BOROUGH OF LEWI SHAM. Annual Report on the VITAL STATISTICS & SANITARY CONDITION of the BOROUGH OF LEWI SHAM and REPORT OF THE PUBLIC ANALYST For the Year 1905, BY A. WELLESLEY HARRIS, M.R.C.S., D.P.H., &c. Medical Officer of Health and Public Analyst for the Borough of Lewisham ; Fellow and Member of the Council of the Sanitary Institute ; Fellow of the Epidemiological Society ; 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. 3 BOROUGH OF LEWISHAM. EPITOME OF VITAL STATISTICS, 1905. Area in acres, exclusive of area covered by water 6,991 Enumerated population (Census, 1901) 127,495 Estimated population to the middle of 1905 144,420 Average number of persons per house (Census, 1901) 5.6 Total number of Births registered in the Borough 3,633 Birth Rate per 1,000 estimated population 25.2 Total number of Deaths registered in the Borough ... 1,804 Total number of Deaths of residents of the Borough, after correction for non-residents dying in Public Institutions, and residents dying outside the District 1,691 Deaths of persons under 1 year of age 338 Infantile Death Rate per 1,000 Births registered 93 Total number of Deaths in Public Institutions in the Borough 569 Deaths of non-residents in the Borough 232 Deaths of residents outside the Borough 119 Corrected Death Rate per 1,000 of the estimated population 11.7 5 To the Mayor, Aldermen, and Councillors oj the Metropolitan Borough of Leivisham. 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, 1905, in compliance with the order of the Local Government Board. The vital statistics contained herein show that Lewisham holds a high position compared with the other Metropolitan Boroughs and the 76 Great Towns. The corrected Death-rate for the year was 11.7 for every 1,000 persons living in the Borough, compared with 12.0 for 1904. This rate compares most favourably with the Deathrate of 15.1 for the County of London, and 15.7 for the 76 Great Towns. Comparing the Death-rate with that for the other Metropolitan Boroughs, Lewisham has the second lowest. In addition to the general Death-rate, it is interesting, as evidence of the healthiness of the Borough, to examine the statistics relating to Infantile Mortality, Zymotic Diseases, and Phthisis. The infantile mortality, calculated upon the number of deaths of children under one year of age to every 1,000 births, was 93, and was the third lowest rate recorded in London. It is considerably below the average for England and Wales, which amounted to 128 per 1,000, the 76 Great Towns with a record of 140 per 1,000, and the County of London, with 129 per 1,000. 6 Table E, which is an additional table inserted in the Appendix by direction of the Local Government Board, gives interesting details of the causes of mortality among infants. Special efforts have been made during the year to educate parents in regard to measures which should have the effect of considerably reducing the infantile mortality, more particularly when caused by diseases which are usually due to ignorance in feeding, and are therefore preventable. Zymotic Diseases.—Notwithstanding the fact that the number of cases notified during the year was larger than in the previous year, the mortality was considerably lower, showing that the disease was less severe in character. The zymotic death-rate for the period under review amounted to 0*83 jier 1,000, compared with 1'40 in 1904. This rate compares most favourably with that for the County of London, 1*70 ; England and Wales, 152 ; and the 76 great towns, 1'88. Phthisis.—The death-rate from phthisis amounted to 0.87 per 1,000, and was the lowest but one in the County of London ; Hampstead being the lowest with 0.83 per 1,000. Notifiable Infectious Diseases.- The number of cases notified during the year was greater than that for the preceding year, the attack rate from all infectious diseases amounting to 5.88 per 1,000, compared with 3.93 in 1904. This increase is chiefly due to the larger number of cases of Scarlet Fever which were notified. Seventy per cent, of the patients were removed to Hospital for isolation, and 7.62 per cent. of this number were returned as not suffering from any infectious disease. In 1904 the percentage of erroneous diagnosis was 9.35. In January we were threatened with an outbreak of Small-pox, in consequence of the non-notification of cases in Mill Road, Lewisham. Fortunately we were able to obtain control over the whole of the contacts. 7 Infant Life Protection.—I have referred in the report to the necessity of an amendment of the provisions of " The Infant Life Protection Act, 1897." The controlling authority under this Act for the County of London (the City excepted) is the London County Council, the work being deputed to the Public Control Department. From the facts which come to our knowledge, I am of opinion that it would be a great advantage if the Borough Councils were entrusted with the execution of the powers conferred by the Act, which requires modification in order that it may also apply to persons who receive for gain for a period of more than 48 hours one child only. During the year 1905 an additional Woman Sanitary Inspector was appointed by your Council. I have much pleasure in stating that the work of the Women Inspectors has been exceedingly valuable to the Department, and greatly appreciated by the public. In conclusion I desire to exjjress my appreciation of the valuable assistance which I have received from the whole of the Staff of the Health Department. I remain, Gentlemen, Your obedient Servant, awellesley Harrui Medical Officer of Health and Public Analyst. March, 1906. CONTENTS. Page Accidents, deaths due to 38 Bacterioscopic Examinations 78 Births 17 ,, illegitimate 18 ! ,, registration of 33 Birth Rates 17 Butter, house-to-house sale 110 „ colouring matter 110 „ samples submitted 110 Cancer, deaths from 37 Cerebro-Spinal Meningitis 77 Circulatory diseases, deaths from 37 Combined drainage 89 Constitutional diseases, deaths from 38 Customs and Inland Revenue Acts, houses examined 90 Deaths, ages at 22 ,, causes of 47 „ effects of season 23 ,, in disease groups 35 Death rate, all causes 20 ,, comparison with other boroughs 45 & 46 ,, in wards and divisions 42 ,, zymotic 34 Diarrhoea epidemic, deaths from 36 ,, leaflet on 131 Digestive diseases, deaths from 38 Diphtheria, deaths from 35 ,, notification of 66 Disinfection 93 Enteric fever, deaths from 36 ,, notification of 67 Factory and workshop inspection 108 Food analysis, samples submitted 107 ., storage of, in home 33 ,, preservatives in 112 ,, supply, warranty clauses 111 ,, unsound 86 Houses let in lodgings 88 House-to-house inspection 86 Houses unfit for human habitation 88 Gipsy encampments 89 Infant life protection 31 ,, feeding pamphlet 133 ,, mortality 24-34 ., ,, causes of 25 & 129 „ „ combative measuresadopted 29 ,, ,, street incidence 28 Page Infectious disease— Age period in relation to 52 & 57 Attack rates 58 & 60 Bathing of children ... 76 Notification of 57 Notification by school teachers 75 School closure on account of 71 Legal proceedings 94 Marriage rate 20 Measles 35 & 71 Mid wives and puerperal fever 67 Milk, additional powers required 113 analysis of 108 dirty 110 ,, dried 111 ,, dyed 110 samples on delivery 108 ,, Sunday samples 108 ,, supply, infected 83 ,, warranty clauses 1ll Nervous diseases, deaths from 37 Phthisis, deaths from 36 & 37 Population 16 Public-house urinals 93 Public mortuary 93 Puerperal fever 67 Respiratory diseases, deaths from 38 Rainfall 53 Scarlet fever, deaths from 35 ,, ,, exposure of a patient 76 ,, ,, notification of 65 Schools, registration of private 85 Small-Pox, deaths from 35 ,, outbreak of 61 ,, cholera and plague contacts 77 Smoke nuisance 92 Still births 26 Test samples 107 Underground bakehouse 92 Vital statistics, epitome of 3 Water certificates 91 ,, supply in tenement houses 92 Whooping cough 35&71 Women sanitary inspectors' work 101 Workshops 96 ,, domestic 96 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 1901-5. Table 2.—Population of the Borough in Divisions obtained at the Census, April, 1901. Also the population estimated at the middle of the years 1901-5. Table 3.—Births and Birth Rates for each Division of the Borough for the years 1910-5. Table 4.—Number of Deaths at various Age Periods and their Percentage to corrected Total Deaths during the years 1902-5. Table. 5.—Percentage of Deaths Under One Year of Age to Total Deaths in Wards and Divisions for the years 1902—5. Table 6.—Analysis of Deaths Under One Year of Age during the years 1903-5. Table 7.—Corrected Death Totals and Death Rates for the years 1901-5. Table 8.—Corrected Total Deaths, male and female, from All Causes in Wards occurring during the four quarters of the year 1905. Table 9.—Corrected Death Rates from all Causes in Wards, Divisions and the Whole Borough for the four quarters of the year 1905. Table 10.—Deaths in Disease Groups in the three Divisions and the Whole Borough for the year 1905. Table 11.—Death Rates in Disease Groups in the Wards and Divisions of the Borough for the year 1905. 10 Table 12.—Death Rates of London and Metropolitan Boroughs during the year 1905, 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 1905, before distribution and after distribution of deaths in Public Institutions. Table 14.—Causes of, and Ages at, Deaths in the Borough for the year 1905. 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 1905. 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 1905. Table 18.—Deaths from Principal Zymotic Diseases arranged in Age Groups for the year 1905. Table 19.—Meteorological Table for London for the year 1905. Pakt II. —Infectious Diseases. Table 20.—Showing Cases of Scarlet Fever and Diphtheria at various Age Periods notified during the year 1905. Table 21.—Number of Cases of Infectious Diseases notified in the ten Wards during the year 1905. Table 22.-—Attack Rates from the Principal Infectious Diseases per 1,000 of the population for the Ten Wards and the Whole Borough for the years 1903-5. Table 23.—Attack Rates at All Ages from Small-Pox, Scarlet Fever and Diphtheria in the Metropolitan Boroughs and the County of London for the years 1903-5. 11 Part III.—General. Table 24.—Houses Examined and Certified under the Customs and Inland Revenue Act. Table 25.—Water Certificates Granted. Tables 26.—Details of Inspection of Factories and Workshops and Defects Found. Table 27.—Details of Workshops and Work-places in the Borough. Tables 28 and 29.—Register of Sanitary Work for 1905. Part IV.—Report of Public Analyst. Table A.—Showing Number of Samples submitted for Analysis, with Results, for the year ended December 31st, 1905. Table B.—Summary of Samples Analysed in the Borough in each year, 1898 to 1905 (inclusive). Table C.—Showing Results of Total Samples submitted during the years 1902-5. Table D.—Showing Results of Total Samples of Milk submitted during the years 1902-5. Table E.—Average Composition of Milk Samples submitted in 1905. Table F.—Average Composition of Milk Samples submitted during the years 1902-5. Table G.—Details of Adulterated Samples of Milk for the year ended December 31st, 1905. Table H.—Showing the Number of Samples of Butter submitted in the four quarters of the years 1902-5. Table I.—Details of Adulterated Samples of Butter submitted in 1905. Table J.—Details of Other Adulterated Samples and other Prosecutions during the year 1905. 12 Appendices. I.—Local Government Board Tables. Table A.—Vital Statistics of Whole District during the years 1901-5. Table B.—Vital Statistics of Separate Localities in the years 1901-5. Table C.—Cases of Infectious Disease notified during the year 1905. Table D.—Causes of, and Ages at, Death during the year 1905. Table B.—Detailed analysis of Deaths under one year of age during the year 1905. II.—Copy of oster on Alcoholism and Physical Deterioration issued by Council. III.—Copy of Leaflet on Precautions against Diarrhoea. IV.—Pamphlet on Infant Feeding. Charts. Chart A.—Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhoea, for the 52 weeks ended 31st December, 1905. Chart B.—Showing Percentage of Deaths in Eleven Groups to Total Deaths during 1905. Chart C.—Showing Weekly Notifications of All Infectious Diseases, also Weekly Notifications of Scarlet Fever, and Diphtheria, during the year 1905. PART 1. VITAL STATISTICS. 15 report OF THE Medical Officer of Health FOR THE YEAR 1905. 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 1905, which amounted to 144,420, compared with 140,401 for 1904, an increase in one year of 4,019 personsThe increase in the population by natural increment, i.e., the excess of births over deaths, amounted to 1,829. It may be assumed, therefore, that the difference of 2,190 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 30th, 1905, 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, 1904 and 1905. Ward. Population at Census, Apr., 1901 Population estimated to the middle of 1901. 1902. 1903, 1904. 1905. Church 6412 6434 6522 6611 6700 6790 Manor 6734 6761 6872 6983 7095 7207 South 5503 5508 5531 5553 5575 5597 Lee Division 18649 18703 18925 19147 19370 19594 Blackheath 6729 6735 6759 6784 6807 6830 Lewisham Village 13842 13887 14070 ] 4253 14437 14622 Lewisham Park 11145 11394 12391 13393 14402 15417 Brockley 10952 10984 11114 11245 11377 11510 Catford 23203 23631 25338 27056 28785 30524 Lewisham Div 65871 66b31 69672 72731 75808 78903 Forest Hill 18051 18063 18115 18166 18218 18270 Sydenham 24924 25083 25720 26361 27005 27653 Sydenham and Forest Hill Div. 42975 43146 43835 44527 45223 45923 17 Table 2. Population of the Borough in Divisions, obtained at the Census April, 1901, also population estimated at the middle of the years 1901, 1902, 1903, 1904, and 1905. Divisions. Population at Census, Apr. '01. Population estimated to the middle of 1901. 1902. 1903. 1904. 1905. Lee 18649 18703 18925 19] 47 19370 19594 Lewisham 65871 66631 69672 72731 75808 78903 Sydenham and Forest Hill 42975 43146 43835 44527 45223 45923 Whole Borough 127495 128480 132432 136405 140401 144420 THE BIRTH RATE. The total number of Births registered in the Borough of Lewisham during the year 1905 was 3,633. Of this total 1,828 were males and 1,805 females. The birth rate for Lewisham is therefore 25.2 per 1,000 inhabitants, compared with 25.6 in the previous year. The birth rate for London was 27.1 per thousand, or 1.9 per thousand in excess of this Borough. Of the total births, 454 were registered in the Lee division, 2,027 in Lewisham, and 1,152 in Sydenham and Forest Hill division. The birth rate in Lee was 23.2, in Lewisham 25.7, and in Sydenham and Forest Hill 25.1 per 1,000 of the inhabitants of each division. Declining Birth Rate.—The Annual Summary of the Registrar-General shows that the birth rate continues to decline throughout England and Wales. The birth rate for the whole 18 country during the year under review amounted to 27.2 per 1000 of the population, which was 0.7 per 1,000 below the rate in 1904, and lower than any rate on record. The 76 Great Towns for which returns are available showed a birth rate of 28.2 per 1,000 of the population, the rates for the three preceeding years having been 30.0, 29.7 and 29.1. It is interesting to note the wide range in the birth rates of various districts: e.g., Bournemouth 16.8, Hastings 17.7, Hornsey 18.5, Halifax 19.2, Northampton 20.9, Sunderland 34.4, Middlesborough 35.0, St. Helens 36.2, Rhondda 37.5, Merthyr Tydfil 38.3. In London the birth rate amounted to 27.1, or 2.2 per 1000 below the average for the past 10 years and also the lowest on record. Here again wide variations occur according to the districts: e.g., City of London 13.5, Hampstead 16.2, City of Westminster 16.8, Kensington 19.3, Stoke Newington 20.5; on the other hand, Stepney 35.3, Finsbury 34.7, Shoreditch 33.5, Bermondsey 33.3. These figures point clearly to the fact that the diminution in the birth rate occurs chiefly among the more wealthy classes, who are in a better position both financially and in other respects to fill the gaps which have been caused by deaths in the ranks of a population. These figures show moreover that the responsibility of maintaining a surplus of the population is falling in a greater proportion upon the working and poorer classes of the community, who in many cases are the least able to maintain their offspring and equip them for future positions in life. Illegitimacy.—During the year 1905, 4,684 infants were registered in London as having been born out of wedlock. This figure gives a proportion of 37 per 1,000 births, which is equal to the average proportion in the preceding 10 years. Table 3. Births and Birth Rates for each Division of the Borough for the years 1901-1905. Division. 1901. 1902. 1903. 1904. 1905. Total Number of Births. Birth Rate per 1000 persons, Total Number of Births. Birth R ate 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 24.2 454 23.2 Lewisham 1882 28.2 1857 26.6 1979 27.2 1967 25.9 2027 25.7 Syd.& Forest Hill 1040 24.1 1153 26.3 1098 24.7 1153 25.5 1152 25.1 Whole Borough 3320 25.9 3491 26.3 3563 26.1 3589 25.6 3633 25.2 County of London 131829 29.0 130478 28.5 130906 28.4 129335 27.9 126620 27.1 19 In regard to Lewisham out of 3,633 total births 121, or 33.3 per 1,000 births were registered as being illegitimate. This being the first year in which we have been supplied with detailed returns in regard to births, we are unable to give the comparative figures for previous years. 20 MARRIAGE RATE. The number of Marriages registered in the Borough during the year amounted to 906, compared with 848 in 1904. The Marriage Rate was 12.5, an increase of 0.5 per 1,000 on 1904, while the Marriage Rate for the whole of London was equal to 16-9 per 1,000. MORTALITY. The total number of Deaths registered in the Borough amounted to 1,804, compared with 1,799 for the year 1904. After deducting the deaths of non-residents (232) dying within the Borough, and adding those of residents (119) who died outside the district, a corrected total of 1,691 is obtained, compared with 1,679 in 1904. The corrected total deaths in Lewisham, 1,691, is equivalent to a Death Rate of 11.7 per 1,000 living at all ages, and compares most favourably with the death rate for England and Wales of 15.2 per 1,000 of the population, which is lower than the rate in any other year on record. The death rate for the County of London, 15.1, is also the lowest on record. The rate for the 76 Great Towns equalled 15.7 per 1,000. Compared with other Metropolitan Boroughs, Lewisham has the second lowest death rate in London. Hampstead is the lowest with 9.3, followed by Lewisham 11.7, Wandsworth 12.6, and Woolwich 12.8 per 1,000 of the population living at all ages. 21 The districts having the highest death rates in London were Shoreditch, 19.7, Finsbury, 19.0, Bermondsey, 18.7, and Bethnal Green, 18.6. (See Tables 12 and 13). The death rate for Lewisham, 11.7 per 1,000 for the year 1905, shows a slight decrease over the previous year. On sub-dividing the corrected deaths into the three divisions of the Borough, it will be noted that the mortality rate (i.e., the number of deaths per 1,000 persons estimated to be living in each Division referred to), was lowest in the Lee Division, 9.5, and highest in the Lewisham Division, 12.2, the Sydenham and Forest Hill Division being 11.7. (See Table 7). Carrying the sub-division a step further, the death rates from all causes in the individual Wards show Blackheath and Lewisham Village to have suffered the highest mortality (14.6); on the other hand Manor and Brockley claim the lowest mortality for the year with 8.9 per 1,000. (See Table 9). Age in relation to Deaths.—A division of the registered deaths at various age periods is arranged in Table 4. This Table shows that, compared with previous years, there was a marked diminution of deaths among children under one. The percentage deaths at this age period, compared with total deaths, amounted to 19.99, compared with 26.21 in 1904. In the period from 25 to 65 years, however, there was an increased percentage. The number of deaths recorded at this age period equalled 32.35 per cent of the total, compared with 27.99 in the previous year. The relation of age periods to mortality from zymotic diseases are set out in Table 18. Of the 120 deaths from these diseases, 84.2 per cent. occurred among children under five years of age. The distribution of zymotic deaths in ward localities appears in Table 16. 22 ANALYSIS OF DEATHS. Table 4 Number of Deaths at Various Age Periods and their Percentage to Corrected Total Deaths during the years 1902, 1903, 1904 and 1905. Age Period. 1902. 1903. 1904. 1905 Number of Deaths. Percentage to Total Deaths. Number of Deaths. Percentage to Total Deaths. Number of Deaths. Percentage to Total Deaths. Number of Deaths. Percentage to Total Deaths. Deaths under 1 yr. 428 23.54 328 21.68 440 26.21 338 19.99 Over 1 & under 5 yrs. 200 11.00 142 9.39 140 8.34 130 7.69 ,, 5 ,, 15 ,, 86 4.73 61 4.03 39 2.32 59 3.49 ,, 15 ,, 25 ,, 86 4.73 76 5.02 85 5.06 63 3.72 „ 25 „ 65 „ 547 30.09 478 31.59 470 27.99 547 32.35 Over 65 years 471 25.91 428 28.29 505 30.08 554 32.76 Total 1818 100.0 1513 100.0 1679 100.0 1691 100.0 Chart A. Showing Weekly Total Deaths from All Causes, from Respiratory Diseases, and from Infantile Diarrhœa, for the 52 Weeks ended December 30th, 1905. 23 Table 5. Percentage of Deaths under one year of age to Total Deaths in Wards and Divisions for the years 1902-5. District. 1902. 1903. 1904. 1905. Church Ward percent. 11.8 percent. 11.3 percent. 19.7 percent. 12.7 Manor Ward 16.4 26.4 26.0 9.4 South Ward 20.3 14.8 13.3 11.8 Lee Division 15.9 17.4 20.7 11.3 Blackheath Ward 14.5 13.8 13.9 17.0 Lewisham Village Ward 18.5 22.2 27.6 20.7 Lewisham Park Ward 25.1 20.8 31.5 20.5 Brockley Ward 26.2 20.0 27.2 15.7 Catford Ward 34.6 32.7 31.3 26.0 Lewisham Division 26.9 24.9 28.2 21.5 Forest Hill Ward 21.7 13.4 18.6 17.5 Sydenham Ward 20.6 21.4 29.1 22.4 Sydenham & Forest Hill Division 21.0 18.2 24.8 20.2 Whole Borough 21.68 23.54 26.21 19.99 Seasonal Mortality.—The highest mortality occurred during the first and last quarters of the year, the death-rates from all causes being 14-3 and 12*2 per 1,000 respectively. The lowest death-rate was 9-7 for the third quarter. 24 Chart A shows deaths from all causes recorded weekly and the seasonal effect with regard to Infantile Diarrhœa 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. INFANT MORTALITY. The infant mortality of a district is measured by the proportion of deaths of infants under one year to registered births. England and Wales.