery. Totals Death Kates from Principal Zymotic Diseases. Church Ward — — 1 1 3 — — 2 — 7 1.04 Manor Ward — — — 1 — — — — 2 — 3 0.44 South Ward - - - - - 1 — 1 - 3 0.54 Lee Division — — 1 2 3 - 1 — 5 1 13 0.67 Blackheath Wd. — — — 2 2 — — — 2 — 6 0.88 Lew. Vill. Wd. - 4 1 — 6 — - — 19 — 30 2.08 Lew. Pk. Wd. — — 1 — 6 — — — 14 — 21 1 .46 Brockley Ward — 1 1 3 5 — — — 5 — 15 1.32 Catford Ward — 2 2 2 13 — — — 32 — 51 1.77 Lewisham Div. — 7 5 7 32 — — — 72 — 123 1.62 Forest Hill Wd. 1 2 1 — — 13 — 17 0.93 Sydenham Ward — 15 1 2 2 — 1 — 22 1 44 1.63 Sydenham and Forest Hill Div. -— 16 1 4 3 - 1 — 35 1 61 1.35 Whole Borough -— 23 7 13 38 — 2 — 112 2 197 1.40 Country of London 25 2256 365 723 1495 — 286 6 4751 9907 2.14 76 Great Towns 208 7218 1786 2925 6065 1557 18287 38046 2.49 Originally termed Simple Continued Fever. 60 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 1904. Disease. Lee Division. Lewisham Division. Sydenham and Forest Hill Div. | Whole Borough County of London. 76 Great Towns. Small.Pox — - - - 0.01 0.01 Measles — 0.09 0.35 0.16 0.49 0.47 Scarlet Fever 0.05 0.07 0.02 0.05 0.08 0.12 Diphtheria 0.10 0.09 0.09 0.09 0.16 0.19 Whooping Cough 0.15 0.42 0.07 0.27 0.32 0.40 Enteric Fever 0.05 — 0.02 0.01 0.06 0.10 Epidemic Diarrœha and Enteritis 0.26 0.95 0.77 0.80 1.02 1.20 Dysentery 0.05 — 0.02 0.01 Total Zymotic Death Rates 0.67 1.62 1.35 1.40 2.13 2.49 Infantile Mortality Rate .. 85 135 117 122 144 160 Phthisis Death Rate 0.72 0.92 0.75 0.84 1.62 — Comparative Rates for other Boroughs will be found in Table 12. 61 Table 18. Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1904. Ages Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Epidemic Diarrhoea and Enteritis. Dysentry. Totals in Age Groups. Under 1 year — 6 — — 23 — 103 — 132 1 and under 5 years — 17 6 7 14 — 7 — 51 5 and under 15 years — — 1 5 1 — — — 7 15 and under 25 years — — — 1 — — — — 1 25 years and upwards - - - - - 2 2 2 6 Total all ages — 23 7 13 38 2 112 2 197 Note.—Typhus Fever should be included in the list of Principal Zymotic Diseases. It is omitted in the above table, as no cases occurred during the year. Ci to Table 19. Meteorological Table for London for the Year 1904. (Deduced from Observations at Greenwich, under the Superintendence of the Astronomer Royal.) 1904. Month. Barometer. AIR TEMPERATURE Bright Sunshine. Rain and other forms of Precipitation Mean pressure at 32" 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. A B Amount Day of Month. Minimum Maximum Minimum. Day of Month Maximum. Day of Month. Ins. 0 0 0 0 Hours Hours Ins. Ins. January 29.778 33.8 43.7 23.8 1 54.8 13 258 26.4 16 2.51 0.42 30 February 29.417 34.5 44.4 27.2 29 54.2 21 287 50.9 19 2.55 0.39 9 March 29.800 33.7 47.3 26.4 18 59.1 9 367 85.0 12 1.36 0.38 2 April 29.771 40.7 57.7 33.2 '22 66.9 14 414 145.3 13 1.01 0.17 13 May 29.781 45.4 62.0 34.2 9 75.1 26 482 135.8 14 1.92 0.41 31 June 29.875 48.6 68.4 43.9 4 76.1 24 494 198.2 8 0.87 0.28 1 July 29.859 552 77.3 49.2 4 85.2 15 497 273.6 14 2.23 1.55 25 August 29.845 51.8 73.0 43.5 21 91.0 4 450 2329 8 1.24 0.52 31 September 29.893 46.9 64.7 38.8 26 74.6 5 378 164.7 11 1.34 0.36 1 October 29.932 43.6 57.5 31.9 15 66.5 4, 18 330 75.9 16 1.74 0.55 7 November 29.892 36.7 47.5 23.2 26 59.0 9 265 46.0 11 1.65 0.59 7 December 29.762 35.6 44.9 24.8 21 56.0 16 244 23.9 '23 2.25 1.11 6 Year 29.800 42.2 57.4 — — — — 4466 1458.6 165 20.67 — — Abstracted from the report of the Registrar.General. PART 2. INFECTIOUS DISEASES. 65 NOTIFIABLE INFECTIOUS DISEASES. The notifiable 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). Chicken Pox was notifiable during part of the year 1904, from April to November. The total number of cases notified during the year (excluding Chicken-pox) amounted to 588, of which 385, or 65 per cent., were removed for isolation to the Metropolitan Asylums Board's Hospitals and other Institutions. In 36 instances, or 9.35 per cent. of the cases removed, the Hospital authorities returned the patient as not suffering from any infectious disease. Deducting these from the gross total of cases, we have a corrected total of 552 cases of notifiable infectious diseases recorded in the Borough during the year, compared with 832 in 1903, and 1,282 in 1902, a satisfactory decrease. Age Periods.—The persons chiefly attacked were young children, and the largest number of notifications related to Scarlet Fever and Diphtheria. Fifty-five per cent. of the Scarlet Fever, and 46 per cent. of the Diphteria cases occurred among children of or below the age of six years, and of the nonnotifiable and yet dangerous infectious diseases (Measles and Whooping Cough), there is evidence that a still larger percentage of cases occurred at the same period of life. There can be no question that the attendance at school of children below the age of six (the period at which they are undoubtedly most susceptible to infection) is most harmful, and not infrequently disastrous. In previous reports I have drawn attention to this fact, and I still urge that an appeal should be made to the school governing authorities to raise the legal 66 age of compulsory school attendance from five to six years, and, what is of still greater importance, prevent children from attending school while they are under the prescribed age. A step in the right direction has already been taken in the provinces, where the Board of Education are not insisting upon the provision of accommodation for children under the age of five, the present compulsory age. The following figures show the percentage of cases occuring among children of the age of six years and under to the total notifications of Scarlet Fever and Diphtheria:— Scarlet Fever. Diphtheria. 1903. 1904. 1903. 1904. 6 years and under 46 54 55 44 5 ” ” 38 44 43 40 4 ” ” 28 29 28 34 Table 20. Age Periods of Cases of Scarlet Fever and Diphtheria, notified during the year, 1904. Age Periods. Scarlet Fever. Diphtheria. Males. Females. Total. Percentage to Total Cases Males Females. Total. Percentage to Total Cases. Under 1 year - 2 2 0.62 2 1 3 2.56 1 to 2 years 7 4 11 3.42 2 2 4 3.42 2”3” 11 10 21 6.52 7 6 13 11.11 3 ” 4 ”14 12 26 8.8 7 3 10 8.5 4 ” 5 ” 22 11 33 10.4 6 4 10 8.5 5” 10” 76 69 145 45.3 10 17 27 23.08 10”15 ” 17 28 45 13.97 7 9 16 13.67 15 ” 25 ” 9 20 29 9.00 5 12 17 14.52 25 years and over 4 6 10 3.10 5 12 17 14.52 At all ages 160 162 322 100.00 51 66 117 100.00 Chart C. Showing Weekly Notifications of all Infectious Diseases, also Weekly Notifications of Scarlet Fever and Diphtheria, during the year 1904. 67 Case Mortality.—The case mortality of the various notifiable infectious diseases is represented by the percentage of fatal cases to the number of persons attacked at all ages. Scarlet Fever.—2.17 per cent. of the cases proved fatal, compared with 2.4 per cent. in 1903. Diphtheria.—Although the notified cases (130) showed a considerable decrease (over 250) for the year 1903, the disease assumed a more fatal type, giving a mortality of 11.1 per cent. compared with 8 per cent. in 1903. Attack Rates represent the number of cases occuring to every 1,000 persons living at all ages. These rates are useful for comparison with other Boroughs in regard to the incidence of infectious diseases. (See Table 21). The attack rate from all notifiable diseases for the whole Borough during the year (excluding Chicken-pox) amounted to 3*93 per 1,000 of the population, compared with 6.09 in 1903, and 9.68 in 1902. The attack rate for the County of London was 6.08. The attack rates for the Wards will be found in Table 21. The Ward having the greatest number of cases in relation to its population was Brockley, with 5.53 per 1,000, and the lowest attack rate was in Church Ward, 2.08 per 1,000. 68 Table 21. Attack rates from the Principal Infectious Diseases per 1000 of the population for the ten Wards and the whole Borough in the years 1902, 1903 and 1904. Wards. Diseases Small.Pox Scarlet Fever Diphtheria Enteric Fever Puerperal Fever Erysipelas Total 1902 1903 1904 1902 1903 1904 1902 1903 1904 1902 1903 1904 1902 1903 1904 1902 1903 1904 1902 1903 1904 Church 1.37 — — 5.05 1.66 0.74 3.37 3.02 0.74 0.30 0.15 — — — 0 .15 0.76 0.60 0 .45 10.87 5.44 2.08 Manor 0.53 — — 6.69 4.44 2.25 5.09 4.44 0.28 0.30 0.43 — — — — 0.87 0.56 — 13.53 9.88 2.53 South 0.18 — — 5.06 2.70 2.87 3.79 1.08 1.07 0.54 — 0 .36 — — — 1.08 0.18 — 10.66 3.96 4.30 Blackheath 0.58 — — 5.17 2.80 2.20 2.36 3.39 1.17 0.44 0.29 — — — 0.15 0.59 0.44 1.17 9.16 6.92 4.70 Lewisham Village 0.35 — — 2.62 1.96 3.39 1.98 3.64 0.62 0.42 0.35 0 .27 — 0.14 — 0.92 0.77 0.76 6.32 6.87 5.05 Lewisham Park 0.96 5.16 4.25 2.29 3.14 1.12 0.90 0.48 0.37 0 .07 0.88 0.44 0.55 10.65 6.19 3.82 Brockley 0.44 - — 4.40 2.40 3.87 5.21 1.42 0.97 0.62 0.17 0 .17 0.26 — 0.09 0.53 0.44 0.43 11.51 4.44 5.53 Catford 0.78 — — 6.55 5.43 1.90 2.72 1.25 0.83 0.39 0.29 0 .10 0.19 0.18 0.07 0.98 0.51 0.52 11.60 7.68 3. 43 Forest Hill 0.05 0.05 — 3.09 2.47 1.97 0.93 0.99 0.71 3.16 0.16 0 .22 0.11 - 0.11 0. 60 1.04 0.88 4.96 4.73 3.89 Sydenham 0.89 — — 4.78 2.57 1.96 2.76 1.32 0.96 0.66 0.53 0.26 0.15 0.03 0. 04 0.97 0.56 0.59 10.22 5.04 3. 81 Whole Borough 0.63 0.00 — 4.81 3.28 2.29 2.83 1.83 0.83 0.44 0.31 0. 16 0.10 0.05 0.05 0.84 0.60 0.58 9.68 6.09 3 .93 69 Return Gases, i.e., cases occurring in a house within a few days of the return of a patient from Hospital. In previous years particulars have been supplied by the Metropolitan Asylums Board of cases admitted to Hospital from houses to which they had previously discharged another patient, but during 1904 this information was not supplied, but of course was obtained by the Sanitary Inspectors in the course of their investigations. During the year 1904 return cases have been far less frequent than in previous years. This may possibly be due to an altered system adopted by the authorities, in which some patients are, during the later stages of the illness, transferred to convalescent hospitals before being returned to their homes. Information is sent to the Health Department from the Hospital of patients due for discharge to their homes, and a letter is dispatched to parents or persons having charge of such patients giving the precautions which should be taken on the patients return in order to avoid the risk of imparting the disease to others. SCARLET FEVER.—The total number of cases notified during the year amounted to 389, compared with 466 in 1903, and 651 in 1902. Of these cases 269, or 79 per cent. of the total, were removed to the Metropolitan Asylums Board's Hospitals. Subsequently, 17, or 6.3 per cent. of the cases admitted to Hospital, were returned to their homes and stated to be not suffering from any infectious disease. Deducting this number, a corrected total of 322 is obtained, equal to an attack rate of 2.29 per 1,000 persons, a marked decrease compared with the attack rate of 3.28 for the year 1903, and 4.81 in 1902. (See Table 21.) 70 An examination of the attack rates for the various Wards shows that the highest occurred in Brockley Ward (3.87 per 1000), and that the least affected was Church Ward, with 0.74. The greatest number of cases occurred amongst children between the ages of five and 10 years (45 per cent. of the total), and 29 per cent. amongst children under five years. Fatal Cases.—Of the 322 cases, seven, or 2.17 per cent. proved fatal, compared with 2.4 per cent. in 1903. DIPHTHERIA.—130 cases of Diphtheria were notified. Of this number 94, or 72 per cent., were removed to Hospital. Thirteen cases were returned from Hospital as not suffering, giving a corrected total of 117. The attack rate per 1,000 of the population amounted to 0.83, compared with l.83 in 1903, and 2.83 in 1902. Blackheath Ward suffered most from this disease, having an attack rate of 1.17, compared with 3.39 in 1903. The ward least affected was Manor Ward, with an attack rate of 0.28. This ward was the highest last year with an attack rate of 4.44. Case Mortality.—Of the 113 cases, 13, or 11.1 per cent., proved fatal, compared with 8 per cent. in 1903. ENTERIC OR TYPHOID FEYER.—Twenty-nine cases were notified, compared with 48 in 1903. Fifteen of these cases were removed to Hospital, and six were returned as not suffering, thus giving a corrected total of 23 cases. The attack rate for the whole Borough was 0.16, compared with 0.31 in 1903. The highest attack rate occurred in South Ward, 0.36 per 1,000. The case mortality equalled 8.7 per cent. of the cases, compared with 20.9 per cent. in 1903. 71 ERYSIPELAS.—Eighty-two persons were notified as suffering from this disease, and three proved fatal. An exactly similar number of cases occurred in 1903. PUERPERAL FEVER.—Eight cases were certified. The attack rate for the whole Borough amounted to 2.2 per 1,000 births. Five of the cases proved fatal. CHICKEN-POX.—This disease was added to the list of notifiable diseases by the London County Council in April for a period of four months, and extended for a further period of three months to November. During the seven months notification was in force 339 cases were notified, distributed in relation to age as follows:— Under 1 year of age 34 1 and under 5 years 125 5 „ „ 15 „ 171 15 „ „ 25 „ 6 25 years and over 3 In several instances I was invited to see the cases. 72 Table 22. 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 1903 and 1904. Borough. Small-Pox. Scarlet Fever. Diphtheria. *All Notifiable Infectious Diseases. 1903. 1904. 1903. 1904. 1903. 1904. 1903. 