—The infant mortality rate for England and Wales was 128 per 1,000, being 17 per 1,000 below 1904, and lower than the rate in any other year on record. In the 76 Great Towns the infant mortality was 140 per 1,000, compared with 150 per 1,000, the mean of the three preceding years. The towns having the lowest figures were Hornsey 66, Handsworth 60, Bournemouth 83, Burton-onTrent 87, Kings Norton 89. The towns with the highest rates were Grimsby 174, Norwich 174, Merthyr Tydfil 193, Hanley 195, and Rhondda 200. In London the average infant mortality amounted to 129 per 1,000 births, compared with 144 in 1904 and 146 the mean of the three preceding years. The lowest records were Marylebone 88, Holborn 92, Lewisham 93, Hampstead 94, and Woolwich 102; the highest being Poplar 153, Bethnal Green 151, Southwark 148, and Bermondsey 148. 25 Lewisham.—In comparison with other districts the low infant mortality rate of 93 per 1,000 births registered is satisfactory and compares favourably with 113 per 1,000, the mean rate in Lewisham for the three preceding years. These figures show that a reduction in the infant mortality was general throughout England and Wales during the year under review. Statistical returns also show that some individual districts were less fortunate, having no reduction, and in some cases even an increase in the infant mortality rate, compared with the previous year. Nevertheless the general reduction in the wastage of infant life is a most welcome fact. As to the cause of such reduction we are not at present in possession of those details necessary to form a definite opinion. Probably it is largely due to the better education of the public in matters so essential for the successful rearing of their children. In regard to Lewisham, however, we have details for the past three years of the causes of infant mortality. These are briefly set out in Table 6 and more fully in Table E of the Appendix, which is a new table introduced for the first time this year at the direction of the Local Government Board. CAUSES OF INFANT DEATHS During the year 338 deaths occurred among children under one year, compared with 440 in 1904. Of this number 8 were certified as Measles and 13 Whooping Cough, compared with 6 and 23 respectively in 1904. Diarrhœal Diseases (i.e., all forms of diarrhœa, enteritis not tuberculous, gastritis and gastro-intestinal catarrh) claimed 59, compared with 122 in 26 1904. It is in this group the greatest reduction in the infant mortality rate occurred in Lewisham. Under the head of Wasting Diseases are included deaths due to Premature Birth—Congenital Defects—Injury at Death— Want of Breast Milk—Atrophy—Debility—Marasmus. To this group 139 deaths were allocated, compared with 151 in 1904. Ten deaths were due to some form of Tubercular Disease (consumption), 43 to Respiratory Diseases, either Bronchitis, Laryngitis or Pneumonia, and 64 to Diseases unclassified or illdefined, such as Convulsions, Suffocation, Overlaying, &c. Premature Birth—or Immaturity, was the cause attributed to 57 or 16.9 per cent. of the recorded infant deaths, compared with 73 in 1904. This classification does not refer to stillborn infants, but to those living at birth and surviving various periods from a few hours to several days. The longest period recorded in these returns was one month. It will be easily understood that owing to the infants' immaturity and consequent lack of vitality, the mortality amongst such children must be exceedingly high, although they may be born to parents whose social position enables the infants to enjoy the best chances of survival which money and skill can secure. Among the poorer classes the chances of survival are more remote. This no doubt accounts for the fact that the larger proportion of deaths in this group occurred in the families of the labouring classes. Doubtless the want of food, plus the ignorance of the mother as to the required care of herself during the anti natal period and the effect upon the embryo are largely responsible for many premature births. Stillborn Infants.—The deaths recorded as due to premature birth and immaturity, which were responsible for 16.9 Chart B. Showing Percentage of Deaths in Eleven Groups to Total Registered Deaths in 1905. 27 per cent. of the total infant deaths, do not include still births. In order to obtain complete information in regard to the wastage of infantile life, it is, I think, important that still births should be registered and the information supplied to us. Table 6. Analysis of Deaths under one year of age, during the years 1903-5. Disease. 1903. 1904. 1903. Number of Deaths under 1 year. Percentage Deaths to total Deaths under 1 year. Number of Deaths under 1 year. Percentage Deaths to total Deaths under 1 year. Number of Deaths under 1 year. Percentage Deaths to total Deaths under 1 year. Common Infectious Diseases 10 3.0 29 6.6 23 6.8 Diarrhœal Diseases 60 18.3 122 27.7 59 17.5 Wasting Diseases 124 37.8 151 34.3 139 41.1 Tuberculous Diseases 14 4.3 14 3.2 10 3.0 Respiratory Diseases 53 16.2 64 14.5 43 12.7 Diseases classified under other headings 67 20.4 60 13.6 64 18.9 Total 328 100.0 440 100.0 338 100.0 Note.—For detailed list of these diseases see Table E of the Local Government Board Tables (page 129). 28 Distribution in Wards.—The following table shows the distribution of infant deaths in the various wards of the Borough. The highest mortality was in the Lewisham Village and Lewisham Park Wards:— Ward. Common Infect. Diseases. Diarr. Diseases. Wasting Diseases Tuber. Diseases. Resp. Diseases. Other Diseases. Total Infant Deaths Death-rate per 1000 of the Population. Church l l 4 — 2 l 9 1.3 Manor — l 3 — — 2 6 0.8 South — l 3 — 1 1 6 1.1 Blackheath 1 2 11 l 1 1 17 2.5 Lewisham Village 3 11 20 — 4 6 44 3.0 Lewisham Park — 13 14 l 4 14 46 3.0 Brockley 2 1 4 l 1 7 16 1.4 Catford 4 18 31 4 17 11 85 2.8 Forest Hill 3 4 16 2 9 8 42 2.3 Sydenham 9 7 33 1 4 13 67 2.5 Total 23 59 139 10 43 64 338 2.3 Occupation of parents in relation to infantile deaths.— An examination of the records and reports made after inquiry show the majority of deaths occurred among children of the labouring classes. This fact is supported by the following street list:— 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. Dacre Street 2 Murillo Road 2 Summerfield Street 3 29 Lewisham. Bowness Road 3 Elthruda Road 2 Longhurst Road 3 Brookbank Road 2 Elverson Road 2 Marnock Road 2 Brookdale Road 4 Essex Place 2 Marsala Road 4 Brownhill Road 2 Farley Road 3 Merritt Road 2 Crathorne Street 2 Fernbrook Road 3 Mill Road 3 Darfield Road 3 George Lane 3 Morena Street 2 Davenport Road 2 Glenfarg Road 4 Nelgarde Road 2 Dermody Road 3 Hazelbank Road 2 Pattenden Road 2 Doggett Road 5 High St., Lewisham 8 Porson Street 4 Dry sdale Road 3 Honley Road 2 Rushey Green 4 Engleheart Road 6 Kneller Road 2 Sandhurst Road 7 Ennersdale Road 5 Lady well Park 4 Thurston Road 3 Ellerdale Street 3 Laleham Road 5 Wellmeadow Road 3 Elsinore Road 2 Leahurst Road 4 Wildfell Road 5 Elswick Road 2 Lethbridge Road 3 Woodlands Street 2 Loampit Hill 2 Sydenham and Forest Hill. Adamsrill Road 5 Elderton Road 2 Perry Hill 2 Bovill Road 3 Holmshaw Road 2 Porthcawe Road 8 Burford Road 5 Hurstbourne Road 2 Relinque Road 2 Clyde Place 2 Maddin Road 2 Stanton Square 2 Coombe Road 2 Malbam Road 4 West Terrace, Fairlawn Park 2 Dalmain Road 10 Miall Road 4 Devonshire Road 3 North Terrace, Fairlawn Park 2 Ewart Road 3 Combative Measures Adopted.—At the end of the year 1904 the request made by the Lewisham Borough Council, in common with other Metropolitan Boroughs, for a weekly return of births registered in the district was granted, and in consequence we have now had the advantage of this information for the whole of the year 1905. These lists are delivered every Monday morning and examined by your Medical Officer of Health, and a selection of homes made where it is thought desirable to send special information in regard to the rearing and feeding of infants. To the selected homes a pamphlet on infant feeding and management, written in a popular style, is distributed by post. (See Appendix 4.) These pamphlets have been very greatly appreciated, and it is hoped that it has in many instances drawn the attention of uneducated parents to the necessity of breast feeding, and to the many pitfalls 30 and dangers which beset artificial feeding of their babes. Our intention was that, in very special cases, the women sanitary inspectors might render valuable services in giving advice to some of the very poorest parents. The London County Council' however, pointed out that the terms upon which the women sanitary inspectors were appointed would not permit of their doing this particular work. They are, however, permitted to visit houses in which infant deaths have occurred, and it is to be hoped that the legal difficulties which seriously handicap our efforts to take preventive action in regard to infantile mortality will be removed. In many cases, notwithstanding the difficult regulations which exist, a considerable amount of most valuable work has been carried out by your women sanitary inspectors, who have, in addition to their other duties, visited and inspected, as sanitary inspectors, 517 homes in the poorest parts of the Borough in which births were known to have taken place. These inspections necessitated the service of many notices for the abatement of existing nuisances. Methods of Feeding.—From information I have been able to obtain from reports before me relating to 517 of the poorest homes, the number of children entirely breast-fed amounted to 147, or 28.4 per cent. Of the remaining 370 infants, for which artificial feeding was resorted to, the method of feeding consisted of condensed milk (often some of the cheaper brands which are seriously deficient in fat), baked flour, sop, and a small proportion on cows' milk. A large number of mothers put out their children to nurse on account of their having daily work. From the information we have obtained it would appear that there is a greater desire than one would believe on the part of poor parents to suckle their own children, the greatest difficulty that arises being their necessity to work. 31 Women who are obliged to work have great difficulty in placing their infants in clean homes, as the following extracts from the women sanitary inspectors' reports show:— "Thirty-nine babies were found left in charge of unregistered women, and 49 other mothers said they intended going to work when they could find it, leaving their children with neighbours, etc. These children are sometimes found put out to be nursed by old women quite incapable of caring for them, or else by young girls of 14 years who have just left school. One baby was found with one of the latter of very weak intellect. She had charge of the baby for ten hours daily, and fed it by giving the comforter a dip into the tinned milk at intervals. Another child found in a very dirty state was being cared for by a woman who had had 16 children of her own, and had lost 10. A woman having the care of a baby of her own, the perpetual care of an illegitimate baby, and the daily care of another—her husband being out of work—does not surprise us by losing two children from whooping cough. During a visit to inspect a house I found a child shut up in a cupboard during the temporary absence of its mother. The infant was possibly quite accustomed to it, and did not seem at all surprised on being discovered. The advisability of inspecting these premises and making enquiries re the care of the infants seems unquestionable." "It is regrettable that any mother with an infant under 12 months old should be obliged to go out to work, for the conditions under which the children are left are anything but satisfactory. The majority of houses where nursed children were taken were found on inspection to be dirty and ill-kept. Besides this, the woman chosen to look after the child during its mother's working hours often possesses a family of small children herself, which necessarily means that only a limited amount of attention can be given to the nursed baby." Infant Life Protection.—Reference has been made in this report to the condition of homes in which nursed children are seen. This brings us to a consideration of the existing powers of the Infant Life Protection Act in its relation to infantile mortality. At the present time there is no legal or 32 or other control over persons who receive into their homes, for the purpose of nursing or maintaining, any number of infants apart from their parents for any period under 48 hours. This Act provides that:— (Sec. 2). "Any person retaining or receiving for hire or reward in that behalf more than one infant under the age of five years for the purpose of nursing or maintaining such infants apart from their parents for a longer period than 48 hours, shall within the said 48 hours give notice thereof to the local authority." The Act also enables the Local Authority to appoint male or female inspectors to enforce the Act. Further, it empowers the Local Authority to fix the number of infants under the age of five which may be retained or received into any dwelling in respect of which notice has been received under the Act. Special provisions are made for dealing with children kept in premises which are unfit or overcrowded, and it provides power to remove infants to a workhouse or place of safety from any person who, from negligence, ignorance or other cause, is so unfit to have its care. The relatives or guardians of any infant by them retained are exempt from the operations of the Act. The Local Authority for the execution of the Act in the County of London is the London County Council; in the City of London, the Common Council; and in other places, the Board of Guardians. From information we have before us even in this district, I am fully convinced that the following amendments will be of great benefit:— (a) That the controlling authority should be the Borough Council, if for no other reason than the fact that 38 we are constantly in receipt of information which would be most difficult for the Central Authority to obtain. (b) That any person retaining or receiving for hire or reward for a period of more than 48 hours one or more infants under the age of five should be controlled by the Act. In regard to children who are only temporarily placed out, sometimes for one or more days a week, during their mothers' absence at work, there is, in my opinion, an urgent necessity for the establishment in the poorer parts of the Borough of a creche. The establishment of such institutions would prove a considerable boon to many of the poorer mothers, and undoubtedly of great benefit to the infants, who would receive care and attention amid cleanly and healthy surroundings. Period for Registration of Births.—Considerable advantage would accrue if the existing period of 42 days within which the registration of a birth is permissible were reduced to 14 days. Storage of Food in the Home.—It seems extraordinary that poorer homes are, almost without exception, without any accommodation for the proper storage of food. One sees the infant's milk stored in all kinds of vessels, placed frequently upon the mantelpiece in the kitchen or the copper in the scullery, inviting contamination from every point. The marvel is that so many children escape infantile diarrhœa during the summer months considering the way in which their food is contaminated for want of proper storage. Homes Visited where Infant Deaths occurred.—Of the 338 homes in which deaths of infants were recorded, sanitary 34 inspection was made in 223 cases. Of the 223 investigations, 78, or 35 per cent., were due to epidemic diarrhoea, enteritis, marasmus or malnutrition. Only 29 children were breast-fed. In 33 cases the mothers had been engaged in work regularly during their child's life, necessitating the child being placed under the care of some other woman during working hours. 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 Diarrhœa, Enteritis and Dysentery. This death rate is also a valuable test of the sanitary condition of a district, and in this respect Lewisham maintains a high position. For the year under review it amounted to 0.83 per 1,000 persons, compared with 1.70 for the County of London, 1.52 England and Wales (or 0.53 per 1,000 below the mean proportion in the 10 preceding years), and 1.88 for the 76 Great Towns. Of the ten South Metropolitan Boroughs, Lewisham possesses the lowest rate. This Borough shows a decrease of 0.57 in the Zymotic death rate over that of the previous year. (See Tables 12 and 17). Of the total 120 deaths from the principal infectious diseases, Measles accounted for 41, Scarlet Fever 5, Whooping Cough 24, Diphtheria 8, Enteric Fever 6, Epidemic Diarrhœa and Enteritis 32, and Small-Pox 4. (See Table 14). The death rates from the above diseases for the whole Borough, the County of London, and the 76 Great Towns, have 35 been calculated and are set out in Table 17. The highest rates in the Borough were due to Measles and Epidemic Diarrhœa. In the three Divisions of the Borough the Zymotic death rates were Lee 0.46, Lewisham 0.84 and Sydenham and Forest Hill 0.98. (See Table 17). ANALYSIS OF DEATHS AT ALL AGES IN RELATION TO DISEASE GROUPS CLASS I.—All Infective Diseases (152). Small-Pox.—Four deaths occurred from this disease. Measles.—Measles was the most fatal zymotic disease, being the cause of 41 deaths, equal to a death rate of 0.28 per 1,000 of the population. The prevalence of this disease was again most marked in the Sydenham and Forest Hill. (See Table 17). Scarlet Fever.—Five deaths were notified in the Borough, equal to a mortality rate of 0.03 per 1,000. Lee Division had the highest mortality, 0.05, the rates for Lewisham and Sydenham and Forest Hill Divisions being 0.03 and 0.04 respectively. The case mortality amounted to 0.9 per cent. of the persons affected. Diphtheria.—There were 8 fatal cases, giving a mortality rate for the Borough of 0.06 per 1,000. Of the three Divisions the greatest mortality occurred in Sydenham and Forest Hill, the mortality being 0.07. The case mortality was 5.6 per cent. of the actual cases. Whooping Cough.—Twenty-four deaths occurred from Whooping Cough, equal to a death rate of 0.17. Most of these deaths took place in the second quarter of the year. 86 Enteric Fever.—There were only six fatal cases, equal to a death rate of 0.04 per 1,000. The case mortality was equal to 18.2 per cent. of the persons affected, compared with 8.7 for the previous year. Epidemic Diarrhœa and Epidemic Enteritis.—The total deaths recorded in the year from these two diseases amounted to 32, compared with 112 in 1904, shewing a death rate of 0.22 per 1,000 of the population compared with 0.80 in 1904. This shews a considerable improvement. In comparison with other Metropolitan Boroughs, Lewisham's record is again the second lowest rate, Hampstead being 0.13. (See Table 12 and Leaflet, Appendix 3.) Death from other Infective Diseases were:—Influenza, 11; Puerperal Fever, 4; Infective Endocarditis, 1; Erysipelas, 2; Venereal Disease, 4; Septicœmia not Puerperal, 6; Pyaemia, 1; and other Septic Diseases, 3. CLASS II.—Tuberculous Diseases (172).—Phthisis.—This disease was responsible for 126 deaths, or 7.5 per cent. of the total 1,691 deaths from all causes. This mortality is equal to a death rate of 0.87 per 1,000 (compared with 0.84 in 1904) 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 mortality from this cause was Holborn, with 2.84 per 1,000. The death rate for the County of London was 1.42. 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 0.82, Lewisham 0.95, and Sydenham and Forest Hill 0.76. 37 Comparing Phthisis with other infectious diseases it was responsible for a greater loss of life than all the zymotic diseases combined. The total deaths from the diseases mentioned were :— Lewisham. County of London. Small-Pox 4 10 Measles 41 1709 Scarlet Fever 5 549 Diphtheria 8 546 Enteric Fever 6 234 Fever (Pyrexia) — 3 Whooping Cough 24 1487 Ep. Diarrhoea and Enteritis 32 3356 Total 120 7894 Phthisis 126 6622 In addition to Phthisis 46 deaths were registered as due to various forms of tubercular disease. (See Table 14). CLASS III.—Malignant Diseases (130).—Cancer was the stated cause of 104 deaths, compared with 92 in 1904, equal to a mortality rate of 0.72 per 1,000. On sub-dividing these deaths, '21 were registered in Lee, 51 in Lewisham, and 32 in Sydenham and Forest Hill. For other diseases of this Class see Table 14. CLASS IV.—Nervous Diseases (114). — This class was responsible for 114 deaths, equal to 6.7 per cent. of the total deaths. Of this number 43 were cases of Insanity, 13 Meningitis, 29 Convulsions; of the latter 23 were children under 1 year. CLASS V.—Diseases of Heart and Circulation (263). Diseases of Heart and Blood Vessels accounted for 263 deaths, equal to 15.6 per cent. of the total deaths. Seventy-six deaths were due to Valvular Heart Disease and Endocarditis. 38 CLASS VI.—Respiratory Diseases (267).—This class was the cause of 267 deaths, equal to 15'8 per cent. of the total deaths from all causes. The highest number of deaths occurred during the seventh 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 (190).—To this class 190 deaths, or 11.2 per cent. of the total deaths, were assigned ; 105 of these occurred to children under 1 year. Cirrhosis of the Liver was the certified cause of 25 deaths, compared with 17 in 1904. CLASS VIII.—Diseases of Urinary Organs (57).—Fiftyseven, or 3.4 per cent. of the total deaths were recorded in this class. CLASS IX.—Diseases of Generative Organs (5).—Only 5 deaths were registered in this group. CLASS X.—General or Constitutional Diseases (298).— Of the 298, or 17.6 per cent. of the total deaths due to disease in this class, Old Age claimed 151 of the total, Premature Birth was the certified cause of 57, and Alcoholism 11, compared with 8 in the previous year.* CLASS XI.—Accidents (32).—Thirty-two fatal accidents occurred, 3 of which were due to overlaying. CLASS XII.—Violence, Suicides, &c. (11).—Nine suicides and 2 other violent deaths occurred in the Borough. NOTE:—Chart B contains a diagramatic comparison of deaths occurring in various groups. Inquests:-One hundred and ten inquests were held during the year and a post mortem examination made in 63 instances. * See Circular re Alcoholism (Appendix 2). 39 DEATHS OF RESIDENTS belonging to the Borough occurring in Public Institutions, &c., in districts outside during the year 1905. Number of Deaths Number of Deaths Fever Hospitals:— Asylums—continued. Long Reach Hospital 3 Manor Asylum, Epsom 1 Brook Hospital 3 Tooting Bec Asylum 1 Northern Hospital 1 Gore Farm Temporary Asylum, Darenth 1 General Hospitals:— Bethlem Royal Hospital 1 Guy's Hospital 15 St. Thomas' Hospital 4 Other Institutions:— Children's Hospital, Great Ormonde Street 4 Evelina Hospital 2 Camberwell Infirmary 2 Charing Cross Hospital 3 Cancer Hospital, Fulham Road 2 London Hospital 3 West London Hospital 2 Royal Chest Hospital, City Road 1 Royal Free Hospital 2 Seamen's Hospital, Greenwich 2 City of London Chest Hospital 1 Middlesex Hospital 1 Mount Vernon Hospital 1 St. Bartholomew's Hospital 1 Whitechapel Infirmary 1 East London (Children) Hospital, Shad well 1 French Hospital 1 St. Mary's Hospital 1 National Hospital, Queen's Square 1 Miller Hospital, Greenwich 1 1 University College Hospital Brompton Hospital 1 1 Kings College Hospital Epileptic Colony, Epsom 1 St. Thomas's Home 1 Asvlums:— Workhouse Home for Friendless Girls, Carshalton 1 Dartford Heath Asylum 22 Banstead Asylum 7 Caterham Asylum 5 Hospital for Epilepsy & Paralysis, Maida Vale 1 Cane Hill Asylum 4 Claybury Asylum 3 50, Weymouth Street, Marylebone 1 Darenth Imbecile Asylum 2 Peckham House Asylum 2 Total 119 Horton Asylum 2 Camberwell House Asylurr 1 40 Table 7. Corrected Death Totals and Death Rates for the years 1901-5. 1901. 1902. 1903. 1904. 1905. Locality. 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. Deathrateper 1,000 of the population. Total Number of Deaths. Death rateper 1,000 ot the population. Total Number of Deaths. Death rateper 1,000 of the population Lee Division 255 13.6 220 11.6 213 11.1 193 10.0 186 9.5 Lewisham Division 856 12.9 991 14.2 816 11.2 941 12.4 966 12.2 Sydenham & Forest Hill Division 557 12.9 607 13.8 484 10.9 545 12.1 539 11.7 Whole Borough 1668 13.0 1818 13.7 1513 11.1 1679 12.0 1691 11.7 County of London 79924 17.1 80105 17.2 69737 15.2 74556 16.1 70442 15.1 41 Table 8. Corrected total Deaths from All Causes in Wards occurring during the four quarters of the year 1905. 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 Churchward 7 15 22 9 8 17 11 4 15 10 7 17 37 34 71 Manor Ward 10 5 15 9 9 18 6 6 12 6 13 19 31 33 64 South Ward 4 5 9 6 10 16 5 7 12 9 5 14 24 27 51 Blackhealth Ward 17 14 31 7 13 20 13 13 26 14 9 23 51 49 100 Lewishum Village Ward 28 32 60 18 23 41 19 24 43 31 38 69 96 117 213 Lewisham Park Ward 39 30 69 28 29 57 26 19 45 29 24 53 122 102 224 Brockley Ward 17 22 39 8 10 18 18 7 25 7 13 20 50 52 102 Catford Ward 49 47 96 42 26 68 33 37 70 42 51 93 166 161 327 Forest Hill Ward 40 39 79 29 32 61 12 28 40 22 38 60 103 137 240 Sydenham Ward 45 52 97 31 37 68 26 37 63 35 36 71 137 162 299 The Whole Borough 256 261 517 187 197 384 169 182 381 205 234 439 817 874 1691 County of London — — 19587 — — 16710 — — 17067 — — 19638 — — 73002 76 Great Towns — — 67082 — — 57159 — — 59088 — — 61509 — — 244838 42 Table 9 Corrected Death Rates from All Causes in Wards, Divisions, and the Whole Borough, for the four Quarters of the Year 1905. Localities. First Quarter. Second Quarter. Third Quarter. Fourth Quarter 1905. Church Ward 13.0 10.0 8.8 10.0 10.5 Manor Ward 8.3 10.0 6.7 10.5 8.9 South Ward 6.4 11.4 8.6 10.0 9.1 Lee Division 9.4 10.4 8.0 10.2 9.5 Blackheath Ward 18.2 11.7 15.2 13.5 14.6 Lew. Village Ward 16.4 11.2 11.8 18.9 14.6 Lew. Park Ward 17.9 14.8 11.7 13.8 14.5 Brock ley Ward 13.6 6.3 8.7 6.9 8.9 Catford Ward 12.6 8.9 9.2 12.2 10.7 Lewisham Division 15.0 10.3 10.6 13.1 12.2 Forest Hill Ward 17.3 13.4 8.8 13.1 13.1 Sydenham Ward 14.0 9.8 9.1 10.3 10.8 Sydenham & Forest Hill Division 15.3 11.2 9.0 11.4 11.7 Whole Borough 14.3 10.6 9.7 12.2 11.7 County of London 16.8 14.3 14.6 16.8 15.1 76 Great Towns 17.2 14.7 15.2 15.8 15.7 43 *Table 10. Deaths in Disease Groups in the Three Divisions and the whole Borough for the year 1905. Disease Classes. Lee Division. Lewisham Division. Sydenham and Forest Hill Division Whole Borough 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Whole Year 1st Qr. 2nd Qr— 3rd Qr. 4th Qr. Whole Year I. Infective 2 4 4 1 11 20 17 30 15 82 15 15 9 20 59 37 36 43 36 152 II Tuberculous 3 5 3 8 19 32 19 26 23 100 15 12 13 13 53 50 36 42 44 172 III. Malignant 4 10 3 7 24 15 20 19 11 65 7 10 13 11 41 26 40 35 29 130 IV. Nervous 3 1 4 3 11 19 22 12 15 68 10 12 9 4 35 32 35 25 22 114 V. Heart & Blood Vessel 8 8 5 10 31 38 38 26 46 148 19 19 16 30 84 65 65 47 86 263 VI. Respiratory 11 5 3 7 26 65 22 16 57 160 39 17 5 20 81 115 44 24 84 267 VII. Digestive 3 6 5 7 21 33 21 32 27 113 . 18 12 17 9 56 54 39 54 43 190 VIII. Urinary 2 2 1 — 5 8 7 9 13 37 7 3 3 2 15 17 12 13 15 57 IX. Generative Organs — 1 — — 1 — — 1 1 1 1 — 1 3 1 2 — 2 5 X. General 8 7 10 6 31 54 31 37 43 165 42 25 16 19 102 104 63 63 68 298 XI. Accidents — 1 1 1 3 8 7 2 6 23 2 1 1 2 6 10 9 4 9 32 XII. Violence 2 1 — — 3 3 — — 1 4 1 2 1 — 4 6 3 1 1 11 Totals 46 51 39 50 186 295 204 209 258 966 176 129 103 131 539 517 384 351 439 1691 * For Diseases in each Class see Table 14. 44 Table 11. Death Rates per 1,000 of the population, in Disease Groups, in the Wards and Divisions of the Borough for the year 1905. Disease Class Wards and Divisions. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Church Manor South Lee Blackheath Lewisham Village Lewisham Park Brockley | Catford Lewisham Forest Hill Sydenham Sydenham and Forest Hiil Whole Borough I. Infective 0 .9 2.8 0.5 0.6 1.5 1.6 0.6 0.9 0.9 1.0 1.4 1.2 1.3 1.1 II. Tuberculous 0.7 1.0 1.3 10 1.3 1.2 1.7 1.5 1.0 1.3 1.3 11 1.2 1.2 III. Malignant 1.5 1.2 0.9 1.2 1.6 0.9 0.7 0.6 0.8 0.8 0.8 1.0 0.9 0.9 IV. Nervous 0.3 1.0 0.4 0.6 0.6 0.8 1.4 0.9 0.7 0.9 0.9 0.7 0.8 0.8 V. Heart and Blood Vessels 1.5 1.9 1.3 1 6 2.5 1.9 2.8 0.9 1.6 1.9 2.5 1.4 1.8 1.8 VI. Respiratory 1.5 0.8 1.8 13 2.3 2.8 2.3 0.9 19 2.0 2.5 1.3 1.8 1.8 VI I. Digestive 1.0 0.8 1.4 11 0.6 1.9 1.5 1.2 1.4 1.4 1.5 1.0 1.2 1.3 VIII.Urinary 0.4 0.3 — 0.3 0.7 0.4 0.4 0.3 0.5 0.5 0.5 0.2 0.3 0.4 IX. Generative Organs 0.1 — 01 _ 0.1 0.0 0.1 0.1 0.0 X. General Diseases 1.9 1.2 1.6 1.6 3.1 2.5 2.7 1.2 1.7 2.1 1.5 2.7 2.2 2.1 XI. Accidents 0.4 — — 0 2 0.3 0.4 0.4 0.3 0.2 0.3 0.2 0.1 0.1 0.2 XII. Violence 0.1 0.3 — 0.2 0.1 0.1 — — 0.1 0.1 0.1 0.1 0.1 0.1 Total Deaths 10.5 8.9 9.1 9.5 14.6 14.6 14.5 8.9 10 7 12.2 13.1 10.8 11.7 11.7 45 Table 12 Death Rates of London and Metropolitan Boroughs during the year 1905, after distribution of deaths in Public Institutions. Per 1000 Persons Living. Deaths under 1 year to 1000 Births registered Deaths from Boroughs Births. All Causes Principal Epidemic Diseases Small-Pox Measles Scarlet Fever Diphtheria Whooping-Cough Typhus Enteric Fever Pyrexia* (Origin uncertain) Diarrhoea Phthisis CntyofL'nd'n 27.1 15.1 1.70 0.00 0.37 0.12 0.12 0.32 — 0.05 0.00 0.72 1.42 129 West. Paddington 21.6 13.3 1.39 — 0.42 0.05 0.02 0.34 — 0.03 — 0.53 0.96 123 Kensington 19.3 14.0 1.39 — 0.31 0.12 0.05 0.33 — 0.07 — 0.51 1.14 144 Hammersmith 26.2 13.9 1.70 — 0.24 0.09 0.18 0.48 — 0.04 — 0.67 1.16 135 Fulham 30.4 15.1 2.71 — 0.54 0.14 0.15 0.53 — 0.06 — 1.29 1.22 145 Chelsea 21.3 14.8 1.03 — 0.07 0.12 0.07 0.30 — 0.05 — 0.42 1.51 117 Ctyof Wstmstr 16.8 13.5 0.81 — 0.22 0.09 0.03 0.16 — 0.02 - 0.29 1.51 114 North. St. Marylebone 30.0 15.5 1.12 — 0.29 0.12 0.04 0.19 0.05 0 01 0.42 1.46 88 Hampstead 16.2 9.3 0.53 — 0.09 0.07 0.03 0.19 0.02 — 0.13 0.83 94 St.. Pancra 24.7 15.8 1.50 — 0.33 0.11 0.11 0.35 0.03 — 0.57 1.52 135 Islington 25.2 14.5 1.47 0.00 0.36 0.11 0.10 0.33 0.05 — 0.52 1.26 125 Stoke Nwingtn 20.5 12.9 1.14 — 0.23 0.06 0.09 0.19 - — — 0.57 1.33 122 Hackney 25.8 140 1.98 0.01 0.36 0.08 0.11 0.29 — 0.12 — 1.01 1.15 129 Central Holborn 28.5 17.5 1.12 — 0.20 0.07 0.07 0.30 — 0.07 — 0.41 2.84 92 Finsbury 34.7 19.0 2.17 — 0.42 0.21 0.12 0.33 — 0.09 — 1.00 2.02 127 City of London 13.5 17'4 0.57 — 0.04 0.04 0.09 0.09 — — — 0.31 1.34 149 East. Shoreditch 33.5 19.7 2.96 0.02 0.54 0.24 0.15 0.76 — 0.03 — 1.22 1.96 167 Bethnal Green 33.2 18.6 2.27 — 0.36 0.20 0.24 0.42 — 0.06 0.01 0.98 2.04 151 Stepney 35.3 17.7 2.58 0.00 0.52 0.19 0.20 0.45 — 0.07 0.00 1.15 1.72 141 Poplar 32.1 17.6 2.65 — 0.47 0.17 0.24 0.47 — 0.06 — 1.24 1.53 153 South. South wark 30.0 18.5 2.39 — 0.74 0.13 0.21 0.38 — 0.05 — 0.88 2.13 148 Bermondsey 33.3 18.7 2.21 — 0.48 0.13 0.14 0.29 — 0.06 — 1.11 1.79 148 Lambeth 28.3 14.9 1.50 — 0.31 0.10 0.12 0.26 — 0.03 — 0.68 1.38 115 Battersea 27.4 14.5 1.99 — 0.71 0.14 0.07 0.29 — 0.03 — 0.75 1.34 131 Wandsworth 260 12.6 1.46 — 0.34 0.11 0.11 0.29 — 0.04 — 0.57 1.02 119 Camberwell 25.6 13.7 1.30 — 0.30 0.11 0.07 0.25 — 0.03 — 0.54 1.21 124 Deptford 28.9 14.3 1.19 — 0.14 0.09 0.08 0.17 — 0.05 — 0.66 1.22 122 Greenwich 25.9 13.4 1.30 — 0.17 0.05 0.16 0.14 — 0.05 — 0.73 1.26 119 Lewisham 25.2 11.7 0.83 0 03 0.28 0.03 0.06 0.17 — 0.04 — 0.22 0.87 93 Woolwich 28.4 12.8 1.02 0.10 0.08 0.14 0.13 — 0.06 0.51 1.52 102 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 described Simple Continued Fever. 46 Table 13. Death rates during 190S 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. Death-rates per 1000 Living. Boroughs. All Causes. Scarlet Fever. Diphtheria Enteric Fever Phthisis. Before Distribution After Distribution Before Distri bution After Distribution Before Distribution . After Distribution Before Distribution After Distribution Before Distribution After Distribution County of London 15.6 15.1 0.12 0.12 0.12 0.12 0.05 0.05 1.46 1.42 West. Paddington 15.0 13 3 — 0.05 0. 01 0.02 0.03 0.03 0.92 0.96 Kensington 15.9 140 — 0.12 0.03 0.05 0.04 0.07 1.98 1.14 Hammersmith 12.0 13.9 — 0.09 0.01 0.18 0.03 0.04 0.83 1.16 Fulham 150 15.1 0.40 0.14 0.33 0.15 0.13 0.06 1.33 1.22 Chelsea 21.7 14.8 — 0.12 0.01 0.07 0.01 0.05 3.11 1.51 City of Westm 14-5 13.5 0.01 0.09 0.01 0.03 0.04 0.02 0.89 1.51 North. St. Marylebone 13.1 15.5 0.12 0.02 0.04 0.05 0.05 0.61 1.46 Hampstead 12.3 9.3 0.90 0.07 0.39 0.03 0.13 0.02 1.88 0.83 St. Pancras 15.9 15.8 0.11 0.05 0.11 0.03 0.03 1.58 1.52 Islington 14.2 14.5 0.01 0.11 0.04 0.10 0.03 0.05 1.50 1.26 Stoke Newington 10.2 12.9 — 0.06 0.06 0.09 — — 0.89 1.33 Hackney 14.9 14.0 0.19 0.08 0.28 0.11 0.18 0.12 1.24 1.15 Central. Holborn 20.1 17.5 0.07 0.20 0.07 0.09 0.07 1-62 2.84 Finsbury 10.4 19.0 0.02 0.21 — 0.12 — 0.09 0-86 2.02 City of London 40.9 17.4 0.04 0.04 0.36 0.09 0.09 — 1-79 1.34 East. Shoreditch 19.2 19.7 0.03 0.24 0.04 0.15 0.01 0.03 2.02 1.96 Bethnal Green 18.1 18.6 — 0.20 0.11 0.24 0.03 0.06 2.19 2.4 Stepney 18.6 17.7 0.02 0.19 0.12 0.20 00.5 0.07 1.52 1.72 Poplar 17.9 17.6 0.01 0.17 0.08 0.24 0.06 0.06 1.67 1.53 South. South wark 16.3 18.5 0.13 0.13 0.21 0.04 0.05 1.33 2.13 Bermondsey 14.9 18.7 0.02 0.13 0.02 0.14 0.02 0.06 1.62 1.79 Lambeth 15.7 14.9 0.18 0.10 0.21 0.12 0.04 003 1.27 1.38 Battersea 14.4 14.5 0.14 0.02 0.07 0.03 0.03 1.24 1.34 Wandsworth 11.8 12.6 0.26 0.11 0.17 0.11 0.06 0.04 1.01 1.02 Camber well 15.0 13.7 0.01 0.11 0.03 0.07 0.01 0.03 1.75 1.21 Deptford 10.0 14.3 0.09 0.03 0.08 0.03 0.05 0.74 1.22 Greenwich 17.7 13.4 0.47 0.05 0.47 0.16 0.16 0.05 1.81 1.26 Lewisham 12. 5 11. 0.50 0.03 0.24 0.06 0.03 0.01 0.78 0.87 Woolwich 11.7 12.8 0.01 0.08 0.03 0.14 0.02 0.06 0.48 1.52 * Taken from Registrar-General's Summary. 47 Table 14. Causes of, and Ages at, Death in the Borough of Lewisham jor the year 1905. 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 13 years 15 and under 25 years 25 and under 65 years 65 years and over Total all Ages Lee Lewisham Sydenham and Forest Hill Class I.—Infective Diseases 1 _2_ 3 4 9 6 7 8 9 10 11 12 13 1 Small-Pox — — — — 2 2 4 4 — 3 — 2 Measles 8 28 3 — 1 1 41 2 20 19 5 — 4 3 Scarlet Fever — 4 1 — — — 5 1 2 2 73 1 70 4 Typhus Fever — — — — — — — — — — — — — 5 Plague — — — — — — — — — — — — — 6 Influenza — — — 2 9 11 1 4 6 1 — 1 7 Whooping Cough 13 11 — — — — 24 2 9 13 — — — 8 Diphtheria 1 4 3 — — — 8 — 5 3 39 — 31 9 Enteric Fever — — 1 3 2 — 6 1 4 1 4 3 2 10 Epidemic Diarrhœa 12 2 — — — — 14 3 8 3 1 — 1 11 Epidemic Enteritis 17 1 — — — — 18 — 14 4 7 1 1 12 Dysentry — — — — — — — — — — — — 13 Venereal Diseases 2 — — — 2 — 4 — 1 3 3 1 1 14 Puerperal Septiœmia Fev — — — — 4 — 4 1 1 2 — — — 15 Infective Endocarditis — — — — 1 — 1 — — 1 — — — 16 Erysipelas — — — — 2 — 2 — 2 — 2 — — 17 Septicaemia not Puerperal 1 — 1 — 3 1 6 — 5 1 3 1 — 18 Pyaemia 1 — — — — 1 — 1 — 2 — 1 19 Other Septic Diseases — — 1 — 2 — 3 — 2 1 2 1 — Class II.— Tuberculous Diseases 20 Phthisis — 1 6 22 89 8 126 16 75 35 35 17 3 21 Meningitis 11 5 — 2 — 22 2 10 10 3 3 1 22 Peritonitis 1 — 1 1 — 4 — 2 2 3 — 2 23 Scrofula — — — — - — — — — — — — — 24 Other Tuberculous Dis — 4 3 1 6 1 20 1 13 6 6 2 1 Class III.— Malignant Diseases '25 Cancer, Carcinoma — — 1 — 59 44 104 21 51 32 18 9 4 26 Sarcoma — — 1 — 8 2 11 1 6 4 4 — — 27 Other Malignant Diseases — — — — 7 8 15 2 8 5 3 2 1 28 Meningitis (not Tuber.) 3 6 4 — — — 13 1 7 5 5 — 4 Class IV.— Nervous Diseases 29 Insanity (G. P. Insane) — — — — 22 21 43 3 31 9 12 16 — 30 Epilepsy — — — 1 5 1 7 1 4 2 5 3 4 31 Convulsions 23 6 — — — — 29 2 16 11 — 1 — 32 Locomotor Ataxy — — — 1 1 2 1 — 1 — — — 33 Paraplegia, Dis. of Cord — — — — 1 2 3 — 2 1 2 — 2 34 Other Nervous Diseases 2 1 2 — 9 3 17 3 8 6 6 6 1 Class V.— Diseases of Heart and Blood Vessels 35 Valvular Disease, Endocarditis — 1 4 6 38 27 76 8 43 25 24 — 1 36 Cerebral Hemorrhage 2 — — 2 19 28 51 5 36 10 22 1 11 37 Thrombosis — — — — 2 1 3 — 2 1 1 — — 38 Apoplexy, Hemiplegia — — — — 4 14 18 4 7 7 2 — 2 39 Aneurysm — — — 1 4 2 7 — 2 5 1 2 — 40 Embolism — — — 2 — 2 — 1 1 — 1 — 41 Thrombosis, not Cerebral — — — 1 1 — 2 1 1 — — — — 42 Other Dis. Heart and Blood Vessels 9 1 2 4 40 48 104 13 56 35 16 9 8 48 Table 14 -continued. Deaths Whole Borough Borough Divisions Deaths in Public Institutions in Borough Deaths of Residents outside Borough Deaths of Non-residents in Borough Causes of Death Under 1 year 1 and under 3 years 5 and under 15 years 15 and under 25 years 23 and under 65 years 63 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) 44 Bronchitis 15 5 — 2 32 77 131 11 79 41 46 2 17 45 Pneumonia 27 19 7 — 32 23 108 9 68 31 26 5 18 46 Asthma Emphysema — — — — — 2 2 — 2 — — — — 47 Pleurisy — — 1 — 2 5 8 2 3 3 — — — 48 Other Respiratory Dis. 4 3 2 — 4 5 18 4 8 6 3 1 — Class VII.— Digestive Diseases 49 Enteritis (not Epidemic) 9 1 — — 1 — 11 1 8 2 2 1 1 50 Gastro Enteritis 9 3 1 — 1 — 14 — 11 3 — — — 51 Peritonitis (not — — 1 2 2 —_ 5 1 3 1 — 3 _ peral) 52 Cirrhosis of Liver — — — — 21 4 25 1 17 7 3 1 2 53 Gastric Ulcer — — — 4 3 1 8 2 3 3 1 1 1 tion of) 54 Other Digestive Diseases 87 12 2 1 11 14 127 16 71 40 46 5 6 Class VIII.— Class Urinary IX. Diseases 55 Nephritis, Acute — 1 1 2 3 2 9 — 5 4 3 1 — 56 Bright's Disease — — — 1 22 12 35 3 25 7 7 5 2 57 Other Urinary Diseases — — — — 5 8 13 2 7 4 3 2 1 58 Generative Organs — — — — 5 — 5 1 1 3 2 — — eases of 59 Old Age — — — — 2 149 151 18 76 57 79 2 29 Class X.General Diseases 60 Premature Birth 57 — — — — _ 57 4 33 20 2 — — 61 Chronic Rheumatism — _— — — — 2 — — 2 — — — — 62 Rheumatic Fever — — 3 — 3 — 6 — 3 3 — — — 63 Parturition, Diseases and — — — 2 4 — 6 — 4 2 1 — Accidents of 64 Alcoholism — _ — — 10 1 11 3 5 3 6 1 — 65 Gout — — — 4 3 7 — 7 4 — 1 66 Diabetes Melletus _ — 1 4 4 4 13 3 5 5 3 — — 67 All Other Diseases 21 — 1 1 14 8 45 3 30 12 10 2 — Class XI.— Accidents 68 Burning _ 3 —_ — 2 2 7 — 7 4 — 1 69 Overlaying 3 — — — — — 3 — 2 1 — — — 70 Poison — — — — 1 — 1 — — 1 — — — 71 Drowning — — — — — — — — — — — — — 72 Other Accidents 1 1 I 1 10 7 21 3 14 4 5 4 1 Class XII.Vio lence 73 Homicide 1 — — 1 — 2 — 1 1 — — — 74 Suicide — — — 1 7 1 9 3 8 3 3 — — Grand Totals 338 130 59 63 547 554 1691 186 966 539 569 119 232 Note—Columns 1 to 10 include deaths of Residents in the Borough, in outside Districts and in Public Institutions, 49 Table 15. Residents and Non-Residents dying in Public Institutions situated in the Borough, 1905. Institution. Deaths of Residents. Deaths of NonResidents. Total. The Park Hospital 12 114 126 Lewisham Infirmary 307 30 337 Lewisham Workhouse 13 — 13 Bermondsey (St. Olave's) Workhouse 1 65 66 St. John's Hospital 3 14 17 Home for Sick Children, Lower Sydenham 2 6 8 Greenwich Union Workhouse, Grove Park 1 — 1 Flower House, Southend 1 — 1 Totals 340 229 569 In addition to the above, deaths of non-residents occurred as follows:—Two on the London, Brighton and South Coast Bailway and one in Canonbie Road. 50 Table 16. Deaths from Principal Zymotic Diseases in Wards, during the year 1905. Localities Small-Pox Measles Scarlet Fever Diphtheria Whooping Cough Typhus Fever Enteric Fever Pyrexia *(origin uncertain) Epidemic Diarrhœa& Epidemic Enteritis Dysentery. Totals Death Kates from Principal Zymotic Diseases. Church Ward — 2 — — 1 — 1 — 1 — 5 0.74 Manor Ward — — 1 — — — — — 1 — 2 0.28 South Ward — — — — 1 — — — 1 — 2 0.36 Lee Division — 2 1 — 2 — 1 — 3 — 9 0.46 Blackheath Wd — 2 — 1 1 — — — 1 — 5 0.73 Lew. Vill. Wd. 3 10 — 1 1 — 1 — 6 — 22 1.50 Lew. Pk Wd. 1 — 1 — — — — — 6 — 8 0.52 Brockley Ward — 3 1 — 3 — — — — — 7 0.61 Catford Ward — 5 — 3 4 — 3 — 9 — 24 0.79 Lewisham Div. 4 20 2 5 9 — 4 — 22 — 66 0.84 Forest Hill Wd. — 9 1 3 5 — — — 2 — 20 1.09 Sydenham Ward — 10 1 — 8 — 1 — 5 — 25 0.94 Sydenham and Forest Hill Div. — 19 2 3 13 — 1 — 7 — 45 0 .98 Whole Borough 4 41 5 8 24 — 6 — 32 — 120 0. 83 County of London 10 1715 549 553 1507 — 246 3410 — 7990 1.70 76 Great Towns 51 6058 2081 2527 4507 — 1252 12877 — 29353 1.88 * Originally termed Simple Continued Fever. 51 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 1905. Disease. Lee Division. Lewisham Division. Sydenham and Forest Hill Div. Whole Borough , County of London. 76 Great Towns. Small-Pox — 0.05 — 0.03 0.00 0.00 Measles 0.10 0.25 0.41 0.28 0.37 0.39 Scarlet Fever 0.05 0.03 0.04 0.03 0.12 0.13 Diphtheria — 0.06 0.07 0.06 0.12 0.16 Whooping Cough 0.10 0.11 0.28 0.17 0.32 0.29 Enteric Fever 0.05 0.05 0.02 0.04 0.05 0.08 EpidemicDiarrhœa and Enteritis 0.15 0.28 0.15 0.22 0.73 0.82 Dysentery — — — — — — Total Zymotic Death Rates 0.46 0.84 0.98 0.83 1.71 1.88 Infantile Mortality Rate 46 103 94 93 129 140 Phthisis Death Rate 0.82 0.95 0.76 0.87 1.41 — Comparative Rates for other Boroughs will be found in Table 12. 52 Table 18. Deaths from Principal Zymotic Diseases arranged in Age Groups, for the year 1905. Ages. Small-Pox. Measles. Scarlet Fever Diphtheria. Whooping Cough. Enteric Fever. Epidemic Diarrhoea and Enteritis. Dysentry. Totals in Age Groups. Under 1 year — 8 — l 13 — 29 — 51 1 and under 5 years — 28 4 4 11 — 3 — 50 5 and under 15 years. — 3 1 3 — 1 — — 8 15 and under 25 years — — — — — 3 — — 3 25 years and upwards 4 2 — — — 2 — — 8 Total all ages 4 41 5 8 24 6 32 — 120 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. 53 Table 19. Meteriologica! Table for London far the Year 1905 (Deduced from Observations at Greenwich, under the Superintendence of the Astronomer Royal.) 1905. Barometer. AIR TEMPERATURE Bright Sunshine. Rain and other forms of Precipitation Mean pressure at 32 ºF. at Station Level (Bar. 159 ft. 1 above M.S.L.) Mean of Absolute Minimum & Maximum. Total possible Total observed Number of Days. Total Fall. Most in a day. Month. A B Minimum. Day of M onth Maximum. Day of Month. Amount Day of Month. Minimum Maximum Ins 0 0 0 0 Hours Hours Ins. Ins. January 30.101 32.4 43.6 19.5 1 54.0 7 259 49.1 8 1.00 0.38 17 February 29.992 37.9 46.8 31.2 20 53.5 16 277 67.4 13 0.72 0.16 26 March 29.594 38.2 52.6 27.1 4 61.4 22 366 121 7 22 3.56 0.93 15 April 29.675 39.8 54.7 811 9 64.9 14 414 96.7 17 1.70 0.56 10 May 29.950 43.4 64.5 34.3 23 82.3 29 481 234.7 8 1.33 0.44 3 June 29.773 51.7 68.8 46.1 7 80.1 27 495 153.2 18 4.32 1.08 5 July 29.882 56.4 77.5 48.2 7 87.2 26 498 226.5 8 0.92 0.34 23 August 29.721 52.0 71.0 44.6 24 76.9 8 451 192.3 13 2.54 0.61 28 September 29.790 49.2 64.0 41.4 15 75.1 3 379 110.6 13 2.31 0.42 25 October 29.848 38.2 52.4 26.1 17 59.6 9 330 90.1 15 0.91 0.26 29 November 29.529 35.3 47.2 23.1 22 54.9 26 266 54.6 18 3.12 0.46 11 December 30.072 35.7 44.6 25.4 11 57.3 7 244 23.3 8 0.60 0.17 8 Year 29.827 42.5 57.3 — — — — 4460 1420.2 161 23.03 — — Abstracted from the report of the Registrar-General. PART 2. INFECTIOUS DISEASES. 57 NOTIFIABLE INFECTIOUS DISEASES. The infectious diseases notifiable under Section 55 of the Public Health (London) Act, 1891, are:—Small-Pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, the diseases known as Scarlatina or Scarlet Fever, and the Fevers known by any of the following names:—Typhus, Typhoid, Enteric, Relapsing, Continued or Puerperal. The total number of cases notified during the year amounted to 898, of which number 630, or 70 per cent., were removed for isolation to the Metropolitan Asylums Board's Hospitals and other Institutions. In 48 instances, or 7.62 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 850 cases of infectious disease notified as occurring in the Borough during the year, an increase of nearly 300 over the number notified in the preceding year, which was 552. In 1903, 832 cases were notified, and in 1902, 1,282. Age Periods.—Fifty per cent. of the Scarlet Fever cases, compared with 54 per cent. in 1904, and 50 per cent. of the Diphtheria cases, compared with 44 per cent. in 1904, occurred among children aged six years and under. 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:— Age. Scarlet Fever. Diphtheria. 1903. 1904. 1905. 1903. 1904. 1905. 6 years and under 46% 54% 50% 55% 44% 50% 5 „ „ 38% 44% 36% 43% 40% 42% 4 „ „ 28% 29% 25% 28% 34% 34% 58 Table 20. Age Periods of Cases of Scarlet Fever and Diphtheria, notified during the year, 1905. Age Periods. Scarlet Fever. Diphtheria. Number of Cases. Percentage to Total Cases Number of Cases. Percentage to Total Cases Under 1 year 3 0.54 5 3.42 1 to 2 years 14 2.55 1 0.70 2 ,, 3 „ 38 6.93 13 9.15 3 „ 4 ,, 29 5.29 13 9.15 4 „ 5 „ 54 9.85 17 11.97 5 „ 10 „ 248 45.25 43 30.28 10 „ 15 „ 83 15.14 15 10.56 15 „ 25 „ 46 8.39 17 11.97 25 years and over 33 6.02 18 12.69 At all ages 548 100.00 142 100.00 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 23). The attack rate from all notifiable diseases for the whole Borough during the year amounted to 5.88 per 1,000 of the population, compared with 3.93 in 1904, and 6.09 in 1903. The attack rate for the County of London was 7'01, compared with 6.08 in 1904. The attack rates for the Wards will be found in Table 22. It will be seen that Manor Ward, in Lee, had the greatest number of cases in relation to its population, having an attack rate of 11.10 per 1,000. The lowest attack rate was in Sydenham Ward, 3.61 per 1,000. Chart C. Showing Weekly Notifications of all Infectious Diseases; also Weekly Notifications of Scarlet Fever and Diphtheria, during the year 1905. 