1904 Paddington 0.03 0.03 2.85 2.47 1.02 0.96 5.09 4.66 Kensington 0.02 0.02 1.87 1.48 1.00 1.04 4.31 3.67 Hammersmith 0.06 — 2.72 2.42 1.43 1.74 5.73 5.64 Fulham 0.07 — 2.74 1.93 1.98 1.96 6.27 5.06 Chelsea 0.09 — 2.81 1.45 1.32 0.82 5.23 3.14 City of Westminster 0.26 0.03 1.96 1.76 1.03 0.81 4.31 3.66 St. Marylebone 0.03 0.06 3.15 2.25 1.73 0.90 6.87 4.98 Hampstead 0.01 0.01 2.04 1.83 1.00 0.66 3.90 3.66 St. Pancras 0.13 0.03 2.79 3.59 2.21 1.48 6.48 6.81 Islington 0.03 0.05 2.55 3.37 2.21 1.01 5.06 5.71 Stoke Newington 0.03 0.15 1.67 2.93 0.76 1.16 3.78 5.58 Hackney 0.01 0.05 2.97 3.79 2.43 2.33 8.01 8.48 Holborn 0.03 0.10 2.48 1.7.1 0.89 0.80 6.02 4.79 Finsbury 0.02 0.15 2.93 3.34 1.29 1.47 5.92 6.56 City of London — 0.08 2.97 1.36 1.10 1.70 5.09 4.64 Shoreditch — 0.12 2.20 2.93 1.31 1.66 5.68 6.64 Bethnal Green 0.02 0.96 3.01 5.07 1.86 3.26 7.07 11.59 Stepney 0.08 0.29 2.90 4.15 1.79 2.70 6.73 9.38 Poplar 0.16 0.24 2.65 3.22 2.50 3.94 6.77 9.25 Southwark 0.19 0.13 2.46 1.99 1.70 1.34 6.17 5.41 Bermondsey 0.05 0.14 3.08 3.50 1.34 1.49 6.66 7.19 Lambeth 0.23 0.08 2.42 2.12 1.12 1.05 5.06 4.44 Battersea 0.21 0.04 2.73 2.19 1.81 1.29 6.18 4.84 Wandsworth 0.11 0.02 3.28 2.95 2.13 1.56 6.94 5.94 Camberwell 0.07 0.07 2.50 3.52 1.37 1.00 5.25 6.20 Deptford 0.01 0.09 4.46 3.56 4.05 1.72 10.08 7.06 Greenwich 0.04 0.01 1.64 2.09 2.08 1.49 5.01 4.94 Lewisham 0.00 — 3.28 2.29 1.83 0.83 6.09 3.93 Woolwich 0.04 0.06 3.21 3.80 1.51 1.32 5.64 6.04 County of London 0.09 0.10 2.71 2.89 1.67 1.55 6.00 6.08 *Note.—Chicken Pox, which was notifiable during parts of 1903 and 1904, has been omitted. 73 MEASLES.—In March, 1903, the London County Council, by their order, brought Measles within the scope of the Sections of the Public Health (London) Act relating to dangerous infectious diseases, for all purposes except compulsory notification. Only a small percentage of the actual existing cases are brought to our notice, and the majority of these are received from the London County Council School Teachers. The number of cases notified during the year amounted to 392. The notifications are examined immediately they are received, and a circular sent to each house. In cases where it is deemed essential to inform the parents of the dangerous character of the disease and the precautions necessary to prevent its spread a personal visit is made by one of the Woman Sanitary Inspectors. During the year under review the Borough was exceptionally free from Measles until the fourth quarter, when a distinct outbreak occurred in Sydenham and Forest Hill. No effort should be spared to impress upon the public the seriousness of this disease, especially to young children. There were more deaths in the Borough from Measles alone than from Small-pox, Scarlet Fever, Diphtheria and Enteric Fever put together. It is also important to note that the 23 recorded deaths from Measles all occurred among children under five years of age. Your Woman Sanitary Inspector visited 316 houses in which we were informed by the School Teachers that Measles existed. In 195 of the cases visited disinfection was carried out by the Department. Of the 71 cases occurring in better class houses, and not visited, 56 applications for disinfection were received. In 46 instances the existence of Measles was denied. 74 Measles is highly infectious, particularly in its early stages, and for this reason, as well as the fact that only a small proportion of the cases existing come to our knowledge, it may be doubtful if disinfection plays any important part in checking the disease. It does, however, impress the public with the necessity of regarding it as a dangerous infectious disease, and often leads to a general cleansing of houses which were badly in need of attention. I think, therefore, that disinfection is valuable, if only as a means of educating the public. The Woman Sanitary Inspector reported that in the majority of the cases she visited parents displayed a sad ignorance of the dangers of the disease and its infectivity, and in many instances she was able to persuade parents to obtain medical aid and advice, which had previously been considered unnecessary. WHOOPING COUGH—Information relating to this disease is obtained from School Teachers; 176 children were notified as suffering from Whooping Cough, and 72 were excluded on account of infection in the houses. The disease accounted for 38 deaths during the year, compared with four only in 1903 Thirty of the deaths occurred in the Lewisham Division. The disease was most fatal to children under one year of age, at which period 23 deaths occurred, and fourteen between the ages of one and five. SCHOOLS AND INFECTIOUS DISEASES. Owing to the outbreak of Measles in Sydenham and Forest Hill a careful watch was kept upon the Schools. The services of tbe Woman Sanitary Inspector in this respect were most valuable. Forty-one visits were made to various schools, and Miss Whitworth's reports sometimes rendered it necessary for me to make personal visits. In some cases closure of the school or a department became necessary, and was followed by 75 good results. During the year the following schools were dealt with:— Sydenham Hill Road School (Infants').—Number on Roll—177; absent—-48. At time of visit the Infants' Department was closed by your Council from September 25th to October 10th in consequence of Measles. St. Phillips', Coombe Road (Infants').—Number on Roll—132; absent—60. We received no information of the existence of Measles amongst the children, the teachers being unaware that the regulations provided for sending information to the Medical Officer of Health. Miss Whitworth's visit revealed the fact that Measles was prevalent in the school, which was immediately closed by your Council from October 10th to October 24th. Watlington Grove Roman Catholic School.—Number on Roll—122; absent—60. No notification received. On visiting the school the Inspector learned that the Managers had closed it in consequence of Measles. The teachers were unaware that notification of the disease was necessary. In order to confirm the action of the Managers the school was closed by your Council from October 26th to November 15th. St. Michael's Schools (Infants').—Number on Roll— 215; absent—88. No notifications were received, and the prevalence of the disease was discovered by Miss Whitworth. The Infants' Department was closed by your Council from October 3rd to October 17th. Haseltine Road London County Council School, Room A (Infants').—Number on Roll—57; absent—10. Room A of the Infants' Department was closed by the London County Council from October 13th to 24th. Upon enquiry it was found that all the class-rooms were affected, and that the closing of one 76 room was ineffectual. The whole of the Infants' Department was closed by your Council from October 25th to November 15th. Kilmorie Road London County Council School (Infants')—Number on Roll—254; absent—129. The whole of the Infants' Department was closed by your Council from December 19th to January 1st on account of Measles. Lewisham Bridge London County Council School, Room D (Infants').—Number on Roll—116; absent—6. Room D was closed by the London County Council from October 6th to 27th on account of Scarlet Fever and Measles. Miss Whitworth has reported that in addition to obtaining information as to the prevalence or otherwise of infectious disease, her visits have resulted in awakening the school keepers to a sense of their duties in relation to maintaining the sanitary conveniences in a cleanly condition. The infectious diseases notified by the School Authorities were as follows:— Children Buffering. Other children excluded. Measles 376 685 Chicken Pox 206 141 Whooping Cough 176 72 Mumps 172 75 Ringworm 74 — Eczema 4 — Scabies 2 — 77 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 AVENUE, THE, GROVE PARK - - - - l l - - - - BLESSINGTON ROAD - — 2 2 — — — - — — BRIGHTFIELD ROAD l l 1 1 — — — - l l BURNT ASH HILL 4 2 1 1 l l — - — — BURNT ASH ROAD 2 2 — — — — — - — — BUTTER FIELD STREET — — — — — — — - l l CAMBRIDGE ROAD 3 2 - - - - - - - — CHURCH STREET — — 1 1 - - - - - - DACRE PARK 2 2 — — — — l 1 l l DACRE STREET 1 1 - - - - - - - - EFFINGHAM ROAD 2 2 - - - - - - - - ELTHAM ROAD 1 1 - - - - - - - - GLENTON ROAD — — — — — — — - l 1 HANDEN ROAD 1 1 - - - - - - - - HEATHER ROAD - - - - - - - - l l HEDGLEY STREET 1 1 - - - - - - - - HIGH ROAD, LEE — — 1 1 — — — - 2 2 LAMPMEAD ROAD 1 1 - - - - - - 2 2 LANSDOWN ROAD 1 1 - - - - - - - - LEE PARK 1 1 - - - - - - - - LEE TERRACE — — — — — — 1 1 — — LEYLAND ROAD 6 3 2 2 - - - - - - LOCHABER ROAD 3 1 — — — — - - — — NEWSTEAD ROAD — — 2 2 — — - - — — QUENTIN ROAD — — 1 1 — — — - — — ROYAL OAK PLACE - - - - - - - - 1 1 st. Mildred's road — — 1 1 — — - - — — SOUTHBROOK ROAD - - - - - - - - 1 1 78  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 SUMMERFIELD STREET l l - - - - - - 2 2 TAUNTON ROAD 3 2 - - - - - - - - TURNER ROAD — — — — — — l l — — WEARDALE ROAD 1 1 - - - - - - - - LEWISHAM DIVISION ABERDEEN TERRACE 1 1 2 2 - - - - - - ADELAIDE ROAD 3 2 — — l l — — 1 1 AITKEN ROAD — — 2 1 — — — — — — ALBACORE CRESCENT 1 1 - - - - - - - - ALGERNON ROAD - - - - - - - - 2 2 ARABIN ROAD — — 1 1 — — l l — — ARDGOWAN ROAD — — 3 3 — — — — 1 1 ARDMERE ROAD — — — — l l — — — — ARNGASK ROAD - - - - - - 1 1 2 2 AVENUE ROAD 3 2 - - - - - - 1 1 AVENUE SQUARE 1 1 - - - - - - - - BEACON ROAD — — 1 1 — — — — — — BENIN STREET 1 1 - - - - - - 1 1 BERLIN ROAD — — 3 2 l l — — — — BERTRAND STREET 1 1 - - - - - - - - BLAGDON STREET 1 1 1 1 — — l l — — BLYTHE VALE 1 1 - - - - - - - - BONFIELD ROAD — — 1 1 — — — — — — BOWNESS ROAD — — — — i l — — — — BRADGATE ROAD 2 2 - - - - - - - - BRAIDWOOD ROAD 2 1 - - - - - - - - BRAXFIELD ROAD 3 2 1 1 — — l l 1 1 BRIGADE STREET 1 1 - - - - - - 1 1 BRIGHTSIDE ROAD - - - - - - - - 1 1 BROADFIELD ROAD - - - - - - - - 1 1 BROCKLEY GROVE 3 3 1 1 - - - - 1 1 79  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 BROCKLEY ROAD - - - - - - 2 2 - - BROOKBANK ROAD l l — — — — 1 1 l l BROOKDALE ROAD 2 l l l l l 1 1 l l BROWNHILL ROAD 7 7 l l — — 1 1 — — CHALSEY ROAD 2 2 - - - - - - - - CLAREMONT TERRACE — — l l — — — — — — CLARENDON ROAD 3 1 - - - - - - - - COLLINS STREET 4 3 l l — — — — l l COMERFORD ROAD 5 3 - - - - - - l l CONNINGTON ROAD 2 1 - - - - - - - - COURTHILL ROAD 1 1 l l — — — — l l CROFTON PARK ROAD 1 1 - - - - - - - - DARFIELD ROAD 3 3 - - - - - - l l DARTMOUTH HILL — — — — — — 1 1 — — DARTMOUTH ROW 1 1 - - - - - - - - DOGGETT ROAD 3 2 l l - - - - - - DOWANHILL ROAD 1 1 — — - — 1 1 — — DRYSDALE ROAD - - - - - - 3 3 l l EASTDOWN PARK 1 1 l l — — — — — — ELIOT HILL - - - - - - - - l l ELIOT PARK - - - - - - - - l l ELLERDALE STREET 3 3 - - - - - - - - ELMER ROAD 1 1 5 l - - - - - - ELSWICK ROAD 4 4 2 l — — — — — — EMBLETON ROAD 6 3 - - - - - - - - ENGLEHEART ROAD 2 2 — — — — 2 2 2 2 ENNERSDALE ROAD 1 1 - - - - - - - - ERMINE ROAD 1 1 - - - - - - - - FARLEY ROAD 1 1 - - - - - - 1 1 FELDAY ROAD 2 2 - - - - - - - - FERNBROOK ROAD .3 2 - - - - - - - - GEORGE LANE 1 1 — — — — 1 1 2 2 GILMORE ROAD - - - - - - 1 1 1 1 GLADIATOR STREET 1 1 - - - - - - - - 80  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 GLENFARG ROAD - - - - - - - - 2 2 GLENVIEW ROAD — — — — - - 2 2 — — GLENWOOD ROAD — - — —. - - 1 1 — — HAFTON ROAD — — 1 1 - - - - - — HALESWORTH ROAD l 1 - - - - - - - - HARVARD ROAD — — — — - - 1 1 — — HAWSTEAD ROAD 4 l - - - - - - - - HAZELBANK ROAD 1 i 2 2 - - - - - - HAZELDON ROAD - - - - - - 1 1 - - HIGH STREET, LEWI SHAM 2 2 - - - - - - 1 1 HITHER GREEN LANE 1 1 2 2 - - 1 1 4 4 HOLBEACH ROAD 1 1 — — - - 1 1 — — HOLDENBY ROAD 3 2 - - - - - - - - HOLLY HEDGE TERRACE - - - - - - 1 1 — - HORTON STREET — — 1 1 - - - — — — HOWSON ROAD 1 1 1 1 - - - — 3 3 JERRARD STREET 1 1 - - - - - - - - KILLEARN ROAD — - 1 1 - - - — — — KNELLER ROAD 6 4 1 1 - - - - - - KNOWLES HILL CRESCENT 1 1 - - - - - - 2 2 LADYWELL PARK 1 1 — — - - 2 2 — — LADYWELL PARK TERRACE - - - - - - 1 1 1 1 LADYWELL ROAD 4 2 - - - - - - - - LALEHAM ROAD — — 1 1 - - - - - - LEAHURST ROAD 1 1 - - - - - - - - LEATHWELL ROAD - - - - - - i 1 1 1 LEWIS GROVE 1 1 - - - - - - - — LEWISHAM PARK 2 2 - - - - - - - - LEWISHAM INFIRMARY 1 1 - - - - - - - - LEWISHAM WORKHOUSE ... 