59 Table 21. Number of Cases of Infectious Diseases notified in the Ten Wards and the Whole Borough during the year 1905. Wards. Small Pox. Scarlet Fever. Diphtheria. Enteric Fever Erysipelas. Puerperal Fever. All Notifiable Infectious Diseases. Church — 14 8 2 5 1 30 Manor — 63 9 — 8 — 80 South — 33 4 2 1 — 40 Lee Division — 110 21 4 14 1 150 Blackheath — 23 12 — 4 — 39 Lewisham Village 7 71 11 5 12 — 106 Lewisham Park 1 58 13 2 10 — 84 Brockley — 55 4 3 14 — 76 Catford — 112 25 9 24 1 171 Lewisham Division 8 319 65 19 64 1 476 Forest Hill — 72 31 5 15 1 124 Sydenham — 47 25 5 16 7 100 Sydenham and Forest Hill Division — 119 56 10 31 8 224 Whole Borough 8 548 142 33 109 10 850 60 Table 22. Attack rates from the Principal Infectious Diseases per 1000 of the population for the ten Wards and the whole Borough in the years 1903, 1904 and 1905. Wards. Diseases Small-Pox Scarlet Fever Diphtheria Enteric Fever Erysipelas Total 1903 1904 1905 1903 1904 1905 1903 1904 1905 1903 1904 1905 1903 1904 1905 1903 1904 1905 Church — — — 1.66 0.74 2.06 3.02 0.74 1.18 0.15 — 0.29 0.60 0.45 0.73 5.44 2 08 4.56 Manor — — — 4.44 2.25 8.74 4.44 0.28 1.38 0.43 — — 0.56 — 1.11 9.88 2.53 11.10 South — — — 2.70 2.87 5.89 1.08 1.07 0.71 — 0.36 0.35 0.18 — 0.17 3.96 4.30 7.14 Blackheath — — — 2.80 2.20 3.36 3.39 1.17 1.75 0.29 — — 0.44 1.17 0.58 6.92 4.70 5.71 Lewisham Village — — 0.47 1.96 3.39 4.85 3.64 0.62 0.75 0.35 0.27 0.34 0.77 0.76 0.82 6.87 5.05 7.24 Lewisham Park — — 0.06 4.25 2.29 3.76 1.12 0.90 0.84 0.37 0.07 0.13 0.44 0.55 0.64 6.19 3.82 5.44 Brockley — — — 2.40 3.87 4.77 1.42 0.97 0.34 0.17 0.17 0.26 0.44 0.43 1.21 4.44 5.53 6.60 Catford — — — 5.43 1.90 3.66 1.25 0.83 0.81 0.29 0.10 0.29 0.51 0.52 0.78 7.68 3.43 5.60 Forest Hill 0.05 — — 2.47 1.97 3.93 0.99 0.71 1.69 0.16 0.22 0.27 1.04 0.88 0.82 4.73 3.89 6.78 Sydenham — — — 2.57 1.96 1.69 1.32 0.96 0.90 0.53 0.26 0.18 0.56 0.59 0.57 5.04 3.81 3.61 Whole Borough 0.00 — 0.05 3.28 2.29 3.79 1.83 0.83 0.98 0.31 0.16 0.22 0.60 0.58 0.75 6.09 3.93 5.88 61 SMALL-POX.—Nine cases of Small-Pox were notified during the year, all of which were removed to Hospital. One case was returned home as not suffering from Small-Pox, thus giving a total of eight cases, equal to an attack-rate of 0'05 per 1,000 of the population. Case 1.—G.L. Male. Aged 44 years. Leahurst Road. On Saturday, January 7th, a medical practitioner requested me to visit the case, which he and another practitioner considered doubtful. On examining the patient I was of opinion that he was suffering from Hæmorrhagic Small-Pox (the most severe form), and he was removed to hospital. The patient died on January 9th. Every precaution was taken, and all contacts were vaccinated and kept under observation. No further cases occurred. The source of infection was impossible to trace, the patient, who was a commercial traveller, having visited many towns prior to his illness. Case 2.—Ernest A. Day. Aged 16 years. 76, Mill Road, Lewisham. Errand Boy. Case 3.- John Day. Aged 71 years. 76, Mill Road. Case 4.—Susan Day. Aged 72 years. 76, Mill Road. Case 5.—John Alfred Day. Aged 44 years. Plasterer. 76, Mill Road. Case 6.—Henrietta Day. Aged 45 years. 76, Mill Road. Case 7.—Eleanor Pollard. Aged 36 years. 56, Loampit Vale. Case 8.—T. C. Aged 50 years. Marsala Road. The following is a synopsis of the Report which I presented to the Public Health Committee with regard to the above cases:— 62 On April 20th a medical practitioner requested me to visit with him a patient, whom he had seen for the first time that morning, and who had a rash which he considered suspicious. On arrival at the house I examined all the occupants. I found John Day suffering from Hæmorrhagic or Black SmallPox ; Susan Day in the preliminary stages of severe Small-Pox; John Alfred Day and Henrietta Day (who were about the house) in the early stages of modified Small-Pox. While we were examining these persons, another member of the family, a boy named Ernest Alfred Day, who had been treated since the beginning of the month for Chicken-Pox, and who had been playing in the streets, returned indoors, and on examining him we found that he showed distinct evidence of Small-Pox in its later stages. Each of these persons was stated to have been vaccinated in infancy, but there was no evidence of re-vaccination. Immediate steps were taken to remove all the patients to hospital. Two children in the house who were not affected were removed to the Council's Shelter in Hither Green Lane. The contents of the house were removed to the Disinfecting Station, the whole of the walls and passages were stripped, and the premises disinfected. Your Medical Officer, with Inspectors Cooper and Knappett, immediately commenced a house-to-house enquiry at the 91 houses in Mill Road. This was continued daily for 16 days, and any cases of sickness or indisposition were reported to me. I then visited the house, and if no doctor was in attendance, examined the person, and fortunately was able to remove any suspicion. Direct and indirect contacts in Mill Road and other places were traced, and kept under observation. As a result, on Sunday April 23rd I was informed of the illness of Mrs. 63 Eleanor Pollard, residing at 56, Loampit Vale, who was aunt to the boy Day. I visited her in company with the medical practitioner who was attending her, on Sunday and twice on Easter Monday, on which day we were satisfied that she shewed early symptoms of a severe form of small-pox. She was removed to hospital the same day, and her husband, two children, and a friend staying with her were removed to the Shelter. A member of the Day family who was in service in Brownhill Road was also removed to the Shelter on April 21st. Fatal Cases.—In the cases of John Day, Susan Day and Eleanor Pollard, the disease proved fatal. Direct Contacts removed to Hither Green Shelter:— Robert Day. Aged 11. 76, Mill Road. Kitty Day. Aged 5. „ „ Maud Day. Aged 16. (Servant in Brownhill Road). Charles Pollard, from 56, Loampit Vale. Ruth Smith „ „ Herbert Howard „ „ Infant Pollard „ „ Several other indirect contacts were kept under observation at their homes. Vaccination.—On April 20th, fearing that the Public Vaccinator might be unable to obtain the necessary vaccine owing to the approaching holidays, I obtained a supply of 40 tubes, which was most useful in preventing delay. Dr. Barnett, the Public Vaccinator, and Mr. Atkins, the Vaccination Officer, rendered most valuable assistance. In consequence of their efforts 43 persons in the infected area were vaccinated without any loss of time. Laundries.—In tracing the movements of the boy Day we found that he had visited two domestic laundries, and was to 64 have conveyed clothing to various homes on the Friday. We immediately took possession of all clothing found on these premises and submitted it to thorough disinfection. Prior to April '20th the boy had delivered laundry to two houses, one of which was outside our district. The owners were warned in respect of this laundry. Pawnbroking.—There was reason to believe that the Days had pawned articles of clothing during the time their premises were infected. The sanitary inspectors, with commendable promptitude, discovered this suspicion to be wellfounded, and secured four bundles of clothing pawned since April 1st. These, together with parcels which had been in close proximity, were readily handed over for disinfection, and were returned to the pawnbroker. Power to remove Contacts to Shelter.—Ruth Smith, who was in close attendance upon Mrs. Pollard, at 56, Loampit Yale, refused to enter the Shelter, as she had to support her mother. In order to overcome this difficulty, and there being no legal power to remove or detain her, I arranged to give her some work while in the Shelter, paying her 10s. 6d. per week. With regard to the man Pollard, his wife was dangerously ill in Hospital, and on being notified of this by the Authorities, he demanded to go and see her. He visited the Hospital each day, afterwards returning to the shelter. His period of detention in the Shelter was consequently increased. Source of Infection.—Every effort was made to trace the source of infection, but we were unable to obtain any distinct evidence. For some time prior to his illness the boy Day had been visiting the various docks in search of work, where, of course, it is possible he may have contracted the disease. 65 No extension of the disease occurred, except to a member of our Disinfecting Staff, who contracted the disease in a modified form. Contacts from other Districts and suspicious Cases.— Early in February we received information that certain individuals in our district had been in contact with cases of smallpox in Deptford and Woolwich. These persons were kept under observation for 14 days. In regard to one particular case in Deptford, a woman had been removed to hospital suffering from small-pox. Her husband immediately removed her infant, whom she had been nursing, to a house in Como Road. Forest Hill. Information was obtained of this incident within a short time of the child's arrival, and it was removed to the Council's Shelter, and kept under observation for 16 days. No infection followed. On Sunday, July 30th, my opinion was invited in regard to a suspicious case at Forest Hill. On examining the patient I came to the conclusion that the case was one of aggravated chicken-pox, which diagnosis subsequently proved correct. Similar results occurred in regard to two other suspected cases which were seen, one on January 14th at Westbourne Road, and the other on May 16th at Longhurst Road. SCARLET FEVER.—The total number of cases notified during the year amounted to 576, compared with 339 in 1904, and 466 in 1903. Of these cases 459, or 79 per cent., were removed to the Metropolitan Asylums Board's Hospitals. Subsequently 28 of the cases were returned to their homes, and stated to be not suffering from any infectious disease. Deducting this number, a corrected total of 548 is obtained, equal to an attack rate of 66 3.79 per 1,000 persons, compared with 2.29 in 1904, an increase of 1.50. (See Table 22). An examination of the attack rates for the various Wards shows that the highest occurred in Manor Ward (8'74 per 1,000) and that the Ward least affected was Sydenham, with 1.69. Forty-five per cent. of the total cases occurred among children between the ages of 5 and 10 years, while 25 per cent. of the cases occurred to children under the age of 5 years. Case Mortality.—Of the 548 cases only 0.91 per cent. proved fatal, compared with 2.17 per cent. in the preceding year. It will be seen that although there was a considerable increase in the number of cases notified compared with the previous year, the disease was of a much milder form, as is shown by the very small case mortality. DIPHTHERIA.—One hundred and fifty-seven cases of Diphtheria were notified, of which number 116, or 74 per cent., were removed to hospital. Fifteen cases were returned home as not suffering, giving a corrected total of 142, a slight increase over the figure for the preceding year (117). The attack rate per 1,000 of the population amounted to 0.98, compared with 0.83 in 1904, and 1.83 in 1903. Blackheath Ward suffered most from this disease, having an attack rate of 1.75. The Ward least affected was Brockley, with an attack rate of 0.34. Case Mortality.—Of the 142 cases, 8, or 5.6 per cent., proved fatal, compared with 11.1 per cent. in 1904. In this disease also, although the number of cases shows a slight increase over the preceding year, the case mortality is very much smaller. 67 ENTERIC or TYPHOID FEYER.—Thirty-seven cases were notified, 22 of which were removed to Hospital. Four were returned home as not suffering, giving as corrected total of 33, an increase of 10 over the preceding year. The attack rate for the whole Borough was 0.22 per 1,000, compared with 0.16 per 1,000 in 1904. The highest attack rate was in South Ward, Lee, with an attack rate of 0.36. This Ward was also the highest in 1904, with 0.35 per 1,000. The case mortality equalled 18.18 per cent., against 8.7 per cent. in 1904. ERYSIPELAS.—One hundred and nine cases of Erysipelas were notified, compared with 82 in the preceding year. PUERPERAL FEYER.—(Fever occuring subsequent to child-birth). During the year 10 cases of puerperal fever were notified, 2 of which were removed to the Lewisham Infirmary. Four cases proved fatal. Case 1 Aged 28 years Church Street, Lee Case 2 Aged 38 years Maddin Road, Lower Sydenham Case 3 Aged 37 years Garthorne Road, Forest Hill Case 4 Aged 32 years De Frene Road, Sydenham Case 5 Aged 40 years Porthcawe Road, Lower Sydenham Case 6 Aged 39 years Porthcawe Road, Lower Sydenham Case 7 Aged 19 years Porthcawe Road, Lower Sydenham Case 8 Aged 20 years Porthcawe Road, Lower Sydenham Case 9 Aged 21 years Porthcawe Road, Lower Sydenham Case 10 Aged 31 years Arngask Road, Catford It will be seen that 5 of the cases occurred in Porthcawe Road, and 1 in Maddin Road, Lower Sydenham. The inhabitants of both these roads are of the poorest class, and 68 frequent house-to-house inspection has revealed the fact that the majority of the houses are nearly always in a dirty condition, a state of affairs which favours this disease. Our investigations elicited the fact that all the cases in the two roads mentioned occurred in the practice of two unregistered midwives, each having three cases during the year. It is unfortunate, in my opinion, that these women are allowed to attend confinement cases. From the knowledge which I possess of the women, I consider their practice must be a danger. Bearing this in mind, one is reminded that we have an Act of Parliament in force for securing the better training of midwives and to regulate their practice, entitled the Midwives Act, 1902. We have also a Central Midwives Board, formed under this Act, who have power to regulate the issue of certificates, the course of training for midwives, the admission of women to the roll of midwives, and to regulate within due limits the practice of midwives, and the conditions under which they may be suspended. Then we have the local supervision of midwives. In London this duty is deputed to the London County Council, who have the power, which up to the present they have not used, of delegating to the Local Authority the powers and duties imposed upon them by the Act. One is forced to admire the very stringent regulations made in regard to registered midwives, but a great omission is made, in respect of persons who do not apply for registration. The women referred to in this report are never likely to apply to be registered, nor, under any condition, would they be accepted. Therefore they are enabled to continue their work without any interruption or interference until the expiration of the period of grace fixed by the Act, viz., April 1st, 1910. The Act states that "From and after April 1st, 1910, no women shall habitually and for gain attend women in child-birth unless she is certified under 69 this Act, except under the direction of a qualified medical practitioner." After each case everything in our power was done to prevent the risk of infection, but to these women it matters little how much disinfection is carried out, either to their clothing or person, the surroundings in which they live quickly renewing their condition. We have pointed out to them the desirability of their ceasing attendance upon women during confinement, and have recently warned them that in the event of further fatal cases occurring in their practice the attention of the Coroner will be drawn to the matter. In regard to the 4 cases occurring in other parts of the Borough, there was no reason to suspect any special cause of infection. 70 Table 23. Attack Rates per 1,000 persons living at all ages from Small-Pox Scarlet Fever and Diphtheria in the Metropolitan Borough and the County of London for the years 1903, 1904, and 1905 Borough. Small-Pox. Scarlet Fever. Diphtheria. All Notifiable Infectious Diseases. 1903 1904 1905 1903 1904 1905. 1903 1904 1905. 1903. 1904. 1905. Paddington 0.03 0.03 0.01 2.85 2.47 1.88 1.02 0.96 0.65 5.09 4.66 3.82 Kensington 0.02 0.02 — 1.87 1.48 1.87 1.00 1.04 0.72 4.31 3.67 3.79 Hammersmith 0.06 — — 2.72 2.42 3.02 1.43 1.74 2.03 5.73 5.64 6.53 Fulham 0.07 — — 2.74 1.93 4.96 1.98 1.96 1.81 6.27 5.06 8.21 Chelsea 0.09 — — 2.81 1.45 3.03 1.32 0.82 0.72 5.23 3.14 5.15 City of Westminster 0.26 0.03 0.01 1.96 1.76 2.09 1.03 0.81 0.68 4.31 3.66 3.79 St. Marylebone 0.03 0.06 — 3.15 2.25 2.14 1.73 0.90 1.01 6.87 4.98 4.80 Hampstead 0.01 0.01 — 2.04 1.83 2.04 1.00 0.66 0.74 3.90 3.66 3.52 St. Pancras 0.13 0.03 0.01 2.79 3.59 4.17 2.21 1.48 1.21 6.48 6.81 6.71 Islington 0.03 0.05 0.00 2.55 3.37 3.49 2.21 1.01 1.02 5.06 5.71 5.62 Stoke Newington 0.03 0.15 0.02 1.67 2.93 3.36 0.76 1.16 1.49 3.78 5.58 5.62 Hackney 0.01 0.05 0.01 2.97 3.79 4.66 2.43 2.33 1.68 8.01 8.48 8.40 Holborn 0.03 0.10 0.01 2.48 1.71 2.76 0.89 0.80 0.81 6.02 4.79 4.65 Finsbury 0.02 0.15 0.01 2.93 3.34 4.88 1.29 1.47 1.42 5.92 6.56 8.01 City of London — 0.08 — 2.97 1.36 3.38 1.10 1.70 0.71 5.09 4.64 5.35 Shoreditch — 0.12 0.01 2.20 2.93 6.80 1.31 1.66 1.56 5.68 6.64 9.11 Bethnal Green 0.02 0.96 0.03 3.01 5.07 6.09 1.86 3.26 2.33 7.07 11.59 10.53 Stepney 0.08 0.29 0.03 2.90 4 15 6.03 1.79 2.70 2.09 6.73 9.38 10.29 Poplar 0.16 0.24 — 2.65 3.22 5.81 2.50 3.94 2.88 6.77 9.25 10.38 Southwark 0.19 0.13 — 2.46 1.99 3.72 1.70 1.34 1.45 6.17 5.41 7.00 Bermondsey 0.05 0.14 — 3.08 3.50 5.82 1.34 1.49 1.29 6.66 7.19 8.73 Lambeth 0.23 0.08 — 2.42 2.12 3.27 1.12 1.05 1.46 5.06 4.44 5.96 Battersea 0.21 0.04 — 2.73 2.19 4.77 1.81 1.29 1.08 6.18 4.84 7.13 Wandsworth 0.11 0.02 0.00 3.28 2.95 5.61 2.13 1.56 1.31 6.94 5.94 8.33 Camberwell 0.07 0.07 0.04 2.50 3.52 4.46 1.37 1.00 0.91 5.25 6.20 7.04 Deptford 0.01 0.09 0.01 4.46 3.56 5.30 4.05 1.72 1.29 10.08 7.06 8.30 Greenwich 0.04 0.01 0.03 1.64 2.09 2.77 2.08 1.49 1.40 5.01 4.94 5.42 Lewisham 0.00 — 0.05 3.28 2.29 3.79 1.83 0.83 0.98 6.09 3.93 5.88 Woolwich 0.04 0.06 0.05 3.21 3.80 4.09 1.51 1.32 2.18 5.64 6.04 7.31 County of London 0.09 0.10 0.01 2.71 2.89 4.15 1.67 1.55 1.38 6.00 6.08 7.01 *Note.—Chicken Pox, which was notifiable during parts of 1903 and 1904, has been omitted 71 MEASLES, WHOOPING COUGH, AND CHICKEN POX. These diseases, not being compulsorily notifiable, are brought to our attention chiefly by notifications from the Head Teachers of the various Schools in the Borough, in compliance with the regulations contained in the School Management Code. Measles.—Where cases of Measles occurred in the poorer districts the homes were visited by the Women Sanitary Inspectors with the view of impressing the parents with the very infectious nature of the disease, and the precautions to be taken to prevent its spread. Two hundred and twenty.seven visits were made for this purpose. Chicken-Pox.—Three hundred and forty-two children were notified to be suffering from this disease, and the Women Sanitary Inspectors made 255 visits to the various homes. Their report sometimes made it necessary for me to visit the house. INFECTIOUS DISEASES NOTIFIED FROM SCHOOLS. Number of children suffering. Children excluded on account of infection in their homes. Measles 1205 1449 Chicken Pox 342 207 Whooping Cough 240 77 Ringworm 169 — Mumps 109 102 SCHOOLS AND INFECTIOUS DISEASES. MEASLES.—This disease was prevalent in the Borough during the early part of 1905, and a recrudescence occurred at the latter end of the year. Careful observation was kept upon all the Schools, which resulted in the closure of the Infants' Department in a number of cases. 72 In the Report of the Education Committee of the London County Council for the year ended March 31st, 1905, the following appears :— "School or class closure in each case is decided on individually and upon its merits. We can now get the returns from the school so quickly that it is safe to judge as to school infection from these returns. As a rule, when measles appear in a single class of an infants' school closure is applied, but where several classes are affected from the first, and especially where several schools in a district are affected, it is held that the district is generally affected, and experience has shown that school or class closure is of no benefit. "Excepting the Borough of Lewisham the method of closing a school on account of the prevalence of measles, and because the attendance has dropped 10 or 20 per cent., has now been abandoned throughout the Metropolis." I am at a loss to understand upon what grounds the statement that in Lewisham the schools are closed because the attendance has dropped 10 or '20 per cent., is based. I am in perfect accord with the view that if school closure in consequence of measles is to be of any benefit, such closure must be accomplished upon the appearance of the first cases. This has been our invariable rule, and in 17 cases we were able to obtain the closure of the class-rooms apparently before the Education Authority were aware of the danger existing. In seven instances, however, the Education Authority were before us in ordering the closure, in some of which cases the Head Teachers had omitted to send us the notifications as directed by the School Management Code. In nearly every case where the closure of the class-rooms was effected it was followed by considerable benefit. The following is a list of the schools closed during the year on account of the prevalence of measles among the scholars:— 73 Kilmorie Road L.C.C. School.—Infants' Department closed by Council, January 10th to 30th. Kilmorie Road L.C.C. School.—Junior Mixed Department closed by Council, January '20th to 30th. Dalmain Road L.C.C. School.—Infants' Department, Class-room F, closed by L.C.C., February 3rd to 13th. Lewisham Bridge L.C.C. School.—Infants' Department, Class-room D, closed by L.C.C., February 6th to 20th. Lewisham Bridge L.C.C. School.—Infants' Department closed by Council, February 27th to March 20th. Brockley Road L.C.C. School.—Infants' Department closed by Council, March 10th to 31st. Southend National School.—Whole School closed by Council, March 16th to April 6th. Torridon Road L.C.C. School.—Infants' Department, Class-room A, closed by L.C.C., March 19th to 26th. Beacon Road L.C.C. School.—Infants' Department closed by Council, March 27th to April 17th. St. Mary's National School, Lewisham.—Infants' Department closed by Council, March 25th to April 15th. Holbeach Road L.C.C. School.—Infants' Department, Class-room H, closed by Council, April 3rd to 17th. Sandhurst Road L.C.C. School.—Infants' Department, Class-room G, closed by Council, April 6th to 20th. Ennersdale Road L.C.C. School.—Infants' Department closed by Council, April 13th to 27th. Plassy Road L.C.C. School.—Infants' Department closed by Council, April l^h to 27th. Manor Lane L.C.C. School.—Infants' Department, Class-room C, closed by L.C.C., May 16th to June 7th. 74 Rathfern Road L.C.C. School.—Infants' Department, Class-room B, closed by L.C.C., May 24th to June 3rd. Dalmain Road L.C.C. School.—Infants' Department, Class-rooms F, G and H, closed by Council, October 11th to 25th. Stillness Road L.C.C. School.—Infants' Department, closed by Council, October 31st to November 21st. Christ Church National School, Forest Hill.—Infants' Department, closed by Council, November 2nd to 23rd. Dalmain Road L.C.C. School.—Infants' Department, closed by Council, November 3rd to 25th. Holy Trinity National School.—Infants' Department, Babies' Class-room, closed by L.C.C., November 6th to 20th. Baring Road L.C.C. School.—Infants' Department, Class-rooms A, B, C and D, closed by Council, November 15th to December 7th. Brownhill Road L.C.C. School.—Infants' Department, Class-room A. closed by L.C.C., November 20th to December 4 th. Haseltine Road L.C.C. School.—Infants' Department, Class-rooms A and B, closed by Council, December 6th to 27th. List of Schools closed in consequence of Scarlet Fever. Northbrook National Schools, Lee.—Infants' Department closed by Council, February 20th to March 14th. 58, Ellerdale Street, Lewisham (Private School).— School closed by Council, March 28th to April 11th. 75 NOTIFICATION OF INFECTIOUS DISEASES BY SCHOOL TEACHERS. Several instances occurred of teachers failing to give notice to the Medical Officer of Health of the absence of children on account of the existence of various infectious diseases. Certain diseases are notifiable by medical attendants, under the Public Health (London) Act, viz., small-pox, diphtheria, cholera, membraneous croup, erysipelas, scarlatina, scarlet fever, and the fevers known by any of the following names:—typhus, typhoid, enteric and relapsing. Chicken-pox is also at times notifiable. In addition to these diseases there are also the following non-notifiable infectious diseases dangerous to school children:— measles, mumps and whooping cough. If any child shows symptoms of any of the above diseases or comes from a house where such disease is known to exist, it must be dealt with in the following manner:— " When no notice has been received from the Medical Officer of Health for the district, the head teacher of the department which the child is attending must at once furnish the Medical Officer of Health for the district with the name and address of the child and the reason for its exclusion." It is more particularly in regard to measles that this information from schools is most valuable. In several instances we were informed by teachers that they were completely ignorant of the fact that it was their duty to send these notifications. Your Public Health Committee communicated with the London County Council drawing their attention to the omissions, in consequence of which a notice was issued in the London 76 Education Gazette reminding teachers of their duties. It is hoped that such notice will have the desired effect. BATHING OF CHILDREN SUFFERING FROM INFECTIOUS DISEASE. A letter was received from the London County Council, stating that the Council was advised that numbers of children attended the hospitals suffering from violent inflammation of the ear, which had been materially aggravated by bathing whilst in an unfit condition ; that swimming instructors and school teachers in the employ of the Council had therefore been warned that there was grave risk to life incurred in bathing by children suffering from any form of discharge of the ear, and that even when the discharge had ceased, such children should not be permitted to enter the water until a medical certificate had been obtained that they could bathe without risk, and under the circumstances it was deemed desirable to bring the matter to your notice. The letter was considered by your Public Health Committee, who directed that notices to the effect that children suffering from ear disease should not be permitted to bathe, be posted ujj in public baths belonging to your Council. EXPOSURE OF A PATIENT SUFFERING FROM SCARLET FEVER. On the 24th March information was received that a case of scarlet fever existed at Panmure Road, Sydenham. On visiting the house a man was found desquamating freely and in an infectious state. He informed me that on the previous Tuesday, March 21st, not feeling well, he visited the out-patients' department of a hospital in London, where he was 77 seen by a doctor who informed him that he was suffering from scarlet fever, and that he must go home without exposing himself more than possible. The man returned home by train. There was no local medical man in attendance and I immediately had him removed to hospital. Communication was made to the Authorities of the hospital, pointing out that should similar circumstances arise, the patient should be detained at the hospital and the Metropolitan Asylums Board immediately communicated with, with a view of obtaining his isolation and so preventing the risk of the spread of infection. CHOLERA, PLAGUE, AND SMALL-POX CONTACTS. During the year information was received from various Port Medical Officers of the arrival in this district of persons who, during the voyage, had come in contact with small-pox, cholera, or plague patients. The contacts were immediately visited and kept under observation during the full period of incubation. In no case was there any development of the disease. The number of contacts visited in the Borough was— small-pox, 26, and cholera, 4. CEREBRO SPINAL MENINGITIS. In May I was invited to give an opinion on two cases in which this disease was suspected. The first patient was in Sandhurst Road. This case appeared to be one of deficient feeding. The second case occurred in Beckenham Lane, and the patient was suffering from double pneumonia, which proved fatal. 78 BACTERIOSCOPIC EXAMINATIONS. The facilities which your Council gave to private medical practitioners to obtain free bacterioscopic examinations in suspected cases of diphtheria, phthisis, and typhoid fever have been greatly appreciated. During the year 144 specimens were examined, the details of which are as follows:— Diphtheria.- In 34 instances diphtheria bacilli were present, and 72 specimens gave a negative result. In one case the result was doubtful, necessitating a further specimen, which also gave a negative result. Phthisis.— Of the 29 specimens of sputa submitted for examination tubercle bacilli was found in only 7. Typhoid Fever.— Of the 6 specimens examined 2 were proved to be from typhoid patients. Other Specimens.— Malaria, 1 specimen was examined, the result proving negative. Three tins of condensed milk were submitted, the bacteriological examination confirming my opinion that the milk was unfit for dietetic use. Of all the above examinations the system has been most useful in regard to diphtheria. In 2 cases the medical attendants submitting the swabs were of the opinion that, but for these examinations, the patients would not have been certified as suffering from diphtheria, and the clinical symptoms were so exceedingly slight that they would have been justified in allowing the patients to mix with other persons. On the other hand, in 72 cases where diphtheria was suspected, a negative result was obtained, the clinical symptoms subsequently proving the bacterioscopic examinations to be correct. 79 The value of these examinations in phthisis cannot be over-estimated. The medical profession are encouraged to send in sputa of all doubtful cases, and in this way the earliest information is obtained of cases of phthisis. This in itself is most valuable to the persons affected, as it enables the early recognition of the disease and the adoption of curative measures before the disease has seriously advanced. In January, a large number of tins of condensed milk of a cheap brand were found. From mere inspection, it was difficult to prove that they were unsound. Bacterioscopic examination showed that decomposition had set in, and that the milk contained a large number of bacteria, which rendered it unfit for dietetic use. On representing these facts to the owners the condensed milk was destroyed voluntarily. As another example of the usefulness of these examinations, I have only to mention the case which occurred at All Saints' Boys' Orphanage. In October a case of diphtheria occurred. Twelve contacts were isolated, and their throats swabbed and examined. One swab contained the specific organisms of diphtheria, and the boy in question was isolated, thus preventing the extension of the disease. But for the examination, this case, showing no clinical symptoms of diphtheria, would probably have passed unnoticed. PART 3. GENERAL 83 MILK SUPPLY AND INFECTIOUS DISEASE. On June 18th I was informed by one of the milk purveyors of the district that he had reason to believe that a case of Scarlet Fever had occurred at a farm in West Sussex from which his supply was derived. He pointed out that under his contract he was unable to stop the supply and requested me to advise him on the matter. Under the existing provisions of the Public Health (London) Act your medical officer is empowered, where there is evidence that the consumption of milk from any dairy is likely to cause any infectious disease to any person residing in the district, to inspect such dairy on condition that he has obtained an order from a magistrate residing in the district in which the dairy is situated. After visiting he shall report to the Sanitary Authority, who may thereupon serve the dairyman with a notice requesting him to appear before them to show why an order should not be made requiring him to discontinue the milk supply within their district. It is obvious that the difficulties which surround such cases make the procedure practically useless. First, one must obtain a magistrate's order. This takes a considerable time. Then comes the visit to the farm. Afterwards the report to the Sanitary Authority, and finally the Sanitary Authority's notice to the dairyman. A period of a week or ten days would probably elapse before any active measures could be taken, supposing they were necessary. Under these circumstances I adopted the course of sending a telegram to the County Medical Officer of Health of West Sussex, who was good enough to reply on the 22nd June, the reply reaching me on the 23rd June, to the effect that a case of scarlet fever had been notified at the farm. The patient was 84 a cowman. On notification of the case immediate steps were taken to isolate the patient and safeguard the milk supply. Dr. Cameron, the Medical Officer of Health for West Sussex, who sent me the information, stated that he was of opinion "that the milk could be supplied with safety." A similar case occurred in July, when I received the information that there was reason to believe that the milk supply from a farm in West Dean was liable to contamination from Scarlet Fever. In reply to a telegraphic inquiry, Dr. Bostock, the Medical Officer of Health, informed me that the case had been removed to hospital for isolation and that the milk was not infected. We have not always been fortunate in securing the speedy co-operation of the authorities having control over the farms as in these cases. v After consideration your Committee expressed the opinion that, in view of the danger of the spread of infection whilst these proceedings were being taken, it was desirable in the interests of the public health that greater facilities should be given to Sanitary Authorities, in order that the supply of milk from any dairy within or without their district may be stopped where there is reason to believe the consumption of such milk would be likely to cause any infectious disease, and suggested that the powers given to Sanitary Authorities under Section 71 of the Public Health (London) Act, 1891, would be of greater value if application for an order to inspect the dairy, and where necessary, for the cessation of the supply of milk were made by a magistrate presiding in the district in which the milk was distributed. A communication was addressed to the Local Government Board urging them to promote legislation 85 with a view to giving effect to this sugggestion, and other Metropolitan Boroughs were asked to support the action of this Council. REGISTRATION OF PRIVATE SCHOOLS. Various private schools were examined during the year with a view to the detection and abatement of overcrowding. Case (a). Forest Hill: School carried on in a private dwelling-house; 36 pupils (18 boarders and 18 day scholars). There was no overcrowding and the premises were well kept. Case (b). Hither Green : Private dwelling-house ; dayschool receiving 100 children in 4 class-rooms. No overcrowding. Case (c). Catford : Private dwelling-house receiving 20 scholars. Nuisance existing from dirty condition of premises; schoolroom found overcrowded. Notice served and the nuisance abated. Case (d). Lee Green: Private dwelling-house receiving 20 scholars. School overcrowded and notice served. Case (e). Lewisham: Private dwelling-house receiving 80 scholars. Also overcrowded. Case (f). Blackheath : Private dwelling-house receiving 12 scholars. Satisfactory. The schools were visited in consequence of information received suggesting the premises were overcrowded. For obvious reasons the exact addresses of the schools have been omitted from this report. There is, in my opinion, a necessity for greater sanitary control over private schools. At the present time we have no power to require that the premises so used shall be suitable. 86 Except in private schools belonging to big companies the general rule is to adapt private dwellings for the purpose and from my personal experience, in some instances these premises are unsuited in nearly every respect. The conditions under which the scholars work in some of these ill-adapted houses must have a prejudicial effect upon the children. I am of opinion that all private schools other than those belonging to public companies who have their medical experts and architects and whose pupils are housed in suitable buildings, should be controlled either by registration or some other means which would ensure proper care being given to the light, air, ventilation and general sanitary fitness of the premises. The proper lighting and ventilation of a schoolroom is of the highest importance. In several I have seen these points receive least attention. The heads of such schools should also be required to notify Medical Officers of Health of the occurrence of any infectious ailment, in a manner similar to that provided for by the Education Authority controlling provided and non-provided schools. UNSOUND FOOD. The following articles were surrendered and destroyed, as being unfit for human food :— 2 barrels of herrings, 2 boxes of bloaters, 1 box of mackerel, 70 lbs. of fish, and 62 tins of condensed milk. HOUSE-TO-HOUSE INSPECTION. During the year under review house-to-house inspection was made of 1,095 dwellings, distributed in the following roads 87 and streets:— Beadnell Road, Boones Street, Church Street, Collins Square, Collins Street, Dacre Street, Dallas Road, Dillwyn Road, Dunsley Place, Essex Place, Kirtley Road, Maddin Road, Maybank Cottages, Maythorn Cottages, Merritt Road, Merton Place, Miall Road, Mount Pleasant Cottages, Nightingale Grove, Porthcawe Road, Queens Street, Regent Street, Relinque Road, Sandhurst Road (part), Sangley Road (part), Saravia Road (part), Smith's Cottages and Sparta Street. The following is a summary of the principal nuisances found:— Defective drains 112 Vent shafts and soil pipes defective 19 Water closets and apparatus defective 144 Insufficient water supply to water closets 172 Defective yard traps, sink wastes, gullies, &c. 448 Dirty premises 694 Overcrowding 2 Drinking water cisterns defective 229 Defective roofs 238 Damp premises 244 Insufficient floor ventilation 126 Defective yard pavings 343 Offensive accumulations 9 Animals so kept as to cause a nuisance 11 Other minor nuisances (ashbins, &c.) 546 Total 3,337 The whole of the above-mentioned defects were remedied on the service of notices, and no summary proceedings were necessary. It is satisfactory to note that overcrowding was only reported in two instauces. 88 HOUSES UNFIT FOR HUMAN HABITATION. Representations were made in respect of two dwellings in the rear of Berlin Road, Catford, known as White House, and premises known as Nos. 33 and 35, Maddin Road, Lower Sydenham. After the service of notices the premises were rendered fit for habitation. HOUSES LET IN LODGINGS. The register contains only seventeen such houses which are situated as follows:- Nos. 5, 16, 23, 25, 31, 43, 45, 47, 51, 53, 55 and 67, Ladywell Park; 1, Ladywell Park Terrace; 42, Hither Green Lane ; 335, Stanstead Road ; 5, Scrooby Street, and 47, Molesworth Street. The occupation of these houses is controlled by bye-laws, and although they may appear to have a very large number of persons in each, provided these persons have the minimum amount of cubic space required by the regulations, the occupation of such houses is legally permitted. Owing to the habits of the people who frequent them, various nuisances are constantly occurring, necessitating almost constant inspection. Occasionally night visits have been made to those houses where overcrowding was likely to exist, with the result that 5 per cent. of the rooms were found to be occupied by members of more than one family, but in only one case was the overcrowding of a serious nature. One unsatisfactory feature, which appears traceable to the night inspections, is the fact that the more respectable inmates of the houses resent the intrusion upon their privacy, and in some cases have left the premises in consequence, their places being filled by more undesirable tenants. 89 During the year the district inspectors have paid 241 visits, discovering 64 nuisances requiring the service of notices. 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:— Aislibie Road, 13 to 43 and Lenham Road, 2 to 6 Algernon Road, 153 to 159 „ „ 6 to 32 Allenby Road, 6 and 8 Beadnell Road, 3 to 7 Blagdon Street, 3 to 21 Bovill Road, 53 to 63 Brookbank Road, 57 to 77 Denmark Terrace, Bell Green Ellerdale Street, 19 to 35 Elsinore Road, 37 to 43 George Lane, 29 to 35 High Road, Lee, 226 to 236 Kemble Road, 25 to 35 Kent House Road, 5 to 19 and Watlington Grove, 1, 2 and 3 Montem Road, 26 to 28 St. Margaret's Road, 43 to 53 Stanstead Road, 282 to 298 Watlington Grove, 11 to 15 „ ,, 16 to 33 GIPSY ENCAMPMENTS Complaints were received of gipsy encampments in various parts of the Borough, namely, Bromley Hill, Baring Road, Grove Park and Hither Green Lane (two). The inspection of the vans, followed by the service of notices on the owners of the land requiring the provision of proper sanitary accommodation, caused their departure. 90 Table 24. Houses Examined and Certified under the Customs and Inland Revenue Acts during 1905. Name of Street. Number of Houses. Number of Dwellings. Number of Certificates Granted. Date of Inspection. Brookdale Road 5 10* Crofton Terrace 1 3 3 April 17th Devonshire Road 7 14 14 February 2nd Engleheart Road 4 8 8 „ 8th Farley Road 1 2 2 March 19th George Lane 9 18 18 November 1st Sangley Road 15 30 30 May 6th Silvermere Road 3 6 6 March 19 th Totals 45 91 81 * Not granted. Note.— These inspections are made upon the application of the owners. The Medical Officer of Health, if satisfied with the sanitary condition of the dwellings, is required by the Customs and Inland Revenue Acts to give the owners a certificate to that effect. This enables them to obtain an abatement in regard to Inhabited House Duty. 91 Table 25. Water Certificates Granted after inspection in accordance with Section 48 of the Public Health (London) Act, 1891, during the years 1903, 1904, and 1905. Ward Number of Water Certificates Granted. 1903 1904 1905 Church - 12 40 Manor 17 41 9 South 30 25 33 Lee Division 47 78 82 Blackheath 5 5 Lewisham Village 72 56 10 Lewisham Park 159 71 67 Brockley 112 109 154 Catford 495 270 297 Lewisham Division 843 506 533 Forest Hill 199 139 95 Sydenham 210 176 208 Syd. & For. Hill Division 409 315 303 Whole Borough 1299 899 918 92 WATER SUPPLY IN TENEMENT HOUSES. It has frequently been felt that there is great difficulty in obtaining a sufficient and proper water supply in tenement houses where each floor is occupied by a separate family. The supply of such premises is usually by a tap on the ground floor only, which arrangement makes it difficult for the upper tenants to secure a supply. A test case was taken by the Woolwich Borough Council, and the magistrate decided that a supply of water from a tap in the yard was not a proper and sufficient supply within the meaning of the Public Health (London) Act. An order to abate the nuisance was made and costs imposed. This, of course, is only a Police Court case. Nevertheless, the decision is a useful one and may assist us in the future, should we meet with similar cases. UNDERGROUND BAKEHOUSE. Information was received that a person was occupying an underground bakehouse at the rear of premises in Montpelier Yale, contrary to the provisions of the Factory and Workshop Act, 1901. Your Council directed that a caution be sent to the occupier, who, in reply, stated that he was prepared to carry out any reasonable alterations to make it satisfactory. On a personal examination of the premises it was found that it would be difficult to render the bakehouse suitable, and it was also pointed out that Section 101 of the Act referred to prohibited the use of an underground bakehouse unless it was so used at the passing of the Act. The premises in question were not occupied previous to the passing of the Act and the occupier subsequently vacated the premises. SMOKE NUISANCE. The Inspector entrusted with this duty made 254 observations during the year as follows:— Laundries 30, flour mills 93 12, bakehouses 30, locomotives 18, breweries 30, sewer construction works 48, jam factories 18, gas works 28, miscellaneous 40. Twenty intimation and five statutory notices were served. In consequence of the action taken better stoking was obtained generally, chimneys were heightened in two cases, alterations were carried out to two boilers, a gas engine was substituted in another case, and steam sprays were introduced in two instances. PUBLIC HOUSE URINALS. During the year an inspection was made of all the public house urinals. The Borough contained 106 public houses, and there were 117 urinals in connection with 101 of the houses. As a result of the examination nuisances were found to exist in 31 instances, due chiefly to defective flushing arrangements. These nuisances were remedied after the service of notices. PUBLIC MORTUARY. One hundred and twenty-three bodies were removed to the Mortuary and 114 inquests held there. Some of these, however, were on residents of other districts. In five instances the bodies were removed from their homes to await interment owing to the person having died from an infectious disease. DISINFECTION. During the year 1873 rooms have been disinfected by formalin spray, and 28,135 articles of bedding, clothing, &c., were removed from infected homes to the Council's Disinfecting Station for treatment in the steam disinfector. The figures for the previous year were 1316 rooms and 27,567 articles. 