9 1 1 1 - - i 1 — — LIMES GROVE 1 1 - - - - - - - - LITTLEWOOD - - - - - - - - 1 1 LOAMPIT HILL 3 2 1 1 - - i 1 — — LOAMPIT VALE 1 1 - - - - 3 3 2 2 81  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 longhurst road 3 2 - - - - - - - - mallett road — — l l — — — — - - malyon's road- 1 1 l l — — — — l l manor lane 1 1 - - - - - - - - marnock road 1 1 l l - - - - - - marsala road 8 7 - - - - - - 1 1 mercia grove - - - - - - - - 1 1 merritt road 4 2 3 2 - - - - - - mill road — — 1 1 — — l l l l minard road 3 3 - - - - - - 3 3 montague avenue - - - - - - - - 1 1 MONTPELIER VALE — — 1 1 — — — — — - morena street l 1 - - - - - - - - mount pleasant road — — 1 1 — — — — — - nelgarde road - - - - - - 1 1 — — overcliff road l 1 1 1 l 1 —- - — - paragon mews 1 1 1 1 - - - - - - paragon road l 1 - - - - - - - - park hospital staff 7 1 7 1 - - - - - - pascoe road - - - - - - - - 1 1 phŒbeth street 1 1 - - - - - - - - plassy road - - - - - - - - 1 1 queen street - - - - - - - - 1 1 radford road 2 2 - - - - - - - - railway terrace - - - - - - - - 1 1 rathfern road 1 1 - - - - - - - - rhyme road 1 1 — - 1 1 — - - - ringstead road 1 1 — - — — 2 2 - - romer place 1 1 - - - - - - - - rusHey green 1 1 — - — — 1 1 1 1 st. fillans road 1 1 - - - - - - 1 1 ST. MARGARET'S ROAD 1 1 - - - - - - - - sandhurst road 2 2 — - — — 1 1 — - sandrock road 2 1 — - — — 1 1 1 1 82  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 SANGLEY ROAD 2 2 - - - - - - - - SHELL ROAD — - - - - - l l - - SHORNDEAN STREET - - - - - - - - l l SHRUBBERY ROAD — — — — — — l l — — SILVERMERE ROAD 2 2 2 2 - - - - - - SLAITHWAITE ROAD 1 1 - - - - - - l l SPARTA STREET 2 2 — — — — 2 2 — — SPRINGBANK ROAD 4 4 - - - - - - l l SPRINGFIELD P'K CRESCENT 1 1 - - - - - - - - STILLNESS ROAD — — — — l l — — — — STONDON PARK — — — — — — — — l l THORNFORD ROAD - - - - - - - - l 1 TRESSILLIAN ROAD — — 1 1 — — — — — — TYRWHITT ROAD — — — — 2 2 — — — — VICAR'S HILL — — 1 1 — — — — — — WELLMEADOW ROAD 3 2 - - - — - - - - WEMYSS ROAD — — 1 1 — — — — — — WESTDOWN ROAD - - - - - - - - l l WHITBREAD ROAD 3 2 - - - - - - - - WHITBURN ROAD — — 1 1 — — — — — — WILDFELL ROAD - - - - - - - - l l WILLOW WALK 1 1 - - - - - - - - WOODLANDS, THE - - - - - - - - l l WOODLANDS STREET - - - - - - - - l l SYDENHAM AND FOREST HILL DIVISION. ACACIA ROAD - - - - - - - - l l ACKROYD ROAD — — — — — — 1 1 — — ADAMSRILL ROAD - - - - - - 1 1 l l BEADNELL ROAD — — 1 1 — — — — — — BELL GREEN 1 1 i 1 - - - - 1 1 83  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 BOVILL ROAD - - - - - - - - l l BRADFORD ROAD — — — — — — l l l l BROCKLEY PARK l l — — — — — — — — BROCKLEY RISE l l 2 l — — 2 l — — BROSELEY GROVE 2 l 1 l - - - - - - CHARLEVILLE CIRCUS — — 1 l - - - - - - CLYDE TERRACE — — — — — — 1 l — — COMO ROAD 1 l - - - - - - - - DALLAS ROAD — — 3 2 — — — — — — DALMAIN ROAD 3 3 4 2 — — 3 3 3 3 DARTMOUTH ROAD — — 1 1 — — — — — — DEVONSHIRE ROAD — — — — l l 2 2 — — DILLWYN ROAD 1 1 — — — — 2 2 — — EBSWORTH STREET — — 1 1 — — — — — — F.LDERTON ROAD - - - - - - - - 1 1 ELSINORE ROAD 2 2 - - - - - - - - EWART ROAD — — 1 1 — — 2 2 1 1 FAIRLAWN PARK 2 2 - - - - - - - - FIR STREET 1 1 — — l l — — — — FRANSFIELD GROVE 2 1 - - - - - - - - GABRIEL STREET — — — — l l — — — — GARTHORNE ROAD 1 1 - - - - - - - - GRAFTON ROAD 1 1 - - - - - - 2 2 HANOVER STREET — — 1 1 — — — — 1 1 HASELTINE ROAD 1 1 - - - - - - 1 1 HELVETIA STREET — — 1 1 - - - - - - HIGH STREET 1 1 — — — — 1 1 — — HIGHCLERE STREET 2 1 - - - - - - - - HILLCREST ROAD - - - - - - - - 1 1 HILLMORE GROVE 1 1 - - - - - - - - HINDSLEY PLACE 1 1 - - - - - - - - HOMECROFT ROAD — — - — — — — — 1 1 HOME FOR SICK CHILDREN 14 1 — — — - - — — — HONOR OAK ROAD 2 1 - - - - - - - - 84  Scarlet Fever Diphtheria Enteric Fever Eryipelas 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 hurstbourne road 1 1 - - - - - - 1 1 jews' walk 1 1 - - - - - - - - kangley bridge road - - - - - - 1 1 - - kent house road 1 1 - - - - - - - - kilmorie road - - 1 1 - - - - - - kirkdale 1 1 i 1 - - 1 1 - - kirtley road - - - - 1 1 - - - - knighton park road 1 1 - - - - - - - - lawrie park 1 1 2 1 - - - - - - lessing street 1 1 - - - - - - - - london road - — — — — - 1 1 1 1 lowther hill - - - - - - - - 1 1 lutwyche road 1 1 — — — - — — 1 1 maddin road 1 1 - - - - - - - - malham road 3 3 — — — - 1 1 3 3 mayow road 1 1 - - - - - - - - miall road - — 1 1 — - 2 2 - — mount ash road — — 1 1 — - — — — — neuchatel road - 1 - - - - - - - - northwood road 1 1 — — 1 1 — — — — oaksford avenue - — 2 1 — 1 — — 1 1 perry hill — — 1 1 — - — — 1 1 perry rise 1 1 — — 1 1 — — 1 1 perry vale 3 2 - - - - - - - - prospect road 1 1 - - - - - - - - queen's road — — — — 1 1 — — - — queens wood road 2 1 — — - - — — - — relinque road — — — — - - 1 1 - — rockbourne road 1 1 — — - - — — - — rutland road 1 1 - - - - - - - - st. german's road — — 2 1 - - 1 1 - — shipman road 2 1 - - - - - - - - siddons road — — — — - - 1 1 - — southend lane - - - - - - 2 2 - - 85  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 springfield - - - - - - l l l l stanstead road 2 2 - - - - - - l l sunderland road 1 1 - - - - - - l l sydenham park 3 2 - - - - - - - - sydenham rise 1 1 l 1 - - - - - - sydenham road 1 1 — - l l — — l l taylor's lane - - 1 1 — — — — — — trewsbury road - - 2 1 — — — — — — trilby road 1 1 - - - - - - - - upper colfe road 1 1 - - - - - - - - vancouver road 1 1 — - l l l l 1 1 venner road 2 2 - - l 1 — — — — vestris road 2 2 - - - - - - - - vevey street 1 1 - - - - - - - - waldenshaw road - - - - - - - - 1 l watlington grove 3 3 — - - - - - - - wells road - - 3 2 - - — — — — west hill 2 2 - - 1 1 — — — — westwood park 1 1 - - - - - - - - whatman road 1 1 - - - - - - - - willow walk - - - - - - 2 2 — — wiverton road — — 1 1 — — — — — — woodvale - - - - - - 1 1 l l woolstone road — — 1 1 — — — — — — wynell road - - - - - - - - 1 1 PART 3. GENERAL 89 CONFERENCE ON THE PUBLIC HEALTH (LONDON) ACT, 1891. In May, the London County Council convened a conference for the purpose of exchanging views as to the results of experiences gained in the administration of the Public Health (London) Act, 1891, and to discuss any general principles which such experience showed it was desirable to adopt. On the invitation of the London County Council your Council appointed two representatives, Dr. Yisger and Mr. Councillor T. White, in conjunction with the Town Clerk and Medical Officer of Health. Your representatives attended the meetings at the County Hall, Spring Gardens, on the 7th and 8th July, at which the following resolutions were passed. These were submitted to your Council for consideration, the London County Council inviting your observations thereon:— Proposals adopted at Conference on Public Health (London) Act, 1891, and the Committee's decisions thereon. Housing. (1). That inasmuch as many difficulties have arisen in the administration of the bye laws relating to houses let in lodgings in consequence of a rental limit being fixed, it is desirable that there should be no rental limit of exemption, but that the bye-law should be framed so as to apply only to such houses as are registered by the sanitary authority. (2). That inspections should be made during the early hours of the morning at other houses where overcrowding is suspected. Note.—This would entail an amendment to the Public Health (London) Act, 1891. At present visits can only be made between the hours of 6 a.m. and 9 p.m., except by special warrant obtained from a Magistrate authorising entry at any hour of the day or night. An amendment of the Act is therefore advisable, with a view of remedying overcrowding. Agreed. Underground Rooms. That a single angle of light and air to underground dwelling rooms should be adopted. That no underground room not complying with the conditions laid down by Section 96 of the Public Health (London) Act, 1891, should be used for sleeping. Agreed. 90 Water Supply. That a draw-off tap from the rising main and a sink should be provided on every floor of a tenement house. Note.—The above are desirable amendments to the existing powers. Agreed. Factories and Workshops. The Conference agreed on the minimum standard of sanitary conveniences for factories and workshops where females are employed, where males only are employed, and where both males and females are employed. Note.—The standard number of conveniences set out in the report appears to be reasonable. Agreed. Shops. Dr. Visger, who was a delegate from your Council, moved that it was desirable that power should be given to local authorities to inspect the sleeping accommodation in shops where the assistants are boarded in. Note.—This motion was adopted by the Conference, and the power is greatly needed. Agreed. Food. The Conference recommended that the London County Council should obtain powers to make bye-laws to regulate premises where food is prepared for sale, and no premises should be used for this purpose unless certified by the Borough Council to be suitable. Note.—Although the inspection of certain places where food is prepared for sale is often carried out by Borough Councils, they have no power should admittance be refused. The proposal to obtain additional powers is a good one. Agreed. Private Slaughter-houses. That the time has arrived when private slaughter-houses should be abolished in London. The Committee are unable to give any definite opinion on this matter as no proposal is made as to how this abolition is to be effected Registration of Milkshops. The Conference recommend that powers should be given to Borough Councils to refuse registration of premises as milk shops where, in their opinion, the premises are unfit for the purpose. Note.—At present the Borough Councils are bound to register any premises on application, and proceedings can only be taken where premises have not been kept in accordance with the Bye-laws after registration has been made. Agreed. 91 Sale of Milk. Legislation is recommended for the penalising of persons selling filthy milk in London. Agreed. Municipal Milk Depots. It is proposed that powers be obtained to enable Borough Councils at their discretion to provide municipal milk depots. Note.—These powers would be permissive. Agreed. Sale of Food and Drugs Acts. That communications be made to the Local Government Board and the Board of Agriculture, asking them to limit the amount of boracic acid and other preservatives which may be mixed with food, and further, that the warranty sections of the Food and Drugs Acts should be repealed. Note.—The repeal of the warranty sections is most important. Under existing conditions a milk retailer, charged with adulteration, may produce a warranty from his dealer, who, again, may produce a warranty from the farmer. In this Borough there have been several examples of the prejudicial way in which the warranty sections may operate. Agreed. Permanent Shelter Accommodation. The Conference recommend that the word "accommodation," mentioned in Section 60, Sub-Section 4, of the Public Health (London) Act, 1891, should, if and when necessary, include the supply of food. Agreed. Offensive Trades. That the businesses of marine store dealer and fried fish shopkeeper should be added to the list of offensive trades specified in Section 19 of the Public Health (London) Act, 1891. In addition to the above, special recommendations were made by the Conference, some of which apply only to points of administration which are already acted upon in this Borough. Agreed. Disinfection. That it is desirable that disinfection should be carried out by the sanitary authority without the intervention of a contractor. That in all cases disinfection should be carried out to the satisfaction of the Medical Officer of Health. That laundries should be provided in connection with disinfecting stations. That at least one permanent shelter should be provided in each Borough for the accommodation of persons during the disinfection of their homes. Agreed. 92 Phthisis. That the voluntary notification of Phthisis should be made general in London. Note.—There is no objection to the principle, although certain modifications would have to be made. That Sanitary Authorities should disinfect premises in which a person suffering from phthisis has died, or from which such a person has been removed. Note.—This is already carried out in this Borough. That the Metropolitan Asylums Board should make provision for sanatoria for the isolation and treatment of phthisis cases. Agreed. House Refuse. That the method of destruction of house refuse by fire should be universally adopted in London. Note.—This recommendation is rather sweeping, and appears to have been made without due consideration being given to the individual characteristics of the various Boroughs, or to the facilities which Boroughs may have for removing house refuse from their Borough expeditiously and more economically. Not agreed to. Collection of Fish Offal and other Offensive Trade Refuse. That this should be undertaken by the Sanitary Authority at the expense of the producers. Agreed. a Municipal Creches. That powers be given to local authorities to establish Creches. Agreed, provided power is permissive only. Smoke Nuisances. That the provisions of the Public Health Act should apply to Crown Buildings. Agreed. Ambulance Service. That the Metropolitan Asylums Board be empowered to provide ambulances for all cases of illness. Not agreed to. Government Property. That the provisions of the Public Health (London) Act and Sanitary Acts should apply to Government property. Agreed. 93 CONFERENCE re SPREAD OF SMALL-POX BY VAGRANTS. A conference was convened by the London County Council in November, Mr. Pinborn, together with your Town Clerk and Medical Officer of Health being deputed to attend. A long discussion took place as to the danger which was occasioned by the freedom with which persons of the vagrant class were permitted to roam about the country generally. Many resolutions were passed, the chief object of which was to obtain legislation which would provide more effective measures than at present exist for the prevention of the spread of infectious diseases by vagrants. BACTERIOLOGICAL EXAMINATIONS. Facilities are now given for the bacteriological examination, without charge, in cases of suspected Diphtheria, Typhoid Fever and Phthisis. This is a measure which I venture to think will be greatly appreciated by the medical practitioners of the Borough, many of whom have already availed themselves of the assistance offered in the diagnosis of doubtful cases. BACTERIOSCOPIC EXAMINATION OF MILK. In December, 1904, the necessary arrangements were made for the bacterioscopic examination of milk. I regard this as an important measure and one which enables us to make more complete examination of samples we may suspect to be unwholesome. GENERAL SANITARY INSPECTION. A detailed summary of the routine sanitary inspection is set out in Table 28. 94 LEGAL PROCEEDINGS. The following is a summary of Legal Proceedings instituted by order of your Council:— Details of the above are set out in Tables F.G. and I. of the Report of the Public Analyst in Part IV of this Report. Proceedings under the Sale of Food and Drugs and Margarine Acts for offences other than Adulteration:— For selling milk in a highway from a can or receptacle which did not have conspicuously inscribed thereon the name and address of the vendor as required by the provisions of the Sale of Food and Drugs Acts, Wm. D. C., of Forest Hill, Wm. H., of Walworth, and A. P., of Forest Hill, were each fined ten shillings and two shillings costs. For refusing to sell milk to one of the Council's Inspectors, such milk being required for the purpose of Analysis, A. E., of Eddystone Road, Crofton Park, was fined £3 and 12s. 6d. costs. E. M., of Killearn Road, Catford, was fined £1 and 2s. costs for a similar offence. In this case, on the Inspector demanding a sample the vendor threw the contents of his can into the roadway. Proceedings taken for offences under the Public Health (London) Act, 1891, or bye-laws made thereunder: — For permitting houses to be occupied without water certificates J. C., of Lewisham, and H. H., were each fined 10s. and 2s. costs. Adulteration of Food and Drugs. Summonses issued 21 Convictions obtained 18 Fines imposed £83 Costs imposed £16 19s. 6d. 95 For improperly constructing sanitary fittings A. H., of Forest Hill, was fined 10s., and 14s. 6d. costs. For keeping cows in an unlicensed shed at Hither Green W. R. was fined £2 and 23s. costs. For removing fish offal contrary to the London County Council bye-laws, F. B., of Romer Road, Lee, was fined £2 and 2s. costs. For omitting to place name and address of vendor upon ice-cream barrow, T. T., of Church Street, Deptford, was fined 10s. and 2s. costs. Proceedings in High Court against Crystal Palace Gas Company. The proceedings instituted by your Council against the Gas Company for polluting the Rivers Pool and Ravensbourne by permitting to escape therein large quantities of water-gas tar derived from the process of manufacture of water-gas, thereby causing a serious nuisance to the districts through which these rivers flowed, a report of which was inserted in the Annual report for 1903, was heard before Mr. Justice Lawrence in the King's Bench Division of the High Court on the 16th and 17th May, 1904. After the case for the Council was opened and the Borough Surveyor and Mr. Butterfield (the Gas Expert) called, Counsel for the Defendant Company raised a point of law that these rivers were not sources of water supply within the meaning of the Public Health (London) Act, 1891, and after argument the Judge decided this point in favour of the Council. On the following day Counsel for the Company informed the Court that after examination of the culvert the previous evening the defendants admitted the pollution, and he thereupon raised further points of law, all of which were decided by the Judge in favour of the Council, and verdict and judgment were given for the Council for £200 and costs. Counsel for the Company asked 96 for a stay of execution with a view to an appeal, which was granted on the terras of the defendants paying the taxed costs of the action on the usual undertaking of the plaintiffs solicitor to return them in the event of the appeal being successful. On the 24th May the Defendant Company gave notice of Appeal asking that the verdict and judgment might be set aside and judgment entered for the defendants or a new trial granted. Table 23. Houses Examined and Certified under the Customs and Inland ReYenue Act during 1904. Name of Street. Number of Houses. Number of Dwellings. Number of Certificates Granted. Date of Inspection  Adamsrill Road 12 24 24 April 8th Adamsrill Road, Durban Terrace 4 8 8 „ 20th Adamsrill Road, Harefield Villas 6 12 12 „ 20th Adamsrill Road, Kimberley Terrace 15 30 30 „ 20th Como Road 3 6 6 „ 20th Ewart Road 5 10 10 March 26th Mallett Road 5 10 10 May 26th Park Mansions, Sydenham Park Road 3 12 12 March 22th Park Road, Forest Hill 1 4 4 December 30th Rhyme Road 6 17 17 March 9th Sangley Road 16 32 32 „ 22nd Siddons Road 4 8 8 Upper Colfe Road 1 2 2 April 20th Totals 81 175 175 97 Table 24. Water Certificates Granted after inspection in accordance tvith Section 48 of the Public Health (London) Act, 1891, during the years 1903 and 1904. Ward. Number of Water Certificates Granted.  1903 1904 Church 12 Manor 17 41 South 30 25 Lee Division 47 78 Blackheath 5 - Lewisham Village 72 56 Lewisham Park 159 71 Brockley 112 109 Catford 495 270 Lewisham Division 843 506 Forest Hill 199 139 Sydenham 210 176 Sydenham and Forest Hill Division 409 315 Whole Borough 1299 899 98 COMBINED DRAINAGE.—During the year the following combined drains were reported to require alteration and amendment. Notices were served under the Metropolis Management Act upon the respective owners requiring them to alter and amend such combined drains, and to do all necessary works in relation thereto:— 118 to 120, Burnt Ash Hill 18 to 26, Horton Street 92 to 96, High Road, Lee 80 to 40, Darfield Road 4 to 14, Wisteria Road 17 to 31, Bowness Road 1 to 15, Bowness Road 9 to 17, Rowland Grove 47 to 53, Lee Terrace 1 to 9 (inclusive), Brookbank 9 to 21, Kilmorie Road Road 55 to 61, Lee Terrace HOUSE-TO HOUSE INSPECTION.—During the year under review house-to-house inspection was made of 1,209 dwellings, distributed in the following roads and streets:— Ardmere Road, Brightfield Road, Brockley Rise (part), Chaplin Street, Crown Terrace (Bell Green), Dalmain Road, Doggett Road, Elderton Road (part), Ewart Road, Glenview Road, Hindsley Place, Herschell Road (part), Killearn Road, Kirtley Road, Ladywell Park, Malham Road, Mill Road, Morena Street, Nelgarde Road, Porthcawe Road, Seager's Cottages, Stanton Square, Stanton Road and Waterloo Place. The following is a summary of the principal nuisances found:— Defective drains 95 Vent shafts and soil pipes defective 55 Water closets and apparatus defective 170 Insufficient water supply to water closets 142 Defective yard traps, sink wastes, gullies, &c 487 Dirty premises 574 Overcrowding 7 99 Drinking water cisterns defective 173 Defective roofs 221 Damp premises 189 Insufficient floor ventilation 111 Defective yard pavings 235 Offensive accumulations 6 Animals so kept as to cause a nuisance 7 Other minor nuisances 517 Total 2,989 The whole of the above-mentioned defects were remedied on the service of notices, and no summary proceedings were necessary. Five hundred and seventy-four houses were reported to be in an insanitary condition, owing to dirty premises, due to the habits of the tenants, and in order to remedy this condition it is necessary that frequent house-to-house inspection should be made in certain streets situated in the district. It is satisfactory to note that overcrowding was only reported in seven instances. POLLUTION OF THE RIYER RAYENSBOURNE. Admission of Crude Sewage—An inspection was made of the River Ravensbourne on the 16th May, when a serious pollution by crude sewage was discovered at the Mill Pond at Southend and in other parts of the river. Men in the employ of the West Kent Main Sewerage Board were found actually cleaning the main sewer belonging to this Board at a point situated at the bottom of Crab Hill, and close to Ravensbourne Station. The sewage was diverted through a 15-inch storm overflow pipe into the river. 100 A further inspection was made, showing the river to be seriously polluted at various points, evidenced by the collection of large quantities of solid excrement. Several samples of the river water were taken and submitted for analysis, and the nuisance increasing, it became necessary for the Borough Surveyor to immediately cleanse the river from Crab Hill to Bromley. The fact that this Sewage Board were able to cleanse their sewers and discharge solid and other excrement into the river at any time shows the pollution was deliberate, and not due to accidental cause. The existence of facilities for its repetition is a danger to the public health of the district. Your Council drew the attention of the West Kent Main Sewerage Board to the nuisance which had been created, and a request was made that they should, without delay, cut off and abolish all overflows from their sewers into the rivers in this Borough, in order to prevent the recurrence of any pollution or contamination. Your Council was subsequently informed by the Board that precautions had been taken which would prevent the occurrence of the nuisance in future. Notice was served under the Rivers Pollution Act, and your Committee insisted in the abolition of all overflows from the sewer above referred to. This requirement was complied with. ADMISSION OF SEWAGE EFFLUENT.—During the early part of the year 1903 an examination was made of the rivers within the Borough, and their tributaries, and a detailed report of the various sources of pollution found was laid before 101 your Committee. Details of this will be found in the Annual Report of 1903. It may be remembered that one of the principal sources of pollution arose from the discharge of an unsatisfactory effluent from the Croydon Sewage Farm into the River Pool, afterwards finding its way into the Ravensbourne. Most careful observations were made, supplemented by repeated chemical and bacteriological examinations. Your Council made special representations to the Croydon Corporation and the Local Government Board, and were subsequently informed by the Croydon Corporation that they were about to appoint an Engineer for the purpose, amongst other things, of dealing with the Sewage Disposal Works. Your Borough Surveyor accompanied me on another visit to the Sewage Works, when the Engineer explained the nature of the work it was intended to carry out to improve the condition of the effluent. It was estimated that these works would take at least six months to complete. Further samples of water were taken from the rivers, the analytical results showing that the water was still in a most unsatisfactory condition, owing to the continued pollution. In February your Committee directed that the attention of the Local Government Board should again be called to the unsatisfactory condition of the effluent from the Croydon Sewage Farm, requesting them to take the necessary steps to prevent the continuation of the pollution. After this action a Local Government Board enquiry was held in respect of an application by the Croydon Corporation for a Loan of £5,000 for the necessary improvement works, which application was, I believe, sanctioned. Up to the present the works have not been completed, and the pollution still continues. 102 FURTHER POLLUTION OF THE RIVERS POOL AND RAYENSBOURNE BY THE ADMISSION OF WATER-GAS TAR FROM THE CRYSTAL PALACE DISTRICT GAS WORKS. On Saturday, May 21st, four days after judgment was obtained, Inspectors Pidwell and Knappett made an inspection of the river at Catford Bridge at 9.30 a.m. and reported that large quantities of tarry matter emitting an offensive odour were floating on the surface of the river. At 10.30 a.m. I visited Catford Bridge and confirmed the report made to me by the inspectors, a serious pollution being evident at the time of my visit. The inspectors then proceeded to Castlands Lane, where the river was covered with tarry matter, and procured sample of water No. 14 (11.0 a.m.). Mr. Wood, of Catford Hill, was present with the inspectors at Castlands Lane. The inspectors then proceeded to inspect the river at Southend Lane, where the water was free from any tarry matter or odour. Sample of water No. 15 was taken at 11.25 a.m. They afterwards visited the gas-works at 11.40 a.m. and saw Mr. Shoubridge, the engineer, who said that he was glad to see them, and that he was doing his utmost to discover the leakage. He told Mr. Malster, the foreman, to show them what was being done. The company were excavating alongside the oil tank about ten feet from the river. Tar was oozing from the ground. A contractor's pump had been fixed and was being used to remove the tarry matter as it accumulated. This was pumped into the well of the tar separating tank. The company had excavated alongside the wall of the culvert. This also contained tarry matter which was being removed by an ejector to the tar separating tank. Other excavations were in progress. 103 Inspectors Pidwell and Knappett went up the culvert on invitation. They found that the Company had cut away the concrete wall in three places near where the tarry matter was found to be oozing through on former occasions- The company had five screens across the river and men were skimming the tarry matter from the river. While the inspectors had proceeded to the above-mentioned points, I visited the junction of the rivers Ravensbourne and Pool at Catford near the crossing of the railways and saw marked evidence of pollution in the Pool, while the Ravensbourne was perfectly clear. At 2.30 in company with Inspectors Pidwell and Knappett I visited Mr. Wains'1 Mill at Lewisham. I examined the mill pond which I found was badly polluted with tarry matter and emitting an offensive odour; this was particularly noticeable in the mill. We took a sample of water (No. 16). Robinsons' Mill.