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, E. M., of Hither Green, was fined 10s. and 2s. costs, and A. and E. R., £1 and 2s. costs. For exposing margarine for sale, not labelled in accordance with the Margarine Act, T. C., of Forest Hill, was fined £3 and 12s. 6d. costs. Proceedings taken for offences under the Public Health (London) Act, 1891, or Bye-laws made thereunder:— For carrying fish offal contrary to the London County Council Bye-laws, F. D., of Perry Vale, was fined £4 and 4s. costs (2 summonses), J. D., of Nelson Terrace, Hither Green, £2 and 2s. costs, and T. M., of Kemble Road, 5s. and 2s. costs. Adulteration of Food and Drugs. Summonses issued 16 Convictions obtained 15 Fines imposed £51 14s. Od. Costs imposed £9 7s. 6d. 95 For a similar offence a summons was issued against A. R., of Deptford, but the defendant could not be found. For omitting to place name and address of vendor upon his ice.cream barrow, H. M., of Cold Bath Street, Greenwich, was fined 10s. and 12s. 6d. costs. For keeping cows in unlicensed sheds at Spicer's Meadow, Claypit Lane, W. W. was fined £3 and £1 Is. costs. For failing to provide sufficient ashpit accommodation at Nos. 14, 16, 18, 20, and 22, Levendale Road, F. W. C. was fined £2 10s. and £1 0s. 6d. costs. For allowing premises, No. 24, Levendale Road, to be occupied as a dwelling.house without a proper and sufficient supply of water, F. W. C. was fined £1 10s. and 12s. 6d. costs. For permitting dwelling.houses, Nos. 2 and 6, Holmesley Street, to be occupied without first obtaining the necessary water certificates, B. & B. were fined £2 and 12s. 6d. costs. For constructing a water.closet without giving notice of same, and for not complying with the requirements of the London County Council Bye.laws in regard to its position and ventilation, N. M., of Weardale Road, was fined £4 10s. and £1 8s. costs. For failing to provide a water.closet with effectual flushing apparatus, as required by the London County Council Bye.laws, J. E. B., of Darfield Road, Brockley, was fined iJl and 2s. costs. A summons was served for the abatement of a nuisance caused by the foul, dilapidated, and defective condition of a stable yard and stables at the junction of Hither Green Lane and High Street. Some difficulty was occasioned on account of the change of ownership of the premises, but the work was 96 eventually carried out and the summons withdrawn on payment of the costs (£1) by the defendant. For non.compliance with a notice requiring the abatement of a nuisance caused by the dirty and dilapidated premises at 4, Crown Place, Bell Green, Mrs. L. was ordered to pay the cost of the summons, and an order to abate the nuisance within 14 days was granted. Proceedings under the Metropolis Management Act:— For refusing to allow the inspector to enter and inspect the drains at Nos. 41 and 43, Aislibie Road, A. E. L. and T. E. R. were fined £5 and £1 Is. costs, and £5 and 2s. costs respectively. ADMINISTRATION OF THE FACTORY AND WORKSHOP ACT, 1901, in connection with Factories, Workshops, Laundries, Workplaces, and Home Work. Workshops.—There are in the Borough 548 workshops, containing 863 workrooms to which provisions of the Factory and Workshop Act apply. The number of workers found on inspection amounted to 2,154, of which 542 were men, 1214 women, and 398 young persons. The largest proportion of these workers were engaged in the dressmaking, laundry and millinery trades, there being 1,180 women, 305 young persons, and 18 men employed. These premises are inspected by the women sanitary inspectors, together with the workshops employing women in other trades. Only 34 women and 93 young persons were employed in all the other trades which necessitate the employment of male labour, and at which 524 men were engaged. Domestic Workshops—i.e., private houses, places, or rooms, where no power is used, and in which the only persons 97 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 851 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 27. Table 26. Inspection of Factories, Workshops, &c. Premises. Inspections Notices served. Factories (including factory laundries) 79 22 Workshops (including workshop laundries) 1519 142 Workplaces 260 25 Homeworkers' premises 212 16 Restaurants 62 5 Total 2132 210 In no case was it found necessary to institute proceedings. 98 Statement of Defects Found. Defect or Infringement. No. found. No. remedied. Referred to H.M. Inspector. Dealt with under Public Health (London) Act— Want of cleanliness 182 *177 1 Want of ventilation 3 3 — Overcrowding 18 18 — Want of drainage of floors 7 7 — Other nuisances 100 100 2 Sanitary accommodation— Insufficient 5 5 — Defective or unsuitable 106 106 — Not separable for sexes 2 2 — Under the Factory and Workshop Act— Illegal occupation of underground bakehouse 1 1 — Other offences — — — Total 424 411 3 *Note.—Including one case where a dirty workroom was not repaired on account of the proposed demolition of the premises in the near future by the London County Council, and another workroom which ceased to be used as such after cleansing notice was served. 99 Other Matters. Failure to affix Abstract required by Section 133 of the Factory and Workshop Act, 1901, and notified to H.M. Inspector of Factories 50 Action taken in matters referred by H.M. Inspectors as remedi. 1able under the Public Health. (London) Act, but not under the Factory Act (Sec. 5). Notified by H.M. Inspector10 Reports of action taken, sent to H.M. Inspector 10 Underground Bakehouses (Section 101):— In use during 1903 23 Certificates granted in 1903 23 „ „ 1904 and 1905 — In use at end of 1905 23 Homework:— List of Outworkers received in accordance with Section 107 242 Number of Outworkers comprised therein 449 Addresses of Outworkers forwarded to other Authorities 144 „ „ received from other Authorities 174 Workshops on the Register at the end of 1905:— Workshops (details in Table 27) 548 „ part time and domestic (details Table 27) 351 Bakehouses 71 „ underground 23 Restaurants 32 Total 1025 100 Table 27. * Workshops and Workrooms on the Register at the end of 1905. 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 152 196 I486 1423 915 — 738 258 77 77 Millinery 39 49 266 254 157 — 62 41 4 4 Laundry 85 266 1109 1043 672 18 880 6 114 192 Tailor 46 49 218 200 138 85 19 8 13 13 Boot 74 75 263 244 163 113 — 16 73 73 Joiner 15 30 515 483 367 51 — 12 4 4 Smith 22 25 301 297 217 58 — 8 3 3 Furrier 4 4 16 14 9 3 8 — — — Cycles 19 36 194 176 134 38 — 9 10 10 Coach builder 10 23 294 279 213 37 — 7 — — Cabinet and Upholsterer 20 26 351 326 238 37 6 6 3 3 Blindmaker 3 5 28 26 17 6 — 3 1 1 Photography 5 13 41 39 25 4 3 1 5 5 Picture. framer 7 8 39 37 27 9 2 5 5 Jeweller 16 17 79 69 47 23 — 7 18 18 Piano 2 2 9 9 6 2 — 1 1 1 Saddler 8 9 55 46 36 19 — 4 2 2 Mason 4 5 62 60 43 8 — 3 1 1 Lathrender 3 5 23 19 14 8 — — — — Various 14 20 118 114 86 23 3 6 17 17 Total 548 863 5467 5158 3524 542 1214 398 351 429 * Note:—Not including Bakehouses (94) and Restaurants (32). 101 SUMMARY OF WORK OF WOMEN SANITARY INSPECTORS. During the year under review the Women Sanitary Inspectors (Miss Whitworth and Miss Jones) have made 4,364 visits throughout the Borough. The following is a summary of the work done:— Factory and Workshop Act.— Miss Whitworth. Miss Jones.* Total. Factories 22 20 42 Workshops 440 136 576 Workplaces 64 117 181 Laundries 152 136 288 Outworkers' homes 148 20 168 Infectious Diseases.— Phthisis 106 49 155 Chicken-pox 117 138 255 Puerperal fever 8 12 20 Measles 80 147 227 Other Visits.— To Schools 96 39 135 To Homes of newly - born Infants 409 406 815 Investigations re Infants' deaths 118 108 216 He Repairs, cleansing, &c 689 489 1276 Miscellaneous inquiries 40 108 148 Notices, &c.— Intimation notices served 147 121 268 Statutory notices served 40 27 67 Written notices complied with 169 129 298 Verbal complaints made 49 24 73 Verbal notices complied with 27 17 44 * Eight months work only—May 1st to December 31st. 102 Table 28. REGISTER OF SANITARY WORK.A. Premises. Number of Places No. of Inspections 1905 No. of Notices 1905. No. of Prosecutions 1905 On Register at end of 1904. Added in 1905. Removed in 1905. On Register at end of 1905 Milk premises 152 40 29 163 277 17 — Cow sheds 16 — 1 15 122 5 1 Slaughter houses 16 — — 16 140 — — Other offensive Trade premises Ice cream premises Registered houses Let in Lodgings 17 6 6 17 241 a 6 b 58 — a Overcrowding, b For other conditions. Total number of intimation notices served for all purposes, '2447. Overcrowding:—Number of dwelling rooms overcrowded 38, remedied 38, proceedings, nil. Underground rooms:—Illegal occupation dealt with and number of rooms closed, nil. Insanitary Houses:—Number closed under the Public Health (London) Act and Housing of the Working Classes Act nil. Premises cleansed under Section '20 of the London County Council (General Powers) Act, 1904, nil. Number of persons accommodated during the year in shelter provided under Section 60 (4) of the Public Health (London) Act, 1891, 1. 103 Revenue Acts:—Houses for which application were received 45, number of tenements comprised therein 91, certificates granted 81, refused 10, deferred nil. Prosecutions under By.laws under the Public Heath (London) Act: (a) For prevention of nuisance arising from snow, ice, salt, filth, &c — (b) For prevention of nuisance arising from offensive matter running out of any manufactory, &c — (c) For the prevention of keeping of animals in such a manner as to be injurious to health — (d) As to paving of yards, &c., of dwelling houses — (e) In connection with the removal of offensive matter, &c 5 (f) As to cesspools and privies, removal and disposal of refuse, &c — (g) For securing the cleanliness of tanks, cisterns, (h) With respect to water.closets, earth.closets, &c. 3 (i) With respect to sufficiency of water supply to water.closets 1 (j) With respect to drainage, &c. (Metropolis Management Act, Section 202) — (,k) With respect to deposit of plans as to drainage, &c. (Metropolis Management Acts Amendment (Bylaws) Act, 1899) — Mortuaries:— Total number of bodies removed 123 Total number of infectious bodies removed 5 Note.—This table was formulated to meet the requirements of the London County Council. 104 Table 29. REGISTER OF SANITARY WORK—B For the year ended 31st December, 1905. Lewisham Division. Sydenham find Forest Hill Division. Lee Division Work shops House to House Description of Work Mr. J. A. K. Cooper j Mr. H. King Mr. E. T Pidwell Mr. B. A. Knappett Mr. R. White Mr. J. Daltry Mr. A. H. Gray Mr. H. L. Hyde Total tor Wuole Boro. Complaints by Residents 86 114 91 102 252 7 5 47 704 Premises inspected 555 772 745 569 450 1557 910 691 6249 lie.inspections of Works in progress 2633 1850 1175 2509 1645 760 5774 4561 20907 Intimation Notices served 176 295 129 120 209 114 660 468 2171 Statutory Notices ordered 158 194 77 66 70 39 120 184 908 Statutory Notices served 30 105 30 57 36 15 67 52 392 Premises repaired, cleansed, &c. 81 168 61 61 58 115 476 359 1369 Defective Roofs, Stackpipes, &c., remedied 47 19 46 50 42 25 380 169 778 Drains re.constructed 157 58 65 91 120 — 82 32 605 Drains repaired 24 59 52 55 70 13 24 38 335 Drains ventilated 37 11 44 22 80 — 28 15 237 Stackpipes, Sinks, Bath Wastes, &c., disconnected from drains ... 98 41 48 45 162 27 4C 467 Gulley Traps provided 187 43 46 295 266 4 111 47 999 Water Closets reconstructed 83 32 131 134 162 17 76 12 647 Water Closets repaired 33 54 21 31 53 78 37 73 380 Water Closets supplied with water 22 39 5 2 30 21 156 61 335 Soil Pipes reconstructed 41 26 37 42 49 1 7 6 209 Soil Pipes repaired and ventilated 14 9 27 22 14 38 6 4 134 Dustbins provided 32 39 24 3b 54 23 211 119 535 Water Supply to Houses reinstated 8 11 13 27 2 2 21 1 84 Cisterns repaired, cleansed or covered 9 28 81 20 15 71 233 20 477 Water Certificates issued 106 11 119 5 65 395 197 20 918 Premises over.crowded 4 26 — — 1 — 1 6 38 Yards paved 34 46 34 107 108 40 212 196 777 Removal of offensive accumulations 9 24 21 10 22 5 7 13 111 Dung Vaults erected or repaired 2 8 1 3 6 2 — 1 23 Animals improperly kept 2 26 2 6 4 4 7 9 60 Lodging.houses visited 34 207 — — — — — — 241 Bake.houses visited 2 12 4 — 18 333 — — 369 Milk.shops visited 6 5 9 23 36 198 — — 277 Cow.sheds visited 5 43 26 16 32 — — — 122 Workshops visited — — — — — 489 — — 489 Slaughter.houses visited 27 24 48 15 26 — — — 140 House.to.house inspections — — — — 35 — 686 533 1254 Legal proceedings 5 2 8 7 11 1 6 2 42 PART 4. REPORT OF PUBLIC ANALYST. 107 REPORT OF THE PUBLIC ANALYST FOR THE YEAR ENDED DECEMBER 31st, 1905. SAMPLES SUBMITTED.—During the period under review 509 samples were submitted for analysis. Of this number, 476 were purchased by your inspectors in conformity with the provisions of the Sale of Food and Drugs Acts. The remaining 33 samples were purchased as test samples, and without declaration to the vendors. ADULTERATED SAMPLES.—Of the 476 official samples submitted, 38, or 7.98 per cent, were adulterated, compared with 9'38 per cent, in the previous year (1904) and 13"53 per cent, in 1903. This diminished percentage of adulterated samples is highly satisfactory. TEST SAMPLES.—Of the 33 test samples submitted, only one, or 3"03 per cent., was adulterated. Samples were subsequently purchased in official form. Test samples were taken in several cases as a result of complaint from householders that the goods they were receiving were of a suspicious quality. The intention was to obtain a sample without the formalities of purchase and in a manner similar to that adopted by the ordinary householder. It is satisfactory to note that only in one case was an adulterated sample obtained. This was a sample of butter containing an excess of water. An official sample subsequently bought from the same vendor was genuine. 108 PURCHASE OF SAMPLES BY DEPUTY.—The system of purchasing by deputy has been continued, and of the 509 samples, 247 or 48.53 per cent., were so purchased. Amongst those purchased by deputy, or taken in course of delivery, the percentage of adulteration was 9.1, whilst of those taken directly by the inspectors amounted to 5.8 per cent. One must not lose sight of the fact, however, that a deputy is used wherever practicable, and that the majority of the samples purchased by the inspectors without assistance were milk from street vendors, where it is not convenient to employ a deputy. MILK.—Of the 278 samples submitted, 20, or 7'19 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 10.8 per cent, in 1904 and 17.41 per cent, in 1903. Table D shows a continued diminution of adulteration with regard to the milk supply of the Borough, and I think it is a matter for congratulation that the percentage of adulteration should have diminished from 20.61 per cent, in 1902, to 7'19 per cent, in the year under review. Sunday Samples.—Twenty.eight samples were purchased on Sundays and six on Bank Holidays, of which four were adulterated (See Nos. 210, 211, 280 and 290, Table G). In two cases out of the four the adulteration was sufficient to warrant prosecution. Samples on Delivery.—Thirty.nine samples were taken in course of delivery, as follows:— From Public Institutions:—Lewisham Union Infirmary and Workhouse, 2 (1 adulterated—See Table G, No. 424); Park Hospital, 2; Home for Sick Children, 2; All Saints' Orphanage, 1. 109 From Other Places:—At Railway Stations, 29 (3 adulterated—See Table G, Nos. 225, 504 and 505) ; at private dwelling houses at the request of householders, 3. Lewisham Union Infirmary and Workhouse.—Of the samples taken at the Union Infirmary and Workhouse, one was of poor quality, and the other (No. 424) was deficient in milk fat to the extent of 17 per cent. The vendor had been previously convicted, and proceedings were taken, resulting in a fine of £15 and 12s. 6d. costs. At a later date the inspector attempted to procure further samples from the same vendor. His van was delivering at the Infirmary and samples were taken of the milk supplied to that institution. The Inspector then desired to take samples of milk from the remaining churns in the van, which he had reason to believe would be delivered at the Workhouse, and he was informed by the man in charge that they were not intended for the Workhouse, but that it was milk which he had to take to the vendor's depot, where he was to pick up the milk to be delivered to the Workhouse. Other Institutions.—The samples taken at the Park Hospital, Home for Sick Children, and All Saints' Orphanage were found to be above standard. Railway Stations.—During the year facilities have been given to milk vendors to secure a pure supply of milk, and where requested the inspectors have attended at railway stations to take samples on delivery. Twenty.nine samples were so taken, three of which were adulterated. No. 225.—This sample was 6 per cent, deficient in milk fat. Your legal advisers, after reviewing the evidence, considered that a successful prosecution could not follow, there being a doubt as to the actual place of delivery. 110 Samples 504 and 505 were of milk arriving from the country at the Forest Hill railway station, and the consignor was cautioned. The three samples taken at the request of householders in course of delivery at private dwelling houses were genuine. Dyed Milks.—One hundred and eighty.seven, or 67.3 per cent, of the milks examined were artificially coloured, compared with 48.6 per cent, during 1904. Twenty of the samples were very highly coloured. Sour Milks.—Three samples were sour when purchased. Analysis showed them to be genuine. Dirty Milks.—Six samples of milk submitted were in a very dirty condition, containing dung and other filth. Skimmed Milk.— Of the four samples of skimmed milk submitted, one was found adulterated (See Table I., No. 278). All four samples were artificially coloured. BUTTER.—One hundred and three samples of butter were submitted, of which 12 were test samples. Of the 91 samples submitted officially, 7, or 7.69 per cent., were adulterated, compared with 6.93 per cent, in 1904. Eighty.eight, or 96.7 per cent., of the samples of butter were taken with the aid of an assistant. Colouring Matter. —The practice of colouring even genuine butters is still increasing, 49'5 per cent, of the butters analysed during the period under review being coloured, as compared with 38.6 per cent, during 1904. Many were coloured with azo red, an analine dye, some containing a very large amount. House.to.House Sale.—Towards the end of the year information was received that a firm, situated outside the 111 Borough, was manufacturing margarine into pats to represent butter, and effecting a large sale in a portion of the district through the agency of a man who conducted a house.to.house call. The inspector obtained two samples but being a stranger to the agent he was supplied with butter. A subsequent purchase was made by a householder acting as a deputy to the inspector. The material upon analysis proved to be a mixture, containing 97 per cent, of foreign fat, proceedings for which are now pending. Various Articles.—A detailed list of other samples submitted for analysis is given in the tables accompanying this report. (See Tables A and J). Dried Milk.—A very useful preparation has come upon the market in the form of dried milk, which, no doubt, will be frequently used as an article of food. There is need, however, of some guarantee as to its quality, as it is possible that it may, during the summer months, be used for the diet of young children, and it is highly desirable that a standard should be fixed in regard to the quality. ADMINISTRATION. Warranty Clauses.—During the year communications have been received from other Borough Councils, pointing out the unsatisfactory state of the law with regard to the warranty clauses of the Sale of Food and Drugs Acts. The question is an important one, and if the defendant is discharged in consequence of a warranty produced, the prosecution may proceed against the person giving the warranty in a Court having jurisdiction in the place where the sample to which the warranty relates was purchased. But it will possibly be found that the farmer will in his turn produce a warranty from one or more other farmers, and so the prosecution fails. 112 The Select Committee on Food Products Adulteration had it suggested to them by several witnesses that a warranty should cease to he a defence, and that the retailer should himself take action against the person giving it. The adoption of such a suggestion would no doubt put the retailer to considerable trouble and expense, and the Committee saw no reason for adopting the suggestion. There is less objection to the suggestion that the retailer should be required to join the giver of the warranty with himself as co.defendant in the original prosecution. There seems to be a general opinion that the givers of warranties have too frequently escaped the responsibilities for adulteration for which they were accountable. Such a condition of things may be due to the apathy of local authorities to incur further expense in regard to a case where they may again be defeated by the production of further warranties. Preservatives in Food.—There is much need for definite legislation in regard to this matter. The recommendations of the Departmental Committee in regard to Preservatives (1901) have not yet been incorporated in any legal measure. The recommendation that formalin should be absolutely excluded from all articles of food and that boracic acid should be excluded from milk is still difficult to enforce. Proceedings taken for such adulterations must be supported by expert evidence, to be met, perhaps, by experts on the other side holding contrary views, while magistrates themselves have been known to make unfavouralle comments in regard to Local Authorities who were attempting to obtain convictions in cases of milk preserved with dangerous material. In 1904 your Council was successful in three prosecutions where formalin had been added to milk in various 113 ties as a preservative. In two of the cases, you may remember, the analysis was contested, but on referring the samples to Somerset House your analyst's certificate was confirmed. The action had a good result inasmuch as during the year under review in no case was this preservative used. In a recent case, however, in another district, a prosecution was instituted for the addition of one part of formalin to 10,000 parts of milk. Here another magistrate expressed astonishment that the action had been taken for the addition of so small an amount and the case was dismissed. As a matter of fact the amount, although sounding so minute, was a very large one, formalin being an exceedingly powerful agent, and when used, even in much smaller quantities in milk, seriously inhibits digestion, a condition which is obviously a danger to infants who are relying upon milk for their sole nourishment. A definite prohibition of its use by law would undoubtedly end this practice. Additional Powers for obtaining Samples of Milk.