—At 3.15 p.m., in company with Inspectors Pidwell and Knappett, I visited Robinson's Mill, Lewisham. The river was badly polluted with tarry matter and emitted an offensive odour. The odour was more perceptible in the water wheel house where there was a very strong smell of water-gas tar. George Susans and John Durtnall, workmen, complained of the nauseating smell and said they had frequently to leave the mill in order to get fresh air. A sample of water was taken (No. 17). At 3.45 p.m., in company with Inspectors Knappett and Pidwell, I again visited the rivers Pool and Ravensbourne at their junction at Catford. The Ravensbourne above the junction with the Pool was free from tarry matter and odour. Took sample of mud marked No. 18. The river Pool and its banks were badly polluted with tarry matter. 104 At 4.15 p.m., in company with the inspectors, I visited the river Pool at Castlands Lane. The river and banks were badly polluted with tarry matter. Took sample of mud No. 19. At 4.40 p.m. we visited the river Pool at Southend Lane. The river and banks were free from tarry matter and odour. Took sample of water marked No. 20. Many complaints were received from residents in the neighbourhood of the River. Report on samples of River Water and Mud collected at various points of the river on May 21st and submitted to the Council's expert Chemist for examination with a view of ascertaining if there were contamination from products of Gas Manufacture. All the samples were received sealed and labelled as having been taken on the 21st May, 1904, at the times given. The labels also bore the initials " E. T. P." and " B. A. K." Sample No. 14.— Water from Pool at Castlands Lane. 11 a.m. This water had the odour of water which had been in contact with carburetted watergas tar, and no other distinctive odour. Sample No. 15.—Water, Pool at Southend Lane. 11.25 a.m. This water had the odour common to somewhat dirty river water, and no odour characteristic of any gas product. Sample No. 16.— Water, Ravensbourne, from Wallis' Mill Pond. 2.30 p.m. This water, had, in a very marked degree, the odour of water which had been in contact with carburetted water-gas tar and no other distinctive odour. Sample No. 17.— Water, Ravensbourne, from Robinson's Mill Pond. 3.15 p m. This water had, in a very marked degree, the odour of water which had been in contact with carburetted water-gas tar, and no other distinctive odour. Sample No. 18. —Mud, Ravensbourne, 30 yards above junction of Pool. 3.45 p.m. This mud had the odour common to somewhat dirty river mud, and no odour characteristic of any gas works' product. It contained a few worms, etc., which were alive. There were no signs of the presence of tarry or oily matter in the mud. Sample No. 19.—Mud, Castlands Lane 4.15 p.m. After leaving this sample undisturbed for some hours a layer of water, an inch in depth, was found above the mud, and a slight rotatory movement of the bottle caused tarry matter to rise to the surface and form a layer on the water. This tarry matter was of a brown colour, highly fluid, and resembled carburetted water-gas tar in its behaviour towards the water, and surface of the glass of the bottle. Small black patches were noticeable 105 throughout the mud, in which no worms, etc., either alive or dead, were visible. The sample had the odour in a marked degree of carburetted water-gas tar, and no other distinctive odour The supernatant water and tarry matter were poured off from the mud, and were distilled until oily products ceased to pass over with the steam. There was thus obtained about 15 cubic centimetres of light oils, such as are produced by distillation from carburetted water-gas tar. This quantity of light oils corresponds with a proportion of not less than 4.4 per cent., by volume, of carburetted water-gas tar in the sample of mud. I am of opinion, from the presence of the light oils in quantity and the behaviour of the tarry matter, that the tar found in the sample was carburetted water-gas tar which had been introduced into the mud not more than 48 hours prior to the taking of the sample. General Conclusions My observations on this series of samples of water and mud, having regard to the times and places at which they are stated to have been taken, lead me to the conclusion that, at some time after 4.0 p.m. on 19th May, and probably after 4.0 p.m. on 20th May. but prior to 11.0 a.m. on 21st May, 1904, a large quantity of carburetted water-gas tar passed into the river Pool, at some point between "Southend Lane" and "Castlands Lane." The evidence of smell, substantiated as it is in the case of Sample No. 19 by analytical evidence, is, in my opinion, conclusive as to the presence or absence of carburetted water-gas tar in water or mud, and I have therefore deemed it superfluous for the purpose of this report to make a more exhaustive examination of the samples. W. J. Atkinson Bdtterfield. Further Pollution of Riyers on May 31st, 1904. On Tuesday, May 31st, Inspectors Pidwell and Knappett reported that at 3.10 p.m. they had made an inspection of the river Pool at Castlands Lane and found large quantities of tarry matter on the water emitting a very offensive odour. At 4.10 p.m. I, in company with the Inspectors, visited the junction of the two rivers at Catford. The Pool showed evidence of recent pollution and the Ravensbourne above its junction with the Pool was free from pollution. Took samples of water Nos. 21 and 22. At 4.40 p.m. in company with the Inspectors I visited the river at Castlands Lane. We found the river polluted with tarry matter emitting a very bad odour. Took sample of water No. 23. 106 At 5 p.m. we inspected the river Pool at Southend Lane where it was free from tarry matter and odour. Took sample marked No. 24. The Inspectors are of opinion that the pollution, although considered serious by me, on the occasion of my visit, was much less compared with that they had seen earlier in the afternoon. Notice was sent to the Company. Report on samples of river water collected May 31st, 1904. Inspected with a view of acertaining if there were pollution from products of gas manufacture. All the samples were received sealed, and were reported to me as having been taken on 31st May, 1904, Nos. 21, 22, 23 and 24 between 4 p.m. and 5 p.m.; and No. 25 at 6.15 p.m., at the places named. Sample No. 21.—Water, Ravensbourne, 30yards above junction with Pool.—This water was almost wholly free from smell, and had the colour and appearance of the water of a "clean " river in time of flood. There was no odour characteristic of any gas works product. Sample No. 22.—Water, Pool, 20 yards above junction with river Ravensbourne — This water was turbid and of rather high colour, and had distinctly the odour of water which had been in contact with carburetted water-gas tar. Sample No. 23.— Water, River Pool at Castlands Lane.—This water was similar to No. 22 except that the odour of carburetted water-gas tar was rather less intense. Sample No. 24.—Water, River Pool, Southend Lane.—This water resembled Nos. 22 and 23 in colour and appearance, but had only a faint odour such as is common with river water, and no odour characteristic of any gas works product. Sample No. 25—River Ravensbourne taken in Molesworth Street Depot at a point below the Mid Kent Railway Bridge.—This water was rather less turbid and less highly coloured than Nos. 22, 23 and 24, but more turbid and more highly coloured than No. 21. It had distinctly the odour of water which had been in contact with carburetted water-gas tar. General Conclusions. My observations on this series of samples of water, having regard to the times and places at which they are stated to have been taken lead, one to the conclusion that the water flowing down the river Pool was being brought into intimate contact with carburetted water-gas tar (or conceivably with carburetted water-gas apart from tar) at some point between Southend Lane and Castlands Lane. This tar taints, or imparts its characteristic odour, to over one million times its volume of water, but is virtually insoluble in 107 water. Hence it is not possible, from any samples of water only, to draw any definite conclusion as to the amount of tar with which they have been in contact. W. J. Atkinson Butterfield. June 1st, 1904. As a result of the judgment obtained, and the further evidence of pollution of which the Company received information, they took necessary measures to remedy the nuisance. Important structural works were carried out by the Company in order to prevent the offending products, resulting from the manufacture of water gas, gaining admission to the River Pool as it passes through their works. We have reason to believe that there will be no recurrence of the nuisance. BALLAST FIRES. Complaints were received of a nuisance arising from the burning of clay and earth in Normanton Street. On investigation a serious nuisance was found to exist, which was abated after written notice. SMOKE NUISANCES. The inspector entrusted with this duty made 199 observations during the year. The majority of complaints were in respect of Laundries, 41 ; Flour Mills, 12 ; Bakehouses, 8; and Locomotives, 85. Nuisances of an important character were reported in 25 instances, for which intimation notices were served. In five cases a further nuisance was reported, in regard to which statutory notices were issued, followed in one case by proceedings for an abatement order. 108 HOUSES UNFIT FOR HUMAN HABITATION. Representations were made by me in respect of a dwelling house situated in Riddington's Yard, Lewisham. The premises were permanently closed. HOUSES LET IN LODGINGS. The following premises were added to the register of Houses Let in Lodgings. The occupation of these houses is now regulated by Bye-laws :—335, Stanstead Road ; 47, Molesworth Street; 5, Pascoe Road. DISINFECTION. During the year 1,316 rooms have been disinfected by formalin spray, and 27,567 articles of bedding, clothing, etc., were removed from infected houses to the Council's Disinfecting Station for treatment in the steam disinfector. WORKSHOPS AND WORKROOMS. There are in the Borough 588 workshops, containing 885 workrooms to which the provisions of the Factory and Workshop Act apply. The total number of workers found on inspection amounted to 2333, of which 597 were men, 1326 women, and 410 young persons. The largest proportion of these workers were engaged in the dressmaking, laundry, and millinery trades, there being 1274 women, 302 young persons, and only 14 men, so employed. These premises are inspected by the Woman Sanitary Inspector, together with the workshops employing women in other trades. Only 52 women and 108 young persons were employed in all the other trades, which necessitate the employment of male labour, and at which 583 men were engaged. 109 Domestic Workshops; i.e. private houses, places, or rooms, where no power is used, and in which the only persons employed are members of the same family dwelling there, are, like domestic factories, subject to special regulations with regard to hours of labour, and not subject to the provisions of the Act which relate to meal times, affixing notices, holidays, notices of accidents, keeping a general register, the means of ventilation, thermometers, and the drainage of floors. There are 345 domestic workshops in the Borough. Although registration is not required the premises are visited with a view to remedying any insanitary conditions. A detailed analysis of workshops is set out in Table 25. Statement of Factories, Workplaces and Homeworkers, for the year 1904. Notices Premises. Inspections. served. Factories — — Workshops 814 54 Workplaces 120 29 Homeworkers' Premises 55 18 Total 989 101 Statement of Defects Found. Nuisances under the Public Health (London) Act:— Want of Cleanliness 98 Defective ventilation 1 Overcrowding 1 Other nuisances 45 Sanitary accommodation:— Insufficient — Defective 47 Not separate for sexes 2 Of the total 203 defects found, all were remedied on service of written notice. There were no prosecutions. 110 Overcrowding. Miss Whitworth reported the existence of overcrowding at a workshop in Sydenham. The workshop contained seven rooms in which a large number of women are employed. Of the seven rooms four were overcrowded. In one room, in which 15 workers were permitted, 22 were discovered. The only action possible was to serve an intimation notice under the Public Health (London) Act, and in the event of further evidence of overcrowding to serve a statutory notice, and on a third offence to apply to a magistrate for an order to prohibit the repetition of the offence, a cumbersome method of obtaining a remedy. Insufficient Sanitary Conveniences. Workshops at 76 and 78, Ewart Road, and Kelvin Hall, Kelvin Grove, were found to be without suitable accommodation in the way of sanitary conveniences for the persons employed in or in attendance at such premises. Notices were served, and complied with. 111 Table 25. Workshops and Workrooms on the Register at the end of 1904. 