—We have reason for believing that occasionally the inspectors have been served from a special can kept in the cart of the milk vendor for that purpose, and on the inspector demanding a sample from other churns or vessels in the cart, he has been informed either that they were empty or that the milk was not for sale. The inspector should be enabled to obtain a sample from any vessel which he has cause to suspect contains milk. During the year we received complaints in regard to itinerant vendors whom we suspected were adulterating their supplies. The samples purchased were served from a small can, and in two cases the analysis showed that a large amount of cream had been addei to the milk. 114 Table A. Showing number of Samples submitted for Analysis, with Results for the year ended December 31st, 1905. (a) Samples taken officially and in accordance with the provisions of the Sale of Food and Drugs Acts. Article. Total. Genuine. Adulterated. Percentage Adulterated. Milk 278 258 20 7.19 Skimmed Milk 4 3 1 25.00 Cream 6 6 — — Butter 91 84 7 7.69 Margarine 2 2 — — Lard 3 3 — — Coffee 23 20 3 13.04 Cocoa 7 6 1 14.29 Demerara Sugar 17 14 3 17.78 Flour 5 5 — — Arrowroot 2 2 — — Mustard 8 8 — — Olive Oil 1 1 — — Lime Water 8 7 1 12.50 Whiskey 6 5 1 16.67 Gin 4 4 — — Rum 1 1 — — Brandy 1 1 — — Quinine Wine 1 1 — — Cream of Tartar 2 2 — — Tincture of Iodine 2 2 — — Tincture of Bark 2 1 1 50 00 Camphorated Oil 1 1 — — Citrate of Magnesia 1 1 (free from delete nous substances) Total official samples 476 438 38 7.98 (b) Samples purchased without the formalities of the Act. Demerara Sugar 11 11 — Butter 12 11 1 8 33 Coffee 9 9 — — Tincture of Valerian 1 1 — — Total “ test” samples 33 32 1 3 03 Total all samples 509 470 39 7 66 Year No. of Samples (not including Test Samples). Genuine Adulterated Percentage Adulterated No. of Prosecutions Fines and Costs imposed Table B. Summary of Samples Analysed in the Borough in each Year, 1898-1905. 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 Various 81 1903 Milk 270 451 390 61 13.53 19 Fine3 £50 15s., costs £11 7s. Butter 76 Various 105 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 o Ci rH Milk 282 476 438 38 7.98 19 Fines £56 4s., costs £10 4s. Butter 91 Coffee 23 Wines and Spirits 12 Drugs 17 Sundries 51, 115 116 Table C. Showing results of Total Samples submitted during the years 1902-5. Quarter. No. of Samples. Adulterated. Percentage Adulterated. 1902 1903 1904 1905 1902 1903 1904 1905 1902 1903 1904 1905 First 115 111 114 123 27 12 16 13 23.48 10.81 1404 10.57 Second 167 72 67 103 22 4 12 9 13.17 5.55 l8.90 8.74 Third 108 152 123 129 14 30 7 6 12.96 19.74 5.69 4.65 Fourth 68 116 112 121 6 15 4 10 8.82 12.93 3.57 8.26 TotalforYear 458 451 416 476 69 61 39 38 15.07 13.53 9.38 7.98 Table D. Showing results of Total Samples of Milk submitted during the years 1902-5. Quarter. No. of Samples Adulterated. Percentage Adulterated. 1902 1903 1904 1905 1902 1903 1904 1905 1902 1903 1904 1905 First 60 70 58 88 15 11 9 8 25.00 15.71 15.52 9.09 Second 70 31 48 53 15 1 10 5 21.43 3.23 20.83 9.43 Third 54 124 91 68 12 30 6 3 22.22 24.19 6.59 4.41 Fourth 44 45 53 69 5 5 2 4 11.36 11.11 3.77 5.80 Total for Year 228 270 250 278 47 47 27 20 20.61 17.41 10.80 7.19 Table E. Average Composition of Milk Samples submitted in 1905. 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 3.61 8.80 3.67 8.84 Second „ 3.50 8.75 3.55 8.78 3.0 8.5 Third „ 3.52 8.63 3.56 8.66 Fourth „ 3.66 8.82 3.69 8.84 Total for Year 3.58 8.75 3.62 8.78 117 Table F. Average Composition of Milk Samples submitted during the Years 1902-5. 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 Year 1902 3.55 8.62 3.66 8.71 3.0 8.5 „ 1903 3.67 8.63 3.81 8.72 „ 1904 3.63 8.69 3.69 8.74 „ 1905 3.58 8.75 3'62 8.78 118 119 Table G. Details of Adulterated Samples of Milk during the year ended December 31st, 1905. No. Adulteration. Remarks. 9 5 per cent, deficient in milk fat Vendor cautioned. 11 10 per cent, deficient in milk fat Vendor fined £3 and 12s. 6d. costs. 19 5 per cent, deficient in milk fat Vendor cautioned. 20 4 per cent, added water Vendor cautioned. 25 2 per cent, added water Vendor cautioned. 92 4 9 per cent, added water Vendor cautioned. 116 8 per cent, deficient in milk fat Summons issued, but withdrawn ; bottle burst. 128 2 per cent, added water Vendor cautioned. 152 2 per cent, added water Vendor cautioned. 204 3 per cent deficient in milk fat Vendor cautioned. *210 3 per cent, added water Vendor cautioned. *211 3 per cent, deficient in milk fat Vendor cautioned, 225 6 per cent, deficient in milk fat Taken on delivery; doubt as to place of delivery ; no action. *278 3 per cent, added water Sample of skimmed milk ; no action. *280 8 per cent, added water Vendor fined £ 1 and 12s. 6d. costs. *290 10 per cent, added water Vendor fined£2 and 12s. 6d. costs. 288 4 per cent, deficient in milk fat Vendor cautioned. 424 17 per cent, deficient in milk fat Taken on delivery at the Lewisham Union Infirmary ; vendor fined £15 and 12s. 6d. costs. 428 3 per cent, added water Vendor cautioned. 504 4 per cent, added water Taken on delivery; consignor cautioned. 505 4 per cent, added water * Sunday or Bank Holiday Samples 120 Table H. Showing the number of samples of Butter submitted in the Four Quarters of the years 1902.5. Quarter. No. of Samples. Adulterated. Percentage Adulterated. 1902 1903 1904 1905 1902 1903 1904 1905 1902 1903 1904 1905 First 44 22 35 22 9 — 5 3 2045 — 14 29 13 62 Second 63 13 9 17 4 — 1 — 6 35 — 1111 — Third 26 15 22 21 1 — 1 — 3 85 — 4.55 — Fourth 16 26 35 31 1 2 _ 4 6 25 7 69 — 12 90 Total for year 149 76 101 91 15 2 7 7 10 07 2 63 693 769 Table I. Details of Adulterated Samples of Butter for the Year ended December 31st, 1905. No. Adulteration. Remarks. 105 92 per cent, foreign fat Vendor fined £3 and 12s. 6d. costs 124 6 per cent, foreign fat Vendor cautioned 126 94 per cent, foreign fat Vendor fined £3 and 12s. 6d. costs 381 22 per cent, of water "Test" sample; official sample genuine 435 18 per cent, of water No action 468 5 5 per cent, foreign fat Further sample to be purchased 476 895 per cent, foreign fat Vendor fined £5 and 12s. 6d. costs 480 52 5 per cent, foreign fat Vendor fined £5 and 12s. 6d. costs 121 Table J. Details of Other Samples Adulterated during the year ended December 31st, 1905. No. Article. Adulteration. Remarks 335 Coffee 10 per cent, added chicory Vendor fined £3 & 12s. 6d. costs 479 Coffee 10 per cent, added chicory Vendor fined £3 & 12s. 6d. costs 489 Coffee 40 per cent, added chicory Declared as mixture on wrapper; no action 41 Demerara Sugar 100 per cent, dyed crystals Vendor fined 10s. &12s. Gd. costs 192 Demerara Sugar 100 per cent, dyed crystals Vendor fined £2 2s. and 12s. 6d. costs 200 Demerara Sugar 100 per cent, dyed crystals Vendor fined £2 & 12s. 6d. costs 185 Cocoa 25 per cent, added sugar and 9 per cent, added starch Vendor fined £2 & 12s. 6d. costs 173 Lime Water Deficient in lime to the extent of 50 per cent. Vendor fined £2 2s. and 12s. 6d. costs 334 Whisky 35 35 degrees under proof Declared on small label attached to bottle; no action 91 Tincture of Bark 8 per cent, deficient in alkaloids Other Prosecutions taken under The Sale of Foods & Drugs Acts. No. Offence. Remarks. 125 T.C. Exposing Margarine for sale, the same not being properly labelled Vendor fined £3 & 12e. 6d. costs 131 E.M. No name on milk barrow and cans Vendor fined 10s.& 2s. costs 134 A. & E.R. No address on can Vendor fined £1 & 2s. costs APPENDICES. 125 Local Government Board Tables. Table A. Vital Statistics of Whole District during the Years 1901-5. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non-residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District Nett Deaths at all Ages eelong1ng to the District. Number. Rate.* Under 1 Year of Age At all Ages. Number. Rate.* Number. Rate per 1000 Births registered. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1901 128481 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 11.5 480 152 99 1513 11.1 1904 140401 3589 25.6 448 125 1799 12.8 542 210 90 1679 12.0 1905 144420 3633 25.2 338 93 1804 12.5 569 232 119 1691 11.7 Note.—Figures for years prior to 1901 are unobtainable. 'Kates 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; Greenwich Union Workhouse, Grove Park ; Park Fever Hospital ; 1'26 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 are:— Long Reach Hospital, Brook Hospital, Northern Hospital, Guy's Hospital, St. Thomas' Hospital, Children's Hospital, Great Ormonde Street, Charing Cross Hospital, London Hospital, West London Hospital, Royal Free Hospital, Seamen's Hospital, Greenwich, Middlesex Hospital, St. Bartholomew's Hospital, French Hospital, St. Mary's Hospital, Miller Hospital, Greenwich, University College Hospital, King's College Hospital, Dartford Heath Asylum, Banstead Asylum, Caterham Asylum, Cane Hill Asylum, Claybury Asylum, Darenth Imbecile Asylum, Peckham House Asylum, Horton Asylum, Camberwell House Asylum, Manor Asylum, Epsom, Tooting Bee Asylum, Gore Farm Temporary Asylum, Darenth, Bethlem Royal Hospital, Evelina Hospital, Camberwell Infirmary, Cancer Hospital, Fulham Road, Royal Chest Hospital, City Road, City of London Chest Hospital, Mount Vernon Hospital, Whitechapel Infirmary, East London (Children's) Hospital, Shadwell, National Hospital, Queen's Square, Brompton Hospital, Epileptic Colony, Epsom, St. Thomas's Home, Carshalton Workhouse Home for Friendless Girls, and the Hospital for Epilepsy and Paralysis, Maida Vale. A death of a resident of this district occurred at No. 50, Weymouth Street, Marylebone. 127 Table B. Vital Statistics of Separate Localities in the Years 1901-5 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. Deaths under 1 year. 1901 o t- 00 398 255 — 66631 1882 856 — 43146 1040 557 - 128480 3320 1668 — 1902 18925 00 220 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 1901 19370 469 193 40 75808 1967 941 265 15223 1153 545 135 140401 3589 1679 440 1905 19594 454 186 21 78903 2027 966 209 45923 1152 539 108 144420 3633 1691 338 Note:—'Figures for years prior to 1901 are unobtainable. Table C. Cases of Infectious Disease Notified during the Year 1905. Notifiable Disease. Cases notified in whole district. Total Casks Notified in each Locality at all Ages. No. of Cases Removed to Hospital from each Locality. At all Ages At Ages—Years. Lee. Lewisham. Sydenham and Forest Hill. Lee. Lewisham. Sydenham and Forest Hill. Under 1 1 to 5. 5 to 15 15 to 25 25 to 65 65 and upwards Small-Pox 8 1 5 2 — 8 – – 8 — Cholera – – – – – – – – – – – – – Diphtheria Membranous croup 142 5 44 58 17 18 — 21 65 56 15 47 39 Erysipelas 109 1 — 10 11 74 13 14 64 31 1 13 8 Scarlet fever 548 3 135 331 46 33 — 110 319 119 92 249 90 Typhus fever — — — — — — — — — Enteric fever 33 — 1 5 12 15 4 19 10 2 12 4 Relapsing fever — — — — — — — — — — — — — Continued fever — — — — — — — — – – – – Puerperal fever 10 — — _ 3 7 1 1 8 — 2 Plague – – – – – – – – – –– – – – Totals 850 9 180 404 90 152 15 150 476 224 110 329 143 128 Table D. Causes of, and Ages at, Death during the Year 1905 Causes 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 #] Small-Pox 4 – – – – 2 2 – 4 – – Measles 41 8 28 3 — 1 1 2 20 19 5 Scarlet fever 5 — 4 1 — — — 1 2 2 73 Whooping-cough 24 13 11 — — — — 2 9 13 — Diphtheria and membranous croup 8 1 4 3 5 3 39 Croup – – – – – – – – – – – Typhus – – – – – – – – – – – Fever Enteric 6 — — 1 3 2 — 1 4 1 4 Other continued — — — — — — — — — — — Epidemic influenza 11 — — — — 2 9 1 4 6 1 Cholera – – – – – – – – – – – Plague — — — — — — — — — — — Diarrhoea (all forms) 35 32 3 — — — — 3 25 7 10 Enteritis 34 27 4 1 — 2 — 1 27 6 2 Puerperal fever 4 — — — — 4 — 1 1 2 — Erysipelas 2 — — — — 2 — — 2 — 2 Other septic diseases 11 2 — 2 — 6 1 — 8 3 7 Phthisis 126 — 1 6 22 89 8 16 75 35 35 Other tubercular diseases 46 10 16 8 2 9 1 3 25 18 12 Cancer, malignant disease. 130 – – 2 – 74 54 24 65 41 25 Bronchitis 131 15 5 — 2 32 77 11 79 41 46 Pneumonia 108 27 19 7 — 32 23 9 68 31 26 Pleurisy 8 — — 1 — 2 5 2 3 3 — Other diseases of Respiratory organs 20 4 3 2 4 7 4 10 6 3 Alcoholism Cirrhosis of liver 36 _ – _ 31 5 4 22 10 9 Venereal diseases 4 2 — — — 2 — — 1 3 3 Premature birth 57 57 4 33 20 2 Diseases and accidents of parturition. 6 2 4 4 2 1 Heart diseases 263 11 2 6 14 110 120 31 148 84 66 Accidents 32 4 4 1 1 13 9 3 23 6 9 Suicides 9 — — — 1 7 1 3 3 3 3 All other causes 530 125 26 15 16 117 231 60 296 174 186 All causes 1691 338 130 59 63 547 554 186 966 539 569 1-29 Table E. INFANTILE MORTALITY DURING THE YEAR 1905. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 Week. 1-2 Weeks 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months 10-11 Months. 11-12 Months. Total Deaths under One Year. All Causes. Certified 55 31 19 14 119 34 39 27 16 21 15 14 19 16 16 2 338 Uncertified – – – – – – – – – – – – – – – – – Common Infectious Diseases Small-pox – – – – – – – – – – – – – – – – – Chicken-pox – – – – – – – – – – – – – – 1 – 1 Measles – – – – – – – – – – – – 3 1 8 1 8 Scarlet Fever – – – – – – – – – – – – – – – – – Diphtheria: Croup – – – – – – – – – – – – – – – – 1 Whooping Cough – — — — — 1 2 2 1 1 3 — 1 2 13 )iarrhcea] Diseases Diarrhoea, all forms — — — — – 3 6 5 5 1 2 3 2 2 3 – 32 Enteritis (not Tuberculous) — 1 — — 1 — 2 2 – 1 1 – 1 1 – – 9 Gastritis, Gastrointestinal Catarrh 1 – 1 2 4 3 1 5 2 2 – – 1 – – – 18 Wasting I Diseases Premature Birth – 18 6 6 55 2 – – – – – – – – – – 57 Congenital Defects – – 2 1 5 2 3 1 – 2 – 1 – – – – 14 Injury at Birth 1 2 — — 3 — — — – – – — — — — — 3 Want of Breast-milk — — — — — 1 _ — — — — — — 1 Atrophy, Debility, Marasmus 9 1 4 2 16 13 12 8 3 3 3 3 1 2 — — 64 Tuberculous Diseases Tuberculous Meningitis – – – – – – – 1 – 1 – – – 1 1 4 Tuberculous Peritonitis: Tabes Mesenterica – – – – – – – — — 1 – — 1 — — – 2 Other Tuberculous Diseases – – – – – 1 – – – – – 3 – – – – 4 Erysipelas – — — — – – – – — — — – – – — – — Syphilis – — — — — — 1 — 1 — — — — — — — 2 Rickets – — — — – – 1 – – – – – – 1 1 – 3 Meningitis (not Tuberculous) – – – – – – – – – 1 – – – – – – 3 Convulsions 8 4 1 – 13 4 2 – — 1 – – 1 1 1 – 23 Bronchitis 1 1 2 4 1 1 1 1 1 2 2 1 1 15 Laryngitis — — — – – — — — — — — — 1 — — 1 Pneumonia — – 1 — 1 1 4 1 1 3 4 2 5 2 3 — 27 Suffocation, overlaying 1 – 1 — 2 2 _ — 1 — 5 Other Causes 7 5 2 1 15 — 2 1 2 2 — 2 1 2 — 1 28 55 31 19 14 119 31 39 27 16 21 15 14 19 16 16 2 338 Population (estimated to middle of 1905), 144,420. Births in the year—legitimate, 3,512 ; illegitimate, 121. Deaths from all causes at all ages, 1,691. 130 II.—COPY OF POSTER ON ALCOHOLISM. Metropolitan Borough of Lewisham. ALCOHOLISM. It is conclusively proved by the Report of the Departmental Committee presented to Parliament by command of His Majesty :— 1. That the abuse of alcoholic stimulants, whether in the form of spirits, wine, or beer, is largely responsible for physical deterioration; it leads to disease in most tissues and organs of the body. 2. That alcoholic excess reduces the natural power of resistance to disease possessed by healthy individuals, rendering them especially liable to many inflammatory disorders, causing them to suffer much more severely from any illness they may contract, and making their recovery slow. 3. That intemperance predisposes to consumption. 4. That children of intemperate parents are seriously affected; they frequently suffer from paralysis, epilepsy, and idiocy, which lead, if not to death, to their permanent disablement. From statistics obtained it was found that the mortality among children of intemperate parents was many times greater than among children of sober parents of the same class. 5. That the increase in lunacy is largely due to intemperance, and that there is also an increase in the number of cases of general paralysis from the same cause. 6. That alcoholism is a disease or chronic poisoning, resulting from the continued and excessive use of spirits, wine, and beer, even though such excess or abuse does not alwaye produce drunkenness. 7. That alcohol in any form has no value as a food. 8. Parents sometimes give alcohol in one form or another to children ; it is decidedly injurious to them, and should in no case be given except by order of a doctor. 9. That, finally, alcoholism is a relentless enemy to family happiness, to personal health, and to national prosperity. The members of the Departmental Committee are impressed with the necessity of widely disseminating the conclusions arrived at from the expert opinions placed before them. The Lewisham Borough Council have decided, therefore, to publish the above facts in order to bring home to men and women the disastrous results of alcoholic excess or abuse to the health and life of individuals and their offspring, and to the efficiency of the State. Town Hall, Catford, London, S.E. October, 1905. 181 III—LEAFLET ON SUMMER DIARRHCEA. Borough of Lewisham. PREVENTION OF SUMMER DIARRHCEA AMONG INFANTS. July, August and September, is the season in which Diarrhoea is most frequent. When it occurs to young persons it should not be regarded lightly. When young children are affected, especially infants, its occurrence is frequently attended by grave danger. Amongst babies this disease in hot, dry, summers, frequently appears as an epidemic, and is exceedingly fatal. In London last summer, Diarrhoea caused 3,356 deaths. The deaths so caused were chiefly among infants under one year. From enquiries made in Lewisham, it was found that the deaths from diarrhoea in infants were most common about the age of six months. These enquiries showed that the deaths occurred among babies who were not fed at the breast, but who were fed by hand. Summer diarrhoea is largely due to artificial feeding, contamination of baby's milk by improper storage, uncleanly conditions of home, of clothing, or of the infant. It also ai ises from giving baby stale and contaminated milk obtained from small vendors, who have not the means of cooling their supplies and are without proper means of storage. Another cause is giving unsuitable food to infants. Always remember that summer diarrhoea is preventable to a very large extent. HOW ? By taking the following precautions :— IN YOUR HOUSE. I. Be sure to keep everywhere in and around your house scrupulously clean. Germs of diseases live in dirt. II. Be sure to have your drains in good order and clean. Flush the watercloset and the gully-trap daily with large volumes of water.—This is very necessary in the summer. If your drains get out of order send notice to the Health Department, Town Hall, Catford. Immediate attention will be given. III. Be sure to burn all potato peelings, stale cabbage, and vegetable rubbish. If this is impossible put it in your sanitary dust-bin and keep the lid well on. Never put anything wet in the dust-bin. IV. Be sure to remember that diarrhoea germs live in manure heaps, and collections of decaying matters. 132 WITH YOUR BABY. I. Let baby have plenty of fresh air and sunshine.—Keep your windows open always. II. Avoid teething powders.—They cause diarrhoea. III. Do not give baby a dummy comforter.—It collects dust, dirt, and diarrhoea germs. IV. Be sure to make a special effort to feed your baby at the breast. Avoid weaning during the months of July and August. Very few babies die from diarrhoea when the mother suckles them. V. Be sure to feed baby regularly and properly ; otherwise its stomach will get out of order, and diarrhoea will follow. WITH THE FOOD. I. Be sure, if you must feed baby with the bottle, to have two bottles, without tubes. Long tubes cannot be kept clean, and are death traps in the summer. II. Be sure, if you must feed baby with a bottle, to keep it scrupulously clean by thoroughly washing it, and then leaving it in clean cold water until wanted. III. Be sure to boil all water before giving it to baby, and buy fresh cows' milk as often as possible. Boil all cows' milk immediately it arrives in the house. IV. Be sure to keep all milk covered, and in a cool well-ventilated place. Stand the covered jug in cold water. Take care to prevent the entrance of flies which are carriers of poison and filth to this food. V. Avoid the use of cheap condensed milk. VI. Avoid using patent Infants' Foods until your doctor advises them. SHOULD DIARRHCEA UNFORTUNATELY OCCUR. Remember that it may prove rapidly fatal. In all cases secure medical advice immediately. If you cannot afford medical attention, apply to the Relieving Officer of your District for the visit of the Parish Medical Officer. Health Department. A. Wellesley Harris, Town Hall, Catford. Medical Officer of Health. A pamphlet on "Infant Feeding and Management " can be obtained on application the Health Department, Town Hall, Catford. 133 IY.—COPY OF PAMPHLET ISSUED BY ORDER OF THE COUNCIL IN RELATION TO INFANT FEEDING AND MANAGEMENT. HINTS ON INFANT FEEDING AND MANAGEMENT. BREAST FEEDING. For perfect nutrition food must be given which contains, in proper proportion, the materials necessary not only to replace the waste but to build up new tissue in the growing child. The most perfect food is human milk, which contains all the required elements in proper proportion. It is Nature's food, and it is free from the many dangers which beset artificial foods. Every mother should make a special effort to suckle her own baby. Such feeding produces the best results. A healthy but delicate mother, however, may be unable to continue breast feeding beyond two or three months, but even this is valuable in tiding over the infant's most difficult period to an age when artificial feeding will be easier. Breast feeding may be impossible by reason of the nonsecretion of milk or prostration of the parent, and it is inadvisable in parents who suffer from epilepsy or nervous diseases, or who have a tendency to consumption or any hereditary disease. The quality of breast milk must of course be good. Frequent weighing of the infant will be a good index of this fact. No mother should suckle her baby after nine months, beyond which period the quality of the milk becomes poor. 134 FREQUENCY OF BREAST FEEDING. The natural milk supply is not fully established until the third day. After the mother has become refreshed by sleep, the infant may be put to the breast four times in the first 24 hours and six times during the second 24 hours after birth. During this period the baby may not get much milk, but there is no cause for alarm. Its hunger may be relieved by an occasional teaspoonful of a mixture of one part of milk and three parts of water until the breast milk is established. By the third day the supply is generally ample, and now the infant must begin regular habits, and should be put to the mother's breast every two hours during the day and every four hours during the night. The baby's stomach at birth will hold very little - about an ounce and a half, that is three tablespoonsful—and is able to take about fourteen or sixteen ounces of milk during the 24 hours. A healthy infant empties the breast in from ten to fifteen minutes. Regular feedings (every two hours during the first month) are essential for the health and comfort of both mother and child. Avoid irregular feeding and the habit of pacifying a crying baby by a feed. Its stomach becomes overloaded and trouble follows. Baby's stomach must have rest in order to digest its regular supply. The mother's breast is equally in need of rest, otherwise the character of the milk will be altered. Cleanliness after suckling will often save endless misery to the mother. Immediately after feeding the infant, the nipples should be carefully washed with warm water by the aid of a 135 piece of soft material (such as lint), and then thoroughly and carefully dried. This, if adopted throughout the nursing period will prevent soreness. TIMES OF BREAST FEEDING IN RELATION TO AGE. First Month.