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 158 195 1351 1276 837 - 718 251 104 104 Millinery 24 24 149 143 91 — 67 41 8 8 Laundry 123 314 1396 1293 858 14 489 10 67 67 305 533 2896 2712 1786 14 1274 302 179 179 Tailor 45 49 203 192 130 91 22 10 15 15 Boot 77 78 272 254 171 123 — 16 89 89 Joiner 16 23 523 491 372 57 — 13 1 1 Smith 25 30 370 342 267 66 — 6 5 5 Furrier 3 3 15 13 8 4 2 1 — — Cycles 21 29 213 195 148 36 — 16 6 6 Coachbuilder 10 23 294 279 213 39 — 6 — — Cabinet and Upholsterer 18 25 354 336 248 50 8 9 6 6 Blindmaker 4 6 34 32 31 6 — 4 1 1 Photography 4 13 52 50 32 7 4 1 5 5 Picture- framer 9 10 48 41 32 11 1 6 6 6 Jeweller 15 16 77 67 46 23 — 9 17 17 Piano 2 2 9 9 6 1 — 1 1 1 Saddler 9 11 68 57 44 21 — 3 3 3 Mason 4 5 62 60 43 13 — 2 1 1 Lathrender 3 5 29 24 18 11 — •— — — Various 18 24 150 143 98 24 15 5 10 10 Total 588 885 5669 5296 3693 597 1326 410 345 345 112 Other Matters. Matters notified to H.M. Inspector of Factories Failure to affix Abstract required by Section 133 of the Factory and Workshop Act, 1901 14 Action taken in matters referred by H.M.Inspectors as remediable Notified by H.M.Inspector 4 under the Public Health Acts, but not under the Factory Act (Sec.5).Reports (of action taken) sent to H.M. Inspector 4 Underground Bakehouses (Section 101) :— In use during 1903 23 Certificates granted in 1903 23 „ 1904 — In use at end of 1904 23 Table 26. List of Outworkers. Class of Homework. 1904, Number of Lists received. 1904. Number of Addresses of Outworkers.  Up to Feb. 1st. Up to Aug. 1st. Forwarded to other Authorities. Received from other Authorities. Wearing Apparel— Dress, Blouses No. of Lists. No. of out workers No. of Lists. No. of out workers 12 49 22 33 17 24 Tailoring 20 30 20 30 104 10 Boot 22 64 22 64 16 — Lace 1 1 1 1 — — Cabinet making — — — — — — Fur pulling — — Other 3 4 7 14 — — Total 68 132 67 133 132 59 113 Table 27. Details oj Premises Subject to Registration by the Local Authority or the London County Council. Premises. Number of Places. No. of Inspections 1904. No. of Notices 1904. No. of Prosecutions 1904  On Register at end of 1903. Added in 1904. Removed in 1904. On Register at end 1 of 1904. Milk premises 148 48 44 152 371 30 - Cow sheds 14 2 — 16 138 6 - Slaughter houses 17 — l 16 147 — - Other offensive Trade premises - - - - - - - Ice cream premises - - - - - - - Registered houses Let in Lodgings 15 4 2 17 Weekly 43 - WOMAN SANITARY INSPECTOR. Your Council have during the year made the appointment of the first woman sanitary inspector. Miss Irene Whitworth, B. Sc., London, was appointed to fill the position. She commenced her duties on September 1st, since which time I have had an opportunity of observing her work, which I am pleased to say has been most valuable. The duties assigned to this officer and approved by the Local Government Board are as follows :— The routine inspection of workshops, workplaces, and laundries, where females are employed. The inspection of homes of female outworkers. 114 The examination of sanitary conveniences used by females at railway stations, restaurants, underground, etc. Special investigations in poor districts as to cause of infant mortality. Investigations in regard to homes where female cases of phthisis are known to exist; giving information as to precautions to be taken to prevent the spread of such disease to others. Visiting homes where deaths from phthisis have occurred, and at which cases of infectious disease have been notified. Visiting Schools from which notifications have been received from teachers of the absence of scholars in consequence of the existence of notifiable and non-notifiable infectious diseases, when so directed by the Medical Officer of Health. EPITOME OF WORK OF WOMAN SANITARY INSPECTOR. Phthisis. Thirty-seven homes in which death from phthisis had occurred were visited. Permission was obtained for disinfection by the Sanitary Authority in 25 instances. Miss Whitworth remarks:— "In the majority of the houses I visited the information that consumption was in any way infectious was news to the occupiers; therefore, to persuade disinfection was a difficult task. The difficulties are somewhat enhanced when, after persuading a householder to have disinfection carried out as a protections to others, the family doctor is referred to and asserts it is entirely unnecessary." Measles Homes. Three hundred and seventy-two investigations were made at homes throughout the Borough :— Homes visited and disinfected 195 Disinfection carried out without visit 56 Disinfection carried out by occupiers 75 Existence of Measles denied 46 115 Epidemic Enteritis and Diarrhoea. Homes visited and reports made 68 Homeworkers. Number of names received 24 *Number visited None. Visits to Factories, Workshops, &c., where women are employed. Factories — Workshops 42 Workplaces — Laundries (domestic) 10 „ (workshops) 7 Failure to Affix Abstract found in Ten Gases. Workrooms Overcrowded 7 (5 in one house) Complaints made and notices served 3 (re cleansing) Total Number of Notices Served 27 Notices complied with 25 Nuisances referred to District Inspector 4 *The houses of outworkers were all visited in January, 1905. 116 Table 28. Register of Sanitary Work for the year ended 31st December, 1904 Description of Work Lewisham Sydenham »nd Forest HiU Lee Work shops House to House Mr. J. F. Charlesworth Mr. J. A. K. Cooper Mr. H. King t Mr. R. J. Davis Mr. E. T Pidwell Mr. B. A. Knappett Mr. It. White Mr. J. Daltry Mr. A. H. Gray J Mr. H. L. Hyde Total for Whole Boro.  Complaints by Residents 3 93 86 18 118 127 277 4 58 1 785 Premises inspected 546 589 444 233 884 588 563 1146 916 315 6224 Re-inspections of Works in progress 426 1231 1015 769 1240 1548 1837 776 4057 1093 13992 Intimation Notices served 196 206 224 69 129 148 236 88 531 240 2067 Statutory Notices ordered 54 169 177 24 98 64 219 31 124 140 1100 Statutory Notices served 5 26 73 13 65 47 92 18 75 35 449 Premises repaired, cleansed, &c. 155 80 82 46 69 82 106 111 314 141 1186 Defective Roofs, Stackpipes, &c., remedied 22 39 16 25 38 70 61 31 342 103 747 Drains re-constructed 127 50 14 76 78 89 33 16 483 Drains repaired 23 28 44 13 55 44 94 14 55 6 376 Drains ventilated — 36 8 4 40 11 84 — 7 5 195 Stackpipes, Sinks, Bath Wastes, &c., disconnected from drains 4 113 41 10 44 45 119 1 8 21 406 Gulley Traps provided 6 201 41 23 175 328 227 16 79 23 1119 Water Closets reconstructed 12 91 16 14 128 154 123 13 48 7 606 Water Closets repaired 5 30 43 15 27 31 87 62 36 37 373 Water Closets supplied with water 41 30 14 16 13 2 57 29 119 35 356 Soil Pipes reconstructed 11 48 19 6 42 53 56 5 6 8 254 Soil Pipes repaired and ventilated 18 5 14 2 24 18 35 26 14 19 175 Dustbins provided 26 40 29 32 39 73 35 190 84 553 Water Supply to Houses reinstated 13 8 10 2 14 11 5 - 8 5 76 Cisterns repaired, cleansed or covered 1 22 13 23 79 32 27 12 161 23 393 Water Certificates issued — 155 20 135 84 13 67 171 231 — 876 Premises over-crowded 1 3 - 2 3 4 — 7 3 23 Yards paved 9 38 35 44 34 89 87 24 167 52 579 Removal of offensive accumulations 4 25 43 6 26 27 28 5 5 2 171 Dung Vaults erected or repaired - 4 19 1 3 1 6 3 1 1 39 Animals improperly kept 10 5 4 _ 2 3 2 1 10 1 38 Lodging-houses registered — 1 3 — - — — — 4 Bake-houses visited — 33 2 47 29 48 88 — — 247 Milk-shops visited — 68 10 - 37 37 69 150 — — 371 Cow-sheds visited — 11 38 2 24 12 51 — — — 138 Workshops visited - 2 - - - 611 - 613 Slaughter-houses visited 29 12 48 14 44 - 147 House-to-house inspections 254 - - 48 - - 83 - 543 281 1209 Legal proceedings — 1 1 — 3 1 2 — - - 8 *6 months only. †5 months only. ‡ 4 months woric. 117 COMMUNICATIONS FROM YARIOUS 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 Committee and reported on by your Medical Officer of Health):— "Return " Cases of Infectious Disease. A letter, dated March 17th, from the Poplar Borough Council calling attention to the alleged discharge of patients from the Metropolitan Asylums Board hospitals in a condition liable to convey infection to other persons, and stating that they requested the Metropolitan Asylums Board to take such steps as may be necessary to prevent in future the discharge of patients while in such condition. The Poplar Borough Council enquired whether any cases of infection, or suspected infection, from the premature discharge of patients from hospitals of the Metropolitan Asylums Board had occurred in this Borough, and asked that the matter might be brought to the notice of the Council with a view to pressure being brought to bear upon the Metropolitan Asylums Board to secure the adoption of more adequate precautions against premature discharges and consequent spread of infection. The Committee received a report from the Medical Officer of Health stating that so far as his personal experience went in this Borough, he was of opinion that every care was taken by the officers of the Metropolitan Asylums Board, by careful examination, to prevent the discharge of patients whilst in an infectious condition; that it was true that on one or two occasions there had been a suspicion that new cases had been traced to children returning from hospital, but there had been no direct evidence that the infection was due to discharged 118 cases, or that any carelessness had been permitted by the Medical Officers in charge of the Board's patients, and that this being so it appeared that, as far as this Council were concerned, they had no complaints to lay before the Metropolitan Asylums Board. The Committee, after considering the report of the Medical Officer of Health, directed that the Poplar Borough Council be informed that this Council were not prepared to take any action in the matter. On June 17th your Committee received a letter from the Metropolitan Asylums Board with reference to the circular letter issued by the Poplar Borough Council, as to an alleged premature discharge of a patient from one of the Board's hospitals, and stating that the Board is confident that the most careful judgment is exercised in every case by the Medical Officers whom they have placed in charge of their hospitals, and assuring the Council that they are taking every means rightly to discharge the responsible duties resting upon them, both as regards the patients and the public. Milk. Your Committee received a letter on the 27th August, from the Lambeth Borough Council forwarding a copy of a report by their Medical Officer of Health on the subject of the cleanliness of the milk supplied, and stating that they had passed the following resolutions on the subject:— (1) That the Local Government Board and the Board of Agiculture, be urged to take such steps as will ensure the better enforcement of the Dairies, Cowsheds and Milk Shop Orders, and the Regulations made thereunder, outside the Metropolis. (2) That, in respect of the Metropolis, the Local Government Board, be urged to carry out their statutory 119 powers as laid down in Section 28 of the Public Health (London) Act, 1891. (3) That the attention of the Railway Companies and the large Metropolitan Milk Societies or Organisations be drawn to the present need of more sanitary means of transit and storage of milk. (4) That the Local Government Board be written to, suggesting that all milkshops and milk stores be required, under penalty, to be licensed annually, as is the case, at present with all cowsheds, and that no person or persons, be allowed to sell milk, unless the premises at which such milk is sold and stored have been previously certified as suitable by the Sanitary Authority for the District. The Committee also considered a report by the Medical Officer of Health stating that in his opinion, milk dealers should be compelled to supply the Local Authority with the list of farms in or outside the district, from which their supply is collected, as this would give an opportunity for having the farms visited by the Local Sanitary Authorities within whose districts they are situated in cases where there are good reasons to suspect the cleanliness of such supply. The Committee concurred with the opinion expressed by the Medical Officer of Health, and by the resolutions of the Lambeth Borough Council, and gave directions for the necessary letters to be written to give effect to such opinions. Warranty. Your Committee had under consideration the operation of Section 25 of the Sale of Food and Drugs Act, 1875, as amended by Section 20 of the Sale of Food and Drugs Act, 1899, which sections are known as the Warranty Sections. These enable a person charged with selling an article of food 120 Unclean Milk. to the prejudice of the purchaser to rely upon a warranty under which he may have received the article in question as a defence to proceedings under the Act. The Committee have considered letters received from several of the Metropolitan Borough Councils on the subject, together with reports from the Town Clerk and Medical Officer of Health. The Committee are strongly of opinion that both sections should be repealed, and they accordingly directed that communications to this effect be addressed to the Presidents of the Local Government Board and the Board of Agriculture. Your Committee received a letter, 20th January, from the Islington Borough Council, forwarding copy of a report by their Medical Officer of Health with reference to the uncleanly condition of the milk supplied to London, stating that they had written to the London County Council suggesting that they should apply to Parliament for powers to prevent the introduction into the Metropolis of milk containing sediment of a dirty character, and to enable them to inspect dairies, cowsheds, and cattle from which milk is supplied to the County of London, and asking that this Council will—if they agree with them—address a similar communication to the London County Council. The Committee received a report from the Town Clerk and Medical Officer of Health stating that they are of opinion that the suggested application to the London County Council would not meet the question so well as a representation to the Local Government Board on the desirability of enforcing the existing regulations with regard to dairies and cowsheds in all the country districts of England and Wales, as the Local Government Board are the controlling authority for districts outside London. Your Committee concurred in the view expressed by the Town Clerk and 121 Preservatives in Milk. Bread Act. Medical Officer of Health, and directed that the Islington Borough Council should be so informed. A letter from the Camberwell Borough Council, 30th May, stating that they had addressed a communication to the Local Government Board requesting them to take such steps as may be necessary in order that a limit might be fixed to the amount of boracic acid (free or combined) which may be mixed with food, and asking if this Council approved that they would take similar action. The Committee concur in the views expressed in this letter, and have directed that a similar communication be addressed to the Local Government Board. The Committee considered a report from the Medical Officer of Health in which they were informed that recently a Royal Commission sat to enquire into the subject, and made certain recommendations not only in regard to preservatives but also as to colouring matter used in food, and they are of opinion that effect should be given to the recommendations then arrived at, and have accordingly directed that the Local Government Board should be asked to take the necessary steps in the matter. A letter (10th February), from the London County Council, stating that a Committee of the Council has under consideration the question of the desirableness of the Council seeking fresh legislation for the better protection of the public than is afforded under the existing law as regards the sale of bread; and that it has been suggested that the best course to be adopted would be to endeavour to obtain the repeal of the Act of 3, George IV., Chapter CVI., so far as its operation in the Administrative County of London is concerned, and to get re-enacted in modern language such 122 Amended Bye-law.— of the provisions of that Act as are still valuable in present circumstances; and also to obtain additional provisions to afford the desired increase of protection to the public. The London County Council request that this Council will be good enough to assist them in the matter by informing them whether any of the provisions of the above-mentioned Act are of value in connection with the prevention of adulteration, etc., and should therefore be re-enacted, or whether in view of the powers bestowed by the Sale of Food and Drugs Act, 1875, the provisions of the former Act as regards adulteration have become obsolete and might, with advantage, be repealed. The Medical Officer of Health has reported that in his opinion the Act of 3, George IV., Chapter CVI., has become obsolete and should be repealed as all proceedings for the prevention of adulteration, etc., are taken under the Sale of Food and Drugs Acts, and the Committee directed that the London County Council be so informed. A letter was received on February 27th from the Clerk of the London County Council on the subject of a proposed amendment of Bye-law No. 26, made by the Council under Section 39 (1) of the Public Health (London) Act, 1891, in relation to water closets, earth closets, privies, and receptacles for dung, and forwarding copy of the proposed amended bye-law in order that the Council may make any representations thereon which it may think desirable for the consideration of the London County Council. The proposed alteration in the Bye-law made by the London County Council is necessitated by a decision in the High Court (King's Bench Division) in the case of Nokes & Nokes v. The Islington Borough Council, to the effect that the Bye-law above referred to, made by the London County Council was 123 Trade Refuse. invalid, as it did not provide for notice to be given before action was taken. The proposed amended bye-law was sent to this Council as the sanitary authority for the district pursuant to the provisions of Section 114 of the Public Health (London) Act, 1891. The Committee raised no objection to the same, and directed that the London County Council be so informed. The Committee received a letter 15th April, from the Loudon County Council, stating that with reference to the proposed amendment of the law imposing upon every sanitary authority the duty of collecting and removing from any premises within their District all trade refuse of an offensive nature, they had received replies that a number of the Sanitary Authorities were opposed to the proposal that it should be their duty to collect offensive refuse, and that with a view of meeting these objections the clauses had been re-drafted so as to enable, but not compel, Sanitary Authorities to undertake such collection. The London County Council forward the amended suggested clauses as follows:— The sanitary authority, if they think fit may:— 1. (a) Employ a sufficient number of scavengers, or contract with any scavengers, whether a company or individuals, for collecting and removing at proper periods, of which sufficient notice shall be given, all trade refuse of an offensive or noxious nature from any premises within their district. (b) Where the sanitary authority, in pursuance of the power hereby conferred, has undertaken the collection of such refuse, and such 124 refuse is not removed from any premises in the district at the period so fixed as aforesaid, and the owner or occupier serves on the sanitary authority a written notice requiring removal of such refuse, the sanitary authority shall comply with such notice within 48 hours after that service, exclusive of Sundays and public holidays. If a sanitary authority fail without reasonable cause to comply with such notice, they shall be liable, on conviction by a court of summary jurisdiction, to a fine not exceeding £20. 2. Offensive or noxious trade refuse shall mean all trade refuse in such a condition as to be or to be liable to become offensive or noxious. If any dispute or difference of opinion arises between the owner or occupier and the sanitary authority as to what is to be considered as offensive or noxious trade refuse, a petty sessional court, on complaint made by either party, may by order determine whether the subject matter of dispute is offensive or noxious trade refuse, and the decision of that court shall be final. 3. The owner or occupier of any premises from which such refuse is removed shall pay to the sanitary authority a reasonable sum, either by way of annual payment or in respect of each such removal, and such sum in case of dispute shall be settled by the order of a petty sessional court. The London County Council asked to be informed as early as possible the opinion of this Council with reference 125 Re Small-Pox Contacts. thereto. The Committee resolved that legislation on the lines indicated would be an advantage, and they directed that the London County Council be informed that this Council approve of the suggested clauses as set out above. Your Committee considered a letter from the Clerk, London County Council (17th May), stating that the Public Health Committee of that Council has considered this Council's letter of the 26th November last, together with the letter from the St. Pancras Borough Council asking the Council to insert in its next General Powers Bill a clause embodying Section 42 of the Brighton Corporation Act, 1903, and also providing that any person inhabiting any house in which there had been a case of Small-Pox, who knowingly and wilfully associated with other persons without having his or her clothes disinfected and cleansed should be liable to a fine, and asking whether this Council had considered the question of the payment of compensation to persons who might as the result of action by the Sanitary Authority be prevented from following their employment because they had been exposed to infection from Small-pox or other infectious disease, and whether this Council was of opinion that Sanitary Authorities should be required or empowered to pay such compensation. The Committee considered a report from the Medical Officer of Health on this letter, and directed that the London County Council be informed that in their opinion permissive power should be granted to local authorities to pay fair recompense to any contacts isolated by them at their shelter during the period of incubation. PART 4. REPORT OF PUBLIC ANALYST. REPORT OF THE PUBLIC ANALYST FOR THE YEAR ENDED DECEMBER 31st, 1904. SAMPLES SUBMITTED.—During the period under review 528 samples were submitted to me for analysis. Of this number, 416 were purchased by your Inspectors in conformity with the provisions of the Sale of Food and Drugs Acts. The remaining 112 samples were purchased as test samples, and without declaration to the vendors. . ; ADULTERATED SAMPLES.—Of the 416 official samples submitted, 39, or 9.38 present were, adulterated, compared with 13.5 percent, in the, previous year (1903) and 15 percent, in 1902. This continued decrease in the number of adulterated samples is most satisfactory. TEST SAMPLES.—Of the 112 test samples submitted, 39, or 13.39 per cent., were adulterated. Samples were subsequently purchased in official form, resulting in prosecution in some cases. (See Table I, Nos. 1,044, 1,047 1,146). MILK.—Of the 250 samples submitted, 27, or 10.8 per cent., were adulterated, or below the standard fixed by the Board of Agriculture. This result compares favourably with the two previous years, when the adulterated samples were 17.4l per cent, in 1903, and 20.6 per cent, in 1902. Sunday Samples.—Seventy-two samples were purchase 1 on Sundays, of which only two were adulterated. 130 Samples on Delivery.—Forty-one samples were taken in course of delivery:— Hither Green Railway Station, 3. Catford Bridge Railway Station, 1. Forest Hill Railway Station, 18 (4 adulterated). On delivery to houses at request of householders, 5. On delivery to shops, 4 (2 poor quality). From Public Institutions:— Lewisham Union Workhouse, 7. Park Hospital, 2 (1 adulterated; See Table F., No. 1,191.) Grove Park Workhouse, 1 (adulterated). Dyed Milks.—48.6 percent, of the milks examined were artificially coloured. Sour Milks.—Eight samples were sour when purchased. Analysis showed them to be genuine. Dirty Milks.—Five samples of milk submitted were in a very dirty condition, containing dung and other filth. Preservatives in Milk.—In 20 instances boracic acid, used as a preservative agent, was detected. The quantity present, however, was not considered sufficient to insure conviction. The vendors were cautioned. Formic Aldehyde.—I regret to report that the use of Formic Aldehyde as a preservative has been found to be increasing. It is the most objectionable form of preservative, having injurious effects more particularly upon children and invalids consuming the milk so preserved. Proceedings were taken by your Council in five instances in consequence of the vendors adding Formic Aldehyde as a preservative to milk. 181 The first proceedings were taken in June in regard to samples Nos. 1178, 1184 and 1187. At the first hearing the defendants' solicitor requested that the samples be referred to Somerset House for analysis. The cases were consequently adjourned. The Somerset House certificate confirmed the report of your analyst. The magistrate considered the evidence submitted by your Council and commented strongly upon the decision of the Departmental Committee on Food Preservatives, which Commission after hearing evidence upon the subject, decided that the addition of formic aldehyde to milk was a dangerous practice and recommended that its use should be absolutely prohibited. The magistrate inflicted a fine of £5 and £2 12s. 6d. costs in respect to samples Nos. 1178 and 1187. The summons in regard to No. 1184 was withdrawn in consequence of the bursting of the bottle containing the sample which had been retained by the Inspector. In two other cases the Inspector demanded samples of milk from a vendor in respect of whom we had received complaints. The milk seller evidently recognised the Inspector and stated that he had no pure milk, only skimmed milk, and the samples were purchased, note being made of the declaration. These samples were found to be heavily preserved with formalin. Proceedings were instituted and the defendant fined. The addition of formic aldehyde to milk is a most dangerous practice if only by reason of the hardening effect it has upon the proteid material, making the digestion of the milk more difficult. The continued consumption of milk so preserved might easily lead to gastric and intestinal troubles in infants fed upon it. Warranty.—In regard to samples Nos. 1191 and 1251 your Council ordered proceedings. After the summonses were 132 issued notices of warranty were given by the defendants and the actions were dismissed by the magistrate Your Council considered the advisability of proceeding against the farmers giving the warranties. Your solicitor advised however, that there was little chance of a successful conviction. Further proceedings therefore were not instituted. BUTTER.—One hundred and sixty-six samples of butter, were submitted, of which 65 were test samples. Of the 101 samples submitted officially 7, or 6.93 per cent., were adulterated. The practice of colouring even genuine butters by azo dye continues to increase VARIOUS ARTICLES.