—Feed every two hours during the day, with two feeds during the night. Second Month.—Daily intervals 2½ hours. One feed during the night. Third to end of ninth Month.—Daily intervals 3 hours. One feed during the night. After seventh Month the night feed may be omitted. At this period some nourishment is generally necessary in addition to breast feeding. This is obtained by an occasional bottle of diluted cows' milk, such as mixture No. 3 (see page 138) thickened with a small teaspoonful of biscuit powder, Benger's or other good infants' food. Raw beef juice may be added with advantage (see page 143). WEANING. No mother should nurse her infant beyond a period of nine months, after which time breast milk becomes poor and deficient in nourishment. Weaning should take place gradually. It is well to begin at the seventh or eighth month, supplementing the breast feeding with a bottle of No. 3 diet, thickened with biscuit powder, Benger's or other approved food. Weaning should always be avoided where possible during the months of July, August and September. These are the months when infantile diarrhoea is most prevalent, which disease 136 is especially fatal to those who are being artificially fed. To wean babies during these months involves a serious risk. HEALTH OF THE MOTHER. The quality of the breast milk is greatly affected by the health and habits of the mother. The mother should obtain as much fresh air as possible, and when strong enough should take moderate exercise. Avoid hot and stuffy rooms. The diet will, of course, be controlled largely by the means of the parents. Where possible it should consist chiefly of milk, oatmeal porridge, assisted by eggs, fish, potatoes and beef. Avoid alcoholic beverages, they are not required, and often affect the quality of the milk. Weak tea with plenty of milk is allowable, but tea and coffee in excess must be avoided. Raw fruits, pastry and highly-seasoned foods must also be avoided. Avoid drugs as much as possible daring the nursing period. When taken by the mother, many drugs show traces in the milk. ARTIFICIAL FEEDING. If breast feeding is impossible artificial feeding must be adopted. The food given must resemble as nearly as possible human milk. In towns we have to rely on cows' milk for artificial feeding. The milk supplied to towns must travel several miles. It is liable to contamination from many sources, and may undergo changes before it reaches the home. It is frequently a day or more old before it is used. Contamination may occur by improper storage in the home. Disease germs may enter the milk by various channels. They quickly multiply and render the milk dangerous for food. 137 Guard against polluted milk by boiling it immediately it arrives at the house, place it in a clean vessel and cool as quickly as possible by standing the jug in a basin of cold running water. Store in a cool place to which light and air have free access. Cover jug or basin with a clean plate to keep out dust and germs. Avoid storage of milk in living room or kitchen. Preparing Cows' Milk for Infants. Cows' milk contains more than double the amount of curd, less sugar, and about the same amount of fat as human milk. The curd in cows' milk is denser and less easily digested. Cows' milk must be prepared in a special manner before it can be adopted as a substitute for human milk in the feeding of infants. Obtain the best milk possible from some reliable dairy. The following mixtures will be found most suitable for ages varying between birth and six months :— Number 1—First Six Weeks :— Fresh milk—a teacupful. *White sugar—a small teaspoonful. Boiling water—2 teacupsful. Pure bicarbonate of soda—as much as will forma thin layer over a sixpence If means allow, add a tablespoonful of cream obtained by skimming a separate portion of milk. *Note:—Better results will be obtained if the same quantity of powdered sugar of milk be used. This is the natural sugar contained in milk and may be obtained from any chemist. 138 Number 2—From Six Weeks to Three Months:— Fresh milk—3 teacupsful. *White sugar—a teaspoonful. Boiling water—3 teacupsful. As much pure bicarbonate of Soda as will form a thin layer over a shilling. Add one and a half tablespoonsful of cream. Number 3—From Three to Six Months:— After three months the proportion of milk may be gradually increased until the infant can digest the followingmixture : — Fresh milk —6 teacupsful. *White sugar—a teaspoonful. Boiling water—2 teacupsful. As much pure bicarbonate of soda as will form a thin layer over a shilling. Add a tablespoonful of cream. At the age of five or six months No. 3 mixture may be continued. The infant will require other food in addition at this age. This is dealt with later. PREPARATION OF ARTIFICIAL FOODS. Cow's Milk.—In preparing the above food dissolve the sugar and the bicarbonate of soda in the boiling water required for the mixture, and then add the milk. Place the jug containing the mixture in a saucepan of water, and let the water boil twenty minutes ; then remove the jug, and cool the food as quickly as possible. Cover the jug with a saucer, to exclude germs and dust, and store in a cool place to which light and air have free *Note:—Better results will be obtained if the same quantity of powdered sugar of milk be used. This is the natural sugar contained in milk and may be obtained from any chemist. 139 access. Warm up sufficient only for each feed as required. The addition of cream is most valuable when it can be obtained; without its addition the food would be deficient in fat. Cream is best obtained by placing a pint of milk in a shallow pie-dish at night; cover it up and store in a cool place ; carefully skim in the morning to obtain cream, which must be added to the fresh milk mixture in the manner described above. Most dairymen in the district supply fresh cream in very small quantities (pennyworths) to meet the convenience of those who cannot afford larger purchases. The use of cream sold in jars and preserved with boracic acid should be avoided. Condensed Milk is a favourite substitute for mother's milk amongst poorer classes. Unfortunately there are many kinds of condensed milk sold, which, if diluted according to directions would lead to starvation of the baby. If condensed milk be chosen, only the unsweetened whole milk brands should be used, and then only as a temporary measure to tide over the period during which it is impossible for the child to digest cows' milk. Mixtures of condensed milk are generally deficient in milk fat, and contain an undue proportion of sugar, which is used in its manufacture. Infants fed for any length of time upon this material are prone to rickets. If condensed milk is used its deficiency in milk fat must be remedied by the addition of a tablespoonful of cream to each bottle Dried Milk.—Recently a new preparation of cows' milk has been introduced in the form of dried milk, which is prepared by passing milk over highly heated cylinders, the result being a milk powder. The heat employed in the process destroys any germs, and although it cannot be considered as perfect as fresh cows' milk it is probable that its use will prove valuable 140 during the months of July and August, the period in which infantile diarrhoea is so rife, owing to the difficulty of obtaining a pure milk supply. Humanized Condensed Milk.—Recently a new preparation has been manufactured. This is really a modified cows' milk prepared so that its composition resembles as nearly as possible Human Milk. It is then condensed and sterilized. The sugar used is milk sugar. It is claimed that when a tin of this milk is diluted with two parts of water the mixture has the same composition as human milk. If this be so this preparation should be of considerable assistance where breast feeding is impossible. The cost, however about 4/- per week, will prohibit its use amongst the poorer classes. AMOUNT OF FOOD REQUIRED AND TIME OF FEEDING FROM BIRTH TO THE AGE OF SIX MONTHS. From Birth to Six Weeks.—Begin with two tablespoonsful of mixture No. 1 at each feed, increasing the quantity gradually, as the infant progresses, to four tablespoonsful. The total quantity given in 24 hours should range from half a pint to a pint. From Six Weeks to Three Months.—Let the quantity of No. 2 mixture increase gradually from four to eight tablespoonsful at each feed. Allow a pint to a pint and a half of the mixture for 24 hours. From Three to Six Months.—Give from eight to ten tablespoonsful of No. 3 mixture. Allow between a pint and a half, and two pints of food for 24 hours. Feeding from Six to Twelve Months. —Most infants of six or seven months of age require additional material to thai 141 supplied by cows' milk. During the first six months of life they are unable to digest starch owing to the absence of saliva, and much mischief is caused by its early use in the form of patent foods. Now, however, saliva is secreted, and the best food will consist of mixture No. 3, thickened with a thin gruel made of oatmeal, barleymeal, biscuit powder, or a suitable malted or dextrinized food, such as Benger's, Savory & Moore's, Mellin's or other good infants' food. Avoid cheap and common forms of infants' foods. They are difficult for infants to digest. Their use causes much serious trouble. From Six to Nine Months.—Give six bottles a day containing 12 to 14 tablespoonsful of mixture No. 3, thickened as described. The addition of two teaspoonsful of meat juice two or three times a day will be a great advantage. Allowabout two pints for the six meals. From Nine to Twelve Months.—Give five meals a day, The quantity for each feed should be about 14 tablespoonsful. Allow two to two and a quarter pints for the day. The milk diets previously referred to may be supplemented by giving the child the yoke of a lightly boiled egg, with stale bread crumbs, once a day. At 10 months old, stale bread-and-butter may be given, and a teacupful of weak mutton or chicken broth. About this time an effort should be made to cease the use of feeding-bottle, substituting spoon or cup feeding. From 12 to 18 months, the following or a similar diet will be suitable:— 7 a.m.—The yoke of an egg lightly boiled. Thin stale bread-and-butter, and a teacupful of new milk. 142 10 a.m.—A teacupful of milk, with a slice of thin breadand-butter. 2 p.m.—A teacupful of beef-tea, or veal or mutton broth, with a slice of stale bread. A tablespoonful of milk and ground rice pudding. When the child is about 14 months old, a tablespoonful of thoroughly-mashed boiled potato in the broth may be given with advantage. 6 p.m.—A teacupful of milk, with a slice of stale bread broken up and soaked in it. 10 p.m.—A breakfast cupful of milk, to which has been added a tablespoonful of infants' food. A cup of warm milk should be available during the night, although the child's sleep should not be disturbed to give it. Suggested Time Table for Feeding; from Birth to Twelve Months. From Birth to Six Weeks Six Weeks to Three Months. Three to Six Months. Six to Nine Months. Nine to Twelve Months. 6 a.m. 6 a.m. 6 a.m. 6 a.m. 6 a.m. 8 „ 8.30 ,, 9 ,, 9 „ 9 30 ,, 10 ,, 11 12 noon 12 noon 1 p.m. 12 noon 1.30 p.m. 3 p.m. 3 p.m. 4.30 2 pm. 4 „ 6 „ 6 „ 8 ,, 4 ,, 6 30 ,, 10 „ 9 ,, ... 6 ,, 9 ,, 2 a.m. *A cupful of warm milk mixture No. 3 should be available for night use if required *A cupful of warm milk should be availablefornight use if required 8 ,, 1130 ,, ... 10 ,, 2 a.m. ... 2 a.m. ... ... The foregoing particulars with regard to the composition of food, and the amounts to be given, are based upon the experience of what suits the average infant best. In some cases it will be found necessary to make the mixtures a little weaker, or some children may take a little more than the quantities mentioned. The great secret in successful artificial feeding is to train the infant's stomach gradually to the use of cows' milk. Therefore 143 the strength of the mixtures mentioned herein as suitable for various ages should be adhered to. Careful watch must be kept. If the infant vomits curd, or passes curdy, loose motions, it is evidence of its inability to digest the amount of curd contained in the mixture, which must be reduced by further dilution. Food given to baby should be pleasantly warm. This is best judged by placing the bottle against the cheek. Do not permit nurse to suck the teat in order to taste the milk. Diseases may be transmitted to the child in this way. After making the food mixtures, warm only sufficient for each meal when due. Avoid use of food warmers. They are often used for keeping food warm at night. Food so kept ferments and turns sour quickly. Remember stale milk is dangerous for infants, and sour milk poison. RECEIPTS. Barley Water.—Place the pearl barley in water over night; wash thoroughly ; take 2 tablespoonsful of barley ; add one quart Of water ; simmer gently for three hours ; strain through fine muslin ; add fresh water to make a quart. This may be used with advantage in some cases instead of plain water for preparing cow's milk mixtures. Oatmeal Water may be made in a similar manner, using the same quantities. Raw Beef Juice.—Mince finely best rump steak. Take 3 tablespoonsful of the mince ; add one tablespoonful of cold water ; stir well together, and stand in the cold for half-an-hour. 144 Then strain through fine muslin by gentle pressure. The occasional use of a teaspoonful or two added to a bottle of milk will be of great benefit to infants. It should be made at repeated intervals, as it will not keep. It is of greater value than the preserved meat juices which can be bought. Lime Water may be purchased of any chemist. Small quantities may be added to artificial food to correct the acidity of milk. A teaspoonful is sufficient in early infancy; in later periods a tablespoonful added to each bottle. Its use is not necessary if pure bicarbonate of soda has been added to the food. Orange Juice,—A dessertspoonful of sweet orange juice twice or three times a week may be given with benefit. FEEDING BOTTLES. Do not use feeding bottles with india rubber tubes, corks and other complicated fittings. It is impossible to clean such bottles thoroughly. Some portion of the food must remain and cause infection of the fresh food supplies when the bottle is next filled. The best forms of bottles are those shown in the sketch below:— 145 The bottles should have lines or divisions showing the number of tablespoonsful it contains—if marked in ounces one division will equal two tablespoonsful. The teat is easily removed and can be turned inside out immediately after use and its inner surface scrubbed with a brush. A tooth brush is useful and should be kept especially for the purpose. The bottle itself should be of good quality and should be well washed with boiling water and soda and the inner surface scoured with a bottle brush. It should be thoroughly rinsed to remove all traces of soda. Both the teat and bottle after cleansing should be kept in a bowl of clean water until they are required for another feeding. After the age of 12 months, use of feeding bottle should cease. Feed with a spoon or cup. IS BABY THRIVING? The index of the satisfactory body growth is ascertained by repeated weighings of the infant. The baby must be stripped and wrapped in a warm piece of flannel of known weight. The weight at birth is usually about seven pounds—this is the average weight. For the first ten days a slight loss of a few ounces may occur. This is usually followed by a regular increase. For the first two months the gain in weight is between five and six ounces per week. The increase continues, the original weight being doubled by the end of the six months, and trebled at the end of twelve months to that registered at birth. 146 An infant should be weighed once a week and a record kept. In the event of loss of weight medical advice should be obtained. GENERAL HINTS. Adopt scrupulous cleanliness in all things. Unless great care and attention are paid in the preparation of food, and adjusting the necessary quantities, various troubles will arise, particularly indigestion, with symptoms of flatulence, colic, vomiting and diarrhoea. These complaints seldom occur amongst breast-fed children. Vomiting is often the result of feeding too quickly, or giving too large an amount. If the practice is continued, chronic vomiting and other troubles will follow. Diarrhoea is most common in the summer months among artificially-fed children, often due to milk contamination. Constipation, on the other hand, may be due to poorness of the food. A child which has been fed upon milk deficient in cream, and which the parent has over-diluted, will often cause constipation. In artificial feeding, train the infant's stomach gradually to digest cows' milk. Do not adopt artificial feeding for baby unless Breast feeding is quite impossible. Feed at regular intervals, adopting the times herein set out. It will lead to comfort, both to the mother and child. Do not attempt to pacify a crying child by a feed if it is not due. It will suffer if you do. 147 All milk must be fresh. Stale milk is dangerous, sour milk acts as a poison. In Lewisham perfectly fresh milk can be obtained if sufficient trouble is taken to obtain it. Keep the nursery at a temperature between 60 and 65 degrees Fahrenheit. Do not indulge in vigorous rocking to send baby to sleep, it is bad for both stomach and brain. Place baby in cot, darken the room, and insist on quietness. Baby will then sleep without rocking. Infantile diarrhoea and other digestive troubles are mainly produced by improper feeding. Mortality among children under one year of age is very great, due principally to ignorance in the methods of feeding the young. During the last summer quarter in Lewisham no less than 11 out of every 100 children born died. After investigation it was found that this was chiefly due to diseases produced by improper feeding. Change napkins immediately they are soiled or wetted. An infant will usually cry when this happens, and if they are immediately changed baby will continue to give the signal when necessary. If a change is neglected baby becomes accustomed to the discomfort and ceases to signal, with the result that great soreness and misery follow. Wash baby's napkins in hot water, using soap. Avoid soda, as its use will make baby sore. When napkins have been wetted by urine only, do not dry them and use again without previous washing; such practice causes soreness. If a child is sick change its soiled clothes at once, otherwise the value of all the care in feeding may be considerably reduced. 148 When baby is out of the nursery flood the room with fresh air. Do not put baby on the floor unless it is scrupulously clean and free from draught. Cot baby at a very early age. Accidental overlaying and suffocation often result when baby shares the parents' bed. Do not neglect small ailments. Neglected colds lead to bronchitis, constipation to digestive troubles, diarrhoea to inflammatory condition of intestines, which may become fatal. Seek medical aid when baby is ill. The use of babv comforters is most harmful, contracting the roof of the mouth, and the air passages at the back of the nose They form an easy channel for the introduction of germs into the system, by means of dirt which they collect. Baby will never miss them if you never begin their use. Bath baby in the morning, all over. Sponge buttocks and groins after each soiling of napkins before putting on clean ones. The temperature of baths should not exceed 100 degrees Fah. Do not test the heat by the mother's hand, but by her elbow. Thoroughly dry baby. Dusting Powder.—Finely powdered oatmeal, or fuller's earth, or pure starch powder are best. Perambulators.—The lying-down position is the best for infants. Do not use mail carts or other vehicles in which the infant is upright when under a year. Do not give castor oil during the first few days after birth to clear the bowels, it is not required and causes colic. If an aperient is wanted give a teaspoonful of sweet oil. 149 Do not give "soothing" syrups, powders, or mixtures. Most of them contain dangerous drugs. Mothers should themselves avoid drugs while nursing, as many are secreted in the milk when taken by mother. Infants take exercise by kicking. Give them every chance of kicking by placing them safely on a bed —or, safer, on a rug on the floor, when they are free from napkins, &c. See the room is warm. Fresh Air.—Take baby out as much as possible. In warm, fine weather, as early as the beginning of the second week; in cold weather at beginning of the fourth week. No child does well if confined to hot rooms. Sleep.—Young infants require long periods of sleep. After each meal sleep should be encouraged by placing the infant in a warm cot in a quiet and darkened room. The upper sash of the window should be open several inches. For the first few months baby cannot have too much sleep. After six months of age an infant should sleep from 10 o'clock at night to 6 o'clock in the morning. It must also have a good sleep during the day. During the summer time baby should sleep outdoors in the fresh air as much as possible, care being taken to protect it from the sun's glare. Remember the world is new to baby. Avoid excitement by showing it to too many visitors. Excitement interferes with its progress. Clothing.—Infants are far more susceptible to the influence of cold than adults. They must be well protected by warm clothing. Loose woollen garments should be used, such as flannel or knitted articles. Take care to protect the whole of the body except the face and the hands.