—Various articles were submitted, (See Table A). The list includes cocoa, lard, bread, sugar, condiments, preserved foods, wines and spirits and drugs. These articles were genuine, except one sample of cocoa and one sample of sherry. PEPPERMINT LOZENGES. — A medical practitioner suspected poisoning from eating peppermint lozenges. Samples were purchased which on analysis showed that they were free from all poisonous materials. 138 Showing number of Samples submitted for Analysis, with Results for the year ended December 81st, 1904. (a) Samples taken officially and in accordance with the provisions of the Sale of Food and Drugs Acts. Total. Genuine. Adulterated. Percentage Adulterated. Milk 250 223 27 10.80 Skimmed Milk (declared) 7 6 1 14.29 Condensed Milk 1 1 — Butter 101 94 7 6.93 Coffee 16 14 2 15.00 Mixture of Coffee and Chicory (declared) 1 1 Cocoa 5 4 1 20.00 Lard 1 1 — — Margarine (declared) 1 1 — — Bread 2 2 — — Demerara Sugar 1 1 — — Mustard 4 4 — — Pepper 2 2 — — Preserved Peas 1 1 (free from poisonous metals) Beer 1 1 (free from poisonous metals) Whiskey 8 3 — — Rum 3 3 — — Gin 3 3 — — Sherry 1 — 1 100.00 Orange Wine 1 1 — — Quinine Wine 1 1 — — Lime Water 4 4 — — Olive Oil* 3 *2 — Tincture of Iodine 1 1 — — Compound Tincture of Bark 1 1 – – Peppermint Lozenges 1 1 (absence of poisons) Total official samples 416 376 39 9.38 (b) Samples purchased without the formalities of the Act. Butter 65 60 5 7.69 Coffee 41 31 10 24.39 Mixture of Coffee and Chicory (declared) 1 1 – – Flour 1 1 — — Mustard 1 1 — — Preserved Pears 1 1 (free from poisonous metals) Ox Tail Soup 1 1 (free from deleterious substances) Golden Crystals 1 1 (dyed crystals) Total " test" samples 112 97 15 13 39 Total all samples 528 473 51 10 23 *Note.—One Sample of Olive Oil was rancid, interfering with analysis 134 Table B. Summary of Samples Analysed in the Borough in each Year, 1898-1904 (inclusive). Year No. of Samples Genuine Adulterated Percentage Adulterated No. of Prosecutions Fines and Costs imposed 1898 Total Samples 36 31 5 13.88 2 Fines £3, costs 15s. 6d. 1899 Total Samples 41 37 4 9.75 1 Fines £5, costs 14s. 6d. 1900 Total Samples 68 61 7 10.29 7 Fines £14 15s., costs £2 13s. 6d. 1901 Total Samples 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 1904 Milk 257 416 376 39 9.38 26 Fines £88 10s , costs £18. Butter 101 Coffee 17 Wines & Spirits 11 Drugs 7 Sundries 23 135 Table C. Showing results of Total Samples submitted during the years 1902-3-4. Quarter. No. of Samples. Adulterated. Percentage Adulterated. 1902 1903 1904 1902 1903 1904 1902 1903 1904 First 115 111 114 27 12 16 23.48 10.81 14.04 Second 167 72 67 22 4 12 13.17 5.55 18.90 Third 108 152 123 14 30 7 12.96 19.74 5.69 Fourth 68 116 112 6 15 4 8.82 12.93 3.57 Total for Year 458 451 416 69 61 39 15.07 13.53 9.38 Table D. Showing results of Total Samples of Milk submitted during the years 1902-3-4. Quarter. No. of Samples Adulterated. Percentage Adulterated. 1902 1903 1904 1902 1903 1904 1902 1903 1904 First 60 70 58 15 11 9 25.00 15.71 15.52 Second 70 31 48 15 1 10 21.43 3.23 20.83 Third 54 124 91 12 30 6 22.22 24.19 6.59 Fourth 44 45 53 5 5 2 11.36 11.11 3.77 Total for Year 228 270 250 47 47 27 20.61 17.41 10.80 136 Table E. Average Composition of Milk Samples submitted in 1904. Period. 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 fat. First Quarter 3.65 8.62 3.72 8.74 3.0 8.5 Second „ 3.38 8.67 3.48 8.72 Third „ 3.63 8.67 3.65 8*70 Fourth „ 3.85 8.81 3.88 8.83 Total for Year 3.63 8.69 3.69 8.74 137 Table F. Details of Adulterated Samples of Milk for the year ended December 31s£, 1904. No. Adulteration. Remarks. 938 B.L. 5 per cent. of added water* 943 S.F. 3 per cent. of added water* 955 L. 13 per cent of added water Fined £6, 15s. costs. 975 B.L. 3 7 per cent. of added water 976 B.L. 5 per cent. of added water 987 L. 8 per cent. of added water Fined £4. 12s. 6d. costs 995 B.L. 3 per cent. of added water See 1231 B.L. & 1251 B.L. (same vendor.) 1049B.L 1 per cent .of added water 1112 B.L. 10 per cent. of added water Fined £2, 12s 6d. costs 1119 S F. 4 per cent. added water 1142 B.L. 2 per cent. of added water 1154 S.F. 28 per cent. deficient in milk fat, Fined £5, £2 12s. 6d. costs 1155 S.F. 5 per cent.deficient in milk fat, Purchased same day as 1151 S.F. irom same vendor. 1157 S.F. 5 per cent. deficient in milk fat. 1173 L. 2 per cent. of added water (See No. 1195 L., same vendor.) 1191 B.L. 15 per cent. deficient in milk fat, Summons dismissed, the vendor producing a warranty. 1192 L. 3 per cent. of added water 1193 L. 2 per cent. of added water 1195 L. 2 per cent. of added water 1231 B.L. 4 5 per cent. of added water Further sample purchased, (see 1251 B.L ) 1232 S.F. 4.5 per cent. of added water No action, these two samples being taken on delivery by request. 1233 S.F. 4.5 per cent. of added water 1248 B.L. 1 per cent. of added water 1251 B.L. 6 per cent. of added water Summons dismissed, the vendor producing a warranty. 1267 B.L. 25 per cent. of added water Fined £10, 12s. 6d. costs 1331 L. 8 per cent. of added water 1365 L. 10 per cent. deficient in milk fat Fined £3, 12s. 6d. costs. 1352 S.F. Declared skimmed milk when purchased, 3 per cent. added water. The letters "B.L.," "S.F," 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 Forest Hill, and "L " Dee Division. * Samples taken on Sunday. 138 Table G. Samples in which Formalin was used as a Preservative. No. Adulteration. Result. 1178 L. Milk containing not less than one part Formic Aldehyde in every 100,000 parts milk Fined £5, £2 12s. 6d. costs 1184 L. Milk Ditto Summons withdrawn; bottle bursting 1187 L. Milk „ Fined £5, £2 12s. 6d. costs 1199 S.F. Milk containing traces of Formic Aldehyde No action 1216 B.L. Skimmed milk containing not less than three parts Formic Aldehyde in every 100,000 parts milk The vendor of these two samples was fined £1, and 12s. 6d. costs in the first case, and 2p. costs in respect of the second offence 1229 B.L. Skimmed Milk containing not less than five parts Formic Aldehyde in every 100,000 parts milk Table H. Showing the number of samples of Butter submitted in the Four Quarters of the years 1902-3-4. Quarter. No. of Samples. Adulterated. Percentage Adulterated. 1902 1903 1904 1902 1903 1904 1902 1903 1904 First 44 22 35 9 — 5 2045 — 14 29 Second 63 13 9 4 — 1 6 35 — 1111 Third 26 15 22 1 — 1 3 85 — 4 55 Fourth 16 26 35 1 2 — 6 25 7 69 — Total for year 149 76 101 15 2 7 1007 2 63 6-93 139 Table I. Details of Adulterated Samples of Butter for the Year ended December 31sf, 1904. No. Adulteration. Result. 959 S.F. 92 per cent. of foreign fat Fined £3, 12s. 6d. costs 964 B.L. 35 per cent. of foreign fat Fined £5, 15s. costs 967 B.L. 5 per cent. of foreign fat 1044 B.L. 33 par cent. of foreign fat Fined £10, 12s. 6d. costs 1047 B.L. 32 per cent. of foreign fat Fined £10, 12s. 6d. costs 1203 S.F. 20 per cent. of foreign fat Fined £4, 12s. 6d. costs 1329 S.F. 85 per cent. of foreign fat Fined £5, 12s. 6d. costs Details of Other Samples Adulterated during the year ended December 31st, 1904. No. Article. Adulteration. Result. 972 L. Coffee 16 5 per cent. added chicory Fined £2, 12s. 6d. costs 1146 B.L. Coffee 8 per cent. added Chicory 965 L. Cocoa 25 per cent. added Sugar & Fined £3, 12s. 6d. costs 1358 B.L. Sherry 9 per cent. added Starch 4 per cent. deficient in Ethyl Hydroxide Other Prosecutions taken under The Sale of Food & Drugs Acts. No. Offence. Result. 74 W.D.C. No name on milk can Fined 10s., 2s. costs 75 W.H. Mo name on milk can Fined 10s., 2s. costs 77 A . P. No name on milk can Fined 10s., 2s. costs 80 A.E. Refused to sell milk to Inspector Fined £3, 12s. 6d. costs 102 E.M. Refused to sell milk to Inspector Fined £1, 2s. costs APPENDIX. LOCAL GOVERNMENT BOARD TABLES. v. 143 Table A. Vital Statistics of Whole District during the Years 1901-4. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non-residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District at all Ages belonging to the District. Number. Rate.* Under 1 Year of Age At all Ages. Number. Rate.* Number. Rate per 1000 Births registered. Number. Rate.* 1 2 3 4 9 6 7 8 9 10 11 12 13 1901 128480 3320 25.9 426 128 1875 14.5 613 289 82 1668 13 .0 1902 132432 3491 26.3 438 125 1942 13.9 568 241 117 1818 13.7 1903 136405 3563 26.1 330 93 1566 11.6 480 152 99 1513 11 .1 1904 140401 3589 25.6 448 125 1799 12.8 542 210 90 1679 12.0 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 at 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; Bermondsey (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 Road ; All Saints' Boys Orphanage, Lewisham. Other Institutions.—The deaths of residents which have been distributed among the several localities in the District: Brook Hospital, Guy's Hospital, St. Thomas' Hospital, Miller Hospital, Greenwich, Evelina Hospital, University College Hospital, Westminster Hospital, Belgrave Children's Hospital Kennington. 144 Bolingbroke Hospital, Battersea, Cancer Hospital, Chelsea, Central London Throat and Ear Hospital, Charing Cross Hospital, Children's Hospital, Great Ormonde Street, King's College Hospital, London Hospital, London Temperance Hospital, Orthopœdic Hospital, Hatton Gardens, St. George's Hospital, Dartford (London County) Asylum, Cane Hill Asylum, Banstead Asylum, Caterham Asylum, Camberwell House Asylum, Darenth Imbecile Asylum, Horton Asylum, Epsom, Colney Hatch Asylum, Friern Barnet Asylum, Ilford Asylum, Tooting Bee Asylum, Bermondsey Infirmary, Epileptic Colony, Epsom, Islington Infirmary, St Luke's House (14, Pembridge Square), St. Peter's Home (Kilburn), and Salvation Army Maternity Home (Hackney). Other deaths of residents of this district occurred in the the River Thames (Charlton), Great Western Hotel, Birmingham, Artillery Mansions, Westminster, London County Council Electric Generating Station, Greenwich, Euston (L.N.W.B.) Station, East Dulwich Railway Station, Earl's Court District Railway, Railway Station, Woolwich Arsenal, Female Protection Society (157, Marylebone Road), and 9, Whitehall Place. Table B. Vital Statistics of Separate Localities in the Years 1901-4 Names of Localities. LEE. LEWISHAM. SYDENHAM & FOREST HILL. WHOLE BOROUGH. Year. Population estimated to middle of each Year. Births registered. Deaths at all ages. Deaths under 1 year. | Population estimated to middle of each Year. Births registered. Deaths at all ages. Deaths under 1 Year. Population estimated to! middle of each year. Births registered. Deaths at all ages. Deaths under 1 Year Population estimated to middle of each year. Births registered. Deaths at all ages. 1 Deaths under 1 year. 1901 18703 398 255 – 66631 1882 856 – 43146 1040 557 — 128480 3320 1668 — 1902 18925 481 220 37 69672 1857 991 261 43835 1153 607 130 132432 3491 1818 428 1903 19147 486 213 37 72731 1979 816 203 44527 1098 484 88 136405 3563 1513 328 1904 19370 469 193 40 75808 1967 941 265 45223 1153 545 135 140401 3589 1679 440 Note:—Figures for years prior to 1901 are unobtainable. 145 Table C. Cases of Infectious Disease Notified during the Year 1904. Notifiable Disease. Cases notified in whole district. Total Cases Notified in each Locality at all Ages. No. of Cases Removed to Hospital from each Locality. At all Ages At Ages—Years. Lee. Lewisham. Sydenham and Forest Hill. Lee. Lewisham. Sydenham and Forest Hill. Under 1 1 to 5. 5 to 15 15 to 25 25 to 65 65 and upwards Small-Pox — — — — — — — — — — — — — Cholera — — — — — — — — — — — — — Diphtheria Membranous croup 117 3 37 43 17 17 — 13 65 39 7 45 29 Erysipelas 82 1 3 12 4 52 10 3 47 32 1 4 1 Scarlet fever 322 2 91 190 29 10 — 37 196 89 26 153 73 Typhus fever — — — — — — — — — — — — — Enteric fever 23 — 3 6 8 6 — 2 10 11 — 4 5 Relapsing fever — — — — — — — — — — — — — Continued fever — — — — — — — — — — — — — Puerperal fever 8 — — — 2 6 — 1 4 3 1 — — Plague — — — — — — — — — — — — — *Chicken-Pox 339 34 125 171 6 3 — 18 196 125 — — — Totals 891 40 259 422 66 94 10 74 518 299 35 206 108 * Notifiable for seven months (April 8th to November 8th). 146 Table D. Causes of, and Ages at, Death during the Year 1904 Cadses of Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in cr 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 23 6 17 — — — — — 7 16 7 Scarlet fever 7 — 6 1 — — — 1 5 1 45 Whooping-cough 88 23 14 1 — — — 3 32 3 1 Diptheria and membranous croup 13 — 7 5 1 — — 2 7 4 53 Croup 2 — 2 — — — — — — 2 — Fever Typhus — — — — — — — — — — — Enteric 2 — — — — 2 — 1 — 1 13 Other continued — — — — — — — — — — — Epidemic influenza 14 1 3 — 1 6 3 2 7 5 — Cholera — — — — — — — — — — — Plague — — — — — — — — — — — Diarrhœa 114 103 7 — — 3 1 6 72 36 31 Enteritis 14 10 2 — — 1 1 — 9 5 1 Puerperal fever 5 — — — 2 3 — 1 2 2 1 Erysipelas 3 1 — — — — 2 — 1 2 1 Other septic diseases 10 — 2 — 3 4 1 1 7 2 7 Phthisis 118 — 1 3 31 73 10 14 70 34 32 Other tubercular diseases. 51 14 21 5 3 8 — 9 24 18 22 Cancer, malignant disease. 115 — — 1 — 67 47 15 53 47 28 Bronchitis 127 26 6 — — 17 78 17 68 42 37 Pneumonia 109 37 18 3 5 24 22 8 77 24 22 Pleurisy 4 — 2 — — 2 — — 3 1 — Other diseases of Respiratory organs. 22 10 3 1 — 5 3 2 9 11 5 Alcoholism Cirrhosis of liver 25 — — — 1 20 4 4 11 10 6 Venereal diseases 1 1 — — — — — — — 1 — Premature birth 73 73 — — — — — 10 37 26 1 Diseases and accidents of parturition. 8 — — — 1 7 — 2 6 1 3 Heart diseases 219 5 — 4 12 86 112 20 119 80 50 Accidents 34 7 2 2 2 14 7 4 19 11 12 Suicides 8 — — — 1 6 1 — 6 2 2 All other causes 520 123 27 13 22 122 213 71 291 158 162 All causes 1679 440 140 39 85 470 505 193 941 545 542